Anatomy of a Formula

A Little Bit of Herbal History

When we compare Eastern and Western herbal medicine, it’s clear that Eastern traditions—such as Chinese medicine and Āyurveda—have long-established formularies. These formulas are prepared with precision, using specific ratios, preparation methods, and combinations passed down for centuries. Most have a basis in longstanding clinical application, and even have modulations to specifically tailor the base formula to suit the unique needs of the patient.

The situation is a bit different in Western herbalism. While we have a history of formula-based practice, it is not as firmly rooted. There are many reasons for this, and much of it comes down to the politics of Western medicine.

In the West, herbal medicine has experienced waves of suppression and resurgence, upheaval and revolution. The Greek Galenic tradition was practiced in Europe for centuries until Paracelsus brought about a paradigm shift in medicine during the Renaissance. In North America, new herbal lineages formed, starting with the Root Doctors and Thomsonianism and evolving into the Physiomedicalists and Eclectics.

Thomsonianism—founded by Samuel Thomson—was a form of accessible, self-healing herbalism for rural dwellers. Physiomedicalism grew from this tradition, with more structured applications of combined herbs and medical school-level training. This lineage gives us glimpses of a distinctly North American formulation tradition.

The Physiomedicalists, in particular, brought a more systematic approach to formulation. They were university-trained physicians who made extensive use of herbal combinations. The Eclectics, while also prolific and holistic in their approach, tended to favor simples (single herbs), though they did use basic formulas as well. The methods used by Physiomedicalists and Eclectics were distinct from conventional European medicine in both approach and, more importantly, the materia medica used. Physiomedicalist philosophy and practice were carried over to the British practitioners, who ended up with their unique branch of the practice, which is nicely summarized in the works of A.W. Priest and L.R. Priest in their book Herbal Medication.  

Many Physiomedicalist and Eclectic practitioners, such as Finley Ellingwood, William Cook, T.M. Lyle, and Priest and Priest, were prolific authors and wrote some of the great herbal tomes, wherein they reference many classic, simple formulas. These traditions flourished in the 19th and early 20th centuries, during the peak of North American herbalism, but were later dismantled mainly with the rise of modern allopathic medicine.

From the 1960s onward, herbal medicine began to re-emerge. But it has been a rocky road: suppressed, reworked, nearly forgotten, then revived. Today, we’re witnessing a renewed effort to rebuild Western herbal medicine.

In this special Plant Path series, we’ll look at North American herbal tradition through a modern lens. We’ll break down simple combinations—pairs and triplets—and examine how their actions, energetics, similarities, and differences work together in effective formulas for individual situations. 

But for now, we need to lay a foundation. In this post, we’ll get started by delving into the foundations of formulas in the context of pairs and triplets.

The Challenges of Formulation

There are a few common issues I see in how people approach formulation. One is what we could call the “kitchen sink” formula—where every herb “good for” a condition gets thrown into the bottle, along with the kitchen sink for good measure.

Another is the “shotgun” approach, where every antiviral or antibacterial herb is combined in hopes of hitting the target. While hope is a fantastic human quality (and one we need in herbalism and life!), we shouldn’t rely on it alone when it comes to clinical strategy. We should build our formulas with intention, intelligence, and precision. Each herb should be added to the formula for a specific rational reason, contributing to a clearly envisioned outcome.

Herbs should combine synergistically, and the formula should address the whole person, not just the symptoms or the disease. This is why generalized herbal formulas can be problematic—they’re often not specific enough. 

For example, a generic headache formula might help some people, sometimes. But it likely won’t work across the board, because headaches vary by cause, location, energetics, and constitution. One person may have a hot, pounding headache from excess tension. Another might have a dull, cold-type headache from deficiency. A one-size-fits-all remedy won’t address those nuances.

You might see five different clients with headaches, each requiring a different approach—different actions, temperatures, and tissue affinities. They require different herbs. So that’s the basis of holistic herbal medicine: we need to be person-specific and not general to the disease. That’s why specificity matters, and it’s why formulation matters.

The Foundations of Herbal Formulas: Pairs and Triplets

The Herbal Pair

What is the foundation of a strong herbal formula? It starts with a simple pair, or combining one herb with another. Simple, yes. But also very powerful when you consider it deeply.  

Most people think of formulas as long ingredient lists of herbs. While this is in a way true, when people are beginning to learn formulation, seeing these big lists is almost immediately overwhelming. Few realize that the magic begins when you combine just two herbs, and that is also considered a formula. The synergy of a well-crafted pair is greater than the sum of its parts. It can be an incredibly powerful thing, especially when you consider the full spectrum of qualities that each herb can possess. When you combine two herbs, you combine their actions, energetics, tastes, and affinities, and yet there’s something distinct that is created that can’t necessarily be seen logically. The interaction has power, where one plus one doesn’t equal two, but more like five or 10.

Taking Ginger (Zingiber officinale) and Gentian (Gentiana lutea) together is not just Ginger plus Gentian. A synergy happens, which creates a different result than either of those herbs could create on their own. 

