张景岳言夏秋之交，乍凉乍热，阴阳相驳，人于此时，凡衣被口腹，最宜节慎，少有不调，为驳杂之气所侵，则霍乱吐泻所由生也，亦宜留意。医案论霍乱之后，用补剂收功，亦因虚化虚之意。医话新制黄土汤，专以治湿为主，符于经旨，切于时用，足称良剂。 略曰：《内经》霍乱，本以太阴湿土为主，因表里寒热虚实而有六化之变，是证多见南方及夏秋之交，湿郁可据。六化之别，仲景详言之矣。后世或执寒以非热，执热以非寒，可谓不能举一以反三，而反执一以废其五也。，而反执一以废其五也。
霍乱论列方
理中丸（五十三） 四物汤（八） 苏合香丸（六） 藿香正气散（十七） 四苓散（五十四） 斑龙丸（五十五） 五苓散（十六） 桂枝汤（五十六） 四逆汤（五十七） 四逆加人参汤（五十八） 益元散（五十九） 桂苓甘露饮（六十） 二陈汤（六十一）
沙蜮第十二
《椿田医话》曰：射影丸，主治射工沙虱溪毒诸证。其病与伤寒温疫霍乱瘴气相类，但手足逆冷者是，甚至手足麻木不仁，冷过肘膝。道光辛巳秋七月，沙毒流行，两足先麻木，（当时流俗名麻脚瘟。）继之腹痛吐泻，肢冷脉伏，剧则大汗身冷，脉脱目陷，四肢瘈疭，须臾不救。因制此方，服之良愈。外以含沙散臭鼻取嚏。或曰闺中妇女，多罹此疾，何含沙射影之有？曰：射工沙虱，致毒于水草之间，灌田浇菜，浸润方土，潜通地脉，流入泉源，何所不可。且此气盛行之年，亦可凌空而至。南方更有蛇毒，其害尤甚。又方土沙气升腾，高于岑楼，因夏秋气候炎热，莫之能见。妇女坐受其气，非男子运行可比，且妇女阴体易感阴毒，以故受病多于男子。今人感之微者，头疼身痛，形神拘倦，欲吐不吐，四肢闭逆，或腹痛欲泻，令人挤眉心、人中、承浆、颈项胸前背后，出见红班如枣大，重则色紫，顷刻即愈，名曰挤沙。相沿成俗，即感受风寒，亦有挤沙而愈者。盖挤沙有发汗之意，在内为血，发外为汗，汗即血故也。 香白芷（一两） 大贝母（一两） 生甘草（五钱） 大蒜头（一两） 青黛（一两） 明雄黄（五钱） 犀角（五钱） 山慈姑（一两） 苍耳子（一两） 厚朴（一两） 紫背萍（一两） 射干（一两） 白知母（一两） 枯矾末（五钱） 朱砂（五钱） 紫菀茸（一两） 槟榔（一两） 雷丸（一两） 虎珀（五钱） 龙齿（五钱） 鬼箭羽（一两） 羚羊角（五钱） 草果仁（五钱） 麝香（五钱） 为细末，水叠丸，每服三钱，开水下。 含沙散，主治沙毒吹入鼻中取嚏。 生大黄（六两） 公丁香（一两五钱） 明天麻（三两） 牙皂角（三两） 丹砂（四两） 明雄黄（四两） 麻黄（三两） 冰片（三钱） 麝香（三钱） 苍术（三两） 蟾酥（一两） 香白芷（三钱） 草果仁（一两五钱） 共为极细末，磁瓶收贮。 《周礼》壶涿氏，掌除水虫，以抱土之鼓驱之，以焚石投之。 《诗》曰：为鬼为蜮，则不可得。（蜮，虫名。《诗注》名含沙。《诗疏》名射影，又名水弩。《广雅》名短狐。《玄中记》名水狐。《博物志》名射工。《酉阳杂俎》名抱枪，其形似蛣蜣，头有一角，长寸余，角上有四歧黑甲，下有翅能飞，足角如弩，以气为矢，因水势含沙射人影成病，沙证之因，盖由此也。《五行传》曰：南方淫惑之气所生，故谓之蜮。） 《玄中记》曰：水狐虫长三四寸，其色黑，广寸许，背上有甲，厚三分，其口有角，向前如弩，以气射人，去二三步即中人，十死六七也。又曰：视其形，虫也。见其气，鬼也。 《博物志》曰：射工江南山溪水中甲虫也。长一二寸，口有弩形，以气射人影，令人发疮。不治，杀人。 《南中志》曰：永昌郡有禁水，惟十一二月可渡，余月则杀人。其气有恶物作声，不见其形，中人则青烂，名曰鬼弹。 《文选》鲍明远诗曰：含沙射流影，吹蛊病行晖。 郭义恭《广志》曰：沙虱在水中，色赤，大不过蚁，入人皮中杀人。 《录异记》曰：潭袁处吉等州，有沙出，即毒蛇鳞甲中虫，蛇被苦毒，入急水中碾出，人中其毒，三日即死。 《九峰医案》曰：客忤沙氛，挥霍撩乱，吐泻交作，三焦俱伤，身冷脉伏，柔汗不收，目赤如鸠，溲红如血，浑如中毒，危在须臾，勉拟元戎法，尽其心力。 人参（二钱） 冬白术（三钱） 炙甘草（五分） 炮姜灰（五分） 煅石膏（一两） 红蓼花梗（一两） 地浆 水煎。 沙氛袭络，遍身苛痹，肢尖逆冷，胸喉气不展舒，六脉细涩无力，正气六和加减。 藿香梗（二钱） 老苏梗（一钱） 荆芥穗（一钱） 云茯苓（三钱） 炙甘草（五分） 制半夏（钱半） 福橘皮（一钱） 宣木瓜（一钱） 川厚朴（八分） 大腹皮（一钱） 烦闷欲吐，颠痛肢尖冷，脉细涩，沙候也。 法制半夏（四钱） 芦根（二两） 甘澜水煎。
