东垣曰。右手气口脉。大于人迎一倍。过在少阴则二倍。太阴则三倍。右手三部属三阴
少阴在关者属脾。太阴在寸主肺肌肤大热。故脾肺二脏之脉皆紧盛。
右寸气口脉。急大而数。时一代而涩。（涩者肺之本脉。代者元气不相接续。此饮食失
节劳役过甚大虚之脉也。）
右关脾脉大而数。（谓独大于五脉也） 数中显缓。时一代也。（此不甚劳役之脉也）
右关胃脉损弱。甚则隐而不见。但内显脾脉之大数。微缓时一代。（此饮食不节寒温失
所之脉也）
右关脉沉而滑。（此宿食不消之脉也）
人迎脉大于气口为外伤。气口脉大于人迎为内伤。外伤则寒热齐作而无间。内伤则寒热
间作
而不齐。外伤恶寒。虽近烈火不除。内伤恶寒。得就温暖即解。外伤恶寒。乃不禁一切风寒
内伤恶风。惟恐些小贼风。外伤症显在鼻。故鼻气不利而拥盛有力。内伤者不然。内伤症
显在口。故口不知味而腹中不和。外伤者无此。外伤则邪气有余。发言壮厉。且先轻而后
重。内伤则元气不足。出言懒怯。且先重而后轻。外伤手背热而手心不热。内伤则手心热
而手背不热。外伤头痛常常有之。直须传里方罢。内伤头痛有时而作。有时而止。若显内症
多者。则是内伤重而外感轻。宜以补养为先。
若显外症多者。则是外感重而内伤轻。宜以发散为急。
一论饮食劳倦伤脾。则不能生血。故血虚则发热。热则气散血耗而无力。或时易饥。或
时饱
闷。不思饮食。变病百端。如遇外感重者。则先理外感六分。而治内伤四分。见效即住。如
外感轻则内伤药用六分矣。能治万病。其效如神。
东垣曰。夫饮食不节则胃病。胃病则气短。精神减少。气不足以息。言语怯弱。腹中不
和。
口不知谷味。或胃当心而痛。或上肢两胁痛甚。则气高而喘。身热而烦。胃既病则脾无所禀
受。故亦从而病焉。若形体劳役而脾病。脾病则怠惰嗜卧。四肢不收。或食少。小便黄赤。
大便或闭或泄。或虚坐。只见些白浓。或泄黄糜。无气以动。而懒倦嗜卧。脾既病则胃不能
独行津液。故亦从而病焉。若外感风寒。俱无此症。故易分别耳。
虚实之症。不可不知。因往往以内伤不足之病。误作伤寒外感有余之症。汗之吐之。差
之毫厘。谬之千里。实实虚虚。医杀之耳。
夫伤寒为六淫之病。风寒始于表。而渐传于里。则初病头项强痛。发热恶寒。身疼。当
汗之。及其邪入于里。热盛内实。谵语狂妄。当下之。不愈即发斑黄厥逆。变生诸症矣。
夫内伤因七情郁结。饮食劳役。为不足之病。始生于里。而发于表也。其病倦怠。四肢
不收
头疼时作时止。其热始发于心膈间。次发于肢体。稍遇风寒。时时畏惧。气短喘促。懒于
言语。脉必微细。或弦而数。或虚而大。只此分别。则内外易见矣。
一论中气不足。或误用克伐。四肢倦怠。口干发热。饮食无味。或饮食失节。劳倦身热
脉
洪大无力。或头痛恶寒自汗。或气高而喘。身热而烦。脉微细软弱。自汗身倦目合。或中气
虚弱。而不能摄血。或饮食劳倦。而患疟痢等症。因脾胃虚而不能愈者。或元气虚弱。感
冒
风寒而不胜发表。用此代之。或入房而后劳役感冒。或劳役感冒而后入房者。急加附子。
愚谓
人之一身。以脾胃为主。脾胃气实。则肺得其所养。肺气既盛。水气生焉。水升则火降。水
火既济。而全天地交泰之令矣。脾胃既虚。四脏俱无生气。故东垣先生着脾胃内外伤等论。
谆谆然皆以固脾胃为本。所制补中益气。又冠诸方之首。观其立方本旨可知矣。故曰补肾不
若补脾。正此谓也。前所治症。概举其略。余当仿此而类推之。是方之妙。并注以表明之
补中益气汤
黄 （蜜炒一钱五分） 人参（一钱） 白术（去芦炒一钱五分） 当归（酒洗一钱五分） 陈
皮（七分） 柴胡（六分） 升麻（八分） 甘草（炙五分）
上锉一剂。姜、枣煎服。如感风寒。头痛发热。加川芎、防风、白芷各一钱。羌活七分
汗多。加黄 五分。如汗多。去升麻、柴胡。加炒酸枣仁一钱。夜间不睡亦加之。如虚火
炎上。加玄参一钱。如阴虚生火。加酒炒黄柏、知母各七分。夏月亦可常用。如阴虚痰
多。加贝母一钱。如泄泻。去当归。加白茯苓一钱。泽泻一钱。白芍煨一钱。如气虚甚
者。必少加大附子制过。以行参 之力也。手足冷。或腹痛。亦如之。如心刺痛者。乃血
涩不足。加当归五分。白豆蔻七分研。如用心太过。神思不宁。怔忡惊悸。加参、苓、酸
枣仁炒、柏子仁各一钱。远志、石菖蒲各七分。如咽干及渴者。加干葛七分。天花粉一钱
如饮食少。或伤饮食。加神曲、麦芽、山楂各一钱。如精神短少者。倍加人参。夏。
加五味子十粒。麦门冬去心一钱。如梦遗。加牡蛎、龙骨 各一钱。如头痛。加蔓荆子
七分。痛甚。加川芎七分。如头顶痛者。加 本一钱。细辛三分。如腰痛。加牛膝、杜
仲、姜炒各一钱。如脚弱。加木瓜一钱。汉防己五分。如有痰加半夏姜制七分。贝母一
钱。如咳嗽。夏加片芩、知母、麦门冬各一钱。如久嗽。肺中有伏火者。减人参。加片
芩、紫菀各一钱。如食不下。胸中有寒。或塞滞。加青皮五分。木香三分。如脚软乏力
或痛。加酒炒黄柏一钱。牛膝、五加皮各一钱。如五心烦躁。加生地黄。若气浮心乱。以
朱砂安神丸镇固之则愈。（方见怔忡）
一论中气虚而胃弱。不爱食。及食不生肉。不长力。或常微热怯冷。神疲倦怠。或带痰
嗽。
加味六君子汤
人参（一钱） 白术（去芦一钱五分） 陈皮（八分） 白茯苓（去皮一钱） 半夏（姜制八分）
干葛（七分） 山楂肉（一钱） 甘草（炙五分） 砂仁（五分）
上锉一剂。姜煎服。
一论此方。药性中和。专理心脾。气弱神昏。体倦多困少力。饮食不进。中满痞噎。心
忪上喘。呕吐泻痢等症。久服养气育神。醒脾益胃。扶正辟邪。
参苓白术散
人参（一钱） 白术（去芦一钱） 白茯苓（去皮七分） 白扁豆（炒一钱） 山药（一钱）
莲肉（去心皮七粒） 桔梗（去芦七分） 薏苡仁（一钱） 砂仁（五个） 甘草（炙四分）
上锉一剂。姜、枣煎服。
一论凡遇劳行辛苦。用力过多。即服此二三剂。免生内伤发热之病。
补气汤
嫩黄 （蜜水炒一钱半） 人参 白术（去芦炒） 陈皮 麦门冬（去心各二钱） 五味子（
