罗谦甫治蒙古百户。因食酒肉。饮潼乳。得霍乱吐泻证。从朝至午。精神昏愦已困。
急来告。罗视之。脉皆浮数。按之无力。所伤之物已出矣。即以新汲水半碗。调桂
苓白术散。徐徐服之。稍得安静。又于墙阴掘地约二尺许。贮以新水。在内搅动。
待一时澄定。用清水一杯。再调服之。渐渐气调。吐泻遂止。至夜安卧。翌日微烦
渴。遂煎钱氏白术散。时时服良愈。或曰。用地浆者何也。曰。坤属地。地属阴。土平
曰静。顺感至阴之气。又于墙阴贮新汲水。以收重阴之气也。阴中之阴。能泻阳
中之阳。霍乱因暑热内伤所得。故用地浆治之也。
又治提举公年近八十。至元丙寅六月初四日中暑毒。霍乱吐利。昏冒终日。不省
人事。时夜方半。请罗治之。诊其脉洪大而有力。一息七八至。头热如火。足冷如
冰。半身不遂。牙关紧急。因思内经五乱篇中云。清气在阴。浊气在阳。营气顺脉。
胃气逆行。乱于胸中。是谓大 。乱于肠胃。则为霍乱。于是霍乱之名。自此而生。
盖因年高气弱。不任暑气。阳不维阴则泻。阴不维阳则吐。阴阳不相维。则既吐
且泻矣。前贤见寒多以理中丸。热多以五苓散为定法。今暑气极盛。阳明得时。
况因动而得之。中 明矣。非甘辛大寒之剂。则不能泻其暑热。坠浮溜之火。而
安神明也。遂以甘露散。甘辛大寒。泻热补气。加白茯苓以分阴阳。约重一两。冰
水调灌。渐渐省事。而诸证悉去。后慎言语。节饮食三日。以参术调中汤之剂增
减。服之理正气。逾十日后。方平复。
又治一仓官。季夏时病。胸项多汗。足逆冷谵语。医者不晓。杂治经旬。罗诊之。关前
濡。关后急。当作湿温治。盖先受暑。后受湿。暑湿相搏。是名湿温。先以白虎加人
参汤。次以白虎加苍术汤。病渐退。足渐温。汗渐止。三日愈。此名贼邪。误用药。有
死之理。心病中暑为正邪。中湿得之。从所不胜者为贼邪。今心受暑而湿邪胜
之。水克火。从所不胜是也。五邪中之最逆也。经曰。湿温之脉。阳濡而弱。阴小而
急。濡弱见于阳部。湿气搏暑也。小急见于阴部。暑气蒸湿也。暑湿相搏。名曰湿
温。是谓贼邪也。予亦素有停饮之疾。每至暑月。两足 。未常干。服此药二三
服即愈。
滑伯仁治一人。病自汗如雨。面赤身热。口燥心烦。盛暑中且帷幕周密。自以至虚
亡阳。服术、附数剂。脉虚而洪数。舌上苔黄。伯仁曰。前药误矣。轻病重治。医者死
之。素问云。必先岁气。毋伐天和。术、附岂可轻用。以犯时令。又云。脉虚身热。得之
伤暑。暑家本多汗。加之刚剂。脉洪数而汗甚。乃令撤幔开窗。少顷渐觉清爽。以
黄连人参白虎。三进而汗止大半。诸证亦减。兼以既济汤。渴用冰水调天水散。七日而愈。
丹溪治一人。夏发大热大汗。恶寒战栗。不自禁持。且烦渴。此暑病也。脉虚微细弱
而数。其人好赌。致劳而虚。以人参。竹叶作汤。调辰砂四苓散。八帖而安。
又治一人。年五十。质弱多怒。暑月因怒后患痢。口渴自引蜜水。病缓数日。后脉稍
大不数。朱令以参术汤调益元散。饮之利减。数日后倦甚。发咳逆。知其久下阴
虚。令守前药。利尚未止。以炼蜜与之。众欲用姜、附。朱谓阴虚。服之必死。待前药
力到自愈。又四日。咳逆止利除。
吴茭山治一妇。冬月感病。洒洒恶寒。翕翕发热。恶食干呕。大便欲去不去。诸医皆
以虚弱痰饮治之。以二陈补心等药服不效。延及半月。吴诊其脉。虚而无力。类
乎伤暑。众不然之。究问病因。其妇曰。因天寒换着绵衣。取绵套一床盖之。须臾
烦渴。寒热呕吐。延绵至今耳。吴曰。诚哉伤暑也。盖绵套晒于盛暑。夹热收入笥
中。必有暑气。尚未开泄。今人体虚。得之易入。故病如是。其妇曰。然。遂制黄连香
薷饮。连进二服而愈。
陈斗 治伦司成。舟中昏晕不知人。自汗螈 。医以为中风。陈曰。人迎脉过盛。病
因饮后便凉。痰火妄动。非中风也。以清暑益气汤。一剂而愈。
汪希说治一壮男子。形色苍黑。暑月客游舟回。患呕哕。颠倒不得眠。粒米不入六
日矣。脉沉细虚豁。诸医杂投藿香、柴、苓等药不效。危殆。汪曰。此中暑也。进人参
白虎汤。人参五钱。服下呕哕即止。鼾睡五鼓方醒。索粥。连进二三服。乃减参。稍轻。调理数剂而愈。
汪石山治一人。年三十余。形体瘦弱。病上吐下泻。水浆不入口者七日。自分死矣。
汪诊脉八至而数。曰。当夏而得是脉。暑邪深入也。吐泻不纳水谷。邪气自甚也。
宜以暑治。遂以人参白虎汤。进半杯。良久复进一杯。觉稍安。三服后。减去石膏、
知母。以人参渐次加至四五钱。黄柏、陈皮、麦冬等。随所兼病而佐使。一月后平复。
又治一人年三十余。忽病渴热昏闷。面赤倦怠。汪诊之。脉皆浮缓而弱。两尺尤甚。
曰。此得之色欲。药宜温热。其人曰。先生之言诚然也。但病热如此。复加热药惑
矣。汪曰。寒极生热。此证是也。肾虚寒者。本病也。热甚者。虚象也。譬如雷火。雨骤
而火愈炽。日出火斯灭矣。遂以附子理中汤煎熟。冷服三帖。热渴减半。再服清暑益气汤。十帖而安。
又治一妇。形色脆白。年五十余。忧劳六月。背疮艾灸百余壮。疮散病疟。身热自汗。
口渴头晕。吐呕泄泻。不进饮食。寒少热多。自用清暑益气汤。病甚。汪诊左脉浮
