哲言
痧者，天地间之厉气也。入于气分，则毒中于气而作肿作胀，入于血分，则毒中于血而为蓄、为瘀。凡遇
食积痰火，气血即因之阻滞而不散，此痧之所以由来也。故人之壮实者有痧证，即人之虚弱者亦有痧证，则痧
之发，何论人之虚实乎？○痧证，先吐泻后心腹绞痛，从秽气而发者多。先心腹绞痛后吐泻，从暑气而发者多。
心胸昏闷，痰涎胶结，从伤暑伏热而发者多。遍身肿胀，疼痛难忍，四肢不举，舌强不言，从寒郁为火毒而发
者多。○痧证，若昏迷不醒，口不能言，其心胸烦闷难过之苦，将何以辨之？宜先观其唇舌；色黑者凶，黄者
重，淡红者较轻。盖黄色而知内热，黑色而知热极，淡红色虽热，然用药不可太冷。○痧痛而绞动者，毒壅于气
而有积也。痛而不移者，毒壅于血而有瘀也。发于上部者，毒瓦斯上壅也。缠于下部者，毒血下注也。有上吐下
泻者，痧气上下冲激也。有烦闷 胀者，痧气壅塞于心膈也。有恶寒发热者，毒瓦斯遏抑于肌表也。有肢体遍痛
者，毒血流滞于经络也。有结滞肠胃者，气积血于而为肿、为胀也。有吐血便血者，痧毒壅于血分而为泛溢也。
有咳嗽喘急者，痧毒壅于气分而生痰涎也。有立时闷伤者，痧毒攻心也。有腿足痿软不能掉动者，痧毒入于血
分而注于下部也。有腰胁俱痛者，痧毒阻于血分而有瘀也。有
身重不能转侧者，痧之毒血壅瘀而不能转运也。有变成肿毒溃烂者，痧血凝滞而攻坏肌肤也。○痧证，最忌热
酒热汤米食诸物，饮此则轻者必重，重者立毙。亦有吃米食诸物，结成痧块，日久变疾难疗。○痧证略松，胸
中觉饿，骤食即复，必耐一、二日，乃可保全。○痧证；心胸高起如馒HT 者不治；角弓反张者死；腰背心胸左右
有一点痛者不治；胁肋痛者不治；四肢肿痛者难治；鼻如烟煤者死；舌卷囊缩者死；昏迷不醒，放痧不出，服
药不应者死；痧块大痛者死。（《痧胀玉衡》）
补编
痧证，实者犯之，固即以有余治之；而虚者犯之，亦当以有余治之。盖有余者非有余于本，原乃有余于痧
毒也。夫人有痧毒，如家之遇贼寇也。人有虚实，如家之有浓薄也。若贼寇入室，岂以家之资薄不驱而出之乎？
可知家有贼寇，必先驱之为是。人有痧毒，亦无不先驱之为是也。故痧发不论虚实，驱毒在所当先，温补必施
于收后，此痧之所以有实无虚也。○痧者，热毒也。误饮热汤，则痧筋隐而不见，即筋略见，放之血不流，刮
之痧不出者，此热汤之为害也。急饮冷水解之，然后再放而血流，再刮而痧出矣。又有痧毒方发，而为食滞所
阻，凝结于中，放刮不出者，此食积之为害也。当先消食而再放刮。又有痧毒凝滞，而于血不流，阻于胸腹，
虽放刮有不尽者，当先散瘀而后放刮。又有痧毒方发，而遇恼怒气逆助胀，致放刮难尽者，当先顺气，再行
放刮，如此则痧毒可渐消矣。○痧气壅遏于中，故作痛胀，用荆芥、防风之类，从表而散也；用青皮、陈皮之
类，从中而消也；用枳实、大黄之类，从大便而下也；用木通、泽泻之类，从小便而行也；用山楂、卜子之类，
治其食之阻也；用银花、红花之类，治其血之壅也；用槟榔、蓬术之类，治其积之滞也。○痧筋有见，有微见，
有乍隐乍见，有伏而不见。痧筋之见者，毒入血分居多，乍隐乍见者，毒入气分居多。微见者，毒阻气分居多。
伏而不见
者，毒结血分居多。夫痧筋之见者，人知刺而放之矣。其微见者，乃痧毒阻于肠胃，致筋不能大显，故虽刺而
无血，即微有血，亦点滴不流，治宜通其肠胃，则筋自见，然后刺放。若乍隐乍见者，人知俟其见而放之。至
有伏而不见者，虽欲放而无可放，人未有能识其为痧，受其害而不觉。若斯者，当从其脉之不合于证而辨之，
又当察其所发之病在缓，所见之证倏而急者，即病与证之不合，更可辨也。治法∶结于血者散其瘀，结于食者
消其食，结于痰者治其痰。则结散之后，痧筋自见，然后刺放，其痧可得而治也。○肌肤痧，用油盐刮之，则
痧毒不内攻。血肉痧，看青紫筋刺之，则毒有所泄。肠胃脾肝肾三阴经络痧，治之须辨经络脏腑在气在血，则
痧之攻内者，可消可散，而绝其病根也。放痧有十∶一、头顶百会穴；一、印堂；一、两太阳穴；一、喉中两
旁；一、舌下两旁；一、双乳；一、两手十指头；一、两臂弯；一、两足十指头；一、两腿弯。（《痧胀玉衡》）
尝考方书，从无痧证之名。惟触犯臭秽而腹痛吐逆，俗以瓷器蘸油刮其背脊，随发红斑者，谓之痧。甚则
欲吐不吐，欲泻不泻，干呕绞痛者，曰绞肠痧。近时有感恶毒异气而骤发黑痧，其证卒然昏倒，腹痛面黑，不
呼不叫，如不急治，两、三时即毙。有微发寒热，腹痛麻瞀呕恶神昏者，或 汗出，或隐隐发斑者，此毒邪
发于表也。亦有发即泻利厥逆，腹胀无脉者，此毒邪内伏，不能外达也，其患最暴。《经》谓邪气入于脏腑，
虽不病而卒死者是也。初觉先将纸捻点淬头额，即以荞麦取末三钱，温汤调服即安。盖荞麦能涤肠胃滓秽，降
气宽胸，而治浊滞为痧毒之专药。其有毒甚面黑者，急于两膝后委中穴砭出黑血，以泄毒邪。盖骤发之病，勿
虑其虚，非此急夺，束手待毙。以此病起于漠北，流入中原，故以番痧目之。原夫此病，与瘴疠相似，瘴则触
冒山岚瘴气，此则触冒恶毒异气。又与时行疫疠不殊，但时疫则沿门阖境传染，此则一人骤感，死于一日、半
日之间，不似时疫之可
以延日也。又与伤寒之伏气相似，但伏气热毒自里达表，此则骤感异气，无分表里脏腑。亦不似中寒 暑，本
虚不胜寒暑之暴也。又与霍乱相似，但霍乱是客邪与水谷之气相并，此则正气暴逆不能与邪相抗也。又与关格
相似，但关格是上下不通，病纯属里，此则兼有斑痧表证也。大略与臭毒相类，然臭毒所触秽气，此则触冒恶
毒，较之尤剧。初起昏愦不省，脉多沉匿不显，或浑浑不清，勿以腹痛足冷而与温药。倘荞麦一时难得，或服
之不应，即宜理气为先，如香苏散加薄荷、荆芥，辛凉透表。次则辟邪为要，栀豉汤加牛蒡、生甘草解毒和中。
表热势甚，清热为急，黄芩汤加连翘、木通分利阴阳。如见烦扰腹胀，脉来数疾，急投凉膈散，则毒从下夺。
若热剧神昏，虽合三黄，多不可救。若烦渴引饮遗尿，速清阳明，白虎汤加葱、豉，使毒从表化。若斑点深赤，
毒在血分者，浓煎茺蔚，少投生蜜，放温恣服，取效最捷，以其专下恶血也。或加莱菔汁者，取其散血之功也。
以上诸法，惟未经误药，庶可挽回一、二。若病家疑信未真，慎毋轻治，变生反掌，取咎未便。且有误认伤寒
而与发散，周身 紫如云而死者；亦有误认麻疹与柽柳樱桃核汤，咽痛失音而死者，以其卒犯恶毒异气，无以
脉诊，故辨治尤难。近世多用火淬砭刺，须知因感恶毒异气而致者，此属外因，火淬为当。因触臭毒秽气而致
者，属不内外因，非砭刺不足以夺其势。然刺之无血，不可救也。（《张氏医通》）
脉候
凡证类太阳寒热，其脉或长或短，时大时小，忽有忽无，如祟脉者，即为痧证。（《痧证集要》）
痧证之脉，与他证不同。如伤寒、伤风，自有伤寒、伤风之脉；若兼痧证，其脉必变，病必凶暴。○痧毒
阻抑经络，故其脉多沉伏，与阴证脉相似，一服温补药，立刻变幻。余尝见有沉微或伏之脉，一似直中三阴，
设外证稍有不合，即取痧筋验之，有则为痧，无为阴证，施治用药，庶乎不失。俟放痧服药后，经络
通而不阻，按其脉便不复如前矣。○痧毒冲激于经络血肉之分，其脉亦有洪数或沉紧，或大而无伦，或洪实有
力，种种不一。若脉证不合，盒饭审其痧筋有无，有则候其放后，再诊脉之何如，以断病之寒热虚实。○痧证
脉微细者生，实大急数者重，洪大无伦者凶。一部无脉者轻，一手无脉者重，两手无脉者死。六脉无根，诸怪
脉见，放痧服药不应者死。（《痧胀玉衡》）
选案
予荆人于初寒时，中阴寒痧毒，呕恶，胸腹搅痛，势不可当。用盐汤探吐，痛不为减，连吐数次，气愈升，
痛愈剧，上塞喉嗌，声不能出，水不可入，危在顷刻。因忆先年曾得刮痧法，择一瓷碗，别用热汤入香油一、
二匙，将碗口蘸油汤内，令其暖滑，覆执其碗于病者背心，轻轻向下刮之，以渐加重，碗干而寒，再浸再刮。
