1. Prescriptions and Pathogenesis

Pathogenesis refers to the essential principles governing the causes, locations, and changes of a disease throughout its course. Only when the pathogenesis is clearly understood can effective syndrome-based treatment be achieved. If we talk about syndrome-based treatment without considering pathogenesis, we will inevitably treat symptoms rather than the root cause, which is no different from Western medicine's symptomatic treatment. The pathogenesis in TCM differs from the pathology and etiology in Western medicine; it is derived from the analysis and synthesis of clinical syndromes through logical reasoning. The "Plain Questions: On the Great Principles of Yin-Yang Correspondence" states: "In treating illness, one must seek the root cause," meaning that when prescribing medications, we should never forget to target the pathogenesis. This shows that a good prescription should be tailored to the clinical pathogenesis in order to achieve the desired effect. Although TCM has the principles of "treat the symptoms first in emergencies" and "treat the root cause in non-emergencies," this does not mean ignoring the pathogenesis when treating acute conditions, nor does it mean neglecting symptoms when treating chronic diseases. The correct understanding is that we should balance both symptoms and pathogenesis, giving priority to one over the other depending on whether the condition is acute or chronic. The roles of君, 臣, 佐, and 使 in a prescription are established precisely to reflect this principle. Generally speaking, the君药 is the main drug that acts on the pathogenesis. TCM syndrome-based treatment strives for the complete unity of theory, method, prescription, and medicine. Here, "theory" refers specifically to pathogenesis. Ancient scholars emphasized: "Formulate methods based on theory, link prescriptions to methods, and use prescriptions to guide medication," showing that pathogenesis is the foundation of theory, method, prescription, and medicine. Only by clearly identifying the pathogenesis of a disease can we correctly implement the unity of theory, method, prescription, and medicine, and carry out syndrome-based treatment in a well-organized manner. Regarding the basic pathogenesis in TCM, there are six meridian differentiation, Wei-Qi-Ying-Xue differentiation, Sanjiao differentiation, Zang-Fu differentiation, and etiology differentiation, among others. Their guiding principles largely originate from texts such as the "Inner Canon" and the "Treatise on Febrile Diseases," so TCM prescription studies must cover all these aspects. For each individual prescription, it should be an integrated whole of theory, method, prescription, and medicine, with drugs targeting the pathogenesis as the core, so as to fully demonstrate the superiority of TCM syndrome-based treatment. Take Xianglian Pill as an example: although it contains only two ingredients, it embodies the principle of balancing symptoms and root causes, with emphasis on addressing the root cause. Damp-heat combination is the fundamental cause of dysentery, which belongs to the root cause; damp-heat combination 6

causes tenesmus and urgency, which belong to the symptoms. Huanglian clears heat and drains dampness, targeting the former, thus treating the root cause; Muxiang moves qi and relieves pain, targeting the latter, thus treating the symptoms. Among the two herbs, using Huanglian alone can treat dysentery, but using Muxiang alone cannot. This is a clinical demonstration of Huanglian treating the root cause and Muxiang treating the symptoms. Although using Huanglian alone can treat dysentery, its efficacy is far inferior to that of using it together with Muxiang, which illustrates the superiority of balancing symptoms and root causes. In short, in TCM prescription and medication, we must clearly identify the pathogenesis in order to formulate prescriptions, prescribe medications, and administer treatments correctly, thereby achieving the goal of syndrome-based treatment.

2. Prescriptions and Therapeutic Methods

The establishment of therapeutic methods is based on pathogenesis, whereas the formation of prescriptions is based on therapeutic methods—this is what is commonly referred to as "formulating prescriptions according to therapeutic methods." Prescriptions formulated without a clear basis in therapeutic methods often have little effect when used to treat diseases, or may only provide symptomatic relief.

