脉
古人以脉辨内外伤于人迎、气口。人迎脉大于气口为内伤，气口脉大于人迎为外伤。此辨固是，但
其说有所未尽耳。外感风寒，皆有余之症，是从前客邪来也。其病必见于左手，左手主表，乃行阳
二十五度。内伤饮食，及饮食不节，劳役所伤，皆不足之症也，必见于右手，右手主里，乃行阴二十五度。
故外感寒邪，则独左寸人迎脉浮紧，按之洪大，紧者后甚于弦，是足太阳寒水之脉。按之洪
大而有力，中见于手少阴心火之脉。丁与壬合，内显洪大，乃伤寒脉也。若外感风邪，则人迎脉缓，而大
于气口一倍，（病在少阳）或二倍，（病在太阳）三倍。（病在阳明）内伤饮食，则右寸气口脉大于人迎
一倍，（病在厥阴）或两倍，（病在少阴）三倍。（病在太阴）若饮食不节，劳役过甚，则心脉变见于气口，
是心火刑肺，其肝木挟心火之势，亦来薄肺。经曰∶侮所不胜，寡于畏者。是也。故气口脉急大而数，
时一代而涩也。涩者肺之本；脉大者元气不相接也。脾胃不及之脉，洪大而数者，心肺刑肺脉也；急者肝木
挟心火，而反克肺金也。若不甚劳役，惟右关脉大而数，数中显缓，时一代也。如饮食不节，寒温失所，则先
后关脉损弱，甚则隐而不见，惟内显脾脉之大数微缓，时一代也。宿食不消，则独右关脉沉而滑。经
云∶脉滑者有宿食也。
证
东垣曰∶甚哉阴阳之证，不可不详也。偏观《内经》中所说，变化百病，其源皆由喜怒过度，饮食失节，
寒温不适，劳役所伤而然。夫元气、谷气、荣气，卫气，生发诸阳上升之气。此四者，皆饮食
入胃，谷气上行，胃气之异名，其实一也。既脾胃有伤，则中气不足。中气不足，则六腑阳气皆绝于外。
故经言∶五脏之气已缓于外者，是六腑之元气病也。气伤脏乃病，脏病形乃应，是五脏六腑真
气皆不足也。惟阴火独旺，上乘阳分，故荣卫失守，诸病生焉。其中变化，皆由中气不足。当补之证，认作
外感风寒，有余客邪之病，重泻其表，使荣卫之气外绝，其死只在旬日之间。所谓差之毫
厘，谬以千里，可不详辨乎？且如外感，则寒热齐作而无间，内伤则寒热间作而不齐。外感恶寒，虽近烈火
不除；内伤恶寒，得就温暖即解。外感恶风，乃不禁一切风寒，内伤恶风，惟恶夫些少贼
风。外感症显在鼻，故鼻气不利，而拥盛有力。内伤者不然，内伤症显在口，故口不知味，而腹中不和。
外感者无此，外感则邪气有余，发言壮厉，且先轻而后重，内伤则元气不足，出言懒怯，且先
重而后轻。外感手背热而手心不热，内伤则手心热而手背不热。外感头痛，常常有之，直须传里方罢；内伤
头痛，有时而作，有时而止。内外辨法，大要如斯。然有内伤而无外感，有外感而无内伤者。苟或内伤外感
兼病而相挟者，则从乎轻重以治之。若显内症多者，则是内伤重而外感轻，宜先补益而后散邪，以补中益气
汤为主，加散邪药。当以六经脉症参究，各加本经药治之。若显外症多者，则是外感重而内伤轻，宜先发散而
后补益，以辛凉等剂解散为君，而以参、术、茯苓、芎、归等为臣、使。以此辨之，则判然明矣。
治
王安常曰∶夫饮食劳倦伤而内热者，乃阴火乘其坤土之位，故内热以及于胸中也。《内经》有云∶劳者温
之，损者温之。惟以温药以补元气而泻火邪。盖温能除大热耳。故东垣立补中益气汤加减以治之，其惠也不
其大哉。然饮食所伤，又当分别。夫劳倦伤，饮食伤，虽与外感风寒暑湿有余之症不同，然饮食伤又与劳倦
伤不同。劳倦伤诚不足也，饮食伤尤当于不足之中，分其有余不足也。何
也？盖饥饿不饮食，与食太过，虽皆是失节，然必明其有两者之
分，方尽其理。节也者何无不及、无太过之中道也。夫饥饿不饮食者，胃气空虚，此为不足，以停滞言则有
余矣。惟其不足故补益，惟其有余故消导。亦有物滞气伤，必补益消导兼行者，亦有物暂滞
而气不甚伤，宜消导独行，不须补益者，亦有既停滞不复自化，不须消导，但当补气，或亦不须补益者。洁
古枳术丸，东垣橘皮枳术丸之类，虽曰消导，固有补益之意存乎其间耳。其他如木香分气
丸，枳实导气丸，大枳实丸之类，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
之药耳。且所滞之物，非枳实之力所能去者，亦安可泥于消导而不知变乎？故备急丸、煮黄
丸，感应丸，瓜蒂散等之推逐者，洁古、东垣亦未尝委之而费用也。故善将兵者，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。若夫劳倦伤
则纯乎补益，固不待议。虽东垣丁宁告诫，然世人犹往往以苦寒之剂，望除劳倦伤之热。及其不愈而反甚，自
甚而至危，但曰病势已极，药不能胜耳。医者、病者，主病者，一委之天命，皆懵然不悟其为妄治之失也。
呜呼！仁人君子，能不痛心也哉！
方
补中益气汤〔批〕（按此方补元气，养脾胃，升提下陷之气，治内伤之要药也）
治中气不足，肢体倦怠，口干发热，饮食无味；或饮食失节，劳倦身热，脉大而虚；或头痛恶寒自汗；
或气高而喘，身热而烦；或脉微细软弱，自汗体倦少食；或中气虚弱而不能摄血；或饮食劳
倦而患疟痢；或疟痢因脾胃虚而不能愈；或元气虚弱，感冒风寒，不胜发表，宜用此代之；或入房而
后感冒；或感冒而后入房，亦用此汤，急加附子；或泻利腹痛，急用附子理中汤。
嫩黄 （蜜水煎炒一钱半，脾胃虚，肺气先绝用之以益皮毛而闭腠理，止自汗）
人参（去芦、一钱，上喘气短，元气大虚，用以补之）
甘草（炙，一钱，甘温以泻火热而补脾胃中元气，若脾胃急痛，腹中急缩者多用之）
以上三味，除渴热、烦热之圣药也。
白术（土炒，一钱，苦甘温，除胃中热，利腰脐间血）
