A History of
Herbal Formulary
There is no one correct way to make herbal medicine. There are, in fact, countless ways to formulate and probably as many valid methods for craftsmanship as there are herbs and herbalists. But there are still some helpful guidelines that have been handed down to us by others who have already tried our “new” ideas and either succeeded or failed. It’s useful to study what people have done in the past and apply these methods to your own current situation, and also to remember that just because it works once doesn’t mean it will always work. Herbs have different effects depending on where they were grown and when they were harvested, just as people respond differently to medications and herbs depending on their environment, their social interactions, and their state of mind at the moment. Flexibility is a key thing to remember and practice in the making of botanical medicine.
Since proper formulary emphasizes the best and most effective ways to combine herbs for healing, it is useful to explore the thousands of years of continuously evolving herbal principles and understanding of human anatomy. Let’s briefly examine the basics of early herbal experimentation and its place within a given culture’s framework of medicine.
Prehistoric Assumptions of Healing
Throughout prerecorded history, people presumably associated healing with unseen gods and mysterious forces of nature. Sickness and healing were purely mystical experiences with no explanation and no reason. Prayer was used as the primary method of healing, and those with perceived supernatural healing abilities became known as shamans, with the term shamanism being applied by Western anthropologists studying the ancient religious practices of the Near East. 1
Shamanism
Later, some of this healing mystique rubbed off on plants, too, especially since ingesting or even touching certain plants can cause profound and immediate reactions, including sickness or death. Plants, and especially trees, were believed to possess magical qualities (such as being the portal to the gateways of death) and even to harbor powerful spirits inside them. The idea of using plants for medicine was infused with something close to a spiritual or even a religious voodoo. Healers (mostly shamans) who used plants were seen as having the special ability to transcend normal boundaries and communicate with deities most people could not. Shamans, a term eventually used to describe “magical” healers in cultures around the world, could communicate with gods, goddesses, sprites, elves, and other unseen forces and ask them to intervene, and most importantly they could communicate with the patient’s own deceased ancestors, who would give guidance and power. Hence, formulary consisted mostly of spiritual communication with the divine—probably part intuition, part listening, part imagination, and part luck. Some shamans and healers were undoubtedly very skilled and began to see effects from the herbs they used; this empirical knowledge was handed down through the generations, but it was also jealously guarded. This amplified the mystique around herbs. In addition, illness was seen as retribution by the gods and punishment for deeds committed on earth. Therefore, since the cause was “supernatural,” often the cure was believed to be supernatural as well, which led to many plants being labeled as magical: mistletoe and mandrake in British lore, for example.
Supernatural Abilities of Plants
The supernatural ability of these magical plants placed them squarely in the center of certain religious beliefs. For example, the ancient Sumerian Epic of Gilgamesh tells of the superhuman king diving into the depths of the sea for the express purpose of bringing up a plant that had the power to confer immortality. 2 In the Judaic story of Genesis, the Tree of the Knowledge of Good and Evil is a magical fruit tree that confers understanding. After eating the fruit of this tree, the first woman and man are banished by God before they can eat from the Tree of Life, which would confer immortality. In both these stories it is implied that eating or tasting one of these particular plants will relieve suffering, heal the body, and sustain immortal life. Though not a “formula,” it is nevertheless fascinating that the idea of plants as vehicles to long or everlasting life is an ancient concept.
A Timeline of Theories
Mysticism did not sit well with inquiring minds who burned to know why plants behaved the way they did in the human body. By the time of Hippocrates (460 BCE–c. 370 BCE), known as the “Father of Medicine,” the theory of humors—using a person’s temperament and coloring to diagnose illness—was well-developed and popular. Hippocrates ushered in the helpful and reasonable ideas that (a) illness is a natural occurrence (not a vindication by angry gods), (b) illness can be treated with natural (rather than supernatural) substances, and (c) the remedies can be gentle and nonviolent (rather than the violent purges used at the time). He also advanced the notion of “humors” and nearly five hundred years later, the Roman physician and philosopher Galen of Pergamon (129 CE–c. 217 CE) built on Hippocrates’s idea with a strict regimen of formulas and protocols based on the theory of humors. His methods indicated an excess or deficit of one of four “liquids” in the body: black bile (melancholy), yellow bile (choleric), phlegm (phlegmatic), and blood (sanguine). Various characteristics were associated with each, including natural elements of the earth (blood with air, yellow bile with fire); physical qualities (black bile was cold and dry while an illness associated with blood was warm and moist); color; and even emotional and personality changes, including thoughtfulness and kindness. Formulary in this system was based on increasing one humor or decreasing another. The patient demonstrating hot and moist (sanguine) characteristics of illness, for instance, might be instructed to eat cold foods and cooling herbs such as chamomile or roses.
