《灵枢》曰∶人有髓海，有血海，有气海，有水谷之海。凡此四者，以应四海也。
胃者，水谷之海；冲脉者，为血之海，又十二经之海；膻中者，为气之海，脑为髓之
海；又曰冲脉者，五脏六腑之海也。五脏六腑皆禀焉。又曰∶人受气于谷，谷入于胃，
以传于肺，五脏六腑，皆以受气，（胃升精于肺，肺散精于脏腑。）其清者为营，浊
者为卫，（《素问》曰∶营者，水谷之精气，卫者，水谷之悍气。）营在脉中，（阴性
精专，随宗气以行于经隧之中。）卫在脉外，（阳性 悍滑利，不入于脉而行，行
于皮肤分肉之间，其浮气之不循经者为卫气，其精气之行于经者，为营气。）周营不休，
五十而复大会，阴阳相贯，如环无端。昼行于阳，夜行于阴，太阴主内。太阳主外，
各二十五度，分为昼夜。夜半后而阴衰，平旦阴尽而阳受气矣。日西而阳衰，
日入阳尽，而阴受气矣。夜半而大会，（阴阳交会），万民皆卧，命曰合阴。平旦阴尽
而阳受气，如是无已，与天地同纪，其始入于阴，常从足少阴注于肾，（气行于
阴则寐，故少阴病但欲寐也）。肾注于心，心注于肺，肺注于肝，肝注于脾，脾复
注于肾，为周营，出于中焦（中脘穴为中焦，胃中谷气传化精微为血。）卫出于
下焦，（脐下一寸阴交穴为下焦，其阳气上升为卫气。）营卫者，精气也，（水谷之
精气。）血者，神气也。盖精能生神，神无所丽，必根据精
血，故血之与气，异名同类焉。
《灵枢》曰∶脾小则脏安，难伤于邪也。脾大则苦凑 ，（ 音眇，胁下软肉处也。）而痛，
不能疾行。脾高，则 引季肋而痛。脾下，则下加于大肠，则脏苦受邪。脾坚。则脏安难伤。
脾脆，则善病，消瘅易伤。脾端正则和好难伤，脾偏倾则善满善胀也。（何以知其然也？黄色小
理者，脾小粗理者，脾大揭唇者，脾高唇下纵者，脾下唇坚者，脾坚唇大而不坚者，脾脆唇上
下好者，脾端正，唇偏倾者，脾偏倾也。）
人以胃气为本者，以其滋养万物。食入于胃，受土之气也。以脾为本者，以其磨化万物，
布五味，以养五脏，荣养百骸，润泽四肢。故胃气调和，则乳哺消化，脾胃虚冷，则宿食不行，大法
温胃补脾为主。若惊惕热甚而不食者，是心脾为子母，当用泻心之剂。若因心虚而脾气亦衰，故恍
惚不食者，当以补心之剂，兼与扶脾，所谓火能生土，母能令子实也。若面白无光，瘦弱腹痛，口
中气冷，不思食而吐水者，是胃气虚冷，法当暖胃扶脾。故胃虚则有呕吐不食之症，胃实则多痞
满内热之虞。且旦则阳气方长，谷气易消，故能食。暮则阴气方迸，谷不能化，故宜少食。若临晚
而倍能食者，是阴虚而邪火杀谷也。然调脾胃者，其人昌；伤脾胃者，其人亡。脾具坤静之德，
而有干健之运，化生精气，清气上升，糟粕下降，浊者为卫，清者为荣，阴阳得此，谓之橐
龠，使一弱焉，则健运之令不行，化生之功失职，厥病之由，靡不始此。婴儿不知饥饱，保育
之功，在于父母。奈情深姑惜，不知宿食未消，新食又进，药之恐儿苦口，节之恐儿饿肚，以致
脾胃愈伤，百病踵作矣。
积滞必用消导。消者，散其积也。导者，行其气也。脾虚不运，则气不流行，气不流行则停
滞而为积，或作泻痢，或成 痞，以致饮食减少，五脏无所资禀，血气日以虚衰，因致危困者多矣。
故必消而导之，轻则用和解之常剂，重必假峻下之汤丸。盖浊阴不降，则清阳不升，客垢不除，则真元
不复，如勘定祸乱，然后可以致太平。若积因于脾虚不能健运药力者，或消补并行，或补多消少，
或先补后消，洁古所谓养正而积自除，故前人破滞削坚之药，必假参术赞助成功。《经》曰∶无致
邪，无失正，绝人长命，此之谓也。东垣曰∶胃乃脾之刚，脾乃胃之柔，饮食不节，则胃先病，脾
无所禀而后病，劳倦则脾先病，不能为胃行气而胃后病。然脾胃为十二经之海，脾胃既虚，十二
经之邪不一而出，故百病皆从脾胃生也。处方者，可不以此为重乎。
夫天包地外，地处天中，以生为长，以收为藏，玄穹不有其功，而功归后土，故土
膏一动，百昌莫不蕃茂，土气一收，万物莫不归根，是以膏沐之沃土，可以发育，灰沙之燥土，
全无生气也。故万物悉从土出，名为万物之母，其在人身则脾胃主之，气血精神，津液筋胃，脏腑
百骸，莫不禀气于胃也。故胃者，卫之源，脾者，荣之本，《针经》曰∶荣出中焦，卫出上焦。然
脾者，坤土也。主乎静而属阴。胃者，干土也。主乎动而属阳。然脾具坤柔之德，而有干运之
功，脾喜燥而恶湿，胃本湿而恶燥。《灵枢》曰∶胃欲寒饮恶热，肠欲热饮恶寒。《内经》
曰∶脾胃者，仓禀之官。胃为水谷之海，五脏六腑之大源，水谷皆入于胃，脾与胃以膜
相连，为胃行其津液，是以食气入胃，散精于肝，淫气于筋，淫精于脉，输精于脾。饮
入于胃，游溢精气，上输于脾，脾气散精，上归于肺。脾胃为人后天元气之本，而饮食
为人化源生发之机，故曰纳谷为室，安谷者昌。若胃虚不能容受，故不嗜食。脾虚不能
运化，故有积滞。所以然者，皆由气虚也。是以东垣创立《脾胃论》，而定补中益气汤，
以开万世补后天元气之祖，所以真气，名元气者，正生身之精也。惟胃气足以滋之，故
胃之一腑若病，则十二经之元气皆为不足，津液皆为不行，四肢百骸，皆失营运，九窍
不通，而百病生矣。故治百病者，未有不以健脾胃为最重也。谓之健者，因脾虚不能运
动，故助其脾之力，以使健运也。然进健脾扶胃，而终不能饮食者，不知更有补母之法
