张景岳言夏秋之交，乍凉乍热，阴阳相驳，人于此时，凡衣被口腹，最宜节慎，少有不调，为驳杂之气所侵，则霍乱吐泻所由生也，亦宜留意。医案论霍乱之后，用补剂收功，亦因虚化虚之意。医话新制黄土汤，专以治湿为主，符于经旨，切于时用，足称良剂。 略曰：《内经》霍乱，本以太阴湿土为主，因表里寒热虚实而有六化之变，是证多见南方及夏秋之交，湿郁可据。六化之别，仲景详言之矣。后世或执寒以非热，执热以非寒，可谓不能举一以反三，而反执一以废其五也。，而反执一以废其五也。
霍乱论列方
理中丸（五十三） 四物汤（八） 苏合香丸（六） 藿香正气散（十七） 四苓散（五十四） 斑龙丸（五十五） 五苓散（十六） 桂枝汤（五十六） 四逆汤（五十七） 四逆加人参汤（五十八） 益元散（五十九） 桂苓甘露饮（六十） 二陈汤（六十一）
沙蜮第十二
《椿田医话》曰：射影丸，主治射工沙虱溪毒诸证。其病与伤寒温疫霍乱瘴气相类，但手足逆冷者是，甚至手足麻木不仁，冷过肘膝。道光辛巳秋七月，沙毒流行，两足先麻木，（当时流俗名麻脚瘟。）继之腹痛吐泻，肢冷脉伏，剧则大汗身冷，脉脱目陷，四肢瘈疭，须臾不救。因制此方，服之良愈。外以含沙散臭鼻取嚏。或曰闺中妇女，多罹此疾，何含沙射影之有？曰：射工沙虱，致毒于水草之间，灌田浇菜，浸润方土，潜通地脉，流入泉源，何所不可。且此气盛行之年，亦可凌空而至。南方更有蛇毒，其害尤甚。又方土沙气升腾，高于岑楼，因夏秋气候炎热，莫之能见。妇女坐受其气，非男子运行可比，且妇女阴体易感阴毒，以故受病多于男子。今人感之微者，头疼身痛，形神拘倦，欲吐不吐，四肢闭逆，或腹痛欲泻，令人挤眉心、人中、承浆、颈项胸前背后，出见红班如枣大，重则色紫，顷刻即愈，名曰挤沙。相沿成俗，即感受风寒，亦有挤沙而愈者。盖挤沙有发汗之意，在内为血，发外为汗，汗即血故也。 香白芷（一两） 大贝母（一两） 生甘草（五钱） 大蒜头（一两） 青黛（一两） 明雄黄（五钱） 犀角（五钱） 山慈姑（一两） 苍耳子（一两） 厚朴（一两） 紫背萍（一两） 射干（一两） 白知母（一两） 枯矾末（五钱） 朱砂（五钱） 紫菀茸（一两） 槟榔（一两） 雷丸（一两） 虎珀（五钱） 龙齿（五钱） 鬼箭羽（一两） 羚羊角（五钱） 草果仁（五钱） 麝香（五钱） 为细末，水叠丸，每服三钱，开水下。 含沙散，主治沙毒吹入鼻中取嚏。 生大黄（六两） 公丁香（一两五钱） 明天麻（三两） 牙皂角（三两） 丹砂（四两） 明雄黄（四两） 麻黄（三两） 冰片（三钱） 麝香（三钱） 苍术（三两） 蟾酥（一两） 香白芷（三钱） 草果仁（一两五钱） 共为极细末，磁瓶收贮。 《周礼》壶涿氏，掌除水虫，以抱土之鼓驱之，以焚石投之。 《诗》曰：为鬼为蜮，则不可得。（蜮，虫名。《诗注》名含沙。《诗疏》名射影，又名水弩。《广雅》名短狐。《玄中记》名水狐。《博物志》名射工。《酉阳杂俎》名抱枪，其形似蛣蜣，头有一角，长寸余，角上有四歧黑甲，下有翅能飞，足角如弩，以气为矢，因水势含沙射人影成病，沙证之因，盖由此也。《五行传》曰：南方淫惑之气所生，故谓之蜮。） 《玄中记》曰：水狐虫长三四寸，其色黑，广寸许，背上有甲，厚三分，其口有角，向前如弩，以气射人，去二三步即中人，十死六七也。又曰：视其形，虫也。见其气，鬼也。 《博物志》曰：射工江南山溪水中甲虫也。长一二寸，口有弩形，以气射人影，令人发疮。不治，杀人。 《南中志》曰：永昌郡有禁水，惟十一二月可渡，余月则杀人。其气有恶物作声，不见其形，中人则青烂，名曰鬼弹。 《文选》鲍明远诗曰：含沙射流影，吹蛊病行晖。 