下。常相联系。故俗名 串。
案金鉴云。若肠鸣三字。与上下文不属。必是错简。侠瘿之瘿字。当是瘰字。每经此证。先劳后瘰。先瘰
后劳者有之。从未见劳瘿先后病也。必是传写之讹。此一偏之见。不可凭也。灵经脉篇。少阳所生病云。腋下
肿马刀侠瘿。而痈疽篇云。其痈坚而不溃者。为马刀侠缨。潘氏医灯续焰释之云。马刀蛤蛎之属。痈形似之。
侠缨者。发于结缨之处。大迎之下颈侧也。二痈一在腋。一在颈。常相联系。故俗名 串。义尤明显。知是
瘿当根据痈疽篇而作缨。马刀侠瘿。即灵寒热篇。所谓寒热瘰 。及鼠 寒热之证。张氏注云。结核
连续者为瘰 。形长如蚬蛤者为马刀。又张氏六要云。马刀。小蚬也。圆者为瘰 。长者为马刀。皆少阳经郁
结所致。久成 劳是也。盖瘰 者。未溃之称。已溃漏而不愈者为鼠 。其所由出于虚劳。瘿者考巢源等。
瘤之生于颈下。而皮宽不急。垂捶捶然者。故说文云。瘿。颈瘤也。与瘰 迥别。瘿
乃缨之讹无疑矣。又案痹挟背行。若肠鸣。马刀侠瘿。各是一证。非必三证悉见也。故以皆字而断之。
脉沉小迟。名脱气。其人疾行则喘喝。手足逆寒。腹满甚则溏泄。食不消化也。（案沈云。喝。当作
急。非也。灵经脉篇。喝喝而喘。）
〔鉴〕脉沉细迟。则阳大虚。故名脱气。脱气者。谓胸中大气虚少。不充气息所用。故疾行喘喝也。阳虚
则寒。寒盛于外。四末不温。故手足逆冷也。寒盛于中。故腹满溏泄。
食不消化也。
〔魏〕沉小兼数。则为阴虚血亡。沉小兼迟。则必阳虚气耗也。故名之曰脱气。
案抱朴子曰。奔驰而喘逆。或咳或懑。用力役体。汲汲短乏者。气损之候也。面无光色。皮肤枯腊。唇
焦脉白。腠理萎瘁者。血灭之证也。所谓气损。乃脱气也。
脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。
虚寒相搏。此名为革。妇人则半产漏下。男子则亡血失精。（此条亦见于辨脉。及妇人杂病。）
〔程〕人之所以有身者。精与血也。内填骨髓。外溉肌肤。充溢于百骸。流行于脏腑。乃天一所生之水。
四大藉此以成形。是先天之神气。必恃后天之精血。以为运用。有无相成。阴阳相生。毋令残害。若其人房室
过伤。劳倦过度。七情暗损。六淫互侵。后天之真阴已亏。先天之神气并竭。在妇人则半产胞胎。或漏下赤
白。在男子则吐衄亡血。或梦交泄精。诊其脉。必弦而大。弦为寒。而大为虚。既寒且虚。则脉成
革矣。革者如按鼓皮。中空之象。即芤大之脉。内经曰。浑浑革至如涌泉。病进而
危弊。故仲景一集中。前后三致意焉。
虚劳里急。悸衄腹中痛。梦失精。四肢 疼。手足烦热。咽干口燥。小建中汤主之。（外台。无悸衄
二字。口燥下。有并妇人少腹痛六字。引古今录验。名芍药汤。）
〔程〕里急。腹中痛。四肢酸疼。手足烦热。脾虚也。悸。心虚也。衄。肝虚也。失精。肾虚也。咽干
口燥。肺虚也。此五脏皆虚。而土为万物之母。故先建其脾土。
〔尤〕此和阴阳。调营卫之法也。夫人生之
道。曰阴曰阳。阴阳和平。百疾不生。若阳病不能与阴和。则阴以其寒独行。为里急。为腹中痛。而实非阴之
盛也。阴病不能与阳和。则阳以其热独行。为手足烦热。为咽干口燥。而实非阳之炽也。昧者以寒
攻热。以热攻寒。寒热内贼。其病益甚。惟以甘酸辛药。和合成剂。调之令和。则阳就于阴。而寒以温。阴就
于阳。而热以和。医之所以贵识其大要也。岂徒云寒可治热。热可治寒而已哉。或问和阴阳调营卫是矣。而必
以建中者何也。曰。中者。脾胃也。营卫生成于水谷。而水谷转输于脾胃。故中气立。则营卫流行。而不失其
和。又中者四运之轴。而阴阳之机也。故中气立。则阴阳相循。如环无端。而不极于偏。是方甘与辛合而生
阳。酸得甘助而生阴。阴阳相生。中气自立。是故求阴阳之和者。必于中气。求中气之立者。必以建中也。
案里急。诸家无明解。巢源虚劳里急候云。劳伤内损。故腹里拘急也。二十九难云。冲脉之为病。逆气
里急。丁注。逆气。腹逆也。里急。腹痛也。此云腹中痛。则巢源为是。
小建中汤方
桂枝（三两去皮） 甘草（三两炙） 大枣（十二枚） 芍药（六两） 生姜（三两） 胶饴（一升）
