Chinese Medicine Book Club Issue 2044
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IIntroduction: Everyone knows that Deng Tie Tao is skilled in using Huang Qi, but how exactly is it used? In which diseases is Huang Qi essential and effective? This article is a personal experience sharing by Elder Deng, filled with practical insights, so save it, friends! (Editor/Wang Chao)
The Wonderful Uses of Huang Qi
Author/Deng Tie Tao
Wang Qingren from the Qing Dynasty was adept at using Huang Qi. I learned from his methods and found that when used appropriately, it indeed has remarkable effects. I will summarize and introduce them as follows.
1. Elevation for Prolapse
Huang Qi is heavily used to elevate prolapse, indicated for conditions such as organ prolapse (e.g., gastric prolapse, uterine prolapse, rectal prolapse, renal prolapse), myasthenia gravis, muscle atrophy, dyspnea, and dizziness, all of which belong to the category of Qi deficiency and descent. These symptoms arise from Qi deficiency leading to descent, causing organs to sag; or the clear Yang failing to rise, resulting in dizziness; or the ancestral Qi being insufficient, leading to difficulty in breathing; or lung Qi being unable to support, obstructing the function of the hundred vessels, resulting in muscle atrophy and weakness.
For gastric mucosal prolapse, one can use Si Jun Zi Tang (Four Gentlemen Decoction) with an additional 30 grams of Huang Qi, and 3 grams of Zhi Ke (Bitter Orange) to assist in the elevation and descent, with more elevation and less descent. Therefore, Zhi Ke is used to assist, as the stomach belongs to the Fu organs and is responsible for receiving and descending. Although the mucosa needs to be elevated, the stomach Qi must descend; thus, Huang Qi is heavily used to tonify Qi and elevate to treat mucosal prolapse, while Zhi Ke is used to comply with the stomach Qi’s descent to promote the recovery of the gastric mucosa.
To treat rectal prolapse, the Inner Mongolia “New Medical Methods of Chinese Herbal Medicine” records a formula using 120 grams of Huang Qi and 9 grams of Fang Feng (Siler). This formula is indeed derived from Wang Qingren’s Huang Qi Fang Feng Tang (Astragalus and Siler Decoction). Wang’s formula: 120 grams of Huang Qi and 3 grams of Fang Feng. Li Dongyuan believed that Fang Feng can restrain Huang Qi, and Huang Qi gains greater efficacy with Fang Feng, indicating a mutual enhancement. This method is indeed effective for treating rectal prolapse.
For uterine prolapse, it is treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Benefit Qi Decoction) plus He Shou Wu (Fo-Ti). The addition of He Shou Wu serves two purposes: one is to guide the treatment, and the other is that the uterus relies on Yin blood for nourishment, where Qi needs blood to circulate, and blood needs Qi to move. When Qi and blood are harmonized, the uterus can return to its original position. If combined with acupuncture to strengthen the regulation of Chong and Ren channels, the effect will be even quicker.
For myasthenia gravis, it is treated with Qiang Ji Jian Li Yin (Strengthen Muscle and Enhance Strength Decoction), which is a self-formulated experience prescription, also heavily using Huang Qi as the main herb. The symptoms of myasthenia gravis are quite complex; in addition to ptosis, there may be diplopia, dysphagia, unclear speech, limb weakness, and in severe cases, dyspnea, with a significant drop in Qi, endangering life. I believe the main characteristic of this disease is muscle weakness, as the spleen governs the muscles, thus it is a case of spleen and stomach Qi deficiency, leading to damage from deficiency, and it is related to the five organs. The treatment focuses on the pathological center of spleen and stomach deficiency, heavily using Huang Qi to tonify Qi and elevate, while also addressing the accompanying symptoms to regulate the five organs, heavily tonifying the spleen and stomach to promote recovery.
