东垣曰∶调经篇云∶阴虚生内热。岐伯曰∶有所劳倦，形气衰少，谷气不盛，
上焦不行，下脘不通，而胃气热，热气熏胸中，故内热。举痛论云∶劳则气耗，劳
则喘且汗出，内外皆越，故气耗矣。夫喜怒不节，起居不时，有所劳伤，皆损其气，
气衰则火旺，火旺则乘其脾土，脾主四肢，故困热无气以动，懒于语言，动作喘乏，
表热自汗，心烦不安。当病之时，宜安心静坐，以养其气，以甘寒泻其热火，以酸
味收其散气，以甘温补其中气。经言劳者温之，损者温之是也。《金匮要略》云∶平
人脉大为劳，脉极虚亦为劳矣。夫劳之为病，其脉浮大，手足烦热，春夏剧，秋冬
瘥，（脉大者，热邪也。极热者，气损也。春夏剧者，时助邪也。秋冬差者，时胜邪也）
以黄 建中汤治之，此亦温之之意也。盖人受水谷之气以生，所谓清气、营气、运气、
卫气、春升之气，皆胃气之别名也。夫胃气为水谷之海，饮食入胃，游溢精气，上输于脾，
脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行，合于四时五脏，阴
阳揆度以为常也。若阴阳失节，寒温不适，脾胃乃伤。喜怒忧恐，损耗元气。脾胃气衰，
元气不足，而心火独盛。心火者、阴火也，起于下焦，其系系于心，心不主令，相
火代之。相火包络之火，元气之贼也。火与元气不两立，一胜则一负，脾胃气虚则
下流肝肾，阴火得以乘其土位，故脾证始得则气高而喘，身热而烦，其脉洪大而头
痛，或渴不止，其皮肤不任风寒而生寒热。盖阴火上冲则气高喘而烦热，为头痛，
为渴而脉洪。脾胃之气下流，使谷气不得升浮，是春生之令不行，则无阳以护其荣
卫，使不任风寒，乃生寒热，此皆脾胃之气不足所致也。然与外感风寒之证颇同而
实异。内伤脾胃，乃伤其气；外感风寒，乃伤其形。伤其外则有余，有余者泻之；
伤其内则不足，不足者补之。汗之、下之、吐之、克之之类，皆泻也；温之、和之、
调之、养之之类，皆补也。内伤不足之病，苟误认作外感有余之证，而反泻之，则
虚其虚也。实实虚虚，如此死者，医杀之耳。然则奈何，唯当以辛甘温剂补其中而
升其阳，甘寒以泻其火则愈矣。经曰∶劳者温之，损者温之。又曰∶温能除大热。
大忌苦寒之药，损其脾胃，今立补中益气汤主之。夫脾胃虚者，因饮食劳倦，心火
亢甚，而乘其土位。其次肺气受邪，须用黄 最多，人参、甘草次之。脾胃一虚，
肺气先绝，故用黄 以益皮毛而闭腠理，不令自汗，损其元气。上喘气短，人参以
补之。心火乘脾，须炙甘草之甘以泻火热，而补脾胃中元气。若脾胃急痛，并大虚
腹中急缩者，宜多用之。经曰∶急者缓之。白术苦甘温，除胃中热，利腰脐间血。
胃中清气在下，必加升麻、柴胡以引之，引黄 、甘草甘温之气味上升，能补卫气
之散解，而实其表也。又缓带脉之缩急。二味苦平，味之薄者，阴中之阳，引清气
上升也。气乱于胸中，为清浊相干，用去白陈皮以理之。又能助阳气上升，以散滞
气，助诸甘辛为用。脾胃气虚不能升浮，为阴火伤其生发之气，荣血大亏，荣气不
营，阴火炽盛，是血中伏火日渐熬煎，血气日减。心包与心主血，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，故加辛甘微温之剂生阳气，
阳生则阴长，故血虚以人参补之，更以当归和之，少加黄柏以救肾水，能泻阴中之
伏火。如烦犹不止，少加生地黄补肾水，水旺而心火自降。如气浮心乱，以朱砂安
神丸镇固之则愈。以手扪之而肌表热者，表证也。只服补中益气汤一二服，得微汗
则已。非正发汗，乃阴阳气和自然汗出也。若更烦乱，如腹中或周身有刺痛，皆血
涩不足，加当归身五分或一钱。如精神短少，加人参五分，五味子十二个。头痛加
蔓荆子三分，痛甚加川芎五分，顶痛脑痛加 本五分、细辛三分，诸头痛并用此四
味足矣。若头上有热，则此不能治，别以清空膏主之。如头痛有痰，沉重懒倦者，
乃太阴痰厥头痛，加半夏五分，生姜三分。耳鸣目黄，颊颔肿，颈肩 肘臂外后廉
痛，面赤，脉洪大者，以羌活二钱，防风、 本各七分，甘草五分，通其经血。加
黄芩、黄连各三分，消其肿。人参五分、黄 七分，益元气而泻火邪，另作一服与
之。嗌痛颔肿，脉洪大面赤者，加黄芩、甘草各三分，桔梗七分。口干嗌干，加葛
根五分，升引胃气上行以润之。久病痰嗽，肺中伏火，去人参，初病勿去之。冬月
或春寒或秋凉时，各宜加不去根节麻黄半钱。如春令大温，只加佛耳草、款冬花各
五分。夏月病嗽，加五味子三、五枚，去心麦门冬五分。如舌上白滑胎者，是胸中
有寒，勿用之。夏月不嗽，亦加人参二分或三分，并五味子、麦门冬各等分，救肺
受火邪也。食不下，乃胸中胃上有寒，或气涩滞，加青皮、木香各三分，陈皮五分，
此三味为定法。如冬月加益智仁、草豆蔻仁各五分。如夏月加黄芩、黄连各五分。
如秋月加槟榔、草豆蔻、白豆蔻、缩砂各五分。如春初犹寒，少加辛热之剂，以补
春气之不足，为风药之佐，益智、草豆蔻可也。心下痞，夯闷，加芍药、黄连各一
钱。如痞腹胀，加枳实、木香、缩砂仁各三分，浓朴七分。如天寒，少加干姜或肉
桂。心下痞，觉中寒，加附子、黄连各一钱。不能食而心下痞，加生姜、陈皮各一
钱。能食而心下痞，加黄连五分、枳实三分。脉缓有痰而痞，加半夏、黄连各一钱。
脉弦四肢满，便难而心下痞，加柴胡七分、黄连五分、甘草三分。胸中气壅滞，加
青皮二分。如气促少气去之。腹中痛者，加白芍药五分、炙甘草三分。如恶寒冷痛
者，加桂心三分。如恶热喜寒而腹痛者，于已加白芍药、甘草二味中，更加生黄芩
三二分。如夏月腹痛而不恶热者亦然，治时热也。如天凉时恶热而痛，于已加白芍
药、甘草、黄芩中，更少加桂。如天寒时腹痛，去芍药，味酸而寒故也，加益智仁
三分，或加半夏五分、生姜三片。如腹中痛，恶寒而脉弦者，是木来克土也，小建
中汤主之。盖芍药味酸，于土中泻木为君。如脉沉细腹中痛，以理中汤主之。干姜
辛热，于土中泻水以为主也。如脉缓体重节痛，腹胀自利，米谷不化，是湿胜也，
平胃散主之。胁下痛或胁下缩急，俱加柴胡三分，甚则五分，甘草三分。脐下痛加
真熟地黄五分，其痛立止。如不已者，乃大寒也，更加肉桂三二分。《内经》所说少
腹痛皆寒证，从复法相报中来也。经云∶大胜必大复，从热病中变而作也。非伤寒
厥阴之证，乃下焦血结膀胱也，仲景以抵当汤并丸主之。身有疼痛者湿，若身重者
亦湿，加去桂五苓一钱。如风湿相搏，一身尽痛，加羌活七分，防风、 本根各半
钱，升麻、苍术各一钱，勿用五苓，所以然者，为风药已能胜湿，故别作一服与之。
如病去勿再服，以诸风药损人元气，而益其病故也。小便遗失，肺金虚也。宜安卧
养气，以黄 、人参之类补之。不愈则是有热也，加黄柏、生地黄各五分，切禁劳
役。如卧而多惊，小便淋者，邪在少阳、厥阴，宜太阳经所加之药，更添柴胡五分。
如淋加泽泻五分，此下焦风寒合病也。经云∶肾肝之病同一治。为俱在下焦，非风
药行经则不可，乃受客邪之湿热也，宜升举发散以除之。大便秘涩，加当归稍一钱，
大黄酒洗煨五分或一钱。闭涩不行者，煎成正药，先用清者一口，调玄明粉五分或
一钱，得行则止。此病不宜下，下之恐变凶证也。脚膝痿软，行步乏力或痛，乃肾
肝伏热，加黄柏五分，空心服。不已，更加汉防己五分。脉缓，显沉困怠惰无力者，
加苍术、泽泻、人参、白术、茯苓、五味子各五分。上一方加减，是饮食劳倦，喜
怒不节，始病热中，则可用之。若末传寒中，则不可用也。盖甘酸适足益其气耳，
如黄 、人参、甘草、芍药、五味之类是也。
【内伤始为热中病似外感阳证】头痛大作，四肢疰闷，气高而喘，身热而烦，上
气鼻息不调，四肢困倦不收，无气以动，无气以言，或烦躁闷乱，心烦不安，或渴
不止。病久者，邪气在血脉中，有湿故不渴。如病渴，是心火炎上克肺金，故渴。
