前门及以下八门，皆须互意参看，读者请知之。
脉候 脉来滑者，为病食也。（《脉经》）（按∶此上曰寸口之中。）
脉弦上寸口者，宿食。降者，头痛。（同上）
浮而滑者，宿食。浮滑而疾者，食不消，脾不磨。（同上）
寸口脉盛而紧者，伤于食。脉缓大而实者，伤于食也。（《病源论》）
经曰气口紧而伤于食，心胸满而口无味，与气口同。气口者，乃脾之外候，故脾胃伤则气口紧盛。（《保
命集》）（按∶原便就气口分轻重，举在次款。）
两手脉皆模糊不清，此宿食结滞，胃气不行，急下夺之。伤食脉有滑涩之异，脾虚不鼓运，胃虚不能熟腐，
故其脉不滑而涩，涩甚则模糊不清矣。（《医通》）
证治诸说 宿食不消，由脏气虚弱，寒气在于脾胃之间，故使谷不化也。宿谷未消，新谷又入，脾气既
弱，故不能磨之，则经宿而不消也。令人腹胀气急，噫气醋臭，时复憎寒壮热是也。或头痛如疟之状。（《病源
论》）
夫食过于饱，则脾不能磨消，令气急烦闷，睡卧不安。（同上）
卒食病似伤寒候，此由脾胃有伏热，因食不消，所以发热，状似伤寒，但言身不疼痛为异也。（同上）
胃中有 食冷物，即痛不能食，有热物即欲食。大腹有
宿食，寒栗发热，如疟状。宿食在小腹者，当暮发热，明旦即止。（《千金》）
夫 饪之邪，从口入者，宿食也。盖五味入口，所以滋养五脏，得之则生，不得则死，伤之则反为生害，
所以宿食为杂病之先。若五脏不平，食不输化，血凝气滞，群证蜂起，皆宿食所为也。治之当量其脏腑虚实浅深
为治，其病头痛，恶风憎寒，心腹胀满，下利不欲食，吞酸噫宿腐气，皆胃实热，食反留滞，其脉数而滑，宜下
之愈。若脾虚，其脉浮大，按之反涩，尺中亦微涩，宜温药消。（《三因》）（按∶陈氏附有如神木香丸、感应
丸，盖所谓温药也。木香丸用木香、 砂、莪、棱、姜、附等十二味。）
善摄生者，谨于和调，使一饮一食，入于胃中，随消随化，则无滞留之患。若禀受怯弱，饥饱失时，或过餐
五味鱼腥乳酪，强食生冷果菜，停留胃脘，遂成宿滞，轻则吞酸呕恶，胸满噫噎，或泄或利（按∶《集成》此下
曰∶其臭如抱坏鸡子），或米谷不化，久则积聚，结为 瘕，面黄羸瘦，此皆宿滞不消而生病焉。（《济生》）
治之须究其原，又须量人气体虚实，病证浅深，投以药饵。病之浅者，则消化之。甚者必须推利，而后调补
脾胃。或有因挟寒暑之气而泄者，又当以脉证辨而料量之。（《大成》）
伤食必恶食。（《丹溪》）
夫伤者，有多少，有轻重。如气口一盛，脉得六至，则伤于厥阴，乃伤之轻也，槟榔丸主之。气口二盛，脉
得七至，则伤于少阴，乃伤之重也，煮黄丸（用雄黄、巴豆）、浓朴丸（用浓朴、黄连、巴豆等二十五味，云与
局方温白丸同）主之。气口三盛，脉得八至，则伤于太阴， 塞闷乱，甚则
心胃大痛，兀兀欲吐，得吐则已，俗呼食迷风是也。经曰上部有脉，下部无脉，其人当吐，不吐则死。宜吐之
以瓜蒂散，如不能则无治也。经曰高者因而越之，下者引而竭之是也。（《保命集》）
食伤太阴、厥阴，寸口大于人迎两倍、三倍者，或呕吐，或痞满，或下痢肠 ，当分寒热轻重而治之。轻则
内消，重则除下。如伤寒物者，半夏、神曲、干姜、三棱、广术、巴豆之类主之。如伤热物者，枳实、白术、
青皮、陈皮、麦 、黄连、大黄之类主之。亦有宜吐者，《阴阳应象论》云在上者因而越之，瓜蒂散之属主之。然
而不可过剂，过剂则反伤肠胃。盖先因饮食自伤，又加之以药过，故肠胃复伤，而气不能化，食愈难消矣，渐至
羸困。故《五常政大论》云∶大毒治病，十去其六；小毒治病，十去其七。凡毒治病，不可过之，此圣人之深戒
也。（《兰室》）
夫膏粱之人，起居闲逸，奉养过度，酒食所伤，以致中脘留饮胀闷，痞膈醋心，可服木香导饮丸（按∶子和
