治肝郁脾弱，胸胁胀满，不能饮食。宜与论肝病治法参看。
野台参（二钱） 生黄 （二钱） 白术（二钱） 广陈皮（二钱） 川浓朴（二钱） 生鸡内金（二钱，捣细）
知母（三钱） 生杭芍（三钱） 桂枝尖（一钱） 川芎（一钱） 生姜（二钱）
世俗医者，动曰平肝，故遇肝郁之证，多用开破肝气之药。至遇木盛侮土，以致不能饮食者，更谓伐肝即
可扶脾。不知人之元气，根基于肾，而萌芽于肝。凡物之萌芽，皆嫩脆易于伤损，肝既为元气萌芽之脏，而开
破之若是，独不虑损伤元气之萌芽乎？《内经》曰“厥阴（肝经）不治，求之阳明（胃经）”，《金匮》曰“见
肝之病，当先实脾”。故此方，惟少用桂枝、川芎以舒肝气，其余诸药，无非升脾降胃，培养中土，俾中宫气
化敦浓，以听肝气之自理。实窃师《内经》求之阳明，与《金匮》当先实脾之奥旨耳。
按∶“见肝之病，当先实脾”二句，从来解者，谓肝病当传脾，实之所以防其相传，如此解法固是，而实
不知实脾，即所以理肝也。兼此二义，始能尽此二句之妙。
一媪，年近六旬。资禀素弱，又兼家务劳心，遂致心中怔忡，肝气郁结，胸腹胀满，不能饮食，舌有黑苔，
大便燥结，十数日一行。广延医者为治，半载无效，而羸弱支离，病势转增。后愚诊视，脉细如丝，微有弦意，
幸至数如常，知犹可治。遂投以升降汤，为舌黑便结，加鲜地骨皮一两，数剂后，舌黑与便结渐愈，而地骨皮
亦渐减。至十剂病愈强半，共服百剂，病愈而体转健康。
治疗肝气郁结、脾气虚弱，表现为胸胁部胀满不适，无法进食。此证宜参考关于肝病治法的论述。
野台参（二钱） 生黄芪（二钱） 白术（二钱） 广陈皮（二钱） 川厚朴（二钱） 生鸡内金（二钱，捣碎成细末）
知母（三钱） 生杭芍（二钱） 桂枝尖（一钱） 川芎（一钱） 生姜（二钱）
世俗的医生，动不动就说要“平肝”，所以遇到肝气郁结的病证，大多使用开破肝气的药物。至于遇到木气过盛克制脾土，导致不能饮食的情况，更认为只要伐肝就可以扶持脾脏。他们不知道人的元气，根基在于肾，而萌芽于肝。凡是事物的萌芽，都娇嫩脆弱，容易受到损伤。肝既然是元气萌芽之脏，如果像这样使用开破之法，难道就不担心损伤元气的萌芽吗？《内经》说：“厥阴（肝经）病治不好，应从阳明（胃经）去求治”，《金匮要略》说：“见到肝病，应当先充实脾脏”。因此这个方子，只是少量使用桂枝、川芎来舒展肝气，其余各种药物，无非是提升脾气、降下胃气，培养中焦脾胃之气，使得中宫气化功能深厚浓郁，从而听任肝气自行调理。这实际上是师承《内经》从阳明求治，以及《金匮》先实脾脏的深奥旨意罢了。
按语：“见到肝病，应当先充实脾脏”这两句话，历来解释的人，认为肝病会传变到脾，充实脾脏是为了防止这种传变，这样的解释固然正确，但实际上并不明白，充实脾脏，也就是在调理肝脏。同时具备这两层含义，才能穷尽这两句话的精妙之处。
有一位老妇人，年龄接近六十岁。她先天禀赋素来虚弱，又加上操持家务劳心费力，于是导致心中心悸不安，肝气郁结，胸腹部胀满，无法进食，舌苔发黑，大便干燥结硬，十几天才排便一次。广泛延请医生为她治疗，半年没有效果，身体消瘦衰弱到了极点，病情反而加重。后来我诊视，脉象细如丝线，略微带有弦象，幸好至数（脉搏频率）正常，知道还可以治疗。于是投用升降汤，因为舌黑且大便干结，加鲜地骨皮一两，服用几剂后，舌黑和大便干结逐渐好转，地骨皮的用量也逐渐减少。服到十剂时，病愈大半，共服用一百剂，病痊愈而体质反而更加健康。
Treats Liver Qi Stagnation (Gan Yu) with Spleen Qi Deficiency (Pi Ruo), manifesting as distension and fullness in the chest and hypochondrium, and inability to eat. This condition should be referred to for discussion on treatment methods for Liver diseases.
