大意
脾胃者。仓廪之官。五味出焉。（经文）脾胃盛则善食而肥。多食不伤。过时不饥。脾胃衰则少食而瘦。多食易
伤。过时易饥。或虽肥而四肢不举。此脾实而邪气亦盛也。或善食而四肢削瘦。此脾强而邪火旺也。脾胃
盛衰可见也。（东垣）
内因
胃可纳受。脾主消导。一纳一消。营运不息。生化气液。（指掌）乃传于脏腑。故胃为五脏之本。六腑之大源也。
（经文）若饮食饥饱。寒暑不调。则伤胃。胃伤则不能纳。忧思恚怒。劳役过度。则伤脾。脾伤则不能化。二者俱
伤。纳化皆难。而恶心胀满。面黄倦怠。食不消化等症作矣。（汇补）
外症
胃病则气短精神少而生大热。有时显火上行。独燎其面。脾病则怠惰嗜卧。四肢不收。肠鸣泄泻。脾胃既
病。下流乘肾。土来克水。则骨乏无力。是为骨蚀。令人骨髓空虚。足不能履地。（东垣）气血精神。由此而日亏。
脏腑脉络。由此而日损。肌肉形体。由此而日削。（指掌）
受病分辨
饮食劳倦。则伤脾胃。（经文）故有劳倦受伤者。有饮食受伤者。有劳倦后继以食伤者。有食伤后加以劳倦
者。大抵劳役伤脾者。心口按之不痛。饮食伤脾者。心口按之刺痛。（谦甫）又食伤。则其症初寒。后变郁热者
多。劳倦。则其症初热。后变虚寒者多。故经曰。始受热中。末传寒中。即是谓欤。
变病分辨
脾属阴。主湿化。胃属阳。主火化。伤在脾者。阴不能配阳而胃阳独旺。则为湿热之病。如痈肿疮疡。食 黄
疸。消渴肉痿。噎膈痰火。食少之类是也。伤在胃者。阳不能配阴而脾阴独滞。则为寒湿之病。如身重肢麻。
面黄浮肿。痞胀噫气。倦怠积块。泻利之类是也。又不能食者病在胃。能食而下能化者病在脾。（汇补）
四肢不用
脾病而四肢不用者。以四肢皆禀气于胃。而不能自至其经。必因于脾乃得禀也。今脾病不能为胃行其
津液。四肢不得禀水谷之气。脉道不利。筋骨肌肉皆无气以生。故不用焉。（经文）
头足浮肿
四肢属脾。眼胞上下亦属脾。脾衰则清气不化。浊液不输。水湿停留。故头足浮肿。（东垣）
九窍不利
凡人饮食入胃。先行阳道。阳气升浮。散满皮肤。充塞巅顶。则九窍通利。病患饮食入胃。先行阴道。阴气降
沉。遽觉流于脐下。辄欲小便。当脐有动气。隐隐若痛状。是真气谷气不能上升。故九窍不利也。（东垣）
食后嗜卧身重
脾旺则饮食运动。脾衰则运动迟难。故凡食入后。精神困倦。沉沉欲睡者。脾气馁而不能运动也。至于身重。亦属
脾湿。或因内受。或从外袭。俱当健脾分利。若无湿气。止属脾虚。并宜补益中气。升腾下陷。大禁渗利。（汇补）
脉法
脾气受伤者。脉浮大而无力。胃气受伤者。脉沉弱而难寻。此皆不足之脉。易于寻按者也。更有脉大饱闷
有似食滞。误用克伐疏利。而郁闷转甚者。此乃脾虚而现假象。即洪大之脉阴必伤。坚强之脉胃必损也。
宜温理黄宫。发育自治。若再用攻伐。变患蜂起矣。（汇补）
脾气变现
脾附于胃之外。形如马刀。闻声则动。动则磨食。以健运为体。喜燥而恶湿。其味甘。其臭香。其色黄。其声歌。
其液涎。有病则五者变现发露于外。（六要）
瘥剧日期
脾病者。愈于庚辛。加于甲乙。甲乙不死。持于丙丁。起于戊己。日 慧。日出甚。下晡静。（经文）
治法
脾之合肉也。其荣唇也。损于脾则肌肉削瘦。饮食不能为肌肤。故宜调其饮食。适其寒温。脾欲缓。急食甘
以缓之。以甘补之。以苦泻之。（经文）
脾虚升阳
阴精所奉其人寿。阳精所降其人夭。（内经）奉者。脾胃和。谷气升。行春夏之令。故人寿。降者。脾胃不和。壳气
下流。行秋冬之令。故人夭。升降之理。所关甚钜。所以脾虚久病。宜升阳扶胃药中。每寓升发之品。（汇补）
脾虚补肾
脾肾交通。则水谷自化。（杨仁斋）若房劳过度。下焦阳虚。不能上蒸脾土。熟腐五谷。致饮食少进。胸膈痞塞。或
不食而胀。或食而呕吐。或食而不化。大便溏泄。用补脾不效者。当责之少火不足。以火能生土故也。其症
必兼肾泄遗精。宜八味丸或四神丸治之。（汇补）
胃症补心
有前富后贫。身心悲苦。或锐志功名。或劳神会计。气散血耗。皆令心主不足。无以生长胃气。由是饮食减
少。肌肉瘦减。宜补养心脏。盖脾为己土。以坎中之火为母。胃为戊土。以离宫之火为母。所以补胃必兼补
心也。其症每多惊悸怔忡。健忘不寐。宜归脾汤加益智仁。寒症见者。加炮姜。（汇补）
用药总法
凡养胃必用参、术。健脾必用枳、术。健者。运也。动也。脾气不运。而助其健运也。与天行健之义同。故七情郁
结。饥饱失常。膏粱浓味。酿成痰火。使脾胃不和。必用枳、术二味。若饮食伤脾。用二陈四君之类。劳倦伤脾。
用补中建中之类。各以见症有余不足加减。补火生土。以八味丸、理中汤。补下焦阴火。以归脾汤、人参养
荣汤。补心火。寸关滑数无力。恶心口渴。不喜饮食。胃有虚火也。二陈汤加姜炒黄连、枳、术。后加人参。气口
缓弱。或迟而无力。或虚大无神。呕吐不食。胃有虚寒也。必过服寒凉生冷所致。宜香砂六君子加浓朴、苍
术。甚者加炮姜。气口滑实。呕吐不食。体浓多郁。属湿痰。仍宜吐之。吐定。以二陈、二术、香附、川芎。开郁行
气。气口脉芤。胸间作胀。口中血腥臭。或胃脘痛。面痿黄。乃胃有死血。加韭汁。后以越鞠丸加血郁药。倍
山栀。凡过食炙爆浓味多怒人。有此症。若四肢倦怠。饮食不进。乃脾虚也。以参、术、白芍补脾。山楂、麦芽
健运。关脉沉缓。能食不化。停滞心下。痞满嗳气。咽酸噫臭。乃脾弱食滞也。宜二陈、枳、术、山楂、麦芽。后用补
剂。平时食不消化。枳术丸最效。随症加减。痰。加半夏。火。加黄连。寒。加砂仁。久病后。吐泻后。食不消化。
脉涩或弦。重取无力。属脾阴血少。津液不能濡润。以致转运失常。宜养血润燥健脾。若四肢倦怠。面黄手
