中药的资源，相当丰富，中药的品种，相当繁多。我国疆域广大，过去由于交通的不便，
尽
管是甲地易得之品，往往乙地又有一时不济现象。再则，有些药材，本身就是很稀少的东西
。所以古代医家，便想出种种解决的方法来，不但作为权宜之计，而且形诸笔墨，留给后人
参考。考中药代用之法，由来已久，张仲景称无猪胆以羊胆代之，又说，无胆亦可用。《金
匮·杂疗方》治饮食中毒方，用苦酒，而方后云∶“或以水煮亦得”。仲景以后方书，类此
者，又层见不穷。今将此类资料，梳剔整理，述其要者，归纳成类，供从事中医中药者之参
考。
１.限于地域的变通使用
（１）植物──《本事方》引柳柳州纂《救死方》用橘叶，注云∶“北地无叶，以皮代
之”。
又《圣济总录》治干香港脚之杉节汤，亦用橘叶，注云∶“皮亦得”。当是考虑北地使用之故
。
（２）水类──《千金方》风眩薯蓣汤，用江水，注云∶“秦中无江水处，以千里东流
水代之
”。又《琐碎录》治痔漏，以海水煎汤熏洗，注云∶“入盐煎亦得”。《苏沈良方》治肠痔
，用河水，注云∶“井水亦得”。《鸡峰普济方》及《圣济总录》均有同样记载。
２.照顾少数民族习惯的变通使用
古方中变通使用之法，颇有可供少数民族地区医疗工作之参考者，特辑为一类，其
最初
立方，虽不必因此而设，但是，能以启发吾辈，俾得触类旁通。
《千金方》肺虚寒门用猪胰，注云∶“无猪胰，以羊胰代”。《圣惠方》治妇人乳痈方以
猪胆汁调服，注云∶“以醋浆
水服之亦得”。
《圣济总录》摩傅神明膏用猪膏，注云∶“以牛酥代猪膏亦佳”。《圣惠方》治头疮方用
猪脂调涂，注云∶“用麻油调
亦可”。
３.季节性的变通使用
（１）冬雪夏水──魏氏鼻衄奇效散，须“频用雪块熨药上”。注云∶“无雪只冷水扫”。
《
保幼大全》治 疮，用雪水，以雪水须预藏，故注云∶“无雪水，用新水”。
（２）冬根夏叶──《博爱心鉴》谓水杨∶“春冬用枝，秋夏用叶”。《备急方》疗口中
及舌
上生疮方用蔷薇根，注云∶“冬用根，夏用枝叶”。《圣惠方》治妇人乳痈方用蔓菁叶，注
云“冬无叶，即用根也”。
（３）冬用干者──《古今录验》苏子汤，用苏子及生苏叶，注云∶“冬天煮干枝、茎
叶亦佳”。《千金方》妊娠尿血
方用生艾叶，注云∶“冬用干者”。
４.鲜货与干货的变通使用
（１）干代鲜──《圣惠方》治难产方“益母草捣汁三合，如无生者，用干者一握，以
水煎服”。
《圣济总录》治舌上出血清心散用刺蓟研绞取汁，注云∶“如无生汁，只捣干者为末
，冷水调下”。又治小儿脾热方
用桑根白皮，取自然汁，注云∶“如无新桑根白皮，取干桑白皮，细
文献极多，如《深师方》五
味子汤，《古今录验》桂心汤等均是。
（２）鲜代干──《肘后方》治笃病新起早劳方用干苏，注云∶“无干者，生亦可用”。
（３）分两须有变动──《本草新编》云∶“蒲公英百斤，无鲜草可用干者，干则不必
百斤。三十斤便可，熬膏取七
斤
也”。《全婴方论》有云∶“如无生地黄，只用干地黄，每干地黄五两，当生地黄一斤。”以
上为干须减量之例。《直指方》
肠痈四圣散中，有生栝蒌一枚，注云∶“若干栝蒌，则用两枚。”又是干须加量之例。
５.不同部份的变通使用
这一类的文献很多，各举一二例，恕不详引。
（１）根代叶──《是斋百一选方》治小儿走马疳，用芭蕉杆或叶，注云∶“无即用根”。
（２）根或根皮代花──《短剧方》茅花汤云∶“若无茅花，取茅根代之亦可”。又《伤
寒百
问歌》治鼻衄方云∶“无（茅）花，可以茅根代之”。《妇人良方》疗妇人乳痈方，以芙蓉花
研烂，注云∶“若无花，只取根上皮，先用竹刀，刮去粗皮，但用内一层嫩白皮，研烂”。
《经验秘方》仙方香连丸用葛花，注云∶“无葛花，以葛粉代之”。葛粉乃葛根中之淀粉也
。
（３）根代子──《证类本草》黄蜀葵条引《经验后方》用黄蜀葵子，注云∶“如无子，
以根
细切，煎汁令浓滑、待冷服”。
（４）侧根（子根）代主根（母根）──《古今录验》牡丹丸中用乌头，注云∶“无乌
头，附子亦
可炮用之”。又《方氏家藏方》健脾散，亦以附子代乌头。
（５）茎、叶代子──《澹寮方》苦参圆∶“苍耳子，无，则以茎叶代用”。
《圣惠方》治龋齿方，用葫芦子，注云∶“茎叶亦可用”。
（６）苗、叶、子代瓜──《圣济总录》消渴竹龙散用冬瓜，注云∶“无冬瓜，用冬瓜
苗、叶
、子煎汤俱可”。
（７）枝代果、子──《圣惠方》治妊娠霍乱转筋方用木瓜，注云∶“如无木瓜，煎枝
亦佳”。
《圣济总录》胞衣不出槐子汤注云∶“如无（槐）子用枝”。
（８）茎叶代花──《外科精要》金银花散注云∶“无花，用苗叶嫩茎代之”。
（９）花代根、叶、子──《直指方》瞿麦汤，“如无茅根，只用茅花”。《圣济总录
》肝藏风毒天麻汤用甘菊叶，注
云∶“如无叶，以花代”。扬氏紫草散用红花子。注云∶“如无，红花代之”。
