者。有触目之形。无碍手之质。即稠如锦纹。稀如蚊迹之象也。或布胸腹。或见四肢。以鲜红起发为吉。紫色成
片者凶。色黑色青者不治。
疹者。有颗粒之象。肿而易痒。即痧瘾之属。须知出要周匀。没宜徐缓。春夏多此。
杨质安注。 与疹当分别。 出于胃。疹出于肺。伤寒失表失清。邪遏于胃。而发蒸成 。故伤寒症发 多。发
疹则仅见也。其虚 阴 。由于中虚寒伏。逼其浮阳外越。无根之火内动。见 隐隐而微。色白不鲜者是也。
治须温补。疹或者时毒袭入肺卫而发。或温暑时邪从肺吸受。由卫入营之证。此邪在上焦。非由失表失清
之故。当辨其在气在营。而用宣肺轻透之法。若遇寒凉。须防抑闭。与 之治法迥然不同。
大抵发汗不出。或虽汗不解。胸膈烦闷。呕恶不纳。足冷耳聋。脉沉而伏。或寸关躁动。便是 疹欲出之候。
杨质安注。沉伏由邪伏于内。脉道不利所致。寸关躁动者。伏邪勃发之兆。 疹将出之时。上吐下泻。其热毒
从吐泻而外出。分消其势。大忌止涩。若出齐后。及将回之时。忌吐泻。恐其邪陷也。又痧 最宜通泄。惟二便
不利。为凶候。
塞邪郁表。恶寒发热。咽痛。身上有淡红白 。舌苔白而薄嫩者。当以荆防败毒散温散之。
温毒弥漫三焦。目赤舌绛。汗出津津。发为赤 丹疹。忌风药升散。宜凉膈散。
阳毒发 。面如涂朱。眼如喷火。六脉洪大。燥渴欲死。此阳明血热已极。毒邪传遍三焦。经络闭塞。营卫不通。非三
黄石膏汤。不能解救。
杨质安注。三焦表里。俱被热毒蒸灼。须两解表里之热邪。 疹方能透达。
伏 证。伤寒邪入太阴。脉静神呆。舌心灰黑。或时感过经不解。舌苔灰黑。或中心黑晕。肌表不甚发热。脉似沉
缓。但神识不清。或郑声作笑。此阳邪陷入太阴。防伏 内发。治宜宣通气血。透提 毒。如连翘赤芍银花紫草楂肉
天虫刺蒺藜犀角二刺之类。 疹外达。自然毒透神清。
杨质安注。太阴为湿土之脏。脾与胃相联。阳邪故易传入。灰黑者太阴。湿与热相蒸也。邪热陷入。抑遏不宣。
故表不甚热。脉见沉缓。不可误认为邪退正虚。浪投滋补。
劳倦内伤。虚火游行于外。亦有淡红 点。其身痛心烦寒热。虽与外感同。第脉虚大。或气口独大。倦怠懒言。动
则自汗为异。投补中益气汤。熟睡。汗止身凉。
杨质安注。此中虚稍挟微邪。用补正略佐达邪。
阴 因有伏寒。或误进寒凉。逼其虚阳浮散于外。其 点隐隐而微。脉虽洪大。按之无力。或六脉沉微。手足逆冷。
舌白滑。或黑胖。寒水克火之征。先用理中汤以复其阳。次随证施治。若内伤生冷。外感寒邪而发阴 。调中汤更捷。
肾虚挟感。 疹无力透达。微现淡红隐隐 点。脉沉细无力。舌苔淡红或紫色。舌形胖嫩圆大。（紫色圆胖少阴
虚证舌也）似寐非寐。神识乍清乍昧。此少阴精不化气。 不得透也。当以左归饮加人参。精气充溢。 自外达。
若兼右尺迟微。手足逆冷。渴不欲饮。此少阴水火俱亏。当以人参八味投之。肾气一充。其 自退。
疹子。有触目可见的形态，但没有阻碍手感的实质质感，即稠密如锦缎花纹、稀疏如蚊虫叮咬痕迹的样子。有的分布在胸腹部，有的出现在四肢，以颜色鲜红、顺利发出为吉兆；若呈紫色成片则为凶兆；颜色发黑或发青的则属不治之症。
痧（此处指类似疹子的疾病，如风痧等）。有颗粒状的形态，肿胀且容易瘙痒，属于痧瘾一类的疾病。需要知道痧疹发出要均匀透彻，消退宜缓慢。春夏季节多见此病。
杨质安注：痧与疹应当加以区分。痧出于胃，疹出于肺。伤寒病因失于解表或清里，邪气郁遏在胃中，从而蒸腾形成痧。所以伤寒病症中出现痧的情况较多，而发疹则较少见。如果是虚证导致的阴痧，是由于中焦脾胃虚弱、寒邪潜伏，逼迫浮阳外越，无根之火在内扰动，表现为痧点隐隐约约且微弱，颜色白而不鲜艳，这种情况治疗必须采用温补法。疹子则是由于时行毒邪侵袭肺卫而引发，或者是温暑时的邪气从口鼻吸入肺脏，由卫分传入营分的证候。这种邪气位于上焦，并非因为失于解表或清里的缘故。应当辨别邪气是在气分还是在营分，从而使用宣通肺气、轻清透达的方法。如果遇到寒凉药物，须防止其抑制闭塞邪气外出，这与治疗痧的方法截然不同。
