内伤劳倦饮食之证，固与风寒暑湿之病
不同矣，然劳倦伤与饮食伤，又岂无可辨者哉！以劳倦言之，经云∶阴虚生内热。又云∶有所劳倦，形气衰少，
谷气不盛，上焦不行，下脘不通，胃气热熏胸中，故内热，此内伤之原也。然人身阴阳，有以表里言者，有以
上下之分言者，有以升降呼吸之气言者。此所谓阴虚之阴，盖劳过则气化为火，水谷之味因而少入，是故阳愈
盛，阴愈衰也 盖指身中之阴气，与水谷之味耳。夫劳倦饮食损伤气分，既有阴气阳气之分，则思虑色欲损伤
血分，又岂无有阴血阳血之异乎？以此见，血阴气阳者，分阴分阳之义也；气血各自有阴阳者，阴阳互为其根
之理也。大法阳气虚者，宜桂、附、兼参、附峻补；阴气虚者，参、术、甘草缓而益之；阴分血虚者，生地、
玄参，龟版、知母、黄柏补之；阳分血虚者，茯苓、参、归、远志之类补之。论至于此，东垣、丹溪之功大矣哉
或以下焦阴分为言，或以肾水真阴为言，皆非也。夫有所劳倦者，过动属火也；形气衰少者，壮火食气也；谷
气不盛者，劳伤元气则少食而气衰也；上焦不行者，清阳不升也；下脘不通者，浊阴不降也。夫胃受水谷，惟阳
升阴降，而后变化出入以滋荣一身，今胃不善纳而气衰少，则清无升浊无降矣。故曰上焦不行，下脘不通。然
非谓绝不行不通也，但比之平人则谓之不行不通耳。上不行下不通则郁矣，郁则少火皆成壮火，而胃居上焦下脘
两者之间，故胃气热，热则上炎，故熏胸中而为内热也。内伤始病热中，末传寒中，阴盛生寒中，多因调治差
误，或妄下之所致。遇寒则四肢厥冷，心胃绞痛，冷汗自出，乃胃之脾胃虚也，宜辛热温药理中下二焦 劳则
气耗气短，喘且汗出，内外皆越，故气耗矣。气耗则火旺，火旺则乘其脾土，脾主四肢，烦热无力，懒于语言，
动作喘乏，表热或表虚恶寒，心烦不眠。劳役初病，少食，小便赤黄，大便或闭或结或虚坐，只见些少白脓，
时有下气，或泄白或黄如糜，苦心下痞塞，或加胃脘当心而痛如刀割之状，有时上支两胁痛，必脐下相火上行，
使阳明经气逆胸中，甚则高喘，但病每互出不并作，与外感异耳。宜安心静养，心之意即真土，意虑不宁，
则脾劳矣 以甘寒泻其热火，以酸味收其散气，以甘温补其中。经言，劳者温之，损者益之，是也。平人脉大
为劳脉，极虚亦为劳。夫劳之为病，其脉浮大，手足烦热，春夏剧秋冬瘥。脉大者，热邪也；极虚者，气损也；
春夏剧者，时助邪也；秋冬瘥者，时胜邪也。以建中补中治之，亦温之之意也。经曰∶湿能除大热，是也。
虽然，劳倦亦有二焉，劳力纯乎伤气而无汗者，补中益气之旨也。夫脾胃虚者，因饮食劳倦，心火亢甚而乘其
土位，其次肺气受邪。须用黄 最多，人参、甘草次之。脾胃一虚，肺气先绝，故用黄 以益皮毛而闭腠理，
不令自汗上喘气短；损其元气，人参以补之∶心火乘脾，炙甘草之甘温以泻火热而补脾胃中元气。若脾胃急痛，
腹中急缩者，宜多用之。经曰∶急者缓之。白术苦甘温，除胃中热，利腰脐间血。胃中清气在下，升麻、柴
胡以引之，引黄 、甘草甘温之气味上升，能补卫气之散解而实其表也，又缓带脉之缩急，二味苦平，味之薄
者，阴中之阳，引清气上升也。气乱于胸中，为清浊相干，用陈皮以理之，又能助阳气之升，以散滞气，助
诸甘辛为用也。脾胃气虚，不能升浮，为阴伤其生发之气，荣血大亏，营气不荣，阴火炽盛，是血中伏火日渐
煎熬，气血日减。心主血，血减则心无所养，致使心乱而烦，病名曰 。 者，心惑而烦闷不安也。故加辛甘
微温之剂生阳气，阳旺则能生阴血，更以当归和之。伤之重者，一日连进二服，得阴阳和而汗自出，病可已矣，
然非发散之谓也 劳心兼伤乎血，而有汗者，黄 建中之义。心力俱劳，气血俱伤者，双和散之所由名也。凡
诸益气汤、保元汤之类，皆自补中、建中而推之也。凡归脾汤、养心汤，及节斋新立二方之类，皆自双和而推
之也 又房劳伤肾，证与劳倦相似；均一内伤发热证也，劳倦因阳气之下陷，宜补其气以升提之；
房劳因阳火之上升，宜滋其阴以降下之。一升一降，迥然不同矣（详发热）。七情动气，脉与饮食无二，盖饮
