桂枝 芍药 生姜各三两 甘草二两 大枣十二枚 龙骨 牡蛎各三两
右七味，以水七升，煮取三升，分温三服。
@@@
虚劳里急，悸衄，腹中痛，梦失精，四肢酸疼，手足烦热，咽干口燥，小建中汤主之
。
【注】
虚劳云云者，概虚劳之证而言也，非谓虚劳之证，止于此也，故下文有诸不足之说也
。均主以小建中汤者，欲小小创建中虚之意，合下六节，皆论虚劳，各有所主之方也
。
桂枝三两 甘草（炙）三两 大枣十二枚 芍药六两 生姜二两 胶饴一升
右六味，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。
@@@
虚劳里急，诸不足，黄耆建中汤主之。
【注】
所谓虚劳里急诸不足者，亦该上条诸不足证之谓也。黄耆建中汤，创建中外两虚，非
单谓里急一证之治也。桂枝龙骨牡蛎汤，即桂枝汤加龙骨、牡蛎。小建中汤，即桂枝
汤加胶饴。黄耆建中汤即桂枝汤加胶饴、黄耆也。故尝因是而思仲景以一桂枝汤出入
加减，无往不利如此。何后世一见桂枝，即为伤寒发汗之剂，是但知仲景用桂枝汤治
伤寒，而不知仲景用桂枝汤治虚劳也。若知桂枝汤治虚劳之义，则得仲景心法矣。盖
桂枝汤辛甘而温之品也，若啜粥温覆取汗，则发散荣卫以逐外邪，即经曰：辛甘发散
为阳，是以辛为主也；若加龙骨、牡蛎、胶饴、黄耆，则补固中外以治虚劳，即经曰
：劳者温之，甘药调之，是以温以甘为主也。由此推之，诸药之性味功能加减出入，
其妙无穷也。
【集注】
魏荔彤曰：气虚甚，加黄耆，津枯甚，加人参，以治虚劳里急，此言里急非单指里急
之谓也，乃虚劳诸不足腹痛之谓也。故名其方为建中，正所以扶持其中气，使渐生阴
阳，达于荣卫，布于肢体也。
尤怡曰：里虚脉急，腹中当引痛也。诸不足者，阴阳诸脉俱不足，而眩悸喘喝，失精
亡血等证，相因而至也。急者缓之必以甘，不足者补之必以温，而充虚塞空，则黄耆
尤有专长也。
桂枝、芍药、生姜各三两，甘草二两，大枣十二枚，龙骨、牡蛎各三两。
以上七味药，用水七升，煎煮至三升，分三次温服。
虚劳病（慢性虚弱性疾病）出现腹部拘急疼痛、心悸、鼻出血、腹中痛、梦中遗精、四肢酸痛、手足心发热、咽喉干燥、口燥渴等症状，用小建中汤主治。
【注释】
所谓“虚劳云云”，是概括性地论述虚劳病的证候，并非说虚劳病只有这些症状，所以下文有“诸不足”的说法。都用小建中汤主治，意在小小地建立中焦之虚损的意思。结合下文六节内容，都是论述虚劳病，各有其主治的方剂。
桂枝三两，甘草（炙）三两，大枣十二枚，芍药六两，生姜二两，胶饴一升。
以上六味药，用水七升，煎煮至三升，去渣，加入胶饴，再用微火加热使其溶解，每次温服一升，每日服用三次。
呕吐患者不可使用建中汤，因为甜味会助湿生痰加重呕吐。
虚劳病出现腹部拘急疼痛及全身各种不足的症状，用黄耆建中汤主治。
【注释】
所谓“虚劳里急诸不足”，也是指上一条文中提到的各种不足证候。黄耆建中汤，是建立中焦和外部的双重虚损，不仅仅针对腹部拘急这一症状的治疗。桂枝加龙骨牡蛎汤，就是在桂枝汤基础上加上龙骨、牡蛎。小建中汤，就是在桂枝汤基础上加上胶饴。黄耆建中汤就是在桂枝汤基础上加上胶饴和黄耆。所以我常因此思考张仲景以桂枝汤为基础进行加减变化，应用如此灵活有效。为什么后世一见桂枝，就认为是治疗伤寒的发汗剂，这是只知道张仲景用桂枝汤治疗伤寒，而不知道张仲景也用桂枝汤治疗虚劳病。如果懂得桂枝汤治疗虚劳病的含义，就掌握了张仲景的心法了。大概桂枝汤是辛甘温性质的药物，如果喝热粥并覆盖衣被取汗，则是发散营卫之气以驱逐外邪，正如经典所说：辛甘发散为阳，是以辛味为主；如果加上龙骨、牡蛎、胶饴、黄耆，则是补益固护内外以治疗虚劳病，正如经典所说：劳者温之，甘药调之，是以温性和甘味为主。由此推论，各种药物的性味功能加减变化，其奥妙无穷无尽。
【集注】
魏荔彤说：气虚严重，加黄耆；津液枯竭严重，加人参，用来治疗虚劳病中的腹部拘急疼痛，这里说的“里急”不仅仅指腹部拘急，而是指虚劳病各种不足引起的腹痛等症。所以将此方命名为建中，正是为了扶持中气，使阴阳逐渐生成，通达于营卫，布散于肢体。
尤怡说：里虚则脉象紧急，腹中应当牵引作痛。所谓的“诸不足”，是指阴阳各类脉象都不足，从而导致眩晕、心悸、气喘、失精、亡血等症状相继出现。紧急的症状必须用甘味来缓急，不足的证候必须用温性来补益，而填补空虚，黄耆尤其有专长。
Cinnamon Twig (Guizhi), White Peony Root (Shaoyao), and Fresh Ginger (Shengjiang) each 3 liang; Licorice Root (Gancao) 2 liang; Jujube (Dazao) 12 pieces; Dragon Bone (Longgu) and Oyster Shell (Muli) each 3 liang.
