痧脉多微缓细涩，有时弦数，纵浮大亦虚而无力，疾徐不伦，时或六脉俱伏，伏亦无妨
，痧退脉即渐还。如头痛壮热，脉应洪实而脉反微迟者，痧也。厥冷不语，脉应沉细而反滑
数者，痧也。脉症不符，便舍症而从脉。诊痧尽此两言。
按∶伤寒、杂病，自有本脉。若一兼痧，其脉必变，病必凶暴。然兼痧之脉可知也，伤
食痧脉多紧实，伤血痧脉多芤滑，伤暑痧脉多洪滑而疾数，伤风痧脉多沉微，秽触痧脉多变
异不常，伤气痧脉多沉伏或如雀啄，伤寒湿痧脉多沉细。或有痧脉似阴症者，尤不可不辨，
如伤寒脉沉迟无力，是直中三阴，治用热药何疑？惟伤寒兼痧，脉似阴症，一服温补热药，
痧毒变幻，悔无及矣。故于其外见症候稍有不合，便取痧筋验之，有则为痧，无则为阴，凉
热异施。且放痧服药后，经络无阻，脉便不复沉伏，然后按脉辨症，治其伤寒，无不效者。
至杂症兼痧有沉伏之脉，亦准此法。
凡痧脉微细者生，实大急数者重，洪大无伦者凶。一部无脉者轻，一手无脉者重，两手
无脉者死。六脉无根及诸怪脉现而放痧、服药不应者不治。
丹溪治杂症，以气、血、痰为先。痧胀何能离此？痧胀有气塞者，为喘急、为胀满、为
呕哕，为头眼胀，其痛紧，脉必洪数，属阳。有气闭者，为昏冒、口噤、目翻、厥冷，虽痛
口不能言，脉必沉伏，属阴。痧有血热者，为烦躁，为紫斑，为头面赤，为衄，口出红沫、
脉必实大属阳。有血阻者，腰痛，胁痛，攻心痛，手足青紫，脉必紧牢，乍大乍小，属阴，
痧有痰寒者，喉中漉漉有声，吐咯不出，呕吐酸水清涎，脉必弦滑，属阳。有痰厥者，卒倒
、手足厥冷，肌肤芒刺，遍身青筋，坐卧不能转侧，脉必微细，似有似无，属阴。亦不得谓
阳痧则生，阴痧则死，痧有脉伏三日亦得救活者，在得其窍而已。
痧症的脉象多表现为微缓、细涩，有时呈现弦数之象；即使脉象浮大，也是虚而无力，快慢无序，有时六部脉都伏匿不见，但伏脉并无大碍，待痧毒消退后脉象自然会逐渐恢复。例如出现头痛和高热，脉象本应洪大有力却反而微弱迟缓的，是痧症。出现四肢厥冷和神志不清不能言语，脉象本应沉细却反而滑数的，也是痧症。当脉象与症状不相符合时，就应当舍弃症状而依据脉象进行诊断。诊断痧症的关键就在这两句话中。
按语：伤寒病和杂病，自有其固有的脉象规律。如果兼夹痧症，脉象必然发生变化，病情必定凶险暴烈。然而，兼夹痧症的脉象是可以辨识的：伤食引起的痧症，脉象多紧实；伤血引起的痧症，脉象多芤滑；伤暑引起的痧症，脉象多洪滑且疾数；伤风引起的痧症，脉象多沉微；秽浊之气触犯引起的痧症，脉象多变异常；伤气引起的痧症，脉象多沉伏或如雀啄般断续；伤寒湿邪引起的痧症，脉象多沉细。有的痧症脉象类似阴证，尤其不可不仔细辨别。例如伤寒脉象沉迟无力，这是寒邪直中三阴经，治疗使用温热药物有什么可怀疑的呢？只有伤寒兼夹痧症时，脉象看似阴证，若服用温补热药，会导致痧毒变幻莫测，后悔莫及。因此，在外在症状稍有不符合常规时，便取痧筋（皮下显露的青紫色静脉）来验证，有痧筋则为痧症，无痧筋则为阴证，凉性和热性治疗方法截然不同。且在放痧（刺络放血）和服药之后，经络通畅无阻，脉象便不再沉伏，然后按照脉象辨析症状，治疗其原本的伤寒病，没有不奏效的。至于杂症兼夹痧症出现沉伏脉象的情况，也遵循此法。
凡是痧症脉象微细的预后良好，脉象实大急数的病情严重，脉象洪大无序的预后凶险。一部脉摸不到的病情较轻，一只手无脉的病情较重，双手均无脉的则主死亡。六部脉均无根底以及出现各种怪脉，且经过放痧、服药后仍无反应的，属于不治之症。
朱丹溪治疗杂病，以气、血、痰为先导。痧胀症怎么能脱离这三者呢？痧胀症中有气机阻滞的，表现为喘促急促、腹胀满闷、呕吐呃逆、头眼胀痛，疼痛剧烈，脉象必洪数，属于阳证。有气机闭塞的，表现为昏晕冒昧、牙关紧闭、眼球上翻、四肢厥冷，虽然痛苦但不能言语，脉象必沉伏，属于阴证。痧症中有血热的，表现为烦躁不安、出现紫斑、头面部发红、鼻衄出血、口吐红沫，脉象必实大，属于阳证。有血行受阻的，表现为腰痛、胁痛、攻冲心痛、手足青紫，脉象必紧牢，忽大忽小，属于阴证。痧症中有痰寒的，表现为喉中漉漉有声、痰液吐咯不出、呕吐酸水清涎，脉象必弦滑，属于阳证。有痰厥的，表现为突然昏倒、手足厥冷、肌肤如有芒刺感、遍身青筋暴露、坐卧不能翻身转动，脉象必微细，似有似无，属于阴证。也不能一概而论说阳痧就能生还，阴痧就会死亡，痧症即使脉伏三日也有救活的可能，关键在于掌握诊治的要窍罢了。
The pulse in Sha disease (a condition characterized by toxic heat and blood stasis often manifesting as acute abdominal distension or skin eruptions) is mostly slightly slow, fine, and choppy; sometimes it is wiry and rapid. Even if it appears floating and large, it is deficient and forceless, with irregular speed, and at times all six pulses may be hidden deep. However, a hidden pulse is not necessarily ominous; once the Sha toxin recedes, the pulse will gradually return to normal. For instance, if there is headache and high fever, the pulse should be surging and solid, but if it is instead weak and slow, it indicates Sha disease. If there are cold extremities and muteness, the pulse should be deep and fine, but if it is instead slippery and rapid, it also indicates Sha disease. When the pulse and symptoms do not correspond, one should discard the symptoms and rely on the pulse for diagnosis. These two principles summarize the diagnosis of Sha disease.
