2: Formulating for the Individual Patient

CHAPTER 2 Formulating for the Individual Patient



A SYSTEMATIC APPROACH


The Western herbal system of prescribing for the individual patient is simpler than that for traditional Chinese and Ayurvedic medicine and does not necessarily require traditional diagnostic techniques such as the pulse and tongue. Nevertheless, the Western system can be powerful, and the author of this text has seen the Western herbal prescription succeed when other approaches have failed. The systematics of the Western herbal approach are summarized here. For a full exposition on this topic, the reader is referred elsewhere.1


The goals of Western herbal prescribing for the individual patient are to:


• Raise vitality, which is central to the individual’s capacity to resist disease.

• Neutralize the perceived causes that either predispose a person to or provoke the disease process.

• Neutralize the sustaining causes that maintain the disease processes; chronic inflammation can be a sustaining cause.

• Promote and nourish the healthy functioning of bodily tissues, organs, and systems (as appropriate to the conditions being treated).

• Control counterproductive symptoms. For example, an itchy rash can interfere with sleep and debilitate the patient and is therefore counterproductive—thus the itch should be alleviated without excessively suppressing the rash.

Information about the causes of a patient’s health problems can come from several sources:


• Clinical experience of the health care professional and their colleagues

• Traditional perspective on the disorder

• Epidemiologic studies, which can provide particular information about the predisposing causes

• Knowledge of the pathologic processes involved in the disorder that can provide particular information about provoking and sustaining causes

• Clinical studies on patients with the disorder, which might provide information about a link with a particular pathogen, an abnormality in bowel flora, or an association with another condition, such as the link between asthma and sinusitis

This information needs to be filtered according to the individual case history. Using the example given, if a patient with asthma does not exhibit signs and symptoms of sinusitis, then focusing treatment on his or her sinus is pointless. Once the processing of the information that an extensive case history provided is done, a series of treatment goals can be established. These treatment goals are then linked to the chosen herbs via the required actions.


The actions are traditional herbal concepts, but scientific research also yields information about the actions of an herb. The stepwise process in linking the treatment goals to the choice of herbs for the prescription is then as follows.



1. Treatment goals should be decided based on:
• Traditional herbal concepts

• The orthodox medical understanding of the disorder and the patient’s case

• The history and needs of the individual patient

2. The goals should be individualized to the requirements of the individual case (after taking an extensive case history).

3. The immediate priorities of treatment should be determined.

4. Required actions are determined are based on the immediate treatment goals.

5. Reliable herbs that have these actions are determined, with as much overlap of actions as possible. For example, if antiinflammatory and antispasmodic actions are required for the gut, chamomile can effectively cover both of these requirements. These herbs are matched to the patient’s constitution and general condition.

6. If a particular action needs to be reinforced, more than one herb with this action is chosen, or an effective herb is used in a higher dose.

7. The liquid herbs are combined in a formula with appropriate doses. Choosing too many herbs should be avoided because this will compromise the patient’s individual doses in the formula and may lead to undefined interactions.

To facilitate this process, the practitioner needs a clear understanding of herbs in terms of their reliable, well-established actions. For this reason, an actions index is included as an important part in this book. The reader will also find the system of prescribing in weekly doses to be a convenient adjunct to this process. (See later discussion.)


The remaining part of this chapter then sets out examples of the process previously described for a number of common disorders under the following headings:


• Background (each disorder is briefly described as appropriate in terms of possible causes, counterproductive symptoms, and sustaining causes and organs or tissues requiring optimization of function)

• Treatment Strategy: Goals, Actions, and Herbs

• Example Formula

• Case History (presented for some disorders)

This approach is missing one important element: the case history of the individual patient. Therefore these examples are designed to illustrate the process and are not intended to provide a definitive statement about how a particular disorder should be treated. The needs of the individual are paramount.



HOW TO PREPARE A FORMULATION ACCORDING TO WEEKLY DOSES


The herbal formulation or prescription is an important aspect of herbal therapy; it allows the health care professional to make up a mixture using herbs that are specific to the patient. Arriving at a formulation can be done in many ways; one of the simplest ways is to use weekly doses.


If the patient is to take 5 ml of a formulation three times a day (15 ml per day), the total amounts to 105 ml per week, which can be rounded down to 100 ml. The herbs in the formulation can then be assigned appropriate doses by referring to their weekly dose ranges in the dosage table provided in Appendix A or in the individual monographs. The total should add up to 100 ml. The patient is then advised to take 5 ml three times per day, thereby automatically receiving the required amount of each herb.


