伤寒食未化，下之太早，反引寒邪入胃，变为热邪固结，所食乃成结胸。若痧症新食，
以吐为先，至所食既久，骤然痧胀，虽食消未尽，下之无碍。尽因痧本火毒在肠胃，肠胃部
分肌肉作肿作胀，盘肠绞痛，遍及脏腑。故外宜刮放，以泄其毒于表，内可即下，以攻毒于
里，则肿胀自当潜消，食积因之通利，非有寒邪入胃变成结胸之可忧也！但下之必先消散食
积，又宜以渐而进中病即止。
霍乱症，恶心腹痛，上吐下泻，泻如水注。此感受暑火暴发，升降不利，清浊不分，所
泻皆五脏津液。宜急用五苓散或胃苓汤，以分利阴阳，清暑火之气。有夹食积者，亦不可过
下，恐津液暴涸，元气损伤也。更有吐泻无物，亦有上下关闭竟不吐泻者，为干霍乱，惟心
腹绞痛，令人立毙。急以炒盐汤深吐，通则可救，即定后，周时勿进粒米，得食复发，慎之
！即如呕尽泻空倦极，当用六和汤调理（方补群方末）。
急症昏迷，先观唇舌，色黑者凶，黄者重，淡红者略轻。盖黄知内热，黑知热极，淡红
虽热，用药不可太冷，又要看舌苔施治。
痧症危急，放血不流，若审无食积，血痰阻滞于中，用阴阳水或泥浆水、晚蚕砂水、细
辛水、白砂糖梅水，择一饮之。稍醒扶起，再治。若有食积血痰，破瘀用桃仁、红花、童便
之类，去新食用盐汤、矾汤吐之。食久痧胀，用楂、卜、麦芽消之。有积阻用槟榔、大黄驱
之，金七方治之。或痰血凝结，昏迷不醒，用菜油、麝香调下，立苏；阻滞去，痧气行，筋
自现，而后可刮可放，当药即药。盖缘痧症初发，未攻坏脏腑故耳。
凡痧药得宜，倘有不效者，盖汤剂多带冷，冷则直入肠胃未能达于肌肤血肉，故治先刮
放也。刮放而药仍不效，必刮放未尽也。刮已到，放已尽，而痧犹在，则毒惟在阳明胃及脾
、肝、肾三阴经络，非药何以治之。
昏迷不醒，难施刮放，当用药救。夫汤药带冷，虽不能即周血肉，然当热毒攻心，正遇
带冷之物，顺流而下，昏迷自醒。有不醒，乃食积血痰所阻，攻而下之，无不醒者。
痧发无寒症，然亦有时为寒，非真寒也。盖因痧热而服大寒之剂以至此。夫痧必无食积
血阻于中，方可服寒饮得效。若一有之，而饮大寒，则食不消、积不行、血不散，而毒反冰
伏矣。尝见岩谷中行旅感冒，渴饮涧泉而即毙者，是名寒痧，盖饮寒毒结，多致不救也。若
幸遇放痧之人，毒血一行，便无阻滞。故方书有服阴阳水者，不独取井水，即此故耳。是以
久服凉饮痧有未痊者，略用三香温和之剂，实为权宜之术。若骤用桂、附、干姜、吴萸、参
、之属，则又误矣。
痧皆属火，火有君、相之别。手少阴君火也，右肾命门为手心主，乃手厥阴胞络之脏。
《经》言心之原出于大陵。凡刺大陵穴者，以泻手心主相火之原耳。又有手少阳三焦，合为
表里，神脉同出现于右尺，二经代君行令。故相火之为病居多，火性炎烈，以致三焦阻塞，
六脉全乖，昏冒痰喘。然相火作病，犹有可回，若犯心君，殒在须臾，莫谓术疏耳！
痧犯咽喉，则痰喘如锯，先放痧，急用薄荷、牛蒡、山豆根、童便之类清之，兼吹竹一
方，余症且缓治。
痧症危急，大便不通，急宜放痧，用润下丸以攻之。小便不通宜放痧，用土四方以分利
之。
痧有心胸高起如馒饺者不治（曾用竹六方愈一妇），心胸左右或背心一点痛者凶，角弓
反
黎
俱
伤寒病中，如果食物尚未消化就过早使用泻下法，反而会将寒邪引入胃中，转化为热邪并固结，导致所食之物形成结胸证。如果是痧症伴有新近摄入的食物，应当以催吐为首选；若饮食停滞时间较长，突然发生痧胀，即使食物尚未完全消化，使用泻下法也无妨碍。这主要是因为痧症本质上是火毒蕴结在肠胃，导致肠胃部位的肌肉肿胀、腹痛如绞，波及脏腑。因此，外部适宜采用刮痧或放血疗法，将毒素从体表宣泄出来；内部可以同时使用泻下法，以攻逐体内的毒素，这样肿胀自然会逐渐消退，食积也能随之通畅，就不必担忧像寒邪入胃变成结胸那样的情况了！但是，使用泻下法之前必须先消散食积，并且应当循序渐进，一旦病情好转就要立即停止。
霍乱症表现为恶心、腹痛、上吐下泻，腹泻如水注般急迫。这是由于感受暑火之邪暴发，导致气机升降失常，清浊之气不分，所泻出的都是五脏的津液。此时应紧急使用五苓散或胃苓汤，以分利阴阳，清除暑火之气。如果有夹杂食积的情况，也不可以过度泻下，恐怕会导致津液骤然枯竭，元气受损。更有甚者出现吐泻无物，或者上下窍闭塞完全不吐不泻的情况，这称为干霍乱，仅见心腹绞痛，令人迅速死亡。此时应紧急用炒盐汤进行深度催吐，若能通畅则有望挽救，症状缓解后，一小时内不要进食任何米粒，否则容易复发，务必谨慎！即使是呕吐干净、泻尽空虚且极度疲倦的情况，也应当使用六和汤进行调理（方剂见全书方剂部分末尾）。
急症昏迷时，先观察嘴唇和舌头的颜色，色黑者预后凶险，色黄者病情严重，色淡红者病情较轻。因为黄色提示内有热邪，黑色提示热极，淡红色虽然也有热，但用药不可过于寒凉，同时还要根据舌苔的情况进行治疗。
痧症危急时，如果放血不出，若确认没有食积，而是血痰阻滞在中焦，可以使用阴阳水、泥浆水、晚蚕砂水、细辛水或白砂糖梅水，选择一种饮用。待患者稍清醒后扶起，再进行后续治疗。如果有食积和血痰，需用桃仁、红花等破瘀药物，以及童便之类，并用盐汤或矾汤催吐以去除新近摄入的食物。对于饮食停滞较久的痧胀，使用山楂、萝卜、麦芽来消食化积。有积滞阻塞的，用槟榔、大黄驱除，配合金七方治疗。如果是痰血凝结导致昏迷不醒，可用菜油调和麝香灌服，可立即苏醒；待阻滞去除，痧气运行，筋脉舒展后，才可以进行刮痧或放血，该用药时就用药。这是因为痧症初发，尚未攻坏脏腑的缘故。
凡是痧药使用得当，如果仍无效，是因为汤剂多带有寒凉性质，寒凉则直入肠胃，未能到达肌肤血肉，所以治疗应先进行刮痧和放血。如果刮痧和放血后药物仍然无效，一定是刮痧和放血做得不彻底。如果刮已到位，放已尽，但痧症仍在，那么毒素只存在于阳明胃经及脾、肝、肾三阴经络中，非药物不能治愈。
昏迷不醒时，难以施行刮痧和放血，应当用药抢救。汤药虽带寒凉，虽不能即刻周流于血肉，但当热毒攻心时，遇到带寒凉的药物流顺而下，昏迷自会苏醒。如果不醒，乃是食积血痰所阻滞，攻逐下去，无不苏醒的道理。
