〔大〕脾属于土，脾为中州，意智之脏也。其肝、心、肺、肾、皆受脾之精气以荣
养焉。脾与胃为表里，脾主化谷纳食，胃为水谷之海，故经言四时皆以胃气为本也。妇
人气血不调，脏腑劳损，风邪冷气，蕴蓄在内，攻于脾胃，脾胃既虚，为邪所乘，则不
能消任五谷，故不能食也。
〔薛〕经云∶胃乃脾之刚，脾乃胃之柔。伤胃则脾无所禀受，伤脾则不能为胃运化，是
以脾胃为之表里，藉饮食以滋养百脉者也。窃谓前证若饮食所伤，六君子汤。（杂病虚劳。）劳
役所伤，补中益气汤。（杂病伤劳倦。）若风寒所伤，用人参理中汤。（杂病霍乱。）木旺乘土，六
君加柴胡。呕吐腹痛或大便不实，前汤加木香。胸膈虚痞，或肚腹不利，六君子汤。郁
怒伤损肝脾，归脾汤。（杂病健忘。）命门火衰，八味丸。（杂病虚劳。）仍审诸经错杂之邪而治之。假
如不能食而肌肉削，乃脾胃经本病，右关脉缓而弱，乃脾胃之本脉。若见弦紧，或四肢
满，闭淋溲便难，转筋，此肝之脾胃病也。若兼洪大，或肌热烦热面赤，此心之脾胃病也。
若兼浮涩，或气短喘急，咳嗽痰盛，此肺之脾胃病也。若兼沉细，或善恐善欠，此肾之
脾胃病也。各当于本经药中，加兼证之药，此东垣先生之治法也。一妇人停食饱闷，或
用人参养胃汤、木香槟榔丸而泄泻吐痰，腹中成块。又与二陈、黄连、浓朴，反加腹胀
不食。余以为脾胃气虚，不能消磨，用补中益气加茯苓、半夏，五十余剂，脾胃健而诸
证痊。一妇人饮食，每用碗许，若稍加非大便不实，必吞酸嗳腐，或用二陈、黄连、枳
实，反加内热作呕。余曰∶此末传寒中。不信，仍作火治，虚证悉至，月经不止。余用
六君加炮姜、木香数剂，诸证渐退，又以补中益气加炮姜、木香、茯苓、半夏数剂全愈。
后因饮食劳倦；兼以怒气，饮食顿少，元气顿怯，仍用前药，更加发热，脉洪大，按之
而虚，两尺如无，此命门火衰，用补中益气加姜、桂及八味丸兼服两月余，诸证寻愈。此
证若因中气虚弱，用人参理中汤，或六君子加木香、炮姜。不应，用左金丸，（两胁胀痛。）或
越鞠丸。（杂病郁。）虚寒加附子理中汤，（中寒。）无有不愈。一妇人饮食后或腹胀，或吞酸，自
服枳术丸，饮食日少，胸膈痞满，腿内酸痛，畏见风寒。或用养胃汤，腿痛浮肿益盛，月
经不行。余以为郁结所伤，脾虚湿热下注。侵晨用四君子、芎、归、二陈，午后以前汤送
越鞠丸，诸证渐愈。又用归脾、八珍二汤，兼服两月余而经行。一妇人胸满少食，或腹
胀吞酸，或经候不调，此中气虚而不能施化也。用补中益气加砂仁、香附、煨姜而饮食
进，更以六君、芎，归、贝母、桔梗而经自调。一妇人年三十余，忽不进食，日饮清
茶水果三年余矣。余谓脾气郁结，用归脾加吴茱萸四剂，遂饮食如常。若人脾肾虚而不
饮食，当以四神丸治之。一妇人不进饮食二年矣，日饮清茶果品之类，肝脾二脉弦浮，
按之微而结滞。余谓肝脾气郁，用六君、木香、吴茱，下痰积甚多，饮食顿进，形体始
瘦，卧床月余，仍服六君之类而康。
草豆蔻散 治妇人血风冷气攻脾胃，呕逆不纳饮食。
草豆蔻（去皮） 白茯苓（去皮） 枇杷叶（炙）
半夏（汤洗七次，切作片，各七钱半） 高良姜 白术（去芦） 缩砂仁 桂心 木香
青橘皮（去白） 甘草（炙，各半两） 人参（去芦，一两）
上 咀，每服五钱，水一中盏半，生姜七片，煎至一大盏，去滓温服，不拘时候。
诃梨勒散 治妇人血风，气攻脾胃，腹胁妨闷，四肢烦疼，或时痰逆，不下饮食
诃梨勒皮 陈橘皮（各一两，去白） 半夏（汤洗七次，切片） 人参（去芦） 桂心
白术（去芦） 细辛（去苗土） 当归（炒，去芦） 甘草（炙，各半两） 藿香 赤茯苓（去皮）
芎（各七钱半）
上制，煎服法同前。
神曲丸 治妇人血风气攻脾胃，腹胁胀满，不思饮食。
神曲 白术（去芦） 附子（炮，去皮脐） 枳实（麸炒，去幅） 诃梨勒皮 桂心
食茱萸 木香 陈橘皮（去白） 人参（去芦，各一两） 桔梗（去芦） 干姜（炮，各半两）
