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Authors: Ma Kun, Chen Yanxia
Affiliation: China Academy of Chinese Medical Sciences
The best season to take Gao Fang (medicated paste) is winter, with the highest number of people consuming it from November to February of the following year. Gao Fang is one of the important methods for “preventive treatment” in Traditional Chinese Medicine (TCM), showcasing the unique characteristics and advantages of TCM, and is suitable for various populations. This edition analyzes Gao Fang and focuses on its application in gynecology.
What is Gao Fang?
Gao refers to the dosage form, while Fang refers to the formula, collectively known as the principles and methods of TCM. It is also called Gao Ji, Jian Gao, or Gao Zi, and is one of the eight traditional TCM dosage forms: decoctions, pills, powders, pastes, elixirs, wines, tinctures, and tablets. According to Qin Bomei’s “Complete Guide to Gao Fang”: “Gao Fang is made by boiling medicinal juices into a viscous liquid, which nourishes the dryness and weakness of the five organs and six bowels, hence it is commonly referred to as Gao Zi medicine.” Gao Fang embodies the unique characteristics and advantages of TCM in preventive treatment, suitable for all types of people, and can improve physical constitution. For healthy individuals, it prevents the risk of “getting sick”; for sub-healthy individuals, it prevents the risk of “becoming ill”; for high-risk individuals, it prevents the risk of “falling ill”; for those already ill, it prevents the risk of “transmitting illness”; and for those in recovery, it prevents the risk of “recurrence”. Gao Fang can be tailored according to the three causes, varying by person, time, and place.
Composition, Preparation, and Usage of Gao Fang
Classification of Gao Fang
Gao Fang can be divided into external and internal preparations. This article focuses on internal Gao Fang, which can be categorized into fixed formulas and customized formulas. Fixed formulas typically have simpler compositions, fixed medicinal flavors, are mass-produced, have definite efficacy, and are highly targeted, making them easy for patients to select and promote, such as Yi Mu Cao Gao (Motherwort Paste), She Dan Chuan Bei Pi Pa Gao (Fritillaria and Snake Gall Paste), and Gui Lu Er Xian Gao (Tortoise and Deer Antler Paste). Customized Gao Fang is based on syndrome differentiation, with one formula for each individual, prepared by a pharmacy or hospital specifically for the individual seeking treatment, making it a personalized remedy.
Composition of Gao Fang
Chinese herbal pieces: These are the main components of Gao Fang, selected based on syndrome differentiation and disease analysis through observation, listening, inquiry, and pulse-taking, according to the principles of monarch, minister, assistant, and envoy. A typical Gao Fang usually contains 30-40 types of herbs, with dosages 10-15 times that of decoctions, totaling around 3 kilograms, not exceeding 5 kilograms. The typical duration of use is 30-50 days. It is essential to consider both “treating disease” and “nourishing deficiency”, focusing on syndrome differentiation without excessively accumulating tonifying herbs.
Fine herbs: These refer to precious herbs such as ginseng and deer antler, collectively known as “fine and precious medicinal materials”, which reflect the nourishing effects of Gao Fang. Examples include Sheng Bai Ren (Fresh Ginseng), Lu Rong (Deer Antler), Hai Ma (Seahorse), and Zi He Che (Placenta). Precious herbs should not be boiled with the herbal pieces to avoid waste; they should be simmered separately to extract a concentrated juice, which is then added to the paste, or they can be ground into fine powder and mixed in during the final stages of preparation to maximize their medicinal effects.
Gums: Used for medicinal and binding purposes. Gums not only nourish deficiencies but also help in the solidification of the paste. The typical amount of gum in a Gao Fang is 200-400 grams, which can be used alone or in combination as needed. For low-sugar or sugar-free Gao Fang or those with difficult-to-extract herbal pieces, the gum amount can be increased to 400-600 grams.
