凡心腹胀痛因痧，既知之矣。痧症仍有不痛不胀者，或兼痧或暗痧，误饮温热，便致凶危等也。余窃谓∶凡遇危症，
病家不识痧筋，犹用刮痧可辨。医家或认脉不清，尚有痧筋可详，若内人不便阅视，果缘痧胀凶极，脉未有对症者，以
是辨之，百不失一也。
胀者，气之闭也。气为毒壅，故作肿作胀，所以治痧，先当治气。如食阻其气于上则吐之；食壅其气于中则消之；
食化而结其气于下则导之，凡诸积之阻滞概然。凡下窍闭者，多上吐，或吐蛔或吐血，当导气于下。中窍闭则下泻，或
泻水或泻蛔，当行气于中。上窍闭而复升则作闷，或头疼或上肿，俱当用清凉引下之。至如气为毒壅必伤血分，若乃血
为毒凝，活血为上；血为毒壅，破血为先；血为毒聚且结，败血为要；故治痧必兼治血，盖血活毒瓦斯行，血破毒瓦斯走，
血败毒瓦斯散。如是，毒瓦斯不留，治斯效也。
凝壅聚结，皆为血分痧毒恶症，其间有轻重之别。凝者，初犯之症；壅者，凝多而壅；聚者，血壅或左或右；结者，
血滞一处。故痧毒中血分，结为重，聚次之，壅又次之，凝为轻。凝以红花、泽兰为主；壅以延胡索、桃仁为主；聚以
苏木、茜草为主；结以五灵脂、降香为主。轻者用药不可重，重则恐伤本原；重者用药不可轻，轻则治之不效。
治验∶
一尹钧万咳嗽痰喘，有以紧劳治之，病日增，背鞠如弓，手足蜷紧，不能展动，咳则胸腹百骸吊痛。延余诊之，脉
洪大无伦，此毒血壅聚也。兼又难刮、难放，先以圆红散微冷冻饮料之，两手稍松，渐为放刮讫，又以圆红散加三七、郁金
末微温饮之，更以苏木、茜草为主，多加顺气活血之类，如前饮之。计日放痧一次者四，日用药一服者五，遂痊。
一万君安内室，两胁如痞，按之则痛，心胃间高起，服药难疗。延余，左脉微细，右脉洪大，此慢痧，痧毒结聚也。
计放痧三次，付以五灵脂、降香为主，加桃仁、延胡索及消食行气之类，日用一服，计十二剂如旧。
一陈弘业，寒热呕吐，苦难俯仰，腹中胀痛，夜不能寐，六脉弦细而紧数，刮放略松，用红花、泽兰、刘寄奴、茜
草、桑寄生，并行气消食之药，微温饮之，二剂而愈。
Whereas heart and abdominal distension and pain caused by Sha (a pathogenic factor characterized by toxicity and stagnation) have been understood, there are still cases of Sha syndrome presenting without pain or distension. These may involve concurrent Sha symptoms or hidden Sha; if mismanaged with warm and hot remedies, it can lead to critical and dangerous conditions. I suggest that in any critical case, if the patient's family cannot identify the Sha veins (visible cyanotic vascular patterns on the skin), scraping therapy (Gua Sha) can be used for differentiation. If a physician is unclear about the pulse, the Sha veins provide detailed diagnostic information. Even if internal examination is不便 (inconvenient due to propriety), if the Sha distension is extremely critical and the pulse does not match the symptoms, this method of differentiation is infallible.