Taking a step back even further, a single plant in some instances could be seen as a formula unto itself. Let’s say someone has gas, bloating, and is nervous and anxious, and you want to support their digestion with a bitter tonic. You also want a carminative, and you want a nervine—something to calm them down. You could pick a carminative like Ginger. You could choose a bitter tonic like Oregon Grape root (Mahonia aquifolium), Dandelion root (Taraxacum officinale), or Gentian. You could put a nervine in there like Blue Vervain (Verbena hastata) or Hops (Humulus lupulus), and then you would have a nervine, a bitter tonic, and a carminative in a simple three-herb formula. 

Or you could just take Chamomile (Matricaria chamomilla)! Chamomile is a nervine, a carminative, and, if made strong enough, a bitter as well. It addresses digestion, the nervous system, and even inflammation, especially when someone is anxious, tense, and bloated. Instead of combining three herbs to achieve these actions, you might reach for a single herb, Chamomile.

This is a powerful shift in perspective. When working with a client, ask yourself: Is there a single herb that checks all the boxes? If so, that herb may be a perfectly matched, specifically indicated remedy.

Of course, people are complex. Often, no single herb can address the full picture. You must know your remedies well to pattern match on that level. This is ultimately what homeopaths and single-herb practitioners (simplers) do. 

We formulate because we cannot always find a single herb to do it all. But we should still aim for elegant, efficient combinations—starting with a strong pair. We will address the various steps, or types of logic, to consider when combining herbs together, but first, let’s look at moving from the pair to the triplet. 

The Herbal Triplet

From a pair, we move to the triplet. This is where things get richer.

Think of each herb as a formula in itself. When you pair two, you’ve created a dynamic duo. Add a third, and the complexity deepens.

Three herbs, thoughtfully chosen, can form a beautifully balanced, powerful formula. Sometimes you do not need more than that. This concept is deeply rooted in Chinese medicine and Āyurveda, and it can inform Western herbal practice too. 

There is an equalizing power to the pattern of three. Indeed, many traditions have some sort of triune pattern (doshas, astrological modes, alchemical principles, three treasures, the holy trinity, etc.) which forms the basis of their cosmological, metaphysical, and even physical structure of life and reality. We even see this geometrically with the equilateral triangle: there are equidistant sides and equal degree angles, a sign of perfect harmony. This is reflected in the trine aspect of astrology, which indicates two points of harmonization, assistance, and general beneficial qualities. I think the same is true when we take a pair and modulate it into an herbal triplet. 

I want to credit Paul Bergner for helping to articulate this approach. Paul is the founder of the North American Institute of Medical Herbalism, and he speaks often about pairs and triplets. When I first encountered this framework, it immediately clicked—of course, formulation starts here!

This mindset also changes how you study herbs. You begin to ask, “Which herbs would pair well with this one?” That kind of relational thinking builds clinical intuition over time. This is an important concept to consider. Herbal formulation is not just something that we do clinically, it becomes a specific strategy for studying and learning herbal medicine. 

The Anatomy of a Formula

When studying an herb, one of the most useful strategies is to explore which other remedies pair well with it. When studying herbal formulas, it’s helpful to break them down to understand everything they do in a step-by-step, logical manner. This is what I call The Anatomy of a Formula.

When I worked in the supplement industry, I’d use slow moments to walk around and read product labels. I carried a little notebook, taking notes like: “Oh, this is their nerve formula, and it has these herbs in it,” or “This one’s warm, that one’s cold.” Sometimes I could tell someone had thought through the temperature energetics; other times, not so much. I’d dissect the formula into its constituent parts and, over time, started to notice patterns.

For example, Hops (Humulus lupulus), Valerian (Valeriana officinalis), and Passionflower (Passiflora incarnata) show up together in many insomnia and nervine formulas. Valerian is warming, Hops is cooling, and Passionflower is pretty neutral (maybe slightly cooling)—together they make a temperature-balanced nervine triplet.

If you’ve been following these posts for a while, you’ve probably seen this framework before. Still, it bears repeating: every herb can be described in terms of its taste, affinities, actions, and energetics.

When analyzing a formula, list these properties for each herb. Once you do this, you’ll see what each herb contributes to the whole. In many cases, you’ll notice that each herb is like a mini-formula—nature’s pre-formed remedy. You’ll see what they have in common, how they’re different, and how they overlap.

For example, in a nervine formula, maybe they’re all targeting the nervous system, or they’re all nervine hypnotics, or they’re all warming or cooling. But you may notice other patterns, such as they’re all also bitter tonics, or carminatives. Perhaps some are nootropic, or they all happen to be hypnotic and might be stronger than a formula containing all milder relaxants. 

Or take a classic alterative formula. You might find herbs that all act as blood purifiers, but some work through the liver (like bitter hepatics), others through the lymph, some through the kidneys (as diuretics), and others through digestion. They share a common action—alterative—but their affinities differ, which broadens the formula’s reach.

