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February 2, 2018

Essential Treatment Principles for the Cold and Flu

Written by: Matthew Wagner, L.Ac., M.S.O.M.

I recently read a blog about how elderberry is a sure-fire way to beat the flu.  The author touted elderberry’s benefits as being due to its strong antiviral properties.  These antiviral properties are supposed to “prevent, treat, and shorten the duration of a viral cold/flu.” Living in the antibiotic era, this reductionist “kill the bug” mentality is one that we’re all familiar with.  So, you really can’t blame someone for this position.  However, this is actually a terrible, terrible way of understanding the body, and a really great way to make yourself much sicker. 

I know many people take their health into their own hands (good for you!).  So, if you do, I want to make sure you do so in a way that you don’t inadvertently make yourself worse.  Let’s face it, there are a lot of bad health ideas floating around out there.  To this end, I’d like to share a very simple description of basic treatment principles. This is not intended to give you enough information to actually treat yourself.  There is no way a simple blog could possibly do that.  (I’m looking at you, Elderberry blog).  Rather, I’m going to discuss the general ways in which a body behaves in certain stages of illness, what actions could potentially help in that stage, and what actions will most definitely harm.  Disclaimer: It goes without saying, this is educational, and not intended to take the place of medical advice.  If you’re sick and not getting better, go see a medical professional.  In the meantime, if you’re the experimental type, here are essential cautions to follow.

Essential Treatment principles for the Cold/Flu

How not to make yourself worse when you’re already sick

We’re all going to get sick at some point in the future, like it or not.  In those moments, most of us will do whatever we can to feel better.  However, in the midst of feeling awful and not thinking clearly, this “whatever we can” often ends up making the situation worse.  I’d like to address this issue in the hopes of giving you some clear treatment principles and cause-and-effect scenarios to help you make the best personal decision you can in the moment.  We’ll start with some very basic concepts of disease and treatment principle, then move into some real world examples.

Treat the person, not the disease

Classical Chinese herbalism isn’t based upon understanding a bug, it’s based upon understanding the body.  This makes sense, right?  If the environment of the body has allowed a disease process to happen, then it’s the environment of the body that needs to be fixed.  If, however, we focus all of our attention on attacking a pathogen, then the body often becomes collateral damage in an ideological war.  This war is “me” vs the “bug”, “self” vs “other”, “good” vs “bad”.  It is wholly a black and white, simplistic point of view, that negates the reality of the body and its environment as a dynamic, organic, and ever-changing process.  You can’t hope to treat a fixed, static entity such as a virus/bacteria when the real health issue is the relationship created by that virus/bacteria.  You have to treat the relationship, and you can only know what this relationship is based upon body symptoms.

Illness location

Effective treatment absolutely depends upon understanding correct treatment principles.  These principles in turn depend not only upon a precise understanding of physiologic function, but also the interplay between that function and medicinal herbs.  Without that, not only is effective treatment a matter of luck, ineffective treatment is often quite dangerous.

Volumes have been written about this in the Chinese literature. However, for our intents and purposes, we’ll look at just a few, essential and life-saving points that you can use in the moment.  This is especially important for anyone who likes to use herbal medicines or OTC medicines on their own.

First of all, we need to know the disease location.  Again, this is something we can only know based on symptoms.  Is it on the exterior of the body?  The interior?  Somewhere in between? Both? Next, we need to know the disease quality.  The exterior of the body means exactly that - the skin, the joints, the head, etc.  Essentially, it’s the periphery.  The interior is generally digestive function, although in Classical Chinese herbalism it’s a little bit broader than that.  The “somewhere in between” is a more difficult concept.  It’s a little bit of the inside; a little bit of the outside; a little hot; a little cold.  It’s a mix that’s not straightforward.  This “somewhere in between” is a more complicated issue that we don’t have the space to explore at the moment, but in general, it includes many recalcitrant conditions relating to hormonal issues and stress response.

Next we need to know the quality.  Is it hot?  Cold?  Excess? Deficient? Sharp?  Dull?  A little of everything?  These answers will get us going in the right direction.

Examples

Illness affecting the exterior looks like; maybe feeling hot; maybe feeling cold; maybe feeling both at the same time; but there will be dislike of wind and/or cold, where the person likes to bundle up. There may be body aches, headache, itchy skin, general skin conditions, sweating with aversion to wind and/or cold.  ETC.

