气血冲和，万病不生，一有怫郁，诸病生焉。故人身诸病，多生于郁。苍术、抚
芎，总解诸郁，随证加入诸药。
凡郁皆在中焦，以苍术、抚芎开提其气以升之。假如食在气上，提其气则食自降矣。余
戴云∶郁者，结聚而不得发越也。当升者不得升，当降者不得降，当变化者不得变化也，
传化失常。六郁之病见矣。气郁者，胸胁痛，脉沉涩；湿郁者，周身走痛，或关节痛，遇
寒则发，脉沉细；痰郁者，动则喘，寸口脉沉滑；热郁者，瞀闷，小便赤，脉沉数；血郁者
四肢无力，能食便红，脉沉；食郁者，嗳酸，腹饱不能食，人迎脉平和，气口脉繁盛者是
又方
气郁
香附（童便浸） 苍术（米泔浸） 抚芎
湿郁
白芷 苍术 川芎 茯苓
痰郁
海石 香附 南星（姜制） 栝蒌（一本无南星、栝蒌，有苍术、川芎、栀子）
热郁
山栀（炒） 青黛 香附 苍术 抚芎
血郁
桃仁（去皮） 红花 青黛 川芎（抚芎亦可） 香附
食郁
苍术 香附 山楂 神曲（炒） 针砂（醋炒七次研极细）
春，加芎；夏，加苦参；秋冬，加吴茱萸。
越鞠丸 解诸郁。又名芎术丸。
苍术 香附 抚芎 神曲 栀子（各等分）
上为末，水丸如绿豆大。
东垣《内外伤辨》甚详，世之病此者为多。但有挟痰者，有挟外邪者，有热郁
者，皆以补元气为主，看所挟而兼用药。如挟痰者，则以补中益气汤加半夏、竹沥，仍少
姜汁传送。凡内伤发斑，因胃气虚甚，是火游行于外，亦痰热所致。火则补而降之，痰热
微汗以散之，切不可下，恐生危证。内伤病退后，燥渴不解者，有余热在肺家，可用参、苓
、甘草、少许姜汁，冷服，或茶匙挑姜汁与之。虚者可用人参。
〔附录〕内伤者，其源皆由喜怒过度，饮食失节，寒温不适，劳役所伤而然。元气者，乃
生发诸阳上升之气。饮食入胃，有伤则中气不足，中气不足则六腑皆绝于外，是六腑之元
病也。气伤脏乃病，脏病形乃应，是五脏六腑真气皆不足也。惟阴火独旺，上乘阳分，故
卫失守，诸病生焉。始受饮食劳倦所伤之病，必气高而喘，身热而烦，及短气上逆，鼻息
调，怠惰嗜卧，四肢困倦不收，无气以动，亦无气以言，皆为热伤元气。以甘温之剂以补
气，即是泻火之药。凡所受病，扪摸之，肌肤间必大热，必燥热闷乱，心烦不安，或渴久
病必不渴，或表虚恶风寒，慎不可以寒凉药与之。经言劳者温之，损者温之，惟以补
中益气汤温药，以补元气而泻火邪。《内经》云温能除大热，正谓此也。
附方
补中益气汤
黄 （劳役病甚可用一钱半，嗽者减去一钱） 人参（一钱，有嗽去之） 甘草（炙，一钱）以
上三味除燥热肌热之圣药） 当归身（酒洗，焙干，半钱，以和血脉） 柴胡（半钱引清气行少阳之气
上升
腾而复其本位） 葛根（半钱，如渴用之，不渴不用，
一方有白芍半钱，秋冬不用 红花三分 少加黄柏三分，以救肾水，泻伏火
上作一服，水煎，午前稍热服。若病日久者，以权立加减法。若头痛，加蔓荆子三分；
痛甚
重懒倦者，乃太阴厥阴头疼，加半夏半钱或一钱，生姜三片；若耳鸣、目黄、颊颔肿，颈肩
肘臂外后廉痛、面赤、脉洪大者，加羌活一钱，防风七分，甘草三分， 本五分，通其经血
，加黄芩、黄连各三分消其肿；嗌痛颔肿，脉洪大，面赤，加黄芩三分，桔梗七分，甘草三
分；口干嗌干或
渴者，加葛根五分，升胃气上行以润之；心下痞，瞀闷者，加芍药、黄连各一钱；如痞腹胀
，加枳实三分，浓朴七分，木香、砂仁各三分；如天寒，加干姜；腹中痛，加白芍药炒半
钱，炙甘草三分；如恶寒觉冷痛，加中桂（即桂心）半钱；夏月腹中痛，不恶寒不恶热者，加
五分，芍药一钱，甘草五分，以治时热；脐下痛者，加真熟地黄半钱；如胸中滞气，加莲花
