By the Numbers: A Brief History of Chinese Medical Formulas
By the Numbers: A Brief History of Chinese Medical Formulas
by Eric Brand
I’m working on a blog regarding classical texts in Chinese medicine, so I thought it would be fun to first start with a review on some interesting highlights related to the development of Chinese herbal formulas. Chinese medicine is characterized by polypharmacy, with literally over a hundred thousand recorded formulas that can still be accessed in the modern day. From a few simple combinations to incredibly complex formulas, the sheer effort that has gone into collecting formulas for the past 2000 years is stunning. Let's look at the numbers.
The earliest accurately dated manuscript (168 B.C.E) to include formulas in Chinese medicine came from a nobleman’s burial chamber at Ma Wang Dui. At this time, there was not yet any influence of visceral manifestation or five-phase theory, and the channels and pulses were not interconnected. In the Ma Wang Dui manuscripts, there is a strong influence of sympathetic magic and a far less cohesive picture of the Chinese medicine that we know today.
The Ma Wang Dui manuscripts contained nearly 400 substances from plant, animal, human, and mineral sources, as well as prepared substances like condiments. 283 formulas were listed, but most of them were simplistic and lacked the developed theory seen in later texts like the Shang Han Lun. Nonetheless, the Ma Wang Dui manuscripts had detailed information on the preparation and dosage of various medicinals, with a variety of forms of topical and internal preparations.
It is believed that the Huang Di Nei Jing (Yellow Emperor's Inner Canon) came about 200 years or so later, in the later part of the Han dynasty. The Nei Jing was primarily concerned with acupuncture and theory, and had relatively few herbal formulas. In fact, it only had 13 formulas, made from 28 medicinals.
A bit later near the end of the Han dynasty, the Shang Han Za Bing Lun (On Cold Damage and Miscellaneous Disease) was written by Zhang Zhong-Jing. This book was later divided into two sections, the Shang Han Lun (On Cold Damage) and the Jin Gui Yao Lue (Essential Prescriptions from the Golden Coffer). The Shang Han Lun contained 113 formulas and was largely focused on external contraction. The Jin Gui had 245 formulas, and was focused on miscellaneous diseases. Together, these books have been the most influential herbal texts throughout the history of Chinese, Korean, and Japanese medicine.
Many of the formulas found in the Shang Han Lun and the Jin Gui have been important formulas for centuries, and our entire understanding of herbal combinations as well as the actions of individual herbs has been influenced by the eloquent combinations seen within these books. Dozens of important formulas came from these books, such as Ma Huang Tang, Gui Zhi Tang, Wen Jing Tang, Mai Men Dong Tang, Si Ni Tang, Si Ni San, etc.
Moving on to the Tang dynasty, Sun Si-Miao’s Qian Jin Yao Fang (approximately 652 C.E.) was a major milestone in formula literature. It contains over 5000 formulas, many of which remain in prominent use today. For example, Du Huo Ji Sheng Tang and Xi Jiao Di Huang Tang were both recorded in Sun’s Qian Jin Yao Fang. This book is also historically interesting because it contains references to both rational medicine and magical influences. It also contains philosophical essays, one of which is sometimes described as a Chinese medical version of the Hippocratic Oath.
In 752 C.E., the Wai Tai Mi Yao (Essential Secrets from Outside the Metropolis) was written by a doctor named Wang Tao. This book contains approximately 6000 formulas, including important formulas such as Huang Lian Jie Du Tang. It was then surpassed in scope by the Tai Ping Sheng Hui Fang (The Great Peace Sagacious Benevolence Formulary) in 992 C.E., which was edited by Wang Huai-Yin.
The Tai Ping Sheng Hui Fang was an imperial collection, with a stunning 16,834 formulas. Another imperial collection from the Song dynasty was the Tai Ping Hui Min He Ji Ju Fang (Tai-Ping Imperial Grace Pharmacy Formulas). This text was written sometime after 1078 C.E., and contained many important formulas that are still in use in the modern day. For example, the formulas Shi Xiao San, Shi Quan Da Bu Tang, Xiao Yao San, Er Chen Tang, and Ba Zheng San all came from this collection, as did Chuan Xiong Cha Tiao San, Shen Ling Bai Zhu San, and Si Jun Zi Tang. Probably second only to the Shang Han Lun and Jin Gui, this book contains tons of our modern textbook formulas. Others include: Mu Li San, Huo Xiang Zheng Qi San, Su Zi Jiang Qi Tang, Bai Du San, Shen Su Yin, and Xiao Huo Luo Dan.
By the Ming dynasty, the huge imperial collections of the Song dynasty were surpassed by the text Pu Ji Fang (Universal Salvation Formulary). This book was edited by Teng Hong in 1406 C.E. and contained 61,739 formulas. Wow.
