钱仲阳云∶脾主困，实则困睡，身热饮水，或不饮水，虚则吐泻生风，脾胃虚寒，则面 白
，目无精光，口鼻气冷，肌体瘦弱，吐水腹痛，不思乳食，用益黄散；下利用调中丸。伤风
手足冷者，脾脏怯也，先用益黄散补脾；后用大青膏发散脾病，见四季皆仿此。顺者易治，
逆者难治。脾怯当面赤黄，若兼五脏相胜，随症治之。又张洁古云∶脾主湿，自病则泄泻多
睡，体重昏倦。若肝乘脾为贼邪，心乘脾为虚邪，肺乘脾为实邪，肾乘脾为微邪。凡脾之得
病，必先察其肝心二脏。盖肝是脾之鬼，心是脾之母，肝气盛则鬼邪有余，心气亏则生气不
足，当用平肝气益心气。若诊其脉，肝心俱和，则脾家自病，察其虚实而治之。窃谓∶前症
实者病气实而形气虚也，若面色 白，吐泻腹痛，口鼻气冷，属寒水侮土，宜用益黄散。若
面青唇黯吐泻，手足并冷，此脾土虚寒，用干姜理中汤。若面色痿黄，手足不冷，此脾土虚
弱，用人参理中汤。若伤风手足并冷，吐痰咳嗽，吐泻腹胀，此脾肺气虚，用五味异功散实
脾气，加防风、升麻散外邪。若发于寅卯之时，用六君、柴胡、升麻，补脾土平肝木。然面
黄者脾之本色也，面赤者火生土为顺，面青者木克土为逆，当平其所胜，以补元气为善。
大青膏（方见肝脏）
调中丸（方见脾胃虚寒）
人参安胃散 治脾胃虚弱，伤热乳食，呕吐泻痢。
人参（一钱） 黄 （二钱） 生甘草 炙甘草（各五分） 白芍药（酒炒，七分） 白茯苓（四分） 陈皮
（三分
上为末，每服二钱，水煎。
愚按∶东垣云∶益黄散内有丁香、青皮之辛热，盖为寒水侮土而设也。若因热药巴豆之类，
损其脾胃，或因暑热伤乳食而成吐泻，口鼻气热而致慢惊者，宜用前散。
益黄散 治脾虚吐泻不食，米谷不化，困倦力少，滑肠夜起，并疳虚盗汗，涎流口角。
陈皮（一两） 丁香（二钱） 诃子（炮，去皮） 青皮（去白） 甘草（炙。各半两）
上为末，每服一钱，水煎服。
愚按∶前症若脾土虚寒，或寒水侮土而呕吐泄泻，手足并冷，或痰涎上壅，睡而露睛，不思
乳食，宜用此方。若因脾土虚弱吐泻者，用六君子汤加柴胡。如不应，或手足俱冷，属虚寒
也，更加木香、炮姜。若因乳母脾虚肝侮，必治以前药。若乳母郁怒，致儿患前症，母服加
味归脾汤。
钱氏泻黄散（一名泻脾散） 治脾热吐舌。
藿香叶 甘草（各七钱五分） 山栀仁（一两） 石膏（五钱） 防风（二两）
上用蜜酒微炒为末，每服一二钱，水煎。
愚按∶前症若作渴饮冷，卧不露睛，手足热甚，或遍身发黄，属胃经实热，宜用泻黄散。若
作渴饮汤，卧而露睛，手足并冷，属胃经虚热，宜用异功散。若面青搐搦，乳食少思，肝乘
脾也，用秘旨补脾汤。若面赤惊悸，身热昏睡，心乘脾也，用秘旨安神丸。若面白喘嗽，肢
体倦怠，肺乘脾也，用补中益气汤。若唇黑泄泻，手足指冷，肾乘脾也，用益黄散。病后津
液不足，口干作渴，宜用七味白术散。若乳母膏粱浓味，七情郁火所致，当审其因而治其母
。
人参理中汤（方见伤寒表里）
五味异功散
六君子汤（二方见天钓、内钓）
钱仲阳说：脾的功能特点是容易受困，实证表现为嗜睡、身体发热、口渴饮水或不渴不饮；虚证则表现为呕吐腹泻并引发肝风（惊风），若脾胃虚寒，则见面色苍白、目光无神、口鼻气息寒冷、肌肉消瘦体弱、呕吐清水、腹痛、不想吃奶或食物，治疗用益黄散；若出现下利症状，使用调中丸。伤风且手足发冷的，属于脾脏气怯，先用益黄散补脾；后用大青膏发散脾经病邪，四季皆参照此法。病情顺者易治，逆者难治。脾脏气怯的面部特征为面赤黄色，如果兼有五脏相克的情况，随症状辨证治疗。
张洁古又说：脾主湿，脾自病则多见泄泻、多睡、身体沉重、昏沉疲倦。如果肝气乘袭脾脏称为贼邪，心气乘袭脾脏称为虚邪，肺气乘袭脾脏称为实邪，肾气乘袭脾脏称为微邪。凡是脾脏得病，必须先观察肝、心两脏的情况。因为肝是脾的“鬼”（即克我者为鬼，此处指肝木克脾土，但在五行生克语境中，通常克我者为官鬼，此处意指肝气盛对脾的影响），心是脾的“母”（火生土）。肝气旺盛则“鬼邪”有余，心气亏损则生化之源不足，应当平抑肝气、补益心气。如果诊察脉象，肝心二脏调和，则是脾脏自身的病变，根据虚实情况治疗。
我认为：上述实证是指病气实而形体之气虚。如果面色㿠白，呕吐腹泻腹痛，口鼻气息寒冷，属于寒水侮土（肾水反侮脾土），宜用益黄散。如果面色青、嘴唇暗紫、呕吐腹泻、手足均冷，这是脾土虚寒，用干姜理中汤。如果面色萎黄、手足不冷，这是脾土虚弱，用人参理中汤。如果伤风导致手足均冷，吐痰咳嗽，呕吐腹泻腹胀，这是脾肺气虚，用五味异功散补益脾气，加防风、升麻疏散外邪。如果在寅时、卯时发病，用六君子汤、柴胡、升麻，补脾土、平肝木。然而，面色黄是脾的本色；面色赤是火生土，为顺证；面色青是木克土，为逆证，应当平抑所胜之脏，以补元气为善。
人参安胃散：治疗脾胃虚弱，因热乳食损伤导致的呕吐、泻痢。
配方：人参（一钱）、黄芪（二钱）、生甘草、炙甘草（各五分）、白芍药（酒炒，七分）、白茯苓（四分）、陈皮（三分）。
制法：以上药物研为细末，每次服用二钱，加水煎服。
按语：李东垣说：益黄散内含有丁香、青皮的辛热之性，这是为了寒水侮土的情况而设的。如果是因热药、巴豆之类损伤脾胃，或因暑热伤及乳食而成吐泻，口鼻气息热而导致慢惊风的，适宜使用前文提到的散剂（指人参安胃散等清热益气之剂）。
益黄散：治疗脾虚引起的呕吐、腹泻、食欲不振，米谷不消化，困倦乏力，滑肠夜起，以及疳积虚汗、涎水流出口角。
