停食者，必胸膈痞塞，恶食噫气，如败卵臭，身热颅汗，掌中倍热，烦啼不能仰
卧，见食憎恶，且亦头痛发热，状如伤寒，但身不痛为异，其脉右手气口紧盛，治法伤
食初起，必兼辛散，不可骤用苦寒，盖食得寒则愈凝，得热乃能腐熟，惟宜导痰消食健
脾。若至已成糟粕，日久生热，须假凉药一二味以降之，故朦石丸内用黄芩也。亦有郁
怒忧抑，伤脾不思饮食者，尤宜行气调中，如冷物停滞者，炮姜、豆蔻辛温之药，以消
导之。宿食已消，而中焦未和者，六君子以养之。食多而滞者，消其滞，食少而不能化
者，助其脾。至有身不壮热，脉不洪大而实，但胸中胀极者，此无根失守之气，逆奔
于上，乃能极胀，大虚症也。盖胸为受气之所，非可藏纳有形之物，当用塞因塞用之
法，以大补为消。
东垣曰∶宿食不化，则独右关脉沉滑。又曰∶浮而滑者，宿食也。又曰∶脉弦者，
伤食。书又曰∶人迎紧盛伤于寒，气口紧盛伤于食，夫人迎乃左寸也，为足阳明之别
脉，而何以伤于寒者，反人迎紧盛乎？气口乃右寸也，为手太阴之动脉，而何以伤于食
者，反气口紧盛乎？盖人身之气血，营运不息，流注于各经，而见动脉。若寒伤于肺，
皮毛外束，邪火燔灼于肺金，以故太阴不能朝百脉而持权衡，阳明一经，独有浊也，故
气血之所注，祗就胃中之无邪者，而输将之。《灵枢》以人迎候阳主外，则知人迎为
阳明之腑脉，专主乎表，故人迎紧盛，而知寒伤乎肺也。若食伤于胃，则精微无由上输
于肺，而金无所养，致失其权，溉脏腑流行三焦之职，由是血止盛乎一经，而不能宣通
上达也。《灵枢》以气喉阴主中，则知气口为太阴之脏脉，而主乎里，故气口紧盛，而
知食伤乎胃也。后世以左右手关前一分为人迎气口，而以辨内外伤，纷无定说。又曰∶
何谓人迎喉旁取之？互参诸书，庶不淆于左表右里之说，而合于《内经》矣。李时珍
曰∶两手六脉，皆肺之经脉也。盖脉行始于肺，终于肝，而复会于肺，肺力气之门户，
寸口曰气口者，因肺主气，气之盛衰，见于此也。凡五脏六腑，两手寸关尺者，皆手太
阴肺金之一脉也，但分其部位以候他脏之气耳，故曰肺朝百脉，而寸口为之大会也。然
岐伯曰∶气口亦太阴，何也？盖五味入口，藏于胃，以养五脏，五脏六腑之气味，皆出
于胃，变见于气口，所以，气口虽为手太阴，而实足太阴之所归，故曰气口亦太阴
也。饮食内伤，亦头疼发热，胸满呕吐，噫气如败卵臭，心口按之必痛，见食恶食，俗
呼夹食伤寒，两寸脉必弦紧，右关弦大有矣。或浮滑而疾，然饮与食又当分别，饮
者，水也，伤无形之气；食者，物也，伤有形之血。
内外之伤既已分明，所伤轻重，尤须酌量，然后投之以药，无不确当，故曰用药无
据，反为气贼。《经》曰∶约方犹约囊也。囊满勿约，则输泄方成，勿约则神与气勿
俱，故古人桂枝汤承气汤下俱云，若一服汗出即止，得更衣即止，不必尽剂，其慎如
此。盖得圣人约囊之旨也。《经》曰∶上工平气，中工乱脉，下工绝气。盖因不知表里
轻重，无据而乱投之也。
脾主四肢，四肢热，即五心烦热也。火
性上行，若郁而不达，则消烁真阴，而肌肤筋骨如火之热也。若饮食填塞至阴则清，阳
不得上行，故不能传化也。《经》曰∶火郁发之。盖火之为性，扬之则光，遏之则减。
今为饮食抑遏，则生道几乎息矣。使清阳出上窍，则浊阴自归下窍，而饮食传化，无抑
遏之患矣。东垣圣于脾胃，治之必主升阳，俗医知降而不知升，是扑其少火也，安望其
卫生耶？
男子以气为主，故宜右手脉盛；女子以血为主，故宜左手脉盛。然人之身气为卫，
血为荣，无分男女，皆以胃气为主。《经》曰，胃为水谷气血之海，化营卫而润宗筋。
又云∶阴阳总宗筋之会，而阴明为之长。盖胃气者，中气也。《易·颐》之象曰∶君子慎
言语，节饮食。慎言语则中气不散而上越，节饮食则中气不滞而下行。
《阴阳应象论》云∶水谷之寒热，感则客人六腑。是饮食之伤，伤于寒热也。《痹
论》云∶饮食自倍，肠胃乃伤。是饮食之伤，伤于饥饱也。古人治法，分上中下三
等，而治之在上者，因而越之，瓜蒂散之类；中者消化，神曲、麦芽、山楂、三棱、
广术之类；在下者，引而竭之，硝石、巴豆、牵牛、甘遂之类。若饮食尚在胃脘，未
曾蒸腐而成下粕，妄行取下，中气被伤，传导失职，燥热愈甚，宜有结胸之变也。古人
又分寒热而治之，伤热物者，以寒药治之，伤寒物者，以热药治之，加伤冷物二分，热
物一分，则用热药二停，寒药一停，若备急丸是也。当随证加减。然饮食之病，伤寒物
者居多，盖热则行而寒易凝也。
当今方家以平胃散为脾胃之准绳，敦知平胃者，胃中有中高阜，则使平之，一平即
止，不可过剂，过剂则平地反成坎。夫今人以为常服者，误也。不若积术丸为胜，夫枳
术丸乃洁古老人所制，用枳实一两，白术二两，补药多于消药，先补而后消，以荷叶裹
饭烧熟为丸，盖取荷叶色青得震卦之体有仰盂之象，中空而清气上升，烧饭为丸，以取
谷气，洁古枳术一方，启东垣末年之悟，补中益气自此始也。但洁古专为有伤食者设，
今人以此丸为补脾药，朝服暮饵。更有益之橘半香砂者，则又甚矣。吾恐枳实一味，有
