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Chapter Eight
Drugs and Prescriptions

The pharmic theories of Sinomedicine were summed up through long medical practice according to the theories of yin and yang, five elements ,viscera-state , meridians and others.

Pharmacy of Sinomedicne mainly includes the contents of nature , function ,contraindication, dosage, usage, classification and compatibility of drugs,as well as prescriptions and others .

1.Drugs

The nature ,function ,contraindication and classification of drugs are discussed mainly in this section .

[1].Nature and Function of Drugs

(1).Four Natures

A.Outline Four natures refers to that drugs have four different natures , that is , cold , hot , warm and cool . Some drugs have mild nature , and cold and hot tendencies of these drugs are not obvious , so it is called neutral nature .

Four natures are summarized according to the different responses and curative effects occurring after action of the drugs on human body. The drugs which can clear away heat and toxic materials , cool the blood , and purge fire ,being used to treat heat-syndrome are mostly cold-natured or cool-natured ; the drugs which can eliminate cold-evil , warm the interior , strengthen yang , and invigorate vital energy , being used to treat cold-syndrome are mostly warm-natured or hot-natured .

(2).Five Flavours

A.Outline Five flavours refer to acrid ,sweet ,sour , bitter and salty flavours . Some drugs also have bland flavour or astringent flavour .

Acrid flavour : Having the effects of dispersing , promoting vital energy circulation , promoting blood circulation , or moisturizing and nourishing ,and others.

Sweet flavour : Having the effects of invigorating , regulating the middle warmer , relieving spasm ,and others .

Sour flavour : Having the effects of inducing astringency and arresting discharge .

Astringent flavour : Having the same effects as sour flavour .

Bitter flavour : Having the effects of relaxing the bowels to expel interior-heat , sending down the adverse flow of vital energy to expel heat-evil , clearing away heat , depriving evil wetness ,and fortifying yin .

Salty flavour : Having the effects of softening hard lumps , dispelling nodes , purgating and others .

Bland flavour : Having the effects of eliminating wetness and promoting diuresis .

Many drugs have more than one flavour . The effects of the drugs with more than one flavour are more complicated .

Every drug has nature and flavour . Only considering both nature and flavour of a drug can we overall understand and correctly use this drug .

(3).Channel Trapism

A.Outline Linking the effects of a drug with the relation of the zang-organs or fu-organs and the channels to explain the treating effects of this drug to pathological changes of the certain zang-organs , fu-organs or channels ,is called channel tropism .

In " Emperor's Canon of Medicine " ,the discussion on " five kinds of entering " and " five kinds of going " , was recorded . " Five kinds of entering " is : sour flavour enters the liver , bitter flavour enters the heart , sweet flavour enters the spleen , acrid flavour enters the lung ,and salty flavour enters the kidney . " Five kinds of going " is : sour flavour goes to the tendon , acrid flavour goes to the vital energy , bitter flavour goes to the blood , salty flavour goes to the bone , and sweet flavour goes to the muscle .

Determination of channel tropism of most drugs bases on the treating effects of the drugs .

Some drugs which can guide potency of other drugs to reach the regions of pathological changes or the certain channels are called channel guiding drugs .

(4).Lifting , Lowering , Floating and Sinking

A.Outline Lifting , lowering ,floating and sinking refer to the tendencies of action of the drugs . The drugs with different tendencies of action can perform regulation to different tendencies of syndromes .

Generally speaking ,upward and outward actions are called lifting and floating , downward and inward actions are called sinking and lowering . These actions of the drugs have close relation with the factors , such as natures and flavours of the drugs , thickness or thinness of odour and flavour of them ,light or heavy qualities of them , methods of preparation of the crude drugs , compatibility and prescription of the drugs , and others .

For natures and flavours of drugs , the acrid ,sweet and warm drugs have the effects of lifting and floating ; the bitter , sour , salty , cold and cool drugs have the effects of sinking and lowering . For thickness or thinness of odour and flavour , among the acrid and warm drugs ,those with thin odour can mostly promote sweating to expel exogenous evils from body surface and lifting up yang energy , while those with thick odour can mostly warm the interior and expel cold ; among the bitter , salty and cold drugs , those with thick flavour can mostly clear away heat and purge while those with thin flavour can mostly promote downward movement and discharge of feces and urine .

