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The pulse in Sha disease (a condition characterized by toxic heat and blood stasis often manifesting as acute abdominal distension or skin eruptions) is mostly slightly slow, fine, and choppy; sometimes it is wiry and rapid. Even if it appears floating and large, it is deficient and forceless, with irregular speed, and at times all six pulses may be hidden deep. However, a hidden pulse is not necessarily ominous; once the Sha toxin recedes, the pulse will gradually return to normal. For instance, if there is headache and high fever, the pulse should be surging and solid, but if it is instead weak and slow, it indicates Sha disease. If there are cold extremities and muteness, the pulse should be deep and fine, but if it is instead slippery and rapid, it also indicates Sha disease. When the pulse and symptoms do not correspond, one should discard the symptoms and rely on the pulse for diagnosis. These two principles summarize the diagnosis of Sha disease.

Note: Cold damage diseases and miscellaneous diseases have their own inherent pulse patterns. If Sha disease is concurrent, the pulse must change, and the illness will inevitably become fierce and violent. However, the pulse of concurrent Sha disease can be identified: Sha caused by food stagnation typically presents a tight and solid pulse; Sha caused by blood injury typically presents a hollow and slippery pulse; Sha caused by summerheat typically presents a surging, slippery, and rapid pulse; Sha caused by wind invasion typically presents a deep and faint pulse; Sha caused by foul contact typically presents an abnormal and unpredictable pulse; Sha caused by Qi injury typically presents a deep and hidden pulse or one that feels like a sparrow pecking (intermittent); Sha caused by cold-dampness typically presents a deep and fine pulse. Some Sha pulses resemble Yin syndromes, which requires careful differentiation. For example, if the pulse in cold damage is deep, slow, and forceless, it indicates direct transmission to the Three Yin meridians, and treatment with hot medicines is unquestionable. However, in cases where cold damage is concurrent with Sha, and the pulse resembles a Yin syndrome, administering warming and tonifying hot medicines will cause the Sha toxin to transform unpredictably, leading to irreparable regret. Therefore, if the external symptoms show any slight inconsistency, one should examine the Sha veins (subcutaneous purple-blue veins) for verification: presence indicates Sha disease, absence indicates a Yin syndrome, requiring distinct cooling and heating treatments. After bloodletting (Fang Sha) and medication, the meridians become unobstructed, and the pulse ceases to be deep and hidden. Only then should one diagnose based on the pulse and treat the underlying cold damage, which will invariably be effective. This method also applies to miscellaneous diseases concurrent with Sha presenting with deep and hidden pulses.

Generally, if the Sha pulse is fine and subtle, the prognosis is good; if it is solid, large, and rapid, the condition is severe; if it is surging, large, and chaotic, the prognosis is ominous. If the pulse is absent in one position, the condition is mild; if absent in one hand, it is severe; if absent in both hands, death ensues. If all six pulses lack root and various strange pulses appear, and there is no response to bloodletting and medication, the case is untreatable.

Zhu Danxi treated miscellaneous diseases by prioritizing Qi, Blood, and Phlegm. How can Sha distension be separated from these? In Sha distension, Qi obstruction manifests as panting and urgency, abdominal fullness, vomiting and hiccups, and swelling/pain in the head and eyes, with tight pain and a surging-rapid pulse, classifying it as a Yang syndrome. Qi closure manifests as dizziness/fainting, locked jaws, upward-rolling eyes, and cold extremities; although painful, the patient cannot speak, with a deep-hidden pulse, classifying it as a Yin syndrome. Sha with Blood Heat manifests as irritability, purple macules, redness of the face and head, epistaxis, and frothy red saliva, with a solid-large pulse, classifying it as a Yang syndrome. Sha with Blood Stasis manifests as lower back pain, hypochondriac pain, stabbing heart pain, and cyanosis of hands and feet, with a tight-firm pulse that fluctuates between large and small, classifying it as a Yin syndrome. Sha with Phlegm-Cold manifests as gurgling sounds in the throat, inability to expectorate phlegm, vomiting of sour water and clear saliva, with a wiry-slippery pulse, classifying it as a Yang syndrome. Phlegm-Jue (syncope) manifests as sudden collapse, cold extremities, sensation of prickles on the skin, exposed blue veins over the body, and inability to turn over while sitting or lying, with a fine-micro pulse that seems present yet absent, classifying it as a Yin syndrome. One must not assume that Yang Sha always survives and Yin Sha always dies; even if the pulse is hidden for three days, Sha patients can still be saved, provided the key therapeutic principles are mastered.