虽有美馔灵药，必赖脾胃运化。盖脾胃一脏一腑属土。《易》曰∶至哉坤元，土为万物之母。
经曰∶饮入于胃，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。盖五脏各得受此精华，为精为血，分布脉络，
灌溉周身，皆仰赖脾胃司纳谷味而成。所以脾为仓廪之官，胃为水谷之海。胃主纳受，脾司运化。
胃不和则食不思，脾不和则食不化。故气血、津液、百骸、脏腑各失荣养，百病滋起矣。虽然胃常
有余，脾常不足，脾尤重焉。故先哲云∶治诸病以健脾为先，调一身以理脾为主。从来补虚皆重
肾经，独东垣云∶补肾不如补脾。苟或饮食失节，寒温失调，思虑过度，四肢劳极，皆伤脾之由
也。夫脾居坤静之德，而有干健之运，健则能食而形体壮盛，伤则少食而肌肉消瘦。故节食、节劳
以养脾也，悦心平怒，惜气寡欲以养四脏也。养四脏，亦以助脾也。母子克制，环相资养之功，知
此则养生之道，思过半矣。
谨按《神农本草经》大黄味苦寒，无毒。主调中化食，破积除痰，通利水谷，肠胃结热，推陈
致新，安和五脏。又按芒硝，味辛苦寒。主五脏积聚久热，破留血，腹中痰实结搏，通经脉，利二便
。古今通治伤寒有余热证。东垣赋云∶大黄定祸乱而致太平，故名将军。如伤寒热邪传阳明之本，
阳邪传入阴经，阳毒火极等证，用之则顷刻回生，舍之则死不逾日。如不能以脉理明辩者，可以舌
色验之。如舌干燥苔，唇焦口渴者，先宜白虎汤，重用钱塘硬石膏（研末）。如小便短赤，大便秘结，
大热大渴，不怕寒，反怕热，扬手掷足，揭去衣被，大便下利，苍黑秽水，名协热自利，脐内梗硬
作痛，乃肠中有燥屎，则大黄可用矣。渴极睛红，苔黄烦躁，芒硝可用矣。如舌苔黑色如芒刺，芒
硝、大黄可倍用矣。如舌燥，虽有白苔，大便下利清水，身无大热，手足厥冷，脉沉细，名协寒自
利，硝、黄不可用也。如舌苔黑色而湿滑，名脏结，有阳证变阴者，皆不可用也。如痢疾初起，或
日数多犹有积滞不清，后重窘迫，非大黄不能通快。如头大痛，目赤肿等证，非酒煮大黄不除。凡
实证凉药不效者，可用数分，专在用之中病，误则伤人，失用尤杀人，岂可畏如鸩毒，一例不用乎
？今医者逢迎病家，不用大黄，恐伤胃气为谈柄，病家敬其谨慎王道，屡有热邪炽极，宁袖手坐视
其毙，呜呼痛哉！余曾见小儿患痘，大渴，失用石膏，胃烂溃穿胸背而死。见痢疾大热，失用大黄
，腰后肾俞枯涸成窟而死。失用硝、黄所致，如此甚多。如明医视病的确，用之无不起死回生。历
代名师治法方中多用。今以硝、黄奏奇功者，岂胜枚举，姑举一案例之。
附纪∶如盐官沈观察弟天谷公，应试南都，与选贡刘芑源公同日患痢。沈忆宏曾语，初感即用
大黄等，一剂获瘳。刘延医不肯用，沈亟往告，医用熟大黄丸一钱，药中仍加白术、山药，失于通
导，竟至不起。又石膏者，伤寒等证神药，医有绝不用者，惜哉！
即使有美味的食物和灵验的药物，也必须依赖脾胃的运化功能。因为脾与胃一脏一腑，五行属土。《易经》说：坤元之德最为伟大，土是万物的母亲。
《内经》说：水饮进入胃中，精气游溢出来，向上输送给脾，脾气散布精微物质，向上归于肺，通调水道，向下输送到膀胱。水液精华四布全身，五脏经脉并行运行，配合四季、五脏、阴阳的变化，作为正常的规律。五脏各自接受这些精华，化为精血，分布于脉络之中，灌溉周身，都仰赖脾胃受纳和运化谷味来完成。所以脾被称为仓廪之官，胃被称为水谷之海。胃主受纳，脾主运化。胃气不和则不想进食，脾气不和则食物不消化。因此气血、津液、肢体百骸、脏腑都会失去滋养，各种疾病就会滋生起来。虽然胃气常有余，脾气常不足，所以脾的作用尤为重要。因此先哲说：治疗各种疾病以健脾为先，调理全身以理脾为主。历来补虚证都重视肾经，唯独李东垣说：补肾不如补脾。如果饮食失节，寒温失调，思虑过度，四肢劳累至极，都是损伤脾的原因。脾具有坤卦安静的美德，同时具备乾卦刚健的运化功能，刚健则能进食且形体壮盛，受伤则食欲减少且肌肉消瘦。所以要节制饮食、节制劳累来养护脾，心情愉悦、平息愤怒、爱惜元气、减少欲望来养护其他四脏。养护其他四脏，也是为了帮助脾。母子相生相克，环环相扣相互资助的功用，懂得这些，养生的道理就掌握了一半了。
