愚按内经千言万语。谆谆教人以胃气为本。有胃气曰生。无胃气曰死。胃气
少曰病。又曰∶脾胃为气血之本。东垣云∶胃中元气胜。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。或少食而肥。虽肥而四肢不举。盖脾虚而邪
气盛也。又有善食而瘦者。胃中伏火邪于气分则能食。脾虚则肌削。即食 也。叔和云∶多
食亦饥者虚。立斋先生曰∶人以脾胃为本。纳五谷。化精液。其清者入营。浊者入胃。阴阳
得此。谓之 。故阳则发于四肢。阴则行于五脏。土旺于四时。善载乎万物。人得土以养
百骸。身失土以枯四肢。又云∶愚按大病后谷消水去。精散卫亡。多致便利枯竭。宜当补
中
益气为要。盖脾为中州浇灌。四傍与胃行其津液者也。况大肠主津。小肠主液。亦皆禀气于
胃。胃气一充津液自行矣。愚窃以为胃气者元气之用也。元气者胃气之主也。然必藉谷气以
资养元气。元气既盛。胃气自充。故气义有二。曰先天气。曰后天气。先天者真一之气。气
化
于虚。因虚化形此气从虚无中来。后天者血气之气气化于谷因形化气此气从调摄中来。然
而运化调摄政所以葆全其虚无之本。胃气其可不重乎。
愚按仲景伤寒论∶有三阴自利证。有协热下利症。自利为阴寒宜温以辛热下利为传经。
三阴
热糜之。证宜从清解。自利脉微小缓弱。相合之脉也。下利则脉沉而有力或洪实和缓。乃邪
热
入里之症也。至所谓痢者。内经谓之肠 。金匮谓之滞下迥与伤寒病机不同也。此从湿热所
致。为肠胃实积之病。多见于溽暑熏蒸之候。故治法从苦寒涤荡。攻积破瘀。既属阳病。
则
脉宜从阳诊。余每疗此病。多有洪大滑数。或沉实者。治却易愈。而脉见沉小迟
弱。及浮大无力者。殊为乖候。大费心力。极意温补。始得渐瘥。奈何高阳生之脉诀。乃谓
下痢微小却为生。脉大浮洪无瘥日。此非积热实病乎。既为积热实病。乃阳病也。阳病而得
微小阴脉而投以苦寒果。可得全生乎。不通害理。莫此为甚。虽然痢固为积热实病矣。而
胃
气未伤。六脉有神。饮食如常。无别蒹证。七日经尽。厥疾自瘳。设若元气胃气两虚病气独
炽。尤须察气施治。必先扶元为主。或少佐以清热之品。可期后效。甚有虚痢而脉病俱亏。
此经所谓五虚者。是势属危困。令人束手敢。曰积热。为患尚须清涤乎。故立斋有云∶夫
人以胃气为主。未有脾胃实而能患疟痢者。若专主发表攻里。降火导痰。是治其末而忘其本
也。以上盖救正高阳生解脉之。误也。大都伤寒杂病。须觇元气虚实。至若错认病机。愈支
离枉谬耳。
我考察《内经》，千言万语，谆谆教导人们以胃气为根本。有胃气就说能生，无胃气就说将死。胃气少就说生病。又说：脾胃是气血的根本。李东垣说：胃中元气充足，就能进食而不受伤，过了饭点也不会觉得饿。脾胃都旺盛，就能进食且身体丰满；脾胃都虚弱，就不能进食且身体消瘦，或者吃得少却发胖，虽然肥胖但四肢无力抬举。这是因为脾虚而邪气盛。又有善于进食却消瘦的人，是因为胃中有潜伏的火邪在气分，所以能进食；脾虚则肌肉削瘦，这就是所谓的“食亦”病（一种消渴类疾病）。王叔和说：吃得多也感到饥饿，这是虚证。薛立斋先生说：人以脾胃为根本，受纳五谷，化生精液，其中清的部分进入营分，浊的部分进入胃（此处指糟粕或浊阴），阴阳依靠这些得以调和，这就叫“冲和”。所以阳气发散于四肢，阴气运行于五脏。土气旺于四季，善于承载万物。人得到土的滋养来供养全身骨骼，身体失去土的滋养则四肢枯槁。我又说：大病之后，谷物消化、水液排出，精气散失、卫气亡失，多导致二便枯竭，应当以补中益气为要务。因为脾居中州，负责灌溉四方，与胃共同输送津液。况且大肠主管津，小肠主管液，也都禀受胃气。胃气一旦充盈，津液自然生成。我私下认为，胃气是元气的作用表现，元气是胃气的主宰。然而必须借助谷气来资助养育元气，元气既已强盛，胃气自然充盈。所以气的含义有二种：曰先天气，曰后天气。先天的是真一之气，气化生于虚无，因虚无而化生形体，这气从虚无中来；后天的是血气之气，气化生于谷物，因形体而化生气，这气从调养摄生中来。然而运化调摄正是为了保全其虚无的根本。胃气怎么可以不重视呢？
我考察张仲景的《伤寒论》：有三阴经自发的下利证，有协热下利的症状。自利属于阴寒，适宜用辛热药温里；下利属于传经之热，应当用清热之法治疗。自利的脉象微小、缓弱，是与病症相合的脉象。下利则脉象沉而有力，或洪实和缓，这是邪热入里的症状。至于所说的痢疾，《内经》称为“肠澼”，《金匮要略》称为“滞下”，这与伤寒的病机完全不同。这主要是由于湿热所致，是肠胃实积的疾病，多见于潮湿暑热蒸腾的时候。所以治法采用苦寒药物涤荡，攻逐积滞、破除瘀血。既然属于阳病，脉象就应当从阳脉诊察。我每次治疗这种病，多见脉象洪大滑数，或沉实，治疗起来容易痊愈。而如果脉象见沉小迟弱，以及浮大无力的，非常违背常理（预后不良），极其耗费心力，极力使用温补方法，才能逐渐好转。为什么高阳生的《脉诀》却说：下痢脉微小却是生机，脉大浮洪就没有痊愈的日子呢？这难道不是积热实证吗？既然是积热实证，就是阳病。阳病却出现微小的阴脉，如果投以苦寒药物，果真能保全生命吗？不通晓医理害处之大，没有比这更严重的了。虽然痢疾固然是积热实证，但如果胃气未伤，六脉有神，饮食如常，没有其他兼夹症状，七日经气尽时，重病自然痊愈。假如元气和胃气两虚，而病气独盛，尤其必须审察气机施治，必须先以扶正固元为主，稍加佐以清热之品，可以期待后续疗效。更有甚者，虚痢而脉象和病证都亏损，这就是《内经》所说的“五虚”证，这种情况势态危急困顿，让人束手无策。敢问：如果是积热为患，尚且需要清涤吗？所以薛立斋有话说：人以胃气为主，没有脾胃充实却能患疟疾痢疾的。如果专门主张发表攻里、降火导痰，这是治疗其末节而忘记了根本。以上大概是为了纠正高阳生解读脉象的错误。大抵伤寒杂病，必须观察元气的虚实。至于错认病机，只会更加支离破碎、荒谬错误罢了。
