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Someone said to me, "Ancient texts record that the appearance of strange pulses such as 'House Leaking' (Wulu) and 'Sparrow Pecking' (Quezhao) indicates death; the appearance of a 'Intermittent Pulse' (Daimai) indicates death, due to the exhaustion of the Qi of the Five Zang organs. If there is no pulse in one position, or in two or three positions, how can there be any hope for life?" Upon studying the pulse patterns of Sha disease (Sha Syndrome) in *Yuheng*, I found that only when all six positions lack a pulse is it fatal. Even with those strange pulses, it is specified that death occurs only if bloodletting (Fangsha) and medication fail to respond. This differs from ancient texts. Why? I replied, "When ancients discussed these pulses as fatal, they were referring to the general rule; my discussion that these pulses should still be treated is due to the variability of Sha disease." The pulses of Sha distension often resemble various fatal pulses. I merely see this illness and feel great pity, hoping for even a one-in-ten-thousand chance of salvation. Because Sha disease varies, I do not adhere rigidly to standard pulse diagnoses to lightly abandon patients.

Clinical Cases:

1. The wife of Chen Jianya was pregnant, suffering from fever, bloody dysentery, and incessant abdominal pain. Other medications were ineffective. My diagnosis revealed her pulse had four beats followed by one pause, which is an Intermittent Pulse (Daimai). Observing Sha veins (Sha Jin), I performed bloodletting at over twenty points. She took Baohua San (Precious Flower Powder) cooled slightly. I prescribed Sangjisheng (Taxilli Herba), Yimucao (Leonuri Fructus), Lianqiao (Forsythiae Fructus), Sugeng (Perillae Caulis), Honghua (Carthami Flos), Jinyinhua (Lonicerae Japonicae Flos), Shanzha (Crataegi Fructus), Bozi (Raphani Semen), Danggui (Angelicae Sinensis Radix), Zhike (Aurantii Fructus), Qingpi (Aurantii Fructus Immaturus), and Huangqin (Scutellariae Radix), taken cold after slight freezing. After four doses, she recovered.

2. A concubine of Zhang Shunzhan suffered from abdominal pain, coughing with phlegm, and vomiting. Upon examination, her pulse felt like striking stones, indicating extreme pain from Sha disease and altered pulse characteristics. I instructed her maid to perform bloodletting at over thirty points on the Sha vessels. She was given Baohua San (Precious Flower Powder), Jiuku Dan (Pain-Relieving Pill), and Amomi Decoction, served slightly cold. I prescribed Duhuo Honghua Tang (Angelicae Pubescentis and Carthami Decoction) added with Shanzha (Crataegi Fructus), Shenqu (Massae Fermentatae Medicinalis), Bozi (Raphani Semen), and Qingpi (Aurantii Fructus Immaturus), served slightly cold. After two doses, she recovered.

3. Fu Chunyu suffered from fever and lethargy, with a pulse resembling untying a knot (Jiesuo). Initially, he drank juice made from mashed taro root mixed with Yin-Yang Water. Bloodletting was performed at over thirty points on the fingers and arms, bringing slight relief. He then took Xixin Dahuang Wan (Asari and Rheum Pills) with clear tea, served slightly cold. I prescribed Jingjie Yinhua Tang (Schizonepeta and Lonicera Decoction) added with Qingpi (Aurantii Fructus Immaturus), taken warm. After two doses, he recovered.

4. Wu Yungong presented with redness and swelling of the head and face, closed eyes, and sore throat. His six pulses lacked root, indicating Sha Qi blocking the pulse pathways. I punctured Sha vessels on the legs and feet over forty times, draining much dark purple-black blood. I then punctured Sha vessels on the arms over twenty times, but the condition did not improve. I prescribed Qingliang Zhibao Yin (Clearing Heat and Treasuring Treasure Drink) with Xixin (Asari Radix) removed, and added Shandougen (Millettiae Speciosae Radix), Shegan (Belamcandae Rhizoma), Niuxi (Achyranthis Bidentatae Radix), Shihu (Dendrobii Caulis), Sangbai pi (Mori Cortex), and Zhike (Aurantii Fructus), served slightly cold. After three doses, he recovered.

