1. Source and History of Huangqi Jianzhong Decoction

1. Classic Source

Huang Qi Jian Zhong Decoction originates from *Synopsis of Prescriptions of the Golden Chamber*, written by Zhang Zhongjing of the Eastern Han Dynasty. This book is hailed as one of the classic works of traditional Chinese medicine and has had a profound influence on the clinical practice and theoretical development of TCM. Huangqi Jianzhong Decoction was first recorded in the chapter "Blood Stasis and Debility: Pulse Patterns and Treatments" of *Synopsis of Prescriptions of the Golden Chamber*, providing an important formulaic basis for later generations to treat debility and other related conditions.

2. Historical Evolution

Since Zhang Zhongjing of the Han Dynasty founded Huangqi Jianzhong Decoction, it has gone through the inheritance and development of physicians in successive dynasties. During different historical periods, physicians further interpreted and expanded the application of this formula based on clinical practice. For example, when Wang Shuhe of the Jin Dynasty collated Treatise on Febrile and Miscellaneous Diseases, he made detailed annotations on the clauses of Huangqi Jianzhong Decoction, making it more accurate and clear in the process of inheritance. As time went by, later physicians continuously enriched its scope of application and modifications, making it one of the commonly used classical formulas in clinical treatment of traditional Chinese medicine.

3. Cultural Background and Influence

The emergence of Huangqi Jianzhong Decoction reflects the ancient physicians' profound understanding of the deficiency and consumption syndromes in the human body and the summary of treatment experience. In ancient times, due to limitations such as living conditions and medical levels, deficiency and consumption syndromes were relatively common. The establishment of Huangqi Jianzhong Decoction provided an effective formula for the treatment of such syndromes, embodying the unique wisdom of traditional Chinese medicine in strengthening the healthy qi and tonifying deficiency. It has not only been widely used in China but also spread to neighboring countries, exerting a certain influence on the development of medicine in the East Asian region and becoming one of the important carriers of the inheritance of traditional Chinese medicine culture.

2. Introduction to Ingredients (King, Minister, Assistant, Guide)

1. King Ingredient - Huangqi

Astragalus membranaceus has a sweet taste and a slightly warm nature. It belongs to the lung and spleen meridians. It has various effects such as replenishing qi and ascending yang, strengthening the superficial resistance to stop sweating, promoting diuresis to reduce edema, promoting the production of body fluid and nourishing blood, promoting qi movement to relieve pain, expelling pus and toxin through support, and promoting granulation and muscle growth. In Huangqi Jianzhong Decoction, Astragalus membranaceus, as the sovereign drug, mainly plays the role of replenishing qi and strengthening the spleen, enhancing the transportation and transformation function of the spleen and stomach, being the source of qi and blood generation, making qi and blood sufficient, and nourishing the zang-fu organs. Its qi-replenishing power is relatively strong, being able to greatly replenish the vital qi of the human body, enhancing the resistance of the body, and playing a crucial therapeutic role in such diseases as consumptive fatigue with acute abdominal pain and qi deficiency of the middle-jiao.

2. Minister Ingredients - Guizhi, Shaoyao

Ramulus Cinnamomi is pungent, sweet in flavor and warm in nature. It pertains to the Heart, Lung and Bladder meridians. It has the effects of inducing sweating to relieve exterior syndrome, warming and dredging the meridians, promoting yang qi transformation, etc. In the Decoction of Astragalus and Ramulus Cinnamomi to Strengthen the Middle Jiao, Ramulus Cinnamomi warms and dredges yang qi, can assist Astragalus membranaceus to enhance the function of supplementing qi, and at the same time can warm and dredge the blood vessels, improving the condition of unsmooth qi and blood circulation. Paeonia lactiflora Pall. (Radix Paeoniae Alba) is bitter, sour in flavor and slightly cold in nature. It pertains to the Liver and Spleen meridians. In the formula, Radix Paeoniae Alba mainly functions to nourish the blood and regulate the nutrient qi, relieve spasm and pain. Combined with Ramulus Cinnamomi, one is dispersing and the other is astringing. It can not only harmonize nutrient qi and defensive qi, but also relieve symptoms such as abdominal pain caused by consumptive fatigue. At the same time, it can nourish the blood and nourish yin, assisting Astragalus membranaceus to supplement qi and blood.

