茫然，竟有令人先服姜汁一盏者；有以大剂温补主治者。皆刊印遍贴通衢，病家信之，死者日
以千计，道 相望。钱塘吴菊，潭茂才告余，曰∶目击一人七窍流血而死，闻之恻然，岂亦劫运使然欤。
《玉衡》曰∶先吐泻而心腹 痛者，从秽气而发者多；先心腹 痛而吐泻者，从暑气
而发者多。然吐泻之霍乱，乃暑秽伤人气分。宜用油盐刮其皮肤，则痧不内攻。若心胸胀闷，腹中 痛，或如板硬，或
如绳缚，或如
筋吊，或如锥刺刀 ，虽痛极而不吐泻者，名干霍乱。乃邪已
入营，宜以针刺出血，则毒有所泄。然后，再审其因而药之。若痧胀已极，难于刮刺者
，又必先以药救醒，乃可以回生，明此三法，庶可十全。
王晋三曰∶痧者，寒热之湿气，皆可以为患，或四时寒湿，凝滞于脉络；或夏月湿热，郁遏
于经隧；或鼻闻臭气，而阻逆经气；或内因停积，而壅塞腑气。则胃脘气逆，皆能胀满作痛，甚
至昏愦欲死。西北人，以杨柳枝蘸热水鞭其腹，谓之打寒痧。东南人以油碗或油线刮其胸背
手
痧。更服玉枢丹等以治其内，是皆内外达窍以泄其气，则气血得以循度而行，其胀即已，实即霍乱耳。非另有痧邪也。
雄案∶方书从无痧证之名，惟干霍乱，有俗呼绞肠痧者，是世俗之有痧，不知起于何时
也。《至医说》始载∶叶氏用蚕蜕纸治痧之法，以蚕性豁痰，祛风利窍，其纸已经盐
腌，而顺下最速也。乃江民莹误为解 证，虽为杭堇浦所讥，然亦可见从前
痧证不多，故古人皆略而不详也。迨国初时，
渐盛，自北而南，所以又有满洲病与番痧之名。郭氏因龚云林青筋之说，而着《痧胀玉衡》
一书，
秽邪也。晋三又辨痧即外邪骤入，阻塞其正气流行之道之谓，而痧之病义益明。至情志多郁
之人，稍犯凉热，即能成痧，且不时举发，亦由气血失其宣畅也。右陶虽有截痧方，而用
药
长洲龙青霏脉学联珠云∶痧胀之证，多属奇经。盖奇经，为十二经之支流也，五脏之清
气不升，六腑之浊气不降。譬犹五湖四渎，漫溢泛滥，尽入江河，而清浊已混，更水甚土崩，泥沙浑
扰，流荡不清，井 壅塞，故其病有痧胀之名。痧胀者，犹沙涨也，总由十二经清浊不分，
流溢入奇经，而奇经脉现，则为痧证也。邪气滞于经络，与脏腑无涉，不当徒以药味攻脏腑
，宜先用提刮之法，及刺法，使经络既通，然后用药，始堪应手也。
雄案∶此说似创而实确，然经络既通，虽不药可愈，特虑邪已渐及腑脏，则刮刺不足了事。
譬如险要为贼所据，不可徒讲防堵也。
《疫疹一得》曰∶凡初起六脉细数沉伏，面色青惨，昏愦如迷，四肢逆冷，头汗如雨，其痛
如劈，腹内搅痛，欲吐不吐，欲泻不泻，此为闷疫，毙不终朝。
闷者，热毒深伏于内而不能发越于外也。渐伏渐深，入脏而死，不俟终日也。至于治法，宜
刺曲池、委中，以泄营分之毒；再灌以紫雪，清透伏邪，使其外达，或可挽回也。
（治法精良。素园）
心中茫然无措，竟然有人让病人先服用一盏姜汁；还有人用大剂量的温补药物作为主治。这些方子都被刊印并张贴在交通要道上，病人家属相信了这些说法，每天有一千多人因此死亡，道路上尸体相互连接。钱塘人吴菊，一位名叫潭茂才的秀才告诉我，说他亲眼目睹一个人七窍流血而死，听到这件事感到悲伤，这难道也是劫数使然吗？
《玉衡》中说：先出现呕吐腹泻而后心腹疼痛的，多因秽浊之气引发；先出现心腹疼痛而后呕吐腹泻的，多因暑气引发。然而，以呕吐腹泻为主要表现的霍乱，是暑湿秽浊之气损伤了人体的气分。适宜用盐和油刮拭皮肤，这样痧毒就不会内攻入里。如果心胸胀闷，腹部疼痛，或者感觉像木板一样坚硬，或者像绳子捆绑一样紧束，或者像筋脉牵引一样绞痛，或者像锥刺刀割一样刺痛，虽然疼痛极度剧烈但没有呕吐和腹泻的，称为干霍乱。这是邪气已经深入营分，适宜用针刺出血的方法，这样毒素才能有所宣泄。然后，再审查其病因进行药物治疗。如果痧胀症状已经极其严重，难以进行刮拭和针刺的，又必须先用药将其救醒，才可以挽救生命，明白这三种方法，差不多就可以达到十全十美的疗效。
