3. Changes in Dosage Adjustments

Even with the same set of herbs, the effects of a formula can differ dramatically depending on the dosage. For example, in “Jin Gui Yao Lü’s” Zhi Zhu Tang, the amount of Zhi is greater than that of Bai Zhu. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: The primary symptom of this condition is “hardness in the heart region, as large as a plate, with edges resembling a spinning disc,” which is caused by water retention. Later, Zhang Yueli modified this condition into Zhi Shi Wan, where the amount of Bai Zhu was greater than that of Zhi Shi, thus becoming the commonly used formula for strengthening the spleen and harmonizing the middle burner. Zhang Zhongjing used Da Huang, Hou Po, and Zhi Shi to create three different formulas. Hou Po was used at 8 liang as the main ingredient, Zhi Shi at 5 pieces as a supporting component, and Da Huang at 4 liang as an auxiliary treatment—this formula was named Hou Po San Wu Tang, primarily treating “pain accompanied by obstruction,” a condition characterized by stagnation of qi. Da Huang was used at 4 liang as the main ingredient, Zhi Shi at 3 pieces as a supporting component, and Hou Po at 2 liang as an auxiliary treatment—this formula was named Xiao Cheng Qi Tang, primarily treating “diarrhea with delirium and dry stools,” a condition associated with the Yangming腑 (intestine). Hou Po was used at 1 chi, Da Huang at 6 liang as the main ingredient, and Zhi Shi at 4 pieces as a supporting component—this formula was named Hou Po Da Huang Tang, primarily treating “accumulation of fluid causing chest fullness,” a condition characterized by phlegm and fluid in the chest.

4. Changes in Dosage Forms

Although the ingredients of the formulas remain the same, differences in dosage form lead to variations in the therapeutic effects. Generally, decoctions have a faster and more potent effect, while pills have a slower and more gradual action. The Ding Dang Tang in Shang Han Lun consists of Shui Zhi, An Chong, Tao Ren, and Da Huang, primarily treating abdominal distension and fullness, often seen in cases of acute blood stasis leading to mania; if this formula were converted into pill form and named Ding Dang Wan, it would treat only chronic blood stasis-related abdominal distension and fullness.

5. Substitution of Medicinal Ingredients

Once you understand the principles behind formula composition and the roles of each ingredient within a formula, you can, in clinical practice, select only the therapeutic approach or the core principles of the formula without using all of its components. This is especially true for rare or expensive herbs, which can often be substituted with similar herbs based on their properties and effects—without compromising therapeutic efficacy. For example, Huang Lian, Huang Qin, and Huang Bo all possess distinct properties but share common characteristics such as bitter cold nature, heat-clearing effects, and damp-drying qualities; they can be used interchangeably in this regard. Similarly, Zhike and Zhi Shi differ in their effects, while Danshen and Dangshen vary in strength; once these facts are understood, clinicians can flexibly choose substitute medications. In recent years, there has been a growing trend toward using Buffalo Horn in place of Rhinoceros Horn, Goat Horn in place of Antelope Horn, and Pearl Mother in place of Stone Decoction—these substitutions have generally yielded satisfactory results. When substituting medicinal ingredients, the dosage should be adjusted accordingly: those with weaker effects should be given higher doses, while those with stronger effects should be given lower doses—for instance, when using Danshen in place of Ginseng, the dosage should be increased; when using Zhi Shi in place of Zhike, the dosage should be reduced. Additionally, depending on the specific effects of each herb, other herbs can be used as substitutes. Take Cornus officinalis as an example: it has both liver- and kidney-tonifying and acid-restraining/tonifying properties. When substituting, clinicians can tailor the substitution based on the clinical purpose of the medication—when focusing on liver and kidney tonification, Cornus officinalis, Goji berries, and Tussilago farfara can be used as substitutes; when emphasizing acid-restraining and tonifying effects, Schisandra chinensis can be employed instead.

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Chapter Four: Classification of Formulas and Dosage Forms

I. Classification of Formula Functions

Formulas are primarily classified according to their primary therapeutic functions. For example, based on eight major therapeutic approaches—such as sweating, vomiting, purgation, harmonization, warming, clearing, tonifying, and resolving—formulas can be categorized into exterior-releasing formulas, emetic formulas, purgative formulas, harmonizing formulas, warming formulas, cooling formulas, digestive formulas, and tonifying formulas. However, since these eight methods alone cannot encompass all formulas, additional categories such as qi-regulating formulas, blood-regulating formulas, wind-dispelling formulas, damp-resolving formulas, opening-sense formulas, astringent formulas, anti-malarial formulas, and deworming formulas have also been developed. Nevertheless, some formulas serve multiple purposes; for instance, Si Wu Tang can both nourish blood and promote blood circulation, so it can be classified under either tonifying or blood-purifying categories. Therefore, formula classification is not always absolute, and the classifications used in various formula manuals often vary. Furthermore, formulas can also be distinguished between general formulas and specialized formulas. General formulas, like Si Jun Zi Tang for qi-nourishment, Si Wu Tang for blood-nourishment, Liu Wei Di Huang Wan for yin-nourishment, or Gui Fu Ba Wei Wan for yang-nourishment, are used for specific conditions. Specialized formulas, on the other hand, are reserved for particular diseases—such as Da Huang Mu Dan Pi Tang, which is known for its heat-clearing and fire-draining properties but is specifically used for intestinal abscesses; or Shi Hui San, which is known for its blood-cold properties but is exclusively used for hemostasis. In recent years, research efforts combining traditional Chinese medicine with Western medicine have led to the development of numerous targeted formulas, including Qiang Gan Tang, Yi Shen Tang, and Dan Dao Pai Shi Tang—all of which are considered specialized formulas.

II. Dosage Forms and Usage of Formulas

Traditional Chinese medicine formulas are commonly available in forms such as pastes, pills, powders, granules, decoctions, tablets, wines, threads, strips, washes, lotions, infusions, slices, and needles.