Echinacea angustifolia,

Echin angus 3 Family: Asteraceae

Common name: Echinacea, Purple Cone Flower, Narrow-leaved Coneflower, American Cone Flower, Black Sampson, Black Susans, Brauneria Angustifolia, Brauneria Pallida, Comb Flower, Coneflower, Echinaceawurzel, Hedgehog, Igelkopfwurzel, Indian Head, Kansas Snakeroot, Narrow-leaved Purple Cone Flower, Pale Coneflower, Purple Cone Flower, Purpursonnenhutkraut, Purpursonnenhutwurzel, Racine d’echininacea, Red Sunflower, Rock-Up-Hat, Roter Sonnenhut, Schmallblaettrige Kegelblumenwurzel, Schmallblaettriger Sonnenhut, Scurvy Root, Snakeroot, Sonnenhutwurzel

Similar species: E. purpurea, E. pallida

Plant description: Echinacea is a herbaceous perennial, with a slender stem bristling with hairs, 50-180 cm in height, arising from thick, black roots. The leaves are 3-veined and vary in shape from lanceolate to linear, slender at the base, the lowermost leaves with short petioles. The flower head consists of white, pink or purple ray florets that fringe a conical disk of tubular florets that give way to a four sided achenes. All taxa within the genus Echinacea hybridize, and thus hybrids within this genus are common.

Habitat, ecology and distribution:The range for Echinacea extends from western Minnesota to eastern Saskatchewan and southwards, east of the Rocky Mountains to Texas, and occurring in greatest concentration on the Great Plains. It prefers open dry forest and grasslands, its presence is an indicator of good range for livestock. Recent drought conditions, overgrazing and over-harvesting has had a serious impact on wild populations, and E. angustifolia is currently on the United Plant Savers “at risk” list (www.plantsavers.org). In some states, unauthorized harvesting is a punishable offense. At this time, the amount of E. angustifolia under cultivation does not appear to meet the market demand, and thus it can be a little more difficult to obtain in very large quantities.

Part used: Roots, seeds, leaf. Commercial sources may be adulterated with other members of the Asteraceae, especially Parthenium integrifolium.[i]

History: This herb is quite misunderstood in modern times. Although Echinacea has become one of the most popular herbs of commerce, it is interesting to note that its therapeutic indications over the years have changed considerably. The earliest usage of Echinacea is found in the First Nations healing tradition, which reportedly used it in the treatment of venomous bites and stings, as a mouth rinse for sore throat and tonsillitis, in the treatment of infected ulcers and sores, and in the treatment of gastrointestinal illness.[ii] Felter and Lloyd state that a Dr. H. F. C. Meyer, of Pawnee City, Nebraska, who marketed it under the name “Meyer’s Blood Purifier”, introduced Echinacea into modern clinical practice. We can literally say that it was the original ‘snake oil’ as that is the way the Meyer promoted it. Following what appears to be a reflection of historical usage, Meyer claimed that it was an antidote for insect stings and in particular the bite of the rattlesnake. Among its other uses indicated by Meyer were malaria, cholera, internal abscesses, typhoid fever, ulcers, herpetic lesions, boils, sore throat, respiratory congestion, hemorrhoids, eczema, acne, headache and ophthalmic disorders. Although the Eclectics had a somewhat more cautious approach, they found that many of Meyer’s claims could be substantiated, and John King especially was impressed by it, and included it in his Dispensatory. [iii]

For quite some time, confusion has surrounded the different species of Echinacea, and whether or not they contain the same properties. This confusion begins with the German homeopaths who imported what they thought was Echinacea angustifolia during the late 1800s. In fact, they were working with a plant classified as another species (Rudbeckia purpure) which now now E. purpurea. In further scientific studies with Echinacea, some German researchers obtained what they thought was E. angustifolia but was in fact E. pallida. With this latter confusion, much of the German research on E. angustifolia before 1987 may be in fact be supporting data for E. pallida, and should be viewed with caution.[iv] Some of the early studies were performed on a completely different plant, Parthenium integrifolium.

From a historical perspective, Echinacea was rarely used for acute conditions. It was used for deeper chronic situations, generally call ‘bad blood’. Even in the period 1970 – 80, we used it as an alterative, not for acute immune issues.