（１０）子代叶、花──《肘后备急方》
疗小儿蠼 疮方用蒺藜叶，注云∶“无叶，子亦可。”
注云∶“无花时，只用葵子。”
（１１）核代果──《朱氏集验方》治骨鲠方用橄榄，注云∶“若无橄榄，核烧为炭，
亦可”。
（１２）骨代脏──《千金翼方》补虚劳方用羊心、肺、肝、肚、肾。注云∶“若无羊
五脏，羊骨亦可用之”。
（１３）角代茸──《寿亲养老书》中有鹿茸方，注云∶“如无，以鹿角屑代之亦妙”。
６.同类品的变通使用
（１）同称异物──《叶氏录验》有用葵叶方，注云∶“如无葵叶，蜀葵子亦得”。
（２）同物异称──《妇人良方》舒经汤云∶“无姜黄，用嫩莪术代之”。
（３）同是油类──《外科精要》白龙膏，用杏子油，注云∶“芝麻油亦可”。
（４）同类而易得──《活人事证后集》糜茸圆注云∶“无糜茸，以鹿茸代”。《活幼口
议》
暖金丹，“无牛黄，以黄牛胆代，加用”。
７.功效相似的变通使用
（１）疗风──《千金翼方》秦王续命大八风散，用牡荆子，注云∶“若无，用柏子仁
代”。
（２）润燥养阴──《活幼口议》黄 散，用天门冬，注云，“麦门冬亦得”。
（３）保肺──《圣济总录》咳嗽百部煎用生百合汁，注云∶“如无，以藕汁代”。
（４）宁心──魏氏小儿安神圆用琥珀，注云∶“如无琥珀，以茯神代之”。
（５）风痹──《朱氏集验方》独活寄生汤注云∶“无桑寄生，则以川续断代”。
（６）除痰──《卫生家宝》中暑地榆夺命散用牛胆制天南星，注云∶“如无，以法制
半夏代之”。
（７）解热──《经心录》漏芦汤用白薇，注云∶“如无，则用知母”。《卫生宝鉴》地
仙丹
用青蒿，注云，“如无，则用竹叶。”
（８）止血──《伤寒蕴要》及《医碥》生地黄汤，均用生藕自然汁，无藕则用刺蓟汁，
再无
则用刺蓟末。
（９）活血──《千金方》之远志汤；茯苓汤；白芷圆；内补当归汤；及《外台秘要》
引深师
温脾丸，均以川芎代当归。
（１０）退黄──《医宗金鉴》于麻黄连轺赤小豆汤下注云∶“无梓皮，以茵陈代之”。
（１１）下气──《寿亲养老书》云∶“如无乌药，用浓朴亦得”。《兰台轨范》引局方
藿香正
气散注云∶“大腹皮换槟榔亦可”。
（１２）温中──《肘后方》治心腹痛方云∶“无桂，用干姜亦佳”。
（１３）通下──《经心录》漏芦汤云∶“无大黄用芒硝。”
（１４）利水──《千金方》甘草圆有泽泻，注云∶“无泽泻，以白术代之”。
（１５）温肾──《活人事证》十柔圆有苁蓉，注云∶“无以鹿茸代之”。
（１６）调经──《妇人明理方》谓“丹参一味，主治与四物相同”。
（１７）外用治汤火伤──《圣惠方》治汤火所灼方用柳白皮，注云∶“用柏白皮亦佳”。
８.代用其一两种功效
前一类，是治疗功效，大致相若的，即某某可代某某。这一类，是仅代其一两种功
效的
，如茯苓代人参定心则可，代其它功能即不适宜。具体材料，仍分数类列下。
（１）定心──《千金翼方》淡竹茹汤（亦见千金，但叙述较略），注云∶“若有人参，
内一两
，若无人参内茯苓一两半，亦佳，人参茯苓，皆治心烦闷及心惊悸，安定精神，有即为良”
。
（２）除烦──《广济方》血气烦闷方用生藕，注云∶“竹沥亦得”。
（３）发血中之表──张文仲疗晚发伤寒方用地黄，注云∶“无地黄，用豉一升”。
《温病条辨》谓生地能发血中之表，此用豆豉，亦代其发表也。
（４）止血兼化瘀──《千金方》白芷圆注云∶“无续断，以大蓟根代之”。
大蓟根仅代续断之止血化瘀作用，其它不能代也。
（５）下气──《圣济总录》小儿吐逆丁香汤，用花桑叶，注云∶“如无，则以枇杷叶
代”。
（６）宣中──《朱氏集验方》仙茅散，注云∶“无仙茅，则以好苍术代之”。
（７）牙疼──魏氏姜黄散，注云∶“偶无姜黄，检本草云∶川芎亦治牙疼，遂以代之”。
（８）解毒──《千金方》伤寒木香汤，内有犀角，注云∶“无犀角，以升麻代之”。
９.应急的变通使用
（１）──《圣济总录》苏合香丸注云∶“仓猝求人参不得，只白汤亦佳”。
（２）──同上、治伤寒狂躁大安丸注云∶“如缓急无地黄汁，新水化下”。
（３）──魏氏中风木香附子汤注云∶“附子炮去皮脐，若急中，不炮”。
（４）──《肘后方》救猝死方破白犬以覆心上，注云∶“无白犬，小鸡亦佳”。
１０.降格以求、甚至缺之亦可
（１）地道问题──《朱氏集验方》木瓜败毒散注云∶“无宣瓜，寻常木瓜亦可。”
（２）品种问题──《千金方》治黄胆方，用小麦苗，捣绞取汁。注云∶“无小麦苗，
野麦苗
亦得”。范注云∶“用小麦胜也”。
（３）大小──《广济方》下乳汁用栝蒌，须青色大者，注云∶“若无大者，用小者两
枚。”
又《圣济总录》香港脚木瓜丸用木瓜大者一枚，注云∶“小者两枚亦可”。
（４）颜色──《广济方》下乳汁用栝蒌，须青色大者。又注云∶“无青色者，黄色者
亦好”。
