Always Tired, No Energy, and Constantly Feverish Like You Have a Cold? Li Dongyuan’s Master Formula Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction)

Patient search terms: chronic fatigue / always tired no energy / low-grade fever that feels like a cold / false cold / middle qi sinking / Li Dongyuan / spleen and stomach weakness

Corresponding medical names: qi deficiency with internal heat (yin fire) · middle qi sinking pattern · post-illness recovery

Opening: walk into any pharmacy in China and ask for Bu Zhong Yi Qi Wan

Walk into any pharmacy in China, anywhere, and ask: “Do you have Bu Zhong Yi Qi Wan (Tonify the Middle and Augment Qi Pills)?” The answer will always be “yes.” In the study of formulary science (fang ji xue), no one can get around this formula. It is Li Dongyuan’s Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) — the most famous formula in the Pi Wei Lun (Treatise on the Spleen and Stomach), and later generations have called it “the master formula among master formulas.”

💬 Note from Doctor Luo: Today we begin discussing one of Li Dongyuan’s most important formulas — Bu Zhong Yi Qi Tang. This formula is tremendously important in the entire theory of Chinese medicine; when you study formulary science you cannot skip it. But here is something you probably would never expect: when Li Dongyuan created this formula, his main purpose was not to “supplement qi” — it was to “reduce fever.” The title of his essay is Yin Shi Lao Juan Suo Shang, Shi Wei Re Zhong Lun (On Injury from Diet and Overwork Beginning as Heat in the Middle) — it starts by talking about the body running a fever. That is slightly different from the emphasis we now place on “tonifying the middle.” Today, let’s take our time and talk through this piece of history that goes beyond what we usually imagine.

Part 1: Why did he create this formula? — The Jin capital under siege, a million people starved to death, a brutal lesson

To understand why Li Dongyuan cared so deeply about the spleen and stomach, you have to go back to the era he lived in.

At that time, the Mongol army had besieged the Jin dynasty capital, Bianjing (modern Kaifeng), so completely that the city ran out of food for months. People had nothing to eat — even Emperor Aizong, the last Jin emperor, could only chew on grass roots. When the siege was finally lifted and food became available, the starving people wolfed everything down — and what happened? Their spleen and stomach gave out first, and enormous numbers of people died. If you have ever listened to traditional storytelling, you have heard this tale: people starved for months during a siege, then came out and ate several big steamed buns, drank water, and dropped dead. Why? Because the spleen and stomach had been destroyed.

💬 Note from Doctor Luo: Li Dongyuan witnessed this process with his own eyes. People who had starved, then suddenly gorged themselves and died of distension — over a million died. Some people today say it was plague (rat-borne disease). Plague certainly existed, but plague would have its own signature features, and none of those features appear in the records. So Li Dongyuan concluded that damaged spleen and stomach were the main cause. That is why he placed such extraordinary weight on the spleen and stomach — this is what he called “irregular diet” (yin shi shi jie). He witnessed the extreme version. But in modern life, skipping breakfast, gorging at noon, and drinking alcohol at night is also irregular diet — the only difference is that modern disorder lasts not months but years, decades, a lifetime.

Part 2: The three reasons the spleen and stomach get hurt: irregular diet, improper cold and warmth, and emotions

In the Pi Wei Lun, Li Dongyuan states it very clearly: when the spleen and stomach are injured, the causes boil down to just a few items.

First, irregular diet. The siege-and-gorging story above is the extreme version; the everyday version is chaotic mealtimes and binge eating.

Second, improper cold and warmth. The moment the weather turns hot, out come the ice-cold beer and cold drinks; or every day it’s scorching-hot, heat-natured food like mala tang (spicy hotpot) and shui zhu yu (boiled fish in chili oil) — that is improper cold and warmth. There’s also the external version: wearing far too little in freezing weather, going wading in cold water with bare legs — that injures the spleen and stomach just the same.

Third, emotions — joy, anger, worry, fear — drain your original qi. Unsettled emotions and a depressed mood deplete your yuan qi (original qi) and your upright qi (zheng qi) — this is another major way the spleen and stomach get hurt.

