Standardized plants

One of the biggest hurdles to phytotherapy is that plants are, after all, living things. Much like my two black (loveable) cats above, even though two plants may be growing side by side, they may still produce a different bouquet of molecules--and they are very different cats; one of them could be white--they're that different.

Some of the more practical amongst us may wonder whether or not it actually matters. After all, 5000 years of practical application have, essentially, confirmed that these plants work.

On the other hand, standardized medications make dosing and scheduling much easier. Can you imagine the tizzy your family physician/GP would be thrown into if the New England Journal of Medicine suddenly recommended that every patient's aspirin be titrated to the optimal dose? Of course, this sort of individualized therapy is part of what makes TCM so powerful--that each and every patient receives a tailored concoction--but you can hardly expect a harried doctor (who's probably more worried about getting sued) with exactly 10 minutes of time, half of which is spent deciphering his colleague's handwriting, to give the sort of individual attention that personal dosing requires. Add to this the fact that a bad licorice season, or a factory being built within 500 feet of a ginseng field, can drastically affect the quality, growth, and compound within a plant, and you can see how things begin to go disastrously wrong if there is no standardization.

At the molecular level, there simply is no way to guarantee that batches of plant extracts from one plant (much less many) will contain exactly the same components, unless we are after only one compound. This is, in part, why we synthesize Taxol (the other part being that Pacific yew is an endangered tree). The best we can hope for, therefore, is an average of chemical signatures given by a particular plant--a "fuzzy fingerprint", if you will.

And this is what makes TCM so unsatisfying for Western physicians. From the Age of Enlightenment onwards, the philosophy of science and medicine has been that knowing more about how we (human bodies) work will lead us to understanding more about how to fix it* when it gets broken. Now, nobody will doubt that bodies get broken, in terms of the physical, physiological, and chemical. The human race has been fixing physical problems for as long as its history, but the physiological and chemical problems have had to wait for the advances of science before we could understand what the nature of the problem was. The history of diabetes provides a wonderful example of how, even in the face of knowing what was wrong, we were still powerless to do anything about it. We are so used to equating "disease" with "broken"--with one single concrete cause, and one single effective cure--that it's now wonder we are surprised when the magic bullet turns out to be a dud. Contrast that with the view TCM takes, that the body isn't really broken, it just needs help getting to where it should be--and that help can come in many, many forms, and they are not all the same for everybody--and you begin to see how the divergence in thinking begins to cause rifts.

This is not to suggest that any old ginseng or lavender plant will yield the right proportion of effective:noneffective ingredients. Maybe the difference matters, and maybe it doesn't. The fuzzy fingerprint may be as close as we will ever get to standardizing things chemically. But that doesn't mean we can't standardize what we can: the soil content and acidity, drainage and water availability, amount of light and darkness. It is even conceivable that air quality could make a difference.

Allow me to end on a note of conceit and ask, "Is there any better reason to ensure that our climate and environment are not going to go to hell in a handbasket?" Considering how much we already depend on it, how much it costs us when things go wrong, and that the potential to save lives could be floating around in some undiscovered plant (or some already-discovered plant), can we really afford to take the chance that the poisons we spew and the trash we discard doesn't have an effect?

*I usually try to avoid using Amazon.com when pimping books, but the synopsis is so wonderfully exact that I didn't think I could do it any better

Systems biology: everything's connected

On the second point of TCM, which is the theme of the week


"Systems biology" sounds complicated--hell, biology sounds complicated. It's the study of life, after all, and what could be more complicated? There are massive numbers of articles published on the opioid receptor, for instance, and that's on three different proteins with relatively well-defined roles. If that's one, imaginee how complicated a system must be.

But that's what the big picture is starting to look like: everything's connected. Jared Diamond illustrates this principle very well in the book Guns, Germs, and Steel, which I highly recommend reading if you like having your brains boggled. Chaos theory's butterfly effect, while formulated to describe a system's dependence on initial conditions, best illustrates the phenomena of a little change blowing up into something big.

Which is precisely what drugs do. You take a pill--by the time it gets into your stomach it's already dissolving. Maybe half of the active molecules make it through the acid bath. Then it gets neutralized, and absorbed into the bloodstream, where it may or may not bind to proteins in your blood, rendering them inactive. It has to get past the liver, which filters out all the crud that's in your blood; it get sloshed around by the heart, possibly ending up however many thousands of miles away from its site of action, all the while being degraded by the heat of the body and whatever enzymes are running rampant throughout your body, hell-bent on destroying any and al invaders. It's a wonder, if you think about it, that any drugs at all work, much less as well as they do.

"Well" might be pushing it--given the very long list of side effects of drugs such as Lexapro (which I've taken for a year) and the very short list of intended actions, let's just say that I don't know of a single boss who would accept that kind of performance from a person. Is this because the drug was specifically designed for the purpose of inhibiting one receptor? Is this why "dirty" drugs, which work on an array of receptors, are currently being explored as therapies?

This is systems biology: you can't touch one without touching everything. And in this respect, TCM, which strives more for "balance" than an actual treatment mechanism, has a lot to teach us in terms of how to view diseases. If you need an example, consider how the treatment paradigm for stomach ulcers has changed: it used to be that you drank milk, or chalk (how else to describe antacids?)--it was thought that the acid in the stomach was the problem, and you had to neutralize it. Or lessen it--I'm sure we all know of at least one person who has been told to "relax" because their ulcers would start "acting up". Then we figured out how to turn off the acid pumps in the stomach--good for the pain, bad for digestion. Then a single maverick doctor from Australia decides that Helicobacter pylori is actually the causative agent for ulcers, proves it by drinking a shot of the bugs. Stomach ulcers are now routinely treated with a course of antibiotics, with acid-lowering agents to manage the symptoms until they heal. But herbalists of all stripes, not just TCM practitioners, have been using licorice to manage ulcers. As far as how it works exactly isn't quite known--there are literally hundreds of active components in licorice, but the main compound, glycerrhyzic acid, is an anti-inflammatory agent--which might help the immune system destroy the bugs, as well as soothe some of the pain.

The point is not to suggest that herbs make for better medicine than drugs developed with a specific purpose in mind. It is merely that focusing on one aspect of the disease (stomach acid) can be counterproductive when trying to find new treatment regimens. It is likely that licorice, because it has hundreds of other active compounds, influences the body in ways that a specifically targeted drug cannot, and therefore "brings it into balance" again. It's like trying to center a tarp over a target using only rope. If you have one very strong rope, you can easily yank the tarp from A to B, but trying to center it can be very difficult. Whereas if you have lots of ropes, you can pull on it in all the right directions, and therefore center it quite easily.

Losing sight of the connections with everything else leads, ultimately, to a myopic view of health and the human body with a knowledge base that is still sorely lacking (ever wonder why we sleep? so do scientists). When you understand the connections, you don't eliminate the holes, but you see other ways to fill them in. Ultimately, nobody can know everything. But knowing more is never a bad thing.