丹溪云∶脾具坤静之德，而有干健之运。夫胃阳也，主气。脾阴也，主血。胃司纳受，脾司
运化，一纳一运，化生精气。清气上升，糟粕下降，纳五谷，化津液，其清者为荣，浊者为
卫，阴阳得此，谓之橐 。故东垣以脾胃为五脏之根本也。脾气既弱则健运之令不行，化生
之功已失职，而嗜卧多困所由生焉。法当温补其脾，脾气既旺，则脏腑清阳之气升举，易于
营运，又何困倦之有。海藏用四君子加木香、半夏，白术倍之，姜、枣煎服，诚良法也。若
脾虚，好睡多惊，则是心血虚而火动之，宜安神养血。若因心脾气虚有痰者，宜用人参、五
味子、茯苓以补心气；当归、芍药、酸枣仁以养心血；橘红、半夏以开痰。若因脾肺气虚，
胸膈有痰，用补中益气汤以健脾胃；胆星天竺丸以化痰涎。若因饮食停滞而作，用四君子汤
以益脾土；山楂、神曲以消饮食。若因脾虚而好睡，用五味异功散以补脾气；当归、芍药以生脾血。芍
药须用酒拌炒黄，不则酸寒伤脾，此假热以对假寒也。若乳母饮酒，致儿昏醉好睡者，以干
姜、陈皮煎汤解之，不应，用异功散加干葛即愈矣。
治验
杨永兴子年七岁，嗜卧兼惊，久不愈。余曰∶好睡是脾气虚困也，善惊是心血虚怯也。此心
火不能生脾土，子母俱病。用补中益气汤及六味地黄丸加鹿茸而愈。
一小儿母因醉后饮乳，困睡不醒，遍身如丹瘤，先君谓酒毒为患，用葛花解醒汤，令母子俱
服而愈。
一小儿病后嗜卧，饮食少思，面色痿黄，中隐青色，用五味异功散加柴胡、升麻为末，每服
钱许，日二三次，月余稍愈。又饮食过多，更患呕吐，手足并冷，饮食顿减，先用六君子汤
加升麻、柴胡、木香、干姜，二剂诸症渐愈，又用补中益气汤为末，日服二三次，月余而安
。
一小儿九岁，患痢后嗜卧唾痰，服化痰药，吐痰益甚，而卧床三年矣。面色痿黄兼白，或时
青赤，右关脉微细，左关脉弦数，余谓肝火乘脾，用六君、升麻、柴胡三十余剂而稍健，乃
以补中益气汤间服，又各三十余剂而少坐，又五十余剂而痊。
一女子十一岁，患痢后，嗜卧唾痰，饮食难化，胸腹膨胀，服化痰利气之剂益甚，余谓悉属
脾胃气虚，而饮食化痰也。朝用补中益气汤，夕用五味异功散，两月而愈。又伤食吐泻，用
六君子汤，月余不应，乃以人参五钱，干姜五分，姜枣煎服百余剂始应，仍用补中益气、异功散而痊
。
胆星天竺丸 治小儿痰涎上壅，喘嗽不休。
牛胆南星（一两） 半夏（汤泡去皮脐姜汁制） 白附子（汤泡去皮脐。各五钱） 天竺黄（三钱） 天麻
防风（各二钱） 辰砂（一钱另研水飞）
上为末，甘草汤为丸，芡实大。每服一丸，空心薄荷淡姜汤化下。
五味异功散
六君子汤
四君子汤（三方见内钓）
补中益气汤（方见虚羸）
六味地黄丸（方见肾脏）
葛花解醒汤（方见热吐）
朱丹溪说：脾具有坤卦安静柔顺的德行，同时具备乾卦刚健不息的功能。胃属阳，主管气；脾属阴，主管血。胃负责受纳食物，脾负责运化水谷，一纳一运，从而化生精气。清轻之气上升，重浊之糟粕下降，摄入五谷，化生津液，其中清轻的部分成为营气（营养血液的物质），浑浊的部分成为卫气（保卫体表的物质），阴阳依靠这些得以维持，这就好比风箱一样。所以李东垣认为脾胃是五脏的根本。如果脾气虚弱，那么健运的功能就无法正常行使，化生精气的职责也就失职了，嗜睡和多困倦的原因就在这里。治疗方法应当温补脾脏，脾气旺盛后，脏腑的清阳之气就能升举，容易运行营运，哪里还会有困倦呢？张元素（海藏）使用四君子汤加入木香、半夏，白术加倍用量，加生姜、大枣煎服，这确实是好方法。如果是脾虚，喜欢睡觉且多惊悸，这是心血虚而虚火内动所致，适宜安神养血。如果是因心脾气虚且有痰湿者，适宜用人参、五味子、茯苓来补益心气；当归、芍药、酸枣仁来滋养心血；橘红、半夏来化痰开结。如果是因脾肺气虚，胸膈有痰，用补中益气汤来健运脾胃；胆星天竺丸来化痰涎。如果是因饮食停滞引起，用四君子汤来补益脾土；山楂、神曲来消食导滞。如果是因脾虚导致嗜睡，用五味异功散来补益脾气；当归、芍药来生养脾血。芍药必须用酒拌炒至黄色，否则其酸寒之性会损伤脾脏，这是以假热来对抗假寒的方法。如果乳母饮酒，导致婴儿昏醉嗜睡，用干姜、陈皮煎汤解酒毒，若无效，用异功散加葛根即可痊愈。
验案记录：
杨永兴的儿子七岁，嗜睡兼有惊悸，久治不愈。我说：爱睡觉是脾气虚弱困顿的表现，易惊是心血虚怯的表现。这是心火不能生助脾土，母子同病。使用补中益气汤及六味地黄丸加入鹿茸而痊愈。
一个小孩的母亲在醉酒后进乳喂养，孩子困睡不醒，全身出现如丹瘤般的红斑，家父认为是酒毒为患，使用葛花解醒汤，让母子一起服用而痊愈。
一个小孩病后嗜睡，饮食减少，面色萎黄，中间隐现青色，使用五味异功散加入柴胡、升麻研成末，每次服用一钱左右，每天两三次，一个多月后逐渐好转。后来因为饮食过多，又患上呕吐，手脚冰凉，饮食骤减，先用六君子汤加入升麻、柴胡、木香、干姜，两剂后各种症状逐渐缓解，后又用补中益气汤研成末，每天服用两三次，一个月后安定。
一个九岁的小孩，患痢疾后嗜睡并吐痰，服用化痰药后，吐痰更加严重，卧床三年之久。面色萎黄兼白，有时青赤，右关脉微细，左关脉弦数，我认为这是肝火乘袭脾土，使用六君子汤加升麻、柴胡三十多剂后稍见好转，然后间歇服用补中益气汤，又各服三十多剂后可以稍微坐起，再服五十多剂后痊愈。
