Although most Chinese medical textbooks and formula com-pendia give standard or suggested dosages for each formula,
BUZHONG YIQI TANG
Sovereigns Huang Qi
Ren Shen
Ministers Gan Cao
Bai Zhu
Assistants Dang Gui
Envoys
Chen Pi Chai Hu Sheng Ma
the issue of dose is one which requires discussion. If we look at the dosages listed for a standard Chinese formula such as Liu Wei Di Huang Wan discussed above in a modern Chinese medical book such as Him-che Yeung’s Handbook of Chinese Herbs and Formulas, Vol. II and then compare these to the Japanese kanpo yaku dosages of the same formula listed in Hong-yen Hsu’s Commonly Used Chinese Herb Formulas with Illustrations, we will see that the standard professional Chinese dosages are roughly three times more across the board than the kanpo yaku dosages. This same discrepancy is apparent if we look at the dosages of standard formulas as listed in the premodern sources in which they first appeared and their modern Chinese doses compared in Bensky &
Barolet’s Chinese Herbal Medicine: Formulas & Strategies. In gen-eral, modern Chinese medical doses are three or more times higher today than in premodern times.
This discrepancy between kanpo yaku doses and modern Chinese doses can be explained by the fact that kanpo yaku practitioners prescribe set formulas with little modification.
Since the formulas they use, the so-called jing fang or classical prescriptions, come from the Han dynasty and are revered as divine revelations, Japanese practitioners tend to regard them as sacrosanct set pieces. If one formula does not work, anoth-er entire formula is chosen. In addition, kanpo yaku practi-tioners emphasize treating the root or ben as opposed to addressing the branches of a disease. They seem to prescribe relatively simple formulas in small doses to be taken over a protracted period of time with slow, steady improvement on the part of the patient.
Modern professional Chinese practitioners, on the other hand, see their patients each week. They do not regard the formulas they use as sacrosanct and inviolable. And they try to achieve relatively speedy relief of all the patient’s branch symptoms at the same time as addressing their disease mecha-nism’s root cause. Thus, modern Chinese medical
practition-ers tend to prescribe highly modified and fairly complex for-mulas at much higher doses per individual ingredient.
The discrepancy between the smaller ancient Chinese doses and larger, modern Chinese doses for the same formulas are more difficult to explain. Is it possible that contemporary patients are sicker than their premodern peers and thus require routinely larger doses? Or is it possible that due to leaching of the soil and overcultivation, Chinese medicinals are not as potent as before. This is not a question we feel we can answer.
Typically in the People’s Republic of China today, most ingre-dients in most formulas are dosed at either nine or 10 grams.
These numbers are derived from the old, premetric system of weights and measures. In that old system, three qian was a standard dose for ruling and ministerial ingredients, two qian for assistant ingredients, and one qian for envoy ingredients.
One qian is slightly more than three grams. Therefore, some practitioners routinely prescribe nine grams for the main ingredients in their formulas and others prescribe 10 grams.
Those that stick to nine grams do so, in part, because nine is an odd or yang number just as three qian is. Those Chinese practitioners that prefer to use 10 grams tend to also be those most influenced by modern Western medicine. Personally, I prescribe mostly on the basis of multiples of 3 – 1.5, 3, 4.5, 6, 9, 12, 15, 18, 21, etc. However, this should be recognized for what it is, a somewhat arbitrary convention based on theory and numerology, not on chemistry.
In a modern Chinese medicinal formula, when more than 9-10 grams of an ingredient are prescribed, there are usually either of two factors at work. First, if a branch symptom is severe, a larger than normal amount of an ingredient may be used. Thus, if qi vacuity is severe, one may use 12, 30, or even 60 grams of Huang Qi (Radix Astragali Membranacei). In this case, Huang Qi may or may not be the ruling ingredient.
Secondly, some ingredients are simply known to be effective
at higher than the usual doses. For instance, Pu Gong Ying (Herba Taraxaci Mongolici Cum Radice) and Bai Jiang Cao (Herba Patriniae Heterophyllae) are routinely prescribed at 21-30 or more grams per packet because those are the doses at which they become effective. Typically, these ingredients are not the ruling ingredients in the formulas in which they appear.
Likewise, when less than 9-10 grams of a single ingredient are prescribed in a modern Chinese medicinal formula, this is usually due to similar reasons. Either the ingredient is merely adjunctive, functioning as an envoy or assistant, or it is so strong-acting and even potentially toxic that it has been determined that only a certain smaller dosage is necessary and advisable. In addition, standard dosages of certain ingre-dients may be reduced if it is understood that, in a given patient, based on their pattern discrimination, that ingredient is likely to cause unwanted side effects or iatrogenesis.
Therefore, although there are standard dosages used in modern