蒋宝素曰：沙毒者本书创立，《内经》所无。见于《诗》《礼》，方书所略。近代多有，乃南方沙土水湿溪涧虫蛇沙虱毒气中人为患，类乎中毒之证也。《周礼》有掌除水虫之氏。《诗》云：为鬼为蜮，则不可得。蜮乃含沙射影水狐等之总名，能致人病蜮惑也。故《金匮要略》本之于《诗》，有狐惑之证，以虫毒蚀于喉为惑，蚀于阴为狐。《博物志》言射工以气射人影，令人发疮，不治杀人，亦本于《诗》义。《南中志》永昌郡有禁水，人不可渡，有物作声，不见其形，中人即死。此从射工而广之，则水亦能病人，不待含沙射影。鲍明远诗曰：含沙射流影，吹蛊病行晖，又从而广之，则其气亦可凌空而至。葛洪《肘后方》：溪毒中人，一名中水，一名中溪，一名水病，似射工而无物，与《南中志》禁水同。又曰：江南射工毒虫，在山间水中，人行或浴，则此虫含沙射人形影为病，此承《诗》与《金匮》《博物志》而言。又葛洪《抱朴子》云：山水间多沙虱甚细，略不可见，人入水中及阴行草中，此虫多着人，钻入皮里，令人皮如芒刺，三日后寒热发疮，虫渐入骨则杀人。又以类推而有沙虱之证。巢元方采诸家之说，有含沙、沙虱、水毒、溪温诸证甚详。《丹溪心法附余》，因腹痛有绞肠沙证，用樟木矾盐等汤探吐，并刺委中出血，论治精详。李时珍《本草纲目》，有挑沙刮沙之说，其法益备。张景岳用磁碗边蘸滚水香油，刮背心从上之下，尤为该简。医案从客忤霍乱中寻出沙证，证无逃隐。医话制含沙散射影丸，治无遗义。
略曰：沙证盖本含沙射影，沙虱着人之义，然不近含沙沙虱而染沙证者，则有禁水吹蛊溪毒之属，即含沙沙虱之类，随方土变更，其气上腾，与六淫相等，不必泥射影而着人。往古所略，近代详焉。至医话含沙散射影丸，诚对证之良方，无出其上者。
瘴气第十三
Zhang Jingyue stated that during the transition between summer and autumn, when the weather fluctuates between cold and hot, and Yin and Yang energies conflict, people should exercise utmost caution and moderation in their clothing and diet at this time. Any slight disharmony may allow mixed pathogenic factors to invade, leading to Huoluan (a disease characterized by sudden vomiting and diarrhea). This requires attention. In medical cases discussing post-Huoluan treatment, using tonifying agents to conclude therapy aligns with the principle of addressing deficiency-induced deficiency. The newly formulated Huangtu Tang (Yellow Earth Decoction) in medical conversations focuses primarily on treating Dampness, conforming to classical principles and fitting seasonal applications, thus worthy of praise as an excellent prescription. Briefly: Huoluan in the *Neijing* is fundamentally rooted in Taiyin Damp-Earth, undergoing six transformations due to exterior-interior, cold-heat, and deficiency-excess variations. This condition is commonly seen in southern regions and during the summer-autumn transition, where Dampness stagnation is evident. Zhang Zhongjing detailed these six transformations. Later generations, however, stubbornly adhered to cold patterns while denying heat, or vice versa, failing to infer one from another and instead discarding five aspects for the sake of one.
