人赖脾胃为养生之本，则在乎健与不健耳。而健脾三方，如洁古之枳术丸，东垣之平胃
散及补中益气汤，俱当今之相传以为准绳者也。夫所谓平胃者，欲平治其不平也，此东垣为
胃强邪实者设，故其性味从辛、从燥、从苦，而能消、能散，惟有滞、有湿、有积者宜之。
今见方家，每以此为常服健脾之剂，动辄用之，而不察可否，其误甚矣。
一、洁古枳术丸，以白术为君，脾得其燥，所以能健，然佐以枳实，其味苦峻，有推墙
倒壁之功，此实寓攻于守之剂，惟脾气不清而滞胜者，正当用之，若脾气已虚，非所宜也，
今人不察，相传为补脾之药，而朝吞暮饵，或以小儿瘦弱而制令常服，则适足以伤其气助其
瘦耳，用宜酌也。
一、补中益气汤，乃东垣独得之心法。盖以脾胃属土，为水谷之海，凡五脏生成，惟此
是赖者，在赖其发生之气运而上行，故由胃达脾，由脾达肺，而生长万物，滋溉一身。即如
天地之土，其气皆然。凡春夏之土，能生能长者，以得阳气而上升，升则向生也。秋冬之土
，不生不长者，以得阴气而下降，降则向死也。今本方以升柴助生气，以参、 、归、术助
阳气，此东垣立方之意，诚尽善矣。第肺本象天，脾本象地，地天既交，所以成泰。然不知
泰之前犹有临，临之前犹有复，此实三阳之元始，故余再制补阴益气煎，正所以助临复之气
，庶乎得根本之道，而足补东垣之未尽也。又补中益气汤之用，原为补中扶阳而设，然补阳
之义，则亦有宜否之辨，用者不可不知。如东垣用此以治劳倦内伤发热等证，虽曰为助阳也
，非发汗也，然实有不散而散之意，故于劳倦感寒，或阳虚咳疟，及脾气下陷等证，则
最所宜也。若全无表邪寒热，而但有中气亏甚者，则升柴之类大非所宜。何也？盖升柴之味
皆兼苦寒，升柴之性皆专疏散，虽曰升麻入脾胃，柴胡入肝胆，能引清气上升，然惟有邪者
，固可因升而散之，使或无邪，能不因散而愈耗其中气乎。即曰此汤以补剂为主，而惟藉升
柴以引达清气，不知微虚者犹可出入，大虚者必难假借，当此之时，即纯用培补犹恐不及，
而再兼疏泄，安望成功？且凡属补阳之剂，无不能升，正以阳主升也，用其升而不用其散，
斯得补阳之大法，此中自有玄机，又奚必升柴之是赖乎。故寇宗 极言五劳七伤之大忌柴胡
者，是诚绝类之真见，而李时珍复又非之，余亦何容再辨哉。然理有一定，孰能越之？兹余
单揭其要，曰∶能散者断不能聚，能泄者断不能补，而性味之苦寒者，亦断非扶阳之物。只
此便是断按，而纷纷之议，或可判矣。
故于诸证之中，凡其不宜用此者，则有不可不察。如表不固而汗不敛者，不可用。外无
表邪而阴虚发热者，不可用。阳气无根而格阳戴阳者，不可用。脾肺虚甚而气促似喘者，不
可用。命门火衰而虚寒泄泻者，不可用。水亏火亢而吐血衄血者，不可用。四肢厥逆而阳虚
欲脱者，不可用。总之，元气虚极者，毫不可泄，阴阳下竭者，毫不可升，真火亏败者，毫
不可用清凉。今人但知补中益气汤可以补虚，一概尚之，而不知病当紧急，则此时几微关系
，判于一举指之间，而纤微不可紊误者，正此类也，余亦安能以笔尽哉。
人依赖脾胃作为养生的根本，关键在于脾胃是否健康。而健脾的三方剂，如张洁古的枳术丸、李东垣的平胃散以及补中益气汤，都是当今世人相传奉为准则的方子。所谓“平胃”，意思是使不平（失调）的胃恢复平衡，这是李东垣针对胃气强盛、邪气实盛的病证设立的，所以它的药性属于辛、燥、苦，能够消导、发散，只有对于有积滞、有湿邪、有食积的患者才适宜。如今见到许多医生，常把这当作日常服用的健脾药剂，动辄使用，而不考察是否对症，这种错误太严重了。
一、张洁古的枳术丸，以白术为君药，脾得到白术的燥性，所以能健运，然而佐以枳实，其味道苦而峻烈，有推倒墙壁般的破气作用，这实际上是一个寓攻于守的方剂，只适用于脾气不清爽而积滞胜出的情况，正当使用；如果脾气已经虚弱，就不适宜使用了。如今人们不考察这一点，相传它是补脾的药，早晚吞服，或者因为小儿瘦弱就规定他们常服，这反而足以损伤他们的正气，助长他们的消瘦罢了，用药应当斟酌。
一、补中益气汤，是李东垣独得的心法。大概因为脾胃属土，是水谷之海，五脏六腑的生成，都依赖于此，这里依赖的是它生发之气向上运行，所以由胃达脾，由脾达肺，从而生长万物，滋润全身。就像天地的土壤一样，其气机也是如此。凡是春夏季的土壤，能生能长，是因为得到了阳气而上升，上升则趋向于生发。秋冬季的土地，不生不长，是因为得到了阴气而下降，下降则趋向于衰亡。现在的本方用升麻、柴胡辅助生气，用人参、[黄芪]、当归、白术辅助阳气，这是李东垣立方的用意，确实尽善尽美了。只是肺本来象天，脾本来象地，天地相交，所以形成泰卦（通泰）。