作者：李飞,柴瑞霁 樊巧玲
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方剂的配伍方法：英文／李飞，柴瑞霁，樊巧玲著．—3版．—北京：人民卫生出版社，2019
ISBN 978-7-117-28644-2
Ⅰ．①方… Ⅱ．①李…②柴…③樊… Ⅲ．①方剂－中药配伍－英文 Ⅳ．①R289.1
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Book Title: Applications of Chinese Formula Compatibility (3 edition)
方剂的配伍方法（第3版）
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First published: 2019
ISBN: 978-7-117-28644-2
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Printed in The People’s Republic of ChinaAbout the Author
Professor Li Fei, born in July 1934, in Haimen City of Jiangsu province, graduated from Nanjing University of CM. He is a consultant for the Formula Branch of the China TCM Academy, as well as a member of the expert advisory committee in Nanjing University of CM.
His main achievements include the long-term teaching, study and clinical work of the texts Chinese Medicinal Formulas and Essentials from the Golden Cabinet. He holds abundant experience in the treatment of diseases of the heart, spleen and stomach, and kidney. He took part in the compiling and planning work of the nationwide teaching material of the second, fourth, and fifth editions of Chinese Medicinal Formulas, organized by the Ministry of Health and National Bureau of Administration of TCM. He compiled the following teaching materials: Teaching Material Series of the TCM Basic - Science of Formulae, Teaching Materials for the Foreign Students in Advanced TCM Universities - Chinese Medicinal Formula, Modern TCM Serial Teaching Material - Chinese Medicinal Formula. The didactical reference books compiled by Professor Li Fei include: Translation and Paraphrasing of The Essentials from the Golden Cabinet, Didactical Reference Material for The Essentials from the Golden Cabinet, Clinical Applications of Chinese Medicinals and Formulas(English and Portuguese versions), Basic Prescriptions Handbook for the TCM Clinic, and Higher Series of TCM - Chinese Medicinal Formula, which received a third class award in the eleventh nationwide competition for excellence in science and technology books category. Professor Li collated the ancient text, Emendation and Paraphrasing of The Discussion on the Origins of the Symptoms of Disease and obtained a third class award for the advancement of science and technology awarded by the National Bureau of Administration of TCM. He participated in the reading and editing of Formulae Thesaurus of TCM (volumes 1-11) which is the topic of the Ministry of Health. He worked as the subeditor and routine member of the editorial board, and obtained the first class award for the advancement of science and technology awarded by the National Bureau of Administration of TCM. Professor Li Fei has also published more than 60 academic theses.Preface
Formulas are comprised of herbal medicinals, and constitute the clinical development and increasing use of Chinese medicinals. After appropriate combinations, Chinese medicinals become formulas and can, firstly, bring into play the synergistic reaction between medicinals and increase the curative effects or change the intrinsic function and produce a new effect. Secondly, it can identify patterns and determine treatment, with consideration of all aspects of syndromes to enlarge the therapeutic range, and to meet the needs of relatively complicated syndromes. Thirdly, regarding those Chinese medicinals with drastic properties or pertaining to those that are toxic, medicinal combinations can restrict the secondary properties and reduce toxicity, hence eliminating the ingredients that are harmful to the human body. Therefore, in a formula, medicinals can supplement, oppose, or complement one another, thereby embodying the superiority of Chinese medicinals combinations.
There is a plethora of formulas in TCM. We had recorded 96, 592 formulas in the Formulae Thesaurus of TCM compiled in the 1990s. From these abundant formulas, there is much to discover and research regarding the compatible rules for mastering the applications of formulas for clinical use. So the study on the compatible theories and methods of formulas is the core issue behind formula research, and is the only way to discover the compatible rules of formulas.
As far as the direction of research is concerned, the difference between the compatible methods of formulas and the treatises on prescriptions is that the latter mainly aims at single formulas, whereas the former aims at formulas as a whole. Compatible methods of formulas operate under the guidance of the theories of therapeutics, in order to apply inductive methods in scientific research, launching from the study of the systematical analysis of a variety of representative formulas (tonic formulas, formulas for relieving exterior syndromes, formulas for invigorating blood and dispelling stasis, etc.)which were in common use in the past. This is done in order to find common ground, particular points and main points of the combination in these kinds of formulas, thereby revealing the compatible essences of the formulas that include the relationships between the Chinese medicinals used in the formulas, their dosage, preparation, and formulation.
