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Li Dongyuan considered that diet and fatigue are the causes of internal injury deficiency diseases, asserting that they result from damage to the Spleen and Stomach due to irregular eating. Generally, the foundation of human life lies in the Spleen and Stomach, which must rely on dietary nourishment. If proper care is neglected and overwork causes excessive damage, leading to a loss of nourishment, the Qi of the Spleen and Stomach becomes deficient and cannot ascend and diffuse. This stagnation transforms into heat, presenting symptoms similar to fever caused by external contraction. People often mistakenly treat internal injury as external contraction, so Li Dongyuan wrote "Treatise on Internal Injury of the Spleen and Stomach" (Pi Wei Nei Shang Lun) and formulated Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). This was not legislated for treating conditions of dietary excess (food stagnation). Wang Andao criticized him for not addressing injuries caused by dietary excess, regarding it as a slight flaw in an otherwise perfect jade, but this may be overly harsh criticism. Nevertheless, internal injury primarily discusses deficiency patterns; the treatment for sinking of Stomach Qi focuses on lifting and tonifying, and should not be confused with other types. For injuries caused by dietary excess, methods of digestion and guiding out can be used. Now, injuries from dietary excess are classified separately in the Spleen and Stomach section and should not be attached to those caused by fatigue and deficiency. Students should seek understanding within each respective category.

The Yellow Emperor asked: How does Yin deficiency generate internal heat? Qibo answered: Due to excessive fatigue, the Qi derived from grains declines, and the Qi of the form is not robust. The lower Jiao becomes obstructed, and the Upper Jiao fails to disseminate. Heat arises in the Stomach, steaming the chest, thus generating internal heat.
It is also said: Diseases originating from Yin are caused by diet, living conditions, imbalances of Yin and Yang, and emotions such as joy and anger.
The Treatise on Taiyin and Yangming states: Yang represents Heaven's Qi, governing the exterior; Yin represents Earth's Qi, governing the interior. Thus, the Path of Yang tends toward Excess, while the Path of Yin tends toward Deficiency. Those afflicted by treacherous winds and empty pathogens first affect Yang; those affected by unregulated diet and irregular起居 (daily routine)—which constitute internal injury—first affect Yin. When Yang is affected, the pathogen enters the Six Fu Organs; when Yin is affected, it enters the Five Zang Organs. Entering the Six Fu Organs results in body fever, inability to sleep at appropriate times, and upward manifestations like panting and calling; entering the Five Zang Organs results in abdominal fullness and obstruction, downward manifestations like undigested stool diarrhea, and if prolonged, intestinal dysentery. This demonstrates the differences in Yin-Yang and Excess-Deficiency between internal injury and external contraction. How can one prescribe treatment without distinguishing between internal/external and excess/deficiency patterns?
The Chapter on the Normal Person's Qi and Pulse States: Humans take water and grain as their root; therefore, if humans cut off water and grain, they die.
The Chapter on Thorough Evaluation of Excess and Deficiency States: Headache, tinnitus, and dysfunction of the nine orifices are generated by the intestines and stomach.
It also states: The generation of Yin essence originates from the five flavors; the five palaces of Yin are damaged by the five flavors.
Li Dongyuan stated: Examining the Neijing thoroughly, the sufficiency of Yuan Qi depends entirely on the Spleen and Stomach Qi being uninjured, thereby nourishing Yuan Qi. If the root of Stomach Qi is weak and food intake doubles, the Qi of the Spleen and Stomach is injured, Yuan Qi cannot be filled, and various diseases arise. The purport of the Neijing is as bright as the sun and stars. Fearing later generations might not fully understand, the Ling Shu Jing reiterates this theory. The classic says: Water and grain enter the mouth, their flavors divide into five categories, each pouring into their respective seas, with fluids taking their own pathways. The Stomach is the Sea of Water and Grain. Its transport points are above at Qichong (St30) and below at Zusanli (ST36). If the Sea of Water and Grain has excess, there is abdominal fullness; if it has deficiency, there is hunger but an inability to accept food. The Qi received by humans comes from grain. The place where grain pours is the Stomach. The Stomach is the Sea of Water, Grain, Qi, and Blood. The clouds and Qi circulating in the sea are like the winds of the world. The Qi and Blood exiting the Stomach travel through the meridians. The meridians are the great collaterals of the Five Zang and Six Fu Organs. It also says: When five grains enter the Stomach, their dregs, fluids, and Zong Qi divide into three groups. Thus, Zong Qi accumulates in the chest, ascends to the throat, penetrates the Heart and Lungs, and governs respiration. Ying Qi secretes its fluids, injects them into the vessels, transforms into blood, nourishes the four extremities, and internally injects into the Five Zang and Six Fu Organs, corresponding to the timekeeping of clepsydrae. Wei Qi issues forth from its fierce, rapid Qi, moving continuously among the four extremities, muscles, and skin. It also says: The Qi issuing from the Middle Jiao also runs alongside the Stomach, emerging after the Upper Jiao. The Qi received here separates dregs, steams fluids, transforms into refined essences, pours upward into the Lung vessels, then transforms into blood to nourish the living body. Nothing is more precious than this. The Sages repeat these words tirelessly, driven by profound benevolence towards future generations. Therefore, irregular diet and inappropriate cold or warmth injure the Spleen and Stomach. This occurs because joy, anger, sorrow, and fear deplete Yuan Qi and assist Heart Fire. Fire and Yuan Qi cannot coexist; if Fire prevails, it attacks the Earth position (Spleen/Stomach), causing disease.