食七情，俱能闭塞三焦，熏蒸肺胃，清道肺为气主，由是而失其宣化之常，所以气口独紧且盛，其证呕泄痞
满腹痛，亦太相似。但伤食恶食，七情虽作饱亦不恶食，临时消息问察 俱不可不细辨之。兹述其略，尚当于
各类融会而贯通之可也。以饮食伤者言之，经云∶因而大饮则气逆，因而饱食，筋脉横解，则肠癖为痔。盖饮
者，无形之气，伤之则宜发汗，利小便，使上下分消其湿，解醒汤、五苓散之类是也。酒之气味俱阳，若以大
热大寒之药下之，是无形之气受伤，而反下有形阴血，致损真水，阳毒太旺，愈增阴火冲上，元气消亡，七神
何根据？虽不即死，而虚损之病成矣。所以酒疸不许下，下之久久成黑疸，盖以此也，食者，有形之物，伤之则
宜损其谷，其次莫若消导，丁香烂饭丸、枳术丸之类主之；稍重则攻化，三棱消积丸、木香见 丸之类主之；
尤重者，则或吐或下，瓜蒂散、备急丸之类主之，此大法也。条分缕析，其间有大饥伤饱而无停滞者，或饮食
不调之后加之劳力，或劳力过度之后继以不调，皆谓之不足，而当补益者也。有自己喜食，或与人斗食而停滞
者，此为有余，而当消导者也。又有伤生冷硬物者，有伤辛辣热物者，或热物多而寒物少，或寒物多而热物少，
或先食热物而后食冷物，以致前食热物亦不消化，所伤之不同如此，安可以执一乎？况人之气禀盛衰，每每相
反，有物滞气伤，必补益消导兼行者；有物暂滞而气不甚伤，宜消导独行不须补益者；有既停滞而复自化，不
须消导，但当补益，或亦不须补益者。洁古、东垣枳术丸之类，虽曰消导，固有补益之意存乎其间。方以白术
甘苦温，甘温补脾之元气，苦味除胃中之湿热，利腰脐间血，故先补脾胃之弱，过于枳实克化之药一倍。枳实
味苦寒，泄心下之痞闷，消化胃中所伤，此药下胃，其所伤不能即去须待一、两时辰许则消化，是先补其虚，
而后化其所伤，则不峻利矣。荷叶中空象震，震者，动也，人感之生。足少阳甲胆者，风也，生化万物之根蒂
也。《内经》云∶立端于始，序则不愆，人之饮食入胃，营气上行，即少阳甲胆之气也。其手少阳三焦经之司，
胃气、谷气、元气，甲胆上升之气一也。荷叶空青而象风木，食药感此气之化，胃气何由不上升乎？更以烧饭
和药，与白术协力滋养，令胃浓再不至内伤。若伤热用丁香、巴豆热药，伤冷用大黄、牵牛寒药，不但遗留药
毒，重泻元气，又且饮食伤中焦，而反泻上焦清气，暗损人寿，不得终其天年，但人不自觉耳 其他如木香分
气丸、导气枳实丸、大枳壳丸之类，虽无补益，然施之于物暂滞，气不甚伤者，岂不可哉！但不宜视为通行之
药尔。且所滞之物，非枳术丸之力所能去者，亦安可泥于消导而弗之变乎？故备急丸、瓜蒂散等之推逐者，
亦未尝委之而弗用也。故善用兵者，攻亦当，守亦当；不善者，则宜攻而守，宜守而攻，其败也，非兵之罪，
用兵者之罪耳。观乎此，则知消导补益推逐之理矣。吁！均一内伤也，劳倦不足一而已矣。饮食有有余不足之
分焉，误用补益，则甘温助湿生痰，变生呕泻胀满危证；误用推逐，重伤元气，脱下而死。利害匪轻如此，
故妄缀之为内伤辨。
内伤中因劳倦和饮食不当引起的病证，固然与风寒暑湿等外感病不同。然而，劳倦损伤与饮食损伤之间，难道就没有可以辨别的地方吗？
从劳倦方面来说，《内经》说：“阴虚则生内热。”又说：“由于过度劳倦，形体正气衰弱减少，水谷精微之气不旺盛，导致上焦气机不通畅，下脘（胃之下口）传导不利，胃中热气熏蒸于胸中，所以产生内热，这就是内伤的根源。”
然而，人身体的阴阳，有从表里角度论述的，有从上下的角度划分的，也有从升降呼吸之气的角度分析的。这里所说的“阴虚”之阴，大概是指身体中的阴气以及水谷的精微物质罢了。因为过度劳累会使气化功能转化为火邪，同时水谷摄入减少，因此阳气越盛，阴气越衰。这指的是体内的阴气与水谷精微。
既然劳倦和饮食损伤了气分，既有阴气和阳气的区别，那么思虑过度、房事不节损伤血分，难道没有阴血和阳血的区别吗？由此可见，“血属阴、气属阳”是区分阴分和阳分的意义；而“气血各自包含阴阳”，则是阴阳互为其根本的道理。