I have examined the *Neijing* (Inner Canon), which, through thousands of words, earnestly teaches that Stomach Qi (Stomach Energy) is the root. The presence of Stomach Qi indicates life; its absence indicates death. A deficiency of Stomach Qi indicates disease. It also states: The Spleen and Stomach are the root of Qi and Blood. Li Dongyuan said: If the Original Qi in the Stomach is sufficient, one can eat without injury and not feel hungry past meal times. If both the Spleen and Stomach are vigorous, one can eat and become plump; if both are deficient, one cannot eat and becomes emaciated, or eats little yet becomes fat, though with limbs unable to lift due to movement. This is because Spleen deficiency leads to an excess of pathogenic factors. There are also those who eat well but remain thin; this occurs when latent fire pathogens reside in the Qi level within the Stomach, allowing for appetite, while Spleen deficiency causes muscle wasting, a condition known as "Shi Yi" (a type of Xiao Ke/Wasting-Thirst disorder). Wang Shuhe stated: Eating much yet feeling hungry is a sign of deficiency. Mr. Xue Lijia said: Humans rely on the Spleen and Stomach as their root, receiving the five grains and transforming them into essence and fluids. The clear portion enters the Ying (Nutrient) level, while the turbid portion remains in the Stomach. Yin and Yang achieve harmony through these, termed "Chong He" (Harmonious Balance). Thus, Yang Qi manifests in the four limbs, and Yin Qi circulates within the five Zang organs. Earth Qi prospers across the four seasons and supports all things. Humans rely on Earth to nourish the bones and skeleton; losing Earth's support causes the limbs to wither. I further observe: After severe illness, when grain is digested and water eliminated, Jing (Essence) scatters and Wei (Defensive) Qi perishes, often leading to dryness and obstruction of bowel movements and urination. In such cases, tonifying the Middle and augmenting Qi is essential. This is because the Spleen resides in the Central Province, irrigating the surroundings, and together with the Stomach, transports fluids. Moreover, the Large Intestine governs Jin (Fluids), and the Small Intestine governs Ye (Thick Fluids); both derive Qi from the Stomach. Once Stomach Qi is充盈 (full/abundant), fluids generate spontaneously. I privately believe that Stomach Qi is the functional expression of Yuan Qi (Original Qi), while Yuan Qi is the master of Stomach Qi. However, it must rely on Gu Qi (Grain Qi) to nourish Yuan Qi. Once Yuan Qi is robust, Stomach Qi naturally becomes abundant. Therefore, the concept of Qi has two aspects: Pre-Heaven Qi and Post-Heaven Qi. Pre-Heaven Qi is the True One Qi, generated from emptiness, transforming form from void; this Qi comes from non-being. Post-Heaven Qi is the Qi of Blood and Qi, generated from grain, transforming Qi from form; this Qi comes from regulation and preservation. Yet, transformation and regulation serve to preserve the original state of emptiness. How can Stomach Qi be disregarded?
