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Common Cold/Sore Throat

Also indexed as: Pharyngitis, Upper Respiratory Infection, URI

Illustration

Coughing. Aching Sneezing. Take a few simple actions to knock out the annoying common cold. According to research or other evidence, the following self-care steps may be helpful:

What you need to know

  • Be sure to rest
  • Give your body some down time to help it fight off the cold
  • Drink those fluids
  • Get plenty of water and other clear fluids to help thin mucus
  • Take extra vitamin C
  • Studies have shown 1 to 4 grams a day may make your cold shorter and less severe
  • Shorten sick time with echinacea
  • At the first signs of a cold, take 3 to 5 ml of this herb as a juice or tincture every two hours to make your cold less severe
  • Use zinc lozenges
  • Use lozenges containing zinc gluconate, zinc gluconate-glycine, or zinc acetate, providing 13 to 25 mg every two hours, to help stop the virus and shorten the illness

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full common cold article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About the common cold

The common cold is an acute (short-term) viral infection of the upper respiratory tract that may be spread through the air (by sneezing, for example) or by contact with contaminated objects.

Product ratings for the common cold

Science Ratings Nutritional Supplements Herbs
3Stars

Vitamin C

Zinc (as lozenges)

Andrographis (for symptoms)

2Stars

Propolis

Zinc (as nasal spray)

American ginseng

Echinacea (for symptoms; effective only for adults)

Garlic

Geranium (Pelargonium sidoides)

Throat Coat tea (marshmallow root, licorice root, elm bark)

1Star  

Asian ginseng

Astragalus

Blackberry

Blueberry

Boneset

Chinese artichoke

Coltsfoot

Elderberry

Eleuthero

Eucalyptus oil

Goldenseal

Goldthread

Horseradish

Hyssop

Linden

Malvia

Marshmallow

Meadowsweet

Mullein

Myrrh

Peppermint

Red raspberry

Sage

Schisandra

Slippery elm

Usnea

Wild indigo

Wood betony

Yarrow

See also:  Homeopathic Remedies for Common Cold
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

The common cold often causes runny nose, sore throat, and malaise (vague discomfort). Sore throat is sometimes a symptom of a more serious condition distinct from the common cold, such as strep throat, which may require medical diagnosis and treatment with appropriate antibiotics. Since it is a viral infection, antibiotics are not effective against the common cold.

Medical options

Over the counter products may help to reduce the symptoms associated with the common cold and sore throats, but they do not speed recovery. Analgesics, such as aspirin (Bayer, Ecotrin, Bufferin), ibuprofen (Motrin, Advil), and acetaminophen (Tylenol), reduce pain due to sore throats and headaches. Products containing local anesthetics such as benzocaine (Cepacol Maximum Strength, Spec-T) and phenol (Cepastat) provide temporary relief from sore throat pain. Topical nasal decongestants such as oxymetazoline (Afrin) and phenylephrine (NeoSynephrine) may provide relief from nasal congestion, but they should only be used for a few days. The oral decongestant pseudoephedrine (Sudafed) may help relieve nasal congestion, while antihistamines such as diphenhydramine (Benadryl), brompheniramine (Dimetapp), and chlorpheniramine (Chlor-Trimeton) might help dry excess mucus and reduce sneezing. Guaifenesin (Robitussin) is an expectorant used to remove mucus in the sinuses, lungs, and ears. The cough suppressant dextromethorphan (DM) may be recommended at bedtime to facilitate sleep; however, since expectoration of sputum is considered a valuable mechanism for expelling infectious organisms and congested secretions, a cough should not be suppressed during the day. Most products available over the counter to treat the common cold combine decongestants, antihistamines, analgesics, expectorants, and cough suppressants.

