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1. Internal injury results from excessive labor damaging the Spleen Qi, and improper diet damaging the Stomach and the physical form. Damage to the form arises from irregular lifestyle and excessive exposure to cold or heat, leading to Qi being affected by Dampness, Heat, Summerheat, Fire, or Cold.
[Note] Excessive labor damages Qi, specifically Yuan Qi (Original Qi). Improper diet damages the Form, specifically the Stomach organ. Damage to Qi should be treated with tonification; there are differences among Repletion of Heat, Damp-Heat, Summerheat-Heat, Fire Depression, and Cold Invasion. Damage to the Form should be treated with resolution/digestion; there are differences among dietary irregularity, and excessive consumption of warm/hot or cold foods.

2. In internal injury, the pulse is large and prominent at the Qikou (Cunkou/Radial artery); in external contraction, the pulse is large and prominent at the Renying (Carotid artery). Regarding headache: internal injury causes intermittent pain, whereas external contraction causes constant pain. Regarding aversion to cold: internal injury resolves with warmth and clothing, whereas external contraction persists even near intense fire. Regarding fever: internal injury fever resides in the muscle layer, feeling as if heat radiates from within when palpated; external contraction fever resides in the skin layer, feeling superficially light when palpated. Regarding spontaneous sweating: internal injury presents with shortness of breath, fatigue, and a weak voice, whereas external contraction presents with robust breathing and a loud voice. Regarding hand temperature: internal injury causes heat in the palms, whereas external contraction causes heat on the dorsum of the hands. Regarding respiration: internal injury presents with short, asthmatic nasal breathing, whereas external contraction presents with rapid, wheezing nasal breathing. Regarding appetite: internal injury involves loss of appetite with no taste in the mouth, whereas external contraction involves aversion to the smell of food. Regarding thirst: internal injury causes immediate thirst with small water intake, whereas external contraction causes thirst after three days with large water intake.
[Note] Both internal injury and external contraction present with a large pulse. In internal injury, the Qikou pulse is larger than the Renying pulse, unlike external contraction where the Renying pulse is larger than the Qikou. Both involve headache; internal injury headache is intermittent, unlike external contraction which is constant. Both involve aversion to cold; internal injury aversion resolves with warmth, unlike external contraction which persists despite proximity to fire. Both involve fever; internal injury fever is deep in the muscles, radiating from within upon palpation, unlike external contraction fever which is superficial in the skin. Both involve spontaneous sweating; internal injury sweating accompanies shortness of breath, fatigue, and a weak voice, unlike external contraction sweating which accompanies robust breathing and a loud voice. Both involve heat in the hands; internal injury heat is in the palms, unlike external contraction heat which is on the dorsum. Both involve nasal discomfort; internal injury involves short, asthmatic breathing, unlike external contraction which involves rapid, wheezing breathing. Both involve anorexia; internal injury anorexia is due to lack of taste, unlike external contraction anorexia which is due to aversion to food smells. Both involve thirst; internal injury thirst occurs immediately with little intake, unlike external contraction thirst which occurs later with heavy intake.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)

3. Buzhong Yiqi Tang raises Yang and clears deficiency heat, indicated for Qi sinking and a large, deficient, flooding pulse caused by Heat damaging Yuan Qi due to overwork. Symptoms include headache, exterior heat, spontaneous sweating, vexation, thirst, aversion to wind/cold, fatigue, reluctance to speak, Qi deficiency, and panting/loud voice upon exertion. This formula uses Ginseng, Astragalus, and Licorice (Baoyuan Tang) with sweet-warm properties to eliminate great heat, allowing Blood to return; Atractylodes tonifies the Spleen channel; Tangerine Peel descends turbidity and disperses stagnant Qi; Cimicifuga and Bupleurum guide Yang upward from the Stomach. If Yin Fire causes Kidney restlessness, add Rehmannia and Phellodendron; if Yang Heat causes vexation, combine with Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) to drain Fire and calm the Spirit.
[Note] Buzhong Yiqi Tang treats internal injury, clearing sinking Clear Yang caused by overwork and Heat damaging Yuan Qi, resulting in a deficient, large, and flooding pulse. Internal injury headache is intermittent. Internal injury exterior heat often presents with spontaneous sweating. Vexation indicates Qi deficiency and aversion to mental/physical exertion. Thirst indicates Qi sinking failing to steam and transform fluids. Aversion to cold/wind indicates exterior Qi deficiency failing to guard the exterior. Fatigue and reluctance to speak indicate Qi deficiency failing to circulate fully. Panting upon movement indicates insufficient Lung Qi. "Baoyuan" refers to Ginseng, Astragalus, and Licorice, named Baoyuan Tang. The minister herb Angelica harmonizes Spleen Blood; Atractylodes benefits Spleen Qi; the assistant herb Tangerine Peel descends turbidity and disperses chest stagnation; Cimicifuga and Bupleurum raise Clear Yang, guiding Yang from the Stomach. If Yin Fire manifests as irritability/heat, add Phellodendron and Rehmannia to nourish Water and save Yin. If Yang Heat causes day-and-night vexation, combine with Zhusha Anshen Wan to drain Fire and calm the Spirit.
Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction)

