\r脏气法时升降浮沉补泻图说\ps123a1.bmp\r
五行相生，木、火、土、金、水，循环无端，惟脾无正行，于四季之末各旺一十八日，
以生四脏。四季者，辰、戌、丑、未是也。人身形以应九野，左足主立春，丑位是也；左手
主立夏，辰位是也；右手主立秋，未位是也；右足主立冬，戌位是也。戌湿，其本气平，其
兼气温、凉、寒、热，在人以胃应之；己土，其本味咸，其兼味辛、甘、酸、苦，在人以脾
应之。脾胃兼化，其病治之，各从其宜，不可定体；肝肺之病，在水火之间，顺逆传变不同
，温凉不定，当求责耳。
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，则不能
食而瘦。或少食而肥，虽肥而四肢不举，盖脾实而邪气盛也。又有善食而瘦者，胃伏火邪于
气分，则能食，脾虚则肌肉削，即食亦也。叔和云∶多食亦肌虚，此之谓也。
夫饮食不节则胃病，胃病则气短精神少而生大热，有时而显火上行，独燎其面，《黄帝
针经》云∶面热者，足阳明病。胃既病，则脾无所禀受，脾为死阴，不主时也，故亦从而病
焉。形体劳役则脾病，脾病则怠惰嗜卧，四肢不收，大便泄泻；脾既病，则其胃不能独行津
液，故亦从而病焉。
大抵脾胃虚弱，阳气不能生长，是春夏之令不行，五脏之气不生。脾病则下流乘肾，土
克水，则骨乏无力，是为骨蚀，令人骨髓空虚，足不能履地，是阴气重叠，此阴盛阳虚之证
。大法云，汗之则愈，下之则死。若用辛甘之药滋胃，当升当浮，使生长之气旺。言其汗者
，非正发汗也，为助阳也。
夫胃病其脉缓，脾病其脉迟，且其人当脐有动气，按之牢若痛，若火乘土位，其脉洪缓
，更有身热心中不便之证。此阳气衰弱，不能生发，不当于五脏中用药法治之，当从《脏气法
时论》中升降浮沉补泻法用药耳。
如脉缓，病怠惰嗜卧，四肢不收，或大便泄泻，此湿胜，从平胃散。若脉弦，气弱自汗
，四肢发热，或大便泄泻，或皮毛枯槁，发脱落，从黄 建中汤。脉虚而血弱，于四物汤中
摘一味或二味，以本显证中加之。或真气虚弱，及气短脉弱，从四君子汤。或渴，或小便闭
涩，赤黄多少，从五苓散去桂，摘一二味加正药中。
以上五药，当于本证中随所兼见证加减。假令表虚自汗，春夏，加黄 ；秋冬，加桂。
不转者，勿加。虽气不转，而脾胃中气不和者，勿去，但加浓朴以破滞气，然亦不可多用，
于甘草五分中加一分可也。腹中夯闷，此非腹胀，乃散而不收，可加芍药收之。
如肺气短促，或不足者，加人参、白芍药。中焦用白芍药，则脾中升阳，使肝胆之邪不
敢犯也。腹中窄狭及缩急者，去之，及诸酸涩药亦不可用。
腹中痛者，加甘草、白芍药，稼穑作甘，甘者己也；曲直作酸，酸者甲也。甲己化土，
此仲景妙法也。腹痛兼发热，加黄芩；恶寒或腹中觉寒，加桂。
怠惰嗜卧，有湿，胃虚不能食，或沉困，或泄泻，加苍术；自汗，加白术。
小便不利，加茯苓，渴亦加之。
气弱者，加白茯苓、人参；气盛者，加赤茯苓、缩砂仁；气复不能转运，有热者，微加
黄连；心烦乱亦加之。
小便少者，加猪苓、泽泻；汗多津液竭于上，勿加之。是津液还入胃中，欲自行也。不
渴而小便闭塞不通，加炒黄柏、知母。
小便涩者，加炒滑石；小便淋涩者，加泽泻。且五苓散治渴而小便不利，无恶寒者，不
得用桂。
不渴而小便自利，妄见妄闻，乃瘀血证，用炒黄柏、知母，以除肾中燥热。
窍不利而淋，加泽泻、炒滑石。只治窍不利者，六一散中加木通亦可。心脏热者，用钱
氏方中导赤散。
中满或但腹胀者，加浓朴；气不顺，加橘皮；气滞，加青皮一、橘皮三。
气短小便利者，四君子汤中去茯苓，加黄 以补之；如腹中气不转者，更加甘草一半。
也，血虚则里急；或血气虚弱而目睛痛者，皆加当归身。
头痛者，加川芎；苦头痛，加细辛，此少阴头痛也。
发脱落及脐下痛，加熟地黄。
予平昔调理脾胃虚弱，于此五药中加减，如五脏证中互显一二证，各对证加药，无不验
，然终不能使人完复，后或有因而再至者，亦由督、任、冲三脉为邪，皆胃气虚弱之所致也
。法虽根据证加减，执方料病，不根据《素问》法度耳，是以检讨《素问》《难经》及《黄帝针
经》中说脾胃不足之源，乃阳气不足，阴气有余，当从六气不足，升降浮沉法，随证用药治
之。盖脾胃不足，不同余脏，无定体故也。其治肝、心、肺、肾，有余不足，或补或泻，惟
益脾胃之药为切。
经云∶至而不至，是为不及，所胜妄行，所生受病，所不胜乘之也。至而不至者，谓从
后来者为虚邪，心与小肠来乘脾胃也。脾胃脉中见浮大而弦，其病或烦躁闷乱，或四肢发热
，或口干舌干咽干。盖心主火，小肠主热，火热来乘土位，乃湿热相合，故烦躁闷乱也。四
肢者，脾胃也，火乘之，故四肢发热也。饮食不节，劳役所伤，以致脾胃虚弱，乃血所生病
，主口中津液不行，故口干咽干也。病患自以为渴，医者治以五苓散，谓止渴燥，而反加
渴燥，乃重竭津液，以至危亡。经云∶虚则补其母。当于心与小肠中以补脾胃之根蒂者。甘
温之药为之主，以苦寒之药为之使，以酸味为之臣佐。以其心苦缓，急食酸以收之。心火旺
则肺金受邪，金虚则以酸补之，次以甘温及甘寒之剂，于脾胃中泻心火之亢盛，是治其本
也。
所胜妄行者，言心火旺能令母实，母者，肝木也，肝木旺则挟火势，无所畏惧而妄行也
，故脾胃先受之。或身体沉重，走疰疼痛，盖湿热相搏，而风热郁而不得伸，附着于有形也
。或多怒者，风热下陷于地中也。或目病而生内障者，脾裹血，胃主血，心主脉，脉者，血
