Rongtong Dictionary · Formula

Buzhong Yiqi Decoction: Li Dongyuan's Spleen-Stomach Doctrine, Sweet-Warm Fever-Clearing, and Yang-Raising Logic with Modern Evidence

Published and reviewed 2026-07-09

Buzhong Yiqi (Tonify the Middle and Boost Qi) Decoction comes from the Jin-Yuan master Li Dongyuan (Li Gao) and his Piwei Lun and Neiwai Shang Bianhuo Lun, nicknamed the 'king-of-medicine decoction,' and is the representative formula for 'tonifying the spleen-stomach and raising clear yang' — the clinical crystallization of Li's doctrine that 'internal damage to the spleen-stomach gives rise to the hundred diseases.' It pioneered 'boost qi and raise yang' and 'sweet-warm clears fever,' built from astragalus, ginseng, atractylodes, licorice, angelica, tangerine peel, cimicifuga, and bupleurum for the 'spleen-deficiency qi-sinking' and 'qi-deficiency fever' patterns. It is both a model of the 'raise yang, lift the sunken' idea (cimicifuga and bupleurum being its finishing touch) and a case where the traditional 'sinking of central qi' is not a modern diagnosis of organ prolapse or chronic fatigue.

Origin: Li Dongyuan and the crystallization of the internal-damage doctrine

Buzhong Yiqi Decoction comes from Li Dongyuan (Li Gao, 1180-1251), one of the four great masters of the Jin-Yuan period, in his Piwei Lun (Treatise on the Spleen and Stomach) and Neiwai Shang Bianhuo Lun, and is nicknamed the 'king-of-medicine decoction.' It was born of wartime: observing that a besieged populace, eating irregularly and overworked, suffered internal spleen-stomach damage and consequent fever, Li devised the formula on the principle that 'the central primordial qi of the spleen and stomach is the root of the person' and that 'internal damage to the spleen-stomach gives rise to the hundred diseases,' distributing it as a powder and saving countless lives — thereby founding his 'internal-damage doctrine' and the spleen-stomach school.

Its method draws on the Suwen's 'supplement what is depleted, warm what is taxed,' pioneering 'boost qi and raise yang' and 'sweet-warm clears fever' — using sweet, warm agents to tonify central qi and raise clear yang for a 'qi-deficiency fever,' rather than directly cooling with bitter-cold drugs. This differs sharply from treating externally-contracted fever and is the core of Li's contribution of 'distinguishing internal damage from external contraction.' The original doses were tiny (astragalus and licorice five fen each, the rest three fen each, roughly ten grams per dose); modern clinical doses are far larger. This page identifies the entity only and offers no dose conversion or preparation procedure.

Composition: cimicifuga and bupleurum, the finishing touch

Eight ingredients: astragalus (Astragali Radix, sovereign), ginseng (Ginseng Radix, minister), atractylodes (Atractylodis Macrocephalae Rhizoma, minister), honey-fried licorice (Glycyrrhizae Radix, minister), angelica (Angelicae Sinensis Radix, assistant), tangerine peel (Citri Reticulatae Pericarpium, assistant), cimicifuga (Cimicifugae Rhizoma, assistant-envoy), and bupleurum (Bupleuri Radix, assistant-envoy).

In the textbook reading, astragalus tonifies central qi, raises yang, and secures the exterior as sovereign; ginseng, atractylodes, and honey-fried licorice, sweet and warm, boost qi and tonify the spleen-stomach as ministers, the four together greatly tonifying central qi; tangerine peel regulates qi so tonification does not stagnate and angelica nourishes and harmonizes blood, as assistants. Crucially, cimicifuga and bupleurum — cool in nature, small in dose — work with ginseng and astragalus to raise the sunken clear yang, and generations of physicians have called them the formula's 'finishing touch,' 'drawing the sweet-warm qi of astragalus and licorice upward.' As the physician Gao Jianzhong stressed, 'without cimicifuga and bupleurum it is no longer Buzhong Yiqi,' and in principle they cannot be removed in modifications. The whole both tonifies and raises: tonifying qi and the spleen to restore the source of generation, and lifting central qi so the sunken returns to place — achieving 'tonify the middle, boost qi, raise yang, lift the sunken.'