心热。脉大无力。宜补中益气汤。久病不食。或食不消化。或过服克伐。致损脾胃。六君子汤。脾胃两伤。
纳化皆难。或吐或泻。面色痿黄。倦怠乏力。参苓白术散。衰年久病。脾胃不和。食少不磨。或吐或泻。补脾药
中。加砂仁、肉果、补骨脂等。温暖下焦。或用八味丸以补命门。皆虚则补其母也。所以健脾不应者。用之屡
效。浅见者去桂、附。即不效。肥人体倦。脾胃不和。食少饱闷。胃中有湿痰也。宜燥之。二陈、二术、香附、浓朴。
少加枳实。气下坠不行。加升、柴。丹溪谓升柴二陈二术汤。能使大便顺而小便长。盖为湿痰滞于中。致清
阳不升。浊阴不降。痞塞填闷。以致二便阻塞。甚至小水不通者设。二术燥脾湿。二陈化痰气。升、柴引清气
上升。清气一升。浊气自降。郁结开通。津液四布。湿流燥润。而小便长矣。瘦人脾胃不和。传化失常。大便
干燥。口中燥渴。心下饱闷。多属血虚。宜健脾养血。忌渗涌分利。以白术、白芍、陈皮、甘草、麦芽、浓朴、姜炒黄
连、当归、麦冬之类。如中焦湿热太盛。即是有余。须五苓平胃之类。削其敦阜之土。若病久。或禀赋怯弱。
生冷油腻伤脾。而虚闷痞满不食者。必以白术为君。茯苓、陈皮、香、砂和中药为佐。若喜食而运化迟者。以
枳术加神曲、山楂、二陈、谷芽之类。砂仁、白蔻。气味辛香。俱能快膈开胃。但恐积湿成热。故无火者宜之。如
胃弱面青。面白淡黄。手冷脉缓者。稍加二味于参、苓、术、草中。最效。今人不知其性。动言白蔻太克。岂知杨
仁斋云。虚人脾胃弱而痰食交滞成疟者。加白豆蔻使元气运动。而脾胃流通。寒热自解。且东垣于补中
调中诸方。尚用草豆蔻之辛烈者。何惮白豆蔻之辛平乎。又食入倦怠迷闷。辄欲小便者。此元气下陷。
补中益气汤倍升、柴。膈间痞闷不食。面惨脉沉。此是气郁。当从郁治。不可填补。凡补脾胃药中。须入
补心药。盖火能生土也。即古方用益智仁之意。
脾胃选方
二陈汤（方见痰症） 六君子汤 八味丸 补中益气汤（三方俱见中风） 枳术丸（方见伤食） 平胃散（方见暑
症） 小建中汤（方见劳倦）
参苓白术散 治脾胃虚弱。食少不进。呕吐泻利。或大病后。扶脾助胃。极效。
人参 白术 茯苓 山药 扁豆（姜炒各一两半） 甘草
桔梗 薏苡仁 莲肉（各一两）
末之。每服二钱。枣汤下。张三锡加麦芽一两。砂仁三钱。山楂五钱。为丸屡效。有痰。加半夏八钱。若
脾弱多燥结者。以前本方入猪肚中。缝紧煮烂。捣丸服。
健脾丸 如无他症。但食后不能传化。因而食少者用之。
人参 白术（各四两） 山楂肉（一两半） 麦芽 橘皮（各一两）
或再加砂仁。或木香、荷叶煮陈谷芽。米粥为丸。如四肢倦怠。面色痿黄。口淡食少。耳鸣。本方加炙甘
草五钱。茯苓二两。便泻。加山药、扁豆、莲肉、肉果。如有湿痰。加半夏一两。胆星一两半。蛤粉、赤苓各
一两。以神曲糊丸。如有火。嘈杂恶心。加炒山栀一两。黄连五钱。水泛丸。如多郁。心下不舒。食少倦
怠。妇女多有此症。去人参。加香附五两。川芎一两半。神曲糊丸。如血少肠胃枯涩。口干便秘。皮肤枯
燥。食不能运。妇人经血衰少。淡白色。加当归、白芍各二两。抚芎、麦冬、柏子仁各一两。建糖丸。
治中汤 治脾胃不和。中满呕逆。恶心泄泻。
人参 干姜 白术（各一钱） 陈皮 青皮 甘草（各七分）
水煎。
枳缩二陈汤
即二陈汤加枳壳、砂仁。
浓朴温中汤 治脾胃着寒。停食。
陈皮 浓朴 干姜 茯苓（各八分） 甘草 木香（各五分）
水煎。
人参开胃汤 治脾虚停食。
人参 白术 茯苓 甘草 陈皮 半夏 神曲 麦芽 砂仁 浓朴 丁香 藿香 莲肉 生姜 枣肉
水煎。
七味白术散 治脾胃虚而伏火。
人参 白术 茯苓 甘草 干葛 藿香 木香
椒术养脾丸 治脾胃虚而着湿。
人参 白术 茯苓 甘草 川椒 麦芽 苍术 干姜 砂仁
实脾饮（济生） 治脾虚挟寒湿肿胀。
白术 茯苓 浓朴 木香 木瓜 草果 干姜 大腹皮 附子（炮各一两） 甘草（炙五钱）
每服四钱。水一钟。姜三片。枣一枚。煎服。
【大意】
脾胃，是负责饮食储藏和运化的器官。五味（酸、苦、甘、辛、咸）由脾胃化生。（出自经文）脾胃功能旺盛时，食欲好且身体丰满，多吃也不易受伤，到了饭点不觉得饿；脾胃功能衰弱时，吃得少且身体消瘦，稍微多吃就容易受伤，不到饭点就感到饥饿。有的人虽然肥胖但四肢无力抬举，这是脾实而邪气也盛的表现；有的人食欲好但四肢消瘦，这是脾强而邪火旺盛的表现。通过观察这些现象，可以判断脾胃的盛衰。（李东垣观点）
【内因】
胃负责受纳食物，脾负责消化传导。一纳一消，循环不息，从而生化出气和津液。（出自《医宗指掌》）进而输送到脏腑。所以胃是五脏的根本，六腑的大源头。（出自经文）如果饮食饥饱不均，寒暑失调，就会损伤胃，胃受伤就不能受纳；如果忧思恼怒，劳累过度，就会损伤脾，脾受伤就不能运化。两者都受伤，则受纳和运化都困难，于是出现恶心、胀满、面色发黄、疲倦乏力、食物不消化等症状。（出自《证治汇补》）
【外症】
胃病会导致气短、精神不足并产生大热，有时火热之气上行，只烧灼面部；脾病会导致怠惰嗜睡、四肢不收、肠鸣泄泻。脾胃既已生病，病气下流乘袭肾脏，土克水，导致骨骼乏力和无力，这称为“骨蚀”，使人骨髓空虚，脚不能踩地。（李东垣观点）气血精神，由此一天天亏损；脏腑脉络，由此一天天受损；肌肉形体，由此一天天消瘦。（出自《医宗指掌》）
【受病分辨】
饮食和劳倦会损伤脾胃。（出自经文）所以有因劳倦受伤的，有因饮食受伤的，有先劳倦后饮食伤的，也有先饮食伤后加劳倦的。大致来说，劳役伤脾的，心口部位按压不痛；饮食伤脾的，心口部位按压刺痛。（赵谦甫观点）另外，饮食所伤，症状初起多为寒，后来多变为郁热；劳倦所伤，症状初起多为热，后来多变为虚寒。所以经书说：“始受热中，末传寒中”，说的就是这个道理。
