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What to do when tonics don't work


I have chronic fatigue of deficent type, with yin fire flaring when I do too much exertion; I also have poor appetite. I tried Bu Zhong Yi Qi Wan and Ginseng capsules, yet they don’t give any effect. In case of Bu Zhong Yi Qi Wan they actually worsen my condition. I feel emptiness and pain in my chest. What to do, is moxa the only alternative to combat fatigue and weakness?


Are you taking the formula after being diagnosed by a TCM practitioner or are you taking it on your own?


On my own, but I’m a practitioner myself. I have pale tongue with white coat.


Are you doing anything with food therapy? That would be where I would start - eating more simple, well cooked foods, avoiding dairy and spicy and greasy foods. Soups and congee would probably good to eat a few times a week as well. Try making barley tea once a day, see if you notice any difference after a week with that.

When it comes to self diagnosis, well there is a whole thread on that you can look at here. My own recommendation would be to see another practitioner as it would likely help to get some fresh/outside input to your condition.

As for moxa I would recommend only using distal points like ST 36 or SP 3, not using any points on the abdomen.


Can you include a picture of your tongue? What is your pulse? And what other symptoms besides “fatigue” do you have that you feel lead towards a true deficiency pattern? Finally, what do you mean when you say you have “yin fire flaring” when you do “too much exertion”? What are your exact symptoms from doing exactly what? Sweating from walking up stairs, panic attacks from jogging, what exactly?

Long story short, if bu zhong yi qi wan made you worse, you most likely have a far more layered condition than a true deficiency (what it is best at).


Thank you for answers. Here is my reply:

Why not abdomen?

Yes. It looks yellow, but in reality it is more white.

[quote]What is your pulse?[/quote]I am not proficent in pulse diagnosis.

[quote]And what other symptoms besides “fatigue” do you have that you feel lead towards a true deficiency pattern?[/quote]I’m very sensitive to foods or herbs. For example when I eat raw fruit my spleen hurts.

[quote] Finally, what do you mean when you say you have “yin fire flaring” when you do “too much exertion”? [/quote]I’m refering to terms from Treatise on Stomach and Spleen, where there is talk about ministerial fire rising upwards, similiar to empty heat.

[quote] What are your exact symptoms from doing exactly what?[/quote]For example I go to downtown for dinner, when I go back (by public transportation) I’m exhausted. I feel pain and emptiness in my chest. In extreme cases also hot feet. I often have cold feet.

I’m unemployed because I’m too weak for any work.

I also have psoriasis, sometimes slight, currently severe.


I had this myself and treated it quite successfully, however it takes diligence so I’m not going to sugar-coat the reality of what you have to do. I’m an intensive herbalist, have cured myself and friends of so very much, and I lived in China and Taiwan for many years with fluency in Mandarin.

The reason 補中益氣丸 makes you worse is because when taken continually it depletes the liver of its yang and further exacerbates the very clear damp stagnation you have–most likely originating in the spleen. Many ingredients (which vary among producers) exacerbate dampness and can actually create damp-heat (like Gan Cao and Huang Qi), so you have to mindful of these properties. You may feel better hours or days after the initial administration, but soon after you’ll feel much worse. Because of the systemic dampness you exhibit, your digestion is impaired. Because of poor digestion, your absorption of nutrients is poor and thus you have blood deficiency. When emptiness is coupled with stagnation over a chronic timeline this is the perfect scenario for yin fire to emerge (as it had in myself). The good news is this condition is very receptive to the proper formula and administration method, but still the majority of practitioners lack the understanding needed to effectively see this nasty pattern resolved.

Herbal treatment of Yin Fire demands gentleness, or “the Kingly Dao.” The trick is to tonify without exacerbating the damp retention in the organ channels that accumulate the most dampness–which in your case I would say is both the spleen and liver. The liver typically responds the quickest to herbal treatments since the active constituents of herbs have to traverse through the blood and channels initially where they target eventual organs and organ systems. For example, if one uses Dang Gui they must account for its damp nature (it’s contraindicated with abdominal distention and damp-heat patterns in the lower burner–which is where the liver and kidney resides). Dang Gui is used to quicken and nourish the blood but it is heavy and cloying in nature. I would substitute this for Hong Hua which is much lighter in action and therefore does NOT encumber dampness but instead works to help resolve it gradually. Also, substitute Chai Hu with Xiang Fu instead. The latter enters all channels to rectify the qi, and it is temperature-neutral and gentle-enough to be used long-term in formulas with constitutional weakness and deficiency. Xiang Fu and Hong Hua work synergistically to gently and powerfully resolve stagnation.

