（东垣李先生内伤纂要）
人身以胃气为主，凡言阳气、元气、谷气、荣气，清气、卫气、春升之气，皆胃气之别名耳。脾胃一伤，中
气不足，谷气不能上行以滋养心肺，乃下流而乘肝肾（痿厥气逆之渐也），肾受脾湿，闭塞其下，致肾间阴火
上冲心肺。心肺者，天之气，是无形之气受病，故饮食劳役失节，为内伤不足之证。肝肾者，地之气，是有形
之质受病，故风寒邪侵筋骨（风伤肝筋，寒伤肾骨），为外伤有余之证。
经曰∶天之邪气感则害人五脏，水谷寒热感则害人六腑。又曰∶犯贼风虚邪者阳受之，饮食不节起居不时
者阴受之。阳受之则入六腑，阴受之则入五脏，两说似反而实不反也。盖内外之伤，脏腑皆尝受之，但随其所
从所发之处而为病耳。经曰∶东风入肝，西风入肺，南心北肾，西南则舍于脾。观此则天之邪气，固伤五脏矣。
然虚邪中人，从皮肤而入络脉而经而输，伏冲之脉以至于肠胃。又曰∶东北风伤人，内舍于大肠，西北舍于
小肠，东南舍于胃。则天之邪气，又岂不伤六腑乎？经曰∶饮食自
倍，肠胃乃伤。则水谷寒热，固伤六腑矣。又曰∶形寒饮冷伤肺，饮食劳倦伤脾。亦未尝不伤五脏也。至于地
湿，亦未必专害皮肉筋脉，而不能害脏腑。邪气水谷，亦未必专害脏腑，而不能害皮肉筋脉也。但以邪气无形，
脏主藏精气，故以类相从而多伤脏。水谷有形，腑主传化物，故因其所由而多伤腑。湿气浸润，其性缓慢，故
从下而上，从浅而深，而多伤于皮肉筋脉耳，孰谓湿气全无及于脏腑之理哉！观此则知伤寒、温暑、内伤、杂
病，阴阳虚实之理一而已矣。仲景、东垣、丹溪、河间，又岂有优劣哉！
有余者泻，不足者补，补泻一差，生死立判。其所以疑而似者，为百病皆起于恶寒、恶风、发热、头疼等
证。杂病，亦有六经所见之证，外科亦然，所以世俗混而无别 其最易辨者，伤寒恶寒，猛火不除；内伤恶寒，
元气下流，心肺无所禀受，皮肤间无阳以护，但见风寒便恶，非常常有之无间断也 稍就温暖即止。伤风恶风，
不耐一切风寒∶内伤恶风，偏恶些小贼风。避居密室，则不恶矣 外伤恶热，无有休歇，日晡转剧，直待汗
下方退；内伤发热，亦似伤寒及中 之证，但烦躁时止时作，或自袒裸亦便清凉。凡体弱食少过劳，及常斋
胃薄之人，因劳役得疾，皆与阳明中 相似，误服白虎必死。但中 日晡热甚，或作谵语；内伤日晡病减，
为阳明气旺故耳 外伤筋骨疼痛，不自支持便着床枕；内伤倦怠，有似伤寒及中湿之证，但四肢不收，无力嗜
卧而已。间有脾为热乘，则骨消筋缓，亦非得病即显是证。
内伤寒热，间作而不齐；
或因口吸风寒之气，郁其阴火，使咽膈不通，其吸入之气欲入也，为膈上冲脉之火所拒，使阴气不得入，
其胸中之气，为外风寒所遏而不得伸，令人口开眼瞪，极则声发于内，气不能上下，塞于咽中而气欲绝。又或
因哕、因呕、因吐而燥热发，必有所因，方有此证。其表虚恶风寒之证复见矣，表虚之弱为阴火所乘，燥发须
臾而过∶其表虚无阳不任风寒复见矣，是表虚无阳常常有之，其燥热则间而有之，此二者不齐，燥作寒已，寒
作燥已，非如外伤之寒热齐作，无有间断也。
外伤寒热，齐作而不间。内伤头痛，时止时作；外伤头痛。非发散直传入里方罢，然岂特初证似太阳可辨
哉！内伤则元气不足，神思昏怠，语言倦懒，先重而后轻；外伤则邪气有余，神思猛壮，语言强健，先轻而后
重。内伤则手心热而手背不热；外伤则手背热而手心不热。内伤邪在血脉中有余则不渴，间有渴者，心火克肺，
乃伤之重者也 外伤邪气传里则大渴。内伤证显在口，虽食亦不知味，多唾涎沫，鼻息不调或有清涕；外伤证
显在鼻，伤寒鼻塞，伤风流涕，虽不能食而亦知味。内伤气口脉大，外伤人迎浮紧。
外感风寒，则人迎脉缓或紧，而大于气口一倍或两三倍。内伤饮食，则气口脉大于人迎一倍，伤之重者，
过在少阴则两倍，太阴则三倍，此内伤饮食之脉。若劳役过甚，心脉变见于气口，是心火刑肺，其肝木挟心火
之势，亦来薄肺，故气口脉急大而数，时一代而涩也。涩者，肺之本脉；代者，元气不相接，脾胃不及之脉；
洪大而数者，心脉刑肺也；急者，肝木挟心火而反克肺金也。若不甚劳役，唯右关脉数而独大于五脉，数中显
缓，时一代也。如饮食不节，寒暑失所，则先右关胃脉损弱，甚则隐而不见，唯内显脾脉之大数微缓，时一代
也。宿食不消，则独右关脉沉而滑。
若显内证多者，则是内伤重而外感轻，宜以补养为先。若显外证多者，则是外感重而内伤轻，宜以发散为
急，此医之大关键也。奈何业者，不学妄行，凡病莫分内外，专以发散为先，实实虚虚，可胜叹哉！
