解百药毒；兼治筋疝筋疝者，茎中挈痛，挺胀不堪，此由用春方邪术而得之，用此方者
，亦取其解毒。
甘草（二两） 黑豆（半升）
此足阳明药也。甘草和中以解毒，黑豆散热以解毒（苏颂曰∶古称大豆解百药毒，试之
不
本方加大黄，名大黄甘草汤∶治上中下三焦消渴。
经曰∶诸气 郁，皆属于肺。又曰∶怒则气上，喜则气缓，悲则气消，恐则气下，寒则
气收，热则气泄，惊则气乱，劳则气耗，思则气结，九气不同，百病皆生于气也。夫人身之
所恃
出入升
行者
志过
冲和
证矣。无病之时，宜保之养之，和之顺之；病作之时，当审其何经何证，寒热虚实而补泻之
治烦劳内伤，身热心烦，头痛恶寒，懒言恶食，脉洪大而虚，或喘或渴，或阳虚自汗（宜
本汤加麻黄根、浮小麦，升、柴俱宜蜜水炒过，欲其引参、 至表，故又不可缺），或气虚
不能摄血，或疟痢脾虚，久不能愈，一切清阳下陷，中气不足之证（中者，脾胃也，脏腑肢
体，皆禀气于脾胃，饥饱劳役，伤其脾胃，则众体无以禀气而皆病矣。阳气下陷，则阴火上
乘，故热而烦，非实热也；头者诸阳之会，清阳不升，则浊气上逆，故头痛，其痛或作或止，
非如外感头痛不休也；阳虚不能卫外，故恶寒自汗；气虚故懒言；脾虚故恶食；脾胃虚则火
上干肺故喘；金受火克，不能生水故渴；脾虚不能统血，则血妄行而吐下；清阳下陷，则为
泻痢；气血两虚，则疟不止，名 疟。 ，老也。李东垣《内伤外感辨》∶伤于饮食劳役七
情六欲为内伤，伤于风寒暑湿为外感。内伤发热，时热时止；外感发热，热甚不休；内伤恶
寒，得暖便解；外感恶寒，虽浓衣烈火不除；内伤恶风，不畏其风，反畏隙风；外感恶风，
见风便恶；内伤头痛，乍痛乍止；外感头痛，连痛不休，直待表邪传里方罢；内伤有湿，或
不作渴，或心火乘肺，亦作燥渴；外感须二三日外表热传里，口方作渴；内伤则热伤气，四
肢沉困无力，倦怠嗜卧；外感则风伤筋，寒伤骨，一身筋骨疼痛；内伤则短气不足以息；外
感则喘壅气盛有余；内伤则手心热；外感则手背热。天气通于肺，鼻者肺之外侯，外感伤寒
则鼻塞，伤风则流涕，然能饮食，口知味，腹中和，二便如常。地气通于脾，口者脾之外侯，
内伤则懒言恶食，口不知味，小便黄赤，大便或秘或溏。左人迎脉主表，外感则人迎大于气
口；右气口脉主里，内伤则气口大于人迎。内伤证属不足，宜温、宜补、宜和；外感证属有
余，宜汗、宜吐、宜下。若内伤之证，误作外感，妄发其表，重虚元气，祸如反掌，故立补
中益气汤补之，又有内伤外感兼病者，若内伤重者，宜补养为先，外感重者，宜发散为急。
此汤惟上
黄 （蜜炙。钱半） 人参 甘草（炙。一钱） 白术（土炒） 陈皮（留白） 当归
（五分）
精神短少加人参、五味，肺热咳嗽去人参，咽干加葛根（风药多燥，葛根独能止渴者，以其
能生胃中清气，入肺而生水耳），头痛加蔓荆子，痛甚加川芎，脑痛加 本、细辛；风湿相
搏，一身尽痛，加羌活、防风；有痰加半夏、生姜；胃寒气滞加青皮、蔻仁、木香、益智；
腹胀加枳实、浓朴、木香、砂仁；腹痛加白芍、甘草；热痛加黄连，能食而心下痞加黄连；
咽痛加桔梗；有寒加肉桂；湿胜加苍术；阴火加黄柏、知母；阴虚去升、柴，加熟地、山茱、
山药。大便秘加酒煨大黄；咳嗽，春加旋复、款冬，夏加麦冬、五味，秋加麻黄、黄芩，冬
加不去根节麻黄，天寒加干姜；泄泻去当归，
此足太阴、阳明药也。肺者气之本，黄 补肺固表，为君；脾者肺之本（土能生金，脾
胃一虚，肺气先绝），人参、甘草补脾益气、和中泻火，为臣（东垣曰∶参 甘草，泻火之
圣药，盖烦劳则虚而生热，得甘温以补元气，而虚热自退，故亦谓之泻），白术燥湿强脾，
当时和血养阴，为佐（补阳必兼和阴，不然则己亢），升麻以升阳明清气（右升而复其本位），
柴胡以升少阳清气（左旋而上行），阳升则万物生，清升则阴浊降；加陈皮者，以通利其气
（陈皮同补药则补，独用则泻脾），生姜性温，大枣甘温，用以和营卫，开腠理，致津液。
诸虚不足，先建其中，中者何，脾胃是也（李东垣曰∶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 ，而人参甘草次之。脾胃一虚，肺气先绝，故用黄
以益皮毛而固腠理，不令自汗；上喘气短，故以人参补之；心火乘脾，用炙草甘温以泻火热
而补脾元，若脾胃急痛并大虚，腹中急缩，宜多用之，中满者减之；白术苦甘温，除胃中之
热，利腰脐间血；胃中清气在下，必加升麻、柴胡以升之，引参 甘草甘温之气味上升，以
补胃气之散，而实其表，又缓带脉之缩急；气乱于中，清浊相干，用去白陈皮以理之，又助
