尝考方书。从无痧证之名。惟触犯臭秽。而腹痛呕逆。世俗以瓷器蘸油刮其脊上。随发红斑
者。谓之曰痧。甚则欲吐不吐。欲泻不泻。干呕绞痛者。曰绞肠痧。近时有感恶毒异气而骤发黑
痧。俗名番痧。卒然昏倒腹痛。面色黑胀。不呼不叫。如不急治。两三时即毙。有微发寒热。腹
痛麻瞀。呕恶神昏者。或 汗出。或隐隐发斑。此毒邪 发于表也。亦有发即泻利厥逆。腹胀
无脉者。此毒邪内伏。不能外发也。所患最暴。多有不及见斑而殂者。经谓大气入于脏腑。虽不
病而卒死是也。初觉先将纸捻点淬头额。即以荞麦焙燥。去壳。取末三钱。温汤调服。重者。少
顷再服即安。盖荞麦能炼肠胃滓秽。降气宽胸而治浊滞。为痧毒之专药。但服过荞麦者。后患别
病。药中有绿矾者。切勿犯之。其毒甚面黑者。急于两膝后委中穴。砭出黑血。以泄毒邪。盖骤
发之病。勿虑其虚。非此急夺。束手待毙。以此病起于漠北。流入中原。故以番痧目之。原夫此
病与瘴疠相似。瘴则触冒山岚瘴气。此则触冒恶毒异气。与时行疫疠不殊。但时行则沿门阖境传
染。此则一人骤感。死于一日半日之间。不似时行之可以迁延数日也。又此病与伤寒之伏气相似。
伏气发温。热毒自里达表。此则一身骤感异气。无分表里脏腑。亦不似中寒 暑。本虚不胜寒暑之暴也。又此病与挥
霍撩乱相似。霍乱是客邪与水谷之气相并。此则正气暴逆。不能与邪相亢也。又此病与关格相似。
关格是上下不通。病纯属里。此则兼有斑痧表证也。大略与臭毒相类。然臭毒所触秽气。此则触
冒恶毒。较之疠疫尤剧。初起昏愦不省。脉多沉匿不显。或浑浑不清。勿以腹痛足冷而与温药。
倘荞麦一时难得。或服之不应。即宜理气为先。如香苏散加薄荷、荆芥。辛凉透表。次则辟邪为
要。栀子破汤加牛蒡、生甘草。解毒安中。表热势甚。清热为急。黄芩汤加连翘、木通。分利阴
阳。如见烦扰腹胀。脉来数疾。急投凉膈散。如局方以竹叶易生姜。则毒从下夺。热剧神昏。虽
合三黄。多不可救。烦渴引饮遗尿。速清阳明。白虎汤加葱、豉。使毒从表化。以上诸法。在未
经误药。庶可挽回一二。若病家疑信未真。慎毋轻治。脱或变生反掌。取咎未便。曾见一商。初
到吴会。畅饮酣歌。席间霎时不安。索生姜汤一啜而逝。又有朔客到枫。觅混澡浴。忽然眩晕呕
逆。到舟即毙。继有医者。饭后寒热腹痛。手足逆冷。不终夕而告殂。更有文学。乡居到郡作吊。
归即腹痛。坐立不宁。语言不次。然见客犹能勉力作揖。诊之。六脉模糊。是夜即便捐馆。迩来
卒患腹痛死者。比比皆然。虽无斑现。靡不谓之番痧。近有年少新婚。陡然腹痛麻瞀。或令饮火
酒半瓯。而腹痛转剧。旋增颅胀。身发红点。与芦根汁得吐乃解。复有鼻衄口燥。胸腹略见红斑。
啜童子小便稍宁。医与葱白、香豉浓煎。仍入童便。续续与之。得大吐汗出而痊。若斑点深赤。
毒在血分者。浓煎茺蔚。少投生蜜。放温恣服。取效最捷。以其专下恶血也。或加生莱菔汁半杯。
总取散血之功。且有误认伤寒而与发散。周身 紫如云而死者。亦有误认麻疹而与柽柳、樱桃核
汤。咽痛失音而死者。况有停食感冒。误认番痧。而与寒凉解毒。反减去衣被。不慎风寒。烦热
躁扰而死者。以其卒犯恶毒异气。无以脉诊。故辨治尤难。是以近世多用火淬砭刺之法。须知因
感恶毒异气而致者。此属外因。火淬为当。
因触臭毒秽气而致者。属不内外因。非砭刺不足以夺其势。然刺之无血。不可救也。
我曾考证医书，从未有过“痧证”这一名称。只有因触犯臭秽之气，导致腹痛、呕吐逆气者，世俗之人用瓷器蘸油刮其脊背，随即出现红斑的，称之为“痧”。病情严重的，想吐吐不出，想拉拉不出，干呕且腹部绞痛，称为“绞肠痧”。近来有人感染恶毒异气而突然发作黑痧，俗称“番痧”，突然昏倒、腹痛，面色发黑肿胀，不呼也不叫，如不及时治疗，两三个时辰内就会死亡。有的轻微发作寒热，腹痛麻木昏乱，呕吐恶心神志昏迷，有的出汗，有的隐隐发出斑点，这是毒邪发散于体表。也有发病即腹泻、四肢厥冷、腹胀无脉的，这是毒邪内伏，不能外发。这种病最为暴烈，多有来不及见斑就死亡的。《内经》说：“大气进入脏腑，即使没有生病也会突然死亡”，指的就是这种情况。
初觉不适时，先将纸捻点燃淬刺头额部位，然后用荞麦焙干，去壳，取粉末三钱，用温水调服。重症者，过一会儿再服一次即可安定。因为荞麦能炼化肠胃中的糟粕污秽，降气宽胸并治疗浊气停滞，是治疗痧毒的专用药物。但服用过荞麦后，若后续患其他疾病，药方中含有绿矾的，千万不要服用。如果毒性很盛且面色发黑，急于在两膝后方的委中穴，用砭石刺破放出黑血，以泄出毒邪。因为这是突然发作的疾病，不要顾虑患者体虚，不用这种急攻之法，只能束手待毙。因为这个病起源于漠北，流入中原，所以称之为番痧。
原来这个病与瘴疠相似，瘴气是触冒山岚瘴气所致，而这个病是触冒恶毒异气，与时行疫病没有区别。只是时行疫病会沿门阖境传染，而这个病是一个人突然感染，在一日半日之间死亡，不像时行疫病可以迁延数日。另外，这个病与伤寒的伏气相似，伏气引发温病，热毒从里达表；而这个病是一身突然感受异气，不分表里脏腑，也不像中寒中暑那样，因本虚不胜寒暑而暴病。还有，这个病与霍乱撩乱相似，霍乱是客邪与水谷之气相搏结，而这个病是正气暴逆，不能与邪气抗衡。另外，这个病与关格相似，关格是上下不通，病纯属里证，而这个病兼有斑痧表证。大略与臭毒相似，然而臭毒所触的是秽气，而这个病是触冒恶毒，比疠疫更为剧烈。
初起时昏愦不省人事，脉象多沉匿不显，或浑浑不清。不要因为腹痛脚冷就使用温药。倘若一时难以得到荞麦，或者服用后无效，就应当以理气为先。如香苏散加薄荷、荆芥，辛凉透表。其次则以辟邪为要，栀子豉汤加牛蒡子、生甘草，解毒安中。如果表热势甚，清热为急务，黄芩汤加连翘、木通，分利阴阳。如果见到烦躁扰攘、腹胀，脉来数疾，急投凉膈散，如果是局方制剂，以竹叶代替生姜，则毒邪从下而夺。如果热剧神昏，虽然符合三黄泻心汤的证候，大多不可救治。如果烦渴引饮、遗尿，速清阳明经热，白虎汤加葱白、豆豉，使毒邪从表化解。以上诸法，在未经误治用药的情况下，或许可以挽回一二。如果病家疑信未定，切勿轻易治疗，否则一旦变故发生，反掌之间，追究责任不便。
