经曰。饮食不节。起居不时。阴受之。阴受之则入六腑。身热不时卧。上为喘呼。阴虚生内
热者。有所劳倦。形气衰少。谷气不盛。上焦不行。下脘不通。而胃气热。热气熏胸中。故内热。
阳盛则外热者。因上焦不通。则皮肤致密。腠理闭塞。玄府不通。卫气不得发泄。故外热。劳则
喘且汗出。内外皆越。故气耗矣。
东垣云。夫喜怒不节。起居不时。有所劳倦。皆损其气。气衰则火旺。火旺则乘其脾土。脾
主四肢。故困热。无气以动。懒于语言。动作喘乏。表热自汗。心烦不安。经言劳者温之。夫劳
之为病。其脉浮大。手足烦热。春夏剧。秋冬瘥。以黄 建中汤治之。人受水谷之气以生。所谓
清气营气运气卫气春升之气。皆胃气之别名也。夫胃为水谷之海。脾胃气虚。则下溜肝肾。阴火
得以乘其土位。故脾病。始得则气高而喘。身热而烦。脉洪大而头痛。或渴不止。其皮肤不任风
寒而生寒热。若阴火上冲。则气高而喘。烦热。为头痛。为渴。而脉洪。脾胃之气下溜。使谷气
不得升浮。是春升之气不行。而无阳以护其营卫。使不任风寒。乃生寒热。此皆脾胃之气不足所
致也。然与外感风寒之证。颇同而实异。内伤脾
胃。乃伤其气。外感风寒。乃伤其形。伤其外则有余。有余者泻之。伤其内则不足。不足者补之。
汗之下之吐之克之之类。皆泻也。温之和之调之养之之类。皆补也。内伤不足之病。苟误认作有
余之证而反泻之。则虚其虚也。惟当以辛甘温剂。补其中而升其阳。甘寒以泻其火则愈矣。以阳
气下陷。故用味薄气清之品。若升麻、柴胡之类举而扬之。使地道左旋。升于九天之上。倘阴气
不降者。用黄柏、泽泻之类抑而降之。使天道右迁。而入于九地之下。此东垣补中益气。为万世
无穷之利。不必降也。清升浊自降矣。血中伏火。日渐煎熬。如气浮心乱。朱砂安神丸镇固之。
以手扪之。而肌表热者表证也。只服补中益气汤一二服。得微汗则已。非正发汗。乃阴阳气和。
自然汗出也。如腹中痛。恶寒而脉弦者。是木来克土也。小建中汤。如脉沉结。腹中痛。理中汤。
如脉缓体重节痛。腹胀自利。米谷不化。是湿胜也。平胃散燥克之。胁下缩急。加柴胡。脐下急。
加肉桂。身体疼重者湿也。合五苓散。如风湿相搏。一身尽痛。加羌、防、 本、升麻、苍术。
勿用五苓。所以然者。为风药已能胜湿。别作一服与之。内伤有虚实之分。如饮食失节。劳役所
伤。发热自汗。倦怠乏力。乃虚中之证。应补益中和之剂调治。无施解表。若饮食过饱。乃虚中
之实。为其所伤饮食。积滞不消。以致心胸痞闷。仍发寒热。恶心恶食。须用消导之剂。俟其消
克。心胸舒泰。仍用益脾之药。使无重虚元气。有宿食不消。日晡热气实者下之。亦要详审。无
过妄利。故虚人饮食所伤。及外感暴病新愈之后。皆当用六君子理胃为主。内伤劳倦。及久病之
后。用补中益气理脾为主。理脾则百病不生。不理脾则诸病续起。久之仍入于胃也。
内外伤辨 人迎脉大于气口为外感。气口脉大于人迎为内伤。外则寒热俱作而无间。内则寒
热间作而不齐。外感恶寒。虽近火不除。内伤恶寒。得暖则解。外感恶风。乃不禁一切风寒。内
伤恶风。却恶门隙中贼风。外感证显在
鼻。故鼻息不利。而气拥有力。虽不能食。而不恶食。内伤证显在口。故口不知味。而腹中不和。
怯弱妨食。恶闻食气。外感则邪气有余。发言壮厉。先轻而后重。内伤则元气不足。出言懒怯。
先重而后轻。外感头痛。常常而痛。多见于脑后额上。以及遍身肢体腰脊筋骨挛痛。内伤头痛。
时作时止。不离两太阳额颅。多兼肩背胸胁腰腿骨节酸疼。外感则手背热而手心不热。内伤则手
心热而手背不热。外感小便赤涩而痛。终日难得。内伤小便黄赤。必短而频。外感燥结。则发热
腹中硬痛。内伤秘涩。则虚坐常见些少白脓。外感胸腹结痛。则痛不可按。内伤有时胃脘当心而
痛。上支两胁。外感则手足动摇。烦扰不宁。内伤则四肢不收。倦怠嗜卧。东垣辨法如此。然或
二者兼病。则其脉必并见而难辨。尤宜细心求之。若内证多者。则内伤重而外感轻。宜补养而兼
散邪。补中益气加羌活。若外感多者。则外感重而内伤轻。宜和营而邪自解。黄 建中加当归。
内伤始为热中病似外感阳证 头痛大作。气高而喘。身热而烦。上气鼻息不调。四肢困倦不
收。无气以动。无气以言。或烦躁闷乱。心烦不安。或渴或不渴。心火上炎克肺经则渴。血脉中
有湿则不渴。或表虚不任风寒。目不欲开。口不知味。气口脉大于人迎两三倍。但急大而时见一
代。此内显脾气不续之脉也。补中益气汤。若有宿食。则右关独沉而滑枳术丸。
内伤末传寒中病似外感阴证 腹胀胃脘当脐痛。四肢与两胁拘急。膈噎不通。或涎唾。或清
涕。或多溺。足下痛。不能任身履地。骨乏无力。喜睡。两丸多冷。阴阴作痛。或妄见鬼状。腰
背肩胛脊膂皆病。不渴不泻。脉盛大以涩。名曰寒中。宜枳实理中加附子、肉桂、益智、草豆蔻。
兼肾脏火衰。面黑足寒。小便不利者。八味丸加鹿茸、五味子
内伤似外感阳明中热证 有天气大热时。劳役得病。与阳明伤热白虎汤证相似。此脾胃大虚。
元气不足之证。因饥困劳役之后。肌热躁闷。烦渴引饮。口鼻气促。目赤面红恶热。昼夜不息。
脉大而虚。重按全无。经曰。脉虚则血虚。血虚则发热。误服白虎必危。当归补血汤。
内伤似外感恶风寒证 有因劳役辛苦。肾中阴火沸腾。后因脱衣或沐浴歇息于阴凉处。其阴
火不行。还归皮肤。腠理极虚无阳。被风与阴凉所遏。以此表虚不任风寒。与外感恶风相似。其
证少气短促。懒于言语。困弱无力。不可同外感治。补中益气加紫苏、羌活。甚者加桂枝最当。
劳倦所伤虚中有寒 脾胃虚弱。不能运化。致寒物冷痰胶固于中焦。时时痞闷。不觉饥饱。
其脉虽弦而按之不鼓。当温暖以助脾健运。清理中宫。理中丸。若脐下筑者。肾气动也。去术加
桂。吐多者。气上壅也。去术加生姜。下多者。气泄而不收也。还用术。悸者饮聚也。加桂、苓。
