Huang Qi – Astragalus root – Milk-vetch

Nature: sweet, slightly warm

Enters: Spleen, Lung

Actions: Tonifies spleen Qi and Lung Qi; lifts spleen Qi (raises the Yang Qi of the spleen and stomach); tonifies defensive (Wei) Qi; protects/stabilizes the body surface and eliminates pathogenic factors from the surface; discharges pus; promotes tissue regeneration; promotes urination, relieves edema; regulates water metabolism; nourishes blood (via Qi); can connect the Lungs and spleen.

Indications:
• Lung and spleen Qi deficiency: poor appetite, loose stool, fatigue, shortness of breath.
• Spleen Qi sinking: chronic diarrhea, uterine bleeding, prolapsed rectum, stomach, or uterus.
• Wei Qi deficiency: spontaneous sweating, frequent EPI’s.
• Qi and blood deficiency: non-healing carbuncles, boils, post-partum fever; also used in recovery from severe loss of blood.
• Spleen failing to transform and Lung failing to dominate the water passages: edema, scanty urination, retention of water, dampness, obesity.
• Used often for wind-stroke (with Hong hua, Dang gui, Chuan xiong).
• When appropriate: for wasting and thirsting, paralysis, numbness of the limbs.
• Chronic ulcerations or sores due to deficiency that have formed pus but have not drained or healed well.
• Appropriately combined, it may be used for excessive sweating associated with Qi, Yin, or Yang deficiency.
• Its function to stabilize the exterior may be used to produce a therapeutic sweat when diaphoretics do not work.
• Vasodilator: lowers blood pressure.
• Compared to Dang shen and Ren shen, Huang qi focuses more on the superficial aspects of the Qi (especially Wei Qi), is better for warming and raising the Qi and tonifying the Qi to improve metabolism, whereas Dang shen and Ren shen focus more on the source Qi. Tonification is more complete when these substances are used together.
• Fry (dry or with honey) to focus the herb’s action on tonifying Qi and raising Yang (rather than securing the exterior, promoting urination, and reducing swelling).
Liu tends to use a minimum of 30g per day.
Michael & Leslie Tierra: When combined with Gan cao, it regulates blood sugar – useful for both diabetes and hypoglycemia.
Heiner Fruehauf: A supplement with an anti-Gu nature, possessing acrid, toxin-resolving qualities, useful in Gu Zheng (Gu parasites) formulas.
Botanical Influences on Illness: Enhances T-lymphocyte function, may enhance macrophage phagocytic function, increases NK cell activity.
Pearls From the Golden Cabinet: Unprocessed: fortifies the surface: will bring sweat if there is none (when the body is too weak to expel pathogens), and will astringe sweat if there is too much (by stabilizing the surface).
• Processed: produces blood, generates muscles, accelerate formation of (transformation of toxins into) and expulsion of pus – good for boils.
• Purely Yang in nature – best for the surface, Yang-collapse, weak eruptive force behind skin problems. Ginseng is more for water exhaustion and problems of Qi diffusion, while astragalus is more for fire exhaustion with the inability of Qi to reach the upper and outer regions of the body.
Hsu: Effective for nephritis, especially in treating proteinuria.
• Vasodilator, improves blood circulation to the skin, antibacterial, hypotensive, diuretic.
DY: Fills the interstices; secures the exterior; fluid and mobile.
• With Dang gui to supplement the Qi to strongly engender and transform blood, to effectively supplement the Qi and blood. For the following indications, wine mix-fried Dang gui and honey mix-fried Huang qi should be used. Also, the whole Dang gui root (Quan dang gui) or the body of Dang gui (Dang gui or Dang gui shen) should be used. The dosage of Dang gui for the following indications should be relatively low if there is Qi deficiency and weakness in the middle burner.
– 1. Delayed menstruation (a long cycle), postpartum weakness, agalactia due to Qi and blood deficiency. (Shi Quan Da Bu Tang)
– 2. Low-grade fever caused by blood deficiency. (Dang Gui Bu Xue Tang) Wu Kun of the Ming dynasty said, “When the blood is full, the body is cool. When the blood is vacuous, the body is warm.”
– 3. Sores and welling abscesses that do not heal, due to blood and Qi deficiency. (Tou Nong San)
– 4. Numbness of the limbs due to deficient blood not nourishing the sinews.
– 5. Various hemorrhages due to Qi not containing the blood within the vessels. (Dang Gui Bu Xue Tang)
• With Fang feng to supplement the defensive Qi without retaining external evils in the body, to drain external evils without damaging correct Qi and without causing perspiration, to secure the exterior, prevent invasion by external evils, and stop perspiration. This combination appears in Yu Ping Feng San for indications such as:
– 1. Spontaneous perspiration due to exterior deficiency.
– 2. Tendency to contract EPIs frequently due to defensive Qi deficiency.
Yu Ping Feng San should not be used to treat wind affections that are already established. This combination is too astringent once the evil Qi and the defensive Qi are already struggling. Its use might, in this case, retain the external evil inside the body.
– The pair Fang feng and Huang qi, when combined with Zhi ke, yields good results in the treatment of prolapse of the rectum, external hemorrhoids, flatulence, and abdominal distention. For rectal prolapse, the best approach is to add 3g Fang feng and 6g Zhi ke to Bu Zong Yi Qi Tang.
• With Dang shen to powerfully supplement the Qi, to effectively supplement the Qi of the middle burner and the exterior defensive. For specific indications and notes, see Dang shen in this category.
• With Fu xiao mai to supplement Qi, nourish the heart, clear heat, secure the exterior, and stop perspiration. For indications such as spontaneous sweating due to exterior deficiency. (Mu Li San) Use stir-fried Fu xiao mai.
• With Fu zi for mutual reinforcement, to supplement the Qi and warm the Yang, return Yang, secure the exterior, and stop perspiration. For indications such as cold spontaneous perspiration accompanied by aversion to cold, cold limbs, lassitude of the spirit, a pale tongue with white fur, a fine, weak pulse, and in severe cases, profuse sweating, loss of consciousness, and a minute pulse due to Yang deficiency or Yang collapse.
• With (Han) Fang ji to simultaneously drain and supplement, to support the correct Qi and drain evil Qi at the same time, to regulate the upbearing and downbearing of the Qi mechanism and strongly promote diuresis. For the following indications, the combination is found in Fang Ji Huang Qi Tang:
– 1. Edema due to wind-water with fever, fear of wind, edema predominantly in the upper body and face, joint pain, scanty urination, and a floating pulse. If wind attacks the exterior and blocks the Lung Qi, this causes a disturbance in the Lungs’ diffusing and downbearing function. Therefore, because the water passageways are not regulated, dampness is not moved downward. Thus, there is accumulation of dampness in the upper body and edema appears.
– 2. Rheumatic pain due to damp Bi with heavy limbs, joint numbness, and sometimes swollen joints.
– 3. Chronic nephritis and cardiac disease with edema due to Qi deficiency and accumulation of dampness.
• With Mu li to supplement Qi, constrain Yin, secure the exterior, and stop perspiration. For indications such as:
– 1. Spontaneous perspiration due to Qi or Yang deficiency. (Mu Li San) Use calcined Mu li.
– 2. Night sweats due to Yin deficiency. (This combination is appropriate for moderate Yin deficiency. In cases of deficiency fire, this pair cannot be used alone.)
– 3. Spontaneous and nighttime perspiration due to Qi and Yin deficiency. (Mu Li San) Use calcined Mu li.
Huang qi pi is outer bark of Huang qi. It has a greater affinity than Huang qi does for the exterior, and is more potent for securing the exterior, stopping perspiration, disinhibiting urination, and treating edema.
Subhuti Dharmananda: Astragalus root (huangqi) is a commonly used Chinese herb from the Fabaceae family (legumes). It belongs to the subfamily Papilionoideae, which is the source of several popular Chinese herbs, including licorice (gancao), millettia (jixueteng), sophora (kushen), and pueraria (gegen).