3. Assistant Ingredients - Shengjiang, Dazao

Ginger is pungent in flavor and slightly warm in nature. It pertains to the lung, spleen, and stomach meridians. It has the effects of inducing sweating to dispel cold, warming the middle-jiao to stop vomiting, and warming the lungs to arrest cough. In the Huangqi Jianzhong Decoction, ginger warms the stomach to dispel cold, harmonizes the middle-jiao and suppresses adverse qi, enhances the transportation and transformation functions of the spleen and stomach, and simultaneously acts synergistically with drugs such as cinnamon twig and peony to regulate the ascending and descending functions of the spleen and stomach, promoting the generation and circulation of qi and blood. Chinese date is sweet in flavor and warm in nature. It pertains to the spleen, stomach, and heart meridians. On the one hand, Chinese date assists drugs such as astragalus root and cinnamon twig to supplement qi and strengthen the spleen. On the other hand, it can nourish blood and nourish yin, moderate the properties of drugs, making the properties of the whole prescription milder and easier to absorb.

4. Assistant Drug - Prepared Licorice Root

Prepared Licorice Root is sweet in flavor, neutral in nature, and belongs to the Heart, Lung, Spleen, and Stomach meridians. It has the effects of tonifying the spleen and replenishing qi, moistening the lungs and relieving cough, clearing heat and detoxifying, and harmonizing all herbs. In Huangqi Jianzhong Decoction, Prepared Licorice Root serves as the guiding herb. It can both tonify the spleen and replenish qi, enhancing the transportation and transformation functions of the spleen and stomach, and harmonize all herbs, enabling the various herbs in the formula to synergize with each other and achieve the best therapeutic effect. At the same time, Prepared Licorice Root can also alleviate the toxicity and potency of herbs, protect the qi of the spleen and stomach, and prevent excessive damage to healthy qi during the process of combining purging and supplementation in the formula.

III. Pathogenesis, Effects and Treatments

1. Pathogenesis Analysis

The pathogenesis targeted by Huangqi Jianzhong Decoction is mainly deficiency-cold in the middle jiao and insufficiency of qi and blood. The spleen and stomach are the foundation of acquired constitution and the source of qi and blood transformation. If there is deficiency-cold in the spleen and stomach and the transportation and transformation functions are weakened, then the transformation of qi and blood will be insufficient, leading to the body lacking nourishment and presenting various symptoms of consumptive fatigue. With deficiency-cold in the middle jiao and the yang qi unable to warm and nourish, symptoms such as abdominal spasmodic pain and preference for warmth and pressure may occur; with insufficiency of qi and blood and the limbs lacking nourishment, manifestations such as sallow complexion, fatigue, and palpitations may appear.

2. Effects

Based on the above pathogenesis, Huangqi Jianzhong Decoction has the effects of warming the middle-jiao to replenish qi, soothing the interior and alleviating spasm, regulating yin and yang, nourishing blood and dredging meridians. By using drugs such as Astragalus membranaceus and Honey-fried Licorice to greatly tonify the qi of the spleen and stomach, the yang qi in the middle-jiao is sufficient, and the transportation and transformation function returns to normal, thus promoting the generation of qi and blood. The whole formula tonifies both yin and yang, regulates qi and blood simultaneously, restores the balance of the body, and strengthens the healthy qi.

