凡得劳心、嗜欲、七情、饮食、纵酒、饥饱过度，此内伤也。初不自觉，久则成患，以致身
热、头痛、恶寒。或因微热，脱换衣服，腠理不密，易感风寒，症类伤寒，实非伤寒。医不
明此，骤用麻黄、紫苏、荆芥大发其汗，热未退，仍以寒凉泻火之剂，下陷清气，浊气转升
，故食下腹满，又大下之，故中愈不足，以致汗多亡阳，下多亡阴，阳耗散，死不旋踵，实医杀之耳。
伤寒发表，汗透而愈。内伤寒热，间作不齐，发热而微汗至颈或脐而还，（脐字误，仲
剂颈而还。剂，际也。谓汗仅在头，齐颈而下无汗也。）口不知味，似疟非疟，或兼泄泻，
医与诸伤寒药，不愈。如是者，名曰内伤。杂病多端，汗而又热，热而又汗，亦头痛发热，
或自语烦躁，不思饮食，遍身骨痛者，用补中益气加羌活；或泄泻而热不退，此阳虚也，补
中加附子；头痛甚，加蔓荆子、川芎；或无汗而热不退，亦补中；或咳嗽痰中带红，亦补中
。此病里虚不足，反用汗下清利，死可待矣。内伤病中，有泄泻、呕吐、腹胀疼痛、咳嗽、
清涕，四君加和中散，无有不效。
元气藏于肾中，静则为水，动则化而为火。肾者肝之母也，元气足则肝子足以承乎心。心为
主，神明出焉，元气不足，心神失养，相火抗拒，脾土受亏，金衰木旺，诸脏皆病矣。惟胃
气不绝，用药力以培之，庶可冀幸万一。生脉散加参、 或保元之类是也。但见潮热，宜补
中。火炽，宜发，用升阳散火汤。虚而不泻，宜血分中补气，保元加滋阴。若泻发困热，宜
气分中补血，保元、四君加芍药。泻则加松花。如自汗，乃阳气虚，加附子。内似火烁，胸
中嘈痛，白术一钱，黄连一分，陈皮二分，神曲为丸细小。临卧时嚼碎，津咽下三十丸，三日
愈，则止。久泻伤肾，用保元兼四神丸。或腹胀，和中散并补中。脉见平和，而病不愈，乃
药力未至，不可改换。倘不愈，又脉见细数、紧数，皆邪脉变异，更兼呕吐，不祥之兆也
。又口失滋味，不思饮食，不可误作胃绝，是内有虚火，当滋生元气，不可以燥剂动火。盖
总以脾胃为主，脾胃四季皆扰，常自不足，伤寒言阳明有余，因火邪郁于胃中，故泻胃中之火耳。
虚损由于内伤证，与外感相似。外感头疼、发热、恶寒，其脉浮数有力，宜汗解而愈，从表
入里，脉洪大，大便燥，宜和解通利之。内伤亦头痛、发热、恶寒，其脉紧数无力，宜补中
加羌、防。元气一足，邪气自散。羌活领太阳经而出，前证俱退矣。不效，再一剂，自然见
汗，乃愈。庸医不知此理，仍用发表，汗至颈而还，一旦发似疟，作疟治之，又似痢，作痢
治之，更加发热，庸医无措手处矣。伤寒脉洪大有力，内伤豁大，似洪而无力，亦大便结燥
，仍用清凉汗下解散之法，大伤脾胃，则肺已亏矣。咳嗽吐痰，或吐红痰，又作阴虚火动治
之。脾土一损，杂病多端，潮热似痢似疟，且脾虚不能统血，而吐血之症成矣。若因火盛，
脾阴不足，血枯之症，亦不可用滋阴剂，当用救阴之法。阴从阳生，阳从阴长之义。人参、
白术、莲子、五味、甘草、白茯苓之类是也。恶心，加干姜；不思饮食，加砂仁；胸中气滞
，加陈皮；泄泻，去陈皮；汗多，加白术、黄 ；恶寒，加肉桂；吐红，去桂。若泄泻而诸
药不愈，胃虚而难受药者，陈腊肉骨灰、陈米锅焦，共三分，炒松花一分，米糊丸，人参看
轻重虚实用之，煎汤送下六、七十丸。此法活人多矣。
凡是因劳心过度、纵欲无度、七情内伤、饮食不节、酗酒或饥饱失常导致的损伤，这属于内伤病。起初人们往往没有察觉，时间久了便酿成祸患，导致身体发热、头痛、怕冷。有时因为轻微发热，更换衣物时腠理（皮肤毛孔）疏松不紧密，容易感受风寒，症状类似伤寒，但实际上并非伤寒。医生如果不明白这个道理，突然使用麻黄、紫苏、荆芥等药物大发其汗，热势未退，又接着使用寒凉泻火的药剂，导致清气下陷，浊气反而上逆，因此进食后腹部胀满；此时若再大剂量攻下，会导致中气更加虚弱，以致出汗过多而亡阳，腹泻过多而亡阴，阳气耗散，死亡就在眼前，这实际上是医生害死了病人。
