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Treats cases where the exterior syndrome of Shanghan (Cold Damage) has not yet resolved, or where there is palpitation accompanied by irritability, or acute abdominal pain, with a pulse that is choppy at the Yang position and wiry at the Yin position.
Guizhi Tang (Cinnamon Twig Decoction) ingredients: Cinnamomi Ramulus (Guizhi, 桂枝) 3 liang, Paeoniae Radix Alba (Baishao, 白芍) 6 liang, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 3 liang (sliced), Glycyrrhizae Radix et Rhizoma Preparata (Zhigancao, 炙甘草) 2 liang, Maltose (Jiaoyi, 胶饴) 1 jin, Ziziphus Jujuba (Dazao, 大枣) 12 pieces (split). The above six herbs are boiled in 7 sheng of water to obtain 3 sheng of decoction. The dregs are removed, Maltose is added, and it is heated again until dissolved. It is taken orally in three divided doses daily. Patients with vomiting should not use Jianzhong Tang (Build the Middle Decoction) because sweetness may exacerbate vomiting.
[Note] This formula is essentially Guizhi Tang (Cinnamon Twig Decoction) with doubled Baishao (White Peony Root) and added Maltose. It is named Xiao Jianzhong Tang (Minor Build the Middle Decoction), indicating the modest establishment of Middle Qi (Spleen and Stomach energy). Since the Middle Jiao (Middle Burner) is already deficient but the exterior has not yet harmonized, drastic tonification is avoided. Therefore, Guizhi Tang (Cinnamon Twig Decoction) is used to harmonize Ying (Nutrient) and Wei (Defensive) Qi. Doubling Baishao (White Peony Root) and adding Maltose regulates and establishes the Middle Jiao (Middle Burner). Unlike Guizhi Tang (Cinnamon Twig Decoction), one does not drink warm millet gruel or take warm covers to induce sweating, as the focus here is on Middle deficiency rather than the exterior syndrome of Shanghan (Cold Damage). Once the Middle deficiency is established, Ying (Nutrient) and Wei (Defensive) Qi naturally harmonize, body fluids are generated, and the disease resolves through sweating, eliminating irritability and palpitations. A floating pulse with a choppy quality in Shanghan (Cold Damage) indicates insufficiency of Ying (Nutrient) and Wei (Defensive) Qi; a deep pulse with a wiry quality indicates Wood invading Earth (Liver affecting Spleen/Stomach). Insufficiency of Ying (Nutrient) and Wei (Defensive) Qi leads to exterior deficiency; Wood invading Earth leads to interior tension. Due to exterior deficiency and interior tension, this decoction is also indicated for primary treatment. Vomiting patients should not use it, meaning anyone suffering from vomiting should avoid it, fearing that sweetness will aggravate the vomiting.

Treats cases of Shanghan (Cold Damage) with knotted and intermittent pulses and palpitations. It also treats Feiwei (Lung Withered-Flower), characterized by excessive coughing and expectoration of saliva, and a sensation of warmth and fluid regurgitation in the heart region.
Glycyrrhizae Radix et Rhizoma Preparata (Zhigancao, 炙甘草) 4 liang, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 3 liang (sliced), Cinnamomi Ramulus (Guizhi, 桂枝) 3 liang, Ophiopogonis Tuber (Maidong, 麦冬) half sheng, Sesami Semen (Huo Ren, 火麻仁) half sheng, Ziziphus Jujuba (Dazao, 大枣) 12 pieces (split), Ginseng Radix et Rhizoma (Renshen, 人参) 1 liang, Ecliptae Cortex / Asini Corii Colla (Ejiao, 阿胶) 2 liang, Rehmanniae Radix Praeparata (Shudihuang, 熟地黄) 1 jin. The above nine herbs are boiled in 7 sheng of clear wine and 8 sheng of water. First, boil the first eight herbs to obtain 3 sheng of decoction. Remove the dregs, add Ejiao (Donkey-hide Gelatin), melt it completely, and take 1 sheng per dose, three times daily.
[Collected Notes] Ke Qin stated: Zhang Zhongjing uses Baishao (White Peony Root) to benefit Yin when the pulse is weak and Yin is deficient; he uses Guizhi (Cinnamon Twig) to unblock Yang when Yang is deficient; and if severe, adds Renshen (Ginseng) to generate the pulse. He never used Dihuang (Rehmannia) or Maidong (Ophiopogon). Is it because the principle of treating Shanghan (Cold Damage) emphasizes supporting Yang? Or is there no method for sudden tonification of Yin? In this case, due to Heart deficiency causing knotted and intermittent pulses, Shudihuang (Prepared Rehmannia Root) is used as the Sovereign herb, and Maidong (Ophiopogon Tuber) as the Minister herb, to vigorously tonify True Yin, opening a path for subsequent generations to treat Yin deficiency. Dihuang (Rehmannia) and Maidong (Ophiopogon) are sweet in taste but cold in nature; they are not herbs that disperse stagnation or promote growth. They must be combined with Renshen (Ginseng) and Guizhi (Cinnamon Twig) to unblock Yang meridians, Shengjiang (Fresh Ginger) and Dazao (Jujube) to harmonize Wei (Defensive) and Ying (Nutrient) Qi, Ejiao (Donkey-hide Gelatin) to nourish Blood, Suanzaoren (Ziziphus Seed) to calm the Spirit, Gancao (Licorice) to moderate action and prevent rapid descent, and clear wine to facilitate rapid upward movement. This harmonizes the interior and exterior, calming palpitations and restoring the pulse. Using 7 sheng of wine and 8 sheng of water to yield only 3 sheng means prolonged boiling reduces the potency, which is a method for using wine in deficiency cases. It also shows that Dihuang (Rehmannia) and Maidong (Ophiopogon) work best with wine. For this condition, Suanzaoren (Ziziphus Seed) should be used; for Feiwei (Lung Withered-Flower), Huo Ren (Hemp Seed) is appropriate. If genuine Ejiao (Donkey-hide Gelatin) is unavailable, Gui Ban Jiao (Tortoise Shell Gelatin) can be substituted.
Discussion on Guizhi Tang (Cinnamon Twig Decoction) combined with Renshen Tang (Ginseng Decoction) and Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction): When the exterior syndrome of Taiyang (Greater Yang) has not resolved, but multiple purgations have been performed, leading to dysentery with heat, persistent diarrhea, unresolved exterior and interior syndromes, a faint pulse, and epigastric fullness and hardness, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is the primary treatment. If a Guizhi Tang (Cinnamon Twig Decoction) pattern is present, but the physician incorrectly uses purgatives, resulting in persistent diarrhea, a rapid pulse, wheezing, and sweating, Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) is the primary treatment.