2. “Elevation” is to Balance
Here, “elevation” refers to elevated blood pressure. Hypertension is often due to excessive liver Yang. Clinically, products that calm the liver and subdue Yang, and reduce rebellious Qi are commonly used, but some may not be effective. I treat Qi deficiency and phlegm-damp type hypertension by heavily using Huang Qi combined with Wen Dan Tang (Warm the Gallbladder Decoction) to treat it.
According to the “Abstracts of Chinese Medicine Research Literature,” a report by Japanese researcher Terada Bunjiro and others states: “Compared with six other injectable antihypertensive agents, Huang Qi’s effect is powerful. Although some agents can cause sustained decreases in blood pressure, their extensive use can weaken the animals.” This conclusion supports the heavy use of Huang Qi for lowering blood pressure from a pharmacological research perspective.
Furthermore, I agree with the following viewpoint: the reason for elevated blood pressure is a self-regulatory signal from the body, resulting from the imbalance of Yin and Yang in the internal organs, not the cause. Of course, chronic hypertension can lead to further changes in the heart, brain, and kidneys. Western medicine focuses on the impact of hypertension on these organs, thus using arterial blood pressure indicators as diagnostic criteria and treatment targets, seeking to find antihypertensive drugs by all means.
In recent years, some scholars have reevaluated this viewpoint from the perspective of syndrome differentiation and treatment, believing that the original cause of elevated blood pressure is the imbalance of blood flow supply and demand, particularly in the heart, brain, and kidneys. These three organs have a high demand for blood flow, and when the supply and demand of blood flow to the heart, brain, and kidneys are imbalanced, hypertension occurs. The elevation of blood pressure plays a particularly important role in maintaining the blood supply to these organs, and the serious consequences of prolonged hypertension are mainly reflected in the severe disconnection of blood flow supply and demand in these three important organs.
Since the deeper essence of elevated blood pressure is the imbalance of blood flow supply and demand, and elevated blood pressure itself is an effort to compensate for this imbalance, which is not entirely successful, thus the vascular response leading to elevated blood pressure persists. Elevated blood pressure is not purely a negative pathological destruction and should not be treated as a target for suppression; it should be seen as a service object and a support object for treatment. If treatment helps improve the blood flow supply and demand relationship, assisting the compensatory response that elevated blood pressure aims to achieve, then there is no need for the persistent triggering of the hypertensive response.
This viewpoint elucidates that treating Qi deficiency type hypertension with heavy use of Huang Qi aims to regulate the balance of Yin and Yang in the organs, changing the severe disconnection of blood flow supply and demand in important organs, promoting the alleviation of the “vascular response to elevated blood pressure” and achieving the effect of lowering blood pressure. This is the mechanism of heavy use of Huang Qi for lowering blood pressure.
For hypertensive crises, I often use acupuncture at the Tai Chong point (Liver 3) (bilateral), heavily using the draining method, leaving the needles for thirty to forty minutes, treating once a day for 1-3 times depending on the situation, and adding Chinese medicine, most achieving satisfactory results. In TCM, acupuncture for stroke often effectively regulates blood pressure by unblocking meridians and balancing Qi and blood Yin and Yang, achieving rapid treatment effects. This also strongly supports the aforementioned mechanism.
How to explain the dual action of Huang Qi in lowering blood pressure and elevating? Some may think that Chinese medicine often has “biphasic effects,” thus Huang Qi can elevate and lower blood pressure. How to grasp the mechanism of elevation and descent? My experience is: light use of Huang Qi raises blood pressure, while heavy use lowers blood pressure. Why does pharmacological research only yield a result of lowering blood pressure? Because animal experiments are conducted with large doses of medication, leading to the conclusion of lowering blood pressure.
