所谓砂者，身上有斑点如砂，或用麻刮之，则累累如朱砂，故名曰砂。此乃风寒湿邪，或山岚瘴气，
袭于肌皮之间。皮者，肺之合；肌者，脾之合。肺主气而脾主腹，邪内干于肺，则气逆而面青肢冷，干于
脾，则腹中绞痛。故浅者刮之，深者刺之，使邪气外泄，而痛可止。若邪甚而失于救刺，则邪干脏而气机
不转，即不能救矣。近时名曰斑砂，宜刺百会。盖刺百会出血，名为开 门， 即斑疹，故以治 之法治
之。若非热盛发斑，又不必取百会矣，虞天民《医学正传》曰∶治砂证，或先用热水蘸搭臂膊，而以苎麻
刮之；甚者针刺十指出血，或以香油灯照视胸背，有
红点处皆烙之。是斑点之说，其来旧矣。淬烙之法，有行之矣。近时以为新有之斑砂，乃失于涉略故耳！
夫热邪在于皮肤，或寒邪化热而后成斑，若卒中而
即入于内者，面青肢冷，有何斑点？若不急刺，则为卒死，又何假于照淬乎！
痘疹之论，自昔及今，不啻百有余家。然不参究《灵》、《素》诸经，不知脏腑血气之生始出入，是以
止知顺、险、逆之证，而不知顺、险、逆之因，不知其因，则不能用救治之法矣。夫人秉阴阳水火之气而成此形，
盖有正气，必有邪淫，此天地自然之理也。（在天地亦有淫气。）是痘之毒瓦斯，已萌于有生之初。夫有生之初，犹
太极也；三月而成形，先生两肾，犹太极而分两仪。是痘之根原在肾。肾为水脏，主藏精而化血，又为生
气之原。少阳之气，乃水中之生阳，上与心主包络相合，故痘之起发，随少阳之正气而上达于心包。（肾气之交于
心包，必从中焦而上。邪在阳明，则为呕逆，阳明热盛，则为发狂。故痘前发惊
者，可治。若发于肝、脾、肺外合之皮肤肌肉间，毒邪不解，反内伤于肝则发惊，
伤脾则泄泻，伤肺则喘急，是以痘后发惊者，不治。）心主血，而包络主
脉，故毒从经而脉，脉而络，络而孙，从孙络而出于皮肤者，顺也。盖痘乃精血中之火毒，故走于血分，而后能贯
脓结痂，若走于气分，则为水泡白壳矣。夫经络为血分，皮肤肌腠为气分。皮毛者，肺之合；肌肉者，脾
之合。皮肤、肌肉之中，有充肤热肉之血，肝所主也，亦为气分。故痘之顺者，从经络而出于皮肤，是
以陆续出，而参差大小不齐，根窠收敛，界地分明。盖界地乃皮肤、肌肉，而不为邪毒所伤故也。血华色
而润泽，根红顶白，气领成浆，盖气行脉外而血随气化也。所谓逆证者，走于皮肤之气分，则一齐涌出如
痱，时俗所谓肺经痘者此也。如走于气分而留于肌腠，则唇肿眼胀，肉先浮而痘反平塌，时俗所谓脾经
痘者此也。如走于气分而留于充肤热肉之血间，则皮薄而娇红可爱，光亮如灯，三者皆无血以成浆，终为
不救，此因毒随气而走于肺脾肝，外合之皮肤肌肉间，实非肺经、脾经、肝经之痘毒也。又有一种夹疹
之痘，此分走于气分、血分，故尚为可治。若纯走于气分，虽智巧之士，不能为无米之炊矣。夫所谓险证
者，乃火毒太盛，或阻滞于肾脏，或留蓄于心包。（毒滞于肾脏，则为腰疼肚痛，寒战切牙，甚则紫斑黑陷；
毒留于心包，则壮热烦躁，便血，神昏。）此事在良医，急施妙用，表实者解表，
里实者疏里，热毒盛者急宜清解，不起发者攻发为先。此乃可生可死之急证，匪延时日者也。故证有重
轻，方有缓急，若服平和汤而愈者，原不死之证，勿药亦可；服平和汤而后成不救者，医之罪也。夫救逆
之法，方书却有冰肌散，治痘一齐涌出，服之复能敛入。予谓此方平易浅薄，焉能救其大逆！门人金西
铭，在丹阳，得一救逆汤方。予于邱汉冲先生处，得一丸方。以此三方，斟酌增减，合为一方，名曰五类
救逆丹，逆证、险证，服之皆有奇验。至于表里、血气、寒热、虚实，又在临证之士，兼以汤药治之可也。
所谓“砂”，是指身上出现像沙子一样的斑点，如果用麻布刮擦，就会呈现出累累如朱砂般的红色，因此得名叫作“砂”。这是由于风寒湿邪，或者山间的瘴气，侵袭于肌肤之间。皮是肺的外合；肌是脾的外合。肺主气而脾主腹部，邪气内犯于肺，就会导致气逆而出现面色青紫、四肢冰冷；侵犯于脾，则会导致腹中绞痛。所以病位浅的可以用刮法治疗，病位深的可以用针刺法治疗，使邪气从体外排出，疼痛就可以停止。如果邪气严重而未能及时救治和针刺，那么邪气就会干犯脏腑，导致气机运转停滞，这就无法挽救了。近代称之为“斑砂”，适宜针刺百会穴。因为针刺百会穴出血，名为“开门”，即针对斑疹的治疗方法，所以用这种方法来治疗它。如果不是热盛导致的发斑，就不必取用百会穴了。虞天民在《医学正传》中说：治疗砂证，可以先用热水蘸湿搭在胳膊上，然后用苎麻刮拭；严重的用针刺十指使其出血，或者用香油灯照射胸背部，对有红点的地方进行烙烫。关于斑点的说法，由来已久。淬烙的方法，也有人在施行。近代人认为这是新出现的“斑砂”，是因为缺乏涉猎和了解罢了！
