Li  Dong  Yuan  and  Bu  Zhong  Yi  Qi  Tang  

 

 

 

                       

 

 

 

 

Debbie  Yu  

Bastyr  University    

May  2013  

 

 

 

 

 

When  epidemic  disease  broke  in  the  Song  dynasty,  doctors  believed  their  army  

was  infected  by  exogenous  cold  pathogens,  as  described  by  the  Shang  Han  Lun.  

“Releasing  the  exterior”  through  diaphoretics,  emetics  and  laxatives  only  made  

situations  worse.  Li  Dong  Yuan  pinpointed  the  causal  root  as  deficiency  of  the  spleen  

and  stomach;  and  if  left  untreated,  yin  fire  would  rise.  This  pathology  is  similar  to  that  

of  autoimmune  diseases,  with  three  common  symptoms  of  fatigue,  fever,  and  general  

malaise.  A  base  formula  of  bu  zhong  yi  qi  tang  can  help  treat  the  root.  

We  receive  qi  from  water  and  grains  and  the  stomach  is  the  sea  of  water  and  

grains.  Together,  the  spleen  and  stomach  form  gu  qi.  This  gu  qi  is  a  vital  component  of  

all  other  forms  of  acquired  qi  -­‐  yuan  qi,  zong  qi,  ying  qi,  and  wei  qi.    

When  the  spleen  qi  is  deficient,  then  excess  pressure  is  put  on  the  yuan  

(original)  qi,  that  of  which  is  derived  from  jing  (essence).  When  there  is  poor  

nutrition,  or  when  food  cannot  be  processed  correctly,  inner  resources  are  consumed  

instead.  It  is  also  said  that  the  spleen  qi  ascends,  so  when  it  cannot  ascend,  it  will  

descend  down  to  the  kidneys,  overwhelming  the  kidneys  and  leading  to  yin  fire.  This  

yin  fire  and  the  yuan  qi  cannot  exist  simultaneously.    The  yuan  qi  loses,  and  this  

excess  burns  up  the  natural  yin  and  fluids.    

It  is  the  natural  tendency  of  fire  to  ascend.    With  no  root  below  now,  there  will  

be  cold  below  and  warm  above.  Signs  and  symptoms  may  include:  generalized  fever,  

irritability,  headache,  thirst,  aversion  to  wind  and  cold,  shortness  of  breath,  and  a  

large  surging  pulse.    

When  a  middle  jiao  deficiency  leads  to  such  cold  and  heat,  bu  zhong  yi  qi  tang  

is  indicated.  It  contains  acrid,  sweet,  and  warm  herbs  to  tonify  the  spleen  qi  and  

support  the  immune  system.  It  also  contains  a  couple  of  herbs  that  are  cool  (to  cool  

the  yin  fire)  as  well  as  upbearing  to  raise  the  yang.  

In  Western  medical  terminology,  this  could  apply  to  acquired  autoimmune  

conditions.  The  “inner  resources”  or  yuan  qi  corresponds  to  adrenal  energy.  Once  this  

runs  out,  one  acquires  adrenal  fatigue  or  possibly  adrenal  insufficiency  (the  yin  

depletes).  Soon  after,  one’s  condition  is  deemed  “autoimmune.”  It  should  also  be  

noted  that  women  tend  toward  autoimmune  diseases,  just  as  in  Chinese  medicine,  

women  tend  toward  yin  xu.    

Primary  adrenal  insufficiency  is  an  endocrine  disorder  where  the  adrenal  

glands  produce  insufficient  quantities  of  steroid  hormones.  80%  of  these  cases  are  

due  to  an  autoimmune  condition  called  Addison’s  disease.  Progression  is  often  slow,  

but  common  signs  and  symptoms  include:  fatigue,  muscle  weakness,  dizziness,  

hypotension,  fever,  nausea,  vomiting,  diarrhea,  poor  appetite,  cravings  for  salty  foods,  

and  low  tolerance  for  stress,  cold,  and  anxiety.      

A  milder  version,  termed  adrenal  fatigue,  is  not  yet  recognized  by  the  medical  

community,  but  exhibits  much  of  the  same  signs  and  symptoms.  The  patient  can  

produce  cortisol,  but  will  have  a  hard  time  maintaining  normal  levels.  

Hashimoto’s  thyroiditis  is  the  most  common  cause  of  hypothyroidism.  It  is  an  

autoimmune  disease  leading  to  inflammation  of  the  thyroid  gland.  The  etiology  (in  

Western  medicine)  of  Hashimoto’s  is  still  unknown  but  there  are  several  risk  factors  

or  associations  that  seem  to  correlate  -­‐  namely  genetics  and  being  a  middle-­‐aged  

female.  Other  risk  factors  include  smoking  and  history  of  any  other  autoimmune  

disease  such  as  type-­‐1  diabetes  or  Addison’s.  In  Traditional  Chinese  Medicine,  

lifestyle  and  diet  also  play  a  big  role.  Too  little  exercise,  too  much  stress  or  anxiety,  

consuming  too  much  sugar,  wheat,  raw,  and  cold  foods  can  all  contribute  to  the  

pathology.  

The  condition  may  be  asymptomatic  in  the  early  stage.  As  it  progresses,  signs  

and  symptoms  are  the  same  as  hypothyroidism,  but  there  may  also  be  bouts  of  

hyperthyroidism.  Signs  and  symptoms  include:  fatigue,  depression,  mania,  weight  

gain,  goiter,  sensitivity  to  cold  and  heat,  constipation,  body  aches  and  pain,  muscle  

cramps,  migraines,  panic  attacks,  bradycardia,  tachycardia,  and  menorrhagia.  

