治证同前。
大附子（一只，姜汁一碗，煮干） 母丁香（一个）
上为细末，以少许安掌中舐服。
治证同前。
上用白水牛喉，去两头节，井筋膜脂肉，节节取下，如阿胶片。以好米醋一大盏浸，微
火频番匀炙干，再蘸再炙，醋尽为度，存性，不要见日，火焙燥为末，每服一钱，陈米饮
治翻胃呕噎。
半夏曲（炒） 枯矾（各一两） 皂角（火炙，刮去皮弦子，二两） 黑牵牛（取头末，
三两）
上为细末，用萝卜煮熟捣烂和丸，如梧桐子大，每服五十丸，食远用生姜汤送下。
夫脾胃者，清纯冲和之气，位居中州，其属土也，无物不入，无物不包，营卫出焉。而
脾又受胃之禀，行其气血，灌溉诸经，荣养百骸，生发诸阳上升之气，元气由此而充焉，故
为十二经之海。常以食入于胃，散精于肝，淫气于筋，食气入胃，浊气归心，淫精于脉，脉
气流经，气归于肺，肺朝百脉，输精皮毛，毛脉合精，行气于腑，腑精神明，流于四脏，气
归于权衡，权衡以平，气口成寸，以决生死也，饮入于胃，游溢精气，上输于脾，脾气散精
，上归于肺，通调水道，下输膀胱，水精四布，五经并行，合于四时五脏阴阳，揆度以为常
也。凡人之生，皆以胃气为本，经云∶谷入于胃，脉道乃行，水入于经，其血乃成，若人绝
水谷则死，盖胃气绝而故也。正所谓安谷则昌，绝谷则亡，水去则营散，谷消则卫亡，营散
卫消，将何以立，此之谓也。盖天地以生五气五味，人之所养，莫重于此，慎勿以太过不及
，以伤其正，故曰阴之所生，本在五味，阴之五宫，伤在五味，可不谨乎？此乃大经大法，
故《调经篇》论云∶病生阴者，得之饮食居处，阴阳喜怒，五乱交作。病则身热头痛，目眩
体重，四肢不收，怠惰嗜卧，实者则腹胀中满，停食霍乱，虚者为呕吐哕逆，泄泻浮肿恶心
。又曰∶饮食劳倦则伤脾，脾伤则内闭九窍，外壅肌肉，卫气散解，此谓自伤，气之削也，
盖脾好干恶湿，或湿邪所淫为五泄，变为痢为疸。《原病式》云∶诸湿肿满，皆属脾土。土
衰则不能制水，水泛四肢，上乘于肺，为肿为满为喘，为小便不利，为泄泻，为饮食停积胃
口，脾不能克化，郁而为痰，变生嗽喘眩晕，嘈杂嗳气吞酸，翻胃吐食，胃脘当心而痛，有
脾间虫动。其为痛也，气血痰水、食积风冷诸证之痛，每每停聚而不散，惟虫痛则乍作乍止
，来去无定，又呕吐清沫之为可验。又有动气，按之牢若痛者，脾胃虚之故也。若人汤饮入
胃，至脐便欲小便者，由精不输于脾，不归于肺，心火上攻，令人口燥咽干，阴火太盛也。
东垣发明，迨尽其旨之要。人之百病，皆由脾胃衰而生也。至于经论天地之邪气，感则害人
，五脏六腑及形气俱虚，乃受外邪，不因虚邪，贼邪不能独伤人乎，岂不从脾胃虚而生明矣
，然所伤之因不一，为病多端。分而其略，饮食伤胃，劳倦伤脾，饥则损气，饱则伤气，劳
则气耗，逸则气滞，及喜怒忧恐，皆能损胃之元气，而为不足之证。惟饮食所伤者有异耳。
一则内弱强食，填塞不化，此有物也，属乎克伐；一则中虚少食，痞满难运，此不足也，属
乎补养。医者便以饮食内伤，中气不和之病治之，不分何物所伤，又不审伤物之有无，又不
辨脾胃之强弱，而据投《局方》之剂。轻以香热克化，重以巴豆攻逐，一途取利，实实虚虚
之祸岂小哉？实者则已，虚者愈损其胃，甚至病转危殆而死者有之。今将治法分类施之，是
以物各有性。若伤于饮者，饮乃无形之物，或微汗散之于表，或淡渗利之于下，或若湿以燥
其中；伤于食者，或损谷以和之，或强脾以磨之，果因食物停滞甚盛而作闷乱者，吐下以夺
之；中有物伤于寒者则热之，伤于热者则凉之，寒热共伤者，各从其性以和之；伤于鱼肉菜
果之类，求其气之相克而相制者用之，如 砂阿魏治肉积，胡黄连麝香治果积，神曲麦 礞
石巴豆皆治酒积食积痰积，是皆有形之物，填塞不化，必待驱逐，然后从其所宜，制之而得
安，岂可一例而用香热药也？若夫饮食劳倦，内伤中气，脾胃虚弱，虚满不食，使营运减削
