（痧 附合参金鉴治法汇叶案第一书）
者。有触目之形。而无碍手之质。即稠如锦纹。稀如蚊迹之象也。或布于胸腹。或
见于四肢。总以鲜红起发者为吉。紫色成片者为重。色黑色青者。不治。
邵评∶ 之形状。平而贴于肌肉之间。并无点粒高起。以手摸之。平而不碍手。或
红色成片。稠如锦纹者。此属阳邪胃热。有稀如蚊迹。而色淡不解者。此是正虚邪伏。此症有阴阳寒
热虚实之不同。当看其外症。参其脉象。而施温凉补泻之治法。
疹者。有颗粒之象。肿而易痒。即痧瘾之属。须知出要周匀。没宜徐缓。春夏多此。 疹二者。不外
手太阴与足阳明之治。又 为胃家毒火。疹属脾家湿热。须互参之。
邵评∶发疹于皮肤之上。起有颗粒。如粟如粒。以手摸之。有尖刺而触手者也。与
之平而在肌肉者不同。 由阳明胃热而发。疹因肺受风温而出。 有虚寒阴症。可用温补。疹无不由
邪火而作。阴寒之症罕有。故治疹之法。不外辛凉清透。宣肺化邪。温补之药。每禁用也。盖因疹子
即痧 一类。即天行时毒。入于肺中而发。邪盛者。点子稠密。肌肤微肿而稍痒。有红白二种。邪入营
者红疹。邪入卫者白点。大忌冒风凉遏。犯则肺闭内陷。发喘而死矣。
疹之发。伤寒由于失表失清。其邪不得外达。蕴于胃腑。走入营中而发也。温热
之症。外邪与内热相搏。湿热凝滞。自然发 发疹。有发热一二日便见者。有发热
三四日始见者。非因失治而然。
邵评∶ 与疹必当分别。 发于胃。疹出于肺。伤寒失表失清。邪遏于胃而热蒸
成。故伤寒症发 者多。而发疹则仅见也。其虚 阴 。由于中虚寒伏。逼其
浮阳外越。无根之火内动。见 隐隐而微。色白不鲜者是也。治须温补。至于疹。悉是外邪致病。天行痧疹。
时毒。袭入肺卫而发者。或温暑时邪。从肺吸受。由卫入营之症。其邪从肺外达而发疹者。此邪在上焦。
非由失表失清之故。当辨其在气在营。而用宣肺清透之法。若遇寒凉。防其抑闭。与 之治法。判然不同。二
症岂可不分辨哉。故约言之。 属胃。疹属肺。二症须分别论治。
大抵发汗不出。或虽汗不解。胸膈烦闷。呕恶不纳。足冷耳聋。脉沉而伏。或寸关脉
躁动。便是 疹欲出之候。须细诊之。
邵评∶邪热郁伏于中。蒸热为 。故汗不出。而烦闷呕恶。足冷耳聋。此是 疹将
发之见象。犹天将雨而闷热郁蒸也。脉沉伏。由于邪伏于内。脉道不利所致。寸关躁动者。伏邪勃发之兆也。
凡 疹欲出之际。若得上吐下泻者吉。毒瓦斯上下俱出故也。
邵评∶ 疹将出之际。上吐下泻。其热毒从吐泻而外出。分消其势。大忌止涩。若
出齐后。及将回之时。忌见吐泻。恐其邪陷也。故 疹吐泻。须辨其先后缓急之势。庶免误治之弊。
凡 红赤者。为胃热。紫色为热甚。紫黑为胃烂。赤 五死五生。黑 九死一生。鲜
红起发稀朗者。虽大不妨。如针头稠密。紫黑成片者。难治。杂蓝 黑烂者死也。
邵评∶此辨 色。以验病之吉凶生死。学人最宜着眼。
凡 既出。须得脉洪滑有力。手足温者。易治。脉微足冷。元气虚弱。难治。 疹透后。
神识宜清。反加昏沉者。难治。
邵评∶ 出之后。辨其脉象。及症之顺逆。语皆精实。
凡温热 疹。已见阳明少阳新法中。伤寒失表发 。已见太阴新法中。此更详天时寒暄燥湿。邪
在足经手经。气分营分。外感内伤为治。当以温热疫疠兼参之。
邵评∶伤寒自表入里。从足经施治。邪入阳明。热甚发 。由先时失表失清所致。
所谓 发于胃。非比疹之从肺而出。故伤寒症阳明极热。每多发 。而发疹者
稀有也。若温邪暑热自肺吸入。宗三焦立法。从手经论治。其邪之入里。或自肺
卫而入营。则发疹而外达。即天行痧疹时毒之邪。亦从肺经吸入而发疹也。所
谓疹出于肺。或由肺卫而入阳明胃者。胃火盛亦有发 也。其治与伤寒发
同。至治疹当宣肺清营。提透疹邪为主。至于 与疹之所发。其源各异。而治法亦须分别。详列于后。
胃热 发 舌苔黄燥者。胃中热极也。从阳明治。犀角、连翘、黄芩、黄连、银花、牛蒡、
葛根、薄荷之类。不可过用风药。
邵评∶此阳明胃热发 之正法。
营热 赤 舌苔鲜红者。营分血热也。神昏谵语。邪干膻中。病在手经。不可妄用
风药。以劫胃津。亦不可纯用苦寒。直入中焦。法当清疏营分。轻透。 毒。如犀角尖、
连翘心、元参、丹皮、牛蒡、银花、薄荷、人中黄之类。神昏加菖蒲数分。西黄二三分。以开心窍。
邵评∶膻中。心包络也。邪在手经。自肺卫而入心营。逆传包络。危险之症。急当清心达邪。芳香开秘。
忌用风药升散。劫耗阴津。且邪在上焦。并宜轻清。若用苦寒
重浊之剂。直走肠胃。与包络结邪无干涉矣。此方是营热发 。邪入心包之正
法。
如 已透。当清火解毒以化之。如连翘、赤芍、元参、丹皮、花粉、知母、黄芩、净银花、人
中黄之类。脉洪大。加石膏。舌绛色。加鲜生地。
邵评∶ 透之后。余热未净。治宜清化余邪。此方是 透后。余邪未净之良法。
