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I have examined medical texts and found no mention of the term "Sha Syndrome" (Sha Zheng, sand-poisoning). It refers only to cases where one encounters foul odors, leading to abdominal pain and vomiting. In common practice, people use porcelain dipped in oil to scrape the spine, causing red spots to appear, which is called "Sha". In severe cases, there is an urge to vomit but inability to do so, an urge to defecate but inability to do so, dry heaving, and colicky abdominal pain, known as "Jiao Chang Sha" (Intestinal Cramping Sha). Recently, some individuals have suddenly developed black Sha due to exposure to toxic and abnormal qi, commonly known as "Fan Sha" (Foreign Sha). They collapse suddenly with abdominal pain, dark and swollen facial complexion, without shouting or crying. If not treated urgently, death occurs within two to three shichen (4-6 hours). Some present with mild chills and fever, abdominal pain, numbness, confusion, nausea, and vomiting; some sweat, while others show faint rashes. This indicates the pathogenic toxin is manifesting on the exterior. Others develop diarrhea and cold limbs immediately upon onset, with abdominal distension and absent pulse; this signifies the toxin is hidden internally and cannot manifest externally. This disease is extremely violent, with many dying before rashes even appear. The Classics state: "When great qi enters the zang-fu organs, sudden death may occur even without prior illness," referring to this condition.

Upon initial suspicion, first cauterize the forehead and head using a lit paper wick. Then, roast buckwheat until dry, remove the husks, take three qian (approx. 11-15g) of the powder, and mix with warm water for oral administration. For severe cases, repeat the dose after a short interval to achieve stability. Buckwheat can refine and eliminate turbid waste in the stomach and intestines, descend qi, broaden the chest, and treat turbid stagnation; it is a specific remedy for Sha toxins. However, if other diseases arise after taking buckwheat, medications containing green vitriol (Luofan, Ferrous Sulfate) must strictly be avoided. For cases with severe toxicity and black complexion, urgently perform bloodletting at the Weizhong (BL40) acupoint behind both knees to drain black blood and expel the toxin. Since this is an acute onset disease, do not worry about deficiency; without this urgent draining method, one can only wait helplessly for death. As this disease originated in the northern deserts and spread to the Central Plains, it is named Fan Sha.

Originally, this disease resembles Miasma (Zhang Li). Miasma results from exposure to mountain miasma qi, whereas this disease results from exposure to toxic and abnormal qi, similar to epidemic seasonal pathogens. However, epidemic pathogens spread door-to-door across regions, while this disease affects individuals suddenly, causing death within one to half days, unlike epidemics which can persist for days. Furthermore, this disease resembles the latent qi of Cold Damage (Shanghan). Latent qi triggers Warm Disease, with heat toxins moving from interior to exterior. In contrast, this disease involves sudden whole-body exposure to abnormal qi, affecting neither exterior nor interior, nor zang-fu specifically, differing from sudden Cold Damage or Summerheat caused by underlying deficiency unable to withstand climatic extremes. Additionally, it resembles Huoluan (Cholera-like disorder). Huoluan involves external pathogens combining with food and drink qi, whereas here, healthy qi rebels violently and cannot resist the pathogen. It also resembles Guange (Obstruction and Repletion), where upper and lower passages are blocked, and the disease is purely interior. Here, however, there are exterior signs of rashes and Sha. Broadly, it is similar to Chou Du (Foul Poison), but while Chou Du is triggered by filthy odors, Fan Sha is triggered by toxic substances, making it more severe than plagues.

At onset, patients are confused and unconscious. Pulses are often deep, hidden, indistinct, or chaotic. Do not administer warming medicines simply because of abdominal pain and cold feet. If buckwheat is unavailable or ineffective, prioritize regulating qi. Use Xiang Su San (Perilla and Licorice Decoction) plus Bohe (Mint) and Jingjie (Schizonepeta), using pungent-cool methods to vent the exterior. Next, focus on dispelling evil: Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) plus Niubangzi (Arctium Seed) and Sheng Gancao (Raw Licorice) to detoxify and stabilize the middle. If exterior heat is intense, clearing heat is urgent: Huang Qin Tang (Scutellaria Decoction) plus Lianqiao (Forsythia) and Mutong (Akebia Stem) to separate yin and yang. If restlessness and abdominal distension appear with rapid pulses, urgently administer Liang Ge San (Cool the Chest Powder); if using the Bureau Formula version, replace Ginger with Zhuye (Bamboo Leaf) to drain toxins downward. If heat is extreme with coma, even Sanhuang Xie Xin Tang (Three Yellows Draining Heart Decoction) may be unavailing. If there is irritability, thirst with excessive drinking, and urinary incontinence, quickly clear Yangming heat: Bai Hu Tang (White Tiger Decoction) plus Congbai (Green Onion White) and Chijiao (Fermented Soybean) to transform toxins via the exterior. These methods may salvage a few cases if no prior mismedication has occurred. If the family is hesitant, do not treat lightly; otherwise, changes may happen in the blink of an eye, leading to liability.

I once saw a merchant who arrived in Wu-Yue, drank heavily and sang loudly. Suddenly uncomfortable at the banquet, he asked for ginger soup, took one sip, and died. Another northern traveler went to Fengqiao to bathe in mixed waters, suddenly became dizzy and vomited, and died upon reaching his boat. Subsequently, a physician developed chills, fever, and abdominal pain after eating, with cold limbs, and died within a night. A scholar went to the prefecture for mourning, returned home with abdominal pain, restlessness, and disordered speech. Although he could still bow when seeing guests, his six pulses were blurred, and he died that night. Recently, sudden deaths from abdominal pain are common; even without rashes, they are all called Fan Sha.

Recently, a young newlywed man suddenly suffered abdominal pain, numbness, and confusion. Someone advised him to drink half a cup of fiery wine, which worsened the pain and caused head swelling. Red spots appeared on his body; drinking reed root juice induced vomiting, providing relief. Another case involved epistaxis, dry mouth, and slight red rashes on the chest and abdomen. Drinking urine from an uncircumcised boy provided slight comfort. The doctor decocted Congbai (Green Onion White) and Chijiao (Fermented Soybean) thickly, added the boy's urine, and administered it continuously. The patient achieved profuse sweating and vomiting and recovered. If spots are deep crimson, indicating toxin in the blood level, decoct Chongwei Zi (Vernonia Seed) thickly with a little raw honey, serve warm, and allow free consumption for fastest effect, as it specifically drains bad blood. Adding Banxia Lu Bo (Radish) juice helps scatter blood. There are also cases mistaken for Cold Damage and treated with diaphoretics, resulting in purple cloud-like discoloration and death. Others mistaken for Measles and treated with Chengliu (Clematis) and Cherry Pit Decoction died from sore throat and loss of voice. Furthermore, cases of food stagnation and cold mistaken for Fan Sha, treated with cold-clearing detoxifiers, led to removal of clothing/bedding, exposure to wind-cold, irritability, and death. Because this disease strikes suddenly with toxic abnormal qi and lacks distinct pulse signs, differentiation and treatment are particularly difficult. Hence, modern practitioners often use fire cauterization and bloodletting. Note that cases caused by toxic abnormal qi belong to external causes, making fire cauterization appropriate. Cases caused by foul odors belong to non-internal/non-external causes; bloodletting is necessary to curb the momentum. However, if bleeding does not occur upon pricking, the case is incurable.