推墙倒壁之功，而人之肠胃中，既已有伤，墙壁不固，能经几番推倒乎？至若山楂、神
曲、麦芽三味，举世所常用者，然山楂能化肉积，凡年久母猪肉煮不熟者，入山楂一
撮，皮肉尽烂。又产妇儿枕痛者，用山楂二十粒，砂糖水煎一碗服之，儿枕立化，可见
其破气破血，不可轻用。曲 者，以米与水在瓷缸中，必藉曲以酿成酒，必藉 以酿成
糖，脾胃在人身非瓷缸比，原有化食之能，今食不化者，因其所能者病也。只补助其
能，而食自化，何必用此消克之药哉！脾气一受伤于食，再受伤于药，而复能还原健运
者，鲜矣。
大凡元气完固之人，多食不伤，过时不饥。若人先因本气不足，致令饮食有伤，前
药一用饮食虽消，但脾既已受伤，而复经此一番消化，愈虚其虚后日食不化，犹谓前药
已效，汤丸并进，展转相害，羸瘦日增，良可悲哉！窃痛此弊，因申言之，凡太平丸、
保和丸、肥儿丸之类，其名虽美，然名之美者，其药必恶，故以美名加之，以欺人耳
目，非大方家可用也。故医有贫贱之医，有富贵之医，膏梁之子弟，与藜藿之民不同，
太平之民，与疮痍之民不同。乡村闾巷，顽夫壮士，暴有所伤，一服可愈。若膏梁子
弟，禀受虚弱，奉养柔脆，以此施之，贻害不小。若脾胃惟东垣为圣，选而用之，以调
中盖气，补中益气二方，出人增减，真知其寒物伤也。本方中加热药如姜桂之类，热物
伤也。加黄连之类，真知有肉食伤也。加山楂数粒，酒食伤也。加葛花一味，随症调
理，此东垣之法，方家之绳墨也。
如有食填太阴，名曰食厥，即木郁也。上部有脉，下部无脉，不吐则死，急以阴阳
盐汤探吐其物即愈，盖厥阴少阳属木，于令为春，乃人身生发之气也。食者，阴物也。
脾胃者，坤土也。饮食填塞太阴，不能健化，则生气不能上升而木郁矣。吐去上焦有
形之物，则木得条达，而遂其升生之性以愈矣。如有食积肠腹绞痛，手不可按者，不得
不下。审知其为寒积，必用巴豆感应丸；审知其为热积，必用大黄承气汤下之，不当，
死生立判，慎之哉！然为积为食所伤者，乃有形之物也，宜消之，重则吐下。若为饮为
酒所伤者，是无形之物致病，而无形之元气受伤，饮宜发汗或利小便，酒宜发汗，或补
元气，不可妄行利下，使既伤无形之元气，复损有形之阴血，益增其病矣。况《经》
曰∶大积大聚，其可犯也。衰其大半而止，过者死，况其饮乎？
造化生物，天地水火而已。生之者天，成之者地也。故干知大始，坤作成物，至于
交合变化之用，则水火二气也。天运水火于地之中，则物生矣。然水火不可偏盛，大旱
物不生，火偏盛也。大涝物亦不生，水偏盛也。煦之以阳光，濡之以雨露，水火和平而
物始生，自然之理。人之脏腑以脾胃为主，然脾胃能化物，实由于水火二气，非脾胃所
能也。火盛则脾胃燥，水盛则脾胃湿，皆不能化物，乃生诸病。如消渴者，火偏盛而水
不能制也。水肿者，水偏盛而火不能化也。制其偏而使之平，则治之之法也。制其偏而
使之平，一句甚好，所谓制者，非去水去火之谓。人身水火，原自均平，偏者，病也。
火偏多者，补水配火，不必去火。水偏多者，补火配水，不必去水譬之天平，此重则
彼轻，一边重者，只补足轻之一边，决不凿去马子，盖马子一定之数，今人欲泻水降火
者，凿马子者也。
伤食必因于脾弱，治者必以助脾顺气，俟其腐熟而去之。滞去之后，尤当补养脾
胃，庶不再伤。若妄用攻下，耗伤津液，积滞转固，或即攻去。脾胃愈虚，停滞接踵，
中气一伤，变生百病矣。故《经》曰∶平人皆禀气于胃。《灵枢》曰∶胃满则肠虚，肠
满则胃虚，更虚更满，故气得上下，五脏安定，血脉和，则精神乃居。故神者，水谷之
精气也。可不重欤！
伤饮者，乃无形元气受伤也。惟宜参苏饮，倍人参，加木香微汗之，或五苓散，加
葛根微利小便，使上下分消，与治湿同法。醒后独参汤最宜。有强酒胀满欲呕者，以盐
花擦牙，温水漱下如汤沃雪，实时通快，是盐能下走而通水也。
停食（食物停滞）的患者，必然出现胸膈部痞闷堵塞感，厌恶进食并伴有打嗝，打出的气带有如臭鸡蛋般的臭味，身体发热且头部出汗，手掌心异常发热，烦躁啼哭无法仰卧，见到食物就感到憎恶。同时也会出现头痛、发热的症状，表现类似伤寒病，但区别在于身体不疼痛。其脉象表现为右手气口脉紧盛。治疗上，伤食初起时，必须兼用辛散的方法，不可骤然使用苦寒药物，因为食物遇到寒凉会更加凝结，遇到温热才能腐熟消化，因此适宜采用导痰、消食、健脾的方法。如果食物已经变成糟粕，日久生热，则需要借用一两味凉性药物来降泄它，所以礞石丸中使用了黄芩。也有因郁怒忧抑导致脾脏受伤而不思饮食的情况，尤其适宜行气调中；如果是冷物停滞，则用炮姜、豆蔻等辛温药物来消导。宿食已经消除，但中焦脾胃尚未调和的，用六君子汤来调养。吃得过多而导致停滞的，要消除其停滞；吃得少而不能消化的，要辅助其脾脏功能。至于那些身体没有壮热，脉象不洪大充实，只是胸部极度胀满的，这是元气无根失守，逆乱奔涌于上，才导致极度胀满，属于大虚证。因为胸是受纳气的地方，不能容纳有形的实物，应当采用“塞因塞用”的方法，以大补元气的方法来消除胀满。
