如心火乘脾。乃血受火邪。而不能升发。阳气伏于地中。地者人之脾也。必用当归
和血。少用黄柏以益真阴。
如脾胃不足之证。须少用升麻。盖升麻乃足阳明太阴引经之药也。使行阳道。自
脾胃中左迁。少阳行春令。生万物之根蒂也。更少加柴胡。使诸经右迁。生发阴阳之气。以滋春之和气也。
如脾虚缘心火亢盛。而乘其土也。其次肺气受邪。为热所伤。必用黄 最多。甘草
次之。人参又次之。三者皆甘温阳药也。盖脾虚肺气先绝。故用黄 之甘温。以益
皮毛之气。而闭腠理。不令自汗而损元气也。上喘气短懒言语。须用人参以补之。
心火乘脾。须用炙甘草以泻火热。而补脾胃中元气。然甘草最少者。恐滋满也。若
脾胃之急痛。并脾胃大虚。腹中急缩。腹皮急缩者。却宜多用。经曰急者缓之之义
也。若从权治。必加升麻以引之。恐左迁之邪坚盛。卒不肯退。反致项上及臀尻肉
添而行阴道。故引之以行阳道。使清气出地。右迁而上行。以和阴阳之气也。若中
满者去甘草。咳甚者去人参。口干嗌干者加干葛。
如脾胃既虚。不能升浮。为阴火伤其生发之气。荣血大亏。荣气伏于地中。阴火炽
盛。日渐煎熬。血气亏少。且心胞络与心主血。血减则心无所养。致使心乱而烦。病
名曰 。 者心惑而烦闷不安也。是由清气不升。浊气不降。清浊相干。乱于胸中。
使周身血气逆行而乱。经曰。从下上者。引而去之。故当加辛温甘温之剂生阳。阳
生而阴长也。或曰。甘温何能生血。又非血药也。曰。仲景之法。血虚以人参补之。阳
旺则能生阴血也。更加当归和血。又宜稍加黄柏。以救肾水。盖甘寒泻热火。火减
则心气得平而安也。如烦乱犹不能止。少加黄连以去之。盖将补肾水。使肾水旺
而心火自降。扶持地中阳气也。
如气浮心乱。则以朱砂安神丸镇固之。得烦减。勿再服。以防泻阳气之反陷也。如
心中痞。亦少加黄连。气乱于胸。为清浊相干。故以陈皮理之。能助阳气之升而分
滞气。又助诸甘辛为用。故长夏湿土。客邪火旺。可从权加苍术、白术、泽泻。上下散
消其湿热之气。湿气大盛。主食不消化。故食减不知谷味。加炒曲以消之。更加五
味子、麦门冬、人参。泻火益肺气。助秋损也。此三伏中长夏正旺之时之药也。
按东垣意见精密。立方中和。清暑益气汤。近世多宗之。然气血虚弱之人。用之最
宜。如遇强壮者。不能取效。且助湿火。不可不斟酌也。
如果心火侵犯脾土，这是血液受到火热邪气的侵害，导致阳气无法升发。阳气潜伏在体内（地者指人的脾脏）。此时必须使用当归来调和血液，少量使用黄柏以滋养真阴。
如果是脾胃不足的证候，需要少量使用升麻。因为升麻是足阳明胃经和足太阴脾经的引经药，能使阳气运行于阳分，从脾胃中向左上升（左迁）。少阳经主行春令，能生养万物的根基。再稍微加入柴胡，使各条经络之气向右下降（右迁），生发阴阳之气，以滋长春季的和缓之气。
如果是因脾虚导致心火亢盛而乘袭脾土，其次是肺气受邪，被热邪所伤。此时必须最多用量黄芪，甘草次之，人参再次之。这三味药都是甘温性质的补阳药。因为脾虚会导致肺气先衰绝，所以用黄芪的甘温之性，来补益皮毛之气，并固密腠理，防止自汗而损伤元气。出现上气喘促、气短、懒言等症状时，必须用人参来补益。心火侵犯脾土，必须使用炙甘草来清泻火热，并补益脾胃中的元气。然而甘草用量最少，是担心其滋腻导致脘腹胀满。如果是脾胃剧烈疼痛，以及脾胃极度虚弱，腹部拘急收缩，腹皮紧绷的情况，却应当多用甘草。这正是《内经》所说的“急者缓之”的道理。如果是权宜之计进行治疗，必须加入升麻来引导药力，担心向左上升的气机邪气坚固强盛，突然不肯消退，反而导致邪气上行至项部及臀部肉际而行于阴分。所以用升麻引导它行于阳分，使清气出于体表，向右下降而上行，以调和阴阳之气。如果有中焦胀满症状的，去掉甘草；咳嗽严重的，去掉人参；口干咽干的，加用干葛根。
