小建中湯
出自《傷寒論》
【組成】 桂(gui)枝三兩(liang)，去皮(9g) 甘草二兩(liang)，炙(6g) 大棗十二枚，擘(6枚)芍(shao)藥六兩(liang)，(18g) 生姜三兩(liang)，切(9g)膠飴一升(30g)
【用(yong)法】 上六味(wei)，以水七升，煮取三(san)升，去滓(zi)，納飴，更上微火消解。溫(wen)服一升，日三(san)服 (現代用(yong)法:水煎取汁，兌入飴糖，文(wen)火加熱(re)溶(rong)化(hua)，分兩次溫(wen)服) 。
【功用(yong)】 溫中補虛，和(he)里緩急(ji)。
【主治(zhi)】 中焦虛寒，肝脾不和證(zheng)。腹(fu)中拘(ju)急疼痛，喜(xi)(xi)溫喜(xi)(xi)按，神疲乏力，虛怯少氣;或心中悸動，虛煩不寧，面(mian)色無(wu)華;或伴四(si)肢酸楚，手足煩熱，咽(yan)干口燥;舌淡苔(tai)白，脈細弦。
【方解(jie)】 本方病(bing)(bing)證因(yin)中(zhong)(zhong)(zhong)(zhong)焦(jiao)(jiao)虛(xu)寒, 肝(gan)脾失和，化(hua)(hua)(hua)源(yuan)不足所致。中(zhong)(zhong)(zhong)(zhong)焦(jiao)(jiao)虛(xu)寒，肝(gan)木乘土，故腹中(zhong)(zhong)(zhong)(zhong)拘急(ji)疼(teng)痛，喜溫(wen)(wen)喜按(an)。脾胃為氣(qi)(qi)(qi)血生化(hua)(hua)(hua)之(zhi)源(yuan)，中(zhong)(zhong)(zhong)(zhong)焦(jiao)(jiao)虛(xu)寒，化(hua)(hua)(hua)源(yuan)匱乏，氣(qi)(qi)(qi)血俱虛(xu)，故見心悸、面色無華(hua)、發熱、口燥(zao)咽干(gan)等。癥雖不同，病(bing)(bing)本則一，總由中(zhong)(zhong)(zhong)(zhong)焦(jiao)(jiao)虛(xu)寒所致。治當(dang)溫(wen)(wen)中(zhong)(zhong)(zhong)(zhong)補(bu)(bu)虛(xu)而(er)兼(jian)養陰(yin)，和里緩(huan)急(ji)而(er)能(neng)止(zhi)痛。方中(zhong)(zhong)(zhong)(zhong)重(zhong)用甘(gan)(gan)(gan)溫(wen)(wen)質潤(run)之(zhi)飴糖(tang)為君，溫(wen)(wen)補(bu)(bu)中(zhong)(zhong)(zhong)(zhong)焦(jiao)(jiao)，緩(huan)急(ji)止(zhi)痛。臣以辛(xin)溫(wen)(wen)之(zhi)桂枝(zhi)，溫(wen)(wen)陽(yang)氣(qi)(qi)(qi)，祛寒邪;酸甘(gan)(gan)(gan)之(zhi)白芍(shao)，養營(ying)陰(yin)，緩(huan)肝(gan)急(ji)，止(zhi)腹痛。佐以生姜溫(wen)(wen)胃散寒，大(da)棗補(bu)(bu)脾益氣(qi)(qi)(qi)。炙甘(gan)(gan)(gan)草益氣(qi)(qi)(qi)和中(zhong)(zhong)(zhong)(zhong)，調和諸(zhu)藥(yao)，是為佐使(shi)之(zhi)用。其中(zhong)(zhong)(zhong)(zhong)飴糖(tang)配(pei)桂枝(zhi)，辛(xin)甘(gan)(gan)(gan)化(hua)(hua)(hua)陽(yang)，溫(wen)(wen)中(zhong)(zhong)(zhong)(zhong)焦(jiao)(jiao)而(er)補(bu)(bu)脾虛(xu);芍(shao)藥(yao)配(pei)甘(gan)(gan)(gan)草，酸甘(gan)(gan)(gan)化(hua)(hua)(hua)陰(yin)，緩(huan)肝(gan)急(ji)而(er)止(zhi)腹痛。六藥(yao)合用，溫(wen)(wen)中(zhong)(zhong)(zhong)(zhong)補(bu)(bu)虛(xu)緩(huan)急(ji)之(zhi)中(zhong)(zhong)(zhong)(zhong)，蘊有(you)柔肝(gan)理(li)脾、益陰(yin)和陽(yang)之(zhi)意，用之(zhi)可使(shi)中(zhong)(zhong)(zhong)(zhong)氣(qi)(qi)(qi)強健，陰(yin)陽(yang)氣(qi)(qi)(qi)血生化(hua)(hua)(hua)有(you)源(yuan)，故以“建(jian)中(zhong)(zhong)(zhong)(zhong)”名之(zhi)。
