Chronic Lyme disease and its associated co-infections present complex clinical challenges not only due to persistent infection but also because of profound immune dysregulation. Borrelia burgdorferi—a stealth pathogen—evades immune detection through antigenic variation, complement inhibition, and biofilm formation, leading to chronic activation of the immune system and systemic inflammation. This results in suppression of innate immune pathways, disruption of Th1/Th2/Th17 balance, mitochondrial dysfunction, and auto-inflammatory signaling cascades, contributing to symptoms such as fatigue, neuropsychiatric instability, cognitive dysfunction, pain syndromes, and dysautonomia (Anderson & Brissette, 2021; Levy et al., 2017).

Pharmaceutical antibiotics, while often necessary to reduce microbial burden, can further impair immune function through microbiome disruption, hepatotoxicity, and persistence of non-replicating bacterial forms. As such, restoring immunocompetence—the body's innate capacity to respond appropriately to infection and inflammation—is a critical component of successful, long-term resolution. This involves not only eradication of pathogens, but also terrain repair: modulating inflammation, rebalancing immune function, and supporting organ systems responsible for detoxification and barrier integrity (Cristofori et al., 2021; Schwartz et al., 2020).

Herbal and lifestyle medicine offer a systems-based framework for restoring immunocompetence. Botanical agents such as Scutellaria baicalensis, Polygonum cuspidatum, Cordyceps sinensis, and Ashwagandha have been shown to inhibit inflammatory cytokines (e.g., IL-6, IL-8, TNF-α), regulate NF-κB signaling, restore T-cell function, and promote resilience across immune networks (Feng et al., 2020; Gasmi et al., 2023; Liu et al., 2019). Antimicrobial botanicals including Cryptolepis sanguinolenta, Houttuynia cordata, and Artemisia annuaexhibit efficacy against both active and stationary forms of Borrelia, while avoiding the adverse effects of antibiotics on gut and liver function (Shor & Schweig, 2023; Park et al., 2017).

Therapeutic lifestyle modifications—particularly those that address gut health, sleep regulation, stress, and environmental toxic load—are equally essential. Chronic tickborne infection is commonly accompanied by dysbiosis and increased intestinal permeability, which further impair immune signaling and drive neuroinflammation (Levy et al., 2017; Rogers et al., 2016). Therefore, a comprehensive, individualized protocol that integrates herbal therapeutics, immune and mitochondrial support, detoxification strategies, and microbiome repair is essential to resolving infection and achieving sustainable wellness.

This presentation outlines the clinical rationale and practical application of herbal and lifestyle interventions in restoring immunocompetence in patients with persistent Lyme disease and tickborne illness. It presents a model of care that is evidence-informed, terrain-centered, and designed to help patients shift from chronic illness to restored immune capacity and long-term remission.