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Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Huangqi (Radix Astragali, one qian) Danggui (Radix Angelicae Sinensis) Renshen (Radix Ginseng) Zhi Gancao (Prepared Radix Glycyrrhizae) Chenpi (Pericarpium Citri Reticulatae) Shengma (Rhizoma Cimicifugae) Chaihu (Radix Bupleuri) Baizhu (Rhizoma Atractylodis Macrocephalae)

This formula was created by Li Dongyuan. It is a formula for treating internal injury diseases. In ancient formulas, only Huangqi (Radix Astragali) was used at one qian, while the other herbs were each used at three fen. Xue Lizhai commonly used Renshen (Radix Ginseng) and Huangqi (Radix Astragali) at one and a half qian each, Baizhu (Rhizoma Atractylodis Macrocephalae) at one qian, Danggui (Radix Angelicae Sinensis) at one qian, Chenpi (Pericarpium Citri Reticulatae) at seven fen, and Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) at five fen each. Adjusting and adding/subtracting according to the condition yields miraculous and infinite effects. If the disease is severe, Renshen (Radix Ginseng) and Huangqi (Radix Astragali) may be increased to three or five qian, added according to the syndrome. Generally, the Spleen and Stomach prefer sweet flavors and dislike bitter ones; they favor tonification and oppose purgation; they prefer warmth and dislike cold; they favor unblocking and oppose stagnation; they favor ascending and dislike descending; they prefer dryness and oppose dampness. This formula aligns with these preferences.

A question arose: Since ancient times, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) has been praised as an infinitely beneficial remedy for all generations. What is its rationale? The answer is: It elucidates insights not previously expressed by predecessors, continuing the traditions of Zhang Zhongjing and Liu Wan'er, with profound significance. When people see fever, they immediately attribute it to external pathogenic factors such as Wind-Cold, Summer-Heat, or Dampness, believing that pathogens can only be resolved through dispersing methods. However, they fail to accurately distinguish between Wind-Cold, Summer-Heat, and Dampness to apply targeted treatments. Instead, they universally use exterior-resolving formulas, such as Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction), Bai Du San (Detoxicate Powder), or Shi Shen Tang (Ten-God Decoction). Even worse, they indiscriminately combine formulas like Liang Ge San (Cool the Diaphragm Powder) and Bai Hu Tang (White Tiger Decoction), leading to many deaths. Li Dongyuan deeply lamented this harm and established this formula, based on the principle that "where pathogenic factors gather, Qi must be deficient." Internal injuries are common, while external invasions are occasional. Even when external pathogens exist, they enter due to deficiency. By tonifying the middle and augmenting Qi, pathogens naturally retreat without needing direct attack. Attacking pathogens would further weaken the already deficient state, leading to imminent danger. If there is an external invasion but the internal injury is mild, appropriate herbs can be added to this base formula, allowing external pathogens to recede spontaneously. This is akin to a benevolent army, invincible in the world. Regarding fevers caused by irregular diet and overexertion, where Yang Qi of the Stomach becomes deficient and sinks into the Yin level, this is a self-induced illness due to Yang deficiency. Misdiagnosing this as an external invasion and using dispersing methods exacerbates the deficiency, causing significant harm. There is another type of fever caused by internal injury to True Yin, which resembles internal injury to Yang Qi. This requires tonifying True Yin, not using Si Wu Tang (Four Substances Decoction) or Kan Li Wan (Kan-Li Pill); details are found in *Xian Tian Yao Lun* (Essential Discussion on Pre-Heaven). The Heart and Lung are located above, the Kidney and Liver below, while the Spleen and Stomach reside in the Central Region, acting as the masters of Qi for the four Zang organs. The formless Qi of the Middle Jiao steeps and decomposes food and drink, governing ascending, descending, exiting, and entering. This is Pre-Heaven Qi, which also serves as the master of the Spleen. Post-Heaven Spleen Earth cannot function without Pre-Heaven Qi. This formula addresses the situation where Qi, due to fatigue, sinks into the Kidney and Liver, preventing clear Qi from ascending and turbid Qi from descending. Therefore, Shengma (Rhizoma Cimicifugae) is used to guide Qi upward via the right axilla, and Chaihu (Radix Bupleuri) guides Qi upward via the left axilla. Without the efficacy of Renshen (Radix Ginseng) and Huangqi (Radix Astragali), the lifting power would be insufficient. Thus, this formula tonifies the Pre-Heaven within the Post-Heaven.

