伤寒集中，仅有四症类伤寒。至于痧症类伤寒，较之四症，尤为凶暴。而伤寒书内，从未载及，故医者不识。夫伤
寒头痛、恶寒、发热，属足太阳膀胱经风寒，宜表，是寒从肌表而入，故宜发散为先。若痧症头痛，是痧毒之气，上攻
头面三阳；不因外感寒气，其恶寒发热，虽在肌表，是时行之气所感，由呼吸而入，搏激于肌表之中；做为毒热，内热
则外寒，故亦恶寒。治宜先刺颠顶，放痧以泄其毒，用药惟在透窃解毒顺气为主。若误认伤寒足太阳膀胱经症，用羌活、
麻黄、发表太甚，反助痧毒火邪，益张其焰，势必恶毒攻冲，作肿作胀，立时见凶。故痧症与伤寒，其头痛，恶寒，发
热虽同，治之当异，要知痧症宜清凉，则痧毒可内解；伤寒宜辛散，则寒气可外舒。固不可以治痧症者治伤寒，更不可
以治伤寒者治痧症也。
治验∶
一林管家长子，六月，发热五日，昏迷不醒。余诊之，病似伤寒，而脉沉微无力，实非伤寒症也。阅腿弯下痧筋，
放紫黑毒血三针，指头九针，不愈，用阿魏丸并大黄丸凉茶饮之，昏迷遂醒，越两日身凉乃痊。
一车文显次子恶寒发热十二日，昏迷沉重，不省人事。适余至乡，延余诊之，见其面色红黑，十指头俱青黑色，六
脉洪数，皆曰∶新婚燕尔、症必属阴。余日∶“非也。若以阴治，一用温补热药，殆迫其死矣。”夫脉洪数者，痧毒搏激
于经络也。十指青黑者，痧之毒血流注也。面色红黑者，痧毒升发于头面三阳也。及视腿弯痧筋，若隐若现，放之，微
有紫黑血点而已。其父素知痧患，便云此真痧也。奈前因暗痧莫识，数饮热汤，毒血凝聚于内，放之不出，将何以救之。
余用宝花散，晚蚕沙汤冷冻饮料之，渐醒，痧筋复现于左腿弯二条，刺出紫黑毒血如注，乃不复如前之昏迷矣。但发热身重，
不能转侧，肩背多痛，用大剂桃仁、苏木、乌药、香附、白蒺藜末、泽兰、独活、山楂微温服之，渐能转运。尤身热不
凉，大便不通，用卜子、麦芽、枳实、大黄、紫朴、桃仁温服，便通热减，后调补三月而痊。
一方居安内室，正月头痛、恶寒、发热，心胸烦闷，口渴咽干，头汗如雨，痰喘面黑，十指头具有黑色，已五日矣。
延余诊之，气口脉虚，时或歇指，左手三部，洪数无伦。余曰∶“非痧而有是脉，恐不能生矣”。因看痧筋，幸其弟善放
痧，见有青筋，曰∶“此真痧也”。刺顶心一针，左臂弯一针，右腿弯一针，毒血已去，不愈。余想其饭后起病，即以矾
汤稍冷多服，吐去宿食，烦闷痰喘头汗具除，余症未愈。次日，其弟复为放痧，饮以阴阳水一碗，亦未愈。余用柴胡、
山楂、连翘、红花、卜子、枳实、荆芥、花粉，加酒制大黄二钱，俟微冷服二剂，大便通而安。迨后十余日，腹中大痛，
口吐涎沫，此又因秽气所触而复痧也。令其刮痧，少安，用藿香正气汤稍冷服之，腹痛顿止，后用补中益气汤、十全大
补汤调理如旧。
一甄复先，恶寒发热，呕哕心烦，服他药，昏迷不醒。或谓阴虚而然，余诊之，六脉沉微，手足大热，唇舌鲜红，
身体重痛，余曰∶“痧毒冲心，入于血分瘀滞故尔。”不信。连易三医莫任。复求余治，呼之不应，扶之不起，用晚蚕沙
煎汤微冷服，次以宝花散、煎砂仁汤微冷送下，稍醒，然后扶起放痧数十针，未愈。用桃仁、延胡索，苏木、乌药、红
花、香附、山楂一剂，始能转侧。后服小柴胡汤，寒热具除，调理两月而痊。
伤寒类病书中，仅记载了四种病症类似伤寒。至于痧症类似伤寒的情况，比起那四种病症，更加凶险暴烈。而伤寒类书籍中，从未记载过此类病症，所以医生们都不认识。
伤寒引起的头痛、恶寒、发热，属于足太阳膀胱经受风寒侵袭所致，适宜用解表法治疗，这是因为寒气从肌表侵入，所以应当以发散为先。如果是痧症引起的头痛，是痧毒之气上攻头面三阳经；并非因为外感寒气，其出现的恶寒发热，虽然表现在肌表，但这是由时行之气（流行性致病因素）通过呼吸侵入，搏结激荡于肌表之中；形成毒热，内热则外显寒象，所以也出现恶寒。治疗应当先刺头顶部位，放痧以泄出毒邪，用药主要在于透发痧毒、解毒顺气为主。如果误认为是伤寒足太阳膀胱经的病症，使用羌活、麻黄等药物发表太过，反而助长痧毒火邪，使其火势更旺，势必导致恶毒攻冲，出现肿胀，立刻显现凶险之兆。所以痧症与伤寒，虽然都有头痛、恶寒、发热的症状，但治疗方法应当不同，要知道痧症适宜清凉，则痧毒可以从内部解除；伤寒适宜辛温发散，则寒气可以从外部舒展。绝不可以用治痧症的方法去治伤寒，更不可以用治伤寒的方法去治痧症。
医案记录：
一位林管家的长子，六月时，发热五天，昏迷不醒。我诊察他，病情看似伤寒，但脉象沉微无力，确实不是伤寒症。查看他腿弯处的痧筋，放出紫黑色的毒血三针，手指尖九针，病情未愈，于是服用阿魏丸和大黄丸，并用凉茶送服，昏迷随即清醒，过了两天身体凉爽才痊愈。
