30 Returning Our Focus to the Flavour and Nature of Herbs Journal of Chinese Medicine • Number 105 • June 2014

Returning Our Focus to the

Flavour and Nature of Herbs
Abstract
By:JulieAnn The foundational theories of Chinese herbal medicine originate in the Nei Jing (Inner Classic), which states that it is
Nugent-Head the flavour and nature of herbs that govern how they interact with the human body. However, this theory has more
recently become superseded by theories of herbal actions, disease indications and modern research, which are
invariably used in textbooks and by practitioners to inform prescription of herbal medicines. This article explains
Keywords: why these approaches to the practice of herbal medicine are incorrect, and how such approaches can easily damage
Chinese herbal the health of patients taking herbal medicines. The correct method of prescribing herbs based on the Nei Jing is
medicine, Nei Jing, described, and illustrated with various case examples.
flavour, nature, qi,
wei, herb actions, Introduction
herb indications. The foundations and tenets of herbal theory that have Understanding that these words lie behind the herb
guided the great doctors of Chinese medicine through choices in every classical formula can immediately
history originate in the Nei Jing (Inner Classic). However, improve our effectiveness and safety in the clinic.
the application of Nei Jing herbal medicine theory seems Conversely, if we do not understand the importance
largely forgotten in today’s Chinese medicine education. of these words, we may be tempted to prescribe herbs
It is in the Nei Jing that flavour and nature are defined according to their documented actions, chemical
as the primary principles that govern how herbs interact components or performance in scientific research.
with the human body. The Nei Jing puts forth that the Such approaches to prescribing herbs can potentially
flavour and nature of herbs affect the qi in specific harm our patients.
ways, which in turn affects the organs and physiological
systems, and can thus either restore them to health if The modern paradigm: focus on
prescribed correctly or damage them if used incorrectly.1 herb action
In contrast, the current herbal paradigm tends to focus Today’s predominant herbal paradigm tends to
on herbal actions, disease names and modern research. involve studying herbs according to their actions
Prior to the development of this modern perspective, and indications. For example, substances are labeled
every classical herbalist referred to the following words as ‘tonify qi’ herbs, ‘clear heat’ herbs or ‘dispel wind-
from the Nei Jing as their source of understanding for damp’ herbs. Herbal medicines are also designated
how herbs affect qi in the body, and put these words into according to modern scientific research as being ‘anti-
action with every formula they wrote: bacterial’ or ‘anti-viral’, being able to treat or prevent
cancer, or having the capacity of boosting the immune
辛能散、能行。Xin neng san, neng xing. system. While it is not wrong to state that herbs may
Acrid can disperse, can [make things] move. have qi-tonifying or heat-clearing effects, or that they
may even be able to successfully treat cancer, stating
甘能補、能緩、能和。Gan neng bu, neng huan, neng he. the potential effect of a particular herb is not the
Sweet can build, can slow, can harmonise. same as understanding why it will affect the body
in a specific way. For example, understanding how a
苦能泄、能燥、能堅。Ku neng xie, neng zao, neng herb alleviates a headache and the type of headache
jian. it may treat is considerably different from having the
Bitter can drain, can dry, can make firm. simplistic belief that it has the function of ‘treating
headache’.
酸能收、能澀。Suan neng shou, neng se. The Ben Cao Bei Yao (本草備要,Complete Essentials
Sour can gather, can astringe. of Materia Medica) written by Wang An in the Qing
Dynasty highlights the danger of an action- and
鹹能下、能軟。Xian neng xia, neng ruan. indication-focused perspective:
Salty can descend, can soften.

淡能滲、能利。Dan neng shen, neng li.

Bland can leach, can benefit [create flow].
Journal of Chinese Medicine • Number 105 • June 2014 Returning Our Focus to the Flavour and Nature of Herbs 31

‘如治痰之藥，有治燥痰者，有治濕痰者，諸書第以 (showing poor circulation or qi reversal) or painful/scanty