【变病分辨】
脾属阴，主湿化；胃属阳，主火化。伤在脾的，阴不能配阳而胃阳独旺，则成为湿热之病，如痈肿疮疡、黄疸、消渴、肉痿、噎膈痰火、食少等就是这类。伤在胃的，阳不能配阴而脾阴独滞，则成为寒湿之病，如身重肢麻、面黄浮肿、痞胀嗳气、倦怠积块、泻利等就是这类。不能进食的病在胃，能进食但消化吸收不好的病在脾。（出自《证治汇补》）
【四肢不用】
脾病导致四肢不能使用的，是因为四肢都禀受胃气，但不能自行到达经脉，必须依靠脾的转输才能禀受。现在脾病不能为胃传输津液，四肢得不到水谷之气，脉道不利，筋骨肌肉都没有气以生养，所以不能使用。（出自经文）
【头足浮肿】
四肢属于脾，眼睑上下也属于脾。脾衰则清气不化，浊液不输，水湿停留，所以头部和足部浮肿。（李东垣观点）
【九窍不利】
凡人饮食入胃，先行阳道，阳气升浮，散布于皮肤，充塞于头顶，则九窍通利。病人饮食入胃，先行阴道，阴气降沉，立刻感觉流注于脐下，随即想小便，肚脐周围有动气，隐隐作痛状，这是真气和谷气不能上升，所以九窍不利。（李东垣观点）
【食后嗜卧身重】
脾旺则饮食运动正常，脾衰则运动迟缓困难。所以凡是饭后精神困倦，沉沉欲睡的，是脾气虚弱而不能运动所致。至于身体沉重，也属于脾湿，或因内伤，或从外感侵袭，都应当健脾分利。如果没有湿气，仅属脾虚，都宜补益中气，升腾下陷之气，严禁使用渗利药物。（出自《证治汇补》）
【脉法】
脾气受伤的，脉象浮大而无力；胃气受伤的，脉象沉弱而难寻。这些都是不足的脉象，容易诊察。更有脉象大且饱闷，看似食滞，误用攻伐疏利药物，反而郁闷更严重的，这是脾虚出现的假象，即洪大的脉象阴必伤，坚强的脉象胃必损。应当温理脾胃（黄宫），发育元气自会痊愈。如果再使用攻伐，变故就会蜂拥而起。（出自《证治汇补》）
【脾气变现】
脾附着在胃的外面，形状像马刀，听到声音就会动，动则磨碎食物，以健运为本体，喜燥而恶湿，其味甘甜，其气香，其色黄，其声歌，其液为涎。有病时这五种表现会显露于外。（出自《医方六要》）
【瘥剧日期】
脾病，在庚辛日痊愈，在甲乙日加重。甲乙日不死，在丙丁日维持，在戊己日起色。白天清醒，日出时加重，傍晚安静。（出自经文）
【治法】
脾合肉，其华在唇。损伤脾则肌肉消瘦，饮食不能化为肌肤，所以应当调理饮食，适应寒温。脾欲缓和，急食甘味以缓之，以甘味补之，以苦味泻之。（出自经文）
【脾虚升阳】
阴精上奉于人长寿，阳精下降于人夭折。（出自《内经》）奉者，是指脾胃调和，谷气上升，施行春夏之令，所以人长寿。降者，是指脾胃不和，客气下流，施行秋冬之令，所以人夭折。升降的道理，关系非常重大。所以脾虚久病，应当在升阳扶胃的药中，每寓升发之品。（出自《证治汇补》）
【脾虚补肾】
脾肾交通，则水谷自然化育。（杨仁斋观点）如果房劳过度，下焦阳虚，不能上蒸脾土，熟腐五谷，导致饮食减少，胸膈痞塞，或者不吃也胀，或者吃了呕吐，或者吃了不消化，大便溏泄，用补脾药无效时，应当责之于少火不足，因为火能生土。其症状必然兼有肾泄、遗精，宜用八味丸或四神丸治疗。（出自《证治汇补》）
【胃症补心】
有前富后贫，身心悲苦，或者锐志功名，或者劳神会计，气散血耗，都会导致心主不足，无法生长胃气，由此饮食减少，肌肉消瘦，宜补养心脏。盖脾为己土，以坎中之火为母；胃为戊土，以离宫之火为母。所以补胃必须兼补心。其症状多有惊悸怔忡、健忘不寐，宜用归脾汤加益智仁。见寒症的，加炮姜。（出自《证治汇补》）
【用药总法】
凡养胃必用人参、白术。健脾必用枳壳、白术。健，就是运，就是动。脾气不运，助其健运，与天道运行不息的意义相同。所以七情郁结，饥饱失常，膏粱厚味，酿成痰火，使脾胃不和，必用枳壳、白术两味。若饮食伤脾，用二陈汤、四君子汤之类；劳倦伤脾，用补中益气汤、小建中汤之类。各根据症状有余不足加减。补火生土，用八味丸、理中汤；补下焦阴火，用归脾汤、人参养荣汤；补心火，寸关脉滑数无力，恶心口渴，不喜欢饮食，是胃有虚火，用二陈汤加姜炒黄连、枳壳、白术，后来加人参。气口脉缓弱，或迟而无力，或虚大无神，呕吐不食，是胃有虚寒，必定是过服寒凉生冷所致，宜用香砂六君子汤加厚朴、苍术，甚者加炮姜。气口脉滑实，呕吐不食，体质肥浓多郁，属湿痰，仍宜吐法。吐定后，用二陈汤、二术、香附、川芎，开郁行气。气口脉芤，胸间作胀，口中血腥臭，或胃脘痛，面色萎黄，是胃有死血，加韭汁，后用越鞠丸加血郁药，倍用山栀。凡是过食炙爆厚味且多怒的人，有此症状，若四肢倦怠，饮食不进，是脾虚，用人参、白术、白芍补脾，山楂、麦芽健运。关脉沉缓，能食不化，停滞心下，痞满嗳气，咽酸嗳臭，是脾弱食滞，宜用二陈汤、枳壳、白术、山楂、麦芽，后用补剂。平时食不消化，枳术丸最效。随症加减：痰，加半夏；火，加黄连；寒，加砂仁。久病后，吐泻后，食不消化，脉涩或弦，重取无力，属脾阴血少，津液不能濡润，以致转运失常，宜养血润燥健脾。若四肢倦怠，面黄手心热，脉大无力，宜用补中益气汤。久病不食，或食不消化，或过服攻伐，致损脾胃，用六君子汤。脾胃两伤，纳化皆难，或吐或泻，面色萎黄，倦怠乏力，用参苓白术散。衰年久病，脾胃不和，食少不磨，或吐或泻，在补脾药中，加砂仁、肉果、补骨脂等，温暖下焦，或用八味丸以补命门，都是虚则补其母的方法。所以健脾不应者，用此法屡效。浅见者去掉桂枝、附子，就不见效。肥人体倦，脾胃不和，食少饱闷，胃中有湿痰，宜燥湿，用二陈汤、二术、香附、厚朴，少加枳实。气下坠不行，加升麻、柴胡。