The art & science of herbal formulation can be viewed as a pinnacle of clinical herbal medicine. And from a societal perspective, a defining factor in human intellectual and medical achievement as well. Every culture in the world has hundreds of species they rely on for their health and well-being; we can define the ability to recognise a few hundred species at every stage of growth, as well as know how to use every part of the plant, as a sign of high cultural intelligence. Our ability to have sifted through the 250,000 or so flowering plants, (along with numerous fungi, minerals and fauna), to refine a collection of the most therapeutic, and then be able to combine them for maximum efficacy is a wonder of human ingenuity and compassion.
All herbalists know that creating a differentially diagnosed treatment plan develops the building blocks to make a personalised formula that optimise the chances of clinical success. However, there are as many ways to prescribe herbs as there are routes up a mountain, be that as a single herb, in formulas, low-dose, high-dose, as teas, decoctions, tinctures, pills, salves, steams or subjects of contemplation to mention a few. And beyond the desired efficacy there are many important factors to consider in terms of quality, safety, sustainability, dosage, contraindications, interactions, side-effects, compliance, cost and taste. Its no surprise that the world of herbal pharmacy is complex; its dealing with the very heart of Nature and our interdependent relationship with that complexity.
The oldest recorded evidence of medicinal plant recipes has been found on Sumerian clay slabs from Nippur, dated c2500 BCE. Numerous prescriptions including a range of over 250 plants have been found. Further evidence of our growth in medical knowledge occurs in the Ayurvedic Charaka Samhita c150BCE and early Chinese teachings in the Huang Di Nei Jing (Yellow Emperor’s Inner Classic) and the Shanghan Lun, Treatise on Cold Diseases, from c200CE. Earlier formulations from around 3BCE have been discovered in China such as the Wu Shi Er Bing Fang (Formulas for Fifty Ailments) but they are more basic constructs lacking names, energetics and differentiation. Collectively, these seminal texts contain the earliest evidence of the first formula classifications based on differential diagnosis. As knowledge and experience grew the great herbal traditions of Greece, India, China, Japan, Africa, Arabia, and the Americas all developed insight into blending different species to gain more specific and enhanced effects. Whether you call it a blend, prescription, recipe or formula, its at the heart of clinical herbal medicine.
What’s in a formula?
A herbal prescription is a blend of herbs ranging from 1 to over 50 herbs plus, though more commonly from around 6-12 herbs. These formulas are often prescribed as a powder, pill, water (tea or decoction) or alcohol extraction (tincture or extract). Depending on the client, the illness, and the herb(s), the dose can range from low milligram doses to 100g or more a day. Today we understand this idea of formulation, of how combining species together brings greater efficacy and safety, through the idea of synergy which is another way of saying “The whole is more than the sum of its parts”. Synergy implies a reciprocally beneficial relationship where plants’ nutrients and phytochemicals potentiate and support one another yielding a therapeutically superior result beyond that of their individual effects. It opens up to the ideas of creative emergence where something can materialise out of the complexity that would not have manifested otherwise.
Given our 10 million or so years of human evolution its no surprise that our human genes respond very well to a wide range of low dose natural phytochemicals. Just think, if there are 1000 compounds in a plant and as we used to sustain our diet from around 150 species of plants (compared with around 20 today) our human eco-system is familiar with around 150,000 plant molecules. In contrast to this, modern medicine’s high-dose, single-molecule medicine has no precedent in our evolutionary history. Whilst a high dose of a drug may be valuable in an emergency, herbs are the medicines we evolved to use for our everyday health. Tradition and synergy prove they work best when used as whole herbs, or full-spectrum extracts, in blended formulae.
As alluded to above, synergy is coupled with diversity. More diversity leads to greater efficacy and safety. Synergy is coupled with greater efficacy as a low dose of many compounds work together to enhance their effects; e.g. energetically Ginger and Black pepper when used together are more pungent than when used alone, and phytochemically, Berberine’s bacteria modulating effects are enhanced by Methyoxylated flavonolignans in Mahonia aquafolium, or the multiple compounds in Hypericum perforatum that have been attributed with neurological effects, are more effective taken together than alone. And safer. Synergy is coupled with safety as it can also ameliorate potential toxicity of some compounds; many herbs, such as aconite or calamus are traditionally prepared with other herbs, such as licorice and/or ginger, to mitigate extremes.
A great summary of synergy in herbal medicine is here by Eric Yarnell : https://restorativemedicine.org/journal/synergy-in-herbal-medicines-part-1/
Also valuable to read is Lisa Ganora’s Herbal Constituents, Foundations of Phytochemistry.
Whilst there many insights from different cultures, my experience is rooted in the Ayurvedic, Chinese and Western herbal traditions and so we will explore those approaches to making a herbal formula.
