脾胃位于中而最易受伤，巢太医书于五脏六腑外，更立脾胃诸病候，而后世诸家多从之，良有由也。今仍
其例，采掇方论，以冠伤食等证之首。至如东垣所谓内伤，则自是一种病，盖当时兵荒，人多劳役以致之，而
学人沿袭为说，不知其实非今日所见，兹仅存梗概，以备参照已。
中焦义蕴 胃处腹中，犹灶中之火；谷在腹外，犹灶外之薪。薪不得灶内之火则不燃，故谷气要胃气
腐之；火不得灶外之薪则易熄，故胃气要谷气充之。究竟火之燃薪，只是要变其体质，以为发端。既变后，莫
非取波之体，助我之用。薪在灶内燃动，薪势莫非火势，谷在腹中运化，谷气莫非胃气。当此薪火合势，炎炎
不息时，自有一种升腾簇动之象氤氲而发为焰者，充盈于灶内，此即胃家之有中气也。胃气指
腑言，中气指焦言。凡火之能腐熟一切，使釜中之气，充盈蒸润，能升能溢者，皆焰之力也，焰力到则釜中之
气足。釜中之气在人身，即膻中之气也，凡所谓洒陈六腑、和调五脏者，皆此气透上华盖，而肺得之以输布周
身者也。故凡肺气虚者，膻中之气乏也，膻中之气乏者，釜底之焰微也。欲盛其焰，须是火足；欲足其火，须
是薪添。薪之为言谷也，谷入于阴，长养于阳，则实此谷者，非阳而何。然则胃之有阳气，又何气也？曰∶阳气
之与胃气，一而二、二而一者也。胃气从发宣处见，虽是发宣，只有具体；阳气从包蕴处见，虽是包蕴，用则
无穷。究而言之，阳气即胃中所禀之性，犹夫火之云热也。火性热，故釜底热，则釜上无火之处无不热。火不
能化一切之非火而为火，而火性之热，则能化一切之非热而为热。故谷气足则胃气充，尚是后一层事；而阳气
充则谷气化，实是先一层事。犹之夫火，将欲化彼之非热而为热，自不得不先化此薪之非火而为火也。所以此
处之阳，专隶在胃上言，非与阴字对看，乃胃之所具，以统乎五脏六腑者也。其所以统乎五脏六腑者，正以其
能长养谷气也。谷气者五脏六腑皆以受气，故能养此者即能统彼，以中气在我，凡四旁上下之气，皆从我布也。由中气
列之为阳气、为胃气、
为谷气，此皆就其气候未成，物交物则引之者而言；若已经融化后，则数气只抟为一气。一气者，何气也？中
气也。以其于数者完全具足，而又能扩而充之，天地已于此分造化，更何诸气之偏隶乎。故治法，只以中之一
字该之，而助阳化谷，以宣行胃气，则皆理字内功夫也（按句曰脏腑不调，中气不运，病久不愈，俱理中证，
故测云尔）。若脾之为气，不过为胃行其津液，平常只可与胃作对峙，而在此处，犹之薪火接合处，用之作抽
添扇扬力者。火非抽添扇扬则不炎，
胃无消磨健运则不化，故言胃气，内已该括及脾气，不可抽出与中气、阳气、谷气等并提而互举也。此则中焦
之义蕴，大略尽此。盖人身之有气血津液，皆从中焦造作酝酿出来，到得膻中而上，则有升有降，皆从自然处
布宣，无待于五脏六腑之为造作、为酝酿也。然则中之一字在人身，其为义之大何如也。（《医径句测》）
脉候 关上脉涩而坚，大而实，按之不减有力，为中焦实，有伏结在脾，肺气塞，实热在胸中。关上
脉时来时去、乍大乍小、乍疏乍数者，胃中寒热，羸劣不欲饮食，如疟状。尺脉弱寸强，胃络脉伤。（《脉经》）
实紧，胃中有寒，苦不能食，时时利者。难治（一作时时呕，稽留难治）。滑疾，胃中有热。（同上）
趺阳脉浮而涩，浮即胃气微，涩即脾气衰，微衰相搏，即呼吸不得，此为脾家失度。趺阳脉微而涩，微即
无胃气，涩即伤脾，寒在于膈而反下之，寒积不消，胃微脾伤，谷气不行，食已自噫，寒在胸膈，上虚下实，
谷气不通，为秘塞之病。凡有所击仆，若醉饱入房，汗出当风则伤脾，脾伤则中气，阴阳离别，阳不从阴，故
以三分候死生。（同上）（按∶三分未详其义，或者三部，当考。）
尺中伏，水谷不消。寸口弦，胃中拘急（一作心下 ）。关上弦，胃中有寒，心下拘急。关上数，胃中
有热。关上芤，胃中虚。（同上）
人身之脾胃，专借之以容纳五谷而克化之。脾属土而居五脏之中，寄旺于四时之内，以土能容载万物，故
好静。其脉常喜沉细而缓，带浮紧洪数者，即有病之脉也。（《大成》）
证治诸说 脾者脏也，胃者腑也，脾胃二气相为表里，
胃受谷而脾磨之。二气平调，则谷化而能食。若虚实不等，水谷不消，故令腹内虚胀或泄，不能饮食，所以谓
之脾胃气不和，不能饮食也。（《病源论》）
胃中元气盛，则能食而不伤，过时而不饥。脾胃俱旺，则能食而肥。脾胃俱虚，则不能食而瘦，或少食而
肥，虽肥而四肢不举，盖脾实而邪气盛也。又有善食而瘦者，胃伏火邪于气分则能食，脾虚则饥肉削，即食
也。叔和云多食亦肌虚，此之谓也。夫饮食不节则胃病，胃病则气短精神少而生大热，有时而显火上行，独燎
其面。《黄帝针经》云∶面热者足阳明病。胃既病则脾无所禀受，脾为死阴，不主时也，故亦从而病焉。形体
劳役则脾病，脾病则怠惰嗜卧，四肢不收，大便泄泻。脾既病，则其胃不能独行津液，故亦从而病焉。（《脾
胃论》）
寻常理脾助胃之道，当用以平和之药。（《大成》）
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。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。脾胃停食，不能消导，曲 橘半枳术丸或保和丸。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。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（是钱氏方）。胃火齿痛，清胃散（
方见《口齿》中）。脾胃中湿者，平胃散。脾胃中湿泻利者，胃苓汤，脾胃寒湿脾泄者，椒术养脾丸。（《指掌》）
（养脾丸系理中加麦芽、茯苓、苍术、砂仁、川椒）
若人脾胃素弱，饮食虽化，食多即腹中不和，疼痛泄泻，此虚寒也，宜温补兼消导。若人性多气恼，夹气
伤食，气滞不通者，宜行气而化食。若人能食好食，而食后反饱难化，此胃火旺而脾阴虚也，宜清胃以扶脾。
若年高人脾虚血燥，易饥易饱，大便燥难，宜润之养之，消之升之。（《医彀》）
脾虚，忌下、降泄、破气、苦寒，宜甘温，佐以辛香、酸平。饮食劳倦伤脾发热，忌破气、发散、下、苦
寒，宜补中益气、甘温升、酸。饮食不消化，属脾气虚，忌破气、消导克伐、苦寒，复忌燥。胃虚，忌下、破
气、苦寒、燥热，宜益气、甘平、甘淡、酸。胃弱不纳食及不思饮食，忌同胃虚，宜同胃虚，仍分寒热治。脾
实，即湿热邪胜，忌湿润、收涩、滞腻、热、咸、甘，宜除湿清热、利小便、辛散、风燥、苦寒。胃实，忌升、
补敛、辛温、燥热、湿润，宜下，如邪未结，宜清热、发散、苦寒、辛寒、甘寒。（《本草经疏》）
不嗜食（妇人不食）（食挂）不嗜食有数端，有三焦客热不嗜食，有胃热不嗜食，有胃寒不嗜食，有
六腑气寒不嗜食，固当随证用药治之，而针灸者亦当知补泻之法可也。（《资生》）（按∶《医通》载绝粒不
食，用鹅血效，录在《膈噎》中，宜参。）
有人全不进食，服补脾药皆不验。予授此方（按∶即二神丸，用破故纸、肉豆蔻，方见《泄泻》），服之
顿然而愈。此病不可全作脾虚，盖因肾气怯弱，真元衰劣，自是不能消化饮食。譬如鼎釜之中，置诸米谷，下
无火力，虽终日米不熟，其何能化。黄鲁直尝记服菟丝子净淘酒浸曝干，日抄数
匙，以酒下，十日外，饮啖如汤沃雪，乃知此理也。（《本事》）（按∶《要诀》以不喜食分为四证，其说
颇为嗳昧，不录。）
不能食者，由脾胃馁弱，或病后而脾胃之气未复，或痰客中焦，以故不思食，非心下痞满而恶食也。治当补
益以开豁之，丹溪导痰运脾之法皆是也。（《赤水》）
不能食，有虚有实。实则心下痞满口苦，宜消导。虚则倦怠面色痿黄，必心下软和，宜异功散加砂仁；有