Constituents: Although some of the data on the various Echinacea species may be confused, it appears that many constituents are shared across all three major species (e.g. angust., purp., pall.).[v] The most characteristic constituents of Echinacea are the akylamides. These are mostly comprised of isobutylamides that provide for the characteristic tingling sensation felt in the mouth upon ingestion, a constituent said to be highest in E. pallida. Other constituents found in the root include caffeic acid esters, primarily echinacoside, as well as chicoric acid (E. purpurea only) and cynarin (E. angustifolia only). The root has also been shown to contain an essential oil, polyacetylenes, polysaccharides, phytosterols and non-toxic pyrrolizidine alkaloids. Both the seeds and the leaf contain a similar range of constituents as the root, but also contain flavonoids.[vi],[vii]

Medical Research: Echinacea has undergone a significant amount of experimental investigation since the 1950’s, much of which has led to the current view of it as an antimicrobial and antiviral agent, with immunostimulatory, immune-modulator and anti-inflammatory properties. Unfortunately most of this research is based upon in vitro models, or in vivo models that use isolated constituent extracts, often injected into the bloodstream of experimental animals. The botany of the raw material used was not always consistent. The primary observations made in these studies, many of them involving the activity of the purified polysaccharides (which are precipitated in tincture and inert), include an increase in non-specific and immune-specific activities, e.g. inhibition of hyaluronidase, cytokine activation (e.g. IL-1), leukocyte migration, phagocytic enhancement, an increase in T-lymphocytes activity (with a shift of the T4/T8-cell ratio in favor of T4 cells), and viral inhibition. As useful as this information is, it does not provide any real understanding of how an oral dose of Echinacea exerts its effect in the human body. Mills and Bone mention that the only effect that has been noted in experimental oral doses is a non-specific enhancement of immunity.[viii]

One of the more common misconceptions of Echinacea is that its immunostimulant properties wear off after a period of weeks if taken on a regular basis. Thus one recommendation suggests that Echinacea doses should be pulsed, taken for 10 days on, five days off, etc. This is based on an English mistranslation of the original German study written by Jurcic et al published in 1989.[ix] In the original article, the study shows that the Echinacea-induced elevation of phagocytosis begins to decline after day five and levels off from day eight to ten. However, the dose of Echinacea used in the study was discontinued after day five, a fact that was missing from the English translation. Thus instead of showing a diminished response to Echinacea over ten days, the study appears to indicate that there is an elevation of phagocytosis for five days after the Echinacea was discontinued.[x] There have been a few clinical studies with Echinacea, mostly very preliminary, looking at its measured effect in clinical trials of cold and flu symptoms. The majority of these studies show a benefit for Echinacea, especially if taken at the very early stages of a cold or flu. There are almost as many studies however that show no statistical benefit in taking Echinacea when compared with placebo. The problem may lie in poor quality control in the market place, and thus it is difficult to come to any sort of conclusion from the many studies. The following are a few examples of the clinical studies that have been conducted so far:

echinacea

•Cold and flu symptoms: various Echinacea preparations have shown to reduce the symptoms, duration and severity of common cold by 10 – 30%.[xi],[xii],[xiii],[xiv],[xv],[xvi],[xvii],[xviii],[xix],[xx],[xxi] Echinacea is best if started before the symptoms and carried on for the first 7 – 10 days. It has it best effect in the first five days depending on the dosage form. Not all studies have been favorable, with discrepancies most likely due to different material and extraction techniques used.[xxii],[xxiii],[xxiv],[xxv] A randomized, double-blind, placebo-controlled community-based trial examined the efficacy of an encapsulated mixture of unrefined Echinacea purpurea herb (25%) and root (25%) and E. angustifolia root (50%), taken in 1-g doses six times on the first day of illness and three times on each subsequent day of illness for a maximum of 10 days. The results indicated no statistically significant difference between the Echinacea and placebo groups for any of the measured outcomes.[xxvi] A randomized, double-blind, placebo-controlled clinical trial of 80 men and women examined the efficacy Echinacea purpurea herb (Echinacin, EC31J0) in reversing cold symptoms. In the Echinacea group the median time of illness was 6.0 days compared to 9.0 days in the placebo group. EC31J0 was well tolerated and clinically effective in alleviating symptoms more rapidly than placebo in patients with a common cold.[xxvii] A random double-blind placebo-controlled study examined the efficacy of an Echinacea compound herbal tea preparation (Echinacea Plus) given at early onset of cold or flu symptoms in 95 subjects. Researchers noted a significant difference between the experimental group and control group, suggesting that Echinacea at early onset of cold or flu symptoms was more effective than a placebo.[xxviii] Patients attending one of 15 study practitioners as a result of acute symptoms of the common cold were enrolled in a randomized double-blind placebo-controlled study of a preparation of Echinacea root, Baptisia root and Thuja occidentalis, 3 tabs t.i.d. for 7 to 9 days. In all, 259 patients were evaluated, the results indicating the superiority of the herbal remedy over placebo. In the subgroup of patients that started the therapy at an early phase in their cold symptoms, the efficacy of the herbal remedy was most prominent. The therapeutic benefit of the herbal remedy was found to occur by day 2 and attained its greatest significance on day 4, continuing until the end of the treatment.[xxix]

