痧气慢者，常觉头眩内热，或半边头痛，心烦不安，宜刮痧，不愈，用清热下气之剂。
痧毒传变，忽足忽手，忽发肌肤，忽为痰喘，隐现无定，来去不常，而痧脉又不现，最
难识认。有热似流火，肿似流痰，而不比流火流痰之轻缓。或痛极难忍，或痒痛不已，此等
验于痧筋发现，刺之无疑，然后凭脉所犯风寒暑湿及食积痰血气阻分治之，斯能有效。
一妇日间左小腿红肿大痛，暮即腹痛而足痛止，次日右小腿红肿大痛，腹痛又止。六脉
如常，难据为痧。腿弯有青筋三条，刺血甚多，反加痰喘，此放痧未尽之故，用竹二方加土
贝母二钱，两服稍愈。次日左腿弯又刺痧筋一条，颠顶一针，服前汤加牛膝三钱，痧即退，
更服丝七方，俱痊。
一人晚间右腿红肿痛方已，喉旁肿痛，不觉为痧，只见时症犯此者多。细看两臂痧筋，
刺血，用石八方倍楂、卜加大黄一钱，食消便下而安。
先有痰喘气急，痧胀因之，先治痧，后治痰气，无令痧为本病之助。先有痧胀，痰喘气
急因之，但治痧而痰气自愈。若痧有寒热不清痰喘气急者兼和解。痧有但热无寒喘急者，兼
消食顺气。有大便不通，小便不利喘急者，又有痢下脓血喘急者，俱宜攻里。有瘀血凝滞、
小便利、大便黑喘急者，
当虑痧毒攻坏脏腑，不痛可治，痛而不已难治，服药不应者死（土五）。
一人发热头痛，胀闷昏迷、痰喘气急，六脉无根。若痧胀则有救，因放痧、用石五方、
丝四方、稍冷服。又用土五方一服，昏迷即醒，胀喘俱平，更用金一方加青、翘、楂、卜、
熟军，发热头疼俱已，脉复旧。
一妇痰喘气急，胀闷不已，刺乳下二针，出紫黑血，稍可，用竹四方三服愈。
一人痰喘气急，发热身重，腹中绞痛，刮放不愈，用金四方并石六方加大黄服之愈。
痧气发作缓慢者，常感觉头晕目眩、体内发热，或者出现半边头痛、心烦意乱、坐卧不安的症状，适宜进行刮痧治疗；如果刮痧后未痊愈，则使用具有清热降气功效的方剂。
痧毒发生传变时，症状忽而在足部忽而在手部，忽而发于肌肤表面，忽而表现为痰喘，症状隐现不定，来去无常，且脉象中不显现典型的痧脉，因此最难辨识。有的热象类似流火（一种急性丹毒），肿胀类似流痰（一种慢性皮下脓肿），但病情并不像普通的流火或流痰那样轻微缓和。有的疼痛剧烈难以忍受，有的瘙痒与疼痛交替不止。这类情况可以通过观察发现“痧筋”（皮下显露的青紫色静脉）来验证，对其进行刺络放血治疗是毫无疑问的，然后根据脉象判断所犯之风寒暑湿以及食积、痰浊、瘀血、气阻等不同病因进行分型治疗，这样才能取得疗效。
有一位妇女白天左小腿红肿剧痛，傍晚时分腹痛发作而腿痛停止；第二天右小腿红肿剧痛，腹痛又停止。此时六脉如常，难以据此判断为痧证。但在腿弯处发现三条青色筋脉，刺破后放出大量血液，反而加重了痰喘症状，这是因为放痧不彻底的缘故。于是使用竹二方加入土贝母二钱，服用两剂后症状稍有好转。第二天在左腿弯处又刺出一条痧筋，并在头顶百会穴针刺一针，服用前方剂加入牛膝三钱，痧毒随即消退，随后再服用丝七方，最终全部痊愈。
有一人晚间右腿红肿疼痛刚刚缓解，喉旁却出现肿痛，当时并未意识到这是痧证，只见患时行疾病出现此类症状的人很多。仔细查看其双臂发现有痧筋，进行刺络放血，使用石八方加倍山楂、萝卜子，并加大黄一钱，待食积消除、大便通畅后病情安定。
如果是先有痰喘气急，导致痧胀随之产生，应先治疗痧证，后治疗痰气，不要让痧证成为本病的帮凶。如果是先有痧胀，导致痰喘气急随之产生，只需治疗痧证，痰气自然就会痊愈。如果痧证伴有寒热不清、痰喘气急的情况，兼用和解法治疗。如果痧证只有热象没有寒象、气喘急促的，兼用消食顺气法治疗。如果有大便不通、小便不利、气喘急促的情况，又有痢疾下脓血伴气喘急促的情况，都适宜采用攻里法治疗。如果有瘀血凝滞、小便通利、大便色黑、气喘急促的情况，应当顾虑是痧毒攻坏脏腑所致，如果不痛还可以治疗，如果疼痛不止则难治，服药后无反应的则死亡（参考土五方）。
有一人发热头痛，胸腹胀闷昏迷、痰喘气急，六脉微弱无根。如果是痧胀则还有救，通过放痧，并使用石五方、丝四方，稍微冷却后服用。又服用土五方一剂，昏迷立即苏醒，胀满和喘息都平息了，随后再用金一方加入青蒿、连翘、山楂、萝卜子、熟大黄，发热头疼全部消失，脉象恢复常态。
When Sha Qi (Sha syndrome) develops slowly, the patient often feels dizzy with internal heat, or experiences unilateral headache, mental restlessness, and uneasiness. Scraping therapy (Gua Sha) is suitable; if it does not cure, use a formula to clear heat and descend qi.
