柏银花 竹叶 橘皮 枇杷叶之方，冬瓜汤煎，一剂而热退神清，再剂霍然。
王某，久患吐血，体极孱弱，沈琴痴嘱其丐孟英治之，服药甫有小愈。而酷暑之时，陡患霍乱转筋，大汗如雨，
一息如丝。孟英视之曰∶阴血久夺，暑热鸱张，吾霍乱论中之缺典也。姑变法救之。用∶北沙参 枇（杷）叶
龙（骨） 牡（蛎） 木瓜 扁豆 苡仁 西滑石 桑叶 蚕砂 石斛 豆卷，投之良愈。嗣后每日调理，仍
服滋补以治宿恙。阅二载，闻服温补药，致血暴涌而亡。
周 ，于七月十八日夜，患霍乱转筋甚剧。仓促间，误服青麟丸钱许。比晓，急邀孟英诊之，脉微弱如无，
耳聋目陷，汗出肢冷，音哑肌削，危象毕呈。药恐迟滞，因嘱其母先煎高丽参汤亟为接续，随以∶（高丽）参 （白
）术 白芍 茯苓 附（片） （肉）桂 干姜 木瓜 苡仁 扁豆 莲实为方，一剂，各症皆减。
次日复诊，孟英曰∶气分偏虚，那堪吐泻之夺泄？误饵苦寒，阳微欲绝。昨与真武（汤）、理中（丸）合法，
脾胃之阳复辟矣。刚猛之品，可以撤去。盖吐泻甚而津液伤，筋脉失养，则为之转。薛生白比之“痉”病，例可推也。
凡治转筋，最要顾其津液，若阳既回而再投刚烈，则津液不能复而内风动矣。此治寒霍乱之用桂、附，亦贵有
权衡，不可漫无节治，致堕前功也。即于前方裁去（干）姜、附（片）、（肉）桂，加黄 、石斛，服至旬日而愈。
余（周 自称）谓此番之病，危同朝露，若非孟公，恐不能救，常闻张柳吟云∶但使病者听孟英论病之无微不入，
用药之无处不到，源源本本，信笔成章，已觉疾瘳过半。
古云∶“檄愈头风”，良有以也。
己丑（年）五月，天气骤热，孟英母，陡患霍乱，肢冷，自汗，脉微，苔白，腹大痛，欲重按。是中虚有
素，因热而受寒侵也。进大剂理中汤加桂枝、白芍，覆杯而愈，此所谓舍时从证也。
褚子耘使女患此，已身僵矣。孟英以夺命丹二分，嘱其灌入，顷刻活动，随以解毒活血汤，数服得生。
一人，孟英治愈后，已溺行能食。余热外泄，满面赤瘰，忽然神气瞀乱而死。
一人，孟英治愈，二便已如常矣。越数日，云饮食不得下，戴眼呃忒而逝。
一人，业已向愈，忽然神情恍惚，药不及救。
陈解香弟。患此垂危，孟英治愈，遂不服药，月余复来请勘，已咽痛碍进水谷，颐肿牙糜，牙关甚紧，痰嗽胁
痛，溺赤管痛，便溏色酱。此余毒蕴隆，失于清解，脉已弦紧数疾，莫可措手。并录以告贾旅者。
沈春泉，年五十七，立冬前五日，食蟹面后，陡患霍乱转筋，所吐泻者皆水。初进桂、附药，筋转益甚，
周身微汗，神倦懒言，指渐冷，脉渐伏，时欲太息。更方用∶牡蛎（一两） 龟板（八钱） 阿胶（四钱），服后势较剧。
孟英视之，苔黄大渴，小便全无，泻出极热，心下拒按。曰∶此伏暑挟食之证。不知何所见而与燥补涩腻之药？
嗣闻其次郎于立冬后，亦患此证，医知伏暑，用黄连等药，吐泻已止。因脉未遽起，不知为伏暑
未清，改投桂、附等，三帖而亡。尤可哀也。
陈艺圃，亦知医，其室人于仲秋患霍乱转筋，自诊以为寒也。投热剂，势益甚，招朱椒亭视之，亦同乎
主人之见也。病尤剧，乃延孟英决之，曰∶此寒为外束之新邪，热是内伏之真病。口苦而渴，姜、附不可投矣。
与∶河间法（谓表里双解、清热育阴之法），人皆不信也。再与他医商之，仍用热剂，卒至口鼻出血而死。极其