郭义恭《广志》曰：沙虱在水中，色赤，大不过蚁，入人皮中杀人。 《录异记》曰：潭袁处吉等州，有沙出，即毒蛇鳞甲中虫，蛇被苦毒，入急水中碾出，人中其毒，三日即死。 《九峰医案》曰：客忤沙氛，挥霍撩乱，吐泻交作，三焦俱伤，身冷脉伏，柔汗不收，目赤如鸠，溲红如血，浑如中毒，危在须臾，勉拟元戎法，尽其心力。 人参（二钱） 冬白术（三钱） 炙甘草（五分） 炮姜灰（五分） 煅石膏（一两） 红蓼花梗（一两） 地浆 水煎。 沙氛袭络，遍身苛痹，肢尖逆冷，胸喉气不展舒，六脉细涩无力，正气六和加减。 藿香梗（二钱） 老苏梗（一钱） 荆芥穗（一钱） 云茯苓（三钱） 炙甘草（五分） 制半夏（钱半） 福橘皮（一钱） 宣木瓜（一钱） 川厚朴（八分） 大腹皮（一钱） 烦闷欲吐，颠痛肢尖冷，脉细涩，沙候也。 法制半夏（四钱） 芦根（二两） 甘澜水煎。
蒋宝素曰：沙毒者本书创立，《内经》所无。见于《诗》《礼》，方书所略。近代多有，乃南方沙土水湿溪涧虫蛇沙虱毒气中人为患，类乎中毒之证也。《周礼》有掌除水虫之氏。《诗》云：为鬼为蜮，则不可得。蜮乃含沙射影水狐等之总名，能致人病蜮惑也。故《金匮要略》本之于《诗》，有狐惑之证，以虫毒蚀于喉为惑，蚀于阴为狐。《博物志》言射工以气射人影，令人发疮，不治杀人，亦本于《诗》义。《南中志》永昌郡有禁水，人不可渡，有物作声，不见其形，中人即死。此从射工而广之，则水亦能病人，不待含沙射影。鲍明远诗曰：含沙射流影，吹蛊病行晖，又从而广之，则其气亦可凌空而至。葛洪《肘后方》：溪毒中人，一名中水，一名中溪，一名水病，似射工而无物，与《南中志》禁水同。又曰：江南射工毒虫，在山间水中，人行或浴，则此虫含沙射人形影为病，此承《诗》与《金匮》《博物志》而言。又葛洪《抱朴子》云：山水间多沙虱甚细，略不可见，人入水中及阴行草中，此虫多着人，钻入皮里，令人皮如芒刺，三日后寒热发疮，虫渐入骨则杀人。又以类推而有沙虱之证。巢元方采诸家之说，有含沙、沙虱、水毒、溪温诸证甚详。《丹溪心法附余》，因腹痛有绞肠沙证，用樟木矾盐等汤探吐，并刺委中出血，论治精详。李时珍《本草纲目》，有挑沙刮沙之说，其法益备。张景岳用磁碗边蘸滚水香油，刮背心从上之下，尤为该简。医案从客忤霍乱中寻出沙证，证无逃隐。医话制含沙散射影丸，治无遗义。
略曰：沙证盖本含沙射影，沙虱着人之义，然不近含沙沙虱而染沙证者，则有禁水吹蛊溪毒之属，即含沙沙虱之类，随方土变更，其气上腾，与六淫相等，不必泥射影而着人。往古所略，近代详焉。至医话含沙散射影丸，诚对证之良方，无出其上者。
瘴气第十三
张景岳说，夏秋交替之际，天气忽冷忽热，阴阳二气相互冲突。人在这个时候，对于衣着和饮食最应当节制谨慎。稍有不调和，被驳杂之气所侵袭，就会发生霍乱（以突发呕吐、腹泻为主要表现的疾病）吐泻，这也应当留意。医案论述霍乱之后，使用补剂来收功，也是顺应因虚致虚的道理。医话中新制的黄土汤，专门以治疗湿邪为主，符合经典旨意，切合时令应用，足以称为良方。简略地说：《内经》中的霍乱，本以太阴湿土为主，因为表里寒热虚实而有六种转化变化，这种病症多见于南方以及夏秋之交，湿邪郁结是可以确定的。六种转化的区别，张仲景已经详细论述了。后世有人固执于寒证而否定热证，固执于热证而否定寒证，可以说不能举一反三，反而固执一端而废弃其余五端。
霍乱论列方
理中丸 四物汤 苏合香丸 藿香正气散 四苓散 斑龙丸 五苓散 桂枝汤 四逆汤 四逆加人参汤 益元散 桂苓甘露饮 二陈汤
沙蜮第十二
