经行之际，适遇痧发，经阻逆行，或鼻红，或吐红，肚腹肿胀，卧床不能转侧者是也。肚腹不痛，亦为暗痧。若痧
毒攻坏脏腑者不治。
治验∶
一沈弘先内人，经期发热，鼻血如注，昏迷沉重、肚腹作胀。延余诊之，脉伏。余曰∶“兼痧而经逆者也”。弘先善
放痧，刺腿弯二针，出紫黑毒血，不愈。余用桃仁、红花、独活、细辛、山楂、香附、青皮加童便饮之，经行调理而愈。
（头汗痧、狂、谵语附）
痧气壅盛，发为热症，或热而不凉，或日晡发热，或潮热往来，皆痧毒之气阻而不通，搏激肌表，发而为热。不识
者，认为外感，传经热症，发汗温饮，即慢痧迟缓，势必痧气益盛，变出头汗发狂，种种重症。不知外感之脉浮数而紧；
热症之脉，洪数有力；痧症之脉，终有不同，或有可疑，须看痧筋有无，辨之即明。
治验∶
一沈怀先，夏月，日晚发热，五日不凉，诸药不效，反益昏闷烦躁。余诊之，右三部及左关，俱微细无力。余见其
病气有余，脉反若不足，知非真不足，乃痧脉之变者也。先令刮背上痧，又于十指臂弯，刺出紫黑毒血三十余针，不愈。
用冷茶送宝花散二服，又以陈皮浓朴汤主之，倍加玄胡索，香附煎汤稍冷服，四剂而痊。
一邵洪玉内室，日晡发热，头汗如雨。延余，六脉震动不常，故知其痧。刺出十指紫黑毒血二十针，不愈。煎紫朴
汤稍冷服三剂，痧气已尽。用大黄三钱，枳实、陈皮、浓朴各一钱，煎汤温饮，下其结粪。热退身凉后，朝用补中益气
汤，夕用六味地黄丸，调理而痊。
一褚元龙，夏月潮热往来，已六日矣，服他药，热极不凉，发狂谵语。延余，左脉俱微，右脉俱洪大，非痧脉不若
是之异也。视其乳下青筋二条，刺出紫黑毒血，不愈。用桃仁、泽兰等分煎汤平服，神情始定，日渐调理，半月而痊。
在月经来潮期间，恰逢痧症发作，导致经血受阻并逆行，出现鼻出血或吐血，腹部肿胀，卧床无法翻身的情况。如果腹部不疼痛，也属于暗痧。若痧毒攻坏脏腑，则属不治之症。
治疗案例：
沈弘先的夫人，经期发热，鼻血如注，神志昏迷沉重，腹部胀满。请我诊治，脉象伏匿。我说：“这是兼有痧症且经血逆行的情况。”沈弘先擅长放痧疗法，针刺腿弯两处，放出紫黑色的毒血，但病未愈。我使用桃仁、红花、独活、细辛、山楂、香附、青皮，加入童便（儿童尿液）煎服，经血通畅后调理而痊愈。
（头汗痧、狂躁、胡言乱语附见）
痧气壅盛，引发热证，表现为发热而不恶寒，或傍晚时分发热，或寒热往来，这都是因为痧毒之气阻滞不通，搏击肌表，从而引发发热。不认识此病的人，误认为是外感风寒，按传经热证处理，采用发汗和温饮的方法，会导致慢痧病情迟缓，势必使痧气更加旺盛，进而演变成头汗出、发狂等种种重症。不知道外感病的脉象浮数而紧；热证的脉象洪大数而有力；痧症的脉象最终有所不同，即使有疑问，只要查看是否有痧筋（皮下显露的青紫色血管），辨别起来就很清楚。
治疗案例：
沈怀先，夏季，傍晚发热，五天不退凉，各种药物无效，反而更加昏闷烦躁。我诊察他的脉象，右手三部及左手关部，都微细无力。我看见他病气有余，脉象却显得不足，知道这不是真正的虚损，而是痧症脉象的变化。先让他刮背上的痧，又在十个手指和臂弯处，刺出紫黑色的毒血三十多针，病未愈。用冷茶送服宝花散两剂，又用陈皮浓朴汤为主方，加倍加入玄胡索、香附，煎汤稍冷服用，四剂后痊愈。
邵洪玉的妻子，傍晚发热，头汗如雨。请我诊治，六脉震动无常，因此知道是痧症。刺出十个手指的紫黑色毒血二十针，病未愈。煎紫朴汤稍冷服用三剂，痧气已尽。再用大黄三钱，枳实、陈皮、厚朴各一钱，煎汤温服，排出结滞的大便。热退身凉后，早晨服用补中益气汤，晚上服用六味地黄丸，调理而痊愈。
褚元龙，夏季寒热往来，已经六天了，服用其他药物，热极不退，发狂胡言乱语。请我诊治，左脉都微弱，右脉都洪大，不像普通的痧脉，如此特异。查看他乳房下方的两条青色筋脉，刺出紫黑色的毒血，病未愈。用桃仁、泽兰等量煎汤平服，神情才安定，日渐调理，半个月后痊愈。
During menstruation, if Sha (a pathogenic factor characterized by acute pain and swelling) erupts, menstrual flow may be obstructed and reverse its course, manifesting as epistaxis or hematemesis, abdominal distension, and an inability to turn over in bed. If the abdomen is not painful, it is also classified as "Hidden Sha" (Sha syndrome with concealed symptoms). If Sha toxin attacks and damages the Zang-Fu organs, it is incurable.