悔叹，始服孟英之卓识。余谓霍乱一证，近来时有，而医皆不甚识得清楚，死于误治极多。孟英特着专论，虽急
就成章，而辨晰简当，略无支漏，实今日医家首要之书，以其切于时用，不可不亟为熟读而研究哉！
罗吉人，立冬前，患霍乱转筋，某知其阴分素亏，病由伏暑，服药已得转机。数日后，渐有呃忒。孟英视
之∶脉弦数左甚，苔焦而渴，龈衄、脘闷、便溏色酱，小便短赤。皆伏暑未清，气机阻塞之象。既失清肃，当
脐尚贴回阳膏。屡嘱揭去不从，后闻不起。
石雨田母，年近五旬，陡患霍乱转筋，苔黄大渴，神情烦躁，证属伏暑，脉颇不恶，而浑身冷汗，摇煽不停，
已为阳越之象。不敢与方，寻即告殒。
朱巽泉父，年以六旬，患霍乱转筋，证不甚剧，问答音清，而脉微欲绝。亦决其不治，已而果然。
某，丙夜（指午夜）患此证，刺出黑血。侵晓，孟英往视，形脉两脱，大汗如淋，目陷音嘶，溺无苔腻，平素嗜
饮少谷，好善忘劳。（此）暑湿蕴中，正气溃散，勉投参药，竟不能救。
方氏女，播迁三载，秋抵申，患肿，因在旅寄，竟不调治。交霜降，肿忽消。不数日，又患霍乱，即神气瞀乱，
屋中盘走，口呼姊姊。乃姊强纳之卧，两目转旋不停，泪涔涔下，牙关即紧，欲延孟英诊，竟不及也。
孟英曰∶此流离困苦，忧郁深沉，木土相乘，吐泻而肿，节交霜降，气肃肿消，郁无所宣，直凌脾胃，吐泻陡
作，木火勃升，狂走目张，阳从上越，此情志内伤霍乱也。故告危如是之速。
徐氏，素无病，胃亦强，且善作劳，夜分忽泻二次，
晨起为孟英梳发未毕，又泻一次。因诊之，脉七至，而细促不耐按，略无病。若此脉病患不病，殆不始于今日，不
可救药也。既而泻颇缓，且食山东挂面一小碗，然尚能以乳哺女，而既吸之后，乳即瘪（塌陷）而不
起矣。形亦渐削，汗亦渐多，脉亦渐脱，音亦渐嘶，戌刻遽逝。及中气卒然溃散，绝无仅有之候也。
余抗（一）纸客，在舟次病此。至乞孟英诊之，已舌卷囊缩，口开苔黑，形脱神离，不可救药矣。询途中并未服
药，谛思其故，暑湿既可伏至深秋而发为霍乱，则冬伤于寒者，至春不为温病，亦可变为霍乱也。虽为温病之变证，
而温即热也，故与伏暑为病，不甚悬殊。且细绎仲圣书，亦未尝不微露其意也。如太阳与少阳合病，自下利者，与
黄芩汤，若呕者，黄芩加半夏生姜汤主之。张石顽注云∶温病始发，即当用黄芩汤去热为主。若伤寒必传至少阳，
热邪入里，方可用黄芩、柴胡解之。盖黄芩汤乃温病之主方，即桂枝汤以黄芩易桂枝而去生姜。以桂枝主在表之风
寒，黄芩主在里风热，乃不易之定法，其生姜辛散，非温热所宜，故去之。此表里寒热之不可不知者也。周禹载注云∶
明言太少二阳，何不用二经药？非伤寒也。伤寒由表入里，此则自内发外。无表何以知？或胁满，或头痛，或口苦引
饮，或不恶寒而即热，故不得谓之表也。如伤寒合病，皆表病也。今不但无表，且有下利里证，伤寒协热利，必自
传经而入，不若此之即利也。温何以即利？其人中气本虚，内伏已深，不能尽泄于外，势必下走利也。孟英谓∶
此论温邪外发未久，即可下走为利，本文更有“若呕者”句，岂非温病可转霍乱，早逗端倪于此乎？。曩纂《温热
经纬》，于此条下附注云∶少阳胆木，挟火披猖，呕是上冲，利由下迫，何必中虚始利，饮聚而呕？半夏、生姜，
专开饮结，如其热炽，易以（黄）连、（竹）茹。
