1. Herbal Combination Theories
Materia Medica I

2. 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

3. 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

4. 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

5. “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)

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

7. 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

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

9. 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

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

11. 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

12. Mutual Counteraction
Ban Xia fears Sheng Jiang

13. 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.

14. Mutual Suppression
Sheng Jiang kills Ban Xia

15. 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

16. Mutual Antagonism
Lai Fu Zi antagonizes Ren Shen

17. 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)

18. 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)

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

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

21. 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

22. 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

23. 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

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

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

26. 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?

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