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In the third year of Daoguang, my father was seventy-one years old. In early March, a boil (furuncle) appeared on the side of his right hypochondrium, approximately two fingers long and less than one inch in diameter. The pain was so severe that it felt like being stabbed with a knife. All the surgeons in the city were consulted, but every time herbal poultices were applied, the pain intensified. After the Dragon Boat Festival, his flesh gradually wasted away, and his appetite decreased. A month later, during the day he could only drink thin rice gruel, no more than one or two teacups. After the beginning of autumn, his condition worsened; he became restless and irritable, unable to sleep peacefully day or night, and for over ten days he could not even touch water or grain (HT). We had no choice but to hastily prepare for his death. Suddenly, around midnight on the Mid-Autumn Festival, he briefly regained consciousness (HT). We gave him half a cup of rice soup, after which he felt bloated (HT). I thought, how could anyone survive without eating grains for half a month? So, gently persuading my father, I urged him to force down a few spoonfuls of thin rice gruel each day. Three days later, he could consume one teacup morning and evening. Only then did his spirit stabilize. He then commanded (HT), "The books I have authored over the years are still incomplete. Specifically, the sections on cholera with vomiting and diarrhea must be rewritten. In the past three years, eight or nine out of ten who died from this disease died due to improper medication. Regarding cholera, ignorant people today wrongly label the excess syndrome of 'intestinal colic' (Jiao Chang Sha), where eating causes death, as 'dry cholera' (Gan Huo Luan); and they name the cholera syndrome associated with Cold Damage as 'wet cholera' (Shi Huo Luan). These two opposing views lead to the interchangeable use of medicines, causing harm far beyond just one or two individuals." He ordered me to record Zhang Zhongjing's Lizhong Tang and Sun Simiao's Zhizhong Tang, to correct the errors of various theories and to demonstrate the purity of ancient medical legislation.

Zhizhong Tang
Renshen (Ginseng Radix), Ganjiang (Zingiberis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) [each 3 liang].
The above four ingredients are crushed. Boil in 8 sheng of water to obtain 3 sheng. Divide into three doses. If not cured, administer frequently for three courses. For traveling to prevent cholera, prepare pills according to the previous method, sized like tung seeds. Take 30 pills per dose. If prepared as powder, take one fangcun bi (a square-inch measure) per dose. Taking with wine is also acceptable. If muscle cramps occur, add Shigao (Gypsum Fibrosum) 3 liang. I fear Gypsum Fibrosum is too mild, so add another 3 liang, totaling 6 liang combined with the original formula. (Zhang Zhongjing stated: If there is palpitation above the navel, indicating Kidney Qi movement, remove Baizhu and add Guixin (Cinnamomi Ramulus) 4 liang; if vomiting is excessive, remove Baizhu and add Shengjiang (Zingiberis Rhizoma Recens) 3 liang; if diarrhea is excessive, reuse Baizhu; if palpitations occur, add Fuling (Poria) 3 liang; if thirsty for drinking water, increase Baizhu to make a total of 4.5 liang; if abdominal pain occurs, add Renshen to make a total of 4.5 liang; if cold sensations prevail, add Ganjiang to make a total of 4.5 liang; if abdominal fullness exists, remove Baizhu and add Fuzi (Aconiti Lateralis Radix Praeparata) 7 pieces. After taking the decoction, wait about the time of one meal, then drink 1 sheng of hot porridge to maintain slight warmth. Do not expose yourself to cold by removing clothes or blankets. The sage's teachings are brilliant and do not forbid consuming porridge.)

