读伤寒书，有发黄发 ，余以为有痧焉者。盖发黄发 皆即伤寒现症也。或中秽气，或因暑气，或感时行不正之气，
遂兼痧胀，即伤寒兼痧之说也。
治验∶
一孔叔元，伤寒传胃腑，口渴壮热，头汗发黄，舌胎芒刺，腹胀迷闷，舌短声重，气急发喘。余见脉左寸关伏，余
脉弦紧。曰∶“痧毒阻于筋脉，脉气不宣，故微伏而弦紧。兼之胃腑热极，痧毒乘之，一饮热汤、热物，痧毒横行，攻击
脏腑，故见此等恶症。”先放头顶痧一针，次放指头痧二十余针，及乳上痧二针，迷闷即松。付以乌药顺气汤加石膏、黄
连、大黄、桃仁二剂，微冷服之。头汗舌胎始退，余症渐解。复放指上痧，付枳实大黄汤减槐花加红花、芒硝二剂，温
服乃瘳。
一孙彦衢内室，壮热发黄，头汗如雨，大渴唇焦。左脉弦紧，右脉沉微。放手臂腿弯上下痧四十余针，流出紫黑毒
血，未愈。付细辛大黄丸、沉香郁金散，微冷汤下。用桃仁红花汤加牛膝、石斛二剂，微温饮之乃痊。
一梁钟素，伤寒六日，壮热发 ，大渴昏沉。余见脉洪大无伦，两太阳青筋，刺痧三针，放腿弯痧五针，出毒血，
未愈。用荆芥红花汤合清凉至宝饮加石膏，稍冷送下四剂而愈。
一汤茂珍次女，八月伤寒，日晡壮热，口渴发 ，头痛如破，声重耳聋，吐蛔二条，迷闷几死，两寸脉微无力，两
关弦细，两尺左滑右紧。放腿弯痧三针，略松。用清凉至宝饮加黄芩、牛膝、石膏、桃仁、泽兰、乌药、枳壳微冷冻饮料之。
不应复放痧，用熟大黄三钱、细茶一撮，煎服而痊。
阅读《伤寒论》相关的书籍时，遇到出现发黄、发斑等症状的患者，我认为其中夹杂有痧证。因为发黄和发斑本身就是伤寒病中显现的症状。这些症状可能是由于中受秽浊之气，或因暑热之气，或感受时行不正之气，从而兼夹了痧胀，这就是“伤寒兼痧”的说法。
治疗案例：
一位名叫孔叔元的患者，伤寒邪气传入胃腑，表现为口渴、高热，头部出汗且皮肤发黄，舌苔上有芒刺，腹部胀满且神志迷闷，舌头短缩、声音沉重，呼吸急促并伴有喘息。我诊察发现其左寸、关脉伏匿，其余脉象弦紧。我说：“痧毒阻滞于筋脉，导致脉气不能宣通，所以脉象微伏且弦紧。加之胃腑热势极盛，痧毒乘虚而入，此时若饮用热汤或食用热物，痧毒便会横行无忌，攻击脏腑，因此出现这些严重的症状。”我先在头顶部位针刺放痧一针，接着在手指头部位针刺放痧二十多针，又在乳房上方针刺放痧两针，患者的迷闷症状随即缓解。随后给予乌药顺气汤，加入石膏、黄连、大黄、桃仁，共两剂，稍微冷却后服用。之后头部出汗减少，舌苔消退，其他症状逐渐解除。再次在手指上放痧，给予枳实大黄汤，减去槐花，加入红花、芒硝，共两剂，温服后痊愈。
另一位是孙彦衢的夫人，表现为高热、发黄，头部出汗如雨，极度口渴且嘴唇焦裂。左脉弦紧，右脉沉微。我在其手臂及膝盖弯曲处上下共针刺放痧四十多针，流出紫黑色的毒血，但病情未愈。给予细辛大黄丸、沉香郁金散，用稍微冷却的药汤送服。再用桃仁红花汤，加入牛膝、石斛，共两剂，稍微温热后饮服，最终痊愈。
还有一位叫梁钟素的患者，患伤寒六天，高热、发斑，极度口渴且神志昏沉。我诊察发现其脉象洪大无比，两侧太阳穴处青筋暴露，于是针刺放痧三针，并在膝盖弯曲处针刺放痧五针，放出毒血，但病情未愈。使用荆芥红花汤合清凉至宝饮，加入石膏，稍微冷却后送服四剂而痊愈。
还有一位叫汤茂珍的次女，八月患伤寒，傍晚时分高热，口渴、发斑，头痛剧烈如破裂感，声音沉重、耳聋，吐出两条蛔虫，神志迷闷几乎死亡，两手寸脉微弱无力，两手关脉弦细，左手尺脉滑，右手尺脉紧。先在膝盖弯曲处针刺放痧三针，症状略微缓解。使用清凉至宝饮，加入黄芩、牛膝、石膏、桃仁、泽兰、乌药、枳壳，稍微冷却冷冻后饮服。服药后未见明显效果，再次放痧，使用熟大黄三钱、细茶一撮，煎煮后服用而痊愈。
When reading books on *Shanghan* (Cold Damage), encountering patients with jaundice or petechiae, I believe there is an accompanying Sha syndrome. This is because jaundice and petechiae are symptoms manifesting in *Shanghan*. These conditions may arise from inhaling foul odors, exposure to summer heat, or contracting pathogenic qi of the season, thereby complicating into Sha distension. This constitutes the theory of "*Shanghan* complicated by Sha."
