经义
脾胃者，仓廪之官，五味出焉。○平人之常，气廪于胃。人无胃气曰逆，逆者死。○脾与胃，以膜相连耳，
而能为之行其津液。○饮食劳倦则伤脾。○脾病者，善饥，肉痿，身重，足不收，行善 ，脚下痛；虚则腹满，
肠鸣，飧泄，食不化。（《素问》）
人受气于谷，谷入于胃，以传于肺，五脏六腑，皆赖以受气；其清者为营，浊者为卫。（《灵枢》）
哲言
胃中元气盛，则能食而不伤，过时而不饥。脾胃俱旺，则能食而肥。脾胃俱虚，则不能食而瘦；或少食
而肥，虽肥而四肢不举，盖脾实而邪气盛也。又有善食而瘦者，胃伏火邪于气分则能食，脾虚则肌肉削，即食
也。夫饮食不节则胃病，胃病则气短，精神少而生热；胃既病，则脾无所禀受，故亦从而病焉。形体劳役则
脾病，脾病则怠惰嗜卧，四肢不收，大便泄泻；脾既病，则胃不能独行津液，故亦从而病焉。大抵脾胃虚弱，
阳气不能生长，是春夏之令不行，五脏之气不生，此阴盛阳虚之证。大法云∶汗之则愈。用辛甘之药，当升当
浮，使生长之气旺。言其汗者，非正发汗也，为助阳也。○《经》言∶人以胃气为本。盖人受水谷之气以生，
所谓清气、营气、卫气、春升之气，皆胃气之别称也。夫胃为水谷之海，饮食入胃，游溢精气。上输于脾，脾气
散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行，合于四时五脏阴阳，揆度以为常也。若饮食失
节，寒温不适，则脾胃乃
伤。喜怒忧恐，损耗元气。脾胃既衰，元气不足，而心火独盛。心火者阴火也，起于下焦，其系系于心，心
不主令，相火代之。相火者，下焦包络之火，元气之贼也。火与元气不两立，一胜则一负。脾胃气虚，则下
流于肾，阴火得以乘其土位，故气高而喘，身热而烦，其脉洪大而头痛，或渴不止，其皮肤不任风寒而生寒热，
此皆脾胃之气不足所致也。然与外感风寒之证颇同而实异∶内伤脾胃，乃伤其气；外感风寒，乃伤其形。伤其
外为有余，有余者泻之；伤其内为不足，不足者补之。内伤不足，苟误认外感有余，而反泻之，则虚其虚也。
惟当以辛甘温之剂，补其中而升其阳，甘寒以泻其火则愈矣。《经》曰∶劳者温之，损者温之。又云∶甘温能
除大热。大忌苦寒，损其脾胃。（李东垣）
人以水谷为本，脾胃为养生之本，东垣独知其义，发为《脾胃论》，垂惠后世，开导末学之功诚非小矣。
独怪其论中有矛盾之谈，如曰∶饮食失节，寒温不适，脾胃乃伤。此因喜怒忧恐，损耗元气，资助心火，心不
主令，相火代之；相火者，下焦包络之火，元气之贼也；火与元气不两立，火胜则乘其土位，所以为病。若此
数语，则大见矛盾矣。观其前条，则虑阳气之受伤，故曰大忌苦寒之药。此节又云火胜之为病，更当何法以治
之？夫元气既损，多见生阳日缩，神气日消，何以反助心火？脾胃属土，得火则生，何谓火乘土位？且人之元
气，本贵清和，寒固能病，热亦能病。然热伤元气，而因劳动火者，固常有之。若因劳犯寒，而寒伤脾胃者，
尤酷尤甚。第热证显而寒证隐，故热证易见，而寒证不觉也。真热证犹易辨，而假热证尤不易辨也。矧元气属
阳，火其类也，而热为同气，邪犹可制；阴为阳贼，寒其仇也，而生机被伐，无不速亡。故《经》云少火生气，
未闻少寒生气也；又云避风如避箭，未闻避热如避箭也。由此观之，则何不曰寒与元气不两立，而反云火与元
气不两立呼？再考补中益气等方，每用升、柴，此即培养春生之意；而每用芩、连，亦即制火之意。
第以二、三分之芩、连，固未必即败阳气；而以五、七分之参、术，果即能斡旋元气呼？○脾胃有病，自宜治
脾胃。然脾为土脏，灌溉四旁，是以五脏中皆有脾气，而脾胃中，亦皆有五脏之气，此其互为相使，有可分而
不可分者在焉。故善治脾胃者，能调五脏，即所以治脾胃也。能治脾胃，而使食进胃强，即所以安五脏也。今
人止知参、苓、枳、术、山楂、麦芽、神曲、浓朴之类，乃为脾胃之药，而不知风寒湿热，皆能犯脾，饮食劳
倦，皆能伤脾。如∶风邪胜者，宜散之；寒邪胜者，宜温之；热邪胜者，宜寒之；湿邪胜者，宜燥之；饮食停积
者，宜行之；劳倦内伤者，宜补之。然脏腑虽分十一，而同有阴阳，同此血气。矧太阴常多血少气，阳明常多
血多气，使此中之血瘀，则承气、抵当之类，总属脾胃之药；使此中之血虚，则四物、五物、理阴、五福之类，
又孰非脾胃之药乎？再若五脏之邪，皆通脾胃，如肝邪之犯脾者，肝脾俱实，单平肝气可也；肝强脾弱，舍肝
而救脾可也；心邪之犯脾者，心火炽盛，清火可也；心火不足，补火以生土可也。肺邪之犯脾者，肺气壅塞，
当泄肺以苏脾之滞；肺气不足，当补肺以防脾之虚。肾邪之犯脾者，脾虚则水能反克，救脾为主；肾虚则启
闭无权，壮肾为先。至若胃司受纳，脾主运化，若能纳而不化，此脾虚之兆易见；若既不能纳，又不能运，此脾胃之气俱已大亏，即速用十全大补、六味回阳等剂，尤恐不及，而尚欲楂、苓、枳、术，冀为脾胃之永赖乎？
是以脾胃受伤，但使能去其伤者，即是脾胃之药。此中理奥机圆，诚有非言能尽悉者也。（张景岳）
脾胃之论，莫详于东垣。所着补中益气、调中益气、升阳益胃等汤，诚补前人之未备。察其立方之意，
因以内伤劳倦为主；又因脾乃太阴湿土，且胃阳衰者居多，故用参、 以补中，二术以燥湿，升、柴升下陷之
清阳，陈皮、木香理中宫之气滞，脾胃合治，用之得宜，效诚桴鼓。盖东垣之法，不过详于治脾，略于治胃耳。
后人宗其意，竟将脾胃总论，即以治脾之药笼统治胃。
今观叶氏书，始知脾胃当分析而论。盖胃属戊土，脾属己土，戊阳己阴，阴阳之性有别也。脏宜藏，腑宜通，
脏腑之体用有殊也。若脾阳不足，胃有寒湿，一脏一腑，皆宜于温燥升运者，自当恪遵东垣之法。若脾阳不亏，
胃有燥火，则当遵叶氏养胃阴之法。观其立论云∶纳食主胃，运化主脾；脾宜升则健，胃宜降则和。又云∶太
阴湿土，得阳始运，阳明燥土，得阴自安，以脾喜刚燥，胃喜柔润也。仲景急下存津，其治在胃；东垣大升阳
气，其治在脾。此等议论，实超出千古。故凡遇禀质木火之体，患燥热之证，或病后热伤津液，以致虚痞不食，
舌绛咽干，烦渴不寐，肌燥 热，便不通爽，此九窍不和，都属胃病，岂可以 、术、升、柴治之乎？所谓胃
宜降则和者，非辛开苦降，亦非苦寒下夺，以损胃气，不过甘平，或甘凉濡润，以养胃阴，则津液来复，使
之通降而已矣。此义即宗《内经》所谓六腑者，传化物而不藏，以通为用之理也。总之，脾胃之病，虚实寒热，
宜燥宜润，固当详别，其于升降二字，尤为紧要。盖脾气下陷固病，即不下陷，但不健运，已病矣。胃气上逆
固病，即不上逆，但不通降，亦病矣。（《临证指南》）
东垣治脾胃之法，莫精于升降。夫升降之法易知，而升降之理难明。《经》曰∶脾胃者，仓廪之官，五
味出焉。盖脾主运化，其用在于无形，其属土，地气上腾，然后能载物，故健行而不息，是脾之宜升也明矣。
胃者，水谷之海，容受糟粕，其主纳，纳则贵下行，譬如水之性莫不就下，是胃之宜降也又明矣。又曰∶清气
在下，则生飧泄；浊气在上，则生 胀。夫清气何？盖指脾气而言，不然何以在下则飧泄也？其浊气何？盖
指胃气而言，不然何以在上则 胀也？是非可为脾升胃降之一确证欤。由此而推，如仲圣所立青龙、越脾等方，
即谓升脾之清气也可；所立三承气诸方，即谓降胃之浊气也无不可。（《吴医汇讲》）
