Source: AYXT Lao Du
1. Common Knowledge and Learning Methods of Chinese Herbal Medicine
Is the medicine we get from the Chinese herbal pharmacy, which needs to be decocted, called Chinese herbal medicine? Or is it simply any medicine used in China from ancient times to the present? This is not entirely accurate. We do not need to delve too deeply; we will only discuss one of the most important characteristics of Chinese herbal medicine – it refers to natural medicines and their processed products used for the prevention and treatment of diseases under the guidance of the basic theories of Traditional Chinese Medicine (TCM). For example, the herbal medicine Wu Wei Zi (Schisandra), according to TCM theory, has a sour taste and astringent properties, which can stop coughs and can be used for various types of coughs, whether cold, hot, deficient, or excess. If a doctor uses it to treat cough and asthma due to lung qi deficiency, it is considered Chinese herbal medicine because it is used under the guidance of TCM theory. However, if another doctor uses it to treat hepatitis with the aim of reducing the release of transaminases from the liver, it is used under Western medicine and pharmacological theory, and thus it is not considered Chinese herbal medicine.
In ancient times, Chinese herbal medicine was referred to as “Ben Cao” (本草), because it primarily consists of herbal plants. For this reason, the “Shuo Wen Jie Zi” (说文解字) explains “medicine” as “herbs that treat diseases.” Since Western medicine was introduced to China, people have distinguished traditional Chinese medicines by calling them “Chinese herbal medicine.” Chinese herbal medicine generally includes three major categories: plant medicines, animal medicines, and mineral medicines. Among plant medicines, there are various categories such as herbs, trees, fruits, vegetables, and grains. Animal medicines can be divided into insects, fish, shellfish, birds, poultry, and mammals. Mineral medicines include natural minerals, processed mineral products, and animal fossils. If we classify Chinese herbal medicine according to the source of the medicinal materials, it can be divided into wild and cultivated varieties. Some Chinese herbal medicines are processed products of natural medicines, such as Shen Qu (神曲), Ejiao (阿胶), and Ku Fan (枯矾), which are made from plant, animal, and mineral materials respectively. In addition to the names “Chinese herbal medicine” and “Ben Cao,” in the past two to three decades, the term “herbal medicine” or “Chinese herbal medicine” has also become popular. However, in reality, herbal medicine is also a part of Chinese herbal medicine; it generally refers to natural medicines that are widely circulated among the people but are less commonly used by practitioners, with relatively brief documentation and less standardized processing. It should be noted that modern Chinese herbal medicine also originates from earlier herbal medicines. Once a certain herbal medicine becomes well-known and standardized in its use, it is then called Chinese herbal medicine. It is likely that modern herbal medicines will eventually become recognized as Chinese herbal medicine. There are also ethnic medicines, such as Tibetan medicine, Mongolian medicine, Uyghur medicine, Dai medicine, Miao medicine, and Yi medicine, which are completely equivalent to Chinese herbal medicine, and some medicinal materials even overlap, but the guiding theories differ, each with its own strengths.
2. “Authentic Medicinal Materials” in TCM
Natural medicinal materials are closely related to certain natural conditions. China has a vast territory with significant differences in natural geographical environments, such as soil, sunlight, climate, and biological distribution, between the north and south. The production of various medicinal materials is somewhat regional. This gives rise to the concept of “authentic medicinal materials” (习惯上不叫“地道药材”), such as the Four Great Huai Medicines and the Eight Flavors of Zhejiang. Authentic medicinal materials are a specialized term for high-quality, genuine Chinese herbal medicines. They refer to medicinal materials with a long history of production, excellent varieties, and outstanding therapeutic effects. For example, the goji berries from Ningxia, Huang Qi (Astragalus) from Inner Mongolia, ginseng from Northeast China, Di Huang (Rehmannia) from Henan, San Qi (Notoginseng) from Yunnan, Chuan Xiong (Ligusticum) from Sichuan, Ejiao from Shandong, Bei Mu (Fritillaria) from Zhejiang, Bo He (Mint) from Jiangsu, and Chen Pi (Dried Tangerine Peel) from Guangdong have all been considered authentic medicinal materials since ancient times. However, it cannot be generalized. For instance, is San Qi from Yunnan necessarily the best? Even the best production areas can have varying qualities. Is it true that the worst medicinal materials from authentic production areas are better than the best from other areas? Certainly not. Therefore, “excellent varieties and outstanding therapeutic effects” are the most important standards. However, authentic medicinal materials are often limited to small regions, and their production cannot meet national demand. Without significantly affecting efficacy, we should not be overly rigid about authentic medicinal materials. To further develop high-quality and efficient production of authentic medicinal materials, the country is implementing standardized production bases for various new medicinal materials, believing that this will make significant contributions to the development of authentic medicinal materials in China.
3. Yin and Yang of Diseases, Temperature of Medicines
The four qi of Chinese herbal medicine, also known as the four natures, refers to the four different properties of cold, hot, warm, and cool. This does not refer to the temperature of the medicine but rather its inherent nature. “Cold and cool” medicines are those that can treat heat-related diseases; “warm and hot” medicines are those that can treat diseases with cold manifestations. Therefore, the property of a medicine among the four natures is discovered through clinical practice. The four qi embodies the concept of yin and yang, where cold and cool belong to yin, and warm and hot belong to yang. The difference between cold and cool, and warm and hot is mainly one of degree; essentially, there are only two properties: cold and hot. Additionally, there are so-called “neutral” medicines that are neither cold nor hot, but they slightly lean towards warm or cool, still within the range of the four natures, with no absolute neutral property. Specifically, warm and hot medicines are often used to treat a series of yin-cold conditions such as wind-cold bi syndrome, cold abdominal pain, cold hernia pain, blood-cold amenorrhea, impotence, infertility due to cold in the uterus, and yang collapse. Cold and cool medicines are mainly used for a series of yang-heat conditions such as excess heat thirst, warm toxin rashes, blood-heat vomiting, fire toxin sores, heat constipation, and heat dysuria. Cold medicines treat heat conditions, while hot medicines treat cold conditions; they must not be reversed, or it will lead to further deterioration of the condition. This reminder is mainly to avoid encountering extreme phenomena such as true cold and false heat, or true heat and false cold. A person with true cold and false heat may appear agitated and unable to tolerate the heat, yet they drink very little water; a person with true heat and false cold may have cold hands and feet, but their chest and abdomen feel hot to the touch. True cold requires the use of strong heat medicines, while true heat requires the use of strong cold medicines. However, if the heat or cold toxins are too severe, even if the direction of the medicine is correct, sometimes the patient may vomit after taking the medicine, which is called “excess evil qi, refusing to accept the medicine.” In this case, a small amount of warm medicine can be added to the strong cold medicine, or a small amount of cold medicine can be added to the strong hot medicine to prevent vomiting. This is somewhat like finding an insider to open the city gate during ancient battles, allowing for a swift attack.
4. Distinguishing the Five Tastes
Each seeking its own place, the so-called five tastes originally refers to the five different flavors of sour, bitter, sweet, pungent, and salty in medicines. The phrase “overturned the five-taste bottle” actually implies that there are more than just five tastes; it is merely a convention to use these five common and easily distinguishable flavors as standards. The emergence of the five tastes initially reflected the true flavors of medicines. Later, it was discovered that in many cases, medicines with the same flavor would produce similar reactions in the human body, while medicines with different flavors would produce different reactions. Thus, a theory regarding the five tastes of medicines was summarized. Since the theory of five tastes emerged as a way to summarize the effects of medicines, the “taste” of the five tastes has also transcended the realm of taste perception and is now based on efficacy. Therefore, there may be instances in Chinese herbal texts where the recorded taste does not match the actual taste. Below are the effects and indications of the medicines represented by the five tastes:
**Pungent taste**: Often has the effect of dispersing exterior pathogens and promoting the flow of qi and blood, commonly used to treat exterior conditions and qi-blood stagnation.
**Sweet taste**: Often has the effect of tonifying the body, soothing the stomach, harmonizing the properties of other medicines, and relieving pain, commonly used to treat qi deficiency, gastrointestinal discomfort, and body pain.
