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When Sha toxin (Sha toxin, a pathogenic factor in TCM) enters the Qi level and the toxin remains on the muscle surface, patients may experience abdominal distension, vomiting, slight dizziness, aversion to cold, and lack of hunger. At this time, scraping therapy (Gua Sha) should be performed immediately to prevent the toxin from attacking the internal organs, and the condition will heal; therefore, scraping must not be delayed. If the Sha toxin enters the Blood level and the toxin stagnates in the flesh and blood, patients may experience pain, diarrhea, mental restlessness, fever, or distending pain in both hypochondria. In such cases, pricking therapy (bloodletting) should be performed immediately to allow the toxin to escape from the exterior, and the condition will heal. If the Sha toxin penetrates deeply and the condition is severe, with toxin stagnating within the Zang-Fu organs and meridians, directly attacking the heart and abdomen, causing unresponsiveness to calls and inability to stand even when supported, life is in imminent danger. Even after scraping and pricking, medication must still be used for rescue. However, differentiation among wind-cold, summerheat, and dampness is required, and food retention and phlegm-qi must be distinguished; treatment should be administered according to the specific symptoms. Furthermore, cool water should be poured into the mouth first to slightly reduce the Sha qi, or alum mixed with Yin-Yang water (a mixture of freshly drawn well water and boiled water) should be administered before giving other medicines, so that survival may be possible. Hot soups, hot wine, porridge, and rice foods are strictly contraindicated. Failure to observe these prohibitions will cause mild conditions to become severe and severe conditions to become critical, or lead to the formation of Sha masses, resulting in bizarre symptoms. Especially in such cases, scraping and pricking must be performed first to vent the toxin before medication can take effect.

It is heard that in the streams and creeks of Jiangnan, there are "She Gong" insects (archerfish-like mythical insects). They shoot sand at people's shadows. Once hit, one experiences alternating chills and fever, headache, tendon stiffness, body rigidity, chest oppression, confusion, groaning, salivation, and coughing. Immediately upon infection, speech becomes impossible, with symptoms being lighter in the morning and heavier in the evening. Those unfamiliar with it mistake it for Taiyang disease (Exterior syndrome characterized by aversion to cold and fever). Locals say: "This is Sha disease." Taking one tablet of genuine Yushu Dan (Jade Pivot Pill), ground and taken orally, brings immediate relief. When crossing areas with toxic insects, one should first strike the water surface with a bamboo pole and cross quickly to avoid harm.

Commentary: Patients infected by She Gong stream toxins present with symptoms similar to Taiyang disease, including alternating chills and fever and sores localized to one side. One may drink one sheng (approx. 200ml) of juice extracted from fresh Amaranthus tricolor stems and leaves, taken twice daily, and apply the residue topically. Portulaca oleracea has the same effect. Since geese favor eating these insects, households nearby often raise geese.

In the Lingnan region, where miasma is prevalent, Sha diseases are particularly common. These are caused by various insects such as stream toxins, sand lice, water bows, archer insects, hidden insects, short foxes, and shrimp-whiskers, all capable of shooting sand at humans. Those poisoned by them experience aversion to cold with high fever, a sensation of limbs disintegrating, soreness and pain in joints, resembling the initial stage of Taiyang disease. Local treatment involves palpating the painful area, inserting a horn tube into the skin, and sucking out the sand with the mouth. Externally, garlic is baked until hot, mashed into a paste, and applied to the wound, leading to recovery. Among these insects, the shrimp-whisker is the most toxic. If not treated early, eight or nine out of ten will die. The toxin entering the bone resembles shrimp whiskers, and the sores resemble Ding swellings (carbuncles). There are certain birds in that region that specifically eat these insects. Consuming ash made from their feathers and feces, or placing cages containing these birds near the infected person to inhale their scent, causes the Sha toxin to exit naturally upon smelling the odor. Other treatments are detailed in previous and subsequent sections.

Plague and Sha distension are both caused by "Qi". This may result from irregular wind, rain, cold, and warmth, steaming and moving damp-heat from mountains and marshes, or the foul air accumulated from corpses during war and famine. This air circulates with the ascending and descending of Heaven and Earth. Humans, existing within this Qi intersection, have no way to escape, leading to mutual transmission. Thus, Sha disease includes the symptom of touching foulness. People are especially advised against traveling at night, as this frequently leads to contracting Sha due to exposure to Yin-turbid Qi.

In the Guiwei year (1643) at the end of the Ming Dynasty, a great plague broke out in the capital. Some patients had full chests and abdomens with white hair growing on them; some had heads swollen like buckets, with eyes and noses submerged; others had red and swollen cheeks with obstructed phlegm and wheezing. Countless died within moments of breathing. All were types of Sha. Pricking to release blood resulted in immediate recovery. Later, symptoms transformed into coughing and wheezing. Although seemingly mild, death occurred within half a day. Pricking as previously described also led to immediate recovery. The method of releasing Sha has been practiced for a long time.