Note: Cold damage diseases and miscellaneous diseases have their own inherent pulse patterns. If Sha disease is concurrent, the pulse must change, and the illness will inevitably become fierce and violent. However, the pulse of concurrent Sha disease can be identified: Sha caused by food stagnation typically presents a tight and solid pulse; Sha caused by blood injury typically presents a hollow and slippery pulse; Sha caused by summerheat typically presents a surging, slippery, and rapid pulse; Sha caused by wind invasion typically presents a deep and faint pulse; Sha caused by foul contact typically presents an abnormal and unpredictable pulse; Sha caused by Qi injury typically presents a deep and hidden pulse or one that feels like a sparrow pecking (intermittent); Sha caused by cold-dampness typically presents a deep and fine pulse. Some Sha pulses resemble Yin syndromes, which requires careful differentiation. For example, if the pulse in cold damage is deep, slow, and forceless, it indicates direct transmission to the Three Yin meridians, and treatment with hot medicines is unquestionable. However, in cases where cold damage is concurrent with Sha, and the pulse resembles a Yin syndrome, administering warming and tonifying hot medicines will cause the Sha toxin to transform unpredictably, leading to irreparable regret. Therefore, if the external symptoms show any slight inconsistency, one should examine the Sha veins (subcutaneous purple-blue veins) for verification: presence indicates Sha disease, absence indicates a Yin syndrome, requiring distinct cooling and heating treatments. After bloodletting (Fang Sha) and medication, the meridians become unobstructed, and the pulse ceases to be deep and hidden. Only then should one diagnose based on the pulse and treat the underlying cold damage, which will invariably be effective. This method also applies to miscellaneous diseases concurrent with Sha presenting with deep and hidden pulses.
Generally, if the Sha pulse is fine and subtle, the prognosis is good; if it is solid, large, and rapid, the condition is severe; if it is surging, large, and chaotic, the prognosis is ominous. If the pulse is absent in one position, the condition is mild; if absent in one hand, it is severe; if absent in both hands, death ensues. If all six pulses lack root and various strange pulses appear, and there is no response to bloodletting and medication, the case is untreatable.
Zhu Danxi treated miscellaneous diseases by prioritizing Qi, Blood, and Phlegm. How can Sha distension be separated from these? In Sha distension, Qi obstruction manifests as panting and urgency, abdominal fullness, vomiting and hiccups, and swelling/pain in the head and eyes, with tight pain and a surging-rapid pulse, classifying it as a Yang syndrome. Qi closure manifests as dizziness/fainting, locked jaws, upward-rolling eyes, and cold extremities; although painful, the patient cannot speak, with a deep-hidden pulse, classifying it as a Yin syndrome. Sha with Blood Heat manifests as irritability, purple macules, redness of the face and head, epistaxis, and frothy red saliva, with a solid-large pulse, classifying it as a Yang syndrome. Sha with Blood Stasis manifests as lower back pain, hypochondriac pain, stabbing heart pain, and cyanosis of hands and feet, with a tight-firm pulse that fluctuates between large and small, classifying it as a Yin syndrome. Sha with Phlegm-Cold manifests as gurgling sounds in the throat, inability to expectorate phlegm, vomiting of sour water and clear saliva, with a wiry-slippery pulse, classifying it as a Yang syndrome. Phlegm-Jue (syncope) manifests as sudden collapse, cold extremities, sensation of prickles on the skin, exposed blue veins over the body, and inability to turn over while sitting or lying, with a fine-micro pulse that seems present yet absent, classifying it as a Yin syndrome. One must not assume that Yang Sha always survives and Yin Sha always dies; even if the pulse is hidden for three days, Sha patients can still be saved, provided the key therapeutic principles are mastered.