除痰概之。頭痛之藥，有治內傷頭痛者，有治外感頭 menses (showing cold, blood stasis or lack of blood and
痛者，諸書唯言治頭痛而已。此皆相反之證，未可混 qi movement). In these examples, warming, building and
施。’ moving the qi and blood are appropriate, while cooling
‘If a herb treats phlegm, there are those that treat dry phlegm, and gathering are not. Therefore, using Si Wu Tang as
there are those that treat damp phlegm. All books only generalise an unmodified unit - to which herbs are then added for
[these herbs] as phlegm eliminating. Headache medicines: there patients with cold hands or scanty menses - is less elegant
are [those] that treat internal injury headache and [those] that than recognising that Dang Gui (Angelicae sinensis Radix)
treat external influence headache. Books only speak of [a herb and Chuan Xiong (Chuanxiong Rhizoma) are the only two
with the action of] ‘treat headache’. All of these contradicting appropriate constituents therein. If one has only studied
illnesses, it is not appropriate to confuse or muddle the the actions and indications of Bai Shao (Paeoniae Radix
application.’ alba) – such as that it ‘nourishes the blood’ or ‘softens
the Liver’ – it is easy to include this apparently benign
It is easy to understand that the treatment for a headache herb in prescriptions where its effect on the qi will not be
caused by cold pernicious is considerably different than the conducive to successful treatment. Any herb in a classical
treatment for a headache from internal injury. However, if we formula, no matter how complete the formula may seem,
memorise herbs according to their actions and indications, may have a flavour and nature that could be detrimental
it becomes easy to overlook this important distinction and to the health of any specific patient. By emphasising the
prescribe herbs according to the disease label or symptom flavour and nature of herbs as our pivotal focus it becomes
name. Furthermore, it is important to understand that herb evident that the appropriateness of each herb in a formula
actions and indications – such as ‘clearing heat’ or ‘treating should be considered individually, instead of using any
headache’ – merely represent the historical documentation formula as an unmodified unit to which herbs are added
of the successful application of herbs or herbal formulas. for the individual patient.
Stated more clearly, it is not that any herb ‘treats headache’,
but rather that specific herbs or formulas have been shown The historical importance of flavour
to treat headache. This distinction may seem purely and nature
semantic, but it is imperative to understand in order to Students and practitioners of Chinese medicine may
use herbs correctly. Herbs do not actually ‘do’ things in the wonder how the great doctors of history were able to create
body like turning on a light switch. A herb does not enter such powerful formulas that remain so relevant today.
the body and ‘turn off’ a headache, or ‘turn on’ the immune The truth is that they did not create formulas to be used
system. Rather, herbs affect the qi. If the way they affect the as unmodified building blocks. Following the theories of
qi is beneficial to the condition being treated, then the result the Nei Jing, they recognised the causative factor in their
will be the resolution of symptoms. On the other hand, the patients that was creating an imbalance in the yin and yang
same herb used in a different (i.e. ‘wrong’) situation may and resulting in symptoms. They then decided whether the
affect the qi in such a way as to aggravate the condition, best way to affect that causative factor and rebalance the
and even create other symptoms. yin and yang was through introducing acrid, sweet, sour,
A fundamental principle of Chinese herbal medicine bitter or salty flavours into the body in order to influence
involves diagnosis of the individual patient and identification the qi in a specific way. Thus, herbal formulas were created
of a clear strategy of treatment, before choosing a formula by combining herbs with the appropriate flavours to affect
and considering the appropriateness of each constituent the qi - dispersing, moving, building, slowing, draining,
herb therein. However, diagnosing a patient with a pattern drying, gathering, astringing, descending, softening or
of blood deficiency and selecting the treatment methods permeating - which then resulted in resolution of the
of warming, moving and building the blood (using warm, symptom or disease. In contrast, practitioners today tend
acrid and sweet herbs) is not the same as deciding to use Si to start at the end of this process - selecting a formula or
Wu Tang (Four Substance Decoction) based on the fact that single herbs to treat specific illnesses or patterns - without
it is the formula traditionally believed to ‘nourish blood’. realising that the formulas themselves do not ‘treat’ IBS,
While Bai Shao (Paeoniae Radix alba) - a constituent herb high blood pressure, diabetes, heart disease or cancer, nor
of Si Wu Tang - is indeed said to nourish the blood and do they expel cold, pacify Liver yang or anchor the shen.
regulate the menses, it is a cool, sour herb that is included In actuality, herbs are simply a vehicle for flavour, and
in this formula to treat yin deficient heat due to lack of it is the effect of the flavour and nature of the herb that
blood. Thus patients with blood deficiency and secondary creates change in the body. The difference between these
symptoms of dry lips, mouth ulcers and other empty heat approaches may not seem so profound, but it is actually the
signs would benefit from having Bai Shao (Paeoniae Radix basis of the Chinese medicine aphorism, ‘因人而異’ (‘[treat
alba) in the formula, whereas it would be inappropriate for each situation] according to the person’). From a classical
patients with blood deficiency accompanied by cold hands Chinese medicine perspective the individual is treated
32 Returning Our Focus to the Flavour and Nature of Herbs Journal of Chinese Medicine • Number 105 • June 2014

