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"The element Earth governs sowing and reaping, and its flavor is sweet. Yi Tang (Maltose) is the essence of the essence derived from agricultural crops. Spleen Earth resides in the center. If it is deficient and requires the establishment of the Middle Jiao (Middle Burner), there are five substances that tonify the Spleen: Ren Shen (Ginseng Radix et Rhizoma), Da Zao (Jujubae Fructus), Jing Mi (Oryzae Semen Glutinosum), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Yi Tang (Maltose). All can treat abdominal pain due to Spleen deficiency, yet each has its appropriate and inappropriate applications. In cases of deficiency accompanied by Cold, one must employ a sovereign herb to dispel Cold, such as in Da Jian Zhong Tang (Great Construct the Middle Decoction), where Ren Shen and Yi Tang coordinate with Hua Jiao (Zanthoxyli Pericarpium) and Gan Jiang (Zingiberis Rhizoma). However, if the Cold resides in the Lower Jiao (Lower Burner), these five substances are inappropriate, as seen in Dang Gui Sheng Yang Rou Tang (Angelica Sinensis, Ginger, and Mutton Decoction) and Wu Tou Gui Zhi Tang (Aconite Root and Cinnamon Twig Decoction), which do not contain these five herbs. Fu Zi Bing Mi Tang (Aconite Root and Rice Decoction) treats rumbling abdominal pain caused by Cold Qi in the abdomen, along with rebellious fullness and vomiting in the chest and hypochondrium. Is this not also Cold in the Lower Jiao? Why does it contain Jing Mi, Gan Cao, and Da Zao, but lack Ren Shen and Yi Tang? The answer is that without precise correspondence of flavors, one must carefully examine the specific syndrome. The pain in the abdomen caused by Cold actually stems from turbid Yin rising from the Lower Jiao, leading to rebellious fullness and vomiting in the chest and hypochondrium. Fu Zi (Aconiti Lateralis Radix Praeparata) warms the Kidney; Ban Xia (Pinelliae Tuber) stops vomiting. Although Spleen deficiency requires tonification, when there is vomiting indicating deficiency, the Middle Jiao should not be cloyed or stagnant. To benefit Yin, Jing Mi, Da Zao, and Gan Cao are used to tonify deficiency and nourish Yin. Ren Shen is avoided because it tends to raise Qi; Yi Tang is avoided because it tends to cause stagnation in the Middle. Therefore, they are excluded. In Xiao Jian Zhong Tang (Small Construct the Middle Decoction), Gan Cao is honey-fried, whereas here it is not, precisely because of its potential to cause stagnation.

Zou stated that Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction plus Paeonia Root) primarily treats abdominal fullness and pain, while Xiao Jian Zhong Tang primarily treats abdominal urgency and pain. This is because Shao Yao (Paeoniae Radix Alba) is sour and breaks up Yin stagnation, while Yi Tang is sweet and relieves urgency. This statement is correct. However, there is a reason why Shao Yao remains in Xiao Jian Zhong Tang when treating urgent pain. Xu stated that for external syndromes, Gui Zhi Tang (Cinnamon Twig Decoction) resolves the muscle layer and harmonizes Ying (Nutrient) and Wei (Defensive) Qi. For internal syndromes, it transforms Qi and harmonizes Yin and Yang. Gui Zhi and Gan Jiang coordinate with Gan Cao and Da Zao to transform Yin. Shao Yao coordinates with Gan Cao and Da Zao to transform Yang. Since Shao Yao treats more than just abdominal fullness, Xiao Jian Zhong Tang is indicated for various conditions such as deficiency consumption, interior urgency, palpitations, and epistaxis. Only when treating fullness and pain is the original formula of Gui Zhi Tang modified by doubling the dosage of Shao Yao, while Yi Tang is excluded.

Regarding the distinction between large and small Jian Zhong formulas, Zou proposed two theories: 'combined vs. separated momentum' and 'focused vs. weak power,' concluding with 'the sovereign is honored and the minister obeys' versus 'the sovereign is humble and the minister acts independently.' In reality, none of these assertions hold true. Why? The indications for Xiao Jian Zhong Tang vary, but its key lies in 'establishing the Middle.' To say it establishes the Middle implies it is the lesser form of establishing the Middle. In contrast, Da Jian Zhong Tang specifically treats deficiency-Cold of the Middle Zang-Fu organs, without addressing other meridians. The phrase 'Cold in the abdomen' is the primary symptom, while others are merely repercussions of abdominal Cold. Zhou Yangjun stated: When Middle Qi is deficient, Yang Qi cannot distribute, resulting in the accumulation of Cold-Fluid and the rushing of Cold Qi. You Zaijing stated: Yin condenses into visible forms, and insects within the abdomen move upon this condition. Both explanations are highly appropriate. No herb warms the Spleen better than Gan Jiang; no substance tonifies the Spleen better than Ren Shen and Jiao Yi Tang (Gelatinous Maltose). Hua Jiao can travel from the Spleen to the Kidney to eliminate fluid retention and kill parasites, making it an essential herb for warming the Spleen. These four substances provide great warmth and tonification, remaining within the Central Palace (Spleen/Stomach). Is there anything greater for establishing the Middle? Observing that Da Jian Zhong Tang is listed only under the category of 'Abdominal Fullness,' whereas Xiao Jian Zhong Tang appears in various sections of Shang Han Lun (Treatise on Cold Damage) and Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet) covering Blood Bi, Jaundice, and Women's Miscellaneous Diseases, Zhang Zhongjing's intention in naming and formulating these decoctions becomes clearly evident. It is indeed strange that commentators throughout history have overlooked this point."