《椿田医话》说：射影丸，主治射工、沙虱、溪毒等各种证候。这些病与伤寒、温疫、霍乱、瘴气相似，但手足逆冷的是这类病，甚至出现手足麻木不仁，寒冷超过肘部和膝盖。道光辛巳年（1821年）秋季七月，沙毒流行，两脚先麻木（当时民间称为麻脚瘟），接着出现腹痛吐泻，四肢冰冷脉伏，严重则大汗淋漓身体冰冷，脉搏消失眼睛凹陷，四肢抽搐，片刻之间无法救治。因此制作此方，服用后痊愈。外用含沙散通过臭鼻取嚏法治疗。有人说闺阁妇女多患此病，怎么会有含沙射影的情况呢？回答说：射工沙虱，在水草之间产生毒性，灌溉田地浇灌蔬菜，浸润土壤，潜通地脉，流入泉源，没有什么地方不可以到达的。而且在这种气盛行的年份，也可以凌空而至。南方还有蛇毒，危害更加严重。另外地方上的沙气升腾，高于高楼，因为夏秋气候炎热，人们看不见它。妇女坐着承受这种气，不像男子那样运行，而且妇女属阴体容易感受阴毒，所以受病多于男子。现在人感染轻微的，头疼身痛，形体精神拘谨疲倦，想吐吐不出来，四肢闭塞逆冷，或者腹痛想泻，让人挤压眉心、人中、承浆穴、颈项胸前背后，出现红色斑块像枣子大小，重的颜色紫黑，顷刻间就痊愈，名叫挤沙。相沿成俗，即使是感受风寒，也有通过挤沙而痊愈的。大概挤沙有发汗的意思，在内表现为血，发于外表现为汗，汗即是血的原因啊。
香白芷（一两） 大贝母（一两） 生甘草（五钱） 大蒜头（一两） 青黛（一两） 明雄黄（五钱） 犀角（五钱） 山慈姑（一两） 苍耳子（一两） 厚朴（一两） 紫背萍（一两） 射干（一两） 白知母（一两） 枯矾末（五钱） 朱砂（五钱） 紫菀茸（一两） 槟榔（一两） 雷丸（一两） 虎珀（五钱） 龙齿（五钱） 鬼箭羽（一两） 羚羊角（五钱） 草果仁（五钱） 麝香（五钱） 研为细末，用水泛丸，每次服用三钱，开水送下。
含沙散，主治沙毒吹入鼻中取嚏。
生大黄（六两） 公丁香（一两五钱） 明天麻（三两） 牙皂角（三两） 丹砂（四两） 明雄黄（四两） 麻黄（三两） 冰片（三钱） 麝香（三钱） 苍术（三两） 蟾酥（一两） 香白芷（三钱） 草果仁（一两五钱） 共研为极细末，用瓷瓶收贮。
《周礼》壶涿氏，掌管清除水虫，用抱土之鼓驱赶它们，用焚烧过的石头投掷它们。
《诗经》说：是鬼是蜮，却不可捉摸。（蜮，虫名。《诗经注》名为含沙。《诗经疏》名为射影，又名水弩。《广雅》名为短狐。《玄中记》名为水狐。《博物志》名为射工。《酉阳杂俎》名为抱枪，其形状像屎壳郎，头上有一角，长一寸多，角上有四个分叉的黑甲，下面有翅膀能飞，足角像弩，以气为箭，顺着水势含沙射人影致病，沙证的成因，大概就是这样。《五行传》说：这是南方淫惑之气所生，所以叫作蜮。）
《玄中记》说：水狐虫长三四寸，颜色黑，宽约一寸，背上有甲，厚三分，口中有角，向前像弩，以气射人，距离二三步就能射中人，十个人死六七。又说：看它的形状，是虫；看见它的气，是鬼。
《博物志》说：射工是江南山溪水中的甲虫。长一二寸，口有弩形，以气射人影，使人发疮。不治疗，会杀人。
《南中志》说：永昌郡有禁水，只有十一月十二月可以渡河，其他月份则杀人。那气中有恶物发出声音，看不见形状，射中人则皮肤青烂，名叫鬼弹。
《文选》鲍明远诗说：含沙射流影，吹蛊病行晖。
郭义恭《广志》说：沙虱在水中，颜色红，大不过蚂蚁，进入人皮中杀人。
《录异记》说：潭袁处吉等州，有沙出，即毒蛇鳞甲中的虫，蛇被苦毒困扰，进入急水中碾出，人中了它的毒，三天就死。
《九峰医案》说：客忤沙氛，挥霍撩乱，吐泻交作，三焦俱伤，身体冰冷脉搏伏匿，冷汗不收，眼睛红得像斑鸠，小便红得像血，浑身像中毒，危险在顷刻之间，勉强拟定元戎法，尽尽心力。
