Medieval medicine and the renaissance of polypharmacy
All that's old is new again (to researchers)
A recent article in The Guardian newspaper detailed medieval cures coming back into vogue in biomedicine. It was titled “Medieval medicine: the return to maggots and leeches to treat ailments,” so you could be forgiven for thinking it was solely about creepy-crawly cures. But buried in the article was this fascinating paragraph about medieval herbal medicine:
“When [Prof. Christina Lee] and her colleagues tested out a 1,000-year-old Anglo-Saxon treatment for eye infections, they were amazed by the results. After mixing allium (garlic, onion and leek) together with wine and bile from a cow’s stomach (oxgall), the team tested the mixtures on artificial wounds and later sent the recipe to America to be tested on mice. In 2015, they reported that the remedy – translated by Lee from a 10th-century medical textbook, Bald’s Leechbook – killed 90% of MRSA bacteria in wounds. The AncientBiotics team believe it is not one ingredient that made the salve so potent, but the combination that had an effect."
This stuck out to me, because this is an example of polypharmacy, the simultaneous use of multiple drugs in a “cocktail” to treat a single ailment or condition. Polypharmacy also happens to be standard practice in Traditional East Asian Medicine or TEAM (also called Traditional Chinese Medicine or TCM), as I’ve discussed here. The question Lee asks is, why aren’t these useful and sophisticated cures used now? “If it worked, why was it given up? Is it that at some point it became redundant, something better came out? Or is it that this was something only known to a few people?”
The TEAM approach
One might ask the same about TEAM herbal medicine. We have decades of studies, many of them well-designed, placebo-controlled studies published in peer-reviewed journals that established statistical significance, that the herbal medicine tradition of East Asia is chock full of amazing remedies that truly work, and often work better than the equivalent pharmaceuticals.
Here are a few examples of recent studies conducted on the efficacy and safety of Chinese herbal medicine:
Treatment of Menopausal Symptoms: A study published in the journal Menopause in 2021 found that Chinese herbal medicine was effective in reducing the frequency and severity of hot flashes and improving sleep quality in menopausal women. The study used a formula of Chinese herbs called Huoxue Jiedu, which included ingredients such as Chinese angelica root, safflower, and red peony root.
Treatment of Rheumatoid Arthritis: A meta-analysis published in the Journal of Clinical Pharmacy and Therapeutics in 2020 found that Chinese herbal medicine was effective in reducing pain and inflammation in patients with rheumatoid arthritis. The study reviewed 23 randomized controlled trials that used a variety of Chinese herbal formulas.
Treatment of Type 2 Diabetes: A randomized controlled trial published in the Journal of Alternative and Complementary Medicine in 2020 found that a Chinese herbal formula called Tang-Min-Ling was effective in reducing blood sugar levels in patients with type 2 diabetes. The formula included herbs such as astragalus root, Chinese yam, and Chinese cinnamon.
Safety of Chinese Herbal Medicine: A systematic review published in the journal Drug Safety in 2021 found that Chinese herbal medicine was generally safe when used according to traditional guidelines. The review analyzed data from 36 studies involving over 2.5 million patients and found that the incidence of adverse events was low.
Time to get medieval on microbes
Overall, these studies suggest that Chinese herbal medicine may be an effective and safe treatment option for a range of health conditions. I personally have found incredible results for GI issues, hormonal issues, endocrine + metabolic issues, and for colds, flu and bacterial infections. For example, I never travel without Huo Xiang formula for stomach flu or food poisoning — it stops vomiting and kills the bug, also good for overindulging food + drink if you take it before bed or before you feel too sick. And I carry Cold Away with me in my bag to work in case I get a scratchy throat or start sneezing or just start feeling under the weather — I don’t have time to get sick, as most of you don’t I’d imagine! It is based on a combo of two formulas that have been around for centuries. It treats “External Pathogenic Influences” in TEAM-speak; it is full of herbs that have done well in studies treating viruses and bacterial infections, as well as symptomatic relief especially from sinusitis.
If it’s so good…
So why then, as Lee asks about medieval cures, don’t most people know about these medicines? And why isn’t Western biomedicine more gung-ho to employ them?
There is a stigma attached to supplements, including those that are prescribed by trained herbalists, that they are “unregulated” and therefore cannot be trusted, whereas FDA-approved medicines can be. But it is also true that most properly-prescribed, FDA-approved drugs can make you sick, maim you, or kill you! Approval doesn’t mean risk-free. It just means that the risk-benefit ratio was deemed acceptable. But that ratio is established without consideration of natural medicines. So if there is a medicine with a longstanding history of safe use that also has decent research proving efficacy, it still does not exist as an option to judge pharmaceuticals against when ascertaining the relative risk-benefit. And the cost of running trials on unpatentable natural medicines is insurmountable without public research, because the profit to recoup the costs just isn’t guaranteed if anyone can use the research to manufacture the same product. Which means that safer and possibly even more efficacious medicines never get approved and then incorporated into standard medical practice, and more problematic drugs get approved because even if they are risky, if there is no other better treatment that has been approved, the relative benefit appears much higher.
In short, perhaps the what’s old may be new again, but cheap and useful medicines being suppressed or forgotten by the high priests of medical orthodoxy, whether as “unregulated” or “unproven” (to the FDA), or whether as old-fashioned or perhaps too witchy in the case of medieval medicines, seems to never go out of style, alas. If there’s money to be made by discrediting them, and relatively little to be made by promoting them, it’s hard to see how that changes except with consumer dollars.
At the moment, federal law in the United States allows non-FDA approved substances to be sold, and the supplement industry is a multi-billion dollar sector of the economy. Most of those sales are directly to consumers for general health and wellness, and most of those supplements have far less research behind them than TEAM formulas, which excel at treating specific health conditions. Traditional East Asian medicines are much tricker to self-prescribe, however, since they are complex and require extensive training to match to not just particular symptoms but to a particular patient’s entire state of health and their general constitution, which can comprise hereditary as well as acquired traits (i.e, both nature and nurture). Add that to the fact that these formulas generally are named poetically but strangely (since they tend to date from 500 to 2000 years ago), and you get the status quo of why TEAM formulas aren’t the first thing that come to mind for most health consumers outside Asia.
This is why I always try to keep abreast of published research in the traditional herbal medicine space, so I can feel even more confident recommending these ancient formulas for modern woes, and I will usually send patients home with material on the traditional uses as well as modern uses. It’s an opportunity for people to learn about the wonderful language of ancient Chinese physicians — the world of “draining damp,” “tonifying qi and blood,” and “soothing heart fire” — strategies that map onto specific herbs that treat specific symptoms, even if wrapped up in flowery phrases.
So if you’ve been wondering about all those formulas behind me when you check out at the clinic, please do ask! Just be prepared to get an earful :-).