青皮一分或二分，壅滞可用，气促少气者去之；如身体重疼，乃风湿相搏，加羌活半钱，
风半钱，升麻一钱，柴胡半钱， 本根半钱，苍术一钱。如病去，勿再服。若大便秘涩，加
当归梢一钱；若久病痰嗽者，去人参，冬月加不去节麻黄，秋凉亦加不去根节麻黄，春月天
温，只加佛耳草三分，款花一分，勿加麻黄。若初病之人，虽痰嗽不去人参，必不增添。
久病肺中伏火者，去人参，以防痰嗽增益耳。长夏湿土，客邪大旺，加苍术、白术、泽泻，
上下分消其湿热之气。湿热大胜，主食不消，故食减不知谷味，则加曲以消之，加五味子
麦门冬，助人参泻火，益肺气，助秋损也，在三伏中为圣药。胁下急或痛，俱加柴胡、甘草
、人参；多唾，或唾白沫，胃口上停寒也，加益智仁；若胃脘当心痛，加草豆仁三分。
疲甚之人，参、 、术有用至一两二两者。
枳术丸 治痞，消食强胃。又云食过伤损元气，以此主之。
枳实（炒，一两） 白术（二两）
上用荷叶裹烧饭丸。白术者，本意不取其食速化，但久令人胃气强实，不复伤也。
气血调和，万病不生；一旦气机怫郁，各种疾病便由此产生。因此，人身上的各种疾病，大多源于郁滞。苍术、抚芎（川芎），能总解诸种郁滞，需根据具体证候加入其他药物。
凡是郁滞都发生在中焦，用苍术、抚芎升提气机使其上升。假如食物停滞在气分之上，提升气机则食物自然下降。另外，戴元礼说：所谓“郁”，是指结聚而不能发散。该升的不能升，该降的不能降，该变化的不能变化，导致传化功能失常。于是出现了六种郁滞的病证。气郁的表现是胸胁疼痛，脉象沉涩；湿郁的表现是周身游走性疼痛，或关节疼痛，遇寒冷发作，脉象沉细；痰郁的表现是活动后气喘，寸口脉象沉滑；热郁的表现是头昏闷乱，小便赤黄，脉象沉数；血郁的表现是四肢无力，食欲正常但大便带血，脉象沉；食郁的表现是嗳气酸腐，腹部饱胀不能进食，人迎脉平和，气口脉象繁盛。
又一方：
气郁方：香附（童便浸泡）、苍术（米泔水浸泡）、抚芎。
湿郁方：白芷、苍术、川芎、茯苓。
痰郁方：海浮石、香附、南星（姜制）、栝蒌。（另一版本无南星、栝蒌，有苍术、川芎、栀子）
热郁方：山栀（炒）、青黛、香附、苍术、抚芎。
血郁方：桃仁（去皮）、红花、青黛、川芎（抚芎也可）、香附。
食郁方：苍术、香附、山楂、神曲（炒）、针砂（醋炒七次研极细）。
春季加川芎；夏季加苦参；秋冬季节加吴茱萸。
越鞠丸：解诸种郁滞。又名芎术丸。
组成：苍术、香附、抚芎、神曲、栀子（各等分）。
将上述药物研为末，用水泛丸如绿豆大。
李东垣在《内外伤辨》中论述得非常详尽，世上患此病的人很多。但有的兼夹痰饮，有的兼夹外邪，有的兼夹热郁，都以补益元气为主，根据所兼夹的病邪配合用药。如兼夹痰饮的，用补中益气汤加半夏、竹沥，并少加姜汁作为引药传送。凡是内伤发斑，是因为胃气极度虚弱，火邪游行于体表，这也是由痰热所致。对于火邪，用补法兼以降之；对于痰热，用微汗法以散之，切不可用泻下法，恐怕产生危重证候。内伤病退后，若燥渴不解，说明有余热在肺脏，可用人参、茯苓、甘草及少许姜汁，冷服，或用茶匙挑姜汁喂服。体质虚弱的可用用人参。
〔附录〕内伤的根源，都是由喜怒过度、饮食失节、寒温不适、劳役损伤所致。元气，是生发诸阳上升之气。饮食入胃，若有损伤则中气不足，中气不足则六腑之气皆绝于外，这是六腑的根本病变。气受伤则脏腑发病，脏腑发病则形体应验，这是五脏六腑的真气都不足了。只有阴火独旺，上乘于阳分，导致卫气失守，各种疾病由此产生。起初受饮食劳倦所伤的疾病，必然出现气高而喘，身热而烦，以及短气上逆，鼻息调匀，怠惰嗜卧，四肢困倦不收，无气以动，也无气以言，这些都是热邪损伤元气。用甘温的药剂来补气，也就是泻火的方法。凡所受之病，触摸肌肤，必定大热，必定燥热闷乱，心烦不安，或者口渴，久病则必不渴，或者表虚恶风寒，千万不要用寒凉药给予治疗。经书说“劳者温之，损者温之”，只用补中益气汤这类温药，来补元气而泻火邪。《内经》说“温能除大热”，正是说的这个意思。