十粒） 甘草（炙七分）
上锉一剂。生姜三片。枣二枚。水煎服。劳倦甚者。加附子五分。
一论凡遇劳心思虑。损伤精神。头目昏眩。心虚气短。惊悸烦热等症。
补血汤
当归（酒洗） 白芍（酒炒） 白茯苓（去皮木） 酸枣仁（炒） 麦门冬（去心各一钱） 人
参（一钱二分） 川芎（六分） 怀熟地黄（二钱） 陈皮 栀子（炒各五分） 五味子（十五
粒） 甘草（炙五分）
上锉一剂。水煎。温服。
一论脾胃虚弱。元气不足。四肢沉重。食后昏沉。怠于动作。嗜卧无力。
补胃汤
黄 （蜜炒二钱） 人参（五分） 甘草（炙二钱） 当归（五分） 神曲（炒七分） 柴胡（三
分） 升麻（二分） 苍术（米泔浸一钱） 青皮（去穣五分） 黄柏（酒炒三分）
上锉一剂。水煎。食后服。
一论病后元气虚弱。脾胃亏损。此药补气和血。健脾理胃。进美饮食。壮健身体。充实
四肢。清火化痰。解郁顺气。
参苓白术丸
人参（一两） 白术（去芦土炒一两半） 白茯苓（去皮一两） 怀山药（炒一两） 白扁豆（
姜汁炒一两） 桔梗（去芦一两） 薏苡仁（炒一两） 莲肉（去心皮二两） 陈皮（一两）
半夏（汤泡姜汁炒一两） 砂仁（五钱） 黄连（姜汁炒一两） 神曲（炒一两） 香附（童便
炒一两） 白芍（酒炒一两） 当归（酒炒二两） 甘草（炙五钱）
上为末。姜、枣煎服。打神曲糊为丸如梧子大。每服百丸。食后。米汤下。加远志去心
一两亦妙。
一论此方养元气。健脾胃。生肌肉。润肌肤。益血秘精。安神定志。壮筋力。养精神。
进饮食之上品也。又治虚劳瘦怯。泄泻腹胀。肿满喘嗽等症。
阳春白雪糕
白茯苓（去皮） 怀山药 芡实仁 莲肉（去心皮各四两共为细末） 陈仓米（半升） 糯米
（半升） 白砂糖（一斤半）
上先将药米二味。用麻布袋盛放甑内。蒸极熟取出。放簸箕内。却入白砂糖同搅极匀。
揉作一块。用小木印印作饼子。晒干收贮。男妇小儿任意取食。妙不可言。
一秀才劳役失宜。饮食失节。肢体倦怠。发热作渴。头痛恶寒。误用人参败毒散。痰喘
昏愦
扬手掷足。胸膈发斑。如蚊所咬。余用补中益气汤。加姜、桂、麦门、五味补之而愈。
一男子发热烦渴。时或头痛。因服发散药。反加喘急腹痛。其汁如水。昼夜谵语。余意
此
劳伤元气。误汗所致。其腹必喜手按。询之果然。遂与十全大补汤。加附子一钱。服之熟睡
唤而不醒。举家惊惶。及觉。诸病顿退。再剂而痊。凡人饮食劳役。起居失宜。见一切火
症。悉属内真寒而外假热。故肚腹喜暖。口畏冷物。此乃形气病气。俱属不足。法当纯补元
气为善。
一人因劳役失于调养。忽然昏愦。此元气虚火妄动夹痰而作。急令灌童便。神思渐爽。
更用
参、 各五钱。芎、归各三钱。玄参、柴胡、山栀、炙草各一钱。服之稍定。察其形倦甚。
又以十全大补汤。加五味、麦门治之而安。凡人元气素弱。或因起居失宜。或因饮食劳倦。
或
因用心太过。致遗精白浊。自汗盗汗。或面热晡热潮热发热。或口干作渴。喉痛舌裂。或胸
乳膨胀。胁肋作痛。或头颈时痛。眩晕
目花。或心神不宁。寤而不寐。或小便赤涩。茎中作痛。或便溺余滴。脐腹阴冷。或形容不
充。肢体畏寒。或鼻气急促。或更有一切热症。皆是无根虚火。但服前汤。固其根本。诸症
自息。若攻其风热。则误矣。一人面如血红发热。终日不食。沉困。相火冲上。予以补中益
气汤煎半碗。童便半碗。合而服之。日进五服而愈。
一论大凡大病后。谷消水去。精散卫亡。多致便利枯竭。实当补中益气为主。盖为中州
浇灌
四旁。与胃行其津液者也。况大肠主津。小肠主液。亦皆禀受于胃。胃气一充。津液自行矣
燥甚者。则当以辛润之。以苦泄之。
李东垣说：右手气口脉（手腕桡动脉寸关尺中的“关”和“尺”部，主要反映脏腑内部状况），比人迎脉（手腕桡动脉的“寸”部，主要反映体表经络状况）大一倍。如果病在少阴经（心、肾经），则大两倍；病在太阴经（脾、肺经），则大三倍。右手的三部脉归属于三阴经。其中，位于关部的少阴脉属于脾脏；位于寸部的太阴脉主司肺脏及肌肤。如果肌肤大热，那么脾脏和肺脏的脉象都会呈现紧盛之象。
右寸气口脉，脉象急大而数（快），偶尔出现代脉（脉搏节律不齐，有间歇）且涩（往来艰涩不畅）。（涩脉是肺脏的本脉；代脉表示元气不能相互接续，这是饮食不节制、劳役过度导致的大虚之脉。）
右关脾脉，脉象大而数。（意思是单独比其他五部脉都大）在数的脉象中显现出缓（慢）意，偶尔出现代脉。（这是劳役不太严重的脉象。）
右关胃脉，脉象损弱，严重时隐伏不见，只在内部显现出脾脉的大而数，兼见微缓并偶尔出现代脉。（这是饮食不节制、寒温失调导致的脉象。）
右关脉沉而滑。（这是宿食不消化导致的脉象。）
人迎脉大于气口脉，属于外伤（外感邪气）。气口脉大于人迎脉，属于内伤（内在损伤）。外伤表现为恶寒和发热同时发作，没有间隔。内伤则恶寒和发热交替发作，且不相齐整。外伤恶寒，即使靠近烈火也不能消除；内伤恶寒，得到温暖即可缓解。外伤恶寒，是不禁受一切风寒侵袭；内伤恶风，只怕微小的贼风（轻微的风邪）。外伤的症状表现在鼻部，所以鼻气不利且壅盛有力；内伤则不是这样。内伤的症状表现在口部，所以口不知味且腹中不和；外伤者没有这种情况。外伤则是邪气有余，说话声音壮厉，且病情先轻后重；内伤则是元气不足，说话懒怯，且病情先重后轻。外伤手背热而手心不热；内伤则手心热而手背不热。外伤头痛经常存在，直到病邪传入里层才停止；内伤头痛有时发作，有时停止。如果内症表现多的，则是内伤重而外感轻，应当以补养为先。如果外症表现多的，则是外感重而内伤轻，应当以发散（解表）为急。
有一论断认为：饮食和劳倦损伤脾脏，则不能生血，所以血虚则发热。热则气散血耗而无力，有时容易饥饿，有时饱闷，不想吃东西，变生各种疾病。如果遇到外感重的情况，则先治疗外感占六分，治疗内伤占四分，见效就停止。如果外感轻，则内伤用药占六分。能治万病，效果如神。
