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.

Abstract
One classical prescription can be modified to treat a broad range of disease patterns, and historical precedent establishes this as an effective method of treatment. By studying the evolution of a prescription, and its relationship to modified prescriptions, it becomes possible to become conversant in treating a wide range of disorders.

Xu Da-cun, in Yi-xue yuan liu lun/Forgotten Traditions of Ancient Chinese Medicine, divides prescriptions into those for governing or primary treatment (zhu zhi fang) and for general treatment (tong zhi fang). Governing or primary prescriptions treat specific disorders with a limited therapeutic scope, while general prescriptions, despite having a broad therapeutic scope, can also be used for specific disorders, especially when modified. The second category of prescriptions for general use is discussed here, with an emphasis on yin vacuity disorders, to illustrate a rational method of developing new prescriptions for specific treatment.

Jin gui shen qi wan/Golden Cabinet Kidney Qi Pill
The beginning of our study is again in the Jin gui yao lue/Prescriptions from the Golden Cabinet, where this prescription was originally listed. Like the prescriptions listed in part one of this article (wu mei wan/Fructus Mume Pill, ban xia xie xin tang/Pinellia Drain the Heart Decoction, and wen jing tang/Warm the Menses Decoction), this prescription has complementary/antagonistic ingredients to supplement and drain, warm and cool, and ultimately harmonize the kidney system. The ingredients of this prescription are as follows:

hu di huang/rx. rehmannia, prepared 24 g
shan zhu yu/fr. corni 12 g
shan yao/rx. dioscorea 12 g
fu ling/sclerotium poria cocos 9 g
ze xie/rz. alisma plantago 9 g
mu dan pi/rx. moutan (tree peony) 9 g
fu zi/rx. aconite 3 g
rou gui/cx. Cinnamoni 3 g

Jin gui shen qi wan/Golden Cabinet Kidney Qi Pill is the primary prescription for supplementing kidney yang and mingmen fire. It is basically divided into three groups of ingredients. The first group, in the largest dosages, includes the supplementing ingredients rx. rehmannia, fr. corni, and rx. dioscorea, for supplementing kidney yin. The next group, including poria cocos, rz. alisma, and rx. moutan, drain excess moisture and vacuity heat. The final group has two ingredients, in the smallest dosage, supplement kidney yang and mingmen fire. The principle of this prescription is to supplement yang within the yin. When supplementing kidney yang or mingmen fire, one must first and primarily supplement the yin to avoid overactivating mingmen fire, which can easily overheat and overstimulate the body, leading to an overall exhaustion and depletion. Therefore, the yang supplementing ingredients are used in small doses. About this prescription, the famous Ming dynasty physician Li Shi-zhen wrote the following: When the ancient physicians used supplementing herbs they necessarily combined them with herbs that drain the pathogenic influences. When the pathogenic influences are removed, the supplementing herbs gain in strength. The draining ingredients such as rz. alisma guide the kidney yang supplementing medicinals (rx. aconite and cx. cinnamon) into the kidney channel. This prescription treats basic patterns of kidney yang vacuity, with pale swollen tongue, thin, forceless pulse, and coldness in the lower part of the body (below the navel, lower back, lower extremities).

Prescriptions from the Golden Cabinet was written in the Han Dynasty approximately 1700 years ago. However, the most famous modification of this prescription (Golden Cabinet Kidney Qi Pill), liu wei di huang wan/Rehmannia Six Flavor Pill was written much later, in 1119 C.E. by Qian Yi, a Song dynasty physician. He wrote one of the first and most essential pediatric texts, Xiao er yao zheng zhi jue/Craft of Medicinal Treatment for Childhood Disease Patterns. The prescriptions in this text follow the criteria of Zhang Zhong-jing in using few, carefully chosen ingredients, mild in effect. Qian yi taught that children's viscera were delicate and immature, therefore harsh medicinals should not be used in their treatment. He was true to principle when he modified the Golden Cabinet Kidney Qi Pill by eliminating rx. aconite and cx. cinnamon, which were too harsh for children. In doing so, he initiated the famous prescription, liu wei di huang wan/Rehmannia Six Flavor Pill, still the most popular prescription for supplementing kidney yin. This prescription treats basic kidney yin vacuity with heat, with red tongue, thin rapid pulse, wasting thirst (diabetic disorder), night sweats, nocturnal emissions, light-headedness, and irritability.

