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The *Treatise on the Correspondence of Yin and Yang* states: "The cold and heat of water and grain, if pathogenic factors are contracted, will damage the six fu-organs." This indicates that injury from diet is caused by cold and heat pathogens. The *Treatise on Bi Syndrome* states: "If food and drink intake doubles, the intestines and stomach will be injured." This indicates that injury from diet is due to irregular hunger and fullness.

Ancient methods of treatment divided this condition into upper, middle, and lower levels for management. For conditions in the upper jiao (upper burner), the method of "inducing vomiting according to the location" was used, primarily employing formulas such as Gualisan (Melon Seed Powder). For conditions in the middle jiao, the method of digestion and transformation was used, primarily employing herbs such as Shenqu (Medicated Leaven), Maiya (Germinated Hordeum Fruit), Shanzha (Crataegi Fructus), Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma). For conditions in the lower jiao, the method of "guiding and draining" was used, primarily employing substances such as Xiaoshuang (Natrii Sulfas), Huanglian (Coptidis Rhizoma - *Note: Text says Huanglian but context implies Da Huang/Rhubarb for purgation, however text explicitly says 'Xiaohuang' which usually refers to Da Huang or similar purgatives, here translated as Purgatives like Natrii Sulfas, Rheum, Croton, etc.*), Baidu (Crotonis Semen), Qianniu (Pharbitidis Semen), and Gansui (Kansui Radix).

The ancients also treated based on cold and heat properties. Injuries from hot-natured foods were treated with cold-natured medicines; injuries from cold-natured foods were treated with hot-natured medicines. For example, if two parts were cold food and one part hot food, two parts hot medicine and one part cold medicine would be used, such as Beiji Wan (Emergency Rescue Pill). I believe it should be modified according to symptoms. Generally speaking, dietary diseases are mostly caused by cold food injury. The aforementioned methods may not serve as fixed standards.

Contemporary physicians primarily use Pingwei San (Flat Stomach Powder), making additions and subtractions, which can serve as a standard for regulating the spleen and stomach. "Pingwei" means flattening the stomach; when there is a high mound in the stomach (referring to damp-turbidity stagnation), it must be flattened. One should stop once it is flat and not overdose. Overdosing turns a flat land into a pit (damaging healthy qi). Today, people take Pingwei San as a daily tonic, which is a mistake. It is better to use Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill). Zhizhu Wan was created by Elder Jiegu. It uses one tael of Zhishi (Aurantii Fructus Immaturus) and two taels of Baizhu (Atractodis Macrocephalae Rhizoma), with more tonifying herbs than resolving herbs, tonifying first and then resolving. It is wrapped in lotus leaves with rice, steamed, and made into pills. This likely takes advantage of the green color of lotus leaves, corresponding to the Zhen trigram, having the image of an open bowl facing up, hollow inside allowing clear qi to rise. Cooking the rice into pills assists grain qi. Thus, Elder Jiegu's Zhizhu formula initiated Li Dongyuan's enlightenment in his later years, and the method of tonifying middle and boosting qi began here. However, Elder Jiegu designed this specifically for patients with food retention. Today, people treat this pill as a spleen-tonifying medicine, taking it morning and night, even adding Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), and Fanshashen (Amomi Fructus), which is even worse. I fear that Zhishi alone has the power to push down walls and topple battlements. If the intestines and stomach are already injured and the walls are not solid, how many times can they withstand being pushed down?

As for Shanzha (Crataegi Fructus), Shenqu (Medicated Leaven), and Maiya (Germinated Hordeum Fruit), which are commonly used worldwide, I permanently discard them. Shanzha can resolve meat accumulation. For old sow meat that cannot be cooked thoroughly, adding a pinch of Shanzha makes the skin and flesh rot completely. For postpartum uterine lochia pain (postpartum blood stasis abdominal pain), using twenty grains of Shanzha decocted with rock sugar in one bowl of water resolves the lochia immediately. This shows its ability to break qi and blood; it should not be used lightly. Shenqu requires rice and water in a porcelain jar, relying on yeast to brew wine and mold to brew sugar. The spleen and stomach in the human body are not comparable to a porcelain jar; they originally have the ability to transform food. When food is not transformed, this ability is diseased. One only needs to assist this function, and food will transform naturally. Why use these resolving and suppressing drugs? Generally, people with complete and solid yuan qi can eat much without injury and do not feel hungry past meal times. If one initially lacks constitutional qi, leading to dietary injury, using the aforementioned drugs, although the food is digested, the spleen is already injured. After undergoing this digestion again, the deficiency becomes more deficient. Tomorrow and the next day, food fails to digest again, yet one claims the previous drugs were effective and the dosage was insufficient, combining decoctions and pills, causing mutual harm, leading to increasing emaciation, which is truly tragic. I lament this flaw and therefore elaborate. Formulas such as Taiping Wan, Baohe Wan, and Feier Wan, though their names are beautiful, I dare not use. Because drugs with beautiful names must be harsh, so beautiful names are added to deceive people. They are not suitable for great physicians.

