Guest guest Posted May 9, 2004 Report Share Posted May 9, 2004 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: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2004 Report Share Posted May 10, 2004 , 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. Quote Link to comment Share on other sites More sharing options...
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