For light or heavy quality of drugs , flowers and leaves of plants have lighter , quality and they can mostly lift and float , seeds and fruits of plants , and minerals have heavier quality and sticky and greasy nature , and they can mostly sink and lower.However ,there are exceptions to this rule ,for example , Flos Inulae is flower , but it can lower;Fructus Arctii is fruit , but it can lift .

For methods of preparation of the crude drugs ,the drugs prepared with alcohol have the effect of lifting ; those prepared with ginger juice ( Succus Zingiberis ) have the effect of dispersing ; those prepared with vinegar have the effect of astringing ; those prepared with salt have the effects of going to the kidney and travelling downwards.

For compatibility of the drugs , when a lifting or floating drug is matched with a series of sinking and lowering drugs ,the former can also fall with the latter ; when a sinking or lowering drug is matched with a series of lifting or floating drugs ,the former can also rise with the latter.

[2].Contraindication of Drugs

Contraindication of drugs includes contraindication of drugs incompatibility,contraindication of drugs in pregnancy and contraindication of foods in drugs' taking . Contraindication of drugs in pregnancy and contraindication of foods in drugs' taking will be discussed here mainly.

(1).Contraindication of Drugs in Pregnancy

A.Outline The drugs which are harmful for pregnancy can be divided into two kinds ,that is , the drugs contraindicated and those used with caution .

The drugs contraindicated are mostly the drugs with stronger toxicity or those with more violent effects . The drugs used with caution are mostly the drugs with violent effects or those with mild toxicity.

The drugs contraindicated can not be used absolutely; the drugs used with caution must be used according to the gravida's condition properly , but if it is not necessary , usage of these drugs must be avoided as far as possible.

B.Principle The drugs contraindicated and those used with caution are mostly toxic , biological activity of these drugs is stronger , and they can cause contraction of the smooth muscle of the uterus and violent change of bloodflow of the uterus ,resulting in abortion or premature labour,or being harmful for development of the fetus .

[3].Classification of Drugs

(1).Drugs for Expelling Superficial Evils

The drugs which can disperse superficial evils and relieve superficies-syndrome are called drugs for expelling superficial evils .

Among drugs of this kind ,the drugs which are acrid and warm, have the effect of dispersing wind-cold evil,and are applicable to superficies-syndrome due to wind-cold evil are called drugs with acrid flavour and warm nature for expelling superficial evils,the drugs which are acrid and cool, have the effect of dispersing wind-heat evil,and are applicable to superficies-syndrome due to wind-heat evil are called drugs with acrid flavour and cool nature for expelling superficial evils.

In addition ,a part of drugs for expelling superficial evils also have the effects of leting out measles , subsiding swellings , dispersing sores and others,and these drugs are used in the patients of appearance early and disturbance of appearance of measles ; those of superficies-syndrome with unfestered sores,and redness,tumescence,pain and edema ,as well as aversion to cold ,and fever ; and those with wind-wetness evil in the superficies and pain of the trunk and extreminties.

The common drugs with acrid flavour and warm nature for expelling superficial evils are Herba Ephedrae , Ramulus Cinnamomi , Herba Schizonepetae , Radix Ledebouriellar , Radix Angelicae Dahuricae , Herba Asari , Rhizoma seu Radix Notopterygii , Rhizoma ligustici and others . The common drugs with acrid flavour and cool nature for expelling superficial evils are Herba Menthae , Periostracum Cicadae , Fructus Arctii , Folium Mori , Flos Chrysanthemi , Radix Bupleuri , Radix Puerariae , Fructus Viticis , Semen Sojae Praeparatum , Rhizoma Cimicifugae and others .

(2).Drugs for Purging

The drugs which can cause diarrhea or lubricate the large intestine and promote defecation are called drugs for purging.

The drugs for purging can be divided into three kinds, that is , drugs for purging to eliminate evils,drugs for lubricating intestinal tract and promoting defecation ,and drugs for potently purging and expelling water.

The common drugs for purging to eliminate evils are Radix et Rhizoma Rhei , Folium Cassiae , Aloe , Natrii Sulfas and others . The common drugs for lubricating intestinal tract and promoting defecation are Fructus Cannabis , Semen Pruni , Mel and others . The common drugs for potent purging and expelling water are Radix Euphorbiae Kansui , Flos Genkwa , Semen Pharbitidis and others .

