The 4-Tier
Formula Structure
Bearing all this in mind, we can begin to put together an herbal platform that will readily address many illnesses to nourish and support the person’s efforts toward wellness. The formula may comprise a few different remedies given in proportion to one another; not every ingredient needs to be in the same bottle. For example, you may give certain medicines in a tea and other medicines in a topical compress, or a salve, oil, tincture, syrup, or other remedy, knowing that each remedy is part of a broader protocol for the client. You may give one tincture in the first week of therapy and change to another tincture later. The overall formula may include all of these, with you keeping in mind that all the herbs are working synergistically despite not being in the same bottle or even in the same timeframe.
We also must remember that short-term gains cannot substitute for long-term wellness. While part of our efforts must be immediate (for pain relief or symptom reduction), the holistic framework of herbalism teaches that we think long-term, that we adopt strategies that will empower the person toward wellness well into the future, and that we, as healers, engender a sense of responsibility in the person that is absent in the quick popping of a pill.
The inclusion of such an herb, so that the minimal number of herbs needed in a formula all overlap or are complementary, is called exquisite formulary. It’s a graceful and harmonious blend of action, purpose, and fulfillment. In the 1990s, I worked with “the last American man” Eustace Conway at North Carolina’s Turtle Island Preserve, and he told me his philosophy for efficient homesteading, which I think perfectly applies to herbal formulary. He said, “It’s an economic perspective. What is the best, most streamlined use of energy? Think of it as the martial art of energy use—graceful, fine, correct choices for life.” Similarly, making the most graceful and correct choices for the herbs in a formula is respectful of both the plant and the person and will result not only in better recordkeeping and observation, but ultimately in better health.
To accomplish these lasting and effective results, many herbalists develop and stick with a formula that works for them and serves as a springboard for all their formula making endeavors. I’ve developed a formula-making philosophy I call the 4-tier formula structure, and I generally use this as a launching pad from which I 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 from which you can develop and pursue your own methods.
Tier 1: The Tonic
The foundation of my formula structure is nourishment, which is tier 1, the basis of every formula. Tier 1 herbs are meant to be taken long-term to nourish, support, and sustain.
Many tier 1 herbs are precisely those sustaining herbs 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 oats milky tops, gotu kola, vervain, ginkgo, red raspberry leaf, violet leaf and flower, holy basil (tulsi), and hawthorn (for a more complete list of tonic herbs, see Glossary C and Glossary D at the end of this book). Tonics are safe, plentiful herbs that are not endangered or at-risk (see Glossary E: United Plant Savers Lists); 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, or a wound or injury, or a mental or other physical illness? Because your client is not only that infection or illness. He or she is a whole person who happens to be suffering from something that is keeping him or her from attaining the greatest health potential at the moment. By addressing the client as a victim, or as the illness itself, or as a number (these are common habits in the modern system of allopathic medicine), your client loses self-respect, self-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, in all the following formulas, 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.”
Why Use Tonics?
Because tonics are the primary and largest part of a formula (especially in the 4-tier formula), it is worthwhile to more fully explore what tonic herbs and how they work. Literally, a tonic is an astringent herb that will tighten and tone tissues. But generally speaking, herbalists use a tonic (or trophorestorative herb) in the broad sense of an herb that will support and nourish an organ or a system of the body—not necessarily an astringent, but rather any herb that offers support, nutrients, or support for the proper, robust, and long-term function of part of the body. A tonic will help sustain a person because of its effects on an organ or system that complement all other organs and systems, since everything in the body is, of course, connected. An herb that replenishes, supports, and provides for the needs of a part of the body (or mind), and that is safe to be taken long-term, and that has few if any side effects, is a tonic—and listed as a tier 1 herb in the 4-tier formula structure.
The ultimate goal of most herbalists is to educate people in how to use tonics, because this is preventive medicine. Tier 2, 3, and 4 herbs are usually “reactive” herbs, those used when something has already gone wrong, when we are sick or injured. But tier 1 tonic herbs can be used at any time, before or after illness, and are often responsible for keeping us healthy enough that we don’t need the other types of herbs. tonic herbs are our vitamin supplements and are meant to be taken daily over the course of several weeks, months, or even years. The general criteria for a tonic herb is that it:
I also add that a good tonic must be plentiful (not endangered or threatened), and that it provides what the body needs (i.e., it’s not superfluous but is genuinely needed). Many herbalists also include the trait that a tonic is an herb with a long history of use (in any tradition). Most tonic herbs are very body-friendly, but some should not be used during certain circumstances such as hyperthyroidism (bladderwrack or kelp). But most can be enjoyed widely and with noticeable improvements for the organ or body system they support. Many people experience enhanced energy, stronger nails, teeth and hair, clearer skin, healthier libido, better metabolism, and better strength in general after using tonic herbs over a period of time.
