Herpes: The Botanical Practitioner’s Perspective

Herpes simplex virus infection is a major global health problem, and its association with HIV infection makes it imperative to develop effective prevention and treatment strategies. The efficacy of many topical pharmaceutical agents in treating herpes has been somewhat disappointing and inconsistent, and additionally, are costly. Patients are often looking for safe and effective alternative measures to reduce the frequency of outbreaks and shorten their duration. It is also important to look for agents that will be effective at preventing the virus from inculcating into nerve cell bodies, proliferating, and taking up host residence. Botanicals represent a promising area for research. Unfortunately, at present there are few well-designed human clinical trials looking at the effects of herbs on herpes simplex virus. However a number of botanicals have demonstrated antiherpetic activity in vitro, offering some validation of the traditional use of herbs for infection. Several herbs have been shown to be topically healing for wounds, and as discussed in site, have demonstrated efficacy in improving immune response and reducing stress. These latter categories are listed in Table 8-7 with brief descriptions of their applications to herpes simplex virus treatment, but discussions of these herbs are found elsewhere throughout this site.

Clinically, patients using a combination of botanical and nutritional therapies report reduced frequency, severity, and length of outbreaks. Herbalists have found botanical medicines effective at relieving symptoms associated with outbreaks, preventing outbreaks, and reducing the frequency of outbreaks (Table Botanical Treatment Strategies for herpes simplex virus-1 and herpes simplex virus-2). Some patients have reported going 10 years or more without an outbreak, even with a history or regularly recurrent outbreaks. Similarly, pregnant women have been shown to cease to have recurrent outbreaks during gestation, even with a history of regular recurrence in prior pregnancies (see Case History: Herpes Genitalis). It is unknown how botanicals affect asymptomatic shedding.

Botanical Treatment Strategies for herpes simplex virus-1 and herpes simplex virus-2

Therapeutic GoalTherapeutic ActivityBotanical NameCommon Name
Pain relief for systemic aching and discomfort in primary outbreakAnalgesicActaea racemosaBlack cohosh
CorydalisCorydalis
Piscidea erythrina|amaican dogwood
Viburnum spp.Cramp bark and black haw
Reduce systemic viral replication, inhibit viral attachment to cells; topical antiviral activityAntiviralAloe veraAloe
Calendula officinalisCalendula
Echinacea spp.Echinacea
Canoderma lucidumReishi
Glycyrrhiza glabraLicorice
Hypericum perforatumSt. John’s wort
Melissa officinalisLemon balm
Salvia officinalisSage
Thuja Occident a UsThuja
Uncaria tomentosaCat’s claw
Wound-healing agents to promote granulation of new, healthy tissueVulneraryAloe veraAloe
Calendula officinaleCalendula
Symphytum officinaleComfrey
Relieve local painTopical analgesicHypericum perforatumSt. John’s wort
Mentha piperitaPeppermint
Piper methysticumKava kava
Relieve local painAnti-inflammatoryGlycyrrhiza glabraLicorice
Hypericum perforatumSt. John’s wort
Lavandula officinalisLavender
Scutellaria baicalensisChinese skullcap
Symphytum officinalisComfrey
Dry weeping lesionsAstringentsHamamelis virginianaWitch hazel
Plantago spp.Plantain
Quercus albaWhite oak bark
Dry weeping lesionsAntimicrobial powderCommiphora mol-molMyrrh
Enhance immune response, increase general resistanceImmunomodulationAndrographis paniculataAndrographis
Enhance immune response, increase general resistanceAdaptogensEleutherococcus senticosusEleuthero
Panax ginsengGinseng
Panax quinquefoliusAmerican ginseng
Rhaponticum carthimoidesRhaponticum
Rhodiola roseaRhodiola
Schizandra chinensisSchizandra
Withania somniferaAshwagandha
Improve stress responseAdaptogensEleutherococcus senticosusEleuthero
Panax ginsengGinseng
Panax quinquefoliusAmerican ginseng
Rhaponticum carthimoidesRhaponticum
Rhodiola roseaRhodiola
Schizandra chinensisSchizandra
Withania somniferaAshwagandha
NervinesAvena sativaMilky oats
Eschscholzia califomicaCalifornia poppy
Lavandula officinalisLavender
Leonurus cardiacaMotherwort
Melissa officinalisLemon balm
Passiflora incarnataPassion flower
Scutellaria laterifloraSkullcap
Turnera diffusaDamiana