Sugars: Used for flavor adjustment, medicinal purposes, and binding. Sugars not only mask the bitterness of the herbs, making the paste easier to consume, but also have certain nourishing effects and help solidify the paste. Common sugars include white sugar, brown sugar, rock sugar, and honey, typically used in amounts of 500 grams, while maltose is generally used in 600-800 grams. Diabetic patients can use sugar-free sweeteners like xylitol, usually in amounts of 200-300 grams. Rock sugar is used to tonify the middle and benefit qi, strengthen the spleen, moisten the lungs, resolve phlegm, and stop cough; brown sugar is used to tonify qi and blood, strengthen the spleen, warm the stomach, relieve pain, and invigorate blood circulation; honey is used to tonify the spleen and stomach, moisten the lungs, stop cough, relieve constipation, and alleviate pain; white sugar is used to moisten the lungs and generate fluids, tonify the middle, and relieve symptoms; maltose is used to tonify the middle and nourish deficiency, generating fluids and moistening dryness.
Auxiliary materials: Yellow wine is an essential auxiliary material in the preparation of Gao Zi, used for soaking animal-derived medicinal gums. The properties of wine are hot and sweet, and it not only has the effects of flavor adjustment, invigorating blood circulation, dispelling cold, and guiding the medicinal properties but also serves as an excellent organic solvent. The typical amount of yellow wine in a Gao Fang is generally 250-500 milliliters for every 500 grams of gum, soaked and heated to dissolve.
Preparation and Storage of Gao Fang
Soaking: Excluding gum-based herbs, the herbal pieces are placed in a clean clay pot or stainless steel pot, submerged in clean water, and soaked for more than 6 hours or overnight.
Decoction: The soaked herbal pieces are added to water, covering the herbs by one-third, and decocted using the conventional method, with the first decoction lasting about 3 hours and the second and third decoctions lasting about 2 hours each. The three decoctions are then combined, allowed to settle, filtered, and the clear liquid is collected.
Concentration: The clear liquid is boiled down, starting with high heat and then reducing to low heat, constantly stirring and skimming off foam to prevent burning. As the medicinal liquid thickens, care must be taken to adjust the heat, avoiding excessive heat. Fine herbs like ginseng can be added at this stage, concentrating until the medicinal liquid drips onto paper without spreading, which indicates the formation of clear paste.
Collecting the paste: Sugar and gums (previously processed or melted) are added to the concentrated liquid, and the heat is adjusted while stirring thoroughly. When the paste is nearly formed, fine herbs such as black sesame and walnut kernels are added gradually while stirring until well mixed. The paste should be thick enough that it does not easily drip from chopsticks or forms beads when dripped into water.
Storage: The finished paste should be transferred while hot into containers (which have been cleaned, disinfected, and dried), labeled, and moved to a cool area to cool naturally. After cooling completely, cover the containers; if covered before cooling, it is prone to mold. When using a Gao Fang packaging machine, it should be packaged while hot.
Storage: Store in a cool, dark place; refrigeration is preferable. The spoon used to scoop the Gao Fang should be clean, dry, and designated for this purpose. Currently, vacuum-sealed plastic bags are popular.
Quality Standards for Gao Fang
Appearance quality: The finished paste should not have crystallized sugar, and there should be no burnt or strange odors. The paste should be fine, black, shiny, and have a fragrant medicinal aroma, with a moderately thick consistency, ideally achieving a state of “black as lacquer, bright as a mirror”.
Internal quality: First, check for insoluble substances by taking 5 milliliters of the finished product into a container, adding 200 milliliters of hot water, stirring to dissolve the paste, and observing after 3 minutes; there should be no burnt lumps or medicinal residues. For pastes containing powdered herbs, check before adding the powder, and do not check for insoluble substances afterward. Second, check the density of the paste according to the pharmacopoeia; the relative density should not be less than 1.4.
Usage of Gao Fang
Season for consumption: Spring is for growth, summer for flourishing, autumn for harvest, and winter for storage. Winter is the season when all things lie dormant, making it the best time for nourishment throughout the year. There is a saying that “winter nourishment leads to a strong year ahead”. Generally, it is recommended to consume from the beginning of winter (around early November) to the beginning of spring (early February of the following year), approximately 2 months. If extended, it can be from the frost descent to the spring equinox of the following year. With improved storage conditions, some patients can consume Gao Fang year-round.
