Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)

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Indications

Western Uses:

• What conditions is Bu Zhong Yi Qi Tang used for in modern practice?

  Bu Zhong Yi Qi Tang raises "sunken" middle qi — the Spleen-qi deficiency and organ-prolapse pattern — so it is referenced for a broad set of prolapse, fatigue, and chronic-deficiency conditions: gastric prolapse (gastroptosis), rectal and uterine prolapse, functional uterine bleeding, myasthenia gravis, recurrent miscarriage, chronic bronchitis, chronic vaginal discharge (leucorrhoea), chronic hepatitis, corneal ulcers, cerebral arteriosclerosis, pernicious anaemia, leukopenia, and chronic nephritis.

  The unifying thread is the TCM sinking-qi / qi-deficiency pattern, not any single diagnosis — which is why the list spans so many systems. Organ prolapse, abnormal uterine bleeding, myasthenia gravis, the anaemias, and kidney or liver disease all require medical diagnosis and management; this formula is a traditional adjunct to that care, not a substitute. Traditional-use correlates only, not a treatment claim.

  Source: Sacred Lotus sources & references (pattern) + Bensky & Barolet, Formulas & Strategies; biomedical correlates as reference only. Not medical advice.

Originally Appeared In:

• Discussion of the Spleen and Stomach (Pi Wei Lun)

Notes:

• How is Bu Zhong Yi Qi Tang different from Ju Yuan Jian and Sheng Xian Tang?

  All three formulas raise sunken qi around a Huang Qi/Ren Shen core, but they diverge in scope and in exactly which herbs are kept or dropped.

  • vs Ju Yuan Jian (Lift the Source Drink, Zhang Jing-yue): a pared-down five-herb formula — Ren Shen, Huang Qi, Bai Zhu, Gan Cao, and Sheng Ma — that omits both Dang Gui and Chai Hu. It is used for more urgent qi collapse with profuse uterine bleeding ("qi failing to hold blood"), where Dang Gui's blood-moving quality and Chai Hu's more vigorous, dispersing lift are traditionally considered less desirable than Bu Zhong Yi Qi Tang's broader, gentler tonify-and-raise action.
  • vs Sheng Xian Tang (Uplift the Sinking Decoction, Zhang Xi-chun, early 20th century): a later formula built on the same Huang Qi + Sheng Ma + Chai Hu logic but adding Zhi Mu (to balance Huang Qi's warmth) and Jie Geng (to "carry" qi upward via the Lung), without Ren Shen, Bai Zhu, Dang Gui, or Chen Pi. It is generally reserved for more acute or pronounced qi-collapse presentations (e.g., marked shortness of breath with a sensation of qi sinking), while Bu Zhong Yi Qi Tang remains the standard formula for chronic, broader Spleen-qi deficiency with sinking.

  What is the classical source of Bu Zhong Yi Qi Tang?

  Bu Zhong Yi Qi Tang was devised by Li Dong-yuan (Li Gao, 1180–1251), a physician of the Jin-Yuan era and founder of the Spleen-Stomach school, as the flagship formula of his "yin fire" theory — that internal fever can arise from qi collapse itself, not only from external or excess heat.

  Secondary sources differ slightly on the exact originating text: most formula compendia (e.g., Bensky & Barolet) attribute it to Li Dong-yuan's Pi Wei Lun (Treatise on the Spleen and Stomach, 1249); a number of other references instead date its first appearance to his earlier Nei Wai Shang Bian Huo Lun (Clarifying Doubts about Damage from Internal and External Causes, 1247). Both are works by the same author, two years apart, within the same Spleen-Stomach doctrine, so this reads as a bibliographic variant between sources rather than a substantive dispute about the formula itself.

  Japanese Kampo lineage: the same formula is known in Japan as Hochuekkito (TJ-41), used clinically for fatigue, weakness, and immune support; commercial Kampo preparations sometimes add Sheng Jiang (ginger) and Da Zao (jujube) to the core eight herbs, so composition can vary slightly by manufacturer even though the formula strategy is the same.

  Source: Bensky & Barolet, Formulas & Strategies (formula comparisons, classical attribution); Wikipedia/Kampo manufacturer references cross-checked for the Hochuekkito lineage note.

Clinical Studies & Research:

• Is there modern research on Bu Zhong Yi Qi Tang?

  Yes — several systematic reviews and meta-analyses, mostly pooling Chinese-language randomized controlled trials, have examined Bu Zhong Yi Qi Tang (BZYQT) as an adjunct therapy, though the authors of each review call for larger, higher-quality trials.

  • Chronic obstructive pulmonary disease (systematic review/meta-analysis, 16 RCTs, ~1,400 participants): BZYQT, alone or combined with conventional treatment, was associated with improved clinical symptoms, exercise capacity, lung function, and quality of life in stable COPD, with an excellent reported safety profile (PMID 27912964).
  • Cancer-related fatigue (systematic review/meta-analysis with exploratory network pharmacology, 2024): the Buzhong Yiqi method showed significant efficacy in reducing cancer-related fatigue with minimal adverse reactions across pooled trials (PMID 39564104; PMC 11573511).
  • Atopic dermatitis (systematic review protocol, 2019): summarizes existing clinical evidence and experimental anti-allergic, anti-inflammatory, and immunoregulatory findings for BZYQT (or modified BZYQT) in atopic dermatitis; a protocol synthesizing prior studies rather than new trial results (PMID 30608425; PMC 6344144).
  • Functional dyspepsia (feasibility study protocol, 2017): a single-arm, non-randomized pilot (n=30) testing BZYQT for functional dyspepsia with a Spleen-qi-deficiency pattern over 4 weeks; a feasibility protocol only, not efficacy results (PMID 28951846; PMC 5605384).

  Sources: PubMed 27912964; PubMed 39564104 / PMC 11573511; PubMed 30608425 / PMC 6344144; PubMed 28951846 / PMC 5605384. Research context, not a therapeutic claim; evidence is preliminary/mixed-quality and largely limited to the cited indications above.