Library

In treating conditions caused by temporary dietary injury, one must also differentiate between deficiency and excess. If food stagnates in the Middle Jiao (Middle Burner: Spleen and Stomach), causing distension or pain, this is an Excess syndrome; one should first eliminate the food accumulation, preferably using Da He Zhong Yin (Greatly Harmonize the Middle Decoction). However, no method of eliminating food is superior to regulating Qi, among which Pai Qi Yin (Dispel Qi Decoction) is the best choice. If the retained food remains in the Upper Jiao (Upper Burner: Chest and Diaphragm), inducing vomiting is the most expedient method, or using emetic agents is also acceptable. If food stagnates in the Lower Jiao (Lower Burner: Abdomen below the umbilicus), accompanied by severe pain and distension, purgation is required to remove it; Shen You Wan (Divine Protection Pill), Bei Ji Wan (Emergency Aid Pill), or Chi Jin Dou (Red Gold Bean) are suitable. If accidental consumption of cold/raw or greasy/unclean foods leads to vomiting, diarrhea, abdominal distension, and pain with Excess pathogenic factors, Yi Fu Jian (Suppress and Support Decoction) is indicated; if there is no Cold, Wu Zhu Yu (Evodiae Fructus) should be omitted from the formula before decocting, or Pai Qi Yin (Dispel Qi Decoction) and He Wei Yin (Harmonize Stomach Decoction) are both excellent choices. If pain and distension persist, Shen Xiang San (Aromatic Powder) should be used concurrently.

Item 1: When dietary injury to the Spleen causes severe vomiting and diarrhea, if one observes no fullness in the center (epigastrium), no abdominal pain, but only incessant nausea and vomiting, this indicates that the food has likely already been expelled, and the condition arises from severe deficiency due to injury to the Central Qi. Alternatively, if the patient appears fatigued and restless, suffers from shortness of breath and profuse sweating, and presents with six pulses (Radial artery pulses at Cun, Guan, and Chi positions on both wrists) that are hollow, large, and lacking spirit, Li Zhong Tang (Regulate the Center Decoction), Wu Jun Zi Jian (Five Gentlemen Decoction), or Wen Wei Yin (Warm the Stomach Decoction) are appropriate. In cases of extreme vomiting leading to profound deficiency, Si Wei Hui Yang Yin (Four-Ingredient Return to Yang Decoction) is indicated; in cases of extreme diarrhea leading to profound deficiency, Wei Guan Jian (Stomach Gate Decoction) is indicated. Following severe vomiting and diarrhea, abdominal distension often occurs. If the distension is apparent externally but not felt internally, or if the patient dislikes the smell of food and lacks appetite, these are signs of severe Spleen Qi deficiency; prompt treatment with the aforementioned warming and tonifying methods is necessary.

Item 2: Young people and children often indulge their appetites, leading to unclear Stomach Qi, occasional mild distension, occasional pain, or a bloated abdomen with loss of appetite. These conditions result from Spleen injury, specifically caused by food stagnation. For significant stagnation, He Wei Yin (Harmonize Stomach Decoction) is suitable; for minor stagnation, Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) or Shao Yao Zhi Zhu Wan (Peony, Immature Bitter Orange, and Atractylodes Macrocephala Pill) taken gradually over days, combined with dietary restraint, will lead to complete recovery.

Item 3: Irregular eating habits or damage to the Spleen and Stomach often cause chest and diaphragm stuffiness, indigestion, reduced appetite, tastelessness in the mouth, belching with acid regurgitation, and mental and physical fatigue. These arise from Spleen Qi injury and Central Deficiency. Mu Xiang Ren Shen Zhi Zhu Wan (Aucklandia, Ginseng, Immature Bitter Orange, and Atractylodes Macrocephala Pill) or Da Jian Pi Wan (Greatly Strengthen the Spleen Pill) with Huang Lian (Coptidis Rhizoma) removed are indicated. For severe deficiency, Li Zhong Tang (Regulate the Center Decoction) or Wen Wei Yin (Warm the Stomach Decoction) are suitable. If the deficiency lies in the Lower Jiao, characterized by Yin without Yang (failure of Fire to generate Earth), modifying Li Yin Jian (Nourish Yin Decoction) is the best approach.