Illness affecting the interior can look like one of two things.  If it’s interior weakness (cold), it will be diarrhea, gas, bloating, nausea (mostly with eating or drinking), chill, lack of appetite, lack of thirst, irregular BM, irregular urination.  If it’s interior excess (heat) it can look like high fever, thirst, sweat, and constipation. ETC. Sometimes, both can occur together.

Illness affecting “somewhere in between” typically show up as sore throat, tight chest, chest pressure, or achey ribs, accompanied by some digestive symptoms, like gas, bloating, ETC.  There may also be distinctly alternating chills and fever.

Keep in mind, these treatment principles and examples are very simple. They are only meant to get you thinking about looking in the body in a different way.  Clinical reality is much more complicated.

Treatment principles

You always have to treat the illness based on its location, regardless of whatever name you give to it.  For example, allergies, joint pain, and eczema all occur on the exterior of the body.  Therefore, the exterior of the body is what you have to treat .  In clinical practice, this will look like the same types of herbs used in all of these conditions.

For our intents and purposes, we’re going to ignore the fact that illness can, and often does, affect multiple layers of the body at the same time, requiring multiple treatment strategies. Instead, we’re going to keep things simple.

If an illness is on the exterior, treat the exterior.  This usually looks like promoting or preventing sweating.

 Examples of herbs that promote a strong sweat are Blue Vervain or Ephedra.  Herbs that promote a mild sweat would be fresh ginger root and scallions.  Herbs that stop a sweat are astragalus, peony root, or ephedra root.

If there is cold on the interior resulting in gas, bloating, fatigue, loose BM, etc, you have to warm the interior. 

Examples of interior warming herbs are mature, winter-harvested ginger root, Sichuan pepper, Chinese or Korean ginseng, and cooking spices, like cinnamon, cloves, etc.

If there is heat on the interior manifesting as high fever (with no aversion to cold), profuse sweat, and possibly dry constipation, you need to purge heat from the interior. 

Examples of interior heat clearing/purging herbs are rhubarb root, senna, goldenseal, and yellow dock.

If the illness is “somewhere in between”, or both on the interior and exterior, you need to skillfully do a little of everything, or follow strict treatment principles as to which aspect to address first.

Getting it wrong

It stands to reason that if an illness occurs in a particular aspect of the body, you treat that aspect.  But, is there any consequence if you treat the wrong part? The short answer is yes, and it can be serious.

Inappropriate sweating - Treating the exterior when the exterior isn’t the (main) problem

If the disease is one of interior cold (gas, bloating, lack of appetite/thirst etc.) and you treat the exterior by taking sweat-promoting herbs, taking a hot bath, or sitting in a sauna, you will weaken the interior even further.  (The exact mechanism for this is part of a much larger conversation).  This happens all of the time with people who work out when they have a cold, or feel like they might be getting one, but at the same time have a weak GI.  It’s the same when someone feels a chill and draws a hot bath or sits in a sauna.  In all of those scenarios, the person over-sweats, and weakens their already weakened core.  The result is fatigue, gas, bloating, diarrhea, cloudy head and loss of appetite.  “Runner’s trots” is similar - acute over-sweating leads to loss of internal tone, which results in diarrhea.

This is actually one of the most serious mistakes.  This aspect of the interior, which pertains to core body temperature, tone, and function, is called the Tai Yin (太陰) in Chinese medicine.  There is an expression in Chinese medicine that “death flows through the Tai Yin”. Casually over-sweating may seem like no big deal, but in reality, it’s quite serious.  When a disease reaches the core, you better get your act together and fix it, as serious trouble is not that far away.  The last thing you want to do is invite that disease in.

In terms of herbal medicine and pharmacology, this looks like being inappropriately prescribed ephedrine, or self-administering ephedra, Blue Vervain, or any other sweat promoting herb.

Hypothetical real-world scenario:

A person is worn out from over-working.  They haven’t been eating right and haven’t been sleeping much.  As a result, they don’t have much appetite and they feel sluggish.  Maybe they have loose or difficult bowels.  Maybe their urination is slightly irregular - either going a lot, or not going very much, or maybe waking at night to urinate.  All of these symptoms are easy to ignore.  They also have muscle aches and pains from sitting in front of a computer for too long.  When they finally get a weekend away, they stay in a cabin with a sauna, which they are excited to use.  The next day after the sauna they experience profound fatigue, nausea, lack of appetite, gas, bloating, and loose, difficult BM.

What should they have done instead?

With interior weakness, a much better choice would be a small, well-cooked meal with LOTS of warm spices, such as ginger, fennel, cinnamon, cumin.  A prime example would be a homemade curry with little fat and no coconut milk.  Then, have a small glass of wine to warm the interior and move the blood.  Read a book.  Go to bed early.