之腑也，或云心主血，又云肝主血，肝之窍开于目也。或妄见妄闻，起妄心，夜梦亡人，四
肢满闭，转筋，皆肝木火盛而为邪也。或生痿，或生痹，或生厥，或中风，或生恶疮，或作
肾痿，或为上热下寒，为邪不一，皆风热不得升长，而木火遏于有形中也。
所生受病者，言肺受土火木之邪，而清肃之气伤。或胸满少气短气者，肺主诸气，五脏
之气皆不足，而阳道不行也。或咳嗽寒热者，湿热乘其内也。
所不胜乘之者，水乘木之妄行而反来侮土，故肾入心为汗，入肝为泣，入脾为涎，入肺
为痰。为嗽、为涕、为嚏，为水出鼻也。一说，下元土盛克水，致督、任、冲三脉盛，火旺
煎熬，令水沸腾，而乘脾肺，故痰涎唾出于口也。下行为阴汗，为外肾冷，为足不任身，为
脚下隐痛。或水附木势而上为眼涩，为眵，为冷泪，此皆由肺金之虚而寡于畏也。
夫脾胃不足，皆为血病，是阳气不足，阴气有余，故九窍不通。诸阳气根于阴血中，阴
血受火邪则阴盛，阴盛则上乘阳分，而阳道不行，无生发升腾之气也。夫阳气走空窍者也，
阴气附形质者也，如阴气附于土，阳气升于天，则各安其分也。
今所立方中，有辛甘温药者，非独用也；复有甘苦大寒之剂，亦非独用也。以火、酒二
制为之使，引苦甘寒药至顶，而复入于肾肝之下，此所谓升降浮沉之道，自耦而奇，奇而至
耦者也。（阳分奇，阴分偶。）泻阴火以诸风药，升发阳气以滋肝胆之用，是令阳气生，上出于
阴分，末用辛甘温药接其升药，使大发散于阳分，而令走九窍也。
经云∶食入于胃，散精于肝，淫气于筋。食入于胃，浊气归心，淫精于脉，脉气流经，
经气归于肺，肺朝百脉，输精于皮毛，毛脉合精，行气于腑。且饮食入胃，先行阳道，而阳
气升浮也。浮者，阳气散满皮毛；升者，充塞头顶，则九窍通利也。若饮食不节，损其胃
气，不能克化，散于肝，归于心，溢于肺，食入则昏冒欲睡，得卧则食在一边，气暂得舒，
是知升发之气不行者此也。经云∶饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺。
病患饮入胃，遽觉至脐下，便欲小便，由精气不输于脾，不归于肺，则心火上攻，使口燥咽
干，是阴气大盛，其理甚易知也。况脾胃病则当脐有动气，按之牢若痛，有是者乃脾胃虚，
无是则非也，亦可作明辨矣。
脾胃不足，是火不能生土，而反抗拒，此至而不至，是为不及也。
白术（君），人参（臣），甘草（佐），芍药（佐），黄连（使），黄 （臣），桑白皮（佐）。
诸风药皆是风能胜湿也，及诸甘温药亦可。
心火亢盛，乘于脾胃之位，亦至而不至，是为不及也。黄连（君），黄柏（臣），生地黄（臣），芍
药（佐），石膏（佐），知母（佐），黄芩（佐），甘草（佐）。
肝木妄行，胸胁痛，口苦舌干，往来寒热而呕，多怒，四肢满闭，淋溲便难，转筋，腹
中急痛，此所不胜乘之也。
羌活（佐），防风（臣），升麻（使），柴胡（君），独活（佐），芍药（臣），甘草（臣），
白术（佐），茯苓（佐），猪苓、泽泻（佐），肉桂（臣）， 本、川芎、细辛、蔓荆子、白芷、石膏、黄柏
（佐），知母、滑石。
肺金受邪，由脾胃虚弱，不能生肺，乃所生受病也。故咳嗽气短、气上，皮毛不能御寒
，精神少而渴，情惨惨而不乐，皆阳气不足，阴气有余，是体有余而用不足也。
人参（君），白
术（佐），白芍药（佐），橘皮（臣），青皮（以破滞气），黄 （臣），桂枝（佐），桔梗（引用），桑白皮（佐），甘草
（诸酸之药皆可），木香（佐），槟榔、五味子（佐，此三味除客气）。
肾水反来侮土，所胜者妄行也。作涎及清涕，唾多，溺多，而恶寒者是也。土火复之，
及三脉为邪，则足不任身，足下痛，不能践地，骨之无力，喜睡，两丸冷，腹阴阴而痛，妄
闻妄见，腰脊背胛皆痛。
干姜（君），白术（臣），苍术（佐），附子（佐炮，少许），肉桂（佐去皮，少
许），川乌头（臣），茯苓（佐），泽泻（使），猪苓（佐）。
夫饮食入胃，阳气上行，津液与气，入于心，贯于肺，充实皮毛，散于百脉。脾禀气
于胃，而灌溉四旁，营养气血者也。今饮食损胃，劳倦伤脾，脾胃虚则火邪乘之，而生大热
，当先于心分补脾之源，盖土生于火，兼于脾胃中泻火之亢甚，主生化之源；足阳明为十二经之海，主经营之气，
诸经皆禀之。言阳明，厥阴与何经相并而为病，酌中以用药，如权之在衡，在两则有在两之中，在斤则有在斤之中
也。所以言此者，发明脾胃之病，不可一例而推之，不可一途而取之，欲人知百病皆由脾胃衰而生也，毫厘之失，
则灾害立生。假如时在长夏，于长夏之令中立方，谓正当主气衰而客气旺之时也，后之处方者，当从此法加时令药，
名曰补脾胃泻阴火升阳汤。
《脏气法时升降浮沉补泻图说》
五行相生，即木、火、土、金、水，循环往复，没有尽头。只有脾脏没有固定的主令季节，它在四季（春、夏、秋、冬）的最后十八天各旺一次，以此来滋养其余四脏。所谓四季的末尾，是指辰月、戌月、丑月、未月。人的身体形态对应着九州方位：左足对应立春，位于丑位；左手对应立夏，位于辰位；右手对应立秋，位于未位；右足对应立冬，位于戌位。戌月湿气重，其本气平和，兼有温、凉、寒、热之气，在人体中由胃来对应；己土味咸，其本味为咸，兼有辛、甘、酸、苦之味，在人体中由脾来对应。脾胃相互兼化，它们的疾病治疗应当根据具体情况适宜处理，不能拘泥于固定模式；肝和肺的疾病，处于水火之间，顺传逆传的变化不同，温凉治法也不固定，应当仔细推求病因。
