Colds, Flu and Fever

In traditional medicine, a cold, flu or fever is viewed as a superficial condition – the invasion of some kind of exogenous agent that challenges the body’s mechanism of non-specific resistance and immunity.  All systems of traditional medicine have unique and yet remarkably similar perspectives on this dynamic, in Ayurveda as the imbalance of the dosha, whereas in TCM it is the relative balance of yin and yang, and the influence of the Six Evils. From a Western medical perspective superficial conditions are the result of some kind of viral or bacterial invasion.

Jvara: The Ayurvedic concept of febrile disease

Jvara is the term in Ayurvedic medicine that is most commonly understood and translated as ‘fever.’ The pathogenesis of fever in Ayurvedic medicine however, is distinctly different from that of medical science. Ayurvedic medicine designates that the center of all metabolic activities in the body is the digestive tract, or the amasaya. Changes or alterations in metabolic patterns, such as increase or decrease in body temperature, almost always relates to the activity of digestion, called agni.

Agni becomes affected when the other doshas influence its function. When kapha accumulates, representing moist, sticky, heavy and oily influences, the effect upon agni is to slow it down, called mandagni, in much the same that a fire is slowed when wet leaves and branches are thrown upon it. The accumulation of kapha in the gastrointestinal tract is marked by a thick whitish coating on the tongue, lassitude, pelvic heaviness, slowed peristalsis and nausea.  If this process continues unabated ama begins to form.

In contrast, hot, light and dynamic influences vitiate pitta, and cause an increase in the function of agni, called tikshna agni, such as an increase in hunger and thirst, a red tongue, burning pain in the mid abdomen, biliousness, and frequent loose motions or constipation from dehydration.

Vata has a labile effect upon digestion, called vishamagni, like a wind that blows on the embers to create symptoms of a pitta increase, or a wind that gusts across the fire, causing it to smolder like a kapha influence. Often these influences will change with each meal, and are linked to food sensitivities and the irregular function of visceral nerves. The symptoms of vishamagni are irregular appetite, eructation and acid reflux, bloating and flatulence, and irregular bowel movements.

When kapha enters the amasaya, thereby inhibiting the catabolic capacity of agni, the resultant ahara rasa is improperly refined and contains ama. Further, when these products of improper digestion enter into the dhatus, it causes srotorodha, the blockage of the channels of circulation (srotas), including perspiration (sweda). This obstruction within the srotas and the amasaya, forces agni out of the digestive tract into the periphery of the body, but is contained in the periphery because of the blockage of sweda. If the influence is of a kapha nature only, the result of this scenario is a constant low grade fever that peaks in mid afternoon, mucus congestion, dyspnea, generalized low grade body pain and lassitude called kapha jvara. If vata accumulates in the amasaya because ama blocks its flow, agni is forced to the periphery of the body as in kapha jvara. The labile nature of vata however, promotes a fluctuating body temperature with the fever peaking in the evening, with migrating body pain that alternates in intensity, a loss of sensation, dehydration, shivering, and weakness. Pitta jvara is the association of pitta with vata, with the presence of ama forcing vata to push agni out of the amasaya into the periphery of the body, promoting a consistently high body temperature, thirst, hemoptysis, ulceration of the mouth and nose, rashes, dizziness, profuse perspiration and loose motions. Apart from the three principle forms of vata, pitta and kapha jvara, two or three of the doshas may associate to form a combined dosha jvara that displays the signs and symptoms of each dosha.

When the fever continues even beyond the presence of ama, this is called jirna jvara, a condition in which kapha and ojas becomes depleted. Vishama jvara is a chronic fever that comes and goes over a period of days or weeks, resulting from the continuing influence of ama.

Treatment of Jvara

The first and primary treatment of any form of jvara is to eliminate ama and rekindle the digestive fire (agni). If the strength of the patient is strong, an emetic therapy is often administered to remove ama, followed with foods and medicines that increase the digestive fire. Emetic therapies are an important aspect of many traditional healing systems, and do not have to be totally unpleasant. A common method in Ayurveda is to have the patient drink 2 litres of a weak decoction of equal parts Yashtimadhu (Glycyrrhiza glabra), Vacha (Acorus calamus) and Shatapushpi (Anethum graveolens), prepared with 20 g of saindhava (rock salt) and 60 g of honey, as quickly as possible. The patient should then prepare themselves to vomit, perched over the toilet or a large bowl, and induce vomiting by sticking their index and middle fingers of their right hand down their throat, with their left hand gently massaging the stomach. Upon emesis, the patient should notice the voiding of much liquid, mucus, undigested food and, at the end, yellowish bile. After vamana therapy the patient should lie down for 10-20 minutes, after which drinking small amounts of ginger tea.

