Source: Xiao Xiangru Channel
Abstract: Today we will learn from the experiences of Zhang Xuewen and Jiao Shude using Buyang Huanwu Decoction.
Zhang Xuewen’s Experience
Master Zhang observed through numerous clinical cases that most coronary heart disease is related to Qi deficiency and blood stasis. While there is certainly blood stasis in the pathogenesis of coronary heart disease, the fundamental cause lies in insufficient heart Qi, which leads to an inability to circulate blood. The obstruction of the heart vessels is merely a direct cause of chest obstruction, while the fundamental reason for the occurrence of chest obstruction is the deficiency of heart Qi and the abnormal circulation of Qi and blood. Qi deficiency and blood stasis are the main contradictions throughout the entire process of chest obstruction, with Qi deficiency being the primary aspect leading to the occurrence of this disease. One should not only focus on the obstruction but ignore the root cause, treating coronary heart disease solely with methods to invigorate blood circulation and resolve stasis. Therefore, the treatment of this disease should involve both tonifying and unblocking, with a combination of tonification and unblocking, and the correct treatment method is to benefit Qi and invigorate blood. Master Zhang stated: “Buyang Huanwu Decoction is a representative formula for tonifying Qi and invigorating blood. Although it is designed for stroke, the heart and brain are similar. In the pathological process of chest obstruction, the pathology of Qi deficiency and blood stasis can be effectively treated with this formula.” Master Zhang emphasized that when using this formula, attention should be paid to: the ratio of blood-invigorating herbs to Qi-tonifying herbs; the blood-invigorating herbs should not be too heavy, and the amount of Huang Qi (Astragalus) should not be too light, with at least 30g of Huang Qi used. This formula often shows significant effects in the early stages, and as the condition progresses, it is advisable to continue using the original formula without increasing the amount of Huang Qi. This is indeed a matter of experience. Li, a 60-year-old male official, has experienced intermittent chest tightness and pain for over 4 years. Symptoms are triggered by fatigue, with chest tightness, chest obstruction, and shortness of breath lasting for several minutes before relief. He has been diagnosed with coronary heart disease at various major hospitals. Recently, due to fatigue, chest tightness and shortness of breath reoccurred and gradually worsened, accompanied by palpitations, cough, a small amount of thin white phlegm, and poor appetite. His tongue was dark with a thin white coating, and his pulse was deep and thin. The diagnosis indicated weak heart Qi and poor blood circulation. The treatment should benefit Qi and eliminate obstruction, promoting blood circulation.Prescription: Huang Qi (Astragalus) 30g, Dang Gui (Angelica Sinensis) 10g, Chuan Xiong (Ligusticum Chuanxiong) 10g, Chi Shao (Red Peony) 10g, Tao Ren (Peach Kernel) 10g, Shan Zha (Hawthorn) 15g, Gua Lou (Trichosanthes) 12g, Xie Bai (Garlic Chives) 10g, Sha Ren (Amomum) 6g.Follow-up: After taking the above formula for 6 doses, the symptoms of chest tightness and shortness of breath significantly improved. The formula was modified by removing Xie Bai and adding Tan Xiang (Sandalwood) 6g, Chao Suan Zao Ren (Fried Sour Jujube Seed) 30g, and Lu Xian Cao (Herba Hedyotis) 15g for consolidation of treatment. A total of over 20 doses were taken, and clinical symptoms disappeared, with no recurrence during follow-up.
Comment
This formula can be adjusted to include Dan Shen (Salvia Miltiorrhiza) and Shan Zha (Hawthorn). Master Zhang believes: Dan Shen is a bitter herb that enters the blood and returns to the heart, dispelling stasis and generating new blood, acting without damaging the existing blood. It has been praised by predecessors as “Dan Shen alone has the same effect as Si Wu Decoction.” Shan Zha not only invigorates blood and aids digestion but also has the ability to lower lipids and prevent excessive tonification that could stagnate the stomach and spleen. The master said: There is no distinction between expensive and cheap herbs; it all depends on the proper application. In addition, during the treatment of coronary heart disease, one can consider adding herbs that nourish Yin, enrich blood, and calm the spirit, such as Suan Zao Ren (Sour Jujube Seed), Bai Zi Ren (Platycladus), Mai Dong (Ophiopogon), He Shou Wu (Fo-Ti), and Lu Xian Cao. Master Zhang emphasized: The heart governs blood vessels, and the function of the heart in governing the spirit is a prerequisite for the continuous circulation of Qi and blood, allowing it to perform its normal physiological functions. Adding calming herbs is beneficial for the recovery and improvement of heart function.[Yu Weimin, Feng Guangkui. Professor Zhang Xuewen’s Experience in Treating Coronary Heart Disease with Buyang Huanwu Decoction, Journal of Traditional Chinese Medicine, 1994 (3): 31]
Jiao Shude’s Experience
Can Buyang Huanwu Decoction be used to treat all cases of stroke and hemiplegia? Based on years of experience in treating stroke, I believe that for initial stroke with hemiplegia, where the evil Qi is excessive, with facial redness and swelling, a rattling sound in the throat, thick greasy tongue coating, and a strong, slippery pulse; for stroke with hemiplegia accompanied by liver Yang rising, head swelling or migraine, irritability, constipation, yellow tongue coating or red tongue, and a strong, wiry pulse; for stroke with hemiplegia accompanied by limb spasms and opisthotonos; and for stroke with hemiplegia that has persisted for a long time but with a stronger pulse on the affected side than the healthy side; all these cases are not suitable for using Buyang Huanwu Decoction. In summary, treatment should be based on the principle of syndrome differentiation to improve efficacy. Buyang Huanwu Decoction is suitable for the deficiency syndrome of Qi deficiency and blood stasis. It is not appropriate for cases without Qi deficiency but with excessive evil Qi. Furthermore, when treating stroke, one should not only consider the presence of blood stasis in the brain and increase the blood-invigorating herbs in the formula. It is important to recognize that the causes of stroke also include liver wind, phlegm turbidity, Qi fire, Qi and blood counterflow, and deficiency of righteous Qi. There are also different syndromes involving the channels, organs, and viscera. Symptoms may include constipation, prolonged absence of bowel movement; confusion and hyperactivity; loss of consciousness, incontinence, drooling, and limb weakness; rattling phlegm, thick greasy tongue coating, and a slippery pulse; aphasia with a stiff tongue, choking on water; or even clear consciousness with only hemiplegia, etc. In terms of constitution, some may have kidney deficiency, liver deficiency, both liver and kidney deficiency; some may have spleen deficiency with excessive phlegm; some may have spleen deficiency with insufficient Qi; some may have excess above and deficiency below; some may have excessive heart fire; some may have lung Qi stagnation, etc. All these situations need to be comprehensively considered and analyzed from a holistic perspective for syndrome differentiation and treatment. One must not hastily use Buyang Huanwu Decoction upon encountering stroke and hemiplegia. (“Collection of Experiences from Famous Old TCM Practitioners in China”)Note: Please follow medical advice for specific treatment and medication! This article is excerpted from “Collection of Medical Techniques from Famous Physicians of the Qing Dynasty, Xu Rongqing, Zhou Heng (Editors), China Medical Science Publishing House, 1994.12. This public account is used solely for academic exchange; if there is any infringement, please contact for deletion, and please indicate the source when reprinting.Cover image source: Shetu Network.
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