CLINICAL APPLICATIONS

* Infection and inflammation in ears, nose, and throat (ENT)

§ Ear infection: suppurative otitis media

§ Nose infection: sinus infection, sinusitis, and rhinitis

§ Throat infection: infectious parotitis, tonsillitis, pharyngitis, strep throat, severe sore throat, bad breath, and mouth ulcers 

* Other infections: infectious mononucleosis, erysipelas, and sores and ulcerations in the oral cavity

 

WESTERN THERAPEUTIC ACTIONS

* Antiviral properties to treat viral infections

* Antibacterial properties to treat bacterial infections

* Antipyretic effect to reduce fever

* Anti-inflammatory effect to reduce swelling, relieve inflammation and alleviate pain

 

CHINESE THERAPEUTIC ACTIONS

* Clears heat in the head and the upper jiao

* Eliminates toxins

 

DOSAGE

Take 3 to 4 capsules three times daily on an empty stomach, with warm water. Dosage may be increased to 6 to 8 capsules three times daily, if necessary. The herbs should be taken with meals for those with a sensitive stomach.

 

INGREDIENTS

Ban Lan Gen (Radix Isatidis)

Bo He (Herba Menthae)

Chai Hu (Radix Bupleuri)

Chen Pi (Pericarpium Citri Reticulatae)

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Huang Lian (Rhizoma Coptidis)

Huang Qin (Radix Scutellariae)

Jie Geng (Radix Platycodonis)

Lian Qiao (Fructus Forsythiae)

Ma Bo (Lasiosphaera seu Calvatia)

Niu Bang Zi (Fructus Arctii)

Xuan Shen (Radix Scrophulariae)

Zhe Bei Mu (Bulbus Fritillariae Thunbergii)

 

BACKGROUND

A healthy person has numerous defense mechanisms that protects against invasion of micro-organisms. These host defense mechanisms include natural barriers (i.e., skin), non-specific immunity (i.e., phagocytic cells) and specific immunity (i.e., antibodies). However, if the host defenses are defective or becomes disrupted, the micro-organisms may enter and affect various parts of the body. While infection may occur at any parts of the body, infection of the head is relatively common as the openings in the head (i.e., ear, nose and throat) directly connect the body to the outside world, and therefore, are often the first places affected by micro-organisms. Thus, optimal treatment of infective disorders affecting the ear, nose and throat requires use of treatment agents to kill the micro-organisms and preventative agents that block the spread of the infection.

 

FORMULA EXPLANATION

Herbal ENT is designed to treat wind, heat, and toxin invasion to the head region, leading to symptoms such as severe sore throat, redness and swelling of the face and head, difficulties opening the eyes, swollen glands, ear infection, and thirst. It contains herbs with actions to clear heat and eliminate toxins.

          Huang Qin (Radix Scutellariae) and Huang Lian (Rhizoma Coptidis), the chief herbs of this formula, are used to clear heat in the head and eliminate toxins. Niu Bang Zi (Fructus Arctii), Lian Qiao (Fructus Forsythiae), and Bo He (Herba Menthae) disperse the accumulation of the wind-heat factor in the head. They are all crucial herbs in the treatment of sore throat. Xuan Shen (Radix Scrophulariae), Ma Bo (Lasiosphaera seu Calvatia) and Ban Lan Gen (Radix Isatidis) clear heat and eliminate toxins. Ma Bo (Lasiosphaera seu Calvatia) is especially effective for severe sore throat with difficulty to swallow. Jie Geng (Radix Platycodonis), Zhe Bei Mu (Bulbus Fritillariae Thunbergii) and Gan Cao (Radix et Rhizoma Glycyrrhizae) have a synergistic effect to soothe sore throat, thus helping the heat-clearing herbs. Xuan Shen (Radix Scrophulariae), besides benefiting the throat, also prevents the heat-clearing and dampness-drying herbs from injuring the yin. Jie Geng (Radix Platycodonis) also has an expectorant effect to bring out the sputum and prevent the spread of the infection deeper into the body. Chen Pi (Pericarpium Citri Reticulatae) descends Lung qi, relieves cough and eliminates phlegm. Finally, besides dispersing the wind-heat factor, Chai Hu (Radix Bupleuri), acts as a guiding herb to bring the other herbs upward to the head region, where the condition is most critical.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* This formula should be used with caution in those with loose stools or diarrhea caused by Spleen qi deficiency. Take this formula after meals in patients who have a weak digestive system.