李东垣说：饮食不节制则胃病，胃病则气短，精神减少，气息不足以喘息，言语怯弱，腹中不和，口不知谷物的味道，或者胃当心部位疼痛，或者上肢两胁疼痛严重，则气逆而喘，身体发热而烦躁。胃既已病，脾脏无所禀受（依赖），所以也跟着生病。如果形体劳役导致脾病，脾病则怠惰嗜睡，四肢不收摄，或者食量减少，小便黄赤，大便或闭结或泄泻，或者虚坐努责（想拉拉不出，只见到少量白脓），或者泄下黄糜样便，无气以动，懒倦嗜卧。脾既已病，胃不能独自运行津液，所以也跟着生病。如果外感风寒，都没有这些症状，所以容易区分。
虚实病症，不可不知道。因为往往把内伤不足的病，误作伤寒外感有余的症，用发汗、催吐的方法治疗，差之毫厘，谬以千里。实证用泻法使实更实，虚证用补法使虚更虚，这是医生杀人啊。
伤寒是六淫（风、寒、暑、湿、燥、火）引起的病，风寒始于体表，逐渐传于里层，所以初病时头项强痛，发热恶寒，身疼，应当发汗。等到邪气入里，热盛内实，谵语狂妄，应当攻下。如果不愈，就会发斑、发黄、厥逆，变生各种病症。
内伤因七情郁结、饮食劳倦引起，属于不足的病，开始生于里层，而发于体表。其病表现为倦怠，四肢不收摄，头疼时作时止，其热开始发于心膈间，其次发于肢体，稍遇风寒，时时畏惧，气短喘促，懒于言语，脉象必微细，或弦而数，或虚而大。只凭这些区别，内外就容易分辨了。
有一论断认为：中气不足，或者误用克伐药物，导致四肢倦怠，口干发热，饮食无味，或者饮食失节、劳倦导致身热、脉洪大无力，或者头痛恶寒自汗，或者气高而喘，身热而烦，脉微细软弱，自汗身倦目合，或者中气虚弱而不能摄血，或者饮食劳倦而患疟痢等症，因脾胃虚而不能痊愈的，或者元气虚弱，感冒风寒而不能胜任发表药物的，用此方代替。或者房事后又劳役感冒，或者劳役感冒后又行房事的，急加附子。我认为人的身体，以脾胃为主，脾胃气实，则肺得到滋养，肺气既盛，水气产生。水升则火降，水火既济，就具备了天地交泰的功能。脾胃既虚，四脏都没有生气，所以李东垣先生著述脾胃内外伤等论，谆谆教导都以固护脾胃为本。他所制的补中益气汤，又列于诸方之首，看他的立方本旨就可以知道了。所以说补肾不如补脾，正是这个意思。前面所治疗的病症，概举其略，其余应当仿照此类推。此方的妙处，并加注以表明。
补中益气汤
黄芪（蜜炒一钱五分）、人参（一钱）、白术（去芦头炒一钱五分）、当归（酒洗一钱五分）、陈皮（七分）、柴胡（六分）、升麻（八分）、甘草（炙五分）。
以上锉成一剂，加生姜、大枣煎服。如果感受风寒，头痛发热，加川芎、防风、白芷各一钱，羌活七分。如果汗多，加黄芪五分。如果汗多，去掉升麻、柴胡，加炒酸枣仁一钱，夜间睡不着也加上。如果虚火炎上，加玄参一钱。如果阴虚生火，加酒炒黄柏、知母各七分，夏季也可常用。如果阴虚痰多，加贝母一钱。如果泄泻，去掉当归，加白茯苓一钱，泽泻一钱，煨白芍一钱。如果气虚很甚，必须少加制过的附子，以通行人参、黄芪的力量。手足冷，或者腹痛，也像这样处理。如果心刺痛，那是血涩不足，加当归五分，白豆蔻七分研末。如果用脑太过，神思不宁，怔忡惊悸，加人参、茯苓、炒酸枣仁、柏子仁各一钱，远志、石菖蒲各七分。如果咽干及口渴，加干葛七分，天花粉一钱。如果饮食少，或者伤食，加神曲、麦芽、山楂各一钱。如果精神短少，加倍加人参，夏季加五味子十粒，麦门冬去心一钱。如果梦遗，加牡蛎、龙骨各一钱。如果头痛，加蔓荆子七分，痛甚加川芎七分。如果头顶痛，加藁本一钱，细辛三分。如果腰痛，加牛膝、杜仲（姜炒）各一钱。如果脚弱，加木瓜一钱，汉防己五分。如果有痰，加姜制半夏七分，贝母一钱。如果咳嗽，夏季加片芩、知母、麦门冬各一钱。如果久咳，肺中有伏火者，减人参，加片芩、紫菀各一钱。如果食不下，胸中有寒，或者塞滞，加青皮五分，木香三分。如果脚软乏力或者痛，加酒炒黄柏一钱，牛膝、五加皮各一钱。如果五心烦躁，加生地黄。如果气浮心乱，用朱砂安神丸镇固它就好了。（方剂见怔忡条下）
有一论断认为：中气虚而胃弱，不爱吃饭，以及吃了不长肉、不长力气，或者常微热怯冷，神疲倦怠，或者带痰咳嗽。
加味六君子汤
人参（一钱）、白术（去芦头一钱五分）、陈皮（八分）、白茯苓（去皮一钱）、半夏（姜制八分）、干葛（七分）、山楂肉（一钱）、甘草（炙五分）、砂仁（五分）。
以上锉成一剂，加生姜煎服。
有一论断认为：此方药性中和，专门调理心脾。气弱神昏，体倦多困少力，饮食不进，中满痞噎，心慌上喘，呕吐泻痢等症。久服养气育神，醒脾益胃，扶正辟邪。
参苓白术散
人参（一钱）、白术（去芦头一钱）、白茯苓（去皮七分）、白扁豆（炒一钱）、山药（一钱）、莲肉（去心皮七粒）、桔梗（去芦七分）、薏苡仁（一钱）、砂仁（五个）、甘草（炙四分）。
以上锉成一剂，加生姜、大枣煎服。
有一论断认为：凡是遇到劳累行走辛苦，用力过多，就服用此方二三剂，避免生内伤发热的病。
补气汤
嫩黄芪（蜜水炒一钱半）、人参、白术（去芦头炒）、陈皮、麦门冬（去心各二钱）、五味子（十粒）、甘草（炙七分）。
以上锉成一剂，加生姜三片，大枣二枚，水煎服。劳倦甚重的，加附子五分。
有一论断认为：凡是遇到劳心思虑，损伤精神，头目昏眩，心虚气短，惊悸烦热等症。
补血汤
当归（酒洗）、白芍（酒炒）、白茯苓（去皮木）、酸枣仁（炒）、麦门冬（去心各一钱）、人参（一钱二分）、川芎（六分）、怀熟地黄（二钱）、陈皮、栀子（炒各五分）、五味子（十五粒）、甘草（炙五分）。
以上锉成一剂，水煎，温服。
有一论断认为：脾胃虚弱，元气不足，四肢沉重，食后昏沉，怠于动作，嗜卧无力。
补胃汤
黄芪（蜜炒二钱）、人参（五分）、甘草（炙二钱）、当归（五分）、神曲（炒七分）、柴胡（三分）、升麻（二分）、苍术（米泔水浸一钱）、青皮（去瓤五分）、黄柏（酒炒三分）。
以上锉成一剂，水煎，饭后服。
有一论断认为：病后元气虚弱，脾胃亏损，此药补气和血，健脾理胃，增进美味饮食，壮健身体，充实四肢，清火化痰，解郁顺气。