阴阳交而天地泰，精气合而入身安，人身一小天地，精气二
字从米，是精气皆生于米也。故曰∶得谷者昌，失谷者亡。人之所恃以生者，精气也，卫气也，营气也。精气
从肾所生，卫气从肺所生，营气从肝、心所生，三者之气，虽各有所自，然合而一之，则均以脾胃为本。
《经》曰∶脾者孤脏，以灌四旁。又曰∶五脏者，皆禀气于胃。故古人有补肾不如补脾之论也。（《冯氏锦囊》）
凡病颠倒难明，必从脾胃调理。○清阳下降，则水火不交而成痞；心肺为邪火所迫，渐至血枯。《经》
云∶地气上为云，天气下为雨。人身阳气升腾，则气降而为血，故补肾以滋阴，不若补脾以升阳。○东垣云∶
补肾不若补脾。论水生木而言，试观江、河、塘、海场，未见生木；木赖土生，土先克水，滋生元气，则木有
生生之意。（周慎斋）
脾虚少食，弗可克伐，补之自然能食。东方之仇木宜安，恐木实则侮土而厥张。西方之子金宜顾，恐子
虚则窃母气以自救。至若下焦少火，实为生气之元。中央土虚，必须补母。（罗谦甫）
余于脾胃，分别阴阳水火而调之。如不思食，此属阳明胃土受病，须补少阴心火，归脾汤补心火以生
胃土也。能食不化，此属太阴脾土受病，须补少阳相火，八味丸补相火以生脾土也。若理中汤用干姜，所以制
土中之水也。建中汤用白芍，所以制土中之木也。黄 汤所以益土之子，使其不食母气也。六味丸所以壮水之
主也，八味丸所以益火之原也。（赵养葵）
今人只知脾胃虚则当补，补之不应，则补其母，如是足矣。而不知更有妙处，补肾是也。脾土克肾水，
不相为用，如何反补其所胜，以滋肝木乎？曰∶不然，此其妙正在相克处也。五行以相克为用，今且以水与土
言之，水不得土，何处发生？何处安着？土不得水，却是一个燥坌物事，如何生出万物来？水土相滋，动植化
生，此造化相克之妙。而医家所以谓脾为太阴湿土，“湿”之一字，分明土全赖水为用也。故曰∶补脾必先补肾。
至于肾精
不足，则又须补之以味，故古人又谓补肾不若补脾。二言各有妙理，不可偏废也。（王宇泰）
水者，先天之本，水旺则阴精充而上奉，故可永年，则补肾宜急也。土为后天之本，土衰则阳精败而下陷，
故当夭折，则补脾宜急也。薛立斋深明此义，多以六味地黄汤壮水，为奉上之计，兼以补中益气汤扶土，为降
下之防。○今之明者，知保脾矣。然四君之甘温，能守而不能走，或以二陈燥湿，或以木香破滞，或以砂仁醒
脾，或以神曲去旧生新，补而兼之以行，则补者方可成功。若不明此，而一于补，则脾胃湿热，固结不散，呕
吐泻利，胸膈饱闷，其能免乎？（查了吾）
中州为元气之母。俗云气无补法，此为气实者言之。如脾虚正气不行，邪着为病，当调理中州，复其健运
之职，则浊气降而痞满除。如不补气，气何由行？○补脾胃药内，必用心经药者，以火能生土也，故古方用
益智仁，正合此意。（朱丹溪）
常见脾虚之人，大病之后，补以参、术则腹胀，消以枳、朴则便泻，惟用焦术以健脾，加丹参以生新血，
佐鸡内金、五谷虫、砂仁、陈皮、茯苓、麦芽、锅粑粉以化食，每每获效。（吴篁池）
阴虚火动，脾胃衰弱；阴者水也，脾胃者土也。土虽喜燥，然太燥则草木枯槁；水虽喜润，然太润则草
木湿烂。是以补脾滋肾之剂，务在燥湿得宜耳。○脾虚气短，不能以续，变作喘促，尚用降气定喘之药；脾虚
卫气不行，变为浮肿，尚用耗气利水之药；脾虚郁滞，变作寒热，尚用外感表散之药，虚而益虚，真气尽矣。
（喻嘉言）
脾旺则饮食运动，脾衰则运动迟难。凡人食后神倦欲睡者，脾气馁而不能运动故也。（《证治汇补》）
胃中之阳，能化津液以归肺者，全藉脾阴转输之力。脾阴不足，则胃中之火，莫非心火，壅而上行，
生金者从此刑金。脾阴得复，胃中之心火自平也。（程郊倩）
不问阴阳与冷热，先将脾胃与调和。（严用和）
百凡治病，胃气实者，攻之则去，而疾易愈。胃气虚者，攻之不去。盖胃本虚，攻之而胃气益弱，反不
能行其药力，而病所以自如也，非药不能去病也，胃气不行药力故也；若峻攻之，则元气伤而病益甚；若不知
机，攻尽元气则死矣。如虚热者，服寒凉之药，而热反盛，何也？《经》曰∶服寒而反热者奈何？岐伯曰∶不
味旺，是以反也。胃气实者，虽有病不攻自愈。故中医用药，亦常效焉。观夫藜藿常病不药自愈可知矣。故云∶
治病不察脾胃之虚实，不足以为太医。（《见闻录》）
脉候
脾气伤者，脉浮大而无力；胃气伤者，脉沉弱而难寻，此皆不足之脉，易于寻按者也。更有脉大、饱闷，
有似食滞，此乃脾虚而见假象，即洪大之脉阴必伤，坚强之脉胃必损也。（《证治汇补》）
附方
八仙糕 调理脾胃之仙方。茯苓、山药、苡仁、莲子、砂仁、芡实、扁豆、谷芽。八味制末，加炒陈米
一升，磨粉和入，再加洋糖，做成糕样，早晏随食。
[Classic Discourse]
The Spleen and Stomach are the officials of the granary, from which the Five Flavors (Sour, Bitter, Sweet, Pungent, Salty) arise. ○ In a healthy person, Qi is stored in the Stomach. If a person lacks Stomach Qi, it is called "Ni" (Rebellion), and the appearance of "Ni" leads to death. ○ The Spleen and Stomach are connected by membranes, yet they cooperate to transport Body Fluids. ○ Irregular diet or overwork damages the Spleen. ○ When the Spleen is diseased, symptoms include easy hunger, muscle atrophy and weakness, heaviness of the body, inability to hold the feet steady, frequent pulling pain during walking, and pain under the soles; if deficiency, there is abdominal fullness, borborygmus, undigested food in stool (Sun Xie), and failure to digest food. (From *Su Wen*)
Humans obtain Qi from grain. Grain enters the Stomach, is transmitted to the Lungs, and all Zang-Fu organs rely on it to receive Qi; the clear portion becomes Ying (Nutritive) Qi, and the turbid portion becomes Wei (Defensive) Qi. (From *Ling Shu*)