配方：陈皮（一两）、丁香（二钱）、诃子（炮制，去皮）、青皮（去白）、甘草（炙。各半两）。
制法：以上药物研为细末，每次服用一钱，加水煎服。
按语：上述病症如果是脾土虚寒，或寒水侮土导致的呕吐泄泻，手足均冷，或痰涎上壅，睡眠时眼睛睁开（露睛），不想吃奶或食物，适宜用此方。如果是因脾土虚弱导致的吐泻，用六君子汤加柴胡。如果无效，或者手足俱冷，属于虚寒，再加木香、炮姜。如果是因乳母脾虚、肝气乘侮所致，必须以前述药物治疗。如果乳母因郁怒导致孩子患上述病症，母亲服用加味归脾汤。
钱氏泻黄散（又名泻脾散）：治疗脾热引起的吐舌。
配方：藿香叶、甘草（各七钱五分）、山栀仁（一两）、石膏（五钱）、防风（二两）。
制法：以上药物用蜜酒微炒后研为细末，每次服用一二钱，加水煎服。
按语：上述病症如果是口渴喜冷饮，睡觉时眼睛不睁开，手足很热，或全身发黄，属于胃经实热，宜用泻黄散。如果是口渴喜热饮，睡觉时眼睛睁开（露睛），手足均冷，属于胃经虚热，宜用异功散。如果面色青、抽搐，食欲少思，是肝气乘袭脾脏，用秘旨补脾汤。如果面色赤、惊悸、身体发热、昏睡，是心气乘袭脾脏，用秘旨安神丸。如果面色白、气喘咳嗽、肢体倦怠，是肺气乘袭脾脏，用补中益气汤。如果嘴唇黑、泄泻、手指冷，是肾气乘袭脾脏，用益黄散。病后津液不足，口干口渴，宜用七味白术散。如果是因乳母食用膏粱厚味，七情郁火所致，应当审察病因并治疗母亲。
Qian Zhongyang stated: The Spleen is prone to being constrained. In excess conditions, it manifests as lethargy, fever, and thirst with or without drinking water. In deficiency conditions, it leads to vomiting, diarrhea, and the generation of wind (convulsions). If the Spleen and Stomach are deficient and cold, symptoms include a pale complexion, lackluster eyes, cold breath from the mouth and nose, emaciation, vomiting of clear fluids, abdominal pain, and anorexia for milk or food. These should be treated with Yihuang San (Eulogy Powder); for diarrhea, Tiaozhong Wan (Regulate the Middle Pill) is used. For wind-strike accompanied by cold hands and feet, it indicates Spleen Qi deficiency; first use Yihuang San to tonify the Spleen, then Daqing Gao (Great Blue Ointment) to disperse Spleen pathogenic factors. This principle applies across all seasons. Cases that follow the natural course are easy to treat; those that go against it are difficult. Spleen deficiency presents with a reddish-yellow face. If complicated by the mutual overcoming of the Five Zang organs, treatment should be based on specific symptoms.
Zhang Jiegu further stated: The Spleen governs dampness. When diseased itself, it often causes diarrhea, excessive sleepiness, heavy body sensation, dizziness, and fatigue. If Liver Qi overacts on the Spleen, it is called "Thief Evil" (Ze Xie); if Heart Qi overacts on the Spleen, it is called "Deficiency Evil" (Xu Xie); if Lung Qi overacts on the Spleen, it is called "Excess Evil" (Shi Xie); if Kidney Qi overacts on the Spleen, it is called "Minor Evil" (Wei Xie). Whenever the Spleen is