（５）触类旁通──《卫生家宝》紫金丹中用鹿脊骨，注云∶“以羊脊骨代之亦得”。《直
指方》吐血地黄煎用鹿胶，
注云∶“无鹿胶，以透明阿胶代用”。《方氏家藏方》王医师麝香
“如无鹿角胶，蜜和亦得。”
（６）废物利用──《肘后方》治霍乱方注云∶“无新药，煮滓亦得”。
（７）缺之亦可──《幼幼新书》引婴孺黄 散，注云∶“若无黄 ，可缺也”。《济生
方
》
五香连轺汤注云∶“桑寄生，无真者，宁缺之”。《施氏续易简方》丁附汤，注云∶“急切
，无丁香亦得”。又《肘后方》治水病方亦云∶“无苏合，可缺之也”。
１１.结 语
以上就已有材料，分为十类。古人有言，“世无难治之病，有不善治之医；药无难代之
品，
有不善代之人”。观于上引种种，可悉变通使用，亦是一门学问，灵活而不呆板，辨证而不
机械，若能通盘掌握，豁然于胸，自可随机应变。中医诊疗之特点，在于辩症论治，理、法
、方、药，自有其规矩绳墨，然法有定而方药无定，立法既准，使用何药，可以广为选择，
所
以不惮辞费而广征博引者，意在多所启发，广我思路，俾临症使用时之灵活变通耳。若不加
变化，目其为固定不移，认为某某等于某某，恐终将行之鲜效，则又非演述者落笔之本意也
。
从上引材料里，可以反映出，祖国的药用资源，是极其广泛的。过去的医务工作
者，在
向疾病作斗争的过程中，是有其丰富经验的。就所录各条来看，有很多代用之品，并未
载于
本草书。温习此项材料，可以广开思路，对于扩大药源并充分的利用原有药材来说，会
有一些
参考意义。近年来，各地民间贡献出许多单方草药，编纂了许多草药方书，在群众的防
病治病方
面，在城乡的保建医疗方面，都发挥了巨大的作用。
The resources of Chinese materia medica are quite abundant, and the varieties are numerous. Our country has a vast territory; in the past, due to inconvenient transportation, even if a medicinal material was easily obtained in one place, it often suffered from temporary shortages in another place. Furthermore, some medicinal materials are inherently very rare. Therefore, ancient physicians devised various solutions, not only as expedient measures but also recorded them for future generations to reference. The practice of substituting Chinese medicinal materials has a long history. Zhang Zhongjing mentioned using sheep gallbladder (Yang Dan) when pig gallbladder (Zhu Dan) was unavailable, and stated that other substitutes could be used if no gallbladder was available. In *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) · Miscellaneous Therapeutic Methods, a formula for treating food poisoning uses Ku Jiu (Vinegar), with a post-formula note stating: "Alternatively, boiling with water is acceptable." Since Zhang Zhongjing, such records have appeared frequently in medical texts. Here, these materials are sorted and organized, summarizing the important points into categories for reference by those engaged in Traditional Chinese Medicine (TCM) and materia medica.