参苓白术丸
人参（一两）、白术（去芦土炒一两半）、白茯苓（去皮一两）、怀山药（炒一两）、白扁豆（姜汁炒一两）、桔梗（去芦一两）、薏苡仁（炒一两）、莲肉（去心皮二两）、陈皮（一两）、半夏（汤泡姜汁炒一两）、砂仁（五钱）、黄连（姜汁炒一两）、神曲（炒一两）、香附（童便炒一两）、白芍（酒炒一两）、当归（酒炒二两）、甘草（炙五钱）。
以上研为末，加生姜、大枣煎汤送服，或用打碎的神曲糊做成梧桐子大的丸药，每次服用一百丸，饭后，米汤送下。加去心的远志一两也很好。
有一论断认为：此方养元气，健脾胃，生肌肉，润肌肤，益血秘精，安神定志，壮筋力，养精神，是增进饮食的上品。又治疗虚劳瘦怯，泄泻腹胀，肿满喘嗽等症。
阳春白雪糕
白茯苓（去皮）、怀山药、芡实仁、莲肉（去心皮各四两共为细末）、陈仓米（半升）、糯米（半升）、白砂糖（一斤半）。
以上先将药米两味，用麻布袋盛放蒸笼内，蒸极熟取出，放在簸箕内，再加入白砂糖同搅极匀，揉作一块，用小木印印作饼子，晒干收贮。男女小儿任意取食，妙不可言。
一位秀才因劳役失宜，饮食失节，肢体倦怠，发热作渴，头痛恶寒，误用人参败毒散，导致痰喘昏愦，扬手掷足，胸膈发斑，如蚊所咬。我用补中益气汤，加生姜、肉桂、麦门冬、五味子补益而痊愈。
一名男子发热烦渴，时而头痛，因服用发散药，反而加重喘急腹痛，出汗如水，昼夜谵语。我心想这是劳伤元气，误用发汗所致，他的腹部一定喜欢用手按压，询问果然如此。于是给予十全大补汤，加附子一钱，服用后熟睡，叫不醒，全家惊慌。等他醒来，诸病顿退，再服两剂而痊愈。凡人的饮食劳役，起居失宜，见到一切火症，都属于内真寒而外假热。所以肚腹喜暖，口畏冷物。这是形气病气，都属于不足，治法应当纯补元气为好。
一人因劳役失于调养，忽然昏愦，这是元气虚火妄动夹痰而作。急忙让人灌服童便，神思渐爽。再用参、芪各五钱，川芎、当归各三钱，玄参、柴胡、山栀、炙草各一钱，服用后稍定。观察他形倦甚，又以十全大补汤，加五味子、麦门冬治疗而安。凡人元气素弱，或因起居失宜，或因饮食劳倦，或因用心太过，导致遗精白浊，自汗盗汗，或者面热晡时潮热发热，或者口干作渴，喉痛舌裂，或者胸乳膨胀，胁肋作痛，或者头颈时痛，眩晕目花，或者心神不宁，寤而不寐，或者小便赤涩，茎中作痛，或者便溺余滴，脐腹阴冷，或者形容不充，肢体畏寒，或者鼻气急促，或者更有一切热症，都是无根虚火。只要服用前面的汤剂，固其根本，诸症自然平息。如果攻其风热，那就错了。一人面如血红发热，终日不食，沉困，相火冲上，我给他补中益气汤煎半碗，童便半碗，合而服之，每天进服五次而痊愈。
有一论断认为：大凡大病后，谷消水去，精散卫亡，多致便利枯竭，实在应当以补中益气为主。因为它是为中州（脾胃）浇灌四旁，与胃行其津液的。况且大肠主津，小肠主液，也都禀受于胃。胃气一充，津液自行矣。干燥严重的，则应当以辛润之，以苦泄之。
Li Dongyuan said: The Qi Kou pulse (the radial artery at the Guan and Chi positions, primarily reflecting internal organ status) on the right hand is one times larger than the Ying Shou pulse (the radial artery at the Cun position, primarily reflecting exterior meridian status). If the disease is in the Shaoyin channel (Heart and Kidney channels), it is two times larger; if in the Taiyin channel (Spleen and Lung channels), it is three times larger. The three positions of the right hand belong to the Three Yin channels. Among them, the Shaoyin pulse at the Guan position belongs to the Spleen; the Taiyin pulse at the Cun position governs the Lung and skin. If there is significant heat in the skin, the pulses of both the Spleen and Lung will appear tight and vigorous.
The Qi Kou pulse at the right Cun position is urgent, large, and rapid (fast), occasionally showing a Dai pulse (irregular rhythm with pauses) and a Se pulse (rough and difficult to flow smoothly). (The Se pulse is the native pulse of the Lung; the Dai pulse indicates that Yuan Qi cannot connect continuously; this is a pulse of severe deficiency caused by irregular diet and excessive labor.)
