Ten Key Formula Families in Chinese Medicine

By introducing the concept of constitutions and the attendant vulnerabilities of those constitutions to certain types of disorders, he hands the reader a very useful key to understanding how and when to use these formulas in the clinic.

The ten families of formulas are grouped around the following herbs:

• Cinnamon - Cinnamomi Ramulus (gui zhi)
• Ephedra - Ephedrae Herba (ma huang)
• Bupleurum - Bupleuri Radix (chai hu)
• Gypsum - Gypsum fibrosum (shi gao)
• Rhubarb - Rhei Radix et Rhizoma (da huang)
• Coptis - Coptidis Rhizoma (huang lian)
• Aconite accessory root - Aconiti Radix lateralis preparata (zhi fu zi)
• Dried ginger - Zingiberis Rhizoma (gan jiang)
• Astragalus - Astragali Radix (huang qi)
• Pinellia - Pinelliae Rhizoma preparatum (zhi ban xia)

For each family of formulas, Dr. Huang describes the associated presentation and constitutional aspects common to all members of the family, then turns to the individual formulas that are especially useful for treating particular aspects of that presentation. The discussion is embellished with case histories and relevant clinical research.

In the preface to this book, Dr Huang says it was written for those beginning their study of Chinese medicine. As someone who feels perpetually stuck at the “just beginning” stage, I think it will keep me going for quite some time to come. It is full of treasure, and presents a whole new way of approaching diagnosis and formulas. What’s more, it’s highly portable. With approximately 340 pages of attractively presented text (plus the occasional cartoon) it weighs in at just 598g, making it unlikely to cause shoulder strain if carried on public transport (which is where much of my ongoing study seems to occur). The basic premise underlying Dr Huang’s approach is that certain herbs and, by extension, certain herbal formulas, match a particular constitution or a specific constellation of signs and symptoms presented by someone with that particular constitution. The translator, Michael Max, helpfully points out that this method of clinical reasoning draws on the Japanese Kampō tradition and has historical roots that can be traced back to the early Qing dynasty and further to passages in the Shāng Hán Lùn. Dr Huang explains it thus: “No matter which [differential diagnostic] system is used, the result is always an herbal formula…. The matching of herbs and presentations, or formulas and presentations, is the fundamental principle of clinical work in Chinese medicine.”

He focuses on 10 key herbs – guì zhī, má huáng, chái hú, shí gāo, dà huáng, huáng lián, zhì fù zǐ, gān jiāng, huáng qí, and zhì bàn xià - and the ‘family’ of formulas based on them. Each family is given its own chapter and together they encompass 64 classic herbal formulas (the vast majority of which come from the Shāng Hán Lùn and the Jīn Guì Yào Lü.), selected because they embody the essence of Chinese medicine. The constitution and/or presentation that match each herb or herbal formula is described (the guì zhī and chái hú ‘families’ are dealt with particularly thoroughly) and key signs and symptoms are identified for each case. Reports on the application of the various formulas by clinicians in China and Japan are also given, illustrating their effectiveness in the treatment of a wide range of conditions, along with case studies of interest from Dr Huang’s clinic. Reading the text one gets a real sense not just of the author’s knowledge and experience (derived from 35 years of involvement in Chinese medicine), but also of his enthusiasm for his subject and the sincerity of his desire to assist and inspire effective healing. Dr Huang comes across as a gentle and very generous teacher, leading us carefully from formula to formula, as if along stepping stones, setting out the various presentations and contrasting them with others in the same family so as to highlight their distinguishing features. He also provides an abundance of crosscomparisons with formulas from other families that match similar presentations. I personally find these particularly helpful. The careful description of the tongue pictures associated with the various constitutions and presentations and the inclusion of detailed abdominal diagnostic information are also most welcome.

Each chapter gives a brief account of the pharmacological effects of the heads of the various formula families. These sections occasionally provide some rather disturbing insights into the type of laboratory research into Chinese medicinals that is being conducted (presumably in China, though one can’t say for sure as no references are given for these sections). The paragraph on pharmacological research in the Aconite Formula Family chapter, for example, concludes with the following clang: “There is also documentation of Aconiti Radix lateralis preparata (zhì fù zǐ) having analgesic effects in experiments that involved the application of electrical shocks to the tails of rats.” One wonders who is trying to prove what, to whom, and for what purpose? And what would, for instance, Sūn Sī-Miǎo have made of this brave new world?

For me, one of the delights of this book is the way Dr Huang elucidates phrases such as “epigastric focal distention” and “alternating chills and fevers.” It is always a pleasure to encounter these “ah ha!” moments when things which had been faintly puzzling or only vaguely comprehended are picked up and reexamined by an expert with such clear light.

The translator, Michael Max, appears to have done a fine job; the text flows easily with a nice light tone. He also deserves thanks for securing an ‘upgrade’ for this English edition by including in it insights garnered both from his association with Dr Huang in clinic and during the clarification of points of the translation. I must, however, lodge a grumble about the way the herbs and formulas are named, with the Latin pharmacological term taking precedence over the pīnyīn (which trails behind imprisoned in brackets) and asserting its dominance long-windedly on each and every occasion. Someone somewhere has decided that this is a Good Thing, but it certainly makes for a clumsy “reading experience.” A single page in the zhì fù zǐ chapter, for instance, forces our eyes to stumble and trip over “Aconiti Radix lateralis preparata (zhì fù zǐ)” nine times in three paragraphs. Enough already! The very first words of this chapter have established that Aconiti Radix lateralis preparata = zhì fù zǐ. Surely thereafter the brevity of the pīnyīn should suffice? Or if the editors think we’re in danger of forgetting this equation, then OK, repeat it for the first occurrence in each section and/ or provide a cross-reference appendix. Such relentless pharmacologicalisation discombobulates.

On the positive side, I raise a heartfelt hallelujah for the inclusion of the pīnyīn tone markings, without which we’re all at sea with the sounds and will surely sink as soon as we open our mouths. The book concludes with a brace of appendices. The first (Formulas Arranged by Disease Names) lists biomedicallydefined diseases along with formulas that may be associated with them; the second (Basic Formulary for Important Symptoms) lists the formulas appropriate for a number of key symptoms, beginning with “Appetite, poor” and ending with “Wind, aversion to.” Questions might be raised about the thoroughness of these appendices. Frigid Extremities Decoction plus Ginseng (sì nì jiā rén shēn tāng), for example, is not included in the Diarrhoea category, despite the formula’s cartoon illustration which clearly suggests that it should have been. Appendices such as these, however, will always offer fertile ground for carpers with time on their hands. But they may serve for some as a starting point at least and, in my view, the book is better off with them than without.

Finally, it will not have gone unnoticed by readers in the UK that the heads of three of the 10 formula families presented in this book - má huáng, shí gāo and zhì fù zǐ – are off limits. So I close with a hopeful prayer that we will soon have returned to us the ability to call on these and other currently exiled medicinals to assist our work as responsible practitioners seeking the best possible medicine for our patients.

Dominic Harbinson