痧有寒热往来，类乎疟疾。或昏迷沉重，或狂言乱语，或痰喘不休、或心胸烦闷，叫喊不止、或呕哕吐痰，睡卧不
安、或大小便结，舌黑生芒。如此重极，脉必变异，不与疟同，宜细辨之。
治验∶
一沈日岩，七月间，日晡寒热，昏沉胀闷，大便不通，舌焦苔浓。延余治疟，左脉浮大而虚，右脉沉细而涩，愚意
疟疾见凶，脉不应虚且涩，视其乳下有青筋，刺出紫血毒血二针，令其刮痧，不愈。用散痧消毒活血之剂，加大黄三钱，
稍冷服之，大便通，诸症退，惟寒热未已，用小柴胡汤治之，后用四君子汤调治而痊。
疟疾卧床，往往有因暑热相侵，心中迷闷，或时疫之气相感，兼犯乎痧，疟因痧变，势所必至，不可漫以为疟而忽
视之也。疟之为害，尚可延久；痧之为害，必致伤人，即令痧之轻者，苟不知治，缠扰于身，不克骤愈，虽或幸愈，数
复难痊。自非先治其痧，决难全愈，兼痧之祸，可胜道哉。
治验∶
一钱拱宸内室患疟，发热不凉，痰嗽烦闷，口渴不食。余诊之，气口脉虚，左三部微涩而数，此兼痧之症也。令
其放痧，用散痧顺气活血解毒药，不愈。次日又放痧，脉始弦数，又如前剂服之，不复烦闷矣。后用柴胡双解饮三剂，
疟愈。止用消痰顺气药加童便饮五剂，痰嗽俱痊。
一余三子，五月间，患疟凶暴，左脉沉微，右手脉伏，验有腿弯、手臂青筋，刺出紫黑毒血，稍觉胸中爽快，用宝
花散，沉香丸稍冷服之，遂用大黄丸并服，可扶而起。次日复伤食又患兼痧，凶暴益甚，更放痧，凶暴始减，用散痧消
食顺气解毒药五剂，稍安。后又伤食发热，用山楂、卜子、青皮、陈皮、紫朴、白芥子四剂，大便不通，加枳实、大黄，
便通热减。惟病久虚极，时觉眩晕心跳，夜睡不宁，用枣仁、茯神、人参、黄 、熟地加熟附子一二片煎服，夜睡神安，
调补四月而痊。
一沈恒生内室，六月间疟疾，日晡寒热已八日，忽壮热不已，昏沉不醒。延余诊之，左脉弦数不匀，右脉虚而沉
涩，余曰∶“左不匀，右虚涩，非疟脉也。殆其为疟之变症，非痧而何”。刺左臂青筋一针，紫黑毒血流出如花，不愈。
服荆芥汤加藿香、卜子、紫朴、槟榔并化毒丹微冷冻饮料之，稍醒。次日，复刺指头紫黑血三针，用荆芥汤加枳实、大黄微
冷冻饮料之，热退后，用三香散，运动其气，调理一月而痊。
痧症表现为寒热往来，症状类似疟疾。有的出现昏迷沉重，有的胡言乱语，有的痰喘不止、心胸烦闷，叫喊不停；有的呕吐呃逆吐痰，睡卧不安；有的大小便不通畅，舌苔黑且生芒刺。病情如此严重，脉象必然发生变异，与疟疾不同，应当仔细辨别。
治疗案例：
沈日岩，七月间，傍晚时分寒热交替，昏沉胀闷，大便不通，舌面焦燥苔厚腻。请我诊治疟疾，左脉浮大而虚，右脉沉细而涩。我认为疟疾出现这种凶险的脉象是不正常的，脉不应既虚又涩。查看他乳下有青色筋络显现，针刺放出紫黑色毒血两针，并让他刮痧，但病未愈。使用散痧、消毒、活血的药物，加入大黄三钱，稍冷后服用，大便通畅，各种症状消退，只有寒热未止，用小柴胡汤（Minor Bupleurum Decoction）治疗，后来用四君子汤（Four Gentlemen Decoction）调理而痊愈。
患疟疾卧床时，往往因为暑热侵袭，心中迷乱闷塞，或因时疫之气感染，兼犯痧症，疟疾因痧症而变化，这是必然的趋势，不能随意当作疟疾而忽视它。疟疾的危害，还可以拖延日久；痧症的危害，必定致人受伤。即使痧症较轻，如果不知道治疗，缠绕身体，不能迅速痊愈，虽然有时侥幸痊愈，过几天也难以彻底康复。如果不是先治疗痧症，很难完全治愈，兼有痧症的祸害，怎能说得完呢？
治疗案例：
钱拱宸的妻子患疟疾，发热不退凉，痰嗽烦闷，口渴不想进食。我诊察她，气口脉虚，左手寸关尺三部脉微涩而数，这是兼有痧症的症状。让她放痧（刺络出血），使用散痧、顺气、活血、解毒的药物，病未愈。第二天再次放痧，脉象变为弦数，又像之前那样服药，不再感到烦闷了。后来用柴胡双解饮（Bupleurum Dual-Resolution Drink）三剂，疟疾痊愈。只用消痰顺气的药物加童便（Child's Urine）饮用五剂，痰嗽全部痊愈。
余三的第五个儿子，五月间，患疟疾凶险暴烈，左脉沉微，右手脉伏匿不见，检查发现腿弯、手臂有青色筋络，针刺放出紫黑色毒血，稍微觉得胸中爽快，用宝花散（Precious Flower Powder）、沉香丸（Agarwood Pill）稍冷后服用，接着用大黄丸（Rhubarb Pill）一起服用，可以扶起来。第二天又因伤食再次患兼痧，凶险暴烈更加严重，再次放痧，凶险暴烈才开始减轻，用散痧、消食、顺气、解毒的药物五剂，稍微安定。后来又因伤食发热，用山楂、萝卜子、青皮、陈皮、紫朴（厚朴）、白芥子四剂，大便不通，加入枳实、大黄，大便通后热势减退。只是病久极度虚弱，时常感觉眩晕心跳，夜间睡不宁，用酸枣仁、茯神、人参、黄芪、熟地黄加上熟附子一两片煎服，夜间睡眠安稳，调补四个月而痊愈。
