东垣曰∶调经篇云∶阴虚生内热。岐伯曰∶有所劳倦,形气衰少,谷气不盛,
上焦不行,下脘不通,而胃气热,热气熏胸中,故内热。举痛论云∶劳则气耗,劳
则喘且汗出,内外皆越,故气耗矣。夫喜怒不节,起居不时,有所劳伤,皆损其气,
气衰则火旺,火旺则乘其脾土,脾主四肢,故困热无气以动,懒于语言,动作喘乏,
表热自汗,心烦不安。当病之时,宜安心静坐,以养其气,以甘寒泻其热火,以酸
味收其散气,以甘温补其中气。经言劳者温之,损者温之是也。《金匮要略》云∶平
人脉大为劳,脉极虚亦为劳矣。夫劳之为病,其脉浮大,手足烦热,春夏剧,秋冬
瘥,(脉大者,热邪也。极热者,气损也。春夏剧者,时助邪也。秋冬差者,时胜邪也)
以黄 建中汤治之,此亦温之之意也。盖人受水谷之气以生,所谓清气、营气、运气、
卫气、春升之气,皆胃气之别名也。夫胃气为水谷之海,饮食入胃,游溢精气,上输于脾,
脾气散精,上归于肺,通调水道,下输膀胱,水精四布,五经并行,合于四时五脏,阴
阳揆度以为常也。若阴阳失节,寒温不适,脾胃乃伤。喜怒忧恐,损耗元气。脾胃气衰,
元气不足,而心火独盛。心火者、阴火也,起于下焦,其系系于心,心不主令,相
火代之。相火包络之火,元气之贼也。火与元气不两立,一胜则一负,脾胃气虚则
下流肝肾,阴火得以乘其土位,故脾证始得则气高而喘,身热而烦,其脉洪大而头
痛,或渴不止,其皮肤不任风寒而生寒热。盖阴火上冲则气高喘而烦热,为头痛,
为渴而脉洪。脾胃之气下流,使谷气不得升浮,是春生之令不行,则无阳以护其荣
卫,使不任风寒,乃生寒热,此皆脾胃之气不足所致也。然与外感风寒之证颇同而
实异。内伤脾胃,乃伤其气;外感风寒,乃伤其形。伤其外则有余,有余者泻之;
伤其内则不足,不足者补之。汗之、下之、吐之、克之之类,皆泻也;温之、和之、
调之、养之之类,皆补也。内伤不足之病,苟误认作外感有余之证,而反泻之,则
虚其虚也。实实虚虚,如此死者,医杀之耳。然则奈何,唯当以辛甘温剂补其中而
升其阳,甘寒以泻其火则愈矣。经曰∶劳者温之,损者温之。又曰∶温能除大热。
大忌苦寒之药,损其脾胃,今立补中益气汤主之。夫脾胃虚者,因饮食劳倦,心火
亢甚,而乘其土位。其次肺气受邪,须用黄 最多,人参、甘草次之。脾胃一虚,
肺气先绝,故用黄 以益皮毛而闭腠理,不令自汗,损其元气。上喘气短,人参以
补之。心火乘脾,须炙甘草之甘以泻火热,而补脾胃中元气。若脾胃急痛,并大虚
腹中急缩者,宜多用之。经曰∶急者缓之。白术苦甘温,除胃中热,利腰脐间血。
胃中清气在下,必加升麻、柴胡以引之,引黄 、甘草甘温之气味上升,能补卫气
之散解,而实其表也。又缓带脉之缩急。二味苦平,味之薄者,阴中之阳,引清气
上升也。气乱于胸中,为清浊相干,用去白陈皮以理之。又能助阳气上升,以散滞
气,助诸甘辛为用。脾胃气虚不能升浮,为阴火伤其生发之气,荣血大亏,荣气不
营,阴火炽盛,是血中伏火日渐熬煎,血气日减。心包与心主血,血减则心无所养,
致使心乱而烦,病名曰 。 者、心惑而烦闷不安也,故加辛甘微温之剂生阳气,
阳生则阴长,故血虚以人参补之,更以当归和之,少加黄柏以救肾水,能泻阴中之
伏火。如烦犹不止,少加生地黄补肾水,水旺而心火自降。如气浮心乱,以朱砂安
神丸镇固之则愈。以手扪之而肌表热者,表证也。只服补中益气汤一二服,得微汗
则已。非正发汗,乃阴阳气和自然汗出也。若更烦乱,如腹中或周身有刺痛,皆血
涩不足,加当归身五分或一钱。如精神短少,加人参五分,五味子十二个。头痛加
蔓荆子三分,痛甚加川芎五分,顶痛脑痛加 本五分、细辛三分,诸头痛并用此四
味足矣。若头上有热,则此不能治,别以清空膏主之。如头痛有痰,沉重懒倦者,
乃太阴痰厥头痛,加半夏五分,生姜三分。耳鸣目黄,颊颔肿,颈肩 肘臂外后廉
痛,面赤,脉洪大者,以羌活二钱,防风、 本各七分,甘草五分,通其经血。加
黄芩、黄连各三分,消其肿。人参五分、黄 七分,益元气而泻火邪,另作一服与
之。嗌痛颔肿,脉洪大面赤者,加黄芩、甘草各三分,桔梗七分。口干嗌干,加葛
根五分,升引胃气上行以润之。久病痰嗽,肺中伏火,去人参,初病勿去之。冬月
或春寒或秋凉时,各宜加不去根节麻黄半钱。如春令大温,只加佛耳草、款冬花各
五分。夏月病嗽,加五味子三、五枚,去心麦门冬五分。如舌上白滑胎者,是胸中
有寒,勿用之。夏月不嗽,亦加人参二分或三分,并五味子、麦门冬各等分,救肺
受火邪也。食不下,乃胸中胃上有寒,或气涩滞,加青皮、木香各三分,陈皮五分,
此三味为定法。如冬月加益智仁、草豆蔻仁各五分。如夏月加黄芩、黄连各五分。
如秋月加槟榔、草豆蔻、白豆蔻、缩砂各五分。如春初犹寒,少加辛热之剂,以补
春气之不足,为风药之佐,益智、草豆蔻可也。心下痞,夯闷,加芍药、黄连各一
钱。如痞腹胀,加枳实、木香、缩砂仁各三分,浓朴七分。如天寒,少加干姜或肉
桂。心下痞,觉中寒,加附子、黄连各一钱。不能食而心下痞,加生姜、陈皮各一
钱。能食而心下痞,加黄连五分、枳实三分。脉缓有痰而痞,加半夏、黄连各一钱。
脉弦四肢满,便难而心下痞,加柴胡七分、黄连五分、甘草三分。胸中气壅滞,加
青皮二分。如气促少气去之。腹中痛者,加白芍药五分、炙甘草三分。如恶寒冷痛
者,加桂心三分。如恶热喜寒而腹痛者,于已加白芍药、甘草二味中,更加生黄芩
三二分。如夏月腹痛而不恶热者亦然,治时热也。如天凉时恶热而痛,于已加白芍
药、甘草、黄芩中,更少加桂。如天寒时腹痛,去芍药,味酸而寒故也,加益智仁
三分,或加半夏五分、生姜三片。如腹中痛,恶寒而脉弦者,是木来克土也,小建
中汤主之。盖芍药味酸,于土中泻木为君。如脉沉细腹中痛,以理中汤主之。干姜
辛热,于土中泻水以为主也。如脉缓体重节痛,腹胀自利,米谷不化,是湿胜也,
平胃散主之。胁下痛或胁下缩急,俱加柴胡三分,甚则五分,甘草三分。脐下痛加
真熟地黄五分,其痛立止。如不已者,乃大寒也,更加肉桂三二分。《内经》所说少
腹痛皆寒证,从复法相报中来也。经云∶大胜必大复,从热病中变而作也。非伤寒
厥阴之证,乃下焦血结膀胱也,仲景以抵当汤并丸主之。身有疼痛者湿,若身重者
亦湿,加去桂五苓一钱。如风湿相搏,一身尽痛,加羌活七分,防风、 本根各半
