TCM Book Club Issue 1391
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IIntroduction：In the opening of this article, Elder Deng states that this text is a summary of the experiences of Wang Qingren in using Huang Qi (Astragalus) combined with his own clinical cases. Reading this article provides a comprehensive overview of the applications of Huang Qi. (Editor/Ju Ye)
The Wonderful Uses of Huang Qi
Author/Deng Tie-Tao
Wang Qingren of the Qing Dynasty was adept at using Huang Qi, and I have learned from his methods. When used appropriately, it indeed has remarkable effects. I will summarize and introduce the following applications.
1. Elevating the Depressed
Use Huang Qi extensively to elevate the depressed, applicable 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 leading to descent. These symptoms arise from Qi deficiency and inability to elevate, causing organs to sag; or the clear Yang failing to rise, leading to dizziness; or insufficient Zong Qi resulting in difficulty in breathing; or lung Qi being unable to support, obstructing the function of the hundred vessels, leading to muscle atrophy and weakness.
For gastric mucosal prolapse, Si Jun Zi Tang (Four Gentlemen Decoction) can be modified by adding Huang Qi (30g) and Zhi Qiao (3g) to assist in elevation and descent, with more elevation and less descent. Therefore, Zhi Qiao is used to assist, as the stomach is a hollow organ that primarily receives and descends. Although the mucosa needs elevation, the stomach Qi must descend, hence the heavy use of Huang Qi to tonify Qi and elevate to treat mucosal prolapse, while Zhi Qiao is used to harmonize the stomach Qi for descent, promoting the recovery of the gastric mucosa.
Treating rectal prolapse: According to the “Selected Materials of New Medical Methods of Chinese Herbal Medicine” from Inner Mongolia, a formula using Huang Qi (120g) and Fang Feng (9g) is recorded. This formula is derived from Wang Qingren’s Huang Qi Fang Feng Tang. Wang’s formula consists of Huang Qi (120g) and Fang Feng (9g). Li Dongyuan believed that Fang Feng can restrain Huang Qi, and when Huang Qi is combined with Fang Feng, its efficacy is enhanced, as they mutually support each other. This method is indeed effective for treating rectal prolapse.
For uterine prolapse, treat with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shou Wu (Polygonum multiflorum). The addition of Shou Wu serves two purposes: to guide the treatment to the meridians and because the uterus relies on Yin blood for nourishment, where Qi supports blood and blood facilitates Qi movement. When Qi and blood are harmonized, 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 quicker.
For myasthenia gravis, treat 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 complex, including ptosis, diplopia, dysphagia, unclear speech, weakness in limbs, and in severe cases, dyspnea, with Qi descending dangerously, threatening life. I believe the main characteristic of this disease is muscle weakness, as the spleen governs the muscles, hence it is a pattern of spleen and stomach Qi deficiency, which leads to damage and 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 accompanying symptoms to regulate the five organs, heavily tonifying the spleen and stomach to promote recovery.
2. Elevation Balances
Here, “elevation” refers to elevated blood pressure. Hypertension is often due to excessive liver Yang. Clinically, we often use herbs to pacify the liver, subdue Yang, and extinguish wind, but there are cases where these methods are ineffective. I treat patients with Qi deficiency and phlegm-damp type hypertension by heavily using Huang Qi combined with Wen Dan Tang (Warm the Gallbladder Decoction) to address it.
According to the “Abstracts of Chinese Medicine Research Literature”, a report by Terada Bunjiro from Japan states: “Compared with six other injectable antihypertensive agents, Huang Qi has proven to be 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. 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, hence using arterial blood pressure as a diagnostic basis and seeking antihypertensive medications. 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 are imbalanced, blood pressure rises. 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 the elevation itself is a compensatory response to overcome this imbalance, the vascular responses leading to elevated blood pressure persist. Elevated blood pressure is not purely a negative pathological destruction and should not be treated as a target for suppression; rather, it should be seen as an object of treatment and support. 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 the heavy use of Huang Qi for Qi deficiency type hypertension is aimed at regulating the balance of Yin and Yang in the organs, changing the serious disconnection of blood flow supply and demand in important organs, thereby alleviating the “vascular response of elevated blood pressure” and achieving the effect of lowering blood pressure. This is the mechanism behind the heavy use of Huang Qi for lowering blood pressure.
For hypertensive crises, I often use acupuncture at the Tai Chong (Liver 3) point (bilateral), employing a draining method, leaving the needles for thirty to forty minutes, treating once to three times a day as needed, and adding Chinese medicine. Most patients achieve satisfactory results. The acupuncture treatment for stroke in TCM often effectively regulates blood pressure by unblocking the meridians and balancing Qi and blood Yin and Yang, resulting in rapid therapeutic 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 herbs often have “biphasic effects”, hence Huang Qi can both elevate and lower blood pressure. How to grasp the mechanism of elevation and descent? My experience is:When Huang Qi is used lightly, it elevates blood pressure; when used heavily, it lowers blood pressure.Why does pharmacological research only yield a result of lowering blood pressure? Because animal experiments are conducted with high doses of medication, leading to the conclusion of lowering blood pressure.