柴胡（五分，能使胃中之清气左旋而上达）
升麻（五分，能使胃中之满气从右而上迁）
橘红（一钱，理胸中之气，又能助阳气上升，以散滞气肋诸脾胃为用）
当归身（酒洗，一钱，用之以和血脉）
上锉一剂，生姜三片，水煎温服。或少加黄柏以救肾水，而泻阴中之伏火也。红花三分，入心养血。内
伤挟外感者，以本方为主，从六经所见之证，加减用之。如见太阳证，头项痛，腰脊强，加羌活、 本、桂
枝。如阳明，则身热，目痛，鼻干，不得眠，倍升麻、加干葛。如少阳，则胸胁痛而耳聋，加黄芩、半
夏、川芎，倍柴胡。如太阴，则腹满而嗌干，加枳实、浓朴。如少阴，则口燥舌干而渴，加生甘草、桔梗。
如厥阴，则烦满，多加川芎。如变证发斑，加葛根、玄参，倍升麻。如挟痰，加半夏、竹沥、姜汁。若头
痛，加蔓荆子，或加川芎。顶痛脑痛，加 本、细辛。诸头痛，此四味足矣。若耳鸣目黄，颊颌肿颈肩
肘臂后廉痛，面赤脉洪者，加羌活一钱，防风七分，甘草、 本各五分，通其经血。加黄芩、黄连各
三分，消肿。嗌痛颔肿，面赤，脉洪大，加桔梗七分，黄芩、甘草三分。口干嗌干，或渴
者，加葛根五分，升胃气，上行润之。心下痞闷，加芍药、黄连一钱。腹中痞闷，加枳实三分，浓朴七分，
木香、砂仁各三分。如天寒，加干姜。腹中痛者，加炒白芍药、炙甘草各三分。如
恶寒觉冷痛，加桂五分。夏月腹中痛，不恶寒反恶热者，加黄芩
五分，芍药一钱，甘草五分，以治时热。脐下痛者，加熟地一钱。如胸中滞气，加青皮五分。壅滞可用，短促
少气，去之。如身体重疼，乃风湿相搏，加羌活、防风各五分，升麻一钱，柴胡五分， 本、苍术各一钱，
中病即止。大便闭涩，加归梢一钱。病久痰嗽者，去人参，初病勿去之。冬月、春寒或秋凉，各宜加不
去节麻黄。若春温热，加沸耳草三分，款冬花一分。长夏湿土，客邪大旺，加苍术、白术、泽泻，上下
分消其湿热之气。湿热之气大胜，主食不消，故食减不知谷味。加神曲以消之，加五味子、麦
门冬，助人参泻火益肺金，助秋损也。在三伏中为圣药。胁下急或痛，俱加柴胡、甘草、人参。多唾或
唾白沫，胃口上停寒也，加益智仁。若胃脘当心痛，加草豆蔻仁三分。若食不下，乃胸中有寒，或气涩滞，加
青皮、陈皮、木香。寒月加益智仁、草豆蔻，夏月加黄芩、黄连；秋加槟榔、砂仁。若脚软乏力或痛，加
酒炒黄柏。不已，加汉防己。心烦躁，加生地黄。若气浮心乱，以朱砂安神丸镇固之，则愈。
白术散〔批〕（按此方治胃虚之剂） 治胃虚不能食，而大渴不止，不
可用淡渗药，恐胃中元气虚少故也。并治伤寒杂病，一切吐泻烦渴，霍乱，虚损气弱，及治酒积呕哕。
人参（一钱） 白术（一钱，土炒） 茯苓（一钱） 藿香（八分） 木香（五分） 葛根
（一钱） 甘草（七分）
上锉一剂，水煎温服。如饮水者，多煎与之时时服。如能食而渴者，人参白虎汤。
补气汤〔批〕（按此方治气虚之剂） 凡遇劳倦辛苦，用力过多，即服此
三、四剂，免致内伤发热之病，宜预防之。
黄 （一钱半） 人参（一钱） 白术（一钱） 麦门冬（一钱） 陈皮（一钱） 五味
子（十粒） 甘草（炙，七分）
上锉一剂，姜三片，枣二枚，水煎食前服。劳倦甚，加熟附子五分。
补血汤〔批〕（按此方治血虚之剂） 凡遇劳心思虑，损伤精神，头眩目
昏，心虚气短，惊悸烦热等症，并宜服之。
生地黄（一钱） 人参（一钱） 当归（一钱） 白芍药（炒，一钱） 茯神（一钱） 陈
皮（五分） 栀子（炒黑，五分） 酸枣仁（炒，一钱） 麦门冬（一钱） 五味子（十粒） 甘草（炙，七分）
上锉一剂，加圆眼十枚，水煎，空心服。
参苓白术散 治脾胃虚弱，饮食不进，或致呕吐泄泻，及大病后，调脾助胃，此方最宜。
白术（土炒，一钱） 人参（八分） 甘草（八分） 干山药（一钱） 白茯苓（八分）
白扁豆（一钱） 莲子肉（十个） 薏苡仁（八分） 砂仁（炒，五分） 桔梗（八分） 陈皮（一钱）
上为末，每服二钱，黑枣泡汤，空心调下。
参苓白术丸（云林制） 治病后元气虚弱，此药进美饮食，壮健身
体，充实四肢，清火化痰，解郁固本。
人参（一两） 白术（二两，土炒） 白茯苓（一两） 干山药（炒，一两） 莲肉（去
皮，二两） 陈皮（一两） 半夏（制，一两） 白扁豆（炒，一两） 薏苡仁（炒，二两） 桔
梗（二两） 黄连（姜炒，一两） 神曲（炒，一两） 香附（一两） 砂仁（五钱） 甘草（一两）
当归（一两） 远志（一两） 石菖蒲（五钱）
上为末，姜、枣煎汤，打神曲糊为丸，如梧桐子大。每服百丸，空心白汤送下，忌食生冷、油腻之物。
白术八宝丹（胡云阁传） 治一切虚损之症。
白术（半斤，二两朝阳土炒，六两熬膏） 人参（五钱，如有嗽，去之） 白茯神（去
皮木，一两半） 远志（去骨，两半） 陈皮（去白，两半） 白芍药（酒炒，两半） 神曲
（炒，一两） 麦芽（五钱）
上为末，用白术膏丸，如梧桐子大。每服一钱，或加至一钱五分，白沸汤空心送下。
白术膏 治脾胃大虚，自汗乏力，四肢怠倦，饮食不思；或食而不化，呕吐泻痢，泻下完谷白沫。
白术（一斤，去芦，火上炙一块，锉一块成片）
上用水十碗，熬汁二碗，去渣。再入水再熬，又滤出，将渣捣烂，入水再熬。如是五次，共得药汁十
碗，合一处，入白蜜半斤，再熬至稠粘，滴水成珠为度。日服二、三次，白沸汤调下。
白云膏（单孟齐传）〔批〕（按此方养元气，健脾胃，王道之剂） 调脾健胃，固本还元。
大米（一升） 糯米（一升） 山药（四两） 芡实（四两） 莲肉（去皮、心，四两）