渴欲饮水者。津液不足也。倍用术。腹中痛者。倍人参。寒多。倍干姜。腹满者。去术加附子。
劳倦所伤虚中有热 饥饱劳役。损伤脾胃。元气不足之人。其脉多弦。或洪缓。按之无力中
时一涩。其证身体沉重。四肢困倦。百节烦疼。胸满短气。膈咽不通。心须不安。耳聋耳鸣。目
热如火。视物昏花。口中沃沫。饮食失味。忽肥忽瘦。怠惰嗜卧。溺色变赤。或清利而数。或上
饮下便。或时飧泄。腹中虚痛。不思饮食。调中益气汤。如时显热躁。是下元真火蒸蒸然发也。
加生地、黄柏。如大便虚坐不得。或大便了而不了。腹中常逼迫。气血虚涩也。倍归身。如无以
上证。只服黄 、人参、甘草、橘皮、柴胡、升麻、苍术、酒黄柏。饮食不节。劳倦所伤。腹胁
满闷短气。遇春则口淡无味。遇夏虽
热犹有恶寒。饥则常如饱。不喜食冷物。升阳顺气汤。劳倦所伤。寒温不适。身热头疼。自汗恶
寒。脉微而弱。黄 建中汤。饥饱劳役。胃气不足。脾气下溜。气短无力。不时寒热。早饭后转
增昏闷。须要眠睡。怠惰嗜卧。四肢不收。懒倦动作。五心烦热。先服升阳补气汤二三剂。后服
补中益气汤。脾胃虚弱。喘促少气。衄血吐血。门冬清肺饮。
脾胃之气俱病似痿弱证 脾胃虚则怠惰嗜卧。四肢不收。时值秋燥令行。湿热少退。体重节
痛。口干舌燥。饮食无味。不欲食。食不消。大便不调。小便频数。兼肺病。洒洒恶寒。惨惨不
乐。而色槁不和。乃阳气不伸故也。升阳益胃汤。王安道曰。经云。阴虚生内热奈何。曰。有所
劳倦。形气衰少。谷气不盛。上焦不行。下脘不通。胃气热。热气蒸胸中。故内热。嗟夫。此内
伤之说之原乎。夫人身之阴阳。有以表里言者。有以上下之分言者。有以气血言者。有以身前身
后言者。有以脏腑言者。有以升降呼吸之气言者。余如动静语默起居之类甚多。不必悉举。此所
谓阴虚之阴。其所指与数者皆不同。盖劳动太过。则阳气皆亢极而化为火矣。况水谷之气又少入。
故阳愈甚而阴愈衰。此阴虚之阴。盖指身中之阴气。与水谷之味耳。或以下焦阴阳为言。或以肾
水真阴为言。皆非也。夫有所劳役者。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。
故清阳升而浊阴降。以传化出入。滋荣一身也。今胃不能纳而谷气衰少。则清无升而浊无降矣。
故曰。上焦不行。下脘不通。然非谓绝不行不通也。但比之平常无病时。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。故胃气热则上炎熏胸中而
为内热也。东垣所言。正与经旨相合。固宜引此段经文。于内外伤辨以为之主。乃反不引此。却
谓火乘土位。此不能无疑者也。又经曰。劳者温之。温者养也。东垣
以为温凉之温。谓用温药以补元气而泻火邪。又改损者益之。为损者温之。又以温能除大热为内
经所云。而遍考内经。并无此语。亦不能无疑者也。然温药之补元气泻火邪者。亦惟气温而味甘
者斯可矣。盖温能益气。甘能助脾而缓火。故元气复而火邪息也。夫宜用温药以为内伤不足之治
则可。以为劳者温之之注则不可。苟以补之除之抑之举之散之等说。比类而观。则其义自着矣。
陆丽京曰。内伤之原有三。曰劳役伤脾。曰饥饱伤胃。曰负重伤血。三者虚实悬殊。所谓劳
役伤脾者。证必发热头痛。恶风畏食。自汗喘乏。脉必气口虚大。平昔未惯劳役人多此。东垣补
中益气证也。饥饱伤胃者。证必黄肿痞满。喘嗽恶食。发热身疼。脉必气口粗大。藜藿劳苦人多此。
平胃散加枣矾。负重伤血者。在胃口则咳呕血腥。痞满少食。膈间隐隐刺痛。脉必气口见弦。饱
食奔驰人多此。犀角地黄汤加酒大黄。稍夺其势。即当因病制宜。余积不攻而去矣。
周慎斋云。内伤左脉常细而涩。右脉多浮而大。阳气下陷不能生阴。故血枯而左脉细涩。脾
胃亏损。不能生金。故气虚而右脉浮大。内伤寸口大于尺内。此阳盛脉也。保元加归、芍引下。
则大脉去而阳气亦内收也。此从阳引阴之法。肝脉细。余脉和缓。补中加枸杞。以枸杞补肝血故
也。脉气不足。用四君子。脉气有余。用平胃散。有余则泻。不足则补。五脏皆然。病重药宜轻
缓。剂宜减小。只以固中剂三四味。以俟胃气之复。脾气虚而脉弦者。服补中益气汤。后必发疟。
脾气虚而湿胜。服补中益气汤。后必患痢。此邪寻出路。仍服前汤自愈。清阳下陷。阴火上升。
若用寒药。则阳愈陷。火愈炽。火寻出窍。虚者受之。或目痛。或耳聋。或齿痛。从其虚而散也。
脾脉豁大。须防作泻。虚阳作泻。遇此脉必难愈。凡胸前作胀痛者。皆阳气不达于胸。阴气填塞
故也。盖阳则气化通达。阴则痰凝气滞。清阳
下陷。阴火上升。则为气逆。浊气凝滞。则为痰厥。所谓脾气下溜。乘于肾肝。而成痰厥气逆之
渐也。香港脚上升则为清阳。下行则为邪气。内伤中虚表热。或潮热自汗。补中正方。表热。加羌、
防。腹中满。加附子。中气不和。加青皮、神曲。间用八珍调理。气血俱虚。十全大补。阴虚火
动。脉洪大而不作泻。六味丸。恶寒。八味丸。腹痛少食。理中丸。作泻。六味去熟地加远志、
沉香、砂仁。不应。加补骨脂、肉豆蔻。倘病颠倒难明。必从脾胃调理。凡用补中。病热已退。
升、柴不可用也。若大便燥结。小便不利。或平常见此证。此清气下陷。补中虽数帖无妨。如热
甚不去者。甘草少故也。如用补中。汗少肺气不开。加用黄 。汗多里气不守。加用人参。热不
退。加用甘草。脐以下无汗。加酒黄柏三分。浑身拘急作胀。系风寒。宜加羌、防。但作胀不拘
急。为内寒。宜加附子。内伤大便闭者。补中加苏子、枳壳、杏仁。小便不利。加牛膝。汗多。
加白芍减升麻。口干。加煨葛根、五味子。无汗。加用升麻。久病而热不退。气短促。用保元、
桂、附。烦躁、加当归、白芍、麦冬、五味。大便欲去而不去。或着而不出为气虚。了而不了为
