3 Formulas for Harmonization and Resolution

Formulas for harmonization and resolution have the function of harmonizing the shaoyang , coordinating the liver and spleen, regulating the intestines and stomach, and are used for the shaoyang diseases, lack of coordination between the spleen and liver, the intestine and stomach, and malaria. Wang Ang called them “formulas of harmonization and resolution” in the Medical Formulas Collected and Analyzed and Wu Yiluo called them the “ doorway to resolution ” (表散门) in the Practical Usage of Established Formulas and categorized them under the“ harmonization treatment ” section of the Eight Treatment Methods.

The origin and development of formulas for harmonization and resolution are closely related to the course of harmonization recognized in Chinese medicine. Before the Han and Tang Dynasty, the concept of harmonization had a wider connotation, as was noted in Basic Questions - Treatise on Vital Qi Connecting with Heaven ( Shēng Qì Tōng Tiān Lùn , 生气通天论) that: “ The importance of yin and yang is that yang's denseness makes the firmness. The discordance of the two is like spring against autumn, and winter against summer. Thus their harmonization is called the yin yang sagely principle ” (凡阴阳之要，阳密乃固. 两者不和，若春无秋，若冬无夏，因而和之，是谓圣度); it was also noted that “ thus the divine harmonizes yin and yang to achieve harmony of the sinew and vessel, sturdy skeleton, and regular circulation of qi-blood, realizing harmony in the interior and the exterior undamaged by pathogens ” (是以圣人陈阴阳，筋脉和同，骨髓坚固，气血皆从. 如是则内外调和，邪不能害). The word “ harmonization ”(和) refers to the method of harmonizing yin and yang in a broad sense. In the Discussion on Cold Damage , Zhang Zhong-jing in the Eastern Han Dynasty created many formulas for harmonization and resolution such as Dà Chái Hú Tāng (Major Bupleurum Decoction)and Xiăo Chái Hú Tāng (Minor Bupleurum Decoction) for harmonizing the shaoyang , Sì Nì Săn (Counterflow Cold Powder, 四逆散) for rectifying the liver and spleen, and Bàn Xià Xiè Xīn Tāng (Pinellia Heart-Draining Decoction), Shēng Jiāng Xiè Xīn Tāng (Fresh Ginger Heart-Draining Decoction, 生姜泻心汤), Gān Căo Xiè Xīn Tāng (Licorice Heart-Draining Decoction, 甘草泻心汤) and Huáng Lián Tāng (Coptis Decoction) for harmonizing the stomach and intestine, which, however, were not indicated in the clauses of the formulas’ indications. Although Guì Zhī Tāng (Cinnamon Twig Decoction) and Xiăo Chéng Qì Tāng (Minor Qi-Coordinating Decoction) are considered as effective for“harmonization”, it is proven that the meaning of“harmonizing” was not established as a specific therapy at that time. Wang Shu-he in the Western Jin Dynasty summarized methods of sweating, expectorating, purgation, and warming recorded in the Discussion on Cold Damage in his Pulse Classic ( Mài Jīng , 脉经), but harmonization is not found. In the Song , Jin , and Yuan Dynasties, Cheng Wu-ji explained the treatment theory of the Discussion on Cold Damage by emphasizing that: “ In the cold damage diseases, if the evil qi is located in the exterior, it should be treated by inducing sweating; if the evil qi is located in the interior, it should be treated by flushing; if the evil qi is located in neither the exterior nor interior, namely half-interior and halfexterior, which cannot be cured by inducing sweating, expectorating or purgation, it should be treated by harmonizing. Xiăo Chái Hú Tāng(Minor Bupleurum Decoction) is the formula for harmonizing the exterior and the interior ” (伤寒邪气在表者，必渍形以为汗；邪气在里者，必荡涤以为利；其于不外不内，半表半里，既非发汗之所宜，又非吐下之所对，是当和解之可矣. 小柴胡汤为和解表里之剂也), cited from Clarification of the Theory of Cold Damage . He also stated that: “ If the diseases in the taiyang are transferred into the shaoyang, the evil is located half in the interior and half in the exterior, Xiăo Chái Hú Tāng (Minor Bupleurum Decoction)should be used for harmonization ” (太阳转入少阳，邪在半表半里之间，与小柴胡汤以和解之), cited from Annotation and Explanation of the Discussion of Cold Damage . This was the first time the indications and representative formulas of harmonization were proposed, which assigned a new connotation to harmonizing of the shaoyang , and differentiated it from the other three methods, i. e. sweating, expectorating, and purgation. Thus, it was considered a principle by medical experts in the later generations. In the Ming and Qing Dynasties, experts in warm diseases explained and expanded on the understanding of harmonization and its formulas. For example, Wu You-xing claimed the theory of evil hidden in the membrane-source, he held that the membrane-source was “ neither in the zang-fu organs in the interior, nor in the channels and collaterals in the exterior, but in the paravertebrals, near the stomach and not far from the exterior. Thus, it was half interior and half exterior with the separation of interior and exterior ” (内不在脏腑，外不在经络，舍于夹脊之内，去表不远，附近于胃，乃表里分解，是为半表半里), cited from Discussion on Warm Epidemics . He also created Dá Yuán Yĭn (Membrane-Source-Opening Beverage, 达原饮)for relieving evil in the membrane-source; Ye Gui noted the theory of “ retention of pathogens in the san jiao ” (邪留三焦) in the Writings on External Contraction of Warm-Heat , he claimed that dispelling evils by purgation when treating warm diseases with concurrent dampness retained in the qi level of the san jiao and marked by the shaoyang disease patterns similar to cold damage, is the method of harmonization. Hāo Qín Qīng Dăn Tāng (Sweet Wormwood and Scutellaria Gallbladder-Clearing Decoction, 蒿芩清胆汤) created by Yu Gen-chu in Popular Guide to the Discussion on Cold Damage considered both cooling the shaoyang and transforming phlegm to dispel dampness, and further developed the combination of formulas for harmonization and resolution. Regarding the discussion by Zhang Jie-bin that: “ All diseases with concurrent deficiency should be treated by supplementing and harmonizing; diseases with concurrent stagnation should be treated by moving and harmonizing; diseases with concurrent cold should be treated by warming and harmonizing; and diseases with heat should be treated by clearing and harmonizing ” (凡病兼虚者，补而和之；兼滞者，行而和之；兼寒者，温而和之；兼热者，清而和之), cited from Collected Treatises of [Zhang] Jing-yue - Eight New Formulas ( Xīn Fāng Bā Zhèn , 新方八阵), encourages the combined application of harmonization with other methods of treatment. After the founding of the People’s Republic of China, formulas for harmonization and resolution attained great advancement in both clinical and experimental study, they not only are applied and effective for epidemic catarrh, infection of the biliary tract, malaria, pneumonia, pleuritis, etc. , but are also widely used for the convalescence stage of acute abdominal disease, chronic gastritis, functional disturbances of the gastrointestinal tract, intercostal neuralgia, premenstrual tension, etc.

