Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction): A Classic TCM Formula for Supporting Righteous Qi Against Cancer
Hamamatsu University School of Medicine in Japan once reported a case of partial tumor regression in a patient with stage IV hepatocellular carcinoma. The patient came to hospital in July 2005 and was found to have a liver tumor; CT showed a 5-cm liver tumor and portal vein tumor thrombus, with no lymphatic metastasis. Diagnosed as T4N0M0 (stage 4A) hepatocellular carcinoma, the doctors thought there was no hope of treatment and recommended best supportive care, giving up all anti-cancer treatment.
In August, to improve symptoms, doctors gave the patient the patent medicine Buzhong Yiqi Tang granules. At follow-up in October, part of the tumor had disappeared, part had calcified, and the portal vein tumor thrombus had vanished. But a 2-cm tumor appeared in the left lobe of the liver. Treatment continued afterward, and the patient's condition achieved further remission.
This is a very typical cancer-treatment case in which TCM's Buzhong Yiqi Tang achieved good efficacy. Of course, some Western doctors attribute the disappearance of this patient's cancer focus to spontaneous remission. In judging the efficacy of Chinese medicine, many Western doctors show their bias and arrogance.
I recently treated a brain tumor patient whose tumor had compressed the brainstem to the point that he could no longer move normally and had to be monitored in the ICU. After taking the Chinese medicine I prescribed, the patient's symptoms improved markedly. The Western doctors treating him strenuously denied any role for the Chinese medicine in the treatment, attributing the effect to mannitol; the family also doubted the effect of the Chinese medicine.
But Western medicine had no good options for this patient. Later, after the patient left Western treatment and continued with Chinese medicine alone, improvements became more and more obvious; after about a month of treatment, he could even walk and eat. Only then did the family become convinced that the effect of the Chinese medicine on the patient had been the main one.
This kind of prejudice against TCM is widespread among many Western doctors educated in the modern system. Because modern medicine is dominated by Western medicine, their views also indirectly affect patients' and families' objective evaluation of TCM efficacy, and affect their correct decision-making about treatment plans.
Because for thousands of years TCM has occupied an important place in Japan's medical care, the Japanese still recognize the action of Kampo medicines. So this case of liver cancer treated with Buzhong Yiqi Tang was also objectively recognized by some Japanese doctors as a genuine effect of Kampo medicine.
Buzhong Yiqi Tang is a renowned formula created by Li Dongyuan, one of the four great masters of the Jin-Yuan period, and appears in his famous work Pi Wei Lun (Discussion of the Spleen and Stomach / Differentiation of Interior and Exterior Damage).
Buzhong Yiqi Tang is not only a classic formula for "supplementing the center and boosting qi, raising yang and lifting prolapse," but also a classic formula for "using sweet-warm to eliminate great heat." While supporting righteous qi, Buzhong Yiqi Tang also treats fever in deficient patients. When selected according to pattern, its effect is outstanding.
Buzhong Yiqi Tang is composed of Huangqi (Astragalus), Baizhu (Atractylodes), Chenpi (aged tangerine peel), Shengma (Cimicifuga), Chaihu (Bupleurum), Renshen (ginseng), Gancao (licorice), Danggui (Angelica), plus appropriate amounts of Dazao (jujube) and Shengjiang (ginger) when decocting.
In Li Dongyuan's Pi Wei Lun, the doses and decocting method of Buzhong Yiqi Tang are: Huangwu five fen (one qian for those with severe illness heat from labor), Zhi Gancao five fen, Renshen, Shengma, Chaihu, Jupi (i.e., modern Chenpi), Danggui-shen (wine-washed), Baizhu, each three fen. Crush the above herbs, make one dose, with two sheng of water, decoct to one sheng, strain, take warm after breakfast. For severe damage, two doses cure; treat according to severity.
Common modern doses as a decoction are: Huangqi 10-15 g, Renshen 6 g (or Dangshen 15 g), Chao Baizhu (fried Atractylodes) 6 g, Zhi Gancao 10 g, Chenpi 6 g, Shengma 6 g, Chaihu 6 g. For children, depending on age and weight, halve or use only one-third the adult dose. One dose per day, twice a day, morning and evening.
Li Dongyuan was the founding master of the TCM spleen-stomach (earth) school; in treating disease he emphasized protecting and regulating the spleen and stomach. The Pi Wei Lun is Li Dongyuan's breakthrough work, and Buzhong Yiqi Tang is its first formula, so this formula has had a great influence on later generations.
Even today, Buzhong Yiqi Tang is not only widely used in oncology (among root-supporting formulas in oncology, Buzhong Yiqi Tang accounts for a considerable proportion) but is also widely used for rectal prolapse, uterine prolapse, chronic diarrhea and dysentery, metrorrhagia, gastroptosis, chronic gastroenteritis, loose stools, myasthenia gravis, chronic hepatitis, chyluria, ptosis of the eyelid, fatigue and limp limbs, low voice and reluctance to move, restless fetus in pregnant women, and menorrhagia in women, among many other diseases.
The patent medicines Buzhong Yiqi Wan and Buzhong Yiqi granules, produced according to the Buzhong Yiqi Tang formula, are also commonly used. In Japan, Buzhong Yiqi Tang granules from major Kampo manufacturers can be seen everywhere. The patent medicine is cheap, portable, and easy to take, well suited to modern patients.
