钱 胃虚少纳。土不生金。音低气馁。当与清补。（胃阴虚不饥不纳）
麦冬 生扁豆 玉竹 生甘草 桑叶 大沙参
王 数年病伤不复。不饥不纳。九窍不和。都属胃病。阳土喜柔偏恶刚燥。若四君异功等。竟是
治脾之药。腑宜通即是补。甘濡润。胃气下行。则有效验。
麦冬（一钱） 火麻仁（一钱半炒） 水炙黑小甘草（五分） 生白芍（二钱）
临服入青甘蔗浆一杯。
某（二四）病后胃气不苏。不饥少纳。姑与清养。
鲜省头草（三钱） 白大麦仁（五钱） 新会皮（一钱） 陈半夏曲（一钱） 川斛（三钱） 乌梅（五分）
某（三四）脉涩。体质阴亏偏热。近日不饥口苦。此胃阴有伤。邪热内炽。古称邪火不杀谷是也。
金石斛 陈半夏曲 生谷芽 广皮白 陈香豉 块茯苓
某 理肺养胃。进以甘寒。（肺胃阴虚）
甜杏仁 玉竹 花粉 枇杷叶 川贝 甜水梨汁
某 脉数。口渴有痰。乃胃阴未旺。
炒麦冬 生白扁豆 生甘草 白粳米 北沙参 川斛
陈（二十）知饥少纳。胃阴伤也。
麦冬 川斛 桑叶 茯神 蔗浆
某 胃阳受伤。腑病以通为补。与守中必致壅逆。（胃阳虚）
人参 粳米 益智仁 茯苓 广皮 炒荷叶
某 食谷不化。胃无火也。
生白芍 浓朴 新会皮 益智仁 茯苓 砂仁
计（三三）阳微痰黑。食入不化。
人参 生益智 桂心 茯神 广皮 煨姜
高（六八）脉 小带弦。知饥不欲食。晨起吐痰。是胃阳不足。宜用外台茯苓饮。
又 人参 白术 茯苓 广皮 半夏 枳实皮 白蒺藜 地栗粉
席（二三）脉右濡。脐上过寸有聚气横束。几年来食难用饱。每三四日一更衣。夫九窍失和。都属胃
病。上脘部位为气分。清阳失司。仿仲景微通阳气为法。
薤白 栝蒌汁 半夏 姜汁 川桂枝 鲜菖蒲
某（三二）脉濡自汗。口淡无味。胃阳惫矣。
人参 淡附子 淡干姜 茯苓 南枣
王 脉小。右弦。病属劳倦。饮食不和。医投柴葛。杂入消导。升表攻里。致汗泄三日。脘中不饥。全
是胃阳大伤。防有哕呃厥逆之变。
生益智仁 姜汁 半夏 茯苓 丁香 炒黄米
孙 长夏热伤。为疟为痢。都是脾胃受伤。老年气衰。不肯自复。清阳不肯转旋。脘中不得容纳。
口味痰吐不清。脉弦右濡涩。下焦便不通调。九窍不和。都胃病也。此刚补不安。阳土不耐辛
热矣。议宣通补方。如大半夏汤之类。 大半夏汤加川连姜汁。
又 小温中丸。
钱（二二）壮年肌柔色黯。脉小濡涩。每食过不肯运化。食冷物脐上即痛。色脉参合病象。是胃阳不
旺。浊阴易聚。医知腑阳宜通。自有效验。
良姜 草果 红豆蔻 浓朴 生香附 乌药
汪 舌灰黄。脘痹不饥。形寒怯冷。脾阳式微。不能运布气机。非温通焉能宣达。（脾阳虚）
半夏 茯苓 广皮 干姜 浓朴 荜茇
周（四十）脉象窒塞。能食少运。便溏。当温通脾阳。
生白术（一钱半） 茯苓（三钱） 益智仁（一钱） 淡附子（一钱） 干姜（一钱） 荜茇（一钱）
又 温通脾阳颇适。脉象仍然窒塞。照前方再服二剂。如丸方。当以脾肾同治着想。
吴 酒多谷少。湿胜中虚。腹痛便溏。太阴脾阳少健。平胃合四苓加谷芽。
王（五十）素有痰饮。阳气已微。再加悒郁伤脾。脾胃运纳之阳愈惫。致食下不化。食已欲泻。夫脾胃
为病。最详东垣。当升降法中求之。（脾胃阳虚）
人参 白术 羌活 防风 生益智 广皮 炙草 木瓜
张（十九）食加便溏。胃醒脾不运也。方药当以太阴阳明是调。异功散加甘松益智。
周（四二）脉缓弱。脘中痛胀。呕涌清涎。是脾胃阳微。得之积劳。午后病甚。阳不用事也。大凡脾阳宜
动则运。温补极是。而守中及腻滞皆非。其通腑阳间佐用之。
人参 半夏 茯苓 生益智 生姜汁 淡干姜
大便不爽。间用半硫丸。
朱（五四）阳微。食后吞酸。
茯苓（四两） 炒半夏（二两） 广皮（二两） 生于术（二两） 浓朴（一两） 淡干姜（一两）
荜澄茄（一两） 淡吴萸（一两） 公丁香（五钱） 水法丸。
某（二八）脉弦。食下 胀。大便不爽。水谷之湿内着。脾阳不主默运。胃腑不能宣达。疏脾降胃。令其
升降为要。（湿伤脾胃）
