Formulas · Text · Donguibogam 東醫寶鑑

Internal Damage

Naesang

한글  ·  Pinyin Nei Shang

內傷

Treating illness with food and with medicine 食藥療病

安身之本, 必須於食, 救疾之道, 惟在於藥. 不知食宜者, 不足以全生, 不明藥性者, 不能以除病. 故食能排邪而安藏府, 藥能恬神養性以資血氣. 爲人子者, 不可不知此二事. 是故君父有疾, 期先命食以療之, 食療不愈, 然後命藥. 故孝子深知食藥二性可也. 《千金》

The root of securing the body must be sought in food; the way of rescuing from illness lies only in medicine. One who does not know what foods are fitting cannot keep life whole; one who is not clear on the natures of medicines cannot remove disease. Thus food can expel the evil and quiet the viscera and bowels, and medicine can calm the spirit and nourish the nature so as to fund Blood and Qi. One who would be a true son may not be ignorant of these two things. Therefore when one's lord or father falls ill, first prescribe food to treat it; only when food-treatment does not cure, then prescribe medicine. Hence the filial son knows the two natures — of food and of medicine — deeply.
Clinical note The chapter opens not with a disease but with an ethic — food before drugs, stated as filial duty rather than clinical preference. Sun Simiao's ordering is the whole chapter in miniature: what enters the mouth daily outranks what enters it occasionally, and the physician's first pharmacy is the kitchen.

Cheongeum 千金 — Sun Simiao

Water and grain are the root that nourishes life 水穀爲養命之本

天地間養人性命者, 惟五穀耳. 備土之德, 得氣之中和. 故其味淡甘而性和平, 大補而滲泄, 乃可久食而無厭, 是大有功於人者. 在藥則不然, 雖參ㆍ芪性亦偏, 況攻擊者乎. 《丹心》

Between Heaven and Earth, what nourishes human life is the five grains alone. They are furnished with the virtue of Earth and obtain the centered harmony of Qi; hence their flavor is bland-sweet and their nature even and mild — greatly supplementing yet freely draining — and so they can be eaten long without surfeit. This is their great merit for humankind. With medicines it is not so: even ginseng and astragalus are one-sided in nature — how much more the attacking drugs!
Clinical note Danxi's startling hierarchy — rice above ginseng. The grains' virtue is precisely their blandness: only the unremarkable can be taken daily for a lifetime. Even the chapter's most beloved tonics are here filed under 'one-sided,' a caution written by the tradition's greatest prescriber of them.

Dansim 丹心 — Zhu Danxi

世俗以肉爲補性之物, 然肉無補性, 惟補陽. 而今之虛損者, 不在於陽而在於陰, 以肉補陰, 猶緣木而求魚也. 《丹心》 ○諺有之曰, 人無根本, 水食爲命. 盖脾胃屬土, 主納水穀, 人之根本也. 《丹心》

The common world takes meat to be a thing of supplementing nature — yet meat has no supplementing nature; it supplements only the Yang. And today's vacuity detriment lies not in the Yang but in the Yin: to supplement Yin with meat is like climbing a tree in search of fish. — And there is a proverb: a person has no taproot — water and food are their life. For Spleen and Stomach belong to Earth and govern the intake of water and grain: they are the human root.
Clinical note Two aphorisms that still preach — the polemic against meat-as-panacea (borrowing Mencius's fish-up-a-tree), and the proverb that names the stomach as humanity's substitute for roots. Plants stand in the ground; people stand in their next meal.

Dansim 丹心 — Zhu Danxi

The essence of water and grain transforms into Yin and Yang and moves as construction and defense 水穀之精化陰陽行榮衛

食氣入胃, 濁氣歸心, 淫精於脉. 脉氣流經, 經氣歸於肺, 肺朝百脉, 輸精於皮毛. 毛脉合精, 行氣於府, 府精神明, 留於四藏, 氣歸於權衡. 權衡以平, 氣口成寸, 以決死生. ○飮入於胃, 游溢精氣, 上輸於脾. 脾散精, 上歸於肺, 通調水道, 下輸膀胱. 水精四布, 五經幷行, 合於四時五藏陰陽, 揆度以爲常也. 《內經》

The Qi of food enters the stomach; its rich Qi turns to the heart and steeps its essence into the vessels. The vessel Qi flows through the channels; the channel Qi turns to the lung — the lung holds court over the hundred vessels — and transports essence to skin and hair. Hair and vessels join their essence and move Qi into the bowels; the bowels' essence, spirit-bright, lodges in the four viscera, and the Qi returns to the balance-beam. The balance level, the Qi-mouth forms its inch — and by it life and death are decided. — Drink enters the stomach; its essence-Qi drifts and brims and is carried up to the spleen. The spleen scatters the essence upward to the lung, which frees and regulates the waterways, sending down to the bladder. Water-essence spreads to the four quarters, the five channels move together — joined to the four seasons, the five viscera, and Yin and Yang, measured and gauged as the constant.
Clinical note The Inner Classic's two great circulation hymns, food and drink each given its itinerary — solids to the heart and vessels, fluids through spleen and lung to the bladder. The closing image is the chapter's thesis in an object: the radial pulse as a balance-beam weighing, at the wrist, what the stomach received an hour ago.

Naegyeong 內經

帝曰, 榮衛之行, 柰何. 伯高曰, 穀始入于胃, 其精微者, 先出于胃之兩焦, 以漑五藏, 別出兩行, 榮衛之道. 其大氣之搏而不行者, 積于胸中, 命曰氣海. 出于肺, 循咽喉, 故呼則出, 吸則入. 天地之精氣, 其大數常出三入一. 故穀不入, 半日則氣衰, 一日則氣少矣. 《靈樞》 ○平人穀入於胃, 脉道乃行, 水入於經, 其血乃成. 水去則榮散, 穀消則衛亡. 榮散衛亡, 神無所依. 《綱目》

The Emperor asked: how do construction and defense move? Bogao replied: when grain first enters the stomach, its fine essence issues first from the stomach's two burners to irrigate the five viscera, then parts into two currents — the paths of construction and defense. The great Qi that gathers and does not move accumulates in the chest and is called the Sea of Qi; it issues from the lung and follows the throat — hence with exhalation it goes out, with inhalation it comes in. Of the essential Qi of Heaven and Earth, the great count is ever three parts out to one part in: therefore if grain does not enter, in half a day the Qi wanes, and in one day the Qi is scant. — In the ordinary person, grain enters the stomach and only then do the vessel-paths move; water enters the channels and only then is the blood completed. When water departs, construction scatters; when grain is spent, defense perishes — and construction scattered, defense perished, the spirit has nothing to lean upon.
Clinical note The physiology comes with a countdown — half a day unfed and the Qi wanes, one day and it is scant — and with the chapter's starkest dependency: the spirit itself leans on breakfast. 神無所依, 'the spirit has nothing to rest upon,' is the classical sentence behind every patient whose mood collapsed when their eating did.

Yeongchu 靈樞 · Gangmok 綱目

水穀入胃, 其濁者爲渣滓, 下出幽門, 達大小腸而爲糞, 以出於穀道. 其淸者, 倐然而化爲氣, 依脾氣而上升於肺. 其至淸而至精者, 由肺而灌漑乎四體, 而爲汗涎津唾, 助血脉益氣力, 爲生生不息之運用也. 其淸中之濁者, 下入膀胱而爲尿, 以出乎小便耳. 其未入而在膀胱之外者, 尙爲濁氣, 旣入而在膀胱之內者, 卽化爲水也. 《正傳》

Water and grain enter the stomach. The turbid of it becomes dregs, descends through the dark gate, reaches the large and small intestines, becomes stool, and exits by the grain path. The clear of it transforms in a flash into Qi and, leaning on the spleen Qi, ascends to the lung. The clearest and most quintessential of it is poured from the lung to irrigate the four limbs, becoming sweat, drool, liquid, and spittle, aiding the blood vessels and boosting strength — the working of life engendering life without cease. The turbid within the clear descends into the bladder and becomes urine, exiting by the waterway. What has not yet entered and stands outside the bladder is still turbid Qi; once entered within the bladder, it transforms at once into water.
Clinical note A complete metabolic flowchart in one paragraph — one meal sorted into stool, breath-Qi, the body's four secretions, and urine, each with its gate and direction. The Jeongjeon even pauses on a subtlety modern renal physiology would applaud: the stuff bound for the bladder changes state at the threshold. Everything the chapter will say about damage assumes this sorting-house; internal damage is what happens when the sorter breaks.

Jeongjeon 正傳

Internal damage has two causes — damage from food and drink, and damage from taxing toil 內傷有飮食傷勞倦傷二因

飮養陽氣, 食養陰氣. 飮食無過, 則入於口, 達於脾胃, 入於鼻, 藏於心肺, 氣味相承, 陰陽和調, 神乃自生. 盖精順五氣以爲靈, 若食氣相惡, 則傷其精神. 受五味以成體, 若食味不調, 則傷其形也. 《入門》

Drink nourishes the Yang Qi; food nourishes the Yin Qi. When food and drink are without excess, they enter by the mouth and reach Spleen and Stomach, enter by the nose and are stored in Heart and Lung; Qi and flavor receive each other, Yin and Yang harmonize, and the spirit is born of itself. For the essence follows the five Qi to become numinous — if food and Qi are set against each other, the essence-spirit is damaged; the body is formed by receiving the five flavors — if the flavors of food are unattuned, the form is damaged.

Immun 入門

夫胃爲淸純冲和之氣, 人之所賴以爲生者也. 若謀慮神勞, 動作形苦, 嗜慾無節, 思想不遂, 飮食失宜, 藥餌違法, 皆能致傷. 旣傷之後, 須用調補. 恬不知怪, 而乃恣意犯禁, 舊染之證, 尙未消遣, 方生之證, 與日俱積. 吾見醫藥將日不暇給, 而傷敗之胃氣無復完全之望, 去死近矣. 《東垣》

The stomach is the clear, pure, and gently harmonious Qi — that upon which a person leans in order to live. Scheming and worry that tax the spirit, movement and labor that embitter the form, appetites indulged without measure, longings unfulfilled, food and drink taken unfittingly, medicines used against their law — all of these can inflict the damage. And once damaged, it must be regulated and supplemented. But if one placidly suspects nothing and instead willfully violates the prohibitions, then the old-dyed pattern is not yet dispersed while newly arising patterns pile up with the days. I have seen it: the medicines soon cannot keep pace, the defeated stomach Qi has no further hope of wholeness — and death is near.
Clinical note Dongyuan's grim arithmetic of the untended stomach — old damage compounding with new until treatment can no longer keep pace with living. The list of causes is notably not dietary alone: worry, overwork, thwarted desire, and misused medicine stand beside the meals. The stomach, in his accounting, absorbs the whole of a life.

Dongwon 東垣 — Li Dongyuan

王安道曰, 勞倦傷飮食傷, 二者不可混而爲一. 勞倦傷, 誠不足也. 飮食傷, 尤當於不足之中, 分其有餘不足也. 何者, 盖飢餓不飮食, 與飮食太過, 雖皆失節, 然必明其兩者之分. 夫飢餓不飮食者, 胃氣空虛, 此爲不足, 固失節也. 飮食自倍而停滯者, 胃氣受傷, 此不足之中兼有餘, 亦失節也. 《東垣》

Wang Andao said: damage from taxing toil and damage from food and drink — the two may not be blurred into one. Taxation damage is truly insufficiency. Food damage, however, must be further divided, within the insufficiency, into its surplus and its insufficiency. How so? Starving without food, and eating to great excess, are both losses of measure — yet the two must be clearly told apart. In the one who starves and does not eat, the stomach Qi is empty and vacant: this is insufficiency, a loss of measure indeed. In the one whose eating doubles itself and stagnates, the stomach Qi is damaged: this is surplus joined within insufficiency — also a loss of measure.
Clinical note The chapter's central algebra, stated once and assumed everywhere after — toil subtracts; overeating subtracts and adds at once, leaving a weakened stomach with a full house. Every treatment decision to come (disperse? supplement? both, in what order?) is an answer to which side of this equation the patient sits on.

