Herbal Medicine for Fantasy Writers Part 1 - Making It Up (Kind Of)

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Sometimes, you're writing a pre-industrial or non-industrial setting, and you need a character to get, and
be treated for, a condition that can be diagnosed and treated in the here and now, but wasn't known, or wasn't treatable, in the technologically equivalent real-world time period. Maybe there's no magical healing in your world, maybe it's not accessible to the character right now (or their condition is chronic and it's just not available consistently), or maybe it doesn't work for this particular thing. In any case, you know what you need to do: treat it with Herbs. 

However, this can get kind of tricky, as the nature of conditions that were not treatable until the advent of modern medicine is that there probably isn't a well-established and effective herbal remedy. What's more, you don't always want to just invent a plant out of whole cloth, and if you repurpose a real plant, there's a solid chance that someone will Notice. So here's what you do. Please note that this is going to involve a lot of Wikipedia, and if you don't like having a bunch of tabs open, you may want to use a separate window. 

1. Look up current medications for the condition you're trying to treat - Wikipedia will probably have a good list, but feel free to look elsewhere as well. The first thing you're gonna do is look at the Wikipedia page for each medication, and do two things - first, note the mechanism of action. This will usually be expressed as Something Something Inhibitor, Something Something Agonist, or Something Something Antagonist, although the specifics will vary. 

2. Read their pages to see if they have any known natural sources. Let's say your character is a recovering alcoholic, and either support groups don't exist or you have Things To Say about medication assisted treatment. We're gonna skip issues of withdrawal for now, that's a different medication process. For the post-detox treatment of alcoholism, there are basically thee medications: acamprosate, naltrexone, and disulfiram. Disulfiram is an easy one here - its wikipedia page straight up lists the other substances that do what it does, and one of them is coprine, which naturally occurs in inky cap mushrooms. (To a sufficient extent that another name for the mushroom is Tippler's Bane). Unfortunately, what it does is make alcohol violently, rather than mildly, toxic. Unless there are no other options, or the healer providing treatment believe that addiction is a character flaw and wants to punish our alcoholic as much as he wants to help, this is probably not what we want to go with. (Although there are other situations where we might. For example, if the character is a known drunk, and will need at some point to prove that she was sober when some particular thing occurred, being able to say "I take stuff that makes me extremely and immediately ill if I drink, so since I wasn't obviously, debilitatingly sick, you can be sure I wasn't drunk." might be very helpful.) 

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3. With the mechanisms of action in hand, start finding out what else does what they do. You may be able to find a list of Something Something Antagonists, but more likely you'll need to follow the name of the Something Something Receptor, scroll down to Ligands, and then find Antagonists. Naltrexone is a competitive opioid receptor antagonist, or a weak partial opioid receptor agonist. Acamprosate is a Mystery, but currently believed to be an NMDA receptor antagonist and positive allosteric modulator of GABA-a receptors. It's okay if you don't know what those words mean - I'm not actually sure on the last one. There are a quite a few opioid receptor antagonists, but following all of them down, plus a google search for "naturally occurring opioid receptor antagonists" doesn't point us to any plants or fungi with this effect, even after we spell "occurring" correctly on the third try. It looks like naltrexone is off the table, although it and most drugs like it are derived from opioids, so if you have alchemists or something like them and a willingness to fake it beyond the scope of this post, you may have options. Let's try acamprosate. There are a lot of NMDA receptor antagonists, and they come in flavors, but we can immediately narrow our search a little by finding acamprosate on the list of "uncompetitive channel blockers". (I must stress, again, it's okay if you don't know what that means). PCP is apparently on this list. It's synthetic, but it's also an old drug with a complex history so we'll bookmark that for further investigation. Agmatine is apparently present in fermented foods, so we'll bookmark that as well. Argiotoxin is certainly naturally occuring - it comes from orb-weavers, an incredibly common class of spider found just about everywhere, many of which are not dangerous to humans. I have no idea if the amount of argiotoxin produced by a normal spider bite would do anything here, but if you already have giant spiders, again, options. Ethanol is on this list, and is of course naturally occurring, but rather defeats the purpose here. Magnesium?! Just...magnesium. If managing this with food feels like an option, maybe we can consider this in combination with agmatine. A search for "naturally occurring nmda receptor antagonists" (not in quotes) retrieves an article listing several herbs used in Chinese traditional medicine, and describes how they operate. Unfortunately, they use more descriptive terms than "competitive agonist" and "uncompetitive channel blocker", so now we are going to need to know what those words mean. Wikipedia says that "uncompetitive antagonists block binding to a site within the ion channel" an includes a helpful little diagram, so let's see how that lines up. It sounds like that could be the same thing as "block NMDA-induced current", and one of the things listed as doing that (and nothing else) is an antitussive, a cough supressant, of which there are several (mostly DXM and its relatives) on our list of uncompetitive channel blockers. This sounds very plausible. Folium ginko is the dried leaf of Ginko biloba - finally, a plant! So for our NMDA receptor antagonist, we can use foods rich in agmatine and magnesium, a great deal of orb weaver venom, or ginko leaf tea. Or some combination thereof. 