Since the end of the 1970s, I have engaged in this direction with research, publishing the first article, Discussions on the Compatible Methods of Formulae for Relieving Exterior Syndromes, in the first issue of Nanjing University of CM Transaction in 1982. Thereafter, I was engaged in the studies of formula compatibility in tonic formulas, purgative formulas, and formulas for treating wind syndromes, among others, which were published in succession in the Journal of TCM and other magazines of TCM in many provinces throughout the country. These studies played an important role in the teaching of undergraduate students and majors of TCM, in advancing the study of teachers and training of postgraduate students, to enhance the teaching quality and provide guidance for formulating prescriptions in the clinic. Due to the heavy demands of teaching, research and clinical work, it took over 20 years for me to amend, supplement and collect all the research theories on the compatible methods of formulas which were finally published in 1999.
Formulas for treating dryness syndromes are divided into formulas that can slightly disperse outer dryness and formulas that can nourish yin to moisturize dryness. As dryness and heat injure fluids in the body, the Basic Questions - Great Treatise on the Correspondences and Manifestations of Yin and Yang said: “If dryness prevails, the body becomes dry.” So the compatible characteristic of formulas for treating dryness syndromes is that both dispersing outer dryness and nourishing yin to moisturize dryness and nourishing fluids should all be considered, at all times. It may be embodied in the representative formulas for treating dryness syndromes recorded in the past version of the teaching material in Chinese Medicinal Formulas. Regarding the aspect of combination, formulas for slightly dispersing outer dryness are similar to formulas for relieving exterior syndromes, and formulas for nourishing yin to moisturize dryness are similar to formulas for nourishing yin, so these kinds of formulas are simply just mentioned in this book.
Since the publication of this book in 2008, it has received wide acclaim and recognition by the clinical, research and academic professionals of the TCM community. With the development of traditional Chinese medicine, there is constant change and progress in research. It is my sincere wish that those readers of this book who have an interest and background in TCM will provide their valued suggestions for further amendments of this work.Li Fei
Professor of Chinese Medicinal Formulas Nanjing University of CMJune 2019Introduction The Principle of Formulating Prescriptions
On the basis of certain formulating principles, a formula is combined of proper medicinals in deliberate doses which are selected according to the condition of disease after differentiating syndrome, identifying causes of disease and determining therapeutic methods.
The Basic Questions -Great Treatise on the Essentials of Supreme Truth (Sù Wèn-Zhì Zhēn Yào Dà Lùn, 素问·至真要大论) indicated that“The medicinal aiming at the main syndrome is called the chief, the medicinal assisting the chief medicinal is called the deputy, the medicinal responding to the deputy medicinal is called the envoy.”(主病之谓君，佐君之谓臣，应臣之谓使) This is the principle of composing a formula.
About two thirds of the 314 prescriptions recorded in the Discussion on Cold Damage(Shāng Hán Lùn, 伤寒论) and in the Essentials from the Golden Cabinet (Jīn Guì Yào Lüè, 金匮要略) compiled by Zhang Zhong-jing in the Han Dynasty are based on the above principle.
In the Important Formulas Worth a Thousand Gold Pieces [for Any Emergency] (Bèi Jí Qiān Jīn Yào Fāng, 备急千金要方) compiled by Sun Si-miao and the Arcane Essentials from the Imperial Library (Wài Tái Mì Yào, 外台秘要) by Wang Tao in the Tang Dynasty, many effective formulas are composed rigorously of the chief, the deputy and the envoy medicinals.
It indicates that “the chief, deputy, assistant and envoy” (君臣佐使) theory of composing a formula had been applied widely by many doctors in the Han and Tang Dynasties.
During the Song, Jin and Yuan Dynasties, Cheng Wu-ji compiled the Clarification of the Theory of Cold Damage -Treatise on Prescriptions (Shāng Hán Míng Lĭ Lùn- Yào Fāng Lùn, 伤寒明理论·药方论) to discuss the principle of syndrome differentiation and formulation in the Discussion on Cold Damage, and launched into the research on the theory of prescription formulation, and popularized the theory of formulation from the Inner Classic (Nèi Jīng, 内经) for successive doctors in creating new formulas.
Thereafter, many doctors, such as Zhang Yuan-su, Li Gao, Wang Hao-gu, He Bo-zhai, Xu Hong, Wu Kun, Wang Ang, Ke Qin, etc. individually developed and contributed to the principles of composing formulas in theory and practice, and enriched the theories of composing formulas, thereby the “chief, deputy, assistant and envoy” theory was enhanced further in composing and applying formulas.
Since the founding of the People’s Republic of China, with the establishment of Chinese Medicinal Formulas as a subject, the compatible theory and methods of formulas were summarized and studied systematically. Especially, experimental researches on formulas were developed deeply to reveal many scientif ic connotations of the principle “chief, deputy, assistant and envoy” in composing formulas.
In the national medical college textbook for the Chinese Medicinal Formulas versions 1-5 and in the teaching material of the general higher education on Chinese Medicinal Formulas, the theory of “chief, deputy, assistant and envoy” is believed as the principle of composing formulas, and it is held up as the guide for the research on compatibility theory and methods of formulas, and has become an important topic in modern research on formulas.