1. Substitutions limited by geography
(1) Plant-based — *Ben Shi Fang* (Effective Prescriptions Worth a Thousand Pieces of Gold) cites Liu Zongyuan's compiled *Jiu Si Fang* (Prescriptions for Saving Lives), which uses Ju Ye (Tangerine Leaf). The note states: "In northern regions where leaves are unavailable, replace with peel (Pi)." Additionally, *Sheng Ji Zong Lu* (Compendium of Holy Emergency) uses Ju Ye in Shan Jie Tang (Cedar Joint Decoction) for Gan Jiao Qi (Dry Foot Leg Qi disease, a condition characterized by heaviness or pain in the limbs), noting: "Peel is also acceptable." This consideration likely stems from usage in northern regions.
(2) Water-based — *Qian Jin Fang* (Thousand Gold Formulas) uses Jiang Shui (River Water) in Feng Xuan Shu Yu Tang (Wind-Dizziness Dahuang Decoction), noting: "In areas of Guanzhong without river water, substitute with water flowing eastward for a thousand li." Additionally, *Suo Sui Lu* treats Zhi Lou (Hemorrhoids with Fistula) by fumigating and washing with decocted sea water, noting: "Adding salt during decoction is also acceptable." *Su Shen Liang Fang* uses He Shui (River Water) for Chang Zhi (Intestinal Hemorrhoids), noting: "Well water is also acceptable." *Ji Feng Pu Ji Fang* and *Sheng Ji Zong Lu* contain similar records.
2. Substitutions accommodating ethnic minority customs
Many substitution methods in ancient formulas offer reference for medical work in ethnic minority regions, specifically collected here as a category. Although the original formulation may not have been intended for this purpose, they can inspire us to apply principles analogously.
*Qian Jin Fang*, under the section for Lung Deficiency Cold, uses Zhu Yi (Pig Pancreas), noting: "If pig pancreas is unavailable, substitute with sheep pancreas." *Sheng Hui Fang* treats Ru Yong (Acute Mastitis) in women using Zhu Dan Huang (Pig Gallbladder Bile) mixed for administration, noting: "Taking it with Cu Jiang Shui (Vinegar Slurry) is also acceptable."
*Sheng Ji Zong Lu* uses Zhu Gao (Lard/Pig Fat) in Mo Fu Shen Ming Gao (Massage Paste for Divine Clarity), noting: "Substituting with Niu Su (Cow Butter/Ghee) for lard is also excellent." *Sheng Hui Fang* treats Tou Chuang (Head Sores) by mixing with Zhu Zhi (Pig Fat), noting: "Mixing with Ma You (Sesame Oil) is also acceptable."
3. Seasonal substitutions
(1) Winter Snow and Summer Water — Wei Shi Bi Xu Qi Xiao San (Wei's Miraculous Effective Powder for Epistaxis) requires "frequently applying snow blocks to iron the medicine." The note states: "If no snow is available, simply sweep with cold water." *Bao You Da Quan* treats Dou Chuang (Smallpox/Chickenpox) using Xue Shui (Snow Water); since snow water must be stored in advance, the note states: "If snow water is unavailable, use fresh water."
(2) Winter Roots and Summer Leaves — *Bo Ai Xin Jian* states regarding Shui Yang (Willow): "Use branches in spring and winter, leaves in autumn and summer." *Bei Ji Fang* treats sores in the mouth and on the tongue using Qiang Wei Gen (Rose Root), noting: "Use roots in winter, branches and leaves in summer." *Sheng Hui Fang* treats Ru Yong in women using Man Jing Ye (Turnip Leaves), noting: "If no leaves are available in winter, use roots."
(3) Dry Materials in Winter — *Gu Jin Lu Yan* Su Zi Tang (Perilla Seed Decoction) uses Su Zi (Perilla Seeds) and fresh Su Ye (Perilla Leaves), noting: "Decocting dry branches, stems, and leaves in winter is also good." *Qian Jin Fang* for hematuria in pregnancy uses Sheng Ai Ye (Fresh Mugwort Leaves), noting: "Use dried materials in winter."
