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The treatment of diseases must rely on pulse diagnosis. If one suffers from *Shazhang* (Sha Distension), the pulse will not correspond to the symptoms, and the symptoms will not match the pulse; alternatively, relying on "Sha Jin" (visible subcutaneous purple-black blood vessels) as evidence is also merely an external manifestation. Furthermore, Sha Distension may be caused by food stagnation obstruction, or by blood-phlegm obstruction. The obstruction may occur in the upper, middle, or lower regions, or on the left, right, or both sides of the hypochondrium. Unless the symptoms are identified with precision, it will be difficult to find a treatment that strikes the disease accurately. Therefore, when treating Sha Distension, upon observing a pulse that does not conform to the norm, one should first examine the Sha Jin, secondly assess the complexion, thirdly listen to the voice, and fourthly deduce the cause of the illness. If there are obstructions by food stagnation or blood-phlegm in the upper, middle, lower, left, or right areas, one must carefully distinguish the etiology before administering medication to avoid error. In Sha pulses, either a single region is distinctly abnormal, or all six positions are abnormal. Even within these abnormalities, Yin-Yang deficiency and excess can be distinguished, and the spirit of the pulse is discernible. One cannot adhere to a single aspect; careful examination is required.

One might ask: Regarding Sha Distension, you sometimes administer medication before bloodletting and scraping, and sometimes after. Are there no other methods besides bloodletting and scraping? I reply: The methods of bloodletting and scraping are analogous to treating Taiyang channel syndromes in Cold Damage (*Shanghan*), where herbs such as Qianghuo (Notopterygii Rhizoma et Radix) and Mahuang (Ephedrae Herba) must be used; for Shaoyang channel syndromes, Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) must be used. Depending on the site of invasion, the treatment is appropriate accordingly. Generally, if Sha toxin resides in the Qi level, scraping is indicated; if it resides in the Blood level, bloodletting is indicated. This is an unchangeable principle. However, if Sha toxin affects the Zang-Fu organs and meridians, leading to symptoms such as coma and unconsciousness, it cannot be cured by bloodletting and scraping alone; combining them with herbal medication is not surprising.

The eruption of measles (*Mazen*) occurs due to wind-heat injury, resulting in high fever, cough, and irritability, which are signs of impending rash. In other regions, measles is known as "Cuozi" or "Zaozhen"; in Li's region, it is called "Shazi". Since Sha Distension is also named "Sha", this distinction must not be overlooked. Measles arises from wind pathogen invasion, causing the exterior to be deficient; thus, toxins vent out through this deficiency. Therefore, although the herbs used may be cooling, they can still be taken with hot drinks. In contrast, Sha Distension may be triggered by foul air, summerheat, epidemic miasma, or latent cold/heat pathogens manifesting later. It fundamentally does not originate from external wind-heat injury; consequently, the exterior remains solid. When the exterior is solid, heat-toxin qi already distends within the chest, abdomen, and intestines. If hot drinks are administered, the heat assists the distension, preventing venting. Patients suffering from this condition may die instantly from swelling; this distinction is crucial.