**Sour taste**: Often has the effect of astringing and consolidating, commonly used to treat excessive sweating, chronic cough due to lung deficiency, chronic diarrhea, nocturnal emissions, frequent urination, and persistent leukorrhea.
**Bitter taste**: Often has the effect of clearing heat, descending rebellious qi, promoting bowel movements, drying dampness, and consolidating yin (draining fire while preserving yin), commonly used for heat conditions, fire conditions, cough, nausea, constipation, damp conditions, and yin deficiency with excess fire.
**Salty taste**: Often has the effect of purging and promoting bowel movements, softening hardness and dissipating masses, commonly used to treat constipation, phlegm nodules, goiters, abdominal masses, etc. The five tastes can sometimes be associated with the five zang organs. For example, bitter medicines often enter the heart, sweet medicines often enter the spleen, and salty medicines often enter the kidneys. Of course, this is only relative; for instance, pungent medicines are generally thought to enter the lungs, but many pungent dispersing qi medicines primarily enter the liver, and there are many such exceptions, so the theory of five tastes can only serve as a reference.
5. Contraindications in Medication
Think twice before writing
1. Compatibility contraindications: Some medicines, when used together, can produce severe toxic side effects or diminish the original efficacy, and should therefore be avoided. The most typical examples are the “Eighteen Reversals” and “Nineteen Avoidances.”
**Eighteen Reversals Song**: The classics clearly state the eighteen reversals: Wu Tou (including Chuan Wu, Cao Wu, and Fu Zi) cannot be used with Bei Mu, Gua Lou (including Tian Hua Fen), Ban Xia, Bai Ji, Bai Lian, etc.; Gan Cao cannot be used with Gan Sui, Da Ji, Hai Zao, Yan Hua, etc.; Li Lu cannot be used with Ren Shen, Dan Shen, Xuan Shen, Sha Shen, Xi Xin, Shao Yao, etc.
**Nineteen Avoidances Song**: Sulfur is the essence of fire, and when it meets natron, it will fight; mercury must not meet arsenic; wolf poison fears the use of Mitodeng; Ba Dou is extremely potent and does not get along with Qian Niu; clove must not meet turmeric; Chuan Wu and Cao Wu do not get along with rhinoceros horn; Ya Shao fears San Leng; Guo Gui (cinnamon) can harmonize cold qi, but if it encounters red stone fat, it will be deceived. In general, compatibility should be considered based on the principles of harmony and opposition, and the methods of processing and preparation should not be mixed.
According to the 1963 edition of the “Chinese Pharmacopoeia,” it is clearly stated: “The indicated avoidances, evils, and reversals refer to those that are generally not suitable for concurrent use.” If problems arise due to violations of the pharmacopoeia regulations, legal responsibility must be borne. Although there are many ancient records of using opposing medicines together, believing that they can achieve opposing effects, the clinical use of medicines should adopt a cautious approach, and it is best not to use them to avoid accidents.
2. Disease and syndrome contraindications: The effects of medicines have their applicable ranges and should not be exceeded. For example, Ma Huang is a strong sweating medicine and should not be used for patients who are already sweating; Shu Di is very greasy, and Ru Xiang has a strange taste, so caution should be exercised for those with poor spleen and stomach.
3. Pregnancy contraindications: Some medicines can harm the fetus and should be listed as contraindicated during pregnancy. Caution should be exercised with medicines such as Tao Ren, Hong Hua, Niu Xi, Da Huang, Zhi Shi, Fu Zi, Rou Gui, Gan Jiang, Mu Tong, Dong Kui Zi, Qu Mai, etc.; prohibited medicines include Ba Dou, Qian Niu, Da Ji, Shang Lu, She Xiang, San Leng, E Zhu, Shui Zhi, Ban Mao, Xiong Huang, and Pi San.
In short, when prescribing medicines for pregnant women, caution is paramount.
6. Dietary Restrictions When Sick
As the saying goes: “When sick, do not be careless with your diet; it will wear out the doctor’s legs.” Therefore, patients should pay attention to dietary restrictions. For example, in cases of fever, spicy, greasy, and fried foods should be avoided; in cold conditions, raw and cold foods and cool drinks should be avoided; patients with coronary heart disease should avoid fatty meats, fats, animal organs, and smoking and drinking; those with high blood pressure should avoid pepper, chili, garlic, and other spicy and warming foods; hepatitis patients should eat less animal fat and avoid spicy, smoking, drinking, and other stimulating foods; those with weak spleen and stomach should avoid fried, greasy, cold, hard, and difficult-to-digest foods; patients with gastritis should avoid yam, which can induce symptoms; kidney disease patients should eat less salty, alkaline, or overly spicy foods; patients with skin diseases or skin redness and pus should avoid fish, shrimp, crabs, and other pungent and stimulating foods, especially dried shrimp, and should eat less goose meat (for example, the legend of Xu Da and Zhu Yuanzhang, where “steamed goose” indirectly led to death).
When taking certain Chinese medicines, there are special dietary restrictions. Although they are not strictly enforced, it is best to adhere to them. For example: Gan Cao (when roasted), Huang Lian (with wine), Jie Geng, and Wu Mei should avoid pork; Bie Jia should avoid amaranth; Chang Shan should avoid scallions; Di Huang (Sheng Di, Shu Di) and He Shou Wu should avoid scallions, garlic, and radishes; Dan Shen, Fu Ling, and Fu Shen should avoid vinegar; Tu Fu Ling and Shi Jun Zi should avoid tea; Bo He should avoid crab meat; honey should not be mixed with raw scallions, and persimmons should not be mixed with crabs. In general, regardless of the disease or medicine, one should avoid raw, cold, greasy, pungent, and stimulating foods.
7. Best Utensils for Decoction
Clay pots and earthenware jars are the best, followed by enamel pots, and heavy stainless steel pots are also good. This is to avoid chemical changes that may affect efficacy. Some have used copper pots to decoct medicine, resulting in green-colored medicine. Copper, iron, and aluminum pots should be avoided. The author recommends stainless steel pots, which only need to be cleaned once before the first use, making them easy to clean and maintain, and allowing for flexible water amounts. However, using clay pots or earthenware jars can be easy to burn hands, and they are often smaller in volume, and the first use requires boiling three times with water, which is not very convenient.
8. Water for Decoction and Decoction “Heat”
In ancient times, long-flowing water, well water, rainwater, spring water, and rice washing water were used to decoct Chinese medicines. Nowadays, tap water, well water, and distilled water are commonly used, but clean and fresh water is always preferred. For prescriptions containing Chuan Wu and Cao Wu, honey water can be used for decoction to reduce toxicity. For prescriptions treating head and facial diseases, a little white wine can be added during decoction to enhance the upward movement of the medicine. For prescriptions treating qi stagnation, a little vinegar can be added during decoction to enhance the effect of regulating qi and unblocking.
First, soak the medicine in water for 20 minutes to 1 hour (not exceeding half an hour in summer). How much water to soak? Use the amount of water you plan to use for decoction. The soaked medicine is directly placed on the fire for decoction without changing the water. The amount of water for soaking should consider the decoction time. For cold medicine, use less water; press the medicine with your palm and add water to exceed the surface of the medicine by 1 cm, or just cover the back of your hand with water. For decocting tonic medicines, more water should be added because they need to be boiled longer to avoid drying out. First, boil with high heat, then use low heat to maintain a gentle boil for 30 to 60 minutes. Regardless of the amount of water, heat intensity, or duration, the final decoction should yield a volume of about one and a half bowls of rice, making it easier for patients to persist. If there is too much, they cannot drink it all; if there is too little, much will stick to the dregs, wasting it. We also advocate squeezing the dregs to extract the juice, but this is generally not feasible due to conditions (Korean domestic Chinese medicine decoction machines have this function). Generally, one package of Chinese medicine (also called one dose) is decocted twice (also called two doses), with the second dose using 2/3 of the water of the first dose. The two decoctions are mixed and taken in two doses. If you want to avoid trouble, you can decoct one dose and drink it immediately.
