My Medical Philosophy: What Is the Large-Formula Multi-Target Special Therapy? (2)

Here I offer a definition of the large-formula multi-target special therapy I advocate: it is a comprehensive approach to treating refractory diseases whose causes and pathology are both intricate. It is a treatment strategy designed, on the basis of full consideration of a disease's known etiological and pathological features, to address every relevant dimension. Because the approach aims to be comprehensive, it requires many kinds of herbs and a large prescription. It relies on the synergistic action of various drugs to achieve better clinical results.

From my own prescribing experience, although prescriptions built on this approach are large, the actual dose of each herb is small. When I use large prescriptions to treat disease, I do not take them as decoctions but as pills, powders, pastes, and pellets (wan san gao dan). This conserves medicinal materials, keeps safety doses controlled, ensures side effects remain within a manageable range, and greatly reduces the financial burden on patients. In fact, the cost of large-formula pills, powders, pastes, and pellets is far lower than that of ordinary small decoctions.

Theoretically, the large-formula multi-target special therapy is the approach most likely to improve outcomes in refractory disease and create therapeutic miracles. Moreover, this approach does not exclude combining Western and Chinese drugs so that they act together.

Thus the hallmarks of the large-formula multi-target special therapy I advocate are: large prescriptions, comprehensive composition logic, micro-dosing, and reliance on synergistic action among drugs to enhance efficacy.

How small are the doses? Most herbs are used at under 1 gram per day; toxic herbs under 0.1 gram per day; highly toxic herbs under 0.01 gram per day. I keep essentially all drug doses below 1/100 of the median lethal dose, and the doses of toxic herbs below 1/1000 of the median lethal dose.

China's renowned pharmacognosy professor Zhang Tingmo and formula-studies professor Wang Mianzhi both wrote about how, when Chinese herbs are combined in formulas, their effects are enhanced while the actual doses used drop sharply.

For example, Zhijing San (Antispasmodic Powder) consists of Quanxie (Scorpio) and Wugong (Scolopendra). Half a gram of Scolopendra plus half a gram of Scorpio, combined, has a greater effect than 10 grams of Scolopendra alone or 10 grams of Scorpio alone. At the same time, because the body's daily absorptive capacity is limited, 10 grams of Scolopendra combined with 10 grams of Scorpio is no more effective than 0.5 grams of each. Using more merely wastes herbs and adds to the patient's cost.

Herbal synergism can reduce dosing so dramatically that the advantages of this approach are self-evident. The more herbs we combine within one formula, the smaller the dose of each needs to be. This is of major significance for lowering the dosage of toxic herbs, reducing the risk of death, disability, and teratogenicity, and improving safety. Moreover, the large-formula multi-target special therapy can minimize the use of toxic drugs altogether, relying instead on the synergistic action of safer herbs to treat refractory disease.

In practice I have seen the real effects and safety of this approach. My large-formula regimen for stroke sequelae has an effective rate above 80%, even working for some especially intractable patients (such as those in a vegetative state). Yet each herb the patient takes daily is dosed in mere milligrams.

My "Chai Gui Jiedu Wan" (Chai-Gui Detoxifying Pill), formulated during the pandemic, contains so many herbs that the total per dose is only 3–6 grams. Spread across each ingredient, the actual dose is measurable only in milligrams. Yet many patients needed only a single dose to resolve the problem. Chai Gui Jiedu Wan also treated several severe viral pneumonia cases with good results. For some viral pneumonia patients, the entire course of medication cost no more than a few dozen to a couple of hundred yuan.

Thus, although the large-formula multi-target special therapy is not simple, it retains TCM's traditional virtues of "cheap" (lian) and "accessible" (yi). I have long opposed long-term decoction use by cancer patients, using decoctions only briefly when acute complications arise; I still hold this view today.

Ancient TCM did not use decoctions much for chronic illness; it generally used "pills, powders, pastes, and pellets" for gradual treatment. Although called gradual, slow is actually fast; patients treated this way often have shorter courses than those taking decoctions.

China's distinguished TCM warm-disease expert, Professor Zhao Shaoqin, once recounted what his father told him. His father, Zhao Wenkui, was the last head of the Imperial Medical Academy in the Qing dynasty (equivalent to the top leader of today's National Health Commission).

Zhao Wenkui told Zhao Shaoqin that treating disease is like finding the key to open a lock: the point is to get the direction right, not to use brute force. If the direction is right, the lock opens easily; if it is wrong, piling on dosage is useless. That is why Zhao Shaoqin always used light doses, yet his clinical results were the finest in the capital.

So the large-formula multi-target special therapy I advocate also contains a key character: "small"—i.e., small dosage. This special therapy must achieve its effect through comprehensive, refined, and rigorous composition rather than through dosage; it uses clever leverage, not brute force.

Going forward, I will gradually introduce the rationale and techniques behind composing large-formula multi-target prescriptions, along with case examples. My goal is that clinicians with a TCM foundation who are interested in this therapy will, after reading this book, fully grasp its essence and become doctors who can themselves compose prescriptions on this principle.

The book will be divided into two parts. Part One is the general theory, explaining the principles; Part Two is the specific treatment discussion, organized by disease, detailing my large-formula multi-target approach for each condition I know well. I hope readers will then be able to extrapolate, applying similar attempts and research to other diseases for the benefit of their own patients.

This book will take a long time to complete, and I will revise it again ten years later, incorporating further reflections as I acquire new knowledge. I want to spend a lifetime patiently refining a medical work of real value.