Also, beware that some herbalists erroneously consider certain herbs such as cayenne, thyme, or garlic to be tonics for specific body systems, such as the respiratory or immune systems. I don’t include these herbs here because they don’t meet the definition: i.e., these are stimulants and “curative” herbs best used to work reactively as antibacterial agents against an illness for a short period of time. Cayenne, thyme, and garlic are strong herbs best used in short-term situations to reverse a given condition, not long-term as prevention, and in the formulas in this book they will feature not as tier 1 Tonics but as tier 2 specifics, tier 3 corollary, or tier 4 vehicle herbs. Stimulants are rarely used as long-term trophorestorative tonics, with the exception (in my experience) of ginger, which can be used in very small (food) doses in certain circumstances for short-term (not long-term) support. While herbs do not necessarily need to be sedative or calming, they shouldn’t have stimulating action that constantly puts the body on alert or forces the body and its organs to endlessly perform. Quite the opposite—they should restore, refuel, support, and nourish.
Whereas herbal medicine differs from conventional (allopathic) medicine, so, too, do tonics differ from what most people consider herbal medicine. Allopathic medicine is usually synthetic, concentrated, fast-acting, and with side effects. It has been called “the heroic” approach since it targets symptoms and can be “warlike” in its terminology, since the doctor acts as the “hero” who saves the patient through his or her actions. Herbal medicine differs from this in that it is natural (nature-based), semi-concentrated, and much slower-acting. Herbal medicine has far fewer side effects (though side effects do exist), and it is holistic, educating, and engaging the patient in his or her own care.
Herbal tonics, while being within the realm of herbal medicine, differ again. They are natural (nature-based), not overly concentrated, very slow-acting, but much longer-lasting than either conventional or herbal specifics. They are holistic, with the responsibility for healing resting with the person (not the doctor or herbalist), and they are generally used in a preventive fashion instead of reactionary.
Tonics (Rasayanas) in Ayurvedic Medicine
Ayurveda has a long tradition of using herbal and food tonics to replenish exhausted body systems as well, and as these philosophies and herbs differ somewhat from Western herbal medicine, it is useful to describe the basics of how Ayurvedic tonics work. Ayurvedic tonics are central to a holistic support program for individuals recuperating from illness or going through a challenging period of life. Ayurveda incorporates “rasayana” as one of its eight main branches of life study; rasayana herbs are used to nourish and replenish the body after detox and also for anyone who is in a weakened or otherwise stressed state: pregnancy, convalescent, elderly, etc. Many rasayana herbs are antioxidant and are also foods: kichari, a mixture of brown rice, mung beans, spices and ghee is one of the predominant foods eaten as a restorative tonic. 7 Grains, nuts, and seeds, milk, ghee, beans, and warming spices are also rasayana foods and tonics.
One of the biggest differences in how these two philosophies approach tonics is that whereas Western herbal medicine generally uses non-warming nutritive herbs as tonics, Ayurvedic practitioners prize the carminative and stimulating herbs and spices that stimulate vigor and metabolism: cinnamon, ginger, clove, cumin, and garlic. Many bitters are also used as tonics in Ayurveda, whereas they would normally be employed strictly as digestive aids in Western herbal medicine. The idea behind the use of spicy, bitter, and stimulating is to give that extra oomph and strengthen the entire body toward aliveness and away from sedentary “kapha” states of being. But these stimulating and sometimes spicy herbs are tempered in the overall diet with sustaining and sweet foods such as honey, maple syrup, milk, and raw sugar for a general effect of nourishment, stimulation, and true “feeding” from the inside out. Other rasayana herbs include tulsi (holy basil, or Ocimum sanctum, and other species), ashwagandha (Withania somnifera), shatavari (also spelled shatawari, Asparagus racemosus), amla (Emblica officinalis), haritaki (Terminalia chebula), and bala (Sida cordifolia).