The applications of astragalus underwent dramatic changes during the past 50 years because of two medical concerns: the increasing use of chemotherapy for cancer, in which case herbs to counter the immune-debilitating effects were sought, and the rise of cardiovascular diseases (e.g., heart attack and stroke). For the former, the combination astragalus with ligustrum (nüzhenzi) was most publicized due to involvement of Western investigators; for the latter, the combination of astragalus with salvia (danshen) became well known.

A look at the use of astragalus before the influences of these modern trends is offered by Smith and Stuart (1), who reported at the end of the 19th century that astragalus was “in great repute as a tonic, pectoral [alleviates disorders of the lungs and chest], and diuretic medicine…every sort of wasting or exhausting disease is thought to be benefited by it.” At that time, a frequently occurring wasting disease involving the lungs was tuberculosis, and the herbal therapies usually included astragalus. The original description of astragalus in the Shennong Bencao Jing (ca. 220 A.D.) would be hardly recognizable for someone who learns of this herb from modern literature:

It mainly treats welling and flat abscesses and enduring festering sores by expelling pus and relieving pain, great wind lai disease [leprosy], the five kinds of hemorrhoids, and “mouse fistulas.” It supplements deficiency and is good for hundreds of diseases in children.

The herb was used to treat skin disorders, superficial swellings, and children’s ailments. The editors of the modern translation quoted here (2) no doubt felt compelled to offer some information that is more in keeping with the current applications of astragalus and added a footnote quoting from Wang Haogu, an herbalist of the Jin-Yuan reform period (3), more than 700 years ago: “Astragalus replenishes the defensive and, therefore, is a medicinal for the exterior. It boosts the spleen and stomach and, therefore, is a medicinal for the center. Since it is able to treat cold damage with the cubit pulse not arriving, it supplements the kidney origin and, hence, is a medicinal for the internal.” Through this explanation, astragalus is seen as a broadly useful tonic ingredient to include in prescriptions.

A substantial number of traditional formulas indicated primarily for tonification that come to us today contain astragalus, though it may be included as a small proportion of the prescription. As an example, in the tonic section of Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (4), over 80 prescriptions are listed, including four of the ones in the above table (Yupingfeng San is placed with astringent formulas instead); about one in four of all the tonic formulas contain astragalus as an ingredient.

Two of the traditional formulas with astragalus have been adopted for modern use as “immune enhancing” prescriptions, sometimes given to patients undergoing cancer therapies: Buzhong Yiqi Tang and Shiquan Dabu Tang.

IS ASTRAGALUS STRONG OR MILD?

Some practitioners may think of astragalus as a “strong” qi invigorating herb because of its frequent use in tonic formulas; however, most traditional sources place it in a mild to intermediate category. Yang Yifan, in her book on Chinese Herbal Medicines: Comparisons and Characteristics (5), displays a scale of strength of qi tonics and places astragalus well below ginseng, but slightly above codonopsis (dangshen). In the Advanced Textbook on Traditional Chinese Medicine and Pharmacology (6), astragalus is listed with two other herbs, ginseng and codonopsis, as tonics that have the similarities of replenishing qi of the spleen and stomach. As to differences, ginseng is described as being able to “replenish primordial qi potently,” codonopsis is described as have properties similar to ginseng but with much weaker effect, and astragalus is described as “consolidating superficial defensive qi.” So, in terms of qi tonics, ginseng is considered potent, codonopsis is relatively weak, and astragalus is somewhat stronger than codonopsis, but aimed at the surface defense while codonopsis and ginseng, act on the primordial (original) qi.

There are some characteristics that may be associated with mild versus strong herbs. Mild acting herbs have these qualities: low toxicity; low incidence of adverse reactions at normal dosage; and the normal dosage is relatively high. As a contrast to mild acting herbs, there are those that have notable toxicity (such as raw aconite), those that easily cause adverse reactions (such as rhubarb causing intestinal cramping or loose stool), and those that have significant effects at low dosage (e.g., the potent heating effect of zanthoxylum at just a gram per day). Astragalus clearly fits the category of mild-acting herbs. It has a gentle warming nature, a mild, sweet taste, and can be used in doses of 30 grams or more without adverse effects. Laboratory animal studies show virtually no toxicity with administration of very high oral dosage or even with injections (7).

ASTRAGALUS INGREDIENTS AND ACTIONS

After several decades of study, three groups of active constituents have become known for astragalus: flavonoids (which give the yellow color to the root slice), saponins (a common ingredient of plants in this family), and polysaccharides (long-chain polysaccharides with potential medicinal benefit mediated by white blood cells). The quantities of these components will vary depending upon the species of Astragalus used, as well as the growing conditions and other factors. No other potential active constituents have been found in significant quantities. Of course, there are many other components of astragalus root, but they are either ordinary components found in foods (such as carbohydrates and proteins) or ingredients that are present in such small amounts as to not contribute significantly to the effect of the whole herb preparations even when the herb is used at high dosage (e.g., sterols). Those who have used astragalus root in decoction recognize that it is a very fibrous root, for which most of the material remains behind in the dregs after prolonged boiling.

FLAVONOIDS

Astragalus contains small amounts of several flavonoids, primarily isoflavones, such as formononetin (see image, below) and its glucoside, ononin, which are metabolized in the body to yield the common legume flavonoid daidzein, an ingredient in pueraria and soy beans. Flavonoids are found in all higher plants, but some plants are rich sources of them. In fact, pueraria root has flavonoids as the primary active ingredient (aside from its starches that are soothing to the gastro-intestinal system). There are numerous potential beneficial effects of flavonoids (8), but when present in modest amounts, as is the case with astragalus, the primary effect is to benefit circulation. Other actions, that are noted for high doses of flavonoids, such as anti-allergy and anti-viral activity, would not be expected from astragalus extracts.

In one recent study (9) it was noted that “In the roots, isoflavonoid content was extremely variable, but reached 3.04 mg/gram, whereas flavonol content was 0.49 mg/gram.” Modern supplements that provide flavonoids such as quercetin for therapeutic benefit have several hundred milligrams making up a one day dose, while isoflavones in soy and clover (which are essentially the same as found in astragalus), are reputed to help with menopausal symptoms and have other benefits at doses of 60-180 mg or more per day. The combined isoflavonoid and flavonol content mentioned here (using the figure given for the maximum) is 3.5 mg/gram (0.35%), so that a 15 gram daily dose of astragalus in decoction would yield only about 50 mg of these flavonoids if all were extracted. This is a small amount, and most roots have lower levels of the flavonoids, typically less than 0.1%. In commercial extracts, standardization of astragalus root concentrate is for the product at just 0.4-0.5% of the main isoflavone, a tiny amount. The astragalus flavonoids contribute the yellow color seen in the central part of the roots, which is frequently used as a monitor of root quality (those with stronger yellow coloration are considered better quality).

In sum, though the flavonoids may contribute to a general beneficial effect of astragalus, their effects are probably minor until the astragalus dosage exceeds 15 grams, as is common in modern clinical practice in China, but not as herbs are usually prescribed in the West. In the book Chinese Drugs of Plant Origin (10), flavonoids are not included in the list of astragalus active constituents; only the saponins and polysaccharides are included.

