伤食则恶食，已详饮食门，此举他证言之耳。大抵不能食由于胃满，而致满非
一。有寒气滞于胃而满者，有热气壅于胃而满者；有湿痰不运而满者；有命门火衰致
脾胃虚寒而满者；有肾水不足，虚火上冲而满者。寒滞者，六君子（见气）加干姜。热壅
者，石膏、白芍、枳实、黄连、陈皮之属。湿者，除湿汤（见中湿）、平胃散（见伤食）。痰者，
二陈汤（见痰）。痰积痞隔，皂 烧存性研末，酒调服一钱。肾火虚者，八味丸（见虚损）、二
神丸。肾水虚者，六味丸（见虚损）。其有饥而不能食者，脾热则消谷而饥，本欲食，因
胃脘枯槁不能纳，或火热上冲，或痰涎上壅，食不得下也。若缘脾胃衰败之极，欲
食不能，则殆矣。热则消谷善饥，乃热而能营运者，若壅滞不行，则不能食矣。
劳则气耗，以喘而汗出。喘则气内越，汗出则气外越，故气耗也。又劳则动火，
火动则气益散，气愈虚而火愈炎矣。（气盛则运而不积，纵有火亦能行散，不见其为火。气虚则不能运
而火聚，聚故炎也。）然非特劳为然也，七情过甚，色欲过度，饮食不时，皆能伤其真气，
皆能生火。火为元气之贼，壮火食气，一盛则一衰。火聚于中，脾胃受热则困倦，
四肢疰闷，（疰，住也，注也。言四肢 闷，住而不去，或走注也。）无气以动，动即喘乏。脾失健运
之常，（阴阳和平乃运，一有偏胜则不运矣。寒固有之，热亦宜然。）即不思食，口不知味，饮食日少，
谷气不盛。（气衰则资于饮食，乃谷气又衰，则愈不运而郁积矣。）以故气不能升而上焦不行，不能
下降而下脘不通，止郁于脾胃之中而作热。热气上蒸于胸，外透于表，以故气喘，
心烦，头痛而渴，或不渴，（津液或存或亡之故。）表热自汗，或皮肤不任风寒而生寒热，
脉浮大而虚，春夏剧，秋冬瘥，谓之阳虚内热。病者首宜安心静坐，以存养其气，
而以酸味收其散越，甘温补其虚衰，（按东垣云∶《经》曰∶劳者温之，损者温之。又曰∶温能除大热，
是也。大忌苦寒之药损其胃气。王安道驳之曰∶《经》谓劳者温之，温乃温养之谓，凡调其饮食，适其起居，与用药
调养皆是，非寒温之温。损者温之，《经》原作损者益之。温能除大热，遍考《内经》无此语。又曰∶温能除热，亦
惟气温而味甘者斯可耳。盖温能益气，甘能缓火也。愚谓安道此论甚是，可为妄用附、桂者当头一棒。）又以甘
寒泻其热火。东垣特立补中益气汤。（见气。）中者何？胃也。气生于胃，盖天元真气虽
五脏皆具，而必得后天水谷之气充养，乃能生生不息。胃独为水谷之海，饮食入胃，
其精气游行淫溢，藉脾之营运，以上输于肺，而充营卫，布周身，故言气必归之胃
也。胃气虚则下陷于肝肾，故用参 以补其虚。黄 又能益肺固表，不令自汗以泄
元气。甘草能泻脾胃之火。（火性急，甘以缓之，即为泻也。）若脾胃太虚，腹中急痛，甘
草宜多用。升麻、柴胡二物味薄，阴中之阳，从地升天者也，能引清气上行，以举
其下陷，兼引参、 、甘草等甘温之气上升，以补卫气之解散而实表。清浊相干，
（清不升则浊不降，反混于清阳之位。）用去白陈皮以理之，又能助阳气上升以散滞气。白术苦
甘温，除胃中热，利腰脐间血。（脾得补则气盛，而湿行热泄，血气流通也。）火盛则血亏，血中
有火，日渐煎熬，血减则心无所养，致心烦乱，病名曰 。 者烦闷不安也，故以
当归补血，又得人参补阳，为阳生阴长之用。（以上补中益气方，共八味。）火虽属心，而起
于下焦肾中之阴火也。火旺则肾水虚，少加黄柏以泻阴火救肾水。如烦犹不止，加
生地黄以滋肾，肾水旺则心火自降。如气浮心乱，别以朱砂安神丸（见烦躁）镇固之。若
更烦乱，血不足也；如腹中或周身有刺痛，血不足而涩滞也，加当归身五分或一钱。
如精神短少，加人参五分、五味子十二个。头痛加蔓荆子三分，痛甚加川芎五分，
顶脑痛加 本五分、细辛三分，诸头痛并用此四味足矣。若兼头上热（风热上盛。）则
此不能治，别以清空膏（见头痛）主之。如头痛有痰，沉重懒倦，乃太阴湿土痰厥头痛，
加半夏五分、生姜三分。耳鸣目黄，颊颔肿，颈、肩、 、肘、臂外后廉痛，面赤，
脉洪大者，（皆风热上攻也，属手太阳经。）羌活二钱，防风、 本各七分，甘草五分，通其经
血∶（风热上壅，经脉不行，故肿痛也。）加黄连、黄芩各七分，以清热消肿；人参五分，黄
七分，益气而泻火，（气旺则营运，而火散。）另作一服与之。嗌痛颔肿，加黄芩、甘草各三
分，桔梗七分。口干嗌干，（胃中津液不升。）加葛根五分。升胃气以上润之、久病痰嗽，
肺中伏火，去人参，初病勿去之。（初病指未嗽时言。正藉参以补气，故不可去。若肺热而嗽，则当去
之。）冬月或春寒秋凉，加不去根、节麻黄五分。如春令大温，只加佛耳草、款冬花各
五分。夏月加五味子三五枚、去心麦冬五分。夏月不嗽，亦加人参三二分，并五味、
麦冬救肺受火邪也。如舌上白滑胎者，（舌上凉滑白润。）是胸中有寒，勿用麦冬、五味。
食不下，乃胸中胃上有寒，或气涩滞，加青皮、木香各三分，陈皮五分，此三味为
定法。如冬月加益智仁、草豆蔻各五分；如夏月加黄连、黄芩各五分；如秋凉加槟
榔、草豆蔻、白豆蔻、缩砂各五分；如春寒少加辛热之品，以补春阳之不足，益智
仁、草豆蔻可也。胸中气滞宜青皮，如气促气少，去之。心下痞，有寒有热。（二者皆
能使气不运而痞。）如觉寒热兼者，加附子、黄连各一钱；寒痞不能食，加生姜、陈皮各
一钱；热痞能食，加黄连五分、枳实三分。脉缓有痰而痞。加半夏、黄连各一钱。
脉弦、四肢满闷、便难（肝热滞于脾，不运不达之故也）而痞，加柴胡七分、黄连五分、甘草三
分。痞而夯闷，加芍药、黄连各一钱。痞而腹胀，加枳实、木香、缩砂各三分，浓
朴七分。如天寒，少加姜、桂。腹中痛者，加白芍五分、炙甘草三分。（肝热散满腹中，
急胀而痛，故用白芍寒敛其热，甘草缓其急而扶脾。）如恶寒冷痛，加桂心三分。如恶热喜寒而痛，
于已加白芍、甘草中，更加生黄芩三二分。夏月腹痛，虽不恶热，亦然治时热也。
（苦恶寒则不可加矣。）如天凉时，恶热而痛，于已加白芍、甘草、黄芩中，更少加桂。如
天寒，去芍药，加益智仁三分，或加半夏五分、（取其辛温。）生姜三片。如腹痛、恶寒、
脉弦，是木克土，小建中汤主之，内芍药味酸，于土中泻木为君。（寒证而用芍药之寒何
也？盖取其收敛肝之散满，且有桂可制其寒也。）如脉沉细，腹中痛，理中汤（见中寒），干姜辛热，于
土中泻水为主。（此是肾寒反克。）胁下痛，或缩急，俱加柴胡三五分、甘草三分。脐下痛，
（血虚。）加熟地五分，立止。如不止，乃寒也，更加桂三二分。如脉缓，体重节痛，腹
胀自利，米谷不化，湿也，平胃散。（见伤饮食。）身体重者，湿，加去桂五苓散一钱。
（见伤湿。）如风湿相搏，一身尽痛，加羌活七分，防风、 本根各五分，升麻、苍术各
一钱。勿用五苓，为风药已能胜湿也。别作一服与之，病去勿再服。小便遗失，肺
气虚不能摄也，宜安卧养气，黄 、人参补之。不愈，是热也，（热下迫也。）加黄柏、
生地各五分。如卧而多惊，小便淋者，邪在少阳、厥阴，宜太阳经所加之药，（指羌、
防、 本等味，肝火郁故用风药以升发之。）更添柴胡五分。如淋，（观此二字，知上文只就卧而多惊言。）加
泽泻五分，此下焦风寒合病也。（风寒犹云肝肾。）《经》云肝肾之病同一治，为俱在下焦
也。非风药行经则不可，（故宜太阳经所加药。）乃受客邪之湿热也，（肝肾受热，故卧而多惊。受热
不行，故淋也。）宜升举发散以除之。（风药能散热除湿也。）大便秘涩，加当归梢一钱、（润而下行，
血药也。大便有形属血分，血燥故大便秘。）大黄酒洗煨五分或一钱。仍不行者，煎成正药，先
