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[Qian Yiyuan] The Spleen is prone to being constrained. In excess conditions, there is lethargy (somnolence), fever, and thirst with desire to drink. In deficiency conditions, there is vomiting, diarrhea, and the generation of wind (internal stirring of wind). Spleen disease presents with lethargy, diarrhea, and lack of appetite. If the Spleen and Stomach are deficient and cold, the face is pale, the eyes lack luster, the breath from the mouth and nose is cold, and the body is emaciated. For symptoms such as vomiting clear water, abdominal pain, and refusal of milk or food, use Yihuang San (Yellow Benefit Powder). For loose stools, use Tiaozhong Wan (Regulate the Middle Pill). For wind-strike causing cold hands and feet, it is a case of Spleen deficiency; first use Yihuang San to tonify the Spleen, then use Daqing Gao (Great Cyan Ointment) to disperse external pathogens. When Spleen disease manifests in any season, treat it by referring to the methods for the other four Zang organs. Cases where the pulse and symptoms agree are easy to treat; those where they contradict are difficult. Spleen deficiency manifests as a red face and yellow eyes. When the Five Zang organs act contrary to their normal generating/restraining cycles, treat according to the specific syndrome.

[Jiegu/Li Dongyuan] The Spleen governs dampness. Self-disease of the Spleen results in frequent diarrhea, excessive sleep, heavy body, dizziness, and fatigue. When the Spleen suffers from dampness, urgently consume bitter flavors to dry it. Excess conditions present as diarrhea with red-yellow stool, and sleep with eyes open; Xiehuang San (Drain Yellow Powder) is the primary formula. Deficiency conditions present as diarrhea with white stool, and sleep with eyes exposed (exposed eyelids); Baizhu San (Atractylodes Macrocephala Powder) is the primary formula. Liver Qi invading the Spleen is called "Thief Evil," presenting as wind-diarrhea with vomiting; Fuling Banxia Tang (Poria and Pinellia Decoction) is used. Heart Qi invading the Spleen is called "Deficient Evil," presenting with high fever, heavy body, and diarrhea; Qianghuo Huangqin Cangzhu Gancao Tang (Notopterygium, Scutellaria, Atractodes, and Licorice Decoction) is used. Lung Qi invading the Spleen is called "Excess Evil," presenting with ability to eat but constipation, vomiting, and coughing; Tingli Wan (Descurainia Seed Pill) is administered using a decoction of Binglang (Areca Nut) and Dahuang (Rhubarb) as the vehicle. Kidney Qi invading the Spleen is called "Minor Evil," presenting with aversion to cold and diarrhea; Lizhong Wan (Regulate the Middle Pill) and similar formulas are used.

[Liu Wansu] Whenever the Spleen becomes diseased, one must examine the excess or deficiency of the Liver and Heart, trace the origin, and then treat. The Liver is the "Ghost" (pathological constraint) of the Spleen, and the Heart is the Mother of the Spleen. If Liver Qi is excessive, the constraint prevails; if Heart Qi is deficient, the generative Qi of the Spleen is insufficient. Excess should be suppressed to recede, and deficiency should be supplemented to be abundant. Hence, there are two medicinal approaches: suppressing Spleen Qi and supplementing Heart Qi. Upon palpating the pulse, if both Liver and Heart are harmonious, the illness originates solely in the Spleen; treat based on its excess or deficiency.

[Xue Ji] The aforementioned excess condition refers to pathogenic Qi being excess while form Qi is deficient. If the face is pale, with vomiting, diarrhea, abdominal pain, and cold breath from mouth/nose, this is Cold Water insulting Earth (Kidney Water insulting Spleen Earth); use Yihuang San. If the face is green and lips dark, with vomiting, diarrhea, and cold hands and feet, this is Spleen Earth deficient and cold; use Ganjiang Lizhong Tang (Dried Ginger Regulate the Middle Decoction). If the face is sallow/yellowish without cold hands and feet, this is Spleen Earth weakness; use Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). If wind-strike causes cold hands and feet, with phlegm vomiting, cough, diarrhea, and abdominal distension, this is Spleen-Lung Qi deficiency; use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) to solidify Spleen Qi, adding Fangfeng (Saposhnikovia) and Shengma (Cimicifuga) to disperse external pathogens. If symptoms occur during Yin-Mao hours (5 AM - 9 AM, Wood time), use Liu Jun Zi Tang (Six Gentlemen Decoction), Chaihu (Bupleurum), and Shengma to tonify Spleen Earth and calm Liver Wood. Generally, a yellow face is the true color of the Spleen; a red face indicates Fire generating Earth (favorable); a green face indicates Wood controlling Earth (unfavorable). One should calm the controlling element and prioritize tonifying Yuan Qi.

[Zhang Yuansu] When the Spleen suffers from dampness, urgently consume bitter flavors to dry it, such as Baizhu (Atractylodes Macrocephala). When the Spleen desires relaxation, urgently consume sweet flavors to soothe it, such as Gancao (Licorice). Use sweet flavors to tonify, such as Renshen (Ginseng). Use bitter flavors to drain (clear heat), such as Huanglian (Coptis). For Spleen deficiency, tonify with Gancao and Dazao (Jujube); if no other symptoms exist, use Qian's Yihuang San to tonify the Spleen. For deficiency, tonify the Mother; the Heart is the Mother of the Spleen, so use fried salt to tonify the Heart.

