痧毒之气，阻抑于经络、血肉之间，故其脉多沉伏，即有别病兼痧者亦然。如人有伤寒，脉沉微无力，是直中三阴
经之脉也，治以阴症用热药，有何疑哉？然尝见有用之而愈者，有用之而不愈者。用之而愈，则人将曰∶阴症之药，在
所宜用；用之而不愈，则人又将曰∶阴症之药，不可骤用。此岂其认脉之不真，而治伤寒之有未当欤。夫亦惟为伤寒兼
痧，痧脉与阴症脉相似莫辨，故一服温补热药，痧毒变幻，而有此悔尔。余尝临症治伤寒，按之见有沉微或伏之脉，一
似直中三阴经，而其外现症候，稍有不合于三阴经症，便取痧筋而验之，有则为痧，无则为阴，施治之药，或凉或热，
万不失一。且放痧服药之后，血肉经络之分，通而无阻，即按其脉，便不复如前之沉微或伏矣。余然后按脉辨症，用药
以治其伤寒，药未有不得其效者。至如杂病兼痧，有沉微或伏之脉，亦以此法验之，诚至当不易之论也。
痧之毒瓦斯，冲激于经络，血肉之分，故其脉多洪数，或沉紧，或大而无伦，或洪实有力，种种不一。若症脉稍有不
合，盒饭审其痧筋有无，有则俟其放痧之后，再诊其脉之来复何如，以断其病之寒热虚实施治；若无，即以其脉断其寒
热虚实用药。余尝治一劳弱吐红之症，其脉洪实有力，他医遇此，以为劳弱吐红，脉忌洪实，兼之症候凶危，谢事而去。
余惟见其病势之暴而疑之，爰视其腿弯有青筋色，先放其痧，六脉遂和，症候亦平。又付散痧消食去积之药，气血无阻，
凶暴潜消，饮食渐进，后用六味地黄丸及十全大补汤服之，劳弱不足之症亦愈。盖因其向来病气，俱从痧气而泄，所以
一用补药遂得全效也。
痧毒之气，阻滞在经络和血肉之间，所以它的脉象多呈沉伏状；即使是有其他疾病兼夹痧症的情况，也是如此。比如有人得了伤寒，脉象沉微无力，这是寒邪直中三阴经的脉象，治疗时按照阴症使用热性药物，有什么可怀疑的呢？然而我常常见到有用此法治愈的，也有用此法未愈的。用了而治愈了，人们就会说：阴症的药，是应当使用的；用了而未愈，人们又会说：阴症的药，不可贸然使用。这难道是因为他们诊脉不真切，或者治疗伤寒的方法不当吗？其实只是因为伤寒兼夹痧症，痧脉与阴症脉相似难以分辨，所以一服用温补热性的药物，导致痧毒性质发生变幻，从而出现这种后悔的情况罢了。
我曾经临证治疗伤寒，切脉时发现脉象沉微或伏，乍一看似乎就是寒邪直中三阴经，但如果其外在表现出的症状，稍微有一点不符合三阴经的症状特征，我就立即检查患者是否有“痧筋”（皮下显露的青紫色静脉）来验证，有痧筋就是痧症，没有就是纯阴症，施治的药物，无论是凉性还是热性，都能万无一失。而且在放痧（刺络放血）并服药之后，血肉经络之间的阻滞得以疏通，此时再按摸脉象，就不再像之前那样沉微或伏了。然后我再通过诊脉辨证，用药治疗其原本的伤寒，药物没有不得到疗效的。至于杂病兼夹痧症，出现沉微或伏的脉象，也用这种方法来验证，这确实是极其恰当且不可更改的论断。
痧的毒气，冲击激荡于经络、血肉的间隙，所以它的脉象多呈洪数（浮大有力且跳动快），或者沉紧，或者大而杂乱无章，或者洪实有力，各种情况不一。如果症状与脉象稍有不合，就应当仔细审查患者是否有痧筋，如果有，就等待放痧之后，再诊察脉象恢复后的情况，以此来判断疾病的寒热虚实以决定治疗方案；如果没有，就直接根据脉象判断寒热虚实来用药。
我曾经治疗一个因劳损虚弱导致吐血的患者，他的脉象洪实有力。其他医生遇到这种情况，认为劳弱吐血的病症，脉象忌讳洪实，再加上症状凶险危急，便推辞不治离开了。我只见其病势凶猛而产生怀疑，于是查看他腿弯处有青色的筋脉显露，先给他放痧，六部脉象随即变得平和，症状也随之平息。随后又给予散痧、消食、去积滞的药物，气血不再受阻，凶险暴烈的病势潜然消退，饮食逐渐进用，后来再用六味地黄丸及十全大补汤服用，劳损虚弱的不足之症也痊愈了。大概是因为他以往的病气，都随着痧气的排出而泄出，所以一旦使用补益药物就能取得完全的效果。
The pathogenic qi of sha (sand disease/toxin) obstructs the meridians and the space between flesh and blood, therefore its pulse is mostly deep and hidden (Chen Fu Mai). This also applies to cases where other diseases are complicated by sha. For instance, if a person has Shanghan (Cold Damage), and the pulse is deep, thready, and weak (Chen Wei Wu Li), this is the pulse pattern of direct invasion into the Three Yin Meridians (Zhi San Yin Jing). In treating it as a Yin syndrome using hot-natured herbs, what could there be to doubt? However, I have often seen cases where this treatment resulted in a cure, and others where it did not. When cured, people will say: "The medicine for Yin syndrome is appropriate." When not cured, people will say: "The medicine for Yin syndrome should not be used hastily." Is this because their pulse diagnosis was inaccurate, or because the treatment of Shanghan was improper? Actually, it is merely because Shanghan is complicated by sha, and the sha pulse resembles the Yin syndrome pulse so closely that they cannot be distinguished. Consequently, upon taking a dose of warm, tonifying, and hot-natured medicine, the nature of the sha toxin transforms, leading to such regrettable outcomes.
