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Mute and silent, speaking without sound, the body resembling that of a mute person; this is due to the excessive accumulation of Sha Qi (pathogenic factor associated with "sha" disease), where hot phlegm ascends, obstructing and reversing the flow in the respiratory tract, thus causing blockage of the throat. Treatment should first involve Sha bloodletting (releasing Sha pathogen by pricking vessels). It is crucial to examine the pulses of the Lung, Kidney, and Spleen meridians, and then carefully investigate the pulses of other meridians to determine the root of the disease.

Case Record:
The daughter of Wu Zirui suddenly developed Sha distension in November, experiencing mental restlessness, lethargy, and muteness. Mr. Wu was skilled in Sha bloodletting; after slight recovery of consciousness, she remained voiceless throughout the day. Upon examination, the pulse at the Left Guan position was forceful, while the Right pulse was deep and hidden, indicating Sha injury to Qi. This girl had been scolded daily by her stepmother, leading to this condition. I prescribed one pill of Chenxiang Wan (Agarwood Pill) decocted in water, cooled slightly, and administered orally. She regained some ability to make sounds, but was not cured. The next day, the Left pulse became wiry, long, and active. I stated, "Anger injures the Liver; it is because Sha Qi remains obstructed in the Liver meridian." I pricked three needles into the purple veins behind the knees, resulting in profuse bleeding. I also pricked over twenty points on the vertex and fingers. Then, I administered Sanxiang San (Three Fragrances Powder) combined with Chenpi Nongpo Tang (Tangerine Peel and Magnolia Bark Decoction) plus Yanhusuo (Corydalis Rhizome) and Xiangfu (Cyperus Rhizome), served warm. She recovered.

Extreme distension in the chest and heart, with Sha toxin attacking internally, causes the head to tilt backward, resembling opisthotonos (body arched like a bowstring). This indicates destruction of the Zang-Fu organs, representing a fatal syndrome that cannot be treated.

Excessive accumulation of saliva and phlegm, rapid breathing and wheezing, roaring sounds in the throat like sawing, and pain resembling Hou'e (throat goose/swollen throat). However, in Hou'e syndrome, there is swelling inside the throat; whereas in Sha syndrome, there is pain similar to Hou'e but without such swelling. It may resemble Ji Houfeng (acute wind-stroke of the throat), but in Houfeng, the pain is fixed in location; in Sha syndrome, the pain is migratory/unfixed, and Sha syndrome presents with Sha veins (visible subcutaneous veins); Hou'e does not have Sha veins. This distinction allows for differentiation.

Case Record:
Shi Sanxian suffered from excessive phlegm-Qi stagnation. After using medicated powder blown into the throat to induce vomiting of phlegm, his condition became more violent and painful. Upon examination, his pulses were highly irregular, indicating Sha disease of the Sanjiao (Triple Burner) and Mingmen (Gate of Life). I observed the veins on the arms and fingers and applied eleven needle pricks. There were greenish veins behind the knees, which were pricked three times, releasing a large amount of dark purple toxic blood. The condition did not improve immediately. I administered Chenxiang Yujin San (Agarwood and Turmeric Powder) and Jiuku Dan (Pain-Relieving Pill) with clear tea, cooled. Externally, Bingpeng San (Borneol and Borax Powder) was blown into the throat. He also drank Jingjie Yinhua Tang (Schizonepeta and Forsythia Decoction), cooled slightly. After three doses, he recovered.
Zhou Longsheng suffered from extreme throat pain and excessive saliva/phlegm. When summoned, I diagnosed him with Sha disease. He did not believe me and drank hot water. By evening, he died.