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Formulas vs. simples

Medical Herbalism 3(1):3

In Western herbalism, we see several schools of thought about herbal remedies. One school, perhaps best embodied in the approach of the famed Dr. Christopher, uses formulas that may have as many as eight or ten components. The other approach is to use “simples,” one or two herbs taken in larger doses. Understanding both approaches is important for the practicing herbalist. The editors of Medical Herbalism love to pose questions that don’t necessarily have one answer, so we’ve invited letters on this controversy. The first letter below is by herbalist Roy Upton, trained in both Western and Chinese herbalism. The second is an excerpt from Herbal Medicine by German phytotherapist R.F. Weiss, MD. Your letters on this or any other subject are welcome. Please state with your correspondence any company affiliation you might have.

To The Editor:

I wanted to pass along my comments regarding the use of “simples” or simpler formulas, as compared to poly-pharmacy. Though I use both simples and formulas extensively, in conjunction with an overall program, I have a few comments that may be of interest.

With the exception of herbal shamanism in traditional cultures, I am not sure that the use of single herbs is historically representative of medical herbalism. The present day popular use of single herbs I am afraid is due to modern Western herbalism’s paralleling of conventional medicine’s symptomatic approach to healing, i.e. the use of aspirin/willow bark for pain, antibiotics/echinacea for infections, stimulants/ginseng for fatigue. It is not indicative of medical herbalism throughout the ages.

Many of the older formulas of Chinese medicine included 3-6 herbs, as compared to an average today of 6-9 herbs per formula. Depending on the herbs used, a 3-6 herb blend can have as broad a spectrum of action as a 6-9 herb blend. In most cases, this action will be broader than a true “simple” (single remedy). I also do not believe we can define the combining of two herbs as a “simple” as the action of the two can be dramatically altered as compared to the single herb alone. This is especially true if the second ingredient is an essential oil, or some other “potentiating” substance. Likewise, the “simpler” formulas in early China cannot be thought of in the same way as the Western use of simples.

In my experience, the most appropriate use of single herbs is for acute herbal treatments, and as tonics, I can think of only a few cases in which a single herb could effectively resolve a chronic condition.

Generally speaking, the use of standardized concentrates as they appear on the market today, definitely follows the Western symptomatic approach. They are drug-like in their effect of dealing with, generally speaking one aspect of a specific condition. They are made to provide natural alternatives to the drugs used by Western medicine.

I feel that different formulas can be as skillfully combined as individual herbs. In cases of life-threatening disease the approach of combining different formulas can be extremely advantageous for the patient. In the case of AIDS, a three-step approach is necessary. First is to support the constitution of the patient as determined by differential diagnosis. The second is to support immune function through the use of tonics. Third is to address the virus, and the manifestations of the virus with anti-virals and other appropriate herbs.

My philosophical preference is to use formulas based on the underlying differential diagnosis of the patient, or the condition being treated. By matching the herbal formula/s to the specific needs of the patient, or to the particular makeup of the condition, allow you the greatest potential for true healing.

                     Roy Upton,     General Manager,     Planetary Formulas

The formulation of herbal prescriptions

It is always important to be clear in one’s mind as to why any particular herb is to be used. The aim should always be to prescribe simple remedies, ideally one herb only, or only very few in combination, so that we have a clear understanding of their interactions. Even if it is necessary, in an individual case, to prescribe two or more medicaments, it is usually better, and more scientific, to give them separately, say one in the morning and the other at night. The use of mixtures has become very much a habit, and doctors have been prone to it through the ages.

Care must be taken never to combine remedies with the same or very similar actions. This is usually pointless. Similarly it is not permissible simply to list all individual constituents and their actions to arrive at the mode of action of a mixture; the proportions, dosage, etc. must also be stated. The longer the formula, the greater should be the caution with which we approach it. This kind of thing has done much damage to the reputation of herbal medicines. We must produce clear and easily understood prescriptions.

There are of course formulations combining drugs that have a definite purpose … These are no arbitrary mixture of herbs that might be useful, but formulas devised according to strict rules, like any other prescription. Every formula for a tea consists of the basic remedy (the remedium cardinale); an adjuvant or auxiliary remedy that enhances or complements the action of the basic remedy in one direction or another; in many cases also an excipient, a material used to give increased bulk; and a ‘corrigent’ (corrector) to improve the flavor or tolerance of the tea.

    Some rules for tea formulations

Two or three basic remedies at most, preferably only one. The formula should be short.

Only one auxiliary remedy, or two at most, so that the mode of action can still be clearly determined.

The corrigent, or improver should as far as possible have an action similar to that of the basic remedy, but at the same time improve the flavor (which is why plants containing volatile oils are preferred—peppermint leaves, anise or fennel seed.)

Plants used as fillers or to improve the appearance should also act in the same direction as the basic remedy (e.g. everlasting flowers for teas used to treat gallbladder and kidney conditions, mallow flowers for cough teas, feverfew flowers for stomach teas.

Excerpt from Herbal Medicine by RF Weiss, MD.
  Copyright 2001 Paul Bergner  

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