Huang Qi

Healing Disc Injuries

A reader requested a post on Huang Qi (Radix Astragali). Huang Qi is certainly a fascinating and popular herb, and thus much written about. So I replied that I would try to come up with an interesting angle to explore.

Modern and Ancient Views

Let’s start with the TCM view, paraphrased from Wiseman and Brand (2020):

Huang Qi

Sweet slightly warm, SP LU

 Actions:

Boosts qi, upbears yang

Boosts defense, secures exterior

Disinhibits water, disperses swelling

Expresses toxin and engenders flesh

And from Shen Nong Ben Cao Jing (Wilms translation, 2017)

Huangqi

“yellow attainment”

Sweet, slightly warm

Treats welling and flat abscesses and chronic putrefying sores; pushes out pus and stops pain, treats great wind leprosy, five types of hemorrhoids, rat fistulas, supplements emptiness [i.e., tonifies deficiency], and treats the hundred diseases of children.

The uses for the herb in ancient and modern sources are largely the same. What strikes me is that the tonic function in Shen Nong is way down the list, after treating sores, expelling pus and stopping pain. This is very different from, say, Ren Shen, which in the Shen Nong has a much more spiritual vibe. I think that one of the most interesting things about Huang Qi is that, for a qi tonic, it is a mobilizing agent rather than something super-starchy and nourishing.

Huang Qi and Musculoskeletal Healing

A prime indicator of Huang Qi’s active nature is the herb’s presence in musculoskeletal formulas. Huang Qi Wu Wu Tang, Fang Ji Huang Qi Tang, Bu Yang Huan Wu Tang, and Juan Bi Tang are a few examples.

A while back I started investigating wind-damp formulas, with the question of why a patient would be better off taking Chinese herbs for something like back pain rather than just taking an analgesic/anti-inflammatory OTC medication. I ran across a paper by Yu et al (2014) on using Chinese herbs for ruptured lumbar discs. Later I found a similar study by Dai et al (2020). In both papers, the formula used was an amalgamation of two Astragalus formulas (Fang Ji Huang Qi Tang and Bu Yang Huan Wu Tang) called Xiao Sui Hua He Tang (消髓化核汤).

The formula composition is as follows:

The researchers looked at the formula’s ability to promote resorption (shrinkage or disappearance) of the disc protrusion, relieving the symptoms and eliminating the need for surgery. Dosage for the Dai study was 120 mL (about half a cup) twice daily from 8 weeks to 6 months. In the Yu study the decoction was administered for 8-16 weeks. Roughly half of the patients in both studies had some degree of disc resorption according to MRI (including 50% or more resorption in about 24% of cases). Symptom relief occurred in up to 85% of the subjects.

Both papers discussed a process by which the ruptured disc is resorbed. I have summarized it here:

1. When the disc material ruptures through the posterior ligament, the immune system recognizes the presence of tissue in a place where it is not supposed to be, and begins the process of removing it.

2. To promote the movement of macrophages to the area, the process of angiogenesis begins, growing new blood vessels in the area.

3. Inflammatory reactions occur which break down the intruding tissue.

4. The byproducts of all these processes along with phagocytes, platelets, etc, are released into the extracellular fluid environment which is then drained away from the local area (resorbed) by the body.

From a TCM view, the formula actions might look something like this:

1. Huang Qi mobilizes the defensive qi to eliminate pathogenic factors from the exterior; the process is aided by the wind damp herbs such as Wei Ling Xian and Mu Gua (remember that the sinews and bones are still considered exterior to the organs, and that physiological tissue outside its normal limits has transformed into a pathogenic factor).

2. Huang Qi with the help of Dang Gui (the two herbs together comprise the formula Dang Gui Bu Xue Tang) quickly builds and vitalizes blood (angiogenesis); they are assisted by Chuan Xiong and Di Long.

