Library

(Excerpt from Mr. Li Dongyuan's *Summary of Internal Injury*)

The human body relies on Stomach Qi (Wei Qi, 胃气) as its foundation. All terms mentioned such as Yang Qi (Yang Qi, 阳气), Yuan Qi (Original Qi, 元气), Grain Qi (Grain Qi, 谷气), Ying Qi (Nutritive Qi, 营气), Clear Qi (Clear Qi, 清气), Wei Qi (Defensive Qi, 卫气), and Spring-rising Qi (Spring-rising Qi, 春升之气) are all alternative names for Stomach Qi. Once the Spleen and Stomach are damaged, Middle Qi (Middle Qi, 中气) becomes insufficient. Grain Qi cannot ascend to nourish the Heart and Lungs but instead flows downward and attacks the Liver and Kidneys (this is the beginning of Atrophy Syndrome [Wu Zheng, 痿证], Jue Syndrome [Jue Zheng, 厥证], and Qi rebellion). The Kidney is affected by Spleen dampness, which blocks the lower part, causing Yin Fire (Yin Huo, 阴火) in the Kidney area to rush upward to the Heart and Lungs. The Heart and Lungs belong to the Qi of Heaven; they are diseases affecting formless Qi. Therefore, irregular diet and overwork constitute internal injury characterized by deficiency. The Liver and Kidneys belong to the Qi of Earth; they are diseases affecting formed substance. Therefore, Wind-Cold pathogenic factors invading the sinews and bones (Wind damages Liver sinews, Cold damages Kidney bones) constitute external injury characterized by excess.

The Classics state: Pathogenic factors of Heaven, when invading, harm the Zang organs; cold and heat from food and drink, when invading, harm the Fu organs. It also states: Those who suffer from thieving wind and empty pathogens receive them in the Yang channels; those with irregular diet and improper daily routine receive them in the Yin channels. Receiving in Yang channels leads to entry into the Fu organs; receiving in Yin channels leads to entry into the Zang organs. These two statements seem contradictory but are actually not. Generally, both internal and external injuries affect the Zang and Fu organs, but the disease manifests according to where the pathogen enters and originates. The Classics say: East wind harms the Liver, West wind harms the Lungs, South wind harms the Heart, North wind harms the Kidneys, and Southwest wind affects the Spleen. From this, we see that pathogenic factors of Heaven indeed harm the Zang organs. However, empty pathogens enter humans from the skin into the Luo vessels, then into the Jing meridians and Shu points, lying hidden in the Chong vessel, and finally reaching the intestines and stomach. It also says: Northeast wind harms humans, internally residing in the Large Intestine; Northwest wind resides in the Small Intestine; Southeast wind resides in the Stomach. Thus, do pathogenic factors of Heaven not also harm the Fu organs? The Classics say: If food intake doubles, the intestines and stomach are injured. Thus, cold and heat from food and drink indeed harm the Fu organs. It also says: Physical cold and cold drinks harm the Lungs; dietary irregularity and fatigue harm the Spleen. This does not mean they do not harm the Zang organs either. As for Earth dampness, it does not necessarily only harm the skin, flesh, sinews, and vessels without harming the Zang and Fu organs. Nor do pathogenic factors and food/drink necessarily only harm the Zang and Fu organs without harming the skin, flesh, sinews, and vessels. It is simply because pathogenic factors are formless, and Zang organs store essence and Qi, so like attracts like, often harming the Zang organs. Food and drink are formed, and Fu organs transmit and transform substances, so following their path, they often harm the Fu organs. Dampness infiltrates slowly, so it moves from below upward and from shallow to deep, often harming the skin, flesh, sinews, and vessels. Who would say that dampness has no effect on the Zang and Fu organs! From this, we know that the principles of Yin-Yang and deficiency-excess in Cold Damage (Shang Han, 伤寒), Warmth-Heat [diseases] (Wen Shu, 温暑), internal injury, and miscellaneous diseases are identical. Are Zhang Zhongjing, Li Dongyuan, Zhu Danxi, and Liu Hejian really superior or inferior to one another?