Dongwon 東垣, citing Wang Andao

Pulse method 脉法

勞倦傷亦有二焉. 勞力純乎傷氣, 勞心兼傷乎血. 房勞傷腎, 與勞倦相似. 七情動氣, 脉與飮食無二. ○勞倦傷, 手按心口不痛, 飮食傷, 手按心口刺痛. 《入門》

Taxation damage is itself twofold: toil of the body damages purely the Qi; toil of the mind damages the Blood as well. Bedroom taxation damages the Kidney and resembles ordinary taxation; the seven affects stirring the Qi give a pulse no different from food damage. — In taxation damage, pressing the hand over the pit of the stomach brings no pain; in food damage, pressing there brings stabbing pain.
Clinical note Amid the pulse lore, one maneuver that needs no wrist at all — press the epigastrium: tender means food, quiet means toil. A bedside differential of two seconds, and essentially the same palpation a modern intake performs for the same reason.

Immun 入門

趺陽脉浮而數, 浮則傷胃, 數則傷脾. ○寸口脉緊, 胸中有宿食不化. ○脉緊如轉索無常者, 有宿食也. 《仲景》 ○陽脉滑而緊, 滑則胃氣實, 緊則脾氣傷, 得食不消者, 此脾不和也. ○脉浮滑而疾者, 食不消, 脾不磨也. 《東垣》 ○氣口緊盛, 爲傷於食, 食不消化, 浮滑而疾. ○內傷勞役豁大不禁, 若損胃氣隱而難尋, 內傷飮食滑疾浮沈. 《脉訣》

The instep-Yang pulse floating and rapid: floating, the stomach is damaged; rapid, the spleen is damaged. — A tight pulse at the inch-mouth: abiding food in the chest, untransformed. — A pulse tight like a twisting rope, without constancy: there is abiding food (Junggyeong 仲景). — A Yang pulse slippery and tight: slippery, the stomach Qi is replete; tight, the spleen Qi is damaged — food taken and not dispersed is the spleen out of harmony. A pulse floating, slippery, and racing: food undispersed, the spleen not grinding (Dongwon 東垣). — The Qi-mouth tight and exuberant means damage by food, food undigested, floating-slippery and racing. In internal damage from taxing labor the pulse is gaping-large and unrestrained; where the stomach Qi is injured it hides and is hard to find; in internal damage from food and drink it is slippery, racing, floating, or sunken. (Maekgyeol 脉訣)
Clinical note The pulse pictures sort along the same algebra as Wang Andao's — food damage reads replete at the wrist (tight, slippery, racing: a full house), while pure taxation reads gaping or hidden (an empty one). The rope that twists without constancy is the classical image for a gut arguing with last night's dinner.

Junggyeong 仲景 · Dongwon 東垣 · Maekgyeol 脉訣

Patterns of food damage 食傷證

飮食自倍, 腸胃乃傷. ○水穀之寒熱, 感則害人六府. ○因而飽食, 筋脉橫解, 腸澼爲痔. ○陰之所生, 本在五味, 陰之五宮, 傷在五味. 註曰, 陰謂五藏也. 《內經》

When eating doubles itself, intestines and stomach are thereupon damaged. — The cold and heat of water and grain, when they strike, harm the six bowels. — Gorging upon it, the sinews and vessels slacken crosswise, and intestinal afflux becomes hemorrhoids. — What engenders the Yin is rooted in the five flavors; the five palaces of the Yin are damaged by the five flavors. The commentary: the Yin means the five viscera.
Clinical note Four sentences from the Inner Classic that found the whole section, ending on its sharpest paradox — the five flavors that build the viscera are the same five that wound them. Nourishment and damage differ not in substance but in measure: the chapter's first principle, delivered by its oldest voice.

Naegyeong 內經

傷食之證, 氣口脉必緊盛, 胸膈必痞塞, 噫氣如敗卵氣臭, 亦有頭痛身熱, 但身不痛爲異耳. 《丹心》 ○宿食不消, 則獨右關脉沈而滑. 經云, 脉滑者, 有宿食也. 《丹心》

In the pattern of food damage, the Qi-mouth pulse is invariably tight and exuberant, the chest and diaphragm invariably glomus-blocked, and the belching Qi is foul like rotten eggs; there may also be headache and body heat — only, the body does not ache: that is the distinction. — When abiding food does not disperse, the right bar pulse alone is sunken and slippery. The Classic says: a slippery pulse means abiding food.
Clinical note The rotten-egg belch is the section's signature sign — sulfurous eructation from a meal fermenting where it stalled, a symptom so specific patients still describe it in exactly these words. And the closing distinction is the external-contraction differential in miniature: fever with headache, yes, but the body does not ache — this cold is not a cold.

Dansim 丹心

傷食因多飡, 飮食不能運化, 停於胸腹, 飽悶惡食不食, 噯氣作酸, 下泄臭屁, 或腹痛吐瀉, 重則發熱頭痛. 左手關脉平和, 右手關脉緊盛, 此傷食也. ○盖食物飽甚, 耗氣非一. 或食不下而上涌, 嘔吐以耗靈源, 或飮不消而作痰, 咯唾以耗神水. 大便頻數而泄, 耗穀氣之化生, 溲便滑利而濁, 耗源泉之浸潤. 至於精淸冷而下漏, 汗淋瀝而自泄, 莫不由食物之過傷, 滋味之太厚也. 《回春》

Food damage comes of eating too much: what is eaten cannot be moved and transformed, and it halts in chest and abdomen — stuffed oppression, aversion to food and refusal to eat, sour belching, foul flatus passing below, perhaps abdominal pain with vomiting and diarrhea, and in the severe, heat effusion and headache. The left bar pulse even and calm, the right bar tight and exuberant: this is food damage. — For when food fills to excess, the wasting of Qi is not of one kind. Food that will not go down surges upward, and vomiting wastes the numinous source; drink undispersed becomes phlegm, and hawking spittle wastes the spirit-water. Stool frequent and discharging wastes the engendering transformation of grain Qi; urine slick and turbid wastes the moistening of the wellspring. Even essence turning thin and cold and leaking below, and sweat dribbling out of itself — none of it but arises from the excess-damage of food, from savors too rich.
Clinical note The Hoechun's ledger of a single oversized meal — every exit of the body itemized as a separate account being drained: vomit, phlegm, stool, urine, seminal loss, sweat. The closing indictment of 'savors too rich' reads uncomfortably well four centuries into the age of the rich savor; this is the classical text's case study in metabolic overload.

Hoechun 回春

Methods of treating food damage 食傷治法

凡飽則傷肺, 飢則傷氣. 《得效》 ○食者, 有形之物, 傷之則宜損其穀. 其次莫若消導, 丁香爛飯丸ㆍ枳朮丸之類主之. 稍重則攻化, 三稜消積丸ㆍ木香見睍丸之類主之. 尤重則或吐之, 或下之. 《丹心》

Gorging damages the Lung; starving damages the Qi (Deukhyo 得效). — Food is a thing with form: when it has done the damage, first reduce the grain itself. Next, nothing surpasses dispersing and abducting — the likes of Jeonghyangnanban-hwan and Jichul-hwan 枳朮丸 govern it. Somewhat heavier, then attack and transform — the likes of Samreungsojeok-hwan and Mokhyanggyeonhyeon-hwan govern it. Heavier still — then vomit it out, or purge it down. (Dansim 丹心)
Clinical note Danxi's escalation ladder, and its first rung is not a drug — eat less. Only then the gentle dispersers, then the attackers, and only at the top the emetics and purgatives. A four-step protocol whose opening prescription costs nothing and is still the hardest one to fill.

Deukhyo 得效 · Dansim 丹心

夫飢餓不飮食, 與飮食太過, 雖皆失節, 然必明其兩者之分. 夫飢餓胃虛, 此爲不足, 飮食停滯者, 此爲有餘. 惟其不足故補益, 惟其有餘故消導. 人之盛衰不同, 又有物滯氣傷, 必須補益消導兼行者. 亦有物暫滯而氣不甚傷, 宜消導獨行, 不須補益者. 亦有旣停滯而復自化, 不須消導, 但當補益者. 易老枳朮丸, 東垣橘皮枳朮丸, 雖曰消導, 固有補益之意存乎其間. 若所滯之物, 非枳朮丸所能去, 則備急丸 方見救急ㆍ煮黃丸, 當推逐而去之. 觀乎此, 則知消導補益之理矣. 《東垣》

Starving without food and eating to great excess are both losses of measure, yet the two must be clearly distinguished: the starved stomach is vacant — this is insufficiency; food halted and stagnant — this is surplus. For insufficiency, therefore, supplement and boost; for surplus, therefore, disperse and abduct. But people flourish and decline unalike: there are those in whom the matter stagnates and the Qi is damaged, where supplementing and dispersing must go together; those in whom the matter stalls briefly and the Qi is little hurt, where dispersing goes alone and no supplement is needed; and those in whom what had stalled transforms again of itself, where no dispersing is needed and one should only supplement. Yilao's Jichul-hwan and Dongyuan's Gyulpijichul-hwan, though called dispersers, assuredly carry the intent of supplementation within them. And if what has stalled is beyond what Jichul-hwan can remove, then Bigeup-hwan — formula in the Emergencies chapter — and Jahwang-hwan must push and expel it. Contemplate this, and the principle of dispersing versus supplementing is known.
Clinical note The decision tree the whole chapter runs on — four patient types, four treatment shapes, and the disclosure that the flagship 'disperser' is secretly half a tonic. Dongyuan's closing invitation to contemplate is earned: this paragraph is the internal-damage clinic's entire triage logic in one breath.

Dongwon 東垣 — Li Dongyuan

Dispersing and abducting medicines for food damage 食傷消導之劑

傷食則必惡食, 胸中有物. 宜導痰補脾, 二陳湯 方見痰飮, 加白朮ㆍ山査ㆍ川芎ㆍ蒼朮. 《丹心》 ○補脾胃藥內必用心經藥, 盖火能生土故也. 古方用益智仁, 正是此意. 《丹心》 ○傷寒物者, 半夏ㆍ神麴ㆍ乾薑ㆍ三稜ㆍ蓬朮ㆍ巴豆之類主之. 傷熱物者, 枳實ㆍ白朮ㆍ靑皮ㆍ陳皮ㆍ麥芽ㆍ黃連ㆍ大黃之類主之. 《東垣》

One damaged by food will invariably loathe food, with a something lodged in the chest: abduct the phlegm and supplement the spleen — Ijin-tang 二陳湯 — formula in the Phlegm-Rheum chapter — with white atractylodes, hawthorn, cnidium, and atractylodes added (Dansim 丹心). — Within spleen-stomach supplementing formulas, a Heart-channel medicinal must be used, for Fire can engender Earth; the old formulas' use of alpinia is exactly this intent (Dansim 丹心). — For damage by cold foods: the likes of pinellia, medicated leaven, dried ginger, sparganium, curcuma, and croton govern it. For damage by hot foods: the likes of unripe bitter orange, white atractylodes, green tangerine peel, tangerine peel, barley sprout, coptis, and rhubarb govern it. (Dongwon 東垣)
Clinical note Three working rules before the formulary opens — the food-averse patient with a 'something' in the chest gets phlegm treatment, every spleen tonic smuggles in a heart herb because Fire is Earth's mother, and the pharmacy splits by the temperature of what was eaten: warm drugs for the cold meal, cold drugs for the hot one. Damage keeps the thermal signature of its cause.