When Sha Du (Sha toxin) transmits and changes, symptoms may suddenly appear on the feet or hands, occasionally manifesting on the skin, or alternatively presenting as phlegm and wheezing. The symptoms are indistinct and irregular in their appearance and disappearance, and the typical Sha pulse is absent, making diagnosis extremely difficult. Some cases present with heat resembling Liu Huo (acute erysipelas) and swelling resembling Liu Tan (chronic subcutaneous abscess), but the condition is neither mild nor slow compared to ordinary Liu Huo or Liu Tan. Some suffer from unbearable pain, while others experience incessant itching and pain. Such cases can be verified by the presence of Sha Jin (subcutaneous cyanotic veins); pricking them for bloodletting is undoubtedly correct. Subsequently, treatment should be differentiated based on the pulse diagnosis regarding the pathogenic factors involved, such as wind, cold, summerheat, dampness, food stagnation, phlegm, blood stasis, or qi obstruction, which will ensure efficacy.
A woman suffered from redness, swelling, and severe pain in her left lower leg during the day. At dusk, abdominal pain occurred while the leg pain ceased. The next day, redness, swelling, and severe pain appeared in her right lower leg, and the abdominal pain stopped again. Her six pulses were normal, making it difficult to diagnose Sha syndrome based on this alone. However, three green veins were found in the popliteal fossa. After pricking and releasing a large amount of blood, her phlegm and wheezing worsened, due to incomplete Sha release. Zhuer Fang (Bamboo Formula No. 2) was used with Erchen Mu (Fritillaria Thunbergii Bulb) added at 2 qian. After two doses, she improved slightly. The next day, another Sha vein was pricked in the left popliteal fossa, and one needle was inserted into the vertex (Baihui). She took the previous decoction with Niuxi (Achyranthes Bidentata Root) added at 3 qian, after which the Sha toxin receded. Finally, Sizhi Fang (Silk Formula No. 7) was administered, leading to complete recovery.
A man’s right lower leg redness, swelling, and pain had just subsided in the evening when swelling and pain appeared beside his throat. It was not recognized as Sha syndrome at the time, as many patients with seasonal epidemics presented with similar symptoms. Upon careful examination, Sha veins were found on both arms. Bloodletting was performed, and Shiba Fang (Stone Formula No. 8) was used with doubled Zhizi (Gardeniae Fructus) and Boluozhong (Radish Seed), plus Dahuang (Rhei Radix et Rhizoma) at 1 qian. After food stagnation was resolved and stool passed, the condition stabilized.
If phlegm and wheezing with rapid breathing occur first, causing Sha Zhang (Sha distension) subsequently, treat the Sha first, then the phlegm and qi, ensuring that Sha does not assist the primary disease. If Sha Zhang occurs first, causing phlegm and wheezing with rapid breathing subsequently, only treat the Sha, and the phlegm and qi will heal themselves. If Sha presents with unclear alternating chills and fever along with phlegm and wheezing, combine with harmonizing methods. If Sha presents with heat only, no chills, and rapid wheezing, combine with methods to digest food and regulate qi. If there is constipation, dysuria, and rapid wheezing, or if there is dysentery with pus and blood accompanied by rapid wheezing, purgative methods for the interior are appropriate. If there is blood stasis stagnation, free urination, black stool, and rapid wheezing, one must consider that Sha toxin has damaged the zang-fu organs. If painless, it is treatable; if painful and unceasing, it is difficult to treat; if medication yields no response, death ensues (refer to Tu Wu Fang).
One patient presented with fever, headache, chest and abdominal distension, coma, and phlegm with rapid wheezing. His six pulses were rootless. If this is Sha Zhang, there is hope for rescue. Treatment involved bloodletting and administering Shi Wu Fang (Stone Formula No. 5) and Si Si Fang (Silk Formula No. 4), taken slightly cool. Then, Tu Wu Fang (Earth Formula No. 5) was given once; the coma cleared immediately, and distension and wheezing subsided. Subsequently, Jin Yi Fang (Gold Formula No. 1) was used with Qinghao (Artemisia Annua Herb), Lianqiao (Forsythia Fruit), Zhizi, Boluozhong, and Shujun (Prepared Rhei Radix et Rhizoma). Fever and headache disappeared, and the pulse returned to normal.
A woman suffered from phlegm, wheezing, rapid breathing, and incessant chest and abdominal distension. Two needles were inserted below the nipples, releasing purple-black blood, providing slight relief. Zhusi Fang (Bamboo Formula No. 4) was administered for three doses, resulting in cure.
One patient presented with phlegm, wheezing, rapid breathing, fever, heavy body, and colicky abdominal pain. Scraping and bloodletting did not cure him. Jinsi Fang (Gold Formula No. 4) combined with Shiliu Fang (Stone Formula No. 6) with added Dahuang was administered, leading to recovery.