陈芰裳之太夫人，陡患呕吐，彻夜不止。次早延孟英诊之，自述因寒而致。孟英知芰裳进场，家无主药之人，
若明言属“热”，必致畏药不服，漫应曰∶固“寒”也。而疏方则以（黄）芩 （黄）连 栀（子） （川）楝
等，以大苦寒为剂，投之良愈。
赵子善令嫒，患发热呕吐，口渴便秘，而年甫三龄，不能自言病苦。孟英视其舌，微绛，而苔却干黄。因与∶
海 鼠矢 竹茹 知母 花粉 杏（仁） 贝（母） （山）栀 （石）斛之药，二剂，果下未化宿食，色酱
粘腻。设投俗尚，予温燥消散法，必致阴竭而亡。继往维扬，孟英临别赠言，谓其体质，勿宜温补。次年患病，
果为参、术殒命，惜哉！
朱湘搓令郎留耕，忽于饱食后大吐而厥，冷汗息微。急延孟英视之，厥甫回而腹痛异常，口极苦渴，二便不行，
脉来弦缓。乃痰滞而热伏厥阴，肝气无从疏泄也。投∶雪羹 栀（子） 楝（实） 元胡 苁蓉 （吴）萸 （
黄）连 橘核 旋复 竹茹（芦）菔汁之药，一剂痛减，再服，便行而愈。
上古无痘，至汉始有，今时罕有不出痘者。以生齿日繁，地气日热。所以古人最重伤寒，而今世偏多温热也。
于此日上海病因，尤为贴切。地气以日热，秽气亦日盛，若伏暑欲发，客邪外入，两邪交讧，肠胃乃乱，故气道立
时闭塞，血脉因而瘀滞，四肢厥冷，手面皆黑。阳明多气多血之经，见证若是之骤者，非气血忽然枯槁也。夫人气
以成形耳，气不流行，血肉即死。故初起亟宜开闭。俾气通血活，邪得外泄，则正（气）自复。昧者不知邪闭血凝，热
深厥深之理，见其肢冷脉伏，即以为寒，又疑为脱，既不敢刺，更投热药，使邪无宣泄，愈闭愈冷，虽七窍流血而
死，亦不悔悟。亦有邪闭而正气无以自容而外脱者，阳从上脱则汗多而气夺，阴从下脱则泻多而液亡。所谓内闭外
脱也。欲其不外脱，必开其内闭，如紫雪、绛雪、行军散，皆开闭透伏之良方也。而飞龙夺命丹即合行军、绛雪
二方而加峻者，且有人中白引浊下行，尤具斩关夺命之能。
丁酉（岁），八九月间，杭州盛行霍乱转筋之证。沈氏妇，夜深患此，继即音哑厥逆。比晓，孟英诊其脉，弦细
以涩，两尺如无，口极渴，而沾饮即吐不已。足胫坚硬如石，转时痛楚欲绝。乃暑湿内伏，阻塞气机，宣降无权，
乱而上逆也。为仿《金匮》鸡矢白散例，处蚕矢汤一方。令以阴阳水煎成，候凉徐服。此药入口竟不吐。外以烧
酒，令人用力摩擦其转戾坚硬之处。擦及时许，郁热散而筋结始软，再以盐卤浸之，遂不转戾，吐泻渐止。日晡（
即下午三时至五时），复与前药半剂，夜得安寐。
次日，但觉困极耳。与致和汤数服而痊。
后治相类者多人，悉以是法出入获效，惟误服附子者，最难救疗。
郑凤梧，年六十余，秋间患霍乱，凛寒厥逆，烦闷躁扰，口不甚渴。孟英诊之，脉细欲伏，苔白而浓，乃暑湿
内蕴未化也。须具燃犀之照，庶不为病所蒙。因制燃照汤与之，一饮而厥逆凛寒皆退，脉起而吐泻渐止。随以清
涤法愈之。
陆叟，年七十余。仲秋患霍乱。自服单方二三日，呕吐虽已，且频频作哕，声不甚扬。面赤目闭，小便不通。
孟英视之，脉虽虚软，并无脱象。况舌赤而干，利下臭恶。（此证乃）气分伏暑，业扰及营，虑其络闭神昏，胡
可再投热剂？遂以∶紫雪（丹）三分，用竹茹 枇杷叶 通草 丹参 连翘 石菖蒲 桔梗 黄芩 芦根煎汤，
候冷，调而徐服。
次日复诊，目开哕止，小溲稍行，于前方裁去紫雪，加石斛、苡仁，服二剂，利减能啜米饮矣。随用致和
汤十余服而瘳。
一妇，年少体瘦，初秋患霍乱转筋，舌绛目赤，大渴饮冷，脉左弦强，而右滑大。此肝胃之火素盛，而热
复侵营也。以∶白虎汤去（粳）米、（甘）草，加生地、蒲公英、益母草、黄柏、木瓜、丝瓜络、薏苡仁，一剂
知，二剂已。丹溪云∶“转筋由于血热”，此证是矣。
纪运翔，年十七。五月（患）霍乱，势亦垂危。孟英往视，然已手面皆黑，目陷睛窜，厥逆音嘶，脉伏无溺，
舌紫苔腻，大渴汗淋，神情瞀乱，危象毕呈。时未交芒种，暑湿之令未行，仍是冬寒内伏，春令过冷，入夏犹
凉，气机郁遏不宣，故欲变温病者，皆转为此证。殊途同归，但不腹痛耳。以寒邪化热，究与暑湿较异也。亟令
刺曲池。委中，出血如墨。方以黄芩为君，臣以（山）栀、（豆）豉、（黄）连、（竹）茹、（薏）苡、半（夏
），佐以蚕矢、芦根、丝瓜络，少加吴茱萸为使，阴阳水煎，候温，徐徐服之，遂不吐。
次日，脉稍起，又两剂，黑色稍淡，肘膝稍和，反加睛赤烦躁，是伏邪将从外泄也。去吴萸、蚕矢，加连翘、
益母草、滑石，而 发遍身，苔始渐化，肢温得寐，小溲亦行。随予清搜化毒之药，多剂而痊。名其方曰“黄芩定