I examine Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage): It describes spontaneous diarrhea in the Three Yin meridians and dysentery accompanied by fever. Spontaneous diarrhea belongs to Yin-Cold and should be treated with acrid-hot warming methods; diarrhea resulting from transmitted heat should be treated with clearing and resolving methods. The pulse for spontaneous diarrhea is minute, slow, and weak, matching the syndrome. For diarrhea, the pulse is deep and forceful, or surging and full yet harmonious, indicating pathogenic heat entering the interior. As for dysentery (Li Ji), the *Neijing* calls it "Chang Pi" (Intestinal Turbidity), and the *Jingui Yaolue* calls it "Zhi Xia" (Stagnant Downward Flow), which differs significantly from the pathogenesis of cold damage diseases. Dysentery arises primarily from damp-heat and is a disease of excess accumulation in the intestines and stomach, commonly seen during humid and hot summer conditions. Therefore, treatment employs bitter-cold purgatives to cleanse, attacking accumulation and breaking stasis. Since it is a Yang disease, the pulse should be diagnosed according to Yang characteristics. In my clinical practice, this disease often presents with a surging, large, slippery, and rapid pulse, or a deep and solid pulse, making it easier to cure. Conversely, if the pulse is minute, small, slow, and weak, or floating, large, and powerless, it contradicts the expected pattern (indicating poor prognosis), requiring immense effort and intensive warming and tonification to gradually improve. Why does Gao Yangsheng’s *Mai Jue* (Pulse Classic) claim that a minute pulse in dysentery indicates life, while a surging, floating, and surging pulse indicates no hope of recovery? Is this not an excess disease of accumulated heat? If it is an excess heat disease, it is a Yang disease. If a Yang disease presents with a minute Yin pulse, and bitter-cold herbs are administered, can life truly be preserved? Ignorance of medical principles causes harm greater than anything else. Although dysentery is indeed an excess heat disease, if Stomach Qi is unharmed, the six pulses show spirit, diet is normal, and there are no other complicating symptoms, the severe illness will heal spontaneously after seven days as the meridian cycle completes. However, if both Yuan Qi and Stomach Qi are deficient while pathogenic Qi is rampant, one must carefully assess Qi before treating, prioritizing supporting the Original Qi, with slight adjuvants of heat-clearing agents, to expect subsequent efficacy. Even more critically, in deficiency-type dysentery where both pulse and syndrome indicate depletion, this corresponds to the "Five Deficiencies" described in the *Neijing*, representing a critical and desperate situation leaving practitioners helpless. One might ask: If the pathology is accumulated heat, does it still require cleansing? Thus, Xue Lijia stated: Humans rely on Stomach Qi as their mainstay; there are no cases where robust Spleen and Stomach function lead to malaria or dysentery. To exclusively advocate releasing the exterior, purging the interior, descending fire, or guiding out phlegm is to treat the branch while forgetting the root. The above remarks aim to correct the errors in Gao Yangsheng’s interpretation of pulses. Generally, in cold damage and miscellaneous diseases, one must inspect the deficiency or excess of Yuan Qi. Misidentifying the pathogenesis only leads to fragmented and absurd errors.