【歌】脾胃相通五谷消，输精脉络裕三焦。当其健运施生化，能食而肥气血饶。四时胃气为根本，脉实
弦洪与石毛。一有所伤营运远，从此便觉此身娇。劳形过食中州损，怠惰贪眠面色焦。水不营运生痞胀，食难
克化肉潜消。脾胃既病如何疗，要适寒温饮食调。
【论】夫脾为仓廪之官，胃为水谷之海。然胃主司纳，脾主消导，一表一里，一纳一消，营运不息，生
化气血，滋荣脉络，四肢百骸，五脏六腑皆借此以生养。故四时皆以胃气为本，如易之坤浓载物，德合无疆，
故万物资生于坤元也。《脾胃论》云∶人之脾胃盛，则多食而不伤，过时而不饥。脾胃衰，则多食而伤，少食
而瘦，过时而饥，此脾胃盛衰可见也。不善摄生者，饮食不节，寒暑不调，喜怒失常，劳役无度，未有不损其
脾胃者也。经云∶饮食劳倦则伤脾胃。脾土既伤，不能输运，则气血精神由此而日亏，脏腑脉络由此而日损，
肌肉形体因此而日削。故有怠惰嗜卧，四肢无力，面色痿黄，食亦消瘅，肿满泄痢之病生焉。经云∶三损损于
肌肉，肌肉消瘦，饮食不能为肌肤。故损其脾者，调其饮食，适其寒温，此调理脾胃之良法也。
脾胃不和
脾不和，则食不化；胃不和，则不思食；脾胃不和，则不思而且不化。或吐或泻，或胀满，或吞酸，或嗳气，或恶
心，用治中汤。脾不和，不喜食而食不消者，枳缩二陈汤、枳术丸。胃不和者，平胃散。
治中汤
治脾胃不和，呕逆霍乱，中满虚痞，或泄泻。
人参（一钱） 甘草（炙，一钱） 干姜（炮，一钱） 白术（土炒，一钱） 青皮（一钱） 陈皮（一钱）
上锉，作二服，水二盏，煎一盏，空心服。
枳缩二陈汤
即二陈加砂仁、枳壳。（方见痰证条。）
枳术丸
治痞消食强胃。
枳实（麸炒，一两） 白术（二两）
加橘皮名橘皮枳术丸。
加曲、 名曲 枳术丸。
加木香名木香枳术丸。
加半夏名半夏枳术丸。
加芩连名芩连枳术丸。
上为末，荷叶煮饭为丸如桐子大，空心白汤送下五、六十丸。
脾胃虚损
脾胃虚损者，补中益气汤，四君子汤。脾胃虚，饮食不进，呕吐泻利，四肢无力，怠惰嗜卧，或病后脾胃
受伤，元气不足，参苓白术散、建中汤。
补中益气汤（方见内伤。）
四君子汤
补脾胃大虚，饮食不思，呕吐泄泻等证。
人参（去芦，一钱） 白茯苓（一钱） 白术（土炒，二钱） 甘草（蜜炒，一
钱）
上锉，一剂，生姜三片，大枣二枚，水二钟，煎八分服。
如吐泻，加藿香、白扁豆。咳嗽加桑白皮、五味子。心烦不定加辰砂、酸枣仁、远志。心热加麦门冬、茯
神、莲肉。惊风阴证加全蝎、白附子。口渴加干葛、乌梅。胃冷加丁香、砂仁、木香。腹胀不思饮食加白豆蔻、
砂仁。喘急胸膈不宽加枳壳。盗汗加黄 、小麦。小便涩加猪苓、泽泻、木通。水泻不止加木香、诃子、豆蔻。
参苓白术散
调理脾胃受伤，元气不足，诸虚等证。
白术（二两，土炒） 人参（二两，去芦） 甘草（二两，炙） 干山药（二两，炒） 白茯苓（二两）
白扁豆（一两五钱，姜汁炒，去皮） 莲肉（一两，去皮） 薏苡仁（一两） 砂仁（一两，炒） 桔梗
（一两，炒）
上为末，每服二钱，枣汤调下。
建中汤（方见恶寒。）
脾胃停食
脾胃停食，不能消导，曲 橘半枳术丸，或枳桔二陈汤加山楂、神曲，或保和丸。脾胃不和，伏痰留饮者，
二陈汤加泽泻、猪苓、浓朴、苍术，或利膈化痰丸。
枳桔二陈汤
即二陈加枳壳、桔梗。（方见痰证。）
保和丸（方见伤食。）
二陈汤（见痰证。）
利膈化痰丸（方见痰证。）
脾胃虚寒
脾胃有寒，脉迟，理中汤。脾胃虚冷，心腹胀满疼痛，浓朴温中汤。胃寒不进食，香砂养胃汤、进食散。
理中汤（方见中寒。）
浓朴温中汤
浓朴（姜炒，八分） 干姜（七分） 甘草（炒，六分） 木香（五分） 陈皮（八分） 茯苓（八分）
上锉，一剂，生姜三片，大枣二枚，水二钟，煎八分服。
人参开胃汤
人参（去芦，一钱） 白术（土炒，一钱） 白茯苓（一钱） 甘草（炙，八分） 陈皮（八分） 半夏
（姜制七分） 神曲（炒，七分） 麦芽（炒，七分） 砂仁（炒，七分） 浓朴（姜汁拌匀，炒燥，七分）