痧症通常没有寒症表现，但有时也会表现为寒象，但这并非真正的寒证。这是因为痧热而服用大寒之剂导致的。只有当痧症没有食积和血阻于中时，服用寒凉饮品才能见效。如果一旦有食积或血阻，再饮用大寒之物，则食物不消化、积滞不行、血液不散，反而使毒素冰伏在内。曾见在山谷中行旅之人感冒后，口渴饮用山涧泉水而立即死亡的案例，这名为寒痧，因为是饮入寒毒导致凝结，大多无法救治。如果幸运遇到会放痧的人，毒血一出，便没有阻滞。所以医书中有服用阴阳水的记载，不仅取井水之意，也是因为这个原因。因此，久服凉饮而痧症未愈者，略用三香温和之剂，实为权宜之计。如果骤然使用桂枝、附子、干姜、吴茱萸、人参之类的药物，那就错了。
痧症皆属于火，火有君火和相火的区别。手少阴心经为君火，右肾命门为手心主，即手厥阴心包络之脏。《内经》说心的原穴出于大陵。凡针刺大陵穴，是为了泻手心主相火的源头。又有手少阳三焦经，与心包络互为表里，神门脉同时出现在右尺部，这两条经脉代替君火行使职能。所以相火致病居多，火性炎烈，导致三焦阻塞，六脉全乱，昏冒痰喘。然而相火作病，还有挽回的余地，如果侵犯心君，顷刻间就会死亡，不要说医术疏忽啊！
痧症侵犯咽喉，则痰喘声如拉锯，应先放痧，紧急使用薄荷、牛蒡子、山豆根、童便等药物清热，兼用竹一吹喉方，其余症状暂缓治疗。
In the course of a cold damage (Shanghan) disease, if purgation is used too early before food has been digested, it may instead draw cold pathogens into the stomach, transforming them into heat pathogens that become firmly consolidated, causing the undigested food to form a Jie Xiong (Chest Binding syndrome). If Sha syndrome (Sha Zheng) occurs with newly ingested food, emesis should be prioritized; however, if food has been retained for a long time and sudden Sha distension occurs, even if digestion is incomplete, purgation is permissible. This is because Sha syndrome essentially involves fire-toxin accumulating in the intestines and stomach, causing swelling and distension of the muscles in these areas, along with intestinal colic affecting the zang-fu organs. Therefore, external treatments such as Gua Sha (scraping) or bloodletting are suitable to vent the toxin from the exterior, while internal purgation can be used simultaneously to attack the toxin within the interior. Consequently, the swelling will naturally subside, and food stagnation will be cleared, eliminating the worry associated with cold pathogens entering the stomach to form Jie Xiong. However, before using purgation, food stagnation must first be dissipated, and treatment should proceed gradually, stopping immediately once the disease is addressed.
Huo Luan (Cholera-like syndrome) presents with nausea, abdominal pain, vomiting, and diarrhea, with stools flowing like water. This results from an acute onset of summer-heat and fire pathogens, leading to dysfunction of ascending and descending qi mechanisms, failure to separate clear and turbid substances, and the loss of fluid essence from the five zang organs. Urgent use of Wu Ling San (Five-Ingredient Powder with Poria) or Wei Ling Tang (Stomach Strength Decoction) is indicated to differentiate