人之一身，脾胃为主。胃阳主气，脾阴主血，胃司受纳，脾司运化，一纳一运，化生精气，津液上升，
糟粕下降，斯无病矣。人惟饮食不节，起居不时，损伤脾胃。胃损则不能纳，脾损则不能化，脾胃俱损，
纳化皆难，元气斯弱，百邪易侵，而饱闷、痞积、关格、吐逆、腹痛、泄痢等症作矣。况人与饮食，岂能一一
节调，一或有伤，脾胃便损，饮食减常，元气渐惫矣。故洁古制枳术之丸，东垣发脾胃之论，使人常以调理
脾胃为主，后人称为医中王道，厥有旨哉！近世论治脾
胃者，不分阴阳气血，而率皆理胃所用之药，又皆辛温燥热助火消阴之剂，遂致胃火益旺，脾阴愈伤，清纯
中和之气，变为燥热，胃脘干枯，大肠燥结，脾脏渐绝，而死期迫矣。殊不知脾胃属土属湿，位居长夏，故
湿热之病十居八九，况土旺四季，寒热温凉各随其时，岂可偏用辛热之剂哉！今举枳术丸方，立加减法
于后。
白术（二两） 枳实（一两，麸炒）
上为细末，荷叶包饭烧取出，杵烂和药，杵匀，丸绿豆大。每服五、六十丸，清米汤下。此法一补一
消，取饮食缓化，不令有伤。东垣加陈皮一两，名枳术橘丸，治老幼元气衰弱，饮食少进，久服令人多
食而不伤。
愚按经云，脾为消化之器，熏蒸腐熟五谷者也。若饮食自倍，肠胃乃伤，则不能运化其精
微，故嗳气、吞酸、胀满、痞闷之症作矣。故用此丸消之，实非专主补养。若脾胃虚弱者，宜用四君
子汤；脾胃虚寒者，宜用四君子加炮姜；命门火衰者，用八味丸。
廷评张汝翰，饮食难化，服枳术丸，体瘦，发热，脉浮大。余以为命门火衰，而脾胃虚寒，用八味
丸，不月而饮食进，三月而形体充。
工部陈禅亭患前症，服消导之药益甚。余曰∶此火衰而不能生土，故脾病也。当益火则土自实而脾安
矣。不悟，仍服前药，后遂殁。
若元气素弱，饮食难化，食多即腹内不和，疼痛，泄泻，此虚寒也，加人参、白芍药（酒炒）、
神曲（炒）、大麦芽（炒杵去皮）一两。
愚按前方乃饮食所伤之治法也。东垣先生云∶亦有六淫而致泻者，有七情而致泻者，又有饮食所伤而
致泻者，有因胃气下流而致泄者，有因风而成飧泄者，有因痰积于上焦，以致大肠不固而泄者，有因脾胃
气虚而泄者。治法∶外淫所伤，当调六气；七情所伤，当平五脏；饮食所伤，当消停滞；胃气下流，当
升举之；因风而成，当解散之；痰积于上焦，当去其痰，而不治其泄；脾胃气虚者，当补益之。
丹溪先生谓饮食毕而肠鸣、腹痛、泻尽食物者，脾虚食泻，用理中汤加炮姜；攻刺腹痛，洞下水谷，名
寒泻，用理中汤送大戊己丸，寒甚者附子桂香丸，恶食者八物汤；粪色青黄，肛门痛，烦躁作渴，小便不
利者，名热泻，用五苓散、香连丸；泻而恶食，而气噫腐臭者，名食泻，治中汤加砂仁，或送感应丸。
金宪高如斋，饮食难化，腹痛，泄泻，用六君子加砂仁、木香治之而痊，后复作完谷不化，腹痛，头
疼，体重困倦。余以为脾虚受湿，用芍药防风汤而愈。
太仆杨举元，先为饮食停滞，小腹重坠，用六君子加升麻、柴胡渐愈，后饮食难化，大便不实，里急
后重，数至圊而不得，用升阳除湿防风汤而痊，后心腹作痛，饮食不甘，用和中丸倍加益智仁而寻愈。
光禄杨立之，元气素弱，饮食难化，泄泻不已，小便短少，洒淅恶寒，体重节痛。余以为脾肺虚，
用升阳益胃汤而痊。大凡泄泻服分利调补等剂不应者，此肝木郁于脾土，必用升阳益胃之剂，庶能保
生。其五脏胜负所致者，见第二卷泄泻各条下。
若素有痰火，胸膈郁塞，咽酸噎气，及素有吞酸吐酸之症，或有酒积，泄泻结痛，此皆湿热也，加
黄连（姜汁炒）、白芍药（酒炒）、陈皮各一两，石膏、生甘草各五钱，缩砂、木香各一钱，川芎四钱。
愚按前症吐酸吞酸，大略不同。吐酸者，湿中生热；吞酸者，虚热内郁。皆属脾胃虚寒，中传末症。
故《内经》以为火者，指其病形而言也；东垣以为胃寒者，指其病本而言也。凡患此者，先当辨其
吞吐，而治以固本元为主。若服寒凉，复伤胃气，则实实虚虚者矣。更审其脾气虚而饮食不能输化，
浊气不能下降者，须用六君子汤补养脾胃为主，少佐越鞠丸以清中。故东垣先生云，邪热不杀谷。
若误认为实热，而妄用寒凉，必变败症。
若伤食饱闷痞塞不消，加神曲、麦芽、山楂各一两；有食积痞块在腹者，再加黄连、浓朴（俱姜制）
各五钱；
积坚者，再加蓬术（醋煮）、昆布各三钱。
愚按前症若脾胃素实，止因倍食暴伤而患者，宜用前药，否则慎用也。东垣云∶脾胃之气壮，则多食
而不伤，过时而不饥。前症若因脾气虚弱，不能腐化者，宜培补之；若脾胃虚寒者，宜温养之；若命门火
衰者，宜温补之。大凡食积痞块症为有形，所谓邪气胜则实，真气夺则虚，惟当养正则邪积自除矣。虽云
坚者削之，客者除之，若胃气未虚，元气尚实，乃可用也。或病久虚羸，或元气素弱者，亦当固本为主，
而佐用前法，不然反致痞满不食、而益其病矣。然古人立法，皆备其常也，而为按图索骥可乎？学人推此
而用，其庶几乎！
若伤冷食不消，腹痛，溏泄，加半夏（姜制）一两，缩砂、干姜、神曲（各炒）、大麦芽各五钱。
愚按前症若伤性热之物者，用二陈加黄连、山楂；伤湿面之物者，用二陈加神曲、麦芽；伤米食者，用
六君加谷 ；伤面食者，用六君加麦 ；伤肉食者，用六君加山楂；伤鱼腥者，用六君倍加陈皮；伤角黍炊
饭者，用六君倍加酒曲；若物已消而泻未愈者，此脾胃受伤也，宜用六君子汤；若饮食减少，或食而难化
者，属脾胃虚寒也，加炮姜、木香、肉果，不应加五味、吴茱、骨脂；脾肾虚寒者，须服八味丸，否则
多患脾虚中满之症。其神曲、麦芽，虽助戊土，以腐熟
水谷，麦芽一味，余尝以治妇人丧子，乳房胀痛欲成痈者，用一、二两炒熟，煎服即消，
其破血散气可知矣。丹溪云麦芽消肾，《妇人良方》云神曲善下胎，皆克伐之功多而补益之功少，
亦不宜轻用。
唐仪部胸内作痛月余，腹亦痛，左关弦长，右关弦紧，面色黄中见青。此脾胃虚弱，肝邪所乘，以
补中益气汤加半夏、木香，二剂而愈；又用六君子汤，二剂而安。
李仪部常患腹痛，余以补中益气汤加山栀即愈。一日因怒，肚腹作痛，胸胁作胀，呕吐不食，肝脉弦
紧，面色青黄。此肝乘脾也，仍用补中益气吞左金丸，一服即愈。
若人性多气恼，夹气伤食，气滞不通，加川芎、香附（炒）各七钱，木香、黄连（姜炒）各五钱。
愚按前症若因中气虚弱，不能营运者，宜用六君子加山栀、木香；如不应，送保和丸。
太守朱阳山，因怒腹痛作泻，或两胁作胀，或胸乳作痛，或寒热往来，或小便不利，或饮食不入，呕
吐痰涎，神思不清。此肝木乘脾土，用小柴胡加山栀、炮姜、茯苓、陈皮、制黄连，一
剂即愈。（制黄连，即黄连、吴茱萸等分，用熟水拌湿，罨二、三日，同炒焦，取黄连。后仿此。）
阳山之内，素善怒，胸膈不利，吐痰甚多，吞酸嗳腐，饮食少思，手足发热，所服非芩、连、枳实，
必槟、苏、浓朴。左关弦洪，右关弦数。余以为肝火血燥，木乘土位也。朝用六味地黄丸，以滋养
肝木，夕用六君子加当归、芍药，以调补脾土，不月而愈。后因恚怒，前疾复作，或用二陈加石膏，服
之吐涎如涌，外热如灼，脉洪大按之如无。余曰∶脾主涎，乃脾损发热而涎泛溢也。用六君子加姜、
桂，一服即睡觉，而诸症顿失，又数剂而康。若服理气化痰等药，必变腹胀、喘促、腿浮膝肿、
淋沥等症，急用济生加减肾气丸救之，多有得生者。详见各方。
若胸膈不利，过服辛香燥热之药，以致上焦受伤，胃脘干燥，呕吐，噎膈，反胃，加黄连（姜炒）、山
栀仁（炒）各五钱，白芍药、当归各一两，桔梗、生甘草、石膏各三钱。胸膈顽痰胶结，及大便
燥秘，再加芒硝五钱。
愚按王安道先生曰∶内膈呕逆，食不得入，是有火也；若病而吐，食入反出，是无火也。治法∶
若脾胃气虚而胸膈不利者，用六君子汤壮脾土生元气；若辛热之剂而呕吐噎膈者，用四君子加芎、
归，益脾土以抑阴火；胃火内格而饮食不入者，用六君子加芩、连清热养胃；若病呕吐，食入而反
出者，用六君子加木香、炮姜温中补脾；若服耗气之剂，血无所生，而大便燥结者，用四君子加芎、
归补脾生血；若火逆冲上，食不得入者，用四君子加山栀、黄连清热养血；