上六味。以水七升。煮取三升。去滓。纳胶饴。更上微
火消解。温服一升。日三服。呕家。不可用建中汤。以甜故也。
〔原注〕千金。疗男女因积冷气滞。或大病后。不复常。苦四肢沉重。骨肉 疼。吸吸
少气。行动喘乏。胸满气急。腰背强痛。心中虚悸。咽干唇燥。面体少色。或饮食无味。
胁肋腹胀。头重不举。多卧少起。甚者积年。轻者百日。渐致瘦弱。五脏气竭。则难可复
常。六脉俱不足。虚寒乏气。小腹拘急。羸瘠百病。名曰黄 建中汤。又有人参二两。○
案此千金肾脏文。本于肘后。积冷气滞。作积劳虚损。胸满气急。作小腹拘急。胁肋腹胀。
头重不举。作阴阳废弱。悲忧惨戚。六脉俱不足以下。则肺脏门。小建中汤主疗。六脉俱
不足。作肺与大肠俱不足。方后注云。肘后。用黄 人参各二两。名黄 建中汤。此所引颇舛。
〔程〕内经曰。脾为中央土。以灌四旁。故能生万物。而法天地。失其职。则不能为胃行其津液。五脏
失所养。亦从而病也。建中者。必以甘。甘草大枣胶饴之甘。所以健中。而缓诸急。通行卫气者。必以辛。
姜桂之辛。用以走表。而通卫。收敛荣血者。必以酸。芍药之酸。用以走里。而收营。
营卫流行。则五脏不失权衡。而中气斯建矣。
外台。集验黄 汤。即黄 建中汤。方后云。呕者。倍生姜。又古今录验黄 汤。亦即黄 建中汤。
方后云。呕即除饴糖。总病论云。旧有微溏。或呕者不用饴糖也。
虚劳里急。诸不足。黄 建中汤主之。
〔尤〕里急者。里虚脉急。腹当引痛也。诸不足者。阴阳诸脉。并俱不足。而眩悸喘喝。失精亡血等证。
相因而至也。急者缓之必以甘。不足者补之必以温。而充虚塞空。则黄 尤有专长也。
黄 建中汤方 于小建中汤内。加黄 一两半。余根据上法。
气短胸满者。加生姜。腹满者。去枣。加茯苓一两半。及疗肺虚损不足。补气加半夏三两。（千金。及外
台。引集验。用黄 三两。气短胸满四字。作呕者二字。茯苓作四两。及疗以下十四字无。方后云。此本仲景方。）
〔程〕生姜泄逆气。故短气胸满者。加生姜。甘令中满。
故去大枣。淡能渗泄。故加茯苓。茯苓能止咳逆。故疗肺虚不足。补加半夏。未详。
案小建中汤。黄 建中汤。考千金诸书。主疗及分两异同。药剂增减颇多。兹见其一二。以示运用之法。
千金建中汤。治五劳七伤。小腹急痛。膀胱虚满。手足
逆冷。食饮苦。吐酸。痰呕泄下。少气目眩。耳聋口焦。小便自利方。
于黄 建中汤内。加干姜当归人参半夏橘皮附子。
又大建中汤。治五劳七伤小腹急。脐下彭亨。两胁胀满。腰脊相引。鼻口干燥。目暗KT KT 。愦愦
不乐。胸中气急。逆不下食饮。茎中策策痛。小便黄赤。尿有余沥。梦与鬼神交通去精。惊恐虚乏方。
于黄 建中汤。加远志当归泽泻人参龙骨。（千金翼。无当归。）
又前胡建中汤。治大劳虚劣。寒热呕逆。下焦虚热。小便赤痛。客热上熏头目。及骨肉疼痛口干方。
于黄 建中汤。加前胡当归茯苓人参半夏。
又芍药汤。治产后苦腹少痛方。
即小建中汤。
又云。凡身重不得食。食无味。心下虚满。时时欲下。喜卧者。皆针胃脘太仓。服建中汤。及服平胃丸。
又坚中汤。治虚劳内伤。寒热呕逆吐血方。
于小建中汤方内。加半夏三两。（千金翼。无甘草桂心。有生地黄。）
外台删繁建中汤。疗肺虚损不足。补气方。
于黄 建中汤内。加半夏。（案原文所载即是。盖系于后人所附。程云。未详。失考耳。）
又古今录验黄 汤。主虚劳里急。引少腹绞痛极挛。卵
肿缩疼痛。
即黄 建中汤。方后云。呕即除饴。
又芍药汤。主疗及方。并与本文小建中汤同。
又黄 汤。疗虚劳里急。少腹痛。气引胸胁痛。或心痛短气。
于黄 建中汤内。加干姜当归。
又建中黄 汤。疗虚劳短气。少腹急痛。五脏不足。
于黄 建中汤。去芍药。
又深师黄 建中汤。疗虚劳腹满。食少。小便多。
于黄 建中汤内。加人参半夏。去饴。
又必效黄 建中汤。疗虚劳下焦虚冷。不甚渴。小便数。
于黄 建中汤内。加人参当归。若失精。加龙骨白蔹。
又深师黄 汤。疗大虚不足。少腹里急。劳寒拘引脐。气上冲胸。短气言语谬误。不能食。吸吸气乏闷乱者。