表寒 春应温而反寒。夏应热而反凉。有病恶寒发热咽痛。身上有淡红白 。舌
苔白而薄嫩者。此寒邪在表也。当以荆防败毒散温散之。
邵评∶此表寒抑遏而发 之良法。
温毒 秋应凉而反热。冬应寒而反温。或天时亢旱久燥。温疫流行。发为赤 丹
疹。其毒弥满三焦。目赤舌绛。汗出津津。切忌风药升散。宜凉膈散。去芒硝、大黄。加
石膏、牛蒡、赤芍、人中黄。大便秘者。去硝留黄。
邵评∶应寒凉而反温热。又或天时燥旱。阳热亢极。非其时而有其气。是不正之邪气而成
瘟疫也。疫邪火毒。酿成 疹。热毒蕴伏阳明。三焦俱病。是名温毒发 。症多肺胃火盛。此方极合。
阳毒 温疫阳毒发 。面如涂朱。眼如喷火。六脉洪大。燥渴欲死。此阳明血热已
极。毒邪传遍三焦。经络闭塞。荣卫不通。非三黄石膏汤不能解救。
邵评∶三焦表里。俱被阳邪热毒蒸灼。气血经络凝塞不通。邪郁不宣之候。必须两解其表里之热
邪。则 疹方能外达。此方治邪遍表里三焦。阳毒发 。的是良剂。
伏 凡伤寒邪入太阴。脉静神呆。舌心灰黑。防有伏 。或时感之症。过经不解。
舌苔灰黑。或中心黑晕。肌表不甚发热。脉象亦似沉缓。但神识不清。或郑声作笑。
此阳邪陷入太阴。防有伏 内发。其脉静身凉。非邪退正复也。乃阳邪陷于阴分也。法宜宣通气血。透提
毒。以实症治之。如连翘、赤芍、银花、紫草、生楂肉、槟榔、天虫、刺蒺藜、犀角尖、角刺之类。
透之提之。 疹外达。自然毒透神清。（参第一书）
邵评∶阳经之邪入于太阴。太阴为湿土之脏。脾与胃相联。阳邪故易传入于阴。
入于阴则脉反静。邪气内伏。故神呆。舌灰黑。太阴舌苔也。如此形症。防有伏 。
不但伤寒邪入太阴。实时感迁延。亦有陷入太阴之症。舌灰黑者。太阴湿与热
相蒸也。邪热陷入。抑遏不宣。故肌表不甚热。而脉见沉缓也。 毒内伏。则神不
清。而糊言妄笑矣。此阳邪实热陷入太阴。 毒内伏之候。不可误认为邪退正
虚。而进滋补。仍宜宣通伏邪。提透 毒。必使 从外达。陷入之邪自化耳。此方
治阳邪陷入太阴。 毒内伏之良法。
内伤 凡劳倦内伤。虚火游行于外。亦有淡红 点。其身痛心烦。恶寒发热。与外
感同。第脉虚大。或气口独大。倦怠懒于言动。自汗为异。投补中益气。熟睡汗止身凉而愈。
邵评∶此劳倦中虚。稍挟微邪。虚火外浮而发 。用补正略佐化邪一法。为治劳
倦伤脾。中虚发 。名曰虚 之良剂。
伏阴 阴 者。因内有伏寒。或误进寒凉。逼其虚阳浮散于外。其 点隐隐而微。
脉虽洪大。按之无力。或六脉沉微。手足逆冷。舌苔白滑。或黑苔胖滑。此阴 无疑
也。先用炮姜理中汤。以复其阳。次随症治。若内伤生冷。外感寒邪。而发阴 。调中汤最捷。
邵评∶禀体阳虚。其人内有伏寒。又有误用凉药寒物。阴寒极盛。阳火衰微。逼其无根之火外
浮而发 。阴伏不达。名曰阴 。大虚大寒之症。虚阳浮越。其脉浮取洪大。重按无力。阳微欲脱
之脉也。若脉沉微。阳微之正脉。均宜用温中扶阳之法。此方治阴寒内盛。阳火衰微而发阴 之正法。
少阴 凡肾虚挟感。 疹无力透达。肌肤中微现淡红隐隐之点。脉象沉细无力。
舌苔淡红或紫色。舌形胖嫩圆大。似寐非寐。神识乍清乍昧。此少阴精不化气。
不得透也。当以左归饮加人参进之。精气充溢。 自外达矣。若兼右尺迟微。手足
逆冷。渴不欲饮。此少阴水火俱亏也。当以人参八味投之。肾气一充。其 自透。
邵评∶肾水亏。以六味地黄壮水。肾火衰。用附桂以补火。人参以扶元气。乃阴阳两虚之正法。
内 凡温疫时感。每有内 。其 发于肠胃嗌膈之间。肌肤间不得而见。其脉
短滑。似躁非躁。外证口干目赤。手足指冷。烦躁气急。不欲见火。恶闻人声。耳热面
红。或作寒噤。或作喷嚏。昏不知人。郑声作笑。种种形证。皆内 之验。治法。亦宜宣
通气血。解毒化 。如连翘、地丁、赤芍、紫草、楂肉、槟榔、净银花、人中黄、白僵蚕、钩藤
钩之类主之。俾得脉和神清。方为毒化 解。（此条参伤寒第一书）
邵评∶时毒瘟疫。口鼻吸受。直行中道。邪伏膜原。毒凝气滞。发为内 。内 者。发
于躯壳里面。肠胃膈膜之处。外之肌肉皮肤。不见 点。毫无形迹。犹内痈之类
也。此症罕见。时症瘟疫症中。或有此症。其所见外症。俱是阳明热毒。火邪壅遏
于中。气不宣通之候。 发于内。提透非宜。治法当宣通邪滞。解毒消 。清营化热之剂。症虽少见。
医者不可不知。盖内 外无形迹可见。全在察脉辨症。庶无贻误。以上俱论 症。
疹子悉属风热。浮小有颗粒。随出随没。而又出一翻者是。与小儿痧子同。宜疏风解热为先。不可骤
用寒凉。必兼辛散。吴地曰痧子。浙江曰 子。同一病也。恒发于小儿。若疹子。不拘大小皆有。三疾主治
略同。总不出乎肺家风热。身热一二日即发者轻。三五日发者重。亦当辨其天时寒暄燥湿。邪在气分营分分治。
