Like everyone, when I began studying herbs, it seemed very complicated and somewhat arcane. Studying in China 30+ years ago, I had the good fortune to have my first teachers pull me out of the TCM learning paradigm and plant me firmly in the classical approach of understanding formulas and choosing herbs. After 28 years in China, I returned to the United States and, with my wife JulieAnn Nugent-Head, founded a teaching clinic in Asheville, NC where licensed practitioners can watch our treatments, see our formulas and judge just how effective a no nonsense, classically driven, clinically focused practice can be.
But observers in our clinic who were not frequently using herbs were baffled at our speed and ease in writing formulas; classically trained herbalists were confused that classically trained practitioners such as ourselves were not using classical formulas—or so they thought! This sparked our current mission to explain how we were trained and what we practice: Classical Thinking, Custom Formulas. This then lead to creating the first of what will be many posts under the title of The Practical Herbalist.
The Practical Herbalist is not a list of shortcuts and is not a substitution for a classical understanding of prescribing herbs from the Flavor and Nature paradigm that defined our medicine. It expects the reader to have this as a foundation and assumes this knowledge as I write about herbs and their usage going forward. If the reader is new to the concept of prescribing from the Flavor Nature perspective that was established in the Nei Jing, or would like refreshing on its core principals, they are directed to the four excellent articles by JulieAnn Nugent-Head on classical herbalism published by the Journal of Chinese Medicine. If they wish more information, they can also watch her 3 hour introductory video The Nei Jing as Our Guide to Herbs or her in-depth online training course, The Classical Herbalist, an In Depth Training Course. Both are available on the Association for Traditional Studies’ online teaching platform: https://association-for-traditional-studies.teachable.com. Simply search for them in the search box to find them among our many online courses.
Classical Thinking, Custom Formulas
Our herbal practice reflects the Nei Jing Flavor and Nature writings, the three levels of herb usage from the Shen Nong Ben Cao, honed by Zhang Zhongjing’s instrumental writings and enriched by the writings of the classically focused doctors through the ages to our own teachers. The first and most important thing to understand is that in any formula, the herb represents a flavor and nature, not that specific herb. The herbal name is a placeholder for the flavor nature needed and was chosen for its flavor and nature.
Guizhi tang, for example, is not Guizhi, Baishao, Jiang—Zao—Gancao. It is a strongly moving warm acrid herb at a dose of 45g, balanced with a mild cool sour herb at an equal dose. This allows the Guizhi to dominate and rewarm while not pushing too much fluid out the pores. This combination is supported by another spicy acrid which warms but does not travel, a thick sweet herb that nourishes to give fuel to warm and lessens the sharp edges of the Guizhi, and an herb that can affect flow in the body and has been made warming by processing.
By seeing the single herbs in a formula as flavor and nature place holders instead of ‘must use this particular herb or it is not this formula’, we see the nature of the formula and thus understand its usage. This is important, as without this classical understanding, we can only know WHEN to use a classical formula by studying the classics instead of understanding the HOW of the formula. It also means that we can slide in any appropriate Warm Acrid with Cool Sour herbs and still harmonize the Ying and Wei without the belief that it is Guizhi and Baishao as magical plants which do so to the exclusion of all others with similar flavor and natures.
It is also critical, because if we do not have Guizhi Baishao on hand, or their quality is very bad, or we happen to have a great batch of Gao Ben or our Zhimu is more sour than bitter or sweet, or... we can easily create the effect we want from what we have on hand instead of developing a superstition around the name of the herb. Given that any given year and with any given crop the quality of herbs can and does change, we must know the herb actually in our hands as we fill the formula, not its actions as listed in a book.
When we take a moment to look at formulas and replace herb names with flavor-nature-intensity-level (their yin and yang/heavy light, SNBC category), we see and can easily follow the classic flavor nature patterns of formulas, no longer needing to rely on the herbs that were used. It becomes quite enlightening to group the herbs in a formula that way and see what the overall effect is instead of rigidly believing that the classical formulas work better. They represent brilliant flavor-nature strategy thinking, and that is what needs to be studied and followed.
I do have one formula writing habit which is not traditional. 20+ years ago, an observer would have seen my formulas as very much following the SHL JK, with small numbers of herbs and minimal variation. One thing my last teacher Dr. Li Hongxiang learned post 1949 was ‘never trust the pharmacy’. He helped me develop the habit of writing 3 herbs for every one flavor/nature herb needed. Frequently the pharmacies would not have half of the herbs in a formula, or upon inspection their quality was very low and thus ineffectual. Think of the difference between a supermarket tomato and an August farmers’ market tomato—both share the same name, but the former adds nothing but color and the latter is the foundation of Italian cuisine. So it is with herbs in any given formula filled by any given pharmacy on any given day—are they filling supermarket herbs for my patients or farmers’ market herbs for my patients?
By writing three herbs for every one flavor-nature actually needed, Dr. Li kept the patient from having to come back several days later saying the pharmacy didn’t have such and such, was there a substitute, and they had not yet taken their formula. While this is not serious in a wellness practice, when treating acute diseases, the delay in taking herbs can be the difference between success and failure. This method of covering the bases not only accounted for herbs being unavailable, but also allowed for potential poor quality of any one herb. Confucius’ famed line: 三人行必有我師 (in a group of three people, one of them certainly has something to teach me) is this thinking’s origin. His joke was If we use three herbs, we could count on at least one of them being effective.
This was a great habit when we practiced in China and herbs were so inexpensive that we did not charge our patients for their formulas, simply the treatments. But as herbs have grown astronomically expensive compared to 10 years ago, having that many herbs in a formula is becoming more and more expensive for our patients. As mentioned earlier, 20+ years ago I wrote small formulas based on rigid classical thinking, and probably in the next few years I will return to small formulas again—this time for cost to patient reasons. The good news is as herbs become more profitable for growers, we can start to demand better quality herbs for our own pharmacy. At the costs we pay, we expect organic, lab tested, and the right to send back any batch of our usual herbs which suddenly arrive sub standard. We are still in the early stages of a new era in herb farming, but as growers discover higher profits, the quality is rising along with cost to us in the herbal market.
I look forward to sharing this Practical Herbalist column here, and thank Thomas Leung of Kamwo Meridian Herbs for giving me the opportunity to do so. From here on in, I will be writing about single herbs and how we use them practically in our clinic.
Andrew Nugent-Head
January 18, 2019