For excess, use purgation; for deficiency, use tonification. A slight error in tonification or purgation can determine life or death instantly. The reason for doubt and confusion lies in the fact that hundred diseases all begin with symptoms such as aversion to cold, aversion to wind, fever, and headache. Miscellaneous diseases also present symptoms seen in the Six Channels, and surgical diseases are the same, which is why laypeople confuse them without distinction. The easiest to distinguish is: In Cold Damage, aversion to cold is fierce and unrelenting like a hot fire; in internal injury, aversion to cold occurs because Yuan Qi flows downward, leaving the Heart and Lungs without nourishment, and there is no Yang Qi in the skin to protect against it. Any exposure to wind-cold causes fear, which is constant and uninterrupted. It stops slightly upon approaching warmth. In Wind Strike, aversion to wind means intolerance to all wind-cold; in internal injury, aversion to wind is specifically sensitive to minor thieving winds. One feels no aversion if staying in a sealed room. In external injury, aversion to heat is relentless, worsening at Shen hour (3-5 PM), and only subsides after sweating; in internal injury, fever resembles Cold Damage or Heat Stroke (Zhong Shu, 中暑), but irritability comes and goes, or feeling cool after exposing oneself. For those with weak constitutions, low appetite, overwork, or thin stomach Qi due to vegetarianism, illness caused by labor resembles Yangming Heat Stroke (Yangming Zhong Shu, 阳明中暑); misusing Baihu Tang (White Tiger Decoction) will cause death. However, in Heat Stroke, heat peaks at Shen hour, sometimes with delirium; in internal injury, condition improves at Shen hour because Yangming Qi is vigorous. External injury causes bone and joint pain, requiring bed rest due to inability to support oneself; internal injury causes fatigue, resembling Cold Damage or Dampness Strike, but merely involves flaccid limbs, weakness, and lethargy. Occasionally, if Spleen is attacked by heat, bone wasting and sinew laxity occur, but these are not immediate signs.

Internal injury presents alternating and irregular cold and heat; or due to inhaling wind-cold air, suppressing Yin Fire, blocking the throat and diaphragm. The inhaled air wants to enter but is rejected by the fire in the Chong vessel above the diaphragm, preventing Yin Qi from entering. Chest Qi is suppressed by external wind-cold and cannot extend, causing open mouth and staring eyes. In extreme cases, sound emanates from within, Qi cannot move up or down, gets stuck in the throat, and breath seems about to cease. Alternatively, dryness and heat arise due to hiccup, vomiting, or regurgitation, always having a cause. The syndrome of exterior deficiency with aversion to wind-cold reappears; the deficiency of exterior is attacked by Yin Fire, and dryness passes quickly. The syndrome of exterior deficiency lacking Yang, unable to withstand wind-cold, reappears; this lack of Yang in the exterior is constant, while dryness is intermittent. These two are irregular: when dryness appears, cold disappears; when cold appears, dryness disappears. This differs from external injury where cold and heat appear together without interruption.

External injury features simultaneous and uninterrupted cold and heat. Internal injury headache comes and goes; external injury headache persists until dispersed and transmitted inward. Is it not just that initial symptoms resembling Taiyang syndrome are distinguishable? Internal injury involves insufficient Yuan Qi, dull and lethargic spirit, tired and lazy speech, starting heavy and becoming light. External injury involves excess pathogenic Qi, vigorous spirit, strong speech, starting light and becoming heavy. Internal injury presents hot palms and cool backs of hands; external injury presents hot backs of hands and cool palms. In internal injury, if excess pathogenic Qi is in the blood vessels, there is no thirst; occasional thirst indicates Heart Fire attacking Lung Metal, a severe injury. In external injury, when pathogenic Qi transmits inward, there is intense thirst. Internal injury symptoms manifest in the mouth: even when eating, taste is unknown, excessive saliva, irregular breathing, or clear nasal discharge. External injury symptoms manifest in the nose: Cold Damage causes nasal congestion, Wind Strike causes runny nose; although eating is difficult, taste is known. Internal injury shows large Qi Kou pulse; external injury shows floating and tight Ren Ying pulse.

External contraction of wind-cold results in Ren Ying pulse being slow or tight, larger than Qi Kou by one or two to three times. Internal injury from diet results in Qi Kou pulse larger than Ren Ying by one time; if severe, involving Shaoyin, it is twice as large; involving Taiyin, three times as large. This is the pulse of internal dietary injury. If overwork is severe, Heart pulse changes appear at Qi Kou, indicating Heart Fire punishing Lung Metal. Liver Wood, carrying the momentum of Heart Fire, also attacks Lung Metal, so Qi Kou pulse is urgent, large, rapid, occasionally intermitted and choppy. Choppy is the native pulse of Lung; intermitted indicates disconnected Yuan Qi and insufficiency of Spleen-Stomach; large and rapid indicates Heart Fire punishing Lung; urgent indicates Liver Wood carrying Heart Fire counter-punishing Lung Metal. If overwork is not severe, only the Right Guan pulse is rapid and uniquely larger than the other five pulses, showing slowness within rapidity, occasionally intermitted. If diet is irregular and climate mismatched, first the Right Guan Stomach pulse becomes weak, severely invisible, showing only the inner Spleen pulse as large, rapid, slightly slow, occasionally intermitted. Undigested food shows exclusively Right Guan pulse deep and slippery.

If internal symptoms predominate, internal injury is heavy and external contraction is light; tonification should be prioritized. If external symptoms predominate, external contraction is heavy and internal injury is light; dispersing should be urgent. This is the key point for physicians. Alas, practitioners who do not study act recklessly, failing to distinguish between internal and external conditions, focusing solely on dispersal, leading to treating excess as excess and deficiency as deficiency (exacerbating the condition). How lamentable!