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In cases where symptoms such as headache, aversion to cold, and fever associated with Shanghan (Cold Damage disease) occur, whether during the summer heat, due to exposure to foul odors, or contracted from epidemic pestilence, if Sha Zhang (Sha Distension) is suddenly triggered, it can only be differentiated by examining the pulse and observing the collateral vessels. The Sha condition must be treated first; only after the Sha subsides should the Shanghan be addressed. If hot soups or hot-natured medicines are mistakenly ingested, a slow progression may still be salvageable, but an acute progression will immediately lead to critical conditions.

Clinical Cases:

1. My nephew, Tanbu Wenmu's eldest son, aged twelve, suffered from headache, body fever, and absence of sweating. Other physicians treated him for Shanghan without success. Upon my examination, his six pulses were slightly moderate (Wei Huan), leading me to diagnose it as Shanghan complicated by Sha. I punctured three cyanotic veins in the popliteal fossa, releasing a large amount of dark purple-black toxic blood. As symptoms persisted, he was administered Fangfeng Shengjin Tang (Windproof Metal-Overcoming Decoction) cooled slightly, two doses, which caused the Sha to subside. Subsequently, Xiaochaihu Tang (Minor Bupleurum Decoction) was taken, resulting in recovery.

2. A patient surnamed Che, in May, had suffered from Shanghan for fourteen days when he suddenly became severely lethargic and unable to turn over in bed. I examined him and stated, "This is Shanghan complicated by Sha. If the Sha is not treated first, I cannot take responsibility." He did not believe this and sought treatment from other physicians, which resulted in deeper coma. He later returned to me. I explained, "The Sha Qi (Sha Pathogenic Factor) rushing to the Heart causes the coma; the Sha toxin entering the Blood level and collaterals prevents voluntary movement. If the Sha is treated first, there is still hope for recovery." He requested my treatment. I performed bloodletting (Fangsha). As symptoms persisted, Baohua San (Precious Flower Powder), Yuanhong San (Round Red Powder), and Fangfeng Shengjin Tang were all administered cooled slightly. After the Sha subsided, the Shanghan was treated, leading to recovery.

3. My second daughter, in April, presented with headache and fever, characteristic of the Taiyang Channel syndrome of Shanghan. I treated her with modified Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction), which provided slight relief. By the fourth day, continuing treatment according to Shanghan protocols proved ineffective. Her face turned red, body fever increased, and she experienced persistent chest stuffiness. Her six pulses were excessively surging (Hong Da). I stated, "This is Shanghan complicated by Sha. One must inspect the Sha collaterals and puncture them." My daughter did not believe this. By evening, her condition worsened, and she finally agreed to bloodletting. A cyanotic vein below the left popliteal fossa was punctured, releasing dark purple-black toxic blood. However, finer cyanotic veins were not clearly visible because the delay caused Sha Qi stagnation, making the collaterals faint. She drank three bowls of Bisheng Tang (Invincible Victory Decoction) and felt somewhat relaxed, but did not recover. The next day, Sha collaterals reappeared on her fingers; nine needle pricks released blood, yet medication failed to cure her. At night, two cyanotic veins appeared on the right popliteal fossa; they were punctured to release toxic blood, and Yuanhong San was taken, bringing slight stability. Later, sudden overeating caused recurrent fever and facial flushing. A decoction of Hawthorn Fruit (Shanzha), Radish Seed (Buzi), Bupleurum Root (Chaihu), and Tangerine Peel (Chenpi) was given without effect. The pulse remained excessively surging, indicating a recurrence of Sha toxin. Cyanotic veins on all ten toes were punctured to remove toxic blood. Bisheng Tang was administered cooled slightly for two doses, but the condition persisted. Accidentally drinking slightly warm tea immediately induced delirium, indicating that the Sha had not fully dispersed and was reignited by the warm drink. Three bowls of cold well water were consumed, followed by five doses of cold medicine, after which the Sha Qi cleared. However, due to prolonged illness and physical deficiency causing dizziness, Shen Tang (Ginseng Decoction) was given to restore consciousness. Finally, modified Shiquan Dabu Tang (Complete Great Tonifying Decoction) was used for regulation, and she recovered after two months of convalescence.