沈恒生的妻子，六月间患疟疾，傍晚寒热已经八天，突然高热不止，昏沉不醒。请我诊察，左脉弦数不均匀，右脉虚而沉涩，我说：“左脉不均匀，右脉虚涩，不是疟疾的脉象。大概是疟疾的变化症状，除了痧症还能是什么呢？”针刺左臂青色筋络一针，流出如花般的紫黑色毒血，病未愈。服用荆芥汤（Schizonepeta Decoction）加藿香、萝卜子、紫朴、槟榔以及化毒丹（Detoxification Pill）微冷冻后饮用，稍微清醒。第二天，再次针刺手指头放出紫黑色血三针，用荆芥汤加枳实、大黄微冷冻后饮用，热退后，用三香散（Three Fragrances Powder），行气调理一个月而痊愈。
Sha syndrome presents with alternating chills and fever, resembling malaria. Some cases exhibit coma and heaviness, or delirium; some suffer from incessant phlegm-wheezing, chest and heart vexation and stuffiness, and unremitting shouting; some experience vomiting, hiccups, expectoration of phlegm, and restless sleep; some have constipation of both stool and urine, and a black tongue with prickles. When the condition is this severe, the pulse must be abnormal and different from that of malaria, requiring careful differentiation.
Clinical Case 1:
Shen Riyang, in July, experienced alternating chills and fever at dusk, accompanied by coma, distension, and stuffiness, along with constipation and a scorched tongue with thick coating. He sought my treatment for malaria. His left pulse was floating, large, and deficient, while his right pulse was deep, fine, and choppy. I reasoned that such ominous pulses (deficient and choppy) are inappropriate for malaria. Upon inspection, bluish veins were visible under his breasts. I punctured them to release two needles' worth of purple-black toxic blood and instructed him to perform Sha scraping (Gua Sha), but he did not recover. I prescribed a formula to dissipate Sha, detoxify, and invigorate blood, adding three qian of Da Huang (Rhei Radix et Rhizoma). Taken slightly cold, it promoted bowel movement and alleviated most symptoms, except for the persistent chills and fever. I then treated him with Xiaochaihu Tang (Minor Bupleurum Decoction), followed by Sijunzi Tang (Four Gentlemen Decoction) for regulation, leading to recovery.