乱汤”。嗣治多人，悉以此法增损获效。有史客，素吸洋烟而患此证，与此方数贴后，反便秘目赤，渴汗昏狂，
亦是久伏之邪，渐欲外越也。与竹叶石膏汤加减而瘳。
此外，湿盛者，加茵陈，滑石，气实者，加枳（壳）、桔（梗）；饮阻食滞者，加浓朴、莱菔；肝郁气结
者，加紫苏、楝实。口渴，用茅根汤或藕汁频灌。
王季杰外家，秋夜陡患霍乱，腹痛异常。诊其脉，细数而弦，肢冷畏寒，盖覆甚浓。询其口，不渴而泻，亦
不热，然小溲全无，吐者极苦，舌色甚赤。（孟英）曰∶此新凉外束，伏暑内发也。以绛雪、玉枢丹灌之皆不
受。泻至四五次，始觉渐热，而口大渴，仍不受饮，语言微謇。孟英令捣生
藕汁徐灌之，渐能受。随以∶（黄）芩 （黄）连 （薏）苡 楝（实） 栀（子） （竹）茹
桑（叶） （石）斛 蒲公英，煎服，痛即减，吐泻亦止。改用轻清法而愈。
陈妪，年已七旬，辛亥秋，患霍乱转筋甚危，亟拉孟英救之，已目陷神消，肢冷音飒
，脉伏无溺，口渴汗多，腹痛苔黄，自欲投井（此乃烦渴之极也）。令取西瓜汁先与恣饮，方
用∶白虎（汤） 加（黄）芩、（黄）连、黄柏、木瓜、威灵仙，略
佐细辛分许为剂，覆杯即安。人皆疑用药太凉，何以径效？孟英曰∶凡夏热亢旱之年，入秋多有此证。岂非伏
暑使然，况见证如是之炽烈乎？今秋，余已治愈多人，询其病前有无影响？或曰∶五心烦热者数日矣。或曰∶别
无所苦，惟见物如红如火，已而病即陡发。夫端倪如此，更为伏暑之的据焉。
附∶一仆夫，纵酒饮食无节，患霍乱吐泻，转筋烦渴等症，几殆。时六七月，霖雨昼夜，饮檐流（溜）水
数升而愈。《千金方》云∶“轻者，水瘥”。此偶合古方，余目见其事。后路途中，及六合县，见一人亦患此，
服新汲井水，愈。（摘自《陈修园医书七十四种·霍乱论》）。
钱某，患霍乱，自汗，肢冷，脉无。平日贪凉饮冷，人谓寒证，欲用大剂热药，孟英曰∶苔虽白，然浓，而（舌）
边绛，且渴甚，头大痛。不可因寒凉致病，而不察其有暑热之伏也。遂以五苓（散）去（白）术，加黄连、浓朴、
黄芩、竹茹、木瓜、扁豆叶，服后，脉稍出，汗渐收，吐利亦缓。即去肉桂，加桑枝、滑石、甘草，头痛、
吐、利皆止，苔色转黄，随用清暑和中而愈。
丁姓，患霍乱。苔色白薄而不渴，但觉口中粘腻。彼自知医，欲从寒湿治。孟英曰∶中焦原有寒湿，所以不渴。
然而粘腻，岂非暑入而酿其湿为热乎？以∶胃苓（汤）去甘（草）、（白）术，加苡仁、黄连、半夏、枇杷叶，
二剂而瘳。
胡泉琴舅氏家之潘妪，年逾古稀，患霍乱转筋频危。孟英用自制蚕矢汤治之而瘳。
某老人，霍乱后，目闭呃忒。医谓“陷脱在即”，拟与桂、附回阳，而未服。孟英询之，
得知溺赤口渴，脉情软数。改与整肃肺胃之剂，果得渐安。
段尧卿之太夫人，患霍乱转筋，年逾七十。孟英投自制连朴饮，三啜而瘳。
陈楚珍媳，陡患霍乱，脐间贴以回阳膏而不效。孟英按脉，滑数右甚，口渴苔黄。令揣胸下，果坚硬而痛。
曰∶吐泻虽多，食尚恋膈，非寒证也。回阳膏亟宜揭去，以∶菖（蒲） 枳（实） 苏（叶） （黄）连 （黄）
芩桔（梗） （竹）茹 牛（蒡） 海 芦菔为剂，一服而瘳。
王寿和，甫六岁，陡患凛寒身热，筋 面红，谵妄汗频，四肢厥冷，苔色黄腻，口渴唇红。（孟英曰）∶此
时邪挟食也。以∶枳实 栀豉汤加菖蒲及冬干芦菔菜，煎成（汤），调入玉枢丹五分灌之。
次日，谵、 皆减，而腹痛吐泻，邪欲转霍乱以外泄也。孟英谓∶“不但伤寒可转霍乱，温热暑湿皆可转
霍乱也”。治当迎刃而导之，于前方加苏叶一分、黄连二分，同炒煎服。连吐三、五次，泻六、七次，痛即减。
第三日，神始爽慧。然“去疾莫如尽”。再服原方一剂，遂愈。凡小儿之病，因于食滞者多。胃不和则卧
不安，阳明实则谵 。若吐泻，乃病之出路，而世人动辄以惊风药治之，每致偾事。
钱某，患霍乱，兼吐蛔十余条，而口干脉细。是暑伏厥阴以犯中也。以∶（黄）连 （乌）梅 （竹）茹
（川）楝 （薏）苡 （石）斛 苏（叶） （黄）芩，清之而愈。
陈某，患霍乱。而所下皆血。苔黄大渴，而舌色紫黯。乃暑毒深伏，起病时又饮烧酒也。用∶犀角 益母
地丁 茅根 菖蒲 绿豆 银花 （黄）芩 （黄）连 黄柏 藕汁，大剂灌之，投匕而瘥。
李华甫继室，陡患霍乱，兼溺血如注，头痛如劈，自汗息微，势极危殆。速孟英诊视，脉甚弦驶。曰∶此肝
火内炽，暑热外侵也。以∶犀角 木通 滑石 栀子 竹叶 薏苡 银花 茅根 菊叶为大剂，和入藕汁，送
当归龙荟丸，吐泻即已，溺血亦减。惟小便时头犹大痛，必使人紧抱其头，重揿其巅，始可略耐。尚是风阳僭