上为细末，酒煮面糊和丸，如梧桐子大。每服三十丸，空心食前生姜汤下，日进二服。
进食散 李潜云∶治脾胃虚寒，不思饮食，及久病患脾胃虚，全不入食者，只两服
能食。（陈云∶此方既有川乌，治血风攻脾不食，岂无良验。）
青皮 陈皮 粉草 桂心 良姜（各二钱半） 川乌头（炮，去皮尖） 草豆蔻仁（各三枚）
诃子（去核，五枚）
为细末，每服一钱，水一盏，生姜三片，煎七分，温服。
【大】脾归属于土，位于人体中焦，是主管意念与智慧的脏器。肝、心、肺、肾都依赖脾输送的精气来滋养。脾与胃互为表里，脾主消化谷物和接纳食物，胃是水谷汇聚的海港，所以医经说四季养生都以胃气为根本。妇女如果气血不调，脏腑劳损，风邪冷气蕴积在体内，攻冲脾胃，导致脾胃虚弱，被邪气侵袭，就不能消化五谷，因此出现不能进食的症状。
【薛】医经说：胃是脾的刚强之腑，脾是胃的柔和之脏。损伤了胃，脾就得不到营养来源；损伤了脾，就不能帮助胃进行运化，因此脾胃互为表里，依靠饮食来滋养全身血脉。我认为上述病症如果是饮食所伤，用六君子汤（杂病虚劳篇）；如果是劳累过度所伤，用补中益气汤（杂病伤劳倦篇）。如果是风寒所伤，用人参理中汤（杂病霍乱篇）。如果是肝木旺盛克制脾土，在六君子汤基础上加柴胡。如果有呕吐腹痛或大便不成形，在前一方基础上加木香。如果是胸膈部虚性痞满，或腹部不适，用六君子汤。如果是郁怒损伤肝脾，用归脾汤（杂病健忘篇）。如果是命门火衰，用八味丸（杂病虚劳篇）。还要审察各经脉错杂的邪气进行治疗。假如不能进食且肌肉消瘦，这是脾胃经的本病，右关脉缓而弱，是脾胃的本脉。如果见到弦紧脉，或四肢胀满，小便淋涩困难，转筋，这是肝病传及脾胃的病证。如果兼见洪大脉，或肌热烦热面赤，这是心病传及脾胃的病证。如果兼见浮涩脉，或气短喘急，咳嗽痰多，这是肺病传及脾胃的病证。如果兼见沉细脉，或易惊恐、爱打哈欠，这是肾病传及脾胃的病证。应当在本经药物中，加入治疗兼证的药物，这是李东垣先生的治法。有一个妇人因停食饱闷，有人用人参养胃汤、木香槟榔丸治疗，结果导致泄泻吐痰，腹中出现肿块。又用二陈汤、黄连、厚朴治疗，反而加重腹胀不食。我认为这是脾胃气虚，不能消磨食物，用补中益气汤加茯苓、半夏，服用五十多剂，脾胃功能恢复，各种症状痊愈。另一个妇人饮食量每顿约一碗，如果稍微多吃点，不是大便不成形，就是吞酸嗳腐，有人用二陈汤、黄连、枳实治疗，反而加重内热作呕。我说：这是末传寒中证。病人不信，仍按火热证治疗，虚证全部出现，月经淋漓不止。我用六君子汤加炮姜、木香，服用数剂，各种症状逐渐消退，又用补中益气汤加炮姜、木香、茯苓、半夏，服用数剂后完全痊愈。后来因为饮食劳倦，加上生气，饮食突然减少，元气突然怯弱，仍然用前面的药，更加发热，脉象洪大，重按则空虚，两尺脉像没有一样，这是命门火衰，用补中益气汤加干姜、肉桂以及八味丸同时服用两个多月，各种症状很快痊愈。这个病症如果是因为中气虚弱，用人参理中汤，或者六君子汤加木香、炮姜。如果无效，用左金丸（两胁胀痛），或者越鞠丸（杂病郁证）。虚寒证加附子理中汤（中寒证），没有不愈的。有一个妇人饭后或腹胀，或吞酸，自己服用枳术丸，饮食日渐减少，胸膈痞满，大腿内侧酸痛，害怕风吹受寒。有人用养胃汤，腿痛浮肿更加严重，月经不行。我认为这是郁结所伤，脾虚湿热下注。清晨用四君子汤、川芎、当归、二陈汤，午后用前面的汤药送服越鞠丸，各种症状逐渐好转。又用归脾汤、八珍汤，同时服用两个多月后月经来潮。有一个妇人胸满少食，或腹胀吞酸，或月经不调，这是中气虚而不能运化。用补中益气汤加砂仁、香附、煨姜，饮食增加，再用六君子汤、川芎、当归、贝母、桔梗，月经自然调顺。有一个三十多岁的妇人，忽然不进饮食，每天只喝清茶水果三年多。我认为这是脾气郁结，用归脾汤加吴茱萸，服用四剂，于是饮食恢复正常。如果人脾肾虚而不进食，应当用四神丸治疗。有一个妇人不进饮食两年了，每天只喝清茶果品之类，肝脾二脉弦浮，重按微而结滞。我认为这是肝脾气郁，用六君子汤、木香、吴茱萸，排出很多痰积，饮食突然增加，身体开始消瘦，卧床一个多月，仍然服用六君子汤之类的药物而康复。