李东垣说：宿食不化，独见右关脉沉滑。又说：脉浮而滑的，是宿食。又说：脉弦的，是伤食。书中还说：人迎脉紧盛是伤了寒邪，气口脉紧盛是伤了食积。人迎脉位于左手寸部，是足阳明胃经的别脉，为什么伤于寒邪反而让人迎脉紧盛呢？气口脉位于右手寸部，是手太阴肺经的动脉，为什么伤于食积反而让气口脉紧盛呢？这是因为人身的气血营运不息，流注于各条经脉，从而表现出动脉。如果寒邪伤了肺，皮毛被外束，邪火在肺金中燔灼，导致太阴肺经不能朝会百脉而维持平衡，阳明一经独留浊气，所以气血所注之处，只流向胃中没有邪气的部分进行输布。《灵枢》认为人迎候阳主外，可知人迎是阳明腑脉，专门主管表证，所以人迎紧盛，就知道是寒邪伤了肺。如果食积伤了胃，那么精微物质就无法上输于肺，导致肺金无所养，致使失去权衡调节的能力，灌溉脏腑、流行三焦的功能受阻，于是血液只在一条经脉中盛聚，而不能宣通上达。《灵枢》认为气口候阴主中，可知气口是太阴脏脉，而主管里证，所以气口紧盛，就知道是食积伤了胃。后世医家将左右手关前一分为人迎和气口，用来辨别内外伤，说法纷杂没有定论。又问：什么叫在人迎喉旁取脉？互参各种书籍，才不会混淆左表右里的说法，而符合《内经》的原意。李时珍说：两手六脉，都是肺的经脉。因为脉的运行始于肺，终于肝，然后又汇合于肺，肺是气的门户，寸口称为气口，是因为肺主气，气的盛衰表现在这里。凡是五脏六腑，两手的寸关尺，都是手太阴肺金的一条经脉，只是分部以候察其他脏腑之气罢了，所以说肺朝百脉，而寸口是大会之处。然而岐伯说：气口也是太阴，为什么呢？因为五味入口，藏于胃，以滋养五脏，五脏六腑的气味，都出于胃，变化显现于气口，所以，气口虽然是手太阴，但实际上是足太阴的归宿，所以说气口也是太阴。饮食内伤，也会头疼发热，胸满呕吐，打嗝如臭鸡蛋味，心口按压必痛，见到食物就厌恶食物，俗称夹食伤寒，两寸脉必弦紧，右关脉弦大有力。或者脉浮滑而疾速。然而饮和食应当分别对待，饮是水，伤害无形之气；食是物体，伤害有形之血。
内外之伤既然已经分明，所伤的轻重，尤其需要斟酌衡量，然后投药，无不恰当，所以说用药没有依据，反而成为气的贼害。《内经》说：约束方剂就像约束口袋一样。口袋满了不要约束，就会漏泄；方剂形成了，如果不加约束（控制剂量），神与气就不能俱存，所以古人用桂枝汤、承气汤下面都注明，如果一服汗出就停止，换衣服后还出汗就停止，不必喝完所有药剂，谨慎到了这种地步。这大概是得到了圣人关于约束口袋的要旨。《内经》说：上工平气，中工乱脉，下工绝气。大概是因为不知道表里轻重的关系，没有依据而乱投药物所致。
脾主四肢，四肢发热，就是五心烦热。火性上行，如果郁结而不能通达，就会消烁真阴，使肌肤筋骨像火一样热。如果饮食填塞至阴部位，则清阳不得上行，所以不能传化。《内经》说：火郁发之。火的性质，扬起来就有光，遏制它就减弱。现在被饮食抑制遏制，那么生机几乎要熄灭了。如果让清阳出于上窍，那么浊阴自然归于下窍，而饮食传化，就没有抑制遏制的祸患了。李东垣精通脾胃学说，治疗必定以升阳为主，俗医只知道降而不知道升，这是扑灭少火的做法，怎么指望他们能养生呢？
男子以气为主，所以宜右手脉盛；女子以血为主，所以宜左手脉盛。然而人的身体，气为卫，血为荣，不分男女，都以胃气为主。《内经》说，胃是水谷气血的海，化生营卫而滋润宗筋。又说：阴阳总宗筋之会，而阳明为之长。胃气就是中气。《易经·颐卦》的象辞说：君子慎言语，节饮食。慎言语则中气不散而上越，节饮食则中气不滞而下行。
《阴阳应象大论》说：水谷的寒热，感受了就会客居于六腑。这是饮食的伤害，伤害于寒热。《痹论》说：饮食自倍，肠胃乃伤。这是饮食的伤害，伤害于饥饱。古人的治法，分上中下三等而治疗。治在上者的，因而越之，如瓜蒂散之类；治在中者的，消化之，如神曲、麦芽、山楂、三棱、莪术之类；治在下者的，引而竭之，如芒硝、巴豆、牵牛、甘遂之类。如果饮食还在胃脘，未曾蒸腐而成糟粕，妄行攻下，中气被伤，传导失职，燥热更甚，可能会出现结胸的变证。古人又分寒热而治疗，伤热物的，用寒药治之；伤寒物的，用热药治之。如果加上伤冷物二分，热物一分，则用热药二份，寒药一份，如备急丸就是这样的。应当随证加减。然而饮食的病，伤于寒物的居多，因为热则行而寒易凝。
当今的方家以平胃散作为脾胃病的准绳，岂知平胃的意思是胃中有高阜（指积滞），使之平复，一旦平复就停止，不可过量，过量则平地反成坑坎。如今的人把它当作常服的药物，是错误的。不如积术丸更好。积术丸是洁古老人所制，用枳实一两，白术二两，补药多于消药，先补而后消，用荷叶裹饭烧熟做成丸。大概取荷叶色青得震卦之体，有仰盂的形象，中空而清气上升，烧饭为丸，以取谷气。洁古的枳术一方，启发了李东垣晚年之悟，补中益气汤由此开始。但洁古专为有伤食者设立，如今的人把这个丸当作补脾药，早晚服用。更有添加橘皮、半夏、香附、砂仁的，那就更严重了。我恐怕枳实一味药，有推墙倒壁的功效，而人的肠胃中，既然已经有损伤，墙壁不坚固，能经得起几次推倒呢？至于山楂、神曲、麦芽这三味药，举世所常用的，然而山楂能化肉积，凡是年久母猪肉煮不熟的，放入一撮山楂，皮肉尽烂。还有产妇儿枕痛的，用山楂二十粒，砂糖水煎一碗服下，儿枕立化，可见其破气破血，不可轻用。神曲，是用米与水在瓷缸中，必须借助曲才能酿成酒，必须借助蘖才能酿成糖。脾胃在人身不是瓷缸可比，原本就有化食的能力，现在食不化，是因为它的功能生病了。只补助它的功能，而食物自然消化，何必用这种消克药物呢！脾气一旦被食物所伤，再被药物所伤，而还能还原健运的，很少见了。
