丁酉八九月间。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。足腓坚硬如石。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。晡时复予前药半剂。夜得安寐。
次日但觉困极耳。予致和汤数服而痊。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。
附录致和汤方 治霍乱后津液不复。喉干舌燥。溺短便溏。 北沙参 生扁豆 石斛 陈仓
米（各四钱
)枇杷叶（刷) 鲜竹叶 麦冬（各三钱) 陈木瓜（六分) 生甘草（一钱) 水煎服。（蚕矢汤
因暑湿内伏。气机宣降无权。故于辛苦清凉中重用豆卷以宣之。木瓜以降之。若暑湿未全内
伏。执方重用豆卷。即犯热证温散之例。豆卷木瓜均酌减可也。热霍乱热极似寒。故转筋。
烧酒大热。善行皮肤。擦一时许。导引其热势外行四散。故旋以大咸寒之盐卤浸之。以杜热
邪复炽。晡时复予前药半剂尤妙。日晡为阳明司令之时。阳证多旺于申酉。晡时不予药则恐
余热复炎。予全方则虞过剂伤正。孟英理精心苦。允堪宗法。蚕矢汤方详此卷末。)
郑凤梧年六十余。秋间患霍乱。凛寒厥逆。烦闷躁扰。口不甚渴。或以为寒。余察脉细欲伏
。苔白而浓。乃暑湿内蕴未化也。须具然犀之照。庶不为病所蒙。因制然照汤予之。一饮而
厥逆凛寒皆退。脉起而吐泻渐止。随以清涤法愈之。
附录然照汤方 治暑秽挟湿。霍乱吐下。脘痞烦渴。苔色白腻。外显恶寒肢冷者。 飞滑石
（四钱) 香豉（炒，三钱) 焦栀（二钱) 黄芩（酒炒) 省头草（各一钱五分) 制浓朴 制半
夏（各一钱) 水煎去滓。研入白蔻仁（八分) 温服。苔腻而浓浊者。去白蔻。加草果仁。（
一钱。以滑石栀芩为正治。就中以滑石清其沉分之热。以栀芩清其浮分之热。宣之以香豉。
通之以朴夏。行之以蔻仁。宣解后清涤乃有所着手)
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。而热复侵荣也。以白虎汤去米草。加生地蒲公英益母草黄柏木瓜丝瓜络薏苡。一剂知。
二剂已。丹溪云。转筋由于血热。此证是矣。（生石膏先煎一两二钱。酒炒知母五钱。大生
地泡冲去渣八钱。蒲公英一两。益母草五钱。酒炒川黄柏一钱半。陈木瓜三钱。丝瓜络三
钱。生苡仁杵八钱。)
陆叟年七十余。仲秋患霍乱。自服单方二三日。呕吐虽已。利犹不止。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。气分
伏暑。业扰及荣。虑其络闭神昏。胡可再投热剂。遂以紫雪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。候凉调而徐服。次日复诊。目开哕止。小溲稍行。于前方裁紫雪
。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。（舌赤而干二句。皆气
分伏有暑邪实热之现证。姜竹茹三钱。姜枇叶三钱。方通草三钱。紫丹参三钱。连翘壳三钱
。石菖蒲次入二钱。苦桔梗次入三钱。酒炒枯芩一钱半。鲜芦根二两。候药凉调送紫雪三分
。玩舌赤而干二句。自服方必系温补窒热。频频作哕四句。病邪皆在气分。气机失其升降。
欲降暑邪。必清气道。故投凉润清通之品。稍佐菖桔紫雪以行之。紫雪候凉调服。盖恐药汤
沸热。减损紫雪辛香之性。)
陈妪年已七旬。辛亥秋患霍乱转筋甚危。孟英诊之。已目陷形消。肢冷音飒。脉伏无溺。口
渴汗多。腹痛苔黄。自欲投井。因先取西瓜汁命予恣饮。方用石膏知母麦冬黄柏芩连竹茹木
瓜威灵仙。略佐细辛分许。煎成徐服。覆杯而瘥。（此证可治在口渴汗多。腹痛苔黄。正旺
则邪亦旺。汗为阴液。汗多则阴津未竭可知。此脉伏无溺。乃热邪伤肺。肺气不行。非气液
两
竭之比。重用知柏芩连之苦。合木瓜之酸。以敛其汗入内。则此汗即是阴液。又用灵仙细辛
。行使一派沉降苦寒之药。生石膏先煎一两六钱。酒炒知母五钱。酒炒川黄柏二钱。酒炒枯
芩一钱半。酒炒川连一钱。花麦冬五钱。陈木瓜四钱。威灵仙次入一钱半。北细辛次入二分
。)
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。口竭苔黄。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。以菖枳苏连芩桔茹牛
海芦菔为剂。一服而瘳。（脉滑数右甚。为肺胃痰实兼挟阴虚。石菖蒲次入二钱。苦桔梗
次入三钱。生苏子研次二钱。炒枳实一钱半。姜枯芩一钱半。姜川连八分。姜竹茹三钱。姜
牛子研三钱。淡海 先煎二两。鲜芦菔切一两。)
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。时
邪
夹食也。以枳实栀豉汤加菖蒲及冬干芦菔菜。煎成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。（炒枳
实
八分。姜栀皮一钱半。炒豆豉一钱半。石菖蒲次入六分。冬干芦菔菜五钱。煎成调送玉枢丹
五分。续方苏叶一分。黄连二分。即苦辛并用。轻可去实之义。)
纪运翔年十七。五月霍乱。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。与伏暑为患者
。殊涂同归。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。臣以栀豉连茹苡半。佐以蚕矢芦根丝瓜络。少加吴萸为使。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。而斑发遍身。苔始渐化。肢温得寐。小溲亦行。随予
清搜化毒之
证。予此方数帖后。反便秘目赤。渴汗昏狂。亦是久伏之邪渐欲外越也。予竹叶石膏汤加减
而瘳。此外湿盛者加茵陈滑石。气实者加枳桔。饮阻食滞者加浓朴芦菔。肝郁气结者加紫苏
楝实。口渴用茅根汤或藕汁频灌。
附录黄芩定乱汤方 治温病转为霍乱。腹不痛而肢冷脉伏。或肢不冷而口渴苔黄。小水不行
。神情烦躁。 黄芩（酒炒) 焦栀子 香豉（炒，各一钱五分) 原蚕砂（三钱) 制半夏橘红
