内经云。五脏者。藏精气而不泻也。故满而不实。六腑者。传化物而不藏。故实而不满也。
气口何以独为五脏主胃者水谷之海。六腑之大源也。五味入口。藏于胃以养五脏气。气口亦太阴
也。是以五脏六腑之气味。皆出于胃。变见
于气口。
经言。水谷之寒热。感则害人六腑。又曰。阴气者。静则神藏。躁则消亡。饮食自倍。肠胃
乃伤。此乃混言之也。分之为二。饮也。食也。饮者水也。因而大饮则气逆。形寒饮冷则伤肺。
肺病则为喘咳。为肿满。为水泻。轻则发汗利小便。上下分消其湿。如重而蓄积为满者利下之。
食者物也。因而饱食。筋脉横解。肠 为痔。又饱食劳力。伤太阴厥阴。则气口滑大于人迎两倍
三倍。或呕吐痞满。或下利肠 。当分寒热轻重治之。轻则内消。重则除下。亦有宜吐者。所谓
在上者因而越之也。然不可过剂。过则反伤脾胃。盖先饮食自伤。加之药过。脾胃复伤而气不能
化。食愈难消也。
赵养葵云。今方家治伤饮食者。以平胃散为主。出入增减。以为脾胃之准绳。平胃者。胃中
有高阜。则使平之。一平即止。不可过剂。过剂则平地反成坎矣。而枳术丸尤胜。今人以此丸为
补脾药。朝服暮饵。更有益之橘、半、香、砂者。则又甚矣。至若山楂、神曲、麦芽三味。举世
所常用者。盖山楂能化肉积。产妇儿枕痛者。用炒黑山楂。砂糖水煎服。儿枕立化。其性消积破
血。岂可轻用。曲 者。以米与水在瓷缸中。心藉曲以酿成酒。必藉 以酿成糖。脾胃在人身。
非瓷缸比。原有化食之能。今食不化者。其所能者病也。只补助其能而食自化。何必用此消克之
药哉。大凡元气完固之人。多食不伤。过时不饥。若人先因本气不足。致令饮食有伤。前药一用。
饮食虽消。但脾胃既已受伤。而复经此一番消化。愈虚其虚矣。明后日食复不化。犹谓前药已效。
药力欠多。汤丸并进。展转相害。羸瘦日增。良可悲哉。
东垣论饮食劳倦。为内伤不足之证。而王安道又分饮食伤为有余。法当消导。东垣自有枳术
丸等方。劳倦伤为不足。专立补中益气汤主治。其伤食之证。胸膈痞闷。吐逆咽酸。噫败卵臭。
畏食头疼。发热恶寒。病似伤寒。但气口脉大
于人迎。身不痛耳。宜豁痰运脾。二陈加枳、术、曲、 、山楂、香附之类。挟气脉沉。加木香、
青皮。停食感冒。芎苏散加消导一二味。食滞中宫。胸膈痞闷嗳气。发热头痛。有类外感。藿香
正气散。若七八日不大便。口干烦躁。脐上硬痛。枳实导滞丸。因忧气食湿粘结于中脘。发热。
腹皮底微痛。心下痞满。不思饮食。食之不化。常常痞气。木香化滞汤。食积痞满。消瘦发热。
保和丸。虚。加白术二两。名大安丸。调理之。食滞心下。初起不可骤用苦寒。必兼辛散。二陈、
平胃消导之。及枳实、白术、青皮、陈皮、山楂、曲、 之类。以食得寒则凝。得热则腐也。日
久成积发热者。加姜汁炒川连、连翘之属清利之。若已成糟粕。日久生热。燥结不行。方可用承
气辈攻下之。如冷物停滞作吐。二陈加炮姜、白豆蔻、苍术、浓朴、神曲、藿香之类。甚则广术、
巴豆之属。若冷食停蓄。心腹暴痛作胀。当用红丸子、备急丸温下之。痰饮结聚。谷不得入。冷
痰宿食在上脘者。用白散涌吐之。痰食已消。中焦未和。不思饮食。或吐或泻。倦怠面黄。按之
心下软。脾胃受伤也。六君子加木香、砂仁。燥渴。用七味白术散。老人虚人。易于伤食。或膨
胀痞闷。或腹满作泻。当消补兼施。宜九味资生丸常常服之。若口淡思食。而见食不甘。食过则
厌。兼恶心胸膈不快。胃虚挟痰饮也。六君子加枳实、香、砂。若不思饮食。食不克化。食后反
饱。脾虚不能健运也。枳实理中丸。病后饮食不调。中脘隐隐作痛。有时得食则已。有时得食转
加。此胃中火燎作痛。得食以压其势。故痛少安。若饮食稍过。气不能运转其食。故痛转加。连
理汤加沉香。灵枢云。夫胃满则肠虚。肠满则胃虚。更实更虚。其气乃居。若醉饱过度。或感风
寒。或着气恼。以致填塞胸中。胃气不行。忽然厥逆昏迷。口不能言。肢不能举。此名食厥。若
误作中风中气治之。必死。宜煎姜盐汤探吐之。风寒者。藿香正气散。气滞者。八味顺气散。吐
后别无他证。只以苍术、白术、陈皮、浓朴、甘草之类调之。如遇此卒暴之病。必须审问明
白。或方食醉饱。或饮食过伤。但觉胸膈痞闷。痰涎壅塞。气口脉紧盛者。宜作食滞治之。
伤诸肉食。用草果、山楂。挟外感风寒。山楂须用姜汁炒黑。则不酸寒收敛。兼能破血和伤。
消导食积更速。伤面食。炒莱菔子。伤麸筋粽子等物。诸药不能消化。俱用本物拌绿矾烧灰。砂
糖酒下。二三服效。伤糯米粉食。炒酒药。或酒曲。砂糖调。淡姜汤服。伤索粉。用杏仁炒黑。
研如脂。砂糖拌。姜汤服。伤生冷果菜。宜木香、砂仁、炮姜、肉桂。伤蟹腹痛者。丁香、紫苏、
生姜。伤蛋满闷。姜汁、蒜泥。伤肉生鱼 。必用生姜、草果、炮黑山楂。积久生热。口干噫气。
二陈加姜汁炒川连及消导药。
伤酒 经曰。因而大饮则气逆。酒入于胃。则络脉满而经脉虚。脾主为胃行其津液者也。
若饱以入房。气聚于脾中不得散。酒气与谷气相搏。热盛于中。故热遍于身。内热而溺赤也。东
垣云。酒者。大热有毒。气味俱阳。乃无形之物也。若伤之。止当发散。汗出则愈。其次莫如利
小便。使上下分消其湿。今之病酒者。或以雄黄、巴豆、蝎梢大热之药下之。或用牵牛、大黄、
甘遂大寒之药下之。是无形元气受病。反下有形阴血。则真水愈弱。阳毒太旺。反增阴火。是以
元气消烁。折人长命。患此者。不得已用葛花解酲汤。或五苓散加人参、草豆蔻。伤酒食积发热。
者曲 丸。腹满虚胀。合塌气丸。不应。神保丸、酒症丸。并加酒炒黄连。胃气虚者。上法俱不
可用。惟独参汤助其胃气立苏。神验。
喻嘉言曰。夫酒者。清洌之物。不随浊秽下行。惟喜渗入者也。渗入之区。先从胃入胆。胆
