Overview
Types of Medicinal Preparations
The type of preparation refers to the specific form of the medicinal formulation that is processed based on the composition of the formula, the needs of the condition, and the different properties of the herbs. The history of medicinal preparations is long, with the earliest records in the 13 formulas of the Nei Jing (Inner Canon), which included forms such as decoctions (汤), pills (丸), powders (散), ointments (膏), wines (酒), and elixirs (丹). Later practitioners developed additional forms such as tablets, strings, strips, cakes, tinctures, and sitz baths. With the advancement of the pharmaceutical industry, new forms such as tablets, granules, and injections have been developed.
I. Liquid Preparations
1. Decoctions (汤剂): Also known as boiled preparations, they are made by soaking herbal pieces in water or wine, then boiling for a certain period to extract the essence. This is the oldest and most widely used form in clinical practice, showcasing the unique advantages of Traditional Chinese Medicine (TCM). Decoctions are primarily for internal use, such as Ma Huang Tang (Ephedra Decoction). For external use, they are often used for bathing, steaming, or gargling. The advantages include rapid absorption and the ability to quickly exert therapeutic effects, especially the unique adaptability to changes in the condition, making it comprehensive and flexible to meet individual needs. It is particularly suitable for complex or unstable conditions. Li Gao stated: “Decoctions are for expelling major illnesses.” However, the preparation and storage of decoctions can be inconvenient, and the taste may be unpalatable.
2. Medicinal Wines (酒剂): Also known as medicinal wine, they are made by soaking herbs in white or yellow wine, or by heating them in a water bath to extract the liquid for internal or external use. Wine has properties that invigorate blood circulation, promote the flow of meridians, and enhance the efficacy of the herbs, thus commonly used in formulas for dispelling wind and promoting circulation, such as rheumatic medicinal wine and ginseng and deer antler wine. Externally, medicinal wines can dispel wind, invigorate blood, relieve pain, and reduce swelling. However, there are individual limitations in their use.
3. Tinctures (酊剂): These are liquid preparations obtained by extracting the active components of herbs using ethanol of varying concentrations, primarily for external use. Generally, the concentration of herbal tinctures is 20%, while toxic substances are at 10%. Tinctures have the characteristics of high active ingredient content, small dosage, rapid action, and resistance to spoilage.
4. Elixirs (露剂): Also known as medicinal elixirs, they are made from fresh herbs containing volatile components, distilled to create a clear aromatic solution. Generally used as beverages and for cooling and relieving summer heat, medicinal elixirs have a light flavor and pleasant taste, such as Jin Yin Hua Lu (Honeysuckle Elixir).
5. Syrups (糖浆剂): These are made by boiling herbs, extracting the juice, concentrating it, and then dissolving it in an appropriate amount of sugar. Syrups have the characteristics of sweet taste, small volume, convenience of use, and rapid absorption, making them particularly suitable for children, such as cough syrup.
6. Oral Liquids (口服液): These are liquid preparations made by extracting herbs with water or other solvents and refining them. They have the advantages of small dosage, rapid absorption, convenience of use, and pleasant taste, such as Sheng Mai Kou Fu Ye (Sheng Mai Oral Liquid).
7. Injectable Solutions (注射液): Also known as injections, these are sterile solutions, sterile suspensions, or sterile powders for reconstitution made from extracted herbs, suitable for subcutaneous, intramuscular, or intravenous injection. They have the characteristics of accurate dosage, rapid efficacy, and independence from the digestive system, making them suitable for emergency use in acute and severe patients, especially for those who are comatose or unable to take oral medications, such as Shuang Huang Lian Injection.
II. Solid Preparations
1. Powders (散剂): These are made by grinding herbs into a fine powder and mixing them evenly. They can be for internal or external use. Internal powders are often taken with warm water, and smaller doses can be swallowed directly, such as Qi Li San (Seven Thousandths Powder); they can also be made into coarse powders for decoction, known as boiled powders, such as Yin Qiao San (Honeysuckle and Forsythia Powder). Their characteristics include simple preparation, rapid absorption, saving of herbs, and convenience for use and transport. Li Gao stated: “Powders are for dispersing, used for acute illnesses.” External powders are often sprinkled on wounds or affected areas, such as Jin Huang San (Golden Yellow Powder); they can also be used for eye drops or throat sprays, such as Ba Bao Yan Yao (Eight Treasure Eye Medicine) and Bing Peng San (Ice Boron Powder).
