Research On History Of Compatibility Theory Of TCM Prescription

In the pharmacotherapy of Traditional Chinese Medicine(TCM), the numerous prescriptions are the crystallizations of clinical experiences of physicians of past generations. The prescriptions of TCM consist of appropriate drugs which properly combined together according to the principles of prescriptions to determine the dosage and usage after the syndrome differentiation and pathogenic examinations as well as therapeutic determinations,and the compatible theory is one of the important components.The original meaning of fang (方) in medicine without special texture research yet. In the book "Shuo Wen Jie Zi" of Xu Shen in Han dynasty,it interpreted as "the ships side by side". The emergence of fang in TCM demonstrated that the medications came to a higher stage of mutual compatibilities. The most ancient name of prescription is "decoction". The early literature such as one paragraph in "Zhuangzi -Xiaoyao you" had clearly manifested that fang already had the connotation of prescriptions. Ji (剂) ,generally as qi(齐) in eary time,refered to medicament combined with diverse drugs."Compatibility" is a modern term,while in ancient time,was replaced as "mediating recipe" and and other words of similar meaning.According to the above. "Compatibility" recorded in the book "The Terminology of TCM" is the method of application of drugs according to the purpose of the treatment and characteristics of medicine property, selecting the appropriate application of theoretical principles" .The theory refers to the system of concept and principle which is a systematic rational cognition. Based on such above concepts, the compatibility criteria seletion of this article relating to the compatible theory is:On the premise of certain principles and methods,making investigation in the subject of selecting drugs according to some theory to compose effective prescription in the level of medicine and prescription; the compatible theory clearly recorded in the past prescription books (before 1840) which had complete systems; new prescriptions created according to some compatible theory which also applied to explaining part of prescriptions in the past prescription books."sovereign,minister,assistant and courier" is one important component of prescriptions compatible theory of TCM. The earlist discussion on the connotation of "sovereign,minister,assistant and courier" recorded in "Suwen·Zhizhenyao Dalun" (Plain Questions·Disscussion on the Most Important and Abstruse Theory) is "The drugs for treating disease are called the sovereign drugs;the drugs for assisting the sovereign drugs are called the Minister drugs;and the drugs corresponding to the Minister drugs are called the courier drugs."In addition,Shennongbencaojing(Shennong's Classic of Materia Medica)"recorded that the top grade drug called sovereign drug, medium grade drug called minister drug,low grad drug called assistant and courier drugs,which demonstrated the classification method of good and bad."Fuxingjue Zangfu Yongyao Fayao "recorded 360 pieces of prescriptions such as prescriptions of nourishment as well as that of treating disease and eliminating pathogenic factors, killing germs, exorcising evil spirits and treating superficial infections which were created after the differentiation of "sovereign,minister,assistant and courier" by the method of three grades classifications in Shennongbencaojing(Shennong's Classic of Materia Medica)".In "sovereign,minister,assistant and courier",sovereign drug is the most principal and indispensable.Making texture research on the past literatures,we can find sovereign drug of prescription recorded in past literatures have different meanings and quantities which including nine kinds of different meanings: "Suwen·Zhizhenyao Dalun ( Plain Questions·Disscussion on the Most Important and Abstruse Theory) :"the drugs for treating disease are called the sovereign drugs ","Shennongbencaojing(Shennong's Classic of Materia Medica)":"top grade drugs are called sovereign drugs". "Fuxingjue Zangfu Yongyao Fayao ":"the drugs dominate reinforcing and reducing are called sovereign drugs.""Yaoxinglun"(Treatise on medicinal property):"the drugs for harmonizing are called sovereign drugs.""Zazhubencao" (Miscellaneous Notes of Materia Medica):" the drugs for treating Yin disease are called sovereign drugs.""Yixue Qiyuan"(the origin of medicine): "the drugs with the most quantities are called sovereign drugs.""Piweilun·Junchenzuoshifa"(Treatise on the spleen and stomach·the method for sovereign,minister,assistant and courier): sovereign drug is the most powerful one. "Tujing Beiyao Bencao Shijue" stipulate some drug as sovereign drug;"Yilun·Douzhenfawei"(Treatise on medicine·Revealing the mystery of the exanthema variolosum:"the sovereign drugs varied from different years."There is usually one sovereign drug in the prescription before the song dynasty. But it is not limited to just one, which changed a lot until Jin and Yuan dynasties. The prescription book of Ming dynasty followed this change that the amount of the sovereign drugs had already turned into two or three. Even taking the decoction for sovereign drugs.The prescription according to "Fuxingjue Zangfu Yongyao Fayao" was recorded from "Tangye Jingfa" of Yiyin. At the same time, the book also stated that the prescription of Zhongjing originated from "Tangye Jingfa".By making comparison with the prescription