痧有兼症、类症、变症，非望闻问切所能尽，惟看痧筋辨之。夫痧筋所见者，青紫之色
也。痧症所原者，血中之毒也。血中之毒既无可消则百病生，治之自宜刮放，刮放不尽，则
宜用药，先去其痧，后理其病；其或当兼治当预防者，务详审之。
凡伤寒头痛寒热诸症，或受暑、触秽、感疫，忽兼犯痧，惟认脉看筋，必先治痧，痧退
乃治伤寒。若误饮热汤姜引，慢者犹可，紧者立见凶危（匏五）。
一人伤寒十四日，忽昏沉身重，医治不醒。予曰∶痧气冲心故昏迷，痧入血分经络故不
能转侧，先放痧用匏五方，痧退，治伤寒而痊。
一女头痛发热，属太阳症，用羌活冲和汤稍愈，至四日药忽不应，更面赤身热烦闷，六
脉洪大无伦。此伤寒兼犯痧症。刺青筋一针，流流黑血，余细筋隐隐，服匏二方两帖，稍松
。次日痧筋大现，刺九针，服丝七方少安，后骤进饮食，复发热面赤，又刺两足青筋，用匏
二方两帖，稍愈。偶饮温茶，立刻狂言，令饮冷井水二碗，更服数帖，痧气乃清。但病久身
虚发晕，服参汤而苏。
伤寒集中有四症类伤寒，未若痧类伤寒之凶暴。夫伤寒头痛寒热，属足太阳膀胱经，是
寒从肌表而入，故宜发散为先。若痧症头痛，是毒瓦斯上攻，不因个感寒气，其寒热虽在肌表
，乃时气由呼吸而入，郁为热毒，搏击肌表，内热则外寒，故亦恶寒。宜先刺颠顶放痧泄毒
，用药透窍解毒顺气为主，若误用羌活、麻黄发表太甚，反助痧焰，势必攻冲肿胀，立时见
凶，要知痧症宜清凉，而痧毒可内解。伤寒宜辛散，则寒气可外舒，断不可以互混（匏六、
七）。
一人寒热昏沉，面色红黑，指头青黑，脉洪数，皆曰新昏，症必属阴。予曰∶非也。脉
洪数，痧毒搏击也；指青黑，毒血流注也；面红黑，痧毒升发头面三阳也。视痧筋放之，微
见紫黑血，用石二方、晚蚕砂汤服。渐醒，复刺血如注，但发热身重，肩背痛，用大剂匏六
方，渐能转运，犹身热大便不通，用卜、实、军、朴、麦芽、桃仁温服，便通热减，痊。
一妇，头痛寒热，烦闷喘渴，头汗如雨，面黑指青，气口脉虚歇止，左三部洪数无伦，
若非痧而有是脉，恐不能生。刺顶心一针，臂、腿数针，不愈。彼因饭后起病，用矾汤吐之
，烦闷喘汗俱除。余症未愈，用匏七方二帖，大便通而安，后十余日腹中大痛，口吐涎沫，
又因秽触而然，刮痧，用金四方而愈。
痧症有兼夹症状、类似症状和变证，仅靠望、闻、问、切四诊难以完全辨别，只有观察“痧筋”才能确诊。所谓痧筋，呈现的是青紫色的色泽。痧症的根源，在于血液中的毒素。既然血液中的毒素无法通过常规手段消除，便会引发各种疾病，治疗时自然适宜采用刮痧或刺络放血的方法；若刮痧放血未能彻底清除，则适宜用药，先去除痧毒，再调理其他病症；如果是应当兼治或需要预防的情况，务必详细审察。
凡是伤寒引起的头痛、恶寒发热等症状，或是感受暑气、触犯秽浊之气、感染疫疠之气，忽然又兼犯痧症，必须通过诊脉和观察筋络来确认，必须先治疗痧症，待痧退去后再治疗伤寒。如果误饮热汤或姜汁引药，病情缓慢者尚可挽救，病情急骤者立刻会出现凶险危重的情况（参考匏五方）。
有一人患伤寒十四天，忽然神志昏沉、身体沉重，医生医治不醒。我说：这是痧气冲心导致昏迷，痧毒进入血分和经络导致不能转动身体，先用刮痧放血法治疗，使用匏五方，待痧退后，再治疗伤寒而痊愈。
有一名女子头痛发热，属于太阳病（足太阳膀胱经受邪所致的病证），服用羌活冲和汤后稍有好转，到了第四天药效突然不再起作用，反而出现面色红赤、身体发热、烦躁闷乱，六脉洪大无比。这是伤寒兼犯痧症。针刺青筋一针，流出黑血，其余细微的痧筋隐约可见，服用匏二方两剂，症状稍缓解。第二天痧筋明显显现，针刺九针，服用丝七方后稍安。后来突然大量进食，再次发热面赤，又针刺双足的青筋，用匏二方两剂，稍见好转。偶然喝了温茶，立刻胡言乱语，让人饮用两碗冷井水，再服用数剂，痧气才清解。但因为病久身体虚弱而发晕，服用人参汤后苏醒。
《伤寒论》集中有四类症状类似伤寒，但不如痧症类似伤寒那样凶险暴烈。伤寒的头痛恶寒发热，属于足太阳膀胱经，是寒气从肌表侵入，所以适宜以发散为先。如果是痧症头痛，是毒瓦斯向上攻冲，并非因为感受寒气，其恶寒发热虽然表现在肌表，但其实是时行疫病之气由呼吸侵入，郁结化为热毒，搏击肌表，内热导致外寒，所以也怕冷。适宜先针刺头顶放痧泄毒，用药以透窍解毒、顺气为主，如果误用羌活、麻黄等发表药物过于猛烈，反而会助长痧毒火势，势必导致攻冲肿胀，立刻出现凶险，要知道痧症适宜清凉，而痧毒可以从内部解除。伤寒适宜辛散，寒气才可以向外舒展，绝不可以互相混淆（参考匏六、七方）。
