〔大〕脾属于土，脾为中州，意智之脏也。其肝、心、肺、肾、皆受脾之精气以荣
养焉。脾与胃为表里，脾主化谷纳食，胃为水谷之海，故经言四时皆以胃气为本也。妇
人气血不调，脏腑劳损，风邪冷气，蕴蓄在内，攻于脾胃，脾胃既虚，为邪所乘，则不
能消任五谷，故不能食也。
〔薛〕经云∶胃乃脾之刚，脾乃胃之柔。伤胃则脾无所禀受，伤脾则不能为胃运化，是
以脾胃为之表里，藉饮食以滋养百脉者也。窃谓前证若饮食所伤，六君子汤。（杂病虚劳。）劳
役所伤，补中益气汤。（杂病伤劳倦。）若风寒所伤，用人参理中汤。（杂病霍乱。）木旺乘土，六
君加柴胡。呕吐腹痛或大便不实，前汤加木香。胸膈虚痞，或肚腹不利，六君子汤。郁
怒伤损肝脾，归脾汤。（杂病健忘。）命门火衰，八味丸。（杂病虚劳。）仍审诸经错杂之邪而治之。假
如不能食而肌肉削，乃脾胃经本病，右关脉缓而弱，乃脾胃之本脉。若见弦紧，或四肢
满，闭淋溲便难，转筋，此肝之脾胃病也。若兼洪大，或肌热烦热面赤，此心之脾胃病也。
若兼浮涩，或气短喘急，咳嗽痰盛，此肺之脾胃病也。若兼沉细，或善恐善欠，此肾之
脾胃病也。各当于本经药中，加兼证之药，此东垣先生之治法也。一妇人停食饱闷，或
用人参养胃汤、木香槟榔丸而泄泻吐痰，腹中成块。又与二陈、黄连、浓朴，反加腹胀
不食。余以为脾胃气虚，不能消磨，用补中益气加茯苓、半夏，五十余剂，脾胃健而诸
证痊。一妇人饮食，每用碗许，若稍加非大便不实，必吞酸嗳腐，或用二陈、黄连、枳
实，反加内热作呕。余曰∶此末传寒中。不信，仍作火治，虚证悉至，月经不止。余用
六君加炮姜、木香数剂，诸证渐退，又以补中益气加炮姜、木香、茯苓、半夏数剂全愈。
后因饮食劳倦；兼以怒气，饮食顿少，元气顿怯，仍用前药，更加发热，脉洪大，按之
而虚，两尺如无，此命门火衰，用补中益气加姜、桂及八味丸兼服两月余，诸证寻愈。此
证若因中气虚弱，用人参理中汤，或六君子加木香、炮姜。不应，用左金丸，（两胁胀痛。）或
越鞠丸。（杂病郁。）虚寒加附子理中汤，（中寒。）无有不愈。一妇人饮食后或腹胀，或吞酸，自
服枳术丸，饮食日少，胸膈痞满，腿内酸痛，畏见风寒。或用养胃汤，腿痛浮肿益盛，月
经不行。余以为郁结所伤，脾虚湿热下注。侵晨用四君子、芎、归、二陈，午后以前汤送
越鞠丸，诸证渐愈。又用归脾、八珍二汤，兼服两月余而经行。一妇人胸满少食，或腹
胀吞酸，或经候不调，此中气虚而不能施化也。用补中益气加砂仁、香附、煨姜而饮食
进，更以六君、芎，归、贝母、桔梗而经自调。一妇人年三十余，忽不进食，日饮清
茶水果三年余矣。余谓脾气郁结，用归脾加吴茱萸四剂，遂饮食如常。若人脾肾虚而不
饮食，当以四神丸治之。一妇人不进饮食二年矣，日饮清茶果品之类，肝脾二脉弦浮，
按之微而结滞。余谓肝脾气郁，用六君、木香、吴茱，下痰积甚多，饮食顿进，形体始
瘦，卧床月余，仍服六君之类而康。
草豆蔻散 治妇人血风冷气攻脾胃，呕逆不纳饮食。
草豆蔻（去皮） 白茯苓（去皮） 枇杷叶（炙）
半夏（汤洗七次，切作片，各七钱半） 高良姜 白术（去芦） 缩砂仁 桂心 木香
青橘皮（去白） 甘草（炙，各半两） 人参（去芦，一两）
上 咀，每服五钱，水一中盏半，生姜七片，煎至一大盏，去滓温服，不拘时候。
诃梨勒散 治妇人血风，气攻脾胃，腹胁妨闷，四肢烦疼，或时痰逆，不下饮食
诃梨勒皮 陈橘皮（各一两，去白） 半夏（汤洗七次，切片） 人参（去芦） 桂心
白术（去芦） 细辛（去苗土） 当归（炒，去芦） 甘草（炙，各半两） 藿香 赤茯苓（去皮）
芎（各七钱半）
上制，煎服法同前。
神曲丸 治妇人血风气攻脾胃，腹胁胀满，不思饮食。
神曲 白术（去芦） 附子（炮，去皮脐） 枳实（麸炒，去幅） 诃梨勒皮 桂心
食茱萸 木香 陈橘皮（去白） 人参（去芦，各一两） 桔梗（去芦） 干姜（炮，各半两）
上为细末，酒煮面糊和丸，如梧桐子大。每服三十丸，空心食前生姜汤下，日进二服。
进食散 李潜云∶治脾胃虚寒，不思饮食，及久病患脾胃虚，全不入食者，只两服
能食。（陈云∶此方既有川乌，治血风攻脾不食，岂无良验。）
青皮 陈皮 粉草 桂心 良姜（各二钱半） 川乌头（炮，去皮尖） 草豆蔻仁（各三枚）
诃子（去核，五枚）
为细末，每服一钱，水一盏，生姜三片，煎七分，温服。
[Da] The Spleen belongs to Earth, resides in the Central Region (Zhongzhou), and is the organ governing intention and wisdom. The Liver, Heart, Lungs, and Kidneys all receive the essence and qi of the Spleen to be nourished. The Spleen and Stomach are exterior-interior pairs; the Spleen governs the transformation of grains and the reception of food, while the Stomach is the sea of water and grains. Therefore, the classics state that the stomach qi serves as the root for all four seasons. In women, if blood and qi are disordered, and zang-fu organs are damaged by overwork, wind pathogens and cold qi may accumulate internally, attacking the Spleen and Stomach. Once the Spleen and Stomach are deficient and attacked by pathogens, they lose the ability to digest the five grains, resulting in an inability to eat.