丁香（五分） 藿香叶（六分） 莲肉（十个，去皮） 生姜（三片）
上锉，一剂，水二盏，煎八分，空心服。
香砂养胃汤（方见疟疾。）
脾胃伏火
脾胃郁火，二陈加芩、连、山栀。脾胃虚热，津不足，白术散。脾胃有热，消谷善饥，三黄枳术丸。脾热
口臭，泻黄散。胃火齿痛，清胃散。
白术散
即四君子汤加木香、藿香、干葛。（方见前。）
三黄枳术丸
即枳术丸合三黄丸。（枳术丸方见前，三黄方见火证。）
泻黄散（见火证。）
清胃散（见火证。）
脾胃中湿
脾胃中湿者，平胃散。脾胃中湿泻痢者，胃苓汤。脾胃寒湿脾泄者，椒术养脾丸。脾湿身肿便涩，五苓
散。虚者实脾散，实者十枣汤。
平胃散（方见中湿。）
五苓散（方见中湿。）
胃苓汤（方见中湿。）
椒术养脾丸
治脾胃虚冷，心腹胀闷，呕逆泄泻。
麦芽（炒，四两） 白茯苓（四两） 人参（去芦，二两） 苍术（泔浸，晒干，炒燥，二两） 白术
（土炒，二两） 干姜（炮，五钱） 砂仁（五钱） 川椒（去目，三钱） 甘草（炙，四钱）
上为末，炼蜜丸，每两作八丸，每服一丸，细嚼，姜汤下。
实脾散
治阴水发肿，用此先实脾土。
白术（土炒，一钱） 白茯苓（一钱） 木香（八分） 浓朴（姜汁拌匀，炒燥，八分） 木瓜
（一钱） 干姜（炮，八分） 草果（八分） 大腹子（一钱） 甘草（炙，七分）
上锉，一剂，姜三片，枣二枚，水二盏，煎八分，空心服。
十枣汤
治悬饮内痛。
芫花（熬） 甘遂 大戟（等分）
上为末，以水一升半，煮大枣十枚，煎至八合，去渣，纳药末，强壮者一钱，虚弱人五分，平旦服之。不
下，再加五分，下后以糜弱调之。
按∶本方乃泄水散饮之圣药，然有毒，不可轻用。
[Verse] The Spleen and Stomach are interconnected, allowing the five grains to be digested; the meridians that transport essence are abundant in the Triple Burner (San Jiao). When they function vigorously and perform their transformative roles, one can eat well and become plump, with abundant Qi and Blood. The Stomach Qi is the root for all four seasons, reflected in pulse qualities that are solid, wiry, flooding, stone-like, or hairy. Once injured, their transport and transformation slow down, and from then on, the body feels frail. Overexertion of the form and overeating damage the Middle Jiao (Central Region), leading to lethargy, excessive sleepiness, and a sallow complexion. If water fails to circulate, it generates fullness and distension; if food is difficult to digest, muscles gradually waste away. How to treat diseased Spleen and Stomach? The key lies in adapting to cold and warmth and regulating diet.
