Panax ginseng is a key ingredient in Bu Zhong Yi Qi Tang but may be substituted with codonopsis root.

In this discussion, TCM organs describe functions that do not perfectly correspond to what we know regarding the Western anatomical organs.

In traditional Chinese Medicine (TCM), Qi means “life energy.” Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination) is the most effective and commonly used Qi tonic formula for treating low energy caused by weak metabolic function, which in TCM is described as Spleen Qi deficiency.

The TCM Spleen has to do with deep level digestion and assimilation of both macro and micro nutritional elements circulating in the blood. From a Western physiological perspective, these nutrients feed the cells and are responsible for the creation and proliferation of cellular energy-producing mitochondria in the cell, which then are able to manufacture Adenosine triphosphate (ATP).

The TCM Spleen function involves the metabolic transformation of food and fluids. This requires metabolic heat (called Spleen Yang).

The TCM Spleen vs the TCM Kidneys and Qi

TCM maintains that Qi is stored in the Kidneys, while the Spleen acquires Qi from food, drink and air. While one can live without the anatomical spleen, the TCM Spleen function exists through the entire body regardless of whether there is an actual spleen present or not. The TCM Kidney function includes the adrenal glands which regulate the hormones associated with the sympathetic and parasympathetic nervous systems.

Conditions involving low energy, blood deficiency, dampness and Phlegm are the cardinal signs of Spleen Qi deficiency. There is usually a pale tongue often with tooth marks on the side. Tending more to cold sensitivity are also signs of TCM Spleen and TCM Kidney (hormonal) Qi deficiency. Physiologically, this affects both male and female hormones regulated by the TCM Kidneys creating a deficiency of thyroid hormones.

Because of this distinction in how the body uses Qi, TCM has developed two different schools of thought regarding treatment strategy for deficient Qi. The Kidney approach seeks to preserve Qi while the Spleen approach seeks to strengthen the Spleen’s ability to create Qi from food and air.

Second-century physician Li Dong Yuan, who is celebrated like a saint in China, developed the principle that rather than treating chronic dysfunctions related to Qi deficiency from the perspective of TCM Kidney, which is where Qi is stored, he instead focused treatment on the TCM Spleen (digestion) where ongoing acquired Qi is created. The brilliant formula Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) was Li Dong Yuan’s invention and flagship formula for treating low energy, blood deficiency, dampness, and Phlegm. While there are many variations of this formula, it remains one of the most widely used TCM formulas for Qi deficiency.

Bu Zhong Yi Qi Tang Ingredients

Huang Qi (Radix Astragali) – (8-20g)

Bai Zhu (Rhizoma Atractylodis macrocephalae) (10g)

Dang Gui (Radix Angelicae sinensis) (10g)

Ren Shen (Radix Ginseng) or milder counterpart Dang shen (Codonopsis) (10g)

Chen Pi (Pericarpium Citri reticulatae) (6g)

Sheng Ma (Rhizoma Cimicifugae) (5g)

Chai Hu (Radix Bupleuri) (5g)

Mix-fried Gan Cao (Radix Glycyrrhizae) (5g)

Li Dong Yuan’s Bu Zhong Yi Qi Tang formula tonifies with ginseng (or codonopsis), astragalus root, which raises metabolism and benefits digestion, along with white atractylodes, also a Qi tonic. Honey-fried licorice root tonifies and harmonizes the absorption of all the herbs in the formula. The cortisone-sparing effect of licorice is minimized by the traditionally smaller amount used in this and most TCM herbal formulas. Because of its harmonizing effect in herbal formula’s is sometimes called the “peacemaker.” Dampness and TCM Phlegm resulting generally from the overuse of rich foods and even tonic herbs like ginseng, is resolved and prevented with tangerine peel. Black cohosh (sheng ma) and Bupleurum root (Chai hu) both clear heat and regulate Qi, which in this case, means regulating hormones. However, these two herbs, having an upward energy, further assist the TCM Spleen’s ability to circulate the pure energy derived from the complex process of digestive metabolism throughout the body. Sometimes a small amount of mint is added to further move the pure energy to the brain, generating mental clarity.

Planetary Formulas markets Bu Zhong Yi Qi Tang as “Ginseng Elixir.” The dose is two or three tablets two or three times daily.

Bu Zhong Yi Qi Tang and Dampness/Phlegm

Bu Zhong Yi Qi Tang is a formula that overall raises metabolism by increasing Qi, tonifying and moving blood, and resolving the accumulation of dampness and Phlegm. “Phlegm” in the TCM sense is considered the most difficult condition to resolve. As a toxic element that also impairs circulation, it is comparable to what Ayurveda calls “ama.”