[Xue] The classics state: "The Stomach is the rigid aspect of the Spleen, and the Spleen is the soft aspect of the Stomach." Injury to the Stomach means the Spleen has no source of reception; injury to the Spleen means it cannot assist the Stomach in transportation and transformation. Thus, the Spleen and Stomach are exterior-interior pairs, relying on dietary intake to nourish the hundred vessels. I suggest that for the aforementioned symptoms caused by dietary injury, use Liu Jun Zi Tang (Six Gentlemen Decoction) [from Miscellaneous Diseases: Deficiency and Fatigue]. For injuries caused by physical exertion, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) [from Miscellaneous Diseases: Injuries from Labor and Fatigue]. For injuries caused by wind-cold, use Ren Shen Li Zhong Tang (Ginseng Regulate the Middle Decoction) [from Miscellaneous Diseases: Cholera]. If Wood excess attacks Earth, add Chai Hu (Bupleuri Radix) to Liu Jun Zi Tang. If vomiting, abdominal pain, or loose stools occur, add Mu Xiang (Aucklandiae Radix) to the previous decoction. For deficiency-type fullness in the chest and diaphragm, or abdominal discomfort, use Liu Jun Zi Tang. If depression and anger damage the Liver and Spleen, use Gui Pi Tang (Restore the Spleen Decoction) [from Miscellaneous Diseases: Forgetfulness]. If Ming Men Fire (Fire of the Gate of Life) is deficient, use Ba Wei Wan (Eight-Ingredient Pill). One must also examine and treat mixed pathogens from various meridians. For instance, if one cannot eat and muscles waste away, this is a primary disease of the Spleen and Stomach meridians; a slow and weak pulse at the right Guan position indicates the primary pulse of the Spleen and Stomach. If a wiry and tight pulse appears, or if there is fullness in the four limbs, difficult urination, or muscle cramps, this is a Liver disease affecting the Spleen and Stomach. If accompanied by a surging and large pulse, or feverish sensation, irritability, and red face, this is a Heart disease affecting the Spleen and Stomach. If accompanied by a floating and choppy pulse, shortness of breath, rapid breathing, coughing, and profuse phlegm, this is a Lung disease affecting the Spleen and Stomach. If accompanied by a deep and fine pulse, or excessive fearfulness and yawning, this is a Kidney disease affecting the Spleen and Stomach. In each case, herbs addressing the concurrent symptoms should be added to the primary meridian herbs; this is the treatment method of Mr. Dongyuan (Li Dongyuan).