一个十一岁的女孩，患痢疾后，嗜睡吐痰，饮食难消化，胸腹膨胀，服用化痰利气的药物后病情加重，我认为这都是脾胃气虚，加上饮食积滞化痰所致。早晨服用补中益气汤，晚上服用五味异功散，两个月后痊愈。后来又因伤食导致呕吐腹泻，使用六君子汤，一个多月无效，于是用五钱人参、五分干姜，加姜枣煎服一百多剂才见效，随后仍用补中益气汤、异功散而痊愈。
胆星天竺丸 治疗小儿痰涎上壅，喘咳不止。
牛胆南星（一两） 半夏（汤泡去皮脐，姜汁制） 白附子（汤泡去皮脐。各五钱） 天竺黄（三钱） 天麻 防风（各二钱） 辰砂（一钱另研水飞）
以上研为细末，用甘草汤泛丸，大小如芡实。每次服用一丸，空腹时用薄荷淡姜汤送服。
五味异功散
六君子汤
四君子汤（三方见内钓章节）
补中益气汤（方见虚羸章节）
六味地黄丸（方见肾脏章节）
葛花解醒汤（方见热吐章节）
Zhu Danxi said: The spleen possesses the virtue of Kun (earth), characterized by stillness and yielding, yet it has the function of Qian (heaven), characterized by vigorous movement. The stomach is yang and governs qi; the spleen is yin and governs blood. The stomach is responsible for receiving and accepting food, while the spleen is responsible for transportation and transformation. One receives, one transforms, thereby generating essence and qi. Clear light qi ascends, while turbid waste descends. By consuming the five grains, fluids are transformed; the clear portion becomes Ying (nutritive qi), and the turbid portion becomes Wei (defensive qi). Yin and Yang rely on these to maintain balance, resembling a bellows. Therefore, Li Dongyuan regarded the spleen and stomach as the root of the five zang organs. If spleen qi is weak, the command of healthy transportation fails, and the function of generating essence and qi is neglected, giving rise to lethargy and fatigue. The treatment method should be to warm and tonify the spleen. Once spleen qi is robust, the clear yang qi of the zang-fu organs can ascend and circulate easily, eliminating fatigue. Zhang Yuansu (Haizang) used Si Jun Zi Tang (Four Gentlemen Decoction) added with Mu Xiang (Aucklandiae Radix) and Ban Xia (Pinelliae Rhizoma), doubling the dosage of Bai Zhu (Atractylodis Macrocephalae Rhizoma), decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus); this is indeed an excellent method. If there is spleen deficiency manifesting as hypersomnia and frequent startle, this is due to heart blood deficiency with hyperactive fire; calming the mind and nourishing blood is appropriate. If