（俗称冷痧。势急者又名急痧。势缓者则名慢痧）。
【因】日间触闻臭秽。夜间露宿贪凉。其大要也。夏秋最多。缓则寒湿凝滞于脉络
。或湿热郁遏于经隧。急则鼻闻臭毒而阻逆上气。或内因食积而壅塞中气。皆能气胀成痧
。故通称痧气。又称痧胀。或称痧秽。
【证】头胀晕痛。发热恶寒。胸闷气逆。腹痛胀满。轻现红点。重现青筋。甚有上
下不通。吐泻不得。四肢厥逆。
绞肠剧痛。或挟臭毒。或挟食滞。面色青黯而指甲亦青。舌苔灰白而滑者。冷痧夹食
也。面色紫浊而指甲亦紫。舌红苔白而糙者。热痧夹食也。甚或猝然腹痛昏倒。面色黑
胀。不呼不叫。舌苔灰腻者。此为痧闭。证最危急。亦有一发即洞泄肢冷。腹胀无脉。舌
苔白腻者。此为痧泻。证亦凶险。
【脉】沉弦而滞。甚则沉伏者。此寒闭于外。痧郁于内。气郁血凝而不能外达也。
若沉弦而数。甚则沉牢者。此冷食中阻。痧毒内伏。湿遏热结而不能外发也。初尚弦劲搏
指。继则昏厥无脉者。《内经》所谓大气入于脏腑。病多猝死是也。
【治】伤寒兼痧者。先去外寒。急用辛香流气以发表。香苏葱豉汤去甘草。加
越鞠丸（三钱）白蔻末（六分冲）、继辨其因以去痧。寒湿凝滞脉络者。急用辛温流气
以芳透。仁香汤加浙苓皮（四钱）、生苡仁（六钱）、湿热郁遏经隧者。急用苦辛凉淡
以疏利。藿香正气汤加辰砂拌滑石（五钱）、绵茵陈（三钱）、焦山栀（三钱）。臭毒
阻逆上气者。急用芳香辟秽以宣上。连翘栀豉汤加紫金锭（二枚、磨汁冲）。食积壅塞
中气者。若其人吐泻不得。急用涌吐法。炒盐汤冲生萝卜汁。继用理气法。香砂二陈汤
冲紫金锭汁。若其人泻利无脉。当辨阴阳。阴痧急用正阳四逆汤。以回阳通脉。阳痧
急用红灵丹。（一二分、凉开水调下。）或行军散。（二三分、鲜石菖蒲汤调下。）以
开关通脉。至其外治法。轻则用刮痧法。（用瓷碗盖搽香油。刮肩背及手足臂湾等
处）。搐鼻法。（用通关散吹入鼻孔以取嚏）。重则用刺痧法。（用银刀刺入少商、中
冲、尺泽、委中、及舌紫筋出血以放痧）。此皆宣气活血。内外开通之法也。
【秀按】自古医书。从无痧证之名。始见于赵宋三世医张季明医说。引叶氏录验方
辩痧一则。谓痧病江南旧无。今东西皆有之。其证初发寒栗似伤寒。状似疟。头疼壮热
。手足厥冷。初以饮艾汤试吐。即是其证。急以五月蚕蜕纸一片。剪碎按碗中。以盘盖
密。以沸汤泡半碗许。仍以纸封盘缝。勿令透气。良久。乘热饮之。就卧。以浓衣被盖
之。令汗透便愈云云。此即后世所谓冷痧之滥觞也。继起者。前明张景岳。着刮痧新案
。其说简略。惟国初郭张王三家。各有发明。郭右陶着痧胀玉衡。其说甚辩。大旨谓书
虽不载痧名。而所云青筋白虎。中恶。干霍乱等名。实皆痧证之见于诸书也。至俗称
绞肠痧。由来已久。其病种种不一。或为暗痧。或为闷痧。或为痧晕。或为痧痛。或为
痧胀。或为痧块。或现痧筋。或现痧斑。总由于气郁血凝。湿滞食积。其总因则以地方
不洁。冷热不调。饮食不节。情志不畅者居多。看法。先辨表里。次辨冷热。其治法。
痧在肌肤。当刮即刮。痧在血肉。当放即放。痧在胃肠经络。当药即药。若痧气横行。
表里充斥。当三法兼用。刮痧用油盐搽在瓷碗盖中。先刮胸前脘腹。次刮后背脊骨。又
次刮手足两湾。使痧毒不致内攻。放痧要看痧筋。痧筋色青者。血毒初郁。证尚轻而易
放。色紫红者。血毒已盛。证已重而难放。色黯黑者。证极重而放亦不出。或现于数处
。或现于一处。必须用银针刺之。去其毒血。一放头顶百会穴。一放两太阳穴。一放印
堂。一放舌下两旁。一放喉外两旁。一放双乳两旁。均须浅刺。一放两手足十指头。
一放两臂腿湾。均须深刺。放尽然后审因用药。痧因气郁者。藿香汤（杜藿香、制香附
、小青皮各钱半、生枳壳、苏薄荷、青连翘各一钱、略煎数沸、稍冷服。）理气避秽。
痧因血结者。必胜汤（光桃仁、炒山楂、生川军、五灵脂、小青皮、赤芍各一钱、制香
附钱半、川贝二钱、杜红花四分、煎十余沸微温服。）破血散结。痧因食结者。宣化饮
（新会皮、大腹皮、炒麦芽、前胡各钱半、炒萝卜子三钱、小青皮一钱、先用小山楂一
两、煎汤代水、煎成去渣、稍温服。）消食和气。痧因窍闭者。牛黄八宝丹（西黄、琥