Incorrect sweating - promoting a sweat when you’re already sweating

Let’s suppose you DO have an relatively severe exterior condition, complete with runny nose and body aches.  You may feel a little flushed, but you also feel a little chilled at the same time.  Most importantly, you want to bundle up and avoid the cold.  You have also felt sweaty for a couple of days.  What do you do??? Promote a sweat or stop a sweat?

If you said promote a sweat (hot bath, sauna, diaphoretic herbs or pharmaceuticals) you would be wrong, and you may very well make yourself much worse.  The point of sweating is to break a fever.  If you’re still sweating after a fever has broken, or if you never actually had a fever but you’re sweating anyway, it means the exterior of the body is weak.  Further sweating will just weaken it more.  Now, we know from above that sweating ultimately drains the interior of the body, so, if you keep sweating, eventually your GI functions are going to weaken.  You can think of this as over-sweating draining the body’s core vitality, or, as over-sweating dragging the pathogen deeper into the body.  Either way, the result is the same.  So, what was once a simple exterior condition has transmuted into a complex and serious interior condition.  To reiterate, “death flows through the Tai Yin”. In a scenario of spontaneous sweating, you need to STOP sweating.

Hypothetical real-world example #1:

A person has been fighting a mild cold for several days.  They feel chilled and want to bundle up.  The thought of going outside sounds awful.  They have body aches.  They feel clammy and sweaty.  They draw a piping hot bath and sit in it for an hour, all the while sweating profusely.  The next day, they have non-stop cold sweats.  They feel profoundly fatigued.  They are chilled to the core.  Finally, they have a splitting headache.

Hypothetical real-world example #2:

The same set up as #1, except this time, the person ignores the fact that they are sick and goes to a hot yoga class, where the sweat profusely for an hour.  The next day, they have bloating with cold cramping in the upper abdomen.  They have lack of appetite and thirst and have watery diarrhea multiple times per day.

What should they have done instead?

The exterior is quite weak in this case, as evidenced by the fact the person has already been sweating for several days.  The best thing to do is see a qualified herbalist.  Formulas used to treat this condition generally use a combination of cinnamon and peony root. Other possibilities are astragalus.  One should avoid intense cardio or sweat-inducing exercise until the condition has passed.

When should you sweat?

As you can see, knowing when it is and is not appropriate to sweat is an essential understanding in treating many illnesses.  Now that we’ve talked about when it’s not appropriate to sweat, let’s talk about when you should.  Sweating is called for when: 1) there is fever with lack of sweat, but also a dislike of cold and wind.  There may be strong body aches and a headache.  In this case, it is appropriate to promote a strong sweat.  2) In the very beginnings of a MILD cold, where there is a slight clammy feeling or muscle and joint aches. In this case, it is appropriate to very MILDLY promote a sweat with such herbs as ginger and scallions.

In both cases, once sweating has been achieved, STOP promoting a sweat.  You have achieved the therapeutic effect.  You don’t want to over sweat and run into the same problems as above.  It should be fairly obvious, but it bears mentioning, if you have just broken a sweat, don’t unbundle, don’t take the blanket off, and don’t go outside.  You’ll just make the cold worse and bring all of your symptoms back. You will also need to be careful not to get cold after showering. Or better yet, not take a shower that day.

Responding to objections

I know that someone is going to be thinking, “yeah, but I take a sauna all of the time when I catch a cold”, or, “I work out all of the time when I’m sick”.  To this I would say, the human body is remarkably resilient; resilient enough to bounce back from both a serious illness, and from all of the contraindicated things one does trying to treat it.  This doesn’t mean that what was done in the moment actually worked (outside of placebo).  Most importantly, it doesn’t mean you can keep doing it, year after year.  You may be strong enough to do it now, but that doesn’t mean it’s the right thing to do.  Eventually, ill treatment is going to catch up and there will come a time when the body doesn’t bounce back, and is actually made much worse.  That time is hastened with every incorrect treatment.

Inappropriate purging - purging the exterior / purging a cold interior

This one is almost entirely done by accident.  The scenario almost always involves some kind of over-the-counter laxative, although it may happen just as easily with pharmaceuticals, antibiotics or herbal “supplements”.  There are two different occasions in which this happens.