大致而言，如果发汗后邪气未出，或者虽然出汗但病不解，出现胸膈部烦闷、恶心呕吐不能进食、脚冷耳聋、脉象沉伏，或者寸关部脉搏躁动，这就是痧疹将要发出的征兆。
杨质安注：脉象沉伏是因为邪气潜伏在体内，导致脉道运行不畅所致；寸关部脉搏躁动，是伏邪勃发的征兆。在痧疹即将发出之时，如果出现上吐下泻，这是热毒通过吐泻向外排出，分散了病势，此时最忌讳使用止涩的药物。如果在痧疹出齐后，以及即将消退的时候，则忌讳出现吐泻，恐怕会导致邪气内陷。另外，对于痧疹，最适宜的方法是通利泄邪，只有当大小便不通利时，才属于凶险的征候。
邪气闭塞郁结在肌表，出现恶寒发热、咽喉疼痛，身上出现淡红色白色的痧点，舌苔白而薄嫩，应当用荆防败毒散进行温散治疗。
温毒弥漫三焦，出现眼睛发红、舌质深红、汗出津津、发出赤色丹疹，忌用风药升散，宜用凉膈散。
阳毒引发痧疹，面色像涂了朱砂一样红，眼睛像喷火一样，六脉洪大，极度干燥口渴想死，这是阳明经血热到了极点，毒邪传遍三焦，经络闭塞，营卫不通，非用三黄石膏汤不能解救。
杨质安注：三焦的表和里，都被热毒蒸灼，必须同时解除表里两方面的热邪，痧疹才能透发出来。
伏痧证。伤寒邪气侵入太阴经，脉象平静、神情呆滞，舌中心灰黑色，或者是时令感邪经过多经仍未痊愈，舌苔灰黑，或者中心有黑晕，肌表不是很发热，脉象似乎沉缓，但是神识不清，或者自言自语、傻笑，这是阳邪陷入太阴，防止伏痧在内爆发，治疗宜宣通气血，透提痧毒，如连翘、赤芍、银花、紫草、山楂肉、天虫、刺蒺藜、犀角、二刺（指皂角刺和穿山甲，或指其他具有穿透作用的药材）之类的药物。使痧疹向外透达，自然毒邪透出、神识清醒。
杨质安注：太阴是湿土之脏，脾与胃相连接，阳邪因此容易传入。舌苔灰黑是太阴湿与热相互蒸腾的结果。邪热陷入，被抑制而不能宣散，所以体表不是很热，脉象呈现沉缓，不可误认为是邪气退去、正气虚弱而胡乱投用滋补药物。
劳倦导致内伤，虚火游行于体表，也会出现淡红色的斑点。身体酸痛、心烦、寒热交替，虽然与外感相似，但脉象虚大，或者气口脉独大，倦怠懒言，一动就自汗，这是不同之处。投用补中益气汤，患者熟睡后，汗止身凉。
杨质安注：这是中气虚弱稍微夹杂微邪，用补益正气略微佐以透达邪气的方法。
阴痧因为体内有伏寒，或者误服寒凉药物，逼迫虚阳浮散于体外，其痧点隐隐约约且微弱，脉象虽然洪大，但按之无力，或者六脉沉微，手足逆冷，舌苔白滑，或者黑胖，这是寒水克火的表现。先用理中汤来恢复阳气，随后根据症状施治。如果是内伤生冷、外感寒邪而引发的阴痧，用调中汤更快捷。
肾虚夹杂外感，痧疹无力透达，微微显现淡红色隐隐的斑点，脉象沉细无力，舌苔淡红或紫色，舌形胖嫩圆大。（紫色圆胖是少阴虚证的舌象），似睡非睡，神识时而清醒时而模糊，这是少阴精不化气，痧毒不得透发的表现。应当用左归饮加人参，精气充溢，痧毒自然向外透达。
Rash (Zhen). It has a form visible to the eye but lacks a substantial texture that impedes the hand, resembling dense patterns like brocade or sparse marks like mosquito bites. It may be distributed on the chest and abdomen or appear on the limbs. A bright red color upon emergence is auspicious; purple patches appearing together are inauspicious; black or bluish-black colors indicate an untreatable condition.