如果脾胃已经虚弱，不能升浮，被阴火伤害了生发之气，营血严重亏损。营气潜伏在体内，阴火炽盛，日渐煎熬，导致血气亏少。而且心包络与心主血脉，血减少则心无所养，致使心神紊乱而烦躁。这种病名为“心惑”。所谓“惑”，就是心中疑惑烦闷不安。这是由于清气不升，浊气不降，清浊之气相互干扰，乱于胸中，使周身血气逆行而混乱。《内经》说：“病势从下向上逆的，要用引导的方法祛除它。”所以应当加入辛温、甘温的药物来生发阳气，阳气生发则阴血也能随之增长。有人问：甘温的药怎么能生血？它们又不是补血药。回答是：张仲景的法则是，血虚用人参来补益，阳气旺盛就能生发阴血。再加上当归调和血液，又适宜稍加黄柏，以救肾水。因为甘寒之性能清泻火热，火气减退则心气得以平和安宁。如果烦躁混乱仍然不能停止，少量加入黄连来清除它。这是为了补肾水，使肾水旺盛而心火自然下降，扶持体内的阳气。
如果气浮越导致心神紊乱，就用朱砂安神丸来镇固心神。等到烦躁减轻后，不要再服用，以防泻阳气导致阳气反陷。如果心中痞塞，也少量加入黄连。气乱于胸中，是因为清浊之气相互干扰，所以用陈皮来调理，它能帮助阳气升发并分散滞气，又辅助各种甘味、辛味药物发挥作用。所以在长夏湿土当令，客邪火旺的时候，可以权宜加入苍术、白术、泽泻，上下消散湿热之气。湿气大盛时，主要影响食物消化，导致食欲减退、不知谷味，加入炒神曲来消食导滞。再加入五味子、麦门冬、人参，以清泻火热、补益肺气，帮助恢复秋季肺金的功能。这是三伏天中长夏正气旺盛之时所用的方药。
按李东垣的意见，思路精密，处方中和。清暑益气汤，近代人多效法。但是气血虚弱的人，使用最为适宜。如果遇到体质强壮的人，不能取得疗效，且会助长湿火，不可不仔细斟酌。
If Heart Fire invades the Spleen Earth, this is due to Blood being harmed by Fire pathogenic factors, preventing Yang Qi from ascending. Yang Qi lies dormant within (the "Earth" refers to the human Spleen). In this case, Dang Gui (Angelicae Sinensis Radix) must be used to harmonize the Blood, and a small amount of Huang Bo (Phellodendri Cortex) should be used to nourish True Yin.
For syndromes of Spleen and Stomach deficiency, Sheng Ma (Cimicifugae Rhizoma) should be used in small amounts. This is because Sheng Ma is a guiding herb for the Foot-Yangming Stomach Meridian and Foot-Taiyin Spleen Meridian, enabling Yang Qi to circulate in the Yang aspects, moving upward and leftward (Zuo Qian) from the Spleen and Stomach. The Shaoyang meridian governs the Spring command, generating the roots of all things. Additionally, a slight addition of Chai Hu (Bupleuri Radix) causes the Qi of various meridians to move downward and rightward (You Qian), generating the Qi of Yin and Yang to nourish the harmonious Qi of Spring.
