Class 4: Qi Tonics

Xianhui Li

Introduction of Tonifying Herbs

• Definition: – These are the herbs that can supplement the substances of the

body, improve functional activities, enhance the resistance ability of the human body and relieve the syndromes of deficiency types

• Classification: – Qi tonics, yang tonics, blood tonics and yin tonics

• Attention: – Due to the mutual supplementary effect between yin and yang, qi

and blood, their tonics are often used together

– Not suggested for patients with excess pattern

– Improper use of these herbs may cause damage

– Protect the spleen and stomach or use the herbs that can promote digestion

Qi Tonics

• Qi deficiency:

– Mainly related to the spleen and the lung

• Applications:

– Qi deficiency

– Used as assistance for blood deficiency

• Herbs that can promote flow of qi should be used properly when there are the symptoms of stagnation of qi due to qi tonics

Herbs

• Radix Ginseng (Ren Shen) MM: pp 710-714

• Radix Codonopsis (Dang Shen) MM: pp 714-717

• Sclerotium Poriae (Fu Ling) MM: pp 267-271

• Rhizoma Atractylodes macrocephalae (Bai Zhu) MM: pp 726-730

• Radix Glycirrhizae (Gan Cao) MM: pp 732-735

• Pericarpium Citri (Chen Pi) MM: pp 510-514

• Tuber Pinelliae (Ban Xia) MM: pp 413-418

• Radix Saussureae (Mu Xiang) MM: pp 529-533

• FructusAmomi (Sha Ren) MM: pp 479-481

• Semen Dolichoros (Bai Bian Dou)

• Semen Nelumbinis (Lian Zi) MM: 879-881

• Semen Coicis (Yi Yi Ren) MM: 275-277

• Radix Platycodi (Jie Geng) MM: pp 429-432

Ren Shen (Radix Ginseng)

(Bai Shen, Hong Shen, Ye Shan Shen, Ji Lin

Shen)• Categories: tonifying qi

• Taste and property: sweet, slightly bitter, slightly warm

• Meridian Tropism: Lung and spleen

• Actions: Drastically tonify the primordial qi, supplement the spleen and the lung, promote production of body fluid to quench thirst, calm the mind and improve intelligence

• Applications:– Collapse of qi: Du Shen Tang or Shen Fu Tang

– Spleen qi deficiency: Si Jun Zi Tang

– Lung qi deficiency: Short breath, lassitude, asthma on slight movement, weak pulse and spontaneous sweating, Ren Shen Hu Tao Tang

– Thirst and diabetes due to impairment of body fluid: Bai Hu Jia Ren Shen Tang, Sheng Mai San (for deficiency of both qi and yin)

– Restlessness of the heart spirit marked by insomnia, dream-disturbed sleep caused by qi deficiency, i.e. Gui Pi Tang (Spleen Heart Tonics)

– Blood deficiency or impotence

• Dosage: 5-10g. It should be decocted with soft fire separately. Powder 1-2g

• Attention: Not suggested for excess or heat pattern, Incompatible with Li Lu, Wu Ling Zhi, Lai fu zi, Avoid taking tea and radish

Dang Shen (Radix Salviae

Miltiorrhizae)

• Categories: tonifying qi

• Taste and Property: Sweet and neutral

• Meridian tropism: Lung and spleen

• Actions: Tonify the middle jiao, supplement qi and promote production of body fluid and nourish blood

• Applications:– Deficiency of qi of middle jiao: Often used with Bai Zhu, Fu Ling and

Gan cao

– Lung qi deficiency: Used with Huang Qi and Wu Wei Zi, i.e. Bu Fei tang

– Short breath with thirst due to impairment of body fluid in febrile diseases

– Sallow complexion, dizziness and palpitation due to blood deficiency” It works by tonifying qi to nourish blood, i.e. Ba Zhen tang

• Dosage: 10-30g

• Attentions: Incompatible with Li Lu

Fu Ling (Poria, Radix Poria)• Categories: transforming dampness

• Taste and Property: Sweet, bland and neutral

• Meridian Tropism: Heart, spleen and kidney

• Actions: Induce diuresis, Strengthen the function of the spleen, Tranquilize the mind

• Application:– Difficulty in urination, edema or water retention: Being an

important herb, Fu Ling is often used together with Zhu Ling and Ze Xie to strengthen the effect of inducing diuresis and eliminating dampness.