若痰饮阻滞而食不得入者，用六君子加木香、山栀补脾化痰；若脾胃虚寒，饮食不入或入而不化者，用六
君子加木香、炮姜温补脾胃。更非慎房劳、节浓味、调饮食者，不治；年高无血者，亦不治。
一男子，食少胸满，手足逆冷，饮食畏寒，发热，吐痰，时欲作呕。自用清气化痰之剂，胸腹愈
胀，呼吸不利，吐痰，呕食，小便淋漓，又用五苓散之类，小便不利，诸病益甚。余曰∶此脾土虚寒无火
之症，故食入不消而反出，非气膈所致。遂用八味丸、补中益气，加半夏、茯苓、姜、桂，旬日乃愈。
秀才杨君爵，年将五十，胸痞，少食，吐痰，体倦，肌肉消瘦。所服方药，皆耗气、破血、
化痰、降火。余曰∶此气郁所伤，阳气不能升越，属脾经血虚之症，当用归脾汤解郁结、生脾血，用补
中益气壮脾气、生发诸经，否则必为中满气膈之患。不信，仍服前药，后果患前症而殁。
若素有痰火者，加半夏（姜炒）、橘红、白茯苓各一两，黄芩（炒）、黄连（姜炒）各五钱。
愚按前症亦有因脾气不足者，有因脾气郁滞者，有因脾肺之气亏损者，有因肾阴虚不能摄水泛而
似痰者，有因脾气虚不能摄涎上溢而似痰者，有因热而生痰者，有因痰而生热者，有因风寒暑湿而得者，
有因惊而得者，有因气而得者，有因酒而得者，有因食积而得者，有脾虚不能运化而生者，有胸中痰郁而
似鬼附者，各审其原而治之。
若人能食好食，但食后反饱难化，此胃火旺脾阴虚也，加白芍药（酒炒）一两五钱，人参七钱，
石膏（火 ）一两，生甘草五钱，黄连（炒）、香附（炒）、木香各四钱。
愚按东垣先生云∶胃中元气盛，则能食而不伤，过时而不饥；脾胃俱旺，则能食而肥；脾胃俱虚，不
能食而瘦，或少食而肥，虽肥而四肢不举。又有善食而瘦者，胃中火邪于气分，则能食而肉削。今能食而难
化者，脾气虚弱，不能腐化水谷，故前药不应。或热渴呕吐，或腹胀泄泻等症者，乃是脾胃复伤，急用六
君子加芍药、木香、炮姜补之。亦有属脾气郁结者，当解郁健脾，若用清凉降火，以致中气虚痞而不食，或
食而食反出，又以为膈噎用行气化痰者，必不能疗也。
若年高人脾虚血燥，易饥易饱，大便燥难，用白芍药、当归各一两，人参七钱，升麻、甘草（炙）各四钱。
山楂、大麦芽、桃仁（去皮尖另研）各五钱。此老人常服药也。
愚按前症属形气、病气俱不足，脾胃虚弱，津血枯涸，而大便难耳！法当滋补化源。又有脾约症，成
无己云，胃强脾弱，约束津液不得四布，但输膀胱，小便数而大便难者是也，宜用脾约丸。阴血枯槁，内
火燔灼，肺金受邪，土受木克，脾肺失传，大便秘而小
便数者，宜用润肠丸。病气有余之治法也。经云脾为至阴，己土而主阴。然老弱之人，当补中益气以生阴血。
职方陈莪斋，年逾六旬，先因大便不通，服内疏等剂后，饮食少思，胸腹作胀，两胁作痛，形体倦
怠，两尺浮大，左关短涩，右关弦涩，时五月。此乃命门火衰，不能生脾土，而肺金又克肝木，决其金旺
之际不起，后果然。
一老妇，痰喘内热，大便不通，两月不寐。此肝肺肾亏损。朝用六味丸，夕用逍遥散，各三十余剂，
计所进饮食百余碗，腹始痞闷，乃以猪胆汁导而通之，用十全大补汤调理而安。若间断前药，饮食不
进，诸症复作。
人的全身，以脾胃为核心。胃阳主导气机，脾阴主导血液，胃负责接受和容纳食物，脾负责消化和转运，一纳一运，化生精气和津液，津液向上输布，糟粕向下排泄，这样就没有疾病了。人之所以生病，只是因为饮食没有节制，起居没有规律，损伤了脾胃。胃受损就不能受纳，脾受损就不能运化，如果脾胃都受损，受纳和运化都困难，元气就会虚弱，各种邪气容易入侵，于是饱胀、痞块积聚、关格（大小便不通）、呕吐逆气、腹痛、泄泻痢疾等症状就发作了。况且人与饮食之间，怎么能一一做到节制调节呢？一旦有损伤，脾胃就会受损，饮食减少，元气逐渐疲惫。所以金元四大家之一的张元素（洁古）制作了枳术丸，李东垣阐发了关于脾胃的论述，让人常以调理脾胃为主，后人称之为“医中王道”，这确实是有深意的！近代讨论治疗脾胃的人，不分阴阳气血，而一概使用理胃的药物，又都是辛温燥热、助火伤阴的药剂，导致胃火更加旺盛，脾阴更加受伤，清纯中和之气，变成了燥热，胃脘干枯，大肠燥结，脾脏逐渐衰竭，死亡的日子就近了。却不知道脾胃属土、属湿，位居长夏季节，所以湿热病十有八九，况且土旺于四季，寒热温凉各随其时，怎么可以偏用辛热药剂呢！现在列举枳术丸方剂，在后面立下加减法。
白术（二两） 枳实（一两，麸皮炒）
以上药物研成细末，用荷叶包裹米饭烧熟取出，捣烂与药粉混合，捣匀，制成如绿豆大小的丸药。每次服用五六十丸，用清米汤送服。这种方法一补一消，取饮食缓慢消化的意思，不让身体受到伤害。李东垣加入陈皮一两，名为枳术橘丸，治疗老人小孩元气衰弱，饮食少进，长期服用让人多吃而不受伤。
我按语：经典说，脾是消化的器官，熏蒸腐熟五谷的。如果饮食加倍，肠胃就会受伤，那么就不能运化其中的精微物质，所以嗳气、吞酸、胀满、痞闷等症状就发作了。所以用这个丸药来消除积滞，实在不是专门主司补养。如果脾胃虚弱者，宜用四君子汤；脾胃虚寒者，宜用四君子汤加炮姜；命门火衰者，用八味丸。
廷评张汝翰，饮食难以消化，服用枳术丸后，身体消瘦，发热，脉象浮大。我认为这是命门火衰，而脾胃虚寒，用八味丸，不到一个月饮食就增进，三个月身体就充实了。
工部陈禅亭患前症，服用消导药物后病情加重。我说：这是火衰而不能生土，所以是脾病。应当益火则土自实而脾安矣。他不醒悟，仍然服用前药，后来就去世了。
如果元气素来虚弱，饮食难以消化，吃多即腹内不和，疼痛，泄泻，这是虚寒，加人参、白芍药（酒炒）、神曲（炒）、大麦芽（炒杵去皮）各一两。
我按语：前方乃是饮食所伤的治法。李东垣先生说：也有六淫外邪导致腹泻的，有七情内伤导致腹泻的，又有饮食所伤导致腹泻的，有因胃气下流导致泄泻的，有因风邪而成飧泄的，有因痰积于上焦，以致大肠不固而泄的，有因脾胃气虚而泄的。治法：外淫所伤，当调六气；七情所伤，当平五脏；饮食所伤，当消停滞；胃气下流，当升举之；因风而成，当解散之；痰积于上焦，当去其痰，而不治其泄；脾胃气虚者，当补益之。
丹溪先生谓饮食毕而肠鸣、腹痛、泻尽食物者，脾虚食泻，用理中汤加炮姜；攻刺腹痛，洞下水谷，名寒泻，用理中汤送大戊己丸，寒甚者附子桂香丸，恶食者八物汤；粪色青黄，肛门痛，烦躁作渴，小便不利者，名热泻，用五苓散、香连丸；泻而恶食，而气噫腐臭者，名食泻，治中汤加砂仁，或送感应丸。
金宪高如斋，饮食难化，腹痛，泄泻，用六君子加砂仁、木香治之而痊，后复作完谷不化，腹痛，头疼，体重困倦。余以为脾虚受湿，用芍药防风汤而愈。
太仆杨举元，先为饮食停滞，小腹重坠，用六君子加升麻、柴胡渐愈，后饮食难化，大便不实，里急后重，数至圊而不得，用升阳除湿防风汤而痊，后心腹作痛，饮食不甘，用和中丸倍加益智仁而寻愈。
光禄杨立之，元气素弱，饮食难化，泄泻不已，小便短少，洒淅恶寒，体重节痛。余以为脾肺虚，用升阳益胃汤而痊。大凡泄泻服分利调补等剂不应者，此肝木郁于脾土，必用升阳益胃之剂，庶能保生。其五脏胜负所致者，见第二卷泄泻各条下。
若素有痰火，胸膈郁塞，咽酸噎气，及素有吞酸吐酸之症，或有酒积，泄泻结痛，此皆湿热也，加黄连（姜汁炒）、白芍药（酒炒）、陈皮各一两，石膏、生甘草各五钱，缩砂、木香各一钱，川芎四钱。
我按语：前症吐酸吞酸，大略不同。吐酸者，湿中生热；吞酸者，虚热内郁。皆属脾胃虚寒，中传末症。故《内经》以为火者，指其病形而言也；东垣以为胃寒者，指其病本而言也。凡患此者，先当辨其吞吐，而治以固本元为主。若服寒凉，复伤胃气，则实实虚虚者矣。更审其脾气虚而饮食不能输化，浊气不能下降者，须用六君子汤补养脾胃为主，少佐越鞠丸以清中。故东垣先生云，邪热不杀谷。若误认为实热，而妄用寒凉，必变败症。
若伤食饱闷痞塞不消，加神曲、麦芽、山楂各一两；有食积痞块在腹者，再加黄连、浓朴（俱姜制）各五钱；积坚者，再加蓬术（醋煮）、昆布各三钱。
