Liquid Herb Mixing Guide

By Pete Wisniewski

The art and skill of mixing individualized herbal formulations is what sets serious herbalists apart from other health care professionals. Liquid blending has rich tradition based on wholistic principles and evidence-based research to provide clinically-effective results and improve the lives of patients.

I hope this guide will serve as an introduction into the world of Western Liquid Herbs. Take advantage of the Liquid Herbal Calculator and Custom Liquid Label, to quickly start blending liquid herbs.

Liquid Herb Patient Benefits

  1. Liquid herb formulas can be customized for each individual patient. Practitioners can individualize based on assessment criteria. Weekly doses of herbs can be changed based on how the patient is responding.
  2. Customized liquid blends promote confidence and loyalty because patients know that this is their own formula that cannot be ordered from Amazon or competing area practitioners.
  3. Because liquid extracts are minimally processed, they most accurately reflect the phytochemistry of the original herb.
  4. Liquid herbs are extremely bioavailable. The extracts are readily absorbed and the active constituents can be delivered much faster than tablets or capsules. Many practitioners report back that the liquid versions of the herbs act faster.
  5. Herbal extracts are easy to take. The patient has to only open and pour from one bottle, not several.
  6. Finally, liquid herbs provide great value for patients in relation to therapeutic value. Patients get a potent dose in a concentrated form.

Dosing Liquid Herbs

Dosing liquid herbs is relatively simple. Most practitioners utilize a general 5mL dose (1 teaspoon) with 10-20mL of water or juice, two to three times per day. This takes into consideration of minimum and maximum ranges when the 100mL guideline is used. As you start to become more skilled, you will utilize different herbs at different times (e.g. adrenal herbs at the adrenal drop times or Chaste Tree upon rising).

When dosing for children, we recommend using formulas based on the child’s age. For under two years of age use the Fried’s Rule and for over two years, use the Salisburry Rule. Note: both are included on the Children’s Dosing Sheet in the online Liquid Herb Calculator (see below).

Taste and Patient Compliance

Taste is an essential factor in the physiologic response, especially when using bitter herbs. However, it can cause issues with patient compliance… It is important to taste a sample with the patient and resolve any taste issues before they leave your office. Here are some suggestions taken from The Guide that can help:

  • A 5 mL dose of liquid mixture should be taken in no more than 20 mL of water or juice. This amount is easy to swallow quickly in one go and reduces contact time in the mouth.
  • The patient should have another 50 mL of water or juice ready so that they can quickly drink this after the liquid mixture to further reduce contact time of the herbal liquid in the mouth.
  • Another option is to have the patient suck ice prior to taking the liquid mixture as described above. This deadens the taste buds and olfactory nerve.
  • Pleasant tasting herbs such as licorice or marshmallow can be used in the blend to offset the negative tasting herbs.

Liquid Blending Supplies

Getting started is quick and easy as long as the correct working space is developed. We recommend having a sink within reach to properly sanitize the glassware. You can follow the links to purchase on Amazon.

Start-up Inventory

Base your starting inventory of single liquid blends on a few formulas and common body systems. Dr. Ronda Nelson has provided a great starting inventory:

  • Rehmannia 1:2
  • Licorice 1:2 (500 mL)
  • Ashwaganda 1:1
  • Echinacea 1:2 (500mL)
  • Schisandra 1:2
  • Skullcap 1:2
  • St. John’s Wort 1:2
  • Globe Artichoke 1:2
  • Sage 1:2
  • Turmeric 1:1
  • Valerian 1:2
  • California Poppy 1:2

Educational Resources

Here you will find an updated list of professional professional education materials. I selected products that were the most inexpensive in each category with Amazon Prime Free Shipping. Many of these books are available through Standard Process.

