Classic Formulae of Traditional Chinese Medicine
In this section, the formulae are listed according to their general actions on the body. For each category, a brief introduction about the basic concepts, clinical applications and contradictions are provided. Each formula will have it name given in both English and Chinese, the list of herbal ingredients and indications for use.
1. Exterior-relieving formulae
These formulae treat disharmonies in the superficial portion of the body through the actions of inducing sweating, releasing muscles or promoting eruption. In TCM, the body surface forms the first barrier against the invasion of exogenous pathogens, and is dominated by the lung and bladder meridians. When exogenous pathogens first attack the body, a so called "the exterior syndrome" appears which is characterized by chills, fever, headache, generalized aching and a floating pulse. TCM's strategy is to dispel the pathogens from the exterior and prevent it going deeper into the body.
In the formulae, the main ingredients are pungent-spicy in flavor, which cause sweating and release the exterior. Some of the herbs have additional effects including promoting the lung's dispersing function and strengthening water metabolism, thus they can also treat edema, cough, asthma, joint pain, the early stage of measles, skin infections, dysentery and some infectious diseases.
The formulae should be prescribed carefully for the elderly, pregnant women and other weak conditions, as they can easily lead to exhaustion of yang-qi and body fluids.
2. Purgative formulae
These formulae break down the interior accumulations through vigorous evacuation of the bowels. In TCM, purgation therapy is not only used as laxatives for relieving intestinal stagnancy, but also for removing heat, fire, toxins and even retained fluids. Individuals usually present with fullness, distention and pain in the gastric and abdominal regions, constipation, poor appetite and a thick tongue coating.
In the formulae, the main ingredients stimulate or lubricate the large intestine to promote bowel movement. With the exception of those moistening and lubricating formulae, they generally have a drastic effect and can easily damage stomach functioning and drain excessive body fluids. The purgative formulae should be stopped once they take effect; these cannot be used for long-term consumption and have to be carefully used in the weakened individuals. The formulae should also not be used when there is an exterior syndrome. Greasy or foods that difficult to digest should not be eaten while taking these formulae.
3. Digestive formulae
These formulae promote digestion and remove food retention. Improper diet damages the digestive system (in the middle burner) leading to symptoms such as distention and fullness in the gastric and abdominal regions, poor appetite, bad breath, belching, nausea, thick and greasy tongue fur, loose bowels and sometimes diarrhea.
In the formulae, common active ingredients include hawthorn fruit, medicated leaven, malt, sprouted grain, radish seed and chicken gizzard skin. Among them, hawthorn fruit relieves indigestion caused by over-consumption of meat and greasy foods; medicated leaven, malt and sprouted grain assist in digesting grainy foods such as bread, noodles or rice; radish seed and immature bitter orange ease focal fullness and distention; when food retention is really severe, herbs like pharbitis seed, Chinese rhubarb and areca seed are added to achieve a laxative effect.
4. Harmonizing formulae
These formulae mediate or regulate the physiological functions needed so as to achieve in a new balanced condition, which involve complex processes in different levels of the body. They are usually used in Shao Yang diseases, disharmonies between the liver and spleen, and gastrointestinal problems.
Shao Yang diseases refers to conditions due to unrelieved exterior syndromes that have transmitted into the interior; the pathological changes are neither on the exterior nor in the interior but stays in between. Areas like the liver, gallbladder, spleen and stomach are affected, with symptoms such as a bitter taste in mouth, dry throat, blurred version, alternating chills and fever, poor appetite, chest fullness and nausea. On examination, a white tongue coating and taut pulse is present. TCM believes that there are kind of health problems that cannot be solved by therapies like reducing or tonifying alone, but need to carry out both to smooth the disharmony between the damaged organs or functions, and are therefore indicated for harmonizing formulae
Although the harmonizing formulae have gentle properties that only can mildly expel pathogens as well as rectify deviated functions, they should still be prescribed according to specific indications.
5. Heat-clearing formulae
These formulae treat various heat syndromes through the actions of clearing away heat, draining fire, cooling blood, eliminating the associated toxicity and nourishing the body. TCM believes that heat accumulation can originate both internally and externally; factors like exogenous invasion, emotional stimulation, over exhaustion of fundamental substances all can contribute to it. Heat syndromes present in wildly different clinical manifestations, physicians will specifically identify its source (exogenous pathogen, toxin or endogenous factor), severity of heat signs (fire, heat or warmth), location (which circulation or organ), and to decide in the specific strategy to be used. Typical heat signs include high fever, profuse sweating, a surging pulse, excessive thirst, bleeding, altered consciousness and ulcerated skin sores.
In these formulae, herbs with cool and cold properties are used as the main ingredients. As they can easily lead to digestive damage, and thus should be used carefully for individuals who already have weakened spleen and stomach systems. Furthermore, preserving yin and body fluids is another important guideline for the treatment of heat syndromes.
