经曰∶胃、大肠、小肠、三焦、膀胱五者，天气之所生也，其气象天，故泻而不藏。九窍者，五脏之所主，
然必得胃气乃能通利，胃气一虚，口目耳鼻俱为之病。其身热头痛，耳鸣目眩，沉重，为热所伤元气故也。阳
气最恶烦劳，顺之则固。惟脾胃和，则谷气上升，为春夏令行而人寿；脾胃不和，则谷气下流，为收藏令行而
人夭。凡十一脏，皆取决于胆，胆气升则余脏从之，胆气不升，则飧泄肠 。天食人以五气，地食人以五味，
味藏于胃，以养五气，气
或乖错，形何以存，故诸病从脾胃而生明矣。姑以胜衰者言之，胃中元气盛，则能食不伤，过时不饥。脾胃俱
旺，则能食而肥；脾胃俱虚，则不能食而瘦；或少食而肥，虽肥而四肢不举，盖脾实而邪气盛也。又有善食
而瘦者，胃伏火邪于气分则能食，脾虚则肌肉削。故面热者，胃病也，胃病则脾无所禀受，故亦从而病焉。脾
病则下流乘肾（土克水），令人骨髓空虚乏力，足不能履地，是阴气重叠，阴盛阳虚，汗之则愈，下之则死。
然非正发汗也，用辛甘之药滋胃，当升当浮，使生长之气旺以助阳耳。夫胃病其脉缓，脾病其脉迟，若火乘土
位，其脉洪缓。更有身热心中不快之证，此阳气衰弱，当从升降浮沉补泻法中用药（详后用药法象）。
盖治病不达升降浮沉之理，虽愈亦幸耳。昔有病脾胃久衰，视听半失，淫雨阴寒，逾月不止，泄利体重肢
节痛，大便泄下，小便闭，若用淡渗之剂，病虽即已，降之又降，是益其阴而重竭其阳，精神愈短。故必用升
阳药，以羌活、独活、柴胡、升麻各一钱，防风、甘草各五分，水煎稍热服，阳气升腾而疾去矣。又有脾胃虚
损，目疾时作，身面目睛俱黄，小便或黄或白，大便不调，食少气短怠惰，医以泻肝散下数行，而前疾愈甚，
适当暑雨，素有黄证，所以增剧也，因立清神益气汤治之。茯苓、升麻各二分，泽泻、苍术、防风各三分，生
姜四分，此数药能走经除湿热而不守，故不泻本脏肺与胃脾本中气之虚弱；青皮一分，生甘草、白芍、白术各
二分，人参五分，此数药能守本而不走经，不走经者，不滋经络中之邪，守者能补脏之元气；黄柏一分，麦门
冬、人参各二分，五味子三分，此药去时令浮热湿热。水煎，空心热服而愈，举此二者，以为证佐。
如脉缓，病怠惰嗜卧，四肢不收，或大便泄泻，此湿胜也，以平胃散。若脉弦，气弱自汗，四肢发热，泄
泻，毛枯发落，从黄 建中汤。
苟脉缓而建中，脉弦而用平胃，则误矣。
脉虚血弱，摘四物汤一二味；脉弱气短，摘四君子汤一二味；或小便赤黄，从五苓散去桂，摘一二味，俱
以本证中加之。如妨闷此非腹胀，乃散而不收，可加芍药收之，中焦用芍药，则脾中升阳，使肝胆之邪不敢犯。
如腹中窄狭及缩急者去之，及诸涩酸药，亦不可用。腹痛者加甘草、白芍。稼穑作甘，甘者己也；曲直作酸，
酸者甲也；甲己化土，此仲景之妙也。五苓散治渴而小便不利，无恶寒者不可用桂。不渴而小便自利，妄见妄
闻，乃瘀血证，用炒黄柏、知母。心脏热而窍不利者，导赤散。或虚坐而大便不得者，皆血虚也，血虚则里急，
或血气虚弱而目睛痛者，皆加当归身，调理脾胃。于此五药中加减，无不应验，然终不能使人完复。
内伤以脾胃虚败为甚，酒色次之。凡虚损，脾胃盛者易复，脾胃弱者，只可半愈，故农樵终岁劳苦而不成
伤，能纳能化，脾胃盛耳。
后或有因而再至者，亦由督任冲三脉（阴火）为邪，胃气虚弱之所致也。法须根据证加减，如执方疗病，非
《素问》之旨也。经云∶至而不至，是为不及，所胜妄行，所生受病，所不胜乘之也。至而不至者，谓从后来
者为虚邪，心与小肠乘脾胃也，脉见浮大而弦，病或四肢烦躁，口苦舌干咽干。盖心主火，小肠主热，火热
乘土，湿热相合，故烦躁闷乱；四肢，脾胃之末也，火乘之故发热；饮食劳役所伤，以致脾胃虚弱，乃血所生
病，主口中津液不行，故口干咽干也。
心之神，乃真气之别名。今七神离形而脉中惟有火矣。善治斯疾，惟使心无凝滞。人或逢喜事，或天气暄
和，或食滋味，或眼前见可爱事，则慧然无病矣，盖胃中元气得舒伸故也。
忌用五苓散（亡津液），宜补其母于心与小肠中，以补脾胃之根蒂。甘温（白术）为主，苦寒（黄连）
为使，酸味（芍药）为之臣佐。以其心苦缓，急食酸以收之（此治心火不能生土，是为不及）；火旺则肺金受
邪，金虚则以酸（补之）；以甘温、甘寒（芩、连、知、柏、生地之类）之剂于脾胃中泻心火之亢盛，是治
其本也。
火盛乘脾，亦为不及。心火者，阴火也，起于下焦，其丝系于心。心不主令，相火代之。相火，下焦包
络之火，元气之贼也。火与元气不两立，一胜则一负。如脉见洪大，而烦渴气喘，是火大旺而气大衰也。阴火
说自东垣，乃发《素问》之未发者也。
所胜妄行者，言心火旺能令母实。母者，肝木也，木旺则挟火而妄行，故脾胃先受之，或身体沉重，走
注胁痛。盖湿热相搏，风热郁不得伸，附着于有形也；或多怒者，风热下陷于地中也；或目病内障，肝主血，
开窍于目也；或妄见妄闻起妄心，夜梦亡人，或寒热往来，或四肢满闭，或淋溲便难转筋，皆肝木火盛而为邪
也；或生痿，或生痹，或生厥，或中风，或生恶疮，或作肾痿，或上热下寒，皆风热不得升长，而水火过于有
形中也。
宜柴胡为君，防风、赤芍、甘草、桂枝为臣，猪苓、泽泻、茯苓、苍术、知母、黄柏、滑石、石膏、羌
