夫脾胃者，水谷之海也，水谷入口，而胃以纳之，脾以克之，脾胃气旺，则谷肉果菜俱
能消化为糟粕矣。经云∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道
，下输膀胱，水精四布，五经并行，合于四时五脏，阴阳揆度，以为常也。盖脾土宜暖，而
不宜生冷，若人之原禀，脾胃怯弱，气血虚惫，兼以不善调摄，或恣其饮食，或寒温不适，
饥饱失宜，愈伤脾气。凡百饮食，入于胃中，不能克消，以致停蓄，遂成宿滞，变生诸疾，
东垣因以内伤论为证名也。至若又谓荣气谷气元气清气运气卫气之六者，斯皆胃气之别名，
其实为一也。且人身五脏，皆禀于胃，胃和则谷气上升，而谷气者，乃足少阳胆、手少阳三
焦，元气始发，生长万化之用者也。胃伤则中气不足，中气不足则不能滋养元气，元气不充
，则脏腑真气皆为不足，而心火独盛矣。心火者，阴火也，起由下焦，其系于心，心不自主
，相火代之。相火者，下焦心胞之火，乃为元气之贼也。然火与元气不两立，必一盛则一负
矣，而脾胃气衰，则下流于肾肝，阴火得以乘其上位，于是元气受病，系于上焦心肺之气。
盖心主荣血，肺主卫气，荣卫失守，则诸病生焉。夫人之真气衰旺，岂不由乎饮食之致然哉
？凡诸饮食所伤，当各以消导之药，以克其所伤之物，俾脾气愈旺，而五谷之精华上腾，应
乎天而为清气也。彼神气强盛，七神卫护，生气不乏，增益大旺，气血周漩，百病不能侵矣
。虽有大风苛毒，岂能为害耶？是以易水张先生，当谓停滞不可恣用利药，下咽少顷，其药
味施化，标皮之力始开，便觉宽快。及致所伤之物已去，稍过三两时辰，其药品尽化，性味
大作，而其停滞虽大，不知脾胃反伤矣。脾胃一伤，则真元之气败坏，致生诸虚百疾而夭人
寿，此医之过欤。而东垣论其内伤，皆由喜怒劳役，饮食饥饱，致伤脾胃而然也。刘河间又
谓∶天真者，为造化之元气，在人身得以执天机而行六气，分地纪而运五行。是故人身也，
天地也，一而二，二而一者也。若人调理适宜，邪勿能伤，而血脉壮盛，精气增益，周身生
化，则一疾无矣。或于忧愁思虑，饥饱劳役，大惊卒恐，致真气耗散，血气分离，其五行六
气，遂有愆膈，则百病作矣。故经曰∶饮食劳倦则伤脾，形寒饮冷则伤肺也。原夫宿食为病
，由脏气虚弱，寒在脾胃之间，致谷食不能消化，停积于中也。且旧谷未消，新谷又入，脾
气已弱，不复能克，而新旧相积，故经宿不消，则令人腹胀气急，噫气醋心，食臭恶心，时
复憎寒壮热，或头痛似疟也，且噫气醋心者，由上焦有停痰积饮，胃中有宿冷食积，脾气不
能磨克其食，故腹胀而气逆，所以好噫气吞酸，气息食臭也。恶心者，缘心下有停水积饮之
故也。而心主火，脾主土，土性克水，今脾虚不能克消，水饮米饮不散，上乘于心，复遇冷
气所加，致令火气不宣，则心中淡淡然欲吐也，其脉右寸浮而大，按之反涩，尺脉亦微而涩
。假若脾胃有伏热，亦因食积不消者，身则发热，状似伤寒，惟身不痛为异也。大抵宿食所
伤，则皆恶寒，然当分上中下三脘治之。积物之停于中下脘者，重则根据仲景法，大小承气汤
备急丹类用之，轻则以东垣枳术等丸治之，在上脘而食物，其气反壅塞于上，其脉气口紧，
盛于人迎两三倍者，必以吐之。经云∶上部有脉，下部无脉，其人当吐不吐者死，宜以瓜蒂
散，吐去其物。若去不尽，以消导药磨之；若物已去，而脾胃元气或被伤者，以东垣内伤所
论，补益法中益气等汤，是有如先食热物而不伤，继用寒物，因后寒食，致前食亦不消化而
伤者，当询问其寒食热食，孰多孰少，斟酌以药。如其寒物一分，热物二分，则当以寒药二
分，热药一分，相合投之。或先饮酒而后食寒冷，及伤热物冰水等物者，当询其次序多寡所
伤，量其寒热之剂，分散可也。职于医者，宜临证察脉，看人虚实老幼，以施治疗，庶不苟
且。切不可便用辛燥峻利等药服之，求愈而反为害也，则当慎之。
脾胃，是受纳和腐熟水谷的器官。饮食入口，由胃来接纳，由脾来运化消化。如果脾胃之气旺盛，那么谷物、肉类、水果和蔬菜都能被消化转化为糟粕。《内经》说：“饮食进入胃中，其精微物质游溢出来，向上输送给脾；脾气将精微散布，向上归于肺；（肺气）通调水道，向下输送到膀胱；水液精微四布全身，五脏经脉并行运行，顺应四时变化与五脏规律，通过阴阳的衡量判断，形成正常的生理常态。”大概脾属土，适宜温暖而不宜生冷。如果一个人先天禀赋不足，脾胃怯弱，气血虚衰疲惫，再加上不善于调养摄生，或者放纵饮食，或者寒温不适，饥饱无度，就会进一步损伤脾气。凡是各种饮食进入胃中，如果不能被运化消化，导致停滞蓄积，就形成了宿食积滞，进而引发各种疾病，李东垣因此将这类病症命名为“内伤”。至于所谓荣气、谷气、元气、清气、运气、卫气这六种气，其实都是胃气的别名，本质上是一回事。况且人身五脏，都禀受于胃气。胃气调和，则谷气上升；而谷气，是足少阳胆经、手少阳三焦经中元气开始发动，发挥生长万物变化的作用。胃受伤则中气不足，中气不足就不能滋养元气，元气不充盛，那么脏腑的真气都会不足，而心火就会独自亢盛。心火，就是阴火，起源于下焦，其联系在心，心气不能自主控制，由相火代替行使职权。相火，是下焦心包络之火，它是元气的贼害者。然而火与元气不能两立，必定是一方强盛另一方就衰弱。脾胃气衰败，气机下流于肾肝，阴火得以乘袭上位，于是元气受病，牵连到上焦心肺之气。大概心主掌荣血，肺主掌卫气，荣卫失守，各种疾病就会产生。人的真气衰旺，难道不是由饮食造成的吗？凡是饮食所伤，应当分别使用消导的药物，来化解所伤之物，使脾气更加旺盛，五谷的精华向上腾升，应合天道成为清气。那样神气强盛，七神护卫，生气充沛，增益大旺，气血循环周流，百病不能侵袭。即使有大风毒邪，怎么能伤害人体呢？所以易水张先生（张元素）曾说，对于停滞之证不可恣意滥用泻利药物。药咽下去不久，药味发挥作用，标皮（表层/轻浅部位）的力量才开启，便觉得宽舒畅快。等到所伤之物已经去除，稍微过两三时辰，药品完全化开，性味大作，虽然停滞严重，但不知脾胃反而受伤了。脾胃一旦受伤，真元之气败坏，导致产生各种虚损百病而折损人寿，这是医生的过错吧。而李东垣论述内伤，都是由喜怒劳役、饮食饥饱，导致损伤脾胃而形成的。刘河间又说：天真，是造化的元气，在人体内执掌天机而行六气，分判地纪而运五行。因此人身也就是天地，一分为二，二合为一。如果人调理适宜，邪气就不能伤害，血脉壮盛，精气增益，周身生化正常，就没有疾病了。如果在忧愁思虑、饥饱劳役、大惊卒恐的情况下，导致真气耗散，血气分离，五行六气出现差错隔阂，那么百病就产生了。所以经文说：“饮食劳倦则伤脾，形寒饮冷则伤肺。”推究宿食为病的根源，是由于脏气虚弱，寒邪在脾胃之间，导致谷食不能消化，停积在中焦。而且旧谷未消，新谷又入，脾气已弱，不再能运化，新旧相互积聚，所以经过一夜不消化，就会让人腹胀气急，打嗝泛酸，食物腐败气味恶心，时常怕冷高热，或者头痛像疟疾一样。至于打嗝泛酸，是因为上焦有停痰积饮，胃中有宿冷食积，脾气不能磨化消化食物，所以腹胀且气逆，因此喜欢打嗝吞酸，呼吸带有食物臭味。恶心，是因为心下有停水积饮的缘故。而心属火，脾属土，土性克水，现在脾虚不能克制消化，水饮米饮不散，上乘于心，又遇到冷气相加，导致火气不宣通，心中淡淡然想要呕吐。