* Use this formula with caution in cases of yang and qi deficiencies.

 

CLINICAL NOTES

* If the condition does not improve after seven days, modification of the treatment may be necessary.

* There is no evidence thus far that use of heat-clearing herbs may permit secondary infections to arise (as is the case with antibiotic drugs). However, those who have recurrent infections should take acidophilus prophylactically, especially if they have a history of repeated antibiotic drug usage.

* Herbal ENT is stronger than Lonicera Complex in the treatment of wind-heat invasion. It is used in cases where there is severe sore throat accompanied with other wind-heat symptoms.

* Herbal ENT 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 Wei-Yen Chang:

* Upper respiratory viral infection: deep and weak pulse on the right cun

* Upper respiratory bacterial infection: superficial and forceful pulse on the right cun

* Lower respiratory infection: Yangwei pulse, a pulse extending distally from the cun position towards the thumb on the right hand. It is one of the eight extra meridian pulses.

 

SUPPLEMENTARY FORMULAS

* For common cold or influenza with sore throat, combine with Lonicera Complex.

* For sinus infections, use with Magnolia Clear Sinus or Pueraria Clear Sinus.

* For respiratory tract infections, add Respitrol (Heat) or Respitrol (Cold).

* For yellow or greenish phlegm due to respiratory tract infections, use with Pinellia XPT.

* With more damp and phlegm in the body, add Pinellia Complex.

* To enhance the antibiotic effect, add Herbal ABX.

* To enhance the antiviral effect, add Herbal AVR.

* With more inflammation, add Astringent Complex.

* For high fever and excess heat in the body, add Gardenia Complex.

* For headache, add Corydalin (AC) or Corydalin (CR).

* With severe infectious mononucleosis with swollen lymph nodes, add Resolve (AI).

* With severe suppurative otitis media, add Gentiana Complex.

* With constipation, add Gentle Lax (Excess).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Middle ear infection: Fengchi (GB 20), Yifeng (TH 17), Tinggong (SI 19), Hegu (LI 4), Waiguan (TH 5), Zulinqi (GB 41), Shenshu (BL 23), Quchi (LI 11)

* Sinus infection:

§ Feishu (BL 13), Hegu (LI 4), Quchi (LI 11), Shangyang (LI 1), Lingtai (GV 10)

§ Shaoshang (LU 11), Quchi (LI 11), Yingxiang (LI 20)

* Sore throat:

§ Tinghui (GB 2), Yifeng (TH 17), Jiache (ST 6), Hegu (LI 4), Lieque (LU 7), Fenglong (ST 40), Jiexi (ST 41), Shaoshang (LU 11), Jiaosun (TH 20)

§ Shaoshang (LU 11), Hegu (LI 4), Neiting (ST 44), Tianrong (SI 17)

 

Classic Master Tung's Points:

* Throat infection: Houjian (T 44.29)*, Linggu (T 22.05), Chongzi (T 22.01), Chongxian (T 22.02), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Zusanli (ST 36), Hegu (LI 4), Tongshen (T 88.09), Tongwei (T 88.10), Tongbei (T 88.11). Bleed Shaoshang (LU 11) and also dark veins nearby Yinlingquan (SP 9) to Xuehai (SP 10), Quling (T 33.16), Cesanli (T 77.22), Cexiasanli (T 77.23) and the throat. Bleed before needling for best result.