by focusing on the appropriate way to affect their qi. The Although the words of Zhou Xueting discuss the dangers
modern perspective, on the other hand, focuses on the of incorrect herb use during pregnancy and state that
pattern, disease or symptom name, with less thought to the prohibitions are just for ‘beginning students’, his words
appropriateness of the herbs for the individual as a whole. might be applied to every herb and formula we use today.
The Ben Cao Bei Yao states that the order of our By focusing herb use on actions and indications without
methodology when prescribing herbs is crucial to success: stressing the appropriateness of their flavour and nature,
they can become ‘as dangerous as poison in the blood’.
‘每藥先辨其氣味形色，次著其所入經絡，乃為發明其功
用，而以主治之證，具列於後，其所以主治之理, 既在 The Shanghan Lun
前功用之中...’ The Shang Han Lun (傷寒論,Treatise On Cold Damage) is
‘Each herb: first differentiate its flavour and nature, form and possibly the greatest example of the application of flavour
colour; secondly the channel it enters. Only then [can one] and nature in herbal treatment. In the Shang Han Lun, Zhang
expound upon its function, and the illness that it treats. After Zhongjing collected the great formulas of antiquity, laying
aligning these [qualities], the reason why it is used to treat out how the flavour and nature of herbs are best used,
[a given disease is] already included in the aforementioned as well as pointing out what happens when patients are
functions.’ mistreated by doctors who, for example, use bitter when
they should have used acrid, use acrid when they should
The Ben Cao Bei Yao echoes the words of the Nei Jing that have used sour, or use sour when they should have used
our first consideration should be the flavours of the herbs sweet. For example, In the Taiyang chapter of the Shang Han
we prescribe; only then will we understand the patterns the Lun, Gui Zhi Tang (Cinnamon Twig Decoction) is indicated
herbs can treat. While this theory may seem elementary, for treating invasion of pernicious wind manifesting with
and one may feel obliged to seek more scientific or erudite a floating pulse, headache, fear of wind and sweating. In
explanations of how herbs work in the body, the succinct Gui Zhi Tang light, warm and acrid Gui Zhi (Cinnamomi
and profound words from the Nei Jing were the foundation Ramulus) disperses the pernicious wind from the surface
of herbal application for the great doctors who have come (muscle layer), while thick, warm and acrid Sheng Jiang
before us, who treated both acute and chronic illnesses with (Zingiberis Rhizoma recens) disperses the wind that has
considerable success. In the following quotation the Qing entered more deeply. Sweet and neutral Da Zao (Jujubae
dynasty physician Zhou Xueting makes the relationship of Fructus) and Gan Cao (Glycyrrhizae Radix) slow down the
flavour, nature and the patient quite clear: wind, and prevent it from penetrating into the body more
deeply. Lastly, cool and sour Bai Shao (Paeoniae Radix
‘周學庭曰：黃芩安胎者也、烏附傷胎者也，而胎當寒 alba) restrains the yin fluids that are leaking out through
結，黃芩轉為傷胎之鴆血烏附又為安胎之靈丹。白朮安 sweat, and prevents the formula from being too warm and
胎者也，芒硝傷胎者也，而胎當熱結，白朮反為傷胎之 damaging the yin. Thus, in a small five-herb formula we
砒霜，芒硝又為安胎之妙品。無藥不可以安胎，無藥不 see the direct application of three aspects of Nei Jing herbal
可以傷胎，有何一定之方，有何一定之藥也。彼本草所 theory: acrid disperses, sweet slows and sour astringes.
注安胎，藥性所言禁服，不過為初學導之先路。’ Also in the Taiyang chapter, Gui Zhi Tang is modified
‘Zhou Xue Ting states: “Huang Qin [Scutellariae Radix] by removing Bai Shao (Paeoniae Radix alba) to become a
calms the foetus, Hei Fu Zi [Aconiti Radix lateralis preparata] ‘new’ formula named Gui Zhi Qu Shao Yao Tang (Cinnamon
harms the foetus, but if there is cold accumulation, Huang Twig Decoction Minus Peony). The associated symptoms of
Qin [Scutellariae Radix] will harm the foetus [as if there is] a skipping pulse and chest fullness are explained as being
poison in the blood, and Hei Fu Zi [Aconiti Radix lateralis due to damage to the yang qi from inappropriate purging
preparata] will protect it like a miracle medicine. Bai Zhu using cold and bitter herbs. The appropriate treatment in
[Atractylodis macrocephalae Rhizoma] calms the foetus, Mang such cases is to use acrid and warm herbs to stimulate the
Xiao [Mirabilitum] harms the foetus. But if there is heat yang qi with movement and warmth. In this situation, sour
accumulation, Bai Zhu [Atractylodis macrocephalae Rhizoma] (Paeoniae Radix alba) is removed because the gathering/
will harm the foetus like arsenic and Mang Xiao [Mirabilitum] astringing effect of its sour flavour would aggravate the
will benefit the foetus like a magical substance. Every herb fullness in the chest, and of course its cool nature would
could be used to protect the foetus, and every herb could harm not be appropriate when warming yang is the focus of
the foetus. There can be no set formulas, there can be no fixed treatment.
herbs. The Ben Cao notes [a herb] as calming to the foetus, or In the Taiyin chapter of the Shang Han Lun we see the
states that the nature of a herb [makes it] forbidden to be used opposite scenario, where Gui Zhi Tang is modified by
[in pregnancy], this is only for beginning students to guide doubling the dosage of cool, sour Bai Shao (Paeoniae Radix
them in their early path.”’ alba). In this situation the patient presents with a soft
pulse, diarrhoea and abdominal pain. In this application
of Gui Zhi Jia Bai Shao Tang (Cinnamon Twig Decoction
Journal of Chinese Medicine • Number 105 • June 2014 Returning Our Focus to the Flavour and Nature of Herbs 33

