补阳还五汤

3. Tongue and pulse

• Tongue: Pale-purple tongue, or an enlarged, swollen tongue body with tooth marks, with white coating.
• Pulse: Moderate (slow) and forceless pulse, or thin and choppy pulse.

4. Common modifications

• For predominant cold, with cold limbs: add Shu Fu Zi (prepared aconite root) to warm yang and dispel cold.
• For Spleen-Stomach weakness, with reduced appetite and loose stool: add Bai Zhu (white atractylodes rhizome) and Shan Yao (Chinese yam) to strengthen the Spleen and boost qi.
• For profuse phlegm: add Ban Xia (pinellia rhizome) and Tian Zhu Huang (tabasheer) to resolve phlegm.
• For marked speech difficulty: add Shi Chang Pu (acorus rhizome) and Yuan Zhi (polygala root) to open the orifices and resolve phlegm.
• For marked deviation of the mouth and eye: add Bai Fu Zi (typhonium rhizome), Jiang Can (stiff silkworm), and Quan Xie (scorpion) to dispel wind, resolve phlegm, and unblock the collaterals.

5. Cautions and clinical notes

• Contraindications:
  • Not to be used in the early stage of wind-stroke where the pattern is Liver yang hyperactivity or wind-phlegm obstructing the collaterals. This presents with clouded consciousness, red face, red tongue with yellow greasy coating, and a wiry, slippery, forceful pulse.
  • Not to be used in cases of yin deficiency with blood heat.
  • This formula requires prolonged, gradual use before an effect is seen; it should not be expected to work quickly.
  • Contraindicated in pregnancy.

6. Granule conversion and dose

• Calculation of total raw herb weight in the original formula:
  • Raw Huang Qi (astragalus root) 120 g + Dang Gui Wei (tail of Chinese angelica root) 6 g + Chuan Xiong (Sichuan lovage rhizome) 3 g + Chi Shao (red peony root) 5 g + Tao Ren (peach kernel) 3 g + Hong Hua (safflower) 3 g + Di Long (earthworm) 3 g = 143 g.
• Conversion to 5:1 granules:
  • 143 g raw herb ÷ 5 = 28.6 g granules.
• Recommended dose:
  • One dose per day, taken in two portions, morning and evening, dissolved in warm water, about 14 g per dose.
  • Or as directed by the practitioner. Because the dose of Huang Qi in this formula is very large, practitioners commonly start at 30-60 g according to the severity of the patient's qi deficiency and gradually increase it up to 120 g. The dose of granules must therefore be precisely converted according to the total raw herb amount prescribed by the practitioner.