虚痰者，六君子汤。（《汇补》）
恶食非止一端，有胸中痰滞者，宜导痰以助脾。有伤食恶食者，宜消化以助脾。有病久胃虚者，宜参术以健
脾。（同上）
不能食者，胃中元气虚也，然有虚冷虚热之异，宜分别治之。（《金匮翼》）
一妇人年三十余，忽不进饮食，日饮清茶三、五碗，并少用水果，三年余矣，经行每次过期而少。余以为
此脾气郁结，用归脾加吴茱，不数剂而饮食如常。（《内科摘要》）
一妇人年逾二十，不进饮食二年矣，日饮清茶果品之类，面部微黄浮肿，形体如常，仍能步履，但体倦，
肝脾二脉弦浮，按之微而结滞。余用六君加木香、吴茱，下痰积甚多，饮食顿进，形体始瘦，卧床月余，仍服六
君之类而安。
（同上）（按∶《丹溪翁传》一女子病不食且半载，翁诊之，肝脉弦出左寸口。曰∶此思男子不得，气结于
脾故耳。乃以怒解之。当参。）
朱思古，眉州人，年三十岁时，得疾不能食，闻荤腥即呕，惟用大铛旋煮汤，沃淡饭，数数食之，医莫能治。
史载之曰∶俗辈不读医经，而妄欲疗人之疾，可叹可骇，君之疾正在《素问》经中，名曰食挂。凡人之肺六叶，
舒张而盖，
下覆于脾。子母气和，则进食。一或有戾，则肺不能舒，脾为之敝，故不嗜食。遂授之一方，以清气润肺为治。
服之三日，病者鼻闻肉味觉香，取啖之甚美。此事宋人载于传记（按∶此出《闲窗括异志》），余考之岐黄书，
皆无食挂之说，或记者假托耳，或史公妄言，以欺世惑人欤，二者皆未可知。（《续医说》）
善饥（善食而瘦）（不能食而瘦） 舍侄偶食罢即饥，再食又饥，自碎生姜，浓泡二碗服愈。（《资生》）
易饥属脾家邪火，忌升、辛温、大热、香燥，宜清火除热、生津液、益脾阴、甘寒、苦寒、酸寒。（《本
草经疏》）
善食而瘦者，多因有火（按∶此本于东垣，既见上），然当察火之微甚。微火者，微清之，如生地、芍药、
丹皮、沙参、麦冬、石斛、竹叶、地骨皮、黄芩、知母、细甘草之属是也。若火甚者，或随食随饥，随饮随渴，
或肌肤燥热，二便涩结，则石膏、黄连、栀子、黄柏、龙胆草、苦参之属所不可免。此当察其三焦五脏，随所
在而治之。然阳盛者阴必虚，如一阴煎、二阴煎、四阴煎之属，皆当择而用也。不能食而瘦者，必其脾胃虚弱，
不能健运而然，故或为嗳气吞酸、痞满不饥等证，宜四君子汤、归脾汤。（《景岳》）
湿热 湿热之原，盖因寒温饥饱失常，喜怒劳役过度以伤脾胃。夫脾胃乃水谷之海也，今脾胃受伤而
动火，火则熏蒸水谷而为湿热者也。又按胃司纳受，脾司运化，今脾不能运化饮食，饮食停积而生湿热，亦良
多矣。为治之法，人壮实则专攻其湿热，人弱虚则攻补兼施，而补脾、消谷、导水三者不可阙一也。（《丹溪
附余》）
《脉理提纲》曰∶湿热，脉缓大。（同上）
血虚脾弱 今之人治脾病，不曰补，则曰健。《内经》
曰∶脾苦湿，急食苦以燥之。参、苓、白术，补之燥之者是也。又如易所称天行健，易老作枳术丸，一消一补，
健之者是也。二者世人知之矣，至于血虚脾弱，鲜有论及其理何哉？人之五脏，二脏属气，三脏属血。脾血藏也，
善统血者也。血枯脾弱，致失其职，亦不能司转输。用参术补之燥之则误，一消一补健之则非。吾乡溪南吴隐君
（讳正学）传一秘方，名正中散，用当归、白术、香附、茯神、黄连、木香，共为末，胸胀伤食气逆，随意米饮、
酒、水皆可调服，传之数世，皆谓神方。客问曰∶血虚脾弱，外证何似？曰∶思虑则伤脾。心脾相连，心生血而
脾统血。血枯脾弱，外证则大肠干燥而秘结，非若饮食不节，脾气损伤，大肠多溏也。当归补血药，故用之最多。
然不外乎实脾土，故次多白术。思虑者，开郁为主，香附次之。宁神者，茯神为先，则又次之。血少火生，黄连
用以清火。然气又不可不顺，故少加木香。（《星海》）
东垣内外伤辨概略 外感八风之邪，乃有余证也。内伤饮食不节，劳役所伤，皆不足之病也。其内伤亦
恶风自汗，若在温暖无风处，则不恶矣。与外伤鼻流清涕、头痛、自汗颇相似，细分之特异耳。外感风邪，其恶
风、自汗、头痛、鼻流清涕，常常有之，一日一时，增加愈甚，直至传入里作下证乃罢，语声重浊，高厉有力，
鼻息壅塞而不通，能食腹中和，口知味，大小便如常，筋骨疼痛，不能动摇，便着床枕，非扶不起。其内伤与饮
The Spleen and Stomach are located in the middle of the body and are most susceptible to injury. Chao Yuanfang, in his *Book on Pathogenesis and Symptomatology of Various Diseases* (*Zhubing Yuanhou Lun*), established syndromes for various Spleen and Stomach diseases outside of the five Zang and six Fu organs, and later generations of physicians mostly followed this example, which is indeed well-founded. Now, still following this example, we collect and extract prescriptions and theories, placing them at the beginning of syndromes such as food injury. As for Li Dongyuan's concept of "internal injury," it is a specific type of disease, likely arising because during times of war and famine, many people suffered from excessive labor, and subsequent scholars inherited this theory without realizing that its actual context differs from what is seen today. Here, only a general outline is preserved for reference.
**Implications of the Middle Jiao:** The Stomach is located within the abdomen, like fire in a stove; food enters the abdomen from outside, like firewood outside the stove. Firewood cannot burn without the fire inside the stove, so the Qi of grains requires the Qi of the Stomach to rot and digest it; fire easily extinguishes without firewood outside the stove, so the Qi of the Stomach requires the Qi of grains to nourish it. Ultimately, fire burning firewood is