车文显的次子恶寒发热十二天，昏迷沉重，不省人事。恰逢我回到乡下，请我去诊治，见其面色红黑，十个手指头都呈青黑色，六脉洪数，大家都说：“新婚不久，病症必定属阴证。”我说：“不对。如果用阴证的方法治疗，一旦使用温补热药，几乎会逼死病人。”脉象洪数，是因为痧毒搏结激荡于经络之中。十个手指青黑，是痧毒血流注滞塞所致。面色红黑，是痧毒升发于头面三阳经所致。等到查看腿弯处的痧筋，若隐若现，进行放痧，只流出微量的紫黑血点而已。他的父亲素来知道痧症的祸患，便说这真是痧症。无奈之前因为暗痧未被识别，多次饮用热汤，导致毒血凝聚在体内，放不出来，该如何救治呢？我使用宝花散，配合晚蚕沙汤冷冻后让他饮用，逐渐苏醒，左腿弯处再次显现两条痧筋，针刺放出如注般的紫黑毒血，这才不再像之前那样昏迷。但是仍然发热身重，不能翻身转动，肩背多痛，使用大剂量的桃仁、苏木、乌药、香附、白蒺藜末、泽兰、独活、山楂，微温服用，逐渐能够活动。特别是身体发热不退，大便不通，使用莱菔子、麦芽、枳实、大黄、厚朴、桃仁，温服后，大便通畅，热势减退，之后调理三个月才痊愈。
一方居的妻子，正月里头痛、恶寒、发热，心胸烦闷，口渴咽干，头部出汗如雨，痰喘面色黑，十个手指头都具有黑色，已经五天了。请我去诊治，气口脉虚，有时脉搏间歇，左手三部脉洪数无比。我说：“如果不是痧症而有这种脉象，恐怕难以生存。”于是查看痧筋，幸好他弟弟擅长放痧，见到有青筋，说：“这真是痧症。”刺顶心一针，左臂弯一针，右腿弯一针，毒血已去，但病情未愈。我想他是饭后发病，就用矾汤稍微冷却后让他多服，吐出宿食，烦闷、痰喘、头汗全部消除，其余症状未愈。第二天，他弟弟再次为他放痧，饮一碗阴阳水，也未见效。我使用柴胡、山楂、连翘、红花、莱菔子、枳实、荆芥、花粉，加入酒制大黄二钱，等待稍微冷却后服用两剂，大便通畅而安定。此后十多天，腹中大痛，口吐涎沫，这又是因秽气触碰而复发的痧症。命令他刮痧，稍作缓解，使用藿香正气汤稍微冷却后服用，腹痛立即停止，之后用补中益气汤、十全大补汤调理恢复如初。
甄复先，恶寒发热，呕吐呃逆心烦，服用其他药物后，昏迷不醒。有人说这是阴虚所致，我诊察他，六脉沉微，手足大热，唇舌鲜红，身体重痛，我说：“这是痧毒冲心，进入血分瘀滞的缘故。”他不相信。接连更换三位医生都无法胜任。后来又来求我治疗，呼唤不应，扶起不起，我用晚蚕沙煎汤稍微冷却后服用，接着用宝花散，用砂仁汤稍微冷却送下，稍许清醒，然后扶起来放痧数十针，病情未愈。使用桃仁、延胡索、苏木、乌药、红花、香附、山楂一剂，才开始能够翻身转动。后来服用小柴胡汤，寒热症状全部去除，调理两个月才痊愈。
In the collected works on Cold Damage (Shanghan), only four types of syndromes are described as resembling Cold Damage. However, Sha syndrome (a condition characterized by toxic heat and blood stasis often manifesting with skin eruptions or subcutaneous congestion) resembling Cold Damage is even more fierce and violent than those four types. Since Sha syndrome has never been recorded in books on Cold Damage, physicians are unfamiliar with it.
Headache, aversion to cold, and fever caused by Cold Damage belong to Wind-Cold invading the Foot-Taiyang Bladder Meridian; it is appropriate to use exterior-releasing methods because the Cold pathogen enters from the muscle layer, so dispersing should be prioritized. If the headache is caused by Sha syndrome, it is due to Sha toxin Qi attacking upward to the three Yang meridians of the head and face. It