李士材曰∶不能食，东垣云胃中元气盛，则能食而不伤，过时而不肌。脾胃俱旺，能食而肥。脾胃俱
虚，不能食而瘦。罗谦甫云∶脾胃弱而食少，不可克伐，补之自然能食。许学士云，不能食者，不可全作脾
治。肾气虚弱，不能消化饮食，譬之釜中水谷，不有火力，其何能熟？严用和云∶房劳过度，真阳衰弱，不能
上蒸脾土，中州不运，以致饮食不进，或胀满痞塞，或滞痛不消，须知补肾。肾气若壮，丹田火盛，上
蒸脾土，脾土温和，中焦自治，膈开能食矣。
愚按∶脾胃者，具坤顺之德，而有干健之运。故坤德所渐，补土以培其卑监；干健稍弛，益火以助其
转运。故东垣、谦甫以补土立言，学士、用和以壮火垂训，盖有见于土强则出纳自如，火强则转输不怠。
火者土之母也，虚则补其母，治病之常经。每见世俗一遇不通食者，便投香、砂、积、朴、曲、卜、楂、芽，
甚而黄连、山栀，以为开胃良方，而夭枉者多矣。不知此皆实则泻子之法，因脾胃间有积滞有实火，元气
未衰，邪气方张者设也。虚而伐之，则愈虚。虚而寒之，遏真火生化之源，有不败其气而绝其谷乎？且误以
参、术为滞闷之品。畏之如砒毒，独不闻经云虚者补之，又云塞因塞用乎？又不闻东垣云∶脾胃之气，实则
枳实、黄连泻之，虚则白术、陈皮补之。故不能食者，皆属脾虚。补之不效，当补其母，八味地黄丸、二神
丸。挟痰宜化，六君子汤；挟郁宜开，育气汤；仇木宜安，异功散加木香，沉香；子金宜顾，肺气虚则盗土
母之气以自救，而脾益虚，甘、桔、参、苓之属。夫脾为五脏之母，土为万物之根，安谷则昌，绝谷则亡，
慎毋少忽。
赵养葵曰∶余于脾胃，分别阴阳水火而调之。如不思饮食，此属阳明胃土受病，须补少阴心火，归脾汤补
心火以生胃土也；能食不化，此属太阴脾土，须补少阳相火，八味丸补相火以生脾土也。理中汤用干姜，
所以制土中之水也；建中汤用芍药，所以制土中之木也。黄 汤所以益土之子，使不食母之气也。六味丸所以
壮水之主也，八味丸所以益火之源也。土无定位，寄旺于四季，无专能，代天以成化，故以四脏兼用。总之，
以补为主，不用克伐。脾气下陷，补中益气。肝火乘脾，加左金丸，郁怒伤脾，归脾汤。脾虚不能摄
痰，六君子汤。脾肾两虚，四君、四神。阴火乘脾，六味丸。命门火衰，不生脾土，八味丸。先天之气足，
而后天之气不足者，补中气为主；后天之气足，而先天之气不足者，补元气为主。
张三锡曰∶《内经》曰，有所劳倦，形气衰少，谷气不胜，上焦不行，下脘不通，胃气热，热气熏
胸中，故内热。大凡劳倦过度，则阳和之气亢极而化为火矣。况水谷之味，少食是阳愈亢而阴愈衰。此阴字，
指身中之阴，与水谷之气耳。然有所劳倦者，过劳伤气也。形气衰少者，壮火食气也。谷气不胜者，食少不
能胜邪火也。上焦能行者，清阳不升也。下脘不通者，浊阴不降也。夫胃受水谷，生化气血，故清阳升而浊
阴降，以传化出入，滋养一身。今胃不纳食而谷气少，则清无升浊无降矣。故上焦不行，下脘不通，非谓全
不行不通，但较之平时不行不通耳。上不行下下通，则郁矣。郁则少火皆成壮火，而胃居上焦、下脘两者之
间，若虚火上炎，故熏胸中而为内热。此劳倦内伤生热如此。
李士材说：不能进食，李东垣认为胃中元气充足，就能进食而不受伤，即使过了饭点也不会损伤肌肉。脾胃都旺盛，就能进食且身体丰满；脾胃都虚弱，就不能进食且身体消瘦。罗谦甫说：脾胃虚弱导致食量减少，不可使用攻伐药物，通过补益自然能进食。许学士说，不能进食的人，不能完全当作脾病来治。肾气虚弱，无法消化饮食，就像锅里的水和食物，如果没有火力，怎么能煮熟呢？严用和说：房事过度，真阳衰弱，不能上蒸脾土，中焦运化无力，导致饮食不进，或者出现胀满痞塞，或者停滞疼痛不消，必须知道要补肾。肾气如果强壮，丹田火盛，上蒸脾土，脾土温和，中焦自然调理好，膈间通畅就能进食了。
我按语：脾胃具有坤卦顺承的德行，并具备乾卦刚健的运化功能。所以顺应坤德，需要补土以培养其卑监之性（指脾土卑弱需培补）；若乾健稍显松弛，需益火以助其转运。因此李东垣、罗谦甫以补土立论，许学士、严用和以壮火垂训，大概是因为看到了土强则出纳自如，火强则转输不怠。火是土的母亲，虚证时补其母，这是治病的常规法则。常见世俗之人一遇到饮食不通的情况，就投用香附、砂仁、枳实、厚朴、神曲、卜子（莱菔子）、山楂、麦芽等药，甚至用黄连、山栀，以为这是开胃良方，但因此夭折枉死者很多。不知道这些都是针对实证泻子的方法，是因脾胃间有积滞或实火，元气未衰，邪气正盛的情况下设立的。对虚证而用攻伐，就会更虚；对虚寒而用寒凉，会遏制真火生化之源，难道不会败坏其正气并断绝其谷气吗？况且误将人参、白术当作滞闷的药物，像畏惧砒毒一样害怕它们，难道没听说过经典说“虚者补之”，又说“塞因塞用”吗？难道没听说过李东垣说：“脾胃之气，实证用枳实、黄连泻之，虚证用白术、陈皮补之。”所以不能进食，都属于脾虚。补脾无效时，应当补其母（肾），可用八味地黄丸、二神丸。兼挟痰湿宜化痰，用六君子汤；兼挟郁结宜开郁，用育气汤；兼挟肝木克脾宜安肝，异功散加木香、沉香；兼挟肺金宜顾护肺气，肺气虚则会盗取脾土之母气以自救，导致脾更虚，可用甘草、桔梗、人参、茯苓之类。脾是五脏的母亲，土是万物的根本，能受纳谷气则昌盛，断绝谷气则灭亡，千万不要轻视。