The Spleen pulse at the right Guan position is large and rapid. (Meaning it is distinctly larger than the other five positions.) Within the rapid quality, a slow (sluggish) aspect appears, occasionally accompanied by a Dai pulse. (This is a pulse indicating mild labor.)
The Stomach pulse at the right Guan position is damaged and weak; in severe cases, it is hidden and invisible, only revealing internally the large and rapid quality of the Spleen pulse, with a slight sluggishness and occasional Dai pulse. (This is a pulse caused by irregular diet and improper regulation of cold and warmth.)
The right Guan pulse is deep and slippery. (This is a pulse caused by retained food not digesting.)
When the Ying Shou pulse is larger than the Qi Kou pulse, it is considered an external injury (exogenous pathogenic factors). When the Qi Kou pulse is larger than the Ying Shou pulse, it is considered an internal injury (internal damage). External injury presents with simultaneous aversion to cold and fever without interval. Internal injury presents with alternating aversion to cold and fever, which are irregular. External injury aversion to cold persists even near intense fire; internal injury aversion to cold resolves with warmth. External injury aversion to cold implies intolerance to all wind-cold; internal injury aversion to wind implies fear only of slight thief-wind (minor wind pathogens). External injury symptoms manifest in the nose, causing nasal obstruction and forceful breathing; internal injury does not present this way. Internal injury symptoms manifest in the mouth, causing loss of taste and abdominal disharmony; external injury does not have this. External injury involves excess pathogenic qi, resulting in loud speech, with severity increasing from light to heavy; internal injury involves deficiency of Yuan Qi, resulting in timid speech, with severity decreasing from heavy to light. External injury causes heat in the back of the hand but not the palm; internal injury causes heat in the palm but not the back of the hand. External injury headache is constant until the pathogen transmits to the interior; internal injury headache comes and goes. If internal symptoms predominate, internal injury is severe and external contraction is mild; tonification should be prioritized. If external symptoms predominate, external contraction is severe and internal injury is mild; dispersing (releasing the exterior) should be urgent.
