From, “Selected Cases from Famous Doctors in the Shang Han Tradition” (Shang Han Ming Yi Yan An Jing Xuan), p. 132

Xiao Jian Zhong Tang

(minor strengthen the center decoction)

Ingredients:

Gui zhi 9

Bai shao 18

Sheng jiang 9

Da zao 4 pc

Zhi Gan cao 6

Yi tang (barley malt) 30 g

Take the about six herbs, cook in seven sheng of water until three sheng remain.  Remove the dregs, dissolve in the maltose.  Take one sheng, warm, three times per day.

Primary text:

            When in cold damage, the yang pulse (superficial) is rough and the yin pulse (deep) is wiry.  There should be acute pain in the abdomen.  First use xiao jian zhong tang.  If this doesn’t do the trick, then xiao chai hu tang governs it.  (100)

            When in cold damage that has lasted for two to three days, with heart palpitations and vexation, xiao jian zhong tang governs it. (102)

Commentary:

            This pattern is Heart and Spleen, qi and blood vacuity.  One also sees various symptoms of vacuity taxation with complete insufficiency.  This formula is gui zhi tang with an increase in the dose of bai shao and with yi tang added, so that instead of releasing the exterior, it strengthens the middle.  The chief herb is yi tang, which is sweet and warm and tonifies the middle.  Yi tang with gui zhi, gan cao, and sheng jiang are acrid and sweet and can transform yang.  Combined with bai shao and da zao, the sour and sweet flavors can transform yin.  This formula can tonify the middle qi, strengthen transportation and transformation, evenly tonify yin and yang, and regulate and harmonize qi and blood.  It is used for middle burner vacuity cold, and qi and blood insufficiency patterns.  This is a commonly used formula. 

Case study:

            Abdominal pain (from Liu Du Zhou’s cases):

Li, 38 year old woman.  After birth she lost lots of blood, the weather was severely cold, and she developed pain in the middle of her abdomen.  With the pain, she is aware of a stirring or palpation on the skin of her abdomen that spasms deeper inside.  She likes to use a hot water bottle or heating pad, which temporarily relaxes the spasm and eases the pain.  Her pulse is thin and wiry, and the tongue is pale with a thin coat.  This pattern is blood vacuity not nourishing the Liver, Liver attacking the Spleen, and since the Spleen governs the abdomen, this causes spastic pain.  The pain is worse when she comes in contact with cold. 

            Formula:  gui zhi 10, bai shao 30, zhi gan cao 6, sheng jiang 9, da zao 7 pc, dang gui 10, yi tang 40 (dissolved in).

            The patient took three packs, and the abdominal pain didn’t return.  The formula was the then changed to shuang he yin (both harmonize drink), to tonify both the qi and the blood. 

            This case is a typical vacuity cold abdominal pain.  It is due to blood vacuity, with blood unable to nourish the Liver, which causes the Liver to attack the Spleen, leading to spasm and pain in the abdomen, liking warmth and pressure, with a wiry and thin pulse.  Xiao jian zhong tang tonifies the Spleen and Stomach and can concurrently calm and soothe the Liver and GB qi.  It can also relax spasms of the sinews and vessels.  It is used in this case to directly address this pathological mechanism.  According to Master Liu’s experience, in treating Spleen qi vacuity with Liver and GB qi tension causing abdominal pain, one can first try this formula.  If this doesn’t work, then xiao chai hu tang, minus huang qin plus shao yao will have a good effect.