by Z'ev Rosenberg, L. Ac.

One may compare herbal prescribing to calligraphy. Someone may already be quite an expert in using the brush, but his composition of characters is unbalanced; or the form of the characters is complete, but the individual strokes are not accomplished. In all these cases one could not state that this person was an able calligrapher -- Xu Da-chun

Complementary Antagonism in the Art of Prescription Writing
In this article, I would like to concentrate on several prescriptions that use antagonistic yet complementary ingredients to restore equilibrium to the body mind and spirit. These prescriptions combine herbs that are moving (regulating qi and blood, removing stasis) and quiet (restraining and consolidating), supplementing and draining, hot and cold, raising and sinking. They are all taken from the Shang Han Lun /Treatise on Cold Damage and Jin Gui Yao Lue/Prescriptions from the Golden Cabinet by Zhang Zhong-jing.

This text, a companion to the Shang Han Lun and taken from the same original text (the Shang Han Za Bing Lun), takes as its subject matter za bing/miscellaneous disorders. In a modern context, these are primarily complex chronic disorders generated by internal factors such as emotional excesses, stress, and functional disorders, including a wide range of autoimmune and endocrine disorders. Although it is possible that xie qi/pathogenic qi may be a part or origin of these disorders, they have lodged themselves in the viscera, qi, blood and fluids, and as a result are more difficult to treat than early stage traumas or pathogens. Xu Da-chun writes of the Shang Han Lun and Jin Gui Yao Lue the subtleties and mysteries of his doctrine cannot be discussed exhaustively! Although he never applied (in one therapy) more than five or six substances, the effects of his prescriptions were always all-encompassing.

The prescriptions he applied were all based on the Nei Jing. The herbal prescriptions of Zhang Zhong-jing utilize antagonistic ingredients to restore equilibrium to the entire body-mind network. Such prescriptions as Wu mei wan/Fructus Mume Pill Wen jing tang/Warm the Menses Decoction, Gui zhi jia long gu mu li tang/Cinnamon plus Dragon Bone and Oyster Shell Decoction, and Ban xia xie xin tang/Pinella Drain the Heart Decoction all work in this way. They induce a kind of controlled chaos that when introduced into the body as medicine, conduct qi and balance yin and yang. This allows spontaneous order and health to emerge from the chaos of illness. Many patients with chronic disorders will develop combinations of paradoxical symptoms as a result of systemic chaos, such as heat and dryness in the upper jiao, spleen vacuity in the middle jiao, and damp heat or blood stasis in the lower jiao. In order to treat such complex patterns, a formula must be built in layers, to rectify the disharmony and restore equilibrium.

A Discussion of Prescriptions

Gui zhi jia long gu mu li tang/Cinnamon plus Dragon Bone and Oyster Shell Decoction
This prescription, first mentioned in chapter 6, section 8 of the Jin gui yao lue/Prescriptions from the Golden Cabinet, and modified from Gui zhi tang/Cinnamon Twig Decoction in the Shang han lun/Treatise on Cold Damage, is a prime example of how a classical prescription can be completed changed in its focus by adding just two ingredients. Gui zhi tang originally was designed to regulate the ying qi/constructive qi and wei qi/defensive qi, especially by the interaction between gui zhi/rm. Cinnamoni, warm, sweet and pungent, and bai shao/rx. Peony alba, cool sour and moistening. However, by adding long gu/os draconis and mu li/concha ostrae, which are both astringent, sinking medicinals, the action of regulating ying and wei is brought from the yang layers into the yin, deeper layers. This prescription as a result is more deeper acting, regulating the heart and kidney, qi and blood, treating frequent seminal emission, loss of hair, extreme fatigue, feeble pulse.

Gan mai da zao tang/Licorice, Wheat and Jujube Deoction
Originally designed to treat zang zao/visceral agitation, first mentioned in the Shang Han Lun. This prescription contains only three ingredients, da zao/fr. jujube, gan cao/rx. glycyrrhizae and fu xiao mai/sm. triticum (wheat). However, this combination of three ingredients is very effective in treating loss of regulation of the viscera, and emotional distress. Gan mai da zao tang can treat restless sleep, crying spells, melancholia with moaning or sighing, disorientation and loss of control. This combination of herbs, although quite simple is effective in nourishing the yin and qi of heart, liver and spleen. It is very effective for a wide variety of female disorders, including menapausal depression, PMS, post-partum depression, and night sweats.