本(ben)方是由桂(gui)枝(zhi)(zhi)湯倍芍(shao)藥，重加飴糖(tang)組成。然其理法與桂(gui)枝(zhi)(zhi)湯有(you)別，桂(gui)枝(zhi)(zhi)湯以桂(gui)枝(zhi)(zhi)為君(jun)，具有(you)解肌發表(biao)，調(diao)和營(ying)衛(wei)之功，主治外(wai)感風(feng)寒(han)(han)表(biao)虛(xu)，營(ying)衛(wei)不和證。本(ben)方以飴糖(tang)為君(jun)，意在溫中補虛(xu)，緩急止痛(tong)，主治中焦虛(xu)寒(han)(han)，虛(xu)勞里急證。
本(ben)方與(yu)理(li)中丸同為溫(wen)中祛寒(han)之(zhi)劑，但理(li)中丸純用溫(wen)補藥物，以溫(wen)中祛寒(han)，益氣健脾(pi)為主。
小建中湯乃溫補藥(yao)配以(yi)調理肝脾之(zhi)品，重在溫中補虛，緩(huan)急止痛。
【運用】
1.辨(bian)證(zheng)要點：本方既是溫(wen)(wen)中補虛(xu)，緩(huan)急(ji)止痛之劑，又為(wei)調和陰陽(yang)，柔肝理脾之常用方。臨床以腹中拘急(ji)疼痛，喜(xi)溫(wen)(wen)喜(xi)按(an)，舌淡(dan)，脈細弦為(wei)辨(bian)證(zheng)要點。嘔(ou)吐(tu)或中滿(man)者(zhe)不宜使用;陰虛(xu)火旺之胃脘(wan)疼痛忌用。
2.加(jia)(jia)減法：若中焦(jiao)寒重者(zhe)，可加(jia)(jia)干(gan)姜以(yi)增強溫中散寒之力;兼有氣滯者(zhe)，可加(jia)(jia)木(mu)香行氣止痛;便溏(tang)者(zhe)，可加(jia)(jia)白(bai)術健脾燥濕止瀉;面色(se)萎黃，短氣神疲(pi)者(zhe)，可加(jia)(jia)人(ren)參、黃芪、當(dang)歸以(yi)補養氣血。
3.現代(dai)運用：本(ben)方適用于(yu)胃及十二指腸潰(kui)瘍、慢(man)性肝炎(yan)、慢(man)性胃炎(yan)、神(shen)經(jing)衰弱、再(zai)生障礙(ai)性貧(pin)血、功能性發熱(re)等屬中(zhong)焦虛寒，肝脾不和者(zhe)。
【附方】
1.黃芪建(jian)中湯(tang)(《金(jin)匱要略》) 桂枝三兩(liang)，去(qu)皮(9g) 甘草(cao)二兩(liang)，炙(6g) 大棗(zao)十二枚(mei)，擘(6枚(mei)) 芍藥(yao)六兩(liang)，(18g) 生姜三兩(liang)，切(9g)膠飴一升(30g) 黃芪一兩(liang)半(ban)(5g) 煎服法同小建(jian)中湯(tang)。功用：溫(wen)中補氣，和(he)里(li)(li)緩急。主治：陰(yin)陽氣血俱(ju)虛證。里(li)(li)急腹(fu)痛，喜溫(wen)喜按，形體羸(lei)瘦，面色無華(hua)，心悸氣短(duan)，自汗(han)盜汗(han)。
2.當歸(gui)建(jian)中湯(《千金翼方》) 當歸(gui)四兩(liang)(12 g)桂(gui)心三兩(liang)(9g) 甘(gan)草炙二兩(liang)(6g) 芍藥六兩(liang)(18g) 生姜三兩(liang)(9g)大(da)(da)棗12枚(mei)(6枚(mei)) 擘 上六味 咀，以水一斗，煮取三升，分為三服，一日令盡。若大(da)(da)虛，加飴糖(tang)六兩(liang)(30g)作湯成，內(nei)之于火上暖(nuan)，令飴糖(tang)消(xiao)。功用：溫補氣(qi)血，緩急止痛。主治：產(chan)后虛羸不(bu)足，腹中 痛不(bu)已，吸吸少氣(qi)，或小腹拘急攣痛引腰背，不(bu)能飲食(shi)者(zhe)。