3. Treatable Diseases

Huangqi Jianzhong Decoction is mainly used to treat consumptive fatigue with interior urgency. The symptoms include cramped pain in the abdomen, preferring warmth and pressure, the pain alleviating with warmth, sallow complexion, palpitations, shortness of breath, spontaneous sweating and night sweating, and a thready and taut pulse. In addition, it also has good curative effects on diseases such as epigastric pain, loss of appetite, dyspepsia, lassitude and weakness caused by deficiency-cold in the middle-jiao. Clinically, it is commonly used to treat chronic digestive system diseases, anemia, and physical weakness, etc., which belong to the syndromes of deficiency-cold in the middle-jiao and insufficiency of qi and blood.

IV. Analysis of Formula Principles

1. Tonify Qi and Invigorate Spleen to Treat Root

In the formula, Astragalus membranaceus is used in large doses as the sovereign drug to greatly tonify the qi of the spleen and stomach, enabling the spleen and stomach to function healthily and the qi and blood to be generated有源. The spleen and stomach are the foundation of acquired constitution. Only when the functions of the spleen and stomach are normal can the human body digest and absorb nutrients and maintain the normal physiological functions of the body. Astragalus membranaceus has a strong qi-tonifying power and can fundamentally improve the condition of deficiency-cold in the middle-jiao, laying a foundation for the treatment of consumptive fatigue diseases.

2. Regulate Ying and Wei to Harmonize Middle

Cinnamon Twig and White Peony are used in combination. One is warm and the other is cold, one disperses and the other astringes, regulating nutrient qi and defensive qi. Disharmony between nutrient qi and defensive qi is one of the important factors leading to consumptive fatigue diseases. Cinnamon Twig warms and dredges the defensive yang, and White Peony nourishes the nutrient yin. The two cooperate with each other to make the nutrient qi and defensive qi coordinated and the qi and blood unobstructed, thus alleviating various discomfort symptoms caused by consumptive fatigue.

3. Warm Middle to Stop Pain

Fresh Ginger, Chinese Date and Cinnamon Twig act synergistically to enhance the power of warming the middle-jiao and dispelling cold. The cramped pain in the abdomen caused by deficiency-cold in the middle-jiao is one of the main symptoms of Huangqi Jianzhong Decoction. Fresh Ginger and Chinese Date warm the stomach and dispel cold, and Cinnamon Twig warms and dredges the meridians. The three work together to effectively relieve the pain symptoms, making the patient's abdomen warm and comfortable and the pain reduced.

4. Nourish Blood Yin to Strengthen

White Peony, Chinese Date and Honey-fried Licorice have the function of nourishing blood and nourishing yin. Insufficiency of qi and blood is a common manifestation of consumptive fatigue diseases. These drugs can supplement yin blood, nourish the zang-fu organs, make the qi and blood sufficient, moisten the body, enhance the resistance of the body, help strengthen healthy qi and eliminate pathogenic factors, and promote the recovery of the disease.

5. Harmonize Herbs to Enhance Effect

Honey-fried Licorice, as the guiding drug, harmonizes all the drugs, enabling the drugs in the formula to cooperate with each other synergistically and exert the best therapeutic effect. It can not only enhance the efficacy of other drugs but also relieve the interaction between drugs, making the whole formula have a mild property and be easy to absorb, ensuring the safety and effectiveness of the formula in the treatment process.

V. Comparison with Other Similar Formulas

1. Comparison with Minor Bupleurum Decoction

Minor Bupleurum Decoction comes from Treatise on Febrile Diseases and is composed of Cinnamon Twig, Licorice, Chinese Date, White Peony, Fresh Ginger and Glutinous Rice Syrup. Its main effects are warming the middle-jiao to reinforce deficiency and soothing the interior and alleviating spasm. Compared with Huangqi Jianzhong Decoction, Minor Bupleurum Decoction focuses on warming the middle-jiao to reinforce deficiency and alleviating spasm and pain, and is mainly used to treat diseases with relatively mild deficiency-cold in the middle-jiao and abdominal pain as the main symptom. Huangqi Jianzhong Decoction adds Astragalus membranaceus on the basis of Minor Bupleurum Decoction, with a stronger qi-tonifying power, and is more suitable for consumptive fatigue with interior urgency caused by deficiency-cold in the middle-jiao and accompanied by insufficiency of qi and blood.