4. Tiaozhong Yiqi Tang is indicated for pulses that are wiry, flooding, slow, deep, and choppy, accompanied by body fatigue, bone/joint soreness, shortness of breath, vexation, fluctuating weight changes, salivation, regurgitation of food, tinnitus/deafness, chest/opium discomfort, loss of taste, bowel/bladder dysfunction, undigested stool, or pus/blood in stool. The formula contains Baoyuan Tang (Ginseng, Astragalus, Roasted Licorice), Cimicifuga, Bupleurum, Atractylodes, Tangerine Peel, and Phellodendron. Removing Phellodendron and adding Aucklandia retains the name Tiaozhong Yiqi Tang.
[Note] Tiaozhong Yiqi Tang also treats internal injury, addressing sinking Clear Yang, ascending Turbid Qi, their interference, and accompanying Damp-Heat, leading to bowel/bladder dysfunction and dysentery with undigested food/pus/blood. Although this formula elucidates similar principles to Buzhong Yiqi Tang, its symptoms and pulses must be distinguished. In internal injury, once Spleen/Stomach Yuan Qi is deficient, the Four Zang organs lose harmony, causing mixed Zang pulses: Liver wiry, Heart flooding, and Spleen slow pulses appear superiorly. Palpating reveals deep/choppy Lung pulses inferiorly. Heavy limbs/fatigue indicate Qi failure to circulate. Bone/joint soreness indicates Blood failing to nourish. Shortness of breath indicates Middle Qi deficiency. Vexation indicates Heart Blood deficiency. Fluctuating weight indicates Fire attacking the Earth element; ascending to Yang aspect causes blood to rise, red face, and apparent obesity; descending to Yin aspect causes blood to fall, pale/blue face, and emaciation. Saliva indicates Spleen failing to distribute essence. Regurgitation indicates Stomach deficiency failing to receive. Tinnitus/deafness indicates Yin Fire rushing upward. Chest discomfort indicates Turbid Qi stagnation. Loss of taste indicates Stomach Qi damage. Bowel/bladder dysfunction indicates Spleen Dampness failing to separate. Undigested stool (Sun diarrhea) indicates Spleen deficiency failing to transform Dampness. Pus/blood indicates Spleen Damp-Heat brewing. "Baoyuan" refers to Ginseng, Astragalus, Roasted Licorice, Cimicifuga, Bupleurum, Atractylodes, Tangerine Peel, Phellodendron. Removing Phellodendron and adding Aucklandia is also named Tiaozhong Yiqi Tang, suitable for cases with less Heat and Qi disharmony.
Shengyang Yiewei Tang (Raise Yang and Benefit the Stomach Decoction)

