阴阳应象论云。水谷之寒热。感则害人六腑。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。自伤于饥饱也。古人治法。分上中下三等而治之。在上者因而越之。瓜蒂散之类主之。中者
消化。神曲麦芽山楂三棱广术之类主之。在下者引而竭之。硝黄巴豆牵牛甘遂之类主之。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。如伤冷物二分。热物一分。则用热药二停。
寒药一停。若备急丸是也。予意当随证加减。大抵饮食之病。伤寒物一边居多。以上法门。未必可为典要也。
当今方家。以平胃散为主。出入增减。亦可为脾胃之准绳。
平胃者。胃中有高阜。则使平之。一平即止。不可过剂。过剂则
平地反成坎矣。今人以平胃散。为常服补剂者。误也。不若枳术丸为胜。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。以助谷气。谓洁古枳术一方。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。更有益之橘半番砂者。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。余独永弃。盖山楂能化肉积。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。可见其破气又破血。不
可轻用。曲 者。以米与水在瓷缸中。必借曲以酿成酒。必借 以酿成糖。脾胃在人身。非瓷缸比。原有化食
之能。今食不化者。其所能者病也。只补助其能而食自化。何必用此消克之药哉。大凡元气完固之人。多食不
伤。过时不饥。若夫先因本气不足。致令饮食有伤矣。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。明后日食复不化。犹谓前药已效。药力欠多。汤丸并进。展转相害。羸瘦日增。良可悲哉。余
痛此弊。因申言之。凡太平丸保和丸肥儿丸之类。其名虽美。俱不敢用。盖名之美者。其药必恶。故以美
名加之。以欺人耳目。非大方家可用也。故医有贪贱之医。有富贵之医。膏粱之子弟。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。若膏粱子弟。禀受虚弱。奉养柔脆。概
以此术施之。贻害不小。夫有医术。有医道。术可暂行一时。道则流芳千古。有古方。有今方。有圣方。
有俗方。余以为今人不如古人。不敢自立一方。若脾胃惟东垣
为圣。择而用之。以调中益气补中益气二方。因人增减。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。随证调理。此东垣之法。方士之绳
墨也。然以寒治热而热不去。以热治寒而寒不除。奈之何。经曰。寒之不寒。是无水也。热之不热。是无火也。
壮水之主。益火之原。此东垣之未及也。
如有食填太阴。名曰食厥者。上部有脉。下部无脉。不治则死。急以阴阳盐汤。探吐其物即愈。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。
昔张子和动辄言下。盖下之当也。仲景三承气。审之详密。可下不可下急下。分毫不爽。如下血积。必用
桃仁红花。下水必用牵牛甘遂。下水中之血。必用虻虫水蛭。今人畏而不敢下者。不明之罪小。无忌而妄
用者。杀人之罪大。医司人命。岂易言哉。
何柏斋云。造化生物。天地水火而已。主之者天。成之者地也。故曰干知大始。坤作成物。至于天地交合
变化之用。则水火二气也。天运水火干地之中。则物生矣。然水火不可偏盛。太旱物不生。火偏盛也。太涝物
亦不生。水偏盛也。水火和平而物生。自然之理。人之脏腑。以脾胃为主。盖饮食入于胃。而运以
脾。犹地之土也。然脾胃能化物。实由于水火二气。非脾所能也。火盛则脾胃燥。水盛则脾胃湿。皆不能
化物。乃生诸病。制其偏而使之平。则治之之法也。
愚按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。
余于脾胃。分别阴阳水火而调之。如不思饮食。此属阳明胃土受病。须补少阴心火。归脾汤补心火。以生
胃土也。能食不化。此属太阴脾土。须补少阳相火。八味丸补相火。以生脾土也。无非欲人培养一点先天之火
气。以补土之母耳。若理中汤用干姜。所以制土中之水也。建中汤用芍药。所以制土中之木也。黄 汤所以益