上为细末，入白砂糖一斤半，搅和令匀，入笼蒸糕，任意食之。
脉象
古人通过人迎穴和气口穴的脉象来辨别内伤与外感。人迎脉大于气口脉属于内伤，气口脉大于人迎脉属于外感。这种辨别方法固然正确，但其中的理论尚有不完善之处。外感风寒，都属于邪气有余的病证，这是由外来客邪引起的。其病征必然出现在左手，因为左手主表，对应阳气运行二十五度。内伤饮食，以及饮食不节制、劳役过度所致的损伤，都属于正气不足的病证，其病征必然出现在右手，因为右手主里，对应阴气运行二十五度。
因此，若外感寒邪，则左寸人迎脉呈现浮紧之象，重按之下洪大有力。“紧”脉比“弦”脉更为严重，这是足太阳膀胱经寒水之脉的特征。重按洪大有力，中间显现出手少阴心火之脉的特征。丁（火）与壬（木/水，此处指天干化合关系，实指水火既济或相关脏腑联系，原文意指心肾或相关五行生克，结合上下文“伤寒脉”，通常指寒邪束表，阳气郁闭化热或正邪相争），内显洪大之象，这就是伤寒的脉象。如果外感风邪，则人迎脉缓，且比气口脉大一倍（病在少阳经），或大二倍（病在太阳经），或大三倍（病在阳明经）。
若内伤饮食，则右寸气口脉比人迎脉大一倍（病在厥阴经），或大二倍（病在少阴经），或大三倍（病在太阴经）。如果是饮食不节制、劳役过度，则心脉的变化会反映在气口上，这是心火刑克肺金的表现，肝木挟带心火的势头，也来侵薄肺金。《内经》说：“侮所不胜，寡于畏者。”说的就是这个道理。所以气口脉急大而数，时常出现代脉且涩。涩脉是肺的本脉；脉大是因为元气不相接续。脾胃功能不及的脉象，表现为洪大而数，这是心肺之火刑克肺金的脉象；急脉是肝木挟带心火，反过来克制肺金。如果不甚劳累，仅见右关脉大而数，数中带有缓意，时常出现代脉。如果是饮食不节制，寒温失调，则左右关脉受损虚弱，严重时隐伏不见，仅在内里显现脾脉的大数微缓，时常出现代脉。如果有宿食不消化，则独见右关脉沉而滑。《内经》说：“脉滑者有宿食也。”
证候
李东垣说：阴阳的证候，不可不详细辨别啊。遍观《内经》中所说的各种变化百病，其根源都来自于喜怒过度、饮食失节、寒温不适、劳役所伤。元气、谷气、营气、卫气、生发诸阳上升之气，这四种气，都是饮食入胃后，谷气上行，胃气的不同名称，其实质是一样的。既然脾胃受到损伤，那么中气就会不足。中气不足，六腑的阳气都会在体表衰竭。所以《内经》说：“五脏之气已缓于外者，是六腑之元气病也。”气受伤则脏生病，脏生病则形体应验，这说明五脏六腑的真气都不足了。只有阴火独自旺盛，上乘于阳分，导致营卫失守，各种疾病由此产生。其中的变化，都源于中气不足。应当用补法的证候，如果被误认为是外感风寒、有余客邪的病证，从而重用泻法解表，使营卫之气在体外断绝，死亡就在十天半月之内。所谓差之毫厘，谬以千里，怎能不仔细辨别呢？
例如外感病，寒热同时发作且无间歇；内伤病，寒热交替发作且不整齐。外感恶寒，即使靠近烈火也不能缓解；内伤恶寒，靠近温暖环境即可解除。外感恶风，是不能忍受一切风寒；内伤恶风，只是厌恶少许贼风。外感病的症状表现在鼻部，所以鼻气不利，气息壅盛有力。内伤者不是这样，内伤病的症状表现在口部，所以口不知味，腹中不和。外感病没有这种情况。外感病邪气有余，说话声音壮厉，且病情先轻后重；内伤病元气不足，说话懒怯，且病情先重后轻。外感病手背发热而手心不热；内伤病则手心发热而手背不热。外感头痛，经常存在，必须传到里证才会停止；内伤头痛，有时发作，有时停止。内外辨别的要点大致如此。然而，有单纯内伤而无外感的，也有单纯外感而无内伤的。如果内伤外感兼病相互夹杂，则根据病情的轻重来治疗。如果内症表现多的，则是内伤重而外感轻，宜先补益而后散邪，以补中益气汤为主，加入散邪药物。应当结合六经脉症参究，各加本经药物治疗。如果外症表现多的，则是外感重而内伤轻，宜先发散而后补益，以辛凉等剂解散为君药，以人参、白术、茯苓、川芎、当归等为臣使药。以此辨别，则判然分明。
治法
王安常说：饮食劳倦损伤而导致内热的，是阴火乘袭坤土（脾胃）之位，所以内热波及胸中。《内经》说：“劳者温之，损者温之。”只能用温药来补元气而泻火邪。因为温能除大热。所以李东垣创立补中益气汤加减来治疗它，其恩惠难道不大吗？然而，饮食所伤，又应当分别对待。劳倦伤和饮食伤，虽然与外感风寒暑湿等有余之证不同，但饮食伤又与劳倦伤不同。劳倦伤确实是不足之证，饮食伤尤其应当在不足之中，分辨其有余还是不足。为什么呢？饥饿不进食，与吃得太多，虽然都是失节，但必须明确区分这两者的不同，才能穷尽其理。所谓的“节”，就是无不及、无太过之中的正道。饥饿不进食，胃气空虚，这属于不足，但从停滞的角度看则有有余（指气机停滞）。正因为不足所以要补益，正因为有余所以要消导。也有物滞气伤，必须补益消导并用的；也有物暂时停滞而气未受重伤，宜单独使用消导，不需要补益的；也有已经停滞不再自行化解，不需要消导，只当补气，或者甚至不需要补益的。洁古的枳术丸、东垣的橘皮枳术丸之类，虽然说是消导，其中固有补益之意存留其间。其他如木香分气丸、枳实导气丸、大枳实丸之类，虽然没有补益作用，但施用于物暂滞、气不甚伤的情况，难道不可以吗？只是不宜将其视为通用的通行药物罢了。况且所停滞的食物，不是枳实的药力所能去除的，又怎么能拘泥于消导而不知道变通呢？所以备急丸、煮黄丸、感应丸、瓜蒂散等推逐攻下的方剂，洁古、东垣也未尝废弃不用。所以善于用兵的人，进攻得当，防守也得当；不善于用兵的人，该进攻时防守，该防守时进攻，失败不是军队的罪过，而是指挥者的罪过。观察这一点，就知道消导、补益、推逐的道理了。至于劳倦伤，则纯粹是补益，固然是不用讨论的。虽然李东垣再三告诫，但世人往往还用苦寒的药剂，希望消除劳倦伤的热象。等到病不愈反而加重，从加重发展到危险，只说病势已到极点，药不能胜任罢了。医者、患者、主治者，全都委之于天命，都懵懂不觉悟这是妄治的错误。唉！仁人君子，能不痛心吗！
