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Treats the critical condition of cholera with extreme vomiting and diarrhea, where the spirit is lethargic and breath is faint, indicating a perilous state.

Lupang Shen (Codonopsis Pilosae Radix) (8 qian), Raw Shanyao (Dioscoreae Oppositae Rhizoma) (1 liang), Raw Hangshao (Paeoniae Radix Alba) (5 qian), Shanzhrou (Corni Fructus) (8 qian, pits removed completely), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) (3 qian), Zheshi (Hematitum) (4 qian, ground fine), Zhusha (Cinnabaris) (5 fen, ground fine).

First, heat half a cup of child's urine in a steamer, use it to administer the Zhusha, then follow with the decoction.

Both of the above formulas are essential medicines for treating cholera. However, the former focuses on expelling pathogens, while this one focuses on supporting healthy qi. Indeed, patients with this condition often suffer from improper treatment, leading to incessant vomiting and diarrhea day and night, resulting in extreme deficiency and impending collapse, with danger imminent. At this stage of the disease, there is no time to deeply investigate whether the initial cause was cold or heat; the priority is to urgently use a heavy dose of Renshen (Ginseng Radix) to restore yang, Shanyao and Shaoyao to nourish yin, Shanzhrou to consolidate the leakage of liver qi (at the onset of vomiting and diarrhea, Liver Wood assists pathogens and insults Spleen Earth; at the extreme of vomiting and diarrhea, Liver Qi tends to leak first), and Zhi Gancao to harmonize the dissipation of middle qi. This explains why Jiuj Huiyang Tang is necessary. The use of Zheshi not only utilizes its ability to stop vomiting so that ingested medicine is not vomited out, but also because prolonged vomiting and diarrhea lead to the separation of yin and yang. Zheshi, being red and entering the Heart, cooperates with Renshen to assist Heart Qi in descending. Meanwhile, Shanyao in the formula warms and secures the lower jiao and nourishes true yin, cooperating with Renshen to prevent Kidney Qi from sinking and guiding it upward. The use of Zhusha administered with child's urine is because at this time, the hundred vessels are blocked, the heart is damaged by toxic vapors, and its pulsating mechanism is about to extinguish. Therefore, Zhusha enters the Heart directly to detoxify, and child's urine guides the toxic vapors out through the urethra. Furthermore, the nature of child's urine can stimulate Kidney Yang to ascend and reach the Heart. Thus, this decoction is an agent to restore yang, but in reality, it is an agent to communicate between the Heart and Kidney and harmonize yin and yang. After taking this decoction, if the body becomes warm and the pulse appears, and the patient feels heat in the chest with irritability, one should urgently nourish the yin aspect, using herbs such as Xuanshen (Scrophulariae Radix) and raw Shaoyao, adding Gancao to harmonize. Decoct a large dose and drink it warm in several portions. This follows the method in the Taiyang Chapter of Shanghan Lun: first using Gancao Ganjiang Tang, followed by Gancao Shaoyao Tang.

My disciple Gao XX once treated a young woman. She suffered from vomiting and diarrhea for a day and night, feeling extremely exhausted. A concentrated decoction of Renshen was prepared, and Yiyuan San was administered with it, resulting in recovery. Generally, Dushen Tang (Single Ginseng Decoction) restores yang, while Yiyuan San nourishes yin, harmonizes the middle (Huashi and Gancao harmonize the middle to stop vomiting and diarrhea), and detoxifies (Gancao and Zhusha detoxify), and can guide toxic vapors out through urination. Hence, it produced prompt effects. This reflects the intention behind my proposed Jiuj Huiyang Tang.

The muscle spasms (zhuanjin) occurring in this condition are mostly due to incessant vomiting and diarrhea, where Liver Wood takes advantage of Spleen Qi deficiency to insult Spleen Earth. Therefore, medical books often use Mugua (Chaenomelis Fructus) to treat spasms, as its sour taste can astringe Liver Qi, thereby pacifying the Liver. However, herbs that pacify the Liver do not necessarily have to be Mugua. In the autumn of Renyin year, during a cholera epidemic, I used Lingyangjiao (Saigae Tataricae Cornu) alone, 3 qian, curing several cases. This is because Lingyangjiao is good at clearing heat toxins and is an excellent herb for pacifying the Liver. Once, a person asked me for a prescription to treat diarrhea. I advised him to crush Sour Pomegranate (Shiliu) with the peel and decoct it for drinking. Later, when cholera occurred, he used this prescription to treat the initial diarrhea of cholera. After taking it, the diarrhea stopped, and the cholera also resolved. From this, we see that Pomegranate is also an important herb for astringing Liver Qi, and the method of astringing Liver Qi is indeed a key measure in treating cholera.