极，肺胃不清也。以∶苇茎汤去桃仁，加百合、白薇、元参、小蓟、蒲公英、竹叶、西瓜翠衣、莲子心为方，
和入童溺，仍吞当归龙荟丸，服旬日痊愈。
张二梅，年逾六旬，秋间患霍乱转筋。医见高年而厥逆多汗，拟进温补，张不敢服。但用平淡单方，及外治法
而瘥。然从此大便不坚，时时自汗，遍身疮疥，畏热异常。立冬后，孟英诊之∶脉甚滑数，口渴苔黄，便溺皆热，
犹着夹衣，是赋质偏阳，湿热内盛。幸而未进温补，得以引年，与大剂清化法，渐愈。
某传一方，（治遍身疮疥）颇佳，以麻黄（一两） 川椒（五钱） 蛇床子（五钱） 斑蝥（七枚），雄猪油或地沥青
熬透去渣。另用明矾 黄柏（各一两） 蓖麻子 大枫子（各四十粒），共研细末，调入油内，绢包擦患处，能拔蕴毒伏
邪，未出旬日可愈。无后患。比余（孟英自称）火酒摩转筋之义正同。
姜秋农，疟泻初痊，遽劳奔走，陡患霍乱转筋。面臂色紫，目陷音嘶，胸闷苔黄，汗
多口腻，神疲溲秘，脉细而弦。孟英以∶沙参 蚕矢 苡仁 竹茹 半夏 丝瓜络 木瓜 车前子 扁豆叶 阴阳水
煎，送左金丸一钱，外以吴萸一两研末，盐水调涂涌泉穴。
服后，吐泻渐止，噫气不舒，呃忒胁痛，汗减口燥，脘下拒按，脉软而弦。以素多肝郁也。去沙参、蚕矢、木
瓜、车前、左金（丸）。加紫菀、郁金、楝实、通草、枇杷叶，二贴（后），溲行呃止，苔退足温，腰胀腿痛，手紫
渐淡，去郁（金）、（紫）菀、（木）通、（川）楝，加沙参、石斛、兰叶、藕（肉）、鲜稻头。
亦二帖，脉和胀减，啜粥口咸，体素阴亏也。去半夏、扁豆叶，加归身、花粉、橘皮。
又二帖，大解行而安谷，腰酸少寐。为易∶西洋参，加麦冬、羊藿以调之。
数贴后，又加枸杞、杜仲而愈。
蒋循庵媳，患霍乱转筋，交三日矣。厥逆目窜，膈闷无溺，苔黄苦渴，脉极弦细。屡进桂、附、姜、术，气逆
欲死。与∶昌阳泻心汤加减，煎成徐服。外以吴萸研末，卤调贴涌泉穴，服二剂，吐止足温。去（紫）苏、（浓）朴，
加（川）楝、（石）斛、蒲公英，多剂获痊。盖伏暑挟素盛之肝阳为病，误服温补，以致遽难廓清也。
戚媪者，年六十余矣，自幼佣食杭州黄连泉家，忠勤敏干，老而弥甚。壬寅秋，患霍乱转筋。余（孟英）视之，
暑也。投蚕矢汤，两帖而瘥。
三日后，忽蜷卧不能反侧，气少不能语言，不食不饮。莲泉惶惧，就近邀一老医诊之，以为“霍乱皆属于寒”，且
昏沉欲脱，定附子理中汤一方。莲泉知药猛烈，不敢遽投，商之王君安伯，安伯云∶且忽服也。若谓寒证，则前日之
药，下咽即毙，吐泻安得渐止乎？莲泉大悟。乃着人飞刺招余往勘。余曰∶此高年之体，元气随吐泻而虚，治宜用
补，第余暑未清，热药在所禁耳（先清后补，缓急之间，此中须大学问）。若在孟浪之人，必以前之凉药为未当，今日温
补为极是，纵下咽不及救，亦惟归罪于前手寒凉之误也。设初起即误死于温补，而举世亦但知霍乱转筋，是危险之
Madam, the grandmother of Chen Jishang, suddenly suffered from vomiting that lasted all night. The next morning, Meng Ying was invited to diagnose her. She claimed it was caused by cold. Knowing that Jishang had gone to take the imperial examination and there was no one in charge of medication at home, Meng Ying knew that if he explicitly stated it was a "heat" syndrome, the patient would fear taking medicine and refuse treatment. So he casually agreed, saying it was indeed "cold." However, he prescribed a formula containing Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Chuanlianzzi (Meliae Semen) as a major bitter-cold decoction. After administration, she recovered quickly.