阳气上升以散滞气；脾胃气虚，为阴火伤其生发之气，营血大亏，血减则心无所养，致令心
满而烦，病名曰 ，故加甘辛微温之剂生阳气。仲景之法，血虚以人参补之，阳旺则能生阴
血，更以当归和之；少加黄柏以救肾水，泻阴中伏火；如烦犹不止，少加生地黄补肾水，水
旺则心火自降。李士材曰∶虚人感冒，不任发散者，此方可以代之。东垣曰∶肌热者，表热
也，服此汤一二服，得微汗则已，非正发汗，乃阴阳气和，自然汗出也。《准绳》曰∶凡四
时伤寒，通宜补散。故丹溪治伤寒，多用补中益气汤；气虚者四君子加发散药，血虚者四物
汤加发散药。东垣治风湿，用补中益气加羌活、防风、升麻、 本、苍术。海藏治风湿，无
汗者用神术汤，有汗者用白术汤；治刚痉神术汤加羌活、麻黄，治柔痉白术汤加 、术、桂
心；治中 ，脉弦细芤迟者，用黄 汤。此皆仲景所谓辛苦之人触冒之病，伤寒是也。《明
医杂着》云∶发热有数种，治各不同，仲景论伤寒伤风，此外感也，故宜发表以解散之，此
麻黄桂枝之义也。感于寒冷之月，实时发病，故用辛热以胜寒；如春温之月，则当变以辛凉
之药；夏暑之月，则当变以甘苦寒之剂。又有冬温，此天时不正，阳气反泄，用药不可温热；
又有寒疫，却在温热之时，此阴气反逆，用药不可寒凉；又有温疫，沿门阖境相似者，此天
地之厉气，当随时令参气运而治，宜辛凉甘苦寒之药以清热解毒。若夫饮食劳倦，为内伤元
气，则真阳下陷，内生虚热，故东垣发补中益气之论，用甘温之药，大补其气而提其下陷，
此用气药以补气之不足也；又有劳心好色，内伤真阴，阴血既伤，则阳气偏胜而变为火，是
谓阴虚火旺劳瘵之证，故丹溪发阳有余阴不足之论，用四物加黄柏、知母，补其阴而火自降，
此用血药以补血之不足者也。又有夏月伤暑之病，虽属外感，却类内伤，东垣所谓清暑益气
是也；又有因暑热而过食冷物以伤其内，或过取风凉以伤其外，此则非暑伤人，乃因暑而致
之病，治宜辛热解表，辛温理中之药，却以伤寒治法相类者也。外感之与内伤，寒病之与热
病，气虚之与血虚，如冰炭相反，治之若差，则轻病必重，重病必死矣。《医贯》曰∶读伤
寒书而不读东垣书，则内伤不明，而杀人多矣；读东垣书而不读丹溪书，则阴虚不明，而杀
人多矣。东垣《脾胃论》深明饥饱劳役发热等证，俱是内伤，悉类伤寒，切戒汗下，以为内
伤多而外感少，只须温补，不必发散；如外感多内伤少，温补中少加发散，以补中益气为主；
如内伤兼寒者，加麻黄；兼风者加桂枝；兼暑者，加黄连；兼湿者，加羌活；实万世无疆之
利，此东垣特发阳虚发热之一门也。然阴虚发热者，十之六七亦类伤寒，今人一见发热，则
曰伤寒，须用发散，发散而毙，则曰伤寒之法已穷。余尝于阴虚发热者，见其大热面赤，口
渴烦躁，与六味地黄丸一大剂即愈。如下部恶寒足冷，上部渴甚躁极，或饮而反吐，即加肉
桂、五味，甚则加附子冷冻饮料，以此活人多
本方除当归、白术，加木香、苍术，名调中益气汤（东垣）∶治脾胃不调，胸满肢倦，
食少短气，口不知味（心和则舌知味）；及食入反出。本方加白芍、五味子，亦名调中益气
汤（东垣）∶治气虚多汗，余治同前（补中汤纯用甘温，所谓劳者温之，损者温之；此加白
芍、五味之酸，以收耗散之气，有发有收，此东垣，别开一路，以广补中之妙者乎）。本方
加苍术倍分，半夏、黄芩各三分，名参术益胃汤（东垣）∶治内伤劳倦，燥热短气，口渴无
味，大便溏黄。本方去白术加草蔻、神曲、半夏、黄柏，名升阳顺气汤东垣∶治饮食劳倦所
伤，满闷短气，不思食，不知味，时恶寒（吴鹤皋曰∶升柴辛甘升其清，清升则阳气顺矣；
柏皮苦寒降其浊，浊降则阴气顺矣；参 甘草当归补其虚，虚补则正气顺矣，半夏陈皮利其
膈，膈利则痰气顺矣；豆蔻神曲消其食，食消则谷气顺矣。东垣曰∶升麻柴胡，味薄性阳，
引脾胃清气行于阳道，以滋春气之和，又引参 甘草上行，充实腠理，使卫外为固，凡补脾
胃之药，多以升阳补气名之者此也。又曰∶但言补之以辛甘温热之剂，及味之薄者，诸风药
是也，此助春夏之升浮者也，此便是泻，秋收冬藏之药也，在人之身乃肝心也；但言泻之以
酸苦寒凉之剂，并淡味渗泄之药，此助秋冬之沉降者也，在人之身，是肺肾也）。本方加炒
芩、神曲，名益胃升阳汤（东垣）∶治妇人经水不调；或脱血后食少水泻（东垣曰∶脱血益
气，古圣之法也。故先补胃气，以助生发之气）。本方加黄柏、生地，名补中益气加黄柏生
地汤∶治阴火乘阳发热昼甚，自汗短气，口渴无味。本方加白芍、细辛、川芎、蔓荆，名顺
气和中汤（《宝鉴》）∶治清阳不升，头痛恶风，脉弦微细。本方加羌活、防风、细辛、川芎，