胃中元气充足，就能进食而不受伤，过了饭点也不会感到饥饿。如果脾胃都旺盛，就能进食且身体丰满；如果脾胃都虚弱，就不能进食且身体消瘦。有的人吃得少却肥胖，虽然肥胖但四肢无力抬举，这是因为脾实而邪气盛。又有的人善于进食却消瘦，这是因为胃中伏藏火邪于气分，所以能进食，但脾虚导致肌肉消瘦，即使吃了东西也长不出肉来。王叔和说：“多吃也会导致肌肉虚弱”，说的就是这个道理。
饮食不节制就会损伤胃，胃受损则气短、精神减少并产生大热，有时火热之气上行，只烧灼面部，《黄帝针经》说：“面部发热，是足阳明胃经的病”。胃既然病了，脾就无所禀受，脾属于死阴，不主宰时令节气，所以脾也跟着生病。形体过度劳累就会伤脾，脾病则倦怠嗜睡，四肢松弛无力，大便泄泻；脾既已病，胃就不能独自运行津液，所以胃也跟着生病。
大抵脾胃虚弱，阳气不能生长，这就好比春夏的生长命令不能施行，五脏之气也就无法生成。脾病则气机下流侵犯肾脏，土克水，导致骨乏无力，这称为“骨蚀”，使人骨髓空虚，脚不能踩地，这是阴气重叠，属于阴盛阳虚的证候。大法规定，发汗则愈，攻下则死。如果用辛甘味的药物滋养胃气，应当使其升发浮越，使生长之气旺盛。所说的“汗”，并不是真正的发汗，而是助长阳气。
胃病脉象缓，脾病脉象迟，而且病人肚脐周围有动气，按压感觉坚硬或疼痛。如果火邪侵犯土位，脉象洪缓，更有身体发热、心中烦闷不适的症状。这是阳气衰弱，不能生发，不应当在五脏常规用药法治之，而应当从《脏气法时论》中的升降浮沉补泻法来用药。
如果脉缓，病症表现为倦怠嗜睡、四肢无力、或大便泄泻，这是湿胜，用平胃散。如果脉弦，气弱自汗、四肢发热、或大便泄泻、或皮肤枯槁、头发脱落，用黄芪建中汤。如果脉虚且血弱，在四物汤中选取一味或两味药，加到主要针对显证的方剂中。如果是真气虚弱，以及气短脉弱，用四君子汤。如果有口渴，或小便闭塞涩痛，赤黄程度不一，用五苓散去桂枝，选取一二味药加到正药中。
以上五种方药，应当根据本证中伴随的症状进行加减。例如表虚自汗，春夏季节加黄芪；秋冬季节加桂枝。如果气机不运转，不要加黄芪。虽然气不运转，但脾胃中气不和的，不要去掉甘草，只需加厚朴来破滞气，但也不可多用，在五分甘草中加入一分即可。腹中胀闷，这不是腹胀，而是气散不收，可加芍药来收敛。
如果肺气短促，或不足的，加人参、白芍药。在中焦使用白芍药，可以使脾中阳气上升，使肝胆之邪不敢侵犯。如果腹中狭窄紧迫的，去掉白芍药，以及其他酸涩的药物也不可用。
腹中痛的，加甘草、白芍药，稼穑作甘，甘味属己土；曲直作酸，酸味属甲木。甲己化土，这是张仲景的妙法。腹痛兼发热，加黄芩；恶寒或腹中觉寒，加桂枝。
倦怠嗜睡，有湿，胃虚不能食，或沉重困倦，或泄泻，加苍术；自汗，加白术。
气弱的，加白茯苓、人参；气盛的，加赤茯苓、缩砂仁；气复而不能转运，有热的，微加黄连；心烦乱也加黄连。
小便少的，加猪苓、泽泻；如果汗多津液枯竭于上部，不要加这些药。因为津液要回归胃中，想要自行恢复。如果不渴而小便闭塞不通，加炒黄柏、知母。
小便涩滞的，加炒滑石；小便淋沥涩痛的，加泽泻。而且五苓散治疗口渴而小便不利，如果没有恶寒症状，不得用桂枝。
不渴而小便自利，出现幻觉妄见妄闻，这是瘀血证，用炒黄柏、知母，以清除肾中的燥热。
窍道不利而淋沥，加泽泻、炒滑石。只治疗窍道不利的，在六一散中加入木通也可以。心脏有热的，用钱乙方中的导赤散。
胸脘痞满或仅腹部胀满的，加厚朴；气不顺，加橘皮；气滞，加青皮一两、橘皮三两。
气短小便利的，在四君子汤中去掉茯苓，加黄芪来补益；如果腹中气机不运转的，再加一半量的甘草。血虚则里急；或者气血虚弱导致眼睛痛的，都加当归身。
我平时调理脾胃虚弱，就在这五个方子中加减。如果五脏证候中互现一两个症状，各自对证加药，无不灵验。然而终究不能使人完全康复，后来或有因此再次发病的，这也是因为督脉、任脉、冲脉受到邪气侵袭，都是胃气虚弱所致。治疗方法虽然根据证候加减，但执着于方剂猜测病情，不依据《素问》的法度，所以我检讨《素问》《难经》及《黄帝针经》中关于脾胃不足的原因，乃是阳气不足，阴气有余，应当从六气不足、升降浮沉的方法，随证用药治疗。大概脾胃不足，不同于其他脏腑，没有固定的体性。治疗肝、心、肺、肾的有余不足，或补或泻，唯有益脾胃的药最为切要。
经文说：“至而不至，是为不及，所胜妄行，所生受病，所不胜乘之也。”“至而不至”，是指从后面来的为虚邪，心与小肠来乘袭脾胃。脾胃脉中见到浮大而弦的脉象，病症或是烦躁闷乱，或是四肢发热，或是口干舌干咽干。大概心主火，小肠主热，火热来乘袭土位，乃是湿热相合，所以烦躁闷乱。四肢属于脾胃，火邪乘袭它，所以四肢发热。饮食不节，劳役所伤，导致脾胃虚弱，这是血所生的病，主管口中津液不行，所以口干咽干。病患自以为渴，医生用五苓散治疗，说是止渴燥，反而加重了渴燥，这是双重耗竭津液，以至于危亡。经文说：“虚则补其母。”应当在心与小肠中补益脾胃的根本。以甘温的药为主，以苦寒的药为使，以酸味的药为臣佐。因为心气易缓，急需食用酸味来收敛它。心火旺则肺金受邪，金虚则以酸味补之，其次用甘温及甘寒的药剂，在脾胃中泻心火的亢盛，这是治本。
“所胜妄行”，是说心火旺能使母亲（肝木）实，母亲是肝木，肝木旺则挟带火势，无所畏惧而妄行，所以脾胃先受其害。或是身体沉重，走注疼痛，大概是湿热相搏，风热郁结而不能伸展，附着于有形之体。或是多怒，是风热下陷于地中。或是眼病而生内障，脾裹血，胃主血，心主脉，脉是血的府库，有人说心主血，又有人说肝主血，肝的窍开于目。或是妄见妄闻，起妄心，夜间梦见死人，四肢满闭，转筋，都是肝木火盛而为邪。或是生痿证，或是生痹证，或是生厥证，或是中风，或是生恶疮，或是作肾痿，或是上热下寒，邪气不一，都是风热不能升长，而木火遏阻在有形之中。
