桂枝（三两去皮） 甘草（三两炙） 大枣（十二枚擘） 芍药（六两） 生姜（二两切） 胶饴（一升）
上六味。以水七升。煮取三升。去滓。内胶饴。更上微火。消解。温服一升。日三服。呕家不可用建中汤。以甜故
也。（呕家必胃有邪热。而胸中作满。中满者。勿食甘。若用建中汤之甜。是助其满。内经云实实者。是也。）
（成氏明理论云。脾者。土也。应中央。处四藏之中。为中州。治中焦。生育营卫。通行津液。一有不调。则营卫
失所育。津液失所行。必以此。汤温建中。藏是以建中名焉。胶饴味甘温。甘草味甘平。脾欲缓。急食甘以缓之。建脾
者。必以甘为主。故以胶饴为君。甘草为臣。桂味辛热。辛散也。润也。营卫不足。润而散之。芍药味酸。微寒。酸。
收也。泄也。津液不逮。收而行之。是以桂枝芍药。为佐。生姜味辛温。大枣味甘温。胃者卫之源。脾者营之本。黄帝
针经曰营出中焦。卫出上焦是矣。卫为阳。不足者。益之必以辛营为阴。不足者补之必以甘。辛甘相合。脾胃健而营卫
通。是以姜枣为使。琥按小建中汤。补中有发散之义。大抵中气虚寒者宜用之。倘伤寒家有水气冲心而悸。热邪壅膈而
烦者。上汤不宜轻用也。内台方议或问曰。建中汤方。与桂枝汤同。只多胶饴。所主之病。全然不同。何也。答曰。桂
枝汤中。桂枝芍药等分。以芍药佐桂枝而治卫气也。建中汤中。芍药多半。而桂枝减少。以桂枝佐芍药。而益其营气也。
是以大有不同愚以上言。犹为未尽其义。盖桂枝汤中。以芍药佐桂枝。则辛甘相合。散而助表。建中汤中。以桂枝佐芍
药。则酸甘相合。敛而补中。能达此义。斯仲景制方之意无余蕴矣。）
（附后例）太阳病过经十余日。反二三下之。后四五日。柴胡证仍在者。先与小柴胡汤。呕不止（云云至）与大柴
胡汤下之。则愈。（按此条证云。太阳病过经十余日。其时已传少阳。为柴胡证矣。故以下之为反。先与小柴胡汤也。正
文与注并。）
桂枝（三两，去皮） 甘草（三两，炙烤） 大枣（十二枚，掰开） 芍药（六两） 生姜（二两，切片） 胶饴（一升）
以上六味药。用水七升。煮取三升药液。滤去药渣。加入胶饴。再用小火微煮。使其溶解。每次温服一升。每日服用三次。呕吐患者不可使用建中汤。因为甜味的原因。（呕吐患者必然胃中有邪热，导致胸中胀满。中焦胀满的人，不应食用甘味食物。如果使用建中汤的甜味，会助长其胀满。《内经》所说的“实实”之误，就是这种情况。）
（成无己在《明理论》中说：脾属土，对应中央，位于四脏之中，处于中州，主管中焦，化生营卫之气，通行津液。一旦失调，则营卫失去化生之源，津液失去运行之道。必定要用此汤温补建立中气，因能建立中气，故名为建中汤。胶饴味甘性温，甘草味甘性平。脾喜缓急，紧急时用甘味食物来缓和它。建立脾脏功能，必须以甘味为主。所以用胶饴作为君药，甘草作为臣药。桂枝味辛性热，辛能发散，也能润养。营卫不足时，用润养和发散的方法。芍药味酸性微寒，酸能收敛，也能泄降。津液不能到达时，用收敛和运行的方法。因此桂枝和芍药作为佐药。生姜味辛性温，大枣味甘性温。胃是卫气的源头，脾是营气的根本。《黄帝针经》说营气出于中焦，卫气出于上焦，正是如此。卫气属阳，不足时，必须用辛味来增益；营气属阴，不足时，必须用甘味来补益。辛味和甘味相结合，脾胃健运而营卫通畅。因此姜和大枣作为使药。琥按：小建中汤，补益中带有发散的意义。大体上中气虚寒者适宜使用。如果伤寒病患者有水气冲心而心悸，热邪壅塞胸膈而烦躁的，上述汤剂不宜轻易使用。《内台方议或问》说：建中汤方，与桂枝汤相同，只是多了一味胶饴，所主治的病证却完全不同，为什么呢？回答说：桂枝汤中，桂枝和芍药分量相等，以芍药辅助桂枝来治疗卫气的问题。建中汤中，芍药分量加倍，桂枝减少，以桂枝辅助芍药来补益营气。因此有很大不同。我以上的说法，还不够详尽其义。大概桂枝汤中，以芍药辅助桂枝，则辛甘相合，发散而助表；建中汤中，以桂枝辅助芍药，则酸甘相合，收敛而补中。能通达这个意义，那么张仲景制方的意旨就没有遗漏了。）
（附后例）太阳病经过十余日，反而进行了两三次攻下治疗。之后四五日，柴胡证仍在的，先给予小柴胡汤。呕吐不止（中间省略内容至）与大柴胡汤攻下。则痊愈。（按：此条证候说，太阳病经过十余日，此时已经传入少阳，成为柴胡证了。所以用攻下法是反治。先给予小柴胡汤。正文与注释并列。）
Cinnamon Twig (Guizhi, 3 liang, bark removed) Licorice Root (Gancao, 3 liang, honey-fried) Jujube (Dazao, 12 pieces, split open) White Peony Root (Shaoyao, 6 liang) Fresh Ginger (Shengjiang, 2 liang, sliced) Maltose (Jiaoyi, 1 sheng)
The above six ingredients. Use seven sheng of water. Decoct to obtain three sheng of liquid. Strain out the dregs. Add the maltose. Heat gently over a low fire until dissolved. Take one sheng warm. Administer three times daily. Patients with vomiting should not use Jianzhong Tang (Middle-Jian Decoction). This is due to the sweet taste. (Patients with vomiting necessarily have pathogenic heat in the stomach, causing fullness in the chest. When there is fullness in the middle jiao, one should not consume sweet foods. Using the sweetness of Jianzhong Tang would exacerbate the fullness. This corresponds to the "reinforcing excess" error mentioned in the *Neijing*.)