金石斛（三钱） 浓朴（一钱） 枳实皮（一钱） 广皮白（一钱半） 苦参（一钱） 神曲（一钱半） 茯苓皮
（三钱） 麦芽（一钱半）
不运。洞泄之后。而神倦食减。湿伤脾胃清气。用东垣清暑益气主之。
清暑益气法
洪（妪）脉虚涩弱。面乏淖泽。鼻冷肢冷。肌腠麻木。时如寒凛微热。欲溺大便有不化之形。谷食不
纳。此阳气大衰。理进温补。用附子理中汤。（脾肾阳虚）
赵（三七）气分本虚。卫少外护。畏风怯冷。冬天大气主藏。夏季气泄外越。此天热烦倦一因也。是气
分属阳。故桂附理阳颇投。考八味古称肾气。有通摄下焦之功。能使水液不致泛溢。其中阴
药味浓为君。乃阴中之阳药。施于气虚。未为中 。历举益气法。无出东垣范围。俾清阳旋转。
脾胃自强。偏寒偏热。总有太过不及之弊。补中益气加麦冬北味。（中气虚）
又 间服四君子汤。
宣（三五）痛而纳食稍安。病在脾络。因饥饿而得。当养中焦之营。甘以缓之。是其治法。（饥伤） 归建中汤。
戈 小便短涩混浊。大便频溏。不欲纳谷。此伤食恶食也。当分消土。（食伤）
生益智 广皮 茯苓 泽泻 炒白芍 炒山楂
脾胃之论。莫详于东垣。其所着补中益气。调中益气。升阳益胃等汤。诚补前人之未备。察其立方之意。因以内伤
劳倦为主。又因脾乃太阴湿土。且世人胃阳衰者居多。故用参 以补中。二术以温燥。升柴升下陷之清阳。陈皮木香。
理中宫之气滞。脾胃合治。若用之得宜。诚效如桴鼓。盖东垣之法。不过详于治脾。而略于治胃耳。乃后人宗其意者。
凡着书立说。竟将脾胃总论。即以治脾之药。笼统治胃。举世皆然。今观叶氏之书。始知脾胃当分析而论。盖胃属戊土。
脾属己土。戊阳己阴。阴阳之性有别也。脏宜藏。腑宜通。脏腑之体用各殊也。若脾阳不足。胃有寒湿。一脏一腑。皆
宜于温燥升运者。自当恪遵东垣之法。若脾阳不亏。胃有燥火。则当遵叶氏养胃阴之法。观其立论云。纳食主胃。运化
主脾。脾宜升
则健。胃宜降则和。又云。太阴湿土。得阳始运。阳明阳土。得阴自安。以脾喜刚燥。胃喜柔润
也。仲景急下存津。其治在胃。东垣大升阳气。其治在脾。此种议论。实超出千古。故凡遇禀
质木火之体。患燥热之症。或病后热伤肺胃津液。以致虚痞不食。舌绛咽干。烦渴不寐。肌
燥热。便不通爽。此九窍不和。都属胃病也。岂可以 术升柴治之乎。故先生必用降胃
之法。所谓胃宜降则和者。非用辛开苦降。亦非苦寒下夺。以损胃气。不过甘平。或甘凉濡
润。以养胃阴。则津液来复。使之通降而已矣。此义。即宗内经所谓六腑者。传化物而不藏。
以通为用之理也。今案中所分胃阴虚。胃阳虚。脾胃阳虚。中虚。饥伤。食伤。其种种治法。最
易明悉。余不参赘。总之脾胃之病。虚实寒热。宜燥宜润。固当详辨。其于升降二字。尤为紧
要。盖脾气下陷固病。即使不陷。而但不健运。已病矣。胃气上逆固病。即不上逆。但不通降。
亦病矣。故脾胃之治法。与各门相兼者甚多。如呕吐肿胀泄泻。便闭不食。胃痛腹痛。木乘
土诸门。尤宜并参。互相讨论。以明其理可也。（华岫云）
徐评 发明亦切当。
钱某：胃气虚弱，食欲减退。土（脾）不能生金（肺），声音低微，气息短促。应当采用清补法。（这是胃阴虚导致的没有饥饿感、无法进食）
麦冬 生扁豆 玉竹 生甘草 桑叶 大沙参
王某：患病多年，身体损伤后未能恢复。没有饥饿感，无法进食。九窍功能失调，都归属于胃病。阳土（胃）喜欢柔和而厌恶刚燥。像四君子汤、异功散等，完全是治疗脾的药物。腑病以通利即为补益。用甘味濡润之品，使胃气下行，就能见效。
麦冬（一钱） 火麻仁（一钱半，炒） 水炙黑小甘草（五分） 生白芍（二钱）
服药时加入青甘蔗浆一杯。
某人（二十四岁）：病后胃气未苏醒。没有饥饿感，食欲少。暂且给予清养之法。
鲜省头草（三钱） 白大麦仁（五钱） 新会皮（一钱） 陈半夏曲（一钱） 川斛（三钱） 乌梅（五分）
某人（三十四岁）：脉象涩。体质阴亏偏热。近日没有饥饿感，口苦。这是胃阴受伤，邪热内炽。古人所说的“邪火不杀谷”就是这种情况。