Miss Zhao, daughter of Zhao Zishan, suffered from fever, vomiting, thirst, and constipation. At only three years old, she could not express her suffering. Meng Ying observed her tongue, which was slightly crimson (deep red) with dry yellow coating. He therefore prescribed Haipiaoxiao (Sepiae Endoconcha), Shuzhi (Trogopterori Faeces), Zhuru (Bambusae Caulis in Taeniam), Zhimu (Anemarrhenae Rhizoma), Huafen (Trichosanthis Radix), Xingren (Armeniacae Semen Amarum), Beimu (Fritillariae Bulbus), Shanzhizi (Gardeniae Fructus), and Shihu (Dendrobii Caulis). After two doses, undigested food residue was passed; it was dark brown and sticky. Had the common practice of warm-drying and dispersing methods been used, it would certainly have led to exhaustion of Yin and death. Later, when visiting Weiyang, Meng Ying advised on parting that her constitution was unsuitable for warm tonification. The following year, when she fell ill, she indeed died due to the consumption of Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). What a pity!
Liu Geng, son of Zhu Xiangcuo, suddenly vomited violently and experienced limb coldness (Jue) after a full meal, with cold sweat and faint breathing. Meng Ying was urgently summoned. As soon as the limb coldness resolved, severe abdominal pain ensued, accompanied by extreme bitterness and thirst in the mouth, and obstruction of urination and defecation. The pulse was wiry and slow. This was phlegm stagnation with heat concealed in the Jueyin channel, preventing the free flow of Liver Qi. A prescription of Xiegeng Tang (Snow Broth Decoction) added Zhizi (Gardeniae Fructus), Lianshi (Meliae Fructus), Yuanhu (Corydalis Rhizoma), Congrong (Cynomorii Herba), Wuzhuyu (Evodiae Fructus), Huanglian (Coptidis Rhizoma), Juhe (Citri Reticulatae Pericarpium), Xuanfu (Inulae Flos), Zhuru (Bambusae Caulis in Taeniam), and Luofu juice (Radish Juice) was administered. Pain decreased after one dose; after another dose, bowel movement occurred, and she recovered.
In ancient times, smallpox did not exist; it appeared starting from the Han Dynasty. Nowadays, few people do not contract smallpox. This is because the population has increased daily, and the earth's qi has become increasingly hot. Therefore, ancients valued Shanghan (Cold Damage) most, while modern times see more Wenre (Warm Heat) diseases. This is particularly applicable to the etiology in Shanghai today. As the earth's qi becomes hotter day by day, turbid qi also increases. If latent summer-heat is about to erupt and external pathogenic factors invade, the two pathogens clash, causing chaos in the intestines and stomach. Consequently, the airway closes immediately, blood vessels become stagnant, limbs turn cold, and hands and face turn black. The Yangming channel is rich in qi and blood; such sudden manifestations are not due to sudden exhaustion of qi and blood. Human form is constituted by qi; if qi does not circulate, flesh and blood die. Therefore, at the onset, it is urgent to open the blockage. Once qi flows and blood activates, pathogens can be expelled externally, and healthy qi will recover naturally. Ignorant practitioners do not understand the principle that deep heat causes deep coldness (Re Shen Jue Shen). Seeing cold limbs and hidden pulses, they assume it is cold or collapse. They dare not puncture and instead administer hot medicines, preventing pathogen expulsion. The more blocked, the colder it gets. Even if bleeding from the seven orifices occurs leading to death, they remain unrepentant. There are also cases where pathogens block internal qi, forcing healthy qi to escape externally. Yang escaping from above leads to excessive sweating and loss of qi; Yin escaping from below leads to excessive diarrhea and loss of fluids. This is called internal blockage with external collapse. To prevent external collapse, one must open internal blockage. Formulas like Zixue (Purple Snow), Jiangxue (Crimson Snow), and Xingjun San (Army March Powder) are excellent for opening blockages and venting latent pathogens. Feilong Duoming Dan combines Xingjun San and Jiangxue with stronger potency, and Renzhongbai (Calcinata Hominis Os) guides turbidity downward, possessing the ability to break through barriers and save lives.
In the Dingyou year, between August and September, Huoluan (Cholera-like disease) with tendon twitching prevailed in Hangzhou. Mrs. Shen contracted this illness late at night, followed by hoarseness and limb coldness. By dawn, Meng Ying diagnosed her pulse as wiry, fine, and choppy, with the Chi positions (Kidney pulse) feeling almost absent. Her mouth was extremely thirsty, but any sip caused immediate vomiting. Her calves were hard as stone, and the twitching caused excruciating pain. This was latent summer-dampness obstructing qi mechanism, losing its ability to diffuse and descend, causing chaotic upward reversal. Mimicking the Jishi Bai San (Chicken Dropping White Powder) example from *Jingui Yaolue*, he prescribed Can Shi Tang (Mulberry Twig Foot Decoction). He instructed to decoct it with Yin-Yang Water (a mixture of boiled and raw water), let it cool, and drink slowly. The medicine stayed down without vomiting. Externally, burning wine was applied with vigorous friction on the hardened, twitching areas. After an hour, the constrained heat dispersed, and the muscle knots softened. Then, brine was applied, stopping the twitching, and vomiting/diarrhea gradually ceased. In the afternoon (3-5 PM), half a dose of the previous medicine was given again, allowing peaceful sleep that night.