Cold-Percolated Ethanol Distillation

MediHerb uses a proprietary cold-peculated water and ethanol method for making their liquid herbs. Based on the individual herb, water and ethanol alcohol is used at varying percentages to break-down the cell wall and dissolve the active constituents. Percentages ranging from 25% to 90% are needed based on herb constituents. Here are some general percentages based on plant constituents:

  •  25%: water-soluble parts such as mucilage, tannins, and some glycosides (including some flavonoids and a few saponins).
  • ƒ  45–60%: essential oils, alkaloids, most saponins and some glycosides.
  • ƒ  90%: resins and oleoresins.

According to Master Western Herbalist Kerry Bone, “It would be very difficult to administer many herbs without the use of solvents. There are however examples where ethanol would not be a suitable solvent. Examples include herbs that require high water solubility. As a consequence, slippery elm (Ulmus rubra) and psyllium (Plantago ovata, P. psyllium, P. indica) are best administered in powder form and mixed in water. Marshmallow (Althaea of cinalis) root is often prescribed as a glycetract (where glycerol mixed with water is used as the solvent). Glycerol however is a poor solvent for most plant constituents. Ethanol is the best solvent to sterilise the dried plant material when extraction begins and to preserve the resulting extract.”

According to The MediHerb Liquid Prescriber’s Guide, “There are some cases where use of an ethanolic extract is not suitable, e.g. different ethnic groups, ex-alcoholics and those with significant liver disorders. (patients with mild liver conditions are not likely to be adversely affected by a small ethanol intake, such as that from a liquid extract.) In these cases other forms of remedy can be used, such as well-manufactured tablets, or the ethanol content of the liquid extract can be reduced by carefully evaporating off the alcohol (not advised for essential oil-containing extracts).”

Avoiding Precipitations

When two different liquid herbs with different water and alcohol ratios are mixed, then precipitations are seen. General cloudiness, colors, fogginess, and particles form. This is common and impossible to avoid. Here are some guidelines from The Liquid Prescriber’s Guide, which can be followed to avoid precipitations:
  • Tannin containing herbs (eg Agrimony) are incompatible with alkaloid containing herbs (eg Golden Seal). If blended a precipitate will form. Tannins and alkaloids should be dispensed separately and taken at different times.
  • Bladderwrack is also not compatible with tannin containing herbs.
  • Herbs extracted in a high percentage of alcohol (e.g. Ginger, Myrrh) often contain resins that precipitate when mixed with liquids of lower alcohol percentage. To avoid this include a small amount of Licorice (10%) in the formula. The saponins in the Licorice act as an emulsifying agent keeping everything in suspension. The Licorice should be added first before adding the resinous liquid.
  • Mix herbal liquids in ascending order in terms of their ethanol content.
  • Mucilaginous herbs (e.g. Marshmallow root) are not compatible with high ethanol extracts and should be dispensed separately.
  • Always remember to have your patient “shake the bottle well before pouring.”

Formulating Your Blend

There is a 5 step process for formulating your patient’s individualized liquid blend. Here are two worksheets that may help you through the process:

Liquid Blending Worksheet Dosing

Liquid Blending Worksheet Actions and Goals

Step 1: Treatment Goals

Customizing a formula for your patient is based on your treatment goals. According to Principles and Practice of Phytotherapy: Modern Herbal Medicine by Kerry Bone, Simon Mills, “Treatment goals will obviously vary according to the needs of the individual case at the particular time of treatment. However, based on the above considerations they an be be divided into two main categories: sympomatic treatment and treatment of the underlying issues.”

During your consultation, treatment goals should be listed. Goals are two faced. You can have a symptoms such as “Menopause Hot Flashes, Stressed Out, Gets Sick Often” that can be related to multiple body systems (i.e. adrenal, ovary, pancreas, etc).

Herbs By Body System and Action

Step 2: Herbal Actions

Once you list the treatment goals that can be symptom and/or gland based, now choose the herbal actions. Choose the herbal actions that match the patient’s body system.

For our “Menopausal Symptoms” example you may need the following actions:

  • antispasmodic
  • oestrogenic
  • uterine tonic
  • nervine tonic
  • adaptogenic
  • immune modulating

Complete Listing of Herbal Actions

Step 3: Choosing the Herbs

Once you decide of the actions, then you choose your herbal tinctures(s). You will find a cross-reference in the above link.