9. Distinguishing Medicinal Material Quality and Mastering Different Decoction Methods
Some medicines require special decoction methods due to their different qualities, and the prescription should specify this. In summary, there are different decoction methods such as pre-decoction, post-decoction, bag decoction, separate decoction, melting, soaking, and using decoction as water.
(1) Pre-decoction: Some mineral and shell medicines should be crushed and pre-decocted for 20-30 minutes before adding other medicines to facilitate the full extraction of effective components. For example, Shi (magnetite), Dai Zhe Shi (hematite), Sheng Shi Gao (gypsum), Long Gu (dragon bone), Mu Li (oyster), Hai Ge Ke (clam shell), Hai Piao Xiao (sea cucumber), Wa Leng Zi (ceramic), Zhen Zhu Mu (mother of pearl), Shi Jue Ming (clam shell), Gui Ban (tortoise shell), and Bie Jia (soft-shelled turtle shell). Additionally, Fu Zi, Chuan Wu, and Cao Wu, which have strong toxic side effects, should be pre-decocted for 45-60 minutes before adding other medicines to reduce toxicity and ensure safe use.
(2) Post-decoction: Some aromatic medicines or certain cold medicines should be added after other medicines have boiled for 5-10 minutes, as prolonged decoction can easily cause the effective components to evaporate, thus reducing efficacy. For example, Ma Huang, Bo He, Xiang Ru, Mu Xiang, Sha Ren, Qing Hao, Chen Xiang, Bai Dou Kou, and Cao Dou Kou. Some medicines, although not aromatic, can also have their effective components destroyed by prolonged decoction, such as Gou Teng, Lei Wan, and Fan Xie Ye. Moreover, if Da Huang is boiled for too long, it can release tannins that hinder bowel movements, causing rebound constipation or even worsening the condition, so it should also be added later or used in soaking methods.
(3) Bag decoction: Some sticky, powdered, or hairy medicines should be wrapped in gauze and decocted with other medicines to prevent the decoction from becoming cloudy or irritating the throat, causing coughing, or sinking to the bottom of the pot and burning or sticking. For example, Ha Fen (talc), Hua Shi (slippery elm), Qing Dai (indigo), Xuan Fu Hua (inula flower), Xin Yi (magnolia flower), Che Qian Zi (plantago seed), and Pu Huang (cattail pollen).
(4) Separate decoction: Also known as separate stewing, this refers to certain precious medicinal materials that should be decocted separately for 2-3 hours to better extract effective components. After decoction, they can be taken alone or mixed with other decoctions. For example, Ren Shen (ginseng), Xi Yang Shen (American ginseng), Ling Yang Jiao (antelope horn), She Xiang (musk), Lu Rong (deer antler), and Hai Ma (seahorse).
(5) Melting: Also known as dissolving. For certain gelatinous or highly soluble medicines, to avoid sticking to the pot or affecting the decoction, they can be soaked in water or yellow wine, then heated separately to dissolve, and then mixed with the decoction. For example, Ejiao (donkey-hide gelatin), Lu Jiao Jiao (deer antler gelatin), Gui Ban Jiao (tortoise shell gelatin), and Bie Jia Jiao (soft-shelled turtle gelatin). Honey and syrup can be directly mixed into the decoction.
(6) Soaking: Certain effective components easily dissolve in water or are easily destroyed by prolonged decoction can be soaked in boiling water or hot decoction of other medicines, preferably covered and steeped for 10-15 minutes before taking. For example, Da Huang, Fan Xie Ye, and Pang Da Hai.
(7) Direct consumption: For certain precious medicines that are used in small amounts, to prevent loss, they are often ground into fine powder and taken directly with warm water or the juice of other medicines. For example, She Xiang, Niu Huang, Zhen Zhu, Ling Yang Jiao, Hou Zao, Ma Bao, Xi Yang Shen, and Lu Rong; some medicines, depending on the condition, are often ground into powder for direct consumption to enhance efficacy, such as San Qi, Hua Rui Shi, Bai Ji, Zi Zhu Cao, Xue Yu Tan, and Zong Lin Tan for stopping bleeding; Wu Gong, Quan Xie, Jiang Can, and Di Long for stopping spasms; and Wu Zei Gu for acid relief and pain relief. Some medicines that are easily destroyed by high temperatures or undergo toxic transformations at high temperatures can only be taken as powders. For example, Lei Wan, He Cao Ya, and Zhu Sha; some liquid medicines such as bamboo juice, ginger juice, lotus root juice, water chestnut juice, and fresh Rehmannia juice should also be taken directly.
(8) Using decoction as water: Some medicines should be decocted separately to prevent the decoction from becoming too cloudy and difficult to take. For example, Zao Xin Tu (ceramic) and Chi Shi Zhi (red stone fat) should be decocted in a large amount of water first, and the clear liquid should be used as water for decocting other medicines. Half of the amount of Chi Shi Zhi is generally also directly mixed with water for better results.
10. Dosage of Medicines – The “Secret” of TCM Treatment
It is said that before the liberation, there was a TCM practitioner named Lei in Chengdu who always used a dosage of two (equivalent to 31 grams), even for Gan Jiang and Fu Zi, he dared to prescribe half a pound, earning him the nickname “Daring Lei.” The medicines he prescribed required a large clay pot for decoction, yet patients flocked to him. In a nearby small town, there was a famous doctor named Li, who prescribed no more than one qian (equivalent to 3.1 grams) for each Chinese medicine, and a tea cup was sufficient for decoction. He was known as “Cautious Li,” and patients also crowded to see him. Furthermore, a pediatrician known as “Little Wang” was skilled in using Yin Qiao San to treat diseases, inheriting his father’s practice, he also used Yin Qiao San. One day, a parent of a child who had taken his son’s Yin Qiao San without effect came to seek his father’s help. Little Wang took his son’s prescription, made no changes, but adjusted the dosage, and it worked immediately. Therefore, it is said: “The secret of TCM lies in the dosage of medicines.” The essence of TCM treatment is in the differentiation and treatment, and the dosage of medicines is determined by the individual, the time, and the condition, while the dosage also determines its efficacy. For example, Long Dan Cao used in small amounts can promote appetite, while larger amounts can clear liver and gallbladder fire; San Qi in small doses can stop bleeding, in medium doses can invigorate blood, and in large doses can break blood; Bo He in Xiao Yao San is used at 3 grams to soothe the liver and regulate qi, while in treating wind-heat colds, it can be used up to 10 grams to disperse wind-heat; Gui Zhi in Gui Zhi Tang is used at 9 grams to warm the meridians and dispel cold, while in Wu Ling San, it is used at less than 5 grams to warm and promote bladder qi transformation. Thus, the dosage of Chinese medicine is very flexible and must be treated differently according to various situations. The amount of medicine directly affects the efficacy and effectiveness. If the dosage is too small, it will not have a therapeutic effect and may delay the condition (using deworming medicine in this way may even backfire, causing the worms to become restless and flare up); if the dosage is too large, it can harm the body and cause unnecessary waste. Additionally, the relative proportions of each medicine in the prescription are also important, as they can affect the overall efficacy of the prescription. Therefore, a scientific and cautious attitude should be adopted regarding the use of Chinese medicine dosages. Generally speaking, the following factors should be considered:
1. The relationship between the nature of the medicine and the dosage: Potent or strongly acting medicines should have their dosages strictly controlled. Initially, a small amount should be used, gradually increasing the dosage. Once the condition improves, the dosage should be immediately reduced or stopped to prevent overdose or accumulation of toxicity. For example, Fu Zi, when the condition is not urgent, can be used at 6-10 grams of processed Fu Zi for several days (note that it should be pre-decocted); for emergency resuscitation of yang collapse, it can be used at 15-30 grams of raw Fu Zi, and only 1-2 packets of medicine should be used during the day of rescue. Additionally, light medicines should be used in smaller amounts, such as She Tui (cicada slough); heavy mineral medicines should be used in larger amounts, such as Shi Gao (gypsum) and Shan Yao (Chinese yam); fresh products are generally 2-4 times the amount of dried products.