用清者一口，调元明粉五分或一钱，得行即止，不宜大下，致变凶证。脚膝痿
软，行步乏力或痛，乃肝肾伏热，（热则软弱，寒则坚劲，凡物皆然。）加黄柏五分，空心服。
不已，更加汉防己五分。脉缓，沉困，怠怠无力者，加苍术、泽泻、人参、白术、
茯苓、（以治湿热。）五味子。（利湿防泻气，故以此收之且清热也。）上补中益气一方加减，（观此句，则
上文所云加减，俱就补中益气一方而言。）初病热中则可用，若寒中则不可用。（劳役伤气，有热
中、湿热、暑热、火郁、寒中之分。）盖此为甘酸之剂，适足以益其病耳，如参、 、甘草、
芍药、五味子之类是也，不能治寒也。（甘滞酸敛，皆不能行散寒气也。）
按阳虚内热，与外感风寒之证相类，其辨别处，详四诊问寒热条中。夫内伤脾
胃，乃伤其气，外感风寒，乃伤其形。（营卫血脉，乃形也。）伤其外则为有余，（邪气有余。）有
余者泻之，吐汗下皆泻也。伤其内则不足，（正气不足。）不足者补之，温和调养皆补也。
误治则有实实虚虚之祸矣。若内伤而兼外感，亦只用补中益气汤一二服，得微汗即
已，非正发汗，乃阴阳和，（犹云气充。）自然汗出也。
又有时当夏令，兼受暑邪，肌肤壮热，烦躁闷乱，恶热，大渴引饮，气上
喘促，目赤面红，身体疼痛，日西谵语，证似伤寒阳明经白虎证者，误服白虎汤（见
发热）必死。白虎证脉洪大有力，此洪大而虚，重按全无，气血两虚也。经曰∶血虚则
脉虚而发热。宜清暑益气汤（见伤暑），或当归补血汤。（见血。）
寒中者，乃水来侮土，寒湿之证，腹胀，（寒湿不运。）胃脘当心而痛，（亦气不运
所致。）膈噎不通，或涎唾。（寒湿上泛。）或清涕，（肺寒涕冷）或多溺，（气虚寒湿盛不能摄。）足下痛
不能任身履地，（足寒气不运，故痛也。）骨乏无力，（肾虚。）两丸多冷，阴阴作痛，或妄见鬼
状，梦见亡人。（阳虚见鬼，无非阴象。）腰背皆痛，不渴，脉迟细，或盛大以涩，（盛，弦劲有
力之意。盛大，寒实也，如寒痰冷食之类。寒滞气血不行，故涩也。）治用神圣复气汤、（见腹痛。）白术附
子汤、草豆蔻丸，（见心痛。）或用理中汤（见中寒）加减。脐下筑者，肾气动欲作奔豚也，
气壅而不行则筑筑然动跳，白术壅滞，去之，而加肉桂以温散之。吐多亦因气壅而
逆，去白术，加生姜。若泻多则留白术，正取其壅补，使气不下泄。且泻者多湿，
术又能胜湿也。心悸者加茯苓，饮聚则心神被水寒所迫，不安故悸，茯苓以利之。
渴者倍白术，水湿凝滞，气不布化，则津液不生，故渴。术除湿，湿去则气行而津
生也。腹痛加人参，气虚则不运，不通而痛，故加参以补气。寒加干姜。腹满去白
木加附子，附子味辛热，热能胜寒，辛能散满。或用建中汤，饴糖、甘草以益土；
姜、桂以散寒，且辛润能通营卫；芍药酸收，津液不通，收而行之，（既不通，何以用酸
收，盖气散漫不行，故津液不流通，收聚其气，而后津液能行也。）性微寒以济姜、桂之热。使不伤阴
气也。呕家不可用此汤，以甜也。（甜则滞而满闷。）
内伤气虚多汗，调中益气汤，即补中益气汤加白芍、五味也，以收耗散之气。
又补中益气汤除当归、白术，加木香、苍术，亦名调中益气汤，有湿而气滞者宜之。
若湿多热少，清阳为湿所郁不得上升，其证身重而痛，二便不调，洒洒恶寒，（阳不外
达。）惨惨不乐，（阳不外伸。）升阳益胃汤（见恶寒。）若过食寒凉遏火，阳郁于脾，肌肤困热烙
手，恶寒，脉沉数，升阳散火汤、火郁汤。（见发热。）若热多湿少，阴火困脾，阳
不上升，补中益气汤去白术、当归、陈皮，加石膏、黄芩、黄连、苍术、羌活。若
肾火上蒸，时显燥热，加生地、黄柏。
凡言补之以辛甘温热之剂，及味之薄者，乃助春夏之升浮，即泻秋冬之收脏也。
凡言泻之以酸苦寒凉之剂，及淡渗之味者，乃助秋冬之沉降，即泻春夏之升浮也。
（心肝同春夏论，肺肾同秋冬论。）
Food retention leads to aversion to food, which has been detailed in the section on diet and beverages; here it is merely mentioned in the context of other syndromes. Generally, inability to eat results from fullness in the stomach, but the causes of such fullness are not singular. There is fullness caused by cold qi stagnating in the stomach; there is fullness caused by heat qi obstructing in the stomach; there is fullness due to damp-phlegm failing to transform; there is fullness resulting from deficiency-cold of the Spleen and Stomach caused by decline of Mingmen fire; and there is fullness caused by deficiency of Kidney water with deficient fire rushing upward. For cold stagnation, use Liujunzi Tang (Six Gentlemen Decoction) (see Qi) with added Ganjiang (Dried Ginger). For heat obstruction, use herbs such as Shigao (Gypsum Fibrosum), Baishao (White Peony Root), Zhishi (Immature Bitter Orange), Huanglian (Coptis Rhizome), and Chenpi (Aged Tangerine Peel). For dampness, use Chushi Tang (Dampness-Removing Decoction) (see Damp-Wetness) or Pingwei San (Stomach-Pacifying Powder) (see Food Retention). For phlegm, use Erchen Tang (Two-Aged Decoction) (see Phlegm). In cases of phlegm accumulation causing epigastric distension and blockage, burn Zaojiao (Gleditsia Sinensis Fruit) until carbonized, grind into powder, and take one qian mixed with wine. For deficiency of Kidney fire, use Bawei Wan (Eight-Ingredient Pill) (see Deficiency and Damage) orershenshen Wan (Two-Spirit Pill). For deficiency of Kidney water, use