赵以德云∶松江一男子年三十余，胸腹胀大，发烦躁渴，面赤不得卧而足冷。余以
其人
素饮酒，必酒后入内，夺于所用，精气溢下，邪气因从之上逆，逆则阴气在上，是生 胀。
浊气在上，清气在下，则生 胀。其上焦之阳，因下逆之邪所迫，壅塞于上，故发烦躁。
此因
邪从下上而盛于上者也。于是用吴茱萸、附子、人参辈，以退阴逆水邪；冷冻饮料之，以解上焦
之浮热，
入咽觉胸中顿爽，少时腹中气转如牛吼，泄气七次，明日其证愈矣。《范氏方》云∶凡腹胀
经久，忽泻数升，昼夜不止，服药不效，乃为气脱。宜用益智仁煎浓汤服之立愈。
今人只知脾胃虚则当补，补之不应，则补其母，如是足矣。而不知更有妙处，补肾是也
。赵养葵云∶补脾不若补肾，果肾虚，命火微弱，用八味丸为要方，许叔微之二神丸法亦妙
。脾土
克肾水不相为用，如何反补其所胜以滋肝木，曰∶不然，此其妙正在相克处也。五行以
相克为用，所以《尚书》大禹谟说个水火金木土谷惟修，此圣人立言之妙，其说长甚。
今
且以水与土言之，水不得土，何处发出，何处安着，土不得水，却是一个燥坌，物事如何
生出，万物以水土相滋，动植化生，此造化相克之妙，而医家所以谓脾为太阴湿土，湿之一
字，分明土
全赖水为用也。故曰补脾必先补肾。至于肾精不足，则又须补之以味，故古人又谓补肾不
若补脾。二言各有妙理，不可偏废也。
《本事方》云∶有人全不进食，服补脾药皆不效。余授二神丸方服之，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，置诸米谷，下无火
力，
终日米不能熟，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。
《岩氏济生方》云∶人之有生，不善摄养，房劳过度，真阳衰虚，坎火不温，不能上蒸
脾土，
冲和失布，中州不运，是以饮食不进，胸膈痞塞，或不食而胀满，或食不消，大腑溏泄。古
人云∶补肾不如补脾，余谓补脾不如补肾。肾气若壮，丹田火盛，益火之原，以消阴翳。上
蒸脾土，脾土温和，中焦自治，膈开能食矣。
按∶许岩之说，皆与余说冥合。然却不知水土相滋之妙，故犹谆谆以火为言，是混水火
为一途
也。薛氏云∶余尝病脾胃，服补药及针灸脾俞等穴，不应，几殆。吾乡卢丹谷先生令余服八
味丸
，饮食果进，三料而平。余兄年逾四十，貌丰气弱，遇风则眩，劳则口苦生疮，胸尝有痰，
目尝
赤涩。又一人脾虚发肿，皆以八味丸服之而愈。此皆补肾之明验也。杨仁斋医学，恐当在丹
溪之右。有云∶脾肾之气交通，则水谷自然克化，其见亦及此。
赵以德说：松江有一位三十多岁的男子，胸部和腹部胀大，发作时烦躁口渴，面色发红无法躺卧，但双脚冰冷。我因为这个人平时爱喝酒，必定是酒后行房事，导致精气外泄，邪气因此从下向上逆行，逆乱则阴气停留在上部，从而产生胀病。浊气滞留于上部，清气沉陷于下部，就会发生胀病。他的上焦阳气，被下方逆上的邪气逼迫，壅塞在上方，所以出现烦躁症状。这是邪气从下向上并在上方盛行的情况。于是使用吴茱萸、附子、人参等药物，来消退阴寒逆乱和水湿邪气；将药液冷冻后服用，以解除上焦的浮热，药液咽下后感觉胸中顿时清爽，过了一会儿腹中气体转动发出如牛吼般的声音，排气七次，第二天病症就好了。《范氏方》说：凡是腹胀经久不愈，突然腹泻数升，昼夜不停，服药无效，这就是气脱证。适宜用益智仁煎煮浓汤服用，立刻痊愈。
现在的人只知道脾胃虚弱应当进补，如果补脾没有效果，就补益其母脏（肾），认为这样就足够了。却不知道还有更奥妙的方法，那就是补肾。赵养葵说：补脾不如补肾，如果是肾虚，命门之火微弱，八味丸是关键方剂，许叔微的二神丸方法也很奇妙。脾土克制肾水，二者不相为用，为什么反而要补益被克制的对象以滋养肝木呢？回答说：不对，这其中的奥妙正是在于相克的关系中。五行以相克为作用机制，所以《尚书·大禹谟》中说“水火金木土谷惟修”，这是圣人立言的奥妙，道理深远。现在暂且用水与土来说明，水如果没有土，从哪里发出，又安顿在哪里？土如果没有水，只是一个干燥的尘土，事物如何能生长？万物依靠水土相互滋养生息，动植物的化生，这是造化中相克的奥妙，而医家所以说脾是太阴湿土，“湿”这个字，分明表明土完全依赖水的作用。所以说补脾必须先补肾。至于肾精不足，则又需要用厚味的药物来补益，所以古人又说补肾不如补脾。这两句话各有妙理，不可偏废。
《本事方》说：有人完全不能进食，服用补脾药物都没有效果。我传授二神丸方给他服用，立刻能够进食，这种病不能完全当作脾气虚来治疗。这是因为肾气怯弱，真元衰败削弱，所以不能消化饮食。好比鼎釜之中，放置米谷，下面没有火力，整天米也不能煮熟，怎么能消化呢？黄鲁直曾记载服用菟丝子，淘洗干净后用酒浸泡晒干，每天挑几匙，用酒送服，十多天后，饮食如同热水浇雪般容易消化。也是懂得这个道理。
