邑北境刘氏妇，年近四旬，得霍乱暴脱证。
病因 受妊五六个月，时当壬寅秋令，霍乱盛行，因受传染，吐
泻一昼夜，病似稍愈，而胎忽滑下。自觉精神顿散，心摇摇似不能支持。遂急延为诊视。
证候 迨愚至欲为诊视，则病势大革，殓服已备，着于身将舁诸床，病家辞以不必入视。愚曰∶此
系暴脱之证，一息尚存，即可挽回。遂入视之，气息若无，大声呼之亦不知应，脉象
模糊如水上浮麻，莫辨至数。
诊断 此证若系陈病状况，至此定难挽回，惟因霍乱吐泻已极，又复流产，则气血暴脱，
故仍可用药挽救。夫暴脱之证，其所脱者元气也。凡元气之上脱必由于肝（所以人之将脱者，肝风先动），
当用酸敛之品直趋肝脏以收敛之。即所以杜塞元气上脱之路，再用补助气分之药辅之。虽病势垂
危至极点，亦可挽回性命于呼吸之间。
处方 净杭萸肉（二两） 野党参（一两） 生怀山药（一两）
共煎汤一大盅，温服
方虽开就而药局相隔数里，取药迫不及待，幸其比邻刘××是愚表兄，有愚所开药方，取药二
剂未服，中有萸肉共六钱，遂急取来暴火煎汤灌之。
效果 将药徐徐灌下，须臾气息稍大，呼之能应，又急煎渣灌下，较前尤明了。问其心中何如，
言甚难受，其音惟在喉间，细听可辨。须臾药已取到，急煎汤两茶杯，此时已自能服药。俾分三次温
服下，精神顿复，可自动转。继用生山药细末八钱许，煮作茶汤，调以白糖，令其适口当点心服之。
日两次，如此将养五六日以善其后。
帮助 按人之气海有二，一为先天之气海，一为后天之气海。《内经》论四海之名，以膻中
（即膈上）为气海，所藏者大气，即宗气也，养生家及针灸家皆以脐下为气海，所藏者元气，
即养生家所谓祖气也。此气海之形状，若倒提鸡冠花形，纯系脂膜结成而中空（剖解猪腹者，
名之为鸡冠油），肝脏下垂之脂膜与之相连，是以元气之上行，原由肝而敷布，而元气之上脱，亦即
由肝而疏泄也（《内经》谓肝主疏泄）。惟重用萸肉以酸敛防其疏泄，借以杜塞元气上脱之路，
而元气即可不脱矣。所最足明征者，若初次即服所开之方以治愈此证，鲜不谓人参之功居多，乃
因取药不及，遂单服萸肉，且所服者只六钱即能建此奇功。由此知萸肉救脱之力，实远胜人参。
盖人参以救无气之下脱，犹足恃，而以救元气之上脱，若单用之转有气高不返之弊（说见俞氏《寓意
草》），以其性温而兼升也。至萸肉则无论上脱下脱，用之皆效。盖元气之上脱由于肝，其下脱
亦由于肝，诚以肝能为肾行气（《内经》谓肝行肾之气），即能泻元气自下出也。为其
下脱亦由于肝，故亦可重用萸肉治之也。
或问 同为元气之脱何以辨其上脱下脱？答曰∶上脱与下脱，其外现之证可据以辨别者甚多。今
但即脉以论，如此证脉若水上浮麻，此上脱之征也。若系下脱其脉即沉细欲无矣。且元气上脱
下脱之外，又有所谓外脱者。周身汗出不止者是也。萸肉最善敛汗，是以萸肉亦能治之。来复
汤及山萸肉解后载有治验之案数则，可参观也。
[Background Information]
Book: *Yixue Zhongzhong Canxi Lu* (Record of Medical Studies Integrating Chinese and Western Medicine)
Author: Zhang Xichun
Dynasty: Qing
Chapter: 4. Cholera with Sudden Collapse Syndrome
Category: Medical Discourse
[English Translation]
A woman surnamed Liu in the northern part of the county, approaching forty years of age, suffered from Cholera with Sudden Collapse Syndrome (a critical condition characterized by sudden exhaustion of Yuan Qi due to severe vomiting and diarrhea).
**Etiology:** She was five or six months pregnant when, during the autumn of the Renyin year, cholera was prevalent. She contracted the disease, experiencing vomiting and diarrhea for a full day and night. The illness seemed to improve slightly, but the fetus suddenly miscarried. She felt her spirit instantly dissipate, her heart trembling as if unable to sustain itself. Consequently, she urgently summoned me for consultation.
**Symptoms:** When I arrived to examine her, the condition had drastically worsened. Funeral clothes were already prepared and worn on her body, ready to be carried onto a bed. The family refused my entry, stating that further examination was unnecessary. I said, "This is a case of Sudden Collapse. As long as there is still one breath remaining, it can be reversed." I then entered to examine her. Her breathing was faint as if nonexistent; even loud calls elicited no response. Her pulse was indistinct and blurry, resembling hemp seeds floating on water, making it impossible to distinguish the rate or rhythm.