（盐水炒，各一钱) 蒲公英（四钱) 鲜竹茹（二钱) 川连（姜汁炒六分) 陈吴萸（泡淡一分)
阴阳水二盏煎一盏。候温徐服。此外转筋者加生苡仁八钱。丝瓜络三钱。溺行者用木瓜三
钱。湿盛者加连翘茵陈各三钱。（此证可治在舌紫苔腻。大渴汗淋。温热全在气分。大渴肺
阳尚旺。汗淋有汗则阴津未竭。刺曲池委中出血最要。针刺以疏泄其邪。投药方能有效。嗣
去吴萸蚕矢。加酒炒翘壳一钱半。酒炒益母三钱。二味同次入。西滑石先煎四钱。)
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。今
世偏多温热也。于此日上海病因。尤为贴切。地气既日热。秽气亦日盛。若伏邪欲发。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。亦有邪闭则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。
附录飞龙夺命丹方 治痧胀疗痛。霍乱转筋。厥冷脉伏神昏危急之证。及受温暑瘴疫秽恶阴
晦诸邪。而眩晕痞胀。瞀乱昏狂。或卒倒身强。遗溺不语。身热螈 。宛如中风。或时证逆
传。神迷狂谵。小儿惊痫。角弓反张。牙关紧闭诸证。 朱砂（飞二两) 明雄黄（飞) 灯心
灰（各一两) 人中白（漂 ，八钱) 明矾 青黛（飞，各五钱) 梅冰 麻黄（去节，各四钱)
真珠 牙皂 当门子 蓬砂（各三钱) 西牛黄（二钱) 杜蟾酥 火硝（各一钱五分) 飞真
金（三百页) 十六味各研极细。合研匀。瓷瓶紧收。毋令泄气。以少许吹鼻取嚏。重者再用
凉开水调服一分。小儿减半。
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。随予解毒活血汤。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
。颐肿舌糜。牙关甚紧。痰嗽胁疼。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。并录以为贾旅告。
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。至左弦滑。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。予枳桔芩连茹夏苏翘芦根枇杷叶滑石开痰
行食。舒结通阳。两剂呃果止。而遍身赤斑。又两剂燥矢下而苔化溺行。右脉渐振。随予清
肃法调养而瘳。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。以霍乱转筋而见呃忒。皇皇然以为虚脱之象。故温补日以加峻。纵使一蹶不起。病
者
无怨。医家不悔。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。虽以热药杀之不知。呃忒则尤多枉死。孟英尝治一角妓。患呃累
日。破身太早。固是虚证。然血去阴伤。岂可反以温燥助热。遂致下焦不摄。妓性畏药。用
一
味鸡子黄。连进数服而安。（炒枳实一钱半。苦桔梗次入三钱。酒炒枯芩一钱半。酒炒川连
八分。制半夏二钱。姜竹茹三钱。生苏子研次一钱半。连翘壳三钱。姜枇叶刷包三钱。鲜芦
根一两。西滑石先煎四钱。)
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。盖复甚浓。询其口。
不渴而泻。亦不热。然小便全无。吐者极苦。舌色甚赤。新凉外束。伏暑内发也。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。随以芩连苡楝栀茹桑斛蒲公英煎服。痛即减。吐泻亦止。改用轻清法而愈。
（酒炒枯芩一钱半。酒炒川连八分。生苡仁杵八钱。酒炒楝核二钱杵先。酒炒栀皮一钱半。
冬桑叶三钱。姜竹茹次入三钱。石斛先煎八钱。蒲公英五钱。药温服。)
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。伏暑挟食之
证。不知何所见而予燥补涩腻之药。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。不知为伏热不清。改投附桂等三帖而亡。尤可哀已。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。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。予河间法。人皆不信。再与他医商之。仍用热剂。卒至口鼻出血而死。此案已见
正编卷二。不抄不印。
Between the eighth and ninth months of the Dingyou year, cholera with muscle cramps was prevalent in Hangzhou. A woman surnamed Shen contracted this illness late at night, followed immediately by hoarseness and cold extremities (Jue Ni). By dawn, Mengying examined her pulse: it was wiry (Xian), fine (Xi), and choppy (Se), with the Chi positions on both sides being extremely weak, almost imperceptible. Her mouth was extremely thirsty, but any fluid swallowed caused immediate and incessant vomiting. Her calf muscles were hard as stone, and the spasms caused excruciating pain. This indicated