[Dissertation] The Spleen is the official responsible for storing grain, and the Stomach is the sea of water and grain. However, the Stomach governs reception, while the Spleen governs digestion and transportation. One is exterior, the other interior; one receives, the other transforms. Their continuous operation generates Qi and Blood, nourishes the meridians, and sustains the four limbs, hundred bones, five Zang organs, and six Fu organs. Thus, all four seasons rely on Stomach Qi as the foundation, just as the Kun trigram in the I Ching carries all things with boundless virtue, so that all things are born from the Kun Yuan (Earth). *Pi Wei Lun* (Treatise on the Spleen and Stomach) states: When a person's Spleen and Stomach are vigorous, eating much does not cause injury, and passing meal times does not bring hunger. When Spleen and Stomach are weak, eating much causes injury, eating little leads to emaciation, and passing meal times brings hunger; this shows the vigor or weakness of the Spleen and Stomach. Those who do not know how to preserve health—those with unregulated diet, imbalanced exposure to cold and heat, irregular emotions, and excessive labor—will inevitably damage their Spleen and Stomach. The Classics state: Dietary irregularities and fatigue injure the Spleen and Stomach. Once the Earth element of the Spleen is injured and cannot transport and transform, Qi, Blood, and Spirit will daily diminish, the Zang-Fu organs and meridians will daily deteriorate, and the muscles and physique will daily waste away. Thus arise diseases such as lethargy and desire to lie down, weakness in the four limbs, sallow complexion, loss of appetite and emaciation, swelling and fullness, diarrhea, and dysentery. The Classics state: The third level of damage affects the muscles; when muscles waste away, food cannot be transformed into flesh. Therefore, for those whose Spleen is damaged, regulating diet and adapting to cold and warmth is an excellent method for regulating the Spleen and Stomach.
Spleen and Stomach Disharmony
If the Spleen is disharmonious, food is not digested; if the Stomach is disharmonious, there is no desire to eat; if both are disharmonious, there is neither desire to eat nor digestion. Symptoms may include vomiting or diarrhea, distension, acid regurgitation, belching, or nausea. Use *Zhizhong Tang* (Govern the Middle Decoction). For Spleen disharmony characterized by dislike of food and indigestion, use *Zhisuo Erchen Tang* (Bitter Orange and Amomum Two-Chen Decoction) or *Zhizhu Wan* (Bitter Orange and Atractylodes Pill). For Stomach disharmony, use *Pingwei San* (Calm the Stomach Powder).
Zhizhong Tang (Govern the Middle Decoction)
Treats Spleen and Stomach disharmony, vomiting and chaotic reflux, epigastric fullness and deficiency-type bloating, or diarrhea.
Renshen (Ginseng Radix et Rhizoma, 1 qian) Gancao (Licorice Root, honey-fried, 1 qian) Ganjiang (Dried Ginger, processed, 1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried, 1 qian) Qingpi (Green Tangerine Peel, 1 qian) Chenpi (Aged Tangerine Peel, 1 qian)
Crush these ingredients, divide into two doses. Add two cups of water, decoct to one cup, and take on an empty stomach.
Zhisuo Erchen Tang (Bitter Orange and Amomum Two-Chen Decoction)
This is Erchen Tang (Two-Chen Decoction) added with Sharen (Amomi Fructus) and Zhike (Aurantii Fructus). (Formula see Phlegm Syndrome section.)
Zhizhu Wan (Bitter Orange and Atractylodes Pill)
Treats痞 (fullness/lumps), eliminates food stagnation, and strengthens the Stomach.
Zhishi (Immature Bitter Orange Fruit, bran-fried, 1 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang)
Adding Jupi (Tangerine Peel) makes it Jupi Zhizhu Wan.
Adding Qu (Medicated Leaven) and Maiya (Sprouted Hordeum Fruit) makes it Qumai Zhizhu Wan.