附方：
补中益气汤
黄芪（劳役病重者可用一钱半，咳嗽者减去一钱） 人参（一钱，有咳嗽者去掉） 甘草（炙，一钱）（以上三味是除燥热肌热的圣药） 当归身（酒洗，焙干，半钱，用以调和血脉） 柴胡（半钱，引导清气运行，使少阳之气上升，腾跃而回复本位） 葛根（半钱，如口渴用之，不渴不用，一方有白芍半钱，秋冬不用） 红花三分 少加黄柏三分，用以救肾水，泻伏火。
以上为一服，水煎，午前稍热时服用。如果病程日久，按权立加减法处理。若头痛，加蔓荆子三分；痛甚且懒倦者，乃太阴厥阴头疼，加半夏半钱或一钱，生姜三片；若耳鸣、目黄、颊颔肿，颈肩肘臂外侧后方疼痛、面赤、脉洪大者，加羌活一钱，防风七分，甘草三分，藁本五分，通其经络血气，加黄芩、黄连各三分消其肿；咽喉痛颔肿，脉洪大，面赤，加黄芩三分，桔梗七分，甘草三分；口干咽干或口渴者，加葛根五分，升胃气上行以滋润之；心下痞满，头昏闷乱者，加芍药、黄连各一钱；如痞腹胀，加枳实三分，浓朴七分，木香、砂仁各三分；如天气寒冷，加干姜；腹中痛，加炒白芍药半钱，炙甘草三分；如恶寒觉冷痛，加肉桂（即桂心）半钱；夏月腹中痛，不恶寒不恶热者，加五味子五分，芍药一钱，甘草五分，以治时热；脐下痛者，加真熟地黄半钱；如胸中滞气，加莲花青皮一分或二分，壅滞可用，气促少气者去掉；如身体重疼，乃风湿相搏，加羌活半钱，防风半钱，升麻一钱，柴胡半钱，藁本根半钱，苍术一钱。如果病去，不要再服。若大便秘涩，加当归梢一钱；若久病痰嗽者，去人参，冬月加不去节麻黄，秋凉亦加不去根节麻黄，春月天温，只加佛耳草三分，款冬花一分，勿加麻黄。若初病之人，虽有痰嗽也不去人参，必定不会增添副作用。久病肺中伏火者，去人参，以防痰嗽增益耳。长夏湿土，客邪大旺，加苍术、白术、泽泻，上下分消其湿热之气。湿热大胜，主食不消，故食减不知谷味，则加神曲以消之，加五味子、麦门冬，助人参泻火，益肺气，助秋损也，在三伏中为圣药。胁下急或痛，俱加柴胡、甘草、人参；多唾，或唾白沫，胃口上停寒也，加益智仁；若胃脘当心痛，加草豆蔻三分。
疲劳严重的人，参、芪、术有用至一两二两者。
枳术丸：治痞满，消食强胃。又说食物过伤损伤元气，以此方主治。
枳实（炒，一两） 白术（二两）
上用荷叶裹烧饭为丸。白术的本意不是取其食物速化，而是长久使人胃气强实，不再受伤。
When Qi and Blood are harmonious, myriad diseases do not arise; once there is stagnation (Fuyu), various diseases emerge. Therefore, most diseases of the human body originate from stagnation. Cangzhu (Atractylodis Rhizoma) and Fuxiong (Chuanxiong Rhizoma) can generally resolve all types of stagnation, with additional herbs added according to the specific syndrome.