为清净之府。同气相求。然胆之摄受无几。其次从胃入肠。膀胱渗之。化溺为多。逮至化溺。则
所存者。酒之余质。其烈性惟胆独当之。每见善饮者。
必浅斟缓酌。以俟腹中之渗。若连飞数觥。则倾囊而出耳。灵枢云。怯士之得酒。怒不避勇士者。
其气 悍。入于胃中则胃胀。气上逆满于胸中。肝浮胆横。当是之时。同比于勇士。气衰则悔。
名曰酒悖。盖胆之府。原无输泻。善饮者。胆之热恒移于脑。则为鼻渊。或头间多汗。脑热大泄。
或注于肠。则大便时溏。湿热下泄。俱不为大患也。如胆之热汁满而溢出于外。以渐渗于经络。
则身目皆黄。为酒瘅之病。以渗而出也。转驱而纳诸膀胱。从溺道而消也。
〔诊〕气口脉浮大。按之反涩者。有宿食也。脉数而滑者。有宿食也。脉迟而滑者。宿食作胀
也。气口脉紧。寒食停滞胃中。温消而下之。气口脉沉紧而细。冷食伤脾。温补兼消之。两手脉
皆模糊不清。此宿食结滞。胃气不行。急下夺之。伤食脉有滑涩之异。脾虚不能鼓运。胃虚不能
熟腐。故其脉不滑而涩。涩甚则模糊不清矣。若人迎紧盛而气口滑者。停食感冒也。
许叔微治一酒客。感冒风寒。倦怠不思饮食。已半月矣。睡后发热。遍身疼如被杖。微恶寒。
六脉浮大。按之豁然。作极虚受寒治之。用六君子加黄 、当归、葛根。大剂与之。五服后遍身
汗出如雨。得睡。诸证悉平。
江南仲治一人。冬月覆舟。尽力救货。忍饥行五十里。遇族人纵饮青楼。遂发热四肢如火。
左胁一点疼痛。小便赤涩。五日不更衣。医作伤食治。不效。脉弦数无力。气口倍于人迎。此醉
饱竭力伤肝所致。内经所谓数醉饱以入房。气聚于脾中不得散。酒气与谷气相搏。热盛于中。故
热遍于身。内热故溺赤。酒气 悍。肾气日衰。阳气胜故手足为之热也。与四君子加神曲、枳壳、
白芥子。二服热退。调理而愈。
石顽治幼科汪五符。夏月伤食。呕吐发热颅胀。自利黄水。遍体肌肉扪之如刺。六脉模糊。
指下寻之似有如无。足
胫不温。自认阴寒而服五积散。一服其热愈炽。昏卧不省。第三日自利不止。而时常谵语。至夜
尤甚。乃舅叶阳生以为伤暑。而与香薷饮。遂头面汗出如蒸。喘促不宁。足冷下逆。歙医程郊倩
以其证大热而脉息模糊。按之殊不可得。以为阳欲脱亡之候。欲猛进人参、附子。云间沈明生以
为阴证断无汗出如蒸之理。脉虽虚而证大热。当用人参白虎。争持未决。取证于石顽。诊其六脉
虽皆涩弱模糊。而心下按之大痛。舌上灰刺如芒。乃食填中宫。不能鼓运其脉。往往多此。当与
凉膈散下之。诸医正欲藉此脱手。听余用药。一下而神思大清。脉息顿起。当知伤食之脉。虽当
气口滑盛。若屡伤不已。每致涩数模糊。乃脾不消运之兆也。此证设非下夺而与参、附助其壮热。
顷刻立毙。可不详慎。而妄为施治乎。
又诊叶新宇停食感冒。而两寸关皆涩数模糊。两尺皆沉弦。而按之益坚。虽其人尚能行走。
而脉少冲和。此必向有陈气在少腹。询之果患寒疝数年。因缓辞不便用药。是夜即腹暴满而逝。
门人问曰。叶子偶抱小恙。何以知其必死而辞之。曰。凡人胃满则肠虚。肠满则胃虚。更实更虚。
其气乃居。今胸有嘏而腹有积。上下俱困。能保其不交攻为患乎。当知厥疝入腹。香港脚冲心等疾。
皆是阴邪搏结。郁积既久。则挟阴火之势而上升。若胸中阳气有权。则阴邪仍归阴位而止。今胸
中先为宿食填塞。腹中陈气不逆则已。逆则上下俱满。正气无容身之地。往往有暴绝之虞。所以
不便用药。实未知其即死也。故凡诊六部中病脉有不相应处。即当审其有无宿病。不可轻忽。以
招诽谤也。
癸卯元夕。周徐二子。过石顽斋头纵饮。次日皆病酒不能起。欲得葛花汤解酲。余曰。东垣
葛花解酲汤。虽为伤酒
专剂。然人禀气各有不同。周子纵饮。则面热多渴。此酒气皆行阳明肌肉之分。多渴知热伤胃气。
岂可重令开泄以耗津液。与四君子汤去甘草加藿香、木香、煨葛根、泽泻。下咽即苏。徐子久患
精滑。饮则面色愈青。此素常肝胆用事。肾气并伤。酒气皆行筋骨。所以不上潮于面。葛花胃药。
用之何益。与五苓散加人参倍肉桂。服后食顷。溲便如皂角汁而安。
《黄帝内经》说：五脏的功能是贮藏精气而不向外排泄，所以它们的状态是充满精气但内部不充实（指无糟粕）；六腑的功能是传导和消化水谷而不长期贮藏，所以它们的状态是暂时充实但不充满（指无精气）。
气口脉为什么能单独作为诊断五脏病变的主脉？因为胃是水谷汇聚的海洋，也是六腑功能的根本来源。各种味道进入口中后，储藏于胃中以滋养五脏之气。气口脉属于手太阴肺经（与足太阴脾经相表里，脾胃之气上注于肺，故气口可候脾胃及五脏之气）。因此，五脏六腑的水谷精微气味，都源于胃，并变化反映在气口脉上。
医经中说：“水谷的寒热属性，如果感受邪气，会伤害六腑。”又说：“阴气（指人体内的宁静、收敛之气），安静时神志内守，躁动时则耗散消亡。饮食过量一倍，肠胃就会受伤。”这是笼统的说法。如果细分开来，分为“饮”和“食”两类。“饮”指的是液体。如果大量饮水，会导致气机上逆；形体受寒又饮用冷物，会损伤肺脏。肺病表现为气喘咳嗽、水肿胀满、水样腹泻。轻症采用发汗和利小便的方法，上下分消体内的湿气；如果病情重且体内有积滞导致胀满，则用泻下法治疗。
“食”指的是固体食物。如果吃得太饱，会导致筋脉松弛弛缓，大肠发生病变形成痔疮。如果饱食后又从事体力劳动，会损伤太阴脾经和厥阴肝经，此时气口脉的搏动会比人迎脉大两倍或三倍，或者出现呕吐、痞闷胀满，或者腹泻、肠鸣等症状。应当根据寒热的轻重来治疗。轻症采用内消导滞的方法，重症采用攻下排除的方法。也有适合使用催吐法的，即所谓“病位在上者，因而越之（通过呕吐排出）”。但是不可用药过猛，过量反而会损伤脾胃。因为原本就是饮食自伤，再加上药物过量，脾胃再次受损，气机不能运化，食物就更难消化了。
