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After the recovery from smallpox, the middle Qi (Vital Energy of the Middle Jiao) is often deficient; any pathogenic invasion will inevitably cause damage, so special protection is advisable. I have observed cases where children, after the scabs of smallpox had fallen off and they were seemingly fine, suddenly developed Sha Zhang (Sha distension/swelling) upon exposure to summer-heat or foul odors. These conditions often change abruptly. People generally attribute them to malignant smallpox toxins, and even specialists in smallpox treatment share this view, failing to realize that Sha can be so harmful.

Clinical Cases:
1. The son of a Mr. Hu, aged seven, had his smallpox erupt and scab over in August. His skin was smooth, diet normal, and movement unchanged. On the twenty-fifth day, he suddenly screamed incessantly, felt dizzy as if dying, and everyone believed it was due to residual toxins from malignant smallpox. Upon my examination, the pulses in all six positions of both wrists were faint, thin, and deep-hidden. I reasoned that if it were a transformation caused by residual smallpox toxins, the pulse should be deep, tight, and forceful. The current faint and hidden pulse contradicted the symptoms. Observing his Sha veins (distended subcutaneous veins), they were clearly palpable. After puncturing and draining purple-black toxic blood, there was no improvement. I then prescribed Jingjie Yinhua Tang (Scutellaria and Forsythia Decoction) combined with He Pi Xuan Hua Yin (Spleen-Harmonizing and Transformation-Dispersing Drink), administered slightly cooled. He recovered consciousness shortly after. Later, he suffered lower abdominal pain and developed dysentery. I used Dang Gui (Radix Angelicae Sinensis) 5 qian, Shan Zha (Fructus Crataegi) 1 qian, and Shu Da Huang (Prepared Rhizoma et Radix Rhei) 5 fen, mixed with fresh urine (Tong Bian) and given warm. Symptoms eased slightly, but full recovery required four doses of Dang Gui and Shan Zha alone.

2. The daughter of Zhang Kelou, aged fifteen, on the thirty-second day after smallpox, suddenly experienced severe dizziness and heaviness, unable to turn her body. Upon consultation, the right pulse was faint and thin, while the left pulse was surging and large, with occasional intermittent beats. Her fingertips appeared black, and green veins were clearly visible. Puncturing and draining toxic blood yielded no result. Jiangxiang Taohua San (Aquilaria and Peach Blossom Powder) combined with Zhishi Dahuang Tang (Immature Bitter Orange and Rhubarb Decoction) was given slightly cooled, without success. Finally, Sanxiang Wan (Three Fragrances Pill) was administered warm, leading to recovery. Later, due to food stagnation and exposure to foul air, she suffered abdominal pain. Scraping therapy (Gua Sha) was performed, and Lengzhu Tang (Borneol and Curcuma Decoction) with 2 fen of Ming Fan (Alumen) was given slightly cooled, resulting in stability.

Sha in pregnant women easily harms the fetus; Sha in postpartum women requires vigilance against E Zu (nausea/vomiting during pregnancy/postpartum complications), which is more severe than in ordinary individuals. Urgent treatment is necessary to intervene before Sha toxins destroy the Zang-Fu organs. If it is "Dark Sha" (hidden Sha) occurring at these times, the Sha pulse may be confused with the pregnancy pulse, and the postpartum Sha pulse may be mixed with E Zu symptoms. Without severe heart or abdominal pain, and with Sha manifesting internally, one must carefully investigate the symptoms, observe the voice and complexion, check for Sha veins, and urgently puncture them. If Sha congestion is prominent on the skin, oil and salt therapies are particularly important. However, if Sha toxins run rampant and attack the Zang-Fu organs uncontrollably, recovery is impossible. One must be cautious and not act rashly to endanger lives.

Clinical Case:
The wife of Zhao Fangheng, six months pregnant, suffered alternating chills and fever, restlessness, and discomfort. When consulted, the Sha toxin was just beginning to emerge, and the pulse had not yet manifested distinctly. Initially, Sha was not suspected, and medication failed. She suddenly fell into a coma. The next day, her left pulse was found to be deep-hidden, and her face and eyes were slightly dark. Recognizing it as Sha, I punctured six points on the blue veins in the popliteal fossa (back of the knee), draining toxic blood. She improved slightly. A decoction of Sang Ji Sheng (Taxillus), Hong Hua (Carthamus), Xiang Fu (Cyperus), Yi Mu Cao (Leonurus), Jing Jie (Schizonepeta), Xi Xin (Asarum), Bo Zi (Raphanus Shenqu), and Shen Qu (Medicated Leaven), mixed with Sha Ren (Amomum) powder, was taken slightly cool, bringing relief. Subsequently, Xiao Chai Hu Tang (Minor Bupleurum Decoction) was used to reduce fever, followed by Shen Ling Gui Di Tang (Ginseng, Poria, Angelica, and Rehmannia Decoction) to strengthen the Spleen and nourish Blood, leading to complete recovery.