2. The relationship between dosage forms, compatibility, and dosage: Generally, the same medicine in decoction requires a larger dosage than in pills or powders (3:1). Self-made pills and powders save medicinal materials and are economical, but the effects are slower; using single medicines for treatment requires larger amounts; in compound prescriptions, the main medicines should be used in larger amounts than auxiliary medicines.
3. The relationship between age, constitution, and dosage: Generally, the elderly, children, postpartum women, and patients with weak constitutions should use smaller amounts, while adults and patients with strong constitutions should use larger amounts. Children under 5 years old should take 1/4 of the adult dosage, while children over 5 years old should take half the adult dosage.
4. The relationship between seasonal changes and dosage: Sweating and exterior-releasing medicines and pungent warm medicines should not be used in excess in summer; in winter, sweating and exterior-releasing medicines and pungent warm medicines can be used more.
11. Timing of Taking Medicines – The “Decisive Factor” in TCM Efficacy
1. Timing of taking decoctions: The two doses of medicine should be taken 6-8 hours apart. In clinical practice, the dosage can be adjusted according to the condition. For example, in acute severe diseases, each dose of medicine is decocted twice, with intervals of 20-30 minutes between doses, until it is confirmed that the disease has been controlled. Additionally, some medicines that are irritating to the gastrointestinal tract should be taken after meals, such as Ma Qian Zi (Strychnos nux-vomica) and Ya Dan Zi (Strychnos nux-vomica); tonic medicines that are rich and greasy should be taken on an empty stomach; medicines for treating malaria should be taken two hours before the onset of the disease; sedative medicines should be taken 1-2 hours before sleep; and medicines for sudden illnesses should be taken as soon as possible. For painful conditions such as stone dysuria and throat diseases, decoctions should be taken as tea drinks at irregular times. The rest should be taken half an hour to an hour before meals for best results.
2. Methods of taking medicines:
(1) Decoctions: Exterior-releasing medicines should be taken hot, and after taking, the patient should be covered warmly or consume hot porridge to assist sweating; cold medicines should be taken cold. If true heat and false cold occur, cold medicines should be taken warm, while true cold and false heat should take hot medicines cold. This is another method of preventing vomiting, in addition to the previously mentioned “Yin and Yang of Diseases, Temperature of Medicines.”
(2) Pills: Should be taken with warm water.
(3) Powdered medicines: Can be mixed with honey for easier swallowing or placed in capsules to avoid direct swallowing, which may cause the powder to stick in the throat and induce coughing.
(4) Pastes: Each mouthful should be small and swallowed slowly. They can also be taken with hot water.
(5) Granules and syrups: Granules are designed to be taken with hot water; syrups are also taken directly. Additionally, critically ill patients should take small amounts frequently to avoid choking; patients with vomiting should also take small amounts frequently; and for those with nasal congestion, powders can be blown into the throat to relieve throat swelling and pain.
12. How to Learn Chinese Herbal Medicine
Chinese herbal medicine is one of the foundational subjects in TCM. There are many varieties of Chinese herbs, which can be easily confused and difficult to remember. Self-learners often find it challenging to grasp the key points. How to study Chinese herbal medicine? The following points may be helpful:
1. Focus on key points and understand efficacy: The basic theories of Chinese herbal medicine and the specific effects and applications of individual herbs are the key points of study. Mastering efficacy is crucial for learning Chinese herbal medicine. Understanding efficacy is not simply memorizing efficacy terms. Efficacy is closely related to the properties and indications of the herbs. When studying, one should analyze efficacy using theories such as flavor and meridian entry, while also linking efficacy to indications to make it practical. For example, Huang Lian (Coptis) has the effect of clearing heat, which is closely related to its bitter and cold nature. Bitter clears and descends, while cold clears heat, thus it can clear fire evil. Since it enters the heart, stomach, and liver meridians, it is suitable for heat diseases with symptoms such as agitation, insomnia, and mouth sores due to excessive heart fire, as well as stomach fire causing nausea and liver fire causing red eyes. By centering on the heat-clearing efficacy, one can connect flavor, meridian entry, and indications, deepening the understanding of Huang Lian’s heat-clearing efficacy while highlighting the key points. One should not isolate and rigidly memorize flavor, meridian entry, and indications.
2. Recognize commonalities and emphasize characteristics: Chinese herbal medicine is classified by the functions of the herbs. Herbs in the same chapter share common efficacy and indications, but each has its own characteristics. When studying, grasp the overall functions and indications of the chapter, and then memorize the other aspects of each herb. This makes it easier to remember and less likely to confuse. The same applies to flavor, meridian entry, dosage, and compatibility; general characteristics should be understood, while special characteristics should be noted. For example, most qi-regulating herbs are pungent and warm, which is a general characteristic, while Ku Lian Zi (Melia toosendan) is bitter and cold, which is a special characteristic that requires special attention. Similarly, mineral herbs are generally heavier and can be used around 30 grams, while Zhu Sha (cinnabar) is a mineral herb but is toxic and should only be used at 0.3-1.5 grams. Regarding usage, most herbs can be used in decoctions, but some laxative herbs like Gan Sui do not dissolve in water, and deworming herbs like Lei Wan lose their effective components when heated, so they should not be used in decoctions. As for compatibility, a general understanding is sufficient; excessive focus on the composition and application of formulas is not the focus of this course and should be distinguished from formula studies. When studying Chinese herbal medicine, one should not memorize everything indiscriminately, nor should one overlook special content as general; rather, one should pay special attention to mastering its uniqueness.
3. Good summarization and differentiation: When studying, compare and analyze comparable herbs, highlighting their similarities and differences, which can further deepen understanding and mastery of the properties, effects, and indications of the studied herbs. First, compare herbs with similar effects, noting their similarities and differences, such as Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig), Shi Gao (Gypsum) and Zhi Mu (Anemarrhena), Ban Xia (Pinellia) and Nan Xing (Arisaema). By analyzing and comparing, one can deepen their impression and facilitate understanding. Secondly, compare herbs with similar indications, which is beneficial for a comprehensive understanding of efficacy and guiding correct clinical use. For example, Huang Lian, Gan Jiang, and Dang Shen can all treat diarrhea; Ma Huang, Huang Qin, Bei Sha Shen, and Wu Wei Zi can all treat cough and asthma; Sheng Jiang, Ban Xia, Zhu Ru, and Huo Xiang can all treat vomiting, but their effects and indications differ. Furthermore, the same herb can have differences in properties, effects, and indications due to different varieties, processing methods, and medicinal parts, and comparing these can help distinguish them and avoid confusion, such as Chuan Bei Mu (Fritillaria) and Zhe Bei Mu, Sheng Di (Rehmannia) and Shu Di, Sheng Da Huang (Rhubarb) and Zhi Da Huang, Fu Zi (Aconite) and Wu Tou (Aconitum). In summary, by applying the above learning methods during self-study, one can gain a comprehensive view of Chinese herbal medicine, mastering the internal connections between herbs in a systematic manner, thus making the study of Chinese herbal medicine organized and coherent.
4. Memory techniques for Chinese herbs:
1. Five Elements Memory Method: The Five Elements Memory Method for Chinese herbs is a method of memorizing the properties, effects, and indications of herbs through the relationships of the five colors and five tastes.