Dansim 丹心 · Dongwon 東垣

宿食消化, 宜用枳朮丸ㆍ橘皮枳朮丸ㆍ木香枳朮丸ㆍ半夏枳朮丸ㆍ麴糵枳朮丸ㆍ橘半枳朮丸ㆍ橘連枳朮丸ㆍ三黃枳朮丸ㆍ平胃散 方見五藏ㆍ香砂平胃散ㆍ加味平胃散ㆍ棗肉平胃散ㆍ內消散ㆍ消滯丸ㆍ加減保和丸ㆍ七香元ㆍ枳實導滯丸ㆍ木香化滯湯ㆍ豆蔲橘紅散ㆍ香殼丸ㆍ二黃丸ㆍ三稜消積丸ㆍ穀神元. 《諸方》 ○食麥多令人腹脹, 煖酒和薑汁, 飮一兩盃卽消. 《得效》

Clinical note The disperser cabinet in full — eight variations on one two-herb theme (Jichul-hwan grows a new co-pilot for each complication), four grades of Pyeongwi-san, and a dozen heavier movers, closing with a folk remedy for the barley bloat that costs a cup of warm wine. Entries link as their pages arrive; the two flagship families are already open.

Various formularies 諸方

荷葉包飯爲丸, 恐不能盡荷葉之味, 不若以荷葉煮粥用之更妙. 《丹心》 ○初未悟荷葉燒飯爲丸之理, 老年味之始得, 可謂奇矣. 夫荷葉之物, 中央空, 象震卦之體. 人感之, 生足少陽甲膽, 先化萬物之根蔕也. 飮食入胃, 榮氣上行, 卽少陽甲膽之氣也. 荷葉色靑, 形乃空, 象風木者也. 食藥感此氣之化, 胃氣何由不上升乎. 以爲引用, 可謂遠識深慮, 合於道也. 《東垣》

Wrapping rice in a lotus leaf to bind the pills may fail to draw out the leaf's full flavor — better to boil the leaf into gruel and use that: finer still (Dansim 丹心). — At first I did not grasp the principle of the lotus-leaf-baked rice binding; only in old age, savoring it, did I finally obtain it — marvelous indeed. The lotus leaf is a thing hollow at its center, imaging the body of the Thunder hexagram. Stirred by it, a person engenders the foot-lesser-Yang wood-gallbladder Qi — the very root and stem that first transforms the ten thousand things. When food and drink enter the stomach and the construction Qi ascends, that is precisely this lesser-Yang gallbladder Qi. The lotus leaf is green in color and hollow in form, imaging Wind and Wood. When food and medicine are touched by the transformation of this Qi, how could the stomach Qi fail to ascend? To take it as the conductor may be called far sight and deep forethought — in accord with the Way.
Clinical note The chapter's most beautiful footnote — a lifetime after prescribing the lotus-leaf binder, Dongyuan finally explains it to himself: the hollow green leaf is the Thunder hexagram, is spring wood, is the gallbladder Qi that lifts every digestion. The excipient was the doctrine all along. And Danxi, ever practical, adds that the gruel extracts it better.

Dansim 丹心 · Dongwon 東垣

Supplementing and boosting medicines for food damage 食傷補益之劑

宿食吐下後, 氣虛, 宜補, 四君子湯 方見氣門ㆍ六君子湯 方見痰飮ㆍ補中益氣湯. 《入門》

After abiding food has been vomited or purged away and the Qi stands vacuous, one should supplement: Sagunja-tang 四君子湯 — formula in the Qi chapter —, Yukgunja-tang 六君子湯 — formula in the Phlegm-Rheum chapter —, and Bojungikgi-tang 補中益氣湯.
Clinical note The escalation ladder's epilogue — once the emetics and purgatives have done their eviction, the chapter turns immediately to repairing the house. The three formulas named are the tradition's plainest Qi restoratives: what follows demolition is always the Four Gentlemen.

Immun 入門

食傷胃弱, 宜用醒脾育胃湯ㆍ參朮健脾湯ㆍ七珍散ㆍ八珍散ㆍ健胃保和元ㆍ養脾丸ㆍ八味理中丸ㆍ滋脾丸ㆍ異功散 方見五藏ㆍ健脾丸ㆍ參苓壯脾元ㆍ千金養脾元.

Clinical note The supplementing cabinet complete, and completely linked — twelve answers running from millet-and-ginseng powders to the twenty-five-herb warm pantry, sorted in practice by one question: is this stomach weak, cold, or both? Wang Andao's other column, now fully stocked.

Donguibogam · Naesang

Wine damage 酒傷

酒入於胃, 則絡脉滿而經脉虛. 脾主爲胃行其津液者也. 陰氣虛則陽氣入, 陽氣入則胃不和, 胃不和則精氣竭, 精氣竭則不營其四肢也. ○醉飽入房, 則氣聚脾中而不得散, 酒氣與穀氣相薄, 熱盛於中. 故熱遍於身, 內熱而尿赤也. ○因而大飮則氣逆. 註曰, 飮多則肺布葉擧, 故氣逆而上奔也. 《內經》

When wine enters the stomach, the network vessels fill while the channel vessels empty. The spleen is what moves the stomach's liquids for it: when the Yin Qi is vacuous the Yang Qi enters; the Yang Qi entering, the stomach loses harmony; the stomach disharmonious, the essence Qi is exhausted; and the essence Qi exhausted, the four limbs go unnourished. — Entering the bedchamber drunk and full, the Qi gathers in the spleen and cannot scatter; the wine Qi and the grain Qi press upon each other and heat flares in the center — hence heat spreads through the body, and with the internal heat the urine runs red. — Drinking greatly upon it, the Qi counterflows. The commentary: with much drink the lung's lobes spread and lift, and so the Qi counterflows and rushes upward.
Clinical note The Inner Classic's three-part physiology of a bender — vessels flooded and emptied at once, the drunken bedchamber as a heat engine, and the counterflow of the over-full lung. The middle passage is the ancestor of every warning this chapter will issue: wine's worst work is done in combination.

Naegyeong 內經

酒者, 五穀之津液, 米麴之華英, 雖能益人, 亦能損人. 何者, 酒有大熱大毒. 大寒凝海, 惟酒不氷, 是其熱也. 飮之昏亂, 易人本性, 是其毒也. 若辟風寒, 宣血脉, 消邪氣, 引藥勢, 無過於酒也. 若醉飮過度, 盆傾斗量, 毒氣攻心, 穿腸腐脇, 神昏錯謬, 目不見物, 此則喪生之本也. 《類聚》

Wine is the liquid essence of the five grains, the flowering glory of rice and leaven — able to benefit a person, and able to harm one. How so? Wine possesses great heat and great toxin. When great cold congeals the sea, wine alone does not freeze: that is its heat. Drunk, it clouds and disorders, changing a person's very nature: that is its toxin. For repelling wind and cold, freeing the blood vessels, dispersing evil Qi, and conducting the force of medicines, nothing surpasses wine. But drunk to excess — tipped by the basin, measured by the peck — its toxic Qi assaults the heart, pierces the intestines, rots the flanks; the spirit darkens into error and the eyes cease to see: this then is the root of losing one's life.
Clinical note The tradition's most balanced verdict on alcohol, hinged on one unforgettable proof — the sea freezes, wine does not. Solvent, circulatory aid, and drug-courier on one side; the basin-tipped ruin of heart, gut, and sight on the other. Everything the chapter prescribes next lives between these two sentences.

Yuchwi 類聚

酒者, 大熱有毒, 氣味俱陽, 乃無形之物也. 若傷之, 止當發散, 汗出則愈矣. 其次莫如利小便, 使上下分消其濕可也. 葛花解酲湯主之. 《東垣》 ○酒雖與水同體, 然傷於腸胃, 則升之不散, 降之不下, 鬱於氣分無形之位. 今人飮醇酒則小便少, 此其可驗. 故治法宜汗宜利小便爲上策. 東垣以爲無形之物固不可, 後人以傷飮食同治亦不可. 《丹心》

Wine is greatly hot and toxic, its Qi and flavor both Yang — a thing without form. When it has done the damage, one should simply effuse and scatter: sweat comes out, and it is cured. Next best is nothing other than freeing the urine, letting the damp be dispersed and consumed above and below. Kudzu Flower Sober-Up Decoction governs it (Dongwon 東垣). — Yet wine, though one body with water, when it damages the intestines and stomach neither scatters on being raised nor descends on being downborne, but depresses in the formless station of the Qi aspect. That people who drink strong wine pass little urine — this is the proof. Hence the methods of treatment: sweating and freeing the urine are the highest strategy. But Dongyuan's calling it a formless thing will assuredly not do — and later men's treating it identically with food damage will not do either. (Dansim 丹心)
Clinical note A live methodological quarrel preserved mid-sentence — master and successor agreeing entirely on the treatment (two exits: sweat and urine) while disputing the metaphysics. Danxi's position is the working one: wine is neither formless vapor nor stalled food but a third thing, and the little-urine observation he offers as proof is one any Friday-night clinician can replicate.

Dongwon 東垣 · Dansim 丹心

酒醉, 宜以熱湯漱口, 盖其毒在齒也. 大醉則以熱湯於密室洗面數次, 梳頭數十遍卽醒. 《丹心》 ○酒食傷積, 或被人勸過傷, 以鹽花擦牙, 溫水漱下, 不過三次卽爲通快. 《醫鑑》 ○一方, 靑皮(炒) 二兩, 葛根 一兩, 縮砂 五錢. 右爲細末, 濃茶調一二錢, 服之能醒酒消食. 《丹心》

When drunk on wine, rinse the mouth with hot water — for the toxin lodges in the teeth. When greatly drunk, wash the face several times with hot water in a closed room and comb the hair some tens of strokes: one sobers at once (Dansim 丹心). — For wine-and-food damage accumulated, or damage from being pressed by others to excess: rub the teeth with flower-of-salt and rinse it down with warm water — within three times, all is freed and eased (Uigam 醫鑑). — Another formula: dry-fried green tangerine peel 2 nyang, kudzu root 1 nyang, amomum 5 don, finely powdered; 1–2 don stirred into strong tea sobers from wine and disperses food. (Dansim 丹心)
Clinical note Sobering without a single decoction — hot rinses, a salt tooth-scrub, a hundred comb-strokes in a warm room. The tooth doctrine ('the toxin lodges in the teeth') is folk empiricism of a high order: the mouth does hold the night's residue, and the ritual it prescribes is, step for step, a very good end-of-party protocol.

Dansim 丹心 · Uigam 醫鑑

醒酒不醉, 宜萬盃不醉丹ㆍ神仙不醉丹ㆍ醉鄕寶屑ㆍ益脾丸ㆍ龍腦湯ㆍ葛花散ㆍ三豆解酲湯.

Clinical note The never-drunk cabinet, fully linked — seven graduated answers from the imperial two-flower couplet to the ox-bile masterwork, a pharmacology built for a world where the next round could not be refused. Read today, the cabinet doubles as social history: its existence is the measure of the pressure.

Donguibogam · Naesang

Prohibitions in drinking wine 飮酒禁忌

酒不過三盃, 多則傷五藏, 亂性發狂. 《活人心》 ○飮酒不欲過多, 多則速吐之爲佳. ○醉後不可强食, 或發癰疽. ○醉臥當風, 使人失音. ○醉飽不可走車馬及跳越. ○醉不可入房, 小者面䵟咳嗽, 大者傷絶藏脉, 損壽命. 《得效》 ○凡面白人, 不可多飮酒, 耗血故也. 《丹心》 ○勿飮濁酒食麪, 使塞氣孔. 《入門》 ○酒客病, 不可服桂枝湯, 得湯則嘔, 以酒客不喜甘故也. 凡甘物皆宜忌之. 《仲景》

Wine should not pass three cups: more damages the five viscera, disorders the nature, and breaks into mania (Hwalinsim 活人心). — Do not wish to drink to excess; if excess, vomiting it out quickly is best. — After drunkenness one must not force food, lest welling- and flat-abscesses arise. — Lying drunk in a draft makes a person lose the voice. — Drunk and full, one must not race carts and horses or leap and vault. — Drunk, one must not enter the bedchamber: at the least, facial dark spots and cough; at the worst, the visceral vessels damaged to severance and the lifespan cut (Deukhyo 得效). — A white-faced person must not drink much wine, for it wears the Blood (Dansim 丹心). — Do not drink turbid wine and then eat noodles, which stops up the pores of Qi (Immun 入門). — The wine-lover fallen ill must not take Cinnamon Twig Decoction — given the decoction, he vomits, for wine-lovers do not favor the sweet: all sweet things should be avoided (Junggyeong 仲景).
Clinical note Five centuries of drinking wisdom in one paragraph of prohibitions — the three-cup ceiling, the drunk bedroom warned against twice over in this chapter, and Zhongjing's pharmacological gem closing the list: the habitual drinker's palate turns against sweetness itself, and the prescription must follow the palate.