In the first scenario, a person has a cold on the exterior (has chills, body aches, runny nose, etc.), but for some reason is also taking laxatives.  This can be for several different reasons.  The person may be self-treating for constipation with stimulant laxatives, like Senokot or Ex-lax.  This typically occurs in the elderly, who are prone to dry, hard constipation.  This may also occur with people who are taking osmotic laxatives, like Miralax, or Magnesium Citrate, although this is generally much less severe.  This may also occur when someone is self-administering one of the various “cleanses” on the market, as these cleanses generally use harsh purgatives, like rhubarb, senna, or cascara sagrada.  By far, though, the worst case scenario is someone with chronic constipation who is prescribed laxatives by their doctor, and then also gets a cold.  Generally, chronic constipation is due to body “weakness” i.e. lack of tone or strength, as opposed to acute constipation, which is due to infectious process, inflammation, or nervous excitation.  Someone with chronic constipation is usually already quite weak.  Purgatives remove tone from the GI and only make the condition worse.

In the second scenario, the person doesn’t have any symptoms of exterior cold.   But, they do have all of the signs of interior cold and weakness.  These people will have lack of appetite, gas, bloating, fatigue, and will feel like they are cold at the core.  Again, taking laxatives with these symptoms will only make things worse.  In this scenario, any constipation is due to weakness.  A laxative will certainly move the bowels for a short period of time.  However, it will further weaken the body’s core vitality, so that the bowels become more and more sluggish over time, resulting in a dependency on laxatives.  All the while, the person becomes more and more fatigued.

Hypothetical real-world scenario:

A person has sluggish bowels, tending towards dry and difficult.  They are generally tired, have low appetite, and tend to be on the colder side.  They frequently take some kind of laxative to help with bowel movements.  At some point, they catch a seasonal bug that’s been going around.  As a result of purging the interior while there is an exterior condition, the person now has hard, distending pain in the abdomen, bloating with profound discomfort, and the BM is either even more constipated and difficult, OR, there is watery, thin diarrhea multiple times per day.  To top it off, the person is profoundly fatigued and cold, and their muscle aches from the cold are much worse.  After several weeks, they are diagnosed with chronic fatigue.

What should they have done instead?

Stop using laxatives.  This goes for taking magnesium to treat muscle cramping, as well.  Laxatives are only indicated in specific symptom complexes.  They are entirely overused in this country.  Even if there is a tendency towards sluggish bowels they should still be avoided. There is a better way to treat those conditions; one that rebuilds body strength, instead of tearing it down.  See a qualified Classical Chinese herbalist.

Mistreating an overheated interior - adding fuel to the fire

Excess heat on the interior has four cardinal signs; 1) high fever with dislike of heat; 2) increased thirst; 3) profuse, hot sweat; 4) rapid heart rate.  When this happens, one MUST (and can only) clear interior heat.  This presentation is perfect for antibiotics.  Good herbal alternatives would be gypsum, coptis, goldenseal, and rhubarb root.

Two very serious interactions can occur if this stage is mistreated. If, in this situation, one mistakes sweating and fever as an exterior sign, and then takes something to promote a sweat even further, like Blue Vervain, ephedra, or ephedrine, thinking that it’s “good for a cold”, the excess sweating which results will dry out the body even further and make the fever much worse.  If, in this situation, one takes ginseng, astragalus, licorice, or some other adaptogen, thinking that these herbs are “good for immunity”, they will quickly cause a profound spike in fever which can result in coma, and possibly even death.  This is a life and death situation, and not something to mess around with if you don’t know what you’re doing.

Having previously stressed when laxatives should not be taken, it’s important to explain when their use is essential.  In this context of extreme interior heat, if there is also dry, hard constipation, THEN laxatives are indicated (in conjunction with other indicated herbs). Indeed, in this situation, laxatives are life-saving.  The indication for rhubarb root, for example, is high fever with constipation.  This internal heat has one exit point, which is through the bowels.  If the heat is not purged, the fever will not go down and it could become life threatening.

What should they have done instead?

If one knows a very good Chinese herbalist, get in as quickly as you can.  If one doesn’t know an herbalist, doesn’t trust how good their herbalist is, or if the fever is dangerously high, go to the ER.  The treatment will undoubtedly be antibiotics.  Don’t be concerned about gut flora and GI health at this time.  Work with your herbalist afterwards to repair any damage the antibiotics may have done.

Summary

Hopefully, this brief write-up gives you an idea of how much of the conventional wisdom regarding cold/flu treatment is incorrect and dangerous. Now that you have been exposed to the concepts of disease location and treatment principle, you’re in a much better position to know what to do, what not to do, and why.  With better care, I’d like to think that we can all stay a little healthier through this cold/flu season.