〔薛〕经曰∶脾病则面黄善噫。噫者，寒气客于胃，厥逆从下上散，复出于胃而
为噫。又善思善味，其证当脐有动气，按之牢若痛。其病腹胀满，食不消，体重节
痛，怠惰嗜卧，四肢不收。经曰∶脾主四肢，有是者脾也。又曰∶二阳一阴发病，
主惊骇背痛善噫。何谓也？窃谓上焦受气于中焦，中焦气未和，不能消谷，故为噫
耳。中焦，亦脾胃之分也，脾土虚寒，由命门火衰，不能温蒸水谷，古人有服菟丝
子旬日间饮食如汤沃雪，亦此义也。补脾宜人参理中汤。补右肾宜用八味丸。胃气
虚不能运化水谷者，六君子加木香。郁结伤脾者，加味归脾汤。木克土者，四君柴胡、
升麻，兼嘈杂者，加吴茱萸、半夏。治者审之。
理中汤（吐泻） 八味丸（虚羸） 加味归脾汤（惊悸）
《本事》枳壳散 治心下痞闷，或作痛多噫。
枳壳（去瓤，炒） 白术（各半两） 香附子（炒，一两） 槟榔（三钱）
上为末。每服一钱，空心，米饮调下。
四味萸连丸 治腹胀噫气吞酸，食不能化。
吴茱萸（炒） 黄连（炒） 神曲 荷叶（各等分）
上为末，煮神曲糊丸，桐子大。每服二十丸，白汤下。黄连，当量病微甚，或
炒黑炒黄用之。
〔薛〕刘河间云∶肠胃郁结，谷气内发而不能宣通于肠胃之外，故喜噫下气也。
若癫痫劳瘵，气下泄而不止者必死，乃真气竭绝，腠理闭塞，谷气不能宣通于肠胃
之外，故从肠胃中泄出。娄全善云∶下气属心虚。经云∶夏脉者心也，心脉不及，
下气为泄者是也。经又云∶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，此平人也。若七情内伤，六淫外侵，
饮食不节，房劳过度，致脾土之阴受伤，转运之官失职，不能输化，故下气也。又
曰∶阴精所奉，其人寿，阳精所降，其人夭。阴精者，乃五谷之精，上荣心肺，以
降肾肝，故曰其人寿。阳精者，乃胃中之清气，陷入肾肝，不能升浮，上输心肺，
故曰其人夭。若饮食过度，肠胃郁结，用平胃散。癫痫劳瘵，用补中益气汤。心气
虚弱，用补心丸。心气虚寒，用补心汤。脾胃虚寒，用理中汤。肝木乘睥，用六君
子汤加木香。脾气郁结，用加味归脾汤。脾气下陷，用补中益气汤。命门火衰，用
八味丸。肾气不足，用六味地黄丸。大凡噫气下气者，其脉不及本位，内经云∶短
则气病。以其无胃气也。诸病见此脉难治，但纯补胃气为善。
平胃散（不能食） 补心丸（即茯神散为丸，方见惊悸） 补心汤（痞） 理中汤（吐泻）
加味归脾汤（惊悸） 八味丸（不能食）
【薛己按语】《黄帝内经》说：脾有病则面色发黄，且容易嗳气。所谓嗳气，是寒气侵袭胃腑，厥逆之气从下向上散漫，再出于胃而形成的嗳气。另外，如果患者思虑过多、口味异常，其证候表现为肚脐周围有搏动感，按压时感觉坚硬或疼痛。这类疾病会出现腹部胀满，食物不消化，身体沉重，关节疼痛，倦怠嗜睡，四肢无力收持的症状。《内经》说：脾主四肢，出现上述症状的就是脾病。又说：阳明（胃）与厥阴（肝）发病，主要表现为惊恐、背痛和容易嗳气。这是什么意思呢？我认为上焦接受中焦的气化作用，如果中焦气机不和，不能腐熟水谷，所以产生嗳气。中焦，也是脾胃的范畴，脾土虚寒，是由于命门火衰，不能温煦蒸腾水谷所致。古人有服用菟丝子十几天间饮食像雪遇热水一样迅速消化的例子，也是这个道理。补脾宜用人参理中汤。补右肾宜用八味丸。胃气虚弱不能运化水谷的，用六君子汤加木香。因郁结损伤脾气的，用加味归脾汤。肝木克伐脾土的，用四君子汤合柴胡、升麻，兼有嘈杂感的，加吴茱萸、半夏。治疗者请仔细审察。
理中汤（主治吐泻） 八味丸（主治虚羸消瘦） 加味归脾汤（主治惊悸）
《本事方》枳壳散 主治心下痞闷，或者作痛并多嗳气。
枳壳（去瓤，炒） 白术（各半两） 香附子（炒，一两） 槟榔（三钱）
以上研为细末。每次服一钱，空腹时，用米饮调服。
四味萸连丸 主治腹胀、嗳气吞酸，食物不能消化。
吴茱萸（炒） 黄连（炒） 神曲 荷叶（各等分）
以上研为细末，煮神曲糊为丸，如梧桐子大。每次服二十丸，用白开水送下。黄连应根据病情的轻重，或炒黑或炒黄使用。
【薛己按语】刘河间说：肠胃郁结，谷气内发但不能宣通于肠胃之外，所以喜欢嗳气和排气（下气）。如果是癫痫、劳瘵等疾病，气向下泄出而不止的必然死亡，这是真气竭绝，腠理闭塞，谷气不能宣通于肠胃之外，所以从肠胃中泄出。娄全善说：下气属于心虚。《内经》说：夏脉对应心脏，心脉不及，出现下气泄出的症状就是这种情况。《内经》又说：饮食进入胃，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，这是健康人的状态。如果七情内伤，六淫外侵，饮食不节，房劳过度，导致脾土之阴受伤，转运之官失职，不能输布化生，所以下气。又说：阴精上奉，人长寿；阳精下降，人短命。阴精，是五谷的精微，上荣养心肺，下降滋养肾肝，所以说人长寿。阳精，是胃中的清气，陷入肾肝，不能升浮上输心肺，所以说人短命。如果饮食过度，肠胃郁结，用平胃散。癫痫劳瘵，用补中益气汤。心气虚弱，用补心丸。心气虚寒，用补心汤。脾胃虚寒，用理中汤。肝木乘脾，用六君子汤加木香。脾气郁结，用加味归脾汤。脾气下陷，用补中益气汤。命门火衰，用八味丸。肾气不足，用六味地黄丸。大凡嗳气、下气的患者，其脉象不及本位，《内经》说：脉短则是气病。这是因为没有胃气。各种疾病出现这种脉象都难治，只有纯补胃气才是好的治疗方法。
平胃散（主治不能食） 补心丸（即茯神散为丸，方见惊悸条下） 补心汤（主治痞证） 理中汤（主治吐泻） 加味归脾汤（主治惊悸） 八味丸（主治不能食）
