夫脾胃者。仓廪之官也。属土以滋众脏。安谷以济百骸。故胃于中宫。职司南政。旺于
四季
体应四肢。胃形如囊。名水谷之海。脾形若掌。乘呼吸而升降。司运化之权。其致呼吸者
元气也。脾居其间。附胃磨动。所以谷气消而转输也。胃属于戊脾。乃己也。至哉坤元。
万物滋生。人之一元。三焦之气。五脏六腑之脉。统宗于胃。故人以胃气为本也。凡善调脾
胃者。当惜其气。气健则升降不失其度。气弱则稽滞矣。运食者元气也。生血气者饮食也。
无时不在。无时不然。故无专名。亦无定位。经言胃气脉不可得见。衰乃见耳。六脉之偏胜
而出独弦独浮独洪独沉之脉。是脉无胃气之神也。甚至屋漏雀啄等脉。必元气先竭。然后
胃气不相接济故也。气将绝。则升降之道废。运化之机弛也。大凡膈不快。食不美者。是气
之虚也。苟或饮食自倍。所伤乃一时膨闷。过则平矣。若伤之日久。
仍不宽快者。得非元气亏损。而胃气弱乎。古今论脾胃。及内外伤辨。惟东垣老人用心矣。
但繁文衍义。卒难措用。盖内伤之要。有三致焉。一曰饮食劳倦即伤脾。此常人之患也。因
而气血不足。胃脘之阳不举。宜补中益气汤主之。二曰思欲而伤脾。此富贵之患也。资以浓
味。则生痰而泥膈。纵其情欲。则耗精而散气。内经曰。肾者胃之关。夫肾脉从脚底涌泉穴
起。上股内 。夹任脉。抵咽嗌。精血枯。则乏润下之力。故吞酸而便难。胸膈渐觉不舒爽
宜加味六君子汤加红花三分知母盐炒一钱主之。三曰饮食自倍。肠胃乃伤者。劳力者之患
也。宜保和丸。三因和中丸权之。此内伤之由如此。而求本之治。宜养心健脾疏肝为要也。
夫心气和则脾土荣昌。心火脾土之母。肝木脾土之贼。木曰曲直作酸。故疏肝则胃气畅矣。
肺乃传送之官。肺主气属金。肺金有力。则能平肝木。不能作膈闷矣。人多执于旧方香燥耗
气之药。致误多矣。予家传三因和中健脾丸。为脾胃家之通用。其功效不可尽述。原夫世俗
但知枳术丸为脾胃之要药者。肤略之传也。人或信为健脾养胃之药而可久服。谬之甚矣。
不
特无效。抑且剥削真气。凡知素难大旨者。察安危全在于胃气。盖三焦司纳司化司出者。本
诸元气。凡治内伤。不知惜气者。诚实实虚虚之谓。学人宜致思焉。
脾胃，是负责饮食收纳与消化的器官，如同掌管粮仓的官员。它五行属土，能够滋养其他各个脏腑；通过消化食物来供养全身骨骼形体。因此，胃位于人体中焦（中宫），主要职能是顺应南方火气（南政，指心火/君火，此处喻指胃气如君主般重要或受火生土之意，结合上下文更侧重其核心地位），在四季之末（长夏等季）旺盛。它的生理状态反映在四肢。胃的形状像口袋，被称为“水谷之海”；脾的形状像手掌，随着呼吸运动而升降，主管运化功能的权力。所谓随呼吸升降的动力，来源于元气。脾位于胃之间，附着于胃并辅助磨动，从而使谷物之气得以消化和转输。胃属阳土（戊土），脾属阴土（己土）。大地坤元之德伟大，万物由此滋生。人体的根本元气、三焦之气、五脏六腑的经脉，都统属于胃。所以人是以胃气为根本的。
凡是善于调养脾胃的人，应当爱惜胃气。胃气强健，则升降功能不失常态；胃气虚弱，则气机就会停滞不前。推动食物运行的动力是元气，生成气血的物质基础是饮食。元气无处不在，无时不然，所以没有专门的名字，也没有固定的位置。经书说，正常的胃气脉象是难以单独察觉到的，只有当胃气衰败时，脉象才会显露出来。如果六部脉象出现偏胜，表现出独弦、独浮、独洪、独沉等脉象，这说明脉象中失去了胃气的柔和之神韵。甚至出现像屋漏滴水、雀啄食米等怪脉，必定是因为元气先已枯竭，然后导致胃气无法相互接济的缘故。当气即将断绝时，升降的道路就会废弃，运化的机能就会松弛懈怠。
大凡感到胸膈不快、食欲不佳的，这是气虚的表现。如果偶尔饮食过量，造成的伤害只是一时的胀闷，过后就会平复。如果受伤时间较长，仍然感觉不舒畅，难道不是元气亏损、胃气虚弱吗？古往今来论述脾胃及内外伤辨别的著作中，只有李东垣老人用心最深。但他的文字繁复、义理衍伸过多，最终难以直接应用。大概内伤的成因，主要有三种：一是饮食不节和劳倦过度损伤脾脏，这是普通人的常见病。因此导致气血不足，胃脘部的阳气不能升举，适宜用补中益气汤主治。二是思虑过度损伤脾脏，这是富贵人的常见病。如果食用浓烈滋腻的食物，就会生痰并阻滞胸膈；如果放纵情欲，就会耗损精血并散失元气。《内经》说：“肾是胃的关口。”肾脉从脚底的涌泉穴起始，向上经过大腿内侧，夹行于任脉两侧，抵达咽喉。如果精血枯涸，就缺乏滋润下行的力量，从而导致吞酸和大便困难，胸膈逐渐觉得不舒服，适宜用加味六君子汤，加入红花三分、知母一钱（盐炒）主治。三是饮食过量损伤肠胃，这是从事体力劳动者常见的病。适宜用保和丸，或者酌情使用三因和中丸。内伤的成因就是这样，而寻求根本的治疗方法，应当以养心、健脾、疏肝为关键。
