Within the Chinese medical journal literature there are several different genres of articles. One of these is the "new uses" genre. In this type of essay, the author takes an ancient or classical formula and present several case histories exemplifying new uses of this formula. From a Western medical perspective, these would be called "off-label" uses. This is the use of a formula for a disease or disorder for which this formula is not standardly indicated. This is an example of the basic dictum of professional Chinese medicine, "Treatment is based on pattern discrimination (bian zheng lun zhi)." In other words, although a formula may not be normally indicated for the treatment of this or that disease, if the patient's pattern fits the formula's pattern discrimination, then the formula may be used, all be it with appropriate additions and subtractions. This genre of article underscores the fundamental, over-riding importance of basing a patient's treatment primarily on their pattern discrimination and not simply or even primarily on their disease diagnosis.

Below is a summary of three case histories taken from an article titled, "New Uses of Bu Zhong Yi Qi Tang," by Qiu Li-ming appearing in Si Chuan Zhong Yi (Sichuan Chinese Medicine), #6, 2000, p. 57. Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) is one of the famous Jin-Yuan Dynasty doctor, Li Dong-yuan's most famous formulas. It is comprised of Radix Astragali Membranacei (Huang Qi), Radix Panacis Ginseng (Ren Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Angelicae Sinensis (Dang Gui), Rhizoma Cimicifugae (Sheng Ma), Pericarpium Citri Reticulatae (Chen Pi), Radix Bupleuri (Chai Hu), and mix-fried Radix Glycyrrhizae (Gan Cao). This formula banks and supplements the spleen and stomach, supplements the center and boosts the qi, upbears yang and lifts the fallen. It treats all conditions of spleen-stomach qi vacuity with clear yang falling down. However, as originally conceived by Li Dong-yuan, it also sweetly and warmly clears qi vacuity heat or yin fire via upbearing and out-thrusting. In addition, based on an analysis of its individual ingredients, it supplements the spleen and boosts the qi, courses the liver and rectifies the qi. Therefore, for those who truly understand this formula, its scope of application is much greater than qi vacuity downward falling conditions.

The patient was a 34 year old male cadre who was first examined on Oct. 25, 1998. The man had had recurrent oral ulcers for five years. For the last two months, the number of these oral sores had increased and they were both burning hot and peppery painful. Due to this, the man was not able to eat. The patient had already taken various Chinese medicinals to clear heat and drain fire as well as vitamin B complex and several Western medicines, all without effect. Accompanying the oral sores were venter and abdominal glomus and fullness, torpid intake, loose stools, lassitude of the spirit, lack of strength, a dry throat, somnolence, a pale, fat tongue with teeth-marks on its edges and thin, white fur, and a deep, fine, rapid pulse. On examination, there were ulcers on the man's upper and lower lips and the mucus membranes on both sides of his cheeks. The tip of his tongue also had many ulcerated sores whose bases were concave and depressed. The color of these sores was ashen white, and pressure pain was pronounced.

Based on the above signs and symptoms, the man's pattern was categorized as spleen-stomach vacuity weakness with clear yang not being upborne and yin fire ascending and flaming, steaming and burning the mouth and tongue. Thus treatment should supplement the center and boost the qi, subdue and downbear yin fire. The formula used was Bu Zhong Yi Qi Tang with additions and subtractions: Radix Astragali Membranacei (Huang Qi), 30g, Radix Codonopsitis Pilosulae (Dang Shen) and Rhizoma Atractylodis Macrocephalae (Bai Zhu), 15g each, Rhizoma Cimicifugae (Sheng Ma), Radix Bupleuri (Chai Hu), Herba Lophatheri Gracilis (Dan Zhu Ye), and Fructus Evodiae Rutecarpae (Wu Zhu Yu), 10g each, Pericarpium Citri Reticulatae (Chen Pi) and mix-fried Radix Glycyrrhizae (Gan Cao), 6g each, and Cortex Cinnamomi Cassiae (Rou Gui), 3g. After administering seven ji of this formula, the ulcers had shrunk and become smaller and eating was no longer painful. All the man's symptoms were greatly reduced. Ten more ji were administered continuously and the ulcers were cured as well as all other symptoms. On follow-up in 2000, there had been no recurrence.

