人以水谷为本，故脾胃为养身之本。惟东垣独知其义，发为《脾胃论》。因引《内经》之义，如生气
通天论曰∶苍天之气，清净则志意治，顺之则阳气固，虽有贼邪，勿能为害也。阳气者，烦劳则张。故苍天
之气贵清净，阳气恶烦劳，此病从脾胃生者一也。
又引《五常政大论》曰∶阴精所奉其人寿，阳精所降其人夭。阴精所奉，谓脾胃既和，谷气上升，
春夏令行，故其人寿。阳精所降，谓脾胃不和，谷气下流，收藏令行，故其
人夭。此病从脾胃生者二也。
又引《六节藏象论》曰∶脾、胃、大肠、小肠、三焦、膀胱者，仓廪之本，营之居也。此至阴之类
，通乎土气。凡十一藏者，皆取决于胆也。夫胆者，少阳春生之气，春气升则
万物安。故胆气春生则余脏从之，胆气不升则飧泄、肠 ，不一而起。此病从脾胃生者三也。
又引本论曰∶天食人以五气，地食人以五味，此之谓气者。上焦开发，宣五谷味，熏肤充身泽毛，
若雾露之溉，是谓气。气或乖错，人何以生？此病从脾胃生者四也。诸如此论，皆东垣独得之见。
兹察其所谓苍天贵清净，阳气恶烦劳者，此指劳倦之为病也。所谓收藏令行，故其人夭者，此指阴盛阳
衰之病也。所谓春生则万物安者，此指降则无生之为病也。所谓气或乖错，人何以生者，此指阳气受伤之
为病也。东垣垂惠后世，开导来学，诚非小矣。
独怪其论中有曰喜怒忧恐损耗元气，资助心火，火与元气不两立，火胜则乘其土位，所以为病，若此
数语，大见矛盾。
夫元气既损，多见生阳日缩，神气日消，何以反助心火？脾胃属土，得火则生，何谓火胜则乘其土位耶？
且人之元气，本贵清和，寒固能病，热亦能病。而因劳动火者，固常有之，自不得不从清补，若因劳犯寒
，而寒伤脾胃者，尤酷尤甚。第热症显而寒症隐，真热症易辨，假热症尤不易辨也。矧元气属阳，热为同气
，邪犹可制；阴为阳贼，寒其仇也，生气被伐，无不速亡，由此观之，寒与元气，尤不两立。若东垣前
言，独令后人之妄言火者，反忘前四条之格言，而单执火不两立之说为成案。此白璧之瑕，余实不能不为东
垣惜也。
及再考东垣之方，如补中益气、升阳益胃、黄 人参、清暑益气汤等方，每用升、柴，此即其培养春
生之气。而每用芩、连，亦即其制伏邪之意。第二三分之芩、连，固未必即败阳气；而以五七分之参、
术，果能斡旋元气乎？思古仲景立方之则，用味不过三四品，用数每至二三两。且人之气血本大同，疾病多
相类，而仲景之方大而简，东垣之方小而杂，何其悬绝一至如此？此其中必有至道存焉。实以后学不敢雌
黄，而私心向往，不能不霄壤于其间也。
人以水谷为根本，因此脾胃是养生的根本。只有李东垣独自领悟了这一道理，从而撰写了《脾胃论》。他引用《黄帝内经》中的义理，例如《生气通天论》中说：“苍天的气候，保持清净则人的意志安定，顺应它则阳气固密，即使有贼邪之气，也不能造成伤害。”又说：“人体的阳气，在烦劳过度时会亢盛外越。”所以苍天之气贵在清净，阳气厌恶烦劳，这是疾病从脾胃产生的第一种情况。
他又引用《五常政大论》说：“阴精上奉于人体的人长寿，阳精下泄于人体的人短命。”所谓阴精上奉，是指脾胃调和，谷气上升，如同春夏季节令施行，所以人长寿。所谓阳精下泄，是指脾胃不和，谷气下流，如同秋冬收藏之令施行，所以人短命。这是疾病从脾胃产生的第二种情况。
他又引用《六节藏象论》说：“脾、胃、大肠、小肠、三焦、膀胱，是仓廪之本，也是营气所居之处。这些属于至阴一类，与土气相通。然而十一脏的功能都取决于胆。”胆具有少阳春生之气，春气升发则万物安宁。所以胆气春生则其余脏腑随之而安，胆气不升则会导致飧泄（完谷不化的腹泻）、肠澼（痢疾）等病症相继而起。这是疾病从脾胃产生的第三种情况。
他又引用本论说：“天给人提供五气，地给人提供五味，这就叫做气。上焦开发，宣散五谷的气味，熏蒸皮肤，充实身体，润泽毫毛，就像雾露滋润万物一样，这就叫做气。如果气出现乖错紊乱，人怎么能生存呢？”这是疾病从脾胃产生的第四种情况。诸如此类的论述，都是李东垣独到的见解。
现在考察他所指的“苍天贵清净，阳气恶烦劳”，这是指劳倦致病的情况。所谓“收藏令行，故其人夭”，这是指阴盛阳衰的病症。所谓“春生则万物安”，这是指降而不升导致无生机产生的病症。所谓“气或乖错，人何以生”，这是指阳气受伤导致的病症。李东垣垂惠后世，开导来学，功劳确实不小。
唯独奇怪的是他的论述中有这样的话：“喜怒忧恐损耗元气，资助心火，火与元气不两立，火胜则乘其土位，所以为病。”这几句话，显得大有矛盾。
既然元气已经受损，多见生发之阳日渐萎缩，神气日渐消减，怎么反而能助长心火呢？脾胃属土，得火则生，为什么说火胜则乘其土位呢？况且人的元气，本来贵在清和，寒固能致病，热也能致病。因为劳动而生火的情况，固然常有，自然不得不采用清补的方法；但如果因为劳累而触犯寒气，寒气损伤脾胃，那就更加严重了。只是热症表现明显而寒症隐蔽，真热症容易辨别，假热症尤其不易辨别。何况元气属阳，热与元气同气相求，邪气尚且可以制约；阴是阳的贼害，寒是仇敌，生气被伐害，没有不迅速死亡的。由此看来，寒与元气，尤其是不两立的。如果李东垣前面的言论，只让后人妄言火邪，反而忘记了前面四条格言，而单执守“火与元气不两立”的说法作为定案。这是白玉上的瑕疵，我实在不能不为李东垣感到惋惜。