我按语：前症若脾胃素实，止因倍食暴伤而患者，宜用前药，否则慎用也。东垣云∶脾胃之气壮，则多食而不伤，过时而不饥。前症若因脾气虚弱，不能腐化者，宜培补之；若脾胃虚寒者，宜温养之；若命门火衰者，宜温补之。大凡食积痞块症为有形，所谓邪气胜则实，真气夺则虚，惟当养正则邪积自除矣。虽云坚者削之，客者除之，若胃气未虚，元气尚实，乃可用也。或病久虚羸，或元气素弱者，亦当固本为主，而佐用前法，不然反致痞满不食、而益其病矣。然古人立法，皆备其常也，而为按图索骥可乎？学人推此而用，其庶几乎！
若伤冷食不消，腹痛，溏泄，加半夏（姜制）一两，缩砂、干姜、神曲（各炒）、大麦芽各五钱。
我按语：前症若伤性热之物者，用二陈加黄连、山楂；伤湿面之物者，用二陈加神曲、麦芽；伤米食者，用六君加谷芽；伤面食者，用六君加麦芽；伤肉食者，用六君加山楂；伤鱼腥者，用六君倍加陈皮；伤角黍炊饭者，用六君倍加酒曲；若物已消而泻未愈者，此脾胃受伤也，宜用六君子汤；若饮食减少，或食而难化者，属脾胃虚寒也，加炮姜、木香、肉果，不应加五味、吴茱、骨脂；脾肾虚寒者，须服八味丸，否则多患脾虚中满之症。其神曲、麦芽，虽助戊土，以腐熟水谷，麦芽一味，余尝以治妇人丧子，乳房胀痛欲成痈者，用一、二两炒熟，煎服即消，其破血散气可知矣。丹溪云麦芽消肾，《妇人良方》云神曲善下胎，皆克伐之功多而补益之功少，亦不宜轻用。
唐仪部胸内作痛月余，腹亦痛，左关弦长，右关弦紧，面色黄中见青。此脾胃虚弱，肝邪所乘，以补中益气汤加半夏、木香，二剂而愈；又用六君子汤，二剂而安。
李仪部常患腹痛，余以补中益气汤加山栀即愈。一日因怒，肚腹作痛，胸胁作胀，呕吐不食，肝脉弦紧，面色青黄。此肝乘脾也，仍用补中益气吞左金丸，一服即愈。
若人性多气恼，夹气伤食，气滞不通，加川芎、香附（炒）各七钱，木香、黄连（姜炒）各五钱。
我按语：前症若因中气虚弱，不能营运者，宜用六君子加山栀、木香；如不应，送保和丸。
太守朱阳山，因怒腹痛作泻，或两胁作胀，或胸乳作痛，或寒热往来，或小便不利，或饮食不入，呕吐痰涎，神思不清。此肝木乘脾土，用小柴胡加山栀、炮姜、茯苓、陈皮、制黄连，一剂即愈。（制黄连，即黄连、吴茱萸等分，用熟水拌湿，罨二、三日，同炒焦，取黄连。后仿此。）
阳山之内，素善怒，胸膈不利，吐痰甚多，吞酸嗳腐，饮食少思，手足发热，所服非芩、连、枳实，必槟、苏、浓朴。左关弦洪，右关弦数。余以为肝火血燥，木乘土位也。朝用六味地黄丸，以滋养肝木，夕用六君子加当归、芍药，以调补脾土，不月而愈。后因恚怒，前疾复作，或用二陈加石膏，服之吐涎如涌，外热如灼，脉洪大按之如无。余曰∶脾主涎，乃脾损发热而涎泛溢也。用六君子加姜、桂，一服即睡觉，而诸症顿失，又数剂而康。若服理气化痰等药，必变腹胀、喘促、腿浮膝肿、淋沥等症，急用济生加减肾气丸救之，多有得生者。详见各方。
若胸膈不利，过服辛香燥热之药，以致上焦受伤，胃脘干燥，呕吐，噎膈，反胃，加黄连（姜炒）、山栀仁（炒）各五钱，白芍药、当归各一两，桔梗、生甘草、石膏各三钱。胸膈顽痰胶结，及大便燥秘，再加芒硝五钱。
我按语：王安道先生曰∶内膈呕逆，食不得入，是有火也；若病而吐，食入反出，是无火也。治法∶若脾胃气虚而胸膈不利者，用六君子汤壮脾土生元气；若辛热之剂而呕吐噎膈者，用四君子加芎、归，益脾土以抑阴火；胃火内格而饮食不入者，用六君子加芩、连清热养胃；若病呕吐，食入而反出者，用六君子加木香、炮姜温中补脾；若服耗气之剂，血无所生，而大便燥结者，用四君子加芎、归补脾生血；若火逆冲上，食不得入者，用四君子加山栀、黄连清热养血；若痰饮阻滞而食不得入者，用六君子加木香、山栀补脾化痰；若脾胃虚寒，饮食不入或入而不化者，用六君子加木香、炮姜温补脾胃。更非慎房劳、节浓味、调饮食者，不治；年高无血者，亦不治。
一男子，食少胸满，手足逆冷，饮食畏寒，发热，吐痰，时欲作呕。自用清气化痰之剂，胸腹愈胀，呼吸不利，吐痰，呕食，小便淋漓，又用五苓散之类，小便不利，诸病益甚。余曰∶此脾土虚寒无火之症，故食入不消而反出，非气膈所致。遂用八味丸、补中益气，加半夏、茯苓、姜、桂，旬日乃愈。
秀才杨君爵，年将五十，胸痞，少食，吐痰，体倦，肌肉消瘦。所服方药，皆耗气、破血、化痰、降火。余曰∶此气郁所伤，阳气不能升越，属脾经血虚之症，当用归脾汤解郁结、生脾血，用补中益气壮脾气、生发诸经，否则必为中满气膈之患。不信，仍服前药，后果患前症而殁。
若素有痰火者，加半夏（姜炒）、橘红、白茯苓各一两，黄芩（炒）、黄连（姜炒）各五钱。
我按语：前症亦有因脾气不足者，有因脾气郁滞者，有因脾肺之气亏损者，有因肾阴虚不能摄水泛而似痰者，有因脾气虚不能摄涎上溢而似痰者，有因热而生痰者，有因痰而生热者，有因风寒暑湿而得者，有因惊而得者，有因气而得者，有因酒而得者，有因食积而得者，有脾虚不能运化而生者，有胸中痰郁而似鬼附者，各审其原而治之。
若人能食好食，但食后反饱难化，此胃火旺脾阴虚也，加白芍药（酒炒）一两五钱，人参七钱，石膏（火煅）一两，生甘草五钱，黄连（炒）、香附（炒）、木香各四钱。
我按语：东垣先生云∶胃中元气盛，则能食而不伤，过时而不饥；脾胃俱旺，则能食而肥；脾胃俱虚，不能食而瘦，或少食而肥，虽肥而四肢不举。又有善食而瘦者，胃中火邪于气分，则能食而肉削。今能食而难化者，脾气虚弱，不能腐化水谷，故前药不应。或热渴呕吐，或腹胀泄泻等症者，乃是脾胃复伤，急用六君子加芍药、木香、炮姜补之。亦有属脾气郁结者，当解郁健脾，若用清凉降火，以致中气虚痞而不食，或食而食反出，又以为膈噎用行气化痰者，必不能疗也。
若年高人脾虚血燥，易饥易饱，大便燥难，用白芍药、当归各一两，人参七钱，升麻、甘草（炙）各四钱。山楂、大麦芽、桃仁（去皮尖另研）各五钱。此老人常服药也。
我按语：前症属形气、病气俱不足，脾胃虚弱，津血枯涸，而大便难耳！法当滋补化源。又有脾约症，成无己云，胃强脾弱，约束津液不得四布，但输膀胱，小便数而大便难者是也，宜用脾约丸。阴血枯槁，内火燔灼，肺金受邪，土受木克，脾肺失传，大便秘而小便数者，宜用润肠丸。病气有余之治法也。经云脾为至阴，己土而主阴。然老弱之人，当补中益气以生阴血。
职方陈莪斋，年逾六旬，先因大便不通，服内疏等剂后，饮食少思，胸腹作胀，两胁作痛，形体倦怠，两尺浮大，左关短涩，右关弦涩，时五月。此乃命门火衰，不能生脾土，而肺金又克肝木，决其金旺之际不起，后果然。
一老妇，痰喘内热，大便不通，两月不寐。此肝肺肾亏损。朝用六味丸，夕用逍遥散，各三十余剂，计所进饮食百余碗，腹始痞闷，乃以猪胆汁导而通之，用十全大补汤调理而安。若间断前药，饮食不进，诸症复作。