Therapeutic methods in TCM are an important component of syndrome-based treatment. Some say, "Therapeutic methods are determined by pathogenesis and guide prescriptions," playing a bridging role in the complete system of theory, method, prescription, and medicine. Therefore, prescription classification has always been based on therapeutic methods, such as exterior-releasing agents, interior-penetrating agents, heat-clearing and fire-draining agents, and so on. Traditional TCM therapeutic methods include eight categories: sweating, vomiting, purging, harmonizing, warming, clearing, tonifying, and eliminating. Later, additional methods such as regulating qi, regulating blood, transforming dampness, and resolving phlegm were added, collectively known as twelve therapeutic methods. The formation of these twelve methods is all based on pathogenesis; and the establishment of pathogenesis, in turn, is based on the analysis of clinical syndromes. Syndromes are obtained through observation, auscultation, inquiry, and palpation. Therefore, accurate syndrome-based treatment is closely related to the accuracy of the four diagnostic methods. For example, a patient presents with pale complexion, poor appetite, fatigue, and shortness of breath after a thorough examination using the four diagnostic methods. The clinician then uses logical reasoning to analyze the syndromes and determine the underlying pathogenesis: the spleen governs yellow color, so spleen deficiency leads to pale complexion; the spleen governs the transformation of food and water, and also governs thinking, so spleen deficiency results in poor appetite; the spleen governs muscles, so spleen deficiency leads to fatigue; the spleen governs central qi, so spleen deficiency causes shortness of breath. These analyses indicate that the patient's main pathogenesis is spleen qi deficiency, which becomes the prerequisite for determining the therapeutic method. According to the principles of "tonify when deficient" and "benefit when damaged," the appropriate therapeutic method should be tonifying spleen qi and benefiting qi. As for the choice of prescription, naturally, Buzhong Yiqi Tang with modifications would be the best option. This example demonstrates that although the establishment of therapeutic methods is based on pathogenesis, once established, it plays a decisive role in the composition and creation of prescriptions. Thus, the relationship between therapeutic methods and prescriptions is extremely close.

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3. Combining Prescriptions with Other Therapies

Prescriptions are an important measure in TCM treatment, but they are not the only one. Traditional therapies also include acupuncture, massage, external treatments, and physical therapy. Since the integration of TCM and Western medicine began, medical professionals have also developed many effective new therapies. TCM syndrome-based treatment often relies primarily on prescriptions, but when appropriate, combining them with other therapies can often enhance efficacy. For example, for chronic cold-deficiency diseases, while taking tonifying agents, one can also incorporate a certain amount of physical therapy; for acute infectious diseases, while taking heat-clearing and detoxifying agents, external treatments can be applied under certain circumstances; for chronic joint diseases, while taking herbs that relax tendons and activate collaterals and dispel wind and dampness, acupuncture and massage can also be used. In short, in TCM syndrome-based treatment, the use of prescriptions can be combined with other therapies to achieve greater efficacy.

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Chapter 3: Composition and Variation of Prescriptions

