Class 6: Qi and Blood Tonics

1. Class 6: Qi and Blood Tonics Fayi Wu

2. Herbs • Radix Astragalus (Huang qi) MM: pp 718-722 • Cortex Cinnamoni (Rou gui) MM: pp 684-687 • Fructus Longan (Long Yan Rou) MM: pp 762-764 • Semen Zizyphi (Suan Zao Ren) MM: pp 926-928 • Radix Polygalae (Yuan Zhi) MM: pp 930-933

3. Huang Qi (Radix Astragalus) • Categories: herbs that tonify qi • Taste and property:Sweet and slightly warm • Meridian tropism:spleen and lung • Actions:Tonify qi and ascending yang, supplement qi to consolidate the surface, promote outward discharge of toxin and generation of new tissues, induce diuresis to relieve edema • Applications • Deficiency of the spleen qi and lung qi or collapse of the qi in the middle jiao: This is an very important herb for qi deficiency: Qi deficiency after disease: Used with Ren Shen, Spleen qi deficiency: Used with Bai Zhu, Deficiency of both qi and blood: Used with Dang Gui, Yang qi deficiency marked by aversion to cold and much sweating: Used with Fu Zi, Collapse of qi of middle jiao: Used with Ren Shen, Bai Zhu and Sheng Ma, i.e. Bu Zhong Yi Qi Tang, Hematochezia or metrostaxis or metrorrhagia: Use with Ren Sen, Long Yan Rou and Suan Zao Ren, i.e. Gui Pi Tang • Spontaneous sweating due to deficiency of the defensive qi: Used with Mu Li, Fu Xiao Mai and Ma Huang Gen, Mu Li San. Night sweating due to yin deficiency can also be treated with this herb plus Sheng Di and Huang bai, i.e. Dang Gui Liu Huang tang

4. Huang Qi (Radix Astragalus) • Failure of carbuncle to erupture or failure of the wound to heal: Often used with Dang Gui, Chuan Shan Jia and Zao Jiao Ci, Shi Quan Da Bu Tang • Edema with oliguria: Applicable to water retention due to failure of the deficient qi to move water, i.e. Fang Ji Huang Qi Tang • Numbness of the limbs: Huang Qi Gui Zhi Wu Wu Tang • Arthralgia marked by pain in the shoulder and arms: Juan Bi Tang • Hemiplegia in stroke: Bu Yang Huan Wu tang (Dang Gui, Chuan Xiong, di long, Tao Ren and Hong Hua) • Diabetes: Used with Sheng Di, Mai Dong and Tian Hua Fen • Dosage:10-15g, or up to 30-60g. Used after stir-fried for tonifying qi and yang • Attentions: Not suggested for patients with excess pathogen in the exterior, stagnation of qi and dampness, food retention, hyperactivity of yang due to yin deficiency, etc.

5. Rou Gui (Cinnamon Bark, Cortex Cinnamoni) • Categories: herbs that warm the interior • Taste and Property: Pungent, sweet and hot • Meridian tropism: Kidney, spleen, heart and liver • Actions: Tonify fire, assist yang, Disperse cold to relieve pain, Warm up and remove obstruction from collaterals • Indications: • Kidney yang deficiency marked by aversion to cold, cold limbs, soreness and weakness of the loins and knees, impotence and frequent urination or deficiency of both the spleen yang and the kidney yang marked by cold pain in the abdomen, poor appetite and loose stool. Often used together with Fu Zi, Shu Di and Shan Zhu Yu, I.e. Gui Fu Ba Wei Wan, or with Fu Zi, Gan Jiang and Bai Zhu, i.e. Gui Fu Li Zhong Wan. It can also be used to induce the heat from the floating deficient yang back to its origin • Cold pain in the abdomen, arthralgia due to cold dampness, pain in the lower back and cold stagnation in the blood marked by amenorrhea and dysmenorrhea. • Carbuncle that fails to rupture after formation of pus: This herb can disperse cold and warm up yang to promote flow of qi and blood, often used together with Shu Di, Lu Jiao Jiao and Ma Huang, i.e Yang He Tang • Deficiency of both qi and blood: Used in a small amount in herbs tonifying qi and blood, i.e. Shi Quan Da Bu Tang • Dosage: 2-5g, to be taken in powder with water. It should be decocted later when used in decoction • Attentions: Use this herb with great care for patients with fire exuberance due to yin deficiency, excessive heat, bleeding due to blood heat or pregnant woman

6. Suan Zao Ren (Semen Zizyphi) • Categories: herbs that calm the spirit • Taste and Property:Sweet, sour and neutral • Meridian Tropism:Gallbladder, liver, heart andspleen • Actions:nourishes the heart yin and liver blood, promotes sleep, inhibits the sweating • Applications: • For irritability, insomnia, and palpitations with anxiety due to either blood deficiency or yin deficiency, used with zhi mu, fu ling, suan zao ren tang, used with dang shen, fu ling, long yan rou, gui pi tang • For both spontaneous sweating and nightsweats, used with huang qi, wu wei zi, shan zhu yu • Dosage:9-15g • Attention:used with caution in cases of severe diarrhea or heat from excess