(3).Drugs for Eliminating Wind-wetness Evil

The drugs which can eliminate wind-wetness evil and treat arthralgia-syndrome are called drugs for eliminating wind-wetness evil.

The common drugs for eliminating wind-wetness evil are Radix Angelicae Pubescentis , Radix Clematidis , Cortex Acanthopanacis Radicis , Ramulus Mori , Fructus Chaenomelis , Rhizoma Homalomenae and others .

(4).Drugs for Resolving Wetness and Promoting Diuresis

The drugs with fragrance which can expel wetness evil and the drugs which can promote diuresis and filtrate wetness evil are called drugs for resolving wetness and promoting diuresis.

The common drugs with fragrance for expelling wetness evil are Herba Agastachis , Herba Eupatorii , Fructus Amomi , Rhizoma Atractylodis and others . The common drugs for promoting diuresis and filtrating wetness evil are Poria , Polyporus Umbellatus , Rhizoma Alismatis , Semen Coicis , Semen Plantaginis , Caulis Akebiae , Herba Lysimachiae , Spora Lygodii and others .

(5).Drugs for Warming the Interior

The drugs which have hot-nature or warm-nature and treat internal cold syndrome are called drugs for warming the interior.

The common drugs for warming the interior are Radix Aconiti Praeparata , Cortex Cinnamomi , Rhizoma Zingiberis , Fructus Evodiae , Frutus Foeniculi , Flos Syzygii Aromatici and others .

(6).Drugs for Clearing away Heat

The drugs which have cold-nature or cool-nature and take clearing away internal heat as their main effect are called drugs for clearing away heat.

According to properties of the drugs,the drugs for clearing away heat can be divided into four types,that is,drugs for clearing away heat and purging fire,drugs for clearing away heat and toxic materials,drugs for clearing away heat and depriving wetness evil, and drugs for clearing away heat and cooling the blood.

The common drugs for clearing away heat and purging fire are Gypsum Fibrosum , Rhizoma Anemarrhenae , Frutus Gardeniae , Rhizoma Coptidis , Radix Scutellariae , Cortex Phellodendri , Spica Prunellae , Radix Sophorae Subprostratae and others . The common drugs for clearing away heat and toxic materials are Flos Lonicerae , Frutus Forsythiae , Radix Isatidis , Herba Taraxaci , Herba Oldenlandiae Diffusae and others . The common drugs for clearing away heat and depriving wetness evil are Herba Artemisiae Scopariae , Frutus Bruceae , Radix Pulsatillae and others . The drugs for clearing away heat and cooling the blood are Radix Rehmannia , Radix Scrophulariae , Cortex Moutan Radicis , Cortex Lycii Radicis and others .

(7).Drugs for Regulating Qi(Vital Energy)

The drugs which can regulate functional activities of vital energy and relieve stagnation of vital energy are called drugs for regulating qi (vital energy).

The common drugs for regulating qi are Cortex Magnoliae Officinalis , Pericarpium Citri Reticulatae , Pericarpium Citri Reticulatae Viride, Fructus Aurantii Immaturus , Radix Aucklandiae , Radix Linderae , Radix Curcumae , Rhizoma Corydalis , Fructus Citri Sarcodactylis and others .

(8).Drugs for Regulating Blood Condition

The drugs which can stop bleeding, dredge the blood vessels,and disperse blood stasis are call drugs for regulating blood condition.The drugs for regulating blood condition generally can be divided into four types , that is , drugs for activating blood circulation to dissipate blood stasis , drugs for stopping bleeding , drugs for enriching the blood and drugs for cooling the blood.The drugs for activating blood circulation to dissipate blood stasis and the drugs for stopping bleeding are discussed mainly in this section.

The common drugs for activating blood circulation to dissipate blood stasis are Rhizoma Ligustici Chuanxiong , Radix Salviae Miltiorrhizae , Flos Carthami , Semen Persicae , Commiphora Myrrha , Rhizoma Sparganii , Rhizoma Zedoariae , Herba Leonuri , Radix Achyranthis Bidentatae , Caulis Spatholobi , and others . The common drugs for stopping bleeding are Rhizoma Imperatae , Cacumen Biotae , Flos Sophorae , Radix Notoginseng , Radix Rubiae , Nodus Nelumbinis Rhizomatis , Herba Agrimoniae , Rhizoma Bletillae and others.

