夏伤于暑，秋必疟痢。痢初必先泄泻，肠胃空虚，则易感秽气，即成痧痛。或炎热疫疠
，因积而发，亦致痧痛。夫痢不兼痧，积去便轻，若一兼犯，必绞痛异常，止治痢无效，或
变如猪肝色，如屋漏水、或惟血水，或变噤口不食，呕哕凶危，或休息久痢，绵延岁月，惟
先治痧兼治积，则痧消而积易去，积去而痧可清矣。
一人发热痢血水，日百余次，肛门窘迫，腹痛异常，呕哕不食，六脉迟数不常，或时歇
止，此痧痢也。刮放后，痛减半，用石一方、砂仁汤下，煎用竹六方，去赤白滞甚多，诸症
悉愈。
一人发热胀闷沉重，痢下紫血，医但治痢，甚危笃。见六脉洪大不匀，令刮痧，用匏三
方入童便饮，次以苏木、红花、五灵脂、茜草、乌药、香附、当归导瘀乃安。
痧有寒热往来，类乎疟疾，或昏沉、或狂乱、或痰喘、或烦闷叫喊，或呕哕吐痰，睡卧
不安，或大小便结，舌黑生芒，如此重极，脉必有变，不与疟同，宜细辨。
一人日晡寒热，昏沉胀闷，大便不通，舌焦苔浓，左脉浮大而虚，右沉细而涩，不似疟
脉，视乳下有青筋，刺出毒血，用散痧消毒活血药，诸症退。又用润下丸二钱，大便通，惟
寒热未退，用小柴胡汤而痊。
疟忽兼犯乎痧，疟必因痧而变，苟慢以为疟而忽视之，必至伤人，是非先治其痧，即轻
痧亦必有遗患（土一）。
一少男患疟凶暴，验筋放痧，稍松，用石二、金八方两服，扶而起，次日伤食患益甚，
更放痧，用散痧消食顺气解毒药，三服稍安。后又伤食发热，用楂、卜、青、陈、紫朴、白
芥四服，大便不通加大黄、枳实，便通热减，但病久虚晕心跳，用枣仁、茯神、参、 、熟
地之类，调补一月，痊。
一妇疟八日，忽壮热不已，昏沉不醒，左脉不匀，右虚涩，非疟脉也。刺臂青筋，流紫
黑血，不愈。服金五方加藿、朴、槟、卜并土一方，稍醒，次日又刺指头，服金五方加军、
枳，热退后用丝二方运动其气，痊。
Summer damage by heat, autumn must have malaria and dysentery. Dysentery initially must first present with diarrhea; when the intestines and stomach are empty, it is easy to be infected with turbid qi, which immediately forms sha pain (pain caused by sha syndrome). Or due to epidemic pestilence in hot weather, developing because of accumulation, also causing sha pain. If dysentery does not combine with sha, after the accumulation is removed, the stool becomes lighter; if once combined with sha, there must be abnormal severe colic. Treating only dysentery is ineffective, or it may change to a color like pig liver, like dripping roof water, or only bloody water, or change to jinkou li (dysentery with inability to eat), vomiting and hiccups being fierce and dangerous, or chronic intermittent dysentery lasting for years. Only by first treating sha and simultaneously treating accumulation can sha be eliminated so that accumulation is easily removed, and once accumulation is removed, sha can be cleared.
One person had fever and dysentery with bloody water, over a hundred times a day, anus feeling urgent and oppressive, abdominal pain extremely severe, vomiting and hiccups preventing eating, six pulses slow and rapid irregularly, sometimes pausing intermittently; this is sha dysentery. After scraping and bleeding, pain reduced by half. Using Shi Yi Fang (Formula One of Stone) administered with Amomum fruit decoction, decocting Zhu Liu Fang (Formula Six of Bamboo), removing much red and white stagnation, all symptoms completely healed.
One person had fever, distension, oppression, and heaviness, passing purple blood in stool. The physician only treated dysentery, condition becoming very critical. Observing six pulses surging and large but uneven, ordered scraping. Using Pao San Fang (Formula Three of Gourd) taken with child's urine, then using Spatholobus stem, Carthamus flower, Trogopterus dung, Rubia root, Lindera root, Cyperus rhizome, Angelica sinensis to guide out stasis, thus stabilized.
Sha has alternating chills and fever, resembling malaria, or coma, or mania, or phlegm wheezing, or irritability and shouting, or vomiting and spitting phlegm, restless sleep, or constipation of both bowels and bladder, black tongue with prickles. Such extreme severity implies pulse changes different from malaria; careful differentiation is required.
One person had evening chills and fever, coma, distension and oppression, no bowel movement, scorched tongue with thick coating, left pulse floating, large and deficient, right pulse deep, fine and choppy, unlike malaria pulse. Viewing bluish veins under the breast, pricked to release toxic blood, used herbs to dissipate sha, detoxify, and invigorate blood, all symptoms receded. Then used Run Xia Wan (Moistening Down Pill) 2 qian, bowel movement unblocked, only chills and fever remained unreduced, used Xiao Chai Hu Tang (Minor Bupleurum Decoction) for recovery.
Malaria suddenly combining with sha, malaria must change due to sha. If neglected as mere malaria, it will surely harm people. It is not [so] unless sha is treated first; even mild sha must leave sequelae.
A young male suffered violent malaria. Checking tendons and performing sha bleeding provided slight relief. Used Shi Er Fang (Formula Two of Stone) and Jin Ba Fang (Formula Eight of Gold) two doses, supported him to sit up. Next day, food stagnation made illness worse. Performed sha bleeding again, used herbs to dissipate sha, digest food, smooth qi, and detoxify. Three doses brought slight peace. Later, food stagnation caused fever. Used Hawthorn seed, Radish, Green tangerine peel, Aged tangerine peel, Purple Magnolia bud, White mustard seed four doses. No bowel movement added Rhubarb and Immature bitter orange. Bowel movement unblocked, heat reduced. But long illness caused deficiency, dizziness, and palpitations. Used Sour jujube seed, Poria cocos, Ginseng, [missing character], Prepared Rehmannia root etc., tonifying and regulating for one month, recovered.
A woman suffered malaria for eight days, suddenly high fever unceasing, coma unconscious. Left pulse uneven, right pulse deficient and choppy, not malaria pulse. Pricked arm bluish veins, flowed purple-black blood, not cured. Took Jin Wu Fang (Formula Five of Gold) plus Agastache, Magnolia bark, Areca nut, Radish and Tu Yi Fang (Formula One of Earth), slightly awake. Next day pricked fingertips, took Jin Wu Fang plus Jun (Rhubarb), Immature bitter orange. Heat retreated, then used Si Er Fang (Formula Two of Silk) to move qi, recovered.