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The *Ling Shu* (Spiritual Pivot) states: The human body has a Sea of Marrow, a Sea of Blood, a Sea of Qi, and a Sea of Grain and Water. These four seas correspond to the four seas in the body.
The Stomach is the Sea of Grain and Water; the Chong Mai (Penetrating Vessel), which regulates the blood of the twelve meridians, is the Sea of Blood and also the Sea of the Twelve Meridians; the Dan Zhong (Chest center, location of the Pericardium) is the Sea of Qi; the Brain is the Sea of Marrow. It is also said that the Chong Mai is the Sea of the Five Zang and Six Fu organs. The Five Zang and Six Fu organs all receive nourishment from it. It is further stated that humans obtain Qi from food; when food enters the Stomach, its essence is transmitted to the Lung, allowing the Five Zang and Six Fu organs to receive Qi. (The Stomach ascends essence to the Lung, and the Lung disperses essence to the Zang and Fu organs.) The pure part becomes Ying Qi (Nutritive Qi, circulating within the vessels), and the turbid part becomes Wei Qi (Defensive Qi, circulating outside the vessels). The *Su Wen* (Basic Questions) states: Ying Qi is the refined essence of grain and water; Wei Qi is the fierce and rapid Qi of grain and water. Ying Qi circulates within the vessels, (being Yin in nature, pure and dedicated, it travels with Zong Qi through the meridian tunnels.) Wei Qi circulates outside the vessels, (being Yang in nature, fierce and slippery, it does not enter the vessels but moves between the skin and muscle layers; the floating Qi that does not follow the meridians is called Wei Qi, while the refined Qi moving within the meridians is called Ying Qi.) They circulate continuously without rest, meeting again after fifty cycles, with Yin and Yang interconnecting like a circle without beginning or end. During the day, they move in the Yang aspect; at night, in the Yin aspect. The Tai Yin governs the interior movement, and the Tai Yang governs the exterior movement, each completing twenty-five circuits to divide day and night. After midnight, Yin declines; at dawn, Yin is exhausted, and Yang receives Qi. In the afternoon, Yang declines; at sunset, Yang is exhausted, and Yin receives Qi. At midnight, there is a great convergence of Yin and Yang, (Yin-Yang intersection), when all people sleep, termed "He Yin" (Union of Yin). At dawn, Yin is exhausted, and Yang receives Qi. This cycle continues endlessly, mirroring the rhythms of Heaven and Earth. Initially entering the Yin, it typically flows from the Foot Shaoyin Kidney channel into the Kidneys. (When Qi moves into Yin, one sleeps; thus, Shaoyin disease manifests as drowsiness.) From the Kidney, it goes to the Heart; from the Heart, to the Lung; from the Lung, to the Liver; from the Liver, to the Spleen; and from the Spleen back to the Kidney, completing a cycle of Ying Qi circulation, originating from the Middle Jiao (Zhongwan acupoint represents the Middle Jiao, where grain Qi in the Stomach transforms into essence and blood). Wei Qi originates from the Lower Jiao (Yinjiao acupoint, one cun below the umbilicus, represents the Lower Jiao, where Yang Qi ascends to form Wei Qi). Ying and Wei Qi are both refined essence (the refined Qi of grain and water). Blood is the carrier of Shen Qi (Spiritual Qi). Since Essence generates Spirit, and Spirit requires a substrate, it must rely on Essence and Blood; therefore, Blood and Qi, though named differently, are of the same substance.

The *Ling Shu* states: If the Spleen is small, the internal organs are peaceful and difficult to injure by pathogens. If the Spleen is large, it causes pain in the hypochondriac soft tissue area (Miao), making rapid walking difficult. If the Spleen is high, it pulls on the costal margin causing pain. If the Spleen is low, it presses down on the Large Intestine, making the organs susceptible to pathogens. If the Spleen is firm, the organs are peaceful and hard to injure. If the Spleen is fragile, it is prone to disease, such as Xiao Dao (wasting-thirst) and can be easily injured. If the Spleen is upright, it remains harmonious and hard to injure; if tilted, it is prone to fullness and distension. (How do we know this? Yellow complexion with fine texture indicates a small Spleen; coarse texture indicates a large Spleen; protruding lips indicate a high Spleen; drooping lips indicate a high Spleen; firm lips indicate a low Spleen; large but not firm lips indicate a fragile Spleen; well-formed upper and lower lips indicate an upright Spleen; deviated lips indicate a tilted Spleen.)

