大意
饮食自倍。肠胃乃伤。（内经）一或有伤。脾胃便损。饮食减少。元气渐惫。（杂着）
内因
有过食生冷瓜果鱼腥寒物者。有过食辛辣炙爆酒面热物者。有壮实人恣食大嚼者。有虚弱人贪食不
化者。（指掌）有饮食不调之后。加之劳力。劳力过度之后。继以不调者。（安道）
外候
令人腹胀气逆。胸膈痞塞。咽酸噫气。如败卵臭。或呕逆恶心。欲吐不吐。恶闻食气。或胃口作痛。或手按腹
疼。或泄泻黄白而绞痛尤甚。或憎寒壮热头疼。似外感疟疾。但外感则身多疼痛。左脉浮盛。伤食则身无
疼痛。右脉滑大。（汇补）亦有旧谷未消。新谷遽入。脾气虚弱。经宿不化者。（巢氏）其有热者。令人吞酸。其无热
者。令人噫臭。（吴 ）
脉法
气口紧盛伤于食。（内经）右关浮滑。或沉滑。按之有力者。宿食不消。（脉经）凡人上部有脉。下部无脉。当问其
胸满恶心欲吐欲呕者。此食填胸中。气不下降。故尺部无脉。乃天道不能下济之象。探吐自愈。如胸中无
食。又不欲吐。而尺无脉者。此根本已废。短期迫矣。又停食脉沉滑。伤冷硬物。宜温以克之。脉洪数。伤辛热
物。宜苦以胜之。脉缓滑。伤腥咸物。宜甘以胜之。脉弦紧。伤酸硬物。宜辛以胜之。脉洪滑。伤甜烂物。宜酸以
胜之。脉微迟。伤冷物。且有积聚痰涎。宜温剂和之。若见单伏者。主食不化。且有外寒凝滞。宜辛温发之。（汇补）
治法
在上者。未入于胃。乃可吐之。在中者。消导之。在下者。已入于胃。宜下之。（玉册）然皆不可过剂。恐损元气也。
（汇补）
峻剂宜戒
肠胃为市。所伤食物。过在中焦。设用破气之剂。徒损上焦清气。峻烈之品。复伤下焦阴血。皆谓之诛伐无
过。惟当顺气化痰。助脾腐化。更视元气何如。所伤何物。徐徐消导。润而去之。滞去之后。犹当补养脾胃。以
复健运之常。若概用牵牛、巴、黄。损伤脾气。潜耗津液。积聚转固。而药之余毒留于肠胃。渐变呕吐肿泄痿
黄。即或临时痊可。而暗夺其纪者多矣。（汇补）
挟寒挟热
其有身受寒气。口伤生冷而暴病者。初时便宜辛温开导。盖食得寒则凝。得热则化也。稍久寒郁成热。当
兼一二辛凉降火之味。（丹溪）所以伤食之人。腹痛日久。时作时止。口干唇燥。小便短赤。大便干结。亦有泄
泻黄糜。肛门如火者。皆湿中生热之症。反以苦寒取效。可见伤食亦有挟寒挟热之异。犹之外感有寒实
结胸热实结胸之别。故凡临症之顷。大宜审察。（汇补）
伤食成痞
食伤之后。物滞虽消。元气受损。或已经攻下而脾阴受伤。至高之气乘虚下陷而为蓄满痞塞者。宜理脾
胃。和气血。治以辛发升散之剂。则痞结自解。不可再用枳、朴等类。重损中州。（入门）
脾虚甘补
平人饮食入胃。脾能运之。故随食随化。病患饮食入胃。脾勿能运。则食反磨脾。故有食入即痛者。不可与
伤食同治。致变不测。但补脾胃。其食自化。（汇补）
肾虚温补
饮食虽入中焦。其变化精微。实赖少火上蒸。中年之后。大病之余。元阳亏损。不能熟腐。因而衰馁。易于停
食。作痞作痛。为呕为泻。宜补火以生土。譬之锅底加薪。水谷尽熟也。（玉机）
胃枯平补
又有专事清虚。素食粗 。肠胃无以滋养。久久枯涩。易于停食。治者不求其本。喜攻速效。妄用辛香燥热。
徒快一时。变生噎膈臌胀。背痈嗽脓等症。若早知胃枯。但与平补。久而自效。（汇补）
用药
食填上焦。宜单盐汤。或二陈汤加桔梗芦吐之。吐后。以二陈加香砂和之。食停在中。保和丸主之。肉食伤。
加草果、山楂。面伤。加神曲、莱菔。水果伤。加肉桂。豆粉伤。加杏仁。瓜 伤。加糯米。糯米伤。加酒曲。饭食伤。
加陈六安茶。炙 伤。加淡豆豉。外着暴寒。加苏叶、干葛。内伤生冷。加干姜、桂枝。挟气滞。加木香、乌药、枳壳、
槟榔。挟寒湿。加苍术、浓朴。久而挟郁热。加姜汁炒山栀。郁热便秘者。加大黄。挟热便泻者。加黄连炭。如初起
自吐者。二陈加藿香、豆蔻、浓朴、砂仁。自泻者。二陈加白芍、木香、木通、神曲。吐下未净者。枳术丸消之。吐下
已虚者。六君子补之。至于伤食感寒腹痛。有用备急丸攻下者。有用理中汤温补者。虚实之间。最当详辨。
久病不运化者。以六君子加谷芽、益智、砂仁之类。
凡伤食。必问所食何物。寒者热者。是喜食而太过耶。当助脾消导。或乘饥困而食之耶。当补中益气。是气
恼后得食。或食后着气耶。当舒气解郁。兼以消化。若病后。疮溃后。产妇高年。凡有食滞。只宜补益消化。若
概用攻下。立见倾危。凡左脉微弱。右脉弦滑。或弦大。形气俱虚。又兼饥馁。骤得饮食。食而过节者。此不
足中有余也。以受伤言不足。以停滞言有余也。故标本当审缓急。更有物停气伤。宜消补兼行者。有物停
气不甚伤。当消导独行者。有既停滞。不能自化。但须补脾使之营运。不必消导者。当临时消息。不可一偏。
至如枳术丸。虽曰消导。固有补益之功存乎其间。和中最妙。其他如木香分气丸、枳实消导丸、大枳壳丸。
虽无补益。然施于有余实症。无不获效。但不可视为常法。若所滞之物。非枳术丸等所能去者。安可泥常
而不通变。则备急丸、煮黄丸、感应丸、瓜蒂散等。东垣丹溪亦未常委之勿用也。（安常）
【附恶食】
恶食非止一端。有胸中痰滞者。宜导痰以助脾。有伤食恶食者。宜消化以助脾。有病久胃虚者。宜参术以
健脾。（汇补）
【附不能食】
不能食有虚有实。实则心下痞满。恶心口苦。宜消导。虚则倦怠。面色痿黄。必心下软和。宜异功散加砂仁。
有虚痰者。六君子汤。用补脾不效者。宜二神丸。虚则补其母也。若善饥不能食。属胃热。脉洪而虚者。异功
散加竹茹、黄连。脉洪而实者。人参白虎汤治之。（汇补）
伤食选方
保和丸（丹溪） 治食积酒积。
山楂肉（二两） 半夏 橘红 神曲 大麦芽 白茯苓（各二两） 黄连 莱菔子 连翘（各五钱）
末之。滴水丸。白汤下。加白术。名大安丸。
枳术丸（洁古） 消食强胃。治痞宽胸。
枳实（一两） 白术（二两）
末之。荷叶裹烧饭为丸。陈茶姜汤任下。
三黄枳实丸 治食郁成热。腹胀便秘壮实者。
大黄 黄连 黄芩 白术 陈皮 枳实 神曲
各等分。末糊丸。姜汤下。以利为度。
枳实导滞丸 行湿热之物。去积滞闷痛。
大黄（十两） 神曲（五两） 枳实（五两） 茯苓 黄芩 白术 黄连（各二两半） 甘草（一两） 泽泻（二
两）
炊饮丸。
和中丸 治胃虚食滞。厌厌不食。大便或秘或溏。
浓朴（一两） 白术（一两二钱） 半夏（一两） 陈皮（八钱） 木香（二钱半） 甘草（三钱） 枳实（三钱）
姜汁糊丸。桐子大。每服三四十丸。白汤下。
备急丸 治胃停生冷。心腹急痛。手不可按。右寸关脉紧盛者。
大黄 干姜 巴豆（各等分）
末之。蜜丸如豆大。姜汤下三丸。得吐利为度。此方并治中恶客忤。心腹胀痛。卒如刀刺。气急口噤卒
死者。以暖水下。或不下。捧起头。得下咽。须臾便瘥。再与三丸。以腹中鸣转。得吐下。即愈。
感应丸 化积化滞。不动脏腑。
丁香 木香 肉果 干姜（各一两） 杏仁（一百四十粒） 百草霜（二两） 巴豆（去皮膜七十粒）
同研入药内和匀。加糯米糊。入药杵千余下。丸如莱菔子大。每服十丸。食滞。陈皮汤。气滞。茴香汤。呕吐。
生姜汤下。
大枳壳丸 治一切酒食伤胃。胸膈闷痛。饮食不下。两胁刺痛。呕逆恶心。
蓬术 浓朴 人参 青皮 黑牵牛 枳壳 茯苓 木香（各一两） 大黄（二两） 陈皮 白术（各一两） 槟榔 半