Opening formula: Before taking Gao Fang, the doctor prepares a small plan based on the specific situation and special conditions of the user, allowing them to try a short-term decoction to observe the effects, especially for first-time users of Gao Fang. Generally, this lasts 1 to 3 weeks, or even longer. This serves to eliminate residual pathogens, gradually acclimatize, and awaken the spleen and appetite. Gao Fang differs from decoctions in that it uses a large number of nourishing herbs, especially those like Ejiao (Donkey-hide Gelatin), Lu Rong (Deer Antler), and Gui Ban (Tortoise Shell), which are rich in nutrients and can be sticky and heavy, potentially obstructing the spleen and generating dampness. Therefore, an opening formula is necessary to regulate the spleen and stomach, transform dampness, and enhance the digestive function of the spleen and stomach, creating conditions for the digestion and absorption of Gao Fang. Additionally, it prevents the retention of pathogens; the opening formula clears the source before discussing the foundation. Once Gao Fang is prepared, it often requires continuous use for one to two months. Some individuals may experience various discomforts upon first taking Gao Fang, so an opening formula is used for 1-2 weeks as a trial to observe the response to the medication. If the patient’s overall condition is good and the prescribed herbs are suitable, they can then begin using Gao Fang.
Methods of consumption: There are three common methods: 1) sublingual, meaning to dissolve the Gao Fang in the mouth; 2) mixing with water, meaning to dissolve the Gao Fang in boiled water; 3) adjusting the Gao Fang, meaning for pastes that are difficult to dissolve, they can be heated in a water bath. It is emphasized to take Gao Fang on an empty stomach, as the gastrointestinal tract is empty and absorption is strong. If taking on an empty stomach is uncomfortable, it can be taken when slightly hungry. Pastes that promote sleep can be taken 15-30 minutes before bedtime; the typical dosage is twice daily, with each dose being one tablespoon (approximately 20-30 grams). The specific amount should be determined based on the nature of the Gao Fang, the severity of the disease, and the patient’s constitution.
Precautions: First, dietary restrictions. During the consumption of Gao Fang, avoid raw radishes, radish seeds, mung beans and their products, pickled vegetables, and limit oily, cold, and spicy foods. Avoid alcohol and smoking. It is best to space the consumption of Gao Fang from tea or coffee by 3-4 hours. Second, handling special situations. If experiencing a cold or fever, it is advisable to pause for a few days and resume once the condition improves. A thick and greasy tongue coating indicates that taking Gao Fang may worsen the situation. Additionally, there are populations unsuitable for taking Gao Fang, such as those seeking quick results, those with acute diseases or infections, and patients in the active phase of chronic diseases.
Experience in Gynecological Application of Gao Fang
Women experiencing perimenopausal syndrome may present with clinical manifestations such as menstrual irregularities, hot flashes, sweating, irritability, facial flushing, dizziness, palpitations, insomnia, lower back pain, facial swelling, and emotional instability around menopause. Treatment should focus on clearing heat without excessive cooling, dispelling cold without excessive warmth, and avoiding the reckless use of aggressive herbs. Hormone replacement therapy may be necessary, and treatment should be combined with a healthy diet and regular exercise for comprehensive adjustment.
Liver and Kidney Yin Deficiency Syndrome
Clinical manifestations: Menstrual irregularities before and after menopause, with scanty or excessive flow, or spotting; bright red menstrual blood; dizziness, hot flashes, sweating, five hearts heat, chest tightness, irritability, restlessness, insomnia with vivid dreams, lower back and knee pain, heel pain, dry and itchy skin, dry mouth, scanty urination, constipation; tongue is red with little coating, pulse is deep, thin, and wiry.
Treatment method: Nourish the kidney and soften the liver, with assistance in clearing the heart and calming the yang.
Representative formulas: Zuo Gui Wan (Left Return Pill) combined with Er Zhi Wan (Two Ultimate Pill), Liang Wei Di Huang Tang (Six Flavor Rehmannia Decoction), Zhi Bai Di Huang Wan (Anemarrhena and Phellodendron Pill), etc.