Clinical Cases:
1. Kong Shuyuan contracted *Shanghan* that transmitted to the Stomach Fu organ. Symptoms included thirst, high fever, sweating on the head with yellowing of the skin, prickles on the tongue coating, abdominal distension with mental confusion, a short tongue with heavy voice, rapid breathing, and panting. Upon examination, the pulse at the left Cun and Guan positions was hidden (Fu), while other pulses were wiry and tight (Xian Jin). I stated: "Sha toxin obstructs the sinews and vessels, preventing the free flow of Qi in the vessels, hence the pulse is slightly hidden and wiry-tight. Additionally, the Stomach Fu is extremely hot; the Sha toxin takes advantage of this. If one drinks hot soup or eats hot food, the Sha toxin will rampage and attack the Zang-Fu organs, resulting in such severe symptoms." First, I performed bloodletting acupuncture at one point on the vertex. Next, I performed bloodletting at more than twenty points on the fingertips, and two points above the breasts. The mental confusion immediately relieved. I prescribed Wuyao Shunqi Tang (Aucklandia Decoction to Smooth Qi) with added Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma), and Taoren (Persicae Semen), for two doses, taken slightly cooled. Subsequently, head sweating ceased, tongue coating receded, and other symptoms gradually resolved. Bloodletting was performed again on the fingers. Then, Zhishi Dahuang Tang (Immature Bitter Orange and Rhubarb Decoction) was prescribed, with Huaihua removed and Honghua (Carthami Flos) and Mangxiao (Natrii Sulfas) added, for two doses, taken warm, leading to recovery.
2. The wife of Sun Yanqu presented with high fever, jaundice, profuse sweating on the head like rain, extreme thirst, and cracked lips. The left pulse was wiry and tight, and the right pulse was deep and faint. I performed bloodletting acupuncture at over forty points along the arms and above and below the popliteal fossae, draining purple-black toxic blood, but the condition did not resolve. I prescribed Xixin Dahuang Wan (Asarum and Rhubarb Pill) and Chenxiang Yujin San (Aquilaria and Curcuma Powder), administered with slightly cooled decoction. Then, Taoren Honghua Tang (Peach Kernel and Safflower Decoction) with Niuxi (Achyranthis Bidentatae Radix) and Shihu (Dendrobii Caulis) was prescribed for two doses, taken slightly warm, resulting in complete recovery.
3. Liang Zhongsu had suffered from *Shanghan* for six days, presenting with high fever, petechiae, extreme thirst, and lethargy. Examination revealed an excessively surging and large pulse, with prominent green veins at both temporal regions. I performed bloodletting acupuncture at three points and five points at the popliteal fossae, releasing toxic blood, but the illness persisted. Jingjie Honghua Tang (Schizonepeta and Safflower Decoction) was combined with Qingliang Zhibao Yin (Cooling Precious Treasure Drink) with added Shigao (Gypsum Fibrosum), taken slightly cooled for four doses, leading to recovery.
4. The second daughter of Tang Maozhen contracted *Shanghan* in August. She experienced high fever at dusk, thirst, petechiae, severe headache as if splitting, heavy voice, deafness, vomiting of two roundworms, and near-fatal mental confusion. The pulses at both Cun positions were weak and powerless; the Guan positions were wiry and thin; the left Chi position was slippery, and the right Chi position was tight. Bloodletting was performed at three points in the popliteal fossae, providing slight relief. Qingliang Zhibao Yin (Cooling Precious Treasure Drink) was prescribed with added Huangqin (Scutellariae Radix), Niuxi (Achyranthis Bidentatae Radix), Shigao (Gypsum Fibrosum), Taoren (Persicae Semen), Zelan (Lycopus Lucidus Herba), Wuyao (Linderae Radix), and Zhiqiao (Aurantii Fructus Immaturus), taken cold. When this proved ineffective, bloodletting was repeated. A decoction of Shudahuang (Prepared Rhubarb) 3 qian and Xiacha (Fine Tea) a pinch was prepared and administered, resulting in recovery.