Paralyzed on One Side After a Stroke, Slurred Speech, Constant Drooling? The Qing Dynasty Classic Bu Yang Huan Wu Tang (Tonify Yang to Restore Five-Tenths Decoction): The Formula for Qi Deficiency with Blood Stasis

Patient search terms: stroke sequelae / hemiplegia (half-body paralysis) / slurred speech / drooling / cerebral infarction / cerebral hemorrhage / qi deficiency with blood stasis

Corresponding medical names: post-stroke syndrome · qi deficiency with blood stasis pattern

Opening: a formula even more famous than the one we talked about last time

Not long ago we talked about high blood pressure, and I explained that for many friends their hypertension is actually caused by blood stasis (yu xue) — I introduced the method of taking san qi powder (notoginseng), dan shen powder (salvia) and American ginseng powder together. Today, picking up that thread, I want to introduce a formula even more famous than that one — Bu Yang Huan Wu Tang (Tonify Yang to Restore Five-Tenths Decoction), the classic formula for treating stroke sequelae.

💬 Note from Doctor Luo: This formula is a classic in Chinese medicine — it appears in every formulary textbook. It treats stroke, and specifically addresses all kinds of stroke sequelae — hemiplegia (paralysis on one side), facial distortion with a crooked mouth and eye, slurred speech, drooling from the corner of the mouth, frequent urination or even urinary incontinence. And stroke, of course, is closely related to high blood pressure.

Who created this formula? — Doctor Wang Qingren, the Qing dynasty physician bold enough to dissect corpses in secret

Who came up with this formula? The famous Qing dynasty physician Doctor Wang Qingren — the same man Doctor Luo often pronounces playfully as “Wang Qianren.”

💬 Note from Doctor Luo: Wang Qingren was a fascinating character, extremely straightforward in temperament. He specialized in studying blood stasis, so many of his formulas are “expel stasis” decoctions — Shao Fu Zhu Yu Tang (Lower Abdomen Expelling Stasis Decoction) and Xue Fu Zhu Yu Tang (Blood Mansion Expelling Stasis Decoction) are both his, and his research on blood stasis was deeply insightful. He had another trait: he never blindly followed the ancients. Much of what the ancients said, he thought was wrong — even Zhang Zhongjing’s pronouncements he sometimes disagreed with; he had his own views.

Even more remarkable, he loved studying anatomy. In old China, people generally did not dissect corpses, because everyone held that “the dead should be honored.” Wang Qingren dissected in secret, in order to understand the physical structure of the human body — so he is a truly fascinating physician.

Why is a stroke called zhong feng (“struck by wind”)? — Two thousand years of physicians arguing

The very name “zhong feng” (stroke) contains a history of Chinese medical theory. In ancient times, physicians all founded their theories on wind — look, the disease itself is called “zhong feng,” and this wind-based theory began with Zhang Zhongjing’s Jin Gui Yao Lue (Essentials from the Golden Cabinet).

💬 Note from Doctor Luo: Later physicians considered many approaches. In the Jin-Yuan era, Doctor Liu Hejian founded his theory on fire — when fire flares up, it rises; severe fire can cause this. Doctor Zhu Danxi founded his on phlegm — when phlegm-dampness is heavy inside the body, turbid phlegm clouding the clear orifices can cause this. Doctor Li Dongyuan, in contrast, held that this was qi deficiency. Each physician had a different angle.

When it came to Wang Qingren, he settled it: what Zhang Zhongjing, Liu Hejian and Zhu Danxi said was all somewhat biased — Li Dongyuan was right: most cases are qi deficiency.

💬 Note from Doctor Luo: Wang Qingren’s view is very vivid. Suppose a person’s upright qi (zheng qi) is ten parts when healthy. As you keep consuming it, your upright qi drops to five parts — half of what it was. At this point the qi is too weak to push the qi and blood along, which leads to blood stasis — the blood gets stuck. If it gets stuck in the head, that is a cerebral stroke, hence the crooked mouth and eye and hemiplegia. What to do? Didn’t you lose five parts of upright qi? I give them back to you — I pay you back those five! Once the qi is sufficient, add a little blood-invigorating, stasis-resolving medicine to open the stasis, and the stroke symptoms gradually improve.