There are many herbs that are used in jvara, and all of them in one way or another are considered to be dipana-pachana, or herbs that enkindle digestion (dipana) and help to dentaure or ‘cook’ the consumed food (pachana). Examples of such herbs include:

  • Musta (Cyperus rotundus): root; pungent, bitter and astringent in taste, cold in energy; dipana-pachana, slightly constipating, alleviates kapha and pitta; used in the treatment of jvara, ulcers, gastrointestinal inflammation, diarrhea, dysentery, Candiasis, parasitic infection, skin diseases, bronchitis, amenorrhea, dysmenorrhea, PMS, hemorrhaging, renal calculi, neurasthenia, epilepsy and poor memory; dosage is 3-9 g in decoction, 2-4 mL in tincture (dried root, 1:5). Contraindicated in constipation and in vata conditions.
  • Guduchi (Tinospora cordifolia): peeled stem; sweet, bitter and astringent in taste, warm in energy; dipana-pachana, slightly constipating, alleviates vata, rejuventative; used in the treatment of fever, dyspepsia, gastralgia, candidiasis, parasitic infection, inflammations, skin diseases, cough, bronchitis, asthma, jaundice, anemia, splenopathy, diabetes, gout, uropathy, and debility; 3-9 g in decoction, 2-4 mL in tincture (dried stem and root, 1:5). Contraindicated in constipation.

One formula that can be used generally for any form of jvara is a weak decoction called Shadangam jala, comprised of equal parts Musta (Cyperus rotundus), Chandana (Santalum album), Shunthi (Zingiber officinalis), Ushira (Vetiveria zizanoides), Parpata (Fumaria parviflora) and Balaka (Coleus vettiveroides), dosed a 100 ml t.i.d. Another formula that may be used is Vyakriadi kashayam, a decoction prepared from three parts Vyaghri (Solanum xanthocarpum), two parts Guduchi (Tinospora cordifolia) and one part Shunthi (Zingiber officinalis).

In regard to diet, a thin rice soup called peya, cooked with a little ginger and salt, is considered to be very useful, but should be avoided in Kapha jvara. Cold foods and drinks are strictly avoided in any form of jvara, as is oil massage, bathing and the consumption of heavy and oily foods like dairy, meat and flour.

External evils: Chinese treatment of superficial conditions

In TCM, an upper respiratory tract viral infection is regarded as an external pathogen that invades the superficial levels of the body. These pathogens, such as Wind-Cold, Wind-Heat, Wind-Dampness and Summer Heat, become lodged in the superficial levels of the body, manifesting as chills, headache, stiffness and muscular pain. Initially, warming and acrid herbs are used to release the exterior, acting as diaphoretics (herbs that initiate sweating) to initiate the elimination of the pathogen through perspiration. Example of such herbs include:

  • Ma Huang (Ephedra sinica): stem; releases the exterior and disperses cold; for wind-cold excess with chills, fever, headache, absence of sweating and a tight, floating pulse; promotes descending of Lung qi, controls obstruction of Lung qi by Wind and Cold; 3-9 g in decoction. Contraindicated in high BP, deficiency and insomnia. Ephedra is very drying, and astringe mucous membranes excessively, inhibiting IgA-laden mucosal secretions that ward off infection.
  • Gui Zhi (Cinnamonum cassia): twig; releases superficial area; warms meridians, unblocks and circulates yang energy; 3-9 g in decoction. Contraindicated in excess heat, yin deficiency with heat, and pregnancy.

Other similar herbs include Sheng Jiang (Zingiber officinalis), Xi Xin (Asarum sieboldii), Gao Ben (Ligusticum sinense), and Xin Yi Hua (Magnolia liliflora).