💬 Note from Doctor Luo: A master like Li Dongyuan states the causes of disease directly and clearly: irregular diet, improper cold and warmth, and emotional problems. Do we modern people have all three? I dare say we do — and far more severely than the ancients. So when the qi of the spleen and stomach is injured and original qi is insufficient, what problems arise? This is something Li Dongyuan took very seriously — he said that at this point “heart fire burns alone” (xin huo du sheng). Many later readers could not make sense of this phrase. Let’s explain it thoroughly.

Part 3: When the spleen and stomach weaken, the qi mechanism sinks — what “heart fire burning alone” really means

What does a healthy spleen and stomach do? They raise the clear and descend the turbid (sheng qing jiang zhuo). Spleen qi rises on the left side, and liver qi rises along with it (the liver rises with the spleen); gallbladder qi descends on the right side along with stomach qi (the gallbladder descends with the stomach). The heart sits above and represents summer; lung metal sits above and represents autumn, sending qi downward — heart fire follows lung metal down the right side into the kidneys to nourish kidney water, so the kidney water is never cold; kidney water then rises up the left side to nourish heart fire, so the heart fire is never overheated. That is the healthy circulation of the human body.

When the spleen and stomach weaken, the qi mechanism sinks — this is called middle qi sinking (zhong qi xia xian) — and it can no longer raise the clear and descend the turbid; it gets stuck and cannot circulate. At this point heart fire can no longer descend to nourish kidney water, so it burns alone up above; the upper body becomes extremely hot, and even lung metal can be injured. This is what Li Dongyuan meant by “heart fire burning alone.”

💬 Note from Doctor Luo: Later, one whole school of medicine kept teaching this very theory — who? Doctor Huang Yuanyu. He was the one who taught the rising and descending of the spleen and stomach, the single circulation of qi. Why does heart fire burn alone up above? Let me give you a homely analogy: it is like a car engine. A high-power engine finishes the job in one stroke. A low-power engine has to keep chugging away — and the more it chugs, the more heat it generates. People are the same: when upright qi is sufficient, one beat of the heart provides enough force to supply blood to the whole body. When upright qi is insufficient, the heart beats feebly and has to work twice as hard — burning more energy and producing more deficient heat. So you see: the pulse beats faster, breathing quickens, you feel breathless, the upper body feels hot and restless — “qi rises high and causes panting; the body feels hot and the mind is vexed” — these are exactly the symptoms Li Dongyuan describes later.

Part 4: What exactly is “yin fire”? — A concept that has baffled later experts for centuries

Several concepts appear in this passage of Li Dongyuan: heart fire, yin fire, and ministerial fire (xiang huo). Doctor Luo says: never mind if your head is spinning — many later specialists, even the most famous physicians, read this and felt dizzy too.

Li Dongyuan’s original text reads: “Heart fire is yin fire. It arises from the lower burner, and its thread connects to the heart; because the heart does not issue commands, ministerial fire acts in its place.” He also says: “Ministerial fire is the fire of the pericardium in the lower burner — the thief of original qi. Fire and original qi cannot coexist; when one wins, the other loses.” What exactly is this “ministerial fire”? Later scholars have debated it endlessly, and roughly these views exist:

One view: ministerial fire is the fire that arises from kidney yang warming the lower body — a normal function of the body;
Zhu Danxi’s view: when sexual desire or passion stirs, the deficient fire that emerges is ministerial fire;
Zhang Jingyue’s view: a step further — the fire stirred by lust and desire might as well be called evil fire;
Another view (and this is what Li Dongyuan means here): when spleen dampness is too heavy, spleen-stomach qi sinks downward, dampness enters the kidneys and causes qi stagnation in the lower burner — the damp-heat fire produced this way is ministerial fire.

Fire and original qi cannot coexist; when one wins, the other loses: when original qi is sufficient, the ministerial fire in the lower burner gradually fades; when original qi loses, ministerial fire grows stronger and the body fills with deficient heat.