（李东垣先生《内伤纂要》摘要）
人体以胃气为根本，凡是提到的阳气、元气、谷气、营气、清气、卫气、春升之气，都是胃气的别称。脾胃一旦受损，中气不足，谷气就不能上行滋养心肺，反而下流并侵犯肝肾（这是痿证、厥证和气逆的开端）。肾受到脾湿的影响，闭塞下部，导致肾间的阴火上冲至心肺。心肺属于天之气，是无形的“气”受病，所以饮食不节和劳役过度，属于内伤不足的病证。肝肾属于地之气，是有形的“质”受病，所以风寒邪气侵袭筋骨（风伤肝筋，寒伤肾骨），属于外伤有余的病证。
《内经》说：天之邪气侵入则伤害五脏，水谷的寒热之邪侵入则伤害六腑。又说：遭受贼风虚邪的是阳经受病，饮食不节、起居无常的是阴经受病。阳经受病则邪入六腑，阴经受病则邪入五脏。这两种说法看似相反，实则并不矛盾。大概内外之伤，脏腑都曾受病，只是根据邪气入侵和发病的部位不同而表现为不同的病症罢了。《内经》说：东风伤肝，西风伤肺，南风伤心，北风伤肾，西南风伤脾。看这一点，天之邪气确实伤害五脏。然而虚邪中人，从皮肤进入络脉，再传入经脉、输穴，伏行于冲脉，最终到达肠胃。又说：东北风伤人，内舍于大肠；西北风伤人，内舍于小肠；东南风伤人，内舍于胃。那么天之邪气，难道不也伤害六腑吗？《内经》说：饮食过量一倍，肠胃就会受伤。那么水谷的寒热之邪，确实伤害六腑。又说：形体受寒、饮冷会伤肺，饮食劳倦会伤脾。这也没有不伤害五脏的道理。至于地湿，也未必专门伤害皮肉筋脉，而不能伤害脏腑。邪气和水谷之邪，也未必专门伤害脏腑，而不能伤害皮肉筋脉。只是因为邪气无形，脏主藏精气，所以同类相从，多伤及脏。水谷有形，腑主传化物，所以顺着其路径，多伤及腑。湿气浸润，性质缓慢，所以从下向上，由浅入深，多伤害皮肉筋脉罢了，谁说湿气完全不影响脏腑的道理呢！由此可知，伤寒、温暑、内伤、杂病，阴阳虚实的道理是一样的。张仲景、李东垣、朱丹溪、刘河间，又哪里有高下优劣之分呢！
有余的用泻法，不足的用补法，补泻稍有差错，生死立刻分明。之所以让人疑惑且难以区分，是因为百病都起于恶寒、恶风、发热、头痛等症状。杂病也有六经所见到的症状，外科疾病也是如此，所以世俗之人混淆而没有区别。最容易辨别的是：伤寒的恶寒，像猛火一样无法消除；内伤的恶寒，是因为元气下流，心肺得不到禀受，皮肤间没有阳气护卫，只要见到风寒就害怕，这种恐惧是非常常有且无间断的，稍微靠近温暖环境就会停止。伤风的恶风，不能耐受一切风寒；内伤的恶风，只特别厌恶微小的贼风。如果避居在密室里，就不怕了。外伤的恶热，没有休止，下午申时加重，直到出汗后才退热；内伤的发热，也像伤寒和中暍的症状，但烦躁是时有时无，或者自己解开衣襟裸露身体也会感到清凉。凡是体质虚弱、食量减少、过度劳累，以及经常吃斋导致胃气薄弱的人，因为劳役得病，都与阳明中暍相似，误服白虎汤必死。但是中暍是下午申时热势加重，有时出现胡言乱语；内伤则是下午申时病情减轻，这是因为阳明经气旺盛的缘故。外伤导致的筋骨疼痛，无法支撑身体就要躺卧；内伤的倦怠，有点像伤寒和中湿的症状，但只是四肢无力下垂，嗜睡乏力而已。偶尔有脾被热邪乘袭的情况，会出现骨骼消耗、筋脉弛缓，但这也不是生病一开始就显现的症状。
内伤的寒热，交替发作且不整齐；或者因为口吸入风寒之气，郁遏阴火，使咽喉膈膜不通，吸入的气想进去，却被膈上冲脉的火所拒绝，使阴气不得进入，胸中的气被外风寒遏制而不能舒展，导致人口开眼瞪，严重时声音发自内部，气不能上下运行，堵塞在咽喉中而气息欲绝。又或者因为呃逆、呕吐、吐食而引发燥热，必定有原因，才会有这些症状。表虚恶风寒的症状再次出现，表虚的虚弱被阴火乘袭，燥热一会儿就过去；表虚无阳不能任受风寒的症状再次出现，这是表虚无阳常常有的，燥热则是偶尔有的，这两者不整齐，燥热发作后寒象消失，寒象发作后燥热消失，不像外伤那样寒热同时发作，没有间断。
外伤的寒热，同时发作且无间断。内伤的头痛，时有时无；外伤的头痛，如果不发散解表，邪气直传入里才会停止，但这岂止是初起症状像太阳病可以辨别吗！内伤则是元气不足，神思昏沉怠惰，语言疲倦懒言，先重后轻；外伤则是邪气有余，神思猛烈强壮，语言强健有力，先轻后重。内伤则是手心热而手背不热；外伤则是手背热而手心不热。内伤邪气在血脉中有余则不口渴，偶尔有口渴的，是心火克肺金，这是受伤较重的情况；外伤邪气传入里则大渴。内伤的症状显现在口，即使吃东西也不知道味道，多唾涎沫，鼻息不调或有清涕；外伤的症状显现在鼻，伤寒鼻塞，伤风流鼻涕，虽然不能进食但也知道味道。内伤的气口脉大，外伤的人迎脉浮紧。