Case 1: A woman suffered from food stagnation and fullness. She was treated with Ren Shen Yang Wei Tang (Ginseng Nourish the Stomach Decoction) and Mu Xiang Bing Lang Wan (Aucklandia and Areca Seed Pill), which resulted in diarrhea, expectoration of phlegm, and abdominal masses. Subsequent treatment with Er Chen Tang (Two-Cured Decoction), Huang Lian (Coptidis Rhizoma), and Hou Po (Magnoliae Officinalis Cortex) worsened her abdominal distension and anorexia. I diagnosed Spleen-Stomach qi deficiency failing to digest food, and prescribed Bu Zhong Yi Qi Tang with Fu Ling (Poria) and Ban Xia (Pinelliae Rhizoma). After more than fifty doses, her Spleen-Stomach function recovered, and all symptoms resolved.
Case 2: Another woman could only consume about one bowl of food per meal; any slight increase led to loose stools, acid regurgitation, and belching with putrid odor. Treatment with Er Chen Tang, Huang Lian, and Zhi Shi (Immature Bitter Orange) exacerbated internal heat and vomiting. I diagnosed this as "late-stage transmission to Cold in the Middle" (transformation into Spleen-Stomach deficiency-cold). The patient did not believe me and continued treating it as a heat syndrome, leading to the appearance of all deficiency symptoms and menorrhagia. I used Liu Jun Zi Tang with Pao Jiang (Prepared Ginger) and Mu Xiang for several doses, gradually resolving the symptoms. Then, I used Bu Zhong Yi Qi Tang with Pao Jiang, Mu Xiang, Fu Ling, and Ban Xia for several doses, achieving a complete cure. Later, due to dietary irregularities, fatigue, and anger, her food intake suddenly decreased, and her yuan qi (original qi) became frail. Using the previous formula again, she developed fever, with a surging and large pulse that was empty upon deep pressure, and the Chi positions at both wrists were imperceptible. This indicated deficiency of Ming Men Fire. I prescribed Bu Zhong Yi Qi Tang with Gan Jiang (Dried Ginger) and Rou Gui (Cinnamon Bark), along with Ba Wei Wan, taken concurrently for over two months, after which all symptoms quickly resolved.
For this condition, if caused by middle qi deficiency, use Ren Shen Li Zhong Tang or Liu Jun Zi Tang with Mu Xiang and Pao Jiang. If ineffective, use Zuo Jin Wan (Left Metal Pill) [for hypochondriac distension and pain] or Yue Ju Wan (Solving Depression Pill) [from Miscellaneous Diseases: Depression]. For deficiency-cold, use Fu Zi Li Zhong Tang [for Cold in the Middle]; there will be no failure to heal.
Case 3: A woman experienced abdominal distension or acid regurgitation after meals. Self-medicating with Zhi Zhu Wan (Ardisia and Immature Bitter Orange Pill) led to reduced food intake, chest fullness, soreness in the inner thighs, and aversion to wind and cold. Treatment with Yang Wei Tang worsened leg pain and edema, and menstruation ceased. I diagnosed this as injury from depression, with Spleen deficiency and damp-heat pouring downward. In the morning, I used Si Jun Zi Tang (Four Gentlemen Decoction) with Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Er Chen Tang. In the afternoon, I administered Yue Ju Wan using the previous decoction as a vehicle. Symptoms gradually improved. Subsequently, Gui Pi Tang and Ba Zhen Tang (Eight-Treasure Decoction) were taken concurrently for over two months, restoring menstruation.
Case 4: A woman presented with chest fullness, poor appetite, abdominal distension, acid regurgitation, and irregular menstruation. This was due to middle qi deficiency failing to transform and transport. I prescribed Bu Zhong Yi Qi Tang with Sha Ren (Amomi Fructus), Xiang Fu (Cyperii Rhizoma), and Wei Jiang (Roasted Ginger), which improved her appetite. Then, I used Liu Jun Zi Tang with Chuan Xiong, Dang Gui, Bei Mu (Fritillariae Cirrhosae Bulbus), and Jie Geng (Platycodonis Radix), which naturally regulated her menstruation.
Case 5: A woman in her thirties suddenly stopped eating, consuming only clear tea and fruits for over three years. I diagnosed Spleen qi depression and prescribed Gui Pi Tang with Wu Zhu Yu (Evodiae Fructus) for four doses, after which her diet returned to normal. If an individual has Spleen-Kidney deficiency and cannot eat, Si Shen Wan (Four Spirits Pill) should be used.
Case 6: A woman had not eaten for two years, consuming only clear tea and fruits. Her Liver and Spleen pulses were wiry and floating, but faint and knotted upon deep pressure. I diagnosed Liver-Spleen qi depression. Using Liu Jun Zi Tang, Mu Xiang, and Wu Zhu Yu, she expelled a large amount of phlegm accumulation. Her appetite suddenly increased, though her body emaciated, and she remained in bed for over a month. Continued treatment with Liu Jun Zi Tang formulas led to recovery.