2. Comparison with Regulate the Middle Pill

The Lizhong Pills are composed of ginseng, dried ginger, licorice, and atractylodes macrocephala. Its efficacy is to warm the middle-jiao and dispel cold, replenish qi and strengthen the spleen. Compared with the Huangqi Jianzhong Decoction, both have the effect of warming the middle-jiao and strengthening the spleen. However, on the basis of replenishing qi and strengthening the spleen, the Huangqi Jianzhong Decoction pays more attention to regulating nutrient qi and defensive qi, nourishing blood and harmonizing the middle-jiao, and has a better therapeutic effect on symptoms such as qi and blood deficiency, disharmony between nutrient qi and defensive qi in consumptive fatigue syndrome, and its treatment scope is relatively wider.

3. Comparison with Bazhen Decoction

The Bazhen Decoction is composed of ginseng, atractylodes macrocephala, poria cocos, licorice, angelica sinensis, chuanxiong, white peony root, and prepared rehmannia root. It has the efficacy of replenishing qi and nourishing blood. The Bazhen Decoction focuses on tonifying both qi and blood, while the Huangqi Jianzhong Decoction mainly warms the middle-jiao and replenishes qi, and also regulates nutrient qi and defensive qi, nourishes blood and harmonizes the middle-jiao. However, its qi-tonifying power is more prominent than that of the Bazhen Decoction, and it is more suitable for qi and blood deficiency caused by deficiency-cold in the middle-jiao.

VI. Clinical Applications and Indications

1. Digestive System Diseases

Huangqi Jianzhong Decoction It is commonly used to treat digestive system diseases such as chronic gastritis and peptic ulcer. These diseases are mostly caused by deficiency-cold in the middle-jiao and weakness of the spleen and stomach. Patients often present symptoms such as epigastric pain, preference for warmth and pressure, loss of appetite, and indigestion. The Huangqi Jianzhong Decoction can effectively relieve epigastric pain, improve the function of the spleen and stomach, promote digestion and absorption through the effects of warming the middle-jiao and replenishing qi, and soothing the interior and relieving spasm, thus alleviating the symptoms of patients and improving the quality of life.

2. Anemia

For patients with iron deficiency anemia, megaloblastic anemia, etc. belonging to the type of qi and blood deficiency and spleen and stomach deficiency-cold, the Huangqi Jianzhong Decoction also has a certain therapeutic effect. In the formula, drugs such as astragalus membranaceus, Chinese date, and white peony root have the efficacy of replenishing qi and nourishing blood, can promote the hematopoietic function of bone marrow, increase the content of red blood cells and hemoglobin, and improve anemia symptoms. At the same time, the improvement of the function of the spleen and stomach helps the absorption of nutrients, provides sufficient raw materials for hematopoiesis, and further promotes the recovery of anemia.

3. Physical Weakness

For some people with weak constitutions, prone to colds, fatigue and weakness, who are differentiated by traditional Chinese medicine as belonging to deficiency-cold in the middle-jiao and qi and blood deficiency, the Huangqi Jianzhong Decoction can also be used for conditioning. By taking this formula, the resistance of the body can be enhanced, the constitution can be improved, the body can be made healthier, and the occurrence of diseases can be reduced.

4. Recovery of Chronic Diseases

In the recovery period of some chronic diseases such as chronic hepatitis and chronic nephritis, if symptoms of deficiency-cold in the middle-jiao and qi and blood deficiency appear, the Huangqi Jianzhong Decoction can be used as an auxiliary treatment formula. It can help patients recover the function of the spleen and stomach, supplement qi and blood, enhance the repair ability of the body, promote the improvement of the condition, and improve the quality of recovery of patients.