3.大建中(zhong)湯(《金匱要略》) 蜀椒二(er)合(he)，去汗(6g) 干姜四(si)兩(12g) 人參二(er)兩(6g) 上(shang)三味，以水四(si)升(sheng)(sheng)，煮取二(er)升(sheng)(sheng)，去滓，內膠飴一(yi)升(sheng)(sheng)(30g)，微火煮取一(yi)升(sheng)(sheng)半，分溫再服，如(ru)一(yi)炊頃，可飲(yin)粥二(er)升(sheng)(sheng)，后更服，當(dang)一(yi)日食(shi)糜，溫覆之(zhi)。功用：溫中(zhong)補虛，降逆止痛(tong)。主治：中(zhong)陽(yang)衰弱，陰寒內盛之(zhi)脘腹劇(ju)痛(tong)證。腹痛(tong)連及胸脘，痛(tong)勢(shi)劇(ju)烈，其(qi)痛(tong)上(shang)下(xia)走(zou)竄無定處，或(huo)腹部時見塊狀物上(shang)下(xia)攻撐(cheng)作痛(tong)，嘔吐劇(ju)烈，不能飲(yin)食(shi)，手足(zu)厥冷，舌質淡，苔白(bai)滑，脈沉(chen)伏而遲。
小建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)、黃芪(qi)(qi)建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)、當(dang)歸(gui)建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)、大建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)四方(fang)均(jun)屬(shu)溫中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)補(bu)虛之(zhi)劑(ji)。但(dan)(dan)小建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)以(yi)辛甘(gan)為(wei)主(zhu)，佐以(yi)大量芍藥，又有(you)(you)(you)酸甘(gan)化陰(yin)之(zhi)意，宜于(yu)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)陽(yang)虛而營陰(yin)亦(yi)有(you)(you)(you)不足(zu)之(zhi)證;黃芪(qi)(qi)建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)于(yu)小建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)內加(jia)黃芪(qi)(qi)，是增強益氣(qi)建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)之(zhi)力(li)，使陽(yang)生陰(yin)長，諸虛不足(zu)之(zhi)證自除;當(dang)歸(gui)建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)治產后(hou)虛羸，以(yi)產后(hou)百脈(mo)空虛，所(suo)以(yi)加(jia)苦辛甘(gan)溫、補(bu)血(xue)和血(xue)之(zhi)當(dang)歸(gui)。兩方(fang)若(ruo)與小建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)相(xiang)比較，則(ze)小建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)雖陰(yin)陽(yang)并補(bu)，但(dan)(dan)以(yi)溫陽(yang)為(wei)主(zhu);黃芪(qi)(qi)建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)則(ze)側重于(yu)甘(gan)溫益氣(qi);當(dang)歸(gui)建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)乃(nai)偏重于(yu)和血(xue)止痛(tong)。