凡内伤调理脾胃。必用羌活散其肝邪。此为正治。内伤用补中。十余剂而无汗。及汗不至足者。
难治。然亦有服至二三十剂而汗出者。若服后遍身疼痛者。亦难治。气虚作胀而脉虚。用补中等
和中药。脉反有力者。不治。内伤寒热间作。气血两虚。一不宜头痛。二不宜便秘。三不宜绝谷
泻利。三者皆难治。凡内伤误用竹叶石膏。须防失血。过二十日必有反
复。误服黄柏、知母等药。须防泄泻呕吐。二三日便见。内伤身无大热。头不甚疼。胸膈饱闷。
大便不通。庸医下之而闭。闭而复下。下而不愈。阳已将去。或遍身疼痛。不能转动。腹胀内有
积血。虽神气清爽。饮食可进。亦不能治。或问素有病患。过劳役动作。反觉精神强健何也。曰。
此阴火沸腾。扶助于内。不觉元气之不足也。若静养调适。反觉神倦气弱。此阴火已退。阳无以
复。本相透露故也。
〔诊〕气口脉大而虚者。为内伤于气。气口脉大而时显一涩者。为内伤于血。气口脉大而涩。
人迎及尺弦者。为醉饱入房。肝脾气血俱伤。人迎脉弦而数者。为瘀血。气口脉滑而实者。为宿
食也。
汪石山治一人。形长而瘦。色白而脆。年三十余。得奇疾。遍身淫淫如虫行。从左脚腿起。
渐次而上至头。复下至右脚。自觉虫行有声之状。医多不识为何病。汪诊其脉浮小而涩。按之不
足。兼察形视色。知其为虚。仲景曰。身如虫行。汗多亡阳也。遂用补中益气倍参、术。加酒炒
黄柏五分。服至二十余剂而愈。
For internal injury diseases, when regulating the spleen and stomach, Qiang Huo San (Notopterygii Rhizoma and Root Powder) must be used to disperse liver pathogenic factors. This is the correct treatment method. If patients with internal injuries take Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) for more than ten doses without sweating, or if the sweating is insufficient and does not reach the extremities, it is difficult to treat. However, there are cases where sweating occurs after taking twenty to thirty doses. If severe body pain occurs after taking the medicine, it is also difficult to treat. If abdominal distension is caused by qi deficiency and the pulse is weak, mild and harmonizing medicines such as Buzhong Yiqi Tang can be used; but if the pulse is surprisingly forceful, it is incurable.
Internal injury causing alternating cold and heat, accompanied by dual deficiency of qi and blood, presents three unfavorable prognostic signs: first, accompanying headache; second, constipation; third, inability to eat at all accompanied by diarrhea and dysentery. All three conditions are difficult to treat. Whenever internal injury is mistakenly treated with Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), one must guard against hemorrhage. After twenty days, relapse is inevitable. Mistakenly taking cold-natured herbs such as Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma) requires guarding against diarrhea and vomiting, which will appear within two or three days.
Patients with internal injury may have no high fever, only slight headache, fullness and oppression in the chest and diaphragm, and constipation. Quack doctors use purgative methods, leading to obstruction; after obstruction, they purge again, yet the disease persists. At this point, yang qi is about to depart. There may be severe body pain preventing movement, abdominal distension with accumulated blood stasis. Even if the spirit is clear and food intake is possible, it cannot be cured.
Someone asked: "Why do those who have been chronically ill feel spiritually vigorous after overwork and physical exertion?" The answer is: "This is due to Yin Fire (Deficiency Heat) boiling and assisting internally, making one unaware of the insufficiency of primordial qi. If one rests quietly and regulates lifestyle, one instead feels fatigued and weak. This is because Yin Fire has receded, leaving yang without support to manifest its true nature."
[Diagnosis] A Cun Kou pulse (Radial Pulse at the Cunkou Position) that is large and deficient indicates qi internal injury. A Cun Kou pulse that is large and occasionally shows a choppy texture indicates blood internal injury. A Cun Kou pulse that is large and choppy, combined with a Ren Ying pulse (Carotid Artery Pulse) and Chi pulse (Distal Radial Pulse) that are wiry, indicates damage to liver and spleen qi and blood due to sexual intercourse after drunkenness and overeating. A Ren Ying pulse that is wiry and rapid indicates blood stasis. A Cun Kou pulse that is slippery and excess indicates retained food.
Wang Shishan treated a patient who was tall and thin, with white and fragile complexion, aged over thirty. He suffered from a strange disease: a sensation of insects crawling all over his body, starting from the left leg, gradually moving up to the head, then down to the right foot, with an audible sensation of crawling. Many physicians did not know what disease this was. Wang palpated the pulse as floating, small, and choppy, with insufficient strength upon deep pressure. Observing his form and complexion, he determined it was a deficiency syndrome. Zhang Zhongjing stated: "The body feeling like insects crawling is due to excessive sweating leading to loss of yang." Therefore, Wang prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction), doubling the dosage of Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), adding five fen of Jiu Chao Huang Bo (Phellodendri Cortex prepared with wine). After taking more than twenty doses, the patient recovered.