土之子。使不食母之食也。六味丸所以壮水之主也。八味丸所以益火之原也。土无定位。寄旺于四时。无专
能。代天以成化。故于四脏中兼用之。总之以补为主。不用克伐。脾气下陷。补中益气。肝木乘脾。加左金
丸。郁怒伤脾。归脾汤。脾虚不能摄痰。六君子汤。脾肾两虚。四君四神。阴火乘脾。六味丸。命门火衰。不
生脾土。八味丸。先天之气足。而后天之气不足者。补中气为主。后天足而先天不足者。补元气为主。或
曰。正当胸膈饱闷之时。数日粒米不下。陈皮枳壳木香乌药。日夜吞咽。尚且不通。复可补乎。曰此正因初
先不知补益。擅用发散。克伐太过。虚痞之病也。经曰。下焦虚乏。中焦痞满。欲治其虚。则中满愈甚。欲消
其痞。则下焦愈乏。庸医值此。难以措手。疏启其中。峻补于下。少用则邪壅于上。多用则峻补于下。所谓
塞因塞用者也。善用者能以人参一两。或七八钱。少加升麻一钱。大剂一服即愈。此内经之妙用。不可不知也。
东垣云。酒者大热有毒。气味俱阳。乃无形之物也。若伤之。止当发散。汗出则愈矣。其次莫如利小便
。乃上下分消其湿。今之病酒者。往往服酒症丸大热之药下之。又有牵牛大黄下之者。是无形元气受病。反
下有形阴血。乖误甚矣。酒性大热。已伤元气。而复重泻之。又损肾水真阴。及有形血气。俱为不足。如此则阴
血愈虚。真水愈弱。阳毒之热大旺。反增其阴火。是元气消铄。折人长命。不然则虚损之病成矣。宜以葛花解
酲汤主之。
葛花解酲方
青皮（去瓤三钱） 木香（五分） 橘红 人参 茯苓（各一钱五分） 猪苓（一钱五分） 白豆蔻（五
分） 葛花（五分） 砂仁（五分） 泽泻（一钱） 白术（二钱） 干姜（一钱） 神曲（一钱） 上为细
末。每服（三钱）。白汤调下。得微汗则病去。此东垣原方。宜加减用。
《阴阳应象大论》中说：“水谷的寒热属性，若感受邪气，则会伤害六腑。”这说明饮食之伤，是受寒热之气所伤。《痹论》中说：“饮食过量一倍，肠胃就会受损。”这说明饮食之伤，是由于饥饱不均所致。
古人治疗此病的方法，分为上、中、下三等来治疗。病位在上焦的，采用“因势利导，涌吐”的方法，主要使用瓜蒂散之类的方剂。病位在中焦的，采用消食化积的方法，主要使用神曲、麦芽、山楂、三棱、莪术之类的药物。病位在下焦的，采用“引导排泄，攻逐”的方法，主要使用芒硝、大黄、巴豆、牵牛子、甘遂之类的药物。
古人又根据寒热性质分别治疗。损伤热性食物的，用寒凉药治疗；损伤寒性食物的，用温热药治疗。例如，损伤冷物占二分，热物占一分，则使用两份热药，一份寒药，像备急丸就是这种用法。我认为应当随证加减。大体上来说，饮食致病，多属于寒凉食物损伤一边居多。上述方法，未必可以作为固定的准则。
当今的医生，以平胃散为主方，进行出入增减，也可以作为调理脾胃的标准。所谓“平胃”，是因为胃中有高阜（指湿浊停滞如高地），所以要使其平坦。一旦平坦就停止用药，不可过量。如果过量，原本平坦的地方反而会变成坑坎（指损伤正气）。现在的人把平胃散当作常服补剂，这是错误的。不如枳术丸更好。枳术丸是洁古老人所创制，用枳实一两，白术二两，补药多于消药，先补而后消。用荷叶包裹米饭，蒸熟后制成丸剂。大概是取荷叶色青，对应震卦的体象，有仰盂（向上开口）的形象，中空而清气上升。将饭烧熟为丸，以助谷气。可以说，洁古老人的枳术一方，开启了李东垣晚年悟道的契机，补中益气法从此开始。但洁古老人创立此方是专门针对有伤食的患者，现在的人却把这个丸药当作补脾药，早晚服用，甚至加入橘红、半夏、番砂仁等有益之品，那就更严重了。我担心枳实一味药，有推墙倒壁的功力，而人的肠胃既然已经受伤，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，是举世常用的，我却永远弃用。因为山楂能化解肉积，凡是存放多年的母猪肉，煮不熟的，放入一撮山楂，皮肉就会全部烂掉。还有产妇儿枕痛（产后瘀血腹痛）的，用山楂二十粒，砂糖水煎一碗服用，儿枕立时化解。可见其破气又破血，不可轻用。神曲，是用米和水在瓷缸中，必须借助酒曲才能酿成酒，必须借助糖曲才能酿成糖。脾胃在人身，不像瓷缸那样，原本就有消化食物的能力。现在食物不消化，是因为这个能力生病了。只需补助其功能，食物自然能消化，何必用这些消克（消磨克制）的药物呢？大凡元气完固的人，多吃也不会受伤，过了吃饭时间也不觉得饿。如果是本来元气不足，导致饮食受伤，前面那些药一用，虽然饮食消了，但脾既已受伤，再经过这一番消化，会使虚者更虚。明天后天食物再次不消化，还说是前面的药有效，药力不够，汤剂和丸剂并用，辗转相害，身体日益消瘦，实在可悲啊。我痛心于这种弊端，因此申述说明。凡是太平丸、保和丸、肥儿丸之类的，名字虽然好听，我都不敢用。因为名字美好的药，药性一定峻烈，所以用美名来加上去，欺骗人的耳目，这不是大方家（高明医生）可以用的。