The next day, she felt only extreme fatigue. Several doses of Zhihe Tang (Harmonizing Decoction) cured her.
Subsequently, many similar cases were treated successfully using variations of this method. Only those who mistakenly consumed Fuzi (Aconiti Lateralis Radix Praeparata) were difficult to save.
Zheng Fengwu, over sixty years old, contracted Huoluan in autumn. He felt chills and limb coldness, with irritability and restlessness, but little thirst. Meng Ying diagnosed a fine, nearly hidden pulse and thick white coating, indicating latent summer-dampness not yet transformed into heat. One must possess the insight of a rhino-horn lamp to avoid being deceived by the disease. Thus, Ran Zhao Tang (Illuminating Observation Decoction) was prepared. After one dose, limb coldness and chills subsided, the pulse returned, and vomiting/diarrhea stopped. Subsequently, a clearing and purging method cured him.
Old Man Lu, over seventy, contracted Huoluan in mid-autumn. After self-medicating with folk prescriptions for two to three days, vomiting stopped, but hiccups persisted with low voice. His face was red, eyes closed, and urination obstructed. Meng Ying observed that although the pulse was deficient and soft, there were no signs of collapse. Moreover, the tongue was red and dry, and excrement was foul-smelling. (This syndrome is) latent summer-heat in the Qi level, disturbing the Ying level. Concerned about collateral blockage and confusion of spirit, how could hot agents be used again? Thus, 3 fen of Zixue Dan (Purple Snow Pill) was mixed with a decoction of Zhuru (Bambusae Caulis in Taeniam), Pipaye (Loquat Leaf), Tongcao (Tetrapanacis Medulla), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Lianqiao (Forsythiae Fructus), Shichangpu (Acori Tatarinowii Rhizoma), Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), and Lugeng (Phragmitis Rhizoma). It was cooled and taken slowly.
On the second day, upon re-examination, his eyes opened, hiccups stopped, and urination improved. Zixue was removed from the previous formula, and Shihu (Dendrobii Caulis) and Yiren (Coicis Semen) were added. After two doses, diarrhea decreased, and he could consume rice broth. Subsequently, over ten doses of Zhihe Tang (Harmonizing Decoction) cured him.
A young, thin woman contracted Huoluan with tendon twitching in early autumn. Her tongue was crimson, eyes red, with extreme thirst for cold drinks. The left pulse was wiry and strong, the right slippery and large. This indicated inherent excess fire in the Liver and Stomach, compounded by heat invading the Ying level. Baihu Tang (White Tiger Decoction) was modified by removing Jingmi (Oryzae Semen) and Gancao (Glycyrrhizae Radix), adding Shengdi (Rehmanniae Radix), Pugongying (Taraxaci Herba), Yimucao (Leonuri Herba), Huangbai (Phellodendri Cortex), Mugua (Chaenomelis Fructus), Sigualuo (Luffae Retinervia), and Yiren (Coicis Semen). Improvement was seen after one dose, recovery after two. Danxi said, "Tendon twitching arises from blood heat," which applies here.
Ji Yunxiang, seventeen years old, contracted Huoluan in May, with critical condition. Upon Meng Ying's visit, hands and face were black, eyes sunken with erratic movements, limb coldness, hoarseness, hidden pulse, no urine, purple tongue with greasy coating, extreme thirst, profuse sweating, and confused spirit—all critical signs presented. Although it was before Mangzhong (Grain in Ear solar term) and the summer-damp season had not arrived, winter cold was latent inside. Spring was too cold, and early summer remained cool, suppressing qi mechanism. Thus, conditions intended to transform into Warm Diseases turned into this type. Different paths, same destination, except for lack of abdominal pain. Since cold transforms into heat, it differs somewhat from summer-dampness. Urgently, Quchi (LI11) and Weizhong (BL40) were punctured to bleed, with blood coming out like ink. The formula used Huangqin (Scutellariae Radix) as Sovereign, Shan Zhi (Gardeniae Fructus), Douchi (Sojae Semen Preparatum), Huanglian (Coptidis Rhizoma), Zhuru (Bambusae Caulis in Taeniam), Yiyi (Coicis Semen), Banxia (Pinelliae Rhizoma) as Ministers, Can Shi (Mulberry Twig Foot) and Lugen (Phragmitis Rhizoma), Sigualuo (Luffae Retinervia) as Assistants, with a small amount of Wuzhuyu (Evodiae Fructus) as Guide. Decocted with Yin-Yang Water, warmed, and taken slowly, vomiting ceased.
The next day, the pulse rose slightly. After two more doses, the black color faded, elbows and knees relaxed, but eye redness and irritability appeared, indicating latent pathogens venting externally. Wuzhuyu and Can Shi were removed; Lianqiao (Forsythiae Fructus), Yimucao (Leonuri Herba), and Huashi (Talcum) were added. Rash broke out over the body, tongue coating began to resolve, limbs warmed, sleep was achieved, and urination resumed. Clearing and detoxifying herbs were then administered for several doses until recovery. The formula was named "Huangqin Dingluan Tang" (Scutellaria Stabilizing Cholera Decoction). Subsequent cases were treated successfully with modifications. A guest surnamed Shi, who smoked opium, contracted this. After several doses of this formula, he developed constipation, red eyes, thirst, sweating, and delirium, indicating long-latent pathogens attempting to exit. Zhuyegao Shi Tang (Bamboo Leaf and Scrophularia Decoction) modified cured him.