For our example, you may choose the following herbs:

  • Ashwaganda 1:1
  • Black Cohosh 1:2
  • Sage 1:2
  • Echinacea Premium 1:2

Step 4: Minimum and Maximum Weekly Doses

Once you choose your herbs, then you need to find your weekly ranges. These are the ranges that you need to stay within in order to receive a therapeutic dose. Too low, you may not get the desired effect; too high, and the patient may feel horrible.

Minimum and Maximum Weekly Dose Reference

For our example we have the following weekly ranges:

  • Ashwaganda: 20-45mL
  • Black Cohosh: 10-20mL
  • Sage: 15-30mL
  • Echinacea Premium: 15-40mL

Step 5: Choosing Your Blend Doses (mLs)

Once you have your list of herbs, then you can choose the individual amounts so that they add up to 100mL per week. This is about 5mLs, three times per day.

For our example I choose the following mLs:

Ashwaganda: 40mL
Black Cohosh: 20mL
Sage: 20mL
Echinacea Premium: 20mL

Total: 100mL

Liquid Pricing and Blending Calculator

I put together the calculator workbook using Google Spreadsheets in order to make the formulation and pricing process hassle-free. I want to thank Dr. Ronda Nelson and Lee Carroll for commenting on the spreadsheet.

Copy the Google Spreadsheet

WARNING! You must be logged into a Google Account (i.e. Gmail) to make an editable copy and save it to your Google Drive.

Download the Excel Spreadsheet

It’s divided into five sheets:

  1. Liquid Calculator
  2. Liquid Blend Overview
  3. Children Dosages
  4. Resources
  5. Recipes

The Liquid Calculator Sheet

The Liquid Calculator sheet is used to formulate a liquid blend. This sheet will automatically calculate the patient’s price, number of bottles, and the final blended milliliters. To use this sheet, complete the yellow cells. These include:

  • Program Length (B3) – The number of weeks that your patient will be on the blend. Typically patients will start with a two week supply (200mL bottle). The longer the program length, the more bottles that will be recommended. Note: formulas longer than 8 weeks are not recommended without reassessing the patient’s formula.
  • Bottle Size (B4) – The bottle size is the final bottle that your customized blend will be poured into. The most common sizes are 2oz (60mL), 8oz (200mL), and 16oz (500mL). Choose the appropriate bottle size from the drop-down menu. This is used to calculate the blending formula. Note: the most populate bottle size is 200mL. You will find information to purchase in the resources section.
  • Blending Charge (B6) – This is the amount you will add into the formula to cover fixed costs (staff , cleaning, administration, stickers, etc.). Note: we have $5, but you should adjust based on your overhead.
  • Bottle Cost (B7)– This is the amount that an individual bottle with cap costs. We have the cost at $2.95, but may be more or less based on volume. Note: you will find information to purchase in the resources section.
  • 100mL Selected Dose (Column F) – This is the amount of herbs needed for a week. Choose no more than 7 individual herbs. All Weekly Minimum Dosages must add-up to be 100mL. They must fall within the Weekly Dosage Range for each herb. Note: at the bottle of the column, you will notice a color-changing cell to indicate total mL. Green = good, Red = Too Much.

The Liquid Blend Overview Sheet

Once all the yellow cells have been filled in on The Liquid Calculator Sheet, then choose The Liquid Blend Overview. Use this sheet to provide the patient with a list of different herbs and amounts.

You can turn this sheet into a .PDF document to give to a staff member who is mixing the formula. Staff members can also use the information on this sheet to fill out the label that will be stuck to the blended bottle.

You can also provide this sheet to the patient with the blended bottle. File > Download As… > PDF document (.pdf).