名调荣养卫汤（节庵）∶治劳力伤寒，身痛，体热，恶寒，微渴，汗出，身痛，脉浮无力。
解百药毒；兼治筋疝。所谓筋疝，是指阴茎内部牵引性疼痛，肿胀挺举难以忍受，这通常是由于使用春方邪术所致，使用此方也是取其解毒的功效。
此方属于足阳明胃经的药物。甘草能调和脾胃以解毒，黑豆能散热以解毒。（苏颂说：古时候称大豆能解百药之毒，试验起来确实如此。）
《内经》说：各种气机郁滞的病证，都归属于肺。又说：怒则气机上逆，喜则气机缓散，悲则气机消沉，恐则气机下陷，寒则气机收敛，热则气机泄越，惊则气机紊乱，劳则气机耗损，思则气机结聚。九种气机变化不同，但百病皆由气产生。人体所依赖的，是气的出入升降运行。如果志意过度，就会损伤冲和之气。无病的时候，应该保养它、调和它、顺应它；发病的时候，应当审察属于哪一经、哪一种证候，根据寒热虚实进行补泻治疗。
治疗烦劳内伤，身体发热心烦，头痛恶寒，懒言恶食，脉象洪大而虚，或者气喘或者口渴，或者阳虚自汗（宜在本汤中加入麻黄根、浮小麦，升麻、柴胡都用蜜水炒过，想要它们引导人参到达体表，所以不可缺少），或者气虚不能摄血，或者疟疾痢疾因脾虚久治不愈，一切清阳下陷、中气不足的证候（中，指脾胃。脏腑肢体，都禀受脾胃之气。饥饱劳役损伤了脾胃，那么全身就无所禀受而生病。阳气下陷，阴火就会上乘，所以发热心烦，这不是实热；头为诸阳之会，清阳不升，浊气上逆，所以头痛，其痛或作或止，不像外感头痛那样持续不休；阳虚不能卫护体表，所以恶寒自汗；气虚所以懒言；脾虚所以恶食；脾胃虚弱则火气上干于肺所以气喘；肺金受火克伐，不能生水所以口渴；脾虚不能统摄血液，则血液妄行而吐血便血；清阳下陷，则成为泻痢；气血两虚，则疟疾不止，名为劳疟。劳，即老的意思。李东垣《内伤外感辨》说：饮食劳役七情六欲导致的是内伤，风寒暑湿导致的是外感。内伤发热，时热时止；外感发热，热势严重且持续不退；内伤恶寒，得暖便缓解；外感恶寒，即使穿厚衣烤烈火也不能消除；内伤恶风，不是怕风本身，而是怕缝隙中的穿堂风；外感恶风，见到风就害怕；内伤头痛，突然痛突然停；外感头痛，连续痛不停，直到表邪传入里才停止；内伤有湿，或者不口渴，或者心火乘肺，也出现燥渴；外感需要二三天后表热传里，口才开始发渴；内伤则是热伤气，四肢沉重困倦无力，倦怠嗜睡；外感则是风伤筋，寒伤骨，一身筋骨疼痛；内伤则是短气不足以呼吸；外感则是喘促气盛有余；内伤则是手心热；外感则是手背热。天气通于肺，鼻是肺的外候，外感伤寒则鼻塞，伤风则流鼻涕，然而能饮食，口知味道，腹部平和，二便正常。地气通于脾，口是脾的外候，内伤则懒言恶食，口不知味道，小便黄赤，大便或者秘结或者溏泄。左人迎脉主表，外感则人迎脉大于气口脉；右气口脉主里，内伤则气口脉大于人迎脉。内伤证属于不足，宜温、宜补、宜和；外感证属于有余，宜汗、宜吐、宜下。如果内伤的证候，误当作外感，妄用发汗解表，会再次亏损元气，祸患如反掌之间，所以设立补中益气汤来补益。又有内伤外感兼病的，如果内伤重者，宜先补养；外感重者，宜急发散。
黄芪（蜜炙。一钱半） 人参 甘草（炙。一钱） 白术（土炒） 陈皮（留白） 当归（五分）
精神短少加人参、五味子；肺热咳嗽去人参；咽干加葛根（风药大多燥烈，唯独葛根能止渴，因为它能生胃中清气，入肺而生津液）；头痛加蔓荆子，痛甚加川芎，脑痛加藁本、细辛；风湿相搏，一身尽痛，加羌活、防风；有痰加半夏、生姜；胃寒气滞加青皮、蔻仁、木香、益智仁；腹胀加枳实、浓朴、木香、砂仁；腹痛加白芍、甘草；热痛加黄连，能进食但心下痞满加黄连；咽痛加桔梗；有寒加肉桂；湿胜加苍术；阴火加黄柏、知母；阴虚去升麻、柴胡，加熟地黄、山茱萸、山药。大便秘结加酒煨大黄；咳嗽，春季加旋覆花、款冬花，夏季加麦冬、五味子，秋季加麻黄、黄芩，冬季加不去根节的麻黄，天寒加干姜；泄泻去当归。
此方属于足太阴脾经、足阳明胃经的药物。肺是气之本，黄芪补肺固表，作为君药；脾是肺之本（土能生金，脾胃一虚，肺气先绝），人参、甘草补脾益气、和中泻火，作为臣药（李东垣说：人参、甘草是泻火的圣药，因为烦劳则虚而生热，得到甘温药物补益元气，虚热自然消退，所以也称为泻），白术燥湿强脾，当时和血养阴，作为佐药（补阳必须兼和阴，否则就会亢盛）。升麻提升阳明清气（右升而复归本位），柴胡提升少阳清气（左旋而上行），阳升则万物生，清升则阴浊降；加入陈皮，是为了通利气机（陈皮同补药一起用则补，单独用则泻脾）。生姜性温，大枣甘温，用来调和营卫，开泄腠理，化生津液。