Plus Peony), warm acrid Gui Zhi and warm acrid Sheng that are typically thought to treat or tonify the Spleen, but
Jiang (Zingiberis Rhizoma recens) stimulate the yang they are consistently applied in the formulas of the Pi Wei
qi and disperse pathogenic cold, while sweet Gan Cao Lun to do just this.3
(Glycyrrhizae Radix) and Da Zao (Jujubae Fructus) assist It is important to understand that the term ‘tonify’ (補,
by building the Spleen qi. The sour function of Bai Shao bu), while having the meanings of ‘boosting’ and ‘building’
(Paeoniae Radix alba) is then used to create a gathering in the West, also means ‘to benefit’, ‘to be of help’ or ‘to
action in order to stop the diarrhoea. In this example we can repair’ in Chinese. Thus benefitting or repairing the patient
see that the gathering action is the focus of the treatment.
Whereas in unmodified Gui Zhi Tang cool, sour Bai Shao In the formulas of Li Dongyuan, strengthening the middle
(Paeoniae Radix alba) astringes yin due to loss of fluids
from sweat, in this formula the increased dosage of a sour is done by draining, raising and building qi in ratios
herb is necessary as the fluid loss is more severe. It is also appropriate to the patient's condition.
apparent that the cool nature of Bai Shao (Paeoniae Radix
alba) is tempered by warm Gui Zhi (Cinnamomi Ramulus)
and Sheng Jiang (Zingiberis Rhizoma recens), and that the – in other words affecting the patient’s qi in a way that
yang has not been damaged to the extent that the inclusion returns the yin and yang of the body to harmony - can be
of a cool herb is inappropriate. achieved by removing a blockage, expelling pernicious,
restraining what is leaking, warming, dispersing and so on.
The Pi Wei Lun When the qi is moving optimally, the patient returns to a
Examination of historical formulas from a flavour and state of health, and in a sense has been ‘tonified’. But this
nature perspective reveals that the brilliance of the doctors should not be confused with simply prescribing Huang Qi
of antiquity was simply due to their effective application of (Astragali Radix) or Bai Zhu (Atractylodis macrocephalae
Nei Jing herbal theory. Li Dongyuan, author of the Pi Wei Rhizoma) in order to give ‘more qi’ to the Spleen, or indeed
Lun (脾胃論, Treatise on Spleen and Stomach) states: using tonifying herbs to benefit any other system of the
body. In the formulas of Li Dongyuan, strengthening the
‘脾胃為元氣之本而主升發，若因飲食劳倦所傷，脾胃不 middle is done by draining, raising and building qi in
主升發，元氣不足．乃百病發生之由’ ratios appropriate to the patient’s condition. It is therefore
‘[The] Spleen and Stomach are the root of yuan qi and govern fundamental that we redefine our understanding of
raising and spreading. If there Is damage by drink/liquids, food treatment to focus on returning the patient’s yin and yang,
and by physical labour and fatigue, the Spleen and Stomach and the movement of their qi, to optimal function. This
cannot govern raising and spreading qi, and [therefore] the involves applying the words of the Nei Jing by choosing
yuan qi will not be full. Thus, the hundred illnesses2 can herbs with flavours that affect the patient’s qi in a manner
happen.’ which repairs or benefits them as a whole.

