经云。人之善饥而不嗜食者。精气并于脾。热气留于胃。胃热则消谷。故善饥。胃气逆上。则
胃脘寒。故不嗜食也。东垣云。太阴所谓恶闻食臭。胃无气。故恶食臭也。胃中元气虚。则能食而
不伤。过时而不饥。脾胃俱旺。则能食而肥。脾胃俱虚。则不能食而瘦。故不能食。皆作虚
论。若伤食恶食。自有本门。不在此例。病患脉缓。怠惰。四肢重着。或大便泄泻不食。此湿胜
也。胃苓汤。病患脉弦。气弱自汗。四肢发热。或大便泄泻不食。皮毛枯槁发脱。黄 建中汤加
减。病患脉滑。气口盛于人迎。或涩滞不调。其人痞满。呕逆不食。此有宿食。保和丸、枳术丸
消导之。病患脉虚气弱。脾胃不和。或兼恶心不食。六君子、枳实理中选用。有痰。用导痰汤。
虚而有痰。用人参四两。半夏一两。姜汁浸一宿。晒为末。面糊丸。食后生姜汤下。
许学士云。有人全不进食。服补脾药皆不效。授以二神丸服之。顿能进食。五更肾泻尤宜。
此病不可全作脾气治。盖肾气怯弱。真元衰削。是以不能消化饮食。譬之釜底无薪。水谷不能腐化也。
恶食 恶食有虚实之分。实则心下闷痛。恶心口苦。二陈加黄连、枳、术。虚则倦怠。色痿
黄。心下软。异功散加砂仁、木香。有痰恶心。六君子加香、砂。
饥不能食 此证有二。一属胃中虚热。六君子加姜汁炒川连。一属阴火乘胃。六味丸加赤桂、
五味。又热病后
余热未尽。脉虚洪不实者。人参白虎汤。
石顽曰。胃主出纳。脾司运化。故不食皆为中土受病。然胃之土。体阳而用阴。脾之土。体
阴而用阳。胃实则痞满气胀。胃虚则饮食不甘。胃热则饥不能食。胃寒则胀满不食。胃津不布。
则口淡无味。胃中火盛。则消渴易饥。有痰则恶心呕涎。脾虚则食后反饱。脾津不藏。则口甘畏
食。脾挟肝热。则吞酸吐酸。此皆中土受病也。至于肾脏阳虚。不能腐熟水谷。又当归重于命门。
火为土母故也。
喻嘉言治一人。病后胃中隐隐作痛。有时得食则已。有时得食转加。大便甚难。小水不畅。
盖因脾中津液。为邪火所烁。津液未充。火势内蕴。易于上燎。所以得食以压其火则安。若食饮
稍过。则气不能转运其食。而痛亦增。是火不除。则气不复。气不复。则胃中清浊混乱。不肯下
行。而痛终不免也。于是为订降火生津。下气止痛方。为常用之药。务先收摄肾气不使外出。然
后浊气之源清。而膀胱得吸引。上中二焦之气以下行矣。
石顽治孝廉徐俟斋尊阃。不得寐。不能食。心神恍惚。四肢微寒。手心热汗。至晚则喉间热
结有痰。两耳时如充塞。遍服安神清火药罔效。邀石顽诊之。六脉萦萦如蜘蛛丝。而微显弦数之
象。此中气久郁不舒。虚火上炎之候也。
盖缘俟斋索居涧上。自鼎革三十年来。茧足杜门。 粥不继。乃阃克相夫志。力竭神劳所致。
本当用归脾汤以补心脾之虚。奈素有虚痰阴火。不胜 、圆之滞。木香之燥。遂以五味异功。略
加归、芍。肉桂以和其阴。导其火。不数服而食进寝宁。诸证释然矣。
《黄帝内经》说：人容易感到饥饿但不想吃东西，是因为精气汇聚于脾，热气停留于胃。胃中有热则消化食物快，所以容易感到饥饿；胃气上逆，导致胃脘部寒冷，所以不想吃东西。李东垣说：太阴病所说的厌恶闻到食物的气味，是因为胃中无气，所以厌恶食物的气味。胃中元气虚弱，虽然能吃但不会受伤，过了饭点也不会觉得饿；脾胃都旺盛，就能吃东西且身体肥胖；脾胃都虚弱，就不能吃东西且身体消瘦。因此，“不能食”的症状，都当作虚证来论治。如果是伤食导致的恶食，自有专门的章节论述，不在此例。
如果病人脉象缓弱，精神倦怠懒惰，四肢沉重，或者大便泄泻、不想吃东西，这是湿邪偏胜所致。用胃苓汤治疗。
如果病人脉象弦细，气弱自汗，四肢发热，或者大便泄泻、不想吃东西，皮肤毛发干枯脱落，用黄芪建中汤加减治疗。
如果病人脉象滑利，寸口脉盛于人迎脉，或者脉涩滞不调，病人感觉心腹痞满，呕吐逆气、不想吃东西，这是有宿食停滞。用保和丸、枳术丸来消食导滞。
如果病人脉虚气弱，脾胃不和，或者兼有恶心、不想吃东西，选用六君子汤或枳实理中汤。如果有痰，用导痰汤。如果是虚证兼有痰，用人参四两，半夏一两，用姜汁浸泡一夜，晒干研为细末，用面糊做成丸药，饭后用生姜汤送服。
许叔微说：有人完全不吃东西，服用补脾的药都没有效果。后来给他服用二神丸，立刻就能进食了。这种病症尤其适合五更肾泻的情况。这个病不能完全当作脾气虚来治疗，因为肾气怯弱，真元衰败削减，所以不能消化饮食。这就好比锅底下没有柴火，水和谷物就无法腐熟化生一样。
恶食（厌恶进食）有虚实之分。实证表现为心下闷痛，恶心口苦，用二陈汤加黄连、枳壳、白术。虚证表现为倦怠，面色萎黄，心下柔软，用异功散加砂仁、木香。如果有痰且恶心，用六君子汤加木香、砂仁。
饥不能食（感到饥饿却不能吃）这个证候有两种情况。一种属于胃中虚热，用六君子汤加姜汁炒黄连。一种属于阴火乘袭胃部，用六味地黄丸加肉桂、五味子。另外，热病之后余热未尽，脉象虚大而按之不实者，用人参白虎汤。
周石顽说：胃主管受纳和排泄，脾主管运化和转化，所以不吃东西都是中焦脾胃出了毛病。然而，胃的土性，体阳而用阴；脾的土性，体阴而用阳。胃实则出现痞满气胀，胃虚则饮食不甘美味，胃热则感到饥饿却吃不下东西，胃寒则胀满不想吃东西，胃津液不能布散则口淡无味，胃中火盛则消渴易饥，有痰则恶心呕吐涎沫，脾虚则吃完饭后反而饱胀，脾津液不能固藏则口甘畏食，脾夹杂肝热则吞酸吐酸。这些都是中焦脾胃受病的表现。至于肾脏阳虚，不能腐熟水谷，又因为命门之火是脾土之母的缘故。