Basic herbs: Nourishing the kidney and liver with Gui Ban (Tortoise Shell), Bie Jia (Soft-shelled Turtle), Huang Jing (Polygonatum), Gou Qi Zi (Goji Berries), Sheng Shu Di (Raw Rehmannia), Tian Dong (Asparagus), Shi Hu (Dendrobium), Sang Shen (Mulberries), Nu Zhen Zi (Ligustrum), Mo Han Lian (Eclipta), Wu Wei Zi (Schisandra), Zi He Che (Placenta), Shan Yao (Chinese Yam), Shan Yu Rou (Chinese Wolfberry), etc.; for clearing heat and dispelling steaming, add Gui Ban, Bie Jia, Zhi Mu (Anemarrhena), Huang Bai (Phellodendron), Dan Pi (Moutan), Di Gu Pi (Lycium), Xuan Shen (Scrophularia), Shi Hu, Bai He (Lily), Qing Hao (Artemisia), Bai Wei (Cynanchum), etc.; for calming the liver and subduing yang, add Duàn Lóng Gǔ (Calcined Dragon Bone), Duàn Mǔ Lì (Calcined Oyster Shell), Zhen Zhu Mu (Mother of Pearl), Zi Bei Zhi (Purple Shell), Dai Zhe Shi (Hematite), Shi Jue Ming (Abalone Shell), etc.; for soothing the liver and regulating qi, add Chen Pi (Tangerine Peel), Bo He (Mint), Yu Jin (Curcuma), Fo Shou Pian (Buddha’s Hand), Xiang Yuan (Citron), Mei Gui Hua (Rose), Bai Shao (White Peony), etc.; for clearing the heart and relieving irritability, add Gou Teng (Uncaria), Lian Zi Xin (Lotus Seed Heart), Ku Ding Cha (Bitter Tea), Huang Lian (Coptis), Yu Jin (Curcuma), Zi Dan Shen (Red Sage), Qing Long Zhi (Green Dragon Tooth), etc.; for strengthening the spleen and protecting the stomach, add Tai Zi Shen (Pseudostellaria), Dang Shen (Codonopsis), Chen Pi, Bai Zhu (Atractylodes), Mu Xiang (Saussurea), Jiao Shan Zha (Hawthorn), Chao Mai Guo (Fried Barley), etc.; for tonifying the kidney and assisting yang, add Tu Si Zi (Cuscuta), Lu Jiao Shuang (Deer Antler Velvet), Yin Yang Huo (Epimedium), Xian Ling Pi (Epimedium), Xian Miao (Corydalis), etc. Fine herbs and others: Xi Yang Shen (American Ginseng), honey, maltose, black sesame, walnut meat, etc.
Spleen and Kidney Yang Deficiency Syndrome
Clinical manifestations: Before and after menstruation, excessive menstrual flow, dark menstrual blood, or spotting; dull complexion, fatigue, hot flashes, sweating, cold limbs, edema, scanty urination, loose stools, accompanied by dizziness, depression, forgetfulness, restlessness, disturbed sleep, fullness in the abdomen, belching, reduced appetite, and restless sleep; tongue is swollen with white slippery coating, pulse is deep and weak.
Treatment method: Warm the kidney and support yang, strengthen the spleen and resolve dampness, with assistance in calming the mind.
Representative formulas: You Gui Wan (Right Return Pill) combined with Er Xian Tang (Two Immortals Decoction), Gui Fu Li Zhong Tang (Cinnamon and Aconite Decoction), Zhen Wu Tang (True Warrior Decoction).
Basic herbs: For tonifying the kidney and assisting yang, add Tu Si Zi, Xian Ling Pi, Yin Yang Huo, Lu Jiao Pian (Deer Antler), Bu Guo Zhi (Psoralea), Yi Zhi Ren (Alpinia), Xian Miao, Ba Jiao Tian (Morinda), Zi Shi Ying (Amethyst), etc.; for warming the middle and tonifying the spleen, add Fu Zi (Aconite), Gan Jiang (Dried Ginger), Wu Zhu Yu (Evodia), Gao Liang Jiang (Galangal), etc.; for strengthening the spleen and resolving dampness, add Dang Shen, Huang Qi (Astragalus), Cang Zhu (Atractylodes), Bai Zhu, Fu Ling (Poria), Yi Ren (Job’s Tears), Bai Bian Dou (Lima Bean), etc.; for regulating qi and protecting the stomach, add Jiao San Xian (Fried Three Immortals), Mu Xiang, Chen Pi, Fo Shou Pian, Su Geng, etc.; for nourishing kidney yin, add Sheng Gui Ban, Sheng Bie Jia, Huang Jing, Gou Qi Zi, Nu Zhen Zi, Mo Han Lian, Wu Wei Zi, Zi He Che, etc.