曾见一个商人，刚到吴越之地，畅饮高歌，席间霎时感到不安，索要生姜汤喝了一口就去世了。又有北方客商到枫桥，寻找混澡沐浴，忽然眩晕呕吐，到了船上就死了。接着有医生，饭后出现寒热腹痛，手足逆冷，不到一夜就去世了。更有文人，住在乡下到郡城吊唁，回家后腹痛，坐立不宁，言语错乱，虽然见到客人还能勉强作揖，诊察发现六脉模糊，当晚就去世了。近来突然患腹痛死亡的，比比皆是，虽然没有斑点出现，无不称之为番痧。
近来有一个年少新婚的人，突然腹痛麻木昏乱，有人让他喝半瓯火酒，结果腹痛加剧，随即增加头部胀痛，身上发红点，喝芦根汁吐出后才缓解。又有鼻衄口燥，胸腹略微见红斑，喝童子小便稍感安宁，医生给予葱白、香豉浓煎，再加入童便，连续服用，得大吐大汗而痊愈。如果斑点深赤，毒在血分的，浓煎茺蔚子，少加生蜜，放温后随意服用，取效最快，因为它专门下行恶血。或者加生莱菔汁半杯，总取其散血的功效。也有误认伤寒而给予发散药，导致周身紫如云而死的。也有误认麻疹而给予柽柳、樱桃核汤，导致咽痛失音而死的。况且有停食感冒，误认番痧，而给予寒凉解毒药，反而减去衣被，不慎风寒，导致烦热躁扰而死的。因为其突然触犯恶毒异气，无法通过脉诊辨别，所以辨治尤为困难。因此近世多用火淬、砭刺的方法。须知因感受恶毒异气而致的，这属于外因，火淬是恰当的。因触冒臭毒秽气而致的，属于不内外因，非砭刺不足以夺取其病势。然而如果刺之无血流出，就无法救治了。
I have examined medical texts and found no mention of the term "Sha Syndrome" (Sha Zheng, sand-poisoning). It refers only to cases where one encounters foul odors, leading to abdominal pain and vomiting. In common practice, people use porcelain dipped in oil to scrape the spine, causing red spots to appear, which is called "Sha". In severe cases, there is an urge to vomit but inability to do so, an urge to defecate but inability to do so, dry heaving, and colicky abdominal pain, known as "Jiao Chang Sha" (Intestinal Cramping Sha). Recently, some individuals have suddenly developed black Sha due to exposure to toxic and abnormal qi, commonly known as "Fan Sha" (Foreign Sha). They collapse suddenly with abdominal pain, dark and swollen facial complexion, without shouting or crying. If not treated urgently, death occurs within two to three shichen (4-6 hours). Some present with mild chills and fever, abdominal pain, numbness, confusion, nausea, and vomiting; some sweat, while others show faint rashes. This indicates the pathogenic toxin is manifesting on the exterior. Others develop diarrhea and cold limbs immediately upon onset, with abdominal distension and absent pulse; this signifies the toxin is hidden internally and cannot manifest externally. This disease is extremely violent, with many dying before rashes even appear. The Classics state: "When great qi enters the zang-fu organs, sudden death may occur even without prior illness," referring to this condition.