Pattern, not disease: 'sinking of central qi' is not a modern diagnosis of prolapse

The textbook gives two patterns. First, 'spleen-deficiency qi-sinking': reduced appetite, fatigue and limp limbs, faint voice, sallow complexion, loose stool, and prolapse of the rectum, uterine prolapse, chronic diarrhea and dysentery, and flooding. Second, 'qi-deficiency fever': fever with spontaneous sweating, thirst preferring warm drinks, shortness of breath, and a weak, large, forceless pulse. The mechanism is spleen-stomach qi deficiency with sinking of clear yang: the spleen governs raising the clear, so its deficiency lets clear yang fail to rise and central qi sink, producing the 'falling' and 'sinking' signs, while clear yang trapped in the lower burner and constrained generates fever.

Here 'central qi,' 'clear yang,' and 'sinking of central qi' are traditional functional constructs. It must be clarified: the rectal or uterine 'prolapse' described under 'sinking of central qi' is a holistic account of a class of functional states, not a synonym for the modern anatomical diagnoses of 'rectal prolapse' or 'pelvic organ prolapse'; and 'qi-deficiency fever' is not a synonym for any modern febrile illness. Likewise, treating the formula as a general 'qi-tonifying anti-fatigue' supplement ignores its specific 'sinking clear yang' premise. Similar symptoms or sites do not imply the same pattern — organic prolapse, fever of unknown origin, and weight loss should all first be evaluated by modern medicine.

Historical development: the unfolding of the 'boost qi, raise yang' line

Buzhong Yiqi pioneered 'boost qi and raise yang,' and later ages modified it into a series. Li himself also made Shengyang Yiwei Decoction (astragalus with ginseng-atractylodes-licorice to tonify, and bupleurum, siler, notopterygium, and pubescent angelica to raise yang and dispel damp, with pinellia, tangerine peel, poria, alisma, and coptis to drain damp and clear heat) for spleen-stomach qi deficiency with clear yang failing to rise and damp-constraint heat. The Qing physician Zhang Xichun created Shengxian Decoction (astragalus with cimicifuga, bupleurum, and platycodon, tempered by cool anemarrhena) for 'sinking of the great qi of the chest.' Ming physician Zhang Jingyue's Juyuan Jian (ginseng-astragalus-atractylodes-licorice with cimicifuga) treats central-qi sinking with failure to contain blood in flooding and collapse.

These share Buzhong Yiqi's intent — heavily using spleen-tonifying qi agents combined with yang-raising, sunken-lifting agents — forming a 'boost qi, raise yang' lineage. After transmission to Japan, the formula became the famous Kampo medicine 'Hochu-ekki-to,' widely used across East Asia for taxation fatigue, post-operative states, and low immunity. Clinically the formula is applied very broadly across digestive, respiratory, urinary, and immune systems, but always on the premise of the 'central-qi-insufficient, clear-yang-sinking' mechanism, not boundless 'tonifying.'

Active constituents and experimental exploration of 'raising'

In modern terms, the material basis decomposes into each herb's actives: astragalus's astragaloside and polysaccharides, ginseng's ginsenosides, atractylodes' volatile oil and polysaccharides, angelica's ferulic acid, and the triterpene saponins of cimicifuga and bupleurum. Pharmacology reports immunomodulatory, anti-fatigue, and smooth-muscle-tone-regulating effects on the gut and uterus. Early studies observed a 'selective excitatory' effect on uterine and surrounding tissue in vivo and in vitro, an effect prominent in preparations containing cimicifuga and bupleurum and weakened on their removal — a testable experimental footnote to the traditional 'raising' experience.

Hexadecanoic acid and other constituents extracted from the formula have been reported to promote proliferation of bone-marrow mesenchymal stem cells, and network-pharmacology studies attempt to sketch a 'multi-component, multi-target' tonifying-mechanism hypothesis. The caveat stands: these are largely in-vitro, animal, and computational — mechanistic exploration, not human proof, and animal experiments on 'raising uterine/intestinal tone' cannot be directly extrapolated to 'treating human organ prolapse.'

Evidence: what several systematic reviews show

The formula has systematic-review-level evidence in several directions, all needing careful reading. Respiratory: a 2016 systematic review and meta-analysis in Complementary Therapies in Medicine suggested that treatment improves clinical symptoms, exercise capacity, lung function, and quality of life in stable chronic obstructive pulmonary disease (COPD). Prolapse: a systematic review/meta-analysis (PMID 33031344) assessed the efficacy and safety of 'the decoction combined with surgery' for rectal prolapse — note the intervention is 'combined with surgery,' not monotherapy. Cancer support: a meta-analysis with network pharmacology (PMID 39564104) assessed the 'Buzhong Yiqi method' for cancer-related fatigue.