赵养葵说：我在脾胃方面，区分阴阳水火来进行调理。如不思饮食，这属于阳明胃土受病，须补少阴心火，归脾汤补心火以生胃土；能食但不消化，这属于太阴脾土受病，须补少阳相火，八味丸补相火以生脾土也。理中汤用干姜，是用来制约土中的水湿；建中汤用芍药，是用来制约土中的木气。黄芪汤用来益土之子（心/火），使不耗损母气。六味丸用来壮水之主（肾阴），八味丸用来益火之源（肾阳）。土没有固定的位置，寄旺于四季，没有专门的功能，代天完成化育，所以用四脏兼治。总之，以补为主，不用攻伐。脾气下陷，用补中益气汤。肝火乘脾，加左金丸；郁怒伤脾，用归脾汤。脾虚不能摄痰，用六君子汤。脾肾两虚，用四君子汤、四神丸。阴火乘脾，用六味丸。命门火衰，不生脾土，用八味丸。先天之气充足，而后天之气不足的，以补中气为主；后天之气充足，而先天之气不足的，以补元气为主。
张三锡说：《内经》说，有所劳倦，形体之气衰少，谷气不胜，上焦不通行，下脘不通畅，胃气热，热气熏蒸胸中，所以产生内热。大凡劳倦过度，则阳和之气亢极而化为火。何况水谷的味道，少食则是阳愈亢而阴愈衰。这个阴字，指的是人身中的阴，以及水谷之气。然而有所劳倦，是过劳伤气。形气衰少，是壮火食气。谷气不胜，是食少不能胜邪火。上焦不行，是清阳不升。下脘不通，是浊阴不降。胃受纳水谷，生化气血，所以清阳升而浊阴降，以此传化出入，滋养一身。现在胃不纳食而谷气少，则清无升浊无降了。所以上焦不行，下脘不通，并非完全不行不通，只是比平时不行不通罢了。上不行而下不通，则气机郁结。郁结则少火皆成壮火，而胃居上焦、下脘两者之间，若虚火上炎，所以熏蒸胸中而为内热。这就是劳倦内伤生热的道理。
Li Shicai stated: Regarding the inability to eat, Li Dongyuan (Li Gao) claimed that if the primordial qi in the Stomach is abundant, one can eat without injury; even if meals are delayed, muscles will not be damaged. If both Spleen and Stomach are vigorous, one can eat and become plump; if both Spleen and Stomach are deficient, one cannot eat and becomes emaciated. Luo Qianfu said: When Spleen-Stomach weakness leads to reduced food intake, one must not use attacking or purgative methods; supplementation will naturally restore appetite. Xu Xueshi said: For those unable to eat, treatment should not focus solely on the Spleen. Weakness of Kidney Qi fails to digest food, akin to water and grain in a pot that cannot cook without fire. Yan Yonghe said: Excessive sexual activity depletes True Yang, preventing it from steaming the Spleen Earth upwards. The Middle Jiao fails to transport, leading to loss of appetite, distension, fullness, obstruction, stagnation, pain, or indigestion. One must understand the need to tonify the Kidney. If Kidney Qi is strong and the Fire of the Dantian is vigorous, it steams the Spleen Earth upwards. With warm Spleen Earth, the Middle Jiao regulates itself, the diaphragm opens, and eating resumes.
My commentary: The Spleen and Stomach possess the virtue of Kun (Earth) for receptivity and the function of Qian (Heaven) for movement. Thus, following Kun's nature requires tonifying Earth to support its humble monitoring function; if Qian's vigor slackens, benefiting Fire assists its transportation. Therefore, Li Dongyuan and Luo Qianfu established theories on tonifying Earth, while Xu Xueshi and Yan Yonghe emphasized strengthening Fire. This reflects the understanding that strong Earth allows free intake and discharge, while strong Fire ensures unceasing