“所生受病”，是说肺受土、火、木之邪，清肃之气受伤。或是胸满少气短气的，肺主诸气，五脏之气皆不足，而阳道不行。或是咳嗽寒热的，湿热乘袭其内。
“所不胜乘之”，是水乘木之妄行而反来侮土，所以肾入心为汗，入肝为泣，入脾为涎，入肺为痰。表现为嗽、涕、嚏，水从鼻出。另一种说法，下元土盛克水，导致督、任、冲三脉盛，火旺煎熬，令水沸腾，而乘袭脾肺，所以痰涎唾出于口。下行则为阴汗，外肾冷，脚不能支撑身体，脚下隐痛。或是水附木势而上，导致眼涩，眵多，冷泪，这都是由于肺金之虚而缺乏畏惧（制约）。
大概脾胃不足，皆为血病，是阳气不足，阴气有余，所以九窍不通。诸阳气根于阴血中，阴血受火邪则阴盛，阴盛则上乘阳分，而阳道不行，没有生发升腾之气。阳气走空窍，阴气附形质，如阴气附于土，阳气升于天，则各安其分。
现在所立的方剂中，有辛甘温药的，不是单独使用；也有甘苦大寒的药剂，也不是单独使用。用火、酒两种方法炮制作为引导，引苦甘寒药至头顶，再进入肾肝之下，这就是所谓的升降浮沉之道，自耦变奇，奇而至耦。（阳分属奇，阴分属偶。）用各种风药泻阴火，升发阳气以滋助肝胆之用，这是让阳气生发，向上出于阴分，最后用辛甘温药承接其升药，使其大发散于阳分，从而通达九窍。
经文说：“食入于胃，散精于肝，淫气于筋。食入于胃，浊气归心，淫精于脉，脉气流经，经气归于肺，肺朝百脉，输精于皮毛，毛脉合精，行气于腑。”而且饮食入胃，先行阳道，而阳气升浮。浮，是阳气散布充满皮毛；升，是充塞头顶，则九窍通利。如果饮食不节，损伤胃气，不能消化，散于肝，归于心，溢于肺，食入则昏冒欲睡，躺下则食物停在一边，气暂时得以舒展，可知这是升发之气不行的缘故。经文说：“饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺。”病患饮水入胃，立刻觉得到达脐下，就想小便，是因为精气不输送给脾，不归还给肺，则心火上攻，使口燥咽干，这是阴气大盛，道理很容易知晓。况且脾胃病则当脐有动气，按压坚硬或疼痛，有这样的就是脾胃虚，没有就不是，这也足以明辨了。
脾胃不足，是火不能生土，而反抗拒，这是“至而不至”，是为不及。
白术（君药），人参（臣药），甘草（佐药），芍药（佐药），黄连（使药），黄芪（臣药），桑白皮（佐药）。
各种风药都是风能胜湿，以及各种甘温药也可以。
心火亢盛，乘袭脾胃之位，也是“至而不至”，是为不及。
黄连（君药），黄柏（臣药），生地黄（臣药），芍药（佐药），石膏（佐药），知母（佐药），黄芩（佐药），甘草（佐药）。
肝木妄行，胸胁痛，口苦舌干，往来寒热而呕，多怒，四肢满闭，淋溲便难，转筋，腹中急痛，这是“所不胜乘之”。
羌活（佐药），防风（臣药），升麻（使药），柴胡（君药），独活（佐药），芍药（臣药），甘草（臣药），白术（佐药），茯苓（佐药），猪苓、泽泻（佐药），肉桂（臣药），藁本、川芎、细辛、蔓荆子、白芷、石膏、黄柏（佐药），知母、滑石。
肺金受邪，由脾胃虚弱，不能生肺，是“所生受病”。所以咳嗽气短、气上逆，皮毛不能御寒，精神少而渴，心情凄惨而不乐，都是阳气不足，阴气有余，是体有余而用不足。
人参（君药），白术（佐药），白芍药（佐药），橘皮（臣药），青皮（以破滞气），黄芪（臣药），桂枝（佐药），桔梗（引用药），桑白皮（佐药），甘草（所有酸味药皆可），木香（佐药），槟榔、五味子（佐药，这三味除客气）。
肾水反来侮土，是“所胜者妄行”。表现为作涎及清涕，唾多，溺多，而恶寒。土火复之，及三脉为邪，则脚不能支撑身体，脚下痛，不能践地，骨之无力，喜睡，两丸冷，腹阴阴而痛，妄闻妄见，腰脊背胛皆痛。
干姜（君药），白术（臣药），苍术（佐药），附子（佐药，炮制，少许），肉桂（佐药，去皮，少许），川乌头（臣药），茯苓（佐药），泽泻（使药），猪苓（佐药）。
饮食入胃，阳气上行，津液与气，入于心，贯于肺，充实皮毛，散于百脉。脾禀受气于胃，而灌溉四旁，营养气血。现在饮食损伤胃，劳倦伤脾，脾胃虚则火邪乘袭之，而生大热，应当先在心的分位补脾之源，盖土生于火，兼于脾胃中泻火之亢甚，主生化之源；足阳明胃经为十二经之海，主经营之气，诸经都禀受它。言阳明，厥阴与何经相并而为病，斟酌中间以用药，如秤锤在秤杆上，在两则有在两之中，在斤则有在斤之中。所以说这些，是为了阐明脾胃的病，不可一例而推之，不可一途而取之，想让人知道百病皆由脾胃衰而生也，毫厘之差，灾害立即发生。假如时在长夏，在长夏的命令中立方，谓正当主气衰而客气旺的时候。后来的处方者，应当从此法加时令药，名叫补脾胃泻阴火升阳汤。
"Diagram and Explanation of Ascending, Descending, Floating, and Sinking Tonification and Purging According to Viscera Qi and Time"
