经曰∶胃为水谷之海，六腑之大源也。人身气血腑脏，俱由胃气而生。故东垣之法，一以脾
胃为主，所谓补肾不若补脾，正此意也。在小儿虽得乳食，水谷之气未全，尤仗胃气，胃气
一虚，则四脏俱失所养矣。故丹溪谓∶小儿多肝脾之疾也。若面色 白，目无睛光，口中气
冷，不食吐水，肌瘦腹痛，此胃气虚寒之症，用五味异功散或六君子汤主之；若大便不实，
兼脾虚也，加干姜温之；中满不利，脾不运也，加木香开之。喜冷便秘，胃实热也，用泻黄
散凉之。命门火衰，不能生土者，用八味丸补之，禀赋胃气不足，亦用此丸。盖下焦真阳充
盛，则上生脾元，自能温蒸水谷矣。
治验
一小儿伤食，吐泻不已，后便泄青色，睡而露睛，手足指冷，额黑唇青。余谓大便青色，木
胜土也；或时溏泄，脾气不足也；额黑唇青，寒水侮土也；悉属中气虚寒。用五味异功散加
升麻、柴胡、木香、附子，二剂而愈。
一小儿盛暑呕吐飧泄，服黄连香薷饮益甚，用白虎石膏汤而腹胀作痛，手足并冷。余谓脾气
虚寒，且夏月伏阴在内也，用五味异功散加木香而愈。
一小儿因伤乳食，杂用消导之药，遂变痢，久而不愈，先用六君加木香而渐痊，后用五味异
功散而痊愈。
一小儿手足常冷，腹中作痛，饮食难化。余谓胃气虚寒也，先用益黄散，二服痛止；次用六
君子汤，数剂即愈。
一小儿九岁，素畏风寒，饮食少思，至秋冬口鼻吸气，阴冷至腹，手足如冰，饮姜汤及烧酒
方快，其脉细微，两尺如无，余谓此禀命门火衰也，用还少丹不应，改用八味丸，旬余诸症
即愈。
平胃散 治脾胃不和，不思饮食，心腹胀痛，口苦短气，恶心嗳气吞酸，面黄体瘦，嗜卧体
痛，霍乱吐泻等症。
浓朴（姜汁制，五两） 陈皮 甘草（炙。各一两） 苍术（米泔浸焙，八两）
上为末，每服二钱，姜枣水煎，沸汤点服亦得。常服调气暧胃，化宿食，消痰饮，辟四时不
正之气。
愚按∶前症若乳食停滞，嗳腐吞酸，呕哕恶心者，宜服是方。若饮食既消，脾胃虚弱，呕吐
恶心者，则宜四君子汤。
调中丸 治脾胃虚寒。
白术 人参 甘草（炒。各五分）
八味地黄丸 即六味地黄丸加肉桂、附子各一两。治禀赋命门火衰，不能生土，以致脾土虚
寒
此药也。
钱氏益黄散（一名补脾散） 治脾胃虚冷吐泻。（方见脾脏）
愚按∶前方若脾土虚寒，或寒水侮土，而呕吐泄泻，手足并冷；或痰涎上涌，睡而露睛，不
思乳食者，宜用此方。若脾土虚弱吐泻者，用六君、柴胡，如不应，或手足俱冷者，属虚寒
，加木香、炮姜。若因乳母脾虚肝侮，亦治以前药。若乳母郁怒，致儿患前症者，其母兼服
加味归脾汤。
泻黄散（方见脾脏）
观音散（方见呕吐）
银白散（方见慢惊）
归脾汤
异功散
六君子汤（三方见内钓）
《黄帝内经》说：胃是受纳水谷的仓库，也是六腑气血生成的根本源头。人身的气血和脏腑，都依赖胃气来化生。所以李东垣的学术思想，始终以脾胃为核心，所谓“补肾不如补脾”，正是这个意思。对于小儿来说，虽然摄取了乳食，但水谷的精微之气尚未完全充盛，尤其依赖胃气的支撑。一旦胃气虚弱，那么肝、心、肺、肾四脏都会失去滋养。所以朱丹溪说：小儿多患肝脾方面的疾病。如果面色苍白，眼神无光彩，口中呼出冷气，不吃东西且呕吐清水，肌肉消瘦并伴有腹痛，这是胃气虚寒的症状，使用五味异功散或六君子汤为主治疗；如果大便稀溏不成形，兼有脾虚的情况，加入干姜以温中；如果脘腹胀满且排便不畅，是脾失健运的表现，加入木香以行气开郁。如果喜冷饮且大便秘结，是胃中有实热，使用泻黄散以清热凉之。如果是命门火衰，不能温煦脾土的情况，使用八味丸以补益；如果是先天禀赋导致胃气不足，也使用此丸。因为下焦的真阳充足，就能向上滋生脾元，自然能够温蒸腐熟水谷。
医案记录：
有一个小儿因伤食，呕吐腹泻不止，后来大便呈青色，睡觉时眼睛半睁（露睛），手指脚趾发冷，额头色黑嘴唇发青。我认为是大便青色，属于肝木克制脾土；有时大便稀溏，是脾气不足；额头色黑嘴唇发青，是寒水反侮脾土；这些都归属于中气虚寒。使用五味异功散加入升麻、柴胡、木香、附子，服用两剂后痊愈。
有一个小儿在盛夏时节呕吐并伴有完谷不化的泄泻，服用黄连香薷饮后病情加重，又用白虎加石膏汤治疗后出现腹胀疼痛，手脚冰凉。我认为是脾气虚寒，而且夏季体内潜伏阴寒之气，于是使用五味异功散加入木香而痊愈。
有一个小儿因为损伤乳食，混杂使用了消导药物，结果变成了痢疾，久治不愈。先用六君子汤加入木香，症状逐渐好转，后用五味异功散彻底痊愈。
有一个小儿手脚经常发冷，腹中疼痛，饮食难以消化。我认为是胃气虚寒，先用益黄散，服用两次后疼痛停止；接着用六君子汤，服用几剂后即痊愈。
有一个九岁的小儿，平时怕风怕冷，饮食减少缺乏食欲，到了秋冬季节吸气时感到口鼻寒冷，寒气直透腹部，手脚像冰一样冷，喝姜汤及烧酒后才感觉舒适，脉象细微，两手尺脉微弱如无。我认为是先天禀赋导致命门火衰，使用还少丹无效，改用八味丸，十几天后各种症状即痊愈。
平胃散：治疗脾胃不和，不思饮食，心腹胀痛，口苦短气，恶心嗳气吞酸，面色萎黄身体消瘦，嗜睡身体疼痛，霍乱吐泻等症状。
浓朴（用姜汁炮制，五两） 陈皮 甘草（炙，各一两） 苍术（用米泔水浸泡后焙干，八两）
