脾胃皆属土，脾为己土，胃为戊土，而脏腑分焉。脾为脏，胃为腑，凡脏主守，腑主通，脏阴而腑阳也。
经言胃为水谷之海，饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，脾主为胃
行其津液者也。故胃主纳，脾主运，胃喜凉，脾喜燥，昔人每多混治，惟叶氏医案，谓脾宜升则健，胃宜降则
和。太阴湿土，得阳始运；阳明阳土，得阴始安；以脾喜刚燥，胃喜柔润也。仲景急下存津，其治在胃；
东垣大升阳气，其治在脾。又言五脏以守为补，六腑以通为补，卓然有见。岫云华氏，称其议论越出千古，
其叙叶案曰∶《脾胃论》莫详于东垣，其补中益气、调中益气、升阳益胃诸汤，以劳倦内伤为主，故用
人参、黄 以补中，白术、苍术以温燥，升麻、柴胡升下陷之清阳，陈皮、木香理中宫之气滞，以太阴恶湿，
而病患胃阳衰者居多，用之得宜，效如桴鼓。若脾阳不亏，胃有燥火，则当用香岩养胃阴之法。凡病后热伤
肺胃津液，以致虚痞不食，舌绛嗌干，烦渴不寐，便不通爽，此九窍不和皆胃病，岂可以 、术、升、柴治乎。
故先生必用降胃之法，所谓胃宜降则和者，非辛开苦降，亦非苦寒下夺，以损胃气，不过甘平或甘凉濡润以养
胃阴，则津液来复，使之通降而已，此即宗《内经》六腑者传化物而不藏，以通为用之理也。故治胃阴虚，
不饥不纳，用清补，如麦冬、沙参、玉竹、杏仁、白芍、石斛、茯神、粳米、麻仁、扁豆子。治胃阳虚，食谷
不化，用通补，如人参、益智、陈皮、浓朴、乌药、茯苓、生术、地栗粉、半夏、韭子、生姜、黄米。治脾
阴虚，胸嘈便难，用甘润，如甘草、大麦仁、白芍、当归、杏仁、麻仁、红枣、白蜜。治脾阳虚，吞酸嗳腐，
用香燥，如砂仁、丁香、炒术、神曲、麦芽、干姜。如四君、六君、异功，凡守补皆脾药。
治脾胃阳虚，运纳俱少，食已欲泻，用升降法，如补中益气汤加茯苓、益智、木瓜，或益黄散。治湿伤脾胃，
用平胃散，或清暑益气汤加减。治中气虚，用补中益气汤加麦冬、五味子。治饥伤，痛而纳食稍安，病在脾络，
因伤饥饿而得，当甘缓以养脾营，当归建中汤。治食伤，伤食恶食，腹痛作饱，当分消胃土，用生益智、草果、
广皮、茯苓、鸡内金、炒楂肉、神曲、煨姜。病后调理脾元，参苓白术散，或六君子汤。其分治合治，于病情
尤为允惬者矣。
白术炒用则守，生用则和。甘草炒用则补，生用则泻火。上方分列脾胃，大抵脾脏以守为补，胃腑以通为
补，脾宜升运，胃宜通降也。其方治与饮食症参观，则备矣。
脾胃在五行中均归属于土，脾为己土（阴土），胃为戊土（阳土），由此区分脏腑。脾属于脏，胃属于腑，凡是脏的功能主于固守，腑的功能主于通降，脏属阴而腑属阳。
经典医籍记载，胃是受纳水谷的“海”，饮食进入胃中，其中的精微物质游溢出来，向上输送给脾；脾气将这些精微散布，上归于肺；通过肺的通调水道功能，向下输送到膀胱。脾的主要功能是替胃运行津液。因此，胃主受纳，脾主运化；胃性喜凉，脾性喜燥。古人治疗时常将二者混淆，只有叶天士（叶氏）在《临证指南医案》中指出：脾宜升发则功能强健，胃宜通降则气机调和。太阴湿土（脾），得到阳气的温煦才能运化；阳明阳土（胃），得到阴液的滋润才能安宁；这是因为脾喜欢刚燥，胃喜欢柔润的缘故。张仲景采用急下法以保存津液，其治疗重点在胃；李东垣主张大升阳气，其治疗重点在脾。又有说法认为五脏以固守为补益，六腑以通降为补益，见解卓越。