The Five Elements generate each other: Wood, Fire, Earth, Metal, Water. They cycle endlessly without beginning or end. Only the Spleen (Zang organ responsible for transformation and transportation) has no fixed ruling season; it prospers for eighteen days at the end of each of the four seasons (Spring, Summer, Autumn, Winter), thereby nourishing the other four Zang organs. The ends of the four seasons refer to the months of Chen, Xu, Chou, and Wei. The human body corresponds to the Nine Regions (geographical divisions in ancient Chinese cosmology): the left foot corresponds to Start of Spring, located in the position of Chou; the left hand corresponds to Start of Summer, located in the position of Chen; the right hand corresponds to Start of Autumn, located in the position of Wei; the right foot corresponds to Start of Winter, located in the position of Xu. The month of Xu is heavy with Dampness (a pathogenic factor characterized by heaviness and stagnation); its primary Qi is balanced, while it combines with Warm, Cool, Cold, and Hot qualities. In the human body, this corresponds to the Stomach (organ responsible for receiving and ripening food). The Ji Earth flavor is salty as its primary taste, combining with Pungent, Sweet, Sour, and Bitter flavors; in the human body, this corresponds to the Spleen. The Stomach and Spleen transform jointly; their diseases should be treated according to appropriateness, not rigidly defined. Diseases of the Liver and Lung lie between Water and Fire; their transmission (forward or backward) differs, and warm or cool treatments are not fixed; one must seek the root cause.
If Yuan Qi (original vital energy) in the Stomach is abundant, one can eat without injury and feel no hunger even after the meal time. If both Stomach and Spleen are strong, one can eat and become plump; if both are deficient, one cannot eat and becomes thin. Some people eat little but are fat; although fat, their limbs cannot lift, because the Spleen is excess and pathogenic factors are strong. Others eat well but remain thin; this is because Stomach Fire Evil (pathogenic heat) is hidden in the Qi level, allowing them to eat, but Spleen deficiency causes muscle wasting, so even eating does not build flesh. Shuhe said, "Eating much also leads to muscle emptiness," which refers to this.