Though most symptoms of the common cold are controlled with over the counter products, some individuals might require prescription strength cough suppressants, such as codeine (Robitussin A-C) and hydrocodone (Vicodin Tuss, Tussionex, Hycodan). Individuals with sore throats that last for more than a few days should be checked by a healthcare practicioner as their condition might be caused by a bacterial infection, which requires oral antibiotics such as amoxicillin (Amoxil) and cephalexin (Keflex). Some health care practitioners may prescribe oral antibiotics to prevent a secondary bacterial infection in immune deficient patients.

A warm, humid environment created by a humidifier may provide comfort during the common cold. Rest is recommended, especially for people with severe symptoms. Increased fluid intake is necessary in order to maintain water balance and to thin secretions.

Dietary changes that may be helpful

Excessive sugar, dietary fat, and alcohol have been reported to impair immune function, although no specific information is available on how these foods may affect the course of the common cold.

Vitamins that may be helpful

A review of 21 controlled trials using 1 to 8 grams of vitamin C per day found that “in each of the twenty-one studies, vitamin C reduced the duration of episodes and the severity of the symptoms of the common cold by an average of 23%.”1 The optimum amount of vitamin C to take for cold treatment remains in debate but may be as high as 1 to 3 grams per day, considerably more than the 120 to 200 mg per day that has been suggested as optimal intake for healthy adults. A review of 23 controlled trials found that vitamin C supplementation produces a greater benefit for children than for adults.2 The same review found that a daily amount of 2 grams or more was superior to a daily amount of 1 gram at reducing the duration of cold symptoms.

Zinc interferes with viral replication in test tubes, may interfere with the ability of viruses to enter cells of the body, may help immune cells to fight a cold, and may relieve cold symptoms when taken as a supplement.3 In double-blind trials, zinc lozenges have reduced the duration of colds in adults4 5 but have been ineffective in children.6 Lozenges containing zinc gluconate, zinc gluconate-glycine, and, in most trials, zinc acetate7 8 have been effective; most other forms of zinc and lozenges flavored with citric acid,9 tartaric acid, sorbitol, or mannitol have been ineffective.10 Trials using these other forms of zinc have failed, as have trials that use insufficient amounts of zinc.11 For the alleviation of cold symptoms, lozenges providing 13 to 25 mg of zinc (as zinc gluconate, zinc gluconate-glycine, or zinc acetate) are used every two hours while awake but only for several days. The best effect is obtained when lozenges are used at the first sign of a cold.

An analysis of the major zinc trials has claimed that evidence for efficacy is “still lacking.”12 However, despite a lack of statistical significance, this compilation of data from six double-blind trials found that people assigned to zinc had a 50% decreased risk of still having symptoms after one week compared with those given placebo. Some trials included in this analysis used formulations containing substances that may inactivate zinc salts. Other reasons for failure to show statistical significance, according to a recent analysis of these studies,13 may have been small sample size (not enough people) or not enough zinc given. Thus, there are plausible reasons why the authors were unable to show statistical significance, even though positive effects are well supported in most trials using gluconate, gluconate-glycine, or acetate forms of zinc.

Zinc nasal sprays may be even more effective than zinc lozenges at speeding the resolution of cold symptoms. A double-blind trial showed a 74% reduction in symptom duration in people using a zinc nasal spray four times daily, compared with the 42 to 53% reduction reported in trials using zinc gluconate or zinc acetate lozenges.14 The average duration of symptoms after the beginning of treatment was 2.3 days in the people receiving zinc, compared with 9.0 days in those receiving placebo. However, in another double-blind study, zinc nasal spray was no more effective than a placebo; in both groups the median duration of symptoms was seven days.15 The beneficial effect of zinc nasal sprays should be weighed against a potentially serious side effect. At least ten cases have been reported of people with previously normal sense of smell who experienced severe or complete loss of smell function after using intranasal zinc gluconate. In some cases the loss of smell was long-lasting or permanent.16

Propolis is the resinous substance collected by bees from the leaf buds and bark of trees, especially poplar and conifer trees. Propolis extracts may be helpful in preventing and shortening the duration of the common cold. A preliminary clinical trial reported propolis extract (daily dose not given) reduced upper respiratory infections in children.17 In one small, double-blind trial of propolis for the common cold, the group taking propolis extract (amount unstated) became free of symptoms more quickly than the placebo group.18 Most manufacturers recommend 500 mg of oral propolis products once or twice daily.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

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.