所以医生有贪图低贱患者的医，有对待富贵患者的医。膏粱子弟（富贵人家子女）与藜藿之民（贫苦百姓）不同，太平之民（健康人）与疮痍之民（病患）不同。乡村里巷的强壮男子，突然受到外伤，一服药即可痊愈。如果是膏粱子弟，禀赋虚弱，奉养柔脆，一概用这种方法施治，留下的危害不小。
医术与医道不同，术可以暂行一时，道则可以流芳千古。古方与今方不同，圣方与俗方不同。我认为今人不如古人，不敢自立一方。如果说脾胃方面只有李东垣堪称圣人，选择他的方子来用，根据病情增减。真正知道是寒凉食物损伤的，在原方中加入温热药，如干姜、肉桂之类；真正知道是热性食物损伤的，加入黄连之类；真正知道有肉食损伤的，加入几粒山楂；酒食损伤的，加入葛花一味。随证调理，这是李东垣的方法，也是方士的法度。然而，如果用寒凉药治热证而热不去，用温热药治寒证而寒不除，该怎么办呢？《内经》说：“寒之不寒，是无水也；热之不热，是无火也。”壮水之主，以制阳光；益火之源，以消阴翳。这是李东垣没有涉及到的。
如果有食物填塞太阴，名叫“食厥”，上部有脉，下部无脉，如果不治就会死亡。急需用阴阳盐汤，探吐吐出食物即可痊愈。如果有食积，肠腹绞痛，手不能按压的，不得不使用泻下法。确知是寒积，必须用巴豆感应丸；确知是热积，必须用大黄承气汤。泻下不当，生死立判，务必谨慎。
过去张子和动不动就言“下法”，这是因为下法得当。张仲景的三承气汤，审察详细严密，可下、不可下、急下，分毫不差。如下血积，必须用桃仁、红花；下水必用牵牛子、甘遂；下水中之血，必须用虻虫、水蛭。现在的人畏惧而不敢下，是不明理的罪小；无忌惮而妄用，是杀人的罪大。医生掌管人命，岂能轻易说话？
何柏斋说：“造化生物，天地水火而已。主之者天，成之者地也。”所以说“乾知大始，坤作成物”。至于天地交合变化的作用，则是水火二气。天运水火于地之中，则万物生矣。然而水火不可偏盛，太旱则物不生，是火偏盛；太涝则物亦不生，是水偏盛。水火和平则物生，这是自然之理。人的脏腑，以脾胃为主。饮食进入胃，由脾运化，就像地上的土一样。然而脾胃能化物，实际上是由于水火二气，不是脾单独能做到的。火盛则脾胃燥，水盛则脾胃湿，都不能化物，从而产生各种疾病。制约其偏颇使之平衡，就是治疗的方法。
我按语：所谓“制其偏而使之平”这句话，很好。所谓的“制”，不是去掉水或火的意思。人身的水火，原本自是均平的，偏颇才是病。火偏多的，补水以配火，不必去火；水偏多的，补火以配水，不必去水。这就好比天平，这边重那边就轻，一边重了，只补足轻的一边，绝不会凿去秤砣（马子）。因为秤砣是固定的数量。现在的人想要泻水降火的，就是在凿去秤砣。
我在调理脾胃时，区分阴阳水火。如不思饮食，这属于阳明胃土受病，须补少阴心火，用归脾汤补心火，以生胃土。能食但不消化，这属于太阴脾土受病，须补少阳相火，用八味丸补相火，以生脾土。无非是想让人培养一点先天之火气，以补土之母（火生土）。如果理中汤用干姜，是用来制约土中的水；建中汤用芍药，是用来制约土中的木；黄耆汤是用来益土之子（土生金），使子不食母之食；六味丸是用来壮水之主；八味丸是用来益火之原。土没有固定位置，寄旺于四季，没有专能，代天以完成化育。所以在四脏中兼用之，总之以补为主，不用克伐。脾气下陷，用补中益气汤；肝木乘脾，加左金丸；郁怒伤脾，用归脾汤；脾虚不能摄痰，用六君子汤；脾肾两虚，用四君子和四神丸；阴火乘脾，用六味丸；命门火衰，不生脾土，用八味丸。先天之气足，而后天之气不足的，以补中气为主；后天足而先天不足的，以补元气为主。
有人问：“正当胸膈饱闷之时，数日粒米不下，陈皮、枳壳、木香、乌药，日夜吞咽，尚且不通，还可以补吗？”我说：“这正是起初不知道补益，擅自使用发散、克伐太过，导致的虚痞病。《内经》说：‘下焦虚乏，中焦痞满。欲治其虚，则中满愈甚；欲消其痞，则下焦愈乏。’庸医遇到这种情况，难以措手。疏启其中，峻补于下。少用则邪壅于上，多用则峻补于下。这就是‘塞因塞用’。善于使用的，能用人参一两，或者七八钱，少加升麻一钱，大剂一服即愈。这是《内经》的妙用，不可不知。”