in "Fuxingjue" and prescription book of Zhongjing by modern scholars,it had similar origin:Tangye Jingfa.and the thirteen pieces of prescriptions for treating exogenous epidemics which were recorded in Fuxingjue can find similar ones in Shanghanlun(Treatise on Cold Damage Disease) and Jinguiyaolue(Synopsis of Prescription of the Golden Chamber) of Zhangzhongjing.Making comparison with the sovereign drug in the two books,we can find the sovereign drug in Dayindan Tang (decoction of Dayindan) and Xiaochaihu Tang (decoction of Bupleurum tenue Buch) were all Bupleurum root.Xiaozhuniao Tang(decoction of small red bird) and Huanglian Ajiao Tang(decoction of coptidis rhizome and colla corii asini) were found different in sovereign drug: Xiaozhuniao Tang(decoction of small red bird) took fresh egg yolk as sovereign drug while Huanglian Ajiao Tang(decoction of coptidis rhizome and colla corii asini) took coptidis rhizome and Radix Scutellariae as dominant drugs, fresh egg yolk is only:"assist coptidis rhizome and Radix Scutellariae in purging heart."Taohongjing stated that although it was novel to make adjustments to the prescriptions in Tangye Jingfa(Classic and method of decoction) by Zhangzhongjing, he did not agree to the arbitrary action.Lizhong Wan was originated from Shanghanlun(Treatise on Cold Damage Disease).Some hold that the sovereign drug of this prescription is ginseng such as" Shanghan Minglilun" of Cheng wuji in Jin dynasty,Danxi Shoujing of Zhu zhenheng of Ming dynasty.The conception of assistant and courier drugs were different in past dynasties.The function of assistant drug includes right assistant and reverse assistant.The meaning of reverse assistant of modern times includes restrained action and corrigent action,that is:applying the herb that is opposite to the nature and flavor of sovereign herb so as to eliminate or decrease the toxic or drastic action of sovereign and minister herbs.There are two kinds of courier drugs such as meridian-guiding herb and mediating herb which have the function of guiding the herbs in the prescription to the site of disease and harmonizing all the herbs.The nature of medicinals had already been recorded in Shennongbencaojing(Shennong's Classic of Materia Medica) which have different connotations in ancient and modern times.The meaning of nature of medicinals in Shennongbencaojing refers to four qi and five flavors while had different meaning of nature and efficacy of medicinals in Zhonghuabencao(Chinese materia medica) such as four qi and five flavors,ascending,descending,floating and sinking,meridian entry etc."Flavor" was early emerged in Bencaojingjizhu(Variorum of the Classic of Materia Medica) of TAO Hong-jing of Liang dynasty.The flavor compatibility which was recorded in Huangdineijing(Huangdi's Inner Classic) was explained mainly associated with the theory of six qi excess.and the scholars of past dynasties elaborated in details on the flavor theory.The compatible theory of thickness and thinness of flavors,yin and yang,ascending and descending was also recorded in Huangdineijing(Huangdi's Inner Clssic) which was connected with specific herbs and prescriptions by LIU Wan-su of Jin dynasty.ZHANG Yuan-su of Jin dynasty elaborated on the relationship between thickness and thinness of flavors,yin and yang,ascending and descending and discussed the relationship between the nature and flavor of herbs and ascending and descending.LI Dong-yuan of Jin dynasty connected thickness and thinness of flavors,yin and yang with specific five flavors. and the scholars of past dynasties developed the theory.The compatible theory of tonification and purgation of five zang and five flavors was recorded in Suwenzangqifashilun which was applied to explain the compatibility of prescription by Fuxingjuezangfuyongyaofayao of TAO Hong-jing in Liang dynasty.ZHANG Yuan-su of Jin dynasty added four qi of herbs and corresponding herbs on the basis of the theory. and the scholars of past dynasties developed the theory.Meridian entry was a site-specific conception refers to the alternative function of herbs to some position of the body which was early recorded in Bencaoyanyi of KOU Zong-shi of Song dynasty and put forward officially as one component of medical theory by ZHANG Yuan-su of Jin dynasty whose medical book:Zhenzhunang raised up the theory of guiding action of herbs.Many physicians of later ages inherited and developed his meridian entry theory.Seven relationships of Chinese materia medica refers to using a single drug,mutual assistance,mutual reinforcement,mutual restraint,mutual suppression,mutual inhibition and mutual adverse which first emerged in Shennongbencaojing(Shennong's Classic of Materia Medica).Mutual reinforcement refers to the compatible relations of applying the Chinese materia medica with similar nature and flavors together so as to increase the efficacy. Mutual assistant refers to the relations that the nature and flavor of Chinese materia medica is the same or similar, different nature and flavor of herbs can be matched together,one is the principal,the other is the subordinate so as to increase the efficacy of principal herbs.Mutual inhibition refers to the compatible relations that one herb can decrease even eliminate the original efficacy of another; mutual restraint refers to the compatible relations that the toxic reaction or side effect of one herb can be decreased or eliminated by another;mutual adverse refers that using