# Hierarchy and herb combinations in learning Chinese herbal formulas

One of the most important reasons Chinese herbal medicine is different than the majority of Western herbal medicine because of its intentionally constructed formulas of multiple herbs. Where herbs are abstracted from their formulas and extracted to reveal their constituent components, the results are usually disappointing. I have personally found the most success with formulas when I seek (and manage) to fully appreciate the structure of a formula. This, unfortunately, is not very often a simple task.

The way most students learn about formula structure is twofold. First, students learn herbal combinations and interpret all formulas based on the combinations they contain. Second, if they’re diligent, they learn some version of Jun, Chen, Zuo, Shi (Emperor, Minister, Assistant and Servant). In other words, they learn a hierarchy of importance of each herb within the formula. Learning these things steadfastly can certainly improve formula recall and allow some basic comprehension of the formula. What more can you ask for, really?

Well, a lot more, if you’re me. This seems a good time to post this video:

The relevant quote, of course, being, “How DARE you waste my time with anything less than your very best?”

So, let’s break it down – quickly – because I have to drive for 1.5 hours here in a minute. I think I’ve already talked about learning formulas by learning combinations first. I don’t like it, in short. I’d prefer if we just started out with formulas, and proceeded to single herbs from there. Failing that, let us learn single herbs through the Shennong Bencao Jing and then proceed directly to formulas. Why?

Well, an example is the best way to illustrate what I’m thinking about. But, the same example will serve well to address the problems in the Jun, Chen, Zuo, Shi method of learning formula hierarchy. So, let’s talk briefly about that first.

I do believe that formulas have hierarchies. By that, I mean, I do believe that there are herbs that are so critical to a formula that removing them destroys the formula completely. This is due to the interrelatedness (and/or modularity) of most classical formulas. If you remove one herb, you usually have another formula – or most of one. However, the assignment of Jun, Chen, Zuo, Shi that you see in textbooks is not something laid down by the formula originators on creation of the formulas. You will find different assignments, particularly past the Emperor, depending on what resource you are using. This can be very, very confusing. At minimum, it makes a student unclear as to the utility of the concept of hierarchy in formulas. Most students don’t pay much attention to it, and sort of grow numb to the concept.

Those who DO learn it, committing it to memory, end up with a problem. The Emperor herb is usually pretty clear, and makes sense. What is Sini San without Chaihu? Guizhi Tang without Guizhi? Knowing that the formula has one major protagonist helps you to understand what sort of basic universe the formula operates within. However, the positions beyond that are difficult to interpret. Is the minister herb in Guizhi Tang Baishao? Why? Why not Shengjiang? Why are Shengjiang, Dazao and Gancao always relegated to an inferior position? If you think that doesn’t negatively impact people’s understandings of formulas, I’d be interested to hear your reasoning.

Anyway – to wrap up, let’s just take an example – my favorite formula and yours Xiao Chaihu Tang** (小柴胡湯).** Using one method of translating the classical dosage units, we end up with the following composition:

- Chaihu 24g
- Huangqin 9g
- Banxia 12g
- Shengjiang 9g
- Renshen 9g
- Dazao 9g
- Gancao 9g

Interpreted through most people’s understanding of combinations, the formula looks like a couple of pairs and some other random stuff. The pairs in question would be Chaihu + Huangqin and Banxia + Shengjiang. The former is mostly memorized as a pair to harmonize the Shaoyang, relieving alternating fever and chills as well as congested Qi and heat in the Shaoyang channels and organs. The latter is typically thought to be a pair for phlegm in the center, nausea and vomiting. The last three are usually thought to be something having to do with digestion, harmonizing and detoxifying the formula, or something like that.

Interpreted through most people’s understanding of Jun, Chen, Zuo, Shi, we have Chaihu as the clear emperor (by dosage and effect) with Huangqin the minister (poorly explained in every source I’ve found) and everyone else sort of hanging out there for fun.

What have we learned through these methods about this formula? It has something to do with Shaoyang, the person probably has those classic Shaoyang symptoms we learn by rote. Maybe there’s something to do with nausea, or maybe some kind of phlegm. The digestion must be weak, or maybe the Qi needs to be tonified, or something. I’m telling you, this is the farthest most people go. If someone comes in with alternating chills and fever or a temporal headache or a sore throat, they might think of this formula. Of course, if they have learned through some level of discipleship the wide application of Xiao Chaihu Tang, then the poor understanding of the formula structure is compensated for.

Chaihu and Huangqin are undoubtedly an important part of this formula. But can we understand the combination of Chaihu and Shengjiang? What about Chaihu and Dazao? Are they not also combined in this formula? What about the combination of Shengjiang, Dazao and Gancao – 3/5ths of Guizhi Tang? What is the difference of the combination of Chaihu and Gancao in this formula as differentiated from Sini San? What happens to our understanding if we think of Chaihu and Huangqin as equal in the hierarchy with all the rest of the herbs combining to be equally important as one of those two?

Many of these questions, and many more, could be explored and even answered by reading the original modification commentary in the Shanghan Lun. If the patient is thirsty, what is done? What does this mean about those herbs?

If we simply learn formulas by memorizing combinations and Jun, Chen, Zuo, Shi we can quickly become too mentally constipated to perform these acrobatics. By doing so, we miss out on the vast utility of some of our most beautiful formulas. That’s all I’m saying, folks.

## About Eric Grey

Hi - I'm the founder of Deepest Health. When I'm not writing here, you can find me reaching out to the Chinese Medicine community across the web and in my own backyard. I currently teach Chinese herbs at my alma mater, the National College of Natural Medicine. Additionally, I'm the founder of Watershed Community Wellness, a thriving local clinic in Southeast Portland in Oregon. No matter where I'm working, you'll find my focus on the Classical approach to Chinese medicine laced throughout everything I do.