各种虚损不足，先建立中气，中气是什么？就是脾胃（李东垣说：脾胃虚者，因饮食劳倦，心火亢盛，从而乘袭脾土之位，其次肺气受邪，须用黄芪，人参甘草次之。脾胃一虚，肺气先绝，所以用黄芪益皮毛而固腠理，不让自汗；上喘气短，所以用人参补益；心火乘脾，用炙甘草甘温以泻火热而补脾元，如果脾胃急痛并大虚，腹中急缩，宜多用之，中满者减量；白术苦甘温，除胃中之热，利腰脐间血；胃中清气在下，必须加升麻、柴胡以提升，引导人参、甘草甘温的气味上升，以补胃气之散失，充实肌表，又缓和带脉的缩急；气乱于中，清浊相干，用去白陈皮以调理，又助阳气上升以散滞气；脾胃气虚，被阴火伤了生发之气，营血大亏，血减则心无所养，导致心满而烦，病名曰“悸”，所以加甘辛微温的药物生阳气。张仲景的方法，血虚用人参补益，阳旺则能生阴血，再加当归调和；少加黄柏以救肾水，泻阴中伏火；如果烦躁仍不止，少加生地黄补肾水，水旺则心火自降。李士材说：虚人感冒，不能耐受发散治疗的，此方可以替代。李东垣说：肌热，是表热，服用此汤一二服，得到微汗就好了，不是正发汗，而是阴阳气和，自然汗出。《准绳》说：凡四时伤寒，通宜补散并用。所以朱丹溪治伤寒，多用补中益气汤；气虚者四君子汤加发散药，血虚者四物汤加发散药。李东垣治风湿，用补中益气汤加羌活、防风、升麻、藁本、苍术。海藏治风湿，无汗者用神术汤，有汗者用白术汤；治刚痉神术汤加羌活、麻黄，治柔痉白术汤加附子、白术、桂心；治中喝，脉弦细芤迟者，用黄芪汤。这些都是张仲景所说的辛苦之人触冒邪气得的病，即伤寒。《明医杂着》说：发热有好几种，治法各不相同，张仲景论伤寒伤风，这是外感，所以宜发表解散，这是麻黄桂枝的意义。感于寒冷之月，即时发病，所以用辛热药以胜寒；如春温之月，则当变用辛凉药；夏暑之月，则当变用甘苦寒剂。又有冬温，这是天时不正，阳气反泄，用药不可温热；又有寒疫，却在温热之时，这是阴气反逆，用药不可寒凉；又有温疫，沿门阖境相似的，这是天地厉气，当随时令参气运而治，宜辛凉甘苦寒药以清热解毒。至于饮食劳倦，损伤元气，则真阳下陷，内生虚热，所以李东垣提出补中益气之说，用甘温药，大补其气而提其下陷，这是用气药以补气之不足；又有劳心好色，内伤真阴，阴血既伤，则阳气偏胜而变为火，这叫阴虚火旺劳瘵之证，所以朱丹溪提出阳有余阴不足之说，用四物汤加黄柏、知母，补其阴而火自降，这是用血药以补血之不足。又有夏月伤暑的病，虽属外感，却类内伤，李东垣所谓清暑益气是也；又有因暑热而过食冷物以伤其内，或过取风凉以伤其外，这并非暑伤人，乃因暑而致的病，治宜辛热解表，辛温理中之药，却与伤寒治法相似。外感与内伤，寒病与热病，气虚与血虚，如冰炭相反，治之若差，则轻病必重，重病必死。《医贯》说：读伤寒书而不读东垣书，则内伤不明，杀人多矣；读东垣书而不读丹溪书，则阴虚不明，杀人多矣。李东垣《脾胃论》深明饥饱劳役发热等证，俱是内伤，悉类伤寒，切戒汗下，认为内伤多而外感少，只须温补，不必发散；如外感多内伤少，温补中少加发散，以补中益气为主；如内伤兼寒者，加麻黄；兼风者加桂枝；兼暑者，加黄连；兼湿者，加羌活；实万世无疆之利，这是李东垣特别发挥阳虚发热的一门学说。然而阴虚发热者，十之六七也类似伤寒，今人一见发热，就说伤寒，须用发散，发散而死，就说伤寒之法已穷。我曾在阴虚发热者，见其大热面赤，口渴烦躁，给一大剂六味地黄丸即愈。如下部恶寒足冷，上部渴甚躁极，或饮而反吐，即加肉桂、五味子，甚则加附子冷冻饮料，以此活人多矣。
本方除当归、白术，加木香、苍术，名为调中益气汤（李东垣）：治疗脾胃不调，胸满肢倦，食少短气，口不知味道（心和则舌知味道）；以及食入反出。本方加白芍、五味子，亦名调中益气汤（李东垣）：治疗气虚多汗，其余治疗同前（补中益气汤纯用甘温，所谓劳者温之，损者温之；这里加白芍、五味子的酸味，以收敛耗散之气，有发有收，这是李东垣别开一路，以广补中之妙吗）。本方加苍术倍分，半夏、黄芩各三分，名为参术益胃汤（李东垣）：治疗内伤劳倦，燥热短气，口渴无味，大便溏黄。本方去白术加草蔻、神曲、半夏、黄柏，名为升阳顺气汤（李东垣）：治疗饮食劳倦所伤，满闷短气，不思食，不知味道，时恶寒（吴鹤皋说：升麻柴胡辛甘升其清，清升则阳气顺了；黄柏苦寒降其浊，浊降则阴气顺了；人参甘草当归补其虚，虚补则正气顺了，半夏陈皮利其膈，膈利则痰气顺了；豆蔻神曲消其食，食消则谷气顺了。李东垣说：升麻柴胡，味薄性阳，引脾胃清气行于阳道，以滋春气之和，又引人参甘草上行，充实腠理，使卫外为固，凡补脾胃的药，多以升阳补气命名的原因在此。