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Chapter Two Design of Formula

A formula is mainly composed of more than two herbs along with application of the single herb. The design of a formula is not to pile op herbs at one’s pleasure, but being guided by principles of treatment based on syndrome differentia don. Some proper herbs are chosen to constitute them in the certain pattern of forming a formula so that they can eomplenient each other to reduce the toxicity and side effects of herbs and increase the efficacy of herbs. A formula can be modified according to status of disease, constitution, sdx and age, so it can flexible and accurate suit to treat complicated and changeable diseases. Discussions on the for mation, compatibility and modification of the formula are as follows:
Section 1 Structure of Forming a Formula
A formula consists of principal, assistant, adjuvant and dispatcher herbs. They were called “monarch, minister, sdjuvant and dispatcher” in ancient time. The chapter 74 in the Plain Questions states: “Those that are used to control disease is termed monarch; those that assist monarch are named ministers; those that fallow instructions of the minister are known as dispatchers”. This explains the basic structure of forming a furniula. Later on, physician Li Dongyaan in the jin Dynasty said: “The herb that controls the main symptoms is termed monarch; bat for accompanying symptoms, adjuvant and dispatcher herbs can he taken to deal with them respectively. This is the key paint to constitute a formula. “ Physician Ke Bozhai painted out: “Generally speaking, the herbs which are taken to treat disease have their own actions that they dominate. The herb that dominates the disease is termed monarch herb; Those that assist monarch herbs are named mm
ister herbs. Those that are opposite and complementary to the monarch herbs are called adjuvant herbs. Those that guide the effects of herbs to the diseased region are known as dispatcher herbs. “These quotations show that structural conception of forming a formala has been making constantly development, supplement and improvement. The terms “principal, assistant, adjuvant and dispatcher herbs” are taken tn generalize the structure of forming a formula in this textbook. Their meanings are as follows:
Principal herb: A principal herb is one which is aimed at prodoeing the lead iag effects in treating the main symptom of a disease.
Assistant herb:An assistant herb is one which helps to ineresse the effects of the principal herb.
Adjnvnnt herb: The adjuvant herh eon he divided into three types. The first one assists the principal and assistant herbs in strengthening their therapeutic effects or treats accompanying symptoms or secondary symptoms by itself. The second one is to restrain or eliminate drastic aetiobs of the principal and assistant herbs and the toxicity of herbs. The third, aimed at dealing with possible vomiting in serious eases after taking deeoetinn with too potent effect, possesses the prop erties opposite tn those of the principal herb in compatibility, but creates supple menting effects in the treatment of diseases.
Dispatcher herb:A dispatcher herb can he divided into two types:The one is known as herb for meridian guiding leading the other herbs in the formola to the affected site. 1he second is called a mediating herb coordinating the effects of various ingredients in the formula.
As the above mentioned, the establishment of principal, assistant, adjovant and dispatcher herbs in the formula should be based on their respective importance of effect, potency and dosage in a formula. The principal herb is absolutely necessary in a formola, hot that whether or not assistant, adjovant and dispatcher herbs are all ready should he dependent on disease state and herbal property. For example, the principal or assistant herb in some formulas has vast actions, which itself possesses the effect of adjovant or dispatcher herb. In this condition, the as sistant or adjovant herb is not necessary to he osed in a formula. If it is difficult to distinguish the principal, assistant, adjovant and dispatcher herbs in the heavy forniola with quite a lot of medicinal ingredients, the herbs of formula can be divided into main part and secondary part by their effects. As for ingredients of principal, assistant, adjuvani and dispatcher herbs in a formula, there is not mechanical regulation. Generally speaking, the principal herb is osed in the few medicinal ingredients, hot in large dosage with great potency, whilst the assistant and adjovant herbs may be used in more medicinal ingredients..he Ephedra Decoction can hr taken as an example.
