不能食症，昔贤俱责之脾胃虚弱。按东垣云∶胃中元气盛，则多食而不伤，过时而不饥，脾胃俱
旺，能食而肥，脾胃俱衰，不能食而瘦。罗谦甫云∶脾胃弱而食少，不可克伐，补之自然能食。每见
世俗，一遇不能食者，便投楂、
芽、枳、朴之属，甚而用黄连、山栀，以为开胃良方，不知此皆实则泻之之法，因脾胃间有积滞，有
实火，元气未衰，邪气方张者设也。虚而伐之则愈虚，虚而寒之，遏真火生化之源，有不败其气而绝其
谷乎？且误以参、术为滞闷之品，畏之如砒鸩，独不闻经云∶虚者补之。又曰∶塞因塞用乎？
又不闻东垣云∶脾胃之气实，则枳实、黄连泻之，虚则白术、陈皮补之乎？故不能食，皆属脾虚。异功、
归脾、资生之属，补之不效，当补其母。挟痰宜化，挟郁宜开，HT 木宜安，子金宜顾。夫脾为五脏之
母，土为万物之根，安谷则昌，绝谷则亡，关乎人者，至为切亟，慎毋少忽。
异功散〔见中风。〕
归脾汤 资生丸〔俱见虚劳。〕俱治脾胃虚弱，食少难化。
如挟痰，异功散加半夏。〔若阴虚之痰则忌之。〕如挟郁，归脾汤或合逍遥散，加沉、砂、郁金、
香附之属。肝木乘脾，或异功、或归脾，俱合左金丸。如肺气虚者，异功倍用人参加黄 。〔益土之子，
使其不食母气。〕
此三方，一专补脾胃，一兼养阴血，一兼消导，以助脾家之健运随症采用加减。
桃麻丸 久服令人能食肥健，填髓固精，润肌黑发。
胡桃肉〔益命门，利三焦，命门以体言，为藏精系胞之物；三焦以用言，为出纳腐熟之司。桃肉
状类两肾命门，润能滋肾燥，热能助真火，精气内充，自然能食肥健。〕 黑芝麻〔味甘入脾，能补
中益气，色黑通肾，能补阴填髓。各等分，捣烂，丸如龙眼肉大，空心饥时细嚼数枚，白汤过
口，参汤圆汤弥佳。〕
此温补脾肾之润剂也。
八味丸 治命门火衰，不能上蒸脾土，中州不运，以致食少难化，痞痛溏泄。〔譬之釜中水谷，下
无火力，其何能熟。〕或下元衰惫，脐腹疼痛，夜多旋溺等症。
六味〔补肾水。〕加附子 肉桂〔益真火，各一两。〕无附子名七味丸。
此补肾中真火，以生脾土之剂。许学士、严用和皆言∶不能食者用补脾药不效，宜作肾中真阳衰弱
治之。又按赵氏以不思饮食者，属胃土受病，用归脾补心火以生胃土，以能食不化者，属脾土受病，用八
味补相火以生脾土。此皆论虚则补母，而从火衰为治者也。然仲淳又云∶胃气弱则不能纳，脾阴亏则不能
消。世人阴虚者多，故附、桂不可概投。审果真火衰弱，而见畏寒厥冷，小便清白，大便骛溏，脉沉小
迟者；方可用附、桂，否则，以火济火，病反增剧，不可不慎。
The syndrome of inability to eat has, in the past, been attributed by sages to the deficiency of Spleen and Stomach. According to Li Dongyuan: If the primordial Qi (Vital Energy) in the Stomach is abundant, one can eat more without injury, and will not feel hungry even after the usual meal time; if both Spleen and Stomach are vigorous, one can eat well and become plump; if both Spleen and Stomach are depleted, one cannot eat and becomes emaciated. Luo Qianfu stated: When weak Spleen and Stomach lead to reduced food intake, one must not use attacking methods; tonification will naturally restore appetite. I often see that when lay physicians encounter patients with inability to eat, they immediately administer herbs such as Hawthorn Fruit (Shanzha), Malt (Maiya), Immature Bitter Orange (Zhishi), and Magnolia Bark (Houpo), or even Coptis Rhizome (Huanglian) and Gardenia Fruit (Shanzhi), considering them good prescriptions for opening the stomach. They fail to realize that these are methods of "draining excess" (treating excess syndromes by purging), intended only for cases where there are food stagnation or excess fire in the Spleen and Stomach, while the primordial Qi is not yet depleted and pathogenic factors are flourishing. Attacking a deficiency makes it more deficient; cooling a deficiency suppresses the source of generation of True Fire (Ministerial Fire/Kidney Yang), leading inevitably to the destruction of Vital Qi and the severing of grain assimilation. Moreover, they mistakenly treat Ginseng Radix (Renshen) and Atractylodes Macrocephala Rhizome (Baizhu) as causes of distension and fullness, fearing them like arsenic and poison. Have they not heard the Classic state: "Deficiency should be tonified"? Nor have they heard of the principle of "treating obstruction with tonification" (using tonifying methods for obstructive syndromes caused by deficiency)? Have they not heard Li Dongyuan say: "If Spleen and Stomach Qi is excess, use Immature Bitter Orange and Coptis to drain it; if Spleen and Stomach Qi is deficient, use Atractylodes Macrocephala Rhizome and Tangerine Peel to tonify it"? Therefore, inability to eat belongs to Spleen deficiency. If Yigong San (Isolated Efficacy Powder), Guipi Tang (Restore the Spleen Decoction), or Zisheng Wan (Nourishing Life Pill) fail to produce effects upon tonification, one should tonify its mother organ (Kidney). If accompanied by phlegm, resolve it; if accompanied by depression/stagnation, relieve it; if Liver Wood overacts on Spleen Earth, calm the Liver; if Lung Metal is deficient, protect the Lung. Since the Spleen is the mother of the five Zang organs, and Earth is the root of all things, the ability to receive grain leads to prosperity, while the loss of grain leads to death. This concerns human life profoundly and urgently; do not neglect it slightly.