Yihuang San [Qian's Formula]: Also known as Bupi San (Tonify Spleen Powder), treats Spleen-Stomach deficiency-cold.
Chenpi (Tangerine Peel, 1 liang), Qingpi (Green Tangerine Peel), Hezirou (Pericarpium Arecae Semen Preparatum), Gancao (Licorice, each 0.5 liang, crushed and stir-fried), Dingxiang (Clove, 2 qian).
Grind into fine powder. Take 2 qian per dose, add 1 cup of water, boil to 0.6 cup, take warm before meals.

Li Dongyuan stated: Yan Xiaozhong compiled Qian's formulas, using Yihuang San to tonify Earth, stating that Wind prosperity must overcome Spleen Earth, so one must first solidify the Spleen. Ignorant practitioners fail to examine cold/heat in the Spleen and uniformly use Spleen-tonifying herbs. They also fail to notice that Dingxiang and Qingpi are acrid-hot and greatly drain Lung Metal. In Spleen deficiency, how can one drain the Son (Lung)? This leads to Cold Water insulting Earth. For middle-jiao cold with vomiting, abdominal pain, green-white dysentery/diarrhea, and cold breath from mouth/nose, Yihuang San is a miraculous remedy. However, if vomiting/diarrhea arises from overuse of hot drugs like Badou (Croton Seed) damaging the Spleen/Stomach, or from summer heat accumulation damaging the Spleen/Stomach, leading to hot breath from mouth/nose and slow convulsions, this formula is contraindicated. I now establish a formula to treat Wind-Heat in the Stomach, named Renshen Anwei San (Ginseng Calm the Stomach Powder).

Xue Ji stated: For Spleen Earth deficiency-cold with Cold Water insulting it, as described by Li Dongyuan, use this formula (Yihuang San). For vomiting/diarrhea due to Spleen Earth weakness, use Liu Jun Zi Tang plus Chaihu; if ineffective or if hands/feet are cold (indicating deficiency-cold), add Muxiang (Aucklandia) and Paojiang (Prepared Ginger). If the infant's condition is caused by the nursing mother's Spleen deficiency and Liver invasion, treat with the aforementioned medicines. If the mother's depression and anger cause the infant's condition, the mother should take Jiawei Guipi Tang (Modified Restore the Spleen Decoction).

Renshen Anwei San: Treats Spleen-Stomach deficiency-heat.
Huangqi (Astragalus, 2 qian), Renshen (Ginseng), Chenpi (Tangerine Peel, peeled, each 1 qian), Sheng Gancao (Raw Licorice), Zhi Gancao (Honey-fried Licorice, each 0.5 qian), Baishao (White Peony Root, 0.7 qian), Baifuling (Poria, 0.4 qian), Huanglian (Coptis, a small amount).
Grind into coarse powder. Take 2-3 qian per dose, boil in water for five boils, strain, and take warm.

Sijunzi Tang (Four Gentlemen Decoction) and Liu Junzi Tang (see "Vomiting and Diarrhea" section).

[Zhang Yuansu] For Spleen excess, drain with Zhishi (Immature Bitter Orange); if no other symptoms, use Qian's Xiehuang San to drain. For excess, drain the Son; the Lung is the Son of the Spleen, so drain the Lung with Sangbaipi (Morus Alba Bark).

Xiehuang San [Qian's Formula]: Also known as Xiepi San (Drain Spleen Powder).
Huoxiangye (Agastache Leaf, 7 qian), Shanzhiziren (Gardenia Seed, 1 liang), Shigao (Gypsum, 0.5 liang), Gancao (Licorice, 3 liang), Fangfeng (Saposhnikovia, 4 liang, remove rhizome, cut, roast).
Crush, stir-fry slightly with honey and wine until fragrant, grind into fine powder. Take 1-2 qian per dose, add 1 cup of water, boil to 0.5 cup, take warm clear liquid at any time.

[Xue Ji] Regarding the aforementioned syndromes: If there is thirst with desire for cold drinks, sleep with eyes closed, and very hot hands/feet, or generalized jaundice, this is Stomach Meridian excess-heat; use Xiehuang San. If there is thirst with desire for hot drinks, sleep with eyes open, and cold hands/feet, this is Stomach Meridian deficiency-heat; use Yigong San. If the face is green with spasms/clenching, and poor appetite/milk intake, this is Liver invading Spleen; use Mizhi Bupi Tang (Secret Instruction Tonify Spleen Decoction). If the face is red with fright and palpitations, fever, and lethargy, this is Heart invading Spleen; use Mizhi Anshen Wan (Secret Instruction Calm Spirit Pill). If the face is white with wheezing/cough and limb fatigue, this is Lung invading Spleen; use Buzhong Yiqi Tang (Boost the Middle and Augment the Qi Decoction). If the lips are black with diarrhea and cold toes, this is Kidney invading Spleen; use Yihuang San. After illness, if fluid deficiency causes dry mouth and thirst, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder). If the condition is caused by the nursing mother consuming rich/greasy foods or emotional stagnation-fire, investigate the cause and treat the mother.