〔薛〕经曰∶脾病则面黄善噫。噫者，寒气客于胃，厥逆从下上散，复出于胃而
为噫。又善思善味，其证当脐有动气，按之牢若痛。其病腹胀满，食不消，体重节
痛，怠惰嗜卧，四肢不收。经曰∶脾主四肢，有是者脾也。又曰∶二阳一阴发病，
主惊骇背痛善噫。何谓也？窃谓上焦受气于中焦，中焦气未和，不能消谷，故为噫
耳。中焦，亦脾胃之分也，脾土虚寒，由命门火衰，不能温蒸水谷，古人有服菟丝
子旬日间饮食如汤沃雪，亦此义也。补脾宜人参理中汤。补右肾宜用八味丸。胃气
虚不能运化水谷者，六君子加木香。郁结伤脾者，加味归脾汤。木克土者，四君柴胡、
升麻，兼嘈杂者，加吴茱萸、半夏。治者审之。
理中汤（吐泻） 八味丸（虚羸） 加味归脾汤（惊悸）
《本事》枳壳散 治心下痞闷，或作痛多噫。
枳壳（去瓤，炒） 白术（各半两） 香附子（炒，一两） 槟榔（三钱）
上为末。每服一钱，空心，米饮调下。
四味萸连丸 治腹胀噫气吞酸，食不能化。
吴茱萸（炒） 黄连（炒） 神曲 荷叶（各等分）
上为末，煮神曲糊丸，桐子大。每服二十丸，白汤下。黄连，当量病微甚，或
炒黑炒黄用之。
〔薛〕刘河间云∶肠胃郁结，谷气内发而不能宣通于肠胃之外，故喜噫下气也。
若癫痫劳瘵，气下泄而不止者必死，乃真气竭绝，腠理闭塞，谷气不能宣通于肠胃
之外，故从肠胃中泄出。娄全善云∶下气属心虚。经云∶夏脉者心也，心脉不及，
下气为泄者是也。经又云∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，
通调水道，下输膀胱，水精四布，五经并行，此平人也。若七情内伤，六淫外侵，
饮食不节，房劳过度，致脾土之阴受伤，转运之官失职，不能输化，故下气也。又
曰∶阴精所奉，其人寿，阳精所降，其人夭。阴精者，乃五谷之精，上荣心肺，以
降肾肝，故曰其人寿。阳精者，乃胃中之清气，陷入肾肝，不能升浮，上输心肺，
故曰其人夭。若饮食过度，肠胃郁结，用平胃散。癫痫劳瘵，用补中益气汤。心气
虚弱，用补心丸。心气虚寒，用补心汤。脾胃虚寒，用理中汤。肝木乘睥，用六君
子汤加木香。脾气郁结，用加味归脾汤。脾气下陷，用补中益气汤。命门火衰，用
八味丸。肾气不足，用六味地黄丸。大凡噫气下气者，其脉不及本位，内经云∶短
则气病。以其无胃气也。诸病见此脉难治，但纯补胃气为善。
平胃散（不能食） 补心丸（即茯神散为丸，方见惊悸） 补心汤（痞） 理中汤（吐泻）
加味归脾汤（惊悸） 八味丸（不能食）
【薛己按语】《内经》说：脾有病则面色发黄，喜欢打嗝。所谓打嗝（噫气），是寒气侵入胃中，厥逆之气从下向上散发，再从胃中排出而形成的。另外，如果患者思虑过多且口味异常，其症状表现为肚脐周围有搏动感，按压时感觉坚硬且疼痛。这类疾病会出现腹部胀满、食物不消化、身体沉重关节疼痛、倦怠嗜卧、四肢无力等症状。《内经》说：脾主管四肢，出现这些症状就是脾病。又说：阳明经与厥阴经发病，主要表现为惊恐、背痛和喜欢打嗝。这是什么意思呢？我认为上焦的气来源于中焦，如果中焦气机不和，不能腐熟水谷，所以就会打嗝。中焦，也就是脾胃的范畴。脾土虚寒，是因为命门之火衰弱，不能温煦蒸腾水谷，古人说服用菟丝子十几天后，饮食像雪落入热水中一样迅速消化，也是这个道理。补脾宜用人参理中汤。补右肾宜用八味丸。胃气虚弱不能运化水谷的，用六君子汤加木香。因郁结损伤脾气的，用加味归脾汤。肝木克伐脾土的，用四君子汤合柴胡、升麻，兼有嘈杂感的，加吴茱萸、半夏。治疗者需仔细审察。
理中汤（主治吐泻） 八味丸（主治虚羸消瘦） 加味归脾汤（主治惊悸）
《本事方》枳壳散 主治心下痞闷，或者作痛且多打嗝。
枳壳（去瓤，炒） 白术（各半两） 香附子（炒，一两） 槟榔（三钱）
以上药物研为细末。每次服用一钱，空腹时，用米汤调服。
四味萸连丸 主治腹胀、打嗝、吞酸，食物不能消化。
吴茱萸（炒） 黄连（炒） 神曲 荷叶（各等分）
以上药物研为细末，煮神曲糊制作成丸药，如梧桐子大。每次服用二十丸，用白开水送下。黄连应根据病情的轻重，或炒黑或炒黄使用。
【薛己按语】刘河间说：肠胃郁结，谷气在内发作但不能宣通于肠胃之外，所以喜欢打嗝和下气（排气）。如果是癫痫、劳瘵等疾病，气向下泄出而不止的必然死亡，这是真气竭绝，腠理闭塞，谷气不能宣通于肠胃之外，所以从肠胃中泄出。娄全善说：下气属于心虚。《内经》说：夏脉对应心脏，如果心脉不及，出现下气并伴随泄泻的就是这种情况。《内经》又说：饮食进入胃中，游溢精气，向上输送给脾，脾气散布精微，向上归于肺，通调水道，向下输送到膀胱，水液精微遍布全身，五脏经脉并行，这是健康人的状态。如果七情内伤，六淫外侵，饮食不节制，房事过度，导致脾土之阴受伤，转运功能失职，不能输布转化，所以下气。又说：阴精上奉，人长寿；阳精下降，人短命。阴精，是指五谷的精微，向上荣养心肺，向下降入肾肝，所以说人长寿。阳精，是指胃中的清气，陷入肾肝，不能升浮上行输布心肺，所以说人短命。如果饮食过度，肠胃郁结，用平胃散。癫痫劳瘵，用补中益气汤。心气虚弱，用补心丸。心气虚寒，用补心汤。脾胃虚寒，用理中汤。肝木乘脾，用六君子汤加木香。脾气郁结，用加味归脾汤。脾气下陷，用补中益气汤。命门火衰，用八味丸。肾气不足，用六味地黄丸。大凡打嗝和下气的患者，其脉象不及本位，《内经》说：脉短则是气病。这是因为没有胃气。各种疾病出现这种脉象都难治，只有单纯补益胃气才是好的治疗方法。