Fine herbs and others: Dong Chong Xia Cao (Cordyceps), Hong Shen (Red Ginseng), Black Sesame, Walnut Meat, Tian Shan Xue Lian (Snow Lotus), etc. Adjustments: If there is significant coldness in the limbs, add Xi Xin (Asarum), Sang Zhi (Mulberry Branch), Gui Zhi (Cinnamon Twig), Rou Gui (Cinnamon); for insomnia and vivid dreams, add Yu Jin, Fu Shen (Poria), Suan Zao Ren (Sour Jujube Seed), He Huan Pi (Mimosa Bark), Yuan Zhi (Polygala); for blood stasis, add Tao Ren (Peach Kernel), Hong Hua (Safflower), Zelan (Plantago), Yi Mu Cao (Motherwort), Zi Dan Shen (Red Sage).
Gao Fang for Treating Postpartum Pain
During the postpartum period, if there is pain, numbness, or heaviness in the limbs or joints, it is commonly referred to as “postpartum wind”. This is due to the deficiency of blood and qi after childbirth, leading to insufficient nourishment of the meridians, or the invasion of wind, cold, and dampness, which obstructs the joints and meridians. Common syndromes include wind-cold syndrome, blood stasis syndrome, blood deficiency syndrome, and kidney deficiency syndrome.
Wind-Cold Syndrome
Clinical manifestations: Joint pain postpartum, difficulty in flexion and extension, pain in unspecified locations, or severe cold pain resembling needle pricks, relieved by warmth, or swelling and numbness in the joints, accompanied by aversion to cold and fear of wind; tongue is pale with thin white coating, pulse is soft and thin.
Treatment method: Nourish blood and dispel wind, scatter cold and eliminate dampness.
Representative formula: Du Huo Ji Sheng Tang (Angelica and Pubescent Angelica Decoction) with modifications.
Basic herbs: For dispelling cold and wind, add Fang Feng (Siler), Qiang Huo (Notopterygium), Gui Zhi, Jing Jie (Schizonepeta), Bai Zhi (Angelica Dahurica), Zi Su (Perilla), Sheng Jiang (Fresh Ginger), Cang Zhu; for scattering cold and eliminating dampness, add Wei Ling Xian (Clematis), Du Huo (Angelica), Mu Guo (Papaya), Can Sha (Silkworm), Xun Jin Cao (Sichuan Pepper), Xun Gu Feng (Wind Grass), Hai Feng Teng (Sea Wind Vine); for nourishing blood, add Shu Di (Cooked Rehmannia), Zhi He Shou Wu (Prepared Fo-Ti), Dang Gui (Angelica), Ji Xue Teng (Spatholobus), Shou Wu Pian (Fo-Ti), Zi He Che (Placenta), etc.; for invigorating blood and resolving stasis, add Dan Shen (Salvia), Dang Gui, Chuan Xiong (Chuanxiong), Zelan, Yi Mu Cao, Hua Niu Xi (Achyranthes), San Qi (Notoginseng), Shan Zha (Hawthorn); for nourishing the stomach and protecting the spleen, add Bai Zhu, Jin Zhen Guo (Golden Zhen Guo), Yi Ren, Bian Dou, Liang Shen Qu (Fermented Barley), Hua Shan Yao (Chinese Yam), Chao Guo Yu (Fried Barley), etc.
Fine herbs and others: Tai Zi Shen, Huang Jiu (Yellow Wine), Xylitol, Longan Meat, etc. Adjustments: If dampness is heavy, add Chuan Po (Chuan Po), Cang Zhu, Fang Ji (Stephania), Yi Yi Ren (Coix Seed); for severe joint pain, add Yan Hu Suo (Corydalis), Chuan Wu (Aconite), Cao Wu (Aconite); if lochia is not flowing smoothly, add Dan Shen, Yi Mu Cao.
