Anosmia

Keywords: Chinese medicine, Chinese herbal medicine, Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction)

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In Chinese medicine, treatment is primarily based on each patient's personally presenting pattern(s) and only secondarily on their disease diagnosis. Therefore, patients with completely different diseases may receive basically the same or similar treatment if the Chinese medical patterns they present are the same. Thus a single Chinese medical formula for the treatment of a single pattern may be used clinically to treat a large variety of Western medical diseases. Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) is a formula created by Li Dong-yuan in the Yuan dynasty approximately 800 years ago. It is one of the most commonly prescribed herbal formulas within Chinese medicine. It is for spleen qi vacuity with or without central qi downward falling. It may also be used for a liver-spleen disharmony depending on the dose of Chai Hu (Radix Bupleuri). The following case histories give some example of the broad scope of application of this famous formula as well as the prescriptive methodology of professional Chinese medicine. These cases have all been taken from recently published Chinese medical journals.

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On pages 41-42 of issue #12, 2004 of Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), Meng De-ying and Zhao Xiao-juan published an article titled "Clinical Uses of Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction)" which consisted of four cases histories of the successful use of Bu Zhong Yi Qi Tang.

Case 1: Oral apthae

The patient was a 35 year-old male who was initially examined by the authors on April 5, 1996. The patient complained of recurrent oral apthae for the last six years. For the last two years, these had persisted insidiously without ever healing. The patient's body was emaciated and he had a lusterless facial complexion. His intake was torpid and his stools were loose. In addition, his tongue was pale red and fat with teeth-marks on its edges. His pulse was deep and fine. Based on the foregoing, his Chinese medical pattern was categorized as spleen-stomach qi vacuity with middle burner vacuity cold. The treatment principles were to fortify the spleen, supplement the qi, and warm the middle, for which the following modification of Bu Zhong Yi Qi Tang was prescribed:

Huang Qi (Radix Astragali Membranacei), 30g

stir-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae), 15g

Sheng Ma (Rhizoma Cimicifugae), 6g

Chai Hu (Radix Bupleuri), 10g

Dang Shen (Radix Codonopsitis Pilosulae), 12g

Gui Zhi (Ramulus Cinnamomi Cassiae), 10g

Chen Pi (Pericarpium Citri Reticulatae), 10g

Gan Cao (Radix Glycyrrhizae Uralensis), 6g

Da Zao (Fructus Zizyphi Jujubae)

Sheng Jiang (uncooked Rhizoma Zingiberis Officinalis), undisclosed amounts

After taking five packets of the above medicinals, the man's oral sores were healed.

Case 2: Small lobe mammary hyperplasia

The patient was a 37 year-old female worker who was initially examined by the authors in October of 1999. This woman had had recurrent premenstrual breast distention and pain for the last two years which spontaneously remitted after each menstruation. The patient had already been treated with liver-coursing, depression-resolving formulas, such as Xiao Yao San (Rambling Powder) and Chai Hu Shu Gan San (Bupleurum Course the Liver Powder), but without good effect. When examined, bilateral mammary hyperplasia was palpable along with marked pressure pain. Mammography confirmed the diagnosis of bilateral small lobe mammary hyperplasia. Therefore, the woman was treated with the following modification of Bu Zhong Yi Qi Tang:

Huang Qi (Radix Astragali Membranacei), 30g

Dang Shen (Radix Codonopsitis Pilosulae), 15g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 15g

Sheng Ma (Rhizoma Cimicifugae), 6g

Chai Hu (Radix Bupleuri), 12g

Dang Gui (Radix Angelicae Sinensis), 12g

Bai Shao (Radix Albus Paeoniae Lactiflorae), 15g

Chi Shao (Radix Rubrus Paeoniae Lactiflorae), 12g

Yan Hu Suo (Rhizoma Corydalis Yanhusuo), 15g

Chuan Lian Zi (Fructus Meliae Toosendam), 10g

Wang Bu Liu Xing (Semen Vaccariae Segetalis), 10g

Gan Cao (Radix Glycyrrhizae Uralensis), 6g

After taking 12 packets of these medicinals, the patient was cured.