5. Shengyang Yiewei Tang treats internal injury where excess Dampness and slight Heat suppress the rising of Clear Yang. Symptoms include fatigue, reluctance to eat, heavy painful body, bitter taste, dry tongue, irregular bowels/bladder, shivering aversion to cold (Lung disease), and depression (Yang injury). The formula contains Liu Jun Zi Tang (Six Gentlemen Decoction: Ginseng, Atractylodes, Poria, Roasted Licorice, Tangerine Peel, Pinellia) plus White Peony, Coptis, Alisma, Astragalus, Notopterygium, Saussurea, Bupleurum, and Saposhnikovia.
[Note] Internal injury Qi deficiency with excess Dampness and slight Heat, suppressing the Spring-like Clear Yang from rising to the Spleen/Stomach, is treated with this decoction. Symptoms: fatigue, reluctance to eat, heavy painful body, bitter taste, dry tongue, irregular bowels/bladder (bowel irregularity, frequent urination). Shivering aversion to cold indicates Wei Qi deficiency, a Lung/skin-hair disorder. Depression and unhealthy complexion indicate Yang injury failing to extend. "Liu Jun" refers to Ginseng, Atractylodes, Poria, Roasted Licorice, Tangerine Peel, Pinellia. Adding White Peony, Coptis, Alisma, Astragalus, Notopterygium, Saussurea, Bupleurum, and Saposhnikovia constitutes Shengyang Yiewei Tang.
Bu Piwei Xie Yinhuo Shengyang Tang (Tonify Spleen/Stomach, Drain Yin Fire, Raise Yang Decoction)

6. Bu Piwei Xie Yinhuo Shengyang Tang tonifies the middle, raises Yang, and drains Yin Fire, indicated for excess Fire and slight Dampness confining Spleen Yang. Although similar to Shengyang Yiewei Tang indications, it lacks bowel irregularity, frequent urination, shivering aversion to cold (Lung disease), and depression (Yang injury). The formula contains Ginseng, Astragalus, Licorice to tonify Spleen/Stomach Qi; Bupleurum, Cimicifuga, Notopterygium to raise Yang; Gypsum, Scutellaria, Coptis to drain Yin Fire; and Atractylodes due to long summer dampness.
[Note] Internal injury Qi deficiency with excess Heat and slight Dampness, where Yin Fire confines the Spleen preventing Yang from rising, is treated with this formula. Although similar to Shengyang Yiewei Tang indications, it lacks bowel irregularity, frequent urination, shivering aversion to cold (Lung disease), and depression (Yang injury).
Modifications for Internal Injury Buzhong, Tiaozhong, Shengyang Yiewei Decoctions

