The common cold (cold) and the influenza (flu) are both respiratory illnesses but they are caused by different viruses. Because these two types of illnesses have similar flu-like symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, or cough are more common and intense. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

Causes
Common cold can be caused by a number of different types of viruses. More than 200 different types of viruses are known to cause the common cold. Because so many different viruses can cause cold and new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem.

Flu, also referred to as seasonal flu, is a highly contagious illness caused by the influenza virus.  Anyone can get the flu as it is spread easily from person to person, usually when an infected person coughs or sneezes.  The virus may belong to one of three different influenza virus fami¬lies: A, B or C.  In addition to seasonal flu, there are two other flu viruses receiving extra attention around the globe today: Novel 2009 H1N1 Influenza Virus and Avian Flu (H5N1).

Conventional treatment
Antibiotics are not effective against the viruses that cause the cold and flu. There are no approved antiviral drugs for the common cold.  At this time, two antiviral drugs are available for flu: oseltamivir and zanamivir.  These two drugs have been shown to reduce flu symptoms if started within a day or two of getting sick. Anti-viral medicine is recommended for people with more severe illness and at higher risk for complications.

The treatment is directed at alleviating the symptoms associated with the common cold. Over-the-counter medications such as throat lozenges, throat sprays, cough drops, and cough syrups may help bring relief. Decongestants may be used for nasal symptoms. Acetaminophen (Tylenol and others) and ibuprofen (Advil and others) can help with fever, sore throat, and body aches.

Chinese medicine
Exogenous pathogenic factors are the main causes of cold/flu. Most common types are wind-cold and wind-heat, in addition, the summer heat, dampness and dryness evils can also joint wind to cause illnesses. However, whether or not those exogenous pathogenic factors cause the diseases depends intimately on the strength or weakness of the body’s defensive system. If body’s defensive system is weak, exogenous pathogenic factors attack the body easily. An improper lifestyle or excessive fatigue can cause laxity of the interstitial spaces and dissipation of defensive ability. In such circumstances an exogenous evil can attach the skin, hair, the lung or the defensive system and result in injury. Furthermore, differences in the body’s constitution are associated with different susceptibilities. For example, wind-cold can easily exploit yang deficiency; wind-heat or dryness heat can easily exploit yin deficiency; and exogenous dampness can easily complicate a body with much phlegm and endogenous dampness. The route of attack from exogenous pathogenic factors is the lung system and exterior defensive system. And the location of the illness is generally also limited to the lung-defensive level. If the defensive yang is constrained by any factor, there may be disharmony between nutritive qi and defensive qi. The struggle between evil qi and genuine qi can generate such symptoms of defensive level or the exterior such as cold-aversion and fever. When an exogenous evil attacks the lung, the air passage becomes blocked. Lung qi can not rise and clarify the body properly, giving rise to cough and nasal mucosal congestion. Flu, because it is a more serious attach by the exogenous evil, has more severe symptoms, and can manifest high fever and delirium. If the patient’s constitution or defensive system is strong, the exogenous pathogenic factors are confined to the lung-defensive level and illness is mild, with mainly symptoms of the exterior. But if the patient is elderly, or has a weak constitution, or weak defensive system, the exogenous pathogenic factors can migrate from the exterior to the interior, which will aggravate the illness and may lead to complications.

Chinese medicine treatment for cold/flu includes acupuncture, herbal medicine, and some other modalities such as acupressure, moxibustion, Tuina, gwasha.  The choice of treatment modality depends completely on the diagnosis and individual constitution. There are a large number of classical and modern herbal formulas used for the treatment of common cold/flu. It sounds that common colds are easily treated with over-the-counter herbal preparations. However, since there are different types of common cold/flu, the most important aspect is differentiating different types of cold/flu. Therefore, seeking the guidance of an experienced Chinese Medicine practitioner is very important, which will help you to properly diagnose your condition, choose proper treatment modality or proper herbal formula, helping to shorten the duration and severity of the condition, as well as preventing future colds/flu.

Classification and treatment principle
A. Wind-cold

• Symptoms: An aversion to coldness, shivering, low or no fever, chills predominated over feelings of heat, no sweat, occipital headache, stiff neck, body aches, slight cough, sneezing, and running nose with discharge
• Tongue: Thin white coating or normal
• Pulse: Floating and tight or floating and slow
• Treatment principle:
  • Expel the wind
  • Disperse the cold
  • Restore the lung qi

B. Wind-heat

• Symptoms: Fever and chills with fever predominating, slight sweating, runny nose with yellow discharge, headaches, body aches, cough, sore throat, and slight thirst
• Tongue: Red on the edge
• Pulse: Floating and fast
• Treatment principle:
  • Expel the wind-heat
  • Release the superficial symptoms
  • Restore the descending and dispersing function of the lung qi

C. Wind-dry

• Symptoms: Aversion to cold, fever, slightly sweating, dryness of nose, mouth or throat, and dry cough
• Tongue: Dry, slightly red in the areas of lung and heart
• Pulse: Floating
• Treatment principle:
  • Release the superficial
  • Expel wind
  • Restore the descending and dispersing function of the lung qi
  • Tonify body fluids