(1) Five Colors Memory Method: Utilize the five colors of green, red, yellow, white, and black of herbs, according to the relationship of the five colors entering the five zang organs to memorize the effects and indications of herbs. For example, green enters the liver, and green herbs often treat liver-related diseases. For instance, Qing Pi (Green Peel) enters the liver meridian, can soothe the liver and break qi, and is good for treating liver qi stagnation causing rib pain or breast distension; Qing Hao (Artemisia annua) clears and drains liver and gallbladder heat, good for treating damp-heat jaundice; Qing Xiang Zi (Green Box) clears the liver and brightens the eyes, good for treating liver heat and red eyes. Red enters the heart, and red herbs often treat heart-related diseases. For example, Dan Pi (Moutan Root) enters the heart meridian, has the effect of clearing heat and cooling blood, activating blood and dispelling stasis, good for treating heat entering the blood level causing bleeding; Dan Shen (Salvia) is the root of the plant, red-purple in color, enters the heart meridian, has the effect of dispelling stasis and relieving pain, good for treating stasis-related pain. Yellow enters the spleen, and yellow herbs often treat spleen-related diseases. For example, Huang Qi (Astragalus) is yellow and soft, can tonify the spleen and qi, solidify the exterior and raise yang, good for treating spleen qi deficiency and sinking of the middle qi; Huang Jing (Polygonatum) is yellow and has a black hue, has the effect of tonifying the spleen and moistening the lungs, good for treating spleen deficiency and lack of appetite. White enters the lungs, and white herbs often treat lung-related diseases. For example, Shi Gao (Gypsum) clears the lungs and drains heat, relieves thirst, good for treating lung heat cough and asthma; Bei Mu (Fritillaria) stops cough and transforms phlegm, clears heat and dissipates nodules, good for treating phlegm-heat obstructing the lungs. Black enters the kidneys, and black herbs often treat kidney-related diseases. For example, Shu Di (Rehmannia) is black after repeated steaming and drying, has the effect of nourishing kidney yin, good for treating kidney and liver yin deficiency causing soreness in the lower back, dizziness, night sweats, thirst, and nocturnal emissions. He Shou Wu (Polygonum multiflorum) is made from the tuber of He Shou Wu, cooked with black beans, and is black, entering the kidney meridian, has the effect of tonifying the liver and kidneys, benefiting essence and blood, good for treating kidney deficiency and blood deficiency causing premature graying of hair.
2. Five Tastes Memory Method: Utilize the five tastes of pungent, sweet, bitter, sour, and salty, according to the relationship of the five tastes entering the five zang organs to memorize the effects and indications of herbs. For example, pungent herbs enter the lung (wei) meridian, good for treating lung wei exterior conditions. For example, Ma Huang (Ephedra) is pungent and warm, releases the exterior, promotes sweating, opens the lungs, and relieves asthma, good for treating wind-cold exterior binding and lung qi not dispersing, causing aversion to cold and fever without sweating; Jing Jie (Schizonepeta) is pungent and warm, releases the exterior, good for treating lung wei exterior conditions and cold symptoms. Bo He (Mint) is pungent and cool, disperses wind-heat, clears the throat, and benefits the throat, good for treating wind-heat exterior conditions or the initial stage of warm diseases, with symptoms in the lung wei exterior. Sweet herbs enter the spleen (meat) meridian, good for treating spleen and stomach disorders. For example, Bai Zhu (Atractylodes) is sweet and bitter, warm in nature, can tonify the spleen and qi, dry dampness, and strengthen the spleen, good for treating spleen qi deficiency, poor appetite, and fatigue. Gan Cao (Licorice) is sweet and neutral, tonifies the middle and benefits qi, alleviates pain, good for treating spleen qi deficiency, fatigue, and abdominal pain. Shan Yao (Chinese Yam) is sweet and neutral, tonifies the spleen and benefits the stomach, nourishes the lungs and strengthens the kidneys, good for treating spleen and stomach weakness, poor appetite, and chronic diarrhea. Bitter herbs enter the heart (blood) meridian, good for treating heart-related disorders. For example, Huang Lian (Coptis) is bitter and cold, clears the heart, relieves agitation, and drains fire and detoxifies, good for treating excessive heart fire, agitation, insomnia, and other heat-related symptoms. Niu Huang (Cattle Gall) is bitter and cool, clears the heart and detoxifies, good for treating warm diseases that reverse to the heart, high fever, delirium, convulsions, and other heat-closed conditions. Sour herbs enter the liver (tendons) meridian, good for treating liver-related disorders. For example, Mu Guo (Wood Apple) is sour and warm, relaxes tendons and activates collaterals, good for treating wind-damp bi pain and muscle stiffness. Bai Shao (White Peony) is sour and slightly bitter, nourishes blood, softens the liver, suppresses yang, and alleviates pain. Salty herbs enter the kidney (bones) meridian, good for treating kidney-related disorders. For example, Gui Ban (Tortoise Shell) is salty and neutral, nourishes yin, subdues yang, tonifies the kidneys, and strengthens bones, good for treating kidney yin deficiency, bone steaming, night sweats, nocturnal emissions, or yin deficiency with yang excess, dizziness, and tinnitus. Lu Rong (Deer Antler) is salty and warm, tonifies the kidneys, strengthens yang, benefits essence and blood, and strengthens bones; Wu Wei Zi (Schisandra) is salty and neutral, tonifies the kidneys and benefits the lungs, regulates qi, and calms asthma.
3. Memory through Names: This method involves understanding and memorizing the properties and effects of herbs through their names. For example, Yi Mu Cao (Motherwort) is a key herb in gynecology, with the effect of invigorating blood and regulating menstruation, hence the name “herb that benefits mothers.” Fan Xie Ye (Senna) is a laxative herb, produced in “Fan” and used as “leaves,” hence the name “laxative leaves.” Xu Duan (Dipsacus) tonifies the liver and kidneys, strengthens tendons and bones, and can mend fractures, hence it is used for treating sprains and fractures. Han Shui Shi (Cold Water Stone) has the meaning of cold water like ice, indicating its effect of clearing heat, draining fire, and relieving thirst. Tong Cao (Rice Paper) implies “opening and benefiting,” which can promote lactation and facilitate urination. Jie Gu Mu (Elderberry) implies the ability to connect bones and tendons, thus it has the effect of treating injuries and fractures. Duan Xue (Blood Stopping) implies the ability to stop bleeding, hence it can treat various bleeding conditions. Gu Sui Bu (Drynaria) means it can strengthen bones, as the kidneys govern bones, thus it can tonify the kidneys and strengthen bones, invigorating blood and dispelling wind.
4. Phonetic Similarity Memory: Due to the transmission of TCM knowledge using Chinese characters, the use of characters and their development is closely related, especially with the frequent use of ancient and modern characters and homophones. In the names of Chinese medicines, this phonetic similarity is often used. Utilizing this phonetic similarity to memorize Chinese medicines is also a common memory method. For example, Ze Xie (Alisma) can be phonetically linked to “ze xie” (to choose to drain), indicating its selective draining effect, thus it drains turbid without harming the clear, benefits water without harming fluids; Gao Ben (Ligusticum) can be phonetically linked to “gao ben” (high root), indicating its ability to treat headaches at the vertex; Ci Shi (Magnetite) can be phonetically linked to “zi shi” (to nourish stone), as stone belongs to water in the five elements, corresponding to the kidneys, thus it has the effect of nourishing the kidneys, treating kidney deficiency and tinnitus. Bi Xie (Dioscorea) can be phonetically linked to “bi jie” (to relieve wind dampness), indicating its ability to relieve wind dampness and bi pain; Po Gu Zhi (Corydalis) can be phonetically linked to “bu gu zhi” (to nourish bones), indicating its ability to nourish the kidneys and strengthen bones, invigorating blood and dispelling wind.
5. Shape Symbolism Memory: This method involves abstractly linking the shape of the medicine with the human body and the symptoms of diseases to achieve the goal of memorizing the properties of Chinese medicines. For example, Ren Shen (Ginseng) resembles a human shape, and since humans are based on qi, ginseng is a key medicine for tonifying original qi; Gou Teng (Uncaria) resembles limbs in spasm, thus it has the effect of calming the liver and extinguishing wind; Huai Niu Xi (Achyranthes) resembles the knee joint of a cow, thus it has the effect of tonifying the liver and kidneys and strengthening tendons and bones, good for treating pain in the lower back and knees, and difficulty in bending and stretching; Gou Ji (Cibotium) resembles a dog’s spine, thus it has the effect of tonifying the liver and kidneys and strengthening tendons and bones; He Tao Ren (Walnut) resembles the human brain, which is the sea of marrow, thus it has the effect of tonifying the kidneys and assisting yang; Hai Gou Shen (Sea Dog Kidney) resembles the male external genitalia, thus it often tonifies the kidneys, benefits essence, and strengthens yang.