人参（二钱） 冬白术（三钱） 炙甘草（五分） 炮姜灰（五分） 煅石膏（一两） 红蓼花梗（一两） 地浆 水煎。
沙氛袭络，遍身苛痹，肢尖逆冷，胸喉气不展舒，六脉细涩无力，正气六和加减。
藿香梗（二钱） 老苏梗（一钱） 荆芥穗（一钱） 云茯苓（三钱） 炙甘草（五分） 制半夏（钱半） 福橘皮（一钱） 宣木瓜（一钱） 川厚朴（八分） 大腹皮（一钱）
烦闷欲吐，颠痛肢尖冷，脉细涩，沙候也。
法制半夏（四钱） 芦根（二两） 甘澜水煎。
蒋宝素说：沙毒这一概念是本书创立的，《内经》中没有。见于《诗经》《周礼》，方书有所忽略。近代多有发生，乃是南方沙土水湿溪涧虫蛇沙虱毒气中人为患，类似于中毒的证候。《周礼》有掌除水虫的官职。《诗经》说：是鬼是蜮，却不可捉摸。蜮是含沙射影水狐等的总称，能致人病蜮惑。所以《金匮要略》依据《诗经》，有狐惑的证候，以虫毒蚀于喉为惑，蚀于阴为狐。《博物志》说射工以气射人影，使人发疮，不治疗杀人，也是依据《诗经》的意义。《南中志》永昌郡有禁水，人不可渡，有物发出声音，看不见形状，射中人即死。这是从射工推广而来，那么水也能病人，不必等待含沙射影。鲍明远诗说：含沙射流影，吹蛊病行晖，又从而推广，那么它的气也可以凌空而至。葛洪《肘后方》：溪毒中人，一名中水，一名中溪，一名水病，似射工而无物，与《南中志》禁水相同。又说：江南射工毒虫，在山间水中，人行或浴，则此虫含沙射人形影为病，这是承接《诗经》与《金匮》《博物志》而言。又葛洪《抱朴子》说：山水间多沙虱甚细，几乎看不见，人进入水中及阴行草中，此虫多附着在人身上，钻入皮里，使人皮如芒刺，三天后寒热发疮，虫渐入骨则杀人。又以类推而有沙虱的证候。巢元方采集诸家之说，有含沙、沙虱、水毒、溪温各种证候非常详细。《丹溪心法附余》，因为腹痛有绞肠沙证，用樟木矾盐等汤探吐，并刺委中出血，论治精详。李时珍《本草纲目》，有挑沙刮沙的说法，其方法更加完备。张景岳用磁碗边蘸滚水香油，刮背心从上之下，尤为简要。医案从客忤霍乱中寻出沙证，证候没有逃脱隐匿。医话制作含沙散射影丸，治疗没有遗漏意义。
简略地说：沙证大概本于含沙射影，沙虱着人的意义，然而不靠近含沙沙虱而染上沙证的，则有禁水吹蛊溪毒之类，即含沙沙虱之类，随方土变更，其气上腾，与六淫相等，不必泥守射影而着人。往古所忽略，近代详细记载。至于医话含沙散射影丸，确实是对症的良方，没有超过它的。
瘴气第十三
Zhang Jingyue stated that during the transition between summer and autumn, when the weather fluctuates between cold and hot, and Yin and Yang energies conflict, people should exercise utmost caution and moderation in their clothing and diet at this time. Any slight disharmony may allow mixed pathogenic factors to invade, leading to Huoluan (a disease characterized by sudden vomiting and diarrhea). This requires attention. In medical cases discussing post-Huoluan treatment, using tonifying