良久胸胀渐宽，始能出声，顷之腹响，大泻如倾，其痛遂减，泻后得睡，通身痒极，发出疙瘩风饼，不计其数。
愈后细穷其义，盖五脏之系，咸附于背，向下刮之，则邪气随降。凡毒瓦斯上行则逆，下行则顺。虽近有两臂刮
痧之法，然毒深病急，非刮背不可。至若风饼之由，正以寒毒之气充塞，表里经脏俱闭，脏气未调，则表亦不
解；表邪未散，则脏必不和。此其表里相关，义自如此，故治分缓急，权衡在人矣。（张景岳）
一商初到吴会，畅饮酣歌，席间霎时不安，索姜汤一啜而逝。又有朔客到枫混堂洗澡，忽眩晕呕逆，到舟
即毙。继有医者饭后寒热腹痛，手足逆冷，不终夕而殂。更有文学乡居到郡作吊，归即腹痛，坐立不安，语言
不次，六脉模糊，是夜即便捐馆。又有少年新婚，陡然腹痛麻瞀，或令饮火酒半瓯，腹痛转剧，旋增颅胀，身
发红点，与芦根汁饮之，得吐乃解。后有一人鼻衄口燥，胸腹略见红斑，啜童子小便稍安，医与葱豉浓煎，仍
入童便，得吐汗而痊。（《张氏医通》）
附方
防风散痧汤 痧证有因于风者，此方主之。防风、荆芥、细辛、枳壳、陈皮、金银花。
陈皮浓朴汤 痧证有因于气阻者，此方主之。陈皮、浓朴、乌药、青皮、山楂。
桃仁红花汤 治痧证血结不散之剂。桃仁、红花、苏木、青皮、乌药、独活、白蒺藜。
沉香郁金散 治痧气寒凝之剂。沉香、郁金、木香、降香、乌药细辛。共为细末，每服三分，砂仁汤调下，稍冷服。
冰硼散 治痧证咽喉肿痛。冰片、硼砂、元明粉、天竺黄。共研细末，吹入喉中。
宝花散 治痧之仙剂。郁金、细辛、降香、荆芥。共为细末，每服三匙，清茶调下，稍冷服。
急救神方 治痧证牙紧目闭，喉肿，心腹绞痛危候。牙皂、细辛、防风、白芷、薄荷、半夏、陈皮、桔梗、
甘草、木香、枯矾、雄黄、贯众、朱砂。共为细末装入瓷瓶。每用三分，先吹鼻内，再用淡姜汤冲服一钱，服
后以红纸捻照心窝、背心、舌底三处见有红点，用银针挑破。
刺腿弯痧筋法 腿弯上下有细筋，或紫或红，即是痧筋。刺之有紫黑毒血出。其腿上大筋不可刺，刺亦无
血，反令人心烦。腿两弯硬筋不可刺，恐令人筋吊臂弯。筋色亦如此辨之，至顶心用针，惟取挑破，略见微血，
以泄沙毒，不可直刺，指尖刺近指甲，令人头眩。一应刺法，不过针锋微入，不必深入。
刮痧法 背脊颈骨及胸胁两臂等处，用铜钱或刮舌蘸香油刮之。头额腿上用麻线蘸香油刮之。大小腹软肉
用食盐擦之。
擦羊毛痧法 其证憎寒壮热，头身胀痛，呕恶烦闷。先用生姜擦胸背肢体，再用青布蘸热水频擦，有白毛
随出即愈。亦有用粽糕擦者。湖北多有此证，称为羊毛痧。
Zhe Yan (Philosophical Remarks)
Sha (Sha disease, a type of acute toxic condition often associated with heatstroke or food poisoning in traditional contexts) is a fierce pathogenic qi (strong致病邪气) in the heaven and earth. If it enters the Qi level (the functional aspect of the body), the toxin affects the Qi causing swelling and distension; if it enters the Blood level (the material aspect of the body), the toxin affects the Blood leading to accumulation and stasis. Whenever there is food stagnation and phlegm-fire, the Qi and Blood become obstructed and cannot disperse; this is the origin of Sha. Therefore, robust individuals can suffer from Sha syndrome, and weak individuals can also suffer from Sha syndrome. Thus, the occurrence of Sha does not depend on whether a person is excess or deficient. ○ In Sha syndrome, if vomiting and diarrhea occur first followed by colicky pain in the heart and abdomen, it is mostly caused by foul qi. If colicky pain in the heart and abdomen occurs first followed by vomiting and diarrhea, it is mostly caused by summer-heat. If there is mental confusion and chest oppression with sticky saliva and phlegm, it is mostly caused by summer-heat injury and latent heat. If the whole body is swollen, pain is unbearable, limbs cannot move, tongue is stiff and speechless, it is mostly caused by cold stagnation transforming into fire-toxin. ○ In Sha syndrome, if the patient is comatose and unable to speak, how can one distinguish the suffering of chest vexation and oppression? One should first observe the lips and tongue: black color indicates a poor prognosis, yellow indicates severe condition, and pale red indicates a milder condition. Yellow indicates internal heat, black indicates extreme heat, and although pale red also indicates heat, medications should not be too cold. ○ Sha pain that feels twisting indicates toxin obstruction in the Qi level with accumulation. Pain that is fixed in location indicates toxin obstruction in the Blood level with stasis. Manifestation in the upper part indicates upward congestion of toxic vapors. Entanglement in the lower part indicates downward pouring of toxic blood. Upper