[Masters' Opinions]
If Yuan Qi (Original Qi) in the Stomach is vigorous, one can eat without injury and not feel hungry past meal times. If both Spleen and Stomach are robust, one can eat and become plump; if both are deficient, one cannot eat and becomes thin; or eats little but gains weight, though limbs are weak and unable to lift, this is because Spleen Excess with pathogenic Qi is prevalent. Some people eat much but remain thin; this is due to Fire Evil hidden in the Qi level of the Stomach allowing for appetite, while Spleen Deficiency causes muscle wasting, known as "Shi Yi" disease. Generally, irregular diet damages the Stomach; Stomach damage leads to shortness of breath, reduced spirit, and internal heat; once the Stomach is diseased, the Spleen has nothing to receive, thus also becoming diseased. Physical overwork damages the Spleen; Spleen damage leads to lethargy, desire to lie down, limb weakness, and diarrhea; once the Spleen is diseased, the Stomach cannot independently transport fluids, thus also becoming diseased. Generally, Spleen-Stomach weakness prevents Yang Qi from growing, akin to the failure of Spring-Summer growth seasons, preventing the generation of Qi in the Five Zang organs; this is a syndrome of Yin Excess and Yang Deficiency. The great principle states: treatment via sweating will cure it. Use Pungent and Sweet herbs that ascend and float to promote vigorous growth Qi. The term "sweating" here does not mean actual diaphoresis, but rather assisting Yang Qi. ○ The *Classic* says: Humans take Stomach Qi as their root. Essentially, humans survive on water-grain Qi; so-called Clear Qi, Ying Qi, Wei Qi, and Spring-Ascending Qi are all alternative names for Stomach Qi. The Stomach is the Sea of Water and Grain; upon entry, essence and Qi overflow. They are transported upward to the Spleen; the Spleen scatters essence, sending it up to the Lungs, regulating water passages, and transporting downward to the Bladder. Water essence distributes everywhere, meridians run together, harmonizing with the Four Seasons and Five Zang Yin-Yang, establishing normalcy. If diet is irregular or cold/heat inappropriate, Spleen and Stomach are injured. Joy, anger, worry, fear deplete Yuan Qi. Once Spleen-Stomach decline, Yuan Qi is insufficient, and Heart Fire becomes solitary and excessive. Heart Fire is also Yin Fire, arising from the Lower Jiao, connected to the Heart; if the Heart does not govern, Xiang Huo (Ministerial Fire) takes over. Xiang Huo is the fire of the Pericardium in the Lower Jiao, the thief of Yuan Qi. Fire and Yuan Qi cannot coexist; when one wins, the other loses. Spleen-Stomach Qi deficiency causes Qi to flow downward to the Kidneys, allowing Yin Fire to invade the Earth position, resulting in high-pitched breathing and asthma, body heat and irritability, surging-large pulse with headache, or unquenchable thirst, skin intolerance to wind-cold causing