Cao Dou Kou San (Grass Cardamom Powder)
Indications: Women's Blood-Wind and Cold-Qi attacking the Spleen and Stomach, causing vomiting, regurgitation, and inability to accept food.
Ingredients: Cao Dou Kou (Grass Cardamomi Fructus, peeled), Bai Fu Ling (Poria, peeled), Pi Pa Ye (Loquat Leaf, roasted), Ban Xia (Pinelliae Rhizoma, washed seven times in hot water, sliced, 7.5 qian each), Gao Liang Jiang (Galangal Rhizome), Bai Zhu (Atractylodis Macrocephalae Rhizoma, de-rhizomatous), Suo Sha Ren (Amomi Fructus, peeled), Gui Xin (Cinnamomi Cortex), Mu Xiang (Aucklandiae Radix), Qing Ju Pi (Green Tangerine Peel, de-albedo), Gan Cao (Licorice Root, roasted, 0.5 liang each), Ren Shen (Ginseng Radix et Rhizoma, de-rhizomatous, 1 liang).
Preparation: Coarsely crush the ingredients. Take 5 qian per dose, boil with 1.5 zhans of water and 7 slices of fresh ginger until reduced to 1 zhan. Strain and take warm, at any time.
He Li Le San (Persimmon Sepal Powder)
Indications: Women's Blood-Wind, Qi attacking the Spleen and Stomach, causing abdominal and hypochondriac oppression, painful heaviness in the four limbs, occasional phlegm regurgitation, and inability to eat.
Ingredients: He Li Le Pi (Persimmon Sepal), Chen Ju Pi (Aged Tangerine Peel, de-albedo, 1 liang each), Ban Xia (Pinelliae Rhizoma, washed seven times in hot water, sliced), Ren Shen (Ginseng Radix et Rhizoma, de-rhizomatous), Gui Xin (Cinnamomi Cortex), Bai Zhu (Atractylodis Macrocephalae Rhizoma, de-rhizomatous), Xi Xin (Asari Radix et Rhizoma, de-tuberous roots and soil), Dang Gui (Angelicae Sinensis Radix, stir-fried, de-rhizomatous), Gan Cao (Licorice Root, roasted, 0.5 liang each), Huo Xiang (Agastaches Herba), Chi Fu Ling (Red Poria, peeled), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 0.75 qian each).
Preparation: Process as above. Decoct and administer as described previously.
Shen Qu Wan (Medicated Leaven Pill)
Indications: Women's Blood-Wind Qi attacking the Spleen and Stomach, causing abdominal and hypochondriac fullness, and lack of appetite.
Ingredients: Shen Qu (Medicated Leaven), Bai Zhu (Atractylodis Macrocephalae Rhizoma, de-rhizomatous), Fu Zi (Aconiti Lateralis Radix Praeparata, processed, de-skin and de-navel), Zhi Shi (Immature Bitter Orange, bran-fried, de-wing), He Li Le Pi (Persimmon Sepal), Gui Xin (Cinnamomi Cortex), Shi Zhu Yu (Zanthoxyli Fructus), Mu Xiang (Aucklandiae Radix), Chen Ju Pi (Aged Tangerine Peel, de-albedo), Ren Shen (Ginseng Radix et Rhizoma, de-rhizomatous, 1 liang each), Jie Geng (Platycodonis Radix, de-rhizomatous), Gan Jiang (Dried Ginger, processed, 0.5 liang each).
Preparation: Grind into fine powder. Mix with paste made from boiling flour in wine to form pills the size of paulownia seeds. Take 30 pills per dose, before meals on an empty stomach, washed down with Ginger Decoction. Twice daily.
Jin Shi San (Promote Eating Powder)
Li Qian stated: Treats Spleen-Stomach deficiency-cold with lack of appetite, and chronic patients with Spleen-Stomach deficiency who cannot eat at all; just two doses can restore appetite. (Chen Yun noted: Since this formula contains Chuan Wu Tou, its efficacy in treating Blood-Wind attacking the Spleen causing anorexia is undoubtedly excellent.)
Ingredients: Qing Pi (Green Tangerine Peel), Chen Pi (Aged Tangerine Peel), Fen Cao (Licorice Root), Gui Xin (Cinnamomi Cortex), Liang Jiang (Galangal Rhizome, 2.5 qian each), Chuan Wu Tou (Aconiti Radix, processed, de-skin and de-tip), Cao Dou Kou Ren (Grass Cardamomi Fructus Kernel, 3 seeds each), He Zi (Chebulae Fructus, de-pitted, 5 seeds).
Preparation: Grind into fine powder. Take 1 qian per dose, boil with 1 zhan of water and 3 slices of fresh ginger until reduced to 70%. Take warm.