本文以查爾士 •盧森堡（Charles Rosenberg)「框構疾病」（framing disease)的概念，討論清代以前已存在的痧症，為何到了清代才出現那麼多和痧相關的文本，並改變了性質，成為疫病的指稱？由此分析在中國傳統醫學中，文本在指稱疾病所扮演的角色、醫家如何藉此建構其専業形象、新的疾病範疇的建構如何引起爭議、以及清代社會如何透過功徳的概念，刊刻醫書、頒發丸藥，由士紳提供資源，醫者和家庭提供照護，處理身染瘟疫的病患。

This paper analyzes how the term sha 痧 came to refer to a new category of epidemic disease during the Qing dynasty. Sha physicians in the Qing described sha as an acute, lethal, painful, and contagious disease demanding immediate attention. They recommended the widely-used treatment of scratching and bloodletting while at the same time warning the patient of the danger of applying these treatments without enough medical knowledge. This framing of sha as epidemic disease largely transformed its significance and the social responses to it.
The responsibility for treating epidemics in the Qing was largely left to the gentry. For this reason, publication of sha books became associated with the religious belief in merit which would be converted into a blessing for oneself or one’s offspring. This social context underlined the form of sha texts which were mostly in the form of medical quick reference manuals. In circulating texts and medicine, Qing society found a way of coping with epidemics while maintaining the moral authority and leadership of the gentry.