Medicines can treat diseases, and physicians pass down formulas. Tracing back through history, the best remedies for illnesses are undoubtedly the top ten famous formulas. Among these ten, there is one that stands out with its unique characteristics, precise composition, and harmonious interactions among its ingredients. This is the Bu Zhong Yi Qi Tang (补中益气汤), a formula meticulously developed by the renowned physician Li Dongyuan (李东垣) in his practice. Even today, it remains beloved by later generations of physicians.The timeless Qi-boosting formula, Bu Zhong Yi Qi Tang, originally consists of 18 grams of Huang Qi (黄芪, Astragalus), 10 grams of Ren Shen (人参, Ginseng), 10 grams of Bai Zhu (白术, Atractylodes), 5 grams of Zhi Gan Cao (炙甘草, Honey-fried Licorice), 10 grams of Jiu Dang Gui (酒当归, Wine-processed Angelica), 6 grams of Chen Pi (陈皮, Aged Tangerine Peel), 5 grams of Sheng Ma (升麻, Cimicifuga), and 5 grams of Chai Hu (柴胡, Bupleurum), among other eight medicinal ingredients.
So, what conditions can this formula treat?1. Organ prolapse, such as gastric prolapse and uterine prolapse. In simple terms, this is due to Qi deficiency, where the muscles lack strength to support the organs, leading to their descent.What does Bu Zhong Yi Qi aim to replenish? It replenishes Qi, specifically Pi Qi (脾气, Spleen Qi) and Zhong Qi (中气, Central Qi). When Qi is sufficient, it naturally lifts.In TCM, the spleen governs the muscles and is responsible for Zhong Qi. All forms of muscle prolapse, such as eyelid droop, breast sagging, gastric prolapse, uterine prolapse, and facial muscle droop, are related to the insufficiency of Zhong Qi and the spleen’s inability to support the muscles.2. Muscle weakness. Modern medicine considers muscle weakness to be a chronic disease caused by impaired neuromuscular transmission, which currently has no solution.
In TCM, the spleen governs the muscles. Whether it is mild muscle weakness leading to ocular muscle weakness and eyelid droop, or severe muscle weakness, Qi must be replenished, and the spleen must be treated to maintain its function.3. Hypoglycemia and hypotension. TCM states that Qi is the commander of blood; when blood sugar and blood pressure are low, the pressure decreases. Treating the blood alone is ineffective; instead, one must replenish Qi to elevate it.Simply taking Bu Zhong Yi Qi Wan is not enough; it should be combined with ginger and jujube, brewed as tea for consumption. Ginger is warming and dispersing, while jujube can replenish deficiency. “The spleen is the foundation of postnatal life and the source of Qi and blood production,” so it is essential to mobilize the strength of the spleen and stomach.4. Constipation and rectal prolapse. Many elderly individuals experience difficulty in bowel movements, sometimes going several days without a bowel movement, and when they do, it can be a strenuous effort. If one is not careful and exerts too much force, it can lead to rectal prolapse. This is due to Qi deficiency, which fails to promote intestinal peristalsis.5. Hunched back and weak legs. As people age, their back and legs deteriorate. In their youth, they may have stood tall, but as they grow older, their vision becomes closer, and their heads lower, almost touching the ground.This is akin to a car tire that, over time, loses air and cannot support the body’s weight; thus, it needs to be inflated to replenish Qi.6. Nosebleeds and gum bleeding. Qi can contain blood, and the spleen can regulate blood. When the spleen is deficient and Zhong Qi is insufficient, blood will not be contained and will run amok.However, it is important to note that this applies to individuals with Qi deficiency. If one is robust, they should not replenish Qi, as it may lead to excessive heat and nosebleeds.7. Menorrhagia and irregular menstruation. For example, if the menstrual cycle is 28 days, it is like carrying a bucket of medicine for 28 steps. If one lacks strength and Qi, they may not complete the journey and will spill water everywhere.