Li Dongyuan founded the Bu Tu Pai (補土派, Nourish Other texts

the Earth School), which recommended an approach to It was not only Zhang Zhongjing and Li Dongyuan who
treatment focused on returning the Spleen and Stomach focused on the flavour of herbs to inform their treatment
to harmony. He believed that an unobstructed Spleen was strategies. Ming Dynasty physician Zhang Jingyue stated
the key to preventing the ‘100 illnesses’ and used herbs that flavour and nature are not just important to consider –
accordingly to relieve obstructions hindering the healthy they are ‘the Dao’ of herbal usage:
movement of the Spleen qi. Li’s approach is today often
simplistically presented as being focused on ‘tonifying’ ‘用藥之道無他也，惟在精其氣味，識其陰陽，則藥味
the Spleen with herbs such as Huang Qi (Astragali Radix), 雖多，可得其要矣。’
Bai Zhu (Atractylodis macrocephalae Rhizoma) or Fu Ling ‘The way of using herbs, there is one way, there is no other. That
(Poria). In fact, examination of the formulas of the Pi Wei is to master the herb’s nature and flavour, and to understand its
Lun shows a prevalence of acrid and light herbs that are yin and yang.4 Only with this understanding, even if the herbs
designed to disperse accumulation, separate the clear from are many, can you achieve desired results.’
the turbid and assist the raising and spreading of the clear
yang qi. Thus, the Spleen is ‘tonified’ by removing what Basing herb selection on flavour and nature is critical. By
is impairing its function, not by adding/building ‘more qi’ doing so, not only can we understand classical formulas
to make the Spleen work better. Herbs like Chuan Xiong and achieve desired treatment, we can avoid injuring our
(Chuanxiong Rhizoma), Du Huo (Angelicae pubescentis patients by accidently affecting the qi inappropriately. In
Radix), Qiang Huo (Notopterygii Rhizoma seu Radix), the Song Dynasty Pang Anshi highlighted this important
Fang Feng (Saposhnikoviae Radix), Chai Hu (Bupleuri point:
Radix) and Sheng Ma (Cimicifugae Rhizoma) are not herbs
 34 Returning Our Focus to the Flavour and Nature of Herbs Journal of Chinese Medicine • Number 105 • June 2014

