Install
openclaw skills install aky-tcm-prescriptionaky-tcm-prescription
AI-powered Traditional Chinese Medicine (TCM) prescription assistant based on classical texts: Shanghan Lun (伤寒论), Jingui Yaolue (金匮要略), and Formula Study (方剂学). Supports syndrome differentiation (八纲/六经/脏腑/卫气营血), formula recommendation with composition analysis, herb safety checking (十八反十九畏, 妊娠禁忌), dosage guidance, and formula modification. Trigger when users ask about: TCM prescription, Chinese herbal formula, syndrome differentiation, 开方, 中药方, 辨证论治, formula analysis, herb substitution, classical formulas (经方), or any TCM clinical guidance.
Aky TCM Prescription Assistant (经方AI)
AI-powered TCM prescription assistant grounded in classical Chinese medical texts. Supports the complete clinical workflow: 四诊合参 → 辨证 → 立法 → 选方/组方 → 用药安全审核.
Integrates six advanced TCM approaches:
- 法证对应 (Pattern-Principle Correspondence) — break symptoms into pattern elements, establish principles, flexibly select herbs
- 理法方药 (Principle-Method-Prescription-Medicine) — systematic formula learning from pathogenesis to formula song
- 君臣佐使 (Monarch-Minister-Assistant-Messenger) — structured formula composition analysis
- 六经辨证 (Six Meridian Differentiation) — classical Shanghan Lun framework
- 体质适配 (Constitution Matching) — adjust formulas to 9 constitution types
- 经方时方结合 (Classical & Modern Integration) — comprehensive formula coverage
⚠️ DISCLAIMER: This skill is for educational and reference purposes only. All outputs must be reviewed by a licensed TCM practitioner before clinical use. This does NOT constitute medical advice.
I. Core Workflows
Workflow A: Clinical Prescription (完整开方流程)
The standard end-to-end prescription workflow — suitable for syndrome → formula → safety check.
Step 1: Collect patient information
├── Chief complaint (主诉)
├── History of present illness (现病史)
├── Past medical history (既往史)
├── Current medications (TCM & Western)
└── Constitution type assessment (体质辨识)
→ Read references/constitution-clinical.md for 9 types
Step 2: Four Examinations (四诊)
├── Inspection (望诊): tongue body/coating, complexion, spirit
├── Listening & Smelling (闻诊): voice, breathing, body odor
├── Inquiry (问诊): chills/fever, perspiration, appetite, thirst,
stools/urine, sleep, pain, menses → See references/diagnosis-guide.md
└── Palpation (切诊): pulse quality (28脉), abdominal palpation
Step 3: Syndrome Differentiation (辨证)
├── Identify pattern → Read references/syndrome-differentiation.md
├── Six Meridian (六经) → 先辨六经再选方 (Ni Haixia principle)
├── Zang-Fu (脏腑) → precise organ pattern identification
├── Eight Principles (八纲) → yin/yang, exterior/interior, cold/heat, deficiency/excess
├── Wei-Qi-Ying-Xue (卫气营血) → warm disease stage
└── Advanced: 法证对应 证素拆解 → Read references/formula-analysis.md §1
Step 4: Decompose Pattern Elements (证素拆解 — 法证对应)
├── Break into elemental units (病性+病位)
├── Each element → corresponding treatment principle
├── Identify primary vs secondary elements (主证 vs 兼证)
└── See references/formula-analysis.md §1 for complete framework
Step 5: Determine Treatment Principle (立法)
├── Select method(s): 汗/吐/下/和/温/清/消/补
├── Main principle + auxiliary principle
├── Consider: 法不变而药可变 (principle constant, herbs variable)
└── Document rationale
Step 6: Select & Modify Formula (处方)
├── Classic formula match → Read references/formula-database.md
├── Apply 君臣佐使 analysis → See references/formula-analysis.md §3
├── Apply 配伍结构 understanding → See references/formula-analysis.md §2, §5
├── Modify based on constitution → See references/constitution-clinical.md §2
├── Compare if multiple formulas fit → 一病多方择优推荐
└── Document modifications with reasoning (法不变而药可变)
Step 7: Safety Review (安全审核) — MANDATORY
├── Check 十八反 (Eighteen Incompatibilities)
├── Check 十九畏 (Nineteen Antagonisms)
├── Check 妊娠禁忌 (Pregnancy contraindications)
├── Verify all dosages within safe range per 《中国药典》
├── Check toxic herbs and processing → See references/safety-rules.md §4
└── Flag potential herb-drug interactions → See references/safety-rules.md §6
Workflow B: Formula Analysis & Learning (方剂拆解与学习)
For users who want to understand, deconstruct, or learn a formula — not for prescribing.
