Which are the best herbs for me to take? Is ginseng good for me? What about ashwagandha? I’ve heard it’s amazing! Dong quai is one of the best herbs for women, right? Women should take it for hot flashes too, shouldn’t they?

Herbal selection is something that a lot of patients have many legitimate questions about, and which the rightly ask. This is primarily because there are some really incredible herbs that can do extraordinary things for human beings. Yet, although there will always be circumstances in which they can be transformative and have a significantly positive effect on some people’s health and well-being, not everyone gets the same effect from any given herb. Let’s explore why.

As word of the great benefits of herbs circulates around the internet, and certain ones gain fame for “being awesome,” people gravitate to them, which creates a frenzy of marketing and hubbub that sets off a carnival of health-industry nuttery around whatever little flower, root, tree, or seed might be in favour at the moment. They’ll also get advice from friends and neighbours and try different herbs in hopes of hitting on the right product or combination.

The net effect of all this from the herbal practitioner’s point of view, is that patients sometimes come through the door with an assortment of herbs and supplements that would seem more or less randomly selected. Now that may not necessarily be the case, and they may have a good rationale for their choices stemming from personal experience and preferences, as well as strategies introduced by other practitioners. However, there is a principle of herbal prescription from traditional Chinese medicine that is vital to understand if you want to attain good results: Herbs influence one another when combined, and their joint influence is what results in the actual effects. 

A cold, detoxifying herb for gastrointestinal inflammation may not have exactly the same effect if you combine it with a hot, pungent herb for warming the body. The combination may have a mitigating effect that you would find useful, as the cold herb might be too cold for a particular condition, and you may want to moderate its action (as in some cases taking the cold herb could lead to loose stools or cramping). But on the other hand, if the herb’s cooling effect is the intention of the treatment, you might, for example, want to combine it with another cool herb in order to preserve the first herb’s anti-inflammatory function, and help steer the formula towards affecting the stomach or small intestine rather than the colon. These are the kinds of considerations necessary when combining two herbs together. Now imagine the implications of combining five, six, or twenty. 

An herb with a warming effect can moderate another’s cooling effect. One that causes qi to rise can offset the effect of an herb that causes qi to fall. With the proper combination, this contrast can result in a formula that will have a very useful regulating function if there is a stagnation or disharmony involving the organs, the flow of blood, the movement of food through the digestive tract, or even something like a cough. If multiple herbs with similar functions are paired, they tend to reinforce one another, which can be helpful if a condition is very simple and straightforward. However, too many herbs that have similar characteristics could exacerbate an existing imbalance or symptom — someone who is already tending towards running hot or dry taking a formula that has too many hot herbs, for example.

These interactions generally are not side effects, and, in principle, combining herbs like this is how good formulas are designed. It’s the interaction between the herbs and the influence they exert on one another that produces the formula’s desired effect — something that any of the ingredients individually might not be able to produce. 

The most important consideration when choosing herbs is not: “Which are the best herbs on the market?” Rather, it is: “Which is the right combination for my specific situation right now?” The answers to these two questions could be very different. 

So let’s revisit the question: How do you choose herbs?

The first step is simplification. The fewer herbs and supplements you combine, the easier it is to create a strategy that will have a consistent and strong result. The more products you combine, the more likely they will interact in ways that will cause them to neutralize each other and so be of no help to you. Because of current safety standards, these days it’s unlikely that you would create a detrimental effect, but you simply might not get the full benefit from everything you’re using. 

The second step is understanding exactly what you’re seeking to accomplish, and how to get to the root of your issue(s).  For example, there are some cases in which a patient whose primary concern is sleeplessness might benefit more from an herbal formula composed of herbs for increasing energy than one full of herbs that ostensibly have a more calming or sedating effect. The reason is that sleep is a function that requires certain specialized resources from the body. If a person has gone through a long period of protracted fatigue, and overused such resources, then sometimes the shortest route to a good sleep is to give them herbs that rebuild their energy levels, and the resources that support such energy, like yin, yang, and blood. 

Consider this case study of a male athlete in his 50s seeking to increase his energy and performance levels for endurance events. The textbook choice would probably have involved ginseng, astragalus, cordyceps or an herb with a similar effect. All of these herbs are great, and all of them are good “for energy.” However, in practice this guy actually benefitted most from a textbook formula for a dry cough with some sputum, shortness of breath, and inflammation of the upper respiratory tract and mucus membranes. Why? He had a history of asthma, but it was seemingly under control through his lifestyle choices and his occasional use of a puffer. He initially reported that his asthma was not a problem, and he did not think it was affecting his workouts either. Yet this detail was an important clue in understanding exactly what his body actually needed. It wasn’t a warm, yang-tonifying herb such as cordyceps: it was lily bulb. And the issue with his energy wasn’t the deficiency of qi that ginseng or astragalus would have had a positive effect on.

Herbs that moistened his lungs, reduced his tendency towards running hot (such as rehmannia), and helped improve his respiratory function made the biggest practical difference to his energy levels and, in turn, his performance in his sport. 

Selecting herbs is not about just piling them on top of one another or trying to cover all your bases. It’s about identifying what produces the best effect on your health at this specific time in your life, helping you to achieve balance, and supporting and enhancing your health in the way that is most relevant to your lifestyle and other health factors. 

The good news is that using this approach means you probably don’t need to buy anywhere near as many different products as you might think you need. But the upshot is that you may need to have professional guidance to assess what you really require, and to help select the right combination for you.