Tonify the Middle and Augment the Qi Decoction

Pattern-based

• Spleen Qi deficiency with sinking Qi
• Organ prolapse or chronic diarrhea
• Fatigue worse with exertion and low-grade fever

Biomedical correlates

• Chronic fatigue syndrome
• Gastroptosis and prolapse
• Recurrent infections from weakness

Donguibogam 東醫寶鑑

治勞役太甚, 或飮食失節, 身熱而煩, 自汗倦怠. 黃芪 一錢半, 人參ㆍ白朮ㆍ甘草 各一錢, 當歸身ㆍ陳皮 各五分, 升麻ㆍ柴胡 各三分. 右剉, 作一貼, 水煎服. 《東垣》 ○一方, 黃芪 一錢半, 人參ㆍ白朮ㆍ陳皮ㆍ當歸ㆍ甘草 各一錢, 升麻ㆍ柴胡 各五分, 加黃柏三分以滋腎水, 紅花二分入心養血. 《醫鑑》 ○夫脾胃一虛, 肺氣先絶, 故用黃芪以益皮毛而閉腠理, 不令自汗. 上喘氣短, 損其元氣, 用人參以補之. 心火乘脾, 用灸甘草之甘溫, 以瀉火熱而補胃中元氣. 若脾胃急痛, 腹中急縮者, 宜多用之. 此三味, 除濕熱煩熱之聖藥也. 白朮苦甘溫, 除胃中熱, 利腰臍間血. 升麻ㆍ柴胡苦平味之薄者, 升胃中之淸氣, 又引黃芪ㆍ甘草甘溫之氣味上升, 能補衛氣之散解而實其表, 又緩帶脉之縮急. 當歸以和血脉, 橘紅以理胸中之氣, 助陽氣上升以散滯氣, 此立方本旨也. ○凡脾胃不足之證, 須用升麻ㆍ柴胡, 引脾胃中淸氣, 行於陽道及諸經, 生發陰陽之氣. 故凡治脾胃藥, 多以升陽補氣名之者, 此也. 《東垣》

Translation

Treats taxing labor gone to great excess, or eating out of measure: body hot and vexed, spontaneous sweating, weariness. Astragalus 1.5 don; ginseng, white atractylodes, and licorice, 1 don each; angelica body and tangerine peel, 0.5 don each; cimicifuga and bupleurum, 0.3 don each. Cut the above, make one packet, decoct in water and take (Dongwon 東垣). — One version: astragalus 1.5 don; ginseng, atractylodes, tangerine peel, angelica, and licorice, 1 don each; cimicifuga and bupleurum, 0.5 don each; adding phellodendron 0.3 don to enrich the Kidney Water, and safflower 0.2 don to enter the heart and nourish the Blood (Uigam 醫鑑). — For once the Spleen-Stomach is vacuous, the Lung Qi is the first cut off: hence astragalus is used to boost skin and hair and close the interstices, not letting the sweat escape of itself. For panting above and short breath, the origin Qi damaged, ginseng is used to supplement. For heart fire riding the spleen, the sweet warmth of roasted licorice is used to drain the fire heat and supplement the origin Qi within the stomach — and where spleen and stomach gripe and the abdomen cramps tight, use it generously. These three flavors are the sagely medicines for removing damp heat and vexing heat. White atractylodes, bitter-sweet and warm, removes heat within the stomach and disinhibits the blood between lumbus and navel. Cimicifuga and bupleurum, bitter, even, and thin of flavor, raise the clear Qi within the stomach, and further conduct the sweet warm Qi of astragalus and licorice upward — able to supplement the defense Qi where it has scattered and secure the exterior, and to ease the girdling vessel's cramping. Angelica harmonizes the blood vessels; red tangerine peel orders the Qi within the chest, aiding the Yang Qi's ascent to scatter stagnant Qi. This is the root intent of the formula's construction. — In all patterns of Spleen-Stomach insufficiency, cimicifuga and bupleurum must be used, to conduct the clear Qi of Spleen and Stomach along the Yang path and the various channels, engendering and effusing the Qi of Yin and Yang. This is why the medicines that treat the Spleen and Stomach are so often named for raising Yang and supplementing Qi. — Dongwon 東垣 (Donguibogam · Naesang)