Additionally, for excess dampness, add Yinchen (Artemisiae Scopariae Herba) and Huashi (Talcum); for excess qi, add Zhike (Citri Reticulatae Pericarpium) and Jiegeng (Platycodonis Radix); for fluid retention and food stagnation, add Houpo (Magnoliae Officinalis Cortex) and Laifu (Raphani Semen); for Liver depression and qi knotting, add Zisu (Perillae Folium) and Lianshi (Meliae Fructus). For thirst, frequently administer Maogen (Imperatae Rhizoma) decoction or Ouji (Nymphaeae Semen Nelumbinis) juice.
Wang Jijie's relative suddenly contracted Huoluan on an autumn night with severe abdominal pain. Pulse was fine, rapid, and wiry; limbs were cold, fearing cold, covered heavily. Mouth was not thirsty, stool was loose, no fever, but no urination. Vomiting was extremely bitter, tongue very red. Meng Ying said: This is new coolness binding the exterior and latent summer-heat erupting internally. Jiangxue (Crimson Snow) and Yushu Dan (Jade Pivot Pill) were forced down but rejected. After four or five diarrheas, slight warmth was felt, but extreme thirst persisted, rejecting drinks, with slight speech impediment. Meng Ying ordered fresh Ouji (Lotus Root Juice) to be crushed and slowly fed, which was eventually accepted. Then, Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Yiyi (Coicis Semen), Lianshi (Meliae Fructus), Zhizi (Gardeniae Fructus), Zhuru (Bambusae Caulis in Taeniam), Sangye (Mori Folium), Shihu (Dendrobii Caulis), and Pugongying (Taraxaci Herba) were decocted and taken. Pain decreased, vomiting and diarrhea stopped. Light and clear methods completed the cure.
Old Madam Chen, over seventy, critically suffered from Huoluan with tendon twitching in autumn of Xinhai year. Meng Ying was urgently called. Eyes were sunken, spirit fading, limbs cold, voice faint, pulse hidden, no urine, thirst, sweating, abdominal pain, yellow coating. She wanted to jump into a well (extreme irritability/thirst). Watermelon juice was given freely first. Formula: Baihu Tang (White Tiger Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Mugua (Chaenomelis Fructus), Weilingxian (Syneilesis Herba), with a trace of Xixin (Asari Radix et Rhizoma). Peace was achieved after one cup. People doubted the cooling nature of the medicine, asking why it worked directly. Meng Ying said: In years of extreme summer heat and drought, autumn often sees this syndrome. Is it not caused by latent summer-heat? Especially with such fierce manifestations. This autumn, I have cured many. Asking about pre-symptoms: Some reported five-center heat for days; others saw objects as red/fire before sudden onset. These clues confirm latent summer-heat.
Appendix: A servant, indulging in alcohol and irregular diet, suffered Huoluan with vomiting, diarrhea, tendon twitching, and irritability/thirst, nearly dying. In June/July, continuous rain fell. He drank several liters of gutter runoff water and recovered. *Qianjin Fang* states: "For mild cases, water cures." This coincidentally matched an ancient prescription, witnessed by me. Later, en route and in Liuhe County, another person with this condition recovered after drinking fresh well water. (Excerpted from *Chen Xiuyuan's 74 Medical Books · Huoluan Lun*).
Qian Mou, suffering from Huoluan, spontaneous sweating, cold limbs, and absent pulse. Habitually seeking coolness and drinking cold liquids, others diagnosed cold syndrome and desired large doses of hot medicine. Meng Ying said: Although coating is white, it is thick, tongue edges are crimson, thirst is severe, and headache is intense. One must not ignore latent summer-heat just because the cause was cold/drink. Thus, Wuling San (Five-Ingredient Powder with Poria) minus Baizhu (Atractylodis Macrocephalae Rhizoma), plus Huanglian (Coptidis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taeniam), Mugua (Chaenomelis Fructus), and Biandouye (Lablab Leaf). After ingestion, pulse emerged slightly, sweating stopped, vomiting/diarrhea slowed. Rougui (Cinnamomi Cortex) was removed; Sangzhi (Mori Ramulus), Huashi (Talcum), and Gancao (Glycyrrhizae Radix) were added. Headache, vomiting, and diarrhea ceased. Coating turned yellow. Clearing summer-heat and harmonizing the middle cured him.
Ding Mou, suffering from Huoluan. Coating was thin white, no thirst, only sticky sensation in mouth. Self-diagnosing, he wished to treat Cold-Damp. Meng Ying said: Middle Jiao originally has Cold-Damp, hence no thirst. But stickiness indicates Summer-Heat entering and fermenting dampness into heat. Weiling Tang (Stomach-Poria Decoction) minus Gancao (Glycyrrhizae Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), plus Yiren (Coicis Semen), Huanglian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma), and Pipaye (Loquat Leaf). Two doses cured him.
Pan Po, aunt of Hu Quanqin, over seventy, critically suffered from Huoluan with frequent tendon twitching. Meng Ying cured her with his self-made Can Shi Tang (Mulberry Twig Foot Decoction).
An old man, post-Huoluan, had closed eyes and hiccups. Doctor said "collapse imminent," planned Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata) to restore Yang, but not taken. Meng Ying asked and learned of red urine, thirst, and soft-rapid pulse. Changed to formulas regulating Lung and Stomach, resulting in gradual peace.
Madam Duan Yaoqing, over seventy, suffered from Huoluan with tendon twitching. Meng Ying prescribed his self-made Lianpo Yin (Coptis and Magnolia Drink). Three cups cured her.