金石斛 陈半夏曲 生谷芽 广皮白 陈香豉 块茯苓
某人：调理肺脏，滋养胃脏。进用甘寒之品。（这是肺胃阴虚）
甜杏仁 玉竹 花粉 枇杷叶 川贝 甜水梨汁
某人：脉数。口渴且有痰。这是胃阴尚未旺盛。
炒麦冬 生白扁豆 生甘草 白粳米 北沙参 川斛
陈某（二十岁）：知道饥饿但吃得少。这是胃阴受伤。
麦冬 川斛 桑叶 茯神 蔗浆
某人：胃阳受伤。腑病以通利为补。如果固守中焦，必然导致壅滞逆乱。（这是胃阳虚）
人参 粳米 益智仁 茯苓 广皮 炒荷叶
某人：吃谷物不消化。这是胃中没有火（胃阳不足）。
生白芍 浓朴 新会皮 益智仁 茯苓 砂仁
计某（三十三岁）：阳气微弱，痰色黑。食物进入后不消化。
人参 生益智 桂心 茯神 广皮 煨姜
高某（六十八岁）：脉象小而带弦。知道饥饿但不想吃东西。早晨起来吐痰。这是胃阳不足。宜用《外台秘要》中的茯苓饮。
又方：人参 白术 茯苓 广皮 半夏 枳实皮 白蒺藜 地栗粉
席某（二十三岁）：脉象右部濡软。脐上超过寸部有聚气横束。几年来吃饭难以吃饱。每三四天排便一次。九窍失和，都归属于胃病。上脘部位属于气分。清阳失去主持。仿照张仲景微通阳气的方法。
薤白 栝蒌汁 半夏 姜汁 川桂枝 鲜菖蒲
某人（三十二岁）：脉濡，自汗。口淡无味。胃阳疲惫了。
人参 淡附子 淡干姜 茯苓 南枣
王某：脉小。右脉弦。病症属于劳倦。饮食不和。医生投用柴胡、葛根，混杂消导药。升表攻里，导致出汗泄泻三天。胃脘中没有饥饿感。完全是胃阳大伤。防止出现呃逆、厥逆的变化。
生益智仁 姜汁 半夏 茯苓 丁香 炒黄米
孙某：长夏季节热邪损伤。患疟疾或痢疾，都是脾胃受伤。老年人元气衰败，不肯自行恢复。清阳不肯转旋。胃脘中不得容纳。口味不清，痰吐不清。脉象弦，右脉濡涩。下焦大便不通调。九窍不和，都是胃病。这种刚补的方法让人不安，阳土不耐受辛热。建议宣通补方。如大半夏汤之类。大半夏汤加黄连、姜汁。
又方：小温中丸。
钱某（二十二岁）：壮年，肌肉柔软，面色暗。脉象小、濡、涩。每次吃过食物不肯运化。吃冷物脐上即痛。结合面色和脉象判断病机，是胃阳不旺，浊阴容易聚集。医生知道腑阳宜通，自然有效验。
良姜 草果 红豆蔻 浓朴 生香附 乌药
汪某：舌苔灰黄。胃脘痹阻，没有饥饿感。形体寒冷，怕冷。脾阳式微。不能运布气机。如果不温通，怎么能宣达？（这是脾阳虚）
半夏 茯苓 广皮 干姜 浓朴 荜茇
周某（四十岁）：脉象窒塞。能吃但运化少。大便溏薄。应当温通脾阳。
生白术（一钱半） 茯苓（三钱） 益智仁（一钱） 淡附子（一钱） 干姜（一钱） 荜茇（一钱）
又方：温通脾阳很合适。脉象仍然窒塞。照前方再服两剂。做成丸方。应当从脾肾同治来考虑。
吴某：酒多谷少，湿气胜而中焦虚。腹痛，大便溏薄。太阴脾阳稍健。平胃散合四苓散加谷芽。
王某（五十岁）：素有痰饮，阳气已微弱。再加上忧郁伤脾。脾胃运纳的阳气更加疲惫。导致食物下去不消化，吃完想泻。脾胃为病，最详细的是李东垣。应当在升降法中寻求治疗。（这是脾胃阳虚）
人参 白术 羌活 防风 生益智 广皮 炙草 木瓜
张某（十九岁）：食量增加但大便溏薄。胃醒了但脾不运化。方药应当调和太阴和阳明。异功散加甘松、益智。
周某（四十二岁）：脉缓弱。胃脘中痛胀。呕吐涌出清涎。这是脾胃阳微。得之于积劳。午后病情加重，因为阳气不在主事的时候。大凡脾阳宜动则能运化。温补极是。但守中和腻滞都不对。在通腑阳的同时佐用。
人参 半夏 茯苓 生益智 生姜汁 淡干姜
大便不爽。间或用半硫丸。
朱某（五十四岁）：阳气微弱。饭后吞酸。
茯苓（四两） 炒半夏（二两） 广皮（二两） 生于术（二两） 浓朴（一两） 淡干姜（一两）
荜澄茄（一两） 淡吴萸（一两） 公丁香（五钱） 水泛为丸。
某人（二十八岁）：脉弦。进食后腹胀。大便不爽。水谷之湿内着。脾阳不主默运。胃腑不能宣达。疏脾降胃，令其升降为要。（这是湿伤脾胃）