Liuwei Wan (Six-Ingredient Pill) (see Deficiency and Damage). Those who feel hungry but cannot eat: Spleen heat causes digestion of grain and hunger; although they desire to eat, the epigastrium is withered and dry, unable to receive food, or fire/heat rushes upward, or phlegm-saliva obstructs upward, preventing food from going down. If it is due to extreme failure of the Spleen and Stomach, where one desires to eat but cannot, the condition is critical. Heat consumes grain and promotes hunger because heat can facilitate movement and transformation; if obstruction prevents movement, eating becomes impossible.
Labor exhausts Qi, manifesting as panting and sweating. Panting causes Qi to escape inward, and sweating causes Qi to escape outward, thus leading to Qi exhaustion. Furthermore, labor stirs up Fire; when Fire stirs, Qi scatters further, becoming more deficient while Fire becomes more blazing. (When Qi is abundant, it moves without stagnation; even if Fire exists, it can disperse, so it does not appear as pathogenic Fire. When Qi is deficient, it fails to move, causing Fire to gather; gathered Fire blazes.) However, this is not limited to labor. Excessive Seven Emotions, excessive sexual activity, and irregular eating habits can all damage True Qi and generate Fire. Fire is the thief of Yuan Qi; vigorous Fire consumes Qi, so for every increment of Fire, there is a decrement of Qi. Fire gathering in the middle jiao heats the Spleen and Stomach, causing fatigue and heaviness in the four limbs (Zhu means staying or lodging; referring to heavy and stifling sensations in the limbs that stay put or wander), lack of energy to move, and panting/fatigue upon exertion. The Spleen loses its normal function of healthy transportation and transformation (Harmony of Yin and Yang allows transformation; once biased, transformation ceases. This applies to Cold, and similarly to Heat). Thus, there is no appetite, loss of taste, decreasing food intake, and weak Gu Qi. (When Qi is weak, it relies on dietary nourishment; if Gu Qi is also weak, transformation stagnates further.) Consequently, Qi cannot ascend, blocking the Upper Jiao, and cannot descend, blocking the Lower Jiao, remaining stagnant in the Spleen and Stomach to generate heat. Heat steams upward to the chest and penetrates outward to the exterior, causing panting, vexation, headache, and thirst, or sometimes no thirst (due to preservation or loss of Jin-Ye), exterior heat with spontaneous sweating, or skin intolerance to wind-cold causing alternating chills and fever, floating-large and empty pulse, worsening in Spring/Summer and improving in Autumn/Winter. This is called Yang Deficiency with Internal Heat. The patient should first calm the mind and sit quietly to nurture Qi, use sour-flavored herbs to astringe scattered Qi, and use sweet-warm herbs to tonify deficiency (Li Dongyuan stated: "The Classic says: Labor requires warming, deficiency requires warming." And again: "Warming can eliminate great heat." This is correct. Bitter-cold herbs must be strictly avoided as they damage Stomach Qi. Wang Andao refuted this: "The Classic's 'warming' refers to warm nurturing, including dietary regulation, lifestyle adjustment, and medicinal care, not necessarily temperature. 