大凡元气完固的人，多食不伤，过时不饥。如果人本来因为本气不足，导致饮食有伤，前面的药一用，饮食虽然消除了，但脾既已受伤，又经过这一番消化，更加虚弱其虚。日后食不化，还说是前面的药有效，汤丸并进，辗转相害，消瘦日益增加，实在可悲啊！我痛心这个弊端，因此申述说明。凡是太平丸、保和丸、肥儿丸之类的，名字虽然美好，但名字美好的，其药性必然恶劣，所以用美名加之，以欺骗人的耳目，不是大方家可用的。所以医生有贫贱之医，有富贵之医。膏粱子弟，与藜藿之民不同；太平之民，与疮痍之民不同。乡村闾巷的顽夫壮士，暴有所伤，一服可愈。如果是膏粱子弟，禀受虚弱，奉养柔脆，以此施治，贻害不小。若说脾胃方面只有李东垣为圣，选择而使用他的方法，以调中益气，补中益气二方，出人增减，真正知道是寒物伤的，本方中加入姜桂之类热药；热物伤的，加入黄连之类；真正知道有肉食伤的，加入数粒山楂；酒食伤的，加入葛花一味，随症调理，这是东垣的方法，方家的绳墨。
如果有食填塞太阴，名叫食厥，也就是木郁。上部有脉，下部无脉，不吐出来就会死，急忙用阴阳盐汤探吐其物即愈。因为厥阴、少阳属木，于时令为春，是人身生发之气。食，是阴物。脾胃，是坤土。饮食填塞太阴，不能健运消化，则生气不能上升而木郁。吐出上焦有形的实物，则木得以条达，而顺遂其升生之性而痊愈。如果有食积肠腹绞痛，手不可按的，不得不攻下。审知其为寒积，必须用巴豆感应丸；审知其为热积，必须用大黄承气汤攻下，如果不恰当，生死立判，务必谨慎！然而为积、为食所伤的，是有形之物，适宜消导，重则吐下。如果是为饮、为酒所伤的，是无形之物致病，而无形之元气受伤，饮适宜发汗或利小便，酒适宜发汗，或补元气，不可妄行利下，使既伤无形之元气，又损有形之阴血，更加增加病情了。况且《内经》说：大积大聚，其可犯也。衰其大半而止，过者死，何况是饮呢？
造化生物，天地水火而已。生之者天，成之者地。所以乾知大始，坤作成物，至于交合变化之用，则是水火二气。天运水火于地之中，则物生了。然而水火不可偏盛，大旱物不生，是火偏盛。大涝物也不生，是水偏盛。煦之以阳光，濡之以雨露，水火和平而物始生，这是自然的道理。人的脏腑以脾胃为主，然而脾胃能化物，实际由于水火二气，不是脾胃所能单独做到的。火盛则脾胃燥，水盛则脾胃湿，都不能化物，乃生诸病。如消渴，是火偏盛而水不能制约。水肿，是水偏盛而火不能化。制约其偏而使之平，就是治疗的方法。所谓制，不是去水去火的意思。人身水火，原本自均平，偏者是病。火偏多的，补水配火，不必去火。水偏多的，补火配水，不必去水。譬如天平，此重则彼轻，一边重者，只补足轻的一边，决不凿去砝码。盖砝码是固定的数量，今人想泻水降火的，就是凿去砝码的人。
伤食必然因为脾弱，治疗者必须以助脾顺气为主，等待其腐熟而去之。滞去之后，尤其应当补养脾胃，才不再受伤害。如果妄用攻下，耗伤津液，积滞转固，或者即使攻去了，脾胃更虚，停滞接踵而至，中气一伤，变生百病。所以《内经》说：平人皆禀气于胃。《灵枢》说：胃满则肠虚，肠满则胃虚，更虚更满，故气得上下，五脏安定，血脉和，则精神乃居。所以神，是水谷的精气。能不重视吗！
伤饮，是无形元气受伤。只适宜用参苏饮，倍用人参，加木香微汗之，或用五苓散，加葛根微利小便，使上下分消，与治湿同法。醒后独参汤最适宜。有强饮酒致胀满欲呕的，用盐花擦牙，温水漱下，如汤沃雪，实时通快，这是盐能下走而通水。
Food stagnation (stagnation of food) patients inevitably present with a sensation of fullness and obstruction in the chest and diaphragm, aversion to eating accompanied by belching, with the belched air having an odor like rotten eggs. They exhibit body heat and sweating on the head, excessive heat in the palms, irritability and crying inability to lie supine, and aversion to seeing food. Simultaneously, headache