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**Shisi Wei Jianzhong Tang (Fourteen-Ingredient Decoction to Greatly Reconstruct the Middle):** Treats deficiency of Qi and Blood, consumptive debility (emaciation and weakness), shortness of breath with a tendency to lie down, conditions approaching Laozai (chronic consumptive disease, similar to tuberculosis), and macules appearing in Yin syndromes. [Note: This may arise from improper use of sweating, vomiting, or purging methods leading to exhaustion of healthy Qi, or from sexual excess damaging Kidney Qi, or from excessive intake of cold-natured medicines, resulting in a Yin syndrome. Cold pathogens lurk in the lower Jiao, forcing the rootless and unanchored Lung Qi to float outward, thereby causing macules to appear. Their color is pale red, faintly visible on the skin surface, which differs from the purple-red macules seen in Yang syndromes. This indicates that Stomach Qi is constrained by cold and chill, leading to immediate peril. Wu Hegao stated: Using Ginseng, Cinnamon Twig, and Aconite to treat macules is a method of variation. If physicians do not understand flexibility, how can they discuss pulselessness?]

**Ingredients:** Astragali Radix (Huangqi) (honey-fried), Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu) (soil-stir-fried), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao) (honey-fried), Pinelliae Rhizoma (Banxia) (ginger-processed), Angelicae Sinensis Radix (Danggui) (wine-washed), Paeoniae Radix Alba (Baishao) (wine-washed), Rehmanniae Radix Praeparata (Shudihuang), Chuanxiong Rhizoma (Chuanxiong), Ophiopogonis Radix (Maidong), Cistanches Herba (Rongshu), Aconiti Lateralis Radix Praeparata (Fuzi) (prepared), Bupleuri Radix (Chaihu).

**Formula Analysis:** Huangqi benefits the Defensive Qi and strengthens Yuan Qi; it is the primary herb for tonifying the Middle. Si Jun Zi Tang (Four Gentlemen Decoction) tonifies Qi, and Si Wu Tang (Four Substance Decoction) nourishes Blood. When Yin and Yang are harmonized, Qi and Blood remain in their proper positions. Banxia harmonizes the Stomach and strengthens the Spleen. The combination of Fuling, Baizhu, Maidong, Chuanxiong, Shudihuang, and Rongshu constitutes the "Bawei Da Jianzhong Tang" (Eight-Ingredient Decoction to Greatly Reconstruct the Middle), with identical indications. If Chuanxiong and Shudihuang are removed, and Baizhu, Fuzi, and Rongshu are added along with Chaihu, it becomes Shisi Wei Jianzhong Tang.

**Yangzhong Jian (Decoction to Nourish the Middle):** Treats deficiency-cold of the Middle Qi manifesting as vomiting and diarrhea.

**Ingredients:** Ginseng Radix et Rhizoma (1–3 qian), Dioscoreae Rhizoma (Shanyao) (stir-fried, 2 qian), Dolichos Lablab Semen Album (Baibiandou) (stir-fried, 2–3 qian), Glycyrrhizae Radix et Rhizoma (Zhi Gancao) (1 qian), Zingiberis Rhizoma Recens (Ganjiang) (stir-fried until yellow, 1–2 qian).

**Baitong Tang Plus Human Urine and Pig Gallbladder Juice:** From Zhang Zhongjing's *Shanghan Lun*, treating Shaoyin disease with diarrhea and a faint pulse. Administer Baitong Tang. If diarrhea persists, accompanied by cold extremities, absence of pulse, dry retching, and irritability, death ensues if the pulse suddenly emerges violently, but survival occurs if the pulse gradually returns. [The Kidney serves as the gate of the Stomach. The anterior orifice eliminates water, and the posterior orifice eliminates grain. Confinement by cold pathogens causes diarrhea. Baitong Tang is given to restore Yang and dissipate cold. If after administration diarrhea persists, extremities become cold, pulse vanishes, and there is dry retching and irritability, this indicates rejection and chaotic reversal of Yang Qi. If the pulse suddenly emerges violently after taking this decoction, it signifies the collapse of Healthy Qi due to leakage, hence death. If the pulse slowly continues, it signifies the gradual recovery of Yang Qi, hence life.]

**Ingredients:** Allii Tuberosi Bulbus (Congbai) (4 stalks), Zingiberis Rhizoma Recens (Ganjiang) (1 liang), Aconiti Lateralis Radix Praeparata (Fuzi) (one piece, prepared), Human Urine (Wuren) (5 he), Porcine Bile (Zhudanzhi) (1 he). Modifications follow the same rules as Sini Tang (Frigid Extremities Decoction).

**Formula Analysis:** The pungency of Congbai unblocks Yang Qi. The heat of Jiang (Ginger) and Fu (Aconite) dissipates Yin cold. This is Baitong Tang. If there is no response after ingestion, it is due to Yin excess rejecting Yang? Emotional stagnation and failure of Qi mechanism to reach may lead to great benefit. The Classics state: Treating against the pathogenic trend or following it; treating Zheng (regular) diseases with Zheng methods, and Fan (rebellious/atypical) diseases with Fan methods—this is what is meant. [Using hot herbs to treat cold diseases and cold herbs to treat hot diseases is Zheng Zhi (Regular Treatment). Using hot herbs to treat hot diseases and cold herbs to treat cold diseases is Fan Zhi (Rebellious Treatment), also called Cong Zhi (Following Treatment), meaning to follow the apparent nature to subdue the true pathogen.]

**Commentary:** Jue (Cold Extremities) syndromes are divided into Yin Jue and Yang Jue. In Yin Jue, the body is cool, there is no thirst, and the pulse is slow, fine, and faint. In Yang Jue, extreme Yang heat paradoxically causes cold extremities; although the limbs are cold, there is irritability, thirst, delirium, and occasional warming of the body with a rapid pulse. If Yang Jue is extremely deep, leading to a cold body and a pulse so faint it seems about to cease, this indicates extreme heat approaching death. Urgently administer Dacheng Qi Tang (Major Order the Qi Decoction) to purge; then the cold extremities will resolve. It is said that cold herbs can generate the pulse and warm the body. If hot herbs are used to assist Yang, Yin Qi will abruptly perish, leading to death. For Yin Jue, Baitong Tang or Sini Tang must be administered urgently; delay renders treatment ineffective.