珀、辰砂、梅冰、雄精各一钱、羚角片、明乳香各三钱、犀
角片钱半各为细末、先用蜜银花、紫花地丁各二两、川贝、川连各三钱、煎胶、打糊
为丸、每丸重二分、年幼者一丸、长者二丸、鲜石菖蒲叶一钱、灯心三小帚、鲜卷心竹
叶三十六枝、煎汤调下。）开窍透毒。痧因斑隐者。活络透毒饮（荆芥穗、小青皮、净
蝉衣各一钱、青连翘、蜜银花各钱半、炒牛蒡、紫花地丁各二钱、杜红花五分、先用活
水芦笋一两、大青叶四钱、煎汤代水。）解毒透斑。痧因痰壅者。清气化痰饮（光杏仁
、川贝各二钱、广橘红、生枳壳、小青皮各一钱、莱菔子二钱、天竺黄三钱、白蔻末五
分冲、煎成、微冷服。）理气消痰。至于伤寒兼痧。必先治痧。痧退后。乃治伤寒。痧
类伤寒。轻则刮痧。重则放痧。用药以理气活血透窍解毒为主。切忌误认伤寒。妄用辛
温发汗。反助痧毒益张。慎之。张路玉。着臭毒番痧二则。谓触犯臭秽。腹痛呕逆。世
俗以瓷器蘸油。刮其脊上。随发红斑者。俗为之痧。若感恶毒异气。腹疼肢麻。呕恶神
昏。骤发黑斑。起于漠北。流入中原者。俗名番痧。欲吐不吐。欲泻不泻。干呕绞痛者。
曰绞肠痧。甚或形寒肢厥。面青脉伏。或壮热神昏。面紫脉坚。此由其人素体火衰火盛
。猝中恶毒异气。俗称冷痧热痧之别也。其病与瘴疠相似。霍乱相类。缓则尚可迁延时
日。急则夕发早死。初觉先将纸捻点淬头额。即以荞麦焙燥。去壳取末三钱。冷开水调
服。重者少顷再服即安。盖荞麦能炼肠胃滓秽。降气宽胸。善消浊滞。为痧毒之专药。
其毒甚面黑者。急于两膝后委中穴刺出恶血。以泄毒邪。如荞麦一时莫得。或服之不应
。即宜理气为先。如香苏饮加薄荷荆芥。辛凉透表。次则避邪为要。栀子豉汤加牛蒡、
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。烦渴引饮
遗溺。速清阳明。白虎汤加葱豉。斑点深赤。毒在血分者。浓煎益母草两许。少投生蜜
。冲入生莱菔汁半杯。放温恣服。散其恶血。取效最捷。此皆使毒从表化。若见烦扰腹
胀。便闭脉疾。表里俱急者。急投凉膈散。使毒从下泄。世俗有用水搭肩背及臂者。
有以苎麻水湿刮之者。有以瓷碗油润刮之者。有以瓷锋刺委中出血者。有以炒盐探吐
者。有以冷水送下川椒数粒者。有以研生白矾冷水调服二三钱
者。有以油纸点照。视背上有红点处皆 之者。总欲使腠理开通。气血畅达之意耳。其
脉多伏。即不伏亦浑浑不清。或细小紧涩。或紧劲搏指。中带促结。皆是阴匿阳伏之象
。不可误认阴寒而投热药。亦勿以腹痛足冷而与温药。若见面青唇黑。脉劲搏指。厥逆
喘促。多不可救。王晋三着古方选注。中有论痧一则。谓痧者。寒热之湿气。皆可为患
。轻则胃脘气逆。胀满作痛。甚则昏愦欲死。西北人以杨柳枝蘸热水鞭其腹。谓之打寒
痧。东南人以油碗或油线。刮其胸背手足内 。谓之刮瘀。以瓷锋及扁针。刺舌下指尖
及曲池委中出血。谓之 痧。更服神香散（公丁香、白豆蔻各七粒、为末、清汤调下
、如小腹痛者、加春砂仁七粒。）以治寒湿痧胀。益元散（滑石六钱、生甘草一钱、辰
砂一钱、为末、每服三四钱。）以治湿热痧胀。均有神功。是皆内外兼治以泄其气。则
气血得以循度而行。其胀即已。非另有痧邪也。近世俗医。另立痧科。凡见腹痛胀满。
烦闷不安。咸谓之痧。惟欲自炫其术。反戒患家勿轻用药。殊堪捧腹。合观三论。右陶
因龚云林青筋之说。而着痧胀玉衡。名状甚多。而痧之证治乃备。路玉分臭毒番痧为
二。谓恶毒疠气。甚于秽浊。晋三辨痧即外邪骤入。阻塞其正气。气血失循行之道。而
痧之病理益明。
【廉勘】宋明时诸前哲。及前清国初石顽老人。痧皆作沙。其说有三。一谓溪砾中
沙虱射人之毒瓦斯。一谓沙漠中恶毒之异气。一谓尘沙中臭秽之恶气。故其病有沙涨沙秽
之名。后贤以其为病。乃加 焉。窃谓麻疹之俗称。亦名曰痧。未免彼痧与此痧相混。
不如遵宋张季明医说。仍书沙证。较为典雅。若以其执沙刮沙之后。皮肤现红点或紫黑
点者。故名曰痧。则凡皮肤不现痧点者。抑又何说。其实即系各区之地方病也。故又有
翻挣龌龊之别名。其俗名约有百数十种。较古今风病伤寒为尤繁。类皆见形取名。并无
坚义。而于病因病理。反多缺而不讲。王晋三所谓俗医自炫其术是也。余于沙秽一症。
