CLINICAL APPLICATIONS

* Viral infections including the common cold, influenza (flu), oral herpes, genital herpes, herpes zoster  (shingles), Epstein-Barr virus, viral hepatitis, infectious mononucleosis (mono), chickenpox, viral gastroenteritis, and viral pneumonia

* Chronic, unresolved viral infections: chronic unexplained fatigue, continued weight loss, low-grade fever, night sweats and chills, vague body aches and pain

 

WESTERN THERAPEUTIC ACTIONS

* Antiviral effect to inhibit viral replication

* Virucidal effect to kill viruses

* Immunostimulant to enhance the immune system

 

CHINESE THERAPEUTIC ACTIONS

* Releases wind-heat, clears deficiency heat

* Eliminates toxic heat

* Nourishes yin

* Tonifies qi and enhances the wei (defensive) qi

 

DOSAGE

Take 3 to 4 capsules three times daily on an empty stomach. The dosage may be increased up to 6 to 8 capsules every four to six hours as needed.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Ban Lan Gen (Radix Isatidis)

Bo He (Herba Menthae)

Chai Hu (Radix Bupleuri)

Chen Pi (Pericarpium Citri Reticulatae)

Fu Ling (Poria)

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Huang Lian (Rhizoma Coptidis)

Huang Qi (Radix Astragali)

Huang Qin (Radix Scutellariae)

Jie Geng (Radix Platycodonis)

Jin Yin Hua (Flos Lonicerae Japonicae)

Lian Qiao (Fructus Forsythiae)

Ma Bo (Lasiosphaera seu Calvatia)

Mai Dong (Radix Ophiopogonis)

Niu Bang Zi (Fructus Arctii)

Nu Zhen Zi (Fructus Ligustri Lucidi)

Ren Shen (Radix et Rhizoma Ginseng)

Shan Yao (Rhizoma Dioscoreae)

Sheng Ma (Rhizoma Cimicifugae)

Xian He Cao (Herba Agrimoniae)

Xiang Chun Ye (Folium Toonae Sinensis)

Xuan Shen (Radix Scrophulariae)

Yu Xing Cao (Herba Houttuyniae)

 

BACKGROUND

Viruses are the smallest parasites composed of an RNA or DNA core and an outer cover of protein or lipid. There are several hundred different viruses, most of which infect humans via respiratory or enteric excretion, and some are transmitted via sexual contact or transfusion of blood. For infection to occur, the virus must attach and enter the host cell, replicate itself inside the host cell, and release new viruses to infect other host cells. Because viruses are made from RNA or DNA, covered by protein or lipid, and reside inside the host cell, they are very difficult to identify and kill. Treatment of viral infections with pharmaceutical drugs is mostly ineffective, or offers minimal benefits. In most cases, supportive care is given to alleviate signs, symptoms, and complications of viral infections. Vaccines are effective for prevention, but are available for only a few types of viruses. Protective measures, such as hand washing, proper food preparation, water treatment, and avoidance of contact with infected individuals, are important to prevent viral infections. All in all, the body¡¦s own immune system is the most effective way to prevent and treat viral infection.

 

FORMULA EXPLANATION

Viral infections become a problem when the host's protective immune mechanisms are compromised. Many of these patients experience persistent infections because the body is unable to clear the virus after the initial infection. Therefore, optimal treatment requires simultaneous efforts to treat the infection and strengthen the immunity. In traditional Chinese medicine (TCM), treating viral infections requires three strategies. First, use herbs to clear wind-heat and toxic heat. Second, tonify qi and enhance the body¡¦s immune system. Third, tonify yin to address symptoms of yin-deficient fire, such as low-grade fever in cases of chronic viral infections.

          Herbal AVR contains herbs to clear wind-heat and eliminate toxins. Many of the following herbs show excellent antiviral effect. Huang Qin (Radix Scutellariae), Huang Lian (Rhizoma Coptidis), Xuan Shen (Radix Scrophulariae), Ma Bo (Lasiosphaera seu Calvatia), and Ban Lan Gen (Radix Isatidis) clear heat and eliminate toxins. Niu Bang Zi (Fructus Arctii), Lian Qiao (Fructus Forsythiae), and Bo He (Herba Menthae) disperse wind-heat accumulation. Also, they are excellent for fever, sore throat, and swollen glands. Jie Geng (Radix Platycodonis) and Gan Cao (Radix et Rhizoma Glycyrrhizae) act synergistically to relieve sore throat, thus helping the heat-clearing herbs. Chen Pi (Pericarpium Citri Reticulatae) regulates qi circulation to reduce swelling and inflammation. Sheng Ma (Rhizoma Cimicifugae) and Chai Hu (Radix Bupleuri), in addition to dispersing wind-heat, have an antipyretic effect to reduce body temperature. Jin Yin Hua (Flos Lonicerae Japonicae), Xian He Cao (Herba Agrimoniae), Yu Xing Cao (Herba Houttuyniae), and Xiang Chun Ye (Folium Toonae Sinensis) have an excellent antiviral effect and are included in this formula.

