（东垣）
治心下虚痞，恶食懒倦，右关脉弦（脾虚不运，故痞满恶食；脾主四肢，虚故懒倦；右
关属脾，脉弦者，脾虚而木来侮之也。经曰∶太阴所至，为积饮痞膈，皆阴胜阳也。受病之
脏，心与脾也，因而郁塞为痞者，火与湿也。盖心，阳火也，主血；脾，阴土也，主湿。凡
伤其阳
枳实（麸炒） 黄连（姜汁炒，五钱） 浓朴（姜炒，四钱） 半夏曲 麦芽（炒） 人
参白
此足太阴、阳明药也。枳实苦酸，行气破血（脾无积血，心下不痞）；黄连苦寒，泻热
开郁，并消痞之君药；浓朴苦降，散湿满而化食浓肠；麦芽咸温，助胃气而软坚破结；半夏
燥痰湿而和胃，干姜去恶血而通关（开五脏六腑，通四肢关节）；皆所以散而泻之也。参、
术、苓、草，甘温补脾，使气足脾运而痞自化，既以助散泻之力，又以固本使不伤真气也（《玉
机微义》曰
（东垣）
治脾积在于胃脘，大如盘，久不愈，令人四肢不收；或发黄胆，饮食不为肌肤（《金匮》
云∶
不运
满则
心下；
热太甚
以散之
实之证
阴之意
黄连（八钱） 浓朴（五钱） 吴茱萸（三钱） 白术（土炒） 黄芩（二钱） 茵陈
（酒炒） 干
五分） 桂 巴豆霜
此足太阴、阳明药也。黄连泻热燥湿，治痞君药（仲景治痞满，诸泻心汤皆用之）；浓
朴、砂仁行气而散满；茵陈、苓泻利水以实脾；黄芩清肺而养阴；椒、萸燥脾而逐冷；姜、
桂、川乌补命火以生脾土，而姜、桂又能去瘀生新（痞多血病，黄连、枳实皆血分药）；巴
豆能消有形积滞，为斩关夺门之将，借之以为先驱；加参术者，以补脾元正气，正旺然后可
以祛邪也（洁古曰∶养正积自除。李东垣曰∶痞满，皆血证也，下多亡阴，谓脾胃水谷之阴
亡也，心主血，心虚而邪陷于血之分，故致心下痞，宜理脾胃，以血药治之，若全用气药，
则痞益甚；而复下之，气愈下降，必变为中满鼓胀矣。世有用气药治痞而不效者，盖未明此
理也）。
本方除吴茱萸、白术、茯苓、泽泻、茵陈、川椒、砂仁，加菖蒲、茯神、丹参、红豆，
名伏梁丸∶治心积起脐上至心下，大如臂，令人烦心。本方除吴茱、砂仁、桂、术、黄芩、
泽泻
疟
皮
秋冬
附
豚状，上下无时，令人喘咳骨痿，及男子七疝，女子瘕聚带下（此东垣五积方也。虽有破滞
消坚之药，多借人参之力赞助成功。经曰∶大积大聚，其可犯也，衰其大半而止，过者死。
吴鹤
(Li Dongyuan)
Treats deficiency-type epigastric stuffiness (epigastric fullness and obstruction due to deficiency), aversion to food, lethargy, and a wiry pulse at the right Guan position. (This is because Spleen deficiency leads to impaired transportation and transformation, resulting in stuffiness and food aversion; the Spleen governs the four limbs, so deficiency causes lethargy; the right Guan position corresponds to the Spleen, and a wiry pulse indicates Spleen deficiency with Liver Wood overacting upon it. The Classic states: When Taiyin dampness prevails, it manifests as fluid retention, stuffiness, and obstruction, all caused by Yin overcoming Yang. The affected Zang organs are the Heart and Spleen; thus, stagnation leading to stuffiness is due to Fire and Dampness. The Heart is Yang-Fire, governing Blood; the Spleen is Yin-Earth, governing Dampness. Whenever Yang is injured...