and fever may occur, resembling Shaoyang disease (a syndrome caused by pathogenic factors affecting the Shaoyang channel), but distinguished by the absence of body pain. The pulse at the Qi Kou (pulse point at the wrist, corresponding to the Lung meridian) on the right hand is tight and vigorous. In treatment, for early-stage food stagnation, acrid-dispersing methods must be combined; bitter-cold medicines should not be used abruptly because food becomes more coagulated when exposed to cold and requires heat to decompose and digest. Therefore, it is appropriate to employ methods that guide out phlegm, resolve food stagnation, and strengthen the spleen. If the food has turned into feces and generated heat over time, one or two cooling herbs are needed to drain it downward; hence, Huangqin (Scutellariae Radix) is used in Mengshi Wan (Calamine Pill). There are also cases where anger, depression, or worry injures the Spleen, leading to loss of appetite; these are particularly suitable for qi-moving and middle-jiao-regulating methods. For stagnation caused by cold substances, Paojiang (Prepared Zingiberis Rhizoma) and Doukou (Amomi Fructus Rotundus), which are acrid-warm herbs, are used to guide digestion. When old food stagnation has been resolved but the Middle Jiao (middle burner/spleen and stomach) remains unharmonized, Liu Junzi Tang (Six Gentlemen Decoction) is used to nourish. For excessive intake causing stagnation, the stagnation should be resolved; for insufficient intake failing to digest, the Spleen function should be assisted. In cases where there is no intense fever, the pulse is not surging-large and solid, but only extreme chest distension, this is due to rootless and lost-anchoring Qi rushing upward, causing extreme distension; this is a severe deficiency syndrome. Since the chest is the residence of Qi and cannot store tangible objects, the method of "treating obstruction with obstruction" (using tonification for excess-type symptoms) should be applied, using major tonification to resolve the distension.
