by Eric Brand

I’ve studied granules for the past several years, scouring libraries and bookstores, talking to experts, visiting factories. By far the majority of granule resources in the Chinese literature are scientific publications (clinical trials and extraction techniques), and clinical handbooks are few and far between. Well, last night I discovered an absolute little gem hiding in Bob’s library here at Blue Poppy, a tiny little pocket-sized paperback written in 1980 by a doctor in Taiwan. This innocuous little book is one of the best examples of a Chinese granule handbook that I have ever seen, and I discovered it completely by accident. The author 許鴻源 Xu Hong-Yuan was born in Taiwan in 1917; he studied in Japan prior to returning to Taiwan, where he spent his life deeply involved in the field of Chinese medicine. Below are a few examples of little gems from his book.

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The book has a brief little introduction wherein the author covers some basic principles of formula modification and historical influences (Jin Gui, Shang Han Lun, Yi Zong Jin Jian, Eight Principles, etc), and he mentions that the dosages used in the book relate to granule powders from Sun Ten (Shun Tian Tang). He also mentions that if raw herbs are used instead of granules, the dosages can be increased six-fold.

Here are a few examples of his formula modifications:

Xiang Su San (Cyperus and Perilla Powder)

Zi Su Ye (Perillae Folium) 1.0 g
Xiang Fu (Cyperi Rhizoma) 3.0
Chen Pi (Citri Reticulatae Pericarpium) 0.8
Gan Cao (Glycyrrhizae Radix) 0.6
Sheng Jiang (Zingiberis Rhizoma Recens) 0.6

The base formula is indicated for common cold with qi depression, as well as rashes due to seafood poisoning. It can be modified as follows:

Add Wu Yao (Linderae Radix) and Gan Jiang (Zingiberis Rhizoma) or Zheng Qi Tian Xiang San (Qi-Righting Lindera and Cyperus Powder) to treat the base pattern in cases that present with pain.

Add Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma), and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to influenza patients with weakness of the stomach and intestines.

Add Bai Zhu (Atractylodis Macrocephalae Rhizoma) 0.6 g and Fu Ling (Poria) 0.6 g for cases with diarrhea.

Add Ban Xia (Pinelliae Rhizoma) 0.8 g for patients with phlegm.

Add Ban Xia (Pinelliae Rhizoma) 0.8 g and Xing Ren (Armeniacae Semen) 0.6 g for incessant coughing.

Add 0.5 g each of Chuan Xiong (Chuanxiong Rhizoma) and Xi Xin (Asari Radix) and 0.4 g of Bai Zhi (Angelicae Dahuricae Radix) for headache.

Add 0.5 g each of Xing Ren (Armeniacae Semen) and Sang Bai Pi (Mori Cortex) for cough.

For another example, let’s look at Shi Quan Da Bu Tang (Perfect Major Supplementation Decoction) modifications:

Shi Quan Da Bu Tang (Perfect Major Supplementation Decoction) 5.8 g

Add Zhi Ke (Aurantii Fructus), Xiang Fu (Cyperi Rhizoma), and Lian Qiao (Forsythiae Fructus) for patients with qi-blood vacuity and swollen ulcerated sores that have not formed pus.

Add Chen Pi (Citri Reticulatae Pericarpium) 0.5 g, Ban Xia (Pinelliae Rhizoma) 0.5 g, and Tian Ma (Gastrodiae Rhizoma) 0.3 g for qi and blood vacuity patterns of dizziness.

Add 0.4 g each of Shan Zhu Yu (Corni Fructus) and Wu Wei Zi (Schisandrae Fructus), and 0.7 g each of Mai Dong (Ophiopogonis Radix) and Shan Yao (Dioscoreae Rhizoma) to treat dream emission or seminal emission.

Remove Huang Qi (Astragali Radix) and add 0.5 g each of Chen Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), and Fang Feng (Saposhnikoviae Radix), and 0.6 g each of Qin Jiao (Gentianae Macrophyllae Radix), Niu Xi (Achyranthis Bidentatae Radix), and Qiang Huo (Notopterygii Rhizoma et Radix) to treat numbness and pain of the extremities.

Add 1.4 g of Chai Hu (Bupleuri Radix) to treat steaming bone.

One interesting feature of this book is the fact that it largely uses single formulas with single herb modifications. The author often recommends the removal of ingredients from the base formula and the addition of other ingredients, which, combined with the way that the formula ingredients are presented with individual doses, suggests that the author builds base formulas from singles instead of exclusively starting with pre-made base formulas. This is atypical of what I now see in Taiwan today, wherein doctors commonly add to pre-made base formulas and often combine multiple formulas together. In the Taiwanese style of prescribing granules, one can usually only add ingredients; subtraction is not possible when an ingredient is already cooked into one of the base formulas.

It is hard to say whether these differences reflect the personal style of the doctor who wrote the book, or whether they were indicative of a wider trend in the Taiwanese granule style 30 years ago. We find a few instances of formulas being used together (for example, Huang Qi Fang Ji Tang plus Wu Ling San for swelling with prominent dampness), but by and large most of the modifications are based on single herb additions. This feature is a bit different than the typical style that one observes today, but the prescribing style of the book still clearly reflects the Taiwanese method. Some of the formulas have many suggested modifications while others have only a few; for example, Si Wu Tang lists 141 modifications! Additionally, the book often recommends a fairly low dose of about 6 + grams per day, which is much lower than the 12-18 gram range that is prevalent in Taiwan today. Whether this is a feature of the doctor’s personal style, the Japanese Kampo influence, or a larger trend is unclear to me.

Truly a great find in the library!