1. Single-Ingredient vs. Compound Formulas

To meet clinical needs, drugs are processed and formed into specific dosage forms, which are called prescriptions. Prescriptions composed of a single herb are called single-ingredient formulas, such as loquat leaf paste, mulberry branch paste, and single ginseng paste. In recent years, products like kushen tablets and banlangen injection have also been classified as single-ingredient formulas. Additionally, folk remedies such as purslane for bacterial dysentery, fish mint for lung abscess, and stink tree for hypertension should also be considered single-ingredient formulas. Single-ingredient formulas have the advantages of clear symptom targeting, focused action, easy availability of ingredients, and ease of use, but their drawback is that they cannot adapt to complex and changing conditions. Therefore, in medical practice, people gradually created compound formulas. Compound formulas are made up of two or more herbs, and their characteristic is that they can adapt to complex and changing clinical conditions. Clinically, it is common to encounter complex syndromes involving alternating cold and heat, deficiency and excess, wind and dampness, qi stagnation and blood stasis, and other factors. In such cases, only compound formulas can achieve the desired effect. Take the treatment of bacterial dysentery as an example: the cause of this disease is the combination of damp-heat, so Huanglian is used to clear heat and dry dampness to treat the root cause; dampness tends to obstruct qi flow, and when qi flow is blocked, there is tenesmus and urgency, so Muxiang and Binglang are used to regulate qi and relieve urgency; activating blood circulation helps pus discharge naturally, so Danggui and Baishao are used; Dahuang is used to address the root cause directly, acting like pulling the plug at the bottom of the pot; Rougui warms and tonifies the lower jiao, used to generate vital energy with gentle heat. With this combination, an effective compound formula for treating dysentery—Shaoyao Tang—is formed. The transition from Huanglian treating dysentery to Shaoyao Tang treating dysentery is a process of moving from single-ingredient formulas to compound formulas, reflecting a gradual deepening of people's understanding of dysentery, a progression from practical experience to theoretical formulation, and a significant milestone in the development of prescription studies. The use of compound formulas, in addition to adapting to complex and changing conditions, also has many other advantages, such as correcting imbalances in herbal properties, removing toxicity from drugs, and maximizing the effectiveness of medications. For example, in Zuojin Wan, Huanglian is paired with Wuzhuyu, which corrects the tendency toward cold; in Xiao Banxia Tang, Banxia is paired with ginger, which removes its toxicity; in Si Ni Tang, Fupian is paired with Ganjiang, which doubles the efficacy. It can be seen that the use of compound formulas promotes research on herbal compatibility and also facilitates the summarization of major therapeutic principles. Therefore, studying and researching prescription studies is not only clinically meaningful but also of great significance for advancing the entire field of TCM scholarship.

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2. Principles of Prescription Composition

The composition of prescriptions (compound formulas) traditionally involves four components:君, 臣, 佐, and 使. However, since this terminology carries a certain feudal connotation, in recent years it has been replaced by 主治药, 辅助药, 兼治药, and 引和药, often abbreviated as 主, 辅, 兼, and 引. The 主治药 is the drug that treats the primary syndrome; the 辅助药 assists the 主治药 to enhance its efficacy; the 兼治药 treats secondary syndromes and sometimes alleviates side effects of the 主治药; the 引和药 guides the drugs directly to the site of the disease, while some also serve to adjust the taste or shape of the formula, i.e., to harmonize the various herbs. For example, Ma Huang Tang is a representative formula for treating wind-cold exterior syndrome. In this formula, Ma Huang releases the exterior, disperses cold, and induces sweating, serving as the 主治药; Gui Zhi loosens muscles and disperses cold, assisting Ma Huang in releasing the exterior, so it serves as the 辅助药; exterior syndrome often comes with cough, so Xing Ren clears the lungs and stops coughing to treat the secondary syndrome, serving as the 兼治药; Gan Cao harmonizes all the herbs and serves as the 引和药. Generally, a prescription has only one 主治药, but in more complex formulas, there can be 2–3 主治药; as for 辅助药, 兼治药, and 引和药, there are usually two or more. Some simple formulas consist only of 主治药 and 辅助药, or 主治药 and 兼治药, or 主治药 and 引和药. However, it is rare for a formula to lack a 主治药. Sometimes a single formula can treat several syndromes, and as the primary syndrome treated changes, the composition of the formula also changes accordingly.

3. Variations in Prescription Composition

Although prescriptions have a fixed composition, their ingredients and dosages should frequently change according to the syndrome being treated. The former addresses the general nature of the disease, while the latter addresses its specific characteristics. In clinical prescriptions, if we focus only on the basic composition of the formula and ignore the changes in ingredients and dosages according to the syndrome, we will not be able to adapt to complex and changing clinical conditions; if we focus only on adjusting the drugs and dosages based on the syndrome and ignore the basic composition of the formula, we will not be able to summarize the rules of disease treatment. Therefore, in clinical prescriptions, we must pay attention to both the basic composition of the formula and the adjustments made according to the syndrome, striving to achieve "a formula for every syndrome" in order to improve clinical efficacy.