If diaphoretics do not dislodge the pathogen, it begins to move deeper in the body, into the muscles. At this point there is profuse sweating, high fever, mild chills and sore throat. The next category of herbs to be used are cooling, acrid herbs that releases the exterior.

  • Bo He(Mentha haplocalyx): herb; disperses wind-heat; vents rashes; allows constrained Liver qi to flow; 1.5-6g in infusion. Contraindicated in exterior deficiency, yin deficiency with heat, lactation.
  • Niu Bang Zi (Arctium lappa): seed; disperses wind-heat and benefits throat; clears heat and relieves toxicity; vents rashes; moistens wind-heat constipation; 3-9g in decoction. Contraindicated in qi deficiency, diarrhea and open sores.

Other similar herbs include Ju Hua (Chrysanthemum moriflorum), Ge Gen (Peuraria lobata), Chai Hu (Buplerum chinense), and Sang Ye (Morus alba leaf).

Viral infection

The phytotherapeutic method of treating upper respiratory tract viral infections resembles both that of Ayurveda and TCM, and a Western clinical herbalist may incorporate elements of each of these systems during treatment. For the nascent symptoms of an upper respiratory tract infection warming and stimulating botanicals are favoured, often combined with botanicals that can inhibit viral replication:

  • Toothache plant (Spilanthes acmella): native to Africa and western Asia, this plant is exceptionally high in immunostimulating isobutylamides, also found in Purple Coneflower (Echinacea spp.) and Prickly Ash (Zanthoxylum spp.). It has a spicy and warming energy that stimulates glandular and mucosal secretions. Dose of the tincture (fresh plant 1:2, 95%) is 30-60 gtt, t.i.d.-q.i.d.
  • Biscuit root (Lomatium dissectum): Long used by the First Nations people of North America, Biscuit root gained the respect of early European settlers for the treatment of influenza. It has antiviral and antimicrobial and is very safe, although longterm usage may produce a rash in some people. It is, however, endangered, and care should be taken not to overuse it. Dose of the tincture (fresh plant, 1:2, 95%) is 30-60 gtt, t.i.d. – q.i.d.

Special mention should be given to “Composition Powder,” a time-honored Thompsonian remedy. The following recipe is taken from Benjamen Coby’s 1864 book “A Guide To Health,” and in my opinion, should be in every bathroom medicine cabinet to combat an oncoming cold and digestive troubles. Take the powders of:

  • Bayberry bark (Myrica cerifera) 2 parts
  • Ginger root (Zingiber officinalis) 1 part
  • Cayenne fruit (Capsicum spp.) 1/8 part
  • Cinnamon bark (Cinnamomum cassia) 1/8 part
  • Prickly ash bark (Zanthoxylum americanum) 1/8 part

Mix well and sift through a sieve. The dose is one teaspoon in a half a cup of hot water. There are endless variations of this formula, and instead of powders, tinctures of the same herbs can be combined in the same proportion, but the dosage can be reduced by half. Other herbs may be added for additional benefit including Biscuit root (Lomatium dissectum), Turmeric (Curcuma longa) and White Pine bark (Pinus albicaulis).

Fever is regarded a friend in herbal medicine, and therapies are used to support the fever, to enhance the body’s innate resistance and speed resolution. Modern medicine, even in the face of sound physiological reasons to support the fever process, still emphasizes therapies that shut it down, such as acetaminophen and paracetamol. As can be seen in the Ayurvedic or TCM model, such an approach, while alleviating the symptoms of heat, actually drive the pathogen deeper into the body where it will manifest as a disease at some later point. The modern medical approach thus inhibits the body from mounting a defense.

Fever management

Fever management in herbal medicine rests upon understanding the two stages of any fever:

  1. Initiation, with coldness and chills, indicating that the body temperature is lower than that which is set in the hypothalamus, and is likely going up.  If the fever is having trouble starting, circulatory stimulants such as Ginger root (Zingiber officinalis), Cayenne (Capsicum spp.), Cinnamon (Cinnamomum cassia) and Angelica (Angelica archangelica) are useful to raise body temperature. Sudation therapies are also warranted, such as hot fomentations and warm water enema.
  2. Crisis, with hot, flushed skin and sweating, indicating that the body temperature is higher than that which is set in the hypothalamus, and is likely coming down. In most circumstances nothing needs to be used at this point, except perhaps sponging with cool water, or sliced tofu placed on forehead