Humans take Stomach Qi as their root because it nourishes all things. Food enters the Stomach and receives the Qi of Earth. The Spleen is taken as the root because it grinds and transforms all things, distributing the Five Flavors to nourish the Five Zang organs, enriching the bones, and moistening the limbs. Therefore, when Stomach Qi is harmonious, milk and food digest easily; when the Spleen and Stomach are deficient and cold, retained food fails to move. The general treatment principle is to warm the Stomach and tonify the Spleen. If there is no appetite due to fright, palpitations, and severe heat, this involves the Mother-Child relationship between the Heart and Spleen, and formulas for draining the Heart should be used. If the Spleen Qi is weak due to Heart deficiency, leading to mental confusion and lack of appetite, Heart-tonifying formulas should be used alongside Spleen-supporting measures, following the principle that Fire generates Earth, and the Mother organ strengthens the Child. If the face is pale and lusterless, the body is thin with abdominal pain, breath feels cold, there is no desire to eat, and water is vomited, this is Stomach Qi deficiency and cold; the method should be to warm the Stomach and support the Spleen. Thus, Stomach deficiency leads to vomiting and anorexia, while Stomach excess often leads to痞满 (fullness/stagnation) and internal heat. Moreover, in the morning, Yang Qi is just growing, and grain Qi digests easily, so one can eat. In the evening, Yin Qi is rising, and grain cannot be transformed, so one should eat less. If one eats significantly more in the late evening, this indicates Yin deficiency with pathogenic fire consuming the grain. However, those who regulate the Spleen and Stomach prosper; those who damage them perish. The Spleen possesses the stillness of Kun (Earth) but the activity of Qian (Heaven), transforming and generating essence and Qi, with clear Qi ascending and turbid waste descending. Turbidity becomes Wei Qi, clarity becomes Ying Qi. Yin and Yang utilize this mechanism, known as "Tuoyue" (bellows), providing the motive force for respiration and Qi movement. If either weakens, the function of vigorous transformation ceases, and the merit of generation is lost; the origin of various diseases lies here. Infants do not know hunger or satiety; the responsibility of care lies with parents. However, out of deep affection and reluctance to see the child suffer, parents may fail to realize that old food has not digested before new food is introduced. Medicines may be too bitter, and dietary restrictions may cause hunger, leading to further damage to the Spleen and Stomach and the onset of myriad diseases.

Accumulation and stagnation must be treated with resolution and guidance. "Resolution" means dispersing accumulation; "guidance" means promoting Qi movement. When Spleen deficiency fails to transport, Qi does not flow; when Qi does not flow, it stagnates and forms accumulation, potentially causing diarrhea or dysentery, or forming Pi syndrome (abdominal mass/fullness), leading to reduced diet, lack of nourishment for the Five Zang organs, and daily decline of Blood and Qi, often resulting in critical conditions. Therefore, one must resolve and guide. For mild cases, use standard harmonizing formulas; for severe cases, employ drastic purgative decoctions or pills. Because if turbid Yin does not descend, clear Yang cannot ascend; if external filth is not removed, true Yuan Qi cannot recover. Just as peace follows the pacification of chaos. If accumulation is due to Spleen deficiency failing to mobilize medicinal power, one may combine resolution and tonification, use more tonification than resolution, or tonify first then resolve. As Li Dongyuan (Jiegu) stated, nurturing righteousness causes accumulation to self-resolve. Thus, predecessors using drugs to break stagnation and soften hardness must rely on Ginseng and Atractylodes to assist success. The Classics state: Do not exacerbate evil, do not lose righteousness, thereby cutting short life—this is what is meant. Li Dongyuan said: The Stomach is the rigid aspect of the Spleen; the Spleen is the soft aspect of the Stomach. Irregular diet injures the Stomach first, leaving the Spleen without nourishment, which then gets injured. Overwork injures the Spleen first, preventing it from moving Qi for the Stomach, which then gets injured. Since the Spleen and Stomach are the Sea of the Twelve Meridians, once they are deficient, pathogens from the Twelve Meridians emerge in various ways, so all diseases arise from the Spleen and Stomach. Prescribers should not neglect this importance.