夏神曲（各三两） 三棱 麦芽（各一两）
姜汁糊丸。
资生丸（缪仲淳） 健脾开胃。消食止泻。调和脏腑。醉饱之后服之。大能消食。
白术（三两） 人参（三两） 茯苓（一两半） 陈皮（二两） 山楂肉（二两） 神曲（二两） 黄连（姜汁炒）
豆蔻 泽泻（各三钱） 桔梗 炙甘草 藿香（各五钱） 白扁豆（一两） 莲肉（一两） 薏苡仁（三两） 山药 麦
芽芡实（各一两半）
炼蜜为丸。每丸重二钱。每服一丸。醉饱后。细嚼。淡姜汤下。
大健脾丸
白术（三两） 广皮（一两） 黄连（八钱） 木香（七钱半） 人参（一两半） 山药
肉果（各一两） 甘草（七钱） 山楂肉 神曲 砂仁 谷芽（炒各一两） 茯苓（二两）
为末。蒸饼丸。如绿豆大。空心。午后陈皮汤下五十丸。
平胃散 人参白虎汤（二方俱见暑症） 理中汤（方见中寒）
二神丸
补骨脂（炒四两） 肉果（二两生用）
为末。枣子五十枚。生姜四两。同切片。煮烂。去姜取枣。剥去皮核。以肉研入药。和丸桐子大。每服三四十丸。
二陈汤 瓜蒂散（二方俱见痰症） 异功散（方见血症） 六君子汤（方见中风）
【大意】
饮食过量一倍，肠胃就会受到损伤。（出自《内经》）一旦有伤食的情况，脾胃功能就会受损，导致食欲减退，元气逐渐衰弱。（出自《杂着》）
【内因】
有过量食用生冷瓜果、鱼腥等寒凉食物的人；有过量食用辛辣、烧烤、酒类、面食等热性食物的人；有身体壮实之人放纵饮食、大口吞咽的人；有身体虚弱之人贪吃难以消化食物的人。（出自《指掌》）有在饮食不规律之后，又加上过度劳累；或在过度劳累之后，继以饮食不调的人。（出自《安道》）
【外候】
（伤食）会导致腹部胀满、气机上逆，胸膈部痞塞不通，咽喉泛酸、打嗝，气味像腐烂的鸡蛋。或者出现呕吐恶心，想吐却吐不出来，厌恶闻到食物的气味。或者胃脘部疼痛，或者用手按压腹部时感到疼痛。或者出现腹泻，大便呈黄白色，且绞痛特别严重。或者出现怕冷和高热、头痛，症状类似外感疟疾。但是，外感病通常身体多处疼痛，左脉浮盛；而伤食则身体没有疼痛感，右脉滑大。（出自《汇补》）也有旧的食物尚未消化，新的食物就进入体内，脾气虚弱，经过一夜仍不能消化的情况。（出自《巢氏病源》）其中有热邪的，会导致吞酸；没有热邪的，会导致打嗝有臭味。（出自《吴医汇讲》）
【脉法】
气口脉紧盛，是伤于食的表现。（出自《内经》）右关脉浮滑，或沉滑，按之有力，是宿食不消的表现。（出自《脉经》）凡是人体上部有脉，下部无脉，应当询问是否有胸满、恶心、想吐的症状。这是因为食物填塞胸中，气机不能下降，所以尺部无脉，这是天道之气不能下济的象征，通过探吐可以自愈。如果胸中没有食物，也不想吐，但尺部无脉，这是根本已废，寿命将尽的征兆。另外，停食脉象沉滑，是伤了冷硬之物，宜用温性药物来克制；脉象洪数，是伤了辛热之物，宜用苦味药物来胜之；脉象缓滑，是伤了腥咸之物，宜用甘味药物来胜之；脉象弦紧，是伤了酸硬之物，宜用辛味药物来胜之；脉象洪滑，是伤了甜烂之物，宜用酸味药物来胜之；脉象微迟，是伤了冷物，且有积聚痰涎，宜用温和的药物调和；若见到单伏脉，主要是食物不化，且有外寒凝滞，宜用辛温药物发散。（出自《汇补》）
【治法】
病位在上部的，食物尚未进入胃中，可以采用催吐的方法；病位在中间的，采用消导的方法；病位在下部的，食物已进入胃中，宜采用泻下的方法。（出自《玉册》）然而这些方法都不可用药过猛，恐怕会损伤元气。（出自《汇补》）
【峻剂宜戒】
肠胃如同市场，所伤的食物多在中焦。如果使用破气的药剂，只会损伤上焦的清气；使用峻烈之品，又会损伤下焦的阴血，这都称为“诛伐无过”（惩罚无罪之人）。只应当顺气化痰，帮助脾胃腐熟消化，再根据元气的强弱和所伤食物的性质，徐徐消导，润利而去之。积滞去除后，还应当补养脾胃，以恢复其健运的正常功能。如果一概使用牵牛子、巴豆、大黄等峻下药，会损伤脾气，暗中消耗津液，使积聚变得更加顽固，药物的余毒留在肠胃，逐渐转变为呕吐、肿胀、泄泻、痿证、黄疸等症状。即使当时痊愈，暗中损耗生命根基的情况也很多了。（出自《汇补》）
【挟寒挟热】
有的人身体感受寒气，口中吃了生冷食物而突然发病的，初起时适宜用辛温药物开导。因为食物遇寒则凝结，遇热则消化。稍久以后，寒郁结而成热，应当兼用一二种辛凉降火的药物。（出自《丹溪心法》）所以伤食的人，如果腹痛日久，时作时止，口干唇燥，小便短赤，大便干结，也有出现腹泻黄糜，肛门如火烧一样的，这都是湿中生热的症状，反而用苦寒药物取得了疗效。可见伤食也有挟寒和挟热的不同，就像外感病有寒实结胸和热实结胸的区别一样。所以凡是在临症之时，非常应当仔细审察。（出自《汇补》）
【伤食成痞】
伤食之后，虽然食物积滞已消，但元气已受损，或者已经经过攻下治疗而脾阴受伤，至高之气乘虚下陷，形成蓄满痞塞的症状。适宜调理脾胃，调和气血，用辛散升提的药物治疗，则痞结自然解除。不可再用枳实、厚朴等类药物，以免再次损伤中焦脾胃。（出自《入门》）
【脾虚甘补】
普通人饮食入胃，脾能运化，所以随吃随化。病人饮食入胃，脾不能运化，则食物反而磨耗脾气，所以有的吃下去就痛，不能与普通的伤食同治，否则会导致变生不测。只要补益脾胃，食物自然会消化。（出自《汇补》）
【肾虚温补】
饮食虽然进入中焦，但其变化精微物质，实在依赖于命门少火上蒸。中年之后，大病之余，元阳亏损，不能熟腐水谷，因而身体衰败，容易停食，形成痞块或疼痛，表现为呕吐或腹泻。适宜补火以生土，就像给锅底添加柴火，水谷就能全部煮熟一样。（出自《玉机微论》）
【胃枯平补】
又有专门从事清淡素食、粗茶淡饭的人，肠胃得不到滋养，久而久之变得枯涩，容易停食。治病者如果不求根本，喜欢追求速效，妄用辛香燥热的药物，只是暂时痛快，变生出噎膈、鼓胀、背痈、咳脓等症状。如果早知道是胃枯，只用平和补益的方法，时间久了自然见效。（出自《汇补》）
【用药】
食物填塞上焦，适宜单用盐汤，或者二陈汤加桔梗、芦根来催吐。吐后，用二陈汤加木香、砂仁调和。食物停在中间，主方用保和丸。肉食伤，加草果、山楂；面食伤，加神曲、莱菔子；水果伤，加肉桂；豆粉伤，加杏仁；瓜类伤，加糯米；糯米伤，加酒曲；米饭伤，加陈年六安茶；炙烤食物伤，加淡豆豉；外受暴寒，加苏叶、干葛；内伤生冷，加干姜、桂枝；挟气滞，加木香、乌药、枳壳、槟榔；挟寒湿，加苍术、厚朴；久而挟郁热，加姜汁炒山栀；郁热便秘者，加大黄；挟热便泻者，加黄连炭。如果是初起自吐者，二陈汤加藿香、豆蔻、厚朴、砂仁；自泻者，二陈汤加白芍、木香、木通、神曲。吐下未净者，用枳术丸消除；吐下后体虚者，用六君子汤补益。至于伤食感寒腹痛，有用备急丸攻下的，有用理中汤温补的，虚实之间，最应当详细辨别。久病不运化的，用六君子汤加谷芽、益智仁、砂仁之类。