Irregular diet damages the Stomach; Stomach damage leads to shortness of breath, reduced spirit, and generation of intense Heat. Sometimes Fire Qi ascends, burning only the face. The *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture) states: "Facial heat indicates disease of the Foot Yangming channel." Once the Stomach is diseased, the Spleen receives nothing; the Spleen belongs to Yin Death (a state where Yin dominates and Yang is absent), does not govern seasonal timing, and thus also becomes diseased. Physical overexertion damages the Spleen; Spleen disease leads to lethargy, desire to sleep, flaccidity of the four limbs, and diarrhea. Once the Spleen is diseased, the Stomach cannot independently transport Body Fluids (Jin-Ye), so the Stomach also becomes diseased.
Generally, when Spleen and Stomach are weak, Yang Qi cannot grow; this is like the commands of Spring and Summer failing to operate, causing the Qi of the five Zang organs not to generate. Spleen disease causes Qi to flow downward and attack the Kidney; Earth overcoming Water leads to bone weakness and fatigue, termed "Bone Erosion," causing empty marrow and inability to stand on feet. This is overlapping Yin Qi, a syndrome of Yin Excess and Yang Deficiency. The general rule states: sweating cures it, purging kills it. Using Pungent and Sweet medicines to nourish Stomach Qi should promote ascending and floating, making the growing Qi vigorous. The term "sweat" here does not mean actual diaphoresis, but assisting Yang Qi.
Stomach disease presents with a slow pulse; Spleen disease presents with a delayed pulse. Moreover, there is moving Qi at the navel, hard and painful upon pressure. If Fire attacks the Earth position, the pulse is surging and slow, accompanied by fever and central chest discomfort. This is due to weak Yang Qi unable to generate and ascend; treatment should not follow standard Zang organ methods but should use the ascending, descending, floating, and sinking tonification and purging methods from the *Zangqi Fashi Lun*.
If the pulse is slow, with symptoms of lethargy, limb flaccidity, or diarrhea, this is Dampness Excess; use Pingwei San (Regularize the Stomach Powder). If the pulse is wiry, with weak Qi, spontaneous sweating, limb fever, diarrhea, dry skin, or hair loss, use Huangqi Jianzhong Tang (Astragalus Decoction for Building the Middle). If the pulse is empty and Blood is weak, select one or two herbs from Siwu Tang (Four Substance Decoction) and add them to the main formula addressing the prominent symptoms. For True Qi deficiency, shortness of breath, and weak pulse, use Sijunzi Tang (Four Gentlemen Decoction). For thirst or obstructed, painful, yellow-red urination, use Wuling San (Five-Ingredient Powder with Poria) minus Guizhi (Cinnamon Twig), adding one or two herbs to the main formula.
These five formulas should be modified based on accompanying symptoms. For example, for exterior deficiency with spontaneous sweating: add Huangqi (Astragalus Root) in Spring/Summer; add Guizhi (Cinnamon Twig) in Autumn/Winter. Do not add Huangqi if Qi circulation is stagnant. Although Qi may not circulate, if Middle Jiao Qi is disharmonious, do not remove Gancao (Licorice Root); instead, add Houpo (Magnolia Bark) to break Qi stagnation, but not in large amounts—one part Houpo to five parts Gancao is sufficient. For abdominal fullness that is not distension but rather scattered Qi failing to gather, add Shaoyao (Peony Root) to astringe.
For shortness of lung Qi or insufficiency, add Renshen (Ginseng Root) and Baishao (White Peony Root). Using Baishao in the Middle Jiao raises Spleen Yang, preventing Liver and Gallbladder pathogens from invading. Remove Baishao if the abdomen feels narrow and tight; other sour/astringent herbs are also contraindicated.
For abdominal pain, add Gancao (Licorice Root) and Baishao (White Peony Root). "Acres and harvests make Sweet"; Sweet belongs to Ji Earth. "Bending and straightening make Sour"; Sour belongs to Jia Wood. Jia and He transform into Earth; this is Zhang Zhongjing's subtle method. For abdominal pain with fever, add Huangqin (Scutellaria Root). For aversion to cold or feeling cold in the abdomen, add Guizhi (Cinnamon Twig).
For lethargy, desire to sleep, dampness, Stomach deficiency with anorexia, heaviness, or diarrhea, add Cangzhu (Atractylodes Rhizome). For spontaneous sweating, add Baizhu (Atractylodes Macrocephala Rhizome).
For difficult urination, add Fuling (Poria); add it also for thirst.
For weak Qi, add Baifuling (White Poria) and Renshen (Ginseng Root). For excessive Qi, add Chifuling (Red Poria) and Suosharen (Amomum Fruit). For Qi recurrence but failure to transport, with Heat, add a small amount of Huanglian (Coptis Rhizome); add it also for mental restlessness.
For scanty urine, add Zhuling (Polyporus) and Zexie (Alisma Rhizome). Do not add these if sweating is profuse and fluids are exhausted above, as fluids intend to return to the Stomach naturally. If there is no thirst but urinary obstruction, add fried Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome).
For astringent, difficult urination, add fried Hutong (Talcum). For dribbling, astringent urination, add Zexie (Alisma Rhizome). Note: Wuling San treats thirst with difficult urination; if there is no aversion to cold, Guizhi (Cinnamon Twig) must not be used.
If there is no thirst but urination is free, with hallucinations, this is a Blood Stasis syndrome; use fried Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) to clear Kidney Dryness-Heat.
