How medical herbal therapy preparations work

With a standardized group of herbal active ingredients as the core, it uses multiple targets to collaboratively intervene in human physiological pathways, regulate the homeostasis of the internal environment, and at the same time reduce the toxic and side effects of a single ingredient, ultimately achieving the effects of treatment, auxiliary treatment or rehabilitation.

Maybe you think this is a bit empty. Let me tell you a real story that I encountered during the follow-up in the Traditional Chinese Medicine Department of a tertiary hospital two years ago. At that time, there was a 30-year-old patient with chronic urticaria who had been taking second-generation antihistamines for more than half a year. Every time he took it, he felt drowsy, which seriously affected his work. Later, he switched to the compound Lithospermum cream prepared in the hospital for external use, and took it with flavored Yupingfeng granules for oral use. After adjusting the dosage three times, the frequency of wheal attacks was reduced by more than half in less than half a month, and the problem of drowsiness disappeared. The old director who taught at that time told us that we should not always think of herbal therapy as "empirical metaphysics". Nowadays, the action pathways of many ingredients have been clearly understood.

To understand the logic behind this, we must first understand the core difference between medical herbal preparations and the health teas we usually drink and the decoctions we cook at home: all active ingredients in medical-grade preparations are standardized, and they are not just ground and mixed together. Take the most familiar artemisinin, for example. It is a single active ingredient extracted from Artemisia annua, which directly acts on the membrane structure of the malaria parasite, destroying its cell nucleus and organelles. Its anti-malarial mechanism is as clear as that of chemical drugs. This is also the most uncontroversial logic of herbal preparations - extracting a single high-purity active ingredient and accurately acting on the target is essentially the same as the development logic of chemical drugs.

Oh, by the way, many people think that herbal preparations are only used for conditioning and are not used in acute and severe cases. In fact, many herbal preparations have been approved for the auxiliary treatment of acute pancreatitis and sepsis. The pathway of action is to inhibit the inflammatory factor storm, and the clinical data are quite good.

However, more than 90% of medical herbal preparations on the market are compound formulas, and this part is also the most controversial. When I attend industry academic conferences, I often encounter scholars from different backgrounds who are very noisy. Researchers with a background in Western medicine generally feel that the so-called "multi-target synergy" essentially means "unclear effects": the content of active ingredients in many compound preparations fluctuates greatly due to the origin and processing technology of the medicinal materials, and the reproducibility of clinical effects is poor, and there are even some For different varieties, it is not even clear which ingredients are at work. Previously, it was revealed that the content of bitter glycosides in different batches of a commonly used heat-clearing and detoxifying oral liquid differed by three times, and the effects of different patients vary greatly. This is indeed a pain point that cannot be avoided in the current industry.

However, scholars with a background in traditional Chinese medicine and systems biology research completely disagree with this statement: the human body itself is a complex dynamic system, especially chronic diseases such as hypertension, diabetes, and autoimmune diseases. Multiple pathways have problems at the same time. Single-target chemicals are prone to drug resistance and obvious side effects. Take patients with type 2 diabetes as an example. The commonly used metformin can lower blood sugar, but it cannot improve the common problems of dry mouth, fatigue, and constipation. Herbal preparations containing berberine and astragalus polysaccharide can not only regulate the sensitivity of insulin receptors to assist in lowering blood sugar, but also simultaneously improve the complications caused by glucose metabolism disorders. This is difficult to achieve with single-component drugs.

To be honest, I have been researching and developing medical herbal preparations for 6 years, and I feel that both sides are reasonable. Previously, our team made a spray preparation for postoperative incision healing. We tried it 17 times just to adjust the ratio of emodin and bisabolol. It must not only ensure sufficient antibacterial and anti-inflammatory effects to avoid incision infection, but also promote the proliferation of fibroblasts and accelerate healing. The effect is much worse if it is more or less. The "synergistic effect" of medical-grade herbal preparations is not just talked about casually, but must be accumulated through experimental data.

There is another common misunderstanding that everyone should mention: many people think that herbal preparations are "purely natural and have no side effects." This is completely wrong. The principle of action of medical herbal preparations inherently includes strict screening of indications. For example, if analgesic preparations containing aconitine are not prepared properly, they can easily cause arrhythmia. Even the mildest ingredients of chrysanthemum and honeysuckle preparations can cause long-term diarrhea if used too much in patients with spleen and stomach deficiency. There is no such thing as a "magic pill".

In fact, the current controversy over medical herbal therapy is essentially about whether the single-ingredient evaluation system of modern pharmacy can adapt to the complex group of active ingredients. My own feeling is that there is really no need to fit herbal preparations into the standard framework of chemical drugs. As long as the production process is controllable, the clinical effects are clear, the safety risks can be predicted, and the actual problems of patients can be solved, that is enough - after all, no matter what kind of medicine it is, the ability to cure diseases is the first priority.