Case 3: Dizziness

The patient was a 21 year-old female who was initially seen by the authors on May 3, 2000. The patient had experienced dizziness, impaired memory, insomnia, fatigue, and lack of strength for two months. Her facial complexion was somber white. She also had scanty qi, disinclination to speak and/or a faint, weak voice, a pale tongue with thin, white fur, and a fine, forceless pulse. Therefore, her pattern was assessed as central qi insufficiency with lack of nourishment of the brain and orifices, for which she was prescribed the following version of Bu Zhong Yi Qi Tang:

Huang Qi (Radix Astragali Membranacei), 30g

Dang Shen (Radix Codonopsitis Pilosulae), 12g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 15g

Sheng Ma (Rhizoma Cimicifugae), 10g

Chai Hu (Radix Bupleuri), 12g

Dang Gui (Radix Angelicae Sinensis), 10g

stir-fried Suan Zao Ren (Semen Zizyphi Spinosae), 15g

Yuan Zhi (Radix Polygalae Tenuifoliae), 12g

Long Yan Rou (Arillus Euphoriae Longanae), 10g

Yan Hu Suo (Rhizoma Corydalis Yanhusuo), 10g

Chen Pi (Pericarpium Citri Reticulatae), 10g

Gan Cao (Radix Glycyrrhizae Uralensis), 6g

One packet of these medicinals was decocted in water and administered per day. After two continuous weeks of administration, the patient was cured.

Case 4: Urinary syncope

The patient was a 47 year-old male who was first examined by the authors on August 11, 1998. Twice in the recent past the patient had suddenly felt dizzy and fainted after urinating. The man's local hospital had diagnosed this condition as urinary syncope and had attempted to treat him with a variety of "nerve" drugs administered orally, but none of these had been effective. When examined by the Chinese medical practitioners, this man's facial complexion was sallow yellow and lusterless. His affect was poor and he was fatigued and without strength. His tongue was pale with thin fur and his pulse was deep and forceless. Therefore, his Chinese medical pattern was described as central qi downward falling with qi following the urine's desertion, thus causing dizziness and reversal or inversion. The man was prescribed the following version of Bu Zhong Yi Qi Tang:

Huang Qi (Radix Astragali Membranacei), 50g

Ren Shen (Radix Panacis Ginseng), 9g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 15g

Sheng Ma (Rhizoma Cimicifugae), 10g

Chai Hu (Radix Bupleuri), 12g

Dang Gui (Radix Angelicae Sinensis), 12g

Chen Pi (Pericarpium Citri Reticulatae), 10g

Gan Cao (Radix Glycyrrhizae Uralensis), 6g

After taking 14 packets of the above medicinals, the patient was cured.

On page 11 of issue #9, 2004 of Gan Su Zhong Yi (Gansu Chinese Medicine), Gu Ju-qing published an article titled, "New Uses of Bu Zhong Yi Qi Tang," which was comprised of two case histories using this famous formula.

Case 5: Loss of smell

The patient was a 40 year-old female who had suffered from anosmia for 20 days after catching a cold. This woman had previously been treated with both Chinese and Western medicines but without effect. Her signs and symptoms consisted of inability to distinguish fragrance from fetor but lack of nasal congestion or discharge, fatigue, lack of strength, fear of cold, chilled limbs, dizziness, and downward sagging of her vaginal meatus. When questioned more carefully, it was found that this patient had had a hysterectomy due to a uterine myoma as well as four surgeries for ovarian cysts. Her tongue was pale with white fur, and her pulse was deep and weak. Examination of her nasal cavity showed no abnormalities. Therefore, her pattern was discriminated as qi vacuity and blood weakness with clear yang falling downward. Based on the treatment principles of boosting the qi and supplementing the blood, warming yang and lifting the fallen, she was prescribed the following Chinese medicinals:

Huang Qi (Radix Astragali Membranacei), 30g

Hong Shen (Radix Rubrus Panacis Ginseng), 10g

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 10g

Chen Pi (Pericarpium Citri Reticulatae), 10g

Dang Gui (Radix Angelicae Sinensis), 20g

Shan Yao (Radix Dioscoreae Oppositae), 10g

Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli), 6g

Sheng Ma (Rhizoma Cimicifugae), 12g

Chai Hu (Radix Bupleuri), 15g

Rou Gui (Cortex Cinnamomi Cassiae), 6g

Shu Di (cooked Radix Rehmanniae Glutinosae), 15g

Dan Pi (Cortex Radicis Moutan), 10g

Jie Geng (Radix Platycodi Grandiflori), 6g

Zhi Ke (Fructus Citri Aurantii), 10g

One packet of these medicinals was decocted in water and administered per day. After taking five packets, the patient could just slightly discriminate fragrance from fetor. However, all her other symptoms were less. Her tongue and pulse were the same as before. Therefore, another five packets of the same prescription were given, after which the woman's sense of smell had returned and all her other symptoms had disappeared. In order to secure and consolidate the therapeutic effect, the patient was told to take Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills) as well as Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pills). On follow-up after one half year, there had been no recurrence.

Case 6: Insomnia

The patient was a 50 year-old female who, due to overtaxation and fatigue at work as well as family difficulties, gradually had developed insomnia for 10 years. The patient had already tried many different Chinese and Western medicines, but all without effect. Her signs and symptoms included inability to go to sleep at night, dizziness, lack of strength, reduced appetite and torpid intake, occasional spontaneous perspiration which was worse on exertion, and a downward sagging of her vaginal meatus. Her tongue was pale with white fur and scanty fluids, while her pulse was vacuous and forceless. Fine questioning revealed that this patient had been pregnant 10 times and had given birth eight times. Therefore, her pattern was categorized as spleen vacuity with falling qi and blood not nourishing the heart. The medicinals prescribed included:

Dang Shen (Radix Codonopsitis Pilosulae), 20g

Huang Qi (Radix Astragali Membranacei), 30g

Sheng Ma (Rhizoma Cimicifugae), 10g

Chai Hu (Radix Bupleuri), 12g

Chen Pi (Pericarpium Citri Reticulatae), 10g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 10g

Dang Gui (Radix Angelicae Sinensis), 12g

stir-fried Suan Zao Ren (Semen Zizyphi Spinosae), 30g

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 6g

Five packets of these medicinals were prescribed to be taken after being boiled in water as a decoction, one packet per day in two divided doses. On her second visit, the woman said that her sleep had markedly improved after two packets and her insomnia was cured by three. Afterwards, she was prescribed Bu Zhong Yi Qi Wan and Gui Pi Wan (Restore the Spleen Pills to secure and consolidate the therapeutic effects.)

On pages 34-35 of issue #5, 2004 of the Hu Nan Zhong Yi Za Zhi (Hunan Journal of Chinese Medicine), Tang Dong-yun of the Zhenjiang Chinese Medical Hospital in Jiangsu province published an article titled, "Raising the Borders of the Use of Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction)."