diseased, one must first examine the Liver and Heart. The Liver is the "Ghost" (overacting element) of the Spleen, and the Heart is the "Mother" (generating element) of the Spleen. Excessive Liver Qi results in surplus "Ghost Evil," while deficient Heart Qi leads to insufficient generative energy. One should soothe the Liver Qi and tonify the Heart Qi. If pulse diagnosis shows both Liver and Heart harmonious, the disease originates within the Spleen itself; treat according to excess or deficiency.
I suggest: The aforementioned excess condition refers to pathological Qi being excess while constitutional Qi is deficient. If the complexion is sallow-white, with vomiting, diarrhea, abdominal pain, and cold breath, this indicates Cold Water insulting Earth (Kidney Water insulting Spleen Earth), suitable for Yihuang San. If the face is green, lips dark, with vomiting, diarrhea, and cold extremities, this is Spleen Earth deficiency and cold, treatable with Ganjiang Lizhong Tang (Dried Ginger Regulate the Middle Decoction). If the complexion is withered yellow without cold extremities, this is Spleen Earth weakness, treatable with Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). If wind-strike causes cold extremities, phlegm expectoration, cough, vomiting, diarrhea, and abdominal distension, this is Spleen-Lung Qi deficiency; use Wuyi Gong San (Five Agents Efficacy Powder) to tonify Spleen Qi, adding Fangfeng (Saposhnikovia Root) and Shengma (Cimicifugae Rhizoma) to dispel external pathogens. If onset occurs during Yin or Mao hours, use Liujunzi Tang (Six Gentlemen Decoction), Chaihu (Bupleuri Radix), and Shengma to tonify Spleen Earth and level Liver Wood. A yellow face is the true color of the Spleen; a red face indicates Fire generating Earth, which is favorable; a green face indicates Wood controlling Earth, which is unfavorable. One should level the overacting element and tonify Yuan Qi (Original Qi).
Daqing Gao (See Liver Chapter for formula)
Tiaozhong Wan (See Spleen-Stomach Deficiency-Cold Chapter for formula)
Renshen Anwei San (Ginseng Calming the Stomach Powder): Treats Spleen-Stomach deficiency caused by heat-damaged milk/food, leading to vomiting and dysentery.