治疗的大法：阳气虚者，适宜用桂枝、附子，配合人参、附子进行峻补；阴气虚者，用人参、白术、甘草缓慢调补；阴分血虚者，用地黄、玄参、龟板、知母、黄柏来滋补；阳分血虚者，用茯苓、人参、当归、远志之类来补益。
谈到此处，李东垣、朱丹溪的贡献真是巨大啊！但有些人只以下焦阴分为言，或以肾水真阴为言，这都是不对的。
所谓“有所劳倦”，是指过度活动属于火邪范畴；“形气衰少”，是指壮火食气（亢盛的火邪消耗元气）；“谷气不盛”，是因为劳伤元气导致食欲减退、气力衰弱；“上焦不行”，是指清阳之气不能上升；“下脘不通”，是指浊阴之气不能下降。
胃接受水谷，只有阳气上升、阴气下降，才能完成变化出入的过程以滋养全身。现在胃受纳功能不良且气力衰弱，就会导致清气不升、浊气不降。所以说“上焦不行，下脘不通”。但这并不是说完全不通，只是相对于正常人而言称为不通。上焦不清、下焦不畅就会郁结，郁结则少火（生理之火）都变成壮火（病理之火），而胃位于上焦和下脘两者之间，所以胃气发热，热势上炎，熏蒸胸中从而产生内热。
内伤病初期表现为热中（热证），后期传变为寒中（寒证）。阴盛产生的寒中，多因调理治疗失误，或误用攻下法所致。遇到寒冷则四肢厥冷，心胃绞痛，冷汗自出，这是脾胃虚寒的表现，适宜用辛热温里的药物调理中下二焦。
劳倦会导致气耗散，出现气短、喘息且出汗，内外之气皆外越，所以称为气耗。气耗则虚火旺，虚火旺则乘袭脾土。脾主四肢，故见烦热无力、懒于说话、动作时气喘乏力，体表发热或表虚恶寒，心烦失眠。
劳役初起，表现为少食，小便赤黄，大便或闭结或虚坐努责，仅见少量白脓，时有排气，或泄泻白色或黄色如糜状之物。苦闷于心下痞塞，或伴有胃脘当心处疼痛如刀割状，有时向上牵引两胁疼痛，这是因为脐下相火上冲，使阳明经气逆乱于胸中，严重时甚至高喘。但这些症状往往交替出现而不是一起发作，这与外感病不同。
治疗方法宜安心静养。心之意即真土（脾），意念不宁则脾劳。应用甘寒药清泻火热，用酸味药收敛散失之气，用甘温药补益中气。《内经》说：“劳者温之，损者益之”，正是此意。
平时人脉象大为劳脉，极虚也是劳脉。劳病的脉象浮大，手足烦热，春夏季节病情加重，秋冬季节减轻。脉大代表热邪；极虚代表气损；春夏加重是因为时令助长邪气；秋冬减轻是因为时令克制邪气。用建中汤、补中益气汤治疗，也是“温之”的意思。《内经》说：“湿能除大热”，也是这个道理。
虽然如此，劳倦也有两种情况：劳力过度纯粹伤气且无汗的，符合补中益气汤的宗旨。
脾胃虚弱的人，因饮食劳倦，导致心火亢盛而乘袭脾土，其次肺气也受邪。此时须重用黄芪，人参、甘草次之。脾胃一虚，肺气先绝，所以用黄芪来益皮毛、固腠理，防止自汗、上喘、气短；元气受损，用人参来补益；心火乘脾，用炙甘草的甘温之性来泻火热并补益脾胃中气。如果脾胃急痛，腹中拘急收缩，应多用此类药物。《内经》说：“急者缓之”。白术苦甘温，能除胃中湿热，利腰脐间血。胃中清气在下陷，用升麻、柴胡来引举，引导黄芪、甘草甘温的气味上升，能补益卫气的散解并充实肌表，又能缓解带脉的拘急。这两味药味薄，属阴中之阳，能引导清气上升。
气乱于胸中，造成清浊相干，用陈皮来理气，又能助阳气上升，疏散滞气，辅助各种甘辛药物发挥作用。
脾胃气虚，不能升浮，被阴邪损伤了生发之气，营血大亏，营气不荣，阴火炽盛，这是血中伏火日渐煎熬，导致气血日渐减少。心主血，血减则心无所养，致使心神紊乱而烦躁，这种病名叫“心悸”（注：原文此处缺字，根据上下文及中医理论推测为“悸”或类似描述心神不安的词，此处依文意译为心神不安/心悸）。悸，就是心中困惑而烦闷不安。所以加入辛甘微温的药物以生阳气，阳气旺盛则能生阴血，再加当归调和。
病情严重者，一天连续服用两次，待阴阳调和后自然出汗，病即可愈，但这并非发散解表之意。
劳心兼伤血且有汗的，符合黄芪建中汤的意义。心力与体力俱劳，气血俱伤的，这就是双和散的命名由来。凡是各类益气汤、保元汤之类，都是从补中益气汤、建中汤推演而来的。凡是归脾汤、养心汤，以及节斋新立的两个方子之类，都是从双和汤推演而来的。
