凡泄泻病误服参、 等甘温之药，则病不能愈，
而或变为黄胆。盖泄属湿，甘温之药能生湿热，故反助病邪，久则湿热甚而为疸矣。惟用苦寒
泻湿热、苦温除湿寒则愈。泄止后脾胃虚弱，方可用参、 等药以补之。
愚尝治少宰李蒲汀，庚寅冬，湿热泄泻，因未生子，惑于人言淡渗之剂能泻肾，而服参、 等药，后
变黄胆，小便不利，腹胀，胸痞。余曰∶有是病必用是药，须以淡渗疏导其湿热。遂用茵陈五
苓散，诸症顿退。至辛卯冬生子。
南方人称发热为劳发，盖谓劳苦而发热，即东垣内伤之旨也。此病轻者一、二发自愈，重者用东垣法
补之，甚则加熟附子。若因劳力辛苦而发热，切不可误作外感轻易发汗也。
愚按内伤发热者，因饮食过时，劳役过度，而损耗元气，阴火得以乘其土位，故翕翕然而发热，宜用
补中益气汤以升其阳；若因劳力辛苦，入房不节，亏损精血，虚火妄动而发热者，宜用六味地黄丸以补其
阴。不可认作有余之火，而用黄柏、知母之类也。
东垣论饮食劳倦为内伤不足之证，治用补中益气汤。《溯洄集》中又论不足之中，又当分别饮食伤为
有余，劳倦伤为不足，予谓伤饮食而留积不化，以致宿食郁热，热发于外，此为有余之症，法当消导，东
垣自有枳术丸等治法具于饮食门矣。其补中益气方论，却谓人因伤饥失饱，致损脾胃，非有积滞者也，
故只宜用补药。盖脾胃全赖饮食之养，今因饥饱不时，失其所养，则脾胃虚矣。又脾主四肢，若劳力辛苦伤其
四肢，则根本竭矣。或专因饮食不调，或专因劳力过度，或饮食不调之后加之劳力，或劳力过度之后继以
不调，故皆谓之内伤元气不足之症，而宜用补药也。但须于此四者之间，审察明白，为略加减，则无不效矣。
愚按饮食劳倦颇同而理异也。王安道先生曰∶劳倦伤、饮食伤二者，虽俱为内伤，不可混而为一。夫饮
食受伤而留滞不化，则有余矣，有余者泻之；伤饥失饱致损脾胃，非有积滞，则不足矣，不足者补之。如
东垣枳术丸之类，虽曰消导，固有补益于其间，然亦施于不甚伤者耳，原非以为通行之药也。盖停滞之物，
非枳术丸之力所能去者。若泥于消导而弗知变，则不善用前人之意矣。
凡是泄泻病，如果误服人参、白术等甘温性质的药物，疾病就不能痊愈，甚至可能转变为黄疸。因为泄泻属于湿邪为患，甘温的药物能够滋生湿热，所以反而助长了病邪，时间久了湿热严重就会形成黄疸。只有使用苦寒的药物来清泻湿热、使用苦温的药物来祛除寒湿，才能治愈。泄泻停止后，脾胃虚弱时，才可以用人参、白术等药物来补益。
我曾经治疗少宰李蒲汀，庚寅年冬天，他患有湿热泄泻，因为没有生育子女，听信他人说淡渗利湿的药剂会泻伤肾气，于是服用了人参、白术等药物，后来变成了黄疸，小便不通畅，腹部胀满，胸膈痞闷。我说：有什么样的病就必须用什么样的药，必须用淡渗利湿的方法来疏导体内的湿热。于是使用了茵陈五苓散，各种症状立刻消退。到了辛卯年冬天，他生下了儿子。
南方人把发热称为“劳发”，大概是指因劳累辛苦而发热，这就是李东垣关于内伤的理论宗旨。这种病轻的一两次发作后会自愈，重的采用李东垣的方法进行补益，严重的加上熟附子。如果是因体力劳动辛苦而发热，切不可误认为是外感轻易使用发汗法。
我按语：内伤发热，是因为饮食不按时，过度劳累，导致元气损耗，阴火得以乘虚占据土位（脾胃），所以身体感到烘热般发热，适宜使用补中益气汤来提升阳气；如果是因体力劳动辛苦，房事不节制，亏损精血，虚火妄动而发热，适宜使用六味地黄丸来滋补阴液。不可将其认作有余之火，而使用黄柏、知母之类的药物。
李东垣论述饮食劳倦是内伤不足的证候，治疗使用补中益气汤。《溯洄集》中又论述在不足之中，应当分别饮食损伤为有余，劳倦损伤为不足，我认为饮食损伤导致食物停滞不化，致使宿食郁结产生热，热发散于外部，这是有余的证候，治法应当消食导滞，李东垣自有枳术丸等治疗方法记载在饮食门类中了。他的补中益气方论，却说人因为饥饿或过饱损伤脾胃，并没有积滞，所以只适宜使用补药。因为脾胃完全依赖饮食的滋养，现在因为饥饱不规律，失去了滋养，所以脾胃虚弱了。另外脾主四肢，如果因体力劳动辛苦损伤了四肢，那么根本就枯竭了。或者是专门因饮食不调，或者是专门因劳力过度，或者是饮食不调之后加上劳力，或者是劳力过度之后继以饮食不调，所以都称之为内伤元气不足的病症，适宜使用补药。但是必须在这四种情况之间，仔细审查明白，稍微加减用药，就没有不有效的了。
我按语：饮食和劳倦虽然相似但道理不同。王安道先生说：劳倦损伤、饮食损伤两者，虽然都属于内伤，不可混淆为一。饮食受伤导致停滞不化，就是有余，有余的应当泻下；因饥饿或过饱导致脾胃受损，没有积滞，就是不足，不足的应当补益。像李东垣的枳术丸之类，虽然说能消食导滞，其中固有补益的作用，但也只适用于损伤不太严重的情况，原本就不是作为通用的药物。因为停滞的食物，不是枳术丸的力量所能去除的。如果拘泥于消导而不知道变通，就是不善于运用前人的意图了。
In cases of diarrhea (Xie Xie), if sweet and warm herbs such as Renshen (Ginseng Radix) and Baizhu (Atractylodis Rhizoma) are mistakenly administered, the disease will not resolve, and may transform into jaundice (Huang Dan). This is because diarrhea is attributed to dampness (Shi); sweet and warm herbs can generate damp-heat (Shi Re), thereby inadvertently assisting the pathogenic factor. Over time, severe damp-heat leads to jaundice. Cure is achieved only by using bitter-cold herbs to drain damp-heat and bitter-warm herbs to dispel cold-dampness. After the diarrhea ceases, when the Spleen and Stomach are weak, Renshen and Baizhu may then be used for tonification.
