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Li Shicai stated: Regarding the inability to eat, Li Dongyuan (Li Gao) claimed that if the primordial qi in the Stomach is abundant, one can eat without injury; even if meals are delayed, muscles will not be damaged. If both Spleen and Stomach are vigorous, one can eat and become plump; if both Spleen and Stomach are deficient, one cannot eat and becomes emaciated. Luo Qianfu said: When Spleen-Stomach weakness leads to reduced food intake, one must not use attacking or purgative methods; supplementation will naturally restore appetite. Xu Xueshi said: For those unable to eat, treatment should not focus solely on the Spleen. Weakness of Kidney Qi fails to digest food, akin to water and grain in a pot that cannot cook without fire. Yan Yonghe said: Excessive sexual activity depletes True Yang, preventing it from steaming the Spleen Earth upwards. The Middle Jiao fails to transport, leading to loss of appetite, distension, fullness, obstruction, stagnation, pain, or indigestion. One must understand the need to tonify the Kidney. If Kidney Qi is strong and the Fire of the Dantian is vigorous, it steams the Spleen Earth upwards. With warm Spleen Earth, the Middle Jiao regulates itself, the diaphragm opens, and eating resumes.

My commentary: The Spleen and Stomach possess the virtue of Kun (Earth) for receptivity and the function of Qian (Heaven) for movement. Thus, following Kun's nature requires tonifying Earth to support its humble monitoring function; if Qian's vigor slackens, benefiting Fire assists its transportation. Therefore, Li Dongyuan and Luo Qianfu established theories on tonifying Earth, while Xu Xueshi and Yan Yonghe emphasized strengthening Fire. This reflects the understanding that strong Earth allows free intake and discharge, while strong Fire ensures unceasing transport. Fire is the mother of Earth; tonifying the mother in deficiency is a standard therapeutic principle. I often see laypeople, upon encountering food stagnation, immediately administer herbs such as Xiangfu (Cyperus Rhizome), Sharen (Amomum Fruit), Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Shenqu (Massa Medicata Fermentatus), Boluozhizi (Radish Seed), Shanzha (Hawthorn Fruit), and Maiya (Germinated Grain), and even Huanglian (Coptis Rhizome) and Shanzhi (Gardenia Fruit), considering them good formulas for opening the stomach. Consequently, many die prematurely. They do not realize these are methods for draining the son in excess patterns, intended for cases where there is accumulation or excess heat in the Spleen-Stomach, with intact Yuan Qi and flourishing pathogenic factors. Attacking deficiency makes it more deficient; cooling deficiency suppresses the source of True Fire's generation. Will this not ruin their Qi and cut off their grain? Moreover, they mistakenly treat Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) as stagnating agents, fearing them like arsenic. Have they not heard the classic saying "Tonify the deficient" and "Treat obstruction with obstruction"? Have they not heard Li Dongyuan say: "For Spleen-Stomach Qi excess, use Zhishi and Huanglian to drain; for deficiency, use Baizhu and Chenpi to tonify." Thus, inability to eat belongs to Spleen deficiency. If tonifying the Spleen is ineffective, one should tonify its mother (Kidney), using Shuihu Dihuang Wan (Eight-Ingredient Rehmannia Pill) or Ershen Wan (Two-Essence Pill). If accompanied by phlegm, resolve it with Liujunzi Tang (Six-Gentlemen Decoction); if accompanied by depression, open it with Yuqi Tang (Qi-Nourishing Decoction); if Liver Wood attacks Spleen, pacify the Liver with Yigong San (Extraordinary Power Powder) added with Muxiang (Aucklandia Root) and Chenxiang (Aquilaria Wood); if Lung Metal needs care, protect Lung Qi, as Lung Qi deficiency steals Mother Qi from Spleen Earth to save itself, worsening Spleen deficiency, using Gancao (Licorice Root), Jiegeng (Platycodon Root), Renshen, and Fuling (Poria). The Spleen is the mother of the five Zang organs, and Earth is the root of all things. Abundance of grain brings prosperity, absence brings death; do not neglect this lightly.