以上研为细末，每次服用二钱，用生姜和大枣煎水送服，用沸水冲服也可以。常服可以调理气机、温暖胃腑，化解积食，消除痰饮，抵御四季不正之气。
我按语：前面的病症如果是乳食停滞，嗳气带有腐臭味，吞酸，呕吐呃逆恶心的，适宜服用此方。如果饮食已经消化，但脾胃虚弱，出现呕吐恶心的，则适宜用四君子汤。
八味地黄丸：即六味地黄丸加入肉桂、附子各一两。治疗先天禀赋命门火衰，不能温煦脾土，从而导致脾土虚寒的药物。
钱氏益黄散（又名补脾散）：治疗脾胃虚冷引起的呕吐泄泻。（方剂见脾脏章节）
我按语：前面的方剂如果是脾土虚寒，或者寒水反侮脾土，而出现呕吐泄泻，手脚冰凉；或者痰涎上涌，睡觉露睛，不想吃奶吃东西的，适宜用此方。如果是脾土虚弱导致的吐泻，用六君子汤、柴胡，如果无效，或者手脚都冷的，属于虚寒，加入木香、炮姜。如果是由于乳母脾虚导致肝木克制脾土，也用上述药物治疗。如果是因为乳母抑郁愤怒，导致孩子患上前述症状的，其母亲兼服加味归脾汤。
The *Classic of Medicine* states: The Stomach is the sea of water and grain, and the great source of the six fu organs. The qi, blood, and zang-fu organs of the human body are all generated by Stomach Qi. Therefore, in Li Dongyuan's methodology, emphasis is placed primarily on the Spleen and Stomach. The saying "tonifying the Spleen is better than tonifying the Kidney" embodies this very meaning. In infants and children, although they consume milk and food, the qi derived from water and grain is not yet fully developed; they rely heavily on Stomach Qi. If Stomach Qi becomes deficient, the four other zang organs (Liver, Heart, Lung, Kidney) will all lose their nourishment. Thus, Zhu Danxi stated that infants and children often suffer from Liver and Spleen disorders. If the complexion is pale, the eyes lack luster, breath from the mouth feels cold, there is anorexia with vomiting of clear fluid, emaciation, and abdominal pain, these are symptoms of Deficient-Cold of Stomach Qi. The primary treatment should be Wuwei Yigong San (Five-Ingredient Powder for Restoring the Extraordinary) or Liu Junzi Tang (Six-Gentleman Decoction). If the stool is loose and unformed, indicating concurrent Spleen deficiency, add Ganjiang (Dried Ginger) to warm the middle. If there is abdominal fullness and difficulty in defecation, indicating failure of Spleen transportation, add Muxiang (Aucklandia Root) to promote qi movement. If there is a preference for cold drinks and constipation, this indicates Excess-Heat in the Stomach; treat with Xiehuang San (Powder to Drain the Yellow) to cool. If Mingmen Fire (Fire of the Gate of Life) is deficient and unable to generate Earth (warm the Spleen), use Bawei Wan (Eight-Ingredient Pill) to tonify. For congenital insufficiency of Stomach Qi, this pill is also used. When the True Yang of the lower jiao is abundant, it generates Yuan Qi of the Spleen upwards, naturally enabling the warming and steaming digestion of water and grain.
