痧症始发虽暴未必身重，若饮热毒阻，遍身重痛，不能转侧。放痧后，急宜消瘀解毒，
久则难治，放痧不效者死（匏三、四）。
一人腊月腹微痛，呕酸水，饮姜汤大痛，胀重不能转侧，右脉伏，放痧，用匏三方痧减
，又放痧服匏四方愈。
痧冲心胸，故心烦或嗜睡，此等俱慢痧，若误以心烦嗜睡治之，日甚一日。倘饮热物，
必渐凶险，遂成不起之疾。治法∶刺血为主，可不药而痊。
一羸瘦人惯发痧，一月数发，发则面青如靛，满身青筋胀起，如箸，痛自小腹攻上胸胁
，困倦难伏。向作虚损温补，惫益甚。针曲池、委中，黯血如注，少苏，用火酒进涤痧丸，
立效，后连进数服。竟绝根。
暑热疫毒，攻里则为痰喘为血瘀，昏沉不省。若元气实，内不受邪，即散于肌肉，为肿
为胀。误饮热汤，便成大害。此痧之暗者，宜从脉异处辨之。
一女，手足俱肿，将逮于腹，六脉弦细沉迟，此慢痧变症。缘不肯放血，数日肿胀益甚
，勉强放二十余处，紫黑血出，用石二方，并散痧解毒消瘀顺气药，以痧久绵延，服十余帖
肿胀始消。
一婢，久患疮，腹大如臌，手足俱肿，左脉微数，右歇止。夫疮毒入内肿胀，脉必洪
数有力，今脉症不合，此慢痧为患也，腿弯果有青筋，刺五针，未愈，又刺指头十余针，用
石二方并匏四方，五服，遂如旧。
痧症刚开始发作时，虽然病情急骤，但未必会出现身体沉重的症状；如果是因为饮用热毒之物导致阻滞，就会出现全身沉重疼痛，无法翻身转动。进行放痧治疗后，应当立即采用消除瘀血、解除毒素的方法，若拖延日久则难以治愈，若放痧无效者将会死亡（参考《匏尊医案》卷三、四）。
有一人在腊月里腹部轻微疼痛，呕吐酸水，喝了姜汤后疼痛加剧，感到胀满沉重且无法翻身转动，右手脉象伏匿不起。经过放痧治疗，使用了《匏尊医案》中的三方，痧症减轻；再次放痧并服用《匏尊医案》中的四方后痊愈。
痧毒冲犯心胸部位，所以出现心烦或嗜睡的症状，这些都属于慢发性痧症。如果错误地按照治疗心烦嗜睡的方法来处置，病情会一天比一天加重。倘若饮用了热性食物，必定逐渐变得凶险，最终成为不可救治的疾病。治疗方法：以刺络放血为主，可以不依靠药物而痊愈。
有一位消瘦的人经常发作痧症，一个月发作数次，发作时面色青黑如靛蓝，满身青色筋脉胀起，像筷子一样粗，疼痛从小腹攻冲至胸胁，困倦乏力难以支撑。以往当作虚损病使用温补药物治疗，疲惫感反而更加严重。针刺曲池穴、委中穴，流出暗黑色血液如注，患者稍得舒缓，随后用热酒送服涤痧丸，立刻见效，之后连续服用数剂，竟然彻底断绝了病根。
暑热疫毒，攻入体内则形成痰喘和血瘀，导致神志昏沉不省人事。如果元气充足，内部不受邪气侵袭，邪气就会散漫于肌肉之间，表现为肿胀。误饮热汤，就会造成大害。这是隐蔽型的痧症，应当从脉象的异常之处来辨别。
有一位女子，手足都肿胀，即将蔓延至腹部，六部脉象弦细沉迟，这是慢发性痧症的变证。因为不肯放血，几天后肿胀更加严重，勉强在二十多处穴位放血，流出紫黑色血液，使用石氏二方，配合散痧、解毒、消瘀、顺气的药物，由于痧症病程长久绵延，服用十余帖药后肿胀才消退。
有一位婢女，长期患有疮疡，腹部膨大如鼓胀病，手足都肿胀，左脉微数，右脉有歇止现象。如果是疮毒内陷导致的肿胀，脉象必定洪大、快速且有力，现在脉象与症状不符，这是慢发性痧症造成的危害。腿部腘窝处果然有青色筋脉，针刺五针，未痊愈，又针刺手指头十余针，使用石氏二方并配合《匏尊医案》中的四方，服用五剂后，便恢复了正常。
Although Sha disease (Sha syndrome) begins abruptly, it does not necessarily present with heaviness of the body. If caused by obstruction from ingested heat-toxin, the entire body becomes heavy and painful, making turning over impossible. After bloodletting (Fangsha), it is urgent to eliminate stasis and detoxify; if left untreated for a long time, it becomes difficult to cure, and if bloodletting is ineffective, death ensues (referencing *Pao San, Juan Si*).
