凡饮食伤脾之证，有寒伤，有热伤，有暂病，有久病，有虚证，有实证。但热者、暂者
、实者，人皆易知，而寒者、久者、虚者，人多不识。如今人以生冷瓜果致伤胃气，而为泻
、为痢、为痛之类者，人犹以为火证，而治以寒凉者，是不识寒证也。有偶因停滞而为胀，
为痛者，人皆知其实也，然脾胃强壮者，即滞亦易化，惟其不能化者，则最有中虚之证。故
或以不食亦知饥，少食即作胀；或以无饥无饱，全然不思饮食；或以胃虚兼呕而腹满膨膨；
或以火不生土而时食时吐；或中气不化，则胸喉若有所哽，而本非饮食之滞者；或因病致伤
胃气，则久不思食，而本非中满之病者。且胃病于暂者多实，脾病于久者多虚。时医于此，
无论邪正久暂，鲜有不用开胃消导等剂，是不知虚证也。盖脾胃之职，原以化食为能，今既
不能化食，乃其所能者病，而尚可专意克伐以害其能乎？且凡欲治病，必须先藉胃气以为行
药之主，若胃气实者，攻之则去，而疾常易愈，此以胃气强而药力易行也。胃气虚者，攻亦
不去，此非药不去病也，以胃虚本弱，攻之则益弱，而药力愈不能行也。若久攻之，非惟药
不能行，必致元气愈伤，病必愈甚，尽去其能，必于死矣。矧体质贵贱尤有不同，凡藜藿壮
夫及新暴之病，自宜消伐，惟速去为善，若以弱质弱病，而罔顾虚实，概施欲速攻治之法，
则无不危矣。
一、伤食者必恶食。
一、素喜冷食者，内必多热，素喜热食者，内必多寒，故内寒者不喜寒，内热者不喜热
。然热者嗜寒，多生中寒，寒者嗜热，多生内热，此《内经》所谓久而增气，物化之常也；
气增而久，夭之由也。故凡治病养生者，又当于素禀中察其嗜好偏胜之弊。
一、饮食致病，凡伤于热者，多为火证，而停滞者少；伤于寒者，多为停滞，而全非火
证。大都饮食之伤，必因寒物者居多，而温平者次之，热者又次之。故治此者，不可不察其
所因。
一、偶病之人，多有非食而疑食者，曰∶某日曾食某物或某肉某面，其日即病。医者不
论虚实，但闻此言，且见胃口不开，必先治食。夫未病之人，谁有不食？岂必预为停食而待
病至者，斯可信其无食乎？及其病也，则或因劳倦，或因风寒，或因七情，病发不测，而且
无胀无滞，与食何干？药不对病，而妄行剥削，必反增病，此斯道中之莫须有也。由此推之
，则凡无据无证而妄指胡猜者，皆其类也，良可慨矣。
凡是饮食损伤脾胃的证候，有因寒邪所伤，有因热邪所伤，有急性发病，有慢性久病，有虚证，有实证。但是，属于热性、急性、实性的病证，人们都容易知晓；而属于寒性、慢性、虚性的病证，许多人却不认识。如今有些人因为食用生冷瓜果导致胃气受损，出现腹泻、痢疾、腹痛等症状，人们却还以为是火证（火热之邪为患），用寒凉药物治疗，这是不认识寒证的表现。有的人偶然因为食物停滞而出现腹胀、腹痛，人们都知道这是实证，然而脾胃功能强壮的人，即使有食滞也很容易消化；只有那些不能消化的情况，才最有可能是中焦虚损的证候。所以有的表现为虽然不吃东西也知道饿，但稍微吃一点就感到腹胀；有的表现为既不觉得饿也不觉得饱，完全不想吃东西；有的因为胃虚兼有呕吐，导致腹部胀满膨隆；有的因为命门火衰不能温煦脾土（火不生土），导致时而进食、时而呕吐；有的因为中气运化无力，感觉胸喉间好像有什么哽塞，但这本不是饮食停滞造成的；有的因为其他疾病导致胃气受伤，长期不想进食，但这本不是中焦痞满的病证。而且胃病在急性期多属实证，脾病在慢性期多属虚证。当时的医生对此，无论病因是邪气还是正气，无论病程长短，很少有不使用开胃消导等药物的，这是不知道虚证的表现。大概脾胃的功能，原本是以消化食物为能事，现在既然不能消化食物，那就是其“能”的功能发生了病变，怎么还可以专门使用攻伐药物来损害它的功能呢？况且大凡想要治病，必须先借助胃气作为推动药物运行的主导力量，如果胃气充实，攻逐邪气则邪气易去，疾病常常容易痊愈，这是因为胃气强盛而药力容易运行。如果胃气虚弱，攻逐邪气则邪气不去，这不是因为药物不能去除病邪，而是因为胃气本身虚弱，攻伐之后会更加虚弱，导致药力更加无法运行。如果长期攻伐，不仅药物无法发挥作用，必定会导致元气进一步受损，疾病必然加重，彻底丧失其功能，最终导致死亡。何况人的体质贵贱（强弱）尤其不同，凡是吃粗茶淡饭的壮汉以及新近突发的疾病，自然适宜使用消伐之法，以迅速祛除病邪为好；如果是体质虚弱且患病日久的人，如果不顾虚实情况，一概施用急于求成的攻治方法，那么没有不危险的。
一、伤食的人一定厌恶食物。
一、平时喜欢冷食的人，体内必然多有热邪；平时喜欢热食的人，体内必然多有寒邪，所以体内有寒的人不喜欢寒冷，体内有热的人不喜欢温热。然而，喜冷食者嗜寒，多会生成中焦寒证；喜热食者嗜热，多会生成内热证，这就是《内经》所说的“久而增气，物化之常也”；气偏盛时间久了，就是折寿的原因。所以大凡治病养生的人，应当在平素的禀赋中观察其嗜好偏胜的弊端。
一、饮食致病，凡是伤于热邪的，多表现为火证，而食物停滞的情况较少；伤于寒邪的，多表现为食物停滞，而完全不是火证。大抵饮食所伤，大多是因为寒凉之物居多，温和平性之物次之，热性之物又次之。所以治疗这种情况的人，不可不考察其致病原因。
一、偶尔生病的人，有很多并不是因为饮食不当却怀疑是饮食所致，说：“某一天吃了某种食物或某肉某面，当天就生病了。”医生不论虚实，只要听到这话，并且看到胃口不开，就一定先治疗食积。其实没生病的人，谁有不吃饭的？难道一定是预先停食等待疾病到来吗？这怎么能相信是没有食积呢？等到生病时，可能是因为劳累疲倦，可能是因为风寒外袭，可能是因为七情内伤，疾病发作出乎意料，而且没有腹胀和停滞感，这与饮食有什么关系？药物不对症，却胡乱进行攻伐剥削，必定反而增加病情，这是医道中的莫须有（无中生有）的现象。由此推论，那么凡是没有任何依据和证据却胡乱指责猜测的，都属于这一类，实在令人感慨。