agents to conclude therapy aligns with the principle of addressing deficiency-induced deficiency. The newly formulated Huangtu Tang (Yellow Earth Decoction) in medical conversations focuses primarily on treating Dampness, conforming to classical principles and fitting seasonal applications, thus worthy of praise as an excellent prescription. Briefly: Huoluan in the *Neijing* is fundamentally rooted in Taiyin Damp-Earth, undergoing six transformations due to exterior-interior, cold-heat, and deficiency-excess variations. This condition is commonly seen in southern regions and during the summer-autumn transition, where Dampness stagnation is evident. Zhang Zhongjing detailed these six transformations. Later generations, however, stubbornly adhered to cold patterns while denying heat, or vice versa, failing to infer one from another and instead discarding five aspects for the sake of one.
Prescriptions Listed in the Discussion on Huoluan
Lizhong Wan (Regulate the Middle Pill), Siwu Tang (Four Substance Decoction), Suhexiang Wan (Styrax Pill), Huoxiang Zhengqi San (Agastache Powder to Rectify Qi), Siling San (Four-Ling Powder), Banlong Wan (Spotted Dragon Pill), Wuling San (Five-Ling Powder), Guizhi Tang (Cinnamon Twig Decoction), Sini Tang (Frigid Extremities Decoction), Sini Jia Renshen Tang (Frigid Extremities Decoction plus Ginseng), Yiyuan San (Benefit Origin Powder), Guiling Ganlu Yin (Cassia and Poria Sweet Dew Drink), Erchen Tang (Two-Aged Decoction).