书无所考）以治之。夫 荛之人，饮食粗 ，衣服寒薄，劳役动作，一切酒食所伤，以致心腹满闷，时呕酸水，
可用进食丸（用牵牛、巴豆）治之。（《治病百法》）
初因食一物过伤，得病后再食之，旧病复作，一味红丸子常服。伤食兼感风寒，其证与前同（按∶前文用巢
氏说），但添身疼一证，俗谓之夹食伤寒，宜生料五积散，或养胃汤、香苏散、和解散（见《和剂》）选用。若不瘥
而病入里者，宜下之。（《要诀》）
凡治饮食暂伤者，亦当辨虚实。若停滞中焦，或胀或痛者，此实证也，当先去其食，宜大和中饮主之（用陈、枳、
砂，楂、朴、麦芽、泽泻）。然去食莫先于理气，又惟排气
饮为主（用陈、藿、枳、泽、朴、乌药、香附、木香）。若所停犹在上焦，莫若用吐为捷法，或用吐剂亦可。若
食停下焦，痛极兼胀者，须下而去之，宜神 丸或备急丸。（《景岳》）
饮食伤脾而吐泻已甚者，但察其无中满，无腹痛，而惟呕恶不能止，此其食物必已尽去，而以中气受伤，
大虚而然。或其人困倦不宁，少气多汗，六脉豁大无神者，宜理中汤之类主之。凡大吐大泻之后，多为腹胀，若
但外胀而内不觉胀，或恶闻食气，不欲饮食者，皆脾胃大虚之候，速宜用温补诸法调治之。（同上）
病后胃口不开，饮食不进者，有二证∶盖一以浊气未净，或余火未清，但宜以小和中饮（用陈、楂、茯、朴、
甘、扁豆）加减主之。一以脾胃受伤，病邪虽去而中气未复，故或有数日不能食，或旬日不能开，或胸喉中若有
所哽如梅核气者，此中本无停积，但以阳气未舒，阴翳作滞，胃气太虚，不能运化而然，轻则温胃饮（系理中加归、
陈、扁豆）甚则必加人参、附子，但使阳气得行，则胃口自开也。（同上）
饥饱伤者，胃寒积亏，补之则气自复。饮食伤者，中有停积，胃气不行，若非攻克，病何由除。然有寒伤、
有热伤，有暂病、有久病，有虚证、有实证。寒者非热不行，热者得寒乃解。新食而实者，在上则吐之，在中则消
之；其虚者，必补益与消导兼行，如洁古枳术丸之类是也。久伤而实者，在中则和之，在下则减之；其虚者必纯与
甘温怏脾壮气，如理中汤、养胃汤之类是也。（《汇论》）
食滞心下，初起不可骤用苦寒，必兼辛散，二陈、平胃消导之，及枳实、白术、青皮、陈皮、山楂、曲、 之类，
以食得寒则凝，得热则腐也。日久成积发热者，加姜汁炒川
连、连翘之属清利之。若已成糟粕，日久生热，燥结不行，方可用承气辈攻下之。如冷物停滞作吐，二陈加炮姜、
白豆蔻、苍术、浓朴、神曲、藿香之类，甚则广术、巴豆之属。若冷食停蓄，心腹暴痛作胀，当用红丸子、备急
丸温下之。痰饮结聚，谷不得入，冷痰宿食在上脘者，用白散涌吐之。痰食已消，中焦未和，不思饮食，或吐或
泻，倦怠面黄，按之心下软，脾胃受伤也，六君子加木香、砂仁；燥渴，用七味白术散。老人虚人易于伤食，或膨
胀痞闷，或腹满作泻，当消补兼施，宜九味资生丸（系四君子加橘红、楂肉、神曲、黄连、白蔻）常常服之。若口
淡思食，而见食不甘，食过则厌，兼恶心胸膈不快，胃虚挟痰饮也，六君子加枳实、香、砂。若不思饮食，食不克
化，食后反饱，脾虚不能健运也，枳实理中丸。病后饮食不调，中脘隐隐作痛，有时得食则已，有时得食转加，此
胃中火燎作痛，得食以压其势，故痛少安，若饮食稍过，气不能运转其食，其痛转加，连理汤加沉香。（《医通》）
伤食，忌润湿、苦寒，宜健脾、消导、甘温、辛香。（《本草经疏》）
鹤年曰∶伤食与停食宜分两项∶伤食者，饮食自倍，肠胃乃伤，病在不及消化；停食不论食之多少，或当食
而怒，或当食而病，在气结而不能化也。治伤食，宜偏重于食，或吐或下或消；若停食，则偏重在气，惟理气而
兼之以消，吐下之法不可用也。大都伤食当分上中下三焦，而停食则专在胃脘也。（《金匮翼》）