草豆蔻散 治疗妇人血风冷气攻冲脾胃，呕吐逆气，不能纳食。
草豆蔻（去皮） 白茯苓（去皮） 枇杷叶（炙）
半夏（开水洗七次，切作片，各七钱半） 高良姜 白术（去芦头） 缩砂仁 桂心 木香
青橘皮（去白） 甘草（炙，各半两） 人参（去芦头，一两）
以上药材切碎，每次服用五钱，用水一中盏半，生姜七片，煎至一大盏，去渣温服，不限时候。
诃梨勒散 治疗妇人血风，气攻脾胃，腹胁胀闷，四肢烦疼，有时痰逆，不下饮食。
诃梨勒皮 陈橘皮（各一两，去白） 半夏（开水洗七次，切片） 人参（去芦头） 桂心
白术（去芦头） 细辛（去苗土） 当归（炒，去芦头） 甘草（炙，各半两） 藿香 赤茯苓（去皮）
川芎（各七钱半）
以上制成粗末，煎服法同前。
神曲丸 治疗妇人血风气攻脾胃，腹胁胀满，不思饮食。
神曲 白术（去芦头） 附子（炮制，去皮脐） 枳实（麸炒，去瓤） 诃梨勒皮 桂心
食茱萸 木香 陈橘皮（去白） 人参（去芦头，各一两） 桔梗（去芦头） 干姜（炮制，各半两）
以上研为细末，用酒煮面糊和丸，如梧桐子大。每次服用三十丸，空腹饭前用生姜汤送下，每日两次。
进食散 李潜说：治疗脾胃虚寒，不思饮食，以及久病患者脾胃虚弱，完全不能进食的，只要服用两服就能进食。（陈云：此方既有川乌，治疗血风攻脾不食，难道没有良好的疗效吗？）
青皮 陈皮 粉草 桂心 良姜（各二钱半） 川乌头（炮制，去皮尖） 草豆蔻仁（各三枚）
诃子（去核，五枚）
研为细末，每次服用一钱，水一盏，生姜三片，煎至七分，温服。
[Da] The Spleen belongs to Earth, resides in the Central Region (Zhongzhou), and is the organ governing intention and wisdom. The Liver, Heart, Lung, and Kidney all receive the essence and qi of the Spleen to be nourished. The Spleen and Stomach are exterior-interior pairs; the Spleen governs the transformation of grains and acceptance of food, while the Stomach is the sea of water and grains. Therefore, the classics state that the stomach qi is the foundation for all four seasons. In women, if blood and qi are disordered, and zang-fu organs are damaged by overstrain, wind pathogens and cold qi accumulate internally, attacking the Spleen and Stomach. Since the Spleen and Stomach are deficient and attacked by evil, they cannot digest the five grains, resulting in an inability to eat.
