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Wang XX, aged thirty-eight, from Tianjin, contracted cholera (Huoluan) at the end of winter.

Etiology: The affairs in the factory were complicated at the year's end, leading to excessive mental exertion and secretly generating internal heat (Nei Re). Additionally, anger stirred up Liver Fire (Gan Huo). Before the anger subsided, he went to bed abruptly. At one o'clock in the morning, he felt disturbance in the heart region and abdominal pain. After a while, vomiting and diarrhea occurred simultaneously, thus forming cholera.

Symptoms: There was feverish sensation and thirst in the heart region, nausea, and palpitations (Zheng Chong). Water vomited out shortly after drinking. Abdominal pain came and went; when severe, diarrhea ensued. During defecation, there was an abnormal sensation of heat. Occasionally, there was slight urination, which also felt hot. Sometimes, the tendons in both legs cramped (Zhuan Jin), but not severely. The pulse was weak but showed no signs of obstruction or closure.

Diagnosis: In cases of cholera, it is common for the pulse to show no signs of heat while the actual condition involves significant internal heat. Even if symptoms like closed pulse and cold body reveal a cold pattern, one should not hastily diagnose it as cold. In this case, although the pulse shows no heat signs, the patient feels heat and thirst in the heart region, and especially feels heat in both urine and stool. This undoubtedly indicates substantial internal heat accumulation. The reason the pulse lacks heat signs is that the heart has been paralyzed by toxins, causing weakness in the opening and closing mechanisms of the vessels. I propose using a large dose of cold-natured herbs to clear the internal heat, assisted by substances that detoxify and eliminate bacteria.

Prescription: Raw Gypsum (Sanliang, crushed fine), Raw Hang Shaoyao (Baeckea frutescens / Paeonia lactiflora var. albiflora - Eight Qian), Clear Banxia (Pinellia ternata - Five Qian, rinsed three times with warm water), Raw Huai Shanyao (Dioscorea opposita - Five Qian), Tender Zhuru (Bambusa textilis - Three Qian, chopped), Gan Song (Nardostachys jatamansi - Two Qian), Gancao (Glycyrrhiza uralensis - Three Qian).

Decoct together to make three bowls of soup, taken warm in three doses. Each time, take fifty pills of Weisheng Fangyi Baodan along with the decoction.

The formula is recorded in the subsequent section. Gan Song, also known as Gan Song Xiang, is Valerian officinalis in Western medicine. *Bencao Gangmu* cites Ma Shi's *Kaibao Bencao*, stating it treats foul odors and sudden epigastric/abdominal pain and fullness. Westerners believe it effectively treats muscle cramps, hence it is considered a key herb for treating cholera. Furthermore, its nature is suitable for fumigating against tuberculosis (Lao Zhai), truly possessing power to detoxify and eliminate bacteria.

Follow-up Visit: After taking the medicine in two doses, symptoms such as vomiting, diarrhea, abdominal pain, and muscle cramps all resolved. However, the patient still felt heat and thirst in the heart region, and heat in urine and stool. Palpation revealed the pulse was stronger than before, clearly showing signs of fire. This is because the heart had ceased to be paralyzed, and the regulatory mechanisms became flexible, hence the change in pulse. The remaining heat and thirst are due to residual fire not yet cleared. Severe vomiting and diarrhea severely damage Yin fluids. Damage to the Yin level easily generates deficiency heat and causes thirst. Therefore, one cannot treat this merely with cooling herbs that purge fire. I propose adding substances that greatly nourish True Yin (Zhen Yin).

Prescription: Raw Huai Shanyao (One Liang), Da Gan Gouqi (Lycium barbarum - One Liang), Bei Shashen (Adenophora stricta - One Liang), Lizhong Dan (Five Qian).

Take the first three herbs, decoct them into one large bowl of soup, and take half of the Lizhong Dan with it. Four hours later, decoct the dregs again into one large bowl of soup, and take the remaining half of the Lizhong Dan.

Outcome: After taking the medicine in three doses, the heat receded, thirst stopped, and the illness was completely cured.

Commentary: Cholera cases involve both Yin and Yang patterns. However, based on my fifty years of experience, I know that eight-tenths of these cases belong to Yang patterns and should be treated with cooling medicines; one-tenth belongs to Yin patterns and should be treated with warming medicines; and one-tenth belongs to semi-Yin semi-Yang patterns, requiring the combination of cooling and warming medicines to harmonize Yin and Yang. Later commentators often claim that only the cholera described in *Shanghan Lun* is true cholera, and those cured with cooling medicines are false cholera. They do not realize that *Shanghan Lun*'s treatment methods for cholera do not exclusively use warming medicines. For instance, Section 7 of that chapter states: "For cholera with headache, fever, body ache, more heat than cold, and desire to drink water, Wuling San governs it. For more cold than heat and no desire to drink water, Lizhong Wan governs it." Since it explicitly mentions distinguishing between more heat and more cold, it clearly indicates that cold and heat can be differentiated. Although Guizhi (Cinnamon Twig) is present in Wuling San, its dosage is light. Meanwhile, Zexie (Alisma rhizome), Fuling (Poria), and Zhuling (Polyporus) have slightly cool natures; thus, this formula cannot be classified as warming. Moreover, examining the bacteria of this disease under a microscope reveals curved rod shapes. Therefore, regardless of whether the clinical presentation is cold or heat, if the infectious pathogenic bacteria appear as curved rods, it is undoubtedly cholera. To accurately distinguish the cold or heat nature of this disease without error, one should refer to the formulas for cholera and the chapters discussing cholera treatment methods, thereby ensuring accuracy in clinical practice.