Bu Yang Huan Wu Tang — the secret of healing is hidden in its very name

How do we read the four characters “Bu Yang Huan Wu”? Bu yang means tonifying qi; huan wu means returning to you those five parts of original qi (yuan qi) — this explanation is delightfully apt.

💬 Note from Doctor Luo: The structure of this formula is very distinctive. Wang Qingren said the huang qi must be raw huang qi (sheng huang qi, raw Astragalus), used at a maximum of 120 g — a very large dose! He advised starting from a small amount, gradually increasing, and only when you reach 120 g does it truly take effect.

Now look at the accompanying herbs — dang gui wei (the tail section of Chinese angelica) (about 6 g in today’s terms): the ancients were extremely particular — dang gui is divided into the head (tou), the body (shen) and the tail (wei), each with different functions. Dang gui tou stops bleeding; dang gui shen mainly tonifies blood; dang gui wei invigorates blood and breaks stasis — it both nourishes blood and invigorates/cracks blood stasis. So to invigorate blood and resolve stasis you must buy the dang gui wei — ordinary pharmacies may not carry it; you need to go to an established, large pharmacy.

💬 Note from Doctor Luo: Next is chi shao (red peony root), also about 6 g — bai shao (white peony) astringes yin, while chi shao invigorates blood; their functions differ, and here we take chi shao to invigorate blood and unblock the collaterals. Then di long (earth dragon — earthworm): di long invigorates blood, unblocks collaterals, cools blood, and extinguishes wind while unblocking collaterals. Add chuan xiong (Sichuan lovage), which works together with dang gui wei to invigorate blood and unblock collaterals. Finally, tao ren (peach kernel) and hong hua (safflower): tao ren transforms tangible blood stasis, while hong hua transforms the scattered, intangible kind — about 3 g each.

Do you see it? In this formula the blood-invigorating, stasis-resolving herbs are extremely small in dosage — three grams, six grams, very little; while huang qi is the overwhelming dose, up to 120 g.

💬 Note from Doctor Luo: His thinking is fascinating: primarily tonify qi — once the upright qi is fully supplemented, give it just a little unblocking, and the body should restore itself — this is the tonify qi, invigorate blood, and unblock collaterals approach.

Di long and hemorrhoids: the truth about a “family secret formula”

About the di long in this formula, Doctor Luo also told a story from his own family. What is di long used for? Treating hemorrhoids.

💬 Note from Doctor Luo: What are hemorrhoids? Hemorrhoids are blood stasis. Once humans stood upright, the venous return in the pelvic area of the buttocks became sluggish, the venous plexus dilated, and hemorrhoids formed. Our family secret formula uses di long to treat hemorrhoids. Someone might say: this existed in ancient times — is it really your family secret formula? Let me tell you my view — every so-called secret formula in the hands of folk practitioners in China can actually be found in ancient medical books. Ancient China had roughly 500,000+ formulas, covering basically everything. A so-called secret formula may simply be something an ancestor learned from some medical book, used it all his life, and it became a family secret; but many people never saw that book, so they don’t know. I once made a bet with someone: whatever secret formula you name, I can find it in the ancient books — it’s just that this family used it especially well and never told anyone else, so it became a “secret formula.”

Where does blood stasis come from? — Four causes, four treatments

A person’s blood stasis has many causes, and Doctor Luo has explained them all before.

💬 Note from Doctor Luo: For example, liver qi constraint (gan qi bu shu) produces blood stasis — you must soothe the liver qi and simultaneously resolve stasis; blood deficiency produces blood stasis — our Tao Hong Si Wu Tang (Peach Kernel and Safflower Four-Substance Decoction) nourishes blood and unblocks collaterals; there is also cold invasion producing blood stasis — you must warm the yang and unblock collaterals; and then there is qi deficiency producing blood stasis — the classic formula for that is precisely this Bu Yang Huan Wu Tang.

When can you use it, and when must you absolutely not? — Look at the tongue and pulse

This formula works extremely well in treating cerebral stroke and can be modified appropriately. But there is one especially important warning: patients with cerebral hemorrhage must be extremely cautious — the prescription must come from a physician; do not use it casually; for cerebral infarction this formula works very well.

