下载掌阅APP，畅读海量书库
立即打开
Since the theory of the “chief, deputy, assistant and envoy” in composing formulas was firstly put forth in the Inner Classic, many doctors have tried to discuss and differentiate the objective evidences of the “chief, deputy, assistant and envoy” in their own views. In general, the following three aspects should be mentioned.
The chief medicinal is the main ingredient in the composition of a formula, and its dosage is relatively large, but the dosages of the deputy, assistant and envoy are reduced successively. So, many doctors took the dosage of a medicinal in a formula as an evidence to differentiate “the chief, deputy, assistant and envoy”.
Li Gao said that “ The dosage of the chief medicinal is the largest, then the deputy’s dosage is the second, and it is not allowed to exceed the dosage of the chief ” (君药分量最多，臣药次之，不可令臣过于君). ( Discussion on the Spleen and Stomach , Pí Wèi Lùn , 脾胃论)
Wang Hao-gu also said that “ The dosage of the chief medicinal is the largest, the deputy medicinal is the next, and the assistant medicinal is third. If the medicinals have the same effects, they should be applied in an equal dosage ”. (为君者最多，为臣者次之，佐者又次之，药之为证所主同者，则等分) ( Materia Medica for Decoctions , Tāng Yè Bĕn Căo , 汤液本草).
Wu Qiu further indicated that “ about the medicinal dosages in a formula, the medicinal producing the main treatment effect on a disease is the chief, and its dosage is taken as a scale of 10, then the deputy medicinal’s dosage is scaled from seven to eight, and the assistant medicinal’s dosage is scaled from 5 to 6, while the envoy medicinal’s dosage is scaled from 3 to 4 ” (凡用药铢分，主病为君，以十分为率，臣用七八分，辅佐五六分，使以三四分) ( Thoughts on Curing - Huó Rén Xīn Tŏng , 活人心统).
All of the above statements are somewhat reasonable to help us to differentiate “the chief, deputy, assistant and envoy” according to the dosages of the medicinals, but because of the significant variance in characteristic and force of the effects, and the different properties of medicinals, in addition to the different needs for individual therapies, it is insufficient to determine “the chief, deputy, assistant and envoy” solely by the dosage.
For example, Dà Chéng Qì Tāng (Major Qi-Coordinating Decoction, 大承气汤) from the Discussion on Cold Damage , Ke Qin believed that “the dosage of hòu pò (厚朴, Cortex Magnoliae Officinalis) is twice that of dà huáng (大黄, Radix et Rhizoma Rhei), so hòu pò (Cortex Magnoliae Officinalis), as the medicinal for promoting qi, is the chief medicinal” (厚朴倍大黄，是气药为君). (Collected Writings on Renewal of the Discussion on Cold Damage - Further Appendices to the Discussion on Cold Damage , Shāng Hán Lái Sū Jí - Shāng Hán Fù Yì , 伤寒来苏集·伤寒附翼)
This subject necessitates further discussion.
First, in terms of the property of dà huáng (Radix et Rhizoma Rhei) and hòu pò (Cortex Magnoliae Officinalis), the former is bitter and cold, with the effect of reducing heat through purging, cleaning the turbidity from the intestines and the stomach, invigorating blood and removing stasis.
The latter is bitter and warm, with the effect of promoting qi activities and removing stagnation, and relieving accumulation and fullness, and is indicated for yangming fu -organs excess syndrome. Therefore, in this formula, dà huáng (Radix et Rhizoma Rhei) is used as the chief medicinal.
Secondly, analyzing from the selection of medicinals in the three formulas named by Chéng Qì Tāng (Qi-Coordinating Decoction, 承气汤), hòu pò (Cortex Magnoliae Officinalis) is not used in all of them, but dà huáng (Radix et Rhizoma Rhei) must be used in these three formulas. It means that though these three formula are named as Chéng Qì Tāng (Qi-Coordinating Decoction, 承气汤), dà huáng (Radix et Rhizoma Rhei) is the chief medicinal.