The Chapter on Living Qi Connecting with Heaven states: The Qi of the blue sky is pure and clear, regulating one's will and intent. Following it consolidates Yang Qi; even if treacherous pathogens exist, they cannot harm. This follows the order of seasons. Thus, sages conserve spirit, serve Heaven's Qi, and communicate with divine illumination. Deviating from this causes internal closure of the nine orifices, external congestion of muscles, and dispersion of Wei Qi. This is called self-injury, the depletion of Qi. Yang Qi, when subjected to烦劳 (mental/physical exertion), expands excessively; essence is exhausted. Accumulating into summer, this leads to Jian Jue (Frying Collapse). Eyes become blind, unable to see; ears become closed, unable to hear. Chaos ensues like a breached dam. Thus, Heaven's Qi values purity, and Yang Qi abhors exertion. This is the first way diseases originate from the Spleen and Stomach.
The Chapter on Great Regularity of the Five Constants states: Where Yin essence is offered upwards, people live long; where Yang essence descends downwards, people die young. "Yin essence offered upwards" means the Spleen and Stomach are harmonious, grain Qi ascends, and the Spring-Summer commands execute, hence longevity. "Yang essence descending downwards" means the Spleen and Stomach are disharmonious, grain Qi flows downward, and the Autumn-Winter commands execute, hence early death. This is the second way diseases originate from the Spleen and Stomach.
The Chapter on Six Sections and Viscera Manifestations states: The Spleen, Stomach, Large Intestine, Small Intestine, San Jiao, and Bladder are the roots of the granary, the residence of Ying Qi, named "vessels," capable of transforming dregs and transporting flavors in and out. Their brilliance manifests in the lips and surrounding area; their substance fills the muscles; their flavor is sweet; their color is yellow. These belong to Supreme Yin, connecting with Earth Qi. All eleven organs depend on the Gallbladder. The Gallbladder possesses the ascending Qi of Shaoyang Spring. When Spring Qi ascends, all transformations are peaceful. Thus, when Gallbladder Qi ascends in spring, the remaining organs follow. If Gallbladder Qi does not ascend, undigested diarrhea and intestinal disorders arise incessantly. This is the third way diseases originate from the Spleen and Stomach. The classic says: Heaven feeds humans with five Qi, Earth feeds humans with five flavors. Five Qi enter via the nose, store in the Heart and Lungs, making complexion lustrous and voice resonant. Five flavors enter via the mouth, store in the Spleen and Stomach. Flavors are stored to nourish the five Qi. Harmonized Qi generates life; fluids complement each other; Shen naturally arises. This "Qi" refers to the Upper Jiao opening and disseminating, promoting the flavors of five grains, warming the skin, filling the body, and moistening hair, like mist and dew. If Qi is disordered, how can humans survive? This is the fourth way diseases originate from the Spleen and Stomach.
Are there only these four cases? Regarding the classics discussing heaven and earth's pathogens, upon contact, they harm the Five Zang and Six Fu Organs. Only when both form and Qi are deficient does one accept external pathogens. Without deficiency pathogens, treacherous pathogens cannot independently harm humans. It is clear that many diseases originate from the Spleen and Stomach. The Sage's intent appears repeatedly, detailed thus, and leaves warnings: Follow Yin and Yang, harmonize with techniques and numbers, regulate diet, maintain regular routines, avoid reckless labor. Thus, form and Shen remain united, completing one's natural lifespan, reaching a hundred years before passing. From this perspective, can one not be cautious regarding diet and daily routine?