‘設當行辛甘而用酸苦，設當行酸苦而用辛甘，是昧於 炒棗仁 Chao Zao Ren (Dry-fried Ziziphi spinosae

陰陽之用，如此醫殺之耳。’ Semen) 25g
‘When the method should be [to use] acrid and sweet but 白芍藥 Bai Shao Yao (Paeoniae Radix alba) 12g
instead sour and bitter are used, or the method should be [to 金櫻子 Jin Ying Zi (Rosae laevigatae Fructus) 9g
use] sour and bitter but instead acrid and sweet are used, this is 山茱萸 Shan Zhu Yu (Corni Fructus) 12g
to be blind to the use of yin and yang, and in this way a doctor 炒黃連 Chao Huang Lian (Dry-fried Coptidis
kills their patient.’ Rhizoma) 1.5g
Shang Han Zong Bing Lun (傷寒總病論三卷, Complete 阿膠 E Jiao (Asini Corii Colla) 9g
Treatise on Cold Damage, Third Scroll)
After two days of this formula, the bleeding reduced to
slight spotting that appeared in the afternoons only. Based
The formula did not contain any 'stop bleeding' herbs - on this progress, she was prescribed five more doses.
Within one week, the bleeding had stopped completely.
and yet the formula effectively stopped the bleeding. The patient continued to take the formula for two more
weeks in order to ensure the symptoms did not return.
This treatment was notable for two reasons. Firstly, the
patient presented without a distinct reason for her uterine
Flavour and nature in the clinic bleeding: the heat in the body did not appear excessive
To successfully apply the Nei Jing theory of flavour and enough to force blood out of the vessels, she did not have
nature in the clinic one must first be clear about one’s weak enough Spleen qi to explain the blood leaking out
chosen treatment strategy. One should ask oneself whether of the vessels, nor did she have a history of trauma or
it is necessary to disperse, move, build, slow, harmonise, the presence of abdominal masses that would indicate
gather, astringe, drain, dry, soften or descend. By being blood stasis forcing blood out of the pathways (this had
specific about what we wish to do in our treatment, it also been confirmed by a hospital ultrasound scan during
becomes clear what we do not wish to do. Such clarity is week seven of her bleeding). Her previous symptoms,
critical whether we are writing a formula of our own or however, provided a context from which to understand
making additions and subtractions to a classical formula. her constitution. The patterns of Liver heat, yin deficiency,
With flavour and nature as our starting point, we can rebellious qi in the Stomach with thirst and night sweats
confidently prescribe formulas that are safe and effective. A suggested that the application of bitter, cold herbs to clear
recent case from the author’s clinic provides an example of heat and stop the uterine bleeding would be inappropriate,
this approach. The patient was a woman in her late forties and may even have caused these previously treated
from the countryside of China. She had a history of acid symptoms to reappear by damaging fluids and exacerbating
reflux, night sweats, thirst, constipation and insomnia, yin deficient heat. Instead, focusing on sour and cool herbs
although these were not present during her current visit to address the Liver-Stomach disharmony by gathering
to the clinic. This time she had come seeking treatment for and cooling the Liver qi and cooling and protecting the
a slight but continuous leakage of menstrual blood, which Stomach yin was intended to benefit the blood leakage
had been going on for nine weeks. She also remarked without it being the obvious focus of treatment. As I had
that she was thirsty and had very strong-smelling breath. little concrete information to go on, prescribing the formula
After checking her pulse and tongue, the diagnosis was for two days initially allowed me to determine if the
Liver excess affecting the Stomach. While this diagnosis formula was appropriate before proceeding to longer-term
did not seem to specifically explain the uterine bleeding, it treatment. Secondly, and more pertinent to the discussion
was clear that overall the Liver and Stomach needed to be in this article, the formula did not contain any ‘stop
harmonised by restraining the excess Liver qi and cooling bleeding’ herbs - and yet the formula effectively stopped
Stomach heat. In order to harmonise, cool and restrain, the the bleeding. This illustrates how herb flavours can create
focus of the prescription was on sweet, cool and sour herbs. broader possibilities of effect than those documented as
This combination of flavour and nature was intended actions or indications in modern textbooks.
to restrain the Liver qi, cool and moisten the Stomach as To illustrate this point further, let us examine five herbs
well as restrain and slow the leakage of blood, making the from the ‘Stop Cough and Wheezing’ chapter of the
formula appropriate not only for the pattern of disharmony modern text Chinese Herbal Medicine: Materia Medica.5 Xing
but also the specific symptom for which she was seeking Ren (Armeniacae Semen), Zi Wan (Radix Asteris Tatarici),
treatment. The following formula was initially prescribed Kuan Dong Hua (Farferae Flos), Zi Su Zi (Fructus Perillae
for two days in order to determine the accuracy of the Frutescentis) and Sang Bai Pi (Mori Cortex) are all listed as
diagnosis, before proceeding further. having the capacity to ‘stop cough and wheezing’. Looking
at their flavours and natures, however, shows that they
are very different herbs. Xing Ren (Armeniacae Semen)
Journal of Chinese Medicine • Number 105 • June 2014 Returning Our Focus to the Flavour and Nature of Herbs 35

