时有壮热烦闷，遍身痛如刺蝥所伤，乡俗相传，名为刺蝥瘟焉。以痧治之，可全也。
治验∶
一 林悦溪，犯时疫瘟疾，壮热口渴，胸腹迷闷，以手抚摩之，即如刺蝥伤痛，遍体皆然。放腿弯痧二十余针，毒
血成流。用穿山甲、天虫、角刺，加活血顺气之药，稍冷冻饮料之而痊。
时有北疾，村俗相传，名为地葡瘟者，阅之亦有痧也。治在前“遍身肿胀痧”条内，故不更载治验，但恐时人或误，
故复记之。
痧者，凶疾也。痧而发颐毒瓦斯上攻，尤凶之甚也。宜急治之，迟则难救。
治验∶
一汪云文，壮热目赤，口渴烦闷，谵语神昏，左脉沉微，右脉歇指，痧也。先服阴阳水一碗，神昏少清，谵语稍
定，然后扶起，放痧讫。外用赤豆水捣敷围，内吹冰硼散，付以穿山甲、天虫、角刺、射干、山豆根、土贝母、连翘、
乌药、枳壳、川连、牛膝微冷冻饮料之，颐遂出脓些须，四日而愈。
痘有顺、有险、有逆。险者尤可回生，逆者断难疗治，此不易之论也。然余观婴儿出痘，暗犯兼痧，其痘未有不逆。
故兼痧之痘，或难放标；或标而不分，颗不起发；或当起发，分颗而反隐；或发 疹；或变焦黑；或见飞浆；或生血泡；
或肉肿痘不肿；或下体先发，而脸额不起，顶不行浆；或琐屑细密，色泽晦暗；或一片如咽脂色。种种逆症，往往因痧
毒恶血壅阻，以致殒命。愚尝先放其痧，随宜用药则毒血一行，壅阻俱散。逆者可转而为顺；难标者即标；难起者即起；
当浆者即浆。无奈世人以痘不可放痧，误事不少。不知逆痘难疗，更无生路，惟兹一法可救。但恐痧助痘毒内攻甚速，
迟难挽回。若逆痘始现，有痧即放，治之甚易。凡遇逆痘，急宜鉴诸。
治验∶
一金权可女四岁，十一月间，痘五朝，放标至足，面痘犹细如芥子，隐隐不发，其腰下痘，反有水珠色，真逆痘
也。阅左腿弯有痧筋，放一针；手指上痧，放十五针，俱紫黑毒血，面痘立时红活起发。余看痧气已绝，惟用十神解毒
汤减大腹皮加天虫、大力子、山楂、青皮一剂，次日，面有行浆之势。惟用养血、托浆，清凉解毒之药五剂，痘即如期
灌脓收靥而愈。
一金权可子三岁，十二月间，痘六朝，左腰痘密有 窠形，色如水珠。其面脸痘，紫赤满顶不发，服酒浆桑虫一
条，反变两颧一片，如脂脂色。不分颗粒，左额见飞浆一粒，亦逆痘也。余为放指上痧二十余针，痘即分颗红活。余惟
用痧痘可兼治之。药一剂治之，次日，痘即行浆。后惟用治痘常药，遂灌脓收靥而痊。
一汪扶摇子八岁，六月间，痘五朝，面上肉肿痘不肿，他医谢事。延余阅腿弯有痧筋，放四针，紫黑毒血成流。用
宝花散，兼圆红散微温汤服，次日，痘即起胀。后惟用大补气血药，助灌脓收靥而愈。
一褚隽甫女，十二岁，八月间，痘四朝，遍身紫 ，他医莫治。延余，阅指臂上痧筋，放二十余针。用大黄丸稍冷
汤饮之， 退痘起。后惟用清凉解毒之药，即如期灌浆收靥，乃瘳。
一詹福先子，六岁，九月间，痘四朝，大渴舌心有黄黑胎，腰腹大痛，面部痘色焦紫过顶不发。延余，阅有痧筋，
放腿弯、指头痧二十余针，痛不止。用细辛大黄丸清茶微冷冻饮料饮之，痛稍减，付必胜汤加川连、石膏一剂，微温饮之，
痛止胎退，痘渐起胀。尤大便不通，去川连、石膏，日服此汤，灌脓收靥，便通而愈。
当时有出现高热、烦闷，全身疼痛如同被刺蝥（一种毒虫）叮咬所伤的情况，民间习俗相传，称之为“刺蝥瘟”。用治疗痧症的方法来处理，可以完全治愈。
治验：
林悦溪，感染了当时的瘟疫疾病，高热口渴，胸腹部迷乱闷胀，用手抚摸皮肤，就像被刺蝥叮咬伤痛一样，全身都是如此。在腿弯处放痧二十多针，流出如水流般的毒血。使用穿山甲、天虫（僵蚕）、角刺（皂角刺），加入活血顺气的药物，稍加冷却后饮用，于是痊愈。
当时又有北方的一种疾病，乡村习俗相传，称为“地葡瘟”的，查看起来也有痧症的表现。治疗方法在前面“遍身肿胀痧”条中已有记载，所以不再重复记录治验，只是担心时人可能会误解，所以再次记录下来。
痧症，是凶险的疾病。如果痧症引发颐部（腮颊部）毒瓦斯上攻，尤其是非常凶险的。应当紧急治疗，拖延则难以救治。
治验：
