What is the Meaning of "Yiqi" in Buzhong Yiqi Tang?

Implications for Use of Various Yiqi Ingredients in Formulas

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Buzhong Yiqi Tang is a formula that was described in an important text of the Chinese tradition, the Pi Wei Lun (Treatise on Spleen and Stomach, 1249 A.D.), which is available in English translation (1). Its author, Li Gao (also known as Li Dongyuan) was considered the leader of the "Spleen/Stomach School," a movement within the evolving ancient tradition that focused on deficiency of spleen and stomach as the origin of numerous diseases. This was one of four leading schools of thought that developed during the Chinese medicine reforms of the Jin-Yuan Dynastic period (see: Jin-Yuan Medical Reforms). Li had good reason to focus on this area: he suffered from such a disorder himself. In the course of describing how to use herbs in treating the spleen-stomach disorders, Li wrote:

I myself suffered from a disease of long-standing weakness of the spleen and stomach resulting in my vision and hearing being reduced by half. This was a disease of excessive yin overwhelming the yang. In addition, my qi was limited, my essence-spirit was insufficient, and my pulse was thin and wiry. This was a deficiency disease. It was due to speaking too much. All this indicated decrepit and weak yang qi, which, being confined within the yin, was unable to smoothly flow where it should.

Before discussing his herbal formulas and the terminology used in depicting their actions, it is worthwhile to note that a prescription based on Li's work-but described by a later author, Ni Weide-is specifically designed for this condition of weak yang qi leading to loss of visual and auditory acuity: it is called Yiqi Congming Tang. These are also indications for Buzhong Yiqi Tang. Li has ascribed an unusual causative factor to his syndrome: speaking too much. No doubt, he had much to tell people and, apparently, they were sufficiently willing to make up an audience to keep him talking, perhaps for hours on end. This is a type of "taxation," that is, an overstraining of the body or its parts, which can weaken the qi. When taxation is repeated often enough the qi is drained and one becomes susceptible to various illnesses that can further damage the qi.

Li's focus of concern was the yang qi. A substantial discussion of this concept was provided much earlier in the first pages of the Neijing Suwen. The translation of this renowned text by Maoshing Ni is especially easy to understand, and I have added in brackets some explanatory comments (2):

The yang qi moves like the sun. As the sun begins to rise at dawn, the yang qi begins to move to the outer body [muscles, skin, and hairs; moving from the inner regions, the viscera], and the pores open. The peak of the yang qi is at noon, and when the yang qi is most active [which occurs around this time] it is advisable to relax and stay quiet so that the yang qi does not escape [i.e., through sweating]. As the sun sets, the yang qi moves inward and the pores begin to close. At this time, it is harmful to engage in strenuous physical activity [when the yang qi should settle inward and not be forced again to the surface] or expose oneself to cold, damp, mist, or fog [that is, to yin influences]. If one violates the natural order of the yang qi as it emerges, peaks, and sets, the body will gradually be weakened by pathogenic factors and be subject to disease and degeneration.

Yin is the essence of the organs and the fountain of the qi. Yang protects the exterior of the body against pathogens and makes the muscles function. When the yin fails to contain the yang, the flow in the channels will become rapid, causing the yang qi to become reckless. If, on the other hand, the yang qi is deficient and unable to counterbalance the yin, communication between the viscera will be disrupted, and the nine orifices will cease to function [this includes the eyes and ears as two orifices; also the mouth, in terms of taste, and the nose in terms of smell, so the sensory organs of the upper body will be impaired].

