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Li Dongyuan said: The ancient sages thoroughly investigated the creation and transformation of Yin and Yang, and explored the boundaries between life and death. In the *Neijing* (Inner Canon), it is consistently stated that humans rely on Stomach Qi (Stomach Energy) as their foundation. Essentially, humans derive life from the Qi of water and grain. The so-called Yuan Qi (Original Qi), Gu Qi (Grain Qi), Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), Qing Qi (Clear Qi), and the Spring-rising generating Qi are all referred to as alternative names for Stomach Qi, as they ascend with the Grain Qi. If the Grain Qi fails to ascend and float, the function of growth and development cannot be executed. Consequently, there is no Yang Qi to protect the Ying and Wei Qi, leaving the body unable to withstand Wind-Cold, thereby generating symptoms of chills and fever. These are all caused by a deficiency in Spleen and Stomach Qi. However, this condition is quite similar to exterior syndromes caused by Wind-Cold invasion, yet the underlying mechanism differs. Internal injury to the Spleen and Stomach damages the Qi (Zheng Qi/Righteous Qi); external injury by Wind-Cold damages the physical form. Injury from external pathogens constitutes an Excess syndrome (Shi Zheng), which should be treated with draining methods; injury from internal causes constitutes a Deficiency syndrome (Xu Zheng), which should be treated with tonifying methods. Sweating, purging, vomiting, and reducing are all draining methods; warming, harmonizing, regulating, and nourishing are all tonifying methods. For diseases of internal deficiency, if mistakenly identified as external excess and treated with draining methods, the deficiency will be exacerbated. The *Nan Jing* (Classic of Difficult Issues) states: "Making the excess more excess and the deficiency more deficient, damaging what is insufficient and benefiting what is already excessive"—such deaths are caused by the physician's killing of the patient. So, what should be done? The answer is: One must use sweet-warm formulas to tonify the Middle Jiao (Middle Burner) and raise the Yang Qi, and use sweet-cold herbs to clear and drain the Fire, after which the illness will heal. The *Neijing* states: "For exhaustion, use warmth; for loss, use warmth." Warmth can eliminate great heat; therefore, bitter-cold formulas that drain Stomach Qi are strictly contraindicated. I have now established the Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

Furthermore, he stated: Unregulated emotions and irregular daily routines, along with various forms of overexertion, all damage the Qi. When Qi declines, Fire flares up; when Fire flares, it attacks the Spleen and Earth. Since the Spleen governs the four limbs, one feels fatigued and hot, lacks energy to move, is reluctant to speak, experiences panting and fatigue upon movement, has surface heat and spontaneous sweating, and feels restless and uneasy. During the onset of the disease, one should sit quietly with a calm mind to nurture the Qi, use sweet-cold herbs to drain the Fire-Heat, use sour-flavored herbs to astringe the scattered Qi, and use sweet-warm herbs to tonify the Middle Qi. This aligns with the scriptural teaching: "For exhaustion, use warmth; for loss, use warmth." The *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: "A normal person with a large pulse suffers from Lao (chronic depletion/exhaustion); extreme weakness also indicates Lao." In cases of Lao disease, the pulse is floating and large, with vexation and heat in the hands and feet; symptoms worsen in spring and summer and improve in autumn and winter. It is treated with Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle), which embodies the principle of warming.

He further stated: When the Spleen and Stomach suffer from labor-induced ailments, and dietary habits become irregular again, lingering in illness for a long time, once affairs cease and the mind calms, excessive eating causes the disease to flare up severely. Thus, internal injury from diet also leads to aversion to wind and cold. This is due to the failure of Ying and Wei Qi to guard the exterior, where a lack of Yang Qi in the skin prevents nourishment and resistance to Wind-Cold. The destruction of the hair and skin barrier implies the destruction of the root of the Lung and Heart. Because Stomach Qi does not ascend and Yuan Qi does not reach, the Lung and Heart cannot be nourished, resulting in a deficiency syndrome. The causes of disease vary: irregular diet, injury from labor, and subsequent overeating lead to many cases of internal injury, while external injuries occur occasionally. Physicians of the world often mistake conditions of insufficient Yuan Qi for exterior excess syndromes caused by Wind-Cold, and incorrectly treat the Lung and Heart, thereby doubly severing the exterior Yang. How could such patients not die? If you say otherwise, let me prove it with what people have seen and heard. Previously, during the change of era name in the Renchen year, the capital was under siege. By late March, after being besieged for half a month, upon relief, almost none of the city dwellers escaped illness, and those who fell ill died in succession. At the twelve gates of the capital, the number of bodies delivered daily ranged from over two thousand to at least one thousand, continuing for nearly three months. Did all these million people contract external Wind-Cold? It goes without saying that people within the besieged city suffered from irregular diet and labor-induced injury. Due to morning hunger and evening gluttony, irregular routines, and exposure to improper temperatures for months, their Stomach Qi had been depleted for a long time. Once they ate too much, became infected, and received improper treatment, their death was inevitable. This was not only true for Daliang (Kaifeng); even during the Zhenyou and Xingding eras, in places like Dongping, Taiyuan, and Fengxiang, after sieges were lifted, deaths from illness and injury were universal. While in Daliang, I personally witnessed cases where physicians used dispersing agents, Cathartics like Radix Euphorbiae Pekingensis (Badou), or Chengqi Tang (Chengqi Decoction) for purging. Soon, patients developed Jie Xiong (Chest Binding) and jaundice, leading to further treatments with Xin Xiong Tang Wan (Xin Xiong Decoction Pills) and Yinchen Tang (Artemisia Capillaris Decoction) for purging, resulting in certain death. Initially, these were not Shanghan (Cold Damage) cases; due to diagnostic and therapeutic errors, the condition transformed to resemble true Shanghan. This was the fault of the medication. Past events cannot be retrieved, but future ones can be addressed. Therefore, based on my lifelong validated experience, I wrote the essay "Bian Lun Nei Wai Shang" (Discrimination between Internal and External Injury), elucidating the remaining theories of former sages and citing recent incidents, hoping that colleagues may judge its validity, extend understanding through analogy, and prevent premature death in future generations.

Li Dongyuan distinguished between Scanty Qi and Abundant Qi: In exterior Wind-Cold invasion, Qi is congested and abundant (Excess); in internal injury from diet and labor, Qi at the mouth and nose is short and rapid, insufficient for breathing. How to differentiate them? In exterior Wind-Cold, the Yuan Qi of the Lung and Heart is initially undiminished, and the pathogenic Qi adds to it, causing nasal congestion and obstruction, reddish face, and inability to exhale through the nose, forcing exhalation through the mouth. Speech begins lightly and ends heavily, with a strong, vigorous, and powerful voice, indicating an Excess syndrome. In Wind Strike, clear nasal discharge occurs, the voice is hoarse, and speech sounds resonant as if from a jar, also beginning lightly and ending heavily, with high-pitched and powerful tones, confirming Qi abundance and Excess. In internal injury from diet and labor, the Qi of the Lung and Heart is first damaged by Heat. Since Heat damages Qi, the limbs lack strength to move. Thus, Qi at the mouth and nose is short and scant, accompanied by upper panting, reluctance to speak, and a desire to avoid answering questions (one in ten responses). Even if forced to answer, the breath is timid and the voice low, confirming Qi shortage and Deficiency. Such clarity allows even women to distinguish these conditions; how could physicians fail to do so?

Li Dongyuan differentiated headache: Internal headaches come and go intermittently; external headaches persist constantly until they transmit into interior Excess syndromes, at which point they cease. This marks the difference between internal and external syndromes.