SAPONINS

The saponins of astragalus include several called astragalosides (-oside indicates that it is a glycoside, that is, has a sugar attached to an active molecule, such as a pentacyclic compound usually found in saponins). In a study of astragalus roots from China, the saponin content was found to be from 0.019 to 0.184%, with astragaloside I as the main component (10); others consider that astragaloside IV is the main component (see image, below). When astragalus extracts are made and standardized for saponin content, a 0.5% saponin level is the most that is usually attained (one Chinese source indicates a range of 0.2 to 20% saponin content available). In a previous analysis of saponin-containing herbs, it was shown that to get substantial activity for these compounds one would need to administer doses of 60-900 mg (11). Based on a maximum root content of about 0.184% saponins, a 15 gram daily dose of astragalus might yield about 28 mg total saponins, a small amount. These saponins of astragalus, if they were given in sufficient quantity, may have properties of reducing inflammation, resolving phlegm, reducing platelet sticking, and promoting cardiac function.

Ginseng (renshen) is an herb that has saponins as its primary constituent, and good quality red ginseng roots can have about 4-5% saponins in the dried material; extracts may have up to 85% saponins. Thus, the ginseng saponins are easier to get in reasonable quantities. An herb that is used like astragalus for treating abscesses and certain other skin diseases is platycodon (jiegeng); it also relies on saponins as a key active component, but it contains even more saponin than ginseng, usually over 6% in the dried roots. A traditional formula for treating abscesses that relies on both astragalus and platycodon is Qianjin Neitou San; the formula also has saponins from ginseng and licorice.

In sum, the saponins in astragalus may be present in small enough quantities that they don’t provide much therapeutic effect on their own. However, when astragalus saponins are combined with saponins from other herbs in a formula, they may contribute to getting the necessary amount for the desired therapeutic effect.

POLYSACCHARIDES

The polysaccharides of astragalus, called astragalans, may be present in relatively large quantity. It is important to recognize that polysaccharides (long chains of sugars; see image of a repeating structure, below) are not soluble in alcohol, so are not present in tinctures or other alcoholic preparations; they are soluble in hot water, but the desired high molecular weight ingredients (20,000-25,000 daltons) may be only partially extracted from the herb under normal conditions. It is relatively easy to isolate polysaccharides by first using hot water extraction and then condensing these large molecules out of solution with alcohol. Commercial astragalus extracts have been standardized to 40-50% polysaccharides; some sources claim ability to provide 70-90% polysaccharides. These levels are as high as attained with mushrooms that are used specifically for their polysaccharides (typically 40% polysaccharides in the standardized extracts, but sometimes higher percentages). A reasonable estimate for the content of the dried roots is about 10% extractable medicinally active polysaccharides (in one of the most commonly used commercial astragalus extracts made by hot water extraction, the concentrated material has just 16% polysaccharide and 0.2% flavones). The crude powdered herb may be a better source of polysaccharides than a boiled preparation, but a polysaccharide rich extract is the most convenient means of getting high doses of this component.

In a previous analysis of medicinally active polysaccharides and their applications, it was shown that a daily dosage of 3.0-3.5 grams of these components would be reasonable to attain some level of immunological activity (12). A 30 gram dose of astragalus would have about this amount of polysaccharides. The polysaccharides have the reputation of enhancing immune functions and specifically in improving white blood cell responses; the large molecules probably stimulate the white blood cells to respond just as they might to saccharide chains on the surface of bacteria; there may also be a stimulation of white blood cell production by the bone marrow. Polysaccharides have been used, especially, in attempts to overcome the immune debilitating effect of radiation and chemotherapy as used in cancer treatments. In China, astragalus is most often used in doses of 15-30 grams per day in decoction for this application.

It appears that the polysaccharides are present in sufficient quantity that the high dosage astragalus preparations could affect the white blood cell activity.

DOSAGE AND EFFECT

The analysis of active constituents present above reveals that a dose of about 15 grams of astragalus, as frequently used in decoctions, may be sufficient to attain only some of the desired effects of the known active components, but that a 20-30 gram dose would be more suitable.

The Chinese Materia Medica recommendations for astragalus dosing are 9-15 grams/day (with the understanding that astragalus is to be used in formulas with other herbs); high doses of 30-60 grams are also suggested, at least for some applications (usually not specified). When dosing at or below 15 grams, an herbalist is counting on other herbs in a formula to contribute some similar active components in order to get the desired therapeutic action. Thus, for example, a decoction made with astragalus, ganoderma (lingzhi), and red ginseng would provide polysaccharides and saponins from all three herbs, and so long as the total dosing of these three ingredients was sufficient, then astragalus at 9-15 grams/day would be acceptable.

The formula Yiqi Congming Tang has three botanically-related herbs-astragalus, licorice, and pueraria-all contributing flavonoids and saponins, as well as having ginseng with additional saponins. Thus, astragalus is not the sole herb relied on for these active components. This formula is not used for immune enhancing purposes, so the limited amount of polysaccharides from other ingredients is not a concern.

Lower doses of astragalus would not be entirely ineffective, but the action would be limited. As an example, the polysaccharides can have benefits for the stomach (e.g., alleviating ulcers) at doses below that necessary to yield the general immunological effects, because of the direct action of the full amount of the herb ingredients on the stomach before being distributed throughout the body. Thus, pills with a relatively small amount of astragalus included will have this type of action from astragalus. Following absorption from the small intestine, the astragalus ingredients are diluted into a large volume of blood and some begin to be metabolized and eliminated after just a few minutes.

The recommended high doses of astragalus, at 30-60 grams per day (sometimes as high as 120 grams/day), are used in short-term therapies to get a stronger action of the herbs, and this dosage should yield a substantial effect from both the saponins and polysaccharides, with some effect also from flavonoids. It is not known if prolonged use of these higher dosages could be detrimental, but a reasonable caution would be to limit the duration to a few days at a time when needed, rather than a continuous therapy.

TRADITIONAL INDICATIONS FOR ASTRAGALUS

In the book Chinese-English Manual of Commonly Used Herbs in Traditional Chinese Medicine (13), five major actions and associated uses are given, as well as some miscellaneous new uses (item 6):

Invigorate qi and spleen (poor appetite, loose stools, fatigue, and bleeding).
Invigorate qi to activate yang (prolapse of stomach, uterus, or rectum)
Invigorate qi to strengthen the body (common cold in debilitated patients, profuse sweating due to weakness)
Relieve skin infection and promote tissue regeneration (abscesses, skin erosion, unhealthy wound); also for erosion of stomach lining (ulcer, atrophic gastritis)
Promote diuresis and relieve edema (spleen-deficiency type edema).
Miscellaneous new uses: diabetes, hemiplegia, asthma, and leukocytopenia (low white blood cells); astragalus is indicated for these disorders in cases of qi deficiency or qi and yang deficiency.

It is important for practitioners to distinguish between traditional indications (some of which are based solely on dogma and not on careful observation) and known effective actions (which might be confirmed through clinical trials). For example, it would be a mistake to think that a prolapsed organ would go back into place merely by taking some astragalus or by using this herb in a qi tonic formula. This indication for astragalus comes from three considerations:

A prolapse indicates muscular weakness; the muscles are ruled by the spleen qi, becoming weaker with reduced qi; astragalus is a spleen qi tonic.
A prolapse represents a falling of an organ from its place; the upward flow of qi is promoted by herbs that invigorate qi and yang, hence astragalus is appropriate in that its “direction” of action is upward against the fall of the organ.
Since a prolapse often produces a heavy sensation and fullness or swelling where the organ has moved, the syndrome is like one of moisture accumulation; herbs that remove dampness, such as astragalus, may help.