For orifice obstruction leading to dribbling, add Zexie (Alisma Rhizome) and fried Hutong (Talcum). To treat only orifice obstruction, add Mutong (Akebia Caulis) to Liuyi San (Six-to-One Powder). For Heart Heat, use Daochi San (Guide Out Redness Powder) from Qian Shi's formulas.
For epigastric fullness or abdominal distension alone, add Houpo (Magnolia Bark). For unsmooth Qi, add Ju pi (Citrus Peel). For Qi stagnation, add Qingpi (Green Citrus Peel) 1 part and Ju pi (Citrus Peel) 3 parts.
For shortness of breath with frequent urination, remove Fuling (Poria) from Sijunzi Tang (Four Gentlemen Decoction) and add Huangqi (Astragalus Root) to tonify; if abdominal Qi does not circulate, add half the amount of Gancao (Licorice Root). For Blood deficiency causing interior urgency, or eye pain due to Qi/Blood weakness, all add Danggui Shen (Angelica Sinensis Root Body).
For headache, add Chuanxiong (Ligusticum Rhizome). For severe headache, add Xixin (Asarum Root), which indicates Shaoyin headache.
For hair loss and pain below the navel, add Shudihuang (Prepared Rehmannia Root).
In my usual regulation of Spleen/Stomach weakness, I modify within these five formulas. If one or two symptoms from the five Zang syndromes appear together, adding herbs accordingly is always effective. However, complete recovery is rarely achieved; relapses occur due to pathogens affecting the Du, Ren, and Chong vessels, caused by weak Stomach Qi. Although treatment follows symptom modification, relying solely on formulas without adhering to *Suwen* principles is flawed. Therefore, I reviewed *Suwen*, *Nanjing*, and *Huangdi Zhenjing*: the source of Spleen/Stomach insufficiency is insufficient Yang Qi and excess Yin Qi. Treatment should follow the six Qi insufficiency and ascending/descending/floating/sinking methods. Spleen/Stomach insufficiency differs from other Zang organs as it lacks a fixed form. Treating Liver, Heart, Lung, Kidney excess or deficiency via tonification or purging is best achieved by benefiting the Spleen and Stomach.
The Canon states: "Arrival without arrival is insufficiency; the overcome element acts recklessly; the generated element suffers disease; the overcoming element attacks." "Arrival without arrival" refers to Empty Pathogens coming from behind; Heart and Small Intestine attacking Spleen/Stomach. In Spleen/Stomach pulses, floating, large, and wiry qualities appear. Symptoms include irritability, confusion, limb fever, dry mouth/tongue/throat. Heart governs Fire; Small Intestine governs Heat. Fire/Heat attacking Earth combines with Dampness, causing irritability. Limbs belong to Spleen/Stomach; Fire attacking them causes limb fever. Irregular diet and overwork cause Spleen/Stomach weakness, leading to Blood disorders, failure of oral fluids, and dry mouth/throat. Patients may feel thirsty; if doctors treat with Wuling San to stop thirst/dryness, they worsen the condition by depleting fluids further, leading to danger. The Canon says: "Deficiency tonifies the Mother." One should tonify the root of Spleen/Stomach via Heart/Small Intestine. Use Sweet-Warm herbs as Sovereign, Bitter-Cold as Envoy, Sour as Ministers/Assistants. Since Heart dislikes laxity, use Sour to astringe. When Heart Fire is hyperactive, Lung Metal suffers; tonify Metal with Sour, then use Sweet-Warm/Cold to purge Heart Fire in Spleen/Stomach, treating the root.
"Overcome element acts recklessly": Hyperactive Heart Fire makes the Mother (Liver Wood) excess. Liver Wood, carrying Fire, acts recklessly without fear, first affecting Spleen/Stomach. Symptoms include heavy body, wandering pain (Damp-Heat clashing with Wind-Heat郁结), anger (Wind-Heat sinking), eye diseases/internal cataracts (Spleen envelops Blood, Stomach governs Blood, Heart governs Pulse/Vessels, Liver opens to eyes), hallucinations, nightmares, limb fullness/closure, spasms—all due to Liver Wood/Fire excess. Also atrophy, Bi syndrome, Jue syndrome, stroke, malignant sores, Kidney atrophy, upper Heat/lower Cold—all due to Wind-Heat failing to ascend, blocked by Wood/Fire in有形 forms.
"Generated element suffers disease": Lung suffers Earth/Fire/Wood pathogens, damaging Clear/Pure Qi. Symptoms include chest fullness, shortness of breath (Lung governs all Qi; Zang Qi insufficient, Yang pathway blocked); cough/chills-fever (Damp-Heat invading internally).
"Overcoming element attacks": Water attacks Wood's recklessness and insults Earth. Kidney affects Heart as sweat, Liver as tears, Spleen as saliva, Lung as phlegm. Symptoms include cough, mucus, sneezing, nasal discharge. Another view: Lower Yuan Earth excess overcomes Water, causing Du/Ren/Chong vessels to surge; Fire boils Water, attacking Spleen/Lung, producing saliva/phlegm. Downward flow causes Yin sweat, cold external genitals, inability to bear weight, foot pain. Upward flow with Wood causes dry eyes, discharge, cold tears—all due to Lung Metal deficiency lacking restraint.
Spleen/Stomach insufficiency involves Blood disorders, Yang insufficiency, Yin excess, blocking the nine orifices. Yang Qi roots in Yin Blood; Yin Blood受热 causes Yin excess, attacking Yang levels, blocking Yang pathways, preventing ascending Qi. Yang Qi moves through orifices; Yin Qi attaches to form. Like Yin attaching to Earth and Yang rising to Heaven, each finds its place.
