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The symptoms manifest as aversion to cold and fever, or abdominal pain, resembling malaria but not exactly so, with rapid breathing and wheezing, swelling of the head and face, fullness and distension in the chest and abdomen, or diarrhea and dysentery with pus and blood in the stool.
Mild cases may persist for a month, while severe cases become critical within a short time. Treatment should prioritize Fangsha (bloodletting for sha disease) to resolve food stagnation. Once the sha toxin has been vented, then employ harmonizing methods to clear cold and heat, and strengthen the spleen and nourish blood to tonify the deficiency of the middle jiao (middle burner).

In sha disease, cyanotic or purple veins may appear, either in several locations or just one. It is essential to use needles to remove toxic blood, and then prescribe medication based on the specific symptoms. (Note: For mild cases, needle treatment yields immediate results, and no further medication is needed.)

Acupoints include: Baihui (DU20), located at the center of the vertex. Yintang (EX-HN3), located between the two eyebrows. Taiyang (EX-HN5), located in the depression at the outer ends of the eyebrows. Both sides of the laryngeal prominence. Both sides of the veins under the tongue. The breasts. (All these points are treated with oblique picking/scratching.) The thin skin between the fingertips on the dorsum of both hands, near the nails. Both cubital fossae (elbow creases). The thin skin between the fingertips on the dorsum of both feet, near the nails. Both popliteal fossae (knee creases). (These points are treated only with perpendicular insertion.)

(The original text refers to this as "Ci Sha" (puncturing sha), now changed to "Fang" (release/vent), encompassing both picking and puncturing techniques.)
Fine veins above and below the knee creases that are deep cyanotic, purple, or deep red indicate the presence of sha. (In individuals with fair and tender skin, purple-red coloration becomes visible.) Puncture will yield dark purple-black toxic blood. Do not puncture the large tendons of the thighs; puncturing them yields no toxic blood and may instead cause restlessness. Do not puncture the small veins lying superficially on the hard tendons along the sides of the legs. (The "hard tendon" refers to the largest thick tendon of the leg; the "superficial vein" refers to the small veins close to the skin.) Puncturing these may lead to tendon contraction (cramping). The veins in the arms are identified similarly. For areas suitable for needle picking, merely break the skin until slight bleeding occurs. (If there is no blood, squeeze manually.) Puncturing too close to the nail on the fingertips may cause dizziness. Needles should not be inserted too deeply; silver needles are preferred because iron possesses toxic properties.
Jin's Note: Only the bilateral popliteal fossae and cubital fossae are suitable for seeking out sha veins for puncture. In other areas, if sha veins are not mentioned, it implies their absence. One need only perform bloodletting according to the acupoints. Methods vary between perpendicular insertion and oblique picking, hence the term "Fang" (release) covers both. Regarding picking techniques, treatment should also be adapted to symptoms: for headache, pick Yintang and Taiyang; for stomachache, pick the epigastrium; for abdominal pain, pick around the umbilicus. For hypochondriac pain, densely pick both flanks and Jianjing (GB21); for back and neck pain, pick the back and neck; for ear pain, pick the auricular apex and lobule; for waist pain, pick the waist and soft ribs. (These sites are all mandatory points for various sha diseases.) Use needles to obliquely pick the skin and squeeze out blood. Shao Shang (LU11) and the fingertips of both hands and feet are treated with perpendicular insertion; even if there is no blood, it must be squeezed out.