A question arose: I observe that you frequently establish theories based on Pre-Heaven and Post-Heaven. I examined the diagrams of Pre-Heaven and Post-Heaven in the *I Ching*, such as Qian in the South, Kun in the North, Li in the East, and Kan in the West. These trigram positions seem incompatible with medical theory, yet you discuss them incessantly. What is the meaning? The answer is: Your question is peculiar. By Pre-Heaven, I refer to a trace of formless Fire Qi. By Post-Heaven, I refer to the有形 (form) body, including Zang-Fu organs, flesh, blood, skin, and fluids like saliva and mucus. Since it is called Pre-Heaven, Heaven had not yet formed at that time, so how could there be a diagram of Qian in the South and Kun in the North? Question: Then why did Fuxi establish this diagram? Answer: This is not the Pre-Heaven diagram, but the Zhong Tian (Middle Heaven) Bagua diagram. Heaven is above, Earth is below, the sun rises in the East, water originates in the West, wind and rain are in the sky, mountains and thunder are underground, and humans and all things occupy the center. I once saw Shao Yong arrange it thus, with numbers for the Zhong Tian Bagua. Today, only Wen Wang's Post-Heaven diagram is used: emerging from Zhen, balancing with Xun, meeting at Li, serving at Kun, speaking joyfully at Dui, battling at Qian, laboring at Kan, and completing at Gen. It corresponds to the twelve hours of spring/autumn and day/night to determine Yin and Yang, decide life and death, and deduce astronomy, geography, astrology, medicine, and divination, all following this diagram. As for Pre-Heaven, it is formless and invisible, corresponding to the "Emperor" who emerges from Zhen in the *I Ching*. "Shen" (Spirit) refers to the spirit that wondrously creates all things. The Emperor and Spirit are what I call the True Lord and True Master in *Xian Tian Yao Lun* (Essential Discussion on Pre-Heaven). They are originally formless, but names were reluctantly assigned to serve as the substance governing Pre-Heaven and the function circulating in Post-Heaven. Mr. Li Dongyuan uniquely grasped this essence. In Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), he used Chaihu (Radix Bupleuri) and Shengma (Rhizoma Cimicifugae) precisely to ascend and generate Pre-Heaven Qi within Spleen Earth, truly benefiting all generations. Hence my earnest exhortations. Everyone knows the human body relies on the Spleen and Stomach, but Pre-Heaven, hidden in formlessness, is ignored by the world. Thus, after establishing *Xian Tian Yao Lun* (Essential Discussion on Pre-Heaven), in *Hou Tian Lun* (Discussion on Post-Heaven), I expounded on Li Dongyuan's *Pi Wei Lun* (Treatise on the Spleen and Stomach), emphasizing Pre-Heaven formlessness as the core. Readers of *Pi Wei Lun* (Treatise on the Spleen and Stomach), upon reaching the phrase "humans are born from the Qi of water and grain," will understand that Clear Qi, Ying (Nutrient) Qi, Wei (Defensive) Qi, Yuan (Original) Qi, Gu (Grain) Qi, and Chun Sheng (Spring Ascending) Qi are all aliases of Stomach Qi. Food entering the stomach is like grain in a pot; without fire, it does not cook. The Spleen transforms food entirely relying on the formless Shaoyang Ministerial Fire steaming and decomposing in the Lower Jiao. If cold-cooling herbs are used at this time, food and drink cannot be transformed. The fire in the Spleen and Stomach, the fire in Earth, corresponds to "Fire in the Furnace" in Na Yin. To maintain furnace fire, coal must be added frequently, keeping it warm with hot ashes so the fire energy remains. Once exposed to cold water, it becomes dead ash. How then can one steam and decompose food or light candles? All around is hellish scenery; one must beware! The Classics say: "For exhaustion, use warmth; for deficiency, use warmth." This takes the meaning of warming and nourishing.