喻嘉言治疗一个人，病后胃中隐隐作痛，有时吃了东西疼痛就停止，有时吃了东西疼痛反而加重，大便非常困难，小便不畅。这是因为脾中的津液被邪火灼烧，津液尚未恢复充盈，火势内蕴，容易向上燎灼。所以吃东西能压制住火势则安适，如果饮食稍微过量，气就不能转运食物，疼痛也会增加。如果不消除火邪，气就不能恢复；气不恢复，胃中清浊之气就会混乱，不肯下行，那么疼痛终究不可避免。于是为他制定降火生津、下气止痛的方子，作为常用药物。务必先收敛肾气，不让其外泄，然后浊气的源头才能清净，膀胱得到吸引，上焦和中焦的气机才能下行。
周石顽治疗孝廉徐俟斋的夫人，失眠，不能进食，心神恍惚，四肢微微发冷，手心发热出汗，到了晚上喉间热结有痰，两只耳朵时常像堵塞了一样。遍服安神清火的药都没有效果。邀请周石顽诊治，六脉细微如蜘蛛丝，且微显弦数之象。这是中气长久郁结不舒展，虚火上炎的征候。
大概因为徐俟斋独居山涧之上，自从朝代更替三十年来，足不出户，连粥都接济不上，是他的妻子辅助丈夫志向，心力交瘁、神思劳累所致。本来应该用归脾汤来补益心脾之虚，无奈她素有虚痰和阴火，承受不了附子、肉桂等丸药的滋腻阻滞，也承受不了木香的燥烈。于是用五味异功散，略微加入当归、白芍，以及肉桂来调和她的阴血，引导虚火。没吃几服药，食欲增进，睡眠安宁，各种症状都消除了。
The *Yellow Emperor's Inner Classic* states: When a person feels hungry easily but has no desire to eat, it is because the essence and qi (vital energy) gather in the Spleen, and heat qi lingers in the Stomach. Heat in the Stomach accelerates the digestion of food, hence the feeling of hunger; when Stomach Qi rebels upward, it causes coldness in the epigastrium, hence the lack of appetite. Li Dongyuan stated: In Taiyin disease, the aversion to the smell of food occurs because there is no Qi in the Stomach, leading to an aversion to food odors. If the primordial Qi in the Stomach is deficient, one may eat without injury and not feel hungry past meal times; if both the Spleen and Stomach are robust, one can eat and become fat; if both the Spleen and Stomach are deficient, one cannot eat and becomes thin. Therefore, "inability to eat" is generally treated as a deficiency syndrome. Cases of aversion to food due to food stagnation have their own dedicated sections and are not included here.
If the patient presents with a slow pulse, lethargy, heavy limbs, or diarrhea with anorexia, this indicates excess Dampness. Treat with Weiling Tang (Gastrodia and Atractylodes Macrocephala Decoction).
If the patient presents with a wiry pulse, weak Qi with spontaneous sweating, heat in the four limbs, or diarrhea with anorexia, dry skin and hair loss, treat with Huangqi Jianzhong Tang (Astragalus Decoction for Building the Middle) with modifications.