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1. Changes in ingredients: If the primary syndrome of the formula remains unchanged and the main formula stays the same, as the condition evolves, we should add some herbs that suit the condition or remove those that do not. For example, when using Yin Qiao San to treat wind-heat exterior syndrome, we can flexibly adjust the formula according to accompanying symptoms. If there is concurrent yin deficiency and thirst, add Tian Hua Fen; if there is concurrent heat congestion in the throat causing sore throat, remove Jing Jie and Dou Chi, and add Ma Bo, Xuan Shen, and Ban Lan Gen; if there is concurrent severe heat injuring the meridians and causing nosebleeds, remove Jing Jie and add Bai Mao Gen and Ce Bo Ye. Similarly, when using Gui Zhi Tang to treat wind-cold exterior deficiency syndrome, we can flexibly adjust the formula according to accompanying symptoms. If there is concurrent stiffness in the neck and back, add Ge Gen; if there is concurrent rapid pulse and chest fullness, remove Shao Yao; if there is concurrent slight tightness in the limbs making it difficult to bend and stretch, add Fu Zi; if there is concurrent asthma, add Hou Pu and Xing Ren; if there is concurrent palpitations and restlessness, add Yi Tang and double the amount of Bai Shao.

2. Changes in herbal compatibility: Within a formula, adjusting the compatibility of the main herbs can alter the formula's primary function. For example, Ma Huang Tang is a specialized formula for treating wind-cold exterior syndrome, and it only has this effect when Gui Zhi is paired with Ma Huang; if gypsum is paired with Ma Huang, it treats exterior cold and interior heat; if Fu Zi is paired with Ma Huang, it treats exterior cold and interior deficiency. Similarly, if a disease is in the interior and classified as a real syndrome, it is suitable for purging, and Dahuang should be the main herb; if there is severe heat but no hard mass, just restlessness and abdominal distension, and constipation, then Dahuang should be paired with Mang Xiao, using salty and cold properties to drain heat and attack the real syndrome, resulting in Cheng Qi Tang; if there is a hard mass but no severe heat, just a feeling of fullness in the stomach and overall abdominal distension, then Dahuang should be paired with Zhi Shi and Hou Pu to disperse the mass, resulting in Xiao Cheng Qi Tang; if both heat and mass are severe, with symptoms of fullness, dryness, and hardness, then all three—Mang Xiao, Dahuang, and Hou Pu—should be used together, resulting in Da Cheng Qi Tang. Moreover, a single herb can exhibit completely different effects depending on how it is paired with other herbs. For example, Ma Huang paired with Gui Zhi releases the exterior, Ma Huang paired with Xing Ren stops asthma, and Ma Huang paired with gypsum has diuretic effects.

3. Adjustments in dosage: The same few herbs, due to differences in dosage, can form formulas with completely different effects. For example, in Jin Gui Yao Lue, Zhi Shu Tang uses more Zhi Shi than Bai Shu, mainly to treat "a hard mass in the stomach, as big as a plate, with edges like a spinning disk," caused by fluid retention; later, Zhang Yuan Su changed it to Zhi Shu Wan, where Bai Shu is used more than Zhi Shi, turning it into a common spleen-tonifying and middle-balancing formula. Zhang Zhongjing used Dahuang, Hou Pu, and Zhi Shi to compose three formulas. Hou Pu is the main ingredient, with eight liang, Zhi Shi is the auxiliary ingredient, with five pieces, and Dahuang is the兼治药, with four liang, named Hou Pu San Wu Tang, mainly to treat "pain and blockage," a syndrome of qi stagnation. Dahuang is the main ingredient, with four liang, Zhi Shi is the auxiliary ingredient, with three pieces, and Hou Pu is the兼治药, with two liang, named Xiao Cheng Qi Tang, mainly to treat "diarrhea, delirium, and hard stools," a Yangming organ syndrome. Hou Pu is the main ingredient, with one chi, and Dahuang is the main ingredient, with six liang, Zhi Shi is the兼治药, with four pieces, named Hou Pu Da Huang Tang, mainly to treat "phlegm accumulation in the chest," a syndrome of phlegm in the chest.