merely to change its substance as a starting point. Once changed, it is nothing but taking the form of the firewood to assist my function. When firewood burns in the stove, its momentum becomes part of the fire's power; when food transforms and transports in the abdomen, the Qi of grains becomes the Qi of the Stomach. When firewood and fire merge, burning incessantly, there naturally arises an image of rising, surging, and misty emission becoming flames, filling the stove. This is the "Middle Qi" possessed by the Stomach family. "Stomach Qi" refers to the Fu organ aspect, while "Middle Qi" refers to the Jiao (region) aspect. Whatever fire can cook and mature, making the Qi in the pot full, steaming, moist, rising, and overflowing, is all the power of the flame. When the power of the flame reaches, the Qi in the pot is sufficient. In the human body, the Qi in the pot is the Qi of the Danzhong (Chest Center). Whatever is called "sprinkling and arranging the six Fu organs" and "harmonizing the five Zang organs" is this Qi penetrating up to the Huagai (Lungs), which the Lungs use to distribute throughout the body. Therefore, whenever Lung Qi is deficient, it is due to a lack of Qi in the Danzhong; a lack of Qi in the Danzhong means the flame at the bottom of the pot is weak. To make the flame vigorous, one must have sufficient fire; to make the fire sufficient, one must add firewood. Firewood speaks of grain; grain enters Yin and grows/nourishes in Yang. Thus, what fills this grain is none other than Yang. Then, what is the Yang Qi of the Stomach? It is said: Yang Qi and Stomach Qi are one yet two, and two yet one. Stomach Qi manifests from its dispersing and venting aspects; although it disperses and vents, it has only concrete form. Yang Qi manifests from its enveloping and storing aspects; although it envelopes and stores, its function is infinite. In essence, Yang Qi is the nature endowed in the Stomach, just as heat is the nature of fire. Fire is hot, so if the bottom of the pot is hot, everywhere above the pot without direct fire is also hot. Fire cannot transform everything non-fire into fire, but the heat of fire can transform everything non-hot into hot. Thus, sufficient Grain Qi makes Stomach Qi full, which is a secondary matter; whereas sufficient Yang Qi causes Grain Qi to transform, which is a primary matter. Like fire, to transform the non-hot elsewhere into hot, one must first transform this firewood into fire. Therefore, this Yang specifically belongs to the Stomach, not viewed in opposition to Yin, but is what the Stomach possesses to command the five Zang and six Fu organs. The reason it commands them is precisely because it can nourish Grain Qi. Grain Qi is what all five Zang and six Fu organs receive Qi from; thus, he who can nourish it can command them, because Middle Qi is within me, and all Qi around and above/below spreads from me. From Middle Qi, it is listed as Yang Qi, Stomach Qi, and Grain Qi; these are discussed regarding their climate not yet formed, where things interact and attract each other. If already melted and transformed, then