The human body regards the Spleen and Stomach as its core. The Yang of the Stomach governs Qi, while the Yin of the Spleen governs Blood. The Stomach is responsible for receiving and accepting food, and the Spleen is responsible for digestion and transportation. Through this combination of reception and transformation, Essence and Qi are generated. Body fluids ascend, and waste materials descend; thus, disease does not arise. Illness occurs only when dietary habits are irregular and daily routines are unregulated, thereby damaging the Spleen and Stomach. If the Stomach is damaged, it cannot receive food; if the Spleen is damaged, it cannot transform nutrients. If both are damaged, both reception and transformation become difficult, leading to weakness of Yuan Qi (Original Qi), making the body susceptible to invasion by various pathogenic factors. Consequently, symptoms such as fullness, distension, accumulation of masses, Guan-Ge syndrome (obstruction of upper and lower orifices), vomiting, abdominal pain, diarrhea, and dysentery manifest. Moreover, how can one strictly regulate every aspect of diet? Once damage occurs, the Spleen and Stomach are impaired, food intake decreases, and Yuan Qi gradually becomes exhausted. Therefore, Zhang Yuansu (Jiegu) formulated Zhizhu Wan (Bitter Orange and Atractylodes Macrocephala Pill), and Li Dongyuan elaborated on theories regarding the Spleen and Stomach, advocating for the constant regulation of the Spleen and Stomach as the primary approach. Later generations referred to this as the "Kingly Way in Medicine," which indeed holds profound significance! In recent times, those discussing the treatment of the Spleen and Stomach fail to distinguish between Yin and Yang or Qi and Blood, instead indiscriminately using herbs for regulating the Stomach, which are predominantly acrid, warm, drying, and heating agents that assist Fire and injure Yin. This results in excessive Stomach Fire and further injury to Spleen Yin. The pure, neutral, and harmonious Qi transforms into dryness and heat, leading to dryness of the epigastrium, constipation of the Large Intestine, gradual exhaustion of the Spleen, and an approaching end. They fail to realize that the Spleen and Stomach belong to Earth and Dampness, corresponding to the late summer season; thus, eight or nine out of ten diseases are related to Damp-Heat. Furthermore, Earth prospers in all four seasons, with cold, heat, warmth, and coolness varying according to the time. How can one偏 (deviate) to using exclusively acrid-hot agents? Now, I present the formula for Zhizhu Wan (Bitter Orange and Atractylodes Macrocephala Pill) and establish methods for modification below.
Atractylodis Macrocephalae Rhizoma (2 liang), Zhi Shi (Immature Bitter Orange Fruit, 1 liang, stir-fried with bran).
Grind the above into a fine powder. Wrap the powder in lotus leaves with rice and roast until cooked. Remove, pound into a paste, mix with the powder, and pound evenly to form pills the size of mung beans. Take 50-60 pills per dose, washed down with clear rice soup. This method combines tonification and reduction, aiming for slow digestion of food without causing harm. Li Dongyuan added Chen Pi (Tangerine Peel, 1 liang), naming it Zhizhu Ju Wan (Bitter Orange, Atractylodes, and Tangerine Peel Pill), used for elderly and children with weak Yuan Qi and poor appetite. Long-term use allows increased food intake without injury.