chills and fever; these are all caused by insufficiency of Spleen-Stomach Qi. However, this differs significantly from exterior Wind-Cold invasion: Internal injury to Spleen-Stomach damages Qi; exterior Wind-Cold damages Form. Exterior damage is Excess, treated by purging; interior damage is Deficiency, treated by tonifying. Mistaking internal deficiency for exterior excess and purging it makes deficiency worse. One must use Pungent-Sweet-Warm formulas to tonify the Middle and raise Yang, and Sweet-Cold herbs to purge Fire, then the disease cures. The *Classic* says: Treat exhaustion with warmth, treat loss with warmth. Also: Sweet-Warm can remove great heat. Bitter-Cold herbs are strictly forbidden as they damage Spleen-Stomach. (Li Dongyuan)
Humans rely on water-grain as the root, and Spleen-Stomach as the foundation of health preservation. Li Dongyuan alone grasped this meaning, publishing *Pi Wei Lun* (Treatise on Spleen and Stomach), benefiting future generations, a merit indeed significant. I find his arguments contradictory, e.g., stating diet irregularity damages Spleen-Stomach, yet also attributing it to emotions depleting Yuan Qi, aiding Heart Fire, leading to Ministerial Fire taking over, where Fire and Yuan Qi conflict, and Fire invades Earth. This shows contradiction. In earlier sections, he feared Yang injury, forbidding Bitter-Cold. Here he discusses Fire excess; how to treat? If Yuan Qi is damaged, vitality shrinks daily; why aid Heart Fire? Spleen-Stomach is Earth, born by Fire; why say Fire invades Earth? Human Yuan Qi should be clear and mild; Cold causes disease, Heat causes disease. Heat damages Yuan Qi from labor-induced Fire, common. But Cold damaging Spleen-Stomach from labor-cold exposure is even more severe. Heat signs are obvious, Cold signs hidden; true Heat is easy to distinguish, false Heat difficult. Yuan Qi is Yang, Fire is similar, Heat is same Qi, pathogens controllable; Yin is Yang's thief, Cold is enemy, vitality destroyed rapidly. *Classic* says: Minor Fire generates Qi; never heard Minor Cold generates Qi. Avoid wind like avoiding arrows; never heard avoid heat like avoiding arrows. Thus, why not say Cold and Yuan Qi cannot coexist, instead saying Fire and Yuan Qi cannot coexist? Examining Bu Zhong Yi Qi Tang, using Sheng Ma and Chai Hu cultivates Spring growth; using Huang Qin and Huang Lian controls Fire. Small doses of Qin/Lian likely don't destroy Yang; large doses of Ren Shen/Bai Zhu, do they truly manage Yuan Qi? ○ Spleen-Stomach diseases should be treated in Spleen-Stomach. Spleen is Earth organ, irrigating four directions; thus Spleen Qi exists in all Zang, and Zang Qi exists in Spleen-Stomach, mutually assisting, divisible yet indivisible. Good Spleen-Stomach treatment regulates Zang, thereby treating Spleen-Stomach. Treating Spleen-Stomach improves appetite and Stomach strength, thereby calming Zang. People only know Ren Shen, Fu Ling, Zhi