（俗称冷痧。势急者又名急痧。势缓者则名慢痧）。
【因】日间触闻臭秽。夜间露宿贪凉。其大要也。夏秋最多。缓则寒湿凝滞于脉络
。或湿热郁遏于经隧。急则鼻闻臭毒而阻逆上气。或内因食积而壅塞中气。皆能气胀成痧
。故通称痧气。又称痧胀。或称痧秽。
【证】头胀晕痛。发热恶寒。胸闷气逆。腹痛胀满。轻现红点。重现青筋。甚有上
下不通。吐泻不得。四肢厥逆。
绞肠剧痛。或挟臭毒。或挟食滞。面色青黯而指甲亦青。舌苔灰白而滑者。冷痧夹食
也。面色紫浊而指甲亦紫。舌红苔白而糙者。热痧夹食也。甚或猝然腹痛昏倒。面色黑
胀。不呼不叫。舌苔灰腻者。此为痧闭。证最危急。亦有一发即洞泄肢冷。腹胀无脉。舌
苔白腻者。此为痧泻。证亦凶险。
【脉】沉弦而滞。甚则沉伏者。此寒闭于外。痧郁于内。气郁血凝而不能外达也。
若沉弦而数。甚则沉牢者。此冷食中阻。痧毒内伏。湿遏热结而不能外发也。初尚弦劲搏
指。继则昏厥无脉者。《内经》所谓大气入于脏腑。病多猝死是也。
【治】伤寒兼痧者。先去外寒。急用辛香流气以发表。香苏葱豉汤去甘草。加
越鞠丸（三钱）白蔻末（六分冲）、继辨其因以去痧。寒湿凝滞脉络者。急用辛温流气
以芳透。仁香汤加浙苓皮（四钱）、生苡仁（六钱）、湿热郁遏经隧者。急用苦辛凉淡
以疏利。藿香正气汤加辰砂拌滑石（五钱）、绵茵陈（三钱）、焦山栀（三钱）。臭毒
阻逆上气者。急用芳香辟秽以宣上。连翘栀豉汤加紫金锭（二枚、磨汁冲）。食积壅塞
中气者。若其人吐泻不得。急用涌吐法。炒盐汤冲生萝卜汁。继用理气法。香砂二陈汤
冲紫金锭汁。若其人泻利无脉。当辨阴阳。阴痧急用正阳四逆汤。以回阳通脉。阳痧
急用红灵丹。（一二分、凉开水调下。）或行军散。（二三分、鲜石菖蒲汤调下。）以
开关通脉。至其外治法。轻则用刮痧法。（用瓷碗盖搽香油。刮肩背及手足臂湾等
处）。搐鼻法。（用通关散吹入鼻孔以取嚏）。重则用刺痧法。（用银刀刺入少商、中
冲、尺泽、委中、及舌紫筋出血以放痧）。此皆宣气活血。内外开通之法也。
【秀按】自古医书。从无痧证之名。始见于赵宋三世医张季明医说。引叶氏录验方
辩痧一则。谓痧病江南旧无。今东西皆有之。其证初发寒栗似伤寒。状似疟。头疼壮热
。手足厥冷。初以饮艾汤试吐。即是其证。急以五月蚕蜕纸一片。剪碎按碗中。以盘盖
密。以沸汤泡半碗许。仍以纸封盘缝。勿令透气。良久。乘热饮之。就卧。以浓衣被盖
之。令汗透便愈云云。此即后世所谓冷痧之滥觞也。继起者。前明张景岳。着刮痧新案
。其说简略。惟国初郭张王三家。各有发明。郭右陶着痧胀玉衡。其说甚辩。大旨谓书
虽不载痧名。而所云青筋白虎。中恶。干霍乱等名。实皆痧证之见于诸书也。至俗称
绞肠痧。由来已久。其病种种不一。或为暗痧。或为闷痧。或为痧晕。或为痧痛。或为
痧胀。或为痧块。或现痧筋。或现痧斑。总由于气郁血凝。湿滞食积。其总因则以地方
不洁。冷热不调。饮食不节。情志不畅者居多。看法。先辨表里。次辨冷热。其治法。
痧在肌肤。当刮即刮。痧在血肉。当放即放。痧在胃肠经络。当药即药。若痧气横行。
表里充斥。当三法兼用。刮痧用油盐搽在瓷碗盖中。先刮胸前脘腹。次刮后背脊骨。又
次刮手足两湾。使痧毒不致内攻。放痧要看痧筋。痧筋色青者。血毒初郁。证尚轻而易
放。色紫红者。血毒已盛。证已重而难放。色黯黑者。证极重而放亦不出。或现于数处
。或现于一处。必须用银针刺之。去其毒血。一放头顶百会穴。一放两太阳穴。一放印
堂。一放舌下两旁。一放喉外两旁。一放双乳两旁。均须浅刺。一放两手足十指头。
一放两臂腿湾。均须深刺。放尽然后审因用药。痧因气郁者。藿香汤（杜藿香、制香附
、小青皮各钱半、生枳壳、苏薄荷、青连翘各一钱、略煎数沸、稍冷服。）理气避秽。
痧因血结者。必胜汤（光桃仁、炒山楂、生川军、五灵脂、小青皮、赤芍各一钱、制香
附钱半、川贝二钱、杜红花四分、煎十余沸微温服。）破血散结。痧因食结者。宣化饮
（新会皮、大腹皮、炒麦芽、前胡各钱半、炒萝卜子三钱、小青皮一钱、先用小山楂一
两、煎汤代水、煎成去渣、稍温服。）消食和气。痧因窍闭者。牛黄八宝丹（西黄、琥
珀、辰砂、梅冰、雄精各一钱、羚角片、明乳香各三钱、犀
角片钱半各为细末、先用蜜银花、紫花地丁各二两、川贝、川连各三钱、煎胶、打糊
为丸、每丸重二分、年幼者一丸、长者二丸、鲜石菖蒲叶一钱、灯心三小帚、鲜卷心竹
叶三十六枝、煎汤调下。）开窍透毒。痧因斑隐者。活络透毒饮（荆芥穗、小青皮、净
蝉衣各一钱、青连翘、蜜银花各钱半、炒牛蒡、紫花地丁各二钱、杜红花五分、先用活
水芦笋一两、大青叶四钱、煎汤代水。）解毒透斑。痧因痰壅者。清气化痰饮（光杏仁
、川贝各二钱、广橘红、生枳壳、小青皮各一钱、莱菔子二钱、天竺黄三钱、白蔻末五
分冲、煎成、微冷服。）理气消痰。至于伤寒兼痧。必先治痧。痧退后。乃治伤寒。痧
类伤寒。轻则刮痧。重则放痧。用药以理气活血透窍解毒为主。切忌误认伤寒。妄用辛
温发汗。反助痧毒益张。慎之。张路玉。着臭毒番痧二则。谓触犯臭秽。腹痛呕逆。世
