痧者，暑热时疫恶毒之气，攻于里则为痰喘，为血瘀，昏迷沉重，不省人事。若元气壮实，内不受邪，不入于里，
即散其毒于肌肤血肉之表，为肿、为胀。若误饮热汤热酒，便成大害，此痧之暗者，宜从脉异处辨之。
治验∶
一翰黄闻兄一婢，久生疮患，腹大如臌，手足俱肿。延余诊之，左脉微数，右脉或时歇指。余思疮毒入内作肿作胀，
其脉必然洪数有力，方见脉症相对，乃可治其疮毒。今左脉微数，右脉歇指，脉症不合，必慢痧为患也。视其腿弯，果
有痧筋青色，刺五针，紫黑毒血流之如注，未愈。又刺指头毒血二十针，用宝花散并付桃仁红花汤八服，服后肿胀俱消
如旧。
一翰黄闻兄长女，手足具肿，将逮于腹。延余诊之，六脉弦细沉迟，知其为慢痧之变症也。云宜先放其痧，缘畏刺
不放。余辞不用药，恐药气稍冷，不能治及于血肉之分也。越六日，肿胀益甚，复延余治，令其仆妇，为主女放痧三十
余针，紫黑毒血已出。用宝花散稍冷服之，并用散痧解毒，消瘀顺气之剂治之。以其痧久绵延，难于速效，计服二十四
剂，方得肿胀具消，安平如旧。
一贾峰青，遍身肿胀，服药不应。延余治之，余见心口将平，脐有青筋。余曰∶“危哉，诊脉无根，殆不可疗”。然
视其指上、腿弯青筋交现，刺出毒血甚多。彼又谓痧症不当服药遂已，后至二月余，终成真臌而死，惜哉。
一余邻许姓者，有子四岁，头面胸腹，手足遍身，俱肿胀红色，头汗如珠不绝。求余诊视，两关两尺，皆洪大滑
实，两寸厥厥动摇，此伤食之痧，感于脾经，故遍身肌肉肿胀。及看其痧筋不现，刮痧不起，此因误饮热汤，痧气内攻，
壅塞冲心，故遍身作肿作胀。惟冲心，心脏不受其害，故上干头面，化而为汗，出之如珠，皆心液也。用紫朴汤加大黄
丸，微冷冻饮料之，胀消汗止而愈。
痧症，是暑热和时行疫气中的恶毒之气。如果这股邪气攻入体内，就会导致痰喘、血瘀，出现昏迷沉重、不省人事的症状。如果患者元气壮实，体内不受邪气侵袭，邪气也不深入体内，而是将毒素发散在肌肤血肉的表层，就会表现为肿胀、胀满。如果此时误饮热水或热酒，就会造成严重的危害。这是隐蔽型的痧症，应当从脉象的异常之处来辨别。
治疗案例：
一翰黄闻的一位兄长家的婢女，长期患有疮疡，腹部大如鼓胀，手足都浮肿。请我诊治，左脉微数，右脉时有间歇（歇指）。我思考疮毒入内导致肿胀，脉象必然洪数有力，这样才符合脉症相应，才可以治疗其疮毒。现在左脉微数，右脉间歇，脉症不符，必定是慢痧在作祟。查看她的腿弯处，果然有青色的痧筋，针刺五针，流出紫黑色的毒血如注，但病未愈。又针刺手指头排毒二十针，使用宝花散并配合桃仁红花汤服用八剂，服药后肿胀全部消退，恢复如初。
一翰黄闻的兄长的长女，手足全部浮肿，即将蔓延至腹部。请我诊治，六脉弦细沉迟，我知道这是慢痧的变症。我说应该先放出痧毒，因为她害怕针刺而没有放痧。我推辞不再用药，恐怕药气稍冷，不能作用于血肉之分。过了六天，肿胀更加严重，再次请我诊治，命令她的仆妇为主人女儿放痧三十多针，紫黑色的毒血已经流出。用宝花散稍微冷却后服用，并用散痧解毒、消瘀顺气的药剂治疗。因为痧症拖延日久，难以迅速见效，共服用二十四剂，才使肿胀全部消退，平安如旧。
贾峰青，遍身肿胀，服药无效。请我诊治，我看到他心口部位即将平复，脐部有青色筋络显现。我说：“危险啊，诊脉无根，大概不可治愈了。”然而看他手指上、腿弯处青色筋络交错显现，刺出很多毒血。他又认为痧症不当服药而自行停止治疗，后来到了两个多月后，最终变成真臌胀而死，可惜啊。
邻居许姓的人，有个四岁的儿子，头面胸腹、手足遍身都肿胀发红，头部出汗如珠粒般不绝。求我诊治，两关两尺脉皆洪大滑实，两寸脉厥厥动摇，这是伤食引起的痧症，邪气感于脾经，所以遍身肌肉肿胀。再看他的痧筋不显现，刮痧不出痧，这是因为误饮热汤，痧气内攻，壅塞冲心，所以遍身作肿作胀。只有心脏不受其害，所以邪气上干头面，化而为汗，出来如珠粒，这些都是心液。使用紫朴汤加大黄丸，微冷冻凉后饮用，胀消汗止而痊愈。
Sha (Sha disease, a type of acute heat-toxin syndrome) is caused by the malignant qi of summer-heat and epidemic pathogens. If this pathogenic qi attacks the interior, it results in phlegm and panting, blood stasis, coma with heaviness, and loss of consciousness. If the patient's primordial Qi is robust, preventing internal invasion and deep penetration, the toxin is dispersed on the surface of the skin, muscles, and blood vessels, manifesting as swelling and distension. If hot water or hot wine is mistakenly consumed, it leads to severe harm. This is a concealed form of Sha, which should be differentiated by observing abnormal pulse characteristics.