李东垣说：“酒者大热有毒，气味俱阳，乃无形之物也。如果伤了它，只应当发散，汗出就好了。其次不如利小便，乃上下分消其湿。现在的病酒者，往往服酒症丸等大热之药下之，又有用牵牛、大黄下之的。这是无形元气受病，反下有形阴血，乖误甚矣。酒性大热，已伤元气，而复重泻之，又损肾水真阴，及有形血气，俱为不足。如此则阴血愈虚，真水愈弱，阳毒之热大旺，反增其阴火，是元气消铄，折人长命。不然则虚损之病成矣。宜以葛花解酲汤主之。”
葛花解酲汤方
青皮（去瓤三钱） 木香（五分） 橘红 人参 茯苓（各一钱五分） 猪苓（一钱五分） 白豆蔻（五分） 葛花（五分） 砂仁（五分） 泽泻（一钱） 白术（二钱） 干姜（一钱） 神曲（一钱） 以上研为细末。每次服用三钱，白开水调下。得微汗则病去。这是李东垣的原方，适宜加减使用。
The *Treatise on the Correspondence of Yin and Yang* states: "The cold and heat of water and grain, if pathogenic factors are contracted, will damage the six fu-organs." This indicates that injury from diet is caused by cold and heat pathogens. The *Treatise on Bi Syndrome* states: "If food and drink intake doubles, the intestines and stomach will be injured." This indicates that injury from diet is due to irregular hunger and fullness.
Ancient methods of treatment divided this condition into upper, middle, and lower levels for management. For conditions in the upper jiao (upper burner), the method of "inducing vomiting according to the location" was used, primarily employing formulas such as Gualisan (Melon Seed Powder). For conditions in the middle jiao, the method of digestion and transformation was used, primarily employing herbs such as Shenqu (Medicated Leaven), Maiya (Germinated Hordeum Fruit), Shanzha (Crataegi Fructus), Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma). For conditions in the lower jiao, the method of "guiding and draining" was used, primarily employing substances such as Xiaoshuang (Natrii Sulfas), Huanglian (Coptidis Rhizoma - *Note: Text says Huanglian but context implies Da Huang/Rhubarb for purgation, however text explicitly says 'Xiaohuang' which usually refers to Da Huang or similar purgatives, here translated as Purgatives like Natrii Sulfas, Rheum, Croton, etc.*), Baidu (Crotonis Semen), Qianniu (Pharbitidis Semen), and Gansui (Kansui Radix).