《岩氏济生方》说：人活着之后，如果不善于调养，房劳过度，导致真阳衰虚，肾中命火不温，不能向上蒸腾脾土，冲和之气失于布散，中焦运化失常，所以饮食不进，胸膈痞塞，或者不吃东西也感到胀满，或者吃了不消化，大便溏泄。古人说：补肾不如补脾，我认为补脾不如补肾。肾气如果强壮，丹田火旺盛，通过益火之源来消除阴翳，向上蒸腾脾土，脾土温和，中焦自然调理，膈部开通就能进食了。
按语：许岩的说法，都与我所说的暗中契合。然而他不知道水土相互滋生的奥妙，所以还谆谆教导以火为主，这是混淆了水和火为一途。薛氏说：我曾经患脾胃病，服用补药及针灸脾俞等穴位，都没有效果，几乎危及生命。我同乡的卢丹谷先生让我服用八味丸，饮食果然增进，服用三料后病情平复。我的哥哥年过四十，体态丰满但气力虚弱，遇到风就头晕，劳累后口苦生疮，胸口常有痰，眼睛常发赤涩。还有一个人脾虚导致浮肿，都用八味丸服用而痊愈。这些都是补肾的明显验证。杨仁斋的医学造诣，恐怕应当在朱丹溪之上。他说：脾肾之气交通，则水谷自然消化，他的见解也达到了这一层次。
Zhao Yi-de said: A man in Songjiang, over thirty years old, suffered from abdominal distension and swelling. He experienced irritability, thirst, a red face, inability to lie down, yet his feet were cold. Since he habitually drank alcohol, I presumed that after drinking, he engaged in sexual activity, leading to the leakage of essence and vital energy. Consequently, pathogenic factors ascended from below due to this reversal. When Qi reverses, Yin Qi remains in the upper body, giving rise to distension (Zhang). When turbid Qi stays in the upper part and clear Qi sinks to the lower part, distension occurs. The Yang Qi of the Upper Jiao (Upper Burner), pressured by the ascending pathogenic factors from below, became congested in the upper region, causing irritability. This was a case where pathogens ascended from below and prevailed in the upper area. Therefore, I used herbs such as Evodiae Fructus (Wuzhuyu), Aconiti Lateralis Radix Praeparata (Fuzi), and Ginseng Radix et Rhizoma (Renshen) to dispel the reverse flow of Yin and water-dampness; the decoction was cooled before administration to resolve the floating heat in the Upper Jiao. Upon swallowing, he felt immediate relief in his chest. Shortly after, gas moved in his abdomen with a sound like a bellowing ox, and he passed flatus seven times. By the next day, his symptoms had resolved. *Fan's Formulas* states: For chronic abdominal distension that suddenly leads to profuse diarrhea, lasting day and night, unresponsive to medication, this indicates collapse of Qi. It is appropriate to use Alpiniae Oxyphyllae Fructus (Yizhiren) decocted into a strong soup, which will bring about an immediate cure.
