治病须凭脉。若犯痧胀，则脉不对症，症不合脉，或云痧筋为据，亦为现外焉。且痧胀有为食积阻滞者，有为血
痰阻滞者，或阻于上，或阻于中，或阻于下，又或阻于左，或阻于右，或阻于两腰胁，苟非辨症的确，求其中病也，难
矣。故治痧胀，一见脉之不合，先看痧筋，次审气色，三听声音，四推犯病之由。其间或有食积血痰阻于上中下、左右
各处之分，须细辨其病原，后用药不误也。凡痧脉有一部独异，有六脉俱异，即有异之中，亦有阴阳虚实，脉之神气可
辨。要非一端可执，尚其审诸。
或曰子于痧也。有先用药而放刮者，有先放刮而用药者。非放与刮，治更无别法欤。曰放刮之法，犹犯伤寒太阳经
症，必用羌活、麻黄等药，少阳经症，必用柴胡，黄芩等药。症有所犯，治有所宜。凡气分有痧宜用刮，血分有痧宜用
放，此不易之法。至脏腑经络有痧，若昏迷不醒等症，非放刮所得治，兼用药疗之无足怪也。
麻疹之发，因伤风热故身体壮热，咳嗽烦闷，即是 疹之候。麻疹在他方，有名厝子，有名蚤疹，在 李则名痧子，
而痧胀亦名为痧，不可不辨。麻疹因伤风，肌表必虚，则毒瓦斯乘虚而泄，故药虽或凉仍可用热饮。若痧胀，或因秽气所
触，或因暑气所感，或动时行不正之气，或乘伏寒伏热过时而来。总不起于外伤风热，故肌表必实，实则热毒之气既
胀于胸腹肠胃之中，若更用热饮，则热气适助其肿胀，无从而泄，故犯此者，有立时胀死，此不可不辨也。
治疗疾病必须依据脉象。如果患的是痧胀病，那么脉象与症状不相符合，症状也不对应脉象，或者以“痧筋”（皮下显露的紫黑色瘀血络脉）作为诊断依据，这也是外在的表现。况且，痧胀病有的是因为食积阻滞所致，有的是因为血痰阻滞所致，阻滞部位可能在上方，可能在中部，可能在下方，也可能在左侧，在右侧，或在两侧腰胁部。如果不是确切地辨别症状，想要找到击中病处的治疗方法，是很困难的。因此，治疗痧胀病，一见到脉象不合常规，首先观察痧筋，其次审视气色，第三听声音，第四推究致病的原因。其间如果有食积、血痰阻滞在上、中、下或左、右各处的情况，必须仔细辨别其病因，之后用药才不会出错。凡是痧脉有一个部位特别异常，有六脉都异常的，即使在异常之中，也有阴阳虚实的区别，脉的神气是可以辨别的。这不能仅凭一端来执定，应当审慎考察。
有人问：您对于痧胀病，有先用药后放血刮痧的，有先放血刮痧后用药的。难道除了放血和刮痧，治疗就没有其他方法了吗？回答说：放血和刮痧的方法，就像治疗伤寒太阳经证候，必须用羌活、麻黄等药物；少阳经证候，必须用柴胡、黄芩等药物。病症所侵犯的部位不同，治疗也就有所适宜。凡是气分有痧毒宜用刮痧，血分有痧毒宜用放血，这是不可改变的原则。至于脏腑经络有痧毒，如果出现昏迷不醒等症状，不是单靠放血刮痧所能治愈的，兼用药物治疗也是不足为怪的。
麻疹的发疹，是因为感受风热之邪，所以身体壮热，咳嗽烦闷，这就是出疹的先兆。麻疹在其他地方，有的叫“厝子”，有的叫“蚤疹”，在李氏（指作者家乡或特定地区）则叫“痧子”。而痧胀病也叫做“痧”，这一点不可不加以辨别。麻疹是因为感受风邪，肌表必然虚弱，那么毒邪就会乘虚外泄，所以药物虽然性质偏凉，但仍可以用热饮送服。如果是痧胀病，有的是因为秽浊之气所触犯，有的是因为暑气所感染，有的是因为时行不正之气引发，有的是因为潜伏的寒邪或热邪过时发作。总之，它不是起于外伤风热，所以肌表必然充实。肌表充实，热毒之气就已经在胸腹肠胃中胀满，如果再用热饮，热气正好帮助其肿胀，无法从体表宣泄，所以患此病的人，有立即因肿胀而死的可能，这一点是不可不辨别的。
The treatment of diseases must rely on pulse diagnosis. If one suffers from *Shazhang* (Sha Distension), the pulse will not correspond to the symptoms, and the symptoms will not match the pulse; alternatively, relying on "Sha Jin" (visible subcutaneous purple-black blood vessels) as evidence is also merely an external manifestation. Furthermore, Sha Distension may be caused by food stagnation obstruction, or by blood-phlegm obstruction. The obstruction may occur in the upper, middle, or lower regions, or on the left, right, or both sides of the hypochondrium. Unless the symptoms are identified with precision, it will be difficult to find a treatment that strikes the disease accurately. Therefore, when treating Sha Distension, upon observing a pulse that does not conform to the norm, one should first examine the Sha Jin, secondly assess the complexion, thirdly listen to the voice, and fourthly deduce the cause of the illness. If there are obstructions by food stagnation or blood-phlegm in the upper, middle, lower, left, or right areas, one must carefully distinguish the etiology before administering medication to avoid error. In Sha pulses, either a single region is distinctly abnormal, or all six positions are abnormal. Even within these abnormalities, Yin-Yang deficiency and excess can be distinguished, and the spirit of the pulse is discernible. One cannot adhere to a single aspect; careful examination is required.
One might ask: Regarding Sha Distension, you sometimes administer medication before bloodletting and scraping, and sometimes after. Are there no other methods besides bloodletting and scraping? I reply: The methods of bloodletting and scraping are analogous to treating Taiyang channel syndromes in Cold Damage (*Shanghan*), where herbs such as Qianghuo (Notopterygii Rhizoma et Radix) and Mahuang (Ephedrae Herba) must be used; for Shaoyang channel syndromes, Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) must be used. Depending on the site of invasion, the treatment is appropriate accordingly. Generally, if Sha toxin resides in the Qi level, scraping is indicated; if it resides in the Blood level, bloodletting is indicated. This is an unchangeable principle. However, if Sha toxin affects the Zang-Fu organs and meridians, leading to symptoms such as coma and unconsciousness, it cannot be cured by bloodletting and scraping alone; combining them with herbal medication is not surprising.
The eruption of measles (*Mazen*) occurs due to wind-heat injury, resulting in high fever, cough, and irritability, which are signs of impending rash. In other regions, measles is known as "Cuozi" or "Zaozhen"; in Li's region, it is called "Shazi". Since Sha Distension is also named "Sha", this distinction must not be overlooked. Measles arises from wind pathogen invasion, causing the exterior to be deficient; thus, toxins vent out through this deficiency. Therefore, although the herbs used may be cooling, they can still be taken with hot drinks. In contrast, Sha Distension may be triggered by foul air, summerheat, epidemic miasma, or latent cold/heat pathogens manifesting later. It fundamentally does not originate from external wind-heat injury; consequently, the exterior remains solid. When the exterior is solid, heat-toxin qi already distends within the chest, abdomen, and intestines. If hot drinks are administered, the heat assists the distension, preventing venting. Patients suffering from this condition may die instantly from swelling; this distinction is crucial.