又说：但言补之以辛甘温热之剂，及味之薄者，诸风药是也，此助春夏之升浮者也，此便是泻，秋收冬藏之药也，在人之身乃肝心也；但言泻之以酸苦寒凉之剂，并淡味渗泄之药，此助秋冬之沉降者也，在人之身，是肺肾也）。本方加炒黄芩、神曲，名为益胃升阳汤（李东垣）：治疗妇人经水不调；或脱血后食少水泻（李东垣说：脱血益气，是古圣之法。所以先补胃气，以助生发之气）。本方加黄柏、生地，名为补中益气加黄柏生地汤：治疗阴火乘阳发热昼甚，自汗短气，口渴无味。本方加白芍、细辛、川芎、蔓荆，名为顺气和中汤（《宝鉴》）：治疗清阳不升，头痛恶风，脉弦微细。本方加羌活、防风、细辛、川芎，名为调荣养卫汤（节庵）：治疗劳力伤寒，身痛，体热，恶寒，微渴，汗出，身痛，脉浮无力。
To resolve the toxicity of all medicines; also treats tendon hernia (Jin Shen). Tendon hernia refers to pulling pain in the penis, with unbearable swelling and protrusion. This is usually caused by the use of aphrodisiac sorcery. Using this formula also aims at its detoxifying effect.
Gancao (Licorice Root, 2 liang) Heidou (Black Soybean, half sheng)
This belongs to the Foot-Yangming Stomach Meridian. Gancao harmonizes the middle jiao to detoxify, and Heidou dissipates heat to detoxify. (Su Song said: Ancient texts state that soybeans can resolve the toxicity of all medicines; testing confirms this.)
Adding Dahuang (Rhubarb Root and Rhizome) to this formula creates Dahuang Gancao Tang (Rhubarb and Licorice Decoction): treating Xiao Ke (Wasting-Thirst) affecting the Upper, Middle, and Lower Jiao.
The *Neijing* states: All qi stagnation disorders belong to the Lung. It also says: Anger causes qi to rise, joy causes qi to scatter, grief causes qi to consume, fear causes qi to sink, cold causes qi to contract, heat causes qi to leak, shock causes qi to become chaotic, labor causes qi to be depleted, and overthinking causes qi to knot. The nine types of qi changes differ, yet all diseases arise from qi. The body relies on the ascending, descending, exiting, and entering movements of qi. If will/ambition (Zhi) is excessive, it damages the harmonious qi. When healthy, one should nourish, harmonize, and smooth it; when diseased, one must examine which meridian and syndrome are involved, and apply tonification or draining based on cold, heat, deficiency, and excess.