热邪停留在皮肤，或者寒邪化热后形成斑点，如果是突然中邪随即深入体内的，会出现面色青紫、四肢冰冷，哪里有斑点呢？如果不紧急针刺，就会突然死亡，哪里还顾得上照灯烙烫呢！
关于痘疹的论述，从古至今，不止一百多家。然而如果不参究《灵枢》、《素问》等经典，不了解脏腑气血生成的始末及出入规律，就只知道顺证、险证、逆证的表现，而不知道产生这些证候的原因。不知道原因，就不能运用救治的方法。人禀受阴阳水火之气而形成形体，既然有正气，必然会有邪气的侵淫，这是天地自然的道理。（在天地间也有淫气。）痘毒的瓦斯，已经在生命形成的初期就萌发了。生命的初期，就像太极一样；三个月时形成胎儿形体，先生成两肾，就像太极分化为两仪。所以痘的根本根源在于肾。肾是水脏，主藏精并化生血液，又是生气之源。少阳之气，是水中所生的阳气，向上与心主包络相合，所以痘的起发，随着少阳的正气向上到达心包。（肾气交于心包，必须从中焦向上。邪气在阳明经，就会呕吐逆乱；阳明热盛，就会发狂。所以痘前出现惊悸的，可以治疗。如果邪气发于肝、脾、肺外合的皮肤肌肉间，毒邪不解，反而内伤肝脏就会发惊，损伤脾脏就会泄泻，损伤肺脏就会喘急，所以痘后出现惊悸的，难以治愈。）心主血，而心包络主脉，所以毒邪从经络进入脉，从脉进入络，从络进入孙络，从孙络而出现在皮肤，这是顺证。大概痘是精血中的火毒，所以走于血分，然后才能化脓结痂；如果走于气分，就会变成水泡白壳。经络属于血分，皮肤肌腠属于气分。皮毛是肺的外合；肌肉是脾的外合。在皮肤、肌肉之中，有充养肌肤、温暖肌肉的血，由肝所主，也属于气分。所以痘的顺证，是从经络而出现在皮肤，因此陆续发出，参差不齐大小不一，根窠收敛，界限分明。这是因为界限所在的皮肤、肌肉没有被邪毒伤害的缘故。血色华润光泽，根部红顶部白，气引领化成浆液，这是因为气行于脉外而血随气化。所谓的逆证，是毒邪走于皮肤的气分，就会一齐涌出像痱子一样，世俗所说的“肺经痘”就是这种情况。如果走于气分而留滞于肌腠，就会出现嘴唇肿胀、眼睛胀大，肌肉先浮肿而痘反而平塌，世俗所说的“脾经痘”就是这种情况。如果走于气分而留滞在充肤热肉的血之间，就会皮薄而娇红可爱，光亮如灯，这三种情况都没有血来化成浆液，最终无法救治。这是因为毒邪随着气走于肺、脾、肝外合的皮肤肌肉间，实际上并不是肺经、脾经、肝经的痘毒。又有一种夹带疹子的痘，这种痘分别走于气分和血分，所以还可以治疗。如果纯走于气分，即使是聪明灵巧的人，也不能做无米之炊（无法救治）。所谓的险证，是火毒太盛，或者阻滞于肾脏，或者留蓄在心包。（毒邪阻滞于肾脏，就会腰疼肚痛，寒战咬牙，甚至出现紫斑黑陷；毒邪留滞于心包，就会高热烦躁，便血，神志昏迷。）这事情在于良医，急需施展妙手，表实者解表，里实者通里，热毒盛者急需清解，不能起发的以攻发为先。这是可生可死的急证，不能拖延时日。所以证候有轻重，方剂有缓急，如果服用平和汤药而痊愈的，原本就不是死证，不吃药也可以；如果服用平和汤药后反而导致无法救治的，是医生的罪过。救治逆证的方法，方书中确有冰肌散，治疗痘疹一齐涌出，服用后可以使其收敛回去。我认为这个方子平易浅薄，怎么能救治大的逆证！门人金西铭，在丹阳得到一方救逆汤。我在邱汉冲先生处，得到一方丸药。以此三方为基础，斟酌增减，合并为一个方子，名叫五类救逆丹，对于逆证、险证，服用都有奇效。至于表里、血气、寒热、虚实，又在临诊的医生，兼以汤药治疗就可以了。
The term "Sha" (Sand spots) refers to spots on the body resembling sand; when scraped with hemp, they appear clustered like cinnabar, hence the name. This condition arises from wind-cold-damp pathogenic factors or mountain miasma invading between the skin and muscle. The skin is the exterior correspondence