Buzhong Yiqi Tang is sometimes named Ginseng and Astragalus Combination after two of its key spleen-tonifying ingredients, and its name is often translated as "The Decoction to Tonify the Center and Boost the Qi." The term "bu" appears often in the description of Chinese therapeutics and in the name of herbal formulas. It is usually translated as "tonify" or "supplement," and it is a term typically used in combination with the four primary essences: buqi, buyang, buxue, buyin (to supplement, respectively, the qi, yang, blood, and yin). The implication of bu is actually to refill: to replenish something that has been depleted. Zhong means the "center" of the body, and refers to the central organ, the spleen (and its associated organ, stomach); this is as opposed to the upper organs (lung and heart) and lower organs (liver and kidney). So, the formula's action, described by buzhong, is to tonify or supplement the depleted spleen and enliven the impaired stomach function. Tang is a decoction, which was the original preparation of the formula. Today, one can also get the herbs in pill form (wan), usually made from powdered herbs (according to the Pharmacopoeia of the PRC). Thus, this is a decoction to replenish the deficient qi, and provide another action, yiqi.

The term "yi" is often translated today as "to benefit;" it may also indicate to increase, prolong, and enlarge. These latter terms are somewhat different than what is implied by bu, because they don't have to refer to replenishing a deficiency, they can indicate growth beyond what is usually present. This term was introduced for herbal formulas by Li Gao and he made it clear in his Pi Wei Lun that the main concern was with the raising of yang qi as part of the healthy digestive process; the contrary condition is sinking of yang qi, but this downward flow is not its appropriate direction in relation to the spleen function. To raise up the yang qi is described by yet another term: "shengyang" (some authors now translate this as "upbearing" the yang). Li used the term yiqi for a similar concept, but it also implies shoring up the organs from the bottom, to assure that the qi doesn't have a chance to sink down, but, will rise up instead as it is supposed to. To shore up from the bottom, the impetus must come from below.

To sum up, Li's key formula Buzhong Yiqi Tang is intended to replenish the deficiency of spleen and stomach and to prevent the yang qi from sinking, aiding it in rising. This is the main "benefit" to the qi. He described the basis for this concept as follows:

After water and grain enter the stomach, yang qi ascends. Fluids and qi enter the heart and penetrate the lungs to replenish the skin and hair and to disperse throughout the hundreds of vessels. The spleen receives qi from the stomach to irrigate the four limbs and nourish the qi and blood. If, on the other hand, the stomach is injured by improper food and drink and the spleen is damaged by being overwhelmed [taxation fatigue], they become deficient.

This yang qi that ascends is a clear essence (a fluid) derived from food and beverage which is then distributed by the spleen to the upper viscera (the heart and lungs), and from there to the body surface. A share of this essence "rains down" from the lungs to the lower organs, where it can replenish the yin and essence of the kidney; a portion of that essence that has properly been deployed to the lower body is then circulated upward by the "steaming" action of the kidney yang.

However, with the deficiency of spleen and stomach, a substantial fraction of the yang qi doesn't ascend and the body is not properly nourished. Further, one can develop a downward flow of the yang qi:

Generally speaking, if the spleen and stomach are deficient and weak, yang qi is unable to grow and rise up….When the spleen is diseased, yang qi flows down to overwhelm the kidneys. That is, the earth element restrains the water element and, as a result, there occur weak and flaccid bones….It causes the bones to become deficient in marrow and the legs are unable to walk on the ground. This is an imposition of yin qi, a pattern of excess yin and deficient yang.

The description of "weak and flaccid bones" may seem odd, but the reference is to increasing difficulty in walking with the sensation that the normally strong bones are not holding one up. In fact, using modern descriptions we would mainly indicate that this is a syndrome of weakening of the muscles, possibly accompanying a weakening of the nerve signals to the muscles so that they are no longer very responsive. The excess of yin may reveal itself as fluid-filled limbs, or overall obesity.

The downward flow of yang qi is also depicted in Li's chapter about deficiency syndromes: "When the spleen and stomach are severely deficient, the qi of damp earth slides down below the umbilicus and the kidneys and bladder suffer from evils." One can almost picture a hillside where the topsoil is not well connected to the surface below, and, upon becoming wet, slides down as heavy mud, pouring into a stream that it blocks and disrupts.

As to the remedy for this problem, Li points out first that: "the foot yangming is the sea of the 12 channels governing the movement of qi and all the channels depend upon it for their supply of qi." Hence, he recommends using herbs that benefit this channel. The foot yangming channel is the stomach channel, and it has, among other essential acupuncture points, the most commonly used of all the tonifying points: ST-36 (zusanli).

