Chinese Herbs Graphic Methods for Formula Modifications

1. Modification of herbs:

When the main symptoms of a syndrome remain constant, but the secondary symptoms don't fit the specific picture presented for the usual use of a formula, changes in the secondary herbs can be made to better treat the individual symptoms of the patient. Changes are made only to the secondary herbs, never to the King herbs. New herbs can be added to a formula and/or the original herbs can be taken away.

For example: Si Jun Zi Tang is for Spleen/Stomach Qi deficiency. If the patient also has Qi stagnation, Chen Pi can be added to regulate the Qi. It is then named Yi Gong San. If the patient also has phlegm damp, Chen Pi and Ban Xia can be added to regulate Qi and resolve phlegm damp. Then this formula becomes Liu Jun Zi Tang.

Gui Zhi Tang is for wind cold attack due to an exterior deficiency (of wei Qi). If the patient also has a cough or asthma, Hou Po and Xing Ren can be added to lower the adverse flow of Qi and relieve asthma. It is then named Gui Zhi Jia Hou Po Xing Zi Tang. If the patient has accompanying symptoms such as a sensation of fullness in the chest which demonstrates that the chest Yang has been blocked, Bai Shao with its sour, cool, yin/soft natures should be excluded from the formula. With this modification, the formula becomes Gui Zhi Qu Shao Yao Tang. If the patient has the symptoms of an oppressing sensation in the chest and slight cold which indicates that the Yang Qi has been seriously impaired, Shao Yao should be excluded from the formula and Fu Zi should be added so as to warm the channels to ensure the flow of Yang Qi.

2. Modification of dosages:

This refers to increasing or decreasing the dosage of an herb in a formula without any change in its ingredients. This method can either change the potency of the original prescription or extend the scope of the treatment. Sometimes the primary and secondary roles of the herbs in a formula may be changed so as to suit them to new indications.

For example:

Zhi Gan CaoFu ZiGan Jiang
Si Ni Tang6 g5-10 g5 g
Tang Mai Si Ni Tang6 g15 g10g

Si Ni Tang is for Yang (Kid, Ht, Sp) deficiency marked by diarrhea with indigestion, vomiting, chills, cold limbs, body aches, deep thready week pulse.

Tang Mai Si Ni Tang is for diarrhea with undigested food. Cold limbs, no chills, flush face, very deep and faint pulse. Severe Yang deficiency with false heat (Yin cold is so overly strong that the Yang separates from it and floats to the exterior.) Gui Zhi Jia Shao Yao Tang is a modified version of the original formula: Gui Zhi Tang. Plus, it has a double dosage of Shao Yao which extends its scope of treatment to a certain degree. It's indicated for Gui Zhi Tang syndromes accompanied by fullness and pain in the abdomen.

3. Modification of the form of administration

This means that the same formula can produce different effects based on its form of administration. Pills or powders are of slow-acting and have lasting effects; decoction is for speedy and drastic effects.

For example, Li Zhong Wan (Tang) is used for Spleen Yang Deficiency, but if the condition of the illness is mild and chronic, the pill is preferable. If the case is serious and acute. It is better to take the decoction instead.

The above mentioned three modifications of formulas can either be applied separately or be made simultaneously. Clinically it depends on the specific condition of the patient's illness.


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