The use of a thermometer is a useful tool in fever management to asses the progress of a fever. If the body temperature is 40 degrees Celsius and the patient were feeling hot, we could expect that the temperature would fall. The use of cooling diaphoretics such as Lime blossom (Tilia), Catnip (Nepeta cattaria), Yarrow (Achillea millefolium) and Elder flower (Sambucus nigra) are all useful in this case, and especially so for children. If, on the other hand the patient felt cold, we could expect the temperature to increase. If the latter occurs, we must monitor the fever often, and be prepared to use antipyretic therapies to inhibit the dangerous and life-threatening progression of the fever. Initially however, it is still better to try to use stimulants, such as Lobelia (Lobelia inflata) or Cayenne (Capsicum spp.). If the fever remains persistent and high, herbs with an antipyretic activity such as Trembling Aspen (Populus tremuloides), Willow bark (Salix ssp.), Goldenseal (Hydrastis canadensis), and Peruvian bark (Cinchona spp.) can be used. After a fever has resolved, stomachics such as Elecampane (Inula helenium), and Cardamom (Elettaria cardamomum), and bitter restoratives such as Dandelion root (Taraxacum officinalis), and Gentian (Gentiana luteum) are all useful, to restore digestive capacity and stimulate appetite.

In addition to the timely and appropriate use of diaphoretics, antipyretics and digestive stimulants, herbs with antiviral roperties can also be used. There are several plants that have antiviral activities, but those that have the greatest activity upon upper respiratory tract infections include Biscuit root (Lomatium dissectum) and Osha (Ligusticum spp.). Additionally, both these herbs have a profound diaphoretic activity and will promote a fever to break.

During a fever, one of the most unpleasant side-effects is muscular and joint pain. Although uncomfortable, such symptoms indicate that interferon is doing its job, enhancing antiviral and phagocytic activity. While heartening to know, this rarely provides all that much comfort. Thus, a special class of herbs that have diaphoretic, antipyretic and antispasmodic properties can be used, such as Boneset (Eupatorium perfoliatum), Crawley root (Corallorhiza odontorhiza, C. maculata ) and Black Cohosh (Cimicifuga racemosa).

Immunomodulants are herbs that regulate the activities of the immune system, enhancing immune activity but also regulating the inflammatory response. Many immunomodulant herbs are actually contraindicated in fever, as many have a building and restorative activity that will actually further and prolong the congestion that underlies the fever. These herbs, such as Huang Qi (Astragalus membranaceus), Marshmallow root (Althaea officinalis) and Ashvagandha (Withania somnifera) are used more appropriately after a fever has resolved and the appetite returns.

Bacterial infections

If an upper respiratory tract viral infection is sufficient to provide enough of a challenge, which of course is dependent upon host resistance, a bacterial infection will likely result. This is noted by a change in the mucous membranes, which may become dry and irritated, and begin to crack or bleed. There may be ulceration and mucosal secretions will be mucopurulent (yellow-green discharge). Additional symptoms may include fever, a swollen sore throat and lymphadenopathy.

In Ayurvedic medicine bacterial infections are a pittasama condition, in which pitta is aggravated by the ongoing presence of ama. Pittasama conditions are addressed by botanicals with a cooling and antimicrobial energy that reduce pitta, such as Neem(Azadirachta indica), Bhunimba (Andrographis paniculata), Bhringaraj (Ecipta alba), Katuka (Picrorrhiza kuroa), Manjishta (Rubia cordifolia) and Chandana (Santalum album). In TCM, herbs that clear heat and relieve toxicity are useful, such as Ye Ju Hua (Chrysanthemumindicum), Huang Lian (Coptis chinense), Lian Qiao (Forsythia suspens), Jin Yin Hua (Lonicera japonica), Ban Lan Gen (Isatis tinctoria) and Huang Qin (Scutellaria baicalensis). Important Western herbs with antibacterial properties include Garlic (Allium sativum), Wild Indigo (Baptisia tinctoria), Purple Coneflower (Echinacea angustifolia), Goldenseal (Hydrastis canadensis) and Old Man’s Beard (Usnea spp.).