丹溪说升麻、柴胡、二陈、二术汤，能使大便顺而小便长，这是因为湿痰滞于中，致清阳不升，浊阴不降，痞塞填闷，以致二便阻塞，甚至小水不通者设。二术燥脾湿，二陈化痰气，升、柴引清气上升，清气一升，浊气自降，郁结开通，津液四布，湿流燥润，而小便长矣。瘦人脾胃不和，传化失常，大便干燥，口中燥渴，心下饱闷，多属血虚，宜健脾养血，忌渗涌分利，用白术、白芍、陈皮、甘草、麦芽、厚朴、姜炒黄连、当归、麦冬之类。如果中焦湿热太盛，即是有余，须用五苓散、平胃散之类，削其敦阜之土。若病久，或禀赋怯弱，生冷油腻伤脾，而虚闷痞满不食者，必以白术为君药，茯苓、陈皮、香附、砂仁和中药为佐药。若喜食但运化迟者，用枳术丸加神曲、山楂、二陈汤、谷芽之类。砂仁、白蔻，气味辛香，俱能快膈开胃，但恐积湿成热，故无火者适宜。如胃弱面青，面白淡黄，手冷脉缓者，稍加这两味于人参、茯苓、白术、甘草中，最效。今人不知其性，动辄说白蔻太克伐，岂知杨仁斋说，虚人脾胃弱而痰食交滞成疟者，加白豆蔻使元气运动，而脾胃流通，寒热自解。而且李东垣在补中调中诸方中，尚用草豆蔻之辛烈者，何必忌惮白豆蔻之辛平呢？又食入倦怠迷闷，辄欲小便者，此元气下陷，用补中益气汤倍用升麻、柴胡。膈间痞闷不食，面色惨暗脉沉，这是气郁，当从郁治，不可填补。凡补脾胃药中，须入补心药，盖火能生土也，即古方用益智仁之意。
【脾胃选方】
二陈汤（方见痰症） 六君子汤 八味丸 补中益气汤（三方俱见中风） 枳术丸（方见伤食） 平胃散（方见暑症） 小建中汤（方见劳倦）
参苓白术散：治脾胃虚弱，食少不进，呕吐泻利，或大病后，扶脾助胃，极效。
人参、白术、茯苓、山药、扁豆（姜炒各一两半）、甘草、桔梗、薏苡仁、莲肉（各一两）。
研末。每服二钱，枣汤送下。张三锡加麦芽一两，砂仁三钱，山楂五钱，制成丸剂屡效。有痰，加半夏八钱。若脾弱多燥结者，以前本方入猪肚中，缝紧煮烂，捣丸服。
健脾丸：如无他症，但食后不能传化，因而食少者用之。
人参、白术（各四两）、山楂肉（一两半）、麦芽、橘皮（各一两）。
或再加砂仁，或木香、荷叶煮陈谷芽，米粥为丸。如四肢倦怠，面色萎黄，口淡食少，耳鸣，本方加炙甘草五钱，茯苓二两。便泻，加山药、扁豆、莲肉、肉果。如有湿痰，加半夏一两，胆星一两半，蛤粉、赤茯苓各一两，以神曲糊丸。如有火，嘈杂恶心，加炒山栀一两，黄连五钱，水泛丸。如多郁，心下不舒，食少倦怠，妇女多有此症，去人参，加香附五两，川芎一两半，神曲糊丸。如血少肠胃枯涩，口干便秘，皮肤枯燥，食不能运，妇人经血衰少，淡白色，加当归、白芍各二两，抚芎、麦冬、柏子仁各一两，建糖为丸。
治中汤：治脾胃不和，中满呕逆，恶心泄泻。
人参、干姜、白术（各一钱）、陈皮、青皮、甘草（各七分）。
水煎。
厚朴温中汤：治脾胃着寒，停食。
陈皮、厚朴、干姜、茯苓（各八分）、甘草、木香（各五分）。
水煎。
人参开胃汤：治脾虚停食。
人参、白术、茯苓、甘草、陈皮、半夏、神曲、麦芽、砂仁、厚朴、丁香、藿香、莲肉、生姜、枣肉。
水煎。
七味白术散：治脾胃虚而伏火。
人参、白术、茯苓、甘草、干葛、藿香、木香。
椒术养脾丸：治脾胃虚而着湿。
人参、白术、茯苓、甘草、川椒、麦芽、苍术、干姜、砂仁。
实脾饮（济生）：治脾虚挟寒湿肿胀。
白术、茯苓、厚朴、木香、木瓜、草果、干姜、大腹皮、附子（炮各一两）、甘草（炙五钱）。
每服四钱，水一钟，姜三片，枣一枚，煎服。
[General Principles]
The Spleen and Stomach are the officials responsible for storage and transportation. The Five Flavors (Sour, Bitter, Sweet, Pungent, Salty) originate from them. (From Classic Texts) When the Spleen and Stomach are vigorous, appetite is good and the body is plump; excessive eating does not cause injury, and one does not feel hungry at irregular times. When the Spleen and Stomach are weak, appetite is poor and the body emaciates; slight overeating causes injury easily, and hunger arises before mealtime. Some individuals are obese but unable to lift their limbs; this indicates Spleen Excess with concurrent pathogenic Qi abundance. Some have good appetite but emaciated limbs; this indicates Spleen Strength with flourishing pathogenic Fire. Through these observations, the prosperity or decline of the Spleen and Stomach can be discerned. (Viewpoint of Li Dongyuan)