等到再考察李东垣的方剂，如补中益气汤、升阳益胃汤、黄芪人参汤、清暑益气汤等方子，每用升麻、柴胡，这就是他在培养春生之气。而每用黄芩、黄连，这也是他制伏邪气的意思。其中二三分的黄芩、黄连，固然未必就会败坏阳气；但是用五七分的参、术，果真能斡旋元气吗？思考古代张仲景立方的法则，用药味不过三四品，用量每味达到二三两。而且人的气血本来大同，疾病多相类似，而张仲景的方子宏大而简约，李东垣的方子细小而繁杂，为何悬殊竟到了这种地步？这中间必定有至高之道存在。实在是因为后辈不敢随意评论，但内心向往，不能不在两者之间产生霄壤之别的感觉。
Human beings rely on water and grain as their foundation; therefore, the Spleen and Stomach are the root of nourishing life. Only Li Dongyuan alone comprehended this principle, leading him to compose *Pi Wei Lun* (Treatise on the Spleen and Stomach). He drew upon the principles of the *Huangdi Neijing* (Yellow Emperor's Inner Canon), such as from the *Shengqi Tongtian Lun* (Treatise on Vital Energy Connecting with Heaven): "The Qi of the blue sky, if pure and clear, brings order to one's will and spirit; complying with it consolidates Yang Qi, so that even if pathogenic evils exist, they cannot cause harm." It also states: "Yang Qi in the body becomes hyperactive when subjected to excessive toil and fatigue." Thus, the Qi of heaven values purity and clarity, while Yang Qi abhors excessive toil. This constitutes the first reason why diseases arise from the Spleen and Stomach.
He further cites the *Wuchang Zheng Dalun* (Great Treatise on the Five Constant Policies): "Those whose Yin Essence is offered upward live long; those whose Yang Essence descends downward die young." The phrase "Yin Essence is offered upward" refers to a state where the Spleen and Stomach are harmonious, Grain Qi ascends, and the seasonal commands of Spring and Summer prevail, thus ensuring longevity. The phrase "Yang Essence descends downward" refers to a state where the Spleen and Stomach are disharmonious, Grain Qi flows downward, and the storage commands of Autumn and Winter prevail, thus leading to premature death. This constitutes the second reason why diseases arise from the Spleen and Stomach.