* Tonsillitis: Sanjian (LI 3), Mu (T 11.17), Qihu (T 77.26), Waisanguan (T 77.27), Xinling (T 33.17)*, Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Hegu (LI 4), Linggu (T 22.05), Dabai (T 22.04), Tushui (T 22.11), Shiyin (T 88.32), Cesanli (T 77.22), Zuqianjin (T 77.24). Bleed Shaoshang (LU 11) and also dark veins nearby Yinlingquan (SP 9) to Xuehai (SP 10). Bleed before needling for best result.

* Middle ear infection: Wanshunyi (T 22.08), Linggu (T 22.05), Fugesan (T 44.30)*, Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Huoying (T 66.03), Tianhuangfu [Shenguan] (T 77.18). Bleed dark veins nearby 2 cuns above the lateral malleolus. Bleed before needling for best result.

* Mumps: Linggu (T 22.05), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Shangquan (T 88.22), Zhongquan (T 88.21), Xiaquan (T 88.20), Waisanguan (T 77.27). Bleed Shaoshang (LU 11). Bleed before needling for best result.

* Influenza or common cold: Fugesan (T 44.30)*, Linggu (T 22.05), Hegu (LI 4), Ganmaoyi (T 88.07), Ganmaoer (T 88.08), Fugesan (T 44.30)*, Huofuhai (T 33.07), Mu (T 11.17)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Ear, nose, throat infection: Needle Dabai (T 22.04), Sanchasan (T 22.17)*. Bleed Yuji (LU 10), Shaoshang (LU 11).

 

Balance Method by Dr. Richard Tan:

* Left side: Tianjing (TH 10), Quchi (LI 11), ah shi points from Yanggu (SI 5) to Yanglao (SI 6), Yingu (KI 10), Ququan (LR 8), Yinlingquan (SP 9)

* Right side: Quze (PC 3), Shaofu (HT 8), ah shi points from Taiyuan (LU 9) to Yuji (LU 10), Yanglingquan (GB 34), Zusanli (ST 36), Weizhong (BL 40)

 

Ear Acupuncture:

* Kidney, Inner Ear, Endocrine, Outer Ear. Bleed any distended veins on the back of the ear.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Otitis media: Internal Ear, External Ear, Temple, San Jiao, Endocrine, Spleen, Adrenal Gland. Bleed Ear Apex. Bleed Helix 5.

* Earache: Lesser Occipital Nerve, Large Auricular Nerve, Auriculotemporal Nerve, corresponding points (to the area of pain). Bleed Ear Apex and Helix 5.

* Sore throat: Pharynx, Larynx, Glottis, Mouth, Lung, Endocrine, Trachea. Bleed Ear Apex.

* Tonsillitis: Tonsil, Trachea, Throat, Larynx and Teeth, Mouth. Bleed Ear Apex and Helix 6.

* Acute laryngeal pharyngitis: Pharynx, Larynx, Mouth, Sanjiao, Endocrine, Teeth, Trachea. Bleed Ear Apex.

* Chronic laryngeal pharyngitis: Larynx, Pharynx, Lung, Teeth, Trachea, Spleen, San Jiao, Endocrine. Bleed Ear Apex.

* Erysipelas: Lung, Allergic Area, Liver, Spleen, Adrenal Gland, Endocrine. Bleed Ear Apex.

 

NUTRITION

* Food or beverages that are cool or cold in nature should be consumed. Among these are watermelon, lotus nodes, melon, seaweed, cranberries, celery, cucumber, cactus and winter melon.

* Drink plenty of water and urinate often.

* Increase supplementation with vitamin C and B complex.

* Increase intake of nourishing, cooling foods/roots such as Mexican yam, yam, radishes, potatoes, carrots, melons, cucumbers, beets, turnips, malanga, celeriac, taro, and rutabaga.

* 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.

* Avoid spicy, fried or greasy foods.

 

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

* Chronic sinusitis or rhinitis

§ Recommendations: ginger, green onions, magnolia flower, bananas, garlic, black mushrooms, chrysanthemum flowers, mulberry leaves, and apricot kernel.

§ Avoid coffee and stop smoking.