凡是伤食，必须询问吃了什么食物。是喜食太过导致的寒或热吗？应当助脾消导。或者是饥饿困倦时吃的吗？应当补中益气。是生气恼怒后吃东西，或者吃完东西后生气吗？应当舒气解郁，兼以消化。如果是病后、疮溃后、产妇或高龄老人，凡是有食滞，只宜补益消化。如果一概使用攻下，立刻就会陷入危险。凡是左脉微弱，右脉弦滑，或弦大，形气俱虚，又兼饥饿，骤然进食且吃得过多过节的，这是“不足中有余”。从受伤的角度说是不足，从停滞的角度说是有余。所以标本应当审察缓急。更有食物停滞而气机受伤的，宜消补兼行；有食物停滞而气机损伤不严重的，当单独使用消导；有已经停滞，不能自行消化，只需补脾使其营运，不必消导的，应当临时斟酌，不可偏执一端。至于如枳术丸，虽说有消导作用，其中固有补益之功存在，和中最为巧妙。其他如木香分气丸、枳实消导丸、大枳壳丸，虽然没有补益作用，但施用于有余实证，无不获效。只是不可视为常法。如果所停滞的食物，不是枳术丸等所能去除的，怎能拘泥常法而不通变呢？那么备急丸、煮黄丸、感应丸、瓜蒂散等，李东垣、朱丹溪也未尝经常不用。（出自《安常》）
【附恶食】
恶食不止一种原因。有胸中痰滞的，宜导痰以助脾；有伤食导致恶食的，宜消化以助脾；有病久胃虚的，宜用人参、白术健脾。（出自《汇补》）
【附不能食】
不能食有虚有实。实证表现为心下痞满，恶心口苦，宜消导；虚证表现为倦怠，面色萎黄，必有心下软和，宜异功散加砂仁。有虚痰的，用六君子汤；用补脾无效者，宜二神丸，这是虚则补其母的方法。如果善饥但不能食，属于胃热，脉洪而虚的，用异功散加竹茹、黄连；脉洪而实的，用人参白虎汤治疗。（出自《汇补》）
【伤食选方】
保和丸（朱丹溪） 治疗食积、酒积。
山楂肉（二两） 半夏 橘红 神曲 大麦芽 白茯苓（各二两） 黄连 莱菔子 连翘（各五钱）
研末，滴水为丸，白开水送服。加白术，名为大安丸。
枳术丸（张洁古） 消食强胃，治疗痞满宽胸。
枳实（一两） 白术（二两）
研末，用荷叶包裹烧饭为丸，陈茶姜汤任下。
三黄枳实丸 治疗食郁成热，腹胀便秘体质壮实者。
大黄 黄连 黄芩 白术 陈皮 枳实 神曲
各等分，糊丸，姜汤送服，以利为度。
枳实导滞丸 行湿热之物，去积滞闷痛。
大黄（十两） 神曲（五两） 枳实（五两） 茯苓 黄芩 白术 黄连（各二两半） 甘草（一两） 泽泻（二两）
炊饮为丸。
和中丸 治疗胃虚食滞，厌厌不想吃东西，大便或秘或溏。
厚朴（一两） 白术（一两二钱） 半夏（一两） 陈皮（八钱） 木香（二钱半） 甘草（三钱） 枳实（三钱）
姜汁糊丸，梧桐子大。每服三四十丸，白开水送服。
备急丸 治疗胃停生冷，心腹急痛，手不可按，右寸关脉紧盛者。
大黄 干姜 巴豆（各等分）
研末，蜜丸如豆大。姜汤送服三丸，以吐利为度。此方并治中恶客忤，心腹胀痛，卒如刀刺，气急口噤卒死者，用暖水送下。如果不下，捧起头，得下咽，须臾便好转。再与三丸，以腹中鸣转，得吐下，即愈。
感应丸 化积化滞，不动脏腑。
丁香 木香 肉果 干姜（各一两） 杏仁（一百四十粒） 百草霜（二两） 巴豆（去皮膜七十粒）
同研入药内和匀，加糯米糊，入药杵千余下，丸如莱菔子大。每服十丸。食滞，陈皮汤送下；气滞，茴香汤送下；呕吐，生姜汤送下。
大枳壳丸 治疗一切酒食伤胃，胸膈闷痛，饮食不下，两胁刺痛，呕逆恶心。
蓬术 厚朴 人参 青皮 黑牵牛 枳壳 茯苓 木香（各一两） 大黄（二两） 陈皮 白术（各一两） 槟榔 半夏神曲（各三两） 三棱 麦芽（各一两）
姜汁糊丸。
资生丸（缪仲淳） 健脾开胃，消食止泻，调和脏腑。醉饱之后服之，大能消食。
白术（三两） 人参（三两） 茯苓（一两半） 陈皮（二两） 山楂肉（二两） 神曲（二两） 黄连（姜汁炒） 豆蔻 泽泻（各三钱） 桔梗 炙甘草 藿香（各五钱） 白扁豆（一两） 莲肉（一两） 薏苡仁（三两） 山药 麦芽芡实（各一两半）
炼蜜为丸，每丸重二钱。每服一丸，醉饱后，细嚼，淡姜汤送下。
大健脾丸
白术（三两） 广皮（一两） 黄连（八钱） 木香（七钱半） 人参（一两半） 山药 肉果（各一两） 甘草（七钱） 山楂肉 神曲 砂仁 谷芽（炒各一两） 茯苓（二两）
为末，蒸饼为丸，如绿豆大。空心，午后陈皮汤送服五十丸。
二神丸
补骨脂（炒四两） 肉果（二两生用）
为末，枣子五十枚，生姜四两，同切片，煮烂，去姜取枣，剥去皮核，以肉研入药，和丸桐子大。每服三四十丸。
[General Principle]
If food intake doubles, the intestines and stomach will be injured. (From *Neijing*) Once there is an injury from food, the spleen and stomach functions are impaired, leading to reduced appetite and gradual exhaustion of Yuan Qi (Primordial Energy). (From *Zazhe*)
[Etiology: Internal Factors]
There are cases of excessive consumption of cold/raw fruits, vegetables, fish, and other cold-natured foods; excessive consumption of spicy, roasted, fried, alcoholic, or wheat-based hot-natured foods; robust individuals indulging in gluttony and large bites; and weak individuals greedily eating indigestible foods. (From *Zhizhang*) There are also cases where irregular dieting is followed by physical labor, or where irregular dieting follows excessive physical exertion. (From *Andao*)
[External Manifestations]
