Traditional Chinese Medicine/Herb To Herb Interactions

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In Traditional Chinese Medicine, herb-to-herb interactions have been known for a long time, and include both synergistic as well as antagonistic interactions.

Synergistic Interactions

Synergistic Interactions are of the following two types:

Mutual Accentuation

In Mutual Accentuation, two herbs with similar functions are used together to increase their therapeutic effect. Examples include:

  1. Jing Jie (荆芥) with Fang Feng (防风) to expel wind and release the exterior
  2. Jin Yin Hua (金银花) with Lian Qiao (连翘) to reduce heat-toxin
  3. Da Huang (大黄) with Mang Xiao (芒硝) to promote bowel movement

Mutual Enhancement

In Mutual Enhancement, two herbs with different functions are used. The first directly targets the pathological condition, and the second increases the therapeutic effect of the first. Examples include:

  1. Zhi Mu (知母) with Huang Bai (黄柏), where Zhi Mu nourishes yin of the kidney and clears heat in the Lower-Jiao, while Huang Bai reduces empty-heat in the Lower-Jiao and is able to enhance the function of Zhi Mu.
  2. Fu Zi (附子) with Zhi Gan Cao (炙甘草), where sweet Gan Cao can moderate the speed of hot Fu Zi.
  3. Da Huang (大黄) with Zhi Gan Cao (炙甘草), where sweet Gan Cao can reduce the harsh purging effect of Da Huang.

Antagonistic Interactions

Antagonistic Interactions are of the following four types:

Mutual Counteraction

In Mutual Counteraction, the characteristic side effects or toxicity of the first herb can be minimized or neutralized by the second herb. An example is:

  1. Ban Xia (半夏) with Sheng Jiang (生姜), where the toxic effects of Ban Xia can be reduced by Sheng Jiang.

Mutual Suppression

In Mutual Suppression, the first herb suppresses or minimizes the toxicity of the second herb. Examples include:

  1. Lv Dou (绿豆) with Ba Dou (巴豆), where Lv Dou can reduce the toxicity of Ba Dou.
  2. Ge Hua (葛花) with alcohol (酒), where Ge Hua can reduce the toxicity of ethanol.

Mutual Antagonism

The following is the classic list of eighteen substances that exhibit Mutual Antagonism to each other. For example, the effects of Ding Xiang will be countered by Yu Jin, and the herbs should not be taken together, although both are very common herbs.

No. Herb Name Counteracting Herb Name
1 Mercury (Shui Yin) 水银 Arsenolite (Pi Shuang) 砒霜
2 Rhizoma Euphorbiae E. (Lang Du) 狼毒 Lithargyrum (Mi Tuo Seng) 密陀僧
3 Semen Crotonis (Ba Dou) 巴豆 Semen Pharbitidis (Qian Niu Zi) 牵牛子
4 Flos Caryphyili (Ding Xiang) 丁香 Radix Curcumae (Yu Jin) 郁金
5 Nitrum Depuratum (Ya Xiao) 牙硝 Rhizoma Sparganii (San Leng) 三棱
6 Cornu Rhinoceri (Xi Jiao) 犀角 Rhizoma Aconiti Kusnezoffii (Cao Wu) 草乌
7 Cornu Rhinoceri (Xi Jiao) 犀角 Rhizoma Aconiti (Chuan Wu) 川乌
8 Radix Ginseng (Ren Shen) 人参 Rhizoma Trogopterorum (Wu Ling Zhi) 五灵脂
9 Cortex Cinnamomi (Rou Gui) 肉桂 Hallositum Rubrum (Chi Shi Zhi) 赤石脂
10 Sulfur (Liu Huang) 硫磺 Mirabilitum (Mang Xiao) 芒硝

Mutual Incompatibility

The following is the classic list of nineteeen substances that are incompatible with each other, and using them together can have dangerous results:

No. Pinyin Simplified Chinese
1 Gan Sui甘遂
2 Da Ji大蓟
3 Yuan Hua芫花
4 Hai Zao海藻
No. Pinyin Simplified Chinese
1 Chuan Bei Mu川贝母
2 Zhe Bei Mu浙贝母
3 Gua Lou, Gua Lou Ren, Gua Lou Pi栝楼, 栝蒌仁, 栝蒌皮
4 Ban Xia半夏
5 Bai Lian白蔹
6 Bai Ji白芨
7 Tian Hua Fen 天花粉
No. Pinyin Simplified Chinese
1 Ren Shen人参
2 Bei Sha Shen北沙参
3 Nan Sha Shen南沙参
4 Ku Shen苦参
5 Dan Shen丹参
6 Xuan Shen玄参
7 Bai Shao白芍
8 Chi Shao赤芍
9 Xi Xin细辛

Single Effect

Although rather rare, some herbs may be used alone (单行) because they have reasonably balanced properties and functions. These include


Herbs That Are Prohibited During Pregnancy

No. Pinyin Simplified Chinese
1 Chuan Wu川乌
2 Cao Wu草乌
3 Pi Shuang砒霜
4 Chan Su蟾酥
5 Qing Fen轻粉
6 Dan Fan胆矾
7 Ba Dou巴豆
8 E Zhu莪术
9 Gua Di瓜蒂
10 Jing Da Ji京大戟
11 Yuan Hua芫花
12 Shui Zhi水栀
13 Shui Yin水银
14 Gan Sui甘遂
15 She Xiang麝香
16 Ban Mao斑蝥
17 Qian Niu Zi牵牛子
18 Shang Lu商陆
19 Xiong Huang雄黄
20 San Leng三棱
21 Ma Qian Zi马钱子
22 Meng Chong虻虫
23 Gan Qi干漆
24 Li Lu藜芦

Herbs That Are Used With Caution During Pregnancy

No. Pinyin Simplified Chinese
1 Niu Xi牛膝
2 Rou Gui肉桂
3 Lu Hui芦荟
4 Jiang Huang姜黄
5 Fu Zi附子
6 Mu Dan Pi牡丹皮
7 Zhi Ke枳壳
8 Tao Ren桃仁
9 Zhi Shi枳实
10 Da Huang大黄
11 Hong Hua红花
12 Fan Xie Ye番泻叶
13 Chuan Xiong川芎
14 Mang Xiao芒硝

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Ref: http://apps.who.int/medicinedocs/documents/s17556en/s17556en.pdf

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