微。似有似无。右脉浮小。按之不足。曰。病虽属疟。当作虚治。根据方而用清暑益气
汤。固与病宜。但邪重剂轻。病不去耳。令以参、术加作五钱。黄 三钱。茯苓一钱。
陈皮七分。甘草五分。煎服病退。
石山翁年逾六十。形质近弱。八九月酷热时。往来休歙。外有药剂之劳。内有病者
之忧。内外弗宁。昼夜不静。至十月初旬。疟作三日。午后一发。寒热不甚。喜热恶
寒。寒去热来。则觉爽快。口干微渴。临发昏倦嗜卧。左脉沉小而数。右脉浮濡无
力。亦近于数。独脾部弦而颇洪。疟去则脉皆大小浮沉相等。微觉缓弱而已。初
服补中益气汤十余帖。病无加减。夜苦盗汗。继服当归六黄汤。黄 每帖四钱。五帖汗止。
疟如旧。再服白虎汤。人参四钱。石膏三钱。知母一钱。甘草六分。米一撮。煎服十余帖而愈。
又治一人。病霍乱。欲吐不吐。欲泻不泻。心腹绞痛。脉之沉伏如无。此干霍乱也。急
令盐汤探吐。宿食痰涎碗许。遂饮与六和汤而愈。
Luo Qianfu treated a Mongol hundred-household commander. Because he consumed alcohol and meat, and drank Tongru (a type of dairy product), he developed Huoluan (cholera-like syndrome with vomiting and diarrhea) with vomiting and diarrhea. From morning to noon, his spirit was confused and exhausted. He urgently sought treatment. Luo examined him and found the pulse floating and rapid, but powerless upon deep pressure, indicating that the ingested harmful substances had already been expelled. He immediately used half a bowl of newly drawn cold water to mix Guiling Baizhu San (Cinnamon Twig, Poria, and Atractylodes Macrocephala Powder), which the patient took slowly. The patient felt slightly relieved. Then, Luo dug a pit about two chi deep in the shady wall area, filled it with newly drawn water, and stirred it. After waiting for one shi (two hours) for the water to settle, he took one cup of clear water to mix with the medicine again. The patient's breathing gradually regulated, and vomiting and diarrhea stopped. That night, he slept peacefully. The next day, he had slight irritability and thirst, so Luo decocted Qianshi Baizhu San (Dr. Qian's Atractylodes Macrocephala Powder) for the patient to take frequently, leading to recovery. Someone asked, "Why use mud water (Dijiang)?" Luo replied, "Kun represents Earth, and Earth belongs to Yin. Earth is level and quiet, complying with the extreme Yin qi. Storing newly drawn water in the shady wall gathers heavy Yin qi. Yin within Yin can drain Yang within Yang. Huoluan is caused by internal injury from summer-heat, so mud water is used for treatment."