或表虚不任风寒，目不欲开，恶食，口不知味，右手气口脉大于左手人迎三倍，其
气口脉急大而数，时一代而涩。涩是肺之本脉。代是无气不相接，乃脾胃不足之脉。
大是洪大，洪大而数，乃心脉刑肺。急是弦急，乃肝木挟心火克肺金也。其右关脾
脉比五脉独大而数，数中时显一代，此不甚劳役，是饮食不时，寒温失所，则无右
关胃脉损弱，隐而不见，惟内显脾脉如此也。治用补中益气汤。
【内伤末传寒中病似外感阴证】腹胀，胃脘当心痛，上支两胁，隔噎不通，
或涎唾，或清涕，或多溺，足下痛，不能任身履地，骨乏无力，喜唾，两丸多冷，
阴阴作痛，或妄见鬼状梦亡人，腰背胛眼脊膂皆痛，不渴不泻，脉盛大以涩，名曰
寒中。治用神圣复气汤、白术附子汤、草豆蔻丸。
【似外感阳明中热证】有天气大热时劳役得病，或路途劳役，或田野中劳役，或
身体怯弱食少劳役，或长斋久素胃气久虚劳役。其病肌体壮热，躁热闷乱，大恶热，
渴饮水，此与阳明伤寒热白虎汤证相似，鼻口中气短促上喘，此乃脾胃久虚，元气
不足之证，身亦疼痛，至日西作，必谵语热渴闷不止，脉洪大空虚或微弱。白虎汤
证，其脉洪大有力，与此内伤中热不同，治用清暑益气汤。饥困劳役之后，肌热躁
热，困渴引饮，目赤面红，昼夜不息，其脉大而虚，重按全无。经曰∶脉虚则血虚，
血虚则发热，证象白虎，惟脉不长实为辨也。误服白虎汤必危，宜黄 当归补血汤。
【似外感恶风寒证】有因劳役坐卧阴凉处后，病表虚不任风寒，少气短促，懒言
语，困弱无力。此因劳役辛苦，肾中阴火沸腾，后因脱衣或沐浴，歇息于阴凉处，
其阴火不行，还归皮肤，腠理极虚无阳，被风与阴凉所遏，以此表虚不任风寒，与
外感恶风相似。不可同外感治，宜用补中益气汤。
【内伤似外感杂证】饮食失节，劳役所伤，脾胃中州变寒，走痛而发黄，治用小
建中汤，或理中汤，或大建中汤，选而用之。
【劳倦所伤虚中有寒】理中丸。心肺在膈上为阳，肾肝在膈下为阴，此上下脏
也。脾胃属土，处在中州，在五脏曰孤脏。在三焦曰中焦。因中焦治在中，一有不
调，此丸专主，故名曰理中丸。人参味甘温，《内经》曰∶脾欲缓，急食甘以缓之。
缓中益脾，必以甘为主，是以人参为君。白术味甘温，《内经》曰∶脾恶湿，甘胜
湿。温中胜湿，必以甘为助，是以白术为臣。甘草味甘平，《内经》曰∶五味所入，
甘先入脾。脾不足者以甘补之，补中助脾必须甘剂，是以甘草为佐。干姜味辛热，
喜温而恶寒者胃也，寒则中焦不治。《内经》曰∶寒淫所胜，平以辛热。散寒温胃，
必先辛剂，是以干姜为使。脾胃居中，病则邪气上下左右无所不之，故有诸加减焉。
若脐下筑者，肾气动也，去白术加桂。气壅而不泻，则筑然动也，白术味甘补气，
去白术则气易散。桂辛热，肾气动者，欲作奔豚也，必服辛热以散之，故加桂以散
肾气，泄奔豚气。吐多者，去白术加生姜。气上逆则吐多，术甘而壅，非气逆者之
所宜。《千金》曰∶呕家多服生姜，以其辛散，故吐多者加之。下多者还用白术，气
泄而不收则下多，术甘壅补，使正气收而不下泄也。或曰湿胜则濡泄，术专除湿，
故下多者加之。悸者加茯苓，饮聚则悸，茯苓味甘，渗泄伏水，是所宜也。渴欲得
水者倍加术，津液不足则渴，术甘以补津液，故加之。腹中痛者加人参，虚则痛，
经曰∶补可以去弱，人参、羊肉之属是也。寒多者加干姜，以辛热能散寒也。腹满
者去白术，加附子。《内经》曰∶甘者令人中满，术甘壅补，于腹中满者则去之。附
子味辛热，气壅郁腹为之满，以热胜寒，以辛散满，故加附子。经曰∶热者寒之，
寒者热之，此之谓也。建中汤，《内经》曰∶肝生于左，肺生于右，心位在上，肾处
在下，左右上下四脏居焉。脾者土也，应中央，处四脏之中州，治中焦，生育荣卫，
通行津液，一有不调，则荣卫失所育，津液失所行，必以此汤温中益脾，是以建中
名之焉。胶饴味甘温，甘草味甘平，脾欲缓，急食甘以缓之。建脾者，必以甘为主，
故以胶饴为君，而甘草为臣。桂辛热，散也、润也，荣卫不足，润而散之。芍药味
酸，微寒，收也、泄也，津液不通，收而行之。是以桂、芍药为佐。生姜味辛温，
大枣味甘温，胃者卫之源，脾者荣之本。《灵枢经》云∶荣出中焦，卫出上焦是也。
卫为阳，不足者益之必以辛；荣为阴，不足者补之必以甘。甘辛相合，脾胃建而荣
李东垣说：《素问·调经论》中提到：“阴虚则生内热。”岐伯解释说：“由于过度劳累，导致形体衰弱、正气不足，水谷精微化生减少，上焦之气不能宣发，下脘之气不能通降，致使胃气郁而化热，热气熏蒸于胸中，所以产生内热。”《素问·举痛论》中说：“劳倦则耗伤元气，劳倦会导致气喘和出汗，体内的气和津液从内外两方面外泄，因此元气被耗伤。”如果喜怒没有节制，起居没有规律，或者有所劳损，都会损伤人体的气。气衰则相火偏旺，火旺则会克制脾土。脾主四肢，所以会出现身体困重发热、无力活动、懒于说话、动作时气喘乏力、体表发热、自汗、心烦不安等症状。在患病期间，应当安心静坐以养气，用甘寒的药物清泻火热，用酸味的药物收敛散失的元气，用甘温的药物补益中气。这就是经文所说的“劳者温之，损者温之”的道理。《金匮要略》中说：“正常人脉象大而无力是劳损的表现，脉象极虚也是劳损的表现。”劳损这类疾病，其脉象浮大，手足烦热，春夏季节病情加重，秋冬季节病情减轻。（脉大是因为有热邪；极虚是因为气受损；春夏加重是因为时令助长邪气；秋冬减轻是因为时令克制邪气。）治疗用黄芪建中汤，这也是“温之”的意思。
大概人依靠水谷之气生存，所谓的清气、营气、运气、卫气、春升之气，都是胃气的别名。胃是水谷之海，饮食进入胃中，游溢精气，向上输送给脾，脾气散布精微物质，向上归于肺，通调水道，向下输送到膀胱，水液精微四布全身，五脏经脉并行，顺应四时五脏的变化，阴阳平衡作为常态。如果阴阳失调，寒温不适，就会损伤脾胃。喜怒忧恐会损耗元气。脾胃气衰，元气不足，心火就会独盛。心火也就是阴火，起于下焦，其联系系于心，但心不主令，由相火代替。相火即包络之火，是元气的贼害。火与元气不能两立，一方胜则另一方负。脾胃气虚，气机下流肝肾，阴火得以乘袭脾土之位。所以脾病初起时，会出现气逆喘息、身热烦躁、脉象洪大而头痛，或者口渴不止，皮肤不能耐受风寒而忽冷忽热。因为阴火上冲，所以气逆喘促、烦热、头痛、口渴、脉洪大。脾胃之气下流，使水谷精气不能上升浮越，这就好比春季生发的命令不能执行，没有阳气来护卫营卫，使其不能耐受风寒，从而产生寒热症状。这都是脾胃之气不足所致。然而这与外感风寒的证候颇为相似，但实际上不同。内伤脾胃，是损伤了气；外感风寒，是损伤了形。损伤外在形体表现为有余，有余的要用泻法；损伤内在正气表现为不足，不足的要用补法。发汗、攻下、催吐、克伐等方法，都属于泻法；温补、调和、调理、滋养等方法，都属于补法。内伤不足的疾病，如果错误地认为是外感有余的证候，反而使用泻法，那就是使虚者更虚。实证更实，虚证更虚，像这样死亡的，是医生杀死了病人。那么该怎么办呢？只应当用辛甘温的药物补益中气并升发阳气，用甘寒的药物清泻火热，病就能痊愈了。经文说：“劳者温之，损者温之。”又说：“温能除大热。”特别忌讳苦寒的药物，以免损伤脾胃。现在制定补中益气汤来主治。
