Zhang Zhong-jing once said, about 1800 years ago, ‘a doctor who uses herbal medicine is like a soldier using his weapons’.


The formation of prescriptions with combination herbal formulas has undergone a considerably long history. Through long clinical practice, Chinese ancestors recognized that a recipe composed of two or more drugs proved more advantageous for disease treatment. The oldest extant medical formulary books are The Prescriptions for 52 Kinds of Diseases and Huangdi’s Classic on Medicine, dated over 2000 years ago (Fan, 2002). The former was discovered in 1973 during the excavation of the Ma Wang Dui tomb (dated 168 BC) at Changsha of Hunan Province.
The Prescriptions listed 52 diseases, with 283 known prescriptions for their treatment, over two-thirds of which were combination formulas containing two or more components (Jia, 2002). TCM assumes synergy to be taking place in a combination herbal formula and it has become an intrinsic part of its philosophy. Speculation as to the reason for this, whether it involves synergy, reduced toxicity, enhanced bioavailability, cumulative effects or simply the additive properties of the constituents requires research with modern scientific means as well as a thorough understanding of the TCM theory. This paper outlines and discusses some of the issues involved in the research of Chinese ancient herbal formulas.
Traditional Chinese medicine is governed by the same principles of balance and harmony that run throughout the traditional Chinese arts and sciences. Traditional Chinese science was based on the ‘Theory of Birth-to- Death’ and characterized by the ‘Cycle-Production’ model (Wang et al., 2001). Influenced by the thinking model of traditional culture, the TCM takes Qi as its core conception to describe and summarize the live activities of human body, and uses Yin-yang and the Five Elements as its basic model to establish a system of physiology, pathology, diagnosis and therapy of diseases (Xu, 1996; Fan, 2002). While Western medicine is, to a great extent, based on anatomy and quantitative analysis, TCM describes the life regulation with different perspectives including society, culture, physiology and psychology. A number of ancient combination formulas are under extensive pharmacological evaluation for treatment of medically challenging diseases such as HIV infection, Alzheimers disease, various types of cancer, and many chronic and debilitating diseases such as diabetes, rheumatoid arthritis, osteoporosis, and glomerulonephritis.
However, the pharmacological study of combination formula appeared to be difficult using the existing animal models and clinical protocols originally developed in Western medicine. It is unlikely to demonstrate and elaborate the advantages and characteristics of combination formulas during the evaluation. Presently, a number of animal models based on TCM theory have been developed at many TCM research institutes for the evaluation of various herbal formulas.
The research of combination formulas is rather like a complex engineering system. The main function and compatibility of all herbs in combination formulas are the fundamental part of the study. The work involving differentiation, optimization, and selection of combination formulas, and use of appropriate pharmacological models and multidisciplinary technology would be the main avenue of establishing a modern platform of drug development from traditional medicine.  Chinese philosophy draws its inspiration and insight directly from the perennial pattern of nature, which is why the Tao (Way) transcends all cultural boundaries and consistently withstands the tests of time. The very fact that many ancient Chinese herbal formulas have been in continuous use by millions of people for thousands of years, with consistently positive results, is a clear testimony to their safety and reliability. This extensive record of clinical experience is arguably a more reliable basis for human therapeutics than the relatively brief and limited laboratory tests on which modern pharmaceutical standards are based. With the change of the economy, culture and living style in various regions as well as the aging in the world population, the disease spectrum has changed. And such a change has paved the way for the new application of traditional medicine. Besides, the new requirements initiated by the new diseases and the achievements and limitations of modern medicine have also created challenges for traditional medicine.
As a healing art, the future of TCM including those ancient combination formulas is promising with its success in research and education.
PHYTOTHERAPY RESEARCH. Vol.18, Pp.681–6 (2004). DOI: 10.1002/ptr.1506
References
Fan QL. 2002. Science of Prescription. Shanghai TCM University Press: Shanghai.
Jia DD. 2002. History of Chinese Medicine. Shanxi Science & Technology Press: Taiyuan.
Wang J, Zhang LG, Meng SH. 2001. Chemical, pharmacological and organizational considerations of combination Chinese medicines. J Chin Materia Medica 26: 799–804.
Xu G. 1996. Chinese Herbal Medicine. Vermilion: London.
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