人有内伤，讵无外感。外感之症，不独风寒，即夏月暑热之气，时疫传染之气，秽恶触犯之气，一受于身，亦如外
感。然则内伤者本病，外感者标病。故伤寒集中，有内伤外感之症，此之集中，有内伤兼痧之症。治法主意，先辨痧症
治其标，后审内伤治其本。
治验∶
一曹洪宇子之外戚，争夺家产，涉讼公庭，有老妇造其家，互相争殴，发热沉重，咳嗽吐痰，胸中胀闷，诸亲戚惟
恐毙于曹姓室中。延医青来王兄，更邀余往视，青来几不敢任，余怜悯此妇不治，入命重情，彼此俱败，若一救之，不
特活妇一命，亦且保全两家，是亦大德。余为诊之，知其内伤兼痧症也。刺痧筋二十余针，付宝花散微温服之，胀闷稍
松。爰定一方，即于青来厢中取药，用桃仁、赤芍、泽兰、玄胡索、红花、陈皮、乌药、独活，治其内伤。服后，下黑
粪，瘀血俱消，诸症俱愈。但其旧有不足之症，非参不可，后青来用参 大补，乃健而归。
痧症不内攻则外溃，余于发蒙论中，已略陈其概矣。无
如痧症变异，更有难尽述者，即若为肿为毒之外，又有发为紫血 者，此真痧之异者也。余故记之以例其余。
治验∶
一余邻许秀芝女，嫁为养媳妇，手足下半身俱肿，大腹亦胀，发出两腿足紫血 ，如圆眼大，密难数记，皆云此烂
疯之症，服药益甚。秀芝怜惜其女，载与俱归，求余治。视 多可畏，及见有痧筋，发现于腿弯，方知痧者，尤树之根
者，尤树之叶也。遂为放痧三针，又刺指头痧二十一针，尽去其毒血。复诊其脉，六部俱和，殆其痧毒之气已散，但
存
肌表紫 而已，用苏木、红花、泽兰、桃仁、乌药、桔梗、川芎、牛膝，二剂温服，凡紫血 尽收靥结痂而愈。
Humans with internal injury (internal damage) certainly also have external contraction (external pathogenic invasion). The symptoms of external contraction are not limited to wind-cold; even in summer, the qi of summer-heat and dampness, the qi of epidemic contagion, and the qi of foul and noxious contact, once invaded by the body, are also like external contraction. However, internal injury is the root disease (ben), and external contraction is the branch disease (biao). Therefore, in the *Shanghan Lun* (Treatise on Cold Damage), there are cases of internal injury combined with external contraction; in this book, there are cases of internal injury combined with sha syndrome (a condition characterized by toxic heat and blood stasis often associated with miasma or acute infectious diseases). The main principle of treatment is first to differentiate sha syndrome and treat the branch, then to examine internal injury and treat the root.
Case Record:
The son-in-law of Cao Hongyu's relative, due to a dispute over family property and litigation in court, had an old woman come to his house where they fought each other. He developed fever with heaviness, coughing with expectoration, and chest distension and oppression. All relatives feared he would die in the Cao household. They invited the physician Qinglai (Brother Wang) for consultation and also invited me to examine him. Qinglai was almost afraid to take responsibility. I pitied that if this woman were not treated, it would involve a heavy life-and-death situation and serious legal implications, causing both sides to fail. If saved, not only would one life be preserved, but two families would be protected, which is also a great virtue. I examined her pulse and determined she had internal injury combined with sha syndrome. I punctured the sha veins (visible subcutaneous veins indicating stasis) more than twenty times, administered Baohua San (Treasure Flower Powder) lukewarm, and the distension and oppression slightly relieved. Then I prescribed a formula, obtaining herbs from Qinglai's side room, using Tao Ren (Peach Kernel), Chi Shao (Red Peony Root), Ze Lan (Euphrasia Herb), Yuan Hu Suo (Corydalis Rhizome), Hong Hua (Safflower), Chen Pi (Aged Tangerine Peel), Wu Yao (Lindera Root), and Du Huo (Angelica Pubescens Root) to treat the internal injury. After taking the medicine, black stool was passed, blood stasis was eliminated, and all symptoms resolved. However, she had pre-existing deficiency conditions requiring Ginseng (Ren Shen); later, Qinglai used Ren Shen for major tonification, and she recovered health and returned home.
If sha syndrome does not attack inward, it will ulcerate outward. I have briefly outlined this in my *Fa Meng Lun* (Treatise on Enlightening the Ignorant). Unfortunately, the variations of sha syndrome are too numerous to describe completely. Besides manifesting as swelling and toxicity, there are cases manifesting as purple blood spots, which are true variations of sha. Therefore, I record this to exemplify others.
Case Record:
My neighbor Xu Xiuzhi's daughter, married as a foster daughter-in-law, had swelling in her hands, feet, and lower half of the body, with abdominal distension. Purple blood spots appeared on both legs and feet, the size of longan seeds, so dense they could hardly be counted. Everyone said this was "rotten madness" (a severe skin disease), and medication made it worse. Xiuzhi, pitying her daughter, brought her back to seek my treatment. The lesions were mostly terrifying to look at. Upon seeing sha veins appearing in the popliteal fossae (back of the knees), I realized that sha syndrome is like the root of a tree, while symptoms are like its leaves. I then performed sha release (bloodletting) three times and punctured twenty-one sha points on the fingers, draining all toxic blood. On follow-up examination, the pulses in all six positions were harmonious, suggesting the sha toxin qi had dispersed, leaving only the purple blood spots on the skin surface. I prescribed Su Mu (Sappan Wood), Hong Hua (Safflower), Ze Lan (Euphrasia Herb), Tao Ren (Peach Kernel), Wu Yao (Lindera Root), Jie Geng (Platycodon Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome), and Niu Xi (Achyranthes Root), taken warm for two doses. All purple blood spots scabbed over and healed.