谨按《神农本草经》记载：大黄味苦性寒，无毒。主要作用是调和脾胃、消化食积，破除积滞、消除痰饮，通利水谷通道，清除肠胃结热，推陈出新，安和五脏。又据记载：芒硝味辛苦性寒。主要治疗五脏积聚已久的热邪，破除停留的血瘀，腹中痰实结聚搏结，通利经脉，通畅大小便。古今通用治疗伤寒病余热未尽的证候。李东垣赋中说：大黄能平定祸乱而致太平，所以名叫将军。如伤寒热邪传入阳明本经，阳邪传入阴经，阳毒火极等证候，使用它就能顷刻间起死回生，不使用则不出几天就会死亡。如果不能通过脉理明确辨别者，可以通过舌色来验证。如舌面干燥有苔，嘴唇焦裂口渴者，先用白虎汤（White Tiger Decoction），重用钱塘产的硬石膏（研成粉末）。如小便短少色赤，大便秘结，大热大渴，不怕寒冷反而怕热，扬手掷足，掀开衣被，大便下利苍黑秽臭的水，名为协热自利（Diarrhea with Heat），脐内梗硬作痛，这是肠中有燥屎，这时就可以使用大黄了。口渴极度严重，眼睛发红，舌苔黄，烦躁不安，可以使用芒硝了。如舌苔黑色像芒刺一样，芒硝和大黄可以加倍使用。如舌燥，虽然有白苔，但大便下利清水，身体没有大热，手足厥冷，脉象沉细，名为协寒自利（Diarrhea with Cold），硝石和大黄不可使用。如舌苔黑色而湿滑，名为脏结（Zang Jie, organ binding），有阳证转为阴证的，都不可使用。如痢疾初起，或者天数多仍有积滞不清，里急后重窘迫，非用大黄不能通快。如头痛剧烈，眼睛红肿等证候，非用酒煮大黄不能去除。凡是实证用凉药无效者，可以使用少量，关键在于用药中病即止，误用则伤害人体，该用不用尤其会杀人，怎么能畏惧它如鸩毒一般，一律不用呢？现在的医生迎合病人心理，不用大黄，担心损伤胃气成为谈资，病人敬重其谨慎的王道疗法，屡次遇到热邪炽盛到了极点，却袖手旁观坐视其死亡，呜呼，真是痛心啊！我曾经见过小儿患痘疮，极度口渴，因未使用石膏，导致胃烂溃穿胸背而死。见过痢疾大热，因未使用大黄，导致腰部后方肾俞穴处枯涸成窟而死。因未使用硝石、大黄而导致死亡的案例非常多。如果明医诊断准确，使用它们没有不起死回生的。历代名医治法方剂中多用此药。如今用硝石、大黄奏出奇功的案例，岂能一一列举，姑且举一个案例来说明。
附记：如盐官沈观察的弟弟天谷公，去南京参加科举考试，与入选贡生的刘芑源公同一天患上痢疾。沈忆宏曾讲述，起初患病就用大黄等药，一剂药就痊愈了。刘延请医生不肯使用，沈急忙前去告知，医生使用熟大黄丸一钱，药方中仍加入白术、山药，失于通导，最终导致死亡。另外石膏是治疗伤寒等证的神药，有的医生绝对不用，可惜啊！
Even with exquisite food and miraculous medicines, their transformation and transportation must rely on the Spleen and Stomach. The Spleen and Stomach are one Zang organ and one Fu organ, both belonging to Earth in the Five Elements. The *Book of Changes* states: "The virtue of Kun Yuan is supreme; Earth is the mother of all things."
