* ECHINACEA: CONEFLOWER

Although we typically focus our antimicrobial arsinal on antibiotics, there are a few agents which we use in naturopathic medicine which are immunostimulating or immunomodulating.

The best known of these is echinacea. A quick search for "echinacea" on MD Consult reveals 99 references and on PubMed reveals 152. The Cochrane Database reviewed echinacea studies in January 2000 and concluded after analyzing 16 trials that "the majority of the available studies report positive results."

Careful review of the clinical and in vivo studies conclude that echinacea significantly increases phagocytic activity. The polysaccharides, as just one of the active ingredients in Echinacea species, have received the most press and do enhance macrophage activity.1

Phagocytes are part of the non-specific immunity and as such are an important part of immune surveillance. Because of its importance in immune surveillance, Echinacea appears to work best as a PREVENTATIVE or in EARLY STAGES of cold or flu.2 In a review of studies encompassing over 3900 pts, Echinacea was shown to decrease the frequency, severity and overall symptoms of the common cold.3-6

In the early 20th century Echinacea was used to treat kidney and bladder infections and syphilis.7 Its use for infections declined after the 1930's with the introduction of Sulpha drugs and later other more broad-spectrum antibiotics. There are no reports of Echinacea preparations causing toxicity, carcinogenicity or mutagenicity. However, on rare occasions reversible skin reactions have been reported, so caution may be needed in atopic individuals.

DRUG INTERACTIONS: avoidance of use with hepatotoxic drugs ( anabolic steroids, amiodarone, methotrexate, ketoconazole); it may intensify the effects of warfarin; and the most controversial area is that of potential antagonistic effect on the action of immunosuppressive drugs.8 This later concern has been extensively addressed and with a careful reading of the literature in which those studies occur, one can conclude it is far more of an immunomodulator than immunostimulant and may therefore be used in this setting.

COMMON DOSING for flus and colds: It is ideal to use echinacea before the onset as a preventative or at the earliest onset of S&S. Take a full course when experiencing aggravated cold or flu S&S. Also you can have additive effects if the tincture (liquid) form is added into a cup of ginger, sage or lemon tea.

MAINTENANCE DOSE (preventative): 1/2 dropper 2x/day; 2 caps/ 2x/day

FULL COURSE: 1-2 dropperfull every 2 hrs while awake; 3-4 caps every 2 hours while awake until better, then wean to maintenance or tonic dose.

CHILDRENS DOSE: under 6: 10 gtts maximum dose age 7-10: 20 gtts maximum CHILDREN'S DOSE: Under 6 yrs: 10 gtts max dose. Age 7-10: 20 gtts max dose. Age 11 on up or around 90-100 lbs: adult dose according to how you are treating, i.e. tonic, full course, etc.

VITAMIN C-ASCORBATE
Vitamin C is probably the most well-known water soluble vitamin and antioxidant. Ascorbate is known to render many toxins water soluble and inert through its properties as an antioxidant. Vitamin C is thought to be the most effective and lowest risk antiviral agent.9 Many studies indicate its efficacy in chronic viral syndromes, including hepatitis10; mononucleosis with persistent fatigue, EBV, CMV, HIV11; also SLE and Sjogren's syndrome.

Vitamin C taken at tissue saturation ( the level at which gas and mild diarrhea occur: once this occurs go back to the dose just before this) strengthens immune functioning in general. Buffered Vitamin C is tolerated in higher levels intestinally than the ascorbic acid form and the buffered form is found readily. This form also serves as a supplemental source of magnesium, potassium and zinc.

Toxicity: "Vitamin C reduced and crystallized in its native state, free of oxidized forms or contaminants, has virtually no toxic side effects. It has been given in doses up to 300 Gms/day, orally and intraveniously, without complications." 12

REFERENCES:

1-Bone, K.M. Echinacea: what Makes It Work? Alternative Medical Review 1997: 2 (2): 87-93.
2-Bone, K.M. Echinacea: When Should It Be Used? Alt. Med Rev. 1997: 2 (6): 451- 458.
3-Melchart, et al. Echinacea For Preventing and Treating The Common Cold. Cochrane Database Syst Rev 2000; CD 00530;
4-Hennicke-von Zeplin, H. et al. Efficacy And Safety of a Fixed Combination Phytomedicine in The Treatment of The Common Cold, results of a randomized, double-blind , placebo controlled, muticenter study. Curr Med Res Opin, 1999; 15:214-227;
5-Brinkborn, RM et al. Echinaforce and Other Echinacea Fresh Plant Preparations in the treatment of the Common Cold. a randomized, placebo controlled, double blind clinical trial. Phtomedicine 1999;6:1-6.;
6-Lindenmuth, GF, et al. The Efficacy of Echinacea Compund Herbal Tea Preparation On The Severity and Duration Of Upper Respiratory and Flu symptoms, a randomized, placebo double blind study. J of Alt Compl. Med 2000; 6: 327=334.
7-Hobbs, C. The Echinacea Handbook. 1989 Box 742, Capitola, CA. Botanica Press.
8-Echinacea- Alternative Therapies; Amer. J. Health Syst. Pharm. 1999, 56 (Jan15); 121-122; Miller, LG Herbal Medicinals: Selected Clinical Considerations Focusing On Known Or Potential Drug-Herb Interactions. Arch Intern Med. 1998, 158:2200-2221.
9- Murata A. Viracidal Activity of Vit C: Vit C for Prevention and Treatment of Viral Diseases, Proc Cong of Intern'l Assoc of Micro Soc.3: 432-442, 1975.;
10-Baetgen D. Results of Treatment of Epidemic Hepatitis in Children With High Doses of Ascorbic Acid in the Years 1957-1959. Medizinische Monatshrift 15:30- 36, 1961.
11- Baetgen D (see 13); Baur H. et al Hepatitis Therapy With Infusions of Ascorbic Acid. Schweiz Med Wachenschrift84: 594-600, 1954; Calleja HP et al. Acute Hepatitis Treated with High Doses Of Vit C. Ohio State Med J. 8;821-823, 1960
12- Brighthope, IE. Aids: Remissions Using Nutrient Therapies and Megadose Intravenous Ascorbate. Int'l Clin Nut Rev. 13: 53-75, 1989