Clinical Cases:
An infant suffered from food stagnation, resulting in incessant vomiting and diarrhea. Later, the stool turned green, the eyes remained half-open during sleep (exposing the pupils), and the fingers and toes were cold. The forehead appeared dark and the lips cyanotic. I reasoned that green stool indicates Wood overacting on Earth; intermittent loose stools indicate Spleen Qi deficiency; a dark forehead and cyanotic lips indicate Cold Water insulting Earth. All these belong to Deficient-Cold of Middle Qi. I prescribed Wuwei Yigong San added with Shengma (Cimicifuga Rhizome), Chaihu (Bupleurum Root), Muxiang, and Fuzi (Prepared Aconite Root). After two doses, the condition resolved.
An infant suffered from vomiting and undigested diarrhea during midsummer. After taking Huanglian Xiangru Yin (Isatis and Mosla Drink with Coptis), the condition worsened. Subsequently, using Baishu Gao Shi Tang (White Tiger Decoction with Gypsum) led to abdominal distension and pain, with cold hands and feet. I reasoned that this was Deficient-Cold of the Spleen, compounded by latent Yin cold within the body during summer. I treated with Wuwei Yigong San added with Muxiang, resulting in recovery.
An infant suffered from damaged milk and food intake. Due to the indiscriminate use of digestive-promoting herbs, the condition transformed into dysentery and persisted for a long time. Initially, Liu Junzi Tang added with Muxiang was used, leading to gradual improvement. Finally, Wuwei Yigong San was administered, leading to complete recovery.
An infant had constantly cold hands and feet, abdominal pain, and difficulty digesting food. I diagnosed this as Deficient-Cold of Stomach Qi. Yi Huang San (Benefit the Yellow Powder) was prescribed first; after two doses, the pain ceased. Then, Liu Junzi Tang was administered for several doses, leading to recovery.
