Inheriting the legacy of Qi Huang, a public account with substance and warmth.
Ai Yu Xiang Tang
Astragalus (Huang Qi) has a sweet and slightly warm flavor, and it enters the Spleen and Lung meridians, making it a favored herb among practitioners. The “Tang Ye Ben Cao” states that it is a medicine for the upper, middle, and lower Jiao. “Ben Cao Qiu Zhen” refers to it as the best among Qi tonics, hence its name “Qi”. This article summarizes years of experience in the application of Astragalus as follows:
1. Tonifying Qi and invigorating blood to relieve chest obstruction: Astragalus tonifies Lung Qi and promotes blood circulation, effectively warming the chest and alleviating chest Yang deficiency and Qi and blood stagnation. It is often combined with Dan Shen (Salvia miltiorrhiza), Chi Shao (Red Peony Root), Hong Hua (Carthamus tinctorius), Chuan Xiong (Ligusticum chuanxiong), Ge Gen (Pueraria lobata), etc. The dosage of Astragalus is often greater than that of blood-invigorating herbs, as its purpose is to promote circulation. This is particularly effective for chest obstruction with a tongue that is swollen and tender with teeth marks. For example, a 58-year-old female patient with coronary heart disease experienced palpitations and chest tightness, with stabbing pain exacerbated by exertion and emotional stress, requiring hospitalization for each episode. Upon examination, her tongue was pale and swollen, with a blue and thick sublingual vein, and her pulse was thin and slow. The diagnosis was Qi deficiency and blood stasis causing chest obstruction. The treatment aimed to tonify Qi and invigorate blood, warming and unblocking the heart meridian, using 50g of Astragalus combined with Dan Shen, Dang Shen (Codonopsis pilosula), Chuan Xiong, Su Mu (Sappan wood), Jiang Xiang (Dalbergia odorifera), Gui Zhi (Cinnamon twig), Fu Pian (Aconite), and Yu Jin (Curcuma longa), adjusted as needed. After two months of treatment, symptoms alleviated, and the frequency of episodes significantly decreased, followed by consolidation with pill formulation.2. Tonifying Qi and unblocking channels for hemiplegia: Astragalus is the best Qi tonic, promoting blood circulation, thus facilitating the movement and resolution of blood stasis. For stroke with Qi deficiency and blood stagnation, presenting with hemiplegia, limb numbness, facial droop, stiff tongue, and slurred speech, Astragalus is often used in combination with Wu Gong (Centipede), Di Long (Earthworm), Shui Zhi (Leech), Quan Xie (Scorpion), Ji Xue Teng (Spatholobus suberectus), Dang Gui (Angelica sinensis), Wei Ling Xian (Clematis), Tao Ren (Peach kernel), and Hong Hua. Many cases have shown good results.3. Sweet and warm to clear heat and rescue lung tuberculosis: Astragalus enters the Lung to tonify Qi and solidify the exterior. “Ben Cao Feng Yuan” states: “It can tonify the five organs and clear Yin fire, removing Lung heat.” A case of disseminated pulmonary tuberculosis in a 24-year-old male patient who had persistent fever for six months, with fluctuating high temperatures between 38°C and 40°C, pale complexion, shortness of breath, spontaneous sweating, fatigue, cough with unproductive sound, poor appetite, and loose stools, resulted in a weight loss of 11kg. His tongue was pale red with teeth marks, and his pulse was thin and rapid. After taking over a hundred doses of Yin-nourishing, fire-clearing, and lung-moistening herbs, and two months of Western anti-tuberculosis treatment, the fever persisted, and the patient and family lost confidence in treatment. After careful diagnosis, despite the thin and rapid pulse, the lack of strength, and the pale complexion, the high fever was irregular rather than occurring in the afternoon, and there were no signs of Yin deficiency heat. This was undoubtedly Qi deficiency. Remembering Professor Li Ke Shao’s experience of using Astragalus to reduce tuberculosis fever, I prescribed a modified Bu Zhong Yi Qi Decoction with Bie Jia (Soft-shelled turtle), Qin Jiao (Gentiana macrophylla), and a heavy dose of 50g of Astragalus. After seven doses, the body temperature began to decrease, peaking at 38°C, appetite improved, and the patient regained confidence. After fourteen more doses, the fever subsided, and with slight adjustments and combined with Western anti-tuberculosis treatment, after three months, chest X-rays showed significant absorption of lung lesions, and weight was restored. This demonstrates the reliable efficacy of Astragalus in reducing tuberculosis fever and rescuing lung health.4. Strengthening the spleen and securing essence to manage proteinuria: Nephrotic syndrome and chronic nephritis with significant proteinuria are generally considered to be due to kidney Qi