汪云文，高热，眼睛发红，口渴烦闷，说胡话且神志昏迷，左脉沉微，右脉间歇性停跳，这是痧症。先服用一碗阴阳水，神志稍微清醒，说胡话稍微安定，然后扶起患者，放完痧。外用赤豆水捣碎敷在周围，内服冰硼散，并开具穿山甲、天虫、角刺、射干、山豆根、土贝母、连翘、乌药、枳壳、川连（黄连）、牛膝等药，稍加冷却后饮用，腮颊部遂排出少许脓液，四天后痊愈。
痘疹有顺证、险证、逆证。险证尚可挽回生命，逆证则极难治疗，这是不变的真理。然而我观察婴儿出痘，暗中兼夹痧症，其痘疹没有不是逆证的。所以兼夹痧症的痘疹，有的难以透发；有的虽然透发但不分颗粒，不起发；有的应当起发，分颗却反而隐没；有的发出疹子；有的变成焦黑色；有的出现飞浆（浆液外溢）；有的生成血泡；有的肌肉肿胀而痘不肿；有的下部先发，而脸额不起，顶部不行浆；有的琐碎细密，色泽晦暗；有的成片如咽脂色。种种逆证，往往因为痧毒恶血壅阻，以致死亡。我曾先放出其痧，随即根据情况用药，那么毒血一行，壅阻俱散。逆证可转为顺证；难透发的即能透发；难起发的即能起发；当行浆的即能行浆。无奈世人认为痘不可放痧，误事不少。不知道逆痘难治，更是毫无生路，只有这一方法可以救命。只是担心痧助长痘毒内攻速度很快，拖延难以挽回。如果逆痘刚开始显现，有痧就放，治疗很容易。凡是遇到逆痘，急宜以此为鉴。
治验：
金权可的女儿四岁，十一月间，出痘第五天，透发到足部，面部痘疹仍细小如芥子，隐隐不出，腰部以下的痘疹，反而有水珠色，真是逆痘啊。查看左腿弯有痧筋，放一针；手指上的痧，放十五针，都是紫黑色的毒血，面部痘疹立即红活起发。我看痧气已绝，只用十神解毒汤减去大腹皮，加入天虫、大力子（牛蒡子）、山楂、青皮一剂，第二天，面部有行浆的趋势。只用养血、托浆，清凉解毒的药物五剂，痘疹即如期灌脓收靥而痊愈。
金权可的儿子三岁，十二月间，出痘第六天，左侧腰部痘疹密集有窠形，颜色如水珠。其面颊痘疹，紫赤满顶不发，服用酒浆桑虫一条，反而变成两颧一片，如脂脂色。不分颗粒，左额见飞浆一粒，也是逆痘啊。我为他放手指上的痧二十多针，痘疹即分颗红活。我只用痧痘可兼治的药一剂治疗，第二天，痘疹即行浆。后来只用治疗痘疹的常药，于是灌脓收靥而痊愈。
汪扶摇的儿子八岁，六月间，出痘第五天，面上肉肿痘不肿，其他医生推辞不治。请我诊治，查看腿弯有痧筋，放四针，紫黑色毒血流成线。使用宝花散，兼服圆红散，用微温汤送服，第二天，痘疹即起胀。后来只用大补气血的药物，帮助灌脓收靥而痊愈。
褚隽甫的女儿，十二岁，八月间，出痘第四天，全身紫暗，其他医生无法治疗。请我诊治，查看指臂上有痧筋，放二十多针。使用大黄丸，稍加冷汤饮服，紫暗退去痘起。后来只用清凉解毒的药物，即如期灌浆收靥，于是病愈。
詹福先的儿子，六岁，九月间，出痘第四天，大渴，舌心有黄黑苔，腰腹剧痛，面部痘色焦紫过顶不发。请我诊治，查看有痧筋，放腿弯、指头痧二十多针，疼痛不止。使用细辛大黄丸，清茶稍加冷却后饮用，疼痛稍减，给予必胜汤加川连、石膏一剂，微温饮之，疼痛停止苔退，痘疹渐起胀。尤其大便不通，去掉川连、石膏，每日服用此汤，灌脓收靥，便通而痊愈。
At that time, there were cases of high fever and restlessness, with body pain all over as if injured by the bite of a Ci Mao (a type of venomous insect). Local custom passed it down as "Ci Mao Plague." Treating it as Sha disease (Sha syndrome, characterized by microvascular congestion and toxicity) can lead to complete recovery.