Summerheat-Dampness hidden internally, obstructing Qi mechanism, leading to a loss of dispersing and descending functions, resulting in chaotic upward rebellion. Following the example of Jishibai San from *Jin Gui Yao Lue*, he prescribed Can Shi Tang, instructing to decoct it with Yin-Yang Water and take it slowly after cooling. The medicine stayed down without vomiting. Externally, warm wine was used for vigorous friction on the hardened, spasming areas. After about an hour of friction, the stagnant heat dissipated, and the muscle knots softened. Subsequently soaking them in brine stopped the spasms, and vomiting and diarrhea gradually ceased. In the afternoon, half a dose of the previous medicine was administered again, allowing for peaceful sleep that night. The next day, she only felt extreme fatigue. She recovered after taking Zhi He Tang several times. Later, many similar cases were treated successfully using this method with modifications. Only those who mistakenly took Fuzi were difficult to save.
Appendix: Zhi He Tang Formula. Treats post-cholera condition where fluids are not restored, characterized by dry throat and tongue, short urination, and loose stools. Bei Sha Shen, Sheng Bian Dou, Shi Hu, Chen Cang Mi (each 4 qian); Pi Pa Ye (brushed), Xian Zhu Ye, Mai Dong (each 3 qian); Chen Mu Gua (6 fen); Sheng Gan Cao (1 qian). Decoct in water and take orally. (Can Shi Tang is used because Summerheat-Dampness is hidden internally, causing loss of Qi mechanism dispersal and descent. Therefore, Dou Juan is heavily used among bitter-warm and cool-clear herbs to disperse, and Mu Gua to descend. If Summerheat-Dampness is not fully hidden, insisting on heavy use of Dou Juan violates the principle of using warm-dispersing methods for heat syndromes. Both Dou Juan and Mu Gua can be reduced if necessary. In Heat Cholera, extreme heat mimics cold, causing muscle cramps. Warm wine is very hot and promotes circulation in the skin; friction for an hour guides the heat outward. Thus, it is immediately followed by soaking in salty-cold brine to prevent the re-ignition of heat pathogens. Administering half a dose of the previous medicine in the late afternoon is particularly effective. Late afternoon is when the Yangming channel governs; Yang syndromes often peak during Shen and You hours. Not giving medicine then risks residual heat flaring up; giving the full formula risks damaging healthy Qi through overdose. Mengying’s careful and diligent management is worthy of emulation. See the end of this volume for the Can Shi Tang formula.)