When prescribing for children, the practitioner can still work on the 100-ml-per-week approach and still include the full adult weekly doses in the formulation. Adjustment is then made to the formulation dose; for example, it may become 2 ml three times per day rather than 5 ml. The way in which this adjustment can be made for children has already been outlined.


An example prescription for 1 week might be similar to that shown in Table 2-1.



TABLE 2-1

image

In this example, the herbs were selected, and then the appropriate dose of each herb was chosen by considering the weekly dose range in conjunction with the purpose of the herb in the formula. Each of the herbs selected falls within its dose range, and the total also adds up to 100 ml. If the total turns out to be greater than 100 ml, then the formula would normally be adjusted (by lowering the dose of individual herb or herbs—but not below the minimum in the dose range—or by reducing the number of herbs or by substituting an herb that has a lower dose range). Alternatively, the total might be adjusted to 105 or 110 ml without compromising the doses of individual herbs.


The previous sample prescription provides enough formula for 1 week. When dispensing for more than 1 week, the weekly doses are multiplied by the number of weeks required. For example, see Table 2-2.



TABLE 2-2

image

Generally, formulations should not contain more than six or seven herbs. If using 1:5 tinctures, fewer herbs must be used in the formulation to ensure that no less than the minimum weekly dose is prescribed for each herb. Prescribing herbs below the minimum in the dose range, for example, at less than 5 ml per week of ginger 1:2 (dose range: 5 to 15 ml per week), means that a therapeutic effect may not be achieved.


When preparing formulations for patients that are to be taken over extended periods, the maximum dose is usually not exceeded for safety reasons. When prescribing for acute conditions, the maximum dose may need to be exceeded, but usually not for long (1 to 2 weeks). Following the normal weekly dose system and increasing the frequency of the 5 ml dose to say 5 or 6 times per day achieves this goal.


If more than six or seven herbs are required in a formulation, then the total may be set at 150 ml. The dosage for the patient then becomes 7.5 ml (or 8 ml) three times a day.



THERAPEUTICS



ACUTE BRONCHITIS



Background.


Acute bronchitis, a bacterial infection of the trachea and bronchi, commonly follows the common cold, influenza, measles, or whooping cough. Patients with chronic bronchitis are particularly prone to developing episodes of acute bronchitis (when their sputum turns from gray or white to yellow or green). Other factors that can predispose a person to this kind of bacterial infection include cold, damp, and dusty conditions, as well as cigarette smoking.


Initially, an irritating, unproductive cough occurs, which eventually progresses over a few days to copious, mucopurulent sputum. Infection usually starts in the trachea and progresses to the bronchi accompanied by a general febrile disturbance with temperatures of 38° to 39°C (100° to 102°F). Gradual recovery should occur over the next 4 to 8 days. However, the condition may progress to bronchiolitis or bronchopneumonia.



Treatment Strategy: Goals, Actions, and Herbs



• Immune function can be improved with immune enhancing herbs such as Echinacea root and Andrographis, and respiratory infection can be controlled with respiratory antiseptic herbs such as elecampane and thyme. These herbs should be prescribed throughout the course of the infection and preferably should be continued 1 week into recovery to prevent relapse.

• During the dry, unproductive cough phase, reflex demulcents such as marshmallow root should be prescribed to alleviate the resultant irritation and debilitation from an unproductive cough.

• Diaphoretic herbs are indicated during the febrile phase, particularly pleurisy root, which is almost a specific for acute lower respiratory tract infections. The herb is often combined with ginger to enhance its effectiveness. Other diaphoretics such as lime flowers and yarrow can also be prescribed.

• Expectorant herbs, which include elecampane, thyme, licorice, fennel, and white horehound, can help clear mucous secretions and alleviate cough. These herbs can be prescribed throughout the course of the disorder. Pleurisy root will also act as an expectorant.

• Anticatarrhal herbs, especially mullein and golden seal, may be indicated when the sputum is particularly copious or if the productive cough lingers beyond the acute stage.

• Antitussive herbs such as Bupleurum and licorice should be used to help the cough, especially at night, and wild cherry is particularly indicated to allay cough if tracheitis predominates.


Example Formula.


See Table 2-3.


TABLE 2-3































Echinacea root (E. angustifolia or E. purpurea) 1:2 25 ml
Pleurisy root 1:2 20 ml
Ginger 1:2 5 ml
Elecampane 1:2 20 ml
Licorice 1:1 15 ml
Fennel 1:2 20 ml
Total   105 ml

Dosage: 5 ml with 40 ml warm water five to six times a day.