A nine-year-old child was constitutionally afraid of wind and cold, had poor appetite, and in autumn and winter, inhalation caused coldness in the mouth and nose, with coldness penetrating to the abdomen. The hands and feet were ice-cold, and only felt comfortable after drinking ginger soup or burning wine. The pulse was fine and minute, with the Chi positions of both wrists being imperceptible. I diagnosed this as congenital Deficiency of Mingmen Fire. Huanshao Dan (Elixir of Returning to Youth) was ineffective. I switched to Bawei Wan (Eight-Ingredient Pill), and after more than ten days, all symptoms resolved.
Pingwei San (Peace the Stomach Powder): Treats disharmony between the Spleen and Stomach, anorexia, epigastric and abdominal distension and pain, bitter taste in the mouth, shortness of breath, nausea, belching, acid regurgitation, sallow complexion, emaciation, lethargy, body aches, cholera-like vomiting and diarrhea, etc.
Houpo (Magnolia Bark, processed with ginger juice, 5 liang) Chenpi (Aged Tangerine Peel) Gancao (Licorice Root, honey-fried, 1 liang each) Cangzhu (Atractylodes Rhizome, soaked in rice wash water and baked, 8 liang)
Grind into powder. Take 2 qian per dose, decocted with ginger and jujube. It can also be taken by mixing with boiling water. Regular consumption regulates qi, warms the stomach, resolves food stagnation, eliminates phlegm-fluids, and wards off pathogenic factors from the four seasons.
My Commentary: For the aforementioned conditions, if there is food stagnation, belching with a rotten odor, acid regurgitation, vomiting, hiccups, and nausea, this formula is suitable. If the food has been digested but the Spleen and Stomach remain weak, causing vomiting and nausea, Sizijunzi Tang (Four-Gentleman Decoction) is more appropriate.
Tiaozhong Wan (Regulate the Middle Pill): Treats Deficient-Cold of the Spleen and Stomach.
Baizhu (Atractylodes Macrocephala Rhizome) Renshen (Ginseng Root) Gancao (Licorice Root, stir-fried, 5 fen each)
Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill): This is Liujun Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Rougui (Cinnamon Bark) and Fuzi (Prepared Aconite Root), 1 liang each. It treats congenital Deficiency of Mingmen Fire, which fails to warm Earth, resulting in Deficient-Cold of the Spleen Earth.
Qian Shi Yihuang San (Dr. Qian’s Benefit the Yellow Powder, also known as Buspi San): Treats vomiting and diarrhea due to Deficient-Cold of the Spleen and Stomach. (Formula see Chapter on Zang Organs: Spleen)
My Commentary: For the previous formulas, if there is Deficient-Cold of Spleen Earth, or Cold Water insulting Earth, presenting with vomiting and diarrhea, cold hands and feet; or surging phlegm-saliva, sleeping with eyes open, and refusal of milk/food, this formula is suitable. If vomiting and diarrhea are due to Spleen Earth weakness, use Liu Junzi Tang and Chaihu. If ineffective, or if hands and feet are cold, indicating Deficient-Cold, add Muxiang and Paojiang (Fried Ginger). If the condition arises because the nursing mother has Spleen deficiency leading to Liver Wood insulting Earth, treat with the aforementioned medicines. If the nursing mother’s depression and anger cause the child to suffer from the aforementioned symptoms, the mother should concurrently take Jiawei Guipi Tang (Modified Restore the Spleen Decoction).
Xiehuang San (Powder to Drain the Yellow) (See Chapter on Zang Organs: Spleen)
Guanyin San (Guanyin Powder) (See Chapter on Vomiting)
Yinbai San (Silver-White Powder) (See Chapter on Slow Convulsion)
Guipi Tang (Restore the Spleen Decoction)
Yigong San (Restoring the Extraordinary Powder)
Liu Junzi Tang (Six-Gentleman Decoction) (The above three formulas see Chapter on Internal Hook)