Heaven envelops the Earth, and the Earth lies within Heaven. Growth is the primary function, and storage is the secondary. Although Heaven performs these functions, the merit belongs to the Earth (Post-earth). When the soil moisture moves, all things flourish; when Earth Qi recedes, all things return to roots. Therefore, fertile, moist soil can develop life, while dry, sandy soil lacks vitality. All things emerge from Earth, hence it is called the Mother of All Things. In the human body, the Spleen and Stomach govern this. Blood, Qi, Spirit, fluids, sinews, bones, Zang-Fu organs, and limbs all receive Qi from the Stomach. Thus, the Stomach is the source of Wei Qi, and the Spleen is the root of Ying Qi. The *Zhen Jing* (Needle Classic) states: Ying Qi emerges from the Middle Jiao, Wei Qi emerges from the Upper Jiao. The Spleen is Kun Earth, governing stillness and belonging to Yin. The Stomach is Dry Earth, governing movement and belonging to Yang. However, the Spleen possesses the softness of Kun and the function of Qian's movement. The Spleen prefers dryness and dislikes dampness; the Stomach is originally damp and dislikes dryness. The *Ling Shu* states: The Stomach desires cold drinks and dislikes heat; the Intestines desire hot drinks and dislike cold. The *Nei Jing* states: The Spleen and Stomach are the officials of the granary. The Stomach is the Sea of Grain and Water, the great source of the Five Zang and Six Fu organs. Food and drink enter the Stomach. The Spleen connects to the Stomach via membranes and transports fluids for the Stomach. Thus, food Qi entering the Stomach scatters essence to the Liver, overflowing into sinews, overflowing into vessels, and transmitting essence to the Spleen. Drink entering the Stomach overflows with essence and Qi, transporting upward to the Spleen. The Spleen scatters essence, sending it upward to the Lung. The Spleen and Stomach are the root of post-natal Yuan Qi, and diet is the source of generation. Hence, it is said: "Accepting grain establishes the chamber; those who accommodate grain prosper." If Stomach deficiency cannot accept, there is aversion to eating. If Spleen deficiency cannot transform, there is accumulation. This is due to Qi deficiency. Therefore, Li Dongyuan established the *Pi Wei Lun* (Treatise on the Spleen and Stomach) and formulated Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), serving as the ancestor for all future methods of tonifying post-natal Yuan Qi. True Qi, or Yuan Qi, is the essence that generates the body. Only Stomach Qi can nourish it. If the Stomach腑 is diseased, the Yuan Qi of the Twelve Meridians will be insufficient, fluids will not circulate, limbs and bones will lose operation, nine orifices will be blocked, and hundred diseases will arise. Therefore, treating hundred diseases always prioritizes strengthening the Spleen and Stomach. "Strengthening" implies assisting the Spleen's power to overcome deficiency and restore movement. However, if taking Spleen-strengthening and Stomach-supporting drugs still results in inability to eat, one fails to know the method of tonifying the Mother. To tonify Earth (Spleen), nothing precedes tonifying Fire (Heart/Mingmen). If one has no appetite, this is a disease of Yangming Stomach Earth, requiring tonification of Shaoyin Sovereign Fire. Guipi Tang (Restore the Spleen Decoction) tonifies Heart Fire to generate Stomach Earth. If one can eat but not digest, this is a disease of Taoyin Spleen Earth, requiring tonification of Shaoyin Ministerial Fire. Bawei Wan (Eight-Ingredient Pill) tonifies Ministerial Fire to generate Spleen Earth. One should know that the miraculous power of tonifying Fire also includes the subtlety of nourishing Water. The Spleen and Stomach transform all things due to the interaction of Water and Fire. The five elements interact through overcoming and supporting; overcoming is the means of supporting. Without Earth, where does Water originate? Without Water, how can dry Earth produce life? Earth achieves the moistening virtue of Water; Water achieves the generative merit of Earth. Water and Earth support each other. The Spleen is Taoyin Damp Earth, relying entirely on Water for its function. Hence, "tonifying the Spleen is不如 (inferior to) tonifying the Kidney." Tonifying the Kidney involves both Fire and Water. Tonifying Fire generates Earth; tonifying Water nourishes Earth. Taoyin Damp Earth relies on dampness for function. If one does not understand this and merely uses pungent, aromatic, drying, and hot drugs to aid the Spleen and open the stomach, it only causes dryness and cracking, rendering the Earth useless. Like the sky not raining, the earth cannot be moistened; if Water and Earth are not harmonious, the command of generation fails. Furthermore, creation produces life through a unified Qi of Yang and Harmony. For example, duck eggs hatch with warmth; silkworm eggs hatch with body heat. With the turn of spring, plants sprout. By analogy, the principles of generation are clear.