5. Zu Yi, the second son of Jin Zijin, in September, due to labor and irregular diet, suddenly developed high fever and headache. He used Perilla Soup to fumigate his head, causing profuse sweating, leading to chest fullness and oppression. Other physicians used purgatives, causing him to vomit white foam. Some suggested it was Sha disease, so another physician examined him. Seeing gray tongue coating, they treated it as Cold Damage (Shanghan). Jin Zijin feared triggering Sha Qi and tested half a small cup first. Shortly after, he experienced delirium, which ceased after a moment. The fever persisted, and he felt increasingly heavy. His pulse reached eight beats per respiration (Ba Zhi). Three physicians consecutively diagnosed Cold Damage (Shanghan). After three doses of medicine, he remained lethargic and delirious. On the fifth day, his eyes were red as fire, lips red as cinnabar, nose black as soot, tongue coating black and dry, short and shriveled, voice unclear, feet cold up to the abdomen, scrotum retracted, muscles wasted, and spirit confused. Physicians refused treatment, and funeral preparations began. On the seventh day, bloodletting was finally performed. Due to the critical condition, only two needles were used. The fatal signs regarding lips, eyes, tongue, and voice instantly resolved. The scrotum and testes gradually relaxed. The pulse normalized. Abdominal pain appeared, and thirst was noted. Confused by advice that Sha disease cannot be treated with herbs, he only drank child's urine and took Zijin Ding (Purple Gold Tablet), stopping the pain. He continued taking it with pain episodes and resumed eating. Stool became dry and hard. On the eighteenth day, honey suppositories were used, leading to diarrhea, occurring 50-60 times daily. After six days, one dose of Sha disease medication allowed him to sleep peacefully, and the diarrhea stopped. Later, other doctors attempted tonification. Within days, during sleep, he developed widespread Crystal Sha (a type of Sha manifestation); upon waking, it vanished. Doctors were puzzled. Jin Zijin noticed that scraping the neck and forehead released sweat. Night sweats ensued. Other doctors attributed this to deficiency collapse from chronic illness and used strong tonics to stop sweating. This worsened spontaneous sweating and caused undigested food in stool. Urine became scant, red, and frequent, turning into Sand Lin (Gravel Strangury). Doctors again gave up. I performed bloodletting again and prescribed Bazheng San (Eight-Normal Powder) for two doses. The Sha Qi transformed. He developed high fever for about two double-hours (four hours), then cooled down and sweating stopped. He ate raw Colocasia esculenta (Taro) for five to six days. The Sand Lin stopped, and he fully recovered. Zu Yi's illness was prolonged and变幻 (variable). It was entirely due to only two needles being used and no Sha-specific medication being taken to remove the root cause. Ultimately, treating Sha disease restored the full pulse and addressed the rapid pulse (Ba Zhi). Although many fatal signs were present, could we have abandoned him?

6. Quan Ke, the eldest son of Jin Zijin, in August, developed a rash all over the body resembling measles. Other physicians diagnosed it as "Rash" (Zhen). Pediatricians also diagnosed it as "Sha Rash" (Sha Zhen). After ten days of medication without improvement, his pulse slowed to two beats per respiration (Er Zhi). Doctors suspected grief-induced deficiency collapse from his recent widowhood and proposed tonification. Jin Zijin feared it was Sha Qi and forbade the medicine. Upon inspection, the body was covered with active Sha spots flowing into the skin and flesh of both legs, which were red and purple. I punctured one point at the popliteal fossa (leg bend), and the skin turned white. Several more punctures at the leg bends turned the skin white, except for the lower legs which remained red and purple. When lying down, the rash flowed and scattered over the body, appearing as sparse dots. Since the pulse was only two beats, I administered a small pill made of Chuanwu (Aconiti Radix Preparata) and Caowu (Aconiti Kusnezoffii Radix). The pulse returned to normal, profuse sweating occurred, and he recovered.