焉。盖补土者，莫先于补火，如人不思饮食，此属阳明胃土受病，须补少阴君火，归
脾汤正补心火以生胃土也。如人能食而不化，此属太阴脾土受病，须补少阴相火，八
味丸正补相火，以生脾土也。岂知补火之神功，更兼滋水之妙用，盖脾胃能化万物，实
由于水火二气之中，五行相克为用，相克即所以相成，水不得土籍，何处以发生？土不
得水，燥槁何能生物？故土以成水柔润之德，水以成土化育之功，水土相资，故脾为
太阴湿土，全赖以水为用，故曰∶补脾不若补肾者，既补肾中之火，尤补肾中之水，补
火者生土也，补水者滋土也。太阴湿土，全仗以湿为用，苟不知此，而徒以辛香燥热，
以为助脾开胃，适足致为燥裂，无用之土矣。犹天之不雨，地土不能湿润，则水土不
和，而生化之令不行。且造化生物，惟有阳和一气，即如鸭卵，以火暖而雏，蚕子以人
怀而出，阳春一转，草木甲拆，触类旁通，化育之理昭然矣。
肥人体倦，脾胃不和，食不饱闷，此胃有湿痰，郁滞中焦，以致清阳不升，浊阴不
降，痞塞填病，二便阴塞，宜用四君，则陈半升柴，则脾胃自强，情升浊降，郁化滞
行，津液四布。湿流燥润，二便如常，精神饮食俱健矣。
胃中元气盛，则多食而不伤，过时而不饥。脾胃俱旺，则能食而肥。脾胃俱虚，则
不能食而瘦。饮食不节，则胃病。胃病则气短，精神少而生大热，宜甘温以除之。形体
劳后则脾病，脾辰则怠情嗜卧，四肢不收，宜调补以健之。平人饮食入胃，先行阳道，
而阳气升浮，散满皮肤，充塞头顶，则九窍返利也。病患饮食入胃，先行阴道而阴气降
沉，遽觉至脐下，辄欲小便，当脐有动气，按之若痛，故九窍不利也。《经》曰∶阴精
上奉其人寿。谓脾胃既和，谷气上升，春夏令行，故其人寿。阳精所降，其人夭。谓脾
胃不和，谷气下流，收藏令行，故其人夭。又曰∶人以水谷为本，故安谷则昌，绝谷则
亡。水去则荣散，谷消则卫亡。荣散卫亡，将何以立？故血不可不养，卫不可不温，然
人之元气充足，皆由脾胃之气，无所伤损也。
下气属心虚，《经》云∶夏脉者，心也。心脉不及，下为气泄者是也。河间云∶肠胃
郁结，谷气内发，而不能宣通于肠胃之外，故善噫嚏而下气也。如颠痫痨瘵，若气下泄不
止者，必死。此真气竭绝，肠胃腠理闭塞，谷气不能宣通于肠胃之外，故从肠胃中泄出
此气者，乃肠胃生养之气也。
有胃病之后，而胃脉和平，其心肾肝肺之脉，反不能安其常者，此因中央气弱，不
能四迄，如母病而四子失乳，故现饥馁之象耳。更有食后迷闷倦怠，转欲小便者，即是
元气下陷也，宜补中益气汤，倍加蜜酒炒升麻。然安佚之人多犯之，盖气无神运，则下降也。
《灵枢》说：人体有髓海、血海、气海和水谷之海。这四海对应着人体的四个重要部位。
胃，是水谷之海；冲脉（奇经八脉之一，调节十二经气血），是血海，也是十二经脉之海；膻中（两乳之间，心包所在处），是气海；脑，是髓海。又说：冲脉，是五脏六腑之海。五脏六腑都依赖它而得到滋养。又说：人从食物中获取精气，食物进入胃后，将精气传送给肺，五脏六腑都能从中获得营养。（胃将精微物质上输于肺，肺将精微散布到脏腑。）其中清纯的部分成为营气（行于脉中，具有营养作用的气），浑浊的部分成为卫气（行于脉外，具有防御作用的气）。《素问》说：营气，是水谷的精微之气；卫气，是水谷的悍烈之气。营气在脉管之中运行，（阴性质地精纯专一，随着宗气在经络隧道中运行。）卫气在脉管之外运行，（阳性质地悍利滑疾，不进入脉管而行，运行于皮肤和肌肉纹理之间，那些浮散而不循常道运行的气称为卫气，而在经脉中运行的精微之气称为营气。）它们周流循环不停歇，每五十个周期重新大会合一次，阴阳相互贯通，像圆环一样没有尽头。白天运行于阳分，夜晚运行于阴分，太阴经主管内部运行，太阳经主管外部运行，各运行二十五周，以此划分昼夜。半夜之后阴气衰退，天亮时阴气耗尽而阳气开始受气。日落时分阳气衰退，太阳落山时阳气耗尽而阴气开始受气。半夜时阴阳交会，（阴阳交汇），百姓都在睡觉，这叫作“合阴”。天亮时阴气耗尽而阳气受气，如此循环不止，与天地运行的规律相同。其初始进入阴分时，通常从足少阴肾经注入肾脏，（气行于阴则入睡，所以少阴病表现为只想睡觉）。肾注于心，心注于肺，肺注于肝，肝注于脾，脾再注回肾，完成一周期的营气运行，出于中焦（中脘穴位于中焦，胃中的谷气转化精微生成血液）。卫气出于下焦，（脐下一寸的阴交穴位于下焦，其阳气上升形成卫气）。营气和卫气，都是精气，（水谷产生的精微之气）。血，是神气的载体。因为精能生神，神没有依附之处，必须依托于精血，所以血和气，名称不同但本质同类。
《灵枢》说：脾脏小则内脏安宁，不易受邪气伤害。脾脏大则会感到胁下软肉处疼痛，不能快速行走。脾脏位置偏高，会牵引季肋部疼痛。脾脏位置偏低，则向下压迫大肠，导致内脏容易受邪气侵害。脾脏坚实，则内脏安宁难受伤损。脾脏脆弱，则容易患病，易患消渴、瘅热等病且易受损伤。脾脏位置端正则平和难伤，脾脏偏斜则容易腹胀满闷。（怎么知道这些情况呢？面色黄而纹理细腻者，脾小；纹理粗糙者，脾大；嘴唇外翻者，脾高；唇下垂纵者，脾高；唇坚厚者，脾下；唇大但不坚厚者，脾脆；唇上下形态良好者，脾端正；唇形偏斜者，脾偏斜。）