赵养葵说：现在医生治疗伤食，以平胃散为主方，根据情况加减变化，将其作为调理脾胃的标准准则。“平胃”的意思是，如果胃中有高阜（指食积停滞形成的壅塞），就使其平复。一旦平复就停止用药，不可过量。过量则平地反成坑坎（比喻脾胃功能受损凹陷）。其中枳术丸的效果更好。现在的人把这种药丸当作补脾药，早晚服用，甚至再加入陈皮、半夏、木香、砂仁等药，那就更严重了。至于山楂、神曲、麦芽这三味药，是举世常用的。山楂能化解肉食积滞，产妇因儿枕痛（产后瘀血腹痛），可用炒黑山楂加砂糖水煎服，儿枕立化。山楂的性质是消积破血，怎么能轻易使用呢？神曲，是用米和水在瓷缸中，借助酒曲酿造成酒，借助麴菌酿造成糖。脾胃在人体内，不像瓷缸那样需要外力发酵，它本身就有消化食物的能力。现在食物不消化，是因为这种能力生病了。只需要辅助恢复它的功能，食物自然就能消化，何必使用这些消克（消耗克制）的药物呢？大凡元气坚固的人，多吃也不会受伤，过了饭点也不觉得饿。如果人本来元气不足，导致饮食受伤，前面提到的那些消导药一用，虽然饮食消了，但脾胃已经受伤，再经过这一番消化过程，会使虚者更虚。明后天食物再次停滞不化，还认为前面的药有效，只是药力不够，于是汤剂和丸剂并用，辗转相互伤害，身体日益消瘦，真是可悲啊。
李东垣论述饮食劳倦，认为是内伤不足的证候；而王安道又将饮食伤分为有余之证，治法应当消导。李东垣自有枳术丸等方剂；劳倦伤属于不足，专门设立补中益气汤主治。对于伤食的证候，表现为胸膈痞闷，呕吐逆气，咽喉酸楚，打嗝有腐败卵臭味，畏食，头痛，发热恶寒，病症类似伤寒，但气口脉大于人迎脉，身体不疼痛罢了。适宜豁痰运脾，用二陈汤加枳实、白术、神曲、麦芽、山楂、香附之类。如果兼有气滞，脉象沉，加木香、青皮。如果是停食兼感冒，用芎苏散加一两味消导药。如果是食滞在中焦，胸膈痞闷嗳气，发热头痛，类似外感，用藿香正气散。如果七八天不大便，口干烦躁，脐上硬痛，用枳实导滞丸。如果是因忧思、气滞、食积、湿浊粘结在中脘，发热，腹皮底部微痛，心下痞满，不思饮食，食之不化，常常痞气，用木香化滞汤。如果是食积痞满，消瘦发热，用保和丸。如果体质虚弱，加白术二两，名为大安丸，用来调理。如果是食滞在心下，初起不可骤用苦寒药，必须兼用辛散药，用二陈汤、平胃散消导，以及枳实、白术、青皮、陈皮、山楂、神曲、麦芽之类。因为食物遇寒则凝结，遇热则腐熟。日久形成积滞发热，加姜汁炒黄连、连翘等清热利湿。如果已经变成糟粕，日久生热，燥结不通，才可以使用承气汤类攻下。如果是冷物停滞导致呕吐，用二陈汤加炮姜、白豆蔻、苍术、厚朴、神曲、藿香之类。严重时加莪术、巴豆之类。如果是冷食停蓄，心腹突然疼痛胀满，当用红丸子、备急丸温下。如果是痰饮结聚，谷物无法进入，冷痰宿食在上脘的，用白散涌吐。痰食已消，中焦未调和，不思饮食，或吐或泻，倦怠面黄，按压心下柔软，这是脾胃受伤，用六君子汤加木香、砂仁。如果有燥渴，用七味白术散。老人和体虚之人，容易伤食，出现膨胀痞闷，或腹满作泻，应当消补兼施，宜常服九味资生丸。如果口淡想吃饭，但看到食物觉得无味，吃过之后厌恶，兼有恶心胸膈不快，这是胃虚挟痰饮，用六君子汤加枳实、木香、砂仁。如果不思饮食，食物不能消化，食后反而饱胀，这是脾虚不能健运，用枳实理中丸。病后饮食不调，中脘隐隐作痛，有时吃了食物就好了，有时吃了食物反而加重，这是胃中火热作痛，吃了食物可以压制火势，所以疼痛稍安。如果饮食稍多，气机不能运转食物，所以疼痛加重，用连理汤加沉香。《灵枢》说：胃满则肠虚，肠满则胃虚，虚实交替，气机才能正常运行。如果醉饱过度，或感受风寒，或遭遇气恼，以致填塞胸中，胃气不行，忽然厥逆昏迷，口不能言，肢体不能举动，这名叫食厥。如果误作中风或中气治疗，必死无疑。适宜煎姜盐汤探吐。如果是风寒所致，用藿香正气散；气滞所致，用八味顺气散。吐后没有其他症状，只用苍术、白术、陈皮、厚朴、甘草之类调理。如果遇到这种突发急病，必须审问明白，是否是刚吃完饭或醉酒饱食，只要觉得胸膈痞闷，痰涎壅塞，气口脉紧盛，就应当按食滞治疗。
损伤各种肉食，用草果、山楂。如果兼夹外感风寒，山楂须用姜汁炒黑，这样就不酸寒收敛，兼能破血和伤，消导食积更快。损伤面食，用炒莱菔子。损伤麸筋粽子等物，诸药不能消化的，都用本物拌绿矾烧灰，砂糖酒送服，二三服见效。损伤糯米粉食，用炒酒药，或酒曲，砂糖调服，淡姜汤送服。损伤索粉（粉丝），用杏仁炒黑，研如脂状，砂糖拌，姜汤服。损伤生冷果菜，宜用木香、砂仁、炮姜、肉桂。损伤螃蟹腹痛者，用丁香、紫苏、生姜。损伤鸡蛋导致满闷，用姜汁、蒜泥。损伤生鱼肉，必用生姜、草果、炮黑山楂。积久生热，口干噫气，用二陈汤加姜汁炒黄连及消导药。
损伤饮酒，《内经》说：大量饮酒会导致气机上逆。酒进入胃中，络脉满盈而经脉空虚。脾主为胃运行津液。如果饱食后行房事，气聚于脾中不得疏散，酒气与谷气相搏，热盛于中，所以热遍全身，内热而小便赤涩。李东垣说：酒是大热有毒之物，气味俱阳，属于无形之物。如果伤了酒，只应当发散，出汗就好了。其次不如利小便，使上下分消湿气。现在的治酒病者，有的用雄黄、巴豆、蝎梢等大热药攻下，或用牵牛、大黄、甘遂等大寒药攻下。这是无形元气受病，反而攻下有形阴血，导致真水更弱，阳毒太旺，反而增加阴火，从而消烁元气，折损寿命。患此病者，不得已才用葛花解酲汤，或五苓散加人参、草豆蔻。如果是伤酒食积发热，用神曲丸。腹满虚胀，合塌气丸。无效，用神保丸、酒症丸，并加酒炒黄连。胃气虚者，上述方法都不可用，唯独参汤助其胃气，立刻苏醒，神验。
