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。
内伤是由于饮食不节和过度劳累引起的疾病。其发热恶寒的症状，与瘴疟（一种由山岚瘴气引起的疟疾）相似。如果将内伤劳役之病误认为是瘴疟，而使用治疗内伤劳役的药物来治疗，就会导致神识昏乱，胡言乱语如同发狂一样。
其热势会更加剧烈，服药过多甚至会导致死亡。这都是因为没有仔细察看病症候所致。现在详细辨析如下：内伤劳役之病，其恶寒的表现是：见到风、见到寒冷或居住在阴凉处，如果没有阳光照射的地方就会感到恶寒；如果避开风寒，居住在温暖的地方，或者增添衣被，就不会感到恶寒。有时虽然发作寒战，但身体一暖和就停止了。其发热的表现是：热气蒸腾，向上直达头顶，向旁扩散至皮毛，向下到达腰足，浑身燥热；如果敞开衣被，靠近凉爽的地方症状就会缓解；或者热极出汗后也会解除。如果稍微受凉片刻，又会感到恶寒；增添衣被，则不再恶寒。再次发热时，必须服用甘温性质的药物，服多则病愈。其他伴随症状有：头痛，身体沉重，手心发热，口渴，心烦，舌苔黑，胡言乱语，产生幻觉妄见，大便秘结或稀溏，小便赤涩，或呕吐，口不知味。其脉象在气口（右寸关尺中的右关，候脾胃）表现为洪大，或者兼有其他脏腑形证的内伤之病。
像这样，瘴疟发作时的恶寒，起初起于毫毛竖立，伸欠之后才出现寒战栗抖，颈项和腰部酸痛，即使穿厚衣服盖厚被子，用滚水和热火取暖，也不能温暖。寒去之后，内外都发热，想喝冷水，即使脱去衣被，躺在冰冷的泉水中也不能降温。或者先冷后热，或者先热后冷，或者一天发作一次，或者隔天发作一次，或者一天发作两三次。这是冷瘴。其脉象洪、弦、数。冷瘴与内伤，其寒热表现不同，又如此。只有热瘴在热未间断时，才需要进一步仔细辨别。内伤的发热，浑身上下都热；热瘴的发热，只有额头极热，胸腹极热，腰部以下则不热，脚部发凉（厥逆）。这也容易辨别。也有脚热的情况，但即使热也不严重。内伤的发热，脱去衣被片刻即可缓解；热瘴的发热，即使躺在冷地上也不能缓解。内伤的脉象，气口独显洪大而每息六至；热瘴的脉象，六脉俱弦洪而每息七八至。或者阳证却见到阴脉。总之，虽然兼症很多，但只要潜心分别寒热及脉象，那么瘴疟和内伤的区别就像冰和炭一样明显了。如果错误地把瘴疟认作内伤，而使用补中益气汤（具有升提阳气作用的方剂），那么热势会更剧烈，神志更昏沉。这是因为瘴疟是因为阳气不降所致，升麻、柴胡是轻清升提的药，会使本就不降的阳气更加飞越散失。瘴疟类似于天时的郁蒸，天气郁蒸，得雨才能解除。瘴疟的热闷，想要等待下元（肾阳）温固，自然出汗才会舒畅。黄、白术是收敛腠理的药物，使腠理闭塞，汗不得出，会更加加重热闷神昏。如果是内伤，此药一进，病势就会逐渐减轻，即使不减轻也不会加重。病的疑难之处如此。医者如果不明白望闻问切的道理，不分别内伤、瘴疟、伤寒，而胡乱施治，那就是屠夫刽子手一类的人。
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.