Comment: According to Chinese medical theory, the spleen opens into the orifice of the mouth, and oral cavity ulcers and sores are mostly due to heart-spleen brewing heat or yin vacuity fire effulgence. In this case, there was spleen-stomach qi vacuity with clear yang not being upborne. Thus yin fire was taking advantage of spleen-stomach vacuity and flaming upward. This was then steaming and burning the mouth and tongue, hence producing the sores and ulcers. This is as Li Dong-yuan said in the Pi Wei Lun (Treatise on the Spleen & Stomach):

In terms of the spleen and stomach's production of yin fire, the grain qi becomes blocked and obstructed and pours downward. The clear qi is not upborne and this results in the nine orifices becoming inhibited.

Normally, one uses either bitter cold medicinals to drain fire or sweet, cold medicinals to downbear fire. However, in this case, either of these would further harm the central qi, thus further aggravating yin fire. This is why the previous treatments had not been effective. Instead, the author of this case used Bu Zhong Yi Qi Tang to supplement the center and boost the qi and, therefore, regulating the mechanisms of upbearing and downbearing. Once the spleen recovered its fortification and movement, clear yang ascended and was upborne, yin fire was hidden and stored, and all the symptoms were automatically cured.

The patient was a 29 year old female teacher who was first examined on Dec. 2, 1997. This woman had caught cold two years earlier after having given birth and had lost her regular nourishment. This resulted in the emission of chill in both her lower extremities. Initially this was not serious. However, during the last year, this condition had gradually worsened to the point that all four limbs emitted chill. This was especially bad during the cold and chilly seasons. The woman had already seen several doctors and had been diagnosed with cold lodged in her blood vessels resulting in uneasy flow of the qi and blood. For this, she had been given yang-warming, cold-scattering, blood-quickening, and network vessel freeing Chinese medicinals, after which there was slight improvement. The coldness and chilling were most severe below her elbows and knees. Her facial complexion was lusterless, and her stools were loose. Intake was torpid, there was bodily fatigue, and she lacked strength. The use of her body and limbs was normal, and there was no numbness, pain, or itching. Her tongue was pale with thin, white fur, and her pulse was deep and fine.

Based on the above signs and symptoms, the patient's Chinese medical pattern was categorized as middle burner vacuity cold with spleen qi unable to upbear, emit, and spread clear yang to the four extremities. The treatment principles were to supplement the center and boost the qi, upbear and emit clear yang. The formula used was Bu Zhong Yi Qi Tang with added flavors: Radix Astragali Membranacei (Huang Qi), 50g, Radix Codonopsitis Pilosulae (Dang Shen), 30g, Radix Angelicae Sinensis (Dang Gui), Rhizoma Atractylodis Macrocephalae (Bai Zhu), and Ramulus Cinnamomi Cassiae (Gui Zhi), 15g each, and Rhizoma Cimicifugae (Sheng Ma), Radix Bupleuri (Chai Hu), Pericarpium Citri Reticulatae (Chen Pi), dry Rhizoma Zingiberis (Gan Jiang), and mix-fried Radix Glycyrrhizae (Gan Cao), 6g each. Ten ji of these medicinals were administered orally, after which her four limbs were already warm, her intake of food had improved, and her loose stools had disappeared. Therefore, these same medicinals were administered for another half month when all her symptoms were eliminated. On follow-up after one year, there had been no recurrence.