Blood Stasis Syndrome
Clinical manifestations: Postpartum pain, especially in the upper and lower limbs and lower back, with numbness, hardness, heaviness, swelling, and difficulty in flexion and extension, with scanty lochia, dark color with clots, and abdominal pain that resists pressure; tongue is dark, with a white coating, pulse is wiry and rough.
Treatment method: Nourish blood, invigorate blood circulation, resolve stasis, and eliminate dampness. Representative formula: Shen Tong Zhu Yu Tang (Body Pain Eliminating Decoction) with modifications.
Basic herbs: For invigorating blood and resolving stasis, add Zi Dan Shen, Dang Gui, Chuan Xiong, Zelan, Yi Mu Cao, Chuan Niu Xi (Achyranthes), Jiang Can (Silkworm), Quan Xie (Scorpion), Wu Gong (Centipede), etc.; for nourishing blood, add Shu Di, Zhi He Shou Wu, Dang Gui, Ji Xue Teng, Ejiao, Zi He Che, etc.; for nourishing the stomach and protecting the spleen, add Bai Zhu, Roasted Huang Qi, Jin Zhen Guo, Yi Ren, Bian Dou, Liang Shen Qu, Hua Shan Yao, Chao Guo Yu, etc.
Fine herbs and others: Tai Zi Shen, Sheng Bai Ren, Huang Jiu, Longan Meat, etc. Adjustments: For severe joint pain, add Hu Zhang (Polygonum), Tuo Guo Cao (Corydalis), Zhi Cao Wu (Aconite); if lochia is not flowing smoothly, add Dan Shen, Yi Mu Cao.
Blood Deficiency Syndrome
Clinical manifestations: Postpartum joint pain throughout the body, with numbness, pale yellow complexion, dizziness, palpitations, and poor appetite; tongue is pale with thin coating, pulse is thin and weak.
Treatment method: Nourish blood and benefit qi, warm the meridians and open the collaterals.
Representative formula: Huang Qi Gui Zhi Wu Wu Tang (Astragalus and Cinnamon Five Ingredients Decoction) with modifications.
Basic herbs: For nourishing blood, add Shu Di, Zhi He Shou Wu, Dang Gui, Bai Shao (White Peony), Longan Meat, Ejiao, Zi He Che, etc.; for benefiting qi, add Tai Zi Shen, Dang Shen, Huang Qi, Bai Zhu, Hong Jing Tian (Rhodiola), etc.; for warming the meridians, add Rou Gui, Fu Zi, Ai Ye (Mugwort), Wu Zhu Yu, Pao Jiang (Ginger), Xiao Hui Xiang (Fennel), Chuan Jiao (Sichuan Pepper), etc.; for invigorating blood and resolving stasis, add Dan Shen, Dang Gui, Chuan Xiong, Chi Shao (Red Peony), Zelan, Yi Mu Cao, San Qi, etc.; for nourishing the stomach and protecting the spleen, add Bai Zhu, Fu Ling, Yi Ren, Bian Dou, Liang Shen Qu, Hua Shan Yao, Chao Guo Yu, etc.
Fine herbs and others: Sheng Bai Ren, Xylitol, Longan Meat, Black Sesame. Adjustments: For dizziness and palpitations, add Dang Shen, Chai Hu (Bupleurum), Sheng Ma (Cimicifuga); for excessive blood loss during childbirth, add Ejiao, Zhi He Shou Wu, Dang Gui, Shu Di, Bu Guo Zhi; for joint pain and numbness, add Di Long (Earthworm), Wei Ling Xian, Chuan Shan Jia (Pangolin), Qiang Huo; for lower back pain, add Du Zhong (Eucommia), Gou Ji (Cibotium).
Kidney Deficiency Syndrome
Clinical manifestations: Postpartum lower back pain, weak knees, heel pain, difficulty bending and stretching, dizziness, tinnitus, frequent urination at night; tongue is pale and dark, pulse is deep, thin, and wiry.
Treatment method: Tonify the kidney and nourish blood, strengthen the waist and bones. Representative formula: Yang Rong Zhuang Shen Tang (Nourishing and Strengthening Kidney Decoction).