心气调和，则脾土繁荣昌盛。心火是脾土的母脏，肝木是脾土的克星（贼）。木的特性是曲直并作酸味，所以疏理肝气则胃气就能通畅。肺是传导的官职，肺主气，五行属金。肺金有力，就能制约肝木，就不会产生胸膈闷塞的感觉。世人大多拘泥于旧方中使用香燥耗气的药物，导致误治的情况很多。我家传承的“三因和中健脾丸”，是治疗脾胃病的通用方剂，其功效无法详尽叙述。原本世俗之人只知道枳术丸是调理脾胃的要药，这是一种肤浅的流传。如果有人相信它是健脾养胃的药而可以长期服用，那就错得厉害了。不仅没有效果，反而会剥削真气。凡是懂得《黄帝内经》和《难经》大旨的人，都知道察看病情的安危全在于胃气。因为三焦主管受纳、运化和排泄的功能，都本源于元气。凡是治疗内伤，不懂得爱惜胃气的人，这就是所谓的“实其实、虚其虚”（使实证更实，虚证更虚，即犯虚实误治的错误）。学习中医的人应当深入思考这个问题。
The Spleen and Stomach are the officials of the granary. They belong to Earth and nourish all other Zang organs. By digesting food, they sustain the entire body. Therefore, the Stomach resides in the Central Palace (Middle Jiao), governing the Southern direction (symbolizing its pivotal role akin to the Heart/Fire generating Earth), and is prosperous during the transitional seasons of the year. Its condition corresponds to the four limbs. The Stomach resembles a bag and is named the "Sea of Water and Grain." The Spleen resembles a palm, ascending and descending with respiration, holding the authority over transformation and transportation. The source of this respiratory movement is Yuan Qi (Original Qi). The Spleen resides between them, attached to the Stomach and assisting in grinding, thereby facilitating the digestion and distribution of grain Qi. The Stomach belongs to Yang Earth (Wu), while the Spleen belongs to Yin Earth (Ji). Great is the Kun Yuan (Earthly Origin), from which all things grow. In humans, the primal Qi, the Qi of the San Jiao (Triple Burner), and the meridians of the Five Zang and Six Fu organs all converge upon the Stomach. Thus, humans rely on Stomach Qi as their foundation.
