痧筋有现，有微现、有乍隐乍现，有伏而不现。痧筋之现者，毒入于血分者多；乍隐乍现者，毒入于气分者多；微
现者，毒阻于气分者多；伏而不现者，毒结于血分者多。夫痧筋之现者，人皆知刺而放之矣。其微现者，乃其毒之阻于
肠胃，而痧筋不能大显，故虽刺而无血，即微有血而点滴不流。治疗之法，但宜通其肠胃而痧筋自现，然后俟其痧筋之
现，刺而放之。若乃痧筋之乍隐乍现者，人又皆知俟其现而放之矣。至有伏而不现者，虽欲放而无可放，吾观善放痧之
人，亦未有能识其为痧者，所以痧症之祸，往往人受其害而不觉。若斯者，必从其脉之不合于症而辨之，必取其所发之
病在缓，所见之症候更倏有其甚急者，即病与症之不合，又可辨其为痧，则痧毒之结聚不散者，自可细详。治疗之法，
结于血者散其瘀；结于食者，消其食而攻之；结于痰积者，治其痰积而驱之。则结散之后，痧筋必然复现，然后刺而放
之，其痧可得而理也。如是之痧，亦有可治。若继余之业者，甚勿以其痧症之凶危，而弃之欤。
痧症之发，未有其寒者矣。而亦有其痧之为寒，非痧之有真寒也，盖因世人知痧之热，而服大寒之饮，以至于是。
然寒饮服于犯痧之人，有即愈者，有不即愈者，是何以故？夫犯痧症，必其无食、无积、无血所阻于中，方可服寒饮而
得其效。若一有食、积、血阻于中，而服大寒之饮，则食不消、积不行、血不散，而痧毒反冰伏凝阻于中，未有得宁者
矣。尝见高岩穷谷之中，山路迢遥，行旅感暑热之气，往往有一饮山涧之水而即毙者，是名寒痧。若幸遇放痧之人，乃
得以识其痧而救其命。盖缘痧毒攻心，服寒饮太过，而痧毒随冰寒凝结于心胸，故有即毙者尔。若一遇放痧之人，毒血
一行，便无凝滞，此人所以得有其命也。今近处往往有犯痧症，服冷水不愈者，此类是也。故方书所载，服阴阳之水，
而不独取乎井水者，诚有见于此尔，是以久服凉饮之后，痧有未痊者，又当用微温之药以施之。余于是集方中，所载三
香丸，又有略用附子、干姜之类，均稍冷冻饮料之，诚为权宜之善剂欤。若其方书所云寒痧，谓当即以真寒治之，而骤多用
桂、附、干姜、吴茱、参、 之类，此诚有误，不可服也。
痧筋有显现的，有轻微显现的，有忽隐忽现的，有潜伏而不显现的。痧筋显现的，多是毒邪深入血分；忽隐忽现的，多是毒邪深入气分；轻微显现的，多是毒邪阻滞于气分；潜伏而不显现的，多是毒邪结聚于血分。对于痧筋显现的情况，人们都知道通过针刺来放血排毒。至于轻微显现的，是因为毒邪阻滞在肠胃，导致痧筋不能充分显露，所以即使针刺也没有血液流出，即便有少量血液也是点滴不流。治疗的方法，只应当疏通肠胃，痧筋自然会显现出来，然后等待痧筋显现后，再进行针刺放血。如果是痧筋忽隐忽现的情况，人们又都知道等待其显现后再放血。至于那些潜伏而不显现的，虽然想放血却找不到可放的部位。我观察善于放痧的人，也未能识别出这是痧症，所以痧症带来的祸害，往往让人受害而不自知。像这种情况，必须通过脉象与症状不相符合来辨别，一定要选取那些发病过程相对缓慢，但所见症状却突然非常急迫的情况，既然病情与症状不相符合，就可以辨别为痧症，那么对于痧毒结聚不散的情况，自然可以详细分析。治疗的方法，毒邪结聚在血的，就消散其瘀血；结聚在食的，就消食导滞并攻下；结聚在痰积的，就治疗痰积并驱除它。这样结聚消散之后，痧筋必然重新显现，然后再进行针刺放血，痧症就可以得到调理了。像这样的痧症，也是可治的。继承我事业的人，千万不要因为痧症凶险危重，就放弃治疗啊。
痧症发作时，没有表现为寒证的。但也有因痧引起的“寒”证，这并不是痧本身具有真正的寒性，大概是因为世人只知道痧症属热，而服用大寒性质的饮品，以至于造成这种局面。然而，寒凉饮品被患痧症的人服用后，有的立即痊愈，有的没有立即痊愈，这是什么原因呢？患痧症的人，必须体内没有食物、积滞、瘀血阻滞在中焦，才可以服用寒凉饮品而取得疗效。如果一旦有食物、积滞、瘀血阻滞在中焦，而服用大寒的饮品，就会导致食物不消化、积滞不运行、瘀血不消散，而痧毒反而像被冰冷冻住一样凝滞阻塞在中焦，没有能安宁的。我曾经看到在高峻的山岩和偏僻的山谷中，山路遥远，行路的人感受暑热之气，往往有一口喝下山涧冷水就立即死亡的，这叫做寒痧。如果幸运遇到会放痧的人，才能识别出是痧症并挽救生命。这是因为痧毒攻心，加上服用寒凉饮品过多，导致痧毒随着冰寒凝结在心胸部位，所以有立即死亡的。如果遇到会放痧的人，毒血一经排出，就没有凝滞了，这个人因此得以保全性命。现在近处往往有人患痧症，服用冷水后不愈的，就是这类情况。所以医方书籍中所记载的，服用阴阳水（半井半泉水），而不单独取用井水的原因，确实是有鉴于此。因此在长期服用凉饮之后，痧症仍未痊愈的，又应当使用微温的药物来施治。我在本集方书中，所载的三香丸，又有略微使用附子、干姜之类的药物，都稍加冷冻饮料送服，这确实是权宜之计的好方剂啊。如果有些医方书籍所说的寒痧，认为应当直接用真寒证的方法来治疗，而骤然大量使用桂枝、附子、干姜、吴茱萸、人参等温热药物，这确实是有误的，不可服用。
Sha Jin (visible subcutaneous veins associated with Sha disease) may appear fully, appear slightly, appear intermittently, or remain latent and invisible. When Sha Jin appears fully, it indicates that the pathogenic toxin has mostly entered the Blood Level (Xue Fen); when it appears intermittently, it indicates that the toxin has mostly entered the Qi Level (Qi Fen); when it appears slightly, it indicates that the toxin is mostly obstructing the Qi Level; when it remains latent and invisible, it indicates that the toxin is mostly knotted in the Blood Level. Regarding cases where Sha Jin appears, people generally know to puncture and bleed them. In cases where Sha Jin appears only slightly, it is because the toxin is obstructed in the intestines and stomach, preventing the Sha Jin from manifesting prominently; thus, even if punctured, no blood flows out, or if a small amount of blood appears, it drips without flowing. The treatment method should be to unblock the intestines and stomach first, after which the Sha Jin will naturally become visible, and then one can wait for its appearance before puncturing and bleeding. For cases where Sha Jin appears intermittently, people generally know to wait for its appearance before bleeding. However, in cases where Sha Jin remains latent and invisible, although one wishes to bleed, there is no visible vessel to target. I have observed that even experts