by Holly Bellebuono 
One of the most eye-opening (and lighthearted) assignments I give my students in my herbal medicine school is to open their medicine cabinets, pull out any tinctures or herbal remedies they have purchased, and review the label. From the list of ingredients, they try to determine if the manufacturer used a method or reason for including the herbs in the bottle. Often, my students puzzle over a long list of herbs that appear to serve the same function or seem to be fillers or included for taste. They learn that there is actually a very logical method for including herbs in a remedy, and while most commercial producers ignore this, herbalists can easily apply this method—what I call the four-tier formula—to make better and more effective healing remedies.
Despite its high-school-chemistry-sounding name, formulary is simply a way to structure your thoughts when combining herbs into a remedy; it’s a way to categorize a plant’s actions to determine if it should be used for a client or patient for a particular illness or situation and then combine herbs based on those actions. Formulary involves pharmacology, anatomy, and chemistry, as well as intuition and a connection to the person in need. It is a very creative and fulfilling endeavor; there are as many ways to do it as there are herbalists and healing traditions. Many traditions, including Ayurveda and Traditional Chinese Medicine, have perfected their own healing philosophies and methods for formulary, using a solid understanding of how herbs work in a formula. Many also include the ideas of using simples (one single herb at a time) or polypharmacy (the practice of combining more than one herb to create a blend). No one formula is right for every culture or every person, though the four-tier formula is a good starting point when learning how to think about creating your own blends or including herbal medicine in your practice.
Given that there are so many plants to choose from, my students find it immensely helpful to use the four-tier formula structure to narrow down the vast possibility of herbs to a concise few. Many of my students have been relieved to learn how to think about formulary this way because it gives them a practical platform for organizing all those useful herbs. Overwhelmed herbalists ask, “Should I include this herb because it seems relevant? Or perhaps this one? My client needs a soothing demulcent herb. Should I give her mallow or aloe or slippery elm? How do I know which herb will be most beneficial? Could eight herbs be better than four? Can there be too many, or should I throw in everything but the kitchen sink?” The sensible structure of the four-tier formula helps narrow down all those potential herbs to the few that will be most effective.
For the practitioner who is new to herbs or wants to increase his or her knowledge of using plants for health, formulary can seem overwhelming. We have access to literally hundreds, if not thousands, of herbs around the world that have dozens of actions, chemicals, and stories attesting to their uses; combine this with the fact that an herb can be used in one way in Western herbalism and in an opposite way in India’s Ayurveda, and there are countless ways a new herbalist might be confused when creating a new tea blend or tincture. Which herbs are best for which ailments, and which are contraindicated? How much of this herb compared to that one? What about secondary symptoms and other issues? Here is where formulary shines and where the handed-down knowledge of plants really gets exciting. Blending different plants together to complete a whole medicine with a variety of attributes has long been hailed as a master’s-level approach to herbalism, not to mention it’s a lot of fun. Formulary brings together empirical knowledge of pharmacology, botany, anatomy, and, for holistic practitioners, a sense of self and intuitive integrity that is central to the healing arts.
Is there a “right” number of herbs in a formula? Some compound formulas combine every herb with a similar action, but remember that too many herbs in a formula can create a burden for the body to process and expel and can actually render a formula weak since the primary herbs are in lesser quantity. Rather than think about the ideal number of herbs, consider the action of the herb itself, the needs of the patient, and what herbalism has the most to offer:
• Specific curative effects for organs, body systems, and acute illnesses
• Sustainable modulating effects for chronic issues
• Preventive nutritive support for long-term nourishment
Four is not a magic number, but it allows the herbalist to bring in herbs with various actions as tonics, for specific disease support, for corollary issues, and with organ systems in mind. This framework provides a creative springboard from which almost any remedy can be created, a launching pad from which you can adjust or enhance any given treatment for the most effective and nourishing remedies possible. Feel free to use this as a base for your crafting to develop and pursue your own methods.
Four-Tier Formulary
First, begin with understanding an herb’s many actions. Its actions are those properties or qualities that an herb has on an organ or system of the body. It’s what an herb does. For example, motherwort (Leonurus cardiaca) has several actions: it is nervine, cardiotonic, and bitter. This means motherwort can be used in situations when someone is feeling anxious, is experiencing hypertension, or has indigestion. Ideally, motherwort’s actions will overlap to help someone experiencing a range of related issues: motherwort is perfect for a person who is so nervous or anxious that she gets an upset stomach and a racing heart.
Plant actions are at the heart of herbal medicine and formulary. Learn that sage is astringent and antibacterial and antifungal. Learn that peppermint is aromatic and carminative and too many more actions to list. Slippery elm is demulcent; calendula is emollient. By educating yourself about an herb’s actions, you will learn all the ways it can be used in various situations. I encourage my students to keep an action notebook with pages titled (in alphabetical order) astringent, bitter, carminative, emmenagogue, immunomodulating, sedative, tonic, and so on. There are scores of actions attributed to herbs, and keeping such a journal helps the herbalist categorize which herb does what and how its many actions overlap.