The *Classic of Acupuncture and Moxibustion* (*Huangdi Neijing*) says: "When fluids enter the Stomach, their essence floats and overflows, moving upward to be transmitted to the Spleen; the Spleen scatters the essence, sending it upward to return to the Lung; (the Lung) regulates the water passages, transmitting them downward to the Bladder. Water essence distributes in all directions, and the five meridians run in parallel, conforming to the four seasons, five Zang organs, and Yin-Yang, establishing this as the normal physiological pattern." Each of the five Zang organs receives these essences, transforming them into Jing (Essence) and Blood, distributing them through the collaterals, and irrigating the entire body. All of this relies on the Spleen and Stomach to receive and digest grains. Therefore, the Spleen is called the "Official of the Granary," and the Stomach is called the "Sea of Water and Grain." The Stomach governs reception, and the Spleen governs transformation and transportation. If the Stomach is disharmonious, there is no appetite; if the Spleen is disharmonious, food cannot be digested. Consequently, Qi and Blood, Body Fluids, bones and muscles, and Zang-Fu organs will all lose nourishment, and various diseases will arise. Although Stomach Qi is often in excess and Spleen Qi is often deficient, the Spleen is particularly important. Thus, ancient sages said: "To treat various diseases, prioritize strengthening the Spleen; to regulate the whole body, focus on regulating the Spleen." Historically, tonifying deficiency has always emphasized the Kidney Meridian, but Li Dongyuan alone stated: "Tonifying the Spleen is superior to tonifying the Kidney." Causes of Spleen injury include irregular diet, improper regulation of cold and warmth, excessive thinking, and extreme physical fatigue of the limbs. The Spleen possesses the quiet and yielding virtue of Kun (Earth), yet has the vigorous function of Qian (Heaven). When vigorous, one can eat well and the body is strong; when injured, appetite decreases and muscles emaciate. Therefore, regulating diet and labor nurtures the Spleen; maintaining a joyful heart, calming anger, cherishing Qi, and reducing desires nurture the other four Zang organs. Nurturing the four Zang organs also assists the Spleen. Through mutual generation and restriction among mother and child elements, they support each other in a cycle. Understanding this means one has grasped more than half of the principles of health preservation.