有一人寒热交作、神志昏沉，面色红黑，手指头青黑，脉象洪数，大家都说是新近发生的昏厥，病症一定属阴证。我说：不对。脉象洪数，是痧毒搏击的表现；手指青黑，是毒血流注的表现；面色红黑，是痧毒升发到头面部三阳经的表现。观察痧筋进行放血，微微见到紫黑血，使用石二方、晚蚕砂汤服用。逐渐清醒，再次刺血如注，只是仍然发热身体沉重、肩背疼痛，使用大剂量匏六方，逐渐能够活动转运，仍然身热大便不通，使用卜（厚朴）、实（枳实）、军（大黄）、朴（厚朴）、麦芽、桃仁温服，大便通畅热势减退，痊愈。
有一位妇人，头痛恶寒发热，烦躁闷乱、气喘口渴，头部出汗如雨，面色黑手指青，气口脉虚且有间歇，左三部脉洪大无比，如果不是痧症而有这种脉象，恐怕难以生存。针刺顶心一针，手臂、腿部数针，未愈。因为她是在饭后发病，用矾汤催吐，烦闷气喘出汗都消除了。其余症状未愈，用匏七方两剂，大便通畅而安定，后来十多天腹部剧烈疼痛，口吐涎沫，又是因触犯秽浊之气所致，刮痧，用金四方而痊愈。
Sha disease has concurrent symptoms, similar symptoms, and transformed syndromes, which cannot be fully distinguished by the four diagnostic methods of inspection (Wang), auscultation and olfaction (Wen), inquiry (Wen), and palpation (Qie). Only by observing the "Sha veins" can it be identified. The Sha veins manifest as bluish-purple discoloration. The origin of Sha disease lies in the toxins within the blood. Since these blood toxins cannot be eliminated through conventional means, various diseases arise; therefore, treatment should naturally involve scraping (Guasha) or pricking to release blood. If scraping and bloodletting fail to completely remove the Sha, medication is appropriate: first eliminate the Sha toxin, then treat the underlying condition. In cases requiring concurrent treatment or prevention, careful examination is essential.
In cases where Shanghan (Cold Damage) presents with headache, aversion to cold, and fever, or when affected by summerheat, foul turbidity, or epidemic pestilence, if suddenly complicated by Sha disease, one must rely on pulse diagnosis and vein observation. Treatment must prioritize Sha disease first; only after the Sha recedes should Shanghan be treated. If hot soups or ginger juice are mistakenly ingested, the outcome may be manageable if the progression is slow, but if rapid, critical danger will appear immediately (see Formula Pao Wu).