Immune System:increases in phagocytosis and increases lymphocyte activity, possibly by promoting the release of tumor necrosis factor (TNF), interleukin-1 (IL-1), and interferon have been found.[xxx],[xxxi],[xxxii] Although many constituents of echinacea seem to be involved in creating non-specific immune response; high-molecular weight polysaccharides, such as heteroxylan and arabinogalactan; and lower molecular weight compounds, including alkylamides and caffeoyl conjugates such as chicoric acid and echinacosides seem to be the most significant. Heteroxylan seems activate phagocytosis, and arabinogalactan most likely induces macrophages to produce the cytokines TNF, IL-1, and interferon beta-2.[xxxiii] Arabinogalactan have been found to activate macrophages, creating a cytotoxic effect against tumor cells and micro-organisms[xxxiv] Chicoric acid and echinacosides constituents play a role in enhancing phagocytosis.[xxxv] Polysaccharides in echinacea have moderate effects on B-lymphocytes, but not the same apparent activity on T-lymphocytes.[xxxvi]

Anti-inflammatory: in vitro research suggests constituents of echinacea have an anti-infamatory activity, inhibiting cyclooxygenase and 5-lipogenase.[xxxvii],[xxxviii] Clinical research also shows anti-inflammatory effect as seen from serum ferritin, which is an indicator of inflammatory cytokines, is lowered in people treated with echinacea.[xxxix]

Antineoplastic: Mills and Bone report two clinical studies that looked at the efficacy of Echinacea (E. angustifolia and E. pallida) in combination with Baptisia and Thuja in the treatment of breast cancer, in conjunction with chemo-radiation therapy. Overall, this combination showed some benefit, promoting the recuperation of the hematopoietic system and reducing the incidence of infection, when compared with controls.[xl]

Vaginal candidiasis. Taken orally in combination with a topical antifungal cream, Echinacea has been shown to be effective for preventing recurrent vaginal yeast infection. Herb juice of Echinacea purpurea in combination with topical econazole (Spectazole) lowers recurrence rate to 16.7% compared to 60.5% with econazole alone.[xli] Polyacetylenic compounds in echinacea, (ketoalkenes and ketoalkynes) have antifungal activity, including activity against Candida yeast.[xlii]

Leukopenia. An isolated polysaccharide fraction of Echinacea purpurea, given intravenously has reduced leukopenia caused by chemotherapy.[xliii]

Wound Healing: echinacoside constituent of echinacea help protect type III collagen from free radical damage, having activity against bacterial hyaluronidase. Animal research shows that the extracts can speed would healing, enhance epithelialization, and reduce inflammation.[xliv]

UV Skin protection: caffeoyl found in echinacea helps prevent UV radiation skin damage by protecting collagen from free radical damage.[xlv]

Cytochrome p450: Echinacea modestly inhibit cytochrome P450 1A2 (CYP1A2) in vivo. Clinical research using caffeine as a probe for CYP1A2 activity has demonstrated that echinacea can inhibit caffeine clearance by 27%.[xlvi] But it alsoinduce hepatic cytochrome P450 3A4 (CYP3A4), but it inhibits intestinal CYP3A4. [xlvii],[xlviii] These opposing effects seem to cancel each other out or more specifically give a moderating effect on the body as herbalists have been stating for years.