If the patient presents with a slippery pulse, where the Cun position is stronger than the Renying position, or a choppy and irregular pulse, accompanied by chest and abdominal fullness, vomiting, and anorexia, this indicates retained food. Use Baohe Wan (Preserve Harmony Pill) or Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) to digest and guide out stagnation.
If the patient presents with a deficient pulse and weak Qi, disharmony between the Spleen and Stomach, or nausea with anorexia, select Liujunzi Tang (Six Gentlemen Decoction) or Zhishi Lizhong Tang (Immature Bitter Orange and Zingiber Decoction for Warming the Middle). If Phlegm is present, use Daotan Tang (Expel Phlegm Decoction). For deficiency with Phlegm, use 4 liang of Renshen (Ginseng Radix), 1 liang of Banxia (Pinellia Rhizoma), soaked overnight in Jiangzhi (Zingiberis Recens Juice), dried, powdered, and formed into pills with wheat paste. Take with Shengjiang Tang (Fresh Ginger Decoction) after meals.
Xu Shuci stated: There was a case of a person who could not eat at all, and spleen-tonifying medicines were ineffective. After administering Ershen Wan (Two Venerables Pill), they could eat immediately. This condition is particularly suitable for "Five Watch Kidney Diarrhea." This disease should not be treated solely as Spleen Qi deficiency, because Kidney Qi is timid and the True Yuan (Primordial Essence) is depleted, rendering the body unable to digest food. It is like a pot without fire underneath; water and grains cannot be cooked and transformed.
Aversion to food (Eshi) has excess and deficiency patterns. Excess patterns manifest as oppression and pain in the epigastrium, nausea, and bitter taste in the mouth; treat with Erchen Tang (Two Aged Substances Decoction) plus Huanglian (Coptidis Rhizoma), Zhike (Aurantii Fructus Immaturus), and Baizhu (Atractylodis Macrocephalae Rhizoma). Deficiency patterns manifest as fatigue and sallow complexion, with a soft epigastrium; treat with Yigong San (Yi Gong Powder) plus Sharen (Amomi Fructus) and Muxiang (Aucklandiae Radix). If Phlegm causes nausea, use Liujunzi Tang plus Muxiang and Sharen.