外寒内热 痧疹发于暴寒之时。肌表头面不透。是外袭寒邪。内蕴伏热。宜两解
肺卫之邪。麻杏石甘汤。加桔梗、薄荷、射干、牛蒡主之。
邵评∶痧疹将发。值天寒暴冷之时。寒邪抑遏于表。痧疹热毒蕴伏于肺。不能外
达。疹不透而气急烦闷。故用麻黄开肺散寒。石膏、杏仁清热下气。余药提透疹邪也。
若秋候凉风外袭。伏热内蒸。以致咳嗽或喘者。亦宜麻杏石甘汤。加桑皮、象贝、枯
芩、苏子之类。麻黄须蜜炙或水炒。
邵评∶发疹在秋令。被凉风抑遏肌表。疹不透而肺火内灼。咳嗽喘急者。亦用麻杏石甘汤开肺散
风之法。此与上条是肺有热邪。欲发疹子。外受寒风。郁于肌表。疹不透达。肺火燔灼。最易闭闷
发喘而成危症。故用麻杏石甘开肺清热。加味散表邪而发疹。
风温 若值天时晴燥已久。而患咳嗽、咽哑、喉痛之症。兼痧疹者。此风温客于太
阴手经也。治宜辛凉清润之品。大忌升、葛、防风、蝉蜕等药。当以羚羊角、连翘、薄荷、
牛蒡、元参、射干、杏仁、桔梗、象贝、净银花、芦根之类选用。继以粉参、川斛、麦冬、花粉、
知母、梨浆之品。以养肺胃之阴。
邵评∶风温之邪袭肺。火燥伤金。故见咽哑喉痛而发痧疹。肺之火毒极盛。若内
湿火上蒸。咽喉作腐者。是烂喉疫痧。治法亦宜辛凉清透。大忌辛温升散之品。
寒凉苦降。亦在禁忌。防其郁遏内邪也。治宜辛凉宣泄。清肺达邪。为风温发疹邪在肺卫者正治之法。
即烂喉疫痧。亦不外此方。此条风温热邪在于肺卫。欲发疹子。用宣肺达邪清透为治。是正法也。
血热 痧疹初起。舌绛如朱。疹色如丹。环口燥裂。大渴引饮。脉象洪数。乃阳明血
热也。宜犀角、连翘、鲜生地、丹皮、赤芍、元参、花粉、净银花、人中黄之类选用。继以大
小甘露出入。以救胃阴。
邵评∶此条营分邪盛。血热而发疹。用清营宣透凉血解毒之治。亦正法也。此与上条俱即养阴药
继之。可见温热病以阴为重也。
肺郁 痧透后。痰多气急咳嗽者。余热郁于肺也。宜宣之开之。如栀豉、桑杏、桔梗、
枯芩、薄荷、象贝、蒌皮、通草、芦根之类。
邵评∶此为痧邪余热挟内之痰火。郁于肺中。气不下降所致。宜宣肺化痰清火
治之。为痧疹之后痰热郁肺之正法。
如痧疹虽透。而咳嗽声哑喉痛者。此痧毒不能尽发。郁于气分也。亦宜宣通肺气。
如羚羊角、前胡、桑杏、连翘、牛蒡、射干、薄荷、银花、甘桔、通草、黄芩、芦根之类选用。
邵评∶痧疹透而声哑。咽喉痛而咳嗽者。乃火邪痧毒郁伏肺中。气火上升为患
(Sha [sand rash] — Attached: Synthesized with Jinjian Treatment Methods, Huiye Case Book No. 1)
Sha refers to rashes that have a visible form but lack a raised texture upon touch. Whether dense like brocade patterns or sparse like mosquito bites, these are all manifestations of sha. They may appear on the chest and abdomen or on the limbs. Generally, those that are bright red and raised are auspicious; those that are purple and成片 (成片 - forming patches) indicate severe conditions; those that are black or bluish-green are considered incurable.
Shao's Commentary: The shape of sha is flat and adheres to the muscles, without any granular elevation. Touching it feels smooth and unraised. If it appears as red patches dense like brocade, this belongs to Yang pathogenic factors and stomach heat. If it is sparse like mosquito bites and pale in color without resolving, this indicates deficiency of righteous Qi and latent pathogens. This condition varies in Yin/Yang, Cold/Heat, and Deficiency/Excess. One must observe external symptoms and reference pulse images to apply warming, cooling, tonifying, or draining treatments.
