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Cholera is the most dangerous and urgent condition. This condition is divided into Yin syndrome and Yang syndrome. Yin syndrome should be treated with warm-natured medicines, while Yang syndrome should be treated with cool-natured medicines. If differentiation is unclear and opposite-natured medicines are mistakenly administered, critical danger will appear immediately. Even if differentiation is clear, if the administration of warm or cool medicines is not precise enough, it may not necessarily save more than half of the patients.

In early autumn of the Jiwei year (1919), cholera was prevalent in Fengtian (modern Shenyang). Patients presented with vomiting, diarrhea, and muscle spasms (Zhuanjin). In severe cases, the pulse was imperceptible, the body was cold as ice, yet the heart felt hot, and there was a strong desire to drink cold water. I diagnosed this as Yang syndrome and formulated a prescription called Jijiu Huisheng Dan (Emergency Rescue Pill). Although the medicinal nature of this pill is cool, it is excellent at inducing sweating and detoxifying. It can cause the latent toxic heat inside the body to penetrate the surface and exit, thereby warming the cold body and restoring the imperceptible pulse. Most patients who took this formula recovered.

Subsequently, I formulated another prescription called Weisheng Fangyi Baodan (Health Protection and Epidemic Prevention Precious Pill). I added two acrid-aromatic and warm-unblocking herbs to the previous formula to balance the warm and cool properties. Taking dozens of pills daily could secretly eliminate the root of the disease without being noticed. Containing a few pills could prevent infection when visiting patients. At that time, Mr. Liu XX saw a patient lying on the street with vomiting, diarrhea, and spasms, in a critical condition. Mr. Liu XX happened to have Weisheng Fangyi Baodan with him, gave the patient dozens of pills, and then went to a teahouse to find half a cup of boiling water for administration. Within moments, the vomiting, diarrhea, and spasms ceased, and the patient could sit up. Later, Mr. Shang XX came to my clinic to buy epidemic prevention medicine, and I gave him 200 packs of Weisheng Fangyi Baodan. The coal miners suffering from cholera took either 80 or 120 pills, all of whom were completely cured. From this, we know that Weisheng Fangyi Baodan can both prevent cholera before onset and control it after onset; its efficacy is no less than that of Jijiu Huisheng Dan.

[Commentary from "Chu Yan on Seasonal Hidden Yin" by Li XX] On June 30th of the Xinyou year (1921), I was treating a relative when unexpectedly my eldest son XX (then 12 years old) suffered from incessant severe diarrhea. By the time I returned home, he also began vomiting. His pulse was particularly tight and slow, his four extremities were slightly numb, he had a headache, fever, no sweat, and thirst. This was Hidden Yin syndrome complicated by external contraction. Therefore, I administered the Jijiu Huisheng Dan created by Mr. Zhang. Although this case belongs to Hidden Yin, due to the complicating symptoms, exterior resolution is necessary. Moreover, Mr. Zhang stated that this pill can restore warmth and induce sweating upon ingestion, so I gave it to him. From this, it can be seen that whether it is Hidden Yin cholera or not, at the initial stage, this pill can be given first to induce sweating and reduce the pathogenic force, followed by differentiated treatment (if it is purely Hidden Yin syndrome, giving the Weisheng Fangyi Baodan made by Mr. Zhang first would be even better). After taking the medicine, sweat appeared shortly, and the trend of vomiting and diarrhea slowed down. Subsequently, I prescribed Piao Cangzhu (Washed Atractylodis Rhizoma) 3 qian, Zhike (Aurantii Fructus) 2 qian, Houpo (Magnoliae Officinalis Cortex) 1.5 qian, Xi Sharen (Amomi Fructus Rotundus) 1 qian, Guang Chenpi (Citri Reticulatae Pericarpium) 1 qian, Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) 1 qian, Su Ye (Perillae Folium) 1 qian, Bohe (Menthae Haplocalycis Herba) 8 fen, plus Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), decocted in water and taken orally. The patient recovered before finishing the dose.