Chen Chuzhen's daughter-in-law suddenly contracted Huoluan. Applying Guiyang Gao (Restore Yang Plaster) to the navel failed. Meng Ying palpated a slippery-rapid pulse, stronger on the right, with thirst and yellow coating. Pressing below the chest revealed hardness and pain. He said: Despite vomiting/diarrhea, food remains stuck in the diaphragm; this is not Cold. Remove Guiyang Gao immediately. Prescription: Shichangpu (Acori Tatarinowii Rhizoma), Zhishi (Aurantii Fructus Immaturus), Zuye (Perillae Folium), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Jiegeng (Platycodonis Radix), Zhuru (Bambusae Caulis in Taeniam), Niubangzi (Arctii Fructus), Haipiaoxiao (Sepiae Endoconcha), and Luofu (Radish). One dose cured her.
Wang Shouhe, six years old, suddenly had chills, fever, facial redness, delirium, frequent sweating, limb coldness, yellow-greasy coating, thirst, and red lips. Meng Ying said: This is seasonal pathogen combined with food stagnation. Zhishi Zhizi Chi Tang (Immature Bitter Orange and Gardenia Tea Decoction) plus Shichangpu (Acori Tatarinowii Rhizoma) and dried winter Luofu vegetable was decocted. 5 fen of Yushu Dan (Jade Pivot Pill) was mixed in and fed.
Next day, delirium and惊悸 (palpitations/fright) decreased, but abdominal pain, vomiting, and diarrhea appeared, indicating pathogens venting via Huoluan. Meng Ying said: Not only Shanghan can transform into Huoluan; Warm-Heat and Summer-Damp can too. Treatment should guide the pathogen along its course. Add Zuye (Perillae Folium) 1 fen and Huanglian (Coptidis Rhizoma) 2 fen to the previous formula, stir-fry together, and decoct. After vomiting 3-5 times and diarrhea 6-7 times, pain decreased. On the third day, spirit cleared. "To remove disease completely is best." Another dose of the original formula cured him. Most pediatric illnesses stem from food stagnation. When Stomach is disharmonious, sleep is restless; when Yangming is full, delirium occurs. Vomiting/diarrhea are outlets for disease. Worldly practitioners often use Jingfeng (Wind-Shock) medicines, causing harm.
Qian Mou, suffering from Huoluan, vomited over ten roundworms, with dry mouth and fine pulse. This is latent summer-heat in Jueyin attacking the center. Huanglian (Coptidis Rhizoma), Wu Mei (Mume Fructus), Zhuru (Bambusae Caulis in Taeniam), Chuanlian (Meliae Semen), Yiyi (Coicis Semen), Shihu (Dendrobii Caulis), Zuye (Perillae Folium), and Huangqin (Scutellariae Radix) cleared the heat, curing him.
Chen Mou, suffering from Huoluan, passed only blood. Coating yellow, extreme thirst, tongue purple-dark. This is deep-seated summer-toxin, exacerbated by drinking liquor at onset. Xijiao (Rhinocerotis Cornu - note: substitute with Niujiao or Shuiniu Jia in modern practice, though text says Xijiao), Yimucao (Leonuri Herba), Dideng (Violaris Herba), Maogen (Imperatae Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma), Lvdou (Phaseoli Semen Mungo), Yinhua (Lonicerae Japonicae Flos), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), and Ouji (Nymphaeae Semen Nelumbinis) were used in large doses. Recovery occurred rapidly.
Li Huafu's second wife suddenly contracted Huoluan with massive hematuria, splitting headache, spontaneous sweating, and faint breathing—critical condition. Meng Ying diagnosed a wiry-rapid pulse. Said: Internal blazing Liver Fire with external invading Summer-Heat. Large dose of Xijiao (Rhinocerotis Cornu), Mutong (Akebiae Caulis), Huashi (Talcum), Zhizi (Gardeniae Fructus), Zhuye (Bambusae Folium), Yiyi (Coicis Semen), Yinhua (Lonicerae Japonicae Flos), Maogen (Imperatae Rhizoma), and Juye (Chrysanthemi Folium), mixed with Ouji (Lotus Root Juice), delivering Danggui Longhui Wan (Angelica and Gardenia Pill). Vomiting/diarrhea stopped, hematuria reduced. However, head still hurt severely during urination, requiring tight holding and pressing of the crown to endure. Wind-Yang was hyperactive, Lung/Stomach unclear. Weijing Tang (Reed Shoot Decoction) minus Tao Ren (Persicae Semen), plus Baihe (Lilii Bulbus), Baiwei (Clematidis Radix et Rhizomatis), Yuanshen (Scrophulariae Radix), Xiaoji (Sansevieriae Rhizoma), Pugongying (Taraxaci Herba), Zhuye (Bambusae Folium), Xiguacuiyi (Watermelon Rind), and Lianzixin (Nelumbinis Plumula), mixed with Tongni (Child's Urine), swallowing Danggui Longhui Wan. Cured after ten days.
Zhang Ermei, over sixty, contracted Huoluan with tendon twitching in autumn. Doctors saw elderly age, limb coldness, and sweating, planning warm tonification. Zhang refused. Used plain folk remedies and external treatments, recovering. However, stools became unformed, spontaneous sweating continued, body covered in sores/itching, extreme heat intolerance. After Lidong (Start of Winter), Meng Ying diagnosed slippery-rapid pulse, thirst, yellow coating, hot urination/defecation, yet wearing lined clothes. Constitution biased toward Yang, internal damp-heat. Fortunately, no warm tonification was taken, allowing longevity. Large doses of clearing-transforming methods gradually cured her.
