痧之初发，必从外感。感于肌表，人不自知，则入于半表半里，故胸中作闷，或作呕吐，而腹痛生焉。此可以刮痧
而愈，不愈，用荆芥汤、藿香汤之类而选用之。痧感于半表半里，人不自知，则入于里，故欲吐不吐，欲泻不泻。痧
毒冲心，则心胸大痛，痧毒攻腹，则盘肠吊痛。此可以放痧而愈，不愈，用陈皮紫朴汤、棱术汤之类而选用之。痧中于
里，人不自知，则痧气壅阻，恶毒逆攻心膂，立时发晕，即欲刮痧而痧不起；即欲放痧而扶之不起，必不得放，即扶起
放之，而发晕之时，气血不流，放之亦无紫黑毒血流出，即有些须，亦不能多，略见紫黑血点而已。此痧毒入深，大凶
之兆。斯时病家求救甚切，方可用药。余但审脉辨证，的系风寒暑湿，气血、食积、痰饮，何因而施治，令其苏醒，气
血流动，然后扶起放痧，渐以调治。如不醒，即择牛黄丸、三香丸、救苦丹之类以救之。如此重症，必需医者慈心大发，
立时连进汤丸，方能有救，迟则必死。
痧犯太阳，则头痛发热；犯少阳，则耳旁肿胀，寒热往来；犯阳明，则面目如火，但热而不寒；犯太阴则腹痛；犯
厥阴则少腹痛或胸胁痛；犯少阴则腰痛而皆身凉。犯乎肺则咳嗽痰喘微热，甚则鼻衄；犯乎心则心痛或心胀，其头额冷
汗如珠，而身或热或凉；犯乎膀胱则小便溺血，甚则身热；犯乎大肠则痢下脓血，重则呕吐身热；犯乎肝则沉重不能
转侧，晡热、内热，甚则吐血；犯乎三焦则热毒内攻，上则口渴，下则便结。治痧当辨身凉身热。盖身凉者、内热者，
宜攻其里，表热者，宜透其肌。
痧症初发，必定由外感邪气引起。邪气侵袭肌表时，患者往往自己察觉不到，于是邪气进入半表半里之间，导致胸中感到闷胀，或者出现呕吐，进而产生腹痛。这种情况可以通过刮痧治疗而痊愈；如果刮痧无效，则选用荆芥汤、藿香汤等方剂进行治疗。
若邪气感受于半表半里之间，患者同样不自知，邪气便会深入体内（入里），表现为想吐却吐不出来，想泻却泻不出来。如果痧毒冲犯心脏，就会引起心胸剧烈疼痛；如果痧毒攻冲腹部，就会引起肠绞痛（盘肠吊痛）。这种情况可以通过放痧（刺络出血）治疗而痊愈；如果放痧无效，则选用陈皮紫朴汤、棱术汤等方剂进行治疗。
如果痧邪直接中于体内（入里），患者不自知，就会导致痧气壅滞阻塞，恶毒之气逆冲心膈和脊背，患者会立即头晕目眩。此时即使想要刮痧，痧疹也刮不出来；即使想要放痧，患者虚弱得扶不起来。必须不能强行放痧，因为如果在患者发晕之时强行扶起放痧，由于气血运行停滞，放出的血也不会流出紫黑色的毒血；即便有少量流出，量也不会多，仅仅能看到少许紫黑色的血点罢了。这是痧毒深入体内的表现，是大凶的征兆。
这时病人家属求救心切，才可以使用药物。医生只需仔细诊察脉象、辨析证候，明确是风寒暑湿，还是气血、食积、痰饮所致，根据病因施治，使患者苏醒，气血流通，然后再扶起患者进行放痧，随后逐渐进行调理治疗。如果患者不醒，就选择牛黄丸、三香丸、救苦丹等药物来急救。对于如此重症，必须依靠医者大发慈悲之心，立即连续服用汤药或丸药，才有可能挽救生命，拖延则必然死亡。
痧邪侵犯太阳经，就会出现头痛发热；侵犯少阳经，就会出现耳旁肿胀，寒热往来交替；侵犯阳明经，就会出现面目红赤如火，只有发热而没有恶寒；侵犯太阴经，就会出现腹痛；侵犯厥阴经，就会出现小腹痛或胸胁痛；侵犯少阴经，就会出现腰痛且全身发凉。
痧邪侵犯肺脏，会出现咳嗽、痰喘及轻微发热，严重时会出现鼻出血；侵犯心脏，会出现心痛或心腹胀满，头部额头冷汗如珠，身体有时发热有时发凉；侵犯膀胱，会出现小便带血，严重时全身发热；侵犯大肠，会出现痢疾下脓血，重者呕吐并伴有发热；侵犯肝脏，会出现身体沉重无法翻身转动，傍晚发热、内热，严重时吐血；侵犯三焦，会出现热毒内攻，上部表现为口渴，下部表现为大便干结。
At the initial onset of Sha (Sha disease, a condition characterized by toxic heat and stagnation), it must stem from external pathogenic factors. When pathogens invade the muscle and surface (the exterior layer of the body), the patient is often unaware of it; consequently, the pathogens enter the half-exterior and half-interior stage. This leads to a sensation of oppression in the chest, vomiting, and abdominal pain. This condition can be cured by scraping therapy (Gua Sha); if scraping is ineffective, formulas such as Jingjie Tang (Schizonepeta Decoction) or Huoxiang Tang (Agastache Decoction) should be selected for treatment.