[Xue Ji's Commentary] The *Classic of Difficult Issues* (Nan Jing) states: "When the Spleen is diseased, the face turns yellow and there is frequent belching." Belching is caused by cold pathogenic factors invading the Stomach; the rebellious Qi rises from below and scatters upward, then exits through the Stomach, resulting in belching. Furthermore, if a patient exhibits excessive thinking and abnormal taste sensations, with pulsation around the umbilicus that feels firm or painful upon pressure, these are signs of Spleen disease. Such conditions manifest as abdominal distension and fullness, indigestion, heaviness of the body, joint pain, lethargy, drowsiness, and weakness of the four limbs. The *Classic* states: "The Spleen governs the four limbs"; thus, the presence of these symptoms indicates Spleen pathology. It also states: "When Yangming (Stomach) and Jueyin (Liver) are affected, the main manifestations are fright, back pain, and frequent belching." What does this mean? I believe that the Upper Jiao receives Qi from the Middle Jiao. If the Qi in the Middle Jiao is not harmonized and cannot digest food, belching occurs. The Middle Jiao refers to the Spleen and Stomach. Spleen Earth deficiency and coldness result from the decline of Mingmen Fire (Gate of Life), which fails to warm and steam water and grain. Ancient texts mention that taking Cuscuta Seed (Tusizi) for ten days can lead to digestion as rapid as snow melting in hot water; this illustrates the same principle. To tonify the Spleen, Ren Shen Li Zhong Tang (Ginseng Decoction to Regulate the Middle) is appropriate. To tonify the Right Kidney (Mingmen), Ba Wei Wan (Eight-Ingredient Pill) should be used. For Stomach Qi deficiency failing to transform water and grain, Liu Jun Zi Tang (Six Gentlemen Decoction) with Mu Xiang (Aucklandia Root) is indicated. For Spleen injury due to emotional constraint, Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) is prescribed. When Liver Wood overacts on Spleen Earth, Si Jun Zi Tang (Four Gentlemen Decoction) combined with Chai Hu (Bupleurum Root) and Sheng Ma (Cimicifuga Rhizome) is used; if accompanied by acid regurgitation or epigastric discomfort, Wu Zhu Yu (Evodia Fruit) and Ban Xia (Pinellia Tuber) are added. Practitioners should examine carefully.