Ephedra Deeoetion is composed of ephedra, cinnamon twigs, bitter apricot kernel and licorice root and is indicated for aversion to (old, fever, headache, pan talgia, panting without perspiration, thin and whitish coating of the tongue, float13
ing and tight pulse, etc. Among them, aversion to cold, fever, oo perspiration, thin and whitish tongue coating, floating and tight pulse arc main symptoms and pertain to exterior syndrome of excess type due to exogenous wind-cold. Ilesdache, pantalgia and panting src sccondary symptoms. Wind cold evils attack the surface of the body, sweat pores being obstructed and defense-yang being depressed, because cold is characterized by contraction and is likely to consume yang-qi. So a version to cold, fever and no perspiration resslt. The lung qi fails to perform its dispersing and deporative desending fonetions, so asthma occors. Headache and pantalgia resolt from failore of defense-qi to distribution and obstruction of nieridian qi, qi and blood. Thin and whitish coating of tongue and floating and tight pulse indicate the presence of wind-cold in the exterior, sod prosperity of both the genoine-qi and the evil-qi. Exterior syndrome should be treated by diaphoretie therapy.Cold-evil should be removed by warming therapy. Asthma should he re lieved by lowering the adverse flow of qi. So the principles of treatment are inducing the sweating with the pungent and warm herbs, and dispersing the lung to relieve asthma.
Principal herb: ephedra, pungent in flavor end warm in property, acting on the lung and urinary bladder meridians, has the effects of relieving the exterior with dispelling cold from the exterior syndrome and dispersing the lung to relieve asthma. It is used as a group of principal herbs which is aimed at producing the leading effects against the disease.
Assistant herb: Cinnamon twigs, pungent and sweet in flavor and warm in property, acting an the lung, heart and urinary bladder meridians, has the effects of relieving the exterior syndrome with pungent and warm property, warming and activating meridians, and reinforcing yang to promote the flow of qi. It assists ephedra in inducing diaphoresis to expel the evil-qi.
Adjuvant herh:Bitter apricot kernel, hitter in flavor and warm in property, acting on the lung and lsrge intestine meridians, can assist ephedra in strengthe ning the effects of lowering the adverse flow of qi to relieve ssthma. It aims at secondary symptoms -
Dispatcher herb : Licorice root, sweet in flavor and warm in property, can co ordinate the dry and drastic reactions of both ephedra and cinnamon twigs so as to prevent impairment of the genuine-qi. As the first three herbs in the formula act on the lung meridian, this is the reason why it is unnecessary to use guiding herb in the formula. The combination of foor herbs clearly shows their respective
effects, primery and secondary, supplementing one another, thus forming a formu Ia which is simple and potent.
Through the analysis of Ephedra Decoction, it is clear thet one has to follow the pathological mechanism, distinguishing the primary and secondary symptOms, and to master the theory of natore of herbs so as to designate the principal, assistant, ad] ovant and dispatcher herbs when eonstitoting a formola. Only in this way can a perfect formula he formed to achieve good result in clinical practice.
Section 2 Modification of a Formula
The constitution of a formula has its definite structure, but it shnold also be accommodated to the concrete conditions such as the mild, serious, chronic and emergent states of illness, age, sex, diathesis, occupation, birth place 0f patient, the occurring season of the disease and the weather change, etc. When applying a formula in clinical practice, the above-mentioned conditions should be taken into con sideretiun to modify the formula so as to fit to the illness and enhance its therapeutic effects. Generally, the modification of a formula includes modification of herbs, mudificstinn of dose and modification of preparation.
1. Modification of Herbs
it refers to modifying corresponding assistant and ad] uvant herbs in accord ancê with the veriation in the accompanying symptoms or secondary symptnms presenting without any change of the mnain symptoms and the principal herbs to meet the need of conditions of illness. For example, Cinnamon Twig Deenction from Treatise on Cold-Attack composed of cinnamno twig, peony root, fresh ginger, Chinese date and licorice root has the functiuns of expelling pathogenic fac tors from the muscles and skin and harmonizing nutrient qi and defensive qi to relieve exterior syndrome. It is suitable for the exterinr deficiency syndrome due to affection of exogenous wind cold marked by fever, headache, perspiratiun, aversiun to wind, floating and moderate pulse. If the case alsn has a cough and asthma without any change of main symptoms, magnolia should he added to the formula tn lower qi and relieve fullness and apricot kernel should he added to lbwer qi and relieve asthma. The formula is then called Cinnamon Twig Decoction with Magno ha and Apricot Kernel. If erroneous purgation impairs yang qi of the spleen and stomach, giving rise to the accompanying symptoms such as fullness sensation in the chest and rapid irregular internnttent pulse, peony with sour, cold, yin and soft
property should excluded from the formula. It is then named cinnamon Twig Dccoction minos Peony. So it is ev.idcnt that the modification of thc herbs in the same formula according to variation in the accompanying symptoms reflects the adepta bility in forming a formula.