[Xue] The classics state: The Stomach is the rigid aspect of the Spleen, and the Spleen is the soft aspect of the Stomach. Injury to the Stomach means the Spleen has nothing to receive; injury to the Spleen means it cannot assist the Stomach in transportation and transformation. Thus, the Spleen and Stomach are exterior-interior pairs, relying on diet to nourish the hundred vessels. I suggest that for the aforementioned condition caused by dietary injury, use Liu Jun Zi Tang (Six Gentlemen Decoction) (from Miscellany Diseases: Deficiency and Consumption). For injury due to labor and fatigue, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) (from Miscellany Diseases: Injury from Labor and Fatigue). For injury due to wind-cold, use Ren Shen Li Zhong Tang (Ginseng Regulate the Middle Decoction) (from Miscellany Diseases: Cholera). If Wood excess attacks Earth, add Chai Hu (Bupleurum Root) to Liu Jun Zi Tang. If there is vomiting, abdominal pain, or loose stools, add Mu Xiang (Aucklandia Root) to the previous decoction. If there is deficiency-type fullness in the chest and diaphragm, or discomfort in the abdomen, use Liu Jun Zi Tang. If depression and anger damage the Liver and Spleen, use Gui Pi Tang (Restore the Spleen Decoction) (from Miscellany Diseases: Forgetfulness). If Ming Men Fire is deficient, use Ba Wei Wan (Eight-Ingredient Pill). One must also examine the mixed pathogens of the various meridians and treat accordingly. For instance, if one cannot eat and muscles waste away, this is a primary disease of the Spleen and Stomach meridians; a slow and weak pulse at the right Guan position indicates the primary pulse of the Spleen and Stomach. If a wiry and tight pulse appears, or if there is fullness in the four limbs, difficulty in urination, tendon twitching, this is a Liver disease affecting the Spleen and Stomach. If accompanied by a surging and large pulse, or feverish sensation, irritability, and red face, this is a Heart disease affecting the Spleen and Stomach. If accompanied by a floating and choppy pulse, or shortness of breath, rapid panting, cough with profuse phlegm, this is a Lung disease affecting the Spleen and Stomach. If accompanied by a deep and fine pulse, or frequent fear and yawning, this is a Kidney disease affecting the Spleen and Stomach. In each case, herbs treating the concurrent symptoms should be added to the herbs of the primary meridian; this is the treatment method of Mr. Dongyuan (Li Dongyuan).
Case 1: A woman suffered from food stagnation and fullness. Someone used Ren Shen Yang Wei Tang (Ginseng Nourish the Stomach Decoction) and Mu Xiang Bing Lang Wan (Aucklandia and Areca Nut Pill), which resulted in diarrhea, expectoration of phlegm, and masses forming in the abdomen. Then Er Chen Tang (Two-Aged Decoction), Huang Lian (Coptis Rhizome), and Hou Po (Magnolia Bark) were used, which aggravated abdominal distension and anorexia. I considered this to be Spleen and Stomach qi deficiency failing to digest food. I used Bu Zhong Yi Qi Tang plus Fu Ling (Poria) and Ban Xia (Pinellia Tuber). After more than fifty doses, Spleen and Stomach function recovered and all symptoms resolved.
