TCM Pharmacology of Streptococcal Infections by M.M. Van Benschoten, OMD

TCM Pharmacology of Streptococcal Infections by M.M. Van Benschoten, OMD

Streptococcal infections have an incidence of 3.2 to 6.9 cases per 100,000 persons for group A and B type bacteria. Diseases related to group A strep include pharyngitis (strep throat), impetigo, pneumonia, cellulitis, osteomyelitis, otitis media, sinusitis, and meningitis. Outbreaks of group A strep were common before the pasteurization of milk, and recently salad bars have been implicated as a source.

Streptococcus pneumonia, also known as pneumococcus, causes sinusitis, otitis, meningitis, conjunctivitis, pericarditis, and pneumonia. Streptococcus faecalis, also known as enterococcus, can cause urinary tract infection, endocarditis, meningitis, and food poisoning. Streptococcal food poisoning symptoms include diarrhea, vomiting, and abdominal pain. In mild cases, constipation, gas, and bloating may be present. Bacterial overgrowth from refined sugars can include E. coli and Streptococcus faecalis resulting in acid reflux, gastritis, and colitis.

Patients with residual infection after multiple courses of antibiotics can be treated by combining laboratory research on antimicrobial effects of herbs with TCM syndrome differentiation to obtain optimum results. Combining antistreptococcal herbs on the basis of their TCM clinical applications for constipation, diarrhea, cough, sore throat, and fever will provide both symptomatic relief and growth inhibition of the pathogenic factor.

anticonstipation - crataegus (shan zha), curcuma zedoria (e zhu), dandelion (pu gong ying), polygonum cuspidatum (hu zhang), terminalia (he zi)

antidiarrheal - agastache (huo xiang), alpinia officinarum (gao liang jiang), andrographis (chuan xin lian), aucklandia (mu xiang), baphicacanthus (da qing ye), elsholtzia (xiang ru), fraxinus (qin pi), magnolia bark (hou pu), moutan (mu dan pi), paeony (bai shao), sanguisorba (di yu), sargentoxoda (hong teng)

Streptococcal infections of the respiratory tract often accompany viral infections due to common cold or influenza viruses. A history of tonsillectomy confirms increased susceptibility to streptococcus. Nosebleeds with frequent headaches indicates possible streptococcal sinusitis. Dizziness, hearing loss, vertigo may be triggered by strep infections that spread from the sinuses into the eustachian tube and middle ear. Fatigue, night sweats, and palpitations without cough and phlegm production can indicate low level strep in the lungs.

From a TCM perspective, streptococcal infections can produce wind cold, wind heat, and wind damp syndromes as the disease process progresses from the initial stage of chills and clear discharge to high fever with yellow or green phlegm, followed by fatigue, joint pain, and swelling. Blood heat due to phlegm fire with hemorrhages from lungs, nasal passages and intestines occur in the most severe cases.

upper respiratory/sinus - chrysanthemum (ju hua), chrysanthemum indicum (ye ju hua), forsythia (lian qiao), angelica dahurica (bai zhi), magnolia flower (xin yi), morus leaf (sang ye), schizonepeta (jing jie), xanthium (cang er zi)

lower respiratory/lung - anemarrhena (zhi mu), asparagus (tian men dong), fritillaria (bei mu), houttuynia, (yu xing cao), isatis root (ban lan gen), mahonia (gong lao ye), peucedanum (qian hu), plantago (che qian zi), prunella (xia gu cao), scute (huang qin), sophora root (ku shen), viola (zi hua di ding)

antipyretic - anemarrhena (zhi mu), andrographis (chuan xin lian), baphicacanthus (da qing ye), bupleurum (chai hu), coptis (huang lian), elsholtzia (xiang ru), forsythia (lian qiao), lonicera (jin yin hua), moutan (mu dan pi), polygonum cuspidatum (hu zhang)

antiinfluenza/antistreptococcus - andrographis (chuan xin lian), artemisia argyi (ai ye), baphicacanthus (da qing ye), bupleurum (chai hu), chrysanthemum indicum (ye ju hua), coptis (huang lian), elsholtzia (xiang ru), forsythia (lian qiao), houttuynia (yu xing cao),
isatis root (ban lan gen), licorice (gan cao), lonicera (jin yin hua), mahonia (gong lao ye), moutan (mu dan pi), paeony red (chi shao), peucedanum (qian hu), phellodendron (huang bai), polygonum cuspidatum (hu zhang), prunella (xia gu cao), scute (huang qin), terminalia (he zi)

Optimum response to treatment requires ingredients that boost macrophage function and phagocytosis in addition to antibacterials. This corresponds to the TCM model of Qu Xie/Fu Zheng, expelling the pathogenic factor and tonifying the righteous. Several antistreptococcal species have immune stimulating effects, including qi tonics, blood tonics, and clear heat/toxin herbs. The best clinical results with custom formulations use a ratio of 70-80% antibacterial species to 20-30% tonics.

macrophage phagocytosis promoter - andrographis (chuan xin lian), angelica sinensis (dang gui), astragalus (huang qi), forsythia (lian qiao), houttuynia (yu xing cao), lonicera (jin yin hua).