Upon initial suspicion, first cauterize the forehead and head using a lit paper wick. Then, roast buckwheat until dry, remove the husks, take three qian (approx. 11-15g) of the powder, and mix with warm water for oral administration. For severe cases, repeat the dose after a short interval to achieve stability. Buckwheat can refine and eliminate turbid waste in the stomach and intestines, descend qi, broaden the chest, and treat turbid stagnation; it is a specific remedy for Sha toxins. However, if other diseases arise after taking buckwheat, medications containing green vitriol (Luofan, Ferrous Sulfate) must strictly be avoided. For cases with severe toxicity and black complexion, urgently perform bloodletting at the Weizhong (BL40) acupoint behind both knees to drain black blood and expel the toxin. Since this is an acute onset disease, do not worry about deficiency; without this urgent draining method, one can only wait helplessly for death. As this disease originated in the northern deserts and spread to the Central Plains, it is named Fan Sha.
Originally, this disease resembles Miasma (Zhang Li). Miasma results from exposure to mountain miasma qi, whereas this disease results from exposure to toxic and abnormal qi, similar to epidemic seasonal pathogens. However, epidemic pathogens spread door-to-door across regions, while this disease affects individuals suddenly, causing death within one to half days, unlike epidemics which can persist for days. Furthermore, this disease resembles the latent qi of Cold Damage (Shanghan). Latent qi triggers Warm Disease, with heat toxins moving from interior to exterior. In contrast, this disease involves sudden whole-body exposure to abnormal qi, affecting neither exterior nor interior, nor zang-fu specifically, differing from sudden Cold Damage or Summerheat caused by underlying deficiency unable to withstand climatic extremes. Additionally, it resembles Huoluan (Cholera-like disorder). Huoluan involves external pathogens combining with food and drink qi, whereas here, healthy qi rebels violently and cannot resist the pathogen. It also resembles Guange (Obstruction and Repletion), where upper and lower passages are blocked, and the disease is purely interior. Here, however, there are exterior signs of rashes and Sha. Broadly, it is similar to Chou Du (Foul Poison), but while Chou Du is triggered by filthy odors, Fan Sha is triggered by toxic substances, making it more severe than plagues.
