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I have read Li Dongyuan's discussion in *Nei Wai Shang Bian Huo Lun* (Differentiation of Internal Injury and External Contraction), where he states: External contraction of wind-cold pathogenic factors constitutes an excess syndrome, which should be treated with purging methods rather than tonifying methods. Internal injury caused by improper diet and overexertion constitutes a deficiency syndrome, which should be treated with tonifying methods rather than purging methods. Since this viewpoint was proposed, people in the world and subsequent generations have understood the distinction between internal injury and external contraction, realizing that Zhang Zhongjing's treatment principles cannot be mechanically applied; is not the benefit derived from this immense? However, upon careful examination of his theory, there remain points worthy of doubt. I presume to list them as follows:

He states that internal heat resulting from dietary indiscretion and fatigue is due to "Yin Fire" attacking the position of Spleen Earth (Kun Earth), thus causing extreme internal heat confined to the chest. He further says: The *Classic* records, "For exhaustion, use warmth; for loss, use warmth." It is only appropriate to use warm-natured herbs to tonify Yuan Qi (Original Qi) and drain Fire Pathogens. He also claims: Sweet and warm substances can eliminate great heat. He adds: Wine belongs to formless "Qi"; when injured, it should be treated by inducing sweating and promoting urination to disperse dampness from above and below. Food belongs to tangible matter; when injured, grain intake should be reduced, or preferably, digestion-promoting methods should be used. Such statements naturally raise doubts.

I respectfully refer to the *Suwen·Tiao Jing Lun* (Treatise on Regulating the Meridians): "How does Yin deficiency generate internal heat?" Qibo answers: "Due to excessive labor, the physical energy declines, and Gu Qi (Grain Qi) becomes insufficient. The Upper Jiao fails to circulate, and the Lower Wan (stomach outlet) fails to conduct. Stomach Qi stagnates and generates heat, which steams upward into the chest, thus generating internal heat." Alas! This is the source of the theory of internal injury! Let me explain its meaning as follows: The Yin and Yang of the human body can be discussed from perspectives of exterior-interior, Qi-Blood, and Zang-Fu organs, such as ascending-descending and respiration, which are numerous and need not be listed exhaustively. The "Yin" referred to here as "Yin deficiency" varies in its specific reference.

Generally, excessive labor causes Yang Qi to hyperactive and transform into Fire. Moreover, since the intake of water and food is scant, Yang becomes more excessive while Yin becomes more deficient. This "Yin" in "Yin deficiency" refers to the body's Yin Qi and the essence of water and food. Interpreting it as the Yin division of the Lower Jiao or the True Yin of Kidney Water is incorrect. Those engaged in labor exert themselves excessively, generating fire; the decline of physical energy occurs because vigorous Fire consumes Qi; insufficiency of Grain Qi results from labor injuring Yuan Qi, leading to poor appetite and weakness; failure of the Upper Jiao to circulate means Clear Yang fails to ascend; obstruction of the Lower Wan means Turbid Yin fails to descend.

The Stomach receives food and drink, allowing Clear Yang to ascend and Turbid Yin to descend, facilitating transformation and transportation to nourish the whole body. Now, if the Stomach fails to receive food and Gu Qi declines, there is no ascent of Clear Qi and no descent of Turbid Qi. Hence, it is said, "The Upper Jiao fails to circulate, and the Lower Wan fails to conduct." This does not mean absolute cessation, but rather a state compared to normal health, described as non-circulation and non-conduction. When the upper part does not circulate and the lower part does not descend, Qi stagnates. Stagnation transforms Shao Huo (Physiological Fire) into Zhuang Huo (Pathological Fire). Since the Stomach lies between the Upper Jiao and Lower Wan, Stomach Qi becomes hot, flares upward, steams the chest, and generates internal heat.

Li Dongyuan should have cited this passage as the root of internal injury fever, yet he did not. Instead, he claimed Yin Fire attacks the Spleen Earth position, causing internal heat in the chest, which is indeed doubtful. The term "Yin Fire" never appears in the *Huangdi Neijing* or *Nan Jing*, yet Li Dongyuan uses it frequently. The *Suwen* contains only the phrase "Beside the seventh vertebra, there is the Small Heart," which Liu Wansu (Shouzhen) interpreted as referring to the Mingmen (Gate of Life) belonging to Fire rather than Water, citing ancient texts stating "Heart is Sovereign Fire, Kidney is Ministerial Fire" as evidence, yet he did not name it "Yin Fire." Thus, the term "Yin Fire" likely originated with Li Dongyuan.