– Spleen deficiency: Marked by lassitude, poor appetite and loose stool, often used together with Dang Shen, Bai Zhu and Gan Cao, i.e. Si Jun Zi Tang

– Palpitation and insomnia: Often used together with Zhu Sha, Suan Zao Ren and Yuan Zhi

• Dosage: 10-15g

Bai Zhu (Rhizoma Atractylodes

Microcephone)• Categories: tonifying qi

• Taste and property: Bitter, sweet and warm

• Meridian tropism: Spleen and stomach

• Actions: Tonify qi, strengthen the spleen, dry dampness, stop sweating and calm the fetus

• Applications:– Spleen qi deficiency: Used with Ren Shen, Fu Ling and Gan Cao, i.e. Si Jun Zi

Tang

– Spleen deficiency cold: Used with Dang Shen, Gan Jiang and Zhi Gan Cao: Li Zhong Wan

– Spleen deficiency with retained food: Used with Zhi Shi, Zhi Zhu Wan

– Spleen deficiency with retention of dampness marked by phlegm and retained water: Ling Gui Zhu Gan Tang for phlegm, used with Chen Pi, Da Fu Pi and Fu Ling Pi for edema

– Spleen qi deficiency marked by spontaneous sweating, used with Huang Qi, and Fu Xiao Mai

– Restlessness of fetus due to spleen deficiency: Used with different herbs for different types

• Dosage: 5-15g. Used raw for drying dampness and inducing diuresis, stir-fried for supplementing spleen qi and stir-fried to yellow for diarrhea due to spleen deficiency

• Attentions: This herb tends to impair yin because it has a dry property, so it is applicable only to the spleen deficiency with dampness

Gan Cao (Radix Glycyrrhiziae)• Categories: tonifying qi

• Taste and Property: Sweet and neutral

• Meridian Tropism: Heart, spleen, lung and stomach

• Actions: Supplement the spleen qi, moisten the lung to relieve cough, relax spasm to relieve pain and harmonize functions of other herbs

• Applications:– Weakness of the spleen and stomach marke by short breath, lassitude and loose stools:

Used with ren Shen, Bai Zhu and Fu Ling, i.e. Si Jun Zi Tang

– Cough and asthma: Used with Ma Huang and Xing Ren (San Ao Tang) for that caused by wind cold. Used with Sheng Shi gao (Ma Xing Shi gan Tang) for that caused by stagnated heat in the lung

– Carbuncles or food or drug poisoning• Sore throat: Jie Geng tang

• Carbuncles: Jin Yin Hua and Pu Gong Ying

• Food or drug poisoning: Used alone or with Liu Dou (green Bean)

– Spasm of abdomen or limbs: • Abdominal pain due to deficiency cold of the spleen and stomach: Used with Gui Zhi, Shao Yao and Yi

Tang, Xiao Jiang Zhong Tang

• Spasm of limbs due to deficiency of ying blood: Shao Yao Gan Cao Tang

– Harmonize functions of other herbs• Used with Fu Zi and Gan Jiang: Prevent yin impairment

• Used with Shi Gao and Zhi Mu: Reduce the cold nature of these two herbs

• Used with Da Huang and Mang Xiao: Slow the purging effect

• Dosage: 2-10g. Used raw for clearing heat and removing toxic materials and after stir-fried for tonifying the middle jiao

• Attention: Large dosage of gan Cao may cause edema

Ban Xia (Pinellia Rhizome)• Categories: Warm Herbs that Transform Phlegm-Cold

• Taste and Property: Pungent, warm and toxic

• Meridian Tropism: Spleen, stomach and lung

• Actions: Dry dampness to dissolve phlegm, lower rising of the stomach qi to relieve vomiting and disperse stagnancy and dissipate nodules

• Applications:– Much phlegm with cough and dyspnea due to accumulation of phlegm following failure of the

spleen to transform water: This herb serves as an important herb for damp phlegm, often used with Chen Pi and Fu Ling, i.e. Er Chen Tang. For cold phlegm used with Xi Xin and Gan Jiang additionally, while for hot phlegm, used with Huang Qin, Zhi Mu and Gua Lou additionally.