He also treated a Tiju Gong (Official Title) who was nearly eighty years old. On the fourth day of the sixth month of the Bingyin year of Zhiyuan, he suffered from midsummer-heat toxicity, resulting in Huoluan with vomiting and diarrhea, daily coma, and loss of consciousness. It was midnight when Luo was summoned. His pulse was surging and powerful, with seven or eight beats per breath. His head was hot as fire, feet cold as ice, hemiplegia, and lockjaw. Luo recalled the passage from the *Neijing* chapter on Five Disorders: "Clear qi stays in Yin, turbid qi stays in Yang, Ying qi follows the vessels, Wei qi moves against the flow. Disorder in the chest and middle is called Da Men; disorder in the intestines and stomach is called Huoluan." Thus, the name Huoluan originated. Probably because of advanced age and weak Qi, he could not withstand the summer-heat. When Yang cannot maintain Yin, there is diarrhea; when Yin cannot maintain Yang, there is vomiting. When Yin and Yang do not maintain each other, both vomiting and diarrhea occur. Former sages often used Lizhong Wan (Regulate the Middle Pill) for cold syndromes and Wuling San (Five-Ingredient Poria Pill) for heat syndromes as standard methods. However, now the summer-heat is extremely prevalent, and the Yangming channel is at its peak. Moreover, it was contracted through movement, clearly indicating midsummer-heat. Without sweet, acrid, and great-cold agents, one cannot drain the summer-heat, subdue the floating fire, and calm the Spirit. Therefore, Ganlu San (Sweet Dew Powder) was used. This formula is sweet, acrid, and great-cold, draining heat and tonifying Qi. Bai Fuling (Poria with Hostwood) was added to differentiate Yin and Yang, weighing approximately one liang. It was mixed with ice water and administered. The patient gradually regained consciousness, and all symptoms disappeared. Later, he guarded his speech and regulated his diet for three days, taking modified Shenzhu Tiaozhong Tang (Ginseng and Atractylodes Decoction to Regulate the Middle) to regulate Zheng Qi, recovering completely after ten days.
He also treated a Cang Guan (Granary Official) who fell ill in late summer. He sweated profusely on the chest and neck, had cold feet, and spoke deliriously. Doctors did not understand the condition and treated it indiscriminately for ten days. Luo diagnosed the pulse: Ru (soft) before the guan position, Ji (urgent) after the guan position. This should be treated as Shiwen (damp-warmth). It was first exposed to summer-heat, then to dampness. Summer-heat and dampness struggling together is named Shiwen. First, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) was used, followed by Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodes Lancea). The illness gradually receded, feet became warm, sweating stopped, and he recovered in three days. This is called Zei Xie (Thieving Pathogen). Misusing medication could lead to death. Heart disease caused by summer-heat is Zheng Xie (Direct Pathogen); contracting dampness makes it Zei Xie (from the overcoming relationship). Now the heart suffers summer-heat, and dampness overcomes it. Water conquers Fire, fitting the description of Zei Xie. This is the most adverse among the five pathogens. The classic states: "The pulse of damp-warmth is Ru and weak in the Yang portion, small and urgent in the Yin portion." Ru and weak appearing in the Yang portion indicates dampness clashing with summer-heat; small and urgent appearing in the Yin portion indicates summer-heat steaming dampness. Summer-heat and dampness struggling together is named Shiwen, which is Zei Xie. I also have a chronic retention of fluids. Every summer, my feet are moist and never dry. Taking this medicine two or three doses cures it.