Like the previous sheet, complete the yellow cells:

  • Patient Name (B3) – Type in your patient name to use as reference.
  • Clinic Name (B5) – Enter your Clinic’s Name if providing this to your patient.
  • Clinic Phone Number (B6) – Type in your Clinic’s Phone Number if you are providing this to your patient.
  • Re-Order Number (B7) – If you want to track each formulation, you can enter a number here. Note: If you use this type of system, then it is recommended that you add the reorder number to the bottle’s label.

Children’s Dosages Sheet

If the herbal blend is to be given to a child, then use this sheet to quickly calculate Fried’s Rule (for under two years of age) and the Salisburry’s Rule (for over two years of age). The formulas in this sheet will automatically calculate based on:

  • Child’s Age (B2) – The age of the child in years. This can be in decimals (e.g. 2.25, 2.5, 2.75).
  • Child’s Weight (B4) – The weight of the child in pounds. This will be automatically converted into kilograms for the formulations.
  • Adult’s Daily Dose (B6) – The daily dose that is appropriate for an adult. Note: most commonly it is 15mL a day.

The Custom Liquid 200mL Label

I created a modern, professionally looking label to use in your clinic. The label has many time saving features. Thanks to Dr. Nelson and Lee Carroll for providing feedback to the label, it is much appreciated. This label is to be fastened to a 230mL Amber Round bottle. You can download the .pdf and send to your own printer. You can also order the labels from Sticker Giant. Mention Reorder #853774

Note: all of the information to write on the label can be found on the Liquid Blend Overview Sheet in the MediHerb Liquid Calculator:

  • Clinic Name – Write the name of the clinic here.
  • Blend Name/Ingredients – Write the blend’s name and herbs that were used in the formula here in the white box.
  • Suggested Use – Write the number of mL and the number of times per day based on the liquid formula you are using in the orange box.
  • Directions – Underline the time of day you want the patient to take the formula and any additional directions in this purple box.
  • Dispensed Date – Write the date that the formula was given to the patient in the blue box.
  • Expiration Date – Write the expiration date in the blue box.
  • Clinic Phone Number – Write your clinic’s phone number patient in the blue box.
  • Initials – To be initialed by the person who blended the formula.
Download Liquid Herb Blend Label (200mL)

The Legal Environment

The following is intended exclusively for educational purposes and should not be construed as legal advice. The following outtakes are taken from American Herbalists Guild. Once you open the liquid bottles, you are now considered a manufacturer and Good Manufacturing Practices apply to your clinic.

“According to The American Herbalists Guild, “However, the FDA has decided to use its discretion to not focus on individual practitioners who sell supplements to clients as part of an individualized consultation.  Theoretically the FDA could decide at any time to modify this practice.”

About GMPs

“It is advisable for individual herbalists in this situation to familiarize themselves with the GMPs and implement some of the most important best practices such as methods for positive identification of ingredients, tracking of source materials, and proper documentation.”

FDA cGMP for Dietary Supplements Small Entity Compliance Guide
FDA cGMP Clearinghouse of Info Page

Label Requirements

“Requirements for labels include: statement of identity, net quantity of contents, directions for use, other ingredients in descending order of predominance and by common name or proprietary blend, and a Supplement Facts panel.

Manufacturers are also now required to put contact information on their labels and must report all serious adverse effects (whether causation has been determined or not), defined as  “death; a life-threatening experience; inpatient hospitalization; significant or persistent disability; congenital anomaly or birth defect, or requires, based on reasonable medical judgment, medical or surgical intervention to prevent above”.

FDA Labeling Guide

Conclusion

I hope that this guide will help you quickly start and maintain a custom liquid herbal program within your functional medicine practice.

Steps to Start:

  1. Purchase the Liquid Blending Glass Supplies
  2. Become familiar with the MediHerb Liquid Calculator
  3. Order Labels
  4. Purchase a Start-Up Liquid Herb Inventory
  5. Start Blending Based on an Initial Assessment

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Disclaimer

The information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.

Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Midwest Nutritional Service expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. Midwest Nutritional Service does not endorse specifically any test, treatment, or procedure mentioned on the site.