凡伤寒头痛寒热诸症，或当暑天，或触秽气，或疫疠所感，忽犯痧胀，是惟认脉、看筋辨之，先治其痧，痧退之后，
乃治伤寒。若误饮热汤、热药，慢者尤可，紧者立时见凶。
治验∶
一余甥坦卜文木长子十二岁，头痛身热无汗。他医皆治其伤寒，不应。余诊之，六脉微缓，乃知其伤寒兼痧者也。
刺腿弯青筋三条，紫黑毒血涌出甚多，不愈，用防风胜金汤稍冷服二剂，痧退。服小柴胡汤而痊。
一车姓者，五月，伤寒十四日，忽尔发昏沉重，卧不能转。延余诊之，余曰∶“此伤寒犯痧，若不先治其痧，余不
敢任”。不信，延他医治之，益昏迷不醒。复求余，余曰∶“痧气冲心，故昏迷；痧毒入于血分经络间，故病不能自转侧。
若先治痧，尚有廖日”。即求余治，先放痧，不愈，用宝花散、圆红散、及防风胜金汤，俱微冷服，痧退后，治伤寒而
痊。
一余次女，四月间，头痛发热，属伤寒太阳经症，用羌活冲和汤加减治之，稍愈。至第四日，原照伤寒治之，不应，
更面赤身热、心胸闷闷不已，六脉洪大无伦。余曰∶“此伤寒兼犯痧症，当看痧筋刺之”。余女不信，至晚，疾益甚，始
欲放痧，在左腿弯下，刺青筋一针，流紫黑毒血，余更有细青筋不甚现，是缘不信，多缠绵一日，痧气壅阻，故痧筋有
隐隐者尔。服必胜汤三头服，稍觉身松，未愈。次日指上痧筋复现，刺血九针，服药未愈。俟至夜，右腿弯复现青筋二
条，刺出毒血，服圆红散，乃少安。后又骤进饮食，复发热面赤，用山楂、卜子、柴胡、陈皮之类饮之，不应。脉仍洪
大无伦，此因痧毒复发而然，刺两足十趾青筋，去其毒血，用必胜汤稍冷服二剂未已。偶饮稍温茶，立刻狂言，此痧未
尽散，因温饮而复发也。用冷井水三碗饮之，更冷服药五剂，然后痧气乃清，但病久身虚发晕，服参汤而苏，后用十全
大补汤加减治之，调理二月而痊。
凡是伤寒引起的头痛、恶寒发热等各种症状，无论是发生在暑天，还是因接触污秽之气，或是感染疫疠之气，突然引发痧胀病证，这只能通过诊察脉象、观察筋络来辨别。应当先治疗痧胀，待痧症消退之后，再治疗伤寒。如果误饮热汤或服用热性药物，病情发展缓慢的尚可挽救，病情急骤的会立刻出现凶险之兆。
治验案例：
我的外甥坦卜文木的长子十二岁，头痛、身体发热且无汗。其他医生都按伤寒治疗，但无效。我诊察后，发现六脉微缓，才知道这是伤寒兼夹痧症。在他腿弯处刺破三条青色静脉，涌出大量紫黑色的毒血，症状未愈，于是让他稍冷服防风胜金汤两剂，痧症消退。随后服用小柴胡汤而痊愈。
有一位姓车的人，五月时患伤寒十四天，忽然昏沉严重，卧床无法翻身转动。请我去诊治，我说：“这是伤寒兼夹痧症，如果不先治疗痧症，我不敢承担责任。”他不相信，请其他医生治疗，结果更加昏迷不醒。后来再次求我诊治，我说：“痧气上冲于心，所以昏迷；痧毒进入血分和经络之间，所以身体不能自行转动。如果先治疗痧症，还有治愈的日子。”他随即请求我治疗，我先进行放痧疗法，症状未愈，接着使用宝花散、圆红散以及防风胜金汤，均微冷服用，痧症消退后，再治疗伤寒而痊愈。
我的次女，四月间，头痛发热，属于伤寒太阳经的症状，我用羌活冲和汤加减治疗，稍微好转。到了第四天，依然按照伤寒治疗，却无效，反而出现面色发红、身体发热、心胸烦闷不止，六脉洪大无比。我说：“这是伤寒兼夹痧症，应当查看痧筋并针刺。”我女儿不信，直到晚上，病情加重，才想要放痧。在左腿弯下方，刺破一条青色静脉，流出紫黑色毒血。但我还有细小的青色静脉不明显显现，这是因为之前不信，多拖延了一天，导致痧气壅阻，所以痧筋有隐约可见的情况。服用必胜汤三碗，稍微觉得身体轻松，但未痊愈。第二天手指上的痧筋再次显现，刺血九针，服药仍未愈。等到夜晚，右腿弯又显现两条青色静脉，刺出毒血，服用圆红散，病情才稍微安定。后来又突然进食过多，再次发热面赤，用山楂、萝卜子、柴胡、陈皮等煎水饮用，无效。脉象仍然洪大无比，这是因为痧毒复发所致。刺破双脚十个脚趾的青色静脉，排出毒血，再用必胜汤稍冷服用两剂仍不停止。偶然喝了稍温的茶，立刻胡言乱语，这是因为痧气未尽散，因温热饮食而复发。用三碗冷井水喝下，再冷服药物五剂，然后痧气才清除。但因为病久身体虚弱而发晕，服用参汤后苏醒，后来用十全大补汤加减治疗，调理两个月而痊愈。
In cases where symptoms such as headache, aversion to cold, and fever associated with Shanghan (Cold Damage disease) occur, whether during the summer heat, due to exposure to foul odors, or contracted from epidemic pestilence, if Sha Zhang (Sha Distension) is suddenly triggered, it can only be differentiated by examining the pulse and observing the collateral vessels. The Sha condition must be treated first; only after the Sha subsides should the Shanghan be addressed. If hot soups or hot-natured medicines are mistakenly ingested, a slow progression may still be salvageable, but an acute progression will immediately lead to critical conditions.