How to state it? First, most positive conclusions come from 'combined with conventional treatment' scenarios (such as combined with surgery or usual care), and cannot be extrapolated to 'monotherapy can replace.' Second, included studies often contain modified formulas, with variable sample size and methodological quality and often high heterogeneity. Third, different reviews address different disease populations and outcomes. The defensible statement is that, in specific disease populations and largely combination-therapy settings, a signal of improving certain outcomes was shown, with variable evidence quality needing high-quality RCT confirmation — not that the formula is proven to treat COPD, prolapse, or cancer-related fatigue.

Quality standards, patent medicines, and the Western-drug context

Astragalus, ginseng, atractylodes, angelica, tangerine peel, cimicifuga, bupleurum, and licorice are all Chinese Pharmacopoeia (2020) materials (astragalus by astragaloside and calycosin glucoside, bupleurum by saikosaponins). The market offers Buzhong Yiqi Pill, granule, and oral liquid, plus the Japanese Kampo Hochu-ekki-to granule; same-named forms may differ in ratio and process, and selection still requires differentiation.

As contextual overlap (relationship only, not an efficacy comparison): the formula's modern research settings (chronic fatigue, reduced digestive function, COPD, post-prolapse-surgery recovery) have no single Western-drug counterpart — they may be adjacent to categories such as prokinetics, bronchodilators/respiratory-rehabilitation drugs, and various symptomatic supportive treatments. This is adjacency of application only, never equivalence of constituents or efficacy. Ginseng, licorice, and angelica constituents carry reported interactions with hypoglycemic, antihypertensive, anticoagulant, and corticosteroid drugs, so combination requires professional assessment.

Safety boundaries: 'sweet-warm clears fever' most of all requires telling true from false deficiency

The formula's 'sweet-warm clears fever' targets the specific 'qi-deficiency fever' mechanism; if misused for repletion heat, yin-deficiency fever, or externally-contracted fever, the sweet-warm tonifying-raising approach may 'add fuel to fire' and worsen the condition — precisely the warning behind Li's 'distinguish internal damage from external contraction.' The formula most of all must not be used without telling true from false, deficiency from repletion. Angelica moves blood, so pregnant women should use with caution; ginseng should not be combined with veratrum or trogopterus dung; licorice at high prolonged doses may affect blood pressure and electrolytes; yin-deficiency-with-fire and repletion-heat patterns are unsuited.

On the boundary of use: rectal, uterine, and other prolapse should first have their nature and degree clarified by modern medicine (most organic prolapse needs specialist assessment and possibly surgery); fever of unknown origin, weight loss, and chronic fatigue must first have their cause established, excluding infection, tumor, and endocrine disease, rather than being self-treated long-term under 'boost qi, raise yang.' The formula is an excellent model for the wisdom of 'raise yang, lift the sunken' and 'sweet-warm clears fever,' but its clinical use belongs to professional differentiation.

A checklist for reading any formula article

1. Composition and preparation: does a stated effect come from Buzhong Yiqi itself, or from Shengyang Yiwei, Shengxian, or other relatives or a patent medicine? Are cimicifuga and bupleurum retained?
2. Pattern versus disease: has 'sinking of central qi' been equated directly with rectal or pelvic organ prolapse, or 'qi-deficiency fever' confused with external or repletion-heat fever?
3. Evidence tier and scenario: is the positive result 'monotherapy' or 'combined with surgery/usual care,' and a human RCT or animal/network-pharmacology work — with what quality and heterogeneity?
4. Safety and interactions: does it stress that 'sweet-warm clears fever' requires telling true from false deficiency, that misuse in repletion/yin-deficiency may worsen, and that organic prolapse and unexplained fever need medical evaluation first?
5. Dose and procedure: responsible education identifies the entity and stops short of individual dosing and modifications — prescriptions require a qualified physician and pharmacist.

Educational and academic reference only. It does not provide a diagnosis, prescription, dosage, or treatment recommendation. 'Sweet-warm clears fever' requires strict differentiation, and misuse in repletion or yin-deficiency fever may worsen the condition. Prolapse, fever of unknown origin, or weight loss should first be medically evaluated for nature and cause; consult a licensed physician and pharmacist for any prescription.