Bu Zhong Yi Qi Tang (BZYQT), also known as “Hochu-ekki-to” in Japan and “Bojungikki-tang” in Korea, stands as a widely recognized herbal drug with a rich history in East Asian countries. This traditional Chinese medicine (TCM) formula, first documented in Pi Wei Lun, a 13th-century Treatise on the Spleen and Stomach, has been extensively employed to address various health conditions. Historically, BZYQT has been used to treat fatigue and weakness. BZYQT, which is referred to as a decoction to tonify the middle and augment the Qi formula, was first recorded in Dong Yuan Ten Medical Books, a medical text written by Li Dong-yuan in the year 1249. In traditional Chinese medicine (TCM), Bu Zhong Yi Qi Tang tonifies Qi of the middle jiao (or middle burner) and raises sunken Yang. It is known as a herbal treatment for gastrointestinal diseases, cancer, and chronic fatigue syndrome associated with the syndrome of “sinking of qi due to spleen deficiency,” a concept of traditional medicine. This article delves into the benefits, uses, and potential side effects of BZYQT, providing a comprehensive overview of this herbal remedy.
Composition of Bu Zhong Yi Qi Tang
BZYQT is composed of 8 medical plants, Astragali radix, Atractylodis Rhizoma Alba, Ginseng radix, Angelicae Gigantis Radix, Citri Unshius Pericarpium, Glycyrrhizae Radix et Rhizoma, Cimicifugae Rhizoma, and Bupleuri radix. BZYQT consists of eight herbs: Chen Pi (Citrus reticulata), Dang Gui (Angelica sinensis), Gan Cao (Glycyrrhiza uralensis), Huang Qi (Astragalus membranaceus), Sheng Ma (Cimicifuga foetida), Bai Zhu (Atractylodes macrocephala), Chai Hu (Bupleurum chinense) and Ren Shen (Panax ginseng). Each herb plays a specific role in the formula:
- Huang Qi (Astragalus membranaceus): Huang Qi is a king ingredient in Bu Zhong Yi Qi Tang. Strongly tonifies Qi and raises the Yang Qi of the Spleen and Stomach.
- Bai Zhu (Atractylodes macrocephala): Bai Zhu is a deputy ingredient in Bu Zhong Yi Qi Tang. Tonifies the Spleen Qi. Fortifies the Spleen Yang and dispels Damp through urination. Tonifies Qi and stops sweating.
- Gan Cao (Glycyrrhiza uralensis): Gan Cao is a deputy ingredient in Bu Zhong Yi Qi Tang. Tonifies the Basal Qi and nourishes the Spleen Qi. Clears Heat and dispels toxicity. Moistens the Lungs expel phlegm and stop coughing. Relieves spasms and alleviates pain.
- Dang Gui (Angelica sinensis): Dang Gui is an assistant ingredient in Bu Zhong Yi Qi Tang. Tonifies the Blood. Lubricates the Intestines. Relieve constipation. Promotes circulation and dispels Bi Pain.
- Chen Pi (Citrus reticulata): Chen Pi is an assistant ingredient in Bu Zhong Yi Qi Tang.
- Chai Hu (Bupleurum chinense): Chai Hu is an envoy ingredient in Bu Zhong Yi Qi Tang. Harmonizes exterior and interior.
- Sheng Ma (Cimicifuga foetida): Sheng Ma is an envoy ingredient in Bu Zhong Yi Qi Tang. Relieves the Exterior, scatters Wind and clears Heat. Allows the release of toxicity from the skin and clears Heat. Raises the Yang associated with Middle Qi Deficiency. Directs herbs upwards.
- Ren Shen (Panax ginseng):
Common Applications of Bu Zhong Yi Qi Tang
BZYQT is traditionally used to address a range of health issues. Some of the common applications include:
Gastrointestinal Diseases
BZYQT is known as a herbal treatment for gastrointestinal diseases.
Allergic Rhinitis and Atopic Dermatitis
BZYQT has been shown to have anti-allergic, anti-inflammatory, and immunoregulatory properties in experimental studies, and there is substantial clinical evidence of its effect on AD. In East Asian countries, BZYQT is extensively used for treatment of various diseases, such as allergic rhinitis, and AD.