Zhao Yangkui said: In treating Spleen and Stomach, I differentiate Yin-Yang and Water-Fire for regulation. Lack of appetite belongs to pathology of Yangming Stomach Earth; one must tonify Shaoyin Heart Fire. Guipi Tang (Restore the Spleen Decoction) tonifies Heart Fire to generate Stomach Earth. Ability to eat but failure to digest belongs to Taoyin Spleen Earth pathology; one must tonify Shaoyang Ministerial Fire. Shuihu Wan (Eight-Ingredient Pill) tonifies Ministerial Fire to generate Spleen Earth. Lizhong Tang (Regulate the Middle Decoction) uses Ganjiang (Dried Ginger) to control Water within Earth. Jianzhong Tang (Establish the Middle Decoction) uses Shaoyao (Peony Root) to control Wood within Earth. Huangqi Tang (Astragalus Decoction) benefits the child of Earth (Heart/Fire) so it does not consume the mother's Qi. Liuwei Wan (Six-Ingredient Pill) strengthens the master of Water (Kidney Yin); Shuihu Wan (Eight-Ingredient Pill) benefits the source of Fire (Kidney Yang). Earth has no fixed position, thriving during the four seasons, lacking specific functions, assisting Heaven in transformation, thus treated via the four Zang organs. In summary, the approach is primarily tonification, avoiding attacking methods. For sinking of Spleen Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For Liver Fire invading Spleen, add Zuojin Wan (Left Metal Pill); for depression and anger injuring Spleen, use Guipi Tang. For Spleen deficiency failing to control phlegm, use Liujunzi Tang. For dual deficiency of Spleen and Kidney, use Sijunzi Tang (Four-Gentlemen Decoction) and Sishen Wan (Four-Essence Pill). For Yin Fire invading Spleen, use Liuwei Wan. For Mingmen Fire decline failing to generate Spleen Earth, use Shuihu Wan. If congenital Qi is sufficient but acquired Qi is insufficient, focus on tonifying Middle Qi; if acquired Qi is sufficient but congenital Qi is insufficient, focus on tonifying Yuan Qi.

Zhang Sanxi said: The Neijing states: Due to fatigue and overwork, physical and Qi resources diminish, Grain Qi cannot overcome [the strain], the Upper Jiao fails to circulate, and the Lower Wan (stomach/intestines) fails to transmit. Stomach Qi becomes hot, and hot Qi steams the chest, causing internal heat. Generally, excessive fatigue causes Yang and harmonious Qi to become hyperactive and transform into Fire. Moreover, regarding the taste of water and grain, eating less means Yang becomes more hyperactive and Yin more deficient. This "Yin" refers to the body's Yin and the Qi of water and grain. However, fatigue implies Qi damage from overwork. Diminished physical and Qi resources imply Strong Fire consumes Qi. Grain Qi failing to overcome [strain] implies insufficient food intake cannot counteract pathogenic Fire. Failure of the Upper Jiao to circulate implies Clear Yang fails to ascend. Blockage of the Lower Wan implies Turbid Yin fails to descend. The Stomach receives water and grain, transforming and generating Qi and Blood, so Clear Yang ascends and Turbid Yin descends, facilitating transmission and nourishment of the whole body. Now, if the Stomach fails to receive food and Grain Qi is scarce, Clear Yang has nothing to ascend and Turbid Yin has nothing to descend. Thus, "Upper Jiao fails to circulate, Lower Wan fails to transmit" does not mean complete cessation, but rather worse than usual. If the upper does not circulate and the lower does not transmit, stagnation occurs. Stagnation transforms Shao Huo (Mild Fire) into Zhuang Huo (Strong Fire). Since the Stomach lies between the Upper Jiao and Lower Wan, if Deficient Fire flares upward, it steams the chest, causing internal heat. This is how fatigue and internal injury generate heat.