TCM Pharmacology of Herpesvirus Infections by M.M. Van Benschoten, OMD
Herpesviruses are common infections in humans and animals. Herpes simplex (HSV I and II), cytomegalovirus (CMV), Epstein Barr virus (EBV), Varicella Zoster Virus (VZV), Human Herpes Viruses HHV6, 7, and 8 all are characterized by an initial infection followed by latency and reactivation. Latent infection does not kill the host cell as viral DNA persists in a circular form with low levels of viral transcription.
Herpes Simplex Virus I and II generate blistering lesions of the mouth or genitals caused by axonal transport of viral particles along nerve cells. Viral shedding may occur even in the latent state. Herpes keratitis is an ocular infection that can damage vision. HSV I replication in the facial nerve is related to onset of Bell’s palsy, and HSV I causes 10% of all cases of viral encephalitis in the U.S. Herpes gladiatorum originates by skin to skin transmission during athletic competition. Recurrences may be triggered by stress, multiple infections, immunosuppressive drugs, or toxic environmental exposures. HSV II infections are sexually transmitted and associated with fertility disorders.
Cytomegalovirus, also known as CMV or HHV-5, is usually asymptomatic and infects 50-80% of the human population. CMV may be a contributing factor in the development of atherosclerosis and diabetes according to several studies. In immunosuppressed patients due to chemotherapy, transplant drugs, or HIV, reactivation of CMV may result in esophagitis, encephalitis, pneumonia, or retinitis. New onset schizophrenia and fatigue in breast cancer patients can be correlated to CMV activity.
Epstein Barr Virus or HHV-4 is the cause of mononucleosis. More than 90% of adults have antibodies to this infection. Due to persistence in B cells of the bone marrow, EBV is related to several cancers and autoimmune disorders, including nasopharyngeal cancer, lymphoma, lupus, rheumatoid arthritis, and multiple sclerosis. Chronic fatigue syndrome is often accompanied by elevated EBV titers.
Varicella Zoster Virus or HHV-3 creates the childhood illness known as varicella or chicken pox. Later reactivation is commonly called shingles, or herpes zoster. Although most cases present with skin symptoms alone, pneumonia and meningitis may develop in very young or elderly patients. Post herpetic neuralgia is a chronic pain condition that continues after clearance of the initial skin lesions.
Human Herpes Virus 6 was discovered in 1987 in blood samples of patients with lymphoproliferative disorders. It was later identified as the causative factor for roseola or exanthema subitum, a nearly universal childhood illness with a prevalence rate of 90% by age 2. Recent research associates HHV-6 with multiple sclerosis and chronic fatigue syndrome.
Human Herpes Virus 7 is related to pityriasis rosea, a skin condition. The virus was isolated in 1990 from healthy T cells. Fever and skin rash can occur with reactivation in transplant recipients. Neurological illnesses in children linked to HHV-7 include encephalitis, febrile seizures, and Guillian Barre syndrome, an autoimmune demyelinating disorder.
Human Herpes Virus 8 or Kaposi Sarcoma associated herpesvirus (KSHV) was found in 1994, and has a prevalence of 2-5% in healthy blood donors. HIV patients have a 40-50% infection rate, and those with Kaposi’s sarcoma are 80-95% seropositive. HHV-8 is also considered in multicentric Castleman’s disease, and primary effusion lymphoma, a rare B cell malignancy.
TCM syndromes related to herpesvirus infections include wind heat, heat toxin, damp toxin, and fire toxin. The most commonly used classical formula is Long Dan Xie Gan Tang containing antiHSV ingredients plantago and glycyrrhiza. Wu Wei Xiao Du Yin includes fire toxin clearing lonicera, chrysanthemum indicum, viola, and dandelion modified by adding portulaca, paeony red, forsythia, moutan, and isatis root.
Laboratory investigations of the antiherpesvirus activity of TCM materia medica can be utilized in the clinic to create formulations that directly address the inhibition of viral replication with evidence based prescribing. The immunological and neuroprotective benefits of herbal medicines combined with their antiviral effects provide excellent clinical responses with persistent treatment. Acute outbreaks can be managed with pharmaceuticals for powerful and immediate effects, with the recovery period and prevention of recurrence supported by TCM materia medica. Augmenting NK cell and T cell functions helps to control viral replication. Neutralizing antibodies can inactivate extracellular virus, however cell to cell transmission can cause persistence even with high antibody titers.
Effective formulations for herpesvirus disorders should address TCM syndromes and include evidence based antiviral and immune modulating components. A minimum of three to five antivirals with one or two NK cell activating tonics may be combined with classical pain relieving formulas such as Shao Yao Gan Cao Tang in herpes zoster or Jie Geng Tang in herpes pharyngitis. In Alzheimer’s disease where HSV I is considered to be a potential contributing factor, antivirals may combine with neurotrophic species including acorus (shi chang pu), curcuma aromatica (yu jin), lycium fruit (gou ji zi), and polygala (yuan zhi). This rationale can also be applied to children with learning or behavioral disorders due to low level persistence of inflammatory states from herpesvirus infections. Chronic fatigue syndrome and fibromyalgia will respond best to classical formulas modified by antiEBV herbs with blood stasis relieving effects. A history of chicken pox and mononucleosis, frequent cold sores, fever blisters, or canker sores may indicate poor immune control over herpesviruses.
