夏间有不头痛发热，但觉小腹疼痛，或心腹俱痛，鼓胀痞满，不能屈伸者，人或疑为阴证，或执为食生冷过多，不
知皆暑火流注脏腑不能解，故先小腹痛，后及遍心腹。法宜六和
汤清解之，或五苓散加香薷、木瓜、紫苏、半夏之类利散之自愈。若以为阴病生冷，而用热药热物助之，不可救
已。或用炒盐和滚水服，探吐痰涎亦妙。亦有发热身痛等证，内兼心腹痛，大概吐法为上，用藿香正气散，或二
陈汤加浓朴、炒栀佳。
霖按∶痧胀为寒热错杂之病，其因甚繁，绞肠特其一证耳，《金匮》所谓阴毒阳毒者是也，其试痧之法∶脉
与证相反者痧也；嚼黄豆无豆腥气，嚼带毛生芋子而不麻口者痧也。辨痧之法∶先吐泻而心腹绞痛者，多由秽气而
发；先心腹绞痛而吐泻者，多由暑气而发；心胸昏闷，痰涎胶结者，多从伏热而发；遍身肿胀疼痛，四肢不举，舌
强不言者，多因寒气冰伏火毒而发。治痧之法∶病在孙络者表也，先宜在病者背心轻轻向下刮之；病在络脉者里
也，先宜于十手足指甲处舌下两旁两臂弯及委中等穴刺之，以泄其毒，然后审证制方。王养吾痧书，郭右陶玉衡言
之最详，岂六和、五苓、正气、二陈、便能蒇事哉？仲景于《金匮》未便定方，只以一升麻鳖甲汤加减，示人途径，
其意深矣！然痧胀之治难定，而痧胀之原，不可不知。
又按∶《内经》言营气取营运于中之义，西医谓食入于胃，至小肠皆有微丝管吸其精液，上至颈会管，过肺入心
左房，化赤为血，此即清者为营也。其血从左房入总脉管，由脊之膂筋，循行经脉间，一日夜五十周，尽八百十丈
之脉道，以应呼吸漏下者之营气也。经言卫气取卫护于外之义，西医谓经脉中之血气，由脉管之尾，出诸气街，入
微丝血管，（经谓孙络者是也。）与阳明之悍气（人之饮食，五味杂投，奚能无毒？西医谓之炭气者是也。）相合，
散布通体皮腠之间，充肤热肉，淡渗毫毛，此即浊者归卫也。脉管之赤血，既入微丝血管，合阳明悍气，则其色渐
变渐紫，（西医因其有毒，谓之炭气。）散布遍体，渐并渐粗，入回血管（经谓络脉者是也。）之尾，血入回血
管，内而脏腑，外而经脉，并脉管交相逆顺而行，外行经脉者，有阴阳之别，一支浮于肌腠之上，一支沉于分肉之间
，即阳络行于皮表，阴络行于皮里，而皆与脉管偕行，经言营在脉中，卫在脉外者是也。回血管内外行遍入总回
管，至心右房，递入于肺，呼出悍气，吸入生气，其血复化为赤，入心左房，经言阴阳相贯，如环无端者，此之谓也
。痧胀为寒暑错杂之毒邪，由皮毛而入者，与阳明悍气合，阻遏缠布周身孙络中之血气，由口鼻吸受者，阻遏络脉
中之血气，暑毒郁遏悍气，愈遏其毒愈烈，故一发燎原，苟不急治，则毒由回血管入心，入心则死矣。急治之法，药饵
功缓，故宜刮宜刺，急泄其毒邪，不令入心，徐图解救，否则不明致痧之原，妄使汤药，几同操刃。
夏季有人出现不头痛、不发热的症状，只感觉小腹疼痛，或者心腹俱痛，腹部鼓胀痞满，身体不能屈伸。人们有时怀疑这是阴证，或固执地认为是吃生冷食物过多所致，却不知道这都是暑火流注于脏腑无法化解的缘故，所以先从小腹开始疼痛，随后波及整个心腹。治疗法则适宜用六和汤来清解，或者用五苓散加入香薷、木瓜、紫苏、半夏等药物以利湿发散，这样病自然会好。如果误以为是阴病或生冷所致，而使用热药热物来助长它，那就不可救药了。也可以用炒盐和滚水服用，通过探吐排出痰涎，这也是很好的方法。也有发热身痛等症状，内部兼有心腹痛的，大概以催吐法为上策，可用藿香正气散，或者二陈汤加厚朴、炒栀子效果更佳。
霖按：痧胀是寒热错杂的疾病，其成因非常繁杂，绞肠痧只是其中一种证候罢了，这就是《金匮要略》所说的阴毒阳毒。测试是否为痧的方法有：脉象与症状相反的，就是痧；嚼黄豆没有豆腥味，嚼带毛的生芋头而不觉得麻口的，就是痧。辨别痧的方法有：先呕吐腹泻而后心腹绞痛的，多由秽浊之气引发；先心腹绞痛而后呕吐腹泻的，多由暑气引发；心胸昏闷，痰涎胶结的，多从伏热引发；遍身肿胀疼痛，四肢不能抬起，舌强不能言语的，多因寒气冰伏火毒引发。治疗痧的方法有：病在孙络（细小的分支络脉）属于表证，先在患者背部轻轻向下刮拭；病在络脉属于里证，先在十个手足指甲处、舌下两旁、两臂弯及委中穴等处刺破出血，以泄出毒素，然后审察证候制定方药。王养吾的痧书，郭右陶玉衡说得最详细，难道仅凭六和汤、五苓散、藿香正气散、二陈汤就能解决问题吗？张仲景在《金匮要略》中不便直接定下方剂，只用一升麻鳖甲汤进行加减，以此示人治疗途径，其用意深远啊！然而痧胀的治疗难以固定，但痧胀的根源，不可不知道。