于黄 建中汤内。加半夏人参。去饴。若手足冷。加附子。
又大建中汤。疗内虚绝里急。少气。手足厥逆。少腹挛急。或腹满弦急。不能食。起即微汗出阴缩。或
腹中寒痛。不堪劳苦。唇口舌干。精自出。或手足乍寒乍热。而烦苦酸疼。不能久立。多梦寤。补中益气方。
于黄 建中汤内。加人参当归半夏附子。去饴。
又短剧黄 汤。疗虚劳胸中客热。冷癖痞满。宿食不消吐噫。胁间水气。或流饮肠鸣。不生肌肉。
头痛。上重下轻。目视KT KT 。恍惚志损。常燥热。卧不得安。少腹急。小便赤
余沥。临事不起。阴下湿。或小便白浊伤多方。
于黄 建中汤内。加人参当归。去饴。有寒。加浓朴。
苏沈良方云。小建中汤。治腹痛如神。然腹痛按之便痛。
重按却不甚痛。此止是气痛。重按愈痛而坚者。当自有积也。气痛不可下。下之愈甚。此虚寒证也。此药偏
治腹中虚寒。补血尤主腹痛。（三因方治此证加味小建中汤于本方内加远志。）王氏易简方云。
或吐或泻。状如霍乱。及冒涉湿寒。贼风入腹。拘急切痛。加附子三分。名附子建中汤。疝气发作。当于附子
建中汤。煎时加蜜一箸头许。名蜜附子汤。（易简小建中汤。无饴。）
张氏医说云。养生必用方。论虚劳不得用凉药。如柴胡鳖甲青蒿麦门冬之类。皆不用服。唯服黄 建中
汤。有十余岁女子。因发热咳嗽喘急。小便少。后来成肿疾。用利水药得愈。然虚羸之甚。遂用黄 建中汤。
日一服。三十余日遂愈。盖人禀受不同。虚劳小便白浊。阴脏人。服橘皮煎黄 建中汤。获愈者甚众。至于阳
脏人。不可用暖药。虽建中汤不甚热。然有肉桂。服之稍多。亦反为害。要之用药亦量其
所禀。审其冷热。而不可一概以建中汤。治虚劳也。（出医余。）
圣济总录。结阴门芍药汤。治非时便血。
小建中汤。去大枣。
直指方。黄 建中汤。治伤湿鼻塞身痛。
即本方。不用胶饴。
又加味建中汤。治诸虚自汗。
于本方。加炒浮小麦。
又黄 建中汤。加川 当归。治血刺身痛。
危氏得效方。黄 建中汤。治汗出污衣。甚如坯染。皆
由大喜伤心。喜则气散。血随气行。兼服妙香散。金银器麦子麦门冬煎汤下。病名红汗。
王氏准绳云。小建中汤。治痢不分赤白久新。但腹中大
痛者神效。其脉弦急。或涩浮大。按之空虚。或举按皆无力者是也。
示儿仙方。建脾散。治脾痞胁痛。
即小建中汤加缩砂。
徐氏医法指南。小建中汤。治失血虚者。
本方。阿胶。代胶饴。
虚劳腰痛。少腹拘急。小便不利者。八味肾气丸主之。（方见妇人杂病中。）
〔程〕腰者肾之外候。肾虚则腰痛。肾与膀胱为表里。不得三焦之阳气以决渎。则小便不利。而少腹
拘急。州都之官。亦失其气化之职。此水中真阳已亏。肾间动气已损。与是方
以益肾间之气。气强则便溺行。而小腹拘急亦愈矣。
案抱朴子云。今医家通明肾气之丸。内补五络之散。骨
填枸杞之煎。黄 建中之汤。将服之者。皆致肥。肾气丸黄 建中汤。出于晋以前。可以知矣。
肘后云。干地黄四两。茯苓。薯蓣。桂。牡丹。山茱萸。各二两。附子。泽泻。一两。捣蜜丸如梧子。
服七丸。日三加至十丸。此是张仲景八味肾气丸方。疗虚劳不足。大伤饮
水。腰痛小腹急。小便不利。又云。长服即去附子。加五味子。治大风冷。（千金。补肾门同。用干地黄。八
两。山茱萸。薯蓣。各四两。泽泻。牡丹皮。茯苓。各三两。桂心。附子。各二两。注。仲景云。常服去
附子。加五味子。姚公云。加五味子。二两。苁蓉四两。张文仲云。五味子。苁蓉。各四两。）
和剂局方。八味丸。治肾气虚乏。下元冷惫。脐腹疼痛。夜多漩溺。脚膝缓弱。肢体倦怠。面色黧黑。
不思饮食。又治香港脚上冲。少腹不仁。及虚劳不足。渴欲饮水。腰重疼痛。
少腹拘急。小便不利。或男子消渴。小便反多。妇人转胞。小便不通。（即本方。用茯苓。牡丹皮。泽泻。
各三两。熟干地黄。八两。山茱萸。山药。各四两。附子。肉桂。各二两。方后云。久服壮元阳。益精髓。
Below. [The two swellings] are often connected, hence commonly called "chuan" (string-like).