其脉象右寸浮大而按之反涩，尺脉也微而涩。假若脾胃有伏热，也是因食积不消，身体就会发热，症状类似伤寒，只是身体不痛作为区别。大抵宿食所伤，都会恶寒，但应当分上、中、下三脘来治疗。积物停在中下脘的，重的根据张仲景的方法，用大小承气汤、备急丹之类；轻的用李东垣的枳术丸等治疗。在上脘的食物，其气反而壅塞于上，脉象气口紧盛，比人迎脉大三两倍，必须用吐法。经文说：“上部有脉，下部无脉，其人当吐不吐者死”，宜用瓜蒂散，吐出其中的积物。如果没吐干净，再用消导药磨化；如果积物已去，而脾胃元气被伤害的，根据李东垣内伤论中的补益法，用益气汤等。如果有先吃热物没受伤，继而又吃寒物，因为后来的寒食，导致前面的食物也不消化而受伤的，应当询问寒食热食哪个多哪个少，斟酌用药。如果寒物一分，热物二分，就用寒药二分，热药一分，混合投服。或者先饮酒后吃寒冷食物，以及伤于热物冰水等物的，应当询问次序多少所伤的情况，量其寒热药剂，分散服用即可。身为医者，应当临证察脉，观察人的虚实老幼，以施行治疗，才不会草率苟且。切不可随意使用辛燥峻利等药物服用，追求痊愈反而造成危害，这点必须谨慎。
The Spleen and Stomach are the sea of water and grain. When food and drink enter the mouth, the Stomach receives them, and the Spleen transforms them. If the Qi of the Spleen and Stomach is vigorous, then grains, meats, fruits, and vegetables can all be digested and transformed into waste. The Classics state: "When food and drink enter the Stomach, their essence floats and overflows, moving upward to the Spleen; the Spleen scatters the essence, sending it upward to return to the Lung; (the Lung) regulates the water passages, transmitting downward to the Bladder; water and essence distribute throughout the four directions, and the five meridians run in parallel, conforming to the four seasons and five Zang organs, measuring Yin and Yang, thus establishing normalcy." Generally, Spleen Earth prefers warmth and dislikes cold and raw foods. If a person's innate constitution is weak, with Spleen and Stomach deficiency, and Qi and Blood exhausted, combined with poor self-care, indulgence in diet, improper temperature regulation, or irregular eating habits, the Spleen Qi will be further injured. All kinds of food entering the Stomach, if unable to be transformed and digested, will stagnate and accumulate, forming retained food retention (Su Shi), which gives rise to various diseases. Li Dongyuan therefore named this category of syndromes as Internal Injury (Nei Shang). As for the six types of Qi mentioned—Ying Qi (Nutritive Qi), Gu Qi (Food Qi), Yuan Qi (Original Qi), Qing Qi (Clear Qi), Yun Qi (Transporting Qi), and Wei Qi (Defensive Qi)—these are all alternative names for Stomach Qi, essentially being one and the same. Moreover, the five Zang organs of the human body all derive from the Stomach. When Stomach Qi is harmonious, Gu Qi ascends; and Gu Qi is the source from which the Original Qi of the Foot-Shaoyang Gallbladder and Hand-Shaoyang Sanjiao meridians begins to move, exerting the function of growth and transformation of all things. If the Stomach is injured, Middle Qi becomes insufficient; if Middle Qi is insufficient, it cannot nourish Original Qi; if Original Qi is not充盈 (full/vigorous), then the True Qi of the Zang and Fu organs will all be deficient, while Heart Fire will flourish independently. Heart Fire is also called Yin Fire, originating from the Lower Jiao, connected to the Heart. When Heart Qi cannot control itself, Xiang Fire (Ministerial Fire) takes over. Xiang Fire is the fire of the Pericardium in the Lower Jiao, acting as a thief to