by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Intestinal parasites and other pathogens have been increasingly reported as a health problem in the U.S., recently.  There are a number of contributing factors to these problems, including:

1.     Frequent visits to distant areas, especially to “third world” countries, where parasitic organisms, and otherwise harmless organisms to which “learned immunity” has not been developed, thrive.

2.     Higher population density, leading to easier cross-contamination and to increased levels of soil and water contamination; the near epidemic of giardia in California is an example of the latter.

3.     Chemical pollution and excessive use of chemical drugs appear to cause some immune system derangements that lead to imbalance of intestinal flora, including overgrowth of the normal yeast candida, and one or more protozoa.  New viral infections, notably HIV, dramatically reduce immunity and thus allow overgrowth of pathogenic intestinal organisms.  Other viral infections, such as hepatitis, may also adversely affect immune functions.

4.     Contamination of food supplies with various organisms: the presence of worms in pork is well-known, but it has been shown that raw fish (as consumed in sushi) and undercooked beef (which is preferred by many) can also be problematic.  In addition, strict vegetarians are still at some risk, since a prevalence of raw vegetables can lead to intestinal infestation by worms which usually contaminate the plants from the soil.

It is important to note that new testing for intestinal parasites, such as that promoted by Great Smokies Diagnostic Laboratory in Asheville, North Carolina, may reveal organisms that are a normal part of the intestinal flora even if this was not recognized earlier.  In the absence of specific symptoms, it may be unwise to use drastic drug therapies to attempt to rid oneself of an organism that is likely to return soon after treatment. It has been hypothesized by some medical practitioners, that several immune system disorders may have intestinal parasitic infections as their basis, not just as a secondary effect.  If true, this would explain a worsening health condition where lowered immunity as the result of parasites would play a part in allowing even more organisms to reside in the intestines, and so on.  Some types of intestinal organisms may eventually migrate to other parts of the body—biliary tract infestation is an example.

ITM has been investigating anti-parasitic herb therapies for more than ten years.  A first venture into this area was stimulated in 1982 by the request of a veterinarian seeking a natural dewormer for pets.  An examination of Chinese medical texts available at the time—including the Barefoot Doctors’ Manual—led to the production of an “antiparasite powder,” which was claimed, by this veterinarian, to be effective.  Its ingredients are non-toxic.  The formula, with some slight modifications over the years (mainly an increase in the proportion of antiparasitic herbs and a decrease in the proportion of digestive tonic herbs) has led to the current mixture identified either as Antiparasite Powder, or when in tablet form, Omphalia 11. 

Soon after that mixture was developed, a student of ITM was diagnosed as suffering from giardia, a protozoal organism.  She had considerable symptoms (abdominal bloating and diarrhea), and she wondered what could be done.  At the time, there was no reference to treatment of this particular parasite in the available Chinese medical literature, so it was suggested that she try the Antiparasite Powder, in case it had a broad spectrum of action.  She reported prompt relief of her symptoms.  Since that time, ITM has received a number of favorable reports in relation to use of this formula for intestinal parasites, mainly worms and giardia.  For example, when groups of people have traveled in India or Mexico, if some individuals use the Antiparasite Powder or Omphalia 11 regularly and others do not, they report that the ones who used the herbs were typically the only ones that did not come down with intestinal diseases.  Recently, ITM received a very enthusiastic letter from India, where giardia is rampant, suggesting that the use of this herb mixture was effective at preventing such infections.  ITM provided information about how to produce the material in India or obtain it from the U.S.  We have also received phone reports from practitioners that Omphalia 11 has helped considerably in treating persistent diarrhea in patients with no clear diagnosis of parasites.

In 1988, a manufacturer of Chinese herb formulas—Health Concerns—asked about producing a broad-spectrum treatment for intestinal problems that might involve various parasites.  A formula, originally developed under the name Aloe 22, and later produced under the name Aquilaria 22, combines the ingredients of Omphalia 11 with other herbs that were deemed helpful for intestinal problems.  It includes aquilaria, cardamon, saussurea, melia fruit, and chih-shih: herbs that can treat abdominal pain and distention and relieve intestinal spasms.  The herbs control diarrhea that is due to infections, and help to treat constipation that is due to weak intestinal function.  Melia has anti-fungal effects and helps get rid of intestinal worms.  The formula also contains the astringent herbs terminalia, pomegranate rind, and nutmeg: these herbs treat diarrhea due to infections, regulate the secretions of the intestines, and treat ulceration of the intestinal mucosa.  Pomegranate rind inhibits fungi, viruses, and bacteria.  The formula contains the additional anthelmintic herbs ulmus and aloe resin.  Aloe resin has anti-fungal properties; it is also a moderately strong purgative used for the treatment of constipation (it stimulates secretion of bile and thereby promotes intestinal peristalsis), but is included in small amounts.  An attempt has been made to balance two forces: one is a dispersing, eliminative force and the other is a contracting and building force.  By harmonizing these forces, the average long-term user will not experience either a debilitating draining of energy, nor a congesting restraint of energy, but rather a vitalizing, free flow of energy.  Aquilaria 22 has been a popular formula.