Another great physician who modified both Golden Cabinet Kidney Qi Pill and Rehmannia Six Flavor Pill was Zhang Jing-yue, sometimes known as Rehmannia Zhang. His most famous saying is that one should use the implications of the six flavors, but do not use the six flavor prescription itself. He came up with two modifications of each prescription in his famous text, Jing-yue quan shu/Collected Treatises of Jing-yue, written in 1624. He eliminated the draining ingredients, except for fu ling/sclerotium poria cocos, and added additional supplementing ingredients to increase the supplement action of the prescriptions. His primary modification of Rehmannia Six Flavor Pill is zuo gui yin/Restore the Left Decoction. It eliminates rx. moutan and rz. alisma, and adds zhi gan cao/rx. glycyrrhiza, prepared, to supplement qi and fluid, and gou qi zi/fr. lycii, to nourish liver and kidney yin. This prescription treats more severe kidney yin depletion, with thin rapid pulse, shiny peeled red tongue, night sweats, thirst, dry mouth and throat, and low back soreness.

Dr. Zhang also modified jin gui shen qi wan/Golden Cabinet Kidney Qi Pill into you gui yin/Restore the Right Decoction and you gui wan/Restore the Right Pill. He based his modifications on the same principle of removing the main draining ingredients and adding more yang supplementing ingredients to make the prescription stronger. To Restore the Right Pill, he added lu jiao jiao/colla cornu cervi, tu si zi/sm. Cuscuta, gou qi zi/fr. lycii, du zhong/cx. eucommia, and dang gui/rx. angelica sinensis to strengthen qi, yang and blood, and to Restore the Right Decoction, zhi gan cao/rx. glycyrrhiza, prepared, gou qi zi/fr. lycii, and du zhong/cx. eucommia. These prescriptions treat more severe kidney yang depletion, with exhaustion, coldness, loose stool, edema and sore lower back and lower extremities. They also supplement jing/essence as well as yang.

Now we return to Rehmannia Six Flavor Pill. There are several modifications to this prescription that treat more specific patterns. The first is zhi bai di huang wan/Anemerrhena and Phellodendron Rehmannia Pill. By adding zhi mu/rx anemerrhena and huang bai/cx. phellodendron, this prescription treats more vigorous vacuity fire with severe night sweats, lower back pain, damp heat disorders, urinary tract or vaginal infections. Next we have qi ju di huang wan/Lycium, Chrysanthemum and Rehmannia Pill, which adds gou qi zi/fr. lycii and ju hua/fl. Chrysanthemum for joint liver/kidney yin vacuity, especially useful for opthomological disorders such as blurry vision, and red or painful eyes. Ba xian chang shu wan/Eight Immortal Pill for Longevity adds wu wei zi/fr. schizandra and mai men dong/tuber ophiopogon, and treats lung/kidney vacuity with cough, afternoon fever, and chronic lung disorders.

There are several other modifications in the literature for rehmannia prescriptions. Other closely related prescriptions include da bu yin wan/Great Tonify the Yin Pill, designed by Zhu Dan-xi for severe liver/kidney yin vacuity with damage to jing/essence, tian wang bu xin dan/Celestial Emperor's Heart Supplementing Elixir for heart/kidney yin vacuity, and ming mu di huang wan/Improve Vision Rehmannia Pill for ophthalmological disorders.

This section of the article deals with a family tree of prescriptions, a way of learning a group of closely related prescriptions to treat a wide variety of disorders. The third and last section of this article will discuss the methods of Zhu Dan-xi and Li Dong-yuan in designing prescriptions.

 

Z'ev Rosenberg, L.Ac., Dipl. Ac. has been practicing Chinese medicine for seventeen years. He is trained in both Chinese and Western Herbal medicine, and is the Chairman of the Department of Herbal Medicine at Pacific College of Oriental Medicine. He is currently working on a book Healing the Broken Vessel and is associate editor of Oriental Medicine, and a contributing writer to Protocol Journal of Botanical Medicine and Journal of Oriental Medicine. He is also a product consultant and formulator at K'an Herb Company.