Basic herbs: For tonifying the liver and kidney, add Huang Jing, Yu Zhu (Polygonatum), Qi Zi (Goji Berries), Shou Wu, Bie Jia, Gui Ban, Shan Yu Rou, Sang Shen, Xian Ling Pi, Xian Miao, etc.; for nourishing blood, add Shu Di, Dang Gui, Bai Shao, Longan Meat, Ejiao, Zi He Che, etc.; for benefiting qi, add Tai Zi Shen, Dang Shen, Huang Qi, Bai Zhu, Hong Jing Tian, etc.; for nourishing the stomach and protecting the spleen, add Bai Zhu, Fu Ling, Yi Ren, Bian Dou, Liang Shen Qu, Hua Shan Yao, Chao Guo Yu, etc.
Fine herbs and others: Dang Shen, Xylitol, Lu Jiao Gao (Deer Antler Gel), Longan Meat, Black Sesame.
Adjustments: For cold pain in the lower abdomen, add Zi Shi Ying, Ba Jiao Tian, Xian Ling Pi; for dizziness and blurred vision, add Gou Qi Zi, Nu Zhen Zi.
Principles of Gao Fang Prescription
Principles of Gao Fang Prescription
Monarch herbs: The monarch herbs in Gao Fang differ from those in general herbal formulas; they are not single or dual herbs but are selected based on the main disease or syndrome, often combining one or two formulas.
Minister herbs: The minister herbs assist the monarch herbs. After prescribing the monarch herbs, the minister herbs are further determined. The purpose of minister herbs is to correct imbalances and harmonize qi, blood, yin, and yang.
Assistant herbs: These are auxiliary herbs. In Gao Fang, assistant herbs often protect the stomach qi, as the high quantity of tonifying herbs can be difficult to digest and may affect appetite. Therefore, herbs that regulate the spleen and stomach and promote qi circulation, such as Mu Xiang, Shen Qu, Jin Zhi Jin (Chicken Inner Gold), Gu Mai Ya (Barley Sprouts), etc., are added.
Envoy herbs: These are guiding and harmonizing herbs that direct the other herbs to the affected area or harmonize the formula. In Gao Fang, guiding herbs include honey and yellow wine.
Characteristics of Gao Fang
Dynamic and static balance: Gao Fang contains many herbs that tonify qi, blood, yin, and yang, which are sticky and difficult to dissolve. If purely tonifying, it may obstruct qi and blood, trapping pathogens inside. Therefore, the formula must balance dynamic and static properties, incorporating aromatic and qi-regulating herbs to tonify without stagnation. Heavier and richer herbs are static, while lighter and thinner herbs are dynamic; nourishing yin and generating fluids are static, while tonifying qi and promoting flavor are dynamic; nourishing blood and tonifying blood are static, while dispelling stasis and invigorating blood are dynamic; nourishing the liver and tonifying the liver are static, while soothing the liver and regulating qi are dynamic; tonifying the kidney and filling essence are static, while strengthening the spleen and transforming dampness are dynamic; strengthening the spleen and benefiting qi are static, while promoting digestion and eliminating stagnation are dynamic; blood herbs are static, while qi herbs are dynamic, and some herbs can have dual effects depending on the formula and condition.
Cold and warmth used together: In clinical practice, pure cold or pure heat conditions are rare, so herbs should be used in a balanced manner to mitigate their tendencies. For example, use Gui Zhi, Yin Yang Huo, Xian Miao, Tu Si Zi, Ba Jiao Tian to warm and tonify yang; then pair with Sheng Di Huang (Raw Rehmannia) to moisten dryness and Gan Cao (Licorice) to moderate toxicity. If there are too many warming herbs, add bitter and cold herbs like Huang Qin (Scutellaria) to balance.