Case 7: Hypersalivation

The patient was a 49 year-old female worker who was first seen by Dr. Tang on January 14, 2003. According to the patient, for the last month, she had been experiencing excessive saliva in her mouth that even spilled over. At night when she slept, the drooling was so bad that her hair was wet when she woke up. In addition, the patient was fatigued, lacked strength, and had a bland taste in her mouth and lack of taste. Her appetite was decreased and there was abdominal distention. Other signs and symptoms included unformed stools, a pale tongue with thin fur and teeth-marks on its edges, and a fine, weak pulse. Based on these findings, her Chinese medical pattern was categorized as spleen-stomach vacuity weakness with central qi insufficiency, non-securing of fluids and humors, and drool and saliva spilling over. The treatment principles were to fortify the spleen and boost the qi, secure fluids and gather drool. The formula Dr. Tang prescribed consisted of:

Huang Qi (Radix Astragali Membranacei), 20g

Dang Shen (Radix Codonopsitis Pilosulae), 20g

Dang Gui (Radix Angelicae Sinensis), 10g

Fu Ling (Sclerotium Poriae Cocos), 15g

stir-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae), 15g

stir-fried Bai Shao (Radix Albus Paeoniae Lactiflorae), 15g

Chai Hu (Radix Bupleuri), 5g

Sheng Ma (Rhizoma Cimicifugae), 5g

Ban Xia (Rhizoma Pinelliae Ternatae), 10g

Chen Pi (Pericarpium Citri Reticulatae), 5g

Rou Gui (Cortex Cinnamomi Cassiae), 5g

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 5g

After taking seven packets of these medicinals, all the patient's symptoms had gradually disappeared.

Case 8: Profuse sweating

The patient was an eight year-old male who was initially seen on April 17, 2002. According to the boy's mother, the child had suffered from excessively profuse perspiration and torpid intake for one week. One week before, the child had caught a cold and had a fever. At that time, he had been given some bitter penicillin orally for three days to clear heat and settle pain; after the fever had abated, sweating would not stop at night. This was accompanied by vexation and agitation, disquieted sleep at night, torpid intake, fatigue, and a sallow yellow facial complexion. The young patient's tongue was pale with thin fur and his pulse was fine. Therefore, his pattern was categorized as spleen-lung qi vacuity with non-securing of the exterior defensive. The treatment principles were to supplement the center and boost the qi, secure the exterior and stop sweating. The medicinals Dr. Tang prescribed based on these principles were:

Huang Qi (Radix Astragali Membranacei), 15g

Tai Zi Shen (Radix Pseudostellariae Heterophyllae), 15g

Fu Ling (Sclerotium Poriae Cocos), 10g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 10g

Fang Feng (Radix Ledebouriellae Divaricatae), 3g

Bai Shao (Radix Albus Paeoniae Lactiflorae), 10g

Fu Xiao Mai (Fructus Levis Tritici Aestivi), 30g

Sheng Ma (Rhizoma Cimicifugae), 3g

Gan Cao (Radix Glycyrrhizae Uralensis), 5g

Da Zao (Fructus Zizyphi Jujubae), 5 pieces

Nuo Dao Gen (Radix Oryzae Sativae), 15g

After taking three packets of these medicinals, the sweating had stopped and all the patient's other symptoms had disappeared.

Case 9: Hypersomnolence

The patient was a 49 year-old female who was first seen on May 12, 2003. The patient reported that she had been fatigued and somnolent for the last two months no matter how much she slept at night. From time to time, she simply felt like sleeping. If another roused her, afterwards she would go back to sleep. When this condition was severe, it affected her ability to work. The patient's physique looked robust, but her affect seemed wan. After eating, the woman's eyelids would become swollen. Her memory power had decreased, and she reported that she had a history of diabetes for five years. The patient's tongue fur was thin and slimy, her tongue had teeth-marks on its edges, and her pulse was bowstring. Therefore, her pattern was categorized as central qi insufficiency with spleen vacuity and damp encumbrance. The treatment principles were to supplement the center and boost the qi, fortify the spleen and transform dampness. The medicinals Dr. Tang prescribed consisted of:

Huang Qi (Radix Astragali Membranacei), 15g

Dang Shen (Radix Codonopsitis Pilosulae), 15g

Cang Zhu (Rhizoma Atractylodis), 10g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 10g