Zhang Luyu said: "The Classic states: Clear Qi descends, Turbid Qi ascends; Ying Qi flows smoothly, Wei Qi moves counter-current. When clear and turbid qi interfere with each other and disturb the intestines and stomach, it results in cholera." This is mostly caused by cold pathogens transmitting to the Lower Jiao, causing the Middle Jiao to fail in digesting food and drink. This damages the San Jiao (Triple Burner) in cases of external cold exposure and internal consumption of cold drinks/foods. However, constitutions vary in Yin-Yang bias, and diseases differ in cold-heat patterns. Therefore, Shanghan Lun first mentions Wuling San (Five-Ling Powder) for those with heat predominance and thirst, and Lizhong Wan (Regulate the Middle Pill) for those with cold predominance and no thirst. Qianjin Fang renamed this 'Zhizhong' and listed it under the San Jiao chapter. 'Li' refers to regulating disharmony between cold and heat; 'Zhi' refers to treating the chaotic symptoms of cholera. The formula primarily uses Ganjiang's acrid-warm nature to encourage the strengthening and transport functions of Renshen and Baizhu, coordinating with Gancao's moderating effect. This is similar to the use of Guizhi (Cinnamon Twig) in Wuling San. Although the degree of cold and heat differs, the principle of warming and dispersing remains the same. Zhu Fengyi added Qingju Pi (Citri Reticulatae Pericarpium Viride) and Chenpi (Citri Reticulatae Pericarpium) to treat food injury. Qianjin Fang added the treatment for muscle cramps, supplementing the incompleteness of Shanghan Lun. The world knows to use Mugua (Chaenomelis Fructus) for muscle cramps, specifically utilizing its sour-astringent property to handle damp-heat injuring the Spleen in summer and autumn. This is because Clear Qi descends and affects the intestines and stomach, hence Ganjiang is used; Turbid Qi ascends and disturbs the sinews, hence Shigao is used. As for the various modifications of Lizhong Wan, they should be strictly followed. Observing that when vomiting and diarrhea cease but body pain persists, one should use Guizhi Tang (Cinnamon Twig Decoction) in small doses to harmonize, as well as Sini Tang (Frigid Extremities Decoction), Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction), Gancao Xiexin Tang (Licorice Heart-Draining Decoction), and Fuzi Jingmi Tang (Aconite and Rice Decoction). These methods do not exceed the treatments for rebellious Qi ascending found in Shanghan Lun and Jingui Yaolue.

Distension Abdomen Syndrome (Gu Zhang). Caused by food stagnation, use Weiling Tang (Stomach and Five-Ling Decoction) plus Banxia (Pinelliae Rhizoma), Ganjiang, Wugu Chong (Bombyx Batryticatus), and Mugua. Make pills using malt paste starch, and swallow 3 qian with aged rice soup. Caused by heat, use the previous pill formula plus Huanglian (Coptidis Rhizoma) as an assistant. These are excess syndromes and are easy to treat. Only deficiency syndromes require Shengshu Jian (Holy Artisan Decoction) plus Fuzi, taken continuously for 40-50 courses to show efficacy. Even isolated abdominal distension does not go beyond this method. Furthermore, cases arising from acid regurgitation should use Lizhong Tang plus Huanglian, named Lianli Wan (Coptis and Regulate-Middle Pill), to use strong medicine to transform the Stomach's state, rather than letting the Stomach adapt to the medicine. This is Yu Jiayan's secret method. For sub-xiphoid aggregation resembling a plate, use Guizhi Tang removing Shaoyao (Paeoniae Radix Alba), adding Mahuang (Ephedrae Herba), Fuzi, and Xixin (Asari Radix et Rhizoma). Take two doses daily and one dose at night, inducing slight sweating to rotate the Great Qi, so the aggregation dissipates. Then use Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction) to drain fullness with bitter flavors. This is Zhang Zhongjing's holy method. Most cases of this disease belong to cold, so it is listed under cold syndromes.

(Classic Meanings) Fu Zhong Lun states: "There is a disease with fullness in the heart and abdomen, where one cannot eat dinner if they ate breakfast, named Distension Abdomen (Gu Zhang). Treat it with Jishi Li (Chicken Excrement Ferment). One dose brings knowledge of improvement, two doses cure it." Shui Zhang Pian: "The Yellow Emperor asked: How is Distension Abdomen? Qibo answered: Abdominal distension with general body enlargement, equal in size to Skin Distension. The complexion is dark yellow, and abdominal veins protrude. This is its sign." Yin Yang Ying Xiang Da Lun states: "Turbid Qi ascending generates abdominal distension." Jing Mai Pian states: "Deficiency of Foot Taiyin leads to Distension Abdomen; Cold in the Stomach leads to fullness." Ben Shen Pian states: "Excess of Spleen Qi leads to abdominal distension; Excess of Kidney Qi leads to distension." Zhi Zhen Yao Da Lun states: "All dampness, swelling, and fullness belong to the Spleen; all abdominal distension and enlargement belong to Heat." Tai Yin Yang Ming Lun states: "Irregular diet and起居 (daily routine) injure the Yin. Injury to Yin enters the Five Zang organs. Entering the Zang organs leads to distension, fullness, and obstruction." Yi Fa Fang Yi Lun states: "People in the North enjoy living in the wild and consuming dairy products. Internal cold generates fullness diseases." Commentary: To treat this disease, one must base treatment on classic principles and select formulas from Zhang Zhongjing to ensure complete recovery. Books after the Tang Dynasty are speculative and mixed, and should not be tentatively tried. Medical texts call isolated abdominal distension 'Gu Zhang' because it resembles a drum—hard yet hollow inside. It is also called 'Gu Zhang' (Poison Worm Distension) because blood and Qi aggregate and cannot disperse, with toxicity like a poison worm.