The ancients also treated based on cold and heat properties. Injuries from hot-natured foods were treated with cold-natured medicines; injuries from cold-natured foods were treated with hot-natured medicines. For example, if two parts were cold food and one part hot food, two parts hot medicine and one part cold medicine would be used, such as Beiji Wan (Emergency Rescue Pill). I believe it should be modified according to symptoms. Generally speaking, dietary diseases are mostly caused by cold food injury. The aforementioned methods may not serve as fixed standards.
Contemporary physicians primarily use Pingwei San (Flat Stomach Powder), making additions and subtractions, which can serve as a standard for regulating the spleen and stomach. "Pingwei" means flattening the stomach; when there is a high mound in the stomach (referring to damp-turbidity stagnation), it must be flattened. One should stop once it is flat and not overdose. Overdosing turns a flat land into a pit (damaging healthy qi). Today, people take Pingwei San as a daily tonic, which is a mistake. It is better to use Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill). Zhizhu Wan was created by Elder Jiegu. It uses one tael of Zhishi (Aurantii Fructus Immaturus) and two taels of Baizhu (Atractodis Macrocephalae Rhizoma), with more tonifying herbs than resolving herbs, tonifying first and then resolving. It is wrapped in lotus leaves with rice, steamed, and made into pills. This likely takes advantage of the green color of lotus leaves, corresponding to the Zhen trigram, having the image of an open bowl facing up, hollow inside allowing clear qi to rise. Cooking the rice into pills assists grain qi. Thus, Elder Jiegu's Zhizhu formula initiated Li Dongyuan's enlightenment in his later years, and the method of tonifying middle and boosting qi began here. However, Elder Jiegu designed this specifically for patients with food retention. Today, people treat this pill as a spleen-tonifying medicine, taking it morning and night, even adding Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), and Fanshashen (Amomi Fructus), which is even worse. I fear that Zhishi alone has the power to push down walls and topple battlements. If the intestines and stomach are already injured and the walls are not solid, how many times can they withstand being pushed down?
As for Shanzha (Crataegi Fructus), Shenqu (Medicated Leaven), and Maiya (Germinated Hordeum Fruit), which are commonly used worldwide, I permanently discard them. Shanzha can resolve meat accumulation. For old sow meat that cannot be cooked thoroughly, adding a pinch of Shanzha makes the skin and flesh rot completely. For postpartum uterine lochia pain (postpartum blood stasis abdominal pain), using twenty grains of Shanzha decocted with rock sugar in one bowl of water resolves the lochia immediately. This shows its ability to break qi and blood; it should not be used lightly. Shenqu requires rice and water in a porcelain jar, relying on yeast to brew wine and mold to brew sugar. The spleen and stomach in the human body are not comparable to a porcelain jar; they originally have the ability to transform food. When food is not transformed, this ability is diseased. One only needs to assist this function, and food will transform naturally. Why use these resolving and suppressing drugs? Generally, people with complete and solid yuan qi can eat much without injury and do not feel hungry past meal times. If one initially lacks constitutional qi, leading to dietary injury, using the aforementioned drugs, although the food is digested, the spleen is already injured. After undergoing this digestion again, the deficiency becomes more deficient. Tomorrow and the next day, food fails to digest again, yet one claims the previous drugs were effective and the dosage was insufficient, combining decoctions and pills, causing mutual harm, leading to increasing emaciation, which is truly tragic. I lament this flaw and therefore elaborate. Formulas such as Taiping Wan, Baohe Wan, and Feier Wan, though their names are beautiful, I dare not use. Because drugs with beautiful names must be harsh, so beautiful names are added to deceive people. They are not suitable for great physicians.
Thus, there are physicians who seek low-status patients and those who seek wealthy patients. Children of rich families differ from commoners of coarse food. Healthy people differ from those with wounds. Strong men in villages suffering sudden trauma can be cured with one dose. However, children of rich families, with weak constitutions and delicate upbringing, subjected to these methods generally suffer significant harm.