Hwalinsim 活人心 · Deukhyo 得效 · Dansim 丹心 · Immun 入門 · Junggyeong 仲景

當酒未醒, 大渴之際, 不可喫水及啜茶. 多被酒引入腎藏, 爲停毒之水, 令腰脚重墜, 膀胱冷痛, 兼水腫消渴攣躄之疾. 酒雖可以陶性情通血脉, 自然招風敗腎, 爛腸腐脇, 莫過於此. 飽食之後, 尤宜忌之. 飮酒不宜麄及速, 恐傷破肺也. 《活人心》

While the wine has not yet cleared and the great thirst is upon one, one must not gulp water or sip tea — much of it is led by the wine into the kidney treasury, where it becomes standing toxic water, making the lumbus and legs heavy and dragging, the bladder cold and painful, joined by water swelling, wasting-thirst, and the hypertonic crippling ills. Wine can indeed mellow the temperament and free the blood vessels — yet for inviting wind and ruining the kidney, rotting the intestines and putrefying the flanks, nothing surpasses it: after a full meal, avoid it above all. And do not drink coarsely or fast, for fear of damaging and bursting the lung. — Hwalinsim 活人心
Clinical note The most counterintuitive rule in the section — no water on the unrisen wine — reasoned through a hydraulic image: fluid chasing alcohol into the kidney and pooling there as 'standing toxic water.' Beneath the pre-modern plumbing sits a real observation about the drinking night's fluid chaos, and the paragraph's even-handed close (wine mellows; wine rots) is the chapter's verdict in miniature.

Hwalinsim 活人心

Wine toxin transforms into the various diseases 酒毒變爲諸病

醇酒之性, 大熱有大毒. 淸香美味, 旣適於口, 行氣和血, 亦宜於體, 由是飮者不自覺其過於多也. 不知酒性喜升, 氣必隨之, 痰鬱於上, 尿澁於下, 肺受賊邪, 金體必燥, 恣飮寒涼, 其熱內鬱, 肺氣得熱, 必大傷耗. 其始也病淺, 或嘔吐, 或自汗, 或瘡痍, 或鼻皻, 或自泄, 或心脾痛, 尙可發散而去之. 及其久而病深, 則爲消渴, 爲黃疸, 爲肺痿, 爲內痔, 爲鼓脹, 爲失明, 爲哮喘, 爲勞嗽, 爲癲癎, 爲難明之疾. 倘非具眼, 未易處治, 可不謹乎. 《丹心》

Strong wine's nature is greatly hot and greatly toxic. Clear-fragrant and fine of flavor, it suits the mouth; moving Qi and harmonizing Blood, it suits the body too — and thus the drinker never notices passing into excess. He does not know that wine's nature loves to rise, and the Qi must follow it: phlegm depresses above, urine turns rough below; the lung receives the thieving evil and the Metal body must dry; and when one drinks the cold and cool at will, that heat depresses inward — the lung Qi, meeting heat, must be greatly damaged and worn. At the start the illness is shallow — vomiting perhaps, or spontaneous sweat, or sores, or a blossoming nose, or spontaneous diarrhea, or heart-spleen pain — and it can still be effused, scattered, and removed. But when it has lasted and deepened, it becomes wasting-thirst, becomes jaundice, becomes lung wilting, becomes internal hemorrhoids, becomes drum distension, becomes loss of sight, becomes wheezing panting, becomes taxation cough, becomes epilepsy — becomes the illnesses hard to fathom. Without the furnished eye, they are not easily treated: can one fail to be careful?
Clinical note Danxi's natural history of alcohol disease, staged like a modern hepatology lecture — the honeymoon (it suits the mouth, it suits the body), the silent mechanism (what loves to rise drags the Qi with it), the reversible early signs, and the register of end-stage transformations running from diabetes and jaundice to blindness and seizures. Six centuries early, the list maps with unsettling accuracy onto alcohol's known sequelae — and the closing question still ends every lecture on the subject.

Dansim 丹心 — Zhu Danxi

Methods of treating wine illness 酒病治法

久飮酒者, 藏府積毒, 致令蒸筋傷神損壽. 《得效》 ○飮酒過多成病, 宜葛花解酲湯ㆍ酒蒸黃連丸 方見血門ㆍ百杯丸ㆍ對金飮子ㆍ解酒化毒散ㆍ葛黃丸ㆍ升麻葛根湯 方見寒門. ○中酒頭痛嘔吐眩暈, 補中益氣湯, 去白朮, 加半夏ㆍ白芍藥ㆍ黃芩ㆍ黃柏ㆍ乾葛ㆍ川芎. 或對金飮子, 加乾葛ㆍ赤茯苓ㆍ半夏 各一錢, 煎服. 《入門》

In the long drinker, the viscera and bowels accumulate the toxin, till it steams the sinews, damages the spirit, and cuts the lifespan (Deukhyo 得效). — Where drinking to excess has become illness, appropriate are Galhwahaejeong-tang 葛花解酲湯, Jujeunghwangryeon-hwan 酒蒸黃連丸 — formula in the Blood chapter —, Baekbae-hwan 百杯丸, Daegeum-eumja 對金飮子, Haejuhwadok-san 解酒化毒散, Galhwang-hwan 葛黃丸, and Seungmagalgeun-tang 升麻葛根湯 — formula in the Cold chapter —. — For wine-struck headache, vomiting, and dizziness: Bojungikgi-tang 補中益氣湯 minus the atractylodes, with pinellia, white peony, scutellaria, phellodendron, kudzu root, and cnidium added; or Daegeum-eumja 對金飮子 with kudzu root, red poria, and pinellia, 1 don each, added, decocted and taken.
Clinical note The wine ward's formulary shelf, and its quiet centerpiece is a modification — even here, at the far end of the chapter's drinking arc, the answer to the wine-struck head circles back to Bojungikgi-tang, retuned with coolers and kudzu. The doctrine holds to the last: whatever the insult, the center is where treatment begins.

Deukhyo 得效 · Immun 入門

Damage from taxing toil 勞倦傷

黃帝曰, 陰虛生內熱, 柰何. 岐伯曰, 有所勞倦, 形氣衰少, 穀氣不盛, 上焦不行, 下脘不通, 而胃氣熱, 熱氣熏胸中, 故內熱. 《內經》 ○此內傷之原也. 此陰虛, 盖指身中之陰氣與水穀之味耳. 《入門》

The Yellow Emperor asked: Yin vacuity engendering internal heat — how is this? Qibo replied: where there has been taxing toil, the form's Qi wanes and lessens and the grain Qi does not flourish; the upper burner does not move and the lower stomach duct does not open through, and so the stomach Qi grows hot — the hot Qi fumes the chest, hence internal heat. — This is the very origin of internal damage. The 'Yin vacuity' here refers simply to the Yin Qi within the body and the flavors of water and grain. (Immun 入門)
Clinical note The founding text of the whole taxation doctrine — overwork produces a fever, and the mechanism runs through the stomach, not an invading pathogen. The Immun's gloss quietly redefines 'Yin vacuity' as nutritional depletion: the heat of the exhausted is the heat of the underfed.

Naegyeong 內經 · Immun 入門

喜怒不節, 起居不時, 有所勞倦, 皆損其氣. 氣衰則火旺, 火旺則乘脾土. 脾主四肢, 故困熱無氣以動, 懶於言語, 動作喘乏, 表熱自汗, 心煩不安. 當安心靜坐, 以養其氣, 以甘寒瀉其熱火, 酸味收其散氣, 甘溫調其中氣. 《東垣》 ○勞則氣散, 氣短喘且汗出, 內外皆越, 故氣耗矣. 《內經》

Joy and anger without measure, rising and resting out of season, and taxing toil — all of these damage the Qi. The Qi waning, fire grows effulgent; fire effulgent, it rides upon Spleen Earth. The spleen governs the four limbs — hence weary heat with no Qi to move, sloth in speech, panting exhaustion at any motion, surface heat with spontaneous sweat, and a vexed unquiet heart. One should quiet the mind and sit still to nourish the Qi; with the sweet and cold, drain the hot fire; with the sour flavor, gather the scattered Qi; with the sweet and warm, attune the center Qi. — For with taxation the Qi scatters: breath short, panting, sweat escaping — overflowing inward and outward alike, and so the Qi is worn away. (Naegyeong 內經)
Clinical note Dongyuan's portrait of burnout, feature by feature — the fatigue that is somehow feverish, the reluctance to speak, the sweat at rest — and the four-flavor treatment plan whose third clause ('with the sweet and warm, attune the center') is the seed from which Bojungikgi-tang grows. The first prescription, though, is neither herb nor flavor: sit down and be quiet.

Dongwon 東垣 · Naegyeong 內經

Distinguishing internal damage from external contraction 辨內外傷證

外感內傷, 乃病之大關鍵, 於此昧焉, 何足云醫. 丹溪云, 內傷證皆以補元氣爲主, 看所挾而兼用藥. 但先生之言, 引而不發, 予今補之. 如內傷挾外感者, 則於補中益氣湯內, 春加川芎ㆍ防風ㆍ柴胡ㆍ荊芥ㆍ紫蘇ㆍ薄荷, 夏加乾葛ㆍ石膏ㆍ麥門冬ㆍ薄荷, 倍升柴, 秋加羌活ㆍ防風ㆍ荊芥, 冬加麻黃ㆍ桂枝ㆍ乾薑之類. 《方廣》

External contraction and internal damage — this is the great hinge and key of illness: one dim on this point, how could he be called a physician? Danxi said that in internal-damage patterns, supplementing the origin Qi is always the governing method, with joined drugs added according to what the case carries alongside. But the master's words drew the bow without loosing the arrow — I now supply it. Where internal damage carries external contraction: within Bojungikgi-tang, in spring add cnidium, saposhnikovia, bupleurum, schizonepeta, perilla, and mint; in summer add kudzu root, gypsum, ophiopogon, and mint, doubling the cimicifuga and bupleurum; in autumn add notopterygium, saposhnikovia, and schizonepeta; in winter add the likes of ephedra, cinnamon twig, and dried ginger.
Clinical note The section opens with a credential exam — miss this distinction and surrender the title of physician — then Fang Guang finishes Danxi's unloosed arrow with a full seasonal modification table for the compound case. The base never changes: tonify the center, and let the calendar choose the escort.

Bang Gwang 方廣

傷寒惡寒, 雖近猛火不除, 內傷惡寒, 稍就溫暖卽止, 但見風寒便惡之也. ○傷寒惡風, 不耐一切風寒, 內傷惡風, 偏惡些少賊風, 避居密室則不惡矣. ○外感發熱, 無休歇, 日晡轉劇, 直待汗下方退, 內傷發熱, 時作時止, 或自袒裸, 亦便淸涼矣. ○外感筋骨疼痛, 或百節皆痛, 內傷但四肢不收, 無氣以動, 困怠嗜臥而已. ○外感, 寒熱齊作而無間以甚, 內傷, 寒熱微而間作, 或不齊. ○外感頭痛, 常常有之, 直待傳經入裏方罷, 內傷頭痛, 有時而作, 有時而止. 《東垣》

In cold damage, the aversion to cold is not removed even beside a fierce fire; in internal damage, it stops the moment one draws near warmth — only on meeting wind and cold does one shrink from it. — In cold damage, the aversion to wind cannot bear any wind or cold at all; in internal damage, one shrinks only from small thieving drafts, and sheltered in a closed room shrinks from nothing. — In external contraction, the heat effusion has no pause, worsening toward late afternoon, retreating only after sweating or purging; in internal damage, the fever comes and goes — bare the shoulders, and one is promptly cool. — In external contraction, sinews and bones ache, or every joint of the hundred hurts; in internal damage, the limbs merely will not gather — no Qi to move them, weary indolence and a craving to lie down, nothing more. — In external contraction, cold and heat arise together and without let-up in their severity; in internal damage, they are mild, intermittent, or unpaired. — External-contraction headache is constant, ceasing only when the evil passes the channels and enters the interior; internal-damage headache now arises, now stops.
Clinical note The first six columns of the tradition's most consequential differential table — and the test conditions are all everyday objects: a stove, a draft, an open collar, an afternoon. Dongyuan's genius was recognizing that the same complaints sort perfectly by their relationship to comfort: the invaded body cannot be consoled; the depleted one can.