All stagnations occur in the Middle Jiao (Middle Burner). Cangzhu and Fuxiong are used to lift and raise the Qi. For instance, if food is stagnant in the upper aspect of the Qi level, lifting the Qi will cause the food to descend naturally. Additionally, Dai Yuanli stated: "Stagnation" refers to condensation that cannot be dispersed. What should ascend fails to ascend, what should descend fails to descend, and what should transform fails to transform, leading to dysfunction in transmission and transformation. Thus, the six types of stagnation syndromes appear. Qi stagnation manifests as pain in the chest and hypochondrium, with a deep and choppy pulse; Dampness stagnation manifests as wandering pain throughout the body or joint pain, which flares up upon exposure to cold, with a deep and fine pulse; Phlegm stagnation manifests as panting upon movement, with a deep and slippery pulse at the Cun Kou position; Heat stagnation manifests as dizziness and oppression, dark red urine, and a deep and rapid pulse; Blood stagnation manifests as weakness in the four limbs, normal appetite but blood in the stool, and a deep pulse; Food stagnation manifests as sour belching, abdominal fullness with inability to eat, a peaceful Ren Ying pulse, and a flourishing Qi Kou pulse.
Another prescription:
For Qi Stagnation: Xiangfu (Cyperi Rhizoma, soaked in child's urine), Cangzhu (Atractylodis Rhizoma, soaked in rice wash water), Fuxiong (Chuanxiong Rhizoma).
For Dampness Stagnation: Baizhi (Angelicae Dahuricae Radix), Cangzhu, Chuanxiong, Fuling (Poria).
For Phlegm Stagnation: Haishi (Calcitum), Xiangfu, Nanxing (Arisaematis Rhizoma, processed with ginger), Gualou (Trichosanthis Fructus). (Another version has no Nanxing or Gualou, but includes Cangzhu, Chuanxiong, and Zhizi).
For Heat Stagnation: Zhizi (Gardeniae Fructus, stir-fried), Qingdai (Indigo Naturalis), Xiangfu, Cangzhu, Fuxiong.
For Blood Stagnation: Taoren (Persicae Semen, skin removed), Honghua (Carthami Flos), Qingdai, Chuanxiong (Fuxiong may also be used), Xiangfu.
For Food Stagnation: Cangzhu, Xiangfu, Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata, stir-fried), Zhensha (Magnetitum, stir-fried in vinegar seven times and ground finely).
In Spring, add Chuanxiong; in Summer, add Kushen (Sophorae Flavescentis Radix); in Autumn and Winter, add Wuzhuyu (Evodiae Fructus).
Yueju Wan (Pass-Through Pill): Resolves all types of stagnation. Also known as Xiongzhu Wan.
Composition: Cangzhu, Xiangfu, Fuxiong, Shenqu, Zhizi (equal parts).
Grind into powder and make pills with water, sized like mung beans.