另外，房劳伤肾，其证候与劳倦相似，都是内伤发热证。但劳倦是因阳气下陷，适宜补气以升提；房劳是因阳火上升，适宜滋阴以降下。一升一降，截然不同（详见发热篇）。
七情扰动气机，脉象与饮食损伤无异。因为饮食和七情都能闭塞三焦，熏蒸肺胃。肺为气之主，清道由此而失去宣发化生的常态，所以气口脉独紧且盛。其症状呕吐、泄泻、痞满、腹痛，也与饮食损伤太相似。但是伤食者厌恶食物，七情致病即使感觉饱胀也不厌恶食物，需临时斟酌询问察辨。
以上简述其略，还应当在各类病症中融会贯通。
从饮食损伤来说，《内经》说：“因而大饮则气逆，因而饱食，筋脉横解，则肠癖为痔。”饮酒属于无形之气，损伤后适宜发汗、利小便，使湿气上下分消，解醒汤、五苓散之类即是此法。酒的气味均属阳，若用大热大寒的药攻下，是无形之气受伤，反而攻下有形的阴血，导致真水受损，阳毒太旺，更加增加阴火冲上，元气消亡，七神何所依托？虽然不立即死亡，但会形成虚损病。所以酒疸不许用攻下法，误下久久会变成黑疸，就是这个原因。
进食属于有形之物，损伤后适宜损耗谷物积滞，其次不如消导法，丁香烂饭丸、枳术丸之类主治；稍重则攻积化滞，三棱消积丸、木香见肿疔丸（注：原文“木香见 丸”疑为脱字，通常指木香槟榔丸或类似行气消积方，此处保留原意译法或通用名）之类主治；特别重的，则或用吐法或用下法，瓜蒂散、备急丸之类主治，这是大法。
条分缕析，其中有因极度饥饿后暴食而无停滞的，或在饮食不调之后加上劳力，或劳力过度之后继以饮食不调，这些都称为不足，应当补益。有自己喜欢多吃，或与人争食而导致停滞的，此为有余，应当消导。又有损伤生冷硬物的，有损伤辛辣热物的，或热物多寒物少，或寒物多热物少，或先吃热物后吃冷物，导致前食的热物也不能消化，所伤的不同如此，怎么能固执一端呢？
况且人的体质盛衰，每每相反。有的物滞气伤，必须补益与消导兼行；有的物暂滞而气不甚伤，适宜单独消导不需补益；有的既停滞又自行化解，不需要消导，只需补益，或者也不需要补益。洁古、东垣的枳术丸之类，虽说是消导，固有补益之意存乎其中。方中以白术甘苦温，甘温补脾之元气，苦味除胃中之湿热，利腰脐间血，所以先补脾胃之弱，力量超过枳实克化药一倍。枳实味苦寒，泄心下痞闷，消化胃中所伤，此药入胃，所伤之物不能立即去除，须待一至两个时辰左右才消化，这是先补其虚，而后化其所伤，就不峻烈了。
荷叶中空像震卦，震者动也，人感之而生足少阳甲胆之气，风也，是生化万物之根蒂。《内经》说：“立端于始，序则不愆”，人之饮食入胃，营气上行，即少阳甲胆之气也。由手少阳三焦经主管，胃气、谷气、元气、甲胆上升之气是一回事。荷叶空青而象风木，食药感此气之化，胃气怎能不上升呢？再用烧饭和药，与白术协力滋养，令胃气浓厚，再不至内伤。
如果伤热用丁香、巴豆等热药，伤冷用大黄、牵牛等寒药，不但遗留药毒，重伤元气，而且饮食伤在中焦，反而泻上焦清气，暗中损害寿命，不得终其天年，只是人自己不觉察罢了。其他如木香分气丸、导气枳实丸、大枳壳丸之类，虽然没有补益作用，但施用于物暂滞、气不甚伤者，难道不可以吗！只是不宜将其视为通用的通行药罢了。况且所滞之物，不是枳术丸之力所能去除的，又怎能拘泥于消导而不改变方法呢？所以备急丸、瓜蒂散等推逐之法，也未尝弃而不用。
所以善用兵者，攻亦当，守亦当；不善者，则宜攻而守，宜守而攻，其败也，非兵之罪，是用兵者的罪过。观于此，就知道消导、补益、推逐的道理了。唉！同样是内伤，劳倦不足一种而已。饮食有有余、不足之分，误用补益，则甘温助湿生痰，变生呕泻胀满等危重证候；误用推逐，重伤元气，脱下而死。利害如此重大，所以妄加撰写此文作为内伤辨。