Item 4: Loss of appetite and inability to eat after illness present two syndromes. One type is due to residual turbid Qi or lingering heat, treated with modified Xiao He Zhong Yin (Slightly Harmonize the Middle Decoction). The other type results from Spleen and Stomach injury where, although the pathogen has cleared, the Central Qi has not recovered; thus, the patient may be unable to eat for several days or even ten days, or feel a sensation of obstruction in the chest and throat similar to Plum-Pit Qi (Globus Hystericus). This is not due to actual accumulation but because Yang Qi has not dispersed, Yin turbidity causes stagnation, and the Stomach Qi is too deficient to transform and transport. Mild cases use Wen Wei Yin (Warm the Stomach Decoction); severe cases require adding Ren Shen (Ginseng Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata). Once Yang Qi moves, the appetite will naturally open.

Item 5: Alcohol-induced injuries generally require damp-draining and water-promoting methods; if Qi is injured, Ren Shen (Ginseng Radix) may be used intermittently. There are three specific patterns to distinguish. First, alcohol-damp injures the Spleen, generating phlegm, rebellious Qi, vomiting, chest stuffiness, and reduced intake; Ge Hua Jie Cheng Tang (Kudume Flower Relieve Intoxication Decoction), Wei Ling Tang (Stomach and Five-Liquids Decoction), or Wu Ling San (Five-Ingredient Powder with Poria) are indicated. Second, alcohol-heat injures Yin, causing fever or bleeding tendencies; Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction), Qing Hua Yin (Clear Transformation Decoction), or Xi Xin Yin (Remove Tinder Decoction) are indicated. Third, alcohol quality injures the Zang organs, causing persistent diarrhea. If the patient has strong Qi and robust constitution, Wu Ling San (Five-Ingredient Powder with Poria) or Wei Ling Tang (Stomach and Five-Liquids Decoction) can drain dampness and stop diarrhea. If dampness generates Cold, and diarrhea injures Yin, damaging Ming Men (Gate of Life) Yang, Wei Guan Jian (Stomach Gate Decoction), Wu De Wan (Five Virtues Pill), or Jiu Qi Dan (Nine-Qi Elixir) are indispensable.

Item 6: Anger injuring the Liver causes Liver Wood Qi to invade Spleen Earth, damaging Stomach Qi and hindering digestion. Although this stems from rebellious Liver Qi, Liver Qi eventually dissipates, whereas Spleen Qi injury persists and causes distress. Therefore, treatment should focus on the Spleen rather than the Liver. In such cases, observe whether there is Qi rebellion or stagnation. If symptoms like hypochondriac pain and distension are absent, Qi-regulating herbs are unnecessary; instead, nourish the Spleen and boost Qi primarily, using formulas like Wu Wei Yi Gong San (Five-Ingredient Extraordinary Power Powder) or Gui Pi Tang (Restore the Spleen Decoction). Adding small amounts of Wu Yao (Linderae Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), or Bai Dou Kou (Amomi Fructus Rotundus) to tonifying formulas is also acceptable.

Item 7: Conditions such as intermittent vomiting after eating or morning-eating-evening-vomiting are detailed under the chapter on Fan Wei (Reverse Regurgitation).