Adding Muxiang (Vladimiria Root) makes it Muxiang Zhizhu Wan.
Adding Banxia (Pinellia Tuber) makes it Banxia Zhizhu Wan.
Adding Huangqin (Scutellaria Root) and Lian (Coptis Rhizome) makes it Qinlian Zhizhu Wan.
Grind these into powder. Use rice boiled in Lotus Leaf leaves to make pills the size of paulownia seeds. Take 50-60 pills with plain warm water on an empty stomach.
Spleen and Stomach Deficiency Damage
For Spleen and Stomach deficiency damage, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Sijunzi Tang (Four Gentlemen Decoction). For Spleen and Stomach deficiency with poor appetite, vomiting, diarrhea, weakness in the four limbs, lethargy, or post-illness Spleen/Stomach injury with insufficient Yuan Qi (Original Qi), use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Powder) or Jianzhong Tang (Establish the Middle Decoction).
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See Internal Injury section.)
Sijunzi Tang (Four Gentlemen Decoction)
Tonifies severe Spleen and Stomach deficiency, treating symptoms like lack of appetite, vomiting, and diarrhea.
Renshen (Ginseng Radix et Rhizoma, removed rhizome, 1 qian) Baifuling (Poria, 1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried, 2 qian) Gancao (Licorice Root, honey-fried, 1 qian)
Crush these ingredients. For one dose, add three slices of Shengjiang (Fresh Ginger) and two dates (Dazao). Add two zhong of water, decoct to eight-tenths, and take.
If vomiting/diarrhea, add Huoxiang (Agastache Herb) and Baibian Dou (White Hyacinth Bean). If cough, add Sangbaipi (Morus Bark) and Wuweizi (Schisandra Fruit). If restlessness, add Chen Sha (Cinnabar), Suanzaoren (Ziziphus Seed), and Yuanzhi (Polygala Root). If Heart heat, add Maidong (Ophiopogon Tuber), Fushen (Poria with Hostwood), and Lianrou (Lotus Plumule). If Yin-type convulsion, add Quanxie (Scorpion) and Baifuzi (Typhonii Rhizoma). If thirst, add Gange (Kudzu Root) and Wumei (Mume Fruit). If Cold Stomach, add Dingxiang (Caryophylli Flos), Sharen (Amomi Fructus), and Muxiang (Vladimiria Root). If abdominal distension and no appetite, add Baixiudou (White Cardamom) and Sharen (Amomi Fructus). If panting and chest tightness, add Zhike (Aurantii Fructus). If night sweats, add Huangqi (Astragalus Root) and Xiaomai (Wheat Fruit). If astringent urination, add Zhuling (Polyporus), Zexie (Alisma Rhizome), and Mutong (Akebia Stem). If persistent watery diarrhea, add Muxiang (Vladimiria Root), Hezi (Chebula Fruit), and Doukou (Black Cardamom).
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Powder)
Regulates Spleen and Stomach injury, insufficient Yuan Qi (Original Qi), and various deficiency syndromes.
Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang, earth-fried) Renshen (Ginseng Radix et Rhizoma, 2 liang, removed rhizome) Gancao (Licorice Root, 2 liang, honey-fried) Ganshanyao (Dried Dioscorea Rhizome, 2 liang, fried) Baifuling (Poria, 2 liang)
Baibian Dou (White Hyacinth Bean, 1.5 liang, fried in ginger juice, peeled) Lianrou (Lotus Plumule, 1 liang, peeled) Yiyiren (Coicis Semen, 1 liang) Sharen (Amomi Fructus, 1 liang, fried) Jiegeng (Platycodon Root, 1 liang, fried)
Grind these into powder. Take 2 qian per dose, mixed with date decoction.
Jianzhong Tang (Establish the Middle Decoction) (See Aversion to Cold section.)