活、独活、川芎、细辛、蔓荆子为使，升麻为使。经云∶惟有阳明、厥阴不从标本从乎中。中乃不定之辞，
非中外之中也。盖厥阴为十二经之领袖，主生化阴阳；足阳明为十二经之海，主经营气血，诸经皆禀之。言
阳明、厥阴与何经相并而为病，酌中以用药。所以言此者，发明脾胃之病，不可一例而推，欲人知百病皆由脾
胃而生也，厘毫之失，灾病立生。假如时在长夏，于长夏之令中立方，谓正当主气衰而客气旺之时也，后之
处方者，当从此法加时令药。如长夏则补脾胃泻阴火，升阳汤是也。大抵此法此药，欲令阳气升浮耳，大禁渗
泄滋阴之味，亦有从权而用黄柏、知母，为督任冲三脉盛也。
所生受病者，由土弱不能生金，反受火水之邪，而清肃之气伤。或胸满少气，短气气上，精神少而倦惰，
惨惨常不乐，皆阳气不足而阴有余也，或咳嗽寒热者，湿热乘其内也。
脾不克化，郁而为痰，变生咳喘眩晕等证。治宜人参为君，白术、芍药为佐，橘皮、青皮以破滞气，桑白
皮、甘草、木香、槟榔、五味子为佐，桂枝、桔梗为引用。
所不胜乘之者，水乘木之妄行，而反来侮土，故肾入心为汗，入肝为泣，入脾为涎，入肺为痰为嗽为涕为
嚏，为水出鼻，自入则为溺多，为恶寒也。
治宜干姜为君，白术、附子、肉桂为臣、茯苓、猪苓、泽泻为佐使。
一说下元土盛克水，致督任冲三脉盛，火旺煎熬，令水沸腾而乘脾肺，故痰唾出于口也；下行为阴汗，
为外肾冷，为足不任地，为腰脊背胛脚下隐痛；或水附木势而上为眼涩、为眵、为冷泪，此皆肺金之虚，而
寡于畏也。夫脾胃不足，皆为血病，故九窍不通。诸阳气根于阴血，阴受火邪则阴盛，阴盛则上乘阳分，而
阳道不行，无生发升腾之气也。夫阳气走空窍者也，阴气附形质者也，如阴气附于土，阳气升于天，则各安其
分也。今所立方中，有辛甘温药者，非独用也；复有甘苦大寒之剂，亦非独用也。以火酒二制为之使，引苦甘
寒药至顶，而复入于肾肝之下，此所谓升降浮沉之道，自偶而奇，奇而至偶者也。
阳分奇，阴分偶，泻阴火以诸风药，升发阳气以滋肝胆之用，是令阳气生，上出于阴分；末用辛甘温药，
按其升药，使不发散于阳分，而令走于九窍也。升降浮沉说∶天以阳生阴长，地以阳杀阴藏。天气旺于寅，
寅者，引也。立春少阳之气，始于泉下，引阴升而在天，草木甲坼；立夏少阴火炽，草木盛茂，此谓天以阳生
阴长，经言岁半以前，天气主之，在乎升浮也。地气旺于申，立秋太阴之气始得大伸，自天而下降彻地，则品
物咸殒；立冬少阴之气伏于泉下，冰水地坼，此所谓地以阳杀阴藏，经言岁半以后，地气主之，在乎降沉也。
春温、夏暑、秋凉，冬冷，正气之序，升已而降，降
已而升，如环无端，运化万物，故曰履端于始序则不愆。人之呼吸升降，放象天地，饮食入胃，气先归脾肺，
上行春夏之令，以滋养周身，乃清气为天者也；升已而下输膀胱，行秋冬之令，为传化糟粕，乃浊阴为地者也。
损伤脾胃，真气下溜，或下泄而久不能升，是有秋冬而无春夏，百病皆起。又有久升而不降者，亦病焉。于此
求之，则履端之义明矣。
经云∶食入于胃，散精于肝，淫气于筋。食入于胃，浊气归心，淫精于脉；脉气流经，经气归于肺，肺
朝百脉，输精于皮毛；毛脉合精，行气于腑。且饮食入胃，先行阳道，而阳气升浮也。浮者，阳气散满皮毛；
升者，克塞头顶，则九窍通利也。若饮食不节，损其胃气，不能克化，散于肝，归于心，溢于肺，食入则昏冒
欲卧，得卧则食在一边，气暂得舒，是知升发之气不行者此也。经云∶饮入于胃，游溢精气，上输于脾；脾气
散精，上归于肺。病患饮入胃，遽觉至脐下便欲小便。由精气不输于脾，不归于肺，则心火上攻，使口燥咽干，
是阴气太盛，其理甚易知也。况脾胃病则当脐有动气，按之牢，若痛，有是者乃脾胃虚，无是则非也，亦可
作辨（明矣）。
《黄帝内经》说：胃、大肠、小肠、三焦、膀胱这五个器官，是受天气（阳气）所生的，它们的性质像天一样，所以功能是“泻而不藏”（传导排泄水谷糟粕，而不贮藏精气）。九窍（眼、耳、鼻、口、前后二阴），由五脏所主宰，但必须依赖胃气才能通畅利用。如果胃气虚弱，口、目、耳、鼻都会发生病变。身体发热、头痛、耳鸣、目眩、身体沉重，这是因为热邪损伤了元气。
阳气最厌恶烦劳，顺应它则正气固密。只有脾胃调和，水谷之气才能上升，如同春夏生长之令施行，人就能长寿；如果脾胃不和，水谷之气就会下流，如同秋冬收藏之令施行，人就会夭折。凡十一脏的功能，都取决于胆气的升发，胆气升发则其他脏腑随之升发；胆气不升发，就会导致完谷不化的泄泻和肠鸣。天给人提供五气（风、暑、火、湿、燥），地给人提供五味（酸、苦、甘、辛、咸），五味藏于胃中，用来滋养五脏之气。如果气机乖错紊乱，形体怎能存在？所以各种疾病从脾胃而生是显而易见的。
姑且以胜衰的情况来说明：胃中元气旺盛，则能进食且不受伤，过了饭点也不觉得饿。脾胃都旺盛，则能进食且身体丰满；脾胃都虚弱，则不能进食且身体消瘦；或者吃得少却肥胖，虽然肥胖但四肢无力抬举，这是因为脾实而邪气盛。又有善于进食却消瘦的人，是因为胃中伏有火邪在气分，所以能食，但脾虚导致肌肉消削。所以面部发热，是胃病；胃病则脾无法禀受水谷精微，所以脾也随之生病。