The syndromes of internal injury caused by fatigue, overwork, and dietary irregularities are indeed different from diseases caused by external pathogenic factors such as wind, cold, summer-heat, and dampness. However, is there no way to distinguish between injuries caused by fatigue and those caused by diet?
Speaking of fatigue, the *Classic of Internal Medicine* (*Huangdi Neijing*) states: "Yin deficiency generates internal heat." It also says: "Due to excessive fatigue, the form and vital energy decline, the Qi of grain and water becomes insufficient, the Upper Jiao fails to function, and the lower stomach (pylorus) fails to transmit. The heat of Stomach Qi steams the chest, thus generating internal heat; this is the origin of internal injury."
However, Yin and Yang in the human body can be discussed from the perspective of exterior and interior, from the division of upper and lower parts, or from the ascending and descending and breathing Qi. The "Yin" referred to here as "Yin deficiency" generally refers to the Yin Qi within the body and the essence of grain and water. Excessive labor causes Qi transformation to turn into Fire, while the intake of food and drink decreases; therefore, Yang becomes more abundant, and Yin becomes more deficient. This refers to the body's Yin Qi and the essence of food and drink.
Since fatigue and dietary injuries damage the Qi aspect, having distinctions between Yin Qi and Yang Qi, do injuries to the Blood aspect caused by excessive thinking and sexual indulgence not have distinctions between Yin Blood and Yang Blood? From this, we see that "Blood is Yin, Qi is Yang" reflects the meaning of distinguishing Yin and Yang aspects; while "Qi and Blood each contain Yin and Yang" reflects the principle that Yin and Yang are mutually rooted.