Ke, Bai Zhu, Shan Zha, Mai Ya, Shen Qu, Hou Po as Spleen-Stomach herbs, ignoring Wind-Cold-Damp-Heat invading Spleen, or diet/labor injuring Spleen. For Wind excess, disperse; Cold excess, warm; Heat excess, cool; Damp excess, dry; Food stagnation, move; Labor injury, tonify. Although eleven Zang-Fu differ, they share Yin-Yang and Blood-Qi. Taiyin has much Blood little Qi; Yangming has much Blood much Qi. If Blood stasis occurs, Cheng Qi Tang or Di Dang Tang belong to Spleen-Stomach meds; if Blood deficiency, Si Wu Tang or Wu Wu Tang belong to Spleen-Stomach meds. Furthermore, Zang pathogens affect Spleen-Stomach. Liver pathogen invading Spleen: if Liver-Spleen Excess, calm Liver; if Liver Strong-Spleen Weak, save Spleen. Heart pathogen invading Spleen: Heart Fire blazing, clear Fire; Heart Fire insufficient, tonify Fire to generate Earth. Lung pathogen invading Spleen: Lung Qi obstruction, drain Lung to relieve Spleen stagnation; Lung Qi insufficient, tonify Lung to prevent Spleen deficiency. Kidney pathogen invading Spleen: Spleen weak, Water counter-controls, focus on saving Spleen; Kidney weak, opening/closing powerless, strengthen Kidney first. Stomach receives, Spleen transforms. If receiving but not transforming, Spleen Deficiency is evident; if neither receiving nor transforming, Spleen-Stomach Qi greatly depleted, even immediate use of Shi Quan Da Bu Tang or Liu Wei Hui Yang Dan may fail; relying on Shan Zha, Fu Ling, Zhi Ke, Bai Zhu for long-term reliance is futile. Therefore, removing the cause of Spleen-Stomach injury constitutes Spleen-Stomach treatment. The principles are profound and circular, beyond words. (Zhang Jingyue)
Discussions on Spleen-Stomach are most detailed by Dongyuan. His formulas Bu Zhong Yi Qi Tang, Tiao Zhong Yi Qi Tang, Sheng Yang Yi Wei Tang supplement predecessors. His intent focuses on internal injury from labor; since Spleen is Taiyin Damp Earth and Stomach Yang often declines, he uses Ren Shen/Gan Cao to tonify Middle, Bai Zhu/Cang Zhu to dry Damp, Sheng Ma/Chai Hu to raise sunken Clear Yang, Chen Pi/Mu Xiang to regulate Middle Qi stagnation. Combined treatment works well. Dongyuan's method details Spleen treatment, neglects Stomach. Later followers generalized this, using Spleen meds for Stomach.
Ye Tianshi showed Spleen and Stomach should be analyzed separately. Stomach is Wu Earth, Spleen is Ji Earth; Wu is Yang, Ji is Yin, natures differ. Zang stores, Fu conducts; substance and function differ. If Spleen Yang insufficient, Stomach has Cold-Damp, both suit Warm-Dry-Rising methods, following Dongyuan. If Spleen Yang intact, Stomach has Dry-Fire, follow Ye's Stomach Yin-nourishing method. Ye stated: Digestion relies on Stomach, transformation on Spleen; Spleen prefers ascending for health, Stomach prefers descending for harmony. Taiyin Damp Earth needs Yang to operate; Yangming Dry Earth needs Yin to settle. Spleen likes firm-dry; Stomach likes