病当审虚实 饮食伤，尤当于不足之中，分其有余不足也。何也？盖饥饿不饮食，与饮食太过，虽皆是
失节，然必明其有两者之分，方尽其理。节也者何？无不及、无太过之
中道也。夫饥饿不饮食者，胃气空虚，此为不足，固失节也；饮食自倍而停滞者，胃气受伤，此不足之中兼有余，
亦失节也。以受伤言则不足，以停滞言则有余矣。惟其不足故补益，惟其有余故消导。亦有物滞气伤，必补益
消导兼行者。亦有物暂滞而气不甚伤，宜消导独行，不须补益者。亦有既停滞不复自化，不须消导，但当补益，
或亦不须补益者。洁古枳术丸、东垣橘皮枳术丸、木香枳术丸之类，虽曰消导，固有补益之意存乎其间。其他如
木香分气丸、导气枳实丸、大枳壳丸之类，虽无补益，然施之于物暂滞、气不甚伤者，岂不可哉，但不宜视为
通行之药耳。且所滞之物，非枳术丸之力所能去者，亦安可泥于消导而不知变乎。故备急丸、煮黄丸、感应丸、
瓜蒂散等之推逐者，洁古，东垣亦未尝委之而弗用也。故善将兵者，攻亦当，守亦当，不善者，则宜攻而守，
宜守而攻，其败也非兵之罪，用兵者之罪耳。观乎此，则知消导、补益、推逐之理矣。（《溯洄集》）
内伤之证，又有虚实之分。如饮食失饥，劳役所伤，发热自汗，倦怠乏力，乃虚中之虚，宜补益中和之剂调
治，毋施解表。若饮食过饱，乃虚中之实，为其所伤饮食积滞不消，以致心胸痞闷，仍发寒热，恶心恶食，须用
化导之剂，俟其消克，心胸舒泰，仍用益脾之药，使无重虚元气。有宿食不消，日晡潮热，气实者，下之亦要详
审，毋妄通利。（《原病集》）
伤食伤饮之别 《痹论》云∶阴气者静则神藏，躁则消亡，饮食自倍，肠胃乃伤。此混言之也，分之为
二，饮也，食也。又经云∶因而大饮则气逆，因而饱食，筋脉横解，则肠 为痔。饮者无形之气，伤之则宜发汗利
小便，使上下分消其湿，解酲汤、五苓散之类主之。食者有形之物，伤之则
宜损其谷，其次莫若消导，丁香烂饭丸（用丁、木、莪、棱、香附、砂仁、甘松等十味）、枳术丸之类主之。稍重
则攻伐，三棱消积丸（用莪、棱、炒曲、青皮、巴豆、茴香等）、木香见 丸（用木香、香附、神曲、三棱、草蔻、
巴霜等）之类主之。尤重者，则或吐或下，瓜蒂散、备急丸之类主之。以平为期。盖脾已伤，又以药伤，使营运之
气减，则食愈难消。（《辨惑论》）（按∶此与前款《兰室》文相类，宜互参。）
伤饮脉症 饮即茶汤酒水之类，或脾虚不运而结滞，或暴渴多饮而停留，或豪兴狂饮而沉醉，或僧家清
客以茶茗自供，往往至后面黄肌瘦，脾泄中满，烦渴肿胀，若遇利疾，危者不少，六脉濡微细滑，举按无力。（《百
问》）
药各有对 人之腑脏，皆因触冒以成疾病，而脾胃最易受触。盖日用饮食，稍或过多，则停积难化，冷
热不调，则吐呕泄痢，膏粱者为尤甚，盖口腹纵恣，不能慎节。近用消化药，或论饮食既伤于前，难以毒药反攻其后，
不复使巴豆、 砂等药，止用曲、 之类。殊不知古人立方用药，各有主对。曲 止能消化米谷。如肉食有伤，
则非 砂、阿魏等药不能治也。至于鱼蟹过伤，则须用橘皮、紫苏、生姜。果菜有伤，则须用丁香、桂心。水饮伤，
则须用牵牛、芫花。固不可以一概论也。必审其所伤之因，对用其药，则无不愈。其间轻重，则随患人气血以增减
之而已。（《鸡峰》）
克伐可否（宜与前虚实条相参）《养生方》戒不得用巴豆，令服青木香丸。如有食癖，非巴豆不克，所
谓扰乎可扰，扰亦无扰。木香丸用牵牛，牵牛最泻人肾，不徒不消食积，而又害于元精，识者知之。（《三因》）
大率才有停滞，当量人虚实，速宜克化之，不可后时，
养成沉 也。（《济生》）（按∶严氏有黑丸子、如意丸、阿魏丸三方，然俱不出感应丸之范围，仍不采入。）
凡饮食伤脾之证，有寒伤，有热伤，有暂病，有久病，有虚证，有实证。但热者暂者实者，人皆易知，而寒
