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Opposing the opinions on the principle of the “chief, deputy, assistant and envoy”, Qin Bowei, a famous contemporary doctor, deems that“ the medicinals in a formula are divided into the four components of the chief, deputy, assistant and envoy, …its essence is to use them to represent the main medicinals and the subsidiary medicinals, to elucidate the organizing structure of a formula ” (方剂的组成，分君臣佐使四项，...实质是用来代表主要药和协助药，以说明方剂的组织形式) ( Introduction to Chinese Medicine , Zhōng Yī Rù Mén , 中医入门). It has also been put forth that the “chief, deputy, assistant and envoy” should not be regarded as the principle for composing formulas, but rather as one of the structures of organizing medicinals in formulas, since in some formulas, “the chief, deputy, assistant or envoy” are not existed, or are difficult to be distinguished (Shaanxi Journal of Traditional Chinese Medicine, 1984, 8:6).This understanding is related to the correct appreciation of the principle of composing formulas, so further discussion is necessary.
The composition of formulas is not a mechanical accumulation or simple addition to the effects of the medicinals. There must be some principles to it. In any one of the formulas (except for the formulas consisting of a single medicinal), there are always the two components of the main medicinal and some complementary medicinals. The main medicinal refers to the chief medicinal, but because the complementary medicinals are further divided into the two sub-categories of the subsidiary-complementary medicinals and the opposite-complementary medicinals, and different medicinals are used in each category, so in a formula, the complementary medicinals can be further differentiated into the deputy, assistant and envoy according to the different roles of the complementary medicinals with the primary or subsidiary effect.
Although the deputy, assistant and envoy medicinals may not always be individually found in a formula, when looking a formula as a whole, “the chief, deputy, assistant and envoy” can basically be generalized as the compatible structure and method for formulas.
We admit that “the chief, deputy, assistant and envoy” belongs to the organizing structure of formulas, but the problem is that if all deputy, assistant and envoy medicinals are simply called complementary medicinals, it may be easy to understand the assisting-complementary combination, but it is difficult to generalize the opposing-complementary combination, especially like combining zhū dăn zhī (Pulvis Fellis Suis) and rén niào (Hominis Urina)in Bái Tōng Jiā Zhū Dăn Zhī Tāng (Scallion Yang-Freeing Decoction Plus Pig’s Bile), and combining huáng qín (Radix Scutellariae) in Huáng Tŭ Tāng (Yellow Earth Decoction, 黄土汤).
As the principle of composing formulas, “the chief, deputy, assistant and envoy” came from the compatible rules summarized from a large number of formulas, it is not only helpful to analyze and study the effective formulas at all times, but also can guide us to create new formulas in practice. Therefore, it can be positively regarded as the principle for composing formulas.
Regarding that “the chief, deputy, assistant and envoy” do not exist or are difficult to be differentiated in some formulas, the reasons should be analyzed according to the specific formula.
For example, Dú Shēn Tāng (Single Ginseng Decoction, 独参汤), is composed of a single medicinal. This kind of formulas usually have specific effects or conduct actions in many different aspects, with forceful effects on various conditions, in which the single medicinal can work.
The other formulas composed of a single medicinal specialize on certain diseases, such as cháng shān (常山, Radix Dichroae)which is used for treating malaria, and bīng láng (槟榔, Semen Arecae) which is used for killing parasites. And some other examples, the formulas are composed of two medicinals, such as Shēn Fù Tāng (Ginseng and Aconite Decoction, 参附汤) and Shī Xiào Săn (Sudden Smile Powder, 失笑散), which are based on the experience of medicinal mutual-promotion theory between the two medicinals. Both of the above instances reflect that Chinese medicine has deep understanding and mature treatment of the diseases, and it does not require “the chief, deputy, assistant and envoy” all existing in a formula.
For example, Qīng Wēn Bài Dú Yĭn (Scourge-Clearing Toxin-Vanquishing Beverage, 清瘟败毒饮). Firstly, this formula is an aggregate of Bái Hŭ Tāng (White Tiger Decoction, 白虎汤), Huáng Lián Jiĕ Dú Tāng (Coptis Toxin-Resolving Decoction, 黄连解毒汤), Qīng Rè Dì Huáng Tāng (Heat Clearing Rehmannia Decoction, 清热地黄汤) ( Xī Jiăo Dì Huáng Tāng , Rhinoceros Horn and Rehmannia Decoction, 犀角地黄汤, being the same in this instance), and those formulas all have their own additional explanations on their composition.