Comment: According to Chinese medical theory, the four limbs are governed by tai yin spleen earth. This case was one of middle burner vacuity cold with spleen qi falling downward. Hence the spleen was unable to upbear and emit clear yang and spread it to the four extremities. This resulted in emission of chill in the four limbs. Therefore, Bu Zhong Yi Qi Tang was used in order to supplement the center and boost the qi, thus promoting fullness and sufficiency of the spleen qi. The yang qi became effulgent and exuberant, the light of yang was able to shine in all directions, and yin chill was automatically scattered. This effect was increased by the addition of dry Ginger and Cinnamon Twigs which warm the center and invigorate yang, warm and free the flow of the blood vessels. Hence cold qi was eliminated and the treatment effect was good.

In actual fact, the symptoms of spleen qi downward fall were, in this case, minimal - really only the loose stools. This shows that this formula has a greater scope of application than spleen qi downward fall conditions. It can be used for simple spleen qi vacuity weakness, even though modern Chinese authors typically feel compelled to talk about upbearing the clear and lifting the fallen whenever discussing this formula.

The patient was a 30 year old female cadre who was first examined on Mar. 5, 1998. One year previously she had caught cold after giving birth. This had resulted in her leaking urine whenever she coughed. Initially this was not severe, and she did not seek treatment for it. However, two months ago, this condition had become more pronounced and her urination had become incontinent. Whenever the patient was fatigued, this incontinence was worse. Other symptoms included low back soreness, weak lower limbs, lassitude of the spirit, shortness of breath, dizziness, blurred vision, occasional venter and stomach distention and fullness, a fat body, a pale red tongue which was also slightly fat with thin, white fur, and a vacuous, fine, forceless pulse.

Based on these signs and symptoms, the woman's Chinese medical pattern was categorized as spleen-kidney qi vacuity with the bladder not doing its duty. The treatment principles were to supplement the center and boost the qi, regulate the qi, secure and gather. The formula used was modified Bu Zhong Yi Qi Tang: Radix Astragali Membranacei (Huang Qi), 30g, Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), and Radix Angelicae Sinensis (Dang Gui), 20g each. Pericarpium Citri Reticulatae (Chen Pi), Rhizoma Cimicifugae (Sheng Ma), Radix Bupleuri (Chai Hu), and Cortex Eucommiae Ulmoidis (Du Zhong), 10g each, Fructus Corni Officinalis (Shan Zhu Yu), 15g, and Ramulus Cinnamomi Cassiae (Gui Zhi) and mix-fried Radix Glycyrrhizae (Gan Cao), 6g each. After taking 10 ji of this formula, the urinary incontinence disappeared. This prescription was then administered for another month, after which all her symptoms disappeared. On follow-up after two years, there had been no recurrence.

Comment: According to the Su Wen (Simple Questions):

The bladder holds the office of the river island which stores fluids and humors. When its qi transforms, [fluids] are able to exit.

The basic disease mechanism of urinary incontinence is inhibition of the bladder qi's transformation. In this case, it was due to spleen-kidney qi vacuity lacking strength to gather the fluids. Hence, the bladder qi was not able to control the urinary tract and urine easily exited. As it is said in the Ling Shu (Spiritual Axis): "When the central qi is insufficient, urination and defecation change [i.e., become abnormal]." When the spleen qi is full and sufficient, the bladder's qi transformation function is normal. This is based on the fact that the latter heaven spleen and former heaven kidneys mutually promote and reinforce each other. Disease of the one typically eventually reaches the other. Therefore, Bu Zhong Yi Qi Tang is a commonly used formula for the treatment of spleen-kidney dual vacuity where spleen vacuity is more pronounced than kidney vacuity. In that case, kidney-supplementing medicinals are added to this formula as in the above case.

Due to the prevalence of spleen vacuity, or more accurately liver-spleen disharmony, among Western patients seeking treatment with Chinese medicine, Bu Zhong Yi Qi Tang is one of the five most common guiding formulas I prescribe. As the above cases illustrate, this formula treats more than just downward fall of the central qi resulting in prolapse of the stomach, intestines, uterus, and bladder. With the proper modifications, it can be used to treat a wide variety of conditions where spleen qi vacuity is the most prominent pattern present.