历经实验。三十余年来。确知沙之为病。赅夏秋杂感而统称之也。就予所见。可先分为
两大端。一凡无传染性者。曰恒沙。一凡有传染性者。曰疫沙。于恒沙中。又分
为湿秽暑秽两种。再辨其所夹何邪。或夹气郁。或夹血瘀。或夹食积。或夹痰水。审其
因而治之。疫沙乃一种中毒性之急证。虽证有阴阳之别。而其受恶菌之毒则一。前哲名
病曰中恶。见证曰青筋。早已表明疫沙之病因病状。而王清任谓疫邪吸自口鼻。由气管
达于血管。将气血凝结。初得病时。宜即用针刺尺泽穴出紫黑血。使毒瓦斯外泄。一面以
解毒活血之药治之。则更发明疫沙治法之正的矣。就余所验。外治除提刮针刺诸法外。
先用飞龙夺命丹（辰砂二钱、明雄黄、灯心灰各一钱、 人中白八分、明矾、青黛各五
分、梅冰、麻黄各四分、真珠、牙皂、当门子、硼砂各三分、西黄二分、杜蟾酥、牙硝
各一分五厘、金箔三十页、十六味各研极细、合研匀、玻瓶紧收。）少许。吹鼻取嚏
。即嚏者轻。无嚏者重。即以阿 呢哑水（按∶即氨溶液）搐鼻。兴奋神经。次用绛雪
（辰砂、牙硝各一钱、明雄黄、硼砂各六分、 礞石四分、梅冰、当门子各三分、金箔
五页各研极细、再研匀、治温疫急沙、及牛马羊瘟、以少许点其眼、喉痹牙舌诸病、
汤火金石诸伤、均搽患处。）点两眼角。刺激神经。此皆开泄其血络机窍之气。为外治冲
锋要法。又次用鸡子白对品生麻油入雄黄末调匀。以头发团蘸药遍擦周身。既可解毒。
又除表热。此亦引毒外出之良法。若中寒阴沙。莫妙于回阳膏（生香附一钱八分、或用
吴茱萸亦可、公丁香一钱二分、上桂心八分、倭硫黄五分、当门子四分、五味共研极细
、每用二三分。）安入脐中。外以膏药封之。一时病即轻减。惟口渴苔黄。二便俱热者
。虽见肢冷脉伏。亦勿妄贴此膏。更张其焰。内治方药。虽以芳香辛散之剂。开闭逐秽
。活血通气为正法。然亦有别。如猝中阴性恶毒者。莫妙于苏合香丸（苏合香、安息香
、广木香各二两、犀角、当门子、梅冰、生香附、明乳香、上沉香、公丁香、冬术各一
两、共研极匀、蜜丸、作二百丸、辰砂为衣、蜡匮、临用去蜡壳、薄荷灯心汤、磨汁服
。）及太乙紫金丹（川文蛤、山慈菇各二两、大戟、白檀香、安息香、苏合油各一两五
钱、千金霜一两、明雄黄、琥珀各五钱、梅冰、当门子各三钱、十一味各研极细、再
合研匀、浓糯米饮杵丸、如绿豆大、飞金为衣、每钱
许、开水调下。）猝中阳性恶毒者。莫灵于诸葛行军散（西黄、冰麝、珠粉、硼砂各
一钱、明雄黄八钱、火硝三分、金箔二十页各研极细、再合研匀、每三五分、凉开水
调下。）及局方紫雪（金箔千页、寒水石、 磁石、生石膏、滑石各五两、犀羚角、
青木香、沉香各五钱、丁香一钱、元参、升麻各一两六钱、生甘草八钱、芒硝一两、焰
硝三两、朱砂五钱、当门子一钱二分、每服三四分至一钱、新水调灌。）阴阳错杂者。
莫捷于来复丹（元精石、倭硫黄、牙硝各一两、橘红、青皮、五灵脂各二钱、每服三十
丸、阴阳水送下、善治上盛下虚、里寒外热、伏暑夹阴、霍乱危症。）汤方则用梦隐解
毒活血汤（生苡仁八钱、紫花地丁、益母草、晚蚕沙各五钱、银花、连翘各三钱、大黑
木耳、鲜石菖蒲各钱半、青蒿、贯众各二钱、阴阳水煮、生绿豆四两、取清汤煎药、
和入生藕茅根二汁各一瓢、或童便一杯、稍凉、徐徐服。）重加桃仁（四钱至五钱）
。以桃仁善杀小虫。小虫即洄溪所谓败血所生之细虫。其濂谓桃仁去血中之微生物。神
妙不可思议也。至于附、姜、椒、桂等药。极宜审慎。应用则用。切勿妄用。观仲景用四
逆汤。于既吐且利之下。紧接曰小便不利。重申曰下利清谷。何等叮咛郑重。故洄溪谓
(Commonly known as Cold Sha. When the condition is acute, it is also called Acute Sha; when slow, it is called Slow Sha).