          The next two groups of herbs tonify qi and nourish yin of the body, which are often deficient from fighting a long-term viral infection. Chronic infection taxes the body and consumes yin. Patients often suffer from weight loss or emaciation and show symptoms of fatigue, tiredness, low-grade fever, loss of appetite, and weakness. The first group of herbs enhances the body¡¦s own wei (defensive) qi or immune system to fight against the infection. They include Ren Shen (Radix et Rhizoma Ginseng), Shan Yao (Rhizoma Dioscoreae), Fu Ling (Poria), and Huang Qi (Radix Astragali). Together, they strengthen the Spleen and boost the immune system while preventing the harsh properties of the heat-clearing herbs from injuring the digestive system. The second group of herbs, the yin tonics, addresses low-grade fever and other signs of deficiency heat. Herbs in this group include Bai Shao (Radix Paeoniae Alba), Mai Dong (Radix Ophiopogonis), and Nu Zhen Zi (Fructus Ligustri Lucidi). Xuan Shen (Radix Scrophulariae) is also effective to prevent the heat-clearing, damp-drying herbs from injuring the yin.

          Together, Herbal AVR is a balanced formula to address acute and chronic viral infections by clearing heat and tonifying the body¡¦s own defense system.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated in cases of deficiency and coldness.

* For patients with a sensitive or weak digestive system, take the herbs 30 minutes after meals.

* This formula is contraindicated during pregnancy and nursing.

 

CLINICAL NOTES

* Though seasonal infections may be caused by either bacterial or viral infections, common cold and influenza (flu) are two of the most common forms of viral infections. It is important to keep in mind that antibacterial drugs should not be used for these viral infections because they are unnecessary and ineffective against viruses. The overuse of antibacterial drugs can weaken the patient, leaving the body more susceptible for future infections. Therefore, accurate diagnosis and proper prescriptions are absolutely essential for successful treatment of viral infections.

* Herbal AVR incorporates numerous antibiotic herbs for two important reasons. First, the use of multiple herbs within an herbal formula has been shown to increase the antibiotic effect more than tenfold. Second, isolated use of single ingredients is often ineffective and increases the risk of development of bacterial and viral resistance.[1] Given these two reasons, it is necessary to combine herbs with appropriate properties to ensure effectiveness in treating the infection and minimizing the potential risk of the micro-organisms developing resistance and/or mutation.

* Patients with encephalitis or meningitis should be sent to the emergency room for immediate medical treatment. Warning signs and symptoms of encephalitis or meningitis include fever, headache, stiff neck, sore throat, vomiting, and mental confusion. In addition to soreness, the stiffness is also characterized by severe pain with gentle taps to the neck, and extreme stiffness and immobility when the patient tries to lower the chin to the chest.

 

Pulse Diagnosis by Dr. Jimmy Chang:

* Viral infections predominantly show a weak pulse to reflect the body¡¦s weakened immune system.

* Upper respiratory viral infection or influenza (flu): deep and weak pulse on the right cun. (If the pulse on the right cun is superficial, forceful, and jumpy, then it is upper respiratory bacterial infection).

* Weakened immune system: tent pulse, a weak, convex-shaped pulse that collapses under pressure, on the right cun.

 

SUPPLEMENTARY FORMULAS

* For respiratory infections, add Lonicera Complex, Herbal ENT or Respitrol formulas.

* For oral herpes, add Lonicera Complex.

* For genital herpes, add Gentiana Complex.

* For herpes zoster, add Dermatrol (HZ).

* For viral infections of the gastrointestinal tract, add GI Care II.

* For patients with weak immune system, add Immune + or Cordyceps 3.

* For chronic fatigue syndrome, add Imperial Tonic.