* Sore throat

§ Recommendations: carrots, olives, daikon, celery, seaweed, licorice, Chinese prunes, cilantro, and mint. Drink a lot of water and gargle with warm salt water.

§ Avoid alcohol, smoking, pollution, sleeping with the mouth open, stimulating or spicy foods, and fatty foods.

 

LIFESTYLE INSTRUCTIONS

* It is important to build up a strong immune system. When not suffering from an infection, exercise regularly, take a short cold shower following a hot shower, and ingest tonic herbs to enhance the immune system.

* Adequate rest is essential for recovery. Stay away from wind by putting on more clothing. Individuals with infection should rest and recover in a separate room, to prevent spreading germs to other people. Ventilate the patient’s room frequently – but make sure the patient is kept warm.

* Stop smoking and drinking, which weaken the immune system.

* Steam inhalation heals the throat, nasal passages, and bronchial tubes. During the acute phase, inhale the steam vapor for 15 minutes three times daily. During the chronic phase, inhale the steam vapor for 15 minutes before going to bed.

 

CASE STUDIES

* H.K., a 26-year-old female, presented with multiple symptoms of sore throat, fever, and slight sweating. Additional symptoms included sinus and chest congestion as well as headache and thirst. The TCM diagnosis was wind-heat obstructing the upper jiao with qi stagnation. For treatment, Herbal ENT was prescribed. She was a very active individual in an inhospitable climate where her symptoms had shown injury to her protective qi and body fluids. After taking the Herbal ENT for a week, the symptoms vanished. Submitted by H.C., Sydney, New York.

* S.F., a 45-year-old female, presented with pain in her left ear which became worse with any manipulation. Other symptoms included pain during swallowing and runny nose. Objective findings included redness and inflammation on the ear canal, yellow thick mucous, and redness on the throat. The practitioner diagnosed this condition as damp-heat in the upper jiao; Western diagnosis was upper respiratory infection. For treatment, Herbal ENT was prescribed. The patient experienced relief of symptoms after one week. She was able to experience more rest without the pain and her breathing had improved. Submitted by S.R., Waterbury, Connecticut.

* A.G., a 36-year-old male, presented with a combination of symptoms, including fever, chills, sore throat, and malaise. He was also experiencing ear pain and sinus congestion. It was also noted that the patient was allergic to sulfur drugs and was weary of taking Western medication. Pulse was superficial and rapid; tongue was swollen with a red tip. The practitioner diagnosed this condition as toxic heat. His Western diagnosis was laryngitis. After taking two bottles Herbal ABX and Herbal ENT, the patient’s symptoms had resolved. He still continued to use Herbal ABX periodically as it had worked well for him. Submitted by V.G., Virginia Beach, Virginia.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Herbal ENT contains many herbs with wide-spectrum antibiotic effects to treat a wide variety of infectious disorders, including bacterial, viral or fungal infections. Furthermore, it also contains several herbs that address the related symptoms of infection that affect the upper parts of the body, such as fever, swelling, inflammation, and pain.

        Many herbs in this formula have excellent antibiotic effects, including but not limited to Huang Qin (Radix Scutellariae),[2] Huang Lian (Rhizoma Coptidis),[3] Xuan Shen (Radix Scrophulariae),[4] Lian Qiao (Fructus Forsythiae),[5] Chai Hu (Radix Bupleuri),[6] Ban Lan Gen (Radix Isatidis),[7] and Niu Bang Zi (Fructus Arctii).[8] Among these herbs, Huang Qin (Radix Scutellariae) and Huang Lian (Rhizoma Coptidis) are generally considered as the most potent herbal antibiotics, as they are effective against micro-organisms such as Bacillus anthracis, Bacillus dysenteriae, Bacillus proteus, beta-hemolytic streptococcus, Bordetella pertussis, Corynebacterium diphtheriae, Diplococcus meningitidis, Diplococcus pneumoniae, E. coli, Mycobacterium tuberculosis, Pseudomonas aeruginosa, Salmonella typhi, Staphylococcus aureus, Vibrio cholerae.[9] Furthermore, berberine, a compound found in Huang Lian (Rhizoma Coptidis), showed antimicrobial activity against numerous strains of beta-lactam-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA).[10] Berberine markedly lowered the minimum inhibition concentrations of ampicillin and oxacillin against MRSA. Berberine and ampicillin exhibited an additive effect, and berberine and oxacillin showed a synergistic effect against MRSA. These results suggest that berberine may have antimicrobial activity and the potential to restore the effectiveness of beta-lactam antibiotics against MRSA.[11] Lastly, in addition to having an antibacterial effect, these herbs also illustrated antiviral, antifungal and antimicrobial activities against a variety of organisms including bacteria, cariogenic bacteria, viruses, fungi, protozoans, helminths, chlamydia, and dermatophytes.[12]^,[13],[14]