人以胃气为根本，因为它滋养万物。食物进入胃中，接受土气的滋养。以脾为本，是因为它磨化食物，布散五味，以滋养五脏，荣养全身骨骼，润泽四肢。所以胃气调和，则乳汁和食物易于消化；脾胃虚寒，则宿食停滞不行，治疗大法以温胃补脾为主。如果因惊恐惕惧、内热严重而不想进食的，这是心脾互为子母关系，应当使用泻心的方剂。如果因心气虚弱导致脾气也衰败，从而精神恍惚不想进食的，应当使用补心的方剂，同时扶助脾气，这就是所谓“火能生土”，母脏能使子脏充实。如果面色苍白无光泽，身体瘦弱腹痛，口中呼出冷气，不思饮食且呕吐清水的，这是胃气虚寒，治疗方法应当暖胃扶脾。所以胃虚会有呕吐、不进食的症状，胃实则多有痞满、内热的隐患。而且早晨阳气刚开始生长，谷气容易消化，所以能进食；傍晚阴气开始旺盛，谷物难以消化，所以应该少吃。如果到了晚上反而加倍能进食的，这是阴虚而邪火消烁谷物的表现。然而调理脾胃的人，身体昌盛；损伤脾胃的人，生命危亡。脾具有坤卦静止的德行，而具备乾卦健运的功能，化生精气，清气上升，糟粕下降，浊气成为卫气，清气成为营气，阴阳依靠这种机制，被称为“橐龠”（风箱，比喻呼吸或气机升降的动力装置），只要其中一方衰弱，那么健运的命令就无法执行，化生的功能就会失职，各种疾病的由来，无不始于此。婴儿不知道饥饱，保育的责任在于父母。无奈父母情深姑且怜惜，不知道宿食未消，新的食物又进来了，喂药恐怕孩子嫌苦口，节制又怕孩子饿肚子，以致脾胃更加受伤，百病接踵而至。
积滞必须使用消导法。消，是消散积滞；导，是行气。脾虚不能运化，则气机不流行，气机不流行则停滞而成积滞，或者造成腹泻痢疾，或者形成痞证，以致饮食减少，五脏得不到滋养，血气日益虚衰，因此导致危险困顿的情况很多。所以必须消积并引导气机，轻症用和解的常规方剂，重症必须借助峻猛的泻下方剂汤丸。因为浊阴不降，则清阳不升，客邪污垢不除，则真元不能恢复，就像平定祸乱之后，才能达到太平。如果积滞是由于脾虚不能健运药力造成的，或者消补并行，或者补多消少，或者先补后消，正如李东垣（洁古）所说养护正气而积滞自然消除，所以前人使用破滞削坚的药物，必须借助人参、白术来赞助成功。《内经》说：不要助长邪气，不要丧失正气，断绝人的寿命，说的就是这个道理。李东垣说：胃是脾的刚强部分，脾是胃的柔和部分，饮食不节制，则胃先生病，脾无所禀受而后生病；劳累过度则脾先生病，不能为胃运行气机而胃后生病。然而脾胃是十二经脉之海，脾胃既然虚弱，十二经脉的邪气就会不一而足地出现，所以百病都从脾胃产生。开处方的人，能不重视这一点吗？
天包裹在地之外，地处于天之中，以生长为长处，以收敛为藏蓄。玄穹（天空）不居其功，而功劳归于后土（大地），所以土壤膏润一动，万物没有不繁茂的；土气一收，万物没有不归根的。因此肥沃湿润的土壤，可以发育万物；灰沙般的干燥土壤，完全没有生气。所以万物都从土中生出，称为万物的母亲，在人体中则由脾胃主宰，气血精神、津液筋骨、脏腑百骸，无不禀受胃气。所以胃是卫气的源头，脾是营气的根本，《针经》说：营气出于中焦，卫气出于上焦。然而脾属坤土，主静而属阴。胃属干土，主动而属阳。然而脾具有坤柔的德行，而有乾运的功能，脾喜欢燥而厌恶湿，胃本湿而厌恶燥。《灵枢》说：胃喜欢寒饮而厌恶热，肠喜欢热饮而厌恶寒。《内经》说：脾胃是仓廪之官。胃是水谷之海，五脏六腑的大源，水谷都进入胃，脾与胃通过膜相连，为胃传输津液，所以食物气息进入胃后，将精微散布于肝，使精气充盈于筋，充盈于脉，将精微输送于脾。饮水进入胃后，游溢精气，向上输送于脾，脾气散布精微，向上归还于肺。脾胃是人后天元气之本，而饮食是人化源生发的关键，所以说“纳谷为室，安谷者昌”（能进食则生命力旺盛）。如果胃虚不能容纳受纳，所以不喜欢吃东西。脾虚不能运化，所以有积滞。之所以这样，都是由气虚造成的。因此李东垣创立了《脾胃论》，并制定了补中益气汤，作为开启万世补益后天元气的祖方。所谓的真气、元气，正是生成身体的精微物质。只有胃气足以滋养它，所以如果胃这一腑生病了，那么十二经的元气都会不足，津液都不能运行，四肢百骸都失去营运，九窍不通，而百病就产生了。所以治疗百病的人，没有不把健运脾胃作为最重要的。称为“健”，是因为脾虚不能运动，所以帮助脾的力量，使其健运。然而服用健脾扶胃的药，最终仍不能饮食的，是不知道还有补母的方法。补土（脾），没有比补火（心/命门）更优先的，如人不思饮食，这属于阳明胃土受病，需要补少阴君火，归脾汤正是补心火以生胃土的方剂。如人能食但不能消化，这属于太阴脾土受病，需要补少阴相火，八味丸正是补相火以生脾土的方剂。哪里知道补火的奇妙功效，更兼有滋水的妙用，因为脾胃能化生万物，实际上是由于水火二气的作用，五行相克为用，相克即所以相成，水不得土籍制，何处以发生？土不得水润，干燥枯槁怎能生物？所以土成就水柔润的德行，水成就土化育的功效，水土相互资助，所以脾为太阴湿土，完全依赖水的作用，所以说“补脾不如补肾”，既补肾中之火，又补肾中之水，补火者生土，补水者滋土。太阴湿土，完全仗赖以湿为用，如果不懂这个道理，而只用辛香燥热的药物来助脾开胃，恰好足以导致干燥开裂，变成无用之土了。就像天不下雨，地土不能湿润，则水土不和，而生化的命令无法执行。况且造化生物，只有一团阳和一气，就像鸭蛋用火温暖孵化出小鸡，蚕子用人怀抱孵出，阳春一转，草木破壳发芽，触类旁通，化育的道理昭然若揭。