About 1,000 years after Galen, both the physician Trotula of Salerno, Italy, and the mystic nun Hildegard of Bingen, Germany, directed herbal clinics, though they used extremely different methods with varying degrees of success. Paracelsus (1493–1541) based most of his healing philosophy on the theory of humors, and even Arabic medicine, normally rational and pragmatic, succumbed in part to the idea of the humors, calling them temperaments. In 1633 John Gerard published his famous Herball and shortly after, in 1653, astrologically-minded Nicholas Culpeper stamped herbal medicine with his star-struck judgments of health and healing. Purging, lancing, and bleeding became favorite methods for removing excess humors, and doctors dismissed any reasonable attempts at nourishment or support.
In the 1830s, renegade herbalist Samuel Thompson challenged physician-directed medicine with assertions that it caused too much harm—often killing the patient instead of saving him, and at the turn of the nineteenth century, Quaker surgeon and inventor Joseph Lister succeeded in educating the medical profession about preventing sepsis and infection. Though popular medicine was becoming more scientifically oriented, it was still badly misshapen around the edges and quite harmful in the mainstream, with patients dying of hospital-caused infection, loss of blood, and continued ignorance of bodily functions. With the advancement of medicine, anatomy, and chemistry, modern medicine or allopathy was finally able to save lives, but it came with a price: herbal medicine, common-sense folk healing, and even the keeping of a nutritious diet were all disparaged in favor of sleek, scientific pills. Finally, in the 1960s, herbalists such as Euell Gibbons were able to reach healers with information about the intrinsic value of plants and their value as nourishing foods and gentle medicines, introducing to formulary the idea of tonics.
Cultural Formulary
All cultures have perfected their own methods for formulary, and many formulas include not only herbs but also animal parts (such as gall bladders or paws), elemental chemicals, minerals, crystals, animal by-products (such as spider webs), and human body parts (such as hair or fingernails). Here we will deal only with healing by plants, so our formulas will be those in which herbs form the foundation of health. Some of the world’s greatest healing philosophies have strong histories of using plants for this purpose and they have developed a wide following and a solid basis for efficacy.
Ayurveda
Ayurvedic methods blossomed in India. Its process for formulary features three human traits expressed by the body as well as by thought and emotion: kapha, vata, and pitta. All of these traits are present in a person, but when they are out of balance, Ayurvedic philosophy teaches that the person will experience changes in his or her structure, function, and emotions. These traits can be measured and illness diagnosed based on the person’s skin tone and color, tongue texture, activity level, mental state, and so on. Formulary is based on balancing these traits through food, massage, materia medica (the “collection” of medicinal plants available to the healer), drink, meditation, and exercise.
Traditional Chinese Medicine (TCM)
TCM promotes polypharmacy, a practice that uses not just a few herbs but as many as sixty or eighty in a single formula. Traditional Chinese Medicine bases its formulary on a person’s energy and “lines” of the body, assessing qi, or energy, deficient states of organs, and presence of heat or cold. In her article “Building a Formula,” herbalist Chanchal Cabrera describes an interesting symbolic part of the Chinese philosophy of formulary: the primary herb in a formula symbolizes the Emperor, the secondary or adjuvant herbs symbolize Ministers of State, and warming or stimulant herbs symbolize servants.
This hierarchy of herbs by head of state easily shows which herb is “most important” or strongest, which is similar to the Western “magic bullet” approach, but it also displays the need for including supportive herbs without which the primary herb would have to work harder, and as Cabrera says, it gives a “layered” effect to the formula. 3
Simplers and Polypharmacy
There are countless ways to formulate medicine within a Western herbal approach, but two of the most basic ways to describe them are the simpler’s method and polypharmacy.
The Simpler’s Method
One of the easiest is the simpler’s method, through which the herbalist uses one herb only, assessing its various qualities and benefits for a holistic view of the patient’s needs. In simple pharmacy, a single plant forms the medicine, and it can be used in a variety of ways. Simples are useful because we can clearly define a plant’s action in the body and determine the pros and cons of that particular plant without having to guess which herb in a formula caused or relieved a certain symptom. Simplers have long been hailed as valuable stewards of plant medicine, and their work is of especial benefit with infants and children.
Using one herb for a variety of issues introduces a potent, singular energy to the healing experience, not to mention a greater depth of understanding of the effects of that herb. Many herbs qualify for the simpler’s cabinet, especially those whose actions overlap, such as yarrow, which is at once antimicrobial, diuretic, and diaphoretic, or motherwort, which is cardiotonic, bitter, and nervine. Another is chamomile: a healer using chamomile can instruct the client to take chamomile capsules before meals for indigestion, sip hot chamomile tea before bed for insomnia, or chew bitter chamomile leaves to calm nerves.
Polypharmacy
But what about combining herbs? What about formulary for complex blends? At a fundamental level, which herbs are best for which ailments and which are contraindicated? How much of this herb compared to that for a specific illness? 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.
Compound formulas, or polypharmacy, utilize many herbs in a given formula. Compound formulas sometimes include everything but the kitchen sink, though too many herbs in a formula create a burden for the body to process and expel, which can actually render a formula weak since the primary herbs are in lesser quantity.