Sha (often referring to wind-rash or similar eruptive diseases). It presents with granular morphology, swelling, and itching, belonging to the category of Sha-Yin (itchy eruptions). It is essential to know that the eruption should be uniform and thorough, while its resolution should be gradual. This condition is common in spring and summer.
Yang Zhi'an's Note: Sha and Zhen must be distinguished. Sha originates from the Stomach, whereas Zhen originates from the Lung. In Cold Damage (Shanghan), if the exterior is not released or heat is not cleared, pathogenic factors become constrained in the Stomach, steaming and generating Sha. Therefore, Sha appears frequently in Shanghan symptoms, while Zhen is seen less often. If it is a deficiency-type Yin-Sha, it arises from middle-jiao deficiency and latent cold, which forces floating Yang to escape outward and rootless fire to move internally. The manifestation is faint and weak Sha spots, white in color and lacking luster. Treatment requires warming and tonifying methods. Zhen, however, is caused by seasonal toxic pathogens invading the Lung and Wei (Defensive) levels, or by warm-summer pathogens entering through the nose and mouth into the Lung, progressing from the Wei level to the Ying (Nutritive) level. This pathogen resides in the Upper Jiao and is not due to failure in releasing the exterior or clearing heat. One must distinguish whether the pathogen is in the Qi level or Ying level and employ methods to diffuse Lung Qi and lightly penetrate the exterior. Caution is needed against using cold-natured herbs that might suppress and close off the pathogen's exit; this treatment approach is completely different from that for Sha.
Generally speaking, if sweating does not expel the pathogen, or if sweating fails to resolve the illness, accompanied by oppression and irritability in the chest and diaphragm, nausea, vomiting, inability to eat, cold feet, deafness, deep and hidden pulse, or restless pulses at the Cun and Guan positions, these are signs that Sha-Zhen is about to emerge.
Yang Zhi'an's Note: Deep and hidden pulses result from pathogens latent within the body obstructing the pulse channels. Restless pulses at the Cun and Guan positions are omens of latent pathogens erupting. When Sha-Zhen is about to emerge, upper vomiting and lower diarrhea may occur; this allows heat toxins to exit via vomiting and diarrhea, dispersing their momentum. At this stage, astringent drugs are strictly contraindicated. However, after the rash has fully erupted or when it is beginning to recede, vomiting and diarrhea are contraindicated to prevent pathogenic sinking inward. Furthermore, for Sha-Zhen, unblocking and purging are most suitable; only when urination and defecation are difficult is it considered a critical sign.
When pathogens are blocked and constrained in the exterior, presenting with aversion to cold, fever, sore throat, and pale red or white Sha spots on the body, with a thin, tender white tongue coating, Jing Fang Bai Du San should be used to disperse them warmly.
When Warm-Toxin pervades the Three Jiao, presenting with red eyes, crimson tongue, profuse sweating, and red Dan-Rash (erysipelas-like rash), aromatic and ascending wind-dispersing herbs are contraindicated. Liang Ge San is appropriate.