肥胖的人身体疲倦，脾胃不和，吃不多就感到胀闷，这是胃中有湿痰，郁滞在中焦，以致清阳不升，浊阴不降，痞塞填病，大小便闭塞，适宜使用四君子汤，加上陈皮、半夏、升麻、柴胡，则脾胃自强，清气上升浊气下降，郁结化解滞气通行，津液四处布散。湿气流动滋润干燥，大小便恢复正常，精神和饮食都健康了。
胃中元气盛，则多吃也不受伤，过了饭点也不觉得饿。脾胃都旺盛，则能吃且身体丰满。脾胃都虚弱，则不能吃且身体消瘦。饮食不节制，则胃病。胃病则气短，精神少而生大热，适宜用甘温药物来清除。形体劳累后则脾病，脾病则怠惰嗜卧，四肢无力不收，适宜调补以强健之。普通人饮食入胃，先走阳道，而阳气升浮，散布充满皮肤，充塞头顶，则九窍通畅。病人饮食入胃，先走阴道而阴气降沉，立刻感觉到至脐下，就想小便，肚脐周围有动气，按压若痛，所以九窍不利。《内经》说：阴精上奉，其人长寿。意思是脾胃既调和，谷气上升，春夏令行，所以其人长寿。阳精所降，其人夭折。意思是脾胃不和，谷气下流，收藏令行，所以其人夭折。又说：人以水谷为根本，所以安谷则昌盛，绝谷则灭亡。水去则营气散失，谷消则卫气消亡。营散卫亡，凭什么站立生存？所以血不可不养，卫气不可不温，然而人的元气充足，都是由脾胃之气没有受到损伤的缘故。
下气（气往下泄）属于心虚，《经》云：夏脉者，心也。心脉不及，下为气泄就是这种情况。刘河间说：肠胃郁结，谷气内发，而不能宣通于肠胃之外，所以容易嗳气、打喷嚏而下气。如癫痫、劳瘵，如果气下泄不止的，必死。这是因为真气竭绝，肠胃腠理闭塞，谷气不能宣通于肠胃之外，所以从肠胃中泄出的气，乃是肠胃生养之气。
有胃病之后，而胃脉和平，其心、肾、肝、肺之脉，反而不能安守常态的，这是因为中央（脾胃）气弱，不能通达四旁，如同母亲生病而四个儿子失去乳汁，所以现出饥饿匮乏的景象罢了。更有进食后迷闷倦怠，转而想要小便的，这就是元气下陷，适宜使用补中益气汤，加倍加入蜜酒炒制的升麻。然而安逸的人多犯此病，盖因气若无神机运化，则下降。
The *Ling Shu* (Spiritual Pivot) states: The human body has a Sea of Marrow, a Sea of Blood, a Sea of Qi, and a Sea of Grain and Water. These four seas correspond to the four seas in the body.
The Stomach is the Sea of Grain and Water; the Chong Mai (Penetrating Vessel), which regulates the blood of the twelve meridians, is the Sea of Blood and also the Sea of the Twelve Meridians; the Dan Zhong (Chest center, location of the Pericardium) is the Sea of Qi; the Brain is the Sea of Marrow. It is also said that the Chong Mai is the Sea of the Five Zang and Six Fu organs. The Five Zang and Six Fu organs all receive nourishment from it. It is further stated that humans obtain Qi from food; when food enters the Stomach, its essence is transmitted to the Lung, allowing the Five Zang and Six Fu organs to receive Qi. (The Stomach ascends essence to the Lung, and the Lung disperses essence to the Zang and Fu organs.) The pure part becomes Ying Qi (Nutritive Qi, circulating within the vessels), and the turbid part becomes Wei Qi (Defensive Qi, circulating outside the vessels). The *Su Wen* (Basic Questions) states: Ying Qi is the refined essence of grain and water; Wei Qi is the fierce and rapid Qi of grain and water. Ying Qi circulates within the vessels, (being Yin in nature, pure and dedicated, it