If Spleen deficiency leads to hyperactivity of Heart Fire which then overacts on Spleen Earth, followed by Lung Qi being affected and injured by Heat, Huang Qi (Astragali Radix) must be used in the largest dose, Gan Cao (Glycyrrhizae Radix et Rhizoma) next, and Ren Shen (Ginseng Radix) third. These three are sweet-warm Yang-tonifying herbs. Since Spleen deficiency causes Lung Qi to fail first, the sweet-warm nature of Huang Qi is used to tonify the Qi of the skin and hair, and close the Cou Li (pores and interstices), preventing spontaneous sweating that would damage Yuan Qi. For symptoms such as upper asthma, shortness of breath, and reluctance to speak, Ren Shen must be used to tonify. When Heart Fire invades the Spleen, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) must be used to drain Fire heat and tonify Yuan Qi in the Spleen and Stomach. However, the dose of Gan Cao should be minimal to avoid causing fullness. If there is severe pain in the Spleen and Stomach, or extreme deficiency of Spleen and Stomach with abdominal cramping and tightening of the abdominal wall, Gan Cao should be used in larger doses. This aligns with the principle in the Classics: "For tension, use soothing methods." If treating as an expedient measure, Sheng Ma must be added to guide the Qi, fearing that the pathogenic factor moving leftward may become entrenched and refuse to recede, potentially leading to pathogenic factors ascending to the nape and buttocks, moving along the Yin pathways. Therefore, it is guided to move along the Yang pathway, allowing Clear Qi to emerge from the interior, move rightward and ascend, thereby harmonizing the Qi of Yin and Yang. If there is middle Jiao fullness, remove Gan Cao; if cough is severe, remove Ren Shen; if there is dry mouth and throat, add Ge Gen (Puerariae Lobatae Radix).
If the Spleen and Stomach are already deficient and unable to ascend and float, and their generating Qi is damaged by Deficient Fire (Yin Fire), Ying Blood is severely depleted. Ying Qi lies dormant within, while Deficient Fire blazes, slowly consuming day by day, resulting in a shortage of Blood and Qi. Furthermore, the Pericardium Collateral and the Heart govern Blood; when Blood decreases, the Heart lacks nourishment, causing mental confusion and vexation. This disease is named "Xin Huo" (Heart Confusion). "Hu" refers to mental perplexity, vexation, and unease. This arises because Clear Qi does not ascend, Turbid Qi does not descend, and Clear and Turbid interfere with each other, causing chaos in the chest, leading to reverse flow and disorder of Blood and Qi throughout the body. The Classics state: "For disorders rising from below, use guiding methods to expel them." Therefore, acrid-warm and sweet-warm agents should be added to generate Yang. When Yang generates, Yin grows. One might ask: How can sweet-warm herbs generate Blood? They are not blood-nourishing herbs. The answer is: According to Zhang Zhongjing's method, for Blood deficiency, Ren Shen is used to tonify; when Yang is vigorous, it can generate Yin Blood. Additionally, Dang Gui is used to harmonize the Blood, and a slight addition of Huang Bo is appropriate to rescue Kidney Water. This is because sweet-cold herbs drain Fire heat; when Fire subsides, Heart Qi becomes peaceful and calm. If vexation and chaos persist, a small amount of Huang Lian (Coptidis Rhizoma) is added to clear it. This is done to tonify Kidney Water, making Kidney Water vigorous so that Heart Fire naturally descends, supporting the Yang Qi within.
If floating Qi causes mental disorder, Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill) should be used to stabilize and secure the mind. Once vexation subsides, do not continue taking it to prevent the rebound effect of draining Yang Qi and causing Yang collapse. If there is epigastric stuffiness, a small amount of Huang Lian is also added. Qi disorder in the chest is due to the interference of Clear and Turbid Qi, so Chen Pi (Citri Reticulatae Pericarpium) is used to regulate it. It assists the ascent of Yang Qi and disperses stagnant Qi, further aiding the action of various sweet and acrid herbs. Therefore, during the late summer when Damp Earth prevails and external Fire pathogens are strong, Cang Zhu (Atractylodis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Ze Xie (Alismatis Rhizoma) can be added expediently to dissipate Damp-Heat above and below. When Dampness is excessive, digestion of food is impaired, leading to reduced appetite and loss of taste for grains. Chao Qu (Fermented Medicinal Leaven) is added to digest food. Additionally, Wu Wei Zi (Schisandrae Chinensis Fructus), Mai Men Dong (Ophiopogonis Tuber), and Ren Shen are added to drain Fire, benefit Lung Qi, and assist the recovery of Autumn (Metal) deficiency. These are the herbs used during the San Fu days when Late Summer Qi is at its peak.
According to Li Dongyuan's opinion, his reasoning is precise, and his prescriptions are balanced. Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) is widely followed in recent times. However, it is most suitable for individuals with weak Qi and Blood. For robust individuals, it may not be effective and could instead promote Damp-Heat; therefore, careful consideration is necessary.