俗以瓷器蘸油。刮其脊上。随发红斑者。俗为之痧。若感恶毒异气。腹疼肢麻。呕恶神
昏。骤发黑斑。起于漠北。流入中原者。俗名番痧。欲吐不吐。欲泻不泻。干呕绞痛者。
曰绞肠痧。甚或形寒肢厥。面青脉伏。或壮热神昏。面紫脉坚。此由其人素体火衰火盛
。猝中恶毒异气。俗称冷痧热痧之别也。其病与瘴疠相似。霍乱相类。缓则尚可迁延时
日。急则夕发早死。初觉先将纸捻点淬头额。即以荞麦焙燥。去壳取末三钱。冷开水调
服。重者少顷再服即安。盖荞麦能炼肠胃滓秽。降气宽胸。善消浊滞。为痧毒之专药。
其毒甚面黑者。急于两膝后委中穴刺出恶血。以泄毒邪。如荞麦一时莫得。或服之不应
。即宜理气为先。如香苏饮加薄荷荆芥。辛凉透表。次则避邪为要。栀子豉汤加牛蒡、
生甘草。解毒和中。表热势甚。清热为急。黄芩汤加连翘、木通。分利阴阳。烦渴引饮
遗溺。速清阳明。白虎汤加葱豉。斑点深赤。毒在血分者。浓煎益母草两许。少投生蜜
。冲入生莱菔汁半杯。放温恣服。散其恶血。取效最捷。此皆使毒从表化。若见烦扰腹
胀。便闭脉疾。表里俱急者。急投凉膈散。使毒从下泄。世俗有用水搭肩背及臂者。
有以苎麻水湿刮之者。有以瓷碗油润刮之者。有以瓷锋刺委中出血者。有以炒盐探吐
者。有以冷水送下川椒数粒者。有以研生白矾冷水调服二三钱
者。有以油纸点照。视背上有红点处皆 之者。总欲使腠理开通。气血畅达之意耳。其
脉多伏。即不伏亦浑浑不清。或细小紧涩。或紧劲搏指。中带促结。皆是阴匿阳伏之象
。不可误认阴寒而投热药。亦勿以腹痛足冷而与温药。若见面青唇黑。脉劲搏指。厥逆
喘促。多不可救。王晋三着古方选注。中有论痧一则。谓痧者。寒热之湿气。皆可为患
。轻则胃脘气逆。胀满作痛。甚则昏愦欲死。西北人以杨柳枝蘸热水鞭其腹。谓之打寒
痧。东南人以油碗或油线。刮其胸背手足内 。谓之刮瘀。以瓷锋及扁针。刺舌下指尖
及曲池委中出血。谓之 痧。更服神香散（公丁香、白豆蔻各七粒、为末、清汤调下
、如小腹痛者、加春砂仁七粒。）以治寒湿痧胀。益元散（滑石六钱、生甘草一钱、辰
砂一钱、为末、每服三四钱。）以治湿热痧胀。均有神功。是皆内外兼治以泄其气。则
气血得以循度而行。其胀即已。非另有痧邪也。近世俗医。另立痧科。凡见腹痛胀满。
烦闷不安。咸谓之痧。惟欲自炫其术。反戒患家勿轻用药。殊堪捧腹。合观三论。右陶
因龚云林青筋之说。而着痧胀玉衡。名状甚多。而痧之证治乃备。路玉分臭毒番痧为
二。谓恶毒疠气。甚于秽浊。晋三辨痧即外邪骤入。阻塞其正气。气血失循行之道。而
痧之病理益明。
【廉勘】宋明时诸前哲。及前清国初石顽老人。痧皆作沙。其说有三。一谓溪砾中
沙虱射人之毒瓦斯。一谓沙漠中恶毒之异气。一谓尘沙中臭秽之恶气。故其病有沙涨沙秽
之名。后贤以其为病。乃加 焉。窃谓麻疹之俗称。亦名曰痧。未免彼痧与此痧相混。
不如遵宋张季明医说。仍书沙证。较为典雅。若以其执沙刮沙之后。皮肤现红点或紫黑
点者。故名曰痧。则凡皮肤不现痧点者。抑又何说。其实即系各区之地方病也。故又有
翻挣龌龊之别名。其俗名约有百数十种。较古今风病伤寒为尤繁。类皆见形取名。并无
坚义。而于病因病理。反多缺而不讲。王晋三所谓俗医自炫其术是也。余于沙秽一症。
历经实验。三十余年来。确知沙之为病。赅夏秋杂感而统称之也。就予所见。可先分为
两大端。一凡无传染性者。曰恒沙。一凡有传染性者。曰疫沙。于恒沙中。又分
为湿秽暑秽两种。再辨其所夹何邪。或夹气郁。或夹血瘀。或夹食积。或夹痰水。审其
因而治之。疫沙乃一种中毒性之急证。虽证有阴阳之别。而其受恶菌之毒则一。前哲名
病曰中恶。见证曰青筋。早已表明疫沙之病因病状。而王清任谓疫邪吸自口鼻。由气管
达于血管。将气血凝结。初得病时。宜即用针刺尺泽穴出紫黑血。使毒瓦斯外泄。一面以
解毒活血之药治之。则更发明疫沙治法之正的矣。就余所验。外治除提刮针刺诸法外。
先用飞龙夺命丹（辰砂二钱、明雄黄、灯心灰各一钱、 人中白八分、明矾、青黛各五
分、梅冰、麻黄各四分、真珠、牙皂、当门子、硼砂各三分、西黄二分、杜蟾酥、牙硝
各一分五厘、金箔三十页、十六味各研极细、合研匀、玻瓶紧收。）少许。吹鼻取嚏
。即嚏者轻。无嚏者重。即以阿 呢哑水（按∶即氨溶液）搐鼻。兴奋神经。次用绛雪
（辰砂、牙硝各一钱、明雄黄、硼砂各六分、 礞石四分、梅冰、当门子各三分、金箔
五页各研极细、再研匀、治温疫急沙、及牛马羊瘟、以少许点其眼、喉痹牙舌诸病、
汤火金石诸伤、均搽患处。）点两眼角。刺激神经。此皆开泄其血络机窍之气。为外治冲
锋要法。又次用鸡子白对品生麻油入雄黄末调匀。以头发团蘸药遍擦周身。既可解毒。
又除表热。此亦引毒外出之良法。若中寒阴沙。莫妙于回阳膏（生香附一钱八分、或用
吴茱萸亦可、公丁香一钱二分、上桂心八分、倭硫黄五分、当门子四分、五味共研极细
、每用二三分。）安入脐中。外以膏药封之。一时病即轻减。惟口渴苔黄。二便俱热者
