Most herbalists have learned that preparing several herbs in a formula which are extracted together or brewed into a tea causes the infinite number of biochemical constituents to interact and to some extent alter so that a formula has the potential of becoming more than the sum of its parts.  In particular, Traditional Chinese Medicine (TCM) is largely based on the use of time-honored complex herbal formulations.Underscoring this practice is the understanding that the most effective treatment is when both the “root and branch,” that is, the presenting symptoms and underlying constitutional imbalances that give rise to them, are attended to with the various components of any of thousands of different TCM formulas. This is only true to a simpler or lesser extent with the practice of Western herbal medicine.

Western Simpling versus Eastern Formulating

The great late 19^th century North American Eclectic herbalist Dr. John Raymond Scudder wrote an important book entitled “Specific Medicines” where such renowned North American herbs such as goldenseal (Hydrastis canadensis), Echinacea (Echinacea angustifolia) and black cohosh (Cimicifuga racemosa), to name only three, are described in terms of their specific uses and doses. In turn, the great herbal pharmacist John Uri Lloyd of Lloyd Bros. Pharmaceuticals produced outstanding alcohol-based extracts of these herbs, and these were widely used and sold throughout the country. Extracts of single herbs like those created by Lloyd supported the mono-herb therapeutic practice called “simpling.” Modern herbal product lines continue to make extacts of single herbs, easily found in health food stores around the country, and thus the practice of simpling is still common today. Because rows and rows of such single herb extracts are so visible on store shelves, the general public has yet to develop an understanding of the superior therapeutic results a well-crafted herbal formula can produce.

One herb taken repeatedly (unless it is a tonic such as ginseng) is limited in its scope of action and unable to attend to the principle of ‘root and branch’ described above. There is also a greater risk of adverse reaction in the event that some latent toxic reaction to an herb becomes apparent. Western herbalists, including myself, are still dismayed by the liver toxicity, genuine or not, reported when people take herbs such as comfrey, kava or ephedra (often for non-traditional reasons), ultimately resulting in these herbs being banned from commerce. TCM and Ayurvedic formulators neutralize or lessen the toxicity of some herbs either by prior preparation or by carefully combining them with sweet herbs and substances such as licorice, jujube dates, honey or ghee.

This is not to say that professional Western herbalists do not prescribe complex formulations, but with very few exceptions, these are strictly according to individual need and do not achieve the longevity and durability that similar TCM formulas have.  As examples of classic formula building blocks that have stood the test of time, any Chinese herbalist knows that Four-Substance Decoction (Si Wu Tang) consisting of the roots of dang gui (Angelica sinensis), peony (Paeonia lactiflora, bai shao), rehmannia (Rehmannia glutinosa, shu di huang) and ligusticum (Ligusticum chuanxiong, chuan xiong) is for Blood deficiency and can be modified in numerous ways to treat any condition associated with Blood and circulation. Similarly, Four Gentlemen (Si Jun Zi Tang) consisting of ginseng (Panax ginseng, ren shen), atractylodes (Atractylodes macrocephela, bai zhu), poria (Poria cocos, fu ling) and licorice (Glycyrrhiza uralensis, zhi gan cao) is for Qi deficiency and is also subject to countless variations and permutations. These are some of the most famous, and but there are many more like them in Chinese herbal medicine. In Ayurveda, the formula Triphala, consisting of three myrobalan fruits each addressing the excesses of each of the three Ayurvedic humours, is perhaps, in my estimation, the single greatest formula of all time and finds itself embedded in most Ayurvedic formulations as well as prescribed separately as part of a healing program for all patients. No such formulas can be found in Western herbal practice.

Dui yao formulation

Many of the therapeutic goals of an entire TCM formula can come down to the use of two herbs, or dui yao (dui means “two” and yao means “herbs”). In this way large complex formulations can be created based on individual root imbalances and branch symptoms by incorporating specific herb pairs. The increased scope of efficacy of two herbs, rather than one, for a particular condition or symptoms promises a better, more wholistic, healing result. There are many reasons and ways two herbs are mated to interact with each other.  One is pure synergy where both have a similar purpose. Another is complementary where one herb has a primary function, while the other either facilitates that function or counterbalances any possible negative reaction.

Western herbal medicine does have a few such ‘unofficial’ combinations such as echinacea and goldenseal for infections. Dr. Christopher, an exponent of the cayenne (Capsicum spp.) metabolic warming school of Western herbal medicine, recommended combining cayenne, an irritating stimulant, with olive oil to lessen its burning qualities. His 19^th century predecessor, the iconoclastic Dr. Samuel Thompson, frequently combined cayenne with bayberry bark (Myrica cerifera) and ginger (Zingiber officinale) in the famous Composition Powder Formula to achieve a synergistic internal metabolic heating effect which often turned the tide of many acute upper respiratory diseases.