vomiting and lower diarrhea indicate Sha qi rushing up and down. Vexation and distension indicate Sha qi congesting the heart and diaphragm. Aversion to cold and fever indicate toxic vapors suppressed at the muscle surface. Generalized limb pain indicates toxic blood stagnating in the meridians. Obstruction in the intestines and stomach indicates Qi and Blood accumulation causing swelling and distension. Hematemesis and hematochezia indicate Sha toxin congesting the Blood level causing overflow. Cough and rapid breathing indicate Sha toxin congesting the Qi level generating phlegm. Sudden闷伤 (stifling injury) indicates Sha toxin attacking the Heart. Flaccidity and inability to move legs and feet indicate Sha toxin entering the Blood level and pouring into the lower part. Pain in both waist and hypochondrium indicates Sha toxin obstructing the Blood level with stasis. Heaviness of body and inability to turn over indicates Sha toxic blood congestion and stasis preventing movement. Transformation into swollen sores and ulceration indicates Sha blood coagulation and stagnation damaging the skin and muscles. ○ Sha syndrome strictly forbids hot wine, hot soup, and rice foods. Consuming these will make mild cases severe and severe cases fatal immediately. Also, eating rice foods may form Sha lumps, which over time become difficult diseases. ○ When Sha symptoms slightly relax and the chest feels hungry, sudden eating will cause recurrence. One must endure for one or two days to ensure safety. ○ Sha syndrome: Chest protruding high like a steamed bun is untreatable; opisthotonos is fatal; single point pain in waist, back, heart, chest, or left/right sides is untreatable; hypochondriac pain is untreatable; swelling and pain in four limbs are difficult to treat; nose resembling coal dust is fatal; curled tongue and retracted scrotum is fatal; coma unresponsive, Sha release ineffective, medication ineffective is fatal; large painful Sha lumps are fatal. (From *Shazhang Yuheng*)
Supplementary Compilation
For Sha syndrome, if it attacks an Excess constitution, it is indeed treated with methods for Excess (attacking pathogens); if it attacks a Deficient constitution, it should also be treated with methods for Excess. Because "Excess" here does not refer to the body's righteous Qi being in excess, but rather that the Sha toxin itself is in excess within the body. Having Sha toxin is like a home encountering bandits. Human constitutions vary between Excess and Deficiency, just as homes have varying wealth. If bandits enter the house, would one not drive them out because the family is poor? Thus, when bandits are in the house, driving them out first is correct. Similarly, when Sha toxin is present, driving it out first is correct. Therefore, regardless of Excess or Deficiency in Sha syndrome, expelling the toxin is the priority; warming and tonifying therapies should only be applied after the treatment concludes. This is why Sha syndrome treatment principles focus on Excess (pathogen removal) rather than Deficiency. ○ Sha is heat-toxin. Mistakenly drinking hot soup causes Sha veins (visible subcutaneous veins used for diagnosis/treatment) to hide