deficiency, leading to essence leakage. The approach is to tonify the kidney and secure essence. I have treated many cases of chronic nephritis with persistent proteinuria using the method of tonifying the kidney and securing essence, but with little effect. I then added Astragalus, Dang Shen, lotus seed flesh, and Sheng Ma (Cimicifuga) to strengthen the spleen, tonify Qi, and assist in transformation, achieving satisfactory results. This indicates that the pathogenesis of proteinuria is related to spleen Qi deficiency and the inability to secure essence. Although the essence of the five organs is stored in the kidneys, it relies on the transformation and distribution of postnatal spleen Qi. If the spleen Qi is strong, the central region can regulate, and the subtle essence can be distributed normally, preventing loss, thus reducing proteinuria. Therefore, the treatment approach of strengthening the spleen and promoting clarity to eliminate proteinuria is worth further exploration.5. Tonifying Qi and securing to treat blood disorders: Astragalus nourishes the organs and tonifies the middle Qi. Qi is the commander of blood; when Qi moves, blood moves, and when Qi secures, blood stops. Thus, it is said that blood loss requires Qi tonification. “Jing Yue Quan Shu” states: “For blood loss and similar conditions, sweet herbs must be used to first tonify the spleen and stomach to enhance the generating Qi, as sweetness can generate blood and nourish the Ying. As long as the spleen and stomach Qi is strong, Yang rises and Yin lengthens, and blood will naturally return to the meridians.” For many years, I have primarily used Astragalus, combined with Ren Shen (Ginseng), Pao Jiang (Dry ginger), Ai Ye (Mugwort), Sheng Di (Rehmannia), Bai Ji (Bletilla), Hai Piao Xiao (Cuttlefish bone), and E Jiao (Donkey-hide gelatin) as needed to treat conditions such as gastric bleeding, blood in stools, and women’s menorrhagia, achieving remarkable results, especially in cases of hematuria treated with a heavy dose of Astragalus in Bu Zhong Yi Qi Decoction, demonstrating the efficacy of Qi tonification in stopping bleeding.6. Stabilizing the two heavens to rescue threatened miscarriage: Astragalus tonifies Qi and raises Yang, effectively treating various forms of descent, such as threatened miscarriage, fetal movement, and habitual abortion. Zhang Yi Chou stated: “The spleen is the bridge of the body… nurturing the fetus relies on the spleen and kidneys. The kidneys are congenital, while the spleen is acquired. If the kidneys are deficient, the foundation is weak; if the spleen is deficient, the basis is thin. Nurturing the fetus is like hanging a bell from a beam; if the beam is soft, the bell will fall and break.” The Chong and Ren meridians are governed by the kidneys, and once pregnancy is established, it relies on the mother’s Qi and blood to nourish it. However, the spleen and stomach are the foundation of postnatal nourishment, the source of Qi and blood generation. Throughout pregnancy, the abundance of congenital kidney Qi and the vigor of the postnatal spleen and stomach are essential for nurturing and sustaining the fetus. I treated a 28-year-old woman who had experienced four miscarriages in five years. This time, she was two months pregnant and recently experienced lower back pain. To prevent another miscarriage, I diagnosed her with spleen and kidney deficiency and unstable Chong and Ren meridians. I prescribed a warming and tonifying formula for the spleen and kidneys to nurture the fetus: 30g of Astragalus, 15g of Dang Shen, 12g of Bai Zhu (Atractylodes), 12g of Fu Ling (Poria), 12g of Shu Di (Rehmannia), 24g of Shan Yao (Chinese yam), 12g of Gou Qi Zi (Goji berry), 12g of Xu Duan (Dipsacus), 15g of Ji Xue Teng, and 12g of Du Zhong (Eucommia). I instructed her to take one dose every other day, rest, and avoid fatigue. After five months of continuous treatment, she delivered a healthy boy at full term.7. Stimulating Qi and blood to relieve pain: For chronic joint stiffness and swelling due to obstruction of the meridians and collaterals, when using wind-dispelling, dampness-dispelling, and cold-expelling herbs yields little effect, adding Astragalus with Gui Zhi (Cinnamon twig) and Bai Zhu can tonify Qi and unblock the channels, promoting the circulation of Qi and blood. In treating rheumatoid arthritis patients, those who only took warming and cold-dispelling herbs showed minimal improvement. However, switching to Astragalus Wu Wu Decoction with Dang Gui, Bai Zhu, Fu Pian, and Qin Jiao yielded satisfactory results. Practice has shown that for obstructive conditions, using wind-dispelling, cold-dispelling, and dampness-dispelling herbs is effective for new conditions, but