Food Retention in Spleen and Stomach
For food retention in the Spleen and Stomach that cannot be digested, use Qumai Ju Ban Zhizhu Wan (Medicated Leaven, Sprouted Barley, Citrus, Pinellia, Bitter Orange, and Atractylodes Pill), or Zhiji Erchen Tang (Bitter Orange and Platycodon Two-Chen Decoction) added with Shanzha (Hawthorn Fruit) and Shenqu (Medicated Leaven), or Baohe Wan (Preserve Harmony Pill). For Spleen and Stomach disharmony with latent phlegm and retained fluids, use Erchen Tang (Two-Chen Decoction) added with Zexie (Alisma Rhizome), Zhuling (Polyporus), Houpo (Magnolia Bark), and Cangzhu (Atractylodis Rhizoma), or Lige Huatan Wan (Clear Diaphragm and Resolve Phlegm Pill).
Zhiji Erchen Tang (Bitter Orange and Platycodon Two-Chen Decoction)
This is Erchen Tang (Two-Chen Decoction) added with Zhike (Aurantii Fructus) and Jiegeng (Platycodon Root). (Formula see Phlegm Syndrome section.)
Baohe Wan (Preserve Harmony Pill) (See Food Injury section.)
Erchen Tang (Two-Chen Decoction) (See Phlegm Syndrome section.)
Lige Huatan Wan (Clear Diaphragm and Resolve Phlegm Pill) (See Phlegm Syndrome section.)
Spleen and Stomach Deficiency-Cold
If the Spleen and Stomach have Cold, with a slow pulse, use Lizhong Tang (Regulate the Middle Decoction). For Spleen and Stomach deficiency-cold with epigastric/abdominal fullness and pain, use Houpo Wenzhong Tang (Magnolia Bark Warms the Middle Decoction). For Cold Stomach preventing eating, use Xiangsha Yangwei Tang (Costus and Amomum Nourish the Stomach Decoction) or Jinshi San (Promote Eating Powder).
Lizhong Tang (Regulate the Middle Decoction) (See Central Cold section.)
Houpo Wenzhong Tang (Magnolia Bark Warms the Middle Decoction)
Houpo (Magnolia Bark, ginger-fried, 8 fen) Ganjiang (Dried Ginger, 7 fen) Gancao (Licorice Root, fried, 6 fen) Muxiang (Vladimiria Root, 5 fen) Chenpi (Aged Tangerine Peel, 8 fen) Fuling (Poria, 8 fen)
Crush these ingredients. For one dose, add three slices of Shengjiang (Fresh Ginger) and two dates (Dazao). Add two zhong of water, decoct to eight-tenths, and take.
Renshen Kaiewei Tang (Ginseng Opens the Appetite Decoction)
Renshen (Ginseng Radix et Rhizoma, removed rhizome, 1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried, 1 qian) Baifuling (Poria, 1 qian) Gancao (Licorice Root, honey-fried, 8 fen) Chenpi (Aged Tangerine Peel, 8 fen) Banxia (Pinellia Tuber, ginger-processed, 7 fen) Shenqu (Medicated Leaven, fried, 7 fen) Maiya (Sprouted Hordeum Fruit, fried, 7 fen) Sharen (Amomi Fructus, fried, 7 fen) Houpo (Magnolia Bark, mixed with ginger juice, fried dry, 7 fen)
Dingxiang (Caryophylli Flos, 5 fen) Huoxiangye (Agastache Leaf, 6 fen) Lianrou (Lotus Plumule, 10 pieces, peeled) Shengjiang (Fresh Ginger, 3 slices)
Crush these ingredients. For one dose, add two cups of water, decoct to eight-tenths, and take on an empty stomach.
Xiangsha Yangwei Tang (Costus and Amomum Nourish the Stomach Decoction) (See Malaria section.)
Latent Fire in Spleen and Stomach
For Spleen and Stomach stagnant fire, use Erchen Tang (Two-Chen Decoction) added with Huangqin (Scutellaria Root), Lian (Coptis Rhizome), and Shanzhi (Gardeniae Fructus). For Spleen and Stomach deficiency-heat with insufficient fluids, use Baizhu San (Atractylodes Powder). For Spleen and Stomach heat causing rapid digestion and hunger, use Sanhuang Zhizhu Wan (Three-Yellow Bitter Orange and Atractylodes Pill). For Spleen heat with bad breath, use Xiehuang San (Drain Yellow Powder). For Stomach fire with toothache, use Qingwei San (Clear Stomach Powder).