Step 1: Identify Formula (确认方剂)
├── Formula name, origin, composition, indications, tongue/pulse
Step 2: Reconstruct Pathomechanism (还原病机)
├── 病因 (etiology) → 病位 (location) → 病性 (nature) → 病势 (dynamics)
└── See references/formula-analysis.md §2
Step 3: Derive Treatment Principle (推导治法)
├── "Because [mechanism], therefore [principle]"
Step 4: Identify Property Requirements (定性味归经)
├── Before naming herbs: what 四气/五味/升降浮沉/归经 are needed?
Step 5: Analyze Herb Roles & Composition (君臣佐使 + 配伍)
├── For each herb: which mechanism? which principle? which role?
├── 配伍结构 analysis: 相须/相使/相畏/一散一收/一升一降/一寒一热 etc.
└── See references/formula-analysis.md §2 (Step 6) and §5
Step 6: Generate Memory Formula Song (方歌)
├── Compress pathogenesis + herbs + structure into song verse
└── See references/formula-analysis.md §5 for examples
Step 7: Discuss Clinical Modifications (临床加减)
├── 法不变而药可变: demonstrate flexible application
└── See references/formula-analysis.md §1 (Appendix)
Workflow C: 法证对应 Advanced Analysis (进阶：法证对应)
For complex cases with mixed patterns — best used when standard pattern→formula mapping is insufficient.
Step 1: Decompose Pattern Elements (拆证素)
├── Break the case into smallest pathological units
├── Each unit = a pair of (病性 + 病位)
├── Example: 气虚+脾, 湿热+下焦, 血瘀+胸胁
└── See references/formula-analysis.md §1
Step 2: Establish Treatment Principles (立治法)
├── Each element → one or more principles
├── Prioritize: which element is primary (主)? which are secondary (兼)?
└── Example: 气虚(补气) + 湿热(清热利湿) + 血瘀(活血)
Step 3: Select Herbs by Principle (按法选药)
├── For each principle: determine required 性味归经
├── Select herbs using herb comparison knowledge
├── Consider herb interactions and 配伍 structure
├── Horizontal comparison (同类药异同) → read references/formula-analysis.md §4
└── Vertical comparison (一味药多功用) → read references/formula-analysis.md §4
Step 4: Assemble Formula (组合组方)
├── Integrate herbs addressing all elements
├── Ensure compatibility — no 十八反/十九畏 violations
├── Adjust doses based on priority and constitution
└── Provide reasoning: "法不变而药可变" explanation
Workflow D: Quick Pattern → Formula Lookup (快速方证对应)
For simple/clear patterns where standard formula matching suffices.
| Key Presentation | Most Likely Pattern | Consider Formula |
|---|---|---|
| Aversion to cold + fever + no sweat + body ache | 风寒表实证 | 麻黄汤 |
| Aversion to cold + fever + sweat | 风寒表虚证 | 桂枝汤 |
| Alternating chills/fever + rib fullness + bitter taste | 少阳病 | 小柴胡汤 |
| High fever + extreme thirst + sweating + surging pulse | 阳明经证 | 白虎汤 |
| Constipation + abdominal pain + tidal fever | 阳明腑实证 | 承气汤 |
| Epigastric fullness + nausea + diarrhea | 寒热错杂痞 | 半夏泻心汤 |
| Cough with frothy phlegm + aversion to cold | 外寒内饮 | 小青龙汤 |
| Edema + dysuria + thirst | 水湿内停 | 五苓散 |
| Fatigue + pale face + poor appetite + loose stools | 脾气虚 | 四君子汤 |
| Lower back soreness + dizziness + tinnitus + night sweats | 肾阴虚 | 六味地黄丸 |
| Cold lower back + cold limbs + frequent urination | 肾阳虚 | 肾气丸/右归丸 |
| Chest stabbing pain + purple tongue | 血瘀 | 血府逐瘀汤 |
| Depression + rib distension + sighing | 肝气郁结 | 柴胡疏肝散 |
| Palpitations + insomnia + poor memory | 心血虚 | 归脾汤/天王补心丹 |
| Mucus cough + chest tightness + greasy coating | 痰湿 | 二陈汤 |
II. Reference Resources
| File | Content | When to Load |
|---|---|---|
| references/syndrome-differentiation.md | Eight Principles, Six Meridian, Zang-Fu, Wei-Qi-Ying-Xue, Qi-Blood-Fluid differentiation | Any prescription workflow Step 3 |