Hua Borren treated a person suffering from spontaneous sweating like rain, red face, body heat, dry mouth, and vexation. During intense summer heat, with curtains tightly closed, he believed himself to have extreme deficiency and Yang collapse, taking Aconite and Ligusticum for several doses. The pulse was deficient, surging, and rapid, with yellow coating on the tongue. Hua said, "The previous medication was wrong. Treating a mild condition severely kills the patient. The *Suwen* says: 'First consider the seasonal Qi, do not violate the harmony of Heaven.' How can Aconite and Ligusticum be used lightly, violating the season?" He also cited, "Deficient pulse and body heat result from summer-heat injury. Those with summer-heat naturally sweat more. Adding harsh warming agents leads to a surging, rapid pulse and severe sweating." He ordered the curtains removed and windows opened. Soon, the patient felt refreshed. Huanglian Renshen Baihu Tang (Coptis, Ginseng, and White Tiger Decoction) was given for three doses, stopping most of the sweating and reducing other symptoms. Jiji Tang (Ji Ji Decoction) was added. For thirst, Bingshui Tianshui San (Ice Water and Tianshui Powder) was taken. Recovery occurred in seven days.
Danxi treated a person who developed high fever and profuse sweating in summer, with aversion to cold and trembling, inability to control himself, and vexation/thirst. This is a summer-heat disease. The pulse was deficient, minute, fine, weak, and rapid. The patient enjoyed gambling, leading to exhaustion and deficiency. Renshen (Ginseng) and Zhuye (Bamboo Leaf) were made into a decoction to mix with Chensha Siling San (Cinnabar and Four-Ingredient Poria Powder). Eight doses brought peace.
He also treated a fifty-year-old man with weak constitution and frequent anger. In summer, after getting angry, he developed dysentery, thirst, and self-administered honey water. The illness eased for a few days, and the pulse became slightly larger but not rapid. Zhu Danxi instructed using Shenzhu Tang (Ginseng and Atractylodes Decoction) to mix Yiyuan San (Benefit Origin Powder). The diarrhea decreased. Days later, he was very fatigued and developed coughing/counterflow qi. Knowing that prolonged diarrhea caused Yin deficiency, Zhu advised continuing the previous prescription. The diarrhea had not stopped yet. Honey was given. Others wanted to use Ginger and Aconite, but Zhu said, "In Yin deficiency, taking these will cause death." He waited for the previous medicine to take effect. Four days later, the coughing stopped, and the diarrhea ceased.
Wu Jiaoshan treated a woman who fell ill in winter with chills, low-grade fever, anorexia, dry retching, and difficulty defecating. All doctors treated her as deficiency-phlegm-fluids, administering Erchen Tang and Xinbao pills without effect. Half a month passed. Wu diagnosed the pulse as deficient and powerless, resembling summer-heat injury. Others disagreed. Upon inquiry, the woman said, "Because of the cold weather, I changed into cotton clothes and covered myself with a cotton quilt. Soon after, I felt vexation, thirst, alternating chills and fever, and vomiting, which persisted until now." Wu said, "Indeed, it is summer-heat injury. The cotton quilt was dried in intense summer heat, stored with heat in a box, retaining summer-heat Qi that had not dissipated. Now the body is weak, allowing it to enter easily, hence the illness." The woman agreed. Wu prepared Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction). Two consecutive doses cured her.
Chen Dou treated Lun Sicheng, who fainted in a boat, sweating spontaneously, and experiencing convulsions. Doctors thought it was wind-stroke. Chen said, "The Renying pulse is overly strong. The cause is drinking then cooling down, causing phlegm-fire to move recklessly. It is not wind-stroke." Qingxu Yiqi Tang (Clear Summer-Heat and Benefit Qi Decoction) cured him in one dose.
Wang Xishuo treated a robust man, dark complexion. Returning from a journey by boat in summer, he suffered from vomiting and hiccups, tossing and turning unable to sleep, having eaten nothing for six days. The pulse was deep, fine, deficient, and empty. Various doctors gave Huoxiang, Chaihu, Lingpi, etc., without effect. The condition was critical. Wang said, "This is midsummer-heat." Ren Shen Baihu Tang (Ginseng and White Tiger Decoction) was administered, with five qian of Ginseng. Vomiting and hiccups stopped immediately. He slept snoring until dawn, asked for porridge, and continued taking two or three doses. Then the Ginseng dosage was reduced. With minor adjustments and several doses of regulation, he recovered.