Treating internal injury from mental fatigue: fever, restlessness, headache, aversion to cold, reluctance to speak, aversion to food, pulse floating-large but empty, or panting/thirst, or yang deficiency with spontaneous sweating (add Mahuang Gen (Ephedra Root), Fuxiaomai (Triticum Fruit); Shengma and Chaihu should be stir-fried with honey water to guide Renshen to the exterior, so they cannot be omitted); or qi deficiency failing to control blood; or malaria/dysentery due to spleen deficiency persisting for a long time; all syndromes of sinking clear yang and insufficient middle qi. ("Middle" refers to the Spleen and Stomach. Zang-fu organs and limbs all derive qi from the Spleen and Stomach. Injury from hunger/fullness or labor damages the Spleen and Stomach, leaving the body without qi, leading to illness. Sinking of yang qi allows yin fire to ascend, causing fever and restlessness, which is not excess heat; the head is the meeting point of all yang meridians; if clear yang does not ascend, turbid qi rebels upward, causing headache. The pain comes and goes, unlike external contraction headaches which are continuous; yang deficiency fails to protect the exterior, causing aversion to cold and spontaneous sweating; qi deficiency causes reluctance to speak; spleen deficiency causes aversion to food; spleen/stomach deficiency allows fire to harass the Lung, causing panting; Metal (Lung) suppressed by Fire fails to generate Water (Kidney), causing thirst; spleen deficiency fails to control blood, leading to hematemesis/melena; sinking of clear yang leads to diarrhea/dysentery; qi and blood dual deficiency leads to persistent malaria, called Lao Nue (Chronic Malaria). "Lao" means old/exhaustion. Li Dongyuan's *Differentiation of Internal Injury and External Contraction*: Injury from diet, labor, seven emotions, and six desires is internal injury; injury from wind, cold, summer-heat, and dampness is external contraction. Internal injury fever comes and goes; external contraction fever is severe and continuous. Internal injury aversion to cold resolves with warmth; external contraction aversion to cold persists despite thick clothes and fire. Internal injury aversion to wind fears drafts; external contraction aversion to wind fears any wind. Internal injury headache is intermittent; external contraction headache is continuous until the pathogen enters the interior. Internal injury with dampness may have no thirst, or heart-fire harassing the lung causes dry thirst; external contraction requires 2-3 days for heat to enter the interior before thirst occurs. Internal injury damages qi, causing heavy/weak limbs, fatigue, and desire to sleep; external contraction damages sinews/bones with wind/cold, causing whole-body pain. Internal injury causes shortness of breath; external contraction causes panting with excess qi. Internal injury causes palm heat; external contraction causes back-of-hand heat. Heaven Qi connects to the Lung; the nose is the external opening of the Lung. External contraction cold causes nasal congestion; wind-cold causes runny nose, yet appetite remains, taste is normal, abdomen is peaceful, and excretion is normal. Earth Qi connects to the Spleen; the mouth is the external opening of the Spleen. Internal injury causes reluctance to speak, aversion to food, loss of taste, yellow urine, and constipation or loose stools. Left Renying pulse governs the exterior; in external contraction, Renying is larger than Qikou. Right Qikou pulse governs the interior; in internal injury, Qikou is larger than Renying. Internal injury syndromes are deficiency, suitable for warming, tonifying, and harmonizing; external contraction syndromes are excess, suitable for sweating, vomiting, and purging. Mistaking internal injury for external contraction and using sweating incorrectly severely depletes Yuan Qi, bringing disaster quickly. Thus, Buzhong Yiqi Tang was established to tonify. For combined internal injury and external contraction: if internal injury is heavier, tonification is priority; if external contraction is heavier, dispersing is urgent.
Huangqi (Astragalus Root, honey-fried, 1.5 qian) Renshen (Ginseng Root) Gancao (Licorice Root, fried, 1 qian) Baizhu (Atractylodes Macrocephala Rhizome, soil-fried) Chenpi (Citrus Reticulata Peel, keeping white pith) Danggui (Angelica Sinensis Root, 0.5 qian)
Add Renshen and Wuweizi (Schisandra Berry) for shortness of spirit; remove Renshen for Lung-heat cough; add Gegen (Pueraria Root) for dry throat (Wind-dispelling herbs are mostly drying; Gegen alone stops thirst because it generates clear qi in the Stomach and generates fluids in the Lung). Add Manjingzi (Vernonia Seed) for headache, Chuanxiong (Ligusticum Rhizome) for severe pain, Gaoben (Ligusticum Rhizome) and Xixin (Asarum Root) for brain pain. Add Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root) for wind-damp binding causing whole-body pain. Add Banxia (Pinellia Tuber) and Shengjiang (Fresh Ginger) for phlegm. Add Qingpi (Citrus Aurantium Green Peel), Kourén (Cardamom Seed), Muxiang (Aucklandia Root), and Yizhiren (Alpinia Oxyphylla Fruit) for stomach-cold and qi stagnation. Add Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Muxiang, and Sharen (Amomum Fruit) for abdominal distension. Add Shaoyao (Peony Root) and Gancao for abdominal pain. Add Huanglian (Coptis Rhizome) for heat-pain; add Huanglian if eating is possible but epigastric fullness exists. Add Jiegeng (Platycodon Root) for sore throat. Add Rougui (Cinnamon Bark) for cold. Add Cangzhu (Atractylodes Lancea Rhizome) for dampness. Add Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) for yin-fire. Remove Shengma and Chaihu and add Shudi (Rehmannia Root), Shanzhuyu (Cornus Fruit), and Shanyao (Dioscorea Rhizome) for yin deficiency. Add Jiuhuang Dahuang (Wine-baked Rhubarb) for dry stool. For cough: Spring adds Xuanjinfah (Inula Flower) and Kuandonghua (Fritillaria Thunbergii Bud); Summer adds Maidong (Ophiopogon Tuber) and Wuweizi; Autumn adds Mahuang (Ephedra Herb) and Huangqin (Scutellaria Root); Winter adds Mahuang without removing roots/joints; add Ganjiang (Dried Ginger) in cold weather. Remove Danggui for diarrhea.