外感风寒，则人迎脉缓或紧，且比气口大一倍或两三倍。内伤饮食，则气口脉比人迎大一倍，伤得重的，涉及少阴则大二倍，太阴则大三倍，这是内伤饮食的脉象。如果是劳役过度，心脉变化显现在气口，这是心火刑克肺金，肝木挟带心火的势头，也来侵薄肺金，所以气口脉急大而数，时而一代而涩。涩，是肺的本脉；代，是元气不相接续，脾胃不及的脉象；洪大而数，是心脉刑克肺金；急，是肝木挟心火而反克肺金。如果不是非常严重的劳役，只有右关脉数而单独大于其他五脉，数中显现缓象，时而一代。如果饮食不节，寒暑失调，则先见右关胃脉损弱，严重时隐伏不见，只内在显现脾脉的大数微缓，时而一代。宿食不消化，则独见右关脉沉而滑。
如果显现的内证多，则是内伤重而外感轻，宜以补养为先。如果显现的外证多，则是外感重而内伤轻，宜以发散为急，这是医家的关键所在。奈何从业者，不学习而妄自行事，凡病不分内外，专以发散为先，造成实证实治、虚证虚治的错误（注：此处原文意指误治导致虚实颠倒或加重，即“实实虚虚”），真是令人叹息啊！
(Excerpt from Mr. Li Dongyuan's *Summary of Internal Injury*)
The human body relies on Stomach Qi (Wei Qi, 胃气) as its foundation. All terms mentioned such as Yang Qi (Yang Qi, 阳气), Yuan Qi (Original Qi, 元气), Grain Qi (Grain Qi, 谷气), Ying Qi (Nutritive Qi, 营气), Clear Qi (Clear Qi, 清气), Wei Qi (Defensive Qi, 卫气), and Spring-rising Qi (Spring-rising Qi, 春升之气) are all alternative names for Stomach Qi. Once the Spleen and Stomach are damaged, Middle Qi (Middle Qi, 中气) becomes insufficient. Grain Qi cannot ascend to nourish the Heart and Lungs but instead flows downward and attacks the Liver and Kidneys (this is the beginning of Atrophy Syndrome [Wu Zheng, 痿证], Jue Syndrome [Jue Zheng, 厥证], and Qi rebellion). The Kidney is affected by Spleen dampness, which blocks the lower part, causing Yin Fire (Yin Huo, 阴火) in the Kidney area to rush upward to the Heart and Lungs. The Heart and Lungs belong to the Qi of Heaven; they are diseases affecting formless Qi. Therefore, irregular diet and overwork constitute internal injury characterized by deficiency. The Liver and Kidneys belong to the Qi of Earth; they are diseases affecting formed substance. Therefore, Wind-Cold pathogenic factors invading the sinews and bones (Wind damages Liver sinews, Cold damages Kidney bones) constitute external injury characterized by excess.