6. Memory through Local Efficacy: The origin and growth environment of medicinal materials affect their efficacy. Memory through local efficacy involves categorizing and memorizing herbs based on their common characteristics of origin and growth environment. Herbs that grow in shady, cold places often have the effect of clearing heat and draining fire. For example, Huang Lian (Coptis) grows in high mountain shaded grass, has the effect of clearing heat and drying dampness, draining fire and detoxifying; Long Dan Cao (Gentiana) grows in damp places on mountain slopes and in bushes, has the effect of clearing heat and draining fire, clearing liver and gallbladder damp-heat; Yu Xing Cao (Houttuynia) often grows in damp ditches and ponds, has the effect of clearing heat and detoxifying, dissipating pus and draining; Feng Wei Cao (Feng Wei Grass) also known as well-side grass, grows at the well-side (inner side), has the effect of clearing heat and detoxifying, promoting urination and stopping bleeding; Chui Pen Cao (Chui Pen Grass) grows in damp rocks, mountain ditches, and streams, has the effect of clearing heat and detoxifying, draining dampness and reducing jaundice; Xia Ku Cao (Selfheal) often grows in bamboo forests and shady places, has the effect of clearing the liver and brightening the eyes, dissipating masses and reducing swelling.
Medicinal materials that grow in coastal areas often have the effect of softening hardness and dissipating masses. For example, Kun Bu (Kelp) and Hai Zao (Seaweed) soften and dissipate masses, clear phlegm and drain water; Hai Ge Ke (clam shell) and Fu Hai Shi (floating sea stone) clear the lungs and transform phlegm, softening and dissipating masses, good for treating cough and asthma due to lung heat; Mu Li (Oyster Shell) calms the liver and subdues yang, softening and dissipating masses, good for treating yin deficiency with yang excess, agitation, insomnia, phlegm-heat obstruction, and phlegm nodules.
7. Memory through Quality: Chinese medicines come from different plants, animals, and minerals, and also differ in roots, stems, leaves, seeds, and flowers, thus the quality of Chinese medicines varies. Based on the quality of the medicines, they can be categorized into different types, and medicines of the same quality share similarities in properties. This method of memory is often referred to as memory through quality.
(1) Heavy quality often descends, calms, and subdues: For example, Dai Zhe Shi (hematite) calms the liver and descends rebellious qi, treating both liver yang rising causing dizziness and lung and stomach qi rebellion causing cough and hiccups; Shi (magnetite) calms the spirit, stabilizes the yang, and nourishes qi, treating yang excess causing tinnitus; Long Gu (dragon bone) and Long Zhi (dragon teeth) calm the spirit, stabilize the liver, subdue yang, and astringe, treating restlessness, palpitations, and insomnia; Shi Jue Ming (clam shell) calms the liver and brightens the eyes, treating liver yang rising causing dizziness and other symptoms.
(2) Light quality often ascends, disperses, and releases: For example, Ma Bo (Mushroom) is light and powdery, clears heat and detoxifies, good for treating heat evil and fire toxin attacking the throat causing swelling and loss of voice; Bo He (Mint) is aromatic and cool, disperses wind-heat, clears the head; Sang Ye (Mulberry Leaf) dispels wind and clears heat, treating head and eye diseases.
(3) Seed types often descend, drain, and lower qi: For example, Su Zi (Perilla Seed) descends qi, resolves phlegm, and stops cough, treating cough and asthma; Lai Fu Zi (Radish Seed) promotes digestion, descends qi, and resolves phlegm, treating food stagnation in the stomach, belching, and acid reflux; Bai Jie Zi (White Mustard Seed) resolves phlegm, removes fluid, and stops pain, treating phlegm obstruction, chest and flank fullness, cough, and shortness of breath; Ting Li Zi (Ting Li Seed) drains the lungs, promotes urination, and resolves phlegm, treating cough and shortness of breath, and generalized edema.
(4) Flower types often ascend, soothe the heart, and relieve depression: For example, He Huan Hua (Mimosa Flower) calms the spirit and relieves depression, treating emotional distress, anxiety, and insomnia; Mei Hua (Plum Blossom) regulates qi and relieves depression, harmonizes blood and stops pain, treating liver and stomach disharmony, chest and flank fullness, and menstrual irregularities; Lu Xue Mei (Green Flower) soothes the liver and relieves depression, regulates qi and harmonizes the stomach, treating liver and stomach qi stagnation, chest and flank fullness, and belching.
(5) Insect types dispel wind, relieve spasms, and stop pain: For example, Wu Gong (Centipede) extinguishes wind, relieves spasms, and opens the collaterals, treating acute and chronic convulsions, tetanus, and spasms; Quan Xie (Scorpion) extinguishes wind, relieves spasms, detoxifies, and stops pain, treating acute convulsions and facial paralysis caused by stroke; Jiang Can (Silkworm) extinguishes wind and relieves spasms, treating convulsions and epilepsy; Di Long (Earthworm) clears heat, relieves spasms, and opens the collaterals, treating high fever and post-stroke hemiplegia; Shui Zhi (Leech) breaks blood, dispels stasis, and opens the collaterals, treating blood stasis obstructing menstruation and abdominal masses.
(6) Blood and flesh tonics fill and nourish essence and blood: Animal medicines are often blood and flesh products that can fill and nourish essence and blood. For example, Gui Ban (Tortoise Shell) nourishes yin, subdues yang, and tonifies the kidneys, strengthening bones; Bie Jia (Soft-shelled Turtle) nourishes yin, subdues yang, and softens masses; Yang Rou (Lamb) benefits qi and tonifies deficiency, warming the middle and warming the lower; Lu Rong (Deer Antler) tonifies the kidneys, strengthens yang, benefits essence and blood, and strengthens bones. Pig spinal marrow has the effect of nourishing yin and benefiting marrow; Ji Zi Huang (Egg Yolk) has the effect of nourishing yin and moistening dryness; Ejiao (Donkey-hide Gelatin) nourishes blood and stops bleeding, treating blood deficiency and dizziness as well as bleeding conditions; Zi He Che (Human Placenta) nourishes the kidneys, benefits essence, and nourishes blood.
(7) Charcoal medicines stop bleeding and diarrhea: Xue Yu Tan (Blood Residue Charcoal) stops bleeding and resolves stasis, treating hematuria, hematemesis, and hematochezia; Ce Bai Ye (Arborvitae Leaf Charcoal) cools blood and stops bleeding, treating various bleeding conditions due to blood heat; Ou Jie Tan (Lotus Root Charcoal) stops bleeding and resolves stasis, treating various bleeding conditions; Zong Lin Tan (Palm Charcoal) astringes and stops bleeding, treating various bleeding conditions without stasis; Di Yu Tan (Bloodwort Charcoal) cools blood and stops bleeding, treating various bleeding conditions, especially suitable for hematochezia and menorrhagia. Additionally, Da Huang (Rhubarb) can be used raw for purging, but when roasted into charcoal, it can stop diarrhea.
8. Reciting Songs and Verses to Memorize Chinese Medicines: Compiling the properties of Chinese medicines into songs and verses for recitation is a traditional memory method in TCM. Due to the compact and catchy nature of the content in Chinese medicine songs, as long as they are read fluently and memorized thoroughly, they will be remembered for a long time. Earlier works such as the “Yao Xing Fu” (Song of Medicinal Properties) are concise but not easy to understand, so in 1962, the Beijing University of Chinese Medicine’s Chinese Medicine and Formulas Teaching and Research Group compiled the “Yao Xing Fu 400 with Vernacular Explanations,” which is more suitable for beginners to memorize and understand. The book also includes the “Eighteen Reversal Medicine Song,” “Nineteen Avoidance Medicine Song,” and “Pregnancy Contraindication Medicine Song.”