Asthma that responds poorly to inhalers and steroids often originates in low level strep infections that fail to completely resolve after acute bronchitis or pneumonia. Exposure to dust, mold, and environmental toxins then amplifies the inflammatory response to residual infection, causing bronchial muscle spasm and wheezing. When the underlying infection is cleared, environmental reactivity is greatly reduced.

antiasthmatic/bronchodilator - artemisia argyi (ai ye), aucklandia (mu xiang), houttuynia (yu xing cao), polygonum cuspidatum (hu zhang), sophora root (ku shen)

Cardiac arrhythmias and coronary atherosclerosis may be induced through the inflammatory effects of streptococcus in the lungs. The TCM syndrome of Lung phlegm heat generating Heart blood stasis describes the progression of pathology. The herbs listed below regulate heart rhythm and protect the heart from the damaging effects of bacterial toxins.

antiarrhythmic - angelica sinensis (dang gui), astragalus (huang qi), bupleurum (chai hu), coptis (huang lian), licorice (gan cao), magnolia bark (hou pu), paeony red (chi shao), sophora root (ku shen)

cardioprotective/coronary vasodilator - angelica sinensis (dang gui), astragalus (huang qi), crataegus (shan zha), peucedanum (qian hu), terminalia (he zi)

Central nervous system inflammation from strep infections can result in migraine headaches, seizures, cognitive dysfunction, mood swings, panic attacks, tics, and insomnia. Children with learning and behavioral disorders frequently have a history of multiple ear infections and strep throats. Treating the inflammatory aftermath of these recurrent infections can improve brain function and school performance. The following herbs have anticonvulsant, sedative, and antistreptococcal effects.

anticonvulsant - anemarrhena (zhi mu), asparagus (tian men dong), bupleurum (chai hu), houttuynia (yu xing cao), licorice (gan cao), moutan (mu dan pi), paeony red (chi shao), scute (huang qin)

anxiolytic/neuroprotective - astragalus (huang qi), magnolia bark (hou pu), paeony (bai shao), scute (huang qin)

sedative - andrographis (chuan xin lian), angelica sinensis (dang gui), artemisia argyi (ai ye), bupleurum (chai hu), chrysanthemum (ju hua), coptis (huang lian), crataegus (shan zha), moutan (mu dan pi), scute (huang qin)

Autoimmune disorders including rheumatoid arthritis and lupus may be induced by responses to streptococcus. Several species of antistreptococcal herbs can alleviate pain and inflammation, downregulate TNF, and protect renal function. Clearance of circulating immune complexes assists the recovery of damaged tissues.

analgesic - angelica sinensis (dang gui), bupleurum (chai hu), eucommia (du zhong), licorice (gan cao), moutan (mu dan pi), paeony (bai shao), paeony red (chi shao), polygonum cuspidatum (hu zhang)

Circulating Immune Complex clearance - angelica sinensis (dang gui), bupleurum (chai hu), rehmannia (di huang), schizandra (wu wei zi), cordyceps (dong chong xia cao)

TNFalpha reduce - asparagus (tian men dong), curcuma zedoria (e zhu), dandelion (pu gong ying), magnolia bark (hou pu), moutan (mu dan pi), phellodendron (huang bai), prunella (xia gu cao), sanguisorba (di yu), xanthium (cang er zi)

proteinuria reduce - angelica sinensis (dang gui), astragalus (huang qi), bupleurum (chai hu), eucommia (du zhong)

renal protection - angelica sinensis (dang gui), astragalus (huang qi), sanguisorba (di yu)

The TCM aphorism that “wind is the cause of a hundred diseases” describes the complex pathological effects of streptococcal infections. In the era of multidrug resistant bacteria, Chinese herbal medicines can help to resolve these illnesses with minimal side effects. Combining modern scientific inquiry with the clinical experience of traditional masters can provide a higher level of care in contemporary practice.

References
http://emedicine.medscape.com/article/228936-overview
http://www.rightdiagnosis.com/s/streptococcal_infections/prevalence.htm#...
http://www.cdc.gov/strep/