ALLERGIC RHINITIS



Background.


Allergic rhinitis is triggered by inhaled allergens and may be perennial or seasonal (hay fever). In the herbal treatment of rhinitis, identifying whether inhaled allergens are involved is important because this determines the approach to treatment.


Allergic rhinitis is usually characterized by sneezing, itching, nasal discharge, conjunctivitis, and nasal congestion. A family history of allergy is usually present, and secretions are often copious, clear, and thin. A positive skin prick test or radioallergosorbent test (RAST) to aeroallergens confirms the diagnosis.


The acute allergic response in rhinitis results from the interaction of inhaled allergen with a specific immunoglobulin E antibody on the surface of mast cells and basophils. This interaction leads to the release of histamine and other factors, which causes the acute symptoms.


Although allergens involved in seasonal allergic rhinitis are usually grass pollens, pollens from other plants, including trees, may be implicated. In perennial allergic rhinitis, house dust mite, molds, cockroaches, and cats are common sources of allergen.



Treatment Strategy: Goals, Actions, and Herbs.


The approach to the herbal treatment of rhinitis is to control symptoms and remove causes. Avoidance measures to reduce exposure to aeroallergens should be part of this treatment.


Dietary exclusions should be trialed for both allergic and nonallergic rhinitis. Herbalists believe that diet can create a state of hypersensitivity and catarrh of the mucous membranes, which predisposes the individual to rhinitis. Importantly, the dietary components that contribute to this process do not necessarily give a positive reaction on the RAST or skin prick test. These components include dairy products, wheat, salt, and refined carbohydrates. Patients with rhinitis should avoid excessive consumption of these dietary components, and complete exclusion of one component (e.g., dairy) should be trialed for at least 3 months.


The goals of herbal treatment include the following:


• Immune system can be balanced with immune modulating herbs, especially Echinacea root.

• Integrity of mucous membranes can be improved with mucous membrane trophorestoratives (golden seal) and anticatarrhal herbs (eyebright, golden rod), which will help prevent the allergen from reaching the mast cells that are deeper in the mucous membranes.

• Allergic response can be toned down with antiallergic herbs such as Albizia and Baical skullcap.

• Effects of stress (which can exacerbate rhinitis) can be alleviated with adaptogens (ashwaganda, Eleutherococcus), anxiolytics (valerian, kava, passion flower), and nervine tonics (St. John’s wort, skullcap).

• Treatment of rhinitis at a deeper level may involve the use of depuratives, particularly blue flag, burdock, cleavers, sarsaparilla, and yellow dock.

• When treating seasonal allergic rhinitis (hay fever), treatment must be commenced 6 weeks before the season starts and continued throughout the season. Any helpful dietary exclusions should also follow this time pattern.


Example Formula.


See Table 2-4.


TABLE 2-4























Echinacea root (E. angustifolia or E. purpurea) 1:2 35 ml
Eyebright 1:2 20 ml
Golden seal 1:3 20 ml
Baical skullcap 1:2 30 ml
Total   105 ml

Dosage: 5 ml with water three times a day before meals.


The reader should note that the tannins in Albizia are not compatible with the alkaloids in golden seal, hence it has not been used in this particular example.



ANXIETY



Background.


Anxiety disorders can be classified as follows:


• Panic disorder, which is characterized by the presence of recurrent and unpredictable panic attacks

• Phobic disorders, which involve marked and persistent fear of objects or situations, exposure to which results in anxiety, such as claustrophobia

• Generalized anxiety disorder in which the patient suffers persistent and often unrealistic worry together with symptoms such as muscle tension, impaired concentration, restlessness, and disturbed sleep

• Posttraumatic stress disorder, which follows extreme trauma such as a life-threatening event

Patients with anxiety should be treated as a whole. Aspects of lifestyle and diet should be considered and extremes corrected when possible, for example excessive use of alcohol, recreational drugs, sexual indulgence, imbalanced diet, excessive tea and coffee intake, and cigarette smoking. Such corrections will need to be carefully considered because patients often use these factors to allay anxiety, and their abrupt withdrawal might exacerbate symptoms.


Appropriate professional guidance and counseling, with the introduction of simple techniques for relaxation, can be beneficial.