9. Clever Use of Associations to Memorize Chinese Medicines: Each chapter of the “Chinese Herbal Medicine” contains many herbs, and to remember all the herb names, one must think creatively. For example, the exterior-releasing wind-cold herbs can be remembered through associations compiled into a song, such as: “Su Ma Gao Gui Xi Bai Ru, Sheng Huo Yi Er Jing Fang Feng” – containing Chinese herbs such as Zi Su (Perilla), Ma Huang (Ephedra), Gao Ben (Ligusticum), Gui Zhi (Cinnamon), Xi Xin (Asarum), Bai Zhi (Angelica), Xiang Ru (Elsholtzia), Sheng Jiang (Ginger), Qiang Huo (Notopterygium), Xin Yi (Magnolia), Cang Er Zi (Xanthium), Jing Jie (Schizonepeta), and Fang Feng (Saposhnikovia). This can be imagined as: In the “Kangxi Dynasty,” there was a Su (Zi Su) Ma (Ma Huang) who was favored by Kangxi, and her high (Gao Ben) and noble (Gui Zhi) qualities were due to her delicate white (Bai Zhi) and moist (Xiang Ru) skin. To maintain her fair and pure appearance, what is most suitable for her to prevent (Sheng Jiang) cold damage? That is to be cautious (Jing Jie) against wind and cold. By using this imaginative method, one can remember 13 pungent and warm exterior-releasing herbs in a fun way.
10. The “Guide” of Formulas – Medicinal Guides: “Medicinal guides” is a term in Chinese herbal medicine, referring to guiding medicines. In formulas, the “medicinal guide” has the function of “guiding the medicine to the meridians,” which can enhance the efficacy of the formula, ensure it reaches the disease site, and harmonize the properties of the medicines. The concept of “medicinal guides” has been used since the Eastern Han Dynasty by the medical sage Zhang Zhongjing in his “Shang Han Lun,” where he applied medicinal guides such as Gan Cao (Licorice), Sheng Jiang (Ginger), Da Zao (Jujube), Jing Mi (Glutinous Rice), Dan Zhi (Bile), Bai Mi (Honey), Jiu (Wine), Cu (Vinegar), and Tong Bian (Children’s Urine). The “Tai Ping Hui Min He Ji Ju Fang” mentions over 90 types of medicinal guides, such as Ba Zheng San using lampwick to guide heat downward; Shi Xiao San using vinegar to guide the medicine into the liver meridian; Liang Ge San using white honey to soften the harshness of the medicine and preserve the stomach’s fluids.
It is said that the origin of medicinal guides is related to Zhu Yuanzhang: During the Hongwu period of the Ming Dynasty, there was a famous doctor named Lou Ying in Xiaoshan, Zhejiang. Lou Ying was highly skilled in medicine, with the ability to bring the dead back to life, and his reputation spread far and wide. People called him “Immortal Grandfather.” One year, the Empress Ma fell seriously ill, and the imperial physicians tried various treatments, using many precious medicines like ginseng and lingzhi, but her condition did not improve. Zhu Yuanzhang, anxious, issued an edict to invite famous doctors from all over the country to treat the empress. Hearing of Lou Ying’s exceptional skills, Zhu Yuanzhang quickly summoned him to the palace. As the saying goes, “Being with the emperor is like being with a tiger,” so any mistake in treating the empress would be unacceptable. Upon entering the palace, Lou Ying did not care about the fatigue of the journey and first inquired about the empress’s condition and the medicines used from the imperial physicians. Seeing that the medicines used by the imperial physicians were all precious herbs like ginseng, deer antler, and lingzhi, he thought to himself: The empress must be gravely ill, and the imperial physicians must have given up hope, resorting to these precious materials. The next day, Lou Ying followed the eunuch to the empress’s bedside. After careful examination, his furrowed brow gradually relaxed. It turned out that the empress, despite her pale complexion, was not suffering from a complicated illness; Lou Ying realized that it was merely a case of overindulgence leading to disharmony of the spleen and stomach, with phlegm and dampness stagnating. He could treat her with common medicines like Da Huang (Rhubarb) and Lai Fu Zi (Radish Seed). After diagnosing the empress’s pulse, Lou Ying felt a bit confused: How could such a minor illness stump the imperial physicians? He thought about the medicines he had seen in the imperial hospital and pondered carefully. Suddenly, he had a realization: These medicines were harmless but perfectly matched the empress’s noble constitution. If he used some inexpensive medicines and something went wrong, it would be blamed on the ineffectiveness of the medicines, and he would face severe consequences. Thus, he hesitated to write the prescription. Just then, the emperor arrived. After bowing to the emperor, Lou Ying’s eyes brightened: He saw a jade pendant on Zhu Yuanzhang’s royal robe, sparkling and translucent! Lou Ying immediately wrote: “Three qian of Lai Fu Zi, with the emperor’s jade pendant as the ‘medicinal guide.'” Zhu Yuanzhang read it, immediately took off the jade pendant, and handed it along with the prescription to the eunuch, instructing him to use it as prescribed. After taking the medicine, the empress’s abdomen rumbled that night, and she had a smooth bowel movement, sleeping soundly through the night. The next day, Lou Ying instructed her to eat only a little light porridge and vegetarian dishes, and after a few days, she miraculously recovered.
“Medicinal guides” use precious jade as a guide, which is extremely valuable. However, jade also has certain medicinal properties. Ancient medical classics such as the “Shen Nong Ben Cao Jing” and “Ben Cao Gang Mu” record that jade has effects such as “clearing internal heat, relieving anxiety, moistening the heart and lungs, aiding the voice, nourishing hair, nourishing the five organs, calming the soul, unblocking blood vessels, and brightening the eyes and ears,” which perfectly matched the empress’s condition. The concept of “medicinal guides” plays an important role in formulas. TCM believes that meridians are the pathways for the circulation of qi and blood in the body. Qi and blood travel through the meridians, nourishing the body and its organs. Medicinal guides act like guides, directing the medicines to specific meridians and organs for targeted treatment. In other words, the special function of “medicinal guides” is to guide the medicinal properties directly to the disease site, achieving the effect of “medicinal action at the site of illness.” There are many types of medicinal guides, but single herbs are the most common. For example, Jie Geng (Platycodon) opens and promotes lung qi, guiding the medicine upward, often used for upper jiao diseases; Niu Xi (Achyranthes) tonifies the kidneys and strengthens tendons, guiding the medicine downward, often used for lower jiao diseases; for treating Tai Yang meridian diseases, Qiang Huo (Notopterygium) and Fang Feng (Saposhnikovia) are used; for Yang Ming meridian diseases, Sheng Ma (Cimicifuga) and Ge Gen (Pueraria) are used; for Shao Yang meridian diseases, Chai Hu (Bupleurum) is used; for throat and pharyngeal diseases, Jie Geng is used; for upper limb diseases, Sang Zhi (Mulberry Branch) is used; for lower limb diseases, Niu Xi is used; and for taking Liu Wei Di Huang Wan and Qi Ju Di Huang Wan, it is advisable to take them with light salt water to guide them into the kidney meridian. Additionally, Sheng Jiang (Ginger) has the effects of promoting sweating, relieving the exterior, warming the middle, and stopping cough, and is often used with 2-3 slices of ginger as a guide when treating wind-cold colds and stomach cold vomiting. Cong Bai (Scallion) can disperse cold, promote yang, detoxify, and dissipate masses, and is often used with 5-7 scallions as a guide when treating wind-cold colds and urinary retention. When using pungent and warm exterior-releasing medicines, adding both ginger and scallion can enhance the effect of promoting sweating and relieving the exterior.
12. Four Elements for Learning Formulas
To learn formula studies well, whether for beginners or advanced learners, one must grasp four elements. First, one must master the medical principles of TCM. Learning formula studies requires a solid foundation of related subjects, including basic theories of TCM and TCM diagnostics. Second, one must understand the pharmacology of Chinese herbs. By studying the basic knowledge related to Chinese herbal medicine, familiarizing oneself with and memorizing a certain number of herbs, and mastering the basic principles of Chinese herbal medicine. Third, one must grasp the characteristics of formula studies, focusing on the most important academic feature of formula-syndrome correlation. On the basis of comprehensively mastering the pathogenesis of formula-syndrome correlation and understanding the compatibility relationships between the herbs in the formula, one should deeply appreciate the relationship between the compatibility of herbs and the pathogenesis of the formula. Fourth, one should understand the overall structure, emphasize memorization, and participate in practice. When studying formula studies, one should pay attention to connecting the content of the same chapter and across chapters, using analogy to analyze the similarities and differences in the differentiation, treatment principles, and composition of related formulas to deepen understanding of the course knowledge. It is essential to focus on key content and basic skills training; the composition, effects, and indications of formulas are fundamental, and memorizing the composition of herbs, deeply understanding their effects, and firmly grasping the indications of diseases are basic requirements for learning formula studies. Reciting formula songs is an effective means to aid memorization and enhance understanding, and beginners should memorize formula songs based on comprehension. Additionally, practice is crucial, such as observing diagnoses and studying medical cases with mentors. In summary, one must handle the relationship between understanding and memorization during learning, cultivating strong abilities in differentiation, treatment principles, and formula composition to lay a foundation for smoothly learning clinical subjects.