My commentary: The Classics state that the Spleen is the organ of digestion, steaming and rotting the five grains. If food intake doubles, the intestines and stomach are injured, unable to transport and transform essences. Thus, belching, acid regurgitation, distension, and stifling sensation occur. Therefore, this pill is used to eliminate stagnation, not primarily for tonification. For Spleen-Stomach deficiency, Si Jun Zi Tang (Four Gentlemen Decoction) is appropriate; for Spleen-Stomach deficiency-cold, Si Jun Zi Tang plus Pao Jiang (Charred Ginger) is suitable; for Mingmen Fire decline, Ba Wei Wan (Eight-Ingredient Pill) should be used.
Zhang Ruhàn, a Tingping (official title), had difficulty digesting food. After taking Zhizhu Wan, he became emaciated, feverish, with a floating and large pulse. I diagnosed Mingmen Fire decline and Spleen-Stomach deficiency-cold, prescribing Ba Wei Wan (Eight-Ingredient Pill). Within a month, his appetite improved; within three months, his physique recovered.
Chen Chanting, from the Ministry of Works, suffered from the aforementioned condition but worsened after taking digestive-promoting drugs. I stated: This is due to Fire decline failing to generate Earth, resulting in Spleen pathology. One must benefit Fire so that Earth naturally solidifies and the Spleen calms. He did not heed this, continued taking previous medications, and eventually died.
If one has inherently weak Yuan Qi, difficulty digesting food, abdominal discomfort, pain, and diarrhea after overeating, this indicates deficiency-cold. Add Ren Shen (Ginseng Root), Bai Shao Yao (White Peony Root, wine-fried), Shen Qu (Medicated Leaven, stir-fried), and Da Mai Ya (Large Barley Sprout, stir-fried, pounded, skin removed), each 1 liang.
My commentary: The previous formula treats injuries caused by food. Mr. Li Dongyuan stated: Diarrhea can also be caused by the Six Excesses (external pathogens), Seven Emotions (internal emotions), food injury, downward flow of Stomach Qi, wind-induced Sundxie (undigested stool diarrhea), phlegm accumulation in the Upper Jiao causing insecure Large Intestine, or Spleen-Stomach Qi deficiency. Treatment methods: For external excesses, regulate the Six Qi; for emotional injuries, balance the Five Zang organs; for food injury, eliminate stagnation; for downward flowing Stomach Qi, raise and lift it; for wind-induced cases, disperse them; for phlegm in the Upper Jiao, remove phlegm without treating diarrhea directly; for Spleen-Stomach Qi deficiency, tonify and benefit.
Mr. Danxi stated: If bowel sounds and abdominal pain occur after eating, followed by diarrhea expelling undigested food, it is Spleen-deficiency food diarrhea, treated with Lizhong Tang (Regulate the Middle Decoction) plus Pao Jiang (Charred Ginger). If stabbing abdominal pain occurs with watery undigested stool, it is named Cold Diarrhea, treated with Lizhong Tang sending Da Wuji Wan (Great Wuji Pill); for severe cold, Fuzi Guixiang Wan (Aconite and Cinnamon-Aromatic Pill); for aversion to food, Babao Tang (Eight Substance Decoction). If stool is green-yellow, anal pain, irritability, thirst, and difficult urination occur, it is named Heat Diarrhea, treated with Wuling San (Five-Ling Powder) and Xianglian Wan (Coptis and Aucklandia Pill). If diarrhea with aversion to food and foul belching occurs, it is named Food Diarrhea, treated with Zhizhong Tang (Regulate the Middle Decoction) plus Sha Ren (Amomum Fruit) or sending Yinggan Wan (Responsive Pill).
