Course F: Formulas of Traditional Chinese Medicine Introduction

Formula is a combination of herbs but not a random collection of herbs whatever. It is composed of corresponding herbs with suitable dosage on bases of definite diagnosis and therapy by means of syndrome differentiation and according to the principle of herb cooperation and proper preparation form. Formula is developed from the application of single herb. The combination of more than two kinds of herbs forms a compound formula. From herb to formula is a process of change from quantity to quality. Single herb possesses its individual specialty, which has simple effect, limited application scope and is easy to produce toxic and side effects. However, formula has cooperative effects of herbs, on the basis of the interaction of herbs, it increases the curative effects through additive and synergetic effects, and decreases the toxic and side effects through mutual restraint and antagonism. By means of adjustment of dosage of different herbs, formula is more suitable to complicate diseases. The study of the formulas is important to the system of theory, therapeutics in traditional Chinese medicine (TCM). It is such a subject to expound the law of herb cooperation in formulae through the study of the composition, modification, and clinical application of the past and current formulae. The course of formulas is one of basic subjects of TCM as well as a bridge between basic theories and clinical application. It is guided by the basic theories of TCM and based on the knowledge of Chinese herbology. Therefore, only is it possible to learn the course of formulas well on the bases of TCM's basic theories and the knowledge of Chinese herbology. On the other hand, because a formula is one of the main methods to treat diseases in various clinical departments, it is the essential foundation for learning different clinical subject to master the basic theories of the formulas and grasp the law of herb cooperation and clinical application of formulae. The development of formulas has a long history. The whole development process reflects two historical phases, i.e. from herbs to formulas and from formulas to therapy.

Chapter 1 Formation of a Formula

The formation of a formula is not only simply to pile up herbs with similar functions and effects but also to treat the head when the head aches or treat the foot when the foot hurts? In TCM, a formula is not only to treat the symptoms but treat the syndrome or the disease based on the differentiation of syndromes, and then some proper herbs are selected and organically constituted in the light of the principles of the formula formation.

Section 1 The Principle of Forming a Formula By the principle of forming a Formula is mainly meant the compatible theory of principal, assistant, adjuvant, and guiding herbs in the formula of TCM. To form a formula in accordance with this theory, it is necessary to make a clear distinction between the principal herb and the secondary ones and make them supplement and restrict one another, thereby, producing the most effective result in the treatment of diseases. Principal herb: A principal herb is one which is aimed at producing the leading effects in treating the cause or the main symptom of a disease. It holds sway in the whole formula. Assistant herb: An assistant herb is firstly meant the herb which helps strengthen the effect of the principal herb and is secondly meant the herb which is aimed at producing the leading effect in the treatment of the accompanying symptoms. Adjuvant herb: An adjuvant herb can be divided into three types: the first type is used to assist the principal and assistant herbs to strengthen their therapeutic effects or treat less important symptoms by itself, the second used to reduce or clear away the toxicity of the principal and assistant herbs, the third used to possess the properties opposite to those of the principal herb. Guiding herb: A guiding herb can be subdivided into two types: one is known as the medicinal guide leading the other herbs in the formula to the affected site, the second is known as a mediating herb coordinating the effects of various ingredients in the formula. Section 2 Modification of a Formula The formation of a formula is not only based on a definite principle but should also bc accommodated in. the light of the concrete conditions such as the state of illness, sex, age, the patient's constitution, the occurring season of a disease and the circumstances. Especially when a set formula is used, the above-mentioned conditions should be taken into serious consideration to accommodate the formation of a formula so as to suit the herbs to the illness and ensure their therapeutic effects. The modification of a formula is usually seen as follows. l. Modification of herbs: It refers to modifying less important herbs in accordance with the difference of the secondary symptoms or the accompanying symptoms without any change of the main symptoms and the principal herbs to meet the need of complicated conditions of illness. In this way, new herbs can be added into a formula or the original herbs may be taken away from it at the same time. For example, the indication of Cinnamon Twig Decoction is for the exterior deficiency syndrome due to affection of pathogenic wind-cold marked by fever, headache, Perspiration, aversion to wind, white and thin fur, floating and slow pulse. If the patient also has a cough or asthma, magnolia and apricot kernel can be added to lower the adverse flow of qi and relieve asthma. If the patient has the accompanying

symptoms such as a fullness sensation in the chest and abrupt pulse, which show impairment of the heart-yang, peony with sour, cold, yin and soft nature should be excluded from the Formula. If the patient has the symptoms of oppressed sensation in the chest and slight cold, which indicate that the yang-qi has been impaired seriously, peony should be excluded from the formula and prepared aconite roots should be added so as to warm the meridians to ensure the flow yang-qi. It is obvious that the modification of the herbs in the same formula in accordance with the difference of the accompanying symptoms reflects the adaptability in forming a formula. 2. Modification of dose: It refers to increasing or decreasing the dose of an herb in a formula without any change in its ingredients. ` This method can either change the potency of the original formula or extend the scope of the treatment, sometimes the dominant and the subordinate roles of the herbs in a formula may be changed so as to suit them to new indications. For example, Decoction for Resuscitation and Decoction for promoting blood circulation and relieving cold are both composed of prepared aconite roots, dried ginger, prepared licorice. Their functions are to recuperate depleted yang-qi and save the patient from collapse. The difference between them is that the latter, consisting of a larger dose of aconite roots and dried ginger than the former, produces a stronger effect of recuperating depleted yang-qi and can treat more severe causes. 3. Modification of dosage forms: It means that the same Formula should be used differently just because of its dosage forms. A Formula can be prepared into various dosage forms each having its own characteristics. Doctors can select the most suitable dosage form to meet the need of the Patient's illness and make it convenient for administration so as to raise the curative effect. For instance, pill or bolus and powder are of slowacting and lasting effects, decoction is of speedy and drastic effect, injection produces effect more quickly and is convenient to use. Let us take Bolus for Regulating the Function of middle-warmer (sanjiao organ) as an example. It is used to treat insufficiency of the spleen yang, but if the condition of the illness is mild and chronic, bolus is preferable, if the case is serious and acute, it is better to take the decoctions instead.