Treatment Strategy: Goals, Actions, and Herbs



• Anxiolytic and sedative herbs such as kava, valerian, and passion flower can help dampen symptoms of anxiety.

• Other herbs in these categories that can provide valuable assistance are California poppy, spiny jujube (Zizyphus jujuba var. spinosa), and Corydalis.

• Nervine tonic herbs also have a role (these herbs are calming, but also lift mood) in the treatment of anxiety. These herbs include St. John’s wort, vervain, lemon balm, skullcap, oats, and damiana.

• Spasmolytic herbs can be used to alleviate spasm. Cramp bark and chamomile may be useful for any visceral symptoms associated with the anxiety, and hawthorn berry can be prescribed when cardiac symptoms are present.

• Anxious patients stress their bodies and deplete their adrenal reserves, which can create a vicious cycle. Hence tonic and adaptogenic herbs may be required. The herb of choice in this context is ashwaganda because of its calming properties.


Example Formula.


See Table 2-5.


TABLE 2-5























Valerian 1:2 20 ml
Passion flower 1:2 20 ml
Ashwaganda 1:2 35 ml
St. John’s wort 1:2 25 ml
Total   100 ml

Dosage: 5 ml with water three times a day.



ASTHMA



Background.


Asthma has been defined as the occurrence of dyspneic bronchospasmodic crises that are linked to a bronchial hyperreactivity (BH).2 Similar to autoimmune disease, asthma is a chronic disturbance of immunologic function, which can be controlled to some extent but not eradicated by modern drug therapy. In other words, asthma is not just the attacks (crises). Asthma is a chronic disturbance of the immune system. The attacks are the “tip of the iceberg.” Hence any treatment aimed only at relaxing airways and relieving symptoms, be it orthodox or herbal, is superficial and will not change the chronicity of the disease.


Recent research has identified many factors that may contribute to the causes and morbidity of asthma. Traditional herbal medicine also recognizes the role of inefficient digestion, poor immunity, stress, inadequate diet, and unhealthy mucous membranes in the development of the disease. Contributing factors identified from research on patients with asthma include inhaled allergens (exposure to which contributes to the chronicity of the disease, not just the attacks), dietary allergens, poor air quality, concurrent sinusitis,3,4 poor hydrochloric acid production,5 gastroesophageal reflux (GER),6,7 coexisting or episodic infections,8–10 excessive salt intake,11 poor immunity,12,13 stress,14,15 and antioxidant status.16–18 Platelet-activating factor (PAF) may be involved in the inflammatory response. (Ginkgo has anti-PAF activity.)



Treatment Strategy: Goals, Actions, and Herbs.


Tables 2-6 and 2-7 outline the treatment strategy for asthma.


TABLE 2-6 Treating the Underlying Factors That Created the Asthmatic Condition



















































Goal Required Actions Herbs
Control the allergic response Antiallergic Baical skullcap, Albizia
Treat sinusitis Anticatarrhal, antiallergic, immune enhancing Eyebright, Andrographis
Increase gastric acid Bitter tonic, digestive Gentian, Andrographis
Control reflux Antispasmodic, demulcent, antacid, mucoprotective Meadowsweet, marshmallow root, licorice
Eliminate infection Immune enhancing, antiviral, antibacterial Echinacea root, Andrographis
Reduce the physical effects of stress Adaptogen Astragalus, Eleutherococcus
Reduce anxiety and tension Sedative and nervine tonic Valerian, St. John’s wort
Boost the hypothalamic-pituitary-adrenal axis Tonic, adrenal tonic Ashwaganda, Rehmannia
Balance immunity Immune modifying, immune depressant Echinacea root, Hemidesmus, Tylophora
Improve antioxidant status Antioxidant Ginkgo, rosemary
Improve the health of mucous membranes Anticatarrhal, mucous membrane trophorestorative, lymphatic, depurative Eyebright, golden seal

TABLE 2-7 Treating the Symptoms and Sustaining Causes of Asthma, Such as Inflammation































Goal Required Actions Herbs
Control the allergic response Antiallergic Baical skullcap, Albizia
Control acute respiratory infection Diaphoretic, immune enhancing See information for common cold and influenza
Reduce inflammation Antiinflammatory, reflex demulcent Ginkgo, Bupleurum, marshmallow root
Clear the airways Expectorant Elecampane, fennel
Relax bronchial smooth muscle Bronchospasmolytic Elecampane, Grindelia, Coleus
Allay debilitating cough Expectorant, demulcent, antitussive Elecampane, marshmallow root, Bupleurum, licorice


Example Formulas



• For both symptomatic treatment and dealing with underlying factors when concurrent sinusitis is involved (see Table 2-8)

• For night cough and GER (Table 2-9)

• When stress and anxiety are significant factors (Table 2-10)

TABLE 2-8























Baical skullcap 1:2 30 ml
Ginkgo (standardized extract) 2:1 25 ml
Eyebright 1:2 15 ml
Echinacea root blend 1:2 30 ml
Total   100 ml

Dosage: 5 ml with water three to four times a day.


