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If the pulse is unclear, one must not administer medication recklessly; if the symptoms are indistinct, one must not prescribe drugs lightly. If the manual techniques are unknown, even medication cannot yield rapid results; therefore, manual techniques are the crucial approach for treating Sha (heatstroke/toxin syndrome).

The first method is "Bleeding" (Fang). When Sha toxin is on the body surface but has not yet erupted, it can be faintly seen under the skin when illuminated by a lamp. At this stage, bleeding should be delayed. Once the Sha has erupted, it resembles mosquito bites, with granules like bran. When sparse, they appear as distinct clusters; when dense, they merge into patches. In some cases, after one layer erupts, two or three more layers may follow. The bleeding technique primarily observes the forehead and both sides of the chest, or the abdomen.

The second method is "Scraping" (Gua). When Sha toxin is trapped beneath the skin and cannot erupt, scraping is used. For areas such as the spine, neck, upper and lower back, chest, ribs, shoulders, arm bends, use a copper coin or the rim of a bowl dipped in sesame oil to scrape. For the forehead, back of the neck, elbows, arms, knees, and wrists, use cotton yarn or ramie rope dipped in oil to scrape until red-purple blood spots appear. For Sha in the soft flesh of the large and small abdomen, rub with salt using the hand. Once the Sha is scraped out, the pain will also alleviate.

The third method is "Puncturing" (Ci). Ancient texts state that in the low-lying and damp regions of the southeast, Bian stones were utilized. This involves using needles to puncture and release toxic blood, which constitutes the Bian method. For severe Sha cases where iron tools are ineffective, porcelain shards should be used as needles for puncturing, as this is the most appropriate and effective method.

[Text fragment regarding specific acupoints]: Baihui (GV20) at the vertex of the head (only prick the skin slightly to reveal trace blood to vent toxic vapors, do not insert the needle deeply); Yintang (EX-HN3) between the eyebrows (used for severe headache, with slight needle insertion)... [Fragmented text regarding Weizhong (BL40) behind the knee].

When Sha veins (distended superficial veins) appear, it indicates the toxin has entered the Blood level, and bleeding is indicated. When they appear intermittently, the toxin has entered the Qi level; bleed only when they manifest. When they are faintly visible, the toxin is obstructing the Qi level; treatment should focus on promoting bowel movement and urination, after which the Sha veins will naturally appear. For those that are latent and do not appear, differentiation based on pulse and symptoms is necessary: if due to blood stasis, resolve the stasis; if due to food retention, digest the food; if due to phlegm accumulation, expel the phlegm. Once the obstruction is resolved and the veins reappear, puncturing and bleeding can then be performed.

Whether Sha veins appear in multiple locations or a single location, malignant blood must be removed to ensure complete discharge of Sha toxin. If hot soup is mistakenly consumed, the Sha veins may retract and become invisible; even if slightly visible, they cannot be scraped or bled out. Immediately drink cold water to resolve this, after which scraping and bleeding can proceed. If Sha is obstructed by food retention and cannot be scraped/bled, food retention must be eliminated first before proceeding. If extreme heat causes blood coagulation and stasis obstructs the chest and abdomen, making scraping/bleeding incomplete, blood stasis must be dispersed first before continuing. If Sha eruption is accompanied by anger, damaging the Liver and causing distension, making scraping/bleeding difficult to complete, Qi-moving and breaking herbs should be administered first, followed by scraping and bleeding. In this manner, Sha toxins can be gradually eliminated.