for chronic conditions, prolonged use may not only fail to relieve pain but may worsen it. Only by supporting the righteous Qi and expelling the evil Qi, addressing both aspects, can efficacy be improved.8. Tonifying Qi and promoting water metabolism to reduce edema: Astragalus benefits the Lung and Spleen, tonifying the three Jiao to regulate Qi transformation, moving Spleen Qi to eliminate water dampness, and is a key herb for tonifying Qi and promoting diuresis, often combined with Fang Ji (Stephania), Fu Ling, and Bai Zhu. For example, in treating a patient with wind heart disease who presented with edema of the head, face, and limbs, especially the lower limbs, along with palpitations, poor appetite, loose stools, and short urination, the tongue was pale and swollen with a thin white coating, and the pulse was intermittent. I used a Qi-tonifying and diuretic method: 50g of Astragalus, 15g of Gui Zhi, 30g of Fu Ling, 15g of Bai Zhu, 30g of Dan Shen, 30g of Yi Mu Cao (Leonurus), 12g of Fu Pian, and 12g of Fang Ji, decocted in water. After three doses, urination improved, and edema slightly reduced. After continuing for over twenty doses, the condition improved significantly, allowing the patient to participate in light labor. I also often use Astragalus with Ling Zhi (Reishi) to treat edema, cough, and palpitations caused by pulmonary heart disease, achieving good results.9. Regulating Qi transformation to treat diabetes: Astragalus benefits Qi, raises Yang, and solidifies the pores, promoting the upward movement of stomach fluids while regulating the Qi transformation in the lower Jiao. It is effective in treating diabetes, often combined with Shan Yao, Yuan Shen (Ophiopogon), and Hua Fen (Pollen) to lower blood sugar levels, particularly suitable for those with insufficient middle Qi and weak Spleen Yang. The principle of treating thirst is to promote Qi transformation. I often use these four herbs as the main ingredients, adjusting as needed to treat diabetes, achieving satisfactory results in controlling disease progression.10. Promoting tissue regeneration and expelling pus to treat sores: The “Ben Jing” states that Astragalus is effective for carbuncles and chronic sores, expelling pus and relieving pain. Its tonifying power can promote internal regeneration of muscle tissue, facilitating the expulsion of pus from chronic sores. I treated a case of a patient with a comminuted fracture of the patella due to a car accident, who underwent multiple surgeries and developed a local infection with a necrotic and pus-producing wound. After three months of treatment with various antibiotics, the wound did not heal, and the patient requested traditional Chinese medicine treatment. Upon examination, the wound was gray and lacked vitality, with thin pus and low spirits. The tongue was pale, and the pulse was thin. This was indeed a case of “after pus formation, the five organs are depleted, and Qi and blood are greatly deficient.” The external signs may appear excessive, but the internal organs are truly insufficient, indicating a need for pure tonification. I prescribed a formula to tonify Qi and nourish the Ying, warm Yang, and expel toxins: 50g of Astragalus, 15g of Dang Gui, 12g of Lu Jiao Jiao (Deer antler glue), 30g of Jin Hua (Honeysuckle), 30g of Dang Shen, 10g of Zhi Shan Jia (Manis), 10g of Rou Gui (Cinnamon), 12g of Bai Zhi (Angelica dahurica), 10g of Pao Jiang, and 12g of Niu Xi (Achyranthes). After fifteen doses, new tissue gradually formed, granulation tissue appeared red, pus decreased, and the patient’s spirit improved. This indicates a positive response, and after another fifteen doses, the wound healed completely.In summary, Astragalus has the effects of tonifying Qi, raising Yang, securing the exterior, promoting diuresis, and regenerating tissue. It is commonly used to treat Spleen and Stomach deficiency, middle Qi sinking, blood stasis, deficiency fatigue, menorrhagia, prolapse, chronic diarrhea, stroke hemiplegia, spontaneous sweating, and other conditions of weak righteous Qi, sores, and swelling due to wind-dampness. It is a commonly used and effective herb among practitioners.In the Qing Dynasty, Wang Qingren skillfully used Astragalus. I have learned from his methods, and when used appropriately, it indeed has remarkable effects. I summarize and introduce the following: (1) For conditions of descent, use Astragalus heavily to raise the descent. Applicable conditions include organ prolapse (such as gastric prolapse, uterine prolapse, rectal prolapse, kidney prolapse, etc.), myasthenia gravis, muscle atrophy, difficulty breathing, and dizziness, all of which are due to Qi deficiency and descent. These symptoms arise from Qi deficiency