岫云华氏称赞这种议论超越千古，他在叙述叶天士医案时说：《脾胃论》论述最详尽的是李东垣，他使用的补中益气汤、调中益气汤、升阳益胃汤等方剂，主要针对劳倦内伤，所以用人参、黄芪来补益中气，用白术、苍术来温燥健脾，用升麻、柴胡提升下陷的清阳之气，用陈皮、木香调理中焦的气滞。因为太阴脾恶湿，且病患中胃阳衰弱的居多，使用这些药物得当，疗效迅速如击鼓应声。如果脾阳不亏损，但胃中有燥火，则应当采用叶天士养胃阴的方法。凡是病后热邪损伤肺胃津液，导致虚痞胀满、不能进食，舌质红绛、咽喉干燥，心烦口渴、无法入睡，大便不通畅，这些都是九窍不和的表现，根源在于胃病，怎么能用白术、苍术、升麻、柴胡这类药物来治疗呢？所以叶先生必定使用降胃的方法，所谓“胃宜降则和”，并不是指辛开苦降，也不是苦寒攻下夺实，以免损伤胃气，不过是使用甘平或甘凉的濡润药物来滋养胃阴，使津液恢复，从而让胃气自然通降罢了，这正是遵循《内经》中“六腑者传化物而不藏，以通为用”的道理。因此，治疗胃阴虚，出现不知饥饿、不能受纳的情况，采用清补法，如麦冬、沙参、玉竹、杏仁、白芍、石斛、茯神、粳米、火麻仁、扁豆。治疗胃阳虚，吃食物不消化，采用通补法，如人参、益智仁、陈皮、厚朴、乌药、茯苓、生白术、荸荠粉、半夏、韭菜子、生姜、黄米。治疗脾阴虚，出现心中嘈杂、排便困难，采用甘润法，如甘草、大麦仁、白芍、当归、杏仁、火麻仁、红枣、白蜜。治疗脾阳虚，出现吞酸、嗳出腐臭气味，采用香燥法，如砂仁、丁香、炒白术、神曲、麦芽、干姜。像四君子汤、六君子汤、异功散，凡是固守补益的都是治脾的药物。
治疗脾胃阳虚，运化和受纳都很少，吃完就想泻肚，采用升降同调的方法，如补中益气汤加茯苓、益智仁、木瓜，或者益黄散。治疗湿气损伤脾胃，采用平胃散，或者清暑益气汤加减。治疗中气虚弱，采用补中益气汤加麦冬、五味子。治疗饥饿过度导致的损伤，疼痛时进食稍安，病位在脾络，因饥饿受损所致，应当用甘缓之法以滋养脾营，用当归建中汤。治疗饮食积滞损伤，厌恶食物，腹痛且有饱胀感，应当分消胃土之积，用生益智仁、草果、广陈皮、茯苓、鸡内金、炒山楂肉、神曲、煨姜。病后调理脾元，用参苓白术散，或者六君子汤。这种分治与合治相结合的方法，对于病情尤为恰当。
白术炒用则偏于固守，生用则偏于平和。甘草炒用则偏于补益，生用则偏于泻火。上述方剂分别列述脾胃的治疗，大体原则是脾脏以固守为补，胃腑以通降为补，脾宜升发运化，胃宜通降下行。将这些方治与饮食相关的病症参照观看，就完备了。
Spleen and Stomach both belong to Earth in the Five Elements. Spleen is Ji Earth (Yin Earth), and Stomach is Wu Earth (Yang Earth), thereby distinguishing Zang (solid organs) and Fu (hollow organs). Spleen belongs to Zang, Stomach belongs to Fu. Generally, Zang organs govern retention/stability, while Fu organs govern transmission/descending. Zang are Yin, and Fu are Yang.