'Deficiency requires warming' was originally 'deficiency requires benefiting.' 'Warming eliminates great heat' is not found in the Neijing. Also, only warm and sweet herbs can eliminate heat, as warmth benefits Qi and sweetness moderates Fire. I agree with Wang Andao; this serves as a warning against the reckless use of Fuzi and Rougui.). Use sweet-cold herbs to clear and drain heat/fire. Li Dongyuan specifically established Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (see Qi). What is "Zhong"? It refers to the Stomach. Qi is generated in the Stomach. Although Tianyuan True Qi exists in all five Zang organs, it must be supplemented by postnatal Gu Qi to sustain life endlessly. The Stomach alone is the Sea of Water and Grain. After food enters the Stomach, its essence travels and overflows; aided by the Spleen's transformation, it transports upward to the Lung to nourish Ying and Wei, distributing throughout the body. Hence, Qi is attributed to the Stomach. When Stomach Qi is deficient, it sinks into the Liver and Kidneys; thus, Renshen (Ginseng Radix et Rhizoma) is used to tonify deficiency. Huangqi (Astragali Radix) benefits the Lung and consolidates the exterior, preventing spontaneous sweating that would leak Yuan Qi. Gancao (Licorice Radix et Rhizoma) clears Stomach/Spleen Fire (Fire is urgent; sweetness moderates it, constituting drainage). If the Spleen/Stomach is extremely deficient with acute abdominal pain, Gancao should be used in larger doses. Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) have thin flavors and belong to Yang within Yin, rising from earth to heaven; they guide clear Qi upward to lift sinking Qi, and simultaneously guide the sweet-warm Qi of Renshen, Huangqi, and Gancao upward to replenish dispersed Wei Qi and solidify the exterior. When Clear and Turbid interfere (Clear failing to ascend causes Turbid to fail to descend, mixing with Clear Yang positions), remove-white Chenpi (Tangerine Peel) regulates this and aids Yang Qi ascent to disperse stagnant Qi. Baizhu (Atractylodis Macrocephalae Rhizoma) is bitter, sweet, and warm; it clears Stomach heat and benefits blood in the waist/navel area (Spleen tonification increases Qi, moving dampness, draining heat, and promoting blood/Qi flow). Excessive Fire depletes Blood; Fire in Blood slowly boils it down; reduced Blood leaves the Heart un-nourished, causing vexation/restlessness, termed Fan (Vexation). Fan means uneasy distress. Thus, Danggui (Angelicae Sinensis Radix) nourishes Blood, and Renshen tonifies Yang, achieving Yang generating Yin. (The above Buzhong Yiqi Tang formula has eight ingredients). Although Fire belongs to the Heart, it originates from Yin Fire in the lower Kidney. Excessive Fire depletes Kidney Water; add small amounts of Huangbai (Phellodendri Cortex) to drain Yin Fire and save Kidney Water. If vexation persists, add