Medical technique and medical dao are different. Technique can last temporarily, while dao lasts forever. Ancient formulas differ from modern ones; sacred formulas differ from vulgar ones. I believe modern people are inferior to ancients and dare not create new formulas. Regarding the spleen and stomach, only Li Dongyuan is considered sacred. Selecting his formulas and modifying them according to the patient: if one truly knows it is cold food injury, add hot medicines like Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus); if one truly knows it is hot food injury, add Huanglian (Coptidis Rhizoma); if one truly knows it is meat injury, add several grains of Shanzha; if it is alcohol/food injury, add Ge Hua (Puerariae Flos). Modulating according to symptoms is Li Dongyuan's method, the rule for physicians. However, if treating heat with cold does not remove the heat, and treating cold with heat does not eliminate the cold, what then? The Classics say: "If cold does not become cold, it is lack of water; if heat does not become warm, it is lack of fire." Strengthen the master of water to control yang; benefit the source of fire to dissipate yin shadow. This was beyond Li Dongyuan's scope.
If food fills the Taiyin, named "Food Jue" (syncope due to food), with pulse present above but absent below, failure to treat leads to death. Urgently use Yin-Yang Salt Soup to induce vomiting, expelling the food leads to recovery. If there is food accumulation, colicky abdominal pain, unable to bear pressure, downward purging is necessary. If confirmed as cold accumulation, Bidou Yingshi Wan (Croton Resonance Pill) must be used; if confirmed as heat accumulation, Dahuang Chengqi Tang (Rhubarb and Magnolia Decoction) must be used. Improper purging determines life or death instantly; be cautious.
In the past, Zhang Hezi often spoke of purging because purging was appropriate. Zhang Zhongjing's three Chengqi formulas were examined in detail and precision: when to purge, when not to purge, and urgent purging, without error. For blood stasis, Taoren (Persicae Semen) and Honghua (Carthami Flos) must be used; for water retention, Qianniu (Pharbitidis Semen) and Gansui (Kansui Radix) must be used; for blood in water, Machong (Blatta) and Shuizhi (Hirudo) must be used. Today, people fear and dare not purge; the sin of ignorance is small; the sin of reckless use is killing. Physicians hold human lives, how can they speak lightly?
He Bozhai said: "Creation generates things through heaven, earth, water, and fire alone. Heaven governs, Earth completes." Thus, "Qian knows the beginning, Kun creates the object." As for the interaction and change of heaven and earth, it is the qi of water and fire. Heaven moves water and fire within the earth, and things are born. However, water and fire cannot be excessive. Too much drought prevents growth, indicating fire excess; too much flood prevents growth, indicating water excess. Water and fire in harmony allow growth, which is natural law. In the human body, the spleen and stomach are primary. Food enters the stomach and is transported by the spleen, like earth on the ground. However, the spleen and stomach transform food actually due to water and fire qi, not solely by the spleen. Fire excess causes spleen/stomach dryness; water excess causes spleen/stomach dampness. Both fail to transform food, generating various diseases. Controlling the deviation to restore balance is the method of treatment.
My commentary: The phrase "control deviation and restore balance" is excellent. "Control" does not mean removing water or fire. Human water and fire are originally balanced; deviation is disease. If fire is excessive, supplement water to match fire, do not remove fire; if water is excessive, supplement fire to match water, do not remove water. It is like a balance scale: if one side is heavy, the other is light. If one side is heavy, only supplement the lighter side; never chisel away the counterweight (Ma Zi). The counterweight is a fixed number. People today who want to drain water and descend fire are chiseling away the counterweight.