and become invisible. Even if veins appear slightly, blood does not flow upon pricking, and scraping yields no Sha. This is the harm of hot soup. Urgently drinking cold water resolves this, then blood flows upon pricking, and Sha appears upon scraping. Again, if Sha toxin has just erupted but is blocked by food stagnation, condensing in the middle jiao, making pricking and scraping ineffective, this is the harm of food accumulation. One must first digest the food before pricking and scraping. Again, if Sha toxin is stagnant and not flowing in the Blood, obstructing the chest and abdomen, such that pricking and scraping cannot fully remove it, one must first resolve stasis before pricking and scraping. Again, if Sha toxin has just erupted but is exacerbated by anger causing Qi rebellion and distension, making pricking and scraping difficult to complete, one must first soothe the Qi, then proceed with pricking and scraping, so that Sha toxin can gradually dissipate. ○ Sha qi congesting the middle jiao causes pain and distension. Use Jingjie (Schizonepetae Herba) and Fangfeng (Saposhnikoviae Radix) to disperse from the exterior; use Qingpi (Aurantii Fructus Immaturus) and Chenpi (Citri Reticulatae Pericarpium) to eliminate from the middle; use Zhishi (Aurantii Fructus) and Dahuang (Rhei Radix et Rhizoma) to descend via the large intestine; use Mutong (Akebiae Caulis) and Zexie (Alismatis Rhizoma) to drain via the small intestine; use Shanzha (Crataegi Fructus) and Luobuzi (Radish Seed) to treat food obstruction; use Yinhua (Lonicerae Japonicae Flos) and Honghua (Carthami Flos) to treat Blood congestion; use Binglang (Arecae Semen) and Ezhu (Curcumae Rhizoma) to treat accumulation stagnation. ○ Sha veins may be visible, slightly visible, intermittently visible, or hidden/invisible. Visible Sha veins mostly indicate toxin entering the Blood level. Intermittently visible Sha veins mostly indicate toxin entering the Qi level. Slightly visible Sha veins mostly indicate toxin obstructing the Qi level. Hidden/invisible Sha veins mostly indicate toxin knotting in the Blood level. For visible Sha veins, people know to prick and bleed. For slightly visible ones, it is because Sha toxin obstructs the intestines and stomach, preventing veins from appearing prominently; thus, even if pricked, no blood flows, or only drops trickle. Treatment should focus on unblocking the intestines and stomach, after which veins will naturally appear, then prick and bleed. For intermittently visible ones, people wait for visibility to bleed. For hidden/invisible ones, although one wishes to bleed, there is nowhere to do so, and people fail to recognize it as Sha, suffering without awareness. In such cases, one should differentiate based on pulse-sign mismatch, and observe that the disease onset is slow while symptoms suddenly become urgent, further confirming the mismatch. Treatment methods: Resolve stasis for Blood knots, digest food for Food knots, treat phlegm for Phlegm knots. After knots are resolved, Sha veins will naturally appear, then prick and bleed, and Sha can be treated. ○ Skin Sha: Scrape with oil and salt so Sha toxin does not attack internally. Flesh-and-blood