Bu Yang Huan Wu Tang (补阳还五汤) — Tonify the Yang to Restore Five-Tenths

Name: Dr (TCM) Attilio D'Alberto
Brand: Dr (TCM) Attilio D'Alberto
SKU: hd-local-wokingham-rg-40
Rating: 5 (233 reviews)

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Overview
TCM pattern
Key herbs
Formula actions
Conditions treated
Cautions

What is Bu Yang Huan Wu Tang?

Bu Yang Huan Wu Tang (“Tonify the Yang to Restore Five-Tenths Decoction”) is the classical Chinese formula for stroke^[18] recovery, devised by Wang Qing Ren in his 1830 work Yi Lin Gai Cuo. The name reflects Wang’s observation that stroke causes patients to lose “half” of their function (hemiplegia) — this formula restores it. The formula is unique in TCM in using an extraordinarily high dose of Huang Qi (typically 120 g) to drive a small constellation of Blood-moving herbs. Modern research demonstrates that the formula improves cerebral blood flow, reduces ischaemic injury and supports neurological recovery after stroke.

Bu Yang Huan Wu Tang TCM pattern

Prescribed for Qi deficiency with Blood stasis obstructing the channels, characterised by: hemiplegia or paralysis (typically post-stroke), facial deviation, slurred speech, drooling, hemiparesis, urinary incontinence, a pale tongue, and a slow, thin pulse. The pattern reflects insufficient Qi to drive Blood through the channels, with the resulting stagnation manifesting as paralysis.

Key herbs

Huang Qi (Astragalus root, 10-120g) — 120 g; the dominant herb at five times the dose of all others combined; tonifies Qi to drive Blood
Dang Gui (tail) — 6 g; tonifies and moves Blood
Chi Shao (red peony, 0.5-12g) — 4.5 g; invigorates Blood and clears Heat
Di Long (earthworm, 0.5-10g) — 3 g; unblocks the channels and opens the collaterals
Chuan Xiong (ligusticum, 0.5-10g) — 3 g; moves Blood and Qi
Tao Ren (peach kernel, 0.5-9g) — 3 g; breaks Blood stasis
Hong Hua (carthamus, 0.5-9g) — 3 g; invigorates Blood

Formula actions

Tonifies Qi
Invigorates Blood and moves the Blood vessels
Unblocks the channels and collaterals
Resolves Blood stasis

Conditions treated

Post-stroke rehabilitation — hemiplegia, hemiparesis, dysphasia
Facial paralysis (Bell’s palsy) in the recovery phase
Sequelae of cerebrovascular disease — cognitive decline, post-stroke depression^[1]
Peripheral nerve injury and peripheral neuropathy with weakness
Diabetic peripheral neuropathy — substantial modern evidence base
Spinal cord injury recovery (specialist supervision)
Sequelae of traumatic brain injury with weakness

Cautions

Not used during the acute stroke phase — only in the recovery phase after the patient has stabilised. Avoid in active haemorrhage, untreated hypertension^[19] and in pregnancy. Use cautiously with anticoagulants — tell your medical team. Always consult a qualified Chinese herbalist registered with the Register of Chinese Herbal Medicine (RCHM). Online herbal consultations are available. See the prices page for costs.

Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide. After a full video consultation, Dr (TCM) Attilio D'Alberto formulates a bespoke herbal prescription and posts your Chinese herbs directly to your door.

References

[1] Butler L, Pilkington K. Chinese herbal medicine and depression: the research evidence. Evid Based Complement Alternat Med. 2013;2013:739716. https://doi.org/10.1155/2013/739716. PMID: 23476690.

[18] Shi YH, Wang Y, Fu H, Xu Z, Zeng H, Zheng GQ. Therapeutic effect of Chinese herbal medicines for post stroke recovery: A traditional and network meta-analysis. Medicine (Baltimore). 2017 Dec;96(49):e9214. https://doi.org/10.1097/MD.0000000000009214. PMID: 29245245.

[19] Wang J, Xiong X, Liu W. Tianma Gouteng Yin as Adjunctive Treatment for Essential Hypertension: A Systematic Review of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2013;2013:706125. https://doi.org/10.1155/2013/706125. PMID: 23710230.

How does Bu Yang Huan Wu Tang work?

Bu Yang Huan Wu Tang combines a single high-dose Qi tonifier with five Blood-moving herbs to address the post-stroke pattern of Qi deficiency with Blood stasis. The dominant herb is Huang Qi at high dose (typically 60-120 g of the traditional decoction; 4-8 g of pharmaceutical-grade granule), which tonifies Spleen and Lung Qi to drive Blood circulation. The five accompanying Blood-moving herbs (Dang Gui Wei, Chuan Xiong, Tao Ren, Hong Hua, Di Long) disperse residual Blood stasis along the affected channels and address the limb-weakness, facial deviation and speech difficulty of post-stroke patterns. Modern pharmacological research has documented neuroprotective, anti-platelet and microcirculation-improving effects from constituent compounds; combined with acupuncture and conventional stroke rehabilitation, the formula may help support functional recovery in TCM clinical practice.