soft-moist. Zhang Zhongjing's urgent purging preserves fluid, treating Stomach; Dongyuan's great raising of Yang treats Spleen. These views surpass ages. For Wood-Fire constitutions with Dry-Heat, or post-illness fluid injury causing empty fullness, anorexia, crimson tongue, dry throat, irritability, insomnia, dry hot skin, constipation—these nine orifices disharmonies belong to Stomach disease; using Ren Shen, Bai Zhu, Sheng Ma, Chai Hu is wrong. "Stomach prefers descending" means not Pungent-opening/Bitter-descending or Bitter-Cold purging damaging Stomach Qi, but Sweet-Pure or Sweet-Cool moistening to nourish Stomach Yin, restoring fluids and promoting descent. This follows *Nei Jing*: Fu organs transmit and transform, do not store, function through unobstructed flow. In summary, Spleen-Stomach diseases vary in Deficiency-Excess, Cold-Heat, Dry-Moist; Ascending-Descending is crucial. Spleen Qi sinking is disease; even if not sinking, poor transport is disease. Stomach Qi rebelling is disease; even if not rebelling, lack of descent is disease. (*Lin Zheng Zhi Nan*)
Dongyuan's Spleen-Stomach treatment excels in Ascending-Descending. Method is easy, principle hard. *Classic*: Spleen-Stomach are granary officials. Spleen transforms, function formless, belongs to Earth; earth qi rises to carry things, moving ceaselessly, hence Spleen ascends. Stomach is sea of grain, holds dregs, receives, reception favors descending, like water flows down, hence Stomach descends. Also: Clear Qi below causes Sun Xie (undigested stool); Turbid Qi above causes distension. Clear Qi refers to Spleen Qi; Turbid Qi refers to Stomach Qi. Is this not proof of Spleen ascending, Stomach descending? By inference, Zhang Zhongjing's Qing Long/Yue Bi formulas raise Spleen Clear Qi; San Cheng Qi formulas descend Stomach Turbid Qi. (*Wu Yi Hui Jiang*)
Yin-Yang interaction brings heaven-earth peace; Essence-Qi union ensures body safety. Body is small universe; Essence-Qi characters contain 'rice', showing Essence-Qi comes from grain. "Obtaining grain prospers, losing grain perishes." Humans rely on Essence Qi, Wei Qi, Ying Qi. Essence Qi from Kidney, Wei Qi from Lung, Ying Qi from Liver/Heart. Though origins differ, united, all root in Spleen-Stomach. *Classic*: Spleen is solitary organ, irrigating four sides. Five Zang all receive Qi from Stomach. Hence ancients said: Tonifying Spleen better than Tonifying Kidney. (*Feng Shi Jin Nang*)
For obscure diseases, always regulate Spleen-Stomach. ○ Clear Qi descending causes Water-Fire non-interaction and fullness; Heart-Lung forced by evil fire lead to blood depletion. *Classic*: Earth qi rises as clouds, Heaven qi descends as rain. Body Yang ascends, Qi descends as Blood; thus tonifying Kidney to nourish Yin is inferior to tonifying Spleen to raise Yang. ○ Dongyuan: Tonifying Spleen better than Kidney. Discussing Water generating Wood: rivers/seas don't grow wood; wood relies on Earth, Earth controls Water, generating Yuan Qi, giving Wood life. (Zhou Shenzhai)