血虚。俱宜补中。气虚。加用人参。血虚。加用当归。里急后重。初起皆属于热。日久作阳气虚
陷治之。前汤加用升、柴。内伤久而不愈。潮热微汗咳嗽。不思饮食。补中加干姜、五味自愈。
不必理痰治嗽。正气足。则痰嗽自除矣。凡用补中。下体痿软。或虚弱者。不可用。当与八味丸。
凡内伤作泻。藏附子于白术中。令其守中以止泻也。表热。藏附子于黄 中。欲其走表以助阳也。
《黄帝内经》说：饮食没有节制，起居没有规律，阴气就会受到损伤。阴气受损，病邪就会传入六腑。身体发热，不能按时休息，向上表现为气喘呼叫。所谓阴虚生内热，是因为过度劳倦，导致形体和正气衰弱，水谷精微之气不足。上焦之气不能宣发，下脘之气不能通降，从而导致胃气郁热，热气熏蒸于胸中，所以产生内热。
所谓阳盛则外热，是因为上焦不通畅，导致皮肤致密，腠理闭塞，汗孔（玄府）不通，卫气不能发泄，所以产生外热。劳作会导致气喘和出汗，体内的气和津液都向外耗散，所以元气就会亏损。
李东垣说：喜怒没有节制，起居没有规律，以及过度劳倦，都会损伤人体的正气。正气衰弱，相火就会亢盛；相火亢盛，就会克制脾土。脾主四肢，所以人会感到困倦发热，没有力气活动，懒得说话，动作时气喘乏力，体表发热且自汗，心烦不安。《内经》说：“劳损的病证，要用温补的方法治疗。”劳倦这类疾病，脉象浮大，手足烦热，春夏季节加重，秋冬季节减轻，用黄芪建中汤治疗。人依靠摄入水谷之气来生存，所谓的清气、营气、运气、卫气、春升之气，都是胃气的不同名称。胃是水谷之海，如果脾胃气虚，气机就会下陷流向肝肾，阴火得以乘袭脾土之位。所以脾病，初起时会出现气逆而喘，身体发热而烦躁，脉象洪大而头痛，或者口渴不止。由于皮肤不能抵御风寒，从而产生寒热症状。如果阴火上冲，就会出现气逆而喘，烦躁发热，头痛，口渴，脉象洪大。脾胃之气下陷，使水谷精气不能上升浮越，这就是春升之气不能运行，没有阳气来护卫营卫，使其不能抵御风寒，从而产生寒热。这些都是脾胃之气不足所致。然而这与外感风寒的证候，表面相似而实质不同。内伤脾胃，是损伤了正气；外感风寒，是损伤了形体。损伤外部则表现为有余（实证），有余的应当用泻法；损伤内部则表现为不足（虚证），不足的应当用补法。发汗、攻下、催吐、克伐等方法，都属于泻法；温养、调和、调理、滋补等方法，都属于补法。内伤不足的疾病，如果错误地认为是实证而反用泻法，就会使虚者更虚。只应当用辛甘温的药物，补益中气并升举阳气，再用甘寒药物清泻火邪，病就能痊愈。因为阳气下陷，所以使用气味轻薄、性质清纯的药物，如升麻、柴胡之类，以升提扬举，使地道左旋，升至九天之上。如果阴气不降，就用黄柏、泽泻之类药物，以抑制并引导其下降，使天道右迁，进入九地之下。这是李东垣创立的补中益气法，为万世带来无穷的利益，不需要刻意降气，清气上升，浊气自然下降。如果血中有伏火，日渐煎熬，出现气浮心乱的情况，用朱砂安神丸镇固心神。用手触摸肌肤，感觉体表发热的，属于表证，只需服用一二服补中益气汤，得到微微出汗就好了，这不是正常的发汗，而是阴阳之气调和，自然出汗的结果。如果腹中疼痛，怕冷且脉象弦，这是肝木来克制脾土，用小建中汤。如果脉象沉结，腹中疼痛，用理中汤。如果脉象缓，身体沉重，关节疼痛，腹胀且自利，大便中有未消化的食物，这是湿气胜，用平胃散燥湿克伐。胁下收缩紧急，加柴胡；脐下紧急，加肉桂。身体疼痛沉重的，是湿邪，合用五苓散。如果是风湿相搏，全身都痛，加羌活、防风、藁本、升麻、苍术，不要用五苓散。之所以这样，是因为风药已经能胜湿。另外开一付药给他。内伤病有虚实的区别。如饮食失节，劳役所伤，出现发热自汗，倦怠乏力，这是虚中的证候，应当用补益中和的药物调治，不要施用解表法。如果是饮食过饱，这是虚中夹实，因为受伤的饮食积滞不消，导致心胸痞闷，仍然发作寒热，恶心厌食，必须用消导的药物，等到积滞消除，心胸舒畅后，再使用健脾的药物，以免再次损伤元气。如果有宿食不消，下午发热且实证明显，可以用下法，但也必须详细审察，不要妄用泻下。所以体虚之人因饮食所伤，以及外感暴病刚痊愈之后，都应当以六君子汤调理胃气为主。内伤劳倦，以及久病之后，应当以补中益气汤调理脾气为主。调理脾气，百病就不会发生；不调理脾气，各种疾病就会相继而起，久而久之病邪仍会传入胃中。
辨别内外伤：人迎脉大于气口脉，是外感；气口脉大于人迎脉，是内伤。外感病寒热同时发作且无间歇；内伤病寒热交替发作且不规律。外感恶寒，即使靠近火源也不能缓解；内伤恶寒，得温暖即可缓解。外感恶风，是不能忍受一切风寒；内伤恶风，却只害怕门缝隙吹来的贼风。外感证的征象表现在鼻，所以鼻息不利，气息有力，虽然不能吃，但不厌恶食物的气味；内伤证的征象表现在口，所以口不知味，腹中不和，怯弱妨碍进食，厌恶闻食物的气味。外感则是邪气有余，说话声音壮厉，先轻而后重；内伤则是元气不足，说话懒怯，先重而后轻。外感头痛，持续疼痛，多见于脑后、额上，以及遍身肢体腰脊筋骨挛痛；内伤头痛，时作时止，不离两太阳穴及额颅，多兼有肩背胸胁腰腿骨节酸疼。外感则手背热而手心不热；内伤则手心热而手背不热。外感小便赤涩而痛，整天难以排出；内伤小便黄赤，必定短少而频数。外感燥结，则发热腹中硬痛；内伤秘涩，则常有虚坐努责，排出少量白脓。外感胸腹结痛，则疼痛不可按压；内伤有时胃脘当心而痛，向上支撑两胁。外感则手足动摇，烦扰不宁；内伤则四肢不收，倦怠嗜卧。李东垣的辨法就是这样。然而如果两者兼病，则脉象必然同时出现而难以辨别，尤其需要细心求索。如果内证多，则内伤重而外感轻，宜用补养兼散邪的方法，用补中益气汤加羌活。如果外感多，则外感重而内伤轻，宜用调和营卫而邪气自解的方法，用黄芪建中汤加当归。
