世医治病不先理脾胃及养血安神是不明标本之理也凡人病脾虚发热痰气壅塞不审虚实寒
热动
辄牛黄清心丸一概施治殊不知药性稍凉胃气受伤失其本矣惟宜温养其胃使其饮食少进而后攻
其他疾是之谓标本之理也前辈有云学贵知要不在贪多用贵适时不专泥古正此谓欤
经云脾为黄婆胃为金翁主养五脏六腑若脾胃坚固则津液通行气血流转使表里冲和一身康
健
若脾胃一虚何病不起盖脾胃属土万物资生李空同曰五行木金水火四气不纳邪邪入则坏惟土纳
汗汗变则化化则神是故贯四时而独功也在人脾为土游溢精液输灌肺肾肝心不然百物食之腥荤
臭味秽杂于胃中何以发神明而行变化庄子曰神奇则臭腐臭腐复为神奇盖言土也
五劳者五脏之劳皆因动作勉强用力过度曰劳索矩新书云受气贪欲则为劳夫人身之真元根
本气
血精液是也世之劳瘵之症最为难治盖因人之壮年恣意酒色以致耗散真元不生津液遂至呕吐血
痰骨蒸体热肾虚精惫面白颊红白浊遗精及痰涎咳嗽谓之火乘金候重则半年而死轻则一年必危
俗医不究其源苦以大寒大热之药妄投乱进殊不知大寒则气愈虚大热则血愈竭是以世之犯此疾
者多不能免于死由医之不得其人也良可悯哉
震泽王文恪公云今世医者率祖李明之朱彦修其处剂不出参术之类所谓医之王道也信知本
者矣
然病出于变非参术辈所能效者则药亦不得不变可变而不知变则坐以待亡变而失之毫厘则反促
其死均之为不可也故曰可与立未可与权药而能权可谓妙矣明之彦修未尝废权也世医师其常而
不师其变非用权之难乎(震泽文集)
世间的医生在治疗疾病时，如果不先调理脾胃以及养血安神，就不明白标本的道理。大凡病人出现脾虚发热、痰气壅塞的症状，若不审察虚实寒热，动辄就使用牛黄清心丸（一种清热开窍的中成药）一概施治，殊不知药性稍凉会损伤胃气，从而失去根本。只应当温养其胃，使其饮食稍微进补，然后再攻治其他疾病，这就叫做懂得标本的道理。前辈有话说：学习贵在抓住关键，不在于贪多；用药贵在适时，不专门拘泥于古法，说的正是这个意思。
《内经》说：脾被称为“黄婆”，胃被称为“金翁”，主要滋养五脏六腑。如果脾胃坚固，那么津液就能通行，气血就能流转，使表里冲和，一身康健。如果脾胃虚弱，什么病不会发生呢？大概脾胃属土，万物依靠它生长。李空同说：五行中的木、金、水、火四行不能容纳邪气，邪气侵入就会败坏；只有土能容纳汗液，汗液变化则化为精微，化生则产生神气。所以土贯穿四季而独显功效。在人体中，脾属土，游溢精液，输送灌溉到肺、肾、肝、心。否则，人吃下的各种食物，腥荤臭味秽杂在胃中，靠什么来发神明并执行变化呢？庄子说：“神奇的东西会变成臭腐，臭腐的东西又会复变为神奇。”这说的就是土的作用。
五劳，是指五脏的劳损，都因为动作勉强、用力过度称为“劳”。《索隐新书》说：受气贪欲则为“劳”。人身上的真元、根本、气血、精液是也。世间的劳瘵（类似肺结核的慢性消耗性疾病）症状最为难治，大概是因为人在壮年时肆意饮酒色欲，导致耗散真元，不生津液，遂至呕吐血痰、骨蒸潮热、体热、肾虚精惫、面白颊红、白浊遗精以及痰涎咳嗽，这叫做“火乘金候”（火克金的病理状态），重的半年而死，轻的一年必危。世俗医生不探究其根源，苦以大寒大热的药物妄投乱进，殊不知大寒则气更虚，大热则血更竭。因此世上患此疾的人大多不能免于死，是由于医生不得其人，实在可怜啊。
震泽王文恪公说：现在的医生大都效法李明之（李杲）、朱彦修（朱震亨），他们开具的方剂不出人参、白术之类，所谓医家的王道，确实是抓住了根本。然而病情出于变化，不是人参、白术这类药所能奏效的，那么药物也就不得不改变。可以改变却不知道变通，那就是坐以待毙；变通而失之毫厘，反而加速死亡，这都是不可取的。所以说，“可以与他确立原则，不可以与他随机应变”。用药能够权变，可以说是妙极了。李明之、朱彦修并没有废弃权变之道。世人只师法常规而不师法变化，这不是运用权变的困难所在吗？（出自《震泽文集》）
Physicians of the world, when treating diseases, if they do not first regulate the Spleen and Stomach (Spleen and Stomach) and nourish blood to calm the mind (Nourishing Blood and Calming Mind), they fail to understand the principle of root and branch (Root and Branch). Generally, when patients suffer from Spleen deficiency with fever (Spleen Deficiency Fever) and phlegm-qi obstruction (Phlegm-Qi Obstruction), without examining deficiency/excess and cold/heat, they indiscriminately administer Niuhuang Qingxin Wan (Calorie Clearing Heart Pill, a traditional Chinese medicine for clearing heat and opening orifices). Little do they know that the slightly cool nature of the medicine damages Stomach Qi (Stomach Qi), thereby losing the root. One should only warm and nourish the Stomach so that food intake gradually increases, and then attack other diseases. This is called understanding the principle of root and branch. The elders said: Learning values grasping the essentials, not greedily using many things; medication values timeliness, not strictly adhering to ancient methods. This is exactly what is meant.
