The method of decoction of drugs is closely related to the clinical efficacy of drugs, and has always been valued by generations of medical practitioners.
In the "Treatise on Febrile Diseases", although the language is concise, Zhang Zhongjing emphasized the method of decoction, which shows his importance to the method of decoction.
The method of decoction refers to the method of decoction of drugs. It is an important link in the formulation of prescriptions, and has been valued by generations of medical practitioners. Xu Lingtai said: "The method of decoction should be explained in depth. The effectiveness of medicine depends on this." Zhang Zhongjing's discussion on the method of decoction is unique, such as first adding to the decoction, later adding to the decoction, decocting separately and taking together, decocting pills, soaking in hot water, removing impurities and decocting again, cooking with rice soup, decocting with wine, decocting with honey, etc. The method of decoction is closely related to the efficacy of drugs and deserves further study.
First adding to the decoction
In the "Treatise on Febrile Diseases", when using strong sweating drugs to treat exterior syndrome, the method of first decocting and removing impurities is often used. This method can dissipate the rising and dispersing warm and dry qi to prevent excessive sweating and loss of yang, and can also alleviate the strong and fierce nature of pungent and warm drugs to avoid restlessness after taking the medicine. Secondly, for drugs with dense and sticky texture, the method of first decocting is also used. For example, drugs such as Gualou and Gegen need to be decocted first to extract all their flavors. For such drugs, patients are often instructed to soak them in cold water for 20-30 minutes before decoction to better extract their effective ingredients.
There are 22 such methods, such as Ephedra Decoction and formulas containing Ephedra, all of which are decocted with Ephedra first. Gegen Decoction and formulas containing Gegen are decocted with Gegen first. In the Yin Chen Decoction, Yin Chen is decocted first. The first decoction is mostly the main drug, which means that the drug is decocted for a long time to make the flavor concentrated, so as to better exert its function. Decocting Ephedra first can remove impurities in the foam and reduce the effects of impurities. There are a total of 7 formulas in "Treatise on Febrile Diseases" that use Ephedra, and although Ephedra is decocted first in these 7 formulas, there are slight differences in the first decoction: one is Ephedra Decoction, Gegen Decoction, Xiaoqinglong Decoction, etc., all of which are "decoct Ephedra first, reduce by two sheng, remove the upper foam"; the second is Guizhi Ephedra Half Decoction, Ephedra Asarum Decoction, etc., which are "first boil Ephedra with one or two sheng, remove the upper foam"; the third is Ephedra Lianyao Chixiaodou Decoction, "first decoct Ephedra, then boil again, remove the upper foam". From this, it can be seen that the decoction time of Ephedra in different formulas is different, that is to say, for different diseases, Zhang Zhongjing adopted different decoction methods to achieve the best therapeutic effect of the drugs.
Later adding to the decoction
According to the characteristics of different drugs, the later adding to the decoction method is used according to the condition. For example, Guizhi not only has the function of relieving muscles and dispersing wind, harmonizing Ying and Wei, but also has the function of warming and promoting the meridians, warming yang and dispersing cold. If it is used for exterior syndrome, it should be separately decocted and then added to the decoction to achieve the effect of dispersing the pungent and aromatic qi. For example, Guizhi Renshen Decoction, the formula states, "add five flavors to nine sheng of water, first decoct the four flavors and take five sheng, then decoct Guizhi and take three sheng". In this formula, Renshen and other four flavors are decocted first to obtain the function of warming the middle and dispersing cold and tonifying the spleen and benefiting qi, and then Guizhi is added to express its pathogenic factors without being hindered by Renshen and Ganjiang. Otherwise, if all five drugs are decocted together, the aromatic fragrance of Guizhi will be transformed into the function of warming the interior and promoting yang, and the purpose of resolving exterior and interior will not be achieved. Similarly, Rhubarb is often decocted with other drugs to obtain its thick and powerful effect of breaking stasis and transforming stasis and stasis, such as Yin Chen Hao Decoction and Danggui Decoction. However, in Dachengqi Decoction and Chaihu plus Longgu Muli Decoction, Rhubarb is added later to achieve its cold and bitter effect of clearing heat and relieving stagnation, promoting the elimination of old and bringing in the new, and clearing and purging the Yangming evil heat. In addition, in the Zhizi Chitang with Fermented Soybean and the Zhizi Chitang with Fermented Soybean and Pig Gallbladder Juice, the soybean and pig gallbladder juice are added later or dissolved. Because these drugs are easily destroyed by long decoction, reducing their efficacy, or do not need to be decocted, just add them to the soup and stir well to dissolve them, so as to better exert their efficacy.
