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Severe Sha (Sha disease, a condition characterized by sudden onset of symptoms due to pathogenic factors) manifests in the pulse, as previously summarized. Regarding miscellaneous diseases complicated by Sha, the initial onset is very subtle and difficult to distinguish, making the method of pulse diagnosis hard to fully capture with words or writing. It relies on the physician's intuitive insight during pulse taking to decisively eliminate Sha at its earliest stage. Generally, slow-onset Sha does not necessarily damage the Zang-Fu organs (internal organs), meridians, or skin surface over time. Even mild cases, while not immediately fatal, if complicated by Sha and misdiagnosed, will lead to chronic, lingering illness with frequent relapses and continuous suffering. This is why Sha is feared and must be anticipated and treated before obvious signs appear.

A fine and thin pulse indicates survival; a full, large, rapid, and forceful pulse indicates severity; an excessively surging and large pulse indicates peril. Absence of pulse in one region suggests mildness; absence in one hand suggests severity; absence in both hands indicates death. If all six pulses lack root and respond neither to bloodletting nor medication, the case is incurable; if strange pulses appear and fail to respond to treatment, it indicates death.

Since "Hidden Sha" (a type of Sha with subtle symptoms often mistaken for other diseases) is unrecognized by many, leading to mishandling, it is listed first to draw attention. The Sha syndromes in the lower volume are easier to understand, so they are placed later.

Symptoms include persistent mental oppression, loss of appetite despite desire to eat, yet normal mobility. Drinking warm fluids shows no immediate danger, and there is no pain in the chest, abdomen, waist, or back. However, the patient gradually becomes emaciated and worse day by day. Without proper treatment, this can become severe. This represents slow and mild Sha, which resolves after bloodletting. Other presentations include headache and fever with abdominal distension, resembling Taiyang syndrome (Exterior Syndrome); alternating chills and fever, resembling malaria but not quite; persistent mental oppression; coughing with irritability, resembling wind-cold invasion; swelling of the head and face with burning eyes; redness and swelling of limbs with heavy body stiffness preventing movement. These represent slow and severe Sha. Ingestion of hot soups, wine, or food exacerbates the condition, leading to coma, phlegm-wheezing,急促 breathing, madness, and ominous signs. In such cases, the physician must accurately diagnose the pulse and symptoms. For exterior involvement, scraping therapy is used; for middle-jiao involvement, bloodletting is applied; for interior involvement, pills, powders, or decoctions are administered continuously until stabilization, followed by gradual regulation.

Case 1: My third aunt, widowed, suddenly fell into deep coma in April, unconscious, with complexion changing to black. My second brothers, Xiangwu and Ciheng, sought other doctors who could not identify the disease. Upon my examination, the left pulse was surging and large, while the right pulse was deep and faint. I diagnosed Hidden Sha. Three green veins were found behind the knees; puncturing them released dark purple-black blood profusely, but she remained unconscious. Scraping also failed. Shenxiang Yujin San (Agarwood and Curcuma Powder) with Amomum fruit, taken cool with Jingjie Decoction, did not work. The next day, Baohua San (Treasure Flower Powder) with Bohe Decoction and Dahuang Pills, taken slightly cool, also failed. On the fifth day, scraping was repeated, and Sanxiang San (Three Fragrances Powder) with Amomum decoction was given warm, after which she woke up and recovered through gradual调理 (regulation).

Case 2: An old servant of my friend Zhu Qizhang suffered from fever and heaviness in June, falling into coma with black tongue coating with prickles, short tongue, cursing madly without recognizing relatives. Pulse diagnosis revealed all six positions were hidden/deep. I stated this was extreme severe Sha. A relative surnamed Li, skilled in bloodletting, was summoned. After being held upright, puncture behind the knee yielded only minor dark blood spots, failing to release Sha blood, pushing the patient toward death. I administered Baohua San and Jili San (Tribulus Powder) with cool water, followed by Zisu Nongpo Tang (Perilla and Magnolia Bark Decoction) slightly cool. The next day, Sha receded slightly, but the body remained heavy as stone, unable to move, and the black tongue coating persisted. Honghua Tang (Safflower Decoction) combined with Qingliang Zhibao Yin (Cooling Precious Treasure Drink) led to gradual recovery.

Case 3: A maid of Brother Zhu Lu'an, aged twelve, had not eaten for six days and had slight facial swelling. Visiting his residence, I examined her pulse to prescribe a digestive remedy. Noting the fine pulse and swollen face, I suspected Sha. Puncturing the leg released dark purple-black blood. Baohua San with cool water cured her after one dose.