transport. Fire is the mother of Earth; tonifying the mother in deficiency is a standard therapeutic principle. I often see laypeople, upon encountering food stagnation, immediately administer herbs such as Xiangfu (Cyperus Rhizome), Sharen (Amomum Fruit), Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Shenqu (Massa Medicata Fermentatus), Boluozhizi (Radish Seed), Shanzha (Hawthorn Fruit), and Maiya (Germinated Grain), and even Huanglian (Coptis Rhizome) and Shanzhi (Gardenia Fruit), considering them good formulas for opening the stomach. Consequently, many die prematurely. They do not realize these are methods for draining the son in excess patterns, intended for cases where there is accumulation or excess heat in the Spleen-Stomach, with intact Yuan Qi and flourishing pathogenic factors. Attacking deficiency makes it more deficient; cooling deficiency suppresses the source of True Fire's generation. Will this not ruin their Qi and cut off their grain? Moreover, they mistakenly treat Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) as stagnating agents, fearing them like arsenic. Have they not heard the classic saying "Tonify the deficient" and "Treat obstruction with obstruction"? Have they not heard Li Dongyuan say: "For Spleen-Stomach Qi excess, use Zhishi and Huanglian to drain; for deficiency, use Baizhu and Chenpi to tonify." Thus, inability to eat belongs to Spleen deficiency. If tonifying the Spleen is ineffective, one should tonify its mother (Kidney), using Shuihu Dihuang Wan (Eight-Ingredient Rehmannia Pill) or Ershen Wan (Two-Essence Pill). If accompanied by phlegm, resolve it with Liujunzi Tang (Six-Gentlemen Decoction); if accompanied by depression, open it with Yuqi Tang (Qi-Nourishing Decoction); if Liver Wood attacks Spleen, pacify the Liver with Yigong San (Extraordinary Power Powder) added with Muxiang (Aucklandia Root) and Chenxiang (Aquilaria Wood); if Lung Metal needs care, protect Lung Qi, as Lung Qi deficiency steals Mother Qi from Spleen Earth to save itself, worsening Spleen deficiency, using Gancao (Licorice Root), Jiegeng (Platycodon Root), Renshen, and Fuling (Poria). The Spleen is the mother of the five Zang organs, and Earth is the root of all things. Abundance of grain brings prosperity, absence brings death; do not neglect this lightly.