脾胃虚弱的人，因为饮食劳倦，心火亢盛，进而乘袭脾土。其次肺气受邪，需要重用黄芪，人参、甘草次之。脾胃一虚，肺气先绝，所以用黄芪来补益皮毛、闭合腠理，防止自汗，以免损伤元气。上气喘促、气短，用人参来补益。心火乘脾，需要用炙甘草的甘味来清泻火热，并补益脾胃中的元气。如果脾胃急痛，以及极度虚弱、腹中拘急收缩的情况，应该多用炙甘草。经文说：“急者缓之。”白术味苦甘性温，能清除胃中湿热，疏通腰脐间的血滞。胃中清气在下，必须加入升麻、柴胡来引导，引导黄芪、甘草甘温的气味上升，能够补益卫气的散解，充实肌表。又能缓解带脉的拘急。这两味药味苦平，气味轻薄，属于阴中之阳，能引导清气上升。如果气乱于胸中，造成清浊相干，用去白皮的陈皮来调理。又能帮助阳气上升，以疏散滞气，辅助各种甘辛药物的作用。脾胃气虚不能升浮，被阴火损伤了生发之气，营血严重亏损，营气不能濡养，阴火炽盛，这是血中伏火日渐煎熬，气血日益减少。心包与心主血，血减少则心无所养，致使心神紊乱而烦躁，这种病名叫“心憺憺大动”。憺憺的意思是心中惑乱而烦闷不安，所以加入辛甘微温的药物以生发阳气，阳生则阴长，所以血虚用人参补益，再用当归调和，少加黄柏来救肾水，能清泻阴中的伏火。如果烦躁仍然不止，少加生地黄补肾水，水旺则心火自然下降。如果气浮心乱，用朱砂安神丸镇固心神则痊愈。用手触摸感觉肌表发热的，是表证。只服用补中益气汤一两服，得到微微汗出就好了。这不是正的发汗，而是阴阳气和合自然汗出。如果更加烦乱，如腹中或周身有刺痛，都是血涩不足，加当归身五分或一钱。如果精神短少，加人参五分，五味子十二个。头痛加蔓荆子三分，痛甚加川芎五分，头顶痛脑痛加藁本五分、细辛三分，各种头痛并用这四味药就足够了。如果头上有热，则这些药不能治，另外用清空膏主治。如果头痛伴有痰湿，头沉重懒倦的，是太阴痰厥头痛，加半夏五分，生姜三分。耳鸣目黄，脸颊下颌肿胀，颈肩肘臂外侧后方疼痛，面色红赤，脉象洪大的，用羌活二钱，防风、藁本各七分，甘草五分，以通其经络气血。加黄芩、黄连各三分，以消除肿胀。人参五分、黄芪七分，以益元气而泻火邪，另作一服给他。咽喉痛、下颌肿，脉洪大面赤的，加黄芩、甘草各三分，桔梗七分。口干咽干，加葛根五分，升引胃气上行以滋润。久病痰嗽，肺中有伏火，去掉人参，初病不要去掉。冬季或春寒或秋凉时，各宜加不去根节的麻黄半钱。如果春季气候大温，只加佛耳草、款冬花各五分。夏季病嗽，加五味子三、五枚，去心的麦门冬五分。如果舌上有白滑苔，是胸中有寒，不要用这些药。夏季不咳嗽，也加人参二分或三分，并五味子、麦门冬各等分，以救肺受火邪。吃不下东西，是胸中胃上有寒，或者气机涩滞，加青皮、木香各三分，陈皮五分，这三味药是固定用法。如果是冬季加益智仁、草豆蔻仁各五分。如果是夏季加黄芩、黄连各五分。如果是秋季加槟榔、草豆蔻、白豆蔻、缩砂各五分。如果是初春还有寒意，少加辛热的药物，以补充春气的不足，作为风药的佐使，益智仁、草豆蔻可以。心下痞满、堵塞闷胀，加芍药、黄连各一钱。如果痞满腹胀，加枳实、木香、缩砂仁各三分，厚朴七分。如果天气寒冷，少加干姜或肉桂。心下痞，感觉中焦寒冷，加附子、黄连各一钱。不能吃且心下痞，加生姜、陈皮各一钱。能吃但心下痞，加黄连五分、枳实三分。脉缓有痰且痞满，加半夏、黄连各一钱。脉弦四肢胀满，大便难且心下痞，加柴胡七分、黄连五分、甘草三分。胸中气机壅滞，加青皮二分。如果气促少气则去掉青皮。腹中痛的，加白芍药五分、炙甘草三分。如果恶寒冷痛，加桂心三分。如果恶热喜寒且腹痛，在已加的白芍药、甘草两味药中，再加生黄芩三二分。如果是夏季腹痛而不恶热的也是这样，治疗时令的热邪。如果是天气凉爽时恶热而痛，在已加的白芍药、甘草、黄芩中，再少加桂枝。如果是天寒时腹痛，去掉芍药，因为芍药味酸而寒。加益智仁三分，或加半夏五分、生姜三片。如果腹中痛，恶寒且脉弦，是木来克土，用小建中汤主治。因为芍药味酸，在土中泻木为君药。如果脉沉细腹中痛，用理中汤主治。干姜辛热，在土中泻水为主药。如果脉缓体重关节痛，腹胀自利，米谷不化，是湿胜，用平胃散主治。胁下痛或胁下拘急，都加柴胡三分，严重时加五分，甘草三分。脐下痛加真熟地黄五分，疼痛立即停止。如果不停止，那是大寒，再加肉桂三二分。《内经》所说的少腹痛都是寒证，是从复法相报中来的。经文说：“大胜必大复”，是从热病中变化而来的。不是伤寒厥阴的证候，而是下焦血结膀胱，张仲景用抵当汤和抵当丸主治。身体疼痛的是湿，如果身体沉重的也是湿，加去桂枝的五苓散一钱。如果风湿相搏，一身尽痛，加羌活七分，防风、藁本根各半钱，升麻、苍术各一钱，不要用五苓散，之所以这样，是因为风药已经能胜湿，所以另外作一服给他。如果病好了不要再服，因为各种风药会损伤人的元气，从而加重病情。小便失禁，是肺金虚。应该安卧养气，用黄芪、人参之类补益。如果不愈，那就是有热，加黄柏、生地黄各五分，切忌劳累役使。如果睡觉多惊，小便淋沥，邪在少阳、厥阴，宜用太阳经所加的药物，再添柴胡五分。如果淋沥加泽泻五分，这是下焦风寒合病。经文说：“肾肝之病同一治。”因为它们都在下焦，不用风药行经是不行的，这是受了客邪的湿热，应该升举发散来清除它。大便秘涩，加当归梢一钱，大黄酒洗煨五分或一钱。闭塞不通的，煎好正药后，先用清液一口，调玄明粉五分或一钱，大便通畅就停止。这个病不宜攻下，攻下恐怕变成凶险的证候。脚膝痿软，行走乏力或痛，是肝肾伏热，加黄柏五分，空腹服。如果不愈，再加汉防己五分。脉缓，明显沉困怠惰无力的，加苍术、泽泻、人参、白术、茯苓、五味子各五分。以上方的加减，适用于饮食劳倦、喜怒不节，起初病在热中，就可以用这个方。如果末传寒中，就不能用了。因为甘酸正好能益其气，如黄芪、人参、甘草、芍药、五味子之类是。
【内伤开始为热中病，症状类似外感阳证】头痛剧烈，四肢沉重困闷，气逆喘息，身热烦躁，上气鼻息不调，四肢困倦不能收持，没有力气活动，没有力气说话，或者烦躁闷乱，心烦不安，或者口渴不止。病程久的，邪气在血脉中，因为有湿所以不渴。如果病渴，是心火炎上克制肺金，所以渴。或者表虚不能耐受风寒，眼睛不想睁开，厌恶食物，口不知味，右手气口脉比左手人迎脉大三倍，其气口脉急大而数，时常出现代脉且涩。涩是肺的本脉。代脉是无气不相接续，是脾胃不足的脉象。大是洪大，洪大而数是心脉刑克肺金。急是弦急，是肝木挟心火克肺金。右关脾脉比这五种脉象单独大而数，数中时常显一代，这不甚劳役，是饮食不定时，寒温失所，则没有右关胃脉，胃脉损弱隐而不见，只有内显脾脉如此。治疗用补中益气汤。
【内伤末传寒中病，症状类似外感阴证】腹胀，胃脘当心而痛，上支两胁，膈噎不通，或者流涎唾，或者流清涕，或者小便多，足下痛，不能承受身体站立在地，骨乏无力，喜欢流唾沫，两睾丸多冷，隐隐作痛，或者妄见鬼状梦见亡人，腰背胛眼脊膂皆痛，不渴不泻，脉盛大以涩，名叫寒中。治疗用神圣复气汤、白术附子汤、草豆蔻丸。
【类似外感阳明中热证】有在天气大热时因劳役得病，或者路途劳役，或者田野中劳役，或者身体怯弱食少劳役，或者长期吃斋久素导致胃气久虚劳役。其病肌肤壮热，躁热闷乱，非常怕热，想喝水，这与阳明伤寒热证的白虎汤证相似，鼻口中气短促上喘，这是脾胃久虚，元气不足的证候，身体也疼痛，到傍晚发作，必定谵语热渴闷不止，脉象洪大空虚或微弱。白虎汤证，其脉洪大有力，与此内伤中热不同，治疗用清暑益气汤。饥饿困倦劳役之后，肌肤热躁热，困渴引饮，目赤面红，昼夜不息，其脉大而虚，重按全无。经文说：“脉虚则血虚，血虚则发热，证象白虎，惟脉不长实为辨也。”误服白虎汤必然危险，宜用黄芪当归补血汤。
【类似外感恶风寒证】有因为劳役坐卧阴凉处后，病表虚不能耐受风寒，少气短促，懒言语，困弱无力。这是因为劳役辛苦，肾中阴火沸腾，后来脱衣或沐浴，歇息于阴凉处，其阴火不行，还归皮肤，腠理极虚无阳，被风与阴凉所遏，以此表虚不能耐受风寒，与外感恶风相似。不可同外感治，宜用补中益气汤。
【内伤类似外感杂证】饮食失节，劳役所伤，脾胃中州变寒，走痛而发黄，治疗用小建中汤，或理中汤，或大建中汤，选而用之。