。虽见肢冷脉伏。亦勿妄贴此膏。更张其焰。内治方药。虽以芳香辛散之剂。开闭逐秽
。活血通气为正法。然亦有别。如猝中阴性恶毒者。莫妙于苏合香丸（苏合香、安息香
、广木香各二两、犀角、当门子、梅冰、生香附、明乳香、上沉香、公丁香、冬术各一
两、共研极匀、蜜丸、作二百丸、辰砂为衣、蜡匮、临用去蜡壳、薄荷灯心汤、磨汁服
。）及太乙紫金丹（川文蛤、山慈菇各二两、大戟、白檀香、安息香、苏合油各一两五
钱、千金霜一两、明雄黄、琥珀各五钱、梅冰、当门子各三钱、十一味各研极细、再
合研匀、浓糯米饮杵丸、如绿豆大、飞金为衣、每钱
许、开水调下。）猝中阳性恶毒者。莫灵于诸葛行军散（西黄、冰麝、珠粉、硼砂各
一钱、明雄黄八钱、火硝三分、金箔二十页各研极细、再合研匀、每三五分、凉开水
调下。）及局方紫雪（金箔千页、寒水石、 磁石、生石膏、滑石各五两、犀羚角、
青木香、沉香各五钱、丁香一钱、元参、升麻各一两六钱、生甘草八钱、芒硝一两、焰
硝三两、朱砂五钱、当门子一钱二分、每服三四分至一钱、新水调灌。）阴阳错杂者。
莫捷于来复丹（元精石、倭硫黄、牙硝各一两、橘红、青皮、五灵脂各二钱、每服三十
丸、阴阳水送下、善治上盛下虚、里寒外热、伏暑夹阴、霍乱危症。）汤方则用梦隐解
毒活血汤（生苡仁八钱、紫花地丁、益母草、晚蚕沙各五钱、银花、连翘各三钱、大黑
木耳、鲜石菖蒲各钱半、青蒿、贯众各二钱、阴阳水煮、生绿豆四两、取清汤煎药、
和入生藕茅根二汁各一瓢、或童便一杯、稍凉、徐徐服。）重加桃仁（四钱至五钱）
。以桃仁善杀小虫。小虫即洄溪所谓败血所生之细虫。其濂谓桃仁去血中之微生物。神
妙不可思议也。至于附、姜、椒、桂等药。极宜审慎。应用则用。切勿妄用。观仲景用四
逆汤。于既吐且利之下。紧接曰小便不利。重申曰下利清谷。何等叮咛郑重。故洄溪谓
【病因】白天接触或闻到污秽之气，夜晚露宿贪图凉快，这是主要的致病原因。夏季和秋季最为多见。病情缓慢时，寒湿之邪凝滞于脉络；或者湿热之邪郁结阻塞在经络通道中。病情急骤时，鼻子吸入臭毒之气导致气机逆乱上冲；或者因为体内有食积而壅塞中焦之气。这些情况都能导致气胀形成痧证。因此通称为痧气，又称痧胀，或称痧秽。
【症状】头部胀痛眩晕，发热恶寒，胸闷气逆，腹部疼痛胀满。轻症皮肤出现红点，重症出现青筋暴露。严重的甚至上下不通畅，想吐吐不出，想拉拉不下，四肢冰冷厥逆，肠道剧烈绞痛。或者夹杂臭毒之气，或者夹杂食物停滞。面色青暗且指甲也发青，舌苔灰白而滑腻的，是冷痧夹带食积。面色紫浊且指甲也发紫，舌质红、舌苔白而粗糙的，是热痧夹带食积。甚至有突然腹痛昏倒，面色黑而肿胀，不喊也不叫，舌苔灰腻的，这叫痧闭，证候最危急。也有的一发病就导致腹泻不止、四肢冰冷、腹胀无脉象，舌苔白腻的，这叫痧泻，证候也很凶险。
【脉象】脉象沉弦而滞涩，严重的甚至沉伏不见，这是寒邪闭塞于体表，痧毒郁结于体内，气机郁滞、血液凝涩而不能外达的表现。如果脉象沉弦而数，严重的甚至沉牢有力，这是冷食阻滞在中焦，痧毒内伏，湿邪遏制、热邪结聚而不能外发的表现。初起脉象尚且弦劲搏指，随后出现昏厥无脉象的，正如《内经》所说的大气进入脏腑，病多猝然死亡的情况。
【治疗】伤寒兼夹痧证的，先去除外感寒邪，紧急使用辛香流气药来发表散邪。用香苏葱豉汤去掉甘草，加入越鞠丸（三钱）、白蔻末（六分，冲服）；接着辨别病因以去除痧毒。如果是寒湿凝滞脉络的，紧急使用辛温流气药以芳香透达。用仁香汤加浙苓皮（四钱）、生苡仁（六钱）；如果是湿热郁遏经隧的，紧急使用苦辛凉淡药以疏利气机。用藿香正气汤加辰砂拌滑石（五钱）、绵茵陈（三钱）、焦山栀（三钱）。如果是臭毒阻逆上气的，紧急使用芳香辟秽药以宣通上焦。用连翘栀豉汤加紫金锭（二枚，磨汁冲服）。如果是食积壅塞中气的，如果其人想吐吐不出、想拉拉不下，紧急使用涌吐法。用炒盐汤冲生萝卜汁。继之用理气法。用香砂二陈汤冲紫金锭汁。如果其人腹泻严重且无脉象，应当辨别阴阳。阴痧紧急使用正阳四逆汤，以回阳救逆、通复脉象。阳痧紧急使用红灵丹（一二分，凉开水调下），或者行军散（二三分，鲜石菖蒲汤调下），以开窍通脉。至于外治法，轻症用刮痧法（用瓷碗盖蘸香油，刮拭肩背及手足肘窝等处）。搐鼻法（用通关散吹入鼻孔以引起喷嚏）。重症用刺痧法（用银刀刺破少商、中冲、尺泽、委中穴位，以及舌下紫筋出血以放痧）。这些都是宣通气血、内外开通的方法。