Those who are skilled at regulating the Spleen and Stomach must cherish their Qi. When Qi is robust, ascending and descending functions remain within proper limits; when Qi is weak, stagnation occurs. The power that moves food is Yuan Qi, while diet and drink are the sources that generate Blood and Qi. It is present everywhere and at all times, so it has no specific name or fixed location. The Classics state that the pulse of Stomach Qi cannot be distinctly seen; it only becomes apparent when it declines. If the six pulses show excessiveness, manifesting as exclusively wiry, floating, flooding, or deep pulses, these pulses lack the spirit of Stomach Qi. Even worse, pulses resembling dripping water from a leaking roof or birds pecking at grain indicate that Yuan Qi has first exhausted itself, causing Stomach Qi to fail in mutual support. When Qi is about to perish, the pathways of ascending and descending cease, and the mechanism of transformation relaxes. Generally, chest discomfort and poor appetite indicate Qi deficiency. If one occasionally overindulges in food, the resulting injury causes temporary bloating and fullness, which resolves afterward. However, if the injury persists for a long time and discomfort remains, is it not due to the depletion of Yuan Qi and weakness of Stomach Qi?
Throughout history, regarding discussions on the Spleen and Stomach and the differentiation of internal versus external injuries, only Master Dongyuan (Li Dongyuan) exerted profound effort. Yet his writings are verbose and complex, making them difficult to apply directly. The essentials of internal injury stem from three causes: First, improper diet and fatigue injure the Spleen, a common affliction of ordinary people. This leads to insufficiency of Qi and Blood, and failure of the Yang Qi in the epigastrium to ascend. One should primarily use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Second, excessive thinking injures the Spleen, a common affliction of the wealthy. Rich and greasy foods generate phlegm and obstruct the chest diaphragm; indulging desires consumes Essence and scatters Qi. The Inner Canon states: "The Kidney is the gate of the Stomach." The Kidney Meridian originates from the Yongquan point (KI-1) at the sole of the foot, ascends along the medial aspect of the thigh, runs alongside the Ren Mai (Conception Vessel), and reaches the throat. When Essence and Blood are dry, there is a lack of moistening and downward-moving force, leading to acid regurgitation and difficulty in defecation, with gradual discomfort in the chest and diaphragm. One should use Jiawei Liujunzi Tang (Modified Six Gentlemen Decoction) added with 3 fen of Honghua (Carthami Flos) and 1 qian of Zhimu (Anemarrhenae Rhizoma, stir-fried with salt). Third, overeating injures the intestines and stomach, a common affliction of laborers. One should use Baohe Wan (Harmonize the Interior Pill) or adjust with Sanyin Hezhong Wan (San-Yin Harmonize the Middle Pill). These are the origins of internal injury. To treat the root, one must prioritize nourishing the Heart, strengthening the Spleen, and soothing the Liver.
When Heart Qi is harmonious, Spleen Earth flourishes. Heart Fire is the mother of Spleen Earth, while Liver Wood is the thief (overcontroller) of Spleen Earth. Wood's nature is bending and straightening, producing sourness. Therefore, soothing the Liver allows Stomach Qi to flow freely. The Lung is the official of transmission; it governs Qi and belongs to Metal. When Lung Metal is strong, it can pacify Liver Wood, preventing chest oppression. Many people stubbornly adhere to old prescriptions containing aromatic, drying, and Qi-consuming herbs, leading to many errors. My family's inherited formula, Sanyin Hezhong Jianpi Wan (San-Yin Harmonize the Middle and Strengthen the Spleen Pill), is a general-purpose remedy for Spleen and Stomach disorders; its efficacy cannot be fully described. Secular people mistakenly believe that Zhizhu Wan (Aurantii Fructus and Atractylodis Macrocephalae Rhizoma Pill) is the essential medicine for the Spleen and Stomach, which is a superficial transmission. If one believes it is a medicine for strengthening the Spleen and nourishing the Stomach that can be taken for a long time, the error is severe. Not only is it ineffective, but it also depletes True Qi. Those who understand the main principles of the Suwen (Basic Questions) and Nanjing (Classic of Difficult Issues) know that observing safety and danger depends entirely on Stomach Qi. Since the San Jiao is responsible for receiving, transforming, and excreting, all these functions originate from Yuan Qi. Anyone treating internal injuries without cherishing Qi commits the error of "reinforcing the excess and depleting the deficient" (Shi Qi Shi, Xu Qi Xu). Students of medicine should reflect deeply on this.