I have clinically treated Shanghan, palpating pulses that were deep, thready, or hidden, which superficially resembled direct invasion of the Three Yin Meridians. However, if the external symptoms manifested slightly differed from those of the Three Yin syndromes, I would immediately examine the patient for "sha veins" (visible subcutaneous cyanotic vessels). If present, it is sha; if absent, it is pure Yin syndrome. The administered medicines, whether cooling or heating, would never fail. Furthermore, after phlebotomy (Fang Sha) and medication, the obstruction in the meridians and tissues between flesh and blood is cleared. Palpating the pulse thereafter, it no longer appears deep, thready, or hidden. Only then do I diagnose based on pulse and symptoms, prescribing medication to treat the underlying Shanghan, and the efficacy is invariably achieved. For miscellaneous diseases complicated by sha presenting with deep, thready, or hidden pulses, verifying them with this method is indeed an unalterable and correct principle.
The toxic qi of sha rushes and agitates within the meridians and the spaces between flesh and blood; thus, its pulse is mostly flooding and rapid (Hong Shu), or deep and tight (Chen Jin), or large and chaotic without order (Da Er Wu Lun), or flooding and solid with strength (Hong Shi You Li), varying greatly. If the symptoms and pulse show slight discrepancies, one must carefully inspect for the presence of sha veins. If present, wait until after phlebotomy, then re-diagnose the pulse to determine its state, thereby judging the cold, heat, deficiency, or excess of the disease to guide treatment. If absent, directly judge the cold, heat, deficiency, or excess based on the pulse to prescribe medication.
I once treated a case of hemoptysis due to consumptive weakness (Lao Ruo Tu Hong). The patient's pulse was flooding, solid, and strong. Other physicians encountering this believed that for consumptive hemoptysis, a flooding and solid pulse is contraindicated. Given the ominous and critical symptoms, they declined treatment and left. Suspecting the violent nature of the illness, I examined his popliteal fossa and observed cyanotic veins. I first performed phlebotomy, after which the six pulses became harmonious, and the symptoms subsided. Subsequently, I prescribed herbs to dissipate sha, aid digestion, and remove accumulation. With the obstruction of qi and blood removed, the violent pathology dissipated quietly, and dietary intake gradually improved. Later, he took Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Shiquan Dabu Tang (Decoction for Tonifying Qi and Blood), and the condition of consumptive weakness was fully resolved. This is likely because his chronic pathogenic qi was expelled along with the sha, allowing subsequent tonic medications to achieve complete efficacy.