One person suffered slight abdominal pain in the twelfth lunar month, vomiting sour fluid. After drinking ginger decoction, the pain intensified, accompanied by distension, heaviness, and inability to turn over. The right pulse was hidden (Fu). Following bloodletting, Formula Pao 3 was used, reducing the Sha symptoms. A second bloodletting followed by administration of Formula Pao 4 led to recovery.
When Sha toxin rushes to the heart and chest, it causes mental restlessness or lethargy. These are all cases of slow-onset Sha. If mistakenly treated as simple mental restlessness or lethargy, the condition worsens day by day. Ingestion of hot substances will inevitably lead to increasing danger, eventually becoming an incurable disease. The treatment method: primarily rely on pricking to bleed; recovery can occur without medication.
A emaciated individual habitually suffered from Sha attacks, occurring several times a month. Upon attack, the face turned dark blue like indigo, and the entire body's green veins swelled up like chopsticks. Pain attacked from the lower abdomen up to the chest and hypochondrium, causing extreme fatigue and inability to bear upright posture. Previously treated as deficiency consumption with warming and tonifying methods, the exhaustion became more severe. Needling Quchi (LI11) and Weizhong (BL40) released dark blood like a stream, providing slight relief. Then, Di Sha Wan (Detoxifying Sha Pill) was advanced with hot wine, yielding immediate effect. Subsequent continuous intake of several doses completely eradicated the root cause.
Summer-heat and epidemic toxins attacking the interior result in phlegm-wheezing and blood stasis, leading to stupor and unconsciousness. If the primordial Qi is substantial and internal organs resist evil, the pathogen scatters into the muscles, manifesting as swelling and distension. Mistakenly drinking hot soup causes great harm. This is concealed Sha, which should be distinguished by identifying anomalies in the pulse.
A young woman had swelling in both hands and feet, spreading towards the abdomen. All six pulses were wiry, thin, deep, and slow, indicating a complication of slow-onset Sha. Due to refusal to undergo bloodletting, the swelling worsened after several days. Reluctantly undergoing bloodletting at over twenty sites released purple-black blood. Shi Shi Er Fang (Shi's Second Formula) was used, combined with herbs to dissipate Sha, detoxify, resolve stasis, and regulate Qi. Because the Sha condition had lingered for a long time, it took over ten prescriptions before the swelling subsided.
A maid suffered from chronic sores for a long time, with an abdomen distended like drum-tympany and swollen hands and feet. The left pulse was slightly rapid, while the right pulse exhibited intermittent skipping. If swelling were caused by internal invasion of sore-toxin, the pulse would necessarily be surging, rapid, and forceful. Since the pulse and symptoms did not match, this was harm caused by slow-onset Sha. Indeed, there were green veins in the popliteal fossa. Five needles were inserted, but she did not recover. Another ten-plus needles were inserted into the fingertips. Shi Shi Er Fang (Shi's Second Formula) combined with Formula Pao 4 were administered. After five doses, she returned to normal.