心下不痞满，自不能食也。东垣云∶胃中元气盛，则能食而不伤，过时而不饥，脾胃俱旺则能食
而肥，脾胃俱虚则不能食而瘦。故不能食，皆作虚论。若伤食恶食，自有本门，不在此例。病患脉缓
怠惰，四肢重着，或大便泄泻，此湿胜也，从平胃
散加味。病患脉弦，气弱自汗，四肢发热，或大便泄泻，皮毛枯槁发脱，从黄 建中汤加味。病患脉
虚气弱，脾胃不和，从四君子、六君子汤加味。有痰，从二陈汤加味，兼下人参半夏丸。虚而有痰，
用人参四两，半夏一两，姜汁浸一宿，曝干为末，面糊丸。食后生姜汤下。痰积痞隔，食不得下，皂
荚烧存性，研末，酒调下一钱匕。和中汤、七珍散、六神汤、钱氏异功散，皆四君子加减例，开胃进
食之正剂也。罗谦甫云∶脾胃弱而饮食难任者，不可一概用克伐之剂，宜钱氏异功散补之，自然能食。
设或嗜食太过伤脾，而痞满呕逆，权用枳实丸一服，慎勿多服。娄全善尝治翁氏久疟食少汗多，先用
补剂加黄连、枳实，月余食反不进，汗亦不止。因悟谦甫此言，遂减去枳、连，纯用补剂，又令粥多
于药而食进，又于原方内加附子三分半，一服而愈。宽中进食丸、和中丸、木香枳术丸、木香干姜枳
术丸，皆有行气之剂，气滞者宜之。许学士云∶有人全不进食，服补脾药皆不效。予授二神丸服之，
顿能进食。此病不可全作脾气治。盖肾气怯弱，真元衰削，是以不能消化饮食，譬之鼎釜之中，置诸
水谷，下无火力，终日米不熟，其何能化。黄鲁直尝记服菟丝子，淘净，酒浸曝干，日挑数匙，以酒
下之，十日外饮啖如汤沃雪，亦知此理也。今按
治法，虚则补其母，不能食者，戊己虚也，火乃土之母，故以破故纸补肾为癸水，以肉豆蔻浓肠胃为
戊土，戊癸化火，同为补土母之药也。杨仁斋云∶脾肾之气交通，则水谷自然克化。《瑞竹堂方》谓
二神丸，虽兼补脾胃，但无斡旋，往往常加木香以顺其气，使之斡旋，空虚仓廪，仓廪空虚则能受物，
屡用见效，其殆使之交通之力欤。严用和云∶人之有生不善摄养，房劳过度，真阳衰虚，坎水不温，
不能上蒸脾土，冲和失布，中州不运，是致饮食不进，胸膈痞塞，或不食而胀满，或食而不消，大腑
溏泄。古人云∶补肾不如补脾。予谓补脾不如补肾，肾气若壮，丹田火盛，上蒸脾土，脾土温和，中
焦自治，膈开能食矣。薛新甫云∶予尝病脾胃，服补剂及针灸脾俞等穴不应，几殆。吾乡卢丹谷先生，
令予服八味丸，饮食果进，三料而平。予兄年逾四十，貌丰气弱，遇风则眩，劳则口舌生疮，胸常有
痰，目常赤涩。又一人脾虚发肿，皆以八味丸而愈。按此皆补肾之验。戴复庵云∶脾运食而传于肺，
脾气不足故不喜食，宜启脾丸、煮朴丸。若脾虚而不进食者，当实脾，宜鹿茸橘皮煎丸。若脾虚寒而
不进食者，理中汤。未效，附子理中汤加砂仁半钱，或丁香煮散。心肾虚致脾气不足以运者，鹿茸橘
皮煎丸。脾上交于心，下交于肾者也。
【饥不能食】《灵枢》大惑篇，黄帝曰∶人之善饥而不嗜食者，何气使然？岐伯曰∶精气并于脾，热气留于胃，
胃热则消谷，消谷故善饥，胃气逆上则胃脘寒，故不嗜食也。运气饥不欲食，皆属湿邪伤肾。经云∶
太阴司天，湿淫所胜，民病心如悬，饥不欲食，治以苦热是也。针灸饥不欲食有二法∶其一清胃。经
云∶胃者水谷之海，其 上在气冲，下至三里，水谷之海不足，则饥不受谷，审守其 ，调其虚实是
也。其二取肾。经云∶肾足少阴之脉，是动则病饥不欲食，心如悬，苦饥状，视盛、虚、热、寒、陷
下取之也。
【恶食】经云∶太阴所谓恶闻食臭者，胃无气故恶食臭也。用大剂人参补之。丹溪云∶恶食者，胸中有物，
导痰补脾，二陈加二术渣芎汤。失笑丸，治虚痞恶食。
心下没有痞塞胀满的感觉，却自己不能进食。李东垣说：胃中元气旺盛，就能进食而不受伤，过了饭点也不会觉得饿；脾胃都强壮就能进食且身体丰满，脾胃都虚弱就不能进食且身体消瘦。所以不能进食，都当作虚证来论述。如果是伤食导致的厌恶食物，自有专门章节讨论，不在此例。病人脉象缓弱、精神倦怠、四肢沉重，或者大便泄泻，这是湿邪偏盛，用平胃散加味治疗。病人脉弦、气弱自汗、四肢发热，或者大便泄泻、皮毛干枯脱发，用黄芪建中汤加味治疗。病人脉虚气弱、脾胃不和，用四君子汤或六君子汤加味治疗。如果有痰，用二陈汤加味，兼服人参半夏丸。虚证而有痰，用人参四两，半夏一两，用姜汁浸泡一夜，晒干研末，用面糊做成丸药。饭后用生姜汤送服。痰积导致痞隔，食物无法咽下，用皂荚烧存性，研成粉末，用酒调服一钱匕。和中汤、七珍散、六神汤、钱氏异功散，都是四君子汤的加减方，是开胃进食的正宗方剂。罗谦甫说：脾胃虚弱而饮食难以承受的人，不可一概使用攻伐的药物，宜用钱氏异功散补益，自然能进食。假如因为嗜食太过损伤脾胃，出现痞满呕逆，权且服用一次枳实丸，千万不要多服。娄全善曾治疗翁氏久患疟疾、食少汗多，先用补剂加入黄连、枳实，一个多月后饮食反而不进，汗也不止。于是领悟到罗谦甫的话，便减去枳实、黄连，纯用补剂，又让粥多于药，饮食逐渐进益，又在原方内加入附子三分半，服用一次就痊愈了。宽中进食丸、和中丸、木香枳术丸、木香干姜枳术丸，都是有行气作用的方剂，气滞者适宜使用。许学士说：有人完全不能进食，服用补脾药都不见效。我传授给他二神丸服用，顿时就能进食。这种病不可完全当作脾气不足来治。这是因为肾气怯弱，真元衰败削减，所以不能消化饮食，好比鼎釜之中，放置各种水谷，下面没有火力，整天米煮不熟，怎么能消化呢？黄鲁直曾记载服用菟丝子，淘洗干净，用酒浸泡晒干，每天挑几匙，用酒送服，十天后饮食如汤沃雪般容易消化，也是懂得这个道理。现在按治法分析，虚则补其母，不能进食，是戊土（胃）和己土（脾）虚弱，火是土的母，所以用破故纸补肾作为癸水，用肉豆蔻厚肠胃作为戊土，戊癸化火，同为补土母的药材。杨仁斋说：脾肾之气交通，则水谷自然消化。《瑞竹堂方》说二神丸，虽然兼补脾胃，但没有斡旋作用，往往常加木香以顺其气，使之斡旋，空虚仓廪，仓廪空虚则能受纳食物，屡用见效，这大概是使其交通的力量吧。严用和说：人出生后不善养生，房劳过度，真阳衰虚，坎水不温，不能上蒸脾土，冲和之气失布，中焦不运，导致饮食不进，胸膈痞塞，或者不食而胀满，或者食而不消，大腑溏泄。古人说：补肾不如补脾。我认为补脾不如补肾，肾气若壮，丹田火盛，上蒸脾土，脾土温和，中焦自治，膈开能进食了。薛新甫说：我曾患脾胃病，服用补剂及针灸脾俞等穴位无效，几乎危殆。同乡卢丹谷先生，让我服用八味丸，饮食果然进益，三料药后平复。我哥哥年过四十，外貌丰腴但气弱，遇风则眩晕，劳累则口舌生疮，胸中常有痰，眼睛常赤涩。还有一人脾虚发肿，都用八味丸治愈。按此皆是补肾的验证。戴复庵说：脾运化食物而传于肺，脾气不足故不喜欢进食，宜用启脾丸、煮朴丸。若脾虚而不能进食者，当实脾，宜用鹿茸橘皮煎丸。若脾虚寒而不能进食者，用理中汤。未见效，用附子理中汤加砂仁半钱，或丁香煮散。心肾虚导致脾气不足以运化的，用鹿茸橘皮煎丸。脾上交于心，下交于肾。