D. Summer-dampness

• Symptoms: Fever, anhidrosis, mild chilliness, heavy and painful sensation over the limbs, headache, dizziness, thirst and desire for a little drink, oppressive feeling over the chest, vomiting, and nausea
• Tongue: Yellow and greasy tongue coating
• Pulse: Rapid, soft floating
• Treatment principle:

• Dispel summer-heat evil from the superficial.
• Eliminate dampness with drugs of fragrant

E. Exterior-cold and interior-heat

• Symptoms: Fever, aversion to cold, anhidrosis, general aching, headache, nasal congestion, sore throat, cough, and sticky sputum with yellow or white color
• Tongue: Red on the edge of tongue, thin and white or thin and yellow coating
• Pulse: Floating and rapid
• Treatment principle:
  • Disperse the wind
  • Activate lung
  • Liberate superficial body
  • Eliminate heat

F. qi deficiency

• Symptoms: Fever, anhidrosis, tiredness, cough, and coughing sputum without strength
• Tongue: Light-white coat
• Pulse: Floating and superficial without strength
• Treatment principle:

• Tonify qi
• Dispel the superficial evil

G. Blood deficiency

• Symptoms: hot body, fever, headache, anhidrosis or slight perspiration, pale complexion, lips and nails, palpation, and dizziness
• Tongue: Light colored tongue with white coat
• Pulse: Thin, superficial without strength, or knot/belt
• Treatment principle:

• Tonify blood
• Dispel the superficial evil

H. yin deficiency

• Symptoms: Hot body, fever, aversion to wind and cold, slight perspiration, dizziness, restless and disquieted, dry month, and dry cough with scanty sputum
• Tongue: Red with scanty coat
• Pulse: Thin and rapid
• Treatment principle:
  • Tonify yin
  • Dispel the superficial evil

I. yang deficiency

• Symptoms: Aversion of coldness from time to time, even chilling with or without fever, anhidrosis or self-sweating, headache, sore and cold bone joints, pale face, low voice, and cold limbs
• Tongue: Corpulent-pale tongue and white coat
• Pulse: Heavy, thin without strength
• Treatment principle:
  • Warm yang
  • Dispel the superficial evil

Clinical studies of Chinese medicine for cold & flu

Complementary and alternative medicine use by otolaryngology patients: a paradigm for practitioners in all surgical specialties. Shakeel M et al. Eur Arch Otorhinolaryngol. 2009 PMID: 19771443.  There is growing interest in complementary and alternative medicine (CAM) amongst the general population. Little information is available on CAM use in otolaryngology patients in the UK. Despite concerns over safety, efficacy and cost-effectiveness, CAM use is common amongst ENT patients. Patients perceive these medications as possible boosters to their immune system. It is becoming increasingly important that health care providers in all specialties ask their patients about CAM use and are aware of the implications it carries. The objective is to study the prevalence and pattern of CAM use among adult and paediatric ENT patients in a UK teaching hospital. A cross-sectional study was done by sending anonymous questionnaire to all outpatient and elective inpatients over a 3-month period. Response rate was 73% (1,789/2,440). Prominent demographics: female, married, over-50 s. Sixty percent had used CAM, 35% in last year. Most common herbs: cod liver oil (n = 481), garlic (n = 255), cranberry (n = 224); non-herbal: massage (n = 287), acupuncture (n = 233), aromatherapy (n = 170). Most commonly cited reasons for using CAM: general health, enhanced immunity and prevention/treatment of common illnesses like the common cold, asthma and bodily aches and pains.

Clinical observation on effects of acupuncture at Dazhui (GV 14) for abating fever of common cold. Xiao Lei et al. Zhongguo Zhenjiu. 2007;27(3):169-72. OBJECTIVE: To explore the therapeutic effect of acupuncture at Dazhui (GV 14) for abating fever of common cold. METHODS: Two hundred and sixty-one cases were randomly assigned to a treatment group of 133 cases and a control group of 128 cases. The treatment group were treated with electroacupuncture at Dazhui (GV 14) and the control group with antondine injection. The transient effect of abating fever within 24 h was observed. RESULTS: After treatment, the body temperature at all observation time points in the treatment group were lower than those in the control group (P < 0.01). The effect-appearing time (1.42 +/- 1.79) h in the treatment group was shorter than that in the control group (3.44 +/- 5.10) h (P < 0.01). The cured rate and the abating fever rate were 27.8% and 75.9% in the treatment group, and 10.9% and 55.5% in the control group, with significant differences between the two groups, the treatment group being better than the control group (P < 0.01). The abating fever rate for the wind-heat type common cold was 75.3% in the treatment group and 50.0% in the control group, with significant difference between the two groups, the treatment group being better than the control group (P < 0.01). CONCLUSION: The method of acupuncture at Dazhui (GV 14) has a definite therapeutic effect on high fever of common cold, and for wind-heat type common cold, Dazhui (GV 14) first may be chosen to abate high-fever and the treatment should be taken as early as possible.