Action Category Herbs
Immune-stimulating Andrographis, Asian ginseng, astragalus, boneset, echinacea, eleuthero, garlic, goldenseal, hyssop, linden, schisandra, wild indigo
Diaphoretic Boneset, elder flower, hyssop, linden, yarrow
Antiviral (test tube studies only) Barberry, elderberry, goldenseal, goldthread, horseradish, myrrh, Oregon grape, usnea, wild indigo
Symptom-relieving Soothe sore throat: blackberry, blueberry, red raspberry (astringents), coltsfoot, mallow, marshmallow, mullein, red raspberry (mucilage)

Reduce nasal stuffiness: eucalyptus, peppermint

Relieve aches: meadowsweet

Miscellaneous sore throat relief: sage, yarrow

Note: These actions have not necessarily been proven in clinical trials in humans and are intended only to clarify distinctions among herbs, not to give recommendations for use.

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.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References:

1. Hemilä H. Does vitamin C alleviate the symptoms of the common cold?—a review of current evidence. Scand J Infect Dis 1994;26:1–6.

2. Hemilä H. Vitamin C supplementation and common cold symptoms: factors affecting the magnitude of the benefit. Med Hypotheses 1999;52:171–8.

3. Macknin ML. Zinc lozenges for the common cold. Cleveland Clin J Med 1999;66:27–32 [review].

4. Eby G, Davis DR, Halcomb WW. Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study. Antimicrobial Agents Chemotherapy 1984;25:20–4.

5. Al-Nakib W, Higgins PG, Barrow I, et al. Prophylaxis and treatment of rhinovirus colds with zinc gluconate lozenges. J Antimicrobial Chemotherapy 1987;20:893–901.

6. Macknin ML, Piedmonte M, Calendine C, et al. Zinc gluconate lozenges for treating the common cold in children. A randomized controlled trial. JAMA 1998;279:1962–7.

7. Petrus EJ, Lawson KA, Bucci LR, Blum K. Randomized, double-masked, placebo-controlled clinical study of the effectiveness of zinc acetate lozenges on common cold symptoms in allergy-tested subjects. Curr Ther Res 1998;59:595–607.

8. Prasad AS, Fitzgerald JT, Bao B, et al. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2000;133:245–52.

9. Eby G. Where’s the bias? Ann Intern Med 1998;128:75 [letter].

10. Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment of the common cold. Ann Pharmacolther 1998;32:63–9 [review].

11. Weismann K, Jakobsen JP, Weismann JE, et al. Zinc gluconate lozenges for common cold. A double-blind clinical trial. Dan Med Bull 1990;37:279–81.

12. Jackson JL, Peterson C, Lesho E. A meta-analysis of zinc salts lozenges and the common cold. Arch Intern Med 1997;157:2373–6.

13. Macknin ML. Zinc lozenges for the common cold. Cleveland Clin J Med 1999;66:27–32 [review].

14. Hirt M, Nobel S, Barron E. Zinc nasal gel for the treatment of common cold symptoms: a double-blind, placebo-controlled trial. Ear Nose Throat J 2000;79:778–80.

15. Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med 2001;111:103–8.

16. Jafek BW, Linschoten MR, Murrow BW. Anosmia after intranasal zinc gluconate use. Am J Rhinol 2004;18:137–41.

17. Crisan I, Zaharia CN, Popovici F, et al. Natural propolis extract NIVCRISOL in the treatment of acute and chronic rhinopharyngitis in children. Rom J Virol 1995;46:115–33.