– Nausea or vomiting due to rising of the stomach qi: Mainly used to treat vomiting due to retention of cold water, used with Sheng Jiang, I,e, Xiao ban Xia Tang

– For vomiting due to stomach deficiency: Used with Ren Shen and Bai Mi

– For vomiting due to stomach heat: Huang Lian and Zhu Ru

– For morning sickness: Su Geng and Sha Ren

– Obstructing feeling in the chest with vomiting due to interlocking of phlegm heat: Used with Huang Lian and Gua Lou, i.e. Xiao Xian Xiong Tang

– Globus Hystericus : With Hou Po, Su Ye an Fu Ling: Ban Xia Hou Pu Tang

– Goiter or scrofula: With Zhe Bei, Kun Bu and Hai Zao

• Dosage: 5-10g

• Attentions: Incompatible with Wu Tou, being warm and dry, this herb should be used with a great care for dry cough due to yin deficiency, bleeding and hot phlegm

Ju Pi (Chen Pi, tangerine peel,

Pericarpium Citri Reticulatae)

• Categories: Herbs that regulate the qi• Taste and Property: Pungent, bitter and warm

• Meridian Tropism: Spleen and lung

• Actions: Regulate flow of qi, harmonize function of the middle jiao, dry dampness and dissolve phlegm

• Applications:– Stagnation of qi in the spleen and stomach marked by fullness in the abdomen

and epigastrium, eructation, vomiting or nausea• Fullness and pain in the epigastrium or abdomen, often used with Zhi Ke and Mu Xiang

• Nausea or vomiting: Used with Sheng Jiang, i.e. Ju Pi Tang

• Vomiting with phlegm heat manifestations: Used with Zhu Ru and Huang Lian

• Abdominal pain and diarrhea due to liver qi attacking the spleen: Used with Bai Zhu, Bai Shao and Fang Fengm i.e. Tong Xie Yao Fang

• Indigestion due to deficiency of the spleen qi, used with Dang Shen, Bai Zhu and Zhi Gan Cao, i.e. Yi Gong Sang

– Dampness obstructing in the middle jiao marked by stuffiness in the chest and abdominal fullness, poor appetite, lassitude, loose stool, thick tongue coating, also for cough, profuse sputum.

• For the former, it is used with Cang Zhu and Hou Po, i.e. Ping Wei San.

• For the latter, used with Ban Xia and Fu Ling, i.e. Er Chen Tang

• Dosage: 3-10g

Bian Dou (Semen Dolichoris

Lablab)

• Categories: tonifying qi

• Taste and Property: Sweet and slightly warm

• Meridian Tropism: Spleen and stomach

• Actions: Strengthen the spleen to remove dampness

• Applications:– Spleen deficiency with dampness marked by loose stools,

diarrhea or leukorrhea, i.e. Shen Ling Bai Zhu San

– Vomiting or diarrhea due to invasion of summer heat and dampness, used with Xiang Ru and Hou Po, i.e. Xiang Ru San

• Dosage: 10-20g

Mu Xiang (Aucklandia root, Radix

Aucklandiae)• Categories: regulating qi

• Taste and property: Pungent, bitter and warm

• Meridian Tropism: Spleen, stomach, large intestine and gallbladder

• Actions: Promotes flow of qi, regulates function of the middle jiao and relieves pain

• Applications:– Stagnation of qi in the spleen and stomach marked by poor appetite, indigestion,

fullness in the epigastrium and abdomen, borborygmus, diarrhea

– Distending pain due to qi stagnation in the epigastrium and abdomen: Used with Zhi Ke, Chuan Lian Zi and Yan Hu Suo

– Diarrhea due to damp heat: Used with Huang Lian

– Failure of the liver to dredge flow of qi due to inability of the spleen to transform and transport marked by distending pain in the hypochondrium, bitter taste in the mouth, yellow coating or even jaundice, often used with Chai Hu, Yu Jin and Zhi Ke, and Da Huang, Yin Chen and Jin Qian Cao

– Deficiency of both the spleen qi and the stomach qi: Used with Dang Shen, Bai Zhu and Sha Ren, i.e. Xiang Sha Liu Jun Zi Tang