I would also recommend using Nu Zhen Zi, Bai Shao, and Du Zhong together to wholly and functionally support the liver and blood. This combination is extremely effective in my experience on myself and on countless clients. Bai Shao shouldn’t be consistently used longer than about 2-3 weeks. After this period, you can swap it with He Shou Wu once a bit of the dampness has cleared from the lower burner.

Keep in mind that although Chen Pi works to clear away dampness and regulate qi, it also easily damages spleen and/or stomach qi which exacerbate one-another. It’s too harsh to be used in particularly deficient patients in my opinion.

I would keep the spleen tonics in 補中益氣丸 and use my suggestions for a decoction (amounts are for one day or three doses):


  • Bai Zhu 9 grams
  • Cang Zhu 9 grams
  • Dang Shen 15 grams
  • Huang Qi or Zhi Huang Qi 15 grams
  • Nu Zhen Zi (crushed) 15 grams
  • Du Zhong 15 grams
  • Bai Shao* 10 grams

Qi Rectifiers and Blood Harmonizers

  • Xiang Fu 6-9 grams (if liver and/or kidney fire is quite strong then instead/alongside use Mu Dan Pi for a while–it can’t be used long-term)
  • Hou Po 6 grams
  • Hong Hua 9 grams

Notes on decoction of ingredients

Always soak all herbs for at least 10 minutes prior to introduction into the cooking pot. Try to use earthenware when possible, or glazed pots (I use a ceramic-coated cast iron dutch oven). Make sure the cooking temperature is at most on medium heat (it should only gently bubble here and there). I first cook the tonics with 6 cups of water for either an hour or until the liquid is down to 3 cups or half the volume–whichever comes first. Just before this is up, soak the Xiang Fu and Hong Hua together for at least 10 minutes and then put them in there with another 3 cups of water (so you’re back to 6 cups total). Then cook that until it’s just about back down to 3 cups again, and then add the Hou Po (soaked) for no longer than 15 minutes. This is because it contains several volatile oils that can evaporate if cooked too long and/or hot. I cook mine for 10 minutes–right on the mark. These processes yields maximum results. Back in the day, I would cook two days’ worth and put in mason jars for easy administration (dose is 1 cup x3 daily). Whenever you heat a dose up, always use the stovetop and NEVER use the microwave. This will rupture the medical constituents of the decoction and render it useless.

Also, on a last note: don’t use pills. These have added strain on the spleen and stomach. It’s my professional opinion that you’re too weak for these yet. You need to decoct your formula for around 2-3 months–and it will definitely change as your body gradually heals. In my clinical practice, I would veer from using tinctures during Yin Fire episodes as well. Also, if and when you receive acupuncture, request that they also supplement the liver (and possibly also the kidney) in addition to the treatment protocol, which will most likely focus on dredging the liver channel (which may feel nice for a while but make you hurt much worse afterwards). Your liver needs supplementing AND coursing simultaneously so that the stagnant, old blood can be dredged while new, healthy, and active blood replaces it. This is the precursor to the healing of your spleen channel–which takes a bit longer to resolve. Your kidney will be the last organ system to resolve if the source of your rebellious fire is the lifegate (命門).

I hope this helps you in some way. I wish you the best in healing. Much love.


Sorry I meant to directly respond to you but I instead clicked on Chad! Oops :blush:


Thank you, I will try that.


I already ordered a week load of herbs according to your formula, however they cost a lot and I can’t provide full price for several months, so I’m looking at pills alternative (they are cheap in my country, and high quality). I actually tollerate pills quite well. What do you think about such combination:

Si Jun Zi Wan/Gui Pi Wan
Chai Hu Shu Gan Wan
Ping Wei Pian

  • Astragalus caps
  • Goji berry

The only con would be too much chen pi.

By the way I forgot to mention that I have tendency towards constipation, but I take Triphala, yoghurt and cooked apples and it helps greatly.


