Da Jian Zhong Tang

Da Jian Zhong Tang (Major Construct the Middle Decoction), from the Jin Gui Yao Lue (Essentials from the Golden Cabinet) by Zhang Zhong-Jing.

Actions: Tonifies and warms the middle jiao; Corrects the reversed flow of qi and relieves pain.

Presentation: Yang deficiency of the middle jiao with proliferation of yin and cold: severe coldness and pain in the chest and epigastrium; vomiting with inability to eat; superficial skin pulsations throughout the abdomen; severe pain in the head and feet; a white, wet tongue coating; and a thin, tight pulse. In severe cases, cold limbs, a hidden pulse, or irregular peristalsis sounding like water movement in the abdomen.

Composition: The COMPOSITION block prints only Hua Jiao, Gan Jiang and Ren Shen; Yi Tang (1 cup [30g]) is added per the preparation instructions.

Cautions:

• Many warm herbs: not for abdominal pain from excess heat, damp-heat or yin-deficient heat
• Overdose may cause non-productive cough, edema, nausea and vomiting

Herb–drug interactions:

• Antipsychotic drugs: in 8 patients with drug-induced constipation/obstruction, 4 significant and 2 moderate improvement
• Chlorpromazine-induced hypoperistalsis: dose-dependent improvement in small-intestinal peristalsis and colonic propulsion; Hua Jiao thought to be the cholinergic-stimulating ingredient
• Morphine-induced constipation in cancer patients: relieved without reducing morphine analgesia

Pharmacological effects reported:

• Gastrointestinal: accelerated small-intestinal movement via cholinergic and 5-HT3 receptors (blocked by atropine, spantide, tetrodotoxin or capsazepine); dose-dependent increase in intestinal blood flow without changing mean arterial pressure; suggested for post-operative adhesive obstruction and intestinal ischemia
• Gallbladder: stimulated bile acid production in rats from 30 minutes to 4 hours after dosing
• Uterine: in rabbits increased intestinal but not uterine motility; more study needed before use in pregnancy

Source: Chen JK, Chen TT. Chinese Herbal Formulas and Applications: Pharmacological Effects & Clinical Research. Art of Medicine Press, 2009, p. 480.

Cook in 4 cups [800 mL] water to 2 cups [400 mL]; strain, add 1 cup [30g] Yi Tang and simmer to 1.5 cups [300 mL]; take warm in two doses daily. Source advises 2 cups [400 mL] of porridge between doses and through the day and keeping covered. Today: bracketed doses, cook twice, add 3g Yi Tang to the strained liquid, take in two doses.