Dongwon 東垣

外感, 邪氣有餘, 壯厲有力, 內傷, 神思昏怠, 氣弱困懶. ○外感, 手背熱而手心不熱, 內傷, 手心熱而手背不熱. ○外感, 邪氣傳經入裏則大渴, 內傷, 邪在血脉中故不渴, 間有渴亦不甚. ○外感, 雖不能食, 而知穀肉之味, 內傷, 雖飮食, 而不知其味. ○外感, 鼻塞流涕, 聲重氣壅, 內傷, 鼻息和緩, 但不調. 《東垣》

In external contraction the evil Qi is in surplus — robust, fierce, forceful; in internal damage the spirit and thought are clouded and indolent, the Qi weak, weary, and slack. — In external contraction the back of the hand is hot and the palm is not; in internal damage the palm is hot and the back of the hand is not. — In external contraction, once the evil passes the channels into the interior, thirst is great; in internal damage the evil lies in the blood vessels, hence no thirst — or an occasional thirst, never severe. — In external contraction, though one cannot eat, one still knows the taste of grain and meat; in internal damage, though one eats and drinks, one does not know their taste. — In external contraction the nose is blocked and runs, the voice heavy, the breath congested; in internal damage the nose's breath is mild and easy, merely unregulated.
Clinical note The table's five finishing columns hold its two immortal signs — the flipped hand (dorsum hot in invasion, palm hot in depletion: a two-second bedside maneuver) and the lost savor (the invaded can't eat but could taste; the depleted eat and taste nothing). That second sign is the chapter's whole doctrine in a mouthful: internal damage is, first and last, a disorder of appetite's meaning.

Dongwon 東垣

外感, 言語高厲有力, 先輕後重, 內傷, 言語困弱無力, 懶於言語. ○外感, 則人迎脉浮緊, 或洪大而數, 內傷, 則氣口脉緊盛, 或滑而疾. ○七情動氣脉, 與飮食無二. 盖飮食七情, 俱能閉塞三焦, 熏蒸肺胃淸道. 其證嘔泄痞滿腹痛亦相似. 但傷食則惡食, 七情則雖作飽, 亦不惡食. 《入門》

In external contraction, speech is high, forceful, and strong — light at first and heavier after; in internal damage, speech is weary, weak, and forceless — one is sloth to speak at all. — In external contraction the Renying pulse is floating and tight, or surging, large, and rapid; in internal damage the Qi-mouth pulse is tight and exuberant, or slippery and racing. — The pulse of the seven affects stirring the Qi is no different from that of food damage — for food and the affects alike can block the triple burner and steam the clear passages of lung and stomach, and their signs of retching, diarrhea, glomus, and pain likewise resemble each other. Only: food damage loathes food, while the affects, though one feels stuffed, do not loathe it.
Clinical note The table's last columns reach the voice and the wrist — and then one refinement deeper: distinguishing the stuffed-by-feelings from the stuffed-by-food. The heartbroken feel full but could still face dinner; the overfed cannot. Emotional and dietary oppression separated by a single question about appetite's attitude.

Immun 入門

或外感挾內傷, 內傷挾外感, 或食積類傷寒, 當明辨治之. 若顯內證多者, 則是內傷重而外感輕, 當以補養爲先, 宜陶氏補中益氣湯ㆍ十味和解散ㆍ加味益氣湯 三方幷見寒門. 若顯外證多者, 則是外感重而內傷輕, 宜以發散爲急, 宜九味羌活湯ㆍ人參養胃湯ㆍ參蘇飮 三方幷見寒門. 食積類傷寒, 宜用陶氏平胃散. 《入門》

There are cases of external contraction carrying internal damage, of internal damage carrying external contraction, and of food accumulation mimicking cold damage: these must be clearly distinguished and treated. If the manifest internal signs are the more numerous, internal damage is the heavier and the contraction light — supplementing and nourishing must come first: Dossi-bojungikgi-tang, Sipmihwahae-san, and Gamiikgi-tang — all three in the Cold chapter —. If the manifest external signs are the more numerous, the contraction is heavier and the damage light — effusing and scattering is the urgency: Gumiganghwal-tang, Insamyangwi-tang, and Samso-eum — all three in the Cold chapter —. For food accumulation mimicking cold damage, Dossi-pyeongwi-san is appropriate.
Clinical note The table's clinical payoff — count the columns, weigh the sides, and the count itself writes the prescription: tonify first when the inside outvotes, scatter first when the outside does, and for the meal masquerading as a flu, a leveled stomach. Triage by tally: the differential made arithmetic.

Immun 入門

Methods of treating taxation damage 勞倦傷治法

內經曰, 勞者溫之, 損者益之. 夫勞則動之太過, 而神不寧矣, 故溫之. 溫也者, 養也. 溫之者, 所以調其飮食, 適其起居, 澄心息慮, 從容以待其眞氣之復常也. 禮記所謂柔色以溫之, 正同此義. 今東垣乃以溫爲溫涼之溫, 謂宜溫藥以補元氣而瀉火邪, 又易損者益之爲損者溫之, 又以溫能除大熱爲內經所云, 而遍攷內經, 幷無此語, 不能無疑也. 又經曰, 形不足者, 溫之以氣. 其溫字亦是滋養之義, 非指溫藥也. 《泝洄》

The Inner Classic says: for the taxed, warm them; for the detrimented, boost them. Taxation is movement gone to excess, the spirit no longer at rest — hence 'warm' them. But warming here means nurturing: to attune their food and drink, fit their rising and resting, still the mind and rest the cares, and unhurriedly await the true Qi's return to its norm. What the Book of Rites calls 'warming with a gentle countenance' is exactly this sense. Yet Dongyuan took 'warm' as the warm of warm-versus-cool, holding that warm drugs should supplement the origin Qi and drain the fire evil; he altered 'for the detrimented, boost them' to 'warm them'; and he attributed 'warmth can eliminate great heat' to the Inner Classic — but search the whole Classic, and no such words exist: one cannot but doubt. And when the Classic says 'for insufficiency of form, warm it with Qi,' that 'warm' too means nourishing — it does not point to warm drugs.
Clinical note One of the boldest paragraphs the Donguibogam preserves — Wang Lü fact-checking the founder of the very doctrine this chapter teaches, and finding a phantom citation ('search the whole Classic: no such words exist'). His counter-reading turns the flagship prescription back into a regimen: warmth as kindness — food attuned, rest fitted, mind stilled — before it is ever a drug temperature. Heo Jun prints the dissent beside the doctrine, trusting the reader with both.

Sohoe 泝洄 — Wang Lü

飮食失時, 勞役過度, 脾胃虛弱, 中氣不足, 以補中益氣湯爲主. 如益胃升陽湯ㆍ升陽順氣湯ㆍ調中益氣湯ㆍ升陽益胃湯ㆍ淸神益氣湯ㆍ黃芪人參湯 方見暑門ㆍ參朮調中湯 方見咳嗽ㆍ人參飮, 皆可選用. ○如氣浮心亂, 以朱砂安神丸 方見神門 鎭固之, 卽愈. 《東垣》

Where meals have lost their times and toil has passed its measure — Spleen and Stomach weak, the center Qi insufficient — Bojungikgi-tang 補中益氣湯 is the governing formula. And such as Ikwiseungyang-tang 益胃升陽湯, Seungyangsungi-tang 升陽順氣湯, Jojungikgi-tang 調中益氣湯, Seungyangikwi-tang 升陽益胃湯, Cheongsinikgi-tang 淸神益氣湯, Hwanggiinsam-tang — formula in the Summerheat chapter —, Samchuljojung-tang — formula in the Cough chapter —, and Insam-eum may all be chosen and used. — And where the Qi floats and the heart is disordered, settle and secure it with Jusaansin-hwan — formula in the Spirit chapter —, and it is cured.
Clinical note The house of Bojungikgi assembled on one page — the master formula and its seasonal and situational children, five of them now open to full pages here. The closing clause quietly extends the doctrine to the mind: when the depleted Qi floats into agitation, the answer is still anchoring, not sedation.

Dongwon 東垣

勞倦亦有二焉. 勞力純乎傷氣而無汗者, 補中益氣湯. 勞心兼傷乎血而有汗者, 黃芪建中湯. 心力俱勞, 氣血皆傷者, 雙和湯 二方幷見虛勞. ○房勞傷腎證, 與勞倦相似, 均一內傷發熱證也. 勞倦因陽氣之下陷, 宜補其氣以升提之. 房勞因陽火之上升, 宜滋其陰以降下之. 一升一降, 逈然不同. 《入門》

Taxation itself is twofold. Toil of the body, damaging purely the Qi, without sweat: Bojungikgi-tang 補中益氣湯. Toil of the mind, damaging the Blood as well, with sweat: Hwanggigeonjung-tang 黃芪建中湯. Mind and body both taxed, Qi and Blood both damaged: Ssanghwa-tang 雙和湯 — both formulas in the Vacuity Taxation chapter —. — The pattern of bedroom taxation damaging the Kidney resembles ordinary taxation — both are internal-damage fevers. But taxation fever comes of the Yang Qi sinking down, and one should supplement the Qi to raise and lift it; bedroom taxation comes of the Yang fire rising up, and one should enrich the Yin to descend and lower it. One raised, one lowered — utterly different.
Clinical note The chapter's finest piece of treatment logic, and its bridge to the vacuity-taxation chapter next door — three grades of overwork matched to three formulas, then the trap disarmed: two fevers that look identical and take opposite verbs. Lift the laborer, lower the lover; confuse them and every herb works against you.

Immun 入門

Vacuity and repletion of the Spleen and Stomach in internal damage 內傷病脾胃虛實

脾胃俱實, 則過時而不飢, 多食而不傷. ○脾胃俱虛, 則不能食而瘦, 與食則少食, 不與則不思食, 飢飽不知. ○食少而肥者, 雖肥而四肢不擧, 盖脾困邪勝也. ○食多而瘦者, 胃伏火邪於氣分則能食, 雖多食而不能生肌肉也. 《回春》

When Spleen and Stomach are both replete, one passes mealtimes without hunger and eats much without damage. — When Spleen and Stomach are both vacuous, one cannot eat and grows thin: given food, one eats little; not given it, one does not think of it — hunger and satiety alike go unfelt. — One who eats little yet is fat: fat, but the four limbs will not lift — the spleen is encumbered and the evil prevails. — One who eats much yet is thin: fire evil lies ambushed in the stomach's Qi aspect, hence the appetite — yet however much is eaten, it cannot engender flesh.
Clinical note Four metabolic phenotypes in four sentences — including the two that fill modern clinics: the low-appetite weight-gainer whose heaviness is encumbrance, not nourishment, and the ravenous weight-loser whose hidden stomach fire burns the meal before the body can bank it. The classical text sorting, centuries early, what we now chase with panels and scans: intake and build are separate ledgers.