者久者虚者，人多不识。如今人以生冷瓜果致伤胃气，而为泻为痢为痛之类者，人犹以为火证而治以寒凉者，
是不识寒证也。有偶因停滞而为胀为痛者，人皆知其实也。然脾胃强壮者，即滞亦易化。惟其不能化者，则最有
中虚之证。故或以不食亦知饥，小食即作胀，或以无饥无饱，全然不思饮食，或以胃虚兼呕而腹满膨膨，或以火
不生土而时食时吐。或中气不化，则胸喉若有所哽，而本非饮食之滞者。或因病致伤胃气，则久不思食，而本非中
满之病者。且胃病于暂者多实，脾病于久者多虚。时医于此，无论邪正久暂，鲜有不用开胃消导等剂，是不知虚证
也。盖脾胃之职，原以化食为能。今既不能化食，乃其所能者病，而尚可专意克化以害其能乎。且凡欲治病，必
The preceding sections and the following eight categories must be cross-referenced; readers should be aware of this.
**Pulse Diagnosis**
A slippery pulse indicates food retention (Shi Shi, retained food). (*Mai Jing*) (Note: The above refers to the Cun Kou position.)
A wiry pulse extending to the Cun Kou position indicates retained food. A sinking pulse indicates headache. (Ibid.)
A floating and slippery pulse indicates retained food. A floating, slippery, and rapid pulse indicates indigestion and weak spleen grinding function (Pi Bu Mo, the spleen's inability to transform food). (Ibid.)
A vigorous and tight pulse at the Cun Kou indicates injury from food. A slow, large, and excess pulse also indicates injury from food. (*Bing Yuan Lun*)
The classics state: A tight Qi Kou pulse indicates injury from food, accompanied by fullness in the chest and heart and a tasteless mouth, which corresponds to changes in the Qi Kou. The Qi Kou is an external manifestation of the spleen; therefore, when the spleen and stomach are injured, the Qi Kou pulse becomes tight and vigorous. (*Bao Ming Ji*) (Note: The original text uses the Qi Kou to distinguish severity, with examples given in the next clause.)