钱,升麻、苍术各一钱,勿用五苓,所以然者,为风药已能胜湿,故别作一服与之。
如病去勿再服,以诸风药损人元气,而益其病故也。小便遗失,肺金虚也。宜安卧
养气,以黄 、人参之类补之。不愈则是有热也,加黄柏、生地黄各五分,切禁劳
役。如卧而多惊,小便淋者,邪在少阳、厥阴,宜太阳经所加之药,更添柴胡五分。
如淋加泽泻五分,此下焦风寒合病也。经云∶肾肝之病同一治。为俱在下焦,非风
药行经则不可,乃受客邪之湿热也,宜升举发散以除之。大便秘涩,加当归稍一钱,
大黄酒洗煨五分或一钱。闭涩不行者,煎成正药,先用清者一口,调玄明粉五分或
一钱,得行则止。此病不宜下,下之恐变凶证也。脚膝痿软,行步乏力或痛,乃肾
肝伏热,加黄柏五分,空心服。不已,更加汉防己五分。脉缓,显沉困怠惰无力者,
加苍术、泽泻、人参、白术、茯苓、五味子各五分。上一方加减,是饮食劳倦,喜
怒不节,始病热中,则可用之。若末传寒中,则不可用也。盖甘酸适足益其气耳,
如黄 、人参、甘草、芍药、五味之类是也。
【内伤始为热中病似外感阳证】头痛大作,四肢疰闷,气高而喘,身热而烦,上
气鼻息不调,四肢困倦不收,无气以动,无气以言,或烦躁闷乱,心烦不安,或渴
不止。病久者,邪气在血脉中,有湿故不渴。如病渴,是心火炎上克肺金,故渴。
或表虚不任风寒,目不欲开,恶食,口不知味,右手气口脉大于左手人迎三倍,其
气口脉急大而数,时一代而涩。涩是肺之本脉。代是无气不相接,乃脾胃不足之脉。
大是洪大,洪大而数,乃心脉刑肺。急是弦急,乃肝木挟心火克肺金也。其右关脾
脉比五脉独大而数,数中时显一代,此不甚劳役,是饮食不时,寒温失所,则无右
关胃脉损弱,隐而不见,惟内显脾脉如此也。治用补中益气汤。
【内伤末传寒中病似外感阴证】腹胀,胃脘当心痛,上支两胁,隔噎不通,
或涎唾,或清涕,或多溺,足下痛,不能任身履地,骨乏无力,喜唾,两丸多冷,
阴阴作痛,或妄见鬼状梦亡人,腰背胛眼脊膂皆痛,不渴不泻,脉盛大以涩,名曰
寒中。治用神圣复气汤、白术附子汤、草豆蔻丸。
【似外感阳明中热证】有天气大热时劳役得病,或路途劳役,或田野中劳役,或
身体怯弱食少劳役,或长斋久素胃气久虚劳役。其病肌体壮热,躁热闷乱,大恶热,
渴饮水,此与阳明伤寒热白虎汤证相似,鼻口中气短促上喘,此乃脾胃久虚,元气
不足之证,身亦疼痛,至日西作,必谵语热渴闷不止,脉洪大空虚或微弱。白虎汤
证,其脉洪大有力,与此内伤中热不同,治用清暑益气汤。饥困劳役之后,肌热躁
热,困渴引饮,目赤面红,昼夜不息,其脉大而虚,重按全无。经曰∶脉虚则血虚,
血虚则发热,证象白虎,惟脉不长实为辨也。误服白虎汤必危,宜黄 当归补血汤。
【似外感恶风寒证】有因劳役坐卧阴凉处后,病表虚不任风寒,少气短促,懒言
语,困弱无力。此因劳役辛苦,肾中阴火沸腾,后因脱衣或沐浴,歇息于阴凉处,
其阴火不行,还归皮肤,腠理极虚无阳,被风与阴凉所遏,以此表虚不任风寒,与
外感恶风相似。不可同外感治,宜用补中益气汤。
【内伤似外感杂证】饮食失节,劳役所伤,脾胃中州变寒,走痛而发黄,治用小
建中汤,或理中汤,或大建中汤,选而用之。
【劳倦所伤虚中有寒】理中丸。心肺在膈上为阳,肾肝在膈下为阴,此上下脏
也。脾胃属土,处在中州,在五脏曰孤脏。在三焦曰中焦。因中焦治在中,一有不
调,此丸专主,故名曰理中丸。人参味甘温,《内经》曰∶脾欲缓,急食甘以缓之。
缓中益脾,必以甘为主,是以人参为君。白术味甘温,《内经》曰∶脾恶湿,甘胜
湿。温中胜湿,必以甘为助,是以白术为臣。甘草味甘平,《内经》曰∶五味所入,
甘先入脾。脾不足者以甘补之,补中助脾必须甘剂,是以甘草为佐。干姜味辛热,
喜温而恶寒者胃也,寒则中焦不治。《内经》曰∶寒淫所胜,平以辛热。散寒温胃,
必先辛剂,是以干姜为使。脾胃居中,病则邪气上下左右无所不之,故有诸加减焉。
若脐下筑者,肾气动也,去白术加桂。气壅而不泻,则筑然动也,白术味甘补气,
去白术则气易散。桂辛热,肾气动者,欲作奔豚也,必服辛热以散之,故加桂以散
肾气,泄奔豚气。吐多者,去白术加生姜。气上逆则吐多,术甘而壅,非气逆者之
所宜。《千金》曰∶呕家多服生姜,以其辛散,故吐多者加之。下多者还用白术,气
泄而不收则下多,术甘壅补,使正气收而不下泄也。或曰湿胜则濡泄,术专除湿,
故下多者加之。悸者加茯苓,饮聚则悸,茯苓味甘,渗泄伏水,是所宜也。渴欲得
水者倍加术,津液不足则渴,术甘以补津液,故加之。腹中痛者加人参,虚则痛,
经曰∶补可以去弱,人参、羊肉之属是也。寒多者加干姜,以辛热能散寒也。腹满
者去白术,加附子。《内经》曰∶甘者令人中满,术甘壅补,于腹中满者则去之。附
子味辛热,气壅郁腹为之满,以热胜寒,以辛散满,故加附子。经曰∶热者寒之,
寒者热之,此之谓也。建中汤,《内经》曰∶肝生于左,肺生于右,心位在上,肾处
在下,左右上下四脏居焉。脾者土也,应中央,处四脏之中州,治中焦,生育荣卫,
通行津液,一有不调,则荣卫失所育,津液失所行,必以此汤温中益脾,是以建中
名之焉。胶饴味甘温,甘草味甘平,脾欲缓,急食甘以缓之。建脾者,必以甘为主,
故以胶饴为君,而甘草为臣。桂辛热,散也、润也,荣卫不足,润而散之。芍药味
酸,微寒,收也、泄也,津液不通,收而行之。是以桂、芍药为佐。生姜味辛温,
大枣味甘温,胃者卫之源,脾者荣之本。《灵枢经》云∶荣出中焦,卫出上焦是也。
卫为阳,不足者益之必以辛;荣为阴,不足者补之必以甘。甘辛相合,脾胃建而荣
