If we compare the “Treatise on the Spleen and Stomach” to a crown, then the Buzhong Yiqi Decoction (补中益气汤) is a pearl on that crown!This formula, created by the great physician Li Dongyuan during the Jin and Yuan dynasties, has been a nourishing remedy for over 900 years, a health tonic that everyone needs. If you don’t need it now, you will definitely need it in the future. If you reach old age and feel you don’t need it, it is not because you don’t need it, but because you are unaware of it.Just as a tire that is flat cannot roll, once it is inflated, it rolls quickly; similarly, as people age, their skin becomes wrinkled and sagging, and they may feel weak when walking or speaking; remember that Qi deficiency (中气虚) can lead to overall weakness, and one must not forget the Buzhong Yiqi Decoction. It is the treasure for maintaining youth, the great pill for delaying aging!Excessive consumption of Ren Shen (人参) can cause heat, too much Lu Rong (鹿茸) can lead to fire, and too much Ejiao (阿胶) can cause indigestion… The Buzhong Yiqi Decoction nourishes without stagnation, replenishes without heaviness, and balances nourishment and elimination, making it stable and effective.After reading this article, you will understand how important the spleen and stomach are for health, what Spleen Qi deficiency (脾虚) is, the symptoms of Spleen Qi deficiency, how to assess whether you have it based on symptoms, which herbs to add to the decoction, and that without nourishing the spleen and stomach, even the best tonics cannot be digested and absorbed. You will learn that when the spleen and stomach are strong, you can transform iron into tools, and that taking pills in small amounts is ineffective…How good is it? Very good! A person lives on Qi (气), and it can replenish Qi. “Where there is stomach Qi, there is life; without stomach Qi, there is death.” Regardless of the illness, as long as there is appetite, there is hope. Without appetite, even minor illnesses become troublesome.What do people live for? To nourish the spleen and stomach. It is the best at replenishing Qi and the energy of the spleen and stomach. When the spleen is healthy, everything is well. “In all four seasons, a strong spleen is not affected by evils.” If the spleen and stomach are healthy throughout the year, one will not fall ill.The central spleen soil can nourish all around. The five organs and six bowels depend on it for sustenance. As long as the central spleen soil is good, everything will thrive; as long as a person’s spleen and stomach are strong, their body will be healthy. The “Inner Canon” states: “The stomach is the root of a person; when the stomach Qi is strong, the five organs and six bowels are also strong.” The heart says, I am the master of the five organs and six bowels; the liver says, I am the general’s office… The spleen and stomach say, what master, general, or minister? Without me, the granary, you will starve!Good crops require good soil; a good physique requires a healthy spleen and stomach. When the spleen and stomach are good, the overweight can slim down; with a good spleen and stomach, the thin can gain weight.The Ming dynasty physician Zhang Jingyue said: “The Buzhong Yiqi Decoction is indeed the unique method of Li Dongyuan.” This “method” is not known to others. The Qing dynasty’s official medical text, the “Golden Mirror of Medicine”, lists the Buzhong Yiqi Decoction as the first choice for treating internal injuries.What happens with Spleen Qi deficiency? The “Spiritual Pivot: Questions of the Mouth” states: “When the upper Qi is insufficient, the brain is not full, the ears suffer from ringing, the head feels heavy, and the eyes become dim; when the middle Qi is insufficient, urination and defecation are abnormal, and the intestines suffer from rumbling; when the lower Qi is insufficient, it leads to weakness and heart disturbances.”Dizziness, tinnitus, difficulty lifting the head, and blurred vision are all signs of insufficient Qi; abnormal urination and intestinal rumbling indicate insufficient middle Qi; weakness, cold extremities, and heart agitation are signs of insufficient lower Qi.Li Dongyuan believed that “the decline of the three sources (the San Jiao元气) is due to the prior weakness of the spleen and stomach, which causes Qi to fail to circulate up and down.” Insufficient upper Qi manifests as brain emptiness, head heaviness, tinnitus, and dizziness. The Qi from food is connected to the spleen; insufficient middle Qi manifests as intestinal rumbling, diarrhea, or difficulty with urination; insufficient lower Qi manifests as weakness in the lower limbs, cold hands and feet, shortness of breath, and agitation. The decline of the San Jiao元气 ultimately stems from the deficiency of the spleen and stomach’s essence from food.Zhang Xichun said: “The spleen and stomach belong to earth… thus they can nourish the entire body. A strong spleen and stomach can digest food, leading to overall health; when have we seen excessive eating and drinking lead to illness?”What ailments are caused by Spleen Qi deficiency? The core of Li Dongyuan’s theory on the spleen and stomach is: “Injuries to the spleen and stomach lead to the emergence of a hundred diseases.” The “Inner Canon” emphasizes the impact of spleen and stomach diseases on the nine orifices, which actually affects the entire body. When the nine orifices are blocked, evils accumulate within, leading to numerous ailments. Thus, the