The general treatment principles are: For Qi Yang deficiency, it is appropriate to use Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root), combined with Renshen (Ginseng) and Fuzi for vigorous tonification; for Qi Yin deficiency, use Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), and Gancao (Licorice Root) for slow nourishment; for Blood deficiency in the Yin aspect, use Shengdi Huang (Rehmannia Root), Xuanshen (Scrophularia Root), Guiban (Tortoise Shell), Zhimu (Anemarrhena Rhizome), and Huangbai (Phellodendron Bark) for tonification; for Blood deficiency in the Yang aspect, use Fuling (Poria), Renshen (Ginseng), Danggui (Angelica Sinensis Root), and Yuanzhi (Polygala Root) for tonification.
When discussing this, the contributions of Li Dongyuan and Zhu Danxi are truly great! However, some who speak only of the Lower Jiao Yin aspect or Kidney Water True Yin are incorrect.
"What is fatigued" refers to excessive movement belonging to the Fire category; "decline of form and Qi" refers to Hyperactive Fire consuming Qi; "insufficiency of Grain Qi" means that damaging Yuan Qi leads to reduced appetite and weak Qi; "failure of the Upper Jiao" refers to the failure of Clear Yang to ascend; "blockage of the lower stomach" refers to the failure of Turbid Yin to descend.
The Stomach receives food and drink; only when Yang ascends and Yin descends can transformation and excretion occur to nourish the whole body. Now, if the Stomach's receiving function is poor and Qi is weak, Clear Qi will not ascend and Turbid Qi will not descend. Hence it is said, "The Upper Jiao fails to function, and the lower stomach is blocked." This does not mean absolute blockage, but rather a relative state compared to normal people. If the Upper Jiao fails to clear and the Lower Jiao fails to unblock, stagnation occurs. Stagnation transforms Shaohuo (Physiological Fire) into Zhuanghuo (Pathological Fire). Since the Stomach is located between the Upper Jiao and the lower stomach, Stomach Qi becomes hot. The heat flares upward, steaming the chest and causing internal heat.
Internal injury initially presents as Re Zhong (Heat Syndrome) and later transmits to Han Zhong (Cold Syndrome). Cold syndrome generated by Yin excess often results from therapeutic errors or improper use of purgatives. Exposure to cold causes cold limbs, cardiac and gastric colic, and spontaneous cold sweating, indicating Spleen-Stomach deficiency-cold. It is appropriate to use acrid-hot warming herbs to regulate the Middle and Lower Jiao.
Fatigue consumes Qi, leading to shortness of breath, panting, and sweating, where both internal and external Qi escape; thus, it is called Qi consumption. Qi consumption leads to hyperactive Fire, which attacks the Spleen Earth. Since the Spleen governs the four limbs, symptoms include irritability, weakness, reluctance to speak, panting and fatigue upon movement, surface heat or aversion to cold due to surface deficiency, irritability, and insomnia.
In the early stage of occupational fatigue, there is poor appetite, dark yellow urine, constipation or tenesmus with only small amounts of white pus, frequent flatulence, or diarrhea of white or yellow porridge-like stool. There is bitter sensation and epigastric fullness, or pain in the epigastrium like knife-cutting, sometimes radiating to both hypochondria. This is due to Minister Fire rising from below the umbilicus, causing rebellious Qi of the Yangming Meridian in the chest, and severe cases may involve high-pitched panting. These symptoms often alternate rather than appearing simultaneously, differing from external contraction.
Treatment should focus on calming the mind and resting. The intention of the Heart corresponds to True Earth (Spleen); restless thoughts cause Spleen fatigue. Use sweet-cold herbs to drain fire and heat, sour herbs to astringe scattered Qi, and sweet-warm herbs to tonify the Middle. The Classic states: "For fatigue, use warmth; for deficiency, use tonification." This is correct. In healthy individuals, a large pulse indicates a fatigue pulse, and an extremely deficient pulse also indicates fatigue. In fatigue disease, the pulse is floating and large, with vexatious heat in hands and feet; symptoms worsen in spring and summer and improve in autumn and winter. A large pulse indicates heat pathogen; extreme deficiency indicates Qi damage; worsening in spring/summer is because the season aids the pathogen; improving in autumn/winter is because the season overcomes the pathogen. Treating with Jianzhong Tang (Middle-Building Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) follows the principle of "warming." The Classic says: "Dampness can remove great heat," which aligns with this logic.