Differentiation of TCM Materia Medica in Human Herpes Virus Infections
Anti HSV I
clear fire toxin - andrographis (chuan xin lian), selaginella tamarascina (wan nian song)
clear heat toxin - bidens (feng wei cao), dandelion (pu gong ying), houttuynia (yu xing cao), ocimum (jiu ceng ta), physalis (pao zai cao), prunella (xia gu cao), thlaspi (bai jiang cao), glycyrrhiza (gan cao)
clear damp heat - centella (ji xue cao), coptis (huang lian), phellodendron (huang bai), plantago (che qian zi), pyrossia (shi wei)
tonics - astragalus (huang qi)
Anti HSV II
clear fire toxin - selaginella tamarascina
clear heat toxin - bidens, hibiscus (fu rong), houttuynia, ocimum, portulaca (ma chi xian), prunella
clear damp heat - centella, plantago
tonics - epimedium (yin yang huo), ganoderma (ling zhi), polygonatum officinale (yu zhu), schizandra (wu wei zi)
AntiCMV
clear heat toxin - bidens, centella, euonymus (da ding huang), forsythia (lian qiao), scute (huang qin), verbena (ma bian cao)
clear summer heat - elsholtzia (xiang ru)
astrigent - terminalia (he zi)
warm interior - clove (ding xiang)
AntiEBV
clear fire toxin - andrographis
clear heat toxin - chrysanthemum, glycyrrhiza, momordica (luo han guo), paederia (ji xiang teng)
clear deficiency heat - artemisia annua (qing hao), picrorhiza (hu huang lian)
blood stasis - angelica sinensis (dang gui), curcuma longa (jiang huang), milletia (ji xue teng)
AntiVZV
clear heat toxin - licorice (gan cao)
clear damp toxin - polygonum cuspidatum (hu zhang)
AntiHHV-6
clear deficiency heat - artemisia annua
clear damp heat - sophora root (ku shen)
AntiHHV-8/KSHV
clear heat toxin - glycyrrhiza (gan cao)
blood stasis - carthamus (hong hua)
Cytotoxic T cell increase/NK cell activate
astragalus, coix (yi yi ren), lycium fruit (gou ji zi), pseudostellaria (tai zi shen)
NK cell activate
cardamon (sha ren), cyathula (chuan niu xi), grifola frondosa (hui shu hua), gynostemma (jiao gu lan), platycodon (jie geng), lentinus (xiang gu), ganoderma, curcuma longa, glycyrrhiza
Clinical Examples
Case 1 Postherpetic neuralgia
shingles outbreak, right arm pain, prior root canal with a course of Augmentin
bupleurum, licorice, coix, (NK cell function) paeony red, polygonum cuspidatum, ganoderma, (antiherpesvirus, pain relief), polygonatum root (T cell function, antiHSV), moutan (dental infection)
Case 2 Bell’s Palsy
left sided facial paralysis, previous ear pain, Zithromax, Acyclovir, Prednisone, post partum memory problems for four years
centella, prunella, lonicera, thlaspi, physalis, ocimum, houttuynia, (antiHSV), rhodiola (neuroprotective)
Case 3 Herpes labialis
right upper lip large swollen blistering lesion with throbbing tingling pain, severe stress and deep dental cleaning prior to onset
pseudostellaria, eleutherococcus, rhodiola (adaptogen, NK cell function), plantago, physalis, prunella, centella, sargassum, schefflera (antiHSV, analgesic), coptis (dental infection)
Case 4 VZV vaccine reaction
post vaccination shingles outbreak on back and leg, tendonitis, rectal bleeding, chondromalacia patella, cough taking Pantoprazole, Pravastatin, Atenolol, Meloxicam, Maxalt
Rx 1
cynanchum atratum, luffa, phragmites (cough), liquidamber, leucas, impatiens (tendonitis), epimedium, paedaria (VZV muscle inflammation), homalomena, moutan (chondromalacia)
knee pain reduced, cough gone, reflux, back pain
Rx 2
bidens, curcuma longa, paeony red, portulaca, (VZV vaccine reaction related pain and fatigue, reflux), cimicifuga, momordica, thlaspi, (hemorrhoidal bleeding) tokoro (back pain)
Case 5 Abductor spasmodic dysphonia
20 years flight attendant, 8 years dysphonia, mold exposure in residence, continuous headache, oral sores
gambir, pueraria, bupleurum, belamcanda (spasmodic dysphonia), paeony red, centella, schefflera, houttuynia, prunella, andrographis (oral sores, HSV I inflammation of brainstem and cranial nerves), oldenlandia, kaopen (daily headaches, mold and jet fuel exposure)
Case 6 Chronic fatigue
headaches, hypoglycemia, positive lab titers for CMV, EBV, HHV6, VZV, Parvo B19, childhood secondhand tobacco exposure, coffee and dairy intolerance
chrysanthemum, curcuma longa, milletia, terminalia, prunella, (anti CMV, EBV) lonicera, scrophularia, (streptococcal sinusitis) codonopsis, (hypoglycemia) polygonatum root, lentinus (NK cell function)
Case 7 Autoimmune hepatitis
onset after 2007 influenza, positive EBV titer, mold exposure in multiple residences, intolerance for goats milk, coffee, tobacco
salvia, schizandra, scute, artemisia scoparia, (liver inflammation) angelica sinensis, curcuma longa, polygonum cuspidatum, thlaspi, sophora root, milletia, paedaria, (antiEBV), magnolia bark (gastrointestinal inflammation)
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