然而不知道在泰卦之前还有临卦，在临卦之前还有复卦，这实际上是三阳之气的元始，所以我再制定补阴益气煎，正是为了辅助临、复的气机，希望能得到根本之道，从而补充李东垣未尽之处。另外，补中益气汤的使用，原本是为了补中扶阳而设，然而补阳的意义，也有适宜与否的区别，使用者不可不知。比如李东垣用此方治疗劳倦内伤发热等证候，虽然说是助阳，并非发汗，但实际上有不散而散的意思，所以对于劳倦感寒，或阳虚咳嗽疟疾，及脾气下陷等证候，是最适宜的。如果完全没有表邪寒热，而只有中气极度亏虚的，那么升麻、柴胡之类就非常不适宜了。为什么呢？因为升麻、柴胡的味道都兼有苦寒，升麻、柴胡的性质都专门用于疏散，虽然说升麻入脾胃经，柴胡入肝胆经，能引导清气上升，然而只有有邪气的情况下，固然可以借着升提而发散它，如果没有邪气，能不因为发散而更加耗损其中气吗？即使说这个汤剂以补剂为主，而只是借助升麻、柴胡来引导到达清气，不知道轻微虚弱的还可以出入调节，极度虚弱的必然难以假借，在这个时候，即使纯用培补恐怕还来不及，如果再兼用疏泄，怎么指望成功呢？而且凡是属于补阳的药剂，没有不能升提的，正因为阳气主升，使用它的升提而不用它的发散，这才是补阳的大法，这其中自有玄机，又何必一定要依赖升麻、柴胡呢？所以寇宗奭极力言说五劳七伤的大忌是柴胡，这确实是绝妙的真知灼见，而李时珍又反驳他，我又何必再多辩解呢？然而道理有一定的定规，谁能超越它呢？现在我单独揭示其要点，说：能散发的绝对不能聚敛，能泄降的绝对不能补益，而性质味道苦寒的，也绝对不是扶助阳气的药物。只凭这一点就是断定的依据，那些纷纷的议论，或许可以判明了。
所以在各种证候之中，凡是不适宜使用此方的，有不可不考察清楚的。比如表卫不固而汗出不止的，不可用。外无表邪而阴虚发热的，不可用。阳气无根而格阳戴阳的，不可用。脾肺极度虚弱而气促似喘的，不可用。命门火衰而虚寒泄泻的，不可用。水亏火亢而吐血衄血的，不可用。四肢厥逆而阳虚欲脱的，不可用。总之，元气极度虚弱的，丝毫不可泄降，阴阳下部枯竭的，丝毫不可升提，真火亏败的，丝毫不可用清凉药。现在的人只知道补中益气汤可以补虚，一概崇尚它，却不知道病情紧急的时候，此时几微的关系，判断在一举手投足之间，而纤毫细微不可错乱的，正是这类情况，我又怎么能用笔完全表达出来呢。
Human health relies on the Spleen and Stomach as the foundation of nourishment, which depends entirely on whether they are strong or weak. Among the three formulas for strengthening the Spleen, such as Zhizhu Wan (Bitter Orange and Atractylodes Macrocephala Pill) by Zhang Jiegou, Pingwei San (Stomach-Pacifying Powder) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) by Li Dongyuan, all are currently passed down as standards. The term "Pingwei" (Stomach-Pacifying) implies restoring balance to an imbalanced state; this was formulated by Li Dongyuan for conditions of excess Stomach heat and pathogenic fullness. Therefore, its properties are pungent, dry, and bitter, capable of resolving stagnation and dispersing pathogens, making it suitable only for cases with stagnation, dampness, and accumulation. However, I observe that many physicians today treat this as a daily tonic for strengthening the Spleen, using it indiscriminately without examining suitability, which is a grave error.