Sha Yu (Sand Demon) Chapter 12
*Chuntian Yihua* (Medical Conversations from Chuntian) states: Sheying Wan (Shadow-Shooting Pill) treats conditions caused by Shigong (Bow-Mouth Bug), Shashi (Sand Mite), and Xidu (Stream Poison). These illnesses resemble Shanghan (Cold Damage), Wenyi (Warm Epidemics), Huoluan, and Zhangqi (Miasma), but are distinguished by cold extremities. Severe cases present with numbness and insensitivity in hands and feet, with cold extending beyond elbows and knees. In the autumn of July in the Xin-Si year of Daoguang (1821), Sha Du (Sand Toxin) prevailed. Patients first experienced numbness in both legs (locally known as Majiao Wen/Numb Foot Plague), followed by abdominal pain, vomiting, and diarrhea, cold limbs, and hidden pulses. In severe cases, profuse sweating, cold body, absent pulse, sunken eyes, and convulsions occurred, leading to death within moments. Therefore, this prescription was formulated, resulting in good recovery. Externally, Hansha San (Sand-Containing Powder) was used to induce sneezing via nasal irritation. Some asked why women in inner chambers suffered from this if it involves "shooting shadows." The response was: Shigong and Shashi generate toxicity among water plants. Irrigation infiltrates soil, connects to underground veins, and flows into springs, reaching everywhere. Moreover, in years of strong Qi prevalence, it can arrive through the air. Southern regions also have Snake Toxicity, which is even more harmful. Additionally, local Sha Qi rises high above buildings; due to hot summer-autumn climates, it is invisible. Women sitting passively receive this Qi, unlike men who move actively. Since women possess Yin constitutions, they easily contract Yin toxins, hence suffering more than men. Mild infections cause headache, body ache, mental fatigue, retching without vomiting, closed extremities, or abdominal pain with urge to defecate. Pressing the brow center, Renzhong, Chengjiang, neck, chest, back, etc., causes red spots like dates to appear, turning purple in severe cases, resolving instantly. This is called Jisha (Squeezing Sand). It became a custom; even Wind-Cold contraction could be cured by Jisha. Jisha implies Sweating; internally it relates to Blood, externally to Sweat, as Sweat is essentially Blood.
Xiang Baizhi (Angelicae Dahuricae Radix, 1 liang), Dabeimu (Fritillariae Thunbergii Bulbus, 1 liang), Sheng Gancao (Glycyrrhizae Radix et Rhizoma Recens, 5 qian), Dasuantou (Allii Sativi Bulbus, 1 liang), Qingdai (Indigo Naturalis, 1 liang), Ming Xionghuang (Realgar, 5 qian), Xijiao (Rhinocerotis Cornu, 5 qian), Shancigu (Smilacis Glabrae Rhizoma, 1 liang), Can'erzi (Xanthii Fructus, 1 liang), Houpo (Magnoliae Officinalis Cortex, 1 liang), Zibeiping (Azolla Sinensis, 1 liang), Shegan (Belamcandae Rhizoma, 1 liang), Baizhimu (Anemarrhenae Rhizoma, 1 liang), Kufan (Alumen Usticum, 5 qian), Zhusha (Cinnabar, 5 qian), Ziwanrong (Asteris Radix et Rhizoma, 1 liang), Binglang (Arecae Semen, 1 liang), Leiwan (Wormwood Fruit, 1 liang), Hu Po (Amber, 5 qian), Long Chi (Dinosaur Bone, 5 qian), Gui Jianyu (Eucommiae Cortex cum Spina, 1 liang), Lingyangjiao (Saiga Tataricae Cornu, 5 qian), Caoguoren (Tsaoko Cardamomi Fructus, 5 qian), Shexiang (Moschus, 5 qian). Grind into fine powder, form pills with water, take 3 qian each time with warm water.
Hansha San (Sand-Containing Powder) treats Sha Du blown into the nose to induce sneezing.