【秀按】自古以来的医书，从来没有“痧证”这个名称，最早见于宋代三世医家张季明的《医说》，引用叶氏的录验方辨析痧证一则，说痧病在江南地区过去没有，现在东西方都有。其症状初发时寒战类似伤寒，状似疟疾，头痛高热，手脚冰冷。起初用饮艾汤尝试催吐，如果是痧证就会吐出。紧急取五月蚕蜕纸一片，剪碎按在碗中，用盘子盖严密，用沸水泡半碗左右，仍用纸封住盘缝，不让透气。过一会儿，趁热喝下去，躺下，用厚衣服被子盖好，让汗透发出来就好了等等。这就是后世所谓冷痧的起源。后来兴起的是明代张景岳，写了《刮痧新案》，说法简略。只有清初郭、张、王三家，各有发明。郭右陶著《痧胀玉衡》，说法很详尽，大意是说虽然书上不记载痧的名字，但所说的青筋、白虎、中恶、干霍乱等名称，实际上都是痧证在诸书中的体现。至于俗称的绞肠痧，由来已久。这种病种种不一，有的叫暗痧，有的叫闷痧，有的叫痧晕，有的叫痧痛，有的叫痧胀，有的叫痧块，有的现痧筋，有的现痧斑，总归是由于气郁血凝、湿滞食积引起的。其总的原因大多是地方不洁净、冷热不调、饮食不节、情志不畅。诊察方法，先辨表里，再辨冷热。治疗方法，痧在肌肤，该刮的就刮；痧在血肉，该放血的就放血；痧在胃肠经络，该用药的就用药。如果痧气横行，表里充斥，应当三种方法兼用。刮痧是用油盐搽在瓷碗盖中，先刮胸前脘腹，次刮后背脊骨，又次刮手足两肘膝弯处，使痧毒不至于内攻。放痧要看痧筋，痧筋色青的，血毒初郁，证候尚轻容易放血；色紫红的，血毒已盛，证候已重难放血；色黯黑的，证候极重放了也出不来血。或者出现在几处，或者出现在一处，必须用银针刺之，排出毒血。一处放头顶百会穴，一处放两太阳穴，一处放印堂，一处放舌下两旁，一处放喉外两旁，一处放双乳两旁，都必须浅刺；一处放两手足十指尖，一处放两臂腿弯处，都必须深刺。放完后再审因用药。痧因气郁的，用藿香汤（杜藿香、制香附、小青皮各一钱半，生枳壳、苏薄荷、青连翘各一钱，略煎数沸，稍冷服），理气避秽。痧因血结的，用必胜汤（光桃仁、炒山楂、生川军、五灵脂、小青皮、赤芍各一钱，制香附一钱半，川贝二钱，杜红花四分，煎十余沸微温服），破血散结。痧因食结的，用宣化饮（新会皮、大腹皮、炒麦芽、前胡各一钱半，炒萝卜子三钱，小青皮一钱，先用小山楂一两，煎汤代水，煎成去渣，稍温服），消食和气。痧因窍闭的，用牛黄八宝丹（西黄、琥珀、辰砂、梅冰、雄精各一钱，羚角片、明乳香各三钱，犀角片一钱半，各为细末，先用蜜银花、紫花地丁各二两，川贝、川连各三钱，煎胶，打糊为丸，每丸重二分，年幼者一丸，长者二丸，鲜石菖蒲叶一钱，灯心三小帚，鲜卷心竹叶三十六枝，煎汤调下），开窍透毒。痧因斑隐的，用活络透毒饮（荆芥穗、小青皮、净蝉衣各一钱，青连翘、蜜银花各一钱半，炒牛蒡、紫花地丁各二钱，杜红花五分，先用活水芦笋一两，大青叶四钱，煎汤代水），解毒透斑。痧因痰壅的，用清气化痰饮（光杏仁、川贝各二钱，广橘红、生枳壳、小青皮各一钱，莱菔子二钱，天竺黄三钱，白蔻末五分冲，煎成，微冷服），理气消痰。至于伤寒兼夹痧证，必须先治痧，痧退后，再治伤寒。痧类同伤寒，轻则刮痧，重则放痧，用药以理气活血、透窍解毒为主。切忌误认伤寒，妄用辛温发汗，反而助长痧毒更加嚣张。务必谨慎。张路玉著《臭毒番痧二则》，说触犯臭秽之气，腹痛呕逆，世俗用瓷器蘸油，刮其脊背，随即发出红斑的，俗称为痧。如果感受恶毒异气，腹痛肢麻，呕恶神昏，骤然发出黑斑，起于漠北，流入中原的，俗名叫番痧。想吐吐不出，想拉拉不下，干呕绞痛的，叫绞肠痧。甚至形体寒冷四肢厥冷，面青脉伏，或者高热神昏，面紫脉坚，这是由其人素体火衰或火盛，猝然中受恶毒异气所致，俗称冷痧和热痧的区别。这种病与瘴疠相似，与霍乱相类，缓则还可以拖延时日，急则晚上发作早上死亡。初觉不适先将纸捻点燃淬烫头额，即用荞麦焙燥，去壳取末三钱，冷开水调服。重的过一会儿再服即安。因为荞麦能炼肠胃滓秽，降气宽胸，善于消除浊滞，是治痧毒的专药。其毒甚重面色黑的，急于在两膝后委中穴刺出恶血，以泄毒邪。如果一时找不到荞麦，或者服用无效，就应当以理气为先。如香苏饮加薄荷荆芥，辛凉透表。其次避邪为要，栀子豉汤加牛蒡、生甘草，解毒和中。表热势甚，清热为急，黄芩汤加连翘、木通，分利阴阳。烦渴引饮遗尿，速清阳明，白虎汤加葱豉。斑点深赤，毒在血分的，浓煎益母草一两许，少加生蜜，冲入生莱菔汁半杯，放温恣意服用，散其恶血，取效最快。这都是使毒从表化解。如果见烦躁腹胀，便秘脉疾，表里俱急的，急投凉膈散，使毒从下排泄。世俗有用用水搭肩背及手臂的，有用苎麻水湿刮的，有用瓷碗油润刮的，有用瓷锋刺委中出血的，有用炒盐探吐的，有用冷水送下川椒数粒的，有用研生白矾冷水调服二三钱的，有用油纸点照，视背上有红点处皆灸之的，总想要使腠理开通，气血畅达的意思罢了。其脉多伏，即使不伏也浑浑不清，或细小紧涩，或紧劲搏指，中带促结，都是阴匿阳伏的现象。不可误认阴寒而投热药，也不要因为腹痛足冷就给温药。如果见面青唇黑，脉劲搏指，厥逆喘促，大多不可救。王晋三著《古方选注》，其中有论痧一则，说痧证，寒热之湿气，都可以为患。轻则胃脘气逆，胀满作痛，甚则昏愦欲死。西北人以杨柳枝蘸热水鞭打其腹部，叫做打寒痧。东南人以油碗或油线，刮其胸背手足内侧，叫做刮瘀。以瓷锋及扁针，刺舌下指尖及曲池委中出血，叫做放痧。更服神香散（公丁香、白豆蔻各七粒，为末，清汤调下，如小腹痛者，加春砂仁七粒）以治寒湿痧胀。益元散（滑石六钱，生甘草一钱，辰砂一钱，为末，每服三四钱）以治湿热痧胀，均有神功。这些都是内外兼治以泄其气，则气血得以循度而行，其胀即已，并非另有痧邪。近世庸医，另立痧科，凡见腹痛胀满，烦闷不安，都称之为痧，只为了自我炫耀医术，反而告诫患者不要轻易用药，实在令人捧腹。综合观看这三种论述，右陶因龚云林关于青筋的说法，而著《痧胀玉衡》，名状很多，而痧的证治于是完备。路玉分臭毒番痧为二类，说恶毒疠气，甚于秽浊。晋三辨痧即外邪骤入，阻塞其正气，气血失循行之道，而痧的病理更加明确。