Seeking balance as the goal: Treating disease must focus on the root cause, with constitution as the foundation and disease as the manifestation. Treating the root means treating the constitution. Gao Fang is not merely a tonifying agent; it also includes the meaning of correcting imbalances. Therefore, the selection of herbs in Gao Fang must consider individual constitution and apply balancing, warming, clearing, and astringent herbs, as well as consider the root cause of the disease and apply herbs that generate fluids, benefit qi, consolidate fluids, and nourish blood. Gao Fang seeks nourishment in the treatment of disease, seeks to dispel pathogens while nourishing deficiencies, supports the righteous while preventing retention of pathogens, and nourishes deficiencies while preventing stagnation, aiming for balance.
Details of Gao Fang Usage
Sweet and fragrant herbs: Dang Shen, Huang Qi, Di Huang, Huang Jing, Yu Zhu, Bai He, Mai Dong, Tian Dong, Bei Sha Shen, Gua Lou, Shan Zhu Yu, Dang Gui, Nu Zhen Zi, Wu Wei Zi, Gou Qi Zi, Rou Cong Rong, Bu Guo Zhi, Longan Meat, Shi Hu, etc. These should comprise more than 1/3 of the formula to improve the aroma and taste of the finished paste.
Dark-colored herbs: Di Huang, Dang Shen, Bai He, Tian Dong, Mai Dong, Yu Zhu, Dang Gui, Roasted Gan Cao, Shan Zha, Da Zao, Mu Guo, Gua Lou, Longan Meat, Gou Qi Zi, Chuan Xiong, etc. These can improve the aroma and taste of the finished paste.
Starch-containing herbs: Fu Ling, Shan Yao, Yi Ren, Qian Shi, Tian Hua Fen, Gu Mai, Mai Ya, Fu Xiao Mai, Tu Fu Ling, Ban Xia, etc.
Aromatic herbs: Sha Ren, Bai Dou Kou, Rou Dou Kou, Cao Dou Kou, Cao Guo, etc., suitable for 50-60 grams per material. Bai Zhi, Tan Xiang, Dai Dai Hua, Mei Gui Hua, Qing Pi, Chen Pi, Xiao Hui Xiang, Tao Ren, Xing Ren, etc., suitable for less than 100 grams per material. Fo Shou and Xiang Yuan can replace Qing Pi and Chen Pi to reduce the impact on the yield of the paste. Hong Jing Tian has good color and aroma, suitable for 200-300 grams per material.
Pungent and dispersing herbs: Fang Feng, Jing Jie, Qiang Huo, Du Huo, etc., suitable for less than 100 grams per material.
Bitter herbs: Huang Lian, Huang Qin, Huang Bai, Zhi Zi, Xia Ku Cao, Chuan Bei, Zhe Bei, Yuan Zhi, Lian Zi Xin, Jue Ming Zi, Ku Shen, etc., suitable for less than 30 grams per material.
Flower and whole herb types: Jin Yin Hua, Ju Hua, He Hua, Xian He Cao, Han Lian Cao, Bai Hua She She Cao, etc., which may reduce the yield of the paste.
Mineral and shell-type herbs: Shi Gao, Hua Shi, Dai Zhe Shi, Ci Shi, Long Gu, Mu Li, Zhen Zhu Mu, Wu Zhi Gu, etc., which may reduce the yield of the paste.
Animal-derived herbs: Jiang Can, Di Long, Shui Zhi, Wu Ling Zhi, Quan Xie, Ci Hu, She Tui, Wu Gong, Zi He Che, etc., which may have strong odors.
Pollen herbs: Pu Huang, Hai Jin Sha, etc., which may reduce the yield of the paste.
Precious and fine herbs: Ren Shen, Xi Yang Shen, Dong Chong Xia Cao, Zang Hong Hua, Chuan Bei, Chen Xiang, San Qi, She Xiang, Ling Zhi, Ling Zhi Spore Powder, Zhen Zhu Fen, etc., as well as Ge Jie, Hu Po, Xiong Dan, Niuhuang, etc. (which may have odors), need to be ground into fine powder and decocted separately.
Medicinal and edible herbs: Longan, Black Sesame, Mulberry, Hawthorn, Pear, Walnut, Jujube, etc., which have good flavors and are suitable for long-term consumption.
Gum herbs: Ejiao, Lu Jiao Gao, Gui Ban Gao, which can make the finished paste smooth, viscous, and shiny.
Source: China Traditional Chinese Medicine News
Editor: Guo Yutong
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