This belongs to the Foot-Taiyin Spleen and Foot-Yangming Stomach meridians. The Lung is the root of qi; Huangqi tonifies the Lung and secures the exterior, serving as the Sovereign herb. The Spleen is the root of the Lung (Earth generates Metal; if Spleen/Stomach are deficient, Lung qi fails first). Renshen and Gancao tonify the Spleen, benefit qi, harmonize the middle, and drain fire, serving as Ministers. (Li Dongyuan said: Renshen and Gancao are holy medicines for draining fire. Fatigue causes deficiency-heat; sweet-warm herbs tonify Yuan Qi, resolving deficiency-heat, hence also called "draining".) Baizhu dries dampness and strengthens the Spleen, while harmonizing blood and nourishing yin, serving as Assistants. (Tonifying yang must harmonize yin, otherwise it becomes hyperactive.) Shengma ascends Yangming clear qi (ascending right to restore position); Chaihu (Bupleurum Root) ascends Shaoyang clear qi (rotating left to move upward). As yang ascends, all things are born; as clear qi ascends, yin turbidity descends. Chenpi is added to regulate qi (Chenpi tonifies when used with tonics, drains the Spleen when used alone). Shengjiang is warm; Dazao (Jujube Fruit) is sweet-warm; they harmonize Ying and Wei, open Couli (pores), and produce fluids.
For all deficiencies, first establish the Middle. What is the Middle? The Spleen and Stomach. (Li Dongyuan said: In spleen-stomach deficiency due to diet/labor, Heart-fire becomes hyperactive and attacks the Earth position, then Lung qi is affected. Huangqi is primary, followed by Renshen and Gancao. Spleen-stomach deficiency leads to early Lung qi failure. Huangqi benefits skin/hair and secures Couli to prevent sweating; Renshen treats panting/shortness of breath; fried Gancao uses sweet-warm nature to drain fire and tonify Spleen yuan. Use more for acute pain/severe deficiency with abdominal tightening; reduce for fullness. Baizhu is bitter-sweet-warm, clearing stomach heat and benefiting blood in the waist/navel area. If clear qi sinks below, add Shengma and Chaihu to ascend, guiding the sweet-warm aroma of Renshen/Gancao upward to replenish scattered Stomach qi, solidify the exterior, and relax the Dai Mai. If qi is chaotic in the middle with mixed clear/turbid, use Chenpi (without white pith) to regulate, assisting yang qi ascent to disperse stagnation. Spleen-stomach qi deficiency injured by yin-fire depletes generating qi and Ying blood; lack of blood leaves the Heart un-nourished, causing palpitations/restlessness, named "Ji" (Palpitation). Add sweet-acrid-mild-warm herbs to generate qi. Zhang Zhongjing's method: tonify blood deficiency with Renshen; strong yang generates yin-blood, harmonized with Danggui. Add small amounts of Huangbai to save Kidney water and drain latent yin-fire. If restlessness persists, add Shengdi (Rehmannia Root) to tonify Kidney water; abundant water lowers Heart-fire. Li Shicai said: For deficient patients with colds who cannot tolerate dispersing, this formula can substitute. Li Dongyuan said: Muscle fever is exterior heat. After 1-2 doses, slight sweating occurs naturally due to harmony of yin-yang qi, not forced sweating. *Zhunsheng* states: Four-season colds generally require tonification and dispersing together. Zhu Danxi treated colds mostly with Buzhong Yiqi Tang; qi deficiency uses Sijunzi Tang plus dispersing herbs; blood deficiency uses Siwu Tang plus dispersing herbs. Li Dongyuan treated wind-damp with Buzhong Yiqi Tang plus Qianghuo, Fangfeng, Shengma, Gaoben, Cangzhu. Haizang treated wind-damp: Wuhu Tang for no sweat, Baizhu Tang for sweat. For Gang Jing (Spastic Rigidity), Wuhu Tang plus Qianghuo/Mahuang; for Rou Jing (Flaccid Rigidity), Baizhu Tang plus Fuzi, Baizhu, Guixin. For Zhong Shu (Heat Stroke) with wiry-thin-empty-slow pulse, use Huangqi Tang. These are diseases from hardworking people exposed to pathogens, i.e., colds. *Mingyi Zazhuo* states: Fever has many types with different treatments. Zhang Zhongjing discusses cold/wind as external contraction, requiring release via Ma Huang Tang or Gui Zhi Tang. Cold month onset requires acrid-hot herbs to overcome cold; Spring Warmth requires acrid-cool herbs; Summer Heat requires sweet-bitter-cold agents. Winter Warmth is abnormal weather with leaking yang; avoid hot/warm herbs. Cold Epidemic in warm weather is reversed yin; avoid cold/cool herbs. Warm Epidemic spreading through communities is pestilential qi; treat according to season and luck cycles with acrid-cool/sweet-bitter-cold herbs to clear heat and detoxify. Diet/labor injures Yuan Qi, causing true yang to sink and internal deficiency-heat. Hence Li Dongyuan proposed Buzhong Yiqi theory, using sweet-warm herbs to greatly tonify qi and lift sinking qi (using qi herbs to tonify qi insufficiency). Mental labor/libido injures True Yin; damaged yin-blood leads to excess yang transforming into fire, called Yin Deficiency