(Cheng Wuji stated in *Minglun Lun*: The Spleen belongs to Earth, corresponds to the Center, resides among the four zang organs, occupies the central region, governs the middle jiao, generates Ying and Wei qi, and circulates body fluids. Once dysfunctional, Ying and Wei lose their source of generation, and body fluids lose their pathway of circulation. One must use this decoction to warm and establish the middle qi. Because it establishes the middle, it is named Jianzhong Tang. Maltose is sweet and warm; Licorice Root is sweet and neutral. The Spleen desires relaxation; when urgent, consume sweet substances to relax it. To establish the Spleen, one must primarily use sweet substances. Therefore, Maltose is used as the Sovereign herb, and Licorice Root as the Minister. Cinnamon Twig is pungent and hot; pungency disperses and moistens. When Ying and Wei are deficient, moisten and disperse them. White Peony Root is sour, slightly cold; sourness collects and drains. When body fluids do not reach, collect and circulate them. Thus, Cinnamon Twig and White Peony Root serve as Assistant herbs. Fresh Ginger is pungent and warm; Jujube is sweet and warm. The Stomach is the source of Wei qi; the Spleen is the root of Ying qi. The *Huangdi Zhenjing* states that Ying qi emerges from the middle jiao and Wei qi emerges from the upper jiao, which is correct. Wei qi is Yang; when deficient, it must be augmented with pungent substances. Ying qi is Yin; when deficient, it must be tonified with sweet substances. Pungent and sweet combine to strengthen the Spleen and Stomach and unblock Ying and Wei. Thus, Ginger and Jujube serve as Envoy herbs. Hu notes: Xiao Jianzhong Tang contains the principle of dispersion within tonification. It is generally suitable for those with deficiency-cold of the middle qi. If a Taiyang disease patient has fluid retention rushing to the heart causing palpitations, or pathogenic heat obstructing the diaphragm causing irritability, the aforementioned decoction should not be used lightly. *Neitai Fangyi Huowen* asks: The Jianzhong Tang formula is identical to Guizhi Tang, except for the addition of Maltose, yet the diseases they treat are completely different. Why? The answer is: In Guizhi Tang, Cinnamon Twig and White Peony Root are equal in dosage; White Peony assists Cinnamon Twig to treat issues of Wei qi. In Jianzhong Tang, the dosage of White Peony is doubled, and Cinnamon Twig is reduced; Cinnamon Twig assists White Peony to tonify Ying qi. Hence, there is a significant difference. My previous explanation was still incomplete. Generally, in Guizhi Tang, White Peony assists Cinnamon Twig, so pungent and sweet combine to disperse and assist the exterior. In Jianzhong Tang, Cinnamon Twig assists White Peony, so sour and sweet combine to astringe and tonify the middle. Understanding this principle reveals the complete intent of Zhang Zhongjing's formula creation.)
(Attached Example) Taiyang disease persists for more than ten days, and contrary treatment involves purging two or three times. After another four or five days, if the Chaihu syndrome remains, first administer Xiao Chaihu Tang. Vomiting continues... (content omitted)... administer Da Chaihu Tang to purge. Then it heals. (Note: This syndrome description states that after Taiyang disease persists for ten-plus days, it has transmitted to Shaoyang, becoming a Chaihu syndrome. Therefore, purging is a contraindicated treatment. First, administer Xiao Chaihu Tang. The main text and commentary are presented together.)