There is a concept in natural healing that when one has been unhealthy for many years, adopting a comprehensive natural health care regimen that includes changes in diet, herbal supplements, etc. will often lead to a temporary period of feeling unwell. This is often been described in natural healing circles as a “healing crisis. It is a typical expectation of practitioners of naturopathic medicine. The healing crisis was frequently mentioned by advocates of fasting and vegetarian diet during the 20th century. 

How could a form of medicine as sophisticated and voluminous as traditional Chinese medicine not recognize this phenomenon? One idea was that the adverse effects experienced from forms of natural medicine that were applied in a one-size-fits-all model rather than the highly personalized approach taken by Chinese physicians was that the initial period of ill effects was due to misdiagnosis and poor prescribing. If these practitioners knew how to do sophisticated pattern differentiation like a Chinese herbalist, these periods of feeling unwell would never occur in the first place. It is notable that the discomfort often centered around the functioning of the gastrointestinal tract. 

The concept of the healing crisis has resurfaced recently amongst those adopting a ketogenic diet. It is often referred to as the keto flu. The observation that the body may go through a period of adjustment when adopting a new health regimen has also surfaced recently in the study of probiotic/prebiotic supplementation. Finally, there is a growing body of evidence that many Chinese herbal medicines, and herbal medicines in general, exert a significant portion of their “balancing” effects via interaction with the microbiome. I think there is a distinct possibility that the healing crisis is a real phenomenon and is largely centered around a sudden alteration of the microbiome. Let’s consider how this hypothesis may explain the occurrence of this phenomenon in a variety of apparently unrelated approaches to heath as well as the absence of this concept from traditional Chinese medicine. 

When you change your diet, you alter your microbiome. This is now abundantly clear. Because your microbiome interacts with the immune, nervous, and endocrine systems, significant alterations cause the body to change its physiological function. During the process of new flora growing and old ones being inhibited, changes to the functioning of the gastrointestinal tract would be expected. Naturopathic physicians of the 19th and 20th century often wrote about the diets of their patients. Those diets tended to center on fatty meats and starches. By the end of the 19th century, many of the animals being eaten by urban dwellers were raised in abysmal hygienic conditions and much of the starch intake was in the form of refined carbohydrates. We know now that a diet of this sort cultivates a microbiome that is not conducive to optimal health. So, when adopting a diet that is high in vegetables, and plus fiber, there will be a period of microbiome adjustment with possible symptoms of discomfort until the process is stabilized.

Why did traditional Chinese physicians not remark frequently about this phenomenon in classical times? Gastrointestinal discomfort is a widely reported symptom by those taking Chinese herbs in the modern west. As I noted above, the occurrence of gastrointestinal symptoms after taking a Chinese herbal formula by a modern western patient is typically dismissed as either an incorrect formula or the need to adjust the formula for problems in the digestive system that were not identified during the initial consultation. I propose another possibility.

That a traditional diet of a premodern Chinese villager was relatively low in animal fat and high in both pre-biotics and probiotics. As a result, the typical patient probably had a good microbial diversity to begin with and the consumption of a Chinese herbal formula that work in part by altering the microbiome was less disruptive than it would be in someone with a more typical modern micro biome. This is also probably the reason for the anecdotal observation amongst practitioners of natural healing that their medicines are far more effective in people living a healthy lifestyle, which has led critics to claim that the medicine itself is without benefit and all of the improvement is due to movement toward healthy diet and exercise.

With this in mind, what is the best course of action when when one is experiencing the feeling of being chronically unwell and is considering seeking out the services of a natural healthcare practitioner. My personal approach would be to first make slow and gradual changes to one’s diet to move oneself in the direction of a healthy microbiome. That would emphasize a whole grain, plant-based diet, consuming about 30 different types of plant foods per week, including small amounts of naturally fermented products like sauerkraut and kimchi. I would make this change slowly and methodically for about a month before beginning an herbal or nutraceutical regimen that was designed for long term rebalancing of one’s physiology. I would take herbs to help with symptoms that arise during this time but steer clear of complex herbal formulas that may be dependent upon a diverse microbiome to be both effective and generally positive in their effects.