If pathogens are contracted at the half-exterior and half-interior level, and the patient remains unaware, the pathogens will penetrate deeper into the interior. Symptoms include the urge to vomit but inability to do so, and the urge to defecate but inability to do so. If Sha toxin rushes to the heart, severe pain in the chest and heart region occurs; if Sha toxin attacks the abdomen, severe intestinal cramping pain (panchang diaotong) ensues. This condition can be cured by bloodletting (Fang Sha); if bloodletting is ineffective, formulas such as Chenpi Zipu Tang (Tangerine Peel and Magnolia Bark Decoction) or Lengzhu Tang (Burreed and Curcuma Decoction) should be selected.
If Sha pathogens directly strike the interior, and the patient is unaware, Sha Qi (Sha energy) becomes stagnant and obstructed. The malignant toxins attack upward against the heart, diaphragm, and spine, causing immediate dizziness and fainting. At this stage, even if scraping therapy is attempted, Sha rashes will not appear; even if bloodletting is intended, the patient may be too weak to stand. One must not forcibly perform bloodletting. If the patient is lifted while fainting, due to the stagnation of Qi and Blood, no dark purple-black toxic blood will flow out. Even if a small amount flows, it will not be much, merely showing a few dark purple-black blood spots. This indicates that Sha toxin has penetrated deeply, which is an ominous sign of great danger.
Only when the family members are urgently seeking help at this critical moment should medication be administered. The physician must carefully examine the pulse and differentiate the syndrome to determine whether the cause is Wind-Cold, Summerheat-Dampness, or stagnation of Qi-Blood, food retention, or phlegm-fluids. Treatment should be applied according to the etiology to restore consciousness and promote the flow of Qi and Blood. Only then should the patient be assisted to undergo bloodletting, followed by gradual regulatory treatment. If the patient does not regain consciousness, emergency rescue medicines such as Niuhuang Wan (Calculus Bovis Pill), Sanxiang Wan (Three Fragrances Pill), or Jiuku Dan (Relieve Suffering Pellet) should be chosen. For such severe cases, the physician must act with profound compassion, administering decoctions and pills continuously without delay to have any chance of saving the patient; delay will inevitably lead to death.
When Sha invades the Taiyang Meridian, headache and fever occur; when it invades the Shaoyang Meridian, swelling beside the ears and alternating chills and fever occur; when it invades the Yangming Meridian, the face and eyes become red like fire, with fever but no chills; when it invades the Taiyin Meridian, abdominal pain occurs; when it invades the Jueyin Meridian, lower abdominal pain or hypochondriac pain occurs; when it invades the Shaoyin Meridian, lower back pain occurs accompanied by a cool body.
If Sha affects the Lung, cough, wheezing with phlegm, and slight fever occur; in severe cases, epistaxis (nosebleed) occurs. If Sha affects the Heart, heart pain or cardiac distension occurs, with cold sweat on the forehead and head resembling beads, while the body temperature may be either hot or cool. If Sha affects the Bladder, hematuria (blood in urine) occurs; in severe cases, high fever occurs. If Sha affects the Large Intestine, dysentery with pus and blood occurs; in severe cases, vomiting and fever occur. If Sha affects the Liver, the body feels heavy and difficult to turn over, with afternoon fever and internal heat; in severe cases, hematemesis (vomiting blood) occurs. If Sha affects the Sanjiao (Triple Burner), internal attack by heat-toxin occurs, manifesting as thirst above and constipation below.
In treating Sha, one must distinguish whether the body is cool or hot. Generally, for those with a cool body or internal heat, purging the interior is appropriate; for those with exterior heat, venting the muscle layer is appropriate.