several Qi condense into one Qi. What is this one Qi? It is Middle Qi. Because it fully possesses the several Qi and can expand and fill them, Heaven and Earth's creation is divided here, so why should any Qi be partially attributed? Therefore, treatment methods are summarized by the character "Middle," and assisting Yang to transform grain, and venting Stomach Qi, are all efforts within the realm of regulation (Li). (Note: The sentence implies that disharmony of Zang and Fu, failure of Middle Qi transport, and chronic illness belong to regulatory syndromes, hence this speculation.) As for the Qi of the Spleen, it merely transports fluids for the Stomach; ordinarily, it stands in opposition to the Stomach. But here, it is like the force used in adding/removing and fanning at the junction of firewood and fire. Fire does not burn without fanning and adding; the Stomach does not digest without grinding and transporting. Thus, speaking of Stomach Qi internally includes Spleen Qi; it cannot be extracted and raised together with Middle Qi, Yang Qi, or Grain Qi. This roughly completes the implications of the Middle Jiao. Generally, the Qi, Blood, Jin-Ye (Body Fluids) of the human body are all manufactured and brewed in the Middle Jiao. Upon reaching the Danzhong and moving upward, they rise and descend, spreading naturally without needing the five Zang and six Fu to manufacture or brew them. Thus, how significant is the meaning of "Middle" in the human body? (From *Yi Jing Ju Ce*)
**Pulse Signs:** A choppy and firm pulse at the Guan position, large and excess, unyielding under pressure, indicates Middle Jiao Excess, with latent knots in the Spleen, blocked Lung Qi, and excess heat in the chest. A Guan pulse that comes and goes, suddenly large and small, sudden sparse and rapid, indicates cold-heat in the Stomach, emaciation, reluctance to eat, resembling malaria. A weak Chi pulse and strong Cun pulse indicate injury to the Stomach collateral vessels. (*Mai Jing*) An excess-tight pulse indicates cold in the Stomach, suffering from inability to eat, with frequent diarrhea; difficult to treat (alternatively: frequent vomiting, lingering difficult to treat). A slippery-rapid pulse indicates heat in the Stomach. (Same source) A Fuyang pulse that is floating and choppy: floating means Stomach Qi is slight; choppy means Spleen Qi is declining. Slight and declining fighting each other leads to difficulty breathing; this is Spleen dysfunction. A Fuyang pulse that is micro and choppy: micro means no Stomach Qi; choppy means injured Spleen. Cold in the diaphragm treated wrongly with purgatives leads to uneliminated cold accumulation, slight Stomach and injured Spleen, non-moving Grain Qi, spontaneous belching after eating, cold in chest/diaphragm, upper deficiency lower excess, non-communicating Grain Qi, resulting in constipation. Any beating or falling, or intercourse after drunkenness/fullness, or sweating exposed to wind, injures the Spleen. Spleen injury damages Middle Qi, separating Yin and Yang, Yang not following Yin, so life/death is assessed by three parts. (Same