Once you know an herb’s actions, you can apply the herb to the proper category in the four-tier formula, as follows:
Tier 1: Tonic
Tier 2: Specific
Tier 3: Corollary
Tier 4: Vehicle
These are straightforward categories that form the basis of every formula. In other words, each remedy you make will contain one herb that is tier 1, one herb that is tier 2, and so on, making for a four-herb remedy. As you become comfortable with this structure, you’ll be able to add on and substitute to customize remedies for your clients and patients.
Tier 1: The Tonic
The foundation of my formula structure is nourishment, which is the tier 1 tonic. Tier 1 herbs are meant to be taken long-term to nourish, support, and sustain. Many tier 1 herbs are precisely those that we enjoy drinking as teas or infusions every day because they are delicious, mineral-rich, and “energizing” (though no tier 1 herbs contain caffeine). Examples of tier 1 herbs are lemon balm, nettle, red clover, alfalfa, ashwagandha, oatstraw and milky oat tops, gotu kola, vervain, ginkgo, red raspberry leaf, violet leaf and flower, holy basil (tulsi), and hawthorn. Tonics are safe, plentiful herbs that are not endangered or at-risk (consult United Plant Savers for more information about at-risk herbs); they contain few phytochemicals (such as alkaloids) that could render them “active” or “curative” medicines; and they almost always are rich in the nutrients our bodies need, such as calcium, potassium, iron, and magnesium.
Generally, tier 1 tonic herbs can be consumed safely, often as foods, and can be taken for weeks, months, or even years with positive effects. Why would a formula not include a more power-packing remedy for tier 1 when your client is suffering from a viral, bacterial, or fungal infection, a wound or injury, or a mental or other physical illness? Because your client is not only that infection or illness. By addressing the client as a victim, as the illness itself, or as a number (these are common habits in the modern system of allopathic medicine), your client loses self-respect, responsibility for healing, and the impetus and inspiration to get well. Instead, herbalism promotes the care of people, not diseases.
Generally, tier 1 tonic herbs are in the greatest quantity in the formula, usually twice as much as tier 2 herbs. For instance, if nettle is tier 1, it is listed as “2 parts” while peppermint, which might be the tier 2 herb, is listed as “1 part.”
Tier 2: The Specific
Tier 2 specifics are the primary herb for any given condition or illness. Specifics are particular to a system of the body, directly influence the body’s ability to deal with an illness, or are capable of ridding the body of a disease. Tier 2 herbs include goldenseal for bacterial infection, yarrow for fever, and elderflower or horseradish for sinus congestion. Tier 2 is the closest thing we’ll come to in herbalism to a magic bullet. When people feel they are coming down with a cold and think, “I should take echinacea,” this is a magic bullet approach. Instead, broaden your approach to include other herbs, one of which (echinacea) may be a tier 2 specific in the formula, working in concert with other herbs to address secondary or corollary symptoms and needs.
Start with the tier 2 specific and build the other tiers of the formula after that. Our minds tend to start with the “magic bullet” approach—the herb that seems most obvious—so let your mind do this and then broaden the formula from there.
The tier 2 herb is also being used with discretion in terms of quantity—often tier 2 herbs will be used in half the quantity as the tier 1 herbs, or even less, though they’ll usually be in greater quantity than tier 3 or tier 4 herbs. It’s also important to remember that tier 2 herbs won’t be used for the same length of time as tier 1 tonic herbs; for example, a person may only need horseradish (tier 2) for a few days, while they’ll need the tonic benefits of nettle or elderflower (tier 1) for weeks. Be sure to adjust the formula as needed so that the specific is only being taken when it’s actually needed.
Tier 3: The Corollary
Tier 3 corollary herbs can be a versatile bunch. They may (1) address issues that come along with an illness, such as a sore throat from vomiting or painful urination from a urinary tract infection; (2) be bitters to support digestive health; or (3) be warming herbs to support circulation. This tier is sometimes called adjuvant, supportive, corollary, or secondary. Tier 3 herbs can either help the specific herb in its function (i.e., help tier 2), or they can address secondary symptoms that aren’t addressed by the tier 2 specific. For example, in the case of a urinary tract infection, fighting infection is the job of the tier 2 specific, but addressing the pain is the job of the tier 3. Echinacea, goldenseal, or yarrow would be an appropriate tier 2, while mallow or calendula would be a tier 3.
In an example of a topical remedy, a formula may be created for a wound that includes calendula as tier 1, yarrow as tier 2, and red clover as tier 3. All three herbs are vulnerary, meaning they help heal wounds. But thinking of red clover as a tier 3 recognizes its soothing effects that are supportive, while yarrow is styptic.
