丹溪治一室女因事忤意。郁结在脾。半年不食。但日食熟菱大枣数枚。遇喜。食馒头弹
子大。深恶粥饭。朱意脾气实。非枳实不能散。以温胆汤去竹茹。数十帖而安。
又治一少妇。年十九。因不如意。遂膈满。不食累月。惫甚。不能起坐。巳午间发热面
赤。酉戌方退。夜间小便数而点滴。月经极少。脉沉涩短小。重取皆有。此气不遂而郁于胃
口。内有瘀血。却因病久。元气已虚。中宫又以勉强进食。郁而生痰。法宜补泻兼施。以参
术各二钱。茯苓、橘皮各一钱。红花六分。食前煎服。少顷。与神佑丸减轻粉牵牛为细丸
如芝麻大。唾津咽十五丸。日夜二药各四服。次日食进。三日热退而愈。
〔附〕四明僧奉真治天章阁待制许元之子。瞑目不食。已逾宿矣。奉真曰。脾已绝。不
可治。死在明日。元曰。予方陛对。能延数日之期否。奉真曰。如此自可。诸脏皆衰。惟肝
独盛。脾为肝所胜。其气先绝。一脏绝则死。若急泻肝气。令肝衰。则脾少缓。可延三日。
过此无术也。乃投药。至晚稍清爽。能张目。渐进稀粥。明日更轻安能食。病家喜。奉真笑
曰。此不足喜。肝气暂舒耳。无能为也。后三日。果卒。
震按不食之因甚多。而因郁因怒。其大端也。所载三案。可以为式。至因他病而不食者
不在此例。夫人身以胃气为本。经年累月。粥饭全废。似无不死者。然予曾见两家闺女。
皆十余岁。皆无病。渐渐厌恶粥饭。每日略啖菱栗枣橘落花生芝麻薄脆豆腐干之类。或饮酒
一二杯。或腐浆数口而止。其父母甚忧之。予视其形色不变。起居如常。六脉匀平。乃许以
无事。亦不处方。后皆婚嫁生子。盖谷肉蔬果。均以养生。去谷而犹存三项。与绝食者原不
同耳。但女与男又别有说。阳动阴静。阳开阴阁。若童男不食粥饭。究非所宜。
朱丹溪治疗一位少女，因事情不合心意，导致气郁结在脾脏，半年不吃东西。她每天只吃几枚熟菱角和大枣，如果心情高兴，就吃像弹子大小的馒头，非常厌恶喝粥吃饭。朱丹溪认为这是脾气实滞，非枳实不能消散，于是用温胆汤去掉竹茹，服用几十帖后病情安定。
又治疗一位少妇，十九岁，因为事情不如意，导致胸膈胀满，几个月不进食，身体极度疲惫，无法起身坐立。巳时和午时之间发热、面红，到了酉时和戌时才退热。夜间小便次数多且点滴而出，月经量极少。脉象沉涩短小，重按仍能触及。这是气机不畅而郁结在胃脘部，体内有瘀血，但因为患病日久，元气已经虚弱，加上中焦脾胃因勉强进食，郁结而生痰。治疗方法应当补泻兼施。用人参、白术各二钱，茯苓、陈皮各一钱，红花六分，饭前煎服。过了一会儿，再给予神佑丸（减轻牵牛子的用量）制成如芝麻大小的细丸，用唾液吞咽十五丸。日夜两种药各服用四次。第二天开始进食，第三天热退而痊愈。
〔附〕四明僧人奉真治疗天章阁待制许元的儿子，闭目不食，已经超过一夜了。奉真说：“脾脏之气已绝，不可治疗，明天就会死亡。”许元说：“我正要上朝应对皇帝询问，能延长几天的期限吗？”奉真说：“这样自然可以。现在五脏都衰弱，只有肝脏独盛。脾脏被肝脏克制，其气先绝。一脏气绝就会死亡。如果急泻肝气，使肝脏衰弱，那么脾脏就能稍微缓解，可以延长三天。过了这个时间就没有办法了。”于是给药。到晚上患者稍微清爽，能够睁眼，逐渐进稀粥。第二天更加轻安并能进食。病家很高兴，奉真笑着说：“这不值得高兴，只是肝气暂时舒缓罢了，无能为力了。”后来三天，果然去世。
俞震按语：不进食的原因很多，但因郁结和愤怒导致的，是主要的大端。所载的三个医案，可以作为典范。至于因为其他疾病而不进食的，不在此例。人的身体以胃气为本，经年累月完全废弃粥饭，似乎没有不死的。然而我曾见过两家的闺女，都是十几岁，都没有生病，渐渐厌恶粥饭，每天只稍微吃点菱角、栗子、大枣、橘子、落花生、芝麻、薄脆、豆腐干之类，或者喝一二杯酒，或者喝几口豆浆就停止。她们的父母非常担忧，我观察她们的神色形态没有变化，起居如常，六脉匀平，于是断定她们没事，也不开处方。后来都婚嫁生子。大概谷物、肉类、蔬菜、水果，都是用来养生的，去除了谷物但还保留其他三项，与绝食者原本不同。但是女子与男子又有另外的说法，阳主动阴主静，阳主开阴主阖，如果是童男不吃粥饭，终究是不适宜的。
Zhu Danxi treated a young unmarried woman who, due to matters not going as she wished, had qi stagnation constrained in the Spleen. For half a year, she did not eat. She only consumed a few cooked water chestnuts and large dates daily. When happy, she would eat a steamed bun the size of a marble, but deeply detested eating rice porridge or plain rice. Zhu reasoned that this was excess condition of the Spleen Qi, which could only be dispersed by Zhi Shi (Immature Bitter Orange). He prescribed Wendan Tang (Gallbladder-Warming Decoction) with Zhuru (Bamboo Shavings) removed. After dozens of doses, her condition stabilized.