The Pu Ji Fang wasn’t surpassed in formula numbers until 1993 C.E., when the modern day Zhong Yi Fang Ji Da Ci Dian (Great Dictionary of Chinese Medical Formulary) was published. This huge set is a compilation of 96,592 formulas. Bob has a copy here at the Blue Poppy library, come in some time and check it out. If you need to find an obscure formula, it is a good place to look. If the formula is not that obscure, the modern Jian Ming Fang Ji Ci Dian (Concise Formula Dictionary) is a good resource since it only has the most common 6000 formulas or so. We have one of those on the shelf, too.
Thanks for visiting our blog!
So, here are my questions. What has the prevalent fashion been during the history of CM? Taking into account some of the formula books of the past emphasizing a vast quantity of specific formulas, (The Pu Ji Fang's 61,739 Rx for example) is custom formula writing a recent trend? Obviously Zhang Zhong-jing would've fallen into the set formula camp, whereas I seem to remember Zhu Dan-xi being a custom Rx kinda dude. What's been more prevalent? Finally, what are your own predilections and what has informed your treatment style?
I think that the practice of modifying base formulas or building formulas from scratch has probably been going on for quite a long time, and collections like the Pu Ji Fang's 61,739 formulas were basically made by compiling and recording all the various written recipes that were floating around at the time. In many cases, these huge formula collections were more about preserving the formulas for prosperity rather than creating a cohesive guide for their clinical use.
In retrospect, we could say that Zhang Zhong-Jing used a lot of set formulas in the Shang Han Lun, but we only think of them as set formulas in the modern day. There are a lot of modifications within the Shang Han Lun that take the formulas in different directions, so he was probably varying them dynamically to a certain extent rather than relying on set formulas. The archetype formulas that he created had combinations of herbs that endured and got recycled into many other formulas over the ages, so the whole history of formula study is in effect a study of formula modifications.
As for my personal predilections, I suppose I always think of base formulas as principles that steer me in certain directions and I can always see the influence of various base formulas in my final prescriptions. Sometimes I'll build the formula from scratch without a base, but invariably there are base formulas and key dui yao combinations from famous formulas within the final custom formula.
In order words, I don't always write out a textbook formula and then subtract and add to it, but my thought process is always informed by base formulas and dui yao combinations. I may not write it out, but the inspiration for all the components of the custom formula could be traced to various classical formulas. For example, if I incorporate Bai Shao and Chai Hu together in a prescription, on some level I am thinking of Si Ni San even if those are the only two herbs from Si Ni San that I am using in that particular custom formula. At what point does such a formula no longer become a modification of Si Ni San? It gets hard to draw the line.
When we speak together in English, we constantly string together words to construct a sentence. Each word has its own meaning and nuance, and tends to be used with certain other words, but the use of language is so ingrained that we don't really think about it. You could look at the finished sentence and break it down into nouns, verbs, etc, but to a certain extent all the background knowledge in one's mind becomes internalized. I would always think about pairing herbs like Chai Hu with herbs like Bai Shao, Zhi Shi, Xiang Fu, Sheng Ma, etc, but the reason that those pairs come to mind is because they are exemplified in various classical formulas that are internalized in my mind.
There is absolutely a trend to incorporate herbs based on their pharmacology. In many instances, the traditional formula and the items added based on pharmacology mesh well based on traditional theory. For example, the formula Dan Shen Yin is commonly used in heart disease, and it contains San Qi and Dan Shen, which are themselves often added to other formulas for heart disease based on pharmacology. Here, these two herbs share a blood-quickening action according to traditional medicine, and Shan Zha could be added based on its traditional blood-quickening effect as well. However, Shan Zha is also important in terms of pharmacology, so it might be preferred rather than another herb that quickens the blood such as Tao Ren.
I agree with you that items added based on pharmacology should generally fit the pattern based on traditional diagnosis. But there is no doubt that there is a whole trend of adding in items based on pharmacology, and there is a wide spectrum of approach and perspectives surrounding this issue. Some doctors pay little heed to traditional medicine and add items based on pharmacology extensively, others prescribe based solely on traditional actions and are never influenced by pharmacology. I suspect the majority use pharmacology as a reference but are more comfortable with additions based on pharmacology when these additions match the pattern.
Some items with very clear effects in terms of pharmacology (such as Dan Shen) are added quite commonly in integrative approaches. Modern journal articles have tons of articles that use prescriptions that have been influenced by pharmacology, so it is safe to say that this is a major trend. Chinese medicine is diverse so there will always be some people on both extremes and many people taking a middle ground on issues like this.
Comments are not allowed from anonymous visitors.