Herbs that may be helpful

Four different categories of herbs are used to help combat the common cold. First, herbs that stimulate the immune system to fight the infection are used during the onset of the common cold—echinacea and Asian ginseng are two examples. Second, herbs known as diaphoretics promote a mild fever and sweating both of which are useful for fighting infection. A fever is a sign that the immune system is working; thus, diaphoretics may also be immune stimulators—elder, boneset, and yarrow are three examples. The third category includes herbs that, based on test tube studies, may directly kill the viruses that cause colds—goldenseal, myrrh, and usnea are examples. Finally, a fourth category of herbs are used to alleviate cold symptoms, such as sore throats. These herbs tend to be high in mucilage and are soothing and anti-inflammatory, or have tannins that are astringent (i.e., that constrict boggy tissue, promoting healing)—marshmallow and red raspberry are two examples.

As the following chart shows, many herbs fit into more than one category; goldenseal is one example, as it has both immune-stimulating and antiviral properties.

Double-blind trials have shown that various echinacea extracts shorten the duration of the common cold.^{19 20} Fresh pressed juice of echinacea (E. purpurea) flowers preserved with alcohol, and tinctures of echinacea (E. pallida) root are the forms most commonly studied and proven effective. In addition, several double-blind trials have found that echinacea (E. angustifolia) root tinctures in combination with wild indigo, boneset, and homeopathic arnica reduce symptoms of the common cold.²¹ In one double-blind trial, a proprietary formulation of echinacea, white cedar, and wild indigo, known as Esberitox®, reduced the length and severity of cold symptoms significantly more than did placebo.²² One double-blind trial found that echinacea was inffective for treating colds that were induced in research subjects by instilling a cold virus (rhinovirus) directly into their noses.²³ However, the relevance of this study to the treatment of naturally occurring colds is not clear. Another double-blind study found that echinacea was not an effective for upper respiratory tract infections in children aged 2 to 11 years.²⁴

Echinacea is believed to work primarily through immune stimulation. The minimum effective amount of echinacea tincture or juice appears to be 3 ml three times per day. Higher amounts, such as 3 to 5 ml every two hours, is generally better and is safe, even for children.²⁵ Encapsulated products may also be effective, according to a double-blind trial using the root of E. pallida.²⁶ Generally, capsules containing 300 to 600 mg are used three times per day. According to one double-blind trial, employees of a nursing home who consumed echinacea tea at the onset of a cold or flu reduced the duration of their symptoms by about two days when compared with people consuming a placebo tea.²⁷ The participants drank five to six cups of tea on the first day of their symptoms and decreased this by one cup each day over the next five days.

Double-blind trials indicate that regular use of echinacea to prevent colds does not work.^{28 29 30} Therefore, it is currently recommended to use echinacea at the onset of a cold, for a total of seven to ten days.

Andrographis contains bitter constituents that are believed to have immune-stimulating and anti-inflammatory actions.³¹ Several double-blind trials have found that andrographis may help reduce symptom severity in people with common colds.^{32 33 34 35} Though the earliest clinical trial among these showed modest benefits, later studies have tended to be more supportive. A combination of a standardized andrographis extract combined with eleuthero, known as Kan jang, has also been shown in a double-blind trial to reduce symptoms of the common cold.³⁶

In a double-blind study, supplementation with American ginseng significantly reduced by 27% the number of colds that people experienced over a four-month period, compared with a placebo.³⁷ The amount used in this study was 400 mg per day of a freeze-dried extract.

In a double-blind trial, participants took one capsule per day of a placebo or a garlic supplement that contained stabilized allicin (the amount of garlic per capsule was not specified) for 12 weeks between November and February. During that time, the garlic group had 63% fewer colds and 70% fewer days ill than did the placebo group.³⁸

Geranium (Pelargonium sidoides) is an herbal remedy used in Germany, Mexico, Russia, and other countries for the treatment of respiratory tract and ear, nose, and throat infections. In a double-blind study of children with acute tonsillitis/pharyngitis that was not due to a Streptococcal infection, participants given an extract of geranium had significantly more rapid resolution of symptoms, compared with those given a placebo.³⁹ The amount of the geranium extract used in this study was 20 drops three times per day for six days.

In a double-blind study, a proprietary product containing marshmallow root, licorice root, and elm bark (Throat Coat®) was effective in providing rapid, temporary relief of sore throat pain in people with acute pharyngitis.⁴⁰ Throat Coat® was taken as a tea in the amount of 5 to 8 ounces, 4 to 6 times per day, for two to seven days.