2. Pills (丸剂): These are made by grinding herbs into fine powder or extracting herbal components, then adding suitable binders to form spherical solid preparations. Compared to decoctions, pills have the characteristics of slower absorption, prolonged efficacy, saving of herbs, and convenience for use and transport. Li Dai stated: “Pills are for gradual treatment.” Pills are suitable for chronic and deficiency diseases, such as Liang Ge Wan (Six Flavor Rehmannia Pill). However, some pills may have strong effects due to the nature of aromatic or toxic herbs that are not suitable for decoction, such as An Gong Niu Huang Wan (Calm the Spirit Pill). Common types of pills include honey pills, water pills, paste pills, and concentrated pills.
(1) Honey Pills (蜜九): These are made by using refined honey as a binder for finely powdered herbs. They are divided into large and small honey pills. Honey pills are soft in nature, have a mild and lasting effect, and have nourishing and flavor-correcting properties, commonly used for treating chronic and deficiency diseases.
(2) Water Pills (水丸): Commonly known as water-dissolved pills, these are made by using water (boiled or distilled) or wine, vinegar, or honey water as a binder for finely powdered herbs. Water pills dissolve and absorb more quickly than dense pills, making them easier to swallow and suitable for various diseases, such as Fang Feng Tong Sheng Wan (Siler and Ephedra Pill).
(3) Paste Pills (糊丸): These are made by using rice paste, flour paste, or dough as a binder for finely powdered herbs. Paste pills have strong adhesion, are hard in texture, dissolve slowly, and can prolong the efficacy of the medicine, reduce adverse reactions of toxic herbs, and lessen gastrointestinal irritation. For example, Zhou Che Wan (Carriage Pills).
(4) Concentrated Pills (浓缩丸): These are made by concentrating the decoction of herbs or part of the formula into a paste, then mixing and drying it with finely powdered herbs to form pills. Due to their small size, high active ingredient content, and small dosage, they can be used to treat various diseases.
3. Tea Preparations (茶剂): These are made from herbs processed into coarse powders or formed into blocks with suitable binders. They are used by steeping in boiling water or decocting and consumed at irregular intervals. They are often used for treating colds, food accumulation, and diarrhea.
4. Strings (条剂): Also known as medicinal strings, these are made by soaking fine powder in medicinal liquid and twisting it into thin strings, or twisting paper into thin strings and soaking them in powdered medicine; they are inserted into wounds or fistulas to promote healing and detoxification, such as Hong Sheng Dan Yao Tiao (Red Rising Dan Medicinal String). Alternatively, mugwort leaves and herbs can be ground into coarse powder, wrapped in paper to form round strings for moxibustion, also known as “moxa sticks.”
5. Threads (线剂): Also known as medicinal threads, these are made by soaking silk or cotton threads in medicinal liquid and drying them to create an external preparation. They are used for treating fistulas, hemorrhoids, or growths. The slight corrosive action of the medicinal threads and their mechanical tightening effect help to promote drainage or shrinkage and detachment.
6. Dan (丹剂): There are both internal and external types. Internal Dan does not have a fixed form, including pills and powders, named for their precious ingredients or significant efficacy, such as Zhi Bao Dan (Treasure Dan) and Huo Luo Dan (Invigorating Dan). External Dan, also known as Dan medicine, is made from certain mineral medicines that are burned at high temperatures to form different crystalline shapes, often ground into powder and sprinkled on wounds to treat ulcers and carbuncles; they can also be made into medicinal strings, threads, and external ointments.
7. Tablets (锭剂): These are made by grinding herbs into fine powder and adding appropriate binders to form solid preparations of specified shapes, available in spindle, cylindrical, or strip forms for internal or external use. For internal use, they can be taken as powdered or juiced forms, while for external use, they can be applied as juice. Common types include Zi Jin Ding (Purple Gold Tablet) and Wan Ying Ding (Universal Tablet).