大建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)則(ze)純用辛甘(gan)之(zhi)品溫建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)陽(yang)，其補(bu)虛散寒(han)之(zhi)力(li)遠較小建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)湯(tang)(tang)(tang)為(wei)峻，且有(you)(you)(you)降逆(ni)止嘔(ou)作用，故名大建(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)，用治中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)陽(yang)衰弱(ruo)，陰(yin)寒(han)內盛(sheng)之(zhi)腹痛(tong)嘔(ou)逆(ni)。
【文獻摘要】
1.原書主治
《傷寒(han)論·辨太陽病脈證并治》：“傷寒(han)，陽脈澀，陰脈弦(xian)，法當腹中急痛，先與(yu)小建(jian)中湯(tang)，不差者(zhe)，小柴胡湯(tang)主之。”
《金匱要略·血痹虛勞病脈(mo)證(zheng)并治》: “虛勞里急,悸(ji)，衄(nv)，腹中痛，夢失(shi)精，四肢酸疼，手足煩熱，咽干(gan)口(kou)燥，小(xiao)建中湯主之。”
2.方論選錄
許宏(hong)《金(jin)鏡內臺方議(yi)》卷4：“建(jian)中(zhong)(zhong)者，建(jian)其脾也。脾欲緩(huan)，急食甘(gan)以緩(huan)之，建(jian)中(zhong)(zhong)之味甘(gan)也。陽脈澀，陰(yin)脈弦者，為(wei)中(zhong)(zhong)虛內寒也。心中(zhong)(zhong)悸(ji)者為(wei)氣(qi)虛，煩(fan)者為(wei)血虛，故用膠飴為(wei)君(jun)，甘(gan)草、大棗為(wei)臣(chen)，以甘(gan)佐甘(gan)緩(huan)之也。白芍藥之酸，能(neng)收斂脾氣(qi)而益其中(zhong)(zhong)，故用之為(wei)佐。桂枝(zhi)、生(sheng)姜之辛，以散余(yu)邪而益其氣(qi)也”。
王子接《絳雪園古方選注》卷上：“建(jian)中(zhong)者(zhe)，建(jian)中(zhong)氣也(ye)。名之(zhi)(zhi)曰小者(zhe)，酸甘(gan)緩中(zhong)，僅能建(jian)中(zhong)焦營氣也(ye)。前桂(gui)(gui)枝湯是芍(shao)藥佐桂(gui)(gui)枝，今建(jian)中(zhong)湯是桂(gui)(gui)枝佐芍(shao)藥，義偏重(zhong)于酸甘(gan)，專和血(xue)脈(mo)(mo)之(zhi)(zhi)陰(yin)。芍(shao)藥、甘(gan)草有(you)戊己相須之(zhi)(zhi)妙(miao)，膠飴為稼穡之(zhi)(zhi)甘(gan)，桂(gui)(gui)枝為陽木，有(you)甲(jia)己化土之(zhi)(zhi)義。使以(yi)姜、棗助脾與胃行津液者(zhe)，血(xue)脈(mo)(mo)中(zhong)之(zhi)(zhi)柔陽，皆出(chu)于胃也(ye)。”
【臨床報道】
小(xiao)建中(zhong)湯治(zhi)(zhi)療(liao)慢(man)性(xing)萎(wei)縮(suo)性(xing)胃(wei)炎(yan)(yan)及慢(man)性(xing)淺表(biao)性(xing)胃(wei)炎(yan)(yan)，確(que)有(you)(you)療(liao)效(xiao)(xiao)。馬(ma)氏(shi)以小(xiao)建中(zhong)湯為主(zhu)治(zhi)(zhi)療(liao)慢(man)性(xing)胃(wei)炎(yan)(yan)58例(li)。