Fire Hyperactivity Consumption Syndrome. Hence Zhu Danxi proposed "Yang Excess, Yin Insufficiency," using Siwu Tang plus Huangbai/Zhimu to tonify yin and lower fire (using blood herbs to tonify blood insufficiency). Summer Heat Stroke is external but resembles internal injury (Li Dongyuan's Qing Shu Yi Qi). Eating cold foods during summer heat injures the interior; seeking coolness injures the exterior. This is not heat injuring people, but disease caused by heat; treat with acrid-hot exterior-releasing and acrid-warm middle-regulating herbs, similar to cold treatment methods. External vs. Internal, Cold vs. Heat, Qi vs. Blood deficiency are like ice and charcoal. Mistreatment turns mild disease severe and severe disease fatal. *Yi Guan* states: Reading Shanghan books without Dongyuan's books leaves internal injury unclear, killing many; reading Dongyuan without Danxi's books leaves yin deficiency unclear, killing many. Dongyuan's *Piwei Lun* clarifies that fever from hunger/labor is internal injury, resembling colds; strictly forbid sweating/purging. Internal injury is common, external rare; only need warm tonification, no dispersing. If external is common, internal rare, add slight dispersing to warm tonification, focusing on Buzhong Yiqi. If internal injury combines cold, add Mahuang; wind, Gui Zhi; summer-heat, Huanglian; damp, Qianghuo. This is a great benefit, specifically addressing Yang Deficiency Fever. However, 60-70% of Yin Deficiency Fever resembles colds. People see fever and say "cold," demanding dispersing; death follows, and they claim cold methods are exhausted. I have seen Yin Deficiency Fever with high fever/red face/thirst/restlessness cured by a large dose of Liuwei Dihuang Wan. For lower body cold/cold feet with upper body extreme thirst/restlessness or vomiting after drinking, add Rougui and Wuweizi; if severe, add Fuzi served cold. Many lives saved this way.
Removing Danggui and Baizhu, adding Muxiang and Cangzhu creates Tiaozhong Yiqi Tang (Li Dongyuan): Treating Spleen-Stomach disharmony, chest fullness, limb fatigue, poor appetite, shortness of breath, loss of taste (Heart harmony allows tongue to taste); and regurgitation. Adding Shaoyao and Wuweizi also creates Tiaozhong Yiqi Tang (Li Dongyuan): Treating qi deficiency with profuse sweating; other treatments same as above. (Buzhong Yiqi Tang uses purely sweet-warm herbs, following "labor requires warming, damage requires warming"; adding sour Shaoyao/Wuweizi gathers scattered qi, combining releasing and gathering. This is Dongyuan's unique approach to expand the wonder of tonifying the middle.) Adding double Cangzhu, Banxia, and Huangqin (each 3 fen) creates Canzhu Yiwei Tang (Li Dongyuan): Treating internal injury from labor, dry-heat, shortness of breath, thirst, loss of taste, loose yellow stool. Removing Baizhu, adding Cao Kou (Cardamom), Shenqu (Medicated Leaven), Banxia, and Huangbai creates Shengyang Shunqi Tang (Li Dongyuan): Treating injury from diet/labor, fullness, shortness of breath, anorexia, loss of taste, intermittent aversion to cold. (W Hegao said: Shengma/Chaihu acrid-sweet ascend clear qi, making yang qi smooth; Huangbai bitter-cold descends turbid qi, making yin qi smooth; Renshen/Gancao/Danggui tonify deficiency, making upright qi smooth; Banxia/Chenpi benefit the diaphragm, making phlegm-q qi smooth; Cardamom/Shenqu digest food, making grain qi smooth. Dongyuan said: Shengma/Chaihu are thin-flavored and yang-natured, guiding Spleen-Stomach clear qi into the Yang pathway to nourish Spring harmony, and guiding Renshen/Gancao upward to fill Couli and secure exterior defense. Hence tonifying Spleen-Stomach herbs are often named "Ascending Yang and Benefiting Qi." Also: Tonifying with acrid-sweet-warm/herbs of thin flavor (wind herbs) assists Spring-Summer ascending/floating—this is actually "draining." Autumn-Winter descending/storing herbs affect Liver/Heart in the body; acid-bitter-cold/drainage herbs assist Autumn-Winter descending/storing, affecting Lung/Kidneys.) Adding fried Huangqin and Shenqu creates Yiwei Shengyang Tang (Li Dongyuan): Treating irregular menstruation in women; or poor appetite/watery diarrhea after blood loss. (Dongyuan said: Tonifying qi after blood loss is ancient sage method. First tonify Stomach qi to aid generating qi.) Adding Huangbai and Shengdi creates Buzhong Yiqi Jia Huangbai Shengdi Tang: Treating yin-fire harassing yang causing daytime fever exacerbation, spontaneous sweating, shortness of breath, thirst, loss of taste. Adding Shaoyao, Xixin, Chuanxiong, and Manjing creates Shunqi Hezhong Tang (*Ba Jian*): Treating sinking clear yang, headache, aversion to wind, wiry-thin pulse. Adding Qianghuo, Fangfeng, Xixin, and Chuanxiong creates Tiaorong Yangwei Tang (Jie'an): Treating labor-induced cold, body pain, fever, aversion to cold, slight thirst, sweating, body pain, floating-weak pulse.