and benefit yin and yang, clearing the qi of summer-heat and fire. In cases complicated by food stagnation, excessive purgation should be avoided to prevent sudden depletion of fluids and damage to primordial qi. Furthermore, there are cases of dry Huo Luan where there is nothing to vomit or pass, characterized by complete closure of the upper and lower orifices, accompanied only by severe heart and abdominal colic leading to rapid death. Emergency deep emesis with fried salt water is required; patency can save the patient. After stabilization, no solid food should be taken for one hour, as refeeding may cause recurrence; caution is essential! Even in cases of empty vomiting and purging with extreme fatigue, Liu He Tang (Six-Harmony Decoction) should be used for regulation (see formula list at the end of the book).
In emergency coma, first observe the lips and tongue: black color indicates a poor prognosis, yellow indicates severe condition, and pale red indicates a milder condition. Yellow suggests internal heat, black indicates extreme heat, and although pale red also implies heat, medications should not be overly cold. Treatment must also be guided by the tongue coating.
In critical Sha syndrome, if bloodletting yields no flow and food stagnation is ruled out, leaving blood-phlegm obstruction in the middle jiao, one may drink Yin-Yang Water, mud water, water infused with late silkworm sand, Asari root water, or plum water with white rock sugar, choosing one. Once the patient regains slight consciousness, support them upright and continue treatment. If there is food stagnation and blood-phlegm, use blood-breaking agents like Peach Kernel (Tao Ren) and Safflower (Hong Hua), along with child's urine, and induce emesis with salt water or alum water to remove new food. For Sha distension due to long-standing food retention, use Hawthorn Fruit (Zha), Radish Seed (Bo), and Malt (Mai Ya) to digest accumulation. For blockage by stagnation, use Betel Nut (Bing Lang) and Rhubarb (Da Huang) to drive it out, treated with Jin Qi Fang. If phlegm and blood coagulation cause coma, administer vegetable oil mixed with Musk (She Xiang) orally for immediate recovery; once obstruction is removed and Sha qi circulates, meridians relax, allowing for Gua Sha or bloodletting, followed by appropriate medication. This is because Sha syndrome is in its initial stage and has not yet damaged the zang-fu organs.