I believe internal heat is not always caused by Yin Fire; rather, it arises from Qi stagnation transforming into heat. Although it is said the Heart, as the Sovereign, does not directly govern pathology, the *Neijing* describes many heat-related diseases. Does this imply Sovereign Fire cannot cause disease, forcing all attribution to Yin Fire? The *Zhizhen Yao Da Lun* (Major Requirements of the Most Genuine) states: "For exhaustion, use warmth; for loss, use benefit." Exhaustion involves excessive movement, disturbing Shen (Spirit). Therefore, "warmth" here implies nourishment and regulation—adjusting diet, adapting to daily life, calming the mind, and waiting patiently for the recovery of True Qi. This aligns with the meaning of "gentle demeanor to warm" in the *Liji* (Book of Rites).

However, Li Dongyuan interprets "warmth" in the context of cold-warm properties as using warm herbs to tonify deficient Yuan Qi and drain Fire Pathogens. He alters "loss, use benefit" to "loss, use warmth" and attributes "sweet and warm eliminates great heat" to the *Neijing*, which is absent upon thorough review. This is also questionable. Nevertheless, using warm herbs to tonify Yuan Qi and drain Fire is valid only for herbs that are warm in nature and sweet in flavor. Warmth benefits Qi; sweetness strengthens the Spleen and moderates Fire, allowing Yuan Qi to recover and Fire Pathogens to subside.

Using warm herbs as a treatment for internal injury deficiency is acceptable, but using it as proof for "for exhaustion, use warmth" is incorrect. The *Yinyang Yingxiang Dalun* states: "For deficiency of form, warm with Qi." Here, "warm" means nourishing, not referring to drugs. "Deficiency of form" indicates Yang deficiency and lack of fullness. "Qi" here refers to the energetic quality of herbs, which vary in intensity. Strong flavors belong to Yin and nourish Essence; strong aromas/energies belong to Yang and nourish Form. Using strong aromatic herbs to tonify Yang inherently nourishes form as well. Thus, "warm with Qi" implies using drug energy to warm and nourish, which also encompasses adjusting diet, lifestyle, and mental calmness. Although "warm" has dual meanings, it should not be equated merely with thermal temperature. By analogizing terms like tonify, purge, suppress, lift, and disperse, the true meaning becomes clear.

The Five Elements operate invisibly in Heaven but manifest materially on Earth. Metal, Wood, Water, and Earth have material substance. Fire has form but lacks solid substance. Wine is hot in nature but liquid in form. Li Dongyuan classifies wine as "formless Qi," which is dubious. If it requires diaphoresis and diuresis for elimination, how can it be considered formless?

Although both fatigue injury and dietary injury are internal injuries, they must not be conflated. The *Nan Jing* states: "Dietary indiscretion and fatigue injure the Spleen." This means the Spleen governs digestion and controls the limbs; thus, irregular eating and physical overwork both damage the Spleen, indicating they are distinct categories. While differing from excess syndromes like Wind-Cold-Damp-Heat, dietary injury differs from fatigue injury. One must observe excess within deficiency. Starvation leads to empty Stomach Qi, representing deficiency due to irregularity. Viewed as injury, it is deficiency; viewed as retention, it is excess. Due to deficiency, tonification is needed; due to excess, resolution is required. Some cases require both resolving and tonifying due to food stagnation and Qi injury; some require only resolving due to temporary stagnation with mild Qi injury; some require only tonifying due to persistent stagnation without self-resolution, or even neither. Ji Gu's Zhizhu Wan and Dongyuan's Jupi Zhishi Wan, though termed resolving agents, contain tonifying intent. Other formulas like Muxiang Fenqi Wan and Daoqi Zhishi Wan, lacking tonifying effects, are suitable for mild stagnation with minimal Qi injury, provided they are not used indiscriminately. If stagnation exceeds the capacity of Zhizhu Wan, one must adapt. Thus, Beiji Wan and Ganying Wan, which purge accumulation, were also utilized by Ji Gu and Dongyuan. A skilled general knows when to attack and defend; a poor general fails due to misapplication, not the army itself. This illustrates the principles of resolving, purging, and tonifying.

Fatigue injury, conversely, purely requires tonification, requiring little debate. Despite Dongyuan's warnings, people still use bitter-cold herbs to treat internal heat from fatigue. When conditions worsen to critical stages, attributing it to "heat too severe for medicine" reflects ignorance of iatrogenic error. Physicians and patients surrender to fate, unaware of their mistakes. Alas! Would not benevolent scholars grieve?

Li Dongyuan is a distinguished sage. How dare I lightly critique him? I fear minor flaws may lead to significant errors for posterity, hence my presumption. May those who understand me judge accordingly.