source) (Note: Meaning of "three parts" unclear, perhaps referring to three pulse positions, to be verified.) Chi pulse deep/hidden indicates undigested water/grain. Cun pulse wiry indicates Stomach tension (alternatively: epigastric tension). Guan pulse wiry indicates cold in Stomach, epigastric tension. Guan pulse rapid indicates heat in Stomach. Guan pulse hollow indicates deficiency in Stomach. (Same source)
The human Spleen and Stomach rely on them to contain and transform the five grains. The Spleen belongs to Earth and resides among the five Zang, flourishing in the four seasons. Because Earth can contain all things, it prefers stillness. Its pulse usually likes to be deep, fine, and slow; floating, tight, large, or rapid pulses indicate disease. (*Da Cheng*)
**Discourses on Syndromes and Treatment:** The Spleen is a Zang, the Stomach is a Fu; their Qi is exterior-interior related. The Stomach receives grain, and the Spleen grinds it. If their Qi is balanced, grain transforms and one can eat. If excess/deficiency are unequal, water/grain do not digest, causing abdominal distension or diarrhea, inability to eat; thus called Spleen-Stomach Qi disharmony, inability to eat. (*Bing Yuan Lun*)
If Yuan Qi in the Stomach is abundant, one can eat without injury and not feel hungry past mealtime. If Spleen and Stomach are both robust, one can eat and become fat. If Spleen and Stomach are both deficient, one cannot eat and becomes thin, or eats little but becomes fat (though limbs are heavy/unlifted); this is because Spleen is excess and pathogenic Qi is strong. Some eat well but become thin because Stomach hides fire pathogen in Qi level (allowing eating), while Spleen deficiency causes muscle wasting despite eating. Shuhe said "eating much also leads to muscular emptiness," referring to this. Irregular diet injures Stomach; Stomach disease leads to shortness of breath, low spirit, and great heat, sometimes fire rising alone scorching the face. *Huangdi Zhenjing* says: Face heat indicates Foot Yangming disease. If Stomach is diseased, Spleen receives nothing; Spleen is dead Yin, not ruling time, so it also becomes diseased. Physical labor injures Spleen; Spleen disease leads to lethargy, desire to lie down, limbs not gathering, diarrhea. If Spleen is diseased, its Stomach cannot independently transport fluids, so it also becomes diseased. (*Pi Wei Lun*)
Ordinary methods to regulate Spleen and assist Stomach should use mild medicines. (*Da Cheng*)
Spleen disharmony leads to undigested food; Stomach disharmony leads to no appetite; Spleen-Stomach disharmony leads to neither appetite nor digestion, possibly vomiting, diarrhea, distension, acid regurgitation, belching, or nausea; use *Zhizhong Tang*. Spleen disharmony, dislike eating, undigested food; use *Zhisuo Erchen Tang*, *Zhizhu Wan*. Stomach disharmony; use *Pingwei San*. Spleen-Stomach deficiency damage; use *Buzhong Yiqi Tang*, *Sijunzi Tang*. Spleen-Stomach deficiency, no intake, vomiting, diarrhea, limb weakness, lethargy, or post-illness Spleen-Stomach injury, insufficient Yuan Qi; use *Shenling