Zheng Fengwu, over sixty years old, suffered from cholera in autumn. He experienced severe aversion to cold and cold extremities, restlessness, and agitation, with little thirst. Some considered it a Cold syndrome. I observed his pulse to be fine and nearly concealed, with a white and thick coating. This was Summerheat-Dampness retained internally without transformation into heat. One must possess the insight of a rhino horn (clear perception) to avoid being deceived by the disease. Therefore, I formulated Ran Zhao Tang for him. After one dose, the cold extremities and aversion to cold receded, the pulse became palpable, and vomiting and diarrhea gradually stopped. He was subsequently cured using a clearing and purging method.
Appendix: Ran Zhao Tang Formula. Treats Summerheat-Turbidity combined with Dampness, cholera with vomiting and diarrhea, epigastric fullness, restlessness, thirst, white greasy coating, and external signs of aversion to cold and cold limbs. Fei Hua Shi (4 qian); Xiang Chi (stir-fried, 3 qian); Jiao Zhi Zi (2 qian); Huang Qin (wine-fried); Sheng Tou Cao (each 1.5 qian); Zhi Hou Po, Zhi Ban Xia (each 1 qian). Decoct in water, strain, and add Bai Kou Ren (8 fen) powder; take warm. If the coating is greasy and turbid, remove Bai Kou Ren and add Cao Guo Ren (1 qian). (Hua Shi, Zhi Zi, and Huang Qin constitute the main treatment. Hua Shi clears heat in the sinking portion, while Zhi Zi and Huang Qin clear heat in the floating portion. Xiang Chi disperses, Hou Po and Ban Xia unblock, and Bai Kou Ren moves Qi. After dispersion and resolution, clearing and purging can be effectively applied.)
A young, thin woman contracted cholera with muscle cramps in early autumn. Her tongue was crimson, eyes red, with intense thirst for cold drinks. The left pulse was wiry and strong, the right pulse slippery and large. This indicated inherent excess Fire in the Liver and Stomach, compounded by Heat invading the Ying (Nutritive) level. I prescribed Bai Hu Tang removing Jing Mi and Gan Cao, adding Sheng Di, Pu Gong Ying, Yi Mu Cao, Huang Bo, Mu Gua, Si Gua Luo, and Yi Yi Ren. Improvement was seen after one dose, and recovery after two. Danxi stated that muscle cramps result from Blood Heat; this case confirms that. (Sheng Shi Gao decocted first, 1.2 liang; Jiu Chao Zhi Mu 5 qian; Da Sheng Di soaked, strained, 8 qian; Pu Gong Ying 1 liang; Yi Mu Cao 5 qian; Jiu Chao Chuan Huang Bo 1.5 qian; Chen Mu Gua 3 qian; Si Gua Luo 3 qian; Sheng Yi Yi Ren pounded, 8 qian.)