Original Qi. However, Fire and Original Qi cannot coexist; when one flourishes, the other declines. When Spleen and Stomach Qi decays, it flows downward into the Liver and Kidney, allowing Yin Fire to attack the upper positions. Consequently, Original Qi is diseased, affecting the Qi of the Upper Jiao Heart and Lung. The Heart governs Ying Qi (Nutritive Blood), and the Lung governs Wei Qi (Defensive Qi). When Ying and Wei lose their guard, various diseases arise. Is the decline or vigor of True Qi not caused by diet? For injuries caused by various foods, one should use resolving and guiding medicines to break down the injured substances, making Spleen Qi more vigorous, so that the essence of the five grains ascends, corresponding to Heaven to become Clear Qi. In such a state, Spirit Qi is strong, protected by the Seven Spirits, Sheng Qi (Vital Qi) is abundant, greatly increased, Qi and Blood circulate freely, and hundred diseases cannot invade. Even with severe wind and toxins, how could they cause harm? Therefore, Master Zhang Yuansu (Zhang Congzheng/Zhang Yishui lineage) stated that for stagnation, one must not recklessly use purgative medicines. Shortly after swallowing, the medicinal properties take effect, opening the superficial layers, bringing relief. Once the injured substance is removed, after two or three hours, the medicine fully metabolizes, its nature and flavor act strongly, and although the stagnation was severe, the Spleen and Stomach may inadvertently be injured. Once the Spleen and Stomach are injured, True Yuan Qi is ruined, leading to various deficiencies and diseases, shortening life span. This is the fault of the physician. Li Dongyuan discussed internal injuries, attributing them to anger, joy, fatigue, labor, dietary irregularities, causing damage to the Spleen and Stomach. Liu Wansu also said: Tian Zhen (Innocent/Natural Truth) is the Original Qi of creation. Within the body, it executes heavenly mechanisms to move the Six Qi, divides earthly registers to operate the Five Elements. Thus, the human body is like Heaven and Earth; one divided into two, two united as one. If regulated properly, pathogens cannot injure; blood vessels become robust, Essence and Qi increase, whole-body metabolism functions normally, and no disease exists. However, due to worry, thought, hunger, fullness, fatigue, labor, sudden fright, or terror, True Qi dissipates, Blood and Qi separate, the Five Elements and Six Qi suffer errors and blockages, and hundred diseases arise. Hence the Classic says: "Dietary excess and fatigue injure the Spleen; physical cold and drinking cold injure the Lung." Investigating the pathology of retained food injury, it stems from weak organ Qi, cold between the Spleen and Stomach, causing food to fail digestion and accumulate in the Middle Jiao. Since old food is not digested, new food enters, and weak Spleen Qi can no longer transform, old and new accumulate. Thus, after a night without