Following are a number of simple Western dui yao or two-herb possibilities that can be considered for effective and efficient formulation:

• Parsley root (Petroselinum crispum) and gravel root (Eupatorium purpureum) for urinary stones
• Elderflower (Sambucus nigra) and yarrow (Achillea millefolium) for colds and flu
• Oregon grape (Mahonia spp.) and wild yam (Dioscorea villosa) for liver and gall bladder complaints
• Dandelion root (Taraxacum officinale) and burdock (Arctium lappa) for detoxification and blood purification; cancer
• Uva ursi (Arctostaphylos uva ursi) and cherry stems (Prunus avium) for cystitis
• Hawthorn (Crataegus monogyna) and motherwort (Leonurus cardiac) for cardiovascular disease
• Gravel root and marshmallow root (Althaea officinale) for urinary stones
• Yerba santa (Eriodictyon californicum) and mullein (Verbascum thapsus) for upper respiratory congestion
• Thyme (Thymus vulgaris) and California poppy (Eschscholtzia californica) for coughs
• Red clover (Trifolium praetense) and burdock root for cancer
• Valerian (Valeriana officinalis) and hops (Humulus lupulus) for insomnia
• California poppy and valerian for insomnia
• Angelica root (Angelica archangelica) and gentian (Gentiana lutea) for digestive disorders
• Slippery elm (Ulmus fulva) and Marshmallow root for gi tract ulcers
• Cascara sagrada (Rhamnus purshiana) and rhubarb (Rheum spp.) for constipation
• Sassafras (Sassafras spp) and sarsaparilla (Smilax spp.) for joint pains
• Black cohosh and blue cohosh (Caulophyllum thalictroides) for menstrual irregularities
• False unicorn root (Chamaelirium luteum) and cramp bark (Viburnum opulus) or black haw (Viburnum prunifolium) for infertility and threatened miscarriage.

Following are some classic TCM dui yao combinations:

• Ginseng and atractylodes for deficient Qi
• Astragalus (Astragalus membranaceus, huang qi) and dang gui for anemia
• Licorice and peony for gastric pains
• Poria and Alisma (Alismatis orientalis, ze xie), for dampness and fluid retention
• Fermented herbs (shen chiu) and hawthorn fruit (shan zha) for digestive weakness
• Ophiopogon (Ophiopogon japonica, mai men dong) and prepared rehmannia for yin deficiency
• Bupleurum (Bupleurum falcatum, chai hu) and white peony for anxiety and mood disorders
• Boswellia  and myrrh (Commiphora spp., mo yao) for rheumatic and arthritic pains

In Ayurveda, the principle of herb pairs is illustrated in the many different guggul formulations. Guggul is a special preparation of Commiphora mukul, which is very closely related to and possibly interchangeable with myrrh. Guggul is deeply detoxifying and is commonly combined with the Triphala. The all-purpose guggul variety is Yogaraj guggul, and it is effective for circulatory conditions, joint pain and stiffness, high cholesterol, thyroid and low metabolism. Other herbs may be added to create various guggul preparations specific for the urinary tract, respiratory conditions, and others. (To my knowledge, the only company carrying an excellent specialty line of various guggul preparations is Banyan Botanicals.) In the western world, guggul is primarily sold because of its ability to lower blood lipids. In my opinion, while guggul is effective for this, only using it for this purpose sells it far short of its potential. It has a much wider application as an anti-inflammatory for a variety of rheumatic aches, pains and strains for which it is a virtual panacea. Sometimes it will show a benefit after one or two doses, but for best results take the indicated dose two or three times daily for at least two weeks.

Extending the dui yao concept to whole formula blending

A practice made possible by the advent of whole formula herb extracts as well as the Plum Flower line of traditional herbal formulas is the expansion of the principle of dui yao further to include the combination of multiple entire or near entire herbal formulas. Like herb pairs, formula pairs are dosed according to the root-branch principle where the branch or primary complaint and symptoms is allotted no less than 30 percent of a formula, while the various underlying deficiencies and excesses are assigned a correspondingly lesser percentage based on the patient’s unique presentation.

In my clinical experience, seldom do I see a patient whose symptoms so neatly correspond to the description of a traditional formulation as described in a book. People present very complex and often what seem like contradictory symptoms, where for example both heat and cold, or yin and yang are imbalanced. In such conditions one can combine formulas with opposite atmospheric (hot or cold) properties so long as the herbs or formulas target different symptoms. For example, a drying formula for the lungs and respiratory tract may be combined with a lubricating or Yin-nourishing formula for the Kidney-adrenals. Here the sovereign rule of prescribing heating or stimulating herbs for cold diseases and cooling, detoxifying herbs for hot or inflammatory diseases is limited to specific organ systems. This is where herb or herbal formula combining really makes the difference over giving one herb for one symptom.

The above touches on higher principles of herbal formulation and practice. Perhaps it is a bit too esoteric for the average consumer, but it is time that the public who looks to herbs for their health needs understand that herbal formulations are often more effective than single herbs. While it may take a bit more work to understand, the art of herbal formulation has been at the heart of herbal medicine for thousands of years and in all ancient cultures.