Difference Between Tonic and Adaptogen
In glossary A at the end of this book you’ll find examples of both tonics and adaptogens with brief definitions. Though they seem quite similar on the surface, they accomplish different things in the body. In the 1960s, Russian scientists researched alternatives to Panax ginseng, studying a shrub native to Russia, Eleutherococcus senticosis, hoping to find a plant that could safely increase military performance. They created a new classification to describe its effects: adaptogen, and herbalists around the world recognized that other medicinal herbs also protect and normalize the endocrine, immune, and nervous systems, including Korean ginseng, astragalus, and echinacea. The term adaptogen now recognizes any herb that modulates the stress response and supports in a nonspecific way the vital balance between the endocrine, immune, and nervous systems.
A tonic, on the other hand, is an herb that supports, in a nonspecific way, the vital function of a particular organ or system of the body.
Tonics and the Magic Bullet Approach
Tonics are not drugs. Tonics will work subtly, over time, often in ways that are immeasurable to those of us who like to quantify and record specific results. I have talked with many people who have given up on herbs or who remain skeptical because herbs did not work “fast enough.” Now, at the beginning of the twenty-first century, people are accustomed to quick turnaround and instant gratification, and herbs have yet to catch up with them. Ancient and patient, tonic herbs are not sudden instigators; rather, they welcome gradual shifts in our bodies that lead us toward positive change. That said, I’ve also worked with many people who are thrilled to report substantial and lasting change due to the long-term use of tonic herbs.
Tonic herbs cannot help a person build strength and health if the person continues to indulge in poor habits such as smoking, not exercising, eating fatty, fried, or sugary foods, or embracing a negative attitude. It’s best to practice an entire program of good health, using all the strategies mentioned in this book over a long period of time.
Malnutrition
The United Nations’ World Health Organization lists malnutrition as the greatest threat to public health—not influenza, lack of exercise, or even cancer. Malnutrition is inexcusable when the world produces enough food-calories to feed every person alive—and when food is routinely thrown out. Americans generated thirty-four million tons of food waste in 2010—a number only surpassed by paper and paperboard waste. Even in America, adults and children suffer severe and chronic malnutrition due to poor food choices, obesity, dysfunctional nutrient absorption, and underlying ill health. Malnutrition in children can quickly lead to poor memory and cognitive dysfunction long before physical symptoms are noticed.
Protein malnutrition, particularly in so-called underdeveloped countries—some prefer to call them under-supported countries, since (especially commercial) development is not necessarily a positive thing—is often a fatal experience. Micronutrient malnutrition can lead to severe nutrient deficiency, vomiting, and diarrhea; diarrhea, in particular, compounds the loss of micronutrients and can quickly bring death, especially for children. Malnutrition combined with social or cultural mandates (such as covering up with sunscreen in the sun or with burkas outdoors) can interfere with the body’s ability to get the vitamin D it needs, which reduces its ability to absorb other nutrients such as calcium. Once the body is deficient in a mineral or vitamin, it’s a short hop to deficiency in many others since their use and absorption are interdependent.
We’re all aware that a deficiency in vitamin C can cause scurvy, and that once the importance of this vitamin was realized, afflicted sailors were provided with limes on voyages to prevent the disease. But nutrient deficient diseases are still common and are more plentiful than we might realize in a culture with grocery stores on every corner. In fact, many people throughout the world suffer from acute and chronic conditions that can be remedied with proper nutrition. A deficiency of iron causes anemia (which can occur after losing blood through an injury, giving birth, or experiencing menorrhagia or heavy periods). A deficiency in vitamin D can cause rickets and skeletal deformities, especially in the presence of genetic predisposition. A deficiency in iodine can cause hypothyroidism, goiter, and severe mental function impairments, with IDD (iodine deficiency disorder) causing cretinism, a dire and incurable form of mental illness.
Diets low in vitamin A can also contribute to complications of infectious diseases, such as rubella and AIDS, and undernutrition exacerbates other diseases such as measles, diarrhea, pneumonia, and malaria. A chronic lack of vitamin A can cause night blindness and vision problems, poor immune function, and growth retardation. Nearly half a million children are afflicted by blindness every year due to vitamin A deficiency, and half of these children die within a year of going blind.