[Internal Causes]
The Stomach receives food, while the Spleen transforms and transports. One receives, one transforms, operating continuously to generate Qi and Body Fluids. (From *Yi Zong Zhi Zhang*) These are then transmitted to the Zang-Fu organs. Thus, the Stomach is the root of the Five Zang organs and the great source of the Six Fu organs. (From Classic Texts) If diet is irregular in quantity, or if cold and heat are unbalanced, the Stomach is injured; an injured Stomach cannot receive. If worry, thought, anger, or excessive labor occur, the Spleen is injured; an injured Spleen cannot transform. If both are injured, both reception and transformation become difficult, leading to symptoms such as nausea, distension, sallow complexion, fatigue, and indigestion. (From *Zheng Zhi Hui Bu*)
[External Manifestations]
Stomach disease leads to shortness of breath, lack of spirit, and generation of intense heat; sometimes fire qi ascends, burning only the face. Spleen disease leads to lethargy, desire to sleep, inability to control the limbs, borborygmus, and diarrhea. Once the Spleen and Stomach are diseased, the pathology flows downward to attack the Kidney; Earth overacts on Water, causing bone weakness and powerlessness, termed "Bone Erosion," leaving the marrow empty and making it impossible to stand. (Li Dongyuan's View) Qi, Blood, and Spirit diminish day by day; Zang-Fu and meridians deteriorate day by day; muscles and physique waste away day by day. (From *Yi Zong Zhi Zhang*)
[Differentiation of Injury]
Diet and fatigue injure the Spleen and Stomach. (From Classic Texts) Therefore, there are injuries due to fatigue, injuries due to diet, injuries where fatigue is followed by dietary excess, and injuries where dietary excess is followed by fatigue. Generally, Spleen injury from labor results in no pain upon pressing the epigastrium; Spleen injury from diet results in stabbing pain upon pressing the epigastrium. (Viewpoint of Zhao Qianfu) Furthermore, dietary injury often begins with Cold and later transforms into Stagnant Heat; fatigue injury often begins with Heat and later transforms into Deficiency Cold. Thus, the Classics state: "Initially suffering from Heat Center, ultimately transmitting to Cold Center." This refers to this phenomenon.