，不能输精皮毛，行气六腑，发为诸证，此乃不足之邪，理宜温之和之，调之养之，必使生
气增益，胃气完而后愈也。脾胃之证，前人所论甚详，后学必须诚究，决无实实虚虚之咎，
岂可轻易哉！
症状与前文所述相同。
大附子（一枚，用一碗姜汁煮至汁液吸干） 母丁香（一个）
将上述药材研成细末，取少量置于掌心，用舌舔服。
症状与前文所述相同。
取上法处理过的白水牛喉，去除两端的关节、井筋膜及脂肉，逐节取下，切成如阿胶片般的薄片。用一大盏优质米醋浸泡，以微火反复均匀炙烤干燥，再蘸醋再炙烤，直至醋液耗尽为止，保留药性，避免日晒，用火焙干后研为细末。每次服用一钱，用陈年米汤送服。
治疗翻胃、呕吐、噎膈。
半夏曲（炒制） 枯矾（各一两） 皂角（火炙，刮去外皮和筋络，二两） 黑牵牛（取头末，三两）
将上述药材研成细末，用煮熟的萝卜捣烂混合制成丸剂，大小如梧桐子。每次服用五十丸，在饭后较远时用生姜汤送下。
脾胃之气，是清纯冲和之气，位居中州（人体中部），其属性属土，无所不纳，无所不包，营气和卫气由此产生。脾又接受胃的禀赋，运行气血，灌溉十二经脉，荣养全身骨骼形体，生发诸阳上升之气，元气因此得以充盈，所以脾胃被称为十二经脉之海。通常食物进入胃中，精微物质散布于肝，滋养筋脉；饮食之气入胃，浊气归于心，精华注入血脉；脉气流经全身，气汇聚于肺，肺朝会百脉，将精气输布至皮毛，皮毛与血脉中的精气相合，将气运行于六腑，六腑精神清明，气流向四脏，气归于平衡协调，平衡协调则气口形成寸脉，以此判断生死。饮水进入胃中，游溢精气，向上输送给脾，脾气散播精微，向上归于肺，通调水道，向下输送至膀胱，水精四布，五脏经脉并行，顺应四时五脏阴阳的变化，以此为常度。大凡人的生存，都以胃气为本。《内经》说：“谷物进入胃中，脉道才能运行；水液进入经脉，血液才能生成。”如果人断绝了水谷摄入就会死亡，这是因为胃气断绝的缘故。正所谓“能进食则昌盛，不能进食则灭亡”，水液流失则营气消散，谷物消化则卫气消亡，营气消散、卫气消亡，身体何以立足？说的就是这个道理。天地化生五气五味，这是人类赖以生存的根本，切勿因太过或不及，而损伤正气。所以说阴气的生成，根本在于五味；阴的五脏，损伤也在于五味，能不谨慎吗？这是大的经典法则，所以《调经篇》论述说：病生于阴分的，是由于饮食起居、阴阳失调、喜怒情绪等因素，导致五乱交错发作。病症表现为身热头痛、目眩、身体沉重、四肢无力、倦怠嗜卧；实证则腹胀中满、停食霍乱；虚证则为呕吐哕逆、泄泻浮肿恶心。又说：“饮食劳倦会损伤脾脏，脾伤则九窍闭塞，肌肉壅滞，卫气涣散，这称为自我伤害，是元气的削弱。”大概脾喜燥恶湿，若被湿邪浸淫则发生五泄，变为痢疾或黄疸。《原病式》说：“各种湿肿胀满，都归属于脾土。”脾土衰弱则不能制约水湿，水湿泛滥四肢，上乘于肺，导致肿胀、胀满、气喘、小便不利、泄泻、饮食停滞胃口、脾不能运化，郁结成为痰饮，变生咳嗽气喘眩晕、嘈杂嗳气吞酸、翻胃吐食、胃脘当心而痛，或有脾间虫动。那些疼痛，无论是气血痰水、食积风冷等证引起的疼痛，往往停聚不散，只有虫痛则是忽作忽止，来去不定，又有呕吐清稀涎沫作为验证。还有出现动气，按压坚实且疼痛的，这是脾胃虚弱的缘故。如果有人喝汤水进入胃中，刚到脐部就想小便，这是由于精气不能输送给脾，不能归于肺，心火上攻，导致人口燥咽干，阴火太盛。李东垣对此阐发发明，穷尽了其中的要旨。人的百种疾病，都是由脾胃衰弱而产生的。至于经络论述天地邪气，感受则伤害人体，五脏六腑及形气俱虚，才会受外邪侵袭，如果不是因为虚邪，贼邪怎能单独伤人呢？这不正是从脾胃虚弱而产生明显的吗？然而受伤的原因不一，病症繁多。粗略分类而言，饮食伤胃，劳倦伤脾，饥饿则损气，饱食则伤气，劳累则气耗，安逸则气滞，以及喜怒忧恐，都能损伤胃的元气，导致不足之证。