If the pulses on both hands are indistinct, this indicates retained food stagnation and blocked stomach qi; urgent purgation is required. Injuries from food can present with either slippery or choppy pulses. Spleen deficiency fails to propel qi and blood, and stomach deficiency fails to rot and ripen food, resulting in a pulse that is not slippery but choppy. Severe choppiness leads to an indistinct pulse. (*Yi Tong*)
**Discussion on Symptoms and Treatment**
Retained food that does not digest is caused by weakness of the zang organ qi and cold qi residing between the spleen and stomach, preventing grain digestion. When old undigested food remains and new food enters, the already weak spleen cannot grind it, leading to non-digestion overnight. This causes abdominal distension, shortness of breath, belching with a sour odor, alternating chills and high fever, or headaches resembling malaria. (*Bing Yuan Lun*)
Overeating prevents the spleen from grinding and digesting, causing shortness of breath, irritability, chest oppression, and restless sleep. (Ibid.)
Acute food injury may resemble Tai Yang Shang Han (Exterior Cold Syndrome); this is due to latent heat in the spleen and stomach. Because food does not digest, fever occurs, resembling Shang Han, but distinguished by the absence of body pain. (Ibid.)
Cold food in the stomach causes pain and anorexia; hot food induces appetite. Retained food in the abdomen causes chills and fever resembling malaria. Retained food in the lower abdomen causes fever in the evening, resolving by morning. (*Qian Jin*)
Pathogenic factors from cooked food entering through the mouth constitute retained food. The five flavors enter the mouth to nourish the five zang organs; obtaining them ensures life, lacking them leads to death, and injuring them becomes harmful. Thus, retained food is often the precursor to miscellaneous diseases. If the five zang organs are imbalanced, food transmission and transformation fail, blood coagulates, and qi stagnates, causing various symptoms to arise from retained food. Treatment must assess the deficiency or excess and depth of the zang organs. Symptoms such as headache, aversion to wind and cold, chest and abdominal fullness, diarrhea with anorexia, acid regurgitation, and belching of rotten food indicate stomach excess-heat with food stagnation; the pulse is rapid and slippery, and purgation is indicated for cure. If spleen deficiency is present, the pulse is floating and large, becoming choppy upon pressure, with slight choppiness at the Chi position; warming herbs are indicated for resolution. (*San Yin*) (Note: Chen Shi included Renshen Muxiang Wan and Yinggan Wan, referred to as warming herbs. Muxiang Wan contains Muxiang, Sharen, Ezhu, Sanleng, Jiang, Fuzi, etc., twelve ingredients.)
Those skilled in health preservation carefully harmonize their diet, ensuring that every drink and meal entering the stomach is digested and transformed immediately, avoiding stagnation. However, those with weak constitution who eat irregularly, or overconsume the five flavors, fish, seafood, dairy, or force raw/cold fruits and vegetables, cause food to remain in the epigastrium, forming retained stagnation. Mild cases present with acid regurgitation, nausea, chest fullness, and obstructive belching, or diarrhea (Note: *Ji Cheng* adds: smelling like a rotten egg), or undigested grains. Long-term stagnation leads to accumulation and formation of masses (Jia), yellow complexion, and emaciation. These are all diseases arising from unresolved retained stagnation. (*Ji Sheng*)
Treatment requires investigating the root cause and assessing the patient's constitutional strength and disease depth to administer appropriate medication. For mild cases, digestive methods are used. For severe cases, purgation is necessary, followed by spleen and stomach tonification. If diarrhea is caused by concurrent cold or summerheat, differentiation by pulse and symptoms is required. (*Da Cheng*)
Food injury invariably involves aversion to food. (*Dan Xi*)
