经曰∶脾病则面黄善噫。噫者，寒气客于胃，厥逆从下上散，复出于胃，而为噫。又善思、
善味，其症当脐有动气，按之牢若痛；其病腹胀满，食不消，体重节痛，怠惰嗜卧，四肢不
收。经曰∶脾主四肢。有是者脾也。又曰∶二阳一阴发病，主惊骇，背痛善噫。何谓也？窃
谓∶上焦受气于中焦，中焦气未和，不能消谷，故为噫耳。中焦亦脾胃之分也，脾土虚寒，
由命门火衰，不能温蒸水谷。古人有服菟丝子，旬日间饮食如汤沃雪，亦此义也。补脾宜人
参理中汤；补右肾宜用八味丸。胃气虚不能运化水谷者，六君子加木香。郁结伤脾者，加味
归脾汤。木克土者，四君、柴胡、升麻；兼嘈杂者，加吴茱萸、半夏，治者审之。
治验
一小儿禀赋虚羸，时常作痢，年十三岁，泄泻不食，手足并冷，诸药不应，余谓命门火衰，
六君子汤、八味丸治之寻愈。毕姻后，劳心过甚，饮食顿少，发热下气，先用参、术各五钱
，姜、枣煎服，诸症稍愈；又用六君子汤加炮姜、肉桂、参、术各一两，一剂诸症顿愈。又
因劳心发热烦渴，用补中益气汤加附子一钱渴止；用参、 各一两，归、术各五钱，附子一
钱，三剂痊瘥。
一小儿十五岁喜噫，面黄腹胀，饮食难化，用六君、益智、木香渐愈。后因怒兼胁痛，少食
下气噫气，用补中益气汤加附子、益智渐愈。后饮食过多，腹胀吞酸，服保和丸，热渴痰甚
，用二陈、黄连、石膏之剂，大便不止，吃逆不食，手足并冷，余用六君、附子，四剂稍愈。又以补中
益气汤加附子及八味丸而遂安。
一女子十九岁患前症，用六君子汤送四味茱萸丸而愈。但怒即发，服此药亦即愈。后因怒气
劳役，前症复作，血崩不止，先用柴胡栀子散一剂，随用补中益气汤加山栀而痊，仍参虚羸
治验。
本事枳壳散 治心下痞闷，或作痛多噫。
枳壳 白术（各半两） 香附子（炒，一两） 槟榔（三钱）
上为末，每服一钱，空心米饮调下。
四味茱连丸 治腹胀噫气吞酸，食不能化。
吴茱萸（炒） 黄连（炒） 神曲 荷叶（各等分）
上为末，水煮神曲糊丸桐子大。每服二十丸，白汤下。黄连当量病微甚，或炒黑炒黄用之。
八味丸（即六味丸加五味子、肉桂，方见肾脏）
四君子汤
加味归脾汤
六君子汤（三方见内钓）
补中益气汤（方见虚羸）
《黄帝内经》说：脾有病则面色发黄，容易打嗝。打嗝，是因为寒气侵入胃中，厥逆之气从下向上散发，再从胃中排出，从而形成打嗝。另外，如果患者思虑过多、味觉异常，症状表现为肚脐周围有搏动感，按压时感觉坚硬且疼痛；其病症包括腹部胀满、食物不消化、身体沉重关节疼痛、倦怠嗜卧、四肢无力收摄。《内经》说：脾主管四肢。出现这些症状的，病位在脾。又说：阳明经（胃与大肠）与厥阴经（肝与心包）同时发病，主要表现为惊恐、背痛和容易打嗝。这是什么原因呢？我认为：上焦的气来源于中焦，如果中焦气机不和，不能腐熟水谷，所以就会打嗝。中焦也是脾胃所属的部位，脾土虚寒，是由于命门之火衰弱，不能温煦蒸腾水谷。古人有服用菟丝子，在十几天内饮食像雪落入热水中一样迅速消化的例子，也是这个道理。补脾适宜用人参理中汤；补右肾适宜使用八味丸。胃气虚弱不能运化水谷的，用六君子汤加木香。因郁结损伤脾气的，用加味归脾汤。肝木克伐脾土的，用四君子汤、柴胡、升麻；兼有嘈杂感的，加吴茱萸、半夏，治疗者需仔细审察。
治验案例：
有一个小儿先天禀赋虚弱瘦弱，时常患痢疾，十三岁时，出现泄泻、不能进食，手脚冰凉，各种药物无效。我认为是命门火衰，用六君子汤和八味丸治疗，不久痊愈。结婚后，用心过度，饮食突然减少，发热并伴有气逆，先用党参、白术各五钱，生姜、大枣煎服，诸症稍好；又用六君子汤加炮姜、肉桂、党参、白术各一两，一剂后诸症顿时痊愈。后来又因为用心过度导致发热烦渴，用补中益气汤加附子一钱，口渴停止；再用党参、[原文缺字]各一两，当归、白术各五钱，附子一钱，三剂后痊愈。
另一个十五岁的小儿喜欢打嗝，面色发黄，腹部胀满，食物难以消化，用六君子汤加益智仁、木香，逐渐好转。后来因为发怒兼有胁痛，少食、气逆、打嗝，用补中益气汤加附子、益智仁，逐渐好转。后来饮食过多，腹胀吞酸，服用保和丸，导致热盛口渴、痰多，用二陈汤、黄连、石膏的药剂，导致大便不止，呃逆不食，手脚冰凉，我用六君子汤加附子，四剂后稍有好转。后又用补中益气汤加附子及八味丸，于是安定。
一个十九岁的女子患上述病症，用六君子汤送服四味茱萸丸而痊愈。但一发怒就发作，服用此药也随即痊愈。后来因为怒气加劳累，前症复发，血崩不止，先用柴胡栀子散一剂，随后用补中益气汤加山栀而痊愈，仍参照虚弱的治验方法。
本事枳壳散：治疗心下痞闷，或作痛且多打嗝。
枳壳、白术（各半两），香附子（炒，一两），槟榔（三钱）。
以上研为末，每次服用一钱，空腹时用米汤调下。
四味茱连丸：治疗腹胀、打嗝、吞酸，食物不能消化。
吴茱萸（炒）、黄连（炒）、神曲、荷叶（各等分）。