caused by heart and spleen qi deficiency with phlegm-dampness, Ren Shen (Ginseng Radix et Rhizoma), Wu Wei Zi (Schisandrae Fructus), and Fu Ling (Poria) should be used to tonify heart qi; Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba), and Suan Zao Ren (Ziziphi Spinosae Semen) to nourish heart blood; Ju Hong (Citri Reticulatae Pericarpium Rubrum) and Ban Xia (Pinelliae Rhizoma) to resolve phlegm. If caused by spleen and lung qi deficiency with phlegm in the chest and diaphragm, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to strengthen the spleen and stomach; Dan Xing Tian Zhu Wan (Calculus Bovis and Tianszhu Huang Pill) to transform phlegm-fluids. If caused by food stagnation, Si Jun Zi Tang (Four Gentlemen Decoction) should be used to benefit spleen earth; Shan Zha (Crataegi Fructus) and Shen Qu (Massa Medicata Fermentata) to digest food. If hypersomnia is due to spleen deficiency, Wu Wei Yi Gong San (Five-Ingredient Decoction for Enhancing the Work of the Spleen) should be used to tonify spleen qi; Dang Gui (Angelicae Sinensis Radix) and Shao Yao (Paeoniae Radix Alba) to generate spleen blood. Shao Yao must be stir-browned with wine; otherwise, its sour and cold nature will damage the spleen. This is using false heat to counteract false cold. If the nursing mother drinks alcohol, causing the infant to become drowsy and sleepy, Gan Jiang (Zingiberis Rhizoma) and Chen Pi (Citri Reticulatae Pericarpium) decocted in water can resolve the toxicity. If ineffective, Yi Gong San (Decoction for Enhancing the Work of the Spleen) added with Ge Gen (Puerariae Lobatae Radix) will cure it.
Case Records:
Yang Yongxing’s son, aged seven, suffered from hypersomnia and startle, which persisted for a long time. I said: Hypersomnia indicates spleen qi deficiency and exhaustion; frequent startle indicates heart blood deficiency and timidity. This is a case where heart fire fails to generate spleen earth, affecting both mother and child. He was cured using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) added with Lu Rong (Cervi Cornu Colla).