It causes abdominal distension and rebellious Qi, chest and diaphragm fullness and obstruction, acid regurgitation, belching with a smell like rotten eggs. Or it presents with vomiting, nausea, desire to vomit but inability to do so, aversion to the smell of food. Or epigastric pain, or tenderness upon pressing the abdomen. Or diarrhea with yellowish-white stools and severe colicky pain. Or aversion to cold with high fever and headache, resembling exterior syndrome malaria. However, exterior syndromes usually involve body aches and a floating, vigorous left pulse; whereas food retention involves no body aches and a slippery, large right pulse. (From *Huibu*) There are also cases where old food has not digested, new food enters abruptly, Spleen Qi is weak, and food remains undigested overnight. (From *Chaoshi*) Those with heat present cause acid regurgitation; those without heat cause foul-smelling belching. (From *Wu Yi Huibian*)
[Pulse Diagnosis]
A tight and vigorous Qi Kou (Radial artery at the cun position) pulse indicates food injury. (From *Neijing*) A floating-slippery or deep-slippery right Guan (stomach/spleen) pulse, which is forceful upon pressure, indicates retained food not digesting. (From *Maijing*) If a person has pulses in the upper positions but none in the lower positions, one should ask if they have chest fullness, nausea, and a desire to vomit. This is because food fills the chest, preventing Qi from descending, hence the absence of the Chi (kidney) pulse. This represents the failure of Heavenly Qi to descend; inducing vomiting leads to self-healing. If there is no food in the chest, no desire to vomit, yet the Chi pulse is absent, this indicates the root is exhausted, and death is imminent. Additionally, a deep-slippery pulse for retained food suggests injury from cold/hard items, treated with warm agents; a flooding-rapid pulse suggests injury from pungent/hot items, treated with bitter agents; a slow-slippery pulse suggests injury from fishy/salty items, treated with sweet agents; a wiry-tight pulse suggests injury from sour/hard items, treated with pungent agents; a flooding-slippery pulse suggests injury from sweet/soft items, treated with sour agents; a faint-slow pulse suggests injury from cold items with accumulated phlegm-fluids, treated with harmonizing warm agents; a single hidden pulse mainly indicates food non-digestion with external cold stagnation, treated with acrid-warm dispersants. (From *Huibu*)
[Therapeutic Methods]
For pathology in the upper jiao, before food enters the stomach, emesis may be used. For pathology in the middle jiao, digestion and guidance (promoting digestion and moving stagnation) are used. For pathology in the lower jiao, after food has entered the stomach, purgation is appropriate. (From *Yuce*) However, these methods must not be overused, lest they damage Yuan Qi. (From *Huibu*)
[Warning Against Harsh Agents]