leading to the inability to raise the organs; or the clear Yang failing to rise, causing dizziness; or the ancestral Qi being insufficient, leading to difficulty in breathing; or Lung Qi being unable to support, obstructing the intake of fresh air, resulting in muscle atrophy and weakness. For gastric mucosal prolapse, one can use Si Jun Zi Decoction with an additional 30g of Astragalus, combined with 3g of Zhi Qiao (Bitter orange) to balance the rising and descending actions. Therefore, Zhi Qiao is used to assist the descent, as the stomach is a hollow organ responsible for receiving and descending. Although the mucosa needs to be raised, the stomach Qi must descend for balance. Thus, heavy use of Astragalus to tonify Qi and raise the mucosa is appropriate, while Zhi Qiao is used to ensure the stomach Qi descends, promoting the restoration of the gastric mucosa. For treating rectal prolapse, a formula from Inner Mongolia’s “New Medical Methods of Chinese Herbal Medicine” suggests using 120g of Astragalus and 9g of Fang Feng (Saposhnikovia). This formula is indeed derived from Wang Qingren’s Astragalus and Fang Feng Decoction. Wang’s formula consists of 120g of Astragalus and 10g of Fang Feng. Li Dongyuan believed that Fang Feng can restrain Astragalus, and when combined, the effect of Astragalus is enhanced, indicating a mutual reinforcement. This shows that Wang Qingren’s Astragalus and Fang Feng Decoction is indeed based on Dongyuan’s principles, and the amount of Fang Feng should not be excessive. This method is effective for treating rectal prolapse.For uterine prolapse, treat with Bu Zhong Yi Qi Decoction plus He Shou Wu (Polygonum multiflorum). The addition of He Shou Wu serves two purposes: first, to guide the formula to the appropriate channels, and second, because the uterus relies on Yin blood for nourishment. When Qi is sufficient, blood nourishes, and when blood flows, Qi circulates, ensuring that the uterus can return to its original position. If combined with acupuncture to strengthen the regulation of the Chong and Ren meridians, the effect will be even faster. For myasthenia gravis, I treat with a self-formulated strengthening and tonifying drink, which also heavily uses Astragalus as the main herb. Myasthenia gravis presents with complex symptoms, including drooping eyelids, diplopia, difficulty swallowing, unclear speech, and weakness in the limbs, with severe cases leading to difficulty breathing and Qi descent, threatening life. I believe the most significant characteristic of this disease is muscle weakness, as the spleen governs the muscles. Therefore, this is a case of spleen and stomach Qi deficiency, which can lead to damage from deficiency, and is related to the five organs. In treatment, it is essential to focus on the pathological center of spleen and stomach deficiency, heavily using Astragalus to tonify Qi and raise the descent, while also addressing any accompanying symptoms to regulate the five organs, thus promoting recovery. (2) For conditions of “elevation”, this refers to elevated blood pressure. Hypertension is often due to excessive liver Yang, and in clinical practice, calming the liver, subduing Yang, and extinguishing wind are commonly used. However, this is not always the case. I treat patients with Qi deficiency and phlegm-damp type hypertension by heavily using Astragalus combined with Wen Dan Decoction. According to a report by Terada Bunjiro and others in the “Chinese Medicine Research Literature Abstracts”, Astragalus has been shown to have a powerful effect compared to six other injectable antihypertensive agents. While some agents can lead to sustained decreases in blood pressure, they may cause weakness in animals after prolonged use. This conclusion supports the use of heavy Astragalus for lowering blood pressure from a pharmacological research perspective. Additionally, I agree with the following viewpoint: the elevation of blood pressure is a self-regulatory signal from the body, resulting from the imbalance of Yin and Yang in the internal organs, rather than the cause. Of course, chronic hypertension can lead to further complications in the heart, brain, and kidneys. Western medicine focuses on the impact of hypertension on these organs, using arterial blood pressure as a diagnostic basis and treatment target, seeking to find medications to lower blood pressure. In recent years, some scholars have reevaluated this perspective from the standpoint of syndrome differentiation and treatment. They believe 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, blood pressure rises. The elevation of blood pressure plays a particularly important role in maintaining the blood supply to these organs. The serious