6. Interior-warming formulae
These formulae warm the interior and unblock the meridians to eliminate cold evils inside the body so normal function of yang-qi can be resumed. When there is inadequate yang-qi or if cold evils attack, the internal body, the organs and their meridians will lack promotion and warmth, which leads to overall under-functioning. Symptoms include chills, fatigue, gastric discomfort, increased urine output, loose bowels; the pulse is also deep and slow.
Since cold influences affect different parts of the body, warming formulae are designed with different strategies in mind. Generally, cold evils tend to attack the middle burner, so formulae for warming the middle burner (the region usually refers to the spleen and stomach) are frequently used. For relatively superficial conditions such as coldness and pain in the limbs, the TCM strategy is to warm the meridians and disperse the coldness. On the other hand, when the body is seriously depleted in yang-qi, the TCM strategy is to revive yang in the kidney and heart.
For this category of formulae, most of the main ingredients are pungent in flavor and have hot and dry natures. They should therefore be used with caution in cases of yin deficiency or blood loss.
7. Tonic formulae
These formulae enrich, augment, nourish or replenish the qi, blood, yin and yang of the body when they are deficient or weak. In TCM, deficient conditions usually result where the body has developed a depletion of fundamental substances or insufficient life force. TCM tonification methods are used to overcome a particular deficiency inside the body. As conditions can vary according to the cause, degree of severity, and organs involved, tonic formulae are categorized in five types: tonify the qi, tonify the blood, tonify both qi and blood, tonify yin and tonify yang. It is important to first address the underlying deficiency before applying the appropriate tonic in order to obtain the maximum benefit.
8. Astringent formulae
These formulae arrest abnormal discharge or leakage of fluids and other substances from the body, such as sweat, sputum, blood, urine, stool, sperm and vaginal discharges. In TCM, qi, blood and body fluids are precious substances for normal life activities and excessive draining of the body's fundamental substances will substantially affect health. If a profound deficiency or weakness inside the body exists, they need immediate intervention. The TCM strategy is to stabilize or tone the weakened processes with an astringent substance. Based on the specific effects of the formulae, they are further divided into: consolidating the exterior (arrest sweating), astringing the lung (stop cough and throat secretions), stabilizing the intestines (stop diarrhea and prevent anal prolapse), stabilizing the kidney (arrest emission and urinary incontinence), and stabilizing the womb (for uterine bleeding and vaginal discharges). In fact, astringent therapy can only provide temporary relief, so tonification therapy alongside astringent therapy is necessary for a complete cure.
It should be noted that astringent formulae are only used for weakened conditions of the body itself. When the discharge processes are forced out by particular pathogens, such as profuse sweating in febrile disease, cough by phlegm retention, diarrhea caused by an improper diet, or excessive menses due to blood heat, then these formulae are contraindicated.
9. Calming formulae
These formulae relieve mental tension and uneasiness and are similar to tranquilizers in Western medicine. TCM believes that disturbances of the spirit are closely related to functional disorders in and among the organs, particularly in the heart, liver and kidney, thus, the therapeutic strategy for such problems is to regulate the functions of the organs. Generally, there are two kinds of approaches to treatment. For conditions that present with anxiety, forgetfulness, disorientation and insomnia, the formulae will focus on nourishing and enriching the blood and yin; for symptoms such as feeling overstressed, manic behavior, bad temper and agitation, then the formulae will focus on calming the spirit with "heavy" substances. However, disorders of the spirit may also occur in specific circumstances such as in the presence of heat exuberance, phlegm obscuring the orifices in the head and blood stasis. In such cases, other therapies (heat clearing, tonification or blood regulation) should be used in combination.
It should be noted that psychological factors play an important role in disorders of the spirit and must therefore be considered during treatment. Some of the calming formulae are comprised minerals, metals and stones as main ingredients; they are toxic and can easily damage the stomach. These formulae are not suitable for long-term administration, especially for those who have a weak spleen and stomach.
10. Orifice-opening formulae
Loss of consciousness, delirium, epilepsy and convulsions are referred as closed conditions of the sensory orifices. TCM aims at using aromatic substances to re-open the sensory orifices for treatment of these conditions, samples of aromatic substances are musk, borneol, bezoar gall stone and benzoin. The orifice-opening formulae are usually used in conditions associated with heat toxin sinking into the pericardium or turbid phlegm misting the heart, individuals should have specific manifestations such as unconsciousness, clenched jaw and fists, rigid limbs, rapid respiration and a forceful pulse. These formulae are only used for treating acute symptoms for a short period of time. Long-term administration may lead to exhaustion of genuine-qi. This category of formulae is usually prepared as pills, powders or liquids for injection to facilitate emergency use.