Most cholera cases involve excess heat; true cold cases account for only one or two percent. Even if the hundred vessels are blocked and the whole body is cold, as long as the patient does not desire covering up and desires drinking cold water, one should not strictly forbid it. One should initially give small amounts of cold water. If the condition worsens after drinking, and although the patient wants more, they do not urgently demand it, cold water should not be given. If the condition does not worsen after drinking, and the patient cannot endure even a short period without it, cold water can be given freely, allowing them to vomit whatever they drink. Using cold water to flush out internal toxins is also a good method. I once encountered someone who recovered by drinking cold water indiscriminately. When asked, he said that during the severe phase of the illness, if he did not drink cold water for a moment, he felt he would not survive. Thus, the efficacy of cold water can be understood. However, cold water must be newly drawn well water to be effective. In places without well water, ice water can be substituted, or swallowing small ice cubes is also good.

Wang Mengying stated: Jishi Bai San (Chicken Droppings Powder) is a formula from Jin Gui Yao Lue for treating cholera with spasms extending into the abdomen. I imitated his idea and formulated Can Shi Tang (Mulberry Worm Faeces Decoction), which is very effective for critical conditions of cholera with spasms, abdominal pain, thirst, and irritability. The formula uses Wancangsha (Bombyx Batryticatus) and Mugua each 3 qian, Sheng Yiren (Coicis Semen) and Dayaoya (Sojae Germen) each 4 qian (if unavailable, Sheng Maiya can be substituted), Chuan Huanglian (Coptidis Rhizoma) and Chao Shanzhi (Gardeniae Fructus Praeparatus) each 2 qian, Cu Chao Banxia (Pinelliae Rhizoma Praeparatum cum Aceto), Jiu Chao Huangqin (Scutellariae Radix Praeparata cum Vino), and Wu Zhu Yu (Evodiae Fructus) each 1 qian. Decoct with Yin-Yang Water, let it cool slightly, and take slowly. In August and September of Dingyou year, cholera with spasms prevailed in our city of Hangzhou. A Mrs. Shen suffered from this late at night, followed by hoarseness and cold limbs. By dawn, her husband sought urgent treatment. Her pulse was wiry, thin, and choppy, with the Chi positions barely perceptible. Her mouth was extremely thirsty, but any fluid intake caused immediate vomiting. Her calves were hard as stone, and she experienced exceptional pain. I prescribed this formula for her. Taken slowly and coolly, the medicine stayed down without vomiting. Externally, good burning wine was applied with vigorous friction to the hardened areas of spasms. After about an hour of friction, the hardness gradually softened and dispersed, the spasms ceased, and vomiting and diarrhea decreased. Half a dose of the previous medicine was given later, and she slept peacefully that night. Subsequently, many similar cases were treated with this method, all achieving success.