travels with Zong Qi through the meridian tunnels.) Wei Qi circulates outside the vessels, (being Yang in nature, fierce and slippery, it does not enter the vessels but moves between the skin and muscle layers; the floating Qi that does not follow the meridians is called Wei Qi, while the refined Qi moving within the meridians is called Ying Qi.) They circulate continuously without rest, meeting again after fifty cycles, with Yin and Yang interconnecting like a circle without beginning or end. During the day, they move in the Yang aspect; at night, in the Yin aspect. The Tai Yin governs the interior movement, and the Tai Yang governs the exterior movement, each completing twenty-five circuits to divide day and night. After midnight, Yin declines; at dawn, Yin is exhausted, and Yang receives Qi. In the afternoon, Yang declines; at sunset, Yang is exhausted, and Yin receives Qi. At midnight, there is a great convergence of Yin and Yang, (Yin-Yang intersection), when all people sleep, termed "He Yin" (Union of Yin). At dawn, Yin is exhausted, and Yang receives Qi. This cycle continues endlessly, mirroring the rhythms of Heaven and Earth. Initially entering the Yin, it typically flows from the Foot Shaoyin Kidney channel into the Kidneys. (When Qi moves into Yin, one sleeps; thus, Shaoyin disease manifests as drowsiness.) From the Kidney, it goes to the Heart; from the Heart, to the Lung; from the Lung, to the Liver; from the Liver, to the Spleen; and from the Spleen back to the Kidney, completing a cycle of Ying Qi circulation, originating from the Middle Jiao (Zhongwan acupoint represents the Middle Jiao, where grain Qi in the Stomach transforms into essence and blood). Wei Qi originates from the Lower Jiao (Yinjiao acupoint, one cun below the umbilicus, represents the Lower Jiao, where Yang Qi ascends to form Wei Qi). Ying and Wei Qi are both refined essence (the refined Qi of grain and water). Blood is the carrier of Shen Qi (Spiritual Qi). Since Essence generates Spirit, and Spirit requires a substrate, it must rely on Essence and Blood; therefore, Blood and Qi, though named differently, are of the same substance.