[Etiology] During the day, exposure to or inhalation of foul odors; at night, sleeping outdoors while seeking coolness—these are the primary causes. It is most common in summer and autumn. In mild cases, cold-dampness stagnates in the meridians; or damp-heat is constrained and obstructed within the collaterals. In acute cases, inhaling toxic foul air causes rebellious Qi to rise upward; or internal food retention blocks the Qi in the Middle Jiao. All these can lead to Qi distension forming Sha syndrome. Therefore, it is generally referred to as Sha Qi, also known as Sha Zhang (Sha Distension), or Sha Hui (Sha Filth).
[Symptoms] Head distension, dizziness, and pain; fever with aversion to cold; chest fullness with rebellious Qi; abdominal pain and distension. Mild cases present with red spots on the skin; severe cases show exposed blue veins. In extreme cases, there is obstruction above and below, inability to vomit or defecate, cold limbs (Jue Ni), and severe intestinal cramping pain. It may be accompanied by toxic foul air or food stagnation. If the complexion is cyanotic-dark and fingernails are also cyanotic, with a grayish-white slippery tongue coating, it is Cold Sha complicated by food retention. If the complexion is purplous-turbid and fingernails are purple, with a red tongue body and dry white coating, it is Heat Sha complicated by food retention. In some cases, sudden abdominal pain with fainting, black and swollen complexion, silence without crying, and a grayish-greasy tongue coating indicate Sha Bi (Sha Closure), which is the most critical condition. Alternatively, immediate onset of profuse diarrhea, cold limbs, abdominal distension without a pulse, and a white-greasy tongue coating indicate Sha Xie (Sha Diarrhea), which is also perilous.
