Traditional Herbal Medicine: A Systems Wide Approach and Why Synergism Is Key

”The way you see people is the way you treat them, and the way you treat them is what they become.’’  ~Johann Wolfgang Goethe

Herbs have become popular as an alternative to conventional medicine and are used in treating a wide range of chronic and acute conditions. But it’s important to realize that this is not traditional herbal medicine. According to the World Health Organization, traditional (herbal) medical systems (TMS) are defined as “the wisdom, knowledge, skills and practices based on the theories, beliefs, principles, and experiences indigenous to different healing traditions and cultures, used in the promotion of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness.”

The TMS Approach: Treatment is Based on A Holistic View

Generally speaking, TMS focuses on the overall condition of the individual, rather than on the particular ailment or disease from which the patient is suffering. The use of herbs, compounded into formulas, is a core part of all systems of traditional medicine.

Diagnosis and treatment are based on a holistic view of the patient and the patient’s symptoms. This is expressed in terms of energetic concepts and various connected layers that include imbalances, deficiencies, and excesses. 

For example, within Traditional Chinese Medicine (TCM), the balance of yin-yang is fundamental to understanding the energetics of herbal prescriptions. Yin‐yang theory consists of two natural, complementary, and contradictory forces of opposite polarity that interact to form a dynamic system in which the entirety is superior to the parts.

Yin represents the earth, cold, and femininity, whereas yang represents the sky, heat, and masculinity. The actions of yin and yang influence the interactions of the five elements composing the universe: metal, wood, water, fire, and earth.

According to TCM philosophy, everything has both yin and yang features. For instance, shadow cannot exist without light. Yin and yang elements are always in dynamic equilibrium, or balance. Yin is negative/passive/ dark/female/water, while yang is positive/active/bright/male/fire. Although yin is stronger, they are always in balance.

“We can find many relevant examples of the yin‐yang balance when this concept is applied to the regulation of cellular and organismal homeostasis (e.g., cyclic adenosine monophosphate [cAMP] and cyclic guanosine monophosphate [c‐GMP], prostacyclin and thromboxane, sympathetic and parasympathetic nervous systems, testosterone, cortisol). For example, the testosterone/cortisol ratio is associated with stress‐related disorder symptoms such as fatigue, decreased performance, and impaired recovery from overtraining syndrome in sports medicine.”^[1]

There are many different systems of traditional medicine. Although the philosophy and practices overlap in their core concepts, they, of course, differ in language and descriptions, as well as in the herbs used. One of the main fundamental objectives of Mederi Care is to combine traditional medical systems and modern medicine into one unified system that all practitioners understand and practice together as a unified ‘ONE.’

“Aim at heaven and you will get earth thrown in. Aim at earth and you get neither.”

C.S. Lewis

Is Herbal Medicine Too Complex and Therefore Neglected?

Probably the biggest problem in pharmacological research on botanicals is the lack of insight into the pharmacodynamics of potentially bioactive natural products in drug mixtures. 

Nature has evolved distinct strategies to modulate biological processes, either by selectively targeting biological macromolecules or by creating molecular promiscuity or polypharmacology (when one molecule binds to different targets). Widely claimed to be superior over monosubstances, mixtures of bioactive compounds in botanical drugs allegedly exert synergistic therapeutic effects. Despite evolutionary clues to molecular synergism in nature, sound experimental data is still needed.

Emerging Concepts in Botanical Drug Network Pharmacology

A. Natural products may interact with multiple targets (polypharmacology), and this could be assessed by (a) ligand pharmacophore models B. There might be synergistic effects between different natural products (here terpenoids) targeting different receptors in different nodes of the biological space (A–E) leading to blockage of certain pathways (black dots) ^[2] 

Different Forms of Herbal Medicine

Herbs and plants can be processed in different ways, and used in a wide variety of applications. This includes the whole herb, teas, syrup, essential oils, ointments, salves, rubs, capsules, and tablets that contain a ground or powdered form of a raw herb or its dried extract.

Herbal extracts vary in the solvent used for extraction, temperature, and extraction time. These include alcoholic extracts (tinctures), vinegars (acetic acid extracts), hot water extract (tisanes), long-term boiled extract, usually used for roots or bark (decoctions), and cold infusion of plants (macerates). There is no standardization, and components of an herbal extract or a product are likely to vary significantly between batches and producers.^[3]

Clinical Concepts of Mederi Care based in TMS:

1. Enhance vitality by strengthening the person in a rational and non-toxic fashion.

2. Balance the endocrine and nervous systems, and improve metabolism, digestion, and assimilation. 

3. Expand the healthy range of dynamic stability.

4. Nourish, Move, Activate, and Detoxify. Take notice of the blood, lymph, liver, kidneys, bowels, lungs, and skin to evaluate what and where detoxification is needed; then address with the indicated remedies.