in Sha bleeding often fail to recognize this as Sha disease; consequently, the harm caused by Sha disease often affects people without their awareness. In such instances, differentiation must be made based on the discrepancy between the pulse and the symptoms. One must identify situations where the onset of the disease is relatively slow, yet the observed symptoms suddenly become extremely urgent. Since the disease process and symptoms are inconsistent, it can be differentiated as Sha disease, allowing for a detailed analysis of the knotted and unresolved Sha toxin. The treatment methods are: if the knot is in the Blood, dissipate the stasis; if the knot is in Food, digest the food and purge it; if the knot is in Phlegm accumulation, treat the phlegm accumulation and expel it. After the knots are dissipated, the Sha Jin will inevitably reappear, at which point puncturing and bleeding can be performed, and the Sha disease can be managed. Such Sha diseases are treatable. Those who inherit my practice must not abandon treatment due to the perceived severity and danger of Sha disease.
The onset of Sha disease rarely presents as Cold. However, there are cases of "Cold" Sha, which do not represent true Cold within the Sha itself, but rather result from the public's misconception that Sha is purely Heat, leading them to consume large amounts of cold-natured beverages. Yet, when patients with Sha disease consume cold drinks, some recover immediately while others do not. Why is this? For a patient with Sha disease to benefit from cold drinks, there must be no Food stagnation, accumulation, or Blood stasis obstructing the Middle Jiao (Zhong Jiao). If there is any obstruction by Food, accumulation, or Blood, and large amounts of cold drinks are consumed, the Food will not digest, the accumulation will not move, and the Blood will not disperse. Consequently, the Sha toxin becomes frozen and coagulated within the middle, finding no relief. I have witnessed travelers on remote mountain paths, suffering from summer-heat, who die instantly after drinking water from mountain streams; this is called Cold Sha. If they are fortunate enough to meet someone skilled in Sha bleeding, the Sha can be identified and their life saved. This occurs because the Sha toxin attacks the Heart, and excessive consumption of cold drinks causes the toxin to condense with the cold in the chest and heart region, leading to instant death. If treated promptly with Sha bleeding, the toxic blood is expelled, removing the stagnation, thereby saving the patient's life. Currently, many nearby cases of Sha disease treated with cold water fail to resolve, which belongs to this category. Therefore, medical texts recommend using Yin-Yang Water (a mixture of well water and spring water) rather than solely well water, precisely for this reason. Thus, for Sha disease that persists after prolonged consumption of cold drinks, mildly warm herbs should be administered. In my collected formulas, San Xiang Wan (Three Fragrances Pill) includes slight additions of Fuzi (Prepared Aconite Root) and Ganjiang (Dried Ginger), taken with slightly chilled beverages; this serves as a prudent and effective temporary remedy. Conversely, if medical texts suggest treating "Cold Sha" with true Cold methods, abruptly using large doses of Guizhi (Cinnamon Twig), Fuzi, Ganjiang, Wuzhuyu (Evodia Fruit), Renshen (Ginseng Root), etc., this is indeed erroneous and should not be taken.