[Pulse] The pulse is deep, wiry, and sluggish; in severe cases, it is deep and hidden. This indicates cold blocking the exterior and Sha toxin郁 (constrained) internally, with Qi stagnation and blood coagulation preventing outward expression. If the pulse is deep, wiry, and rapid, or deep and firm in severe cases, it indicates cold food obstructing the middle, with Sha toxin concealed internally, and dampness restraining heat preventing outward eruption. Initially, the pulse may be wiry and forceful against the finger, followed by fainting and absence of pulse, which corresponds to the *Neijing* statement: "When Great Qi enters the Zang-Fu organs, the disease often results in sudden death."
[Treatment] For Taiyang Syndrome complicated by Sha, first eliminate the external cold. Urgently use acrid-aromatic Qi-moving herbs to release the exterior. Use Xiangsu Congchi Decoction removing Gancao (Licorice Root), adding Yueju Wan (Yueju Pill, 3 qian) and Baiko Powder (White Cardamom Seed Powder, 6 fen, taken with decoction). Then differentiate the cause to remove Sha. For cold-damp stagnating in the meridians, urgently use acrid-warm Qi-moving herbs to aromatic-penetrate. Renxiang Decoction plus Zhe Lingpi (Zhejiang Poria Peel, 4 qian) and Sheng Yiren (Raw Coix Seed, 6 qian). For damp-heat constraining the collaterals, urgently use bitter-acrid-cool-bland herbs to dredge and promote flow. Huoxiang Zhengqi Decoction plus Chen Sha Huaishi (Cinnabar-coated Talcum Powder, 5 qian), Mian Yinchent (Cotton-like Yinchen/Artemisia Capillaris, 3 qian), and Jiao Shanzhi (Charred Gardenia, 3 qian). For toxic foul air obstructing and reversing upper Qi, urgently use aromatic herbs to dispel filth and ventilate the upper Jiao. Lianqiao Zhichi Decoction plus Zijin Ding (Purple Gold Tablet, 2 pieces, ground into juice and mixed). For food retention blocking the Middle Jiao, if the patient cannot vomit or defecate, urgently employ the vomiting method. Use fried salt water mixed with fresh radish juice. Follow with Qi-regulating methods. Xiangsha Erchen Decoction mixed with Zijin Ding juice. If the patient has diarrhea and no pulse, differentiate Yin and Yang. For Yin Sha, urgently use Zhengyang Sini Tang (Sini Decoction for Restoring Yang) to restore Yang and unblock the pulse. For Yang Sha, urgently use Hongling Dan (Red Spirit Pill, 1-2 fen, mixed with cool boiled water) or Xingjun San (Army Marching Powder, 2-3 fen, mixed with fresh Shichangpu Decoction) to open orifices and unblock the pulse. Regarding external treatments: for mild cases, use Gua Sha (Scraping therapy) using a porcelain bowl lid dipped in sesame oil, scraping the shoulders, back, and elbow/knee creases. Chu Bi Fa (Nasal Insufflation) using Tongguan San (Passing Through Powder) blown into the nostrils to induce sneezing. For severe cases, use Ci Sha (Pricking Sha) using a silver knife to prick Shaoshang (LU11), Zhongchong (PC9), Chize (LU5), Weizhong (BL40), and the sublingual purple veins to bleed out Sha toxin. These are all methods to circulate Qi and Blood and open the interior and exterior.