Baizhu San*, *Jianzhong Tang*. Spleen-Stomach food stagnation, unable to digest; use *Quju Ban Zhizhu Wan* or *Baohe Wan*. Spleen-Stomach cold, slow pulse; use *Lizhong Tang*. Spleen-Stomach deficiency-cold, epigastric/abdominal distension/pain; use *Nongpu Wenzhong Tang*. Stomach cold, no intake; use *Xiangsha Yangwei Tang*, *Jinshi San*. Spleen-Stomach depressed fire; use *Erchen Tang* plus Huangqin, Huanglian, Shanzhi. Spleen-Stomach deficiency-heat, insufficient Jin-Ye; use *Baizhu San*. Spleen-Stomach heat, consuming grain, easy hunger; use *Sanhuang Zhizhu Wan*. Spleen heat, bad breath; use *Xiehuang San* (Qian Yi's formula). Stomach fire, toothache; use *Qingwei San* (see *Kou Chi*). Spleen-Stomach dampness; use *Pingwei San*. Spleen-Stomach dampness with diarrhea; use *Weiling Tang*. Spleen-Stomach cold-damp spleen diarrhea; use *Jiaozhu Yangpi Wan*. (*Zhang*) (*Yangpi Wan* is *Lizhong Tang* plus Maiya, Fuling, Cangzhu, Sharen, Chuanjiao.)
If a person's Spleen-Stomach is inherently weak, food digests but too much causes abdominal discomfort, pain, diarrhea; this is deficiency-cold, suitable for warming-tonifying combined with guiding out. If a person is prone to anger, with Qi-injured food, Qi stagnation not flowing; suitable for moving Qi and transforming food. If one eats well but feels full/hard to digest after eating; this is Stomach fire excess and Spleen Yin deficiency, suitable for clearing Stomach to support Spleen. If elderly person has Spleen deficiency and Blood dryness, easy hunger/fullness, dry hard stool; suitable for moistening, nourishing, guiding out, lifting. (*Yi Gou*)
Spleen deficiency: avoid purgatives, descending/draining, Qi-breaking, bitter-cold; use sweet-warm, assisted by pungent-aromatic, sour-neutral. Diet/labor injuring Spleen causing fever: avoid Qi-breaking, dispersing, purgatives, bitter-cold; use *Buzhong Yiqi*, sweet-warm lifting, sour. Undigested food, belonging to Spleen Qi deficiency: avoid Qi-breaking, digestive attacking, bitter-cold, again avoid drying. Stomach deficiency: avoid purgatives, Qi-breaking, bitter-cold, dry-heat; use tonifying Qi, sweet-neutral, sweet-light, sour. Stomach weakness, no intake/no appetite: avoid same as Stomach deficiency, treat same as Stomach deficiency, but distinguish cold/heat. Spleen excess (damp-heat pathogen strong): avoid moistening, astringent, cloying, hot, salty, sweet; use removing dampness/clearing heat, promoting urination, pungent-dispersing, wind-drying, bitter-cold. Stomach excess: avoid lifting, tonifying-astringing, pungent-warm, dry-heat, moistening; use purgative. If pathogen not knotted, use clearing heat, dispersing, bitter-cold, pungent-cold, sweet-cold. (*Bencao Jingshu*)
**Anorexia (Women not eating) (Food Hanging):** Anorexia has several types: Sanjiao guest-heat anorexia, Stomach heat anorexia, Stomach cold anorexia, Six Fu Qi cold anorexia. One must medicate according to syndrome; acupuncture also requires knowing tonifying/reducing methods. (*Zisheng*) (Note: *Yitong* records total fasting cured by goose blood, recorded in *Ge Ye*, refer to it.)