喻嘉言说：酒是清冽之物，不随浊秽下行，只喜欢渗入。渗入的部位，先从胃入胆。胆是清净之府，同气相求。然而胆的容纳量很少，其次从胃入肠，膀胱渗泄，化为尿液最多。等到化为尿液，剩下的就是酒的余质，其烈性只有胆独自承受。常见善于饮酒的人，一定浅斟慢酌，以等待腹中的渗透。如果连续狂饮数杯，则倾囊而出（指酒气直冲）。《灵枢》说：怯懦的人喝了酒，愤怒不避勇士，是因为他的气悍烈。进入胃中则胃胀，气上逆满于胸中，肝浮胆横，这个时候，比同于勇士，气衰则后悔，名叫酒悖。胆之府，原本没有输泻通道。善于饮酒的人，胆的热常移于脑，则为鼻渊，或头间多汗，脑热大泄；或注于肠，则大便时溏，湿热下泄，都不为大患。如果胆的热汁满而溢出于外，逐渐渗入经络，则身目皆黄，成为酒疸病，这是因为酒气从渗出的途径转化。转而驱赶纳入膀胱，从溺道消除。
【诊法】气口脉浮大，按之反涩，是有宿食。脉数而滑，是有宿食。脉迟而滑，是宿食作胀。气口脉紧，是寒食停滞胃中，温消而下之。气口脉沉紧而细，是冷食伤脾，温补兼消之。两手脉皆模糊不清，这是宿食结滞，胃气不行，急下夺之。伤食脉有滑涩的不同，脾虚不能鼓运，胃虚不能熟腐，所以其脉不滑而涩。涩甚则模糊不清。如果人迎脉紧盛而气口脉滑，是停食感冒。
许叔微治疗一位嗜酒客，感冒风寒，倦怠不思饮食，已经半个月了。睡后发热，遍身疼痛如被杖击，微恶寒，六脉浮大，按之豁然空软，按极虚受寒治疗，用六君子汤加黄芪、当归、葛根，大剂量给予。五服后遍身汗出如雨，得睡，诸证悉平。
江南仲治疗一人，冬天翻船，尽力救货，忍饥行走五十里，遇到族人纵情饮酒于青楼，于是发热四肢如火，左胁一点疼痛，小便赤涩，五天不大便。医生按伤食治疗，无效。脉弦数无力，气口倍于人迎，这是醉饱竭力伤肝所致。《内经》所谓多次醉饱后行房事，气聚于脾中不得散，酒气与谷气相搏，热盛于中，所以热遍全身，内热故小便赤。酒气悍烈，肾气日衰，阳气胜故手足为之热。给予四君子汤加神曲、枳壳、白芥子，二服热退，调理而愈。
石顽治疗幼科汪五符，夏天伤食，呕吐发热颅胀，自利黄水，遍体肌肉扪之如刺，六脉模糊，指下寻之似有如无，足胫不温，自认阴寒而服五积散，一服其热愈炽，昏卧不省人事。第三日自利不止，而时常谵语，至夜尤甚。其舅叶阳生认为是伤暑，给予香薷饮，遂头面汗出如蒸，喘促不宁，足冷下逆。歙医程郊倩以其证大热而脉息模糊，按之殊不可得，认为是阳欲脱亡之候，欲猛进人参、附子。云间沈明生认为是阴证断无汗出如蒸之理，脉虽虚而证大热，当用人参白虎汤。争持未决，取证于石顽。诊其六脉虽皆涩弱模糊，而心下按之大痛，舌上灰刺如芒，乃食填中宫，不能鼓运其脉，往往多此情况。当与凉膈散下之。诸医正欲藉此脱手，听任我用药。一下而神思大清，脉息顿起。当知伤食之脉，虽当气口滑盛，若屡伤不已，每致涩数模糊，乃脾不消运之兆也。此证设非下夺而与参、附助其壮热，顷刻立毙，可不详慎而妄为施治乎？
又诊叶新宇停食感冒，而两寸关皆涩数模糊，两尺皆沉弦，而按之益坚。虽然其人尚能行走，而脉少冲和。这必定向来有陈气在少腹，询问果然患寒疝数年。因为缓和推辞不便用药。是夜即腹暴满而逝。门人问曰：叶子偶抱小恙，何以知其必死而辞之？曰：凡人胃满则肠虚，肠满则胃虚，更实更虚，其气乃居。今胸有嘏（通“假”，大之意，此处指邪气积聚）而腹有积，上下俱困，能保其不交攻为患乎？当知厥疝入腹，香港脚冲心等疾，皆是阴邪搏结，郁积既久，则挟阴火之势而上升。若胸中阳气有权，则阴邪仍归阴位而止。今胸中先为宿食填塞，腹中陈气不逆则已，逆则上下俱满，正气无容身之地，往往有暴绝之虞。所以不便用药，实未知其即死也。故凡诊六部中病脉有不相应处，即当审其有无宿病，不可轻忽，以招诽谤也。
癸卯年元宵夜，周徐二子，过石顽斋头纵饮。次日皆病酒不能起，欲得葛花汤解酲。我说：李东垣葛花解酲汤，虽为伤酒专剂，然人禀气各有不同。周子纵饮，则面热多渴，这是酒气皆行阳明肌肉之分，多渴知热伤胃气，岂可重令开泄以耗津液？给予四君子汤去甘草加藿香、木香、煨葛根、泽泻，下咽即苏。徐子久患精滑，饮则面色愈青，这是素常肝胆用事，肾气并伤，酒气皆行筋骨，所以不上潮于面。葛花胃药，用之何益？给予五苓散加人参倍肉桂，服后食顷，溲便如皂角汁而安。
The *Neijing* (Inner Canon) states: The five zang organs store essence and qi without discharging, thus their state is full of essence but not solid with waste. The six fu organs transmit and transform substances without storing, thus their state is solid with substances but not full of essence.