(9).Drugs for Elimination Sputum,Relieving Cough and Asthma

The drugs which can eliminate sputum are called drugs for eliminating sputum.Drugs of the type can alleviate or inhibit cough and asthma,therefore,these drugs are also called drugs for relieving cough and asthma.

According to their natures and effects, these drugs can be divided into three types,that is,drugs with warm-nature for eliminating cold-sputum , drugs with cold-nature for eliminating hot-sputum , and drugs for relieving cough and asthma.

The common drugs with warm-nature for eliminating cold-sputum are Rhizoma Pinelliae , Rhizoma Arisaematis , Semen Sinapis Albae , Flos Inulae , Rhizoma Typhonii and others . The common drugs with cold-nature for eliminating hot-sputum are Fructus Trichosanthis , Bulbus Fritillariae , Caulis Bambusae in Taeniam , Radix Platycodi , Radix Peucedani and others . The common drugs for relieving cough and asthma are Semen pruni Armeniacae , Fructus Perillae , Radix Stemonae , Flos Farfarae , Cortex Mori Radicis and others .

(10).Drugs for Invigorating

The drugs which can invigorate and nourish insufficiency of vital energy , blood , yin and yang of human body and be used to treat asthenia-syndrome are called drugs for invigorating. These drugs can be divided into four types , that is , drugs for invigorating vital energy,drugs for invigorating yang,drugs for enriching the blood, and drugs for invigorating yin.

The common drugs for invigorating vital energy are Radix Ginseng , Radix Codonopsis Pilosulae , Radix Astragali seu Hedysari , Rhizoma Dioscoreae , Rhizoma Atractylodis Macrocephalae , Radix Glycyrrhizae and others . The common drugs for enriching the blood are Radix Angelicae Sinensis , Rhizoma Rehmanniae Praeparatae , Radix Paeoniae Alba , Radix Polygoni Multiflori , Placenta Hominis and others . The common drugs for invigorating yin are Radix Glehniae , Radix Ophiopogonis , Fructus Lycii , Fructus Corni , Fructus Ligustri Lucidi , Bulbus Lilii , Radix Panacis Quinquefolii , Rhizoma Polygonati and others . The common drugs for invigorating yang are Herba Cistanchis , Herba Epimedii , Cortex Eucommiae , Radix Dipsaci , Fructus Psoraleae , Herba Cynomorii , Cordyceps and others .

(11).Drugs for Relieving Muscular Spasm and Tranquilizing the Mind

The drugs which take calming the liver to stop wind, promoting sedation and relaxing muscular spasm as their main effects are called drugs for relieving muscular spasm.The drugs which have the effects of promoting sedation and tranquilizing the mind are called drugs for tranquilizing the mind.

The common drugs for relieving muscular spasm are Rhizoma Gastrodiae , Margarita , Concha Haliotidis and others . The common drugs for tranquilizing the mind are Cinnabaris , Magnetitum , Succinum , Semen Ziziphi Spinosae , Semen Biotae , Radix Polygalae , Cortex Albiziae and others .

(12).Drugs for Waking up from Unconsciousness

The drugs which have fragrant odour,are good at going along the channels , and take loosening the lockjaw and waking up from unconsciousness as their main effects are called drugs for waking up from unconsciousness.

The common drugs for waking up from unconsciousness are Moschus , Borneolum Syntheticum , Rhizoma Acori Graminei , Calculus Bovis and others .

(13).Drugs for Promoting Digestion

The drugs which can relieve indigestion and strengthen appetite are called drugs for promoting digestion.

The common drugs for promoting digestion are medicated leaven , Fructus Crataegi , Semen Raphani , Fructus Hordei Germinatus and others .

(14).Drugs for Expelling Parasites

The drugs which can expel or kill the enterozoa are called drugs for expelling parasites.

The common drugs for expelling parasites are Fructus Quisqualis , Semen Arecae , Fructus Mume , Cortex Meliae , Omphalia and others .

(15).Drugs for Astringing

The drugs which take astriction as their main effect are called drug for astringing.

The common drugs for astringing are Fructus Schisandrae , Semen Myristicae , Fructus Rosae Laevigatae , Semen Nelumbinis , Os Draconis , Concha Ostreae and others .