Injury varies in degree and severity. If the Qi Kou pulse is one-fold stronger than normal, reaching six beats per respiration cycle, the injury affects the Jue Yin channel, representing mild injury, treated with Binglang Wan. If two-fold stronger, reaching seven beats, the injury affects the Shao Yin channel, representing severe injury, treated with Zhuhuang Wan (containing Xionghuang, Badou) or Houpo Wan (containing Houpo, Huanglian, Badou, etc., twenty-five ingredients, similar to Ju Fang Wenbai Wan). If three-fold stronger, reaching eight beats, the injury affects the Tai Yin channel, causing chest obstruction, mental confusion, severe heart and stomach pain, and urge to vomit; vomiting resolves it. This is commonly called "Food Dizziness" (Shi Mi Feng). The classics state: If there is pulse above but no pulse below, the patient should vomit; if they do not, they will die. Genti San is indicated for emesis; if emesis fails, there is no treatment. The classics state: "For pathogens high up, induce vomiting; for pathogens low down, drain them." (*Bao Ming Ji*)
Injury to Tai Yin and Jue Yin channels, where Cun Kou is two or three times larger than Ren Ying, presenting with vomiting,痞满 (pi man, fullness/oppression), or dysentery with abdominal pain, must be treated according to cold/heat and severity. Mild cases are resolved internally; severe cases are purged. For cold food injury, Banxia, Shenqu, Ganjiang, Sanleng, Ezhu, Badou, etc., are used. For hot food injury, Zhishi, Baizhu, Qingpi, Chenpi, Maiya, Huanglian, Dahuang, etc., are used. Emesis is also indicated for upper jiao retention, citing *Yin Yang Ying Xiang Lun*: "For high pathogens, induce vomiting," using Genti San. However, dosage must not be excessive, as over-medication damages the intestines and stomach further. Since the initial injury was self-inflicted by diet, adding excessive drugs re-injures the gut, impairing qi transformation and making digestion harder, leading to emaciation. Thus, *Wu Chang Zheng Da Lun* states: "For highly toxic drugs, stop when 60% of the disease is gone; for mildly toxic drugs, stop when 70% is gone." This is a profound warning from the sages. (*Lan Shi*)
Those indulging in rich foods, living leisurely, and over-nourished suffer from wine and food injury, leading to fluid retention, distension, oppression, and acid reflux in the Zhong Wan (epigastrium). Muxiang Dao Yin Wan can be used (Note: Unverifiable in Zi He's works). Laborers eating coarse food, wearing thin clothes, and overworking suffer from heart and abdominal fullness and occasional sour vomiting due to wine and food injury. Shijin Wan (containing Qianniu, Badou) is indicated. (*Zhi Bing Bai Fa*)
If illness recurs after eating the offending food initially, Hongwanzi can be taken regularly. Food injury complicated by wind-cold presents similarly to previous descriptions (citing Chao Shi), but with added body pain, commonly called "Food-Complicated Shang Han." Shengliao Wuji San, Yangwei Tang, Xiangsu San, or Hejie San (from *He Ji*) can be selected. If the condition worsens and enters the interior, purgation is indicated. (*Yao Jue*)
When treating acute food injury, differentiate deficiency and excess. Stagnation in the middle jiao causing distension or pain is excess; remove the food first using Dahezhong Yin (Chenpi, Zhishi, Sharen, Shanzha, Houpo, Maiya, Zexie). Regulating qi is paramount; Paqi Yin (Chenpi, Huoxiang, Zhishi, Zexie, Houpo, Wuyao, Xiangfu, Muxiang) is primary. If stagnation is in the upper jiao, emesis is the quickest method. If stagnation is in the lower jiao with severe pain and distension, purgation is needed using Shenyou Wan or Beiji Wan. (*Jing Yue*)
For severe vomiting and diarrhea from spleen injury, if there is no middle jiao fullness or abdominal pain, only persistent nausea, the food has likely been expelled, and the issue is severe middle qi deficiency. If the patient is fatigued, short of breath, sweaty, with empty and large pulses without spirit, Lizhong Tang is indicated. After severe vomiting/diarrhea, abdominal distension is common. External distension without internal discomfort or aversion to food smells indicates severe spleen/stomach deficiency; warm tonification is urgent. (Ibid.)
