Herbal Medicine for Lyme Disease and Other Tick-Borne Infections Eric Yarnell, ND, RH (AHG) Abstract vaccines against some of these illnesses. There is also a raging war over the exact scope and definition of many of these con- Numerous tick-borne infections cause problems for humans ditions, most notably Lyme disease, which likely contributes and animals worldwide. Lyme disease is the best known, but significantly to the differences of opinion among various fac- 1 babesiosis, bartonellosis, anaplasmosis, ehrlichiosis, Rocky tions about how to diagnose and treat patients. This is to say Mountain spotted fever, and many others are also serious nothing of the many tick-borne illnesses that affect animal problems. Many studies have confirmed that herbs and herbal species that are important to humans, including dogs, cats, extracts can help to repel the several types of ticks (as can non- cows, horses, and many others. chemical means such as wearing long pants and tucking them Lyme disease, the infection caused by Borrelia burgdorferi, into socks) that spread these diseases, as well as inhibit their B. mayonii, and related organisms, is a major problem around 2 reproduction. Corymbia citriodora (lemon eucalyptus) and its the globe. It is the most commonly reported vector-borne compound para-menthane-3,8-diol (PMD) have most con- disease in the United States and the fifth most common noti- 3 > vincingly been shown to be effective. 2-Undecanone and fiable disease. Since 2008, there have been 30,000 con- nootkatone with carvacrol have also shown some promise. firmed and probable cases of Lyme disease per year reported in Despite many claims of efficacy, no published clinical re- the United States. B. burgdorferi is also found in Eurasia, along search could be located on any herb or herbal constituent to with B. afzelii and B. garinii, the three known causes of Lyme treat any tick-borne illness and thereby validate these claims. disease (B. mayonii, B. bissettii, and B. valaisiana are also Dipsacus fullonum (fuller’s teasel) is used as a case study to suspected of causing disease, but there are too few cases to be show a promising herb that has simply no research on whether sure). A complete discussion of Lyme disease is beyond the it helps people with Lyme disease or any tick-borne infection. scope of this article, which will focus primarily on herbal In vitro and animal studies show some promise for herbs and treatments for this condition and related infections (sometimes herbal compounds such as Brucea javanica (Java brucea) and referred to as co-infections, though they can occur indepen- artemisinin, but they have not been studied in clinical trials. dently of Lyme disease). There remains a black hole in terms of supported herbal Ticks (see Table 2) are tiny parasitic arachnids (thus adults treatments for these infections that urgently needs to be filled have eight legs) that, together with their equally unbeloved with credible clinical trials. cousins the mites, make up the subclass Acari. Ticks have three families, though the Ixodidae or hard ticks are most noted for Keywords: Lyme disease, tick repellent, lemon eucalyptus, spreading disease. They have prominent heads (in both nymph 2-undecanone, herbal medicine and adult stages) and varying sizes of scuta (shields) covering some or all of their bodies, unlike other tick families. Family Ixodidae ticks go through a complex life cycle that requires Introduction three hosts over at least 1 year. After hatching from eggs that the females lay on the ground, the larvae (which are usually the A rising tide of tick-borne spirochete, rickettsial, and viral size of periods in this paragraph) seek blood meals from birds infectious diseases are causing substantial misery around the and small mammals. If successful, they detach, fall to the world, though this article will focus on problems in North ground, and molt to the nymph stage. Nymphs, barely the size America (see Table 1). Lyme disease is the best known of these, of poppy seeds typically, seek larger mammals for another but babesiosis, ehrlichiosis, anaplasmosis, Rocky Mountain blood meal. If successful at this stage, they again fall to the spotted fever, and many others are also on the list. While these ground and molt to adults. Nymphs and larvae generally have infections do not affect anywhere near as many people as distinctive numbers of legs (fewer than the adult) depending on mosquito-borne illnesses, they are still very significant prob- the genus. Female adults then seek a final blood meal from lems. Conventional medicine has offered some treatments and another larger mammal, after which they can lay eggs once ALTERNATIVE AND COMPLEMENTARY THERAPIES DOI: 10.1089/act.2016.29085.eya MARY ANN LIEBERT, INC. VOL. 22 NO. 6 1 DECEMBER 2016 ALTERNATIVE AND COMPLEMENTARY THERAPIES DECEMBER 2016 Table 1. Tick-Borne Infections in North America Organism Disease caused Vectora Geography Borrelia burgdorferi Lyme disease Ixodes scapularis (black-legged tick), I. Midwestern and Eastern United States pacificus (western blacklegged tick) and Canada, West