或问半痴曰∶既肝郁于土而食不下行矣，何以干矢自遗而不觉乎？半痴谓∶胃与大肠，原一气相贯，惟其食滞
于胃而不化，似与大肠气不相贯。故广肠之宿粪出而不觉。经云∶“中气不足，溲便为之变”。是亦变也。所谓不足者，
非言中气虚也。以中气为病所阻，则不足于降浊升清之职，故溲便为之改常也。因思霍乱之吐泻无度，干霍乱之便闭
不行，皆变也。皆中气为病所阻，而不足于降浊升清之职也。设疑不足为虚，则诸霍乱皆当补中气为治矣。此说与
前释“邪之所凑，其气必虚”之说，可以互证。
八月初，秋阳正烈，姚欧亭，初七日忽然身热呕泻，白苔满布，神惫不支，腹痛汗频，音低溺涩。先与∶（人）
参（黄）连 （法半）夏 （浓）朴 （竹茹） 滑（石） 苡（仁） 苏（叶） 蚕砂 扁豆叶，二剂，热退
神清，而左脉仍弦，关上高，呕酸无寐，手足振惕。客邪虽解，土受木乘也，去滑（石）、（浓）朴、蚕砂、扁
豆叶，加茯神、蛤壳、紫菜、绿豆、白蔻仁，三剂，苔化能眠，知饥泻减。去（白）蔻
仁、蛤（壳），加菖蒲、白术，五剂而痊。此霍乱之开阖失常，中枢为邪所乱也。前案之开阖无权，中虚不能主持也。
同是一人，先后一虚一实，正可互勘。至于前病愈后之呕泻振惕，乃为风暑乘虚扰中之霍乱证。
朱鸣岐，患下利转筋。医见肢冷，即投温补，服药即吐，既而呃忒不已。温补加峻，病日以危，延至九朝。孟
英按脉，左至弦滑，右弱不应指，苔黄浓而腻浊，小水不行，脐上拒按。因谓曰∶病原不重，误药致剧。命不应死，
幸而得吐。与∶枳（实） 桔（梗） （黄）芩 （黄）连 （竹）茹 （半）夏 （紫）苏 （连）翘 芦根 枇
杷叶 滑石，开痰行气，舒结通阳。两剂呃果止，而遍身赤 。又二剂，燥矢下而苔化溺行，右脉渐振，随以
清肃法调养而瘥。
此证若初治得法，一二剂可愈。举世以泻证、吐证、霍乱证、霍乱转筋证皆为寒证，往往不察病情，辄投热药，
今见肢冷而右脉软弱，彼方以为虚寒的据，况服药即吐，呃忒随来，以为霍乱转筋而见呃忒，惶惶然以为虚脱之象，
故温补日以加峻，纵使一蹶不起，病者无怨，医家不悔（悟），授受相承，伎俩如是，良可慨已。此外，如胸腹疼
痛，疟疾哮喘，经阻产后等证，世俗亦多指为寒病，虽以热药刹（杀）之不知。呃忒则尤多枉死。孟英尝治一角妓，
患呃累日。此因破身太早，固是虚证，然血去阴伤，岂可反以温燥助热，遂至下焦不摄。妓性畏药，用一味鸡子黄，
连进数服而安。
A prescription composed of *Flos Lonicerae Japonicae* (Baiyin Hua), *Folium Bambusae* (Zhuye), *Pericarpium Citri Reticulatae* (Jupi), and *Folium Eriobotryae* (Pipaye), decocted with *Decoctum Benincasae* (Donggua Tang), resulted in the subsidence of fever and clarity of spirit after one dose, and a complete recovery from cholera after two doses.