In an attempt to also develop somewhat more specific remedies for the different categories of pathogens, ITM formulated two other prescriptions for Health Concerns: Phellostatin and Artestatin.  Phellostatin is a combination of seven herbs that were shown in Chinese laboratory experiments to inhibit candida; their general character, from a traditional Chinese view, is that they inhibit inflammation and diarrhea (in the traditional categories of deficiency heat and damp heat, respectively).  The seven ingredients are phellodendron, anemarrhena, plantago, pulsatilla, capillaris, cnidium fruit, and houttuynia.  Some of these herbs, mainly pulsatilla and capillaris, inhibit protozoa as well, but the main focus of the formula is candida.  These anti-candida herbs are combined with codonopsis, atractylodes, dioscorea, licorice, and cardamon to improve the functions of the digestive system (in the traditional category of stomach/spleen system).  ITM has received numerous reports of benefits from use of this formula and it has become one of Health Concerns’ most popular products.

Artestatin was developed for treatment of giardia and other protozoa.  It contains three anti-protozoal ingredients, ching-hao (Artemisia annua), dichroa, and pulsatilla.  Both ching-hao and dichroa were originally used in China for treatment of malaria (a protozoal disease affecting the red blood cells), and an active component in ching-hao has been developed recently as an antimalarial drug widely prescribed in China.  Pulsatilla has been used mainly for dysentery, including that caused by amoebas (protozoa).  The formula also includes dolichos, magnolia bark, and coptis, herbs that are characteristically given for the treatment of various kinds of intestinal infections, including bacteria and protozoa.  The remainder of the formula includes herbs to enhance the digestion, such as pogostemon, pinellia, and citrus, which are reported in the Chinese literature to counteract the tendency of dichroa to cause nausea in some patients when used in large dosages.  Adverse reactions to this formulation are yet to be reported to ITM.  The presence of a large number of digestive aids reduces the dosage of herbs aimed at inhibiting the protozoa.  However, since most of the herbs (and drugs) that have a powerful killing effect on protozoa also have considerable side effects, the proper balancing of a formula is essential, especially if it is not provided as a drug. 

The formula Picrorrhiza 11 was developed to address candida and other parasites in individuals who are diagnosed as having a “yin deficiency syndrome.”  This is a common problem among some individuals with chronic parasitic disorders, since yin deficiency can arise from chronic malabsorption of nutrients and can lead to immune disorders that may allow some parasites to thrive.  The herb picrorrhiza is used in China as a substitute for coptis and is deemed to be more tonifying in nature.  It was traditionally used in the treatment of “bone-steaming” fever and dysentery, and for a wide range of parasites, including worms.  Other herbs for inhibiting intestinal infections in this formula, already mentioned in relation to the previous formulas, include pulsatilla, phellodendron, plantago leaf, pomegranate, and terminalia.  It also contains stellaria and ilex leaf for treatment of yin deficiency, fraxinus to relieve intestinal inflammation, and lonicera and saussurea as broad-spectrum anti-infection agents.  Picrorrhiza 11 has been used in many AIDS patients, and it appears to be helpful, especially when combined with the digestive tonic formula Ginseng 18. 

Finally, Coptis/Evodia Tablets are made-up primarily of herbs containing berberine and related alkaloids, which give them their bright yellow color.  These alkaloids have been shown to inhibit a wide range of bacteria (they are traditionally used to treat bacillary dysentery) as well as the common yeast candida.  The two herbs coptis and evodia are traditionally given for treatment of abdominal pain (especially just below the ribs), acid regurgitation, and syndromes that produce a yellow tongue coating.  These formulations can be mixed in various ways to attempt a more intensive or broader-based therapy.  None of the formulas are known to have adverse effects, even with prolonged use, though idiosyncratic reactions can occur, especially in those who have a severely distressed gastro-intestinal and/or immune system.  Coptis/Evodia Tablets should be avoided during pregnancy. 

The formulas are generally taken in a dosage of 3–6 tablets each time, prior to meals.  Prophylactic use, as might be the situation when traveling to a high-risk area, is likely managed with a lower dosage (e.g., 3 tablets each time) than when trying to eliminate well-established parasites (5–6 tablets each time).  Lower dosages are given to children, usually according to the amount that one is able to administer (which is usually less than the total dosage desired).  The treatment time for existing parasitic problems is typically 15 to 30 days.  Organisms which are natural to the intestinal flora, such as candida, won’t disappear from stool cultures, and may easily overgrow once again after herbal therapy stops if changes in other influences (diet, emotion, stress, etc.) have not also been addressed. 

If symptom improvements or evaluations by laboratory tests do not reveal a successful outcome, consider these possible explanations:

1.     The parasite or infection is not primarily responsible for the symptoms.

2.     Re-infection is occurring.

3.     Higher dosage or combination of formulas may need to be used.

4.     Different formula may need to be used.

5.     Other health problems or contributing factors have not been addressed.

It is the task of each health professional to manage a patient’s case according to complete information about health status, environment, and therapeutics.  Determination of which formula to be used, or how it is to be applied in a specific case, can only be made by professional evaluation.



July 1996