Li Dongyuan said: Qibo stated that labor and fatigue cause decline in form and Qi, insufficiency of Grain Qi, failure of the Upper Jiao to function, and blockage of the lower stomach, leading to heat in the Stomach. This heat steams the chest, causing internal fever. *Ju Tong Lun* (Treatise on Pain) states: Labor causes Qi consumption. Labor leads to panting and sweating, with Qi escaping internally and externally, hence Qi consumption. Unregulated emotions, irregular living habits, and any labor injury damage Qi. Qi deficiency leads to Fire hyperactivity; Fire hyperactivity attacks Spleen Earth. Since the Spleen governs the limbs, one feels fatigued, weak, reluctant to speak, panting and exhausted during movement, with surface fever, spontaneous sweating, and restlessness. During illness, one should sit quietly to nurture Qi, use Sweet-Cold herbs to drain Fire-Heat, use Sour herbs to collect scattered Qi, and use Sweet-Warm herbs to tonify Middle Qi. The Classic saying "For exhaustion, use warmth; for deficiency, use warmth" applies here. *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: A normal person with a large pulse indicates labor; an extremely empty pulse also indicates labor. The disease of labor presents with a large pulse, vexatious heat in hands and feet, worsening in spring/summer, and improving in autumn/winter. It is treated with Huangqi Jianzhong Tang (Astragalus Decoctum Medium Decoction). This also reflects the intent of warming. Humans are born from the Qi of water and grain; Clear Qi, Ying (Nutrient) Qi, Yuan (Original) Qi, Wei (Defensive) Qi, and Chun Sheng (Spring Ascending) Qi are all aliases of Stomach Qi. The Stomach Qi is the sea of water and grain. Food enters the Stomach, floating and overflowing with essence, transported upward to the Spleen. The Spleen scatters essence, returning it upward to the Lung. The Lung regulates water passages, transporting downward to the Bladder. Water essence distributes in four directions, flowing through the five meridians, harmonizing with the four seasons, maintaining the balance of Yin and Yang in the five Zang organs. If diet is irregular, or cold/heat inappropriate, the Spleen and Stomach are injured. Joy, anger, worry, and fear deplete Original Qi. Spleen and Stomach Qi declines, Original Qi is insufficient, and Fire alone thrives. This Fire is Yin Fire, originating in the Lower Jiao, the thief of Original Qi. Vigorous Fire consumes Qi, while mild Fire generates Qi. Fire and Original Qi cannot coexist; if one wins, the other loses. Spleen and Stomach Qi deficiency allows Qi to flow downward to the Liver and Kidney, termed "Chong Qiang" (Heavy Strength). Yin Fire attacks the Earth position, initiating Spleen syndromes: high breathing and panting, body heat and vexation, a洪大 (Surging-Large) pulse with headache, or unquenchable thirst. The skin cannot withstand Wind-Cold, generating chills and fever. Because Spleen and Stomach Qi flows downward, Grain Qi cannot ascend and float, failing the command of Spring generation. Without Yang to protect Ying and Wei, one cannot withstand Wind-Cold, generating chills and fever. All these result from insufficient Spleen and Stomach Qi. However, this differs significantly from external Wind-Cold syndromes. Internal injury to the Spleen and Stomach damages Qi; external Wind-Cold damages Form. Damage to the exterior results in excess, which is purged; damage to the interior results in deficiency, which is tonified. Sweating, purging, vomiting, and attacking are purging methods; warming, harmonizing, regulating, and nourishing are tonifying methods. If an internal deficiency disease is mistakenly diagnosed as an external excess syndrome and treated with purgation, it further depletes deficiency. Depleting the deficient and reinforcing the excess leads to death; such deaths are murders committed by physicians. So what should