Ingredients: Renshen (Ginseng Radix et Rhizoma) 1 qian, Huangqi (Astragali Radix) 2 qian, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) each 5 fen, Baishao Yao (Paeoniae Radix Alba, wine-fried) 7 fen, Baifuling (Poria) 4 fen, Chenpi (Citri Reticulatae Pericarpium) 3 fen.
Preparation: Grind into powder. Take 2 qian per dose, decoct in water.
Commentary: Li Dongyuan stated: Yihuang San contains Xinre (acrid-hot) herbs like Dingxiang (Caryophylli Flos) and Qingpi (Citri Reticulatae Pericarpium Viride), designed for Cold Water insulting Earth. If vomiting and diarrhea resulting from slow convulsions are caused by hot medicines or Ban Dou (Crotonis Fructus) damaging the Spleen-Stomach, or by summer-heat damaging milk/food causing hot breath, the aforementioned powder (referring to Renshen Anwei San) should be used.
Yihuang San (Eulogy Powder): Treats Spleen deficiency causing vomiting, diarrhea, anorexia, undigested food, lethargy, weak strength, loose stools with nocturnal awakening, malnutrition (Gan syndrome) with night sweats, and drooling at the corners of the mouth.
Ingredients: Chenpi (Citri Reticulatae Pericarpium) 1 liang, Dingxiang (Caryophylli Flos) 2 qian, Hezi (Terminaliae Chebulae Fructus, processed, skin removed), Qingpi (Citri Reticulatae Pericarpium Viride, white pith removed), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) each 0.5 liang.
Preparation: Grind into powder. Take 1 qian per dose, decoct in water.
Commentary: For the above symptoms, if due to Spleen Earth deficiency-cold or Cold Water insulting Earth causing vomiting/diarrhea, cold extremities, phlegm-fluid obstruction, sleeping with eyes open (exposed eyes), and anorexia, this formula is appropriate. If vomiting/diarrhea is due to Spleen Earth weakness, use Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleuri Radix). If ineffective, or if extremities are cold indicating deficiency-cold, add Muxiang (Aucklandiae Radix) and Pao Jiang (Zingiberis Rhizoma Preparatum). If caused by the wet nurse's Spleen deficiency and Liver overaction, treat with the aforementioned medicine. If the wet nurse's depression and anger cause the infant's symptoms, the mother should take Jiawei Guipi Tang (Modified Restore the Spleen Decoction).
Qian Shi Xiehuang San (Qian's Draining Yellow Powder, also known as Xiepi San): Treats tongue protrusion due to Spleen heat.
Ingredients: Huoxiang Ye (Agastaches Herba) 7.5 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 7.5 qian, Shanzhi Ren (Gardeniae Semen) 1 liang, Shigao (Gypsum Fibrosum) 5 qian, Fangfeng (Saposhnikoviae Radix) 2 liang.
Preparation: Lightly stir-fry with honey and wine, grind into powder. Take 1-2 qian per dose, decoct in water.
Commentary: For the above symptoms, if accompanied by thirst for cold drinks, closed eyes during sleep, hot extremities, or generalized jaundice, it belongs to Stomach Meridian Excess Heat, treatable with Xiehuang San. If accompanied by thirst for hot drinks, exposed eyes during sleep, and cold extremities, it belongs to Stomach Meridian Deficiency Heat, treatable with Yigong San (Efficacy Powder). If the face is green with convulsions and poor appetite, it is Liver overacting on Spleen, treatable with Mizhi Bupi Tang (Secret Instruction Tonifying Spleen Decoction). If the face is red with palpitations, fever, and lethargy, it is Heart overacting on Spleen, treatable with Mizhi Anshen Wan (Secret Instruction Calming Spirit Pill). If the face is white with wheezing/cough and limb fatigue, it is Lung overacting on Spleen, treatable with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If lips are black with diarrhea and cold toes, it is Kidney overacting on Spleen, treatable with Yihuang San. After illness, if fluid deficiency causes dry mouth and thirst, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). If caused by the wet nurse's rich diet and emotional fire, investigate the cause and treat the mother.
Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction) (See Taiyang-Taiyin Chapter for formula)
Wuyi Gong San (Five Agents Efficacy Powder)
Liujunzi Tang (Six Gentlemen Decoction) (Both formulas see Tiandiao and Neidiao Chapters)