Li Dongyuan stated: When old food stagnates and fails to transform, only the Right Guan (position on the radial artery corresponding to the Spleen/Stomach) pulse is deep and slippery. He also said: A floating and slippery pulse indicates old food stagnation. And: A wiry pulse indicates food injury. The text further states: A tight and vigorous Ren Ying (pulse at the carotid artery, representing Yang/exterior) pulse indicates Cold injury; a tight and vigorous Qi Kou pulse indicates Food injury. The Ren Ying pulse is located at the Left Cun (position on the radial artery corresponding to Heart/Lung) and is a branch of the Foot-Yangming Stomach meridian. Why does Cold injury result in a tight Ren Ying pulse? The Qi Kou pulse is located at the Right Cun and is the arterial pulse of the Hand-Taiyin Lung meridian. Why does Food injury result in a tight Qi Kou pulse? This is because the Qi and Blood in the human body circulate endlessly, flowing into various meridians and manifesting as arterial pulses. If Cold injures the Lung, the skin and hair are bound externally, and evil fire blazes within the Lung Metal, causing the Taiyin Lung to fail to direct the hundred vessels and maintain balance. The Yangming meridian alone retains turbidity. Thus, where Qi and Blood flow, they only move towards the non-pathogenic parts in the Stomach for distribution. *Ling Shu* (Spiritual Pivot) holds that Ren Ying observes Yang and governs the exterior; thus, knowing Ren Ying is the Yangming Fu organ pulse, specifically governing the exterior, a tight Ren Ying pulse indicates Cold injuring the Lung. If Food injury injures the Stomach, essence and nutrients cannot be transported upward to the Lung, leaving Lung Metal un-nourished, losing its regulatory power, and disrupting the functions of irrigating organs and circulating through the San Jiao (Triple Burner). Consequently, blood accumulates excessively in one meridian and cannot circulate upwards. *Ling Shu* holds that Qi Kou observes Yin and governs the interior; thus, knowing Qi Kou is the Taiyin Zang organ pulse, governing the interior, a tight Qi Kou pulse indicates Food injuring the Stomach. Later generations divided the front one-fen of the Guan position on both left and right hands into Ren Ying and Qi Kou to distinguish internal and external injuries, leading to chaotic and inconsistent theories. Another question arises: What is meant by taking the pulse at the side of the Ren Ying throat? Cross-referencing various books prevents confusion between the left-exterior/right-interior theory and aligns with *Nei Jing* (Inner Canon). Li Shizhen stated: The six pulses of both hands are all Lung meridians. Pulse circulation starts from the Lung, ends at the Liver, and returns to the Lung. The Lung is the gate of Qi. The Cun Kou is called Qi Kou because the Lung governs Qi, and the prosperity or decline of Qi manifests here. All five Zang and six Fu organs, represented by the Cun, Guan, and Chi positions on both hands, belong to the single Hand-Taiyin Lung Metal meridian, merely divided by location to observe Qi of other organs. Hence, it is said that the Lung directs the hundred vessels, and the Cun Kou is the great assembly. However, Qibo asked: Why is Qi Kou also Taiyin? Because the five flavors enter the mouth, are stored in the Stomach, and nourish the five Zang organs. The Qi and flavor of all Zang and Fu organs emerge from the Stomach and manifest at the Qi Kou. Therefore, although Qi Kou is Hand-Taiyin, it is actually the destination of Foot-Taiyin, hence it is called Qi Kou also being Taiyin. Internal injury from diet also causes headache, fever, chest fullness, vomiting, belching like rotten eggs, pain upon pressing the heart region, and aversion to food, commonly known as "Food-clasping Cold Injury." The two Cun pulses must be wiry and tight, and the Right Guan pulse wiry and large. Or floating, slippery, and rapid. However, Drink (fluid retention) and Food must be distinguished. Drink is water, injuring formless Qi; Food is matter, injuring tangible Blood.
Since internal and external injuries are clearly distinguished, the severity of the injury must be carefully weighed before administering medicine to ensure accuracy. Thus, it is said: Using medicine without basis makes it a thief of Qi. *Jing* (Canon) states: Restricting a prescription is like tying a bag. If a bag is full and not tied, it leaks; if a prescription is formed but not restricted (dosage controlled), Shen (Spirit) and Qi will not remain together. Therefore, ancient texts using Guizhi Tang (Cinnamon Twig Decoction) or Chengqi Tang (Descending Qi Decoction) note: "If after one dose sweat occurs, stop immediately; if after changing clothes sweat continues, stop; do not finish the entire dose." Such caution reflects the wisdom of the sages regarding restricting bags. *Jing* states: Superior physicians regulate Qi, average physicians disrupt pulses, inferior physicians exhaust Qi. This is likely due to ignorance of interior/exterior and severity, leading to indiscriminate medication.
