Reflections on the Formulary System from 1997 to the Present.

DISCLOSURES: No funding was received for the writing of this reflection. Avey is a member of the AMCP Foundation and has recently retired from MedImpact Health Systems, where he served as Vice President of Specialty Clinical Solutions.

Processing Method & Distribution of Medicinal Plant Ginseng in Early Modern East Asia -Focusing on Ginseng as a Tribute Item of Joeseon to the Ming Dynasty.

Ginseng started to emerge as an international medicinal material during the Joseon Dynasty. This paper examines ginseng as a tribute presented to the Ming royal family by Joseon Dynasty. Joseon Dynasty presented peeled and dried ginseng (white ginseng) to the emperor. The Ming Dynasty demanded chosam (natural ginseng) with no peeling in 1602. By the request of Joseon Dynasty during the period of Lord Gwanghae, the presented ginseng was again changed to pasam (boiled and dried ginseng). Although Nurhachi of the Jurchen is known to have invented this method of processing pasam, Joseon was exporting pasam to the Ming Dynasty earlier than that. As such, the Nurhachi theory of the invention of the pasam should be reexamined. Joseon Dynasty presented ginseng to each emperor and heir to the throne through its envoys. The total amount of ginseng sent to the royal family of the Ming Dynasty during the Joseon Dynasty is estimated to be approximately 664 to 880 geuns per year in the fifteenth century, 300 to 500 geuns in the sixteenth century, and about 160 to 360 geuns in the 17th century. When the Japanese Invasion of Korea occurred in 1592, the Joseon government informed the Ming Dynasty of the miserable situation of the Joseon people and chose to reduce the tribute. However, even after the war, the amount of tribute ginseng in Joseon continued to be small. This is because the medical industry in the Ming Dynasty grew significantly, and medical books prescribing Joseon ginseng increased, and the rich people of the Ming Dynasty loved ginseng so much that they imported Joseon ginseng at high prices. Local residents of Guangdong, China, a major customer base of Joseon ginseng, also used ginseng as a preventive medicine for JangGi. From the fifteenth to the seventeenth centuries, the amount of ginseng that Joseon tributed to the Ming Dynasty continued to decrease, and the ginseng processing method also moved in the direction of reducing the burden of processing. This was caused by changes in the environment surrounding the use of ginseng, including changes in the international situation at the time, growth of the medical industry, increasing interest in ginseng by the people of the Ming, and economic considerations of the Joseon government. The two countries sought changes in the ginseng tribute through an agreement.

A study on the Introduction and Use of Cold Damage Diseases-related Literature in the Early Joseon Dynasty: Focusing on Publishing, Citation, and Textbooks.

The status or role of Shanghan Lun (Treatise on Cold Damage Diseases) in Joseon is quite different compared to neighboring China and Japan. This is a unique aspect that distinguishes Joseon's medicine from other East Asian countries at that time. Prior studies have conducted research on non-professional books of Shanghan Lun; however, this study aims to analyze the transmission and utilization of professional books of Shanghan Lun. In the citations of medical books in the first half of Joseon period, the domestic introduction of professional books of Shanghan Lun used at the time occurred mostly from the mid-thirteenth century to the first half of the fifteenth century. In particular, the version of professional books of Shanghan Lun quoted in Euibangyoochui (Classified Collection of Medical Prescriptions) were centered on the Yuan edition. In other words, the acceptance of the theory of Cold Damage Diseases was based on the Yuan's medicine. Professional books of Shanghan Lun, which were published separately during the compilation or publication of Euibangyoochui, were intentionally selected. It is important to identify their characteristics. First of all, Shanghan Leishu (Classified Book of Cold Damage) was used as a textbook of Cold Damage in the first half of Joseon dynasty because the author of this book, Yang Shizhen and his practice acted as the basic text. The nature of Shanghan Leishu, which pursued the integration of "several symptoms of internal medicine" and "Cold Damage" instead of pursuing independent medicine of Cold Damage with different internal medicines, may have had some influence in forming the uniqueness of Joseon's medicine of Cold Damage. Shanghanfu (Harm Caused by Cold: A Poem) was an introduction for easy access to formal Cold Damage's content. Shanghanfu is presumed to be a medical book made out of prose poems, the core of Shanghanzhizhangtu. Non-professional books of Shanghanlun have also been cited in the first half of Joseon period's medical texts in relation to Cold Damage. However, these books were not used as textbooks in medical bureaucracy's education. The exclusion of major Cold Damage-related texts from the medical bureaucracy's education may have hampered the development of Joseon's Cold Damage medicine.