Herbal supplements can help strengthen the immune system and fight infections. Adaptogens, which include eleuthero, Asian ginseng, astragalus, and schisandra, are thought to help keep various body systems—including the immune system—functioning optimally. They have not been systematically evaluated as cold remedies. However, one double-blind trial found that people who were given 100 mg of Asian ginseng extract in combination with a flu vaccine experienced a lower frequency of colds and flu compared with people who received only the flu vaccine.⁴¹

According to test tube experiments,⁴² wild indigo stimulates immune function, which might account for its role in fighting the common cold and flu. In combination with echinacea, boneset, and homeopathic arnica, as mentioned above, wild indigo has prevented and reduced symptoms of the common cold in double-blind research. Wild indigo is traditionally considered a strong antimicrobial agent, though it has not yet been investigated as an agent against cold viruses.

Boneset is another immune stimulant and diaphoretic that helps fight off minor viral infections, such as the common cold. In addition, linden and hyssop may promote a healthy fever and the immune system’s ability to fight infections. Yarrow is another diaphoretic that has been used for relief of sore throats, though it has not yet been researched for this purpose.

Goldenseal root contains two alkaloids, berberine and canadine, with antimicrobial and mild immune-stimulating effects.⁴³ However, due to the small amounts of alkaloids occurring in the root, it is unlikely these effects would occur outside the test tube. Goldenseal soothes irritated mucous membranes in the throat,⁴⁴ making it potentially useful for those experiencing a sore throat with their cold. Human research on the effectiveness of goldenseal or other berberine-containing herbs, such as Oregon grape, barberry, or goldthread (Coptis chinensis), for people with colds has not been conducted.

Goldenseal root should only be used for short periods of time. Goldenseal root extract, in capsule or tablet form, is typically taken in amounts of 4 to 6 grams three times per day. Using goldenseal powder as a tea or tincture may soothe a sore throat. Because goldenseal is threatened in the wild due to over-harvesting, substitutes such as Oregon grape should be used whenever possible.

Elderberry has shown antiviral activity and thus may be useful for some people with common colds. Elder flowers are a traditional diaphoretic remedy for helping to break fevers and promote sweating during a cold. Horseradish has antibiotic properties, which may account for its usefulness in easing throat and upper respiratory tract infections. The resin of the herb myrrh has been shown to kill various microbes and to stimulate macrophages (a type of white blood cell). Usnea has a traditional reputation as an antiseptic and is sometimes used for people with common colds.

Herbs high in mucilage, such as slippery elm, mallow (Malvia sylvestris), and marshmallow, are often helpful for symptomatic relief of coughs and irritated throats. Mullein has expectorant and demulcent properties, which accounts for this herb’s historical use as a remedy for the respiratory tract, particularly in cases of irritating coughs with bronchial congestion. Coltsfoot is another herb with high mucilage content that has been used historically to soothe sore throats. However, it is high in pyrrolizidine alkaloids—constituents that may damage the liver over time. It is best to either avoid coltsfoot or look for products that are free of pyrrolizidine alkaloids.

Red raspberry, blackberry, and blueberry leaves contain astringent tannins that are helpful for soothing sore throats.⁴⁵ Sage tea may be gargled to soothe a sore throat. All of these remedies are used traditionally, but they are currently not supported by modern research.

Eucalyptus oil is often used in a steam inhalation to help clear nasal and sinus congestion. It is said to work similarly to menthol, by acting on receptors in the nasal mucous membranes, leading to a reduction of nasal stuffiness.⁴⁶ Peppermint may have a similar action and is a source of small amounts of menthol.

Meadowsweet has been used historically for a wide variety of conditions. It is reputed to break fevers and to promote sweating during a cold or flu. Meadowsweet contains salicylates, which possibly give the herb an aspirin-like effect, particularly in relieving aches and pains during a common cold. While not as potent as willow, which has a higher salicin content, the salicylates in meadowsweet do give it a mild anti-inflammatory effect and the potential to reduce fevers during a cold or flu. However, this role is based on historical use and knowledge of the chemistry of meadowsweet’s constituents; to date, no human studies have been completed with meadowsweet.

Traditional Chinese Medicine practitioners use Chinese artichoke (Stachys sieboldii), a species similar to wood betony (Stachys betonica), for colds and flu.⁴⁷ It is unknown whether wood betony would be useful for people with the common cold.