【饥不能食】《灵枢·大惑论》，黄帝说：人善于饥饿却不嗜好进食，是什么气造成的？岐伯说：精气并于脾，热气留于胃，胃热则消谷，消谷故善于饥饿，胃气逆上则胃脘寒，所以不嗜好进食。运气学说中的饥不欲食，都属于湿邪伤肾。经书说：太阴司天，湿淫所胜，百姓病心如悬，饥不欲食，治疗用苦热之药，就是这种情况。针灸治疗饥不欲食有两种方法：其一清胃。经书说：胃是水谷之海，其上在气冲穴，下至足三里，水谷之海不足，则饥不受谷，审守其经脉，调其虚实即可。其二取肾。经书说：肾足少阴之脉，是动则病饥不欲食，心如悬，苦饥状，视其盛、虚、热、寒、陷下情况取穴治疗。
【恶食】经书说：太阴所谓厌恶闻食物气味，是因为胃无气故厌恶食物气味。用大剂量人参补益。朱丹溪说：恶食者，胸中有物，导痰补脾，用二陈汤加苍术、白术、川芎、甘草渣汤。失笑丸，治疗虚痞恶食。
The epigastrium is not distended or full, yet the patient cannot eat. Li Dongyuan said: When the primordial Qi of the Stomach is vigorous, one can eat without injury and feel no hunger even after the usual meal time; when both the Spleen and Stomach are strong, one can eat and become plump; when both the Spleen and Stomach are deficient, one cannot eat and becomes emaciated. Therefore, inability to eat is generally discussed as a deficiency syndrome. If the aversion to food is due to food stagnation, it has its own dedicated section and is not included in this example. If the patient's pulse is slow and weak, with lethargy and heaviness in the four limbs, or diarrhea, this indicates excess Dampness, treated with Pingwei San (Calm the Stomach Powder) modified. If the patient's pulse is wiry, with weak Qi, spontaneous sweating, heat in the four limbs, or diarrhea, dry skin and hair loss, use Huangqi Jianzhong Tang (Astragalus Decoction for Replenishing the Middle) modified. If the patient's pulse is empty and Qi is weak, with disharmony between the Spleen and Stomach, use Sijunzi Tang (Four Gentlemen Decoction) or Liujunzi Tang (Six Gentlemen Decoction) modified. If there is Phlegm, use Erchen Tang (Two Aged Substances Decoction) modified, combined with Renshen Banxia Wan (Ginseng and Pinellia Pill). For deficiency with Phlegm, use four taels of Renshen (Ginseng Root), one tael of Banxia (Pinellia Tuber), soaked overnight in Ginger Juice, dried, powdered, and formed into pills with wheat paste. Take after meals with Shengjiang Tang (Fresh Ginger Decoction). For Phlegm accumulation causing obstruction where food cannot pass down, burn Zaojiao (Gleditsia Sinensis Fruit) until carbonized but retaining its nature, powder it, and take one qianbi (a small measure) mixed