Li Dongyuan's *Bian Zheng Lu* (Differentiation of Internal and External Injury) discusses this in great detail, and many people in the world suffer from this disease. However, some cases involve concurrent Phlegm, some involve concurrent Exterior pathogens, and some involve concurrent Heat stagnation. The primary treatment is to tonify Yuan Qi (Primal Qi), while adding herbs based on the concurrent pathogen. For cases with concurrent Phlegm, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Banxia (Pinelliae Rhizoma) and Zhuli (Bambusae Sap), along with a small amount of Jiangzhi (Ginger Juice) as a guiding vehicle. Whenever internal injury causes macules (ban), it is due to extreme deficiency of Stomach Qi, causing Fire to wander to the exterior; this is also caused by Phlegm-Heat. For Fire, use tonification combined with descending methods; for Phlegm-Heat, use mild sweating to disperse it. One must absolutely avoid purgatives, lest critical conditions arise. After the retreat of internal injury diseases, if dryness and thirst persist, it indicates residual Heat in the Lung. One may use Renshen (Ginseng Radix et Rhizoma), Fuling, Gancao (Glycyrrhizae Radix et Rhizoma), and a small amount of Ginger Juice, taken cold, or administered drop by drop with a tea spoon. For deficient constitutions, Renshen may be used.
[Appendix] The origin of internal injuries lies in excessive joy or anger, irregular diet, inappropriate temperature regulation, and overexertion. Yuan Qi is the Qi that generates and ascends among the Yang energies. When food enters the Stomach and causes damage, the Middle Qi becomes insufficient. Insufficient Middle Qi leads to the cessation of the Six Fu Organs' Qi externally, which is the fundamental pathology of the Six Fu Organs. When Qi is injured, the Zang organs become diseased; when Zang organs are diseased, the形体 (body/form) responds. This indicates that the True Qi of the Five Zang and Six Fu Organs is all insufficient. Only Yin Fire flourishes alone, ascending to the Yang regions, causing the Wei Qi (Defensive Qi) to lose its guard, and thus various diseases arise. Diseases initially caused by dietary and fatigue injuries must present with high-pitched breathing and panting, fever and irritability, shortness of breath with upward reversal, regular nasal breathing, lethargy and desire to lie down, heaviness and lassitude of the four limbs, lack of Qi to move, and lack of Qi to speak. These are all Heat injuring Yuan Qi. Using sweet-warm agents to tonify Qi is essentially a method of draining Fire. Upon palpation of any such disease, the skin and muscles will definitely feel very hot, accompanied by dry heat, oppression, restlessness, and irritability, or thirst. In long-standing diseases, there is usually no thirst. Or there may be superficial deficiency with aversion to wind and cold. One must strictly avoid giving cold-cooling medicines. The Classics state: "For exhaustion, use warmth; for deficiency, use warmth." Only use warm medicines like Buzhong Yiqi Tang to tonify Yuan Qi and drain Fire evil. The *Neijing* states: "Warmth can eliminate great heat," which precisely refers to this.
Attached Prescription:
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)
Huangqi (Astragali Radix) (Use 1.5 qian for severe fatigue illness; reduce by 1 qian if coughing) Renshen (1 qian; remove if coughing) Gancao (Licorice Root, honey-fried, 1 qian) (These three are holy medicines for eliminating dry heat and muscular heat) Danggui Shen (Angelicae Sinensis Radix, washed in wine, dried by baking, 0.5 qian, to harmonize blood vessels) Chaihu (Bupleuri Radix, 0.5 qian, to guide clear Qi to ascend, allowing Shaoyang Qi to rise and return to its original position) Gegen (Puerariae Radix, 0.5 qian; use if thirsty, do not use if not thirsty; another formula has Baishao 0.5 qian, do not use in Autumn/Winter) Honghua (Carthami Flos, 3 fen) Add a small amount of Huangbai (Phellodendri Cortex, 3 fen) to nourish Kidney Water and drain latent Fire.
