The Formulas Flashcards
Formula Key
C= Chief, monarch, emperor, or principle herb. The chief’s role is to work directly against the principal pattern. D= Deputy, minister, adjutant, associate. The deputy assists the chief and may work against a coexisting pattern. A= Assistant, adjutant, adjuvant. The assistant reinforces the actions of the chief and deputy and moderates their toxicity. In complex disorders, may have an effect that opposes the chief. E= Envoy, messenger, guide, conductor. The envoy guides the actions of the other herbs to certain channels or areas of the body. Harmonizes the other ingredients in the formula.
The chapter commentaries contain chapter references in parenthesis (i.e. Ch. 2.2) which refer the reader to the single herb index of this guide.
Chapter 1: Formulas that Release the Exterior
Exterior (biao), refers to the superficial layers of the body, namely, the skin and muscles. Exterior disorders occur when a pathogenic influence first invades the body.
The skin and muscle layers are perfused with the body’s protective (wei) qi. Protective qi is hot and fierce in nature. It warms the body and protects it from invasion by pathogens. Pathogens that have invaded the protective level obstruct the normal diffusion of qi and fluids. At the same time, they encourage the body to move more protective qi towards the exterior to fight them off. This interaction is what causes symptoms of exterior invasion.
Fever and chills indicate obstruction of the body’s normal physiological warming processes even though there is an excess of protective yang in the exterior. Head and body aches indicate obstruction of qi and fluids in the most yang or exterior areas of the body. A floating pulse reflects the movement of protective yang qi towards the exterior.
Early stages of measles, incompletely expressed rashes, the initial stage of carbuncles and sores accompanied by chills and fever, and acute superficial edema are classified as exterior disorders as well.
“Wind is the leader of the hundred diseases.”
Wind is the vehicle by which exterior pathogens invade the body. It is involved in most exterior disorders, especially those involving cold or heat.
Manifestations of exterior disorders reflect the body’s attempt at overcoming obstruction of the qi dynamic by one of the six pathogenic evils.
The treatment strategy is to support the body’s physiological response to these pathogens by releasing the pathogenic influence from the exterior (jie biao). Light, acrid, moving herbs vent exterior pathogens by unblocking qi obstruction, diffusing the protective qi, and disseminating the body fluids. There is no other strategy for preventing pathogens from penetrating deeper.
Sweating is the first of the eight treatment methods first outlined by Cheng Guo Peng in the 18th century. Sweating after treatment indicates that the obstruction has been overcome. It is an indication that the qi and body fluids have regained the ability to circulate to the surface of the body. It is common for the sweating induced to be pronounced at first. This is especially true if the formulas used were warming and acrid. Profuse sweating should stop once the body has regained homeostasis. Sweating may be mild or profuse at first and turn mild. It is a sign that the qi and fluids have become unblocked and ordered.
“It is best to treat the skin and hair; the next best is to treat the muscles and flesh; the next best is to treat the sinews and vessels, the next best is to treat the six yang organs, the next best is to treat the five yin organs.”-Basic Questions
Releasing exterior pathogens in their initial stages prevents them from developing into serious conditions.
When prescribing, an accurate diagnosis is essential. If an interior disorder develops during the course of an exterior disorder, formulas that release the exterior or that release both the exterior and the interior at the same time may be used. The formulas in this chapter do not treat purely interior conditions (unexpressed rashes, edema due to deficiency).
The nature of the pathogen and the type of sweating that will be induced by the formula should be taken into consideration. The dosages and formulas should be modified to account for the climate, the season, and the individual’s constitution.
The formulas contain light and active substances that are sensitive to heat. They are prepared as decoctions or powders and should only be decocted for a short time. They should be taken hot after meals. Blankets are helpful to encourage slight sweating.
Chapter 1: Formulas that Release the Exterior
Ma Huang Tang (Ephedra Decoction) 1.2
Gui Zhi Tang (Cinnamon Twig Decoction) 1.2
Ge Gen Tang (Kudzu Decoction) 1.2
Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction) 1.2
Xiang Su San (Cyperus and Perilla Leaf Powder) 1.2
Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction) 1.3
Yin Qiao San (Honeysuckle and Forsythia Powder) 1.3
Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction) 1.3
Sheng Ma Ge Gen Tang (Cimicifuga and Kudzu Decoction) 1.3
Ren Shen Bai Du San (Ginseng Powder to Overcome Pathogenic Influences) 1.4
Jia Jian Wei Rui Tang (Modified Solomon’s Seal Decoction) 1.4
Chapter 1 Section 1: Formulas that Release Early-Stage Exterior Patterns
These formulas treat the beginning stages of exterior disorders by venting the pathogenic factors, preventing them from entering further into the body.