The above seven herbs are decocted in 7 sheng of water, reduced to 3 sheng, and taken warm in three divided doses.
In cases of Xu Lao (Chronic Deficiency Syndrome) presenting with abdominal tension and pain, palpitations, epistaxis, abdominal pain, nocturnal emission during dreams, soreness and pain in the four limbs, heat sensation in the hands and feet, dry throat, and dry mouth, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is the primary treatment.
[Annotation]
The phrase "Xu Lao..." generally refers to the syndromes of Xu Lao, not implying that these are the only symptoms of Xu Lao; hence the subsequent mention of "various deficiencies." The use of Xiao Jian Zhong Tang aims to slightly restore the deficiency of the Middle Jiao. The following six sections all discuss Xu Lao, each with its specific formula.
Cinnamon Twig (Guizhi) 3 liang; Licorice Root (Gancao), roasted 3 liang; Jujube (Dazao) 12 pieces; White Peony Root (Shaoyao) 6 liang; Fresh Ginger (Shengjiang) 2 liang; Maltose (Jiaoyi) 1 sheng.
The above six herbs are decocted in 7 sheng of water, reduced to 3 sheng. The dregs are removed, Maltose (Jiaoyi) is added, and it is gently heated over a low fire until dissolved. Take 1 sheng warm, three times daily.
Patients prone to vomiting should not use Jian Zhong Tang because sweetness can aggravate vomiting.
In cases of Xu Lao presenting with abdominal tension and various systemic deficiencies, Huang Qi Jian Zhong Tang (Astragalus Minor Construct the Middle Decoction) is the primary treatment.
[Annotation]
The term "Xu Lao with abdominal tension and various deficiencies" also refers to the various deficiency syndromes mentioned in the previous paragraph. Huang Qi Jian Zhong Tang addresses the dual deficiency of the interior and exterior, not merely treating abdominal tension. Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) is Gui Zhi Tang plus Longgu and Muli. Xiao Jian Zhong Tang is Gui Zhi Tang plus Jiaoyi. Huang Qi Jian Zhong Tang is Gui Zhi Tang plus Jiaoyi and Astragali Radix (Huangqi). Thus, I often reflect on how Zhang Zhongjing utilized Gui Zhi Tang with modifications so effectively. Why do later generations view Cinnamon Twig solely as a diaphoretic for Shang Han (Cold Damage)? This indicates they only know Zhang Zhongjing used Gui Zhi Tang for Shang Han but did not know he also used it for Xu Lao. Understanding the principle of Gui Zhi Tang treating Xu Lao allows one to grasp Zhang Zhongjing's core methodology. Gui Zhi Tang consists of acrid, sweet, and warm substances. If consumed with hot porridge and covered to induce sweating, it disperses Ying and Wei to expel external pathogens, as stated in the Classics: "Acrid and sweet disperse and belong to Yang," emphasizing the acrid nature. However, when combined with Longgu, Muli, Jiaoyi, and Huangqi, it tonifies and consolidates the interior and exterior to treat Xu Lao, as stated in the Classics: "For exhaustion, use warmth; regulate with sweet medicines," emphasizing warmth and sweetness. From this, one can deduce that the modifications of herb properties and functions are infinitely profound.
[Collected Annotations]
Wei Litong stated: For severe Qi deficiency, add Astragali Radix (Huangqi); for severe fluid depletion, add Ginseng Radix et Rhizoma (Renshen) to treat abdominal tension in Xu Lao. Here, "abdominal tension" does not refer solely to tension but encompasses abdominal pain due to various deficiencies in Xu Lao. Hence the name "Jian Zhong" (Construct the Middle), aiming to support Middle Qi, allowing Yin and Yang to gradually generate, reach Ying and Wei, and distribute throughout the limbs.
You Yi stated: Interior deficiency leads to tense pulses and pulling pain in the abdomen. "Various deficiencies" means all Yin and Yang pulses are deficient, leading to symptoms such as vertigo, palpitations, asthma, seminal emission, and blood loss occurring sequentially. Tense conditions must be relieved with sweetness; deficiencies must be supplemented with warmth. To fill voids, Astragali Radix (Huangqi) has particular expertise.