Sheng Dahuang (Rhei Radix et Rhizoma Recens, 6 liang), Gong Dingxiang (Syzygii Aromatisati Flos, 1.5 liang), Ming Tianma (Gastrodiae Rhizoma, 3 liang), Ya Zaojiao (Gleditsiae Sinensis Fructus, 3 liang), Dansha (Cinnabar, 4 liang), Ming Xionghuang (Realgar, 4 liang), Mahuang (Ephedrae Herba, 3 liang), Bingpian (Borneolum Syntheticum, 3 qian), Shexiang (Moschus, 3 qian), Cangzhu (Atractylodis Rhizoma, 3 liang), Chansu (Bufonis Venenum, 1 liang), Xiang Baizhi (Angelicae Dahuricae Radix, 3 qian), Caoguoren (Tsaoko Cardamomi Fructus, 1.5 liang). Grind into extremely fine powder, store in porcelain bottles.
The *Rites of Zhou* mentions Huzhuoshi, who managed the removal of aquatic pests, driving them with drums wrapped in earth and throwing burnt stones at them.
The *Book of Songs* says: "Is it a ghost? Is it a Yu? Yet it cannot be caught." (Yu is an insect name. Zhu Xi's commentary calls it Hansha. Kong Yingda's subcommentary calls it Sheying, also known as Shuinu. *Guangya* calls it Duanhu. *Xuanzhong Ji* calls it Shuihu. *Bowuzhi* calls it Shigong. *Youyang Zazu* calls it Baoqiang. Its shape resembles a dung beetle, with a horn on its head over an inch long, four black claws branching from the horn, wings below for flight, and leg-claws like a crossbow. It shoots sand like arrows using Qi, following water currents to hit human shadows, causing illness. This is the origin of Sha Syndrome. *Wuxing Zhuan* states it arises from excessive seductive Qi in the south, hence named Yu.)
*Xuanzhong Ji* states: Shuihu insects are 3-4 cun long, black, about 1 cun wide, with a 3-fen thick shell on the back. They have horns in their mouths pointing forward like crossbows, shooting Qi at people. Within 2-3 bu, they strike, killing 60-70% of victims. It adds: Looking at its form, it is a bug; seeing its Qi, it is a ghost.
*Bowuzhi* states: Shigong is a shelled insect in Jiangnan mountain streams. 1-2 cun long, with a crossbow-shaped mouth, shooting Qi at human shadows to cause sores. Untreated, it kills.
*Nanzhong Zhi* states: Yongchang Commandery has Forbidden Waters, crossable only in Nov-Dec; otherwise, it kills. Evil sounds emerge, unseen, striking people to cause green rot, named Guidan (Ghost Bullet).
*Bianwen Xuan* quotes Bao Mingyuan: "Containing sand to shoot flowing shadows, blowing gu to harm walking sunlight."
Guo Yigong's *Guangzhi* states: Shashi lives in water, red, no larger than an ant, enters human skin to kill.
*Luyi Ji* states: In Tanzhou, Yuanzhou, Jizhou, etc., Sha emerges from snake scales. Snakes suffer toxic distress, rolling in rapid water to expel them. Humans poisoned by this die in three days.
*Jiufeng Yi'an* (Medical Cases from Jiufeng): Ke Wu Sha Fen (Guest Disturbance and Sand Miasma) causes chaotic vomiting and diarrhea, damaging all Three Burners. Cold body, hidden pulse, cold sweat, red eyes like a dove, bloody urine, resembling acute poisoning, critical in moments. Tentatively applying Yuanrong Method with full effort.
Renshen (Panacis Ginseng Radix, 2 qian), Dong Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata, 5 fen), Pao Jiang Hui (Zingiberis Rhizoma Praeparatum Ash, 5 fen), Duan Shigao (Gypsum Fibrosum Calcined, 1 liang), Hong Liaohuageng (Polygoni Hydropiperis Caulis, 1 liang), Di Jiang (Earth Slurry). Decoct in water.