References and further reading
You can find more articles on Herbal Medicine on our Insights page
- Ayurvedic Pharmacopoeia of India, Government of India, 2001, India
- Bartram, T, Encyclopedia of herbal medicine, Grace Publishers, 1995, UK
- Bensky, D and Gamble, A, Chinese herbal medicine: Materia medica, Eastland Press, 1989, USA
- Bensky, D and Gamble, A, Chinese herbal medicine: Formulas & Strategies Eastland Press, 1993, USA
- Bhishagratna, K, Susruta Samhita, Chowkhamba Press, 1996, India
- Bone, K, Clinical applications of Ayurvedic and Chinese herbs, Phytotherapy Press, 1996, Australia
- Bone, K, A Clinical guide to blending liquid herbs, Churchill Livingstone, 2003, UK
- Bone, K and Mills S, The principles and practice of phytotherapy, 2nd edition Churchill Livingstone, 2013, UK
- British Herbal Medicine Association, British Herbal Compendium, BHMA, Vols 1 and 2, 1992, 2006, UK
- British Herbal Medicine Association, British Herbal Pharmacopoeia. BHMA, 1983, UK
- Che, Chun-Tao & Wang, Zhi & Chow, Moses & Lam, Christopher. (2013). Herb-Herb Combination for Therapeutic Enhancement and Advancement: Theory, Practice and Future Perspectives. Molecules (Basel, Switzerland). 18. 5125-41. 10.3390/molecules18055125.
- Chen J and Chen T, Chinese medical herbology and pharmacology, Art of medicine press 2004, USA
- Dash, B, Fundamentals of Ayurvedic medicine, Konark Publishers, 1978, India
- Dash, B, Materia medica of Ayurveda, Jain Publishers, 1991, India
- Dash, B and Sharma, R, Charaka Samhita, Chowkhamba Press, 1996, India
- Dwarkanath, C, Introduction to Kayachikitsa, Chaukhambha press, 1996, India
- Ganora, L, Herbal Constituents, Foundations of Phytochemistry, 2019, USA
- Gogte, V, Ayurvedic pharmacology and therapeutic uses of medicinal plants, Bhavan’s Book University, 2000, India
- Govind das Vicharita, Bhaishajya Ratnavali, Motilal Banarsidas, 1997, India
- Hoffman, D, Medical herbalism, The science and practice of herbal medicine, Healing Arts Press, 2003, USA
- Kaptchuk, T, The web that has no weaver: understanding Chinese medicine, Congdon and Weed, 1983, USA
- Lad, V, Textbook of Ayurveda: Fundamental Principles, The Ayurvedic Press, 2002, India
- Lad, V, Textbook of Ayurveda: General Principles of Management and Treatment, 2012, The Ayurvedic Press, 2002, India
- Maclean, W and Lyttleton, J, Clinical handbook of internal medicine, Volume 1& 2, University of Western Sydney, 2002, Australia
- Meulenbeld, G, The Madhava Nidana and its chief commentary: chapters 1-10, Leiden and Brill, 1974, Holland
- Meulenbeld, G, Reflectons on the basic concepts of Indian pharmacology, in studies on Indian medical history edited by G Meulenbeld and D Wujastyk, Forsten, 1987, Holland
- Meulenbeld, G, A history of Sanskrit medical literature, Egbert Forsten. 2001, Holland
- Mills, S, The essential book of herbal medicine, Penguin Arkana, 1991, UK
- Murthy, P, Sarangadhara Samhita, Chowkhamba Press, 2001, India
- Murthy, S, Vagbhata’s Astanga Hridayam, Krishnadas Academy, 1991-1995, India
- Murthy, S, Madhava Nidana (Roga viniscaya) of Madhavakara, Chaukambha Orientalia, 1995, India
- Murthy, S, Sarangadhara Samhita, Chaukhamba Orientalia, 1995, India
- Murthy, S, Bhavaprakasha of Bhavamisra, Krishnadas Academy, 2001, India
- Nadkarni, A, Indian materia medica, Popular Prakashan, 1954, India
- Namjoshi, A et al, The Ayurvedic formulary of India, Government of India Press, 1978, , India
- Paranjpe, P, Indian medicinal plants: forgotten healers, Chaukhamba Sanskrit Pratishthan, 2001, India
- Paranjpe, P, Ayurvedic medicine, the living tradition, a guide to Ayurvedic generic formulations Chaukhamba Sanskrit Pratishthan, 2003, India
- Rang, H, Dale, M, and Ritter, J, Pharmacology, Churchill Livingstone, 1999, UK
- Reddy, R, Bhaisajya kalpana vijnanam, Chaukhambha Sanskrit Bhavan, 2001, India
- Sexena, N, Yogaratnakara, Chaukhambha Orientalia, 1995, , India
- Sharma, P, Cakradatta: a treatise on the principles and practices of Ayurvedic medicine, Chaukhamba Publishers, 1998, , India
- Svoboda, R, Prakruti: Your Ayurvedic constitution, Geocom, 1988, USA
- Svoboda, R, Ayurveda: life, health and longevity, Penguin/ Arkana, 1992, India
- Svoboda, R and Lade, A, Tao and Dharma, Lotus Press, 1995, USA
- Tierra, M, Planetary herbology, Lotus Press, 1992, USA
- Tillotson, A, The one earth herbal sourcebook, Twin Streams, 2001, USA
- Tirtha, S, The Ayurveda encyclopedia, Ayurvedic Centre Holistic Press, 1998, USA
- Trease and Evans, Pharmacognosy 16th edition, Harcourt 2009, UK
- Tobyn, G, Culpepper’s medicine: a practice of holistic medicine, Element, 1997, UK
- Williamson, E, Major herbs of Ayurveda, Churchill Livingstone, 2002 (Williamson 1), UK
- Zhou, Xian & Seto, Sai Wang & Chang, Dennis & Kiat, Hosen & Razmovski-Naumovski, Valentina & Chan, Kelvin & Bensoussan, Alan. (2016). Synergistic Effects of Chinese Herbal Medicine: A Comprehensive Review of Methodology and Current Research. Frontiers in Pharmacology. 7. 201. 10.3389/fphar.2016.00201.