金石斛（三钱） 浓朴（一钱） 枳实皮（一钱） 广皮白（一钱半） 苦参（一钱） 神曲（一钱半） 茯苓皮（三钱） 麦芽（一钱半）
不运。洞泄之后，精神疲倦，食欲减少。湿伤脾胃清气。用李东垣的清暑益气法主治。
清暑益气法
洪某（老妇人）：脉虚涩弱。面色缺乏润泽。鼻冷肢冷。肌腠麻木。时常像寒冷微热。想小便和大便时有不化的形状。谷食不纳。这是阳气大衰。理当进用温补。用附子理中汤。（这是脾肾阳虚）
赵某（三十七岁）：气分本虚，卫气少外护。畏风怯冷。冬天大气主藏。夏季气泄外越。这是天热烦倦的一个原因。气分属阳，所以桂附理阳很投合。考察八味丸古称肾气，有通摄下焦之功。能使水液不致泛溢。其中阴药味浓为君，乃阴中之阳药。施于气虚，未为中肯。历举益气法，无出李东垣范围。使清阳旋转。脾胃自强。偏寒偏热，总有太过不及的弊病。补中益气汤加麦冬、北五味子。（这是中气虚）
又方：间服四君子汤。
宣某（三十五岁）：疼痛而进食后稍安。病在脾络。因饥饿而得。应当养中焦之营血。甘以缓之，是其治法。（这是饥伤）归建中汤。
戈某：小便短涩混浊。大便频溏。不想纳谷。这是伤食恶食。应当分消土湿。（这是食伤）
生益智 广皮 茯苓 泽泻 炒白芍 炒山楂
关于脾胃的论述，没有比李东垣更详细的。他所著的补中益气汤、调中益气汤、升阳益胃汤等，确实补充了前人的不足。考察他立方的意思，以内伤劳倦为主。又因为脾是太阴湿土，而且世人胃阳衰者居多，所以用人参、黄芪以补中。苍术、白术以温燥。升麻、柴胡升提下陷的清阳。陈皮、木香理中宫之气滞。脾胃合治，如果用得适宜，确实效如桴鼓。大概李东垣的方法，不过是详于治脾，而略于治胃罢了。于是后人宗奉他的意旨，凡是著书立说，竟将脾胃总论，即以治脾的药，笼统治胃。举世皆然。现在看叶氏的书，才知道脾胃应当分析而论。盖胃属戊土，脾属己土。戊阳己阴，阴阳的性质不同。脏宜藏，腑宜通，脏腑的体用各不相同。如果脾阳不足，胃有寒湿，一脏一腑，都宜于温燥升运的，自然应当恪守李东垣的方法。如果脾阳不亏，胃有燥火，则应当遵循叶氏养胃阴的方法。看他的立论说：“纳食主胃，运化主脾。脾宜升则健，胃宜降则和。”又说：“太阴湿土，得阳始运。阳明阳土，得阴自安。”这是因为脾喜刚燥，胃喜柔润。张仲景急下存津，其治在胃。李东垣大升阳气，其治在脾。这种议论，实在超出千古。所以凡是遇到禀质木火之体，患燥热之症。或者病后热伤肺胃津液，以致虚痞不食，舌绛咽干，烦渴不寐，肌燥热，便不通爽。这九窍不和，都属胃病。岂可以用苍术、升麻、柴胡来治呢？所以先生必用降胃之法。所谓胃宜降则和者，不是用辛开苦降，也不是用苦寒下夺，以损胃气。不过是甘平，或甘凉濡润，以养胃阴，则津液来复，使之通降而已矣。这个义理，即宗奉《内经》所谓六腑者，传化物而不藏，以通为用的道理。现在案中所分的胃阴虚、胃阳虚、脾胃阳虚、中虚、饥伤、食伤，其种种治法，最容易明白。我不再多赘述。总之脾胃的病，虚实寒热，宜燥宜润，固然应当详细辨别。其于升降二字，尤为重要。盖脾气下陷固然是病，即使不下陷，但只要不健运，已经是病了。胃气上逆固然是病，即使不上逆，但只要不通降，也是病了。所以脾胃的治法，与各门相兼的很多。如呕吐、肿胀、泄泻、便闭不食、胃痛、腹痛、木乘土诸门，尤其应当并参，互相讨论，以明其理即可。（华岫云评）
徐评：发明亦切当。
Qian: Stomach Qi deficiency with poor appetite. Earth (Spleen) fails to generate Metal (Lung), resulting in low voice and shortness of breath. Treatment should employ clear tonification. (This is stomach Yin deficiency leading to lack of hunger and inability to eat.)