[Commentary by Xiu] Ancient medical texts never mentioned the name "Sha Syndrome." It first appeared in Zhang Jiming's *Yi Shuo* (Medical Sayings) from the Song Dynasty, citing Ye Shi's recorded prescriptions to discuss Sha. He stated that Sha was previously unknown in Jiangnan but is now found everywhere. Symptoms initially resemble Taiyang Syndrome with chills, similar to malaria, with headache, high fever, and cold extremities. Initially, drinking Ai Tang (Mugwort Decoction) to induce vomiting confirms the diagnosis. Urgently take a piece of paper made from silkworm cocoons shed in May, cut it up, place it in a bowl, cover tightly with a plate, pour boiling water over it, seal the edges with paper to prevent leakage, wait, then drink it hot, lie down, cover with thick clothes and blankets until sweating occurs, and the patient recovers. This is the origin of what later generations called Cold Sha. Later, Zhang Jingyue of the Ming Dynasty wrote *Gua Sha Xin An* (New Cases of Scraping Sha), but his explanation was brief. Only in the early Qing Dynasty did Guo, Zhang, and Wang make innovations. Guo Youtao wrote *Sha Zhang Yu Heng*, providing detailed explanations. His main point was that although books do not record the name Sha, terms like Blue Veins, White Tiger, Zhong E (Sudden Evil Attack), and Gan Huoluan (Dry Cholera) actually refer to Sha syndrome in various texts. The common term "Jiao Chang Sha" (Intestinal Cramping Sha) has existed for a long time. The disease varies: An Sha, Men Sha, Sha Yun (Fainting), Sha Tong (Pain), Sha Zhang (Distension), Sha Kuai (Mass), Sha Jin (Veins), Sha Ban (Spots). All result from Qi stagnation and blood coagulation, damp-stagnation, and food retention. The general causes are mostly unclean environments, improper temperature regulation, irregular diet, and emotional stagnation. Diagnosis involves differentiating exterior/interior and cold/heat. Treatment: If Sha is in the skin, scrape it; if in flesh/blood, bleed it; if in stomach/intestines/meridians, medicate it. If Sha Qi spreads wildly filling interior and exterior, use all three methods. Scraping uses oil and salt on a porcelain bowl, scraping chest/abdomen first, then back/spine, then limb creases, to prevent Sha toxin from attacking inward. Bleeding depends on the color of Sha veins: Blue indicates initial blood toxin constraint, mild and easy to treat; Purple-red indicates abundant blood toxin, severe and difficult; Dark-black indicates extremely severe, bleeding may not occur. Prick with silver needles to remove toxic blood. Points include Baihui (GV20), Taiyang (EX-HN5), Yintang (EX-HN3), sides of sublingual veins, sides of throat, sides of breasts (shallow pricking); tips of ten fingers on hands and feet, arm and leg creases (deep pricking). After bleeding, treat based on cause. For Qi stagnation Sha, use Huoxiang Tang (Duhuo Xiang, Zhi Xiangfu, Xiao Qingpi each 1.5 qian, Sheng Zhike, Su Bohe, Qing Lianqiao each 1 qian, slightly boiled, taken warm) to regulate Qi and dispel filth. For Blood stasis Sha, use Bisheng Tang (Guang Taoren, Chao Shanzha, Sheng Chuanjun, Wulingzhi, Xiao Qingpi, Chi Shao each 1 qian, Zhi Xiangfu 1.5 qian, Chuanbei 2 qian, Du Honghua 4 fen, boiled slightly warm) to break blood and dissipate nodules. For Food retention Sha, use Xuanhua Yin (Xinhui Pi, Dafupi, Chao Maiya, Qianhu each 1.5 qian, Chao Luobuzi 3 qian, Xiao Qingpi 1 qian, decocted with Xiaoshanzha 1 liang as water, filtered, taken warm) to digest food and harmonize Qi. For Orifice closure Sha, use Niuhuang Babao Dan (Xihuang, Hupo, Chen Sha, Meibing, Xiongjing each 1 qian, Lingjiaopian, Ming Ruxiang each 3 qian, Xijiaopian 1.5 qian, all powdered; decoct Miyinhuayin and Zihuadiding each 2 liang, Chuanbei, Chuanlian each 3 qian into glue, mix with powder to make pills, 2 fen each; young children take 1 pill, adults 2 pills, taken with decoction of Xian Shichangpuye 1 qian, Dengxin 3 small bundles, Xian Juanxin Zhuye 36 branches) to open orifices and vent toxin. For Hidden Spots Sha, use Huoluo Toutu Yin (Jingjisui, Xiao Qingpi, Jing Chanyi each 1 qian, Qing Lianqiao, Miyinhuayin each 1.5 qian, Chao Niubang, Zihuadiding each 2 qian, Du Honghua 5 fen, decocted with Huoshui Lusun 1 liang, Daqingye 4 qian as water) to resolve toxicity and vent spots. For Phlegm turbidity Sha, use Qingqi Huatan Yin (Guang Xingren, Chuanbei each 2 qian, Guang Juhong, Sheng Zhike, Xiao Qingpi each 1 qian, Laifuzi 2 qian, Tianzhuhuang 3 qian, Baiko 5 fen mixed in, taken slightly cool) to regulate Qi and resolve phlegm. For Taiyang Syndrome complicated by Sha, treat Sha first; after Sha subsides, treat Taiyang. Sha resembles