Prescriptions Listed in the Discussion on Huoluan
Lizhong Wan (Regulate the Middle Pill), Siwu Tang (Four Substance Decoction), Suhexiang Wan (Styrax Pill), Huoxiang Zhengqi San (Agastache Powder to Rectify Qi), Siling San (Four-Ling Powder), Banlong Wan (Spotted Dragon Pill), Wuling San (Five-Ling Powder), Guizhi Tang (Cinnamon Twig Decoction), Sini Tang (Frigid Extremities Decoction), Sini Jia Renshen Tang (Frigid Extremities Decoction plus Ginseng), Yiyuan San (Benefit Origin Powder), Guiling Ganlu Yin (Cassia and Poria Sweet Dew Drink), Erchen Tang (Two-Aged Decoction).
Sha Yu (Sand Demon) Chapter 12
*Chuntian Yihua* (Medical Conversations from Chuntian) states: Sheying Wan (Shadow-Shooting Pill) treats conditions caused by Shigong (Bow-Mouth Bug), Shashi (Sand Mite), and Xidu (Stream Poison). These illnesses resemble Shanghan (Cold Damage), Wenyi (Warm Epidemics), Huoluan, and Zhangqi (Miasma), but are distinguished by cold extremities. Severe cases present with numbness and insensitivity in hands and feet, with cold extending beyond elbows and knees. In the autumn of July in the Xin-Si year of Daoguang (1821), Sha Du (Sand Toxin) prevailed. Patients first experienced numbness in both legs (locally known as Majiao Wen/Numb Foot Plague), followed by abdominal pain, vomiting, and diarrhea, cold limbs, and hidden pulses. In severe cases, profuse sweating, cold body, absent pulse, sunken eyes, and convulsions occurred, leading to death within moments. Therefore, this prescription was formulated, resulting in good recovery. Externally, Hansha San (Sand-Containing Powder) was used to induce sneezing via nasal irritation. Some asked why women in inner chambers suffered from this if it involves "shooting shadows." The response was: Shigong and Shashi generate toxicity among water plants. Irrigation infiltrates soil, connects to underground veins, and flows into springs, reaching everywhere. Moreover, in years of strong Qi prevalence, it can arrive through the air. Southern regions also have Snake Toxicity, which is even more harmful. Additionally, local Sha Qi rises high above buildings; due to hot summer-autumn climates, it is invisible. Women sitting passively receive this Qi, unlike men who move actively. Since women possess Yin constitutions, they easily contract Yin toxins, hence suffering more than men. Mild infections cause headache, body ache, mental fatigue, retching without vomiting, closed extremities, or abdominal pain with urge to defecate. Pressing the brow center, Renzhong, Chengjiang, neck, chest, back, etc., causes red spots like dates to appear, turning purple in severe cases, resolving instantly. This is called Jisha (Squeezing Sand). It became a custom; even Wind-Cold contraction could be cured by Jisha. Jisha implies Sweating; internally it relates to Blood, externally to Sweat, as Sweat is essentially Blood.