8. Spontaneous sweating and excessive sweating. Blood deficiency leads to no sweating, while Qi deficiency leads to excessive sweating. Night sweats during sleep are termed “night sweats,” while excessive sweating during movement or slight activity is termed “spontaneous sweating” or “deficient sweating.” At this time, Qi must be replenished to stabilize the exterior.9. Dizziness and tinnitus. Qi is the commander of blood; when Qi is deficient, blood supply is inadequate, leading to insufficient nourishment to the head and face, resulting in dizziness and tinnitus.10. Oral ulcers. Oral ulcers can be treated with some heat-clearing medicines, but if they recur frequently, it indicates deficient heat. The spleen governs the middle burner and opens to the mouth, which is caused by spleen and stomach deficiency.The application of Bu Zhong Yi Qi Tang can be classified under various Western medical diagnoses, potentially encompassing hundreds of conditions beyond those mentioned today.While Bu Zhong Yi Qi Tang seems to have a broad range of applications, the reality is that there are fewer practitioners who can effectively utilize it. Often, patients’ symptoms clearly align with the deficiency of Zhong Qi or Qi sinking, yet the results of using Bu Zhong Yi Qi Tang can be “more harm than good.” This primarily stems from three major factors. The first is the dosage; the original formula uses very light dosages, equivalent to about 10 grams in modern terms. Although the dosage can be adjusted based on the patient’s condition, it generally should not exceed three times the original amount. The second is the method of administration, which is “taken warm after breakfast”; it should be taken no later than before noon, as the entire formula is primarily uplifting, ideally corresponding to the rising phase of Yang in nature.Finally, and most importantly, the pulse and symptoms must correspond. In the “Discussion on Differentiating Internal and External Injuries” (《内外伤辨惑论·辨脉》), it is mentioned: “External invasion of wind and cold presents with excess symptoms, indicating the presence of external pathogens, which must be seen in the left hand, as the left hand governs the exterior, corresponding to Yang at 25 degrees. Internal injuries from diet and excessive labor present with deficiency symptoms, which must be seen in the right hand, as the right hand governs the interior, corresponding to Yin at 25 degrees.” “In cases of dietary injury, the right cun pulse is larger than the renying pulse by a factor of two; in severe cases, it may be three times larger in the Shaoyin and four times larger in the Taiyin. This is the pulse of dietary injury. If there is dietary irregularity or excessive labor, the heart pulse will be seen at the Qi position, indicating heart fire injuring the lung, and the liver wood will also attack the lung with its fire.” “If there is no excessive labor, the right guan pulse will be large and rapid, indicating it is larger than the five pulses, and may show a slow pulse during rapid conditions.” In summary, if the right pulse is larger than the left pulse, or if the right cun pulse is larger than the renying pulse, or if the spleen pulse is uniquely large and rapid, it may indicate “rapid pulse with a slow appearance” or even occasionally show a skipped pulse. Additionally, Li Dongyuan discussed that certain pulse patterns should not use Bu Zhong Yi Qi Tang. In the “Four Seasons Medication Adjustments” (方后“四时用药加减法”), it is mentioned that for abdominal pain with a wiry pulse, one should not use it but rather use Xiao Jian Zhong Tang; for a deep and thin pulse, one should not use it but rather use Li Zhong Tang; for a slow pulse, one should not use it but rather use Ping Wei San. Here, I would add that a yellow tongue coating with significant heat should not use it.Let’s see how renowned physician Zhang Zhichun applies it!Old Zhang states: Bu Zhong Yi Qi Tang is an important prescription for treating spleen deficiency and sinking, as described in Li Dongyuan’s “Treatise on the Spleen and Stomach” (《脾胃论》). The original formula consists of small amounts of medicine: 5-10 grams of Huang Qi, 5 grams of Zhi Gan Cao, 3 grams of Ren Shen, and 3 grams each of Dang Gui, Chen Pi, Sheng Ma, Chai Hu, and Bai Zhu. In clinical practice, the dosage is often increased tenfold.In the formula, the combination of Ren Shen and Huang Qi replenishes the original Qi and the spleen Qi, as well as the ancestral Qi. The focus of Bai Zhu and Gan Cao is to replenish the spleen Qi of the middle burner. To prevent stagnation from the tonification, Chen Pi is added to regulate Qi, while Sheng Ma assists Huang Qi in uplifting the spleen and stomach’s Taiyin and Yangming Qi. Chai Hu soothes the liver, benefits the spleen, and can uplift the Shaoyang Qi. Dang Gui combined with Huang Qi forms the Dang Gui Bu Xue Tang (当归补血汤), which can tonify Qi and nourish blood, while Dang Gui combined with Chai Hu soothes the liver, nourishes the liver, and benefits the spleen. Dongyuan believes that “the essence of life is based on stomach Qi”; the theory that “with stomach Qi, there is life; without stomach Qi, there is death” aligns with the notion that the spleen and stomach are the foundation of postnatal life. The middle burner is the pivot point; the spleen governs ascent, and the stomach governs descent. When the ascent and descent are appropriate, the entire meridian system is