Although so, fatigue has two types. Pure Qi injury from physical labor without sweat follows the principle of Buzhong Yiqi Tang. When Spleen-Stomach deficiency leads to hyperactive Heart Fire attacking the Spleen Earth, and subsequently the Lung Qi is affected, one must heavily use Huangqi (Astragalus Root), followed by Renshen (Ginseng) and Gancao (Licorice Root). When Spleen-Stomach is deficient, Lung Qi is first exhausted; thus, Huangqi is used to benefit the skin and hair and close the interstices to prevent spontaneous sweating, panting, and shortness of breath. To replenish damaged Yuan Qi, Renshen is used. To address Heart Fire attacking the Spleen, roasted Gancao's sweet-warm nature is used to drain fire and tonify Spleen-Stomach Yuan Qi. If there is acute Spleen-Stomach pain or abdominal constriction, these herbs should be used in larger doses. The Classic says: "For urgency, use soothing methods." Baizhu (Atractylodes Macrocephala Rhizome) is acrid-bitter-warm, clearing damp-heat in the Stomach and promoting blood flow in the waist and umbilical region. For sinking Clear Qi in the Stomach, Shengma (Cimicifuga Rhizome) and Chaihu (Bupleurum Root) are used to guide the sweet-warm aroma of Huangqi and Gancao upward, replenishing dispersed Wei Qi and consolidating the exterior, while relieving the constriction of the Dai Meridian. These two herbs are slightly flavored, representing Yang within Yin, guiding Clear Qi upward.
For Qi chaos in the chest causing confusion of Clear and Turbid, Chenpi (Tangerine Peel) is used to regulate Qi, assisting Yang Qi ascent and dispersing stagnant Qi, aiding various sweet-acrid herbs. When Spleen-Stomach Qi is deficient and cannot ascend and float, and its generating Qi is damaged by Yin pathogens, Ying Blood is severely depleted, Ying Qi fails to nourish, and Yin Fire blazes. This is latent fire in the blood slowly simmering, daily reducing Qi and Blood. The Heart governs Blood; when Blood is reduced, the Heart lacks nourishment, causing mental disorder and vexation, a condition named "Palpitations" (Ji). Ji means mental confusion and restlessness. Therefore, add acrid-sweet slightly warm agents to generate Yang Qi; when Yang is robust, it generates Yin Blood, further harmonized with Danggui (Angelica Sinensis Root). For severe cases, administer two doses per day until Yin and Yang harmonize and spontaneous sweating occurs, curing the disease; this is not meant as diaphoresis.
Mental labor combined with Blood injury with sweating follows the principle of Huangqi Jianzhong Tang. Combined mental and physical labor with Qi and Blood injury gives rise to Shuanghe San (Double Harmony Powder). All Qi-tonifying soups and Baoyuan Tang (Preserve Origin Decoction) are derived from Buzhong Yiqi Tang and Jianzhong Tang. GuiPi Tang (Restore the Spleen Decoction), Yangxin Tang (Nourish the Heart Decoction), and other newly established formulas are derived from Shuanghe San.
Furthermore, sexual exhaustion injuring the Kidney presents similarly to fatigue; both are internal injury fever syndromes. Fatigue is due to sinking of Yang Qi, requiring Qi tonification to lift; sexual exhaustion is due to rising of Yang Fire, requiring Yin nourishment to descend. One lifts, one descends; they are completely different (see Fever section).
Emotional disturbances affecting Qi present with pulses similar to dietary injuries. Both diet and emotions can block the Three Jiao and steam the Lungs and Stomach. The Lung is the master of Qi; thus, its disseminating and diffusing functions are lost, making the Qi Kou (Radial Artery at the wrist) uniquely tight and abundant. Symptoms like vomiting, diarrhea, fullness, and abdominal pain are very similar. However, food injury involves aversion to food, whereas emotional injury, even feeling full, does not involve aversion to food; temporary observation and inquiry are necessary.
