Small-Dose Buzhong Yiqi Tang for Intractable Abdominal Bloating

Last month, during an outpatient clinic, a middle-aged man arrived early to queue for registration. His chief complaint was abdominal bloating — present from the moment he woke up, especially pronounced in the upper abdomen. Eating made it unbearably worse, yet skipping meals left him painfully hungry. He was truly miserable.

Through the four diagnostic methods of observation, listening, questioning, and pulse-taking, I found that he had long-standing loose stools, an enlarged tongue body with a thin white coating, a preference for cold beer, dry mouth, and a fine, slightly slippery pulse.

Reviewing his medical records, I saw that over the past two months he had sought treatment at multiple renowned hospitals — Guang’anmen Hospital, Dongfang Hospital, Xuanwu Hospital, and Youyi Hospital — receiving both Western and Chinese medicine interventions, all with unsatisfactory results.

I carefully examined the previous Chinese herbal prescriptions he had taken. They were mostly variations of strengthening the spleen and resolving dampness, soothing the liver and regulating qi, or breaking blood stasis with acrid dispersing herbs. Although spleen-strengthening methods were not underutilized, the results always felt like they were missing the mark.

I was also somewhat at a loss. This condition is genuinely difficult to treat. In the past, using modified Zhizhu Pill would often show initial improvement but poor long-term results. The overall principle still needed to tonify while simultaneously ensuring free flow.

Then a flash of inspiration struck — Buzhong Yiqi Tang came to mind. But considering that he was too deficient to tolerate standard tonification, I decided on a very small dose:

Chaihu (Bupleurum) 2g, Shengma (Cimicifuga) 2g, Zhi Huangqi (Honey-fried Astragalus) 5g, Dangshen (Codonopsis) 3g, Chao Baizhu (Stir-fried Atractylodes) 3g, Danggui (Angelica) 6g, Chenpi (Tangerine Peel) 6g, Fuling (Poria) 6g

I asked him to decoct the herbs himself and drink only 50 ml half an hour before each meal.

After one week, he didn’t return for a follow-up visit. I assumed the treatment had been ineffective and he had simply stopped coming. But the following week, he brought his father in for a different condition and reported that by the third day of taking this small prescription, his digestion had completely normalized. His abdomen no longer bloated at all, and he felt very comfortable.

From this we can see that much of the ancient wisdom is well worth studying. Li Dongyuan’s original doses in Pi Wei Lun (Treatise on the Spleen and Stomach) were very small, and the formula was meant to be used as a powder. Modern clinical doses are at least ten times larger than the originals. While these larger doses do produce results, sometimes smaller doses may actually work better.

Of course, although this treatment was quite successful, similar cases of abdominal bloating remain genuinely difficult to cure. I must continue to work hard!

中文原文 / Chinese Original