Thus, there are physicians who seek low-status patients and those who seek wealthy patients. Children of rich families differ from commoners of coarse food. Healthy people differ from those with wounds. Strong men in villages suffering sudden trauma can be cured with one dose. However, children of rich families, with weak constitutions and delicate upbringing, subjected to these methods generally suffer significant harm.

Medical technique and medical dao are different. Technique can last temporarily, while dao lasts forever. Ancient formulas differ from modern ones; sacred formulas differ from vulgar ones. I believe modern people are inferior to ancients and dare not create new formulas. Regarding the spleen and stomach, only Li Dongyuan is considered sacred. Selecting his formulas and modifying them according to the patient: if one truly knows it is cold food injury, add hot medicines like Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus); if one truly knows it is hot food injury, add Huanglian (Coptidis Rhizoma); if one truly knows it is meat injury, add several grains of Shanzha; if it is alcohol/food injury, add Ge Hua (Puerariae Flos). Modulating according to symptoms is Li Dongyuan's method, the rule for physicians. However, if treating heat with cold does not remove the heat, and treating cold with heat does not eliminate the cold, what then? The Classics say: "If cold does not become cold, it is lack of water; if heat does not become warm, it is lack of fire." Strengthen the master of water to control yang; benefit the source of fire to dissipate yin shadow. This was beyond Li Dongyuan's scope.

If food fills the Taiyin, named "Food Jue" (syncope due to food), with pulse present above but absent below, failure to treat leads to death. Urgently use Yin-Yang Salt Soup to induce vomiting, expelling the food leads to recovery. If there is food accumulation, colicky abdominal pain, unable to bear pressure, downward purging is necessary. If confirmed as cold accumulation, Bidou Yingshi Wan (Croton Resonance Pill) must be used; if confirmed as heat accumulation, Dahuang Chengqi Tang (Rhubarb and Magnolia Decoction) must be used. Improper purging determines life or death instantly; be cautious.

In the past, Zhang Hezi often spoke of purging because purging was appropriate. Zhang Zhongjing's three Chengqi formulas were examined in detail and precision: when to purge, when not to purge, and urgent purging, without error. For blood stasis, Taoren (Persicae Semen) and Honghua (Carthami Flos) must be used; for water retention, Qianniu (Pharbitidis Semen) and Gansui (Kansui Radix) must be used; for blood in water, Machong (Blatta) and Shuizhi (Hirudo) must be used. Today, people fear and dare not purge; the sin of ignorance is small; the sin of reckless use is killing. Physicians hold human lives, how can they speak lightly?

He Bozhai said: "Creation generates things through heaven, earth, water, and fire alone. Heaven governs, Earth completes." Thus, "Qian knows the beginning, Kun creates the object." As for the interaction and change of heaven and earth, it is the qi of water and fire. Heaven moves water and fire within the earth, and things are born. However, water and fire cannot be excessive. Too much drought prevents growth, indicating fire excess; too much flood prevents growth, indicating water excess. Water and fire in harmony allow growth, which is natural law. In the human body, the spleen and stomach are primary. Food enters the stomach and is transported by the spleen, like earth on the ground. However, the spleen and stomach transform food actually due to water and fire qi, not solely by the spleen. Fire excess causes spleen/stomach dryness; water excess causes spleen/stomach dampness. Both fail to transform food, generating various diseases. Controlling the deviation to restore balance is the method of treatment.

My commentary: The phrase "control deviation and restore balance" is excellent. "Control" does not mean removing water or fire. Human water and fire are originally balanced; deviation is disease. If fire is excessive, supplement water to match fire, do not remove fire; if water is excessive, supplement fire to match water, do not remove water. It is like a balance scale: if one side is heavy, the other is light. If one side is heavy, only supplement the lighter side; never chisel away the counterweight (Ma Zi). The counterweight is a fixed number. People today who want to drain water and descend fire are chiseling away the counterweight.

