凡心腹胀痛因痧，既知之矣。痧症仍有不痛不胀者，或兼痧或暗痧，误饮温热，便致凶危等也。余窃谓∶凡遇危症，
病家不识痧筋，犹用刮痧可辨。医家或认脉不清，尚有痧筋可详，若内人不便阅视，果缘痧胀凶极，脉未有对症者，以
是辨之，百不失一也。
胀者，气之闭也。气为毒壅，故作肿作胀，所以治痧，先当治气。如食阻其气于上则吐之；食壅其气于中则消之；
食化而结其气于下则导之，凡诸积之阻滞概然。凡下窍闭者，多上吐，或吐蛔或吐血，当导气于下。中窍闭则下泻，或
泻水或泻蛔，当行气于中。上窍闭而复升则作闷，或头疼或上肿，俱当用清凉引下之。至如气为毒壅必伤血分，若乃血
为毒凝，活血为上；血为毒壅，破血为先；血为毒聚且结，败血为要；故治痧必兼治血，盖血活毒瓦斯行，血破毒瓦斯走，
血败毒瓦斯散。如是，毒瓦斯不留，治斯效也。
凝壅聚结，皆为血分痧毒恶症，其间有轻重之别。凝者，初犯之症；壅者，凝多而壅；聚者，血壅或左或右；结者，
血滞一处。故痧毒中血分，结为重，聚次之，壅又次之，凝为轻。凝以红花、泽兰为主；壅以延胡索、桃仁为主；聚以
苏木、茜草为主；结以五灵脂、降香为主。轻者用药不可重，重则恐伤本原；重者用药不可轻，轻则治之不效。
治验∶
一尹钧万咳嗽痰喘，有以紧劳治之，病日增，背鞠如弓，手足蜷紧，不能展动，咳则胸腹百骸吊痛。延余诊之，脉
洪大无伦，此毒血壅聚也。兼又难刮、难放，先以圆红散微冷冻饮料之，两手稍松，渐为放刮讫，又以圆红散加三七、郁金
末微温饮之，更以苏木、茜草为主，多加顺气活血之类，如前饮之。计日放痧一次者四，日用药一服者五，遂痊。
一万君安内室，两胁如痞，按之则痛，心胃间高起，服药难疗。延余，左脉微细，右脉洪大，此慢痧，痧毒结聚也。
计放痧三次，付以五灵脂、降香为主，加桃仁、延胡索及消食行气之类，日用一服，计十二剂如旧。
一陈弘业，寒热呕吐，苦难俯仰，腹中胀痛，夜不能寐，六脉弦细而紧数，刮放略松，用红花、泽兰、刘寄奴、茜
草、桑寄生，并行气消食之药，微温饮之，二剂而愈。
凡是心腹胀痛由痧引起的，已经知道了。但痧症也有不痛不胀的情况，有的是兼夹痧证，有的是暗痧，如果误饮温热药物，就会导致凶险危急等状况。我私下认为：凡是遇到危重病症，如果病人家属不认识痧筋（皮肤上出现的青紫色脉络），还可以用刮痧的方法来辨别。医生如果诊脉不清楚，还有痧筋可以详细观察；如果因内部不便查看，确实是因为痧胀极其凶险，脉象没有与症状对应的，通过这种方法来辨别，百无一失。
所谓胀，是气机闭塞所致。气被毒邪壅滞，所以出现肿胀和胀满，因此治疗痧症，首先应当调理气机。如食物阻滞气机于上部则采用催吐法；食物壅滞气机于中部则采用消导法；食物消化后结聚气机于下部则采用通导法，各种积滞阻滞的情况都是这样。凡下窍闭塞的，多表现为上部呕吐，或者吐出蛔虫或者吐血，应当引导气机下行。中窍闭塞则表现为下部腹泻，或者泻水或者泻出蛔虫，应当疏通中部气机。上窍闭塞且气机上逆则产生闷塞感，或者头痛或者上部肿胀，都应当使用清凉药物引气下行。至于气被毒邪壅滞必然损伤血分，如果血被毒邪凝滞，以活血为第一要务；血被毒邪壅滞，以破血为先；血被毒邪聚结，以败血（消散瘀血）为关键；所以治疗痧症必须兼顾治血，因为血活则毒瓦斯运行，血破则毒瓦斯消散，血败则毒瓦斯散尽。像这样，毒瓦斯不留存，治疗就能见效。
凝、壅、聚、结，都属于血分痧毒的恶症，其中有轻重的区别。凝，是初犯的症状；壅，是凝滞较多而壅塞；聚，是血壅滞或左或右；结，是血滞在一处。所以在痧毒入血分中，结为重证，聚次之，壅又次之，凝为轻证。治疗凝证以红花、泽兰为主药；治疗壅证以延胡索、桃仁为主药；治疗聚证以苏木、茜草为主药；治疗结证以五灵脂、降香为主药。轻证用药不可过重，过重恐怕损伤人体本源；重证用药不可过轻，过轻则治疗无效。
治疗验证案例：
有一位尹钧万，咳嗽痰喘，有人用治疗虚劳紧束的方法治疗，病情日益加重，背部弯曲如弓，手足蜷缩紧缩，不能舒展活动，咳嗽时胸腹全身骨骼都牵引疼痛。请我诊治，脉象洪大无比，这是毒血壅聚所致。兼之又难以刮痧、放血，先用圆红散微冷冻后让他服用，双手稍松，逐渐完成放刮治疗后，又以圆红散加三七、郁金末微温饮用，再用苏木、茜草为主药，多加顺气活血类药物，像前面那样饮用。共计放痧四次，每日用药一剂共服五剂，于是痊愈。
一位万君安的内室眷属，两胁部感觉痞塞，按压则疼痛，心胃之间高起，服药难以治愈。请我诊治，左脉微细，右脉洪大，这是慢痧，痧毒结聚所致。共计放痧三次，处以五灵脂、降香为主药，加桃仁、延胡索及消食行气类药物，每日服用一剂，共计十二剂后恢复如初。
一位陈弘业，寒热交替，呕吐，痛苦得难以俯仰，腹部胀痛，夜间不能入睡，六脉弦细而紧数，刮痧放血后略微舒缓，使用红花、泽兰、刘寄奴、茜草、桑寄生，并行气消食的药物，微温饮用，两剂后痊愈。
Whereas heart and abdominal distension and pain caused by Sha (a pathogenic factor characterized by toxicity and stagnation) have been understood, there are still cases of Sha syndrome presenting without pain or distension. These may involve concurrent Sha symptoms or hidden Sha; if mismanaged with warm and hot remedies, it can lead to critical and dangerous conditions. I suggest that in any critical case, if the patient's family cannot identify the Sha veins (visible cyanotic vascular patterns on the skin), scraping therapy (Gua Sha) can be used for differentiation. If a physician is unclear about the pulse, the Sha veins provide detailed diagnostic information. Even if internal examination is不便 (inconvenient due to propriety), if the Sha distension is extremely critical and the pulse does not match the symptoms, this method of differentiation is infallible.