【劳倦所伤虚中有寒】理中丸。心肺在膈上为阳，肾肝在膈下为阴，这是上下脏。脾胃属土，处在中州，在五脏叫孤脏。在三焦叫中焦。因为中焦治在中，一有不调，此丸专主，所以名叫理中丸。人参味甘温，《内经》说：“脾欲缓，急食甘以缓之。”缓中益脾，必须以甘为主，所以以人参为君药。白术味甘温，《内经》说：“脾恶湿，甘胜湿。”温中胜湿，必须以甘为助，所以以白术为臣药。甘草味甘平，《内经》说：“五味所入，甘先入脾。”脾不足者以甘补之，补中助脾必须用甘剂，所以以甘草为佐药。干姜味辛热，喜温而恶寒的是胃，寒则中焦不治。《内经》说：“寒淫所胜，平以辛热。”散寒温胃，必须先辛剂，所以以干姜为使药。脾胃居中，病则邪气上下左右无所不到，所以有诸加减。如果脐下筑动，是肾气动，去白术加桂枝。气壅而不泻，则筑然动，白术味甘补气，去白术则气易散。桂枝辛热，肾气动者，欲作奔豚，必须服辛热以散之，所以加桂枝以散肾气，泄奔豚气。吐多的，去白术加生姜。气上逆则吐多，术甘而壅，不适合气逆者。《千金方》说：“呕家多服生姜，以其辛散，所以吐多加之。”下利多还用白术，气泄而不收则下多，术甘壅补，使正气收而不下泄也。有人说湿胜则濡泄，术专除湿，所以下多加之。心悸的加茯苓，饮聚则悸，茯苓味甘，渗泄伏水，是适宜的。渴欲得水的倍加白术，津液不足则渴，术甘以补津液，所以加之。腹中痛的加人参，虚则痛，经文说：“补可以去弱”，人参、羊肉之类是。寒多的加干姜，以辛热能散寒也。腹满的去白术，加附子。《内经》说：“甘者令人中满”，术甘壅补，于腹中满的去之。附子味辛热，气壅郁腹为之满，以热胜寒，以辛散满，所以加附子。经文说：“热者寒之，寒者热之”，就是这个意思。建中汤，《内经》说：“肝生于左，肺生于右，心位在上，肾处在下”，左右上下四脏居焉。脾者是土，应中央，处四脏之中州，治中焦，生育荣卫，通行津液，一有不调，则荣卫失所育，津液失所行，必须以此汤温中益脾，所以建中名之焉。胶饴味甘温，甘草味甘平，脾欲缓，急食甘以缓之。建脾者，必须以甘为主，所以以胶饴为君，而甘草为臣。桂枝辛热，散也、润也，荣卫不足，润而散之。芍药味酸，微寒，收也、泄也，津液不通，收而行之。所以以桂枝、芍药为佐。生姜味辛温，大枣味甘温，胃者是卫之源，脾者是荣之本。《灵枢经》说：“荣出中焦，卫出上焦”是也。卫为阳，不足者益之必须以辛；荣为阴，不足者补之必须以甘。甘辛相合，脾胃建而荣卫和。
Li Dongyuan said: The *Tiao Jing Lun* (Chapter on Regulating the Meridians) states: "Yin deficiency generates internal heat." Qibo explained: "Due to overexertion, the physical form weakens and vital Qi declines, causing the transformation of grain essence to be insufficient. The Qi of the Upper Jiao fails to circulate, and the Lower Wan (lower stomach area) becomes obstructed. Consequently, Stomach Qi stagnates and generates heat, which steams upward into the chest, resulting in internal heat." The *Ju Tong Lun* (Chapter on Pain Disorders) states: "Exertion consumes Qi. Exertion leads to panting and sweating; both internal and external aspects leak out, thus consuming Qi." If emotions such as anger and joy are unregulated, daily routines are irregular, or there is any physical strain, all these damage the body's Qi. When Qi declines, Ministerial Fire flares up; when Ministerial Fire flares, it overacts upon Spleen Earth. Since the Spleen governs the four limbs, symptoms include heavy sensation, feverishness, lack of energy for movement, reluctance to speak, panting and fatigue during activity, surface heat, spontaneous sweating, restlessness, and anxiety. During illness, one should sit quietly with a calm mind to nourish Qi, use Sweet-Cold herbs to drain fire-heat, use Sour herbs to gather scattered Qi, and use Sweet-Warm herbs to tonify Middle Qi. This aligns with the classic saying: "For exhaustion, use warming methods; for deficiency, use warming methods." The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: "A normal person with a large pulse indicates labor injury; an extremely deficient pulse also indicates labor injury." In labor injury diseases, the pulse is floating and large, hands and feet feel hot and vexed, symptoms worsen in spring and summer, and improve in autumn and winter. (A large pulse indicates pathogenic heat; an extremely deficient pulse indicates Qi damage; worsening in spring/summer is due to seasonal factors aiding the pathogen; improving in autumn/winter is due to seasonal factors overcoming the pathogen.) It is treated with Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle), which embodies the principle of "warming."