* To strengthen the immune system, add Immune +.

* For chronic viral infection or post viral infection with yin deficiency, add Nourish or Balance (Heat).

* For hepatitis, add Liver DTX.

* For genital human papillomavirus (HPV), add V-Support. Use Yin Care externally as herbal wash is also beneficial.

* With more inflammation, add Astringent Complex.

* With fever, add Gardenia Complex.

 

ACUPUNCTURE POINTS

Traditional Points:

* Check under other formulas that treat the specific disease for the acupuncture protocol.

 

Balance Method by Dr. Richard Tan:

* Left side: Houxi (SI 3), Xiaohai (SI 8), Taichong (LR 3), Ququan (LR 8)

* Right side: Shaohai (HT 3), Shenmen (HT 7), Yanglingquan (GB 34), Zulinqi (GB 41)

* Left and right sides can be alternated from treatment to treatment.

* The above acupuncture prescription is for general inflammation. Please refer to other formulas for acupuncture points depending on each specific condition.

 

Ear Acupuncture:

* Check under other formulas that treat the specific disease for the ear acupuncture protocol.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Enhance the immune functions: Allergic Area, Endocrine, Adrenal Gland, Spleen, Liver, corresponding points (to the area affected). Bleed Ear Apex and Helix 1-6 (selective area).

* Reduce body temperature: Thalamus, Brain Stem, Lung, Sympathetic, Endocrine, corresponding points. Bleed Ear Apex, Tragic Apex and Adrenal Gland.

* Check under other formulas that treat the specific disease for the Auricular Medicine protocol.

 

NUTRITION

* Always eat breakfast! According to the TCM clock, the most optimal time for the digestive system is in the morning from 8:00 to 10:00 a.m.

* Drink plenty of water.

* Avoid sugar: any and all foods containing sugar such as cake, dessert, candy, chocolate, canned juice, soft drinks, stevia, sugar substitutes, agave, xylitol, and corn syrup.

* Avoid raw or cold food/beverages such as sashimi, sushi, salads, steak tartar, and seared meat. Eat all cooked vegetables and nothing straight from the refrigerator.

* Avoid carbohydrates like white rice or bread as they may damage the Spleen and in turn produce more dampness.

* No seafood, especially shellfish like crabs, oyster, scallops, clams, lobster and shrimp (they enter the yangming Stomach channel). This is especially the case if suffering from skin disorder.

* Avoid fermented foods like cheese or fermented tofu.

* No dairy, including milk, cream, yogurt, cheese, and ice cream. Dairy products in general tend to create dampness and therefore should be consumed less. Milk, cheese and other dairy products should be avoided, especially if patients are lactose intolerant.

* Avoid deep-fried or greasy foods. No lamb, beef, goose or duck.

* Most melons (winter melon, watermelon, etc.), nightshades (eggplant, potato, bell and spicy peppers, tomato), bitter melon, seaweed, cucumber, grapefruit, papaya, and pineapple are too cold for the Spleen. Therefore, it¡¦s best to eat sparingly or not at all.

* Avoid the following fruits that are bad for the Spleen because they are cold in nature: plums, citrus, guava, pineapple, papaya, watermelon, honeydew. 

* Avoid certain fruits like mango and durian that have heat producing effect, which aggravates the condition.

* Avoid spicy foods and stimulants like coffee, alcohol, and energy drinks.

* Avoid spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, wasabi, and cardamom.

* Avoid foods and drinks with artificial coloring.

* Consume as few meat products as possible. Do not eat processed meats, such as lunch meats, hot dogs and sausages, as they contain nitrites that are associated with inflammation and chronic disease.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Increase consumption of dandelion greens, ginger, garlic, mung beans, daikons, carrots, mint, and lotus root.

 

LIFESTYLE INSTRUCTIONS

* Sleep by 10:00 p.m. In TCM, 11:00 p.m. to 1:00 a.m. is when the yin shifts to yang. It is crucial for the body to be at rest during this time for optimal health. There is no better way to restore or enhance the immune system other than resting and sleeping before 10:00 p.m.

* Afternoon naps for about 30 minutes are also recommended.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Herbal AVR is an herbal antiviral formula that treats viral infections. Pharmacological effects of this formula include antiviral, virucidal, and immunostimulant effects.