and Zi Wan (Radix Asteris Tatarici) are bitter and slightly Mi (Semen Oryzae) is neutral and sweet. Thus this small
warm, and thus from a flavour and nature perspective will four-herb formula is comprised completely of sweet
warm, and drain. These herbs are therefore appropriate for ingredients. According to the Nei Jing, sweet herbs build,
a cold-damp type cough, but if they were given to a patient slow and harmonise. Thus Xie Bai San is a sweet, cold
with a hot and/or dry cough they would likely exacerbate formula that is appropriate for a hot-dry type of cough
dryness and/or heat and make the condition worse. Kuan and wheezing, yin deficiency involving Lung symptoms,
Dong Hua (Farferae Flos) and Zi Su Zi (Fructus Perillae or heat in the Lungs with deficient yin fluids. Prescribing
Frutescentis) are warm and acrid, and thus will warm and this cold and sweet formula without modification would
disperse in the body when ingested. For a patient with be inappropriate for any condition involving dampness,
pernicious cold or qi constraint these herbs will disperse productive cough, fear of cold, fear of wind, weak Spleen
the cold, invigorate the yang, warm the chest and aid the qi, weak yang qi or any exterior pathogen. While Formulas
Lungs’ ability to disseminate qi. But for a patient with weak and Strategies does state that Xie Bai San is contraindicated
Lung qi causing cough and wheezing, such dispersal may with patterns of wind-cold, wind-heat or damp-phlegm,
lengthen the illness and worsen chances of recovery. Finally, without understanding the flavour and nature of the
Sang Bai Pi (Mori Cortex) is sweet and cold, and thus has constituent herbs it would be difficult to fully understand
cooling, building, slowing and harmonising effects when why this is the case. While one might not use Xie Bai San
ingested. While appropriate for heat with dryness or hot, with an external wind pathogen because the textbook
sticky phlegm that needs to be cooled and moistened, if prohibits this, it would be easy to employ its constituent
prescribed for patients with cold or wet-damp patterns it herbs if we were paging through a materia medica looking
may damage the yang and thus cause an increase in fluid for something to ‘stop cough’ – a potential mistake that
accumulation. Therefore, although these five herbs have could worsen the condition of some patients. Should we
all been documented to have the capacity to stop cough make this mistake, however, we would not be the first
and wheezing, practitioners should not lose sight of the to use Xie Bai San or its ingredients inappropriately. Wu
fact that their different flavours and natures affect the qi in Jutong in his Wen Bing Tiao Bian (Systematic Differentiation
very different ways. Thus the type of cough and wheezing of Warm Disease) wrote the following about the misuse of
they can treat and the manner in which they do this are Xie Bai San:
considerably different. In actual fact, these herbs do not
treat coughing and wheezing. Rather, their flavours and '歷來注此方者，只言其功，不知其弊.... 愚按此方治
natures provide the possibility of stopping coughing and 熱病後，與小兒痘後外感已盡，身虛熱者甚良, 若兼一
wheezing through their effects on the qi, and could just as 毫外感，即不可用，如風寒風溫正盛之時，而用桑皮，
easily create heat and dryness, weaken the qi, damage the 地骨，或于別方中加桑皮，或加地骨，如油入麵，錮結
yang and generate damp. 而不可解。
Choosing a herb primarily for its action – even if one ‘Commentaries about this formula are always about its
pauses to consider whether it makes sense for a patient in achievements and not its drawbacks ... According to [the
terms of its flavour and nature - is less accurate than first principles of] this formula, I have treated sequelae of heat/febrile
considering whether it is necessary to drain, dry, disperse, diseases and pox in children, when the external illness has
descend, gather, soften or build and then choosing a herb already been resolved ... [and if] the body has deficient heat [the
with the appropriate flavour and nature. The formula Xie results are] very good. If concurrently [there is] even a hint of
Bai San (Clear the White Powder) provides an excellent exogenous [disease], then [the formula] cannot be used. If there
example of the importance of prescribing herbs and formula is wind and cold, wind and warmth flourishing, and [you] use
according to flavour and nature. Xie Bai San consists of: Sang Bai Pi or Di Gu Pi, or you add Sang Bai Pi or Di Gu Pi to
another formula, it is like adding oil to flour, [or] plugging and
Chao Sang Bai Pi6 (Dry-fried Mori Cortex) 30g binding with molten metal [that] cannot be separated.’
Di Gu Pi (Cortex Lycii Chinensis Radicis) 30g
Zhi Gan Cao (Honey-fried Glycyrrhizae Radix) 3g After reading this quote many years ago, I began to avoid
Geng Mi (Semen Oryzae) 15-30g Sang Bai Pi [Mori Cortex] and Di Gu Pi [Cortex Lycii
Chinensis Radicis] for fear of inadvertently ‘plugging
In Formulas and Strategies,7 Xie Bai San is discussed in the and binding’ my patients. At the time, reading the actions
chapter ‘Clearing Heat From the Organs’, which states that of these herbs did not clarify how and why they were
the formula treats heat in the Lungs and is indicated for potentially dangerous. But returning to the Nei Jing theory
cough and wheezing. If we study the flavour and nature of on the flavour of herbs elucidates Wu’s admonition. As is
the individual herbs in Xie Bai San, we discover that Sang so often the case in Chinese medicine, we tend to search for
Bai Pi (Mori Cortex) and Di Gu Pi (Cortex Lycii Chinensis complicated theoretical answers when the truth is simple
Radicis) are sweet and cold, Zhi Gan Cao (Honey-fried and clear: ‘Sweet can build, can slow, can harmonise’. The
Glycyrrhizae Radix) is mildly warm and sweet, and Geng cold and sweet natures of Sang Bai Pi [Mori Cortex] and
36 Returning Our Focus to the Flavour and Nature of Herbs Journal of Chinese Medicine • Number 105 • June 2014