Case Record:
The wife of Shen Hongxian experienced fever during her period, with profuse epistaxis, heavy coma, and abdominal distension. Upon consultation, her pulse was hidden (Fu). I stated, "This is a case of reversed menstruation complicated by Sha." Mr. Shen, who is skilled in Sha release therapy, punctured two points at the popliteal fossa, releasing dark purple-black toxic blood, but the condition did not improve. I prescribed Tao Ren (Peach Seed), Hong Hua (Safflower), Duhuo (Angelicae Pubescentis Radix), Xixin (Asari Radix et Rhizoma), Shan Zha (Crataegi Fructus), Xiang Fu (Cyperi Rhizoma), and Qing Pi (Tangerine Peel Immature), administered with Tong Bian (child's urine). After the menstrual flow normalized, she recovered through regulation.
(Attached: Head Sweat Sha, Mania, Delirium)
When Sha Qi (Sha energy) is abundant and congested, it manifests as heat syndromes. These may present as fever without chills, afternoon fever, or alternating chills and fever. All these are caused by Sha toxin Qi being blocked and unable to circulate freely, clashing with the muscle surface, thereby generating heat. Those unfamiliar with this condition may mistake it for an external contraction, treating it as a transmitted heat syndrome. Administering diaphoresis (sweating-inducing methods) and warm drinks will cause the Sha to linger slowly, inevitably causing Sha Qi to become even more vigorous, evolving into severe conditions such as sweating on the head only and mania. It is unknown that the pulse of external contraction is floating, rapid, and tight; the pulse of heat syndrome is surging, rapid, and forceful; whereas the pulse of Sha syndrome differs significantly. Even if there is doubt, one must examine whether Sha Jin (visible subcutaneous blue-purple veins) are present; upon doing so, the differentiation becomes clear.
Case Record:
Shen Huaixian suffered from evening fever in summer, which did not subside for five days. Various medicines were ineffective, and he became increasingly drowsy, stifled, and irritable. Upon examination, the pulses in the three positions of the right hand and the Guan position of the left hand were all faint, fine, and weak. Observing that his pathological Qi was excessive while the pulse appeared deficient, I knew this was not true deficiency but a variation of the Sha pulse. First, I instructed him to scrape Sha from his back. Then, I punctured thirty-plus points on his ten fingers and arm flexures, releasing dark purple-black toxic blood, but the condition persisted. I had him take two doses of Bao Hua San (Precious Flower Powder) delivered with cold tea. Subsequently, I used Chen Pi Nong Po Tang (Tangerine Peel and Magnolia Bark Decoction) as the main formula, doubling the dosage of Yuan Hu Suo (Corydalis Rhizoma) and Xiang Fu (Cyperi Rhizoma), prepared as a decoction to be taken slightly cool. He recovered after four doses.
The wife of Shao Hongyu experienced evening fever with profuse sweating on the head like rain. Upon consultation, her six pulses were irregular and trembling, indicating Sha. I punctured twenty points on her ten fingers, releasing dark purple-black toxic blood, but the condition did not resolve. She took three doses of Zi Pu Tang (Purple and Magnolia Decoction) slightly cool, after which the Sha Qi was exhausted. I then prescribed Da Huang (Rhei Radix et Rhizoma) 3 qian, Zhi Shi (Aurantii Fructus Immaturus), Chen Pi (Tangerine Peel), and Hou Po (Magnoliae Officinalis Cortex) each 1 qian, decocted and taken warm to purge accumulated feces. After the fever subsided and the body cooled, she took Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment the Qi) in the morning and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in the evening, recovering through regulation.
Chu Yuanlong suffered from alternating chills and fever in summer for six days. After taking other medicines, the fever became extreme and did not subside, leading to mania and delirium. Upon consultation, his left pulses were all faint, and his right pulses were all surging and large, a variation unlike typical Sha pulses. I observed two blue veins under his breasts and punctured them, releasing dark purple-black toxic blood, but the condition persisted. I prescribed Tao Ren (Peach Seed) and Ze Lan (Lycopus Herba) in equal parts, decocted and taken evenly. His mental state stabilized, and he gradually recovered over half a month.