Xiang Baizhi (Angelicae Dahuricae Radix, 1 liang), Dabeimu (Fritillariae Thunbergii Bulbus, 1 liang), Sheng Gancao (Glycyrrhizae Radix et Rhizoma Recens, 5 qian), Dasuantou (Allii Sativi Bulbus, 1 liang), Qingdai (Indigo Naturalis, 1 liang), Ming Xionghuang (Realgar, 5 qian), Xijiao (Rhinocerotis Cornu, 5 qian), Shancigu (Smilacis Glabrae Rhizoma, 1 liang), Can'erzi (Xanthii Fructus, 1 liang), Houpo (Magnoliae Officinalis Cortex, 1 liang), Zibeiping (Azolla Sinensis, 1 liang), Shegan (Belamcandae Rhizoma, 1 liang), Baizhimu (Anemarrhenae Rhizoma, 1 liang), Kufan (Alumen Usticum, 5 qian), Zhusha (Cinnabar, 5 qian), Ziwanrong (Asteris Radix et Rhizoma, 1 liang), Binglang (Arecae Semen, 1 liang), Leiwan (Wormwood Fruit, 1 liang), Hu Po (Amber, 5 qian), Long Chi (Dinosaur Bone, 5 qian), Gui Jianyu (Eucommiae Cortex cum Spina, 1 liang), Lingyangjiao (Saiga Tataricae Cornu, 5 qian), Caoguoren (Tsaoko Cardamomi Fructus, 5 qian), Shexiang (Moschus, 5 qian). Grind into fine powder, form pills with water, take 3 qian each time with warm water.
Hansha San (Sand-Containing Powder) treats Sha Du blown into the nose to induce sneezing.
Sheng Dahuang (Rhei Radix et Rhizoma Recens, 6 liang), Gong Dingxiang (Syzygii Aromatisati Flos, 1.5 liang), Ming Tianma (Gastrodiae Rhizoma, 3 liang), Ya Zaojiao (Gleditsiae Sinensis Fructus, 3 liang), Dansha (Cinnabar, 4 liang), Ming Xionghuang (Realgar, 4 liang), Mahuang (Ephedrae Herba, 3 liang), Bingpian (Borneolum Syntheticum, 3 qian), Shexiang (Moschus, 3 qian), Cangzhu (Atractylodis Rhizoma, 3 liang), Chansu (Bufonis Venenum, 1 liang), Xiang Baizhi (Angelicae Dahuricae Radix, 3 qian), Caoguoren (Tsaoko Cardamomi Fructus, 1.5 liang). Grind into extremely fine powder, store in porcelain bottles.
The *Rites of Zhou* mentions Huzhuoshi, who managed the removal of aquatic pests, driving them with drums wrapped in earth and throwing burnt stones at them.
The *Book of Songs* says: "Is it a ghost? Is it a Yu? Yet it cannot be caught." (Yu is an insect name. Zhu Xi's commentary calls it Hansha. Kong Yingda's subcommentary calls it Sheying, also known as Shuinu. *Guangya* calls it Duanhu. *Xuanzhong Ji* calls it Shuihu. *Bowuzhi* calls it Shigong. *Youyang Zazu* calls it Baoqiang. Its shape resembles a dung beetle, with a horn on its head over an inch long, four black claws branching from the horn, wings below for flight, and leg-claws like a crossbow. It shoots sand like arrows using Qi, following water currents to hit human shadows, causing illness. This is the origin of Sha Syndrome. *Wuxing Zhuan* states it arises from excessive seductive Qi in the south, hence named Yu.)
*Xuanzhong Ji* states: Shuihu insects are 3-4 cun long, black, about 1 cun wide, with a 3-fen thick shell on the back. They have horns in their mouths pointing forward like crossbows, shooting Qi at people. Within 2-3 bu, they strike, killing 60-70% of victims. It adds: Looking at its form, it is a bug; seeing its Qi, it is a ghost.
*Bowuzhi* states: Shigong is a shelled insect in Jiangnan mountain streams. 1-2 cun long, with a crossbow-shaped mouth, shooting Qi at human shadows to cause sores. Untreated, it kills.
*Nanzhong Zhi* states: Yongchang Commandery has Forbidden Waters, crossable only in Nov-Dec; otherwise, it kills. Evil sounds emerge, unseen, striking people to cause green rot, named Guidan (Ghost Bullet).
*Bianwen Xuan* quotes Bao Mingyuan: "Containing sand to shoot flowing shadows, blowing gu to harm walking sunlight."
Guo Yigong's *Guangzhi* states: Shashi lives in water, red, no larger than an ant, enters human skin to kill.
*Luyi Ji* states: In Tanzhou, Yuanzhou, Jizhou, etc., Sha emerges from snake scales. Snakes suffer toxic distress, rolling in rapid water to expel them. Humans poisoned by this die in three days.
*Jiufeng Yi'an* (Medical Cases from Jiufeng): Ke Wu Sha Fen (Guest Disturbance and Sand Miasma) causes chaotic vomiting and diarrhea, damaging all Three Burners. Cold body, hidden pulse, cold sweat, red eyes like a dove, bloody urine, resembling acute poisoning, critical in moments. Tentatively applying Yuanrong Method with full effort.