Commentary from Jin Jian: The three characters "bowel sounds" do not belong in the context and must be a misplaced slip of the bamboo slips. The character "ying" (goiter) in "xia ying" should be "luo" (scrofula). In experiencing this syndrome, there are cases where labor precedes luo, or luo precedes labor. However, I have never seen labor and goiter occurring sequentially as diseases. It must be a transcription error. This is a biased view and cannot be relied upon. The *Ling Shu: Jing Mai* chapter states that what Shaoyang generates includes "swelling under the armpit, Ma Dao (horse knife), and xia ying." The *Yong Ju* chapter states: "When an abscess is hard but does not suppurate, it is called Ma Dao and xia ying." Pan Shi's *Yi Deng Xu Yan* explains: "Ma Dao belongs to the category of clam shells; the shape of the abscess resembles them. Xia ying occurs at the place where the knot of the hat ribbon is tied, below Daying on the side of the neck. One abscess is in the armpit, the other on the the neck, and they are often connected, hence commonly called 'chuan'. The meaning is particularly clear. Knowing that 'ying' should be written as 'ying' (ribbon) according to the *Yong Ju* chapter, 'Ma Dao and xia ying' refers to the so-called 'han re luo li' (cold-heat scrofula) and 'shu yi han re' (rat-hole cold-heat) syndromes mentioned in the *Ling Shu: Han Re* chapter. Zhang's commentary states: "Tubercles appearing continuously are called luo li; those shaped long like clams are called Ma Dao." Zhang's *Liu Yao* also states: "Ma Dao is a small clam. Round ones are luo li, long ones are Ma Dao. All are caused by depression and accumulation in the Shaoyang meridian, which over time becomes lao (consumptive disease)." Luo li is the term for before ulceration; after ulceration, leaking and not healing is called shu yi. Its origin lies in xu lao (deficiency-labor). Regarding ying, Kao Chao Yuan etc. state: "A tumor arising below the neck, with loose skin that is not tight, hanging down heavily, is called ying." Thus, *Shuo Wen* says: "Ying is a neck tumor." It is distinctly different from luo li. There is no doubt that ying is a corruption of ying (ribbon). Furthermore, regarding Bi syndrome affecting the back, if there are bowel sounds, Ma Dao, and xia ying, each is a separate syndrome; it is not necessary for all three to appear simultaneously. Therefore, the word "jie" (all) is used to conclude this.
If the pulse is deep, small, and slow, it is named Tuo Qi (Loss of Qi). When the person walks quickly, they pant and gasp. Their hands and feet are reversely cold. If abdominal fullness is severe, it leads to loose stools, indicating undigested food. (Commentary: Shen says "he" should be "ji" (urgent), which is incorrect. *Ling Shu: Jing Mai* says "he he er chuan" - panting loudly.)
[Jin]: A deep, fine, and slow pulse indicates significant Yang deficiency, hence named Tuo Qi. Tuo Qi means that the Great Qi in the chest is deficient and scanty, insufficient to support respiration, hence panting and gasping when walking quickly. Yang deficiency leads to cold. When cold is prevalent externally, the four extremities are not warm, hence reversely cold hands and feet. When cold is prevalent internally, there is abdominal fullness and loose stools, with undigested food.
[Wei]: A deep, small pulse accompanied by rapidity indicates Yin deficiency and blood loss. A deep, small pulse accompanied by slowness indicates Yang deficiency and Qi consumption, hence named Tuo Qi.
Commentary from *Baopuzi*: Panting and counterflow qi while galloping, or coughing or feeling stifled, using force to serve the body, rushing and short of breath, are signs of Qi damage. Lack of luster on the face, withered and dry skin, cracked lips, white pulse, and withered pores are signs of blood extinction. What is called Qi damage is indeed Tuo Qi.
If the pulse is wiry and large, wiry indicates reduction, large indicates hollow. Reduction indicates cold, hollow indicates deficiency.
Deficiency and cold clashing together is named Ge (Leather) pulse. In women, it indicates spontaneous abortion and dripping bleeding; in men, it indicates blood loss and essence loss. (This clause also appears in *Bian Mai* and *Fu Ren Za Bing*.)
[Cheng]: The reason humans have bodies is Essence and Blood. Internally filling the bone marrow, externally irrigating the muscles and skin, overflowing through the hundred bones, circulating in the zang-fu organs, it is the Water generated by Heaven One. The Four Elements rely on this to take form. This innate Divine Qi must rely on post-natal Essence and Blood for operation. Existence and non-existence complement each other; Yin and Yang generate each other. Do not allow harm. If one injures excessively through sexual activity, overworks and tires, secretly damages through the Seven Emotions, and is invaded mutually by the Six Evils, the True Yin of the post-natal stage is already deficient, and the Divine Qi of the innate stage is exhausted. In women, this leads to spontaneous abortion of the fetus or dripping red and white discharge. In men, it leads to vomiting blood, nosebleeds, blood loss, or nocturnal emission during dreams of intercourse. Diagnosing their pulse, it must be wiry and large. Wiry indicates cold, large indicates deficiency. Both cold and deficiency present, then the pulse becomes Ge. Ge feels like pressing a drum skin, a hollow center image, which is the Kou Da (Hollow Large) pulse. The *Nei Jing* says: "Hun Hun Ge Zhi Ru Yong Quan" (Chaotic and leather-like arrival like a gushing spring); the disease progresses and becomes critical. Thus, in Zhongjing's collection, attention is paid to this three times before and after.