Zhen (rash) refers to lesions with a granular appearance, swelling, and itching, belonging to the category of sha-yin (itchy rash). It is essential to know that zhen should emerge evenly and completely, and recede slowly. These are common in spring and summer. The treatment of sha and zhen primarily involves regulating the Hand-Taiyin Lung Meridian and Foot-Yangming Stomach Meridian. Furthermore, sha is caused by toxic fire in the stomach, while zhen is due to damp-heat in the spleen; these must be analyzed in conjunction.
Shao's Commentary: Zhen emerges on the skin with granules, resembling millet grains. Touching them reveals sharp, prickly sensations, unlike sha which is flat and located in the muscles. Sha arises from Yangming Stomach heat, whereas zhen results from wind-warmth invading the lungs. Sha can present as cold-deficiency Yin syndromes, allowing for warming and tonification; however, zhen is almost exclusively caused by pathogenic fire, with Yin-cold syndromes being rare. Therefore, the treatment of zhen focuses on acrid-cool clearing and venting, and diffusing the lungs to resolve pathogens. Warming and tonifying herbs are generally contraindicated. Since zhen is a type of sha, it is essentially epidemic toxic heat entering the lungs. When pathogenic factors are strong, the spots are dense, with slight swelling and itching of the skin. There are red and white types: red zhen indicates pathogen entering the Ying (Nutritive) level, while white spots indicate pathogen at the Wei (Defensive) level. It is strictly forbidden to expose oneself to wind and cold, which would obstruct the pathogen; doing so leads to lung closure and internal collapse of the pathogen, resulting in asthma and death.