Note: The son had an external contraction, hence the fever and thirst. If it were merely Hidden Yin syndrome, initially there would be vomiting and diarrhea, followed by cold body, spasms, and sunken eye sockets, which are identical to cholera, except for the absence of heart heat and the presence of limb stiffness. This closely resembles Yin-syndrome cholera described in the *Shanghan Lun* (Treatise on Cold Damage), where the method to restore yang and dissipate yin is Fuzi Lizhong Tang (Aconite and Bupleurum Decoction). Now, Mr. Li suggests using Jijiu Huisheng Dan at the onset, stating that Weisheng Fangyi Baodan would be even better. This is because Weisheng Fangyi Baodan feels cool upon initial ingestion but ultimately becomes warm, as Bingpian (Borneolum Syntheticum) and Bohebing (Borneolum Syntheticum derived from Mentha) are used with a cool nature but possess warm properties, especially since Xixin (Asari Radix et Rhizoma) and Baizhi (Angelicae Dahuricae Radix) are inherently warm. Thus, the miracle of this pill lies in clearing the upper and warming the lower. As for Jijiu Huisheng Dan, lacking the heat of Xixin and Baizhi, and with increased Cinnabaris (Cinnabar), its nature seems cooler. However, Cinnabaris is a compound of mercury and sulfur, containing heat within its coolness. Furthermore, Bingpian and Bohebing are added in large amounts, making sweating very rapid. After ingestion, whether the pathogen is a new external contraction or a long-hidden evil, it can be expelled through sweat. Thus, if it is indeed Yang-syndrome cholera, boldly administering Jijiu Huisheng Dan will surely save life. If one cannot determine whether it is Yin or Yang, administering Weisheng Fangyi Baodan will also be effective.

Weisheng Fangyi Baodan can induce sweating even in larger doses. It is effective for cholera regardless of whether the cause is cold or heat, and it treats all acute diseases and Sha Zheng (sand poisoning), including headache, irritability, limb pain, diarrhea, dysentery, and hiccups (especially effective for hiccups). For healthy individuals, taking 20 pills after each meal promotes rapid digestion and increases appetite, making it an excellent stomach-strengthening medicine. Daily use can further prevent various miscellaneous diseases and avoid infection.

There are cholera cases where the above two formulas are ineffective, specifically those where vomiting and diarrhea are extreme, and the patient is on the verge of collapse with faint breath. Medical books refer to such cholera as "Tuoyi" (collapse-epidemic), referring precisely to this condition. At this stage, regardless of whether the cause is cold or heat, one should urgently administer Renshen (Ginseng Radix) 8 qian to restore Yang, Sheng Shanyao (Dioscoreae Rhizoma) 1 liang and Sheng Hangshao (Paeoniae Radix Alba) 6 qian to nourish Yin, Shanzhuyu (Corni Fructus) 8 qian to consolidate the collapsing Liver Qi (At the start of vomiting/diarrhea, Liver Wood aids the pathogen and insults Spleen Earth; at the extreme, Liver Qi collapses first. Consolidating Liver Qi secures Yuan Qi), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) 3 qian to harmonize the dissipated Middle Qi, Hematitum (Ochre) fine powder 4 qian to guide the power of Renshen downward to prevent vomiting, and Cinnabaris (Cinnabar) with Tongbian (Children's Urine) (First, take 5 fen of Cinnabaris fine powder delivered with warm Children's Urine, then decoct and take the preceding medicine) to interact Heart and Kidney. This formula is named Jijiu Guiyang Tang (Emergency Rescue Yang Decoction) and actually tonifies both Yin and Yang. If the heart feels hot, add Tiandong (Asparagi Radix) 6-7 qian. If the body is cold, pulse is absent, and there is no sensation of heat in the heart, remove Shaoyao (Paeoniae Radix) and add Wufuzi (Aconiti Lateralis Radix Preparata) 1 qian. If the heart still feels hot, even if the body is cold and pulse is closed, do not administer hot medicines. If sweating is excessive, Shanzhuyu can be used up to over 1 liang. For Renshen in the formula, if Yetaishen (Wild Ginseng from Taihang Mountains) is used, follow the dosage in the formula; if Yeshanshen (Wild Mountain Ginseng) is used, the dosage should be halved, stewed separately, and mixed in. Note: This formula should be used after vomiting and diarrhea have stopped. If the condition is critical but vomiting and diarrhea persist, one must still differentiate cold and heat, use the previous two formulas to clear internal toxins, and then follow with this formula. The interval between medications should be about one and a half hours. I once treated an elderly woman surnamed Kou in Fengtian who had cholera vomiting and diarrhea for a day and night. When I examined her, vomiting and diarrhea had stopped, her whole body was cold, six pulses were closed, she was mentally confused, eyes closed and silent, but responsive to calls and often frowned. Knowing the cholera toxin was still disturbing her heart, I asked about her symptoms during vomiting/diarrhea. She frequently said her heart felt hot and she craved cold water, confirming Yang syndrome. I first gave her one-third of Jijiu Huisheng Dan, administered with warm boiled water. Half an hour later, her condition seemed calmer, but she remained cold and pulseless. I had her decoct one dose of Jijiu Guiyang Tang and administered it slowly, instructing to give small amounts of warm boiled water occasionally after medication. The next morning, upon re-examination, she had fever, her pulse emerged, she could speak, but still complained of intense heart heat. I then used Xuanshen (Scrophulariae Radix) 2 liang and Lushen (Codonopsis Radix) 1 liang, decocted in a large bowl, and instructed her to drink it slowly and warmly. She recovered after finishing the dose. Studying this case carefully reveals the key principles for using Jijiu Guiyang Tang.