Mr. Wang had suffered from hemoptysis for a long time and was extremely emaciated. Shen Qinchi advised him to seek treatment from Meng Ying. After taking medicine, he showed only slight improvement. However, during the intense heat of midsummer, he suddenly contracted cholera with tendon retraction, profuse sweating like rain, and a breath as thin as a thread. Upon examination, Meng Ying said: "Yin blood has been depleted for a long time, and summer-heat pathogenic factors are rampant. This is a missing case in my treatise on Cholera. I will temporarily alter the treatment method to save him." The prescription consisted of *Radix Ginseng Radicis Albae* (Beishashen), *Folium Eriobotryae* (Piye), *Os Draconis* (Longgu), *Concha Ostreae* (Muli), *Fructus Chaenomelis* (Muqua), *Semen Dolichoris Lablabis* (Biandou), *Semen Coicis* (Yiren), *Lapis Talci* (Xihuaishi), *Folium Mori* (Sangye), *Massa Bombycis Batryticatae* (Cansha), *Radix Dendrobii* (Shihu), and *Semen Sojae Preparatum* (Doujuan). After administration, he recovered significantly. Subsequently, daily conditioning continued with tonic medicines to treat his chronic condition. Two years later, it was reported that he died from sudden severe hemorrhage due to the consumption of warming and tonifying medicines.
Zhou [Name], on the night of July 18th, suffered severely from cholera with tendon retraction. In haste, he mistakenly ingested about one qian of *Qinglin Wan*. By dawn, Meng Ying was urgently summoned. The pulse was faint and barely perceptible; ears were deaf, eyes sunken, sweat poured out, limbs were cold, voice was hoarse, and muscles wasted away, presenting all critical signs. Fearing that the medicine might act too slowly, he instructed the patient's mother to first decoct *Ginseng Koreanensis* (Gaoli Shen) soup for urgent supplementation, followed by a prescription of: *Ginseng Koreanensis* (Gaolishen), *Rhizoma Atractylodis Macrocephalae* (Baizhu), *Radix Paeoniae Rubra* (Baishao), *Poria* (Fuling), *Radix Aconiti Lateralis Preparata* (Fupian), *Cortex Cinnamomi* (Rougui), *Rhizoma Zingiberis Recens* (Ganjiang), *Fructus Chaenomelis* (Muqua), *Semen Coicis* (Yiren), *Semen Dolichoris Lablabis* (Biandou), and *Semen Nelumbinis* (Lianshi). After one dose, all symptoms decreased.
On the second day's follow-up, Meng Ying said: "The Qi aspect is deficient; how could it withstand the depletion from vomiting and diarrhea? Mistakenly taking bitter-cold medicines caused Yang Qi to become faint and nearly extinct. Yesterday, combining *Zhenwu Decoction* (Zhenwu Tang) and *Lizhong Pill* (Lizhong Wan) restored the Yang Qi of the Spleen and Stomach. The harsh and pungent medicines can now be withdrawn. Severe vomiting and diarrhea damage body fluids; when tendons and vessels lose nourishment, tendon retraction occurs. Xue Shengbai compared this to 'Spasm' disease; the principle can be extrapolated. When treating tendon retraction, protecting body fluids is paramount. If Yang Qi has returned but harsh medicines are administered again, body fluids cannot recover, and internal wind will stir. This explains the use of *Ramulus Cinnamomi* (Guizhi) and *Radix Aconiti Lateralis Preparata* (Fuzi) in treating Cold Cholera; balance is crucial. One must not treat indiscriminately, ruining previous efforts. Remove *Rhizoma Zingiberis Recens* (Ganjiang), *Radix Aconiti Lateralis Preparata* (Fupian), and *Cortex Cinnamomi* (Rougui) from the previous formula, add *Radix Astragali Membranacei* (Huangqi) and *Radix Dendrobii* (Shihu). After ten days of服用, he recovered.