方剂
补中益气汤〔批注〕（按：此方补元气，养脾胃，升提下陷之气，是治疗内伤的要药。）
治疗中气不足，肢体倦怠，口干发热，饮食无味；或饮食失节，劳倦身热，脉大而虚；或头痛恶寒自汗；或气高而喘，身热而烦；或脉微细软弱，自汗体倦少食；或中气虚弱而不能摄血；或饮食劳倦而患疟痢；或疟痢因脾胃虚而不能愈；或元气虚弱，感冒风寒，不胜发表，宜用此方代替；或房事后感冒；或感冒后行房事，也用此汤，急加附子；或泻利腹痛，急用附子理中汤。
嫩黄芪（蜜水煎炒一钱半，脾胃虚，肺气先绝，用之以益皮毛而闭腠理，止自汗）
人参（去芦头，一钱，上气喘气短，元气大虚，用以补之）
甘草（炙，一钱，甘温以泻火热而补脾胃中元气，若脾胃急痛，腹中急缩者多用之）
以上三味，是除渴热、烦热的圣药。
白术（土炒，一钱，苦甘温，除胃中热，利腰脐间血）
柴胡（五分，能使胃中之清气左旋而上达）
升麻（五分，能使胃中之满气从右而上迁）
橘红（一钱，理胸中之气，又能助阳气上升，以散滞气，肋诸脾胃为用）
当归身（酒洗，一钱，用之以和血脉）
以上切碎为一剂，生姜三片，水煎温服。或少加黄柏以救肾水，而泻阴中之伏火。红花三分，入心养血。内伤挟外感者，以本方为主，根据六经所见之证，加减使用。如见太阳证，头项痛，腰脊强，加羌活、藁本、桂枝。如阳明证，则身热，目痛，鼻干，不得眠，倍升麻、加干葛根。如少阳证，则胸胁痛而耳聋，加黄芩、半夏、川芎，倍柴胡。如太阴证，则腹满而咽干，加枳实、厚朴。如少阴证，则口燥舌干而渴，加生甘草、桔梗。如厥阴证，则烦满，多加川芎。如变证发斑，加葛根、玄参，倍升麻。如挟痰，加半夏、竹沥、姜汁。若头痛，加蔓荆子，或加川芎。顶痛脑痛，加藁本、细辛。诸头痛，这四味药足够了。若耳鸣目黄，颊颌肿颈肩肘臂后廉痛，面赤脉洪者，加羌活一钱，防风七分，甘草、藁本各五分，通其经血。加黄芩、黄连各三分，消肿。咽痛颔肿，面赤，脉洪大，加桔梗七分，黄芩、甘草三分。口干咽干，或渴者，加葛根五分，升胃气，上行润之。心下痞闷，加芍药、黄连一钱。腹中痞闷，加枳实三分，厚朴七分，木香、砂仁各三分。如天寒，加干姜。腹中痛者，加炒白芍药、炙甘草各三分。如恶寒觉冷痛，加桂枝五分。夏月腹中痛，不恶寒反恶热者，加黄芩五分，芍药一钱，甘草五分，以治时热。脐下痛者，加熟地黄一钱。如胸中滞气，加青皮五分。壅滞可用，短促少气，去之。如身体重疼，乃风湿相搏，加羌活、防风各五分，升麻一钱，柴胡五分，藁本、苍术各一钱，中病即止。大便闭涩，加归梢一钱。病久痰嗽者，去人参，初病勿去之。冬月、春寒或秋凉，各宜加不去节的麻黄。若春温热，加沸耳草三分，款冬花一分。长夏湿土，客邪大旺，加苍术、白术、泽泻，上下分消其湿热之气。湿热之气大胜，主食不消，故食减不知谷味。加神曲以消之，加五味子、麦门冬，助人参泻火益肺金，助秋损也。在三伏中为圣药。胁下急或痛，俱加柴胡、甘草、人参。多唾或唾白沫，胃口上停寒也，加益智仁。若胃脘当心痛，加草豆蔻仁三分。若食不下，乃胸中有寒，或气涩滞，加青皮、陈皮、木香。寒月加益智仁、草豆蔻，夏月加黄芩、黄连；秋加槟榔、砂仁。若脚软乏力或痛，加酒炒黄柏。不已，加汉防己。心烦躁，加生地黄。若气浮心乱，以朱砂安神丸镇固之，则愈。
白术散〔批注〕（按：此方治胃虚之剂） 治疗胃虚不能食，而大渴不止，不可用淡渗药，恐胃中元气虚少故也。并治伤寒杂病，一切吐泻烦渴，霍乱，虚损气弱，及治酒积呕哕。
人参（一钱） 白术（一钱，土炒） 茯苓（一钱） 藿香（八分） 木香（五分） 葛根（一钱） 甘草（七分）
以上切碎为一剂，水煎温服。如饮水者，多煎与之时时服。如能食而渴者，用人参白虎汤。
补气汤〔批注〕（按：此方治气虚之剂） 凡遇劳倦辛苦，用力过多，即服此三、四剂，免致内伤发热之病，宜预防之。
黄芪（一钱半） 人参（一钱） 白术（一钱） 麦门冬（一钱） 陈皮（一钱） 五味子（十粒） 甘草（炙，七分）
以上切碎为一剂，姜三片，枣二枚，水煎食前服。劳倦甚，加熟附子五分。
补血汤〔批注〕（按：此方治血虚之剂） 凡遇劳心思虑，损伤精神，头眩目昏，心虚气短，惊悸烦热等症，并宜服之。
生地黄（一钱） 人参（一钱） 当归（一钱） 白芍药（炒，一钱） 茯神（一钱） 陈皮（五分） 栀子（炒黑，五分） 酸枣仁（炒，一钱） 麦门冬（一钱） 五味子（十粒） 甘草（炙，七分）
以上切碎为一剂，加圆眼肉十枚，水煎，空心服。
参苓白术散 治疗脾胃虚弱，饮食不进，或致呕吐泄泻，及大病后，调脾助胃，此方最宜。
白术（土炒，一钱） 人参（八分） 甘草（八分） 干山药（一钱） 白茯苓（八分） 白扁豆（一钱） 莲子肉（十个） 薏苡仁（八分） 砂仁（炒，五分） 桔梗（八分） 陈皮（一钱）
以上研为末，每服二钱，黑枣泡汤，空心调下。
参苓白术丸（云林制） 治疗病后元气虚弱，此药进美饮食，壮健身体，充实四肢，清火化痰，解郁固本。