Gao Ruzhai, a Jinxian (official title), had difficulty digesting food, abdominal pain, and diarrhea. Treated with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Sha Ren (Amomum Fruit) and Mu Xiang (Aucklandia Root), he recovered. Later, recurrence occurred with undigested stool in diarrhea, abdominal pain, headache, heavy body, and fatigue. I diagnosed Spleen deficiency with Dampness invasion, treating with Shaoyao Fangfeng Tang (Peony and Saposhnikovia Decoction), resulting in cure.
Yang Juyuan, a Taipu (official title), initially had food stagnation with heaviness and dragging in the lower abdomen. Gradually improved with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root). Later, difficulty digesting food, loose stools, tenesmus, frequent visits to the toilet without success, were cured with Shengyang Qushi Fangfeng Tang (Raise Yang and Dispel Dampness Saposhnikovia Decoction). Subsequently, heart and abdominal pain, aversion to taste, were quickly resolved with Hezhong Wan (Harmonize the Middle Pill) with doubled Yizhi Ren (Alpinia Oxyphylla Fruit).
Yang Lizhi, a Guanglu (official title), had inherently weak Yuan Qi, difficulty digesting food, persistent diarrhea, scanty urine, chills, heavy body, and joint pain. I diagnosed Spleen-Lung deficiency, treating with Shengyang Yiwèi Tang (Raise Yang and Benefit the Stomach Decoction), resulting in cure. Generally, for diarrhea unresponsive to diuretic and tonifying agents, this indicates Liver Wood depression overacting on Spleen Earth. One must use Shengyang Yiwei Tang (Raise Yang and Benefit the Stomach Decoction) to preserve life. Cases caused by the victory and defeat of the Five Zang organs are detailed in Volume 2 under various diarrhea entries.
If one has chronic Phlegm-Fire, chest oppression, sour throat, belching, chronic acid regurgitation, or alcohol accumulation with painful diarrhea, these are all Damp-Heat. Add Huang Lian (Coptis Rhizome, stir-fried with ginger juice), Bai Shao Yao (White Peony Root, wine-fried), and Chen Pi (Tangerine Peel), each 1 liang; Shi Gao (Gypsum Fibrosum) and Sheng Gan Cao (Raw Licorice Root), each 5 qian; Suo Sha (Amomum Fruit) and Mu Xiang (Aucklandia Root), each 1 qian; Chuan Xiong (Ligusticum Chuanxiong Rhizome), 4 qian.
My commentary: Acid regurgitation and swallowing acid differ slightly. Vomiting acid arises from heat generated by dampness; swallowing acid arises from internal depression of deficiency heat. Both belong to Spleen-Stomach deficiency-cold, transmitting to terminal symptoms. Thus, the *Neijing* attributes this to Fire, referring to the pathological manifestation; Li Dongyuan attributes it to Stomach cold, referring to the pathological root. Patients must first distinguish between vomiting and swallowing acid, treating primarily to consolidate the Original Root. If cold-cooling herbs are taken, they re-injure Stomach Qi, leading to reinforcing excess and draining deficiency errors. Further, if Spleen Qi is deficient, unable to transport nutrients and descending turbid Qi, Liu Jun Zi Tang (Six Gentlemen Decoction) should be used to tonify the Spleen and Stomach, assisted slightly by Yueju Wan (Yueju Pill) to clear the middle. Mr. Li Dongyuan said: Pathogenic heat fails to digest grain. Mistaking this for excess heat and recklessly using cold-cooling agents will inevitably transform into a critical condition.
If food injury causes fullness, stifling, and obstruction that does not resolve, add Shen Qu (Medicated Leaven), Mai Ya (Barley Sprout), and Shan Zha (Hawthorn Fruit), each 1 liang. If food stagnation masses exist in the abdomen, add Huang Lian (Coptis Rhizome) and Hou Po (Magnolia Bark), both processed with ginger, each 5 qian. If the accumulation is hard, add E Zhu (Curcuma Zedoaria Rhizome, vinegar-boiled) and Kun Bu (Kelp), each 3 qian.
My commentary: If the Spleen and Stomach are inherently strong and the patient suffers only from acute injury due to overeating, the previous medicines are suitable; otherwise, use with caution. Mr. Li Dongyuan said: When Spleen-Stomach Qi is robust, one can eat much without injury and feel hungry after time passes. If the previous condition is due to Spleen Qi deficiency failing to rot and transform, it should be cultivated and tonified; if Spleen-Stomach deficiency-cold, it should be warmed and nourished; if Mingmen Fire declines, it should be warmed and tonified. Generally, food stagnation masses are tangible forms. As the saying goes, "When pathogenic Qi prevails, it is excess; when True Qi is depleted, it is deficiency." One must nourish righteousness so that pathogenic accumulations remove themselves. Although it is said "Hard things should be reduced, intruders should be expelled," this is only applicable if Stomach Qi is not yet deficient and Yuan Qi is still substantial. If the illness is prolonged and the body emaciated, or if Yuan Qi is inherently weak, one must prioritize consolidating the root and assist with the previous methods; otherwise, it will反而 (instead) cause distension, fullness, anorexia, and exacerbate the disease. However, ancient laws prepare for common scenarios; can one simply follow the map to find the horse? Learners should deduce and apply this, perhaps succeeding!
If cold food injury causes indigestion, abdominal pain, and loose stools, add Ban Xia (Pinellia Tuber, ginger-processed), 1 liang; Suo Sha (Amomum Fruit), Gan Jiang (Dried Ginger), Shen Qu (Medicated Leaven, stir-fried), and Da Mai Ya (Large Barley Sprout), each 5 qian.
My commentary: If the injury is from hot-natured substances, use Er Chen Tang (Two-Cured Decoction) plus Huang Lian (Coptis Rhizome) and Shan Zha (Hawthorn Fruit). If from damp noodles, use Er Chen Tang (Two-Cured Decoction) plus Shen Qu (Medicated Leaven) and Mai Ya (Barley Sprout). If from rice, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Gu Ya (Rice Sprout). If from wheat flour, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mai Ya (Barley Sprout). If from meat, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shan Zha (Hawthorn Fruit). If from fish/fowl, use Liu Jun Zi Tang (Six Gentlemen Decoction) with doubled Chen Pi (Tangerine Peel). If from sticky rice or cooked rice, use Liu Jun Zi Tang (Six Gentlemen Decoction) with doubled Jiu Qu (Wine Leaven). If the food has digested but diarrhea persists, this is Spleen-Stomach injury; use Liu Jun Zi Tang (Six Gentlemen Decoction). If food intake decreases or digestion is difficult, this belongs to Spleen-Stomach deficiency-cold; add Pao Jiang (Charred Ginger), Mu Xiang (Aucklandia Root), and Rou Dou Kou (Nutmeg). If ineffective, add Wu Mei (Mume Fruit), Wu Zhu Yu (Evodia Fruit), and Gu Zhi (Mora Cortex). For Spleen-Kidney deficiency-cold, Ba Wei Wan (Eight-Ingredient Pill) is required; otherwise, Spleen deficiency with middle-fullness often occurs. Shen Qu (Medicated Leaven) and Mai Ya (Barley Sprout) assist Wu Earth (Stomach) in rotting and transforming water and grain. Mai Ya alone: I have used it to treat women who lost a child, experiencing breast swelling and pain threatening abscess formation. Using 1-2 liang stir-fried and decocted resolves it immediately, showing its ability to break Blood and disperse Qi. Danxi said Mai Ya (Barley Sprout) dissipates Kidney essence; *Furen Liangfang* (Good Women's Prescriptions) said Shen Qu (Medicated Leaven) facilitates abortion. Both have more destructive than tonifying effects and should not be used lightly.