consequences of prolonged hypertension are primarily reflected in the severe disconnection of blood flow supply and demand in these three vital organs. Since the deeper essence of elevated blood pressure is the imbalance of blood flow supply and demand, and the elevation itself is an inadequate compensatory response to overcome this imbalance, the vascular response leading to elevated blood pressure persists. Therefore, elevated blood pressure should not be viewed purely as a negative pathological cause; it should be seen as a target for treatment and a means of support. Treatment should focus on improving the relationship between blood flow supply and demand, assisting the compensatory response that elevated blood pressure seeks to achieve, thus alleviating the persistent vascular response. This viewpoint highlights that the use of heavy Astragalus for Qi deficiency type hypertension aims to regulate the balance of Yin and Yang in the internal organs, changing the severe disconnection of blood flow supply and demand in vital organs, thereby alleviating the vascular response that leads to elevated blood pressure, achieving a lowering effect. This is the mechanism behind the use of heavy Astragalus for lowering blood pressure.For hypertensive crises, I often use acupuncture at the Tai Chong (Liver 3) point (bilaterally), employing a draining method, leaving the needles in for thirty to forty minutes, treating one to three times a day as needed, and combining with herbal medicine, achieving satisfactory results in most cases. In traditional Chinese medicine, acupuncture for stroke often effectively regulates the meridians, harmonizes Qi and blood, and balances Yin and Yang, resulting in rapid blood pressure adjustment. This also strongly supports the aforementioned mechanism.How to explain the dual action of Astragalus in raising and lowering blood pressure? Some may think that traditional Chinese medicine often has “dual-directional effects”; thus, Astragalus can both raise and lower blood pressure. How to grasp the mechanism of elevation and descent? My experience is that light use raises blood pressure, while heavy use lowers it. Why do pharmacological studies only yield a lowering effect? Because animal experiments are conducted with large doses of the drug, leading to the conclusion of a lowering effect. In treating hypotension, I prefer using Bu Zhong Yi Qi Decoction, where the amount of Astragalus does not exceed 15g. In treating Qi deficiency and phlegm-damp type hypertension, I prefer using Astragalus combined with Wen Dan Decoction, where the amount of Astragalus must be 30g or more. Indeed, in the Bu Zhong Yi Qi Decoction, besides Astragalus, there are also Chai Hu (Bupleurum) and Sheng Ma, which can enhance the lifting effect; when using heavy Astragalus to lower blood pressure, it is also possible to add herbs that subdue Yang and calm the mind for better results. However, even without these calming herbs, there is still a lowering effect, which is certain. I once consulted on a stroke patient with hemiplegia and aphasia who had elevated blood pressure. The diagnosis was Qi deficiency and blood stasis. I prescribed Bu Yang Huan Wu Decoction, using 120g of Astragalus as per the formula. The Western physician had concerns about the 120g of Astragalus, suggesting adding antihypertensive medication. After explaining the rationale, the patient took the formula, and the blood pressure not only did not rise but actually decreased, leading to the physician’s acceptance. Although it is said that heavy use of Astragalus can lower blood pressure, there is evidence and support for this, but it is still important to note that Astragalus is fundamentally a Qi tonifying and Yang raising herb. If the diagnosis is for hypertension due to excessive liver Yang or internal heat, using several grams of Astragalus to lower blood pressure would be a mistake! Caution is advised. This illustrates that pharmacological research has not yet answered all our questions, and we must still rely on syndrome differentiation and treatment.