18. Szmeja Z, Kulczynski B, Sosnowski Z, Konopacki K. Therapeutic value of flavonoids in Rhinovirus infections. Otolaryngol Pol 1989;43(3):180–4 [in Polish].

19. Brown D. Echinacea root fails to prevent upper respiratory tract infections. Healthnotes Rev Compl Integr Med 1999;6:6–7 [review].

20. Hoheisel O, Sandberg M, Bertram S, et al. Echinagard treatment shortens the course of the common cold: A double-blind, placebo-controlled clinical trial. Eur J Clin Res 1997;9:261–8.

21. Melchart D, Linde K, Worku F, et al. Immunomodulation with echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245–54 [review].

22. Henneicke-von Zepelin H, Hentschel C, Schnitker J, et al. Efficacy and safety of a fixed combination phytomedicine in the treatment of the common cold (acute viral respiratory tract infection): results of a randomised, double blind, placebo controlled, multicentre study. Curr Med Res Opin 1999;15:214–27.

23. Turner RB, Bauer R, Woelkart K, et al. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med 2005;353:341–8.)

24. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 2003;290:2824–30.

25. Schilcher H. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart: Medpharm Scientific Publishers, 1997, 43–5.

26. Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinacea pallidae radix in upper respiratory tract infections. Compl Ther Med 1997;5:40–2.

27. Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Comp Med 2000;6:327–34.

28. Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med 1998;7:541–5.

29. Grimm W, Mueller HH. A randomized controlled clinical trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med 1999;106:138–43.

30. Brikenborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold: A randomized, placebo-controlled, double-blind clinical trial. Phytomedicine 1999;6:1–5.

31. Bone K. Clinical Applications of Ayurvedic and Chinese Herbs: Monographs for the Western Herbal Practitioner. Queensland, Australia: Phytotherapy Press, 1996, 96–100.

32. Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. J Med Assoc Thai 1991;74:437–42.

33. Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata extract in common cold—a pilot trial. Phytomedicine 1996;3:314–8.

34. Hancke J, Burgos R, Caceres D, Wikman G. A double-blind study with a new monodrug Kan Jang: Decrease of symptoms and improvement in recovery from common colds. Phytother Res 1995;9:559–62.

35. Cáceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine 1999;6:217–23.

36. Melchior J, Spasov AA, Ostrovskij OV, et al. Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Ness extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine 2000;7:341–50.

37. Predy GN, Goel V, Lovlin R, et al. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial. CMAJ 2005;173:1043–8.

38. Josling P. Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey. Adv Ther 2001;18:189–93.

39. Bereznoy VV, Riley DS, Wassmer G, Heger M. Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-hemolytic streptococcus tonsillopharyngitis: a randomized, double-blind, placebo-controlled trial. Altern Ther Health Med 2003;9:68–79.

40. Brinckmann J, Sigwart H, van Houten Taylor L. Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study. J Altern Complement Med 2003;9:285–98.

41. Scaglione F, Cattaneo G, Alessandria M, Cogo R. Efficacy and safety of the standardized ginseng extract G 115 for potentiating vaccination against common cold and/or influenza syndrome. Drugs Exptl Clin Res 1996;22:65–72.

42. Beuscher N, Kopanski L. Stimulation of immunity by the contents of Baptisia tinctoria. Planta Med 1985;5:381–4.

43. Murray MT. The Healing Power of Herbs. Rocklin, CA: Prima Publishing, 1995, 162–72.

44. Bradley PR, ed. British Herbal Compendium, Vol. 1. Bournemouth, Dorset, UK: British Herbal Medicine Association, 1992, 119–20.

45. Schilcher H. Phytotherapy in Paediatrics. Stuttgart, Germany: Medpharm Scientific Publishers, 1997, 126–7.

46. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy, 3rd ed. Berlin: Springer Verlag, 1998, 146–7.

47. Li SC, Smith FP, Stuart GA. Chinese Medicinal Herbs. San Francisco: Georgetown Press, 1973:422.

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