Separate decoction and combined administration
Separate decoction refers to the separate decoction of drugs in a prescription, and finally combine the decoction of each drug to take it together. For example, Fuzi Xie Xin Tang is decocted with Fuzi to obtain its thick and heavy flavor and downbearing nature, aiming to warm and tonify kidney yang and consolidate the exterior and strengthen the real. Meanwhile, soak Sanhuang in it to obtain its thin, clear and light upward-moving effect, aiming to relieve heat and eliminate fullness and distension. With this method of decoction, it can clear heat and resolve depression from above, warm yang and strengthen the defense from below, using cold and heat together, helping each other without contradiction. It can be said that cold and heat have different natures, raw and cooked have different flavors, although the drugs are the same, their flavors and temperatures are different, and their effects are different. Zhang Zhongjing's skill in using medicine is so exquisite.
Decocting pills
For some strong and fierce drugs, Zhang Zhongjing not only changes the decoction to pills according to the condition, but also often uses the method of decocting pills, which can slow down the action of strong drugs and make them gentle and harmonious, so as to attack and harmonize. This can make the drugs slowly exert their effects without causing harm to the body due to excessive or rapid action of the drugs. For example, for patients with upper chest obstruction due to real heat, with a slow disease course, Zhang Zhongjing added white honey, apricot kernel, and tianlizi to Daxianxiong Decoction, boiled and decocted, and formed pills, which are taken after decoction. The meaning of "pill" is to slow down. For example, Dangdang Pill, "add four flavors, grind and divide into four pills, boil with one sheng of water, take seven he together." This is to achieve the purpose of gentle attack by reducing the action of strong drugs.
Soaking in boiling water
Boiling water refers to boiling water. Because there are water bubbles the size of sesame seeds on the water surface when the water is just boiling, it is called boiling water. Soaking the drugs in boiling water, stirring and removing impurities, and then drinking the soup is called soaking in boiling water. Dahuang Huanglian Xie Xin Tang is an effective prescription for treating abdominal fullness and stagnation in the epigastric region. Zhang Zhongjing stated in the postscript: "Add boiling water to two sheng of Dahuang and soak it, remove the impurities, and take three sheng." Soaking with boiling water is because Dahuang and Huanglian have thick and heavy qi and taste, and after long decoction, they mostly go to the intestines and stomach and have a laxative effect. Therefore, this formula does not require decoction, but uses boiling water to soak for a short time, and then drink the juice. The decoction obtained by this special method can achieve the purpose of taking its qi and diluting its taste to remove invisible evil heat in the upper part, and treat the heat and fullness. In "Synopsis of the Golden Chamber", Dahuang Huanglian Xie Xin Tang is decocted and taken, taking its thick and powerful taste and clearing heat and eliminating blood stasis as the purpose, and treating hemoptysis. When Zhang Zhongjing used Fuzi Xie Xin Tang to treat "epigastric fullness, with chills and sweating", he used "soak Sanhuang with boiling water for two sheng, strain and swallow it, and take Fuzi separately" to exert the function of warming the meridians and consolidating the exterior.
Removing impurities and decocting again
This method first decocts the drugs for a certain period of time, and then removes the impurities and decocts them again to concentrate and take them. Generally, when decocted according to the usual method, it is difficult to avoid affecting the efficacy due to the uneven nature and taste of the drugs. Using the method of removing impurities and decocting again can make the nature and taste of the drugs harmonious, coordinate the actions, and achieve the purpose of harmonization, thereby improving the therapeutic effect. Just as Chen Xiuyuan said: "Removing impurities and decocting again has its ability." Banxia Xie Xin Tang, Gancao Xie Xin Tang, and Shengjiang Xie Xin Tang are all dispersing agents, used to harmonize the middle and disperse rebellious qi, harmonize the stomach and relieve the middle, disperse and relieve stagnation, and harmonize the stomach and disperse rebellious qi. The postscript states: "Take one dou of water, boil and take six sheng, remove impurities, then decoct and take three sheng". The phrase "remove impurities and decoct again" means to reduce the volume of the drugs using the concentration method, so that the patient does not need to take too much medicine. The purpose is to make the "Three Xie Xin Tang" have outstanding effects of harmonizing yin and yang, promoting ascending and descending, regulating deficiency and excess, and treating the combination of exterior and interior, ascending and descending, cold and heat.
Cooked rice soup
Baihu Tang, Baihu plus Renshen Tang, Baihu plus Guizhi Tang, Zhuye Shigao Tang, Maimendong Tang, etc., these formulas are all noted with "cooked rice soup". The purpose of cooked rice soup is to take advantage of the mild and neutral nature of glutinous rice, while nourishing the spleen, stomach, and lung yin, it can slow down the cold and descending nature of other drugs in the formula, so that the efficacy of the drugs can be exerted sustainably. Because glutinous rice is a dual-purpose medicine and food, mainly food, it is a "discontinued" sliced medicine in most pharmacies and drugstores. When doctors or pharmacists prescribe it, they only tell the patients or users to grab a "handful" from their own rice bag and put it in other medicines to decoct. When there are formulas that contain glutinous rice, "grab a handful of rice and put it in" has become the "mantra" of doctors or pharmacists, and few doctors or pharmacists tell patients or users about the "cooked rice soup".