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4. Technically this should be part of step 3, but that's gotten unconscionably long, so we'll have a separate step for finding our positive allosteric modulator of GABA-a receptors. If we go to the wikipedia page for the GABA-a receptor, and scroll down past a lot of words I don't know, we'll find a description of its ligands, with examples for each type, and there's a decent number of positive allosteric modulators. Just skimming this list, you might actually see some words you do recognize, including ethanol, niacin, theanine, and menthol, as well as some drugs you might know, like barbiturates, benzodiazepines, and zolpidem. Because we appear to have a lot of good options, we're going to start by just checking the ones we can't immediately identify as synthetic drugs. We have options here. Honkiolol and magnolol both come from magnolia bark and seed cones, biacalin comes from skullcap, kavalactones come from kava and shell ginger, niacin is a B vitamin (it's in food), theanine comes from green tea, valerenic acid comes from valerian, and menthol comes from mint. 

5. Make your choices. This is where you have to turn your writer brain back on. Unless you're just describing how something would, theoretically, be treated, for atmosphere, the exact regimen you settle on is going to be informed by the individual you're treating, and her circumstances, and may not represent the entire space of what's available. This particular example is a lot easier if your story is set in Asia or somewhere with a similar biome, because the best confirmed food source of agmatine is doenjang, a traditional Korean fermented soybean paste, and ginko, magnolia, green tea, shell ginger, and one kind of skullcap are all also from Asia. In a European setting, or Europe with the serial numbers filed off, we will have a harder time finding good sources of agmatine (although most fish, meat, and cheese has some), and the word "ginko" may be immersion breaking (although see below), although valerian or concentrated mint are perfectly reasonable sources for our GABA-a modulator, and we can source magnesium from peas, beans, greens, or flaxseed. Obviously, if trade exists, we may be able to work around this, but that's a decision dependent on other factors. So let's say our alcoholic is in a Vaguely European setting. She's getting some dietary intervention. Peas, meat, and fish are all good sources of niacin, peas will add magnesium and the animal products some amount of agmatine. This is great, because she hates peas - conflict! We'll also give her the ink cap mushrooms, less because they're really going to help her than because it makes her partner feel better. We'll use a powder that can go in her tea, rather than making her eat them, though. We can give her valerian for the GABA, maybe with corn mint (we'll make an extract using vinegar). But it's very hard to do without that ginko, especially when we don't have a really good agmatine source. Dextromethorphan, a (hopefully) similar NMDA receptor antagonist, has a half-life of four hours, so that's how often she'll need to drink the tea.

6. Fix the names. Look, there's no particular reason ginko couldn't grow in Europe, it just doesn't, without humans bringing it there. Corn mint, on the other hand, does grow in Europe, but people get distracted by the word "corn". Since you've likely been to the wikipedia pages for both plants at least three times by this point in the process, you probably got this already, but look at alternate names. No one knows what a "maidenhair tree" is, so if you say that's in the tea, it won't be distracting to the casual reader, and the reader who looks things up will be able to follow your reasoning. Corn mint is also called "field mint" or "wild mint", and you can take your pick depending on which has the feel you want. 

7. Explaining and describing. This tea. Is going to taste. Terrible. It's gonna smell like a minty mouse cage. It's gonna be bitter, sour, unsettlingly sweet, and disturbingly thick (because of the mushroom powder), taste subtly but unmistakably like dirt, and burn a little going down. Obviously whether our alcoholic resents this, tolerates it with grim resignation, or thinks it's what she deserves is gonna be down to her characterization. If we don't want tea here, we could make a vinegar based tincture with the herbs (still awful, but you can get it over with faster), and mix the mushroom powder in with the peas she's going to be eating with every meal. Chances are no one in your setting knows what an NMDA receptor is, so we could describe her treatment as being meant to balance her humors, or keep her mind level, or as sort of doing a little of what alcohol does, depending on what a setting-appropriate understanding of medicine looks like here, and what kind of tone you're going for. Since food as part of medical care is more normal than not most times and most places, you probably won't run into any trouble there. 

To be absolutely clear, I can't say for sure if this would work. Medication assisted treatment for alcoholism is a newish thing, newer even than for opiates, and there's a reason we use real drugs instead of herbs. But this isn't really about medical accuracy. Taking this approach will produce results that don't sound wrong, and that will show weirdos like me who google every named medicinal herb in a fantasy series that you did your research.