        In addition to treating the infection, Herbal ENT also contains many herbs that treat the related symptoms of infection. Huang Qin (Radix Scutellariae), Huang Lian (Rhizoma Coptidis), Chen Pi (Pericarpium Citri Reticulatae), Jie Geng (Radix Platycodonis) and Lian Qiao (Fructus Forsythiae) all have anti-inflammatory effects to reduce swelling, relieve inflammation, and alleviate pain.[15]^{,[16],[17],[18],[19]} Huang Qin (Radix Scutellariae) and Huang Lian (Rhizoma Coptidis) also have antipyretic effects to reduce fever.[20]^,[21]

        In regards to clinical applications, herbs in this formula have been used effectively to treat disorders such as common cold,[22] tonsillitis,[23] infectious parotitis,[24] pharyngitis,[25] suppurative otitis media,[26] cough,[27] respiratory tract infection,[28] upper respiratory tract infection,[29] chronic bronchitis,[30] pulmonary abscess,[31] pulmonary tuberculosis,[32] and severe acute respiratory syndrome (i.e., SARS).[33]

        Overall, Herbal ENT is an excellent herbal antibiotic formula that treats infection and inflammation in the upper parts of the body. Clinically, it may be used for bacterial, viral or fungal infections. Its indications include treatment of ear, nose, throat and lung infections.

 

COMPARATIVE ANALYSIS

Discovery of antibiotic drugs is one of the major breakthroughs in modern medicine. It enables doctors to effectively treat many different types of infections. Unfortunately, decades of misuse and abuse have led to growing problems of bacterial mutation and resistance. At this moment, many of these “super bugs” can only be treated with the newest and most potent antibiotic drugs, and unfortunately, many of them have potent side effects as well. Due to the number of antibiotic drugs, and the various species of micro-organisms, it is beyond the scope of this monograph to discuss the benefits and risks of each individual drug. As a category, antibiotic drugs are extremely effective against most types of bacterial infections. The key points are to select the correct antibiotic drug with least potential side effects, and make sure that the patient finishes the entire course of therapy.

        Herbs are also extremely effective for treatment of various infections. In fact, many modern pharmaceutical drugs were originally derived from natural sources, including penicillin [the oldest antibiotic] and gentamicin [one of the most potent]. One of the main benefits of using herbs is their wide spectrum of antibiotic effect, with indications for bacterial, viral and fungal infections. Furthermore, most of these herbs are extremely safe, and do not have the same harsh side effects as drugs.

        Both drugs and herbs are effective to treat mild to moderate cases of bacterial infections. However, drugs are more appropriate for life-threatening infections, such as meningitis or encephalitis, because drugs are more immediately potent and can be prescribed with more laboratory precision (via cultures and sensitivity tests). On the other hand, use of herbs is far more effective than drugs for treating certain viral infections, such as the common cold and influenza, as drugs are essentially ineffective for these conditions. Most importantly, herbs are much gentler to the body and safer than drugs. In other words, herbs treat infection without damaging the patient’s underlying constitution. This allows the patient to recover faster, and become more resistant to re-current or secondary infections.