Di Gu Pi [Cortex Lycii Chinensis Radicis] have potentially ENDNOTES

thick, cold, slowing and cloying effects which can trap a 1 Unfortunately there is not space appropriate combinations
pathogen whilst engendering and slowing fluids, when in this article to discuss the yin to treat the varying patterns
and yang qualities of herbs (i.e. of Spleen and Stomach qi
actually dispersing would be the appropriate treatment their thick/thin natures, which disharmony. This is a quite
method. subsequently became codified different perspective than
as herb channel theory) in any simply adding Huang Qi
depth. This subject is discussed (Astragali Radix), Bai Zhu
Conclusion in more detail in the Introduction (Atractylodis macrocephalae
Without proper emphasis on the Nei Jing as the foundation to Classical Herbalism lecture at Rhizoma) and Fu Ling (Poria)
the following link: <http:// to a formula when one wishes
for the practice of herbal medicine, we may not realise
www.traditionalstudies.org/ to benefit the Spleen.
that we already have the tools to treat patients safely and intro-to-classical-herbalism/> 4 The yin and yang quality of the
effectively, and as successfully as the great doctors from 2 Li uses the term ‘100 illnesses’ specific herb refers to its thick/
history. If we do not understand the source texts of our to refer to the many illnesses thin, light/heavy nature, and
that affect human beings, not thus its ability to affect floating
medicine, we will be unable to fully grasp the medicine we 100 specific ailments. or sinking, lowering or raising
practise, even when we are successful. The medicine may 3 Although the Pi Wei Lun in the body (see endnote 1).
remain deep and mysterious, and we may feel forced to contains more than 40 formulas 5 Bensky, D., Clavey, S. (1993).
focused on Spleen and Stomach Chinese Herbal Medicine: Materia
rely on modern scientific research for explanations of the disharmonies, only half of them Medica. Seattle: Eastland Press
efficacy of herbs in treatment. Yet, if we understand the contain ‘Tonify Spleen’ herbs 6 Xie Bai San traditionally includes
Nei Jing theory of flavour and nature as the basis for the such as Bai Zhu (Atractylodis Chao (dry-fried) Sang Bai Pi.
macrocephalae Rhizoma) Dry-frying a cold and sweet
application of herbal medicine, what seemed mysterious and less than a third of them herb will balance its coldness
becomes obvious, and the skills of the famous doctors who contain Fu Ling (Poria). The and temper its sweetness. This
sheer number of formulas
came before us no longer seem so hard to fathom. With the focused on treating the Spleen
is an important distinction, for
reasons that should be clear
Nei Jing as our foundation, and studying the doctors of the and Stomach, together with from the discussion that follows.
past who treated according to its tenets, every one of us can the preponderance of herbs
not typically considered as 7 Bensky, D., Barolet, R. (1990).
write a classical formula. ‘treat Spleen’ herbs, highlights Chinese Herbal Medicine:
the importance Li Dongyuan Formulas and Strategies. Seattle:
ascribed to combining the Eastland Press
A dedicated practitioner and teacher, JulieAnn Nugent-Head
appropriate flavours in
is part of the Association for Traditional Studies, a not-for-profit
company dedicated to bringing classical knowledge back to the
forefront of Chinese medicine. For more information about the
Association for Traditional Studies, its training programs and
free online video library of educational material, please visit www.
traditionalstudies.org.