Generally, humans rely on the Qi of water and grain for life. The so-called Clear Qi, Ying (Nutritive) Qi, Yun (Transporting) Qi, Wei (Defensive) Qi, and Spring-Rising Qi are all alternative names for Stomach Qi. The Stomach is the Sea of Water and Grain. When food enters the Stomach, its essence floats and overflows, transporting upwards to the Spleen. The Spleen scatters essences, sending them upwards to the Lung, which regulates water passages and transports downwards to the Bladder. Water essences distribute throughout the body, and the five meridians function in parallel, harmonizing with the four seasons and five Zang organs, maintaining balance between Yin and Yang as the norm. If Yin and Yang lose their regulation, and cold and warmth are inappropriate, the Spleen and Stomach are injured. Anger, joy, worry, and fear deplete Yuan (Original) Qi. When Spleen and Stomach Qi decline and Yuan Qi is insufficient, Heart Fire becomes dominant alone. Heart Fire is also called Yin Fire; it originates from the Lower Jiao, connects to the Heart, but since the Heart does not issue commands, Xiang (Ministerial) Fire acts in its place. Xiang Fire is the fire of the Pericardium, a thief of Yuan Qi. Fire and Yuan Qi cannot coexist; if one prevails, the other loses. When Spleen and Stomach Qi is deficient, Qi flows downward to the Liver and Kidney, allowing Yin Fire to invade the position of Earth (Spleen). Thus, at the onset of Spleen disease, there is high Qi and panting, body heat and vexation, a flooding-large pulse with headache, or incessant thirst, and skin that cannot tolerate wind-cold, leading to alternating chills and fever. Because Yin Fire rushes upward, there is high Qi, panting, vexation-heat, headache, thirst, and a flooding pulse. When Spleen and Stomach Qi flows downward, grain essence cannot rise and float, meaning the command of Spring generation does not operate. Without Yang to protect Ying and Wei, they cannot tolerate wind-cold, generating chills and fever. All these are caused by insufficiency of Spleen and Stomach Qi. However, this is similar yet fundamentally different from exterior wind-cold patterns. Internal injury to Spleen and Stomach damages Qi; exterior wind-cold damages the Form. Exterior damage manifests as excess, requiring purgation; internal damage manifests as deficiency, requiring tonification. Methods like sweating, purging, vomiting, and attacking are purgations; warming, harmonizing, regulating, and nourishing are tonifications. For internal deficiency diseases, if mistakenly diagnosed as exterior excess patterns and treated with purgation, it makes the deficiency more deficient. Making excesses more excess and deficiencies more deficient leads to death; such deaths are caused by the physician. Therefore, what should be done? One must use Pungent-Sweet-Warm agents to tonify the center and raise Yang, and Sweet-Cold agents to drain fire, and the disease will heal. The classics say: "For exhaustion, use warming; for loss, use warming." Also: "Warming can eliminate great heat." Bitter-Cold drugs are strictly contraindicated as they damage Spleen and Stomach. Now, Buchong Yiqi Tang (Decoction to Supplement the Middle and Boost Qi) is established as the principal formula.