Renshen (Panacis Ginseng Radix, 2 qian), Dong Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata, 5 fen), Pao Jiang Hui (Zingiberis Rhizoma Praeparatum Ash, 5 fen), Duan Shigao (Gypsum Fibrosum Calcined, 1 liang), Hong Liaohuageng (Polygoni Hydropiperis Caulis, 1 liang), Di Jiang (Earth Slurry). Decoct in water.
Sha Fen invading collaterals causes widespread itching and numbness, cold extremities, chest/throat Qi stagnation, thin and choppy weak pulses. Adjust Zhengqi Liuhe Tang.
Huoxiang Geng (Pogostemonis Herba Caulis, 2 qian), Lao Sugeng (Perillae Caulis, 1 qian), Jingjie Sui (Schizonepetae Spica, 1 qian), Yun Fuling (Poria, 3 qian), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata, 5 fen), Zhi Banxia (Pinelliae Rhizoma Praeparatum, 1.5 qian), Fu Ju Pi (Citri Reticulatae Pericarpium, 1 qian), Xuan Mugua (Chaenomelis Fructus, 1 qian), Chuan Houpo (Magnoliae Officinalis Cortex, 8 fen), Dafupi (Arecae Pericarpium, 1 qian).
Restlessness, urge to vomit, vertex pain, cold extremities, thin choppy pulse indicate Sha pattern.
Fazhi Banxia (Pinelliae Rhizoma Praeparatum, 4 qian), Lugeng (Phragmitis Rhizoma, 2 liang). Decoct in Ganlan Water (water boiled up and down).
Jiang Baosu stated: Sha Du is a concept created in this book, absent in *Neijing*, appearing in *Shijing* and *Zhouli*, but neglected in formularies. Recently common, it results from southern sandy/watery/miasmic environments, insect/snake/sha mite toxins harming humans, resembling poisoning. *Zhouli* had officials removing water pests. *Shijing* says: "Is it a ghost? Is it a Yu? Yet it cannot be caught." Yu is the general term for Hansha, Sheying, Shuihu, etc., causing Yu-huo (bewilderment/illness). Thus *Jingui Yaolue* based on *Shijing* describes Hu-Huo syndrome:虫毒 (insect toxin) eroding throat is Huo, eroding genitals is Hu. *Bowuzhi* says Shigong shoots Qi at shadows causing sores/death, also based on *Shijing*. *Nanzhong Zhi* describes Forbidden Waters killing upon contact, expanding from Shigong to show water itself harms without shadow-shooting. Bao Mingyuan's poem expands further to show Qi can travel through air. Ge Hong's *Zhouhou Beiji Fang* describes Xidu (Stream Poison), also called Zhongshui/Zhongxi/Shuibing, similar to Shigong but intangible, matching *Nanzhong Zhi*. He also notes Jiangnan Shigong bugs in mountain waters infect humans bathing/walking via shadow-shooting, citing *Shijing*, *Jingui*, *Bowuzhi*. Ge Hong's *Baopuzi* mentions fine Shashi in mountains/waters entering skin, causing prickling sensation, fever, sores after 3 days; entering bones kills. By analogy, Shashi syndrome emerged. Chao Yuanfang compiled details on Hansha, Shashi, Shuidu, Xiwen. *Danxi Xinfa Fuyu* discusses Jiaochangsha (Intestine-Twisting Sha) with vomiting via camphor/alum/salt and bleeding Weizhong. Li Shizhen's *Bencao Gangmu* added picking/scraping methods. Zhang Jingyue used magnetic bowl edges with hot oil to scrape the back, concise and effective. Medical cases identified Sha syndrome within Guest Disturbance/Huoluan, leaving no room for concealment. Medical conversations formulated Hansha Sheying Wan, covering all therapeutic meanings.
Briefly: Sha syndrome originates from Hansha Sheying and Shashi attachment. However, contracting Sha Syndrome without proximity to Hansha/Shashi involves Forbidden Waters, Chuigu, Xidu, etc., adapting to local geography, rising Qi equal to Six Evils, not limited to shadow-shooting. Ancient texts neglected this; modern times detail it. The Hansha Sheying Wan in medical conversations is indeed a superior prescription for this indication.
Zhangqi (Miasma) Chapter 13