Baizhu San (Atractylodes Powder)
This is Sijunzi Tang (Four Gentlemen Decoction) added with Muxiang (Vladimiria Root), Huoxiang (Agastache Herb), and Gange (Kudzu Root). (Formula see above.)
Sanhuang Zhizhu Wan (Three-Yellow Bitter Orange and Atractylodes Pill)
This is Zhizhu Wan (Bitter Orange and Atractylodes Pill) combined with Sanhuang Wan (Three-Yellow Pill). (Zhizhu Wan formula see above, Sanhuang formula see Fire Syndrome section.)
Xiehuang San (Drain Yellow Powder) (See Fire Syndrome section.)
Qingwei San (Clear Stomach Powder) (See Fire Syndrome section.)
Dampness Invading Spleen and Stomach
For Dampness invading the Spleen and Stomach, use Pingwei San (Calm the Stomach Powder). For Dampness invading the Spleen and Stomach causing diarrhea/dysentery, use Weiling Tang (Stomach-Water Decoction). For Spleen and Stomach Cold-Damp causing Spleen diarrhea, use Jiaozhu Yangpi Wan (Pepper and Atractylodes Nourish Spleen Pill). For Spleen dampness with body edema and astringent urination, use Wuling San (Five-Ingredient Powder with Poria). For deficiency patterns, use Shipi San (Solidify the Spleen Powder); for excess patterns, use Shizao Tang (Ten Dates Decoction).
Pingwei San (Calm the Stomach Powder) (See Dampness Invading section.)
Wuling San (Five-Ingredient Powder with Poria) (See Dampness Invading section.)
Weiling Tang (Stomach-Water Decoction) (See Dampness Invading section.)
Jiaozhu Yangpi Wan (Pepper and Atractylodes Nourish Spleen Pill)
Treats Spleen and Stomach deficiency-cold, epigastric/abdominal fullness, vomiting, and diarrhea.
Maiya (Sprouted Hordeum Fruit, fried, 4 liang) Baifuling (Poria, 4 liang) Renshen (Ginseng Radix et Rhizoma, removed rhizome, 2 liang) Cangzhu (Atractylodis Rhizoma, soaked in rice water, dried, fried dry, 2 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried, 2 liang) Ganjiang (Dried Ginger, processed, 5 qian) Sharen (Amomi Fructus, 5 qian) Chuanjiao (Sichuan Pepper, eyes removed, 3 qian) Gancao (Licorice Root, honey-fried, 4 qian)
Grind these into powder. Make pills with refined honey. Each liang of powder makes 8 pills. Take one pill per dose, chew thoroughly, and swallow with ginger decoction.
Shipi San (Solidify the Spleen Powder)
Treats edema caused by Yin Water; use this to first solidify the Spleen Earth.
Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried, 1 qian) Baifuling (Poria, 1 qian) Muxiang (Vladimiria Root, 8 fen) Houpo (Magnolia Bark, mixed with ginger juice, fried dry, 8 fen) Mugua (Chaenomelis Fructus, 1 qian) Ganjiang (Dried Ginger, processed, 8 fen) Caoguo (Tsaoko Fructus, 8 fen) Dafuzi (Arecae Semen, 1 qian) Gancao (Licorice Root, honey-fried, 7 fen)
Crush these ingredients. For one dose, add three slices of ginger and two dates. Add two cups of water, decoct to eight-tenths, and take on an empty stomach.
Shizao Tang (Ten Dates Decoction)
Treats internal pain caused by suspended fluid retention (Xuan Yin).
Yuanhua (Genkwa Flos, processed) Gansui (Kansui Radix) Daji (Euphorbiae Pekinensis Radix) (Equal parts)
Grind these into powder. Add one and a half sheng of water, boil ten large dates (Dazao) until reduced to eight he. Strain, add the powder. Strong individuals take 1 qian; weak individuals take 5 fen. Take at dawn. If no bowel movement occurs, increase by 5 fen. After evacuation, restore strength with thin gruel.
Note: This formula is a sacred medicine for draining water and dispersing fluid retention, but it is toxic and should not be used lightly.