人参（一两） 白术（二两，土炒） 白茯苓（一两） 干山药（炒，一两） 莲肉（去皮，二两） 陈皮（一两） 半夏（制，一两） 白扁豆（炒，一两） 薏苡仁（炒，二两） 桔梗（二两） 黄连（姜炒，一两） 神曲（炒，一两） 香附（一两） 砂仁（五钱） 甘草（一两） 当归（一两） 远志（一两） 石菖蒲（五钱）
以上研为末，姜、枣煎汤，打神曲糊为丸，如梧桐子大。每服百丸，空心白汤送下，忌食生冷、油腻之物。
白术（半斤，二两朝阳土炒，六两熬膏） 人参（五钱，如有嗽，去之） 白茯神（去皮木，一两半） 远志（去骨，一两半） 陈皮（去白，一两半） 白芍药（酒炒，一两半） 神曲（炒，一两） 麦芽（五钱）
以上研为末，用白术膏丸，如梧桐子大。每服一钱，或加至一钱五分，白沸汤空心送下。
白术膏 治疗脾胃大虚，自汗乏力，四肢怠倦，饮食不思；或食而不化，呕吐泻痢，泻下完谷白沫。
白术（一斤，去芦，火上炙一块，锉一块成片）
以上用水十碗，熬汁二碗，去渣。再入水再熬，又滤出，将渣捣烂，入水再熬。如是五次，共得药汁十碗，合一处，入白蜜半斤，再熬至稠粘，滴水成珠为度。日服二、三次，白沸汤调下。
白云膏（单孟齐传）〔批注〕（按：此方养元气，健脾胃，王道之剂） 调脾健胃，固本还元。
大米（一升） 糯米（一升） 山药（四两） 芡实（四两） 莲肉（去皮、心，四两）
以上为细末，入白砂糖一斤半，搅和令匀，入笼蒸糕，任意食之。
Pulse Diagnosis
The ancients distinguished between internal injury and external contraction by examining the pulses at the Renying (ST9) and Qikou (LU9) locations. A pulse at Renying larger than that at Qikou indicates internal injury, whereas a pulse at Qikou larger than that at Renying indicates external contraction. While this method of differentiation is fundamentally correct, its theoretical explanation is not exhaustive. External contraction of wind-cold constitutes an excess syndrome caused by exogenous pathogenic factors. Its manifestations necessarily appear on the left hand, which governs the exterior and corresponds to the circulation of Yang qi for twenty-five degrees. Internal injury due to dietary irregularities, excessive eating, or overexertion constitutes a deficiency syndrome. Its manifestations necessarily appear on the right hand, which governs the interior and corresponds to the circulation of Yin qi for twenty-five degrees.
Therefore, in cases of external cold contraction, the Renying pulse at the left Cun position appears floating and tight; upon heavy pressure, it feels surging and large. The "tight" quality is more severe than the "wiry" quality, representing the pulse of the Foot-Taiyang Bladder channel affected by cold-water pathogens. Heavy pressure revealing a surging and forceful quality, with intermediate signs of the Hand-Shaoyin Heart fire pulse, indicates the pulse pattern of Cold Damage (Shanghan). If wind pathogens are contracted externally, the Renying pulse becomes slow and is one times larger than the Qikou pulse (pathology in Shaoyang), two times larger (pathology in Taiyang), or three times larger (pathology in Yangming).