【廉勘】宋明时期的各位前辈，以及前清初年的石顽老人，都将痧写作沙。他们的说法有三种：一种说是溪砾中的沙虱射入人体的毒瓦斯；一种说是沙漠中恶毒的异气；一种说是尘沙中臭秽的恶气。所以他们的病有沙涨、沙秽的名称。后来的贤者认为这是病，于是加上“痧”字旁。我私下认为麻疹的俗称也叫痧，未免将彼痧与此痧混淆。不如遵从宋代张季明《医说》，仍写沙证，较为典雅。如果认为执沙刮沙之后，皮肤现红点或紫黑点，所以名为痧，那么凡皮肤不现痧点的，又怎么说呢？其实这即是各区的地方病。所以又有翻挣、龌龊的别名。其俗名约有百数十种，比古今的风病、伤寒更为繁杂。大都是见形取名，并没有坚实的含义，而对于病因病理，反而多有缺漏而不讲。这正是王晋三所说的俗医自炫其术。我在沙秽一症上，历经实验三十余年，确知沙之为病，概括了夏秋杂感而统称之。就我所见，可先分为两大端：一凡是无传染性的，叫恒沙；一凡是具有传染性的，叫疫沙。在恒沙中，又分为湿秽、暑秽两种，再辨其所夹何邪，或夹气郁，或夹血瘀，或夹食积，或夹痰水，审其因而治之。疫沙乃一种中毒性的急证，虽然证有阴阳之别，而其受恶菌之毒则一。前哲名病曰中恶，见证曰青筋，早已表明疫沙的病因病状。而王清任说疫邪吸自口鼻，由气管达于血管，将气血凝结，初得病时，宜即用针刺尺泽穴出紫黑血，使毒瓦斯外泄，一面以解毒活血之药治之，则更发明疫沙治法的正道了。就我的验证，外治除提刮针刺诸法外，先用飞龙夺命丹（辰砂二钱，明雄黄、灯心灰各一钱，煅人中白八分，明矾、青黛各五分，梅冰、麻黄各四分，真珠、牙皂、当门子、硼砂各三分，西黄二分，杜蟾酥、牙硝各一分五厘，金箔三十页，十六味各研极细，合研匀，玻瓶紧收）少许，吹鼻取嚏。即嚏者轻，无嚏者重。即以阿摩尼亚水（按：即氨溶液）搐鼻，兴奋神经。次用绛雪（辰砂、牙硝各一钱，明雄黄、硼砂各六分，煅礞石四分，梅冰、当门子各三分，金箔五页，各研极细，再研匀，治温疫急沙，及牛马羊瘟，以少许点其眼，喉痹牙舌诸病，汤火金石诸伤，均搽患处）点两眼角，刺激神经。这都是开泄其血络机窍之气，为外治冲锋要法。又次用鸡子白对品生麻油入雄黄末调匀，以头发团蘸药遍擦周身，既可解毒，又除表热，这也是引毒外出之良法。如果是中寒阴沙，莫过于回阳膏（生香附一钱八分，或用吴茱萸亦可，公丁香一钱二分，上桂心八分，倭硫黄五分，当门子四分，五味共研极细，每用二三分）安入脐中，外以膏药封之，一时病即轻减。惟口渴苔黄，二便俱热者，虽见肢冷脉伏，亦勿妄贴此膏，更张其焰。内治方药，虽以芳香辛散之剂，开闭逐秽，活血通气为正法，然而也有区别。如猝中阴性恶毒者，莫过于苏合香丸（苏合香、安息香、广木香各二两，犀角、当门子、梅冰、生香附、明乳香、上沉香、公丁香、冬术各一两，共研极匀，蜜丸，作二百丸，辰砂为衣，蜡匮，临用去蜡壳，薄荷灯心汤，磨汁服）及太乙紫金丹（川文蛤、山慈菇各二两，大戟、白檀香、安息香、苏合油各一两五钱，千金霜一两，明雄黄、琥珀各五钱，梅冰、当门子各三钱，十一味各研极细，再合研匀，浓糯米饮杵丸，如绿豆大，飞金为衣，每钱许，开水调下）。猝中阳性恶毒者，莫过于诸葛行军散（西黄、冰麝、珠粉、硼砂各一钱，明雄黄八钱，火硝三分，金箔二十页，各研极细，再合研匀，每三五分，凉开水调下）及局方紫雪（金箔千页，寒水石、磁石、生石膏、滑石各五两，犀羚角、青木香、沉香各五钱，丁香一钱，元参、升麻各一两六钱，生甘草八钱，芒硝一两，焰硝三两，朱砂五钱，当门子一钱二分，每服三四分至一钱，新水调灌）。阴阳错杂者，莫过于来复丹（元精石、倭硫黄、牙硝各一两，橘红、青皮、五灵脂各二钱，每服三十丸，阴阳水送下，善治上盛下虚、里寒外热、伏暑夹阴、霍乱危症）。汤方则用梦隐解毒活血汤（生苡仁八钱，紫花地丁、益母草、晚蚕沙各五钱，银花、连翘各三钱，大黑木耳、鲜石菖蒲各一钱半，青蒿、贯众各二钱，阴阳水煮，生绿豆四两，取清汤煎药，和入生藕茅根二汁各一瓢，或童便一杯，稍凉，徐徐服），重加桃仁（四钱至五钱）。因为桃仁善于杀小虫，小虫即洄溪所谓败血所生之细虫。其濂说桃仁去血中之微生物，神妙不可思议也。至于附子、干姜、花椒、肉桂等药，极宜审慎，应用则用，切勿妄用。观仲景用四逆汤，于既吐且利之下，紧接曰小便不利，重申曰下利清谷，何等叮咛郑重。故洄溪谓
(Commonly known as Cold Sha. When the condition is acute, it is also called Acute Sha; when slow, it is called Slow Sha).