**Diagnosis:** If this condition were the result of a chronic old disease reaching such a stage, it would indeed be irrecoverable. However, because the vomiting and diarrhea from cholera were extreme, compounded by the miscarriage, causing a sudden depletion of Qi and Blood, medication can still be used to save her. In cases of Sudden Collapse, what is depleted is Yuan Qi (the fundamental vital energy of the human body). Whenever Yuan Qi collapses upward, it is necessarily due to the Liver (therefore, when a person is about to collapse, Liver Wind moves first). One should use sour, astringent herbs that act directly on the Liver to consolidate it. This serves to block the pathway of upward collapse of Yuan Qi, supplemented by herbs that tonify the Qi aspect. Although the condition is critically dangerous, life can be saved within the span of a breath.
**Prescription:**
Jing Hang Yurou (Processed Cornus Officinalis Fruit, 2 liang)
Ye Dangshen (Wild Codonopsis Pilosula Root, 1 liang)
Sheng Huai Shanyao (Raw Dioscorea Oppata Rhizome, 1 liang)
Decoct together in a large cup, take warm.
Although the prescription was written, the pharmacy was several miles away, and obtaining the medicine could not wait. Fortunately, her neighbor, Mr. Liu, was my cousin, who possessed copies of my prescriptions. He had two doses of unmedicated herbs, containing a total of 6 qian of Cornus Officinalis Fruit. These were hurriedly obtained, decocted rapidly over high heat, and administered as a soup.
**Effect:** The medicine was slowly administered. After a short while, her breathing became slightly stronger, and she responded to calls. The dregs were quickly decocted and administered again, after which her consciousness became clearer than before. When asked how she felt in her chest, she said it was very uncomfortable, her voice confined to her throat, discernible only upon close listening. Shortly after, the rest of the medicine arrived. It was quickly decocted into two teacups of soup. At this point, she was able to take the medicine herself. She took it in three divided doses, warm. Her spirit instantly recovered, and she could move her body voluntarily. Subsequently, approximately 8 qian of fine powder from Raw Dioscorea Oppata Rhizome was boiled into a tea-like soup, sweetened with white sugar, and taken as a snack to suit her palate. Taken twice daily, this regimen continued for five or six days to ensure recovery.
**Commentary:** There are two "Qi Seas" in the human body: one is the Pre-Heaven Qi Sea, and the other is the Post-Heaven Qi Sea. The *Neijing* discusses the Four Seas, identifying Danzhong (located above the diaphragm) as the Qi Sea, which stores Da Qi (Great Qi), also known as Zong Qi (Gathering Qi). Health cultivators and acupuncturists identify the area below the navel as the Qi Sea, which stores Yuan Qi, also referred to by health cultivators as Zu Qi (Ancestral Qi). The shape of this Qi Sea resembles an inverted cockscomb flower, formed entirely of fatty membrane and hollow in the center (those who dissect pig bellies call this cockscomb oil). It connects to the fatty membrane hanging from the liver. Therefore, the upward movement of Yuan Qi originally spreads via the Liver, and its upward collapse also occurs through Liver Shuxie (dispersing and draining) (as stated in the *Neijing*: "The Liver governs Shuxie"). Only by heavily using Cornus Officinalis Fruit to astringe via its sour taste can we prevent this dispersal, thereby blocking the pathway of upward collapse of Yuan Qi, so that Yuan Qi does not collapse. The most convincing evidence is this: if the prescribed formula had been taken initially to cure this case, few would not attribute the merit largely to Codonopsis Pilosula Root. However, due to the delay in obtaining medicine, she took only Cornus Officinalis Fruit, and merely 6 qian achieved this miraculous effect. From this, we know that the power of Cornus Officinalis Fruit to rescue collapse far surpasses that of Codonopsis Pilosula Root. Generally, Codonopsis Pilosula Root is reliable for rescuing downward collapse of Qi (Qi sinking), but for rescuing upward collapse of Yuan Qi, using it alone has the drawback of causing Qi to rise and not return (as discussed in Yu Shi's *Yuyi Cao*), because its nature is warm and ascending. In contrast, Cornus Officinalis Fruit is effective for both upward and downward collapse. This is because upward collapse of Yuan Qi is due to the Liver, and downward collapse is also due to the Liver. Indeed, the Liver conducts Qi for the Kidneys (as the *Neijing* states: "The Liver conducts the Qi of the Kidney"), meaning it can guide Yuan Qi to exit from below. Since downward collapse is also due to the Liver, heavy use of Cornus Officinalis Fruit can also treat it.
**Q&A:**
Question: Since both are collapses of Yuan Qi, how do we distinguish between upward and downward collapse?
Answer: There are many external symptoms that can distinguish between upward and downward collapse. For now, let us discuss based on the pulse. If the pulse resembles hemp seeds floating on water, as in this case, it is a sign of upward collapse. If it were downward collapse, the pulse would be deep, thin, and nearly imperceptible. Furthermore, besides upward and downward collapse of Yuan Qi, there is what is called "External Collapse," manifested as incessant sweating all over the body. Cornus Officinalis Fruit is best at astringing sweat, thus it can also treat this. Several verified cases treating these conditions are recorded in *Laifu Tang* and the commentary following *Shanzhuru*, which can be consulted.