One theory states: Diet and fatigue damage the Spleen, preventing blood generation, leading to blood deficiency and subsequent fever. Heat scatters Qi and consumes Blood, causing weakness. There may be intermittent hunger or fullness, lack of appetite, and various complications. If external contraction is severe, treat 60% for external contraction and 40% for internal injury; stop when effective. If external contraction is mild, use 60% medication for internal injury. This can treat myriad diseases with miraculous effect.
Li Dongyuan said: Irregular diet damages the Stomach, leading to shortness of breath, reduced spirit, insufficient respiration, timid speech, abdominal disharmony, loss of taste for grains, pain in the epigastrium, or severe pain in the upper limbs and hypochondrium, leading to rebellious Qi and wheezing, body heat, and irritability. Once the Stomach is diseased, the Spleen has nothing to receive, so it also becomes diseased. Physical labor damages the Spleen, leading to lethargy, desire to lie down, inability to control the four limbs, reduced food intake, yellow-red urine, constipation or diarrhea, tenesmus with only small amounts of white pus, or yellow mushy stools. There is no energy to move, leading to laziness and desire to lie down. Once the Spleen is diseased, the Stomach cannot independently transport fluids, so it also becomes diseased. Exogenous wind-cold does not present these symptoms, making differentiation easy.
Differentiation between deficiency and excess syndromes must not be ignored. Often, internal injury deficiency syndromes are mistaken for exogenous excess syndromes, and sweating or purging methods are used erroneously. A slight error leads to great deviation. Treating excess as excess and deficiency as deficiency kills the patient.
Shanghan (Cold Damage) is a disease caused by the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire). Wind-cold begins at the exterior and gradually transmits inward. Initially, there is stiffness and pain in the head and neck, fever, aversion to cold, and body ache; sweating is indicated. When the pathogen enters the interior, with intense heat and interior excess, delirium and madness occur; purging is indicated. If unresolved, macules may appear, jaundice may develop, or reversal cold may occur, generating various complications.
Internal injury is caused by emotional stagnation, irregular diet, and labor, constituting a deficiency syndrome. It originates in the interior and manifests at the exterior. Symptoms include fatigue, inability to control the four limbs, intermittent headache, heat starting in the chest and diaphragm then spreading to the limbs, fear upon slight exposure to wind-cold, shortness of breath and wheezing, reluctance to speak, and a pulse that is necessarily fine and weak, or wiry and rapid, or empty and large. With these distinctions, internal and external conditions are easily differentiated.
One theory states: Middle Qi deficiency, or misuse of draining drugs, leads to limb fatigue, dry mouth, fever, loss of appetite, or body heat and large but powerless pulse due to irregular diet and fatigue. There may be headache, aversion to cold, spontaneous sweating, high-pitched breathing, body heat, and irritability, with a fine, weak, soft pulse, spontaneous sweating, fatigue, and closed eyes. Or Middle Qi deficiency fails to control blood. Or malaria and dysentery arise from diet and fatigue due to Spleen-Stomach deficiency. Or Yuan Qi is weak, unable to tolerate exterior-releasing drugs after wind-cold invasion. Use this formula instead. Or after intercourse followed by labor and cold invasion, or vice versa, add Aconite urgently. I believe the human body relies primarily on the Spleen and Stomach. When Spleen-Stomach Qi is solid, the Lungs are nourished. When Lung Qi is strong, Water Qi generates. Water rises and Fire descends; when Water and Fire interact, the function of Heaven and Earth's interaction is achieved. When Spleen-Stomach is deficient, the Four Zang organs lack vital energy. Thus, Mr. Li Dongyuan wrote treatises on Spleen-Stomach internal and external injuries, emphasizing the consolidation of Spleen-Stomach as the root. His Buzhong Yiqi Tang is listed first among formulas; its original intent is clear. Hence, "tonifying the Spleen is better than tonifying the Kidney." The previously treated symptoms are briefly summarized; others should be inferred analogously. The efficacy of this formula is noted below.
Buzhong Yiqi Tang (Tonify the Middle and Replenish Qi Decoction)
Huangqi (Astragali Radix, honey-fried, 1.5 qian), Renshen (Ginseng Radix, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, de-rhizome, fried, 1.5 qian), Danggui (Angelicae Sinensis Radix, wine-washed, 1.5 qian), Chenpi (Citri Reticulatae Pericarpium, 0.7 qian), Chaihu (Bupleuri Radix, 0.6 qian), Shengma (Cimicifugae Rhizoma, 0.8 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 0.5 qian).
