人以水谷为本，故脾胃为养生之本，惟东垣独知其义，发为《脾胃论》曰∶历观《内经
》诸篇而参考之，则元气之充足，皆由脾胃之气无所伤，而后能滋养元气，若胃气之本弱，
饮食自倍，则脾胃之气既伤，而元气亦不能充，此诸病之所由生也。因引《内经》之义，如
《生气通天论》曰∶苍天之气，清净则志意治，顺之则阳气固，虽有贼邪，弗能害也。阳气
者，烦劳则张。故苍天之气贵清净，阳气恶烦劳，此病从脾胃生者一也。又引《五常政大论
》曰∶阴精所奉其人寿，阳精所降其人夭。阴精所奉，谓脾胃既和，谷气上升，春夏令行，
故其人寿。阳精所降，谓脾胃不和，谷气下流，收藏令行，故其人夭，此病从脾胃生者二也
。又引《六节藏象论》曰∶脾胃、大肠、小肠、三焦、膀胱者，仓廪之本，营之居也，此至
阴之类，通于土气。凡十一脏者，皆取决于胆也。夫胆者，少阳春生之气，春气生则万化安
，故胆气春升，则余脏从之，胆气不升，则餐泄肠 不一而起，此病从脾胃生者三也。
又引《本论》曰∶天食人以五气，地食人以五味，此之谓气者，上焦开发，宣五谷味，熏肤
，充身，泽毛，若雾露之溉，是谓气。气或乖错，人何以生？此病从脾胃生者四也。夫内伤
脾胃，乃伤其气，外感风寒，乃伤其形，伤其外为有余，有余者泻之；伤其内为不足，不足
者补之。内伤不足之病，苟误认作外感有余之病，而反泻之，则虚其虚也。实实虚虚，如此
死者，医杀之耳。然则奈何？惟当以辛甘温之剂补其中而升其阳，甘寒以泻其火则愈矣。经
曰∶劳者温之，损者温之。又曰∶温能除大热，大忌苦寒之药。诸如此论，皆东垣独得之见
也。
兹察其所谓苍天贵清净，阳气恶烦劳者，此指劳倦之为病也。所谓收藏令行，故其人夭
者，此指阴盛阳衰之为病也。所谓春气升则万物安者，此指降则无生之为病也。所谓气或乖
错，人何以生者，此指阳气受伤之为病也。东垣此言，其垂惠后世，开导末学之功，诚非小
矣。独怪其前论中又有矛盾之谈，如曰饮食失节，寒温不适，脾胃乃伤，此固喜、怒、忧、
恐损耗元气，资助心火，心不主令，相火代之，相火者，下焦包络之火，元气之贼也，火与
元气不两立，火胜则乘其土位，此所以为病。若此数语，则大见矛盾矣。第观其前四条，则
总虑阳气之受伤也，故曰大忌苦寒之药。此一节又云火胜之为病，更当何法以治之？且所云
喜、怒、忧、恐损伤元气，资助心火，火胜则乘其土位，此何说也？夫元气既损，多见生阳
日缩，神气日消，何以反助心火？脾胃属土，得火则生，何谓火胜则乘其土位？且人之元气，
本贵清和，寒固能病，热亦能病。然热伤元气，而因劳动火者，固常有之，此自不得不从清
补；若因劳犯寒，而寒伤脾胃者，尤酷尤甚，此可概言为火乎？第热证显而寒证隐，故热证
易见而寒证不之觉也；真热证犹易辨，而假热证尤不易辨也。矧元气属阳，火其类也，而热
为同气，邪犹可制；阴为阳贼，寒其仇也，而生机被伐，无不速亡，故经云少火生气，未闻
少寒生气也。又云避风如避箭，未闻避热如避箭也。由此观之，则何不曰寒与元气不两立，而
反云火与元气不两立乎？兹举火字特以为言，致令后生之妄言火者，反尽忘东垣前四条之格
言，而单执不两立之说，用为治火之成按，是东垣戒之而反以诲之，此其白璧之瑕，余实不
能不为东垣惜也。
及再考东垣之方，如补中益气汤，升阳益胃汤，黄 人参汤，清暑益气汤等方，每用升
柴，此即其培养春生之意，而每用芩连，亦即其制伏火邪之意，第以二三分之芩连，固未必
即败阳气，而以五七分之参术，果即能斡旋元气乎？用是思及仲景，见其立方之则，用味不
过三四品，用数每至二三两；且人之气血本大同，疾病多相类，而仲景之方大而简，东垣之
方小而杂，何其悬绝一至如此？此其中要必有至道存焉。宾以后学，固不敢直判其孰是孰非
，而私心向往，则不能不霄壤于其间也。一、脾胃三方，有论在前饮食门。
人以水谷为根本，所以脾胃是养生的根本，只有李东垣独自明白其中的义理，撰写了《脾胃论》说：遍观《内经》各篇并加以参考，那么元气的充足，都因为脾胃之气没有受到损伤，之后才能滋养元气，如果胃气本身虚弱，饮食过量一倍，那么脾胃之气既已受伤，而元气也不能充盈，这就是各种疾病产生的原因。于是引用《内经》的义理，如《生气通天论》说：上天的清气，清净则人的意志调顺，顺应它则阳气固密，虽然有贼邪，也不能伤害人。阳气，烦劳过度就会亢张。所以上天的清气可贵在于清净，阳气厌恶烦劳，这是病从脾胃产生的第一种情况。又引用《五常政大论》说：阴精奉养于上的人长寿，阳精降泄于下的人短命。阴精奉养，是说脾胃调和，谷气上升，春夏的令行得以施行，所以人长寿。阳精降泄，是说脾胃不和，谷气下流，收藏的令行得以施行，所以人短命，这是病从脾胃产生的第二种情况。又引用《六节藏象论》说：脾胃、大肠、小肠、三焦、膀胱，是仓廪的根本，营气居住的地方，这属于至阴的一类，通于土气。凡十一脏，都取决于胆。胆，是少阳春生之气，春气生发则万物安宁，所以胆气春升，则其余脏腑跟随它，胆气不升，则飧泄肠澼等病不一而起，这是病从脾胃产生的第三种情况。
又引用《本论》（注：此处指《素问·六节藏象论》或相关篇章，原文可能泛指）说：天给人五气，地给人五味，所说的“气”，是由上焦开发，宣发五谷的味道，熏蒸皮肤，充实身体，润泽毛发，像雾露灌溉一样，这就叫气。气如果乖错，人怎么能生存？这是病从脾胃产生的第四种情况。内伤脾胃，是损伤其气；外感风寒，是损伤其形。损伤外在表现为有余，有余就要泻之；损伤内在表现为不足，不足就要补之。内伤不足的病，如果错误地认作外感有余的病，反而用泻法，那就是使虚者更虚。实其实，虚其虚，像这样死去的，是医生杀死的。那么该怎么办呢？只应当用辛甘温的药剂补其中气而升举阳气，用甘寒的药来清泻火热就好了。经书说：劳损的用温法，亏损的用温法。又说：温能除大热，最忌讳苦寒的药物。诸如此类的论述，都是李东垣独到的见解。