[Differentiation of Transformed Diseases]
The Spleen belongs to Yin and governs Dampness transformation; the Stomach belongs to Yang and governs Fire transformation. Injury to the Spleen means Yin cannot balance Yang, leaving Stomach Yang alone in dominance, resulting in Damp-Heat diseases, such as carbuncles, sores, jaundice, Xiao Ke (Wasting-Thirst), muscle atrophy, dysphagia with phlegm-fire, and poor appetite. Injury to the Stomach means Yang cannot balance Yin, leaving Spleen Yin alone in stagnation, resulting in Cold-Damp diseases, such as heaviness and numbness of limbs, sallow edema, fullness and belching, fatigue and masses, and diarrhea. Inability to eat indicates disease in the Stomach; ability to eat but failure to digest indicates disease in the Spleen. (From *Zheng Zhi Hui Bu*)
[Immobility of Limbs]
When Spleen disease causes immobility of the limbs, it is because the limbs all receive Qi from the Stomach but cannot reach the meridians themselves; they must rely on the Spleen to transmit. Now, Spleen disease fails to transport fluids for the Stomach; the limbs do not receive the Qi of water and grain; the pulse channels are obstructed; bones, sinews, and muscles lack Qi to sustain life; thus, they are immobile. (From Classic Texts)
[Edema of Head and Feet]
The limbs belong to the Spleen, and the eyelids also belong to the Spleen. When the Spleen declines, Clear Qi fails to transform, and Turbid Fluids fail to distribute; water and dampness remain stagnant, causing edema of the head and feet. (Li Dongyuan's View)
[Obstruction of the Nine Orifices]
When ordinary people eat and drink enters the Stomach, it first follows the Yang pathway; Yang Qi rises and floats, spreading through the skin and filling the crown, causing the Nine Orifices to be open and unobstructed. When patients eat and drink enters the Stomach, it first follows the Yin pathway; Yin Qi descends and sinks, immediately flowing below the navel, causing an urge to urinate, with moving Qi at the navel feeling faintly painful. This indicates that True Qi and Grain Qi cannot ascend, hence the obstruction of the Nine Orifices. (Li Dongyuan's View)
[Lethargy and Heaviness After Eating]
When the Spleen is vigorous, food movement is normal; when the Spleen declines, movement is slow and difficult. Therefore, after eating, if one feels mentally exhausted and drowsy, it is due to Spleen Qi deficiency failing to move. As for body heaviness, it also belongs to Spleen Dampness, whether internal or external; treatment should focus on strengthening the Spleen and separating/drainage. If there is no Dampness, it is purely Spleen Deficiency, requiring tonification of Middle Qi and lifting of sunken Qi; diuretics are strictly prohibited. (From *Zheng Zhi Hui Bu*)
[Pulse Methods]
Injury to Spleen Qi presents with a floating, large, yet forceless pulse. Injury to Stomach Qi presents with a deep, weak, and elusive pulse. These are all Deficient pulses, easy to palpate. There are cases where the pulse is large and full, resembling Food Stagnation; mistakenly using purgatives or draining agents makes the oppression worse. This is a false image appearing from Spleen Deficiency; a洪大 (Surging-Large) pulse implies Yin injury, and a firm pulse implies Stomach damage. One should warm and regulate the Spleen (Yellow Palace); self-healing will follow development of Yuan Qi. Further use of attacking methods will cause numerous complications. (From *Zheng Zhi Hui Bu*)
[Manifestations of Spleen Qi]
The Spleen attaches to the outside of the Stomach, shaped like a dagger, moving upon hearing sound, grinding food when moving, with healthy transport as its essence. It likes Dryness and dislikes Dampness; its flavor is Sweet, its odor Fragrant, its color Yellow, its sound Song-like, and its fluid is Saliva. When diseased, these five manifestations appear externally. (From *Yi Fang Liu Yao*)
[Dates of Recovery and Aggravation]
Spleen disease recovers on Geng-Xin days, aggravates on Jia-Yi days. If not fatal on Jia-Yi, it persists on Bing-Ding days, and improves on Wu-Ji days. Clarity during the day, worsening at sunrise, quiet in the late afternoon. (From Classic Texts)
[Therapeutic Methods]
The Spleen combines with flesh, and its luster appears on the lips. Damage to the Spleen causes muscle wasting, and food cannot transform into flesh and skin; therefore, one should regulate diet and adapt to temperature changes. The Spleen desires relaxation; urgently consume Sweet flavors to relax it, use Sweet to tonify it, and use Bitter to drain it. (From Classic Texts)
[Lifting Yang for Spleen Deficiency]
When Yin Essence is offered upward, one lives long; when Yang Essence descends, one dies young. (From *Nei Jing*) "Offering" refers to harmony between Spleen and Stomach, rising of Grain Qi, and execution of Spring-Summer commands, hence longevity. "Descending" refers to disharmony between Spleen and Stomach, flow of guest Qi downward, and execution of Autumn-Winter commands, hence early death. The principle of ascending and descending is crucial. Therefore, for chronic Spleen Deficiency, one should include lifting and dispersing herbs within formulas that lift Yang and support the Stomach. (From *Zheng Zhi Hui Bu*)
[Tonifying Kidney for Spleen Deficiency]
When Spleen and Kidney communicate, water and grain transform naturally. (Yang Renzhai's View) If sexual excess leads to Lower Jiao Yang Deficiency, preventing the upper steaming of Spleen Earth to ripen grains, resulting in poor appetite, chest/epigastric oppression, bloating without eating, vomiting after eating, indigestion, and loose stools, and Spleen-tonifying treatments fail, one should blame insufficient Lesser Fire, as Fire generates Earth. Symptoms likely include Kidney diarrhea and spermatorrhea; treat with Ba Wei Wan (Eight-Ingredient Pill) or Si Shen Wan (Four Spirits Pill). (From *Zheng Zhi Hui Bu*)
[Treating Stomach Symptoms by Tonifying Heart]
Those who were rich then poor, experiencing physical and mental sorrow, or those striving for fame, or engaging in mental labor/accounting, dissipate Qi and consume Blood, leading to Heart Master Deficiency, unable to grow Stomach Qi, resulting in reduced diet and muscle wasting. Treat by nourishing the Heart. The Spleen is Ji Earth, with Kan Fire as its mother; the Stomach is Wu Earth, with Li Fire as its mother. Thus, tonifying the Stomach must concurrently tonify the Heart. Symptoms often include palpitations, forgetfulness, and insomnia; treat with Gui Pi Tang (Restore the Spleen Decoction) plus Yi Zhi Ren (Alpinia Oxyphylla Fructus). For Cold patterns, add Pao Jiang (Prepared Ginger). (From *Zheng Zhi Hui Bu*)