An infant whose mother breastfed him after getting drunk became lethargic and unresponsive, with the whole body presenting erythema resembling carbuncles. My father attributed this to alcohol toxicity and prescribed Ge Hua Jie Xing Tang (Kadsura Flower Decoction to Resolve Intoxication), administered to both mother and infant, resulting in a cure.
An infant, after recovering from illness, suffered from hypersomnia and poor appetite, with a sallow complexion showing hints of cyanosis. Wu Wei Yi Gong San (Five-Ingredient Decoction for Enhancing the Work of the Spleen) added with Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma) was ground into powder. Each dose was approximately one qian, taken two to three times daily. After more than a month, he improved slightly. Later, due to overeating, he developed vomiting, cold hands and feet, and sudden loss of appetite. Liu Jun Zi Tang (Six-Gentlemen Decoction) added with Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Mu Xiang (Aucklandiae Radix), and Gan Jiang (Zingiberis Rhizoma) was used first. After two doses, symptoms gradually subsided. Subsequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was ground into powder and taken two to three times daily. After a month, he stabilized.
A nine-year-old boy suffered from hypersomnia and expectoration of phlegm after dysentery. After taking phlegm-resolving medicines, expectoration worsened, and he remained bedridden for three years. His complexion was sallow and white, sometimes bluish-red. The pulse at the right guan position was faint and fine, while the left guan position was wiry and rapid. I diagnosed liver fire invading the spleen. He took Liu Jun Zi Tang (Six-Gentlemen Decoction) with Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) for over thirty doses, showing slight improvement. Then, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was taken intermittently for another thirty-plus doses, allowing him to sit up briefly. After fifty more doses, he recovered completely.
An eleven-year-old girl suffered from hypersomnia and expectoration of phlegm after dysentery, with difficulty digesting food and abdominal distension. Her condition worsened after taking phlegm-resolving and qi-moving agents. I diagnosed this as entirely due to spleen and stomach qi deficiency combined with food stagnation transforming into phlegm. She took Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning and Wu Wei Yi Gong San (Five-Ingredient Decoction for Enhancing the Work of the Spleen) in the evening. She recovered after two months. Later, she suffered from vomiting and diarrhea due to food injury. Liu Jun Zi Tang (Six-Gentlemen Decoction) was used for over a month without effect. Then, Ren Shen (Ginseng Radix et Rhizoma, 5 qian) and Gan Jiang (Zingiberis Rhizoma, 0.5 qian) were decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) and taken for over a hundred doses before showing effect. Finally, she recovered with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Yi Gong San (Decoction for Enhancing the Work of the Spleen).
Dan Xing Tian Zhu Wan (Calculus Bovis and Tianszhu Huang Pill): Treats pediatric phlegm-fluid obstruction causing incessant wheezing and coughing.
Niu Dan Nan Xing (Calculus Bovis, 1 liang) Ban Xia (Pinelliae Rhizoma, soaked in water, skin and umbilicus removed, processed with Ginger Juice) Bai Fu Zi (Typhonii Rhizoma, soaked in water, skin and umbilicus removed. Each 5 qian) Tian Zhu Huang (Tianszhu Huang, 3 qian) Tian Ma (Gastrodiae Rhizoma) Fang Feng (Saposhnikoviae Radix. Each 2 qian) Chen Sha (Cinnabar, 1 qian, separately ground and floated in water)
Grind all into powder. Use Gan Cao Tang (Licorice Decoction) to form pills the size of Euryales Semen (Qian Shi). Take one pill per dose. On an empty stomach, dissolve in thin mint and ginger tea.
Wu Wei Yi Gong San (Five-Ingredient Decoction for Enhancing the Work of the Spleen)
Liu Jun Zi Tang (Six-Gentlemen Decoction)
Si Jun Zi Tang (Four Gentlemen Decoction) (See section "Nei Diao")
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) (See section "Xu Lei")
Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) (See section "Shen Zang")
Ge Hua Jie Xing Tang (Kadsura Flower Decoction to Resolve Intoxication) (See section "Re Tu")