现在考察他所说的上天可贵在于清净，阳气厌恶烦劳，这是指劳倦致病。所说的收藏令行，所以人短命，这是指阴盛阳衰致病。所说的春气升发则万物安宁，这是指气机下降无生机致病。所说的气如果乖错，人怎么能生存，这是指阳气受伤致病。李东垣的这些言论，他对后世垂惠，开导后学的功劳，确实不小。唯独奇怪的是他前面的论述中又有矛盾的说法，比如他说饮食失节，寒温不适，脾胃乃伤，这固然有喜、怒、忧、恐损耗元气，资助心火，心不主令，相火代之，相火，是下焦包络之火，是元气的贼害，火与元气不两立，火胜则乘袭土位，这就是生病的原因。如果这几句话，就大大见到矛盾了。只看他前四条，总担心阳气受伤，所以说最忌讳苦寒的药物。这一节又说火胜致病，又该用什么方法治疗？况且所说的喜、怒、忧、恐损伤元气，资助心火，火胜则乘袭土位，这是什么说法？既然元气已经受损，多见生阳日渐萎缩，神气日渐消减，怎么反而助长心火？脾胃属土，得火则生，为什么说火胜则乘袭土位？况且人的元气，本来可贵在于清和，寒固能致病，热也能致病。然而热伤元气，而因劳动导致火旺的，固然常有，这自然不得不从清补；如果是因劳累触犯寒冷，而寒冷损伤脾胃的，尤其严重，这可以一概说是火吗？只是热证明显而寒证隐蔽，所以热证容易看见而寒证不容易察觉；真热证还容易辨别，而假热证尤其不容易辨别。何况元气属阳，火也是同类，而热是同气，邪气还可以制约；阴是阳的贼害，寒是仇敌，而生机被砍伐，无不迅速死亡，所以经书说少火生气，没听说少寒生气。又说避风像避箭，没听说避热像避箭。由此看来，为什么不说是寒与元气不两立，反而说火与元气不两立呢？这里特别提出“火”字作为论点，致使后生妄言火的，反而完全忘记了李东垣前四条的格言，而单独执着于不两立的说法，用作治火的成规，这是李东垣告诫的反而用来教诲后人，这是白璧之瑕，我实在不能不为李东垣惋惜。
等到再考察李东垣的方剂，如补中益气汤，升阳益胃汤，黄芪人参汤，清暑益气汤等方子，每用升麻、柴胡，这就是他培养春生意旨的意思，而每用黄芩、黄连，也就是他制伏火邪的意思，只是用二三分的黄芩、黄连，固然未必就败坏阳气，而以五七分的参、术，果真就能斡旋元气吗？因此想到张仲景，看到他的立方法则，用药味不超过三四种，药量每至二三两；而且人的气血本来大同，疾病多相类似，而张仲景的方子大而简练，李东垣的方子小而繁杂，为什么悬殊到这种地步？这其中必定有至道存在。我作为后学，固然不敢直接判断谁是谁非，但私心向往，则不能不在其间有霄壤之别。一、脾胃三方，有论述在前面饮食门。
Humans rely on water and grain as their foundation; therefore, the Spleen and Stomach are the root of health preservation. Only Li Dongyuan alone comprehended this principle, expounding it in his *Pi Wei Lun* (Treatise on the Spleen and Stomach): "Examining various chapters of the *Nei Jing* (Inner Canon) and cross-referencing them, one finds that the sufficiency of Yuan Qi (Original Qi) depends entirely on the Qi of the Spleen and Stomach remaining unharmed, thereby nourishing Yuan Qi. If the fundamental Qi of the Stomach is weak, and food intake doubles, the Qi of the Spleen and Stomach will be injured, and Yuan Qi cannot be replenished. This is the origin of various diseases." He then cites principles from the *Nei Jing*. For instance, the *Sheng Qi Tong Tian Lun* (Treatise on the Unity of Life with Heaven) states: "The Qi of the clear Heaven, when pure and tranquil, governs the mind and will; adhering to it consolidates Yang Qi, so that even pathogenic evils cannot harm. Yang Qi, when subjected to excessive toil, becomes hyperactive. Thus, the clear Heaven values tranquility, and Yang Qi abhors excessive toil. This is the first way diseases arise from the Spleen and Stomach." He further cites the *Wu Chang Zheng Da Lun* (Great Treatise on the Five Regular Movements): "Those whose Yin Essence is offered upward live long; those whose Yang Essence descends die young. 'Yin Essence offered upward' means that when the Spleen and Stomach are harmonious, Grain Qi ascends, executing the functions of Spring and Summer, thus ensuring longevity. 