脾病则气机下流克制肾（土克水），使人骨髓空虚、乏力，脚不能踩地，这是阴气重叠、阴盛阳虚的表现。这种情况应当用发汗法治疗则愈，用攻下法则致死。但这并非真正的发汗，而是使用辛甘味的药物滋润胃气，使其当升当浮，使生长之气旺盛以助长阳气。
胃病其脉象缓，脾病其脉象迟，如果火邪乘袭土位，脉象洪大而缓。更有身体发热、心中不适的症状，这是阳气衰弱，应当根据升降浮沉的补泻法则来用药（详见后文用药法象）。大概治病如果不通晓升降浮沉的道理，即使痊愈也是侥幸。
过去有脾胃久衰的病人，视听功能丧失一半，遇到连绵阴雨阴寒天气，超过一个月不停，出现泄泻、体重身重、肢节疼痛，大便泄下，小便闭塞。如果使用淡渗利湿的药物，病虽然暂时停止，但降之又降，这是增加阴气而双重竭绝阳气，精神更加短少。所以必须使用升阳药，用羌活、独活、柴胡、升麻各一钱，防风、甘草各五分，水煎稍热服用，阳气升腾而疾病去除。
又有脾胃虚损，眼疾时常发作，全身、面目、眼睛都发黄，小便或黄或白，大便不调，食少、气短、怠惰。医生用泻肝散攻下数次，前面的疾病反而加重，又正值暑雨季节，素有黄疸证，所以病情加剧。因此创立清神益气汤治疗。茯苓、升麻各二分，泽泻、苍术、防风各三分，生姜四分，这几味药能走经络除湿热而不守中，所以不会泻本脏肺与胃脾本中的正气；青皮一分，生甘草、白芍、白术各二分，人参五分，这几味药能守中而不走经络，不走经络者，不滋长经络中的邪气，守中能补益脏的元气；黄柏一分，麦门冬、人参各二分，五味子三分，这些药去除时令的浮热和湿热。水煎，空腹热服而愈。列举这两个例子，作为证据佐证。
如果脉缓，病表现为怠惰嗜卧，四肢不收，或大便泄泻，这是湿胜，用平胃散。如果脉弦，气弱自汗，四肢发热，泄泻，毛发枯槁脱落，从黄芪建中汤治疗。
如果脉缓却用建中汤，脉弦却用平胃散，那就错了。
脉虚血弱，摘取四物汤中的一两味药；脉弱气短，摘取四君子汤中的一两味药；或者小便赤黄，从五苓散去桂枝，摘取一两味药，都加在本证方剂中。如感到妨闷，这不是腹胀，而是气散而不收，可加芍药收敛，在中焦用芍药，则脾中升阳，使肝胆之邪不敢侵犯。如果腹中窄狭及拘急收缩的，去掉芍药，以及诸涩酸药，也不可用。腹痛者加甘草、白芍。稼穑作甘，甘味对应己土；曲直作酸，酸味对应甲木；甲己化土，这是张仲景的妙处。
五苓散治疗口渴而小便不利，没有恶寒症状的不可用桂枝。不渴而小便自利，妄见妄闻，是瘀血证，用炒黄柏、知母。心脏热而窍道不利的，用导赤散。或者虚坐努责而大便不得出的，都是血虚，血虚则里急，或者血气虚弱而眼睛痛的，都加当归身，调理脾胃。在这五种方药中加减，没有不应验的，然而终究不能使人完全康复。
内伤以脾胃虚败为甚，酒色过度次之。凡是虚损，脾胃旺盛的容易恢复，脾胃弱的，只能半愈。所以农夫樵夫终岁劳苦却不成为内伤，是因为他们能纳能化，脾胃旺盛。
后来如果有因而再次发病的，也是由于督脉、任脉、冲脉（阴火）为邪，胃气虚弱所致。治疗方法必须根据证候加减，如果固执一方治病，不符合《素问》的宗旨。经书说：至而不至，称为不及，所胜之气妄行，所生之气受病，所不胜之气乘之。
至而不至，谓从后来者为虚邪，心与小肠乘袭脾胃，脉象见浮大而弦，病或四肢烦躁，口苦舌干咽干。因为心主火，小肠主热，火热乘袭土位，湿热相合，所以烦躁闷乱；四肢是脾胃的末梢，火邪乘袭所以发热；饮食劳役所伤，以致脾胃虚弱，乃血所生之病，主管口中津液不行，所以口干咽干。
心的神，是真气的别名。现在七神离形而去，脉中惟有火。善于治疗此病，只有使心无凝滞。人如果遇到喜事，或天气暖和，或吃滋味食物，或眼前见到可爱的事，则豁然无病，因为胃中元气得以舒伸的缘故。
忌用五苓散（亡津液），宜补其母于心与小肠中，以补脾胃之根蒂。以甘温（白术）为主，苦寒（黄连）为使，酸味（芍药）为之臣佐。因为心苦缓，急食酸以收之（这是治心火不能生土，称为不及）；火旺则肺金受邪，金虚则以酸味补之；以甘温、甘寒（黄芩、黄连、知母、黄柏、生地之类）的方剂在脾胃中泻心火的亢盛，这是治其本。
火盛乘脾，也为不及。心火者，即阴火也，起于下焦，其丝系于心。心不主令，相火代之。相火，是下焦包络之火，是元气的贼害。火与元气不两立，一胜则一负。如果脉见洪大，而烦渴气喘，是火大旺而气大衰。阴火之说自李东垣始，是发挥《素问》所未阐发的内容。
所胜妄行者，言心火旺能使母实。母者，肝木也，木旺则挟火而妄行，所以脾胃先受之，或身体沉重，走注胁痛。盖湿热相搏，风热郁结不得伸展，附着于有形之体；或多怒者，风热下陷于地中；或目病内障，肝主血，开窍于目；或妄见妄闻起妄心，夜梦亡人，或寒热往来，或四肢满闭，或淋溲便难转筋，都是肝木火盛而为邪；或生痿，或生痹，或生厥，或中风，或生恶疮，或作肾痿，或上热下寒，都是风热不得升长，而水火过于困阻于有形之中。
宜用柴胡为君药，防风、赤芍、甘草、桂枝为臣药，猪苓、泽泻、茯苓、苍术、知母、黄柏、滑石、石膏、羌活、独活、川芎、细辛、蔓荆子为使药，升麻为使药。经书说：惟有阳明、厥阴不从标本从乎中。中是不定的辞汇，不是中外之中的意思。盖厥阴为十二经之领袖，主生化阴阳；足阳明为十二经之海，主经营气血，诸经皆禀受它。说阳明、厥阴与何经相并而为病，斟酌中气来用药。之所以说这些，是为了阐明脾胃之病，不可一例而推，欲使人知道百病皆由脾胃而生也，毫厘之差，灾病立生。