digestion, one suffers abdominal distension, urgency of Qi, belching, acid regurgitation, foul breath from food, occasional aversion to cold and high fever, or headache resembling malaria. Belching and acid regurgitation occur because there is retained phlegm and fluid in the Upper Jiao, and cold retained food accumulation in the Stomach; Spleen Qi cannot grind and digest the food, causing distension and rebellious Qi, hence the preference for belching and sour regurgitation, with breath smelling of food. Nausea occurs because of retained water and fluid under the Heart. The Heart belongs to Fire, the Spleen to Earth; Earth controls Water. Now, Spleen deficiency fails to control and digest, so water and rice fluids do not disperse, ascending to oppress the Heart. Combined with cold pathogenic factors, Fire Qi fails to diffuse, causing a vague desire to vomit. The pulse at Right Cun is floating and large, but feels choppy upon pressure; Chi pulse is also faint and choppy. If there is latent heat in the Spleen and Stomach due to undigested food retention, the body will fever, resembling Taiyang Cold Damage (Shang Han), except for the absence of body pain. Generally, injuries from retained food involve aversion to cold, but treatment should be differentiated by Upper, Middle, and Lower Epigastrium. For accumulation in the Middle and Lower Epigastrium, severe cases follow Zhang Zhongjing's methods using Da Cheng Qi Tang or Xiao Cheng Qi Tang, or Bei Ji Dan; mild cases use Li Dongyuan's Zhi Zhu Wan. For food stuck in the Upper Epigastrium, Qi rebels and obstructs upwards; the pulse at Qikou is tight and vigorous, two to three times stronger than Renying. Emetic therapy is mandatory. The Classic states: "If there is pulse above but none below, emesis is indicated; failure to emesis leads to death." Use Gua Di San to induce vomiting and expel the substance. If not fully expelled, use resolving and guiding medicines to grind it down; if the substance is gone but Spleen-Stomach Yuan Qi is damaged, apply tonification methods from Li Dongyuan's Internal Injury treatise, such as Yi Qi Tang. If one first eats hot food without injury, then consumes cold food, causing the previous food to fail digestion due to the subsequent cold, inquire about the ratio of cold to hot food consumed, and adjust medication accordingly. If one part cold and two parts hot, use two parts cold medicine and one part hot medicine, mixed and administered. Or if alcohol was drunk before cold food, or injury resulted from hot food and ice water, inquire about the sequence and quantity of injury, and administer appropriate cold or hot remedies dispersively. Physicians must examine pulses clinically, assess the patient's deficiency/excess, age, and constitution to apply treatment, avoiding negligence. One must absolutely avoid using pungent, dry, harsh, or purgative medicines indiscriminately; seeking cure only causes harm. This must be handled with caution.