Dosage and forms

Pharmaceutical-grade granules — 4–8 g/day in 2–3 divided doses, dissolved in warm water. The most potent and individualised form. Typical course 3–6 months in chronic post-stroke recovery; longer for established hemiplegia.
Traditional decoction — the classical preparation. Rarely used in modern UK practice.
Patent pills — lower potency; useful for maintenance dose after the active recovery phase.

I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, individualised within a bespoke prescription.

Cautions and contraindications

Acute haemorrhagic stroke — the Blood-moving constituents are not appropriate during the acute haemorrhagic phase; treatment begins only once the patient is medically stable
Anticoagulation therapy — the formula has antiplatelet activity; monitor INR closely with warfarin and adjust DOAC dosing under specialist supervision
Active bleeding — contraindicated
Yin-deficient heat patterns — the warming Qi-tonifying action may aggravate empty-heat presentations
Pregnancy — not used in pregnancy because of the Blood-moving constituents

Always consult a qualified Chinese herbalist registered with the Register of Chinese Herbal Medicine (RCHM). Treatment runs alongside (not instead of) NHS stroke rehabilitation services.

Online Chinese herbal consultations

I prescribe Chinese herbal medicine through online video consultations for patients throughout the UK and internationally. After a full case-history consultation reviewing your TCM pattern, presenting complaint, current medications and individual constitution, a bespoke prescription is formulated and the pharmaceutical-grade granules from Sun Ten in Taiwan are posted directly to your door. I am a member of the British Acupuncture Council (BAcC) and the Register of Chinese Herbal Medicine (RCHM) with over 25 years of clinical experience.

Treatment runs alongside (not instead of) conventional medical care. Always continue to be seen by your GP or specialist for any diagnosed condition; herbal medicine is used as a complementary therapy. See the prices page for consultation and dispensing fees.

Comparison with related formulas

Xue Fu Zhu Yu Tang — targets Blood stasis without strong Qi deficiency; use for chronic chest pain, stress-pattern headaches and angina rather than for the post-stroke deficient-plus-stasis pattern.
Tao Hong Si Wu Tang — gentler Blood-moving formula combined with Blood tonification. Use where Blood deficiency is more prominent and Qi is intact.
Acupuncture combination — the formula is most effective when combined with scalp acupuncture for motor and language area cortical stimulation, plus body acupuncture targeting LI 4, LI 11, GB 34, ST 36 and the affected limbs.

Frequently asked questions

How long after a stroke can Bu Yang Huan Wu Tang be started?

The formula is not used during the acute phase (first 1–2 weeks) when the haemorrhagic vs ischaemic distinction is still being clarified and acute neurological stability is the priority. Once the patient is medically stable (typically 2–6 weeks post-stroke) the formula can be started alongside ongoing NHS stroke rehabilitation. For chronic post-stroke patients many months or years out, treatment can start at any time.

Can Bu Yang Huan Wu Tang be taken with anticoagulation?

Yes — but with careful monitoring. The formula has antiplatelet activity that may add to the effect of warfarin, aspirin, clopidogrel and DOACs. Patients on anticoagulation should have INR monitored more closely when starting or stopping the formula, and dose adjustments should be made by the prescribing doctor. Most patients tolerate the combination safely but it cannot be self-managed.

How long does it take to see improvement?

Most patients in chronic post-stroke recovery notice initial improvement (reduced spasticity, improved limb sensation, modest motor gains) within 6–8 weeks of daily granule treatment combined with weekly acupuncture. Substantial functional improvement typically develops over 3–6 months. Patients with very long-standing post-stroke deficits (years out) may see slower but still measurable gains. The formula complements, not replaces, NHS physiotherapy and occupational therapy.

Does the formula help recovery in younger stroke patients?

Yes — in TCM clinical practice the formula may help younger post-stroke patients, including patients with cryptogenic stroke or stroke from less common causes (vasculitis, dissection, patent foramen ovale). Treatment alongside the conventional aetiology workup and secondary prevention strategy is appropriate; younger patients with greater neural plasticity often recover more quickly with combined treatment.

Can the formula prevent another stroke?

The formula is used in TCM clinical practice as part of a longer-term recovery and prevention strategy alongside conventional secondary stroke prevention (antiplatelet medication, statin, blood pressure control, lifestyle measures). The Blood-moving and microcirculation effects may help reduce the underlying TCM stasis pattern. Effective secondary stroke prevention still relies primarily on conventional medical management; the formula is complementary to that.