内伤初期为热中证，症状类似外感阳证：头痛剧烈，气逆而喘，身体发热而烦躁，上气鼻息不调，四肢困倦不能收持，没有力气活动，没有力气说话，或者烦躁闷乱，心烦不安，或者渴或者不渴，心火上炎克制肺经则渴，血脉中有湿则不渴，或者表虚不能抵御风寒，眼睛不想睁开，口不知味，气口脉比人迎脉大两三倍，脉象急大而偶尔出现代脉，这是内伤显示脾气不续的脉象，用补中益气汤。如果有宿食，则右关脉独见沉滑，用枳术丸。
内伤末期传变为寒中证，症状类似外感阴证：腹胀，胃脘部当脐疼痛，四肢与两胁拘急，膈噎不通，或者有涎唾，或者有清涕，或者尿多，足下痛，不能站立行走，骨乏无力，喜欢睡觉，睾丸多冷，隐隐作痛，或者幻觉见到鬼怪状，腰背肩胛脊膂皆病，不渴不泻，脉象盛大而涩，名叫寒中，用枳实理中汤加附子、肉桂、益智仁、草豆蔻。兼有肾脏火衰，面色黑，脚冷，小便不利的，用八味丸加鹿茸、五味子。
内伤类似外感阳明中热证：在大热天气时，因劳役得病，症状与阳明伤热白虎汤证相似。但这其实是脾胃大虚，元气不足的证候。因为在饥饿、困顿、劳役之后，肌表发热躁闷，烦躁口渴想喝水，口鼻气促，眼睛红，面红恶热，昼夜不息，脉象大而虚，重按全无。《内经》说：脉虚则血虚，血虚则发热。误服白虎汤必定危险，应用当归补血汤。
内伤类似外感恶风寒证：有人因劳役辛苦，肾中阴火沸腾，后来脱衣或沐浴后在阴凉处休息，阴火不得行散，回归皮肤，腠理极虚无阳，被风和阴凉所遏制，因此表虚不能抵御风寒，与外感恶风相似。其证候少气短促，懒于言语，困弱无力，不可以同外感治疗，用补中益气汤加紫苏、羌活。严重的加桂枝最为恰当。
劳倦所伤，虚中有寒：脾胃虚弱，不能运化，导致寒物冷痰胶固于中焦，时时痞闷，不觉饥饱。其脉虽弦但按之不鼓指，应当用温药以助脾健运，清理中宫，用理中丸。如果脐下有跳动感，是肾气动，去掉白术加肉桂。呕吐多的，是气上壅，去掉白术加生姜。腹泻多的，是气泄而不收，还用白术。心悸的是饮聚，加桂枝、茯苓。想喝水的，是津液不足，加倍用白术。腹中痛的，加倍用人参。寒多的，加倍用干姜。腹满的，去掉白术加附子。
劳倦所伤，虚中有热：饥饱劳役，损伤脾胃，元气不足的人，其脉多弦，或者洪缓，按之无力中时而一涩。其证候身体沉重，四肢困倦，百节烦疼，胸满短气，膈咽不通，心中不安，耳聋耳鸣，眼睛热如火，视物昏花，口中流口水，饮食无味，忽肥忽瘦，怠惰嗜卧，尿色变赤，或者清利而频数，或者上饮下便，或者时常完谷不化的泄泻，腹中虚痛，不思饮食，用调中益气汤。如果时常显现热躁，是下元真火蒸蒸然发，加生地、黄柏。如果大便虚坐不得，或者大便完了却觉得没完，腹中常逼迫，是气血虚涩，加倍用当归。如果没有以上证候，只服用黄芪、人参、甘草、橘皮、柴胡、升麻、苍术、酒黄柏。饮食不节，劳倦所伤，腹胁满闷短气，遇春天则口淡无味，遇夏天虽然热却仍有恶寒，饿了却常像吃饱一样，不喜欢吃冷物，用升阳顺气汤。劳倦所伤，寒温不适，身热头疼，自汗恶寒，脉微而弱，用黄芪建中汤。饥饱劳役，胃气不足，脾气下溜，气短无力，不时寒热，早饭后转增昏闷，想要睡觉，怠惰嗜卧，四肢不收，懒倦动作，五心烦热，先服升阳补气汤二三剂，后服补中益气汤。脾胃虚弱，喘促少气，衄血吐血，用麦冬清肺饮。
脾胃之气俱病，类似痿弱证：脾胃虚则怠惰嗜卧，四肢不收，正值秋燥令行，湿热少退，体重节痛，口干舌燥，饮食无味，不欲食，食不消，大便不调，小便频数，兼有肺病，洒洒恶寒，惨惨不乐，面色枯槁不和，这是阳气不伸的缘故，用升阳益胃汤。
王安道说：《内经》说：阴虚生内热是怎么回事？回答说：有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，胃气热，热气蒸胸中，故内热。唉，这大概是内伤学说的源头吧！人身上的阴阳，有从表里来说的，有从上下来说的，有从气血来说的，有以身身前后来分的，有从脏腑来说的，有从升降呼吸之气来说的。其余如动静语默起居之类很多，不必全举。这里所说的“阴虚”的阴，所指与上述几种都不同。大概劳动太过，则阳气皆亢极而化为火，况且水谷之气又少入，故阳愈甚而阴愈衰。这个“阴虚”的阴，大概是指身上的阴气与水谷之味罢了。或者以下焦阴阳来说，或以肾水真阴来说，都不对。所谓有所劳役，过动属火；形气衰少，是壮火食气；谷气不盛，是劳伤元气，则少食而气衰；上焦不行，是清阳不升；下脘不通，是浊阴不降。胃受纳水谷，故清阳升而浊阴降，以传化出入，滋荣一身。现在胃不能纳而谷气衰少，则清无升而浊无降了。所以说上焦不行，下脘不通。但这不是说完全不行不通，只是比之平常无病时，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，故胃气热则上炎熏胸中而为内热也。李东垣所言，正与经旨相合，本来应该引用这段经文，作为内外伤辨别的主体，反而不引此，却说火乘土位，对此不能不怀疑。又《内经》说：劳者温之。温者养也。李东垣认为“温”是温凉之温，谓用温药以补元气而泻火邪。又把“损者益之”改为“损者温之”，又以“温能除大热”为《内经》所说，而遍考《内经》，并无此语，也不能不怀疑。然而温药补元气泻火邪的，也只有气温而味甘的可以。盖温能益气，甘能助脾而缓火，故元气复而火邪息也。适宜用温药作为内伤不足的治疗是可以的，但作为对“劳者温之”的注解则不可以。如果用补之、除之、抑之、举之、散之等说法，类比而观，则其义自然显明。