2. Modification of Dose
It refers to increasing or decreasing the dose of herbs in the same formula, which alters the functions and indications of the formula. Fur example, Cold Chubs Decoctiun and Decuctiuo for Promoting Blood Circulation end Relieving Cold limbs are both composed of acooitc root, dried ginger and roasted licorice. In grcdieots of the former arc as follows: raw aconite 9g, dried ginger 45g, roasted licorice root 60g. It has effects of restoring yang to rescue the patient from col— lapse, end is indicated fur syndrome of exuberant yin and declined yang niarked by cold limbs, intolerance to cold with curling oneself up, diarrhea with undigested food, fading cod thready pulse of deep and slow pulse. Doses of ingredients of the letter are as folluws:raw acunitc 15g, dried ginger 90g, roasted licorice root 60g. It’s effect is to restore yang to rescue the patient from collapse, and pruduces a stronger effect of recuperating depleted yang and can treat mare severe case, thus it is indicated fur syndrome of exuberant yin repelling yaog marked by cold limbs, intolerance to cold, flushed face, diarrhea with undigested food, faint pulse. If modification of herbal doses leads to the variation in the principal herbs and main symptoms, it alters rhe changes uf indication end function of a formula. For exam plc, both of Minor Purgative Decoction and Magnolia Three Iogredieots Decoct ion are composed of rhubarb, immature bitter oraoge and magnolie. In the former formula, rhubarb l2g is used es e principal herb, immature bittc orange 9g as an as sistant herb, magnolia 6g as an adjuvent and dispatcher herb. It’s effects are to purge heat and case defecatioo, and is indicated for excess syndrome of Yangming fu viscera marked by tidal fever, delirium, constipation, abdominal pain aggrava ted by pressure, etc. In the latter, magnolia 24g is takco as a principal herb, iromaturc bitter orange 15g as an assistant herb, rhubarb 12g as the adjuvant and dispatcher herb, it lies effects of activating qi and casing defecation, and is used for abdominal distention due to qi stagnation and constipation.
Through analysis of above meotioned examples, ii is clear that the first example shows Ihal rnudificutiuo of herbal doses does not alter the basic structure of a formula, pathological mechanisms of syndromes so that the indications for these arc two formulas almost cause, only they are variation in cuoditiona of illness; the

second example shows thot modification of herbal doses, in particolor the voriation in princoipal herb, alter the indications and functions of a formula, actoally, it is a new formula.
3. Modification of Preparation Forms
denotes that the same formola with different preparation forms rosy change therapeutic effects accordingly. A formula can be prepared into various forms of preparation such as decoction, pills and bolos, powder, extracts, pillets arid medicated wines, etc. Owing to differences of manufacturing methods and technological process, each has its own characteristics. One can choosp the most soil able preparation form to meet the reguirement of illness so as to raise the therapeutic effects. ln general, the decoction is easily to lie absorbed, able to produce quick therapeutic effect. It is commonly used for acute diseases. Pills or boluses are moderate in action and of lasting effects, and are suitable for treatment of chronic diseases. Take the Middle-Regulating Pills as example, it is composed of dried gin ger, ginseng, bighead atractylodes rhizome and roasted licorice root, and is used for deficiency cold syndrume uf the middle-jiao marked by watery diarrhea, vomi ting, abdominal pain, pale tongue with whitish coating, deep and slow pulse. If chest blockage syndrome is caused by deficient yang of the middle-jiao, and is sen ous and acute, it is better to tdke the deeoctions of above mentioned four herbs instead. In clinical practice, one can select proper preparation forms in accordance with the need of illness. No more examples are enumerated here.
In sum, mudifications uf a formula are flexible and varied, they can either be applied separately or be used in condonation. However, it should he pointed nut that clinical treatment must be based no the concrete condition of illness in order to have a definite object in view and to avoid blindness in action.

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