In cases of internal dietary injury, the Qikou pulse at the right Cun position is one times larger than the Renying pulse (pathology in Jueyin), two times larger (pathology in Shaoyin), or three times larger (pathology in Taiyin). If caused by irregular diet or severe overexertion, changes in the Heart pulse manifest at the Qikou location. This represents Heart Fire insulting Lung Metal, with Liver Wood joining the momentum of Heart Fire to oppress the Lungs. As stated in the *Neijing*: "Insulting what cannot insult, lacking fear." Thus, the Qikou pulse becomes urgent, large, and rapid, occasionally presenting with intermittent (Dai) and choppy (Se) qualities. The choppy quality reflects the intrinsic nature of the Lung; the large quality indicates a lack of continuity in Yuan Qi (Original Qi). A pulse that is surging, large, and rapid signifies Heart and Lung Fire insulting the Lungs; an urgent pulse signifies Liver Wood joining Heart Fire to counter-act Lung Metal. In cases of mild exertion, only the Guan position on the right may show a large and rapid pulse with a hint of slowness and occasional intermittent beats. If caused by dietary irregularity and improper thermal regulation, the Guan pulses on both sides become damaged and weak; in severe cases, they may be imperceptible, revealing only a surging, rapid, slightly slow, and intermittently beating Spleen pulse internally. If food stagnation persists, the right Guan pulse alone will be deep and slippery. The *Neijing* states: "A slippery pulse indicates retained food."
Symptoms
Li Dongyuan stated: "The patterns of Yin and Yang must be examined in great detail." Reviewing the myriad diseases described in the *Neijing*, their origins all lie in excessive emotions, dietary irregularities, inappropriate thermal exposure, and overexertion. Yuan Qi (Original Qi), Gu Qi (Grain Qi), Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), and the Qi of generating and ascending Yang—all these four names refer to the same essence: the upward movement of Grain Qi after food enters the Stomach. When the Spleen and Stomach are injured, Zhong Qi (Middle Qi) becomes deficient. Deficiency of Zhong Qi leads to the exhaustion of Yang Qi of the Six Fu organs at the exterior. Hence, the *Neijing* says: "When the Qi of the Five Zang organs is slack at the exterior, it is a disease of the Yuan Qi of the Six Fu organs." Injury to Qi causes Zang pathology; Zang pathology manifests in the form. This indicates that the True Qi of all Five Zang and Six Fu organs is deficient. Only the Yin Fire flares up independently, ascending to the Yang regions, causing loss of control over Ying and Wei Qi, thereby giving rise to various diseases. All these variations stem from deficiency of Zhong Qi. Patterns requiring tonification are often mistaken for external wind-cold contraction with excess pathogens. Heavy purgation of the exterior depletes Ying and Wei Qi, leading to death within ten days. As the saying goes, "A miss is as good as a mile"; how can one fail to distinguish carefully?
For instance, in external contraction, chills and fever occur simultaneously without interval; in internal injury, chills and fever alternate irregularly. External contraction involves aversion to cold that is not relieved even by proximity to fire; internal injury involves aversion to cold that is relieved by warmth. External contraction involves aversion to wind where any wind is unbearable; internal injury involves aversion to wind only when slight drafts are present. External symptoms manifest in the nose, causing nasal obstruction and strong breath sounds; internal symptoms do not follow this pattern. Internal symptoms manifest in the mouth, causing loss of taste and abdominal discomfort. External contraction features excess pathogenic Qi, resulting in loud speech and a progression from mild to severe symptoms; internal injury features deficient Yuan Qi, resulting in timid speech and a progression from severe to mild symptoms. External contraction presents with heat in the back of the hands but not the palms; internal injury presents with heat in the palms but not the backs of the hands. External headache is constant until the pathogen transmits to the interior; internal headache comes and goes. These are the general principles for distinguishing internal from external conditions. However, there are cases of pure internal injury without external contraction, and pure external contraction without internal injury. If both exist simultaneously, treatment should follow the severity of the condition. If internal symptoms predominate, internal injury is severe and external contraction is mild; tonification should precede dispersion, primarily using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added dispersing herbs. One should analyze according to the Six Channels' pulse and symptom patterns, adding channel-specific herbs. If external symptoms predominate, external contraction is severe and internal injury is mild; dispersion should precede tonification, using acrid-cool formulas as the sovereign herb, with Ginseng, Atractylodes, Poria, Ligusticum, and Angelica as minister and envoy herbs. By applying this differentiation, the distinction becomes clear.
Treatment Principles
Wang Anchang stated: "Internal heat caused by dietary and fatigue injury results from Yin Fire invading the position of Kun Earth (Spleen/Stomach), thus affecting the chest." The *Neijing* states: "Treat exhaustion with warmth, treat deficiency with warmth." Only warm herbs can tonify Yuan Qi and drain Fire pathogens, because warmth can eliminate great heat. Therefore, Li Dongyuan established Buzhong Yiqi Tang with modifications to treat this condition, offering immense benefit. However, injuries caused by diet require further distinction. Although fatigue and dietary injuries differ from external excess syndromes like wind-cold-dampness, dietary injury differs from fatigue injury. Fatigue injury is purely deficiency; dietary injury requires distinguishing between excess and deficiency within the context of deficiency. Why? Both starvation and overeating are irregularities, but one must clarify their differences to understand the principle fully. "Regulation" implies the middle way of neither deficiency nor excess. Starvation empties Stomach Qi, constituting deficiency; however, regarding stagnation, it presents as excess. Because it is deficient, it requires tonification; because it is stagnant/excess, it requires digestion/promotion. Some cases involve both food stagnation and Qi injury, requiring simultaneous tonification and digestion. Some involve temporary stagnation with minimal Qi injury, requiring only digestion without tonification. Some involve persistent stagnation that does not resolve spontaneously, requiring no digestion but only Qi tonification, or even no tonification at all. Jiegu's Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) and Dongyuan's Jupi Zhizhu Wan, though termed digestive, inherently contain tonifying intent. Other formulas like Muxiang Fenqi Wan, Zhishi Daoqi Wan, and Da Zhishi Wan, while lacking tonifying properties, are suitable for temporary stagnation with minimal Qi injury, provided they are not viewed as universal laxatives. Moreover, if the retained food cannot be removed by Zhishi (Immature Bitter Orange) alone, one must adapt beyond mere digestion. Thus, emergency evacuants like Beijji Wan, Zhuhuang Wan, Yinggan Wan, and Genti San were not discarded by Jiegu and Dongyuan. Just as a skilled commander knows when to attack and when to defend, failure lies in misapplication, not the strategy itself. Understanding this clarifies the principles of digestion, tonification, and evacuation. Fatigue injury, however, is purely a matter of tonification. Despite Dongyuan's warnings, people often use bitter-cold herbs to treat heat from fatigue. When this fails and worsens, leading to critical conditions, they blame fate rather than recognizing the error of wrong treatment. Alas! Would not benevolent gentlemen feel heartbroken?
