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Contraindications in Sha (Sha Syndrome) are a concern of mine; I fear people do not know about Sha and inadvertently violate them. Even more concerning is that even if one knows it is Sha, one fails to recognize the specific contraindications. This is like being lost on a dark night, unable to distinguish high from low terrain; walking among cliffs and valleys, few escape falling.

The pathogenesis of Sha differs from miscellaneous diseases (Zazheng), yet its initial manifestations resemble those of miscellaneous diseases. If patients or their families do not believe it is Sha and treat it as a miscellaneous disease, ignoring Sha's contraindications, the condition will inevitably worsen day by day until it becomes incurable (entering the Gao Huang). At this point, even if someone suggests scraping (Guasha) or bloodletting (Fangsha), it will be too late. This constitutes one type of confusion at the onset of Sha syndrome.

Others may know it is Sha from the beginning. After slight scraping or bloodletting, they assume that since Sha has been treated, other medications should be used. Fortunately, if no Sha contraindication is violated, recovery might be achieved. However, if Sha Qi is not eliminated and a contraindication is violated, further medication increases danger, making life hard to preserve, yet they claim it was not due to Sha. This constitutes one type of confusion at the end stage of Sha syndrome.

Furthermore, some suffer from Sha but fail to recognize it. When other medications prove ineffective, they resort only to scraping or bloodletting without accompanying Sha-specific formulas, or use only one or two doses before switching to treatments for other conditions. This causes Sha to recur, leaving them bewildered. They then claim Sha treatment is ineffective and unreliable. They fail to realize that any mismatch in Sha treatment medication can lead to internal attack by Sha toxin and death. This constitutes another type of confusion regarding the harm of Sha throughout its course.

Moreover, there are specific errors:
1. In cases where Sha presents with sweating like oil, sour and astringent medicines that consolidate the exterior are mistakenly administered.
2. In cases with chills, fever, and anhidrosis, ascending and warming-dispersing prescriptions are mistakenly used.
3. In cases where coldness extends up the legs past the knees, Aconite (Fuzi), Evodia (Wuzhuyu), Ginger (Shengjiang), and Cinnamon Twig (Rougui) are mistakenly given.
4. In cases with vomiting and diarrhea, aromatic, drying, and astringent substances are mistakenly used.
5. In cases with aversion to cold, pungent and spicy foods like ginger and pepper are mistakenly consumed.
6. When the pulse becomes deficient (Xu), warming and tonifying drugs are mistakenly applied.
7. When the pulse becomes vigorous (Wang), icy-cold drugs are mistakenly used.
8. When strange pulses appear, although not always fatal, they are misinterpreted as certain death, leading to abandonment of treatment.
9. Sha often resembles Qi deficiency, leading to mistaken use of Ginseng (Renshen), Poria (Fuling), and Atractylodes (Baizhu) to tonify Qi.
10. Sha often resembles Blood deficiency, leading to mistaken use of Prepared Rehmannia (Shudihuang) and Polygonum multiflorum (Heshouwu) to tonify Blood.
11. Because Sha involves many critical cases with extreme peril, practitioners fail to carefully examine the disease source, assuming the patient will die from other conditions.
12. When Sha symptoms slightly relax, food is introduced too early, causing Sha toxins to bind with food in the chest and heart, making resolution difficult.
13. While Sha persists and toxins remain, sudden consumption of hot soup or hot wine causes recurrence of Sha, with perilous consequences that cannot be contained, often changing in an instant, leaving regret too late.

These instances of confusion are all witnessed by me with a sorrowful heart. As for those who hide the fact of Sha when seen, speak against Sha when disgusted by it, and die from Sha without realizing it is Sha's harm—this may be limited by destiny in the world, and I cannot force change upon them. Similarly, I cannot force those who reject methods of scraping, bloodletting, and treating Sha.

I have observed many scholars in the medical field proficient in Qihuang (Traditional Chinese Medicine) and deeply versed in ancient texts, who constantly cite the *Neijing* (Inner Canon of the Yellow Emperor). Yet they seem unaware that the Yellow Emperor originally established the Nine Needles method to treat the people's diseases, emphasizing acupuncture over herbal medicine. For instance, the *Neijing* states: "In malaria cases where the pulse is not visible, prick the ten fingers to bleed; bleeding ensures cure. First observe any red spots like small beans on the body and treat all of them." It also says: "Prick before the onset, after about the time it takes to eat a meal. One prick reduces severity, two pricks bring improvement, three pricks result in cure. If not cured, prick the two vessels under the tongue to bleed. If still not cured, prick Weizhong (BL-40). Bleed from full meridians, and prick below the neck along the spine; this will surely cure. If headache and heaviness occur first, prick the head, temples, and between the eyebrows to bleed. If neck and back pain occur first, prick there first. If lower back and spine pain occur first, prick Weizhong to bleed. If arm pain occurs first, prick the ten fingers of Hand Shaoyin and Hand Yangming. If lower leg soreness and pain occur first, prick the ten fingers of Foot Yangming to bleed." Furthermore: "For lower back pain radiating to the neck, spine, buttocks, and back feeling heavy, prick the Taiyang main meridian at Weizhong to bleed. Prick Jie Mai at the muscle-bone junction behind the knee, and the transverse vessel on the lateral side; bleed until the blood color changes. Jie Mai causes lower back pain like pulling a belt or breaking the waist, accompanied by fear. Prick Jie Mai at Weizhong where collaterals knot like millet seeds; black shooting blood indicates the need to stop when red blood appears." The scriptures are magnificent, instructing for eternity, serving as models for posterity. Thus, Sha varies greatly, and I cannot describe all variations. Those who do not believe me, please reflect quietly at night. If you encounter such illness and momentarily lose your way, failing to prick when you should, or failing to medicate when you should, whether harming others or yourself, the outcome is similar. I trust we share this understanding. Be cautious! Be cautious!