(16).Drugs for Being Used Externally

The drugs which take dressing ,smearing ,fuming or washing , vesiculating , dropping into the eye , insufflating in the throat , dropping into the ear as their main methods of usage are called drugs for being used externally.

The drugs for being used externally have the effects of detoxifying , detumefying,removing necrotic tissues , draining pus , promoting tissue regeneration , astringing sore , killing parasites, alleviating itch , and others separately.

The common drugs for being used externally are Realgar , Calomelas , Lithargyrum , Alumen and others .

(17).Drugs for Inducing Emesis

The drugs which have the effect of causing vomit are called drugs for inducing emesis.

The common drugs for inducing emesis are Pedicellu Melo , Radix Dichroae , Chalcanthitum and others .

2.Compatibility of Drugs and Prescriptions

[1].Relation of Compatibility

Usage of more than two drugs together is called compatibility.Certain rules can be found in compatibility of drugs . In "Shennong's Pharmacopoeia " ,the relations of various drugs were summarized as seven types , that is , single drugs,mutual promotion,mutual support,weakening of toxicity,counteraction of toxicity by another drug,weakening of effect by another drug and enhancement of toxicity by another drug, which are called "seven consequences".

A.Going lonely:One drug performs effect lonely.
B.Needing each other:When two drugs with same nature and effect are used together, these drugs can produce synergy, and this enhance curative effect.
C.Being guide each other:When two drugs with different natures and effects are used together, these drugs can support each other, this enhance curative effect.
D.Restricting each other:When two drugs are used together,a drug can inhibit or lighten violence or toxicity of another drug.
E.Weakening each other:When two drugs are used together, a drug can lighten or eliminate intoxication or harmful reaction of another drug.
F.Taking aversion to each other:When two drugs are used together , these drugs can inhibit each other , and one drug can cause weakening or loss of effect of another drug.This is a kind of contraindication of compatibility of drugs.
G.Opposing each other : When two drugs are used together, deleterious effect occurs.This is a kind of contraindication of compatibility of drugs.

[2].Incompatibility of Drugs

In relation of compatibility, "taking aversion to each other" and "opposing each other" belong to incompatibility of drugs,and the drugs can not be used together in prescriptions . The predecessors have summarized incompatibility of drugs as " opposition among eighteen drugs" and "aversion among nineteen drugs".

A.Opposition among eighteen drugs :

Radix Aconiti opposes Rhizoma Pinelliae , Fructus Trichosanthis , Bulbus Fritillariae Thunbergii , Radix Ampelopsis and Rhizoma Bletillae ;

Radix Glycyrrhizae opposes Radix Knoxiae , Radix Euphorbiae Kansui , Sargassum and Flos Genkwa;

Veratrum opposes Radix Ginseng , Radix Adenophorae Strictae , Radix Salviae Miltiorrhizae , Radix Sophorae Flavescentis,Radix Scrophulariae,Herba Asari and Radix Paeoniae.

B.Aversion among nineteen drugs:

Sulfur dislikes sodium nitrite;
Mercury dislikes Arsenicum;
Radix Euphorbiae Ebracteolatae dislikes Lithargyrum;
Fructus Crotonis dislikes Semen Pharbitidis;
Flos Syzygii Aromatici dislikes Radix Curcumae;
Mirabilite dislikes Rhizoma Sparganii;
Radix Aconiti Kusnezoffii and Radix Aconiti dislikes Cornu Rhinoceri;
Cortex Cinnamomi dislikes Halloysitum Rubrum.

[3].Composition of Prescriptions

Prescription is the recipe composed by choosing drugs,determine proper dosage and following certain principles of compatibility of drugs under guidance of the theories of Traditional Chinese Medicine, on the basis of choosing methods of treatment according to differentiation of syndromes,and according to the need of state of diseases.

In tradition,composition of a prescription includes four parts,that is,monarch,minister,assistant and guide.

Monarch is the drugs which treat main syndrome and perform main effect in a prescription.

Minister is the drugs which assist the main drugs and strengthen the effect of the main drugs.

Assistant is the drugs which assist the main drugs to treat the auxiliary syndrome,or inhibit toxicity and violence of the main drugs,or assist the main drugs oppositely.

Guide is the drugs which guide various drugs to the region of pathological changes directly,or mediate various drugs.

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