I regulate the spleen and stomach by distinguishing yin, yang, water, and fire. Lack of appetite belongs to Mingyang Stomach Earth pathology; one must supplement Shaoyin Heart Fire. Guipi Tang (Restore the Spleen Decoction) tonifies heart fire to generate stomach earth. Ability to eat but inability to digest belongs to Taiyin Spleen Earth pathology; one must supplement Shaoyang Ministerial Fire. Bawei Wan (Eight-Ingredient Pill) tonifies ministerial fire to generate spleen earth. This is all about cultivating a spark of congenital fire qi to supplement the mother of earth (Fire generates Earth). Lizhong Tang (Regulate the Middle Decoction) uses Ganjiang (Zingiberis Rhizoma) to control water in earth; Jianzhong Tang (Establish the Middle Decoction) uses Shaoyao (Paeoniae Radix Alba) to control wood in earth; Huangqi Tang tonifies the child of earth (Earth generates Metal), preventing the child from consuming the mother's food; Liuwei Wan (Six-Ingredient Pill) strengthens the master of water; Bawei Wan benefits the source of fire. Earth has no fixed position, thriving in the four seasons, with no specific function, assisting heaven in completion. Thus, it is used concurrently among the four zang organs, always prioritizing tonification, avoiding suppression. Spleen qi sinking: Buyuzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction). Liver wood overacting on spleen: Add Zuojin Wan (Left Metal Pill). Depressive anger injuring spleen: Guipi Tang. Spleen deficiency failing to grasp phlegm: Liujunzi Tang (Six Gentlemen Decoction). Spleen and kidney dual deficiency: Si Junzi and Sishen Pills. Yin fire overacting on spleen: Liuwei Wan. Mingmen fire decline failing to generate spleen earth: Bawei Wan. Congenital qi sufficient but postnatal qi insufficient: Focus on tonifying middle qi. Postnatal sufficient but congenital insufficient: Focus on tonifying yuan qi.

Someone asks: "During chest and diaphragm fullness and oppression, unable to eat rice for days, Chenpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus), Muxiang (Aucklandiae Radix), Wuyao (Linderae Radix) swallowed day and night, still blocked, can we still tonify?" I say: "This is precisely because initially one did not know to tonify, rashly using dispersing and suppressing methods excessively, resulting in deficiency-type bloating. The Classics say: 'Lower jiao deficiency and emptiness, middle jiao fullness and obstruction. To treat deficiency, middle fullness worsens; to resolve obstruction, lower jiao emptiness worsens.' Ordinary physicians face this with difficulty. Disperse in the middle, tonify severely in the lower. Small doses cause pathogen stagnation above; large doses severely tonify below. This is 'treating obstruction with obstruction' (Se Yin Se Yong). Skilled practitioners use Ren Shen (Ginseng Radix) one tael, or seven to eight qian, plus a small amount of Shengma (Cimicifugae Rhizoma) one qian, one large dose cures it. This is the subtle application of the Inner Canon, which must be known."

Li Dongyuan said: "Alcohol is greatly hot and toxic, its aroma and flavor are all yang, it is a formless substance. If injured by it, one should only disperse; sweating leads to recovery. Next best is promoting urination, dispersing dampness up and down. Current drinkers often take Jiuzheng Wan (Alcohol Disease Pill) or other hot purgatives, or use Qianniu and Dahuang to purge. This treats formless yuan qi disease by purging formed yin blood, a great error. Alcohol nature is greatly hot, already damaging yuan qi; re-purging damages Kidney water true yin and formed blood/qi, both becoming insufficient. Thus yin blood becomes more deficient, true water weaker, yang poison heat flares, increasing yin fire, depleting yuan qi, shortening life. Otherwise, deficiency-disease forms. One should use Gegua Jieying Tang (Pueraria Flower Relieving Intoxication Decoction)."

Gegua Jieying Tang Formula
Qingpi (remove pith, 3 qian) Muxiang (0.5 qian) Juhong (Exocarpium Citri Reticulatae Rubrum) Renshen (Ginseng Radix) Fuling (Poria) (each 1.5 qian) Zhuling (Polyporus) (1.5 qian) Baidoukou (Amomi Fructus) (0.5 qian) Gegua (Puerariae Flos) (0.5 qian) Sharen (Amomi Fructus) (0.5 qian) Zexie (Alismatis Rhizoma) (1 qian) Baizhu (Atractodis Macrocephalae Rhizoma) (2 qian) Ganjiang (Zingiberis Rhizoma) (1 qian) Shenqu (Medicated Leaven) (1 qian). Grind into fine powder. Take 3 qian per dose, mixed with white boiled water. Obtaining slight sweat removes the disease. This is Li Dongyuan's original formula, suitable for modification.