Shengdihuang (Rehmanniae Radix) to nourish the Kidney; abundant Kidney Water naturally lowers Heart Fire. If Qi floats and the Heart is chaotic, use Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) (see Vexation) to stabilize it. If more restless, it is Blood deficiency; if stabbing pain in abdomen or body, it is Blood deficiency with stagnation; add Danggui Shen (Body of Angelicae Sinensis Radix) 5 fen or 1 qian. If spirit is lacking, add Renshen 5 fen and Wuweizi (Schisandrae Fructus) 12 berries. For headache, add Manjingzi (Vernoniae Semen) 3 fen; if severe, add Chuanxiong (Ligustici Chuanxiong Rhizoma) 5 fen; for vertex pain, add Gaoben (Ligustici Wallichii Rhizoma) 5 fen and Xixin (Asari Radix et Rhizoma) 3 fen. These four herbs suffice for various headaches. If accompanied by heat in the head (Wind-Heat ascending), this formula is ineffective; use Qingkong Gao (Clear the Crown Ointment) (see Headache) instead. If headache involves phlegm, heaviness, and lethargy, it is Taiyin Damp-Earth Phlegm-Jue Headache; add Banxia (Pinelliae Rhizoma) 5 fen and Shengjiang (Fresh Ginger) 3 fen. Tinnitus, yellow eyes, swollen cheeks/jaw, pain along the posterior-lateral aspect of neck, shoulder, arm, elbow, red face, and large pulse (all Wind-Heat attacking upward, belonging to Hand-Taiyang Meridian): Qianghuo (Notopterygii Rhizoma et Radix) 2 qian, Fangfeng (Saposhnikoviae Radix) and Gaoben each 7 fen, Gancao 5 fen to unblock meridian blood (Wind-Heat obstruction causes swelling/pain); add Huanglian and Huangqin (Scutellariae Radix) each 7 fen to clear heat and reduce swelling; Renshen 5 fen, Huangqi 7 fen to benefit Qi and drain Fire (Abundant Qi promotes movement, dispersing Fire). Prepare separately. For sore throat and jaw swelling, add Huangqin and Gancao each 3 fen, Jiegeng (Platycodonis Radix) 7 fen. For dry mouth/throat (Stomach Jin-Ye not ascending), add Gegen (Puerariae Lobatae Radix) 5 fen to raise Stomach Qi to moisten. For chronic cough with phlegm and latent Lung heat, remove Renshen; do not remove in early stages (Early stage refers to before coughing; Renshen is needed to tonify Qi. If Lung heat causes cough, remove it). In winter or cold spring/autumn, add Mahuang (Ephedrae Herba) without roots/stalks 5 fen. In hot springs, add Foercao (Petasitae Flos) and Kuandonghua (Farfarae Flos) each 5 fen. In summer, add Wuweizi 3-5 berries and Maidong (Ophiopogonis Radix) heart-removed 5 fen. Even if no cough in summer, add Renshen 2-3 fen plus Wuweizi and Maidong to protect Lungs from Fire evil. If tongue has white slippery coating (cool, slippery, white/moist), there is Cold in the Chest; do not use Maidong or Wuweizi. Inability to eat due to Cold in Chest/Stomach or Qi stagnation: add Qingpi (Citri Reticulatae Pericarpium Viride) and Muxiang (Aucklandiae Radix) each 3 fen, Chenpi 5 fen (fixed method). In winter, add Yizhiren (Alpiniae Oxyphyllae Fructus) and Caodoukou (Kencuriae Fructus) each 5 fen. In summer, add Huanglian and Huangqin each 5 fen. In cool autumn, add Binglang (Arecae Semen), Caodoukou, Baodoukou (Cardamomi Fructus), and Suosha (Amomi Fructus) each 5 fen. In cold spring, add slight acrid-warm herbs to supplement insufficient Spring Yang, e.g., Yizhiren, Caodoukou. For Chest Qi stagnation, use Qingpi; remove if Qi is short/rapid. For epigastric fullness (Pi), which can be Cold or Heat (both cause Qi stagnation): if Cold-Heat mixed, add Fuzi (Aconiti Lateralis Radix Praeparata) and Huanglian each 1 qian; for Cold Pi with inability to eat, add Shengjiang and Chenpi each 1 qian; for Heat Pi with ability to eat, add Huanglian 5 fen and Zhishi 3 fen. For slow pulse with phlegm and Pi, add Banxia and Huanglian each 1 qian. For wiry pulse, limb fullness/heaviness, difficult stool (Liver Heat stagnating in Spleen, failing to transport/reach) and Pi, add Chaihu 7 fen, Huanglian 5 fen, Gancao 3 fen. For Pi with oppressive stuffiness, add Shaoyao (Paeoniae Radix Alba) and Huanglian each 1 qian. For Pi with abdominal distension, add Zhishi, Muxiang, Suosha each 3 fen, Houpo (Magnoliae Officinalis Cortex) 7 fen. If cold weather, add slight Ginger/Cinnamon. For abdominal pain, add Baishao 5 fen, Zhi Gancao (Honey-fried Licorice) 3 fen (Liver Heat scattering causes abdominal urgency/pain; Baishao cools/astringes heat, Gancao moderates urgency/nourishes Spleen). For aversion to cold/cold pain, add Guixin (Cinnamomi Ramulus) 3 fen. For aversion to heat/preference for cold/pain, add Sheng Huangqin (Scutellariae Radix) 2-3 fen to existing Baishao/Gancao. Summer abdominal pain, even without heat aversion, is treated as seasonal heat (avoid if patient hates cold). If cool weather with heat aversion/pain, add slight Cinnamon to Baishao/Gancao/Huangqin. If cold weather, remove Baishao, add Yizhiren 3 fen, or Banxia 5 fen (for its acrid-warm nature) and Shengjiang 3 slices. If abdominal pain, cold aversion, wiry pulse indicates Wood overcoming Earth, use Xiaojianzhong Tang (Minor Construct the Middle Decoction); Shaoyao's sour flavor drains Wood within Earth as the sovereign herb (Why use cold Shaoyao for Cold? To astringe Liver's scattering, moderated by Cinnamon). If deep-thin pulse with abdominal pain, use Lizhong Tang (Regulate the Middle Decoction) (see Middle Cold); Ganjiang (Dried Ginger) is acrid-hot, draining Water within Earth as primary (Kidney Cold counter-attacking). For hypochondriac pain or contraction, add Chaihu 3-5 fen, Gancao 3 fen. For umbilical pain (Blood deficiency), add Shudihuang (Rehmanniae Radix Praeparata) 5 fen for immediate relief. If not relieved, it is Cold; add Rougui (Cinnamomi Cortex) 2-3 fen. If slow pulse, heavy body/joint pain, abdominal distension, spontaneous diarrhea, undigested food indicates Dampness; use Pingwei San (see Food Retention). Heavy body indicates Dampness; add Wuling San (Five-Ingredient Powder with Poria) minus Cinnamon 1 qian (see Damp-Wetness). If Wind-Damp combing causing whole-body pain, add Qianghuo 7 fen, Fangfeng and Gaoben root each 5 fen, Shengma and Cangzhu (Atractylodis Rhizoma) each 1 qian. Do not use Wuling San as Wind herbs already overcome Dampness. Prepare