E. F. Block
Early workers in herbal medicine in the region of the World in what is now known as China discovered that combining herbal substances yielded more beneficial results in treating disease than in using them individually. The "Prescriptions for Fifty-Two Kinds of Disease", the oldest known recorded work (3rd century BCE) documenting the use of herbal substances, includes 280 formulas for the 52 listed diseases. Work on expanding knowledge and the creation of more effective formulas continued in China and continues to evolve today. The author has by no means exhausted looking at the books available for Western Herbal Medicine. However, it is true that the only formulae that have been encountered in the literature search are those composed as drinks or food dishes. None have been available for medicinal prescription. Even more astonishing is the fact that no information is alluded to for principles of compounding Western herbs into formulae. It is this lack of conceptualization in the Western herbal practice that is being directly addressed with this work.
Many types of formulae have been stated but today most works dealing with Chinese herbal medicine (CHM) list 18 to 21 categories based upon addressing a set of signs and symptoms, much like that with the materia medica. It is important to note that successful treatment requires an accurate differential diagnosis, a comprehensive treatment plan and effective herbal formulae. The signs and symptoms displayed by the patient are a reflection of the physiology and biochemistry that has been altered from normal functional parameters. We understand that this is the result of disharmony in the HBF according to the principles of IM. Consequently, most acute therapy is geared to relieving the symptoms and not the cause of the disharmony. The treatment of chronic disease must do both; treat the signs and symptoms as well as the cause of the disharmony. Thus, medical diagnosis and treatment must take into account both the cause of the disharmony as it affects the HBF and the pathogenic agent. As the patient goes through as series of stages in the progress of the disease and an eventual return to normalcy, the prescribed treatment will need to reflect these changes. Many formulas that are first prescribed deal with the elimination of the pathogen while later formulas assist the body in clearing the residual debris left in the wake of the disease.
Every Chinese herbal formula has four main components that play an essential function within the formula. The chief herb is used to address the direct cause of the disease or its main symptom. This is the essential ingredient of the formula and is used in a large dose to maximize the desired effect. The deputy herb has two functions: it reinforces the effect of the chief herb to treat the main disease/symptom and it treats the associated or co-existing disease/symptom. The assistant herb has three functions: it reinforces the effect of the chief herb or directly treats the secondary symptoms, it counteracts any toxicity of the chief herb or minimizes the drastic effects of the chief herb/deputy herb, or has the opposite effect as, but works in synergy with, the chief herb in order to treat the most complex and serious disorders. The last component is the envoy herb. The envoy herb has two functions: it acts as the channel-guiding herb to direct the formula to the affected channel/areas of the body and it harmonizes all of the herbs within the formula. It is usually used in only small doses.
The dosage of the formula is dependent upon the severity and the time-span of the disease within the body (HBF). However, one needs to be aware of the Arndt-Schultz Rule that states the too large a dose has the opposite of the desired affect. This is why that person with whom you are practicing your skills is indeed your patient in that they need to be patient while you get their treatment protocol correct! And again, the formula that you prescribe now may not be the same one that you prescribe tomorrow.
The chief herb is the most important component of a formula. In general, every formula has only one or 2 chief herbs used in higher dosage to treat the main symptom or disease. The other supporting herbs are used with lesser dosages. The deputy, assistant and envoy herbs are used flexibly according to the condition of the patient. It is not necessary to use all four components; again usage depends upon the complexity of the disease conditions. Also, when the chief herb enters the correct M/C for the disease at hand, it is not necessary to add an envoy herb.
It is very important to follow the guidelines when composing an herbal formula. The individual conditions of the patient will dictate the herbs chosen. Additional consideration must also be given to the age, body weight, clinical presentations and underlying constitution of the patient. Ingredients, doses and dosage forms should be adjusted to optimize treatment results. Herbal formulae are usually given in the form of a decoction but also powders and pills are prescribed or perhaps a medicinal wine.
Concepts of Traditional Chinese Medicine
At this time it is advisable to address some of the wordage used in CHM as part of Traditional Chinese Medicine (TCM). More information concerning the below topics may be found here and the following two articles of the total set of three articles.
The TCM Concept of Yin - Yang
Yin is ultimately derived from the Earth. Yang is ultimately derived from the Sun. These are two polar opposites with gradations of each between. This is a concept only and has no physical objective reality! They do however represent a relationship that seems to be everywhere in nature, different and opposite aspects of the same phenomenon. One example is the alternation between night and day. In TCM, yin relates to the physical structure of matter and the body while yang relates to qi and its distribution. The Yin organs (lungs, heart, liver, kidneys, spleen, pericardium) are solid (inside the body proper) while the yang organs are hollow (stomach, small intestine, large intestine, gallbladder, urinary bladder, three bowls or body cavities) and deal with food processing and waste elimination.
The TCM Concept of the Five Elements
All phenomena in Chinese philosophy are classified according to five elements: wood, fire, earth, metal (air), water. The movement of qi within the M/C system is coordinated with the progression of qi moving from wood to fire to earth to metal to water to wood and so forth over and over. "The Law of Movement of the Five Elements" manifests in the following manner: inter-promoting, interacting, overacting, counteracting and mutual relation between that which comes before with that which comes after.