Formulas
Buzhong Yiqi Tang [Commentary]: Tonifies Yuan Qi, nourishes Spleen and Stomach, raises sunken Qi; it is the essential formula for internal injury.
Indications: Deficiency of Zhong Qi with limb fatigue, dry mouth, fever, and loss of appetite; or fever from dietary irregularity/fatigue with a large and empty pulse; or headache, aversion to cold, and spontaneous sweating; or high-pitched breathing, panting, fever, and irritability; or faint, thin, weak pulse with spontaneous sweating, fatigue, and poor intake; or inability to control blood due to weak Zhong Qi; or malaria/dysentery caused by dietary/fatigue injury; or malaria/dysentery unhealed due to Spleen/Stomach deficiency; or weakness preventing tolerance of diaphoretic treatment for wind-cold (use this instead); or post-coital cold; or cold followed by intercourse (add Aconite urgently); or dysentery with abdominal pain (use Fuzi Lizhong Tang urgently).
Ingredients:
- Huangqi (Astragali Radix): 1.5 qian, stir-fried with honey water. For weak Spleen/Stomach and premature exhaustion of Lung Qi, it benefits the skin/hair, closes pores, and stops sweating.
- Renshen (Ginseng Radix et Rhizoma): 1 qian, radix tip removed. For shortness of breath and severe Yuan Qi deficiency, it tonifies.
- Gancao (Glycyrrhizae Radix et Rhizoma): 1 qian, honey-fried. Sweet and warm to drain fire and tonify Zhong Qi. Use more for acute stomach pain or abdominal cramping.
These three are holy medicines for clearing thirst-heat and irritability-heat.
- Baizhu (Atractylodis Macrocephalae Rhizoma): 1 qian, soil-stir-fried. Bitter, sweet, and warm; clears Stomach heat and promotes blood flow in the waist/navel area.
- Chaihu (Bupleuri Radix): 0.5 qian; directs clear Qi from the Stomach to ascend via the left.
- Shengma (Cimicifugae Rhizoma): 0.5 qian; directs fullness Qi from the Stomach to ascend via the right.
- Juhong (Citri Reticulatae Pericarpium Rubrum): 1 qian; regulates Qi in the chest, assists Yang Qi ascent, and dissipates stagnation.
- Dangguishen (Angelicae Sinensis Radix): 1 qian, wine-washed; harmonizes blood vessels.
Preparation: Cut into pieces for one dose. Add 3 slices of fresh ginger. Decoct in water and take warm. Optionally add Huangbai (Phellodendri Cortex) to nourish Kidney Water and drain latent Yin Fire. Honghua (Carthami Flos) 0.3 qian enters the Heart to nourish blood. For internal injury complicated by external contraction, use this formula as the base and modify according to Six Channel presentations.
- Taiyang pattern (head/neck pain, stiff back): Add Qianghuo, Gaoben, Guizhi.
- Yangming pattern (fever, eye pain, dry nose, insomnia): Double Shengma, add Gegen.
- Shaoyang pattern (chest/hypochondriac pain, deafness): Add Huangqin, Banxia, Chuanxiong; double Chaihu.
- Taiyin pattern (abdominal fullness, dry throat): Add Zhishi, Houpo.
- Shaoyin pattern (dry mouth/tongue, thirst): Add raw Gancao, Jiegeng.
- Jueyin pattern (irritation/fullness): Increase Chuanxiong.
- Eruption/rash: Add Gegen, Xuanshen; double Shengma.
- With phlegm: Add Banxia, Zhuli, Jiangzhi.
- Headache: Add Manjingzi or Chuanxiong.
- Vertex/brain pain: Add Gaoben, Xixin.
- Tinnitus/yellow eyes/jaw swelling/neck-shoulder-arm pain/red face/surging pulse: Add Qianghuo 1 qian, Fangfeng 0.7 qian, Gancao/Gaoben 0.5 qian each to unblock channels. Add Huangqin/Huanglian 0.3 qian each to reduce swelling.
- Sore throat/jaw swelling/red face/surging pulse: Add Jiegeng 0.7 qian, Huangqin/Gancao 0.3 qian.
- Dry mouth/throat/thirst: Add Gegen 0.5 qian to raise Stomach Qi and moisten.
- Epigastric stuffiness: Add Shaoyao, Huanglian 1 qian.
- Abdominal stuffiness: Add Zhishi 0.3 qian, Houpo 0.7 qian, Muxiang/Sharen 0.3 qian each.
- Cold weather: Add Ganjiang.
- Abdominal pain: Add fried Shaoyao, fried Gancao 0.3 qian each.
- Aversion to cold/cold pain: Add Guizhi 0.5 qian.
- Summer abdominal pain (no aversion to cold, aversion to heat): Add Huangqin 0.5 qian, Shaoyao 1 qian, Gancao 0.5 qian.
- Umbilical pain: Add Shudihuang 1 qian.
- Chest stagnation: Add Qingpi 0.5 qian (remove if Qi is short).
- Heaviness/pain (Wind-Damp): Add Qianghuo/Fangfeng 0.5 qian each, Shengma 1 qian, Chaihu 0.5 qian, Gaoben/Cangzhu 1 qian each. Stop when effective.
- Constipation: Add Guishao 1 qian.
- Chronic cough with phlegm: Remove Renshen (keep in early stages).
- Winter/Spring/Autumn cold: Add Mahuang (uncut).
- Spring heat: Add Feiercao 0.3 qian, Kuandonghua 0.1 qian.
- Late Summer dampness: Add Cangzhu, Baizhu, Zexie to drain damp-heat.