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Cancer Support
In cancer settings, small studies suggest benefits of BZQYT in reducing fatigue, improving immune function, and quality of life, reducing cachexia, and increasing muscle mass. BZYQT was shown to restore immunity in mice bearing B16 melanoma by normalizing hypothalamic-pituitary-adrenal axis function, reducing corticosterone levels, and reversing stress-induced suppression of IL-12 production. In gastric cancer models, BZYQT had a synergistic effect with 5-fluorouracil (5-FU) to suppress PD-L1 expression via PI3K/AKT pathway inhibition while elevating CD4+/CD8+ T-cell ratios.
Pediatric Atopic Dermatitis
The Chinese Clinical Guidelines for AD reported deficiency of the spleen with accumulation of dampness to be the most common syndrome of childhood AD, and recommended using BZYQT for the treatment of pediatric AD.
Research and Clinical Evidence
Systematic Review of Randomized Controlled Trials
A systematic review of randomized controlled trials (RCTs) to assess the evidence on the effectiveness of BZYQT for treating AD will be conducted. All RCTs and quasi-RCTs will be included and any trials without parallel comparisons or control groups will be excluded. This study will include AD patients of any age with the following criteria: diagnosis of AD (or atopic eczema) using clinical diagnosis or validated diagnostic criteria. In this study, both BZYQT and modified BZYQT will be included. Modified BZYQT is added or removed medicinal plants according to pattern identification, or syndrome differentiation, resulting in nearly the same actions as the original BZYQT. If orally administered, any formulation of BZYQT will be included. There is no limitation on the number of herbs, dosage, or duration of treatment. All types of controls such as placebo, conventional treatment, or no treatment will be included. Trials in which BZYQT was used as the only treatment or as an adjunct to other treatments, as well as those in which the control group received the same treatment as the intervention group will be included.
Database Searches
Trials from the following electronic databases will be searched for: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), AMED, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Also, 4 Korean medical databases (Oriental Medicine Advanced Searching Integrated System [OASIS], Korean studies Information Service System [KISS], National Digital Science Library [NDSL], and KoreaMed), 1 Chinese database (China Network Knowledge Infrastructure [CNKI]), and 1 Japanese Database (CiNii) will be searched. The reference lists of reviews and the retrieved articles for additional studies will also be checked.
Study Selection and Data Extraction
Three reviewers will review and screen the titles and abstracts to identify eligible trials based on the inclusion criteria. Disagreements will be resolved by discussion, and if required, by the arbiter. We will extract the following information from the included systematic reviews: bibliographic information (e.g., author, publication date, and country), population demographics and setting (e.g., age, sex, and sample size), type of intervention (e.g., dosage, regimen, administration method, and herbal composition of prescription), outcome measures, and adverse events. Two authors will perform data extraction using a predefined data extraction form to record descriptive characteristics of the included reviews. Disagreements will be resolved by discussion among all of the authors, and another author will act as an arbiter for unresolved disagreements. Extracted data will be presented as included study summary table.
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Risk of Bias Assessment
The risk of bias will be assessed in accordance with criteria from the Cochrane Handbook version 5.2.0, which includes random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other sources of bias. The quality of each trial will be categorized on the basis of low/unclear/high risk of bias. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess confidence in estimates of effect.
Data Analysis
Differences between the intervention and control groups will be assessed in this study. For continuous data, we will use the mean difference (MD) with 95% confidence interval (CI) to measure the treatment effects. We will convert other forms of data into MD. For outcome variables on different scales, we will use the standard MD with 95% CI. For dichotomous data, we will present treatment effect as a relative risk (RR) with 95% CI; other binary data will be converted into RR. All statistical analyses will be conducted using Cochrane Collaboration's software program, Review Manager (RevMan), version 5.3 for Windows (Copenhagen, Denmark, The Nordic Cochrane Centre, the Cochrane Collaboration, 2014). If appropriate, we will pool data across studies for a meta-analysis using fixed-effects and random-effects models with 95% CI.
Dosage and Administration
The generally recommended dosage of Bu Zhong Yi Qi Tang is 4.5 g mixed with hot water, 2-3 times per day; or in capsule form, four capsules, two to three times daily. Bu Zhong Yi Qi Tang typically starts to show effects within days.
Potential Side Effects and Precautions
While Bu Zhong Yi Qi Tang is generally considered safe for most people, it can cause side effects in some individuals. Those with migraines should avoid Bu Zhong Yi Qi Tang. Talk with your healthcare providers before taking herbal formulas. They can interact with some medications and affect how they work.
Ensuring Product Quality
If you’re a consumer looking to purchase Bu Zhong Yi Qi Tang, look for suppliers who provide clear information about the product's origin, purity, and testing procedures to ensure you're getting a high-quality product.
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