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Huo Luan (cholera) and various severe conditions such as Sha Zhang (sand swelling/acute abdominal pain due to pathogenic factors), Yi Li (epidemic pestilence), at the initial stage, should be treated immediately by dispersing the pathogenic factors, with careful observation. If red spots are found on the skin, they must be extracted immediately. The patient's clothes should then be removed, and the chest and back carefully examined; if several long hairs are found, they must all be plucked out.
(This occurs because heat-toxin has penetrated deeply into the Ying Level (nutritive level), and since hair is considered the surplus of blood, the flaming toxin rises upward, resulting in redness. In severe cases, the hairs become hard like horse mane, a phenomenon I have witnessed personally. Recorded by my cousin Wang Chenglie Shaowu.)

Various Sha syndromes associated with Huo Luan are caused by healthy Qi being obstructed by pathogenic factors. Consequently, turbid Qi cannot be exhaled, and clear Qi cannot be inhaled, leading to chaotic Qi dynamics in the middle Jiao (middle burner), thus forming an obstruction syndrome. Turbid Qi is extremely hot; Westerners refer to it as "carbon gas" (carbon dioxide). If this carbon gas is not expelled, the person will die from suffocation and coma. However, exhalation is governed by the Lung, which opens into the nose. One may use powder of Gleditsiae Sinensis Fructus (Zaojiao, 皂角) or Tongguan San (Opening the Pass Powder), or blow Sha medicine into the nostrils to induce sneezing, thereby unblocking the airway. This allows pathogenic factors to escape externally and turbid Qi to be discharged, naturally relieving the disease.

Regardless of whether sneezing occurs, Gua Sha (scraping therapy) should follow immediately. If sneezing occurs, although Lung Qi has opened, one must fear that the Qi mechanism of Ying and Wei (defensive) levels remains bi (obstructed). Scraping should be performed to disseminate it. If no sneezing occurs, since Lung Qi has not opened, it is even more necessary to loosen the Wei Qi via scraping, allowing pathogens that have entered the Ying Level to be excreted externally from time to time, so the disease can be relieved. Therefore, areas such as the shoulders, neck, spine, back, chest, anterior costal regions, lateral ribs, arms, and popliteal fossae (bends of both knees) are suitable for scraping using cotton yarn, ramie rope, green thread, or the rim of a porcelain bowl, dipped in vegetable oil, scraped from top to bottom, stopping only when purple-red Sha marks appear. For the soft flesh areas below the neck and on the abdomen, finely ground salt should be used for rubbing with the hand, or fingers dipped in clean water can be used for pinching/cupping-like manipulation. Zhang Jingyue stated: "For conditions with deep toxins and acute illness, scraping the back is indispensable." This is because the connections of the Zang organs (solid organs) are all attached to the back. Rubbing the back with salt is also effective.

When Ying and Wei Qi are obstructed by pathogenic factors and fail to circulate freely, it leads to cold extremities and abdominal pain, with faint red spots appearing on the body. This is named Ban Sha (macular Sha) or Fan Sha. It is erroneous for laypeople to call it Yin Sha (Yin-type Sha) merely because of the cold extremities. The appropriate treatment is to dip a rush stem (Jiedixin, 灯心) slightly in oil, ignite it, and perform Cui Fa (quenching/cauterization therapy) on the affected area. Bring the flame close to the skin and immediately lift it away; if a sound is heard, the disease condition will relieve.