[General Principles of Medication]
To nourish the Stomach, always use Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Rhizoma). To strengthen the Spleen, always use Zhi Ke (Aurantii Fructus) and Bai Zhu. "Jian" (Strength) means transport and movement. If Spleen Qi does not transport, assist its strength, consistent with the meaning of Heaven's continuous movement. Thus, for Seven Emotions stagnation, irregular diet, or rich foods generating Phlegm-Fire causing Spleen-Stomach disharmony, use Zhi Ke and Bai Zhu. For dietary injury, use Er Chen Tang (Two-Aged Decoction) or Si Jun Zi Tang (Four Gentlemen Decoction); for fatigue injury, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) or Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Adjust based on excess or deficiency. To tonify Fire to generate Earth, use Ba Wei Wan or Li Zhong Tang (Regulate the Middle Decoction). To tonify Lower Jiao Deficient Fire, use Gui Pi Tang or Ren Shen Yang Rong Tang (Ginseng Nourish the Blood Decoction). For Heart Fire tonification: if Cun-Guan pulses are slippery, rapid, and forceless, with nausea, thirst, and aversion to food, indicating Stomach Deficient Fire, use Er Chen Tang plus Jiang Chao Huang Lian (Ginger-fried Scutellariae Radix), Zhi Ke, and Bai Zhu, adding Ren Shen later. If Qi Kou pulse is slow-weak, delayed-forceless, or deficient-large without spirit, with vomiting and anorexia, indicating Stomach Deficient Cold (caused by overuse of cold/raw foods), use Xiang Sha Liu Jun Zi Tang (Aucklandiae and Amomi Six Gentlemen Decoction) plus Hou Po (Magnoliae Officinalis Cortex) and Cang Zhu (Atractylodis Rhizoma); add Pao Jiang for severe cases. If Qi Kou pulse is slippery-solid, with vomiting/anorexia, obesity, and depression, indicating Damp-Phlegm, induce vomiting initially. After vomiting settles, use Er Chen Tang, Er Zhu (Two Atractylodes), Xiang Fu (Cyperus Rhizoma), and Chuan Xiong (Ligusticum Chuanxiong Rhizome) to open stagnation and move Qi. If Qi Kou pulse is Kou (Hollow), with chest distension, bloody/foul breath, or epigastric pain, and sallow complexion, indicating Dead Blood in the Stomach, add Jiu Zhi (Allium Tuberosum Juice), then use Yue Ju Wan (Relieve Depression Pill) with Blood Stasis herbs, doubling Shan Zhi (Gardeniae Fructus). For those overeating fried/rich foods and prone to anger: if limbs are fatigued and anorexic, it is Spleen Deficiency; tonify with Ren Shen, Bai Zhu, Bai Shao (Paeoniae Radix Alba); aid transport with Shan Zha (Crataegi Fructus) and Mai Ya (Hordei Fructus Germinatus). If Guan pulse is deep-slow, with ability to eat but failure to digest, stasis in the heart region, fullness, belching, sour regurgitation, indicating Spleen Weakness with Food Stagnation, use Er Chen Tang, Zhi Ke, Bai Zhu, Shan Zha, Mai Ya, followed by tonics. For chronic indigestion, Zhi Zhu Wan (Aurantii and Atractylodes Pill) is most effective. Adjustments: add Ban Xia (Pinelliae Rhizoma) for Phlegm; Huang Lian for Fire; Sha Ren (Amomi Fructus) for Cold. Post-illness/vomiting-diarrhea indigestion with choppy/wiry heavy-pressure forceless pulses indicates Spleen Yin/Blood Deficiency and fluid dryness impairing transport; nourish Blood, moisten dryness, and strengthen Spleen. If limbs are fatigued, sallow face, hot palms, large-forceless pulse, use Bu Zhong Yi Qi Tang. Chronic anorexia/indigestion post-over-purging damaging Spleen/Stomach: use Liu Jun Zi Tang. Spleen-Stomach dual injury with difficulty in reception/transformation, vomiting/diarrhea, sallow face, fatigue: use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). Elderly chronic illness with Spleen-Stomach disharmony, poor digestion, vomiting/diarrhea: add Sha Ren, Rou Guo (Myristicae Semen), Bu Gu Zhi (Psoraleae Fructus) to Spleen tonics to warm Lower Jiao, or use Ba Wei Wan to tonify Ming Men (Gate of Life); this is "tonifying the Mother when Deficient." Thus, if Spleen strengthening fails, this method works repeatedly. Superficial practitioners removing Gui Zhi (Cinnamomi Ramulus) and Fu Zi (Aconiti Lateralis Radix Praeparata) lose efficacy. For obese individuals with fatigue and Spleen-Stomach disharmony, poor appetite, fullness, and gastric Damp-Phlegm: dry dampness with Er Chen Tang, Er Zhu, Xiang Fu, Hou Po, plus minor Zhi Shi (Aurantii Fructus). For sinking Qi, add Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix). Dan Xi stated this formula smooths bowels and increases urine because Damp-Phlegm stagnation blocks Clear Yang ascent and Turbid Yin descent, causing obstruction. Er Zhu dries Spleen Damp; Er Chen resolves Phlegm; Sheng Ma/Chai Hu guide Clear Qi up. Once Clear Qi ascends, Turbid Qi descends, stagnation opens, fluids distribute, moisture balances, and urine increases. For thin individuals with Spleen-Stomach disharmony, abnormal transmission, dry stool, dry mouth/thirst, epigastric fullness: mostly Blood Deficiency; tonify Spleen and nourish Blood; avoid diuretics/purgatives. Use Bai Zhu, Bai Shao, Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Mai Ya, Hou Po, Jiang Chao Huang Lian, Dang Gui (Angelicae Sinensis Radix), Mai Dong (Ophiopogonis Radix). If Middle Jiao Damp-Heat is excessive (Excess), use Wu Ling San (Five-Ingredient Powder with Poria) or Ping Wei San (Peace the Stomach Powder) to reduce Earth. For chronic illness or weak constitution damaged by cold/raw/greasy foods causing deficiency-fullness/anorexia: use Bai Zhu as Sovereign, Fu Ling (Poria), Chen Pi, Xiang Fu, Sha Ren as Ministers. For preference to eat but slow digestion: use Zhi Zhu Wan plus Shen Qu (Massa Medicata Fermentata), Shan Zha, Er Chen Tang, Gu Ya (Oryzae Fructus Germinatus). Sha Ren and Bai Kou (Cardamomi Fructus) are pungent-aromatic, opening the diaphragm and stimulating appetite; suitable for non-Fire patterns fearing Damp-Heat accumulation. For weak Stomach with blueish face, pale-yellow complexion, cold hands, slow pulse: add these two to Ren Shen, Fu Ling, Bai Zhu, Gan Cao for best effect. Moderns misunderstand Bai Kou as too harsh; Yang Renzhai noted it moves Yuan Qi in deficiency cases with Phlegm-Food stagnation causing malaria, resolving chills/fever. Even Li Dongyuan used Ca Dou Kou (Grass Cardamom) in tonifying formulas; why fear Bai Kou? For post-meal fatigue/confusion with urge to urinate: Yuan Qi sinking; use Bu Zhong Yi Qi Tang with doubled Sheng Ma/Chai Hu. Diaphragmatic oppression/anorexia with grim face/deep pulse: Qi Stagnation; treat stagnation, do not tonify fillers. All Spleen-Stomach tonics must include Heart tonics, as Fire generates Earth, echoing the ancient use of Yi Zhi Ren.
