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The epigastrium is not distended or full, yet the patient cannot eat. Li Dongyuan said: When the primordial Qi of the Stomach is vigorous, one can eat without injury and feel no hunger even after the usual meal time; when both the Spleen and Stomach are strong, one can eat and become plump; when both the Spleen and Stomach are deficient, one cannot eat and becomes emaciated. Therefore, inability to eat is generally discussed as a deficiency syndrome. If the aversion to food is due to food stagnation, it has its own dedicated section and is not included in this example. If the patient's pulse is slow and weak, with lethargy and heaviness in the four limbs, or diarrhea, this indicates excess Dampness, treated with Pingwei San (Calm the Stomach Powder) modified. If the patient's pulse is wiry, with weak Qi, spontaneous sweating, heat in the four limbs, or diarrhea, dry skin and hair loss, use Huangqi Jianzhong Tang (Astragalus Decoction for Replenishing the Middle) modified. If the patient's pulse is empty and Qi is weak, with disharmony between the Spleen and Stomach, use Sijunzi Tang (Four Gentlemen Decoction) or Liujunzi Tang (Six Gentlemen Decoction) modified. If there is Phlegm, use Erchen Tang (Two Aged Substances Decoction) modified, combined with Renshen Banxia Wan (Ginseng and Pinellia Pill). For deficiency with Phlegm, use four taels of Renshen (Ginseng Root), one tael of Banxia (Pinellia Tuber), soaked overnight in Ginger Juice, dried, powdered, and formed into pills with wheat paste. Take after meals with Shengjiang Tang (Fresh Ginger Decoction). For Phlegm accumulation causing obstruction where food cannot pass down, burn Zaojiao (Gleditsia Sinensis Fruit) until carbonized but retaining its nature, powder it, and take one qianbi (a small measure) mixed with wine. Hetang Tang (Harmonizing the Middle Decoction), Shizhen San (Seven Treasures Powder), Liushen Tang (Six Deities Decoction), and Qianshi Yigong San (Master Qian's Extraordinary Efforts Powder) are all modifications of Sijunzi Tang and are orthodox formulas for opening the stomach and promoting appetite. Luo Qianfu said: For those with weak Spleen and Stomach who cannot tolerate food, one should not uniformly use attacking/draining agents; instead, use Qianshi Yigong San to tonify, and appetite will naturally return. If excessive indulgence in food damages the Spleen, leading to distension, fullness, and vomiting, one may temporarily administer once dose of Zhishi Wan (Immature Bitter Orange Pill), but be careful not to take it frequently. Lou Quanshan once treated an old man with chronic malaria, poor appetite, and excessive sweating. Initially, he used a tonifying formula added with Huanglian (Coptis Rhizome) and Zhishi (Immature Bitter Orange). After more than a month, the patient's intake decreased further, and sweating did not stop. Realizing the wisdom of Qianfu's words, Lou removed Zhishi and Huanglian, using purely tonifying agents, advised eating more congee than taking medicine, which improved intake, and added Sanfenban (half a fen) of Fuzi (Prepared Aconite Root) to the original formula. One dose resulted in recovery. Kuanzhong Jinshe Wan (Widen the Middle and Promote Eating Pill), Hetang Wan (Harmonizing Middle Pill), Muxiang Zhizhu Wan (Costus and Immature Bitter Orange Pill), and Muxiang Ganjiang Zhizhu Wan (Costus, Dried Ginger, and Immature Bitter Orange Pill) are all formulas that move Qi, suitable for Qi stagnation. Xu Xueshi said: There was a person who could not eat at all, and tonifying Spleen medicines were ineffective. I prescribed Ershen Wan (Two Kidney Pills), and the patient immediately regained appetite. This disease should not be treated solely as Spleen Qi deficiency. It is because the Kidney Qi is timid and the True Yuan (Primal Essence) is depleted, thus failing to digest food. It is like a pot containing grains and water; if there is no fire underneath, the rice will not cook all day, how can it be digested? Huang Luzhi once recorded taking Tusizi (Dodder Seed), washed clean, soaked in wine, and dried. Taking several spoons daily with wine, after ten days, digestion became as easy as snow melting in hot soup, demonstrating understanding of this principle. According to current treatment principles, "tonify the mother when deficient." Inability to eat implies deficiency of Wu Earth (Stomach) and Ji Earth (Spleen). Fire is the mother of Earth. Therefore, using Pogu Zhi (Cibotium Rhizome) to tonify the Kidney as Gui Water, and Rou Doukou (Nutmeg) to thicken the intestines and stomach as Wu Earth, allows