with wine. Hetang Tang (Harmonizing the Middle Decoction), Shizhen San (Seven Treasures Powder), Liushen Tang (Six Deities Decoction), and Qianshi Yigong San (Master Qian's Extraordinary Efforts Powder) are all modifications of Sijunzi Tang and are orthodox formulas for opening the stomach and promoting appetite. Luo Qianfu said: For those with weak Spleen and Stomach who cannot tolerate food, one should not uniformly use attacking/draining agents; instead, use Qianshi Yigong San to tonify, and appetite will naturally return. If excessive indulgence in food damages the Spleen, leading to distension, fullness, and vomiting, one may temporarily administer once dose of Zhishi Wan (Immature Bitter Orange Pill), but be careful not to take it frequently. Lou Quanshan once treated an old man with chronic malaria, poor appetite, and excessive sweating. Initially, he used a tonifying formula added with Huanglian (Coptis Rhizome) and Zhishi (Immature Bitter Orange). After more than a month, the patient's intake decreased further, and sweating did not stop. Realizing the wisdom of Qianfu's words, Lou removed Zhishi and Huanglian, using purely tonifying agents, advised eating more congee than taking medicine, which improved intake, and added Sanfenban (half a fen) of Fuzi (Prepared Aconite Root) to the original formula. One dose resulted in recovery. Kuanzhong Jinshe Wan (Widen the Middle and Promote Eating Pill), Hetang Wan (Harmonizing Middle Pill), Muxiang Zhizhu Wan (Costus and Immature Bitter Orange Pill), and Muxiang Ganjiang Zhizhu Wan (Costus, Dried Ginger, and Immature Bitter Orange Pill) are all formulas that move Qi, suitable for Qi stagnation. Xu Xueshi said: There was a person who could not eat at all, and tonifying Spleen medicines were ineffective. I prescribed Ershen Wan (Two Kidney Pills), and the patient immediately regained appetite. This disease should not be treated solely as Spleen Qi deficiency. It is because the Kidney Qi is timid and the True Yuan (Primal Essence) is depleted, thus failing to digest food. It is like a pot containing grains and water; if there is no fire underneath, the rice will not cook all day, how can it be digested? Huang Luzhi once recorded taking Tusizi (Dodder Seed), washed clean, soaked in wine, and dried. Taking several spoons daily with wine, after ten days, digestion became as easy as snow melting in hot soup, demonstrating understanding of this principle. According to current treatment