be done? One must use Pungent-Sweet-Warm agents to tonify the middle and ascend Yang to achieve recovery. The Classics say: "For exhaustion, use warmth; for deficiency, use warmth." Also: "Warmth can eliminate great heat." Bitter-Cold herbs must be strictly avoided as they damage the Spleen and Stomach. Now, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is established. Whether due to irregular eating and labor, dietary imbalance, excessive physical exertion, labor after eating, or eating after labor, all constitute internal injuries. Once the Spleen and Stomach are deficient, Lung Qi is first severed. Therefore, Huangqi (Radix Astragali) is used to benefit the skin and hair and close the interstices, preventing spontaneous sweating that would damage Original Qi. For shortness of breath and panting, Renshen (Radix Ginseng) is used to tonify. When Heart Fire attacks the Spleen, Zhi Gancao (Prepared Radix Glycyrrhizae) is used for its sweetness to drain great heat and tonify Original Qi in the Spleen and Stomach. For acute abdominal pain and severe deficiency with abdominal contraction, it should be used in larger amounts. The Classic says: "For urgency, use relaxation." Baizhu (Rhizoma Atractylodis Macrocephalae) is Pungent-Bitter-Warm, clearing heat in the Stomach and benefiting blood in the waist and umbilical region. Since Clear Qi of the Stomach sinks below, Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) must be added to guide it, leading the Pungent-Sweet-Warm aromas of Huangqi (Radix Astragali) and Gancao (Radix Glycyrrhizae) upward. This can tonify dispersed Wei (Defensive) Qi and solidify the exterior. It also relaxes the tension of the Dai Mai (Girdle Vessel). Both herbs are Bitter-Ping, thin in flavor, Yang within Yin, guiding Clear Qi of the Stomach to ascend to the Yang pathways and the generating Qi of various meridians, nourishing the harmony of Spring Qi. When Qi is chaotic in the chest, with Clear and Turbid interfering, Chenpi (Pericarpium Citri Reticulatae) with the white pith removed is used to regulate it; as Clear ascends, Turbid descends spontaneously. Stomach Qi deficiency prevents ascending and floating; Yin Fire injures its generating Qi, causing severe depletion of Ying (Nutrient) Blood and failure of Ying Qi to nourish. Yin Fire flares up, burning day by day, reducing Blood and Qi daily. The Heart governs Blood; when reduced, the Heart lacks nourishment, causing chaos and vexation. Therefore, Danggui (Radix Angelicae Sinensis) is used to harmonize. If vexation persists, Dihuang Wan (Rehmannia Pill) is added to tonify Kidney Water; as Water flourishes, Heart Fire naturally descends. Palpating the body surface reveals heat indicating an exterior syndrome. Taking Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) for one or two doses induces slight sweating. This is not merely inducing sweat, but the natural sweating resulting from the harmony of Yin and Yang Qi.

If mental energy is short, double the dosage of Renshen (Radix Ginseng) and Wuzi (Fructus Schisandrae). For headache, add Manjingzi (Fructus Viticis). For headache with heavy phlegm, it is Taiyin Phlegm-Jue Headache; add Banxia (Rhizoma Pinelliae) and Tianma (Rhizoma Gastrodiae). For abdominal pain, add Baishao (Radix Paeoniae Alba). For aversion to cold and painful cold, add Guixin (Cortex Cinnamomi). For aversion to heat, preference for cold, and painful heat, add Huanglian (Rhizoma Coptidis). For abdominal pain with aversion to cold and a wiry pulse, Wood is overcoming Earth; Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment. Baishao (Radix Paeoniae Alba) is Sour, overcoming Wood within Earth as the sovereign herb. For a deep-thin pulse with abdominal pain, Lizhong Tang (Regulate the Middle Decoction) is the primary treatment. Ganjiang (Rhizoma Zingiberis) is Leaf-Hot, overcoming Water within Earth as the primary agent.