The *Ling Shu* states: If the Spleen is small, the internal organs are peaceful and difficult to injure by pathogens. If the Spleen is large, it causes pain in the hypochondriac soft tissue area (Miao), making rapid walking difficult. If the Spleen is high, it pulls on the costal margin causing pain. If the Spleen is low, it presses down on the Large Intestine, making the organs susceptible to pathogens. If the Spleen is firm, the organs are peaceful and hard to injure. If the Spleen is fragile, it is prone to disease, such as Xiao Dao (wasting-thirst) and can be easily injured. If the Spleen is upright, it remains harmonious and hard to injure; if tilted, it is prone to fullness and distension. (How do we know this? Yellow complexion with fine texture indicates a small Spleen; coarse texture indicates a large Spleen; protruding lips indicate a high Spleen; drooping lips indicate a high Spleen; firm lips indicate a low Spleen; large but not firm lips indicate a fragile Spleen; well-formed upper and lower lips indicate an upright Spleen; deviated lips indicate a tilted Spleen.)
Humans take Stomach Qi as their root because it nourishes all things. Food enters the Stomach and receives the Qi of Earth. The Spleen is taken as the root because it grinds and transforms all things, distributing the Five Flavors to nourish the Five Zang organs, enriching the bones, and moistening the limbs. Therefore, when Stomach Qi is harmonious, milk and food digest easily; when the Spleen and Stomach are deficient and cold, retained food fails to move. The general treatment principle is to warm the Stomach and tonify the Spleen. If there is no appetite due to fright, palpitations, and severe heat, this involves the Mother-Child relationship between the Heart and Spleen, and formulas for draining the Heart should be used. If the Spleen Qi is weak due to Heart deficiency, leading to mental confusion and lack of appetite, Heart-tonifying formulas should be used alongside Spleen-supporting measures, following the principle that Fire generates Earth, and the Mother organ strengthens the Child. If the face is pale and lusterless, the body is thin with abdominal pain, breath feels cold, there is no desire to eat, and water is vomited, this is Stomach Qi deficiency and cold; the method should be to warm the Stomach and support the Spleen. Thus, Stomach deficiency leads to vomiting and anorexia, while Stomach excess often leads to痞满 (fullness/stagnation) and internal heat. Moreover, in the morning, Yang Qi is just growing, and grain Qi digests easily, so one can eat. In the evening, Yin Qi is rising, and grain cannot be transformed, so one should eat less. If one eats significantly more in the late evening, this indicates Yin deficiency with pathogenic fire consuming the grain. However, those who regulate the Spleen and Stomach prosper; those who damage them perish. The Spleen possesses the stillness of Kun (Earth) but the activity of Qian (Heaven), transforming and generating essence and Qi, with clear Qi ascending and turbid waste descending. Turbidity becomes Wei Qi, clarity becomes Ying Qi. Yin and Yang utilize this mechanism, known as "Tuoyue" (bellows), providing the motive force for respiration and Qi movement. If either weakens, the function of vigorous transformation ceases, and the merit of generation is lost; the origin of various diseases lies here. Infants do not know hunger or satiety; the responsibility of care lies with parents. However, out of deep affection and reluctance to see the child suffer, parents may fail to realize that old food has not digested before new food is introduced. Medicines may be too bitter, and dietary restrictions may cause hunger, leading to further damage to the Spleen and Stomach and the onset of myriad diseases.