Hoechun 回春

When the Spleen and Stomach are damaged one neither thinks of food nor relishes it 內傷脾胃則不思食不嗜食

帝曰, 人之善飢而不嗜食者, 何氣使然. 岐伯曰, 精氣幷於脾, 熱氣留於胃. 胃熱則消穀, 穀消故善飢. 胃氣上逆, 故不嗜食也. 《靈樞》 ○所謂惡聞食臭者, 胃無氣, 故惡食臭也. 《內經》 ○口多嗜味, 陰虛火動故也. 陰虛則口中有味, 陽虛則口中無味. 《入門》 ○惡食者, 胸中有物, 宜導痰補脾, 二陳湯, 加蒼朮ㆍ白朮ㆍ川芎ㆍ山査肉. 《丹心》 ○憂抑傷脾, 不思飮食, 黃連(炒)ㆍ白芍藥(酒炒)ㆍ香附子ㆍ靑六丸末 方見暑門, 右爲末, 薑汁浸蒸餠作丸服. 《丹心》

The Emperor asked: that a person hungers well yet has no relish for food — what Qi makes it so? Qibo replied: the essence Qi merges into the spleen while hot Qi lodges in the stomach. The stomach hot, it consumes the grain — grain consumed, hence the ready hunger; but the stomach Qi counterflows upward, hence no relish for eating (Yeongchu 靈樞). — What is called loathing the smell of food: the stomach is without Qi, hence the loathing (Naegyeong 內經). — A mouth that craves many flavors: Yin vacuity stirring fire. In Yin vacuity the mouth holds taste; in Yang vacuity the mouth is tasteless (Immun 入門). — One who loathes food has a something in the chest: abduct the phlegm and supplement the spleen — Ijin-tang 二陳湯 with atractylodes, white atractylodes, cnidium, and hawthorn flesh added (Dansim 丹心). — Worry and repression damaging the spleen, with no thought of food: dry-fried coptis, wine-fried white peony, cyperus, and powdered Cheongyuk-hwan — formula in the Summerheat chapter —, powdered together, bound with steamed cake soaked in ginger juice, and taken as pills (Dansim 丹心).
Clinical note The section dissects appetite into its parts and shows each failing separately — hunger without relish (stomach fire below, counterflow above), loathing at the very smell (a stomach out of Qi), craving as a symptom (Yin-vacuous mouths taste too much; Yang-vacuous ones taste nothing). Danxi's last line completes the map at the top: sometimes what sits where dinner should is worry, and the prescription is for the mood.

Yeongchu 靈樞 · Naegyeong 內經 · Immun 入門 · Dansim 丹心

不思飮食, 宜平胃散 方見五藏ㆍ養胃進食丸ㆍ寬中進食丸ㆍ生胃丹ㆍ參苓白朮丸 方見下ㆍ啓脾丸ㆍ二麴元ㆍ香砂六君子湯ㆍ香砂養胃湯ㆍ人參開胃湯ㆍ安胃散ㆍ穀神湯. 《諸方》

For no thought of food or drink, appropriate are Pyeongwi-san 平胃散 — formula in the Five Viscera chapter —, Yangwijinsik-hwan 養胃進食丸, Gwanjungjinsik-hwan 寬中進食丸, Saengwi-dan 生胃丹, Samryeongbaekchul-hwan 參苓白朮丸 — formula below —, Gyebi-hwan 啓脾丸, Iguk-won 二麴元, Hyangsayukgunja-tang 香砂六君子湯, Hyangsayangwi-tang 香砂養胃湯, Insamgaewi-tang 人參開胃湯, Anwi-san 安胃散, and Goksin-tang 穀神湯.
Clinical note The appetite-restoration shelf, twelve deep — from the workhorse leveler to the promised Samryeongbaekchul-hwan, the chapter's ghost link finally standing at its own doorstep. Names link as their pages open.

Various formularies 諸方

Internal damage begins as heat in the center and ends as cold in the center 內傷病始爲熱中終爲寒中

凡內傷脾胃之證, 始則四肢困熱, 無氣以動, 表熱自汗, 心煩不安, 胃氣熱, 熱氣熏胸中, 爲內熱之證, 宜以甘溫補中. 內傷病始爲熱中, 宜補中益氣湯ㆍ益胃升陽湯 二方見上ㆍ參朮調中湯 方見咳嗽ㆍ凝神散ㆍ當歸補血湯ㆍ三補枳朮丸. 《入門》 ○凡脾胃之證, 調治差誤, 或妄下之, 則末傳爲寒中. 復遇時寒, 則四肢厥逆, 心胃絞痛, 冷汗出. 夫六氣之勝, 皆能爲病, 惟寒毒最重, 陰主殺故也. 末傳爲寒中, 宜神聖復氣湯ㆍ白朮附子湯ㆍ草豆蔲丸 方見胸部ㆍ守中金元. 《東垣》

In the patterns of internal damage to Spleen and Stomach, the beginning is weary heat of the limbs with no Qi to move, surface heat and spontaneous sweat, a vexed unquiet heart — the stomach Qi hot, the hot Qi fuming the chest: the pattern of internal heat, to be treated by supplementing the center with the sweet and warm. For internal damage beginning as heat in the center: Bojungikgi-tang 補中益氣湯 and Ikwiseungyang-tang 益胃升陽湯 — both above —, Samchuljojung-tang — formula in the Cough chapter —, Eungsin-san 凝神散, Danggwibohyeol-tang 當歸補血湯, and Sambojichul-hwan 三補枳朮丸 (Immun 入門). — But where the regulation of a Spleen-Stomach pattern goes astray, or it is recklessly purged, the end transmits to cold in the center: meeting the season's cold again, the limbs turn reversal-cold, heart and stomach gripe and twist, and cold sweat comes out. Of all the six Qi in their prevailing, every one can make illness — yet cold toxin is the gravest, for Yin governs killing. For the end transmitted to cold in the center: Sinseongbokgi-tang, Baekchulbuja-tang, Chodugu-hwan — formula in the Chest chapter —, and Sujunggeum-won (Dongwon 東垣).
Clinical note The disease given a life-arc — the burnout that begins feverish ends frozen, especially when treatment itself goes wrong ('recklessly purged'). The closing axiom is the chapter at its darkest: of all climates, cold kills, for Yin governs killing. The heat stage gets the sweet-warm lifters; the cold stage, aconite — and the physician's error is named as one of the roads between them.

Immun 入門 · Dongwon 東垣

Clouded weariness after eating 食後昏困

食入則困倦, 精神昏冒而欲睡者, 脾虛弱也. ○若脾胃不節, 損其胃氣, 不能剋化, 散於肝, 歸於心, 溢於肺, 食入則昏冒欲睡, 得臥則食在一邊, 氣暫得舒, 是知升發之氣不行也. 宜參朮湯. 《東垣》 ○勞傷者, 過於勞役, 耗損元氣, 脾胃虛衰, 不任風寒, 故昏冒, 宜用補中益氣湯. 《回春》 ○食後昏困, 宜用參芪湯ㆍ升陽補氣湯.

When food goes in and weariness follows — the spirit clouded and craving sleep — the Spleen is vacuous and weak. — Where Spleen and Stomach lose their measure and the stomach Qi is damaged, it cannot conquer and transform: scattering to the liver, turning to the heart, brimming into the lung — food enters and the head clouds toward sleep. And on lying down, the food settles to one side and the Qi eases for a moment: from this one knows the rising, effusing Qi is not moving. Samgi-tang is appropriate (Dongwon 東垣). — In taxation damage, toil beyond measure has worn the origin Qi, Spleen and Stomach vacuously debilitated, unable to bear wind and cold — hence the clouding: Bojungikgi-tang 補中益氣湯 (Hoechun 回春). — For clouded weariness after eating: Samgi-tang 參芪湯 and Seungyangbogi-tang 升陽補氣湯.
Clinical note The food coma, diagnosed in the twelfth century with an experiment anyone can run — lie down after lunch, feel the meal slide aside and the head briefly clear: proof, says Dongyuan, that the lifting Qi has stalled, not that sleep is owed. The section's quiet radicalism is to treat the universal nap as a sign, with two formulas for the person it flattens.

Dongwon 東垣 · Hoechun 回春

一室女, 因事忤意, 鬱結在脾, 半年不食, 但日食熟菱棗數枚, 遇喜食饅頭彈子大, 深惡粥飯. 予意脾氣實, 非枳實不能開, 以溫膽湯 方見夢門 去竹茹, 與數十貼而安. 《丹心》

A maiden, crossed in some affair, her will thwarted, the depression knotting in the spleen — for half a year she did not eat, taking daily only a few boiled water-chestnuts and jujubes; when pleased she might eat a pellet-sized piece of steamed bread, and deeply loathed gruel and rice. I judged the spleen Qi replete — nothing but unripe bitter orange could open it — and gave Оndam-tang — formula in the Dream chapter — minus the bamboo shavings: some tens of packets, and she was well.
Clinical note Danxi's most famous eating case — half a year's refusal traced not to a weak spleen but a knotted one, grief sitting where dinner should. Against the whole chapter's tonic instinct he reads repletion, opens rather than fills, and the appetite returns. A standing caution at the section's door: not every empty plate means an empty stomach.

Dansim 丹心 — Zhu Danxi

No relish for food owing to debility of the lower origin's Yang 不嗜飮食由下元陽衰

凡飮食不進, 由房勞過度, 眞火衰弱, 不能熏蒸脾土, 以致中州不運, 胸膈痞塞, 飮食不消. 古人云, 補腎不如補脾, 予謂補脾不若補腎. 若丹田眞火上蒸脾土, 脾土溫和, 則膈開能食. 鹿茸ㆍ巴戟ㆍ鍾乳粉 各一兩, 葫蘆巴ㆍ香附子ㆍ陽起石ㆍ川烏ㆍ肉蓯蓉ㆍ兎絲子ㆍ沈香ㆍ肉豆蔲ㆍ五味子 各五錢. 右爲末, 用羊腰子兩對, 以葱椒酒煮爛, 和酒爲糊, 擣丸梧子大, 每百丸, 空心, 米飮鹽湯任下. 《本事》

Where food will not go in because bedroom taxation has passed its measure, the true fire debilitated and unable to steam the Spleen Earth — the central province ceases to turn, chest and diaphragm block with glomus, and food does not disperse. The ancients said supplementing the Kidney is not so good as supplementing the Spleen; I say supplementing the Spleen is not so good as supplementing the Kidney. For when the true fire of the cinnabar field steams the Spleen Earth from below, and the Spleen Earth is warm and mild, then the diaphragm opens and one can eat. Deer antler, morinda, and stalactite powder, 1 nyang each; fenugreek, cyperus, actinolite, aconite main tuber, cistanche, cuscuta, aquilaria, nutmeg, and schisandra, 5 don each. Powder the above; boil two pairs of lamb kidneys utterly soft in scallion-pepper wine, work with the wine into a paste, and pound into pills the size of parasol-tree seeds. Take 100 pills on an empty stomach with thin rice water or salted water as one pleases. — Bonsa 本事 (Donguibogam · Naesang)
Clinical note The section that dares to disagree with the whole chapter — sometimes the appetite dies not in the stomach but in the furnace beneath it, and the Bonsa flips the ancients' maxim to say so: warm the kidney's true fire until it steams the spleen like a pot on a stove, and the diaphragm opens by itself. The lamb-kidney binder is doctrine as cooking: like warming like, at the root.

Bonsa 本事

Sour swallowing and sour vomiting 呑酸吐酸

諸嘔吐酸, 皆屬於熱. 《內經》 ○嘔吐酸水者, 甚則酸水浸其心, 不任其苦, 其次則吐出酸水, 令上下牙酸澁, 不能相對, 以辛熱劑療之必差. 若以病機之法作熱攻之者, 誤矣. 《東垣》 ○呑酸與吐酸不同. 吐酸是吐出酸水如醋. 盖平時津液隨上升之氣鬱積而成, 鬱積之久, 濕中生熱, 故從木化, 遂作酸味, 非熱而何. 其不能自涌而出, 伏於肺胃之間, 咯不出, 嚥不下, 肌表得風寒則內鬱, 愈鬱而酸味刺心. 肌表得溫煖, 或得香熱湯丸, 亦可暫解. 內經言熱者, 言其本也. 東垣言寒者, 言其末也. 《丹心》 ○木味爲酸, 如飮食熱則易爲酸也. 《河間》

All retching and vomiting of the sour belong to heat (Naegyeong 內經). — In vomiting of sour water, at its worst the sour water steeps the heart, the bitterness unbearable; next, sour water is vomited out, setting upper and lower teeth so sour and rough they cannot meet. Treat it with acrid hot preparations and it will surely mend; to attack it as heat by the rule of the disease mechanisms would be an error (Dongwon 東垣). — But sour swallowing and sour vomiting are not the same. Sour vomiting spits out sour water like vinegar: the everyday fluids, following the upbearing Qi, depress and accumulate; the accumulation grown old, heat is born within the damp, and following the transformation of Wood it turns at last to the sour flavor — if not heat, what? What cannot surge out of itself lies ambushed between lung and stomach — hawked, it will not come up; swallowed, it will not go down; the flesh meeting wind and cold, it depresses inward, and the deeper the depression the sharper the sour sting at the heart. Warm the surface, or give fragrant hot decoctions and pills, and it eases for a while. When the Inner Classic says heat, it speaks of the root; when Dongyuan says cold, he speaks of the branch (Dansim 丹心). — Wood's flavor is the sour: just as food and drink, when hot, readily turn sour (Hagan 河間).
Clinical note A three-generation dispute settled by a kitchen — the Classic calls acid heat, Dongyuan treats it with hot drugs anyway, and Danxi reconciles them with root and branch: heat brews the acid, cold traps it. Hejian's closing proof is the section's best sentence: leave dinner in a warm room and taste what happens. Fermentation as pathology's own witness.