I (Zhou [Name]) consider this illness critically dangerous, fleeting as morning dew. Without Mr. Meng, rescue would have been impossible. I often heard Zhang Liuyin say: "If the patient listens to Mr. Meng's analysis of the disease, which leaves no detail unexamined, and observes his precise medication, clear and coherent, it feels as if half the illness is cured."
As the ancients said: "An edict cures headache," there is indeed reason for this.
In May of the Jichou year, the weather turned hot suddenly. Mr. Meng Ying's mother suddenly contracted cholera, with cold limbs, spontaneous sweating, faint pulse, white coating, severe abdominal pain relieved by pressure. This indicated inherent deficiency of the Middle Jiao, complicated by cold invasion due to heat. A large dose of *Lizhong Decoction* (Lizhong Tang) added with *Ramulus Cinnamomi* (Guizhi) and *Radix Paeoniae Alba* (Baishao) cured her after one cup. This is what is called "abandoning the season to follow the syndrome."
The maid of Chu Ziyun suffered from this disease, her body already stiff. Meng Ying prescribed two fen of *Duoming Dan*, instructing it to be forced down. Instantly, she regained movement, followed by *Jiedu Huoxue Decoction* (Jiedu Huoxue Tang), and survived after several doses.
One person, cured by Meng Ying, could urinate, walk, and eat. Residual heat leaked outward, causing red nodules on the face. Suddenly, his spirit became confused, and he died.
Another person, cured by Meng Ying, had normal bowel and bladder functions. A few days later, he complained that food and drink could not go down, stared upward, hiccuped incessantly, and passed away.
Another person, who was recovering, suddenly became mentally vague; medicine arrived too late to save him.
Chen Jiexiang's younger brother suffered critically from this. After being cured by Meng Ying, he stopped taking medicine. Over a month later, he sought diagnosis again. He had sore throat obstructing food and water intake, swollen cheeks, rotting teeth, locked jaw, phlegm cough, hypochondriac pain, dark scanty urine with painful urethra, and loose stool resembling soy sauce paste. This was residual toxin accumulating heavily, lacking clearing and resolving treatment. The pulse was wiry, tight, rapid, and frantic; no effective measure could be taken. Recorded here to inform travelers.
Shen Chunquan, aged fifty-seven, five days before Start of Winter, ate crab noodles and suddenly contracted cholera with tendon retraction. Both vomit and diarrhea were watery. Initially, *Ramulus Cinnamomi* (Guizhi) and *Radix Aconiti Lateralis Preparata* (Fuzi) were given, worsening the tendon retraction. There was slight whole-body sweat, mental fatigue, reluctance to speak, gradually cold fingers, gradually hidden pulse, and frequent sighing. The formula was changed to: *Concha Ostreae* (Muli) one liang, *Carapax et Plastrum Testudinis* (Guiban) eight qian, *Colla Corii Asini* (Ejiao) four qian. After ingestion, the condition worsened. Meng Ying examined him: yellow tongue coating, extreme thirst, no urination, extremely hot diarrhea, and tenderness upon pressing the epigastrium. He said: "This is a syndrome of latent summer-heat with food retention. What insight led to giving drying, tonifying, astringent, and greasy medicines?" Later, it was heard that his second son also contracted this syndrome after Start of Winter. The doctor knew it was latent summer-heat and used *Rhizoma Coptidis* (Huanglian) etc., stopping vomiting and diarrhea. Because the pulse did not immediately rise, failing to realize latent summer-heat remained unresolved, they switched to *Ramulus Cinnamomi* (Guizhi) and *Radix Aconiti Lateralis Preparata* (Fuzi). After three doses, he died. Most lamentable.