The Spleen governs the four limbs. Heat in the four limbs is equivalent to heat in the five hearts (palms, soles, and heart). Fire nature moves upward. If constrained and unable to diffuse, it consumes True Yin, making skin, muscles, bones, and tendons feel hot like fire. If food fills the Supreme Yin, clear Yang cannot ascend, thus failing to transform and transport. *Jing* states: For constrained fire, release it. The nature of fire is such that fanning it increases its light, while suppressing it reduces it. Now suppressed by diet, the path of life is nearly extinguished. If clear Yang exits through the upper orifices, turbid Yin naturally returns to the lower orifices, and food transformation proceeds without suppression hazards. Li Dongyuan was sage-like in his understanding of Spleen and Stomach; his treatments must prioritize raising Yang. Quack doctors know only to descend and not to raise, thereby extinguishing the "Lesser Fire" (vital warmth). How can they hope to preserve health?
Men primarily rely on Qi, so the Right hand pulse should be vigorous; women primarily rely on Blood, so the Left hand pulse should be vigorous. However, in the human body, Qi acts as Wei (Defensive) and Blood as Ying (Nutritive), regardless of gender, all depend on Stomach Qi. *Jing* states: The Stomach is the sea of water and grain, Qi and Blood, transforming Ying and Wei to moisten the Zong Jin (major tendons). It also says: Yin and Yang converge at the Zong Jin, with Yangming as their leader. Stomach Qi is Middle Qi. The Image of Hexagram Yi (*I Ching*) states: The gentleman is cautious in speech and moderate in diet. Caution in speech prevents Middle Qi from scattering and rising; moderation in diet prevents Middle Qi from stagnating and descending improperly.
*Yin Yang Ying Xiang Lun* (Treatise on Yin-Yang Correspondence to Phenomena) states: The cold and heat of water and grain, if felt, lodge in the six Fu organs. This means dietary injury involves harm from cold and heat. *Bi Lun* (Treatise on Bi Syndrome) states: If diet doubles, the intestines and stomach are injured. This means dietary injury involves harm from hunger and satiety. Ancient treatment methods were divided into upper, middle, and lower levels. For upper level, induce vomiting (e.g., Gouti San); for middle level, digest (e.g., Shenqu, Maiya, Shanzha, Sanleng, Ezhu); for lower level, drain thoroughly (e.g., Xiaoshi, Badou, Qianniu, Gansui). If food remains in the stomach, not yet steamed and rotted into feces, reckless purging injures Middle Qi, causes failure of transmission, worsens dryness-heat, and may lead to Jie Xiong (Chest Binding) complications. Ancients also treated based on cold and heat: Hot substances injured are treated with cold medicine; cold substances injured are treated with hot medicine. If two parts cold substance injury and one part hot substance injury exist, use two parts hot medicine and one part cold medicine, as in Beijji Wan (Emergency Prepared Pill). Dosages should be adjusted according to symptoms. However, among dietary diseases, injury from cold substances is most common, as heat promotes movement while cold easily causes coagulation.
Contemporary practitioners regard Pingwei San (Calm the Stomach Powder) as the standard for Spleen and Stomach disorders. Do they know that "Pingwei" means flattening the high mounds in the stomach (accumulations)? Once flat, stop; do not overdose. Overdosing turns flat ground into pits. Using it as a daily tonic by modern people is erroneous. Zijzhu Wan (Atractylodes and Immature Bitter Orange Pill) is superior. Created by Jiegu Laoren (Elder Jiegu), it uses one tael of Zhishi (Immature Bitter Orange Fruit) and two taels of Baizhu (Atractylodis Macrocephalae Rhizoma), with more tonifying than resolving herbs, tonifying first then resolving. Wrapped in lotus leaves with rice and roasted into pills, it takes advantage of the lotus leaf's green color (Zhen trigram structure, upward-opening vessel image), hollow center allowing clear Qi to rise, and roasted rice to obtain Grain Qi. Jiegu's formula inspired Li Dongyuan's later insights, leading to the creation of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). However, Jiegu designed it specifically for those with food injury. Modern people use it as a spleen tonic morning and night. Adding Chenpi, Banxia, Xiangfu, and Sharen makes it even worse. I fear Zhishi alone has the power to push down walls; if the intestines and stomach are already damaged and walls unstable, how many times can they withstand being pushed down? As for Shanzha (Hawthorn Fruit), Shenqu (Medicated Leaven), and Maiya (Germinated Hordeum Fructus), widely used globally, Shanzha resolves meat accumulations. Old sow meat that won't cook softens completely with a pinch of Shanzha. For postpartum "child pillow pain," twenty grains of Shanzha boiled with brown sugar resolve it instantly, showing its ability to break Qi and Blood; it should not be used lightly. Shenqu requires rice and water in a porcelain jar, relying on qu (leaven) to brew wine, and nie (sprouted barley) to brew sugar. The human Spleen and Stomach are not like porcelain jars; they inherently possess the ability to digest food. When food fails to digest, it is because this function is diseased. One should only assist its function, and food will digest naturally. Why use such resolving drugs? Once Spleen Qi is injured by food, then again by drugs, recovery to robust operation is rare.