(3) Attack can be supplemented: Zhang Xichun believed that the elevating and tonifying effects of Astragalus are particularly effective for treating miscarriage and menorrhagia. However, heavy use of Astragalus can lead to the expulsion of a dead fetus, which is my experience. A dead fetus in the mother has transformed into a pathogenic entity—”evil”—and the condition is classified as a real excess. Since the Song Dynasty, gynecological texts have commonly used Ping Wei San (Ping Wei Powder) with purgative herbs to expel a dead fetus. Ping Wei San is the main formula for promoting the movement of the stomach and intestines to eliminate dampness; Cang Zhu (Atractylodes) is the main herb for promoting movement; Hou Po (Magnolia bark) and Chen Pi (Tangerine peel) enhance the action of moving Qi and drying dampness; adding purgative herbs to moisten and expel. Ancients believed that “when the stomach Qi moves, the dead fetus will naturally be expelled; adding purgative herbs will ensure it is expelled.” After the Ming Dynasty, “Jing Yue Quan Shu” advocated using Tuo Hua Decoction to induce labor and expel a dead fetus, focusing on moving blood while also using Che Qian (Plantago) and Niu Xi to facilitate expulsion. Ping Wei San focuses on Qi stagnation, while Tuo Hua Decoction focuses on blood stasis. I once treated a patient with Qi and Yin deficiency who had a dead fetus in utero. Initially, I used Ping Wei San with Mang Xiao (Sodium sulfate) and combined it with acupuncture, but later switched to Tuo Hua Decoction, both of which were ineffective due to mismatched herbs. After careful differentiation, I borrowed from Wang Qingren’s modified Kai Gu San, using 120g of Astragalus and acupuncture, and after one dose, the dead fetus was expelled. Kai Gu San is based on the Song Dynasty’s Gui Jia Decoction with Chuan Xiong added, and was later known as the modified Xiong Gui Decoction. This formula heavily uses Dang Gui and Chuan Xiong to move blood, while Gui Ban (Tortoise shell) subdues and stops bleeding. This formula does not use purgative or blood-breaking herbs, hence it has been used for labor difficulties since the Ming Dynasty. Wang Qingren believed that the effectiveness of this formula for labor difficulties varies due to an emphasis on nourishing blood and moving blood while neglecting Qi tonification and Qi movement. Therefore, he advocated for heavy use of Astragalus in the basis of Kai Gu San to enhance Qi tonification and Qi movement, making the formula more effective. Why did the modified Kai Gu San work? 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 no strength upon deep pressure. Additionally, the patient reported severe pregnancy symptoms, with intense vomiting and difficulty eating, leading to Qi and fluid depletion. Although the condition was real, the mother was deficient and could not withstand purgation. Therefore, using Ping Wei San and Tuo Hua Decoction was ineffective. Fu Qingzhu pointed out: “Knowing that the child is dead in utero, one cannot use medicine to expel it, as it is dangerous; if one uses aggressive methods to forcefully expel it, it is also dangerous. After six or seven days of labor, the mother’s Qi must be severely depleted; how can she withstand aggressive treatment? If one uses aggressive methods to forcefully 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, allowing her Qi and blood to be abundant, and the dead child will naturally be expelled.” Practice has proven that Fu’s viewpoint is correct, providing an alternative approach to expelling a dead fetus. Fu advocated using Tiao Er San, while I used modified Kai Gu San, achieving similar effects. At that time, Gui Ban was out of stock, so it was not used. This case illustrates that heavy use of Astragalus can expel a dead fetus. This is the method of combining attack with tonification.(4) For paralysis, promote movement: For hemiplegia and paraplegia due to Qi deficiency and blood stasis, Bu Yang Huan Wu Decoction is a particularly famous effective formula. It comes from Wang Qingren’s “Yi Lin Gai Cuo”. Although Zhang Xichun criticized Wang’s emphasis on Yang deficiency in treating hemiplegia, stating that atrophy can be both deficient and excess, he could not deny that “Bu Yang Huan Wu Decoction is indeed a very appropriate formula.” I have used this formula to treat various sequelae of cerebrovascular accidents characterized by Qi deficiency and blood stasis, achieving varying degrees of efficacy, with some recovering 50% and others 80-90%. I treated a young woman with severe paraplegia who had been bedridden for several months, with her legs emaciated and skin tightly wrapped around the bones, requiring assistance to sit, and unable to maintain a sitting position for long. I used Bu Yang Huan Wu Decoction with an initial dose of 120g of Astragalus, increasing to a maximum of 200g over eight months, along with rigorous exercise, and she was able to use a cane to walk slowly after one year, and after two years, she could walk without a cane and later married and had a child. I believe that using Bu Yang Huan Wu Decoction requires attention to two points: first, the diagnosis must be Qi deficiency and blood stasis; second, Astragalus must be used heavily, at least 120g, and should not be less than 60g for efficacy. Other herbs can also be slightly increased, but the proportions must not be reversed.