陆丽京说：内伤的起源有三条：曰劳役伤脾，曰饥饱伤胃，曰负重伤血。这三者的虚实悬殊很大。所谓劳役伤脾，证候必定发热头痛，恶风畏食，自汗喘乏，脉象必定气口虚大，平素不习惯劳役的人多有此证，是李东垣补中益气汤的适应证。饥饱伤胃，证候必定黄肿痞满，喘嗽恶食，发热身疼，脉象必定气口粗大，吃粗粮从事劳苦的人多有此证，用平胃散加枣矾。负重伤血，在胃口则咳呕血腥，痞满少食，膈间隐隐刺痛，脉象必定气口见弦，饱食奔驰的人多有此证，用犀角地黄汤加酒大黄，稍微削弱其势，就应当因病制宜，其余积滞不攻自去。
周慎斋说：内伤者左脉常细而涩，右脉多浮而大。阳气下陷不能生阴，故血枯而左脉细涩；脾胃亏损，不能生金，故气虚而右脉浮大。内伤寸口大于尺内，这是阳盛脉，用保元汤加当归、芍药引下，则大脉去而阳气亦内收，这是从阳引阴的方法。肝脉细，余脉和缓，用补中益气汤加枸杞，因为枸杞补肝血。脉气不足，用四君子汤；脉气有余，用平胃散。有余则泻，不足则补，五脏皆如此。病重药宜轻缓，剂量宜减小，只用固中剂三四味，以等待胃气的恢复。脾气虚而脉弦者，服用补中益气汤后必发疟疾；脾气虚而湿胜，服用补中益气汤后必患痢疾。这是邪气寻找出路，仍服前汤自愈。清阳下陷，阴火上升，若用寒药，则阳愈陷，火愈炽，火寻出窍，虚者受之，或目痛，或耳聋，或齿痛，从其虚而散之。脾脉豁大，须防作泻，虚阳作泻，遇此脉必难愈。凡胸前作胀痛者，皆是阳气不达于胸，阴气填塞的缘故。盖阳则气化通达，阴则痰凝气滞，清阳下陷，阴火上升，则为气逆，浊气凝滞，则为痰厥。所谓脾气下溜，乘于肾肝，而成痰厥气逆之渐也。香港脚上升则为清阳，下行则为邪气。内伤中虚表热，或潮热自汗，用补中正方。表热，加羌活、防风。腹中满，加附子。中气不和，加青皮、神曲。间用八珍汤调理。气血俱虚，用十全大补汤。阴虚火动，脉洪大而不作泻，用六味丸。恶寒，用八味丸。腹痛少食，用理中丸。作泻，用六味丸去熟地加远志、沉香、砂仁。不应，加补骨脂、肉豆蔻。倘若病情颠倒难明，必从脾胃调理。凡用补中益气汤，病热已退，升麻、柴胡不可用。若大便燥结，小便不利，或平常见此证，这是清气下陷，补中益气汤虽数帖无妨。如热甚不去者，是因为甘草少的缘故。如用补中益气汤，汗少肺气不开，加用黄芪。汗多里气不守，加用人参。热不退，加用甘草。脐以下无汗，加酒黄柏三分。浑身拘急作胀，系风寒，宜加羌活、防风。但作胀不拘急，为内寒，宜加附子。内伤大便闭者，补中益气汤加苏子、枳壳、杏仁。小便不利，加牛膝。汗多，加白芍减升麻。口干，加煨葛根、五味子。无汗，加用升麻。久病而热不退，气短促，用保元汤加桂枝、附子。烦躁，加当归、白芍、麦冬、五味子。大便欲去而不去，或着而不出为气虚，了而不了为血虚，俱宜补中益气汤。气虚，加用人参。血虚，加用当归。里急后重，初起皆属于热，日久作阳气虚陷治之，前汤加用升麻、柴胡。内伤久而不愈，潮热微汗咳嗽，不思饮食，补中益气汤加干姜、五味子自愈，不必理痰治嗽，正气足，则痰嗽自除矣。凡用补中益气汤，下体痿软，或虚弱者，不可用，当与八味丸。凡内伤作泻，藏附子于白术中，令其守中以止泻也。表热，藏附子于黄芪中，欲其走表以助阳也。
The *Classic of Internal Medicine* states: If diet is unregulated and daily life lacks regularity, the Yin aspect will be affected. When the Yin is affected, the pathogen enters the Six Fu organs. The body becomes feverish, and one cannot rest at proper times; upward, this manifests as panting and calling out. What is referred to as "Yin deficiency generating internal heat" occurs due to excessive labor and fatigue, leading to a decline in physical form and vital Qi, and a lack of abundant grain Qi. The Qi of the Upper Jiao fails to circulate, and the Lower Wan (stomach area) fails to descend, causing Stomach Qi to become hot. This hot Qi steams the chest, thus generating internal heat.
Regarding "Yang excess generating external heat," it arises because the Upper Jiao is obstructed, causing the skin to become dense, the interstices (Cou Li) to close, and the sweat pores (Xuan Fu) to block. Consequently, Wei Qi (Defensive Qi) cannot dissipate, resulting in external heat. Labor causes panting and sweating, causing both Qi and fluids to escape outward, thereby depleting the Yuan Qi.