Distension refers to the closure of Qi mechanism. When Qi is obstructed by toxic pathogens, swelling and distension occur. Therefore, treating Sha requires first regulating Qi. If food obstructs Qi in the upper jiao, emesis should be induced; if food stagnates Qi in the middle jiao, digestion should be promoted; if digested food forms knots obstructing Qi in the lower jiao, purgation or guiding downward should be employed. This applies generally to all types of accumulation and obstruction. When the lower orifices are blocked, vomiting often occurs, possibly expelling roundworms or blood; thus, guiding Qi downward is necessary. When the middle orifices are blocked, diarrhea ensues, possibly expelling water or roundworms; thus, moving Qi in the middle is required. When the upper orifices are blocked and Qi rebels upward, stifling sensation, headache, or upper body swelling may occur; cool-natured herbs guiding Qi downward should be used. Since Qi obstruction by toxins inevitably damages the Blood level, if Blood is coagulated by toxins, invigorating Blood is paramount; if Blood is congested by toxins, breaking Blood stasis is prioritized; if Blood is gathered and knotted by toxins, dissipating stagnant Blood is essential. Thus, treating Sha must concurrently treat Blood: when Blood moves, toxic vapors circulate; when Blood stasis is broken, toxic vapors disperse; when stagnant Blood is resolved, toxic vapors scatter. In this way, toxic vapors do not remain, and treatment is effective.
Coagulation (Ning), congestion (Yong), gathering (Ju), and knotting (Jie) are all severe manifestations of Sha toxins affecting the Blood level, varying in severity. Coagulation represents the initial stage; Congestion indicates significant coagulation leading to blockage; Gathering refers to Blood congestion located either left or right; Knotting signifies Blood stagnation localized in one area. Among these, within the Blood level involvement of Sha toxins, Knotting is the most severe, followed by Gathering, then Congestion, with Coagulation being the mildest. For Coagulation, Hong Hua (Carthami Flos) and Ze Lan (Lycopus Herba) are primary; for Congestion, Yan Hu Suo (Corydalis Rhizoma) and Tao Ren (Persicae Semen) are primary; for Gathering, Su Mu (Sappan Lignum) and Qian Cao (Rubiae Radix et Rhizoma) are primary; for Knotting, Wu Ling Zhi (Trogopterori Faeces) and Jiang Xiang (Aquilariae Lignum Resinatum) are primary. Mild cases require light medication to avoid damaging the root essence; severe cases require potent medication, as mild treatment will be ineffective.
Case Verification 1: Yin Junwan suffered from cough, phlegm, and wheezing. Treated for consumption with tightness, his condition worsened daily. His back became arched like a bow, hands and feet curled tightly, unable to extend. Coughing caused pulling pain throughout the chest, abdomen, and bones. Upon consultation, the pulse was excessively flooding and large, indicating toxic Blood congestion and gathering. Scraping and bleeding were difficult to perform initially. He was first given Yuan Hong San (Round Red Powder) cooled slightly and drunk. His hands relaxed slightly. After gradual scraping and bleeding, he drank Yuan Hong San added with San Qi (Notoginseng Radix) and Yu Jin (Curcumae Radix) powder at a lukewarm temperature. Subsequently, Su Mu and Qian Cao were used as main ingredients, supplemented with Qi-regulating and Blood-invigorating herbs, administered similarly. He underwent Sha release four times over several days and took five doses of herbal medicine daily, eventually recovering.
Case Verification 2: The wife of Wan Anjun experienced a feeling of fullness and pain upon pressure in both hypochondriac regions, with a raised area between the heart and stomach, resistant to standard medication. Consultation revealed a fine and minute left pulse and a flooding right pulse, indicating slow Sha with toxin knotting and gathering. She underwent Sha release three times. Prescription centered on Wu Ling Zhi and Jiang Xiang, augmented with Tao Ren, Yan Hu Suo, and herbs for digesting food and moving Qi. One dose daily for twelve doses resulted in complete recovery.
Case Verification 3: Chen Hongye presented with alternating chills and fever, vomiting, severe discomfort preventing bending or straightening, abdominal distension and pain, and insomnia. The six pulses were wiry, fine, tight, and rapid. After slight relief from scraping and bleeding, he was treated with Hong Hua, Ze Lan, Liu Ji Nu (Agrimoniae Herba), Qian Cao, Sang Ji Sheng (Taxilli Herba), combined with Qi-regulating and food-digesting herbs, taken lukewarm. Recovery occurred after two doses.