classics have discussed this extensively. The “Plain Questions: Discussion on Deficiency and Excess” states: “Headaches and tinnitus, nine orifices are not functioning, arise from the intestines and stomach.” The “Plain Questions: Discussion on the True Organs” states: “If the spleen is insufficient, it leads to blockage of the nine orifices”; the “Plain Questions: Discussion on the Ascending and Descending Qi” states: “If Yang cannot overcome Yin, the five organs will compete for Qi, and the nine orifices will be blocked”; the “Classic of Difficulties: Difficulty 37” states: “If the five organs are not harmonious, the nine orifices will be blocked”; the “Plain Questions: Discussion on the True Organs” states: “If the spleen is insufficient, it leads to blockage of the nine orifices”… Many attribute tinnitus to kidney deficiency or liver stagnation, forgetting that Spleen Qi deficiency can also lead to tinnitus. The nine orifices refer to the two eyes, two ears, two nostrils, mouth, and the front and back yin. Li Dongyuan explains: “The nine orifices are governed by the five organs; only when the five organs receive stomach Qi can they function properly… When stomach Qi is deficient, the ears, eyes, mouth, and nose will all suffer.” Follow the WeChat account ‘Xingzhi Medical Talk’ for more secret formulas.Fertile soil allows trees to flourish; when the soil is depleted, trees wither. The spleen belongs to earth, the liver to wood; when the earth is deficient, the wood shakes. The liver opens to the eyes, so eye diseases are also related to the spleen.Problems with the nose should also be traced back to the spleen; the spleen belongs to earth, and the lungs belong to metal. The nose is the orifice of the lungs; if the spleen is ill, the lung orifice will also be obstructed, manifesting in the lungs but rooted in the spleen. Earth can generate metal; if the earth does not generate metal, then metal will be ill. Therefore, we must nourish the spleen to generate lung metal.
The ear is the orifice of the kidneys, and the kidneys open to the ears. Kidney deficiency leads to tinnitus. The kidneys are the source of congenital essence, while the spleen and stomach are the source of acquired essence. The strength of the kidneys relies on the nourishment from the acquired spleen and stomach, also known as nurturing the congenital with the acquired. When the congenital is nourished by the acquired, the kidneys will be supported, and the source will not run dry. Some say it is better to nourish the kidneys than the spleen; others say it is better to nourish the spleen than the kidneys. Both have their reasons, depending on the specific situation. Generally speaking, it should be emphasized that “nourishing the spleen is better than nourishing the kidneys”. The reason is that the spleen generates all; if the spleen fails, everything fails. The spleen, as the source of transformation and production, nourishes the five organs, six bowels, limbs, and skin, all relying on the refined essence of food transformed by the spleen.Thus, if the kidneys are ill, their Qi may be trapped in the two thighs, which can be tapped to expel evil Qi. If the kidneys are ill, the ear orifice of the nine orifices will not function properly; treatment should focus on the kidneys but also adjust the spleen.Many people know that the kidneys govern urination, and thus the ailments of the front and back yin are often related to the kidneys. However, some experts believe that the “two yins” refer to the urinary orifice and the essence orifice, not just the back yin. The relationship between the kidneys and the two yins is important, and the relationship between the spleen and the two yins is also significant. Kidney deficiency can lead to kidney leakage, and spleen deficiency can also lead to bleeding and diarrhea. The difference lies only in the timing of the symptoms. Kidney Yang deficiency can cause frequent urination at night, while spleen deficiency can lead to weakness in closing. “Coughing and involuntary urination are treated with Chun Ze Decoction (春泽汤).” Chun Ze Decoction contains Ren Shen, Bai Zhu (白术), and Fu Ling (茯苓), which tonifies Qi and strengthens the spleen. Follow the WeChat account ‘Xingzhi Medical Talk’ for more secret formulas.Outside the nine orifices, there is one orifice that is blocked, leading to a multitude of diseases. This is a major orifice, present throughout the body, known as the hair orifice. If the skin does not exist, where will the hair attach? If the hair orifice is blocked, how can one avoid illness?External pathogens of wind and cold can block the hair orifice, leading to blockage, runny nose, aversion to cold and wind, fever without sweating; if the spleen and stomach are injured, it affects the skin, leading to dryness and flaking or skin wrinkling. Thus, the “Classic of Difficulties” states: “If the spleen is damaged, food will not nourish the skin.” If the spleen is injured, the food consumed cannot be properly transformed into the skin, leading to various skin diseases.Zhao Xianke once said: “The acquired spleen soil cannot function without the congenital Qi; this Qi sinks due to labor, causing the clear Qi not to rise and the turbid Qi not to descend, hence the use of Sheng Ma (升麻) and Chai Hu (柴胡) to assist Ren Shen and Huang Qi (黄芪), which is why this formula nourishes the acquired and supports the congenital. In general, the spleen and stomach prefer sweet