Li Dongyuan stated: Unregulated emotions (joy and anger), irregular daily habits, and excessive labor all damage the Qi. When Qi declines, Fire flares up; when Fire flares, it overacts on Spleen Earth. Since the Spleen governs the four limbs, the person feels fatigued and hot, lacks energy to move, is reluctant to speak, pants and feels weak during movement, experiences surface heat and spontaneous sweating, and feels restless and uneasy. The *Classic* says: "For conditions of exhaustion, use warming methods." In diseases of labor and fatigue, the pulse is floating and large, the hands and feet are vexatiously hot, symptoms worsen in spring and summer, and improve in autumn and winter. These should be treated with Huangqi Jianzhong Tang (Astragalus Decoction for Building Middle). Humans rely on the Qi from food and water for life. The so-called Clear Qi, Ying Qi (Nutritive Qi), Yun Qi (Transporting Qi), Wei Qi, and Spring-Rising Qi are all alternative names for Stomach Qi. The Stomach is the sea of food and water. If Spleen and Stomach Qi are deficient, Qi sinks downward into the Liver and Kidney, allowing Yin Fire to invade the position of Earth. Thus, in Spleen disease, initially there is Qi rebellion with panting, body heat and vexation, a flooding pulse with headache, or incessant thirst. Because the skin cannot withstand wind and cold, chills and fever arise. If Yin Fire rushes upward, there is Qi rebellion with panting, vexatious heat, headache, thirst, and a flooding pulse. The sinking of Spleen and Stomach Qi prevents Grain Qi from ascending and floating, meaning the Spring-Rising Qi does not function, and there is no Yang to protect Ying and Wei, making them unable to resist wind and cold, thus generating chills and fever. All these result from insufficient Spleen and Stomach Qi. However, these are superficially similar but essentially different from exterior wind-cold patterns. Internal injury to Spleen and Stomach damages Qi (deficiency); exterior wind-cold damages the Form (excess). Exterior excess requires purging; interior deficiency requires tonifying. Methods such as sweating, purging, vomiting, and attacking are purging methods. Warming, harmonizing, regulating, and nourishing are tonifying methods. For internal deficiency diseases, mistakenly treating them as excess and using purgatives will further weaken the deficiency. One must use pungent, sweet, and warm agents to tonify the Middle and raise Yang, and use sweet-cold agents to clear Fire, and the illness will heal. Because Yang Qi has sunk, light and pure substances like Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) are used to lift and elevate, rotating the earth's path leftward to ascend to the highest heavens. If Yin Qi does not descend, bitter-cold agents like Huangbai (Cortex Phellodendri) and Zexie (Rhizoma Alismatis) are used to suppress and descend, rotating the heaven's path rightward to enter the deepest earth. This is Dongyuan’s Bu Zhong Yi Qi method, benefiting generations without end; descent is unnecessary, as rising Clear Qi naturally causes turbid Qi to descend. If latent fire lurks in the blood, slowly simmering and causing floating Qi and chaotic heart, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) is used to stabilize. Touching the skin reveals surface heat, indicating an exterior pattern; taking one or two doses of Bu Zhong Yi Qi Tang leads to slight sweating, which resolves it. This is not forced sweating, but natural sweating due to the harmony of Yin and Yang. If abdominal pain, aversion to cold, and a wiry pulse occur, Wood overacting on Earth is diagnosed; Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is used. If the pulse is deep and knotted with abdominal pain, Lizhong Tang (Regulate the Middle Decoction) is used. If the pulse is slow with heavy body and joint pain, abdominal distension, spontaneous diarrhea, and undigested food, dampness predominates; Pingwei San (Level the Stomach Powder) is used to dry and overcome dampness. Add Chaihu if the hypochondrium is tight; add Rougui (Cortex Cinnamomi) if the umbilical region is tight. Heavy body pain indicates dampness; combine with Wuling San (Five-Ingredient Powder with Poria). If wind-dampness combats, causing whole-body pain, add Qianghuo (Rhizoma Notopterygii), Fangfeng (Radix Saposhnikoviae), Gaoben (Rhizoma Ligustici Wallichii), Shengma, and Cangzhu (Rhizoma Atractylodis Macrocephalae); do not use Wuling San, as wind-dispelling herbs already overcome dampness. Prescribe a separate decoction. Internal injuries have deficiency and excess distinctions. Dietary irregularities and labor injuries causing fever, sweating, and fatigue are deficiency patterns; treat with middle-tonifying agents, avoiding exterior-releasing methods. Overeating creates deficiency-with-excess; undigested food stagnates, causing chest fullness, recurring chills/fever, nausea, and food aversion. Use digestion-promoting agents until the chest is comfortable, then use Spleen-tonifying herbs to avoid re-depleting Yuan Qi. Undigested food with afternoon heat and excess signs may require purgation, but examine carefully to avoid reckless purging. After dietary injury in the debilitated, or after acute exterior illness, prioritize Liu Junzi Tang (Six-Gentleman Decoction) to regulate the Stomach. For internal labor fatigue and post-chronic illness, prioritize Bu Zhong Yi Qi Tang to regulate the Spleen. Regulating the Spleen prevents myriad diseases; failing to do so allows diseases to arise and eventually affect the Stomach.
Differentiating Internal and External Injuries: Renying (Carotid) pulse larger than Qikou (Radial) indicates external injury; Qikou larger than Renying indicates internal injury. External injuries present with simultaneous chills and fever without interval; internal injuries present with alternating chills and fever irregularly. External injury aversion to cold persists even near fire; internal injury aversion to cold resolves with warmth. External injury aversion to wind implies intolerance to all wind/cold; internal injury aversion to wind implies fear only of drafts from cracks. External injury signs manifest in the nose (nasal congestion, strong breath, inability to eat but no food aversion); internal injury signs manifest in the mouth (loss of taste, abdominal disharmony, weakness hindering eating, aversion to food odor). External injury features excess pathogen, loud speech progressing from mild to severe; internal injury features deficient Yuan Qi, timid speech progressing from severe to mild. External injury headache is constant, often at the back of head or forehead, with body/joint/spine pain; internal injury headache comes and goes, located at temples/forehead, often with shoulder/back/chest/hypochondrium/leg joint soreness. External injury: hot back of hand, cool palm; internal injury: hot palm, cool back of hand. External injury: red, scanty, painful urination; internal injury: yellow-red, short, frequent urination. External injury dryness/constipation with fever and hard abdominal pain; internal injury constipation with tenesmus and small amounts of white pus. External injury chest/abdominal binding pain is tender to pressure; internal injury epigastric pain radiating to hypochondrium. External injury: restless, tossing limbs; internal injury: limbs collapse, lethargy. Dongyuan’s differentiation is as above. If both exist, pulses merge and are hard to distinguish; careful inquiry is needed. If internal signs predominate, internal injury is heavy, external light; tonify and scatter pathogen with Bu Zhong Yi Qi Tang plus Qianghuo. If external signs predominate, external injury is heavy, internal light; harmonize Ying and resolve pathogen with Huangqi Jianzhong Tang plus Danggui.