Toxicity: Echinacea has displayed no demonstrable toxic effects.[xlix]

Herbal action: alterative, immunostimulant, antimicrobial, antiviral, immunomodulant, anti-inflammatory, lymphatic, vulnerary

Indications: acute fever; chronic catarrhal conditions, including sinus congestion, lymphatic congestion, pharyngitis, and bronchitis; septic conditions (topically and internally); abdominal pain made worse by eating, with bad breath; acne, boils, eczema; pain, in cancer; acute injuries, venomous bites and sting; immunodeficiency

Specific Indications[l]

  • Dull eyes; full feeling of mind and body; shattered in mind or body
  • Fatigue, exhaustion; from overwork, poor work habits; often accompanied by production of boils, dirty, gray visage of the face
  • Ulcerative pharyngitis, tonsillitis and stomatitis (canker sores)
  • Tongue coated dirty brown or black
  • Gastric and duodenal ulcers
  • Enteritis
  • Swollen lymphatics
  • Swollen, blue veins
  • Septicemia, prostrating fever, chills
  • Septic infection; veins leading from wound are swollen, purple; promotes discharge of pus (suppuration)
  • Boils, abscesses, carbuncles, semi-active, low-grade character, with exhaustion and atrophy; chronic, constitutional tendency
  • Eczema from toxins in the blood
  • Bee stings, snake bites, venom; histaminic irritation; applied directly it has a cooling and detoxing effect
  • Deepened, bluish or purplish coloration of the skin or mucosa, with a low form of inflammation
  • Putrescent odor from excess of broken-down material being eliminated from the system; as in scarlet fever, diphtheria, spinal meningitis and typhoid fever (with Baptisia)
  • Old sores, wounds, necrosis, gangrene
  • Chilly

Contraindications and cautions: Mills and Bone describe an immunomodulant property for Echinacea, suggesting that it ‘modulates’ rather than stimulates the immune system. In particular, Mills and Bone argue that the contraindication for autoimmune disease described in the GermanCommission E monographs is not supported by any clinical studies.[li] Even still, anecdotal evidence suggests that Echinacea can promote adverse effects in some patients with autoimmune disease, although this effect may not be noted in all. Thus, Echinacea should be used with caution in autoimmune disease. The contraindication of Echinacea for acquired immunodeficiency cases however, established in the Commission Emonographs, does not match the experience of many herbalists who continue to use it to treat any opportunistic infection.[lii]

Medicinal uses: It is important to note that Echinacea was used differently traditionally than it is today. It was used mostly for deep chronic bad fluids, not for acute immune issues. The most acute issues were snake bites, stings and poisoning of various types. Echinacea is one of the few herbs that has a cooling, stimulating effect. King’s American Dispensatory contains a rather large and enthusiastic entry on Echinacea. John King singled it out as the primary corrector of “depraved fluids,” what in an earlier period was referred to as ‘bad blood,’ evidenced by a tendency to sepsis, malignant ulcers, and foul smelling discharges. Felter and Lloyd write about “…its extraordinary powers—combining essentially that formerly included under the terms antiseptic, anti-fermentative, and antizymotic—are well shown in its power over changes produced in the fluids of the body, whether from internal causes or from external introductions. The changes may be manifested in a disturbed balance of the fluids resulting in such tissue alterations as are exhibited in boils, carbuncles, abscesses, or cellular glandular inflammations. They may be from the introduction of serpent or insect venom, or they may be due to such fearful poisons as give rise to malignant diphtheria, cerebrospinal meningitis, or puerperal and other forms of septicemia. Such changes, whether they are septic or of devitalized morbid accumulations, or alterations in the fluids themselves, appear to have met their antagonist in echinacea. “Bad blood,” so called, asthenia, and adynamia, and particularly a tendency to malignancy in acute and sub-acute disorders, seem to be special indicators for the use of echinacea”. Echinacea was especially indicated if these symptoms were accompanied weakness and emaciation, perhaps with a bluish or purplish coloration to the skin and mucous membranes. The tongue might be covered in a dirty-brown coating, and the pulse will be thin and weak.[liii] From a more modern perspective, we can say that it is best suited for deeper conditions where white blood cell production is required in high concentration. This of course can be a situation where there is a putrefactive circumstance or compromised health from a long-term septic drain on the system as our ancestors use it. It is also very suitable to people that have vital exhaustion due to long-term stress. In this way I often use the botanical as an immune prophylactic for the busy person, especially if they travel a lot. In these cases the tincture is not effective, we need to do the ground herb (usually root). This also helps for long hours in the clinic, working with sick people.