Case Record:
Lin Yuexi contracted the epidemic plague of the time, presenting with high fever, thirst, and a confused, stifling sensation in the chest and abdomen. When touched, the skin felt painful as if bitten by Ci Mao, throughout the entire body. Sha was released from the popliteal fossae (back of the knee) with more than twenty needle pricks, and toxic blood flowed like water. He was treated with Chuan Shan Jia (Pangolin Scales), Tian Chong (Bombyx Batryticatus), and Jiao Ci (Gleditsiae Spina), added with herbs to invigorate blood and regulate qi. The decoction was consumed slightly cooled, and he recovered.
There was also a disease prevalent in the north at that time, locally known as "Di Pu Plague," which upon examination also presented signs of Sha. The treatment is recorded under the section "Sha with Generalized Swelling," so I do not repeat the case record here. However, fearing that contemporaries might misunderstand, I record this again.
Sha disease is a fierce illness. If Sha triggers toxic vapors to attack upward, causing swelling in the parotid region (Yi), it is extremely dangerous. Urgent treatment is required; delay makes rescue difficult.
Case Record:
Wang Yunwen presented with high fever, red eyes, thirst, restlessness, delirium, and coma. The left pulse was deep and faint, and the right pulse had intermittent pauses. This was Sha disease. First, one bowl of Yin Yang Water (water mixed from boiling and raw cold water) was administered. His consciousness cleared slightly, and delirium subsided somewhat. Then, he was helped into an upright position, and Sha was released. Externally, a paste made from Red Bean (Vigna angularis) soaked in water was applied around the affected area. Internally, Bing Peng San (Ice and Borax Powder) was insufflated into the nose. A prescription containing Chuan Shan Jia, Tian Chong, Jiao Ci, She Gan (Belamcandae Rhizoma), Shan Dou Gen (Sophorae Tonkinensis Radix et Cortex), Tu Bei Mu (Fritillariae Thunbergii Bulbus), Lian Qiao (Forsythiae Fructus), Wu Yao (Linderae Radix), Zhi Ke (Aurantii Fructus Immaturus), Chuan Lian (Coptidis Rhizoma), and Niu Xi (Achyranthis Bidentatae Radix) was prescribed. It was taken slightly cooled. The parotid swelling eventually discharged a small amount of pus, and he recovered in four days.
Smallpox has favorable (Shun), critical (Xian), and unfavorable (Ni) patterns. Critical patterns can often be rescued, while unfavorable patterns are extremely difficult to treat; this is an unchangeable principle. However, I have observed that infants contracting smallpox secretly complicated by Sha invariably present with unfavorable patterns. Therefore, smallpox complicated by Sha may fail to erupt; or erupt without distinct grains, failing to rise; or when it should rise, the grains become indistinct and recede; or manifest as rashes; or turn black and scorched; or exhibit flying pus (pus leaking out); or form blood blisters; or show flesh swelling without pustule formation; or appear first on the lower body while the face and forehead remain flat and fail to fill with pus; or be numerous, fine, and dark in color; or appear as a patch resembling the color of swallowed fat. Various unfavorable symptoms often result in death due to the obstruction caused by Sha toxins and evil blood. I once released the Sha first, followed by appropriate medication. Once the toxic blood circulated, the obstructions dispersed. Unfavorable patterns turned favorable; those difficult to erupt erupted easily; those difficult to rise rose easily; those ready for pus filling filled with pus. Regrettably, people believe that Sha should not be released during smallpox, causing many errors. They do not realize that unfavorable smallpox is hard to treat and offers no hope of survival, whereas this method alone can save lives. One must fear that Sha accelerates the internal attack of smallpox toxins, making late intervention unrecoverable. If unfavorable smallpox is just appearing and Sha is present, releasing it makes treatment very easy. Whenever encountering unfavorable smallpox, one should take this as a warning.