Yetai Shen (Radix Ginseng, Wild Tai Type) (2 qian)
Sheng Huangqi (Astragali Radix, Raw) (2 qian)
Baizhu (Atractylodis Macrocephalae Rhizoma) (2 qian)
Guang Chenpi (Citri Reticulatae Pericarpium, Guangxi Origin) (2 qian)
Chuan Houpo (Magnoliae Officinalis Cortex, Sichuan Origin) (2 qian)
Sheng Jineijin (Galli Gigerii Endothelium Corneum, Raw) (2 qian, crushed into fine powder)
Zhimu (Anemarrhenae Rhizoma) (3 qian)
Sheng Hangshao (Paeoniae Radix Alba, Hangzhou Origin, Raw) (3 qian)
Guizhi Jian (Cinnamomi Ramulus, tip portion) (1 qian)
Chuanxiong (Ligustici Chuanxiong Rhizoma) (1 qian)
Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) (2 qian)
Secular physicians often indiscriminately use the term "calming the Liver" (Ping Gan). Consequently, when encountering patterns of Liver Qi Stagnation, they predominantly employ herbs that open and break up Liver Qi. When facing conditions where excessive Wood energy overacts upon Earth (Mu Sheng Wu Tu), leading to an inability to eat, they further assert that subduing the Liver can support the Spleen. They fail to realize that human Yuan Qi (Primordial Qi) is rooted in the Kidney but sprouts from the Liver. Just as the sprouts of all things are tender and fragile, easily damaged, if the Liver is the organ where Yuan Qi sprouts, using such opening and breaking methods, do they not worry about damaging the sprout of Yuan Qi? The *Neijing* states: "If Jueyin (Liver Meridian) cannot be treated successfully, seek treatment from Yangming (Stomach Meridian)." The *Jingui Yaolue* states: "When seeing a disease of the Liver, one must first solidify the Spleen." Therefore, this formula uses only small amounts of Guizhi and Chuanxiong to soothe Liver Qi; the remaining herbs serve solely to ascend Spleen Qi and descend Stomach Qi, cultivating the Middle Jiao (Zhong Gong) to enrich its Qi transformation, thereby allowing Liver Qi to regulate itself naturally. This essentially follows the profound principles of seeking Yangming in the *Neijing* and solidifying the Spleen first in the *Jingui*.
Note: The phrase "When seeing a disease of the Liver, one must first solidify the Spleen" has been interpreted by commentators traditionally as meaning that Liver disease transmits to the Spleen, and solidifying the Spleen prevents this transmission. While this interpretation is correct, it fails to grasp that solidifying the Spleen is itself a method of regulating the Liver. Only by combining these two meanings can one fully appreciate the subtlety of these two sentences.
An elderly woman, nearing sixty years of age, had always possessed a weak constitution. Additionally, due to the mental labor of managing household affairs, she developed palpitations (Xin Zhong Zheng Tong), Liver Qi Stagnation, distension and fullness in the chest and abdomen, inability to eat, black coating on the tongue, and dry, constipated stools, passing stool only once every ten-plus days. Physicians were widely consulted for treatment, but after half a year there was no effect; her emaciation and debility increased, and the disease worsened. Later, I examined her. Her pulse was thin as a thread, slightly wiry (Xian), but fortunately, the rate was normal, indicating that the condition was still treatable. I prescribed Shengjiang Tang. Because of the black tongue coating and constipation, I added 1 liang of fresh Digupi (Dugong Pi / Lycii Cortex, Fresh). After several doses, the black tongue coating and constipation gradually improved, and the dosage of Digupi was reduced accordingly. By the tenth dose, more than half of the illness had resolved. After taking a total of 100 doses, the disease was cured, and her physical health actually improved.