Elder Lu, over seventy, contracted cholera in mid-autumn. After self-medicating with folk prescriptions for two or three days, vomiting stopped, but diarrhea persisted, accompanied by frequent hiccups with low voice, red face, closed eyes, and anuria. Mengying examined him; although the pulse was deficient and soft, there were no signs of collapse. Moreover, the tongue was red and dry, and the stool was foul-smelling. This indicated latent Summerheat in the Qi level disturbing the Ying level. Concerned about meridian closure and confusion, how could hot medicines be administered? Thus, Zi Xue (3 fen) was mixed into a decoction of Zhu Ru, Pi Pa Ye, Tong Cao, Dan Shen, Lian Qiao, Shi Chang Pu, Jie Geng, Huang Qin, and Lu Gen, cooled, and taken slowly. On the second day, his eyes opened, hiccups stopped, and urination improved slightly. Zi Xue was removed from the previous formula, and Shi Hu and Yi Yi Ren were added. After two doses, diarrhea decreased, and he could consume rice broth. He recovered after more than ten doses of Zhi He Tang. (The red and dry tongue indicates real Heat of latent Summerheat in the Qi level. The self-administered formulas were likely warming and tonifying, causing heat obstruction. Frequent hiccups indicate the pathogen remains in the Qi level, disrupting Qi mechanism ascent and descent. To descend Summerheat, the Qi pathway must be cleared; thus, cool, moistening, clearing, and unblocking agents are used, assisted by Shi Chang Pu, Jie Geng, and Zi Xue. Zi Xue is taken cool to preserve its acrid-aromatic properties against boiling hot decoctions.)
Old Woman Chen, seventy years old, suffered critically from cholera with muscle cramps in autumn of the Xinhai year. Mengying found her with sunken eyes, emaciation, cold limbs, hoarse voice, concealed pulse, anuria, thirst, profuse sweating, abdominal pain, and yellow coating. She attempted suicide by jumping into a well. First, watermelon juice was given freely. Then a formula of Shi Gao, Zhi Mu, Mai Dong, Huang Bo, Huang Qin, Huang Lian, Zhu Ru, Mu Gua, Wei Ling Xian, with a trace of Xi Xin was decocted and taken slowly. She recovered immediately after finishing the cup. (This case is treatable due to thirst and sweating indicating Yin fluids are not exhausted, and abdominal pain with yellow coating showing Zheng Qi is still robust. The concealed pulse and anuria result from Heat injuring the Lung, preventing Qi movement, not from exhaustion of Qi and fluids. Heavy use of bitter Zhi Mu, Huang Bo, Huang Qin, and Huang Lian combined with sour Mu Gua astringes sweat, turning sweat back into Yin fluid. Wei Ling Xian and Xi Xin guide the sinking, bitter-cold herbs. Shi Gao decocted first, 1.6 liang; Jiu Chao Zhi Mu 5 qian; Jiu Chao Chuan Huang Bo 2 qian; Jiu Chao Ku Huang Qin 1.5 qian; Jiu Chao Chuan Lian 1 qian; Hua Mai Dong 5 qian; Chen Mu Gua 4 qian; Wei Ling Xian added later, 1.5 qian; Bei Xi Xin added later, 2 fen.)
Chen Chuzhen’s daughter-in-law suddenly developed cholera. Applying Hui Yang Gao to the navel was ineffective. Mengying palpated the pulse: slippery and rapid, stronger on the right. Mouth was parched, coating yellow. Pressing below the chest revealed hardness and pain. He said, “Despite vomiting and diarrhea, food remains lodged in the diaphragm; this is not a Cold syndrome.” Hui Yang Gao should be removed immediately. A formula of Shi Chang Pu, Zhi Shi, Su Zi, Huang Lian, Huang Qin, Jie Geng, Zhu Ru, Niu Bang Zi, Hai Ge Ke, and Xian Lu Fu was prescribed. Recovery occurred after one dose. (Slippery-rapid pulse, stronger on the right, indicates Phlegm-Excess in Lung and Stomach combined with Yin deficiency. Shi Chang Pu added later, 2 qian; Ku Jie Geng added later, 3 qian; Sheng Su Zi pounded and added later, 2 qian; Chao Zhi Shi 1.5 qian; Jiang Ku Huang Qin 1.5 qian; Jiang Chuan Lian 8 fen; Jiang Zhu Ru 3 qian; Jiang Niu Zi pounded, 3 qian; Dan Hai Ge Ke decocted first, 2 liang; Xian Lu Fu sliced, 1 liang.)