For those with Spleen-Stomach deficiency due to diet and overexertion, Heart Fire becomes hyperactive and invades Earth. Secondly, Lung Qi is affected. Huangqi (Astragali Radix) should be used in the largest dose, followed by Renshen (Ginseng Radix) and Gancao (Licorice Radix). When Spleen and Stomach are deficient, Lung Qi is first cut off. Therefore, Huangqi is used to benefit the skin and hair and close the interstices, preventing spontaneous sweating and further damaging Yuan Qi. For upper panting and shortness of breath, Renshen is used to tonify. When Heart Fire invades the Spleen, roasted Gancao (Prepared Licorice Radix) is used for its sweetness to drain fire-heat and tonify Middle Yuan Qi. For acute Spleen-Stomach pain and severe deficiency with abdominal cramping, a larger dose of Gancao is appropriate. The classic says: "For tension, use soothing [sweet] agents." Baizhu (Atractylodis Macrocephalae Rhizoma) is bitter, sweet, and warm; it clears damp-heat in the Stomach and benefits blood circulation in the waist and umbilical region. When Clear Qi of the Stomach sinks, Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) must be added to guide it. They guide the sweet-warm aroma of Huangqi and Gancao upward, replenishing dispersed Wei Qi and consolidating the exterior. They also relax the contraction of the Dai (Girdle) Vessel. These two are bitter and neutral, with thin flavors, representing Yang within Yin, guiding Clear Qi upward. If Qi is chaotic in the chest, causing confusion of clear and turbid, Chenpi (Citri Reticulatae Pericarpium) with the white pith removed is used to regulate it. It also aids Yang Qi ascent to dissipate stagnant Qi, assisting the actions of various sweet and pungent herbs. When Spleen-Stomach Qi is deficient and cannot ascend, and is damaged by Yin Fire affecting the generating Qi, Ying Blood is severely depleted. Ying Qi fails to nourish, Yin Fire blazes, and latent fire in the blood slowly boils, reducing Qi and Blood day by day. The Pericardium and Heart govern Blood; when Blood decreases, the Heart lacks nourishment, causing mental chaos and vexation. This disease is named "Xin Dan Dan Da Dong" (Palpitations with a feeling of fright). "Dan dan" means mental confusion and vexation. Therefore, Pungent-Sweet-Slightly Warm agents are added to generate Yang Qi. When Yang grows, Yin grows. For Blood deficiency, Renshen is used to tonify, and Danggui (Angelicae Sinensis Radix) to harmonize. A small amount of Huangbai (Phellodendri Cortex) is added to rescue Kidney Water and drain latent fire in the Yin. If vexation persists, a small amount of Shengdihuang (Rehmanniae Radix) is added to tonify Kidney Water; when Water is robust, Heart Fire naturally descends. If Qi floats and the Heart is chaotic, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) is used to stabilize and secure. If palpation reveals surface heat, it is an exterior pattern. Taking Buchong Yiqi Tang for one or two doses, resulting in slight sweating, resolves the issue. This is not proper sweating, but natural sweating due to the harmony of Yin and Yang Qi. If vexation worsens, or there are stabbing pains in the abdomen or whole body, indicating Blood stasis and insufficiency, add Danggui Shen (Body of Angelicae Sinensis Radix) 5 fen or 1 qian. If spirit is lacking, add Renshen 5 fen and Wuweizi (Schisandrae Fructus) 12 pieces. For headache, add Manjingzi (Vernoniae Semen) 3 fen; if severe, add Chuanxiong (Ligustici Chuanxiong Rhizoma) 5 fen; for vertex or brain pain, add Gaoben (Ligustici Wallichii Rhizoma) 5 fen and Xixin (Asari Radix et Rhizoma) 3 fen. These four herbs suffice for all headaches. If there is heat on the head, these herbs are ineffective; instead, use Qingkong Gao (Clear the Cavity Ointment). If headache is accompanied by phlegm, heaviness, and lethargy, it is Taiyin Phlegm-Jue Headache; add Banxia (Pinelliae Rhizoma) 5 fen and Shengjiang (Zingiberis Recens Rhizoma) 3 fen. For tinnitus, yellow eyes, swelling of cheeks and jaw, pain in the neck, shoulder, elbow, arm outer posterior border, red face, and flooding pulse, use Qianghuo (Notopterygii Rhizoma et Radix) 2 qian, Fangfeng (Saposhnikoviae Radix) and Gaoben each 7 fen, Gancao 5 fen to unblock meridians and blood. Add Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) each 3 fen to reduce swelling. Renshen 5 fen and Huangqi 7 fen tonify Yuan Qi and drain pathogenic fire; prepare as a separate dose. For throat pain and jaw swelling with flooding pulse and red face, add Huangqin and Gancao each 3 fen, and Jiegeng (Platycodonis Radix) 7 fen. For dry mouth and throat, add Gegen (Puerariae Lobatae Radix) 5 fen to guide Stomach Qi upward for moistening. For chronic cough with phlegm and latent fire in the Lung, remove Renshen; do not remove it in early stages. In winter, or during spring cold or autumn chill, add Mahuang (Ephedrae Herba) without roots and nodes, 0.5 qian. If spring is very warm, add Foercao (Petasitae Flos) and Kuandonghua (Farfarae Flos) each 5 fen. For summer cough, add Wuweizi 3-5 pieces and Maimendong (Ophiopogonis Radix) with heart removed, 5 fen. If there is a white slippery coating on the tongue, indicating cold in the chest, do not use these. In summer without cough, still add Renshen 2-3 fen, along with equal parts Wuweizi and Maimendong to rescue the Lung from Fire pathogen. For inability to eat, indicating cold in the chest/Stomach or Qi stagnation, add Qingpi (Citri Reticulatae Pericarpium Viride) and Muxiang (Aucklandiae Radix) each 3 fen, and Chenpi 5 fen; this is a fixed method. In winter, add Yizhiren (Alpiniae Oxyphyllae Fructus) and Caodoukou (Kniphofiae Rhizoma) each 5 fen. In summer, add Huangqin and Huanglian each 5 fen. In autumn, add Binglang (Arecae Semen), Caodoukou, Baodoukou (Cardamomi Albi Fructus), and Suosha (Amomi Fructus Rotundus) each 5 fen. In early spring if still cold, add a small amount of Pungent-Hot agents to supplement the insufficiency of Spring Qi, acting as assistants to Wind herbs; Yizhiren and Caodoukou are suitable. For epigastric fullness and oppression, add Shaoyao (Paeoniae Radix Alba) and Huanglian each 1 qian. If fullness extends to abdominal distension, add Zhishi (Aurantii Fructus Immaturus), Muxiang, and Suosharen (Amomi Fructus) each 3 fen, and Houpo (Magnoliae Officinalis Cortex) 7 fen. If cold weather, add Ganjiang (Zingiberis Rhizoma) or