平胃散（主治不能食） 补心丸（即茯神散制成丸剂，方见惊悸条下） 补心汤（主治痞证） 理中汤（主治吐泻） 加味归脾汤（主治惊悸） 八味丸（主治不能食）
[Xue Ji's Commentary] The *Classic of Internal Medicine* states: "When the Spleen is diseased, the face turns yellow and there is a propensity for eructation (belching)." Eructation refers to cold pathogenic factors invading the Stomach, with rebellious Qi ascending from below and dispersing, then exiting through the Stomach. Furthermore, if there is excessive thinking and abnormal taste perception, the symptoms manifest as pulsating Qi around the umbilicus, which feels firm and painful upon palpation. Such diseases present with abdominal distension and fullness, indigestion, heavy body and joint pain, lethargy and desire to lie down, and flaccidity of the four limbs. The *Classic* states: "The Spleen governs the four limbs; those who have these signs have Spleen disease." It also says: "When the Yangming and Jueyin meridians are affected, the main manifestations are fright, back pain, and propensity for eructation." What does this mean? I believe that the Qi of the Upper Jiao receives its source from the Middle Jiao. If the Qi of the Middle Jiao is not harmonized and cannot digest food, eructation occurs. The Middle Jiao corresponds to the Spleen and Stomach. Deficient-cold of Spleen Earth results from the decline of Mingmen Fire, which fails to warm and steam water and grain. The ancients stated that taking Cuscutae Semen (Tusizi) for ten days could result in food digesting as quickly as snow melting in hot water; this illustrates the same principle. To tonify the Spleen, Renshen Lizhong Tang (Ginseng and Atractylodes Decoction) is appropriate. To tonify the Right Kidney, Bawei Wan (Eight-Ingredient Pill) is used. For deficiency of Stomach Qi failing to transform water and grain, Liujunzi Tang (Six Gentlemen Decoction) with Muxiang (Aucklandiae Radix) is prescribed. For Spleen injury due to constraint, Jiawei Guipi Tang (Modified Gui Pi Decoction) is used. When Liver Wood overacts on Spleen Earth, Sizijunzi Tang combined with Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma) is employed; if accompanied by acid regurgitation and discomfort, Wuzhuyu (Evodiae Fructus) and Banxia (Pinelliae Rhizoma) are added. Practitioners should examine carefully.