Zhi Shi (Bran-fried Immature Bitter Orange Fruit) Huang Lian (Ginger-juice fried Coptis Rhizome, 5 qian) Hou Po (Ginger-fried Magnolia Bark) Ban Xia Qu (Pinellia Paste) Mai Ya (Fried Malt) Ren Shen (Ginseng Root) Bai Zhu (Atractylodes Rhizome) Fu Ling (Poria) Gan Cao (Licorice Root) Gan Jiang (Dried Ginger)
This prescription consists of herbs for the Foot-Taiyin Spleen Meridian and Foot-Yangming Stomach Meridian. Zhi Shi is bitter and sour, promoting Qi movement and breaking blood stasis (if the Spleen has no blood accumulation, there will be no epigastric stuffiness); Huang Lian is bitter and cold, clearing heat and relieving depression, serving as the chief herb for eliminating stuffiness; Hou Po is bitter and descending, dispersing damp-fullness and transforming food stagnation, widening the intestines; Mai Ya is salty and warm, assisting Stomach Qi and softening hardness while breaking accumulations; Ban Xia dries phlegm-dampness and harmonizes the Stomach, Gan Jiang removes bad blood and opens orifices (opening the five Zang and six Fu organs, connecting the four limbs and joints); these are all used to disperse and purge. Ren Shen, Bai Zhu, Fu Ling, and Gan Cao are sweet and warm, tonifying Spleen Qi, ensuring sufficient Qi and normal Spleen transport so that stuffiness resolves naturally; they both assist the dispersing and purging power and consolidate the root to prevent damage to true Qi (Yu Ji Wei Yi states...)
(Li Dongyuan)
Treats Spleen accumulation located in the epigastrium, large as a plate, persisting for a long time without healing, causing weakness and inability to control the four limbs; or appearing as jaundice, where diet fails to nourish muscles (Jin Gui Yao Lue states: ...
Impaired transportation
Fullness
Epigastric region;
Excessive heat
Dispersal method
Excess syndrome
Yin-cold implication
Huang Lian (8 qian) Hou Po (5 qian) Wu Zhu Yu (3 qian) Bai Zhu (Earth-fried Atractylodes Rhizome) Huang Qin (2 qian) Yin Chen (Wine-fried Artemisia Capillaris Herb) Gan Jiang (Dried Ginger) Fu Zi (Prepared Aconite Root) Gui Zhi (Cinnamon Twig) Ba Dou Shuang (Croton Seed Frost)
This prescription consists of herbs for the Foot-Taiyin Spleen Meridian and Foot-Yangming Stomach Meridian. Huang Lian clears heat and dries dampness, serving as the chief herb for treating stuffiness (Zhang Zhongjing uses it in all Xi Xin Tang formulas for treating epigastric fullness); Hou Po and Sha Ren promote Qi movement and dissipate fullness; Yin Chen and Fu Ling promote urination to solidify Spleen Qi; Huang Qin clears the Lung and nourishes Yin; Jiao Hua (Sichuan Pepper) and Wu Zhu Yu dry the Spleen and expel cold; Gan Jiang, Gui Zhi, and Chuan Wu (Aconitum Carmichaelii Root) tonify Mingmen Fire to generate Spleen Earth, and Gan Jiang and Gui Zhi also remove stasis and generate new tissue (Stuffiness often involves blood disorders; Huang Lian and Zhi Shi are blood-level herbs); Ba Dou can eliminate tangible accumulations, acting as a general who breaches gates and seizes doors, borrowed here as a vanguard; adding Ren Shen and Bai Zhu is to tonify Yuan Qi of the Spleen; only when righteous Qi is robust can pathogenic factors be expelled (Jie Gu says: Nourish righteousness, and accumulation will self-resolve. Li Dongyuan says: Stuffiness belongs to blood syndromes; excessive purging loses Yin, referring to the loss of Spleen-Stomach water-grain Yin. The Heart governs Blood; Heart deficiency allows pathogens to sink into the blood level, causing epigastric stuffiness. One should regulate the Spleen and Stomach and treat with blood herbs. If purely using Qi-moving herbs, stuffiness worsens; if purged further, Qi sinks more, inevitably transforming into abdominal distension and drum-like bloating. Those in the world who use Qi-moving herbs to treat stuffiness with no effect likely do not understand this principle).
Removing Wu Zhu Yu, Bai Zhu, Fu Ling, Ze Xie, Yin Chen, Chuan Jiao, and Sha Ren from this formula, and adding Shi Chang Pu, Fu Shen, Dan Shen, and Hong Dou, named Fu Liang Wan: Treats Heart accumulation starting above the navel up to the epigastrium, large as an arm, causing vexation and anxiety. Removing Wu Zhu Yu, Sha Ren, Gui Zhi, Bai Zhu, Huang Qin, and Ze Xie from this formula...
Malaria
Skin
Autumn and Winter seasons
Fu Zi
Pig-like shape, occurring at any time, causing wheezing, coughing, bone atrophy, as well as seven types of hernia in men, and masses/leukorrhea in women (These are Li Dongyuan's Five Accumulation formulas. Although containing herbs to break stagnation and dissolve hardness, they mostly rely on the assistance of Ren Shen to achieve success. The Classic states: For large accumulations, one may intervene, but stop when half the disease is reduced; exceeding this limit is fatal. Wu He...)