Tier 3 herbs can be warming or bitter. Warming herbs and spices “open up” a person to herbal healing, speeding blood flow and improving both digestion and circulation so that the tier 2 herbs can work most effectively. Warming herbs, such as mustard, cayenne, ginger, clove, and cinnamon, are especially helpful in cold or stagnant conditions, and they can be added whenever there is mental fatigue, blockage, slow movement, or confusion. Bitters make a wonderful tier 3 addition because they naturally stimulate the body toward active digestion, supporting a process central to daily function and indirectly supporting other tiers in the formula.
Tier 4: The Vehicle
Finally, tier 4 herbs are the vehicle or carrier, that special herb that has what herbalists call an “affinity” for a certain organ or system of the body. These herbs usher the real workers to the area of the body where they’re needed, so to speak. In the case of UTI mentioned previously, I might use yarrow as the tier 4 because it is a diuretic and naturally goes to the urinary tract. Yarrow has multiple actions, making it an overlap herb and ideal for a UTI: it is antibacterial, diuretic, diaphoretic, and bitter. As a vehicle, it will usher other herbs to the urinary system; other vehicles for a UTI include pipsissewa, nettle, and dandelion.
The idea of a vehicle or carrier herb may seem vague at first, but it draws from a lengthy heritage of herbalism and observation of how plants act in the body; it refers to the many instances where plant chemistry closely matches body chemistry and certain herbs really do have a pronounced effect on certain organs or systems. For instance, feverfew and ginkgo act as vasodilators, opening the arteries and vessels and thereby increasing blood flow to the brain; as such, these herbs can be considered tier 2 specifics for a headache, but they can also be tier 4 vehicles when another herb is the specific. Similarly, raspberry has traditionally been considered in herbal medicine as having an affinity for the uterus; in formulas for pelvic inflammatory disorder or uterine cramping, raspberry can be an excellent choice as a tier 4 vehicle. External formulas (for salves or ointments) generally do not require a tier 4 herb.
If there are no practical vehicle herbs, you may leave out the tier 4 altogether or replace it with a tier 2 or tier 3 herb. Generally, the goal should be to use as few herbs as possible to achieve the greatest results. For this reason, look for those multipurpose herbs with actions that overlap—herbs that achieve many results in various body systems. The quantity of the tier 4 herb can be much smaller than the others, one-half to one-fourth the quantity of the tier 1.
Formula Examples
When developing formulas, keep in mind the herbs can all be in the same bottle but don’t necessarily have to be. For instance, the tier 1 tonic may be given as a tea throughout the day, while all the other herbs may be in a tincture.
In the following examples, the healing arts practitioner has already learned the actions of the herbs used: we know that skullcap is mildly sedative and nervine, that willow is analgesic, and that feverfew is analgesic and has traditionally been used for its vasodilator effects as a vehicle for the head. Based on these actions and considering the person’s symptoms, the following formula makes sense for a mild headache:
A Formula for a Mild Tension Headache
2 parts skullcap
1 part willow
1 part lavender
1 part feverfew
Similarly, we know that hawthorn, linden, and hibiscus are safe hypotensive herbs (they lower blood pressure) and nervine tonics, that dandelion is diuretic and as such can relieve pressure on the heart, that oats are calcium-rich and nervine, and that motherwort is a great overlap herb for the cardiovascular, digestive, and nervous systems. A couple of good formulas for high blood pressure would draw on these herbs in the following proportions:
A Formula for High Blood Pressure
2 parts hawthorn
2 parts linden
2 parts dandelion leaf
1 part oatstraw or milky oat tops
Another Formula for High Blood Pressure
2 parts hibiscus
1 part hawthorn
1 part linden
1 part motherwort
The following is an example of a four-tier formula without a vehicle herb. If desired, a fourth herb that supports the other tiers, such as holy basil (tulsi), dill, or catnip, could be added.
A Formula for Food-Triggered Gas
2 parts chamomile
1 part fennel
1 part spearmint
Next, we’ll see elderberry and sage both being used but in different ways; the first addresses sinus congestion, while the second is for a wet cough. Astringent sage is ushered to the sinuses using horseradish as the tier 4 vehicle, while the cough employs wild cherry. Be creative, as there is no one right method, and overlap herbs, such as sage, are very versatile. These formulas can be taken as a tea, tincture, or capsule:
A Formula for Sinus Congestion
2 parts elderflower
1 part elderberry
1 part yarrow
1 part sage
½–1 part horseradish
A Formula for a Wet Cough
2 parts mullein
1 part sage
1 part coltsfoot or elderberry
1 part wild cherry
Developing this type of formulary will help the healing arts practitioner build a strong foundation for clear, effective, and intuitive remedies. Formulary is one of the most interesting and enjoyable parts of herbal medicine—up there with spending time in a sunny garden or hearing from a client that they feel better. Using creative formulary is a rewarding and effective skill in your herbal repertoire.