Tang Yibu (official title) suffered chest pain for over a month, also abdominal pain. Left Guan pulse was string-taut and long; Right Guan pulse was string-taut and tight. Complexion was yellow with hints of green. This indicated Spleen-Stomach deficiency with Liver pathogen invasion. Treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Ban Xia (Pinellia Tuber) and Mu Xiang (Aucklandia Root), cured in two doses; then Liu Jun Zi Tang (Six Gentlemen Decoction) for two doses brought peace.
Li Yibu (official title) frequently suffered abdominal pain. I cured him with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shan Zhi (Gardenia Fruit). One day, due to anger, he experienced abdominal pain, chest and hypochondriac distension, vomiting, and anorexia. Liver pulse was string-taut and tight; complexion was blue-green. This indicated Liver overacting on Spleen. Still used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) swallowed with Zuojin Wan (Left Metal Pill), cured in one dose.
If one has a irritable nature, combining Qi stagnation with food injury, causing Qi blockage, add Chuan Xiong (Ligusticum Chuanxiong Rhizome) and Xiang Fu (Cyperus Rotundus Rhizome, stir-fried), each 7 qian; Mu Xiang (Aucklandia Root) and Huang Lian (Coptis Rhizome, ginger-stir-fried), each 5 qian.
My commentary: If the previous condition is due to Middle Qi deficiency failing to circulate, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shan Zhi (Gardenia Fruit) and Mu Xiang (Aucklandia Root). If ineffective, send Baohe Wan (Preserve Harmony Pill).
Zhu Yangshan, a Taishou (prefectural governor), suffered abdominal pain and diarrhea due to anger, or hypochondriac distension, chest/breast pain, alternating chills and fever, difficult urination, anorexia, vomiting of phlegm-saliva, and mental confusion. This indicated Liver Wood overacting on Spleen Earth. Treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Shan Zhi (Gardenia Fruit), Pao Jiang (Charred Ginger), Fu Ling (Poria), Chen Pi (Tangerine Peel), and Zhi Huang Lian (Processed Coptis Rhizome), cured in one dose. (Processed Huang Lian: Equal parts Huang Lian (Coptis Rhizome) and Wu Zhu Yu (Evodia Fruit), moistened with boiled water, covered for 2-3 days, stir-fried together until scorched, then separate the Huang Lian (Coptis Rhizome). Follow this method subsequently.)
Madam Yangshan, prone to anger, had chest oppression, copious phlegm, acid regurgitation, belching of rotten food, poor appetite, and hot hands/feet. Her medications were either Qin (Scutellaria Root), Lian (Coptis Rhizome), Zhi Shi (Immature Bitter Orange Fruit), or Bin Lang (Areca Seed), Su (Perilla Stem), Hou Po (Magnolia Bark). Left Guan pulse was string-taut and surging; Right Guan pulse was string-taut and rapid. I diagnosed Liver Fire and Blood dryness, with Wood overacting on Earth. Morning: Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish Liver Wood. Evening: Liu Jun Zi Tang (Six Gentlemen Decoction) plus Dang Gui (Angelica Sinensis Root) and Shao Yao (Peony Root) to regulate and tonify Spleen Earth. Cured within a month. Later, due to resentment, the previous illness recurred. She used Er Chen Tang (Two-Cured Decoction) plus Shi Gao (Gypsum Fibrosum). Taking it caused vomiting of saliva like a gush, external heat like burning, and a surging pulse that vanished upon pressure. I stated: The Spleen governs saliva; this is Spleen damage with fever causing saliva overflow. Used Liu Jun Zi Tang (Six Gentlemen Decoction) plus Jiang (Fresh Ginger) and Gui (Cinnamon Twig). One dose woke her from sleep, symptoms vanished instantly, and several doses brought recovery. If Liqi Huatan (Regulate Qi and Resolve Phlegm) herbs were taken, it would inevitably transform into abdominal distension, panting, leg edema, knee swelling, and dribbling urination. Urgently use Jisheng Jiajian Shenqi Wan (Modified Kidney Qi Pill from the Sage's Hall) to save them; many survive. See details in respective formulas.
If chest oppression occurs from overusing acrid-aromatic drying-hot herbs, injuring the Upper Jiao, causing dry epigastrium, vomiting, dysphagia, and regurgitation, add Huang Lian (Coptis Rhizome, ginger-stir-fried) and Shan Zhi Ren (Gardenia Seed, stir-fried), each 5 qian; Bai Shao Yao (White Peony Root) and Dang Gui (Angelica Sinensis Root), each 1 liang; Jie Geng (Platycodon Root), Sheng Gan Cao (Raw Licorice Root), and Shi Gao (Gypsum Fibrosum), each 3 qian. For stubborn phlegm coagulation in the chest/diaphragm and dry constipation, add Mang Xiao (Mirabilite), 5 qian.
My commentary: Mr. Wang Andao said: Internal obstruction with vomiting and inability to eat indicates Fire; vomiting while sick and regurgitating after eating indicates no Fire. Treatment methods: For Spleen-Stomach Qi deficiency with chest oppression, use Liu Jun Zi Tang (Six Gentlemen Decoction) to strengthen Spleen Earth and generate Yuan Qi. For vomiting and dysphagia from acrid-hot agents, use Sijunzi Tang (Four Gentlemen Decoction) plus Xiong (Chuan Xiong Ligusticum Rhizome) and Gui (Dang Gui Angelica Root) to benefit Spleen Earth and suppress Yin Fire. For internal gridlock of Stomach Fire preventing food intake, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Qin (Huang Qin Scutellaria Root) and Lian (Huang Lian Coptis Rhizome) to clear heat and nourish the Stomach. For vomiting and regurgitation after eating, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mu Xiang (Aucklandia Root) and Pao Jiang (Charred Ginger) to warm the middle and tonify the Spleen. For blood deficiency from Qi-consuming agents causing dry constipation, use Sijunzi Tang (Four Gentlemen Decoction) plus Xiong (Chuan Xiong Ligusticum Rhizome) and Gui (Dang Gui Angelica Root) to tonify Spleen and generate Blood. For Fire counterflow upward preventing food intake, use Sijunzi Tang (Four Gentlemen Decoction) plus Shan Zhi (Gardenia Fruit) and Huang Lian (Coptis Rhizome) to clear heat and nourish Blood. For food refusal due to Phlegm-Fluid obstruction, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mu Xiang (Aucklandia Root) and Shan Zhi (Gardenia Fruit) to tonify Spleen and resolve phlegm. For Spleen-Stomach deficiency-cold preventing food intake or digestion, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mu Xiang (Aucklandia Root) and Pao Jiang (Charred Ginger) to warm and tonify Spleen-Stomach. Furthermore, without abstaining from sexual activity, moderating rich flavors, and regulating diet, it is untreatable; for the elderly without Blood, it is also untreatable.