The occurrence of zhen in Shanghan (Cold Damage) is due to failure to release the exterior or clear heat, causing pathogens to fail to exit externally, accumulate in the stomach fu organs, and enter the Ying level to erupt. In Warm diseases, external pathogens clash with internal heat, leading to stagnation of damp-heat, naturally causing sha and zhen. Some appear after one or two days of fever, others after three or four days; this is not necessarily due to mismanagement.
Shao's Commentary: Sha and zhen must be distinguished. Sha originates from the stomach, zhen from the lungs. In Shanghan, failure to release the exterior and clear heat causes pathogens to stagnate in the stomach and steam into heat, hence sha is common in Shanghan, while zhen is rare. As for Yin-sha (cold-type sha), it stems from middle-jiao deficiency and latent cold, forcing floating Yang outward and stirring rootless fire internally. It presents as faint, weak, pale-white sha spots. Treatment requires warming and tonification. Zhen, however, is entirely caused by external pathogens, such as epidemic sha-zhen or seasonal toxins attacking the Lung and Wei levels, or warm-summer pathogens inhaled via the nose and mouth, moving from Wei to Ying. Or, pathogens reach the exterior from the lungs to cause zhen; this pathogen is in the Upper Jiao and is not due to failure to release the exterior. One must distinguish whether the pathogen is in the Qi or Ying level and use methods to diffuse the lungs and clear/vent. Caution against cold medicines that might suppress the pathogen; this differs significantly from sha treatment. Thus, sha belongs to the stomach, zhen to the lungs; they must be treated separately.
Generally, if sweating does not occur or fails to resolve the disease, accompanied by chest/diaphragm oppression, nausea/vomiting, aversion to food, cold feet, deafness, deep/fine pulses, or agitated pulses at Cun/Guan positions, these are signs that sha/zhen are about to erupt. Careful diagnosis is required.
Shao's Commentary: Pathogenic heat stagnates in the interior, steaming into sha, causing lack of sweat, oppression, nausea, cold feet, and deafness. This is the precursor sign of sha/zhen eruption, similar to the muggy heat before rain. Deep/fine pulses result from pathogens lying latent and impeding the vessels. Agitation at Cun/Guan signals the sudden emergence of latent pathogens.
When sha/zhen are about to erupt, vomiting and diarrhea are auspicious, as the toxic vapors are expelled through both upper and lower pathways.
Shao's Commentary: Vomiting and diarrhea during the pre-eruption phase allow heat-toxin to exit, dispersing its momentum. Astringents are strictly contraindicated. However, once the rash has fully erupted or is receding, vomiting and diarrhea are contraindicated to prevent internal collapse of pathogens. Thus, one must judge the timing and urgency of vomiting/diarrhea to avoid mismanagement.
Red sha indicates stomach heat; purple indicates intense heat; purple-black indicates gastric decay. Red sha has a 50% mortality rate; black sha has a 90% mortality rate. Bright red, sparse, and clearly raised sha is manageable even if severe. Dense, needle-head-like, purple-black patches are difficult to treat. Mixed blue/black colors with ulceration indicate death.
Shao's Commentary: This distinguishes sha colors to verify prognosis. Students must pay close attention.
After sha has erupted, a surging, slippery, and forceful pulse with warm hands and feet indicates easy treatability. A faint pulse with cold feet and deficient Yuan Qi indicates difficulty. After zhen penetrates, consciousness should be clear; worsening confusion indicates difficulty.
Shao's Commentary: Distinguishing pulse and symptom progression after eruption is precise and practical.
Warm-heat sha/zhen are covered in the new methods for Yangming/ShaoYang. Shanghan sha due to failed exterior release is covered in the new Taoyin methods. Here, we detail treatment based on seasonal climate (cold/warm/dry/damp), meridian involvement (Hand/Foot, Qi/Ying levels), and external/internal factors, integrating warm-heat and pestilence theories.
Shao's Commentary: Shanghan moves from exterior to interior, treating via Foot meridians. Pathogens entering Yangming with intense heat cause sha due to prior failure to release/clear. "Sha originates from the stomach" differs from "zhen originates from the lungs." Hence, extreme Yangming heat in Shanghan often causes sha, rarely zhen. Warm pathogens inhaled follow the Sanjiao system, treating via Hand meridians. Pathogens moving from Lung-Wei to Ying cause zhen. Epidemic toxins also enter via the Lung to cause zhen. "Zhen originates from the lungs," though sometimes involving Yangming Stomach fire (which can also cause sha). Treatment for sha aligns with Shanghan sha. For zhen, the primary method is diffusing lungs, clearing Ying, and venting pathogens. Although origins differ, treatments must be distinguished as follows:
Stomach Heat Sha: Yellow, dry tongue coating indicates extreme stomach heat. Treat via Yangming. Use Rhinoceros Horn (Xijiao), Forsythia (Lianqiao), Scutellaria (Huangqin), Coptis (Huanglian), Honeysuckle (Yinhua), Burdock (Niubang), Kudzu Root (Gegen), Mint (Bohe). Avoid excessive use of wind-dispelling herbs.