Sha: Prick blue-purple veins so toxin has an outlet. Sha of the Intestine, Stomach, Spleen, Liver, Kidney, and three Yin meridians: Treatment must differentiate whether the meridian/organ involvement is in the Qi or Blood level, so that internal attacking Sha can be eliminated and dispersed, cutting off the root of the disease. There are ten sites for Sha release: 1. Baihui (GV20) on the vertex; 2. Yintang (EX-HN3); 3. Taiyang (EX-HN5) on both temples; 4. Both sides of the throat; 5. Both sides under the tongue; 6. Both breasts; 7. Tips of ten fingers on both hands; 8. Both arm creases (cubital fossa); 9. Tips of ten toes on both feet; 10. Both leg creases (popliteal fossa). (From *Shazhang Yuheng*)
I have examined medical texts and found no mention of "Sha Syndrome." Only when foul odors trigger abdominal pain and vomiting, and locals scrape the back with porcelain dipped in oil, causing red spots to appear, is it called Sha. Severe cases involve inability to vomit or defecate, dry heaving, and colic, called "Intestine-Twisting Sha." Recently, sudden Black Sha caused by foul toxic qi leads to sudden collapse, abdominal pain, black face, silence, and death within hours if untreated. Mild cases show alternating chills and fever, abdominal pain, numbness, dizziness, nausea, vomiting, coma, sweating, or faint rashes, indicating toxin erupting to the exterior. Cases with immediate diarrhea, cold extremities, abdominal distension, and absent pulse indicate toxin lurking internally, unable to reach the exterior, which is most violent. The *Classic* states that when pathogenic qi enters the zang-fu organs, sudden death can occur even without prior illness. Initially, apply paper twist cautery to the forehead, then take three qian of buckwheat flour mixed with warm water to settle. Buckwheat cleanses intestinal turbidity, descends Qi, widens the chest, and is specific for treating Sha toxin caused by turbid stagnation. For severe toxicity with black face, urgently prickle Weizhong (BL40) behind both knees to release black blood and vent toxin. Since this is a sudden disease, do not worry about deficiency; without this urgent draining method, one waits helplessly for death. Originating in the Mongolian north and spreading to the Central Plains, it is called Foreign Sha. It resembles Miasma (Zhangli); Miasma is caused by mountain misty qi, while this is caused by foul toxic qi. It is similar to epidemic febrile diseases, but epidemics spread door-to-door, whereas this strikes suddenly and kills within half a day, unlike epidemics which drag on. It resembles latent Qi in Cold Damage, but latent Qi heat-toxin moves from interior to exterior, whereas this is sudden exposure to alien qi affecting all levels and organs indiscriminately. It differs from Cold Damage and Summerheat due to deficiency, as this is not due to weak constitution failing to withstand climate. It resembles Cholera, but Cholera involves external pathogens combining with food/water qi, whereas here righteous Qi rebels violently and cannot resist the pathogen. It resembles Guan-Ge (Obstruction and Rejection), but Guan-Ge is blockage of upper and lower openings purely