The body eliminates waste material at three levels:

(A)       intra-cellular – the interplay of electrolyte functions & the diffusion of chemical ions across the cell membrane.

(B)       organismic – the processes of intermediate metabolism (the liver, spleen & lymphatic system). 

(C)       organs of excretion – special functions to eliminate unusable end products & chemical wastes (lungs, sinuses, bowel, kidneys & skin).

5. Utilize and activate the body’s innate healing mechanisms. In chronic disease this often means ignoring the disease entirely while focusing on balancing everything else. This is hard to do, but the long-term effects are gratifying for both the herbalist and the individual.  Don’t base your entire remedy, or protocol, merely around the complaint, or manifested symptoms. Look deeper, ask questions, and try to understand the whole picture.

6. Determine the specific indications for the remedy, or formulation.  This comes from careful study of the materia medica, and through experience.

According to TMS and Mederi Care the term “remedy” refers to any unified combination of herbs whose natural tendency is to restore diseased tissues to their normal conditions, so that these tissues again can be used fully and freely by the Life force. The action of a remedy must cooperate and harmonize with the action of Nature. The  fundamental objective is to build robustness, while enhancing auto-regulation and auto-organization.

The Art of Herbalism

It is only on rare occasions that the isolated action of any single herb, or any one classification of remedies (whether it be relaxants, tonics, stimulants, astringents etc.) will meet the constitutional requirements of an individual. The vast majority of people do best with a combination of herbs, which include one to three specific or primary herbs blended with other herbs to balance, harmonize and/or circulate the formulation. 

Creating a remedy and determining dosages is truly where the art of herbalism is apparent.  For example, when addressing constipation, adding 10 ml of Culver’s root and 10 ml of mayapple to a 240 ml herbal compound provides just enough action to facilitate a gentle, but therapeutic effect.  These herbs are ideally combined with other tonic/adaptogenic herbs, with the goal of creating harmony and lending a gentle helping hand to the Life force. This, to me, is the essence of working in unison with the Life force.

Where Modern Conventional Medicine Has Failed

One of the issues of modern conventional medicine is that it has refused to recognize the historical texts of traditional medical systems, which are based on hundreds to thousands of years of cumulative observational research. Observations are fundamentally dependent upon the shared theoretical framework of the modern medical research of scientists, and should be highly valued, perhaps above any other study framework.  Clearly, this presents significant problems for TMS, in that it prohibits written medical textbooks from being viewed as a theory-free means of evaluating therapeutic effectiveness.

“The Universe is synergetic. Life is synergetic.” ~Buckminster Fuller (1968)

Synergy is broadly defined as the interaction or cooperation of two or more substances, organizations or other agents to produce a combined effect greater than the sum of their separate parts. Synergy comes from the Greek word “synergos,” which means “working together.”^[4] According to the McGraw–Hill Concise Dictionary of Modern Medicine, synergism or synergy is defined as “the cooperative interaction between two or more components of a system, such that the combined effect is greater than the sum of each part.”

Systems Approaches and Polypharmacology: Using Licorice as an Example

Licorice, one of the oldest and most popular herbal medicines in the world, has been widel

y used in traditional herbal medicine as a cough reliever, anti-inflammatory, demulcent, immunomodulatory, anti-platelet, antiviral (hepatitis) and detoxifying agent. Glycyrrhiza uralensis, Glycyrrhiza inflata Bat., and Glycyrrhiza glabra were officially used as medicine according to the TCM pharmacopoeia.^[5]

A comprehensive systems approach effectively identified 73 bioactive components from licorice and 91 potential targets for this medicinal herb. These 91 targets are closely associated with diseases of the respiratory system, cardiovascular system, and gastrointestinal system. These targets are further mapped to drug-target and drug-target-disease networks to elucidate the mechanism of this herbal medicine.^[6]

If we observe nature, bioactive compounds are very rarely produced alone, but almost always occur in mixtures with other potentially bioactive secondary metabolites. Moreover, many physiological mediators (i.e., amines, fatty acid metabolites, steroids, etc.) act by simultaneously targeting different sites. Biochemical processes often involve multiple signaling molecules that drive the biological response into one or the other direction. It is tempting to reason that nature produces groups of potentially synergistic effectors to increase the chance for success.^[7]

Pharmacological and clinical research indicates that at least four mechanisms may be involved:

1. Synergistic Multi-Target Effects

A compound, mixture or plant extract may act not only on a single target, but may effect different targets; i.e., all functional or structural cell constituents, such as metabolites, receptors, enzymes, ion channels, transporters, nucleic acids, ribosomes, and proteins.^[8]

2. Modulation of Pharmacokinetic or Physicochemical Effects

Synergistic effects may also effect the physicochemical properties, including solubility, of a compound or mixture, providing an improvement of the so-called bioavailability.

