One of the most fascinating aspects of combination therapy is the potential for the effect of a combination of medicinal ingredients to be synergistic.  Practitioners of many kinds, and perhaps especially naturopathic physicians, rightly have a great affection for the term synergism because it speaks to maximizing benefit after bringing together the best fitting combination of available ingredients to fill a patient’s needs.  But what exactly do we mean when we speak of synergy?   In addition to crystallizing in our minds what we mean when we speak of synergy, in this article we explore how synergy in combination therapy occurs and suggest ways in which a traditional approach to combination botanical therapy can facilitate this phenomenon.

As reviewed by Breitinger,¹ the word “synergy” is derived from the Greek term “syn-ergos,” which means “to work together” and means that “the combination and interaction of two or more agents or forces is such that combined effect is greater than the sum of their individual effects.”  There are many ways that an overall synergistic effect can be achieved, including interactions that affect how a medicine moves through the body (absorption, distribution, metabolism, and excretion–pharmacokinetics) and interactions that affect how a medicine acts on the body (pharmacodynamics).  We take a broad view of what constitutes synergy, e.g. any combination of interactions that is greater than the sum of individual effects, and pause briefly to differentiate synergistic effects from additive effects by emphasizing the view that additive effects are those effects that have no interaction at all between them.²