A Discussion of the Eight Strategies (Ba Fa) from the Aspect of Herbal Formulary
by Attilio D'Alberto
The eight strategies (Ba Fa) were originally recorded in the Nei Jing Su Wen. It wasn't until the Qing dynasty that Dr Cheng Zhong-Ling organized and categorized the eight basic strategies known as the 'Eight Methods in Therapy' (Yi Men Ba Fa) (Williams 1992, p28) and recorded them in the 'Medical Revelations' (Yi Xue Xin Wu).
The eight strategies are categorised according to their therapeutic action and are shown below.
- Sweating (Han Fa)
- Vomiting (Tu Fa)
- Draining Downward (Xia Fa)
- Harmonizing (He Fa)
- Warming (Wen Fa)
- Clearing (Qing Fa)
- Reducing (Xiao Fa)
- Tonifying (Bu Fa)
In TCM, diagnosis and treatment are based on an overall analysis of signs and symptoms, aetiology, the nature and location of the illness, the patient's Qi level (weak or strong) and their constitution (Bian Zheng Lun Zhi). The practitioner will then make a syndrome differentiation and use the eight methods to conduct their treatment strategy.
The aim of this essay is to discuss the eight strategies (Ba Fa) in relation to TCM and herbal formulary and present a case study with an analysis of the strategies used.
Sweating - Han Fa
The sweating strategy induces perspiration to aid in the regulation of lung Qi. This facilitates interaction between the nutritive (Ying) and protective (Wei) Qi allowing for the release of pathogens from the exterior of the body. It is used in patients with wind-heat or cold syndromes (i.e. patients with the common cold). Pungent warm formulas are used to release the exterior (Ma Huang Tang), and pungent cool formulas are used to release the exterior (Yin Qiao San).
If sweating is induced in a patient suffering from an exterior syndrome then it should be only for a short period of time after which the patient should feel better. If sweating, whether diseased or medicinal, lasts too long or is excessive it will then injure Yin.
- Externally-contracted exterior excess conditions
- Acute oedema which is more severe in the upper part of the body
- Early-stage pain and swelling from wind-damp
- Skin disorders caused by wind
- Diseases that are working their way out from the interior
Vomiting - Tu Fa
This strategy uses herbs that over-stimulate the stomach to induce vomiting. It is rarely used today except in acute interior full (excess, shi) conditions and is used in emergency or life-threatening conditions (Yi 2000, p19). This is because it injures Yin and the stomach due to its violent action and should therefore only be used in strong patients. When it is used it induces vomiting to quickly remove stagnation of food, phlegm or poisonous materials from either the stomach, throat or oesophagus. An example of a vomiting inducing formula is Gua Di San.
- Phlegm stuck in the throat
- Phlegm accumulation in the chest
- Food stagnation in the stomach
- Ingestion of poisons
Draining Downwards - Xia Fa
This strategy induces defecation to purge the bowels by irritating or stimulating the intestines to treat interior full (excess, shi) conditions. For example to drain heat and move stools (Da Cheng Qi Tang), warm the Yang and guide out accumulation (San Wu Bei Ji Wan), moisten the intestines and unblock the bowels (Ma Zi Ren Wan), and drive out excess water (Shi Zao Tang).
Draining downward formulas (purgatives) are used to treat constipation, certain febrile diseases and certain gynaecological disorders. It should however be used with caution during pregnancy, parturition and menstruation.
- Dried faeces in the intestines
- Heat accumulation
- Cold accumulation
- Excess water
- Blood build up
Harmonizing - He Fa
This strategy is used to harmonize the different levels of the body and the Zangfu organs. Harmonizing can both expel pathogenic factors aswell as tonify the upright Qi (Zheng Qi). It is used to harmonise the Shaoyang (Xiao Chai Hu Tang) when the pathogen lies half-way between the interior and exterior of the body, harmonise the Zangfu organs that are affected simultaneously, for example the liver and spleen (Si Ni San), and the intestines and stomach (Ban Xia Xie Xin Tang). It is also used for complex conditions such as heat with cold or emptiness with fullness.
- Half interior-half exterior (Shaoyang) disorders
- Epigastric focal distention
Warming - Wen Fa
This strategy is used to warm the Yang. It is used to eliminate pathogenic cold conditions of both fullness (excess, shi) and emptiness (deficiency, xu) in either the interior or exterior. For example, to warm the channels and disperse cold (Dang Gui Si Ni Tang), warm the middle jiao and dispel cold (Li Zhong Wan), restore and revive the devastated Yang (Si Ni Tang), and warm the menses and dispel cold (Wen Jing Tang). It can also be used to treat mal-absorption syndromes and certain gynaecological disorders.