Shao's Commentary: Standard method for Yangming Stomach Heat Sha.
Ying Level Heat Sha: Bright red tongue indicates Ying-level blood heat. Confusion and delirium suggest pathogen disturbing Danzhong (Pericardium), affecting Hand meridians. Do not recklessly use wind herbs to consume Stomach fluids, nor purely bitter-cold herbs entering the Middle Jiao directly. Clear and disperse the Ying level, lightly vent sha toxin. Use Rhinoceros Horn tip, Forsythia heart, Scrophularia (Yuanshen), Moutan (Danpi), Burdock, Honeysuckle, Mint, Human Waste Charcoal (Ren Zhong Huang). For confusion, add Acorus (Changpu) and Indian Musk (Xi Huang) to open orifices.
Shao's Commentary: Danzhong is the Pericardium. Pathogen enters Heart-Ying from Lung-Wei, counter-transmitting to Pericardium—a critical condition requiring urgent clearing of Heart and reaching pathogens, using aromatic opening. Avoid wind herbs that deplete Yin. Pathogens in Upper Jiao require light/clear formulas. Bitter-cold heavy agents going to intestines do not address Pericardium pathology. This formula is correct for Ying-heat sha entering Pericardium.
If sha has penetrated, clear fire and detoxify. Use Forsythia, Red Peony Root (Chishao), Scrophularia, Moutan, Trichosanthes Root (Huafen), Anemarrhena (Zhimu), Scutellaria, Pure Honeysuckle, Human Waste Charcoal. If pulse is surging/large, add Gypsum (Shigao). If tongue is crimson, add Fresh Rehmannia (Xiang Shengdi).
Shao's Commentary: After penetration, residual heat remains; clearing and transforming residual pathogens is appropriate. This is a good method for post-penetration residual heat.
Exterior Cold Sha: Spring should be warm but is cold; Summer should be hot but is cool. Symptoms include aversion to cold, fever, sore throat, pale-red/white sha spots, thin tender white tongue coating. This is Exterior Cold. Treat with Jingfang Baidu San to warm and disperse.
Shao's Commentary: Good method for sha caused by exterior cold suppression.
Warm Toxic Sha: Autumn should be cool but is hot; Winter should be cold but is warm. Or prolonged drought/aridity leads to epidemic spread, causing red macules and zhen. Toxin fills the Sanjiao, eyes are red, tongue is crimson, sweating is profuse. Strictly avoid wind-dispersing herbs. Use Liangge San, remove Mangxiao/Dahuang, add Shigao, Niubang, Chishao, Renzhonghuang. If constipated, remove Mangxiao, keep Dahuang.
Shao's Commentary: Abnormal warmth/drought creates improper pathogenic qi leading to plague. Plague fire-toxin brews sha/zhen. Heat-toxin stagnates in Yangming, affecting all Sanjiao. Named Warm Toxic Sha. Often involves Lung/Stomach fire excess; this formula fits well.
Yang Du Sha: Epidemic Yang Du causes sha. Face red as vermilion, eyes fiery, six pulses surging/large, extreme thirst. This is extreme Yangming blood heat, toxin spreading through Sanjiao, collaterals blocked, Ying/Wei不通. Only Sanhuang Shigao Tang can rescue.
Shao's Commentary: Sanjiao interior/exterior scorched by Yang heat-toxin, Qi/Blood/collaterals blocked, pathogen stagnant. Must resolve exterior/interior heat simultaneously for sha to exit. This formula treats widespread Sanjiao Yang Du Sha effectively.
Latent Sha: If Shanghan pathogens enter Taiyin, with quiet pulse and dull spirit, gray-black center of tongue, suspect latent sha. Or seasonal infection lingering past stages, gray-black coating or central black ring, mild surface fever, slow/deep pulse, unclear consciousness, muttering/laughing. This is Yang pathogen sinking into Taiyin, risking latent sha eruption. Quiet pulse/cool body is not recovery, but Yang sinking into Yin. Method: Diffuse Qi/Blood, vent toxin, treat as Excess. Use Forsythia, Chishao, Yinhua, Purple Gromwell (Zicao), Hawthorn (Shazha), Areca Nut (Binglang), Myxomatosis virus insect (Tianchong), Tribulus (Cijili), Rhinoceros Horn tip, Thorn (Jiaoci). Venting raises sha/zhen externally, clearing toxin and spirit. (Ref: Book No. 1)
Shao's Commentary: Yang meridian pathogens enter Taiyin (Wet Earth organ). Spleen/Stomach connected, so Yang pathogens easily enter Yin. Entering Yin makes pulse quiet, pathogens latent, causing dull spirit and gray-black tongue (Taiyin tongue). Suspect latent sha. Seasonal infections lingering can also sink into Taiyin. Gray-black tongue is Taiyin damp-heat steaming. Pathogen sinking suppresses diffusion, causing mild surface fever and slow/deep pulse. Latent toxin clouds spirit/mutters. Do not mistake for recovery/deficiency and tonify. Instead, diffuse latent pathogen, vent toxin, ensure external exit, and internal pathogens transform. This formula treats Yang pathogen sinking into Taiyin with latent toxin.
