土爰稼穑作甘，饴糖乃稼穑精华中之精华。脾土位居中央，若虚乏而当建中，建中而不
旁
补脾之物有五，曰人参、曰大枣、曰粳米、曰甘草、曰饴糖，皆能治脾虚之腹痛，而皆
有宜有不宜。虚而挟寒，则必君以驱寒之品，如大建中汤之以参饴协椒姜是也。寒在下焦不
宜，如当归生姜羊肉汤、乌头桂枝汤之无此五物是也。附子粳米汤，治腹中寒气雷鸣切痛，
胸胁逆满呕吐，何尝不是下焦之寒，何以有粳米甘草大枣，又何以无参饴？曰∶此无味不确
切，须就其证细审之耳。寒在腹中而痛，实由下焦浊阴上泛，致胸胁逆满呕吐。附子所以温
肾，半夏所以止呕，脾虚宜补，而有呕吐之虚，则中不宜滞，阴则宜益，米枣甘草，所以补
虚而益阴。人参嫌其升气，饴嫌其滞中，故避之。小建中甘草用炙而此不炙，亦以其滞故也。
胁
邹氏谓桂枝加芍药汤主腹满痛，小建中汤主腹急痛，盖芍药酸而破阴，饴糖甘而缓急，
此言是矣。然小建中治急痛，而芍药仍在者有故也。徐氏云，桂枝汤，外证得之为解肌、调
营卫。内证得之为化气、和阴阳。桂姜协草枣，所以化阴。芍药协草枣，所以化阳。芍药不
止治腹满，故小建中于虚劳里急悸衄等证皆主之。惟以治满痛，则于桂枝汤原方加一倍，而
饴糖则摈之耳。
邹氏于建中大小之分，创为势合势分，力专力薄二说，而断之以君尊而臣从命，君卑而
臣擅命。实则终无一当也。何以言之？小建中所治不一，而其扼要在建中。以云建中，犹建
中之小者耳。若大建中则专治中藏虚寒，不兼顾他经之证。腹中寒句是主，余皆腹寒之所波
及。周扬俊云∶中气虚则阳气不布，故所积者为寒饮，所冲者为寒气。尤在泾云∶阴凝成象，
腹中虫物乘之而动。二说极当。温脾无过干姜，补脾无过人参胶饴。椒能由脾达肾，以消饮
而杀虫，亦温脾之要药。此四物大温大补，不出中宫，建中有大于是者乎。观于大建中惟入
腹满一门，小建中则分隶于伤寒论，与金匮之血痹黄瘅妇人杂病各门，仲圣制剂标名之意，
更灼然可见。自来注家无论及此者，殊足怪也。
“土”的特性是种植与收获，其味道为甘，饴糖乃是稼穑（农作物）精华中的精华。脾土位居中央，如果脾虚匮乏需要建立中气，那么补益脾脏的药物有五种，分别是人参、大枣、粳米、甘草、饴糖，它们都能治疗脾虚引起的腹痛，但各有适宜和不适宜的情况。如果是虚证兼夹寒邪，则必须以驱寒的药物为主君药，比如大建中汤中以人参和饴糖配合花椒、干姜就是这种情况。如果寒邪位于下焦就不适宜使用这五味药，比如当归生姜羊肉汤、乌头桂枝汤中就没有这五味药。附子粳米汤，治疗腹中寒气如雷鸣般作响且剧烈疼痛，胸胁部气逆胀满并呕吐，这难道不是下焦的寒邪吗？为什么方中却有粳米、甘草、大枣，而没有人参和饴糖呢？回答说：这是因为没有确切的味道对应，必须根据具体证候仔细审察。寒邪在腹中引起疼痛，实际上是由于下焦浊阴之气上泛，导致胸胁气逆胀满和呕吐。附子用来温补肾阳，半夏用来止呕，脾虚应当补益，但有呕吐这种虚象时，中焦不宜滋腻停滞，阴气应当增益，粳米、大枣、甘草的作用正是补虚而益阴。人参因其升提气机而被嫌弃，饴糖因其滋腻碍胃而被回避，所以避开不用。小建中汤中的甘草用炙过的，而此方不用炙甘草，也是因为它容易致滞的原因。
邹氏认为桂枝加芍药汤主治腹部胀满疼痛，小建中汤主治腹部拘急疼痛，大概是因为芍药味酸能破阴结，饴糖味甘能缓解急迫，这种说法是正确的。然而小建中汤治疗急痛，其中仍然保留芍药是有原因的。徐氏说，桂枝汤在外感病证中得到它可解肌表、调和营卫；在内伤病证中得到它可化气机、调和阴阳。桂枝、干姜配合甘草、大枣，是用来化散阴邪的。芍药配合甘草、大枣，是用来化生阳气的。芍药不仅仅治疗腹部胀满，所以小建中汤对于虚劳、里急、心悸、鼻衄等各种证候都主治。如果只是用于治疗胀满疼痛，就在桂枝汤原方中将芍药用量加倍，而将饴糖摒弃不用。
邹氏关于建中汤大小之分，创立了“势合势分”、“力专力薄”两种说法，并用“君尊臣从命”、“君卑臣擅命”来断言。实际上最终没有一个说法是恰当的。为什么说呢？小建中汤治疗的病证不一，但其关键要点在于“建中”。如果说它是建中，那也只是建中法中的较小者罢了。若大建中汤则专门治疗中焦脏腑的虚寒，不兼顾其他经络的病证。“腹中寒”这句话是主症，其余都是腹寒所波及的症状。周扬俊说：中气虚弱则阳气不能布散，所以积聚的是寒饮，冲逆的是寒气。尤在泾说：阴寒凝结成形，腹中的虫物乘势而动。这两种说法非常恰当。温补脾阳没有超过干姜的，补益脾气没有超过人参和胶饴的。花椒能从脾达肾，以消除饮邪并杀虫，也是温脾的重要药物。这四味药大温大补，不出中焦脾胃的范围，还有比这更能建立中气的吗？观察到大建中汤只列入“腹满”一门，而小建中汤则分别隶属于《伤寒论》以及《金匮要略》的血痹、黄疸、妇人杂病等各门，张仲景制剂标名的用意，更加显而易见。自古以来注解家没有提及这一点的，确实令人奇怪。
"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."