herb combinations

[Guest guest]

Roger Wicke and I have been discussing herb combinations. I wanted to

share some thoughts so far.

 

I think it is an important topic. My method of teaching formulation

relies on

using knowledge of established combinations to modify and hone one's

formulas. I use a book called Chinese Materia Medica: Combinations and

Applications by xu and Wang. This book is better than bensky vis a vis

combinations as its combination charts list the treatment principle

being addressed by each combination. However when more than one herb

is combined, it is indeed not always clear what every herb in the combo

is included for. So this could easily led to kneejerk selection of

" classic combos " that include herbs that do not belong. So we are

returned to materia medica study as the only valid basis for choosing

combinations. I can provide numerous examples. The question that gets

begged is whether the classic combinations are useful memory jogs for

experienced px. Your criticisms largely center around the use of such

data as crutches, shortcuts, cookbooks, etc. But that is only true for

the lazy. I believe the expert can use this data to increase

efficiency in clinic as long as all choices are carefully considered.

However it is fraught with risks for students. Arguably, organizing

data like this which is basically extracted from formula and materia

medica study, constitutes a primitive attempt to sort and search the

huge TCM " database " . The problem is not with the sort and search, but

when students and px use this sort and search as some kind of gospel.

So could an expert benefit by easy access to previous sort and searches

of the data (i.e. combination and internal medicine data)

 

Begin forwarded message from Roger:

 

Beginning about 15 years ago, I noticed that students generally

benefited by a case-oriented approach that emphasized developing a

personal learning process in which they boiled down the essence of each

herb's qualities into a sort of nutshell representation inside their

own head, emphasizing understanding rather than rote memorization. I

agonized over the herb combinations that are listed in traditional

texts like Bensky, because I felt a lot of students were using these as

crutches and shortcuts, and worse, memorizing them without

understanding why each combination works the way it does.

 

After years of practice and experience with each herb, I came up with

what I call " herbal action vectors " to summarize numerically the

properties of each herb. These are most definitely not to be

memorized, but I use them in internal calculations to determine the net

effect of a formula, so figured why not display this information in

case others want to use these numbers. That is when I came to the

conclusion that almost all of what are called special " synergistic "

combinations of herbs are not really synergistic or special at all, but

can be explained by simple linear addition of effects. Thus, it's my

belief that the popular synergistic combinations listed in Bensky are

merely examples of combinations that work, and that there is otherwise

nothing special about them, at least in the vast majority of cases.

Most of these herbs are taken from the 90 or so set of most commonly

used Chinese herbs (3-starred herbs in database). I believe this set of

90 is popular mostly because either the herbs are commonly available,

they have the most historical experience to back up their use, and/or

they are especially effective and potent as individual herbs. So if one

needs a formula, one will naturally tend to choose from these set of 90

first, using other less common herbs for more specialized, targeted

actions.

 

For example, of the Qi tonics, Rx Ginseng (or Codonopsis as milder

substitute), Rx Atractylodis Mac., and Glycyrrhizae are the most

commonly used herbs. So when one has Spleen Qi Deficiency, Ginseng is a

bit too rich and can cause Stagnation and Dampness; so can Rx

Glycyrrhizhae. So Rx Atractylodis Mac is a logical choice to pair it

with, because the properties linearly add to balance out the

undesirable Yin-tonic, cloying properties of Rx Ginseng. Then to

counteract the Dampness-inducing properties even more, Poria, another

commonly used herb in the set of 90, is also a logical choice, because

it not only drains Damp, but strengthens Spleen.

 

So instead of giving students a cookbook set of combinations, I show

them how to use the databases to choose logical combinations of herbs,

that in most cases, are the very ones that show up in Bensky's books.

When students had easy access to the cookbook lists of combinations, I

found them automatically using such combinations, even when they did

not make sense. For example, when one has Qi and Yin Deficiency, for

which Sheng Mai San might be an indicated formula, one does not use Rx

Ginseng and Rx Atractylodis Mac. combination because one simply does

not need the latter in this situation. Yet I found students

automatically including it without thinking why it might or might not

be appropriate. By not giving them combinations, which I feel are

redundant anyway, with the exception of true synergisms, I force them

to think.

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

, wrote:

However when more than one herb

> is combined, it is indeed not always clear what every herb in the combo

> is included for. So this could easily led to kneejerk selection of

> " classic combos " that include herbs that do not belong. So we are

> returned to materia medica study as the only valid basis for choosing

> combinations. I can provide numerous examples.

 

 

For example, to support Roger's contention:

 

In the section in yin yang huo in xu and wang, the combination listed is xian

mao, dang

gui, ba ji tian and huang bai. Astute students will recognize the ingredients

of er xian

tang. The function of this combination (including yin yang huo) is described as

supplementing the kidneys and invigorating yang in a case that also includes yin

vacuity

and vacuity fire. However this does not explainthe use of dang gui. Dang gui

harmonizes

the blood. This herbs might be desirable in a given case, but to just add it

because its on

the list shows poor judgement.

 

On gu sui bu, add rou gui, niu xi, bing lang and bu gu zhi for supplementing the

kidneys,

joining sinews and bones indicated for pain and weakness of the lower body. gu

sui bu is

a yang tonic. Why is bing lang necessarily included in this combination? Bu gu

zhi is quite

astringent to diarrhea? should we use it with care in an elderly constipated

patient? There

are so many things to consider when choosing a combination that the lists almost

breed

carelessness. for the same herb under the same subheading, the additionsof shu

di, shan

zhu yu, fu ling, dan pi and ze xie are listed for toothache, tinnitus and

deafness. again,

astute students will recognize liu wei di huang wan. But why are you clearing

heat,

astringing and draining damp? There is no indication in the chart on page 383

of any of

these indications. We know that if there is no need to drain in yin xu, we use

zuo gui yin

instead of liu wei.

 

In many cases, the listed combinations are just some or all of the ingredients

of a classical

formula. Almost all of the combinations in Sionneau's dui yao are pairs used in

numerous

formulas. The value of that book is not that it lists obvious pairs, but that

it details their

dynamics and uses so precisely. Arguably, if one studies materia medica and

formulas in

terms of dynamics and not rote memorization, most " Classical combinations " are

readily

apparent. The lists in books might be good memory jogs for seasoned vets, but

for

novices they may only lead to errors w/o careful thought.