Clinical Cases:
1. My nephew, Tanbu Wenmu's eldest son, aged twelve, suffered from headache, body fever, and absence of sweating. Other physicians treated him for Shanghan without success. Upon my examination, his six pulses were slightly moderate (Wei Huan), leading me to diagnose it as Shanghan complicated by Sha. I punctured three cyanotic veins in the popliteal fossa, releasing a large amount of dark purple-black toxic blood. As symptoms persisted, he was administered Fangfeng Shengjin Tang (Windproof Metal-Overcoming Decoction) cooled slightly, two doses, which caused the Sha to subside. Subsequently, Xiaochaihu Tang (Minor Bupleurum Decoction) was taken, resulting in recovery.
2. A patient surnamed Che, in May, had suffered from Shanghan for fourteen days when he suddenly became severely lethargic and unable to turn over in bed. I examined him and stated, "This is Shanghan complicated by Sha. If the Sha is not treated first, I cannot take responsibility." He did not believe this and sought treatment from other physicians, which resulted in deeper coma. He later returned to me. I explained, "The Sha Qi (Sha Pathogenic Factor) rushing to the Heart causes the coma; the Sha toxin entering the Blood level and collaterals prevents voluntary movement. If the Sha is treated first, there is still hope for recovery." He requested my treatment. I performed bloodletting (Fangsha). As symptoms persisted, Baohua San (Precious Flower Powder), Yuanhong San (Round Red Powder), and Fangfeng Shengjin Tang were all administered cooled slightly. After the Sha subsided, the Shanghan was treated, leading to recovery.
3. My second daughter, in April, presented with headache and fever, characteristic of the Taiyang Channel syndrome of Shanghan. I treated her with modified Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction), which provided slight relief. By the fourth day, continuing treatment according to Shanghan protocols proved ineffective. Her face turned red, body fever increased, and she experienced persistent chest stuffiness. Her six pulses were excessively surging (Hong Da). I stated, "This is Shanghan complicated by Sha. One must inspect the Sha collaterals and puncture them." My daughter did not believe this. By evening, her condition worsened, and she finally agreed to bloodletting. A cyanotic vein below the left popliteal fossa was punctured, releasing dark purple-black toxic blood. However, finer cyanotic veins were not clearly visible because the delay caused Sha Qi stagnation, making the collaterals faint. She drank three bowls of Bisheng Tang (Invincible Victory Decoction) and felt somewhat relaxed, but did not recover. The next day, Sha collaterals reappeared on her fingers; nine needle pricks released blood, yet medication failed to cure her. At night, two cyanotic veins appeared on the right popliteal fossa; they were punctured to release toxic blood, and Yuanhong San was taken, bringing slight stability. Later, sudden overeating caused recurrent fever and facial flushing. A decoction of Hawthorn Fruit (Shanzha), Radish Seed (Buzi), Bupleurum Root (Chaihu), and Tangerine Peel (Chenpi) was given without effect. The pulse remained excessively surging, indicating a recurrence of Sha toxin. Cyanotic veins on all ten toes were punctured to remove toxic blood. Bisheng Tang was administered cooled slightly for two doses, but the condition persisted. Accidentally drinking slightly warm tea immediately induced delirium, indicating that the Sha had not fully dispersed and was reignited by the warm drink. Three bowls of cold well water were consumed, followed by five doses of cold medicine, after which the Sha Qi cleared. However, due to prolonged illness and physical deficiency causing dizziness, Shen Tang (Ginseng Decoction) was given to restore consciousness. Finally, modified Shiquan Dabu Tang (Complete Great Tonifying Decoction) was used for regulation, and she recovered after two months of convalescence.