Li Dongyuan said: The *Tiao Jing Lun* (Chapter on Regulating the Meridians) states: "Yin deficiency generates internal heat." Qibo explained: "Due to overexertion, the physical form weakens and vital Qi declines, causing the transformation of grain essence to be insufficient. The Qi of the Upper Jiao fails to circulate, and the Lower Wan (lower stomach area) becomes obstructed. Consequently, Stomach Qi stagnates and generates heat, which steams upward into the chest, resulting in internal heat." The *Ju Tong Lun* (Chapter on Pain Disorders) states: "Exertion consumes Qi. Exertion leads to panting and sweating; both internal and external aspects leak out, thus consuming Qi." If emotions such as anger and joy are unregulated, daily routines are irregular, or there is any physical strain, all these damage the body's Qi. When Qi declines, Ministerial Fire flares up; when Ministerial Fire flares, it overacts upon Spleen Earth. Since the Spleen governs the four limbs, symptoms include heavy sensation, feverishness, lack of energy for movement, reluctance to speak, panting and fatigue during activity, surface heat, spontaneous sweating, restlessness, and anxiety. During illness, one should sit quietly with a calm mind to nourish Qi, use Sweet-Cold herbs to drain fire-heat, use Sour herbs to gather scattered Qi, and use Sweet-Warm herbs to tonify Middle Qi. This aligns with the classic saying: "For exhaustion, use warming methods; for deficiency, use warming methods." The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: "A normal person with a large pulse indicates labor injury; an extremely deficient pulse also indicates labor injury." In labor injury diseases, the pulse is floating and large, hands and feet feel hot and vexed, symptoms worsen in spring and summer, and improve in autumn and winter. (A large pulse indicates pathogenic heat; an extremely deficient pulse indicates Qi damage; worsening in spring/summer is due to seasonal factors aiding the pathogen; improving in autumn/winter is due to seasonal factors overcoming the pathogen.) It is treated with Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle), which embodies the principle of "warming."
Generally, humans rely on the Qi of water and grain for life. The so-called Clear Qi, Ying (Nutritive) Qi, Yun (Transporting) Qi, Wei (Defensive) Qi, and Spring-Rising Qi are all alternative names for Stomach Qi. The Stomach is the Sea of Water and Grain. When food enters the Stomach, its essence floats and overflows, transporting upwards to the Spleen. The Spleen scatters essences, sending them upwards to the Lung, which regulates water passages and transports downwards to the Bladder. Water essences distribute throughout the body, and the five meridians function in parallel, harmonizing with the four seasons and five Zang organs, maintaining balance between Yin and Yang as