is not caused by external Cold invasion. Although the aversion to cold and fever appear at the muscle level, they are actually contracted via respiration from seasonal epidemic pathogens, which agitate and bind within the muscle layer, forming toxic heat. Internal heat manifests as external cold, hence aversion to cold also occurs. Treatment should first involve pricking the vertex to release Sha (bleeding therapy) to drain the toxin. Medication should primarily focus on venting Sha, resolving toxicity, and regulating Qi. If mistakenly diagnosed as a Foot-Taiyang Bladder Meridian syndrome of Cold Damage and treated with excessive exterior-dispersing herbs like Qianghuo (Notopterygii Rhizoma et Radix) and Mahuang (Ephedrae Herba), it will instead assist the Sha toxin and fire pathogen, intensifying the flame. This will inevitably lead to aggressive toxic attack, swelling, and immediate danger. Therefore, although Sha syndrome and Cold Damage share symptoms such as headache, aversion to cold, and fever, their treatments must differ. One must know that Sha syndrome requires cooling to resolve toxins internally, while Cold Damage requires acrid-warm dispersal to舒 (disperse) Cold externally. Thus, one must not treat Sha syndrome with methods for Cold Damage, nor treat Cold Damage with methods for Sha syndrome.
Clinical Cases:
1. The eldest son of Manager Lin presented with five days of fever and coma. Upon examination, the condition resembled Cold Damage, but the pulse was deep, thready, and weak, indicating it was truly not Cold Damage. Observing Sha veins under the popliteal fossa, I released three needles of dark purple-black toxic blood from the legs and nine needles from the fingertips. As there was no improvement, I administered Awei Wan (Asafoetida Pill) and Dahuang Wan (Rhubarb Pill) with cool tea. The coma resolved, and after two days, when his body temperature normalized, he recovered.