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4. Changes in dosage form: Although the ingredients of a formula are the same, different dosage forms can lead to varying degrees of speed and intensity in treatment. Generally, decoctions act faster and stronger, while pills act slower and milder. Di Dang Tang in Shang Han Lun is composed of leeches, horseflies, peach kernels, and Dahuang, mainly to treat severe abdominal distension and mania caused by blood stasis; if this formula is changed into a pill, named Di Dang Wan, it will only treat mild abdominal distension caused by blood stasis.

5. Substitution of drugs: Once we have mastered the principles of herbal compatibility and clearly understood the role of each herb in the formula, in clinical practice we can sometimes focus only on the therapeutic method and the meaning of the formula, rather than using all the herbs. Especially for rare and expensive herbs, we can often substitute them with herbs that have similar tastes and effects without affecting the efficacy. For example, Huang Lian, Huang Qin, and Huang Bai all have bitter-cold, heat-clearing, and damp-drying properties, so they can be substituted for one another in this regard. Zhi Ke and Zhi Shi have different speeds of action; Ren Shen and Dang Shen have different strengths. Once we understand this fact, we can flexibly manage substitutions in clinical practice. For example, in recent years, it has become popular to substitute water buffalo horn for rhino horn, goat horn for antelope horn, and mother-of-pearl for stone shell, with satisfactory results. When substituting drugs, the dosage should be adjusted accordingly—less potent drugs should be used in larger amounts, while more potent drugs should be used in smaller amounts. For example, when substituting Dang Shen for Ren Shen, the dosage should be increased; when substituting Zhi Shi for Zhi Ke, the dosage should be reduced. In addition, we can also choose other drugs to substitute based on their specific functions. Take Shan Zhu Yu as an example: it has two main functions—tonifying liver and kidney, and astringing and consolidating. When substituting, we can choose different substitutes depending on the purpose of using the drug in clinical practice. If it is mainly used to tonify liver and kidney, we can substitute with Nü Zhen Zi, Gou Qi Zi, and Tu Si Zi; if it is mainly used to astringe and consolidate, we can substitute with Wu Wei Zi.

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Chapter 4: Classification of Prescriptions and Dosage Forms

1. Classification of Prescription Effects

The classification is mainly based on therapeutic methods—for example, according to the eight methods of sweating, vomiting, purging, harmonizing, warming, cooling, tonifying, and eliminating, prescriptions can be divided into exterior-releasing agents, emetic agents, purgative agents, harmonizing agents, warming agents, cooling agents, digestive agents, and tonifying agents. Since the eight methods cannot cover all prescriptions, there are also qi-regulating agents, blood-regulating agents, wind-dispelling agents, dampness-transforming agents, opening-the-orifices agents, astringent agents, anti-malaria agents, and anti-parasitic agents. However, because some prescriptions have multiple effects—for example, Si Wu Tang can both tonify blood and activate blood, it can be classified as a tonifying agent or an activating blood agent. Therefore, the classification of prescriptions is not absolute, and prescription classifications in various prescription books are not entirely consistent. In addition, there is also a distinction between general-purpose prescriptions and specialized prescriptions. General-purpose prescriptions include Si Jun Zi Tang for tonifying qi, Si Wu Tang for tonifying blood, Liu Wei Di Huang Wan for tonifying yin, and Gui Fu Ba Wei Wan for tonifying yang, among others. Specialized prescriptions, on the other hand, are used only for specific conditions—for example, Da Huang Mu Dan Pi Tang, which is designed to clear heat and drain fire, but is exclusively used for intestinal abscess; Shi Hui San, which is designed to cool blood, but is exclusively used for hemostasis. In recent years, in the context of TCM-Western medicine integration research, various regions have developed a number of targeted and effective prescriptions, such as Qiang Gan Tang, Yi Shen Tang, and Dan Dao Pai Shi Tang, all of which fall into the category of specialized prescriptions.

