By Dr Simon Feeney, Founder & Director, Empirical Health
One of the defining strengths of Chinese herbal medicine lies in its adaptability. Formulas are not static recipes but dynamic frameworks designed to be adjusted in response to the shifting nature of the patient’s presentation.
In clinic, however, it’s easy to reach for the same prescriptions time and again. The formula may be broadly suitable, but the true art lies in refining it so that it fits the person in front of you with greater accuracy.
This blog explores when and how to customise safely and confidently, while staying true to the underlying logic of the original formula.
Respecting the Original Structure
Classical formulas were not thrown together. Their ratios, ingredient combinations, and sequencing were carefully crafted to achieve a specific therapeutic effect. When we customise, the aim is not to dismantle the formula but to build on it with intention.
Effective modifications honour the original structure while adjusting to the nuances of the case. This requires a deep understanding of which herbs are central to the formula’s function and which are flexible.
When Should You Customise a Formula?
Here are common scenarios where adjusting a prescription can significantly improve its effectiveness:
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The presentation has shifted : For example, the patient’s main symptom has eased, but a secondary imbalance has become more pronounced.
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There’s a mismatch in strength : The formula may be too warming, dispersing, or tonifying for the current constitution.
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The patient can’t tolerate part of the formula : Taste, digestion, or even ingredient sensitivities may call for slight changes.
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Multiple patterns are present : Sometimes you need to bridge two related patterns without overloading the prescription.
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You want to prevent over-treatment : Removing a strongly moving or warming herb once the acute phase has passed can help avoid aggravation.
How to Customise Effectively
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Retain the core function of the formula
Identify the key herbs responsible for the formula’s direction. These are often your sovereign and minister herbs. They should usually remain unchanged. -
Be precise with what you add or subtract
One or two small additions can make a big difference. But adding too many herbs can muddy the formula and compromise its clarity. -
Choose like for like
If you need to substitute, match not just the function but also the temperature, taste, and movement of the herb. Don’t just swap based on category. -
Use dosage to your advantage
You can shift the effect of a formula by adjusting the dosage of one or two herbs, without needing to alter the composition itself. -
Document your reasoning
Keeping clear notes on what was adjusted and why helps build your own understanding over time. It also creates continuity for future follow-up.
A Simple Example
A patient presents post-viral with fatigue, shortness of breath, and weak voice. You begin with Bu Zhong Yi Qi Tang.
Two weeks in, fatigue improves but now they’re experiencing dryness in the throat and slight night sweats. You might:
- Retain the core formula
- Add Mai Men Dong or Yu Zhu to gently nourish fluids
- Reduce dosage of warming herbs slightly
- Monitor closely for signs of Yin deficiency emerging
This is a subtle shift, not a full reformulation, but it ensures the medicine continues to meet the moment.
Modern Flexibility, Classical Thinking
At Empirical Health, we encourage this kind of responsive, practitioner-led approach. It reflects the essence of true herbal practice, one that listens, adjusts, and evolves with the patient.
Whether you're working with powders or granules, all of our formulas can be customised to suit the specific needs of the people you treat. We’re here to support you in doing that confidently and with clarity.
Final Thought
Customising isn’t about being clever for the sake of it. It’s about ensuring your prescriptions do exactly what they’re meant to, for this patient, in this moment.
When done with skill and integrity, even small changes can lead to more effective, efficient, and responsive care.
Feel free to share your thoughts by leaving your comments below. We could talk about this all day long!