bubble_chart Preparation and Dosage

Grind the medicinal herbs and prepare them as a single dose. Use 300 milliliters of water, boil until reduced to 150 milliliters, strain the dregs, and take it slightly warm on an empty stomach.

bubble_chart Efficacy

Tonifying qi, raising yang, and elevating the drooping; regulating and tonifying the spleen and stomach.

bubble_chart Indications

1. The syndrome of sinking of middle qi includes prolapse of the rectum, uterine prolapse, gastroptosis, and chronic diarrhea.
2. Pattern of qi deficiency and fever. Symptoms include fever, spontaneous sweating, thirst with a preference for hot drinks, shortness of breath, fatigue, lack of strength, pale tongue, white coating, and a weak, soft pulse.

bubble_chart Formula Principles

Li Dong-yuan formulated this prescription to treat dietary overstrain, spleen and stomach qi deficiency, and internal damage due to cold and heat syndromes. He is also the originator of the concept of "sweet and warm herbs eliminating high fever." The prescription heavily uses Astragalus Root and Ginseng to tonify the middle and replenish qi, raising yang and securing the exterior; White Atractylodes Rhizome to dry dampness and invigorate the spleen; Chinese Angelica to nourish blood and tonify deficiency; Dried Tangerine Peel to regulate qi transformation, awaken the spleen, and harmonize the stomach, ensuring tonification without stagnation; Cimicifuga Rhizome and Bupleurum to raise yang and elevate the sinking, assisting ginseng and astragalus in lifting the fallen middle qi; Liquorice Root, Fresh Ginger Rhizome, and Chinese Date to regulate the spleen and stomach. The combination of these herbs strengthens the spleen and stomach, replenishes middle qi, raises clear yang, and lifts sinking qi, gradually curing the symptoms.

The theoretical basis for treating qi-deficiency fever with this prescription, Li Dong-yuan stated: "This fever is not due to external cold-damage disease affecting the skin and hair, but rather the dampness from the kidneys and spleen-stomach flowing downward, blocking the lower part, causing yin fire to surge upward, creating a steaming dryness-heat." He also said: "When the spleen and stomach are deficient and original qi is insufficient, heart fire becomes excessive. Heart fire is yin fire, originating from the lower energizer, connected to the heart. The heart does not govern, so ministerial fire takes over; ministerial fire is the fire of the lower energizer and the pericardium, the enemy of original qi. Fire and original qi cannot coexist; when one prevails, the other is defeated." "Breath becomes rapid and panting, the body feels hot and restless, the pulse becomes full and large, accompanied by headache, or unquenchable thirst, and the skin cannot withstand wind-cold, leading to alternating chills and fever." (Neiwaishang Bianhuo Lun Volume 2) To treat this fever, "Only sweet and warm formulas should be used to tonify the middle, raise yang, and sweet-cold herbs to drain the fire, then recovery will follow." "Warmth can eliminate high fever, and it is strictly forbidden to use bitter-cold herbs to drain the stomach! Now, the Middle-Tonifying Qi-Replenishing Decoction is established." (Neiwaishang Bianhuo Lun)

bubble_chart Pattern Identification

1. shortage of qi, fatigue in speech, weakness in limbs, lack of strength, loss of appetite.
2. Or occasional fever with spontaneous sweating.
3. Or prolapse of internal organs.
4. Pale tongue with white coating.
5. Weak pulse.

bubble_chart Formula Modification

1. 兼 yang deficiency: add Cassia Bark, Aconite Lateral Root, Dried Ginger.
2. anorexia: add hawthorn fruit, Chicken's Gizzard-Skin.
3. difficulty in urination: add Plantain Seed, Poria.
4. chronic diarrhea not stopping: add Chebula Fruit, Smoked Plum.
5. menorrhagia and metrostaxis not stopping: add Sudden Smile Powder, fried Sanguisorba.
6. delayed menstruation: add motherwort herb, Red Peony Root, Salvia, Carthamus.
7. headache: add Sichuan Lovage Rhizome, Chastetree Fruit.
8. limb pain: add Saposhnikovia Root, Notopterygium.
9. excessive leukorrhea: add Poria, Plantain Seed.
10. headache at the vertex, add Chinese Lovage, Asarum to dispel wind and relieve pain;
11. cough, add Schisandra Fruit, Ophiopogon Tuber to astringe the lung and relieve cough;
12. with qi stagnation, add Aucklandia Root, Submature Bitter Orange to regulate qi and relieve depression.
13. common cold in deficient individuals, add a small amount of cultivated purple perilla leaf to enhance the dispersing effect.

bubble_chart Documentation

1. Luo Mei's "Ancient and Modern Mingyi Fanglun, Volume 1": "Whenever the spleen and stomach are deficient, lung qi is the first to be exhausted. Therefore, Astragalus is used to protect the skin and hair and close the striae and interstices, preventing spontaneous sweating. When the original qi is insufficient, leading to laziness in speech and panting, Ginseng is used to replenish it. The sweetness of Prepared Liquorice Root is used to purge heart fire and eliminate irritability, and to tonify the spleen and stomach to generate qi. These three ingredients are sacred medicines for eliminating irritability and heat. White Atractylodes Rhizome is added to strengthen the spleen; Chinese Angelica is used to harmonize the blood. When qi is disordered in the chest, and the clear and turbid are mixed, Dried Tangerine Peel is used to regulate it and also to disperse the stagnation caused by the sweet medicines. When the clearing qi aspect sinks in the stomach, Cimicifuga Rhizome and Bupleurum, which are light in qi and thin in flavor, are used to guide the stomach qi to rise and return to its original position, enabling it to ascend and float to carry out the command of growth. Tonifying the middle is achieved by incorporating exterior-releasing ingredients, thus stabilizing the middle. Tonifying qi is enhanced by relying on clearing qi aspect ingredients, thus doubling the qi. This is the subtlety of mutual reinforcement in the use of medicines."

bubble_chart Cautions and Contraindications

Contraindicated for those with yin-deficiency fever and excessive internal heat.

bubble_chart Modern Application

This formula enhances immunity and digestive absorption, improves blood circulation in gastrointestinal smooth muscles, and strengthens the body's ability to regulate temperature. It is used for conditions such as uterine prolapse, gastroptosis, visceral prolapse, rectal prolapse, hernia, hypotension, post-illness recovery, bladder sphincter weakness, myasthenia gravis, prolonged low-grade fever, habitual late abortion, subcutaneous nodules in the lungs, menstrual irregularities, constipation, frequent urination, and other conditions associated with spleen and stomach qi deficiency or sinking of middle qi.