I would personally be weary of dredging the liver. Make sure you do not have true deficiency of the liver channel underneath all that stagnation, because if you do and you take Chai Hu Shu Gan Wan you will create more problems for sure. Build first, rectify once that is attained (or simultaneously–and very carefully). You should be checking out information on Li Dong-Yuan and Gu conditions.

I would also like to add that Goji is cloying so be very mindful when including it in a treatment regimen wherein a weak spleen is concerned. Personally I would omit it entirely until your spleen function is a bit stronger.

If you have constipation regularly, you could use Dang Gui, or a combination of Dang Gui alongside Hong Hua. Only thing is it’s hard on the spleen when taken long-term and has to be balanced in a formula so that the spleen tonics can do their thing with drying the middle. The trick with Yin Fire/Gu patterns is that you have to do a lot of things at once: tonify the spleen (dry the middle), mobilize the blood, and nourish/rear the new blood in its place.


Interesting that you used term Gu. So this spleen dampness is candida or something like that?

About dredging the liver, I think it is very deficient, so I will remove Chai Hu Shu Gan Wan and take proper herbs in decoction form, it’s not very expensive to take just a few. The rest I will take care of by ready made formulas. (Gui Pi and Ping Wei)


Spleen dampness can manifest as a lot of things. Dysbiosis (candida falls under this category) is one such manifestation of damp-heat in the spleen channels but it can start in other channels as well. I just think that the spleen is the crux of your issues. Secondarily, a deficient liver exacerbates everything into all of the ailments you experience.

Build your formula up like the food pyramid (regarding dosages and number of each used in the category); at the base put your spleen tonics, in the middle aid the liver and nourish the blood, and at the top you can add like one or two qi rectifiers. In the most severe cases, qi rectifiers are omitted since they consume qi. You don’t ever want to be consuming qi when there is deficiency in those channels affected.


Would cardamom (Sha Ren) be good for me? I tried small dosages of it, but with no effect. Still no appetite.


Two points:

(1) Traditional Chinese Medicine (TCM) works synergistically; this is to say that one needle on one acupoint or one herb taken on a regimen is not part of TCM philosophy nor practice. The energies of your body need to work in harmony, and due to the complexity of biological processes then treatments must simultaneously address everything going on.

Basically, TCM is the original (read: oldest form of) functional medicine.

(2) I’m going to share with you some of my findings–in as brief a manner as I can because there’s a lot on this topic: the correlation of dampness leading to heat and the presence of a diet rich in oxalate compounds with a high degree of intestinal permeability and/or dysbiosis. Dybsiosis is an imbalance and/or absence of essential bacteria and microorganisms in the intestinal tract. This leads to the condition of “leaky gut,” or when the immunological response is heightened and inflammation is concentrated in the submucosa (and sometimes even the muscular layers as well) because nutrients can’t be absorbed properly or at all. This causes the villi to erode over time and exacerbate gut disease. Ever hear of naturopaths or functional medicine practitioners talk about how all illness begins in the gut? Now, do you think there’s a coincidence that most patterns in TCM among chronic patients exhibit spleen deficiency as the crux of all other patterns? :bulb: Eureka.

The reason this all relates to cardamom is because many herbs (including cardamom) originating from nuts, fruits, and or seeds contain the highest concentrations of oxalates in nature. Oxalates are normally broken down via the shikamate pathway (a biochemical metabolic process) which is mediated by a variety of bacteria species. If someone doesn’t have enough of the species or the proper variety of them, then this pathway gets compromised. Oxalates are very sharp compounds–when viewed under a microscope these (mostly) calcium crystals are shaped like knives with a texture similar to fiberglass. Would you eat fiberglass? That’s essentially what’s happening to a person with leaky gut if they eat spinach, wheat, beets, bone broth, and nuts–to name just a few. Watching my dietary intake of oxalates alongside supplementation of adequate forms of B6 and lysine was crucial to my own success.

How does oxalate intake and TCM relate? Let’s go back to what I was saying about dampness encumbering heat: Through meticulous study, I’ve found that herbs which have a contraindication of exacerbating dampness (especially in the lower burner) and/or cloying yin tonics have the highest concentration of oxalates. ANYONE with intestinal disease will not heal from a typical herbal regimen unless this concern is addressed properly. Intestinal disease is likely far more complex and commonplace nowadays than it was during the Tang dynasty.