These theoretical reasons for using astragalus are consistent with Chinese medical theory, but there is no evidence to show that the appropriateness of astragalus in this instance corresponds to its effectiveness in alleviating prolapse. Indeed, in order to reverse prolapse non-surgically, one usually needs to strengthen the muscles surrounding the organ, which requires doing physical exercise. If taking herbs will, by whatever mechanism, improve one’s sense of energy and capability, then the person might undertake more exercise. That added activity would, in turn, control or reverse the prolapse through strengthening the muscles. If the herbs do not aid one in pursuing the physical activity, they would be unlikely to have any substantial impact on the prolapse, other than alleviating discomfort.

While an analysis of each of the claimed activities for astragalus is beyond the scope of this article, it can be said that those which directly affect digestion, such as treating low appetite, loose stool, stomach ulcer, and atrophic gastritis, may be partly explained by direct action of the ingredients on the lining of the stomach and intestine. Saponins and polysaccharides are likely to be the main active components, potentially of benefit in small doses in contact with the stomach lining. Resolving skin infections and erosion, aiding treatment of common cold, and promoting while blood cell function are actions that would require the higher dosages discussed above. Claimed diuretic effect of herbs is an area of some difficulty to interpret, as the drinking of decoctions is, in itself, a potential means of diuresis because of the fluid consumed. Further, the body’s elimination of the chemical constituents contained in the herbs and their metabolites is primarily by diuresis. A diuretic effect may be stimulated by high levels of such chemical compounds, with relatively little specific diuretic action of the herbs included in the therapy. Low dosage pills are unlikely to have much diuretic effect, both because of the low dose and because of the lower fluid intake (unless they are swallowed down with a large amount of water or tea).

Astragalus can be an effective agent, though one must give due considerations to its preparation and dosage according to the intended application, and the practitioner must be careful about interpreting indications that appear in the traditional literature.
Huang Huang:
I. Functions

  • A. Supplement qi, strengthen the exterior, dissipate edema.
  • B. Areas of function: metabolic system, immune system, cardiac and cerebralvascular system
  • C. Treats: sweating with edema, able to eat but lack strength
  • Caveat: too much Huang Qi causes distention, can exacerbate gallstones problems.
  • The taste of Huang Qi is bean-like, it is in that family; good quality is nice and soft; it has a 3000year history of use. In Shennon Bencao Jing it is a superior class herb. It is commonly used in China. Huang Qi vs. Zhi Huang Qi: Dr. Huang does not believe Zhi Huang Qi is more supplementing than Sheng Huang Qi; one can just use the unprepared, it is actually better. Dr. Huang feels only toxic herbs should be prepared.
  • Use: What do you use it for? Spleen and Lung qi xu, but in what situation, what symptoms and patterns?

II. Patterns

  • A. Sweating
  • 1. Spontaneous sweating: relatively severe with the clothes often becoming completely soaked and with sweat stains that sometimes have a yellowish color.
  • 2. May sweat worse when eating, with significantly more sweating from the upper portion of the body.
  • 3. In addition to spontaneous sweating in the daytime, may be night sweats, wake to find entire body soaking wet as if immersed in water.
  • 4. Sometimes does not manifest with a significant amount of spontaneous sweating. However, patient usually prone to some type of sweating: readily sweats on minimal exertion, history of spontaneous or night sweating.
  • B. Edema
  • 1. Generalized edema, but worse in the lower body.
  • 2. Easy to develop. These types after long flight feet would swell. If get fatigued, walk a lot, or have salty meal it is easy for them to develop edema.
  • 3. Mornings the facial swelling is worst, but by afternoon, lower legs are worst   4. In some patients, edema is not pronounced, but flesh is soft so they appear like they have edema.
  • 5. Because of accompanying edema, often a subjective sense of the body feeling heavy and uncoordinated. Associated with discomfort, joint pain, hard to walk, a lot of fatigue, athletes must clear fluid to be comfortable. Huang Qi promotes urination.
  • 6. May also be heaviness and pain in the joints.
  • Case History: Patient had generalized edema and asthmatic breathing. Physician gave him 120g Huang Qi with congee, patient urinated copiously, edema lessoned significantly. Edema in upper body eliminated, but foot remained swollen. Sent patient back home, another doctor gave him a purgative for swollen feet, all the swelling came back with fatigue. He was debilitated, doctors felt this was intractable, thought he would die. His wife realized he was still breathing, she made up the first formula, he started urinated again, and little by little he recovered. This first formula is used commonly and successful.
  • Case History: Fan Hou Case History (100 years ago) Post partum woman very edematous. Gave her this formula, which worked.
  • Case History Yue Mei Zhong, (modern doctor) also uses this for chronic nephritis, protein in urine.
  • This is also used for pediatric patients.
  • Huang Qi and Nuo Mi (glutinous rice) modifications:
  • Yue Mei Zhong recipe
  • Sheng Huang Qi 30,
  • Yi Yi Ren 30g,
  • Chi Xiao Dou 15g, [help with percolation]
  • Ji Nei Jin powder 9 [help digestion]
  • Nuo Mi (glutinous rice) 30g,
  • 600 ml water, first cook Huang Qi, take it out, put next two in for 30 minutes, than add last two, cook over low flame until like congee, this is one day dose.
  • Take a dry pressed kumquat (with sugar), helps to pass gas. This helps get rid of gas from large dosage of Huang Qi.
  • Dr. Huang thinks simple recipe is easier and better.
  • Case History: Hu Shi, Chinese studied in US, tried to promote Western culture in China. He disliked Chinese medicine. Then he got edema from diabetes and kidney disease and had heart problems. Went to Rockefeller Western Hospital, but didn’t help. Finally went to a famous old Chinese doctor. He was known as “Mongolian Physician” because used large dosages. [Further north, larger dosages.] He used of 300g Huang Qi. This fixed him up. People asked him, “What do you think now?” He replied that there was a need to find a scientific explanation.
  • Note: Water swelling must be in fleshy exterior of body. This is only the place Huang Qi moves water from, not for water in lungs or for ascites from hepatitis, it doesn’t work for water in chest and abdomen; don’t use for thin patients.
  • Example: Sun Yet San developed ascites from liver cancer. The question was whether to use Chinese or Western medicine. They wanted Hu to treat him. Hu gave him a very large dose of Huang Qi, but he just had a big belly, and was skinny otherwise. This just caused great distention. Hu lost his reputation over this.
  • In the Shang Han Lun, Huang Qi and Ren Shen are not used together. The reason is they go in different directions; Ren Shen is for thin patients with no fluid, lost fluids, Huang Qi for large patients with too much fluid. Ex: Bai Hu Jia Ren Shen Tang for big sweat after fever. Si Ni Jia Ren Shen Tang, for lots of sweat with no pulse, fatigue, use Gui Zhi Jia Ren Shen Tang. Bu Zhong Yi Qi Tang has small quantities of Huang Qi and Ren Shen, but here these have a different function, it is not classical. Ren Shen is good with Gan Cao, Mai Men Dong, all for thin people. It is also good with Bai Zhu.
  • C. Able to eat, but lacks strength
  • 1.Generally good appetite, able to eat large quantities of food without bloating or pain. •
  • 2. Unable to tolerate getting hungry, when hungry, will sweat, feel flustered, and feel a lack of strength
  • 3. Even after eating, feel weary and lack strength
  • 4. “Able to eat but lacks strength” is a symptom, but even more it represents constitutional state
  • Huang Qi will stabilize blood sugar, help people hold off hunger longer, and they will be able to eat less but have more energy. Fatigue may be a symptom, but may be part of the constitution. Using Huang Qi we may be treating the symptom as well as constitution.