3. The blood-breaking insect medicinals, Di Long and Shui Zhi, dissipate the static blood and dead tissue (Yu et al 2014 also mention Wei Ling Xian, with its ability to dissolve fish bone, as being useful for this part of the process).

4. Huang Qi along with the phlegm-resolving and damp-draining herbs (Bai Jie Zi, Han Fang Ji, Bai Zhu) clear and resolve the dampness and turbidity from the area of the disc. (Bai Jie Zi especially dredges the collaterals and clears phlegm between the membranes, where Han Fang Ji and Bai Zhu dry up the edema in the tissues).

Dai et al (2020) note that “phagocytosis of inflammatory cells and growth of new vessels are the key factors in resorption.” Huang Qi has been shown to increase the immune system’s phagocytic ability (Chen et al, 2020). Huang Qi itself and Bu Yang Huan Wu Tang (which includes Huang Qi, Dang Gui, Chuan Xiong, and Di Long) have been found to promote angiogenesis (Cui et al, 2015; Tu et al, 2014). Huang Qi also engenders new flesh, which can help promote regeneration of the damaged tissue (Yue et al., 2022).

Conclusion

Huang Qi is an enormously valuable herb, not only as a qi tonic but as a medicinal for treating musculoskeletal injury as well. Many of its actions come into play in a formula like Xiao Sui Hua He Tang: boosting wei qi, relieving swelling, invigorating the flow of qi and blood, expelling dead tissue and engendering new flesh.

Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Chen, Z., Liu, L., Gao, C., Chen, W., Vong, C. T., Yao, P., Yang, Y., Li, X., Tang, X., Wang, S., & Wang, Y. (2020). Astragali Radix (Huangqi): A promising edible immunomodulatory herbal medicine. Journal of Ethnopharmacology, 258, 112895. https://doi.org/10.1016/j.jep.2020.112895

Cui, H.-J., Yang, A.-L., Zhou, H.-J., Wang, C., Luo, J.-K., Lin, Y., Zong, Y.-X., & Tang, T. (2015). Buyang huanwu decoction promotes angiogenesis via vascular endothelial growth factor receptor-2 activation through the PI3K/Akt pathway in a mouse model of intracerebral hemorrhage. BMC Complementary and Alternative Medicine, 15, 91. https://doi.org/10.1186/s12906-015-0605-8

Dai, F., Dai, Y.X., Jiang, H., Yu, P.-F., & Liu, J.-T. (2020). Non-surgical treatment with XSHHD for ruptured lumbar disc herniation: a 3-year prospective observational study. BMC Musculoskeletal Disorders 21, 690. https://doi.org/10.1186/s12891-020-03723-2

Tu, S., Shao, A., Ren, L., Chen, T., & Yao, D. (2014). Angiogenesis effect of Astragalus polysaccharide combined with endothelial progenitor cells therapy in diabetic male rat following experimental hind limb ischemia. Chinese Medical Journal, 127(11), 2121–2128.

Wilms, S. (2017). Shen Nong ben cao jing: The divine farmer’s classic of materia medica. Happy Goat Productions.

Wiseman, N., & Brand, E. (2020). Comprehensive Chinese Materia Medica. Paradigm Publications.

Yu, P. F., Jiang, H., Liu, J. T., Li, X. C., Qian, X., Han, S., & Ma, Z. J. (2014). Traditional Chinese medicine treatment for ruptured lumbar disc herniation: clinical observations in 102 cases. Orthopaedic surgery, 6(3), 229–235. https://doi.org/10.1111/os.12120

Yue, Y., Liu, X., Pang, L., Liu, Y., Lin, Y., Xiang, T., Li, J., Liao, S., & Jiang, Y. (2022). Astragalus Polysaccharides/PVA Nanofiber Membranes Containing Astragaloside IV-Loaded Liposomes and Their Potential Use for Wound Healing. Evidence-Based Complementary and Alternative Medicine : ECAM, 2022, 9716271. https://doi.org/10.1155/2022/9716271

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