Taiyang; mild cases use scraping, severe cases use bleeding. Medications focus on regulating Qi, invigorating blood, opening orifices, and resolving toxicity. Avoid misdiagnosing as Taiyang and wrongly using acrid-warm diaphoretics, which would exacerbate Sha toxin. Be cautious. Zhang Luyu wrote *Choudu Fan Sha Er Ze*, stating that touching foul odors causes abdominal pain and vomiting; scraping the back with an oil-dipped porcelain vessel causes red spots, commonly called Sha. If infected with evil toxic alien Qi causing abdominal pain, limb numbness, vomiting, coma, and sudden black spots originating from the Mongolian Desert and spreading to Central Plains, it is called Fan Sha (Foreign Sha). Dry heaving and colic without vomiting or defecation is Jiao Chang Sha. Severe cases present with cold form, cold limbs, cyanotic face, hidden pulse, or high fever, coma, purple face, firm pulse. This depends on the individual's constitution being deficient or excessive in fire, suddenly struck by evil toxic alien Qi, distinguishing Cold Sha and Heat Sha. This disease resembles Miasma and is similar to Cholera. Mild cases drag on; acute cases cause death from evening to morning. Upon initial discomfort, burn a paper twist to cauterize the forehead, then take 3 qian of roasted buckwheat flour mixed with cool boiled water. Repeat if severe. Buckwheat refines gastrointestinal waste, descends Qi, expands the chest, and eliminates turbid stagnation; it is a specific drug for Sha toxin. For severe toxicity with black face, urgently prick Weizhong (BL40) behind both knees to bleed out evil blood and vent toxin. If buckwheat is unavailable or ineffective, prioritize regulating Qi, e.g., Xiangsu Yin plus Bohe and Jingjie for acrid-cool exterior release. Next, avoid evil: Zhizi Chi Tang plus Niubang and Sheng Gancao to resolve toxicity and harmonize the middle. For severe exterior heat, clear heat urgently: Huangqin Tang plus Lianqiao and Mutong to separate Yin and Yang. For irritability, thirst, and enuresis, clear Yangming urgently: Baihu Tang plus Congchi. For deep red spots indicating toxin in the Blood level, decoct Yi Mucao (Leonurus Herb) strongly with a little raw honey and half cup of fresh Radish Juice, taken warm to disperse evil blood for quick effect. This vents toxin via the exterior. For irritability, abdominal distension, constipation, rapid pulse, and urgent interior/exterior conditions, urgently administer Liangge San to vent toxin downward. Folk methods include pouring water on shoulders/back/arms, scraping with wet Ramie fiber, scraping with oiled porcelain bowls, pricking Weizhong with porcelain shards, inducing vomiting with fried salt, swallowing Sichuan pepper with cold water, taking dissolved Alum with cold water, or moxa-scarification on red spots seen under oil-paper illumination. All aim to open pores and smooth Qi/Blood circulation. Pulses are mostly hidden, or chaotic, fine/tight/rough, or tight/forceful with intermittent interruptions, indicating Yin hiding and Yang concealed. Do not mistake for Yin-Cold and give hot drugs; do not give warm drugs for abdominal pain/cold feet alone. Cyanotic face/lips, forceful pulse, cold limbs, panting are often incurable. Wang Jinshan in *Gu Fang Xuan Zhu* discusses Sha: Cold/Heat Dampness can cause Sha. Mild cases involve Stomach Qi rebellion, distension, pain; severe cases involve confusion and near-death. Northwest people whip the abdomen with willow branches dipped in hot water (Da Han Sha). Southeast people scrape chest/back/limbs with oiled bowls/threads (Gua Yu). Prick sublingual veins, fingertips, Quchi (LI11), Weizhong with porcelain/sharp needles to bleed (Ci Sha). Take Shenxiang San (Gong Dingxiang, Baidoukou each 7 grains, powdered, taken with clear soup; add Chun Sharen 7 grains for lower abdominal pain) for Cold-Damp Sha Zhang. Yi Yuan San (Huashi 6 qian, Sheng Gancao 1 qian, Chen Sha 1 qian, powdered, 3-4 qian per dose) for Damp-Heat Sha Zhang. Both are effective. These treat interior/exterior to vent Qi, allowing Qi/Blood to flow normally, resolving distension, proving no separate Sha pathogen exists. Modern quacks established a separate Sha department, labeling any abdominal pain/distension/restlessness as Sha to show off, advising patients against medication, which is ridiculous. Combining these three theories: Youtao wrote *Sha Zhang Yu Heng* based on Gong Yunlin's Blue Veins theory, detailing Sha symptoms and treatments. Luyu divided Choudu/Fan Sha into two, noting evil pestilential Qi is worse than filth. Jinshan identified Sha as sudden external evil blocking Zheng Qi, disrupting Qi/Blood flow, clarifying Sha pathology.