III. Huang Qi Constitution

  • A. Tend to be overweight with soft and loose musculature, relatively damp and moist.
  • B. Complexion: dull yellow or dull red
  • C. Huang Qi Abdomen
  • 1. Abdomen is soft and loose
  • 2. Muscle atrophy and fat accumulation
  • 3. Flesh accumulates so navel sinks in
  • 4. Feels soft
  • 5. No pain
  • 6. Not tight
  • D. Good appetite and no pain or distention after meals
  • E. Some may have abdominal fullness, but more a feeling of sagging
  • F. Pitting edema in lower extremity
  • G. Skin in the area is dry and may be dark
  • H. Easily fatigued, copious sweating
  • I. Easily dizzy, short of breath
  • J. Feelings worse with exercise
  • K. Easily develop edema, especially in lower leg
  • L. Easily develop numbness in hands and feet
  • M. Easily develop infections and ulcerations

IV. Common Diseases

  • A. Cerebrovascular disease: hypertension, arteriosclerosis, coronary heart disease, angina pectoris, and basilar arterial insufficiency
  • B. Joint disease: herniated discs, cervical spine disease, bone hyperplasia, frozen shoulder, joint deformity
  • C. Metabolic disease: diabetes, obesity, elevated blood lipids
  • D. Allergic disease: allergic rhinitis, colds
  • E. Immune system disease: nephritis, anemia
  • Huang Qi is more for chronic disease, not so much for acute: there are seven prescriptions with it in the Jin Kui Yao Lüe, none in the Shang Han Lun. It has a strong connection to flesh, helps body produce more flesh. The Shennong Bencao Jing recommends it for non-healing sores. Surgeons use it to help heal cuts, help mm get force. Used for numbness and lack of strength in tissue. May be a performance-enhancing herb. For weight lifters and wrestlers, makes them stronger, Sumo wrestler is example, when water disappears, the mm are stronger.

V. Common Influencing Factors

  • A. Old age
  • B. Chronic disease
  • C. Exhaustion
  • D. Insufficient exercise
  • E. Poor nutrition
  • F. Reckless use of medicines

Huang Qi Gui Zhi Wu Wu Tang
I. Constitution

  • A. Dull yellow or red complexion, enlarged tongue that is dull purple, often middle-
  • aged or elderly
  • B. Easily fatigued, dizziness, SOB, asthma from exercise, chest oppression or pain
  • C. EKG shows lack of blood flow to heart
  • D. Generalized pain, numb limbs, lumber and leg pain
  • E. Edema in lower legs

II. Indications:

  • A. Commonly used for middle-aged and elderly patients with cerebrovascular disease and joint disease. The Shang Han Lun indicates it for painful bi, blood bi. Mostly joint pain. Was used a lot for upper class people, aristocrats, who were fatter, and who didn’t work much, and were therefore weaker, with weak mm, too much fat; when they moved they sweated easily, then exterior opened and wind would invade.
  • B. Chronic degenerative joint disease and diabetes: numbness, antonymic nervous system problems
  • C. For this formula, use in elderly, not kids. Sallow complexion, flesh hangs, Sob, pain, soft abdomen, good appetite, etc. Skin will be dry but swollen. Large dark tongue with greasy thick yellow coat. (see power point picture just before “explanation”) This not due to damp, but because the elderly eat soft food, and don’t have salvia, so the coat is not worn off. So ignore coat, look at body, dark, purplish. These kind of elderly can really eat.

III. Original formula dosages

  • Huang Qi 3 liang
  • Gui Zhi 3 liang
  • Shao Yao 3 liang
  • Sheng Jiang 6 liang
  • Hong Zao 12 pieces
  • Cook from 6 cups down to 2, take three times per day
  • A. Explanation
  • 1. Gui Zhi and Bai Shao is a famous combination to regulate ying and wei. To Dr. Huang, this means regulating the circulation: Gui Zhi dilates arteries, Bai Shao dilates the veins, so circulation is increased. These two work systemically, esp. when combined with Huang Qi.
  • 2. Sheng Jiang: Don’t underestimate the importance of Sheng Jiang. Here in the originally formula used 6 liang, double of others. It promotes peripheral circulation, warms the body, can induce sweating, dispels wind and cold, and can unblock blood impediment. Patients should keep warm after taking it and can use Sheng Jiang in food regularly. Must not wear shorts, lower legs must be covered. Careful, can’t use too much or bloating. (If bloating, the first consideration is are they Huang Qi type?) But if correct, they will bloat but will feel good. You can add lemon, Chen Pi, citrus eaten during day. Use preserved orange peel to keep digestion going.

IV. Dr. Huang’s dosage

  • Huang Qi 30
  • Gui Zhi 15
  • Chi Shao 15
  • Sheng Jiang 15
  • Hong Zao 20g
  • Water decoction: For acute must use full dosage, but for chronic, or for long-term use, one can use less. This tastes good and so patient compliance is high. One can use less for cheap patients or with granules.
  • A. Modifications:
  • 1. Dr. Huang adds Ge Gen up to 30g [equal to Huang Qi] and Chuan Xiong 15 [up to Gui Zhi dose]. Ge Gen raises yang, why use it for hypertension? Ge Gen raising the clear qi, not evil qi. When the clear doesn’t rise one has dizziness etc., due to insufficient circulation to head. These increase blood supply to brain. Also these people have tight nape of neck and further back, an indication for Ge Gen. When blood pressure decreases this feels better. Need to use large dosages to lower blood pressure. Chuan Xiong for HA.
  • 2. Add Ge Gen and Chuan Xiong for cervical spine disease, from head to lower back spine use Niu Xi,.
  • 3. Add Chi Shao, Huai Niu Xi, Dan Shen, Shi Hu for lower leg numbness from diabetes
  • 4. Add Shao Yao Gan Cao Tang and Ma Huang Fu Zi Xi Xin Tang for sciatic pain, severe lower leg pain, and difficulty walking.
  • 5. For distention, citrus eaten during day. Use preserved orange peel to keep digestion going.

V. Classical formula pattern

  • A. In Blood Impediment, yin and yang are both faint, cun and guan are both faint, while the chi is a little tight, the exterior symptoms show numbness on the skin, just as Wind Obstruction, and Huang Qi Gui Zhi Wu Wu Tang governs.
  • B. Explanation:
  • 1. Blood impediment: ancient disease name,
  • 2. Symptoms: inflexible joints, muscle aches
  • 3. Occurs often in patients who are well fed, who lack physical exercise, are fleshy, lack physical strength, fatigued easily, sweat easily
  • C. Common Diseases
  • 1. Hypertension
  • 2. Atherosclerosis
  • 3. Basilar artery insufficiency
  • 4. Strokes
  • 5. Head aches, fatigue, dizziness.
  • Case History: End stage hypertension
  • Shen, 62, BP: 180/100 even though he takes lots of pharmaceuticals (12-15 pills per day.) Swollen leg, soft belly, good appetite. Big nose, big lips. Hematuria (+++). Renal disease and leg pain from diabetes, lower leg edema. Dizzy, very tired, low back sore, dry mouth, swollen tongue with slimy fur in center.
  • Huang Qi 60 (minimum 30g some use 120)
  • Rou Gui 6g (add last)
  • Gui Zhi 10
  • Chi Shao and Bai Shao15g
  • Huai Niu Xi 30
  • Shi Hu 30
  • Dan Shen 12g
  • Ge Gen 30
  • Gan Jiang 6
  • Hong Zao 20g
  • After two months BP stable at 140/80. No fatigue, legs had strength, no LBP, etc.
  • Case History Multiple problems
  • 63 year old man 2004 March
  • 1.Pituitary tumor 2.Severe sleep apnea 3.Mesangial proliferative glomerulonephritis
  • 4.Diabetes 5.Hypertension. Hematuria(+++) As of 2005 November: 180/100mmHg
  • BP. Medication for HTN ineffective.
  • Symptoms: Dizziness, as if drunk or feverish, fatigue, low back soreness, dry mouth,
  • soft loose abdomen, strong appetite, enlarged tender tongue with slimy fur in center
  • Formula:
  • Huang Qi 60g
  • Rou Gui 6g (add last)
  • Gui Zhi 10g
  • Chi Bai Shao each 15g
  • Huai Niu Xi 30g
  • Shi Hu 30g
  • Dan Shen 12g
  • Ge Gen 30g
  • Gan Jiang 6g
  • Hong Zao 20g.
  • After more than two months, BP stable at140/80 mmHg. No fatigue, lower legs have strength, no low back soreness, good complexion.

