Herbal Combination Theories Materia Medica I

History of Combining Herbs Herbal combining is briefly described in the Nei Jing, which mentions 12 herbal prescriptions comprised of one to four substances Zhang Zhong-Jing describes 113 herbal prescriptions in Shang Han Lun Over time, more and more substances were added to the Chinese materia medica as practitioners developed an improved understanding of mechanisms of disease

Reasons for Combining Chinese herbs may be prescribed singly, but are most commonly prescribed in herbal formulas Most diseases are complex and require multiple herbs Prescribing formulas with multiple herbs minimizes side effects as patient is not exposed to large doses of any single herb

Need for Rules and Guidelines Art of combination is the selection for clinical purposes of two or more medicinals Rules and guidelines for combining have been developed Proper combining can increase herbal effectiveness, while improper combining can reduce effectiveness or lead to side effects

“Seven Relationships” Six categories of herb-to-herb interaction plus one category of single herb action Ensure most effective and least injurious treatment Single effect (dan xing) Mutual acceptance (xiang xu) Mutual enhancement (xiang shi) Mutual counteraction (xiang wei) Mutual suppression (xiang sha) Mutual antagonism (xiang wu) Mutual incompatibility (xiang fan)

Single Effect Dan xing (“going alone”) Use of one medicinal substance alone Ren Shen for qi deficiency with yang collapse

Mutual Acceptance Xiang xu (“mutual necessity”) Two substances with similar therapeutic functions are combined to amplify their overall effect Shi Gao + Zhi Mu for high fever Da Huang + Mang Xiao for constipation with hard stool

Mutual Acceptance Shi Gao and Zhi Mu Da Huang and Mang Xiao

Mutual Enhancement Xiang shi (“mutual employment”) Combining two substances with different actions so that one substance enhances the effect of the other Fu Ling enhances Huang Qi for edema Da Huang enhances Huang Qin for painful, red eyes due to interior heat/fire

Mutual Enhancement Fu Ling enhances Huang Qi Da Huang enhances Huang Qin

Mutual Counteraction Xiang wei (“mutual fear”) One substance minimizes the toxicity or side effects of another substance, with emphasis on the substance whose side effects are reduced Ban Xia is counteracted by or ‘fears’ Sheng Jiang

Mutual Counteraction Ban Xia fears Sheng Jiang

Mutual Suppression Xiang sha (“mutual killing”) One substance reduces the toxicity or side effects of another, with emphasis on the substance which does the reducing “Sheng Jiang suppresses or ‘kills’ the toxicity of Ban Xia.” Mutual Counteraction and Mutual Suppression are the same relationship from different points of view.

Mutual Suppression Sheng Jiang kills Ban Xia

Mutual Antagonism Xiang wu (“mutual aversion”) The action of one substance minimizes or neutralizes the desired therapeutic effect of the other Lai Fu Zi antagonizes Ren Shen Ren Shen has an aversion to Lai Fu zi

Mutual Antagonism Lai Fu Zi antagonizes Ren Shen

Nineteen Antagonisms Ding Xiang Wu Tou Rou Gui Ren Shen Yu Jin Xi Jiao Chi Shi Zhi Wu Ling Zhi antagonizes In modern times, some of the traditional antagonisms are ignored if proven to be clinically irrelevant (for example, Ren Shen and Wu Ling Zhi)

Mutual Incompatibility Xiang fan (“mutual opposition”) Combination of two substances creates side effects or toxicity which would not occur when each substance is used alone Eighteen Incompatibilities (Shi Ba Fan)

Eighteen Incompatibilities Gan Cao Wu Tou Bei Mu Ban Xia Bai Lian Bai Ji Gua Lou Gan Sui Da Ji Hai Zao Yuan Hua

Summary of Seven Relationships Desirable Undesirable Single effect Mutual acceptance Mutual enhancement Mutual counteraction Mutual suppression Mutual antagonism Mutual incompatibility

Composition of Herbal Formulas Principles of herbal combination are guidelines for composition of herbal formulas Ingredients perform specific roles which are expressed as a political hierarchy: king, deputy, adjuvant, and envoy

Feudal Hierarchy Role Function King, aka sovereign, chief (jun) Provides the principal therapeutic action to address the main disease Deputies, aka ministers, associates (chen) Enhance therapeutic action of the sovereign Treat concurrent main diseases Adjutants, aka assistants (zuo) Treat secondary diseases or assist chief and deputies Moderate harshness/toxicity Provide an opposite action from the chief Envoys, aka couriers, messengers (shi) Guide (conduct) Harmonize

Ma Huang Tang Role Function King Ma Huang (acrid, warm) promotes sweating, releases the exterior, and stops wheezing Deputy Gui Zhi (acrid, sweet, warm) helps Ma Huang promote sweating and disperse cold Adjutant Xing Ren (bitter, slightly warm) descends the Lung qi and helps Ma Huang stop coughing and wheezing Envoy Gan Cao (sweet, warm) harmonizes all the herbs in the formula

Review Questions Processing (boiling) Ban Xia with Sheng Jiang and Bai Fan exemplifies which relationship?

Review Questions Combining Shi Gao and Zhi Mu to treat a patient with a high fever is an example of which relationship?

Review Questions You are treating a patient with copious phlegm and qi deficiency. Should you prescribe Lai Fu Zi for phlegm and Ren Shen for qi deficiency?

Review Questions Which herbs are incompatible with Gan Cao? Wu Tou? Li Lu?