又按：《内经》说营气取营运于体内的含义，西医认为食物进入胃后，到达小肠都有微细血管吸收其精液，上至颈会管，经过肺进入心脏左房，化为赤色血液，这就是清者成为营气。这些血从左房进入总脉管，沿着脊柱的膂筋，在经脉间循行，一天一夜循环五十周，走遍八百一十丈的脉道，以对应呼吸漏下者的营气。经文说卫气取卫护于外的含义，西医认为经脉中的血气，由脉管的末端，出于诸气街，进入微细血管（经文所说的孙络），与阳明之悍气（人的饮食，五味混杂投入，怎么能没有毒性？西医称之为炭气）相结合，散布遍布全身皮腠之间，充实皮肤肌肉，淡渗毫毛，这就是浊者归于卫气。脉管中的赤血，既然进入微细血管，合于阳明悍气，那么它的颜色逐渐变紫（西医因其有毒，称之为炭气），散布遍体，逐渐汇聚变粗，进入回血管（经文所说的络脉）的末端，血进入回血管，内达脏腑，外达经脉，并与脉管交互逆顺而行。外行于经脉的，有阴阳的区别，一支浮于肌腠之上，一支沉于分肉之间，即阳络行于皮表，阴络行于皮里，而都与脉管共同运行，经文说营在脉中，卫在脉外，就是这个意思。回血管内外行遍后进入总回管，到达心脏右房，递入于肺，呼出悍气，吸入生气，其血重新化为赤色，进入心脏左房，经文说阴阳相贯，如环无端，说的就是这种情况。痧胀是寒暑错杂的毒邪，由皮毛而入的，与阳明悍气结合，阻遏缠布周身孙络中的血气；由口鼻吸受的，阻遏络脉中的血气。暑毒郁遏悍气，越郁遏其毒性越猛烈，所以一发起来就像燎原大火，如果不紧急治疗，那么毒邪就会由回血管进入心脏，进入心脏就会死亡。紧急治疗的方法，药物作用缓慢，所以适宜刮拭和刺破，急泄其毒邪，不让它进入心脏，慢慢图解救，否则不明白导致痧胀的根源，胡乱使用汤药，几乎等同于拿着刀杀人。
In summer, some individuals experience no headache or fever, but only feel pain in the lower abdomen, or pain in both the heart and abdomen, with abdominal distension and fullness, rendering them unable to bend or stretch. People sometimes suspect this is a Yin syndrome (Yin Zheng), or stubbornly attribute it to excessive consumption of raw and cold foods, not realizing that all these cases are due to Summerheat-Fire flowing into the Zang-Fu organs without being resolved, thus starting with lower abdominal pain and subsequently spreading to the entire heart and abdomen. The treatment principle should be to clear and resolve using Liuhe Tang (Six Harmonies Decoction), or to benefit and disperse using Wuling San (Five-Ling Powder) added with Xiangru (Elsholtzia Herba), Mugua (Chaenomelis Fructus), Zisu (Perillae Folium), Banxia (Pinelliae Rhizoma), etc., so that the disease will heal spontaneously. If one mistakenly considers it a Yin disease or caused by cold foods, and uses hot medicines or hot foods to assist it, it becomes incurable. Alternatively, one can take fried salt with boiling water to induce vomiting and expel phlegm-saliva, which is also excellent. There are also cases with symptoms such as fever and body pain, internally accompanied by heart and abdominal pain; generally, the emetic method is superior, using Huoxiang Zhengqi San (Agastache Powder for Rectifying the Qi) or Erchen Tang (Two Aged Decoction) added with Houpo (Magnoliae Officinalis Cortex) and Chao Zhi (Fried Gardenia Fruit) yields good results.