Lu Jiuzhi stated: Cholera involves both cold and heat, with heat accounting for nine-tenths and cold for one-tenth. Cases arising from cooling off and drinking cold drinks in tall buildings are treated by Zhang Zhongjing with Lizhong Tang and Sixni Tang, and later generations with Jiangshui San, Dashun San, Fuyuan Tang, and Lengxiang Yinzi. These diseases are mostly cold, and the medicines should be hot. However, from after Spring Equinox to before Autumn Equinox, Shaoyang Ministerial Fire, Shaoyin Sovereign Fire, and Taiyin Damp Earth jointly exert their influence. Heavenly heat descends, earthly moisture ascends. Humans exist in the intersection of qi, where clear qi is in the yin position and turbid qi is in the yang position. Yin and yang become antagonistic, clear and turbid interfere with each other, qi becomes chaotic in the middle, leading to upper vomiting and lower diarrhea. Treatment should harmonize yin and yang, clarify clear and turbid, and stabilize the chaos. Once stabilized, recovery is assured. This disease is not cold, nor does it require exclusively cold medicines. Commonly used agents like Huoxiang Zhengqi Tang, Pingwei San, and Weiling Tang are warming and unblocking, merely avoiding the highly pungent and hot herbs like Ganjiang, Fuzi, Dingxiang, and Wuzhuyu. There are also cases without vomiting or diarrhea but with sudden chaotic disturbance, often occurring after overeating. In summer, sudden exposure to summer heat combined with food stagnation in the Taiyin Spleen, also called "fullness obstructing breath," causes this condition. It develops fastest and is most destructive, yet people often ignore it. Even those who recognize it attribute it only to food stagnation, failing to believe it is an acute closure syndrome. Closure syndrome presents with cold extremities and hidden pulses, sometimes preferring proximity to intense sun. This is pathogenic closure blocking the airways; the aversion to cold indicates extreme internal heat. Such cases lack only the emetic method. Since the emetic method has been neglected, diseases that could be cured by one emesis are left untreated. Furthermore, there are cases of limb reversal, even whole-body coldness, without aversion to cold but with aversion to heat. This is true internal heat with false external cold, resembling the deep heat and deep reversal of Jueyin disease. Not only should Sixni Tang and Lizhong Tang be avoided, but also Ginger Decoction, Rice Drink, and even Guizhi in Wuling San should not be used. Instead, bitter-cold agents should be used, assisted by bloodletting (scraping and pricking) to release evil blood and vent heat toxins. In Renxu year of Tongzhi era, an epidemic prevailed in Shanghai, Jiangsu, lasting into Guihai year. I cured some cases of summer-heat-damp-heat cholera using Shigao (Gypsum Fibrosum), Huangqin, and Huanglian to clear heat. I cured others of food-stagnation cholera using cold water mixed with Danfan (Alumen) to induce vomiting. Those with cold limbs and hidden pulses were mistakenly treated by prominent physicians with Dingxiang, Wuzhuyu, Guizhi, and Fuzi, causing daily errors without changing strategy, which is truly regrettable.

The above two excerpts offer insights into cholera, so they are recorded in detail for reference.

Cholera should be treated with external therapies to supplement internal medication. Among external therapies, acupuncture and moxibustion are most important. Common acupoints include Shixuan, Zhongwan, Chi Ze, Zu San Li, Yinlingquan, Chengshan, Taixi, Tai Cang (Zhongwan), Taichong, and Gong Sun. While acupuncturists generally know these, the Su Liao point on the Du Meridian is crucial. Pricking it to bleed at a depth of three fen of identical body inch is a key measure for treating cholera. It is effective for vomiting and diarrhea accompanied by mental restlessness. Most acupuncture texts do not mention its efficacy for cholera. Some practitioners prick the tip of the nose or the middle of the nasal bridge, missing the correct point. The area between the nostrils is the nasal bridge. Wang Bing's commentary on Neijing states this point is at the upper end of the nasal bridge, distinct from the tip or the middle. Even missing the correct point often yields results, so hitting the correct point should be even more effective. This point connects with the Du Meridian, and the nose connects with the Ren Meridian. Stimulating this point allows mutual communication between the Du and Ren meridians, facilitating circulation throughout the body.

Scraping therapy should also be supplemented. During severe stages, the body is cold and venous blood stasis occurs. Use a narrow-mouthed tea bowl, apply a little sesame oil to one edge, hold the oiled part with both hands, and scrape along both sides of the spine. Light scraping on the spine itself is also acceptable, stopping when the skin turns red. Since organ connections attach to the spine and shu points are located along the paravertebral region, scraping here is vital. Scrape from top to bottom to guide toxic vapors downward. Next, scrape the chest and hypochondrium, then the flexures of the limbs (Chi Ze, Wei Zhong) and inner/outer legs. The head, forehead, neck, and shoulders can also be scraped with a coin. Bloodletting (fang sha) should also be employed: push venous blood from limbs to the flexures of arms and legs, tie tightly above and below with a band, and prick the veins beside Chi Ze and Wei Zhong with a flat needle to release blood, aiding circulation and releasing carbon gas, thereby reducing cholera bacteria.

Warming methods should also be supplemented. Boil eight new bricks in rolling water and apply them to the axillae, limb flexures, and Yongquan points on both feet. Alternatively, boil thick cloth in water, stack several layers while hot, and apply to spasmodic areas. Even without spasms, apply to the lower abdomen and calves, replacing when cool. Hot water bottles or bags can also be used. Vinegar-fried scallion whites (sliced) or vinegar-fried dried mugwort leaves (crushed) can be used for warming compresses. Rubbing the body and hardened calves with fire alcohol or burning wine is also effective. Various warming methods can be adapted to clinical situations.