separately; stop after cure. Urinary incontinence is due to Lung Qi deficiency failing to control; rest to nurture Qi, tonify with Huangqi and Renshen. If unresolved, it is Heat (Heat forcing downward); add Huangbai and Shengdihuang each 5 fen. If dreaming/startling during sleep with dribbling urine, pathogen is in Shaoyang/Jueyin; use herbs from Taiyang channel (Qianghuo, Fangfeng, Gaoben etc., Wind herbs to rise-depress Liver Fire), add Chaihu 5 fen. If dribbling (context implies this follows startling dreams), add ZeXie (Alismatis Rhizoma) 5 fen; this is combined Cold-Wind in Lower Jiao (Cold-Wind implies Liver/Kidney). Classic states Liver/Kidney diseases share treatment as both are in Lower Jiao. Wind herbs are necessary to move meridians (thus Taiyang herbs); this is pathogenic Damp-Heat (Liver/Kidney heated causes startling dreams; heat stagnation causes dribbling). Use lifting/dispersing to remove it (Wind herbs dissipate heat/dampness). Constipation/hard stool: add Danggui Shao (Tip of Angelicae Sinensis Radix) 1 qian (moistening/downward-moving Blood herb; stool form relates to Blood branch, Blood dryness causes constipation), Dahuang (Rhei Radix et Rhizoma) wine-washed/warmed 5 fen or 1 qian. If still unrelieved, take clear decoction first, mix with Yuánmíngfěn (Mirabilite) 5 fen or 1 qian; stop once bowel moves; avoid drastic purging to prevent catastrophe. Weak/knee softness,乏力 or pain in walking indicates latent Heat in Liver/Kidney (Heat causes weakness, Cold causes firmness); add Huangbai 5 fen, taken fasting. If unresolved, add Hanfangji (Stephaniae Tetrandrae Radix) 5 fen. Slow, deep-tired, weak pulse: add Cangzhu, Zexie, Renshen, Baizhu, Fuling (Poria) (to treat Damp-Heat), Wuweizi (to drain dampness preventing Qi leakage, thus astringing and clearing heat). The above modifications apply to Buzhong Yiqi Tang (see note: all previous modifications refer to this formula). It is suitable for early-stage Heat-Middle, but not for Cold-Middle (Labor injury to Qi includes Heat-Middle, Damp-Heat, Summerheat-Heat, Fire-Stagnation, Cold-Middle). This is a Sweet-Sour formula, sufficient only to worsen the condition (e.g., Renshen, Huangqi, Gancao, Shaoyao, Wuweizi); it cannot treat Cold (Sweet causes stagnation, Sour astringes; neither disperses Cold).
Note: Yang Deficiency Internal Heat resembles Exterior Wind-Cold; differentiation is detailed in Four Diagnostic Methods under Asking about Cold/Heat. Internal injury to Spleen/Stomach damages Qi; Exterior Wind-Cold damages Form (Ying-Wei/Blood-Vessels are Form). Exterior damage leads to Excess (Pathogenic Excess); Excess is drained via vomiting, sweating, purging. Internal damage leads to Deficiency (Righteous Deficiency); Deficiency is tonified via mild/warm nurturing. Mis-treatment causes "Excess reinforcing Excess" or "Deficiency reinforcing Deficiency" disasters. If Internal Injury combines with Exterior Invasion, use Buzhong Yiqi Tang 1-2 doses; slight sweat suffices. This is not proper sweating, but natural sweating due to Yin-Yang harmony (Qi abundance).