3. Interference with Resistance Mechanisms

Synergistic effects may be observed on drug-resistant microorganisms (bacteria, fungi) or cancer cells, thanks to the presence of natural derivatives that may antagonize the development of drug resistance (supplied together with antibiotics or cancer drugs).

4. Elimination or Neutralization Potential

A compound or a plant extract may have the ability to remove or neutralize the toxic effect of a drug (synthetic or not), even reducing or nullifying its adverse effects and resulting in treatment amelioration. With no comprehensive claims, the possible mechanisms of synergistic effects are summarized.^[9],[10]

Mederi Care Offers Guidance for Practitioners

One of the goals of Mederi Care is to provide a theoretical framework to help guide practitioners. Although modern medicine has attempted to divorce itself from TMS,  Mederi Care is committed to providing a fresh perspective, and a new framework. This is not simply a combination of old frameworks, but a new, innovative system of traditional medicine blended with modern conventional medicine with the intention of creating ONE system. Simply put, Mederi Care infuses traditional theories into modern medicine.

My hope is that more people will gain a deeper understanding and appreciation for TMS,  and know that it is a cornerstone for the philosophy and practice of Mederi Care.

---

^[1] Panossian AG, Efferth T, Shikov AN, Pozharitskaya ON, Kuchta K, Mukherjee PK, Banerjee S, Heinrich M, Wu W, Guo DA, Wagner H. Evolution of the adaptogenic concept from traditional use to medical systems: Pharmacology of stress- and aging-related diseases. Med Res Rev. 2021 Jan;41(1):630-703. doi: 10.1002/med.21743.

^[2] Gertsch J. Botanical drugs, synergy, and network pharmacology: forth and back to intelligent mixtures. Planta Med. 2011 Jul;77(11):1086-98. doi: 10.1055/s-0030-1270904. Epub 2011 Mar 16. PMID: 21412698.

^[3] Lester Packer, Ph.D. Enrique Cadenas, M.D., Ph.D. Herbal Medicine: Biomolecular and Clinical Aspects, CRC Press, © 2011 by Taylor & Francis Group, LLC, Chapter 1, OXIDATIVE STRESS AND DISEASE

^[4] Pezzani R, Salehi B, Vitalini S, Iriti M, Zuñiga FA, Sharifi-Rad J, Martorell M, Martins N. Synergistic Effects of Plant Derivatives and Conventional Chemotherapeutic Agents: An Update on the Cancer Perspective. Medicina (Kaunas). 2019 Apr 17;55(4):110. doi: 10.3390/medicina55040110.

^[5] Wang C, Chen L, Xu C, Shi J, Chen S, Tan M, Chen J, Zou L, Chen C, Liu Z, Liu X. A Comprehensive Review for Phytochemical, Pharmacological, and Biosynthesis Studies on Glycyrrhiza spp. Am J Chin Med. 2020;48(1):17-45. doi: 10.1142/S0192415X20500020. Epub 2020 Jan 14. PMID: 31931596.

^[6] Liu H, Wang J, Zhou W, Wang Y, Yang L. Systems approaches and polypharmacology for drug discovery from herbal medicines: an example using licorice. J Ethnopharmacol. 2013 Apr 19;146(3):773-93. doi: 10.1016/j.jep.2013.02.004. Epub 2013 Feb 14. PMID: 23415946.

^[7] Berenbaum MC. What is synergy? Pharmacol Rev 1989; 41: 93–141

^[8] Imming, P.; Sinning, C.; Meyer, A. Drugs, their targets and the nature and number of drug targets. Nat. Rev.  Drug Discov. 2006, 5, 821–834

^[9] Hemaiswarya, S.; Kruthiventi, A.K.; Doble, M. Synergism between natural products and antibiotics against infectious diseases. Phytomedicine 2008, 15, 639–652.

^[10] Pezzani R, Salehi B, Vitalini S, Iriti M, Zuñiga FA, Sharifi-Rad J, Martorell M, Martins N. Synergistic Effects of Plant Derivatives and Conventional Chemotherapeutic Agents: An Update on the Cancer Perspective. Medicina (Kaunas). 2019 Apr 17;55(4):110. doi: 10.3390/medicina55040110.