疮痛者，心火血热所致，故火盛而脓肿作痛，然脓疮虽痛，必渐渐而极，非若兼痧之骤。故凡疮疡兼痧，其肿痛必
多可畏处，况疮疡脉多洪数，兼痧脉固不同，其筋色又有可验也。
治验∶
一潘子亮女，十八岁，患疮已半载。忽一日饮酒后，脓疮大盛，或以其酒助血热，且食鸡鹅发毒之味，脓疮肿痛，
由斯而极。治以凉血活血解毒托里之剂，更觉昏迷饱闷。延余治之，脉不洪数而反沉微。余曰∶“脉不对症，必痧使然”。
刺出指头毒血，又刺头顶心一针，神情方始清爽，但胸中饱闷，用顺气散痧消毒之味四剂，微冷冻饮料之，兼外搽合掌丸，
饱闷脓疮俱愈。
先有劳弱不足之症，或吐血时发；或微微干嗽，两颧唇口鲜红；或骨蒸发热不已，一触犯时气传染；或秽恶之气相
犯，必兼痧胀。或多痰喘；或咽喉如鲠；或心腹胀闷，烦躁发热；较之平时不足之症，益觉沉重。此宜以痧为主治之，
令痧毒退尽，方可治其本症，不然，劳弱未见凶危，痧祸已在目前矣。
治验∶
一妇人吐血干嗽，昼凉夜热已久，忽午后发热异常，胀闷沉重，他医以为怒气血虚，用养血化痰顺气之剂，病势益
盛，昏迷痰喘，不省人事。延余，左关微缓无力，右关似紧非紧，余脉应指不匀。余思怒气填胸，左关必须有力；平时
劳弱，脉亦自宜弦数；内有郁血，上中二部，亦当见芤；何脉不对症若是，看其左腿弯，有紫筋数条，历历可指，其为
兼痧之症明矣，故昏迷痰喘。先刺其痧筋，出其毒血，倍用宝花散，清茶微冷冻饮料之，方得神情清爽，不复痰喘昏迷、胀
闷沉重之势。但劳弱由于本原不足，绵延未愈。
疮痛，是由心火亢盛、血分有热所导致的，因此火热炽盛会引发脓肿并产生疼痛。然而，脓疮虽然疼痛，其程度必然是逐渐加剧达到极点的，不像兼夹痧症那样突然发作。所以凡是疮疡兼夹痧症的情况，其肿胀和疼痛往往有许多令人畏惧的表现。况且，疮疡的脉象多表现为洪大且数急，而兼夹痧症的脉象自然不同，此外，筋络的颜色也有可供验证的特征。
治疗案例：
有一位潘子亮的十八岁女儿，患疮疡已经半年。忽然有一天饮酒之后，脓疮病情急剧加重，有人认为是酒助长了血热，加上食用了鸡肉、鹅肉等发物，导致脓疮肿痛由此达到极点。医生使用凉血、活血、解毒、托里（扶助正气以排出毒邪）的药剂治疗，患者反而感到更加昏迷和饱闷。后来请我诊治，发现脉象不洪大数急，反而呈现沉细微弱之象。我说：“脉象与症状不符，必定是痧症所致。”于是针刺手指放出毒血，又针刺头顶百会穴一针，患者的神情才清爽起来。但胸中仍有饱闷感，于是服用顺气散痧消毒的药物四剂，微冷后少量多次饮用，同时外敷合掌丸，最终饱闷和脓疮都痊愈了。
原本就有劳损虚弱不足的病症，或者时常吐血；或者轻微干咳，两颧和唇口颜色鲜红；或者骨蒸潮热不止，一旦触犯时行传染病邪；或秽恶之气相犯，必定兼夹痧胀。可能出现多痰气喘；或咽喉如有异物梗阻；或心腹胀闷，烦躁发热；比起平时虚弱的病症，感觉更加沉重。这种情况应当以治疗痧症为主，待痧毒完全消退后，才能治疗其本来的虚弱病症，否则，劳弱之症尚未出现凶险危重，痧祸就已经迫在眉睫了。
治疗案例：
一位妇人吐血、干咳，白天凉爽夜间发热已久，忽然午后异常发热，伴有胀闷沉重感。其他医生认为是怒气导致气血虚弱，使用了养血、化痰、顺气的药剂，病情反而更加严重，出现昏迷、痰喘、不省人事的症状。请我诊治时，左关脉微缓无力，右关脉似紧非紧，其余脉象按之不均匀。我思考：若是怒气填胸，左关脉必须有力；平时劳弱，脉象也应当弦数；体内若有郁血，上部和中部脉象也应当见芤脉。为何脉象与症状如此不符？观察她左腿腘窝处，有几条紫色筋络，清晰可辨，这显然是兼夹痧症的明证，所以才会昏迷痰喘。先刺破她的痧筋，放出毒血，加倍使用宝花散，用清茶微冷后少量多次饮用，这才使神情清爽，不再出现痰喘昏迷、胀闷沉重的态势。但是，劳弱是由于先天本源不足，病程绵延未愈。
Pain from sores is caused by excessive Heart Fire and heat in the Blood level; thus, when Fire is abundant, abscesses form and cause pain. However, although sore-pus lesions are painful, their severity increases gradually to an extreme, unlike the sudden onset seen when complicated by Sha (sand/heat toxin). Therefore, in cases where sores are complicated by Sha, the swelling and pain often present many alarming features. Moreover, while the pulse of sores is typically surging (Hong) and rapid (Shu), the pulse in Sha-complicated cases differs distinctly, and the color of the collaterals also provides diagnostic evidence.
