How medical herbal therapy preparations work

The first is the multi-target coordinated regulation of herbal active components, the second is the two-way regulation of the body's immune and metabolic pathways, and the third is the local physical and chemical barrier intervention of some external preparations. Currently, the medical herbal preparations approved for clinical application have completed toxicological verification and evidence-based medical evaluation, and are essentially different from folk homemade herbal prescriptions and unprocessed fresh medicinal materials in terms of action logic and safety.

When I was following up at the Provincial Department of Traditional Chinese Medicine and Dermatology two years ago, I met two patients who also had herpes zoster. They both used a topical compound cream containing artemisia annua and borneol. The young patient’s pain and itching disappeared in 3 days, and the older patient took Bupleurum Shugan Powder orally. After using the modified formula, the scabs were completely scabbed within two weeks and no residual neuralgia was left. Using a single antiviral ointment, it is often difficult to achieve such effects of relieving pain, promoting repair, and preventing residual pain. This is actually a typical manifestation of the multi-target effect of herbal preparations.

On this point, there are considerable differences in the interpretations of different research schools. Scholars who engage in natural medicinal chemistry prefer to break it down at the component level: take the Artemisia annua cream mentioned above as an example. The artemisinin in it can inhibit the replication of the herpes virus, the borneol can quickly penetrate the skin to paralyze nerve endings and relieve pain, and the added Bletilla striata polysaccharide can also form a breathable protective film on the surface of the skin lesions. Each of the several ingredients does their own job, and together they have higher coverage than a single ingredient. Scholars who do theoretical research on traditional Chinese medicine pay more attention to the logic of "compatibility": whether it is a topical cream or an oral prescription, they are all formulated according to the "monarch, minister and assistant" formula. Combining cold-type Artemisia annua with warm-type dried ginger ointment will not irritate the skin like Artemisia annua alone. Instead, it can accurately act on skin lesions with damp-heat syndrome, and the effect will be reduced when applied to other syndrome types. The two explanation systems are still undergoing corresponding research, and there is no unified conclusion yet. However, in clinical practice, both logics can guide medication use and are supported by effective cases.

In addition to multi-target synergy, what laymen find most “magical” about herbal preparations is their two-way regulatory effect. To be honest, when I first entered the clinic, I thought it was unbelievable. The same medical stomach-nourishing granules containing astragalus were given to a patient with constipation caused by subsidence of Qi. He said that after a week of drinking, his bowel movements became smoother. But when he was given to a patient with chronic diarrhea caused by deficiency of the spleen and stomach, he also said that his stools were formed. This sounds completely contradictory at first glance, right? There is now considerable controversy over this mechanism. Most researchers in the Western medicine system believe that this is because the intestinal flora of different people have different metabolic pathways for herbal active ingredients. The polysaccharides in astragalus will be converted by probiotics into different short-chain fatty acids, which act on gastrointestinal peristalsis respectively. Researchers in the traditional Chinese medicine system believe that this is the inherent function of "righting". Astragalus supplements righteousness. With enough righteousness, the body can adjust the disordered functions back to normal. Whether it is constipation or diarrhea, they are manifestations of dysfunction and can naturally be improved.

Compared with the controversy over internal regulation, the logic of external herbal preparations is much more straightforward. For example, medical lithospermum oil is commonly used for burns and scalds. In addition to the shikonin in it, which can resist inflammation and bacteria and promote epidermal repair, the oil itself can isolate bacteria in the air and keep the wound surface moist without scabbing. I once met a college student who splashed boiling water on his forearm. He used lithospermum oil to change the dressing every day, and the scab fell off in a week, leaving almost no pigmentation. The recovery effect is much better than using iodophor alone to change the dressing. There are also herbal nasal sprays for treating rhinitis. In addition to the anti-inflammatory ingredients of magnolia and geese grass, physiological sea water is also added. Spray it in to flush out the allergens in the nasal cavity, and then slowly play the role of anti-inflammatory and clearing the nose. It is equivalent to a two-pronged combination of physical cleansing and pharmacological effects.

To be honest, many people have misunderstandings about medical herbal preparations. They think that since they are “herbal”, they have no side effects and can be used casually. This is actually not the case. We have encountered patients who dug fresh dandelions at home and used them to apply on eczema. They originally thought of "herbal anti-inflammatory", but instead of doing desensitization treatment, they developed contact dermatitis, making the redness and swelling worse. Medical herbal preparations have been processed, attenuated, and optimized in compatibility. For example, the analgesic preparations containing aconitum have reduced the content of aconitine to a safe range after processing, and are not as cardiotoxic as raw aconitum. This is also the biggest difference between medical preparations and folk remedies.

There are still many things that the academic community does not understand about the working principles of herbal preparations. For example, a recent study found that total alkaloids of Sophora flavescens can regulate the immunosuppressive microenvironment of tumor patients, but the specific types of components and through what pathways are still unclear. In fact, we do not need to ask for a black and white conclusion when doing clinical work. Whether it is explained by components or by meridian tropism, the most practical effect is to make patients suffer less and recover better.