三钱。又二帖后。去半夏扁豆叶。加箱归身一钱。南花粉四钱。陈皮八分。又二帖后。沙参
易西洋参。加花麦冬四钱。羊藿一钱。数帖后。加枸杞三钱。川杜仲一钱。)
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。以胃苓汤去甘术。加苡仁川连半夏
枇杷叶。二剂而瘳。（木猪苓三钱。生泽泻三钱。生茅术一钱半。制半夏一钱。制浓朴一钱
。生苡仁杵四钱。酒炒川连一钱。酒炒枇叶刷包三钱。)
胡次瑶妇陡患肢麻昏运。以为急痧。孟英视之。面微红。音低神惫。睛微赤。苔色微黄。足
微冷。身微汗。胸微闷。脉微弦。乃本元素弱。谋虑萦思。心火上炎。内风随以上僭。岂可
误作痧闭。妄投香散之药哉。以人参龙蛎菖连石英麦冬小麦竹叶莲子心为方。两啜而瘥。寻
予平补善其后。（高丽参八分。醋 龙骨杵先五钱。醋 牡蛎杵先二两。石菖蒲次入八分。
酒炒川连一钱。紫石英杵先三钱。花麦冬四钱。北小麦三钱。鲜竹叶二钱。莲子心一钱。)
姚欧亭初夏偶患大泻。后苦脾约。更旬始一更衣。既而匝月一行。甚至月余一行。极其艰滞
。而先硬后溏。汗出神惫。年逾六秩。步履蹇滞。虽广服人乳及润导诸药。率不效。间或纳
食如哽。呕吐酸辣。六脉迟 。苔色白润不渴。小便清长。腹无胀痛。此真中气不足。溲便
为之变也。岂肠燥便秘。可以润药濡之哉。既不宜润。更不可下。以中虚开阖无权。恐一开
而不复阖。将何如耶。亦不可升提。盖吐酸食哽。已形下秘上冲之势。又素吸洋烟。设一阖
而竟不开。又将何如耶。爰以参术橘半旋芍鸡金木瓜枇杷叶为方。服六剂。更衣两次。解四
弹
丸。又三剂。解十五六丸。又三剂。下九丸而始畅。并不坚燥。亦无溏矢。毫不怯力。是药
证已符。为留调理法而别。设或吐酸食哽。则暂用参连橘半旋茹苏叶枇杷叶紫石英以清肃镇
息之。八月初秋阳正烈。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。先予参连夏朴茹滑苡苏蚕砂扁豆叶。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。去蔻蛤。加菖蒲白术。五剂而痊。霍乱之开阖失常。中枢为邪所乱
也。此证之开阖无权。中虚不能主持也。一实一虚。正可互勘。至愈后之呕泻振惕。又为风
暑乘虚扰中之霍乱证。（潞党参三钱。炒白术一钱半。制半夏三钱。陈橘皮一钱半。旋复包
先一钱半。酒炒白芍一钱半。炙鸡金三钱。陈木瓜六分。酒炒枇叶刷包一片。身热呕泻方。
西
洋参三钱。酒炒川连八分。制浓朴一钱。制半夏一钱半。姜竹茹三钱。西滑石先煎四钱。生
苡仁杵四钱。蚕砂五钱。扁豆叶七片。生苏子研一钱。嗣去滑朴蚕砂扁豆叶。加云茯神三钱
。生蛤壳杵先四钱。绿豆先煎五钱。淡紫菜三钱。白蔻仁研入四分。嗣去蔻蛤。加石菖蒲次
入六分。炒白术一钱半。热净则仍健其中。)
己丑五月。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。（辨中虚
受寒。在脉微苔白。腹欲重按。潞党参三钱。炒白术三钱。炒粉草一钱。炒干姜五钱。川桂
枝次入一钱二分。酒炒白芍一钱半。)
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。两目旋转不停。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。乳即瘪而不起矣。形亦渐削。汗
亦渐多。脉亦渐脱。音亦渐嘶。戌刻遽逝。乃中气卒然溃散。绝无仅有之候也。
Three qian. After taking two more doses, remove Banxia (Pinelliae Rhizoma) and Biandouye (Vigna radiata var. angularis folium), add Dangguishen (Angelicae Sinensis Radix) one qian, Tianhuafen (Trichosanthis Radix) four qian, and Chenpi (Citri Reticulatae Pericarpium) eight fen. After another two doses, replace Shashen (Glehniae Radix) with Xiyangshen (Panacis Quinquefolii Radix), add Huaidonghua (Lili Bulbus) four qian, and Yanghuo (Epimedii Folium) one qian. After several doses, add Gouqi (Lycii Fructus) three qian and Chuan Duzhong (Eucommiae Cortex) one qian.)