At onset, patients are confused and unconscious. Pulses are often deep, hidden, indistinct, or chaotic. Do not administer warming medicines simply because of abdominal pain and cold feet. If buckwheat is unavailable or ineffective, prioritize regulating qi. Use Xiang Su San (Perilla and Licorice Decoction) plus Bohe (Mint) and Jingjie (Schizonepeta), using pungent-cool methods to vent the exterior. Next, focus on dispelling evil: Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) plus Niubangzi (Arctium Seed) and Sheng Gancao (Raw Licorice) to detoxify and stabilize the middle. If exterior heat is intense, clearing heat is urgent: Huang Qin Tang (Scutellaria Decoction) plus Lianqiao (Forsythia) and Mutong (Akebia Stem) to separate yin and yang. If restlessness and abdominal distension appear with rapid pulses, urgently administer Liang Ge San (Cool the Chest Powder); if using the Bureau Formula version, replace Ginger with Zhuye (Bamboo Leaf) to drain toxins downward. If heat is extreme with coma, even Sanhuang Xie Xin Tang (Three Yellows Draining Heart Decoction) may be unavailing. If there is irritability, thirst with excessive drinking, and urinary incontinence, quickly clear Yangming heat: Bai Hu Tang (White Tiger Decoction) plus Congbai (Green Onion White) and Chijiao (Fermented Soybean) to transform toxins via the exterior. These methods may salvage a few cases if no prior mismedication has occurred. If the family is hesitant, do not treat lightly; otherwise, changes may happen in the blink of an eye, leading to liability.
I once saw a merchant who arrived in Wu-Yue, drank heavily and sang loudly. Suddenly uncomfortable at the banquet, he asked for ginger soup, took one sip, and died. Another northern traveler went to Fengqiao to bathe in mixed waters, suddenly became dizzy and vomited, and died upon reaching his boat. Subsequently, a physician developed chills, fever, and abdominal pain after eating, with cold limbs, and died within a night. A scholar went to the prefecture for mourning, returned home with abdominal pain, restlessness, and disordered speech. Although he could still bow when seeing guests, his six pulses were blurred, and he died that night. Recently, sudden deaths from abdominal pain are common; even without rashes, they are all called Fan Sha.
Recently, a young newlywed man suddenly suffered abdominal pain, numbness, and confusion. Someone advised him to drink half a cup of fiery wine, which worsened the pain and caused head swelling. Red spots appeared on his body; drinking reed root juice induced vomiting, providing relief. Another case involved epistaxis, dry mouth, and slight red rashes on the chest and abdomen. Drinking urine from an uncircumcised boy provided slight comfort. The doctor decocted Congbai (Green Onion White) and Chijiao (Fermented Soybean) thickly, added the boy's urine, and administered it continuously. The patient achieved profuse sweating and vomiting and recovered. If spots are deep crimson, indicating toxin in the blood level, decoct Chongwei Zi (Vernonia Seed) thickly with a little raw honey, serve warm, and allow free consumption for fastest effect, as it specifically drains bad blood. Adding Banxia Lu Bo (Radish) juice helps scatter blood. There are also cases mistaken for Cold Damage and treated with diaphoretics, resulting in purple cloud-like discoloration and death. Others mistaken for Measles and treated with Chengliu (Clematis) and Cherry Pit Decoction died from sore throat and loss of voice. Furthermore, cases of food stagnation and cold mistaken for Fan Sha, treated with cold-clearing detoxifiers, led to removal of clothing/bedding, exposure to wind-cold, irritability, and death. Because this disease strikes suddenly with toxic abnormal qi and lacks distinct pulse signs, differentiation and treatment are particularly difficult. Hence, modern practitioners often use fire cauterization and bloodletting. Note that cases caused by toxic abnormal qi belong to external causes, making fire cauterization appropriate. Cases caused by foul odors belong to non-internal/non-external causes; bloodletting is necessary to curb the momentum. However, if bleeding does not occur upon pricking, the case is incurable.