内伤饮食劳役过度之病。其发热恶寒。与瘴疟相似。若以瘴疟。而用内伤劳役之药治之。则神识昏乱。谵语如狂。
其热愈剧。服多亦至不起。由不细察其症候耳。今细辨之。内伤劳役之病。其恶寒也。见风见寒居阴处。无日阳处则恶
之。若避风寒。居温暖处。或添衣被。则不恶也。或虽发寒。一暖便已。其发热也。蒸蒸然。上彻头顶。旁彻皮毛。下
至腰足。浑身燥热。若袒衣被。近寒凉处则已。或热极而汗出亦解。若凉片时。即恶寒。添衣被。则不恶寒。又发热。
直至甘温之剂。进多则病已。其他头痛。身重。手心热。口渴。心烦。舌黑。妄语。妄有见闻。大便秘或沸。小便赤涩
或呕。口不知味。其脉气口洪大。或兼各脏形症内伤之病。如此瘴疟之作其寒也。先起于毫毛。伸欠乃作寒栗。鼓领腰
杳俱痛。虽重衣浓被。滚汤热火。不能温。寒去则内外皆热。渴欲饮冷。虽袒去衣被。重冰泉水不能寒。或先寒后热。
或先热后寒。或一日一发。或间日一发。或一日二三发。此是冷瘴。其脉洪弦数。冷瘴与内伤。其寒
热不同又如此。惟热瘴热未间断时。又当细辨之。内伤之热。浑身上下皆热。热瘴之热。惟额极热。
胸腹极热。腰以下则不热。足发厥。又易辨之。亦有足热者。虽热亦不甚。内伤之热。袒去衣被即解片时。
热瘴之热。即卧于冷地亦不解。内伤之脉。气口独洪大而六至。热瘴之脉。六脉俱弦洪而七八至。
或阳症而见阴脉。要之。兼症虽多。惟以寒热及脉。潜心分别。则瘴疟内伤若冰炭矣。苟误认瘴疟为内伤。
而用补中益气汤。则热愈剧而神愈昏。盖瘴因阳气不降而然。升麻柴胡。乃轻清升药。使不降之阳气。
愈飞越矣。瘴乃类天时。天气郁蒸。得雨方解。瘴之热闷。欲俟下元温固。自然出汗方舒。黄 白
术敛腠理药也。使腠理闭塞。汗不得出。
愈加热闷神昏矣。若是内伤。此药一进。病势即渐减。纵不减亦不加。病之疑难如此。医者不明
望闻问切之理。不分别其内伤瘴疟伤寒。而妄为施治者。屠刽之流也。
The disease of internal injury is caused by improper diet and excessive physical exertion. Its symptoms of fever and aversion to cold are similar to those of zhang malaria (a type of malaria caused by mountainous miasma). If the disease of internal injury due to exertion is mistaken for zhang malaria and treated with medicines for internal injury and exertion, it will lead to confusion of consciousness and delirious talk resembling madness.
The heat will become more severe, and taking too much medicine may even lead to death. This is all due to a failure to carefully examine the clinical manifestations. Now, let us distinguish them in detail: In diseases of internal injury due to exertion, the aversion to cold manifests as follows: one feels aversion to cold when exposed to wind, cold, or staying in shady places without sunlight; however, if one avoids wind and cold, stays in a warm place, or adds clothing and bedding, the aversion to cold disappears. Sometimes, although chills occur, they cease once the body warms up. The manifestation of fever is steaming hotness that extends upward to the top of the head, outward to the skin and hair, and downward to the waist and feet, causing whole-body dry heat. If one exposes oneself from clothing and bedding and approaches a cool place, the symptoms relieve; or if sweating occurs when the heat reaches its peak, the condition resolves. If slightly chilled for a moment, aversion to cold returns; adding clothing and bedding alleviates this aversion. Upon recurrence of fever, sweet-warm natured medicines must be administered; taking sufficient doses cures the disease. Other accompanying symptoms include headache, heavy body, hot palms, thirst, irritability, black tongue coating, delirium, hallucinations, constipation or loose stools, red and scanty urination, vomiting, and loss of taste. The pulse at the Qi Kou (the right Guan position, reflecting the Spleen and Stomach) is surging and large, or accompanied by other visceral signs of internal injury.
In contrast, the chills in zhang malaria begin with goosebumps, followed by shivering after yawning, with pain in the neck and lower back. Even wearing thick clothes and quilts, or using boiling water and hot fires, cannot provide warmth. After the chills subside, both interior and exterior become hot, with a desire to drink cold water; even removing clothes and lying in cold spring water does not alleviate the heat. The pattern may present as chills preceding fever, fever preceding chills, occurring once daily, every other day, or two to three times a day. This is called Cold Zhang Malaria. Its pulse is surging, wiry, and rapid. Thus, the chills and fevers of Cold Zhang Malaria differ significantly from those of internal injury. Only when the heat of Hot Zhang Malaria is continuous should careful differentiation be made. In internal injury, the heat is throughout the entire body; in Hot Zhang Malaria, the heat is extreme only on the forehead and in the chest and abdomen, while the area below the waist is not hot, and the feet are cold (Jue Ni). This is also easy to distinguish. Although there are cases where the feet are hot, the heat is not severe. In internal injury, exposing oneself from clothing relieves the heat temporarily; in Hot Zhang Malaria, lying on cold ground does not relieve the heat. The pulse in internal injury shows only the Qi Kou position as surging and large, with six beats per respiration; the pulse in Hot Zhang Malaria shows all six positions as wiry and surging, with seven to eight beats per respiration. Or, Yang syndrome presents with Yin pulse. In summary, although there are many accompanying symptoms, by focusing on differentiating chills/fever and pulse, the distinction between zhang malaria and internal injury becomes as clear as ice versus charcoal. Mistaking zhang malaria for internal injury and administering Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) will exacerbate the heat and deepen the confusion of spirit. This is because zhang malaria results from the failure of Yang Qi to descend; Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) are light, clear, and ascending herbs, which cause the already non-descending Yang Qi to fly away further. Zhang malaria resembles atmospheric stagnation and humidity, which is relieved only by rain. The stifling heat of zhang malaria requires the warming and securing of the Lower Yuan (Kidney Yang) and natural sweating to bring relief. Huang Zhu (Atractylodis Macrocephalae Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) are herbs that consolidate the interstices (Cou Li); they close the pores, prevent sweating, and thereby worsen the stifling heat and confusion of spirit. However, if it is an internal injury, taking these medicines will gradually reduce the disease severity, or at least not aggravate it. Such is the difficulty of diagnosis. Physicians who do not understand the principles of Inspection, Auscultation-Olfaction, Inquiry, and Palpation, fail to differentiate between internal injury, zhang malaria, and Shang Han (Cold Damage), and treat blindly, are akin butchers and executioners.