two kinds of herbs together can generate or increase the toxic reaction or side effect;mutual suppression refers that one drug can decrease or eliminate the toxic reaction or side effect of another.The compatibility of mutual restraint was seldom recorded in the medical literatures of past dynasties.The theory of "eighteen antagonisms" and"nineteen inhibitions"of materia medica evolved during the past dynasties.Throughout the history of the development of traditional Chinese medicine,In addition that the prescription originated from Chinese materia medica,the part of theory of formula study also originated from the related theory of traditional Chinese pharmacy.For example,"ten prescriptions" is derived from "ten kinds of materia medica".The compatibility of Chinese materia medica is derived from "seven relationships" recorded in Shennongbencaojing(Shennong's Classic of Materia Medica),that is: using a single drug,mutual assistance,mutual reinforcement,mutual restraint,mutual suppression,mutual inhibition.However,the compatible theory of prescriptions is not equivalent to the seven relationships compatible theory of Chinese materia medica,including such compatible theory as "sovereign,minister,assistant and courier" and nature of medicinals.Seven relationships compatible theory of prescriptions developed on the basis of seven relationships compatible theory of Chinese materia medica.The nature of medicinals compatible theory of prescriptions is based on the nature of medicinals; the "sovereign,minister,assistant and courier" compatible theory of prescriptions is based on the efficacy of medicinals.In the medical literatures of past generations,the three kinds of compatible theory of prescriptions used either alone,both or triply to explain the compatible theory of prescriptions.Making research on the medical literatures of past dynasties can find that the "sovereign,minister,assistant and courier" compatible theory of prescriptions not only related to the social structure but also to the theory of military and messuage.In conclusion,before the Han dynasty,the treatise on the prescription compatibility was mainly recorded in Huangdineijing(Huangdi's Inner Classic) and Shennongbencaojing(Shennong's Classic of Materia Medica)".There are some theories such as "sovereign,minister,assistant and courier",qi and flavor,six qi excess,thickness and thinness,yin and yang,ascending and descending of flavor,tonification and purgation of five zang and five flavors,principal and subordinate,engendering and restraining of five phases recorded in Huangdineijing(Huangdi's Inner Classic).There are some theoies as flavor and seven relationships recorded in Shennongbencaojing(Shennong's Classic of Materia Medica)".Fuxingjuezangfuyongyaofayao of TAO Hong-jing of Liang dynasty recorded the prescription compatible theories of "sovereign,minister,assistant and courier" and tonification and purgation of five zang and five flavors.Taiyijuzhukechengwen of Song dynasty dicussed the main and secondary compatibility.LIU Wan-su of Jin dynasty elaborated on the therapeutic principle of six qi excesses and supplement the medicinals,associated the thickness and thinness,yin and yang,ascending and descending of flavor with specific medicinals and prescriptions.Zhang Yuan-su of Jin dynasty created the theory of guiding meridian.LI Gao of Jin dynasty associated the theory of principal and subordinate with prescription compatibility;WANG Shi-shan of Ming dynasty applied the theory of principal and subordinate to explain the prescription compatibility.After the determination of pathogenesis,mechanism and syndrome of disease,the compatibility of "sovereign,minister,assistant and courier" determine the sovereign,minister,assistant and courier medicinals.The nature of medicinal compatibility mainly select medicinals combined as prescription in accordance with the nature and flavor of medicinals according to the related therapeutic principle and method in Huangdineijing(Huangdi's Inner Classic).Such above compatible methods were early applied to explain the compatibility of Zhongjing's prescriptions in Shanghanminglilun of CHENG Wu-ji in Jin dynasty.On the basis of texture research of medical literatures of past generations,we conclude the prescription compatible theory with complete context and theory,that is: "sovereign,minister,assistant and courier",nature of medicinal,seven relationships.After the determination of therapeutic theory and method,the general process of formulating prescription according to the compatible theory is to determine the "sovereign,minister,assistant and courier"drugs in terms of efficacy as well as applied disease and syndrome of medicinals,the most important of which is the determination of sovereign drug that is not limited to just one but many,the efficacy of which correspond with the disease and syndrome. After Selecting the appropriate nature of medicinals of sovereign drug in the areas according to the compatible theory of nature of medicinals, determine the "minister,assistant and courier" drugs in accordance with"The drugs for treating disease are called the sovereign drugs;the drugs for assisting the sovereign drugs are called the minister drugs;and the drugs for corresponding to the minister drugs are called the courier drugs."If there are three or four herbs in the prescription,we can consider the "seven relationships" compatibility so as to harmonize the herbs to curing disease.