Hierarchy and herb combinations in learning Chinese herbal formulas

on 11/30/2010 by Eric Grey in Acupuncture, Herbs & Other modalities

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.

View all posts by Eric Grey - Website: http://deepesthealth.com

Steve says:

11/30/2010

Thanks for the enlightening post and the video… There is much to digest here!

Evan says:

11/30/2010

Learning herbs was certainly a trial in my course.

Our lecturer started off with individual herbs. This made it hard to understand the formulas.

My guess is that the best for students would be to start with a favourite formula, then move on to the individual herbs and then move on to related formulas so that some of the same herbs were in the next formulas but in slightly different combinations.

If you come up with a good way of teaching herbs and formulas I think students everywhere will love you.

Evan

Mitesh says:

12/02/2010

I have to say that it would be tough jumping into formulas without a minimal introduction to single herbs. Studying for Formulas Exam is proving tough with several dozen formulas and hundreds of herbs, many repeated over and over again in a multitude of combinations.

I think a great way to start of is teaching herbs that are found ‘next’ to each and play well together. This includes, but goes beyond the herb pairs. We can start examining the Magic 5 or the Tang Ye Jing Wood Class Herbs.

Having studied these smaller alchemical bonds, I feel like its easier to see what’s ‘happening’ in a formula.

Then becoming deeply familiar with the story of a pattern and how its rooted in nature, first and foremost, become paramount. Take ShaoYang for example. We can only talk about it when it goes wrong. But this is without support unless we know how it is right: the warm and balanced breeze of the East commanding life to wake up.

But you are also asking about the deeper structure of formulas as well. As of now, my focus is on the ShangHanLun to understand this. In this way I can see how basic formulas are systematically modified for a variety of symptoms. This reveals not only the ‘indications’ of an herb, but also the integrity of a formula to allow for a variety of herbs to play a role.

Finally, personal experience is second to none.

Paige says:

12/02/2010

Just love the what teachers make clip!! I have not studied herbs – but I have a question about using the basic pre-made formulae.

Is it really necessary to reinvent the formula every time? Do the ‘ancient’ recipes contained in the mass market type pills not work well enough? Does it have to be so complicated? Are the manufacturers not to be trusted to be holding to the ancient formulae? And are’nt there loads of sort of ‘aspirin’ type formulas that would help loads of people without needing a prescription? Free and easy wanderer or black chicken pills off the shelf? I know, I know blasphemy really. But the suffering particularly of women seems so unnecessary and the alternatives to Western medicine so thin on the ground.

What can be done? Just yesterday a patient came who had had a horrendous acupuncture treatment – extremely painful – courtesy of a NHS trained ‘acupuncturist’ probably some nurse who’d had done a weekend course. A previous positive acupuncture experience led him try again with me and he was easily treated and called this am to report 95% improvement in his sciatic pain.

I completely respect that dilution and lack of training can endanger the reputation of Chinese medicine in the West, but intelligent, well-informed use of premade prescriptions? What are your thoughts?

Eric Grey says:

12/06/2010

Mitesh,

Ok, sure, some introduction to herbs is necessary. I guess I’m not suggesting that students have zero understanding of single herbs – just that it isn’t learned as a topic on its own, and that it not be given primacy over formulas. Within the context of Chinese herbalism, herbs make the most sense as members of a working group – a formula.

Combinations, as they are typically taught, are one of the big problems – imho. I really find students struggling to think about Taoren without Honghua. That’s a problem, if you ask me.

Eric

Eric Grey says:

12/06/2010

Paige,

This is really too long for a blog comment. In short, no, I don’t think that patent formulas as found on the common market are good enough. Individual circumstances and constitution and the particular character of environmental pathogens (in a person’s particular place of residence) impact the disease enough that a very individualized approach to creating a formula is necessary.

It’s also true that most of the patent formula companies do not replicate theformulas faithfully. They also are only able to produce the most popular. If there were a company that created all of the Classical formulas in the exact proportions that we see in the texts, I would think differently.

The other problem with patent formulas is the loss of vitality when formulas are mass produced and left to sit on shelves for ages.

I do use premade formulas in the form of Heiner Fruehauf’s Classical Pearls. However, I only use them when the patient perfectly matches the formula. Otherwise, I take the structure of that formula and modify it as necessary as granules or bulk.

Anyway – good discussion and thanks for the fine question.

Eric
I

cipit says:

12/14/2010

thanks for your information about formula traditional medicine.
in my country, Indonesia still many who use traditional medicine.
was almost similar to the traditional Chinese herb which use plants as a medium for healing.
because the traditional ingredients are believed to very effective for treating various illnesses, both mild disease to chronic diseases that are difficult to cure.

thanks for the information you provide.
extremely helpful
: D

Mrs. Life says:

12/17/2010

There should be a lecture first regarding each herb before directly spilling out the formulas. Each of the formula should be grouped accordingly so as not to create confusion with the audience. Nevertheless, this post is packed with great stuff and great video you posted.

Kine says:

03/06/2011

Learning the herbs and their functions in relation to particular formulas or in combination with specific herbs is a neverending discovery. It is a lot of information to absorb as a student in an herb or formulas class but with each new patient you see the herbs come to life, so to speak. Through clinical experience , I continue to appreciate the herbs and revisit their functions each time I am preparing a prescription. For me, each herb has a personality (or a spirit to it ) that is expressed for a particular patient, or in a combination. Experience brings deeper understanding, and personally I Love that variations of functions keep the information from getting stale. I look forward from learning more from my teachers ( the herbs, my patients….and Heiner as well!)

Eric says:

03/06/2011

I agree! As a student, it’s tough. I think back to my third and fourth years and wonder how my brain didn’t explode. I see it in my students, too, at NCNM – they just don’t know how to hold all the information but feel sure that they MUST hold all the information. I keep trying to encourage them to think about learning herbs as a lifelong, experiential process that we’re just touching on in class – but I know what it’s like to be in that student place, feeling such great responsibility!

Thanks for your comment!

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