Addition and subtraction variations

VII. Additions and Subtractions

1. Severe Pain

Yanhusuo (Rhizoma Corydalis) and Muxiang (Radix Aucklandiae) can be added to enhance the effect of promoting qi circulation and relieving pain. Yanhusuo has the function of promoting blood circulation, activating qi and relieving pain, and Muxiang can promote qi circulation to relieve pain and strengthen the spleen and promote digestion. When combined with Huangqi Jianzhong Decoction, they can effectively relieve the abdominal pain symptoms, especially suitable for those with aggravated pain caused by qi stagnation and blood stasis.

2. Obvious Yang Deficiency

Fuzi (Radix Aconiti Lateralis Preparata) can be added to warm yang and dispel cold. Fuzi is extremely hot in nature and can restore yang from collapse, supplement fire and assist yang, and dispel cold and relieve pain. For patients with more severe yang deficiency, presenting symptoms such as fear of cold, cold limbs, and severe cold pain in the abdomen, adding Fuzi can enhance the effect of warming yang and dispelling cold in the formula and better improve the yang deficiency symptoms.

3. Obvious Blood Deficiency

Danggui (Radix Angelicae Sinensis) and Shudihuang (Radix Rehmanniae Preparata) can be added to nourish blood and nourish yin. Danggui nourishes blood and promotes blood circulation, regulates menstruation and relieves pain, and Shudihuang nourishes yin and blood, replenishes essence and marrow. When added to Huangqi Jianzhong Decoction, they can further enhance the effect of nourishing blood and nourishing yin, and are suitable for patients with more prominent blood deficiency symptoms, such as pale complexion, dizziness, etc.

4. Those with qi deficiency and sinking

Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) can be added to lift yang and raise the sinking qi. Shengma and Chaihu have the effect of lifting yang and raising the sinking qi, and can enhance the effect of Huangqi in supplementing qi and lifting yang. They have a good therapeutic effect on diseases such as chronic diarrhea with rectal prolapse and uterine prolapse caused by insufficient middle qi and qi sinking.

VIII. Dosage and Administration

1. Traditional methods

The traditional usage of Huangqi Jianzhong Decoction is to decoct the drugs with water. Generally, Astragalus membranaceus 9g, Cinnamon Twig 9g, Paeony Root 18g, Fresh Ginger 9g, 12 Chinese dates, and Prepared Licorice Root 6g. First, soak the drugs for a period of time, then decoct them slowly with a small fire, and take the decoction in three warm doses.

2. Modern concentrated granules

With the development of modern pharmaceutical technology, there is also a corresponding modern concentrated granule dosage form of Huangqi Jianzhong Decoction. When using it, just take it directly according to the dosage in the instruction manual, 2 - 3 times a day, and take it with boiling water. The modern concentrated granule dosage form is more in line with the fast-paced lifestyle of modern people on the premise of ensuring the medicinal effect, providing convenience for patients.

IX. Precautions and Taboos

1. Dietary taboos

During the period of taking Huangqi Jianzhong Decoction, it is necessary to avoid eating raw, cold, greasy, spicy and other stimulating foods. Raw and cold foods are likely to damage the yang qi of the spleen and stomach and affect the therapeutic effect of the drugs; greasy foods are not easy to digest and will加重 the burden of the spleen and stomach; spicy foods may刺激 the gastrointestinal tract, leading to aggravation of the disease or causing discomfort reactions. It is advisable to keep the diet light and eat more easily digestible and nutritious foods, such as rice porridge, noodles, vegetables, etc., which is helpful for the recovery of the spleen and stomach function and the exertion of the drug efficacy.

2. Special populations

Pregnant women, lactating women, children, as well as the elderly, the weak and those with extremely weak constitutions should consult a doctor before using Huangqi Jianzhong Decoction. Pregnant and lactating women need to use drugs cautiously to avoid adverse effects on the fetus or baby; the physiological functions of children and the elderly are different from those of adults, and the dosage and usage method of drugs need to be adjusted according to individual conditions and must be used under the guidance of a doctor.