Decoct one dose with Ginger and Jujube. If affected by wind-cold with headache and fever, add Chuanxiong (Ligustici Chuanxiong Rhizoma), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix) each 1 qian, Qianghuo (Notopterygii Rhizoma et Radix) 0.7 qian. If sweating is profuse, add Huangqi 0.5 qian. If sweating is profuse, remove Shengma and Chaihu, add Fried Suanzaoren (Ziziphi Spinosae Semen) 1 qian; also add if insomnia occurs at night. If deficient fire flares upward, add Xuanshen (Scrophulariae Radix) 1 qian. If Yin deficiency generates fire, add Jiuhuangbai (Phellodendri Cortex, wine-fried) and Zhimu (Anemarrhenae Rhizoma) each 0.7 qian; commonly used in summer. If Yin deficiency with much phlegm, add Beimu (Fritillariae Thunbergii Bulbus) 1 qian. If diarrhea, remove Danggui, add Baifuling (Poria, 1 qian), Zexie (Alismatis Rhizoma, 1 qian), Wei Baishao (Prepared White Peony Root, 1 qian). If Qi deficiency is severe, add a small amount of processed Fuzi (Aconiti Lateralis Radix Praeparata) to facilitate the action of Renshen and Huangqi. For cold hands and feet or abdominal pain, proceed similarly. For stabbing heart pain due to blood stasis and insufficiency, add Danggui 0.5 qian, Bai Doukou (Amomi Fructus Rotundus, ground) 0.7 qian. For excessive mental exertion causing restless spirit, palpitations, and fright, add Renshen, Fuling (Poria), Fried Suanzaoren, and Baiziren (Biota Seed) each 1 qian, Yuanzhi (Polygalae Radix), and Shichangpu (Acori Tatarinowii Rhizoma) each 0.7 qian. For dry throat and thirst, add Gange (Puerariae Radix) 0.7 qian, Tianhuafen (Trichosanthis Radix) 1 qian. For poor appetite or food stagnation, add Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), and Shanzha (Crataegi Fructus) each 1 qian. For low spirit, double the Renshen; in summer, add Wweizi (Schisandrae Fructus) 10 grains and Maidong (Ophiopogonis Radix, de-heart) 1 qian. For nocturnal emission, add Muli (Concha Ostreae) and Longgu (Fossilia Ossis Mastodi et Humeri) each 1 qian. For headache, add Manjingzi (Viticis Semen) 0.7 qian; if severe, add Chuanxiong 0.7 qian. For vertex headache, add Gaoben (Ligustici Wallichii Rhizoma et Radix) 1 qian, Xixin (Asari Radix et Rhizoma) 0.3 qian. For lower back pain, add Niuxi (Achyranthis Bidentatae Radix) and Duzhong (Eucommiae Cortex, ginger-fried) each 1 qian. For weak legs, add Mugua (Chaenomelis Fructus) 1 qian, Hanfangji (Stephaniae Tetrandrae Radix) 0.5 qian. For phlegm, add Jiangbanxia (Pinelliae Rhizoma Preparatum, ginger-processed) 0.7 qian, Beimu 1 qian. For cough, in summer add Pianqin (Scutellariae Radix), Zhimu, and Maidong each 1 qian. For chronic cough with latent fire in the Lungs, reduce Renshen, add Pianqin and Ziwan (Asternis Radix) each 1 qian. For difficulty eating, cold in the chest, or blockage, add Qingpi (Citri Reticulatae Pericarpium Viride) 0.5 qian, Muxiang (Aucklandiae Radix) 0.3 qian. For weak, painful, or sore legs, add Jiuhuangbai 1 qian, Niuxi, and Wujiaopi (Acanthopanacis Cortex) each 1 qian. For vexation in the five hearts, add Shengdihuang (Rehmanniae Radix). For floating Qi and chaotic mind, use Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) to settle and secure it. (Formula see under Palpitations section)
One theory states: Middle Qi deficiency and weak Stomach lead to anorexia, failure to gain flesh or strength after eating, or persistent mild fever and aversion to cold, spiritual fatigue, or productive cough.
Jiawei Liujunzi Tang (Modified Six Gentlemen Decoction)
Renshen (1 qian), Baizhu (de-rhizome, 1.5 qian), Chenpi (0.8 qian), Baifuling (de-peel, 1 qian), Banxia (Pinelliae Rhizoma, ginger-processed, 0.8 qian), Gange (0.7 qian), Shan Zhangrou (Crataegi Fructus flesh, 1 qian), Gancao (honey-fried, 0.5 qian), Sharen (Amomi Fructus, 0.5 qian).
Decoct one dose with Ginger.
One theory states: This formula has neutral properties, specifically regulating the Heart and Spleen. For symptoms of weak Qi and confused spirit, physical fatigue and weakness, poor appetite, epigastric fullness and obstruction, palpitations with wheezing, vomiting, and diarrhea. Long-term use nourishes Qi and spirit, awakens Spleen and benefits Stomach, supports righteousness and expels evil.
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder)
Renshen (1 qian), Baizhu (de-rhizome, 1 qian), Baifuling (de-peel, 0.7 qian), Baibian dou (White Hyacinth Bean, fried, 1 qian), Shanyao (Dioscoreae Rhizoma, 1 qian), Lianrou (Lotus Seed Flesh, de-heart and peel, 7 grains), Jiegeng (Platycodonis Radix, de-rhizome, 0.7 qian), Yiyiren (Coicis Semen, 1 qian), Sharen (5 grains), Gancao (honey-fried, 0.4 qian).
Decoct one dose with Ginger and Jujube.
One theory states: Whenever encountering strenuous walking or excessive effort, take two or three doses of this to prevent internal injury fever.
Buqi Tang (Tonify Qi Decoction)
Nen Huangqi (Young Astragali Radix, honey-water fried, 1.5 qian), Renshen, Baizhu (de-rhizome, fried), Chenpi, Maidong (de-heart, each 2 qian), Wweizi (10 grains), Gancao (honey-fried, 0.7 qian).
Decoct one dose with 3 slices of Ginger and 2 Jujubes. If fatigue is severe, add Fuzi 0.5 qian.
One theory states: Whenever mental labor injures spirit, causing dizziness, Heart Qi deficiency and shortness of breath, palpitations, and irritability.
Buxue Tang (Tonify Blood Decoction)
Danggui (wine-washed), Baishao (White Peony Root, wine-fried), Baifuling (de-peel and wood), Suanzaoren (fried), Maidong (de-heart, each 1 qian), Renshen (1.2 qian), Chuanxiong (0.6 qian), Huai Shudihuang (Prepared Rehmanniae Radix, 2 qian), Chenpi, Zhizi (Gardeniae Fructus, fried, each 0.5 qian), Wweizi (15 grains), Gancao (honey-fried, 0.5 qian).
Decoct one dose with water, take warm.
One theory states: Spleen-Stomach weakness and insufficient Yuan Qi cause heavy limbs, postprandial drowsiness, reluctance to move, and lethargy.
Bugeng Tang (Tonify Stomach Decoction)
Huangqi (honey-fried, 2 qian), Renshen (0.5 qian), Gancao (honey-fried, 2 qian), Danggui (0.5 qian), Shenqu (fried, 0.7 qian), Chaihu (0.3 qian), Shengma (0.2 qian), Cangzhu (Atractylodis Rhizoma, soaked in rice water, 1 qian), Qingpi (de-albedo, 0.5 qian), Huangbai (Phellodendri Cortex, wine-fried, 0.3 qian).
Decoct one dose with water, take after meals.