A patient suffered from Shanghan for fourteen days and suddenly became comatose with heavy limbs, unresponsive to medical treatment. I stated: This coma is caused by Sha Qi rushing to the heart, and the inability to move results from Sha toxin entering the blood level and meridians. First, apply scraping and bloodletting using Formula Pao Wu. After the Sha receded, treat the Shanghan, resulting in recovery.
A female patient presented with headache and fever, classified as Taiyang disease (disease syndrome of the Foot-Taiyang Bladder channel). She took Qianghuo Chonghe Tang and improved slightly. By the fourth day, the medication ceased to work, and she developed a red face, body heat, restlessness, and oppression, with all six pulses being excessively flooding (Hongda). This was Shanghan complicated by Sha disease. Pricking the blue veins released black blood; other fine veins were faintly visible. After taking two doses of Formula Pao Er, symptoms eased slightly. The next day, the Sha veins appeared prominently; nine needles were applied, and after taking Formula Si Qi, she felt somewhat relieved. Later, sudden overeating caused recurrent fever and facial redness. Pricking the blue veins on both feet and administering two doses of Formula Pao Er led to slight improvement. Accidentally drinking warm tea induced immediate delirium. Drinking two bowls of cold well water, followed by several more doses, cleared the Sha Qi. However, due to prolonged illness and physical deficiency causing dizziness, she recovered after taking Ginseng Decoction.
Among the four types of symptoms resembling Shanghan in Shanghan texts, none are as fierce and violent as Sha disease resembling Shanghan. Shanghan headache, aversion to cold, and fever belong to the Foot-Taiyang Bladder channel, where cold pathogen enters from the muscle surface, so dispersing is the priority. In contrast, Sha headache is caused by toxic vapors attacking upward, not by external cold invasion. Although aversion to cold and fever manifest on the muscle surface, they result from seasonal epidemic qi entering via respiration, stagnating into heat-toxin, and battling the muscle surface. Internal heat causes external cold, hence the aversion to cold. Treatment should prioritize pricking the vertex to release Sha and drain toxin, using medications that open orifices, resolve toxins, and regulate Qi. Mistakenly using strong diaphoretic herbs like Qianghuo or Mahuang (Ephedrae Herba) will exacerbate the Sha fire, leading to swelling and immediate critical danger. It must be understood that Sha disease requires cooling, and Sha toxins can be resolved internally. Shanghan requires acrid dispersion to release cold externally; the two must not be confused (see Formulas Pao Liu, Pao Qi).
A patient presented with alternating chills and fever, coma, reddish-black complexion, and cyanotic fingertips, with a flooding and rapid pulse. Others diagnosed this as recent syncope, attributing it to a Yin syndrome. I disagreed: A flooding and rapid pulse indicates Sha toxin battle; cyanotic fingertips indicate toxic blood stasis; reddish-black complexion indicates Sha toxin rising to the three Yang channels of the head and face. Observing the Sha veins and performing bloodletting revealed slight purple-black blood. Using Formula Shi Er and Can Sha Tang (Mulberry Silkworm Frass Decoction), the patient gradually regained consciousness. Subsequent bloodletting flowed profusely. With persistent fever, heaviness, and shoulder/back pain, a large dose of Formula Pao Liu was used, allowing gradual mobility. For persistent fever and constipation, Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus), Dahuang (Rhei Radix et Rhizoma), Maiya (Hordei Fructus Germinatus), and Taoren (Persicae Semen) were taken warm. Bowel movement restored, heat subsided, and recovery ensued.
A female patient presented with headache, aversion to cold, fever, restlessness, oppression, panting, thirst, profuse sweating on the head, black complexion, and cyanotic fingertips. The Qi Kou pulse was deficient with intermittent stops, while the left three positions were excessively flooding and rapid. Without Sha disease, such a pulse would likely be fatal. Pricking the vertex once and several points on the arms and legs failed to cure. As her illness began after a meal, Fan Tang (Alum Decoction) was used to induce vomiting, resolving restlessness, panting, and sweating. For remaining symptoms, two doses of Formula Pao Qi were administered, leading to relief after bowel movement. More than ten days later, severe abdominal pain and salivation occurred, triggered again by foul turbidity. Scraping and using Formula Jin Si cured her.