the norm. If Yin and Yang lose their regulation, and cold and warmth are inappropriate, the Spleen and Stomach are injured. Anger, joy, worry, and fear deplete Yuan (Original) Qi. When Spleen and Stomach Qi decline and Yuan Qi is insufficient, Heart Fire becomes dominant alone. Heart Fire is also called Yin Fire; it originates from the Lower Jiao, connects to the Heart, but since the Heart does not issue commands, Xiang (Ministerial) Fire acts in its place. Xiang Fire is the fire of the Pericardium, a thief of Yuan Qi. Fire and Yuan Qi cannot coexist; if one prevails, the other loses. When Spleen and Stomach Qi is deficient, Qi flows downward to the Liver and Kidney, allowing Yin Fire to invade the position of Earth (Spleen). Thus, at the onset of Spleen disease, there is high Qi and panting, body heat and vexation, a flooding-large pulse with headache, or incessant thirst, and skin that cannot tolerate wind-cold, leading to alternating chills and fever. Because Yin Fire rushes upward, there is high Qi, panting, vexation-heat, headache, thirst, and a flooding pulse. When Spleen and Stomach Qi flows downward, grain essence cannot rise and float, meaning the command of Spring generation does not operate. Without Yang to protect Ying and Wei, they cannot tolerate wind-cold, generating chills and fever. All these are caused by insufficiency of Spleen and Stomach Qi. However, this is similar yet fundamentally different from exterior wind-cold patterns. Internal injury to Spleen and Stomach damages Qi; exterior wind-cold damages the Form. Exterior damage manifests as excess, requiring purgation; internal damage manifests as deficiency, requiring tonification. Methods like sweating, purging, vomiting, and attacking are purgations; warming, harmonizing, regulating, and nourishing are tonifications. For internal deficiency diseases, if mistakenly diagnosed as exterior excess patterns and treated with purgation, it makes the deficiency more deficient. Making excesses more excess and deficiencies more deficient leads to death; such deaths are caused by the physician. Therefore, what should be done? One must use Pungent-Sweet-Warm agents to tonify the center and raise Yang, and Sweet-Cold agents to drain fire, and the disease will heal. The classics say: "For exhaustion, use warming; for loss, use warming." Also: "Warming can eliminate great heat." Bitter-Cold drugs are strictly contraindicated as they damage Spleen and Stomach. Now, Buchong Yiqi Tang (Decoction to Supplement the Middle and Boost Qi) is established as the principal formula.