In Xu Lao (Deficiency-Labor) with Li Ji (internal urgency), palpitations, nosebleeds, abdominal pain, dream loss of essence, limb pain, vexing heat in hands and feet, dry throat, and dry mouth, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) governs. (*Wai Tai*, lacks the two characters "ji nu"; below "kou zao", there are six characters "bing fu ren shao fu tong", citing *Gu Jin Lu Yan*, named Shao Yao Tang.)
[Cheng]: Li Ji, abdominal pain, soreness and pain in limbs, vexing heat in hands and feet, indicate Spleen deficiency. Palpitations indicate Heart deficiency. Nosebleeds indicate Liver deficiency. Loss of essence indicates Kidney deficiency. Dry throat and dry mouth indicate Lung deficiency. Here, the Five Zang organs are all deficient, and Earth is the mother of all things, hence first construct its Spleen Earth.
[You]: This is the method of harmonizing Yin and Yang, regulating Ying and Wei. The way of human life is Yin and Yang. When Yin and Yang are peaceful, hundreds of diseases do not arise. If Yang pathology cannot harmonize with Yin, then Yin travels alone with its cold, causing Li Ji and abdominal pain, but actually Yin is not excessive. If Yin pathology cannot harmonize with Yang, then Yang travels alone with its heat, causing vexing heat in hands and feet, dry throat, and dry mouth, but actually Yang is not blazing. Ignorant people attack heat with cold, and attack cold with heat. Cold and heat become internal thieves, and the disease worsens. Only by combining sweet, sour, and acrid medicines into a formula, adjusting until harmony is achieved, can Yang join Yin, and cold becomes warm; Yin joins Yang, and heat becomes harmonized. This is why doctors value recognizing the general principles. Is it merely saying cold can treat heat and heat can treat cold? Someone asks: Harmonizing Yin and Yang, regulating Ying and Wei is correct, but why must one use Jian Zhong? I say: Zhong refers to the Spleen and Stomach. Ying and Wei are generated from water and grain, and water and grain are transported by the Spleen and Stomach. Thus, when Middle Qi stands, Ying and Wei circulate without losing their harmony. Also, Zhong is the axis of the four movements and the mechanism of Yin and Yang. Thus, when Middle Qi stands, Yin and Yang circulate like a ring without end, without reaching extremes of bias. In this formula, sweetness combined with acridity generates Yang; sourness aided by sweetness generates Yin. Yin and Yang generate each other, and Middle Qi establishes itself. Therefore, seeking the harmony of Yin and Yang must focus on Middle Qi; seeking the establishment of Middle Qi must use Jian Zhong.
Commentary: Li Ji has no clear explanation by various experts. *Chao Yuan Fang: Xu Lao Li Ji Hou* states: "Labor injury and internal damage cause abdominal tension." *Nan Jing 29* states: "Disease of the Chong Mai involves counterflow qi and Li Ji." Ding's annotation: Counterflow qi is abdominal counterflow; Li Ji is abdominal pain. Here it says abdominal pain, so *Chao Yuan* is correct.
Formula for Xiao Jian Zhong Tang:
Gui Zhi (Cinnamon Twig, 3 liang, peeled), Gan Cao (Licorice Root, 3 liang, honey-fried), Da Zao (Jujube, 12 pieces), Shao Yao (Peony Root, 6 liang), Sheng Jiang (Fresh Ginger, 3 liang), Jiao Yi (Malt Sugar, 1 sheng).
These six ingredients. Use 7 sheng of water, boil to obtain 3 sheng, remove dregs, add Jiao Yi, heat slightly on low fire to dissolve. Warm drink 1 sheng, three times a day. Those who vomit should not use Jian Zhong Tang because of its sweetness.
[Original Note]: *Qian Jin* treats men and women due to accumulated cold qi stagnation, or after a major illness, not returning to normal, suffering from heavy limbs, bone and flesh pain, shallow breathing, shortness of breath when moving, chest fullness and急促qi, stiff and painful waist and back, empty palpitations in the heart, dry throat and lips, lack of color on face and body, or tasteless food and drink, distension and fullness in hypochondrium and abdomen, heavy head unable to lift, sleeping much and rising little. Severe cases last years, mild cases 100 days, gradually becoming emaciated. Exhaustion of Qi in the Five Zang organs makes it difficult to return to normal. All six pulses are insufficient, deficiency-cold lacking Qi, tension in lower abdomen, emaciation and hundreds of diseases, named Huang Qi Jian Zhong Tang. Also add Ren Shen (Ginseng) 2 liang.
Commentary: This text from *Qian Jin* Kidney section originates from *Zhou Hou*. Accumulated cold qi stagnation is made into Accumulated Labor Deficiency-Labor. Chest fullness and急促qi are made into lower abdominal tension. Hypochondriac and abdominal distension, heavy head unable to lift are made into Yin-Yang waste and weakness. Sadness and grief... Below "all six pulses insufficient," then in Lung Organ section, Xiao Jian Zhong Tang governs. "All six pulses insufficient" is made into Lung and Large Intestine both insufficient. Post-formula note says: *Zhou Hou* uses Huang Qi and Ren Shen each 2 liang, named Huang Qi Jian Zhong Tang. This citation is quite erroneous.