I once treated Li Puting, a Vice Minister (Shaozai), in the winter of the Gengyin year. He suffered from damp-heat diarrhea. Because he had no children, he was misled by rumors that diuretic/drainage agents (Dan Shen Zhi Ji) damage the Kidney, so he took Renshen and Baizhu. Subsequently, he developed jaundice, difficulty in urination, abdominal distension, and chest oppression. I stated: "For this specific pathology, specific medication is required; one must use drainage and dispersion methods to guide out the damp-heat." Consequently, Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction) was prescribed, and all symptoms subsided immediately. In the winter of the Xinmao year, he fathered a son.
In southern regions, fever is termed "Lao Fa" (Labor-induced Fever), referring to fever arising from laborious exertion, which aligns with Li Dongyuan’s principles regarding internal injury (Nei Shang). Mild cases resolve spontaneously after one or two episodes. Severe cases require treatment according to Li Dongyuan’s method of tonification; in severe instances, Shu Fuzi (Prepared Aconite Lateral Root) is added. If fever results from physical labor and hardship, it must never be mistaken for an external contraction (Wai Gan) treated lightly with sweating methods.
My commentary: Internal injury fever arises from irregular eating habits and excessive physical/mental labor, which deplete Yuan Qi (Primal Qi). Consequently, Yin Fire (Yin Huo) usurps the position of Earth (Spleen/Stomach), causing a sensation of radiant heat (Xi Xi Ran). This is suitable for treatment with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Yang Qi. If fever results from physical exhaustion and immoderate sexual activity, leading to depletion of Essence and Blood, with deficient fire moving recklessly, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) should be used to nourish Yin. One must not mistake this for excess fire and administer herbs like Huangbai (Phellodendron Bark) or Zhimu (Anemarrhenae Rhizoma).
Li Dongyuan discusses diet and fatigue as syndromes of internal injury and deficiency, treating them with Buzhong Yiqi Tang. In *Suhui Ji*, it is further argued that within deficiency, one must distinguish dietary injury as "excess" and fatigue injury as "deficiency." I posit that dietary injury causing food stagnation and failure to digest leads to retained food generating郁热 (stagnant heat), which manifests externally; this is an excess syndrome, requiring digestion and guidance methods. Li Dongyuan already provides methods such as Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) in the dietary section. His discussion on Buzhong Yiqi Tang states that people injure their Spleen and Stomach due to hunger or overeating, without actual stagnation, thus requiring only tonification. The Spleen and Stomach rely entirely on dietary nourishment; irregular eating habits deprive them of nourishment, causing weakness. Furthermore, the Spleen governs the four limbs; physical labor injuring the limbs exhausts the root. Whether due solely to improper diet, solely to excessive labor, improper diet followed by labor, or excessive labor followed by improper diet, all are considered internal injuries resulting in Yuan Qi deficiency, suitable for tonification. However, careful differentiation among these four scenarios is necessary, with slight modifications to prescriptions, ensuring efficacy.
My commentary: Diet and fatigue are similar in appearance but differ in principle. Mr. Wang Andao stated: Although fatigue injury and dietary injury both belong to internal injury, they must not be conflated. Dietary injury causing stagnation and indigestion constitutes excess; excess requires purgation/draining. Injury from hunger or irregular meals damaging the Spleen and Stomach without stagnation constitutes deficiency; deficiency requires tonification. Formulas like Li Dongyuan’s Zhizhu Wan, while described as promoting digestion, inherently contain tonifying properties, yet are applied only to mild injuries, not as universal remedies. Stagnated material cannot be removed by the power of Zhizhu Wan alone. Adhering rigidly to digestive methods without flexibility demonstrates a failure to properly utilize the intentions of predecessors.