补中益气汤

3. Tongue and pulse

• Tongue: Pale tongue body with thin white coating.
• Pulse: Forceless and soft, deficient, or deficient and large.

4. Common modifications

• With concurrent abdominal pain: Add Bai Shao (white peony root) to soften the Liver and relieve spasm and pain.
• Headache: Add Man Jing Zi (vitex fruit) and Chuan Xiong (chuanxiong rhizome) to clear and benefit the head and eyes, and invigorate blood to stop pain.
• Marked qi stagnation with abdominal distension and fullness: Add Mu Xiang (costusroot) and Zhi Ke (bitter orange) to move qi and relieve distension.
• Chronic diarrhea that fails to resolve: Add He Zi (chebule fruit) and Wu Wei Zi (schisandra fruit) to astringe the intestines and stop diarrhea.
• Marked organ prolapse: The dosages of Huang Qi (astragalus root), Sheng Ma (bugbane rhizome), and Chai Hu (bupleurum root) may be increased.

5. Cautions and clinical notes

• Contraindications:
  • Contraindicated in yin deficiency with internal heat or yin deficiency with effulgent fire, presenting with heat in the palms and soles, dry mouth and throat, and a red tongue with scant coating.
  • Contraindicated for headache or dizziness due to Liver yang rising.
  • Not suitable for exterior excess patterns due to external contraction, or for any excess or heat pattern.

6. Granule conversion and dose

• Calculation of the original formula's total raw herb weight:
  • Huang Qi (astragalus root) 18 g + Ren Shen (ginseng) 6 g + Bai Zhu (white atractylodes rhizome) 9 g + Dang Gui (Chinese angelica root) 3 g + Chen Pi (aged citrus peel) 6 g + Sheng Ma (bugbane rhizome) 6 g + Chai Hu (bupleurum root) 6 g + Zhi Gan Cao (honey-fried licorice root) 9 g = 63 g.
  • (Note: Dang Shen (codonopsis root) is often used clinically in place of Ren Shen, with the dose possibly increased to 9-12 g, and the total raw herb weight changing accordingly.)
• Conversion to 5:1 granules:
  • 63 g raw herbs ÷ 5 = 12.6 g granules.
• Recommended dose:
  • One dose daily, taken in two portions morning and evening, dissolved in warm water on an empty stomach to facilitate the upward movement of the medicinal action. About 6 g per dose.
  • Or as directed by a practitioner, who will modify the formula according to the severity of the patient's qi deficiency and sinking, in which case the total raw herb weight must be recalculated based on the adjusted formula.