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。
凡是内伤疾病，调理脾胃时，必须使用羌活散来疏散肝经的邪气。这是正确的治疗方法。内伤患者如果服用补中益气汤十余剂后仍然没有汗出，或者汗出不透、不到位的，属于难治之症。然而也有服用二三十剂后才出汗的情况。如果服药后出现全身疼痛的，也属于难治之症。如果是气虚导致的腹胀且脉象虚弱，可以使用补中益气汤等平和的药物；但如果脉象反而有力，则属不治之症。
内伤引起的寒热交替发作，若伴有气血两虚，有以下三种情况不宜治疗：一是伴有头痛，二是伴有便秘，三是完全不能进食且伴有腹泻痢疾。这三种情况都属于难治之症。凡是内伤误用了竹叶石膏汤（Zhu Ye Shi Gao Tang, Bamboo Leaf and Gypsum Decoction），必须防止出现失血症状。过了二十天必然会出现病情反复。误服黄柏（Phellodendri Cortex）、知母（Anemarrhenae Rhizoma）等寒凉药物，必须防止出现泄泻和呕吐，这些症状在两三天内就会显现。
内伤患者身体没有大热，头部疼痛不剧烈，胸膈部饱闷胀满，大便不通。庸医采用攻下法治疗导致闭塞，闭塞后又再次攻下，攻下后病仍不愈。此时阳气即将耗竭，或者出现全身疼痛、无法转动，腹部胀满且有积血。虽然神志清醒，饮食尚可进用，但也无法治愈。
有人问：素来有病的人，经过过度劳累和活动后，反而觉得精神强健，这是为什么呢？回答说：这是因为阴火（Yin Fire, Deficiency Heat）沸腾，在体内扶持助长，使人不觉察到元气的不足。如果静养调适，反而觉得神疲气弱，这是因为阴火已经消退，阳气无所依附而显露本相的缘故。
【诊法】气口脉（Radial Pulse at the Cunkou Position）大而虚弱的，是气分内伤；气口脉大而偶尔显现涩象的，是血分内伤；气口脉大而涩，人迎脉（Renying Pulse, Carotid Artery Pulse）及尺脉弦硬的，是因为醉酒饱食后行房事，导致肝脾的气血俱伤；人迎脉弦而数的，是有瘀血；气口脉滑而实的，是有宿食。
汪石山（Wang Shishan）治疗一个人，身形修长而消瘦，肤色白而脆弱，年龄三十多岁，患了一种奇异的疾病，全身感觉像虫子爬行一样，从左脚腿开始，逐渐向上蔓延至头部，再向下至右脚，自觉有虫行有声的感觉。许多医生不知道这是什么病。汪石山诊察其脉象浮小且涩，重按无力，同时观察其形体和面色，知道这是虚证。张仲景说：“身体像虫子爬行，是由于汗多亡阳所致。”于是使用补中益气汤（Buzhong Yiqi Tang, Tonify the Middle and Augment Qi Decoction），加倍人参（Ginseng Radix et Rhizoma）和白术（Atractylodis Macrocephalae Rhizoma），加入酒炒黄柏五分，服用二十余剂后痊愈。
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.