People nowadays only know that when Spleen and Stomach are deficient, one should tonify them. If tonifying the Spleen is ineffective, they tonify its mother organ (Kidney), believing this suffices. They do not realize there is a more profound method: tonifying the Kidney. Zhao Yangkui stated: Tonifying the Spleen is inferior to tonifying the Kidney. If Kidney deficiency exists with weak Mingmen Fire (Gate of Vitality Fire), Bawei Wan (Eight-Ingredient Pill) is the essential formula; Xu Shuwei’s Ershen Wan (Two-Spirit Pill) method is also excellent. Although Earth controls Water, and they may seem incompatible, why should one tonify the controlled element to nourish Liver Wood? The answer is: incorrect. The subtlety lies precisely in the controlling relationship. The Five Elements function through mutual control. Thus, the *Book of Documents* (Shangshu) in the "Great Yu's Advice" mentions "Water, Fire, Metal, Wood, Grain, and Earth must be cultivated." This is the profound meaning of the sages' words, extending deeply. Let us discuss Water and Earth. Without Earth, where does Water emerge and settle? Without Water, Earth is merely dry dust; how can things grow? All things rely on the mutual nourishment of Water and Earth for the generation of flora and fauna. This is the subtlety of creative control. Hence, physicians say the Spleen is Taiyin Wet Earth. The character "wet" clearly indicates that Earth relies entirely on Water for its function. Therefore, it is said: To tonify the Spleen, one must first tonify the Kidney. Conversely, if Kidney Essence is insufficient, it must be tonified with substantial flavors (rich-tasting herbs). Thus, ancients also said: Tonifying the Kidney is inferior to tonifying the Spleen. Both statements have their profound logic and should not be neglected.
*Benshi Fang* states: Someone could not eat at all, and Spleen-tonifying medicines were ineffective. I prescribed Ershen Wan, and he immediately regained his appetite. This condition cannot be treated solely as Spleen Qi deficiency. It is because Kidney Qi is timid and True Yuan (Original Essence) is depleted, rendering digestion impossible. It is like placing grain in a pot without fire underneath; the grain cannot cook all day, let alone digest. Huang Luzhi recorded taking Cuscutae Semen (Tusizi), washed clean, soaked in wine, dried, and taken daily with wine. After ten days, food was digested as easily as snow melting in hot water. This demonstrates understanding of this principle.
*Yan Shi Jisheng Fang* states: Humans who fail to nurture themselves properly, engaging in excessive sexual activity, suffer from depletion of True Yang and weakness of Kan Fire (Kidney Fire). This fire fails to warm and steam the Spleen Earth upwards, disrupting the harmonious distribution of Qi. The Middle Jiao fails to transport, leading to loss of appetite, chest oppression, bloating even without eating, indigestion, and loose stools. Ancients said: Tonifying the Kidney is inferior to tonifying the Spleen. I argue: Tonifying the Spleen is inferior to tonifying the Kidney. If Kidney Qi is strong, Dantian Fire is vigorous, benefiting the source of Fire to dissipate Yin shadows. This steams the Spleen Earth upwards; as the Spleen Earth becomes warm, the Middle Jiao regulates itself, the diaphragm opens, and eating becomes possible.
Note: Xu Yan’s views align closely with mine. However, he ignores the subtlety of Water and Earth mutually nourishing each other, thus focusing excessively on Fire, conflating Water and Fire into one pathway. Xue Ji stated: I once suffered from Spleen and Stomach disorders. Medicinal tonification and acupuncture at Pishu (BL20) were ineffective, nearly proving fatal. Mr. Lu Danggu from my hometown advised me to take Bawei Wan. My diet improved, and after three doses, I recovered. My brother, over forty, had a robust appearance but weak Qi, suffered dizziness upon exposure to wind, bitter taste and mouth sores after exertion, phlegm in the chest, and red, gritty eyes. Another patient with Spleen deficiency edema was cured using Bawei Wan. These are clear validations of the efficacy of tonifying the Kidney. Yang Renzhai’s medical expertise likely surpasses that of Zhu Danxi. He stated: When Spleen and Kidney Qi communicate, food and drink are naturally transformed. His insight reached this level.