Zhao Yangkui said: In treating Spleen and Stomach, I differentiate Yin-Yang and Water-Fire for regulation. Lack of appetite belongs to pathology of Yangming Stomach Earth; one must tonify Shaoyin Heart Fire. Guipi Tang (Restore the Spleen Decoction) tonifies Heart Fire to generate Stomach Earth. Ability to eat but failure to digest belongs to Taoyin Spleen Earth pathology; one must tonify Shaoyang Ministerial Fire. Shuihu Wan (Eight-Ingredient Pill) tonifies Ministerial Fire to generate Spleen Earth. Lizhong Tang (Regulate the Middle Decoction) uses Ganjiang (Dried Ginger) to control Water within Earth. Jianzhong Tang (Establish the Middle Decoction) uses Shaoyao (Peony Root) to control Wood within Earth. Huangqi Tang (Astragalus Decoction) benefits the child of Earth (Heart/Fire) so it does not consume the mother's Qi. Liuwei Wan (Six-Ingredient Pill) strengthens the master of Water (Kidney Yin); Shuihu Wan (Eight-Ingredient Pill) benefits the source of Fire (Kidney Yang). Earth has no fixed position, thriving during the four seasons, lacking specific functions, assisting Heaven in transformation, thus treated via the four Zang organs. In summary, the approach is primarily tonification, avoiding attacking methods. For sinking of Spleen Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For Liver Fire invading Spleen, add Zuojin Wan (Left Metal Pill); for depression and anger injuring Spleen, use Guipi Tang. For Spleen deficiency failing to control phlegm, use Liujunzi Tang. For dual deficiency of Spleen and Kidney, use Sijunzi Tang (Four-Gentlemen Decoction) and Sishen Wan (Four-Essence Pill). For Yin Fire invading Spleen, use Liuwei Wan. For Mingmen Fire decline failing to generate Spleen Earth, use Shuihu Wan. If congenital Qi is sufficient but acquired Qi is insufficient, focus on tonifying Middle Qi; if acquired Qi is sufficient but congenital Qi is insufficient, focus on tonifying Yuan Qi.
Zhang Sanxi said: The Neijing states: Due to fatigue and overwork, physical and Qi resources diminish, Grain Qi cannot overcome [the strain], the Upper Jiao fails to circulate, and the Lower Wan (stomach/intestines) fails to transmit. Stomach Qi becomes hot, and hot Qi steams the chest, causing internal heat. Generally, excessive fatigue causes Yang and harmonious Qi to become hyperactive and transform into Fire. Moreover, regarding the taste of water and grain, eating less means Yang becomes more hyperactive and Yin more deficient. This "Yin" refers to the body's Yin and the Qi of water and grain. However, fatigue implies Qi damage from overwork. Diminished physical and Qi resources imply Strong Fire consumes Qi. Grain Qi failing to overcome [strain] implies insufficient food intake cannot counteract pathogenic Fire. Failure of the Upper Jiao to circulate implies Clear Yang fails to ascend. Blockage of the Lower Wan implies Turbid Yin fails to descend. The Stomach receives water and grain, transforming and generating Qi and Blood, so Clear Yang ascends and Turbid Yin descends, facilitating transmission and nourishment of the whole body. Now, if the Stomach fails to receive food and Grain Qi is scarce, Clear Yang has nothing to ascend and Turbid Yin has nothing to descend. Thus, "Upper Jiao fails to circulate, Lower Wan fails to transmit" does not mean complete cessation, but rather worse than usual. If the upper does not circulate and the lower does not transmit, stagnation occurs. Stagnation transforms Shao Huo (Mild Fire) into Zhuang Huo (Strong Fire). Since the Stomach lies between the Upper Jiao and Lower Wan, if Deficient Fire flares upward, it steams the chest, causing internal heat. This is how fatigue and internal injury generate heat.