Clinical Application and Differentiation Diagnosis of Bu Zhong Yi Qi Tang
By Hongru Wei, LAc, DACM
Bu Zhong Yi Qi Tang (henceforth shortened as BZYQT) is translated in English as "Tonify the Middle and Augment the Qi Decoction." It boosts the middle burner and benefits the qi by nourishing liver and spleen; and also raises and lifts clear yang qi. This formula is used for three major patterns. Let’s review three case studies that successfully implemented BZYQT in treating each of these types of patterns. 3 Patterns BZYQT Can Address The first pattern BZYQT can address is an inability to raise clear qi caused by spleen and stomach deficiency. Patients might present with one or more of the following: dizziness, deafness, shortness of breath, pale complexion, low appetite, or loose stool. The second pattern is qi deficiency fever. Patients experience occasional fever that worsens up exertion, spontaneous sweating, with a pale and puffy tongue. The third pattern is sinking of the middle qi. Patients show symptoms that might include spotting, hemorrhoids, irregular uterine bleeding, organ prolapse, and/or a pale tongue with a weak and soft pulse.
Case #1: Nausea and Anxiety The patient is a 17-year-old Caucasian teenager with a chief complaint of nausea and anxiety for three years. She feels periodic nausea that triggers her anxiety and heart palpitation. She has low appetite and lightheadedness; and an aversion to cold. At her first visit, she has a very pale complexion and talks in a low voice. Her upper stomach is distended with a hard muscle knot above her umbilicus and her stomach feels cold to the touch. Her tongue is puffy with a pale coating, and her pulse is deep and thin. The TCM diagnosis in this case is spleen and stomach deficiency. The spleen in Chinese medicine directs clear qi upward to moisten the lungs, and gathers chest qi to form blood in the heart and nourish orifices. - 1 - Spleen qi deficiency leads to impairment of transportation and transformation, and causes indigestion. Acupuncture is suggested to her twice a month with the herbal formula BZYQT. Acupuncture points included Ren 12, ST 36, PC 6, ST 25, SP 3, SP 10 and LI 10, with indirect moxa over each point until the patient feels a warm sensation on each acupuncture point. Patient recalls that her nausea is gone after her first acupuncture treatment. After one dose of BZYQT, she says she got a burst of energy and doesn’t feel any lightheadedness or other symptoms for the rest of the day. After taking five doses of the decoction, she reports that all the symptoms disappeared, and that she feels more energy with socializing and is not concerned if she might suffer an anxiety attack.
Case #2: Skin Itchiness The patient is a 57-year-old Asian female who has noticed skin itchiness and irritation after showering for about 10 years. The itchiness and irritation normally take 10 to 20 minutes to fade away and she denies any allergies. She has a difficult time falling asleep and frequently wakes up during the night. She notices her body is easily bruised and her limbs are heavy. Sometimes she feels nausea after meals. She often feels tired. Her tongue is puffy with a thick yellow coating. Her pulse is slippery and rapid. Her TCM diagnosis is spleen qi deficiency with damp heat. The ascending of spleen qi brings purifying fluid to the heart and lungs, while the descending of stomach qi eliminates waste to the intestines. If the ascension of spleen qi is impaired, an overabundance of fluid would damage the middle burner and cause dampness and phlegm accumulation. Congealed phlegm causes internal heat, which can dry body yin and general wind. Wind is the backbone of many itchy skin conditions from a TCM perspective. Jeong, et al. (2019), mention that BZYQT suppresses serum immunoglobulin E (IgE) levels and eosinophil infiltration to treat allergic reaction; and that this formula also has antioxidant function on the skin. This patient with skin itchiness immediately noticed that her skin condition improved after taking five doses of BZYQT. She has more energy and better focus. Her skin itchiness disappeared after two weeks of taking BZYQT.
Case #3: Irregular Uterine Bleeding The patient is a 31-year-old Asian mother with two children. She has experienced irregular uterine bleeding for more than six weeks. She describes her menstrual blood color to be bright red and blood volume as very heavy. She feels low energy and a lack of attention span. Unfavorable bleeding interferes her daily life and she feels very stressed. Her complexion is pale and dull. She is underweight. Her extremities are cold. Her pulse is deep and weak. Her TCM diagnosis is spleen deficiency and qi sinking. Spleen qi ascends to send qi above and plays an important role in holding blood in the vessels. Impairment of spleen function leads to qi sinking and manifests as abnormal uterine bleeding, hemorrhoids and organ prolapse. For a few months, this patient is prescribed two doses of BZYQT every day and acupuncture twice a month. Acupuncture points are PC 6, ST 36. Ren 12, Ren 4, ST 25, SP 15, SP 6, Yintang, and Du 20. She stops bleeding after her third visit of acupuncture. Her energy level has increased since she started this formula and she feels more relaxed.
Resources:
Maciocia G. The Foundations of Chinese Medicine. A Comprehensive Text for Acupuncture and Herbalists, 2nd Edition. Elsevier, 2005.
Jeong M, Kim Y, Kim A,et al. The herbal drug, Bu-Zhong-Yi-Qi-Tang, for treatment of atopic dermatitis. Protocol for a systematic review. Medicine, 2019 Jan;98(1):e13938.
Scheid V, Bensky D, Ellis A, Barolet R. Chinese Herbal Medicine Formulas & Strategies. 2nd Edition. USA: Eastland Press, 2009.
Dr. Hongru Wei is a New York State- and New Jersey State-licensed Acupuncturist and a board-certified herbalist. She graduated from PCOM (now PCHS) with a Master of Science in Traditional Oriental Medicine and a Doctorate in Acupuncture and Chinese Medicine. She also graduated from Heidelberg University (Tiffin, Ohio) with a Master of Arts in Education. Dr. Wei specializes in pain management, headaches, allergies, sleep disturbances and digestive problems. She is extremely interested in treating patients with neurological and psychological issues.
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