Secondly, shí gāo (石膏, Gypsum Fibrosum), shuĭ niú jiăo (水牛角, Cornu Bubali) ( xī jiăo , 犀角, Cornu Rhinocerotis, being the same in this instance), shēng dì (生地, Radix Rehmanniae)and huáng lián (黄连, Rhizoma Coptidis) are all used in large dosages in this complicated formula, they are the chief medicinals of the three involved formulas, and actually they are the chief medicinals of the whole formula as well. The other components of the formula are set in the same principle.
Some other similar formulas, such as Bā Zhēn Tāng (Eight-Gem Decoction, 八珍汤) and C hái Píng Tāng (Bupleurum Stomach-Calming Decoction, 柴平汤), are composed of two formulas, in which the components are set based on the same principle.
In these formulas, their components of “the chief, deputy, assistant, and envoy” are sometimes hard to be differentiated, but the relationships between the chief and the subsidiary medicinals in their combination are very clear.
For example, in Huáng Lián Jiĕ Dú Tāng (Coptis Toxin-Resolving Decoction), every medicinal has the effect of clearing heat, reducing fire and relieving toxicity, so it seems that “the chief, deputy, assistant and envoy” are hard to be differentiated. According to the theory that clearing the heart first in case of reducing fire, and fire in all the meridians will descend naturally when fire in the heart is calmed, it can be readily seen that huáng lián (Rhizoma Coptidis) which can simultaneously reduce heart fire and clear heat in the liver and stomach meridians is the chief medicinal, huáng qín (Radix Scutellariae) and huáng băi (黄柏, Cortex Phellodendri Chinensis) which can clear and reduce fire in the upper and lower jiao , and strengthen the effect of huáng lián (Rhizoma Coptidis) on reducing fire and relieving toxicity are the deputy medicinals, zhī zĭ (栀子, Fructus Gardeniae) which can guide heat to descend, and reduce fire in san jiao is the assistant medicinal. Modern pharmacological studies have proved that, compared with the other medicinals in this formula, huáng lián (Rhizoma Coptidis) has the most extensive antimicrobial spectrum, and it can enhance the defensive function of the body. This validates the pharmaceutical evidence for huáng lián (Rhizoma Coptidis) that is used as the chief medicinal and the scientific nature of medicinal combination in the formula.
For example, in Lĭ Zhōng Wán (Center-Rectifying Pill, 理中丸), regarding whether the chief medicinal is gān jiāng (Rhizoma Zingiberis)or rén shēn (人参, Radix et Rhizoma Ginseng), the doctors in different periods held different opinions. This argument can be resolved by academic discussion. When this formula is used to treat deficiency-cold of the spleen and stomach, if it is chiefly manifested by cold syndrome, gān jiāng (Rhizoma Zingiberis)should be regarded as the chief medicinal; if it mainly appears deficiency syndrome, rén shēn (Radix et Rhizoma Ginseng) should be regarded as the chief medicinal; if it is manifested by the syndrome of equal deficiency and cold, both gān jiāng (Rhizoma Zingiberis) and rén shēn (Radix et Rhizoma Ginseng) can be regarded as the chief medicinals.
In the other formulas, such as Bàn Xià Xiè Xīn Tāng (Pinellia Heart-Draining Decoction, 半夏泻心汤), Sháo Yào Tāng (Peony Decoction, 芍药汤) and Sì Nì Tāng (Counterflow Cold Decoction, 四逆汤), the understandings on their chief medicinals can be unified through research and discussion.
These are affected by the development of natural science, and are not completely formulated according to the structure of “the chief, deputy, assistant and envoy”. Some formulas of this kind are influenced by ancient formulas application, such as Gōng Wài Yùn Fāng (Ectopic Pregnancy Formula, 宫外孕方), which is developed from Huó Luò Xiào Líng Dān (Network-Quickening Miraculous Effect Elixir, 活络效灵丹), recorded in the Essays on Medicine Esteeming the Chinese and Respecting the Western ( Yī Xué Zhōng Zhōng Cān Xī Lù , 医学衷中参西录). Some of these formulas are based on research achievements of modern pharmacology and clinical practice, such as Yì Shèn Tāng (Kidney-Boosting Decoction, 益肾汤). This indicates that the theory of composing formulas still needs to be further developed and improved. But, before the new theory is created, “the chief, deputy, assistant and envoy” theory is still regarded as the principle for composing formulas.