Internal Injury Sha: Fatigue/internal injury causes floating deficient fire externally, presenting as pale-red sha spots. Body ache, irritability, aversion to cold/fever mimic exterior syndrome. Differentiation: pulse is large/empty or distinct at Qikou, fatigue/reluctance to speak, spontaneous sweating. Use Buzhong Yiqi Tang. Sleep stops sweating, body cools, cure achieved.
Shao's Commentary: Middle deficiency with slight pathogen, deficient fire floating out. Tonify righteousness slightly assisting pathogen resolution. Good formula for fatigue-induced Spleen injury, middle-deficiency sha (Xu Sha).
Latent Yin Sha: Yin sha stems from latent internal cold or mistaken cold/cool medicine usage, forcing deficient Yang to float. Sha spots are faint/weak. Pulse may be surging/large but empty on pressure, or six pulses deep/faint, cold extremities, white slippery tongue, or black swollen slippery tongue. This is undoubtedly Yin sha. First use Paojiang Lizhong Tang to restore Yang, then treat symptoms. If internal cold damage plus external cold causes Yin sha, Tiaozhong Tang is fastest.
Shao's Commentary: Congenital Yang deficiency, latent internal cold, plus mistaken cold meds cause extreme Yin-cold, weak Yang fire, forcing rootless fire out. Yin latent, named Yin sha. Great deficiency/cold, floating Yang. Pulse superficially large/heavy empty is Yang decline/pre-collapse. Deep/faint pulse is standard Yang decline. Both require warming middle/supporting Yang. This formula treats Yin-cold excess with weak Yang fire Yin sha.
Shaoyin Sha: Kidney deficiency with invasion, sha/zhen unable to penetrate. Faint pale-red spots in skin. Pulse deep/fine/weak, pale-red/purple tongue, swollen/tender tongue, drowsy/unconscious state, fluctuating clarity. This is Shaoyin essence failing to transform Qi, unable to vent. Use Zuogui Yin plus Ginseng. Once essence/Qi充盈, sha exits externally. If Right Chi pulse is slow/faint, cold extremities, thirst without desire to drink, this is Shaoyin Water/Fire dual deficiency. Use Renshen Bawei Wan. Once Kidney Qi fills, sha penetrates.
Shao's Commentary: Kidney Water deficiency uses Liuwei Dihuang to nourish water; Kidney Fire decline uses Fugui to tonify fire; Ginseng supports Yuan Qi. Correct method for Yin/Yang dual deficiency.
Internal Sha: Epidemics often have Internal Sha. Sha erupts in intestines/stomach/throat/diaphragm, invisible on skin. Pulse short/slippery, seemingly agitated but not. External signs: dry mouth, red eyes, cold finger/toes, irritability, rapid breathing, aversion to fire/noise, hot ears/red face, chills/sneezing, unconsciousness, muttering/laughing. All confirm Internal Sha. Treatment: Diffuse Qi/Blood, detoxify/transform sha. Use Forsythia, Vincentka (Diding), Chishao, Zicao, Hawthorn, Binglang, Pure Yinhua, Renzhonghuang, White Silkworm (Bai Jiangcan), Uncaria (Gouteng). Aim for harmonious pulse and clear spirit, indicating toxin resolved/sha dissolved. (Ref: Shanghan Book No. 1)
Shao's Commentary: Seasonal toxins/plagues inhaled travel mid-way, pathogens lie in Membrane Source (Moyuan), toxin condenses Qi stagnation, causing Internal Sha. Internal Sha erupts inside torso/intestines/diaphragm, no skin marks, like internal abscess. Rare in epidemics. External signs show Yangming heat-toxin blocking Qi. Since sha is internal, venting is inappropriate. Treat by diffusing pathogen stagnation, detoxifying, clearing Ying/transforming heat. Though rare, doctors must know. Diagnosis relies on pulse/symptoms to avoid error. Above discusses Sha syndromes.