Ophiopogonis Radix (Maidong), Raw Puerariae Lobatae Radix (Sheng Bian Dou - *Note: Context implies Dioscorea Hypoglauca or similar, but literal translation used*), Polygonati Odorati Rhizoma (Yuzhu), Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao), Mori Folium (Sangye), Large Adenophorae Radix (Dashenshen).
Wang: Ill for years, body damage not recovered. No hunger, unable to eat. Disharmony of the nine orifices all belongs to stomach disease. Yang Earth (Stomach) prefers softness and repels rigidity and dryness. Formulas such as Sijunzi Tang (Four Gentlemen Decoction) and Yigong San (Extraordinary Power Powder) are entirely medicines for treating the Spleen. For Fu organs, unblocking is equivalent to tonifying. Using sweet and moistening agents allows Stomach Qi to descend, yielding effective results.
Ophiopogonis Radix (1 qian), Hemp Seed (Huo Ma Ren, 1.5 qian, stir-fried), Water-processed Black Licorice (Shui Zhi Hei Xiao Gancao, 0.5 fen), Raw White Peony Root (Sheng Baishao, 2 qian).
Add one cup of fresh sugarcane juice before taking the medicine.
Certain patient (24 years old): After illness, Stomach Qi has not revived. No hunger, little appetite. Temporarily provide clear nourishment.
Fresh Mentha Haplocalyx (Xian Shentou Cao, 3 qian), White Coix Seed (Bai Damairen, 5 qian), Xinhui Tangerine Peel (Xinhui Pi, 1 qian), Aged Pinelliae Fermentum (Chen Banxia Qu, 1 qian), Chuan斛 (Chuan Hu, 3 qian), Mume Fructus (Wumei, 0.5 fen).
Certain patient (34 years old): Pulse is choppy. Constitution is Yin deficient with heat tendency. Recently no hunger and bitter taste in mouth. This indicates injury to Stomach Yin with fierce internal pathogenic heat. As the ancients said, "pathogenic fire does not digest grain."
Dendrobii Caulis (Jinshihu), Aged Pinelliae Fermentum (Chen Banxia Qu), Raw Sprouted Grain (Sheng Guya), Guangpi Bai (Peel of Citrus Reticulata), Aged Fermented Soybean (Chen Xiangchi), Kuai Fuling (Poria).
Certain patient: Regulate Lung, nourish Stomach. Advance with sweet-cold herbs. (This is Lung and Stomach Yin deficiency.)
Sweet Almond Seed (Tian Xingren), Polygonati Odorati Rhizoma (Yuzhu), Trichosanthis Radix (Huafen), Loquat Leaf (Pipaye), Fritillariae Thunbergii Bulbus (Chuanbei), Sweet Pear Juice (Tianshui Lizhi).
Certain patient: Pulse is rapid. Thirsty with phlegm. This is because Stomach Yin is not yet vigorous.
Stir-fried Ophiopogonis Radix (Chao Maidong), Raw Puerariae Lobatae Radix (Sheng Baibian Dou), Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao), White Rice (Baijingmi), Northern Adenophorae Radix (Beishashen), Chuan斛 (Chuan Hu).
Chen (20 years old): Knows hunger but eats little. This is injury to Stomach Yin.
Ophiopogonis Radix (Maidong), Chuan斛 (Chuan Hu), Mori Folium (Sangye), Poria (Fushen), Sugarcane Juice (Zheshuang).
Certain patient: Stomach Yang injured. For Fu organ diseases, unblocking is tonification. Adhering rigidly to the center will inevitably cause stagnation and rebellion. (This is Stomach Yang deficiency.)
Ginseng Radix (Renshen), Rice (Jingmi), Alpinia Officinarum Rhizome (Yizhiren), Poria (Fuling), Guangpi (Citrus Reticulata Peel), Stir-fried Lotus Leaf (Chao Hetaye).
Certain patient: Eats grain but does not digest. This is lack of fire in the Stomach (Stomach Yang insufficiency).
Raw White Peony Root (Sheng Baishao), Magnolia Bark (Nongpo), Xinhui Tangerine Peel (Xinhui Pi), Alpinia Officinarum Rhizome (Yizhiren), Poria (Fuling), Amomi Fructus Rotundus (Sharen).
Ji (33 years old): Yang is faint, phlegm is black. Food enters but does not digest.
Ginseng Radix (Renshen), Raw Alpinia Officinarum Rhizome (Sheng Yizhi), Cinnamon Twig (Guixin), Poria (Fushen), Guangpi (Citrus Reticulata Peel), Roasted Ginger (Weijiang).
Gao (68 years old): Pulse is small and slightly wiry. Knows hunger but does not want to eat. Vomits phlegm upon waking. This is insufficient Stomach Yang. Use Waitai Fuling Yin (Fuling Decoction from The External Cabinet).