It has taken a long period to realize, practise and put forward the principle of “chief, deputy, assistant and envoy” in composing formulas, the views of many doctors on this principle have been varied during this period, and the composition of some formulas can not be explained ideally by this principle. Thus, there are some diff iculties in systemic collating and modern researches.
In this chapter, we will discuss this principle from the meaning of the “chief, deputy, assistant and envoy” theory, the different beliefs of many doctors, the development and outlook of its research.THE ORIGINAL MEANING OF THE
“CHIEF, DEPUTY, ASSISTANT AND ENVOY” PRINCIPLE
As a professional phrase, “chief, deputy, assistant and envoy” is also found in Shen Nong’s Classic of the Materia Medica (Shén Nóng Bĕn Căo Jīng, 神农本草经). In this book, according to their different properties and applications, Chinese medicinals are differentiated into three categories of the heaven, the human and the earth based on the “chief, deputy, assistant and envoy”. That is, the heaven medicinals are the chief, the human medicinals are the deputy, and the earth medicinals are the assistant and envoy. The meaning of the “chief, deputy, assistant and envoy” is completely different to that applied in the principle of composing formulas. So the Basic Questions -Great Treatise on the Essentials of Supreme Truth indicates that “The principle of the chief, deputy, assistant and envoy in composing formulas, … is not the three categories of the heaven, human and earth. ” (方制君臣，……非上中下三品之谓也) It means that the original meaning of “the chief, deputy, assistant and envoy” includes two aspects of the classif ication of medicinal properties and the theory of composing formulas.
The origin of the “chief, deputy, assistant and envoy” theory in composing formulas can be found in the book, the Inner Classic. It should be strictly differentiated. The theory of composing formulas during the period of the Inner Classic applied the different positions of the chief, deputy, assistant and envoy in state system to indicate the main or aff iliated positions of medicinals in formulas.“A medicinal aiming at the main syndrome is called the chief; a medicinal assisting the chief is called the deputy; a medicinal responding to the deputy is called the envoy.” It indicates that in a formula, the medicinals producing the main treatment effect are the chief, the medicinals assisting the chief are the deputy, and the medicinals responding to the deputy are the envoy. Different medicinals produce different effects, the main or the aff iliated, in a formula, and the medicinals in the “chief, deputy, assistant and envoy” theory requiring different dosages, according to the different number of medicinals in formulas, the Inner Classic has further formally stipulated the composition of formulas, such as “one chief and two deputies” (君一臣二), “one chief with three deputies and f ive assistants” (君一臣三佐五) and “one chief with three deputies and nine assistants” (君一臣三佐九) etc. Thereby it supplies the principle for selecting medicinals and composing formulas.
Shen Kuo, in the Song Dynasty, indicated that when analyzing the principle of composing formulas, “The theory of one chief, two deputies, three assistants, and five envoys, means that although there are many medicinals in a formula, just one of them mainly aims at the disease, while the others act as deputy, assistance and envoy according to their relations, and they control and restrict to each other in general as well, it is a proper way”. (用药有一君、二臣、三佐、五使之说，其意以谓药虽众，主病者在一物，其他则节节相为用，大略相统制，如此为宜)Dream Creek Essays (Mèng Xī Bĭ Tán, 梦溪笔谈) . It means that the chief, deputy, assistant and envoy are determined according to their respective importance in a prescription.
During the Ming Dynasty, He Bo-zhai further enriched the understanding, and said that“The medicinals in therapy play their effects in different ways. The medicinal producing the main treatment effect is called the chief, the medicinal acting as an assistance for the chief in the treatment is called the deputy, the medicinal antagonizing and assisting the chief is called the assistant, and the medicinal guiding the other medicinals to the disease related meridian or the disease location is called the envoy”. (大抵药之治病，各有所主。主治者，君也；辅治者，臣也；与君相反而相助者，佐也；引经及引治病之药至于病所者，使也.) (The Inside of Chinese Medicine -Yī Xué Guăn Jiàn, 医学管见) He further illustrated the meaning of “chief, deputy, assistant and envoy”.THE UNDERSTANDINGS OF THE DOCTORS IN THE PAST DYNASTIES ON “THE CHIEF, DEPUTY, ASSISTANT AND ENVOY”
Since the theory of the “chief, deputy, assistant and envoy” in composing formulas was f irstly put forth in the Inner Classic, many doctors have tried to discuss and differentiate the objective evidences of the “chief, deputy, assistant and envoy” in their own views. In general, the following three aspects should be mentioned.1.Differentiating “the Chief, Deputy, Assistant and Envoy” According to the Dosages of the Medicinals
The chief medicinal is the main ingredient in the composition of a formula, and its dosage is relatively large, but the dosages of the deputy, assistant and envoy are reduced successively. So, many doctors took the dosage of a medicinal in a formula as an evidence to differentiate “the chief, deputy, assistant and envoy”.