Rougui (Cinnamomi Cortex) slightly. For epigastric fullness with a sensation of cold in the center, add Fuzi (Aconiti Lateralis Radix Praeparata) and Huanglian each 1 qian. For inability to eat with epigastric fullness, add Shengjiang and Chenpi each 1 qian. For ability to eat with epigastric fullness, add Huanglian 5 fen and Zhishi 3 fen. For slow pulse with phlegm and fullness, add Banxia and Huanglian each 1 qian. For wiry pulse, fullness in four limbs, difficult defecation, and epigastric fullness, add Chaihu 7 fen, Huanglian 5 fen, and Gancao 3 fen. For Qi stagnation in the chest, add Qingpi 2 fen; remove if there is rapid breathing and shortness of Qi. For abdominal pain, add Baishaoyao (White Peony Root) 5 fen and Zhigancao (Honey-fried Licorice) 3 fen. If aversion to cold and painful, add Guixin (Cinnamon Twig) 3 fen. If aversion to heat, preference for cold, and abdominal pain, add Sheng Huangqin (Raw Scutellaria) 2-3 fen to the previously added Shaoyao and Gancao. This applies similarly to summer abdominal pain without aversion to heat, treating seasonal heat. If cool weather causes aversion to heat and pain, add a little Guizhi (Cinnamon Twig) to Shaoyao, Gancao, and Huangqin. If cold weather causes abdominal pain, remove Shaoyao because it is sour and cold; add Yizhiren 3 fen, or Banxia 5 fen and Shengjiang 3 slices. If abdominal pain with aversion to cold and wiry pulse, Wood is overacting on Earth; treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction). Shaoyao is sour and acts as the sovereign herb to drain Wood within Earth. If pulse is deep-thin with abdominal pain, treat with Lizhong Tang (Regulate the Middle Decoction). Ganjiang is pungent-hot and acts as the chief herb to drain Water within Earth. If pulse is slow with heavy body and joint pain, abdominal distension, spontaneous diarrhea, and undigested food, Dampness prevails; treat with Pingwei San (Level the Stomach Powder). For hypochondriac pain or constriction, add Chaihu 3 fen, or 5 fen if severe, and Gancao 3 fen. For pain below the navel, add Zhen Shudihuang (True Prepared Rehmannia) 5 fen; pain stops immediately. If not, it is extreme cold; add Rougui 2-3 fen. The *Neijing* states that lower abdominal pain is always a Cold pattern, arising from the law of retribution. The classic says: "Great victory leads to great recovery," changing from heat diseases. This is not a Shaoyin/Jueyin Cold Damage pattern, but Blood stasis in the Bladder in the Lower Jiao; Zhang Zhongjing treats it with Didang Tang and Didang Wan. Body pain indicates Dampness; body heaviness also indicates Dampness; add Wuling San (Five-Ingredient Powder with Poria) without Guizhi, 1 qian. If Wind-Dampness combats, causing whole-body pain, add Qianghuo 7 fen, Fangfeng and Gaoben root each 0.5 qian, Shengma and Cangzhu (Atractylodis Rhizoma) each 1 qian; do not use Wuling San, because Wind herbs already overcome Dampness, so prepare separately. Stop taking if the disease resolves, as Wind herbs damage Yuan Qi and worsen the condition. Urinary incontinence indicates Lung Metal deficiency. Rest and nourish Qi with Huangqi and Renshen. If unresolved, there is Heat; add Huangbai and Shengdihuang each 5 fen; strictly avoid labor. If dreaming frequently while sleeping and urinary dribbling, the pathogen is in Shaoyang and Jueyin; use herbs added for the Taiyang meridian, adding Chaihu 5 fen. If dribbling, add Zexie (Alismatis Rhizoma) 5 fen; this is a combined Cold-Wind and Dampness pattern in the Lower Jiao. The classic says: "Diseases of the Kidney and Liver are treated similarly." Both are in the Lower Jiao; without Wind herbs to move the meridians, it is impossible, as it involves pathogenic Damp-Heat; use ascending and dispersing methods to eliminate it. For constipation and dryness, add Danggui Shao (Tip of Angelicae Sinensis Radix) 1 qian, and Dahuang (Rhei Radix et Rhizoma) wine-washed and baked, 5 fen or 1 qian. If blocked and not moving, take the decocted medicine, first sip the clear liquid, then mix with Xuanningfen (Mirabilite) 5 fen or 1 qian; stop once movement occurs. This disease should not be purged; purging may lead to ominous changes. Weakness and soreness of legs and knees, weakness or pain in walking, indicates latent heat in Liver and Kidney; add Huangbai 5 fen, taken on an empty stomach. If unresolved, add Hanfangji (Stephaniae Tetrandrae Radix) 5 fen. For slow pulse with obvious sinking, fatigue, and weakness, add Cangzhu, Zexie, Renshen, Baizhu, Fuling (Poria), and Wuweizi each 5 fen. The above modifications apply to diseases starting with Heat in the Middle due to diet, overexertion, and emotional dysregulation. If it progresses to Cold in the Middle, it cannot be used. Sweet and Sour herbs sufficiently benefit Qi, such as Huangqi, Renshen, Gancao, Shaoyao, and Wuweizi.
[Internal Injury Initially Manifests as Heat in the Middle, Resembling Exterior Yang Patterns] Severe headache, heavy and stifling sensation in the four limbs, high Qi with panting, body heat and vexation, upper Qi with irregular nasal breathing, four limbs too fatigued to hold themselves, lack of energy for movement or speech, or烦躁闷乱 (restlessness and confusion),心烦不安 (heart vexation and unease), or incessant thirst. In long-standing cases, the pathogen is in the blood vessels; due to Dampness, there is no thirst. If there is thirst, it is because Heart Fire flares upward and overacts on Lung Metal. Or, the exterior is deficient and cannot tolerate wind-cold, eyes do not want to open, aversion to food, loss of taste. The Right Qi Kou pulse is three times larger than the Left Ren Ying pulse. The Qi Kou pulse is urgent, large, and rapid, occasionally showing a Dai (intermittent) pulse and Se (choppy) quality. Se is the native pulse of the Lung. Dai indicates Qi discontinuity, a pulse of Spleen-Stomach insufficiency. Large indicates Flooding. Flooding and rapid indicates Heart Pulse punishing Lung. Urgent indicates Wiry, indicating Liver Wood carrying Heart Fire to punish Lung Metal. The Right Guan Spleen pulse is uniquely large and rapid compared to the other five pulses, with an occasional Dai pulse within the rapidness. This suggests mild overexertion, irregular diet, and improper temperature regulation, resulting in the absence of the Right Guan Stomach pulse due to damage; only the Spleen pulse is visible internally. Treatment uses Buchong Yiqi Tang.