Another prescription: Ginseng Radix (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Guangpi (Citrus Reticulata Peel), Pinelliae Rhizoma (Banxia), Aurantii Fructus Pericarpium (Zhishi Pi), Tribuli Fructus (Bajili), Dioscorea Hypoglauca Tuber (Dilifen).
Xi (23 years old): Right pulse is soggy. Qi accumulation binds horizontally above the navel past the cun position. For years, difficult to eat until full. Bowel movement once every three to four days. Disharmony of the nine orifices all belongs to stomach disease. The upper epigastrium region belongs to the Qi level. Clear Yang loses its control. Imitate Zhang Zhongjing's method of slightly unblocking Yang Qi.
Allii Macrostemonis Bulbus (Xiebai), Trichosanthis Fructus Juice (Gualou Zhi), Pinelliae Rhizoma (Banxia), Ginger Juice (Jiangzhi), Cinnamon Twig (Chuan Guizhi), Fresh Acorus Tatarinowii Rhizome (Xian Changpu).
Certain patient (32 years old): Pulse is soggy with spontaneous sweating. Mouth tastes bland. Stomach Yang is exhausted.
Ginseng Radix (Renshen), Light Processed Aconiti Lateralis Radix Preparata (Dan Fuzi), Light Processed Zingiberis Rhizoma (Dan Jiangjiang), Poria (Fuling), Southern Jujube (Nanzao).
Wang: Pulse is small. Right side is wiry. Disease belongs to fatigue and overwork. Diet is discordant. Physician administered Chaihu and Ge Gen, mixed with digestive aids. Ascending the exterior and attacking the interior caused sweating and leakage for three days. Epigastrium feels no hunger. Entirely due to major injury to Stomach Yang. Prevent changes such as hiccups, reversal cold, or convulsions.
Raw Alpinia Officinarum Rhizome (Sheng Yizhiren), Ginger Juice (Jiangzhi), Pinelliae Rhizoma (Banxia), Poria (Fuling), Clove Flower Bud (Dingxiang), Stir-fried Yellow Rice (Chao Huangmi).
Sun: Heat injury during midsummer. Malaria and dysentery both injure Spleen and Stomach. In old age, Qi declines and refuses to recover spontaneously. Clear Yang refuses to rotate. Epigastrium cannot accommodate. Taste is unclear, expectoration is unclear. Pulse is wiry, right side is soggy and choppy. Lower Jiao bowel movements are unregulated. Disharmony of the nine orifices all belongs to stomach disease. This rigid tonification makes one uneasy; Yang Earth cannot tolerate pungent and hot herbs. Propose a dispersing and unblocking tonification formula, such as Banxiexia Tang (Half-size Pinellia Decoction). Banxiexia Tang added with Coptidis Rhizoma (Chuanlian) and Ginger Juice (Jiangzhi).
Another prescription: Xiaowenzhong Wan (Small Warm Middle Pill).
Qian (22 years old): Young adult, soft muscles, dark complexion. Pulse is small, soggy, and choppy. After eating, food refuses to transform. Eating cold items causes pain above the navel. Combining complexion and pulse analysis, the pathology is weak Stomach Yang, allowing turbid Yin to easily gather. Physicians know that Fu Yang should be unblocked, which naturally yields results.
Alpiniae Katsumadai Rhizoma (Liangjiang), Cardamomi Fructus (Caoguo), Myristica Fragrans Seed (Hong Doukou), Magnolia Bark (Nongpo), Cyperi Rhizoma (Sheng Xiangfu), Linderae Radix (Wuyao).
Wang: Tongue coating is gray-yellow. Epigastric bi obstruction, no hunger. Body feels cold, aversion to cold. Spleen Yang is declining. Unable to distribute Qi mechanism. How can it be disseminated without warming and unblocking? (This is Spleen Yang deficiency.)
Pinelliae Rhizoma (Banxia), Poria (Fuling), Guangpi (Citrus Reticulata Peel), Zingiberis Rhizoma (Ganjiang), Magnolia Bark (Nongpo), Long Pepper Fruit (Bibo).
Zhou (40 years old): Pulse feels obstructed. Can eat but transforms little. Loose stools. Should warm and unblock Spleen Yang.
Raw Atractylodis Macrocephalae Rhizoma (Sheng Baizhu, 1.5 qian), Poria (Fuling, 3 qian), Alpinia Officinarum Rhizome (Yizhiren, 1 qian), Light Processed Aconiti Lateralis Radix Preparata (Dan Fuzi, 1 qian), Zingiberis Rhizoma (Ganjiang, 1 qian), Long Pepper Fruit (Bibo, 1 qian).
Another prescription: Warming and unblocking Spleen Yang is quite suitable. Pulse still feels obstructed. Take two more doses according to the previous prescription. Make into pills. Consider treating Spleen and Kidney simultaneously.
Wu: Drinks much wine, eats little grain. Dampness prevails, middle Jiao is deficient. Abdominal pain, loose stools. Taiyin Spleen Yang is slightly healthy. Pingwei San combined with Siling San plus Sprouted Grain.
