How medical herbal therapy preparations work

The core principle of action of medical herbal therapy preparations is to rely on the synergistic effect of multi-component active substances in natural plants to achieve pathological state intervention and physiological function repair through multi-target regulation of human metabolic pathways, immune responses and microecological environments, which is different from the common single-component single-target action logic of chemical drugs.

When I was rotating at the Provincial Traditional Chinese Medicine Preparation Center a few years ago, I felt particularly intuitive about this principle. At that time, we were making Golden Buckwheat Gargle, which is commonly used in clinical practice. According to the conventional thinking of modern pharmacy, the core of the antibacterial effect is flavonoids. But in the laboratory, the purified flavonoids were mixed into solutions of the same concentration for comparison. The antibacterial effect was actually better than that of the gargle extracted from the whole plant. The liquid was 32% lower - it was later discovered that organic acids and sesquiterpenes, which were originally regarded as "impurities", could help the flavonoids penetrate the biofilm of anaerobic bacteria, which is equivalent to opening a "green channel" for the active ingredients. The three of them work together to achieve good results. Of course, scholars in different research directions have been arguing about this for many years: scholars in natural medicinal chemistry insist on purifying the effective monomers, believing that mixing other ingredients cannot explain the path of action and may lead to the risk of sensitization; while researchers who inherit the logic of traditional herbal preparations feel that this multi-component synergy itself is the core advantage, and if they must be separated into single components, it is equivalent to losing the "soul" of herbal preparations. Both sides are supported by solid data, and there is no absolute conclusion yet.

In addition to the synergy at the component level, the logic of the action of these active substances after entering the human body is also quite interesting. They do not focus on one place, but often regulate several related pathological pathways at the same time. Take the compound mugwort gel commonly used in rehabilitation departments. After applying it, many patients with lumbar prolapse feel that not only their back pain is relieved, but the numb areas on their legs are also much more comfortable. In the past, everyone thought it was the effect of hot compress and local blood circulation. Later, pharmacological experiments were conducted and it was discovered that the ingredients such as cineole and thujone in it can expand local capillaries and accelerate inflammation. The discharge of metabolites can also inhibit the release of TNF-α inflammatory factors around the damaged nerve roots, and at the same time regulate the excitability of subcutaneous sensory nerves. It is equivalent to doing three things at the same time: "relaxing circulation, eliminating edema, reducing sensitivity and analgesic". It uses multiple targets at the same time to deal with this complex local discomfort, and is more comprehensive than a single analgesic. However, there are also many Western medicine clinical scholars who have doubts about this mode of action. They feel that multiple targets mean that the relationship between dose and effect is unclear, the intensity of action cannot be accurately controlled, and the controllability of adverse reactions is not as good as that of chemical drugs. This is one of the core reasons why many herbal preparations are slow to enter clinical guidelines.

There is another action path that has only received widespread attention in recent years, which is the regulating effect of herbal preparations on human microecology. This is also the biggest difference between it and many chemical drugs. I had previously been in contact with a patient who suffered from recurrent fungal vaginitis. He had been taking azole antifungal drugs for more than half a year, and relapsed after stopping the drug for up to two weeks. Then he switched to medical Sophora flavescens gel for two weeks. During the reexamination, not only did the fungus turn negative, but the proportion of beneficial lactobacilli in the vagina increased from 11% to 72%. After three months of follow-up, the patient still had no symptoms. Later, we checked relevant research and found out that the alkaloids in Sophora flavescens only inhibit the biofilm synthesis of harmful bacteria. Not only are they not lethal to beneficial bacteria such as Lactobacillus, but they can help them colonize. This is equivalent to "helping the good and removing the bad", rather than killing both the good and the bad like chemical fungicides. Of course, there is also controversy here. Scholars who do microbiome research have also mentioned that most of the current studies on microecological regulation are small sample experiments and lack long-term data support from large cohorts. Many applications still rely on clinical experience, and there is still a long way to go to form a standardized protocol.

Speaking of which, I always keep medical lithospermum ointment in my medicine cabinet at home. Applying it on mosquito bites can relieve itching faster than calamine. If you accidentally scratch the skin and apply it, it will not cause inflammation. I read the literature before and found that the shikonin in it can inhibit the release of histamine, relieve allergies and relieve itching, and also has a weak anti-herpes virus effect. This "multiple benefits" feature is really a unique advantage of herbal preparations.

In fact, up to now, there are still many things that the academic community has not fully understood about the working principles of medical herbal therapy preparations. Some people do not agree because of the "unclear data", while others have used clinical experience for decades with good results. There is no need to argue about right and wrong. After all, whether it is monomer purification or full-component application, being able to actually solve patients' problems is the core criterion, right?