Case Record:
Jin Quanke’s daughter, aged four, in November, on the fifth day of smallpox eruption, the rash reached her feet, but facial pustules remained as small as mustard seeds, faintly visible and not rising. Pustules below the waist instead had a watery appearance, indicating true unfavorable smallpox. Examining the left popliteal fossa, Sha vessels were found, and one needle prick was performed. Sha on the fingers was released with fifteen pricks, yielding purple-black toxic blood. Immediately, the facial pustules became red, vibrant, and began to rise. Seeing that the Sha pathogen had been exhausted, I used only Shishen Jiedu Tang (Ten-God Detoxifying Decoction) minus Dafupi (Arecae Pericarpium), adding Tian Chong, Dali Zi (Arctii Fructus), Shanzha (Crataegi Fructus), and Qingpi (Citri Reticulatae Pericarpium Viride). After one dose, the next day, the face showed signs of pus formation. Five doses of herbs to nourish blood, support pus formation, and clear heat-toxin were administered, leading to full pus filling, scabbing, and recovery as expected.
Jin Quanke’s son, aged three, in December, on the sixth day of smallpox, pustules on the left waist were dense with crater-like shapes and colored like water droplets. Facial pustules were purple-red, covering the crown but failing to rise. After consuming one wine-soaked mulberry silkworm (Sang Can), both cheeks turned a uniform patch resembling fat color, losing grain definition. A single instance of flying pus appeared on the left forehead, also indicating unfavorable smallpox. I released Sha from the fingers with more than twenty pricks, after which the pustules separated, became red, and vibrant. I treated him with one dose of medicine suitable for concurrent Sha and smallpox treatment. The next day, pus formation progressed. Subsequently, routine smallpox medications were used, leading to pus filling, scabbing, and recovery.
Wang Fuyao’s son, aged eight, in June, on the fifth day of smallpox, the face showed flesh swelling without pustule formation. Other physicians declined treatment. Upon my examination, Sha vessels were found in the popliteal fossae, and four pricks were performed, yielding purple-black toxic blood flowing in streams. Baohua San (Precious Flower Powder) was used, combined with Yuanhong San, taken with slightly warm soup. The next day, the pustules swelled. Later, only major Qi and Blood tonics were used to assist in pus filling and scabbing, resulting in recovery.
Chu Junfu’s daughter, aged twelve, in August, on the fourth day of smallpox, the entire body was purplish-dark. Other doctors could not treat her. Upon my examination, Sha vessels were found on the fingers and arms, and more than twenty pricks were performed. Dahuang Wan (Rhubarb Pill) was administered with slightly cool soup. The purplish-darkness receded, and the pustules rose. Later, only heat-clearing and detoxifying herbs were used, leading to timely pus filling, scabbing, and cure.
Zhan Fuxian’s son, aged six, in September, on the fourth day of smallpox, suffered from extreme thirst, yellow-black coating on the center of the tongue, severe abdominal and lumbar pain, and facial pustules that were scorched-purple, exceeding the hairline, and failing to rise. Upon my examination, Sha vessels were present. Sha was released from the popliteal fossae and fingertips with more than twenty pricks, but pain persisted. Xixin Dahuang Wan (Asarum and Rhubarb Pill) was given with slightly cooled green tea, reducing pain slightly. Biseng Tang (Invincible Decoction) plus Chuan Lian and Shigao (Gypsum Fibrosum) was prescribed, taken slightly warm. Pain ceased, the coating receded, and pustules gradually swelled. Due to constipation, Chuan Lian and Shigao were removed, and this decoction was taken daily until pus filled, scabs formed, bowels moved, and he recovered.