When treating hypotension, I prefer using Bu Zhong Yi Qi Tang, where the amount of Huang Qi is only 15g. For treating Qi deficiency and phlegm-damp type hypertension, I prefer using Huang Qi combined with Wen Dan Tang, where the amount of Huang Qi must be over 30g. Indeed, aside from Huang Qi, Bu Zhong Yi Qi Tang also contains Chai Hu (Bupleurum) and Sheng Ma (Cimicifuga), which can greatly enhance the elevating effect. When heavily using Huang Qi to lower blood pressure, it can also be combined with herbs that subdue Yang and stabilize, which will certainly yield better results, but even without these stabilizing 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 (120g). The Western doctor at the hospital had concerns about the dosage of Huang Qi (120g) and suggested adding Western antihypertensives. After explaining the rationale, the patient took the prescribed medication, and their blood pressure not only did not rise but actually decreased, which convinced them.
Although it is said that heavy use of Huang Qi can lower blood pressure, there is evidence and reasoning for this, but Huang Qi is still a herb that tonifies Qi and elevates Yang, and this point must not be overlooked.If the diagnosis is for hypertension due to excessive liver Yang or internal heat, and one wishes to use a few grams of Huang Qi to lower blood pressure, it would be a mistake to commit the “real-real caution”! Be cautious, be cautious.Thus, it can be seen that pharmacological research has not yet answered all our questions, and we must still rely on syndrome differentiation and treatment.
3. Attack and Supplement
Zhang Xichun believed that the elevation and supplementation of Huang Qi is particularly effective for treating miscarriage and excessive bleeding. However, heavy use of Huang Qi 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 belongs to a real pattern. Since the Song Dynasty, gynecological formula books have commonly used Ping Wei San (Harmonize the Stomach Powder) plus Pu Xiao (Sodium Sulfate) to expel a dead fetus. Ping Wei San is the main formula for promoting the healthy movement of the stomach and intestines, with Cang Zhu (Atractylodes) as the main herb for promoting movement, and Hou Po (Magnolia Bark) and Chen Pi (Aged Tangerine Peel) enhancing the ability to move Qi and dry dampness, adding Pu Xiao for moistening and downward movement. The ancients believed that “when the stomach Qi moves, the dead fetus will naturally be expelled; further adding Pu Xiao will ensure it is expelled.” After the Ming Dynasty, the “Jing Yue Quan Shu” suggested using Da Hua Jian (Flower Decoction) to induce labor and expel a dead fetus, focusing on moving blood while also using Che Qian (Plantago) and Niuxi (Achyranthes) to facilitate downward movement. Ping Wei San focuses on Qi stagnation, while Da 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 plus Mang Xiao (Sodium Sulfate) and combined it with acupuncture, then switched to Da Hua Jian, but none were effective due to mismatched herbs and symptoms. After careful differentiation, I borrowed from Wang Qingren’s modified Kai Gu San (Open Bone Powder), heavily using Huang Qi (120g) and adding acupuncture, and within one dose, the dead fetus was expelled. Kai Gu San is based on the Song Dynasty’s Gui Jia Tang (Tortoise Shell Decoction) with the addition of Chuan Xiong (Chuanxiong Rhizome). This formula emphasizes the use of Dang Gui (Angelica) 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 difficult labor since the Ming Dynasty. Wang Qingren believed that the effectiveness of this formula for difficult labor varies, as it focuses too much on nourishing and activating blood while neglecting Qi tonification and movement. Therefore, he advocated for heavily using Huang Qi to tonify Qi and promote movement, making this formula more complete.
Why was the modified Kai Gu San effective in this case? 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 upon palpation. Additionally, she reported severe pregnancy reactions, with intense vomiting and difficulty eating, leading to injury of fluids and depletion of Qi. Although the condition was real, the mother was deficient and could not withstand purgation, hence the initial use of Ping Wei San and Da Hua Jian was ineffective.
Fu Qingzhu pointed out: “Once it is known that the child is dead in the womb, one cannot use medicine to expel it, as it is dangerous; if one uses strong methods to purge it, it is also dangerous. As the production reaches six or seven days, the mother’s Qi must be very weak; how can she withstand strong purgative treatment? If one uses strong methods to forcibly expel the dead child, it is feared that the dead child will be expelled and the mother will also perish. It is necessary to 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 Li Er San (Child’s Powder) for treatment, while I used modified Kai Gu San with success, 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 combining attack with supplementation.