Obese individuals feel tired, with disharmony of the Spleen and Stomach, feeling full after little food. This is damp-phlegm in the Stomach, stagnating in the Middle Jiao, causing clear Yang not to ascend and turbid Yin not to descend, leading to obstruction and blockage, with constipation or urinary retention. Si Jun Zi Tang (Four Gentlemen Decoction) should be used, adding Chen Pi (Tangerine Peel), Ban Xia (Pinellia), Sheng Ma (Cimicifuga), and Chai Hu (Bupleurum), to strengthen the Spleen and Stomach. Clear Qi ascends, turbid Qi descends, stagnation resolves, and fluids distribute. Dampness flows, dryness is moistened, bowel movements normalize, and spirit and diet improve.

If Yuan Qi in the Stomach is abundant, one can eat much without injury and feel no hunger past meal times. If both Spleen and Stomach are robust, one eats well and gains weight. If both are deficient, one cannot eat and becomes thin. Irregular diet injures the Stomach. Stomach disease causes shortness of breath, low spirit, and intense heat, treatable with sweet-warm herbs. Physical labor injures the Spleen. Spleen disease causes lethargy, drowsiness, and flaccid limbs, treatable with regulation and tonification. In healthy people, food entering the Stomach first travels the Yang pathway; Yang Qi rises and floats, filling the skin and head, ensuring the patency of the nine orifices. In patients, food entering the Stomach first travels the Yin pathway; Yin Qi sinks, immediately reaching below the umbilicus, causing urge to urinate, with pulsation and tenderness at the umbilicus, leading to obstruction of the nine orifices. The Classics state: When Yin essence is offered upward, longevity ensues. This means when Spleen and Stomach are harmonious, grain Qi ascends, mimicking Spring and Summer, leading to longevity. When Yang essence descends, premature death occurs. This means when Spleen and Stomach are disharmonious, grain Qi flows downward, mimicking Autumn and Winter storage, leading to early death. It is also said: Humans take grain and water as their root; accommodating grain leads to prosperity, abandoning grain leads to death. Loss of fluids scatters Ying Qi; loss of grain eliminates Wei Qi. With scattered Ying and eliminated Wei, how can one stand? Thus, Blood must be nourished, and Wei Qi must be warmed. Human Yuan Qi is sufficient only when Spleen and Stomach Qi are undamaged.

Lowering Qi (Qi leaking downward) belongs to Heart deficiency. The Classics say: The Summer pulse corresponds to the Heart. If the Heart pulse is deficient, it manifests below as Qi leakage. Liu Hejian stated: Intestinal and gastric stagnation causes grain Qi to erupt internally but fail to circulate externally, leading to belching, sneezing, and lowering Qi. In epilepsy or consumption, if Qi leakage continues unceasingly, death is certain. This is due to exhaustion of True Qi, closure of intestinal and gastric pores, preventing grain Qi from circulating externally, so the Qi leaking from the intestines and stomach is the nourishing Qi generated by them.

After Stomach disease, if the Stomach pulse is peaceful but the pulses of the Heart, Kidney, Liver, and Lung are abnormal, this is due to weakness of the Central Qi (Spleen/Stomach), unable to reach the four extremities, like a mother sick and her four sons losing milk, showing signs of famine. Additionally, postprandial dizziness, fatigue, and urge to urinate indicate sinking of Yuan Qi. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled honey-fried Sheng Ma (Cimicifuga) is appropriate. This commonly affects sedentary people, as Qi without spiritual movement tends to descend.