痰涎壅盛，喘急如锯，痛若喉蛾，但喉蛾喉内肿胀，痧只痛而无肿胀。形若急喉风，但
喉痛而不移，痧则痛无一定，且痧有痧筋可辨也（竹一、二、三）。
一人，痰气壅盛，脉多怪异，吹吊痰药，益凶暴痛极。此三焦命门痧也。刺臂指、腿弯
青筋，紫黑血甚多，不愈。用石五、丝五方，外吹竹一方，又用竹二方，三服而愈。
一人喉痛极，痰涎壅盛，余视之，痧也。不信，延喉科治之，且饮热汤，至夕殂。此症
用竹三方必效。
心胸胀极，痧毒内攻，故头顶向后，形如角弓反张，是脏腑已坏，死症也。急用白酒将
毛青布蘸抹手足拘急处，再喷其遍体，少顷松动，然后用药，或可回生。药用石二、丝二之
类。附歌∶
手足拘缩角弓张，脏腑攻冲毒势强。
火酒遍喷兼蘸抹，死中求治石丝方。
寒气郁伏肌肉间，至春而发，暑热凝滞血肉中，至秋而发，皆名瘟痧。秋瘟尤易传染。
其症寒热似疟，腹或痛或不痛，或喘急饱闷，头面肿胀，或变下痢脓血，轻者缠绵，重者危
急，宜放痧、消食积为主。俟痧毒已泄，然后和解清里，除其寒热，健脾养血，补其中虚（
竹四）。
一人于九月恶寒发热，痰嗽烦闷，口渴，舌苔，刺血不流，卧床沉重。此误饮热也。用
阴阳水加明矾一钱饮之，又用消食去积药加熟军二钱，微冷冻饮料少愈，次日复刺臂指痧筋去血
，用活血解毒药渐愈。
其妻同时寒热烦闷，头面肿胀，脉伏，放痧不愈，饮微冷矾汤，次用透窍消毒下气药加
牛膝三钱，二服愈。
其子亦寒热如疟，心腹绞痛，吐泻不已，六脉沉紧，用石一方并竹四方入大黄一钱，次
日再服，愈。
痰涎壅盛，呼吸急促伴有哮鸣音如拉锯声，咽喉疼痛如同喉蛾（一种以咽喉肿痛为主症的疾病），但喉蛾表现为喉内肿胀，而痧症仅疼痛而无肿胀。症状表现类似急喉风（急性喉痹，症见咽喉肿痛、呼吸困难），但喉痛部位固定不移，而痧症疼痛位置不固定，且可通过观察“痧筋”（皮下显露的紫黑色静脉）来辨别（参考竹一、二、三篇）。
有一人，痰气壅盛，脉象多怪异，使用吹入吊痰的药物后，病情反而更加凶险暴烈，疼痛至极。这是三焦命门痧（涉及三焦与命门的痧症）。针刺手臂手指及腿弯处的青筋，放出大量紫黑色的血液，但病未愈。使用石五方、丝五方，外用竹一方吹喉，又服用竹二方，服药三次后痊愈。
另一人咽喉剧痛，痰涎壅盛，我诊察认为是痧症。患者不信，延请喉科医生治疗，并饮用热汤，至傍晚死亡。此症若用竹三方必定有效。
心胸极度胀满，痧毒内攻，导致头部向后仰，身体呈角弓反张（背部肌肉强直，身体向后弯曲如弓状）之形，这是脏腑已坏死的死症。紧急时用白酒蘸毛青布擦拭涂抹手足拘挛抽搐的部位，再喷洒全身，片刻后身体松动，然后用药，或许可以救活。药用石二方、丝二方之类。附歌诀：
手足拘缩角弓张，脏腑攻冲毒势强。
火酒遍喷兼蘸抹，死中求治石丝方。
寒气郁结伏留于肌肉之间，到春季发作；暑热凝滞于血肉之中，到秋季发作，都称为瘟痧（具有流行性的痧症）。秋季的瘟痧尤其容易传染。其症状寒热往来似疟疾，腹部或痛或不痛，或呼吸急促、腹胀闷，头面肿胀，或变为下痢脓血，轻者缠绵难愈，重者危急，宜采用放痧（刺络出血）、消食积为主要治法。待痧毒已泄，然后再和解表里、清解里热，消除寒热，健脾养血，补益中气虚弱（参考竹四篇）。
有一人在九月出现恶寒发热，痰嗽烦闷，口渴，舌苔异常，刺络放血时血液不流，卧床沉重不起。这是误饮热汤所致。用阴阳水加明矾一钱服用，又用消食去积药加熟大黄二钱，微冷冻后少量饮用，稍有好转，次日再次针刺手臂手指的痧筋放血，服用活血解毒药逐渐痊愈。
其妻同时出现寒热烦闷，头面肿胀，脉象沉伏，放痧后未愈，饮用微冷的矾汤，随后使用透窍消毒、下气药加牛膝三钱，服药两次后痊愈。
Phlegm and saliva are abundant, breathing is rapid with a sawing sound, and throat pain resembles *Hou'e* (a disease characterized by severe sore throat). However, *Hou'e* presents with swelling inside the throat, whereas Sha (sand/heat toxin) only causes pain without swelling. The presentation resembles *Ji Hou Feng* (acute wind-stroke of the throat), but in *Ji Hou Feng*, the pain is fixed, while in Sha, the pain is not fixed, and it can be distinguished by the presence of "Sha Jin" (visible subcutaneous purple-black veins) (see Bamboo 1, 2, 3).