The intestines and stomach are like a marketplace; injured food mostly resides in the middle jiao. Using Qi-breaking formulas merely damages the clear Qi of the upper jiao; harsh substances further injure the Yin and Blood of the lower jiao. All such actions are termed "punishing the innocent." One should instead regulate Qi, resolve phlegm, assist the spleen in rotting and ripening, and then, depending on the state of Yuan Qi and the type of food injured, slowly guide out the stagnation with moistening agents. After stagnation is removed, the spleen and stomach should be tonified to restore normal transportive function. If one indiscriminately uses harsh purgatives like Qian Niu Zi (Pharbitis Seed), Ba Dou (Croton Seed), or Da Huang (Rhubarb Root), it damages Spleen Qi and secretly depletes body fluids, causing accumulations to harden. Residual drug toxins remain in the intestines and stomach, gradually transforming into vomiting, swelling, diarrhea, flaccidity, and jaundice. Even if temporary recovery occurs, many die from hidden depletion of their life span. (From *Huibu*)
[Accompanied by Cold or Heat]
Some suffer sudden illness due to external cold exposure and ingestion of cold/raw foods. Initially, acrid-warm opening and guiding agents are suitable, as food congeals with cold and transforms with heat. After some time, cold stagnation transforms into heat, requiring the addition of one or two acrid-cool fire-descending herbs. (From *Danxi*) Thus, patients with food retention suffering from long-term intermittent abdominal pain, dry mouth/lips, short dark urine, and dry constipation, or those with yellow mushy diarrhea and burning anus, all exhibit dampness generating heat. The fact that bitter-cold agents sometimes succeed shows that food retention can be accompanied by cold or heat, just as exterior syndromes differ between cold-solid and heat-solid Jie Xiong (Chest Binding). Therefore, careful differentiation is crucial during clinical practice. (From *Huibu*)
[Food Retention Leading to Pi Syndrome (Fullness)]
After food injury, although food stagnation clears, Yuan Qi is damaged. Or, after purgation, Spleen Yin is injured, allowing Supreme Qi to sink due to deficiency, causing accumulation, fullness, and obstruction. Treatment should regulate the spleen and stomach, harmonize Qi and Blood, using acrid-dispersing and ascending agents, so the pi knot resolves naturally. Do not use Zhi Shi (Immature Bitter Orange) or Hou Po (Magnolia Bark) etc., which would further damage the Middle Jiao. (From *Rumen*)
[Spleen Deficiency: Sweet Tonification]
In healthy people, the spleen transports food entering the stomach, digesting it immediately. In patients, the spleen cannot transport food, so food grinds against the spleen, causing pain upon eating. This differs from simple food retention and should not be treated similarly, lest unpredictable changes occur. Only by tonifying the spleen and stomach will food digest naturally. (From *Huibu*)
[Kidney Deficiency: Warm Tonification]
Although food enters the middle jiao, its transformation into essence relies on the steaming of Ming Men Fire (Ministerial Fire). After middle age, or following major illness, loss of Yuan Yang prevents proper cooking and ripening of food, leading to debility and easy food retention, forming pi masses or pain, vomiting, or diarrhea. Treatment should tonify Fire to generate Earth, akin to adding fuel to the pot bottom so water and grain cook thoroughly. (From *Yuji*)
