I use modifiers to some degree, though most buttons have only 1-2 spells. I use Clique to cast heals and dispels by clicking on unit frames (though my shaman's action bar in resto spec does have heals on it too). I use keybinds for things that share functions between classes (eg. C is always bound to a dispel macro/ability, Z is always bound to a CC, etc.). I use OPie for everything else.
I'll post some screenshots later (I'm at work right now) but here's my basic setup from memory:
Enhancement Shaman
Action bar:
1. /cast [mod:alt] Chain Lightning; Lightning Bolt
2. Stormstrike
3. Lava Lash
4. /cast [mod:alt] Frost Shock; Earth Shock
5. /cast [mod:alt] Fire Nova; Flame Shock
6. Unleash Elements
OPie rings:
Middle-click: Totems + Call of the Elements (totem cooldown reset talent) + Totemic Recall
Shift-middle-click: Weapon buffs
Key bindings:
Q = Lightning Shield
Z = Bind Elemental
X = Hex (common binding for primary CC)
C = Purge/Dispel/Resurrect macro (common)
G = Interrupt (common)
P = Water Walk
O = Far Sight
Numpad / = Earth Elemental totem
Numpad * = Fire Elemental totem
Numpad - = Blood Fury (common binding for racial cooldown)
Numpad + = Asecndance (common binding for primary DPS cooldown)
Numpad 0 = Spirit Wolves (common binding for secondary DPS cooldown or primary defensive cooldown)
Numpad 7 = Bloodlust
Numpad . = Astral Shift (common binding for secondary defense cooldown)
Numpad 1 = Spirit Walk (common binding for "go fast" cooldown)
Destruction Warlock
Action bar
1. Immolate
2. Incinerate
3. /cast [mod:alt] Fel Flame; Conflagrate
4. /cast [mod:alt] Shadowburn; Chaos Bolt
5. Rain of Fire
6. Fire and Brimstone
OPie
Middle-click: Things generally used in combat (eg. Burning Rush, Ember Tap, Command Demon, Twilight Ward)
Shift-middle-click: Things generally used out of combat (eg. Soulstone, Healthstone, Soulwell, summon, Demonic Gateway)
Ctrl-middle-click: Summon demons
Key bindings
Q = Soulshatter
W = Havoc
Z = Banish
X = /cast [mod:shift] Howl of Terror; Fear
C = Curse of the Elements (opposite of a dispel
)
G = /cast [mod:shift] Demonic Circle: Summon; Demonic Circle: Teleport
V = Enslave Demon
P = Eye of Kilrogg
O = Underwater Breathing
F5 = Flames of Xoroth
Numpad / = Doomguard
Numpad * = Infernal
Numpad - = Berserking (racial)
Numpad + = Dark Soul: Instability
Numpad 0 = Unending Resolve
Numpad 9 = Dark Intent (common binding for long-duration group buff)
Feral Druid
This is the only class/spec where any button or binding has more than 2 abilities with modifiers. I use the following macro for cat finishing moves:
/cast [mod:ctrl] Maim; [mod:ctrl] Ferocious Bite; [mod:alt] Savage Roar; Rip