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Any injury caused by excessive mental labor, indulgence in desires, emotional disturbances (Seven Emotions), improper diet, alcohol abuse, or irregular eating habits constitutes an internal injury. Initially unnoticed, it becomes a problem over time, leading to body heat, headache, and aversion to cold. Sometimes due to slight fever, changing clothes causes the Cou Li (skin pores) to become loose and insecure, making one susceptible to wind-cold pathogens. The symptoms resemble Shang Han (Cold Damage), but are actually not Shang Han. If physicians do not understand this and suddenly use Ma Huang (Ephedrae Herba), Zi Su (Perillae Folium), Jing Jie (Schizonepetae Herba) to induce heavy sweating, and if the heat does not subside, they then administer cold-natured purgative herbs to clear fire, causing Clear Qi to sink and Turbid Qi to rise. Consequently, abdominal fullness occurs after eating; if strong purgatives are used again, the Middle Jiao becomes even more deficient, leading to excessive sweating with loss of Yang Qi, and excessive diarrhea with loss of Yin Qi. With Yang Qi exhausted and scattered, death follows swiftly; this is essentially physician-induced homicide.

Shang Han is cured when sweat penetrates and releases the exterior. Internal injuries cause alternating cold and heat that occur irregularly. During fever, slight sweat may only reach the neck or navel and then stop (Note: "Navel" in the original text is likely an error for "Ji", meaning boundary; implying sweat is limited to the head, with no sweat below the neck). The mouth loses taste sensation, resembling malaria but not being so, possibly accompanied by diarrhea. Physicians administering various Shang Han remedies find no improvement. Such cases are termed Internal Injury. Various miscellaneous diseases present with sweating followed by fever, fever followed by sweating, along with headache and fever, or muttering, irritability, loss of appetite, and generalized bone pain. In these cases, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Qiang Huo (Notopterygii Rhizoma et Radix); if diarrhea persists with unrelenting heat, indicating Yang deficiency, add Fu Zi (Aconiti Lateralis Radix Praeparata) to Bu Zhong Yi Qi Tang; for severe headaches, add Man Jing Zi (Vittariae Spora) and Chuan Xiong (Ligustici Chuanxiong Rhizoma); if there is no sweat and heat persists, also use Bu Zhong Yi Qi Tang; if coughing produces sputum with blood, also use Bu Zhong Yi Qi Tang. This disease stems from internal deficiency and insufficiency; using sweating, purging, clearing, and draining methods leads inevitably to death. For internal injuries presenting with diarrhea, vomiting, abdominal distension and pain, cough, and clear nasal discharge, Si Jun Zi Tang (Four Gentlemen Decoction) combined with He Zhong San (Harmonize the Middle Powder) is invariably effective.