[Internal Injury Progressing to Cold in the Middle, Resembling Exterior Yin Patterns] Abdominal distension, pain in the epigastrium corresponding to the heart, radiating to both hypochondria, diaphragmatic obstruction, salivation, clear nasal discharge, polyuria, pain in the soles of the feet, inability to bear weight, bone fatigue and weakness, frequent spitting, coldness in both testicles, dull pain, hallucinations of ghosts or dreams of the deceased, pain in the lower back, shoulders, scapulae, eyes, spine, and loins, no thirst, no diarrhea, pulse is large and vigorous yet choppy. This is named Cold in the Middle. Treatment uses Shensheng Fuqi Tang, Baizhu Fuzi Tang, and Caodoukou Wan.
[Resembling Exterior Yangming Heat in the Middle Pattern] Illness contracted during extreme heat from labor, road travel, field work, or in frail individuals with poor appetite undergoing labor, or those with long-term vegetarian diets causing chronic Stomach Qi deficiency. Symptoms include intense body heat, restlessness and confusion, extreme aversion to heat, desire to drink water. This resembles the Baihu Tang pattern of Yangming Cold Damage with heat. Shortness of breath and panting from nose and mouth indicate chronic Spleen-Stomach deficiency and insufficient Yuan Qi. Body pain worsens towards evening, accompanied by delirium, heat, thirst, and unceasing vexation. The pulse is flooding, large, empty, or weak. In Baihu Tang patterns, the pulse is flooding, large, and forceful, differing from this internal Heat in the Middle. Treatment uses Qingshu Yiqi Tang (Decoction to Clear Summerheat and Boost Qi). After hunger, fatigue, and labor, body heat, restlessness, thirst, red eyes and face, day and night without cessation, pulse is large and empty, vanishing under heavy pressure. The classic says: "Empty pulse indicates Blood deficiency; Blood deficiency generates heat. The presentation resembles Baihu, distinguished only by the pulse not being long and solid." Misusing Baihu Tang is dangerous; use Huangqi Danggui Buxue Tang (Astragalus and Angelica Blood-Nourishing Decoction).
[Resembling Exterior Aversion to Wind and Cold Pattern] Illness following labor while sitting or lying in cool places, resulting in exterior deficiency unable to tolerate wind-cold, shortness of Qi, reluctance to speak, and weakness. This is due to labor exhausting the body, causing boiling of Yin Fire in the Kidneys. Later, removing clothes or bathing and resting in cool places causes Yin Fire to fail to circulate and return to the skin. The interstices are extremely deficient with no Yang, obstructed by wind and coolness. Thus, exterior deficiency mimics aversion to wind/cold from exterior invasion. Do not treat as exterior invasion; use Buchong Yiqi Tang.
[Internal Injury Resembling Exterior Miscellaneous Patterns] Dietary irregularity and labor injury cause the Middle Jiao (Spleen-Stomach) to become cold, leading to wandering pain and jaundice. Treat with Xiaojianzhong Tang, Lizhong Tang, or Dajianzhong Tang, selecting as appropriate.
[Labor Injury Deficiency with Internal Cold] Lizhong Wan. Heart and Lung are above the diaphragm (Yang); Liver and Kidney are below (Yin). Spleen and Stomach belong to Earth, located in the Middle Jiao, known as the Solitary Organ among the Five Zang, and Middle Jiao among the Three Jiao. Since treatment of the Middle Jiao is central, any imbalance is addressed by this pill, hence named Lizhong Wan. Renshen is sweet and warm. The *Neijing* says: "The Spleen desires relaxation; urgently feed Sweet to relax it." To relax the middle and benefit the Spleen, Sweet is primary; thus Renshen is the Sovereign. Baizhu is sweet and warm. The *Neijing* says: "The Spleen dislikes Dampness; Sweet overcomes Dampness." To warm the middle and overcome Dampness, Sweet assists; thus Baizhu is the Minister. Gancao is sweet and neutral. The *Neijing* says: "Of the five flavors, Sweet enters the Spleen first." For Spleen deficiency, tonify with Sweet; thus Gancao is the Assistant. Ganjiang is pungent and hot. The Stomach prefers warmth and dislikes cold; cold prevents Middle Jiao treatment. The *Neijing* says: "When Cold dominates, level it with Pungent-Hot." To disperse cold and warm the Stomach, Pungent is necessary; thus Ganjiang is the Envoy. The Spleen and Stomach are central; when diseased, pathogenic Qi moves everywhere. Hence, modifications exist. If pulsation below the navel indicates Kidney Qi movement, remove Baizhu and add Guizhi. Qi stagnation without release causes pulsation; Baizhu is sweet and tonifies Qi, removing it allows Qi to scatter. Guizhi is pungent-hot; for Kidney Qi movement threatening Ben Tun (Fleeing Tumor), Pungent-Hot is needed to disperse; thus add Guizhi. For excessive vomiting, remove Baizhu and add Shengjiang. Qi rebellion causes vomiting; Baizhu is sweet and cloying, unsuitable for rebellion. *Qianjin Fang* says: "Vomiters should take much Shengjiang for its pungent dispersion." For excessive diarrhea, retain Baizhu. Qi leakage requires retention; Baizhu’s sweet cloying nature retains Zheng Qi. Some say Dampness causes loose stools; Baizhu specifically drains Dampness, hence added for diarrhea. For palpitations due to fluid accumulation, add Fuling; Fuling is sweet and leaches hidden water. For thirst, double Baizhu to tonify fluids. For abdominal pain due to deficiency, add Renshen ("Tonification removes weakness"). For excess cold, add Ganjiang. For abdominal fullness, remove Baizhu and add Fuzi. The *Neijing* says: "Sweet causes middle fullness"; remove Baizhu. Fuzi is pungent-hot; it overcomes cold with heat and disperses fullness with pungency. Xiaojianzhong Tang: The *Neijing* describes the positions of the four organs surrounding the Spleen (Earth) in the center. The Spleen governs the Middle Jiao, generates Ying and Wei, and circulates fluids. Any imbalance requires this decoction to warm the middle and benefit the Spleen, hence "Constructing the Middle." Jiaoyi (Malt Sugar) is sweet and warm; Gancao is sweet and neutral. To build the Spleen, Sweet is primary; thus Jiaoyi is Sovereign, Gancao is Minister. Guizhi is pungent-hot, dispersing and moistening; for Ying-Wei deficiency, moisten and disperse. Shaoyao is sour and slightly cold, gathering and draining; for fluid blockage, gather and move. Thus Guizhi and Shaoyao are Assistants. Shengjiang is pungent-warm; Dazao (Jujubae Fructus) is sweet-warm. The Stomach is the source of Wei; the Spleen is the root of Ying. The *Ling Shu* says: "Ying emerges from the Middle Jiao, Wei emerges from the Upper Jiao." Wei is Yang; deficiency requires Pungent to tonify. Ying is Yin; deficiency requires Sweet to tonify. Sweet and Pungent combine to establish the Spleen-Stomach and harmonize Ying and Wei.