• Dosage: 3-10g. Used raw for promote flow of qi and baked for diarrhea

Sha Ren (Amomum Fruit)• Categories: transforming dampness

• Taste and Property: Pungent and warm

• Meridian: Spleen and stomach

• Actions: Remove dampness, Promote flow of qi, Warm up the middle jiao, Relieve excessive fetal movement

• Application: – Dampness obstructing in the middle jiao or stagnation of qi in the spleen

and stomach marked by fullness and distending pain in the epigastrium and abdomen, poor appetite, vomiting and diarrhea: Used together with Hou Po, Cang Zhu and Bai Dou Kou for dampness obstructing in the middle jiao, Used with Mu Xiang, Zhi Shi, Bai Zhu for stagnation of both qi and retained food, i.e. Xiang Sha Zhi Shi Wan, Stagnation of qi due to spleen deficiency: Used together with Dang Shen and Bai Zhu, i.e. Xiang Sha Liu Jun Zi Wan (GI Strength)

– This herb has the action of warming up the middle jiao, so it is specially effective for diarrhea due to spleen deficiency, used alone in the form of powder or such herbs warming up the middle jiao such as Gan Jiang and Fu Zi.

– Morning sickness or excessive fetal movement: This herb works by promoting flow of qi and harmonizing function of the middle jiao, used together Bai Zhu and Su Geng for Morning sickness or excessive fetal movement due to stagnation of qi with spleen deficiency.

• Dosage: 3-6g. To be decocted later for decoction

Lian zi (Lotus seed

Semen Nelumbinis)• Categories: stabilizing and binding

• Taste and property: neutral, sweet, astringent

• Meridian tropism: Kidney, Spleen, and heart

• Actions: Tonifies Spleen and stops diarrhea, Tonifies Kidney and stabilizes essence, Nourishes blood and calms mind

• Applications– For spleen deficiency with chronic diarrhea and loss of appetite, this

herb augments and binds, used with ren shen, bai zhu, fu ling, shan yao, i.e. shen ling bai zhu san.

– For premature ejaculation and spermatorrhea due to unstable, deficiency kidneys, used with qian shi, sha yuan zi, i.e. jin suo gu jing wan

– For palpitations, irritability, anxiety, insomnia, used with suan zao ren, yuan zhi, fu shen,

– Also used for excessive uterine bleeding and vaginal discharge

• Dosage: 6-15g

Yi Yi Ren (Coix Seed, Semen Coicis)• Categories: draining dampness

• Taste and Property: Sweet, bland and slightly cold

• Meridian Tropism: Spleen, stomach and lung

• Actions: Induce diuresis to eliminate dampness, Strengthen the spleen, Relieve Bi syndrome, Clear away heat and drain pus

• Application:– Oliguria, edema, beriberi or diarrhea due to spleen deficiency: This herb is

similar in function as Fu Ling, so it is more suitable for exuberance of dampness due to spleen deficiency. Often used together with the herbs strengthening the function of the spleen. Besides, as this herb is slightly cold in nature, it can clear away damp heat, applicable to stranguria due to damp heat. Single use of the herb is effective for stranguria with stone or sand

– Spasm of the tendons and muscles in Bi Syndrome. This herb can both induce diuresis and relax tendons and muscles. For pain of the whole body due to wind dampness, it is used together with Ma Huang, Xing Ren and Gan Cao, i.e. Ma Huang Xing Ren Yi Yi Gan Cao Tang

– Lung abscess or intestinal absces: This herb can drain pus to treat abscess in the interior. For lung abscess, it is used together with Wei Jing, Dong Gua Ren and Tao Ren, i.e. Wei Jing Tang. For Intestinal abscess, it is used together with Bai Jiang Cao, Dan Pi and Tao Ren.

• Dosage: 10-30g

• This herb is mild in action, so its dosage should be large. When used to strengthen the function of the spleen, it should be used after stir-fried, while for other conditions, used raw.

Jie Geng (Platycodon Root)

• Categories: transforming phlegm and stopping cough

• Taste and property: Bitter, pungent and neutral

• Meridian tropism: Lung

• Actions: Open the lung qi, dissolve phlegm and drain pus

• Applications– Cough with much phlegm, difficult discharge of the phlegm obstructing

feeling in the chest and diaphragm, sore throat and hoarseness

– Cough with much phlegm due to wind cold: Used with Xing Ren, Su Ye and Chen Pi, i.e. Xing Su San

– Cough with sore throat and hoarseness due to wind heat: Used with Sang ye, Ju Hua and Xing Ren, i.e. Sang Ju Yin

– Chets distension due to stagnation of qi and obstruction of phlegm: Used with Zhi Ke and Gua Lou Pi

– Lung abscess marked by chest pain, cough with pus and blood: This herb can drain pus when used with gan Cao, i.e. Jie Geng Tang. At present It is usually used with Yu Xing Cao, Yi Yi ren, etc.