Supporting the First Nations usage of Echinacea, the Eclectics reported that Echinacea met with success in the treatment of acute injuries complicated by infection, and appeared to successfully treat venomous insect bites. Echinacea however is also mentioned in a variety of other complaints, such as tonsillitis (with or without ulceration) as well catarrhal affections of the nose, sinuses, and naospharynx. Similarly, Echinacea is said to be of benefit in chronic bronchitis, and was even used by the Eclectics to “…avert a gangrenous termination in pulmonic affections”. Echinacea is also thought to be helpful “fermentative dyspepsia,” characterized a foul to fruity smelling breath as well as abdominal pain that is aggravated upon eating, especially foods such as flour products and commercial dairy. In fever, Echinacea is an important tool for parents, effectively helping resolve eruptive diseases such as measles, chicken-pox, and scarlet fever, also mentioned in typhoid and especially in malarial fever to control symptoms, but not periodicity. Felter and Lloyd state that influenza is partially ameliorated by Echinacea, used primarily to ensure “…good convalescence”. Echinacea is also mentioned in the Eclectic literature as a remedy for pain, in the treatment of erysipelas, and especially in cancer for which its virtues are extolled by Eli Jones in his text Cancer: It’s Causes, Symptoms and Treatment. Jones states that Echinacea is indicated for the pain of cancer, but does not actually treat it. King’s states that this effect is best noted when the cancer involves the mucous membranes. Echinacea is also used by herbalists as a remedy for the skin, and in particular the treatment of eczema, especially in chronic conditions with a wet, sticky exudate, and which the patients are thin and weak. [liv]

Flower Essence Self-Integration/Immune Interface Positive qualities: Core integrity, contacting and maintaining an integrated sense of Self, especially when severely challenged. Developing immune interface between environment and Self. Patterns of imbalance: Feeling shattered by severe trauma or abuse which has destroyed one’s sense of Self; threatened by physical or emotional disintegration reflected in immune issues. A feeling of being only partially there, and not fully being present. Every time we make a big shift in our life, either from trauma, abuse, or personal growth, we leave the old ‘us’ behind. The image of self is beginning to change, but you are not quite the ‘new you’ yet. Since the immune system is the interface between us and environment, it also needs to adjust. During this adjustment period the immune system is not as active or integrated. If you don’t release the old image of yourself, your energies become stagnant, weakening the immune system. Echinacea flower essence helps you let go of the old image and protects you as you grow into the new image of Self. Echinacea flower essence will help during these transition phases. Just as taking the whole herb is beneficial for the physical body, Echinacea flower essence is important for the emotional shift associated with the immune system

Pharmacy and dosage: •Fresh Plant Tincture: fresh root/seed 1:2, 95% alcohol, 20-60 gtt •Dry Plant Tincture: recently dried root/seed, 1:5, 50% alcohol, 20-60 gtt, 1-10 ml •Hot Infusion: recently dried leaf and flower, 1:20, 60-120 ml •Decoction: recently dried root, 1:20, 60-120 ml •Powder: recently dried root, 500-5000 mg

NHP Monograph[lv]

  • Traditionally used in Herbal Medicine to help relieve the symptoms of upper respiratory tract infections
  • Traditionally used in Herbal Medicine to help relieve sore throats

Dosage: Children 2 – 4 years:

  • Preparation: Dry, Powder, Decoction & Infusion + All Non-Standardised Extracts

Dose(s): 0.17-0.5 Grams per day, dried root and rhizome Children and adolescents 5 – 9 years:

  • Preparation: Dry, Powder, Decoction & Infusion + All Non-Standardised Extracts

Dose(s): 0.25-0.8 Grams per day, dried root and rhizome Adolescents 10 – 13 years:

  • Preparation: Dry, Powder, Decoction & Infusion + All Non-Standardised Extracts

Dose(s): 0.5-1.5 Grams per day, dried root and rhizome Adults and adolescents 14 and over:

  • Preparation: Dry, Powder, Decoction & Infusion + All Non-Standardised Extracts

Dose(s): 1-3 Grams per day, dried root and rhizome Licensing: As of Nov 15, 2010, 378 licenses have been issued by the Canadian NHP for products containing Echinacea.

