Da Jian Zhong Tang, also known as Major Construct the Middle Decoction, is one of the most commonly used traditional Chinese medicine prescriptions. It has a long history of usage that extends back to ancient texts and its application has evolved over time through ongoing discovery and interpretation, reflecting the dynamic and adaptable nature of traditional medicine.
Actions
Tonifies and warms the middle jiao Corrects the reversed flow of qi and relieves pain
Indications
Abdominal pain and distention, cold limbs, severe coldness, and pain in the belly superficial skin pulsations throughout the abdomen, headache, vomit, and water sound in the abdomen Yang deficiency in middle Jiao Tongue/Pulse: a white, wet tongue coating; and a thin, tight pulse.
1. Shang Han Lun
The formula, which tonifies and warms the middle jiao, corrects the reversed flow of qi, and relieves pain, first appeared in the "Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet)", dealing with the treatment of bloating, cold hernia, and indigestion.
“心滿中大寒痛, 嘔不能飮食, 腹中寒, 上衝皮起出見有頭足, 上下痛而不可觸近, 大建中湯主之.”
『금궤요략(金匱要略)』복만한산숙식병맥증치법제십(腹滿寒疝宿食病脈證治法第十)
Despite its singular appearance in classical texts, Da Jian Zhong Tang has been consistently recognized in major medical texts as a prescription for resolving constipation or accumulation based on a cold pattern. This is notably different from its use cases (indications) stated in the classical text, "Shang Han Lun", highlighting the flexibility and adaptability of traditional medical knowledge and practices.
2. In Modern Days
The versatility of Da Jian Zhong Tang is also evident in modern medical practices, particularly in Japan. According to 2013 statistics(picture above), Da Jian Zhong Tang(Daikenchuto) was the second most commonly used prescription [1]. However, the purpose of its use greatly differs from the guidelines in the classic "Shang Han Lun". The prescription is currently used for the prevention of postoperative ileus, a common complication following abdominal surgery. Research has shown that the prescription can improve postoperative ileus requiring long-tube decompression, which makes it a routine choice for many surgeons after operations. [2]
This widespread usage in hospital settings stands in contrast with other Kampo extracts, which are generally used for outpatients in primary care settings. Some hospitals have even incorporated Da Jian Zhong Tang into their standard clinical procedures. This large-scale adoption and routine use in modern medical contexts demonstrate how traditional medical treatments can be repurposed and integrated into modern healthcare settings through continuous verification and reinterpretation.
As frequently used formulae [1] in community health care, syakuyakukanzoto, daikenchuto, kakkonto, rikkunshito, and hochuekkito were listed. The use of these formulae is supposed not to depend on traditional pattern identification. Shakuyakukanzoto is being used as an analgesic for neuralgia and arthralgia, kakkonto for acute upper respiratory inflammation, hochuekkito for conditions alleviated by recovery from fatigue, and rikkunshito and daikenchuto for relief of upper and lower digestive tract complaints. [3]-[7]
Summary;
The evolving use and understanding of Da Jian Zhong Tang over centuries underscores the adaptability and dynamism inherent in traditional medicine. It serves as a reminder that medical knowledge and practices are not static but are constantly evolving through ongoing discovery, interpretation, and verification. This process of continuous evolution allows traditional medicine to stay relevant and valuable in the ever-changing landscape of healthcare.
References
1. Shin-ichi Muramatsu , Original Article Current Status of Kampo Medicine in Community Health Care, General Medicine 2012, vol. 13, no. 1, p. 37-45.
2. H. Yasunaga, H. Miyata, H. Horiguchi, K. Kuwabara, H. Hashimoto, and S. Matsuda, “Effect of the Japanese herbal kampo medicine Dai-kenchu-to on postoperative adhesive small bowel obstruction requiring long-tube decompression: a propensity score analysis,” Evidence-based Complementary and Alternative Medicine, vol. 2011, Article ID 264289, 7 pages, 2011.
3. The Japan Society for Oriental Medicine: Evidence reports of Kampo treatment 2010: 345
4. Kubota, T.; Miyata. A. Successful use of Shakuyaku-kanzo-to, a traditional herbal medicine, for intractable symptoms of thoracic outlet syndrome: a case report. J Anesth. 2005, vol. 19, p. 157-159.
5. Kurokawa, M.; Tsurita, M.; Brown, J.; Fukuda, Y.; Shiraki, K. Effect of interleukin-12 level augmented by Kakkon-to, a herbal medicine, on the early stage of influenza infection in mice. Antiviral Res. 2002, vol. 56, p. 183-188.
6. Manabe, N.; Camilleri, M.; Rao, A. et al. Effect of daikenchuto（TU-100）on gastrointestinal and colonic transit in humans. Am J Physiol Gastrointest Liver Physiol. 2010, 298: G970-975.
7. Kono, T.; Kanematsu, T.; Kitajima, M. Exodus of Kampo, traditional Japanese medicine, from the complementary and alternative medicines: is it time yet? Surgery, 2009, vol. 146, p. 837-840.