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In our local customs, the so-called "Ma Sha" (Plague-like distension) indeed exists. This is largely because the southeastern regions are low-lying and damp, or Lingnan has a warm climate; along rivers and coasts, fog, dew, hurricanes, and sea tides are more severe than elsewhere. Whenever summer arrives, as the heavenly heat rises, the earthly damp turbidity naturally ascends. Thus, the evil pathogens of mountain miasma and sea pestilence, characterized by gloom and obscurity, take advantage of the season to erupt. When humans are subjected to this steaming and humid heat, if their righteous qi (Vital Energy) is deficient, the turbid evil pathogens will directly occupy the Mo Yuan (Membrane Source, a location between the exterior and interior) through the mouth and nose. The Mo Yuan is the collateral network of the Stomach. In the past, Wu Youke formulated the Da Yuan Yin (Reach the Original Decoction), which was based on this concept.

Once the pathogens have潜伏 internally and are activated by the season, one initially feels chest and abdominal fullness and oppression, with a sense of restlessness and pain, desire to vomit but unable to do so, and desire to defecate but unable to do so. This is due to summer-heat, dampness, and foul turbidity obstructing the Middle Jiao (Middle Burner), causing stagnation of the Qi mechanism of the Yangming channel, closure of all collaterals, numbness of the four limbs, and even muscle spasms and contractures. This belongs to Sha Distension (Plague Distension), which is actually a Bi Syndrome (Obstruction Syndrome), also known in medical texts as Jiao Chang Sha (Intestinal Twisting Plague) or Gan Huo Luan (Dry Cholera). This is vastly different from symptoms occurring after vomiting and diarrhea, such as muscle twitching, numbness, cold sweat, and Yang collapse. The medication differs as much as heaven and earth: Collapse Syndromes require warming and tonifying, while Obstruction Syndromes require dispersing and unblocking, though their sudden danger is roughly equal.

If Sha Distension prevents vomiting and diarrhea, accompanied by extreme restlessness and confusion, leading to a submerged pulse and cold limbs, or even numbness and contracture, this is a Yang Syndrome resembling Yin, or an Obstruction Syndrome resembling Collapse. According to standard practice, it should be treated with dispersion and unblocking. One may administer Zhi Chi Tang (Gardenia and Fermented Soybean Decoction) and induce vomiting by probing the throat with a finger, allowing the Qi mechanism to open and the pathogens to vent, leading to recovery. Medical texts record that using salt heated until red, mixed with child's urine, can induce vomiting and cure the condition; this method is extremely effective when tested. Alternatively, holding Bai Fan (Alum) in the mouth to dissolve it; if the taste becomes sweet like cold candy, it is undoubtedly Sha Distension. Even if swallowed arbitrarily, inducing vomiting due to the astringent sensation will lead to recovery.

If vomiting and diarrhea have already occurred, the Qi mechanism is already unblocked, and inducing vomiting again should be avoided, as it would merely damage Stomach Qi. If there is still disharmony in the Stomach, abdominal烦满 (fullness and distress), nausea, aversion to food, and concern that residual pathogens remain, one can harmonize with Huo Xiang Zheng Qi San (Patchouli Powder for Rectifying the Qi), which can also lead to complete recovery. Therefore, what modern folk call "Ma Sha" refers to this condition. To speak of "Cold Ma Sha" is ridiculous. Moreover, some reckless physicians, failing to understand the name, mistakenly diagnose it as Sha and administer dispersing and releasing-the-exterior herbs to patients whose Yang Qi is on the verge of collapse. Is this not adding fuel to the fire? There is no greater disregard for human life than this. One must be cautious and beware.