王晋三说：痧证，无论是寒热还是湿气，都可以致病。或者是四季的寒湿之气，凝滞于脉络之中；或者是夏季的湿热之气，郁结阻塞于经络隧道；或者是鼻闻臭秽之气，导致经气阻逆；或者是体内有停积之物，壅塞腑气。这些都可能导致胃脘气机逆乱，都能引起胀满疼痛，甚至昏厥欲死。西北人，用杨柳枝蘸热水鞭打腹部，称之为“打寒痧”。东南人用油碗或油线刮拭胸背、手臂，称之为“刮手痧”。再服用玉枢丹等药物来治疗内部病症，这些都是通过内外通达孔窍来泄出邪气，使得气血能够按照正常规律运行，胀满的症状就会消除，这实际上就是霍乱罢了。并不是另外有什么所谓的“痧邪”。
我的案语：医书中从来没有“痧证”这个名称，只有干霍乱，有俗称为“绞肠痧”的，这说明世俗所说的“痧”，不知起源于何时。《至医说》开始记载：叶天士用蚕蜕纸治疗痧证的方法，因为蚕性能够豁痰、祛风、利窍，而且这种纸经过盐腌制，下行速度最快。于是江民莹误将其当作解表证的治疗法，虽然被杭堇浦讥笑，但也由此可见从前痧证不多，所以古人都简略而不详细记载。等到清朝初年，这种病逐渐盛行，从北方传到南方，所以又有“满洲病”与“番痧”的名称。郭氏因为龚云林关于青筋的说法，而撰写了《痧胀玉衡》一书，认为这是秽邪所致。王晋三又辨析说“痧”即外邪突然侵入，阻塞正气流行的道路，这样“痧”的病义更加明确。至于那些情志多抑郁的人，稍微受到凉热刺激，就能形成痧证，并且不时发作，这也是由于气血失去了宣通畅达的缘故。右陶虽然有截断痧证的方子，但用药……（原文此处似有缺漏或排版错误，按文意理解为：虽有方药，但需辨证）
长洲龙青霏在《脉学联珠》中说：痧胀之证，多属于奇经八脉。因为奇经是十二正经的支流，五脏的清阳之气不升，六腑的浊阴之气不降。这就好比五湖四渎，漫溢泛滥，全部流入江河，导致清浊混杂，再加上水势浩大、土堤崩塌，泥沙浑浊搅动，流荡不清，井渠壅塞，所以疾病有了“痧胀”的名称。“痧胀”者，就像沙涨一样，总归是由于十二经清浊不分，流溢进入奇经，而奇经的脉象显现出来，就形成了痧证。邪气阻滞在经络，与脏腑没有直接关系，不应当仅仅用药物去攻击脏腑，适宜先用提刮的方法，以及针刺的方法，使经络通畅之后，然后再用药，才能取得应手而效的效果。
我的案语：这种说法看似创新但实际上很确切，然而经络既然已经通畅，即使不用药也可以痊愈，只是担心邪气已经逐渐波及脏腑，那么刮拭和针刺就不足以解决问题。譬如险要关隘被贼寇占据，不可以只讲防守堵截。
《疫疹一得》中说：凡是发病初期，六脉细数沉伏，面色青惨暗，昏厥迷糊如醉，四肢逆冷，头部出汗如雨，疼痛如刀劈，腹部内部搅痛，想吐吐不出来，想拉拉不出来，这称为“闷疫”，不到半天就会死亡。
所谓“闷”，是指热毒深伏于体内而不能发散到体表。邪气逐渐潜伏、逐渐深入，进入脏腑而导致死亡，甚至不等一天结束就会死去。至于治疗方法，适宜针刺曲池穴、委中穴，以泄出营分的毒邪；再灌服紫雪丹，清透伏匿的邪气，使其向外透达，或许可以挽回生命。
（治法精良。素园评）
Feeling at a loss, some people even instructed patients to first consume a cup of ginger juice; others used large doses of warming and tonifying medicines as the main treatment. These prescriptions were printed and posted all over public thoroughfares. Believing in them, patients' families resulted in thousands of deaths daily, with corpses lying along the roadsides. Wu Ju from Qiantang, a scholar named Tan Maocai, told me that he witnessed a person die from bleeding out of all seven orifices. Hearing this, he felt deeply sorrowful, wondering if this was merely the result of a calamitous fate.