TABLE 2-9



















Licorice 1:1 15 ml
Meadowsweet 1:2 20 ml
Marshmallow root glycetract 1:5 65 ml
Total   100 ml

Dosage: 3 to 5 ml undiluted as required up to six times a day.


TABLE 2-10























Astragalus 1:2 30 ml
Valerian 1:2 15 ml
Rehmannia 1:2 30 ml
Ashwaganda 1:2 35 ml
Total   110 ml

Dosage: 5 ml with water three to four times a day.



BENIGN PROSTATIC HYPERPLASIA



Background.


Benign prostatic hyperplasia (BPH) is an androgen-dependent disorder within the prostate. (Androgen is a male hormone.) As men age, significant changes in hormone levels occur:


• Testosterone and particularly free testosterone is decreased.

• Prolactin, estradiol, sex hormone–binding globulin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) are increased.

The ultimate effect is increased dihydrotestosterone (DHT) within the prostate. New generation drugs for BPH such as Proscar (finasteride) inhibit the enzyme 5-alpha-reductase, which converts testosterone into DHT.


Many other factors are likely involved in BPH, including increased DHT receptors in the prostate (which may result from the increased estradiol), reduced metabolism of testosterone and DHT, accumulation of cholesterol, and inflammatory changes in the prostate.


A dynamic component to the symptoms of urethral obstruction is also present, which is known as “prostatism.”19 Alpha-adrenergic (sympathetic) nerve fibers innervate the smooth muscle of the prostatic urethra and bladder neck. Some of the symptoms of BPH are related to the state of contraction of this smooth muscle, which explains why symptoms can vary in severity at any given time for a man with BPH. Alpha-adrenergic blocking drugs such as Minipress (prazosin hydrochloride) are often prescribed to alleviate the symptoms of prostatism.



Treatment Strategy: Goals, Actions, and Herbs



• Prostate function can be improved with antiprostatic herbs, which act by various mechanisms and include saw palmetto, nettle root, and willow herb.

• Male hormonal function can be corrected with male tonics such as Korean ginseng.

• Compromised bladder function can be improved with the bladder tonic Crataeva.

• Prostatism can be alleviated with spasmolytic herbs, especially cramp bark, kava, and valerian.


Example Formula.


See Table 2-11.


TABLE 2-11



















Saw palmetto 1:2 30 ml
Nettle root 1:2 30 ml
Crataeva 1:2 40 ml
Total   100 ml

Dosage: 5 ml with water three times a day.



CHRONIC FATIGUE SYNDROME



Background20.


Chronic fatigue syndrome (CFS) can be viewed as a subtle immune dysfunction possibly resulting from a complex interaction among emotional, infectious, and environmental stressors. This immune dysfunction leads to a state of autotoxicity, which can be further exacerbated by previous or current exposure to environmental toxins. For each patient, the particular factors that may be contributing to this interaction need to be identified and dealt with through the therapeutic regime. In addition, the abnormalities that are now known to occur in CFS should be countered or corrected.


Patients with CFS were usually devitalized before they contracted the disorder. This condition might have been the result of emotional pressures, work pressures, family pressures, ambition, toxins, pregnancy, or even a bad diet; but the end result is the same. The finding that stress is a significant predisposing factor in CFS supports this observation.21 Any stressor, be it chemical, physical, biologic, or emotional, then acts to aggravate the condition. This reduced capacity to cope with stress is a key factor in creating the vicious cycle, which perpetuates the syndrome.


The devitalization then leads to weakened immunity and finally to an abnormal immune response to a viral infection. A stalemate is reached when the resultant hyperimmune state causes autotoxicity but is not sufficiently focused to resolve a viral presence, or any other cause, and to restore health. Devitalization is a curious state in which some compartments of the immune system are overactive, but other compartments are deficient.