Chen Yipu, also knowledgeable in medicine, his wife contracted cholera with tendon retraction in early autumn. She self-diagnosed it as cold and took hot medicines, worsening the condition. Zhu Jiaoting was invited, agreeing with the owner's view. The illness became more severe, so Meng Ying was consulted. He said: "This is new external cold binding the exterior, while heat is the true internal disease. Bitter mouth and thirst mean *Rhizoma Zingiberis Recens* (Jiang) and *Radix Aconiti Lateralis Preparata* (Fu) are contraindicated." He applied Hejian Method (clearing heat, nourishing Yin, resolving both interior and exterior). People did not believe it. Consulting other doctors still resulted in hot medicines, leading to death from bleeding from mouth and nose. Deeply regretful, they finally appreciated Meng Ying's insight. I say: Cholera appears frequently recently, but doctors do not understand it clearly, leading to many deaths from misdiagnosis. Meng Ying specifically wrote a treatise. Although written hastily, the differentiation is concise and accurate, without loopholes. It is truly the primary book for today's physicians because it fits current times; it must be read and studied urgently!
Luo Jiren, before Start of Winter, contracted cholera with tendon retraction. Someone knew his Yin aspect was inherently deficient and the disease stemmed from latent summer-heat. Medicine brought some turn. Days later, hiccups appeared. Meng Ying examined: wiry and rapid pulse, stronger on the left; scorched tongue coating and thirst; gingival bleeding; chest stuffiness; loose stool like soy sauce paste; short dark urine. All indicate latent summer-heat unresolved and Qi mechanism blocked. Since clearing and descending were missed, *Huiyang Gao* (Warming Yang Paste) was still pasted on the navel. Repeatedly urged to remove it, but refused. Later, he died.
Mother of Shi Yutian, nearly fifty, suddenly contracted cholera with tendon retraction. Yellow tongue coating, extreme thirst, irritable spirit, syndrome belongs to latent summer-heat. Pulse was not unfavorable, but whole body cold sweat, shaking fan continuously, indicating Yang floating outward. Dare not prescribe; soon declared dead.
Father of Zhu Xunquan, around sixty, contracted cholera with tendon retraction. Syndrome not severe, clear voice in Q&A, but pulse faint and near extinction. Also judged incurable; indeed so.
Someone, contracting this at midnight, had black blood pricked out. At dawn, Meng Ying visited. Form and pulse both collapsed, heavy sweating like shower, sunken eyes, hoarse voice, no tongue coating in urine, habitually drinking much but eating little, kind-hearted but forgetting labor. This is damp-heat stagnating in the middle, righteous Qi disintegrating. Reluctantly administering Ginseng medicine, yet unable to save.
Daughter of Fang family, displaced for three years, arrived in Shanghai in autumn, suffering edema. Due to lodging in an inn, no treatment was pursued. At Frost Descent, swelling suddenly disappeared. Not long after, contracted cholera, immediately becoming mentally confused, pacing the room, calling for sister. Sister forced her to lie down, eyes rolling constantly, tears flowing, jaw locked. Trying to summon Meng Ying, but too late.
Meng Ying said: "This is displacement and hardship, deep depression. Wood overacting on Earth causes vomiting, diarrhea, and swelling. At Frost Descent, Qi becomes肃 (solemn/clear), swelling subsides. Depression has no outlet, directly attacking Spleen and Stomach, sudden vomiting and diarrhea. Wood and Fire surge upward, wild running, staring eyes, Yang floating from above. This is Cholera caused by emotional internal injury. Hence the rapid danger."
Xu Shi, usually healthy, strong stomach, good at labor. Suddenly had two episodes of diarrhea at night. While combing hair for Meng Ying in the morning, another episode occurred. Pulse seven beats per respiration, fine, rapid, intolerant to pressure, seemingly no illness. Such a pulse in a patient who seems well suggests the issue didn't start today; incurable. Diarrhea slowed slightly, ate a small bowl of Shandong noodles, could still breastfeed daughter, but breasts collapsed after sucking. Body gradually wasted, sweat increased, pulse declined, voice hoarse. Died suddenly at Xu hour. This is sudden collapse of Middle Qi, a rare sign.