internal, whereas this includes exterior rash-Sha signs. Generally similar to Odor-Toxin, but Odor-Toxin involves foul qi, whereas this involves foul toxic qi, which is more severe. Initial stages feature deep coma, pulse is deep-hidden or unclear. Do not use warming medicines for abdominal pain and cold feet. If buckwheat is unavailable or ineffective, prioritize regulating Qi, e.g., Xiangsu San plus Bohe (Menthae Haplocalycis Herba) and Jingjie (Schizonepetae Herba) for acrid-cool exterior release. Next, dispel evil is key: Zhichi Tang plus Niubangzi (Arctii Fructus) and raw Gancao (Glycyrrhizae Radix) to detoxify and harmonize middle. If exterior heat is intense, clearing heat is urgent: Huangqin Tang plus Lianqiao (Forsythiae Fructus) and Mutong (Akebiae Caulis) to separate Yin and Yang. If vexation and abdominal distension appear with rapid pulse, urgently administer Liangge San to drain toxin downwards. If heat is severe with coma, even Sanhuang Tang may be incurable. If vexation, thirst, drinking, and urinary incontinence occur, quickly clear Yangming: Baihu Tang plus Congbai (Allii Fistulosi Bulbus) and Chiqiao (Perillae Fructus) to transform toxin via exterior. If dark red spots indicate toxin in Blood level, decochongwei (Leonuri Fructus) strongly, add raw honey, drink warm freely for fastest effect as it purges bad blood. Adding Radish juice utilizes its blood-dispersing power. These methods work only if no mistaken drugs were given previously. If families hesitate, do not treat lightly; changes happen instantly, bringing blame. Some mistake Cold Damage for dispersal, dying with purple cloud-like skin; some mistake Measles for Chengliu and Cherry Pit Decoction, dying from sore throat and loss of voice. Because they suddenly encounter foul toxic qi without clear pulse signs, differentiation is especially difficult. Modern times use fire cautery and pricking. Note: Caused by foul toxic qi is External Cause, so fire cautery is appropriate. Caused by foul odor/toxic qi is Neither Internal nor External Cause, requiring pricking to reduce momentum. However, if pricking yields no blood, it is incurable. (From *Zhangshi Yitong*)
Pulse Diagnosis
If symptoms resemble Taiyang chills and fever, and the pulse is long or short, large or small, present or absent, resembling a Gui (demon) pulse, it is Sha syndrome. (From *Shazheng Jiyao*)
Sha pulse differs from other syndromes. Cold Damage and Wind Strike have their own pulses; if complicated by Sha, the pulse changes, and the disease becomes violent. ○ Sha toxin suppresses meridians, so the pulse is often deep and hidden, resembling Yin syndrome pulse. One dose of warming/tonifying medicine causes immediate transformation. I have seen deep-micro or hidden pulses resembling direct invasion of the Three Yin. If external signs slightly mismatch, check for Sha veins: presence indicates Sha, absence indicates Yin syndrome. Treatment will then be accurate. After Sha release and medication, meridians unblock, and pulse returns to normal. ○ Sha toxin rushes through meridians and flesh-blood, so pulses can be surging-rapid, deep-tight, excessively large, or surging-strong, varying greatly. If