Buyang Huanwu Tang for TCM Treatment of Paralysis Caused by Stroke Sequelae and Brain Tumors
Buyang Huanwu Tang (Yang-Supplementing and Five-Returning Decoction) is a famous formula by the Qing-dynasty physician Wang Qingren, recorded in his book Corrections of Errors Among Physicians (Yilin Gaicuo). It belongs to the TCM category of blood-regulating formulas.
Buyang Huanwu Tang has the actions of supplementing qi, activating blood, and unblocking the collaterals. It is primarily indicated for the qi-deficiency and blood-stasis pattern presenting in stroke sequelae and paralysis caused by brain tumors. The signs include hemiplegia, deviation of the mouth and eye, sluggish speech, drooling at the mouth corner, frequent urination or enuresis/urinary incontinence, a pale-dark tongue with white coating, and a moderate, forceless pulse.
Modern TCM practitioners often use Buyang Huanwu Tang to treat sequelae of cerebrovascular accidents, coronary heart disease, sequelae of poliomyelitis, and other causes of hemiplegia, paraplegia, or flaccid weakness of one upper limb or one lower limb that belong to the qi-deficiency and blood-stasis pattern. I myself also frequently use Buyang Huanwu Tang to treat brain tumor patients.
Buyang Huanwu Tang is dominated by raw Huangqi (Astragalus); the greatest characteristic of this formula is the heavy use of raw Astragalus. When I use this formula, my usual doses are: raw Huangqi 120 g, Dangguiwei (Angelica tail) 6 g, Chishao (red Paeonia) 5 g, Dilong (earthworm) 3 g, Chuanxiong (Ligusticum) 3 g, Honghua (Carthamus) 3 g, Taoren (peach kernel) 3 g.
Whether the paralysis is caused by stroke sequelae or by a brain tumor, it should be treated early. The earlier the medication, the faster the recovery, the higher the probability of rehabilitation, and the fewer the residual problems.
However, using Buyang Huanwu Tang alone to treat brain tumors is unrealistic. But using Buyang Huanwu Tang as an auxiliary decoction, combined with some anti-tumor herbs, does have a very good effect on paralysis in brain tumor patients. If there is also hydrocephalus, one can consider combining a water-draining, swelling-reducing formula for even better results.
When raw Astragalus is used at 120 g, it can easily raise the patient's blood pressure. Suddenly using 120 g of raw Astragalus may not be tolerated by many patients, who may experience dizziness and other symptoms. So when using Buyang Huanwu Tang, note that the dose of raw Astragalus must be increased gradually.
Generally, starting at half the dose does not cause obvious discomfort; after letting the patient adapt for a few days, then bringing raw Astragalus up to the large dose is much safer.
When using this formula, one must grasp its key indication: the patient must have obvious symptoms of qi deficiency and blood stasis. Qi-deficient patients usually have soft, weak hands and feet, a weak pulse, and even weakness in defecation and urination. For constipation caused by qi deficiency, laxatives must never be used recklessly; although laxatives may temporarily relieve constipation, afterward they make the patient's constipation even worse.
I treated an elderly ovarian cancer patient for two years. Early last year she suddenly suffered a cerebral infarction, after which she developed hemiplegia, qi deficiency and weakness, and great difficulty in defecating. Her family was quite worried and bought some imported bowel-moistening laxatives; although these temporarily relieved the constipation, afterward the patient went to the toilet frequently—more than ten times a day—and basically could not pass stool each time.
When taking the history, I specifically asked the elderly patient whether she felt she lacked the qi to defecate, wanting to push but lacking the strength to push it out. She hurriedly said yes. Based on her condition, I gave her the original Buyang Huanwu Tang formula to take for a week; after a week, her symptoms were markedly relieved.
This kind of qi-deficiency constipation requires raw Huangqi or raw Baizhu (Atractylodes), and the dose must be large. Raw Astragalus can be used above 100 g; raw Atractylodes can be used above 60 g. For safety, the dose must be increased gradually, starting small and increasing day by day.
Brain tumor patients often have the same problem: because of the tumor's compression, they are prone to cerebrovascular accidents, and not only paralyzed but also constipated. To solve this problem, one can start with Buyang Huanwu Tang; after using it, if the stool is still not regular, add raw Baizhu. Do not casually use purgative bowel-moistening herbs like Dahuang (rhubarb), Mangxiao (Glauber's salt), or Huomaren (Cannabis seed).
Although Wang Qingren's formula contains blood-activating and stasis-resolving ingredients, its emphasis is on supplementing qi; the dose of qi-supplementing raw Astragalus far exceeds that of the blood-activating herbs. From this formula we can see that Wang Qingren had great experience in treating stroke and other cerebrovascular diseases.
This formula truly hits the crux of paralysis caused by qi deficiency and blood stasis. In post-stroke patients, the presenting pattern is dominated by qi deficiency. If one does not heavily use raw Astragalus but recklessly uses large doses of blood-activating and stasis-resolving herbs, the patient will mostly die not of the disease but of the medicine.