An Herbalist’s Method: Using Functional Medicine to find the Root Cause

As a clinical herbalist, I often find myself describing to people what, exactly, I do. They may wonder if I can help them sleep better (spoiler: yes), but not really know how I work, or what they will need to do.

Part of the problem is that herbalism in the United States is somewhat on the periphery. In many parts of the world, medicinal herbs are mainstream and commonly relied on by healthcare providers and families. In Australia and parts of Europe, herbal care is even integrated as part of their medical system. Americans haven’t had the same exposure to the profession, and in conversation I have found widely different impressions of what clinical herbal medicine is. Allow me to share some of how herbal medicine is practiced in the United States today (as well as some insight on how an herbalist might help you with health concerns like night sweats, digestive problems, or chronic pain, or whatever is troubling you).

First, it’s probably no surprise that herbs are a primary recommendation you will get from a clinical herbalist. But, they are not the only one. They are part of a holistic strategy that also includes nutritional and lifestyle modifications. Herbs can be quite powerful, but if used without regard to other aspects of our lives – food, movement, rest, social connections – their efficacy can be limited. Similarly, it is important to note that an herb is not a substitute for a pharmaceutical drug.

While it may be tempting to want an herb for _____ symptom or ____ disease, and some doctors and other practitioners will make recommendations like these, a trained herbalist seldom suggests herbs in isolation to treat a single symptom or condition. Instead, herbalists combine herbs synergistically to address what we identify as the root cause of that symptom. To do this, some clinicians (like me), use a Functional Medicine model to assess how well (or not) the body and mind are working.

What is Functional Medicine?

Functional medicine aims to get to the root cause of illness and disease, as opposed to treating the symptoms that are a result of the disease. Instead of looking at body (organ) systems as individual entities, functional medicine organizes an assessment in terms of several functions that the body must perform to maintain overall health.

For example, the Institute for Functional Medicine, started by Dr. Jeffrey Bland, M. D. and his wife Susan, classifies physiologic functions into 7 categories: assimilation (of what we bring into our bodies – food, air), defense and repair (immunity, inflammation), energy (metabolic functions), biotransformation and elimination (detoxifying foreign substances), communication (neural, hormonal), transport (blood and lymph circulation), and structural integrity (musculo-skeletal, also cells and tissues).

If you begin to look at a state of health in terms of these functions which may cross multiple organ systems, it naturally follows that a dys-function may have any number of different causes – different pathologies, multiple pathologies, environmental or genetic influences, diet and lifestyle choices, even social situation. Functional medicine investigates all of this in detail in partnership with the patient. The goal is to discover areas of imbalance that may be resulting in the current (presumed) dys-function – the root cause. The answer will be specific to the individual, which allows for a tailored treatment strategy. The end goal is that by treating the underlying imbalances, the dys-function or dis-ease will disappear (or at least diminish).

The IFM describes the functional medicine model as:

“an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness.”

This is different from what we think of the ‘standard’ medical model, which tends to focus on specific organs or organ systems, often without consideration of relation to other body systems or facets of the individual (think about going to see a cardiologist, an endocrinologist, or any number of other, specialized ‘-ologists’). The goal is to discover a specific, named disease, and then follow a standardized treatment protocol. The IFM agrees that this drug-based model of fighting infectious diseases worked very well in the 20th century; however, it does not align quite as well to today’s growing chronic disease epidemic, which is often caused by genetics, environmental exposures, and lifestyle choices. Instead, the IFM advocates and teaches a systems oriented, patient-focused clinical model, one in which herbs and herbal medicine are particularly well-suited to follow.

Let’s look at an example of how this might play out in herbal medicine. In my practice I see many clients who come to me with ‘sleep issues’. A simple response might be to provide an herb that is known to have sedative effects (valerian is popular for this). Now, this may provide relief for some, but without diving into more detail as to what is causing the sleep issues, results will be very limited. Instead, what I do is begin to explore potential root causes with the client. I ask questions like: Are you having trouble falling asleep and/or staying asleep? What are your stress levels and where do they manifest in your life? Do you have digestive distress (what kind and when)? Cramping or physical pain (where, when, how severe?) For women, do you have any menstrual challenges? Men, do you wake numerous times to urinate?

The answers to these questions guide me into selecting specific herbs to address any multitude of causes that may impair the ability to fall and stay asleep. And the beauty of herbal medicine is that I am not limited to selecting just one! I put together a combination of herbs – some that can individually address more than one functional imbalance – to address what I assess to be the overall root cause of the sleep difficulty.

Root causes and herbal helpers

Here are some actual herbal examples of root causes of sleep dysfunction and herbal matches:

1. Indigestion, nausea: chamomile, peppermint, ginger 2. Anxiety: skullcap, holy basil, kava 3. Stress with cardiovascular symptoms: motherwort, linden (tilia) 4. What I like to call the ‘squirrel brain’ (inability to shut off that circular thinking): bacopa 5. Aches and pains: California poppy, passionflower 6. Night leg cramps: cramp bark, black haw 7. For women: night sweats or hot flashes: sage, possibly chaste tree or black cohosh 8. For men: frequent nocturnal urination: saw palmetto, maca 9. Trouble falling and staying asleep: valerian, hops

In addition to combining these herbs (and many others!), we would also assess the sleeping environment and pre-bedtime routine. These aspects are equally important in improving sleep. In terms of environmental influences I would ask into: what are you eating before bed and when? What is your sleep environment and what, if any, is your wind-down routine? How much movement do you get throughout the day? I have had clients that report back that something as simple as keeping their phone or TV out of the bedroom or taking the time to make a cup of tea made a huge difference in their ability to fall asleep. As you can see, a simple question of ‘Can you help me sleep better?’ can have any number of responses. Using the functional (and herbal) medicine model, there is no single ‘right’ answer for everyone, only what is right for the individual.

Donna Koczaja, M.S., graduated from Maryland University of Integrative Health (formerly Tai Sophia Institute) with a Master of Science in Therapeutic Herbalism and a Post-Master’s Certificate in Clinical Herbalism. Originally educated as a mechanical engineer, she combines the rigor of her original scientific training with the traditional healing art of herbal medicine to partner with her clients to uncover the root cause of their underlying health issues. Also a Master Gardener since 2008, her primary interest is in inspiring others to improve their health and sense of wellbeing through the joys of gardening and the power of natural medicine. Read more about her, what she does, and why she does it at www.greenhavenliving.com.