假如时在长夏，于长夏之令中立方，谓正当主气衰而客气旺之时。后之处方者，应当从此法加时令药。如长夏则补脾胃泻阴火，升阳汤是也。大抵此法此药，欲令阳气升浮耳，大禁渗泄滋阴之味，也有从权而用黄柏、知母，为督任冲三脉盛也。
所生受病者，由土弱不能生金，反受火水之邪，而清肃之气伤。或胸满少气，短气气上，精神少而倦惰，惨惨常不乐，都是阳气不足而阴有余，或咳嗽寒热者，是湿热乘其内也。
脾不克化，郁而为痰，变生咳喘眩晕等证。治宜人参为君，白术、芍药为佐，橘皮、青皮以破滞气，桑白皮、甘草、木香、槟榔、五味子为佐，桂枝、桔梗为引用。
所不胜乘之者，水乘木之妄行，而反来侮土，故肾入心为汗，入肝为泣，入脾为涎，入肺为痰为嗽为涕为嚏，为水出鼻，自入则为溺多，为恶寒也。
治宜干姜为君，白术、附子、肉桂为臣，茯苓、猪苓、泽泻为佐使。
一说下元土盛克水，致督任冲三脉盛，火旺煎熬，令水沸腾而乘脾肺，故痰唾出于口也；下行为阴汗，为外肾冷，为足不任地，为腰脊背胛脚下隐痛；或水附木势而上为眼涩、为眵、为冷泪，此皆肺金之虚，而寡于畏也。夫脾胃不足，皆为血病，故九窍不通。诸阳气根于阴血，阴受火邪则阴盛，阴盛则上乘阳分，而阳道不行，无生发升腾之气也。夫阳气走空窍者也，阴气附形质者也，如阴气附于土，阳气升于天，则各安其分也。今所立方中，有辛甘温药者，非独用也；复有甘苦大寒之剂，亦非独用也。以火酒二制为之使，引苦甘寒药至顶，而复入于肾肝之下，此所谓升降浮沉之道，自偶而奇，奇而至偶者也。
阳分奇，阴分偶，泻阴火以诸风药，升发阳气以滋肝胆之用，是令阳气生，上出于阴分；末用辛甘温药，按其升药，使不发散于阳分，而令走于九窍也。
升降浮沉说：天以阳生阴长，地以阳杀阴藏。天气旺于寅时，寅者，引也。立春少阳之气，始于泉下，引阴升而在天，草木甲坼；立夏少阴火炽，草木盛茂，此谓天以阳生阴长，经言岁半以前，天气主之，在乎升浮也。地气旺于申时，立秋太阴之气始得大伸，自天而下降彻地，则品物咸殒；立冬少阴之气伏于泉下，冰水地坼，此所谓地以阳杀阴藏，经言岁半以后，地气主之，在乎降沉也。
春温、夏暑、秋凉，冬冷，正气之序，升已而降，降已而升，如环无端，运化万物，故曰履端于始序则不愆。人之呼吸升降，放象天地，饮食入胃，气先归脾肺，上行春夏之令，以滋养周身，乃清气为天者也；升已而下输膀胱，行秋冬之令，为传化糟粕，乃浊阴为地者也。
损伤脾胃，真气下溜，或下泄而久不能升，是有秋冬而无春夏，百病皆起。又有久升而不降者，亦病焉。于此求之，则履端之义明矣。
经书说：食入于胃，散精于肝，淫气于筋。食入于胃，浊气归心，淫精于脉；脉气流经，经气归于肺，肺朝百脉，输精于皮毛；毛脉合精，行气于腑。且饮食入胃，先行阳道，而阳气升浮也。浮者，阳气散满皮毛；升者，克塞头顶，则九窍通利也。若饮食不节，损其胃气，不能克化，散于肝，归于心，溢于肺，食入则昏冒欲卧，得卧则食在一边，气暂得舒，是知升发之气不行者此也。
经书说：饮入于胃，游溢精气，上输于脾；脾气散精，上归于肺。病患饮入胃，遽觉至脐下便欲小便。由精气不输于脾，不归于肺，则心火上攻，使口燥咽干，是阴气太盛，其理甚易知也。况脾胃病则当脐有动气，按之牢，若痛，有是者乃脾胃虚，无是则非也，亦可作辨（明矣）。
The *Classic of Difficult Issues* (Jing Yue) states: The stomach, large intestine, small intestine, sanjiao (Triple Burner), and bladder are five organs generated by heavenly qi (yang qi). Their nature resembles heaven; therefore, their function is "to drain and not to store" (transmitting and excreting food residues without storing essence). The nine orifices are governed by the five zang organs, but they must rely on stomach qi to function smoothly. If stomach qi is deficient, the mouth, eyes, ears, and nose will all suffer diseases. Fever, headache, tinnitus, dizziness, and heaviness of the body occur because heat pathogen damages the primordial qi.