For pain below the navel, add Shudihuang (Prepared Radix Rehmanniae). If it does not resolve, it is severe Cold; add Rougui (Cortex Cinnamomi). Small abdominal pain often belongs to Kidney Qi Ben Tun (Rushing Pig); only Cinnamon drains Ben Tun, hence it is added. For hypochondriac pain or contraction under the ribs, add both Chaihu (Radix Bupleuri) and Baishao (Radix Paeoniae Alba). For heavy body and joint pain, or abdominal distension with spontaneous diarrhea, and a soggy-slow pulse, Dampness is excessive; Cangzhu (Rhizoma Atractylodis) and Houpo (Cortex Magnoliae Officinalis) are the primary treatments. For Wind-Dampness intertwining causing whole-body pain, add Qianghuo (Rhizoma Notopterygii), Fangfeng (Radix Saposhnikoviae), and Gaoben (Radix Ligustici Chuanxiong), prepared separately. Do not continue服用 after the disease resolves, as Wind herbs damage Human Original Qi.

In winter, if there is aversion to cold, fever, no sweat, and a floating-tight pulse, add Mahuang (Herba Ephedrae) and Guizhi (Ramulus Cinnamomi) to the base formula. (If Mahuang (Herba Ephedrae) is five fen, use Renshen (Radix Ginseng) and Huangqi (Radix Astragali) at one qian each.) In winter, if there is aversion to wind, fever, sweat, and a floating-slow pulse, add Guizhi (Ramulus Cinnamomi) and Baishao (Radix Paeoniae Alba). Shanghan (Cold Damage)必然 involves aversion to cold; Shangfeng (Wind Injury)必然 involves aversion to wind; Shangshi (Food Injury)必然 involves aversion to food. Shanghan aversion to cold is such that fierce fire cannot warm it, and heavy cotton cannot heat it. For internal injury, seeking warmth, wearing cotton, and applying warm fire removes the aversion. Internal injury from diet causes loss of taste and lack of desire to eat. In Shanghan, although one cannot eat, one still perceives taste. Labor-induced internal injury causes heavy body, tired limbs, painful joints, chest fullness, shortness of breath, and reluctance to speak. In contrast, Shanghan presents with headache in Taiyang, hypochondriac pain in Shaoyang, and eye pain in Yangming, unlike the lethargy and desire to lie down in internal injury. Shanghan fever feels like feathers brushing the skin, heat in the skin and hair. Internal injury fever is intense body heat, burning to the touch. The Right Qi Kou pulse is three times larger than the Left Ren Ying pulse. The Qi Kou pulse is urgent, large, and rapid, occasionally intermittent and choppy. Choppy is the native pulse of the Lung; intermittent indicates disconnected Qi, characteristic of Spleen-Stomach insufficiency. Large refers to Surging-Large; Surging-Large and rapid indicates Heart Fire punishing the Lung. Urgent means wiry-urgent, indicating Liver Wood accompanying Heart Fire to overcome Lung Metal. The Right Guan pulse belongs to the Spleen; among the five pulses, it is uniquely large and rapid, showing intermittence amidst rapidity. This suggests mild labor, irregular diet, improper cold/heat, damaging the Stomach pulse until it hides, revealing only the Spleen pulse. In external injury, the Ren Ying pulse is larger than the Qi Kou pulse.

Li Dongyuan described three methods of palpating heat. Light palpation reveals heat, heavy pressure reveals no heat: heat is in the skin and blood vessels. Heavy pressure between sinews and bones reveals steaming heat, light touch reveals no heat: heat is in the bone marrow. Light palpation reveals no heat, heavy pressure reveals no heat, but moderate pressure reveals heat: heat is above the sinews/bones and below the skin/flesh, i.e., in the muscles. Heat in the muscles is precisely the heat of internal injury from fatigue. For internal injury to True Yin, palpating heat has two types. Burning to the touch, feeling like roasting in the bones: True Yin deficiency in the Kidney. Burning to the touch, but feeling cold when pressing below the sinews/bones: True Yang deficiency in the Kidney. Red face indicates Yin excess below forcing Yang upward. Thirst indicates dried-up Kidney Water seeking self-rescue. Profuse expectoration of clear water-like phlegm indicates Kidney Water flooding upward as phlegm; mouth will not be thirsty. Expectoration of foamy phlegm indicates boiling water creating phlegm, burned by Yin Fire; mouth will be thirsty. Waist and hypochondriac pain indicate Kidney-Liver deficiency. Soles of feet burning like iron indicate exhaustion of Yongquan (KI1). Coldness below the knees indicates衰竭 of Mingmen (Gate of Life), leading to upper Qi panting. Chi pulse must be rapid: Yin Fire is vigorous. Rapid but forceless or nearly absent Chi pulse indicates True Yang decline. Bone pain like breaking indicates Kidney governs bones; bone decline allows Fire to prevail. This distinguishes Yang deficiency from Yin deficiency; within Yin deficiency, there are differences between True Yin and True Yang. Treatment methods are detailed in *Xian Tian Lun* (Discussion on Pre-Heaven).