以上研为末，用水煮神曲制成糊状丸，如梧桐子大。每次服用二十丸，白开水送下。黄连应根据病情轻重，或炒黑或炒黄使用。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Spleen is diseased, the face turns yellow and there is frequent eructation. Eructation occurs when cold pathogenic factors invade the Stomach, causing rebellious Qi to rise from below and disperse upwards, finally exiting through the Stomach. Additionally, if a patient is prone to excessive thinking and has abnormal taste sensations, symptoms include pulsating Qi at the navel area that feels firm and painful upon palpation; the disease manifests as abdominal distension and fullness, indigestion, heavy body with joint pain, lethargy and desire to lie down, and weakness of the four limbs. The *Neijing* states: The Spleen governs the four limbs. Those who present with these signs have a Spleen disorder. It also states: When the Yangming (Stomach and Large Intestine) and Jueyin (Liver and Pericardium) meridians are affected simultaneously, the main manifestations are fright, back pain, and frequent eructation. What is the reason for this? I believe: The Upper Jiao receives Qi from the Middle Jiao; if the Qi in the Middle Jiao is not harmonized and cannot transform food and drink, eructation results. The Middle Jiao belongs to the Spleen and Stomach. Spleen Earth deficiency and coldness arise from the decline of Mingmen Fire (Gate of Life Fire), which fails to warm and steam food and fluids. Ancient texts mention taking Cuscutae Semen (Tusizi, 菟丝子), resulting in digestion within ten days as rapid as snow melting in hot water; this illustrates the same principle. To tonify the Spleen, Renshen Lizhong Tang (Ginseng and Atractylodes Decoction) is suitable; to tonify the Right Kidney, Bawei Wan (Eight-Ingredient Pill) is appropriate. For Stomach Qi deficiency failing to transport and transform food and fluids, Liujunzi Tang (Six Gentlemen Decoction) added with Muxiang (Aucklandiae Radix) is used. For Spleen injury due to emotional constraint, Jiawei Guipi Tang (Modified Heart-Tonifying Decoction) is indicated. For Liver Wood overacting on Spleen Earth, Sijunzi Tang (Four Gentlemen Decoction), Chaihu (Bupleuri Radix), and Shengma (Cimicifugae Rhizoma) are used; if accompanied by epigastric discomfort (zaocao), Wuzhuyu (Evodiae Fructus) and Banxia (Pinelliae Rhizoma) are added. Practitioners should examine carefully.