[Commentary by Lian] In Song/Ming dynasties and early Qing (Shiwen Laoren), Sha was written as Sha (Sand). Three theories existed: 1. Toxic gas from sand lice in streams; 2. Evil alien Qi from deserts; 3. Foul air from dust/sand. Hence names like Sha Zhang/Shahui. Later scholars added the 'disease' radical to create 'Sha'. I argue that Measles is also commonly called Sha, causing confusion between Measles-Sha and this Sha. It is more elegant to follow Zhang Jiming and write Sha (Sand). If named Sha because scraping reveals red/purple spots, what about cases without spots? Actually, these are regional endemic diseases, also called Fan Zheng/Wochuo. There are hundreds of folk names, more complex than ancient Wind/Taiyang diseases. They are named by appearance, lacking theoretical depth, ignoring etiology/pathology, as Wang Jinshan criticized. I have experimented with Sha/Hui for 30+ years, concluding it encompasses Summer/Autumn miscellaneous infections. I divide it into two main types: Non-infectious Heng Sha (Constant Sha) and Infective Yi Sha (Epidemic Sha). Heng Sha splits into Wet Filth and Summer Heat Filth, further differentiated by accompanying pathogens (Qi stagnation, Blood stasis, Food retention, Phlegm/Water). Yi Sha is a toxic acute condition; despite Yin/Yang differences, the cause is bacterial/toxic infection. Ancients called it Zhong E (Mid-Evil) or Blue Veins, indicating etiology/symptoms. Wang Qingren stated epidemic evil enters via mouth/nose, travels trachea to blood vessels, coagulating Qi/Blood. Initial treatment should prick Chize (LU5) to bleed purple-black blood to vent toxin, combined with detoxifying/hemostatic herbs, clarifying Yi Sha treatment. My external treatments include Feilong Duoming Dan (Feilong夺取命 Pill) insufflated into nose to induce sneezing (sneezing = mild, no sneeze = severe). If no sneeze, use Ammonia solution (Amoni Ya Shui) nasally to stimulate nerves. Then apply Jiangxue (Jiangxue Powder) to eye corners to stimulate nerves. These open blood collaterals/orifices. Next, mix Egg White with Sesame Oil and Realgar powder, rub on body with hair tuft to detoxify and relieve exterior heat. For Cold Yin Sha, use Huyang Gao (Restore Yang Plaster) applied to umbilicus. If thirsty, yellow coating, hot urination/stool, do not use this plaster even if limbs are cold/pulse hidden. Internal treatment uses aromatic/acrid-dispersing herbs to open closure, expel filth, invigorate blood, and move Qi. For sudden negative-type evil toxin, use Suhexiang Wan (Suhexiang Pill) or Taiyi Zijin Dan (Taiyi Purple Gold Pill). For sudden positive-type evil toxin, use Zhuge Xingjun San (Zhuge Army Marching Powder) or Jufang Zixue (Bureau Formula Purple Snow). For Yin-Yang mixed cases, use Laifu Dan (Laifu Pill). Decoction: Mengyin Jiedu Huoxue Tang (Mengyin Detoxifying and Blood-Invigorating Decoction) with heavy Taoren (Peach Kernel) to kill parasites/microbes in stagnant blood. Caution with Fuzi, Jiang, Jiao, Gui; use only when indicated. Zhang Zhongjing's use of Sini Tang for vomiting/diarrhea emphasizes checking for difficulty urinating and clear grain diarrhea, showing caution. Thus Xixi said...