Ban Xia (Rhizoma Pinelliae Ternatae), 10g

Fu Ling (Sclerotium Poriae Cocos), 10g

Zhi Ke (Fructus Citri Aurantii), 10g

Shi Chang Pu (Rhizoma Acori Graminei), 10g

Shan Yao (Radix Dioscoreae Oppositae), 15g

uncooked Ji Nei Jin (Endothelium Corneum Gigeriae Galli), 10g

Huo Xiang (Herba Agastachis Seu Pogostemi), 10g

Sha Ren (Fructus Amomi), 5g, added later

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 5g

After taking approximately 30 packets of these medicinals, all the patient's symptoms had disappeared. On follow-up after one year, there had been no recurrence.

On page 52 of issue #5, 2004 of Shan Xi Zhong Yi (Shanxi Chinese Medicine), Fan Zhou-xin and Fan Ying-ying published an article titled, "Lifting the Borders on New Uses of Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction)." This article consisted of three case histories which are presented below.

Case 10: An acute occurrence of chronic urinary tract infection

The patient was a 47 year-old male who was initially examined by Drs. Fan on August 9, 2003. This patient had suffered from hematuria for three years. However, this had gotten worse during the last month. Sometimes there would be blood in the urine and sometimes it would stop. However, this bleeding easily recurred after the man got fatigued. His Western medical diagnosis was chronic urinary tract infection, and he had previously been given various Western and Chinese medical treatments, including Ba Zheng San (Eight [Ingredients] Rectifying Powder) and Xiao Ji Yin Zi (Cephalanoplos Beverage), but without obvious effect. Because of excessive taxation in the last month, the man had developed lower abdominal sagging and distention with recurrence of hematuria. His urine dribbled and dripped and did not stop crisply. This was accompanied by fatigue, lack of strength, shortness of breath, disinclination to speak and/or weak, lazy voice, dizziness, a pale red tongue with white fur, and a vacuous pulse. Urine analysis showed both red and white blood cells present. Based on the foregoing, the patient's Chinese medical pattern was categorized as spleen vacuity and qi falling with gathering of blood losing its duty. Therefore, the treatment principles were mainly to supplement the center and boost the qi assisted by clearing heat and nourishing yin. The medicinals used consisted of:

uncooked Huang Qi (Radix Astragali Membranacei), 15g

Tai Zi Shen (Radix Pseudostellariae Heterophyllae)

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Nu Zhen Zi (Fructus Ligustri Lucidi)

Han Lian Cao (Herba Ecliptae Prostratae)

Bai Mao Gen (Rhizoma Imperatae Cylindricae)

Dang Gui (Radix Angelicae Sinensis), 10g each

Chai Hu (Radix Bupleuri)

Sheng Ma (Rhizoma Cimicifugae), 3g each

Chen Pi (Pericarpium Citri Reticulatae)

Zhi Mu (Rhizoma Anemarrhenae Aspheloidis), 6g each

Huang Bai (Cortex Phellodendri)

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 5g each

One packet of these medicinals was decocted in water and administered orally per day. After taking 12 packets, hematuria could still be seen once in a while. However, the lower abdominal distention and sagging were less. There was still generalized fatigue and lack of strength, shortness of breath, disinclination to speak, and dizziness. So eight more packets of the same formula were prescribed. After this, all the man's symptoms were much better than before, although his tongue and pulse were the same. Drs. Fan next prescribed Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills) at a rate of six grams each time, two times per day. The man did this for a month and all his symptoms disappeared, his affect became vivacious again, and his urine analysis was also normal.