[Decipherment and annotation of some terms in the remnant scrolls of Hui hui yao fang (Huihui Formularies)].

The etymology of the terms in Hui hui yao fang (Huihui Formularies) is complicated. Their origin might be Arabian, Persian, or Sanskrit, or even the northern dialects of Han language during the Yuan and Ming Dynasties. There are obvious mistakes or indefinite decipherments and interpretations of the terms in Song Xian's Investigated Annotations of Huihui Formularies. There are also missing annotations for those transliterated terms. To tackle such defects, 12 such terms are deciphered and annotated here.

[The compilation, contents and spread of Qing li Shan jiu Fang (Formulary for Effective Rescuing in the Qingli Reign].

Qing li shan jiu fang (Formulary for Effective Rescuing in the Qingli Reign), compiled by Hanlin Academy of Medical Official in 1048 under the decree of the Emperor, is a medical formulary exclusively used to prevent and control poisonous parasite disease. It is composed of formulae provided by a medical scholar of Fuzhou, Lin Shiyuan, together with other formulae collected by the imperial physicians and so on. Unfortunately, it was lost about after the demise of the Southern Song Dynasty. However, in the Southern Song Dynasty, two books, Liang Kejia's Chun xi san shan zhi and Hong Mai's Yi jian zhi bu, do record the progress of its compilation, parts of its contents and the condition of its spread and application. Moreover, they also describe the kinds, the feature, the epidemic, prevention and cure of parasite poison. It is especially good that this book preserves three famous formulae, including Zhi gu du zheng fang (Orthodox Formula for Treating Parasitic Poisons) (called A Cathartic Formula with 8 Ingredients in the Yuan Dynasty), Jie du wan (Antidote Pills) and He qi tang san (Powder of Decoction for Harmonious Qi), which are of medical significance for the understanding of the property of Qing li shan jiu fang. The Song emperors, the central government and local officials all paid high attention to the spread and application of this book. They not only enacted it to the counties, and provinces, but also carved it on stone steles for popularizing the knowledge of preventing parasitic poisons to medical workers and common people.

[Study of the Tui and Zui in Wu shi er bing fang (prescriptions for fifty-two diseases)].

Based on the content concerning the characters Tui and Zui in Wu shi er bing fang (Prescriptions for Fifty-two Diseases), we revealed that Tui and Zui are used distinctively, although both have meanings associated with the external reproductive organs: Tui is used for disease names, whereas Zui is used to describe the human body parts. This theory differs from previous studies, as it offers an interpretation for related topics. We posed the new theory to overcome the many misunderstandings of scholars past and present related to Tui disease characteristics. Several issues exist regarding the interpretation of treatment methods for a disease denoted by the character Tui Specifically, while they have failed to observe the principle of restoration to an original state, modern people impose their way of thinking on that of ancient people. This must be corrected.

[Medicinal formulary, edited by the Health Board for Military Hospitals (1788)]. / Formules de médicamens, rédigées; dans le Conseil de santé des hôpitaux militaires (1788).

A royal decree in 1788 created a Health Board for military hospitals. The board members included Bayen, assisted by Pagmentier. A collection of "Medicinal formulae" was then published with a view to standardizing and simplifying the remedies prepared in pharmacies. It comprised 159 formulae for internal and external medicines together with a nomenclature for 249 simple and compound drugs used in military hospitals.

[The formula book. The pharmacies' own formulas]. / Kompositionsbogen.