The classics state that the Stomach is the "Sea of Water and Grain." When food and drink enter the Stomach, their essence floats and overflows, moving upward to be transported by the Spleen. The Spleen scatters these essences, sending them upward to return to the Lung. Through the Lung's regulation of water passages, fluids are transmitted downward to the Bladder. The Spleen's primary function is to distribute the fluids for the Stomach. Therefore, the Stomach governs reception, and the Spleen governs transformation/transportation. The Stomach prefers coolness, while the Spleen prefers dryness. In ancient times, treatments for the two were often confused. Only Ye Tianshi (Ye Shi) in his *Lin Zheng Zhi Nan Yi An* pointed out: "When the Spleen ascends, it becomes robust; when the Stomach descends, it becomes harmonious." Taiyin Wet Earth (Spleen) requires Yang Qi to begin its transportation; Yangming Dry Earth (Stomach) requires Yin fluids to achieve peace. This is because the Spleen prefers rigid dryness, and the Stomach prefers soft moistness. Zhang Zhongjing used urgent purgation to preserve fluids, focusing his treatment on the Stomach; Li Dongyuan advocated greatly raising Yang Qi, focusing his treatment on the Spleen. It is also said that Zang organs are tonified by retention, and Fu organs are tonified by transmission—a profound insight. Xiu Yun Hua praised this discussion as transcending antiquity. In narrating Ye's cases, he stated: *Pi Wei Lun* (Treatise on the Spleen and Stomach) is most detailed in Li Dongyuan's work. His formulas such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction), and Shengyang Yiwetang (Raise the Yang and Benefit the Stomach Decoction) primarily address internal injury from fatigue and overwork. Thus, they use Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) to tonify the Middle; Bai Zhu (Atractylodis Rhizoma) and Cang Zhu (Atractylodis Rhizoma) to warm and dry; Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) to raise sunken clear Yang; Chen Pi (Citri Reticulatae Pericarpium) and Mu Xiang (Aucklandiae Radix) to regulate Qi stagnation in the Middle Jiao. Since Taiyin fears dampness, and most patients suffer from deficient Stomach Yang, using these drugs appropriately yields effects as swift as a drumbeat. However, if Spleen Yang is not deficient but Stomach has dry fire, one should employ Ye Tianshi's method of nourishing Stomach Yin. After illness, heat pathogens damage Lung and Stomach Jin Ye (body fluids), leading to empty fullness, inability to eat, crimson tongue, dry throat, irritability, thirst, insomnia, and unsmooth bowel movements. These are manifestations of disharmony in the nine orifices, all stemming from Stomach disease. How can one treat this with Bai Zhu, Cang Zhu, Sheng Ma, and Chai Hu? Therefore, Master Ye invariably uses methods to descend the Stomach. "When the Stomach descends, it becomes harmonious" does not mean pungent-opening and bitter-descending, nor bitter-cold purgation that damages Stomach Qi. It merely involves using sweet-neutral or sweet-cool moistening herbs to nourish Stomach Yin, allowing Jin Ye to recover and facilitating natural descending and transmission. This follows the principle in *Neijing*: "Fu organs transmit transformed substances without storing, functioning through transmission." Thus, treating Stomach Yin deficiency characterized by lack of hunger and poor reception employs Qing Bu (Clear Tonification), such as Mai Dong (Ophiopogonis Radix), Sha Shen (Glehniae Radix), Yu Zhu (Polygonati Odorati Rhizoma), Xing