*Yu Heng* states: Cases presenting with vomiting and diarrhea preceding heart and abdominal pain are mostly caused by foul qi (pathogenic noxious factors); cases presenting with heart and abdominal pain preceding vomiting and diarrhea are mostly caused by summer-heat qi. However, cholera-like syndromes characterized primarily by vomiting and diarrhea result from summer-heat and dampness-noxieties injuring the Qi level (Qi Fen). It is appropriate to scrape the skin with salt and oil so that Sha toxins do not penetrate inward. If there is chest and epigastric distension and oppression, abdominal pain, feeling as hard as a board, as tight as being bound by a rope, as if tendons are pulling, or as if pierced by awns and knives, despite extreme pain but without vomiting or diarrhea, it is named Dry Cholera (Gan Huoluan). This indicates that the pathogen has entered the Ying (Nutritive) level. It is appropriate to prick the skin to release blood, allowing the toxin to be discharged. Thereafter, one should re-examine the etiology and prescribe medication accordingly. If Sha distension is extremely severe, making scraping and pricking difficult, one must first use medicine to revive the patient before life can be saved. Understanding these three methods allows for near-perfect efficacy.
Wang Jin San stated: Sha syndromes can be caused by cold, heat, or dampness. It may be cold-dampness of the four seasons stagnating in the collaterals; or damp-heat of summer obstructing the meridians; or inhaling foul odors blocking the flow of meridian Qi; or internal accumulation obstructing Fu organ Qi. All these can cause rebellious Qi in the stomach and epigastrium, leading to distension and pain, even to the point of fainting and desire to die. People in the northwest whip their abdomen with willow branches dipped in hot water, calling it "Beating Cold Sha." People in the southeast scrape their chests, backs, and arms with oil bowls or oil threads, calling it "Scraping Hand Sha." They then take Yushu Dan to treat the interior. These methods all open external and internal orifices to vent Qi, allowing blood and Qi to circulate normally, resolving distension. This is essentially Cholera, not a separate "Sha pathogen."
My Case Note: Medical texts never mention the name "Sha Syndrome." Only Dry Cholera has the vulgar name "Intestine-Twisting Sha." Thus, the secular concept of "Sha" has an unknown origin. *Zhi Yi Shuo* first recorded Ye Tianshi's method of using silkworm pupal casings to treat Sha. Since silkworms have properties to resolve phlegm, dispel wind, and open orifices, and the paper is salted, it descends rapidly. Jiang Minying mistakenly interpreted this as treating exterior syndromes, though ridiculed by Hang Jinping, it shows that Sha syndromes were rare previously, hence ancient texts omitted detailed descriptions. By the early Qing dynasty, the disease became prevalent, spreading from north to south, leading to names like "Manchu Disease" and "Foreign Sha." Guo Shi, influenced by Gong Yunlin's theory of green veins, wrote *Sha Zhang Yu Heng*, attributing it to foul pathogens. Wang Jin San further clarified that "Sha" refers to sudden invasion of exogenous pathogens blocking the flow of healthy Qi, clarifying the pathology of Sha. For individuals with emotional depression, slight exposure to cold or heat can induce Sha, which recurs frequently due to impaired circulation of Qi and Blood. Although You Tao had formulas to stop Sha, the medication... [Text fragment]
Long Qingfei of Changzhou, in *Mai Xue Lian Zhu*, stated: Sha distension syndromes mostly involve the Extraordinary Vessels. The Extraordinary Vessels are tributaries of the Twelve Regular Meridians. When clear Qi of the Zang organs fails to ascend and turbid Qi of the Fu organs fails to descend, it is like lakes and rivers overflowing, mixing clear and turbid waters, causing mud and silt to churn, blocking channels. Hence the name "Sha Distension." "Sha" resembles sand rising. It results from the failure of the Twelve Meridians to distinguish clear from turbid, leading to overflow into the Extraordinary Vessels, manifesting as Sha syndromes. Pathogens stagnate in the meridians, unrelated to the Zang-Fu organs directly. One should not merely attack the organs with herbs. Instead, use lifting and scraping methods, and needling, to unblock the meridians first, then administer medication for effective results.
My Case Note: This theory seems novel yet accurate. Once meridians are unblocked, recovery may occur without medicine. However, one must worry that pathogens may gradually affect the Zang-Fu organs, rendering scraping and pricking insufficient. It is like a strategic pass occupied by bandits; mere defense is inadequate.
*Yi Zhen Yi De* states: In the initial stage, if the six pulses are fine, rapid, deep, and hidden, the complexion is dark blue and grim, the patient is confused and dazed, limbs are cold, head sweats profusely, pain feels like splitting, abdominal pain is churning, with inability to vomit or defecate, this is called "Stifling Plague" (Men Yi). Death occurs within half a day.
"Stifling" means heat-toxin is deeply concealed internally and cannot vent outward. As it sinks deeper, entering the Zang organs, death ensues quickly, often within a day. Regarding treatment, it is appropriate to needle Qu Chi (LI11) and Wei Zhong (BL40) to vent toxins from the Ying level; then administer Zi Xue (Purple Snow) to clear and penetrate concealed pathogens, facilitating their outward release, which might save the patient.
(Excellent treatment method. Commented by Suyuan.)