Lizhong Tang (indicated for vomiting and diarrhea) | Bawei Wan (indicated for emaciation) | Jiawei Guipi Tang (indicated for palpitations and fright)
*Ben Shi Fang* Zhike San (Citrus Aurantium Powder) treats epigastric stuffiness or pain with frequent eructation.
Zhiqiao (Citri Reticulatae Pericarpium, pith removed, stir-fried), Baizhu (Atractodis Rhizoma, each half liang), Xiangfuzi (Cyperi Rhizoma, stir-fried, one liang), Binglang (Arecae Semen, three qian).
Grind into powder. Take one qian per dose, on an empty stomach, mixed with rice water.
Siwei Yulian Wan (Four-Ingredient Evodia and Coptis Pill) treats abdominal distension, eructation, acid regurgitation, and inability to digest food.
Wuzhuyu (Evodiae Fructus, stir-fried), Huanglian (Coptidis Rhizoma, stir-fried), Shenqu (Massa Medicata Fermentata), Heye (Nelumbinis Folium, equal parts).
Grind into powder, use fermented dough made from Shenqu as a binder to form pills the size of tung tree seeds. Take twenty pills per dose with plain boiled water. The dosage of Huanglian should be adjusted according to the severity of the condition; it may be stir-fried until black or yellow.
[Xue Ji's Commentary] Liu Hejian stated: "When the intestines and stomach are constrained, the Qi of grain arises internally but cannot be disseminated outside the intestines and stomach, hence there is a preference for eructation and passing wind (xiàqì). In cases of epilepsy or consumptive disease, if Qi leaks downward without stopping, death is inevitable; this indicates the exhaustion of True Qi, closure of the couli (pores), and failure of grain Qi to disseminate outside the intestines and stomach, causing it to leak out from within." Lou Quanshan stated: "Passing wind belongs to Heart deficiency." The *Classic* says: "The summer pulse corresponds to the Heart. If the Heart pulse is deficient, leading to passing wind and diarrhea, this is the case." The *Classic* further states: "Food enters the Stomach, its essence floats and overflows, is transported upward to the Spleen, the Spleen scatters the essence, sends it upward to the Lung, regulates the water passages, transports it downward to the Bladder, allowing water essence to distribute throughout the body and the five meridians to function together; this is the state of a healthy person." However, if internal injury from the seven emotions, external invasion by the six exogenous pathogens, irregular diet, or excessive sexual activity injures the Yin of Spleen Earth, causing the official of transportation to fail in its duties and unable to transport and transform, then passing wind occurs. It is also said: "When Yin essence is offered upward, longevity ensues; when Yang essence descends, premature death follows." Yin essence refers to the essence of grains, which nourishes the Heart and Lung upward and descends to the Liver and Kidney, thus ensuring longevity. Yang essence refers to the clear Qi of the Stomach; if it sinks into the Liver and Kidney and cannot ascend and float to nourish the Heart and Lung, premature death follows. If dietary excess causes constriction of the intestines and stomach, Pingwei San (Pingwei Powder) is used. For epilepsy and consumptive disease, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used. For deficiency of Heart Qi, Buxin Wan (Tonify the Heart Pill) is used. For deficiency-cold of Heart Qi, Buxin Tang (Tonify the Heart Decoction) is used. For deficiency-cold of Spleen and Stomach, Lizhong Tang is used. For Liver Wood overacting on Spleen, Liujunzi Tang with Muxiang is used. For constraint of Spleen Qi, Jiawei Guipi Tang is used. For sinking of Spleen Qi, Buzhong Yiqi Tang is used. For decline of Mingmen Fire, Bawei Wan is used. For insufficiency of Kidney Qi, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used. Generally, in cases of eructation and passing wind, the pulse is deficient relative to its proper position. The *Inner Classic* states: "A short pulse indicates Qi pathology." This is because there is no Stomach Qi. Diseases presenting with this pulse are difficult to treat; only purely tonifying Stomach Qi is beneficial.
Pingwei San (indicated for anorexia) | Buxin Wan (identical to Fushen San made into pills, see Palpitations section) | Buxin Tang (indicated for epigastric fullness) | Lizhong Tang (indicated for vomiting and diarrhea) | Jiawei Guipi Tang (indicated for palpitations) | Bawei Wan (indicated for anorexia)