4. Substitutions between fresh and dried materials
(1) Dried replacing Fresh — *Sheng Hui Fang* for difficult labor states: "Crush Yi Mu Cao (Motherwort) to obtain three he of juice; if fresh is unavailable, use one handful of dried material, decoct in water and administer." *Sheng Ji Zong Lu* uses Ci Ji (Thistle) ground and squeezed for juice in Qing Xin San (Clear Heart Powder) for bleeding on the tongue, noting: "If fresh juice is unavailable, grind dried material into powder and take with cold water." For pediatric spleen heat, Sang Gen Bai Pi (Mulberry Root Bark) is used to extract natural juice, noting: "If fresh mulberry root bark is unavailable, use dried Sang Bai Pi (Mulberry Root Bark), finely shredded." Many such records exist, such as Wu Wei Zi Tang (Schisandra Decoction) in *Shen Shi Fang* and Gui Xin Tang (Cinnamon Heart Decoction) in *Gu Jin Lu Yan*.
(2) Fresh replacing Dried — *Zhou Hou Fang* (Handbook of Prescriptions for Emergencies) uses Gan Su (Dried Perilla) for early-stage severe illness, noting: "If dried is unavailable, fresh is also usable."
(3) Adjustment of Dosage — *Ben Cao Xin Bian* states: "For one hundred jin of Pu Gong Ying (Dandelion), if fresh grass is unavailable, use dried; however, one hundred jin of dried is unnecessary. Thirty jin suffices to produce seven jin of paste." *Quan Ying Fang Lun* states: "If fresh Sheng Di Huang (Rehmannia Root) is unavailable, use Gan Di Huang (Dried Rehmannia); five liang of dried corresponds to one jin of fresh." These are examples of reducing dosage for dried materials. *Zhi Zhi Fang* for Intestinal Abscess Si Sheng San contains one fresh Gua Lou (Trichosanthes Fruit), noting: "If using dried Gua Lou, use two fruits." This is an example of increasing dosage for dried materials.
5. Substitutions using different parts of the plant
There are many such documents; citing one or two examples per category follows.
(1) Root replacing Leaf — *Shi Zhai Bai Yi Xuan Fang* treats Xiao Er Zou Ma Gan (Rapidly Progressing Gangrenous Stomatitis in Children) using Ba Jiao Gan (Banana Stem) or leaves, noting: "If unavailable, use root."
(2) Root or Root Bark replacing Flower — *Duan Ju Fang* Mao Hua Tang says: "If Mao Hua (Mugwort Flower) is unavailable, substitute with Mao Gen (Mugwort Root)." *Shang Han Bai Wen Ge* for epistaxis says: "If no flower, substitute with Mao Gen." *Fu Ren Liang Fang* for Ru Yong crushes Fu Rong Hua (Hibiscus Flower), noting: "If no flower, take the inner tender white bark from the root surface, scrape off the rough outer bark with a bamboo knife, and crush the remaining layer." *Jing Yan Mi Fang* Xian Fang Xiang Lian Wan uses Ge Hua (Kudzu Flower), noting: "If no Kudzu flower, substitute with Ge Fen (Kudzu Starch)." Ge Fen is starch extracted from Ge Gen (Kudzu Root).
(3) Root replacing Seed — *Zheng Lei Ben Cao* cites *Jing Yan Hou Fang* using Huang Shu Kui Zi (Yellow Hollyhock Seed), noting: "If seeds are unavailable, finely slice the root, decoct until thick and slippery, cool, and administer."
(4) Side Root (Child Root) replacing Main Root (Mother Root) — *Gu Jin Lu Yan* Mu Dan Wan uses Wu Tou (Aconite Mother Root), noting: "If Wu Tou is unavailable, Fu Zi (Aconite Child Root) can be processed and used." *Fang Shi Jia Cang Fang* Jian Pi San also substitutes Fu Zi for Wu Tou.
(5) Stem and Leaf replacing Seed — *Dan Liao Fang* Ku Shen Yuan: "If Cang Er Zi (Xanthium Fruit) is unavailable, substitute with stem and leaf." *Sheng Hui Fang* for dental caries uses Hu Lu Zi (Calabash Seed), noting: "Stems and leaves are also usable."
(6) Sprout, Leaf, and Seed replacing Fruit — *Sheng Ji Zong Lu* Xiao Ke Zhu Long San uses Dong Gua (Winter Melon), noting: "If Winter Melon is unavailable, decocting Dong Gua Miao (Sprouts), Ye (Leaves), or Zi (Seeds) is all acceptable."
(7) Branch replacing Fruit and Seed — *Sheng Hui Fang* for pregnancy Hu Luan with muscle cramps uses Mu Gua (Chaenomeles Fruit), noting: "If Mu Gua is unavailable, decocting branches is also good." *Sheng Ji Zong Lu* Huai Zi Tang for retained placenta notes: "If Huai Zi (Sophora Seed) is unavailable, use branches."