        Many herbs in Herbal AVR have shown excellent antiviral and virucidal effects. Ban Lan Gen (Radix Isatidis) has a wide range of antiviral effects. It exerts an antiviral effect against influenza A and B viruses through the inhibition of the hemagglutination to prevent infection.[2] It also has an antiviral effect against many different human or avian influenza viruses, as it has been shown to interfere with attachment of the virus to the host cell surface.[3] Indirubin, one of the biologically active compounds of Ban Lan Gen (Radix Isatidis), has shown significant cytotoxicity on swine pseudorabies virus,[4] as well as an inhibitory effect against influenza virus infection in the human bronchial epithelial cells.[5] Furthermore, isoformononetein from Ban Lan Gen (Radix Isatidis) shows antiviral activity in vitro against the influenza virus A/Hanfang/359/95 (H3N2), the herpes simplex virus 1 (HSV-1), and Coxsackie virus B3 (Cox-B3).[6] Lastly, clemastanin B, one of the major lignans from Ban Lan Gen (Radix Isatidis), has been shown to inhibit different subtypes of human (H1N1, including swine-origin H1N1; H3N2 and influenza B) and avian influenza viruses (H6N2, H7N3, H9N2). Furthermore, treatment with clemastanin B did not easily result in the emergence of viral resistance.[7]

        Yu Xing Cao (Herba Houttuyniae) is another herb with significant antiviral activity in this formula. According to one study, injection of Yu Xing Cao (Herba Houttuyniae) has a remarkable preventive and treatment effect on H1N1 influenza virus.[8] According to another study, the water extract of Yu Xing Cao (Herba Houttuyniae) illustrates an antiviral effect to treat coronavirus in severe acute respiratory syndrome (SARS), a life-threatening form of pneumonia.[9] Furthermore, the hot water extract of Yu Xing Cao (Herba Houttuyniae) significantly inhibits the replication of herpes simplex virus (HSV), with a stronger antiviral effect against HSV-2 than HSV-1.[10] Norcepharadione B, a compound from Yu Xing Cao (Herba Houttuyniae), shows good inhibitory activity against the replication of herpes simplex virus type 1 (HSV-1).[11] In addition, the injection of Yu Xing Cao (Herba Houttuyniae) demonstrates a direct inhibitory activity against pseudorabies herpesvirus in vitro.[12] Finally, the essential oils from Yu Xing Cao (Herba Houttuyniae) demonstrate inhibitory and virucidal activity against herpes simplex virus type 1 (HSV-1), influenza virus, and human immunodeficiency virus type 1 (HIV-1) by interfering with the function of the virus envelope.[13]

        In addition, Xiang Chun Ye (Folium Toonae Sinensis) is an excellent herb with an antiviral effect against coronavirus (CoV) and SARS coronavirus (SARS-CoV), which cause severe acute respiratory syndrome (SARS), a life-threatening disease. According to a study that tested herbs from many references, including Shang Han Lun (Discussion of Cold-Induced Disorders) and Wen Bing Tiao Bian (Systematic Differentiation of Warm Disease), Xiang Chun Ye (Folium Toonae Sinensis) is the only herb found to have an evident effect against SARS-CoV. Xiang Chun Ye (Folium Toonae Sinensis) exerts its antiviral effect by inhibiting the replication of SARS coronavirus in vitro, and according to the researchers, is an important resource against SARS-CoV.[14]

        Herbal AVR contains many other herbs with significant antiviral effects. Xian He Cao (Herba Agrimoniae) has highly-effective antiviral activity against all three subtypes of human influenza viruses, including H1N1 and H3N2 influenza A subtypes and influenza B virus. Xian He Cao (Herba Agrimoniae) also has a virucidal effect against influenza A and B viruses,[15] and an inhibitory effect against human immunodeficiency virus (HIV) type-1.[16] Extracts of Huang Qin (Radix Scutellariae) have displayed a wide spectrum of antiviral activity. Specifically, baicalein and wogonin, two compounds from the herb, boost innate antiviral immunity by stimulating the production of cytokines and increasing the resistance to viral infection in human leukocytes.[17] Lastly, shuangkangsu, a cyclic peroxide from Jin Yin Hua (Flos Lonicerae Japonicae), illustrates significant antiviral activities against influenza virus and respiratory syncytial virus.[18] Finally, other herbs with antiviral effects in this formula are Chai Hu (Radix Bupleuri),[19] Huang Lian (Rhizoma Coptidis),[20] and Lian Qiao (Fructus Forsythiae).[21]