He again cites the *Liujie Zangxiang Lun* (Treatise on the Six Nodes and Viscera Manifestations): "The Spleen, Stomach, Large Intestine, Small Intestine, Sanjiao (Triple Burner), and Bladder are the foundations of the granary and the dwelling place of Ying Qi (Nutritive Qi). These belong to the category of Extreme Yin and connect with Earth Qi. However, the functions of all eleven viscera depend on the Gallbladder." The Gallbladder possesses the Qi of early Spring and spring-like generation. When Spring Qi ascends, all things remain peaceful. Therefore, when Gallbladder Qi generates in spring, the remaining viscera follow suit; if Gallbladder Qi fails to ascend, conditions such as Sund Xie (diarrhea with undigested food) and Chang Pi (dysentery) arise without exception. This constitutes the third reason why diseases arise from the Spleen and Stomach.
He further cites his own treatise: "Heaven provides humans with Five Qi, and Earth provides humans with Five Flavors; this is what is called Qi. The Upper Jiao opens and develops, disseminating the flavors of the five grains, steaming the skin, filling the body, and moistening the hair, much like mist and dew irrigating [the earth]. This is called Qi. If Qi becomes disordered or erroneous, how can human life be sustained?" This constitutes the fourth reason why diseases arise from the Spleen and Stomach. Such discussions represent Li Dongyuan's unique insights.
Upon examining his statement that "the blue sky values purity and clarity, and Yang Qi abhors excessive toil," this refers to illness caused by fatigue and overwork. His statement that "when the storage command prevails, people die young" refers to pathological conditions of Excess Yin and Deficiency of Yang. His statement that "when Spring generates, all things are at peace" refers to illness caused by failure to descend, resulting in a lack of generative vitality. His statement that "if Qi is disordered, how can life exist" refers to illness caused by injury to Yang Qi. Li Dongyuan's contributions to posterity and his guidance for future scholars are indeed significant.
However, it is peculiar that in his discussion he stated: "Joy, anger, worry, and fear deplete Yuan Qi (Primal Qi) and assist Heart Fire. Fire and Yuan Qi cannot coexist; if Fire prevails, it attacks the Earth position, thereby causing disease." These few sentences appear largely contradictory.
If Yuan Qi is already damaged, it typically manifests as a daily shrinkage of Sheng Yang (Generative Yang) and a daily decline of Shen Qi (Spiritual Qi); how could it instead assist Heart Fire? The Spleen and Stomach belong to Earth, which is generated by Fire; how can it be said that prevailing Fire attacks the Earth position? Moreover, human Yuan Qi inherently values purity and harmony. Cold certainly causes disease, but Heat also causes disease. Cases of Fire arising from labor are common, necessitating clearing and tonifying methods. However, cases of contracting Cold due to labor, where Cold injures the Spleen and Stomach, are even more severe. Although Heat syndromes are obvious and Cold syndromes are hidden, True Heat is easy to distinguish, whereas False Heat is particularly difficult to identify. Furthermore, Yuan Qi belongs to Yang, and Heat shares the same nature as Yang; thus, pathogenic factors can still be controlled. Yin is the thief of Yang, and Cold is its enemy. If the Generative Qi is attacked, death follows swiftly. From this perspective, Cold and Yuan Qi are especially incompatible. If Li Dongyuan's earlier remarks lead later generations to recklessly speak of Fire, while forgetting the four maxims mentioned previously and solely adhering to the doctrine that "Fire and Yuan Qi cannot coexist" as a fixed case, this is a flaw in an otherwise perfect jade. I truly cannot help but feel regret for Li Dongyuan.
Upon further examination of Li Dongyuan's prescriptions, such as *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction), *Shengyang Yiwet Tang* (Raise Yang and Benefit the Stomach Decoction), *Huangqi Renshen Tang* (Astragalus and Ginseng Decoction), and *Qingshu Yiqi Tang* (Clear Summerheat and Augment Qi Decoction), each frequently uses Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), which serves to cultivate the Qi of Spring generation. Each also frequently uses Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma), which serves to subdue pathogenic factors. The small doses (two or three fen) of Huangqin and Lianzi certainly do not necessarily damage Yang Qi; however, do large doses (five or seven qian) of Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) truly manage to regulate Yuan Qi? Reflecting on the principles of prescription formulation by Zhang Zhongjing in ancient times, he used no more than three or four herbs per formula, with dosages often reaching two or three liang per herb. Since human Qi and Blood are fundamentally similar, and diseases are often comparable, Zhang Zhongjing's formulas were grand yet simple, whereas Li Dongyuan's formulas were minute yet complex. Why is the disparity so extreme? There must be profound Dao within this. As junior scholars dare not make rash judgments, yet hold private admiration, one inevitably perceives a chasm between the two approaches.