Zhen (rash) is entirely Wind-Heat, small/granular, appearing/disappearing quickly, recurring. Same as pediatric sha. Prioritize dispersing wind/clearing heat. Do not abruptly use cold/cool; must combine acrid dispersion. Wu region calls it Sha Zi, Zhejiang calls it Zhen Zi; same disease. Common in children; Zhen affects all ages. Main treatments similar, rooted in Lung-family Wind-Heat. Fever 1-2 days then eruption is mild; 3-5 days is severe. Differentiate by season/climate, Qi/Ying levels.
Exterior Cold/Internal Heat Sha/Zhen: Erupts during sudden cold. Surface/head/face不透 (not penetrating). External cold invasion, internal latent heat. Resolve Lung-Wei pathogens bilaterally. Ma Xing Shi Gan Tang, add Jiegeng, Bohe, Shegan, Niubang.
Shao's Commentary: Pre-eruption in sudden cold. Cold suppresses exterior, heat-toxin lies latent in Lung, cannot exit. Rash不透 causes asthma/oppression. Mahuang opens Lung/disperses cold, Shigao/Xingren clears heat/descends Qi, other herbs vent zhen.
If autumn cool wind invades, latent heat steams internally, causing cough/asthma, also use Ma Xing Shi Gan Tang, add Sangbai, Xiangbei, Kuqin, Suzi. Mahuang must be honey-fried or water-stir-fried.
Shao's Commentary: Autumn rash suppressed by cool wind,不透 causes internal Lung fire, cough/asthma. Uses Ma Xing Shi Gan Tang to open Lung/disperse wind. Similar to previous: Lung heat wants to erupt, external cold suppresses, Lung fire burns, risk of closure/asthma. Ma Xing Shi Gan Tang clears heat, added herbs disperse exterior/erupt rash.
Wind-Warmth Rash: Prolonged dry weather, cough, hoarseness, sore throat, combined with sha/zhen. Wind-warmth invades Hand-Taiyin. Treat with acrid-cool/moistening. Strictly avoid Shengma, Gegen, Fangfeng, Chantui. Use Lingyangjiao, Lianqiao, Bohe, Niubang, Yuanshen, Shegan, Xingren, Jiegeng, Xiangbei, Pure Yinhua, Lugeng. Follow with Fen Shen, Chuhu, Maidong, Huafen, Zhimu, Pear juice to nourish Lung/Stomach Yin.
Shao's Commentary: Wind-warmth attacks Lung, fire-dryness injures Metal, causing hoarseness/sore throat/sha. Lung fire-toxin extreme. If damp-heat steams throat causing rot, it is Lanhou Yi Sha. Treat with acrid-cool/clearing/venting. Strictly avoid acrid-warm/dispersing. Cold/bitter-downward are also contraindicated to avoid suppressing internal pathogens. Acrid-cool diffusing/clearing Lung/reaching pathogens is correct for Wind-Warmth rash in Lung-Wei. Even Lanhou Yi Sha uses this. This clause addresses Wind-Warmth heat-pathogen in Lung-Wei wanting to erupt; diffusing/clearing/venting is correct.
Blood Heat Rash: Early stage, tongue crimson like vermilion, rash red like cinnabar, cracked lips, extreme thirst, surging/rapid pulse. Yangming blood heat. Use Xijiao, Lianqiao, Xiang Shengdi, Danpi, Chishao, Yuanshen, Huafen, Pure Yinhua, Renzhonghuang. Follow with Da/Xiao Ganlu Decoction variations to save Stomach Yin.
Shao's Commentary: Ying-level pathogen excess, blood heat causing rash. Clearing Ying/venting/blood-cooling/detoxifying is correct. Followed by Yin-nourishing, showing importance of Yin in warm diseases.
Lung Stagnation Rash: After sha penetrates, phlegm/cough/rapid breathing indicates residual heat stagnating in Lung. Diffuse/open. Use Zhichi, Sangxing, Jiegeng, Kuqin, Bohe, Xiangbei, Loupi, Tongcao, Lugeng.
Shao's Commentary: Residual sha pathogen with internal phlegm-fire stagnating in Lung, Qi not descending. Diffuse Lung/resolve phlegm/clear fire is correct for post-sha phlegm-heat in Lung.
If sha penetrates but cough/hoarseness/sore throat persist, sha toxin not fully emitted, stagnating in Qi level. Diffuse Lung Qi. Use Lingyangjiao, Qianhu, Sangxing, Lianqiao, Niubang, Shegan, Bohe, Yinhua, Ganjie, Tongcao, Huangqin, Lugeng.
Shao's Commentary: Hoarseness/sore throat/cough after penetration indicates fire-pathogen/toxin latent in Lung, Qi/Fire rising causing harm.