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In cases of diarrhea (Xie Xie), if sweet and warm herbs such as Renshen (Ginseng Radix) and Baizhu (Atractylodis Rhizoma) are mistakenly administered, the disease will not resolve, and may transform into jaundice (Huang Dan). This is because diarrhea is attributed to dampness (Shi); sweet and warm herbs can generate damp-heat (Shi Re), thereby inadvertently assisting the pathogenic factor. Over time, severe damp-heat leads to jaundice. Cure is achieved only by using bitter-cold herbs to drain damp-heat and bitter-warm herbs to dispel cold-dampness. After the diarrhea ceases, when the Spleen and Stomach are weak, Renshen and Baizhu may then be used for tonification.

I once treated Li Puting, a Vice Minister (Shaozai), in the winter of the Gengyin year. He suffered from damp-heat diarrhea. Because he had no children, he was misled by rumors that diuretic/drainage agents (Dan Shen Zhi Ji) damage the Kidney, so he took Renshen and Baizhu. Subsequently, he developed jaundice, difficulty in urination, abdominal distension, and chest oppression. I stated: "For this specific pathology, specific medication is required; one must use drainage and dispersion methods to guide out the damp-heat." Consequently, Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction) was prescribed, and all symptoms subsided immediately. In the winter of the Xinmao year, he fathered a son.

In southern regions, fever is termed "Lao Fa" (Labor-induced Fever), referring to fever arising from laborious exertion, which aligns with Li Dongyuan’s principles regarding internal injury (Nei Shang). Mild cases resolve spontaneously after one or two episodes. Severe cases require treatment according to Li Dongyuan’s method of tonification; in severe instances, Shu Fuzi (Prepared Aconite Lateral Root) is added. If fever results from physical labor and hardship, it must never be mistaken for an external contraction (Wai Gan) treated lightly with sweating methods.

My commentary: Internal injury fever arises from irregular eating habits and excessive physical/mental labor, which deplete Yuan Qi (Primal Qi). Consequently, Yin Fire (Yin Huo) usurps the position of Earth (Spleen/Stomach), causing a sensation of radiant heat (Xi Xi Ran). This is suitable for treatment with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Yang Qi. If fever results from physical exhaustion and immoderate sexual activity, leading to depletion of Essence and Blood, with deficient fire moving recklessly, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) should be used to nourish Yin. One must not mistake this for excess fire and administer herbs like Huangbai (Phellodendron Bark) or Zhimu (Anemarrhenae Rhizoma).

Li Dongyuan discusses diet and fatigue as syndromes of internal injury and deficiency, treating them with Buzhong Yiqi Tang. In *Suhui Ji*, it is further argued that within deficiency, one must distinguish dietary injury as "excess" and fatigue injury as "deficiency." I posit that dietary injury causing food stagnation and failure to digest leads to retained food generating郁热 (stagnant heat), which manifests externally; this is an excess syndrome, requiring digestion and guidance methods. Li Dongyuan already provides methods such as Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) in the dietary section. His discussion on Buzhong Yiqi Tang states that people injure their Spleen and Stomach due to hunger or overeating, without actual stagnation, thus requiring only tonification. The Spleen and Stomach rely entirely on dietary nourishment; irregular eating habits deprive them of nourishment, causing weakness. Furthermore, the Spleen governs the four limbs; physical labor injuring the limbs exhausts the root. Whether due solely to improper diet, solely to excessive labor, improper diet followed by labor, or excessive labor followed by improper diet, all are considered internal injuries resulting in Yuan Qi deficiency, suitable for tonification. However, careful differentiation among these four scenarios is necessary, with slight modifications to prescriptions, ensuring efficacy.

My commentary: Diet and fatigue are similar in appearance but differ in principle. Mr. Wang Andao stated: Although fatigue injury and dietary injury both belong to internal injury, they must not be conflated. Dietary injury causing stagnation and indigestion constitutes excess; excess requires purgation/draining. Injury from hunger or irregular meals damaging the Spleen and Stomach without stagnation constitutes deficiency; deficiency requires tonification. Formulas like Li Dongyuan’s Zhizhu Wan, while described as promoting digestion, inherently contain tonifying properties, yet are applied only to mild injuries, not as universal remedies. Stagnated material cannot be removed by the power of Zhizhu Wan alone. Adhering rigidly to digestive methods without flexibility demonstrates a failure to properly utilize the intentions of predecessors.