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Sha (Sha disease, a type of acute heat-toxin syndrome) is caused by the malignant qi of summer-heat and epidemic pathogens. If this pathogenic qi attacks the interior, it results in phlegm and panting, blood stasis, coma with heaviness, and loss of consciousness. If the patient's primordial Qi is robust, preventing internal invasion and deep penetration, the toxin is dispersed on the surface of the skin, muscles, and blood vessels, manifesting as swelling and distension. If hot water or hot wine is mistakenly consumed, it leads to severe harm. This is a concealed form of Sha, which should be differentiated by observing abnormal pulse characteristics.

Clinical Cases:
A maid in the household of Brother Yi Hanhuang had suffered from sores for a long time, with an abdomen swollen like drum distension and edema in both hands and feet. I examined her; the left pulse was slightly rapid, and the right pulse showed intermittent skipping (Xie Zhi). I reasoned that if sore toxins entered the interior causing swelling, the pulse would necessarily be flooding and rapid with strength, indicating correspondence between pulse and symptoms, allowing treatment of the sore toxins. However, the left pulse was slightly rapid, and the right pulse skipped, indicating a mismatch between pulse and symptoms. It must be chronic Sha causing the issue. Inspecting her popliteal fossae, cyanotic Sha veins were indeed visible. Five needles were inserted, and dark purple-black toxic blood flowed out profusely, but the condition did not resolve. Twenty more needles were inserted into the fingertips to drain toxic blood. Baohua San (Precious Flower Powder) was administered along with Taoren Honghua Tang (Peach Kernel and Safflower Decoction) for eight doses. After taking the medicine, the swelling subsided completely, and she returned to normal.

The eldest daughter of Brother Yi Hanhuang’s elder brother presented with edema in both hands and feet, which was about to spread to the abdomen. Upon examination, all six pulses were wiry, thin, deep, and slow. I identified this as a variant manifestation of chronic Sha. I advised releasing the Sha first, but she refused due to fear of acupuncture. I declined to prescribe medication, fearing that the cold nature of the herbs might fail to reach the tissue layers. Six days later, the swelling worsened significantly. She requested my treatment again. Her servant maid performed Sha release on the young lady with over thirty needles, draining dark purple-black toxic blood. Baohua San was taken after cooling slightly, combined with formulas designed to disperse Sha, detoxify, eliminate blood stasis, and regulate Qi. Since the Sha condition had persisted for a long time, quick efficacy was difficult to achieve. After twenty-four doses, the swelling fully resolved, and she recovered safely.

Jia Fengqing suffered from generalized swelling and ineffective medication. Upon examination, I observed that his chest area was nearly flat, with cyanotic veins visible around the umbilicus. I stated, "Dangerous! The pulse lacks root; prognosis is poor." However, seeing cyanotic veins interlacing on his fingers and popliteal fossae, I punctured them, extracting a large amount of toxic blood. He believed that Sha diseases should not be treated with medication and stopped treatment. More than two months later, he ultimately died from true abdominal distension. What a pity.

A neighbor named Xu had a four-year-old son with generalized red swelling of the head, face, chest, abdomen, hands, and feet, accompanied by continuous bead-like sweating on the head. Upon examination, the Guan and Chi positions on both sides showed flooding, large, slippery, and excess pulses, while the Cun positions on both sides exhibited turbulent movement. This indicated Sha caused by food stagnation affecting the Spleen Meridian, leading to generalized muscle swelling. No Sha veins were visible, and scraping yielded no Sha spots. This was due to mistaken consumption of hot water, causing Sha Qi to attack internally, obstructing the Chong vessel and heart, resulting in generalized swelling. The Heart remained unaffected, so the pathogen ascended to the head and face, transforming into sweat beads, which are fluids of the Heart. Zipu Tang (Purple Magnolia Bark Decoction) combined with Dahuang Wan (Rhubarb Pill) was prescribed. It was administered cool and slightly frozen. The distension subsided, sweating stopped, and he recovered.