Wang (50 years old): Has chronic phlegm-fluid retention, Yang Qi is already faint. Added to this, depression injures the Spleen. The Yang of Spleen and Stomach transport and receive becomes even more exhausted. Causes undigested food after eating, desire to defecate after eating. Diseases of Spleen and Stomach are most detailed by Dongyuan. Seek treatment within the method of ascending and descending. (This is Spleen and Stomach Yang deficiency.)
Ginseng Radix (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Raw Alpinia Officinarum Rhizome (Sheng Yizhi), Guangpi (Citrus Reticulata Peel), Honey-fried Licorice (Zhicao), Papaya (Mu Gua).
Zhang (19 years old): Increased food intake but loose stools. Stomach wakes up but Spleen does not transform. Prescription should harmonize Taiyin and Yangming. Yigong San plus Catnip (Gansong) and Alpinia Officinarum Rhizome (Yizhi).
Zhou (42 years old): Pulse is slow and weak. Epigastric pain and distension. Vomiting clear saliva. This is faint Spleen and Stomach Yang, acquired from accumulated fatigue. Condition worsens in the afternoon when Yang is not in command. Generally, Spleen Yang should move to transform. Warm tonification is excellent. However, adhering to the center and using cloying/stagnating herbs are incorrect. Use them interspersed with unblocking Fu Yang.
Ginseng Radix (Renshen), Pinelliae Rhizoma (Banxia), Poria (Fuling), Raw Alpinia Officinarum Rhizome (Sheng Yizhi), Fresh Ginger Juice (Shengjiangzhi), Light Processed Zingiberis Rhizoma (Dan Jiangjiang).
Bowels do not feel smooth. Occasionally use Banshu Wan (Half-Sulfur Pill).
Zhu (54 years old): Yang is faint. Acid regurgitation after eating.
Poria (4 liang), Stir-fried Pinelliae Rhizoma (Chao Banxia, 2 liang), Guangpi (Citrus Reticulata Peel, 2 liang), Raw Atractylodis Macrocephalae Rhizoma (Sheng Baizhu, 2 liang), Magnolia Bark (Nongpo, 1 liang), Light Processed Zingiberis Rhizoma (Dan Jiangjiang, 1 liang), Long Pepper Fruit (Bichengqie, 1 liang), Light Processed Evodiae Fructus (Dan Wuyu, 1 liang), Clove Flower Bud (Gong Dingxiang, 5 qian). Water-pill method.
Certain patient (28 years old): Pulse is wiry. Distension after eating. Bowels do not feel smooth. Dampness of water and grain settles internally. Spleen Yang does not govern silent transformation. Stomach Fu cannot disseminate. Disperse Spleen and descend Stomach, making their ascending and descending essential. (This is dampness injuring Spleen and Stomach.)
Dendrobii Caulis (Jinshihu, 3 qian), Magnolia Bark (Nongpo, 1 qian), Aurantii Fructus Pericarpium (Zhishi Pi, 1 qian), Guangpi Bai (Peel of Citrus Reticulata, 1.5 qian), Sophorae Flavescentis Radix (Kushen, 1 qian), Medicated Leaven (Shenqu, 1.5 qian), Poria Peel (Fuling Pi, 3 qian), Barley Sprout (Maiya, 1.5 qian).
No transformation. After watery diarrhea, spirit is fatigued and appetite decreases. Dampness injures the clear Qi of Spleen and Stomach. Use Dongyuan's Qingshu Yiqi Zhu (Clear Summerheat and Boost Qi Main Formula).
Qingshu Yiqi Method.
Hong (Elderly woman): Pulse is empty, choppy, and weak. Face lacks luster. Nose and limbs are cold. Muscle pores are numb. Sometimes feels like slight cold and fever. Urination and defecation show undigested forms. Grain and food are not accepted. This is major decline of Yang Qi. Reasonably advance warm tonification. Use Fuzi Lizhong Tang (Aconite Regulate Middle Decoction). (This is Spleen and Kidney Yang deficiency.)
Zhao (37 years old): Qi level is originally deficient, Wei Qi lacks external protection. Aversion to wind and fear of cold. In winter, atmospheric Qi stores. In summer, Qi leaks outward. This is one reason for restlessness and fatigue in hot weather. Qi level belongs to Yang, so Guiji Liyang (Cinnamon and Aconite Regulate Yang) is quite appropriate. Examining Bawei Wan (Eight-Ingredient Pill), anciently called Shenqi (Kidney Qi), it has the function of connecting and controlling the Lower Jiao. It prevents fluid overflow. Among them, Yin herbs with strong flavor are the sovereign. They are Yang herbs within Yin. Applied to Qi deficiency, they are not entirely fitting. Reviewing all Qi-boosting methods, none exceed Dongyuan's scope. Let Clear Yang rotate. Spleen and Stomach strengthen themselves. Bias towards cold or heat always has the flaw of excess or deficiency. Buzhong Yiqi Tang added with Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Beiweizi). (This is Middle Qi deficiency.)