13. Memory Techniques for Formulas
1. Memory through Formula Names: The naming of TCM formulas has no fixed rules and varies widely. For example, among the thirteen formulas recorded in the “Nei Jing,” many are named after the main herb, such as Sheng Tie Luo Yin (Raw Iron Decoction) and Ze Xie Yin (Alisma Decoction). The “father of formula books,” “Shang Han Lun,” contains formulas named after the main herb, those named after their effects and indications, and those named by analogy or symbolism. Analyzing and summarizing the naming of formulas can be beneficial for memorizing and understanding the composition, effects, and indications of formulas.
(1) Formulas named after herbs: This includes formulas named after the main herb, the composition of the formula, and the number of flavors in the formula. Formulas named after a single main herb include: Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang (Cinnamon Decoction), Wu Zhu Yu Tang (Evodia Decoction), Bai Tou Weng Tang (Pulsatilla Decoction), etc.; formulas named after two main herbs include: Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction), Dang Gui Shao Yao San (Angelica and Peony Powder), Qing Hao Bie Jia Tang (Artemisia and Soft-shelled Turtle Decoction), etc.; formulas named after three main herbs include: Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Powder), Ban Xia Tian Ma Bai Zhu Tang (Pinellia, Gastrodia, and Atractylodes Decoction), San Ren Tang (Three Nut Decoction), etc.
(2) Formulas named after the composition of herbs: This refers to formulas named after all the herbs in the composition. For example, Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) consists of Ma Huang, Xing Ren, Shi Gao, and Gan Cao; Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction), Ling Gui Zhu Gan Tang (Poria, Cinnamon, and Licorice Decoction), and Ling Gan Wu Wei Jiang Xin Tang (Poria, Licorice, Five-flavor, and Ginger Decoction), etc.
(3) Formulas named after the number of flavors: This refers to formulas named after the number of flavors in the composition. For example, Si Wu Tang (Four Substance Decoction) consists of four herbs, Si Jun Zi Tang (Four Gentlemen Decoction) consists of four herbs, and Ba Zhen Tang (Eight Treasures Decoction) consists of four substances from Si Wu Tang and Si Jun Zi Tang, totaling eight herbs; there are also Du Shen Tang (Single Ginseng Decoction), Er Zhi Wan (Two Ultimate Pill), San Zi Yang Qin Tang (Three Seed Nourishing Parents Decoction), Si Mo Yin Zi (Four Milled Drink), Wu Pi Yin (Five Peel Decoction), Liu Wei Di Huang Wan (Six Flavor Rehmannia Pill), Qi Ju Di Huang Wan (Goji and Chrysanthemum Six Flavor Rehmannia Pill), etc.
(4) Formulas named after their effects: This refers to formulas named after their main effects and indications. For example, Da Cheng Qi Tang (Major Order the Qi Decoction) has the effect of strongly purging heat accumulation and promoting the downward flow of stomach qi, indicated for Yang Ming organ excess, heat accumulation, and constipation; Ji Chuan Jian (Benefit the River Decoction) has the effect of moistening the intestines and promoting bowel movements, indicated for kidney deficiency and constipation; Bai Du San (White Toxin Powder) has the effect of benefiting qi and releasing the exterior, dispelling cold and dampness, supporting the righteous qi and dispelling the evil qi, indicated for qi deficiency and exterior wind-cold-dampness; Xiao Yao San (Free and Easy Wanderer Powder) has the effect of soothing the liver, relieving depression, tonifying the spleen, and nourishing blood, indicated for liver qi stagnation and blood deficiency.
2. Memory through Classification: The classification methods of formulas have varied opinions among medical practitioners throughout history, and one of the classification methods is based on the main formula (ancestor formula). Memory through classification is a method of memorizing formulas based on a representative formula. By memorizing this formula, one can also memorize the derived auxiliary formulas and variations. For example, the formulas in Zhang Zhongjing’s “Shang Han Lun” have many derived formulas, such as the Gui Zhi Tang (Cinnamon Decoction) class, which includes Gui Zhi Jia Shao Yao Tang (Cinnamon Decoction with Peony), Gui Zhi Jia Da Huang Tang (Cinnamon Decoction with Rhubarb), Gui Zhi Jia Huang Qi Tang (Cinnamon Decoction with Astragalus), Gui Zhi Jia Xing Ren Tang (Cinnamon Decoction with Apricot Kernel), Gui Zhi Jia Ge Gen Tang (Cinnamon Decoction with Pueraria), Gui Zhi Qu Shao Yao Tang (Cinnamon Decoction without Peony), Xin Jia Tang (Newly Added Decoction), Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), Huang Qi Jian Zhong Tang (Astragalus Construct the Middle Decoction), etc.; the Ma Huang Tang (Ephedra Decoction) class includes Da Qing Long Tang (Major Blue Dragon Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction), Ge Gen Tang (Pueraria Decoction), Ma Huang Sheng Ma Tang (Ephedra and Bupleurum Decoction), etc.; the Chai Hu Tang (Bupleurum Decoction) class includes Da Chai Hu Tang (Major Bupleurum Decoction), Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Decoction), etc. In summary, if one can memorize dozens of representative formulas, the number of formulas that can be memorized will be considerable. Additionally, memory through classification can also be beneficial for studying the commonalities of pathogenesis and treatment principles among similar formulas, helping to deepen the understanding of the main formula’s principles and treatment methods.
3. Reciting Songs and Verses to Memorize Formulas: Reciting songs and verses to memorize formulas is one of the basic skills in learning TCM. From ancient times to the present, most learners of TCM have gone through the process of reciting formula songs. To facilitate learning, many catchy formula songs have been compiled by our predecessors, such as the “Tang Tou Ge Jue” (Song of Decoction Head) by Wang Ang from the Qing Dynasty and the “Tang Tou Ge Jue Bai Hua Jie” compiled by Beijing University of Chinese Medicine. As a beginner, it is advisable to choose a ready-made formula song to memorize. As long as the song is recited fluently and persistently, it will be memorized thoroughly over time, allowing for smooth application in clinical practice.
4. Fun Memory Techniques for Formulas: Fun memory techniques involve transforming the dry and difficult-to-remember formulas into memorable associations with familiar people or things in daily life, or using homophones or near-synonyms. For example, the exterior-releasing wind-cold formula can be remembered through associations compiled into a song, such as: “Su Ma Gao Gui Xi Bai Ru, Sheng Huo Yi Er Jing Fang Feng” – containing Chinese herbs such as Zi Su (Perilla), Ma Huang (Ephedra), Gao Ben (Ligusticum), Gui Zhi (Cinnamon), Xi Xin (Asarum), Bai Zhi (Angelica), Xiang Ru (Elsholtzia), Sheng Jiang (Ginger), Qiang Huo (Notopterygium), Xin Yi (Magnolia), Cang Er Zi (Xanthium), Jing Jie (Schizonepeta), and Fang Feng (Saposhnikovia). This can be imagined as: In the “Kangxi Dynasty,” there was a Su (Zi Su) Ma (Ma Huang) who was favored by Kangxi, and her high (Gao Ben) and noble (Gui Zhi) qualities were due to her delicate white (Bai Zhi) and moist (Xiang Ru) skin. To maintain her fair and pure appearance, what is most suitable for her to prevent (Sheng Jiang) cold damage? That is to be cautious (Jing Jie) against wind and cold. By using this imaginative method, one can remember 13 pungent and warm exterior-releasing herbs in a fun way.