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In the course of a cold damage (Shanghan) disease, if purgation is used too early before food has been digested, it may instead draw cold pathogens into the stomach, transforming them into heat pathogens that become firmly consolidated, causing the undigested food to form a Jie Xiong (Chest Binding syndrome). If Sha syndrome (Sha Zheng) occurs with newly ingested food, emesis should be prioritized; however, if food has been retained for a long time and sudden Sha distension occurs, even if digestion is incomplete, purgation is permissible. This is because Sha syndrome essentially involves fire-toxin accumulating in the intestines and stomach, causing swelling and distension of the muscles in these areas, along with intestinal colic affecting the zang-fu organs. Therefore, external treatments such as Gua Sha (scraping) or bloodletting are suitable to vent the toxin from the exterior, while internal purgation can be used simultaneously to attack the toxin within the interior. Consequently, the swelling will naturally subside, and food stagnation will be cleared, eliminating the worry associated with cold pathogens entering the stomach to form Jie Xiong. However, before using purgation, food stagnation must first be dissipated, and treatment should proceed gradually, stopping immediately once the disease is addressed.

Huo Luan (Cholera-like syndrome) presents with nausea, abdominal pain, vomiting, and diarrhea, with stools flowing like water. This results from an acute onset of summer-heat and fire pathogens, leading to dysfunction of ascending and descending qi mechanisms, failure to separate clear and turbid substances, and the loss of fluid essence from the five zang organs. Urgent use of Wu Ling San (Five-Ingredient Powder with Poria) or Wei Ling Tang (Stomach Strength Decoction) is indicated to differentiate and benefit yin and yang, clearing the qi of summer-heat and fire. In cases complicated by food stagnation, excessive purgation should be avoided to prevent sudden depletion of fluids and damage to primordial qi. Furthermore, there are cases of dry Huo Luan where there is nothing to vomit or pass, characterized by complete closure of the upper and lower orifices, accompanied only by severe heart and abdominal colic leading to rapid death. Emergency deep emesis with fried salt water is required; patency can save the patient. After stabilization, no solid food should be taken for one hour, as refeeding may cause recurrence; caution is essential! Even in cases of empty vomiting and purging with extreme fatigue, Liu He Tang (Six-Harmony Decoction) should be used for regulation (see formula list at the end of the book).

In emergency coma, first observe the lips and tongue: black color indicates a poor prognosis, yellow indicates severe condition, and pale red indicates a milder condition. Yellow suggests internal heat, black indicates extreme heat, and although pale red also implies heat, medications should not be overly cold. Treatment must also be guided by the tongue coating.

In critical Sha syndrome, if bloodletting yields no flow and food stagnation is ruled out, leaving blood-phlegm obstruction in the middle jiao, one may drink Yin-Yang Water, mud water, water infused with late silkworm sand, Asari root water, or plum water with white rock sugar, choosing one. Once the patient regains slight consciousness, support them upright and continue treatment. If there is food stagnation and blood-phlegm, use blood-breaking agents like Peach Kernel (Tao Ren) and Safflower (Hong Hua), along with child's urine, and induce emesis with salt water or alum water to remove new food. For Sha distension due to long-standing food retention, use Hawthorn Fruit (Zha), Radish Seed (Bo), and Malt (Mai Ya) to digest accumulation. For blockage by stagnation, use Betel Nut (Bing Lang) and Rhubarb (Da Huang) to drive it out, treated with Jin Qi Fang. If phlegm and blood coagulation cause coma, administer vegetable oil mixed with Musk (She Xiang) orally for immediate recovery; once obstruction is removed and Sha qi circulates, meridians relax, allowing for Gua Sha or bloodletting, followed by appropriate medication. This is because Sha syndrome is in its initial stage and has not yet damaged the zang-fu organs.

If Sha medicines are appropriate but ineffective, it is often because decoctions are cold-natured; coldness causes direct entry into the intestines and stomach without reaching the skin, muscles, and blood vessels. Thus, treatment should begin with Gua Sha and bloodletting. If these measures fail to make the medicine effective, it means they were not performed thoroughly. If scraping and bleeding are complete but Sha persists, the toxin resides only in the Stomach Meridian of Yangming and the three yin meridians of the Spleen, Liver, and Kidney, which require medicinal intervention.

When coma prevents Gua Sha or bloodletting, medication is necessary. Although cold decoctions do not immediately circulate through the flesh and blood, when heat-toxin attacks the Heart, the cold nature allows the medicine to flow down smoothly, waking the patient from coma. If unresponsive, it is due to obstruction by food stagnation and blood-phlegm; purging will invariably restore consciousness.

Sha syndrome typically lacks cold symptoms, but sometimes presents with cold signs, which are not true cold but result from taking large doses of cold herbs for Sha heat. Cold drinks are effective only if there is no food stagnation or blood obstruction in the middle. If such obstructions exist, consuming large amounts of cold substances will prevent digestion, stagnation movement, and blood dispersion, causing the toxin to freeze internally. Cases have been seen where travelers in rocky valleys died immediately after drinking spring water due to thirst following exposure, known as Cold Sha, caused by freezing toxins from cold intake, often fatal. If lucky enough to encounter someone skilled in bloodletting for Sha, releasing toxic blood removes obstruction. Hence, medical texts mention Yin-Yang Water, not just for well water, but for this reason. Therefore, for those whose Sha does not resolve with prolonged cool drinks, slightly using warm formulas like San Xiang (Three Fragrances) is a temporary expedient. Suddenly using Cinnamon Twig (Gui Zhi), Aconite Root (Fu Zi), Dried Ginger (Gan Jiang), Evodia Fruit (Wu Zhu Yu), or Ginseng would be erroneous.

Sha belongs to Fire, which is divided into Ministerial Fire (Xiang Huo) and Sovereign Fire (Jun Huo). The Hand-Shaoyin Heart Meridian represents Sovereign Fire, while the Right Kidney Mingmen corresponds to the Hand-Jueyin Pericardium. The Classics state that the Yuan-source point of the Heart is Dalíng (PC3). Needling Dalíng drains the source of the Hand-Jueyin Pericardium's Ministerial Fire. The Hand-Shaoyang Sanjiao Meridian forms an interior-exterior relationship with the Pericardium, and their pulses appear together at the right Chi position, acting on behalf of the Sovereign. Thus, diseases of Ministerial Fire are common; its flaming nature causes Sanjiao obstruction, chaotic six pulses, coma, and phlegm-wheezing. While Ministerial Fire pathology is recoverable, invasion of the Heart Sovereign leads to death in an instant; do not attribute this to medical negligence!

When Sha invades the throat, phlegm-wheezing sounds like sawing. First perform bloodletting for Sha, urgently use Mint (Bo He), Burdock Seed (Niu Bang Zi), and Sophora Root (Shan Dou Gen) with child's urine to clear heat, and apply the Bamboo One powder to the throat; treat other symptoms subsequently.

In critical Sha syndrome with constipation, urgent bloodletting for Sha combined with Run Xia Wan (Moistening Down Pill) is needed to purge. For urinary retention, bloodletting for Sha combined with Tu Si Fang (Earth Four Formula) is indicated to promote urination.

Sha syndrome presenting with chest elevation like a steamed bun is incurable (though one woman was cured using Zhu Liu Fang). Pain at a single point on the left or right of the chest or back indicates a poor prognosis. Opisthotonos...