只有饮食所伤的情况有所不同。一种是体内虚弱却强行进食，填塞不化，这是有形的实邪，属于克伐范畴；一种是中焦虚弱吃得少，痞满难运，这是不足之证，属于补养范畴。医生们便以饮食内伤、中气不和的病证来治疗，不分是何物所伤，又不审察是否有伤物，又不辨别脾胃的强弱，就依据《局方》的方剂投药。轻的用香燥温热药物克化，重的用巴豆攻逐，一条路追求通利，造成实实虚虚的祸患难道小吗？实证的人还好，虚证的人更加损伤胃气，甚至病情转为危重而死亡的都有。现在将治法分类施治，是因为万物各有本性。如果伤于饮，饮是无形的物体，或用微汗使之外散于表，或用淡渗药物使其下行利尿，或用燥湿药燥其中；如果伤于食，或用消导药调和它，或用健脾药磨化它，如果因食物停滞严重而导致闷乱，就用吐下法攻夺它；中有物伤于寒的则用热药，伤于热的则用凉药，寒热共伤的，则各从其性调和它；伤于鱼肉菜果之类的，寻求与其气味相克相制的药物使用，如砂仁、阿魏治疗肉积，胡黄连、麝香治疗果积，神曲、麦麸、礞石、巴豆都治疗酒积、食积、痰积，这些都是有形之物，填塞不化，必须等待驱逐，然后顺从其适宜的性质，加以制约而得安宁，怎么能一概使用香燥温热药呢？如果是饮食劳倦，内伤中气，脾胃虚弱，虚满不食，使营运功能减削，不能输精皮毛，行气六腑，发为各种证候，这是不足之邪，理应温中和之，调之养之，必须使生气增益，胃气完备而后痊愈。脾胃的证候，前人所论非常详细，后学者必须诚心探究，决不会有实实虚虚的过错，岂可轻易对待！
Symptoms are the same as described previously.
Da Fuzi (Aconiti Lateralis Radix Preparata, one piece, boiled in one bowl of Ginger Juice until dry) Mu Dingxiang (Syzygii Aromatica Fructus, one piece)
Grind the above into a fine powder. Take a small amount, place it on the palm, and lick it with the tongue.
Symptoms are the same as described previously.
Take the throat of a white water buffalo processed by the above method, remove the joints at both ends, as well as the fascia and fatty meat. Remove them joint by joint, slicing them like pieces of Ejiao (Donkey-hide Gelatin). Soak in one large cup of good rice vinegar. Roast evenly over a slight fire repeatedly until dry, dip again in vinegar and roast again, until the vinegar is exhausted. Preserve the medicinal nature, avoid sunlight, bake dry with fire, and grind into powder. Take one qian per dose, administered with aged rice decoction.