King Mithridates VI, of Pontus and Armenia Minor from about 120–63 BCE, was a poster-child of polypharmacy. To protect himself from being poisoned, he routinely consumed small amounts of poisonous substances as a sort of homeopathic remedy. His concoction, called Mithridatum, was reported by Pliny the Elder to contain fifty-four ingredients, and he was reported to have taken daily doses of substantial poisons, but the end result, after being captured by Pompey of Rome, was that he wished to commit suicide but was unable to poison himself because his body was inured to poison. 4
Centuries later, Galen of Pergamum experimented with this and earlier formulas (one of which contained thyme, sweet myrrh, aniseed, fennel, and parsley and was inscribed on a stone in the Kos Temple of Asclepios) and called it theriac. Galen combined fresh, dried, and fermented ingredients including snake flesh, opium, and spices mixed with honey and wine and used it both topically and internally to treat sufferers of the Antonine Plague or Plague of Galen in Rome. 5 He compounded elaborate and expensive formulas with apparent reckless abandon, including upwards of seventy or more herbs, minerals, and crushed animal parts.
Western herbalism, on the other hand, has largely astringed its delight in multiple herbs and tends to focus on a handful, at most, in its formulary, with many herbalists including no more than six to eight herbs in a single formula. Not long ago (during the age of Samuel Thomson), this handful was condensed to exactly four. The idea was to balance an Equal-Armed Cross based on the earth’s elements of earth, fire, water, and air. Proper formulas would involve each element and arm of the cross in the correct proportions.
Today, formulary generally takes into account the action of the herb itself, the needs of the patient (including body, mind, spirit, and social), and what herbalism has the most to offer: specific curative effects for given organs, body systems, and acute illnesses; sustainable modulating effects for chronic issues; and preventive nutritive support for long-term nourishment and balance. Western herbalists construct their formulas in various ways; Amanda McQuade Crawford calls her approach “The Triangle,” since she focuses on a specific, an adjuvant, and one or more nutritive, or nourishing herbs. Her practical approach stresses the importance of understanding the energy or vibration of the patient, therapeutic priorities, the site of the primary manifestation, and the functions that need rebalancing.
Other approaches include using flavorful herbs that taste good; Oregon herbalist Cascade Anderson Geller told me that she long refused to flavor her remedies, insisting that people simply needed to take the medicines as they were. But she later changed her mind and decided to make her medicines flavorful. “I always want to improve the beauty and flavor of formulas,” she says. “This was something I turned my nose up at early in my career as I felt people should take their medicines, so to speak, no matter what they tasted like. But after working with people I realized they respond better when medicines are gentler and more flavorful.” 6 Many herbalists add spearmint, anise, or licorice as a corrigent, an ingredient that enhances the flavor of a formula for better tolerance.
No Magic Bullet
Today’s practice of herbalism is a rich composite of ancient medical folklore and modern scientific inquiry. We have the great benefit of thousands of years of historical use of certain herbs, as well as the clinical and scientific research of chemistry, physics, and anatomy. Combined, these sciences give us a wonderful foundation for employing plants as healing agents for the body. But I don’t like to assume plants are simply “agents” for our unbridled use; rather, I teach that when used in the proper context—with respect for the natural world, with creativity, with appreciation for the pioneers who went before us, and with humility for all that we have yet to discover—plants and their medicines can become a steady and trustworthy foundation for human medicine. I advocate integrative medicine—blending herbal healing with allopathic medicine and other healing arts when needed to positively benefit the individual since every person and illness is unique and must be approached with creativity and tolerance for other modalities.
In this book, you’ll be introduced to my 4-tier formula structure, which reflects some of the philosophies of these other Western methods. It’s similar in that it provides primary, adjuvant (corollary or helping), and other herbs, but it tends to give greater prominence to supportive and nourishing herbs and less prominence to specific or “active” herbs, making for a balanced formula that can generally be taken with long-term sustenance in mind. Each formula begins with a general tonic or support herb for a particular organ or system of the body, followed by a “specific” herb based on the illness, followed by herbs for corollary support (or, more generally, bitters), and finally the inclusion of a “vehicle” or carrier herb, if needed, since certain herbal chemicals have been shown to congregate in and directly affect certain areas of the body, such as the uterus, the muscles, or the head. This has been a valuable approach for me as I’ve worked with people in a clinical setting as well as in apothecary and craftsmanship settings. An Herbalist’s Guide to Formulary utilizes the 4-tier formula structure and offers sample protocols for a variety of issues; as always, use common sense and work in tandem with a knowledgeable health care professional in order to integrate other forms of medicine.
Over the course of the past twenty-three years, I’ve honed my formula-making methods and have created more than seventy original-blend products for my apothecary’s retail and wholesale lines. Through trial-and-error, using intuition, working with clients, and studying within a vast heritage of herbalists from past centuries as well as those with whom I’ve had the pleasure of meeting and studying, I’ve developed successful formulas pulling from hundreds of herbs. Work with your formulas until you feel you have a practical, inspired, and most of all—effective—formula for a given illness. Part of the equation for holistic healing involves not only effective herbs and curative therapies, but also the corollary/adjunct/helpful/sidelines/sometimes-overlooked efforts of loving and caring for another person. This is the cornerstone of the healing arts.