Why can the Qi Kou pulse alone serve as the master indicator for the five zang organs? Because the Stomach is the sea of water and grain, and the great source of the six fu organs. The five flavors enter the mouth, are stored in the Stomach to nourish the qi of the five zang organs. The Qi Kou pulse belongs to the Hand Taiyin Lung Meridian (which connects with the Foot Taiyin Spleen Meridian; the qi of the Spleen and Stomach ascends to the Lung, so the Qi Kou can reflect the condition of the Spleen, Stomach, and five zang organs). Therefore, the qi and flavor of the water and grain from the five zang and six fu organs all originate from the Stomach and manifest in changes at the Qi Kou pulse.
The classics state: "The cold and heat of water and grain, if pathogenic factors are contracted, harm the six fu organs." It also says: "Yin qi (referring to the quiet, converging qi within the body), when still, the spirit is preserved; when agitated, it dissipates and perishes. If food and drink intake doubles, the intestines and stomach will be injured." This is a general statement. If analyzed separately, it divides into "drinks" (fluids) and "food" (solids). "Drinks" refer to liquids. Excessive drinking causes qi to rebel upward; exposure to cold combined with drinking cold fluids injures the Lungs. Lung disease manifests as wheezing and coughing, edema and distension, and watery diarrhea. For mild cases, induce sweating and promote urination to drain dampness from above and below. If the condition is severe with accumulation causing fullness, use purgation.
"Food" refers to solid matter. Overeating leads to flaccidity of tendons and vessels, and pathological changes in the Large Intestine resulting in hemorrhoids. If one overeats and then engages in physical labor, it injures the Foot Taiyin Spleen Meridian and Foot Jueyin Liver Meridian. In such cases, the Qi Kou pulse beats two or three times larger than the Ying Shou pulse, or symptoms such as vomiting, epigastric fullness and obstruction, diarrhea, and borborygmus occur. Treatment should be based on the severity of cold or heat. Mild cases are treated by internal resolution and digestion; severe cases by purgation and expulsion. There are also indications for emesis, as stated: "For pathogens located above, induce vomiting to expel them." However, medication must not be excessive, as this will damage the Spleen and Stomach. Since the injury was initially caused by diet, adding excessive medication further damages the Spleen and Stomach, impairing qi transformation and making food harder to digest.