Symptomatic relief can be directed at systemic manifestations during a primary outbreak, mostly via analgesics to relieve discomfort and antivirals to control the degree of infection, and can be used topically to speed the healing of lesions and relieve discomfort associated with both primary and recurrent episodes. A number of herbs have been shown to have beneficial effects in supporting and enhancing immunity. Because host immune response plays a role in the outcome of herpes infection, with the immune system modulating infection both in the nervous system and the periphery, prevention focuses on supporting optimal immune response using adapto-gens and the use of antivirals to reduce viral attachment and proliferation. Additionally, herbs that improve the stress response (adaptogens) and relieve stress (nervines) are important, because stress is both a known precipitating factor for outbreaks and suppressive of immune function.

Analgesics

Analgesic herbs are used internally, typically as tinctures, either singly or in combination, for the symptomatic relief of generalized discomfort and aches in uncomplicated primary herpes outbreaks and for aching discomfort in the prodromal phase of recurrent outbreaks. Black cohosh, an antispasmodic and mild analgesic, was historically used specifically for aching, drawing discomfort in the buttocks and the backs of the thighs. Cramp bark and black haw are reliable antispasmodic herbs with analgesic effects. Corydalis and Jamaican dogwood have strong analgesic and sedating effects. See Plant Profiles: Black cohosh, for safety considerations.

Botanical Treatment Strategies for Herpes: Antiviral Botanicals

Botanical Treatment Strategies for Herpes: Immunomodulation and Adaptogenic Support

Botanical Treatment Strategies for Herpes: Nervines

Vulneraries and Anti-lnflammatories

Vulneraries are herbs used to promote wound healing. Among herbs commonly used to heal herpes blisters are those mentioned earlier in this post, such as aloe, lemon balm, St. John’s wort, sage and rhubarb combination, and so forth, and additionally, calendula and comfrey root. Calendula, an herb long relied on for its wound healing and antimicrobial abilities, has demonstrated antimicrobial has been shown to increase rate of cutaneous herpes lesions when combined with acyclovir, over acyclovir alone. Comfrey is primarily used as an anti-inflammatory and to heal wounds, ulcers, and sores.

Any of these herbs may be used topically at the onset of blisters or once they have begun to crust over, and should be applied two to four times daily using a clean cotton swab for each application. Aloe may be used in the form of gel or cream, comfrey is used as a cream or ointment, and calendula and the others may be used in the form of tincture, oil, ointment, cream, or salve.

Topical Analgesics

A number of herbs have shown analgesic effects with topical application. Two studies specifically looked at topical pain management with herpes zoster, a relative of herpes simplex virus that causes painful outbreaks along nerve dermatomes and often leads to significant postherpetic neuralgia. Both 100% geranium oil, applied directly to the affected area, and peppermint oil have demonstrated analgesic effects in a clinical trial and a case report, respectively. Geranium oil relieved pain dramatically in 25% of patients whose pain following shingles had lasted for 3 months or more and was not relieved by standard pain medications such as acetaminophen (Tylenol) or meperidine (Demerol). Fifty percent of patients showed some relief, and 25% did not benefit. Other herbs used for topical analgesia include kava kava and St. John’s wort.

Astringents

According to Schulz et al. virtually all substances with a protein-coagulating, astringent action can improve symptoms associated with herpetic lesions. Those herbs commonly relied on as astringents include witch hazel extract; plantain leaf poultice, salve, or tincture; and white oak bark tincture. Many patients find witch hazel easily acceptable and accessible as it can be used in the readily available drug store form of the extract for external use. Witch hazel is approved by ESCOP and the German Commission E for use as a treatment of mild skin injuries and local inflammation of the skin and mucosa. Plantain is approved by ESCOP for temporary, mild inflammations of mucosa (oral and pharyngeal are specified) and by German Commission E for inflammatory alterations of the skin.