Eighteen controversial herb pairs

You may learn from your textbook TCM that there are some herbs that should not be used at all at the same time with other herbs in one formula. It is called the Eighteen controversial herb pairs.

It tells us that the herb Gancao should not be used together with other herbs such as Gansui, Daji, Haizao, and Yuanhua. Wutou should not be used at the same time with Banxia, Gualu, Beimu, Baiji, and Baijian. Lilu should not be used at the same time with Xixing, Shaoyao and the herbs with the name of Shen.

There are another herbs that should be careful when used at the same time: Luhuang with Puxiao; Shuiyin with Pishuang; Langdu with Mituozen; Badou with Qianniu; Dingxiang with Yujing; Wutou with Xijiao; Yaxiao with Sanlen; Guangui with Shizhi; and Renshen with Wulinzhi.

It is well known that a current famous TCM doctor, Dr. Zhu Liangchun, has been using both Gancao and Haizao to treat lymphatic tuberculosis, hyperthyroidism and goiter, to use Rensheng and Wulinzhi to treat chronic gastritis, duodenal ulcer; to use Gansui and Gancao to treat pleural tuberculosis and more.

In practice in history, this comment is in a large debate though it is taught in the textbook.

It has been summarized that there are more than 565 formula contain such controversial formula in a formula that have been proven effective in clinic. Even from the modern TCM books published in << Quan Guo Zhong Chen Yao Chu Fan Ji>>, a summery book of currently used herb formula, we can find 34 oral herbal formula and 68 non-oral herb formula that contain such controversial herb pairs.

There have been a extensive researches to test if the herb pairs are really more toxic when used together. The results are controversial too. Some study say yes, they are more toxic when used together, but it is dose-depended phenomenon and the toxic also depends on how to give the herbs to the experimental animals, orally or not.

It is still hard to know how the saying of the theory of the eighteen controversial herb pair is proposed. It is suggested that when the herb are used in different dose, their toxic effect is different (dose-dependent phenomenon as all most all chemical drugs), but it might be not so toxic when there is more other herbs in the same formula. As we know well that the toxic effect of a herb with the name of Wutou, can be largely reduced by using honey, Gancao, of green bean in the formula.

There has been several very famous TCM doctors in China suggesting to remove this concept from the textbook. The caution that we have to pay when we use these herbs together is pretty much the same as we use other herbs. We wish that the Chinese TCM authority can spend more effort to help to clarify this very important question. For us, we suggest that we should still use the herbs if it is well recognized formula before. So many times, we have to depend on such herbs to treat tough cases.