Yuan Qi (Original Qi) resides in the Kidneys. In a static state, it manifests as Water; in motion, it transforms into Fire. The Kidney is the mother of the Liver. When Yuan Qi is sufficient, the Liver Wood is nourished and can support the Heart. The Heart is the master, from which Shen Ming (Spiritual Consciousness) emerges. If Yuan Qi is insufficient, the Heart Spirit lacks nourishment, Ministerial Fire rebels, Spleen Earth suffers deficit, Metal (Lung) weakens while Wood (Liver) flourishes, and all Zang-Fu organs become diseased. Only if Stomach Qi remains intact can medicinal force be used to cultivate it, offering a slim hope. Sheng Mai San (Generate the Pulse Powder) with Ren Shen (Ginseng Radix) or formulas like Bao Yuan Tang (Protect the Origin Decoction) are suitable. Whenever tidal fever appears, Bu Zhong Yi Qi Tang is appropriate. If Fire is blazing, dispersion is needed, using Sheng Yang San Huo Tang (Raise Yang and Disperse Fire Decoction). For deficiency without diarrhea, tonifying Qi within the Blood level is indicated, using Bao Yuan Tang with Yin-nourishing herbs. If diarrhea with fatigue and heat occurs, tonifying Blood within the Qi level is indicated, using Bao Yuan Tang and Si Jun Zi Tang with Shao Yao (Paeoniae Radix Alba). Add Song Hua Fen (Pinus Massoniana Pollen) for diarrhea. For spontaneous sweating, indicating Yang Qi deficiency, add Fu Zi. For internal sensations of burning, chest discomfort and pain, use Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 qian, Huang Lian (Coptidis Rhizoma) 1 fen, Chen Pi (Citri Reticulatae Pericarpium) 2 fen, processed with Shen Qu (Medicated Leaven) into small pills. Chew thoroughly before bed and swallow with saliva, 30 pills at a time; discontinue after three days if cured. For chronic diarrhea injuring the Kidneys, use Bao Yuan Tang combined with Si Shen Wan (Four Spirits Pill). For abdominal distension, use He Zhong San together with Bu Zhong Yi Qi Tang. If the pulse is harmonious but the illness persists, the medicinal force has not yet taken effect; do not change the prescription. If the illness persists and the pulse becomes fine-rapid or tight-rapid, these are variations of pathogenic pulses, especially if accompanied by vomiting, which is an ominous sign. Loss of taste and appetite should not be mistaken for Stomach Qi extinction; it indicates internal deficient Fire. One should generate Yuan Qi and avoid dry/hot agents that stir Fire. Generally, the focus is on the Spleen and Stomach. The Spleen and Stomach are easily disturbed in all four seasons and are often deficient. Shang Han texts mention excess in Yangming because Fire Pathogens stagnate in the Stomach, requiring draining of Stomach Fire.

Deficiency syndromes arising from internal injuries resemble external contractions. External contractions cause headache, fever, and aversion to cold with floating-rapid-forceful pulses, cured by sweating; if pathogens move from exterior to interior, pulses become surging-large, stools dry, requiring harmonizing and purging methods. Internal injuries also cause headache, fever, and aversion to cold, but with tight-rapid-weak pulses, treated with Bu Zhong Yi Qi Tang plus Qiang Huo and Fang Feng (Saposhnikoviae Radix). Once Yuan Qi is sufficient, pathogenic factors dissipate naturally. Qiang Huo guides Tai Yang Meridian Qi outward, resolving previous symptoms. If ineffective, another dose will naturally induce sweating and cure. Ignorant physicians fail to grasp this, continuing to use exterior-releasing methods. Sweat stops at the neck; if it resembles malaria, it is treated as malaria; if it resembles dysentery, it is treated as dysentery, causing increased fever, leaving ignorant physicians helpless. Shang Han pulses are surging-large and forceful; internal injury pulses are large and empty, appearing surging but weak, sometimes with dry stools. Using cooling, sweating, purging, and dispersing methods severely damages Spleen and Stomach, leading to Lung deficiency. Coughing with sputum or bloody sputum is wrongly treated as Yin deficiency with Fire hyperactivity. Once Spleen Earth is damaged, numerous miscellaneous diseases arise: tidal fever resembling dysentery or malaria, and since Spleen deficiency fails to control Blood, hematemesis occurs. If Fire excess causes Spleen Yin deficiency and Blood exhaustion, Yin-nourishing agents should not be used; instead, employ methods to rescue Yin, following the principle that Yin generates from Yang and Yang grows from Yin. Use Ren Shen, Bai Zhu, Lian Zi (Nelumbinis Semen), Wu Wei Zi (Schisandrae Chinensis Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Fu Ling (Poria) etc. For nausea, add Gan Jiang (Zingiberis Rhizoma); for loss of appetite, add Sha Ren (Amomi Fructus Rotundus); for chest Qi stagnation, add Chen Pi; remove Chen Pi for diarrhea; for excessive sweating, add Bai Zhu and Huang Qi (Astragali Radix); for aversion to cold, add Rou Gui (Cinnamomi Cortex); for hematemesis, remove Rou Gui. If diarrhea persists despite various medicines, and the Stomach is too weak to tolerate drugs, use aged cured meat bone ash and aged rice pot crust, each 3 fen, mixed with 1 fen roasted Pinus massoniana pollen, formed into pills with rice paste. Administer with Ren Shen decoction based on severity and deficiency/excess, taking 60-70 pills. This method has saved many lives.