Ren Shen Li Zhong Tang (for vomiting and diarrhea) | Ba Wei Wan (for emaciation) | Jia Wei Gui Pi Tang (for palpitations and fright)
*Benshi Fang* Zhi Qiao San (Immature Bitter Orange Powder): Treats subcostal stuffiness or pain with frequent belching.
Zhi Qiao (Immature Bitter Orange, pith removed, stir-fried) [0.5 liang], Bai Zhu (Atractylodes Macrocephala Rhizome) [0.5 liang], Xiang Fu Zi (Cyperi Rhizome, stir-fried) [1 liang], Bing Lang (Areca Seed) [3 qian].
Grind into powder. Take 1 qian per dose, on an empty stomach, mixed with rice water.
Si Wei Yu Lian Wan (Four-Ingredient Evodia and Coptis Pill): Treats abdominal distension, belching, acid regurgitation, and inability to digest food.
Wu Zhu Yu (Evodia Fruit, stir-fried), Huang Lian (Coptis Rhizome, stir-fried), Shen Qu (Medicated Leaven), He Ye (Lotus Leaf) [equal parts].
Grind into powder, use Shen Qu paste to make pills the size of paulownia seeds. Take 20 pills per dose with plain boiled water. The dosage of Huang Lian should be adjusted according to the severity of the condition; it may be stir-fried until black or yellow.
[Xue Ji's Commentary] Liu Hejian stated: "When intestines and stomach are constrained, grain Qi arises internally but cannot circulate freely outside the intestines and stomach, leading to a preference for belching and passing gas (lowering Qi). In cases of epilepsy or consumptive diseases, if Qi leaks downward without cessation, death is inevitable. This indicates exhaustion of True Qi, closure of the interstices (Cou Li), and failure of grain Qi to circulate outside the intestines and stomach, causing it to leak out from within." Lou Quanshan stated: "Lowering Qi belongs to Heart deficiency." The *Classic* says: "The Summer pulse corresponds to the Heart." If the Heart pulse is deficient, lowering Qi with leakage is the manifestation. The *Classic* further states: "Food enters the Stomach, its essence floats up, is transported to the Spleen, dispersed by the Spleen, and sent up to the Lung. The Lung regulates water passages, sending them down to the Bladder. Water essence distributes everywhere, and the five meridians function together; this is the state of a healthy person." However, internal injury from seven emotions, external invasion by six climatic pathogens, irregular diet, or excessive sexual activity can damage Yin of Spleen Earth. When the official of transportation fails in its duties and cannot distribute and transform, lowering Qi occurs. It is also said: "When Yin essence is offered upward, one lives long; when Yang essence descends, one dies young." Yin essence refers to the essence of grains, which nourishes the Heart and Lung above and nourishes the Kidney and Liver below, hence longevity. Yang essence refers to clear Qi in the Stomach; if it sinks into the Kidney and Liver instead of ascending and floating up to the Heart and Lung, life is shortened. For excessive eating causing intestinal and gastric constraint, Ping Wei San (Peace the Stomach Powder) is used. For epilepsy and consumptive diseases, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is used. For Heart Qi deficiency, Bu Xin Wan (Tonify Heart Pill) is used. For Heart Qi deficiency with cold, Bu Xin Tang (Tonify Heart Decoction) is used. For Spleen and Stomach deficiency-cold, Li Zhong Tang (Regulate the Middle Decoction) is used. For Liver Wood encroaching on Spleen, Liu Jun Zi Tang (Six Gentlemen Decoction) with Mu Xiang is used. For Spleen Qi constraint, Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) is used. For Spleen Qi sinking, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is used. For Mingmen Fire decline, Ba Wei Wan (Eight-Ingredient Pill) is used. For Kidney Qi insufficiency, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) is used. Generally, in cases of belching and lowering Qi, the pulse is deficient relative to its proper position. The *Inner Classic* states: "A short pulse indicates Qi pathology." This is due to the absence of Stomach Qi. Diseases presenting with this pulse are difficult to treat; pure tonification of Stomach Qi is the best approach.
Ping Wei San (for anorexia) | Bu Xin Wan (i.e., Fu Shen San made into pills, see Palpitations section) | Bu Xin Tang (for stagnation/fullness) | Li Zhong Tang (for vomiting and diarrhea) | Jia Wei Gui Pi Tang (for palpitations and fright) | Ba Wei Wan (for anorexia)