Coast of United States Francisella tularensis Tularemia Dermacentor variabilis (American East of Rocky Mountains dog tick), Amblyomma americanum (lone star tick), D. andersoni (Rocky Mountain wood tick) Rickettsia rickettsii Rocky Mountain D. variabilis (American dog tick), East of Rocky Mountains, Southwest spotted fever Rhipicephalus sanguineus (brown United States, northern Mexico dog tick), D. andersoni (Rocky Mountain wood tick) Unknown Southern tick-associated Amblyomma americanum Southeastern and South Central rash illness (STARI)b (lone star tick) United States R. parkeri R. parkeri spotted fever A. maculatum (Gulf Coast tick) South Central and Southeastern United States Rickettsia spp 364Dc Unnamed spotted fever D. occidentalis (Pacific Coast tick) Northern California, West Coast of United States Ehrlichia chaffeensis Human monocytic A. americanum (lone star tick), Southeastern and Eastern United ehrlichiosis possibly D. variabilis (American States dog tick) E. ewingiid Human ehrlichiosis A. americanum (lone star tick) Southeastern and Eastern United States E. muris-like Human ehrlichiosis A. americanum (lone star tick) Southeastern and Eastern United States Anaplasma Human granulocytic I. scapularis (black-legged tick), Midwestern and Eastern United phagocytophilum anaplasmosis I. pacificus (western blacklegged States and Canada, West coast of tick), possibly D. variabilis United States (American dog tick) Colorado tick Colorado tick fever D. andersoni (Rocky Mountain Western United States and Canada fever virus wood tick) Babesia microti, Babesiosis I. scapularis (black-legged tick), B. duncani and I. pacificus (western blacklegged tick) B. divergens Bartonella spp Bartonellosis I. pacificus (western blacklegged tick) Western United States and Canada aIn North America only. bMasters E, Granter S, Duray P, Cordes P. Physician-diagnosed erythema migrans and erythema migrans-like rashes following lone star tick bites. Arch Dermatol 1998;134:955– 960; cShapiro MR, Fritz CL, Tait K, et al. Rickettsia 364D: A newly recognized cause of eschar-associated illness in California. Clin Infect Dis 2010;50:541–548; dBuller RS, Arens M, Hmiel SP, Paddock CD, et al. Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis. N Engl J Med 1999;341:148–155. they mate with a male. Males do not feed, or do so minimally, common in this tick species, including one sampling in Cali- and primarily inhabit larger hosts to find mates. fornia at three sites that found 19% of western blacklegged Larvae and nymphs are usually the stages that become in- ticks infested with Bartonella spp.6 Similarly I. pacificus in fected with various parasites when they feed on smaller ani- Western Oregon were found to only be infected <2% of the mals (birds, mammals, and reptiles). These initial hosts are time with B. burgdorferi, and no ticks (which were few in not sickened by the microbes and so act as the reservoir of number anyway) in urban Portland, Oregon, were infected.7 infection. For comparison, I. scapularis ticks in Connecticut, the state The density of tick infection with various microbes is quite with the highest Lyme disease rates in the country, were found variable from location to location. Studies of ticks in the wild to be infected with B. burgdorferi 8.6–24.4% of the time over on the West coast of the United States and Canada have found the period 1989–1996 in one study.8 Such variables must be that most Ixodes pacificus populations are <1% infection, considered in determining the risk of infection in a particular though “hot spots” with up to 10% infection rates have been patient, as well as in where resources should be directed to deal reported.4,5 However, other organisms may be much more with the greatest risk. 2 MARY ANN LIEBERT, INC. VOL. 22 NO. 6 ALTERNATIVE AND COMPLEMENTARY THERAPIES DECEMBER 2016 Table 2. Distinctive North American Adult Female Tick Features Human Tick Coloration aggressiveness Other distinctive features Peak seasona A. americanum Brownish-red, High Single white dot in middle of back Early spring through (lone star tick) white bands on legs (“lone star”) of adult female, move midsummer extremely quickly A. maculatum Dark brown body, Low (prefers V-shaped yellow band on partial Highly variable (adults (Gulf Coast tick) light brown legs other hosts) scutumb prefer dry season) D. andersoni (Rocky Reddish-brown Moderate Yellow partial scutum Spring and summer Mountain wood tick) body and legs D. variabilis (American Black-red legs Moderate Whitish/yellow/black variegated Spring and summer dog tick, wood tick) and body partial scutum I. pacificus (western Very similar to Low Somewhat furry appearance, partial Late spring, summer blacklegged tick) I. scapularis black scutum I. scapularis Black legs, red body Moderate Black partial scutum Late spring, summer (blacklegged tick, deer tick) R. sanguineus Light and dark brown Low (prefers Rim of lighter brown around edge Unknown (brown dog tick) dogs as hosts) of body Nymph forms are also very prone to biting, are usually exceedingly tiny, and often appear quite different from the adult form.