This leads to two main effects:

• Similarity creates potency. In other words, similarities strengthen and direct the formula’s main effect. In the nervine example above, all three nervines amplify each other’s relaxing effects. And yet, excessive similarity may be overly repetitive and not be comprehensive enough to address other dynamics that would support the main focus. 
• Difference creates range. Different affinities and actions make the overall formula more comprehensive in action. Differences broaden its reach and support the primary goal from different angles. This is how a well-crafted herbal formula becomes greater than the sum of its parts. But, excessive difference can also make a formula diffuse, scattered, and not targeted enough. 

Now let’s look at some core formulation strategies: the reasons why we combine herbs in specific ways. These are the principles behind combining herbs into coherent formulas.

1. Sympathetic Properties

This strategy combines two herbs with similar actions and affinities to amplify a shared effect. 

For example, Black Cohosh (Cimicifuga racemosa) and Crampbark (Viburnum opulus). Both are spasmolytic. Together, they produce a stronger muscle-relaxing effect than either one alone. Why? Because even though both reduce spasm, they may do so through different mechanisms, such as different constituents, making the shared action more robust when combined. As noted above, similarity creates potency, so when we find multiple herbs in a formula with a shared effect, we can see what the formula’s focus is. When building formulas, if you want to exemplify a certain property, you’d want to focus on sympathetic properties. 

2. Synergistic Properties

This involves combining two herbs with different but complementary actions that support a shared therapeutic goal.

For example, Burdock root (Arctium lappa) and Nettle leaf (Urtica dioica) are alteratives but have different affinities. Burdock is a liver alterative, while Nettle is a kidney diuretic and blood cleanser. By combining them, you widen the scope of detoxification. Burdock mobilizes metabolic waste, and Nettle helps flush it out, making the action more complete.

There’s a synergy between these two herbs in that they have a similar action, but they go about it very differently. You could argue that this is also a sympathetic property, but they’re supporting different areas of the body. So if you were to give Burdock alone, it would help with hepatic detoxification. Still, adding a diuretic should help whatever the liver is dredging out, perhaps by making it water soluble. The Nettle leaf will help flush the kidneys.

Another example would be Fennel seed (Foeniculum vulgare) and Artichoke leaf (Cynara scolymus). Artichoke is a bitter digestive stimulant; Fennel is an aromatic carminative. They act differently, but together they support digestion more holistically. With synergy, you have two different actions, a bitter and a carminative, for example, but they both lead to the ultimate result of supporting digestion. These differences can exist on an action level and/or on an organ system level. 

3. Harmonizing Properties

Harmonizing properties can focus on a few different areas. This may be energetics or humoral balance, softening a formula to reduce harsh effects, which is especially important when using strong or low-dose herbs, or simply improving the palatability (and thus compliance) of a formula.

This includes tempering potential aggravations. For example, if a formula includes a strong bitter that may cause nausea, like Blue Flag (Iris versicolor) or Poke root (Phytolacca americana), you might add a little Ginger to settle the stomach and prevent digestive upset.

Another common harmonizing tactic is to use moistening herbs to counterbalance astringent or drying herbs, especially for constitutionally dry clients. Licorice root (Glycyrrhiza glabra) is widely used as a harmonizer, especially in Traditional Chinese Medicine. It balances dryness, improves flavor, and can increase compliance. But its effects go deeper than taste. It softens and supports strong herbs both energetically and physiologically, and also tends to have an effect of preventing the toxicity of certain herbs (such as Aconite).

Example combinations:
Osha (Ligusticum porteri) and Licorice respiratory combo: Osha is hot, pungent, and drying. Licorice moistens and balances that dryness. This would be great for a dry cough.

Turmeric (Curcuma longa) and Licorice: Turmeric is bitter and drying. Licorice complements its anti-inflammatory effects while softening its intensity and moistening the formula.

A formula of Oregon Grape (Mahonia aquifolium) and Gentian (Gentiana lutea) might benefit from the addition of some Angelica (Angelica archangelica) to bring a harmonizing effect of warming the coldness of the bitters, improving their flavor, and adding a synergistic effect of carminative to a bitter formula.

Foundations for Building Formulas

These three strategies—sympathetic, synergistic, and harmonizing—form the backbone of herbal formulation. You can think of them as modules. 

With synergy and sympathy, you’re looking at organ affinities and actions that support the ultimate result while harmonizing supports energetic balance and flavor, and reduces toxicity.

Once you find a solid herbal pair or triplet, you can begin stacking these combinations together to create more nuanced and effective formulas. This modular approach to formulation is flexible, dynamic, and rooted in traditional energetics and actions.

In the Vitalist Herbal Practitioner Program, we spend a full eight-hour module on formulation. But even this basic introduction should help you start thinking more clearly about how herbs work together.

In future installments of this series, we’ll dive deeper into classic pairs and triplets used in Western herbalism and beyond. I hope this discussion gives you useful tools as you deepen your materia medica studies.

The Herbal Monograph Map 

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