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When Sha Qi (Sha syndrome) develops slowly, the patient often feels dizzy with internal heat, or experiences unilateral headache, mental restlessness, and uneasiness. Scraping therapy (Gua Sha) is suitable; if it does not cure, use a formula to clear heat and descend qi.

When Sha Du (Sha toxin) transmits and changes, symptoms may suddenly appear on the feet or hands, occasionally manifesting on the skin, or alternatively presenting as phlegm and wheezing. The symptoms are indistinct and irregular in their appearance and disappearance, and the typical Sha pulse is absent, making diagnosis extremely difficult. Some cases present with heat resembling Liu Huo (acute erysipelas) and swelling resembling Liu Tan (chronic subcutaneous abscess), but the condition is neither mild nor slow compared to ordinary Liu Huo or Liu Tan. Some suffer from unbearable pain, while others experience incessant itching and pain. Such cases can be verified by the presence of Sha Jin (subcutaneous cyanotic veins); pricking them for bloodletting is undoubtedly correct. Subsequently, treatment should be differentiated based on the pulse diagnosis regarding the pathogenic factors involved, such as wind, cold, summerheat, dampness, food stagnation, phlegm, blood stasis, or qi obstruction, which will ensure efficacy.

A woman suffered from redness, swelling, and severe pain in her left lower leg during the day. At dusk, abdominal pain occurred while the leg pain ceased. The next day, redness, swelling, and severe pain appeared in her right lower leg, and the abdominal pain stopped again. Her six pulses were normal, making it difficult to diagnose Sha syndrome based on this alone. However, three green veins were found in the popliteal fossa. After pricking and releasing a large amount of blood, her phlegm and wheezing worsened, due to incomplete Sha release. Zhuer Fang (Bamboo Formula No. 2) was used with Erchen Mu (Fritillaria Thunbergii Bulb) added at 2 qian. After two doses, she improved slightly. The next day, another Sha vein was pricked in the left popliteal fossa, and one needle was inserted into the vertex (Baihui). She took the previous decoction with Niuxi (Achyranthes Bidentata Root) added at 3 qian, after which the Sha toxin receded. Finally, Sizhi Fang (Silk Formula No. 7) was administered, leading to complete recovery.

A man’s right lower leg redness, swelling, and pain had just subsided in the evening when swelling and pain appeared beside his throat. It was not recognized as Sha syndrome at the time, as many patients with seasonal epidemics presented with similar symptoms. Upon careful examination, Sha veins were found on both arms. Bloodletting was performed, and Shiba Fang (Stone Formula No. 8) was used with doubled Zhizi (Gardeniae Fructus) and Boluozhong (Radish Seed), plus Dahuang (Rhei Radix et Rhizoma) at 1 qian. After food stagnation was resolved and stool passed, the condition stabilized.

If phlegm and wheezing with rapid breathing occur first, causing Sha Zhang (Sha distension) subsequently, treat the Sha first, then the phlegm and qi, ensuring that Sha does not assist the primary disease. If Sha Zhang occurs first, causing phlegm and wheezing with rapid breathing subsequently, only treat the Sha, and the phlegm and qi will heal themselves. If Sha presents with unclear alternating chills and fever along with phlegm and wheezing, combine with harmonizing methods. If Sha presents with heat only, no chills, and rapid wheezing, combine with methods to digest food and regulate qi. If there is constipation, dysuria, and rapid wheezing, or if there is dysentery with pus and blood accompanied by rapid wheezing, purgative methods for the interior are appropriate. If there is blood stasis stagnation, free urination, black stool, and rapid wheezing, one must consider that Sha toxin has damaged the zang-fu organs. If painless, it is treatable; if painful and unceasing, it is difficult to treat; if medication yields no response, death ensues (refer to Tu Wu Fang).

One patient presented with fever, headache, chest and abdominal distension, coma, and phlegm with rapid wheezing. His six pulses were rootless. If this is Sha Zhang, there is hope for rescue. Treatment involved bloodletting and administering Shi Wu Fang (Stone Formula No. 5) and Si Si Fang (Silk Formula No. 4), taken slightly cool. Then, Tu Wu Fang (Earth Formula No. 5) was given once; the coma cleared immediately, and distension and wheezing subsided. Subsequently, Jin Yi Fang (Gold Formula No. 1) was used with Qinghao (Artemisia Annua Herb), Lianqiao (Forsythia Fruit), Zhizi, Boluozhong, and Shujun (Prepared Rhei Radix et Rhizoma). Fever and headache disappeared, and the pulse returned to normal.

A woman suffered from phlegm, wheezing, rapid breathing, and incessant chest and abdominal distension. Two needles were inserted below the nipples, releasing purple-black blood, providing slight relief. Zhusi Fang (Bamboo Formula No. 4) was administered for three doses, resulting in cure.

One patient presented with phlegm, wheezing, rapid breathing, fever, heavy body, and colicky abdominal pain. Scraping and bloodletting did not cure him. Jinsi Fang (Gold Formula No. 4) combined with Shiliu Fang (Stone Formula No. 6) with added Dahuang was administered, leading to recovery.