Other causative factors might add either to the immune dysfunction or to the autotoxicity, or they may act as stressors to increase devitalization. These factors include:


• Intestinal dysbiosis, endotoxemia, or similar syndromes

• Allergies or food intolerances

• Toxins (e.g., dental amalgam, hair dyes, pesticides)

• Chronic inflammation or infection

These additional factors will not apply in every patient; it is a matter of individualization and appropriate treatment.


Possible factors identified in the cause or progression of CFS include viruses, immune abnormalities, circulatory abnormalities (including reduced blood flow to some parts of the brain), brain abnormalities, pituitary abnormalities, and sleep disorders, as well as muscle, metabolic, and biochemical abnormalities.20 Depression is a common feature that is to be expected given the morbidity of this disorder and its association with poor vitality.



Treatment Strategy: Goals, Actions, and Herbs



• Energy levels can be revitalized with tonics such as Korean ginseng, ashwaganda, and Astragalus; the response to stress can be improved with adaptogens such as Eleutherococcus.

• Depleted adrenal reserves can be restored with adrenal tonics, specifically licorice and Rehmannia.

• Immune function can be balanced with immune modulators, specifically Echinacea root and, when necessary, immune-depressing agents such as Hemidesmus and even Tylophora.

• Any viral association can be managed with antiviral herbs such as St. John’s wort and Thuja.

• Mood and vitality can be boosted with nervine tonics such as St. John’s wort, oats, Bacopa, and skullcap.

• Cerebral blood flow and general tissue perfusion can be improved with Ginkgo.

• Bacopa and Ginkgo will also improve memory.

• Sleep patterns can be improved and restorative sleep can be reestablished with hypnotic herbs such as valerian, spiny jujube, and kava.


Example Formula.


See Table 2-12.


TABLE 2-12



























Korean ginseng 1:2 10 ml
Ashwaganda 1:2 35 ml
St. John’s wort (high hypericin) 1:2 15 ml
Ginkgo (standardized extract) 2:1 20 ml
Astragalus 1:2 30 ml
Total   110 ml

Dosage: 5 ml with water three times a day.



COMMON COLD AND INFLUENZA



Background.


The common cold (acute rhinitis) is a benign viral infection of the upper respiratory tract that usually occurs in the winter months. Viruses commonly involved are rhinovirus, adenovirus, influenza virus, and parainfluenza virus. Acute rhinitis usually begins with a sore throat, nasal congestion, sneezing with clear discharge, and mild fever. After a few days, a mucopurulent discharge occurs resulting from secondary bacterial infection. A few days of bed rest may be necessary, and full recovery usually occurs 7 to 10 days after onset. Complications or sequelae include acute sinusitis, sore throat, tonsillitis, and otitis media.


In contrast, influenza is often a more severe respiratory infection that can result in loss of life. The main viruses that cause influenza are enveloped viruses known as influenza A and B.22 These viruses are capable of mutating, and new strains constantly appear. Influenza is also mainly a winter disease. The influenza virus can produce a range of disease states, from a mild common cold to fatal pneumonia (especially in older adults or people who are severely debilitated). True influenza is usually differentiated from other “flulike” illnesses by its marked systemic symptoms, with high fever, malaise, and muscle pain. Bed rest is usually always required.



Treatment Strategy: Goals, Actions, and Herbs



• Immune function can be improved with immune-enhancing herbs such as Echinacea root and Andrographis.

• Fever can be modified to optimize its fight against the invading pathogen. Diaphoretics are used for this effect and include elder flower, lime flowers, peppermint, and yarrow. These agents work best when administered hot (hot water is added to the herbal liquid) and in conjunction with ginger, acting as a diffuse circulatory stimulant. Chamomile is a good diaphoretic for children.

• Excessive discharge of mucus and upper respiratory congestion can be reduced with anticatarrhal herbs such as elder flower, eyebright, and golden seal. Traditional writers say that golden seal was contraindicated in the acute stage of infection,23 thus its use may be best in the later stages of the secondary bacterial infection, when a thick yellowish nasal discharge occurs.

• The virus can be controlled with antiviral herbs, especially St. John’s wort, which is active against the enveloped viruses that are often involved.


Example Formula.


See Table 2-13.


TABLE 2-13



























Echinacea root (E. angustifolia or E. purpurea) 1:2 35 ml
Ginger 1:2 5 ml
Lime flowers 1:2 20 ml
Eyebright 1:2 20 ml
Elder flower 1:2 20 ml
Total   100 ml

Dosage: 5 ml with 40 ml hot water five to six times a day.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on 2: Formulating for the Individual Patient

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