[Cheng]: The *Nei Jing* says: "Spleen is the Central Earth, irrigating the four directions, thus able to generate all things and model Heaven and Earth." Losing its function, it cannot transport fluids for the Stomach. The Five Zang organs lose nourishment and subsequently become diseased. To build Zhong, one must use sweetness. Sweetness of Gan Cao, Da Zao, and Jiao Yi strengthens Zhong and relieves various tensions. To circulate Wei Qi, one must use acridity. Acridity of Sheng Jiang and Gui Zhi moves outward to unblock Wei. To collect Ying Blood, one must use sourness. Sourness of Shao Yao moves inward to collect Ying. When Ying and Wei circulate, the Five Zang organs do not lose balance, and Middle Qi is established.
*Wai Tai Ji Yi Huang Qi Tang* is Huang Qi Jian Zhong Tang. Post-formula note says: For vomiting, double Sheng Jiang. *Gu Jin Lu Yan Huang Qi Tang* is also Huang Qi Jian Zhong Tang. Post-formula note says: For vomiting, remove Yi Tang. *Zong Bing Lun* says: For those with previous slight diarrhea or vomiting, do not use Yi Tang.
In Xu Lao with Li Ji and all insufficiencies, Huang Qi Jian Zhong Tang (Astragalus Decoction to Construct the Middle) governs.
[You]: Li Ji means internal deficiency with urgent pulse, abdomen should draw in pain. All insufficiencies mean Yin and Yang pulses are all insufficient, and symptoms such as vertigo, palpitations, panting, loss of essence, and blood loss follow sequentially. Urgency must be relaxed with sweetness; insufficiency must be supplemented with warmth. To fill voids and block emptiness, Huang Qi has particular expertise.
Formula for Huang Qi Jian Zhong Tang: Add Huang Qi (Astragalus Root) 1.5 liang to Xiao Jian Zhong Tang. Rest follows the above method.
For shortness of breath and chest fullness, add Sheng Jiang. For abdominal fullness, remove Da Zao, add Fu Ling (Poria) 1.5 liang. And for treating Lung deficiency-insufficiency, adding Qi supplements, add Ban Xia (Pinellia Tuber) 3 liang. (*Qian Jin* and *Wai Tai*, citing *Ji Yi*, use Huang Qi 3 liang. The four characters "qi duan xiong man" are written as "ou zhe". Fu Ling is 4 liang. The following fourteen characters "ji liao..." are absent. Post-formula note says: This is originally Zhongjing's formula.)
[Cheng]: Sheng Jiang drains counterflow Qi, hence for shortness of breath and chest fullness, add Sheng Jiang. Sweetness causes middle fullness, hence remove Da Zao. Blandness can seep and drain, hence add Fu Ling. Fu Ling can stop cough and counterflow, hence for treating Lung deficiency-insufficiency, supplement with Ban Xia. Unclear.
Commentary: Examining Xiao Jian Zhong Tang and Huang Qi Jian Zhong Tang in *Qian Jin* and other books, treatments and dosages differ, and herb additions/deletions are numerous. Here showing a few to demonstrate application methods.
*Qian Jin* Jian Zhong Tang treats Wu Lao Qi Shang (Five Labors and Seven Injuries), lower abdominal urgent pain, bladder deficiency-fullness, reversely cold hands and feet, bitterness in eating and drinking, vomiting acid, phlegm-vomit-diarrhea, shortness of breath, vertigo, deafness, scorched mouth, free urination. Formula: Add Gan Jiang (Dried Ginger), Dang Gui (Angelica Sinensis), Ren Shen (Ginseng), Ban Xia (Pinellia), Ju Pi (Tangerine Peel), Fu Zi (Aconite Root) to Huang Qi Jian Zhong Tang.
Also, Da Jian Zhong Tang (Major Construct the Middle Decoction) treats Wu Lao Qi Shang lower abdominal urgency, bloating below navel, fullness in both hypochondria, pulling pain in waist and spine, dry nose and mouth, dim vision, irritability and unhappiness,急促qi in chest, counterflow preventing food and drink intake, stabbing pain in penis, yellow-red urine, dribbling after urination, dreaming of communicating with spirits and losing essence, fright, deficiency-fatigue. Formula: Add Yuan Zhi (Polygala Root), Dang Gui, Ze Xie (Alisma Rhizome), Ren Shen, Long Gu (Fossilized Bones) to Huang Qi Jian Zhong Tang. (*Qian Jin Yi*, lacks Dang Gui).
Also, Qian Hu Jian Zhong Tang treats severe labor deficiency-superiority, alternating cold and heat, vomiting-counterflow, lower jiao deficiency-heat, red-painful urination, guest-heat steaming upward to head and eyes, and bone-flesh pain, dry mouth. Formula: Add Qian Hu (Peucedani Radix), Dang Gui, Fu Ling, Ren Shen, Ban Xia to Huang Qi Jian Zhong Tang.
Also, Shao Yao Tang treats postpartum bitter abdominal minor pain.
It is Xiao Jian Zhong Tang.
Also says: Whenever body heaviness prevents eating, tasteless food, empty fullness below heart, frequent desire to defecate, preferring to lie down, all should needle Wei Wan (Stomach Well) and Tai Cang (Middle Jiao), take Jian Zhong Tang, and take Ping Wei Wan.