Zhao Yangkui said: Currently, physicians treating food stagnation primarily use Pingwei San (Stomach-Pacifying Powder), modifying it according to circumstances as the standard for regulating the Spleen and Stomach. "Pacifying the Stomach" means flattening any high mounds (referring to food stagnation causing obstruction) in the Stomach. Once flattened, stop medication; do not overdose. Overdosing turns flat ground into depressions (metaphorically damaging Spleen and Stomach function). Zhizhu Wan (Atractylodes and Immature Bitter Orange Pill) is even more effective. Nowadays, people take this pill as a Spleen-tonifying medicine, taking it morning and night, sometimes adding Chenpi (Tangerine Peel), Banxia (Pinellia), Muxiang (Costus Root), and Sharen (Amomum Fruit), which makes the situation worse. As for ShanZha (Hawthorn Fruit), Shenqu (Medicated Leaven), and Maiya (Sprouted Barley), these are commonly used worldwide. ShanZha resolves meat stagnation; for postpartum uterine lochia pain (Erzhen Tong), roasted black ShanZha decocted with rock sugar water can instantly resolve it. ShanZha has properties of resolving stagnation and breaking blood stasis; how can it be used lightly? Shenqu is made by fermenting rice and water in porcelain jars using yeast to make wine, or using molds to make sugar. The human Spleen and Stomach are not like porcelain jars; they inherently possess the ability to digest food. When food does not digest, it is because this ability is diseased. One need only support its function, and food will digest naturally. Why use drugs that consume and suppress? Generally, individuals with robust Yuanqi (Original Qi) can eat much without injury and feel hungry only after the appropriate time. If a person already has insufficient fundamental qi, leading to dietary injury, using the aforementioned resolving drugs may clear the food, but since the Spleen and Stomach are already injured, this process of digestion further depletes their deficiency. Food will stagnate again the next day, yet one might mistakenly believe the previous medicine was effective but insufficient in dosage, leading to concurrent use of decoctions and pills, causing mutual harm and increasing emaciation. This is truly lamentable.
Li Dongyuan discussed diet and overwork as conditions of internal injury and deficiency. Wang Andao classified dietary injury as an excess condition, advocating resolution and guidance therapies. Li Dongyuan had formulas such as Zhizhu Wan; overwork injury is deficiency, for which he established Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For food stagnation syndromes, presenting with chest and diaphragm oppression, vomiting and acid regurgitation, belching with rotten egg odor, aversion to eating, headache, fever, and aversion to wind, resembling Taiyang disease (Exterior Syndrome), but with the Qi Kou pulse larger than the Ying Shou pulse and no body pain, the treatment should be to resolve phlegm and transport the Spleen, using Erchen Tang (Two-Aged Decoction) plus Zhishi (Immature Bitter Orange), Baizhu (Atractylodes Macrocephala), Shenqu, Maiya, ShanZha, and Xiangfu (Cyperus Rhizome). If accompanied by qi stagnation with a deep pulse, add Muxiang and Qingpi (Green Tangerine Peel). For food retention complicated by exterior contraction, use Xiong Su San (Ligusticum and Perilla Powder) plus one or two resolving herbs. For food stagnation in the middle jiao with chest oppression, belching, fever, headache, resembling exterior patterns, use Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi). If there is no bowel movement for seven to eight days, dry mouth, irritability, hardness and pain above the umbilicus, use Zhishi Daohi Wan (Immature Bitter Orange Pill to Guide Out Stagnation). If忧思 (worry/thought), qi stagnation, food retention, and dampness bind in the middle jiao, causing fever, slight pain under the abdominal skin, epigastric fullness, anorexia, undigested food, and chronic qi obstruction, use Muxiang Huazhi Tang (Costus Root Decoction to Transform Stagnation). For food accumulation with fullness, emaciation, and fever, use Baohe Wan (Preserve Harmony Pill). If deficient, add 60g of Baizhu to name Da'an Wan (Great Peace Pill) for regulation. For food stagnation in the epigastrium, early stage treatment should not abruptly use bitter-cold herbs; it must combine acrid-dispersing herbs. Use Erchen Tang and Pingwei San for resolution, along with Zhishi, Baizhu, Qingpi, Chenpi, ShanZha, Shenqu, and Maiya. Food coagulates with cold and rots with heat. For long-standing accumulation generating heat, add Chuanlian (Coptis Rhizome stir-fried with ginger juice) and Lianqiao (Forsythia Fruit) to clear and drain. If it has become fecal matter, generated heat over time, and is dry and obstructed, only then can Chengqi Tang (Gut-Regulating Decoction) types be used for purgation. For cold items stagnating causing vomiting, use Erchen Tang plus Paojiang (Roasted Ginger), Baidoukou (White Cardamom), Cangzhu (Atractylodes Lancea), Houpo (Magnolia Bark), Shenqu, and Huoxiang (Patchouli). For severe cases, add Ezhu (Curcuma Zedoaria) or Badou (Croton Seed). For cold food retention causing sudden heart and abdominal pain and distension, use Hongwanzi (Red Pill) or Beiji Wan (Emergency Pill) for warm purgation. For phlegm-fluid accumulation preventing food intake, or cold phlegm and old food in the upper jiao, use Baisan (White Powder) for emesis. After phlegm and food are resolved but the middle jiao is unharmonized, with anorexia, vomiting or diarrhea, fatigue, and sallow complexion, with softness upon pressing the epigastrium, indicating Spleen and Stomach injury, use Liujunzi Tang (Six-Gentlemen Decoction) plus Muxiang and Sharen. For dry thirst, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder). The elderly and deficient individuals are prone to dietary injury, presenting with bloating and oppression, or abdominal fullness with diarrhea; treatment should combine resolution and tonification, preferably Jiwei Zisheng Wan (Nine-Ingredient Nourishing Life Pill) taken regularly. For bland taste with desire to eat but lack of enjoyment, aversion after eating, nausea, and chest discomfort, indicating Stomach deficiency with phlegm-fluid, use Liujunzi Tang plus Zhishi, Xiang, and Sha. For anorexia, inability to digest, and postprandial fullness due to Spleen deficiency failing to transport, use Zhishi Lizhong Wan (Immature Bitter Orange Pill to Regulate the Middle). Post-illness dietary irregularity causing vague epigastric pain, relieved by eating sometimes but worsened by eating other times, indicates burning pain in the Stomach where food suppresses the fire, providing temporary relief. If slightly overeating impairs qi movement, worsening pain, use Liantang (Coptis Decoction) plus Chenxiang (Aquilaria Wood). The *Ling Shu* states: "When the Stomach is full, the Intestines are empty; when the Intestines are full, the Stomach is empty. Alternating fullness and emptiness allows qi to reside." If overindulgence in food and drink, or exposure to wind-cold, or emotional anger causes blockage in the chest, stopping Stomach qi, sudden reversal coma occurs, with inability to speak or move limbs. This is called Food Reversal (Shi Jue). Misdiagnosing as Wind Stroke or Qi Strike will lead to death. Induce vomiting with Ginger-Salt Decoction. For wind-cold, use Huoxiang Zhengqi San; for qi stagnation, use Bawei Shunqi San (Eight-Gentlemen Smooth Qi Powder). After vomiting, if no other symptoms remain, regulate with Cangzhu, Baizhu, Chenpi, Houpo, and Gancao. For such acute conditions, one must inquire carefully: was it recent overeating or drunkenness? If chest oppression, phlegm-saliva congestion, and tight Qi Kou pulse are present, treat as food stagnation.
For injury from various meats, use Caoguo (Black Cardamom) and ShanZha. If complicated by exterior wind-cold, roast ShanZha with ginger juice until black to avoid sour-astringent properties, allowing it to break blood stasis and harmonize injury, accelerating food resolution. For noodle injury, use fried Radish Seed (Laifuzi). For wheat-gluten dumplings etc., which other drugs cannot digest, mix the original substance with Lvfan (Green Vitriol), burn to ash, and administer with rock sugar wine; effective in two to three doses. For sticky rice powder injury, use fried Jiuyao (Wine Yeast) or Jiuyu (Wine Qu), mixed with rock sugar, taken with light Ginger Decoction. For vermicelli injury, use fried black Apricot Kernel, ground to paste, mixed with rock sugar, taken with Ginger Soup. For raw/cold fruits and vegetables, use Muxiang, Sharen, Paojiang, and Rougui (Cinnamon Bark). For crab-induced abdominal pain, use Dingxiang (Clove), Zisu (Perilla Leaf), and Shengjiang (Fresh Ginger). For egg-induced fullness, use Ginger Juice and Garlic Paste. For raw fish/meat injury, essential use is Shengjiang, Caoguo, and roasted black ShanZha. Long-term accumulation generates heat, dry mouth, and belching; use Erchen Tang plus ginger-stir-fried Chuanlian and resolving herbs.
Alcohol Injury: The Classics state: "Excessive drinking causes qi rebellion." Alcohol enters the Stomach, filling collateral vessels while emptying main vessels. The Spleen governs transporting fluids for the Stomach. If intercourse follows a full meal, qi gathers in the Spleen and cannot disperse. Alcohol qi battles grain qi, generating intense heat in the center, spreading throughout the body, causing internal heat and red urine. Li Dongyuan said: Alcohol is extremely hot and toxic, with yang qi and flavor, belonging to formless substances. If alcohol is injured, one should only disperse it; sweating cures it. Alternatively, promote urination to drain dampness from above and below. Current practitioners treat alcohol sickness with hot purgatives like Xionghuang (Realgar), Badou, or Xieshao (Scorpion Tail), or cold purgatives like Qianni (Artemisia Seed), Dahuang (Rhubarb), or Gansui (Kansui Root). This treats formless Yuanqi pathology by purging有形 (form-yin) blood, weakening True Water, intensifying Yang toxin and Yin Fire, consuming Yuanqi and shortening life. In desperate cases, use Ge Hua Jie Cheng Tang (Kudzu Flower Decoction to Resolve Intoxication) or Wuling San (Five-Ingredient Powder with Poria) plus Renshen (Ginseng) and Caodoukou (Cardamom). For alcohol-food stagnation generating heat, use Shenqu Wan. For abdominal fullness and false distension, use Hetanqi Wan. If ineffective, use Shenbao Wan or Jiu Zheng Wan, adding wine-stir-fried Huanglian (Coptis). For Stomach qi deficiency, the above methods are contraindicated; only Renshen Decoction to boost Stomach qi works instantly and miraculously.
Yu Jiayan said: Alcohol is clear and pure, not descending with turbid waste, but preferring to infiltrate. Infiltration starts from Stomach to Gallbladder. The Gallbladder is a clean vessel, seeking similar qi. However, Gallbladder capacity is small; next, it goes from Stomach to Intestines, and Bladder渗 (seeps) it, converting most to urine. By the time converted to urine, only residual alcohol quality remains, whose potency is borne solely by the Gallbladder. Good drinkers sip slowly to allow abdominal infiltration. Rapid heavy drinking pours it out directly. The *Ling Shu* states: Cowardly persons drinking wine become angry and do not avoid brave warriors because their qi is fierce. Entering the Stomach causes gastric distension, qi rebelling upward to fill the chest, Liver floating and Gallbladder horizontal, resembling bravery, but regretting later when qi fades. This is called Wine Insanity (Jiu Bei). The Gallbladder originally has no output channels. Good drinkers' Gallbladder heat often transfers to the Brain, causing Nasal Sinusitis (Bi Yuan), excessive head sweating, or brain heat leakage; or flows to Intestines causing loose stools. These damp-heat downward discharges are not major issues. If Gallbladder hot bile overflows externally and seeps into collaterals, causing jaundice (Jiu Dan), it is eliminated via渗 (seepage) or driven to Bladder for urinary excretion.