Wang Shishan treated a man in his thirties, thin and weak, suffering from vomiting and diarrhea, unable to keep down fluids for seven days, believing he would die. Wang diagnosed the pulse as eight beats per breath and rapid. He said, "In summer, obtaining this pulse indicates deep invasion of summer-heat pathogen. Vomiting and diarrhea preventing intake of food and fluids means the pathogen is severe. It should be treated as summer-heat." Ren Shen Baihu Tang was given, half a cup initially, then another cup after a while. The patient felt slightly relieved. After three doses, Shigao (Gypsum) and Zhimu (Anemarrhena) were removed. Renshen was gradually increased to four or five qian. Huangbai (Phellodendron), Chenpi (Tangerine Peel), Maidong (Ophiopogon), etc., were added according to accompanying conditions. He recovered after one month.
He also treated a man in his thirties who suddenly developed thirst, heat, confusion, red face, and fatigue. Wang diagnosed the pulse as floating, slow, and weak, especially in the Chi positions. He said, "This results from sexual indulgence. Medication should be warm and hot." The patient said, "Your words are true. But with such heat, adding hot medicines confuses me." Wang said, "Extreme cold generates heat; this case exemplifies it. Kidney deficiency cold is the root disease. Severe heat is a false manifestation. Like thunderfire, heavy rain makes the fire blaze more; sunrise extinguishes it." Fuzi Lizhong Tang (Aconite and Regulate the Middle Decoction) was decocted and taken cold for three doses. Heat and thirst halved. Then Qingxu Yiqi Tang was taken for ten doses, bringing peace.
He also treated a woman, fragile and fair-skinned, over fifty years old. After six months of worry and labor, she had moxibustion on back sores. The sores dispersed, malaria appeared, with body heat, spontaneous sweating, thirst, dizziness, vomiting, diarrhea, anorexia, less chills and more heat. She self-medicated with Qingxu Yiqi Tang, worsening the condition. Wang diagnosed the left pulse as floating and minute, almost imperceptible; the right pulse floating and small, insufficient upon pressure. He said, "Although the disease is malaria, it should be treated as deficiency. Using Qingxu Yiqi Tang according to the formula fits the disease. However, the pathogen is heavy, and the dose is light, so the disease does not go away." He instructed increasing Renshen and Baizhu to five qian, Huangqi (Astragalus) to three qian, Fuling (Poria) to one qian, Chenpi to seven fen, and Gancao (Licorice) to five fen. Decocted and taken, the illness receded.
Shishan Weng, over sixty, near weakness. In the intense heat of August and September, he had alternating chills and fever. Externally burdened by medication efforts, internally worried about illness,内外 restless, day and night unsettled. By early October, malaria attacked for three days, occurring once in the afternoon, with mild chills and fever. He preferred warmth and disliked cold. Feeling refreshed when cold passed and heat came, with dry mouth and slight thirst, feeling dizzy and sleepy before attacks. Left pulse deep, small, and rapid; right pulse floating, Ru, and powerless, also near rapid. Only the Spleen portion was wiry and somewhat surging. After malaria subsided, pulses were equal in size and depth, slightly slow and weak. Initially, Buzhong Yiqi Tang (Tonify the Middle and Benefit Qi Decoction) was taken for over ten doses, with no change. Night sweats troubled him. Then Danggui Liuhuang Tang (Angelica and Rehmannia Decoction) was taken, with Huangqi four qian per dose. Sweating stopped after five doses, but malaria remained. Finally, Baihu Tang was taken: Renshen four qian, Shigao three qian, Zhimu one qian, Gancao six fen, rice a pinch. Decocted and taken for over ten doses, he recovered.
He also treated a person with Huoluan, wanting to vomit but unable, wanting to defecate but unable, severe abdominal pain, pulse deep and hidden, almost absent. This is Gan Huoluan (Dry Cholera). He urgently ordered salt water to induce vomiting. About a bowl of retained food and phlegm-saliva was expelled. Then Liuhe Tang (Six-Harmony Decoction) was given, curing him.