Huang Qi Jian Zhong Tang
by Bob Flaws
Huang Qi Jian Zhong Tang (Astragalus Fortify the Center Decoction) comes from Zhang Zhong-jing’s Jin Gui Yao Lue (Essentials from the Golden Cabinet/Casket) originally published in the late Han dynasty circa 200 CE. Huang Qi Jian Zhong Tang is basically Xiao Jian Zhong Tang (Minor Fortify the Center Decoction) plus Huang Qi. Its ingredients are:
Zhi Gan Cao
According to Chen Yuan-xi, this formula is excellent for supplementing vacuity (i.e., qi vacuity) and plugging the pores, firming up the interstices and freeing the flow of the network vessels. According to Volker Scheid et al. in Formulas & Strategies, it is used to treat abdominal pain from vacuity cold associated with gastritis, peptic or duodenal ulcers, or colitis. However, Scheid et al. also say at the end of their discussion of this formula’s indications that it is also used in pediatrics, and that’s what I’d like to talk about today.
Frankly, Huang Qi Jian Zhong Tang is not a formula I use very often, especially not in adults. Actually, I don’t think I’ve ever used it in an adult. But it is a formula I have used frequently when treating little kids with ear infections. There are several stages to pediatric otitis media. The first begins with pain, fever, agitation and restlessness, and crying. The infant typically bats at its ear as a sign of his or her ear pain. However, externally, there are no pathological changes in the ear. (I’m not talking about using an otoscope.) During this stage, typically, stagnant food in the stomach has transformed heat (usually at one of the periodic waxings of ministerial fire in babies and young children), and these heat evils have followed an internal branch of the yang ming up to the ear where they fuliminate and transform into heat toxins. This is exactly what Blue Poppy’s Bupleurum & Angelica Formula is meant to treat.
If the infection is not treated effectively, the ear drum may eventually rupture. If the heat is still effulgent and toxins are present, there may be a purulent discharge from the ear canal. Chinese medicine treats this mainly by clearing heat and resolving toxins. For instance, this stage might be treated with Bupleurum & Angelica Formula plus some Great Nature Wu Wei Xiao Du Yin. However, most children in the West at this stage will primarily be treated by antibiotics by their Western MDs.
As we know from long experience, treatment of pediatric otitis media with antibiotics is less than ideal. Often the ear infections become recurrent, with the MD changing from one antibiotic to the next each time the infection recurs. Because antibiotics are by nature extremely cold, they can easily damage the spleen and especially so in infants and young children whose spleens are already inherently weak. If the ear drum has ruptured, such treatment with antibiotics often causes a chronic, clear, watery or only slightly cloudy discharge from the child’s ear. In terms of Chinese medicine, spleen vacuity has led to a qi vacuity failing to secure and astringe. Hence fluids run from the ear incessantly. Accompanying signs and symptoms may include cold extremities, a pale face, fatigue, listlessness, poor appetite, loose stools, excessive drooling, and the appearance of a blue vein between the eyebrows above the bridge of the nose.
In this case, an initially replete hot condition has, through iatrogenesis, transformed into a vacuity cold condition. Therefore, heat-clearing medicinals are no longer required. Instead, the treatment principles become to fortify the spleen and boost or supplement the qi, warm the center and stop the discharge, and this is what Huang Qi Jian Zhong Tang does.
The ingredients in Xiao Jian Zhong Tang are all very mild. In fact, most are either foods or culinary spices. As such they are just right for infants and young children. One of the principles of Chinese medical pediatrics is not to overdose children. This means not to use too harsh medicinals, not to use too high of doses, and not to administer medicine too long. For instance, it is commonly said, “When half cured, stop medication.” Due to children’s inherent immaturity, medicines can easily cause adverse reactions if they are too strong or administered too long. However, because the ingredients in Xiao Jian Zhong Tang are so mild, they are perfect for treating infants’ and toddlers’ central qi vacuity. Then, to this base, Huang Qi is added to further boost the qi of the spleen and lungs. One of the qi’s functions is to manage water fluids in the body. The word “manage” here implies specifically holding or containing physiologic water fluids within the body, and Huang Qi is excellent for doing just that. By strongly supplementing the qi, Huang Qi stops the drainage from the ear as well as assists in fortifying the center. If we go to the Shen Nong Ben Cao Jing (The Divine Farmer’s Materia Medica Classic), we see that Huang Qi is described as ruling welling and flat abscesses, enduring defeated/spoiled/decayed sores, and expels pus. The Shen Nong Ben Cao Jing also says it is good for the hundreds of children’s diseases, while the Zhong Yao Da Ci Dian (Great Dictionary of Chinese Medicinals) says it engenders flesh and is good for treating enduring ulcers which do not close.
This very useful formula is available as concentrated extract in the form of tablets from our Great Nature line. To administer this formula to an infant or young child who cannot swallow a tablet, crush the tablet in a spoon and mix with a little water and honey. Then either give the resulting liquid using an eye-dropper for an infant or spoon the liquid into the mouth of a toddler. A half tablet 3-4 times per day should be an appropriate dose.
When this kind of leaky ear is due to post-antibiotic spleen vacuity (an actual recognized syndrome in Chinese pediatrics), Huang Qi Jian Zhong Tang can not only stop the discharge from the ear but also treat all the other signs and symptoms of spleen vacuity/vacuity cold, such as fatigue, poor appetite, cold hands and feet, a pale face, and chronic loose stools. Further, by supplementing the spleen, the source of the defensive qi, this formula can help prevent the child from having further bouts of otitis media as well as from catching colds and developing allergies. So this is an excellent formula to keep on hand if you include infants and children in your practice.
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