[Stomach Dryness: Balanced Tonification]
Some who strictly consume light vegetarian diets and coarse tea/rice lack nourishment for the intestines and stomach. Over time, they become dry and stiff, prone to food retention. Physicians who seek the root but prefer quick results may recklessly use acrid-aromatic dry-hot drugs, providing only momentary relief but causing Yige (Dysphagia), Guzhang (Abdominal Distension), back carbuncles, or coughing pus. If Stomach Dryness is recognized early, balanced tonification applied over time yields results. (From *Huibu*)
[Medication Usage]
For food filling the upper jiao, use salt water alone, or Er Chen Tang (Two-Cured Decoction) with Jie Geng (Platycodon Root) and Lu Gen (Reed Rhizome) to induce vomiting. After vomiting, harmonize with Er Chen Tang plus Mu Xiang (Aucklandia Root) and Sha Ren (Amomum Fruit). For food stopped in the middle, Bao He Wan (Preserve Harmony Pill) is primary. For meat injury, add Cao Guo (Tsaoko Cardamom) and Shan Zha (Hawthorn Fruit); for flour injury, add Shen Qu (Medicated Leaven) and Lai Fu Zi (Radish Seed); for fruit injury, add Rou Gui (Cinnamon Bark); for bean curd injury, add Xing Ren (Apricot Seed); for melon injury, add Nuomi (Glutinous Rice); for glutinous rice injury, add Jiu Qu (Wine Yeast); for rice injury, add aged Lu'an Tea; for roasted food injury, add Dan Dou Chi (Prepared Soybean); for external acute cold, add Su Ye (Perilla Leaf) and Gan Ge (Kudzu Root); for internal cold/raw injury, add Gan Jiang (Dried Ginger) and Gui Zhi (Cinnamon Twig); for accompanying Qi stagnation, add Mu Xiang, Wu Yao (Lindera Root), Zhi Ke (Bitter Orange Peel), and Bing Lang (Areca Seed); for accompanying cold-damp, add Cang Zhu (Atractylodes Rhizome) and Hou Po; for long-standing depression-heat, add Shan Zhi (Gardenia Fruit) stir-fried with ginger juice; for depression-heat with constipation, add Da Huang; for heat with diarrhea, add Chao Huang Lian (Charred Coptis Rhizome). If spontaneous vomiting occurs at onset, use Er Chen Tang with Huo Xiang (Patchouli), Dou Kou (Cardamom), Hou Po, and Sha Ren; if spontaneous diarrhea, use Er Chen Tang with Bai Shao (White Peony Root), Mu Xiang, Mu Tong (Akebia Stem), and Shen Qu. If vomiting/purging is incomplete, use Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill); if deficient after vomiting/purging, use Liu Jun Zi Tang (Six-Gentlemen Decoction). For food retention with cold-induced abdominal pain, Bei Ji Wan (Emergency Rescue Pill) may be used for purging, or Li Zhong Tang (Regulate the Middle Decoction) for warming tonification; differentiation of excess and deficiency is paramount. For chronic failure of transport/digestion, use Liu Jun Zi Tang plus Gu Ya (Sprouted Grain), Yi Zhi Ren (Alpinia Oxyphylla Fruit), and Sha Ren.