[Diagnosis] Qi Kou pulse floating and large, but rough upon pressure, indicates retained food. Pulse rapid and slippery indicates retained food. Pulse slow and slippery indicates retained food causing distension. Tight Qi Kou pulse indicates cold food stagnation in Stomach; treat with warm resolution and purgation. Deep, tight, and thin Qi Kou pulse indicates cold food injuring Spleen; treat with warm tonification and resolution. Both hands' pulses blurred and unclear indicate retained food binding and Stomach qi stagnation; urgently purge. Dietary injury pulses vary between slippery and rough. Spleen deficiency fails to propel, Stomach deficiency fails to ripen, so the pulse is rough rather than slippery. Severe roughness becomes blurred. If Ying Shou is tight and full while Qi Kou is slippery, it is food retention with exterior contraction.
Xu Shumi treated a wine drinker with wind-cold contraction, fatigue, anorexia for half a month. Fever after sleep, body pain like being beaten, slight aversion to cold, six pulses floating and large but hollow upon pressure. Treated as extreme deficiency with cold invasion using Liujunzi Tang plus Huangqi (Astragalus), Danggui (Angelica Sinensis), and Gegen (Kudzu Root) in large doses. After five doses, profuse sweating occurred, sleep was achieved, and all symptoms resolved.
Jiang Nanzhong treated a man who capsized in winter, worked hard to save cargo, walked fifty li fasting, then drank heavily at a brothel. He developed fever, burning limbs, left hypochondriac pain, red scanty urine, and constipation for five days. Doctors treated as food stagnation without effect. Pulse was wiry, rapid, and forceless; Qi Kou was double the Ying Shou. This was Liver injury from drunkenness, overeating, and exertion. As stated in Neijing: frequent drunkenness and intercourse gather qi in Spleen, unable to disperse; alcohol and grain qi battle, generating central heat, spreading body heat, internal heat causing red urine. Alcohol qi is fierce, Kidney qi declines daily, Yang dominance causes hot extremities. Prescribed Sijunzi Tang plus Shenqu, Zhike (Bitter Orange), and Baijiezi (White Mustard Seed). Heat subsided after two doses, cured with regulation.
Shi Wan treated pediatric patient Wang Wufu. Summer food stagnation with vomiting, fever, cranial distension, spontaneous yellow diarrhea, prickly sensation on body muscles, six pulses blurred, faint upon palpation, cold lower legs/shins. Patient self-diagnosed as Yin-Cold and took Wuji San (Five Accumulations Powder); heat intensified after one dose, coma ensued. Third day: continuous diarrhea, delirium, worse at night. Uncle Ye Yangsheng diagnosed Summerheat, gave Xiangru Yin (Elsholtzia Decoction); head/face sweat like steaming, panting, cold feet with reverse flow. Physician Cheng Jiaoqian from She saw great heat with blurred/inaccessible pulses, suspected Yang collapse, wanted to aggressively use Renshen and Fuzi (Aconite). Shen Mingsheng from Yunjian argued Yin syndrome never presents with steaming sweat; though pulse deficient, syndrome is great heat, should use Renshen Baitu Tang (Ginseng and White Tiger Decoction). Dispute unresolved, referred to Shi Wan. Pulses were rough, weak, blurred, but severe pain on epigastric pressure, gray thorny coating on tongue. This was food filling the middle jiao, failing to propel pulses. Prescribed Liangge San (Cool the Diaphragm Powder) for purgation. Physicians agreed. One dose cleared consciousness, pulses revived. Note: Food stagnation pulses are typically slippery/full at Qi Kou, but repeated injury causes rough/rapid/blurred pulses, indicating Spleen failure to transport. Without purgation here, and using Renshen/Fuzi to aid heat, death would be instant. Careful diagnosis is essential.
Another case: Ye Xinyu with food stagnation and exterior contraction. Cun and Guan pulses rough, rapid, blurred; Chi pulses deep and wiry, firm upon pressure. Patient could walk, but pulse lacked harmony. History of chronic Cold Hernia (Han Shan) in lower abdomen. Declined treatment due to mild presentation. Died that night from sudden abdominal fullness. Disciple asked why predict death. Answer: Stomach full/Intestine empty alternation maintains qi. Now chest has evil accumulation and abdomen has stagnation, both trapped. Can we ensure they don't attack each other? Know that Jue Hernia entering abdomen or Leg Ulcer rushing to Heart are Yin evil knots. Long stagnation carries Yin Fire upward. If Chest Yang is strong, Yin evil stays in Yin positions. Now Chest filled with old food, Abdominal stale qi rebels, filling top and bottom, leaving no room for Righteous Qi, risking sudden death. Hence declined treatment, unaware of imminent death. Thus, when six-pulse diagnosis shows mismatch, always check for chronic diseases. Do not neglect, inviting slander.
Gui Mao Lantern Festival evening, Zhou and Xu drank excessively at Shi Wan's residence. Next day, both suffered alcohol intoxication, unable to rise, wanting Ge Hua Tang. I said: Li Dongyuan's Ge Hua Jie Cheng Tang is specific for alcohol injury, but constitutions differ. Zhou's face heat and thirst indicate alcohol qi moving through Yangming muscle layers; thirst shows heat injuring Stomach qi. Cannot use opening/dispersing drugs to consume fluids. Prescribed Sijunzi Tang minus Gancao, plus Huoxiang, Muxiang, Wei Gegen (Roasted Kudzu), and Zexie (Alisma). Revived immediately. Xu had chronic seminal emission, face turned green after drinking, indicating chronic Liver/Gallbladder dominance and Kidney injury, alcohol qi moving through sinews/bones, not rising to face. Ge Hua Stomach drug is useless here. Prescribed Wuling San plus Renshen and doubled Rougui. After eating time, urine resembled soap pod juice, and he recovered.