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At the initial onset of Sha (Sha disease, a condition characterized by toxic heat and stagnation), it must stem from external pathogenic factors. When pathogens invade the muscle and surface (the exterior layer of the body), the patient is often unaware of it; consequently, the pathogens enter the half-exterior and half-interior stage. This leads to a sensation of oppression in the chest, vomiting, and abdominal pain. This condition can be cured by scraping therapy (Gua Sha); if scraping is ineffective, formulas such as Jingjie Tang (Schizonepeta Decoction) or Huoxiang Tang (Agastache Decoction) should be selected for treatment.

If pathogens are contracted at the half-exterior and half-interior level, and the patient remains unaware, the pathogens will penetrate deeper into the interior. Symptoms include the urge to vomit but inability to do so, and the urge to defecate but inability to do so. If Sha toxin rushes to the heart, severe pain in the chest and heart region occurs; if Sha toxin attacks the abdomen, severe intestinal cramping pain (panchang diaotong) ensues. This condition can be cured by bloodletting (Fang Sha); if bloodletting is ineffective, formulas such as Chenpi Zipu Tang (Tangerine Peel and Magnolia Bark Decoction) or Lengzhu Tang (Burreed and Curcuma Decoction) should be selected.

If Sha pathogens directly strike the interior, and the patient is unaware, Sha Qi (Sha energy) becomes stagnant and obstructed. The malignant toxins attack upward against the heart, diaphragm, and spine, causing immediate dizziness and fainting. At this stage, even if scraping therapy is attempted, Sha rashes will not appear; even if bloodletting is intended, the patient may be too weak to stand. One must not forcibly perform bloodletting. If the patient is lifted while fainting, due to the stagnation of Qi and Blood, no dark purple-black toxic blood will flow out. Even if a small amount flows, it will not be much, merely showing a few dark purple-black blood spots. This indicates that Sha toxin has penetrated deeply, which is an ominous sign of great danger.

Only when the family members are urgently seeking help at this critical moment should medication be administered. The physician must carefully examine the pulse and differentiate the syndrome to determine whether the cause is Wind-Cold, Summerheat-Dampness, or stagnation of Qi-Blood, food retention, or phlegm-fluids. Treatment should be applied according to the etiology to restore consciousness and promote the flow of Qi and Blood. Only then should the patient be assisted to undergo bloodletting, followed by gradual regulatory treatment. If the patient does not regain consciousness, emergency rescue medicines such as Niuhuang Wan (Calculus Bovis Pill), Sanxiang Wan (Three Fragrances Pill), or Jiuku Dan (Relieve Suffering Pellet) should be chosen. For such severe cases, the physician must act with profound compassion, administering decoctions and pills continuously without delay to have any chance of saving the patient; delay will inevitably lead to death.

When Sha invades the Taiyang Meridian, headache and fever occur; when it invades the Shaoyang Meridian, swelling beside the ears and alternating chills and fever occur; when it invades the Yangming Meridian, the face and eyes become red like fire, with fever but no chills; when it invades the Taiyin Meridian, abdominal pain occurs; when it invades the Jueyin Meridian, lower abdominal pain or hypochondriac pain occurs; when it invades the Shaoyin Meridian, lower back pain occurs accompanied by a cool body.

If Sha affects the Lung, cough, wheezing with phlegm, and slight fever occur; in severe cases, epistaxis (nosebleed) occurs. If Sha affects the Heart, heart pain or cardiac distension occurs, with cold sweat on the forehead and head resembling beads, while the body temperature may be either hot or cool. If Sha affects the Bladder, hematuria (blood in urine) occurs; in severe cases, high fever occurs. If Sha affects the Large Intestine, dysentery with pus and blood occurs; in severe cases, vomiting and fever occur. If Sha affects the Liver, the body feels heavy and difficult to turn over, with afternoon fever and internal heat; in severe cases, hematemesis (vomiting blood) occurs. If Sha affects the Sanjiao (Triple Burner), internal attack by heat-toxin occurs, manifesting as thirst above and constipation below.

In treating Sha, one must distinguish whether the body is cool or hot. Generally, for those with a cool body or internal heat, purging the interior is appropriate; for those with exterior heat, venting the muscle layer is appropriate.