Naegyeong 內經 · Dongwon 東垣 · Dansim 丹心 · Hagan 河間

宿食留飮, 酸蜇心痛, 牙齒亦酸, 宜麴朮丸. 專吐淸水者, 朮苓湯. ○痰火停食一日半日, 腐化酸水, 吐出黃臭, 或醋心不安, 宜四味茱連丸ㆍ九味茱連丸ㆍ淸痰丸. ○呑酸大便閉者, 透膈湯, 大便利者, 參萸丸. 《入門》 ○呑酸, 宜節厚味, 必蔬食自養, 則病易安. 《正傳》 ○一田父, 病因留飮, 嘔酸水十餘年, 藥餌鍼艾俱不效. 戴人以苦劑越之, 吐涎如膠二三升, 談笑而愈. 《子和》

For abiding food and retained rheum with sour stinging heart pain and teeth set sour: Gukchul-hwan 麴朮丸. For exclusive vomiting of clear water: Chulryeong-tang 朮苓湯. — Where phlegm-fire halts food for a day or half a day, rotting it to sour water vomited yellow and foul, or vinegar-heart unease: Samisuryeon-hwan 四味茱連丸, Gumisuryeon-hwan 九味茱連丸, and Cheongdam-hwan 淸痰丸. — Sour swallowing with the stool blocked: Tugyeok-tang 透膈湯; with the stool free: Samyu-hwan 參萸丸 (Immun 入門). — In sour swallowing, moderate the rich flavors — nourish oneself on vegetable fare, and the illness settles easily (Jeongjeon 正傳). — A farmer, ill of retained rheum, vomited sour water for ten years and more; drugs, needles, and moxa all failed. Daeren ejected it with a bitter preparation — he vomited drool like glue, two or three doe — and was cured amid talk and laughter (Jahwa 子和).
Clinical note The acid clinic's full protocol — formulas sorted by what comes up and what goes down, a dietary prescription (plain food, fewer rich flavors) that reads like modern reflux counseling, and Zihe's ten-year farmer cured in an afternoon of spectacular emesis, laughing before the basin was empty. The section keeps all three registers: pill, plate, and drama.

Immun 入門 · Jeongjeon 正傳 · Jahwa 子和

Gnawing epigastric vexation 嘈雜

嘈雜之證, 似飢不飢, 似痛不痛, 而有懊憹不自寧之況者, 是也. 其證或兼噯氣, 或兼痞滿, 或兼惡心, 漸至胃脘作痛, 皆痰火之爲患也. 治法, 以南星ㆍ半夏ㆍ橘紅之類消其痰, 芩ㆍ連ㆍ梔子ㆍ石膏ㆍ知母之類降其火, 蒼朮ㆍ白朮ㆍ芍藥之類健脾行濕, 壯其本元則安, 宜用化痰淸火湯. 《醫鑑》 ○嘈雜, 只是痰因火而動, 令人心嘈, 似飢非飢, 有積有熱也. 此乃食鬱有熱, 炒梔子ㆍ薑炒黃連, 乃必用之藥也. 《丹心》 ○五更心嘈者, 思慮傷心, 血虛也. 宜養血四物湯ㆍ當歸補血湯. 《回春》

The pattern of gnawing vexation: seeming hunger that is not hunger, seeming pain that is not pain, with a fretful anguish that cannot settle itself — this is it. It may join with belching, with glomus fullness, or with nausea, gradually reaching pain of the stomach duct — all of it the mischief of phlegm-fire. The method: with the likes of arisaema, pinellia, and red tangerine peel, disperse the phlegm; with the likes of scutellaria, coptis, gardenia, gypsum, and anemarrhena, down the fire; with the likes of atractylodes, white atractylodes, and peony, fortify the Spleen and move the damp — strengthen the root origin and it settles: Hwadamcheonghwa-tang 化痰淸火湯 (Uigam 醫鑑). — Gnawing is simply phlegm stirred by fire, setting the heart a-gnaw — hungry yet not hungry: there is accumulation, and there is heat. This is food constraint bearing heat: dry-fried gardenia and ginger-fried coptis are the indispensable drugs (Dansim 丹心). — Gnawing of the heart at the fifth watch: worry and thought have damaged the Heart — Blood vacuity. Yanghyeolsamul-tang and Danggwibohyeol-tang are appropriate (Hoechun 回春).
Clinical note The definition is the diagnosis — a symptom made entirely of almosts: almost hunger, almost pain, and a restlessness that can't name itself. The section's three-front strategy (disperse, cool, fortify) answers the daytime gnaw; the last line catches the 4 a.m. version and reads it differently — the small-hours gnaw belongs to a worried heart and thin Blood, and gets nourishment, not clearing.

Uigam 醫鑑 · Dansim 丹心 · Hoechun 回春

嘈雜, 俗謂之心嘈也. 宜香砂平胃散 方見上ㆍ消食淸鬱湯ㆍ淸鬱二陳湯 卽上增味二陳湯也ㆍ平胃分消飮ㆍ朮連丸ㆍ淸痰丸 方見上ㆍ三聖丸ㆍ平肝順氣保中丸ㆍ交泰丸. 《諸方》

Gnawing vexation is what common speech calls the gnawing heart. Appropriate are Hyangsapyeongwi-san 香砂平胃散 — above —, Sosikcheongul-tang 消食淸鬱湯, Cheongulijin-tang 淸鬱二陳湯 — the Augmented Two Matured Decoction above —, Pyeongwibunso-eum 平胃分消飮, Chulryeon-hwan 朮連丸, Cheongdam-hwan 淸痰丸 — above —, Samseong-hwan 三聖丸, Pyeongansungibojung-hwan 平肝順氣保中丸, and Gyotae-hwan 交泰丸.
Clinical note The gnawing-heart shelf, seven of nine now open — from the fourteen-herb net to the two-herb millet pill, one complaint served at every scale.

Various formularies 諸方

Anguished fretting 懊憹

懊憹, 心中不自如也, 比煩燥更甚. 傷寒表證誤下, 陽氣內陷, 心下固硬者, 則爲結胸. 若胃氣空虛, 客熱在膈, 短氣煩躁微疼, 則爲懊憹. 懊憹者, 煩不得眠, 飢不能食也. 治同嘈雜, 兼見寒門. 《入門》

Anguished fretting is the heart within not being as one would have it — severer still than vexation and agitation. When a cold-damage exterior pattern is purged in error and the Yang Qi falls inward, if what is below the heart sets hard, that becomes chest bind; but if the stomach Qi is vacant and empty, with visiting heat lodged at the diaphragm — short breath, vexed agitation, faint pain — that becomes anguished fretting. The anguished-fretful is vexed and cannot sleep, hungry and cannot eat. Treatment is the same as for gnawing vexation; see also the Cold chapter.
Clinical note The section's shortest entry names one of its subtlest states — the heart 'not as one would have it,' a definition by frustrated ownership. Its two clinical marks are cruel symmetries: sleep wanted and refused, hunger felt and unusable. The text files it as gnawing's deeper register and hands the pharmacy over accordingly.

Immun 入門

Belching Qi 噫氣

噫飽氣, 俗作噯氣. 噫屬心脾. 《綱目》 ○帝曰, 人之噫者, 何氣使然. 岐伯曰, 寒氣客于胃, 厥逆從下上散, 復出于胃, 故爲噫. 補足太陰陽明. 《靈樞》 ○太陰病所謂上走心爲噫者, 陰盛而上走於陽明, 陽明絡屬心, 故上走而爲噫也. 又曰, 心爲噫. 《內經》 ○寸脉緊, 寒之實也. 寒在上焦胸中, 必滿而噫. 《脉經》 ○上焦竭善噫, 何也. 師曰, 上焦受中焦氣未和, 不能消, 故能噫耳. ○寸口脉弱而緩, 弱者陽氣不足, 緩者胃氣有餘, 噫而呑酸, 食卒不下, 氣塡於膈上. 《仲景》

Belching of fullness — commonly written as ae-gi — belongs to Heart and Spleen (Gangmok 綱目). — The Emperor asked: a person's belching — what Qi makes it so? Qibo replied: cold Qi visits the stomach; reversing and counterflowing, it scatters upward from below and issues again from the stomach — hence the belch. Supplement the foot greater-Yin and Yang-brightness (Yeongchu 靈樞). — What the greater-Yin illness calls 'running up to the heart as belching': the Yin exuberant runs up into the Yang-brightness, whose network belongs to the heart — hence it runs upward and becomes belching. It is also said: the Heart makes the belch (Naegyeong 內經). — An inch pulse tight is cold's repletion: cold in the upper burner and chest — fullness there must be, and belching (Maekgyeong 脉經). — 'The upper burner exhausted, one belches readily — why?' The master said: the upper burner receives Qi from the middle burner not yet in harmony; unable to disperse it, one can only belch. — An inch-mouth pulse weak and moderate: weak, the Yang Qi insufficient; moderate, the stomach Qi in surplus — belching with sour swallowing, food suddenly refusing to descend, Qi packing above the diaphragm (Junggyeong 仲景).
Clinical note Six classical voices on the physiology of a burp — cold visiting the stomach and bouncing back out, Yin running up the heart's network, the upper burner receiving what it cannot process and returning it as sound. The humblest symptom in the chapter, and none gets a more distinguished bibliography.

Gangmok 綱目 · Yeongchu 靈樞 · Naegyeong 內經 · Maekgyeong 脉經 · Junggyeong 仲景

氣實噫者, 食罷噫轉腐氣, 甚則物亦噫, 濕熱所致, 宜二陳湯, 加蒼朮ㆍ神麴ㆍ麥芽ㆍ薑炒黃連. ○氣虛噫者, 濁氣塡胸也. 不因飮食常噫者, 虛也. 盖胃有濁氣, 膈有濕痰, 俱能發噫, 六君子湯 方見痰飮, 加沈香爲君, 厚朴ㆍ蘇葉爲臣, 吳茱萸爲使, 煎服. 《入門》 ○噫氣, 宜用星半湯ㆍ順氣和中湯 方見嘔吐ㆍ枳殼散ㆍ破鬱丹ㆍ勻氣丸ㆍ祛痰火丸. ○善飮酒, 每朝長噫不吐者, 小調中湯 方見痰飮 最妙. 《入門》

The repletion belch: after the meal ends, belching turns to rotten Qi — at worst the matter itself comes up with it — damp heat's doing: Ijin-tang 二陳湯 with atractylodes, medicated leaven, barley sprout, and ginger-fried coptis added. — The vacuity belch: turbid Qi packing the chest. One who belches constantly without regard to meals is vacuous — for a stomach holding turbid Qi and a diaphragm holding damp phlegm can each raise the belch: Yukgunja-tang 六君子湯 — formula in the Phlegm-Rheum chapter — with aquilaria as sovereign, magnolia bark and perilla leaf as ministers, and evodia as courier, decocted and taken (Immun 入門). — For belching Qi, appropriate are Seongban-tang 星半湯, Sungihwajung-tang 順氣和中湯 — formula in the Vomiting chapter —, Jigak-san 枳殼散, Paul-dan 破鬱丹, Gyungi-hwan 勻氣丸, and Geodamhwa-hwan 祛痰火丸. — In the good drinker who gives long belches every morning without vomiting, Sojojung-tang — formula in the Phlegm-Rheum chapter — is most wondrous (Immun 入門).
Clinical note The working differential — time the belch against the meal: after dinner and rotten, it's a full house (clear it); anytime and odorless, it's an empty one wearing turbid air (fill it, with aquilaria to anchor the refill). The closing detail is pure clinical connoisseurship: the drinker's long morning belch, assigned its own most-wondrous formula.