Sha Fen invading collaterals causes widespread itching and numbness, cold extremities, chest/throat Qi stagnation, thin and choppy weak pulses. Adjust Zhengqi Liuhe Tang.
Huoxiang Geng (Pogostemonis Herba Caulis, 2 qian), Lao Sugeng (Perillae Caulis, 1 qian), Jingjie Sui (Schizonepetae Spica, 1 qian), Yun Fuling (Poria, 3 qian), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata, 5 fen), Zhi Banxia (Pinelliae Rhizoma Praeparatum, 1.5 qian), Fu Ju Pi (Citri Reticulatae Pericarpium, 1 qian), Xuan Mugua (Chaenomelis Fructus, 1 qian), Chuan Houpo (Magnoliae Officinalis Cortex, 8 fen), Dafupi (Arecae Pericarpium, 1 qian).
Restlessness, urge to vomit, vertex pain, cold extremities, thin choppy pulse indicate Sha pattern.
Fazhi Banxia (Pinelliae Rhizoma Praeparatum, 4 qian), Lugeng (Phragmitis Rhizoma, 2 liang). Decoct in Ganlan Water (water boiled up and down).
Jiang Baosu stated: Sha Du is a concept created in this book, absent in *Neijing*, appearing in *Shijing* and *Zhouli*, but neglected in formularies. Recently common, it results from southern sandy/watery/miasmic environments, insect/snake/sha mite toxins harming humans, resembling poisoning. *Zhouli* had officials removing water pests. *Shijing* says: "Is it a ghost? Is it a Yu? Yet it cannot be caught." Yu is the general term for Hansha, Sheying, Shuihu, etc., causing Yu-huo (bewilderment/illness). Thus *Jingui Yaolue* based on *Shijing* describes Hu-Huo syndrome:虫毒 (insect toxin) eroding throat is Huo, eroding genitals is Hu. *Bowuzhi* says Shigong shoots Qi at shadows causing sores/death, also based on *Shijing*. *Nanzhong Zhi* describes Forbidden Waters killing upon contact, expanding from Shigong to show water itself harms without shadow-shooting. Bao Mingyuan's poem expands further to show Qi can travel through air. Ge Hong's *Zhouhou Beiji Fang* describes Xidu (Stream Poison), also called Zhongshui/Zhongxi/Shuibing, similar to Shigong but intangible, matching *Nanzhong Zhi*. He also notes Jiangnan Shigong bugs in mountain waters infect humans bathing/walking via shadow-shooting, citing *Shijing*, *Jingui*, *Bowuzhi*. Ge Hong's *Baopuzi* mentions fine Shashi in mountains/waters entering skin, causing prickling sensation, fever, sores after 3 days; entering bones kills. By analogy, Shashi syndrome emerged. Chao Yuanfang compiled details on Hansha, Shashi, Shuidu, Xiwen. *Danxi Xinfa Fuyu* discusses Jiaochangsha (Intestine-Twisting Sha) with vomiting via camphor/alum/salt and bleeding Weizhong. Li Shizhen's *Bencao Gangmu* added picking/scraping methods. Zhang Jingyue used magnetic bowl edges with hot oil to scrape the back, concise and effective. Medical cases identified Sha syndrome within Guest Disturbance/Huoluan, leaving no room for concealment. Medical conversations formulated Hansha Sheying Wan, covering all therapeutic meanings.
Briefly: Sha syndrome originates from Hansha Sheying and Shashi attachment. However, contracting Sha Syndrome without proximity to Hansha/Shashi involves Forbidden Waters, Chuigu, Xidu, etc., adapting to local geography, rising Qi equal to Six Evils, not limited to shadow-shooting. Ancient texts neglected this; modern times detail it. The Hansha Sheying Wan in medical conversations is indeed a superior prescription for this indication.
Zhangqi (Miasma) Chapter 13