脉无定准（两手如出两人）面无常（面色如赤如黄，）夜睡流涎鬼祟伤，喻氏却邪汤入妙，凿开
荒径指津梁。
砂证者，病起于骤然，或气逆面青，肢冷，目暗，俗称迷砂是也。或腹中绞痛，俗称绞
肠砂是也。张隐庵曰∶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，袭于肌表之间。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，宜刺百会出
血，名为开喑门。喑门即斑疹，故以治喑之法治之。若非热甚于斑，又不必刺百会也。
（孙男心典）按∶刺法以针刺手腕中、足委中及十指出血。刮法用手掌着热汤，重打手腕、
足委中，至红紫，大有斑如痘大（俗本“砂”作“痧”。
风寒湿与瘴邪干，斑点如砂仔细看，浅则括摩深刺血，救危慎勿等痫观。
正气夺则虚。所谓五虚者，虚在心则脉细，虚在肺则皮寒，虚在肝则气少，虚在肾则泄
利前后，虚在脾则饮食不入。
皮聚毛落则肺亏损，肉脱则皮亏损，脉萎则心亏损，筋骨惫则肝肾亏损，治之奈何。损
其肝者，缓其中；损其心者，和其营卫；损其脾者，调其饮食，适其寒温；损其肺者，益其
气；损其肾者，益其精；防其邪念，节嗜欲，温之以气，养之以味，皆所以救亏损也（以《
难经》为主，而参以各家要言，“温之以气”一句是总结上文之义，治虚劳症当以此为主。
伤寒用理中丸，所以补脾，调和阴阳之方也；附子汤所以补肾，扶坎中之阳也；炙甘草
汤所以补经中之阴也。详“伤寒门”不赘。
脉象没有固定的规律（两手脉搏强弱不一，仿佛出自两人之手），面色无常（面色忽红忽黄），夜间睡眠时流口水，这是被鬼祟邪气所伤。喻嘉言的却邪汤运用精妙，如同在荒径中凿开道路，指引通向津渡的桥梁。
砂证（即痧证），发病突然，有的表现为气逆、面色发青、四肢冰冷、目光昏暗，俗称“迷砂”。有的表现为腹部剧烈绞痛，俗称“绞肠砂”。张隐庵说：身上出现像砂子一样的斑点，用麻线刮拭后，隆起如朱砂颗粒，所以称为“砂”。这多是风寒湿邪或山间瘴气，侵袭于肌表之间。皮是肺的外合；肌肉是脾的外合。肺主气而脾主腹部。邪气内犯于肺，则气逆导致面色青、四肢冷；侵犯于脾，则导致腹部绞痛。所以病浅的用刮法，病深的用刺法，使邪气从外部泄出，疼痛就可以停止。如果病情严重而延误了救治和刺络，那么邪气就会干犯内脏，气机停滞不通，就无法挽救了。近代称为“斑砂”，适宜针刺百会穴放血，名为“开喑门”。“喑门”即指斑疹，所以用治疗失音的方法来治疗它。如果不是热毒极盛导致的斑疹，就不必针刺百会穴了。（孙思邈之孙孙心典）按语：刺法是用针刺手腕中部、足部委中穴以及十个手指尖出血。刮法是用手掌蘸热汤，用力拍打手腕、足部委中穴，直到皮肤呈现红紫色，出现类似痘疮大小的斑点（民间版本将“砂”写作“痧”）。
风寒湿与瘴邪干扰，身上的斑点如砂需仔细看，病浅则用刮摩法，病深则用刺血法，抢救危重病人切勿将其当作癫痫来观察。
正气耗夺则表现为虚证。所谓的“五虚”，虚在心则脉象细弱，虚在肺则皮肤寒冷，虚在肝则气息微弱，虚在肾则大小便失禁，虚在脾则饮食无法入口。
皮毛枯槁脱落则是肺亏损，肌肉消瘦则是脾亏损，血脉萎弱则是心亏损，筋骨疲惫则是肝肾亏损。如何治疗呢？肝脏受损的，舒缓其肝气；心脏受损的，调和其营卫之气；脾脏受损的，调节其饮食，适应寒温变化；肺脏受损的，补益其肺气；肾脏受损的，填补其肾精；防止邪念侵扰，节制嗜欲，用气来温养，用味来滋养，这些都是用来补救亏损的方法（以《难经》为主旨，并参考各家的精要言论，“温之以气”一句是总结上文的意义，治疗虚劳症应当以此为主。伤寒病使用理中丸，是用来补脾、调和阴阳的方剂；附子汤是用来补肾、扶持坎中真阳的方剂；炙甘草汤是用来补益经脉中阴血的方剂。详见“伤寒门”，此处不再赘述）。
The pulse lacks a fixed standard (the pulses in both hands are inconsistent, as if coming from two different people); the facial complexion is variable (the face appears alternately red and yellow); saliva flows during night sleep, indicating injury by demonic influences. Yu's Qiexie Tang (Decoction for Expelling Evil) is applied with exquisite skill, clearing a path through the wilderness to point out the way to safety.