Current formulas use Pungent-Sweet-Warm herbs not alone; Bitter-Cold-Huge-Cold herbs are also not used alone. Fire and Wine processing guide Bitter-Sweet-Cold herbs to the head and back to Kidney/Liver. This is the way of ascending/descending/floating/sinking, changing from Even to Odd, Odd to Even. (Yang is Odd, Yin is Even.) Purge Yin Fire with Wind herbs; raise Yang Qi to benefit Liver/Gallbladder function, allowing Yang to rise from Yin. Finally, use Pungent-Sweet-Warm herbs to catch the ascending action, dispersing vigorously in Yang levels to reach the nine orifices.
The Canon states: "Food enters Stomach, scatters essence to Liver, floods tendons. Food enters Stomach, turbid Qi returns to Heart, floods vessels. Vessel Qi flows through channels, channel Qi returns to Lung. Lung faces hundred vessels, transmits essence to skin/hair. Skin/vessel essence combines, moves Qi through Fu organs." Diet enters Stomach, first travels Yang pathway, Yang Qi floats/rises. Floating spreads Yang to skin/hair; Rising fills head, opening nine orifices. Irregular diet damages Stomach Qi, preventing digestion/scattering to Liver, returning to Heart, overflowing to Lung. Eating causes drowsiness; lying down lets food settle, Qi temporarily relaxes. This shows ascending Qi fails. The Canon states: "Drink enters Stomach, overflows essence/Qi, uploads to Spleen. Spleen scatters essence, returns to Lung." If drink enters Stomach and immediately reaches below navel, triggering urination, it means essence did not upload to Spleen or return to Lung. Heart Fire attacks upward, causing dry mouth/throat—Yin excess is obvious. Spleen/Stomach disease presents with moving Qi at navel, hard/painful on pressure; presence confirms Spleen/Stomach deficiency.
Spleen/Stomach insufficiency is Fire failing to generate Earth, leading to rejection—"arrival without arrival," insufficiency.
Baizhu (Sovereign), Renshen (Minister), Gancao (Assistant), Shaoyao (Assistant), Huanglian (Envoy), Huangqi (Minister), Sangbaipi (Assistant).
All Wind herbs dispel Dampness; Sweet-Warm herbs also work.
Heart Fire hyperactivity attacking Spleen/Stomach is also "arrival without arrival," insufficiency.
Huanglian (Sovereign), Huangbai (Minister), Shengdihuang (Minister), Shaoyao (Assistant), Shigao (Assistant), Zhimu (Assistant), Huangqin (Assistant), Gancao (Assistant).
Liver Wood acting recklessly: hypochondriac pain, bitter taste, dry tongue, alternating chills/fever, vomiting, anger, limb fullness/closure, difficult urination/stool, spasms, acute abdominal pain. This is "overcoming element attacks."
Qianghuo (Assistant), Fangfeng (Minister), Shengma (Envoy), Chaihu (Sovereign), Duhuo (Assistant), Shaoyao (Minister), Gancao (Minister), Baizhu (Assistant), Fuling (Assistant), Zhuling/Zexie (Assistant), Rougui (Minister), Gaoben/Chuanxiong/Xixin/Manjingzi/Baizhi/Shigao/Huangbai (Assistant), Zhimu/Hutong.
Lung Metal suffering pathogens due to Spleen/Stomach weakness failing to generate Lung is "generated element suffers disease." Symptoms: cough, shortness of breath, Qi rebellion, skin unable to resist cold, low spirit, thirst, depression—all Yang insufficiency, Yin excess, substance excess but function insufficiency.
Renshen (Sovereign), Baizhu (Assistant), Baishaoyao (Assistant), Ju pi (Minister), Qingpi (breaks stagnation), Huangqi (Minister), Guizhi (Assistant), Jiegeng (guide), Sangbaipi (Assistant), Gancao (any Sour herb works), Muxiang (Assistant), Binglang/Wuweizi (Assistant, removes external Qi).
Kidney Water insulting Earth, "overcome element acts recklessly": saliva, clear mucus, excessive salivation/urination, aversion to cold. Earth/Fire retaliation and Three Vessel pathogens cause inability to bear weight, foot pain, bone weakness, somnolence, cold testicles, dull abdominal pain, hallucinations, back/spine pain.
Ganjiang (Sovereign), Baizhu (Minister), Cangzhu (Assistant), Fuzi (Assistant, processed, small amount), Rougui (Assistant, peeled, small amount), Chuanwutou (Minister), Fuling (Assistant), Zexie (Envoy), Zhuling (Assistant).
Diet enters Stomach, Yang Qi rises, fluids/Qi enter Heart, penetrate Lung, fill skin/hair, scatter to hundred vessels. Spleen receives Qi from Stomach, irrigates four sides, nourishes Qi/Blood. Now diet damages Stomach, fatigue damages Spleen; Spleen/Stomach weakness allows Fire Evil to attack, generating intense Heat. First tonify Spleen source via Heart division, as Earth is born from Fire. Simultaneously purge excessive Fire in Spleen/Stomach to maintain the source of transformation/generation. Foot Yangming is the Sea of Twelve Channels, governing managing Qi; all channels rely on it. Discussing Yangming and Jueyin combined with other channels determines medication, like a weight on a scale. This emphasizes that Spleen/Stomach diseases cannot be generalized; a slight error brings disaster. All diseases arise from Spleen/Stomach decline. If prescribing in Late Summer, when dominant Qi is weak and guest Qi is strong, add seasonal herbs. This formula is named Buy Piwei Xie Yinhuo Shengyang Tang (Tonify Spleen-Stomach, Purge Yin Fire, Raise Yang Decoction).