Yang qi most detests excessive labor; complying with it consolidates the righteous qi. Only when the spleen and stomach are harmonious can grain qi ascend, mimicking the spring and summer growing mandate, leading to longevity. If the spleen and stomach are disharmonious, grain qi flows downward, mimicking the autumn and winter storage mandate, leading to premature death. The functions of all eleven organs depend on the ascending of gallbladder qi. When gallbladder qi ascends, the other organs follow; if it does not ascend, it leads to undigested diarrhea and borborygmus. Heaven provides humans with the five qi (wind, summer heat, fire, dampness, dryness), and earth provides the five flavors (sour, bitter, sweet, pungent, salty). The flavors are stored in the stomach to nourish the qi of the five zang organs. If the qi mechanism is disordered, how can the form exist? Thus, it is evident that various diseases arise from the spleen and stomach.
Let us discuss the scenario of excess and deficiency: If the yuan qi (original qi) in the stomach is vigorous, one can eat without injury and feel no hunger past meal times. If both spleen and stomach are vigorous, one eats well and becomes plump. If both are deficient, one cannot eat well and becomes thin. Or, one may eat little yet be obese, though unable to lift the limbs due to spleen excess and pathogenic abundance. Some who eat well yet become thin have latent fire pathogen in the qi level of the stomach, allowing them to eat, but spleen deficiency causes muscle wasting. Therefore, facial heat indicates stomach disease; stomach disease means the spleen cannot receive nutrients, so the spleen also becomes diseased.
Spleen disease causes qi to flow downward and overcome the kidney (Earth overcomes Water), resulting in empty marrow, weakness, and inability to stand. This is an accumulation of yin, yin excess, and yang deficiency. Such conditions should be treated with sweating methods to heal, while purgative methods would be fatal. However, this is not true sweating, but rather using acrid-sweet medicines to moisten stomach qi, causing it to ascend and float, thereby strengthening the growing qi to assist yang.