Case Records:
A child with congenital deficiency and emaciation frequently suffered from dysentery. At age thirteen, he presented with diarrhea, anorexia, and cold extremities. Various medicines were ineffective. I diagnosed it as Mingmen Fire decline and treated him with Liujunzi Tang and Bawei Wan, leading to recovery shortly after. After marriage, due to excessive mental exertion, his diet suddenly decreased, accompanied by fever and rebellious Qi. Initially, he was given Dangshen (Codonopsis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), each 5 qian, decocted with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus); symptoms improved slightly. Then, Liujunzi Tang was administered with Paojiang (Prepared Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), Dangshen, and Baizhu, each 1 liang. One dose led to complete resolution of symptoms. Later, due to mental exertion causing fever, irritability, and thirst, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Fuzi (Aconiti Lateralis Radix Praeparata), 1 qian, stopped the thirst. Subsequently, Dangshen and [text missing] each 1 liang, Danggui (Angelicae Sinensis Radix) and Baizhu each 5 qian, and Fuzi 1 qian were given for three doses, resulting in cure.
Another fifteen-year-old boy liked to eructate, had a sallow complexion, abdominal distension, and difficulty digesting food. He was treated with Liujunzi Tang added with Yizhiren (Alpiniae Oxyphyllae Fructus) and Muxiang, gradually improving. Later, due to anger and hypochondriac pain, with reduced appetite, rebellious Qi, and eructation, he was treated with Buzhong Yiqi Tang added with Fuzi and Yizhiren, gradually improving. Later, due to overeating, he developed abdominal distension and acid regurgitation. After taking Baohe Wan (Preserve Harmony Pill), he developed heat, thirst, and profuse phlegm. Treatment with Erchen Tang (Two-Aged Decoction), Huanglian (Coptidis Rhizoma), and Shigao (Gypsum Fibrosum) caused unceasing diarrhea, hiccups, anorexia, and cold extremities. I treated him with Liujunzi Tang added with Fuzi; after four doses, he improved slightly. He was then stabilized using Buzhong Yiqi Tang added with Fuzi and Bawei Wan.
A nineteen-year-old girl suffered from the aforementioned condition and was cured by administering Siwei Zhuyu Wan (Four-Ingredient Evodia Pill) with Liujunzi Tang. However, symptoms recurred upon anger, but resolved immediately upon taking this medicine. Later, due to anger and labor, the previous symptoms recurred with metrorrhagia (profuse uterine bleeding). Initially, one dose of Chaihu Zhizi San (Bupleurum and Gardenia Powder) was given, followed by Buzhong Yiqi Tang added with Zhizi (Gardeniae Fructus), leading to recovery. This case still refers to the treatment principles for deficiency and emaciation.
Ben Shi Zhike San (Essential Abilities Bitter Orange Powder): Treats epigastric stuffiness or pain with frequent eructation.
Zhike (Aurantii Fructus), Baizhu (Atractylodis Macrocephalae Rhizoma) (each half liang); Xiangfu (Cyperi Rhizoma, stir-fried, 1 liang); Binglang (Arecae Semen, 3 qian).
Grind into powder. Take 1 qian per dose, mixed with rice water on an empty stomach.
Siwei Zhulian Wan (Four-Ingredient Evodia-Coptis Pill): Treats abdominal distension, eructation, acid regurgitation, and indigestion.
Wuzhuyu (Evodiae Fructus, stir-fried), Huanglian (Coptidis Rhizoma, stir-fried), Shenqu (Massa Medicata Fermentata), Heye (Nelumbinis Folium) (equal parts).
Grind into powder. Use water-boiled Shenqu paste to make pills the size of tung tree seeds. Take 20 pills per dose with plain boiled water. The dosage of Huanglian should be adjusted according to the severity of the disease; use charred or lightly fried forms as appropriate.
Bawei Wan (Eight-Ingredient Pill) (i.e., Liuwei Wan plus Wuweizi (Schisandrae Chinensis Fructus) and Rougui, see Kidney section)
Sijunzi Tang (Four Gentlemen Decoction)
Jiawei Guipi Tang (Modified Heart-Tonifying Decoction)
Liujunzi Tang (Six Gentlemen Decoction) (see Internal Hook section for formulas)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (see Deficiency and Emaciation section for formula)