Item 8: Individuals who eat well but remain thin often have Fire, but the severity must be assessed. For mild Fire, mild clearing is used, such as Sheng Di Huang (Rehmanniae Radix), Shao Yao (Paeoniae Radix), Dan Pi (Moutan Cortex), Sha Shen (Glehniae Radix), Mai Dong (Ophiopogonis Tuber), Shi Hu (Dendrobii Caulis), Zhu Ye (Bambusae Folium), Di Gu Pi (Lycii Cortex), Huang Qin (Scutellariae Radix), Zhi Mu (Anemarrhenae Rhizoma), and Gan Cao (Glycyrrhizae Radix et Rhizoma). For severe Fire, characterized by immediate hunger after eating, immediate thirst after drinking, dry hot skin, and constipation/dysuria, Shi Gao (Gypsum Fibrosum), Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), Huang Bo (Phellodendri Cortex), Long Dan Cao (Gentianae Radix), and Ku Shen (Sophorae Flavescentis Radix) are unavoidable. Treatment should target the Three Jiao and Five Zang according to the location. Since Yang Excess implies Yin Deficiency, formulas like Yi Yin Jian (One-Yin Decoction), Er Yin Jian (Two-Yin Decoction), and Si Yin Jian (Four-Yin Decoction) should be selected appropriately.

Item 9: Individuals who cannot eat but remain thin suffer from Spleen and Stomach weakness failing to transform and transport, presenting with belching, acid regurgitation, stuffiness, and lack of hunger. Si Jun Zi Tang (Four-Gentlemen Decoction) or Gui Pi Tang (Restore the Spleen Decoction) are indicated. If Cold is concurrent, Wu Jun Zi Jian (Five Gentlemen Decoction), Yang Zhong Jian (Nourish the Center Decoction), or Li Zhong Tang (Regulate the Center Decoction) are suitable. For Ming Men (Gate of Life) Fire Decline, You Gui Yin (Right-Restore Decoction), You Gui Wan (Right-Restore Pill), or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) are indicated.

Item 10: Craving tea or raw rice is often due to latent Fire in the Stomach, which digests these items. I have cured several patients using fire-clearing and Yin-nourishing herbs, observing pulse and symptom signs of Fire. Those craving charcoal likely have Cold and Damp in the Stomach, preferring dry/astringent substances; treatment should focus on strengthening the Spleen and warming the Stomach based on pulse and symptom differentiation.

Item 11: Treatment for dietary injury should be categorized: Mai Ya (Hordei Fructus Germinatus) and Shen Qu (Massa Medicata Fermentata) digest grain/starch accumulations; Sha Ren (Amomi Fructus), Hou Po (Magnoliae Officinalis Cortex), Luo Bo Zi (Raphani Semen), and A Wei (Asini Corii Colla) digest meat accumulations; Shan Zha (Crataegi Fructus) and Zhi Shi (Aurantii Fructus Immaturus) digest fruit/vegetable accumulations. For Dampness, use drying herbs like Ban Xia (Pinelliae Rhizoma), Cang Zhu (Atractylodis Rhizoma), Cao Guo (Tsaoko Fructus), and Ze Xie (Alismatis Rhizoma). For Cold, use warm/hot herbs like Jiang (Zingiberis Rhizoma), Gui (Cinnamomi Ramulus), Wu Zhu Yu (Evodiae Fructus), and Rou Dou Kou (Myristicae Semen). For Heat, use cold herbs like Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), and Qing Pi (Citri Reticulatae Pericarpium Viride). For Qi Stagnation, move Qi with Mu Xiang (Aucklandiae Radix), Wu Yao (Linderae Radix), Xiang Fu (Cyperi Rhizoma), and Bai Jie Zi (Sinapis Semen). For Blood Stasis, move Blood with Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Su Mu (Sappan Lignum), and Yan Hu Suo (Corydalis Rhizoma). For hard, stubborn food masses, use Ba Dou (Crotonis Fructus), Da Huang (Rhei Radix et Rhizoma), San Leng (Sparganii Rhizoma), and Peng Ze (Curcumae Rhizoma). Ancient methods for food stagnation follow these principles. However, this is a general overview; one must weigh depth and deficiency/excess. To attack有形 (tangible pathogens), act through Flavor; to disperse stagnation, act through Qi. Where Qi moves, food follows. The interaction of Qi and Flavor offers subtle synergies, so rigid adherence is discouraged.

Item 12: Food stagnation in the lower abdomen is treated as described in the Heart and Abdominal Pain chapter; refer to that section.