Distension refers to the closure of Qi mechanism. When Qi is obstructed by toxic pathogens, swelling and distension occur. Therefore, treating Sha requires first regulating Qi. If food obstructs Qi in the upper jiao, emesis should be induced; if food stagnates Qi in the middle jiao, digestion should be promoted; if digested food forms knots obstructing Qi in the lower jiao, purgation or guiding downward should be employed. This applies generally to all types of accumulation and obstruction. When the lower orifices are blocked, vomiting often occurs, possibly expelling roundworms or blood; thus, guiding Qi downward is necessary. When the middle orifices are blocked, diarrhea ensues, possibly expelling water or roundworms; thus, moving Qi in the middle is required. When the upper orifices are blocked and Qi rebels upward, stifling sensation, headache, or upper body swelling may occur; cool-natured herbs guiding Qi downward should be used. Since Qi obstruction by toxins inevitably damages the Blood level, if Blood is coagulated by toxins, invigorating Blood is paramount; if Blood is congested by toxins, breaking Blood stasis is prioritized; if Blood is gathered and knotted by toxins, dissipating stagnant Blood is essential. Thus, treating Sha must concurrently treat Blood: when Blood moves, toxic vapors circulate; when Blood stasis is broken, toxic vapors disperse; when stagnant Blood is resolved, toxic vapors scatter. In this way, toxic vapors do not remain, and treatment is effective.
Coagulation (Ning), congestion (Yong), gathering (Ju), and knotting (Jie) are all severe manifestations of Sha toxins affecting the Blood level, varying in severity. Coagulation represents the initial stage; Congestion indicates significant coagulation leading to blockage; Gathering refers to Blood congestion located either left or right; Knotting signifies Blood stagnation localized in one area. Among these, within the Blood level involvement of Sha toxins, Knotting is the most severe, followed by Gathering, then Congestion, with Coagulation being the mildest. For Coagulation, Hong Hua (Carthami Flos) and Ze Lan (Lycopus Herba) are primary; for Congestion, Yan Hu Suo (Corydalis Rhizoma) and Tao Ren (Persicae Semen) are primary; for Gathering, Su Mu (Sappan Lignum) and Qian Cao (Rubiae Radix et Rhizoma) are primary; for Knotting, Wu Ling Zhi (Trogopterori Faeces) and Jiang Xiang (Aquilariae Lignum Resinatum) are primary. Mild cases require light medication to avoid damaging the root essence; severe cases require potent medication, as mild treatment will be ineffective.
Case Verification 1: Yin Junwan suffered from cough, phlegm, and wheezing. Treated for consumption with tightness, his condition worsened daily. His back became arched like a bow, hands and feet curled tightly, unable to extend. Coughing caused pulling pain throughout the chest, abdomen, and bones. Upon consultation, the pulse was excessively flooding and large, indicating toxic Blood congestion and gathering. Scraping and bleeding were difficult to perform initially. He was first given Yuan Hong San (Round Red Powder) cooled slightly and drunk. His hands relaxed slightly. After gradual scraping and bleeding, he drank Yuan Hong San added with San Qi (Notoginseng Radix) and Yu Jin (Curcumae Radix) powder at a lukewarm temperature. Subsequently, Su Mu and Qian Cao were used as main ingredients, supplemented with Qi-regulating and Blood-invigorating herbs, administered similarly. He underwent Sha release four times over several days and took five doses of herbal medicine daily, eventually recovering.
Case Verification 2: The wife of Wan Anjun experienced a feeling of fullness and pain upon pressure in both hypochondriac regions, with a raised area between the heart and stomach, resistant to standard medication. Consultation revealed a fine and minute left pulse and a flooding right pulse, indicating slow Sha with toxin knotting and gathering. She underwent Sha release three times. Prescription centered on Wu Ling Zhi and Jiang Xiang, augmented with Tao Ren, Yan Hu Suo, and herbs for digesting food and moving Qi. One dose daily for twelve doses resulted in complete recovery.
Case Verification 3: Chen Hongye presented with alternating chills and fever, vomiting, severe discomfort preventing bending or straightening, abdominal distension and pain, and insomnia. The six pulses were wiry, fine, tight, and rapid. After slight relief from scraping and bleeding, he was treated with Hong Hua, Ze Lan, Liu Ji Nu (Agrimoniae Herba), Qian Cao, Sang Ji Sheng (Taxilli Herba), combined with Qi-regulating and food-digesting herbs, taken lukewarm. Recovery occurred after two doses.