Thirdly, Hòu Pò Sān Wù Tāng (Officinal Magnolia Bark Three Agents Decoction, 厚朴三物汤) in the Essentials from the Golden Cabinet , its composition is the same to Xiăo Chéng Qì Tāng (Minor Qi-Coordinating Decoction, 小承气汤), but the dosage of every medicinal is the same as that in Dà Chéng Qì Tāng (Major Qi-Coordinating Decoction). It emphasizes the medicinal for prompting qi as the chief medicinal, and is indicated for the condition of abdominal fullness, abdominal pain, but it is called Hòu Pò Sān Wù Tāng (Officinal Magnolia Bark Three Agents Decoction) instead of Chéng Qì Tāng (Qi-Coordinating Decoction).So, if the formula purges as the main effect, dà huáng (Radix et Rhizoma Rhei) is applied as the chief medicinal, and if the formula prompts qi activities as the main effect, hòu pò (Cortex Magnoliae Officinalis) is taken as the chief.
Therefore, it is not comprehensive to differentiate “the chief, deputy, assistant and envoy” just according to the dosages of medicinals in a formula.
To meet the needs in treatment, in composition of a formula, the medicinal with forceful effect is usually needed to act as the chief, while the effects of the deputy, assistant and envoy are relatively weak, so some doctors believed that it needs to differentiate “the chief, deputy, assistant and envoy” according to the forces of the medicinals.
For example, Zhang Yuan-su said that “The medicinal with the strongest effect serves as the chief medicinal” (力大者为君) ( recorded in Grand Materia Medica , Bĕn Căo Gāng Mù , 本草纲目). However, the force of a medicinal in a formula is also correlated to its dosage and preparation, so it is not sufficient to simply emphasize the force of a medicinal.
For instance, Zhĭ Zhú Tāng (Immature Bitter Orange and Atractylodes Macrocephalac Decoction, 枳术汤) recorded in the Essentials from the Golden Cabinet , and Zhĭ Zhú Wán (Immature Bitter Orange and Atractylodes Macrocephala Pill, 枳术丸) recorded in the Discussion on the Spleen and Stomach , are both composed of the two medicinals, zhĭ shí (枳实, Fructus Aurantii Immaturus) and bái zhú (白术, Rhizoma Atractylodis Macrocephalae), and both are indicated for pĭ (痞) and fullness due to deficiency of the spleen. The former mainly targets at pĭ (痞) and fullness, using zhĭ shí (Fructus Aurantii Immaturus) with the stronger effect as the chief medicinal to relieve pĭ and fullness; the latter mainly treats the deficiency of the spleen, using bái zhú (Rhizoma Atractylodis Macrocephalae) with relative weak effect as the chief medicinal to invigorate the spleen. So the correct conclusion cannot be reached solely considering the strength of the two medicinals while ignoring the differences between the two formulas in terms of dosage and preparation.
The other example is Má Zĭ Rén Wán (Cannabis Fruit Pill, 麻子仁丸), recorded in the Discussion on Cold Damage . It is the typical moistening-purgative formula, in which má zĭ rén (麻子仁, Fructus Cannabis) acts as the chief medicinal.
In terms of the force of each medicinal in the formula, dà huáng (Radix et Rhizoma Rhei)can be taken as the chief medicinal because it has the strongest purgative effect, but if so, it not only contradicts the purpose of this particular formula, but also it fails to be differentiated with purposes of the three Chéng Qì Tāng (Three Qi-Coordinating Decoction). So it is also not comprehensive to simply differentiate “the chief, deputy, assistant and envoy” based on the force of the medicinals.