If Sha medicines are appropriate but ineffective, it is often because decoctions are cold-natured; coldness causes direct entry into the intestines and stomach without reaching the skin, muscles, and blood vessels. Thus, treatment should begin with Gua Sha and bloodletting. If these measures fail to make the medicine effective, it means they were not performed thoroughly. If scraping and bleeding are complete but Sha persists, the toxin resides only in the Stomach Meridian of Yangming and the three yin meridians of the Spleen, Liver, and Kidney, which require medicinal intervention.
When coma prevents Gua Sha or bloodletting, medication is necessary. Although cold decoctions do not immediately circulate through the flesh and blood, when heat-toxin attacks the Heart, the cold nature allows the medicine to flow down smoothly, waking the patient from coma. If unresponsive, it is due to obstruction by food stagnation and blood-phlegm; purging will invariably restore consciousness.
Sha syndrome typically lacks cold symptoms, but sometimes presents with cold signs, which are not true cold but result from taking large doses of cold herbs for Sha heat. Cold drinks are effective only if there is no food stagnation or blood obstruction in the middle. If such obstructions exist, consuming large amounts of cold substances will prevent digestion, stagnation movement, and blood dispersion, causing the toxin to freeze internally. Cases have been seen where travelers in rocky valleys died immediately after drinking spring water due to thirst following exposure, known as Cold Sha, caused by freezing toxins from cold intake, often fatal. If lucky enough to encounter someone skilled in bloodletting for Sha, releasing toxic blood removes obstruction. Hence, medical texts mention Yin-Yang Water, not just for well water, but for this reason. Therefore, for those whose Sha does not resolve with prolonged cool drinks, slightly using warm formulas like San Xiang (Three Fragrances) is a temporary expedient. Suddenly using Cinnamon Twig (Gui Zhi), Aconite Root (Fu Zi), Dried Ginger (Gan Jiang), Evodia Fruit (Wu Zhu Yu), or Ginseng would be erroneous.
Sha belongs to Fire, which is divided into Ministerial Fire (Xiang Huo) and Sovereign Fire (Jun Huo). The Hand-Shaoyin Heart Meridian represents Sovereign Fire, while the Right Kidney Mingmen corresponds to the Hand-Jueyin Pericardium. The Classics state that the Yuan-source point of the Heart is Dalíng (PC3). Needling Dalíng drains the source of the Hand-Jueyin Pericardium's Ministerial Fire. The Hand-Shaoyang Sanjiao Meridian forms an interior-exterior relationship with the Pericardium, and their pulses appear together at the right Chi position, acting on behalf of the Sovereign. Thus, diseases of Ministerial Fire are common; its flaming nature causes Sanjiao obstruction, chaotic six pulses, coma, and phlegm-wheezing. While Ministerial Fire pathology is recoverable, invasion of the Heart Sovereign leads to death in an instant; do not attribute this to medical negligence!
When Sha invades the throat, phlegm-wheezing sounds like sawing. First perform bloodletting for Sha, urgently use Mint (Bo He), Burdock Seed (Niu Bang Zi), and Sophora Root (Shan Dou Gen) with child's urine to clear heat, and apply the Bamboo One powder to the throat; treat other symptoms subsequently.
In critical Sha syndrome with constipation, urgent bloodletting for Sha combined with Run Xia Wan (Moistening Down Pill) is needed to purge. For urinary retention, bloodletting for Sha combined with Tu Si Fang (Earth Four Formula) is indicated to promote urination.
Sha syndrome presenting with chest elevation like a steamed bun is incurable (though one woman was cured using Zhu Liu Fang). Pain at a single point on the left or right of the chest or back indicates a poor prognosis. Opisthotonos...