Spleen Deficiency with poor appetite: do not attack, tonify naturally restores appetite. East (Wood) enemy should be pacified, fearing Wood Excess insulting Earth. West (Metal) child should be protected, fearing Child Deficiency stealing Mother Qi. Lower Jiao Minor Fire is source of life. Central Earth Deficiency requires tonifying Mother. (Luo Qianfu)
I regulate Spleen-Stomach by distinguishing Yin-Yang/Water-Fire. No appetite: Yangming Stomach Earth diseased, tonify Shaoyin Heart Fire, Gui Pi Tang tonifies Heart Fire to generate Stomach Earth. Appetite but no digestion: Taiyin Spleen Earth diseased, tonify Shaoyang Ministerial Fire, Ba Wei Wan tonifies Ministerial Fire to generate Spleen Earth. Li Zhong Tang uses Gan Jiang to control Water in Earth. Jian Zhong Tang uses Bai Shao to control Wood in Earth. Huang Qi Tang tonifies Son of Earth to prevent draining Mother. Liu Wei Wan strengthens Master of Water. Ba Wei Wan benefits Source of Fire. (Zhao Yangkui)
People know Spleen-Stomach Deficiency needs tonification; if ineffective, tonify Mother. They miss the subtlety: Tonifying Kidney. Spleen Earth controls Kidney Water, seemingly useless relation, why tonify controlled to nourish Liver Wood? Answer: Subtlety lies in control. Five Elements use control. Water without Earth, where arises? Where settles? Earth without Water, is dry dust, how generates myriad things? Water-Earth nourish each other, life evolves, this is creation's control subtlety. Spleen is Taiyin Damp Earth; "Damp" implies Earth relies on Water. Hence: Tonify Spleen必先 Tonify Kidney. For Kidney Essence Deficiency, tonify with flavor, hence ancients said Tonify Kidney better than Spleen. Both have merits, neither discard. (Wang Yutai)
Water is Pre-heaven Root; Water vigorous, Yin Essence fills and offers up, longevity achieved, Kidney tonification urgent. Earth is Post-heaven Root; Earth declines, Yang Essence fails and sinks, premature death results, Spleen tonification urgent. Xue Lizhai understood this: used Liu Wei Di Huang Wan to strengthen Water for offering up, combined with Bu Zhong Yi Qi Tang to support Earth for preventing sinking. ○ Modern experts know protecting Spleen. Si Jun Zi Tang's Sweet-Warm guards but doesn't move; add Er Chen Tang drying Damp, Mu Xiang breaking stagnation, Sha Ren awakening Spleen, Shen Qu removing old generating new; tonify with movement succeeds. Blind tonification causes Spleen-Stomach Damp-Heat consolidation, vomiting, diarrhea, chest fullness. (Cha Liaowu)
Middle State is Mother of Yuan Qi. Folk say "Qi has no tonification method," referring to Qi Excess. If Spleen Deficiency stops Zheng Qi, pathogen sticks, regulate Middle State, restore transport, Turbid Qi descends, fullness removes. Without tonifying Qi, how does Qi move? ○ Heart channel herbs added to Spleen-Stomach tonics because Fire generates Earth; ancient formula uses Yi Zhi Ren, matching this. (Zhu Danxi)