3. Disease changes

During the process of taking Huangqi Jianzhong Decoction, if the condition changes, such as the symptoms worsen, new symptoms appear, or the original symptoms do not improve significantly, etc., one should seek medical attention in a timely manner, re-evaluate the condition, and adjust the treatment plan. Do not increase or decrease the drug dosage by oneself or continue to take it blindly.

4. Drug Interactions

Although Huangqi Jianzhong Decoction is a classical traditional Chinese medicine formula, there may still be drug interactions when used in combination with other drugs. If you are taking other medications, you should inform your doctor so that the doctor can determine whether there will be interactions, to avoid affecting the treatment effect or causing adverse reactions.

X. Modern Research Progress

1. Pharmacological Research

Modern research shows that Huangqi Jianzhong Decoction has various pharmacological effects. Components such as astragalus polysaccharide in astragalus membranaceus have immunomodulatory effects, which can enhance the body's immunity and improve the body's disease resistance. Drugs such as cinnamon twig and peony have anti-inflammatory and analgesic effects, which can relieve inflammatory reactions and pain symptoms. Ginger, jujube, etc. can promote gastrointestinal peristalsis, enhance digestive function, and contribute to the digestion and absorption of food. In addition, the drugs in the formula also have antioxidant and cardiovascular function regulation effects, etc. These pharmacological effects provide a scientific basis for the clinical application of Huangqi Jianzhong Decoction.

2. Clinical efficacy observation

A large number of clinical studies have confirmed the good curative effects of Huangqi Jianzhong Decoction in the treatment of digestive system diseases, anemia, physical weakness, etc. In the treatment of chronic gastritis, Huangqi Jianzhong Decoction can effectively improve the symptoms of epigastric pain, abdominal distension, indigestion, etc. in patients, and improve the repair ability of gastric mucosa. For anemia patients, it can significantly increase the hemoglobin level and improve anemia symptoms. In the conditioning of physically weak people, it can enhance the body's immunity and improve the condition of fatigue and weakness.

3. Dosage Form Improvement Research

With the development of modern technology, the research on the dosage form improvement of Huangqi Jianzhong Decoction is also continuously deepening. In addition to the modern concentrated granule dosage form, there are also some studies dedicated to developing new preparations of Huangqi Jianzhong Decoction, such as capsules, oral liquids, etc. While maintaining the curative effect of the formula, these new dosage forms further improve the stability and convenience of taking the drug, providing more choices for patients.

4. Mechanism of Action Research

Regarding the mechanism of action of Huangqi Jianzhong Decoction, it is still under in-depth research. Some studies have found that this formula may achieve the purpose of treating diseases and conditioning the body by regulating the functions of multiple aspects of the body's neuroendocrine system, immune system, digestive system, etc. For example, it may improve the body's stress response and metabolic function by regulating the neuroendocrine system such as the hypothalamus-pituitary-adrenal axis; enhance the body's immunity by regulating the cytokine levels of the immune system; improve gastrointestinal function by regulating neurotransmitters and gastrointestinal hormones in the gastrointestinal tract.

Summary

Huangqi Jianzhong Decoction is formed by adding astragalus membranaceus to the classical Xiaojianzhong Decoction (also known as Jianzhong Decoction), belonging to the representative formula for replenishing qi and strengthening the middle-jiao. It comes from Synopsis of the Golden Chamber together with Dajianzhong Decoction. This formula uses astragalus membranaceus to replenish qi, and is combined with three liang of cinnamon twig, cinnamon twig, six liang of white peony (paeonia lactiflora), three liang of ginger, ginger, jujube, roasted licorice root (two liang of licorice), maltose and other drugs, with the effects of warming the middle-jiao to replenish deficiency and relieving spasm to stop pain, and is mainly used to treat syndromes such as deficiency-cold in the spleen and stomach and deficiency and spasm in the interior. In clinical application, Huangqi Jianzhong Decoction is widely used in deficiency-cold diseases of the spleen and stomach such as chronic gastritis, and can be modified according to the condition.