Iron deficiency results in anemia, a chronic problem that afflicts an astounding 30 percent of the world’s population. Anemic children suffer from cognitive disability and impairment, low birth weight, and a higher risk for infections. According to the World Health Organization, anemia contributes to 20 percent of all maternal deaths. 8
Tonics Are Nourishing, Nutritive Herbs
Many tonic herbs are simply nutrient-packed plants that confer their vitamins and minerals to us when we consume them, and when used long-term, especially as infusions, they can significantly impact micronutrient malnutrition. Herbs such as oatstraw, comfrey, red clover, raspberry, horsetail, and nettle are rich in calcium, iron, potassium, phosphorus, vitamins A, B, C, and more; carotenes, amino acids, chlorophyll, and fiber. Many tonic herbs are actually food herbs and can be eaten in great quantities in healthy meals: oats, nettle, dandelion leaf and root, and burdock root, to name a few. Many other edible herbs, such as chickweed, could become tonic herbs if used on a long-term basis and with the intent that they are tonics.
Tonic herbs are especially useful for three conditions:
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 or directly influence the body’s ability to deal with an illness, or they are capable of ridding the body of a particular disease.
Tier 2 herbs for various conditions might 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,” though they’re not being used that way here. When many people feel they are coming down with a cold and think, “I should take some echinacea,” this is a “magic-bullet” approach; here we offer suggestions for broadening that approach to include other herbs, one of which, echinacea, may be a specific in the 4-tier formula. Instead, they’re being employed to work in concert with a number of other herbs, and also they’re 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 length of time as tonic tier 1 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 address issues that come along with an illness, or they may be bitters to support digestive health, or they may be warming herbs to support circulation. This tier is sometimes called adjuvant, supportive, corollary, or secondary. These 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 irritable bowel syndrome (IBS), I might employ slippery elm as the tier 3, because this herb (the soft inner bark of the slippery elm tree ground into powder) is demulcent and soothing to the gastrointestinal tract. The IBS is actually the secondary issue here while stress management is the primary issue, and soothing the gut is a secondary (though important) priority.
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 herbs, 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.
Often, tier 3 herbs are 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 effectively.
Warming herbs such as mustard, cayenne, ginger, clove, and cinnamon are especially helpful in cold or stagnant conditions, but they can also 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 IBS mentioned previously, I might use chamomile because it is both a nervine tonic (soothing to the emotions) and a mild bitter and carminative (soothing to the gastrointestinal tract). As a vehicle, it will “usher” other herbs, such as slippery elm, motherwort, or passionflower, to the appropriate areas of the body.
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 vasodilator, opening the arteries and vessels and thereby increasing the blood flow to the brain; as such, these herbs could be considered tier 2 Specifics for a headache, but they could 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 could be an excellent choice as a tier 4 vehicle.
There might not be a tier 4 herb in every formula, so if there are no practical “vehicle” herbs, you may elect to leave out the tier 4 altogether, or you may choose another tier 1 or tier 3 herb to round out the formula and enhance its efficacy. In every case, 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. Motherwort is a good example of an herb with multiple functions: it is a nervine to relieve stress, a cardiotonic to ease heart palpitations, and a bitter to stimulate proper digestion. The quantity of the tier 4 herb can be much smaller than the others; I generally list it as ½ part.
How to Use This Book: Tiers and Parts
While each chapter discusses the anatomy, issues, and symptoms associated with the major systems of the body and suggests herbal tiers for use in formulary, the formulas are listed with “parts.” This generally corresponds to the tiers and is meant to help the practitioner structure the formula in a concise and easy way, and it allows for making a small batch or a large batch. For instance, the first line of a formula generally lists “2 parts” and refers to what is normally the tier 1 tonic. The next lines generally list “1 part” and refer, in order, to tiers 2, 3, and 4.
The use of “parts” signifies that the tier 1 (herb with 2 parts) is in double the quantity as the following herbs. A formula with 2 parts nettle and 1 part chamomile is calling for double the amount of nettle in the remedy, whether it is a tea, capsule, powder, tincture, etc. It also allows the practitioner to create a small batch using teaspoons (2 parts nettle to 1 part chamomile equals 2 teaspoons nettle to 1 teaspoon chamomile) or larger measures such as cups (2 cups nettle to 1 cup chamomile). In this way, the formulas here are not recipes, but are guidelines for creating remedies based on the 4-tier formula structure. Use these guidelines as a basis for your own herbal formulas.
Examples of Using the 4-Tier Formula Structure
Though there are no steadfast rules, the tiers in the formula begin to take shape when talking to a person and considering his or her many different needs. Let’s create examples of how herbs can be placed in formulas using the 4-tier formula structure.