A transmitted formula (for body sores/itching) is excellent: Mahuang (Ephedrae Herba) 1 liang, Chuanjiao (Zanthoxyli Pericarpium) 5 qian, Shechuangzi (Cnidii Fructus) 5 qian, Banmao (Mylabris) 7 pieces. Boiled in male pig fat or asphalt, strained. Separate Mingfan (Alumen), Huangbai (Phellodendri Cortex) 1 liang each, Bimazi (Ricini Semen), Dafengzi (Aleuritidis Fructus) 40 grains each. Grind to powder, mix into oil. Apply wrapped in silk to affected area. Draws out hidden toxins/pathogens. Cures within ten days without sequelae. Similar to my (Meng Ying's) use of medicinal wine for rubbing tendon twitching.
Jiang Qiunong, recently recovered from malaria/diarrhea, exerted himself running, suddenly contracting Huoluan with tendon twitching. Face/arms purple, sunken eyes, hoarse voice, chest stuffiness, yellow coating, sweating, sticky mouth, fatigue, urinary retention, fine-wiry pulse. Meng Ying used Shashen (Glehniae Radix), Can Shi (Mulberry Twig Foot), Yiren (Coicis Semen), Zhuru (Bambusae Caulis in Taeniam), Banxia (Pinelliae Rhizoma), Sigualuo (Luffae Retinervia), Mugua (Chaenomelis Fructus), Cheqianzi (Plantaginis Semen), Biandouye (Lablab Leaf), decocted with Yin-Yang Water, delivering Zuojin Wan (Left Metal Pill) 1 qian. Externally, Wuzhuyu (Evodiae Fructus) 1 liang ground, mixed with salt water, applied to Yongquan (KI1).
After dosing, vomiting/diarrhea stopped, belching uncomfortable, hiccups/costal pain, sweating decreased, mouth dry, tenderness below epigastrium, soft-wiry pulse. Due to inherent Liver depression, Shashen, Can Shi, Mugua, Cheqianzi, Zuojin Wan were removed. Ziwan (Adenophorae Radix), Yujin (Curcumae Radix), Lianshi (Meliae Fructus), Tongcao (Tetrapanacis Medulla), Pipaye (Loquat Leaf) added. After two doses, urination flowed, hiccups stopped, coating receded, feet warmed, waist distension/leg pain, hand purple fading. Yujin, Ziwan, Tongcao, Chuanlian were removed. Shashen, Shihu (Dendrobii Caulis), Lanye (Orchid Leaf), Ourou (Lotus Root Flesh), Xian Daotou (Fresh Rice Head) added.
Another two doses, pulse harmonized, distension reduced, salty taste when drinking porridge, indicating inherent Yin deficiency. Banxia, Biandouye removed. Guishen (Angelicae Sinensis Radix), Huafen (Trichosanthis Radix), Jupi (Citri Reticulatae Pericarpium) added.
Another two doses, bowel movement regular, appetite stable, lower back sore, poor sleep. Changed to Xiyangshen (American Ginseng), adding Maidong (Ophiopogonis Radix) and Yanghuo (Epimedii Folium) to regulate.
After several doses, Gouqi (Lycii Fructus) and Duzhong (Eucommiae Cortex) added. Cured.
Jiang Xun'an's daughter-in-law, Huoluan with tendon twitching for three days. Limb coldness, erratic eyes, chest stuffiness, no urine, yellow coating, bitter thirst, extremely fine-wiry pulse. Repeated Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Praeparata), Jiang (Zingiberis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma) caused qi rebellion nearing death. Changyang Xiexin Tang (Calamus and Pinellia Heart-Clearing Decoction) modified, decocted and taken slowly. Externally, Wuzhuyu (Evodiae Fructus) powder mixed with brine applied to Yongquan (KI1). Two doses stopped vomiting, warmed feet. Zisu (Perillae Folium), Houpo (Magnoliae Officinalis Cortex) removed. Chuanlian (Meliae Fructus), Shihu (Dendrobii Caulis), Pugongying (Taraxaci Herba) added. Multiple doses cured. Latent summer-heat combined with inherent hyperactive Liver Yang, worsened by mistaken warm tonification, making clearance difficult.
Old Madam Qi, over sixty, served in the Huanglian Spring household in Hangzhou since childhood, loyal, diligent, sharp, becoming more so with age. Autumn of Renyin year, contracted Huoluan with tendon twitching. I (Meng Ying) diagnosed Summer-Heat. Prescribed Can Shi Tang (Mulberry Twig Foot Decoction). Two doses cured.
Three days later, suddenly curled up unable to turn, short of breath unable to speak, refusing food/drink. Lianquan panicked, invited an old doctor nearby, who diagnosed "Huoluan belongs to Cold," noting coma/near-collapse, prescribing Fuzi Lizhong Tang (Aconite and Ginger Decoction for the Middle). Lianquan knew the medicine was potent and dared not administer immediately, consulting Wang Jun Anbo. Anbo said: Do not take it yet. If it were Cold, the previous medicine would have killed her instantly; how could vomiting/diarrhea have stopped? Lianquan realized greatly. Sent urgent message for me. I said: Elderly constitution, vital qi depleted by vomiting/diarrhea, requires tonification. However, residual summer-heat is not cleared; hot medicines are contraindicated (Clear first, tonify later; understanding urgency is crucial). A rash practitioner would blame previous cooling meds and insist on current warm tonification, even if death results, blaming the previous cold error. If initially misdiagnosed and died from warm tonification, the world would only know Huoluan with tendon twitching as dangerous...