伤寒病通过发汗透达表邪而痊愈。内伤引起的寒热交替发作，时间不规律，发热时微汗只到达颈部或肚脐处就停止（注：原文“脐”字有误，应为“际”，意为汗仅在头部，齐颈以下无汗），口不知滋味，似疟疾非疟疾，或者兼有泄泻，医生给予各种治疗伤寒的药物，病情不见好转。像这种情况，称为内伤。杂病种类繁多，出现出汗后又发热、发热后又出汗，也伴有头痛发热，或者自言自语、烦躁不安、不思饮食、全身骨痛等症状的，使用补中益气汤加羌活；如果是泄泻且热势不退，这是阳气虚衰，在补中益气汤中加入附子；头痛严重的，加入蔓荆子、川芎；如果没有汗且热势不退，也用补中益气汤；如果咳嗽痰中带血，也用补中益气汤。这种病本质是体内虚弱不足，反而使用发汗、攻下、清热、利湿的方法，死亡是可以预料的。在内伤病中，如果有泄泻、呕吐、腹胀疼痛、咳嗽、流清涕等症状，用四君子汤加和中散，没有不有效的。
元气藏于肾中，静止时表现为水，运动时则化为火。肾是肝的母亲，元气充足则肝木得以滋养并承接于心。心为主宰，神明由此产生，如果元气不足，心神失去滋养，相火就会抗拒，脾土受到亏损，金（肺）衰弱而木（肝）旺盛，各个脏腑都会生病。只有胃气不绝，用药力来培补它，才有一线希望。生脉散加人参，或者保元汤之类的方剂就是用于此目的。只要见到潮热，适宜用补中益气汤。火势炽盛，适宜发散，使用升阳散火汤。虚证但不腹泻，适宜在血分中补气，用保元汤加滋阴药。如果腹泻且发热困倦，适宜在气分中补血，用保元汤、四君子汤加芍药。腹泻则加入松花粉。如果是自汗，这是阳气虚，加入附子。体内感觉如火烧灼，胸中嘈杂疼痛，用白术一钱，黄连一分，陈皮二分，神曲制成细小的丸药。临睡前嚼碎，随津液吞服三十丸，三天痊愈后即停药。久泻伤及肾脏，用保元汤兼服四神丸。如果腹胀，用和中散配合补中益气汤。脉象平和但病不好转，是药力未到，不可随意更换药物。如果病不好转，脉象又出现细数、紧数，都是邪气变异的表现，再加上呕吐，是不祥之兆。另外，口中失去滋味，不思饮食，不可误认为是胃气绝灭，这是内有虚火，应当滋生元气，不可以用燥烈之剂扰动火势。总的来说以脾胃为主，脾胃在四季中都易受干扰，常常处于不足状态。伤寒论中提到阳明有余，是因为火邪郁结在胃中，所以要泻胃中的火。
虚损由于内伤引起，与外感症状相似。外感引起的头疼、发热、怕冷，脉象浮数有力，适宜发汗解表而愈，病邪从表入里，脉象洪大，大便干燥，适宜和解通利。内伤也出现头痛、发热、怕冷，但脉象紧数无力，适宜用补中益气汤加羌活、防风。元气一旦充足，邪气自然消散。羌活引领太阳经之气外出，前述症状都会消退。如果无效，再服一剂，自然会出汗，病就好了。庸医不懂这个道理，仍然使用发表法，汗出到颈部就停止，一旦发作像疟疾，就按疟疾治疗，又像痢疾，就按痢疾治疗，更加发热，庸医就束手无策了。伤寒脉象洪大有力，内伤脉象豁大，看似洪大但无力，也有大便干结的情况，如果仍用清凉、发汗、攻下、解散的方法，会严重损伤脾胃，那么肺已经亏虚了。咳嗽吐痰，或者吐带血的痰，又被当作阴虚火动来治疗。脾土一旦受损，杂病繁多，潮热似痢似疟，而且脾虚不能统摄血液，吐血的症状就形成了。如果是因火盛导致脾阴不足，血枯的病症，也不可以用滋阴剂，应当用救阴的方法。遵循阴从阳生，阳从阴长的道理。用人参、白术、莲子、五味子、甘草、白茯苓之类的药物。恶心，加干姜；不思饮食，加砂仁；胸中气滞，加陈皮；泄泻，去掉陈皮；出汗多，加白术、黄芪；怕冷，加肉桂；吐血，去掉肉桂。如果泄泻且各种药物无效，胃虚难以承受药物的，用陈腊肉骨灰、陈米锅焦各三分，炒松花粉一分，米糊为丸，人参根据轻重虚实情况使用，煎汤送下六七十丸。这种方法救活了很多人。
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.