One initial sign of an exterior pathogenic invasion is a sensitivity to drafts. Aversion to wind (wu feng) can be treated successfully with a decoction of Cong Bai (Alli fistulosi Bulbus, green scallions) and Dan Dou Chi (Sojae Semen praeparatum).
Stronger chills indicate that the pathogen has progressed.
The formulas in this section should only be prescribed for one or two doses. If no improvements are seen, a stronger formula is needed.
Chapter 1 Section 2: Formulas that Release Exterior Cold
Depending on the strength of the individual, exterior cold disorders manifest in one of two ways, cold damage (shang hun) and wind attack (zhong feng).
Cold damage is characterized by a strong immune response to a strong pathogen. Cold blocks the circulation of protective (wei) qi and fluids in the outer layers, the skin and pores, which prevents sweating. Internally, the constraint of protective (wei) and nutritive (ying) qi causes a high fever and severe body aches. The diagnostic symptom of excess cold is an absence of sweating. Formulas that release the exterior and strongly induce sweating are indicated.
If the defensive response is characterized by disorder and disruption rather than complete obstruction, it is called wind attack. In those cases, even if there is sweating, the condition will not improve. This is because the preexisting protective qi is too weak to expel the pathogen. The treatment will still require sweating, but in these formulas, herbs are often added to regulate and harmonize the relationship between the nutritive qi and the protective qi so that the body can expel the pathogenic factor.
Wind cold symptoms include: fever with chills predominant, head and body aches, clear or white nasal discharge or sputum, and a floating pulse. The treatment for wind cold is to release the exterior and induce sweating.
The herbs primarily used to treat wind cold are acrid and warming. They release the exterior and warm the collaterals. (Ch.1.1)
Cold disrupts the downward directing function of the Lungs which causes coughing and wheezing. Herbs that help the Lungs disseminate and direct qi downward are added. (Ch. 6.3)
Herbs that invigorate blood and unblock the vessels are added for headaches and body pain caused by cold congealing the blood. (Ch. 10.2)
Cold contracts the body fluids turning them into dampness and phlegm. Herbs that dry dampness and transform phlegm are added in these cases. (Ch. 9, 6.2, 6.3)
Chapter 1 Section 2: Formulas that Release Exterior Wind Cold
Ma Huang Tang (Ephedra Decoction) 1.2
Gui Zhi Tang (Cinnamon Twig Decoction) 1.2
Ge Gen Tang (Kudzu Decoction) 1.2
Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction) 1.2
Xiang Su San (Cyperus and Perilla Leaf Powder) 1.2
Ma Huang Tang (Ephedra Decoction)
Ma Huang (9g) Gui Zhi (6g) Xing Ren (9-12g) 70 pieces Zhi Gan Cao (3g)
Method: Decoct ma huang first in 9 cups of water until 7 cups remain. Remove the froth. Add the other ingredients and decoct until 2.5 cups remain. Divide into thirds. Take the strained decoction warm in three doses. Modern method: decoct ingredients together for 20 minutes or less. The decoction is taken hot to encourage significant sweating. Once sweating occurs, do not take again.
A: Releases exterior cold and arrests wheezing.
I: Fever and chills (chills predominant), without sweating, headache, generalized body aches, wheezing.
T: thin, white coating P: floating (exterior), tight (cold)
Syndrome: Wind cold attacking the exterior where it fetters or bottles up the protective qi. Inhibited flow of yang qi in the exterior produces chills. Struggle between normal qi and the external pathogen causes fever, and makes skin warm to the touch.
The head is the meeting point of all the yang channels, wind cold in the head causes headache. Cold causes pores to close and prevents sweating. Cold interferes with nutritive qi in the muscle layer and causes generalized body aches. Lung qi cannot disseminate and rebels, manifesting as a barking cough or wheezing.
