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Whenever there is cold exposure with high fever, sore throat and swelling, headache and cough, chest fullness and nasal congestion, nausea and vomiting, eyes appearing moist and glistening, coldness in the fingers and toes, and a pulse that is soggy and rapid or floating and rapid, this is Li Xie Sha Syndrome (Plague Qi Sha Syndrome). One should administer Jingjie Gegen Tang (Schizonepeta and Pueraria Decoction) for two to three doses. Wait until the patient sweats profusely, the sha toxins emerge fully down to the soles of the feet, and the tongue exhibits red points resembling the seeds of a mulberry fruit (yangmei ci). Only then should one administer flavors that are pungent-cool and clearing-resolving. In summary, treatment of Sha must be cautious at the beginning. If there is even a slightest retention of stagnation in the chest and diaphragm, it means the sha-rash has not fully emerged. One must not prematurely use cold-cooling herbs, as this will suppress the pathogen and lead to untreatable conditions.

When sha-rash is about to emerge but has not yet appeared, it is advisable to disperse early to resolve its toxicity, thereby avoiding residual complications. If one does not pre-emptively resolve the toxin to allow it to fully emerge, or if cold-cooling herbs are administered too early causing suppression, the toxin often accumulates internally. This may result in prolonged high fever leading to emaciation and decline, convulsions and epilepsy, diarrhea and dysentery, rotting of the throat with hemoptysis and panting, or death due to edema and gan erosion (nutritional deficiency ulcers). Although this is caused by a temporary infection of plague qi (li qi), it is not entirely unrelated to inadequate personal care and management.

When sha-rash lingers and fails to emerge, it is due to external constraint by wind-cold and closed skin pores. The primary treatment should be Jingfang Gegen Tang (Schizonepeta, Saposhnikovia and Pueraria Decoction). Externally, apply coriander wine and ramie dipped in medicinal wine to rub the skin. (This may be omitted if exposing the body risks catching wind.)

When there is cold exposure with fever, the face appears flushed like makeup, sha-rash does not emerge, and immediately upon appearance on the skin, there is upper vomiting and lower diarrhea, abdominal pain like wringing, and even syncope, locked jaw, closed eyes, and coma, this indicates internal dampness-stagnation mixed with sha filth, external contraction of plague toxins, sudden cold suppressing the pathogen, simultaneous disease of exterior and interior, and blockage of yin and yang qi. This is a critical condition. Patients often die from morning onset to evening, rarely surviving more than two to three days. If cold-cooling and clearing herbs are administered, it is as dangerous as advancing with a blade in hand. However, using Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) supplemented with baked Pueraria root, Arctii Fructus (Niu Bang Zi), Bombyx Batryticatus (Chan Yi), and roasted Medicated Leaven (Jiao Shen Qu) for one to two doses can induce profuse sweating, stop vomiting and diarrhea, relieve syncope, alleviate pain, and turn the sha rash red. Supporting the patient through three days will ensure no further harm. But after such vomiting and diarrhea, body fluids are severely damaged, inevitably causing thirst and desire for cold. One must absolutely avoid swallowing cold water, sugarcane juice, pear juice, or any other cold-cooling substances. Take extreme caution.

When heat pathogens congest the Lungs and transmit reversely to the Pericardium Collateral, causing sha-rash to fail to emerge or to emerge and then disappear, it is due to suppression by wind-cold. If not treated early, the toxin will attack inward, leading to death from panting and hoarseness. Urgently use Shengma Gegen Tang (Cimicifugae Rhizoma and Pueraria Decoction) added with Schizonepeta, Arctii Fructus, Bombyx Batryticatus, Platycodonis Radix, Prunus avium seed, Lemna Minoris Herba, and Loquat Leaf, decocted and taken orally. Externally, rub with coriander wine and ramie dipped in medicinal wine to make the sha-rash re-emerge and calm the panting; only then can one be free from worry. If the constitution is weak and unable to penetrate and express the pathogen, use Tou Xie Jian (Decoction to Expel Pathogens) or Chai Gui Yin (Bupleurum and Angelica Drink) to disperse it. If these two formulas still do not result in a red rash, urgently administer Tuo Li Ju Ban Tang (Decoction to Support Interior and Raise Macules).

The only concern with sha-rash is whether it can emerge. If it emerges thoroughly and completely, the toxin is resolved. Therefore, treating sha-rash requires caution at the outset. During fever, observe the seasonal climate (cold or warm) and treat accordingly. If the season is severe cold, Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction) or Mahuang Tang (Ephedra Decoction) can both be used; do not hesitate due to adherence to pungent-warm principles. Both formulas should be added with Arctii Fructus, Bombyx Batryticatus, and Platycodonis Radix to facilitate dispersion. If the season is hot, use Shengma Gegen Tang added with Arctii Fructus, Bombyx Batryticatus, and Cinnabar Yi Yuan San (Yi Yuan Powder with Cinnabar) to disperse. If the heat intensity is intense, adding 3-4 qian (approx. 9-12g) of raw Gypsum (Sheng Shigao) is also acceptable. If the season is mild, use Jingfang Gegen Tang added with Lemna Minoris Herba to disperse. Ensure the dispersion is thorough and smooth, preventing any lingering pathogen that could cause variations and chronic persistence.

After sha-rash resolves, do not act recklessly by seeking coolness or preferring cold foods. Strictly avoid heavy meats, seafood, oily/fatty foods, sweet/greasy items, spicy/sour foods, raw/hard foods, and salty/astringent foods to prevent future complications. Maintain these precautions for one hundred days. This is earnestly advised.