Treats Fanwei (Reflux Vomiting), Ouye (Vomiting), and Yeye (Dysphagia).
Banxia Qu (Pinelliae Fermentatum) Kufan (Alumini Sulphas Exsiccatus, each one liang) Zaojiao (Gleditsiae Sinensis Fructus, roasted by fire, skin and fibers scraped off, two liang) Heiqianniu (Pharbitidis Semen, head end powder, three liang)
Grind the above into a fine powder. Mix with cooked, mashed radish to form pills, sized like Sophora japonica seeds. Take fifty pills per dose, administered with Ginger Decoction long after meals.
The Qi of the Spleen and Stomach is pure, clear, and harmonious Qi. It resides in the Middle Jiao (central region of the body), its nature belongs to Earth. It receives all things and encompasses all things; Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) arise from it. The Spleen receives endowment from the Stomach, circulates Qi and Blood, irrigates the meridians, nourishes the bones and body, generates the ascending Yang Qi, and thus the Yuan Qi (Original Qi) becomes充盈 (full). Therefore, it is called the Sea of the Twelve Meridians. Generally, when food enters the Stomach, its essence scatters to the Liver, nourishing the sinews. When dietary Qi enters the Stomach, turbid Qi returns to the Heart, and essence injects into the vessels. Vessel Qi flows through the meridians, gathering in the Lung. The Lung governs all vessels, transmitting essence to the skin and hair. Skin and vessel essence combine, circulating Qi through the Fu organs. The Fu organs become bright and spiritual, and Qi flows to the Zang organs. Qi returns to balance and equilibrium. Equilibrium establishes the Cun pulse at the wrist, used to determine life and death. When water enters the Stomach, its essence floats and overflows, transporting upwards to the Spleen. The Spleen scatters essence, sending it upwards to the Lung. The Lung regulates water passages, transporting downwards to the Bladder. Water essence distributes in four directions, running through the five meridians, conforming to the Yin-Yang of the four seasons and five Zang organs, serving as the standard measure. All human life is based on Stomach Qi. The Classics state: "When grain enters the Stomach, the vessel pathways flow; when water enters the vessels, blood is formed." If a person cuts off grain and water, they will die, because Stomach Qi has ceased. As it is said, "Abundance of grain leads to prosperity, cessation of grain leads to demise." Loss of water causes Ying Qi to scatter, consumption of grain causes Wei Qi to perish. With Ying and Wei scattered and perished, how can the body stand? This is what is meant. Heaven and Earth generate the Five Flavors, which are crucial for human nourishment. One must not be excessive or deficient, thereby injuring righteous Qi. Thus it is said: The generation of Yin originates from the Five Flavors; the injury to the Five Palaces of Yin also stems from the Five Flavors. Can one not be cautious? This is a major canonical principle. Thus, the *Tiao Jing Pian* (Chapter on Regulating Meridians) states: Diseases arising from Yin result from diet, living conditions, Yin-Yang imbalance, and emotions (joy, anger). The five disorders occur simultaneously. Symptoms include body heat, headache, dizziness, heavy body, inability to control limbs, lethargy, and desire to lie down. Excess patterns present as abdominal distension and fullness, food stagnation, cholera-like vomiting and diarrhea. Deficiency patterns present as vomiting, hiccups, reverse qi, diarrhea, edema, nausea. It is also said: "Diet and fatigue injure the Spleen. Spleen injury causes closure of the nine orifices internally and obstruction of muscles externally, dispersal of Wei Qi. This is self-injury, a reduction of Qi." The Spleen prefers dryness and dislikes dampness. If invaded by damp evil, it transforms into the Five Diarrheas, becoming dysentery or jaundice. The *Yuan Bing Shi* states: "All dampness, swelling, and fullness belong to Spleen Earth." When Earth declines, it cannot control Water. Water floods the limbs, ascends to the Lung, causing swelling, fullness, asthma, difficult urination, diarrhea, food stagnation in the stomach, failure of Spleen transformation, accumulation into phlegm, generating cough, asthma, dizziness, heartburn, belching, acid regurgitation, Fanwei (reflux vomiting),吐出 (vomiting), epigastric