Wu and Gui to transform into Fire, serving as herbs that tonify the mother of Earth. Yang Renzhai said: When Spleen and Kidney Qi communicate, water and grain are naturally transformed. The *Ruizhutang Fang* states that although Ershen Wan tonifies the Spleen and Stomach, it lacks a pivoting action. Often, Muxiang (Costus Root) is added to smooth Qi and facilitate pivoting. Emptying the granaries allows them to receive goods; repeated use shows efficacy, likely due to this power of communication. Yan Yonghe said: Humans who fail to cultivate themselves properly, engaging in excessive sexual activity, deplete their True Yang. Kan Water (Kidney Water) fails to warm, unable to steam upward to nourish Spleen Earth. The harmonious Qi fails to distribute, the Central Pivot fails to rotate, resulting in poor appetite, chest and diaphragm oppression, bloating without eating, indigestion after eating, and loose stools. Ancients said: "Tonifying the Kidney is better than tonifying the Spleen." I argue: "Tonifying the Spleen is better than tonifying the Kidney." If Kidney Qi is strong, the Dantian Fire is vigorous, steaming upward to warm Spleen Earth. When Spleen Earth is warm, the Middle Jiao regulates itself, the diaphragm opens, and eating resumes. Xue Xinpu said: I once suffered from Spleen-Stomach disease. Tonics and acupuncture at Pishu (BL20) were ineffective, and I nearly died. Mr. Lu Danggu from my hometown instructed me to take Bawei Wan (Eight-Ingredient Pill). My diet indeed improved, and I recovered after three doses. My brother, over forty years old, appeared plump but had weak Qi, experienced dizziness upon exposure to wind, mouth and tongue ulcers upon exertion, constant phlegm in the chest, and red, gritty eyes. Another person with Spleen deficiency edema was also cured by Bawei Wan. These are all validations of tonifying the Kidney. Dai Fu'an said: The Spleen transforms food and transmits it to the Lung. Insufficient Spleen Qi leads to lack of desire to eat; use Qipi Wan (Spleen-Initiating Pill) or Zhu Pu Wan (Boiled Magnolia Bark Pill). For Spleen deficiency failing to promote eating, one should solidify the Spleen; use Lurong Jupi Jian Wan (Deer Antler and Tangerine Peel Decoction Pill). For Spleen deficiency-cold failing to promote eating, use Lizhong Tang (Regulate the Middle Decoction). If ineffective, add Banqian (half a qian) of Sharen (Amomum Fruit) to Fuzi Lizhong Tang, or use Dingxiang Zhusan (Clove Boiled Powder). For Heart-Kidney deficiency leading to insufficient Spleen Qi to transform, use Lurong Jupi Jian Wan. The Spleen connects upward to the Heart and downward to the Kidney.

[Starvation without Appetite] In the *Lingshu · Daguo Pian*, the Yellow Emperor asked: Why do some people feel hungry but lack desire to eat? Qibo replied: Jing Qi merges with the Spleen, and Heat lingers in the Stomach. Stomach Heat consumes grain, causing hunger; however, rebellious Stomach Qi causes cold in the epigastrium, hence the lack of desire to eat. In the context of Six Qi transformation, starvation without desire to eat belongs to Dampness pathogen injuring the Kidney. The Classics state: When Taiyin governs the year, excessive Dampness causes people to suffer from a sensation of the heart hanging, hunger without desire to eat. Treatment uses bitter-hot herbs. Acupuncture for starvation without desire to eat has two methods: First, clear the Stomach. The Classics state: The Stomach is the Sea of Water and Grain. Its upper point is Qichong (ST30), and its lower point is Zusanli (ST36). When the Sea of Water and Grain is deficient, hunger exists but grain is not accepted. Examine and secure the meridian, regulating deficiency and excess. Second, select points on the Kidney. The Classics state: The Foot-Shaoyin Kidney Meridian, when disturbed, causes disease manifesting as starvation without desire to eat, a sensation of the heart hanging, and distressing hunger. Treat based on fullness, deficiency, heat, cold, or sinking conditions.

[Aversion to Food] The Classics state: What Taiyin refers to as aversion to the smell of food is due to the Stomach lacking Qi, thus aversion to food odors. Use a large dose of Renshen (Ginseng Root) to tonify. Zhu Danxi said: Aversion to food indicates material retention in the chest. Guide out Phlegm and tonify the Spleen using Erchen Tang (Two Aged Substances Decoction) added with Cangzhu (Atractylodes Rhizome), Baizhu (White Atractylodes Rhizome), Chuanxiong (Szechwan Lovage Rhizome), and Gancao (Licorice Root) dregs. Shixiao Wan (Pain-Dispel Pill) treats deficiency-type epigastric fullness with aversion to food.