unobstructed, and the source of Qi and blood production is normal.To reduce heat, one must first elevate it; as long as it can rise, it can naturally descend. The conditions treated by this formula must be due to spleen Qi deficiency that prevents elevation. The spleen governs the limbs, muscles, blood, and the Qi of the entire body. Zhong Qi sinking is essentially due to spleen Qi deficiency, so the main symptoms include insufficient Zhong Qi, overall fatigue, heavy limbs, fullness after eating, and may also present with dizziness, low fever, spontaneous sweating, bleeding, rectal prolapse, uterine prolapse, menorrhagia, blood in stool, and organ prolapse. In my decades of clinical practice, I have cured many of the aforementioned conditions using this formula with modifications. The specific modifications are generally as follows:1. For those with congenital deficiencies or those who have been weak after a major illness and cannot recover for a long time, if there is insufficient Zhong Qi, heavy limbs, fullness after eating, fatigue, or intolerance to exertion, with a swollen tongue and weak pulse, use Bu Zhong Yi Qi Tang, increasing the dosage tenfold, and add Ban Xia (半夏, Pinellia), Sheng Jiang (生姜, Fresh Ginger), and Zhu Ru (竹茹, Bamboo Shavings). Due to prolonged illness, there may be stagnation, leading to phlegm production. Chen Pi in Bu Zhong Yi Qi Tang can help transform phlegm, but its potency is insufficient. If phlegm is not transformed, it is like a machine rusting; to make the machine operate, the rust must be wiped away. To first promote spleen Qi transport, phlegm must be transformed.2. For unexplained low fever, with fever at night and subsiding during the day, poor appetite, overall fatigue, heavy limbs, a swollen tongue, a yellow-white coating, and a weak, rapid pulse, this is due to insufficient transport leading to stagnation and heat. Use Bu Zhong Yi Qi Tang, increasing the dosage tenfold, and add 10 grams of Shan Zhi Zi (山栀子, Gardenia) to promote spleen Qi transport and clear the small heat from the three burners.3. For recurrent cloudy urine without pain, with cloudy sediment at the bottom of the urine bottle, and no special findings on urinalysis, often accompanied by fatigue and weakness, insufficient Zhong Qi, poor appetite, and possibly sore lower back and legs, with a swollen tongue and white coating, and a weak, rapid pulse, this indicates deficiency of both spleen and kidney Qi. Use Bu Zhong Yi Qi Tang, increasing the dosage tenfold, and add Shui Liu Er Xian Dan (水陆二仙丹, Two Immortals of Water and Land) (15 grams of Jin Ying Zi (金樱子, Cherry), 15 grams of Qian Shi (芡实米, Euryale) to help replenish both spleen and kidney Qi, assisting Bu Zhong Yi Qi Tang in its transport and absorption.4. For clear, thin vaginal discharge without foul odor, with insufficient Zhong Qi, fatigue, heavy limbs, poor appetite, and loose stools, with a swollen tongue and white coating, and a weak pulse, use Bu Zhong Yi Qi Tang, increasing the dosage tenfold, and add 15 grams of Chao Cang Zhu (炒苍术, Fried Atractylodes), 10 grams of Huang Bai (黄柏, Amur Cork Tree), 15 grams of Chao Che Qian Zi (炒车前子, Fried Plantago Seed) (in a bag), and 15 grams of Chao Shan Yao (炒山药, Fried Chinese Yam) for good results.5. For pale blood in urine, with no special findings after comprehensive examination, and with insufficient Zhong Qi, fatigue, and a swollen tongue, use Bu Zhong Yi Qi Tang, increasing the dosage tenfold, and add 5 grams of San Qi Fen (三七粉, Notoginseng Powder) (to be taken separately).6. For mild rectal prolapse, with Bu Zhong Yi Qi Tang as the main prescription, add 10 grams of Wu Bei Zi (五倍子, Gallnut) and 6 grams of Zhi Ke (枳壳, Bitter Orange).7. For mild uterine prolapse, with Bu Zhong Yi Qi Tang as the main prescription, add 10 grams of Yi Zhi Ren (益智仁, Alpinia) and 10 grams of Wu Wei Zi (五味子, Schisandra) (crushed).8. For habitual miscarriage, with Bu Zhong Yi Qi Tang as the main prescription, add 10 grams of Tu Si Zi (菟丝子, Cuscuta) and 10 grams of Du Zhong (杜仲, Eucommia) and 10 grams of Chuan Xiong (川断, Ligusticum).9. For chronic diarrhea that does not resolve, with Bu Zhong Yi Qi Tang as the main prescription, add 10 grams of Fen Ge Gen (粉葛根, Pueraria) and 10 grams each of Chao Shan Yao and Chao Che Qian Zi (in a bag), and 10 grams of Bu Guo Zhi (补骨脂, Psoralea).10. For mild kidney prolapse, take 6 grams of Bu Zhong Yi Qi Wan in the morning and one pill of Liu Wei Di Huang Wan (六味地黄丸, Six Flavor Rehmannia Pill) in the evening.11. For mild gastric prolapse, with Bu Zhong Yi Qi Tang as the main prescription, add 10 grams of Ge Gen (葛根, Kudzu) and 3 grams each of Chao Zhi Ke (炒枳壳, Fried Bitter Orange) and Chao Zhi Shi (炒枳实, Fried Bitter Orange). Here, Ge Gen can help Bu Zhong Yi Qi Tang uplift the stomach Qi; however, since the stomach governs descent, if the stomach Qi does not descend, the spleen cannot ascend. Therefore, a slight addition of fried Zhi Ke and Zhi Shi is necessary to ensure the smooth descent of stomach Qi.12. For stagnant fluid in the epigastric region and coldness in the back, with Bu Zhong Yi Qi Tang as the main prescription, add 15 grams of Fu Ling (茯苓, Poria), 20 grams of Gui Zhi (桂枝, Cinnamon Twig), and 10 grams of Ze Xie (泽泻, Alisma).There are many diseases for which Bu Zhong Yi Qi Tang can be used with modifications when the main symptoms are present.If you are experiencing discomfort, please seek help from a professional physician.