A patient had abundant phlegm and Qi stagnation, with bizarre pulse patterns. After using medicated powder to induce expectoration via insufflation, the condition became more violent and painful. This was Sha involving the San Jiao (Triple Burner) and Ming Men (Gate of Life). Pricking the blue veins on the arms, fingers, and popliteal fossae released a large amount of dark purple blood, but the illness did not resolve. Using Shi Wu Formula and Si Wu Formula, combined with external insufflation of Zhu Yi Formula, and subsequently taking Zhu Er Formula, the patient recovered after three doses.
Another patient suffered from extreme throat pain and abundant phlegm and saliva. Upon examination, I diagnosed it as Sha. The patient did not believe this and sought treatment from an ENT specialist, drinking hot water in the process, and died by evening. This condition would have been effectively treated with Zhu San Formula.
Extreme distension in the chest and heart area indicates internal attack by Sha toxin, causing the head to tilt backward and the body to arch like a bow (*Jue Gong Fan Zhang*). This signifies destruction of the Zang-Fu organs and is a fatal case. Urgently apply Mao Qing cloth soaked in white liquor to wipe the limbs where spasms and contractures occur, then spray the entire body. After a short while, when the body relaxes, administer medication; recovery might be possible. Use Shi Er Formula or Si Er Formula. Attached verse:
Limbs contracted, arching back like a bow,
Viscera attacked, toxin's force is strong.
Sprinkle wine all over, wipe with cloth,
Seek life in death with Shi-Si formula.
Cold qi stagnating and hiding between muscles erupts in spring; summer-heat stagnating in flesh and blood erupts in autumn. Both are named Wen Sha (epidemic Sha). Autumn Wen Sha is particularly contagious. Symptoms include alternating chills and fever resembling malaria, abdominal pain that may or may not be present, or rapid breathing and abdominal fullness, swelling of the head and face, or progression to dysentery with pus and blood. Mild cases linger, while severe cases are critical. Treatment should primarily focus on Fang Sha (pricking to bleed) and resolving food stagnation. Once the Sha toxin has been drained, then harmonize and clear the interior, eliminate chills and fever, strengthen the Spleen and nourish Blood, and tonify deficiency in the Middle Jiao (see Zhu Four).
One person, in September, experienced aversion to cold and fever, phlegmy cough, irritability, thirst, abnormal tongue coating, and no bleeding upon pricking. He lay heavy in bed. This was caused by mistakenly drinking hot liquids. Administer Yin Yang Water with one qian of Alum. Then use digestive and stasis-resolving medicine with two qian of cooked Rhubarb (*Shu Jun*), taken cold in small amounts for slight improvement. The next day, prick the Sha veins on arms and fingers to release blood, and take blood-invigorating and detoxifying medicine for gradual recovery.
His wife simultaneously experienced chills, fever, irritability, and swelling of the head and face, with a hidden pulse. Fang Sha did not cure her. She drank slightly cold Alum soup, followed by medication to open orifices, detoxify, and direct Qi downward with three qian of Achyranthes Root (*Niu Xi*), recovering after two doses.
Her son also had chills and fever resembling malaria, severe colic in the heart and abdomen, incessant vomiting and diarrhea, with deep and tight pulses throughout. He used Shi One Formula combined with Zhu Four Formula, adding one qian of Rhubarb (*Da Huang*), and took it again the next day, resulting in recovery.