Commentary: What is called "Big Head Plague" implies pathology not only in the lower body but primarily severe in the upper body. "Bump Plague" implies internal pathology manifesting externally. "Toad Plague" implies abdominal pathology obstructing the throat. Symptoms vary widely, but the primary principle is clearing heat and detoxifying. Treatment may target the upper or lower, interior or exterior, depending on the symptoms. For the above conditions, Puji Xiaodu Yin (Universal Benefit Decoction to Eliminate Toxins) is best, supplemented by the formula Quzhang Biwen Tang (Miasma-Expelling and Plague-Averting Decoction).

In the Xinyou year, a woman nearly eight months pregnant was alone at home. At dusk, she felt unbearable hunger, cooked one sheng of rice, ate it all, and slept. Shortly after, three cries were heard from another room, suggesting labor. Calling her yielded no response. Lighting a lamp revealed she had died, yet the fetus remained intact in the womb. Such a bizarre condition—how could one know it was not Sha? Alas, it was too late to act.

Jie Ji (Joint Dissolution Syndrome) is also a condition. "Jie" refers to bones and joints feeling loose/dissolved; "Ji" refers to tendons failing to bind. Symptoms include sensations of cold and heat, fatigue, irritability, abdominal pain, poor appetite, and vomiting of sour fluid. Causes include alcohol injury with dampness, wind-cold invasion, sexual exhaustion, irregular menstruation in women, or disharmony of Qi and Blood. This belongs to the category of Sha diseases, not Taiyang disease. Initially, soak a cloth in hot water and apply it to the arms, then scrape with ramie fiber. In severe cases, prick the ten fingers and Weizhong (BL-40) to bleed. Alternatively, use an sesame oil lamp to cauterize red spots on the back, opening the pores and promoting smooth Qi and Blood flow for recovery. Suhe Xiang Wan (Styrax Pill) is also suitable.

(Fenzhou) Commentary: Jie Ji is not entirely Sha disease. However, hidden Sha and chronic Sha often resemble Jie Ji, which people should know. *Famous Doctors' Case Records* names Jie Ji as Sha disease, which is not without merit. However, the appended argument by Mr. Hang, insisting Jie Ji is not Sha, aligns with the views of mediocre physicians and should not mislead us.

Baihu Disease (White Tiger Disease): The position following the Tai Sui (Grand Duke Jupiter) is Baihu. For example, if Tai Sui is in Si, Baihu is in Chen; if Tai Sui is in Shen, Baihu is in Wei. If children enter or reside in the direction governed by this deity and offend it, they fall ill. Symptoms include slight fever or chill, occasional crying, and fingers curling as if counting objects. Treat with Jixiang Tang (Collective Fragrance Decoction): using Agarwood, Aquilaria, Sandalwood, and Olibanum, combined with Ginseng, Licorice, Poria, and Ziziphus Seed. Decoct in water, add a small amount of Musk before serving, and burn the dregs in the room.

Regarding infantile exanthems, known as Ma (Smallpox/Measles) or Sha, appearing scattered on the skin like sand grains. Infantile rash typically begins with fever and cough, or vomiting and abdominal pain. The rash appears intermittently and resolves in three days. Current Sha diseases also present with fine millet-like red spots, visible or hidden, most abundant on the forehead, followed by chest, hypochondria, neck, and nape, then hands, feet, waist, and back. Internally, there is heart and abdominal distension/pain; externally, the skin feels prickly. The root cause is excessive heat and toxicity in the blood, hence sharing the name with infantile Sha rashes. If an infant truly has Sha rash, it must be treated according to its own standard protocols and should not be confused with the Sha diseases discussed here. Treating Sha requires understanding miscellaneous diseases to correctly manage concurrent or mimicking conditions.

Miao Zhongchun stated: Jiaochang Sha (Intestine-Twisting Sha) belongs to deficiency of Stomach Qi, suddenly struck by evil foulness, leading to stagnation preventing vomiting or diarrhea, causing extreme intestinal twisting, sudden abdominal distension, and purple-black discoloration of the whole body. Carefully examine the vertex of the head for a red hair; pluck it out immediately. Quickly prick Weizhong (BL-40) with a three-edged needle to drain dark blood, which can restore consciousness instantly. Then, drink copious amounts of newly drawn cool water with about two qian (approx. 7.5g) of salt. Stop once vomiting or diarrhea occurs (snake or insect bites may also present with red hair).