VI. Cardiac diseases

  • Angina pectoris: This is chest bi, easily sweat with activity, swollen legs. One can at least reduce symptom severity and frequency. Add Ge Gen Chuan Xiong Dan Shen, Shi Hu and Huai Niu Xi. For cardiac diseases, one must add Rou Gui in a large dose. Usually more than 20 g . One can use Rou Gui and Gui Zhi together. For these cases substitute Chi Shao for Bai Shao.
  • Case History: Cardiac disease
  • Mr. Wang, govt. official, 58, Nov 2004. Very stressful life, smoke and drink a lot. Had heart attack, did bypass. After surgery, fat, can’t walk, tired, SOB, palpitations. Chief complaint: palpitations and chest oppression for ten years, exercise-induced asthma for 3 years. On oxygen. In 2002 coronary artery bypass surgery; 2004 polymyositis. Frequent weakness in extremities, minimal activity brings on palpitations and SOB. Only able to walk for short stretches. On oxygen for 5 hours a day. Tranquilizers and oxygen before bed. Life activities very limited.
  • Formula:
  • Huang Qi 80
  • Gui Zhi 20
  • Rou Gui 10 (put in at end)
  • Chi Shao 40
  • Bai Shao 20
  • Dan Shen 20
  • Dan Pi 12 for psoriasis
  • Tao Ren 20
  • Huai Niu Xi 60
  • Zi Cao 20
  • Sheng Jiang 4 pc
  • Hong Zao 20
  • Water decoction, take twice a day. Advised to increase exercise as possible.
  • Wang continued on basic formula until 2005 (over 300 packs). Increased physical activity significantly and exercising every day, strength in the extremities, no shortness of breath or palpitations, no breathing difficulty, spirit significantly improved. He lost 18 pounds. However, even though he had quit smoking when he had his operation and led a less prodigal life, last year he died of lung cancer.
  • Case History: Spontaneous sweating in cardiac disease
  • Mr. Jiang, 80,2008 February. Many years of hypertension and heart disease, sweats easily with even minimal activity, copious sweat, after sweating feels cold, cough. Hospitalized for heart disease- improved, but sweating persisted. Relatively strong body, moist skin, asthmatic, lower leg edema, enlarged tongue, pale tongue, floating large pulse
  • Formula:
  • Huang qi 60g
  • Gui Zhi 15g
  • Rou Gui 10g
  • Chi Shao 15g
  • Gan Jiang 10g
  • Hong Zao 30pc
  • 5 packs.
  • After one week, patient said: “Sweating very much better, easier to climb stairs”
  • Dr. Huang increased Huang Qi to 100g, no other changes. After 10 more packs, there was continued improvement.

VII. Musculoskeletal diseases

  • A. Lumbar disc herniation, cervical spine disease, bone hyperplasia,
  • frozen shoulder
  • B. Body pain, weakness, stiffness, difficulty with movement, muscular atrophy
  • C. Modifications: Add Huai Niu Xi, Ge Gen, Bai Zhu
  • Case History: Lumbar spinal stenosis
  • 39 year-old woman: 3 years of numbness and pain in lower extremities, lumbar pain for six months, when fatigued feels as though walking on cotton, knee pain, lameness, low back pain worse with weather changes, dull pale-red tongue, thin moist fur, soggy pulse, spinal stenosis and disc protrusion (L4-5)
  • Formula:
  • Huang Qi 30g
  • Gui Zhi 12g
  • Bai Shao 12g
  • Da Zao 15g
  • Sheng Jiang 40g
  • Bai Zhu 12g
  • Gan Cao 10g
  • Fu Ling 30g
  • 5 packs.
  • After two packs, feeling of heat in back, feeling of qi moving down to feet,
  • subjective symptoms improved. After 5 more packs, even though weather changes, low back not painful, only slight numbness in legs but no pain, knees achy with fatigue but not painful, feeling of walking on cotton very reduced. Continued for 5 more packs

VIII. Other diseases
A. Vascular obliterans. arteritis; peripheral vascular disease: For these add Si Miao Yong An Tang: Dang Gui, Xuan Shen, Jin Yin Hua, Gan Cao.
B. Chronic kidney disease, uremia [because of edema] For people who must use dialysis, or may be able to delay dialysis. Huang Qi Gui Zhi, Bai Shao, have a diuretic effect, but also increase circulation to kidneys, help kidney function.
C. Post-stroke: Can combine with Bu Yang Huan Wu Tang.
D. Diabetic peripheral neuropathy: Numbness of the limbs, decrease in sensation. One can combine this with Si Wei Jian Bu Tang: Huai Niu Xi, Chi Shao, Shi Hu, Dan Shen.
E. Varicose veins: Combine with Gui Zhi Fu Ling Wan.
F. Diabetes: Most patients have a good appetite but are weak, with peripheral neuropathy, sores, hypertension, renal failure, heart problems. This is probably for type 2 diabetes.
Add Ge Gen, Chuan Xiong that reduce blood plasma glucose level. This has cerebral protective effects, heart protection, kidney protection. Makes body work better, lowers hunger.
G. Post-partum disease: spontaneous sweating or night sweating, generalized pain, numbness in the hands, atrophy in the legs
H. High fever or colds in the elderly
Case History: High fever of unknown origin
90 year-old man with diabetes, Parkinson’s, atrial fibrillation, and BPH, but mentally clear and physically fit. Previous spring, high fever with cold shivers, had septicemia, after using antibiotics the fever lowered, but then spiked again, he tried this several times with the same results. Happened once a month. Hospitalized and on various meds but no resolution. Current exam: hand trembling, legs unsteady, swollen legs, thick dry tongue fur, dull pale tongue, lower extremity edema, moderate pulse with occasional irregularity
Formula:
Huang Qi 60g.
Gui Zhi 10g.
Rou Gui10g.
Chi Shao 10g.
Bai Shao 10g.
Gegen 60g
Gan Jiang 10g.
Hong Zao 20g.
Water decoction, one bag for 2-3days.Take for 3 months.
From the time began herbs, temperature was normal. After 3months, no more fevers. Had ringworm of the nails that also resolved.

Fang Ji Huang Qi Tang
I. Indications

  • A. Traditionally used for lower extremity edema with soft, loose flesh and lack of strength

II. Original formula dosages

  • Han Fang Ji 4 liang
  • Gan Cao 2 liang
  • Huang Qi 5 liang
  • Sheng Jiang 3 liang
  • Bai Zhu 3 liang
  • Strongest for promoting urination, effective for pain. For a Huang Qi constitution, urination will increase to varying degrees. Dosage of Huang Qi and Fang Ji (30-60g each per day) must be large, Gan Cao very small, but this is original rx, don’t take Gan Cao out completely. Fang Ji important for joint pain in lower extremities, arthritis and gout, promotes urination, important for edema. Use large quantities.
  • Bai Zhu also promotes urination, expels water from whole body including interior.