A patient surnamed Ding suffered from Huoluan (Cholera-like disease). His tongue coating was thin and white, and he did not feel thirsty; he only felt a sticky sensation in his mouth. Being knowledgeable about medicine himself, he wished to treat it as Cold-Dampness. Mengying said: "There is originally Cold-Dampness in the Middle Jiao, which explains the lack of thirst. However, the sticky sensation suggests that Summerheat has entered and fermented the dampness into Heat." The prescription was Weiling Tang (Poria Decoction) with Gancao (Licorice Root) and Baizhu (Atractylodis Macrocephalae Rhizoma) removed, plus Yiren (Coicis Semen), Chuanlian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma), and Pipaye (Eriobotryae Folium). He recovered after two doses. (Muzhuling (Polyporus), raw Zexie (Alismatis Rhizoma) each three qian; raw Maoshu (Atractylodis Rhizoma) one and a half qian; processed Banxia (Pinelliae Rhizoma) one qian; processed Houpo (Magnoliae Officinalis Cortex) one qian; raw Yiren (Coicis Semen) pounded four qian; wine-fried Chuanlian (Coptidis Rhizoma) one qian; wine-fried Pipaye (Eriobotryae Folium) brushed clean and wrapped for decoction three qian.)
The wife of Hu Ciya suddenly suffered from limb numbness and dizziness, which was considered an acute Sha syndrome (a type of acute pathological condition). Upon examination by Mengying, her face was slightly red, her voice was low, and she appeared mentally exhausted. Her eyes were slightly red, her tongue coating was slightly yellow, her feet were slightly cold, she had slight sweating, slight chest stuffiness, and a slightly wiry pulse. This indicated a fundamental weakness of Yuan Qi (Primordial Qi), excessive worry and thought leading to Heart Fire flaring upward, and Internal Wind rising accordingly. How could this be mistaken for Sha Bi (Sha obstruction) and treated recklessly with aromatic dispersing herbs? The prescription consisted of Renshen (Ginseng Radix), Longgu (Fossilia Ossis Mastodi), Muli (Concha Ostreae), Shichangpu (Acori Tatarinowii Rhizoma), Lian (Coptidis Rhizoma), Shiyingshi (Hematitum), Maidong (Ophiopogonis Radix), Xiaomai (Tritici Fructus), Zhuye (Bambusae Folium), and Lianzixin (Nelumbinis Plumula). She recovered after two administrations. Subsequently, mild tonifying herbs were given for convalescence. (Gaolianren (Korean Ginseng Radix) eight fen; vinegar-processed Longgu (Fossilia Ossis Mastodi) pounded and decocted first five qian; vinegar-processed Muli (Concha Ostreae) pounded and decocted first two liang; Shichangpu (Acori Tatarinowii Rhizoma) added later eight fen; wine-fried Chuanlian (Coptidis Rhizoma) one qian; Zi Shiyingshi (Hematitum) pounded and decocted first three qian; Maidong (Ophiopogonis Radix) four qian; Beixiaomai (Tritici Fructus) three qian; fresh Zhuye (Bambusae Folium) two qian; Lianzixin (Nelumbinis Plumula) one qian.)