Hunger with inability to eat (Ji buneng shi) has two subtypes. One belongs to Empty Heat in the Stomach; treat with Liujunzi Tang plus Chuanlian (Coptidis Rhizoma) stir-fried with ginger juice. The other belongs to Yin Fire attacking the Stomach; treat with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Rougui (Cinnamomi Cortex) and Wuweizi (Schisandrae Fructus). Additionally, in cases where residual heat remains after a febrile disease and the pulse is deficient, large, and empty upon pressure, use Renshen Baihu Tang (Ginseng White Tiger Decoction).
Zhou Shiwang stated: The Stomach governs reception and discharge, while the Spleen governs transportation and transformation. Thus, anorexia always indicates pathology in the Middle Jiao (Earth element). However, the Earth of the Stomach has a Yang substance and Yin function, whereas the Earth of the Spleen has a Yin substance and Yang function. Fullness of the Stomach leads to distension and Qi stagnation; deficiency of the Stomach leads to food lacking flavor; Heat in the Stomach causes hunger but inability to eat; Cold in the Stomach causes distension and anorexia; failure of Stomach fluids to distribute results in a bland taste; excessive Fire in the Stomach causes thirst and easy hunger; Phlegm causes nausea and vomiting of saliva; Spleen deficiency causes postprandial fullness; failure of Spleen fluids to store results in a sweet taste and aversion to food; Liver Heat invading the Spleen causes acid regurgitation. These are all pathologies of the Middle Jiao. Regarding Kidney Yang deficiency, which fails to cook and transform food, this is because the Fire of the Mingmen (Gate of Life) is the mother of Earth.
Yu Jiayan treated a patient who, after illness, experienced dull pain in the Stomach. Sometimes eating relieved the pain, sometimes it worsened. Bowel movements were very difficult, and urination was obstructed. This was because the fluids of the Spleen were scorched by pathogenic Fire, and since the fluids were not yet replenished, the internal Fire tended to flare upward. Thus, eating suppressed the Fire and brought relief; however, if food intake was slightly excessive, Qi could not transport the food, and pain increased. If Fire is not eliminated, Qi does not recover; if Qi does not recover, Clear and Turbid Qi in the Stomach become chaotic and refuse to descend, so pain persists. He prescribed a formula to clear Fire, generate fluids, direct Qi downward, and relieve pain, using common herbs. Crucially, he first consolidated Kidney Qi to prevent its leakage, thereby clearing the source of Turbid Qi, allowing the Bladder to attract it, and enabling the Qi of the Upper and Middle Jiao to descend.
Zhou Shiwang treated the wife of Xiaolian Xu Sizhai, who suffered from insomnia, anorexia, mental restlessness, slight coldness in the four limbs, hot palms with sweating, evening phlegm accumulation in the throat, and a sensation of blockage in both ears. All sedative and cooling medicines failed. Upon examination by Zhou Shiwang, the six pulses were minute like spider silk, showing a wiry and rapid quality. This indicated long-standing depression of Middle Qi and rising of Deficient Fire.
It seems that Xu Sizhai lived secluded by a stream for thirty years since the dynastic change, rarely leaving his home, with insufficient food supplies. His wife’s dedication to supporting her husband led to exhaustion of Qi and spirit. Originally, Guipi Tang (Restore the Spleen Decoction) should have been used to tonify Heart and Spleen deficiency. However, she had pre-existing Deficient Phlegm and Yin Fire, and could not tolerate the cloying nature of pills containing Fuzi (Aconiti Lateralis Radix Praeparata) and Rougui (Cinnamomi Cortex), nor the drying nature of Muxiang (Aucklandiae Radix). Therefore, Wuwei Yigong San (Five-Flavor Yi Gong Powder) was used, slightly modified with Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix Alba), and Rougui (Cinnamomi Cortex) to harmonize Yin and guide Fire. After a few doses, appetite improved, sleep normalized, and symptoms resolved.