4. Movement for Paralysis
For conditions like hemiplegia and paraplegia due to Qi deficiency with obstruction, Bu Yang Huan Wu Tang is a particularly famous effective formula. It originates from Wang Qingren’s “Yi Lin Gai Cuo”. Although Zhang Xichun criticized Wang’s emphasis on insufficient Yang Qi for treating hemiplegia, stating that real patterns can be both deficient and excess, 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 with Qi deficiency and blood stasis leading to hemiplegia, achieving varying degrees of efficacy, with some recovering 50% and others 80-90%.
I once treated a young woman with severe paraplegia who had been bedridden for several months. Her legs were emaciated, with skin tightly wrapped around the bones below the knees, and she needed assistance to sit up, unable to maintain the position for long. I used Bu Yang Huan Wu Tang with modifications, initially using Huang Qi (120g), and at maximum dosage, up to 200g. After taking the medicine for over eight months and undergoing rigorous exercise, she was able to walk slowly with a cane, returned to work a year later, and two years later, she was able to walk without a cane and later married and had a child.
I have learned that using Bu Yang Huan Wu Tang requires attention to two points: first, the diagnosis must be Qi deficiency with blood stasis; second, Huang Qi must be heavily used at 120g, not less than 60g for efficacy. Other ingredients can also be slightly increased, but the proportions must not be reversed.
5. Strengthening the Exterior
Li Dongyuan believed that Huang Qi can tonify the three burners and solidify the defensive Qi. The defensive Qi warms the flesh and fills the skin, nourishing the pores and controlling opening and closing. “Solidifying the defense” means “strengthening the exterior”. For spontaneous sweating, Yu Ping Feng San (Jade Windscreen Powder) is a well-known effective formula.
I have found that this formula not only treats spontaneous sweating but is also applicable for night sweats due to Qi deficiency. For convenience, I often use a decoction with Huang Qi (12g), Fang Feng (3g), and Bai Zhu (15g). The amount of Fang Feng is less than that of 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 using Yu Ping Feng San plus Sheng Long Gu (Raw Dragon Bone) and Sheng Mu Li (Raw Oyster Shell) each at 30g, or adding Fu Xiao Mai (Floating Wheat) and Nuomi Gen (Glutinous Rice Root) each at 30g; if sweating is particularly profuse, add Ma Huang Gen (Ephedra Root) (10g).
For treating ulcers and necrotic tissue, 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 heavy use of Huang Qi (30g), the drainage decreased, and the wound healed in less than half a month, demonstrating the internal support of Huang Qi.
In children, skin abscesses often occur in summer, appearing alternately. This is not uncommon and can be quite troublesome. A military doctor’s child had skin abscesses since the age of two, occurring every summer. Antibiotics provided slight improvement, but the abscesses recurred repeatedly until autumn. After three years, they sought my help. It was June, and the child had abscesses all over their head. Although not thin, their face was yellow and lips pale, with a fat and tender tongue, white coating, and thin pulse. This was due to Qi deficiency failing to resist pathogenic evil, so I aimed 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 Thorn), Qing Tian Kui (Qing Tian Flower), Ye Ju Hua (Wild Chrysanthemum), Zhe Bei Mu (Zhebei Bulb), Yin Hua (Honeysuckle), Pu Gong Ying (Dandelion) each at 9g, Chen Pi (Aged Tangerine Peel), Bai Zhu (White Atractylodes), and Gan Cao (Licorice) each at 6g, Fu Ling (Poria), Green Bean, and Zhi Gan Cao (Honey-fried Licorice) each at 12g.
After taking four doses, the abscesses did not recur. The father sought treatment again a month later to eliminate the root cause, and I prescribed a preventive formula: Huang Qi (9g), Fang Feng, Gan Cao, and Zhe Bei Mu each at 6g, Chen Pi, Bai Zhu, and Pu Gong Ying each at 12g, instructing him to start in April, taking two doses weekly. 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 be appropriate to be effective; inappropriate use can be harmful. I once treated a tuberculosis patient and added Huang Qi (9g) to a nourishing Yin and phlegm-eliminating 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 Huang Qi, 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 cool exterior-releasing formula, which reduced the fever after one dose. When I used Huang Qi (90g) again, the fever returned, and the right upper limb’s movement regressed, indicating that the diagnosis was incorrect. Upon reflection, although the pulse was weak and large, the tongue coating was thick and greasy, and the tongue body was not swollen or had no tooth marks, indicating that phlegm and blood stasis were more prominent than blood stasis. I switched to a formula focusing on phlegm elimination with slight blood stasis 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 swollen with tooth marks, and the pulse is weak and large or weak at the cun position, one can consider its use. As for the dosage, one must always pay attention to changes in symptoms and avoid rigid adherence to rules or seeking solutions without adapting to the situation.
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