Chief syndromes

Other Antidepressants. Antidepressant refinements for the next 30 years primarily consisted of the development of new TCAs. However, in 1988, a novel antidepressant class, the selective serotonin reuptake inhibitors (SSRIs), was introduced in the United States. The chief innovation of the SSRIs was that they afforded the comparable effectiveness of the TCAs with fewer side effects and minimal toxicity. The debut of the SSRIs coincided with the reworking of the nosology of the anxiety disorders in DSM-III and DSM-IV. As a result, the SSRIs have been studied extensively in each of the respective anxiety disorders and in many cases have obtained FDA approval for the treatment of one or more of these anxiety syndromes. The SSRIs currently available in the United States include citalopram (Celexa), escitalo-pram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). 

In the sections Structure of the formula and selection of herbs, a herb may sometimes be assigned a different position in the formula structure (e.g. it may serve as a chief or as a deputy) according to the nature of the presenting syndrome and the understanding of the herb s function. 

Following the treatment principle, which is established in accordance with the syndrome differentiation, a formula can be composed. A formula is neither a group of herbs that treat all symptoms nor a combination that only treats the main syndrome. It has a structure where herbs are organized in order to meet the needs of the treatment. The structure of a formula contains four parts, namely the chief, the deputy, the assistant(s) and the envoy. Each of these has specific functions in the formula. 

The chief is the ingredient that directly treats the principal syndrome, which is manifested by the main symptoms. 

The deputy is the ingredient that has the function of accentuating and enhancing the effect of the chief ingredient to treat the principal syndrome. 

These three herbs are able to expel wind, cold and dampness from the skin, subcutaneous region and muscles. They can be selected as chief in a formula to treat a severe excess condition of wind-cold syndrome. 

Deputy Regulate the Qi and blood, enhance the strength of the chief herbs to expel wind-cold treat the secondary syndrome and coexisting syndromes... 

Gui Zhi is pungent, warm and sweet. Besides expelling wind and cold to treat exterior syndrome, Gui Zhi is able to warm the blood, promote blood circulation and reduce the general pain, stiffness and cold. It is particularly chosen as deputy to enhance the strength of chief herbs to expel wind-cold in treating a severe excess condition of wind-cold syndrome when the general pain of the body is severe. 

Xi Xin is a very pungent and hot herb with an aromatic smell. It does not enter the Bladder meridian, but does enter the Kidney meridian. It can be selected as deputy in the formula to enhance the action of the chief herbs in treating an excess condition of wind-cold syndrome and can release pain. 

Sang Ye and Ju Hua are bitter, sweet and cold, and enter the Lung and Liver meridians. They are often selected as chief herbs in the formula to treat a mild wind-heat syndrome when the wind-heat mainly affects the Lung. 

These two herbs are often selected as chief herbs in a formula to treat a common case of wind-heat syndrome. 

Lian Qiao is bitter, cold and aromatic, and enters the Heart and Small Intestine meridians. Although it does not enter the Lung meridian, it is still often used in formulas to treat wind-heat syndrome as a chief herb. This is because its aromatic smell can disperse the Qi in the Upper-Jiao and gently release the exterior, and it leaches out heat from the Heart through the Small Intestine. It is especially effective in dispersing and clearing heat in the Heart and relieving restlessness and a warm sensation in the chest. 

Fu Zi and Xi Xin are very hot and pungent. They can stimulate the Yang, intensively warm the interior, disperse cold, accelerate Qi movement in the intestines and alleviate pain. They are often used as chief in the formula to treat internal cold syndrome. Since they are poisonous, they should be used with caution. 

Sheng Di Huang is sweet and cold. It primarily enters the Heart, Stomach and Kidney meridians. It can effectively clear heat, cool the blood and nourish the Yin. It matches the syndrome perfectly and is often used as chief in formulas that clear the heat at the Ying level. 

Huang Qi is used as chief. It is sweet and warm, and enters the Lung and Spleen meridians. As it can strongly tonify the Spleen-Qi and Lung-Qi, it can strengthen the Defensive-Qi and stop sweating. It treats both the cause and the manifestations of the syndrome. 

