There are two major trends in formulation style when it comes to granule extracts. In Taiwan, most practitioners create a granule prescription by using one or more pre-made base formulas that have been decocted together, often with single herb additions. By contrast, in mainland China, most practitioners mix single herb extracts to create their desired formula and rarely start with pre-made base formulas when using granules. In the West, we tend to use a hybrid approach- some practitioners start from whole base formulas and others elaborate the formula purely based on singles.
These two broad approaches each have their adherents and arguments, and often people have a very strong opinion as to which method is superior. As in many situations where opinions run strong and clinical trends vary based upon region and culture, it is difficult to make any blanket proclamation that one method is inherently superior, though each practitioner tends to find their own preference and comfort zone. Given the fact that millions of patients have been successfully treated with both approaches, it seems reasonable to suggest that both have merit and clinical efficacy.
Part One: The Merits of Base Formulas
The case for using base formulas that have been cooked together is primarily based on the notion that preserving the interaction of the ingredients at the cooking stage is important. Historically, most formulas were administered by decoction and the herbs were decocted together. Thus, the historical evidence base of Chinese medicine presumes that the ingredients interact in the cooking process.
Many potential examples of herb interactions can be found in the traditional literature, such as the cooking of Da Huang with Gan Cao, the cooking of Wu Tou with honey, or the cooking of Fu Zi with Gan Cao and Gan Jiang (these combinations are thought to moderate the nature of the sovereign ingredient). Modern research has also demonstrated differences in the HPLC fingerprint between formulas that have been cooked together vs. mixed from singles, and, while the clinical significance of such chemical differences remains unclear, many users point to these differences as a reason to preserve the traditional interaction of the decoction process.
Individual constituents are extracted differently under different circumstances: For example, sour herbs will tend to lower the pH of the decoction, which will enhance the ability of alkaloids to enter solution. Many alkaline minerals will tend to raise the pH of the solution, which will cause fewer alkaloids to enter solution. Thus, it is quite possible that there will be a quantitative difference in the ephedrine alkaloids in a formula like Ma Huang Tang vs. a formula like Ma Xing Shi Gan Tang, even if the same amount of Ma Huang was present in each formula. While many traditional pill formulas such as Liu Wei Di Huang Wan do not assume interaction of ingredients as a decoction provides, a large number of classic decoction-based formulas such as Ma Xing Shi Gan Tang or Da Cheng Qi Tang are difficult to duplicate by mixing singles.
Beyond these traditional and chemical explanations, we find that some practitioners prefer mixing from base formulas because they like the aesthetic beauty of ancient prescriptions. Many ancient prescriptions are quite eloquent and balanced, and they have survived the test of time by gaining the respect of countless generations. Just as a chef notices that each dish needs to be cooked by adding certain spices at a certain stage, the traditional formula literature has given us a guide as to how we should prepare classic formulas. Preserving this knowledge and approach is a conservative way to minimize confounding variables while bringing the effects of an ancient medicine into the 21st century.
However, despite the above merits, there are a number of arguments to support the mixing of singles. In tomorrow’s blog, we will investigate the flip side of this issue by looking at the perspectives that support the mixing from singles. As mentioned above, both sides have their own merits, so the following blog will play the devil’s advocate for today’s blog.