| references/formula-database.md | 150+ core formulas with composition, actions, indications, modifications | Formula selection or analysis |
| references/herb-reference.md | 450+ herbs organized by category, with properties, dosages, indications | Herb selection or modification |
| references/safety-rules.md | 十八反, 十九畏, pregnancy contraindications, toxic herbs, herb-drug interactions | EVERY prescription (mandatory) |
| references/diagnosis-guide.md | Four examinations: tongue, pulse, inquiry (十问歌), abdominal palpation | Patient data collection (Step 2) |
| references/formula-analysis.md | 法证对应 framework, 理法方药 learning method, 君臣佐使 analysis, 配伍结构, 药物对比, 方歌 | Advanced analysis (Workflow B/C) or formula deconstruction |
| references/constitution-clinical.md | 九种体质 types, constitutional modifications, famous physician cases, pattern differentiation | Constitution assessment and modification |
III. Output Format
For each prescription recommendation (Workflow A), structure the output as follows:
## Prescription Recommendation
**Pattern Diagnosis (辨证结果):** [Pattern name, basis, and evidence]
**法证对应拆解 (Pattern Elements):**
- Primary element: [病性+病位] → Principle: [method]
- Secondary element: [病性+病位] → Principle: [method]
**Treatment Principle (治法):** [Method and rationale]
**Formula (方名):** [Formula name and origin] | 一病多方选项: [alternative if applicable]
**Composition (组成) — 君臣佐使分析:**
| Herb | Dose | Role | Action in Formula |
|------|:----:|:----:|-------------------|
| [Herb A] | X g | 君 (Monarch) | [addresses primary element: mechanism] |
| [Herb B] | X g | 臣 (Minister) | [reinforces monarch / addresses secondary] |
| [Herb C] | X g | 佐 (Assistant) | [restricts toxicity / concurrent symptom] |
| [Herb D] | X g | 使 (Messenger) | [guides/harmonizes] |
**配伍结构 (Compatibility):**
- [Herb A] + [Herb B]: [relationship structure, e.g., 相须/散收/升降]
- [Herb C] + [Herb D]: [relationship explanation]
**Modifications (加减 — 法不变而药可变):**
- If [symptom A]: add [herb X] X g — [principle preserved]
- If [symptom B]: remove [herb Y], add [herb Z] X g — [principle preserved]
**Constitution Adaptation (体质适配):**
- [Constitution type]: [specific adjustment]
**Safety Check (安全审核):**
✅ / ⚠️ [Eighteen Incompatibilities]
✅ / ⚠️ [Nineteen Antagonisms]
✅ / ⚠️ [Pregnancy contraindications]
✅ / ⚠️ [Dosage ranges]
⚠️ [Additional cautions]
**Classical Reference (典籍出处):**
[Text name, chapter/article]
**Famous Physician Reference (名医参考):**
[Case/quote from famous physician]
IV. Key Safety Rules Summary
Always check references/safety-rules.md for full details.
| Rule | Summary |
|---|---|
| 十八反 | 18 incompatible herb pairs |
| 十九畏 | 19 antagonistic herb pairs |
| 妊娠禁忌 | ~60+ herbs contraindicated/cautious in pregnancy |
| 毒性药材 | Special processing (炮制) required for Fuzi, Banxia, Tiannanxing, etc. |
| 剂量规范 | Per 《中国药典》 — herb-reference.md has detailed ranges |
V. Notes
- Safety is mandatory — ALL prescriptions must pass the full safety check before delivery.
- Dosages per 《中国药典》; adjust for age (children 1/3-1/2, elderly 1/2-2/3), weight, and condition.
- Herb names use standard Chinese names (中药名) with Pinyin.
- For complex mixed patterns, apply 法证对应 framework (Workflow C) rather than simple formula matching.
- For formula learning/deconstruction, use Workflow B with 理法方药 method.
- This skill covers classical formulas (经方) as primary reference; modern additions noted where applicable.
- 倪海厦 principle: 先辨六经再选方 — give priority to six-meridian differentiation.
- 法证对应 principle: 宁舍其药, 不失其法 — the principle matters more than the specific herb.