痧气慢者，上开于三阳头面，常觉头眩内热；或半边头
痛，心烦不安；宜刮痧，不愈，用清凉之剂治之。
治验∶
一钟仲宣数数头眩，日渐益甚，或时右偏头痛，脉症不合，刮痧，不药而痊。
一潘尚峰苦头眩，或左偏头痛，服他药不应。延余，脉微与症不合，放痧不愈，用清热下气之剂而痊。
痧毒传变，不待时日，朝发于足而足肿痛，夕流于手而手肿痛；朝发于肌肤而肌肤红肿，夕入于里而痰喘不休；此
等之痧，乍隐乍现，乍来乍去。按之脉，而痧脉或不现，最难识认。如痧毒所流及之处，热者似流火而非流火，肿者似
流痰而非流痰，或痛极难忍，或痒痛不已，又痧之变者也。欲知此痧，须看病势凶暴，不比流痰流火之轻缓者，验之于
痧筋，发现刺之无疑。然后凭脉，所犯风寒暑湿及食积痰血气阻，分治之，斯能有效。如或不觉，便成死症。
治验∶
一张宏原内室，日间左足小腿红肿大痛，暮即腹痛而足痛止。次日，左足小腿又复红肿大痛，而腹痛又止，来去
不常，痛无一定。延余诊之，六脉如常，而微数，此平人之脉也。难据为痧，但症异凶暴，须看痧筋，发现便有实据，
可从痧而理也。扶看腿弯有青筋三条，刺之，紫黑毒血流出甚多，反加痰喘，此放痧有未尽故也。用荆芥金银花汤加土
贝母二钱，微冷服二剂，少愈。次日，左足腿弯下，又现痧筋一条，刺去毒血并刺巅顶一针，服前汤加牛膝三钱，二剂
痧退。服红花汤，半月肿痛俱痊。
一葛隆生次子，清晨臂上红肿大痛。次日变为足腿上红
肿大痛，乍来乍去。隆生以为流火使然。延余，诊其脉，厥厥动摇，数而又疾。余曰∶“脉异于常，而症多变，殆其痧
欤”。不信，服热汤，二日而殂。
一奚敬峰晚间，右大腿红肿痛方已，喉旁发肿而痛。延余，脉不见异，初不觉其为痧也。只见时症犯此者多，细看
两臂痧筋，刺出毒血如注。诊气口脉洪实，用紫朴汤倍山楂、卜子，加大黄一钱，微冷冻饮料之，食消便下而安。
When Sha Qi (Sha pathogen) develops slowly, it ascends to the head and face of the Three Yang meridians (Taiyang, Yangming, Shaoyang), often causing dizziness and internal heat; or half-head pain, with mental restlessness and unease. Scraping therapy (Guasha) is suitable. If ineffective, treat with cooling formulas.
Case records:
Zhong Zhongxuan frequently suffered from dizziness, which worsened day by day, sometimes accompanied by right-sided headache. The pulse did not match the symptoms. After scraping therapy, he recovered without taking medicine.
Pan Shangfeng suffered bitterly from dizziness, sometimes with left-sided headache, but other medicines were ineffective. Upon my consultation, the pulse was faint and inconsistent with the symptoms. After bloodletting (Fangsha), there was no improvement, so I used a formula for clearing heat and descending qi, after which he recovered.
The transmission and transformation of Sha toxin do not wait for long periods. It may start in the feet in the morning causing swelling and pain, and flow to the hands by evening causing similar symptoms; it may appear on the skin and muscles in the morning causing redness and swelling, and enter the interior by evening causing incessant phlegm and wheezing. Such Sha syndromes appear and disappear suddenly, come and go unpredictably. When palpating the pulse, the Sha pulse may not manifest, making it hardest to identify. Wherever the Sha toxin flows, if hot, it resembles Liu Huo (Flowing Fire/acute erysipelas) but is not Liu Huo; if swollen, it resembles Liu Tan (Flowing Phlegm/chronic abscess or lymphadenitis) but is not Liu Tan. It may cause unbearable pain or unceasing itching and pain, representing variations of Sha syndrome. To diagnose this type of Sha, one must observe if the disease course is fierce and violent, unlike the mild and slow progression of Liu Tan or Liu Huo. Verify by examining "Sha Jin" (visible subcutaneous blue-purple veins); if found, puncture them without doubt. Then, rely on the pulse to differentiate whether the cause is external Wind-Cold-Heat-Dampness or internal Food Stagnation, Phlegm, Blood Stasis, or Qi obstruction, and treat accordingly for effectiveness. If unrecognized, it becomes a fatal condition.
Case records:
The wife of Zhang Hongyuan had redness, swelling, and severe pain in her left lower leg during the day, which ceased when abdominal pain started in the evening. The next day, the left lower leg became red, swollen, and painful again, while the abdominal pain stopped. The symptoms came and went irregularly, with no fixed location for pain. Upon consultation, the six pulses were normal, slightly rapid, typical of a healthy person. It was difficult to attribute this to Sha based on the pulse alone. However, given the abnormal and violent nature of the symptoms, checking for Sha Jin was necessary. Finding them provided concrete evidence to treat as Sha. Lifting the leg revealed three blue veins at the popliteal fossa. Puncturing them released a large amount of dark purple-black toxic blood, which temporarily worsened the phlegm and wheezing due to incomplete bloodletting. I prescribed Jingjie Yinhua Tang (Schizonepeta and Honeysuckle Decoction) with Er Chen Mu (Fritillaria Thunbergii Bulb) 2 qian, taken cool. Two doses brought slight relief. The next day, another Sha Jin appeared below the left popliteal fossa. I punctured it to release toxic blood and also punctured the Baihui point (DU20) on the vertex. She took the previous decoction with Niuxi (Achyranthes Root) 3 qian for two doses, after which the Sha receded. Finally, she took Honghua Tang (Safflower Decoction), and within half a month, both swelling and pain completely resolved.
The second son of Ge Longsheng had redness, swelling, and severe pain on his arm in the early morning. The next day, it shifted to his legs, appearing and disappearing intermittently. Ge Longsheng believed it was Liu Huo (Flowing Fire). Upon consultation, the pulse was trembling and erratic, rapid and swift. I said, "The pulse differs from the norm, and symptoms are variable; it is likely Sha." He did not believe me and administered hot decoctions, leading to death after two days.
Xi Jingfeng, in the evening, had just recovered from redness, swelling, and pain in his right thigh, when swelling and pain developed beside his throat. Upon consultation, the pulse showed no abnormalities, and initially, Sha was not suspected. Given that many seasonal diseases present similarly, I carefully examined the Sha Jin on both arms and punctured them, releasing gushing toxic blood. The Qi Kou pulse (radial artery at the wrist) was surging and solid. I used Zipo Tang (Magnolia Bark and Bupleurum Decoction) with doubled Shan Zha (Hawthorn Fruit) and Bo Zi (Radish Seed), plus Da Huang (Rhubarb Root) 1 qian, served chilled. After digestion cleared and bowels moved, he stabilized.