Chapter One The Relationship of Formulae to Syndrome
Differentiation and the Establishment of Therapies
The formula of traditional Chinese medicine refers to a preparatioo which, based on certain formolating principle and gnided by the syndrome differentiation and the establishment of therapies, combines various herbs for the prevention and treatment of diseases. Therefore, claritying the relationship of the formula to the syndrome differentiation and establishment of therapies will play an important role in selecting patent formula, developing new formula and comprehending for mule ology.
Section 1 The Relationship of Formula
to the Syndrome Differentiation
Syndrome differentiatiun is considered to he a premise for the establishment of therapy, choice of herbs and prescription of forninlae. Ii is a process of analyzing and determining the syndrome of disease. The concept of syndrome differs from that of symptom. The latter points to a pathological state manifested in the cause of a disease, such symptoms as fever, aversion to cold, headache, cough, vomiting, diarrhea, etc. ,but the former is a pathological generalization to the fun darnental cause, location and nature of the disease as well as balance between the evil-qi and the genoine-qi at a certain manifestations, for example, aversion to cold, fever, headache, pain of the body, no sweeting, no thirsty, thin whitish tongue coating, and floating and tense pnlse—all these eon be determined as exterior syndrome of cold-attack, which show the facts that the cause of disease belongs to cold, that the location is in the exterior of the body and the nature is excess.
Actually, syndrome differentiation in TCM is a process by which the efinical data of symptoms and signs obtained through the four diagnostic methods are syn
thetically analyzed and sorted out on basis of the eight principles of syodrome differentiation, visceral syndrome differentiation, meridians syndrome differentiation ond etiological syndrome differentiation, etc. ,so as to determine the cause, the location and the nature of pathological changes and to grasp the essence of the disease as well as to differentiate what is primary and what is secondary. As eausa tive factors are complicated and changeable, the body may be attacked hy single evil-qi or concurrently by a number of evil qi there may appear syndrome of deficiency enmplicated with excess. The syndrome may contain the main symptoms and accompanying symptoms because of primary and secondary causes. The main symptoms signify a group of symptoms and signs that indicate main cause, nature and localion of disease, so it is the principal aspect of a contradiction that decide the occurrence and development of disease and provides hasis fur choice of principal herbs. The accnmpanying symptoms show a group of symptoms and signs indicating the cause, nature and location of disease to a secondary position. It he longs to secondary contradiction which does not play a leading role in the occurrence and development of disease, but provides the basis for choice of assistant herbs.
In addition, when the primary and secondary causative factors attack the body, some symptoms that do not reflect the cause and nature of disease may ac company with main symptoms in the process of syndrome differentiation, such symptoms as headache, cough, vomiting and so on. They belong to accompanying symptoms and may disappear along with elimination of causative factors. For heavy accompanying symptoms, the adjuvant herbs can be used in the formula.
As syndrome differentiation is a process of making correct diagnosis, only by accurate diagnosis, can we have a definite object and work out effective traatmants according to the syndrome of disease.
Section 2 The Relationship of Formulae
to Establishment of Therapy
Establishment of therapy means to set up therapeutic principles which are drawn up an basis of etiology and pathological mechanism after syndrome differ antiation and diagnosis. It is a key link during process of treatment based on syndrome differentiation. For example, cold syndrome should he treated with war ming therapy, heat syndrome with clearing therapy, deficiency syndrome with ton ifying therapy, excess syndrome with purging therapy, and exterior syndrome with
diaphoretic therapy, etc. When the therapy is deterimried, it will Provide main basis for selecting patent formola ond designing new formula in clinical practice. ‘fake the exterior syndrome due to exogenous wind-heat as example, according to the principles uf “exteriur syndrome should be treated with diaphuretic therapy” and “heat syndrome should he treated with cooling therapy” , the therapy of relie ving the exterior syndrome with the pungent and cool herhs can he estahlished, and then tu select set formula or constitute a formula. Thus it cun be seen that establishment of therapy is the guiding principle of designing a formula, and formula, in turn, gives a concrete exptession to the establishment of therapy. When es tablishing the therapeutic methods,- it is a must to distinguish the sequence of therapies and write them in their given order in accordance with primary and see undary symptoms, and neither can he reversed wantonly.