of the Lung; the muscle is the exterior correspondence of the Spleen. The Lung governs Qi, while the Spleen governs the abdomen. If pathogens invade internally affecting the Lung, Qi rebellion occurs, manifesting as a cyan face and cold limbs; if invading the Spleen, it causes colicky abdominal pain. Therefore, superficial cases are treated by scraping, while deeper cases are treated by acupuncture, allowing pathogenic factors to exit externally, thereby stopping the pain. If the pathogen is severe and timely rescue and acupuncture are neglected, the pathogen will interfere with the Zang organs, causing stagnation of Qi mechanism, rendering it incurable. In recent times, this is called "Ban Sha" (Spotted Sand), and acupuncture at Baihui (GV20) is indicated. Acupuncture at Baihui to induce bleeding is named "Opening the Door," which is the method for treating macules and rashes, thus applied here. However, if it is not macule eruption due to excessive heat, Baihui need not be selected. Yu Tianmin stated in *Yixue Zhengzhuan* (Correct Transmission of Medicine): To treat Sha syndrome, one may first apply hot water soaked cloth to the arm and scrape with ramie; for severe cases, prick the ten fingers to bleed, or use an sesame oil lamp to illuminate the chest and back, cauterizing any red spots found. The theory of spots has existed for a long time, and cauterization methods have been practiced. Recent practitioners consider it a new "Ban Sha" due to lack of scholarly engagement! If heat pathogens remain in the skin, or cold pathogens transform into heat forming spots, sudden invasion leading directly inward would present with cyan face and cold limbs, without any spots. Without urgent acupuncture, sudden death would occur, leaving no time for lamp illumination and cauterization!