💬 Note from Doctor Luo: The core concept here is “yin fire.” Note carefully: the yin fire Li Dongyuan speaks of is not the heat of yin deficiency. If it were heat from yin deficiency, you would simply nourish yin. But none of Li Dongyuan’s formulas in this series nourish yin. The yin fire he means is a heat syndrome produced when the organs, weakened in function, work twice as hard to compensate — the engine analogy from a moment ago: not enough power, so the engine strains and gives off more heat. This kind of heat, born of insufficient function, cannot be treated by nourishing yin. You have to strengthen its function and let it recover. Bu Zhong Yi Qi Tang treats exactly this kind of heat. So when later people say, “heat means nourish yin — so isn’t this just yin fire?” No, it is not. First you must strengthen function; only then, if needed, can you add a little heat-clearing and yin-nourishing medicine on top.

Part 5: The other face of qi deficiency: rapid breathing, body heat and restlessness, feeling like you constantly have a cold

Most people’s picture of qi deficiency is: afraid of cold, no energy, tired limbs, loose stools, easy swelling, weak voice, a foggy head. But when Li Dongyuan created Bu Zhong Yi Qi Tang, he actually said little about those — instead he described another set of qi-deficiency features that is rarely discussed:

Qi rises high and causes panting. People with weak spleen and stomach breathe more forcefully and violently. Why the panting? The heart and lung function is weak, so the body must compensate — it works twice as hard.

The body feels hot and the mind is vexed. Heart fire burns alone up above; the beating heart generates heat, so the mind is restless. The body heat is a compensatory response — the body must keep working harder, and the side effect is heat on the surface. Sometimes this heat is only felt subjectively; sometimes there really is a low-grade fever — Doctor Luo has seen patients like this, running a persistent low fever that cleared up as soon as their qi was supplemented. This is what Li Dongyuan called “sweet and warm herbs dispel high fever” (gan wen chu da re).

A surging pulse and headache. With that much heat above, the pulse feels strong and forceful.

Sometimes unquenchable thirst. With heart fire burning alone up above, you feel thirsty.

The skin cannot tolerate wind and cold. The moment a cold wind arrives, you feel colder than everyone else — this is qi deficiency, matching our usual understanding.

💬 Note from Doctor Luo: Notice — at this stage chills and body heat appear at the same time. Why did Li Dongyuan single out this passage? Because he discovered that this heat is very easily confused with a cold. A cold causes fever; and when qi deficiency reaches a certain level, the person also feels feverish. Many qi-deficient people constantly believe they have caught a cold — their temperature may shift a little, but it is not a real cold, and if you treat it as a cold with heat-clearing and toxin-removing herbs, it simply does not work. I once wrote an article called “The False Cold” (Jia Xing Gan Mao): especially elderly and frail people keep feeling, “I’ve caught a cold again, I’ve caught a cold again” — but actually this is caused by internal injury — it is qi deficiency, middle qi sinking — not a real cold. Li Dongyuan himself lamented that many people could not tell the difference and treated this deficient heat as a cold, using cold-dispersing, surface-releasing and heat-clearing methods — the more they treated, the worse it got, and the more severely the middle qi was damaged. He wrote this essay and created this formula precisely to treat that condition. Today when we talk about Bu Zhong Yi Qi we usually mean middle qi insufficiency, weak voice, weak limbs. But the deficient heat and restlessness that qi deficiency can produce — we don’t describe that enough. Many people with qi deficiency have deficient-heat symptoms and mistakenly try to clear heat or nourish yin — both are wrong.

Part 6: Breaking down the formula — nine herbs that build qi and lift it back up at the same time

The strategy of Bu Zhong Yi Qi Tang is: you must support upright qi. First comes huang qi (Astragalus root) — Li Dongyuan most likely used raw huang qi, because he was extremely particular about herb processing and always wrote down the processing method; since he did not write “honey-fried” here, the earliest version used raw huang qi. Later, manufactured pills generally use honey-fried huang qi because it releases more active constituents — use honey-fried for supplementing deficiency, raw for securing the exterior. Huang qi is the most frequently used herb in Li Dongyuan’s qi-supplementing series; later, Doctor Zhang Xichun also used it with exceptional skill. In their eyes, huang qi outranks even ren shen (ginseng) — it is the great general of qi supplementation. Li Dongyuan’s original text: if the heat from overwork is severe, use one qian of huang qi (about 3 g); otherwise use half a qian.