Accumulation and stagnation must be treated with resolution and guidance. "Resolution" means dispersing accumulation; "guidance" means promoting Qi movement. When Spleen deficiency fails to transport, Qi does not flow; when Qi does not flow, it stagnates and forms accumulation, potentially causing diarrhea or dysentery, or forming Pi syndrome (abdominal mass/fullness), leading to reduced diet, lack of nourishment for the Five Zang organs, and daily decline of Blood and Qi, often resulting in critical conditions. Therefore, one must resolve and guide. For mild cases, use standard harmonizing formulas; for severe cases, employ drastic purgative decoctions or pills. Because if turbid Yin does not descend, clear Yang cannot ascend; if external filth is not removed, true Yuan Qi cannot recover. Just as peace follows the pacification of chaos. If accumulation is due to Spleen deficiency failing to mobilize medicinal power, one may combine resolution and tonification, use more tonification than resolution, or tonify first then resolve. As Li Dongyuan (Jiegu) stated, nurturing righteousness causes accumulation to self-resolve. Thus, predecessors using drugs to break stagnation and soften hardness must rely on Ginseng and Atractylodes to assist success. The Classics state: Do not exacerbate evil, do not lose righteousness, thereby cutting short life—this is what is meant. Li Dongyuan said: The Stomach is the rigid aspect of the Spleen; the Spleen is the soft aspect of the Stomach. Irregular diet injures the Stomach first, leaving the Spleen without nourishment, which then gets injured. Overwork injures the Spleen first, preventing it from moving Qi for the Stomach, which then gets injured. Since the Spleen and Stomach are the Sea of the Twelve Meridians, once they are deficient, pathogens from the Twelve Meridians emerge in various ways, so all diseases arise from the Spleen and Stomach. Prescribers should not neglect this importance.
Heaven envelops the Earth, and the Earth lies within Heaven. Growth is the primary function, and storage is the secondary. Although Heaven performs these functions, the merit belongs to the Earth (Post-earth). When the soil moisture moves, all things flourish; when Earth Qi recedes, all things return to roots. Therefore, fertile, moist soil can develop life, while dry, sandy soil lacks vitality. All things emerge from Earth, hence it is called the Mother of All Things. In the human body, the Spleen and Stomach govern this. Blood, Qi, Spirit, fluids, sinews, bones, Zang-Fu organs, and limbs all receive Qi from the Stomach. Thus, the Stomach is the source of Wei Qi, and the Spleen is the root of Ying Qi. The *Zhen Jing* (Needle Classic) states: Ying Qi emerges from the Middle Jiao, Wei Qi emerges from the Upper Jiao. The Spleen is Kun Earth, governing stillness and belonging to Yin. The Stomach is Dry Earth, governing movement and belonging to Yang. However, the Spleen possesses the softness of Kun and the function of Qian's movement. The Spleen prefers dryness and dislikes dampness; the Stomach is originally damp and dislikes dryness. The *Ling Shu* states: The Stomach desires cold drinks and dislikes heat; the Intestines desire hot drinks and dislike cold. The *Nei Jing* states: The Spleen and Stomach are the officials of the granary. The Stomach is the Sea of Grain and Water, the great source of the Five Zang and Six Fu organs. Food and drink enter the Stomach. The Spleen connects to the Stomach via membranes and transports fluids for the Stomach. Thus, food Qi entering the Stomach scatters essence to the Liver, overflowing into sinews, overflowing into vessels, and transmitting essence to the Spleen. Drink entering the Stomach overflows with essence and Qi, transporting upward to the Spleen. The Spleen scatters essence, sending it upward to the Lung. The Spleen and Stomach are the root of post-natal Yuan Qi, and diet is the source of generation. Hence, it is said: "Accepting grain establishes the chamber; those who accommodate grain prosper." If Stomach deficiency cannot accept, there is aversion to eating. If Spleen deficiency cannot transform, there is accumulation. This is due to Qi deficiency. Therefore, Li Dongyuan established the *Pi Wei Lun* (Treatise on the Spleen and Stomach) and formulated Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), serving as the ancestor for all future methods of tonifying post-natal Yuan Qi. True Qi, or Yuan Qi, is the essence that generates the body. Only Stomach Qi can nourish it. If the Stomach腑 is diseased, the Yuan Qi of the Twelve Meridians will be insufficient, fluids will not circulate, limbs and bones will lose operation, nine orifices will be blocked, and hundred diseases will arise. Therefore, treating hundred diseases always prioritizes strengthening the Spleen and Stomach. "Strengthening" implies assisting the Spleen's power to overcome deficiency and restore movement. However, if taking Spleen-strengthening and Stomach-supporting drugs still results in inability to eat, one fails to know the method of tonifying the Mother. To tonify Earth (Spleen), nothing precedes tonifying Fire (Heart/Mingmen). If one has no appetite, this is a disease of Yangming Stomach Earth, requiring tonification of Shaoyin Sovereign Fire. Guipi Tang (Restore the Spleen Decoction) tonifies Heart Fire to generate Stomach Earth. If one can eat but not digest, this is a disease of Taoyin Spleen Earth, requiring tonification of Shaoyin Ministerial Fire. Bawei Wan (Eight-Ingredient Pill) tonifies Ministerial Fire to generate Spleen Earth. One should know that the miraculous power of tonifying Fire also includes the subtlety of nourishing Water. The Spleen and Stomach transform all things due to the interaction of Water and Fire. The five elements interact through overcoming and supporting; overcoming is the means of supporting. Without Earth, where does Water originate? Without Water, how can dry Earth produce life? Earth achieves the moistening virtue of Water; Water achieves the generative merit of Earth. Water and Earth support each other. The Spleen is Taoyin Damp Earth, relying entirely on Water for its function. Hence, "tonifying the Spleen is不如 (inferior to) tonifying the Kidney." Tonifying the Kidney involves both Fire and Water. Tonifying Fire generates Earth; tonifying Water nourishes Earth. Taoyin Damp Earth relies on dampness for function. If one does not understand this and merely uses pungent, aromatic, drying, and hot drugs to aid the Spleen and open the stomach, it only causes dryness and cracking, rendering the Earth useless. Like the sky not raining, the earth cannot be moistened; if Water and Earth are not harmonious, the command of generation fails. Furthermore, creation produces life through a unified Qi of Yang and Harmony. For example, duck eggs hatch with warmth; silkworm eggs hatch with body heat. With the turn of spring, plants sprout. By analogy, the principles of generation are clear.