Yigong San [See Stroke chapter]
Guipi Tang (Restore the Spleen Decoction) and Zisheng Wan (Nourishing Life Pill) [Both see Consumption chapter] both treat Spleen and Stomach weakness, with little appetite and difficulty in digestion.
If accompanied by phlegm, add Pinellia Tuber (Banxia) to Yigong San. [Contraindicated if the phlegm is due to Yin deficiency.] If accompanied by stagnation, use Guipi Tang or combine it with Xiaoyao San (Free and Easy Wanderer Powder), adding Aquilaria Wood (Chenxiang), Amomum Fruit (Sharen), Curcuma Root (Yujin), and Cyperus Rhizome (Xiangfu). If Liver Wood invades Spleen Earth, whether using Yigong San or Guipi Tang, combine with Zuojin Wan (Left Metal Pill). If Lung Qi is deficient, double the dosage of Ginseng Radix and Astragalus Root (Huangqi) in Yigong San. [This benefits the child organ of the Spleen (Lung), preventing it from depleting the mother organ's Qi.]
These three formulas: one specifically tonifies Spleen and Stomach; one nourishes Yin and Blood; one aids digestion and guides out stagnation, assisting the Spleen's transportation and transformation. Use them according to symptoms with modifications.
Taoma Wan (Walnut and Sesame Pill) Long-term consumption enables increased appetite, robust physique, fills the marrow, secures essence, moistens the skin, and darkens hair.
Walnut Kernel [Benefits Mingmen (Gate of Life), promotes Sanjiao (Triple Burner) function. Mingmen refers to structure, being the storehouse of essence and uterus; Sanjiao refers to function, being the manager of reception and rotting/ripening. Walnut kernels resemble the two Kidneys and Mingmen; their moisture nourishes Kidney dryness, and their warmth assists True Fire. With internal abundance of essence and Qi, one naturally eats well and becomes plump and strong.] Black Sesame Seed [Sweet taste enters Spleen, benefits middle Jiao and boosts Qi; black color connects to Kidney, nourishes Yin and fills marrow. Equal parts, pounded into paste, formed into pills the size of longan flesh. Chew several pieces slowly when fasting or hungry, swallow with warm water; taking it with Tangyuan soup is better.]
This is a moistening agent for warming and tonifying Spleen and Kidney.
Bawei Wan (Eight-Ingredient Pill) Treats decline of Mingmen Fire, which fails to steam upward to warm Spleen Earth, causing failure of central transportation, resulting in poor appetite, difficulty digesting, epigastric fullness/pain, and loose stools. [It is like water and grain in a pot; without fire underneath, how can they cook?] Or lower Yuan depletion, pain in the umbilical and abdominal regions, frequent urination at night, etc.
Liujunzi Wan (Six-Ingredient Pill) [Tonifies Kidney Water.] Added with Aconite Lateral Root (Fuzi) and Cinnamon Bark (Rougui) [Benefit True Fire, each 1 liang]. Without Fuzai, it is called Qiwei Wan (Seven-Ingredient Pill).
This is a formula that tonifies True Fire in the Kidney to generate Spleen Earth. Xu Xueshi and Yan Yonghe both stated: For those unable to eat, if Spleen-tonifying medicines fail, treat it as a decline of True Yang in the Kidney. Furthermore, Zhao Shi posited: Those who lack desire to eat suffer from Stomach Earth disease; use Guipi Tang to tonify Heart Fire to generate Stomach Earth. Those who eat but cannot digest suffer from Spleen Earth disease; use Bawei Wan to tonify Ministerial Fire to generate Spleen Earth. These all discuss "tonifying the mother when deficient," treating from the perspective of fire decline. However, Zhongchun also said: Weak Stomach Qi cannot receive food; deficient Spleen Yin cannot digest. Since many people in the world have Yin deficiency, Fuzi and Rougui should not be administered indiscriminately. Only when True Fire decline is confirmed, presenting with aversion to cold, cold limbs, clear and copious urine, loose watery stools, and a deep, small, and slow pulse, may Fuzi and Rougui be used. Otherwise, using fire to supplement fire will aggravate the illness. One must be cautious.