Ren (Armeniacae Semen Amarum), Bai Shao (Paeoniae Radix Alba), Shi Hu (Dendrobii Caulis), Fu Shen (Poria Cum Radix), Jing Mi (Oriza Sativa Granum), Ma Ren (Cannabis Fructus), and Bian Dou (Dolichoris Lablab Semen). Treating Stomach Yang deficiency characterized by undigested food employs Tong Bu (Unblocking Tonification), such as Ren Shen, Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Chen Pi, Hou Po (Magnoliae Officinalis Cortex), Wu Yao (Linderae Radix), Fu Ling (Poria), Sheng Bai Zhu, Di Li Fen (Dioscoreae Hypoglaucae Bulbus), Ban Xia (Pinelliae Rhizoma), Jiu Zi (Allii Tuberosi Semen), Sheng Jiang (Zingiberis Rhizoma Recens), and Huang Mi (Panicomi Semen). Treating Spleen Yin deficiency characterized by epigastric discomfort and difficult defecation employs Gan Run (Sweet Moistening), such as Gan Cao (Glycyrrhizae Radix et Rhizoma), Da Mai Ren (Hordei Fructus Germinatus), Bai Shao, Dang Gui (Angelicae Sinensis Radix), Xing Ren, Ma Ren, Hong Zao (Jujubae Fructus), and Bai Mi (Mellis). Treating Spleen Yang deficiency characterized by acid regurgitation and belching of putrid food employs Xiang Zao (Fragrant Drying), such as Sha Ren (Amomi Fructus Rotundus), Ding Xiang (Caryophylli Flos), Chao Bai Zhu, Shen Qu (Massa Medicata Fermentata), Mai Ya (Hordei Fructus Germinatus), and Gan Jiang (Zingiberis Rhizoma). Formulas like Sijunzi Tang (Four Gentlemen Decoction), Liujunzi Tang (Six Gentlemen Decoction), and Yigong San (Extraordinary Power Powder) are all Spleen-tonifying retentive agents.
For Spleen and Stomach Yang deficiency with poor transport and reception, and desire to defecate after eating, employ ascending-descending methods, such as Buzhong Yiqi Tang plus Fu Ling, Yi Zhi Ren, and Mu Gua (Chaenomelis Fructus), or Yihuang San (Yellow Protecting Powder). For dampness injuring Spleen and Stomach, use Pingwei San (Calm the Stomach Powder) or Qingshu Yiqi Tang (Clear Summerheat and Augment Qi Decoction) with modifications. For Middle Qi deficiency, use Buzhong Yiqi Tang plus Mai Dong and Wu Wei Zi (Schisandrae Chinensis Fructus). For injury from excessive hunger, where pain is relieved slightly by eating, indicating pathology in Spleen collaterals due to starvation, employ sweet-slowing methods to nourish Ying (nutritive) blood of the Spleen, using Danggui Jianzhong Tang (Angelica Building the Middle Decoction). For food injury, characterized by aversion to food, abdominal pain, and false fullness, employ separation and dispersion of Stomach Earth accumulation, using raw Yi Zhi Ren, Cao Guo (Tsaoko Fructus), Guang Pi (Citri Reticulatae Pericarpium), Fu Ling, Ji Nei Jin (Galli Gigerii Endothelium Corneum), Chao Zha Rou (Crataegi Fructus), Shen Qu, and Wei Jiang (Zingiberis Rhizoma Praeparatum). For post-illness regulation of Spleen Yuan (origin), use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) or Liujunzi Tang. Such differentiated and combined treatments are particularly appropriate for the condition.
Chao Bai Zhu (Stir-fried Atractylodis Rhizoma) tends toward retention; raw Bai Zhu tends toward harmony. Chao Gan Cao (Stir-fried Glycyrrhizae Radix et Rhizoma) tends toward tonification; raw Gan Cao tends toward clearing fire. The above formulas list Spleen and Stomach treatments separately, generally adhering to the principle that Zang organs are tonified by retention, and Fu organs are tonified by transmission; Spleen benefits from ascending transportation, and Stomach benefits from descending transmission. Comparing these prescriptions with dietary syndromes renders the treatment comprehensive.