Clinical observation on acupuncture for treatment of high fever due to common cold.  Ling D et al. Zhongguo Zhen Jiu. 2006;26(8):554-6. OBJECTIVE: To observe clinical therapeutic effect of acupuncture in abatement of fever. METHODS: Eighty-six cases of high fever were randomly divided into two groups, an acupuncture group (n = 45) treated with acupuncture at Dazhui (GV 14) and a drug group (n = 41) treated with intramuscular injection of Antongding Injectio. Changes of body temperature before and after 24 hours treatment were observed by single blind. RESULTS: In the acupuncture group, 9 cases were cured, and in the drug group, 2 cases were cured, the acupuncture group was better than the drug group in abatement of fever. CONCLUSION: Acupuncture has a reliable therapeutic effect on fever.

Preventive and curative effects of acupuncture on the common cold: a multicentre randomized controlled trial in Japan. Kawakita K et al. Complementary Therapies in Medicine. 2004;12(4):181-8. OBJECTIVE: To determine the preventive and curative effects of manual acupuncture on the symptoms of the common cold. METHOD: Students and staff in five Japanese acupuncture schools (n=326) were randomly allocated to acupuncture and no-treatment control groups. A specific needling point (Y point) on the neck was used bilaterally. Fine acupuncture needles were gently manipulated for 15 s, evoking de qi sensation. Acupuncture treatments were performed four times during the 2-week experimental period with a 2-week follow-up period. A common cold diary was scored daily for 4 weeks, and a common cold questionnaire was scored before each acupuncture treatment and twice at weekly intervals. A reliability test for the questionnaire was performed on the last day of recording. RESULTS: Five of the 326 subjects who were recruited dropped out. The diary score in the acupuncture group tended to decrease after treatment, but the difference between groups was not significant (Kaplan-Meier survival analysis, log rank test P=0.53, Cox regression analysis, P>0.05). Statistically significantly fewer symptoms were reported in the questionnaire by the acupuncture group than control group (P=0.024, general linear model, repeated measure). Significant inter-centre (P<0.001, general linear model) and sex (P=0.027, general linear model) differences were also detected. Reliability tests indicated that the questionnaire with 15 items was sufficiently reliable. No severe adverse event was reported. CONCLUSION: This is the first report of a multi-centre randomized controlled trial of acupuncture for symptoms of the common cold. A significantly positive effect of acupuncture was demonstrated in the summed questionnaire data, although a highly significant inter-centre difference was observed. Needling on the neck using the Japanese fine needle manipulating technique was shown to be effective and safe. The use of acupuncture for symptoms of the common cold symptoms should be considered, although further evidence from placebo controlled RCTs is required.

Treatment of fever due to exopathic wind-cold by rapid acupuncture. Tan D. Journal of Traditional Chinese Medicine. 1992;12(4):267-71. 57 cases of common cold, influenza, acute tonsillitis and acute bronchitis were treated by rapid needling with filiform needles at Dazhui (Du 14), Fengchi (GB 13), and Quchi (LI 11). The indices for observation were first determined, and the 19 cases that manifested an axilla temperature drop of over 1 degree C after treatment and a ratio of < 0.3 of the main symptom scores after treatment were regarded as markedly effective; the 27 cases that manifested an axilla temperature drop of 0.5-1.0 degree C and a symptom score ratio of 0.3-0.6 were regarded as effective, and the 11 cases that manifested an axilla temperature drop of < 0.5 degrees C and a symptom score ratio of > 0.7 were regarded as failures. The total effective rate was 80.7%. Analysis of the individual patients indicated that the peripheral blood leucocyte and lymphocyte counts differed insignificantly after needling, while the body temperature, rate of respiration, pulse, blood pressure and acupoint temperature all dropped, with a simultaneous increase in the percentage of T-lymphocytes. The immediate effects were especially marked in fevers due to exogenous wind and cold.

The effects of nasal massage of the “yingxiang” acupuncture point on nasal airway resistance and sensation of nasal airflow in patients with nasal congestion associated with acute upper respiratory tract infection. Takeuchi H et al. Am J Rhinol. 1999;13(2):77-9. The aim of our study was to determine whether nasal massage of the “yingxiang” acupuncture point in patients with nasal congestion had any effect on nasal airway resistance (NAR) measured by posterior rhinomanometry and sensation of nasal airflow measured on a visual analog scale (VAS). Twenty patients were randomized into two groups; one group self massaged the yingxiang point for 30 seconds, while the other group acted as control group without nasal massage. NAR and VAS were measured at baseline, and at 2 and 10 minutes after massage. At the end of the study, patients were asked to score any change in their nasal congestion. There was no statistically significant difference between the two groups in percentage change in NAR or VAS from baseline at any time during the study, although the massage group showed trends toward decongestion and relief from congestion. At the end of the study, more patients in the massage group than the control group felt their nasal congestion was improved (p < 0.005). It is interesting that all three measures (NAR, VAS, and end question) showed that the nasal massage group had greater relief from nasal congestion than the control group. The results of this study, when taken together, indicate that nasal massage may provide some relief from nasal congestion and that further studies involving a larger patient population are warranted to determine whether nasal massage has a significant effect on NAR.