For those with Spleen-Stomach deficiency due to diet and overexertion, Heart Fire becomes hyperactive and invades Earth. Secondly, Lung Qi is affected. Huangqi (Astragali Radix) should be used in the largest dose, followed by Renshen (Ginseng Radix) and Gancao (Licorice Radix). When Spleen and Stomach are deficient, Lung Qi is first cut off. Therefore, Huangqi is used to benefit the skin and hair and close the interstices, preventing spontaneous sweating and further damaging Yuan Qi. For upper panting and shortness of breath, Renshen is used to tonify. When Heart Fire invades the Spleen, roasted Gancao (Prepared Licorice Radix) is used for its sweetness to drain fire-heat and tonify Middle Yuan Qi. For acute Spleen-Stomach pain and severe deficiency with abdominal cramping, a larger dose of Gancao is appropriate. The classic says: "For tension, use soothing [sweet] agents." Baizhu (Atractylodis Macrocephalae Rhizoma) is bitter, sweet, and warm; it clears damp-heat in the Stomach and benefits blood circulation in the waist and umbilical region. When Clear Qi of the Stomach sinks, Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) must be added to guide it. They guide the sweet-warm aroma of Huangqi and Gancao upward, replenishing dispersed Wei Qi and consolidating the exterior. They also relax the contraction of the Dai (Girdle) Vessel. These two are bitter and neutral, with thin flavors, representing Yang within Yin, guiding Clear Qi upward. If Qi is chaotic in the chest, causing confusion of clear and turbid, Chenpi (Citri Reticulatae Pericarpium) with the white pith removed is used to regulate it. It also aids Yang Qi ascent to dissipate stagnant Qi, assisting the actions of various sweet and pungent herbs. When Spleen-Stomach Qi is deficient and cannot ascend, and is damaged by Yin Fire affecting the generating Qi, Ying Blood is severely depleted. Ying Qi fails to nourish, Yin Fire blazes, and latent fire in the blood slowly boils, reducing Qi and Blood day by day. The Pericardium and Heart govern Blood; when Blood decreases, the Heart lacks nourishment, causing mental chaos and vexation. This disease is named "Xin Dan Dan Da Dong" (Palpitations with a feeling of fright). "Dan dan" means mental confusion and vexation. Therefore, Pungent-Sweet-Slightly Warm agents are added to generate Yang Qi. When Yang grows, Yin grows. For Blood deficiency, Renshen is used to tonify, and Danggui (Angelicae Sinensis Radix) to harmonize. A small amount of Huangbai (Phellodendri Cortex) is added to rescue Kidney Water and drain latent fire in the Yin. If vexation persists, a small amount of Shengdihuang (Rehmanniae Radix) is added to tonify Kidney Water; when Water is robust, Heart Fire naturally descends. If Qi floats and the Heart is chaotic, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) is used to stabilize and secure. If palpation reveals surface heat, it is an exterior pattern. Taking Buchong Yiqi Tang for one or two doses, resulting in slight sweating, resolves the issue. This is not proper sweating, but natural sweating due to the harmony of Yin and Yang Qi. If vexation worsens, or there are stabbing pains in the abdomen or whole body, indicating Blood stasis and insufficiency, add Danggui Shen (Body of Angelicae Sinensis Radix) 5 fen or 1 qian. If spirit is lacking, add Renshen 5 fen and Wuweizi (Schisandrae Fructus) 12 pieces. For headache, add Manjingzi (Vernoniae Semen) 3 fen; if severe, add Chuanxiong (Ligustici Chuanxiong Rhizoma) 5 fen; for vertex or brain pain, add Gaoben (Ligustici Wallichii Rhizoma) 5 fen and Xixin (Asari Radix et Rhizoma) 3 fen. These four herbs suffice for all headaches. If there is heat on the head, these herbs are ineffective; instead, use Qingkong Gao (Clear the Cavity Ointment). If headache is accompanied by phlegm, heaviness, and lethargy, it is Taiyin Phlegm-Jue Headache; add Banxia (Pinelliae Rhizoma) 5 fen and Shengjiang (Zingiberis Recens Rhizoma) 3 fen. For tinnitus, yellow eyes, swelling of cheeks and jaw, pain in the neck, shoulder, elbow, arm outer posterior border, red face, and flooding pulse, use Qianghuo (Notopterygii Rhizoma et Radix) 2 qian, Fangfeng (Saposhnikoviae Radix) and Gaoben each 7 fen, Gancao 5 fen to unblock meridians and blood. Add Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) each 3 fen to reduce swelling. Renshen 5 fen and Huangqi 7 fen tonify Yuan Qi and drain pathogenic fire; prepare as a separate dose. For throat pain and jaw swelling with flooding pulse and red face, add Huangqin and Gancao each 3 fen, and Jiegeng (Platycodonis Radix) 7 fen. For dry mouth and throat, add Gegen (Puerariae Lobatae Radix) 5 fen to guide Stomach Qi upward for moistening. For chronic cough with phlegm and latent fire in the Lung, remove Renshen; do not remove it in early stages. In winter, or during spring cold or autumn chill, add Mahuang (Ephedrae Herba) without roots and nodes, 0.5 qian. If spring is very warm, add Foercao (Petasitae Flos) and Kuandonghua (Farfarae Flos) each 5 fen. For summer cough, add Wuweizi 3-5 pieces and Maimendong (Ophiopogonis Radix) with heart removed, 5 fen. If there is a white slippery coating on the tongue, indicating cold in the chest, do not use these. In summer without cough, still add Renshen 2-3 fen, along with equal parts Wuweizi and Maimendong to rescue the Lung from Fire pathogen. For inability to eat, indicating cold in the chest/Stomach or Qi stagnation, add Qingpi (Citri Reticulatae Pericarpium Viride) and Muxiang (Aucklandiae Radix) each 3 fen, and Chenpi 5 fen; this is a fixed method. In winter, add Yizhiren (Alpiniae Oxyphyllae Fructus) and Caodoukou (Kniphofiae Rhizoma) each 5 fen. In summer, add Huangqin and Huanglian each 5 fen. In autumn, add Binglang (Arecae Semen), Caodoukou, Baodoukou (Cardamomi Albi Fructus), and Suosha (Amomi Fructus Rotundus) each 5 fen. In early spring if still cold, add a small amount of Pungent-Hot agents to supplement the insufficiency of Spring Qi, acting as assistants to Wind herbs; Yizhiren and Caodoukou are suitable. For epigastric fullness and oppression, add Shaoyao (Paeoniae Radix Alba) and Huanglian each 1 qian. If fullness extends to abdominal distension, add Zhishi (Aurantii Fructus Immaturus), Muxiang, and Suosharen (Amomi Fructus) each 3 fen, and Houpo (Magnoliae Officinalis Cortex) 7 fen. If cold weather, add Ganjiang (Zingiberis Rhizoma) or Rougui (Cinnamomi Cortex) slightly. For epigastric fullness with a sensation of cold in the center, add Fuzi (Aconiti Lateralis Radix Praeparata) and Huanglian each 1 qian. For inability to eat with epigastric fullness, add Shengjiang and Chenpi each 1 qian. For ability to eat with epigastric fullness, add Huanglian 5 fen and Zhishi 3 fen. For slow pulse with phlegm and fullness, add Banxia and Huanglian each 1 qian. For wiry pulse, fullness in four limbs, difficult defecation, and epigastric fullness, add Chaihu 7 fen, Huanglian 5 fen, and Gancao 3 fen. For Qi stagnation in the chest, add Qingpi 2 fen; remove if there is rapid breathing and shortness of Qi. For abdominal pain, add Baishaoyao (White Peony Root) 5 fen and Zhigancao (Honey-fried Licorice) 3 fen. If aversion to cold and painful, add Guixin (Cinnamon Twig) 3 fen. If aversion to heat, preference for cold, and abdominal pain, add Sheng Huangqin (Raw Scutellaria) 2-3 fen to the previously added Shaoyao and Gancao. This applies similarly to summer abdominal pain without aversion to heat, treating seasonal heat. If cool weather causes aversion to heat and pain, add a little Guizhi (Cinnamon Twig) to Shaoyao, Gancao, and Huangqin. If cold weather causes abdominal pain, remove Shaoyao because it is sour and cold; add Yizhiren 3 fen, or Banxia 5 fen and Shengjiang 3 slices. If abdominal pain with aversion to cold and wiry pulse, Wood is overacting on Earth; treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction). Shaoyao is sour and acts as the sovereign herb to drain Wood within Earth. If pulse is deep-thin with abdominal pain, treat with Lizhong Tang (Regulate the Middle Decoction). Ganjiang is pungent-hot and acts as the chief herb to drain Water within Earth. If pulse is slow with heavy body and joint pain, abdominal distension, spontaneous diarrhea, and undigested food, Dampness prevails; treat with Pingwei San (Level the Stomach Powder). For hypochondriac pain or constriction, add Chaihu 3 fen, or 5 fen if severe, and Gancao 3 fen. For pain below the navel, add Zhen Shudihuang (True Prepared Rehmannia) 5 fen; pain stops immediately. If not, it is extreme cold; add Rougui 2-3 fen. The *Neijing* states that lower abdominal pain is always a Cold pattern, arising from the law of retribution. The classic says: "Great victory leads to great recovery," changing from heat diseases. This is not a Shaoyin/Jueyin Cold Damage pattern, but Blood stasis in the Bladder in the Lower Jiao; Zhang Zhongjing treats it with Didang Tang and Didang Wan. Body pain indicates Dampness; body heaviness also indicates Dampness; add Wuling San (Five-Ingredient Powder with Poria) without Guizhi, 1 qian. If Wind-Dampness combats, causing whole-body pain, add Qianghuo 7 fen, Fangfeng and Gaoben root each 0.5 qian, Shengma and Cangzhu (Atractylodis Rhizoma) each 1 qian; do not use Wuling San, because Wind herbs already overcome Dampness, so prepare separately. Stop taking if the disease resolves, as Wind herbs damage Yuan Qi and worsen the condition. Urinary incontinence indicates Lung Metal deficiency. Rest and nourish Qi with Huangqi and Renshen. If unresolved, there is Heat; add Huangbai and Shengdihuang each 5 fen; strictly avoid labor. If dreaming frequently while sleeping and urinary dribbling, the pathogen is in Shaoyang and Jueyin; use herbs added for the Taiyang meridian, adding Chaihu 5 fen. If dribbling, add Zexie (Alismatis Rhizoma) 5 fen; this is a combined Cold-Wind and Dampness pattern in the Lower Jiao. The classic says: "Diseases of the Kidney and Liver are treated similarly." Both are in the Lower Jiao; without Wind herbs to move the meridians, it is impossible, as it involves pathogenic Damp-Heat; use ascending and dispersing methods to eliminate it. For constipation and dryness, add Danggui Shao (Tip of Angelicae Sinensis Radix) 1 qian, and Dahuang (Rhei Radix et Rhizoma) wine-washed and baked, 5 fen or 1 qian. If blocked and not moving, take the decocted medicine, first sip the clear liquid, then mix with Xuanningfen (Mirabilite) 5 fen or 1 qian; stop once movement occurs. This disease should not be purged; purging may lead to ominous changes. Weakness and soreness of legs and knees, weakness or pain in walking, indicates latent heat in Liver and Kidney; add Huangbai 5 fen, taken on an empty stomach. If unresolved, add Hanfangji (Stephaniae Tetrandrae Radix) 5 fen. For slow pulse with obvious sinking, fatigue, and weakness, add Cangzhu, Zexie, Renshen, Baizhu, Fuling (Poria), and Wuweizi each 5 fen. The above modifications apply to diseases starting with Heat in the Middle due to diet, overexertion, and emotional dysregulation. If it progresses to Cold in the Middle, it cannot be used. Sweet and Sour herbs sufficiently benefit Qi, such as Huangqi, Renshen, Gancao, Shaoyao, and Wuweizi.
[Internal Injury Initially Manifests as Heat in the Middle, Resembling Exterior Yang Patterns] Severe headache, heavy and stifling sensation in the four limbs, high Qi with panting, body heat and vexation, upper Qi with irregular nasal breathing, four limbs too fatigued to hold themselves, lack of energy for movement or speech, or烦躁闷乱 (restlessness and confusion),心烦不安 (heart vexation and unease), or incessant thirst. In long-standing cases, the pathogen is in the blood vessels; due to Dampness, there is no thirst. If there is thirst, it is because Heart Fire flares upward and overacts on Lung Metal. Or, the exterior is deficient and cannot tolerate wind-cold, eyes do not want to open, aversion to food, loss of taste. The Right Qi Kou pulse is three times larger than the Left Ren Ying pulse. The Qi Kou pulse is urgent, large, and rapid, occasionally showing a Dai (intermittent) pulse and Se (choppy) quality. Se is the native pulse of the Lung. Dai indicates Qi discontinuity, a pulse of Spleen-Stomach insufficiency. Large indicates Flooding. Flooding and rapid indicates Heart Pulse punishing Lung. Urgent indicates Wiry, indicating Liver Wood carrying Heart Fire to punish Lung Metal. The Right Guan Spleen pulse is uniquely large and rapid compared to the other five pulses, with an occasional Dai pulse within the rapidness. This suggests mild overexertion, irregular diet, and improper temperature regulation, resulting in the absence of the Right Guan Stomach pulse due to damage; only the Spleen pulse is visible internally. Treatment uses Buchong Yiqi Tang.
[Internal Injury Progressing to Cold in the Middle, Resembling Exterior Yin Patterns] Abdominal distension, pain in the epigastrium corresponding to the heart, radiating to both hypochondria, diaphragmatic obstruction, salivation, clear nasal discharge, polyuria, pain in the soles of the feet, inability to bear weight, bone fatigue and weakness, frequent spitting, coldness in both testicles, dull pain, hallucinations of ghosts or dreams of the deceased, pain in the lower back, shoulders, scapulae, eyes, spine, and loins, no thirst, no diarrhea, pulse is large and vigorous yet choppy. This is named Cold in the Middle. Treatment uses Shensheng Fuqi Tang, Baizhu Fuzi Tang, and Caodoukou Wan.
[Resembling Exterior Yangming Heat in the Middle Pattern] Illness contracted during extreme heat from labor, road travel, field work, or in frail individuals with poor appetite undergoing labor, or those with long-term vegetarian diets causing chronic Stomach Qi deficiency. Symptoms include intense body heat, restlessness and confusion, extreme aversion to heat, desire to drink water. This resembles the Baihu Tang pattern of Yangming Cold Damage with heat. Shortness of breath and panting from nose and mouth indicate chronic Spleen-Stomach deficiency and insufficient Yuan Qi. Body pain worsens towards evening, accompanied by delirium, heat, thirst, and unceasing vexation. The pulse is flooding, large, empty, or weak. In Baihu Tang patterns, the pulse is flooding, large, and forceful, differing from this internal Heat in the Middle. Treatment uses Qingshu Yiqi Tang (Decoction to Clear Summerheat and Boost Qi). After hunger, fatigue, and labor, body heat, restlessness, thirst, red eyes and face, day and night without cessation, pulse is large and empty, vanishing under heavy pressure. The classic says: "Empty pulse indicates Blood deficiency; Blood deficiency generates heat. The presentation resembles Baihu, distinguished only by the pulse not being long and solid." Misusing Baihu Tang is dangerous; use Huangqi Danggui Buxue Tang (Astragalus and Angelica Blood-Nourishing Decoction).
