Is a Strong Medicine a Good Medicine?

"Please make it a strong one."

It's something I often hear from people who have been ill for a long time. They've been from place to place with little improvement, so this time they want something that works for sure. I understand that feeling well.

But I ask in return: "What does 'strong' mean?"

The word "strong" mixes two things together

One is that the concentration of the ingredients is high. The other is that the body's reaction is large. We naturally treat these two as the same thing — put in a lot, and there will be a lot of reaction.

But the body is not such a simple device.

What happens when you put in a lot

The body has regulatory machinery. When something floods in, the body processes it and tries to recover its balance.

When you push a single substance in at high concentration, the body has to process it with no room to negotiate. Burden piles up on the organ doing the processing, and the regulatory machinery gets pressed down. And over time the body adapts to that stimulus, so the reaction grows dull.

There's an example I often meet in my practice. People who take large amounts of amino acid or nitric oxide–class supplements while lifting weights come in with problems in their liver values. Nitric oxide widens the blood vessels, but it is itself a powerful oxidizing substance. It acts as much as you put in, and it burdens as much as you put in.

Pushing hard is a way of trying to overpower the body's regulatory machinery. When things are urgent, that's what you need. But in long-standing illness, the story changes.

Long-standing illness calls for a different principle

In a body that has been ill for a long time, what has broken down is usually not some part, but the very ability to regulate. The ability to regulate sleep, regulate digestion, regulate pain, and to switch inflammation off and on.

What's needed here is not pushing, but switching back on.

Medicine has a good example that shows this principle.

Parathyroid hormone is originally a hormone that dissolves bone. Yet when given in small amounts, intermittently, it actually increases bone mass. Give a lot continuously and bone dissolves; give a little, broken up over time, and bone grows. The same substance works in exactly opposite ways depending on the amount and the manner.

Exercise is the same. Give the muscle a moderate load and the muscle is damaged, and that damage summons a recovery response that makes it stronger. Too much load and you get hurt; none at all and it withers.

This phenomenon, in which a low-intensity stimulus actually raises the body's regulatory capacity, is called hormesis.

This is how I understand herbal medicine

The concentration at which the active ingredients of herbal medicines remain in the blood is astonishingly low by the standards of modern drugs. On top of that, a great many of them only become active after passing through the metabolism of gut microbes.

For a long time this low concentration was regarded as herbal medicine's weakness. I see it the opposite way.

Because it is a signal of a size the body can regulate, it works in a way that wakes the body rather than replacing it. It is less about forcing something to be done, and closer to letting the body know that here and now needs to be put in order.

That is precisely what long-standing illness calls for.

That said, I don't only use it gently

Let me leave no misunderstanding. When it's needed, I use it strongly.

When acute inflammation is spreading, when pain is severe enough to keep you from sleeping, or when body fluid has rapidly pooled and pressure has risen, there is no room to wait for the body's regulation. In those cases you have to switch it off first, drain it first.

And in such situations, if tests or conventional-medicine procedures are needed before herbal treatment, I say so.

It is not a matter of strong versus weak, but a matter of order. The judgment of whether, in this person's body right now, there is something to press down or something to wake up comes before the prescription.

So this is what I tell you

When someone says, "Please make it a strong one," I answer this way:

"I'll make sure it works. But whether pushing hard is the sure way — let's look at that together."

The longer an illness has lasted, the less recovery comes in a straight line. It comes like waves, going back and forth between better and worse. Recovery is when the amplitude of those waves gradually shrinks. Try to press it all out at once, and you easily press down along with it the very power of the body that makes those waves.

Finally

Research directly linking hormesis and herbal medicine has not yet accumulated sufficiently. This is a viewpoint I have built through practice and study, and I distinguish between established fact and my own interpretation when I speak.

Still — that what a long-ailing body needs is not a stronger medicine but the power to regulate again — this much is something I have confirmed over and over in the consulting room.

Turning the wish to heal quickly into a path that heals over time. Offering that explanation is the starting point of my practice.