An informational Analysis of the
Principles of Chinese Herbal Formlation
Part Three
The Principles of Chinese Herbal Formulation

E. F. Block
August 2010


Early workers in herbal medicine in the region of the World in what is now known as China discovered that combining herbal substances yielded more beneficial results in treating disease than in using them individually. The "Prescriptions for Fifty-Two Kinds of Disease", the oldest known recorded work (3rd century BCE) documenting the use of herbal substances, includes 280 formulas for the 52 listed diseases. Work on expanding knowledge and the creation of more effective formulas continued in China and continues to evolve today. The author has by no means exhausted looking at the books available for Western Herbal Medicine. However, it is true that the only formulae that have been encountered in the literature search are those composed as drinks or food dishes. None have been available for medicinal prescription. Even more astonishing is the fact that no information is alluded to for principles of compounding Western herbs into formulae. It is this lack of conceptualization in the Western herbal practice that is being directly addressed with this work.

Many types of formulae have been stated but today most works dealing with Chinese herbal medicine (CHM) list 18 to 21 categories based upon addressing a set of signs and symptoms, much like that with the materia medica. It is important to note that successful treatment requires an accurate differential diagnosis, a comprehensive treatment plan and effective herbal formulae. The signs and symptoms displayed by the patient are a reflection of the physiology and biochemistry that has been altered from normal functional parameters. We understand that this is the result of disharmony in the HBF according to the principles of IM. Consequently, most acute therapy is geared to relieving the symptoms and not the cause of the disharmony. The treatment of chronic disease must do both; treat the signs and symptoms as well as the cause of the disharmony. Thus, medical diagnosis and treatment must take into account both the cause of the disharmony as it affects the HBF and the pathogenic agent. As the patient goes through as series of stages in the progress of the disease and an eventual return to normalcy, the prescribed treatment will need to reflect these changes. Many formulas that are first prescribed deal with the elimination of the pathogen while later formulas assist the body in clearing the residual debris left in the wake of the disease.


Every Chinese herbal formula has four main components that play an essential function within the formula. The chief herb is used to address the direct cause of the disease or its main symptom. This is the essential ingredient of the formula and is used in a large dose to maximize the desired effect. The deputy herb has two functions: it reinforces the effect of the chief herb to treat the main disease/symptom and it treats the associated or co-existing disease/symptom. The assistant herb has three functions: it reinforces the effect of the chief herb or directly treats the secondary symptoms, it counteracts any toxicity of the chief herb or minimizes the drastic effects of the chief herb/deputy herb, or has the opposite effect as, but works in synergy with, the chief herb in order to treat the most complex and serious disorders. The last component is the envoy herb. The envoy herb has two functions: it acts as the channel-guiding herb to direct the formula to the affected channel/areas of the body and it harmonizes all of the herbs within the formula. It is usually used in only small doses.

The dosage of the formula is dependent upon the severity and the time-span of the disease within the body (HBF). However, one needs to be aware of the Arndt-Schultz Rule that states the too large a dose has the opposite of the desired affect. This is why that person with whom you are practicing your skills is indeed your patient in that they need to be patient while you get their treatment protocol correct! And again, the formula that you prescribe now may not be the same one that you prescribe tomorrow.

The chief herb is the most important component of a formula. In general, every formula has only one or 2 chief herbs used in higher dosage to treat the main symptom or disease. The other supporting herbs are used with lesser dosages. The deputy, assistant and envoy herbs are used flexibly according to the condition of the patient. It is not necessary to use all four components; again usage depends upon the complexity of the disease conditions. Also, when the chief herb enters the correct M/C for the disease at hand, it is not necessary to add an envoy herb.

It is very important to follow the guidelines when composing an herbal formula. The individual conditions of the patient will dictate the herbs chosen. Additional consideration must also be given to the age, body weight, clinical presentations and underlying constitution of the patient. Ingredients, doses and dosage forms should be adjusted to optimize treatment results. Herbal formulae are usually given in the form of a decoction but also powders and pills are prescribed or perhaps a medicinal wine.

Concepts of Traditional Chinese Medicine

At this time it is advisable to address some of the wordage used in CHM as part of Traditional Chinese Medicine (TCM). More information concerning the below topics may be found here and the following two articles of the total set of three articles.

The TCM Concept of Yin - Yang

Yin is ultimately derived from the Earth. Yang is ultimately derived from the Sun. These are two polar opposites with gradations of each between. This is a concept only and has no physical objective reality! They do however represent a relationship that seems to be everywhere in nature, different and opposite aspects of the same phenomenon. One example is the alternation between night and day. In TCM, yin relates to the physical structure of matter and the body while yang relates to qi and its distribution. The Yin organs (lungs, heart, liver, kidneys, spleen, pericardium) are solid (inside the body proper) while the yang organs are hollow (stomach, small intestine, large intestine, gallbladder, urinary bladder, three bowls or body cavities) and deal with food processing and waste elimination.