💬 Note from Doctor Luo: A stroke — whether hemorrhage or infarction — roughly divides into two types: one is caused by qi deficiency, the other by heat — the phlegm Zhu Danxi described, the liver fire Liu Hejian described. How to tell them apart? When the tongue is very red — red tongue body, yellow greasy coating — never use this formula. Why? That would be pouring oil on fire — you’d be tonifying qi on top of fire! When can you use it? When the tongue is pale in color, the tongue body swollen and large with teeth marks on the edges, with lots of saliva on top, accompanied by other qi deficiency signs — fatigue and weakness, always sleepy and listless; plus signs of blood stasis — the sublingual veins a bit thick, stasis spots on the tongue. Only then do you use tonify-qi-to-unblock-collaterals.

As for usage, generally start from 30 g of raw huang qi, then gradually increase. If there is both qi deficiency and blood stasis, you can also steep it in water to drink, or decoct it for a foot soak — absorbed through the skin, the effect is equally good.

Bonus: a longevity story — the 100-year-old woman of Shenyang and her bowl of “qi tea”

This formula steeped in water also has a true story, which Doctor Luo encountered personally in his hometown of Shenyang.

💬 Note from Doctor Luo: When I was in Shenyang, I knew an old gentleman whose mother was a very long-lived person. Once he told me: “I’ll tell you my mother’s secret to longevity.” I was very curious: what formula? He said his mother used a formula steeped in water, drunk as tea, and her health was excellent. He copied the formula out and gave it to me carefully — I looked at it and laughed — Bu Yang Huan Wu Tang! Of course she didn’t use 120 g of raw huang qi — she grabbed a handful, I estimate 30-plus, 40, maybe 50 g, then the rest according to the proportions — six grams, three grams — steeped in boiling water and drunk as tea. She didn’t decoct it, so the medicinal strength was milder, but the properties still came through in the steeped water. Her mother drank it year-round as tea. When I heard that, I thought it made sense: elderly people are inevitably qi deficient — tonify the qi while adding a little blood-invigorating, collateral-unblocking medicine, and when qi and blood circulate normally, longevity comes easily. People whose tongues are especially swollen with teeth marks all around the edges, pale or dull dark in color (not bright red) — qi deficiency with a bit of blood stasis — can all use this formula steeped as tea.

What did Doctor Zhang Xichun think of this formula?

Doctor Zhang Xichun also commented specifically on Bu Yang Huan Wu Tang.

💬 Note from Doctor Luo: Zhang Xichun said this is a good formula, and everyone who used it got good results, but one caution: if you meet a patient with a deficient, weak pulse — the pulse is empty, lacking strength — and the tongue is swollen with teeth marks on the edges, then this formula takes effect immediately; but if the pulse is full and forceful — bouncing and strong — and the tongue is red with a yellow greasy coating, clearly a pattern of fire, then you should consider the phlegm-resolving, fire-clearing approach of Liu Hejian and Zhu Danxi.

Stroke and high blood pressure — in the end, the same principle

At the end of the lecture, Doctor Luo reveals the underlying logic.

💬 Note from Doctor Luo: After all this talk, cerebral stroke and high blood pressure follow the same principle — hypertension also has theories founded on phlegm, on fire (liver fire), and on deficiency; the deficiency branch further divides into kidney essence deficiency and so on, and within all this there is the qi deficiency type. You see, Chinese medicine is interesting: it’s just these few principles, and they show up across every disease. As long as we can distinguish these types, we understand where many diseases come from.

Finally, let’s sort out the blood-stasis series: for soothing the liver and invigorating blood, we introduced Xue Fu Zhu Yu Tang (Blood Mansion Expelling Stasis Decoction); for tonifying qi and invigorating blood, there is today’s Bu Yang Huan Wu Tang; and for nourishing yin and invigorating blood — san qi powder combined with American ginseng.

💬 Note from Doctor Luo: Some friends say that taking san qi alone has no effect — you must combine it with American ginseng! Some hypertensive people already have a bit of heat; taking san qi alone, you need to add American ginseng to clear the heat: American ginseng is a cool, cold-natured herb that tonifies qi and nourishes yin — combined this way, it doesn’t create heat, and it invigorates blood and unblocks collaterals. Blood stasis — we’ve been explaining it piece by piece; by the time we’re done, you’ll understand: blood stasis forms from so many causes. Remove these causes, and the stasis disappears, and our bodies become healthy.

Compiled from Doctor Luo Dalun’s formula lecture series; the formula comes from Yi Lin Gai Cuo (Corrections on the Errors of Medical Works) by Doctor Wang Qingren of the Qing dynasty.