Goji berry is one of the herbs with the highest concentration of oxalates, next to Da Huang (rhubarb). Asparagus is loaded with these as well (Mai Men Dong and Tian Men Dong). Di Huang has a lot. Turmeric has a lot. Ginger has some. The list goes on and on.

When you examine the functions of these herbs, you begin to notice a pattern: herbs that have more oxalates than others typically have contraindications surrounding dampness leading to heat or heat exacerbating dampness. It’s important to understand that although some of these herbs are cold in nature and may even expel heat (Da Huang for example), if there is an underlying qi deficiency then using these will provide temporary relief with a recurrence of symptoms that are then worsened, because emptiness creates heat as well, and dampness likes to fuse with heat. It then becomes a self-exacerbating cycle–and this is why Gu patterns and Yin Fire scenarios have always been noted as particularly stubborn and complex issues that demand a thorough understanding of all disease patterns and their relationship with other patterns, as well as an appropriate treatment regimen.

Also, certain mineral compounds will bind to dietary oxalates, becoming complexes. These complexes are then expelled as waste, thus preventing a great deal of oxalates from becoming absorbed by the villi of the small intestine and therefore rooting inflammation. I personally take calcium citrate powder or juice a few citrus fruits in stir fry now and then–especially if I eat a high-oxalate meal. Interestingly, in TCM many mineral powders like Long Gu or Gui Ban contain compounds like these, and have properties which anchor the yang to the yin–in Gu, the main cause of gut sagging or bloating is because yin fluids downbear and the yang upbears, causing a whole myraid of nasty symptoms including chronic fatigue. It’s interesting that a yang-anchoring medicinal also functions to complex oxalates in the body. It’s a fascinating and enlightening relationship.


Thank you for all information. So should I take standard B6 vitamine and lysine caps?

Should I expect candida die off with this herbs?


It depends on what your levels are now, but more than likely you’re deficient with both nutrients. There are several herbs that contain either one, the other, or both nutrients (ironically, Goji berry comes to mind) but I would have to go back and reference my materials. I’ll get back to you on this.

Fleeceflower (He Shou Wu) is superb at eliminating pathogenic yeasts–and that’s only a single herb. I’m sure that many other ingredients mentioned have antifungal properties–especially wherein they are combined.


I tried the formula today. It didn’t weaken me like Bu Zhong Yi Qi Wan. I regained some appetite, I’m a little sleepy, probably regenerating. Energy level a bit better. Though my stamina is low, I feel that my yuan qi is restored, becuase Hou Po and Cang Zhu helped me to digest Ren Shen properly. When I’m tired there is no yin fire or empty heat. I will continue my experiments soon.


You may be sleepy from the peony because it is a mild sedative (why it shouldn’t be taken for longer than 3 consecutive weeks)–I put a * next to this on my message above with the formula suggestion. It could also be the resolution of a lot of stagnation, and providing a better connection between the heart and kidney channel. A lot of patients with insomnia and restlessness more pronounced before bedtime exhibit a disconnect between the heart and kidneys. Once it’s more reestablished they can feel drowsy when they need to feel drowsy naturally.

You have real ginseng in your formula? That’s expensive stuff! The wonderful thing about Cang Zhu is that it works so well to boost the spleen and free up the lower burner from dampness accumulation that exacerbates a lot of liver stagnation issues and pathogenic fire. You can eliminate the “food” source of yin fire (dampness) and “starve” out the pathogen. Your stamina is low because you need time to regenerate the kidney channel. Once your liver channel gets supplemented with new, healthier blood to replace the old, stagnant blood you will feel much better. Du Zhong is amazing at this–it nourishes the liver and improves the yang function of it simultaneously. When you add the perfect dose of Hong Hua in the mix, over the period of about a week you’ll see amazing improvement in the liver channel. The liver is often always the most receptive channel to herbal treatment that specifically targets it.


I actually supplement this formula with Ginseng Tabs from Swanson, not raw herb. It is quite cheap in this form.

Update: I think this formula eats a lot of blood, because on yesterday’s kung fu I had to interrupt the training due to stamina exhaustion. I almost fainted.

Also, I have more troubles digesting food.

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