Commonly, Spleen Deficient patients post-major illness: tonify with Ren Shen/Bai Zhu causes bloating; reduce with Zhi Ke/Hou Po causes diarrhea. Only use Charred Bai Zhu to strengthen Spleen, add Dan Shen to generate new blood, assist with Ji Nei Jin, Wu Gu Chong, Sha Ren, Chen Pi, Fu Ling, Mai Ya, rice crust powder to transform food, often effective. (Wu Huangchi)
Yin Deficiency with Fire agitation, Spleen-Stomach weakness; Yin is Water, Spleen-Stomach is Earth. Earth likes Dry, too dry kills plants; Water likes Moist, too moist rots plants. Tonifying Spleen/Nourishing Kidney agents must balance Dry-Moist. ○ Spleen Deficiency shortness of breath turning to asthma: still using Qi-descending asthma meds? Spleen Deficiency Wei Qi stagnation turning to edema: still using Qi-consuming diuretics? Spleen Deficiency stagnation turning to chills/fever: still using exterior-dispersing meds? Deficiency adding to deficiency, True Qi exhausted. (Yu Jiayan)
Spleen vigorous, food moves; Spleen weak, movement slow. Post-meal sleepiness due to Spleen Qi fatigue failing to move. (*Zheng Hui Hui Bu*)
Stomach Yang transforms fluids to Lungs, relying on Spleen Yin transport. Spleen Yin insufficient, Stomach Fire becomes Heart Fire, obstructs and ascends, harming Metal. Spleen Yin restored, Stomach Heart Fire calms. (Cheng Jiaoqian)
Regardless of Yin-Yang/Cold-Heat, first harmonize Spleen-Stomach. (Yan Yonghe)
In all treatments, if Stomach Qi is Solid, attacking removes disease, curing easily. If Stomach Qi is Deficient, attacking fails. Stomach originally weak, attacking weakens Qi further, unable to move drug power, disease remains. Not drugs failing, but Stomach Qi failing to move drugs; harsh attack injures Yuan Qi, worsening disease; ignorance leads to death by exhausting Qi. Deficient Heat taking Cold-Cool meds increases Heat? *Classic*: Why does Cold intake increase Heat? Qibo: Flavor not prosperous, hence reversal. Stomach Qi Solid, disease self-cures without attack. Hence Chinese medicine often effective. Common folk illnesses self-cure without meds. Thus: Treating disease without examining Spleen-Stomach Deficiency-Excess is insufficient for Imperial Physician. (*Jian Wen Lu*)
[Pulse Diagnosis]
Spleen Qi injury: Pulse floating-large and forceless. Stomach Qi injury: Pulse deep-weak and hard to find; these are Deficient pulses, easy to locate. Larger pulse with fullness resembles food stagnation, but is Spleen Deficiency false sign; surging-large pulse indicates Yin injury, firm pulse indicates Stomach damage. (*Zheng Hui Hui Bu*)
[Attached Formula]
Ba Xian Gao (Eight Immortals Cake): Immortal formula for regulating Spleen-Stomach. Fu Ling, Shan Yao, Yi Yi Ren, Lian Zi, Sha Ren, Qian Shi, Bian Dou, Gu Ya. Eight ingredients powdered, mixed with one sheng of fried aged rice powder, plus white sugar, made into cakes, eaten morning/evening as desired.