Stomach disease presents with a slow pulse; spleen disease presents with a delayed pulse. If fire pathogen attacks the Earth position, the pulse is surging and slow. There are also symptoms of body heat and mental discomfort, indicating weak yang qi. Medication should be administered according to the principles of ascending, descending, floating, and sinking for tonification and sedation (see later sections on medicinal properties). Generally, failing to understand the principles of ascending, descending, floating, and sinking means any recovery is merely fortuitous.
In the past, a patient with long-standing spleen and stomach decline lost half of their vision and hearing. During prolonged rainy and cold weather, they suffered from diarrhea, heavy body weight, joint pain, loose stools, and urinary retention. Using diaphoretic agents might temporarily stop the illness, but further descending actions would increase yin and doubly exhaust yang, shortening the spirit. Therefore, ascending-yang herbs must be used: Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Chai Hu (Bupleuri Radix), and Sheng Ma (Cimicifugae Rhizoma), each 1 qian; Fang Feng (Saposhnikoviae Radix) and Gan Cao (Glycyrrhizae Radix), each 0.5 qian. Decocted and taken warm, the ascending yang qi dispels the disease.
Another case involves spleen and stomach deficiency with recurrent eye disorders, jaundice of the whole body, face, and eyes, yellow or white urine, irregular bowel movements, poor appetite, shortness of breath, and lethargy. A physician administered Xie Gan San (Drain Liver Powder) several times, worsening the condition. Coinciding with summer rains and pre-existing jaundice, the condition aggravated. Thus, Qing Shen Yi Qi Tang (Clear Spirit and Boost Qi Decoction) was prescribed. Fu Ling (Poria), Sheng Ma (Cimicifugae Rhizoma), each 2 fen; Ze Xie (Alismatis Rhizoma), Cang Zhu (Atractylodis Rhizoma), Fang Feng (Saposhnikoviae Radix), each 3 fen; Sheng Jiang (Zingiberis Rhizoma Recens), 4 fen. These herbs move through meridians to remove damp-heat without staying central, thus not draining the righteous qi of the lungs, stomach, and spleen. Qing Pi (Citri Reticulatae Pericarpium Viride), 1 fen; Sheng Gan Cao (Raw Glycyrrhizae Radix), Bai Shao (Paeoniae Radix Alba), Bai Zhu (Atractylodis Macrocephalae Rhizoma), each 2 fen; Ren Shen (Ginseng Radix et Rhizoma), 5 fen. These herbs stay central without moving through meridians, avoiding nourishing pathogens in the meridians, while tonifying the yuan qi of the zang organs. Huang Bo (Phellodendri Cortex), 1 fen; Mai Men Dong (Ophiopogonis Radix), Ren Shen (Ginseng Radix et Rhizoma), each 2 fen; Wu Wei Zi (Schisandrae Fructus), 3 fen. These remove seasonal floating heat and damp-heat. Decocted and taken warm on an empty stomach, the patient recovered. These two cases serve as evidence.
If the pulse is slow, with symptoms of lethargy, desire to lie down, flaccidity of limbs, or diarrhea, this is dampness excess; use Ping Wei San (Calm the Stomach Powder). If the pulse is wiry, with weak qi, spontaneous sweating, heat in the four limbs, diarrhea, and brittle hair loss, treat with Huang Qi Jian Zhong Tang (Astragalus Decoction for Building the Middle).
Using Jian Zhong Tang for a slow pulse or Ping Wei San for a wiry pulse would be erroneous.
For deficient pulse and weak blood, select one or two herbs from Si Wu Tang (Four Substances Decoction). For weak pulse and shortness of breath, select one or two herbs from Si Jun Zi Tang (Four Gentlemen Decoction). For red-yellow urine, modify Wu Ling San (Five-Ingredient Powder with Poria) by removing Gui Zhi (Cinnamomi Ramulus), selecting one or two herbs, and adding them to the primary formula. If feeling stifled (not abdominal distension, but scattered qi failing to gather), add Bai Shao (Paeoniae Radix Alba) to astringe. Using Bai Shao in the middle jiao raises spleen yang, preventing liver-gallbladder pathogens from invading. If there is abdominal tightness or cramping, remove Bai Shao and other astringent-sour herbs. For abdominal pain, add Gan Cao (Glycyrrhizae Radix) and Bai Shao (Paeoniae Radix Alba). Sweetness corresponds to Ji Earth; sourness corresponds to Jia Wood; Jia-Ji transform into Earth, which is Zhang Zhongjing's profound method.
Wu Ling San (Five-Ingredient Powder with Poria) treats thirst with difficult urination; do not use Gui Zhi (Cinnamomi Ramulus) if there is no aversion to cold. If there is no thirst but normal urination, accompanied by hallucinations, it is a blood stasis pattern; use Chao Huang Bo (Processed Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma). For heart heat causing orifice obstruction, use Dao Chi San (Directing Red Powder). For tenesmus with inability to pass stool, it is blood deficiency; blood deficiency causes interior urgency. For eye pain due to weak blood and qi, add Dang Gui Shen (Angelicae Sinensis Radix Radix), regulating the spleen and stomach. Adjustments among these five formulas are effective, though complete restoration may not always be achieved.