其中(zhong)治(zhi)(zhi)療(liao)慢(man)性(xing)萎(wei)縮(suo)性(xing)胃(wei)炎(yan)(yan)39例(li)，治(zhi)(zhi)愈21例(li)，占(zhan)53.9%;好(hao)轉13例(li),占(zhan)33.3%;無效(xiao)(xiao)5例(li),占(zhan)12.8%，總有(you)(you)效(xiao)(xiao)率87.2%。治(zhi)(zhi)療(liao)慢(man)性(xing)淺表(biao)性(xing)胃(wei)炎(yan)(yan)19例(li)，治(zhi)(zhi)愈11例(li)，占(zhan)57.9%;好(hao)轉5例(li),占(zhan)26.3%;無效(xiao)(xiao)3例(li),占(zhan)15.8%，總有(you)(you)效(xiao)(xiao)率84.2%。[馬(ma)馨蘭. 小(xiao)建中(zhong)湯治(zhi)(zhi)療(liao)慢(man)性(xing)胃(wei)炎(yan)(yan)58例(li)。實用中(zhong)西醫結合雜志 1998;1(11)：71]
劉氏以(yi)小建中(zhong)湯為主方(fang)，隨證加減治(zhi)(zhi)療(liao)慢(man)性(xing)(xing)乙型(xing)病(bing)(bing)毒性(xing)(xing)肝(gan)(gan)炎(yan)(yan)合并(bing)胃(wei)粘(zhan)(zhan)(zhan)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)癥、潰(kui)瘍(yang)病(bing)(bing)變46例(li)(li)(li)，其中(zhong)男性(xing)(xing)38例(li)(li)(li)，女性(xing)(xing)8例(li)(li)(li);年齡16～30歲26例(li)(li)(li)，31～39歲17例(li)(li)(li)，40歲以(yi)上3例(li)(li)(li);病(bing)(bing)程最(zui)短10個(ge)月，最(zui)長6年，平均2.1年;慢(man)性(xing)(xing)遷延性(xing)(xing)肝(gan)(gan)炎(yan)(yan)35例(li)(li)(li)，慢(man)性(xing)(xing)活動性(xing)(xing)肝(gan)(gan)炎(yan)(yan)11例(li)(li)(li);合并(bing)胃(wei)粘(zhan)(zhan)(zhan)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)癥41例(li)(li)(li)，胃(wei)粘(zhan)(zhan)(zhan)膜(mo)(mo)(mo)(mo)(mo)潰(kui)瘍(yang)4例(li)(li)(li)，十二指腸(chang)粘(zhan)(zhan)(zhan)膜(mo)(mo)(mo)(mo)(mo)潰(kui)瘍(yang)1例(li)(li)(li)。基本方(fang)：桂枝3g 白芍15g 炙甘草9g 茵陳(chen)30g 炮干姜(jiang)9g 白花蛇舌草30g 白豆(dou)蔻6g 豬苓15g 麥芽15g 飴糖(tang)30g (烊化) 大(da)棗5枚(mei) 生姜(jiang)3g 沙參15g 烏(wu)梅15g 五味子9g 丹參20g 黃芪30g，水煎早晚2次(ci)服，30天為1療(liao)程。結果：顯(xian)效 18例(li)(li)(li);有效24例(li)(li)(li);無效4例(li)(li)(li)。[劉紅(hong)書(shu)，等.小建中(zhong)湯治(zhi)(zhi)療(liao)慢(man)性(xing)(xing)乙型(xing)病(bing)(bing)毒性(xing)(xing)肝(gan)(gan)炎(yan)(yan)合并(bing)胃(wei)粘(zhan)(zhan)(zhan)膜(mo)(mo)(mo)(mo)(mo)病(bing)(bing)變。山東中(zhong)醫(yi)雜志 1999;5(18)：211]
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