调理脾胃湿与热
脾性湿，主乎血，阴也；胃火化，主乎气，阳也。太湿则气滞，太干则血燥，湿
热调停则能食能化，而气血生旺。苟或寒湿伤脾，则停饮难化，或不思食；燥热伤胃，则
停食不消，或善食而瘦。由是脾胃不和，交相为病，胃变为寒，脾变为热。大概以脉浮缓
而迟，或带紧为寒湿；脉浮缓而实，或细而数为燥热。又肥人多湿，瘦人多热，更参以饮食
浓薄可也。
且按心口疼不疼，
劳伤，手按心口不痛；食伤，手按心口刺痛。
食伤初寒久则热，劳倦初热久寒生。
劳倦伤，初起热中，宜甘温补中；久变寒中，宜辛热温中。饮食伤，初起寒湿，
宜辛燥消导；久为湿热，宜辛甘苦寒润之。
热病（胸多）火痰（眩）晕吐
痿（或大便闭），湿病肿胀泻难停；消补清热与燥湿，
劳伤元气不足，宜补益；食伤邪气有余，宜消导；劳役饮食俱伤，补益消导兼行
。其中或兼清热，或兼燥湿痰。补剂，补中益气汤主之。消导停食，枳梗二陈汤加山楂、麦芽
，枳术丸。停饮，胃苓汤加半夏，化痰丸。清热，小调中汤、橘皮竹茹汤、凝神散、三黄
枳术丸、保和丸。燥湿，二陈汤、六君子汤、理中汤、生胃丹、单苍术膏。
乘胜虚实脉堪凭。
脾胃为五脏主，风寒暑湿燥五气偏胜，亦能损伤。假令脉弦，风邪所胜，胃风汤
黄建中汤、三白汤；脉洪，热邪所乘，泻黄散、清胃散、调胃承气汤；脉涩，燥邪所乘，
八珍汤、钱氏白术散；脉沉细，寒邪所乘，益黄散、人参养胃汤丸、附子理中汤丸、补真
丸；脉缓濡无力，或时隐伏，正气虚而损也，四君子汤、参苓白术散，脉缓太过，湿邪自甚
也，平胃散。
脾的生理特性偏于湿，主要主管血液，属性为阴；胃的生理特性偏于火（易化火），主要主管气，属性为阳。湿气过重则导致气机阻滞，过于干燥则导致血液枯槁，只有湿热调和，才能正常进食并消化食物，从而使气血生成旺盛。如果寒湿损伤了脾，就会导致水饮停滞难以化解，或者不想吃东西；如果燥热损伤了胃，就会导致食物停滞不消化，或者虽然食欲好但身体消瘦。因此出现脾胃不和，相互影响而致病，胃可能转变为寒证，脾可能转变为热证。大抵而言，脉象浮缓而迟，或者带有紧象的，属于寒湿；脉象浮缓而实，或者细而数的，属于燥热。另外，肥胖的人多湿，瘦弱的人多热，还可以参考饮食的浓淡厚薄来判断。
并且按压心口部位看是否疼痛：如果是劳倦内伤，用手按压心口不痛；如果是饮食积滞损伤，用手按压心口会有刺痛感。
饮食积滞初起时表现为寒证，日久则转化为热证；劳倦内伤初起时表现为热证，日久则转化为寒证。
对于劳倦内伤，初起时多为热中（气虚发热），适宜用甘温的药物补益中气；日久转变为寒中（脾胃虚寒），适宜用辛热的药物温中散寒。对于饮食损伤，初起时多为寒湿，适宜用辛燥的药物消食导滞；日久转化为湿热，适宜用辛、甘、苦、寒性质的药物来润燥清热。
热病（胸部多有痰火）、火痰引起的眩晕呕吐、痿证（或者伴有便秘），湿病引起的肿胀、腹泻不止；治疗方法包括补益、消导、清热和燥湿。
劳倦损伤导致元气不足，适宜补益；饮食积滞导致邪气有余，适宜消导；如果是劳役和饮食共同造成的损伤，则补益和消导的方法兼用。其中或兼有清热，或兼有燥湿化痰。补益剂，以补中益气汤为主。消导停食，可用枳梗二陈汤加山楂、麦芽，或者枳术丸。治疗水饮停滞，可用胃苓汤加半夏，或者化痰丸。清热，可用小调中汤、橘皮竹茹汤、凝神散、三黄枳术丸、保和丸。燥湿，可用二陈汤、六君子汤、理中汤、生胃丹、单苍术膏。
判断虚实可以凭借脉象作为依据。
脾胃是五脏的主宰，风、寒、暑、湿、燥五种外邪之气偏胜，也能造成损伤。假如脉象弦，是风邪所胜，可用胃风汤、黄芪建中汤、三白汤；脉象洪大，是热邪所乘，可用泻黄散、清胃散、调胃承气汤；脉象涩，是燥邪所乘，可用八珍汤、钱氏白术散；脉象沉细，是寒邪所乘，可用益黄散、人参养胃汤丸、附子理中汤丸、补真丸；脉象缓濡无力，或者时而隐伏不见，这是正气虚弱亏损的表现，可用四君子汤、参苓白术散；脉象缓而太过，是湿邪自盛的表现，可用平胃散。
Regulating Spleen and Stomach Dampness and Heat
The physiological nature of the Spleen is damp, primarily governing Blood, and belongs to Yin; the physiological nature of the Stomach is fire (prone to transforming into heat), primarily governing Qi, and belongs to Yang. Excessive dampness leads to Qi stagnation, while excessive dryness leads to Blood desiccation. Only when dampness and heat are harmonized can one eat and digest properly, thereby generating abundant Qi and Blood. If Cold-Dampness injures the Spleen, it causes fluid retention that is difficult to transform, or anorexia; if Dry-Heat injures the Stomach, it causes food stagnation that fails to digest, or polyphagia with emaciation. Thus, disharmony between the Spleen and Stomach arises, mutually causing disease: the Stomach may transform into a Cold syndrome, and the Spleen into a Heat syndrome. Generally, a floating, moderate, and slow pulse, or one with a tight quality, indicates Cold-Dampness; a floating, moderate, and full pulse, or one that is thin and rapid, indicates Dry-Heat. Furthermore, obese individuals tend toward dampness, while thin individuals tend toward heat; this should be further assessed by considering the richness or blandness of their diet.
