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When reading books on *Shanghan* (Cold Damage), encountering patients with jaundice or petechiae, I believe there is an accompanying Sha syndrome. This is because jaundice and petechiae are symptoms manifesting in *Shanghan*. These conditions may arise from inhaling foul odors, exposure to summer heat, or contracting pathogenic qi of the season, thereby complicating into Sha distension. This constitutes the theory of "*Shanghan* complicated by Sha."

Clinical Cases:

1. Kong Shuyuan contracted *Shanghan* that transmitted to the Stomach Fu organ. Symptoms included thirst, high fever, sweating on the head with yellowing of the skin, prickles on the tongue coating, abdominal distension with mental confusion, a short tongue with heavy voice, rapid breathing, and panting. Upon examination, the pulse at the left Cun and Guan positions was hidden (Fu), while other pulses were wiry and tight (Xian Jin). I stated: "Sha toxin obstructs the sinews and vessels, preventing the free flow of Qi in the vessels, hence the pulse is slightly hidden and wiry-tight. Additionally, the Stomach Fu is extremely hot; the Sha toxin takes advantage of this. If one drinks hot soup or eats hot food, the Sha toxin will rampage and attack the Zang-Fu organs, resulting in such severe symptoms." First, I performed bloodletting acupuncture at one point on the vertex. Next, I performed bloodletting at more than twenty points on the fingertips, and two points above the breasts. The mental confusion immediately relieved. I prescribed Wuyao Shunqi Tang (Aucklandia Decoction to Smooth Qi) with added Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma), and Taoren (Persicae Semen), for two doses, taken slightly cooled. Subsequently, head sweating ceased, tongue coating receded, and other symptoms gradually resolved. Bloodletting was performed again on the fingers. Then, Zhishi Dahuang Tang (Immature Bitter Orange and Rhubarb Decoction) was prescribed, with Huaihua removed and Honghua (Carthami Flos) and Mangxiao (Natrii Sulfas) added, for two doses, taken warm, leading to recovery.

2. The wife of Sun Yanqu presented with high fever, jaundice, profuse sweating on the head like rain, extreme thirst, and cracked lips. The left pulse was wiry and tight, and the right pulse was deep and faint. I performed bloodletting acupuncture at over forty points along the arms and above and below the popliteal fossae, draining purple-black toxic blood, but the condition did not resolve. I prescribed Xixin Dahuang Wan (Asarum and Rhubarb Pill) and Chenxiang Yujin San (Aquilaria and Curcuma Powder), administered with slightly cooled decoction. Then, Taoren Honghua Tang (Peach Kernel and Safflower Decoction) with Niuxi (Achyranthis Bidentatae Radix) and Shihu (Dendrobii Caulis) was prescribed for two doses, taken slightly warm, resulting in complete recovery.

3. Liang Zhongsu had suffered from *Shanghan* for six days, presenting with high fever, petechiae, extreme thirst, and lethargy. Examination revealed an excessively surging and large pulse, with prominent green veins at both temporal regions. I performed bloodletting acupuncture at three points and five points at the popliteal fossae, releasing toxic blood, but the illness persisted. Jingjie Honghua Tang (Schizonepeta and Safflower Decoction) was combined with Qingliang Zhibao Yin (Cooling Precious Treasure Drink) with added Shigao (Gypsum Fibrosum), taken slightly cooled for four doses, leading to recovery.

4. The second daughter of Tang Maozhen contracted *Shanghan* in August. She experienced high fever at dusk, thirst, petechiae, severe headache as if splitting, heavy voice, deafness, vomiting of two roundworms, and near-fatal mental confusion. The pulses at both Cun positions were weak and powerless; the Guan positions were wiry and thin; the left Chi position was slippery, and the right Chi position was tight. Bloodletting was performed at three points in the popliteal fossae, providing slight relief. Qingliang Zhibao Yin (Cooling Precious Treasure Drink) was prescribed with added Huangqin (Scutellariae Radix), Niuxi (Achyranthis Bidentatae Radix), Shigao (Gypsum Fibrosum), Taoren (Persicae Semen), Zelan (Lycopus Lucidus Herba), Wuyao (Linderae Radix), and Zhiqiao (Aurantii Fructus Immaturus), taken cold. When this proved ineffective, bloodletting was repeated. A decoction of Shudahuang (Prepared Rhubarb) 3 qian and Xiacha (Fine Tea) a pinch was prepared and administered, resulting in recovery.