[Etiology] During the day, exposure to or inhalation of foul odors; at night, sleeping outdoors while seeking coolness—these are the primary causes. It is most common in summer and autumn. In mild cases, cold-dampness stagnates in the meridians; or damp-heat is constrained and obstructed within the collaterals. In acute cases, inhaling toxic foul air causes rebellious Qi to rise upward; or internal food retention blocks the Qi in the Middle Jiao. All these can lead to Qi distension forming Sha syndrome. Therefore, it is generally referred to as Sha Qi, also known as Sha Zhang (Sha Distension), or Sha Hui (Sha Filth).
[Symptoms] Head distension, dizziness, and pain; fever with aversion to cold; chest fullness with rebellious Qi; abdominal pain and distension. Mild cases present with red spots on the skin; severe cases show exposed blue veins. In extreme cases, there is obstruction above and below, inability to vomit or defecate, cold limbs (Jue Ni), and severe intestinal cramping pain. It may be accompanied by toxic foul air or food stagnation. If the complexion is cyanotic-dark and fingernails are also cyanotic, with a grayish-white slippery tongue coating, it is Cold Sha complicated by food retention. If the complexion is purplous-turbid and fingernails are purple, with a red tongue body and dry white coating, it is Heat Sha complicated by food retention. In some cases, sudden abdominal pain with fainting, black and swollen complexion, silence without crying, and a grayish-greasy tongue coating indicate Sha Bi (Sha Closure), which is the most critical condition. Alternatively, immediate onset of profuse diarrhea, cold limbs, abdominal distension without a pulse, and a white-greasy tongue coating indicate Sha Xie (Sha Diarrhea), which is also perilous.
[Pulse] The pulse is deep, wiry, and sluggish; in severe cases, it is deep and hidden. This indicates cold blocking the exterior and Sha toxin郁 (constrained) internally, with Qi stagnation and blood coagulation preventing outward expression. If the pulse is deep, wiry, and rapid, or deep and firm in severe cases, it indicates cold food obstructing the middle, with Sha toxin concealed internally, and dampness restraining heat preventing outward eruption. Initially, the pulse may be wiry and forceful against the finger, followed by fainting and absence of pulse, which corresponds to the *Neijing* statement: "When Great Qi enters the Zang-Fu organs, the disease often results in sudden death."
[Treatment] For Taiyang Syndrome complicated by Sha, first eliminate the external cold. Urgently use acrid-aromatic Qi-moving herbs to release the exterior. Use Xiangsu Congchi Decoction removing Gancao (Licorice Root), adding Yueju Wan (Yueju Pill, 3 qian) and Baiko Powder (White Cardamom Seed Powder, 6 fen, taken with decoction). Then differentiate the cause to remove Sha. For cold-damp stagnating in the meridians, urgently use acrid-warm Qi-moving herbs to aromatic-penetrate. Renxiang Decoction plus Zhe Lingpi (Zhejiang Poria Peel, 4 qian) and Sheng Yiren (Raw Coix Seed, 6 qian). For damp-heat constraining the collaterals, urgently use bitter-acrid-cool-bland herbs to dredge and promote flow. Huoxiang Zhengqi Decoction plus Chen Sha Huaishi (Cinnabar-coated Talcum Powder, 5 qian), Mian Yinchent (Cotton-like Yinchen/Artemisia Capillaris, 3 qian), and Jiao Shanzhi (Charred Gardenia, 3 qian). For toxic foul air obstructing and reversing upper Qi, urgently use aromatic herbs to dispel filth and ventilate the upper Jiao. Lianqiao Zhichi Decoction plus Zijin Ding (Purple Gold Tablet, 2 pieces, ground into juice and mixed). For food retention blocking the Middle Jiao, if the patient cannot vomit or defecate, urgently employ the vomiting method. Use fried salt water mixed with fresh radish juice. Follow with Qi-regulating methods. Xiangsha Erchen Decoction mixed with Zijin Ding juice. If the patient has diarrhea and no pulse, differentiate Yin and Yang. For Yin Sha, urgently use Zhengyang Sini Tang (Sini Decoction for Restoring Yang) to restore Yang and unblock the pulse. For Yang Sha, urgently use Hongling Dan (Red Spirit Pill, 1-2 fen, mixed with cool boiled water) or Xingjun San (Army Marching Powder, 2-3 fen, mixed with fresh Shichangpu Decoction) to open orifices and unblock the pulse. Regarding external treatments: for mild cases, use Gua Sha (Scraping therapy) using a porcelain bowl lid dipped in sesame oil, scraping the shoulders, back, and elbow/knee creases. Chu Bi Fa (Nasal Insufflation) using Tongguan San (Passing Through Powder) blown into the nostrils to induce sneezing. For severe cases, use Ci Sha (Pricking Sha) using a silver knife to prick Shaoshang (LU11), Zhongchong (PC9), Chize (LU5), Weizhong (BL40), and the sublingual purple veins to bleed out Sha toxin. These are all methods to circulate Qi and Blood and open the interior and exterior.