7. Winter: Add Ginger, Cinnamon, Cardamom, Alpinia to assist Yang. Autumn: Add White Peony, White Cardamom, Amomum, Areca Seed to assist drying/astringency. Summer: Add Scutellaria, Coptis, Phellodendron to descend Yin Fire; or if Qi rushes upward (Yin Fire), add these regardless of season. Spring: Add Wind-dispelling herbs (Notopterygium, Saussurea, Saposhnikovia, Ligusticum) to assist Ginseng/Astragalus in raising Clear Yang. Long Summer: For heaviness/fatigue/low spirit, add Ginseng, Ophiopogon, Schisandra (fearing Summerheat damaging Qi); add Alisma, Poria, Atractylodes to remove Spleen Dampness. Lung Heat cough: Reduce Ginseng, remove Polygala. Spring: Add Boilweed, Coltsfoot to disperse Lung Wind. Summer: Add Ophiopogon, Schisandra to protect Lung Qi. Winter: Add Ephedra with roots/rhizomes to disperse Lung Cold. Headache: Add Vitex to guide to Taiyang; severe pain add Ligusticum for rapid ascent. Vertex/brain pain: Add Ligusticum to enter Du Mai; severe pain add Asarum to traverse Shaoyin. Phlegm-Jue headache/heaviness/vomiting: Add Pinellia, Ginger to treat Phlegm reversal. Dry mouth/throat/exterior heat: Add Kudzu to generate fluids and release muscle layer. Dry constipation: Add Mirabilite; Blood deficiency dryness: Add Angelica; Blood excess dryness: Add Peach Kernel; Heat excess dryness: Add Rhubarb. Epigastric fullness/Qi stagnation: Add Aucklandia; Food stagnation: Add Amomum; Epigastric heat knot: Add Coptis; Epigastric Qi knot: Add Immature Bitter Orange; Stomach Qi congestion: Add Magnolia Bark. Stomach Cold/Winter: Remove Coptis, add Stir-fried Ginger. Stomach pain: Add Cardamom; Stomach Cold/saliva: Add Alpinia; Qi fullness: Add White Cardamom, Green Tangerine Peel. Abdominal pain: Add White Peony, Licorice; check for Heat (add Scutellaria) or Cold (add Cinnamon). Umbilical pain: Add Cinnamon, Prepared Rehmannia. Internal/external stabbing pain (Blood stasis): Add Angelica to invigorate Blood. Hypochondriac pain/tightness: Add Licorice, Bupleurum to harmonize Liver. Heavy body/weak legs: Add Stephania, Atractylodes, Phellodendron to remove internal Damp-Heat. Body pain/fever: Add Ligusticum, Saposhnikovia, Notopterygium to dispel Wind from the exterior.
[Note] Winter additions assist Yang. Autumn additions assist drying/astringency. Summer additions descend Yin Fire. Qi rushing upward indicates Yin Fire; add herbs regardless of season. Spring Wind herbs assist Ginseng/Astragalus in raising Clear Yang. Long Summer additions address Summerheat Qi damage and Spleen Dampness. Lung Heat cough modification avoids Lung Heat. Spring additions disperse Lung Wind. Summer additions protect Lung Qi. Winter Ephedra disperses Lung Cold. Vitex guides to Taiyang. Ligusticum ascends rapidly. Ligusticum enters Du Mai. Asarum traverses Shaoyin. Pinellia/Ginger treat Phlegm reversal. Kudzu generates fluids/releases muscle layer. Mirabilite treats dryness; Angelica treats Blood deficiency dryness; Peach Kernel treats Blood excess dryness; Rhubarb treats Heat excess dryness. Aucklandia treats Qi stagnation. Amomum treats food stagnation. Coptis treats heat knots. Immature Bitter Orange treats Qi knots. Magnolia Bark treats Qi congestion. Ginger replaces Coptis for Cold. Cardamom/Alpinia treat Stomach Cold. White Cardamom/Green Tangerine Peel treat Qi fullness. White Peony/Licorice treat abdominal pain; Scutellaria/Cinnamon added based on Heat/Cold. Cinnamon/Rehmannia treat umbilical pain. Angelica treats Blood stasis. Licorice/Bupleurum harmonize Liver. Stephania/Atractylodes/Phellodendron remove Damp-Heat. Ligusticum/Saposhnikovia/Notopterygium dispel exterior Wind.
Qingshu Yiqi Tang (Clear Summerheat and Augment Qi Decoction) Qingzao Tang (Clear Dryness Decoction)

8. Long Summer damp-summerheat diseases: Summerheat-dominant cases use Qingshu Yiqi Tang. Symptoms: sweating, fever, vexation, thirst, fatigue, Qi deficiency, anorexia, dysuria, loose stools. Formula: Buzhong Yiqi Tang minus Bupleurplus, plus Phellodendron, Alisma, Ophiopogon, Schisandra, Atractylodes, Medicated Leaven, Kudzu, Green Tangerine Peel. Damp-dominant cases causing flaccidity-cold syndrome (lower body weakness, gait disturbance) use Qingzao Tang: former formula plus Rehmannia, Polyporus, Poria, Bupleurum, Coptis; minus Kudzu, Green Tangerine Peel.
[Note] Long Summer season features steaming Summerheat and Dampness. Summerheat-dominant disease presents with sweating, fever, vexation, thirst, fatigue, anorexia, scanty dysuria, loose stools; treated with Qingshu Yiqi Tang (Buzhong Yiqi Tang minus Bupleurum, plus Phellodendron, Alisma, Ophiopogon, Schisandra, Atractylodes, Medicated Leaven, Kudzu, Green Tangerine Peel). Damp-dominant disease causes flaccidity-cold syndrome (lower body weakness, difficulty moving, abnormal gait, tilted feet); treated with Qingzao Tang (former formula plus Rehmannia, Polyporus, Poria, Bupleurum, Coptis; minus Kudzu, Green Tangerine Peel).
Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction) Huoyu Tang (Fire Depression Decoction)