2. Dosage Forms and Usage of Prescriptions

Traditional Chinese medicine prescriptions typically come in various dosage forms, including pastes, pills, powders, decoctions, tinctures, tablets, wines, threads, strips, washes, lotions, infusions, slices, and injections.

1. Pastes: There are two types—internal and external. Internal pastes are made by repeatedly decocting herbal slices, filtering out the residue, concentrating the liquid over low heat, and adding sugar or honey to form a paste, which can be taken long-term. Generally, tonic internal pastes use this dosage form, hence the name "paste tonic," such as Sang Shen Paste and Er Dong Paste. External pastes are usually called plasters; in ancient times they were called "thin patches," made by decocting herbs in oil, filtering out the residue, adding yellow ochre and white wax to form a paste, then heating it and spreading it on paper, leather, or cloth, often used for surgical wounds or wind-cold pain, such as Ba Du Paste and Zhui Feng Paste. In addition, there is also a soft paste, made by finely grinding herbs, sieving them, melting them in lard to form a paste for external use, such as San Huang Paste and Frostbite Paste.

2. Pills: Chemical substances such as mercury, arsenic, and silver, when subjected to high temperatures, undergo chemical changes and produce products called pills, such as Hong Sheng Dan and Bai Jiang Dan. Later, the meaning of "pill" gradually evolved; to describe the mysterious preparation and extraordinary efficacy of certain drugs, many finished medicines came to be called "pills," and "pill" became a general term encompassing various dosage forms such as slices, powders, and pills, such as Bu Xin Dan, Er Yi Dan, Huan Shao Dan, and Gan Lu Disinfection Dan.

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3. Pills: Medicines are finely ground and then either coated with water, mixed with honey, or combined with a flour paste to form round granules, which are called pills. Although they are relatively convenient to take, due to the smaller dosage of crude drugs contained and slower absorption, they are mostly used for chronic diseases that require long-term, gradual treatment. However, some potent medicines also use pills so that they can dissolve slowly and be absorbed gradually, thus avoiding irritation to the gastrointestinal tract; examples include Ten Dates Pills and Didi Pills. Additionally, aromatic medicines such as musk and borneol are not suitable for decoction and are often used in emergencies, so they must be made into pills in advance for timely administration. The drawbacks of pills are that the active ingredients of the medicine are not refined but are made together with the residue, resulting in low efficacy when taken in small doses and hindering digestion when taken in large doses, along with poor absorption and reduced therapeutic effect, thereby limiting their clinical application to a certain extent. Commonly used pills include:

   • ① Honey pills (mixed with honey): Used for chronic tonification, such as Guipi Pills, Liuwei Dihuang Pills, and Shiquan Dabu Pills.
   • ② Paste pills (made with flour paste): Used for strong and heavy medicines, such as Didi Pills and Dahuang Zhichong Pills.
   • ③ Water pills (coated with water): Used for strengthening the stomach and aiding digestion, such as Xiangsha Liujun Pills, Yueju Pills, and Baohe Pills.

   The size of pills varies; honey pills are the largest, weighing up to 6 grams, while paste pills and water pills are smaller, about the size of a wuzi seed or a mung bean. Some pills, due to containing highly toxic substances, are often extremely small, such as Liushen Pills, where one liang may contain as many as 15,000 pills.

4. Powders: Medicines are ground into fine powders, which are called powders. They are divided into two types: internal and external use. Internal powders are taken by dissolving them in hot water or by adding them to herbal decoctions, with effects similar to those of decoctions; however, the dosage is relatively small, absorption is less than ideal, and the effect is weaker than that of decoctions. External powders are mainly used for surgical, trauma, throat, and eye diseases, applied by sprinkling or applying to the affected area.

5. Decoctions: Adding water and boiling the herbs, removing the residue, and taking the juice is called a decoction, which is the most commonly used dosage form in traditional Chinese medicine. Most are used internally, though some are also used externally or for fumigation. The greatest advantage of internal decoctions is rapid absorption, full effectiveness, and easy realization of therapeutic effects. At the same time, it is convenient for clinical adjustments based on syndrome differentiation, making it suitable for TCM's syndrome-based treatment; however, there are also drawbacks such as inconvenient preparation and carrying, which still need further improvement.