[Commentary by Xiu] Ancient medical texts never mentioned the name "Sha Syndrome." It first appeared in Zhang Jiming's *Yi Shuo* (Medical Sayings) from the Song Dynasty, citing Ye Shi's recorded prescriptions to discuss Sha. He stated that Sha was previously unknown in Jiangnan but is now found everywhere. Symptoms initially resemble Taiyang Syndrome with chills, similar to malaria, with headache, high fever, and cold extremities. Initially, drinking Ai Tang (Mugwort Decoction) to induce vomiting confirms the diagnosis. Urgently take a piece of paper made from silkworm cocoons shed in May, cut it up, place it in a bowl, cover tightly with a plate, pour boiling water over it, seal the edges with paper to prevent leakage, wait, then drink it hot, lie down, cover with thick clothes and blankets until sweating occurs, and the patient recovers. This is the origin of what later generations called Cold Sha. Later, Zhang Jingyue of the Ming Dynasty wrote *Gua Sha Xin An* (New Cases of Scraping Sha), but his explanation was brief. Only in the early Qing Dynasty did Guo, Zhang, and Wang make innovations. Guo Youtao wrote *Sha Zhang Yu Heng*, providing detailed explanations. His main point was that although books do not record the name Sha, terms like Blue Veins, White Tiger, Zhong E (Sudden Evil Attack), and Gan Huoluan (Dry Cholera) actually refer to Sha syndrome in various texts. The common term "Jiao Chang Sha" (Intestinal Cramping Sha) has existed for a long time. The disease varies: An Sha, Men Sha, Sha Yun (Fainting), Sha Tong (Pain), Sha Zhang (Distension), Sha Kuai (Mass), Sha Jin (Veins), Sha Ban (Spots). All result from Qi stagnation and blood coagulation, damp-stagnation, and food retention. The general causes are mostly unclean environments, improper temperature regulation, irregular diet, and emotional stagnation. Diagnosis involves differentiating exterior/interior and cold/heat. Treatment: If Sha is in the skin, scrape it; if in flesh/blood, bleed it; if in stomach/intestines/meridians, medicate it. If Sha Qi spreads wildly filling interior and exterior, use all three methods. Scraping uses oil and salt on a porcelain bowl, scraping chest/abdomen first, then back/spine, then limb creases, to prevent Sha toxin from attacking inward. Bleeding depends on the color of Sha veins: Blue indicates initial blood toxin constraint, mild and easy to treat; Purple-red indicates abundant blood toxin, severe and difficult; Dark-black indicates extremely severe, bleeding may not occur. Prick with silver needles to remove toxic blood. Points include Baihui (GV20), Taiyang (EX-HN5), Yintang (EX-HN3), sides of sublingual veins, sides of throat, sides of breasts (shallow pricking); tips of ten fingers on hands and feet, arm and leg creases (deep pricking). After bleeding, treat based on cause. For Qi stagnation Sha, use Huoxiang Tang (Duhuo Xiang, Zhi Xiangfu, Xiao Qingpi each 1.5 qian, Sheng Zhike, Su Bohe, Qing Lianqiao each 1 qian, slightly boiled, taken warm) to regulate Qi and dispel filth. For Blood stasis Sha, use Bisheng Tang (Guang Taoren, Chao Shanzha, Sheng Chuanjun, Wulingzhi, Xiao Qingpi, Chi Shao each 1 qian, Zhi Xiangfu 1.5 qian, Chuanbei 2 qian, Du Honghua 4 fen, boiled slightly warm) to break blood and dissipate nodules. For Food retention Sha, use Xuanhua Yin (Xinhui Pi, Dafupi, Chao Maiya, Qianhu each 1.5 qian, Chao Luobuzi 3 qian, Xiao Qingpi 1 qian, decocted with Xiaoshanzha 1 liang as water, filtered, taken warm) to digest food and harmonize Qi. For Orifice closure Sha, use Niuhuang Babao Dan (Xihuang, Hupo, Chen Sha, Meibing, Xiongjing each 1 qian, Lingjiaopian, Ming Ruxiang each 3 qian, Xijiaopian 1.5 qian, all powdered; decoct Miyinhuayin and Zihuadiding each 2 liang, Chuanbei, Chuanlian each 3 qian into glue, mix with powder to make pills, 2 fen each; young children take 1 pill, adults 2 pills, taken with decoction of Xian Shichangpuye 1 qian, Dengxin 3 small bundles, Xian Juanxin Zhuye 36 branches) to open orifices and vent toxin. For Hidden Spots Sha, use Huoluo Toutu Yin (Jingjisui, Xiao Qingpi, Jing Chanyi each 1 qian, Qing Lianqiao, Miyinhuayin each 1.5 qian, Chao Niubang, Zihuadiding each 2 qian, Du Honghua 5 fen, decocted with Huoshui Lusun 1 liang, Daqingye 4 qian as water) to resolve toxicity and vent spots. For Phlegm turbidity Sha, use Qingqi Huatan Yin (Guang Xingren, Chuanbei each 2 qian, Guang Juhong, Sheng Zhike, Xiao Qingpi each 1 qian, Laifuzi 2 qian, Tianzhuhuang 3 qian, Baiko 5 fen mixed in, taken slightly cool) to regulate Qi and resolve phlegm. For Taiyang Syndrome complicated by Sha, treat Sha first; after Sha subsides, treat Taiyang. Sha resembles Taiyang; mild cases use scraping, severe cases use bleeding. Medications focus on regulating Qi, invigorating blood, opening orifices, and resolving toxicity. Avoid misdiagnosing as Taiyang and wrongly using acrid-warm diaphoretics, which would exacerbate Sha toxin. Be cautious. Zhang Luyu wrote *Choudu Fan Sha Er Ze*, stating that touching foul odors causes abdominal pain and vomiting; scraping the back with an oil-dipped porcelain vessel causes red spots, commonly called Sha. If infected with evil toxic alien Qi causing abdominal pain, limb numbness, vomiting, coma, and sudden black spots originating from the Mongolian Desert and spreading to Central Plains, it is called Fan Sha (Foreign Sha). Dry heaving and colic without vomiting or defecation is Jiao Chang Sha. Severe cases present with cold form, cold limbs, cyanotic face, hidden pulse, or high fever, coma, purple face, firm pulse. This depends on the individual's constitution being deficient or excessive in fire, suddenly struck by evil toxic alien Qi, distinguishing Cold Sha and Heat Sha. This disease resembles Miasma and is similar to Cholera. Mild cases drag on; acute cases cause death from evening to morning. Upon initial discomfort, burn a paper twist to cauterize the forehead, then take 3 qian of roasted buckwheat flour mixed with cool boiled water. Repeat if severe. Buckwheat refines gastrointestinal waste, descends Qi, expands the chest, and eliminates turbid stagnation; it is a specific drug for Sha toxin. For severe toxicity with black face, urgently prick Weizhong (BL40) behind both knees to