Then comes ren shen (ginseng) (three fen, about 1 g; remove the fibrous root; omit it for anyone with a cough) and honey-fried gan cao (licorice) (five fen, about 1.5 g).

💬 Note from Doctor Luo: Li Dongyuan says that these three — huang qi, gan cao, and ren shen — are the “sacred herbs for eliminating damp-heat and vexing heat.” Everyone’s head spins at this: aren’t these three herbs for supplementing upright qi? How can they eliminate damp-heat and vexing heat? Right — once you top up the upright qi and the spleen and stomach, only then can the damp-heat be removed. The vexing heat is a compensatory, deficient hyperactivity born of insufficient function; once middle qi and spleen-stomach qi are restored, this heat disappears. So what was Li Dongyuan aiming at? He was aiming at removing this deficient heat.

Next comes dang gui (Chinese angelica) — what is it for? To harmonize the blood vessels: while supplementing qi, it adds a little blood-nourishing support. Then chen pi (aged tangerine peel, the peel without the white pith removed), two to three fen (about 0.6-1 g) — “to guide the qi”: it keeps the qi moving while you supplement, so the tonics don’t get stuck inside — stagnation would only generate more heat. But chen pi must be used together with these sweet tonics; used alone, it can actually drain the spleen and stomach.

Bai zhu (atractylodes) — what is it for? “To eliminate heat in the stomach and invigorate the blood around the waist and navel.” Once the spleen is strengthened and spleen-stomach qi is sufficient, the deficient heat in the stomach disappears. “Invigorating the blood around the waist and navel” means removing dampness so that the abdominal blood around the lower back can circulate normally. For this purpose raw bai zhu is usually used; in this formula, stir-fried bai zhu is also acceptable.

Finally, sheng ma (cimicifuga) and chai hu (bupleurum) — the most brilliant stroke in the entire formula: sheng ma raises the qi of yangming, chai hu raises the qi of shaoyang, carrying spleen-stomach qi upward and returning it to its proper position. When spleen-stomach qi is deficient it sinks and cannot hold itself up, so sheng ma and chai hu return it to where it belongs — this is called “carrying out the order of spring rising” (xing chun sheng zhi ling): right now your body is not in the spring pattern, and I am putting you back into the pattern of spring — yang qi vigorous and rising upward.

💬 Note from Doctor Luo: This formula is actually very simple: sheng ma and chai hu, matched with huang qi, ren shen, bai zhu, and gan cao, plus a little chen pi and dang gui — on one side it supplements the qi of the spleen and stomach, the middle qi; on the other it lifts the qi upward, bringing the sunken qi back. Once the middle qi returns, spleen-stomach function recovers, upright qi and original qi recover, and the deficient heat vanishes. That was the original intention behind Bu Zhong Yi Qi Tang. Later, Doctor Zhang Xichun became especially skilled at combining sheng ma and chai hu with jie geng (platycodon) and huang qi to raise and lift — that technique was learned from Li Dongyuan.

Part 7: Li Dongyuan’s Bu Zhong Yi Qi Tang vs. Zhang Xichun’s Sheng Xian Tang

Some friends ask: what exactly is the difference between Bu Zhong Yi Qi Tang and Doctor Zhang Xichun’s later Sheng Xian Tang (Lift the Sunken Decoction)?

