Practicing herbalists have always used a form of personalization. The healthcare practitioner would use a variety of diagnostic criteria, some of which might fall outside of the realm of Western diagnostics, such as the appearance of the tongue, the nature of exudations or expectorations, the quality (not just the rhythm) of the pulse and so forth to arrive at a diagnosis and a course of treatment. Then, in the mode of traditional herbalism, the practitioner would make a preparation specific to that patient’s needs.
The goal of personalized healthcare as it relates to dietary supplement formulation is similar. The products that sit on the shelf are generally a one-size-fits-all deal; their dosages, and to some extent their formulations (for multi ingredient products) are arrived at by a process of compromise. And the variegation of dosages, and to some extent the choice of ingredients, remains tied to the underlying science. The Western scientific method seeks to restrict variables as much as possible to arrive at results that can clear the bar of statistical significance. Figuring out study designs that could yield reliable results when you are dealing with subject groups of one, as might be implied with full personalization of products, is challenge for the future.
In the personalization scenario, data could be gathered from the individual consumer, much as an herbalist goes through his or her diagnostic decision making tree, to arrive at formulation more specific to that person’s needs. Can one camp learn from the other?
Roy Upton, a practicing herbalist and founder of the American Herbal Pharmacopoeia, said ‘traditional herbalism’ is a concept that covers a lot of ground. While there are reams of information available on individual herbs from all of the world’s herbal traditions, there is less formal structure around how to use those herbs in concert, with some notable exceptions.
“Not all herbal traditions have well developed principles for how to formulate. However, such principles do exist in Chinese medicine and are fairly well developed,” Upton said.
Bringing ancient ideas into modern age
These underlying principles were developed at time when people didn’t move around much and were more tied to the land. Chinese doctors tried to take into account the local environment when decided on a formula, leading to the inference that the same basic formula be slanted one way by an herbalist practicing in cool, arid north as compared to one treating patients in the humid south.
“Today's populations are not as tied to the environment as we were in ancient times so that does not quite work as nicely anymore but is still a consideration for practitioners. It is just not that applicable to a broad diverse population,” Upton said.
Beth Lambert is CEO of Herbalist & Alchemist, a manufacturer of traditional tincture type products based on formulas put together by company founder David Winston. Lambert said her company’s formulas have always harkened back to these underlying traditional principles, but have to take modern market dynamics into account.
“Traditional herbalism has always been personalized. We herbalists are taught that an herbalist treats a person, not a “condition”. The challenge for a product formulator would be how narrow their formulation would need to be to effectively address a specific condition and still appeal to a wide enough market to make it practical to produce,” she said.
Lambert said the company still does create specific formulas requested by certain practitioners. The company has been winding down the business, but she hesitates to get out of it entirely because some customers have come to rely heavily on the service.
Already personalized to some extent
Lambert said in so far as is possible, her company offers products tailored to support the health of consumers who might be in different stages of health. For instance, to match a consumer up with the best respiratory health product, the company might seek answers to the following questions:
- Is the condition Hot (Red Inflamed tongue and throat)
- Cold (White tongue, more stagnant condition)
- Dry (little to no mucus and hard to expectorate)
- Wet (profuse mucus)
- Or is coughing the major issue.
Formulating for energy support
Upton said understanding what’s going on with the consumer at a deep level is the key issue toward being able to create effective formulas in this mode. This is easier when seeing a patient in person, but applies in principle to all modes of interaction with consumers. And key to the process, too, is knowing in detail how the ingredients work together.
For example, a lack of energy is a frequent complaint on the part of Western consumers. Upton said underlying causes could included overextending oneself or simple old age, poor digesting leading to poor assimilation and poor nourishment, or a sluggish respiratory system from insufficient physical activity or other lifestyle factors. An herbalist might choose from a suite of herbs such as energy tonics such as ginseng or ashwaganda or adaptogens like rhodiola or schisandra to address the first issue. The digesting piece might be tackled by a digestive tonic like astragalus or a warming carminative like cinnamon or ginger, whereas circulatory issues might be dealt with by the inclusion of Chinese salvia or ginseng.
“All medicine is more of an art than a science. Intuition that arises from a strong knowledge base and experience are integral to being a good practitioner,” Upton said. “Formulating in this way addresses the primary factors underlying the condition. Of course, like a chef, you also have to have an understanding of what botanicals work well together complementary and which do not. That comes with experience and is difficult to create as a recipe.”
Lambert said that the more specific the product, the more careful the instructions for use need to be.
“One needs to be very clear about the intent of a formula and describe as well as possible the Specific Indications for its use. David Winston provides such detailed information for the formulas he developed in his book Herbal Therapeutics: Specific Indications for Herbs and Herbal Formulas, which he updates as formulas are changed over time,” she said.