Yang-Toxin causing Sha-Zhen presents with a face as red as cinnabar, eyes like fire, surging-large pulses throughout all six positions, extreme dryness, thirst, and desperation. This indicates extreme blood-heat in the Yangming channel, with toxic pathogens spreading through the Three Jiao, blocking meridians, and obstructing Ying and Wei circulation. Only San Huang Shi Gao Tang can rescue this condition.
Yang Zhi'an's Note: Both the interior and exterior of the Three Jiao are steamed and scorched by heat-toxin. Both exterior and interior heat pathogens must be resolved simultaneously for the Sha-Zhen to penetrate and emerge.
Latent Sha Syndrome. When Cold Damage pathogens enter the Taiyin channel, the pulse is calm, spirit is dull, and the center of the tongue is gray-black. Or, if a seasonal infection persists beyond the expected stages, the tongue coating is gray-black or has a black halo in the center. The body surface is not significantly hot, the pulse seems deep and slow, but consciousness is unclear, possibly with muttering or laughing. This indicates Yang pathogens sinking into Taiyin, risking internal eruption of latent Sha. Treatment should focus on diffusing and unblocking Qi and Blood, and penetrating/extracting Sha-toxin, using herbs such as Lqiao Qiao (Forsythiae Fructus), Chi Shao (Paeoniae Radix Rubra), Yin Hua (Lonicerae Japonicae Flos), Zi Cao (Arnebiae Radix et Rhizoma), Zha Rou (Crataegi Fructus), Tian Chong (Bombyx Batryticatus), Ci Ji Li (Tribuli Fructus), Xi Jiao (Rhinocerotis Cornu), and Er Ci (Spina Gleditsiae and Squali Pinna, or similar penetrating herbs). Once the Sha-Zhen reaches the exterior, the toxin will naturally clear, and consciousness will restore.
Yang Zhi'an's Note: Taiyin is the organ of damp-earth, connected to the Spleen and Stomach; thus, Yang pathogens easily transmit into it. Gray-black coating indicates Taiyin dampness steaming with heat. Pathogenic heat sinking and being suppressed prevents diffusion, resulting in little external heat and a deep-slow pulse. Do not mistakenly diagnose this as pathogen retreat and righteous qi deficiency, nor recklessly administer tonics.
Fatigue-induced internal injury causes deficient fire to wander externally, also producing pale red spots. Symptoms include body ache, irritability, alternating chills and fever, similar to exterior syndromes. However, the pulse is deficient and large, or the Qi-Kou pulse alone is large; there is fatigue, reluctance to speak, and spontaneous sweating upon movement. These differences indicate the use of Bu Zhong Yi Qi Tang. After falling into a deep sleep, sweating stops, and the body cools.
Yang Zhi'an's Note: This is middle-jiao deficiency slightly complicated by minor pathogens. Tonify the righteous qi while slightly assisting in expelling the pathogen.
Yin-Sha occurs due to latent cold within or misadministration of cold-natured herbs, forcing deficient Yang to float and scatter externally. The Sha spots are faint and weak. Although the pulse may seem surging-large, it is forceless upon pressure, or all six pulses are deep and minute. There is cold extremities, white slippery tongue coating, or black-swollen tongue, indicating Water overcoming Fire. First, use Li Zhong Tang to restore Yang, then treat according to specific symptoms. If Yin-Sha is caused by internal injury from raw/cold food and external contraction of cold pathogens, Diao Zhong Tang acts more rapidly.
Kidney deficiency combined with external contraction results in Sha-Zhen unable to penetrate effectively, showing only faint pale red spots. The pulse is deep, fine, and forceless. The tongue coating is pale red or purple, and the tongue body is swollen, tender, round, and large (purple, round, and swollen indicates Shaoyin deficiency). The patient is half-asleep, with fluctuating clarity of consciousness. This indicates Shaoyin essence failing to transform into Qi, preventing Sha-toxin penetration. Use Zuo Gui Yin plus Ren Shen. Once Essence and Qi are abundant, the Sha-toxin will naturally emerge outward.
If accompanied by a delayed and minute Right-Chi pulse, cold extremities, and thirst without desire to drink, this indicates Shaoyin deficiency of both Water and Fire. Administer Ren Shen Ba Wei Wan. Once Kidney Qi is replenished, the Sha-toxin will naturally recede.