(8) Stem and Leaf replacing Flower — *Wai Ke Jing Yao* Jin Yin Hua San notes: "If flowers are unavailable, substitute with sprouts, leaves, and tender stems."
(9) Flower replacing Root, Leaf, and Seed — *Zhi Zhi Fang* Qu Mai Tang: "If Mao Gen is unavailable, use only Mao Hua." *Sheng Ji Zong Lu* Gan Zang Feng Du Tian Ma Tang uses Gan Ju Ye (Chrysanthemum Leaf), noting: "If leaves are unavailable, substitute with flower." Yang Shi Zi Cao San uses Hong Hua Zi (Carthamus Seed), noting: "If unavailable, substitute with Hong Hua (Carthamus Flower)."
(10) Seed replacing Leaf and Flower — *Zhou Hou Bei Ji Fang* for Qu Sou Chuang in children uses Ji Li Ye (Tribulus Leaf), noting: "If leaves are unavailable, seeds are also acceptable." Note: "When flowers are unavailable, use only Kui Zi (Hibiscus Seed)."
(11) Pit replacing Fruit — *Zhu Shi Ji Yan Fang* for bone stuck in throat uses Gan Lan (Olive), noting: "If olives are unavailable, calcined pits are also acceptable."
(12) Bone replacing Organ — *Qian Jin Yi Fang* for tonifying deficiency uses Yang Xin, Fei, Gan, Du, Shen (Sheep Heart, Lung, Liver, Stomach, Kidney). Note: "If sheep viscera are unavailable, sheep bones are also usable."
(13) Horn replacing Antler — *Shou Qin Yang Lao Shu* includes a formula with Lu Rong (Deer Antler Velvet), noting: "If unavailable, Lu Jiao Xie (Deer Horn Chips) are also excellent."
6. Substitutions within similar categories
(1) Same name, different object — *Ye Shi Lu Yan* has a formula using Kui Ye (Hibiscus Leaf), noting: "If Hibiscus leaf is unavailable, Shu Kui Zi (Malva Seed) is also acceptable."
(2) Different names, same object — *Fu Ren Liang Fang* Shu Jing Tang says: "If Jiang Huang (Turmeric) is unavailable, substitute with嫩 E Zhu (Young Curcuma)."
(3) Both are oils — *Wai Ke Jing Yao* Bai Long Gao uses Xing Zi You (Apricot Kernel Oil), noting: "Sesame oil is also acceptable."
(4) Similar category and easily obtained — *Huo Ren Shi Zheng Hou Ji* Mi Rong Yuan notes: "If Mi Rong is unavailable, substitute with Lu Rong (Deer Antler)." *Huo You Kou Yi* Nuan Jin Dan: "If Niu Huang (Calculus Bovis) is unavailable, substitute with Niu Huang Dan (Ox Gallbladder), adding to the formula."
7. Substitutions with similar efficacy
(1) Treating Wind — *Qian Jin Yi Fang* Qin Wang Xu Ming Da Ba Feng San uses Mu Jing Zi (Vitex Seed), noting: "If unavailable, substitute with Bai Zi Ren (Biota Seed)."
(2) Moistening Dryness and Nourishing Yin — *Huo You Kou Yi* Huang [Missing Character] San uses Tian Men Dong (Asparagus Root), noting: "Mai Men Dong (Ophiopogon Root) is also acceptable."
(3) Protecting Lung — *Sheng Ji Zong Lu* Ke Sou Bai Bu Jian uses Sheng Bai He Zhi (Fresh Lily Bulb Juice), noting: "If unavailable, substitute with Ou Zhi (Lotus Root Juice)."
(4) Calming Heart — Wei Shi Xiao Er An Shen Yuan uses Hu Po (Amber), noting: "If Amber is unavailable, substitute with Fu Shen (Poria with Hostwood)."
(5) Wind-Bi (Arthralgia) — *Zhu Shi Ji Yan Fang* Du Huo Ji Sheng Tang notes: "If Sang Ji Sheng (Taxillus) is unavailable, substitute with Chuan Xu Duan (Teasel Root)."
(6) Eliminating Phlegm — *Wei Sheng Jia Bao* Zhong Shu Di Yu Duo Ming San uses Niu Dan Zhi Tian Nan Xing (Gallbladder-processed Arisaema), noting: "If unavailable, substitute with Fa Zhi Ban Xia (Processed Pinellia)."
(7) Clearing Heat — *Jing Xin Lu* Lou Lu Tang uses Bai Wei (Cynanchum Root), noting: "If unavailable, use Zhi Mu (Anemarrhena Rhizome)." *Wei Sheng Bao Jian* Di Xian Dan uses Qing Hao (Sweet Wormwood), noting: "If unavailable, use Zhu Ye (Bamboo Leaf)."