Ying Su Ke and Ren Shen are used as chief. The former stabilizes the Lung-Qi directly the latter can tonify the Qi of the Lung and Kidney, and therefore stabilizes the Lung-Qi. They are used together to treat both the cause and the manifestations of the syndrome. 

Sha Yuan Zi, as chief, is sweet, warm and moist in nature, and enters the Spleen and Liver meridians. It can tonify the essence, strengthen the Kidney-Yang and treat the cause of the syndrome. 

Qin Jiao is pungent, bitter and neutral, and primarily enters the Stomach and Large Intestine meridians. Pungent can disperse the dampness, and bitterness can drain and dry the dampness. In particular, this herb expels the dampness from the subcutaneous region and the muscles and can therefore relax the tendons and muscles. It can be used as chief in a formula to expel dampness in the Upper-Jiao. Since it is a neutral herb, it can be used in either damp-cold or damp-heat syndrome. 

These herbs are the most commonly used herbs to treat phlegm-heat. They are selected as chief in formulas to treat phlegm-heat syndrome. 

The other three herbs are able to leach out dampness and promote urination. They can be selected in the formula to assist the chief and deputy herbs to remove damp-phlegm. Among these herbs, Fu Ling is neutral and can gently tonify the Spleen-Qi Ze Xie and Yi Yi Ren are cold and are more suitable for treating phlegm-heat syndrome. 

Assistant Promote food digestion and enhance the ability of the chief treat the causes and accompanying syndromes... 

The herbs in this group can be selected as chief and deputies to dissolve congealed blood they can also stimulate blood circulation. They are mainly used to treat the more severe or chronic syndromes of blood stagnation where the blood becomes thicker and blood clots are formed, such as in atherosclerosis, hyperlipemia, thrombosis, endometriosis, adhesions in chronic infection and after surgical operations. 

Sheng Di Huang is sweet, bitter and cold, and enters the Heart, Liver and Kidney meridians. As it can directly clear excess heat or empty-heat in the Heart, Liver and Kidney, it can calm the mind and relieve irritability and restlessness. It can cool the blood, thus the function of calming the mind is even stronger. It is frequently used as chief in the formula for treating excess or deficiency syndromes. 

All of these substances can nourish the Yin and moisten dryness. They can be selected as chief in formulas to treat internal wind syndrome due to Yin deficiency. 

Fu Zi enters the Heart, Spleen and Kidney meridians. It is swift and violent in its action of spreading warmth, scattering cold, drying dampness and warming the meridians. Because of its strength, it is considered a herb that enters the 12 regular meridians. It is used as chief to treat Bi syndrome, especially when cold is predominant with symptoms of severe cramping pain. 

These herbs are aromatic, light and cold, and enter the Upper-Jiao. Sang Ye and Bo He enter the Lung meridian and Lian Qiao enters the Heart meridian. Their aromatic smell can disperse the constrained Qi and heat in the Lung and their cold nature can reduce the heat and protect the Yin. They are often selected as chief in the formulas to treat the syndrome of warm-dryness. 

These two herbs are pungent and warm, and enter the Lung meridian. They can gently and effectively disperse the cold-dryness from the superficial region and stimulate the Lung-Qi, thus accelerating the distribution of the Qi and fluid in the body. They are often used as chief in the formula to treat cold-dryness syndrome. 

Although, broadly speaking, all disorders can be considered as reflecting disharmonies of Yin and Yang in the body, some of the syndromes in this chapter are so distinct that they cannot really be classified in any of the other chapters. The composition of these formulas is based on two groups of herbs, each of which partly fulfills the role of chief in the formula, even though the two groups have very different properties and functions. 

Gui Zhi and Rou Gui are sweet and pungent. Gui Zhi enters the Heart meridian and Rou Gui enters the Kidney meridian. They warm the interior, strengthen the Yang of the Heart and Kidney respectively, and can expel cold. They can be used as chief in the formula to treat the cause of Yin-type Yong Yang syndrome. 

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