For  both  these  situations,  there  seems  to  be  a  mixed  pattern  of  SP/KID  yang  xu  

and  yin  xu  heat  above.  Therefore,  bu  zhong  yi  qi  tang  may  be  used  as  the  base  formula.    

Multiple  sclerosis  (MS)  is  yet  another  autoimmune  condition  affecting  the  

central  nervous  system.  In  Western  medicine,  the  etiology  and  pathogenesis  is  not  

clear,  but  viral  infections,  genetics,  and  environmental  factors  may  contribute.  MS  

patients  can  experience  virtually  any  neurological  symptom.  These  may  include:  

parasthesia,  muscle  weakness,  visual  problems,  dizziness,  hearing  loss,  sexual  

dysfunction.  Fatigue  (esp.  in  the  late  afternoon)  and  chronic  pain  are  also  common.  In  

practice,  as  TCM  practitioners,  our  goal  is  to  control  the  severity  of  current  relapses,  

but  ultimately  prevent  them  from  occurring  in  the  first  place.  Common  triggers  

include:  viral  infections,  fever,  stress,  spring  and  summer  time  of  the  year.  Also,  

geographically,  there  is  a  significant  increase  of  diagnoses  in  the  Pacific  Northwest.  

In  TCM,  though  we  learn  a  list  of  differentials,  as  we  also  know,  most  patients  

have  a  mixed  pattern.  From  Li  Dong  Yuan,  all  pathologies  originate  from  the  SP/ST.  

Patients  living  in  the  North  already  have  a  predisposition  to  the  disease.  The  cold  

(and  damp)  accumulate,  weakening  the  middle  jiao.  The  pathology  is  similar  to  that  

as  descried  above.  Eventually  the  adrenal  energy  burns  out  and  the  yin  fire  rises.    

The  myelin  sheath  is  a  fatty  insulation  for  the  nerves.  It  is  nourishment,  thus  it  

is  yin  material.  It  is  composed  of  water,  lipids  and  proteins,  thus  it  is  the  product  of  

the  spleen’s  ability  to  transform  nutrients  and  transport  water  and  nutrients  to  the  

tissues  of  the  body.  The  spleen  also  dominates  the  muscles,  providing  them  adequate  

nutrients  and  qi.    

Relapses  often  occur  in  the  spring  and  summer.    In  yin  xu  patients,  there  is  no  

yin  to  anchor  the  yang,  so  it  rises.  This  is  felt  in  the  pulse;  it  will  be  floating.  In  the  

wintertime,  the  yin  should  be  dominant  and  the  pulse  should  be  deep.  If  this  is  not  the  

case,  and  the  pulse  is  indeed  floating  even  in  the  winter,  then  come  springtime,  when  

the  natural  tendency  is  for  the  yang  to  rise,  any  excess  trigger  will  cause  a  relapse.  

The  yang  nature  of  spring  will  aggravate  the  yin  fire  and  overwhelm  the  patient.    

In  these  cases  of  MS,  bu  zhong  yi  qi  tang  is  again  indicated.  The  middle  jiao  

herbs  –  dang  shen,  bai  zhu,  gan  cao,  and  huang  qi  –  help  the  spleen  transform  and  

transport  nutrients  and  fluids  in  order  to  build  and  maintain  the  myelin  sheath  and  

other  yin-­‐fluid  products.  Dang  gui,  a  blood  tonic,  supports  this  function  as  blood  and  

yin  come  from  the  same  source.  The  cooling  and  ascending  herbs  –  sheng  ma  and  chai  

hu  –  help  cool  the  yin  fire  that  is  ascending  (sheng  ma  is  black  cohosh,  used  in  natural  

medicine  to  remedy  menopausal  symptoms).  Huang  qi  also  ascends  the  clear  yang  of  

the  spleen  and  stomach  and  stabilizes  the  exterior,  or  helps  the  immune  system  to  

prevent  a  viral  infection  or  common  cold  from  triggering  another  relapse.    

Always  look  at  patient  history  to  discover  the  true  pathology;  otherwise  

current  signs  and  symptoms  will  only  lead  one  to  “chase  the  dragon’s  tail.”  Through  

this,  Chinese  medicine  can  be  a  great  adjunct  in  treating  chronically  diseased  patients  

and  improve  their  overall  quality  of  life.    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resources  

"Adrenal Insufficiency and Addison's Disease." National Endocrine and Metabolic Diseases Information Service. Ed. Karen Loechner. U.S. Department of Health and Human Resources, May 2009. Web. 10 Dec. 2012. <http://www.endocrine.niddk.nih.gov/pubs/addison/addison.aspx>.

Cheng, Xinnong, and Liangyue Deng. Chinese Acupuncture and Moxibustion. Beijing:

Foreign Language, 1999. Print. Cheng, Xinnong, and Liangyue Deng. Chinese Acupuncture and Moxibustion. Beijing: Foreign Language, 1999. Print.

Li, Dong-Yuan. The Treatise on the Spleen and Stomach: A Translation of the Pi Wei Lun. Trans. Shou-zhong Yang. 2nd ed. Colorado: Blue Poppy, 2004. Print.

Mayo Clinic Staff. "Hashimoto's Disease." MayoClinic.com. Mayo Clinic, 3 Feb. 2011.

Web. 10 Dec. 2012. <http://www.mayoclinic.com/health/hashimotos-disease/DS00567>.

"Multiple  Sclerosis."  WebMD.com.  WebMD,  n.d.  Web.  10  Dec.  2012.   Townsend, Peter, and Will Maclean. "Ginseng & Astragalus Combination (Bu Zhong Yi

Qi Tang)." Acupuncture.com. Acupuncture.com, n.d. Web. 10 Dec. 2012. <http://www.acupuncture.com/herbs/buzhongyi.htm>.