(8) Stopping Bleeding — *Shang Han Yun Yao* and *Yi Biao* Sheng Di Huang Tang both use Sheng Ou Zi Ran Zhi (Natural Juice of Fresh Lotus Root); if no lotus root, use Ci Ji Zhi (Thistle Juice); if none, use Ci Ji Mo (Thistle Powder).
(9) Invigorating Blood — *Qian Jin Fang* Yuan Zhi Tang, Fu Ling Tang, Bai Zhi Yuan, Nei Bu Dang Gui Tang; and *Wai Tai Mi Yao* citing Shen Shi Wen Pi Wan, all substitute Chuan Xiong (Szechwan Lovage Rhizome) for Dang Gui (Angelica Sinensis).
(10) Resolving Jaundice — *Yi Zong Jin Jian* under Ma Huang Lian Qiao Chi Xiao Dou Tang notes: "If Zi Pi (Paulownia Bark) is unavailable, substitute with Yin Chen (Capillaris)."
(11) Directing Qi Downward — *Shou Qin Yang Lao Shu* says: "If Wu Yao (Lindera Root) is unavailable, Hou Po (Magnolia Bark) is also acceptable." *Lan Tai Gui Fan* citing Ju Fang Huo Xiang Zheng Qi San notes: "Da Fu Pi (Areca Peel) can replace Bing Lang (Betel Nut)."
(12) Warming the Middle — *Zhou Hou Fang* for heart and abdominal pain says: "If Gui Zhi (Cinnamon Twig) is unavailable, Gan Jiang (Dried Ginger) is also good."
(13) Purging Accumulation — *Jing Xin Lu* Lou Lu Tang says: "If Da Huang (Rhubarb) is unavailable, use Mang Xiao (Mirabilite)."
(14) Promoting Urination — *Qian Jin Fang* Gan Cao Yuan contains Ze Xie (Alisma), noting: "If Alisma is unavailable, substitute with Bai Zhu (Atractylodes Macrocephala)."
(15) Warming Kidney — *Huo Ren Shi Zheng* Shi Rou Yuan contains Cong Rong (Cistanche), noting: "If unavailable, substitute with Lu Rong (Deer Antler)."
(16) Regulating Menstruation — *Fu Ren Ming Li Fang* states: "Dan Shen (Salvia miltiorrhiza) alone has indications identical to Si Wu Tang (Four Substance Decoction)."
(17) External Use for Burns — *Sheng Hui Fang* for burns uses Liu Bai Pi (Willow White Bark), noting: "Using Bai Bai Pi (Platycladus Bark) is also good."
8. Partial substitution of efficacy
The previous category involved treatments with roughly equivalent efficacy, i.e., A replaces B entirely. This category involves substituting only one or two specific efficacies. For instance, Fu Ling (Poria) can replace Ren Shen (Ginseng) for calming the mind, but is unsuitable for other functions. Specific materials are listed below by category.
(1) Calming the Mind — *Qian Jin Yi Fang* Dan Zhu Ru Tang (also in *Qian Jin*, but less detailed) notes: "If Ren Shen is available, add one liang; if not, add one and a half liang of Fu Ling, which is also good. Both Ren Shen and Fu Ling treat mental restlessness and palpitations, stabilizing the spirit; having either is beneficial."
(2) Relieving Irritability — *Guang Ji Fang* for blood and qi irritability uses Sheng Ou (Fresh Lotus Root), noting: "Zhu Li (Bamboo Sap) is also acceptable."
(3) Expelling Pathogen from Blood Level — Zhang Wenzhong's formula for late-onset shanghan uses Di Huang (Rehmannia), noting: "If Di Huang is unavailable, use one sheng of Chi Dou (Fermented Soybean)." *Wen Bing Tiao Bian* states that Sheng Di Huang can expel pathogens from the blood level; thus, using Dou Chi serves to substitute this releasing function.
(4) Stopping Bleeding and Resolving Stasis — *Qian Jin Fang* Bai Zhi Yuan notes: "If Xu Duan (Teasel Root) is unavailable, substitute with Da Ji Gen (Great Thistle Root)." Da Ji Gen only substitutes the hemostatic and stasis-resolving action of Xu Duan; it cannot substitute other functions.
(5) Directing Qi Downward — *Sheng Ji Zong Lu* Xiao Er Tu Ni Ding Xiang Tang uses Hua Sang Ye (Mulberry Leaf with Flower), noting: "If unavailable, substitute with Pi Pa Ye (Loquat Leaf)."
(6) Ventilating the Middle — *Zhu Shi Ji Yan Fang* Xian Mao San notes: "If Xian Mao (Curculigo Rhizome) is unavailable, substitute with high-quality Cang Zhu (Atractylodes Lancea)."
(7) Toothache — Wei Shi Jiang Huang San notes: "Occasionally lacking Jiang Huang, checking *Ben Cao* reveals that Chuan Xiong also treats toothache, so I substituted it."