Internal injury initial stage: Heat-in-Middle syndrome resembling exterior Yang pattern. Severe headache, Qi rebellion with panting, body heat/vexation, irregular breathing, limb fatigue/collapse, lack of energy to move/speak, or irritability/restlessness, thirst or no thirst (thirst if Heart Fire attacks Lung; no thirst if dampness in blood vessels), surface deficiency unable to resist wind/cold, eyes unwilling to open, loss of taste. Qikou pulse 2-3 times larger than Renying, rapid-large with occasional intermittent pulse (Dai), indicating Spleen Qi discontinuity. Treat with Bu Zhong Yi Qi Tang. If food retention exists, Right Guan pulse is deep-slippery; use Zhizhu Wan.
Internal injury terminal transmission: Cold-in-Middle syndrome resembling exterior Yin pattern. Abdominal distension, periumbilical pain, limb/hypochondrium spasm, diaphragmatic obstruction, salivation, clear nasal discharge, polyuria, foot pain preventing standing, bone weakness, somnolence, cold/testicular pain, hallucinations, back/shoulder/spine pain, no thirst/diarrhea, large-slow pulse. Named Cold-in-Middle. Treat with Zhishi Lizhong Tang plus Fuzi, Rougui, Yizhi, Caodoukou. If Kidney Fire deficiency with black face/cold feet/dysuria, use Bajia Wan plus Lurong, Wuweizi.
Internal injury resembling exterior Yangming Heat-in-Middle. Occurs in extreme heat after labor, mimicking Baihu Tang syndrome. However, this is severe Spleen/Stomach deficiency and Yuan Qi insufficiency. Post-hunger/fatigue, surface heat/restlessness, thirst/drinking, rapid breathing, red eyes/face, aversion to heat, day/night persistence, large-deficient pulse vanishing on deep pressure. *Classic*: "Pulse deficient means Blood deficient; Blood deficient generates heat." Mistaking this for excess and using Baihu Tang is dangerous. Use Danggui Buxue Tang.
Internal injury resembling exterior Wind-Cold Aversion. Due to labor, Kidney Yin Fire boils; after cooling/bathing in shade, Yin Fire returns to skin. Interstices are extremely empty of Yang, blocked by wind/shade, causing surface deficiency mimicking exterior wind-aversion. Symptoms: shortness of breath, reluctance to speak, weakness. Do not treat as exterior. Use Bu Zhong Yi Qi Tang plus Zisu, Qianghuo. Severe cases add Guizhi.
Labor injury with Deficiency-Cold. Spleen/Stomach weakness fails to transform, causing cold phlegm/stagnation in Middle Jiao, periodic fullness, unaware of hunger/fullness. Pulse wiry but empty on pressure. Warm to aid Spleen transport; use Lizhong Wan. Umbilical throbbing indicates Kidney Qi movement: remove Baizhu, add Rougui. Vomiting indicates Qi rebellion: remove Baizhu, add Shengjiang. Diarrhea indicates Qi leakage: retain Baizhu. Palpitations indicate fluid accumulation: add Guizhi, Fuling. Thirst indicates fluid deficiency: double Baizhu. Abdominal pain: double Renshen. Excess cold: double Ganjiang. Abdominal fullness: remove Baizhu, add Fuzi.
Labor injury with Deficiency-Heat. Hunger/labor damages Spleen/Stomach; Yuan Qi deficient. Pulse wiry or flooding-slow, empty on pressure, occasionally choppy. Symptoms: heavy body, limb fatigue, joint pain, chest fullness/shortness of breath, throat obstruction, heart uneasiness, deafness/tinnitus, burning eyes/blurred vision, foamy saliva, loss of taste, fluctuating weight, lethargy, red urine or clear/frequent urination, upper intake/lower output, sporadic undigested diarrhea, empty abdominal pain, anorexia. Use Tiaozhong Yiqi Tang. If heat/restlessness appears, it is lower Yuan Fire steaming; add Shengdi, Huangbai. If tenesmus or incomplete defecation with abdominal pressure indicates Qi/Blood deficiency-stasis; double Danggui. Without specific symptoms, use Huangqi, Renshen, Gancao, Chenpi, Chaihu, Shengma, Cangzhu, Jiuhuangbai. Dietary irregularity/labor causing abdominal/flank fullness/shortness of breath, bland taste in spring, aversion to cold despite summer heat, feeling full when hungry, dislike of cold food: use Shengyang Shunqi Tang. Labor/cold-heat mismatch causing fever/headache/sweating/aversion-to-cold with micro-weak pulse: use Huangqi Jianzhong Tang. Hunger/labor causing Stomach Qi deficiency, Spleen Qi sinking, shortness of breath, intermittent chills/fever, worsening drowsiness after breakfast, lethargy, limb collapse, five-palm heat: first take Shengyang Bujing Tang 2-3 doses, then Bu Zhong Yi Qi Tang. Spleen/Stomach weakness with panting/shortness of breath, epistaxis/hematemesis: use Maidong Qingfei Yin.
Spleen/Stomach Qi disease resembling Atrophy Syndrome. Spleen deficiency causes lethargy/limb collapse. In autumn dryness, damp-heat recedes, causing heavy body/joint pain, dry mouth/tongue, loss of taste/anorexia, indigestion, bowel/bladder irregularity, combined with Lung disease (chills, depression, sallow complexion) due to Yang Qi not extending. Use Shengyang Yijie Tang.