First, Zhizhu Wan by Zhang Jiegou uses Baizhu (Atractylodis Macrocephalae Rhizoma) as the sovereign herb. The Spleen benefits from Baizhu's drying property, thus achieving strength. However, it is assisted by Zhishi (Immature Bitter Orange), which has a bitter and harsh nature, possessing the power to demolish walls (break qi stagnation). This is actually a formula that incorporates attack within defense, suitable only when Spleen qi is unclear and stagnation prevails. If Spleen qi is already deficient, it is inappropriate. Today, people fail to examine this, mistakenly believing it to be a Spleen-tonifying medicine, taking it morning and night, or prescribing it regularly for thin and weak children. This merely damages their qi and exacerbates their emaciation. Medication should be used with discretion.
Second, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is Li Dongyuan's unique insight. Since the Spleen and Stomach belong to Earth and serve as the sea of water and grain, the generation of the five Zang organs relies upon them. This reliance is on the ascending movement of generative qi, flowing from the Stomach to the Spleen, and from the Spleen to the Lungs, thereby nurturing all things and moistening the entire body. This mirrors the earth in heaven and earth: in spring and summer, earth generates and grows because it receives yang qi and ascends; ascent leads to life. In autumn and winter, earth does not generate or grow because it receives yin qi and descends; descent leads to death. The present formula uses Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) to assist generative qi, and Renshen (Ginseng Radix), Huangqi (Astragali Membranacei Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) to assist yang qi. This intention behind Li Dongyuan's prescription is indeed perfect. However, while the Lung corresponds to Heaven and the Spleen to Earth, and their interaction creates the hexagram Tai (Peace), one must understand that before Tai comes Lin (Approach), and before Lin comes Fu (Return). These represent the origin of the three yang qi. Therefore, I formulated Buyin Yiqi Jian (Decoction to Tonify Yin and Augment Qi) to assist the qi of Lin and Fu, hoping to grasp the root principle and supplement what Li Dongyuan left incomplete. Furthermore, the use of Buzhong Yiqi Tang was originally designed to tonify the middle and support yang. However, there is a distinction regarding the appropriateness of supporting yang, which users must know. For instance, Li Dongyuan used this to treat fever due to fatigue and internal injury. Although described as supporting yang rather than inducing sweating, it inherently contains a dispersing action. Thus, it is most suitable for cold contracted due to fatigue, cough or malaria due to yang deficiency, and sinking of Spleen qi. However, if there is no exterior pathogen or chills/fever, but only severe deficiency of Middle qi, then Shengma and Chaihu are highly inappropriate. Why? Because both Shengma and Chaihu possess bitter-cold flavors and specific dispersing natures. Although Shengma enters the Spleen and Stomach meridians and Chaihu enters the Liver and Gallbladder meridians, guiding clear qi upward, only when pathogens exist can they be dispersed via ascent. Without pathogens, will they not further deplete Middle qi through dispersion? Even if this decoction is primarily a tonic relying on Shengma and Chaihu to guide clear qi, slight deficiency may tolerate this, but severe deficiency cannot borrow from it. At such times, even pure tonification might be insufficient; adding dispersing herbs makes success unlikely. Moreover, all yang-tonifying agents have ascending properties because yang governs ascent. Using the ascending quality without the dispersing quality is the great method of tonifying yang, containing profound mysteries, so why rely solely on Shengma and Chaihu? Therefore, Kou Zongshi's strong warning against using Chaihu for the five labors and seven injuries is truly insightful, even though Li Shizhen refuted it. What need is there for me to argue further? Principles are fixed; who can transcend them? I hereby highlight the key point: what disperses cannot gather; what drains cannot tonify; and bitter-cold substances certainly do not support yang. This alone serves as definitive proof, allowing the chaotic debates to be settled.
Therefore, among various syndromes, those unsuitable for this formula must be carefully examined. It is contraindicated for insecure exterior with unconsolidated sweating. It is contraindicated for yin-deficiency fever without exterior pathogens. It is contraindicated for floating yang due to rootless yang (false heat signs like Daiyang). It is contraindicated for extreme Spleen-Lung deficiency with shortness of breath resembling asthma. It is contraindicated for deficiency-cold diarrhea due to Mingmen fire decline. It is contraindicated for hematemesis and epistaxis due to water deficiency and hyperactive fire. It is contraindicated for cold limbs and impending yang collapse due to yang deficiency. In summary, for extremely deficient yuan qi, nothing should be drained; for exhaustion of yin and yang below, nothing should be ascended; for failure of true fire, cooling agents must absolutely not be used. People today only know that Buzhong Yiqi Tang can tonify deficiency and universally revere it, unaware that in urgent conditions, critical distinctions are made in an instant, where minute errors are unacceptable. Such cases are precisely of this nature, and how could I possibly exhaustively describe them in writing?