The TCM Concept of the Five Elements

All phenomena in Chinese philosophy are classified according to five elements: wood, fire, earth, metal (air), water. The movement of qi within the M/C system is coordinated with the progression of qi moving from wood to fire to earth to metal to water to wood and so forth over and over. "The Law of Movement of the Five Elements" manifests in the following manner: inter-promoting, interacting, overacting, counteracting and mutual relation between that which comes before with that which comes after.

The TCM Concept of Qi

Universal qi is the energy of the environment. In TCM, qi refers to the essential substance of the body that maintains vital & functional activities. Qi is differentiated by source, function and distribution. Congenital qi is inherited from the parents. Clean qi is gathered from the air by the lungs to become chest qi. Nutrient qi is obtained from food. Defensive qi comes from the core of the body. Congenital qi is given while the rest are obtained from the air and food as Acquired qi. Defensive qi protects the surface of the body from exterior pathogens.

The TCM Concept of the Meridians/Channels (M/C)

The M/C system is responsible for the circulation & distribution of qi and blood to all areas of the body extending from the inner core to the most superficial aspects. There are 3 courses of 2 pairs of yin/yang related meridians for a total of 12 main channels that are also related to the major yin/yang organs of the body. Movement of qi within the M/C system is from the core of the body to the hand, from the hand to the head, from the head to the feet and from the feet to the core. Each round passes through the organs each M/C is related, as an example, the Lung meridian through the Lungs and an accessory to the Large Intestine. The five zang (yin & solid) and six fu (yang & hollow) organs, four limbs, nine orifices, skin muscles, vessels, and tendons, although having their respective physiological functions, also maintain the harmonization and uniqueness of interior, exterior, upper, and lower parts of the body as a united and organic entity. This interconnection and organic combination relies upon the function of the channels and collaterals system.

When pathogenic factors invade the skin and the pores are open they enter the collaterals. When the collaterals become full, the pathogenic factors will move into the channels. When the channels are full, the pathogenic factors transmit to and reside in the zang and fu organs. The interior and exterior, upper and lower parts of the body form an integrated entity through the connecting network of channels and collaterals. So under pathological conditions every part of the body will affect the rest of the body via the channels and collaterals. The channels and collaterals are not only the passages of disease transmission, but can also reflect pathological changes. The diseases of the zang-fu organs can be reflected on the body surface, especially in certain areas or at certain points, through the transmission of disharmonious energy by the channels and collaterals. Treatments using traditional medicinal herbs are based on their main actions through the related zang-fu organs and channels. The yin organs are internal while the yang organs deal with digestion and waste elimination.

The TCM Concept of Etiology & Pathogenesis

Many factors may cause disease and they are in general the six exogenous factors, the seven emotions, improper diet, overstrain, stress, lack of physical exercise, traumatic injury, bites of animals & insects, plant poisons, stagnant Qi/Blood and Phlegm fluid. The six exogenous factors are wind, cold, heat (fire), summer heat, damp and dryness. The seven emotions are excessive joy, anger, melancholy, worry, grief, fear and fright. Stagnant blood refers to impaired blood circulation due to coldness, deficiency or stagnation of qi. Phlegm fluid refers to the accumulation of copious thick exudates due to the dysfunction of the lungs, spleen or kidney and the resulting impairment of water metabolism.

In TCM, pathogenesis is the result of the disharmony between those systems tasked with maintaining rheostasis (a technically more correct word than homeostasis) within the body due to the invasion of a pathogenic influence. There will be a shift in the yin/yang balance within the body, a shift in the overall HBF. Also, there will be a concomitant reaction of the bodily defenses to the invasion, whether due to a disharmonious energy or an organism. The result is a disruption in the normal course of circulation of qi within the body and the HBF.

The TCM Concept of the Four Polar Opposites

In TCM, there are 4 sets of polar opposites with a sliding range of conditions in between:

  1. Exterior - Interior
  2. Cold - Heat
  3. Deficiency - Excess
  4. Yin - Yang

All of CHM is utilized in order to return the metabolism and physiology of the body to normal parameters. Each person is different due to genetics and resulting constitution. Thus, a comprehensive intake is made to determine the norm for each individual. In China, the doctor is paid to keep a person healthy and thus usually knows each person very well. The differential diagnosis is couched in relation of the above terms and will be stated in a combination of the relevant terms.