6. Alcoholic preparations: Also known as medicinal wines, these are clear liquids obtained by soaking medicinal materials in yellow wine or white liquor to extract their effective components, suitable for internal consumption as well as external application. Internally, they are mostly used for tonification or wind-cold-dampness bi syndrome, such as Shouwu Wine, Danggui Wine, Goji Berry Wine, and Tiger Bone Wine.

7. Tablets: Medicines are ground into fine powders and mixed with excipients or binders to form solid preparations of a certain size and shape, suitable for external or internal use. For external use, they can be inserted into the affected area to draw out decay and promote tissue regeneration, or ground into a paste and applied to the affected area; for internal use, they can be dissolved in water or ground into a paste and taken. Examples of external tablets include Kuzhi Tablets, while internal tablets include Zijin Tablets and Zhibao Tablets.

8. Thread preparations: Silk threads or cotton threads are soaked in medicinal liquid or boiled together with it, then air-dried for later use. They are commonly used to ligate fistulas or excess flesh, causing them to shrink or fall off on their own.

9. Strip preparations: Mulberry bark paper is glued to the medicine and then twisted into thin strips, used to insert into wounds, which can drain pus, dissolve decay, and promote tissue regeneration.

10. Medicinal distillates: Fresh medicinal materials containing volatile components are placed in water and heated to boiling, allowing the volatile components in the medicine to rise with the steam. The distilled liquid collected through cooling is called a medicinal distillate. This preparation has a fresh and fragrant aroma, making it easy to take orally, such as Yinhua Distillate and Pipa Distillate.

11. Instant powders: Concentrated extracts of medicines are mixed with appropriate excipients (starch, sugar powder) to form granular powders, a new dosage form developed in recent years. They are usually packaged in plastic to prevent moisture absorption. Instant powders act faster than pills and tablets, are easier to carry than decoctions and syrups, and are simple to take—just dissolve in hot water, such as Cold Relief Instant Powder and Cough Suppressant Instant Powder.

12. Tablets: A new dosage form developed in modern times. After processing or refining, medicines are mixed with excipients and mechanically pressed into round tablets, with sizes determined by dosage. Bitter-tasting or foul-smelling medicines can be coated with sugar to make them easier to take. Currently, the use of traditional Chinese medicine tablets is becoming increasingly widespread, such as Chuanxinlian Tablets, Yin Qiao Detoxifying Tablets, and Juhong Tablets.

13. Injections: Also known as injectable solutions, this is a new dosage form developed in recent years. It involves extracting, refining, and formulating traditional Chinese medicines into sterile solutions for subcutaneous, intramuscular, or intravenous injection. It has the advantages of rapid action and protection of the drug from digestive processes, making it suitable for emergency treatment or patients who cannot take oral medication. Examples include Danggui Injection, Dilong Injection, and Chuanxinlian Injection.

In addition to the above dosage forms, there are also enema preparations and moxibustion preparations. Enema preparations are inserted into the anus, where they automatically dissolve and lubricate the anal canal; moxibustion preparations involve twisting mugwort wool into different shapes for moxibustion therapy.

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Chapter 5: Evolution of Decoction Preparation Methods and Dosage