2. The second son of Che Wenxian suffered from twelve days of aversion to cold and fever, progressing to heavy coma and unconsciousness. When I arrived in the countryside to examine him, his complexion was red and black, his ten fingertips were cyanotic-black, and all six pulses were surging and rapid. Everyone claimed, "Given his recent marriage, the syndrome must be Yin-type." I said, "Incorrect. If treated as a Yin syndrome using warm-tonifying hot medicines, it would likely hasten his death." A surging and rapid pulse indicates Sha toxin agitating the collaterals. Cyanotic-black fingertips indicate stagnation of Sha toxic blood. Red-black complexion indicates Sha toxin rising to the three Yang meridians of the head and face. Upon examining the Sha veins in the popliteal fossa, they were faintly visible. Pricking them yielded only minute drops of dark purple-black blood. His father, familiar with Sha hazards, insisted it was true Sha. However, prior misdiagnosis led to repeated consumption of hot soups, causing toxic blood to coagulate internally and preventing effective drainage. How could this be saved? I used Baohua San (Precious Flower Powder) and Lengdongyin (Frozen Ice Water) made from Canarium Album (Late Silkworm Sand). He gradually awakened, and two Sha veins reappeared in the left popliteal fossa. Pricking them released gushing dark purple-black toxic blood, ending the coma. However, he still had fever, heaviness, inability to turn over, and shoulder/back pain. I prescribed a large dose of Taoren (Persicae Semen), Sumu (Sappanwood), Wuyao (Linderae Radix), Xiangfu (Cyperi Rhizoma), Baijili (Tribuli Fructus), Zelan (Lycopus Herba), Duhuo (Angelicae Pubescentis Radix), and Shanzha (Crataegi Fructus), taken slightly warm. Gradually, mobility returned. For persistent fever and constipation, I used Lubizi (Brassicae Semina), Maiya (Hordei Fructus Germinatus), Zhishi (Aurantii Fructus Immaturus), Dahuang (Rhei Radix et Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Taoren, taken warm. Bowel movement resumed, fever subsided, and after three months of conditioning, he fully recovered.
3. The wife of Fang Ju'an presented in January with headache, aversion to cold, fever, chest oppression, thirst, dry throat, profuse sweating on the head, phlegm-panting, blackish complexion, and black discoloration of the fingertips for five days. Upon examination, the Qi-kou pulse was deficient and intermittent, while the three positions on the left hand were excessively surging and rapid. I stated, "If this is not Sha syndrome, such a pulse suggests poor prognosis." Checking for Sha veins, fortunately, her brother was skilled in Sha release. Seeing green veins, he said, "This is true Sha." We pricked the vertex, left arm crook, and right leg crook. Toxic blood was removed, but there was no improvement. Considering the illness started after a meal, I had him drink Fan Tang (Alum Decoction) slightly cooled in large quantities to induce vomiting of retained food. Chest oppression, phlegm-panting, and head sweating ceased, but other symptoms persisted. The next day, her brother performed Sha release again, and she drank a bowl of Yin-Yang Water, yet there was no improvement. I prescribed Chaihu (Bupleuri Radix), Shanzha, Lianqiao (Forsythiae Fructus), Honghua (Carthami Flos), Lubizi, Zhishi, Jingjie (Schizonepetae Herba), and Huafen (Puerariae Radix), plus 2 qian of Jiuhuang (Wine-processed Rhubarb). Taken slightly cool for two doses, bowel movements cleared, and stability was achieved. More than ten days later, severe abdominal pain and salivation occurred, indicating a recurrence of Sha triggered by foul odors. Scraping therapy provided slight relief. She took Huoxiang Zhengqi Tang (Agastache Powder for Regulating the Middle) slightly cooled, stopping abdominal pain immediately. Subsequently, she was conditioned with Buzhong Yiqi Tang (Decoction for Boosting the Middle and Augmenting Qi) and Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) until she returned to normal.
4. Zhen Fuxian presented with aversion to cold, fever, vomiting, hiccuping, irritability, and coma after taking other medications. Some attributed it to Yin deficiency. My examination revealed deep, thready pulses in all six positions, extreme heat in hands and feet, bright red lips and tongue, and heavy body pain. I stated, "Sha toxin rushing to the Heart and causing blood stasis in the Blood level." He did not believe me. Three other physicians failed to treat him. Seeking my help again, he was unresponsive to calls and unable to rise. I administered Lengyin (Cool Tea) made from Canarium Album (Late Silkworm Sand). Then, I gave Baohua San delivered with slightly cooled Shenren Tang (Amomi Fructus Decoction). He regained slight consciousness. I then assisted him in undergoing dozens of needle releases for Sha. There was no immediate improvement. I prescribed a single dose of Taoren, Yanhusuo (Corydalis Rhizoma), Sumu, Wuyao, Honghua, Xiangfu, and Shanzha. Only then could he turn over. Later, Xiaochaihu Tang (Minor Bupleurum Decoction) eliminated chills and fever, and after two months of conditioning, he recovered.