Also, Jian Zhong Tang treats Xu Lao internal injury, alternating cold and heat, vomiting-counterflow, hematemesis. Formula: Add Ban Xia 3 liang to Xiao Jian Zhong Tang formula. (*Qian Jin Yi*, lacks Gan Cao and Gui Xin, has Sheng Di Huang).
*Wai Tai* Shan Fan Jian Zhong Tang treats Lung deficiency-insufficiency, Qi supplementation formula.
Add Ban Xia to Huang Qi Jian Zhong Tang. (Commentary: The original text contains this, likely attached by later generations. Cheng says: Unclear, lost in research.)
Also, *Gu Jin Lu Yan Huang Qi Tang* governs Xu Lao Li Ji, drawing lower abdominal colic extreme cramping, testicular swelling-shrinking pain.
It is Huang Qi Jian Zhong Tang. Post-formula note says: For vomiting, remove Yi Tang.
Also, Shao Yao Tang treatment and formula are the same as Xiao Jian Zhong Tang in this text.
Also, Huang Qi Tang treats Xu Lao Li Ji, lower abdominal pain, Qi drawing chest-hypochondriac pain, or heart pain, shortness of breath.
Add Gan Jiang and Dang Gui to Huang Qi Jian Zhong Tang.
Also, Jian Zhong Huang Qi Tang treats Xu Lao shortness of breath, lower abdominal urgent pain, Five Zang insufficiency.
Remove Shao Yao from Huang Qi Jian Zhong Tang.
Also, Shen Shi Huang Qi Jian Zhong Tang treats Xu Lao abdominal fullness, little food, frequent urination.
Add Ren Shen and Ban Xia to Huang Qi Jian Zhong Tang, remove Yi Tang.
Also, Bi Xiao Huang Qi Jian Zhong Tang treats Xu Lao lower jiao deficiency-cold, not very thirsty, frequent urination.
Add Ren Shen and Dang Gui to Huang Qi Jian Zhong Tang. If loss of essence, add Long Gu and Bai Lian.
Also, Shen Shi Huang Qi Tang treats great deficiency-insufficiency, lower abdominal Li Ji, labor-cold pulling to navel, Qi rushing to chest, shortness of breath, erroneous speech, inability to eat, shallow breathing, fatigue, stifled confusion.
Add Ban Xia and Ren Shen to Huang Qi Jian Zhong Tang, remove Yi Tang. If hands and feet are cold, add Fu Zi.
Also, Da Jian Zhong Tang treats internal deficiency absolute Li Ji, shortness of breath, reversely cold hands and feet, lower abdominal cramping, or abdominal fullness wiry-urgent, inability to eat, rising causes slight sweating, Yin shrinking, or cold pain in abdomen, unbearable to labor, dry lips-mouth-tongue, spontaneous essence loss, or hands-feet suddenly cold-then-hot, vexing-bitter sour-pain, inability to stand long, many dreams-waking, tonify Middle and benefit Qi formula.
Add Ren Shen, Dang Gui, Ban Xia, Fu Zi to Huang Qi Jian Zhong Tang, remove Yi Tang.
Also, Duan Ju Huang Qi Tang treats Xu Lao chest guest-heat, cold-phlegm痞-fullness, undigested food belching, intercostal water-Qi, or flowing drink bowel sounds, failure to grow muscle, headache, heavy top-light bottom, dim vision,恍惚 mind-damage, constant dry-heat, unable to sleep peacefully, lower abdominal urgency, red urine dribbling, impotence, dampness below Yin, or white turbid urine injured many methods.
Add Ren Shen and Dang Gui to Huang Qi Jian Zhong Tang, remove Yi Tang. If cold, add Hou Po.
*Su Shen Liang Fang* says: Xiao Jian Zhong Tang treats abdominal pain like a god. However, if abdominal pain hurts upon pressing, but heavy pressing does not hurt much, this is only Qi pain. If heavy pressing hurts more and is firm, there must be accumulation. Qi pain cannot be purged; purging makes it worse. This is a deficiency-cold syndrome. This medicine specifically treats abdominal deficiency-cold, benefiting blood especially governing abdominal pain. (*San Yin Fang* treats this syndrome by adding Yuan Zhi to Xiao Jian Zhong Tang). *Wang Shi Yi Jian Fang* says:
If vomiting or diarrhea, resembling Huo Luan, and exposing to damp-cold, thief-wind entering abdomen, tense urgent pain, add Fu Zi 3 fen, named Fu Zi Jian Zhong Tang. For Hernia attacks, when decocting Fu Zi Jian Zhong Tang, add a chopstick-head amount of honey, named Mi Fu Zi Tang. (*Yi Jian Xiao Jian Zhong Tang* lacks Yi Tang).
*Zhang Shi Yi Shuo* says: *Yang Sheng Bi Yong Fang* discusses that Xu Lao must not use cool medicines, such as Chai Hu, Bie Jia, Qing Hao, Mai Men Dong, etc., none should be taken. Only take Huang Qi Jian Zhong Tang. There was a girl over ten years old who, due to fever, cough,急促qi, and little urine, later developed edema. Using diuretic medicines cured her. However, being extremely emaciated, she then took Huang Qi Jian Zhong Tang, one dose daily, cured after thirty-plus days. Since people's endowment differs, for Xu Lao with white turbid urine, Yin-Zang persons taking Chen Pi decocted Huang Qi Jian Zhong Tang recovered greatly. As for Yang-Zang persons, warm medicines cannot be used. Although Jian Zhong Tang is not very hot, it contains Rou Gui; taking too much will cause harm. Ultimately, medication must measure endowment, examine cold-heat, and cannot generally use Jian Zhong Tang to treat Xu Lao. (From *Yi Yu*).