Sometimes in summer, combined with Summerheat evil: high fever, vexation/restlessness, heat aversion, intense thirst/drinking, rapid breathing, red eyes/face, body pain, delirium at dusk, resembling Shaoyang/Yangming Baihu Syndrome. Mistakenly using Baihu Tang (see Fever) will cause death. Baihu Syndrome pulse is large-forceful; this case is large-empty, completely empty on deep pressure, indicating Qi-Blood dual deficiency. Classic says: Blood deficiency leads to empty pulse and fever. Use Qingshu Yiqi Tang (Clear Summerheat and Benefit Qi Decoction) (see Summerheat Injury) or Danggui Buxue Tang (Tonify Blood Decoction) (see Blood).
Cold-Middle is Water insulting Earth, a Cold-Damp syndrome: abdominal distension (Cold-Damp not transforming), epigastric pain (Qi stagnation), dysphagia, saliva (Cold-Damp flooding), clear nasal discharge (Lung Cold), polyuria (Qi deficiency/Cold-Damp excess failing to control), foot pain unable to bear weight (Foot Cold/Qi not moving), bone weakness (Kidney deficiency), cold testicles, dull pain, hallucinations/seeing ghosts/dreaming of dead (Yang deficiency seeing ghosts is Yin manifestation). Back/waist pain, no thirst, slow-thin pulse, or large-choppy pulse (Large means strong/tense; Large-Choppy indicates Cold-Excess like Cold-Phlegm/Food; Cold stagnates Qi/Blood causing choppy pulse). Treatment uses Shensheng Fuqi Tang (Divine Holy Restoring Qi Decoction) (see Abdominal Pain), Baizhu Fuzi Tang, Caodoukou Wan (see Heartache), or Lizhong Tang modified. Pulsation below navel indicates Kidney Qi moving toward Ben Tun (Running Piglet); Qi obstruction causes throbbing. Remove Baizhu (stagnating) and add Rougui to warm-disperse. Frequent vomiting due to Qi obstruction/reversal: remove Baizhu, add Shengjiang. Frequent diarrhea retains Baizhu for its cloying-tonic effect to prevent Qi sinking; diarrhea often involves Dampness, and Baizhu overcomes Dampness. Palpitations add Fuling (Fluid accumulation presses Heart Spirit with Cold-Water causing unrest; Fuling drains it). Thirst doubles Baizhu (Water-Damp stagnation prevents Qi distribution/Jin-Ye generation; Baizhu removes Dampness, allowing Qi movement/Jin-Ye generation). Abdominal pain adds Renshen (Qi deficiency fails to move, causing pain; Renshen tonifies Qi). Cold adds Ganjiang. Abdominal fullness: remove Baizhu, add Fuzi (Fuzi is acrid-hot; Heat overcomes Cold, Acrid disperses fullness). Or use Jianzhong Tang: Yitang (Maltose) and Gancao tonify Earth; Jiang/Gui disperse Cold and unblock Ying-Wei with acrid-moistening; Shaoyao is sour-astringent; since Jin-Ye doesn't flow, astringing gathers Qi so Jin-Ye can flow; slight cold nature moderates Jiang/Gui heat to protect Yin. Vomiting patients cannot use this soup due to sweetness (sweet causes stagnation/fullness).
Internal injury Qi-deficiency with sweating: Tiaozhong Yiqi Tang is Buzhong Yiqi Tang plus Baishao and Wuweizi to collect scattered Qi. Another Tiaozhong Yiqi Tang is Buzhong Yiqi Tang removing Danggui/Baizhu, adding Muxiang/Cangzhu, suitable for Dampness with Qi stagnation. If Damp > Heat, Clear Yang depressed by Damp fails to ascend: heavy body/pain, bowel/bladder dysfunction, shivering cold aversion (Yang not reaching exterior), melancholy (Yang not extending), use Shengyang Yiewei Tang (Raise Yang and Benefit Stomach Decoction) (see Cold Aversion). If excessive cold-cool foods suppress Fire, Yang stagnant in Spleen: skin feels hot/burning, cold aversion, deep-rapid pulse, use Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction) or Huoyu Tang (Fire Stagnation Decoction) (see Fever). If Heat > Damp, Yin Fire confining Spleen, Yang not ascending: Buzhong Yiqi Tang remove Baizhu/Danggui/Chenpi, add Shigao, Huangqin, Huanglian, Cangzhu, Qianghuo. If Kidney Fire steaming upward with dryness/heat, add Shengdihuang, Huangbai.
Generally, tonifying with Acrid-Sweet-Warm-Hot and thin-flavored herbs assists Spring-Summer ascending-floating, thereby draining Autumn-Winter descending-collecting. Draining with Sour-Bitter-Cold-Cool and light-permeating flavors assists Autumn-Winter descending-collecting, thereby draining Spring-Summer ascending-floating. (Heart/Liver discussed with Spring-Summer; Lung/Kidney with Autumn-Winter).