The Classics state: Pathogenic factors of Heaven, when invading, harm the Zang organs; cold and heat from food and drink, when invading, harm the Fu organs. It also states: Those who suffer from thieving wind and empty pathogens receive them in the Yang channels; those with irregular diet and improper daily routine receive them in the Yin channels. Receiving in Yang channels leads to entry into the Fu organs; receiving in Yin channels leads to entry into the Zang organs. These two statements seem contradictory but are actually not. Generally, both internal and external injuries affect the Zang and Fu organs, but the disease manifests according to where the pathogen enters and originates. The Classics say: East wind harms the Liver, West wind harms the Lungs, South wind harms the Heart, North wind harms the Kidneys, and Southwest wind affects the Spleen. From this, we see that pathogenic factors of Heaven indeed harm the Zang organs. However, empty pathogens enter humans from the skin into the Luo vessels, then into the Jing meridians and Shu points, lying hidden in the Chong vessel, and finally reaching the intestines and stomach. It also says: Northeast wind harms humans, internally residing in the Large Intestine; Northwest wind resides in the Small Intestine; Southeast wind resides in the Stomach. Thus, do pathogenic factors of Heaven not also harm the Fu organs? The Classics say: If food intake doubles, the intestines and stomach are injured. Thus, cold and heat from food and drink indeed harm the Fu organs. It also says: Physical cold and cold drinks harm the Lungs; dietary irregularity and fatigue harm the Spleen. This does not mean they do not harm the Zang organs either. As for Earth dampness, it does not necessarily only harm the skin, flesh, sinews, and vessels without harming the Zang and Fu organs. Nor do pathogenic factors and food/drink necessarily only harm the Zang and Fu organs without harming the skin, flesh, sinews, and vessels. It is simply because pathogenic factors are formless, and Zang organs store essence and Qi, so like attracts like, often harming the Zang organs. Food and drink are formed, and Fu organs transmit and transform substances, so following their path, they often harm the Fu organs. Dampness infiltrates slowly, so it moves from below upward and from shallow to deep, often harming the skin, flesh, sinews, and vessels. Who would say that dampness has no effect on the Zang and Fu organs! From this, we know that the principles of Yin-Yang and deficiency-excess in Cold Damage (Shang Han, 伤寒), Warmth-Heat [diseases] (Wen Shu, 温暑), internal injury, and miscellaneous diseases are identical. Are Zhang Zhongjing, Li Dongyuan, Zhu Danxi, and Liu Hejian really superior or inferior to one another?
For excess, use purgation; for deficiency, use tonification. A slight error in tonification or purgation can determine life or death instantly. The reason for doubt and confusion lies in the fact that hundred diseases all begin with symptoms such as aversion to cold, aversion to wind, fever, and headache. Miscellaneous diseases also present symptoms seen in the Six Channels, and surgical diseases are the same, which is why laypeople confuse them without distinction. The easiest to distinguish is: In Cold Damage, aversion to cold is fierce and unrelenting like a hot fire; in internal injury, aversion to cold occurs because Yuan Qi flows downward, leaving the Heart and Lungs without nourishment, and there is no Yang Qi in the skin to protect against it. Any exposure to wind-cold causes fear, which is constant and uninterrupted. It stops slightly upon approaching warmth. In Wind Strike, aversion to wind means intolerance to all wind-cold; in internal injury, aversion to wind is specifically sensitive to minor thieving winds. One feels no aversion if staying in a sealed room. In external injury, aversion to heat is relentless, worsening at Shen hour (3-5 PM), and only subsides after sweating; in internal injury, fever resembles Cold Damage or Heat Stroke (Zhong Shu, 中暑), but irritability comes and goes, or feeling cool after exposing oneself. For those with weak constitutions, low appetite, overwork, or thin stomach Qi due to vegetarianism, illness caused by labor resembles Yangming Heat Stroke (Yangming Zhong Shu, 阳明中暑); misusing Baihu Tang (White Tiger Decoction) will cause death. However, in Heat Stroke, heat peaks at Shen hour, sometimes with delirium; in internal injury, condition improves at Shen hour because Yangming Qi is vigorous. External injury causes bone and joint pain, requiring bed rest due to inability to support oneself; internal injury causes fatigue, resembling Cold Damage or Dampness Strike, but merely involves flaccid limbs, weakness, and lethargy. Occasionally, if Spleen is attacked by heat, bone wasting and sinew laxity occur, but these are not immediate signs.