Regarding food retention, always ask what was eaten. Was it excessive craving leading to cold or heat? Assist spleen digestion. Was it eaten while hungry/tired? Tonify Middle and boost Qi. Was it eaten after anger or caused anger after eating? Soothe Qi and resolve depression, aiding digestion. For post-illness, post-ulcer, postpartum, or elderly patients with food stagnation, only tonify and aid digestion. Indiscriminate purging leads to immediate danger. If the left pulse is weak and the right pulse is wiry-slippery or wiry-large, with both form and Qi deficient, plus hunger, sudden overeating constitutes "deficiency containing excess." From the perspective of injury, it is deficiency; from the perspective of stagnation, it is excess. Assess the urgency of root and branch. Cases where food stops and Qi is injured require simultaneous clearing and tonifying; cases where food stops but Qi is less injured require clearing alone; cases where stagnation cannot self-digest require only spleen tonification to promote transport, without clearing. Flexibility is key. Zhi Zhu Wan, though clearing, contains tonifying properties and harmonizes well. Other formulas like Mu Xiang Fen Qi Wan, Zhi Shi Xiao Dao Wan, and Da Zhi Ke Wan lack tonifying effects but work for excess patterns. They should not be viewed as standard methods. If stagnation cannot be cleared by Zhi Zhu Wan, rigid adherence is wrong; Bei Ji Wan, Zhu Huang Wan, Gan Ying Wan, Gua Di San (Melon Tip Powder) were also used by Dong Yuan and Dan Xi when necessary. (From *Anchang*)
[Appendix: Aversion to Food]
Aversion to food has various causes. Phlegm stagnation in the chest requires resolving phlegm to assist the spleen; food retention causing aversion requires digestion to assist the spleen; chronic illness causing Stomach deficiency requires Ginseng and Atractylodes to strengthen the spleen. (From *Huibu*)
[Appendix: Inability to Eat]
Inability to eat can be excess or deficiency. Excess presents with epigastric fullness, nausea, bitter taste, treated by digestion. Deficiency presents with fatigue, sallow complexion, soft epigastrium, treated with Yi Gong San (Extraordinary Efficacy Powder) plus Sha Ren. For deficiency-phlegm, use Liu Jun Zi Tang. If spleen tonification fails, use Er Shen Wan (Two-God Pill), tonifying the mother organ. Hunger with inability to eat indicates Stomach Heat; if pulse is flooding and empty, use Yi Gong San plus Zhu Ru (Bamboo Shavings) and Huang Lian; if pulse is flooding and full, use Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). (From *Huibu*)
[Selected Formulas for Food Retention]
Bao He Wan (Danxi) - Treats food and alcohol accumulation.
Shan Zha Rou (2 liang), Ban Xia, Ju Hong, Shen Qu, Da Mai Ya, Bai Fu Ling (each 2 liang), Huang Lian, Lai Fu Zi, Lian Qiao (each 5 qian).
