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The pathogenic qi of sha (sand disease/toxin) obstructs the meridians and the space between flesh and blood, therefore its pulse is mostly deep and hidden (Chen Fu Mai). This also applies to cases where other diseases are complicated by sha. For instance, if a person has Shanghan (Cold Damage), and the pulse is deep, thready, and weak (Chen Wei Wu Li), this is the pulse pattern of direct invasion into the Three Yin Meridians (Zhi San Yin Jing). In treating it as a Yin syndrome using hot-natured herbs, what could there be to doubt? However, I have often seen cases where this treatment resulted in a cure, and others where it did not. When cured, people will say: "The medicine for Yin syndrome is appropriate." When not cured, people will say: "The medicine for Yin syndrome should not be used hastily." Is this because their pulse diagnosis was inaccurate, or because the treatment of Shanghan was improper? Actually, it is merely because Shanghan is complicated by sha, and the sha pulse resembles the Yin syndrome pulse so closely that they cannot be distinguished. Consequently, upon taking a dose of warm, tonifying, and hot-natured medicine, the nature of the sha toxin transforms, leading to such regrettable outcomes.

I have clinically treated Shanghan, palpating pulses that were deep, thready, or hidden, which superficially resembled direct invasion of the Three Yin Meridians. However, if the external symptoms manifested slightly differed from those of the Three Yin syndromes, I would immediately examine the patient for "sha veins" (visible subcutaneous cyanotic vessels). If present, it is sha; if absent, it is pure Yin syndrome. The administered medicines, whether cooling or heating, would never fail. Furthermore, after phlebotomy (Fang Sha) and medication, the obstruction in the meridians and tissues between flesh and blood is cleared. Palpating the pulse thereafter, it no longer appears deep, thready, or hidden. Only then do I diagnose based on pulse and symptoms, prescribing medication to treat the underlying Shanghan, and the efficacy is invariably achieved. For miscellaneous diseases complicated by sha presenting with deep, thready, or hidden pulses, verifying them with this method is indeed an unalterable and correct principle.

The toxic qi of sha rushes and agitates within the meridians and the spaces between flesh and blood; thus, its pulse is mostly flooding and rapid (Hong Shu), or deep and tight (Chen Jin), or large and chaotic without order (Da Er Wu Lun), or flooding and solid with strength (Hong Shi You Li), varying greatly. If the symptoms and pulse show slight discrepancies, one must carefully inspect for the presence of sha veins. If present, wait until after phlebotomy, then re-diagnose the pulse to determine its state, thereby judging the cold, heat, deficiency, or excess of the disease to guide treatment. If absent, directly judge the cold, heat, deficiency, or excess based on the pulse to prescribe medication.

I once treated a case of hemoptysis due to consumptive weakness (Lao Ruo Tu Hong). The patient's pulse was flooding, solid, and strong. Other physicians encountering this believed that for consumptive hemoptysis, a flooding and solid pulse is contraindicated. Given the ominous and critical symptoms, they declined treatment and left. Suspecting the violent nature of the illness, I examined his popliteal fossa and observed cyanotic veins. I first performed phlebotomy, after which the six pulses became harmonious, and the symptoms subsided. Subsequently, I prescribed herbs to dissipate sha, aid digestion, and remove accumulation. With the obstruction of qi and blood removed, the violent pathology dissipated quietly, and dietary intake gradually improved. Later, he took Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Shiquan Dabu Tang (Decoction for Tonifying Qi and Blood), and the condition of consumptive weakness was fully resolved. This is likely because his chronic pathogenic qi was expelled along with the sha, allowing subsequent tonic medications to achieve complete efficacy.