During the 19th century and part of the 20th, a book of formulas was a useful tool for many Danish pharmacists in their daily work in the pharmacy laboratory. These books were handwritten and contained formulas that supplemented the official formula books, e.g. the pharmacopoeias. They originated from many different sources such as colleagues, the pharmaceutical press, local doctors, veterinarians and dentists. The book of formulas could be a pharmacist's personal document, or it could belong to a pharmacy for general use in the laboratory. The formulas included many drugs, but a number of the products were intended for daily domestic life: ingredients for food and spirits, cosmetics, cleaning and maintenance, etc. Other products were for use by the local hairdresser or photographer, for example. The article provides an overview of 52 formula books in a wide variety of shapes and sizes with instructions for a total of 8,000-10,000 compositions. Part of this large body of practical knowledge by individual pharmacists was collected and published in books in order to be available to all pharmacists. Some of this knowledge was also printed in booklets written for the general public under such pseudonyms as "An old Pharmacist". In the mid-20th century, Sven Holm enjoyed a prominent career as a well-known pharmacist giving advice on the radio and TV and in newspapers and magazines. The need for these formula books declined as pharmacies gradually stopped making up their own medicines towards the end of 20th century and finally ceased altogether in 1990.

[Tai ping sheng hui fang (Taiping Holy Prescriptions for Universal Relief) and the compilation during the early Song Dynasty].

Tai ping sheng hui fang, the first medical formulary of the Song Dynasty, compiled from the 3(rd) year of Taiping-xingguo reign to the 3(rd) year of Chunhua reign (978 ∼ 992), under the edict of the Taizong Emperor, was popularly applied and extensively circulated and called "the first formulary of the Dynasty". It is extremely significant in the medical history of the Song Dynasty due to its theory of prescription art, practical prescriptions and clinical practice. During the process of its circulation, different versions appeared, including the Guozijian Orthodox Version, Guozijian Small-character Version, Chongwen Hall Abridged Version, Newly Carved Version of Zhuanyunsi, and the Local Abridged Version, thus adapting to the demands of various walks of life in the society. Its unique role in the development of the Song society was founded by its introduction, application and popularization by the emperors, local officials, medical scholars, diplomatic envoys, and intellectuals. The "kind administration" of the authority and the government was further greatly facilitated by the involvement of the government and the introduction of printing. Its practical prescriptions became forceful tools to prevent and treat diseases, to conquer witchcraft, to protect local social security, and to pronounce the merits of officials and physicians at all levels.

[Comparison of French and American formularies in 1945: multiple discrepancies that come from technical, political and social differences]. / La comparaison des formulaires français et américain en 1945: des écarts multiples ayant pour origine des divergences techniques, sociales et politiques.

At the end of the Second World War, L'Officine from Dorvault, 1945 edition, gives the state of the art situation of drugs in France. At the same date, is published New and Non-Official Remedies in Chicago, IL, USA. Tiffeneau in France publishes an other reference book of Pharmacology in 1947 (6th edition). From the comparison of these books appears a mismatch between the French and US remedies at the end of the war: well developed within USA, antibiotics, anti-allergic drugs and contraceptive products are more or less absent in France. Analysis of the differences appears related to technical and economical reasons but also to politic and social ones.

Historical lifetimes of drugs in England: application to value of information and cost-effectiveness analyses.

OBJECTIVES: The expected lifetime of a health technology is a critical parameter in value of information analysis and in two methodologies for cost-effectiveness analysis which have recently been suggested. The first method allows for the possibility that a superior technology will become available in the future. The second advocates modeling both the prevalent and all future incident patient cohorts. Unfortunately, for value of information analysis, the period of time over which information about the decision problem would be useful is very uncertain, and existing estimates are seemingly arbitrary. Furthermore, there is very little literature on the historical lifetimes of technologies. Here, I quantify and analyze the historical lifetimes of drugs in England. I then apply this information to inform the value of further research and the cost-effectiveness of health technologies. METHODS: A Weibull regression model was fitted to the historical drug lifetimes of 455 drugs. These represented all British National Formulary drugs in England which were launched from 1981 to 2007, and which did not have very low sales volumes. RESULTS: The mean drug lifetime was 57 years (95% confidence interval 39-79 years), and the median was 46 years (35-60 years). Drugs with low sales volumes tended to have shorter lifetimes. Under certain assumptions, the ratio of population level to per-year expected value of information is 21. Drug lifetimes are used to parameterize the two models of cost-effectiveness. CONCLUSIONS: The distribution function of the historical lifetimes of drugs can inform suitable time horizons for: 1) value of information; and 2) cost-effectiveness analyses related to drugs.