Case 2: A woman’s intake was about one bowl per meal. If she ate slightly more, she would either have loose stools or experience acid regurgitation and belching of rotten food. Someone used Er Chen Tang, Huang Lian, and Zhi Shi (Immature Bitter Orange), which aggravated internal heat and vomiting. I said: This is the late transmission to Cold Center (Han Zhong). She did not believe me and continued treating it as a Heat syndrome. All deficiency symptoms appeared, including metrorrhagia. I used Liu Jun Zi Tang plus Pao Jiang (Prepared Ginger) and Mu Xiang for several doses, after which symptoms gradually receded. Then I used Bu Zhong Yi Qi Tang plus Pao Jiang, Mu Xiang, Fu Ling, and Ban Xia for several doses, leading to complete recovery. Later, due to dietary irregularities and fatigue, combined with anger, her food intake suddenly decreased, and her yuan qi became suddenly weak. Using the previous medicines again, she developed more fever. Her pulse was surging and large but empty upon pressure, and the two Chi positions felt absent. This indicated Ming Men Fire deficiency. I used Bu Zhong Yi Qi Tang plus Sheng Jiang (Fresh Ginger) and Gui Zhi (Cinnamon Twig), along with Ba Wei Wan, taken concurrently for over two months, after which all symptoms quickly resolved.
If this condition is due to middle qi deficiency, use Ren Shen Li Zhong Tang, or Liu Jun Zi Tang plus Mu Xiang and Pao Jiang. If ineffective, use Zuo Jin Wan (Left Metal Pill) (for hypochondriac distension and pain), or Yue Ju Wan (Solving Depression Pill) (from Miscellany Diseases: Depression). For deficiency-cold, add Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) (for Cold Invasion). There will be no failure to heal.
Case 3: A woman experienced abdominal distension or acid regurgitation after meals. She self-administered Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill), causing her food intake to decrease daily, chest and diaphragm fullness, soreness in the inner thighs, and aversion to wind and cold. Someone used Yang Wei Tang, which exacerbated leg pain and edema, and stopped menstruation. I considered this to be injury from depression, with Spleen deficiency and damp-heat pouring downward. In the morning, she took Si Jun Zi Tang (Four Gentlemen Decoction), Xiong (Chuanxiong Rhizome), Dang Gui (Angelica Sinensis Root), and Er Chen Tang. In the afternoon, she took Yue Ju Wan delivered by the previous decoction. Symptoms gradually improved. Then she took Gui Pi Tang and Ba Zhen Tang (Eight Treasure Decoction) concurrently for over two months, after which menstruation resumed.
Case 4: A woman had chest fullness, reduced appetite, abdominal distension, acid regurgitation, or irregular menstruation. This was due to middle qi deficiency failing to transform and transport. I used Bu Zhong Yi Qi Tang plus Sha Ren (Amomum Fruit), Xiang Fu (Cyperus Rhizome), and Wei Jiang (Roasted Ginger), which increased food intake. Then I used Liu Jun Zi Tang plus Xiong, Dang Gui, Bei Mu (Fritillaria Bulb), and Jie Geng (Platycodon Root), after which menstruation regulated itself.
Case 5: A woman in her thirties suddenly stopped eating, consuming only clear tea and fruits for over three years. I considered this to be Spleen qi depression. I used Gui Pi Tang plus Wu Zhu Yu (Evodia Fruit) for four doses, after which her diet returned to normal. If a person has Spleen and Kidney deficiency leading to anorexia, Si Shen Wan (Four Spirit Pill) should be used for treatment.
Case 6: A woman had not eaten for two years, consuming only clear tea and fruits. Her Liver and Spleen pulses were wiry and floating, feeling slight and obstructed upon pressure. I considered this to be Liver and Spleen qi depression. I used Liu Jun Zi Tang, Mu Xiang, and Wu Zhu Yu, which expelled much phlegm accumulation. Her appetite suddenly improved, though her body emaciated initially. After lying in bed for over a month, she continued taking Liu Jun Zi Tang-like formulas and recovered.
Cao Dou Kou San (Grass Cardamom Powder) treats women with blood-wind and cold qi attacking the Spleen and Stomach, causing retching and inability to accept food.