According to the *Shennong Bencao Jing* (*Divine Farmer's Materia Medica*): Dahuang (Rhei Radix et Rhizoma) is bitter and cold, non-toxic. It primarily harmonizes the middle Jiao, transforms food stagnation, breaks up accumulations, eliminates phlegm, unblocks the passage of water and grain, clears heat accumulation in the intestines and stomach, pushes out the old to bring forth the new, and harmonizes the five Zang organs. Regarding Mangxiao (Natrii Sulfas): It is acrid, bitter, and cold. It primarily treats long-standing heat from accumulations in the five Zang organs, breaks up retained blood stasis, resolves phlegm-solid obstructions in the abdomen, unblocks the meridians, and promotes urination and defecation. Since ancient times, it has been commonly used to treat residual heat syndromes in Shanghan (Cold Damage Disease). Li Dongyuan wrote in his fu poem: "Dahuang quells chaos and brings peace, hence its name 'General'." If Shanghan heat pathogen transmits to the Yangming channel proper, or if Yang pathogen enters Yin channels, or in cases of Yang toxicity with extreme fire, using it can restore life instantly; withholding it leads to death within days. For those unable to distinguish clearly by pulse diagnosis, tongue color can be used for verification. If the tongue is dry with coating, lips are cracked, and there is thirst, use Baihu Tang (White Tiger Decoction) first, heavily utilizing Yanguangshi (Gypsum Fibrosum) from Qiantang (ground into powder). If urine is scanty and dark red, stool is constipated, there is high fever and extreme thirst, aversion to cold is absent while fear of heat exists, restlessness involves tossing hands and feet, removing clothes and blankets, and diarrhea produces foul black watery stool, this is called Xiere Zili (Self-diarrhea accompanying heat); hardness and pain inside the umbilicus indicate dry feces in the intestines, at which point Dahuang can be used. If there is extreme thirst, red eyes, yellow tongue coating, and irritability, Mangxiao can be used. If the tongue coating is black like thorns, the dosage of Mangxiao and Dahuang can be doubled. If the tongue is dry, even with white coating, but diarrhea produces clear water, without high fever, with cold extremities, and a deep, fine pulse, this is called Xiehan Zili (Self-diarrhea accompanying cold); Mangxiao and Dahuang must not be used. If the tongue coating is black and slippery, this is called Zangjie (Zang Obstruction); cases where Yang syndrome transforms into Yin syndrome must not use these drugs. In early dysentery, or after many days if stagnation remains unclear, with tenesmus and urgency, only Dahuang can effectively unblock. For severe headache, red and swollen eyes, etc., only Jiuzhu Dahuang (Wine-processed Rhei Radix et Rhizoma) can resolve it. For excess syndromes where cooling herbs fail, small doses can be used; the key lies in stopping once the disease is addressed. Misuse harms the body; failure to use when indicated kills. How can one fear it like poison and refuse to use it altogether? Modern physicians cater to patients, avoiding Dahuang for fear of damaging Stomach Qi becoming a topic of criticism. Patients respect their cautious "Kingly Way" approach. Repeatedly, when heat pathogen is extremely intense, they stand by idly watching patients die. Alas, how painful! I have seen children with variola (smallpox) who died of gastric perforation through the chest and back due to lack of Shigao (Gypsum Fibrosum) for extreme thirst. I have seen patients with severe dysentery heat die because their Shenxu acupoint area became hollow and dried up due to lack of Dahuang. Many deaths result from failing to use Mangxiao and Dahuang. If a skilled physician diagnoses accurately, using these agents can revive the dying. Famous doctors of past dynasties frequently included them in prescriptions. Cases achieving miraculous results with Mangxiao and Dahuang today are too numerous to list; I shall cite one example.
Appendix: Mr. Tiangu, younger brother of Observer Shen from Yanguan, went to Nanjing for imperial examinations. He and Liu Qiyuan, a selected Gongsheng student, contracted dysentery on the same day. Shen Yihong recalled that he immediately used Dahuang upon initial contraction, recovering after one dose. Liu consulted a doctor who refused to use Dahuang. Shen urgently informed him; the doctor prescribed only 1 qian of Shu Dahuang Wan (Prepared Dahuang Pill), adding Baizhu (Atractylodis Macrocephalae Rhizoma) and Shanyao (Dioscoreae Rhizoma), neglecting to purge and unblock. Ultimately, the condition proved fatal. Furthermore, Shigao is a divine medicine for Shanghan and similar syndromes, yet some doctors absolutely refuse to use it. What a pity!