Someone ate nothing, taking Spleen-tonifying medicines with no effect. I gave this prescription (Note: *Ersen Wan*, using Pogu Zhi, Roudoukou, see *Xie Xie*), taken with instant recovery. This disease cannot be entirely treated as Spleen deficiency; it is due to cowardly Kidney Qi, decline of True Yuan, naturally unable to digest food. Like a cauldron with rice/grain, if no fire below, rice won't cook all day, how can it transform? Huang Luzhi recorded taking Tusizi, washed, wine-soaked, sun-dried, scooping spoons daily with wine; after ten days, eating/drinking was like snow melting in boiling water, understanding this principle. (*Benshi*) (Note: *Yaojue* divides dislike eating into four syndromes, explanation obscure, not recorded.)
Inability to eat is due to Spleen-Stomach weakness, or post-illness Spleen-Stomach Qi not recovered, or phlegm guest in Middle Jiao, hence no desire to eat, not epigastric fullness with aversion to food. Treatment should tonify to open/resolve; Danyu's method of guiding phlegm and transporting Spleen is applicable. (*Chuishui*)
Inability to eat has deficiency and excess. Excess: epigastric fullness, bitter taste, use digestion/guiding out. Deficiency: fatigue, sallow complexion, epigastric soft/pleasant, use *Yigong San* plus Chenpi/Renshen (Sha Ren); with deficiency-phlegm, use *Liujunzi Tang*. (*Huibu*)
Aversion to food is not just one type: Phlegm stagnation in chest, use guiding phlegm to assist Spleen. Food-injury aversion, use digestion to assist Spleen. Long-illness Stomach deficiency, use Renshen/Baizhu to strengthen Spleen. (Same source)
Inability to eat is deficiency of Yuan Qi in Stomach, but differs in deficiency-cold and deficiency-heat; treat separately. (*Jinkui Yi*)
A woman, 30+, suddenly stopped eating, drinking 3-5 bowls of clear tea daily, plus some fruit, for over 3 years. Menstruation delayed and scant. I considered this Spleen Qi depression, used *Guipi Tang* plus Wuzhuyu, few doses and diet normalized. (*Neike Yaoyuan*)
A woman, 20+, stopped eating for 2 years, drinking tea/fruit daily, face slightly yellow/swollen, body normal, walking fine, but tired. Liver/Spleen pulses wiry-floating, pressing micro/stagnant. I used *Liujunzi Tang* plus Muxiang, Wuzhuyu, discharged much phlegm-stasis, diet improved, body thinned, bedridden month, continued *Liujunzi* and settled. (Same source) (Note: *Danyu Weng Zhuan* records a girl not eating for half year, Danyu diagnosed Liver pulse wiry emerging left Cun Kou. Said: Thinking of man unrequited, Qi knotted in Spleen. Resolved with anger-inducing method. Refer.)