TCM Phlegm is not simple respiratory mucus but a thick viscous substance that can affect health circulation throughout the body. This would include hyper-cholesterol, plaque causing atherosclerosis in the veins and arteries, and poor circulation in the joints and muscles which causes arthritic conditions. It also affects the brain causing dementia and cognitive impairment.

TCM Dampness is the precedent of TCM Phlegm. Both Dampness and Phlegm are a result of undigested or molecular residue of food accumulating in the blood. An excess of refined sugar, raw, cold foods and drinks, and refined flour causes dampness and Phlegm.

Likewise, A vegan or vegetarian diet consisting of mostly cold-natured foods threatens the TCM Spleen’s function and overall metabolism. This is one reason why, largely for religious or long-standing economic reasons, cultures that eat vegan or vegetarian diets tend to include in their food lots of hot spices such as those found in Asian and Central American diets where an excess of carbohydrates and a threatened deficiency of first-class protein is typical. Just as refined foods and grains lack nutritional value, so also the excess use of hot spices lacking the full metabolic nutritional requirement found in animal protein can also lead to constitutional weakness.  Keep in mind, no amount of hot spices nor even a high-powered Qi tonic such as Asian ginseng can compensate for a poor diet. We can use these as facilitators of digestion, but not as a substitute for good nutrition.


A Warming Formula for Heat?

Bu Zhong Yi Qi Tang tonifies Spleen and Stomach Qi (digestion), raises the pure yang Qi, and prevents Yin Fire manifesting as fever and heat within a general deficiency context. While Yin Fire is relatively uncommon clinically, a common question is: How can a predominantly warming Qi tonic formula can treat fever and heat? Yin Fire refers to heat symptoms occurring because of wasting and deficiency of core (constitutional) energy so that metabolic heat is not stored and floats upwards. Symptoms are:

  1. Great tiredness
  2. Some inflammatory symptoms in the upper parts of the body such as red face, thirst and mouth sores.
  3. The most important sign is that there are both inflammatory and cold symptoms (feeling cold generally, pale tongue)[1]

Giovanni Maciocia says that “Yin Fire is neither full heat, nor empty heat but a different kind of heat deriving from a deficiency of Yuan Qi (constitutional energy).” This is a condition where anti-inflammatory pharmaceuticals (such as antibiotics) as well as anti-inflammatory bitter tasting herbs worsens heat or inflammatory symptoms. Tonics such as ginseng and astragalus are used in carefully formulated formulas such as Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination) are needed to treat this type of heat or fever.

This being said, Bu Zhong Yi Qi Tang does not directly treat Yin Fire but prevents it from occurring by tonifying the constitutional deficiency and clearing the stagnation of Qi and Blood.

Bu Zhong Yi Qi Tang treats the following symptoms:

  • Fatigue
  • heavy body
  • shortness of breath
  • little desire to speak
  • little taste for food
  • sleepiness
  • low appetite
  • deficiency wheezing
  • frequent urination
  • no thirst
  • clear discharge from the nose
  • spontaneous sweating
  • aversion to wind and cold
  • loose stools or diarrhea
  • abdominal pain and distention
  • belching
  • hemorrhoids
  • prolapsed uterus and stomach

The face and tongue will tend to be pale and the pulse may be either flooding or thin and weak, especially rootless in the third or “chi” position of the right wrist.

One need not manifest all of the symptoms described. However, the fundamental indication of Bu Zhong Yi Qi Tang  is deficiency of Qi and blood and weak digestion – this may occur with or without fever and heat with signs of dampness and Phlegm.

Western conditions treated by Bu Zhong Yi Qi Tang

Bu Zhong Yi Qi Tang formula, alone or modified to treat accompanying symptoms such as fibromyalgia and joint pain, is the primary formula for the treatment of Chronic Fatigue Syndrome or  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This is a long-term (six months or longer) condition of severe low energy. People with ME/CFS are often not able to do their usual activities. At times, ME/CFS may confine them to bed. People with ME/CFS have severe fatigue and sleep problems. ME/CFS may get worse after people with the illness try to do as much as they want or need to do. This symptom is called post-exertional malaise (PEM). Other symptoms can include problems with thinking and concentrating, pain, and dizziness. According to an Institute of Medicine (IOM) report, an estimated 836,000 to 2.5 million Americans suffer from ME/CFS. However, most of them have not been diagnosed.[2]

Finally, long-covid symptoms may also be effectively treated with Bu Zhong Yi Qi Tang.





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