C: Ma Huang: warm, acrid, diaphoretic, disseminates Lung qi and treats wheezing
D: Gui Zhi: diaphoretic, releases the exterior, especially the muscle layer. Combined with chief for stronger release of the exterior.
A: Xing Ren: bitter, slightly warm, directs Lung qi downward to help stop wheezing and expel pathogenic influences. Oily, moderates the chief and deputy to moisten the Lungs.
E: Zhi Gan Cao: harmonizes other herbs actions, moderates diaphoretic action of ma huang and protects against slight toxicity of xing ren.
Gui Zhi Tang (Cinnamon Twig Decoction)
Gui Zhi (9g) Shao Yao (9g) Bai Shao is preferred form Sheng Jiang (9g) Da Zao (12 pieces) Modern dose is 4 pieces Zhi Gan Cao (6g)
Method: Coarsely grind the ingredients. Decoct over a low flame in 7 cups of water until 3 cups remain. Take one cup with hot rice gruel to induce sweating. If the first cup is successful, do not take the second cup. If there is little sweating, repeat once or twice, progressively reduce the intervals between doses.
Modern method: Cook no more than 20 minutes, taken hot. Cover patient and allow for slight sweating. Stop administering after patient has sweated a little. Alcohol, cold, raw, greasy or spicy foods are prohibited during medication.
A: Releases pathogenic influences from the muscle layer and regulates the nutritive and protective qi.
I: Fever and chills not made better by sweating, headache, aversion to wind, stiff neck, nasal congestion, dry heaves, no particular thirst, can be used in cases that are similar to exterior wind cold.
T: thin, white, and moist coating P: floating, neither lax or frail
Syndrome: External wind cold or wind attack, characterized by disharmony between the nutritive (yin) and protective qi (yang).
C: Gui Zhi: releases exterior wind cold from the muscle layer
D: Bai Shao: benefits yin and contains the nutritive qi
A: Sheng Jiang: helps gui zhi release the exterior, treats nausea and vomiting by directing qi downward, benefits the Spleen
A: Da Zao: helps bai shao nourish and harmonize nutritive qi and blood, benefits the Spleen
E: Zhi Gan Cao: harmonizes the ingredients to help gui zhi and sheng jiang transform yang, and bai shao and da zao to transform yin
Ge Gen Tang (Kudzu Decoction)
Ge Gen (12g) decoct first Ma Huang (9g) decoct first Gui Zhi (6g) Shao Yao (6g) Bai Shao is the preferred form Sheng Jiang (9g) Da Zao (12 pieces) Modern dose is 4 pieces Zhi Gan Cao (6g)
Method: Decoct ma huang and ge gen in 10 cups of water until 8 cups remain. Add the other herbs and decoct until 3 cups remain. Modern method: decoct all ingredients together.
A: Releases the exterior and muscle layer, and generates fluids
I: Fever and chills without sweating, stiff and rigid neck and upper back
T: thin, white coating P: floating, tight
Syndrome: Externally contracted wind cold affecting the greater yang warp. Distinguishing feature is a stiff and rigid neck and upper back caused by wind cold binding the upper portion of the greater yang channel preventing fluids from reaching the area.
C: Ge gen: releases the muscle layer, especially of the upper back and neck by drawing fluids to the area, and releases the exterior
D: Ma huang: induces sweating, most powerful for releasing excess cold from the exterior
A: Bai shao: preserves yin by preventing other herbs from causing excessive sweating. With gui zhi, regulates the protective and nutritive qi, and helps expel pathogens
A: Sheng jiang: regulates the protective and nutritive qi, harmonizes and protects the Stomach
A: Da zao: regulates the protective and nutritive qi, harmonizes and protects the Stomach
E: Zhi Gan cao: harmonizes actions of other herbs. With bai shao, relieves spasms, treats neck and back stiffness
Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction)
Ma Huang (9g) Gui Zhi (9g) Gan Jiang (9g) Modern dose is 3g Xi Xin (9g) Modern dose is 3g Wu Wei Zi (9g) Bai Shao (9g) Zhi Ban Xia (9g) Zhi Gan Cao (9g)
Method: Decoction. Taken hot. Presently, dose of xi xin and gan jiang is 3g due to their hot natures.