Wang Andao stated: The *Classic* asks about Yin deficiency generating internal heat. The answer describes labor causing Qi decline, Grain Qi deficiency, Upper Jiao stagnation, Lower Wan obstruction, Stomach heat steaming the chest. This is the origin of internal injury theory. Yin/Yang can be defined by exterior/interior, upper/lower, Qi/Blood, front/back, Zang/Fu, or ascending/descending/respiratory Qi. The "Yin" in "Yin deficiency" here differs from these; it refers to bodily Yin Qi and Grain flavors. Excessive labor makes Yang hyperactive transforming into Fire; reduced grain intake exacerbates Yang excess and Yin decline. It is not referring to Lower Jiao Yin/Yang or Kidney True Yin. Labor is excessive movement (Fire); Qi decline is "Flaming Fire consuming Qi"; Grain Qi deficiency is Yuan Qi damage from labor; Upper Jiao stagnation is failure of Clear Yang to rise; Lower Wan obstruction is failure of Turbid Yin to descend. The Stomach receives food/water, allowing Clear Yang to rise and Turbid Yin to descend for transformation and nourishment. Now, Stomach fails to receive, Grain Qi declines, Clear Yang does not rise, Turbid Yin does not descend. "Upper Jiao does not travel, Lower Wan does not pass" means relative stagnation compared to health, not absolute blockage. Stagnation transforms Shaohuo (Lesser Fire) into Zhuanghuo (Blazing Fire). Located between Upper Jiao and Lower Wan, Stomach heat steams the chest causing internal heat. Dongyuan’s view aligns with the *Classic*. It is surprising he did not cite this passage as the basis for differentiating internal/external injuries, instead citing Fire overacting on Earth. Also, Dongyuan interpreted "Lao Zhe Wen Zhi" (Exhaustion requires warming) as using warm herbs to tonify Yuan Qi and drain Fire, changing "Sun Zhe Yi Zhi" (Damage requires benefit) to "Sun Zhe Wen Zhi," and claiming "Wen Neng Chu Da Re" (Warmth removes great heat) is in the *Classic*, which is absent. However, warm herbs that tonify Qi and drain Fire must be warm and sweet. Warmth benefits Qi; sweetness aids Spleen and moderates Fire, restoring Yuan Qi and extinguishing Fire. Using warm herbs for internal deficiency is valid, but annotating "Lao Zhe Wen Zhi" this way is incorrect. Comparing with tonifying, draining, suppressing, lifting, and dispersing theories clarifies the meaning.
Lu Lijing stated: Three origins of internal injury: Labor injuring Spleen, Hunger/Fullness injuring Stomach, Carrying injury damaging Blood. Their deficiency/excess differ greatly. Labor injuring Spleen: fever/headache, wind-aversion/food-aversion, sweating/panting, Qikou pulse void-large. Common in non-laborers. Treated with Dongyuan’s Bu Zhong Yi Qi Tang. Hunger/Fullness injuring Stomach: yellow edema/fullness, panting/cough/food-aversion, fever/body pain, Qikou pulse coarse-large. Common in laborers eating coarse food. Treated with Pingwei San plus Zaofan. Carrying injuring Blood: hemoptysis/hematemesis, fullness/anorexia, stabbing pain in diaphragm, Qikou pulse wiry. Common in those running after meals. Treated with Xijiao Dihuang Tang plus Jiudahuang to reduce intensity, then adapt to condition.
Zhou Shenzhai stated: Internal injury patients often have thin-choppy Left pulses and floating-large Right pulses. Sinking Yang fails to generate Yin, causing Blood depletion (thin-choppy Left); Spleen/Stomach damage fails to generate Metal, causing Qi deficiency (floating-large Right). Internal injury Cunkou larger than Chiri indicates Yang excess. Use Baoyuan Tang plus Danggui, Shaoyao to guide downward, reducing the pulse and retrieving Yang (guiding Yin from Yang). Liver pulse thin, others relaxed: add Gouqi to Bu Zhong Yi Qi Tang to tonify Liver Blood. Qi deficiency: Si Junzi Tang. Qi excess: Pingwei San. Excess purges, deficiency tonifies; applies to all Zang. For severe illness, use light/gentle meds and small doses, focusing on Middle-fortifying herbs to await Stomach Qi recovery. Spleen Qi deficiency with wiry pulse taking Bu Zhong Yi Qi Tang may develop malaria; Spleen deficiency with dampness may develop dysentery. This is pathogens seeking exit; continuing the previous decoction heals them. If Clear Yang sinks and Yin Fire rises, using cold herbs sinks Yang further and blazes Fire, causing Fire to exit through orifices (eye/ear/tooth pain) affecting deficiency sites. Large-empty Spleen pulse warns of diarrhea; difficult to cure if caused by deficient Yang. Chest pain/swelling indicates Yang failing to reach chest, Yin filling space. Yang allows Qi transformation; Yin causes phlegm/Qi stagnation. Sinking Clear Yang and rising Yin Fire cause Qi rebellion; stagnant Turbid Qi causes Phlegm-Jue. Sinking Spleen Qi invading Liver/Kidney leads to Phlegm-Jue and Qi rebellion. Hongjiao (Erysipelas/Lymphedema) rising is Clear Yang; descending is Evil Qi. Internal deficiency with surface heat or tidal sweating: use Bu Zhong Zhengfang. Surface heat: add Qianghuo, Fangfeng. Abdominal fullness: add Fuzi. Middle Qi disharmony: add Qingpi, Shenqu. Intermittently use Bazhen Tang. Qi/Blood dual deficiency: Shiquan Dabu Tang. Yin deficiency with Fire moving, flooding pulse without diarrhea: Liuwei Wan. Aversion to cold: Bajia Wan. Abdominal pain/anorexia: Lizhong Wan. Diarrhea: Liuwei Wan minus Shudi, add Yuanzhi, Chenxiang, Sharen. If ineffective, add Buguzhi, Roudoukou. If diagnosis is unclear, regulate Spleen/Stomach. When using Bu Zhong Yi Qi Tang, if heat subsides, remove Shengma, Chaihu. Dry stool/dysuria indicates sinking Clear Qi; multiple doses of Bu Zhong are acceptable. Persistent heat suggests insufficient Gancao. Low sweat/open Lung Qi: add Huangqi. High sweat/unsecured Interior Qi: add Renshen. Unresolved heat: add Gancao. No sweat below navel: add Jiuhuangbai. Whole-body stiffness/distension due to wind-cold: add Qianghuo, Fangfeng. Distension without stiffness indicates internal cold: add Fuzi. Internal injury constipation: Bu Zhong Yi Qi Tang plus Suzi, Zhike, Xingren. Dysuria: add Niuxi. High sweat: add Shaoyao, reduce Shengma. Dry mouth: add Weige Gen, Wuweizi. No sweat: add Shengma. Chronic illness with unresolved heat/shortness of breath: Baoyuan Tang plus Guizhi, Fuzi. Irritability: add Danggui, Shaoyao, Maidong, Wuweizi. Tenesmus/incomplete evacuation indicates Qi deficiency; incomplete sensation indicates Blood deficiency. Both suit Bu Zhong Yi Qi Tang. Qi deficiency: add Renshen. Blood deficiency: add Danggui. Tenesmus initially heat-related; chronic cases treated as Yang Qi sinking. Add Shengma, Chaihu to previous decoction. Chronic internal injury with tidal sweating/cough/anorexia: Bu Zhong Yi Qi Tang plus Ganjiang, Wuweizi heals without treating phlegm/cough; sufficient Zheng Qi clears phlegm/cough. Do not use Bu Zhong Yi Qi Tang for lower body atrophy/weakness; use Bajia Wan instead. For internal injury diarrhea, hide Fuzi within Baizhu to secure Middle and stop diarrhea. For surface heat, hide Fuzi within Huangqi to move to surface and assist Yang.