夫痧之与痘，同一胎毒也，而有府藏之分焉。其发也，亦有出迟出速之异，以伏藏之地有远近也。第痧之一证，古
人治法，惟以升麻葛根汤为祖剂，芫荽酒之外治而已。其有风寒外束，内毒难出而喘急者，麻杏石甘汤主之。若夫轻浅
之证，竟有不必延医，自用樱桃核、粗草纸、棉纱线煎汤饮之而愈者。即其发也，不过周时而透，透之后亦仅二三日而
自愈矣。今之痧也则不然，有二三日而方透者；有四五日而终未透者；或身肢虽达，而头面不透，咳声不扬，喘逆气粗，
闷伏危殆者；又有一现即回，旋增喘促、狂躁、闷乱，谓之隐早者；更有痧虽外达，而 红紫滞，或目封，或 赤，谵
语、神昏、便秘、腹痛，或便泄无度，种种热盛毒深之象。以向来痧疹门方治之无济，仿治痘之法，先以紫雪芳透于前，
继以犀、羚、芩、连、丹、地、石膏、人中黄大剂清凉解毒，始得转重为轻，易危为安。或有病深药浅，而至于危变者，
几同痘疮，有顺、险、逆之别。嗟嗟！同一痧也，何今昔不侔若此耶？揆其所以然，大率迩年来种痘盛行，胎毒未得尽
泄，借此痧症以泄其毒者有之；抑或近来时厉之气甚于昔日，以致症之险重者有之。要在临此证者，无执前人之治，因
时制宜，因证立方，圆机活泼，勿以痘重痧轻而忽之，庶无愧为司命矣。
痧症与痘疹，同源于胎毒，但在脏腑归属上有所区别。它们发作时，也有出疹快慢的不同，这是因为毒邪潜伏的部位有深浅远近之分。然而对于痧症这一病证，古人治疗的方法，仅以升麻葛根汤作为基础方剂，外加芫荽酒进行外治罢了。如果有风寒束表，导致体内毒邪难以透出并出现气喘急促的情况，用麻杏石甘汤主治。若是病情轻浅的病例，甚至不必请医生，自行用樱桃核、粗草纸、棉纱线煎汤饮用就能痊愈。即使发病，也不过经过一个时辰就能透发，透发之后也仅需两三天就能自愈了。现在的痧症则不是这样，有的要两三天才能透发；有的四五日却始终未能透发；或者身体四肢虽然透发，但头面部不透，咳嗽声音不响亮，气喘逆乱且气息粗重，胸闷伏匿而处于危险境地；又有一种刚现出即回隐，随即增加气喘急促、狂躁、胸闷烦乱的症状，称为“隐早”；更有甚者，痧毒虽向外透达，但颜色红紫晦滞，或者眼睑闭合难睁，或者目睛发红，伴有胡言乱语、神志昏迷、大便秘结、腹痛，或者腹泻无度，呈现出种种热盛毒深的征象。用以往痧疹门的方药治疗已无济于事，仿照治疗痘疹的方法，先用紫雪丹芳香透窍于前，继以大剂量使用犀角、羚羊角、黄芩、黄连、牡丹皮、生地黄、石膏、人中黄等药物进行清凉解毒，才得以使重症转轻，化险为安。如果有病邪深重而用药轻微，从而导致危重变化的情况，几乎同痘疮一样，有顺证、险证、逆证的区别。唉！同样是痧症，为何古今差异如此之大呢？推究其所以然的原因，大抵是近年来种痘盛行，胎毒未能完全发泄，借此痧症来泄除毒邪的情况存在；或者是近来时行厉气比昔日更严重，导致病症变得险重。关键在于面对此证时，不要拘泥于前人的治法，应因时制宜，根据证候确立方药，思维灵活变通，不要因为认为痘重痧轻而轻视它，这样才能无愧于“司命之医”的称号。
Sha (exanthematous disease) and Dou (smallpox/variolous disease) both originate from congenital toxin (congenital pathogenic factor), yet they differ in their zang-fu organ involvement. Their eruption also varies in speed—early or late—due to the depth and distance of the toxin's latent location. However, regarding the treatment of Sha, ancient practitioners primarily relied on Shengma Gegen Tang (Bupleurum and Pueraria Decoction) as the foundational formula, supplemented by external treatment with Yuanxi Jiu (Coriander Wine). In cases where wind-cold binds the exterior, trapping internal toxins and causing wheezing and urgency, Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) is indicated. For mild and superficial cases, medical attention was sometimes unnecessary; patients could recover by self-administering decoctions made from cherry pits, coarse paper, or cotton yarn. Even in such instances, eruption typically occurred within one shichen (two hours), and spontaneous recovery followed within two to three days post-eruption.
Current Sha presentations, however, are different. Some take two to three days to erupt; others fail to erupt even after four to five days. Some exhibit eruption on the limbs but not on the head and face, accompanied by a hoarse cough, wheezing, coarse breathing, chest oppression, and critical danger. Others present with immediate retraction of the rash, followed by worsening wheezing, mania, restlessness, and confusion, termed "Yin Zao" (hidden early). Furthermore, although the rash may reach the surface, it may appear dark red or purple and stagnant, with sealed eyelids or red eyes, delirium, coma, constipation, abdominal pain, or uncontrolled diarrhea, presenting various signs of intense heat and deep-seated toxicity. Traditional formulas for Sha and Zhen prove ineffective. Imitating the treatment of Dou, one must first use Zixue San (Purple Snow Powder) to promote aromatic penetration, followed by large doses of Xijiao (Rhinoceros Horn), Lingyangjiao (Antelope Horn), Huangqin (Scutellaria Root), Lianzi (Coptis Rhizome), Mudanpi (Moutan Cortex), Shengdihuang (Rehmannia Root Prepared with Wine), Shigao (Gypsum Fibrosum), and Renzhonghuang (Human Excrement Charcoal) to clear heat and detoxify. Only thus can severe conditions be alleviated and critical states stabilized. Cases where the disease is deep but the medication is weak may lead to critical transformations, resembling smallpox with favorable, dangerous, and adverse prognoses. Alas! Why is there such a disparity between ancient and modern Sha? Upon investigation, this is largely due to the prevalence of vaccination in recent years, which has prevented the complete discharge of congenital toxins, leading some to vent these toxins through Sha; or perhaps because the epidemic qi of recent times is more virulent than in the past, resulting in more dangerous and severe manifestations. The key lies in not adhering rigidly to ancient treatments when facing such cases, but rather adapting to the times and formulating prescriptions based on specific syndromes, maintaining flexible clinical reasoning. One should not neglect Sha simply because it is considered lighter than Dou, so as to remain worthy of the title of "Guardian of Life."