pulse and signs mismatch, examine Sha veins. If present, wait until after release, then re-examine pulse to determine cold/heat/excess/deficiency. ○ Sha syndrome: micro-thin pulse indicates survival; solid-large-rapid pulse indicates severity; surging-excessive pulse indicates peril. Absent pulse in one section is mild; absent in one hand is severe; absent in both hands is fatal. Rootless six pulses with strange pulses, unresponsive to Sha release and medication, is fatal. (From *Shazhang Yuheng*)
Selected Cases
My wife, during early cold weather, contracted Yin-Cold Sha toxin. She vomited, felt nauseous, and had agonizing abdominal pain, unstoppable. Salt water induced vomiting, but pain did not decrease. After several episodes, Qi rose further, pain intensified, blocking throat, unable to speak or swallow, critical moment. I recalled learning scraping therapy years ago. Selected a porcelain bowl, added one or two spoons of sesame oil to hot water, dipped bowl rim in oil-water mix to make it warm and slippery, placed it on patient's back, and scraped gently downwards, increasing pressure gradually. When bowl cooled, re-dipped and scraped. After a while, chest distension eased, she could speak. Soon, bowel sounds roared, massive diarrhea ensued, pain decreased. After diarrhea, she slept, body itched intensely, releasing countless wheals/hives. Upon recovery, I pondered the principle: Five Zang connections attach to the back. Scraping downwards causes pathogenic Qi to descend. Toxic vapors rising are rebellious, descending are smooth. Although arm scraping exists, for deep toxin and urgent disease, back scraping is essential. The hives formed because cold-toxin qi filled the body, closing exterior-interior and meridians-organs. Unregulated Zang Qi means exterior remains unresolved; unresolved exterior pathogen means Zang remains disharmonious. This interconnection explains why treatment prioritizes urgency. (Zhang Jingyue)
A merchant arrived in Wu-Hui, drank and sang, suddenly felt uneasy, asked for ginger soup, took one sip, and died. Another northern traveler bathed in Feng Hun Tang, suddenly dizzy and vomiting, died upon reaching the boat. A physician later developed chills, fever, abdominal pain after meals, cold extremities, and died before nightfall. A scholar visiting the city for mourning returned with abdominal pain, restlessness, incoherent speech, blurred six pulses, and died that night. A young newlywed suddenly suffered abdominal pain, numbness, dizziness. Someone gave him half a cup of fiery wine, worsening pain, adding head distension, red spots on body. Given Reed Rhizome juice, he vomited and recovered. Later, a man with epistaxis and dry mouth had slight red spots on chest/abdomen. Sipping child's urine provided slight relief. Doctor prescribed thick decoction of Congchi Tang with child's urine, he vomited and sweated, then recovered. (From *Zhangshi Yitong*)
Attached Formulas
Fangfeng San Sha Tang: For Sha caused by Wind. Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Herba), Xixin (Asari Radix et Rhizoma), Zhike (Aurantii Fructus), Chenpi (Citri Reticulatae Pericarpium), Jinyinhua (Lonicerae Japonicae Flos).