Zhu Sigou, Meizhou person, age 30, got disease unable to eat, smelling meat/fish caused vomiting, only boiled soup in big pot, poured on plain rice, ate frequently, doctors couldn't cure. Shi Zaizhi said: Vulgar readers don't read medical classics but wantlessly treat diseases, lamentable/shocking. Your disease is in *Suwen*, named "Food Hanging." Human lungs have six leaves, expanding and covering, lying over Spleen. Child-mother Qi harmonious, then eating. If contrary, Lung cannot expand, Spleen suffers, hence anorexia. Gave one prescription, treating with clearing Qi/moistening Lung. After 3 days, patient smelled meat fragrance, took it delicious. Song people recorded in biographies (Note: From *Xianchuang Kuoyi Zhi*). I examined Qihuang books, no "Food Hanging" theory; maybe recorder fabricated, or Mr. Shi spoke falsely to deceive world? Both possible. (*Xu Yishuo*)
**Easy Hunger (Eat well but thin) (Cannot eat but thin):** My nephew once felt hungry immediately after eating, ate again still hungry. Crushed fresh ginger, steeped thickly in two bowls, drank and cured. (*Zisheng*)
Easy hunger belongs to Spleen evil fire: avoid lifting, pungent-warm, great heat, aromatic-dry; use clearing fire/removing heat, generating Jin-Ye, benefiting Spleen Yin, sweet-cold, bitter-cold, sour-cold. (*Bencao Jingshu*)
Eat well but thin: mostly due to fire (Note: Based on Dongyuan, see above), but observe fire intensity. Mild fire: mildly clear, e.g., Shengdi, Shaoyao, Danpi, Shashen, Maidong, Shihu, Zhuye, Digupi, Huangqin, Zhimu, Xi Gancao. Severe fire: eat then hungry, drink then thirsty, skin dry/hot, urine/stool dry/knotted; Shigao, Huanglian, Zhizi, Huangbai, Longdancao, Kushen are unavoidable. Observe Sanjiao/Five Zang, treat according to location. However, Yang excess means Yin deficiency; e.g., *Yiyin Jian*, *Eryin Jian*, *Siyin Jian* should be selected. Cannot eat but thin: must be Spleen-Stomach weakness, unable to transport strongly, hence belching/acid regurgitation, fullness/no hunger etc.; use *Sijunzi Tang*, *Guipi Tang*. (*Jingyue*)
**Damp-Heat:** Origin of damp-heat is irregular cold/warmth/hunger/fullness, excessive anger/labor injuring Spleen-Stomach. Spleen-Stomach is sea of water/grain; now injured and stirring fire, fire steams water/grain into damp-heat. Also: Stomach governs receiving, Spleen governs transforming; now Spleen cannot transform diet, diet stagnates producing damp-heat, very common. Treatment: Strong/excess persons attack damp-heat directly; weak/deficient persons combine attack/tonify, but tonifying Spleen, transforming grain, guiding water cannot miss one. (*Danxi Fuyu*)
*Mai Li Tigan* says: Damp-heat, pulse slow-large. (Same source)
**Blood Deficiency Spleen Weakness:** Today's people treating Spleen disease say either tonify or strengthen. *Neijing* says: Spleen dislikes dampness, urgently eat bitter to dry it. Renshen, Fuling, Baizhu are tonifying/drying. As *I Ching* says Heaven moves vigorously, Yi Lao made *Zhizhu Wan*, one draining one tonifying, strengthening them. World knows these, but Blood Deficiency Spleen Weakness, rarely discussed why? Five Zang, two belong to Qi, three to Blood. Spleen Blood storage, good at commanding Blood. Blood dry Spleen weak, losing duty, cannot manage transport. Using Renshen/Baizhu tonifying/drying is error; one draining one tonifying strengthening is wrong. My hometown Xinan Wu Yinjun (name Zhengxue) passed secret formula named *Zhengzhong San*, using Danggui, Baizhu, Xiangfu, Fushen, Huanglian, Muxiang, ground to powder, chest distension/food injury/Qi rebellion, mix with rice drink/wine/water as needed, passed generations, called divine formula. Guest asked: Blood deficiency Spleen weakness, external signs? Answer: Worry injures Spleen. Heart-Spleen connected, Heart generates Blood, Spleen commands Blood. Blood dry Spleen weak, external sign is Large Intestine dry/constipated, unlike diet irregular Spleen injury where Large Intestine often loose. Danggui is Blood tonifying, used most. But essentially solidifies Spleen Earth, so next is Baizhu. Worry, mainly resolve depression, Xiangfu next. Calm Spirit, Fushen first, then next. Blood little fire born, Huanglian clears fire. But Qi must not be stagnant, so add little Muxiang. (*Xinghai*)
**Dongyuan General Differentiation of External/Internal Injury:** External contracting Eight Winds pathogen is excess syndrome. Internal injury from diet irregularity, labor injury, are all deficiency diseases. Internal injury also has aversion to wind/sweating; if in warm windless place, no aversion. Similar to external injury runny nose/headache/sweating, finely differentiated distinct. External wind pathogen, aversion to wind/sweating/headache/runny nose, always present, day by day hour by hour increases until entering interior becoming lower syndrome stops, voice heavy/turbid, high/powerful, nasal congestion/blockage, can eat abdomen neutral, mouth knows taste, bowel/bladder normal, bone/tendon pain, cannot move, lies on bed/pillow, cannot rise without support. Its internal injury and diet...