Buyang Huanwu tang

Buyang Huanwu Decoction in the Integrative Rehabilitation of Post‑Stroke Hemiplegia

Abstract

Hemiplegia following stroke is a leading cause of long‑term disability globally. Integrative rehabilitation combining Traditional Chinese Medicine (TCM) modalities with conventional neurological rehabilitation has gained increasing attention. Buyang Huanwu Tang (BHYWD), a classical TCM formula, is widely used for post‑stroke sequelae characterized by Qi deficiency and blood stasis. This essay reviews the TCM rationale for BHYWD, clinical mechanisms, recent evidence, and its role within an integrative rehabilitation framework.

Introduction

Stroke is a neurological event with high morbidity, frequently resulting in persistent motor deficits such as hemiplegia. While conventional rehabilitation (e.g., physiotherapy) remains the cornerstone of recovery, clinical outcomes are often incomplete (Feigin et al., 2022). TCM concepts view post‑stroke hemiplegia as arising primarily from Qi deficiency and blood stasis obstructing the meridians, impairing the nourishment of sinews and muscles. In such patterns, BHYWD is commonly prescribed to “tonify Qi and activate blood” (Wang, 1830/2010).

Traditional Chinese Medicine Pathogenesis

In TCM theory, stroke affects the channels (经络) and collaterals (络脉), with enduring paralysis arising from two principal pathogenic mechanisms:

1. Qi deficiency — Especially of the Lung and Spleen, leading to weak Yang and impaired blood movement.

2. Blood stasis — Blockage of blood flow within channels, obstructing motor function.

These two factors interact synergistically: Qi deficiency fails to move blood, and blood stasis further weakens circulation and nourishment (Zhang & Liu, 2019).

Composition and TCM Actions of BHYWD

BHYWD is a classical formula documented by Wang Qingren (清) in Yilin Gaicuo (Corrections from the Forest of Medical Literature). It consists of seven herbs:

• Astragali Radix (Huang Qi) – Tonifies Qi

• Angelicae Sinensis Radix (Dang Gui) – Nourishes and invigorates blood

• Chuanxiong Rhizoma – Invigorates blood and moves Qi

• Paeoniae Rubra Radix (Chi Shao) – Clears stasis and cools blood

• Persicae Semen (Tao Ren) & Carthami Flos (Hong Hua) – Break blood stasis

• Pheretima (Di Long) – Opens collaterals

The formula’s chief herb, Huang Qi, is used in a relatively high dosage compared to other classical formulas, anchoring its principal action of strengthening Qi to move blood.

Biomedical Mechanisms Relevant to Motor Recovery

Recent biomedical research complements traditional theory, identifying several mechanisms through which BHYWD may support neurological rehabilitation:

1. Neural Repair and White Matter Integrity: Preclinical models indicate that BHYWD enhances remyelination and structural reorganization in the internal capsule, a key motor pathway post‑ischemic injury (Zhao et al., 2023).

2. Anti‑Inflammatory and Neuroprotective Actions: Studies demonstrate that components of BHYWD can reduce pro‑inflammatory cytokines and protect neurons from ischemia‑related damage (Li et al., 2018).

3. Synaptic Plasticity: BHYWD has been associated with improved synaptic protein expression in stroke models, potentially supporting neuroplasticity and functional recovery (Chen et al., 2017).

4. Clinical Rehabilitation Outcomes: Meta‑analyses suggest that BHYWD, when combined with conventional therapy, may improve neurological function and activities of daily living in ischemic stroke rehabilitation (Zhang et al., 2021).

Integrative Rehabilitation: Clinical Application

A recent integrative rehabilitation case reported the use of a modified BHYWD formula alongside acupuncture and manual therapies in a patient with chronic hemiplegia. The treatment focused on:

• Acupuncture to enhance motor cortex excitability and promote neuroplasticity

• Tuina and soft tissue techniques to improve circulation and reduce muscle stiffness

• BHYWD to address underlying Qi deficiency and blood stasis

Clinically meaningful improvements in balance, gait symmetry, and motor strength were observed over the treatment course (Needles & Herb, 2026).

This approach reflects a synergistic model: BHYWD supports systemic and local recovery processes, while rehabilitative modalities work directly on motor function.

Safety and Precautions

Although BHYWD is well‑tolerated in many clinical settings, considerations include potential interactions with antiplatelet and anticoagulant medications, as some herbs possess blood‑thin‑like effects (Ma et al., 2019). Individual pattern diagnosis remains essential to tailor the formula appropriately.

Conclusion

Buyang Huanwu Decoction represents a valuable TCM intervention in the integrative rehabilitation of post‑stroke hemiplegia. Its traditional rationale aligns with emerging biomedical evidence on neural repair, circulation, and functional recovery. When combined with rehabilitative therapies, BHYWD may enhance motor outcomes and overall rehabilitation success. Future rigorous clinical trials are warranted to further validate these findings and refine clinical protocols.

References

Chen, S., Liu, J., & Wang, Y. (2017). Effects of Buyang Huanwu Tang on synaptic proteins in cerebral ischemia‑reperfusion models. Journal of Integrative Medicine, 15(4), 281–287.

Feigin, V. L., Norrving, B., & Mensah, G. A. (2022). Global burden of stroke. Circulation Research, 130(4), 601–615.

Li, X., Zhang, A., & Wang, Y. (2018). Anti‑inflammatory and neuroprotective effects of Buyang Huanwu Tang in experimental ischemic stroke. Neurochemical Research, 43(8), 1545–1553.

Ma, J., Li, Y., & Yang, X. (2019). Herb‑drug interactions with anticoagulants: implications for stroke rehabilitation. Phytotherapy Research, 33(10), 2630–2642.

Needles & Herb. (2026, January). Integrative rehabilitation of post‑stroke hemiplegia [Blog post]. Retrieved from https://neuronk.blogspot.com/2026/01/integrative-rehabilitation-of-post.html?m=1

Wang, Q. (1830/2010). Corrections from the Forest of Medical Literature (Yilin Gaicuo). Beijing: People’s Medical Publishing House.

Zhang, L., & Liu, H. (2019). TCM pattern differentiation in post‑stroke rehabilitation. Chinese Journal of Integrative Medicine, 25(7), 515–522.

Zhang, P., Yu, J., & Chen, Q. (2021). Meta‑analysis of Buyang Huanwu Tang as adjunctive therapy for ischemic stroke rehabilitation. Evidence‑Based Complementary and Alternative Medicine, 2021, 5569315.

Zhao, X., Tang, W., & Li, B. (2023). Effects of Buyang Huanwu Tang on white matter integrity after cerebral ischemia. Frontiers in Neurology, 14, 1045523.