On Specialty Formulas
Xu Lingtai said: every illness must have its principal formula, every formula its principal herb. This is the fruit of his clinical experience — the secret physicians do not teach.
Now people, at the drop of a word, speak of biàn zhèng lùn zhì — boundlessly, so the listener can grasp no center. They have not truly read the TCM canon through; they are stuck at half-knowledge. No wonder, treating illness, they have no settled view, drift further as they turn, change formulas morning to evening, throw cold and heat together, and the result is poor.
Two tendencies now exist in the TCM field: one — neglect pattern-discernment, stress only special formulas and single drugs; the other — stress only pattern-discernment, dispense medicine to whatever pattern. Both lean to one side; neither is right.
I hold: TCM treatment must unite pattern-discernment with special formulas and special drugs. Special formulas and drugs of proven efficacy must be given high attention.
The Song Bureau Formulas (Hejiju Fang) — though heterogeneous in collection and somewhat limiting to medical development by official dosing — played an important part in promoting special formulas and drugs. Today's familiar Zhibao Dan, Xiaoyao San, Suhe Xiang Wan, Huoxiang Zhengqi San all come from the Bureau Formulas.
Beyond this, gathering folk experience is another important route to discovering and organizing special formulas and drugs. If this work is not valued, the precious experience of our medicine will be lost. Special formulas and drugs can lift heavy chronic illness. The ancients' saying "a sea-side formula can shame the famous physician to death" — so the student of medicine must not omit this. The strengths of special formulas and drugs are: (1) effect comes fast; (2) few herbs, cheap; (3) generally simple to use. Effective, cheap, convenient — high value indeed. A few examples to show the importance of special formulas.
Childhood food-damage is most common in clinic. My friend Gao Pinqing once transmitted a formula: for the child with food-damage, inflammation flanking the renzhong below the nose, with two red threadlike streaks hanging down like chive leaves, sometimes with fever, no appetite, or fetid breath. Use hei chouniuzi (black morning-glory seed) and bai chouniuzi (white morning-glory seed) in equal parts, parch them, grind and sift the first powder. Take a pinch with a little brown sugar — stools will turn slightly loose, the red threads vanish at once, the child eats with pleasure, cured. I have used this formula many times, and the effect is as drum to drumstick.
For childhood chronic nephritis: long course, deep illness, face mostly white without blood color, or edema, spirit dispirited. Use cornsilk 30–60 g daily, decocted in place of tea, taken for six months — fair effect.
For crane-knee wind (red, swollen, painful knees, hard to walk): give Yanfang Xinbian's Sishen Jian. Repeatedly effective. The drugs: raw huangqi 240 g, chuan niuxi 90 g, yuanzhi meat 90 g, shihu 120 g — first decoct these four in 10 bowls of water, reducing to 2 bowls; then add jinyinhua 30 g, decoct to 1 bowl, taken at one go. Over the years, my colleagues and I have used this formula many times with effect, more than I can count.
Other examples: for malaria, changshan preparations, Daoyuan Yin; for chest-bi, gualou xiebai preparations; for lung-abscess, Qianjin Weijing Tang; for stomach pain, Xiao Jianzhong Tang — all with good effect.
All these show: special formulas for the disease they target — the effect is real. Tradition has it that Sun Simiao's Qianjin Fang contains 30 secret formulas from the Dragon Palace — the essence of Qianjin Fang. Sun mixed them among the many formulas; later readers cannot tell them apart.
The legend is fanciful, but it speaks to two points: first, the ancients greatly valued formulas of proven efficacy, even regarding them as specific remedies; second, to find the specific formula for a disease, one must, from many formulas, sift out the coarse and keep the fine, screening repeatedly. Only thus does its preciousness become clear. The physician who would advance must put real effort into specific disease, specific formula.
Specific disease, specific formula is medicine's basic thought. The chapters of the Shanghan Lun are all titled "disease — pulse — pattern — treatment." What is disease? What is pattern? Disease is the root, the body. Pattern is the branch, the manifestation. Disease comes first, then pattern. Only by discerning pattern can the disease be recognized; only after recognition can treatment be applied. Each of the six channels has its cardinal pattern, its cardinal formula — the guizhi pattern, the baihu pattern, the chengqi pattern, etc. Whenever this is the pattern, use this drug. So one pattern has one specific formula.
So too in the Jinkui Yaolüe: Baihe disease. The presenting signs vary — and so there are Baihe Zhimu Tang, Baihe Dihuang Tang, Baihe Jizihuang Tang, Huashi Daizhe Tang. But all take baihe preparations as the specific formula. For yin-yang toxin, Shengma Biejia Tang is the specific. For blood-bi, Huangqi Guizhi Wuwu Tang is the specific. Whenever this is the disease, use this drug. So one disease has one specific formula. This method — combining specific formula, specific drug with biàn zhèng lùn zhì — is exactly the foundation of TCM. Otherwise: if disease cannot be identified, how can pattern be recognized; if formula cannot be used, how can treatment be applied? So in studying the classics one must enter the fine; on their spirit, a hair's slip becomes a thousand-mile error. I deeply hope students of TCM will, at every turn, attend to specific formulas — so as not to fail Zhongjing's intent of "broadly gathering many formulas."