[Selected Formulas for Spleen and Stomach]
Er Chen Tang (See Phlegm Patterns) | Liu Jun Zi Tang | Ba Wei Wan | Bu Zhong Yi Qi Tang (First three see Stroke Patterns) | Zhi Zhu Wan (See Food Stagnation) | Ping Wei San (See Summerheat Patterns) | Xiao Jian Zhong Tang (See Fatigue Patterns)
Shen Ling Bai Zhu San: Treats Spleen-Stomach weakness, poor appetite, vomiting/diarrhea, or recovery from major illness; strongly supports Spleen and Stomach.
Ren Shen, Bai Zhu, Fu Ling, Shan Yao, Bian Dou (Ginger-fried, 1.5 liang each), Gan Cao, Jie Geng, Yi Yi Ren, Lian Rou (1 liang each).
Powder. Take 2 qian per dose, washed down with Jujube decoction. Zhang Sanxi added Mai Ya (1 liang), Sha Ren (3 qian), Shan Zha (5 qian), made into pills with frequent success. Add Ban Xia (8 qian) for Phlegm. For Spleen weakness with dry constipation, cook the above formula inside a pig stomach, sew tight, boil until soft, mash into pills.
Jian Pi Wan: For cases without other symptoms, solely post-prandial failure to transform and subsequent poor appetite.
Ren Shen, Bai Zhu (4 liang each), Shan Zha Rou (1.5 liang), Mai Ya, Ju Pi (1 liang each).
Optionally add Sha Ren, or Mu Xiang, or Ye He boiled Chen Gu Ya, mixed with rice gruel into pills. For limb fatigue, sallow face, bland taste, poor appetite, tinnitus: add Zhi Gan Cao (5 qian), Fu Ling (2 liang). For diarrhea: add Shan Yao, Bian Dou, Lian Rou, Rou Guo. For Damp-Phlegm: add Ban Xia (1 liang), Dan Xing (1.5 liang), Ge Fen, Chi Fu Ling (1 liang each), bound with Shen Qu paste. For Fire, acid regurgitation, nausea: add Chao Shan Zhi (1 liang), Huang Lian (5 qian), water-hanging pills. For much Stagnation, chest discomfort, poor appetite, fatigue (common in women): remove Ren Shen, add Xiang Fu (5 liang), Chuan Xiong (1.5 liang), bound with Shen Qu paste. For Blood Deficiency with dry intestines, dry mouth/constipation, dry skin, poor transport, scant menstruation (pale): add Dang Gui, Bai Shao (2 liang each), Fu Xiong, Mai Dong, Bai Zi Ren (1 liang each), bound with Jian Tang (Rock Sugar).
Zhi Zhong Tang: Treats Spleen-Stomach disharmony, middle fullness, vomiting/reversal, nausea, diarrhea.
Ren Shen, Gan Jiang, Bai Zhu (1 qian each), Chen Pi, Qing Pi, Gan Cao (0.7 qian each).
Decoct in water.
Zhi Suo Er Chen Tang: Er Chen Tang plus Zhi Ke and Sha Ren.
Hou Po Wen Zhong Tang: Treats Spleen-Stomach Cold and Food Retention.
Chen Pi, Hou Po, Gan Jiang, Fu Ling (0.8 qian each), Gan Cao, Mu Xiang (0.5 qian each).
Decoct in water.
Ren Shen Kai Wei Tang: Treats Spleen Deficiency with Food Retention.
Ren Shen, Bai Zhu, Fu Ling, Gan Cao, Chen Pi, Ban Xia, Shen Qu, Mai Ya, Sha Ren, Hou Po, Ding Xiang, Huo Xiang, Lian Rou, Sheng Jiang, Zao Rou.
Decoct in water.
Qi Wei Bai Zhu San: Treats Spleen Deficiency with Hidden Fire.
Ren Shen, Bai Zhu, Fu Ling, Gan Cao, Gan Ge, Huo Xiang, Mu Xiang.
Jiao Zhu Yang Pi Wan: Treats Spleen Deficiency with Dampness.
Ren Shen, Bai Zhu, Fu Ling, Gan Cao, Chuan Jiao, Mai Ya, Cang Zhu, Gan Jiang, Sha Ren.
Shi Pi Yin (Ji Sheng): Treats Spleen Deficiency with Cold-Damp Edema.
Bai Zhu, Fu Ling, Hou Po, Mu Xiang, Mu Gua, Cao Guo, Gan Jiang, Da Fu Pi, Fu Zi (Prepared, 1 liang each), Gan Cao (Roasted, 5 qian).
Take 4 qian per dose, decoct with 1 zhong water, 3 slices ginger, 1 jujube.