Internal injury is most severe when spleen and stomach collapse, followed by alcohol and sexual excess. In deficiency patterns, those with strong spleen and stomach recover easily; those with weak spleen and stomach only partially recover. Farmers and woodcutters work hard all year without internal injury because their spleen and stomach are strong, capable of ingestion and transformation.
Subsequent recurrences are often due to pathogens in the Du, Ren, and Chong vessels (yin fire) caused by weak stomach qi. Treatment must be adjusted according to the syndrome. Adhering rigidly to one prescription contradicts the *Su Wen*. The Classics state: "Arrival without arrival" is insufficiency; the overcoming element acts recklessly, the generated element suffers disease, and the overcoming-by element attacks. "Arrival without arrival" refers to deficiency evil coming from behind; Heart and Small Intestine attack Spleen and Stomach. The pulse is floating, large, and wiry. Symptoms include irritability of the four limbs, bitter taste, dry tongue and throat. Since Heart governs Fire and Small Intestine governs Heat, fire-heat attacking Earth combines with damp-heat, causing irritability. The four limbs are the extremities of Spleen and Stomach; fire attack causes heat. Damage from diet and labor weakens Spleen and Stomach, affecting blood generation and fluid transport, causing dry mouth and throat.
The Spirit of the Heart is another name for True Qi. Now, the Seven Spirits have left the form, leaving only Fire in the pulse. To treat this well, one must ensure the Heart has no stagnation. Joyful events, warm weather, tasty food, or pleasant sights can resolve the illness because the Yuan Qi in the Stomach is able to expand.
Avoid Wu Ling San (which depletes fluids). Instead, tonify the Mother organ in the Heart and Small Intestern to strengthen the root of Spleen and Stomach. Use Acrid-Sweet-Warm (Bai Zhu/Atractylodis Macrocephalae Rhizoma) as Sovereign, Bitter-Cold (Huang Lian/Coptidis Rhizoma) as Envoy, and Sour (Bai Shao/Paeoniae Radix Alba) as Minister/Assistant. Because the Heart dislikes laxity, urgently use sour to astringe (treating Heart Fire's failure to generate Earth, termed insufficiency). When Fire is strong, Lung Metal suffers; if Metal is weak, use sour to tonify. Use Acrid-Sweet-Warm and Acrid-Sweet-Cold (Huang Qin/Scutellariae Radix, Huang Lian/Coptidis Rhizoma, Zhi Mu/Anemarrhenae Rhizoma, Huang Bo/Phellodendri Cortex, Sheng Di Rehmanniae Radix) to drain excessive Heart Fire in the Spleen-Stomach, treating the root.
Fire excess attacking Spleen is also insufficiency. Heart Fire is Yin Fire, originating in the Lower Jiao, connected to the Heart. The Heart does not issue commands; Ministerial Fire replaces it. Ministerial Fire is the fire of the Pericardium in the Lower Jiao, a thief of Yuan Qi. Fire and Yuan Qi cannot coexist; one wins, the other loses. A surging pulse with irritability, thirst, and asthma indicates strong fire and weak qi. Li Dongyuan's theory of Yin Fire elaborates on the *Su Wen*.
"Overcoming element acting recklessly" means strong Heart Fire makes the Mother (Liver Wood) full. Wood excess carries fire recklessly, first affecting Spleen and Stomach, causing heavy body and wandering hypochondriac pain. Damp-heat struggles, wind-heat stagnates, attaching to form. Anger indicates wind-heat sinking. Eye cataracts relate to Liver Blood and opening to the eyes. Hallucinations and dreams of the dead indicate wild mind. Alternating chills and fever, limb fullness, difficult urination, and spasms are all Liver Wood-Fire excess pathogens. Atrophy, bi-syndrome, jue-syndrome, stroke, malignant sores, kidney atrophy, upper heat/lower cold—all result from wind-heat failing to ascend and water-fire being trapped in form.
Use Chai Hu (Bupleuri Radix) as Sovereign; Fang Feng (Saposhnikoviae Radix), Chi Shao (Paeoniae Radix Rubra), Gan Cao (Glycyrrhizae Radix), Gui Zhi (Cinnamomi Ramulus) as Ministers; Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Fu Ling (Poria), Cang Zhu (Atractylodis Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Hua Shi (Talcum), Shi Gao (Gypsum Fibrosum), Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Xi Xin (Asari Radix et Rhizoma), Man Jing Zi (Vittariae Fructus) as Envoys; Sheng Ma (Cimicifugae Rhizoma) as Envoy. The Classics state: Only Yangming and Jueyin do not follow the root/surface but follow the middle. "Middle" implies indeterminacy, not location. Jueyin is the leader of the twelve meridians, governing yin-yang generation; Foot-Yangming is the sea of the twelve meridians, managing qi-blood. All meridians rely on them. When Yangming/Jueyin combine with other meridions, adjust based on the middle qi. This emphasizes that spleen-stomach diseases cannot be generalized; all diseases arise from spleen-stomach. A slight error brings disaster.
In late summer, when the dominant qi is weak and guest qi is strong, prescribe accordingly. Add seasonal herbs. For late summer, tonify spleen-stomach and drain yin fire; Sheng Yang Tang (Raise Yang Decoction) is appropriate. This method aims to raise and float yang qi. Strictly avoid diuretic and yin-nourishing substances. Occasionally, Huang Bo and Zhi Mu are used opportunistically due to盛 (excess) in Du, Ren, and Chong vessels.