Another prescription: Intermittently take Sijunzi Tang (Four Gentlemen Decoction).
Xuan (35 years old): Pain relieved slightly by eating. Disease is in Spleen collaterals. Acquired due to hunger. Should nourish Ying (Nutrient) Qi of the Middle Jiao. Sweetness to relax it is the treatment method. (This is injury from hunger.) Guijianzhong Tang (Return and Build Middle Decoction).
Ge: Urine is short, scanty, turbid. Frequent loose stools. Do not want to accept grain. This is food injury causing aversion to food. Should separate and eliminate Earth dampness. (This is food injury.)
Raw Alpinia Officinarum Rhizome (Sheng Yizhi), Guangpi (Citrus Reticulata Peel), Poria (Fuling), Alisma Rhizoma (Zexie), Stir-fried White Peony Root (Chao Baishao), Stir-fried Hawthorn Fruit (Chao Shanzha).
Discussions on Spleen and Stomach are most detailed in Dongyuan. His formulas such as Buzhong Yiqi Tang (Boost Middle and Augment Qi Decoction), Tiaozhong Yiqi Tang (Regulate Middle and Augment Qi Decoction), and Shengyang Yiwet Tang (Raise Yang and Benefit Stomach Decoction) indeed supplement what predecessors lacked. Examining his intent in formulating prescriptions, he focuses on internal injury from fatigue. Furthermore, because Spleen is Taiyin Damp Earth, and most people have deficient Stomach Yang, he uses Ginseng and Astragalus to tonify the middle. Atractylodes to warm and dry. Cimicifuga and Bupleurum to raise sunken Clear Yang. Tangerine Peel and Costus Root to regulate Qi stagnation in the Middle Palace. Treating Spleen and Stomach together, if applied appropriately, yields results like a drumstick striking a drum. Essentially, Dongyuan's method details treating the Spleen but neglects the Stomach. Later generations following his intent, in writing books, treat Spleen and Stomach as a whole, using Spleen-treating medicines to generally treat the Stomach. This is universal. Now, viewing Ye's book, we know Spleen and Stomach should be analyzed separately. Stomach belongs to Wu Earth, Spleen belongs to Ji Earth. Wu is Yang, Ji is Yin; the nature of Yin and Yang differs. Zang organs store, Fu organs unblock; the substance and function of Zang and Fu are distinct. If Spleen Yang is insufficient and Stomach has cold-dampness, both Zang and Fu benefit from warming, drying, ascending, and transforming. One should strictly follow Dongyuan's method. If Spleen Yang is not deficient but Stomach has dryness and fire, one should follow Ye's method of nourishing Stomach Yin. His theory states: "Accepting food is governed by the Stomach, transforming and transporting is governed by the Spleen. Spleen is healthy when ascending, Stomach is harmonious when descending." Also: "Taiyin Damp Earth begins to transform when obtaining Yang. Yangming Yang Earth becomes peaceful when obtaining Yin." This is because Spleen likes rigidity and dryness, while Stomach likes softness and moisture. Zhang Zhongjing's urgent purging to preserve fluids treats the Stomach. Dongyuan's great raising of Yang Qi treats the Spleen. This discussion truly surpasses antiquity. Therefore, whenever encountering constitutions with Wood-Fire qualities suffering from dryness-heat, or post-illness heat injuring Lung and Stomach fluids, leading to empty fullness, anorexia, crimson tongue, dry throat, irritability, thirst, insomnia, dry skin, heat, and unsmooth bowels. These nine orifices disharmonies all belong to Stomach disease. How can one use Atractylodes, Cimicifuga, and Bupleurum to treat it? Thus, the master must use methods to descend the Stomach. What is meant by "Stomach is harmonious when descending" is not using pungent-opening and bitter-descending, nor bitter-cold purging to damage Stomach Qi. It is merely sweet-neutral or sweet-cool and moistening to nourish Stomach Yin. Then fluids return, enabling unblocking and descending. This principle follows the Nei Jing saying that Fu organs transmit and transform without storing, using unblocking as their function. In the cases herein, Stomach Yin deficiency, Stomach Yang deficiency, Spleen-Stomach Yang deficiency, Middle deficiency, hunger injury, and food injury, along with their various treatments, are easiest to understand. I will not add more. In summary, for Spleen and Stomach diseases, one must distinguish deficiency/excess and cold/heat, and whether to use drying or moistening methods. The characters "ascending and descending" are particularly crucial. Spleen Qi sinking is definitely a disease; even if not sinking, if it does not transform healthily, it is diseased. Stomach Qi rebelling upward is definitely a disease; even if not rebelling, if it does not descend smoothly, it is diseased. Therefore, Spleen and Stomach treatment methods overlap with many other categories. Especially in vomiting, swelling, diarrhea, constipation/anorexia, epigastric pain, abdominal pain, and Liver invading Spleen categories, one should refer to them mutually and discuss to clarify the principles. (Commentary by Hua Xiuyun)
Xu's Commentary: The elucidation is also pertinent.