Da Jian Zhong Tang - 大建中湯 - Major Construct The Middle Decoction - Major Zanthoxylu Combination

English:	Major Construct the Middle Decoction
Also Known As:	Major Zanthoxylum Combination Major Decoction for Restoring the Normal Function of the Middle Burner

Herbs And Actions

Pharmaceutical Latin	Pin Yin	Dosage	Actions
Per. Zanthoxyli	Chuan Jiao	2-9g	Stimulates the Yang of the Middle Jiao, attacks and dispels Cold, disperses accumulations, stops pain and kills worms. With Gan Jian, Ren Shen and Yi Tang, for Coldness and pain in the chest with vomiting and inability to eat.
Rz. Zingiberis	Gan Jiang	5-12g	Expels Interior Cold, Rescues Devastated Yang and transforms Phlegm, Warms the Middle Jiao.
Rx. Ginseng	Ren Shen	3-9g	Tonifies Spleen and Stomach Qi. With Yi Tang, tonifies and strengthens the middle Qi, ameliorating painful spasms.
Maltosum	Yi Tang	18-60g	Tonifies the Spleen and moderates spasmodic abdominal pain and Coldness. With Chuan Jiao, Ren Shen and Gan Jiang, for Middle Jiao Yang Deficiency with ascendant Yin marked by chest and abdominal pain, cold limbs and vomiting.

Formula Actions

• Warms and tonifies Middle Jiao Yang
• Directs rebellious Qi downward
• Relieves pain

Syndromes

• Middle Jiao Yang Deficiency with Cold retention.
• Jue Yin Cold
• Middle Burner Yang deficiency (root) + Vigorous Yin-cold (manifestation) (Secondary source)

Clinical Manifestations

Excruciating epigastric and abdominal pain to the point of not being able to to be touched May be borborygmus. Vomiting to the point of not being able to eat Superficial skin pulsations throughout the abdomen May be fluid sounds

May be cold limbs Strong sensation of Cold in the chest and epigastrium. Severe pain in the head and feet T: Pale or Dark purple C: White and greasy or Slippery P: Thin and tight or slow and wiry or Deep and thready or Hidden

Treats

Gastric ulcer Gastric spasms Duodenal ulcer Chronic gastritis Chronic pancreatitis Chronic cholecystitis Urinary calculi Peritonitis Intestinal spasms Slow motility of the Intestines Morphine-induced constipation in cancer patients Nausea/Vomiting Weakness Jaundice Indigestion

Cholelithiasis Uncomplicated intestinal obstruction. Biliary ascariasis Parasites (round worms) Hernia Intestinal spasms Intestinal flaccidity Intestinal colic Acute appendicitis Postoperative ileus Severe constipation Obstructive bowel disease Fatigue Headache Gastroenteritis Chemotherapy for breast cancer

Contraindications And Herb/Drug Interactions

Notes

• Composition: Hua Jiao 3-9g, Gan Jiang 12g, Ren Shen 6g, Yi Tang 18-30g (Secondary source)
• Its focus is on dispelling Cold.
• Da Jian Zhong Tang vs Li Zhong Wan: both treat abdominal pain from Middle Burner Deficiency-Cold, but with Da Jian Zhong Tang the pain is severe and worse with touch, while with Li Zhong Wan it eases with warmth and pressure.
• Chief herb comparison: Li Zhong Wan relies on Gan Jiang for Taiyin Cold; Wu Zhu Yu Tang on Wu Zhu Yu for Cold in Yangming, Jueyin or Shaoyin; Si Ni Tang on Fu Zi for Shaoyin Cold; Da Jian Zhong Tang on Hua Jiao for Excess Cold with Spleen Yang deficiency.

Modifications

For roundworms:		For strengthening the pain relieving actions of formula:
+ Less Maltosum	Yi Tang	+ Rx. Salviae Miltiorrhizae	Dan Shen
+ Fr. Mume	Wu Mei	+ Rz. Corydalis	Yan Hu Suo
+ Sm. Arecae	Bing Lang	+ Rx. Aucklandiae	Mu Xiang
+ Fr. Quisqualis	Shi Jun Zi	For numb hands and feet:
For nausea and vomiting:		+ Ram Cinnamomi	Gui Zhi
+ Rz. Pinelliae Preparatum	Zhi Ban Xia	For cold extremities:
+ Rz. Zingiberis Recens	Sheng Jiang	+ Ram Cinnamomi	Gui Zhi
For constipation:		+ Hb. cum Rx. Asari	Xi Xin
+ Rz. et Rx. Rhei	Da Huang	For Blood Stagnation:
+ Natrii Sulfas	Mang Xiao	+ Rz. Sparganii	San Leng
For Qi Stagnation:		+ Rz. Curcumae	E Zhu
+ Fr. Amomi	Sha Ren	For severe Cold and pain in the chest and epigastric regions:
+ Lignum Santali Albi	Tan Xiang	+ Rx. Aconiti Lateralis Preparata	Zhi Fu Zi
For Cold and pain in the abdomen:		+ Hb. cum Rx. Asari	Xi Xin
+ Construct the Middle Decoction Li Zhong Tang		For fullness and pain in the abdomen:
For nausea, vomiting and severe abdominal pain:		+ Cx. Magnoliae Officinalis	Hou Po
+ Pinellia Decoction to Drain the Epigastrium Ban Xia Xie Xin Tang		+ Sm. Armeniacae	Xing Ren
For headache due to Cold:
+ Fr. Evodiae	Wu Zhu Yu