Regarding syndromes where diet injures the Spleen and Stomach, there are those caused by Cold injury, Heat injury, acute onset, chronic duration, deficiency syndromes, and excess syndromes. However, while Heat, acute, and excess conditions are easily understood by people, Cold, chronic, and deficiency conditions are often unrecognized. Nowadays, when people injure their Stomach Qi by consuming raw or cold fruits and vegetables, resulting in diarrhea, dysentery, or pain, they are still often mistaken for Fire syndromes (syndromes caused by pathogenic fire) and treated with cold-natured medicines; this is a failure to recognize Cold syndromes. Some individuals experience abdominal distension or pain due to occasional food stagnation, which people generally know to be an excess condition. Yet, those with strong Spleen and Stomach functions can easily transform even stagnant food; only when transformation fails does it most likely indicate a Middle Jiao Deficiency syndrome. Thus, some present with hunger despite not eating, but abdominal distension after small amounts of intake; some have no sensation of hunger or fullness and completely lack appetite; some suffer from abdominal distension and bloating due to Stomach deficiency accompanied by vomiting; some experience intermittent eating and vomiting due to the Failure of Ministerial Fire to Warm Earth (Kidney Yang failing to warm the Spleen); some feel a sensation of obstruction in the chest and throat due to the inability of Middle Qi to transform, though this is not actually food stagnation; others lose their appetite for a long time due to other illnesses injuring Stomach Qi, which is not a disease of Middle Jiao fullness. Generally, Stomach diseases in acute phases are mostly excess, while Spleen diseases in chronic phases are mostly deficiency. Contemporary physicians, regardless of whether the cause is pathogenic or healthy qi, and regardless of duration, rarely refrain from using stomach-opening and digestion-promoting agents; this demonstrates a lack of understanding of deficiency syndromes. The function of the Spleen and Stomach is originally to digest food. Now that they cannot digest food, their functional capacity is diseased; how can one solely focus on attacking and depleting to further harm this capacity? Moreover, to treat any disease, one must first rely on Stomach Qi as the master driving the action of medicine. If Stomach Qi is solid, attacking will expel the pathogen, and the disease will often heal easily, because strong Stomach Qi facilitates the movement of medicinal power. If Stomach Qi is deficient, attacking will not expel the pathogen; this is not because the medicine cannot remove the disease, but because the weak Stomach Qi becomes weaker upon attack, making it impossible for the medicinal power to move. Long-term attacking will not only