The three formulas proposed above for treating cholera are: Jijiu Huisheng Dan is suitable for cholera biased towards heat; Weisheng Fangyi Baodan is suitable for cholera biased towards cold; Jijiu Guiyang Tang saves cholera cases on the verge of collapse. Formulas for treating cholera seem roughly complete. However, there are cases of extreme cold and extreme heat in cholera, requiring separate discussion. The *Shanghan Lun* discusses cholera primarily as cold, especially severe cold. Formulas like Lizhong Tang plus Fuzi (Aconiti Radix) and Tongmai Sini Tang plus Renshen are medicines for severe cold. However, in various sections, it mentions aversion to cold, limb stiffness, cold limbs, or vomiting/diarrhea with sweating, or preferring no water due to cold. Only when these signs appear and the pulse is deep, thin, and nearly imperceptible, should one consider using these *Shanghan Lun* formulas to urgently restore Yang. After Yang is restored, some may feel irritability and heat; in such cases, one should urgently take cool-moistening and Yin-nourishing medicines to conclude the treatment. Because once Yang is restored, the heart beats strongly, the pulse returns, the body warms, and vomiting/diarrhea stop. Due to previous severe vomiting/diarrhea damaging Yin, irritability and heat often occur after Yang restoration, necessitating cool-moistening Yin-nourishing medicines for recovery. Such cases are rare; having experienced cholera many times, I have treated only four or five such cases.

Extreme heat cholera, however, is common. I recall in early autumn of the Renyin year (1902), cholera was rampant in my county. Those treated with cooling methods mostly failed, and those treated with warming methods had mixed results. Only those who drank freely from newly drawn well water recovered. I cured several such cases by heavily using Lingyangjiao (Saigae Tataricae Cornu). Later, I asked several people who recovered by drinking well water. They said that although they had simultaneous vomiting and diarrhea, faint pulse, and cold body, their hearts were hot and thirsty, unbearable for moments. Only drinking cold water provided relief, though it was vomited up shortly after, requiring repeated drinking. In half a day, they drank nearly a large bucket of cold water, after which the heat/thirst gradually subsided, and vomiting/diarrhea stopped. Note: Ice water or ice blocks should ideally be consumed, but villages lacked ice, so well water was substituted.