Wang Shouhefu, six years old, suddenly developed aversion to cold, fever, facial redness, delirium, frequent sweating, cold extremities, yellow-greasy coating, thirst, and red lips. This was seasonal pathogens combined with food stagnation. Zhi Shi Zhi Chi Tang was modified with Shi Chang Pu and dried winter Lu Fu Cai. Yu Shu Dan (5 fen) was mixed into the decoction and administered. Delirium subsided the next day, followed by abdominal pain, vomiting, and diarrhea, indicating the pathogen was exiting via cholera-like symptoms. Mengying stated that not only Shanghan can transform into cholera, but also Wen Re, Summerheat, and Dampness. Treatment should guide the pathogen along its course. Su Ye (1 fen) and Huang Lian (2 fen) were added to the previous formula, stir-fried together, decocted, and taken. After three to five episodes of vomiting and six to seven of diarrhea, pain subsided. Mental clarity returned on the third day. However, to eradicate disease completely, another dose of the original formula ensured full recovery. Pediatric illnesses are often due to food stagnation. When the Stomach is disharmonious, sleep is disturbed; Yangming excess causes delirium. Vomiting and diarrhea are outlets for the disease; using anti-convulsant medicines indiscriminately often leads to failure. (Chao Zhi Shi 8 fen; Jiang Zhi Pi 1.5 qian; Chao Dou Chi 1.5 qian; Shi Chang Pu added later, 6 fen; Winter-dried Lu Fu Cai 5 qian; Yu Shu Dan 5 fen mixed in. Continued formula: Su Ye 1 fen, Huang Lian 2 fen, illustrating the combination of bitter and acrid, and the principle that light substances can resolve excess.)
Ji Yunxiang, seventeen years old, suffered critically from cholera in May. Mengying found his hands and face black, eyes sunken with wandering pupils, cold extremities, hoarse voice, concealed pulse, anuria, purple tongue with greasy coating, intense thirst, profuse sweating, and confused spirit. It was before Mangzhong, so Summerheat-Dampness season had not arrived; instead, Winter-Cold was hidden internally. Spring was too cold, and summer remained cool, suppressing Qi mechanism. Those intending to develop Wen Bing transformed into this syndrome, similar to Fu Shu patients but without abdominal pain. Cold transforming into Heat differs from Summerheat-Dampness. Acupuncture at Qu Chi and Wei Zhong was performed immediately, bleeding dark blood. Huang Qin was the sovereign herb, with Zhi Zi, Dou Chi, Huang Lian, Zhu Ru, Yi Yi Ren, and Ban Xia as ministers, Can Shi, Lu Gen, and Si Gua Luo as assistants, and a small amount of Wu Zhu Yu as envoy. Decocted in Yin-Yang Water, taken warm slowly, stopping vomiting. Pulse rose slightly the next day. After two more doses, black color faded, elbows and knees warmed, but eyes turned red with irritability, indicating latent pathogen emerging externally. Wu Zhu Yu and Can Shi were removed, Lian Qiao, Yi Mu Cao, and Hua Shi added. Rash appeared all over, coating began to transform, limbs warmed, sleep returned, and urination resumed. Qing Sou Hua Du method was then used. (See Appendix: Huang Qin Ding Luan Tang). Modifications: Add Sheng Yi Yi Ren and Si Gua Luo for cramps; Mu Gua for urination; Lian Qiao and Yin Chen for dampness. (Treatable due to purple tongue, greasy coating, thirst, sweating. Heat is entirely in Qi level; thirst shows Lung Yang is robust; sweating shows Yin fluids intact. Bleeding from Qu Chi and Wei Zhong is crucial to vent pathogen via acupuncture, making herbal efficacy possible. Later, Jiu Chao Lian Qiao 1.5 qian and Jiu Chao Yi Mu Cao 3 qian added later; Xi Hua Shi decocted first, 4 qian.)