*Sheng Ji Zong Lu*, Jie Yin Men Shao Yao Tang treats non-timeous hematochezia.
Xiao Jian Zhong Tang, remove Da Zao.
*Zhi Zhi Fang*, Huang Qi Jian Zhong Tang treats injury-dampness nasal congestion body pain.
It is this formula, without Jiao Yi.
Also, Jia Wei Jian Zhong Tang treats all deficiencies spontaneous sweating.
Add Chao Fu Xiao Mai (Fried Floating Wheat) to this formula.
Also, Huang Qi Jian Zhong Tang adds Chuan Xiong and Dang Gui, treats blood-stabbing body pain.
*Wei Shi De Xiao Fang*, Huang Qi Jian Zhong Tang treats sweat staining clothes, severely like dyeing, all due to great joy injuring Heart. Joy disperses Qi, Blood follows Qi circulation. Concurrently take Miao Xiang San. Decoct Jin Yin Qi, Mai Zi, Mai Men Dong in water to swallow. Disease name Hong Han (Red Sweat).
*Wang Shi Zhun Sheng* says: Xiao Jian Zhong Tang treats dysentery regardless of red-white, old-new, but if large abdominal pain, it is miraculous. The pulse is wiry-urgent, or choppy-floating-large, pressing empty, or lifting-pressing both powerless.
*Shi Er Xian Fang*, Jian Pi San treats Spleen痞 hypochondriac pain.
It is Xiao Jian Zhong Tang plus Suo Sha (Amomum Fruit).
*Xu Shi Yi Fa Zhi Nan*, Xiao Jian Zhong Tang treats blood-loss deficiency.
This formula, E Jiao (Donkey-Hide Gelatin) replaces Jiao Yi.
In Xu Lao with lower back pain, lower abdominal tension, and difficult urination, Ba Wei Shen Qi Wan (Eight-Ingredient Kidney Qi Pill) governs. (Formula seen in *Fu Ren Za Bing*.)
[Cheng]: Waist is the external manifestation of Kidney. Kidney deficiency causes lower back pain. Kidney and Bladder are exterior-interior. Without San Jiao Yang Qi to dredge, urination is difficult, and lower abdominal tension occurs. The Officer of Zhou Du also loses its Qi transformation function. The True Yang in Water is already deficient, and the Moving Qi between Kidneys is damaged. Give this formula to benefit Qi between Kidneys. When Qi is strong, urination flows, and lower abdominal tension also heals.
Commentary from *Baopuzi*: Now physicians' Tong Ming Shen Qi Wan, Nei Bu Wu Luo San, Gu Tian Gou Qi Decoction, Huang Qi Jian Zhong Tang, those who take them all become fat. Shen Qi Wan and Huang Qi Jian Zhong Tang originated before Jin dynasty, this can be known.
*Zhou Hou* says: Gan Di Huang (Rehmannia Root) 4 liang, Fu Ling, Shu Yu, Gui, Mu Dan, Shan Zhu Yu, each 2 liang. Fu Zi, Ze Xie, 1 liang. Pound into honey pills like wu zi (walnut seeds). Take 7 pills, three times a day, increase to 10 pills. This is Zhang Zhongjing's Ba Wei Shen Qi Wan formula. Treats Xu Lao insufficiency, great injury from drinking water, lower back pain, lower abdominal urgency, difficult urination. Also says: Long-term use, remove Fu Zi, add Wu Wei Zi, treat great wind-cold. (*Qian Jin*, Kidney Tonification section same, use Gan Di Huang 8 liang, Shan Zhu Yu, Shu Yu, each 4 liang. Ze Xie, Mu Dan Pi, Fu Ling, each 3 liang. Gui Xin, Fu Zi, each 2 liang. Note: Zhongjing says: Long-term use remove Fu Zi, add Wu Wei Zi. Master Yao says: Add Wu Wei Zi 2 liang, Cong Rong 4 liang. Zhang Wen Zhong says: Wu Wei Zi, Cong Rong, each 4 liang.)
*He Ji Ju Fang*, Ba Wei Wan treats Kidney Qi deficiency-lack, lower origin cold-fatigue, umbilical-abdominal pain, frequent night urination, weak legs-knees, limb fatigue, dark complexion, no desire to eat. Also treats Hong Jiao (Beriberi) rushing upward, lower abdominal insensitivity, and Xu Lao insufficiency, thirst desiring water, heavy-painful waist, lower abdominal tension, difficult urination. Or men's Xiao Ke (Wasting-Thirst), urine surprisingly frequent. Women's Zhuan Bao (Twisted Bladder), urination blocked. (It is this formula, use Fu Ling, Mu Dan Pi, Ze Xie, each 3 liang. Shu Gan Di Huang 8 liang. Shan Zhu Yu, Shan Yao, each 4 liang. Fu Zi, Rou Gui, each 2 liang. Post-formula note says: Long-term use strengthens Yuan Yang, benefits Essence and Marrow.)