III. Classical formula pattern

  • A. Original wind water
  • 1. Edema from waist down, heavy feeling in body.
  • 2. Copious sweating, aversion to wind, floating pulse.
  • 3. Joint pain, low back, knees, ankles, difficulty walking.
  • 4. This is wind water: the floating pulse indicates the exterior. The person may sweat from the head. No other exterior disease. The disease includes heaviness in the lower body. From the lumbar up, all is well. From the lumbar down is edematous and inflexible.
  • B. Important symptoms
  • 1. edema that is more distinct from the lumbus down and heavy body
  • 2. sweating and aversion to wind
  • 3: joint pain, especially knees and ankles, may also be heaviness in the joints, inhibited movement, and inflexibility

IV. Dr Huang’s dosages

  • Han Fang Ji 15g
  • Gan Cao 3g
  • Huang Qi 30g
  • Sheng Jiang 10 pc or Gan Jiang 10g
  • Bai Zhu 15g
  • Hong Zao 20g

V. Diseases

  • A. Idiopathic edema, common in women, may combine with Wu Ling San, very effective. Hormone function of client is OK. Get lots of urine. May need to add Yue Bi Tang from Jin Kui Yao Lüe. Ma Huang with Huang Qi potentiate each other.
  • B. Musculoskeletal problems: arthritis of joint with deformity, rheumatoid and rheumatic arthritis, gouty arthritis, lower edema often present. If there is pitting edema, will probably work.
  • C. Lumbar disc herniation: can use with Huang Qi Gui Zhi Wu Wu Tang plus Huai Niu Xi
  • D. Gout: add Wu Ling San, this helps excrete uric acid, basic for gout.
  • E. Hypertension In cases with dull yellow complexion, edema in the lower limb, add Ge Gen, Huai Niu Xi, and Ze Xie . Use a very low dosage of Gan Cao if at all. If using Gan Cao one must add Ze Xie to counteract it.
  • F. Various diseases described in case histories below: intractable knee pain, lower body sweating, obesity, diabetes, diabetic ulcerations on lower extremities, body odor, and excessive sweating.
  • Case History: Intractable knee pain
  • Ms. Zhao, 54; multiple year history of bilateral knee pain that did not respond to acupuncture, tui na, herbs, Western meds, and Chinese herbs. Lower leg edema and knee tissue felt soggy, lack of strength, sweating, overweight, pale complexion, loose stool,
  • some redness in the legs. This was a very difficult case, there wasn’t much hope. She was Huang Qi constitutional type, overweight, sweat easily, etc.
  • Formula:
  • Fang Ji 10
  • Huang Qi 30
  • Bai Zhu 25
  • Gan Cao 3,
  • Sheng Jiang 2
  • Da Zao 10
  • Niu Xi 30
  • Dan Shen 15
  • Shi Hu 12
  • Chi Shao 15
  • Ze Lan 10
  • Ze Xie 10
  • Di Long 6
  • 7 packs.
  • Commentary: This was a case of a student of Dr. Huang. The first formula is the classical one, the next 4 additions are those of Dr. Huang’s for the legs, the last additions are those of the student. 2nd visit: edema and pain both reduced. He added Mu Li and Lu Xian Cao. After 14 packs all symptoms reduced, including sweating.
  • Case History: Sweating
  • 33 year-old man had surgery for tibial fracture and ligament tear. After had abnormal sweating from the same leg and pain. Patient well-built, skin of left leg was darker and sweat was copious, so pants and socks were wet. Dull red tongue with thick slimy yellow fur. Pulse small, soft, and slightly rapid. They tried Si Miao San plus Qin Jiao, Wei Ling Xian, and Wei Mao. This helped with pain, but sweating was mostly the same. The sweat was copious, but not foul-smelling, tongue fur had become thin.
  • They changed the formula to: Fang Ji Huang Qi Tang
  • Fang Ji 10
  • Huang Qi 12
  • Cang Zhu 10,
  • Zhi Gan Cao 5
  • Sheng Jiang 4 pc
  • Hong Zao 3 pc.
  • After 3 packs, sweating reduced. Added Wei Ling Xian 15 for 4 more packs.
  • Case History: Obesity
  • Ms. Wang, 46, last year after her period came found she had gained 8 kg. Symptoms included shortness of breath, copious sweating that was worse with exercise, heaviness of the limbs, lack of mental clarity, poor appetite, hypersomnia, loose stools, easily caught cold. Pale enlarged tongue with tooth marks and a white slimy fur. Slippery pulse.
  • Formula:
  • Fang Ji 60
  • Huang Qi 60
  • Bai Zhu 30
  • Cang Zhu 15
  • Fu Ling 15
  • Ze Xie 15
  • Jiao Shan Zha 20
  • Yin Chen Hao 20
  • Gan Cao 6,
  • Chen Pi 10
  • The patient was extremely obese so needed very large dosages. Upper body sort of OK, but middle body big and legs swollen with pitting edema. Can add Wu Ling San.
  • Case History: Diabetes
  • (This has not been translated, see the power point) Report from Japan, 11 cases of overweight diabetic patients. Used granules for six months, blood sugar, cholesterol, glyiscerides improved with significant weight loss.
  • Case History: Diabetic ulcerations on lower extremities
  • (See power point and picture) Report from Japan Edo period. Ulcers can go to bone, clear pus coming out, loose flesh, but with edema. We see this today. Need large dosage of Huang Qi to reduce swelling and generate new flesh. Dr. Huang would use this and his 4 herb addition.
  • Case History: Body Odor
  • Formula:
  • Fang Ji 30
  • Huang Qi 30
  • Bai Zhu 15
  • Gan Cao 6
  • Sheng Jiang 9
  • Da Zao 20
  • Used to treat 12 cases of body odor, all cured in 2-6 months. Report of 15-year case of body odor, patient obese, soft loose flesh, underarm sweating copious, fatigue.
  • After 2nd day on this formula, large amount of urine and sweating reduced. Symptoms gradually abated.
  • Case History: Excessive sweating
  • 24 year-old woman with excessive armpit sweating that stained her clothing yellow and was foul-smelling. Worse around period and in summer. Reduced taste, poor appetite, fatigue, loose stool, late period with pale blood, obese, liked to eat rich foods, pale tongue with turbid white fur, floating slippery pulse.
  • Formula:
  • Fang Ji 30
  • Huang Qi 30
  • Bai Zhu 15
  • Cang Zhu15
  • Fu Ling Pi 20
  • Ze Xie 20
  • Che Qian Zi 12
  • Che Qian Cao 12
  • Gan Cao 6
  • After more than 20 packs, was cured. Used Fang Ji and Huang Qi up to 60g. This can be used for underarm sweating, especially in summer. Effective because reduces sweat? Odor itself hard to deal with, but reducing sweating helps the situation.

VI. Constitution

  • A. Copious sweating, easily sweating, sweat is yellow and/or foul-smelling
  • B. Edema, especially in the lower extremity, often accompanied with knee pain
  • C. Large, soft abdomen, buttocks and legs soft and saggy
  • D. Common in middle-aged and elderly women

VII: Explanation

  • A. The formula promotes urination. Huang Qi constitution: person is like a bag of water. After using this formula, urination will increase to varying degrees.
  • B. Dosage of Huang Qi and Fang Ji must be large (60 g or more), but Gan Cao should be small ( 3-6 g).