fail to allow the medicine to work but will inevitably injure Yuan Qi further, causing the disease to worsen, eventually destroying all function and leading to death. Furthermore, constitutions vary greatly. For robust laborers and newly sudden illnesses, eliminating and attacking methods are appropriate to quickly remove the pathogen. However, for those with weak constitutions and chronic illnesses, if one disregards deficiency and excess and indiscriminately applies rapid attacking treatments, danger is inevitable.
1. Those injured by food retention will necessarily dislike food.
1. Those who habitually prefer cold foods must have internal Heat; those who habitually prefer hot foods must have internal Cold. Therefore, those with internal Cold do not like cold, and those with internal Heat do not like heat. However, excessive preference for cold generates Middle Jiao Cold, and excessive preference for heat generates internal Heat. This is what the *Nei Jing* (Inner Canon) refers to as "long-term accumulation increases qi, which is the normal transformation of things"; prolonged increase of qi is the cause of premature death. Thus, those treating diseases and preserving health should observe the drawbacks of habitual preferences within one's innate constitution.
1. Diseases caused by diet: injuries from Heat mostly manifest as Fire syndromes with little food stagnation; injuries from Cold mostly manifest as food stagnation and are entirely non-Fire syndromes. Generally, dietary injuries are mostly due to cold-natured substances, followed by neutral/warm substances, and least by hot-natured substances. Therefore, treating such cases requires careful examination of the etiology.
1. People suffering from occasional illnesses often suspect food when it is not the cause, saying, "I ate such-and-such food/meat/noodles on such-and-such day, and got sick that same day." Physicians, regardless of deficiency or excess, hearing this and seeing poor appetite, will invariably treat for food retention. But who does not eat before getting sick? Must one retain food beforehand to await illness? How can one believe there is no food retention? When illness occurs, it may be due to fatigue, Wind-Cold invasion, or Seven Emotions, arising unpredictably, without abdominal distension or stagnation—what does this have to do with food? Medicines mismatched to the disease, blindly applied with attacking and depleting methods, will only exacerbate the illness. This is a form of fabrication in medical practice. By extension, any baseless speculation falls into this category, which is truly lamentable.