principles, "tonify the mother when deficient." Inability to eat implies deficiency of Wu Earth (Stomach) and Ji Earth (Spleen). Fire is the mother of Earth. Therefore, using Pogu Zhi (Cibotium Rhizome) to tonify the Kidney as Gui Water, and Rou Doukou (Nutmeg) to thicken the intestines and stomach as Wu Earth, allows Wu and Gui to transform into Fire, serving as herbs that tonify the mother of Earth. Yang Renzhai said: When Spleen and Kidney Qi communicate, water and grain are naturally transformed. The *Ruizhutang Fang* states that although Ershen Wan tonifies the Spleen and Stomach, it lacks a pivoting action. Often, Muxiang (Costus Root) is added to smooth Qi and facilitate pivoting. Emptying the granaries allows them to receive goods; repeated use shows efficacy, likely due to this power of communication. Yan Yonghe said: Humans who fail to cultivate themselves properly, engaging in excessive sexual activity, deplete their True Yang. Kan Water (Kidney Water) fails to warm, unable to steam upward to nourish Spleen Earth. The harmonious Qi fails to distribute, the Central Pivot fails to rotate, resulting in poor appetite, chest and diaphragm oppression, bloating without eating, indigestion after eating, and loose stools. Ancients said: "Tonifying the Kidney is better than tonifying the Spleen." I argue: "Tonifying the Spleen is better than tonifying the Kidney." If Kidney Qi is strong, the Dantian Fire is vigorous, steaming upward to warm Spleen Earth. When Spleen Earth is warm, the Middle Jiao regulates itself, the diaphragm opens, and eating resumes. Xue Xinpu said: I once suffered from Spleen-Stomach disease. Tonics and acupuncture at Pishu (BL20) were ineffective, and I nearly died. Mr. Lu Danggu from my hometown instructed me to take Bawei Wan (Eight-Ingredient Pill). My diet indeed improved, and I recovered after three doses. My brother, over forty years old, appeared plump but had weak Qi, experienced dizziness upon exposure to wind, mouth and tongue ulcers upon exertion, constant phlegm in the chest, and red, gritty eyes. Another person with Spleen deficiency edema was also cured by Bawei Wan. These are all validations of tonifying the Kidney. Dai Fu'an said: The Spleen transforms food and transmits it to the Lung. Insufficient Spleen Qi leads to lack of desire to eat; use Qipi Wan (Spleen-Initiating Pill) or Zhu Pu Wan (Boiled Magnolia Bark Pill). For Spleen deficiency failing to promote eating, one should solidify the