bleed out evil blood and vent toxin. If buckwheat is unavailable or ineffective, prioritize regulating Qi, e.g., Xiangsu Yin plus Bohe and Jingjie for acrid-cool exterior release. Next, avoid evil: Zhizi Chi Tang plus Niubang and Sheng Gancao to resolve toxicity and harmonize the middle. For severe exterior heat, clear heat urgently: Huangqin Tang plus Lianqiao and Mutong to separate Yin and Yang. For irritability, thirst, and enuresis, clear Yangming urgently: Baihu Tang plus Congchi. For deep red spots indicating toxin in the Blood level, decoct Yi Mucao (Leonurus Herb) strongly with a little raw honey and half cup of fresh Radish Juice, taken warm to disperse evil blood for quick effect. This vents toxin via the exterior. For irritability, abdominal distension, constipation, rapid pulse, and urgent interior/exterior conditions, urgently administer Liangge San to vent toxin downward. Folk methods include pouring water on shoulders/back/arms, scraping with wet Ramie fiber, scraping with oiled porcelain bowls, pricking Weizhong with porcelain shards, inducing vomiting with fried salt, swallowing Sichuan pepper with cold water, taking dissolved Alum with cold water, or moxa-scarification on red spots seen under oil-paper illumination. All aim to open pores and smooth Qi/Blood circulation. Pulses are mostly hidden, or chaotic, fine/tight/rough, or tight/forceful with intermittent interruptions, indicating Yin hiding and Yang concealed. Do not mistake for Yin-Cold and give hot drugs; do not give warm drugs for abdominal pain/cold feet alone. Cyanotic face/lips, forceful pulse, cold limbs, panting are often incurable. Wang Jinshan in *Gu Fang Xuan Zhu* discusses Sha: Cold/Heat Dampness can cause Sha. Mild cases involve Stomach Qi rebellion, distension, pain; severe cases involve confusion and near-death. Northwest people whip the abdomen with willow branches dipped in hot water (Da Han Sha). Southeast people scrape chest/back/limbs with oiled bowls/threads (Gua Yu). Prick sublingual veins, fingertips, Quchi (LI11), Weizhong with porcelain/sharp needles to bleed (Ci Sha). Take Shenxiang San (Gong Dingxiang, Baidoukou each 7 grains, powdered, taken with clear soup; add Chun Sharen 7 grains for lower abdominal pain) for Cold-Damp Sha Zhang. Yi Yuan San (Huashi 6 qian, Sheng Gancao 1 qian, Chen Sha 1 qian, powdered, 3-4 qian per dose) for Damp-Heat Sha Zhang. Both are effective. These treat interior/exterior to vent Qi, allowing Qi/Blood to flow normally, resolving distension, proving no separate Sha pathogen exists. Modern quacks established a separate Sha department, labeling any abdominal pain/distension/restlessness as Sha to show off, advising patients against medication, which is ridiculous. Combining these three theories: Youtao wrote *Sha Zhang Yu Heng* based on Gong Yunlin's Blue Veins theory, detailing Sha symptoms and treatments. Luyu divided Choudu/Fan Sha into two, noting evil pestilential Qi is worse than filth. Jinshan identified Sha as sudden external evil blocking Zheng Qi, disrupting Qi/Blood flow, clarifying Sha pathology.
[Commentary by Lian] In Song/Ming dynasties and early Qing (Shiwen Laoren), Sha was written as Sha (Sand). Three theories existed: 1. Toxic gas from sand lice in streams; 2. Evil alien Qi from deserts; 3. Foul air from dust/sand. Hence names like Sha Zhang/Shahui. Later scholars added the 'disease' radical to create 'Sha'. I argue that Measles is also commonly called Sha, causing confusion between Measles-Sha and this Sha. It is more elegant to follow Zhang Jiming and write Sha (Sand). If named Sha because scraping reveals red/purple spots, what about cases without spots? Actually, these are regional endemic diseases, also called Fan Zheng/Wochuo. There are hundreds of folk names, more complex than ancient Wind/Taiyang diseases. They are named by appearance, lacking theoretical depth, ignoring etiology/pathology, as Wang Jinshan criticized. I have experimented with Sha/Hui for 30+ years, concluding it encompasses Summer/Autumn miscellaneous infections. I divide it into two main types: Non-infectious Heng Sha (Constant Sha) and Infective Yi Sha (Epidemic Sha). Heng Sha splits into Wet Filth and Summer Heat Filth, further differentiated by accompanying pathogens (Qi stagnation, Blood stasis, Food retention, Phlegm/Water). Yi Sha is a toxic acute condition; despite Yin/Yang differences, the cause is bacterial/toxic infection. Ancients called it Zhong E (Mid-Evil) or Blue Veins, indicating etiology/symptoms. Wang Qingren stated epidemic evil enters via mouth/nose, travels trachea to blood vessels, coagulating Qi/Blood. Initial treatment should prick Chize (LU5) to bleed purple-black blood to vent toxin, combined with detoxifying/hemostatic herbs, clarifying Yi Sha treatment. My external treatments include Feilong Duoming Dan (Feilong夺取命 Pill) insufflated into nose to induce sneezing (sneezing = mild, no sneeze = severe). If no sneeze, use Ammonia solution (Amoni Ya Shui) nasally to stimulate nerves. Then apply Jiangxue (Jiangxue Powder) to eye corners to stimulate nerves. These open blood collaterals/orifices. Next, mix Egg White with Sesame Oil and Realgar powder, rub on body with hair tuft to detoxify and relieve exterior heat. For Cold Yin Sha, use Huyang Gao (Restore Yang Plaster) applied to umbilicus. If thirsty, yellow coating, hot urination/stool, do not use this plaster even if limbs are cold/pulse hidden. Internal treatment uses aromatic/acrid-dispersing herbs to open closure, expel filth, invigorate blood, and move Qi. For sudden negative-type evil toxin, use Suhexiang Wan (Suhexiang Pill) or Taiyi Zijin Dan (Taiyi Purple Gold Pill). For sudden positive-type evil toxin, use Zhuge Xingjun San (Zhuge Army Marching Powder) or Jufang Zixue (Bureau Formula Purple Snow). For Yin-Yang mixed cases, use Laifu Dan (Laifu Pill). Decoction: Mengyin Jiedu Huoxue Tang (Mengyin Detoxifying and Blood-Invigorating Decoction) with heavy Taoren (Peach Kernel) to kill parasites/microbes in stagnant blood. Caution with Fuzi, Jiang, Jiao, Gui; use only when indicated. Zhang Zhongjing's use of Sini Tang for vomiting/diarrhea emphasizes checking for difficulty urinating and clear grain diarrhea, showing caution. Thus Xixi said...