When treating hypotension, I prefer to use Bu Zhong Yi Qi Tang, with Huang Qi not exceeding 15 grams. For treating Qi deficiency and phlegm-damp type hypertension, I prefer Huang Qi combined with Wen Dan Tang, with Huang Qi’s dosage being at least 30 grams. Indeed, in the formula Bu Zhong Yi Qi Tang, besides Huang Qi, there are Chai Hu (Bupleurum) and Sheng Ma (Cimicifuga), which can greatly enhance the elevating power. When heavily using Huang Qi to lower blood pressure, it can also be combined with products that calm Yang and settle, which will certainly yield better results, but even without settling herbs, there is still a confirmed effect of lowering blood pressure. I once consulted on a stroke patient with hemiplegia and aphasia, who had elevated blood pressure. The diagnosis was Qi deficiency and blood stasis. The prescription was Bu Yang Huan Wu Tang (Tonify Yang and Restore Five Decoction), using Huang Qi as prescribed at 120 grams. The Western doctor had concerns about the 120 grams of Huang Qi and suggested adding Western antihypertensives. After explaining the rationale, the patient took the prescribed medicine, and the blood pressure did not rise but rather decreased, leading to the doctor’s acceptance.
Although it is said that heavy use of Huang Qi can lower blood pressure, there is evidence and reasoning, but Huang Qi is still a Qi tonifying and Yang elevating herb, which should not be overlooked. If the diagnosis is for liver Yang hyperactivity or internal heat type hypertension, using several grams of Huang Qi to lower blood pressure would be a mistake! Caution is advised. Thus, it can be seen that pharmacological research has not yet answered all our questions, and syndrome differentiation and treatment must still be emphasized.
3. Attack and Supplement
Zhang Xichun believed that Huang Qi’s elevation and supplementation are particularly effective for treating miscarriage and excessive vaginal discharge. However, heavy use of Huang Qi can also expel a dead fetus, which is my experience. A dead fetus in the mother has transformed into a pathogenic entity, a “邪 (evil)”, and the disease belongs to the category of excess syndrome. Since the Song Dynasty, gynecological formula books have commonly used Ping Wei San (Calm the Stomach Powder) with added Pu Xiao (Bitter Salt) to expel a dead fetus. Ping Wei San is the main formula for promoting the movement of the stomach and intestines to eliminate dampness, with Cang Zhu (Atractylodes) as the main herb for promoting movement, and Hou Po (Magnolia Bark) and Chen Pi (Dried Tangerine Peel) enhancing the action of moving Qi and drying dampness, with Pu Xiao added for moistening and downward action. Ancients believed, “When the stomach Qi moves, the dead fetus will naturally be expelled; adding Pu Xiao will ensure it is expelled.” After the Ming Dynasty, the “Jing Yue Quan Shu” advocated using Tuo Hua Jian (Expel Flower Decoction) to induce labor and expel a dead fetus, focusing on moving blood while also using Che Qian (Plantago) and Niu Xi (Achyranthes) to facilitate expulsion. Ping Wei San focuses on Qi stagnation, while Tuo Hua Jian focuses on blood stasis.
I once treated a patient with a dead fetus in the womb due to Qi and Yin deficiency. Initially, I used Ping Wei San with Mang Xiao (Glauber’s Salt) and combined it with acupuncture, then switched to Tuo Hua Jian, but both were ineffective due to a mismatch of herbs and symptoms. After careful differentiation, I borrowed from Wang Qingren’s modified Kai Gu San (Open Bone Powder) for difficult labor, heavily using 120 grams of Huang Qi, along with acupuncture, and the dead fetus was expelled after one dose.
Kai Gu San is based on the Song Dynasty’s Gui Jia Tang (Tortoise Shell Decoction) with added Chuan Xiong (Chuanxiong Rhizome). After the Ming Dynasty, it was also known as the modified Xiong Gui Tang. This formula heavily uses Dang Gui (Angelica) and Chuan Xiong to move blood, while Gui Ban (Tortoise Shell) descends, and the charcoal from blood residue stops bleeding. This formula does not use purgative or blood-breaking herbs, thus it has been used for difficult labor since the Ming Dynasty. Wang Qingren believed that the effectiveness of this formula for difficult labor varies due to an emphasis on nourishing blood and activating blood while neglecting Qi tonification and Qi movement, thus he advocated for heavily using Huang Qi to tonify Qi and move Qi, making the formula more complete.
