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The Spleen and Stomach are the sea of water and grain. When food and drink enter the mouth, the Stomach receives them, and the Spleen transforms them. If the Qi of the Spleen and Stomach is vigorous, then grains, meats, fruits, and vegetables can all be digested and transformed into waste. The Classics state: "When food and drink enter the Stomach, their essence floats and overflows, moving upward to the Spleen; the Spleen scatters the essence, sending it upward to return to the Lung; (the Lung) regulates the water passages, transmitting downward to the Bladder; water and essence distribute throughout the four directions, and the five meridians run in parallel, conforming to the four seasons and five Zang organs, measuring Yin and Yang, thus establishing normalcy." Generally, Spleen Earth prefers warmth and dislikes cold and raw foods. If a person's innate constitution is weak, with Spleen and Stomach deficiency, and Qi and Blood exhausted, combined with poor self-care, indulgence in diet, improper temperature regulation, or irregular eating habits, the Spleen Qi will be further injured. All kinds of food entering the Stomach, if unable to be transformed and digested, will stagnate and accumulate, forming retained food retention (Su Shi), which gives rise to various diseases. Li Dongyuan therefore named this category of syndromes as Internal Injury (Nei Shang). As for the six types of Qi mentioned—Ying Qi (Nutritive Qi), Gu Qi (Food Qi), Yuan Qi (Original Qi), Qing Qi (Clear Qi), Yun Qi (Transporting Qi), and Wei Qi (Defensive Qi)—these are all alternative names for Stomach Qi, essentially being one and the same. Moreover, the five Zang organs of the human body all derive from the Stomach. When Stomach Qi is harmonious, Gu Qi ascends; and Gu Qi is the source from which the Original Qi of the Foot-Shaoyang Gallbladder and Hand-Shaoyang Sanjiao meridians begins to move, exerting the function of growth and transformation of all things. If the Stomach is injured, Middle Qi becomes insufficient; if Middle Qi is insufficient, it cannot nourish Original Qi; if Original Qi is not充盈 (full/vigorous), then the True Qi of the Zang and Fu organs will all be deficient, while Heart Fire will flourish independently. Heart Fire is also called Yin Fire, originating from the Lower Jiao, connected to the Heart. When Heart Qi cannot control itself, Xiang Fire (Ministerial Fire) takes over. Xiang Fire is the fire of the Pericardium in the Lower Jiao, acting as a thief to Original Qi. However, Fire and Original Qi cannot coexist; when one flourishes, the other declines. When Spleen and Stomach Qi decays, it flows downward into the Liver and Kidney, allowing Yin Fire to attack the upper positions. Consequently, Original Qi is diseased, affecting the Qi of the Upper Jiao Heart and Lung. The Heart governs Ying Qi (Nutritive Blood), and the Lung governs Wei Qi (Defensive Qi). When Ying and Wei lose their guard, various diseases arise. Is the decline or vigor of True Qi not caused by diet? For injuries caused by various foods, one should use resolving and guiding medicines to break down the injured substances, making Spleen Qi more vigorous, so that the essence of the five grains ascends, corresponding to Heaven to become Clear Qi. In such a state, Spirit Qi is strong, protected by the Seven Spirits, Sheng Qi (Vital Qi) is abundant, greatly increased, Qi and Blood circulate freely, and hundred diseases cannot invade. Even with severe wind and toxins, how could they cause harm? Therefore, Master Zhang Yuansu (Zhang Congzheng/Zhang Yishui lineage) stated that for stagnation, one must not recklessly use purgative medicines. Shortly after swallowing, the medicinal properties take effect, opening the superficial layers, bringing relief. Once the injured substance is removed, after two or three hours, the medicine fully metabolizes, its nature and flavor act strongly, and although the stagnation was severe, the Spleen and Stomach may inadvertently be injured. Once the Spleen and Stomach are injured, True Yuan Qi is ruined, leading to various deficiencies and diseases, shortening life span. This is the fault of the physician. Li Dongyuan discussed