[Theriacs in charity books, during the 17th and the 18th centuries]. / Les thériaques dans les ouvrages charitables aux XVIIe et XVIIIe siècles.

"Charity books" were books containing formulas of remedies, which were easy to prepare and not too expensive. Their purpose was to cure poor people who had not enough money to have access to official Medicine or who lived too far away from medicine doctors and apothecaries. They were then useful for charitable people such as country priests or charitable Ladies. Great Theriacs were very expensive and too difficult to prepare to be described in this kind of books for non-professional people. Simplified formulas were then proposed. They contained much less products and were quite cheaper. Some of these medicines are described in this article.

Doctors' literacy and papyri of medical content.

The Hippocratic Corpus testifies to the existence of literate doctors, as well as to literate laymen interested in medicine, by the close of the fifth century BC. It is only in later Antiquity, however, that one can begin to speak with confidence about medical literacy encompassing a wide range of specific physicians and a lay public with valetudinarian interests. Evidence from the Roman province of Egypt, when coupled with testimony from Galen and others, is particularly helpful in the effort to sketch a portrait of writers and readers for medical texts. Of particular interest are the joins between the medical writers who have come down to us through the manuscript traditions, many of them practicing and lecturing to the elites of Rome, Alexandria, and eventually Constantinople, and the more ordinary practitioners and their students, friends, and neighbors in the towns and villages of Roman Egypt. My paper surveys texts on papyrus and other materials that bear witness to medical literacy: first, private letters that discuss medical matters; second, didactic texts that played a role in doctors' education, such as the catechisms (erotapokriseis) and medical definitions; and third, collections of recipes, some of which receptaria were once rolls of many columns, while others are but a single sheet with one or two recipes. The some four hundred recipes written down in Roman and Byzantine Egypt emphasize the degree to which the same or similar therapeutic medicaments are shared with medical authors of the manuscript traditions from Dioscorides and Galen to Oribasius, Aetius, and Paul of Aegina.

Teaching the Hippocratic gynaecological recipes?

This paper investigates whether the recipes preserved in the main gynaecological treatises--Diseases of Women 1 and 2, Barrenness and Nature of Women--may have been used as a teaching device. I ask two questions: first whether the recipes could have been included in oral lectures before being written down; and second whether the written recipes could have served as a basis for teaching.

The didactic letters prefacing Marcellus' on drugs as evidence for the expertise and reputation of doctors in the late Roman empire.

The didactic letters prefacing Marcellus's On Drugs are examined. It appears that one reason for writing such didactic letters was to equip the addressee with sufficient knowledge to enable him to avoid consulting a doctor, since there was great dissatisfaction with the quality of service rendered and the fees charged by doctors. The letters in the collection will be shown to represent various levels of healers, from the professional city doctor, to the army doctor, to the educated layman. They will also be scrutinized for evidence of the level of expertise of doctors in the late fourth and fifth centuries. Finally, the evidence will be compared with the criteria set some two centuries earlier by Galen in his blueprint for the examination of physicians.

"Divine water" in the alchemical writings of pseudo-Democritus.

The name of the chemical solution (divine water) or (sulfur water) is characterised by semantic ambiguity: the term theion means both "divine" and "sulfur," and Greek alchemists frequently play on this polysemy. This article analyses the use of this and similar expressions in the writings of pseudo-Democritus from both a technical and a philological point of view. A fragment preserved by the alchemists Moses and Synesius shows that pseudo-Democritus knows two different kinds of this "water," the second of which recalls a recipe found in the chemical Leiden Papyrus, and that the composition of the substance determines the form of its name.