Sha syndrome (Shā zhèng, often referring to Sha disease or sand-like rash conditions) arises suddenly. Some cases present with rebellious qi, cyanotic complexion, cold limbs, and dim vision, commonly known as "Mi Sha" (Confused Sha). Others present with severe colic in the abdomen, commonly known as "Jiao Chang Sha" (Intestinal Twisting Sha). Zhang Yin'an stated: When spots resembling sand appear on the body, scraping them with hemp causes them to rise like cinnabar grains; hence it is named "Sha". This condition is caused by wind-cold-dampness pathogens or mountain miasma invading the exterior of the skin and muscles. The skin is the exterior correspondence of the Lung; the muscles are the exterior correspondence of the Spleen. The Lung governs Qi, while the Spleen governs the abdomen. If the pathogen invades the Lung internally, it causes rebellious Qi, leading to a cyanotic face and cold limbs; if it invades the Spleen, it causes severe abdominal pain. Therefore, for superficial conditions, scraping is used; for deep conditions, pricking is used, allowing the pathogenic factors to be expelled externally, thereby stopping the pain. If the condition is severe and treatment via pricking is delayed, the pathogen will invade the Zang organs, causing stagnation of Qi mechanism, rendering the case incurable. In recent times, this is called "Ban Sha" (Spotted Sha). It is appropriate to prick the Baihui GV20 acupoint to induce bleeding, a technique named "Opening the An Gate". The "An Gate" refers to macules and papules; thus, methods used for treating aphonia are applied here. However, if it is not due to extreme heat causing macules and papules, pricking Baihui GV20 is unnecessary. (Sun Xindian, grandson of Sun Simiao) Commentary: The pricking method involves using needles to bleed the center of the wrist, the Weizhong BL40 acupoint at the foot, and the ten fingertips. The scraping method involves using the palm dipped in hot water to heavily strike the wrists and Weizhong BL40 acupoints until the skin turns red-purple, presenting spots as large as smallpox pustules (folk versions write "Sha" as "Sha").
Wind-cold-dampness and miasma pathogens interfere; carefully examine the spots on the body resembling sand. For superficial conditions, use scraping and rubbing; for deep conditions, use bloodletting. When rescuing critical patients, do not mistake this condition for epilepsy.
When righteous Qi is depleted, deficiency occurs. The so-called "Five Deficiencies" are: deficiency in the Heart manifests as a fine pulse; deficiency in the Lung manifests as cold skin; deficiency in the Liver manifests as scanty Qi; deficiency in the Kidney manifests as incontinence of urine and feces; deficiency in the Spleen manifests as inability to ingest food.
Withered and falling hair and skin indicate Lung deficiency; emaciated flesh indicates Spleen deficiency; atrophied vessels indicate Heart deficiency; exhausted sinews and bones indicate Liver and Kidney deficiency. How should these be treated? For Liver damage, soothe its interior; for Heart damage, harmonize Ying and Wei (Nutritive and Defensive Qi); for Spleen damage, regulate diet and adapt to temperature changes; for Lung damage, benefit Qi; for Kidney damage, benefit Essence. Prevent evil thoughts, restrain desires, warm with Qi, and nourish with flavor. All these are methods to rescue deficiency (Based primarily on the Nan Jing [Classic of Difficult Issues], incorporating essential statements from various schools. The phrase "warm with Qi" summarizes the preceding meaning; treating consumptive diseases should focus on this principle. For Cold Damage disorders, Lizhong Wan (Regulate the Middle Pill) is used to tonify the Spleen and harmonize Yin and Yang; Fuzi Tang (Aconite Decoction) is used to tonify the Kidney and support the Yang within Kan; Zhigancao Tang (Honey-Fried Licorice Decoction) is used to tonify Yin within the meridians. See the "Cold Damage Section" for details; no further elaboration here).