Take as one dose, decocted in water, taken slightly warm before noon. If the disease has lasted for a long time, apply the modification methods established by Quan Li. If headache occurs, add Manjingzi (Vittaniae Fructus, 3 fen); if pain is severe with laziness and fatigue, it is Taiyin/Jueyin headache, add Banxia (Pinelliae Rhizoma, 0.5 or 1 qian) and Shengjiang (Zingiberis Rhizoma Recens, 3 slices); if tinnitus, yellow eyes, swelling of cheeks/jaw, pain in the outer posterior neck/shoulder/elbow/arm, red face, and flooding pulse occur, add Qianghuo (Notopterygii Rhizoma et Radix, 1 qian), Fangfeng (Saposhnikoviae Radix, 7 fen), Gancao (3 fen), Gaoben (Ligustici Rhizoma et Radix, 5 fen) to unblock meridians and blood qi, and add Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma, 3 fen each) to reduce swelling; if throat pain and jaw swelling with flooding pulse and red face occur, add Huangqin (3 fen), Jiegeng (Platycodonis Radix, 7 fen), Gancao (3 fen); if dry mouth/throat or thirst occurs, add Gegen (5 fen) to ascend Stomach Qi and moisten; if epigastric stuffiness and dizziness occur, add Shaoyao (Paeoniae Radix Alba) and Huanglian (1 qian each); if epigastric distension occurs, add Zhishi (Aurantii Fructus Immaturus, 3 fen), Houpo (Magnoliae Officinalis Cortex, 7 fen), Muxiang (Aucklandiae Radix), and Sharen (Amomi Fructus, 3 fen each); if weather is cold, add Ganjiang (Zingiberis Rhizoma); if abdominal pain occurs, add fried Baishaoyao (0.5 qian) and roasted Gancao (3 fen); if aversion to cold and cold pain occur, add Rougui (Cinnamomi Cortex, 0.5 qian); if abdominal pain in summer without aversion to cold or heat, add Wuweizi (Schisandrae Fructus, 5 fen), Shaoyao (1 qian), Gancao (5 fen) to treat seasonal heat; if pain below the umbilicus occurs, add Shudihuang (Rehmanniae Radix Praeparata, 0.5 qian); if stagnant Qi in the chest occurs, add Qingpi (Citri Reticulatae Pericarpium Viride, 1 or 2 fen); usable for obstruction, but remove if shortness of breath and scanty Qi occur; if heavy body and pain occur due to Wind-Damp binding, add Qianghuo (0.5 qian), Fangfeng (0.5 qian), Shengma (Cimicifugae Rhizoma, 1 qian), Chaihu (0.5 qian), Gaoben Gen (0.5 qian), Cangzhu (1 qian). Stop taking if the disease resolves. If constipation occurs, add Danggui Shao (0.5 qian); if chronic phlegm-cough occurs, remove Renshen, add Mahuang (Ephedrae Herba, untrimmed joints) in winter, and add Mahuang (untrimmed roots/joints) in cool autumn; in warm spring, only add Fo'ercao (Petasitis Herba, 3 fen) and Kuanhuajie (Farfarae Flos, 1 fen), do not add Mahuang. For initial illness even with phlegm-cough, do not remove Renshen, as it will certainly not increase side effects. For chronic latent Fire in the Lungs, remove Renshen to prevent exacerbating phlegm-cough. In late summer damp earth, when external pathogens are vigorous, add Cangzhu, Baizhu (Atractylodis Macrocephalae Rhizoma), and Zexie (Alismatis Rhizoma) to drain damp-heat from above and below. If damp-heat is excessive, food digestion fails, appetite decreases, and grain taste is lost, add Shenqu to digest, and add Wuweizi and Maidong (Ophiopogonis Radix) to assist Renshen in draining fire, benefiting Lung Qi, and aiding autumn deficiency; this is a holy medicine during the Three Fu days. For tightness or pain in the hypochondrium, add Chaihu, Gancao, and Renshen; for excessive saliva or white frothy sputum, indicating cold retention above the stomach opening, add Yizhiren (Alpiniae Oxyphyllae Fructus); for pain in the epigastrium corresponding to the heart, add Caodoukou (Cardamomi Fructus, 3 fen).
For those with severe fatigue, Renshen, Huangqi, and Baizhu may be used up to 1 liang 2 qian.
Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill): Treats stuffiness, promotes digestion, and strengthens the Stomach. It is said that excessive eating damages Yuan Qi, and this formula treats it.
Zhishi (Immature Bitter Orange, stir-fried, 1 liang) Baizhu (2 liang)
Wrap in Lotus Leaf and steam rice to make pills. The intention of using Baizhu is not to accelerate food digestion quickly, but to strengthen Stomach Qi over time so it is no longer easily injured.