11. Qi-regulating formulae
In TCM theory, qi is the vital substance constituting the body. When pathological change occurs in whatever region, organ or meridian of the body, it will always initially affect the flow of qi. This category of formulae treats disorders related to qi flow, which includes moving qi to relieve stagnation, and sending qi downward to treat a reverse flow of qi.
TCM believes that disorder of qi flow can be seen in a wide range of clinical conditions. Qi stagnation is characterized with fullness, pain that accompanied by a distending sensation, and a preference for belching or breaking wind. For conditions of reverse flow of qi, physicians can identify particular symptoms according to the involved location, such as coughing and shortness of breath in the lung; gastric pain, belching and abnormal bowel movements in the spleen and stomach; and menstrual problems in the liver. The approach of sending qi downwards is usually for treating problems like vomiting, hiccups, belching, and some forms of coughing or wheezing.
The ingredients in these formulae are usually pungent, warm and drying in property, which tends to consume the body fluids and qi when improper use.
12. Blood-regulating formulae
In TCM, blood is viewed simply as the red fluid inside the blood vessels that provides nutrition and lubrication for the body. This category of formulae treats disorders related to blood flow and involve relieving blood stasis and arresting bleeding.
Bleeding problems like nosebleeds, vomiting of blood, blood in the stools, bloody urine, excessive menses, uterine bleeding or traumatic bleeding are associated with injuries, reckless movement of hot blood, blood and qi dysfunctions. Blood stasis refers to general or localized stagnated blood circulation, which are characterized by stabbing pain, cyanosis, swelling, bleeding (dark purplish blood with clotting), dark complexion and a purplish tongue with blood spots. These formulae are prescribed according to organ involved, special pathogenic influences (cold, heat, dampness and deficiency), damaged location, and whether the disorder is acute or chronic.
13. Dampness-dispelling formulae
Dampness is a heavy, sluggish pathogen that leads to disorders processing slowly and lingering inside the body. When it invades the body, it leads to sluggishness, tiredness, heavy limbs, a feeling of distention in the head, stiffness and pain in the joints, or limb puffiness. Any bodily discharge will tend to be sticky and turbid and the tongue will have a sticky coat. Entry of the pathogen originates in two ways, one is externally contracted from the living environment and the other is transformed by an impaired spleen caused by an improper diet or emotional upset. Furthermore, disturbances in water metabolism can also lead to dampness disorders which cause edema, urinary difficulty and respiratory symptoms.
TCM strategies for dispelling dampness include drying, excreting, facilitating urination and purgation. These formulae are mainly composed of pungent, aromatic, warm substances that dry the dampness or sweat and bland substances that leach out dampness. They should be used carefully in those suffering from body fluid exhaustion, weakness after illness and in pregnant women.
14. Phlegm-resolving formulae
In TCM, a disharmony of body fluids can produce either external visible phlegm, such as sputum secreted by the respiratory tract, or internal invisible phlegm. Internal phlegm is usually formed by dysfunction of the lungs and the spleen, and occasionally by the consumption of body fluids by fire and heat evils. Formation of phlegm causes further pathology, and is responsible for the occurrence and development of a range of disorders, such as coughing, wheezing, nausea, dizziness or vertigo, nodules or lumps, and seizures. TCM strategies for treating phlegm disorders vary in accordance with the nature of its pathogenesis. Besides resolving the phlegm, the formulae also aim at improving the functions of the spleen, kidneys, lung and liver so as to prevent transformation of internal phlegm.
15. Wind-eliminating formulae
Wind evil is considered a yang pathogen and it has influential effects. Characteristic conditions involving wind disharmonies are sudden onset and a lingering and changeable nature. It often combines with other pathogenic factors especially coldness to invade the body. Externally contracted wind disorders often attack the body surface, muscles, bones, tendons, joints and meridians and thus lead to headache, itching, skin rash, numbness, spasms, and movement difficulty in the joints. Wind generated internally is usually attributed to liver and kidney dysfunctions, and the conditions are characterized by dizziness, vertigo, tremors, convulsions, loss of muscle tone, difficulty in speaking, sudden loss of consciousness, facial distortion and paralysis. TCM formulae for treating conditions involving wind are divided into expelling exogenous wind and stopping endogenous wind.
16. Dryness-moistening formulae
The dryness evil tends to consume body fluid and causes fluid loss symptoms such as dry wrinkled or withered skin, dry hair and scalp, dry mouth and cracked lips, dry and hard stools. TCM classifies the symptoms involving dryness into external and internal sources. Externally contracted dryness tends to impair the lung and deplete the body fluids and the associated symptoms are headache, cough, throat soreness and secretions, thirst and pant. Internal dryness, which usually involves the lung, spleen, kidneys and large intestine, is due to loss of the organs' essence or fluid depletion. TCM strategies involve enhancing the lung to disperse dryness in external cases, while nourishing the yin and enhancing fluid production in internal cases.
These formulae should be used with caution by individuals with a damp constitution.
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