REFERENCES

Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D’Alessio D. 2002. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. Dec 17, 137(12):939-46 Bauer, R. and S. Foster. 1989. HPLC Analysis of Echinacea simulata and E. paradoxa roots. Planta Medica. 55:637. Bergner, Paul. 2001. Medical Herbalism: Materia Medica and Pharmacy. Boulder, CO: Bergner Communications. Blumenthal, M., T. Hall, R. Rister, B. Steinhoff (eds.; S. Klein and R. Rister (trans). 1996. The German Commission E Monographs. Austin, TX: American Botanical Council. Bradley, Peter R. ed. 1992. British Herbal Compendium. Bournemouth, UK: British Herbal Medicine Association. Felter, HW and JU Lloyd. 1893. King’s American Dispensatory. Digitized version available from http://www.ibiblio.org/herbmed/eclectic/kings/main.html. Henneicke-von Zepelin H, Hentschel C, Schnitker J, Kohnen R, Kohler G, Wustenberg P. 1999. 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. 15(3):214-27 Jurcic K, Melchart D, Holsmann M, Martin P, et al. “Zwei probandenstudien zur stimulierung der granulozyphagozytose durch echinacea-extract-haltige präparate.” Zeitschrift för Phytotherapie. 10:67-70 Lindenmuth GF, Lindenmuth EB. 2000. 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 Complement Med Aug 6(4):327-34 Schulten B, Bulitta M, Ballering-Bruhl B, Koster U, Schafer M. 2001. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial. Arzneimittelforschung. 51(7):563-8 Weiss, Rudolf. 1988. Herbal Medicine. Translated by A.R. Meuss. Beaconsfield, England: Beaconsfield Publishers Willard, Terry. 1992. Edible and Medicinal Plants of the Rocky Mountains and the Neighbouring Territories. Calgary: Wild Rose Coll   [i]Bauer, R. and S. Foster. 1989. HPLC Analysis of Echinacea simulata and E. paradoxa roots. Planta Medica. 55:637 [ii]Willard, Terry. 1992. Edible and Medicinal Plants of the Rocky Mountains and the Neighbouring Territories. Calgary: Wild Rose College of Natural Healing [iii]Felter, HW and JU Lloyd. 1893. King’s American Dispensatory. Digitized version available from http://www.ibiblio.org/herbmed/eclectic/kings/main.html [iv]Bradley, Peter R. ed. 1992. British Herbal Compendium. Bournemouth, UK: British Herbal Medicine Association [v]Speroni E, Govoni P, Guizzardi S, et al. Anti-inflammatory and cicatrizing activity of Echinacea pallida Nutt. root extract. J Ethnopharmacol 2002;79:265-72 [vi] Mills, Simon and Kerry Bone. 2000. Principles and Practice of Phytotherapy. London: Churchill Livingstone [vii]Bradley, Peter R. ed. 1992. British Herbal Compendium [viii]Mills, Simon and Kerry Bone. 2000. Principles and Practice of Phytotherapy, ibid. [ix] Jurcic K, Melchart D, Holsmann M, Martin P, et al. “Zwei probandenstudien zur stimulierung der granulozyphagozytose durch echinacea-extract-haltige präparate.” Zeitschrift för Phytotherapie. 10:67-70 [x] Bergner, Paul. 2001. Medical Herbalism: Materia Medica and Pharmacy. Boulder, CO: Bergner Communications [xi] Brinkeborn 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;6:1-6 [xii]Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory infection. J Fam Pract 1999;48:628-35 [xiii]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 Complement Med 2000;6:327-34 [xiv]Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections. Complement Ther Med 1997;5:40-2 [xv]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 [xvi]Giles JT, Palat CT III, Chien SH, et al. Evaluation of Echinacea for treatment of the common cold. Pharmacother 2000;20:690-7 [xvii]Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2000;2:CD000530 [xviii]Schulten B, Bulitta M, Ballering-Bruhl B, et al. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial. Arzneimittelforschung 2001;51:563-8 [xix]Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther 2004;29:75-83 [xx]Caruso TJ, Gwaltney JM Jr. Treatment of the common cold with echinacea: a structured review. Clin Infect Dis 2005;40:807-10 [xxi]Linde K, Barrett B, Wolkart K, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2006;(1):CD000530 [xxii]Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002;137:939-46 [xxiii] Turner RB. Echinacea for the common cold: can alternative medicine be evidence-based medicine? Ann Intern Med 2002;137:1001-2 [xxiv]Anon. Echinacea: cold comfort. Consum Rep 2004;69:30-2 [xxv]Caruso TJ, Gwaltney JM Jr. Treatment of the common cold with echinacea: a structured review. Clin Infect Dis 2005;40:807-10 [xxvi] Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D’Alessio D. 2002. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. Dec 17, 137(12):939-46 [xxvii] Schulten B, Bulitta M, Ballering-Bruhl B, Koster U, Schafer M. 2001. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial. Arzneimittelforschung. 51(7):563-8 [xxviii] Lindenmuth GF, Lindenmuth EB. 2000. 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. 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