My paper-resisting guest fell ill on a boat. Seeking Meng Ying's diagnosis, tongue curled, scrotum contracted, mouth open, black tongue coating, form and spirit detached, incurable. Asked if medicine was taken en route; none was. Reflecting: if damp-heat can lie dormant until late autumn causing cholera, then winter cold injury, if not becoming warm disease in spring, can also transform into cholera. Though a variation of warm disease, warmth is heat, so not vastly different from latent summer-heat. Studying Zhongjing's writings, hints exist. e.g., Taiyang and Shaoyang combined disease with spontaneous diarrhea treated with *Huangqin Decoction*; if vomiting, *Huangqin Decoction* plus *Rhizoma Pinelliae* (Banxia) and *Rhizoma Zingiberis Recens* (Shengjiang). Zhang Shiwang noted: Warm disease onset should primarily use *Huangqin Decoction* to clear heat. If cold disease transmits to Shaoyang, heat entering interior, then *Huangqin* and *Radix Bupleuri* (Chaihu) resolve it. *Huangqin Decoction* is the main formula for warm disease, essentially *Guizhi Decoction* replacing *Ramulus Cinnamomi* (Guizhi) with *Rhizoma Coptidis* (Huangqin) and removing *Rhizoma Zingiberis Recens* (Shengjiang). *Guizhi* treats exterior wind-cold; *Huangqin* treats interior wind-heat, an unchangeable rule. *Shengjiang* is pungent and dispersing, unsuitable for warm-heat, hence removed. This highlights the importance of knowing interior/exterior and cold/heat. Zhou Yucai noted: Clearly stating Taiyang and Shaoyang, why not use medicines of these two meridians? It is not cold disease. Cold disease goes from exterior to interior; this originates internally and manifests externally. How to know exterior if absent? Or hypochondriac fullness, or headache, or bitter mouth with desire to drink, or no aversion to cold but immediate heat, thus cannot be called exterior. Combined cold diseases are all exterior diseases. Now not only no exterior, but also diarrhea interior syndrome. Cold disease with heat diarrhea must transmit via meridians, unlike this immediate diarrhea. Why does warm disease cause immediate diarrhea? The person's Middle Qi is inherently deficient, latent deeply, cannot fully vent outward, inevitably flows downward causing diarrhea. Meng Ying said: This discusses warm pathogen venting outward shortly, flowing downward as diarrhea. The text adds "if vomiting," implying warm disease can transform into cholera, hinting at this early. Previously compiling *Wenre Jingwei*, I annotated below this clause: Shaoyang Gallbladder wood, carrying fire wildly, vomiting is upward rush, diarrhea is downward pressure. Why must Middle deficiency cause diarrhea, fluid accumulation cause vomiting? *Rhizoma Pinelliae* (Banxia) and *Rhizoma Zingiberis Recens* (Shengjiang) specifically open fluid knots. If heat is blazing, replace with *Rhizoma Coptidis* (Huanglian) and *Spiraxis Scabra* (Zhuru).
Someone asked Ban Chi: "Since Liver depression affects Earth and food cannot descend, why does dry stool leak involuntarily without awareness?" Ban Chi replied: "Stomach and Large Intestine share one Qi. Only when food stagnates in Stomach and fails to transform does it seem disconnected from Large Intestine Qi. Thus, old feces in Rectum exit without awareness. Classics say: 'Deficiency of Middle Qi causes changes in urination and defecation.' This is also a change. The term 'deficiency' here does not mean Middle Qi deficiency. Rather, Middle Qi is blocked by disease, lacking the function of descending turbidity and ascending clarity, thus urination and defecation change norms. Thinking of cholera's unlimited vomiting/diarrhea, and Dry Cholera's constipation, both are changes. Both result from Middle Qi blocked by disease, lacking descending/turbid-clearing function. If one doubts deficiency means emptiness, then all choleras should be treated by tonifying Middle Qi. This theory corroborates the previous explanation of 'Where pathogenic factors gather, Qi must be deficient.'"