Li Gao said that “The dosage of the chief medicinal is the largest, then the deputy’s dosage is the second, and it is not allowed to exceed the dosage of the chief ” (君药分量最多，臣药次之，不可令臣过于君). (Discussion on the Spleen and Stomach, Pí Wèi Lùn, 脾胃论)
Wang Hao-gu also said that “The dosage of the chief medicinal is the largest, the deputy medicinal is the next, and the assistant medicinal is third. If the medicinals have the same effects, they should be applied in an equal dosage”. (为君者最多，为臣者次之，佐者又次之，药之为证所主同者，则等分) (Materia Medica for Decoctions, Tāng Yè Bĕn Căo, 汤液本草).
Wu Qiu further indicated that “about the medicinal dosages in a formula, the medicinal producing the main treatment effect on a disease is the chief, and its dosage is taken as a scale of 10, then the deputy medicinal’s dosage is scaled from seven to eight, and the assistant medicinal’s dosage is scaled from 5 to 6, while the envoy medicinal’s dosage is scaled from 3 to 4” (凡用药铢分，主病为君，以十分为率，臣用七八分，辅佐五六分，使以三四分) (Thoughts on Curing -Huó Rén Xīn Tŏng, 活人心统).
All of the above statements are somewhat reasonable to help us to differentiate “the chief, deputy, assistant and envoy” according to the dosages of the medicinals, but because of the signif icant variance in characteristic and force of the effects, and the different properties of medicinals, in addition to the different needs for individual therapies, it is insuff icient to determine “the chief, deputy, assistant and envoy” solely by the dosage.
For example, Dà Chéng Qì Tāng (Major Qi-Coordinating Decoction, 大承气汤) from the Discussion on Cold Damage, Ke Qin believed that “the dosage of hòu pò (厚朴, Cortex Magnoliae Off icinalis) is twice that of dà huáng (大黄, Radix et Rhizoma Rhei), so hòu pò (Cortex Magnoliae Off icinalis), as the medicinal for promoting qi, is the chief medicinal” (厚朴倍大黄，是气药为君).(Collected Writings on Renewal of the Discussion on Cold Damage -Further Appendices to the Discussion on Cold Damage, Shāng Hán Lái Sū Jí -Shāng Hán Fù Yì, 伤寒来苏集·伤寒附翼)
This subject necessitates further discussion.
First, in terms of the property of dà huáng(Radix et Rhizoma Rhei) and hòu pò (Cortex Magnoliae Off icinalis), the former is bitter and cold, with the effect of reducing heat through purging, cleaning the turbidity from the intestines and the stomach, invigorating blood and removing stasis.
The latter is bitter and warm, with the effect of promoting qi activities and removing stagnation, and relieving accumulation and fullness, and is indicated for yangming fu-organs excess syndrome. Therefore, in this formula, dà huáng(Radix et Rhizoma Rhei) is used as the chief medicinal.
Secondly, analyzing from the selection of medicinals in the three formulas named by Chéng Qì Tāng (Qi-Coordinating Decoction, 承气汤), hòu pò (Cortex Magnoliae Off icinalis) is not used in all of them, but dà huáng (Radix et Rhizoma Rhei) must be used in these three formulas. It means that though these three formula are named as Chéng Qì Tāng (Qi-Coordinating Decoction, 承气汤), dà huáng (Radix et Rhizoma Rhei) is the chief medicinal.
Thirdly, Hòu Pò Sān Wù Tāng (Off icinal Magnolia Bark Three Agents Decoction, 厚朴三物汤) in the Essentials from the Golden Cabinet, its composition is the same to Xiăo Chéng Qì Tāng (Minor Qi-Coordinating Decoction, 小承气汤), but the dosage of every medicinal is the same as that in Dà Chéng Qì Tāng (Major Qi-Coordinating Decoction). It emphasizes the medicinal for prompting qi as the chief medicinal, and is indicated for the condition of abdominal fullness, abdominal pain, but it is called Hòu Pò Sān Wù Tāng (Off icinal Magnolia Bark Three Agents Decoction) instead of Chéng Qì Tāng (Qi-Coordinating Decoction).So, if the formula purges as the main effect, dà huáng (Radix et Rhizoma Rhei) is applied as the chief medicinal, and if the formula prompts qi activities as the main effect, hòu pò (Cortex Magnoliae Off icinalis) is taken as the chief.
Therefore, it is not comprehensive to differentiate “the chief, deputy, assistant and envoy” just according to the dosages of medicinals in a formula.2.Differentiating “the Chief, Deputy, Assistant and Envoy” According to the Forces of the Medicinals
To meet the needs in treatment, in composition of a formula, the medicinal with forceful effect is usually needed to act as the chief,
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