'Yang Essence descending' means that when the Spleen and Stomach are disharmonious, Grain Qi flows downward, executing the functions of Storage and Collection, thus leading to premature death. This is the second way diseases arise from the Spleen and Stomach." He also cites the *Liu Jie Zang Xiang Lun* (Treatise on the Six Nodes and Viscera Manifestations): "The Spleen, Stomach, Large Intestine, Small Intestine, San Jiao (Triple Burner), and Bladder are the roots of the granary, the dwelling place of Ying Qi (Nutritive Qi). These belong to the category of Extreme Yin and connect with Earth Qi. All eleven Zang-Fu organs depend on the Gallbladder. The Gallbladder possesses the Qi of Shaoyang Spring generation; when Spring Qi generates, all transformations are peaceful. Thus, when Gallbladder Qi rises like Spring, the other organs follow; if Gallbladder Qi does not rise, symptoms such as undigested stool in diarrhea (Sun Xie) and bloody dysentery (Chang Pi) arise. This is the third way diseases arise from the Spleen and Stomach."
He further cites the *Ben Lun* (Basic Treatise): "Heaven feeds humans with Five Qi, and Earth feeds humans with Five Flavors. The 'Qi' referred to here is developed by the Upper Jiao (Upper Burner), which disseminates the flavors of five grains, steams the skin, fills the body, and moistens the hair, like mist and dew irrigating. This is called Qi. If Qi is disordered, how can life exist? This is the fourth way diseases arise from the Spleen and Stomach." Internal injury to the Spleen and Stomach damages Qi, whereas external contraction of Wind-Cold damages the Form. Damage to the exterior manifests as Excess (You Yu); Excess requires Purging (Xie). Damage to the interior manifests as Deficiency (Bu Zu); Deficiency requires Tonification (Bu). In diseases of internal injury and deficiency, if mistakenly diagnosed as external excess and treated with purging, it exacerbates the deficiency. To tonify the excess and purge the deficiency leads to death; such deaths are caused by the physician. So, what should be done? One must use Pungent-Sweet-Warm formulas to tonify the Middle and raise Yang, and Sweet-Cold formulas to clear Fire, and the condition will heal. The Classics state: "For exhaustion, use warmth; for loss, use warmth." It also states: "Warmth can eliminate great heat." Bitter-Cold medicines are strictly forbidden. Such arguments represent Li Dongyuan's unique insights.