One theory states: Post-illness Yuan Qi weakness and Spleen-Stomach depletion. This medicine tonifies Qi and harmonizes Blood, strengthens Spleen and regulates Stomach, improves appetite, strengthens the body, fills the limbs, clears fire and transforms phlegm, resolves depression and regulates Qi.
Shenling Baizhu Wan (Ginseng, Poria, and Atractylodes Macrocephala Pill)
Renshen (1 liang), Baizhu (de-rhizome, earth-fried, 1.5 liang), Baifuling (de-peel, 1 liang), Huai Shanyao (Dioscoreae Rhizoma, fried, 1 liang), Baibian dou (White Hyacinth Bean, ginger juice-fried, 1 liang), Jiegeng (de-rhizome, 1 liang), Yiyiren (Coicis Semen, fried, 1 liang), Lianrou (Lotus Seed Flesh, de-heart and peel, 2 liang), Chenpi (1 liang), Banxia (Pinelliae Rhizoma, boiled and ginger-juice fried, 1 liang), Sharen (5 qian), Huanglian (Coptidis Rhizoma, ginger juice-fried, 1 liang), Shenqu (Massa Medicata Fermentata, fried, 1 liang), Xiangfu (Cyperi Rhizoma, child's urine-fried, 1 liang), Baishao (White Peony Root, wine-fried, 1 liang), Danggui (Angelicae Sinensis Radix, wine-fried, 2 liang), Gancao (honey-fried, 5 qian).
Grind into powder. Decoct with Ginger and Jujube for delivery, or make pills using fermented dough like mulberry seeds. Take 100 pills after meals with rice soup. Adding Yuanzhi (de-heart, 1 liang) is also excellent.
One theory states: This formula nourishes Yuan Qi, strengthens Spleen and Stomach, generates muscle, moistens skin, benefits Blood and secures Essence, calms the spirit and stabilizes will, strengthens sinews and bones, nourishes spirit, and promotes appetite. It is a superior remedy for digestion. It also treats consumptive emaciation, diarrhea, abdominal distension, edema, fullness, wheezing, and cough.
Yangchun Baixue Gao (Spring Snow Cake)
Baifuling (de-peel), Huai Shanyao, Qianshi (Euryales Semen), Lianrou (Lotus Seed Flesh, de-heart and peel, each 4 liang, ground finely), Chen Cangmi (Stored Rice, half sheng), Nuomi (Glutinous Rice, half sheng), Baishatang (White Sugar, 1.5 jin).
First, place the medicinal herbs and rice in a hemp bag inside a steamer, steam thoroughly until very cooked, remove, place in a winnowing basket, mix thoroughly with white sugar, knead into a block, stamp into cakes with a small wooden mold, dry, and store. Men, women, and children may eat as desired; the effect is wonderful.
A scholar suffered from improper labor and irregular diet, leading to limb fatigue, fever with thirst, headache, and aversion to cold. He mistakenly used Renshen Baidu San (Ginseng and Detoxification Powder), resulting in phlegm-wheezing, confusion, thrashing, macules on the chest and diaphragm resembling mosquito bites. I used Buzhong Yiqi Tang, adding Ginger, Rougui (Cinnamon Bark), Maidong, and Wweizi to tonify, and he recovered.
A man had fever, irritability, and thirst, with intermittent headache. After taking exterior-releasing drugs, his wheezing and abdominal pain worsened, sweating like water, and delirium day and night. I reasoned this was Yuan Qi injury from labor, exacerbated by erroneous sweating. His abdomen likely preferred pressure; inquiry confirmed this. I prescribed Shiquan Dabu Tang (Ten Great Tonics Decoction) with 1 qian of Fuzi. He fell into a deep sleep, unrousable, alarming his family. Upon waking, symptoms vanished. Two more doses led to recovery. For anyone with irregular diet and labor, or lifestyle imbalance, presenting with any fire symptoms, these are essentially true cold within and false heat without. Thus, the abdomen prefers warmth, and the mouth fears cold substances. Both form and Qi are deficient; the method should be purely tonifying Yuan Qi.
A person suffered sudden confusion due to neglecting rest after labor. This was Yuan Qi deficiency with wild defusing fire and phlegm. Urgently administered child's urine, restoring clarity. Then used Renshen and Huangqi each 5 qian, Chuanxiong and Danggui each 3 qian, Xuanshen, Chaihu, Zhizi, and Zhi Gancao each 1 qian. Symptoms stabilized. Observing extreme fatigue, I treated him with Shiquan Dabu Tang plus Wweizi and Maidong, achieving peace. Anyone with inherently weak Yuan Qi, due to lifestyle imbalance, diet/labor, or excessive mental work, may experience seminal emission, turbid urine, spontaneous or night sweats, facial heat, afternoon tidal fever, dry mouth/thirst, sore throat/tongue fissures, chest/breast swelling, hypochondriac pain, head/neck pain, dizziness/blurred vision, restless spirit/insomnia, red/astringent urination/stinging pain, dribbling urine, cold umbilicus/abdomen/genitals, emaciation, cold limbs, rapid nasal breathing, or any heat symptoms. These are all rootless deficient fire. Taking the aforementioned decoctions to secure the root will naturally subside all symptoms. Attacking wind-heat would be an error. A person with a blood-red face, fever, anorexia, and heaviness, with ministerial fire rushing upward, was treated with half a bowl of Buzhong Yiqi Tang decoction mixed with half a bowl of child's urine, taken five times daily, resulting in recovery.
One theory states: Generally, after severe illness, grain is consumed, water is lost, essence scatters, and defensive Qi perishes, often leading to dryness and constipation. One must primarily use Buzhong Yiqi Tang. It irrigates the four directions from the Central State (Spleen/Stomach) and transports fluids for the Stomach. Moreover, the Large Intestine governs Jin (fluids), and the Small Intestine governs Ye (thick fluids); both receive from the Stomach. When Stomach Qi is充盈 (full), fluids generate spontaneously. For severe dryness, use pungent moistening and bitter draining.