- Damp-heat dominating/poor digestion: Add Shenqu; add Wuweizi, Maidong to assist Renshen in draining fire and benefiting Lung Metal. This is a holy medicine during the Three Fu periods.
- Hypochondriac urgency/pain: Add Chaihu, Gancao, Renshen.
- Excessive saliva/white foam: Cold at stomach opening; add Yizhiren.
- Epigastric pain: Add Caodoukou 0.3 qian.
- Inability to eat (Cold/Qi stagnation in chest): Add Qingpi, Chenpi, Muxiang. Adjust seasonally: Winter add Yizhiren/Caodoukou; Summer add Huangqin/Huanglian; Autumn add Binglang/Sharen.
- Weak/painful legs: Add Jiuhuangbai. If ineffective, add Hanfangji.
- Irritability: Add Shengdihuang.
- Floating Qi/restless Heart: Treat with Zhusha Anshen Wan.
Baizhu San [Commentary]: Formula for Stomach deficiency.
Indications: Stomach deficiency unable to digest food, incessant thirst (avoid diuretics to protect deficient Zhong Qi). Also treats colds/miscellaneous diseases with vomiting/diarrhea/thirst, cholera, deficiency weakness, and alcohol-induced vomiting.
Ingredients: Renshen 1 qian, Baizhu 1 qian (soil-stir-fried), Fuling 1 qian, Huoxiang 0.8 qian, Muxiang 0.5 qian, Gegen 1 qian, Gancao 0.7 qian.
Preparation: Decoct in water, take warm. Drink frequently if thirsty. If able to eat but thirsty, use Renshen Baihu Tang.
Buqi Tang [Commentary]: Formula for Qi deficiency.
Indications: Prevent internal heat from overexertion/fatigue by taking 3-4 doses proactively.
Ingredients: Huangqi 1.5 qian, Renshen 1 qian, Baizhu 1 qian, Maidong 1 qian, Chenpi 1 qian, Wuweizi 10 seeds, Gancao 0.7 qian (fried).
Preparation: Decoct with 3 slices ginger, 2 dates. Take before meals. For severe fatigue, add Shufuzi 0.5 qian.
Buxue Tang [Commentary]: Formula for Blood deficiency.
Indications: Mental overwork damaging spirit, dizziness, blurred vision, palpitations, shortness of breath, irritability-heat.
Ingredients: Shengdihuang 1 qian, Renshen 1 qian, Danggui 1 qian, Baishaoyao 1 qian (fried), Fushen 1 qian, Chenpi 0.5 qian, Zhizi 0.5 qian (charred), Suanzaoren 1 qian (fried), Maidong 1 qian, Wuweizi 10 seeds, Gancao 0.7 qian (fried).
Preparation: Decoct with 10 longan fruits. Take on an empty stomach.
Shenling Baizhu San
Indications: Spleen/Stomach weakness, poor appetite, vomiting/diarrhea, recovery from major illness. Best for regulating Spleen and assisting Stomach.
Ingredients: Baizhu 1 qian (soil-stir-fried), Renshen 0.8 qian, Gancao 0.8 qian, Shanyao 1 qian, Fuling 0.8 qian, Bian Dou 1 qian, Lianrou 10 seeds, Yiyiren 0.8 qian, Sharen 0.5 qian (fried), Jiegeng 0.8 qian, Chenpi 1 qian.
Preparation: Powder. Take 2 qian with black date decoction on an empty stomach.
Shenling Baizhu Wan (Yunlin Preparation)
Indications: Post-illness Yuan Qi weakness. Improves appetite, strengthens body/limbs, clears fire/phlegm, resolves depression, consolidates root.
Ingredients: Renshen 1 liang, Baizhu 2 liang (soil-stir-fried), Fuling 1 liang, Shanyao 1 liang (fried), Lianrou 2 liang (peeled), Chenpi 1 liang, Banxia 1 liang (processed), Bian Dou 1 liang (fried), Yiyiren 2 liang (fried), Jiegeng 2 liang, Huanglian 1 liang (ginger-fried), Shenqu 1 liang (fried), Xiangfu 1 liang, Sharen 0.5 liang, Gancao 1 liang, Danggui 1 liang, Yuanzhi 1 liang, Shichangpu 0.5 liang.
Preparation: Powder. Make pills with Shenqu paste and ginger/date decoction, size of Sophora seeds. Take 100 pills with plain water on an empty stomach. Avoid cold/greasy foods.
Baizhu Babao Dan (Hu Yunge Transmission)
Indications: All deficiency syndromes.
Ingredients: Baizhu 0.5 jin (2 liang stir-fried with sun-facing soil, 6 liang boiled into paste), Renshen 5 qian (omit if coughing), Baifushen 1.5 liang (peeled), Yuanzhi 1.5 liang (de-boned), Chenpi 1.5 liang (peeled), Baishaoyao 1.5 liang (wine-fried), Shenqu 1 liang (fried), Maiya 5 qian.
Preparation: Powder. Form pills with Baizhu paste, size of Sophora seeds. Take 1 qian (up to 1.5 qian) with boiling water on an empty stomach.
Baizhu Gao
Indications: Severe Spleen/Stomach deficiency, spontaneous sweating, fatigue, listlessness, anorexia; indigestion, vomiting/diarrhea/passing undigested food/white foam.
Ingredients: Baizhu 1 jin (remove tips, roast on fire, cut into pieces).
Preparation: Boil in 10 bowls of water until 2 bowls remain. Strain. Add water again, boil, strain. Mash residue, add water, boil again. Repeat 5 times. Combine 10 bowls of juice. Add 0.5 jin white honey. Boil until thick and sticky, forming beads when dropped in water. Take 2-3 times daily with boiling water.
Baiyun Gao (Shan Mengqi Transmission) [Commentary]: Nourishes Yuan Qi, strengthens Spleen/Stomach, a gentle royal method. Regulates Spleen, consolidates root.
Ingredients: Rice 1 sheng, Glutinous rice 1 sheng, Shanyao 4 liang, Qianshi 4 liang, Lianrou 4 liang (peeled/de-heartened).
Preparation: Fine powder. Mix with 1.5 jin white sugar. Steam as cake. Eat as desired.