A man had poor appetite, chest fullness, cold extremities, fear of cold foods, fever, phlegm expectoration, and occasional nausea. Self-medicating with Qingqi Huatan (Clear Qi and Resolve Phlegm) agents worsened chest/abdominal distension, breathing difficulty, phlegm expectoration, food vomiting, and dribbling urination. Using Wuling San (Five-Ling Powder) type agents worsened difficult urination and all diseases. I stated: This is Spleen Earth deficiency-cold without Fire, so food enters but does not digest and regurgitates; it is not Qi obstruction. Thereupon, used Ba Wei Wan (Eight-Ingredient Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), plus Ban Xia (Pinellia Tuber), Fu Ling (Poria), Jiang (Fresh Ginger), and Gui (Cinnamon Twig), cured in ten days.
Scholar Yang Junjue, nearing fifty, had chest stuffiness, poor appetite, phlegm expectoration, fatigue, and muscle emaciation. His prescribed formulas all consumed Qi, broke Blood, resolved phlegm, and descended Fire. I stated: This is Qi depression injury, Yang Qi unable to rise and transcend, belonging to Spleen channel Blood deficiency. Should use Guipi Tang (Restore the Spleen Decoction) to resolve depression and generate Spleen Blood, and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to strengthen Spleen Qi and generate all channels; otherwise, middle-fullness and Qi obstruction will surely occur. He did not believe, continued taking previous medicines, and eventually died from the previous condition.
If one has chronic Phlegm-Fire, add Ban Xia (Pinellia Tuber, ginger-stir-fried), Ju Hong (Tangerine Red Peel), and Bai Fu Ling (White Poria), each 1 liang; Huang Qin (Scutellaria Root, stir-fried) and Huang Lian (Coptis Rhizome, ginger-stir-fried), each 5 qian.
My commentary: The previous condition can also be due to Spleen Qi insufficiency, Spleen Qi stagnation, Spleen-Lung Qi depletion, Kidney Yin deficiency failing to control water flooding resembling phlegm, Spleen Qi deficiency failing to control saliva overflowing resembling phlegm, heat generating phlegm, phlegm generating heat, Wind-Cold-Damp-Heat acquisition, fright acquisition, Qi acquisition, alcohol acquisition, food stagnation acquisition, Spleen deficiency failing to transform generating phlegm, chest phlegm depression resembling ghost possession. Each must examine the origin and treat accordingly.
If one can eat well but feels full and difficult to digest after eating, this is Stomach Fire prosperity and Spleen Yin deficiency. Add Bai Shao Yao (White Peony Root, wine-fried), 1.5 liang; Ren Shen (Ginseng Root), 7 qian; Shi Gao (Gypsum Fibrosum, calcined), 1 liang; Sheng Gan Cao (Raw Licorice Root), 5 qian; Huang Lian (Coptis Rhizome, stir-fried), Xiang Fu (Cyperus Rotundus Rhizome, stir-fried), and Mu Xiang (Aucklandia Root), each 4 qian.
My commentary: Mr. Li Dongyuan said: When Yuan Qi in the Stomach is abundant, one can eat without injury and feel hungry after time passes; when Spleen and Stomach are both prosperous, one can eat and become fat; when Spleen and Stomach are both deficient, one cannot eat and becomes thin, or eats little and becomes fat, though fat, limbs cannot move. There are also those who eat well but are thin; Stomach Fire pathogen in the Qi level allows eating but flesh wastes. Now, those who can eat but digest poorly have Spleen Qi deficiency failing to rot and transform water and grain, hence previous medicines are ineffective. If accompanied by heat-thirst, vomiting, abdominal distension, diarrhea, etc., this is repeated Spleen-Stomach injury; urgently use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shao Yao (Peony Root), Mu Xiang (Aucklandia Root), and Pao Jiang (Charred Ginger) to tonify. Some belong to Spleen Qi depression; one should resolve depression and strengthen Spleen. If cooling and fire-descending agents are used, causing Middle Qi deficiency, distension, anorexia, or regurgitation, and then treated as Ge-Ye (obstruction) with Qi-regulating and phlegm-resolving agents, it will certainly not heal.
For elderly people with Spleen deficiency and Blood dryness, easily hungry and full, dry difficult stool, use Bai Shao Yao (White Peony Root) and Dang Gui (Angelica Sinensis Root), each 1 liang; Ren Shen (Ginseng Root), 7 qian; Sheng Ma (Cimicifuga Rhizome) and Gan Cao (Licorice Root, honey-fried), each 4 qian. Shan Zha (Hawthorn Fruit), Da Mai Ya (Large Barley Sprout), and Tao Ren (Peach Kernel, skin and tip removed, ground separately), each 5 qian. This is a common medicine for the elderly.
My commentary: The previous condition belongs to both Form-Qi and Pathogenic-Qi insufficiency, Spleen-Stomach weakness, exhaustion of fluids and Blood, causing difficult stool! The method should be tonifying and nourishing the source of transformation. There is also Pi Yue Syndrome (Spleen Constriction). Cheng Wuji said: Stomach strong, Spleen weak, constraining fluids so they cannot distribute everywhere, only transporting to Bladder, causing frequent urination and difficult stool; use Pi Yue Wan (Spleen Constriction Pill). With Yin Blood exhaustion, internal Fire blazing, Lung Metal affected, Earth overcome by Wood, Spleen-Lung transmission lost, constipation and frequent urination occur; use Run Chang Wan (Moisten Intestine Pill). This is the treatment method for excess pathogenic Qi. The Classics say the Spleen is Supreme Yin, Ji Earth governing Yin. However, for the old and weak, one should use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to generate Yin Blood.
Chen Ezhai, a Zhifang (official title), over sixty years old. Initially, due to constipation, after taking Neishu (Internal Purging) agents, he had poor appetite, chest/abdominal distension, hypochondriac pain, physical fatigue. Both Chi pulses were floating and large; Left Guan was short and choppy; Right Guan was string-taut and choppy. It was May. This indicated Mingmen Fire decline, failing to generate Spleen Earth, while Lung Metal overacts on Liver Wood. I determined he would not recover during the peak of Metal; indeed, he later died.
An old woman had Phlegm-wheezing, internal heat, constipation, and insomnia for two months. This indicated Liver-Lung-Kidney depletion. Morning: Liuwei Wan (Six-Ingredient Pill). Evening: Xiaoyao San (Free and Easy Wanderer Powder). Over thirty doses each, consuming over a hundred bowls of food, abdomen finally became distended. Then used Pig Gallbladder Juice to guide and unblock. Regulated with Shiquan Dabu Tang (Perfect Ten Great Tonification Decoction) and found peace. If previous medicines were interrupted, food intake ceased, and all symptoms recurred.