余尝考治脾胃莫详于东垣，求东垣治脾胃之法，莫精于升降。夫升降之法易知，而升降之理难明。其在《经》曰∶
“脾胃为仓廪之官，五味出焉。”盖脾主生化，其用在于无形。其属土，地气主上腾，然后能载物，故健行而不息，是
脾之宜升也明矣。胃者，水谷之海，容受糟粕，其主纳，纳则贵下行，譬如水之性莫不就下，是胃之宜降也又明矣。故
又曰∶“清气在下，则生飧泄；浊气在上，则生 胀。”夫清气何？盖指脾气而言，不然何以在下则飧泄也；其浊气何？
盖指胃气而言，不然何以在上则 胀也。是非可为脾升胃降之一确证乎？由此而推，如仲圣所立青龙、越脾等方，即谓
之升脾之清气也可；其所立三承气诸方，即谓之降胃之浊气也无不可。触类引伸，理原一贯，先圣后圣，其揆一也。考
东垣所着补中益气、调中益气、升阳益胃各方，其论虽详于治脾，略于治胃，而其意则一脏一腑，升降各有主治，显然
不可混者，其与先圣之理，又何尝相悖，而后先辉映，足以发明千古，良可师也。苟其颠倒错施，俾升降失宜，则脾胃
伤，脾胃伤则出纳之机失其常度，而后天之生气己息，鲜不夭扎生民者已。余偶读东垣书，详究脾胃，以辨其升降之理
如此。
昔贤有云∶“气有余，便是火。”此当专以病气立论。若元气有不足，而无有余者也，何则？气化于精，精生于水谷，
故人情一日不再食则饥，饥则气怯而倦怠，若饮食适宜，起居有节，始得元气充流，一昼一夜，正合一万三千五百息，
为人身之常度，故圣人御气，如持至宝，非以气之易于不足乎？自夫风、寒、暑、湿、燥、火六淫之气，外侵营卫经府，
阻塞正气流行出入之道，遂致腠理闭塞，胸腹痞满，二便不通，种种显病气有余之象，而元气已形内馁之机，医者但当
察其所因，如风则用和，寒则用汗之类，即不致化火，而元气复矣。若治不中要，病气留着，则六者皆可化火，即热病
为伤寒之类，而病机十九条，属热者多是也，故曰气有余便是火。即七情之病，亦莫不然，如喜太过，则喜气有余而心
火炽，怒太过，则怒气有余而肝火炎，此尤当从脏气之阴阳虚实而调剂之，若执是说以往，不曰破气降气，即曰清火泻
火，吾恐少火生气，一伤则俱伤，一败而难复，非卫生之道也，岂古人立言之旨哉！
我曾经考察过治疗脾胃的方法，没有比李东垣论述得更详尽的；探究李东垣治疗脾胃的法度，没有比“升降”理论更精妙的。升降的法度容易知晓，但升降的原理难以阐明。在《内经》中说：“脾胃是掌管饮食仓库的官员，五味由此产生。”大概脾主司生化功能，其作用体现在无形的层面。脾属土，地气主要向上腾升，然后才能承载万物，所以脾健运而运行不息，这是脾适宜上升的道理已经很明白了。胃是水谷汇聚的大海，容纳接受糟粕，它的主功能是受纳，受纳就贵在向下通行，比如水的本性没有不向低处流的，这是胃适宜下降的道理也很明白了。所以又说：“清气在下，就会发生完谷不化的泄泻；浊气在上，就会发生胀满。”什么是清气？大概是指脾气而言，否则为什么在下就会导致泄泻呢？什么是浊气？大概是指胃气而言，否则为什么在上就会导致胀满呢？这难道不是脾升胃降的一个确凿证据吗？由此类推，如张仲景所设立的青龙汤、越婢汤等方剂，称它们是用来提升脾之清气的也可以；他所设立的三承气汤等方剂，称它们是用来下降胃之浊气的也没有不可以。触类旁通，引申发挥，道理原本是一贯的，先圣后圣，其准则是一致的。考察李东垣所撰写的补中益气汤、调中益气汤、升阳益胃汤各方，虽然他的论述侧重于治疗脾，对治疗胃着墨较少，但他的意图则是脏与腑各有主治，升降各有侧重，明显不可混淆，这与先圣的道理，又何曾相违背，前后辉映，足以阐明千古真理，确实值得效法。如果颠倒错乱施用，使得升降失常，那么脾胃就会受伤，脾胃受伤则出纳的功能失去常态，而后天生成的生气已经停止，很少有不导致百姓早夭的。我偶然阅读李东垣的书籍，详细研究脾胃，像这样来辨析其升降的原理。
从前有贤人说：“气有余，便是火。”这应当专门从病气立论。如果是元气不足，而没有有余的情况，为什么呢？气化生于精，精生于水谷，所以人一天不吃两次饭就会饥饿，饥饿则气怯弱而倦怠，如果饮食适宜，起居有节制，才能得到元气充盛流通，一昼一夜，正好合一万三千五百次呼吸，这是人身体的正常度数，所以圣人驾驭气，如同持有最珍贵的宝物，不是因为气容易不足吗？自从风、寒、暑、湿、燥、火六淫之气，外侵营卫经络脏腑，阻塞正气流行出入的道路，于是导致腠理闭塞，胸腹痞闷胀满，大小便不通，种种显现出病气有余的现象，而元气已经显露出内部虚馁的机兆，医者只应当考察其原因，如风邪则用和解法，寒邪则用发汗法之类，就不会转化为火，而元气也就恢复了。如果治疗不得要领，病气滞留，那么六种邪气都可以化火，即热病属于伤寒之类，而病机十九条中，属于热的很多，所以说气有余便是火。即使是七情致病，也没有不是这样的，如喜太过，则喜气有余而心火炽盛，怒太过，则怒气有余而肝火炎上，这尤其应当从脏气的阴阳虚实来进行调剂，如果固执这种说法去行医，不是破气降气，就是清火泻火，我恐怕少火（生理之火）生气，一旦受损则全部受损，一旦败坏则难以恢复，这不是养生之道，难道是古人立言的本旨吗！
I have examined the treatments for the Spleen and Stomach, none being more detailed than those of Dongyuan (Li Dongyuan). In exploring Dongyuan's methods for treating the Spleen and Stomach, none is more exquisite than the theory of Ascending and Descending (Sheng Jiang). The method of ascending and descending is easy to understand, but the principle behind it is difficult to elucidate. As stated in the *Classic* (*Huangdi Neijing*): "The Spleen and Stomach are the officials of the granary, from which come the five flavors." Generally, the Spleen governs transformation and transportation, its function manifesting in the formless aspect. Belonging to Earth, the qi of the earth primarily ascends upward, thereby enabling it to bear all things; thus, it moves vigorously without ceasing. This clearly demonstrates that it is appropriate for the Spleen to ascend. The Stomach is the sea of water and grain, receiving and containing dregs. Its primary function is reception, and reception necessitates downward movement. Just as the nature of water is invariably to flow downward, it is equally clear that it is appropriate for the Stomach to descend. Therefore, it is also said: "If clear qi is below, it generates diarrhea with undigested food (Sun Xie); if turbid qi is above, it generates distension (Zhang)." What is clear qi? It refers to Spleen Qi; otherwise, how could it cause diarrhea when located below? What is turbid qi? It refers to Stomach Qi; otherwise, how could it cause distension when located above? Is this not a definitive proof of the Spleen ascending and the Stomach descending? By extension, formulas such as Qinglong Tang (Blue Dragon Decoction) and Yueshi Tang (Yue Bi