Internal injury presents alternating and irregular cold and heat; or due to inhaling wind-cold air, suppressing Yin Fire, blocking the throat and diaphragm. The inhaled air wants to enter but is rejected by the fire in the Chong vessel above the diaphragm, preventing Yin Qi from entering. Chest Qi is suppressed by external wind-cold and cannot extend, causing open mouth and staring eyes. In extreme cases, sound emanates from within, Qi cannot move up or down, gets stuck in the throat, and breath seems about to cease. Alternatively, dryness and heat arise due to hiccup, vomiting, or regurgitation, always having a cause. The syndrome of exterior deficiency with aversion to wind-cold reappears; the deficiency of exterior is attacked by Yin Fire, and dryness passes quickly. The syndrome of exterior deficiency lacking Yang, unable to withstand wind-cold, reappears; this lack of Yang in the exterior is constant, while dryness is intermittent. These two are irregular: when dryness appears, cold disappears; when cold appears, dryness disappears. This differs from external injury where cold and heat appear together without interruption.
External injury features simultaneous and uninterrupted cold and heat. Internal injury headache comes and goes; external injury headache persists until dispersed and transmitted inward. Is it not just that initial symptoms resembling Taiyang syndrome are distinguishable? Internal injury involves insufficient Yuan Qi, dull and lethargic spirit, tired and lazy speech, starting heavy and becoming light. External injury involves excess pathogenic Qi, vigorous spirit, strong speech, starting light and becoming heavy. Internal injury presents hot palms and cool backs of hands; external injury presents hot backs of hands and cool palms. In internal injury, if excess pathogenic Qi is in the blood vessels, there is no thirst; occasional thirst indicates Heart Fire attacking Lung Metal, a severe injury. In external injury, when pathogenic Qi transmits inward, there is intense thirst. Internal injury symptoms manifest in the mouth: even when eating, taste is unknown, excessive saliva, irregular breathing, or clear nasal discharge. External injury symptoms manifest in the nose: Cold Damage causes nasal congestion, Wind Strike causes runny nose; although eating is difficult, taste is known. Internal injury shows large Qi Kou pulse; external injury shows floating and tight Ren Ying pulse.
External contraction of wind-cold results in Ren Ying pulse being slow or tight, larger than Qi Kou by one or two to three times. Internal injury from diet results in Qi Kou pulse larger than Ren Ying by one time; if severe, involving Shaoyin, it is twice as large; involving Taiyin, three times as large. This is the pulse of internal dietary injury. If overwork is severe, Heart pulse changes appear at Qi Kou, indicating Heart Fire punishing Lung Metal. Liver Wood, carrying the momentum of Heart Fire, also attacks Lung Metal, so Qi Kou pulse is urgent, large, rapid, occasionally intermitted and choppy. Choppy is the native pulse of Lung; intermitted indicates disconnected Yuan Qi and insufficiency of Spleen-Stomach; large and rapid indicates Heart Fire punishing Lung; urgent indicates Liver Wood carrying Heart Fire counter-punishing Lung Metal. If overwork is not severe, only the Right Guan pulse is rapid and uniquely larger than the other five pulses, showing slowness within rapidity, occasionally intermitted. If diet is irregular and climate mismatched, first the Right Guan Stomach pulse becomes weak, severely invisible, showing only the inner Spleen pulse as large, rapid, slightly slow, occasionally intermitted. Undigested food shows exclusively Right Guan pulse deep and slippery.
If internal symptoms predominate, internal injury is heavy and external contraction is light; tonification should be prioritized. If external symptoms predominate, external contraction is heavy and internal injury is light; dispersing should be urgent. This is the key point for physicians. Alas, practitioners who do not study act recklessly, failing to distinguish between internal and external conditions, focusing solely on dispersal, leading to treating excess as excess and deficiency as deficiency (exacerbating the condition). How lamentable!