        Clinically, herbs in Herbal AVR have been used to treat various viral infections with great success. Ban Lan Gen (Radix Isatidis) has been used in herbal formulas to treat influenza, viral pneumonia, severe acute respiratory syndrome (SARS), acute tonsillitis, epidemic cerebrospinal meningitis, encephalitis B, herpes infection of the skin, and many others.[22]^,[23]^,[24]^,[25] Jin Yin Hua (Flos Lonicerae Japonicae) and Lian Qiao (Fructus Forsythiae) have been used with excellent results to treat 1,150 patients with common colds or influenza.[26] The combination of Huang Qin (Radix Scutellariae), Huang Qi (Radix Astragali) and others has been shown in 21 patients with HIV/AIDS to significantly alleviate the symptoms, improve their immune function, inhibit HIV reproduction to a certain extent or keep it stable, and without obvious toxic or adverse reactions.[27]

        In addition to direct antiviral and virucidal effects, many herbs in Herbal AVR stimulate the immune system to prevent and treat viral infections. Use of Huang Qi (Radix Astragali) increases white blood cells and multinuclear leukocytes, [28] enhances production of IgM,[29] and activates B cells and macrophages.[30] Furthermore, administration of Huang Qi (Radix Astragali) has been shown to prolong allograft survival associated with promotion of CD4+ and CD25+ regulatory T cells.[31] Administration of Nu Zhen Zi (Fructus Ligustri Lucidi) is associated with an increase in white blood cells. It is also effective in reversing neutropenia induced by chemotherapy treatment.[32] Lastly, Ren Shen (Radix et Rhizoma Ginseng) has immune-enhancing effects, as it increases the function of the reticuloendothelial system and increases the total count of IgM.[33] Clinically, use of Huang Qi (Radix Astragali) and others have been shown to prevent infections such as common colds and influenza,[34] pulmonary tract infection,[35] and upper respiratory tract infections.[36]^,[37]

        In summary, Herbal AVR is an excellent formula with marked antiviral, virucidal, and immunostimulant properties. It can be used individually for viral infections, or in combination with another formula to treat the infection and the related complications.

 

COMPARATIVE ANALYSIS

There are several hundred different viruses, with most infecting humans via respiratory or enteric excretion, and some transmitted via sexual contact or transfusion of blood. Viral infections are very difficult to treat because viruses are hard to identify (they are made from RNA or DNA and are covered by protein or lipid) and kill (many reside and replicate inside the host cell). Therefore, successful treatment of viral infections is a challenge to both Western and traditional Chinese medicines.

        In Western medicine, there are many categories of antiviral drugs. Antiviral drugs are generally ineffective for respiratory viruses, such as influenza viruses, adenoviruses, respiratory syncytial virus, and rhinoviruses. In most cases, viral respiratory infection is treated only with supportive care or symptomatic treatment. Antiviral drugs are also mostly ineffective for gastrointestinal viruses, such as rotavirus, norovirus, adenovirus, and coronavirus. The main treatment for viral gastrointestinal infection is supportive care to prevent dehydration and symptomatic relief to alleviate nausea, vomiting, and diarrhea. Antiherpes drugs, such as Zovirax (acyclovir), are effective to inhibit the replication of herpes simplex virus, herpes zoster virus, and varicella. Interferons are sometimes prescribed to treat viral infections, such as hepatitis, hairy cell leukemia, and Kaposi¡¦s sarcoma, but they can cause serious adverse reactions such as depression, hepatitis, and bone marrow suppression. Overall, there are only few choices for antiviral drugs, and most have marginal effectiveness but significant toxic adverse effects.

        In traditional Chinese medicine, through thousands of years of clinical trials and errors, many herbs and formulas have been tested and shown to effectively treat viral infections. Some herbs have antiviral effect to suppress the replication of viruses, some have virucidal effect to kill viruses, and others have immunostimulant effect to boost the immune system to clear the viral infection. Furthermore, many other herbs are available to offer supportive care and symptomatic treatment. Most importantly, most of these herbs are extremely safe, and do not have the same harsh side effects as drugs.

        In conclusion, Western and traditional Chinese medicines are both effective to treat viral infections, they each have their own limitations. Therefore, despite amazing advances in Western medicine and thousands of years of human clinical experience in traditional Chinese medicine, human¡¦s own immune system is still the most effective and best treatment for viral infections.