Discussions on smallpox and rashes have numbered over a hundred schools from ancient to modern times. However, without studying classics such as *Lingshu* (Spiritual Pivot) and *Sujing* (Basic Questions), one cannot understand the origin, exit, and entry of Zang-Fu organs and Qi-Blood. Thus, one only knows the manifestations of favorable (Shun), dangerous (Xian), and adverse (Ni) syndromes, but not their causes. Without knowing the causes, rescue methods cannot be applied. Humans form their bodies by inheriting Yin-Yang and Water-Fire Qi. Where there is righteous Qi, there must be pathogenic excess, which is the natural law of heaven and earth. (Excess Qi also exists in heaven and earth.) The toxic vapor of smallpox sprouts at the beginning of life. The beginning of life is akin to Taiji; at three months, the fetus takes shape, starting with the two Kidneys, akin to Taiji dividing into Two Yi (Yin and Yang). Thus, the root of smallpox lies in the Kidney. The Kidney is a Water organ, storing Essence and transforming Blood, and is the source of generating Qi. Shaoyang Qi is the generating Yang within Water, ascending to combine with the Pericardium. Therefore, the eruption of smallpox follows the righteous Qi of Shaoyang upward to reach the Pericardium. (Kidney Qi interacting with the Pericardium must ascend through the Middle Jiao. Pathogens in the Yangming channel cause vomiting and rebellion; excessive Yangming heat causes mania. Thus, convulsions before smallpox eruption are treatable. If pathogens erupt in the skin and muscle corresponding to Liver, Spleen, and Lung, and toxic pathogens do not resolve, internal injury to the Liver causes convulsions, injury to the Spleen causes diarrhea, injury to the Lung causes panting. Thus, convulsions after smallpox eruption are untreatable.) The Heart governs Blood, and the Pericardium governs Vessels. Therefore, toxins move from channels to vessels, from vessels to collaterals, from collaterals to Sun collaterals, and finally emerge in the skin; this is a favorable course. Smallpox is fire-toxin within Essence and Blood; thus, moving through the Blood level allows it to suppurate and scab. If it moves through the Qi level, it becomes vesicles with white shells. Channels and collaterals belong to the Blood level; skin and interstices belong to the Qi level. Hair follicles correspond to the Lung; muscles correspond to the Spleen. Within skin and muscle, blood that nourishes flesh and warms the body is governed by the Liver and also belongs to the Qi level. Therefore, favorable smallpox emerges from channels into the skin, appearing successively, uneven in size, with converging bases and clear boundaries, because the boundary skin and muscle are unharmed by toxic pathogens. The blood color is lustrous, roots red and tops white; Qi leads the formation of pus, as Qi moves outside vessels and Blood transforms with Qi. Adverse syndromes occur when toxins move into the Qi level of the skin, erupting all at once like miliaria, commonly called "Lung Channel Smallpox." If toxins move into the Qi level and stagnate in interstices, lips swell, eyes puff, flesh floats first while pustules flatten, commonly called "Spleen Channel Smallpox." If toxins move into the Qi level and stagnate between the blood nourishing flesh, the skin is thin, delicately red, and shiny like a lamp. These three types lack blood to form pus and are ultimately incurable. This is because toxins follow Qi into the skin and muscle corresponding to Lung, Spleen, and Liver, actually not being toxin of Lung, Spleen, or Liver channels. Another type is smallpox accompanied by rashes, where toxins separately move through Qi and Blood levels, making them treatable. If purely moving through the Qi level, even skilled physicians cannot cook without rice (cannot cure). Dangerous syndromes involve excessive fire-toxin, either blocking the Kidney or accumulating in the Pericardium. (Toxin blocking the Kidney causes lower back and abdominal pain, chattering teeth, and potentially purple/black depressed spots; toxin accumulating in the Pericardium causes high fever, irritability, bloody stool, and coma.) This depends on skilled physicians applying effective methods: release the exterior for exterior excess, drain the interior for interior excess, clear and resolve rapidly for excessive heat-toxin, and promote eruption first if it fails to rise. These are critical conditions where life and death hang in the balance, requiring no delay. Syndromes vary in severity, and prescriptions vary in urgency. If cured by mild decoctions, the original condition was not fatal, and medication might not even be needed; if mild decoctions lead to incurability, it is the physician's fault. For rescuing adverse syndromes, *Bingji San* (Ice Skin Powder) exists in medical texts to treat simultaneous eruption and induce retraction. I consider this prescription too plain and shallow to save major adverse cases. My disciple Jin Ximing obtained a *Jiuni Tang* (Rescue Adverse Decoction) in Danyang. I obtained a pill prescription from Mr. Qiu Hanchong. Based on these three prescriptions, I adjusted and combined them into one formula named *Wulei Jiuni Dan* (Five-Class Rescue Adverse Elixir), which shows miraculous effects for adverse and dangerous syndromes. Regarding exterior-interior, Qi-blood, cold-heat, and deficiency-excess, attending physicians should treat accordingly with decoctions.