A question arose: Zhu Danxi said people in the Southeast have Yang Qi that easily ascends and should not take Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Are people south of the Yangtze River truly all unsuitable for taking it? Answer: Here, Southeast refers to the Zang-Fu organs of people. The East belongs to the Liver, the South to the Heart. Those with Fire in the Liver and Heart should not take it, fearing Wood and Fire will become even more vigorous. If Huangdi asked questions about the four directions, and Qibo had abilities for four treatments, this refers to geographical positions. If one cannot take formulas for the Southeast, and the person has excess above, they must have deficiency below, with severe Kidney Qi deficiency. It is urgent to tonify the Pre-Heaven Original Qi of the North. In summary, Pre-Heaven and Post-Heaven cannot be strictly separated. Insufficiency of Yuan Yang in the Upper Jiao sinks into the Kidney; it should be taken from the lowest Yin. Insufficiency of True Yin in the Lower Jiao flies to the upper part; how can one not guide it back to its origin? Therefore, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is used together with Shenqi Wan (Kidney Qi Pill): morning dose tonifies Yang, evening dose tonifies Yin, mutually cultivating. The distinction of precedence and weight is known by the wise; no need for detailed explanation.

A question arose: In Shenqi Wan (Kidney Qi Pill), Dihuang (Radix Rehmanniae) is the sovereign. Does it risk clogging the diaphragm or harming the Spleen and Stomach?
Answer: Shenqi Wan (Kidney Qi Pill) contains only Kidmeridian herbs, with none mixed from the Spleen/Stomach meridian, entering the Kidney meridian directly. How could it clog the diaphragm? Medicines must clearly distinguish Yin/Yang and Water/Fire purity. Like the imperial court having six ministries, each has its affairs and personnel. Would you discuss tax collection with officials of the Heavenly Ministry? Question: If so, I mean the Kidney Water Ministry should not mix with the Spleen Household Ministry. Answer: By "not mixing," I mean Kidney Water herbs should not mix with Spleen Earth herbs; Spleen/Stomach herbs should not mix with Kidney herbs. For example, Sijunzi Tang (Four Gentlemen Decoction) is a Spleen meridian herb; mixing Dihuang (Radix Rehmanniae) into it causes clogging. Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) is a Kidney meridian herb; adding Renshen (Radix Ginseng) makes it mixed. Regarding Kidney and Spleen/Stomach, Earth and Water are originally one Qi. People know Earth as ground, but do not know Earth is also Water. From Heaven generating Water, where Water condenses, Earth begins. Solid Earth becomes Stone. After Kan (Water) in the Post-Heaven Bagua comes Gen (Mountain). Gen is Mountain and Earth; Gen Earth is Pre-Heaven Earth, the master within Water. Earth has no fixed position, parasitically growing with its mother, supplementing with its mother. Thus, to tonify Taiyin Spleen Earth, one must first tonify Shaoyang Ministerial Fire in the Kidney. If water and grain are in a pot, without fire underneath, they do not cook. Tonifying the Kidney means tonifying the Fire in the Kidney, requiring Bawei Wan (Eight-Ingredient Pill). Physicians who do not understand this and daily focus on Renshen (Radix Ginseng) and Baizhu (Rhizoma Atractylodis Macrocephalae) are not seeking the root. Earth's origin is Water. The world says tonifying the Kidney is better than tonifying the Spleen; I say tonifying the Spleen is better than tonifying the Kidney.