Early August, autumn sun fierce. Yao Outing, on the 7th, suddenly had fever, vomiting, diarrhea, white coating covering tongue, exhausted spirit, abdominal pain, frequent sweat, low voice, difficult urination. First given: *Ginseng Radix* (Renshen), *Rhizoma Coptidis* (Huanglian), *Rhizoma Pinelliae Preparatum* (Banxia), *Cortex Magnoliae Officinalis* (Houpo), *Spiraxis Scabra* (Zhuru), *Lapis Talci* (Huashi), *Semen Coicis* (Yiren), *Folium Perillae* (Zisu), *Massa Bombycis Batryticatae* (Cansha), *Folium Dolichoris Lablabis* (Biandou Ye). Two doses, fever subsided, spirit cleared, but left pulse still wiry, Guan position high, sour vomiting, insomnia, trembling hands/feet. External pathogens resolved, but Earth oppressed by Wood. Removed *Lapis Talci* (Huashi), *Cortex Magnoliae Officinalis* (Houpo), *Massa Bombycis Batryticatae* (Cansha), *Folium Dolichoris Lablabis* (Biandou Ye); added *Poria Cum Radix Pini* (Fushen), *Concha Meretricis et Cyclinae* (Geke), *Algae Porphyrae* (Zicai), *Semen Phaseoli Mungonis* (Lvdou), *Pericarpium Amomi Rotundum* (Baokouren). Three doses, coating transformed, sleep possible, hunger felt, diarrhea reduced. Removed *Pericarpium Amomi Rotundum* (Baokouren), *Concha Meretricis et Cyclinae* (Geke); added *Rhizoma Acori Tatarinowii* (Changpu), *Rhizoma Atractylodis Macrocephalae* (Baizhu). Five doses, recovered. This is cholera's failure of opening/closing, central pivot disturbed by pathogen. Previous case's lack of opening/closing control was due to Middle deficiency inability to govern. Same person, previously deficiency, now excess, allowing mutual comparison. The post-recovery vomiting/diarrhea/trembling was cholera where wind-summer-heat invaded deficiency disturbing middle.
Zhu Mingqi suffered diarrhea with tendon retraction. Doctor saw cold limbs, gave warming/tonifying, vomited immediately after medicine, then incessant hiccups. Warming/tonifying intensified, illness worsened daily, lasting nine mornings. Meng Ying palpated: left pulse wiry-slippery, right pulse weak imperceptible, thick greasy yellow coating, no urination, tenderness above navel. Said: Pathogen not heavy, mistaken medicine made it severe. Life shouldn't end, fortunately vomited. Prescribed: *Fructus Aurantii Immaturus* (Zhishi), *Radix Platycodonis* (Jiegeng), *Rhizoma Coptidis* (Huangqin), *Rhizoma Coptidis* (Huanglian), *Spiraxis Scabra* (Zhuru), *Rhizoma Pinelliae Preparatum* (Banxia), *Folium Perillae* (Zisu), *Flos Forsythiae* (Lianqiao), *Radix Phragmitis Rhizoma* (Lugen), *Folium Eriobotryae* (Pipaye), *Lapis Talci* (Huashi). To open phlegm, move Qi, relax knots, unblock Yang. Two doses, hiccups stopped, red rashes all over body. Two more doses, dry stool passed, coating transformed, urination resumed, right pulse revived. Conditioned with clearing/descending method, recovered.
If initially treated correctly, one or two doses could cure. The world considers diarrhea, vomiting, cholera, and cholera with tendon retraction as cold syndromes. Often ignoring condition, they give hot medicines. Seeing cold limbs and weak right pulse, they take it as evidence of deficiency-cold. Moreover, vomiting after medicine and subsequent hiccups lead them to think cholera with tendon retraction showing hiccups indicates deficiency collapse. Thus, warming/tonifying intensifies daily. Even if fatal, patient bears no grudge, doctor doesn't repent. Transmission continues, skills remain thus, truly lamentable. Additionally, chest/abdominal pain, malaria, asthma, menstrual obstruction, postpartum conditions are often labeled cold by laypeople. Killed by hot medicines unknowingly. Hiccups especially cause many unjust deaths. Meng Ying once treated a courtesan with days of hiccups. Early sexual debut caused deficiency, but blood loss injured Yin. How could warming/drying assist heat, leading to lower Jiao insecurity? Fearful of medicine, she took only *Ovi Albumen* (Jizi Huang), several doses, and stabilized.