8. Tablets (片剂): These are made by mixing powdered herbs or herbal extracts with excipients and compressing them into tablet forms. Tablets have accurate dosages, small volume, minimal odor, and are convenient for use and storage. If the drug needs to be absorbed in the intestines, it can be coated with enteric coating to dissolve in the intestines. Additionally, there are lozenges and effervescent tablets.
9. Granules (冲剂): These are made by extracting herbal components and mixing them with appropriate excipients or some powdered herbs to form dry granules or blocks. They are taken by dissolving in hot water. Granules have the characteristics of rapid action, pleasant taste, small volume, and convenience of use.
10. Suppositories (栓剂): Also known as sitz medicine or plug medicine, these are solid preparations made by mixing powdered herbs with a base to form a specific shape. They are mainly used in cavities. They release the medicine by melting or dissolving in the cavity, having effects such as insecticidal, anti-itching, and astringent properties. The Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases) mentions the use of She Chuang Zi San (Cnidium Powder) for sitz medicine and honey decoction methods, which are the earliest vaginal and rectal suppositories. Their characteristics include absorption through the rectal mucosa, with 50%-70% of the medicine bypassing the liver and entering systemic circulation directly, reducing the “first-pass effect” in the liver, minimizing the toxic side effects on the liver, and avoiding the influence of gastrointestinal fluids on the medicine and irritation to the gastric mucosa. Rectal administration is more convenient for infants and young children.
III. Semi-Solid Preparations
Ointments (膏剂): These are made by boiling herbs in water or vegetable oil to extract the essence. There are both internal and external types. Internal ointments include fluid extracts, tinctures, and decoctions; external ointments are divided into soft and hard types. Fluid extracts and tinctures are often used to prepare other formulations, such as mixtures, syrups, granules, and tablets. The following describes decoctions and external ointments.
(1) Decoction Ointments (煎膏): Also known as medicinal pastes, these are made by repeatedly boiling herbs in water, concentrating the essence, and adding refined honey or sugar to create a semi-liquid preparation. Their characteristics include small volume, high content, ease of use, and sweet taste, having nourishing and beneficial effects. They are generally used for chronic weakness patients, facilitating long-term medication, such as Lu Tai Gao (Deer Fetus Ointment).
(2) Soft Ointments (软膏): Also known as medicinal ointments, these are made by mixing finely powdered herbs with suitable bases to create a semi-solid external preparation of appropriate consistency. Those using emulsion-type bases are also called creams, commonly used on skin, mucous membranes, or wounds. Soft ointments have a certain viscosity, gradually softening or melting after application, allowing for slow absorption and prolonged therapeutic effects, suitable for surgical wounds, boils, burns, and scalds.
(3) Hard Ointments (硬膏): Also known as medicated plasters, these are made by boiling herbs in vegetable oil to a certain degree, removing the residue, and then boiling until it reaches a bead-like consistency, mixing in yellow lead and cooling to form an external preparation. When used, they are heated and spread on cloth or paper, softening before being applied to the affected area or acupoints, treating local and systemic diseases, such as ulcers, swellings, rheumatism, and pain, such as Gou Pi Gao (Dog Skin Ointment).
In addition, there are capsule preparations, drop pills, moxibustion preparations, poultices, enema preparations, liniments, aerosols, and sponge preparations. In recent years, new types of preparations have continuously emerged, and quality standards have been improved. In the development of modern medicinal preparations, new technologies and processes have been widely applied, such as ultrafiltration technology, rapid disintegration technology, volatile component stabilization technology, freeze concentration technology, dry granulation technology, and sterile filling technology; in quality control, instruments such as thin-layer chromatography, high-performance liquid chromatography, atomic spectroscopy, and nuclear magnetic resonance are used. Certain fixed formulas that have specific efficacy for certain conditions are gradually moving towards a trend of qualitative and quantitative recognition in the field of modern science and technology from the perspective of preparation technology.
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