The formulas for harmonization and resolution have a wide range of indications, including cold damage with evil in the shaoyang , warm epidemic evil latent in the membranesource, warm heat disease with evil remaining in the san jiao , malaria, liver and spleen disharmony, stomach and intestine disharmony, and blood and qi disharmony, etc. . As the liver and gallbladder stand in the interior-exterior relationship, the disease of the gallbladder channel will affect the liver and vice versa. Although these formulas are established for diseases in the foot shaoyang gallbladder channel, they are also used for the liver. Diseases of the liver and gallbladder may affect the spleen and stomach (and the large intestine);the diseased regions, the main symptoms and treatment method of malaria are similar to those of the shaoyang disease. Therefore, the ancient doctors hold that malaria belonged to the shaoyang diseases. Thus, formulas for harmonization and resolution are divided mainly into four types; harmonizing the shaoyang , coordinating the liver and spleen, harmonizing the stomach and intestine and treating malaria. Among the four types, formulas for coordinating the liver and the spleen focus on rectifying qi stagnation patterns, which include formulas for rectifying qi. Formulas for harmonizing the stomach and the intestine consist of huáng qín (Radix Scutellariae), huáng lián (Rhizoma Coptidis), bàn xià (Rhizoma Pinelliae) and gān jiāng (Rhizoma Zingiberis), and other medicinals bitter in flavor for descending and acrid in flavor for opening, to regulate gastro-intestinal function with the combined application of cold or hot medicinals, combined with rén shēn (Radix et Rhizoma Ginseng) and gān căo (Radix et Rhizoma Glycyrrhizae) for supplementing qi and harmonizing the middle, which will not be discussed specially. Therefore, this chapter will focus on the discussion of the representative formulas for harmonizing the shaoyang and treating malaria in the past dynasties; studying and analyzing the compatible theory and main compatible methods.