Lin notes: Shazhang (Sha Distension) is a disease characterized by mixed Cold and Heat, with very complex causes; Jiaochang Sha (Intestine-Twisting Sha) is merely one manifestation thereof, corresponding to what is described in *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet) as Yin Poison and Yang Poison. Methods to test for Sha include: if the pulse contradicts the symptoms, it is Sha; if chewing soybeans does not produce a bean odor, or chewing raw, hairy taro does not cause numbness in the mouth, it is Sha. Methods to differentiate Sha include: vomiting and diarrhea preceding heart and abdominal colic usually arise from turbid miasma; heart and abdominal colic preceding vomiting and diarrhea usually arise from Summerheat; mental confusion and oppression with sticky phlegm-saliva usually arise from latent Heat; swelling and pain throughout the body, inability to move the limbs, stiff tongue and inability to speak usually arise from Cold freezing Fire-Toxin. Treatment methods for Sha include: when the disease is in the Sunluo (fine branch collaterals), it is exterior; first, gently scrape downwards on the patient's back; when the disease is in the Luomai (collateral vessels), it is interior; first, prick the tips of the ten fingernails and toenails, both sides under the tongue, the inner elbows, and the Weizhong (BL40) acupoint to drain the toxin, then examine the syndrome to formulate the prescription. Wang Yangwu’s book on Sha, and Guo Youtao Yuheng’s detailed explanations, suggest that relying solely on Liuhe Tang, Wuling San, Huoxiang Zhengqi San, or Erchen Tang is insufficient to resolve the matter. Zhang Zhongjing, in *Jinkui Yaolue*, did not prescribe fixed formulas but used modifications of Shengma Biejia Tang (Ephedra and Turtle Shell Decoction) to indicate the therapeutic pathway, implying profound intent! However, while the treatment of Shazhang is difficult to standardize, its origin must be understood.
Furthermore: The *Neijing* states that Ying-Qi (Nutritive Qi) circulates within; Western medicine posits that after food enters the stomach, fine capillary tubes in the small intestine absorb its essence, which ascends to the jugular vein, passes through the lungs into the left atrium of the heart, and transforms into red blood; this corresponds to the clear part becoming Ying-Qi. This blood enters the main arterial vessel from the left atrium, travels along the muscles of the spine, circulating through the meridians fifty times a day and night, covering 810 zhang of vascular pathways, corresponding to the Ying-Qi of those breathing. The classics state that Wei-Qi (Defensive Qi) protects the exterior; Western medicine holds that blood and Qi in the meridians exit the ends of the vessels at various Qi-Chuang points, enter the capillaries (referred to as Sunluo in the classics), and combine with the vigorous Qi of the Yangming Stomach channel (dietary intake involves mixed flavors, how can there be no toxicity? Western medicine calls this carbon gas). This combination spreads throughout the skin and interstices, filling the flesh and moistening the hair, which corresponds to the turbid part returning to Wei-Qi. Once the red blood in the arteries enters the capillaries and combines with the vigorous Qi of Yangming, its color gradually turns purple (Western medicine calls this toxic carbon gas). It spreads throughout the body, converging and thickening, entering the venous system (referred to as Luomai in the classics). Blood entering the veins flows internally to the Zang-Fu organs and externally to the meridians, moving in reverse and順顺 directions alongside the arteries. Externally traveling in the meridians, there is a distinction between Yin and Yang: one branch floats above the muscle interstices, and another sinks between the muscle layers; i.e., Yang Luo (Yang Collaterals) run on the surface of the skin, and Yin Luo (Yin Collaterals) run beneath the skin, both accompanying the arterial vessels. This corresponds to the classic statement that Ying resides in the vessels and Wei resides outside the vessels. After circulating inside and outside the veins, blood enters the vena cava, reaches the right atrium of the heart, passes to the lungs, exhales the vigorous Qi, inhales vital Qi, and the blood re-transforms into red, entering the left atrium. The classic statement "Yin and Yang connect continuously, like a circle without end" refers to this process. Shazhang is a pathogenic factor of mixed Cold and Summerheat-Toxin. When entering via the skin and hair, it combines with the vigorous Qi of Yangming, obstructing and entangling the blood and Qi in the Sunluo of the whole body; when inhaled via the nose and mouth, it obstructs the blood and Qi in the Luomai. Summerheat-Toxin suppresses the vigorous Qi; the more suppressed, the fiercer the toxin becomes. Thus, once it erupts, it spreads like a prairie fire. If not treated urgently, the toxin will enter the heart via the veins; once in the heart, death ensues. For urgent treatment, medicinal decoctions act too slowly, so scraping and pricking are suitable to urgently drain the toxin, preventing it from entering the heart, allowing for gradual resolution. Otherwise, failing to understand the origin of Sha and recklessly administering decoctions is akin to wielding a knife against oneself.