Moreover, palpate the epigastrium for pain: in fatigue injury (Lao Shang), pressing the epigastrium does not cause pain; in food injury (Shi Shang), pressing the epigastrium causes stabbing pain.
Food stagnation initially presents as Cold but transforms into Heat over time; fatigue injury initially presents as Heat but transforms into Cold over time.
For fatigue injury, the initial stage often involves Middle Heat (Qi deficiency fever), suitable for treatment with Sweet-Warm herbs to tonify the Middle Jiao; if it long-term transforms into Middle Cold (Spleen-Stomach deficiency cold), treat with Pungent-Hot herbs to warm the Middle Jiao. For food injury, the initial stage often involves Cold-Dampness, suitable for treatment with Pungent-Dry herbs to resolve stagnation and guide out food; if it long-term transforms into Damp-Heat, treat with Pungent, Sweet, Bitter, and Cold herbs to moisten and clear heat.
In Heat diseases (often with Phlegm-Fire in the chest), dizziness and vomiting caused by Fire-Phlegm, flaccidity syndromes (possibly accompanied by constipation), swelling and unceasing diarrhea caused by Dampness: therapeutic methods include tonification, resolution of stagnation, clearing heat, and drying dampness.
Fatigue injury results in insufficiency of Yuan Qi, suitable for tonification; food stagnation results in excess of pathogenic factors, suitable for resolution of stagnation; if both labor and diet cause injury, tonification and resolution of stagnation should be employed concurrently. Among these, some cases require concurrent clearing of heat, others require concurrent drying of dampness and resolving phlegm. For tonification formulas, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is primary. For resolving food stagnation, Zhi Geng Er Chen Tang (Immature Bitter Orange and Licorice Root Er Chen Decoction) added with Shan Zha (Crataegi Fructus) and Mai Ya (Hordei Fructus Germinatus), or Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) may be used. For fluid retention, Wei Ling Tang (Stomach and Cinnamon Twig Decoction) added with Ban Xia (Pinelliae Rhizoma), or Hua Tan Wan (Resolve Phlegm Pill) may be used. For clearing heat, Xiao Tiao Zhong Tang (Minor Regulate the Middle Decoction), Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction), Ning Shen San (Calm the Spirit Powder), San Huang Zhi Zhu Wan (Three Yellows Immature Bitter Orange and Atractylodes Macrocephala Pill), or Bao He Wan (Preserve Harmony Pill) may be used. For drying dampness, Er Chen Tang (Two-Aged Decoction), Liu Jun Zi Tang (Six Gentlemen Decoction), Li Zhong Tang (Regulate the Middle Decoction), Sheng Wei Dan (Generate the Stomach Elixir), or Dan Cang Zhu Gao (Single Atractylodes Macrocephala Ointment) may be used.
Assessing deficiency and excess relies on the pulse.
The Spleen and Stomach are the masters of the Five Zang organs; excess of Wind, Cold, Summerheat, Dampness, and Dryness can also cause damage. For instance, a Wiry (Xian) pulse indicates dominance of Wind Pathogen, treatable with Wei Feng Tang (Wind Protecting Decoction), Huang Qi Jian Zhong Tang (Astragalus Decocted to Establish the Middle Decoction), or San Bai Tang (Three Whites Decoction); a Surging (Hong) pulse indicates dominance of Heat Pathogen, treatable with Xie Huang San (Drain Yellow Powder), Qing Wei San (Clear the Stomach Powder), or Tiao Wei Cheng Qi Tang (Regulate the Weight Descend Qi Decoction); a Choppy (Se) pulse indicates dominance of Dryness Pathogen, treatable with Ba Zhen Tang (Eight Treasures Decoction) or Qian Shi Bai Zhu San (Master Qian’s Atractylodes Macrocephala Powder); a Deep (Chen) and Thin (Xi) pulse indicates dominance of Cold Pathogen, treatable with Yi Huang San (Benefit Yellow Powder), Ren Shen Yang Wei Tang Wan (Ginseng Nourish Stomach Decoction Pill), Fu Zi Li Zhong Tang Wan (Aconite Regulate the Middle Decoction Pill), or Bu Zhen Wan (Tonify True Pill); a Moderate (Huan) and soggy (Ru) pulse with weakness, or intermittently imperceptible, indicates deficiency and depletion of Righteous Qi, treatable with Si Jun Zi Tang (Four Gentlemen Decoction) or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder); a excessively moderate pulse indicates self-excess of Dampness Pathogen, treatable with Ping Wei San (Calm the Stomach Powder).