Li had selected four herbs to focus on for the purpose of elevating yangqi via the stomach channel, three of them are in Buzhong Yiqi Tang: cimicifuga, bupleurum, astragalus, and the other is pueraria. He described the role of the first two of these herbs as follows:

The pattern of insufficient spleen and stomach requires a small quantity of cimicifuga, a medicinal which conducts to the foot yangming and taiyin channels. Yang qi will thus be made to travel the yang tract and turn right from the spleen and stomach [turning right means to rise rather than sink]….Enriching the harmonizing qi of shaoyang with a small quantity of bupleurum used in addition to the cimicifuga turns the various channels right [their flow in the proper direction] so as to generate and effuse the qi of the yangming.

Jiao Shude, in his lectures on the use of medicinals (3), presents a similar picture for use of bupleurum in raising the yang qi:

Bupleurum conducts clear qi upward to treat downward fall of clear yang characterized by spleen-stomach deficiency, shortness of breath, sagging in the abdomen, persistent diarrhea, sagging in the anus, heaviness in the lower back and abdomen, profuse menstruation, frequent urination, prolapse of the internal organs, and prolapse of the uterus. For this, it is combined with medicinals such as astragalus, atractylodes, cimicifuga, pueraria, and codonopsis.

One can see the extended listing of symptoms where fluids are pouring downward (diarrhea, frequent urination, and profuse menstruation) and where the lower body feels heavy or is actually sagging down in prolapse. Here, he lists the other yang qi raising herbs astragalus, cimicifuga, and pueraria, along with the spleen qi tonics atractylodes and codonopsis (ginseng is often indicated here, but China has used codonopsis as a substitute for ginseng for several decades).

The roles of astragalus and pueraria are to aid movement of the qi to the skin and muscles respectively. When referring to the skin (usually as "skin and hair") this means that the qi circulating at the surface is strengthened so that the opening and closing of the pores can be regulated, and, specifically, that the pores can be closed in order to prevent evil influences from entering or to prevent too much perspiration from escaping, carrying with it valuable essences. The hair referred to here is not the hair at the top of the head, but the hairs along the body surface that are thought to accompany the pores. When referring to movement of qi in the muscles, this means the qi circulates and helps them to either contract or relax, and, in particular, to be able to relax as needed so that the body is in harmonious form, while being strong enough to contract to hold up the body structure, such as when walking or lifting. Pueraria is especially important for relaxing the muscles of the upper back, shoulders, neck, and head.

Li Gao listed several formulas that fit this pattern of therapy in his book, several of them include yiqi in the formula name (the designation "tang" is left out of the titles here):

YIQI FORMULAS (By Li Dongyuan, Except Yiqi Congming, Adapted by Ni Weide)

It can be seen that all of the "yiqi" formulas contain cimicifuga and most contain astragalus. The "buzhong" portion of the formula includes astragalus with ginseng, licorice, and atractylodes, which are three of the four ingredients of Si Junzi Tang, the primary spleen qi tonic of Chinese medicine. But, these formulas are not as intensively focused on draining damp as Si Junzi Tang, so (with one exception) they do not include the fourth ingredient, hoelen. In the next table are Li Gao's "shengyang" formulas. These have a similar structure, but add the ingredient chiang-huo, which is intended to help carry the yang qi upward; this herb is sometimes accompanied by others that are similar in action (and are botanically related): siler and/or tu-huo.

SHENGYANG FORMULAS (By Li Dongyuang)

Clearly, these "yiqi" and "shengyang" methods of therapy loomed large in Li's approach to healing. This may be because Li's case of weakened spleen and stomach was not a minor one. He continued his description: "Now, in my case, the intruding evil of excessive cold dampness was sapping the internal qi via the exterior and that was happening in a violent way." Though he didn't specify the violence he might have experienced, it is possible that he suffered symptoms of abdominal pain, digestive disturbance, and other results of visceral deficiency and invasion of cold and damp. In other words, with the yang qi weakened (by speaking too much), he was subject to the invasion of external evils, and he was struck by the yin evils of cold dampness. These adverse influences then further weakened his qi.