Why was the modified Kai Gu San effective? The patient was eight months pregnant, and fetal movement had ceased for seven days. Upon examination, her tongue was pale and tender, with a peeled coating, and her pulse was large and rapid, with weak pressure. Additionally, the patient reported severe pregnancy reactions, with intense vomiting and difficulty eating, leading to injury of fluids and depletion of Qi. Although the condition was excess, the mother was deficient and could not withstand purgation. Thus, using Ping Wei San and Tuo Hua Jian was ineffective. Fu Qingzhu pointed out: “Knowing that the child is dead in the womb, one cannot use medicine to expel it, as it is dangerous; if one uses forceful methods to purge it, it is also dangerous. As the labor approaches six or seven days, the mother’s Qi must be severely exhausted; how can she withstand forceful treatment? If one uses forceful methods to expel the dead child, it is feared that the dead child will be expelled, and the mother will also perish. One must still tonify the mother, so that her Qi and blood are abundant, and the dead child will naturally descend.” Practice has proven that Fu’s viewpoint is correct, providing an alternative path for expelling a dead fetus. Fu advocated using Tiao Er San (Regulate Child Decoction), while I used modified Kai Gu San to achieve results, which can be considered similar in effect. At that time, Gui Ban was out of stock and not used. This case illustrates that heavy use of Huang Qi can expel a dead fetus. This is the method of attacking while supplementing.
4. Movement for Paralysis
For conditions like hemiplegia and paraplegia, which belong to Qi deficiency with obstruction, Bu Yang Huan Wu Tang is a particularly famous effective formula. It comes from Wang Qingren’s “Yi Lin Gai Cuo”. Although Zhang Xichun criticized Wang’s emphasis on insufficient Yang Qi for treating hemiplegia, stating that there are both deficiency and excess types of atrophy, the use of Bu Yang Huan Wu Tang must be appropriate. However, Zhang could not deny: “Bu Yang Huan Wu Tang is indeed a very suitable formula.” I have used this formula to treat various sequelae of cerebrovascular accidents belonging to Qi deficiency and blood stasis type hemiplegia, achieving varying degrees of efficacy, with some recovering 50% and others 80-90%.
I once treated a severely paraplegic young woman who had been bedridden for several months, with her legs emaciated and skin tightly wrapped around her bones, needing assistance to sit up, and unable to sit for long. I used Bu Yang Huan Wu Tang with modifications, initially using 120 grams of Huang Qi, and at maximum dosage, up to 200 grams. After taking the medicine for over eight months and undergoing rigorous exercise, she was able to walk slowly with a cane, returned to work after a year, and after two years, she was able to walk with a limp without a cane, later marrying and having a child.
My experience with using Bu Yang Huan Wu Tang requires attention to two points: first, the differentiation must be Qi deficiency and blood stasis; second, Huang Qi must be heavily used at 120 grams, not less than 60 grams for efficacy, while other herbs can be slightly increased, but the proportions must not be reversed.
5. Strengthening the Exterior
Li Dongyuan believed that Huang Qi can tonify the three Jiao and solidify the Wei Qi. Wei Qi warms the flesh and fills the skin, nourishing the pores and controlling opening and closing. “Solidifying the Wei” means “strengthening the exterior.” For spontaneous sweating, Yu Ping Feng San (Jade Windscreen Powder) is a well-known effective formula. I find this formula not only treats spontaneous sweating but is also applicable for some night sweats due to Qi deficiency. For convenience, I often use decoctions with the following proportions: Huang Qi 12 grams, Fang Feng 3 grams, Bai Zhu 15 grams. The amount of Fang Feng is less than Huang Qi, and the amount of Bai Zhu is the sum of Huang Qi and Fang Feng (as seen in “Yu Ping Feng San”). For treating spontaneous sweating and night sweats with concurrent Yin deficiency, I prefer to use Yu Ping Feng San with an additional 30 grams each of Sheng Long Gu (Raw Dragon Bone) and Sheng Mu Li (Raw Oyster Shell), or 30 grams each of Fu Xiao Mai (Floating Wheat) and Nuo Dao Gen (Sticky Rice Root); if sweating is particularly profuse, I add 10 grams of Ma Huang Gen (Ephedra Root).