Clinical Cases:
A maid in the household of Brother Yi Hanhuang had suffered from sores for a long time, with an abdomen swollen like drum distension and edema in both hands and feet. I examined her; the left pulse was slightly rapid, and the right pulse showed intermittent skipping (Xie Zhi). I reasoned that if sore toxins entered the interior causing swelling, the pulse would necessarily be flooding and rapid with strength, indicating correspondence between pulse and symptoms, allowing treatment of the sore toxins. However, the left pulse was slightly rapid, and the right pulse skipped, indicating a mismatch between pulse and symptoms. It must be chronic Sha causing the issue. Inspecting her popliteal fossae, cyanotic Sha veins were indeed visible. Five needles were inserted, and dark purple-black toxic blood flowed out profusely, but the condition did not resolve. Twenty more needles were inserted into the fingertips to drain toxic blood. Baohua San (Precious Flower Powder) was administered along with Taoren Honghua Tang (Peach Kernel and Safflower Decoction) for eight doses. After taking the medicine, the swelling subsided completely, and she returned to normal.
The eldest daughter of Brother Yi Hanhuang’s elder brother presented with edema in both hands and feet, which was about to spread to the abdomen. Upon examination, all six pulses were wiry, thin, deep, and slow. I identified this as a variant manifestation of chronic Sha. I advised releasing the Sha first, but she refused due to fear of acupuncture. I declined to prescribe medication, fearing that the cold nature of the herbs might fail to reach the tissue layers. Six days later, the swelling worsened significantly. She requested my treatment again. Her servant maid performed Sha release on the young lady with over thirty needles, draining dark purple-black toxic blood. Baohua San was taken after cooling slightly, combined with formulas designed to disperse Sha, detoxify, eliminate blood stasis, and regulate Qi. Since the Sha condition had persisted for a long time, quick efficacy was difficult to achieve. After twenty-four doses, the swelling fully resolved, and she recovered safely.
Jia Fengqing suffered from generalized swelling and ineffective medication. Upon examination, I observed that his chest area was nearly flat, with cyanotic veins visible around the umbilicus. I stated, "Dangerous! The pulse lacks root; prognosis is poor." However, seeing cyanotic veins interlacing on his fingers and popliteal fossae, I punctured them, extracting a large amount of toxic blood. He believed that Sha diseases should not be treated with medication and stopped treatment. More than two months later, he ultimately died from true abdominal distension. What a pity.
A neighbor named Xu had a four-year-old son with generalized red swelling of the head, face, chest, abdomen, hands, and feet, accompanied by continuous bead-like sweating on the head. Upon examination, the Guan and Chi positions on both sides showed flooding, large, slippery, and excess pulses, while the Cun positions on both sides exhibited turbulent movement. This indicated Sha caused by food stagnation affecting the Spleen Meridian, leading to generalized muscle swelling. No Sha veins were visible, and scraping yielded no Sha spots. This was due to mistaken consumption of hot water, causing Sha Qi to attack internally, obstructing the Chong vessel and heart, resulting in generalized swelling. The Heart remained unaffected, so the pathogen ascended to the head and face, transforming into sweat beads, which are fluids of the Heart. Zipu Tang (Purple Magnolia Bark Decoction) combined with Dahuang Wan (Rhubarb Pill) was prescribed. It was administered cool and slightly frozen. The distension subsided, sweating stopped, and he recovered.