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In general, when medication is appropriate for any disease, it is invariably effective. However, in cases of Sha syndrome (an acute condition caused by heat-toxin), even with appropriate medication, there are instances where it fails to take effect. Why is this? Sha refers to heat-toxin. Medications for treating heat-toxin should be cooling rather than warming, and should promote dispersion rather than tonification. When the decoction enters the mouth, it must be cool; a cooling nature allows it to enter the intestines and stomach directly. If it is not cool, although excellent prescriptions are used, how can they reach the skin, muscles, and flesh? Therefore, in treating Sha, nothing takes precedence over scraping (Gua Sha) and bloodletting.

If, after scraping and bloodletting, the toxins in the skin, muscles, and flesh have been eliminated, one then uses medication to drive out the toxins from the intestines, stomach, spleen, liver, kidneys, and the three Yin meridians. In such cases, the medication will certainly be effective. However, there are also situations where, despite scraping and bloodletting, the medication remains ineffective. This is not because the medication itself is ineffective. It is that at the time, although scraping and bloodletting were performed, they may not have been thorough enough, or the scraping may not have reached all areas, meaning the toxins in the skin, muscles, and flesh still remain. Thus, even if medication is administered, it may fail to work. If scraping has indeed reached the necessary extent and bloodletting has been completed thoroughly, yet the symptoms of Sha persist, it indicates that the Sha toxin resides solely within the meridians of the intestines, stomach, spleen, liver, kidneys, and the three Yin channels. Apart from medication, what other method could treat this?

When Sha syndrome becomes critically severe, causing coma and unconsciousness, where the patient cannot be supported upright nor responds to calls, making scraping or bloodletting impossible, there is another method using medication for rescue that guarantees efficacy. Why? Because medication for Sha must be cool. Although cool medicine may not immediately circulate through the skin, muscles, and flesh, coma and unconsciousness occur because the heat-toxin of Sha rushes to the heart and diaphragm area, causing the heart spirit to lose control, resulting in coma. If the medicine enters the mouth while cool, it flows down smoothly from the heart and diaphragm area. Consequently, the heat-toxin qi residing in the heart and diaphragm dissipates along with the medicinal action, so the comatose regain consciousness, and the confused become alert. Even if some do not wake up, it is due to obstruction by food retention, blood stasis, or phlegm. If these can be purged downward via purgation methods, recovery of consciousness is inevitable. This is why, in my treatment of Sha, I achieve guaranteed efficacy by employing medication.

Sha qi stagnation and obstruction invariably block the middle jiao, leading to pain and distension. Use Jingjie (Schizonepetae Herba) and Fangfeng (Saposhnikoviae Radix) to disperse from the exterior; use Qingpi (Aurantii Fructus Immaturus) and Chenpi (Aurantii Pericarpium) to resolve from the middle jiao; use Zhishi (Aurantii Fructus) and Dahuang (Rhei Radix et Rhizoma) to purge downward through the large intestine; use Mutong (Akebiae Caulis) and Zexie (Alismatis Rhizoma) to guide downward through urination; use Shanzha (Crataegi Fructus) and Boluozhi (Radish Seed) to treat obstruction caused by food retention; use Jinyinhua (Lonicerae Japonicae Flos) and Honghua (Carthami Flos) to treat blood stasis; use Binglang (Arecae Semen) and Ezhu (Curcumae Rhizoma) to treat accumulation and stagnation.