Cao Dou Kou (Grass Cardamom Seed, peeled), Bai Fu Ling (White Poria, peeled), Pi Pa Ye (Loquat Leaf, roasted), Ban Xia (Pinellia Tuber, washed seven times in boiling water, sliced, each 7.5 qian), Gao Liang Jiang (Galangal Rhizome), Bai Zhu (Atractylodes Macrocephala Rhizome, de-rhizome head), Suo Sha Ren (Black Cardamom Fruit), Gui Xin (Cinnamon Heart), Mu Xiang (Aucklandia Root), Qing Ju Pi (Green Tangerine Peel, de-albedo), Gan Cao (Licorice Root, roasted, each half liang), Ren Shen (Ginseng Root, de-rhizome head, 1 liang).
All ingredients are coarsely crushed. Take 5 qian per dose, with 1.5 zhans of water and 7 slices of fresh ginger. Decoct until 1 zhan remains, strain, and take warm. No specific time restriction.
He Li Le San (Persimmon Calyx Powder) treats women with blood-wind and qi attacking the Spleen and Stomach, causing abdominal and hypochondriac oppression, painful heaviness in the four limbs, occasional phlegm-regurgitation, and inability to eat.
He Li Le Pi (Persimmon Calyx Skin), Chen Ju Pi (Aged Tangerine Peel, each 1 liang, de-albedo), Ban Xia (Pinellia Tuber, washed seven times in boiling water, sliced), Ren Shen (Ginseng Root, de-rhizome head), Gui Xin (Cinnamon Heart), Bai Zhu (Atractylodes Macrocephala Rhizome, de-rhizome head), Xi Xin (Asarum Root, de-seeds and soil), Dang Gui (Angelica Sinensis Root, stir-fried, de-rhizome head), Gan Cao (Licorice Root, roasted, each half liang), Huo Xiang (Patchouli Herb), Chi Fu Ling (Red Poria, peeled), Xiong (Chuanxiong Rhizome, each 7.5 qian).
Process as above. Decoct and administer as before.
Shen Qu Wan (Medicated Leaven Pill) treats women with blood-wind and qi attacking the Spleen and Stomach, causing abdominal and hypochondriac fullness and loss of appetite.
Shen Qu (Medicated Leaven), Bai Zhu (Atractylodes Macrocephala Rhizome, de-rhizome head), Fu Zi (Aconite Lateral Root, processed, de-skin and navel), Zhi Shi (Immature Bitter Orange, bran-fried, de-pulp), He Li Le Pi (Persimmon Calyx Skin), Gui Xin (Cinnamon Heart), Shi Zhu Yu (Zanthoxylum Fruit), Mu Xiang (Aucklandia Root), Chen Ju Pi (Aged Tangerine Peel, de-albedo), Ren Shen (Ginseng Root, de-rhizome head, each 1 liang), Jie Geng (Platycodon Root, de-rhizome head), Gan Jiang (Dried Ginger, processed, each half liang).
Grind into fine powder. Mix with paste made from flour boiled in wine to form pills the size of Sophora seeds. Take 30 pills per dose, on an empty stomach before meals, with ginger soup. Administer twice daily.
Jin Shi San (Advance Food Powder) Li Qian stated: Treats Spleen and Stomach deficiency-cold, loss of appetite, and long-term patients with Spleen and Stomach deficiency who cannot eat at all. Only two doses are needed to restore appetite. (Chen Yun: This formula contains Chuan Wu Tou; treating blood-wind attacking the Spleen causing anorexia, surely it has good efficacy.)
Qing Pi (Green Tangerine Peel), Chen Pi (Aged Tangerine Peel), Fen Cao (Licorice Root), Gui Xin (Cinnamon Heart), Liang Jiang (Galangal Rhizome, each 2.5 qian), Chuan Wu Tou (Aconitum Carmichaelii Lateral Root, processed, de-skin and tip), Cao Dou Kou Ren (Grass Cardamom Seed Kernel, each 3 pieces), He Zi (Chebula Fruit, de-pit, 5 pieces).
Grind into fine powder. Take 1 qian per dose, with 1 zhan of water and 3 slices of fresh ginger. Decoct until 0.7 zhan remains, and take warm.