The Classic says: The Spleen is called "Huang Po" (Yellow Matron), and the Stomach is called "Jin Weng" (Golden Patriarch), primarily nurturing the Five Zang and Six Fu organs. If the Spleen and Stomach are firm, then Body Fluids (Body Fluids) can circulate, and Qi and Blood (Qi and Blood) can flow, making the interior and exterior harmonious and the whole body healthy. If the Spleen and Stomach are deficient, what disease would not arise? Essentially, the Spleen and Stomach belong to Earth (Earth Element), and all things rely on it for generation. Li Kongtong said: Among the Five Elements, Wood, Metal, Water, and Fire cannot accommodate pathogenic factors; if pathogens enter, they cause damage. Only Earth can accommodate sweat; when sweat transforms, it becomes essence; when transformed, it generates Spirit (Shen). Thus, Earth alone exerts its function throughout the four seasons. In humans, the Spleen belongs to Earth, wandering and overflowing with essence fluids, transporting and irrigating the Lungs, Kidneys, Liver, and Heart. Otherwise, how can various foods eaten by humans, with their fishy, meaty, odorous, and impure qualities in the Stomach, generate Spirit and execute transformation? Zhuangzi said: "What is miraculous becomes putrid; what is putrid becomes miraculous again." This speaks of Earth.
The Five Exhaustions (Five Labors) refer to the exhaustion of the Five Zang organs, all caused by forced movement and excessive exertion, termed "Labor". The *Suoyin Xinshu* states: Receiving Qi through lust leads to Labor. The true Yuan Qi (True Primal Qi), fundamental Qi and Blood, and essence fluids of the human body are these. The condition of Lao Zhai (Chronic Consumptive Disease, similar to tuberculosis) in the world is most difficult to treat. It is generally because people indulge in alcohol and sexual desires during their prime years, depleting True Yuan Qi and failing to generate essence fluids. This leads to vomiting blood and phlegm, bone-steaming tidal fever (Bone-Steaming Fever), body heat, Kidney deficiency with seminal exhaustion, pale face with red cheeks, white turbidity, spermatorrhea, and coughing with phlegm-saliva. This is called "Fire Overacting on Metal" (Fire Overacting on Metal). Severe cases result in death within half a year; mild cases become critical within a year. Vulgar physicians do not investigate the source but recklessly administer extreme cold or extreme hot medicines. They do not know that extreme cold makes Qi more deficient, and extreme heat makes Blood more exhausted. Therefore, those who contract this disease mostly cannot avoid death due to incompetent physicians, which is truly pitiable.
Wenke Gong of Zhenze said: Physicians nowadays mostly follow Li Mingzhi (Li Dongyuan) and Zhu Yanxiu (Zhu Zhenheng). Their prescriptions rarely go beyond herbs like Ginseng (Ren Shen) and Atractylodes Macrocephala (Bai Zhu), which is known as the King's Way of medicine. Indeed, those who grasp the root have done so. However, diseases arise from changes, and Ginseng and Atractylodes cannot be effective in all such cases; thus, medicines must also change. If one can change but does not know how to adapt, it is sitting and waiting for death; if adaptation errs by a hair's breadth, it accelerates death instead. Both are unacceptable. Hence it is said: "One may stand with him [on principles], but one may not weigh with him [on discretion]." Medication that can exercise discretion (Quan) can be called wonderful. Li Mingzhi and Zhu Yanxiu never abandoned discretion. People today only imitate routine practices and do not imitate changes; is this not the difficulty in exercising discretion? (From *Zhenze Wenji*)