Obese individuals feel tired, with disharmony of the Spleen and Stomach, feeling full after little food. This is damp-phlegm in the Stomach, stagnating in the Middle Jiao, causing clear Yang not to ascend and turbid Yin not to descend, leading to obstruction and blockage, with constipation or urinary retention. Si Jun Zi Tang (Four Gentlemen Decoction) should be used, adding Chen Pi (Tangerine Peel), Ban Xia (Pinellia), Sheng Ma (Cimicifuga), and Chai Hu (Bupleurum), to strengthen the Spleen and Stomach. Clear Qi ascends, turbid Qi descends, stagnation resolves, and fluids distribute. Dampness flows, dryness is moistened, bowel movements normalize, and spirit and diet improve.
If Yuan Qi in the Stomach is abundant, one can eat much without injury and feel no hunger past meal times. If both Spleen and Stomach are robust, one eats well and gains weight. If both are deficient, one cannot eat and becomes thin. Irregular diet injures the Stomach. Stomach disease causes shortness of breath, low spirit, and intense heat, treatable with sweet-warm herbs. Physical labor injures the Spleen. Spleen disease causes lethargy, drowsiness, and flaccid limbs, treatable with regulation and tonification. In healthy people, food entering the Stomach first travels the Yang pathway; Yang Qi rises and floats, filling the skin and head, ensuring the patency of the nine orifices. In patients, food entering the Stomach first travels the Yin pathway; Yin Qi sinks, immediately reaching below the umbilicus, causing urge to urinate, with pulsation and tenderness at the umbilicus, leading to obstruction of the nine orifices. The Classics state: When Yin essence is offered upward, longevity ensues. This means when Spleen and Stomach are harmonious, grain Qi ascends, mimicking Spring and Summer, leading to longevity. When Yang essence descends, premature death occurs. This means when Spleen and Stomach are disharmonious, grain Qi flows downward, mimicking Autumn and Winter storage, leading to early death. It is also said: Humans take grain and water as their root; accommodating grain leads to prosperity, abandoning grain leads to death. Loss of fluids scatters Ying Qi; loss of grain eliminates Wei Qi. With scattered Ying and eliminated Wei, how can one stand? Thus, Blood must be nourished, and Wei Qi must be warmed. Human Yuan Qi is sufficient only when Spleen and Stomach Qi are undamaged.
Lowering Qi (Qi leaking downward) belongs to Heart deficiency. The Classics say: The Summer pulse corresponds to the Heart. If the Heart pulse is deficient, it manifests below as Qi leakage. Liu Hejian stated: Intestinal and gastric stagnation causes grain Qi to erupt internally but fail to circulate externally, leading to belching, sneezing, and lowering Qi. In epilepsy or consumption, if Qi leakage continues unceasingly, death is certain. This is due to exhaustion of True Qi, closure of intestinal and gastric pores, preventing grain Qi from circulating externally, so the Qi leaking from the intestines and stomach is the nourishing Qi generated by them.
After Stomach disease, if the Stomach pulse is peaceful but the pulses of the Heart, Kidney, Liver, and Lung are abnormal, this is due to weakness of the Central Qi (Spleen/Stomach), unable to reach the four extremities, like a mother sick and her four sons losing milk, showing signs of famine. Additionally, postprandial dizziness, fatigue, and urge to urinate indicate sinking of Yuan Qi. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled honey-fried Sheng Ma (Cimicifuga) is appropriate. This commonly affects sedentary people, as Qi without spiritual movement tends to descend.