Yao Outing accidentally suffered from severe diarrhea in early summer. Later, he suffered from Pi Yue (Spleen constraint causing constipation), requiring ten days to have a bowel movement once. Eventually, it became once a month, or even once every month or more, extremely difficult and sluggish. The stool was hard at first and loose afterwards. He sweated and appeared mentally exhausted. Over sixty years old, his gait was slow and unsteady. Although he widely consumed human milk and various moistening laxatives, they were ineffective. Occasionally, swallowing food felt like choking, and he vomited sour and spicy substances. The six pulses were slow, the tongue coating was white and moist without thirst, urination was clear and profuse, and there was no abdominal distension or pain. This was true deficiency of Middle Qi, leading to abnormalities in urination and defecation. Could this be intestinal dryness and constipation treatable by moistening herbs? Since moistening is inappropriate, purgation is certainly contraindicated. Due to Middle deficiency, the opening and closing functions are powerless; if opening occurs without closing, what then? Ascending and lifting is also inadvisable because vomiting acid and choking on food already indicate a trend of lower blockage and upper rebellion. Moreover, he habitually smoked opium; if closing occurred without opening, what then? Therefore, the prescription used Dangshen (Codonopsis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Jupi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Xuanfuhua (Inulae Flos), Baishao (Paeoniae Radix Alba), Jijin (Galli Gigerii Endothelium Corneum), Mugua (Chaenomelis Fructus), and Pipaye (Eriobotryae Folium). After six doses, he had two bowel movements, passing stools the size of marbles. After three more doses, he passed fifteen or sixteen such stools. After another three doses, he passed nine stools before feeling completely relieved. The stools were neither hard nor dry, nor were they loose, and he felt no fatigue. This indicated the medicine matched the syndrome. A regimen for regulation was prescribed, and he departed. If vomiting acid or choking on food recurred, temporarily use Dangshen (Codonopsis Radix), Lian (Coptidis Rhizoma), Jupi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Xuanfuhua (Inulae Flos), Zhuru (Bambusae Caulis in Recens), Zi Su Ye (Perillae Folium), Pipaye (Eriobotryae Folium), and Shiyingshi (Hematitum) to clear, descend, and calm. In early autumn when the sun was fierce, on the seventh day of the eighth lunar month, Outing suddenly developed fever, vomiting, and diarrhea. White coating covered the tongue, mental exhaustion was severe, abdominal pain was frequent with sweating, voice was low, and urination was difficult. Initially, Xiyangshen (Panacis Quinquefolii Radix), Lian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), Zhuru (Bambusae Caulis in Recens), Huashi (Talcum), Yiren (Coicis Semen), Zi Su (Perillae Fructus), Can Sha (Bombyx Batryticatus), and Biandouye (Vigna radiata var. angularis folium) were given. Fever subsided and clarity returned after two doses, but the left pulse remained wiry, the Guan position was high, he vomited acid, and could not sleep. Tremors occurred in hands and feet. Although external pathogens were resolved, Earth was overacted by Wood. Huashi (Talcum), Houpo (Magnoliae Officinalis Cortex), Can Sha (Bombyx Batryticatus), and Biandouye (Vigna radiata var. angularis folium) were removed, and Fushen (Poria with Hostwood), Geke (Concha Arcae), Lvcai (Dictyota Dichotoma), Lvdou (Phaseoli Semen), and Baixiaoren (Amomi Fructus Rotundus) were added. After three doses, the coating transformed, sleep improved, hunger returned, and diarrhea decreased. Baixiaoren (Amomi Fructus Rotundus) and Geke (Concha Arcae) were removed, and Shichangpu (Acori Tatarinowii Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) were added. He recovered after five doses. The abnormal opening and closing in Huoluan (Cholera-like disease) is due to the Central Pivot being disturbed by pathogens. The powerlessness of opening and closing in this case is due to Middle deficiency failing to govern. One is excess, one is deficiency; they can be compared. The subsequent vomiting, diarrhea, and tremors after recovery were a Huoluan syndrome where Wind-Summerheat took advantage of deficiency to disturb the Middle. (Ludangshen (Codonopsis Radix) three qian, fried Baizhu (Atractylodis Macrocephalae Rhizoma) one and a half qian, processed Banxia (Pinelliae Rhizoma) three qian, aged Jupi (Citri Reticulatae Pericarpium) one and a half qian, Xuanfuhua (Inulae Flos) wrapped and decocted first one and a half qian, wine-fried Baishao (Paeoniae Radix Alba) one and a half qian, roasted Jijin (Galli Gigerii Endothelium Corneum) three qian, aged Mugua (Chaenomelis Fructus) six fen, wine-fried Pipaye (Eriobotryae Folium) brushed clean and wrapped one slice. For fever, vomiting, and diarrhea: Xiyangshen (Panacis Quinquefolii Radix) three qian, wine-fried Chuanlian (Coptidis Rhizoma) eight fen, processed Houpo (Magnoliae Officinalis Cortex) one qian, processed Banxia (Pinelliae Rhizoma) one and a half qian, ginger-processed Zhuru (Bambusae Caulis in Recens) three qian, Xi Huashi (Talcum) decocted first four qian, raw Yiren (Coicis Semen) pounded four qian, Can Sha (Bombyx Batryticatus) five qian, Biandouye (Vigna radiata var. angularis folium) seven leaves, raw Zi Su (Perillae Fructus) ground one qian. Subsequently remove Huashi (Talcum), Houpo (Magnoliae Officinalis Cortex), Can Sha (Bombyx Batryticatus), Biandouye (Vigna radiata var. angularis folium); add Yun Fushen (Poria with Hostwood) three qian, raw Geke (Concha Arcae) pounded and decocted first four qian, Lü Dou (Phaseoli Semen) decocted first five qian, Dan Zicai (Dictyota Dichotoma) three qian, Baixiaoren (Amomi Fructus Rotundus) ground and added later four fen. Subsequently remove Baixiaoren (Amomi Fructus Rotundus) and Geke (Concha Arcae); add Shichangpu (Acori Tatarinowii Rhizoma) added later six fen, fried Baizhu (Atractylodis Macrocephalae Rhizoma) one and a half qian. Once heat is cleared, continue to strengthen the Middle.)
In the fifth month of Ji Chou year, the weather turned hot suddenly. Mengying's mother suddenly suffered from Huoluan (Cholera-like disease), with cold limbs, spontaneous sweating, fine pulse, white tongue coating, and severe abdominal pain relieved by pressure. This indicated long-standing Middle deficiency, complicated by cold invasion due to heat. A large dose of Lizhong Tang (Regulate the Middle Decoction) with Guizhi (Cinnamomi Ramulus) and Baishao (Paeoniae Radix Alba) was administered, and she recovered after finishing one cup. This is called "abandoning the season to follow the syndrome" (treating based on the specific syndrome rather than seasonal norms). (Differentiating Middle deficiency with cold invasion lies in the fine pulse, white coating, and preference for pressure on the abdomen. Ludangshen (Codonopsis Radix) three qian, fried Baizhu (Atractylodis Macrocephalae Rhizoma) three qian, fried Gancao (Licorice Root) one qian, fried Ganjiang (Zingiberis Rhizoma) five qian, Chuan Guizhi (Cinnamomi Ramulus) added later one and a half qian, wine-fried Baishao (Paeoniae Radix Alba) one and a half qian.)
Ms. Fang had been displaced for three years. In autumn, upon arriving in Shanghai, she developed edema. Because she was staying in transit, she received no treatment. When Frost Descent arrived, the edema suddenly disappeared. Not long after, she suffered from Huoluan (Cholera-like disease), followed by mental confusion, pacing around the room, calling for her sister. Her sister forced her to lie down, but her eyes continued to rotate, tears flowed profusely, and her jaw clenched. Before Mengying could be summoned to diagnose, she passed away. Mengying said: "This resulted from displacement and hardship, deep depression, leading to Liver Wood overacting on Spleen Earth, causing vomiting, diarrhea, and edema. At Frost Descent, the Qi becomes肃 (solemn/clear), and edema subsides. However, the depression had no outlet and directly attacked the Spleen and Stomach, causing sudden vomiting and diarrhea. Liver Fire surged, causing wild running and staring eyes, with Yang floating upwards. This is Huoluan caused by emotional internal injury. Hence, the critical condition arose so rapidly."
Mr. Xu was usually healthy, had strong Stomach Qi, and was accustomed to hard work. Suddenly, he had two episodes of diarrhea late at night. By morning, while brushing his hair for Mengying, he had another episode. Upon diagnosis, his pulse was rapid (seven beats per breath), fine, and hurried, unable to withstand pressure. Superficially, he seemed free of illness. With such a pulse, yet appearing healthy, this condition likely did not start today and was incurable. Later, the diarrhea slowed somewhat, and he ate a small bowl of Shandong noodles. He could still breastfeed his daughter, but after sucking, his breasts collapsed and did not fill. His body gradually wasted, sweating increased, the pulse became increasingly scattered and weak, and his voice became hoarse. He died suddenly at Xu hour. This was a rare sign of sudden collapse of Middle Qi.