pain, and movement of worms in the Spleen. Regarding pain: Pain caused by Qi, Blood, Phlegm, Water, Food Stagnation, Wind-Cold, etc., usually lingers and does not dissipate. Only worm pain comes and goes irregularly, appearing and disappearing without fixed times, verified by vomiting clear saliva. There is also moving Qi, felt as firm and painful upon pressure, due to Spleen-Stomach deficiency. If a person drinks soup/water, and feels the urge to urinate as soon as it reaches the umbilicus, this is because essence fails to transport to the Spleen and return to the Lung. Heart Fire attacks upward, causing dry mouth and throat, indicating excessive Yin Fire. Li Dongyuan elucidated these principles thoroughly. All hundred diseases of humans arise from Spleen-Stomach decline. Regarding the Classics discussing heavenly pathogenic factors: when contracted, they harm the body. Only when the Five Zang, Six Fu, Form, and Qi are deficient will external pathogens invade. Without deficiency, treacherous pathogens cannot harm alone. Does this not clearly show that disease arises from Spleen-Stomach deficiency? However, causes of injury vary, and manifestations are numerous. Briefly classified: Diet injures the Stomach, fatigue injures the Spleen. Hunger damages Qi, overeating injures Qi. Labor exhausts Qi, idleness stagnates Qi. Joy, anger, worry, and fear all damage Stomach Original Qi, leading to deficiency syndromes. Only injuries from diet differ. One type is internal weakness with forced eating, causing blockage and indigestion; this involves tangible excess, belonging to purging/attacking. Another type is middle-jiao deficiency with little intake, causing bloating and difficulty in transportation; this is deficiency, belonging to tonification/nourishment. Physicians often treat internal dietary injury and middle Qi disharmony indiscriminately, without distinguishing the offending substance, whether an offending substance exists, or the strength of the Spleen and Stomach, yet prescribing formulas from the *Ju Fang* (Imperial Formulary). Light cases use aromatic, hot, and resolving drugs; severe cases use Croton Seed (Baidu Dou) for purging. Pursuing unidirectional relief causes the disaster of reinforcing excess and depleting deficiency. Is this not serious? For excess patterns, it may suffice; for deficiency patterns, it further damages the Stomach, even leading to critical illness and death. Now, treatment methods are classified according to nature. Since all things have their specific properties: If injured by fluids (Yin), which are intangible, disperse them via slight sweating at the exterior, promote diuresis with bland-draining herbs downward, or dry the interior with damp-resolving herbs. If injured by food, harmonize with digestive aids or strengthen the Spleen to grind it. If food stagnation is severe causing distress, use emesis or purgation to drain it. If injured by cold within, warm it; if injured by heat, cool it. If injured by both cold and heat, harmonize according to their natures. If injured by meat, fish, vegetables, or fruits, use substances whose properties counteract and restrain them. For example, Sharen (Amomi Fructus) and Awei (Asafoetida) treat meat accumulation; Huhuanglian (Coptidis Rhizoma) and Shexiang (Moschus) treat fruit accumulation; Shenqu (Massa Medicata Fermentata), Maibofu (Triticum Vulgare Bran), Mengshi (Magnitae Concha), and Baidu Dou (Crotonis Fructus) all treat alcohol, food, and phlegm accumulations. These are tangible objects causing blockage and indigestion, requiring expulsion before harmonizing according to suitability. How can aromatic-hot drugs be used uniformly? If it is dietary and fatigue injury damaging middle Qi, resulting in Spleen-Stomach weakness, false fullness, anorexia, reduced circulation, failure to transmit essence to skin/hair, and failure to circulate Qi through Fu organs, generating various symptoms, this is a deficiency pathogen. It should be treated by warming, harmonizing, regulating, and nourishing, ensuring the generation of healthy Qi increases and Stomach Qi is complete before recovery. Previous scholars discussed Spleen-Stomach syndromes in great detail. Students must investigate sincerely. There will be no fault of reinforcing excess and depleting deficiency. How can one treat this lightly!