I regulate the spleen and stomach by distinguishing yin, yang, water, and fire. Lack of appetite belongs to Mingyang Stomach Earth pathology; one must supplement Shaoyin Heart Fire. Guipi Tang (Restore the Spleen Decoction) tonifies heart fire to generate stomach earth. Ability to eat but inability to digest belongs to Taiyin Spleen Earth pathology; one must supplement Shaoyang Ministerial Fire. Bawei Wan (Eight-Ingredient Pill) tonifies ministerial fire to generate spleen earth. This is all about cultivating a spark of congenital fire qi to supplement the mother of earth (Fire generates Earth). Lizhong Tang (Regulate the Middle Decoction) uses Ganjiang (Zingiberis Rhizoma) to control water in earth; Jianzhong Tang (Establish the Middle Decoction) uses Shaoyao (Paeoniae Radix Alba) to control wood in earth; Huangqi Tang tonifies the child of earth (Earth generates Metal), preventing the child from consuming the mother's food; Liuwei Wan (Six-Ingredient Pill) strengthens the master of water; Bawei Wan benefits the source of fire. Earth has no fixed position, thriving in the four seasons, with no specific function, assisting heaven in completion. Thus, it is used concurrently among the four zang organs, always prioritizing tonification, avoiding suppression. Spleen qi sinking: Buyuzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction). Liver wood overacting on spleen: Add Zuojin Wan (Left Metal Pill). Depressive anger injuring spleen: Guipi Tang. Spleen deficiency failing to grasp phlegm: Liujunzi Tang (Six Gentlemen Decoction). Spleen and kidney dual deficiency: Si Junzi and Sishen Pills. Yin fire overacting on spleen: Liuwei Wan. Mingmen fire decline failing to generate spleen earth: Bawei Wan. Congenital qi sufficient but postnatal qi insufficient: Focus on tonifying middle qi. Postnatal sufficient but congenital insufficient: Focus on tonifying yuan qi.
Someone asks: "During chest and diaphragm fullness and oppression, unable to eat rice for days, Chenpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus), Muxiang (Aucklandiae Radix), Wuyao (Linderae Radix) swallowed day and night, still blocked, can we still tonify?" I say: "This is precisely because initially one did not know to tonify, rashly using dispersing and suppressing methods excessively, resulting in deficiency-type bloating. The Classics say: 'Lower jiao deficiency and emptiness, middle jiao fullness and obstruction. To treat deficiency, middle fullness worsens; to resolve obstruction, lower jiao emptiness worsens.' Ordinary physicians face this with difficulty. Disperse in the middle, tonify severely in the lower. Small doses cause pathogen stagnation above; large doses severely tonify below. This is 'treating obstruction with obstruction' (Se Yin Se Yong). Skilled practitioners use Ren Shen (Ginseng Radix) one tael, or seven to eight qian, plus a small amount of Shengma (Cimicifugae Rhizoma) one qian, one large dose cures it. This is the subtle application of the Inner Canon, which must be known."
Li Dongyuan said: "Alcohol is greatly hot and toxic, its aroma and flavor are all yang, it is a formless substance. If injured by it, one should only disperse; sweating leads to recovery. Next best is promoting urination, dispersing dampness up and down. Current drinkers often take Jiuzheng Wan (Alcohol Disease Pill) or other hot purgatives, or use Qianniu and Dahuang to purge. This treats formless yuan qi disease by purging formed yin blood, a great error. Alcohol nature is greatly hot, already damaging yuan qi; re-purging damages Kidney water true yin and formed blood/qi, both becoming insufficient. Thus yin blood becomes more deficient, true water weaker, yang poison heat flares, increasing yin fire, depleting yuan qi, shortening life. Otherwise, deficiency-disease forms. One should use Gegua Jieying Tang (Pueraria Flower Relieving Intoxication Decoction)."
Gegua Jieying Tang Formula
Qingpi (remove pith, 3 qian) Muxiang (0.5 qian) Juhong (Exocarpium Citri Reticulatae Rubrum) Renshen (Ginseng Radix) Fuling (Poria) (each 1.5 qian) Zhuling (Polyporus) (1.5 qian) Baidoukou (Amomi Fructus) (0.5 qian) Gegua (Puerariae Flos) (0.5 qian) Sharen (Amomi Fructus) (0.5 qian) Zexie (Alismatis Rhizoma) (1 qian) Baizhu (Atractodis Macrocephalae Rhizoma) (2 qian) Ganjiang (Zingiberis Rhizoma) (1 qian) Shenqu (Medicated Leaven) (1 qian). Grind into fine powder. Take 3 qian per dose, mixed with white boiled water. Obtaining slight sweat removes the disease. This is Li Dongyuan's original formula, suitable for modification.