While it is possible that the excess yin simply overwhelms the yang, leading to progressively more cold syndromes (as depicted in the Neijing Suwen), it is also possible for the imbalance to lead to a mix of cold and fire symptoms. In the Pi Wei Lun, Li describes how this mix of conditions can arise:

Dietary irregularity and immoderate eating of cold and warm foods may damage the spleen and stomach, while joy, anger, worry, and fright may consume and cause detriment to the original qi. If the spleen and stomach qi becomes decrepit and the original qi becomes insufficient, heart fire may become effulgent on its own. This heart fire is a yin fire. It starts from the lower burner and links to the heart. The heart does not reign exclusively; ministerial fire is its deputy. Ministerial fire is the fire of the pericardium developing from the lower burner. It is a foe to the original qi. This yin fire and the original qi are mutually irreconcilable. If one is victorious, the other must be the loser. When spleen and stomach qi becomes deficient and their qi consequently sinks down into the kidneys, yin fire is given a chance to overwhelm the earth phase.

As in the earlier description, the damp earth sinks down to the lower region and disrupts the normal flow and function. While one may easily envision this dampness quenching the fire of the kidney, in fact, the better analogy is that the damp earth disrupts the stream, causing it to change its course. It no longer proceeds to and cools the area where yang resides. The balance of yin and yang is thereby further disrupted and the deficiency fire flares to the pericardium and heart, and from there flares further upward to affect the sensory organs and the brain function. This outcome is the reason that some of the "yiqi" formulas include coptis, phellodendron, scute or other heat-clearing herbs in a base of warming tonification for the spleen and stomach.

This situation is also depicted in the Yinhai Jingwei, a classic text on eye diseases (4):

A condition to be treated is where the yang cannot overcome the yin, because the yin flourishes and the yang is depleted. As a result, the nine orifices [including the eyes, ears, and nostrils] are not passable. Now, a light-green shade appears at the inner canthi of the eyes, because both the foot yangming [stomach channel] and foot shaoyin [kidney channel] are obstructed. The qi of the foot jueyin [liver channel] cannot freely rise upward….One should make the yang qi of the organs in the yangming and shaoyin channels at the bottom rush up to the heaven [to the head]. This means one should first supplement [and raise] the yang qi. Then, one drains the fire of the foot jueyin from the head of the yangming channel. That above and that below are then balanced in the yang, and the yin is under control.

The recommended formula for such a condition is similar to Buzhong Yiqi Tang, with the addition of several herbs, including chiang-huo, tu-huo, and siler, ingredients found in some of Li's other formulas for raising qi (shengyang) The method of treatment in this ophthalmology text involves using these herbs to raise yang qi in the morning and then use herbs to drain the fire and benefit yin in the evening. However, most physicians combine these methods of therapy into a single formula to be taken twice daily.

The practitioner considering use of a "yiqi" formula should determine whether the yang qi deficiency and descent has developed into a simple cold syndrome or a mixed syndrome of spleen/stomach cold with deficiency heat of the kidney in order to design or select the most appropriate prescription.

REFERENCES

1. Yang Shouzhong and Li Jianyong (translators), Li Dongyuan's Treatise on the Spleen and Stomach, 1993 Blue Poppy Press, Boulder, CO.
2. Maoshing Ni, The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, 1995 Shambhala, Boston, MA.
3. Mitchell C, et al. (translators), Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude, 2003 Paradigm Publications, Brookline, MA.
4. Kovacs J and Unschuld PU, Essential Subtleties on the Silver Sea, 1998 University of California Press, Berkeley, CA.

The foot yangming (stomach channel). It connects the foot to the eye and near the ear to affect sight and hearing; it passes by the spleen and stomach and connects internally to the stomach.

September 2004