• Dosage: 3-10g

Formulas

• Si Jun Zi Tang, Liu Jun Zi Tang, Xiang Sha

Liu Jun Zi Tang FS: pp 236-238

• Er Chen Tang FS: pp 432-433

• Shen Ling Bai Zhu San FS: 239-240

Four-Gentlemen Decoction (si

jun zi tang)

Categories: tonifying qi

Ingredients: Ren shen, Bai zhu,

Fu ling, Gan cao

Actions and indications of the

formula• Actions

– Tonify qi and strengthen spleen

• Indications– Pale complexion, low voice, reduced appetite, loose

stools, weakness in limbs. Pale tongue, thin weak pulse.

Analysis of Formula

• Chief: Ren shen

– tonify qi

• Deputy: Bai zhu, Fu ling

– tonify spleen and drain dampness

• Assistant: Zhi gan cao

– warm and regulate middle jiao

Modern application and

modifications• Modifications

– Liu jun zi Tang: add chen pi, ban xia

• Strengthens the spleen, transforms phlegm and stops vomiting

• For spleen deficiency and phlegm: loss ofappetite, nausea or vomiting, focal distention and a stifling sensation in the chest and epigastrium and often coughing of copious thin, white sputum

– Xiang sha liu jun zi tang: liu jun zi tang add mu xiang, sha ren

• Strenghtens the spleen, harmonizes the stomach, regulates the qi, and alleviates pain

• For spleen and stomach qi deficiency with damp-cold stagnating in the middle burner: reduced appetite with a feeling of surfeit after eating very little, belching, abdominal distention or pain, and sometimes vomiting and diarrhea

• Attention: Not for excess pattern

Shen ling bai zhu san (Ginseng,

Poria and Atractylodes

Macrocephala Powder)

Categories: tonifying qi

Ingredients: Ren shen, Bai zhu, Fu ling, Gan cao; shan yao, bai bian dou, lian zi, yi yi ren, sha ren, jie geng

Actions and indications of the

formula• Actions

– Tonify qi and strengthen spleen

– leach out dampness

– stop diarrhea

• Indications– Loose stool or diarrhea. Pale complexion, low voice,

reduced appetite, weakness in limbs. Pale tongue, thin weak pulse.

Analysis of Formula

• Chief: Si jun zi tang– Tonify spleen

• Deputy: shan yao, bai bian dou, lian zi, yi yi ren, sha ren– tonify spleen, drain dampness and stop diarrhea

• Assistant: Zhi gan cao– warm and regulate middle jiao

• Envoy: Jie geng– disseminate lung qi and help spread nourishment

throughout the body.

• Attention: Not for yin deficiency with heat

Er Chen tang (Two-Cured

decoction)

Categories: treating phlegm

Ingredients: Ban xia, Chen pi (Ju hong), Fu ling, Gan cao, sheng jiang, wu mei

Actions and indications of the

formula• Actions

– Dry dampness, transform phlegm, regulate qi and harmonize the middle jiao

• Indications

– Cough with copious white sputum that is easily expectorated, focal distention and a stifling sensation in the chest and diaphragm, palpitations, nausea or vomiting, dizziness, a swollen tongue with a white, thick, greasy coating and a slippery pulse.

Analysis of Formula

• Chief: Ban xia, chen pi– Ban xia: dry dampness, expel phlegm, and cause the rebellious

stomach qi descend.

– Chen pi: revive spleen and facilitate the flow of qi in the middle jiao.

• Deputy: Fu ling– Fu ling: tonify spleen and drain dampness

• Assistant: Zhi gan cao– Regulate middle jiao

• Envoy: sheng jiang, wu mei– Sheng jiang: control nausea

– Wu mei: counterbalance the dispersing tendency of the chief herb and prevents the dissipation of lung qi

• Attention: Not for Yin deficiency pattern