In late summer of the Dingmao year (1927), the weather was extremely hot. Before sleeping, I accidentally ate several pieces of watermelon. Upon waking at dawn, I felt mental disturbance and nausea, vomiting three times, followed by diarrhea. I urgently took 1 qian of Jijiu Huisheng Dan, and my heart felt slightly calm. Soon, the illness returned, with heart heat, rising fire energy, right leg spasms, but no body coldness or pulse closure. I knew it was purely a heat syndrome. The *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) uses Zhizhong Tang (i.e., Lizhong Tang) for cholera, adding Shigao (Gypsum Fibrosum) for spasms, indicating that Shigao can be heavily used for cholera with heat. I then decocted a large dose of Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). After taking it, the illness improved slightly. Soon, it relapsed, with heart heat/thirst and craving for ice. I bought ice, broke it into small pieces, and swallowed them. In half an hour, I ate about 2 jin (approx. 1 kg) of ice. Heat, thirst, vomiting, and diarrhea all stopped, and the illness vanished. Although this was triggered by eating cold food exciting latent summerheat, vomiting, diarrhea, and spasms constitute cholera. These two cases represent extreme heat. In places without well water or ice, fresh pear slices or watermelon dipped in raw Shigao (Gypsum Fibrosum) fine powder can be eaten. This is my formula for treating Yangming extreme heat in cold-warm diseases accompanied by vomiting and drug rejection. Ultimately, at the onset of the disease, extreme cold cases should first take Weisheng Fangyi Baodan, and extreme heat cases should first take Jijiu Huisheng Dan, because both drugs can eliminate bacteria and assist the heart, preventing the heart from being paralyzed by toxins, thus avoiding danger.

Shen Jiren (from Shunyi County) said: "Cholera has Yin and Yang differentiation. If in June or July, one sits by a window or sleeps outdoors, and suddenly develops vomiting, diarrhea, leg cramps, blue eye sockets, black lips, cold body, sweating, and deep-hidden pulse, this is Yin syndrome. Urgently needle Chize (LU5), Shaoze (SI1), Weizhong (BL40) (deep by about 1 cun), and Shixuan (EX-UE11). If vomiting/diarrhea persist, needle Zhongwan (CV12) and Shuifen (CV9); the disease will heal immediately. If there is fever, no sweat, deep-tight pulse, severe abdominal pain, inability to vomit despite urge, and bloating/inability to defecate, this is Yang syndrome. Urgently needle Shaoshang (LU11), Weizhong (BL40), Chize (LU5). If abdominal pain persists, needle Qihai (CV6), Zhangmen (LR13), Zusanli (ST36). Following these acupuncture and moxibustion methods ensures recovery.

Note: This differentiation of Yin and Yang syndromes is quite accurate. He states that leg cramps in Yin syndrome are not 'Zhuanjin' (spasms/twisting tendons) but rather the 'limb stiffness' mentioned in the *Shanghan Lun*. True 'Zhuanjin' occurs in both Yin and Yang syndromes. Blue eye sockets and black lips are clear signs of Yin syndrome. Cold body and deep-hidden pulse can occasionally occur in Yang syndrome, but Yin syndrome at this stage usually involves aversion to cold and a desire for thick coverings; Yang syndrome never involves aversion to cold, even refusing single blankets. His statement that Yin syndrome has sweat and Yang syndrome does not is most accurate. Regarding abdominal pain, he omitted it for Yin syndrome but emphasized it for Yang syndrome. This is because in Yang syndrome, the pathogen and righteous Qi struggle, retaining resistance; inability to vomit/defecate causes pain, and frequent vomiting/diarrhea also often causes pain. In Yin syndrome, the pathogen is too strong, and righteous Qi too weak, lacking resistance entirely. There might be abdominal pain initially, but it ceases after a few episodes of vomiting/diarrhea. Naming abdominal pain with inability to vomit/defecate as 'Dry Cholera' and attributing it exclusively to Yang syndrome shows unique insight. The十余 (more than ten) acupoints discussed are crucial for treating this condition. Even those unfamiliar with acupuncture should learn these points for emergencies. Combining acupuncture and herbal medicine accelerates recovery. In summary, regardless of cold or heat, if the pathogen resembles tadpole-shaped curved tails, it is cholera. Additionally, Bao XX from Tianjin said: 'For pure Yin cholera with no heat sensation, I use large slices of fresh ginger arranged densely on the navel, two layers thick, and apply moxibustion with mugwort wool sized like a jujube. Vomiting, diarrhea, and spasms stop immediately.'"