Patients bedridden with malaria often contract Sha due to invasion by summerheat and dampness causing mental confusion and stuffiness, or due to epidemic qi interacting with Sha. Malaria transforming into Sha is inevitable. One must not casually dismiss it as mere malaria. While malaria can persist for a long time, Sha causes direct harm to the person. Even mild Sha, if untreated, lingers and cannot heal quickly; even if it miraculously heals, relapse makes full recovery difficult. Unless Sha is treated first, complete recovery is unlikely. The dangers of concurrent Sha are manifold.
Clinical Case 2:
The wife of Qian Gongchen suffered from malaria with persistent fever, phlegm-cough, vexation, thirst, and anorexia. My diagnosis revealed a deficient Qi Kou pulse, and the three positions on the left hand were faint, choppy, and rapid, indicating concurrent Sha. I ordered Sha bleeding (Fang Sha). A formula to dissipate Sha, regulate Qi, invigorate blood, and detoxify was administered without success. On the second day, Sha bleeding was performed again; the pulse became wiry and rapid. Taking the previous formula relieved her vexation. Subsequently, Chaihu Shuangjie Yin (Bupleurum Dual-Resolution Drink) for three doses cured the malaria. Finally, phlegm-resolving and Qi-regulating herbs combined with Tongbian (Child's Urine) for five doses cured the phlegm and cough.
Clinical Case 3:
Yu San's fifth son, in May, suffered from violent malaria. His left pulse was deep and faint, and his right pulse was hidden. Examination revealed bluish veins in the popliteal fossa and arms. Puncture released purple-black toxic blood, providing slight relief in the chest. Baohua San (Precious Flower Powder) and Chenxiang Wan (Agarwood Pill) were taken slightly cold, followed by Dahuang Wan (Rhubarb Pill), allowing him to sit up. The next day, food stagnation triggered another episode of concurrent Sha, worsening the violence. Further Sha bleeding reduced the severity. Five doses of herbs to dissipate Sha, digest food, regulate Qi, and detoxify brought slight stability. Later, food stagnation caused fever again. Shan Zha (Crataegi Fructus), Bo Zi (Brassicae Semens), Qing Pi (Aurantii Fructus Pericarpium Viride), Chen Pi (Citri Reticulatae Pericarpium), Zi Pu (Magnoliae Officinalis Cortex), and Bai Jie Zi (Sinapis Semen) were given for four doses. Constipation ensued, so Zhi Shi (Aurantii Fructus Immaturus) and Da Huang (Rhei Radix et Rhizoma) were added, resolving constipation and reducing fever. Due to prolonged illness and extreme deficiency, he experienced dizziness and palpitations, with restless sleep. Zaoren (Ziziphi Spinosae Semen), Fushen (Poria cum Radix Pini), Renshen (Ginseng Radix), Huangqi (Astragali Radix), and Shudi (Rehmanniae Radix Praeparata) were decocted with one or two slices of Shu Fuzi (Aconiti Lateralis Radix Praeparata). This stabilized his sleep. After four months of tonic regulation, he recovered.
Clinical Case 4:
The wife of Shen Hengsheng contracted malaria in June. After eight days of evening chills and fever, she suddenly developed high fever, coma, and unresponsiveness. My examination showed an uneven wiry-rapid left pulse and a deficient, deep-choppy right pulse. I stated, "An uneven left pulse and deficient-choppy right pulse are not typical of malaria. This must be a variant of malaria, specifically Sha." I punctured a bluish vein on the left arm, releasing flower-like purple-black toxic blood, but there was no improvement. She was given Jingjie Tang (Schizonepeta Decoction) with Huoxiang (Pogostemonis Herba), Bo Zi (Brassicae Semens), Zi Pu (Magnoliae Officinalis Cortex), and Binglang (Arecae Semen), plus Huduan Dan (Detoxification Pill), served slightly chilled. She regained slight consciousness. The next day, three needles punctured the fingertips to release purple-black blood. Jingjie Tang with Zhi Shi (Aurantii Fructus Immaturus) and Da Huang (Rhei Radix et Rhizoma) was served slightly chilled. After the fever subsided, Sanxiang San (Three Fragrances Powder) was used to move Qi. After one month of regulation, she recovered.