(5) For exterior deficiency, secure it: Li Dongyuan believed that Astragalus 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 exterior” means “securing the surface”. For spontaneous sweating, Yu Ping Feng San is a well-known effective formula. I find this formula not only treats spontaneous sweating but also applies to some cases of night sweats due to Qi deficiency. For convenience, I often use decoctions with the following proportions: 12g of Astragalus, 3g of Fang Feng, and 15g of Bai Zhu, with Fang Feng’s dosage being less than that of Astragalus, and Bai Zhu’s dosage being the sum of Astragalus and Fang Feng (as seen in “Yu Ping Feng San”). For treating spontaneous sweating and night sweats with concurrent Yin deficiency, I prefer using Yu Ping Feng San with an addition of Sheng Long Gu (Dragon bone) and Sheng Mu Li (Oyster shell), each 30g, or adding Fu Xiao Mai (Triticum aestivum) and glutinous rice root, each 30g. If sweating is particularly profuse, I add 10g of Ma Huang Gen (Ephedra root).
For treating sores and ulcerated flesh, Astragalus is also an important herb. I once consulted a patient whose wound did not heal after tumor resection under the armpit, with continuous drainage requiring multiple daily changes of gauze. After using a Qi and blood tonifying formula with 30g of Astragalus, the drainage decreased, and the wound healed within half a month, demonstrating the internal tonifying power of Astragalus. In children, sores and boils often occur in summer, with recurrent outbreaks being quite common and troublesome. A military doctor’s child had recurrent boils since the age of two, treated with antibiotics with slight improvement, but they recurred repeatedly until autumn. After three years, the child sought my help in June, presenting with boils all over the head. Although not thin, the child had a yellowish complexion and pale lips, a swollen tongue, a white coating, and a thin pulse, indicating that the righteous Qi was insufficient to resist pathogenic factors. I proposed a treatment plan to support the righteous Qi and expel the evil, using a formula of 9g each of Astragalus, Zao Jiao Ci (Gleditsia), Qing Tian Kui (Tian Kui flower), Ye Ju Hua (Wild chrysanthemum), Zhe Bei Mu (Fritillaria), Jin Hua (Honeysuckle), and Pu Gong Ying (Dandelion), with 6g each of Chen Pi, Bai Zhu, and Gan Cao (Licorice), and 12g each of Fu Ling, mung beans, and roasted licorice, for four doses. The boils did not recur. The father sought treatment again in January of the following year to prevent recurrence, and I prescribed a preventive formula of 9g of Astragalus, 6g each of Fang Feng and Gan Cao, and 12g each of Chen Pi, Bai Zhu, and Pu Gong Ying, instructing him to start taking it in April, with two doses per week. After that, the sores did not recur.(6) Diagnosis must be accurate: Although I favor using Astragalus, it is ultimately a medicine, not food. Its effects depend on proper diagnosis; improper use can harm patients. I once treated a tuberculosis patient and added 9g of Astragalus to a Yin-nourishing and phlegm-resolving formula, resulting in fever on the forehead after one dose, full-body fever after two doses, and neck and face heat after three doses. Upon removing Astragalus, the fever subsided. I also treated a stroke patient who experienced scalp itching and increased body temperature after taking the medicine. Mistakenly thinking it was an external invasion, I switched to a pungent and cool formula, which reduced the fever after one dose. However, when I used 90g of Astragalus again, the fever returned, and the right upper limb’s movement worsened, indicating that the diagnosis was incorrect.Upon careful consideration, although the pulse was thin and large, the tongue coating was thick and greasy, and the tongue body was not swollen or marked, indicating that phlegm and blood stasis were more significant than blood stasis. I switched to a phlegm-dispelling formula with slight blood-stasis herbs, using Wu Zhua Long (a type of herb) instead of Astragalus, and the condition improved. Regarding the indications for using Astragalus, I believe that a pale and swollen tongue with teeth marks, a thin and large pulse, and the presence of other Qi deficiency symptoms can indicate its use. As for the dosage, it is essential to pay attention to changes in symptoms and avoid rigid adherence to fixed rules or seeking solutions without considering the context.This is for clinical reference only; non-professionals should not attempt acupuncture or medication.
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Ai Yu Xiang Tang
Copyright Statement：Edited by Lao Shu, proofread by Feng Tu, sourced from publicly available materials on the internet. Copyright belongs to the original author.
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