Buzhong Yiqi Wan also has very good efficacy. My teacher was once unwell for a time, with obvious center-qi deficiency, whole-body limp weakness, aching pain, and agitated mood. I suggested he use Buzhong Yiqi Wan; in less than a week, using Buzhong Yiqi Wan produced by Hubei Ruihua Pharmaceutical, he had very marked efficacy. I once gave Buzhong Yiqi Wan to a lymphoma patient with long-term low fever and fatigue; the patient's cancer fever and fatigue also eased, and with some additional anti-tumor formulas, the tumor was also brought under control.
No modern monograph on TCM anti-cancer treatment fails to mention Buzhong Yiqi Tang; among the root-supporting formulas that many TCM doctors specializing in clinical oncology use throughout their careers, Buzhong Yiqi Tang and its modifications account for over 20%. This may be because debility and low-grade fever are clinical symptoms widely present among cancer patients.
Buzhong Yiqi Tang contains both tonifying Renshen, Zhi Gancao, and Huangqi, and the exterior-releasing, fever-relieving Chaihu and Shengma; among them, Shengma has a typical center-raising action, and Chaihu in small doses also has a lifting effect, while Chaihu also soothes the liver and resolves stagnation. The formula also contains the mild qi-regulating herb Jupi, and ginger and jujube boost stomach qi. So it is especially suitable for patients with deficiency fever, spontaneous sweating, and depression. I myself have even tried using Buzhong Yiqi Tang to relieve depressive fatigue in depression patients, with some effect, but depression is hard to root out.
In the Pi Wei Lun, Li Dongyuan gave a detailed account of the original intent of formulating Buzhong Yiqi Tang. Li believed: "For those with spleen-stomach deficiency, because of diet and labor, heart-fire becomes exuberant and overacts on the earth position; next lung-qi is attacked. Huangqi must be used in the greatest amount, with Renshen and Gancao next. Once the spleen and stomach are deficient, lung-qi first collapses, so Huangqi is used to benefit the skin and hair and close the interstices, preventing spontaneous sweating that damages original qi. For panting and shortness of breath, Renshen supplements it. When heart-fire overacts on the spleen, the sweet-warm of Zhi Gancao is needed to drain fire-heat and supplement the spleen-stomach's original qi; if the spleen-stomach has urgent pain and great deficiency, with urgent contraction in the abdomen, use more. The Classic says: tighten things with relaxation. Baizhu is bitter, sweet, and warm, removing stomach heat and benefiting blood between the waist and navel. When the clear qi in the stomach is down below, one must add Shengma and Chaihu to lift it, leading the sweet-warm flavor and qi of Huangqi and Gancao upward; this can supplement the scattering of defensive qi and firm the exterior; it also relaxes the tight contraction of the belt vessel. These two are bitter and plain, thin in flavor, yang within yin, leading clear qi upward. When qi is chaotic in the chest, clear and turbid interfering, use white-removed Chenpi (i.e., Jupi) to regulate it; it also helps yang-qi rise to dispel stagnant qi, helping the sweet and acrids to act."
Li Dongyuan also gave methods for modifying Buzhong Yiqi Tang: "For dry mouth and dry throat, add Gegen (i.e., Kudzu, because Gegen stops thirst and generates fluids). If spleen-stomach qi deficiency cannot ascend and float, because yin-fire has damaged the hair-rising qi, nutritive blood is greatly deficient, nutritive qi does not nourish, yin-fire becomes exuberant—this is hidden fire in the blood, day by day simmering, blood and qi day by day decreasing. The pericardium and heart govern blood; when blood decreases, the heart has nothing to nourish it, causing heart chaos and vexation, a disease called man (melancholy/unease). Man means the heart is confused and troubled and restless, so add acrid-sweet slightly warm formulas to generate yang-qi; when yang is generated, yin grows. Some ask: how can sweet-warm generate blood? Answer: by Zhongjing's method, when blood is deficient, Renshen supplements it; when yang flourishes, it can generate yin-blood, and Danggui harmonizes it. Add a little Huangbai to rescue kidney-water; it can drain hidden fire within yin. If vexation still does not stop, add a little Shengdihuang (raw Rehmannia) to supplement kidney-water; when water flourishes, heart-fire of itself descends."
That is to say, Buzhong Yiqi Tang can also be modified according to the patient's concomitant symptoms. Patients with dry mouth and throat can add Gegen. Patients with heart chaos and vexation, and patients with depleted kidney-water, can add small amounts of Huangbai and Dihuang to drain fire and nourish yin.
Li Dongyuan's mother suffered from spleen-stomach disease, and Li Dongyuan himself was plagued by spleen-stomach disease all his life; even this great master ultimately died of illness from overwork plus chronic spleen-stomach disease. So his life can be said to have been spent most on spleen-stomach diseases. Buzhong Yiqi Tang is Li Dongyuan's pride; although, limited by his era, some statements in his discussion of this classic formula he created are not scientifically sound, the efficacy of this classic formula he discovered in practice is truly extraordinary.
Buzhong Yiqi Tang or Buzhong Yiqi Wan is also something I repeatedly use in clinical practice. As long as the pattern belongs to TCM's "center-qi collapse" and is accompanied by fever, irritability, dry mouth, dry throat, and other symptoms, all kinds of deficiency-type diseases can be treated by modifying and adapting Buzhong Yiqi Tang.