Chenpi Houpo Tang: For Sha caused by Qi obstruction. Chenpi (Citri Reticulatae Pericarpium), Houpo (Magnoliae Officinalis Cortex), Wuyao (Linderae Radix), Qingpi (Aurantii Fructus Immaturus), Shanzha (Crataegi Fructus).
Taoren Honghua Tang: For Sha with Blood knotting not dispersing. Taoren (Persicae Semen), Honghua (Carthami Flos), Sumu (Pterocaryx Branch), Qingpi (Aurantii Fructus Immaturus), Wuyao (Linderae Radix), Duhuo (Angelicae Pubescentis Radix), Bajieli (Tribuli Fructus).
Chenxiang Yujin San: For Sha with Cold coagulation. Chenxiang (Aquilariae Lignum Resinatum), Yujin (Curcumae Radix), Muxiang (Vladimiriae Radix), Jiangxiang (Daemonorops Spatha), Wuyao (Linderae Radix), Xixin (Asari Radix et Rhizoma). Powder, 3 fen per dose, taken with Amomum water, slightly cool.
Bingpeng San: For Sha throat swelling/pain. Bingpian (Borneolum Syntheticum), Pengsha (Borax), Yuanmingfen (Mirabilite), Tianzhuhuang (Calami Tuber). Powder, insufflated into throat.
Baohua San: Fairy formula for Sha. Yujin (Curcumae Radix), Xixin (Asari Radix et Rhizoma), Jiangxiang (Daemonorops Spatha), Jingjie (Schizonepetae Herba). Powder, 3 spoons per dose, taken with clear tea, slightly cool.
Jijiu Shenfang: Emergency divine formula for Sha jaw stiffness, closed eyes, throat swelling, severe heart/abdominal colic. Yazao (Gleditsiae Spina), Xixin (Asari Radix et Rhizoma), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Bohe (Menthae Haplocalycis Herba), Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix), Muxiang (Vladimiriae Radix), Kufan (Alumen), Xionghuang (Realgar), Guanzhong (Cyathulae Radix), Zhusha (Cinnabar). Powder in porcelain bottle. 3 fen insufflated into nose, then 1 qian washed down with light ginger soup. After taking, inspect heart pit, back, under tongue for red dots with red paper twist, prick with silver needle.
Leg Crease Sha Vein Pricking Method: Fine veins above/below popliteal fossa, purple or red, are Sha veins. Pricking releases purple-black toxic blood. Do not prick large thigh tendons (no blood, causes irritability). Do not prick hard tendons in leg creases (may cause tendon contraction in arm creases). Vein colors identified similarly. Vertex pricking only pierces skin slightly to release micro-blood for toxin venting; do not thrust deeply. Finger tip pricking near nail causes dizziness. All pricking methods involve minimal needle insertion, not deep.
Scraping Method: Back spine, neck bone, chest, ribs, arms: scrape with copper coin or tongue scraper dipped in sesame oil. Head, forehead, legs: scrape with hemp thread dipped in sesame oil. Lower abdomen soft flesh: rub with salt.
Wool Sha Rubbing Method: Symptoms include aversion to cold, high fever, head/body pain/distension, nausea, vexation. First rub chest/back/limbs with fresh ginger, then frequently rub with green cloth dipped in hot water. White hairs emerging indicates cure. Sometimes sticky rice cake is used. Common in Hubei, called Wool Sha.