Exterior refers to pathological conditions that result from the invasion of the superficial portion of the body by exogenous pathologic factors. Internal refers to the pathological conditions due to the transmission of exogenous factors to the interior of the body that affect the physiology and metabolism of the organ systems of the body and the normal flow of qi.

Cold refers to exposure to exogenous cold or a deficiency in the yang determining systems in the interior of the body. Heat refers to the opposite with invasion of exogenous heat or a deficiency of yin determining systems.

Excess refers to the fact that some body system is in a state of overproduction and thus deficiency is that some body system is in a state of underproduction. Tonicity refers to a state of muscle contraction and should not be used to denote a strengthening by "tonifying"; you are not able to tonify a deficient condition!

Please remember that yin/yang do not denote a physical reality. The relative balance of yin determining systems of the body and the yang determining systems of the body is reflected in rheostasis. Rheostasis is an oscillation around a neuro-physiologically determined set point. Yin/yang determining systems are always engaged in a balancing act that never quite reaches perfection and hence the oscillation.

Levels of Disease Penetration into the Interior

  1. Energy/Qi Level - interior heat diseases where the pathogen affects the organs
  2. Nutritive/Yin Level - more sever where the pathogen severely curtails yin systems and causes disturbances of the consciousness
  3. Blood Level - even more severe where the pathogen now also affects the blood

The Herbal Formulae

The following is the schema for herbal formulae:

  1. Exterior-Releasing Formulae - formulae that treat the early stages of disease
    • Acrid & Warm Exterior-Releasing Formulae - these formulae treat exterior symptoms that are caused by the exterior factors of wind, heat, summer-heat, dampness and dryness
    • Acrid & Cold Exterior-Releasing Formulae - these formulae treat exterior symptoms that are caused by the exterior factors of wind, cold, dampness and dryness
    • Supporting the Upright & Releasing the Exterior Formulae - these formulae treat exterior symptoms that are caused by the exterior factors and strengthen the body at the same time
  2. Downward Draining Formulae - used to break-up and expel acummulations of heat, cold or fluids in the interior
    • Cold Purgatives - these formulae eliminate interior excess conditions due to heat stagnation or accumulation
    • Warm Purgatives - these formulae address interior cold symptoms.
    • Moist Laxatives - moist laxative formulae treat constipation due to heat & dryness in the intestines
    • Harsh Expellants - these formulae treat excess conditions involving the interior accumulation of heat and water via defecation and urination
    • Purgative and Strengthening - these formulae treat constipation that is due to both internal excess and concomitant deficiency
  3. Harmonizing Formulae - treat complicated and co-existing but contrasting diseases that can not be addressed by one easy treatment method
    • Half-Exterior/Half-Interior Harmonizing - alternating fever & chills with chest and/or abdominal issues
    • Liver and Spleen Harmonizing - liver qi stagnation (excess) that affects the chest and abdomen (deficiency)
    • Intestine and Stomach Harmonizing - interlocking heat/cold with reversed qi flow
  4. Exterior and Interior Releasing Formulae - treating simultaneous exterior and interior syndromes
    • Exterior Releasing and Interior Attacking - pathogenic factors present in both the exterior and the interior
    • Exterior Releasing and Interior Clearing - exterior conditions with internal heat
    • Exterior Releasing and Interior Warming - cold in both the exterior and the interior
  5. Heat Clearing Formulae - treat disorders characterized by warmth, heat and fire
    • Energy (Qi) Level Clearing - treat heat excess or heat & deficiency conditions
    • Nutritive (yin) Level Clearing and Blood Cooling- clears heat & cools the blood
    • Energy Level and Blood Level Clearing - clears excess heat and eliminates toxins
    • Heat Clearing and Toxin Eliminating - treat excess heat, fire and toxins in all three body cavities
    • Organ Clearing - clear heat in the organs & their associated channels
  6. Summerheat Dispelling Formulae - relieves summerheat syndromes
    • Summerheat Dispelling and Heat Clearing - treat summerheat syndromes with sever interior heat
    • Summerheat Dispelling and Exterior Releasing - treat interior summerheat and exterior pathogenic factors
    • Summerheat Dispelling and Dampness Draining - relieve summerheat and dispel internal dampness
  7. Interior Warming Formulae - raise the yang, disperse cold and dredge the channels & collaterals
    • Warm the Middle and Dispel Cold - treat deficiency cold syndromes of the digestive organs
    • Yang Resuscitation - recuperate yang systems
    • Channel Warming and Cold Dispersing - treat exterior cold that block the channels & collaterals
  8. Strengthening Formulae - treat deficiency syndromes and damage to the organs
    • Qi Strengthening - treat Spleen and Lung qi deficiencies
    • Blood Strengthening - treat blood deficiencies (Heart & Liver)
    • Qi & Blood Strengthening - treat simultaneous qi & blood deficiencies
    • Yin Strengthening - treat yin deficiencies of Kidney & Liver
    • Yang Strengthening - treat Kidney yang type deficiencies
    • Yin & Yang Strengthening - strengthen both system simultaneously
  9. Spirit Calming Formulae - sooth the consciousness and tranquilize the mind
    • Sedative Formulae - calm the hyperactivity of the Heart yang and the flaring upward of Heart fire
    • Nourishing Formulae that Calm the Spirit - treat disturbances of mind caused by yin & blood deficiency
  10. Orifice Opening Formulae - treat using aromatic herbs that open the senses, awaken the spirit and restore consciousness
    • Cold Formulae to Open the Orifices - cool pathogenic heat toxins
    • Warm Formulae to Open the Orifices - awaken the consciousness from wind stroke, cold stroke and phlegm accumulation
  11. Astringent Formulae - stabilize, bind and stop the loss of qi, blood essence and body fluids
    • Exterior Stabilizing Formulae to Stop Perspiration - treat spontaneous sweating or night sweats
    • Lung Restraining Formulae to Relieve Cough - treat chronic cough
    • Intestine Binding Formulae to Stop Leakage - treat diarrhea, dysentery and incontinence
    • Essence Stabilizing Formulae to Stop Leakage - treat nocturnal emission, urinary incontinence or enuresis
    • Womb Stabilizing Formulae to Stop Leakage - treat various menstrual issues
  12. Qi Regulating Formulae - activate qi circulation and direct qi reversal downward
    • Qi Moving Formulae - activate qi and disperse qi stagnation
    • Qi Descending Formulae - direct reversed qi downwards
  13. Blood Regulating Formulae - invigorate the blood, remove blood stasis and/or stop bleeding
    • Blood Invigorating & Blood Stasis Removing Formulae - treat blood stagnation
    • Stop Bleeding Formulae - treat various types of bleeding
  14. Expelling Wind Formulae - release external wind and calm/extinguish internal wind
    • Releasing External Wind - treat wind invasion into the superficial layers, channels and collaterals
    • Extinguishing Internal Wind Formulae - treat Liver wind rising due to excess or deficiency
  15. Relieving Dryness Formulae - disperse & moisten external dryness and nourish & moisten internal dryness
    • Dispersing & Moistening Formulae - treat external dryness
    • Nourishing & Moistening Formulae - treat internal dryness
  16. Dispelling Dampness Formulae - treat accumulation of dampness and water
    • Damp Drying and Stomach Harmonizing Formulae - treat disharmony of Stomach & Spleen
    • Clearing Heat and Dispelling Damp Formulae - treat damp heat
    • Water Regulating and Resolving Damp Formulae - treat excess damp accumulation blocking the water pathways
    • Warm Formulae that Dissolve Dampness - treat cold type damp disorders
  17. Wind-Damp Dispelling Formulae - treat exterior factors that attack the superficial layers of the body, block the channels, cause swelling and pain
    • Dispelling Wind-Damp - dispel exterior syndromes
    • Dispelling Cold-Damp - treat painful obstruction due to cold
    • Dispelling Heat-Damp - treat painful obstruction due to heat
    • Dispelling Damp-Phlegm - dries damp and eliminates phlegm obstruction the channels & collaterals
  18. Dispelling Phlegm Formulas - treat by dissolving and dispelling phlegm
    • Drying Damp and Dissolving Phlegm Formulae - treat damp-phlegm
    • Clearing Heat and Dissolving Phlegm Formulae - treat phlegm-heat syndromes
    • Moistening Dryness and Dissolving Phlegm Formulae - treats sticky dry phlegm
    • Warm Formulae that Dissolve Cold Phlegm - treat cold-phlegm syndromes
    • Expelling Wind and Dissolving Phlegm Formulae - treats wind-phlegm in the interior
  19. Reducing, Guiding and Dissolving Formulae - treat various types of stagnation in the GI tract
    • Food Stagnation - treat food stagnation
    • Relieve Distention - treat GI fullness
  20. Anti-parasite Formulae - calm, expel or kill various parasites
  21. Emetic Formulae - induce vomiting
  22. Formulae that Treat Abscesses and Sores - treats both External and Internal disorders
    • External Abscesses and Sores
    • Internal Abscesses and Sore

As you might be able to discern, there is very little in the way of disease and the result of trauma that is not treatable by CHM.

Reference - Chen, J. K. and Chen, T. T., 2009, Chinese Herbal Formulas and Applications: Pharmacological Effects & Clinical Research, Art of Medicine Press, City of Industry, CA