Upon examining his statement that "Heaven values purity and clarity, and Yang Qi abhors excessive toil," this refers to illness caused by fatigue and overwork. His statement that "the function of Storage and Collection prevails, leading to early death" refers to illness caused by Yin Excess and Yang Deficiency. His statement that "when Spring Qi rises, all things are at peace" refers to illness caused by the failure of Qi to ascend, resulting in a lack of vitality. His statement that "if Qi is disordered, how can life exist" refers to illness caused by damage to Yang Qi. Li Dongyuan's words have indeed benefited future generations and guided scholars, a merit not to be underestimated. However, I am surprised by the contradictions in his earlier theories. For example, he says: "Irregular diet and inappropriate cold/heat injure the Spleen and Stomach. This inevitably involves Joy, Anger, Worry, and Fear depleting Yuan Qi and assisting Heart Fire. When the Heart fails to command, Ministerial Fire (Xiang Huo) takes over. Ministerial Fire is the fire of the Pericardium in the Lower Jiao, the thief of Yuan Qi. Fire and Yuan Qi cannot coexist; if Fire prevails, it attacks the Earth position, causing disease." These sentences reveal significant contradictions. Looking at his previous four points, he consistently worries about damage to Yang Qi, hence stating "strictly forbid bitter-cold medicines." Yet this section discusses illness caused by Fire prevalence. How should it be treated? Furthermore, he claims that Joy, Anger, Worry, and Fear deplete Yuan Qi and assist Heart Fire, and that Fire prevailing attacks the Earth position. What is the rationale? If Yuan Qi is damaged, one typically sees daily shrinkage of Sheng Yang (Generating Yang) and daily消 (decline) of Shen Qi (Spiritual Qi). How can this assist Heart Fire? The Spleen and Stomach belong to Earth; Earth is generated by Fire. Why say Fire prevailing attacks the Earth position? Moreover, human Yuan Qi values clarity and harmony. Cold certainly causes disease, but Heat also causes disease. While Heat damaging Yuan Qi due to labor-induced Fire is common, requiring Clear-Tonification, cases where labor induces Cold injuring the Spleen and Stomach are even more severe. Can these generally be attributed to Fire? Heat syndromes are obvious while Cold syndromes are hidden; thus Heat is easy to see and Cold is hard to perceive. True Heat is easier to distinguish than False Heat. Since Yuan Qi belongs to Yang, and Fire is its category, and Heat shares the same nature, pathogenic factors can be controlled. Yin is the thief of Yang, and Cold is its enemy; when vitality is destroyed, death follows swiftly. Thus, the Classics say "Lesser Fire generates Qi," but never "Lesser Cold generates Qi." We hear "Avoid wind as if avoiding arrows," but never "Avoid heat as if avoiding arrows." Therefore, why not say "Cold and Yuan Qi cannot coexist," but instead "Fire and Yuan Qi cannot coexist"? By emphasizing "Fire," he has inadvertently led later generations who rashly speak of Fire to forget his earlier maxims and solely adhere to the "non-coexistence" theory as a standard treatment for Fire. This is a flaw in an otherwise perfect jade, and I truly regret this for Li Dongyuan.
Re-examining Li Dongyuan's formulas, such as Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Sheng Yang Yi Wei Tang (Raise Yang and Benefit the Stomach Decoction), Huang Qi Ren Shen Tang (Astragalus and Ginseng Decoction), and Qing Shu Yi Qi Tang (Clear Summerheat and Augment Qi Decoction), he frequently uses Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix), reflecting his intent to cultivate the spirit of Spring generation. He frequently uses Huang Qin (Scutellariae Radix) and Lian Zi (Nelumbinis Semen, likely referring to Lian Zi or Lian Pei in context of clearing heat, though usually Huang Lian is paired with Huang Qin here, let's assume Huang Qin and Huang Lian based on text "Qin Lian"), reflecting his intent to subdue Fire pathogens. However, using only two or three fen of Huang Qin and Huang Lian hardly damages Yang Qi, whereas using five or seven qian of Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), can they truly regulate Yuan Qi? This leads me to consider Zhang Zhongjing. Observing his formula construction, he used no more than three or four herbs per formula, yet dosages reached two or three liang. Human Qi and Blood are fundamentally similar, and diseases are often comparable. Yet Zhang Zhongjing's formulas are grand and simple, while Li Dongyuan's are small and complex. Why is the disparity so extreme? There must be profound principles involved. As a junior scholar, I dare not directly judge right from wrong, but my private admiration creates a chasm between the two approaches. [Note: The text ends with a reference to previous discussions on Spleen/Stomach formulas.]