internal injuries, attributing them to anger, joy, fatigue, labor, dietary irregularities, causing damage to the Spleen and Stomach. Liu Wansu also said: Tian Zhen (Innocent/Natural Truth) is the Original Qi of creation. Within the body, it executes heavenly mechanisms to move the Six Qi, divides earthly registers to operate the Five Elements. Thus, the human body is like Heaven and Earth; one divided into two, two united as one. If regulated properly, pathogens cannot injure; blood vessels become robust, Essence and Qi increase, whole-body metabolism functions normally, and no disease exists. However, due to worry, thought, hunger, fullness, fatigue, labor, sudden fright, or terror, True Qi dissipates, Blood and Qi separate, the Five Elements and Six Qi suffer errors and blockages, and hundred diseases arise. Hence the Classic says: "Dietary excess and fatigue injure the Spleen; physical cold and drinking cold injure the Lung." Investigating the pathology of retained food injury, it stems from weak organ Qi, cold between the Spleen and Stomach, causing food to fail digestion and accumulate in the Middle Jiao. Since old food is not digested, new food enters, and weak Spleen Qi can no longer transform, old and new accumulate. Thus, after a night without digestion, one suffers abdominal distension, urgency of Qi, belching, acid regurgitation, foul breath from food, occasional aversion to cold and high fever, or headache resembling malaria. Belching and acid regurgitation occur because there is retained phlegm and fluid in the Upper Jiao, and cold retained food accumulation in the Stomach; Spleen Qi cannot grind and digest the food, causing distension and rebellious Qi, hence the preference for belching and sour regurgitation, with breath smelling of food. Nausea occurs because of retained water and fluid under the Heart. The Heart belongs to Fire, the Spleen to Earth; Earth controls Water. Now, Spleen deficiency fails to control and digest, so water and rice fluids do not disperse, ascending to oppress the Heart. Combined with cold pathogenic factors, Fire Qi fails to diffuse, causing a vague desire to vomit. The pulse at Right Cun is floating and large, but feels choppy upon pressure; Chi pulse is also faint and choppy. If there is latent heat in the Spleen and Stomach due to undigested food retention, the body will fever, resembling Taiyang Cold Damage (Shang Han), except for the absence of body pain. Generally, injuries from retained food involve aversion to cold, but treatment should be differentiated by Upper, Middle, and Lower Epigastrium. For accumulation in the Middle and Lower Epigastrium, severe cases follow Zhang Zhongjing's methods using Da Cheng Qi Tang or Xiao Cheng Qi Tang, or Bei Ji Dan; mild cases use Li Dongyuan's Zhi Zhu Wan. For food stuck in the Upper Epigastrium, Qi rebels and obstructs upwards; the pulse at Qikou is tight and vigorous, two to three times stronger than Renying. Emetic therapy is mandatory. The Classic states: "If there is pulse above but none below, emesis is indicated; failure to emesis leads to death." Use Gua Di San to induce vomiting and expel the substance. If not fully expelled, use resolving and guiding medicines to grind it down; if the substance is gone but Spleen-Stomach Yuan Qi is damaged, apply tonification methods from Li Dongyuan's Internal Injury treatise, such as Yi Qi Tang. If one first eats hot food without injury, then consumes cold food, causing the previous food to fail digestion due to the subsequent cold, inquire about the ratio of cold to hot food consumed, and adjust medication accordingly. If one part cold and two parts hot, use two parts cold medicine and one part hot medicine, mixed and administered. Or if alcohol was drunk before cold food, or injury resulted from hot food and ice water, inquire about the sequence and quantity of injury, and administer appropriate cold or hot remedies dispersively. Physicians must examine pulses clinically, assess the patient's deficiency/excess, age, and constitution to apply treatment, avoiding negligence. One must absolutely avoid using pungent, dry, harsh, or purgative medicines indiscriminately; seeking cure only causes harm. This must be handled with caution.