Suan zao ren tang/Sour Jujube Seed Decoction
This is an example of a compound prescription, composed of common, mild ingredients that have increased potency when combined. This formula is rarely modified, nonetheless it is very potent for insomnia and irritability when caused by liver and heart blood vacuity. The heart/liver blood vacuity leads to a floating hun/ethereal soul and shen/spirit, causing inability to sleep.

Ban xia xie xin tang/Pinellia Drain the Heart Decoction
This prescription is from the Shang Han Lun, and treats a half internal, half external disorder in a patient with stomach vacuity. Rx. Scutellaria and rz. Coptis are bitter and cold, draining stomach heat. Rx. Glycyrrhiza (honey-fried) Rx. Ginseng and Fr. Jujube supplement the spleen and stomach qi. Rz. Pinellia and Rz. Zingiber are pungent and warm, relieving qi stagnation and relieving nausea. These ingredients combine to supplement spleen/stomach vacuity, relieve bloating, nausea and obstruction, and clear heat from the stomach.

Wen Jing Tang/Warm the Menses Decoction
This is a major prescription from Jin Gui Yao Lue for a variety of menstrual, menopausal and post-partum disorders, all beginning from weakening of the chong and ren channels that govern menstruation. There is a mixed pattern of heat symptoms in the upper jiao, including flushing up, dry mouth and lips, and warm hands, and cold vacuity in the lower jiao, including bloating, water retention, irregular uterine bleeding, spotting, and lower abdominal pain from blood stasis. Wen Jing Tang is a multi-level formula, including herbs to warm the yang and abdominal region (fr. evodia, rm. Cinnamon), nourish and regulate the blood (rx. angelica/dang gui, rx. ligusticum chuanxiong, and rx. peony alba, from Si Wu Tang/Four Substance Decoction), supplement qi (rx. ginseng, rx. Glycyrrhiza, and rx. Zingiber, from Li Zhong Wan/Regulate the Middle Pill), and moisten yin to relieve dryness (gelatin/e jiao and ophiopogon). In summation, this prescription will dispel cold, moisten dryness, supplement blood and qi, and dispel blood stasis by regulating the blood. What is most interesting about this prescription is that this pattern is very common, despite its complexity, because of the nature of chronic disorders as they manifest in human beings. Therefore, despite the complex combination of ingredients, this is a very commonly used prescription.

Wu mei wan/Fructus Mume Pill
This prescription appears in clause 338 of the Shang Han Lun, in the section on Jue Yin patterns, with the symptoms of thirst with frequent urination, a feeling of qi ascending upwards from the abdomen, heat and discomfort in the chest, hunger with inability to eat much, and possible vomiting of worms. There is separation of yin and yang, heat in the upper jiao and coldness and vacuity in the lower jiao. The pulse is weak and forceless, and there is weakness and disharmony of both yin and yang qi.

Although originally used for roundworm as a result of deep-lying chronic weakness and illness, this prescription can be used for such modern problems as candidiasis and fungal infections. In China, it is becoming a prominant prescription for the treatment of cancer patients. This prescription is a combination of hot and cold ingredients that regulate the yin and yang, upper and lower jiao, and strengthen the middle while expelling chong/parasites and other pathogenic factors. Fr. Mume controls parasites and alkalizes the stomach and intestines, asarum and zanthoxylum are hot and pungent, warming the yang and expelling parasites. Coptis and phellodendron are cold and bitter, clearing heat from the upper jiao, and dispelling pathogenic factors. Ginseng and dang gui supplement qi and blood, and with ginger, cinnamon and aconite, warm the essential yang, expel cold and restore normal metabolic function.

Conclusion
The prescriptions of venerable Chinese physicians, such as Li Dong-yuen, Zhang Zhong-jing, Hua-to, Sun Si-miao and Zhang Xi-chun, all realized that a wonderful prescription is greater than the sum of its parts. The proper combination and interaction of herbs, based on the timeless principles of Chinese polypharmacy, has a much greater effect than herbs taken individually or combined only on the basis of their symptomatic effects (so-called shotgun formulas). Each herb has qualities composed of its flavor, thermal influence, vector of movement (floating or sinking), channel and organ affinities. There are principles governing the mixing of ingredients in a prescription according to dosage and mutual compatability that must be carefully considered for maximum clinical effect. It would do us well to study and absorb classical prescriptions as thought out by their authors, and apply them appropriately to clinical practice.

Prescription ingredients
1) Gui zhi jia long gu mu li tang/Cinnamon Twig plus Dragon Bone and Oyster Shell Decoction