and dislike bitter, prefer tonification and dislike purging, prefer warmth and dislike cold, prefer smoothness and dislike stagnation, prefer rising and dislike descending, prefer dryness and dislike dampness; this formula embodies these principles.”Some may ask, with so many theories, why not see the true face of the formula? This is not a redundant question. Differentiating and observing diseases, using formulas and herbs, without theoretical guidance and expert advice, can lead to misdirection and wasted effort.Original formula of Buzhong Yiqi Decoction:For severe illness, use 1 qian of Huang Qi (黄芪), 5 fen of roasted Gan Cao (甘草), 3 fen of Ren Shen, 2 fen of Dang Gui (当归) dried with wine or sun-dried, 2 or 3 fen of Chen Pi (橘皮) without removing the white part, 2 or 3 fen of Sheng Ma, and 2 or 3 fen of Chai Hu (柴胡), and 3 fen of Bai Zhu.All ingredients should be ground together, boiled with 2 cups of water until reduced to 1 cup, strain, and take warm before meals. Modern usage: decoct in water. Alternatively, it can be made into pills, taken with warm water or ginger soup.The original formula uses very small amounts; for “severe illness”, Huang Qi is used at 1 qian. Today, the dosage of the formula has changed significantly.Commonly used dosages are: Huang Qi 15g, Ren Shen (or Dang Shen) 15g, Bai Zhu 10g, roasted Gan Cao 15g, Dang Gui 10g, Chen Pi 6g, Sheng Ma 6g, Chai Hu 12g, Sheng Jiang (生姜) 3 slices, Da Zao (大枣) 6 pieces.Song: Buzhong Yiqi (补中益气) Huang Qi, Bai Zhu, Chen Pi, Sheng Ma, Chai Hu, Ren Shen, Gan Cao, Dang Gui are the main ingredients; it excels in treating internal injuries and also addresses Yang deficiency and external pathogens.After the original formula, there are 23 modifications to accommodate readers who only want to know what diseases the original formula can treat; here, I will not elaborate. I will only mention the modification for headaches as an example.For headaches, add 2 or 3 fen of Man Jing Zi (蔓荆子); for severe pain, add 2 fen of Chuan Xiong (川芎); for vertex pain or brain pain, add 3 or 5 fen of Gao Ben; for bitter pain, add 2 fen of Xi Xin (细辛); for all headaches, these four flavors are sufficient. If there is heat in the head, this formula cannot treat it; use a clearing formula instead.As this text comes to an end, one may ask how to grasp the ancient scales of measurement, how to measure a single fen?With only 8 ingredients in the entire formula, how can it be so powerful, and why are they common herbs?“Whenever the spleen and stomach are deficient, the lung Qi is first exhausted, hence Huang Qi protects the skin and closes the pores, preventing spontaneous sweating; when the original Qi is insufficient, one becomes lethargic and short of breath, so Ren Shen is used to replenish it; the sweetness of roasted Gan Cao alleviates heart fire and removes irritability, nourishing the spleen and stomach to generate Qi. These three ingredients are excellent for alleviating irritability and heat. Bai Zhu is used to strengthen the spleen; Dang Gui harmonizes the blood; when Qi is chaotic in the chest, Chen Pi is used to regulate it, and to disperse the stagnation of sweet herbs; when the clear Qi in the stomach sinks, Sheng Ma and Chai Hu, which are light and thin, are used to lift the stomach Qi upwards, restoring its original position, allowing it to rise and promote growth. The Buzhong Yiqi Decoction is a formula that achieves stability through the use of ascending herbs; a Qi tonifying formula relies on clear herbs to enhance Qi significantly; this is the subtlety of using herbs. This formula can also be used to nourish the heart and lungs; if the lungs are damaged, it benefits Qi; if the heart is damaged, it regulates the Ying Wei (营卫); it can also nourish the liver wood, resolving stagnation. However, it is not suitable for the kidneys; those with Yin deficiency below should not be lifted, and those with Yang deficiency below should not be raised either.” (Luo Mei, “Discussion on Famous Physicians’ Formulas”, Volume 1)The Buzhong Yiqi Decoction is a Qi tonifying formula, but in reality, it primarily tonifies Qi while also nourishing blood; it is a formula that tonifies both Qi and blood.It embodies the medical principle of “to nourish blood, one must first tonify Qi; when Qi flows, blood is generated.” The Huang Qi in the formula tonifies Qi, while Dang Gui nourishes blood; these two herbs are also known as the blood tonifying decoction. Together with the famous Si Jun Zi Tang (四君子汤) for tonifying Qi, it achieves the dual purpose of tonifying Qi and blood.Since it is called “Buzhong” (补中), it implies that all spleen and stomach diseases can be addressed with this formula as a foundation for modifications. An old TCM practitioner could use just the Si Jun Zi Tang with modifications to address many diseases, while others adeptly use the Buzhong Yiqi Decoction to treat various conditions. This is the charm of a famous formula.The key to using this formula lies in recognizing the dual deficiency of Qi and blood. This is the focus of applying this formula. If one can do this, all diseases must consider the spleen and stomach; thus, even difficult TCM conditions, Western medicine’s myasthenia gravis, blood disorders, malignant tumors, etc., can all be treated with appropriate modifications based on symptoms.Mencius said: “I am good at nurturing my righteous Qi.” Our level is low, so we can only say: I nurture the Qi of my spleen and stomach.