[Resembling Exterior Aversion to Wind and Cold Pattern] Illness following labor while sitting or lying in cool places, resulting in exterior deficiency unable to tolerate wind-cold, shortness of Qi, reluctance to speak, and weakness. This is due to labor exhausting the body, causing boiling of Yin Fire in the Kidneys. Later, removing clothes or bathing and resting in cool places causes Yin Fire to fail to circulate and return to the skin. The interstices are extremely deficient with no Yang, obstructed by wind and coolness. Thus, exterior deficiency mimics aversion to wind/cold from exterior invasion. Do not treat as exterior invasion; use Buchong Yiqi Tang.
[Internal Injury Resembling Exterior Miscellaneous Patterns] Dietary irregularity and labor injury cause the Middle Jiao (Spleen-Stomach) to become cold, leading to wandering pain and jaundice. Treat with Xiaojianzhong Tang, Lizhong Tang, or Dajianzhong Tang, selecting as appropriate.
[Labor Injury Deficiency with Internal Cold] Lizhong Wan. Heart and Lung are above the diaphragm (Yang); Liver and Kidney are below (Yin). Spleen and Stomach belong to Earth, located in the Middle Jiao, known as the Solitary Organ among the Five Zang, and Middle Jiao among the Three Jiao. Since treatment of the Middle Jiao is central, any imbalance is addressed by this pill, hence named Lizhong Wan. Renshen is sweet and warm. The *Neijing* says: "The Spleen desires relaxation; urgently feed Sweet to relax it." To relax the middle and benefit the Spleen, Sweet is primary; thus Renshen is the Sovereign. Baizhu is sweet and warm. The *Neijing* says: "The Spleen dislikes Dampness; Sweet overcomes Dampness." To warm the middle and overcome Dampness, Sweet assists; thus Baizhu is the Minister. Gancao is sweet and neutral. The *Neijing* says: "Of the five flavors, Sweet enters the Spleen first." For Spleen deficiency, tonify with Sweet; thus Gancao is the Assistant. Ganjiang is pungent and hot. The Stomach prefers warmth and dislikes cold; cold prevents Middle Jiao treatment. The *Neijing* says: "When Cold dominates, level it with Pungent-Hot." To disperse cold and warm the Stomach, Pungent is necessary; thus Ganjiang is the Envoy. The Spleen and Stomach are central; when diseased, pathogenic Qi moves everywhere. Hence, modifications exist. If pulsation below the navel indicates Kidney Qi movement, remove Baizhu and add Guizhi. Qi stagnation without release causes pulsation; Baizhu is sweet and tonifies Qi, removing it allows Qi to scatter. Guizhi is pungent-hot; for Kidney Qi movement threatening Ben Tun (Fleeing Tumor), Pungent-Hot is needed to disperse; thus add Guizhi. For excessive vomiting, remove Baizhu and add Shengjiang. Qi rebellion causes vomiting; Baizhu is sweet and cloying, unsuitable for rebellion. *Qianjin Fang* says: "Vomiters should take much Shengjiang for its pungent dispersion." For excessive diarrhea, retain Baizhu. Qi leakage requires retention; Baizhu’s sweet cloying nature retains Zheng Qi. Some say Dampness causes loose stools; Baizhu specifically drains Dampness, hence added for diarrhea. For palpitations due to fluid accumulation, add Fuling; Fuling is sweet and leaches hidden water. For thirst, double Baizhu to tonify fluids. For abdominal pain due to deficiency, add Renshen ("Tonification removes weakness"). For excess cold, add Ganjiang. For abdominal fullness, remove Baizhu and add Fuzi. The *Neijing* says: "Sweet causes middle fullness"; remove Baizhu. Fuzi is pungent-hot; it overcomes cold with heat and disperses fullness with pungency. Xiaojianzhong Tang: The *Neijing* describes the positions of the four organs surrounding the Spleen (Earth) in the center. The Spleen governs the Middle Jiao, generates Ying and Wei, and circulates fluids. Any imbalance requires this decoction to warm the middle and benefit the Spleen, hence "Constructing the Middle." Jiaoyi (Malt Sugar) is sweet and warm; Gancao is sweet and neutral. To build the Spleen, Sweet is primary; thus Jiaoyi is Sovereign, Gancao is Minister. Guizhi is pungent-hot, dispersing and moistening; for Ying-Wei deficiency, moisten and disperse. Shaoyao is sour and slightly cold, gathering and draining; for fluid blockage, gather and move. Thus Guizhi and Shaoyao are Assistants. Shengjiang is pungent-warm; Dazao (Jujubae Fructus) is sweet-warm. The Stomach is the source of Wei; the Spleen is the root of Ying. The *Ling Shu* says: "Ying emerges from the Middle Jiao, Wei emerges from the Upper Jiao." Wei is Yang; deficiency requires Pungent to tonify. Ying is Yin; deficiency requires Sweet to tonify. Sweet and Pungent combine to establish the Spleen-Stomach and harmonize Ying and Wei.