- Cold in the channels
- Cold attacking the middle jiao
- Cold with devastated Yang
Clearing Heat - Qing Fa
This strategy is used to clear heat or cool the heat in the body. It eliminates pathogenic heat or drains the fire from the body's interior in full (shi) or empty (xu) conditions. For example, to clear heat from the Qi level (Bai Hu Tang), clear the Ying level and cool the blood (Qing Ying Tang), drain the fire and relieve toxicity (Huang Lian Jie Du Tang), and clear heat from the Zangfu organs (Qing Wei San).
- Interior heat
- Heat in the Zangfu organs
Tonifying - Bu Fa
This strategy is used to either tonify, restore, supplement or replenish emptiness, deficiency or weakness of the body's Qi, Blood, Yin, Yang, fluids, essence or any of the Zangfu organs. For example, to tonify Qi and replenish the spleen (Si Jun Zi Tang), tonify the blood (Si Wu Tang), tonify the Yin (Liu Wei Di Huang Wan) or tonify the Yang (Jin Gui Shen Qi Wan).
- Deficiency of Qi, Blood, Yin or Yang
- Deficiency of the Zangfu organs
Reducing - Xiao Fa
This strategy is used to reduce, dissolve or eliminate accumulation. For example, chronic conditions resulting from the accumulation of hard and swollen substances such as blood (Xue Fu Zhu Yu Tang), phlegm (Er Chen Tang) or food stagnation (Bao He Wan); Qi stagnation (Yue Ju Wan); abscesses (Wu Ling San) and parasites (Wu Mei Wan).
- Qi stagnation
- Blood stasis
- Food stagnation
In many conditions the disease is too complex to be treated with just one method alone, therefore two or more methods are used together. For example a patient presents the following symptoms: night fever and morning coolness with an absence of sweating as the fever recedes, emaciation with no loss of appetite. Upon further inspection the tongue had a red colour with a little coating and the pulse was fine and rapid.
The patient's syndrome is deficient heat due to the advanced stage of febrile disease of an insufficient type (heat smouldering in the Yin regions). Therefore the most appropriate formula for this condition is Qing Hao Bie Jia Tang. It acts by simultaneously nourishing (tonifying-Bu Fa) the Yin and venting (heat clearing-Qing Fa) the heat. Two of the eight strategies are used in this formula, one to tonify the Yin and the other to clear the heat. The eight strategies are further reiterated within the 'feudal system' (king, minister, assistant and envoy) adopted to illustrate the different roles of each herb in any particular formula.
In Qing Hao Bie Jia Tang the king herb Bie Jia (6g) directly enters the Yin regions to enrich the Yin (tonifying-Bu Fa) and reduce the fever caused from deficiency. Qing Hao (15g), another king herb, vents the heat and expels it from the body (heat clearing-Qing Fa). The minister herbs Sheng Di Huang (12g) and Zhi Mu (6g), assists Bie Jia in nourishing the Yin (tonifying-Bu Fa) and clearing heat from deficiency. The assistant herb Mu Dan Pi (8g) drains heat from the Yin regions and assists Qing Hao (8g) in venting and dispersing the heat (heat clearing-Qing Fa).
The eight strategies are the first recorded number of therapeutic actions that are accomplished by formulas and are related to a practitioner's syndrome differentiation. Furthermore the practitioner's treatment strategy is related to the fundamental aspects of the eight strategies.
Due to the nature of the pathogen and the way in which it can move or develop through the body's various levels, a formula often contains two or more strategies in order to treat the condition.
Today the eight strategies have increased tenfold to further subcategorise formulas according to their therapeutic actions. Nevertheless, the eight strategies are the basis and the broad framework from which all strategies originated. As Dr Cheng once said:
"The eight methods exist in any single method. Likewise, a myriad of methods exist within the eight methods." (Bensky and Barolet 1990, p9).
Bensky, D. & Barolet, R. (1990). Formulas & Strategies. Seattle: Eastland Press, Inc.
Williams, J.E. (1992). 'Herbal Prescriptions Corresponding to the Eight Methods', Journal of Chinese Medicine, May, p28-31.
Yi, Q. (2000). The Traditional Chinese Medicine Formula Study Guide. Boulder: Snow Lotus Press.