It should not he mixed up the two different concepts of establishing therapy and treatment method. The former is concrete application of therapeutic principle and provides guiding principle- for selecting herbs and designing a forrnuia, whilst the latter refers to the methods of treatment, including acupuncture and moxibusLion, massage, qigong, formulae, and so forth. lt is thus clear that the formula is unly une uf therapies. The methud of treatment can nut be used instead af establishment of therapy, and it is no more to provide guiding principle for selecting herbs and composing a formula.
Section 3 Common Regulations for Designing Formula
The rdgulation of-prescribing a formula(it is called “regulatiun”fur short. ) is the law of selecting herbs and constituting a formula. The relationship of regola tiun to formula is that between the generality and individuality. During the process of development of formula, it appears before the regulations because regulations are common laws drawn from numerous formulae. They have universal guiding significance to constituting formulae. This concept was put forward by physician Xo Hong in the Song Dynasty, who in his book Cencral Discussion on a Guide tu Clinical Practice pointed oat: “When constituting a formula to treat disease, the first thing to be done is to seek for the causative factors and analyze excess and deficiency of syndrome and then determine tonifyiog method or purging method which should be used. The -formation of a formula is hosed on differentiating the cold and hot changes of climate, observing prosperity and decline of yang and yin, learning sweet and pungent flavor and cold and hot nature of the herbs and desig
nating principal and assistant herbs in the formula. Only in this way can the for mule fit to the disease. This is the essential of designing a formula. This quotation briefly explains the steps arid patterns of establishing formula. Latter on, Physician Cheng Zhongling of the Qin Dynasty further raised “the eight therapeutic mehtods” , who in his book Understanding Medicine stated: “Speaking of causative factors, they can be included in the exngennus attack end interrnal injury. As far as the nature of disease is concerned, it can be attributable to eight types: cold and heat, deficiency and excess, exterior and interior, yin and yang. As to formula, all methods of treatment are contained by eight therapeutic methods, including diaphoresis, harmonizing, purgation, dispersion, ëmesis, clearing, warming and tonif ying. One therapeutic method contains the meaning of eight therapeutic met buds which may possess the implication of one hundred therapeutic methods. The dis ease may be changeable, yet the method in therapeutic essence of all these arc but nne.” This shows that establishment of eight common therapeutic methods for designing formulae is based on etiulugy and tile eight principal of syndrome differ entietion, which can generalize the law nf cnnstituting formulas. Here the contents of the eight therapeutic methods are briefly introduced as follows:
Diaphoretic therapy refers to the method of establishing fnrrnulae used in treatment of the exterior syndromes. It involves the use nf herbs fnr treating exte nor syndrnnie. Harmnnizing therapy refers to the method of composing formulae used for Shaoyang syndromes. It involves the use of herbs fur mediating Shanyang disease. Purgative therapy denotes the niethnds of forming formulae used in treat ment of dry stonl, cold accumulation, blood stasis, phlegm accumulation and fluidretention. The formulae are chiefly composed of purgatives and drastic hydragogues. Resolving therapy implies the method of designing formulae userl fnr tree ting food-retention, abdnnonal mass and unstable gathering. The formulae are mainly compnsed of herbs for improving digestion, removing fond retention and dispersing accumulation. Emetic therapy denotes the method of designing formulae used in treatment of phlegm syncope, food retention, and pntentially harmful substunces through the mouth. Ihe formulae are mainly composed of herbs for causing vomiting. Clearing therapy refers to the method of designing formulae used in treatment of interior heat syndromes. The forniulue mainly involve the use of heat-clearing herbs. Warming therapy refers tn the method of composing for niulae, which is applied in interior cold syndromes, and the formulae mainly involve the use of interior-warming herbs. Tonifying therapy points to the method
of forming formulae, which is applied in treatment of deficiency syndromes, and the formulae are mainly composed of restoratives. The concrete contents of eight therapeutic methods will be disuessed in the elaboration.