Generally, individuals with complete and solid Yuan Qi (Original Qi) can eat much without injury and feel hungry only when overdue. If one initially lacks Ben Qi (Root Qi), leading to dietary injury, previous medicines may eliminate food, but since the Spleen is already injured, this further digestion exacerbates deficiency. Later, food fails to digest, yet one claims previous medicines were effective, combining soups and pills, causing mutual harm, increasing emaciation day by day—truly pitiable! I grieve this flaw and elaborate: Pills like Taiping Wan, Baohe Wan, Feier Wan have beautiful names, but beautiful names often mask harsh properties, deceiving the eyes and ears. They are not for master physicians. Doctors can be for the poor/low-status or the rich/high-status. Children of rich families differ from peasants of coarse food; peaceful citizens differ from wounded ones. Stubborn men and strong soldiers in villages suffer acute injuries cured by one dose. But for children of rich families with weak constitutions and delicate upbringing, applying such treatments causes significant harm. Regarding Spleen and Stomach, only Li Dongyuan was sage-like. Selecting and using his methods to regulate Middle Qi and Tonify Middle Augment Qi, adjusting formulas, truly addresses cold substance injury by adding ginger/cinnamon; heat substance injury by adding Coptis; meat injury by adding hawthorn; alcohol/food injury by adding Ge Hua (Puerariae Flos). This is Dongyuan's method, the standard for practitioners.
If food fills the Taiyin, named Shi Jue (Food Syncope), it is also Mu Yu (Wood Constraint). Upper pulse exists, lower pulse absent; if not vomited, death ensues. Urgently probe vomit with Yin-Yang Salt Soup; immediate relief follows. Jueyin and Shaoyang belong to Wood, corresponding to Spring, the generating Qi of the body. Food is Yin matter. Spleen and Stomach are Kun Earth. Food filling Taiyin prevents healthy transformation, so generating Qi cannot rise, causing Wood constraint. Vomiting tangible objects from the Upper Jiao allows Wood to stretch and follow its ascending nature, leading to cure. If food accumulation causes intestinal/abdominal colic, untouchable by hand, purging is necessary. Confirming cold accumulation, use Badou Ganying Wan; confirming heat accumulation, use Dahuang Chengqi Tang. Inappropriateness leads to immediate life/death judgment; be cautious! Accumulation and food injury involve tangible objects, suitable for resolution; severe cases require vomiting or purging. Drink and alcohol injury involve intangible objects致病, injuring intangible Yuan Qi. Drink is suitable for sweating or promoting urination; alcohol is suitable for sweating or tonifying Yuan Qi. Do not recklessly promote urination/purging, as it injures intangible Yuan Qi and damages tangible Yin Blood, worsening the condition. Moreover, *Jing* states: For major accumulations, attack them cautiously. Stop when reduced by more than half; exceeding this causes death. How much more so for drinks?
Creation generates things through Heaven, Earth, Water, and Fire. Heaven generates, Earth completes. Qian initiates, Kun forms. The interaction and change utilize Water and Fire. Heaven transports Water and Fire within Earth, generating things. Water and Fire must not be excessive. Severe drought stops growth (Fire excess); severe flood stops growth (Water excess). Warmth from sunlight, moisture from rain/dew, bring Water and Fire to peace, allowing things to grow—this is natural law. Human organs prioritize Spleen and Stomach, but their ability to transform substances relies on Water and Fire, not just Spleen/Stomach alone. Fire excess dries Spleen/Stomach; Water excess wets them; neither transforms substances, leading to disease. Xiao Ke (Wasting-Thirst) results from Fire excess unchecked by Water. Shui Zhong (Edema) results from Water excess unchecked by Fire. Regulating the imbalance to restore peace is the treatment method. "Regulating" does not mean removing Water or Fire. Human Water and Fire are originally balanced; imbalance is disease. Excess Fire: tonify Water to match Fire, do not remove Fire. Excess Water: tonify Fire to match Water, do not remove Water. Like a balance scale: if one side is heavy, add weight to the light side; never remove fixed weights. Those who wish to drain Water and descend Fire are removing weights.
Food injury necessarily stems from Spleen weakness. Treatment must aid Spleen and smooth Qi, waiting for decomposition and elimination. After stagnation clears, Spleen and Stomach must be nourished to prevent re-injury. Reckless purging consumes fluids, hardens stagnation, or even if cleared, leaves Spleen/Stomach weaker, with stagnation following closely. Once Middle Qi is injured, myriad diseases arise. Thus, *Jing* states: Healthy people derive Qi from the Stomach. *Ling Shu* states: Full stomach means empty intestines; full intestines mean empty stomach. Alternating emptiness and fullness allows Qi to move up and down, stabilizing five Zang organs, harmonizing blood vessels, so Spirit resides. Spirit is the refined Qi of water and grain. Can this be disregarded!
Drink injury injures intangible Yuan Qi. Suitable treatments include Shen Su Yin (Ginseng and Perilla Decoction) with doubled Ginseng and Muxiang for mild sweating, or Wuling San (Five-Ingredient Powder with Poria) plus Gegen (Puerariae Radix) for mild diuresis, dispersing from above and below, similar to treating Dampness. After waking, Dushen Tang (Single Ginseng Decoction) is best. For forced drinking causing fullness and nausea, rub salt flowers on teeth and rinse with warm water; like pouring soup on snow, instant relief follows, as salt descends and unblocks Water.