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Sha (exanthematous disease) and Dou (smallpox/variolous disease) both originate from congenital toxin (congenital pathogenic factor), yet they differ in their zang-fu organ involvement. Their eruption also varies in speed—early or late—due to the depth and distance of the toxin's latent location. However, regarding the treatment of Sha, ancient practitioners primarily relied on Shengma Gegen Tang (Bupleurum and Pueraria Decoction) as the foundational formula, supplemented by external treatment with Yuanxi Jiu (Coriander Wine). In cases where wind-cold binds the exterior, trapping internal toxins and causing wheezing and urgency, Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) is indicated. For mild and superficial cases, medical attention was sometimes unnecessary; patients could recover by self-administering decoctions made from cherry pits, coarse paper, or cotton yarn. Even in such instances, eruption typically occurred within one shichen (two hours), and spontaneous recovery followed within two to three days post-eruption.

Current Sha presentations, however, are different. Some take two to three days to erupt; others fail to erupt even after four to five days. Some exhibit eruption on the limbs but not on the head and face, accompanied by a hoarse cough, wheezing, coarse breathing, chest oppression, and critical danger. Others present with immediate retraction of the rash, followed by worsening wheezing, mania, restlessness, and confusion, termed "Yin Zao" (hidden early). Furthermore, although the rash may reach the surface, it may appear dark red or purple and stagnant, with sealed eyelids or red eyes, delirium, coma, constipation, abdominal pain, or uncontrolled diarrhea, presenting various signs of intense heat and deep-seated toxicity. Traditional formulas for Sha and Zhen prove ineffective. Imitating the treatment of Dou, one must first use Zixue San (Purple Snow Powder) to promote aromatic penetration, followed by large doses of Xijiao (Rhinoceros Horn), Lingyangjiao (Antelope Horn), Huangqin (Scutellaria Root), Lianzi (Coptis Rhizome), Mudanpi (Moutan Cortex), Shengdihuang (Rehmannia Root Prepared with Wine), Shigao (Gypsum Fibrosum), and Renzhonghuang (Human Excrement Charcoal) to clear heat and detoxify. Only thus can severe conditions be alleviated and critical states stabilized. Cases where the disease is deep but the medication is weak may lead to critical transformations, resembling smallpox with favorable, dangerous, and adverse prognoses. Alas! Why is there such a disparity between ancient and modern Sha? Upon investigation, this is largely due to the prevalence of vaccination in recent years, which has prevented the complete discharge of congenital toxins, leading some to vent these toxins through Sha; or perhaps because the epidemic qi of recent times is more virulent than in the past, resulting in more dangerous and severe manifestations. The key lies in not adhering rigidly to ancient treatments when facing such cases, but rather adapting to the times and formulating prescriptions based on specific syndromes, maintaining flexible clinical reasoning. One should not neglect Sha simply because it is considered lighter than Dou, so as to remain worthy of the title of "Guardian of Life."