Grind to powder, mix with water to make pills, take with white boiled water. Adding Bai Zhu makes Da An Wan.
Zhi Zhu Wan (Jiegu) - Digests food, strengthens stomach, treats pi/fullness, opens chest.
Zhi Shi (1 liang), Bai Zhu (2 liang).
Grind to powder, wrap in Lotus Leaf, roast with rice to make pills. Take with aged tea and ginger soup.
San Huang Zhi Shi Wan - Treats food depression turning to heat, abdominal distension, constipation in robust persons.
Da Huang, Huang Lian, Huang Qin, Bai Zhu, Chen Pi, Zhi Shi, Shen Qu.
Equal parts, paste pills, take with ginger soup, stop when bowel movement occurs.
Zhi Shi Dao Zhi Wan - Moves damp-heat, removes stagnation and stifling pain.
Da Huang (10 liang), Shen Qu (5 liang), Zhi Shi (5 liang), Fu Ling, Huang Qin, Bai Zhu, Huang Lian (each 2.5 liang), Gan Cao (1 liang), Ze Xie (2 liang).
Cook drink to make pills.
He Zhong Wan - Treats stomach deficiency with food stagnation, poor appetite, constipation or loose stools.
Hou Po (1 liang), Bai Zhu (1.2 liang), Ban Xia (1 liang), Chen Pi (8 qian), Mu Xiang (2.5 qian), Gan Cao (3 qian), Zhi Shi (3 qian).
Ginger juice paste pills, size of Sophora seeds. Take 30-40 pills with white boiled water.
Bei Ji Wan - Treats cold/raw food retention in stomach, acute heart/abdominal pain, tenderness, tight-vigorous right Cun/Guan pulses.
Da Huang, Gan Jiang, Ba Dou (equal parts).
Grind to powder, honey pills, size of beans. Take 3 pills with ginger soup, until vomiting/diarrhea occurs. Also treats evil qi invasion, acute abdominal pain, stabbing pain, gasping, locked jaw, sudden death. Use warm water. If not swallowed, lift head, swallow, improves quickly. Give 3 more pills until abdominal rumbling, vomiting/diarrhea, then cured.
Gan Ying Wan - Dissolves accumulations/stagnation without disturbing organs.
Ding Xiang, Mu Xiang, Rou Guo, Gan Jiang (each 1 liang), Xing Ren (140 grains), Bai Cao Shuang (2 liang), Ba Dou (70 grains, peeled).
Grind together, mix with medicine, add glutinous rice paste, pound 1000+ times, pills size of radish seed. Take 10 pills. For food stagnation, Chen Pi soup; for Qi stagnation, Fennel soup; for vomiting, Ginger soup.
Da Zhi Ke Wan - Treats all wine/food injuring stomach, chest/diaphragm stifling pain, inability to eat, stabbing costal pain, vomiting/nausea.
Peng Zhu, Hou Po, Ren Shen, Qing Pi, Hei Qian Niu, Zhi Ke, Fu Ling, Mu Xiang (each 1 liang), Da Huang (2 liang), Chen Pi, Bai Zhu (each 1 liang), Bing Lang, Ban Xia, Shen Qu (each 3 liang), San Leng, Mai Ya (each 1 liang).
Ginger juice paste pills.
Zi Sheng Wan (Miao Zhongchun) - Strengthens spleen, opens appetite, digests food, stops diarrhea, harmonizes organs. Take after heavy meals to greatly digest food.
Bai Zhu (3 liang), Ren Shen (3 liang), Fu Ling (1.5 liang), Chen Pi (2 liang), Shan Zha Rou (2 liang), Shen Qu (2 liang), Huang Lian (fried with ginger juice), Dou Kou, Ze Xie (each 3 qian), Jie Geng, Zhi Gan Cao, Huo Xiang (each 5 qian), Bai Bian Dou (1 liang), Lian Rou (1 liang), Yi Yi Ren (3 liang), Shan Yao, Mai Ya, Qian Shi (each 1.5 liang).
Refined honey pills, 2 qian each. Take 1 pill, chew finely after heavy meals, with light ginger soup.
Da Jian Pi Wan
Bai Zhu (3 liang), Guang Pi (1 liang), Huang Lian (8 qian), Mu Xiang (7.5 qian), Ren Shen (1.5 liang), Shan Yao, Rou Guo (each 1 liang), Gan Cao (7 qian), Shan Zha Rou, Shen Qu, Sha Ren, Gu Ya (fried, each 1 liang), Fu Ling (2 liang).
Powder, steamed cake pills, mung bean size. Empty stomach, afternoon, take 50 pills with Chen Pi soup.
Ping Wei San, Ren Shen Bai Hu Tang (both see Summerheat), Li Zhong Tang (see Middle Cold).
Er Shen Wan
Bu Gu Zhi (fried 4 liang), Rou Guo (2 liang raw).
Powder, 50 dates, 4 liang ginger, slice together, boil till soft, remove ginger, take dates, peel/remove pits, mash date flesh with medicine, pills size of Sophora seeds. Take 30-40 pills.
Er Chen Tang, Gua Di San (both see Phlegm), Yi Gong San (see Bleeding), Liu Jun Zi Tang (see Stroke).