Throughout history, if a formula is named after a medicinal used in it, the medicinal usually is the chief in the formula, such as Má Huáng Tāng (Ephedra Decoction, 麻黄汤) and Guì Zhī Tāng (Cinnamon Twig Decoction, 桂枝汤). Some formulas are named after the combined names of the medicinals in the order of “the chief, deputy, assistant and envoy”, such as Má Huáng Fù Zĭ Xì Xīn Tāng (Ephedra, Aconite, and Asarum Decoction, 麻黄附子细辛汤), Líng Guì Zhú Gān Tāng (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction, 苓桂术甘汤), etc. Many doctors analyzed “the chief, deputy, assistant and envoy” according to the medicinals used in the name of a formula, which is quite reasonable.
However, the meanings of formulas named with medicinals are varied, and not limited in scope to the chief medicinal. For instance, Shí Zăo Tāng (Ten Jujubes Decoction, 十枣汤), recorded in the Discussion on Cold Damage , is the typical formula for removing water retention, in which dà jĭ (大戟, Radix Euphorbiae Pekinensis), yuán huā (芫花, Flos Genkwa) and gān suì (甘遂, Radix Kansui) with the effects of removing water retention by drastically purging and prompting urination are used as the chief and deputy medicinals, yet the formula is named with the medicinal dà zăo (大枣, Fructus Jujubae), with the effect of reinforcing and nourishing the spleen and the stomach.
The name of Shí Zăo Tāng (Ten Jujubes Decoction) actually implies other deep meanings. According to the formula explanation, the medicinals for removing water retention by drastically purging and prompting urination tend to restrict and attack the spleen and the stomach, and damage the healthy qi, ten jujubes are used to be decocted for oral taking with those drastic medicinals. This combination not only supplements the spleen and nourishes the stomach, but also alleviates the drastic property of those medicinals and reduces the toxic reactions, aims to attack the pathogens without damaging the healthy qi. Meanwhile, the combination indicates that the three medicinals of dà jĭ (Radix Euphorbiae Pekinensis), yuán huā (Flos Genkwa) and gān suì (Radix Kansui)are antagonist to gān căo (甘草, Radix et Rhizoma Glycyrrhizae), and they should not be used with other medicinals without careful consideration.
And for another example, Shén Qū Wán (Medicated Leaven Pill, 神曲丸) recorded in the Important Formulas Worth a Thousand Pieces of Gold for Any Emergency , which is originally created for the eye disorders caused by disconnection between the heart and the kidney, water failing to nourish fire. In the formula, cí shí (磁石, Magnetitum) acts on the kidney channel, boosts yin and subdue yang, which is the chief medicinal. Zhū shā (朱砂, Cinnabaris)acts on the heart channel, clearing the heart and calm the mind, which is the deputy medicinal. The combination of these two medicinals not only can nourish the kidney and subdue yang, enrich the kidney essence to benefit the ears and brighten the eyes, but also can help the connection between the heart and the kidney, the communication between water and fire to calm the mind.
The formula is named after shén qū (神曲, Massa Medicata Fermentata). The reasons of this naming are as follows. Firstly, the disorders due to the disconnection of the heart and the kidney, water failing to nourish fire, are related to the dysfunction of the spleen and stomach in the middle jiao besides the disorders of the heart and the kidney. Shén qū (Massa Medicata Fermentata) can help to digest food and invigorate the spleen, and can act on the middle jiao in order to help the connection between the heart and the kidney and the interaction between water and fire. Secondly, cí shí (Magnetitum)and zhū shā (Cinnabaris) are the mineral medicinals, tending to disturb the stomach. Shén qū (Massa Medicata Fermentata) can invigorate the stomach and assist transportation, so it can avoid the side effects of the mineral medicinals disturbing the stomach, but also can quickly digest and transport the fine substances from food and water to infuse the eyes. Therefore, it is not correct to distinguish “the chief, deputy, assistant and envoy” simply according to the medicinals in the formula name.
The above discussion demonstrates that the confirmation of a medicinal as the “chief, deputy, assistant and envoy” is made according to the primary or secondary effects of the medicinal, the needs of the formula combination, as well as the dosage and strength of the medicinal. A comprehensive and integrated analysis is greatly beneficial to the understanding of the principles of formulating a prescription, and to the application of formulating and establishing new prescriptions.