Yarnell E, Abascal K, Rountree R. Herbs for herpes simplex infections. Altern Complement Ther. April 2009,15(2): 69-74.

Herpes simplex viruses (HSV) infect an extraordinary number of people. Although HSV infections are rarely life threatening, they are associated with a high morbidity and can represent severe threats to immunosuppressed subjects. Acy­clovir and related drugs are now widely available to suppress HSV, but inexpensive and effective natural prevention and treatment options are still needed. Natural treatments can be helpful in avoiding the risk of developing drug resistance that exists with single-chemical agents.

In this overview, the authors analyze herbal remedies clinically useful and considered safe and effective for the treatment of herpes simplex: antiviral herbs, tannin-rich herbs, adaptogenic herbs. Among the most studied antiviral herbs are various members of the mint family (Lamiaceae), such as lemon balm (Melissa officinalis), sage (Salvia officinalis), heal all (Prunella vulgaris), peppermint (Mentha x piperita), rosemary (Rosmarinus officinalis), and wild thyme (Thymus serpyllum). In vitro studies of their aqueous extracts demonstrated a strong antiviral activity against HSV-1. Lemon balm leaf contains compounds responsible for blocking activity of HSV-1, such as rosmarinic, caffeic, and ferulic acids, while its terpenoids inhibit HSV-2 replication. Lemon balm concentrated extract in a cream base relieves symptoms of herpes labialis and its pro­longed use increases intervals between outbreaks. Sage is known to contain antioxidant compounds and has a long history for treating different infections. In a double-blind clinical trial with 145 subjects, a cream combining aqueous extracts of sage leaf with Chinese rhubarb (Rheum palmatum) root was as effective as acyclovir cream and significantly more effective than sage cream by itself at treating herpes la­bialis. The time to complete healing was 6.7 days, compared to 6.5 days for acyclovir. Heal all has a long history of use for viral infections: it inhibits HSV via suppression of antigen expression. Other potentially useful herbs in this category are catnip (Nepeta cataria) leaf, oreg­ano (Origanum vulgare) leaf, mint (Mentha spp.) leaf, and basil (Ocimum basilicum).

Tannin-rich herbs represent another category of antiherpetic remedies. Hydrolyzable tannins are potent antiherpetic agents and act by blocking viral adsorption to human cells. They are particularly useful topically when vesicles are starting to weep, since tannins absorb proteins in the exudates and help relieve symptoms. Pomegranate (Punica granatum) pericarp, bloody cranesbill (Geranium sanguineum) aqueous root extract, and a Chinese species of hawthorn (Crataegus sinaica) have shown strong in vitro HSV inhibition. Chinese rhubarb root combined with sage has been effectively used for herpes labialis. Among its active compounds are tannins and anthraquinones that have shown anti-viral activity to HSV and other enveloped viruses in vitro.

Melia (Melia azedarach), tea tree (Melaleuca alternifolia) oil, propolis, and St. John's wort (Hypericum perforatum) have been successfully used to treat HSV. A protein from melia leaves, meliacine, and a compound found in the fruit, 28-deacetylsendanin, interfere respectively with DNA synthesis of the virus and viral replication. The volatile tea tree oil is a popular antifungal and potent in vitro blocker of HSV adsorption. Propolis is a mixture of compounds harvested by bees from the resin of various trees. Topical application of 3% propolis ointment was significantly more effective than acyclovir or placebo at resolving lesions of genital herpes. St. John's wort is a traditional treatment for herpes and other viral infections and its wound healing activity makes this herb particularly suitable for topical use. Formulas that include lemon balm and St. John's wort are often used internally and topically in clinical practice. Various groups of red algae and seaweeds containing sulfated polysaccharides have also shown interesting anti-herpetic effects and need further studies.

A complete, holistic treatment of a patient with HSV re­quires the use of herbs that directly interfere with the virus and herbs that support the immune system: various adaptogenic, immunomodulating herbs that potentiate the patient's own ability to fight the virus, are often added to antivirals. This is particularly im­portant in patients who are immunosuppressed due to chemo­therapy or HIV infection. The inclusion of adaptogenic herbs, such as eleuthero (Eleutherococcus senticosus) root, rhodiola (Rhodiola rosea) medicinal mushrooms, or schisandra (Schisandra chinensis), is recommended to lessen the severity and frequency of HSV outbreaks. Further research is needed on the use of herbs as synergists to pharmaceutical antivirals or as a treat­ment in drug-resistant HSV infections. After thorough review of data collected in clinical practice, in vivo and in vitro studies on herbal remedies for the treatment of HSV, the authors conclude that "a full herbal protocol coupled with nutritional recommendations and stress reduction can cost-effectively and safely help most patients with herpes infections."