Decoction) established by Zhang Zhongjing can be considered as methods to ascend the clear qi of the Spleen; similarly, the various Chengqi formulas (Chengqi Decoctions) he established can be considered as methods to descend the turbid qi of the Stomach. Drawing analogies and extending principles, the logic remains consistent; whether ancient or later sages, their underlying principles are one. Examining Dongyuan's works, including Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction), and Shengyang Yiewei Tang (Raise the Yang and Benefit the Stomach Decoction), although his discussions detail the treatment of the Spleen while briefly mentioning the Stomach, his intent is clear: the Zang organs and Fu organs each have their specific governance, and ascending and descending have distinct indications, obviously not to be confused. How does this contradict the principles of the ancient sages? Their contributions shine together, illuminating truths for millennia, truly worthy of emulation. If these processes are inverted and misapplied, causing ascending and descending to become inappropriate, the Spleen and Stomach will be injured. Once injured, the mechanisms of intake and output will lose their normal rhythm, and the postnatal vital qi will cease. Few people would avoid premature death. Having occasionally read Dongyuan's books and thoroughly investigated the Spleen and Stomach, I have analyzed their principles of ascending and descending as follows.
An ancient sage once said: "Excess of Qi becomes Fire." This statement should be interpreted specifically regarding pathogenic Qi. What if Yuan Qi (Original Qi) is deficient rather than excessive? Why? Qi transforms from Essence, and Essence is generated from water and grain. Thus, if a person does not eat twice a day, they feel hungry; hunger leads to weak Qi and fatigue. Only with appropriate diet and regulated daily life can Yuan Qi be abundant and flowing freely. In a full day and night, there are exactly 13,500 breaths, which is the standard measure for the human body. Therefore, sages treat Qi as a supreme treasure, precisely because Qi is prone to deficiency. When the six pathogenic factors—Wind, Cold, Summerheat, Dampness, Dryness, and Fire (Liu Yin)—invade the Ying and Wei levels and the meridians and fu organs externally, they obstruct the circulation and entry-exit pathways of righteous Qi. This results in closed pores, chest and abdominal fullness and stuffiness, and obstruction of urination and defecation. These manifest as signs of excess pathogenic Qi, while the internal state of Yuan Qi shows signs of depletion. Physicians should only investigate the cause: for Wind, use harmonizing methods; for Cold, use diaphoretic methods, etc. In doing so, transformation into Fire is avoided, and Yuan Qi is restored. However, if treatment misses the key point and pathogenic Qi lingers, any of the six factors can transform into Fire. For instance, heat diseases falling under the category of Cold Damage (Shang Han) are common; among the Nineteen Pathogenesis Patterns, many belong to Heat. Hence, it is said that "excess of Qi becomes Fire." This applies equally to diseases caused by the Seven Emotions. For example, excessive joy leads to an excess of Joyful Qi and blazing Heart Fire; excessive anger leads to an excess of Angry Qi and flaming Liver Fire. In such cases, regulation must be based on the yin-yang and deficiency-excess states of the Zang organ Qi. If one rigidly adheres to this saying, employing only methods to break or descend Qi, or to clear and purge Fire, I fear that the Mild Fire (Shao Huo, which generates Qi) will be damaged, leading to total collapse and irreparable loss. This is not the way to preserve health, nor is it the true intent behind the words of the ancients!