The TCM Concept of Qi
Universal qi is the energy of the environment. In TCM, qi refers to the essential substance of the body that maintains vital & functional activities. Qi is differentiated by source, function and distribution. Congenital qi is inherited from the parents. Clean qi is gathered from the air by the lungs to become chest qi. Nutrient qi is obtained from food. Defensive qi comes from the core of the body. Congenital qi is given while the rest are obtained from the air and food as Acquired qi. Defensive qi protects the surface of the body from exterior pathogens.
The TCM Concept of the Meridians/Channels (M/C)
The M/C system is responsible for the circulation & distribution of qi and blood to all areas of the body extending from the inner core to the most superficial aspects. There are 3 courses of 2 pairs of yin/yang related meridians for a total of 12 main channels that are also related to the major yin/yang organs of the body. Movement of qi within the M/C system is from the core of the body to the hand, from the hand to the head, from the head to the feet and from the feet to the core. Each round passes through the organs each M/C is related, as an example, the Lung meridian through the Lungs and an accessory to the Large Intestine. The five zang (yin & solid) and six fu (yang & hollow) organs, four limbs, nine orifices, skin muscles, vessels, and tendons, although having their respective physiological functions, also maintain the harmonization and uniqueness of interior, exterior, upper, and lower parts of the body as a united and organic entity. This interconnection and organic combination relies upon the function of the channels and collaterals system.
When pathogenic factors invade the skin and the pores are open they enter the collaterals. When the collaterals become full, the pathogenic factors will move into the channels. When the channels are full, the pathogenic factors transmit to and reside in the zang and fu organs. The interior and exterior, upper and lower parts of the body form an integrated entity through the connecting network of channels and collaterals. So under pathological conditions every part of the body will affect the rest of the body via the channels and collaterals. The channels and collaterals are not only the passages of disease transmission, but can also reflect pathological changes. The diseases of the zang-fu organs can be reflected on the body surface, especially in certain areas or at certain points, through the transmission of disharmonious energy by the channels and collaterals. Treatments using traditional medicinal herbs are based on their main actions through the related zang-fu organs and channels. The yin organs are internal while the yang organs deal with digestion and waste elimination.
The TCM Concept of Etiology & Pathogenesis
Many factors may cause disease and they are in general the six exogenous factors, the seven emotions, improper diet, overstrain, stress, lack of physical exercise, traumatic injury, bites of animals & insects, plant poisons, stagnant Qi/Blood and Phlegm fluid. The six exogenous factors are wind, cold, heat (fire), summer heat, damp and dryness. The seven emotions are excessive joy, anger, melancholy, worry, grief, fear and fright. Stagnant blood refers to impaired blood circulation due to coldness, deficiency or stagnation of qi. Phlegm fluid refers to the accumulation of copious thick exudates due to the dysfunction of the lungs, spleen or kidney and the resulting impairment of water metabolism.
In TCM, pathogenesis is the result of the disharmony between those systems tasked with maintaining rheostasis (a technically more correct word than homeostasis) within the body due to the invasion of a pathogenic influence. There will be a shift in the yin/yang balance within the body, a shift in the overall HBF. Also, there will be a concomitant reaction of the bodily defenses to the invasion, whether due to a disharmonious energy or an organism. The result is a disruption in the normal course of circulation of qi within the body and the HBF.
The TCM Concept of the Four Polar Opposites
In TCM, there are 4 sets of polar opposites with a sliding range of conditions in between:
All of CHM is utilized in order to return the metabolism and physiology of the body to normal parameters. Each person is different due to genetics and resulting constitution. Thus, a comprehensive intake is made to determine the norm for each individual. In China, the doctor is paid to keep a person healthy and thus usually knows each person very well. The differential diagnosis is couched in relation of the above terms and will be stated in a combination of the relevant terms.
Exterior refers to pathological conditions that result from the invasion of the superficial portion of the body by exogenous pathologic factors. Internal refers to the pathological conditions due to the transmission of exogenous factors to the interior of the body that affect the physiology and metabolism of the organ systems of the body and the normal flow of qi.
Cold refers to exposure to exogenous cold or a deficiency in the yang determining systems in the interior of the body. Heat refers to the opposite with invasion of exogenous heat or a deficiency of yin determining systems.
Excess refers to the fact that some body system is in a state of overproduction and thus deficiency is that some body system is in a state of underproduction. Tonicity refers to a state of muscle contraction and should not be used to denote a strengthening by "tonifying"; you are not able to tonify a deficient condition!
Please remember that yin/yang do not denote a physical reality. The relative balance of yin determining systems of the body and the yang determining systems of the body is reflected in rheostasis. Rheostasis is an oscillation around a neuro-physiologically determined set point. Yin/yang determining systems are always engaged in a balancing act that never quite reaches perfection and hence the oscillation.
Levels of Disease Penetration into the Interior
The Herbal Formulae
The following is the schema for herbal formulae:
As you might be able to discern, there is very little in the way of disease and the result of trauma that is not treatable by CHM.
Reference - Chen, J. K. and Chen, T. T., 2009, Chinese Herbal Formulas and Applications: Pharmacological Effects & Clinical Research, Art of Medicine Press, City of Industry, CA