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Human health relies on the Spleen and Stomach as the foundation of nourishment, which depends entirely on whether they are strong or weak. Among the three formulas for strengthening the Spleen, such as Zhizhu Wan (Bitter Orange and Atractylodes Macrocephala Pill) by Zhang Jiegou, Pingwei San (Stomach-Pacifying Powder) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) by Li Dongyuan, all are currently passed down as standards. The term "Pingwei" (Stomach-Pacifying) implies restoring balance to an imbalanced state; this was formulated by Li Dongyuan for conditions of excess Stomach heat and pathogenic fullness. Therefore, its properties are pungent, dry, and bitter, capable of resolving stagnation and dispersing pathogens, making it suitable only for cases with stagnation, dampness, and accumulation. However, I observe that many physicians today treat this as a daily tonic for strengthening the Spleen, using it indiscriminately without examining suitability, which is a grave error.

First, Zhizhu Wan by Zhang Jiegou uses Baizhu (Atractylodis Macrocephalae Rhizoma) as the sovereign herb. The Spleen benefits from Baizhu's drying property, thus achieving strength. However, it is assisted by Zhishi (Immature Bitter Orange), which has a bitter and harsh nature, possessing the power to demolish walls (break qi stagnation). This is actually a formula that incorporates attack within defense, suitable only when Spleen qi is unclear and stagnation prevails. If Spleen qi is already deficient, it is inappropriate. Today, people fail to examine this, mistakenly believing it to be a Spleen-tonifying medicine, taking it morning and night, or prescribing it regularly for thin and weak children. This merely damages their qi and exacerbates their emaciation. Medication should be used with discretion.

Second, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is Li Dongyuan's unique insight. Since the Spleen and Stomach belong to Earth and serve as the sea of water and grain, the generation of the five Zang organs relies upon them. This reliance is on the ascending movement of generative qi, flowing from the Stomach to the Spleen, and from the Spleen to the Lungs, thereby nurturing all things and moistening the entire body. This mirrors the earth in heaven and earth: in spring and summer, earth generates and grows because it receives yang qi and ascends; ascent leads to life. In autumn and winter, earth does not generate or grow because it receives yin qi and descends; descent leads to death. The present formula uses Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) to assist generative qi, and Renshen (Ginseng Radix), Huangqi (Astragali Membranacei Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) to assist yang qi. This intention behind Li Dongyuan's prescription is indeed perfect. However, while the Lung corresponds to Heaven and the Spleen to Earth, and their interaction creates the hexagram Tai (Peace), one must understand that before Tai comes Lin (Approach), and before Lin comes Fu (Return). These represent the origin of the three yang qi. Therefore, I formulated Buyin Yiqi Jian (Decoction to Tonify Yin and Augment Qi) to assist the qi of Lin and Fu, hoping to grasp the root principle and supplement what Li Dongyuan left incomplete. Furthermore, the use of Buzhong Yiqi Tang was originally designed to tonify the middle and support yang. However, there is a distinction regarding the appropriateness of supporting yang, which users must know. For instance, Li Dongyuan used this to treat fever due to fatigue and internal injury. Although described as supporting yang rather than inducing sweating, it inherently contains a dispersing action. Thus, it is most suitable for cold contracted due to fatigue, cough or malaria due to yang deficiency, and sinking of Spleen qi. However, if there is no exterior pathogen or chills/fever, but only severe deficiency of Middle qi, then Shengma and Chaihu are highly inappropriate. Why? Because both Shengma and Chaihu possess bitter-cold flavors and specific dispersing natures. Although Shengma enters the Spleen and Stomach meridians and Chaihu enters the Liver and Gallbladder meridians, guiding clear qi upward, only when pathogens exist can they be dispersed via ascent. Without pathogens, will they not further deplete Middle qi through dispersion? Even if this decoction is primarily a tonic relying on Shengma and Chaihu to guide clear qi, slight deficiency may tolerate this, but severe deficiency cannot borrow from it. At such times, even pure tonification might be insufficient; adding dispersing herbs makes success unlikely. Moreover, all yang-tonifying agents have ascending properties because yang governs ascent. Using the ascending quality without the dispersing quality is the great method of tonifying yang, containing profound mysteries, so why rely solely on Shengma and Chaihu? Therefore, Kou Zongshi's strong warning against using Chaihu for the five labors and seven injuries is truly insightful, even though Li Shizhen refuted it. What need is there for me to argue further? Principles are fixed; who can transcend them? I hereby highlight the key point: what disperses cannot gather; what drains cannot tonify; and bitter-cold substances certainly do not support yang. This alone serves as definitive proof, allowing the chaotic debates to be settled.

Therefore, among various syndromes, those unsuitable for this formula must be carefully examined. It is contraindicated for insecure exterior with unconsolidated sweating. It is contraindicated for yin-deficiency fever without exterior pathogens. It is contraindicated for floating yang due to rootless yang (false heat signs like Daiyang). It is contraindicated for extreme Spleen-Lung deficiency with shortness of breath resembling asthma. It is contraindicated for deficiency-cold diarrhea due to Mingmen fire decline. It is contraindicated for hematemesis and epistaxis due to water deficiency and hyperactive fire. It is contraindicated for cold limbs and impending yang collapse due to yang deficiency. In summary, for extremely deficient yuan qi, nothing should be drained; for exhaustion of yin and yang below, nothing should be ascended; for failure of true fire, cooling agents must absolutely not be used. People today only know that Buzhong Yiqi Tang can tonify deficiency and universally revere it, unaware that in urgent conditions, critical distinctions are made in an instant, where minute errors are unacceptable. Such cases are precisely of this nature, and how could I possibly exhaustively describe them in writing?