Yu Ping Feng San
I. Indications

  • A. Traditionally used to consolidate the exterior and stop sweating
  • B. Used for fatigue, spontaneous sweating, aversion to wind

II. Original formula dosages

  • Fang Feng 1 liang
  • Huang Qi 1 liang
  • Bai Zhu 2 liang

III. Dr. Huang’s dosages

  • Huang Qi 15g
  • Bai Zhu 20
  • Fang Feng 15
  • Cook in 1000ml of water for 40 minutes to get 2300 ml. Divide and take 2-3 doses. Can also be used as a powder

IV. Constitution

  • A. Layered over normal Huang Qi type: sweat easily, aversion to wind, easily, allergic, nasal congestion, cough or asthma, colds, easily becomes itchy, i.e. more respiratory problems than previous rx.
  • B. Easily has diarrhea or stool that is not fully formed
  • C. Easily develops edema, especially in the lower leg

V. Suitable Diseases

  • A. Copious sweating following chemotherapy or radiation for cancer: use with Zhen Wu Tang and Huang Qi Gui Zhi Wu Wu Tang for low-grade fever and copious sweating following chemo for myeloma
  • B. Post-surgical abnormal sweating :with Huang Qi Gui Zhi Wu Wu Tang for
  • sweating or slow wound healing after appendectomy.
  • Case History: Myeloma
  • Dr. Huang’s patient had many myelomas, very difficult therapy. She was very afraid of cold, sweating, fever. She said was done with chemo, not afraid to die, used Yu Ping Feng San with 60g of Huang Qi, plus Zhen Wu Tang and Gui Zhi. [and Huang Qi Gui Zhi Wu Wu Tang?.] After a week much better. Continued to treat her, she also had proteinuria from chemo damage, gave her that congee formula. She recovered.
  • Case history: Post surgical abnormal sweating.
  • Abdominal surgery, wound not healing, lots of sweating, added Huang Qi Gui Zhi Wu Wu Tang to get wound to close.

VI. Other Diseases

  • A. Pediatric diabetes: may add Gou Qi Zi to keep insulin stable
  • B. Recurrent respiratory infections in children or the elderly: can be considered like Chinese medicine gamma globulin
  • C. Pediatric allergic rhinitis
  • D. Chronic kidney disease: Use with Zhen Wu Tang and Huang Qi Gui Zhi Wu Wu Tang for proteinuria from chronic nephritis
  • E. Also for diabetic kidney disease and copious sweating in diabetics
  • Case History: Fissures in the skin of the hands and feet
  • Elderly farmer with cracked skin on hands and feet for months that were itchy and painful, severely affecting life quality. He was yellow and swollen.
  • Formula: Yu Ping Feng San plus Huang Qi Gui Zhi Wu Wu Tang with Huang Qi @ 60g
  • After 2 packs, no more itching or pain. After one week, fissures had healed. After 2 weeks, skin was healthy looking.

VII. Explanation

  • A. Small dosage, long duration.
  • B. According to Yue Mei Zhong: treated a patient for exterior deficiency with spontaneous sweating using large dose in decoction. After 3-5 packs, symptoms stopped. Then recurred and same formula again produced effect. Then recurred
  • again. Seemed like formula could not produce lasting effect. Saw Pu Fu Zhou
  • treat a similar pattern with powdered formula, 9 g per day, taken for 1 month.
  • Sweating stopped and did not recur.

VIII. Yu Ping Feng San vs. Huang Qi Gui Zhi Wu Wu Tang

  • A. Both formulas treat spontaneous sweating
  • B. Yu Ping Feng San: immune system irregularity, diarrhea, yellow complexion, edema, respiratory and kidney diseases common, more common for pediatrics
  • C. Huang Qi Gui Zhi Wu Wu Tang: irregularity in neurovascular system, muscle pain, dizziness,
  • palpitations, dull purple tongue, vascular and joint diseases common, more common for elderly

IX. Yu Ping Feng San vs. Fang Ji Huang Qi Tang

  • A. Both treat copious sweating and edema
  • B. Yu Ping Feng San: fear of wind, nasal congestion: problems related to respiratory system: wind in the upper
  • C. Fang Ji Huang Qi Tang: lower extremity joint pain: damp in the lower

X. Fang Feng

  • A. Fang Feng is very useful:
  • 1. Joint pain with Bai Shao , Gan Cao, Qiang Huo, for joint pain, both arthritis.
  • 2. Itching, anti-allergic, with Chai Hu and Jing Jie and Bo He to work like this. Pollen allergies, itchy.
  • 3. Immune system disorders with Huang Qi, Bai Zhu and can add Chai Hu. Xiao Chai Hu Tang, Shan Yao Gan Cao tang + Fang Feng is especially good for liver disease. Sjogrens, autoimmune disease, since Fang Feng acts on the immune system.
  • 4. Abdominal pain, Tong Xie Yao Fang, with Bai Shao, Chai Hu , Gan Cao.

Eric Brand on Raw vs Processed Huang Qi:

Huang Qi was initially processed by simply discarding the “neck” of the root, a practice that dates back to the Jin Gui Yao Lue (“Essential Prescriptions from the Golden Cabinet”). Steaming was added a few centuries later in the Lei Gong Pao Zhi Lun (“Master Lei’s Treatise on Drug Processing”). Honey-processing for Huang Qi developed in the Song dynasty (960-1280 CE). Other adjuvants for Huang Qi processing came later, such as wine, ginger juice, rice water, and even human breast milk. Today, the two most popular forms of Huang Qi on the market are the crude form and the honey processed form.

Honey-processed Huang Qi is made by mixing purified honey with water (in Chinese medicine, honey is often boiled before use to make “purified honey,” known as Lian Mi). The water-honey mix is used to briefly soak the Huang Qi, and then the Huang Qi is dry-fried until it becomes deep yellow and is no longer sticky. A toaster oven is often used in the modern day; the honeyed astragalus is simply baked at a low temperature until it becomes deep yellow and dry.

Unprocessed Huang Qi, called Sheng Huang Qi or simply Huang Qi, is the best form for boosting the defense qi to secure the exterior. It is also preferred for drawing toxin and engendering flesh. Finally, unprocessed Huang Qi is best for disinhibiting urination to reduce swelling. It is generally used for spontaneous sweating or the tendency to catch common colds easily due to insecurity of the exterior with weak defense qi (wei qi). It is also indicated for qi vacuity patterns of water swelling and for flat- and welling-abcesses that fail to rupture or rupture and fail to close. Exemplary formulas include Yu Ping Feng San (Jade Wind-Barrier Powder), Fang Ji Huang Qi Tang (Fangji and Astragalus Decoction), and Tou Nong San (Pus-Outthrusting Powder).

Honey-processed Huang Qi, called Zhi Huang Qi, Mi Huang Qi or Huang Qi (Mi), tends to be moistening and is best for boosting qi and supplementing the middle burner. It is used for spleen-lung qi vacuity with reduced food intake, sloppy stool, shortness of breath, and lack of strength. It is also indicated for center qi fall manifesting in enduring diarrhea, rectal prolapse or uterine prolapse. For bleeding due to spleen qi failing to contain the blood, the honey-processed form is also preferred. Exemplary  formulas include Gui Pi Tang (Spleen-Returning Decoction) and Bu Zhong Yi Qi Tang (Center-Supplementing Qi-Boosting Decoction).

Jiao Shu-De sums up the differences succinctly in his Ten Lectures on Medicinals text: “used raw, Huang Qi moves in the exterior…used mix-fried its emphasis is on the interior.” Despite these stated differences and the emphasis from pao zhi texts, there are a few discrepancies around. For example, multiple pao zhi texts state that the action desired for the formula Yu Ping Feng San is best accomplished with the crude product, but the original source text for the formula specified honey-processed Huang Qi.

Link to Thorne Monograph

 

Dose: 9-60g

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