Immun 入門

The method of convalescent management in internal damage 內傷將理法

五味淡薄, 令人神爽氣淸. 《養性書》 ○飮食務相接而溫和, 宜食多而肉少. 一切肉, 惟須煮爛, 停冷食之. 食畢當漱口數過, 勿食生肉傷胃. 《得效》 ○茶之爲物, 四時皆不可多喫, 令人下焦虛冷. 惟飽食後, 煖飮一兩盞不妨, 盖能消食故也. ○菜苽雖治氣, 又能暗人耳目, 此等物四時皆不可多食, 老人尤宜忌之. ○飽食卽臥, 或不消, 成積聚. 又夜勿過醉飽. 《得效》 ○行住坐臥, 各得其宜, 不可至疲倦. 《東垣》

Keeping the five flavors bland and light makes the spirit fresh and the Qi clear (Yangseongseo 養性書). — Let meals follow one another warm and mild; it is right to eat much grain and little meat. All meat must be boiled soft and eaten after it has cooled; when the meal ends, rinse the mouth several times over; eat no raw meat, which damages the stomach (Deukhyo 得效). — Tea, as a thing, should not be drunk in quantity in any season — it leaves the lower burner vacuous and cold; only after a full meal, one or two cups drunk warm does no harm, for it can disperse the food. — Vegetables and gourds, though they regulate Qi, can also darken the ears and eyes; such things should not be eaten in quantity in any season, and the old above all should shun them. — Lying down straight upon a full meal, the food may fail to disperse and form accumulations; and at night, do not pass into drunkenness and surfeit (Deukhyo 得效). — Walking, standing, sitting, lying — let each find its fit measure, and never be driven to exhaustion (Dongwon 東垣).
Clinical note The chapter's discharge instructions, four centuries early — bland food, more grain than meat, warm tea only after meals, no midnight feasts, no lying down on a full stomach, and a daily life paced short of exhaustion. Handed to a modern patient nearly verbatim, it would pass for current lifestyle counseling; the only anachronism is the suspicion of vegetables.

Yangseongseo 養性書 · Deukhyo 得效 · Dongwon 東垣

脾好音樂. 夜食多則脾不磨. 周禮曰, 樂以侑食. 盖脾好音聲絲竹, 耳纔聞, 脾卽磨矣. 《活人心》 ○每食訖, 以手摩面及腹數百遍, 又行步躊躇, 計使中數里來, 則食易消, 令人能飮食, 無百病. 《得效》

The Spleen loves music. Eat much at night and the spleen does not grind; but the Rites of Zhou say: with music, one accompanies the meal. For the spleen loves the sounds of voice, string, and bamboo — the moment the ear hears, the spleen begins at once to grind (Hwalinsim 活人心). — After every meal, rub the face and abdomen with the hands some hundreds of passes, then walk unhurriedly, reckoning a few li of ground — the food disperses easily, one becomes able to eat and drink, and the hundred illnesses stay away (Deukhyo 得效).
Clinical note The chapter's most delightful physiology — digestion wired to the ear, with the Rites of Zhou as citation: music at the table is not ornament but peristalsis. Paired with the after-dinner rub-and-stroll, it completes a convalescent evening the modern clinic still prescribes in parts: eat lightly, put something beautiful on, and take a walk. The classical warrant, incidentally, for every note of piano played in a treatment room.

Hwalinsim 活人心 · Deukhyo 得效

Excess of the five flavors becomes illness 五味過傷爲病

酸走筋, 多食之, 令人癃, 小便不通也. ○醎走血, 多食之, 令人渴. 《內經》

The sour races to the sinews: eaten in excess, it makes dribbling block — the urine does not pass. — The salty races to the blood: eaten in excess, it makes one thirst.
Clinical note The five-flavor doctrine's disciplinary clause, here in the two lines the extraction preserves — each flavor runs to its tissue, and excess turns the affinity into the injury. The salt-thirst line needs no commentary in any century; the chapter that opened by praising the flavors closes its loop by rationing them.

Naegyeong 內經

Simple medicinals 單方

凡三十七種, 有寬中丸ㆍ獨醒湯ㆍ雙花散. ○碧海水, 飮一二合, 吐下宿食, 臚脹良. 《本草》 ○生熟湯 卽百沸湯和新汲水也, 人大醉, 及食苽果過多, 以生熟湯浸身, 湯皆爲酒及苽味. 《本草》 ○生薑汁, 中熱不能食, 薑汁一合, 和蜜一匙ㆍ水三合ㆍ生地黃汁少許, 頓服立差. 《本草》 ○葛根, 善解燒酒毒, 生食之, 或苽及藤, 擣汁飮. 《俗方》 ○鮒魚, 解酒勞, 生作膾, 和薑醋食之. 《本草》

In all, thirty-seven kinds, including Gwanjung-hwan, Dokseong-tang, and Ssanghwa-san. — Deep-sea water: drinking one or two hop vomits and purges abiding food — good for bloated distension (Bencao 本草). — Raw-and-boiled water — that is, hundred-boiled water mixed with freshly drawn —: when one is greatly drunk, or has eaten melons and fruit to great excess, steep the body in raw-and-boiled water — and the water takes on the taste of the wine and the melons (Bencao 本草). — Fresh ginger juice: struck by heat and unable to eat — one hop of ginger juice with a spoonful of honey, three hop of water, and a little raw rehmannia juice, taken at a draught: cured at once (Bencao 本草). — Kudzu root well resolves distilled-liquor toxin — eaten raw, or the melon-like root and vine pounded for juice and drunk (Sokbang 俗方). — Crucian carp resolves wine taxation — made raw into hoe and eaten with ginger and vinegar (Bencao 本草).
Clinical note The simples cabinet, thirty-seven strong, sampled here at its most vivid — sea water as emetic, a ginger-honey draught for heat-struck appetite, raw kudzu against soju, and carp hoe with ginger-vinegar as a hangover dish any Koreatown table would recognize. The bath entry is the collection's marvel: soak the drunkard, and the water comes out tasting of the party — osmosis as clinical observation.

Bencao 本草 · Sokbang 俗方

斷酒方. 取酒七升着甁中, 朱砂五錢細硏納甁中, 緊塞甁口, 安猪圈中, 任猪動搖, 經七日, 取飮之, 卽不復飮. ○鸕鶿糞灰, 水服一錢, 鷹屎灰亦可, 和酒服, 幷勿令飮人知. 《本草》 ○又井中倒生草, 水煎服. 又竹葉上露, 和酒服. 《俗方》

Methods for breaking off wine. Put seven doe of wine in a jar; grind five don of cinnabar fine and add it; stopper the mouth tight and set the jar in a pig pen, letting the pigs jostle it as they will. After seven days, take it out and give it to drink — and the person drinks no more. — Cormorant-droppings ash, one don taken in water — hawk-droppings ash serves as well, taken in wine — and in either case, let the drinker not know. — Also: grass growing downward in a well, decocted in water and taken; also, the dew off bamboo leaves, taken in wine (Bencao 本草 · Sokbang 俗方).
Clinical note The chapter's folk aversion-therapy annex — wine agitated a week under swine, ash of fish-eating birds slipped into the cup, and twice the instruction that matters: without the drinker's knowledge. Beneath the magic sits the recognizably modern shape of covert aversion treatment, administered by families who had run out of arguments. The well-grass and bamboo dew close the register on its gentlest, most wishful note.

Bencao 本草 · Sokbang 俗方

Prohibitions 禁忌法

凡飮食中, 忌食大醎大辛, 蒜ㆍ韭, 五辢, 醋, 大料物, 薑桂之類, 皆傷元氣. ○藥中澤瀉ㆍ茯苓ㆍ猪苓ㆍ燈心ㆍ琥珀ㆍ通草ㆍ木通ㆍ滑石之類, 皆瀉陽氣, 勿服之. 《東垣》

In food and drink, shun the greatly salty and greatly acrid — garlic, chives, the five pungents, vinegar, the strong spice-stuffs, and the likes of ginger and cinnamon: all damage the origin Qi. — Among medicines, the likes of alisma, poria, polyporus, juncus, amber, tetrapanax, akebia, and talcum all drain the Yang Qi: do not take them. — Dongwon 東垣
Clinical note Dongyuan's convalescent blacklist, in two columns — the kitchen's loud flavors and, more strikingly, the pharmacy's own drainers: eight perfectly respectable medicinals barred because the depleted patient cannot afford their tax on the Yang. The rare prohibition list that warns against medicine as carefully as against food.

Dongwon 東垣

Guided practice 導引法

凡酒食中毒, 正坐仰天, 呼出酒食醉飽之氣, 立飢且醒. 《病源》

For poisoning by wine and food: sit upright, face heaven, and breathe out the Qi of wine, food, drunkenness, and surfeit — at once one hungers, and sobers besides.
Clinical note One sentence of therapy requiring nothing but posture and breath — the chapter's cheapest prescription and, as any over-fed diner who has stepped outside to breathe knows, not its least effective. Internal damage's last resort is also its first: sit up straight and exhale the party.

Byeongwon 病源

Acupuncture and moxibustion 鍼灸法

胃弱不思飮食, 取三里ㆍ三陰交. ○三焦邪熱, 不嗜食, 取關元. 《綱目》 ○全不思食, 取然谷出血, 立飢. ○飢不能食, 飮食不下, 取章門ㆍ期門. 《東垣》 ○飮食不多, 心腹脹, 面色萎黃, 世謂脾腎病, 宜灸中脘. 《資生》 ○食多身瘦, 名曰食晦, 先取脾兪, 後取章門ㆍ太倉. 《資生》 ○飮食不下, 膈塞不通, 邪在胃脘, 刺法, 在上脘則抑而下之, 在下脘則散而去之. 《靈樞》 ○胃病飮食不下, 取三里. 《東垣》 ○吐宿汁呑酸, 取章門ㆍ神光. 《東垣》

For a weak stomach with no thought of food: ST36 Samni and SP6 Sameumgyo. For evil heat of the triple burner with no relish for food: CV4 Gwanwon (Gangmok 綱目). — For no thought of food at all: bleed KI2 Yeongok — hunger at once. For hungering yet unable to eat, food refusing to descend: LR13 Jangmun and LR14 Gimun (Dongwon 東垣). — For scant eating with heart-abdomen distension and a withered sallow face — what the age calls Spleen-Kidney illness — moxa CV12 Jungwan (Jasaeng 資生). — For eating much while the body wastes — named the darkening of food (食晦) — first take BL20 Bisu, afterward Jangmun and Taechang (Jasaeng 資生). — For food not descending, the diaphragm blocked and impassable, the evil in the stomach duct: the needling method — at the upper duct, press it downward; at the lower duct, scatter it away (Yeongchu 靈樞). — For stomach illness with food not descending: Samni (Dongwon 東垣). — For vomiting stale juice and sour swallowing: Jangmun and Singwang (Dongwon 東垣).
Clinical note The needle's version of the whole chapter — appetite absent, appetite false, food stalled high or low, the eat-much-waste-away pattern given its own dark name — each with its points, and the Lingshu's duct rule (press down what sits high, scatter what sits low) as compact a treatment principle as the book contains. On which practical note the Internal Damage chapter closes: after the formularies and the philosophy, a map of where to place the hands.

Gangmok 綱目 · Dongwon 東垣 · Jasaeng 資生 · Yeongchu 靈樞