By Eric Brand

The practice of combining whole formulas is a widespread new trend in the field of Chinese medicine. Formula combining is not an entirely new trend by any means, but the widespread availability of prepared formulas in the modern day has allowed the practice of formula combining to expand significantly. The practice of formula combining is particularly prevalent with granule extracts, and formula combining is a fundamental feature of the basic method of granule use as practiced in Taiwan and Japan. Formula combining is comparatively less common in mainland China, where single herb extracts and raw herbs dominate the market. In the West, we use formula combining on a small scale with granule products and liquid concentrates, but most Western practitioners lack experience and training in the principles of formula combining.

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Historically, we find many examples where a compound formula like Liu Yi San (Six to One Powder) was used as an addition to a whole formula. In the modern day, the availability of hundreds of pre-made granule formulas has greatly expanded the scope of formulas that can be easily combined. As I’ve mentioned in previous blogs, granule formulas are commonly built from single-herb extracts in mainland China, and compound granule formulas that have been decocted together are comparatively rare on the Chinese domestic market. The situation is different in Taiwan and Japan, where granule formulas are generally decocted together, and whole formulas (rather than single herb extracts) form the bulk of most prescriptions. In this prescription style, whole formulas are often added as a single principle, much as one would add a single medicinal to modify a base prescription.

These variations in product availability and prescription styles have fueled different approaches in different regions. Regions that decoct formulas together tend to favor the use of compound formulas, and many practitioners in Taiwan and Japan believe that whole formulas cooked together are more effective than formulas built entirely from single extracts. Whole formulas are thought to have clear direction and succinct principles, with an eloquent balance of ingredients and an enduring historical track record. In fact, Japanese granule manufacturers must apply for arduous “new drug” applications if any aspect of a classical formula is changed, such as variation in the dose ranges of constituent medicinals.

By contrast, in mainland China the prevailing view is that combining multiple whole formulas instead of building a prescription based on single herbs causes one to include unnecessary medicinals, making the formula lose its clarity and direction. In addition, the “formula compounding” method has never been extensively evaluated clinically on the mainland because the whole formula granule products are rarely available there (the domestic market is dominated by raw herbs and single-herb granule extracts). These diametrically opposed viewpoints have caused prescription styles to develop different regional characteristics. Since most Westerners are trained by teachers from mainland China, we often have relatively little exposure to the approach of formula combining. Thus, many practitioners are unclear on how to combine formulas.

Using formulas as building blocks speeds the time required for dispensing, since fewer bottles need to be pulled from the shelves and fewer products need to be weighed. For example, if the pharmacy has only single herbs and Shi Quan Da Bu Tang (Ten Complete Major Supplementation Decoction) needs to be filled, 10 individual herbs must be pulled. If the whole Shi Quan Da Bu Tang formula is not stocked, it can be built from Ba Zhen Tang plus Huang Qi (astragalus) and Rou Gui (cinnamon bark). If Ba Zhen Tang is not available, it can be elaborated by combining Si Jun Zi Tang and Si Wu Tang. In this way, fewer items need to be pulled off the shelf, and one has the advantage that the ingredients have been cooked together to preserve any positive chemical interactions that may result from decocting the items together.

Additionally, strong formulas that have clear principles but are rarely indicated on their own can often be incorporated into compound formulas. Examples include Bai Hu Tang, Er Chen Tang, Si Ni Tang, and Huang Lian Jie Du Tang. Each of these formulas is rarely needed on its own in an unmodified form. Yet each offers a perfect unit of medicinal combinations that is succinct, focused in principle, and highly effective.

A wide variety of formulas can be built from a few base formulas. Small classical formulas are often ideal for use as building blocks. For example:

Si Ni San can be modified towards Xiao Yao San or Chai Hu Shu Gan San
theory (Tong Xie Yao Fang is another good base here)

Si Jun Zi Tang
+Si Wu Tang= Ba Zhen Tang; + Huang Qi & Rou gui=Shi Quan Da
Bu Tang
+ Si Ni Tang=Fu Zi Li Zhong Wan theory
+ Er Chen Tang=Liu Jun Zi Tang theory

Si Miao San is an excellent base for damp-heat

Er Chen Tang
+Bai Zhu & Tian Ma= Ban Xia Bai Zhu Tian Ma Tang
theory
+Zhi Shi & Zhu Ru= Wen Dan Tang
+Zhi Shi, Huang Qin, Gua Lou Ren, Dan Xing=Qing Qi
Hua Tan Wan

Gui Zhi Tang
+Yi Tang= Xiao Jian Zhong Tang
+Huang Qi & Yi Tang= Huang Qi Jian Zhong Tang
+Ma Huang & Ge Gen= Ge Gen Tang

Xiao Yao San
+ Mu Dan Pi and Zhi Zi= Dan Zhi Xiao Yao San
+ Di Huang= Hei Xiao Yao San
Xiao Yao San can be easily modified with single herb additions to strengthen earth supplementation, blood supplementation, or liver-coursing depending on need

Bai Hu Tang
+ Gui Zhi for hot bi (impediment)
+ Ren Shen = Bai Hu Jia Ren Shen Tang

Si Wu Tang
+ Tao Ren & Hong Hua= Tao Hong Si Wu Tang
+ Ai Ye, E Jiao, & Gan Cao= Jiao Ai Tang

Below are some examples of small formulas with clear principles that can often be used to modify another base formula:

Dang Gui Bu Xue Tang (dang gui, huang qi) is an ideal addition to many formulas

Mu Li San (huang qi, mu li, ma huang gen)

Zuo Jin Wan (wu zhu yu, huang lian)

Ling Gui Zhu Gan Tang (fu ling, gui zhi, bai zhu, gan cao)

Zeng Ye Tang (mai men dong, xuan shen, sheng di huang) can nourish yin or be used to modify a cheng qi tang prescription

Sheng Mai San (ren shen, wu wei zi, mai men dong)

Yu Ping Feng San (huang qi, bai zhu, fang feng)

Dao Chi San (sheng di, mu tong, gan cao, zhu ye)

Suo Quan Wan (yi zhi ren, wu yao, shan yao)

Cang Er Zi San (cang er zi, xin yi hua, bai zhi, bo he)

Gui Zhi Fu Ling Wan (gui zhi, fu ling, chi shao, tao ren, dan pi)
+Adding yi yi ren forms an empirical Japanese Kampo formula for skin diseases and acne due to blood stasis

Ma Zi Ren Wan (huo ma ren, xing ren, bai shao, da huang, zhi shi, hou po) combines well as a branch treatment for constipation when mixed with herbs/formulas to treat root

Liang Fu Wan (gao liang jiang, xiang fu)