Zhang Xichun’s Sheng Xian Tang was certainly learned from Li Dongyuan. The difference lies in the point of focus:

Bu Zhong Yi Qi Tang focuses on the whole body, on the spleen and stomach: it has bai zhu and chen pi to regulate qi, and it supplements the spleen and stomach; once the qi of the spleen and stomach recovers, it lifts the qi up, and the whole body’s function recovers gradually. So the symptoms it describes tend to be whole-body ones — fever, chills, panting, high qi, restlessness. Its therapeutic goal is more long-term: only when the spleen and stomach recover slowly can the body recover durably. Li Dongyuan was even confident enough to say this formula — “even for the severely ill, no more than two doses bring recovery” (shi ru shang zhi zhong zhe, bu guo liang fu er yu).
Sheng Xian Tang focuses on the heart and lungs: when heart-lung function fails (large qi sinking, da qi xia xian) and causes whole-body symptoms, fixing the heart and lungs brings the body back immediately — quick, dramatic results. But if the problem is spleen-stomach qi deficiency with poor overall digestion and whole-body middle qi sinking, Sheng Xian Tang may not give durable results; slow regulation with Bu Zhong Yi Qi Tang works better instead.

💬 Note from Doctor Luo: After Zhang Xichun taught Sheng Xian Tang, it seems modern practitioners do not use it much. After I explained it, many patients said: “Oh my — so that’s what the problem was!” and it worked the first time they used it — because when they went to the hospital, no doctor thought of Sheng Xian Tang. But Bu Zhong Yi Qi has had a far-reaching influence: even by the Ming dynasty, the director of the Imperial Academy of Medicine, Xue Lizhai (Xue Ji), treated patients by cycling through just a few formulas — Bu Zhong Yi Qi, Xiao Yao Wan (Free and Easy Pills), Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pills), and Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pills) — and the cases he treated were extremely numerous. And the palace medical cases I often praise — Gong Tingxian, the Ming physician whom the Prince of Lu honored with the plaque “Medical Champion” (Yi Lin Zhuang Yuan), treated the Prince of Lu’s consort using exactly this Bu Zhong Yi Qi approach, with outstanding results. So Bu Zhong Yi Qi is truly the master formula among master formulas.

Part 8: The master of master formulas: from the Imperial Academy of Medicine to the pediatric clinic

Bu Zhong Yi Qi Tang works extremely well for the wide range of conditions caused by overall spleen-stomach weakness with sinking of the qi mechanism and middle qi — and its applications are broad. Doctor Luo once told a story from his own experience:

💬 Note from Doctor Luo: I once met a great pediatric physician — the elderly Doctor Sun from Yizheng, Jiangsu. I asked him: “After a child catches a cold, what do you use to restore them?” He replied: “Generally, after an external contraction, a child’s upright qi is insufficient, so I have them take Bu Zhong Yi Qi for three or four days.” You see how broadly Bu Zhong Yi Qi is applied — the old doctor’s reasoning was: I restore the child’s spleen-stomach function to normal, and then they won’t catch colds anymore; otherwise, with a weak body, they’ll be sick again in two days — that won’t do. You can see how wide the applications of this formula are.

One final reminder: Li Dongyuan wrote out the modifications for every one of his formulas in great detail — add one herb for this condition, two herbs for that one. We tend to overlook these modifications today, but they contain the true intentions behind the original formulas and are enormously instructive for clinical practice.

💬 Note from Doctor Luo: Today we have only opened the door, explaining why Li Dongyuan wrote this formula. It differs slightly from the “origin of the formula” as later generations understand it — he created it to treat deficient heat, to treat the “false cold.” The deeper you understand this mechanism, the deeper your understanding of Bu Zhong Yi Qi becomes, and the more ideas you will have when applying it. In the coming days, we will discuss more of Li Dongyuan’s formulas. I hope they help you all.

Dear friends, that’s all for today. Remember the other face of Bu Zhong Yi Qi: a qi-deficient person may not be afraid of cold — they may instead feel hot and restless and constantly like they have a cold. When that happens, don’t rush to clear heat and resolve toxins — first ask whether the middle qi has sunk. See you next time!

This article is compiled from Doctor Luo Dalun’s lecture series on Li Dongyuan, based on the Pi Wei Lun (Treatise on the Spleen and Stomach) and Nei Wai Shang Bian Huo Lun (Clarifying Doubts About Injury from Internal and External Causes).