Case Record:
The daughter of Pan Ziliang, aged eighteen, had suffered from sores for half a year. Suddenly, after drinking alcohol, her pus-filled sores flared up severely. It was suggested that the alcohol exacerbated Blood Heat, and that consuming chicken and goose—considered "fa" (stimulating/toxic-promoting) foods—caused the swelling and pain of the sores to reach an extreme. Treatment with formulas to cool the Blood, invigorate Blood, resolve toxicity, and support the interior (Tuoli) resulted in increased confusion and chest fullness. I was consulted and found the pulse not surging and rapid, but rather deep (Chen) and faint (Wei). I stated, "The pulse does not match the symptoms; this must be due to Sha." I pricked the fingertips to release toxic blood and inserted one needle at the top of the head (Baihui, GV20). Only then did her mental state clear. However, she still experienced chest fullness. I prescribed four doses of herbs to regulate Qi, dissipate Sha, and detoxify, administered as a slightly cold beverage in small frequent sips, combined with external application of Hezhang Wan. The chest fullness and sores both healed.
When there are pre-existing deficiency patterns of labor and weakness, such as intermittent hemoptysis; or slight dry cough with bright red malar eminences and lips; or persistent bone-steaming fever; once exposed to seasonal epidemic pathogens or foul odors, Sha distension will inevitably complicate the condition. Symptoms may include profuse phlegm and wheezing; a sensation of a foreign body in the throat; abdominal distension and fullness with irritability and fever; feeling heavier than usual for a deficiency pattern. In such cases, treatment should focus primarily on Sha. Only after the Sha toxin has completely subsided should the underlying deficiency be treated. Otherwise, while the labor-weakness may not yet be critical, the disaster of Sha is imminent.
Case Record:
A woman suffering from hemoptysis and dry cough had experienced daytime coolness and nighttime fever for a long time. Suddenly, she developed abnormal afternoon fever accompanied by distension, fullness, and heaviness. Other physicians attributed this to anger causing Qi and Blood deficiency and prescribed formulas to nourish Blood, transform phlegm, and regulate Qi. Her condition worsened, leading to coma, phlegm-wheezing, and unconsciousness. Upon consultation, the Left Guan pulse was slightly slow and powerless; the Right Guan pulse seemed tight but was not truly tight; other pulses were irregular upon palpation. I reasoned: if anger filled the chest, the Left Guan pulse must be forceful; for chronic deficiency, the pulse should naturally be wiry (Xian) and rapid (Shu); if there were stagnant Blood internally, the Upper and Middle positions should exhibit a floating and hollow (Kou) pulse. Why did the pulse so mismatch the symptoms? Observing her left popliteal fossa, several purple collaterals were clearly visible and palpable, clearly indicating a complication of Sha, which explained the coma and phlegm-wheezing. I first pricked the Sha collaterals to release toxic blood, doubled the dosage of Baohua San, and administered it as a slightly cold tea beverage in small frequent sips. This cleared her mental state, resolving the phlegm-wheezing, coma, distension, and heaviness. However, the labor-weakness stemmed from constitutional insufficiency and remained protracted and unhealed.