Decocting with wine
Wine is the essence of water and grain, and has the function of promoting heart yang and invigorating blood vessels. Because of its fierce and slippery nature, it is not easy to enter the blood vessels. Therefore, when using wine to decoct drugs, it is necessary to add twice as much water to change its fierce and slippery nature into mildness and reduce its slippery and rapid nature. For example, in Zhigancao Tang, the original formula requires seven sheng of clear wine and eight sheng of water to be decocted together. The purpose of adding clear wine is to promote the circulation of qi and blood, open the meridians, harmonize yin and yang, assist the action of the medicine, and promote the movement of qi and blood. Especially in tonifying yin drugs or dual tonifying qi and blood drugs, adding wine can promote the circulation of the medicine and achieve the purpose of tonifying without stagnation. Zhi Gancao Tang is a commonly used formula for treating pulse stagnation due to qi deficiency and blood deficiency and palpitations. When decocting, adding clear wine not only enhances the effect of promoting heart yang and blood circulation, but also eliminates the greasy nature of various nourishing yin drugs with clear wine. In addition, wine is also a good solvent. When adding wine to decoct, the effective ingredients in the formula can be dissolved to the maximum extent. Because of its aromatic fragrance, wine is easy to dissipate and volatilize, so it is appropriate to add wine after decoction, and the boiling time should not be too long. In addition, the book also mentions the use of bitter wine to boil, ancient bitter wine is today's rice vinegar, because of its sour and astringent nature, it has the functions of reducing swelling and promoting ulcer healing, activating blood circulation and dissolving blood stasis. For patients with Shaoyin disease, if there are ulcers in the throat due to heat transformation, which affects speech, Zhang Zhongjing uses Banxia and chicken yolk soaked in bitter wine, boils it, removes impurities, and gargles with it, in order to achieve the effect of dissolving swelling and promoting ulcer healing.
Decocting with honey
Fuxiong Pill is made by adding two parts of white honey to two parts of water, boiling and decocting to obtain one part, and taking it warm. Zhang Zhongjing added honey for four purposes: first, to moderate the strong and fierce nature of Fuxiong Pill and reduce its aggressive attack; second, to achieve the effect of harmonizing the middle and protecting the stomach; third, to achieve the effect of nourishing and moistening, assisting the main medicine to exert its function; fourth, to take advantage of the sweetness to correct the taste. "Compendium of Materia Medica" says: "Honey has five functions when used in medicine, clearing heat, tonifying the middle, detoxifying, moisturizing dryness, and relieving pain." "It has the same effect as licorice in harmonizing all medicines" and "harmonizing Ying and Wei, moisturizing the five organs, promoting the three burners, and moistening the spleen and stomach." Nowadays, some doctors often omit honey when prescribing, which reduces the maximum potential of the prescription, which is regrettable.
There are many other examples, such as soaking method, quick decoction method, long decoction method, dissolving and melting, reconstitution, etc. The choice of solvent also includes clear water, flooded water, sweet and clear water, clear paste water, spring water, well flower water, flowing water, etc. In addition, there are also requirements for the cooking time. Zhang Zhongjing wrote the book when there was no paper, so the language in "Treatise on Febrile Diseases" is relatively concise, but why did Zhang Zhongjing spend so much effort on the method of decoction? From this, we can see the importance of the method of decoction.
With the development of modern technology and the acceleration of people's pace of life, it seems that the ancient method of decoction of Chinese herbal medicine is outdated. Nowadays, it is usually boiled using machines, which saves time and effort, but all the drugs are thrown in together. The different effects of first decoction, long decoction, and later addition are difficult to reflect. Some patients also decoct the herbs at home, which can differentiate between first decoction, long decoction, and later addition, but as mentioned above, there are differences even in the first decoction, and few patients can grasp these differences. Nowadays, in order to save time and effort, most people treat decoction of Chinese herbal medicine as the same, but the modernization of Chinese medicine is not like this. Although it is more convenient to decoct herbal medicine, the efficacy of Chinese herbal medicine is greatly reduced, and the therapeutic effect of Chinese medicine cannot be guaranteed.
If you want to treat diseases, you should delve into the decoction method of drugs, so that the soup can wash the internal organs, open the meridians, regulate yin and yang, break up and disperse evil qi, moisturize dryness, nourish the skin, and nourish qi and blood.
