Da Jian Zhong Tang — Major Construct the Middle Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions

Overview

Da Jian Zhong Tang — the “Major Construct the Middle Decoction” — is from Zhang Zhongjing’s Jin Gui Yao Lue. Despite the small ingredient list, it is one of the most powerful warming formulas in classical TCM, used for severe middle-burner Cold with intense cramping pain: visible peristalsis through the abdominal wall, vomiting that prevents any food or fluid intake, marked cold extremities. The pattern is severe Yang collapse in the middle burner often seen in advanced ileus, severe gastroenteritis with cold, or post-surgical paralytic ileus.

I prescribe Da Jian Zhong Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Da Jian Zhong Tang is prescribed for severe middle-burner Cold-deficiency:

• Severe cramping abdominal pain, possibly with visible peristalsis
• Vomiting that prevents food and fluid intake
• Marked cold extremities, aversion to cold
• Pain dramatically relieved by warmth and pressure
• Possible cold sensations rising from the abdomen
• Tongue — pale, white slippery coat
• Pulse — deep, tight, slow, possibly weak

Key herbs

1. Shu Jiao (Pe. Zanthoxyli, 3–6g) — chief; very powerfully warms the middle; disperses cold; stops pain
2. Gan Jiang (Rz. Zingiberis, 6–12g) — warms the middle and Spleen Yang
3. Ren Shen (Rx. Ginseng, 6–12g) — strongly tonifies middle Qi
4. Yi Tang (malt sugar, 30–60g) — sweetens; nourishes Stomach Qi; moderates the harsh warming herbs

Formula actions

1. Strongly warms middle-burner Yang
2. Tonifies Spleen-Stomach Qi
3. Disperses Cold; stops cramping pain
4. Stops vomiting

Conditions treated

1. Severe paralytic ileus with Cold pattern (alongside conventional care)
2. Post-operative cold-pattern ileus
3. Severe acute gastroenteritis with intense cold cramping and vomiting
4. Severe cold-pattern dysmenorrhoea with visible cramping
5. Chronic intestinal pseudo-obstruction with cold pattern
6. Severe IBS-C with cold cramping
7. Adhesive bowel pain in cold-deficient patients (with surgical assessment)

Cautions

Strictly for severe Cold-deficient middle-burner patterns — absolutely not for Heat patterns; the strongly warming herbs would aggravate Heat severely.

Severe acute abdominal pain with vomiting requires urgent medical assessment to exclude bowel obstruction, perforation, peritonitis or other surgical emergencies.

Yi Tang (malt sugar) is the classical sweetener; for diabetic patients, omit and substitute another harmoniser.

Always consult a qualified Chinese herbalist registered with the RCHM.

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