(8) Detoxification — *Qian Jin Fang* Shang Han Mu Xiang Tang contains Xi Jiao (Rhinoceros Horn), noting: "If Rhinoceros Horn is unavailable, substitute with Sheng Ma (Cimicifuga Rhizome)."
9. Emergency substitutions
(1) — *Sheng Ji Zong Lu* Su He Xiang Wan notes: "In haste, if Ren Shen cannot be obtained, plain hot water (Bai Tang) is also good."
(2) — Ibid., Da An Wan for shanghan mania notes: "If urgent and Di Huang Zhi (Rehmannia Juice) is unavailable, dissolve with fresh water."
(3) — Wei Shi Zhong Feng Mu Xiang Fu Zi Tang notes: "Fu Zi should be processed, peeled, and navel removed; if urgent, processing is omitted."
(4) — *Zhou Hou Fang* emergency rescue for sudden death involves placing a broken white dog on the heart, noting: "If white dog is unavailable, a small chicken is also good."
10. Compromising standards or omitting ingredients
(1) Geographic Origin Issue — *Zhu Shi Ji Yan Fang* Mu Gua Bai Du San notes: "If Xuan Gua Lou (Xuanzhou Trichosanthes) is unavailable, ordinary Mu Gua is also acceptable."
(2) Variety Issue — *Qian Jin Fang* for jaundice uses Xiao Mai Miao (Wheat Sprout), crushed for juice. Note: "If wheat sprouts are unavailable, wild wheat sprouts are also acceptable." Fan's annotation states: "Using cultivated wheat is superior."
(3) Size — *Guang Ji Fang* for promoting lactation uses Gua Lou, requiring large green ones. Note: "If large ones are unavailable, use two small ones." *Sheng Ji Zong Lu* Hong Jiao Mu Gua Wan uses one large Mu Gua, noting: "Two small ones are also acceptable."
(4) Color — *Guang Ji Fang* for lactation requires large green Gua Lou. Another note states: "If green ones are unavailable, yellow ones are also good."
(5) Analogical Application — *Wei Sheng Jia Bao* Zi Jin Dan uses Lu Ji Gu (Deer Spine Bone), noting: "Substitute with Yang Ji Gu (Sheep Spine Bone)." *Zhi Zhi Fang* Tu Xue Di Huang Jian uses Lu Jiao Jiao (Deer Horn Glue), noting: "If Deer Horn Glue is unavailable, transparent E Jiao (Donkey-Hide Glue) can be used." *Fang Shi Jia Cang Fang* Physician Wang's She Xiang formula: "If Deer Horn Glue is unavailable, mixing with honey is acceptable."
(6) Waste Utilization — *Zhou Hou Fang* for cholera notes: "If new medicine is unavailable, decocting the dregs (Za) is also acceptable."
(7) Omission Allowed — *You You Xin Shu* cites Ying Ru Huang [Missing Character] San, noting: "If Huang [Missing Character] is unavailable, it may be omitted." *Ji Sheng Fang* Wu Xiang Lian Qiao Tang notes: "If genuine Sang Ji Sheng is unavailable, better to omit it." *Shi Shi Xu Yi Jian Fang* Ding Fu Tang notes: "In urgency, if Ding Xiang (Clove) is unavailable, it is acceptable." *Zhou Hou Fang* for edema also states: "If Su He Xiang (Styrax) is unavailable, it may be omitted."
11. Conclusion
The above materials are divided into ten categories. As the ancients said, "There are no incurable diseases, only doctors who do not know how to treat them; there are no irreplaceable medicines, only people who do not know how to substitute them." Observing the aforementioned cases, it is evident that flexible substitution is a scholarly discipline—flexible yet not rigid, dialectical yet not mechanical. If mastered comprehensively, one can adapt spontaneously to clinical situations. The characteristic of TCM diagnosis and treatment lies in syndrome differentiation and treatment; theory, method, formula, and medicine follow their own rules. However, while methods are fixed, formulas and medicines are not. Once the therapeutic principle is established accurately, any suitable medicine can be widely selected. Thus, the extensive citations herein aim to inspire broad thinking and facilitate flexible substitution in clinical practice. If changes are ignored, viewing prescriptions as fixed and equating one herb directly with another, the results will likely be ineffective, which contradicts the author's original intent.
From these cited materials, it is reflected that the medicinal resources of our nation are extremely extensive. Past medical workers possessed rich experience in the struggle against disease. Many substituted materials recorded here are not found in standard *Ben Cao* (Materia Medica) texts. Reviewing this material can broaden perspectives and provide reference value for expanding drug sources and fully utilizing existing medicinal materials. In recent years, local folk contributions of single-herb remedies and compilations of herbal formula books have played a huge role in mass disease prevention and treatment, as well as urban and rural healthcare.