Example #1: Formula for Urinary Tract Infection (UTI)
Imagine an otherwise healthy woman has been diagnosed with a urinary tract infection. We will construct a formula beginning with a nourishing tonic, which for a UTI could be dandelion or nettle (each of which performs double duty as a diuretic). A tier 2 specific for a UTI would be an antibacterial to eliminate infection: consider goldenseal, yarrow, garlic, echinacea, or Oregon grape root. Since tier 3 is for either corollary infections or issues, or it can be a bitter, we can already see that several of the tonic and specific herbs for the urinary tract are already bitters (yarrow, goldenseal, and dandelion) so these herbs could fulfill two roles in the formula. Finally, we can employ a carrier or vehicle to “transport” the other herbs directly to where they’re needed: consider bearberry, dandelion, or buchu.
Using this method, we can create several effective yet very different formulae depending on what else is going on in this woman’s life:
A Formula for UTI Due to Stress (as a tea, capsule, or tincture)
A Formula for UTI with Heart Palpitations (as a capsule or tincture)
Example #2: Tonics for Cervical Health
A young woman in her late teens gets a Pap smear that shows irregular cells and indicates possible cervical dysplasia. Two formulas (one internal and one external) could be:
A Formula to Support Cervical Health (as a tea to drink)
A Formula to Support Cervical Health
(as a diaphragm pack)
Example #3: Formula for Kidney Stones
A middle-aged man experiences kidney stones (also called gravel). Tonic herbs could include yarrow, nettle, or cleavers; Specifics could include bearberry (which reduces accumulation of uric acid, though it can change the color of the urine). Appropriate bitters include yarrow and dandelion, and carriers include bearberry, dandelion, and cornsilk.
A Formula for Kidney Stones
Example #4: Tonics for Enlarged Prostate
A forty-eight-year-old man experiences enlargement of the prostate gland. Tier 1 tonics could include saw palmetto, nettle root, or kelp. Tier 2 Specifics include saw palmetto, pygeum, nettle root, pumpkin seeds, green tea, and ginger. Tier 3 corollary herbs for inflammation include parsley, turmeric, and mullein (which is often thought of as strictly a respiratory herb but can be useful as a relaxing tonic in any situation). Alternatively, tier 3 bitters include gentian, dandelion, motherwort, green tea, and chamomile, while tier 4 vehicle herbs include saw palmetto.
A Formula for Enlarged Prostate
Example #5: Tonics for Arthritis
A middle-aged woman with lower-than-normal weight, stress, and hypertension presents with painful arthritis. We will give her two remedies: one internal as a tea, and one external that can be applied topically. The internal remedy will include tier 1 tonics and other herbs; the external remedy will not include a tier 1 tonic but will include the other tiers. In this way we are supporting her with tonic herbs for the long-term and also addressing the arthritic pain directly with a salve.
Tier 1 tonics can include nettle, dandelion leaf, and parsley, and these would be given to her as a tea while the rest of the herbs (tiers 2, 3, and 4) are given as a liniment or salve. Tier 2 Specifics can include ginger, cayenne, cinnamon, wild yam, black willow, white poplar, angelica, prickly ash, devil’s claw, arnica, Jamaican dogwood, turmeric, or wintergreen (to be applied topically). Specifics for internal use for inflammation include turmeric and ginger. Corollary herbs can include ginger or prickly ash (for poor circulation), vervain or Jamaican dogwood (for insomnia especially due to pain). Bitters include dandelion leaf and motherwort while carriers include cleavers, cayenne, and prickly ash.
A Formula for Arthritis (as a tea to drink)
A Formula for Arthritis (as a capsule)
A Formula for Arthritis (as a topical salve)
These examples illustrate how formulas might be created for a wide variety of conditions. Be creative with your herb choices and look for ways to use edible herbs, foods, and dietary choices as supportive tonics in both the formula and dietary protocol.
Please take the basis of the information presented here and apply it in the context of your own education, adding to it, experimenting with it, and enhancing it for the greater understanding of your family, your community, and our herbal heritage at large. I encourage you to personalize this information and take what has been kneaded through history and mold it to suit your own needs. There are as many methods for making herbal medicine as there are plants, with no one perfect way, but all of our information, insights, and revelations will inform the future path of herbal healing. Also, use common sense in your approach to creating herbal formulas, understanding that specific drug–herb interactions and contraindications are beyond the scope of this book. For drug–herb interactions, collaborate with a trusted health care practitioner or knowledgeable pharmacist.