Post-illness anorexia has two patterns: 1. Turbid qi or residual heat remains; treat with Xiaozhonghe Yin (Chenpi, Shanzha, Fuling, Houpo, Gancao, Bian Dou) modified. 2. Spleen/stomach injury with unrestored middle qi despite pathogen clearance. Days without appetite or sensation of a lump in the throat (Plum-pit qi) without actual stagnation indicates yang qi failure to expand and yin shadow stagnation due to extreme stomach qi deficiency. Mild cases use Weiwarm Decoction (Lizhong Tang plus Danggui, Chenpi, Bian Dou); severe cases require Renshen and Fuzi to restore yang and open the appetite. (Ibid.)
Injury from hunger/starvation involves cold accumulation and deficiency; tonification restores qi. Injury from overeating involves stagnation and blocked stomach qi; purgation is required. Differentiate cold/hot, acute/chronic, deficiency/excess. Cold requires heat; heat requires cold. Acute excess food injury: emesis for upper, digestion for middle. Deficiency cases require simultaneous tonification and digestion, e.g., Jiegu Zhiju Wan. Chronic excess injury: harmonize middle, reduce lower. Deficiency cases require pure sweet-warm spleen-strengthening formulas like Lizhong Tang or Yangwei Tang. (*Hui Lun*)
Initial food stagnation in the epigastrium should not be treated abruptly with bitter-cold herbs; combine with acrid-dispersing herbs. Erchen Tang and Pingwei San aid digestion, along with Zhishi, Baizhu, Qingpi, Chenpi, Shanzha, Shenqu, Maiya, etc., because food congeals with cold and rots with heat. Long-standing stagnation with fever requires Jiangzhi Chuan Lian and Lianqiao for clearing. If formed into feces with dry constipation from heat, Chengqi Tangs are used for purgation. Cold food vomiting: Erchen Tang plus Paojiang, Baidoukou, Cangzhu, Houpo, Shenqu, Huoxiang; severe cases add Ezhu, Badou. Cold food retention with acute pain/distension: Hongwanzi or Beiji Wan for warm purgation. Phlegm-fluid retention preventing intake, with cold phlegm/food in upper jiao: Baisan for emesis. After phlegm/food resolve but middle jiao unharmonized (anorexia, vomiting/diarrhea, fatigue, yellow face, soft epigastrium): Liujunzi Tang plus Muxiang, Sharen. Dry thirst: Qiwei Baizhu San. Elderly/weak easily injured by food causing distension/diarrhea: Jiuwei Zisheng Wan (Sijunzi Tang plus Juhong, Shanzha, Shenqu, Huanglian, Baiko) for regular use. Pale taste with craving but no satisfaction after eating, nausea/chest discomfort: Stomach deficiency with phlegm-fluid; Liujunzi Tang plus Zhishi, Muxiang, Sharen. No appetite, poor digestion, postprandial fullness: Spleen deficiency failing to transport; Zhishi Lizhong Wan. Post-illness dietary imbalance with vague epigastric pain relieved by eating but worsened by excess: Stomach fire pain suppressed by food; if qi fails to move food, pain increases; Lianli Tang plus Chenxiang. (*Yi Tong*)
Food injury contraindicates moistening and bitter-cold herbs; favors spleen-strengthening, digestive, sweet-warm, and acrid-aromatic herbs. (*Ben Cao Jing Shu*)
He Nian said: Distinguish food injury (Shang Shi) from food retention (Ting Shi). Food injury is overconsumption damaging digestion; treatment focuses on food (emesis, purgation, digestion). Food retention is qi knotting preventing transformation regardless of amount; treatment focuses on regulating qi with mild digestion, avoiding emesis/purgation. Food injury involves all three jiaos; retention is specific to the epigastrium. (*Jin Kui Yi*)
Disease assessment must distinguish deficiency and excess. Food injury requires analyzing excess within deficiency. Hunger/starvation is pure deficiency (loss of regulation). Overeating is deficiency mixed with excess (stagnation). From an injury perspective, it is deficiency; from a stagnation perspective, it is excess. Tonify deficiency; digest excess. Some cases require both. Some have temporary stagnation with mild qi damage, requiring only digestion. Some have permanent stagnation requiring only tonification. Jiegu Zhiju Wan, Dongyuan Jupi Zhiju Wan, Muxiang Zhiju Wan contain tonification within digestion. Other formulas like Muxiang Fenqi Wan lack tonification but suit temporary stagnation; they should not be used routinely. For stubborn stagnation beyond Zhiju Wan's power, variation is needed. Jiegu and Dongyuan did use purgatives like Beiji Wan, Zhuhuang Wan, Yinggan Wan, Genti San when necessary. Good generals know when to attack or defend; failure lies in the commander, not the troops. Understanding this clarifies digestion, tonification, and purgation principles. (*Su Hui Ji*)