7. Yuan Zhi (Radix Polygalae) • Categories: herbs that calm the spirit • Taste and Property: bitter, acrid, slightly warm • Meridian Tropism: heart, lung • Actions: Calm the spirit, transforms phlegm, opens the heart orifice, reestablishes harmonious communication between heart and kidneys • Applications: • For insomnia, and palpitations with anxiety , restless and disorientation. Use with suan zao ren, bai zhu, dang gui, gui pi tang, used with huang qi, dang gui, long yan rou for forgetfulness, palpitations and insomina • For phlegm envelops the orifice of the heart: emotional and mental disorientation, spasms, or seizures, used with yu jin, shi chang pu. Also for phlegm affecting the lungs with copious sputum, especially when it is difficult to expectorate, used with chuan bei mu, gua lou, xing ren. Used for angina pectoris, used with lai fu zi, wang bu liu xiu • For carbuncle and abscess • Dosage: 6-15g • Attention: contraindicated for those with yin deficiency with heat signs as well as those with peptic ulcers or gastritis

8. Long Yan Rou (Fructus Longan) • Categories: herbs that tonify the blood • Taste and Property:Sweet and warm • Meridian Tropism:Heart and spleen • Actions:Tonify both the heart and the spleen, supplement both qi and blood • Applications: • Deficiency of both the heart and the spleen marked by palpitation, insomnia and forgetfulness: This can be used alone or with Huang Qi, Ren Shen, Dang Gui and Suan Zao Ren, i.e. Gui Pi Tang • Dosage:10-15g • Attention:Not suggested for patient with accumulation of dampness in the middle jiao or with phlegm, retained water or fire.

9. Formulas • Ba Zhen Tang, Shi Quan Da Bu Tang FS: pp pp 259-260 • Dang Gui Bu Xue Tang FS: pp pp 254-255 • Gui Pi Tang FS: pp 255-257

10. Ba zhen tang (Eight treasure decoction) • Categories: formulas that tonify qi and blood • Ingredients • Si jun zi tang + Si wu tang + sheng jiang, da zao • Actions Tonify qi and blood • Application: Qi and Blood deficiency, Pallidor sallow complexion, palpitations with anxiety that may be constinuous, reduced appetite, shortness of breath, laconic speech, easily-fatigued extremities, light-headedness and/or vertigo, a pale tongue with a white coating, and a pulse which is either thin and frail or large, deficient, and without strength. • Attention Not for excess pattern • Modifications: Shi quan da bu tang: Ba zhen tang + rou gui , huang qi warm and tonify qi and blood

11. Chief: Ren shen, shu di huang • Deputy: bai zhu, fu ling, bai shao, dang gui • Assistant: chuan xiong, zhi gan cao • Envoy: sheng jiang, da zao

12. Gui pi tang (Restore the spleen decoction) Categories: formulas that tonify qi and blood Ingredients: Ren shen, Bai zhu, Fu ling, Gan cao, Huang qi, suan zao ren, long yan rou, dang gui, mu xiang, yuan zhi, sheng jiang, da zao

13. Actions and indications of the formula • Actions • Tonify qi and blood, strengthen spleen and nourish heart • Indications • Heart and Spleen deficiency: forgetfulness, palpitations, insomnia, dream-disturbed sleep, anxiety and phobia. reduced appetite, pale complexion, pale tongue with a thin white coating, thin deep pulse. Chronic bleeding. Early prolonged periods with pale blood.

14. Analysis of Formula • Chief: Si jun zi tang add Huang qi • tonify spleen qi. . • Deputy: • Suan zao ren, long yan rou: • tonify blood and calm the spirit. • Dang gui: • nourish blood • Zhi yuan zhi: • calm the spirit by facilitating the flow of qi in the heart. • Assistant: Mu xiang • regulate qi and revive spleen. • Envoy: Sheng jiang, da zao • improve appetite and regulate ying qi and wei qi

15. Modern application and modifications • Modern application • Insomnia, anemia, irregular menstruation

16. Formula Comparisons

17. Dang gui bu xue tang (Peony and licorice decoction) Categories: formulas that tonify qi and blood Ingredients: Huang qi 30g, Dang gui 6g

18. Actions and indications of the formula • Actions • Tonify qi and generate blood. • Indications • Hot sensation in the muscles, a red face, irritability, thirst with a preference for a warm beverage, a pale tongue, and a flooding, large and deficient pulse that is forceless when pressed hard. Fever or headache due to loss of blood

19. Modern application and modifications • Attention: • Not for fever due to yin deficiency. • Modifications: • Gui pi tang, bu zhong yi qi tang, dang gui liu huang tang, bu yang huan wu tang