Briefly described above, these should be integrated across categories. Regarding dietary injury, the Classic states: "Excessive drinking causes Qi rebellion; overeating causes tendons and vessels to relax, leading to intestinal dysentery and hemorrhoids." Alcohol is intangible Qi; injury requires diaphoresis and diuresis to disperse dampness downward and upward, using Jiejiu Tang (Alcohol Detoxification Decoction) or Wuling San (Five-Ingredient Poria Powder). Alcohol's nature is purely Yang; using extreme hot or cold purgatives damages intangible Qi while attacking tangible Yin Blood, depleting True Water, exacerbating Yang toxicity and Yin Fire rushing upward, destroying Yuan Qi and destabilizing the Seven Spirits. Though not immediately fatal, it leads to consumptive disease. Therefore, alcohol jaundice should not be treated with purgatives; prolonged misuse leads to black jaundice.
Food is tangible matter; injury requires reducing grain accumulation, preferably via digestion promotion. Dingxiang Lanfan Wan (Carnation Rotting Rice Pill) or Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) are indicated. For heavier cases, attack and transform using Sanleng Xiaoji Wan (Spotted Snailroot Accumulation-Dissipating Pill) or Muxiang Jianzhong Wan (Costus Root Middle-Joint Pill - *Note: Text likely implies a specific formula*). For severe cases, induce vomiting or purging using Goudisan (Melon Spore Powder) or Beiji Wan (Emergency Pill). These are general principles.
Analyzing carefully: Injury from starvation followed by overeating without stagnation, or fatigue after irregular diet, or irregular diet after excessive fatigue, are all deficiencies requiring tonification. Self-induced overeating or competitive eating causing stagnation are excesses requiring digestion promotion. Injuries from raw/cold/hard foods differ from spicy/hot foods. Variations in temperature ratios or sequence of ingestion affect digestion differently. How can one stick to one method? Moreover, individual constitutions vary. Some require both tonification and digestion promotion; some need only digestion promotion; some resolve spontaneously needing only tonification or none. Jiegu and Dongyuan's Zhizhu Wan, though termed digestion-promoting, contains tonifying intent. Baizhu is sweet-bitter-warm; sweet-warm tonifies Spleen Yuan Qi, bitter clears Stomach damp-heat, benefiting waist/umbilical blood. It tonifies Spleen-Stomach weakness twice as effectively as Zhishi (Immature Bitter Orange) which breaks down accumulation. Zhishi is bitter-cold, draining epigastric fullness and digesting Stomach injury. It takes 1-2 hours to work, implying tonifying deficiency first, then resolving injury, avoiding harshness.
Lotus leaf is hollow like Zhen (Thunder), representing movement. It resonates with Shaoyang Gallbladder Qi (Wind), the root of generation. The Classic says: "Establish the beginning, order follows without error." Food entering the Stomach, Ying Qi ascends, corresponding to Shaoyang Gallbladder Qi. Hand Shaoyang Sanjiao Meridian governs Stomach Qi, Grain Qi, Yuan Qi, and Gallbladder ascending Qi as one. Lotus leaf resembles Wind-Wood; food and medicine sensing this Qi help Stomach Qi ascend. Cooking rice with medicine assists Baizhu in nourishing the Stomach, preventing internal injury.
Using hot herbs like Dingxiang or Badou for heat injury, or cold herbs like Dahuang or Qianni for cold injury, leaves drug toxicity, damages Yuan Qi, and drains Upper Jiao Clear Qi from Middle Jiao injury, secretly shortening life. Other formulas like Muxiang Fenqi Wan, Daoqi Zhishi Wan, etc., lack tonification but are suitable for transient stagnation with mild Qi damage, provided they are not viewed as universal promoters. If stagnation exceeds Zhizhu Wan's capacity, one must change methods. Thus, Beiji Wan and Goudisan are not discarded.
Skilled generals know when to attack and defend; failures lie with the commander, not the troops. Understanding this clarifies digestion, tonification, and purgation. Alas! Internal injury includes not just fatigue. Diet has excess and deficiency. Misusing tonification creates phlegm-dampness via sweet-warm herbs, leading to vomiting, diarrhea, and distension. Misusing purgatives damages Yuan Qi, causing collapse and death. The stakes are high; hence this treatise on distinguishing internal injury.