Case 11: Hiatal hernia

The patient was a 52 year-old male who was first examined by Drs. Fan and Fan on January 6, 2003. Due to stomach duct area aching and pain, the man had gone to his local hospital where he had been diagnosed with hiatal hernia for which he was given medication that was ineffective. Therefore, he came to try Chinese medicine. At the time of his intake, the man's signs and symptoms consisted of a somber white facial complexion, a fat body, continuous upper abdominal distention, occasional aching and pain, dizziness, shortness of breath, lack of strength, a pale tongue with white fur, and a deep, soft pulse. Based on these signs and symptoms, the patient's pattern was categorized as central yang insufficiency with qi vacuity falling downward. Therefore, the treatment principles were to supplement the center and boost the qi, upbear yang and lift the fallen. The medicinals used included:

uncooked Huang Qi (Radix Astragali Membranacei), 20g

Tai Zi Shen (Radix Pseudostellariae Heterophyllae)

Dang Gui (Radix Angelicae Sinensis)

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Tian Ma (Rhizoma Gastrodiae Elatae)

Chen Pi (Pericarpium Citri Reticulatae)

stir-fried Zhi Ke (Fructus Citri Aurantii), 10g each

Fang Feng (Radix Ledebouriellae Divaricatae)

Chai Hu (Radix Bupleuri)

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 6g each

After taking 15 packets of the above medicinals, the man's epigastric distention and pain had already stopped. Repeat upper GI X-ray showed the stomach lining to be smooth and shiny with no abnormalities. Further, all evidence of hiatal hernia had disappeared. The man was then switched to taking a formula in order to fortify his spleen and harmonize his stomach, and he was considered cured.

Case 12: Radiation colitis

The patient was a 64 year-old female who was first examined on September 9, 1998. Due to incessant vaginal bleeding, it was found that the woman suffered from cervical cancer which was treated by radiation and Western drugs. However, during the recent half month, the patient had developed downward sagging and aching and pain when she urinated and/or defecated. When severe, there was even prolapse of the rectum. There was a relatively profuse watery discharge from her vagina which had a fishy foul odor. The woman's stools were loose, and, after defecation, there was the discharge of a mixture of blood and mucousy fluid 2-3 times per day. In addition, there was generalized fatigue, lack of strength, lassitude of the spirit, a pale tongue with thin, white fur, and a deep, weak pulse. The patient's Western medical diagnosis was cervical cancer and radiation colitis. Her Chinese medical pattern was categorized as central qi vacuity and decline with loss of duty of upbearing, lifting, securing, and gathering. Therefore, the treatment principles were to supplement the center and boost the qi, upbear yang and secure and gather. The medicinals used consisted of:

Huang Qi (Radix Astragali Membranacei), 20g

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Dang Shen (Radix Codonopsitis Pilosulae), 10g each

Dang Gui (Radix Angelicae Sinensis), 15g

Chen Pi (Pericarpium Citri Reticulatae)

Sheng Ma (Rhizoma Cimicifugae), 6g each

Chai Hu (Radix Bupleuri)

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 5g each

After taking three packets of these medicinals, the patient reported that the downward sagging feeling was less and that her mood had improved. After defecating, she still had a mucousy discharge, and her pulse and tongue were the same as before. Based on these findings, 10 grams of scorched San Xian (three food-dispersing, stagnation-abducting medicinals) were added to the original formula and another six packets were prescribed. After taking that prescription, the woman said the downward sagging was greatly reduced and the watery vaginal discharge had stopped. She had one bowel movement per day in which there was neither pus nor blood. Therefore, Drs. Fan ground up the ingredients of the original formula and made them into pills made with honey as the binder. Each pill weighed 10 grams, and the patient took one pill two times per day in order to secure the therapeutic effects. On follow-up after two months, the colitis was completely healed.

Copyright [c] Blue Poppy Press, 2005. All rights reserved.

For more information on the use of Bu Zhong Yi Qi Tang and Li Dong-yuan's other famous formulas, see Bob Flaws's translation of Li Dong-yuan's Treatise on the Spleen & Stomach available from Blue Poppy Press.

abstracted & translated by Bob Flaws, LicAc, Dipl Ac & CH, FNAAOM

Copyright [c] Blue Poppy Press, 2004. All rights reserved.

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