Spleen; use Lurong Jupi Jian Wan (Deer Antler and Tangerine Peel Decoction Pill). For Spleen deficiency-cold failing to promote eating, use Lizhong Tang (Regulate the Middle Decoction). If ineffective, add Banqian (half a qian) of Sharen (Amomum Fruit) to Fuzi Lizhong Tang, or use Dingxiang Zhusan (Clove Boiled Powder). For Heart-Kidney deficiency leading to insufficient Spleen Qi to transform, use Lurong Jupi Jian Wan. The Spleen connects upward to the Heart and downward to the Kidney.
[Starvation without Appetite] In the *Lingshu · Daguo Pian*, the Yellow Emperor asked: Why do some people feel hungry but lack desire to eat? Qibo replied: Jing Qi merges with the Spleen, and Heat lingers in the Stomach. Stomach Heat consumes grain, causing hunger; however, rebellious Stomach Qi causes cold in the epigastrium, hence the lack of desire to eat. In the context of Six Qi transformation, starvation without desire to eat belongs to Dampness pathogen injuring the Kidney. The Classics state: When Taiyin governs the year, excessive Dampness causes people to suffer from a sensation of the heart hanging, hunger without desire to eat. Treatment uses bitter-hot herbs. Acupuncture for starvation without desire to eat has two methods: First, clear the Stomach. The Classics state: The Stomach is the Sea of Water and Grain. Its upper point is Qichong (ST30), and its lower point is Zusanli (ST36). When the Sea of Water and Grain is deficient, hunger exists but grain is not accepted. Examine and secure the meridian, regulating deficiency and excess. Second, select points on the Kidney. The Classics state: The Foot-Shaoyin Kidney Meridian, when disturbed, causes disease manifesting as starvation without desire to eat, a sensation of the heart hanging, and distressing hunger. Treat based on fullness, deficiency, heat, cold, or sinking conditions.
[Aversion to Food] The Classics state: What Taiyin refers to as aversion to the smell of food is due to the Stomach lacking Qi, thus aversion to food odors. Use a large dose of Renshen (Ginseng Root) to tonify. Zhu Danxi said: Aversion to food indicates material retention in the chest. Guide out Phlegm and tonify the Spleen using Erchen Tang (Two Aged Substances Decoction) added with Cangzhu (Atractylodes Rhizome), Baizhu (White Atractylodes Rhizome), Chuanxiong (Szechwan Lovage Rhizome), and Gancao (Licorice Root) dregs. Shixiao Wan (Pain-Dispel Pill) treats deficiency-type epigastric fullness with aversion to food.