Internal injury has deficiency and excess types. Irregular eating/labor causing fever, sweating, fatigue is deficiency-within-deficiency; treat with harmonizing tonics, avoid exterior-resolving. Overeating causing chest oppression, chills/fever, nausea is deficiency-within-excess; use transforming/digestive agents until relief, then tonify spleen to protect yuan qi. Retained food with afternoon tidal fever and excess qi requires careful purgation, avoiding reckless draining. (*Yuan Bing Ji*)
Distinction between Food and Drink Injury: *Bi Lun* states overeating injures intestines/stomach generally. Separating them: Drink (Yin) is formless qi/water; injury requires diaphoresis and diuresis to disperse dampness (Jie Cheng Tang, Wuling San). Food (Shi) is solid matter; injury requires reducing intake and using digestion (Dingxiang Lanfan Wan, Zhiju Wan). Moderate severity requires attacking (Sanleng Xiaoji Wan, Muxiang Jianchong Wan). Severe cases require emesis or purgation (Genti San, Beiji Wan). Aim for balance. Further drug injury to an already damaged spleen reduces transporting qi, worsening digestion. (*Bian Huo Lun*) (Note: Similar to *Lan Shi*, cross-reference.)
Pulse/Symptoms of Drink Injury: Drinks include tea/wine. Caused by spleen deficiency, sudden thirst drinking, or intoxication. Results in yellow skin, emaciation, spleen diarrhea, middle fullness, thirst, swelling. Dangerous if misdiagnosed as heat and treated with draining. Pulses are soggy, fine, slippery, weak on pressure. (*Bai Wen*)
Specificity of Medicines: Organs are injured by external pathogens; spleen/stomach are most vulnerable. Overeating causes stagnation; temperature imbalance causes vomiting/diarrhea. Rich food sufferers are worst due to lack of moderation. Recent trends avoid harsh drugs like Badou/Sharen after food injury, using only Shenqu/Maiya. This ignores ancient specificity. Shenqu/Maiya digest grains only. Meat injury requires Sharen, Awei. Fish/crab injury requires Chenpi, Zisu, Shengjiang. Fruit/vegetable injury requires Dingxiang, Guixin. Water/drink injury requires Qianniu, Yuanhua. Must match cause to medicine. Dosage adjusts to patient's qi/blood. (*Ji Feng*)
On Purging (Refer to Deficiency/Excess section): *Yang Sheng Fang* forbids Badou, prescribing Qingmuxiang Wan. For food癖 (癖积), only Badou works. Using Qianniu in Muxiang Wan harms kidney essence and fails to digest food. Wise practitioners know this. (*San Yin*)
Generally, upon stagnation, assess deficiency/excess and purge quickly to prevent chronic disease. (*Ji Sheng*) (Note: Yan Shi's Black Pill, Ruyi Pill, Aw ei Pill are variations of Yinggan Wan, excluded here.)
Food injury to spleen includes cold/hot, acute/chronic, deficiency/excess. Heat/acute/excess are easy to identify; cold/chronic/deficiency are often missed. Cold food injury causing diarrhea/pain is often misdiagnosed as heat and treated with cold herbs, missing the cold pattern. Temporary stagnation causing pain is known as excess; strong spleens digest it easily. Failure to digest indicates middle deficiency. Symptoms include hunger without eating, bloating with small meals, total anorexia, vomiting with fullness, or intermittent eating/vomiting due to fire not generating earth. Middle qi failure causes throat lump sensation without actual stagnation. Illness-induced stomach injury causes long-term anorexia without true fullness. Acute stomach disease is often excess; chronic spleen disease is often deficiency. Modern doctors rarely distinguish deficiency, overusing opening/digestive agents, harming the spleen's natural function of transformation. To treat disease...