I. Decoction Preparation Methods

Different types of medicines require different decoction methods. Medicines that disperse and induce sweating should not be decocted for too long; rich and nourishing medicines should be decocted over low heat for a longer time; shellfish and minerals should be decocted first and for a longer duration; aromatic medicines that cannot withstand prolonged decoction should be added later. Gelatinous medicines, such as donkey-hide gelatin, deer antler gelatin, and turtle shell gelatin, should be added to the decoction while it is still hot after it has been prepared, so that they can melt. Valuable and small medicines, such as pearls and bezoar, should be ground into powder and taken by dissolving in water; valuable and hard-to-grind medicines, such as rhino horn and antelope horn, can be ground into powder using water grinding or filing methods before being taken. Juicy fresh medicines, such as rehmannia root and sugarcane, can be juiced and drunk. Medicines containing mud and sand, such as Fulonggan and raw iron filings, can be decocted first to obtain the supernatant, which can then be used to decoct other medicines. Some medicines are soaked in water or decocted with alcohol before being cooked, to make it easier to extract their effective components. Throughout history, medical practitioners have debated extensively about the water used for decoction, with some advocating for running water or sweet-surfaced water, others for freshly drawn water or earthy water, some for麻沸水 or yin-yang water, and still others for rainwater or snow water—there is no single consensus. Nowadays, tap water, well water, and spring water are commonly used, with cleanliness and hygiene being the top priority. Typically, one dose is decocted twice and taken twice; for urgent conditions, it can be taken all at once. Decoctions are generally taken warm; if the patient feels excessively hot and restless, or if there is a condition of yang excess obstructing yin, cold decoctions may be given; if the patient experiences severe vomiting, cold decoctions can also be administered, with frequent small sips. The timing of medication should be flexibly adjusted according to the condition: for chronic illnesses, one dose per day or every other day; for acute illnesses, two doses per day are also acceptable. If the illness is in the upper jiao and the aim is to keep the medicinal effect in the upper jiao, the medicine can be taken after meals; if the illness is in the lower jiao and the aim is to deliver the medicinal effect directly to the lower jiao, the medicine can be taken before meals.

II. Dosage Conversion

Due to the frequent changes in measurement systems throughout history, ancient prescriptions and names of medicines have varied, and even modern scholars' research has not reached a consensus. Roughly speaking, three jin during the Han and Jin dynasties were equivalent to one jin today; one liang was roughly equivalent to three qian today; one chi was roughly equivalent to six cun and nine fen today; one dou was roughly equivalent to two sheng; one sheng of water was roughly equivalent to two he (200 ml); one qian of powdered medicine was roughly equivalent to three fen; and one pill the size of a chicken egg was roughly equivalent to three qian.

In 1978, various regions across China successively implemented a metric system for prescription dosages, with the following conversion standards: one jin equals 500 grams, one liang equals 30 grams, and one qian equals 3 grams.

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Specific Discussions

Chapter 1: Exterior-Resolving Formulas

The "exterior" refers to exterior syndromes, whose clinical manifestations include headache, fever with chills, body pain, and floating pulse. If there is sweating and a slow pulse, it is called exterior deficiency (stroke); if there is no sweating and a tight pulse, it is called exterior excess (cold damage); if there is thirst, sore throat, excessive heat, and a rapid pulse, it is called exterior heat (warm disease). Together, these three constitute the exterior syndrome; the first two combined are called wind-cold exterior syndrome, while the last one is called wind-heat exterior syndrome. The "Plain Questions" states: "Lift what is light and disperses it." It also says: "For what is on the skin, induce sweating to expel it." Based on this principle, later generations established two therapeutic principles for treating exterior syndromes: dispersing wind-cold and clearing wind-heat. Any formula that embodies these principles is called an exterior-resolving formula. The "Essential Principles of the Plain Questions" states: "Treat cold with heat, and treat heat with cold." Therefore, for wind-cold, warm medicines should be used; for wind-heat, cool medicines should be used. Both wind-cold and wind-heat are caused by wind pathogens invading the upper part of the body, so they should be dispersed with pungent medicines. Consequently, formulas for treating wind-cold are called pungent-warm exterior-resolving formulas, while formulas for treating wind-heat are called pungent-cool exterior-resolving formulas.

I. Pungent-Warm Exterior-Resolving Formulas

This category is designed for wind-cold exterior syndrome, which is the general term used in the "Treatise on Cold Damage" to refer to stroke and cold damage. Clinical manifestations: headache, body pain, fever with chills, and floating pulse. This syndrome is further classified into exterior deficiency and exterior excess based on whether there is sweating or not, and whether the pulse is slow or tight, as previously mentioned.