For treating ulcerated wounds, Huang Qi is also an important herb. I once consulted on a patient whose wound did not heal after the removal of an axillary tumor, with continuous drainage requiring multiple changes of gauze daily. After using a Qi and blood tonifying formula with 30 grams of Huang Qi, the drainage reduced, and the wound healed in less than half a month, demonstrating Huang Qi’s internal support function.
In children, skin abscesses often occur in summer, appearing and disappearing frequently, which can be quite troublesome. A military doctor’s child had been suffering from summer abscesses since the age of two, slightly improving with antibiotics but recurring repeatedly for three years. When I was consulted, it was June, and the child had abscesses all over his head, though not thin, his face was yellow and lips pale, with a fat and tender tongue, white coating, and thin pulse. This was due to the righteous Qi being unable to resist pathogenic evil, so I planned to support the righteous Qi and expel the evil, treating both the root and the branch.
The prescription was: Huang Qi, Zao Jiao Ci (Soapberry), Qing Tian Kui (Blue Sky Flower), Ye Ju Hua (Wild Chrysanthemum), Zhe Bei Mu (Zhejiang Fritillaria), Yin Hua (Honeysuckle), and Pu Gong Ying (Dandelion) each 9 grams, Chen Pi (Dried Tangerine Peel), Bai Zhu, and Gan Cao (Licorice) each 6 grams, Fu Ling (Poria), Green Bean, and Zhi Gan Cao (Honey-fried Licorice) each 12 grams. After four doses, the abscesses did not recur. The father sought treatment again in January of the following year to eliminate the root cause, and I prescribed a preventive formula: Huang Qi 9 grams, Fang Feng, Gan Cao, and Zhe Bei Mu each 6 grams, Chen Pi, Bai Zhu, and Pu Gong Ying each 12 grams, advising him to start taking it weekly from April. After that, the abscesses did not recur.
6. Diagnosis Must Be Scrutinized
Although I enjoy using Huang Qi, it is ultimately a medicine, not food. Its use must match the symptoms for efficacy; improper use can harm people. I once treated a tuberculosis patient, adding 9 grams of Huang Qi to a nourishing Yin and phlegm-eliminating formula, resulting in fever in the forehead after one dose, full body heat after two doses, and neck and face heat after three doses. Upon removing Huang Qi, the fever subsided. I also treated a stroke patient whose scalp became itchy and body temperature increased after taking the medicine. Mistakenly thinking it was an external invasion, I switched to a pungent cool exterior-releasing formula, which reduced the fever after one dose. When I used 90 grams of Huang Qi again, the fever returned, and the right upper limb’s movement regressed, indicating that the differentiation was incorrect. Upon careful consideration, the patient’s pulse was large and weak, but the tongue coating was thick and greasy, and the tongue body was not fat and had no teeth marks, indicating that phlegm and blood stasis were more prominent than blood stasis. I changed to a phlegm-eliminating formula with a slight addition of blood-moving herbs, replacing Huang Qi with Wu Zhua Long (Five Claw Dragon), and the condition improved. Regarding the indications for using Huang Qi, I believe that if the tongue appears pale and fat with teeth marks, and the pulse is large and weak, one can consider using it, while also observing for other symptoms of Qi deficiency. As for the dosage, one must pay attention to changes in symptoms and avoid rigid adherence to rules and seeking swords in the boat.
Recommended Reading:
Huang Qi + Zhi Ke, Treating Gastric Prolapse
Deng Tie Tao: The Dosage of Yu Ping Feng San is Huang Qi + Fang Feng = Bai Zhu
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