"Generated element suffering disease" occurs when weak Earth fails to generate Metal, instead suffering from Fire/Water pathogens, damaging clear-pure qi. Chest fullness, shortness of breath, low spirit, lethargy, and sadness indicate insufficient yang and excess yin. Cough and chills/fever indicate damp-heat invading internally.
Spleen failing to transform leads to phlegm, causing cough, asthma, and vertigo. Treat with Ren Shen (Ginseng Radix et Rhizoma) as Sovereign; Bai Zhu (Atractylodis Macrocephalae Rhizoma), Bai Shao (Paeoniae Radix Alba) as Assistants; Chen Pi (Citri Reticulatae Pericarpium), Qing Pi (Citri Reticulatae Pericarpium Viride) to break stagnation; Sang Bai Pi (Mori Cortex), Gan Cao (Glycyrrhizae Radix), Mu Xiang (Aucklandiae Radix), Bing Lang (Arecae Semen), Wu Wei Zi (Schisandrae Fructus) as Assistants; Gui Zhi (Cinnamomi Ramulus), Jie Geng (Platycodonis Radix) as Guides.
"Overcoming-by element attacking" refers to Water attacking Wood recklessly, then insulting Earth. Kidney entering Heart causes sweat; entering Liver causes tears; entering Spleen causes saliva; entering Lung causes phlegm, cough, mucus, sneezing, nasal discharge; self-entry causes polyuria and aversion to cold.
Treat with Gan Jiang (Zingiberis Radix) as Sovereign; Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Zi (Aconiti Lateralis Radix Preparata), Rou Gui (Cinnamomi Cortex) as Ministers; Fu Ling (Poria), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma) as Assistants/Envoys.
Another view: Excess lower-earth overcomes Water, causing盛 in Du, Ren, Chong vessels. Fire boils water, which attacks Spleen-Lung, causing sputum. Downward flow causes genital sweat, cold external kidneys, inability to bear weight, back pain. Water following Wood rises causing dry eyes, discharge, cold tears. This is Lung Metal deficiency and lack of restraint. Spleen-Stomach insufficiency leads to blood disease, blocking the nine orifices. All yang qi roots in yin blood. Yin receiving fire becomes excess, attacking yang, blocking yang pathways, preventing rising qi. Yang qi moves through hollow orifices; yin qi attaches to solid forms. Like yin attaching to earth and yang rising to heaven, each stays in its place. Current prescriptions use Acrid-Sweet-Warm and Bitter-Cold together. Wine serves as envoy to guide bitter-cold herbs to the top and then to Kidney/Liver. This is the way of ascending/descending/floating/sinking, moving from even to odd, odd to even.
Yang is odd, Yin is even. Drain yin fire with wind herbs; raise yang to nourish Liver/Gallbladder use, allowing yang to rise from yin. Finally, use Acrid-Sweet-Warm to anchor the rising herbs, preventing dispersion in yang, directing them to the nine orifices.
Ascending/Descending/Floating/Sinking theory: Heaven generates yin with yang; Earth kills/stores yin with yang. Heaven qi peaks at Yin hour (leading). Spring begins with Shaoyang qi rising from springs, leading yin up, cracking seeds. Summer heat peaks, plants flourish—Heaven generates yin with yang. First half of year, Heaven qi dominates, focusing on ascending/floating. Earth qi peaks at Shen hour. Autumn Taiyin qi expands from heaven to earth, things perish. Winter Shaoyin qi hides in springs, ice cracks—Earth kills/stores yin with yang. Second half of year, Earth qi dominates, focusing on descending/sinking.
Spring warmth, Summer heat, Autumn coolness, Winter cold are the sequence of righteous qi. Ascend then descend, descend then ascend, like a circle, transforming all things. Hence, "starting correctly ensures no error." Human breathing and qi movement mirror heaven and earth. Food enters stomach, qi goes to Spleen-Lung, ascends via Spring-Summer mandate to nourish the body (clear yang as heaven); descends to Bladder via Autumn-Winter mandate to transmit waste (turbid yin as earth).
Damaging spleen-stomach causes true qi to sink or leak, unable to rise, creating autumn/winter without spring/summer, giving rise to all diseases. Long ascent without descent also causes disease. Seeking here clarifies the meaning of "starting correctly."
The Classics state: Food enters stomach, disperses essence to Liver, floods sinews. Food enters stomach, turbid qi returns to Heart, floods vessels. Vessel qi flows through meridians, meridian qi returns to Lung. Lung faces all vessels, transmits essence to skin/hair. Hair-vessel essence combines, moves qi to fu organs. Diet enters stomach, first follows yang dao, raising and floating. Floating scatters yang in skin/hair; Rising reaches head, opening nine orifices. Irregular diet damages stomach qi, failing to transform, disperse to Liver, return to Heart, overflow Lung. Eating causes drowsiness; lying down allows food to settle, qi temporarily relaxes. This shows failure of ascending qi.
The Classics state: Drink enters stomach, overflows essence, transports up to Spleen. Spleen disperses essence, returns up to Lung. Patient drinks, feels urge to urinate below navel. Essence fails to transport to Spleen, return to Lung. Heart fire attacks upward, causing dry mouth/throat. This is yin excess, easily understood. Moreover, spleen-stomach disease presents with pulsation at the navel, firm and painful upon pressure. Presence indicates spleen-stomach deficiency; absence indicates otherwise. This aids differentiation.