In ancient times, there were no smallpox cases; they appeared starting from the Han Dynasty. Now, few people do not contract it, due to population growth and increasing terrestrial heat. Thus, ancients feared Shanghan most, while modern times see more Wen Re. This is particularly relevant to Shanghai’s etiology. As terrestrial heat increases, turbid qi also grows. If latent pathogens emerge and external pathogens enter, they clash, disrupting intestines and stomach, causing immediate Qi blockage and blood stasis, leading to cold extremities and black hands/face. Yangming channel has abundant Qi and Blood; such sudden manifestations are not due to sudden exhaustion of Qi and Blood. Humans are formed by Qi; without Qi flow, flesh and blood die. Therefore, initial treatment must open blockages to restore Qi and Blood flow, allowing pathogen expulsion and Zheng Qi recovery. Ignorant practitioners do not understand that deep heat causes deep cold (Re Shen Jue Shen). Seeing cold limbs and concealed pulse, they diagnose Cold or Collapse, avoiding acupuncture and administering hot medicines, further closing the pathogen, increasing cold until death from seven-orifice bleeding occurs. Some experience internal closure leading to external collapse: Yang collapses from above (profuse sweating, Qi loss); Yin collapses from below (profuse diarrhea, fluid loss). This is Internal Closure and External Collapse. To prevent external collapse, internal closure must be opened. Zi Xue, Jiang Xue, and Xing Jun San are excellent formulas for opening closure and venting latent pathogens. Fei Long Duo Ming Dan combines Xing Jun San and Jiang Xue with stronger potency. Ren Zhong Bai guides turbidity downward, possessing decisive power.
Appendix: Fei Long Duo Ming Dan Formula. Treats Sha Zhang, carbuncles, cholera with cramps, critical conditions with cold extremities, concealed pulse, and coma; also warmth, summerheat, miasma, and evil turbid yin pathogens causing dizziness, fullness, confusion, coma, sudden collapse with rigidity, enuresis, mutism, fever with convulsions resembling stroke, reverse transmission of seasonal diseases with confusion and mania, pediatric epilepsy, opisthotonos, and locked jaw. Zhu Sha (flying, 2 liang); Ming Xiong Huang (flying); Deng Xin Hui (each 1 liang); Ren Zhong Bai (washed, 8 qian); Ming Fan; Qing Dai (flying, each 5 qian); Mei Bing; Ma Huang (deheaded, each 4 qian); Zhen Zhu; Ya Zao; Dang Men Zi; Peng Sha (each 3 qian); Xi Niu Huang (2 qian); Du Chan Su; Huo Xiao (each 1.5 qian); Fei Zhen Jin (300 sheets). Grind sixteen ingredients to fine powder, mix evenly, store tightly in porcelain bottle to prevent gas escape. Blow a small amount into nose to induce sneezing. For severe cases, mix 1 fen with cool boiled water and administer. Half dose for children.
Chu Ziyun’s maid suffered this, body rigid. Mengying administered 2 fen of Duo Ming Dan; she moved instantly. Jie Du Huo Xue Tang was then given, saving her life. One patient cured by Mengying recovered bowel/bladder function and appetite, but died suddenly from mental confusion as residual heat vented externally with facial rash. Another patient cured by Mengying had normal bowels/bladder but died days later from inability to swallow, eye rolling, hiccups. Another recovering patient suddenly became confused and died despite medication. Chen Xiexiong’s younger brother was critically ill; Mengying cured him, but he stopped medication. A month later, he returned with sore throat, swollen cheeks, ulcerated tongue, locked jaw, phlegm cough, rib pain, red painful urination, and soy-sauce colored loose stools. Residual toxin accumulated, lacking clearing resolution; pulse was wiry, tight, rapid, and untreatable. Recorded as a warning for travelers.