9. Blood deficiency and Stomach weakness from excessive cold/raw food cause Yang depression in the Spleen, treated with Shengyang Sanhuo Tang. Symptoms: heat sensation in skin/muscles/bones/limbs, burning to touch, very high heat. Formula: Notopterygium, Saussurea, White Peony, Saposhnikovia, Cimicifuga, Bupleurum, Kudzu, Ginseng, two Licorices (Roasted/Raw), Jujube, Ginger. For Fire Depression: add Scallion, reduce Ginseng/Saussurea. This is a method to dissipate aversion to cold.
[Note] Two Licorices refer to Roasted Licorice and Raw Licorice. "Aversion to cold" means despite burning heat, the patient feels cold. Deep, rapid pulse indicates Fire depressed in the muscle interior; treat by dispersing with this formula.
Baizhu Fuzi Tang (Atractylodes Macrocephala and Aconite Decoction) Jiawei Lizhong Tang (Modified Center-Regulating Decoction)

10. Internal injury where Water insults Earth (Cold-Damp) uses Baizhu Fuzi Tang. Symptoms: excess saliva/phlegm, abdominal distension, frequent urination, weak legs, pain, back/shoulder/scrotal/testicular pain, cold scrotum, intermittent阴阴 pain. Formula: Atractylodes, Aconite, Wuling San (Five-Ling Powder), Tangerine Peel, Pinellia, Magnolia Bark. For deficiency, use Lizhong Tang plus Aconite, Poria, Atractylodes.
[Note] Dongyuan's internal injury: Heat-Repletion uses Buzhong Yiqi Tang; Cold-Repletion uses Baizhu Fuzi Tang. Cold-Repletion is Water insulting Earth (Cold-Damp). Internal symptoms: abdominal distension, frequent urination, excess saliva/phlegm. External symptoms: weak legs, shoulder/back/scrotal/testicular pain. Spleen/Stomach Cold-Damp without Qi deficiency uses this formula (Wuling San plus Atractylodes, Aconite, Tangerine Peel, Pinellia, Magnolia Bark). Spleen/Stomach Cold-Damp with Qi deficiency uses Lizhong Tang plus Aconite, Poria, Atractylodes.
Renshen Zisheng Wan (Ginseng Nourishing Life Pill)

11. Zisheng Wan treats dual Spleen/Stomach deficiency, a neutral tonifying formula. Symptoms: poor appetite, indigestion, postprandial fullness, sallow complexion, emaciation, severe fatigue.
[Note] Miao Zhongchun formulated Zisheng Wan as a neutral tonifier for dual Spleen/Stomach deficiency. Indications: reduced appetite, delayed digestion, postprandial fullness/distension, sallow complexion, gradual emaciation, severe fatigue. Formula recorded in other texts, so ingredients omitted.
Qingwei Lipi Tang (Clear Stomach and Regulate Spleen Decoction)

12. Qingwei Lipi Tang treats Damp-Heat and Food Stagnation, using Pingwei San modified with Three Yellows (Coptis, Scutellaria, Rhubarb). Symptoms: sticky foul stool, red urine, preference for cold drinks, oral/tongue ulcers.
[Note] Qingwei Lipi Tang is Pingwei San plus Coptis, Scutellaria, Rhubarb. "Modified Three Yellows" implies Rhubarb is omitted if there is Heat stagnation without excess accumulation. "Food Stagnation" includes distension, hiccups/vomiting, anorexia, acid regurgitation, nausea, belching. Accompanied by sticky foul stool, red dysuria, preference for cold, oral ulcers—all indicating Damp-Heat from rich foods/alcohol.
Lizhong Tang (Center-Regulating Decoction)

13. Lizhong Tang treats Deficient-Cold-Damp injury. Symptoms: poor appetite, preference for hot foods, sallow-blue complexion, abdominal pain, borborygmus, vomiting cold saliva, fishy-smelly duck-like loose stool.
[Note] Baizhu Fuzi Tang treats Spleen/Stomach Cold-Damp with robust constitution. Lizhong Tang treats Spleen/Stomach Cold-Damp with deficient constitution. Deficiency symptoms: poor appetite, preference for hot foods, sallow-blue complexion, abdominal pain, borborygmus, cold saliva vomiting, non-foul fishy stool resembling clear duck feces; thus, this decoction is appropriate.
Xiaoshi Jianpi Wan (Digest Food and Strengthen Spleen Pill)