He also treated a young married woman, aged nineteen. Due to dissatisfaction, she suffered from fullness in the chest and diaphragm and had not eaten for months. She was extremely exhausted and unable to sit up or rise. Between Si (09:00-11:00) and Wu (11:00-13:00), she experienced fever and facial flushing, which subsided only during You (17:00-19:00) and Xu (19:00-21:00). At night, she had frequent urination with only drops passing, and her menstrual flow was extremely scanty. Her pulse was deep, choppy, short, and small, yet palpable even with heavy pressure. This indicated that Qi was not flowing smoothly and was constrained at the Stomach gate, with blood stasis inside. However, due to the long duration of illness, the Yuan Qi (Primary Qi) was already deficient. Furthermore, forced eating in the Middle Jiao led to constraint generating phlegm. The treatment method should combine tonification and purgation. He prescribed Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome), each 2 qian; Fu Ling (Poria) and Chen Pi (Tangerine Peel), each 1 qian; and Hong Hua (Safflower Flower), 6 fen. These were decocted and taken before meals. Shortly after, he administered Shenyu Wan (Divine Protection Pill) with reduced quantity of Qian Niu Zi (Morning Glory Seed), formed into fine pills the size of sesame seeds. She swallowed fifteen pills using saliva. Both medicines were taken four times daily. On the next day, she began to eat. By the third day, the fever subsided, and she recovered.
[Appendix] Monk Fengzhen from Siming treated the son of Xu Yuan, Waiting Attendant in Tianzhang Pavilion. The boy kept his eyes closed and did not eat for over a night. Fengzhen said, "The Qi of the Spleen has already perished; it is untreatable. Death will occur tomorrow." Xu Yuan said, "I am about to attend an imperial audience. Can you extend my time by a few days?" Fengzhen replied, "In that case, it is possible. All viscera are now weak, but the Liver alone is excessive. The Spleen is overcome by the Liver, so its Qi perishes first. When one viscus perishes, death ensues. If you urgently purge the Liver Qi to weaken the Liver, the Spleen will relax slightly, allowing for an extension of three days. Beyond this, there is no remedy." He then administered medicine. By evening, the patient felt somewhat refreshed, could open his eyes, and gradually took thin rice gruel. The next day, he was even more comfortable and able to eat. The family was delighted, but Fengzhen smiled and said, "This is not worth rejoicing; it is merely temporary relief of Liver Qi. It is powerless [to save him]." Three days later, he indeed died.
Yu Zhen commented: There are many causes for not eating, but those caused by depression/stagnation and anger are the major categories. The three cases recorded above can serve as models. Cases where non-eating results from other diseases are excluded here. The human body relies on Stomach Qi as its foundation. To completely abandon rice porridge and grain for years seems inevitably fatal. However, I have seen two daughters from different families, both in their teens, who were healthy but gradually developed aversion to rice porridge. They ate only small amounts of water chestnuts, chestnuts, dates, oranges, peanuts, sesame, crisp crackers, and dried tofu, or drank one or two cups of wine, or a few mouthfuls of soy milk, then stopped. Their parents were very worried. Upon examination, I found their complexion and form unchanged, daily activities normal, and all six pulses regular and balanced. I concluded they were fine and prescribed no medicine. Later, both married and bore children. Generally, grains, meats, vegetables, and fruits are all used for nourishment. Removing grains but retaining the other three categories is fundamentally different from total starvation. However, there is another consideration for women versus men. Yang is active and Yin is quiet; Yang opens and Yin closes. If a young unmarried man does not eat rice porridge, it is ultimately inappropriate.