Zhu Mingqi suffered diarrhea with cramps. Doctors saw cold limbs and administered warming tonics, causing immediate vomiting, followed by incessant hiccups. Warming tonics increased, worsening the condition until the ninth day. Mengying palpated: left wiry-slippery, right weak and imperceptible; thick yellow-greasy coating; anuria; tenderness above umbilicus. He said, “Pathogen was mild, worsened by wrong medicine. Life should not be lost. Fortunately, vomiting occurred.” Prescribed Zhi Shi, Jie Geng, Huang Qin, Huang Lian, Zhu Ru, Ban Xia, Su Zi, Lian Qiao, Lu Gen, Pi Pa Ye, Hua Shi to resolve phlegm, move food, relieve constraint, unblock Yang. Hiccups stopped after two doses. Red spots appeared all over. After two more doses, dry stool passed, coating transformed, urination resumed, right pulse strengthened. Qing Su method restored health. If treated correctly initially, recovery would take one or two doses. The world wrongly considers diarrhea, vomiting, cholera, and cholera cramps as Cold syndromes, often administering hot medicines without observing the condition. Seeing cold limbs and weak right pulse, they assume Deficient-Cold. Vomiting upon taking medicine and subsequent hiccups are misinterpreted as Collapse signs, leading to escalating warming tonics. Even if fatal, patients blame no one, doctors repent not. Such transmission of skill is lamentable. Additionally, chest/abdominal pain, malaria, asthma, menstrual obstruction, and postpartum conditions are often misdiagnosed as Cold, killing patients with hot medicines. Hiccups cause especially many wrongful deaths. Mengying once treated a courtesan with persistent hiccups. Early sexual activity caused Deficiency, but blood loss injured Yin. Using warm-dry herbs to assist heat led to lower jiao insecurity. Fearful of medicine, she was cured by consuming multiple doses of chicken egg yolk alone. (Chao Zhi Shi 1.5 qian; Ku Jie Geng added later, 3 qian; Jiu Chao Ku Huang Qin 1.5 qian; Jiu Chao Chuan Lian 8 fen; Zhi Ban Xia 2 qian; Jiang Zhu Ru 3 qian; Sheng Su Zi pounded and added later, 1.5 qian; Lian Qiao Qiao 3 qian; Jiang Pi Pa Ye wrapped, 3 qian; Xian Lu Gen 1 liang; Xi Hua Shi decocted first, 4 qian.)
Wang Jijie’s maternal relative suddenly developed cholera on an autumn night with severe abdominal pain. Pulse was fine, rapid, and wiry; cold limbs, fear of cold, heavy clothing. Mouth not thirsty, stool not hot, but anuria. Vomiting was extremely bitter, tongue very red. New Cool constrained exterior, latent Summerheat erupted internally. Jiang Xue and Yu Shu Dan were refused. After four to five diarrheas, slight heat and intense thirst appeared, but drinking was still refused. Speech was slightly slurred. Mengying ordered fresh lotus root juice to be slowly administered; gradually tolerated. Then Huang Qin, Huang Lian, Yi Yi Ren, Liu Shen, Zhi Zi, Zhu Ru, Sang Ye, Shi Hu, Pu Gong Ying were decocted and taken. Pain subsided, vomiting and diarrhea stopped. Light-clearing method completed recovery. (Jiu Chao Ku Huang Qin 1.5 qian; Jiu Chao Chuan Lian 8 fen; Sheng Yi Yi Ren pounded, 8 qian; Jiu Chao Liu He pounded and decocted first, 2 qian; Jiu Chao Zhi Pi 1.5 qian; Dong Sang Ye 3 qian; Jiang Zhu Ru added later, 3 qian; Shi Hu decocted first, 8 qian; Pu Gong Ying 5 qian; take warm.)
Shen Chunquan, fifty-seven, suddenly developed cholera with cramps five days before Lidong after eating crab noodles. Vomit and stool were watery. Initial Gui Fu medicines worsened cramps. Slight whole-body sweat, fatigue, reluctance to speak, cold fingers, concealed pulse, occasional sighing. Modified formula: Mu Li (1 liang), Gui Ban (8 qian), E Jiao (4 qian). Condition worsened after taking. Mengying observed: yellow coating, intense thirst, anuria, extremely hot stool, epigastric tenderness. This was latent Summerheat with food stagnation. Why prescribe drying, tonifying, astringent, and cloying herbs? His second son also contracted this after Lidong. Doctor knew latent Summerheat, used Huang Lian etc., stopped vomiting/diarrhea. But pulse didn’t rise quickly; doctor didn’t realize latent heat wasn’t cleared, switched to Fu Gui for three doses, resulting in death. Tragic. Chen Yipu, also knowledgeable in medicine, had his wife contract cholera with cramps in mid-autumn. Self-diagnosed as Cold, took hot medicines, condition worsened. Called Zhu Jiaoting, who agreed with the host. Condition aggravated. Mengying was summoned, stating, “This Cold is new pathogen constraining exterior; Heat is true latent pathogen. Bitter mouth and thirst contraindicate Jiang and Fu.” Prescribed He Jian method. Others disbelieved, consulted other doctors, continued hot medicines, died from nose and mouth bleeding. This case appears in Main Volume II, not copied here.