14. Stomach Strong/Spleen Weak condition: able to eat but cannot digest, treated with Xiaoshi Jianpi Wan. Formula: Pingwei San (Atractylodes, Magnolia Bark, Licorice, Tangerine Peel) plus Fried Salt, Pepper, Malt, Medicated Leaven, Hawthorn, Tribulus.
[Note] Stomach Strong/Spleen Weak: Stomach strong allows eating; Spleen weak fails to digest. Treat with Xiaoshi Jianpi Decoction/Pill to aid digestion. Ingredients: Atractylodes, Tangerine Peel, Magnolia Bark, Licorice, Fried Salt, Pepper, Hawthorn, Medicated Leaven, Malt, Tribulus, powdered, honey-pilled. Dietary restriction is essential for Spleen/Stomach harmony and transport.
Kaiwei Jinshi Tang (Open Appetite and Promote Eating Decoction)

15. Kaiwei Jinshi Tang treats anorexia due to Spleen/Stomach deficiency (poor intake, indigestion). Formula: Dingxiang (Clove), Muxiang (Aucklandia), Huoxiang (Patchouli), Lianzi (Lotus Seed), Houpo (Magnolia Bark), Liujun Zi Tang (Six Gentlemen Decoction) plus Sharen (Amomum), Maiya (Malt), Shenqu (Medicated Leaven).
[Note] Treats lack of appetite and inability to digest small amounts due to dual Spleen/Stomach deficiency. Formula is Liujun Zi Tang plus Clove, Aucklandia, Patchouli, Lotus Seed, Magnolia Bark, Amomum, Malt, Medicated Leaven.
Pingwei San (Peaceful Stomach Powder)

16. Pingwei San treats all Food Stagnation Spleen/Stomach diseases. Symptoms: distension, hiccups/vomiting, anorexia, acid regurgitation, nausea, belching. Formula: Atractylodes, Magnolia Bark, Licorice, Tangerine Peel. Modifications: Kuai Ge adds Immature Bitter Orange, Atractylodes; Phlegm adds Pinellia, Poria; Grain stagnation adds Malt, Rice Sprout, Amomum, Medicated Leaven; Meat stagnation adds Hawthorn; Flour stagnation adds Radish; Heat adds Scutellaria, Coptis, Phellodendron, Rhubarb.
[Note] Food Stagnation treated with Pingwei San (Atractylodes, Magnolia Bark, Licorice, Tangerine Peel). Kuai Ge modification adds Immature Bitter Orange, Atractylodes. Phlegm adds Pinellia, Poria. Grain stagnation adds Malt, Rice Sprout, Amomum, Medicated Leaven. Meat stagnation adds Hawthorn. Flour stagnation adds Radish. Heat adds Scutellaria, Coptis, Phellodendron, Rhubarb, used judiciously.
Gehua Jiecheng Tang (Kudua Flower Relieve Intoxication Decoction)

17. Gehua Jiecheng Tang treats alcohol intoxication via sweating. Symptoms: anorexia, fever/fatigue, vomiting, headache, aversion to cold. Formula: Ginseng, Kudua Flower, Siling (Four Poria: Atractylodes, Poria, Polyporus, Alisma), White Cardamom, Amomum, Medicated Leaven, Ginger, Tangerine Peel, Aucklandia, Green Tangerine Peel.
[Note] Alcohol injury treated by inducing sweat with Gehua Jiecheng Tang; recovery follows sweating. Symptoms: headache, anorexia, vomiting, fever, fatigue/vexation—resembling external contraction but caused by alcohol. Formula: Ginseng, Kudua Flower, Atractylodes, Poria, Polyporus, Alisma, White Cardamom, Amomum, Medicated Leaven, Ginger, Tangerine Peel, Aucklandia, Green Tangerine Peel.
Mifang Huazhi Wan (Secret Formula Resolve Stagnation Pill)