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Zhao Yi-de said: A man in Songjiang, over thirty years old, suffered from abdominal distension and swelling. He experienced irritability, thirst, a red face, inability to lie down, yet his feet were cold. Since he habitually drank alcohol, I presumed that after drinking, he engaged in sexual activity, leading to the leakage of essence and vital energy. Consequently, pathogenic factors ascended from below due to this reversal. When Qi reverses, Yin Qi remains in the upper body, giving rise to distension (Zhang). When turbid Qi stays in the upper part and clear Qi sinks to the lower part, distension occurs. The Yang Qi of the Upper Jiao (Upper Burner), pressured by the ascending pathogenic factors from below, became congested in the upper region, causing irritability. This was a case where pathogens ascended from below and prevailed in the upper area. Therefore, I used herbs such as Evodiae Fructus (Wuzhuyu), Aconiti Lateralis Radix Praeparata (Fuzi), and Ginseng Radix et Rhizoma (Renshen) to dispel the reverse flow of Yin and water-dampness; the decoction was cooled before administration to resolve the floating heat in the Upper Jiao. Upon swallowing, he felt immediate relief in his chest. Shortly after, gas moved in his abdomen with a sound like a bellowing ox, and he passed flatus seven times. By the next day, his symptoms had resolved. *Fan's Formulas* states: For chronic abdominal distension that suddenly leads to profuse diarrhea, lasting day and night, unresponsive to medication, this indicates collapse of Qi. It is appropriate to use Alpiniae Oxyphyllae Fructus (Yizhiren) decocted into a strong soup, which will bring about an immediate cure.

People nowadays only know that when Spleen and Stomach are deficient, one should tonify them. If tonifying the Spleen is ineffective, they tonify its mother organ (Kidney), believing this suffices. They do not realize there is a more profound method: tonifying the Kidney. Zhao Yangkui stated: Tonifying the Spleen is inferior to tonifying the Kidney. If Kidney deficiency exists with weak Mingmen Fire (Gate of Vitality Fire), Bawei Wan (Eight-Ingredient Pill) is the essential formula; Xu Shuwei’s Ershen Wan (Two-Spirit Pill) method is also excellent. Although Earth controls Water, and they may seem incompatible, why should one tonify the controlled element to nourish Liver Wood? The answer is: incorrect. The subtlety lies precisely in the controlling relationship. The Five Elements function through mutual control. Thus, the *Book of Documents* (Shangshu) in the "Great Yu's Advice" mentions "Water, Fire, Metal, Wood, Grain, and Earth must be cultivated." This is the profound meaning of the sages' words, extending deeply. Let us discuss Water and Earth. Without Earth, where does Water emerge and settle? Without Water, Earth is merely dry dust; how can things grow? All things rely on the mutual nourishment of Water and Earth for the generation of flora and fauna. This is the subtlety of creative control. Hence, physicians say the Spleen is Taiyin Wet Earth. The character "wet" clearly indicates that Earth relies entirely on Water for its function. Therefore, it is said: To tonify the Spleen, one must first tonify the Kidney. Conversely, if Kidney Essence is insufficient, it must be tonified with substantial flavors (rich-tasting herbs). Thus, ancients also said: Tonifying the Kidney is inferior to tonifying the Spleen. Both statements have their profound logic and should not be neglected.

*Benshi Fang* states: Someone could not eat at all, and Spleen-tonifying medicines were ineffective. I prescribed Ershen Wan, and he immediately regained his appetite. This condition cannot be treated solely as Spleen Qi deficiency. It is because Kidney Qi is timid and True Yuan (Original Essence) is depleted, rendering digestion impossible. It is like placing grain in a pot without fire underneath; the grain cannot cook all day, let alone digest. Huang Luzhi recorded taking Cuscutae Semen (Tusizi), washed clean, soaked in wine, dried, and taken daily with wine. After ten days, food was digested as easily as snow melting in hot water. This demonstrates understanding of this principle.

*Yan Shi Jisheng Fang* states: Humans who fail to nurture themselves properly, engaging in excessive sexual activity, suffer from depletion of True Yang and weakness of Kan Fire (Kidney Fire). This fire fails to warm and steam the Spleen Earth upwards, disrupting the harmonious distribution of Qi. The Middle Jiao fails to transport, leading to loss of appetite, chest oppression, bloating even without eating, indigestion, and loose stools. Ancients said: Tonifying the Kidney is inferior to tonifying the Spleen. I argue: Tonifying the Spleen is inferior to tonifying the Kidney. If Kidney Qi is strong, Dantian Fire is vigorous, benefiting the source of Fire to dissipate Yin shadows. This steams the Spleen Earth upwards; as the Spleen Earth becomes warm, the Middle Jiao regulates itself, the diaphragm opens, and eating becomes possible.

Note: Xu Yan’s views align closely with mine. However, he ignores the subtlety of Water and Earth mutually nourishing each other, thus focusing excessively on Fire, conflating Water and Fire into one pathway. Xue Ji stated: I once suffered from Spleen and Stomach disorders. Medicinal tonification and acupuncture at Pishu (BL20) were ineffective, nearly proving fatal. Mr. Lu Danggu from my hometown advised me to take Bawei Wan. My diet improved, and after three doses, I recovered. My brother, over forty, had a robust appearance but weak Qi, suffered dizziness upon exposure to wind, bitter taste and mouth sores after exertion, phlegm in the chest, and red, gritty eyes. Another patient with Spleen deficiency edema was cured using Bawei Wan. These are clear validations of the efficacy of tonifying the Kidney. Yang Renzhai’s medical expertise likely surpasses that of Zhu Danxi. He stated: When Spleen and Kidney Qi communicate, food and drink are naturally transformed. His insight reached this level.