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In the winter of the first year of Daoguang (1821), Mr. Jin Lusi, moved by his grandfather's hardships, ordered me to assist him in managing salt affairs at Xiaoshun Street in Wuzhou. In my spare time from official duties, I would peruse medical books, burning oil late into the night and continuing through the day, deriving joy from this without tiring.

In the summer of the third year (1823), Mr. Zhou Guangyuan, a Chief Administrator, was twenty-seven years old, with a very plump and fair complexion. After using the toilet, he suddenly felt cold, sweated spontaneously, had white lips, and a low voice. Everyone considered it Sha disease (a condition characterized by sudden pain, vomiting, diarrhea, or fainting, often attributed to external pathogens or toxins), and wanted to administer opening-orifice medicines. At that time, I was seventeen years old. Privately holding his arm to diagnose the pulse, I found it already weak and nearly imperceptible. Therefore, I strongly opposed the consensus, saying: "This is Yang Qi about to collapse, not Sha pathogen internal blockage. Administering aromatic dispersants again will likely hasten his peril." Everyone laughed at me for being a child who knew nothing. Fortunately, Mr. Zhou nodded in agreement repeatedly. Due to the urgency, there was no time to purchase medicine. I happened to have a piece of three-year-old female ginger (Peijiang) gifted by a relative, weighing about four or five qian. I hastily decocted it and administered it orally; he immediately stabilized. Later, tonification therapy was used, primarily consisting of Renshen (Ginseng Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma). This was because Mr. Zhou's constitution was one of deficient Yang Qi. He was deeply grateful and regarded me as a younger brother, praising me to everyone, thus I gained a reputation undeservedly. In the Gui Mao year (1843), Mr. Zhou published my medical cases for me. I felt ashamed and had no way to repay him.

Mr. Zhou passed away peacefully at the age of fifty, which was actually due to sudden collapse of deficient Yang Qi. He had no sons, only one daughter married to the Cai family. His wife was over sixty years old. After the second fall of Hangzhou city, her whereabouts were unknown, making it impossible to inquire. Recording this case brings deep regret.

On the day before the Winter Solstice in the Gui Mao year (1843), Grand Secretary Guan Jiaoxuan suddenly experienced profuse sweating and shortness of breath after urination, with altered complexion and faint speech. I happened to be attending a funeral at Lingyin Temple. Three times messengers were sent to urgently summon me back to the office. By then, Sha medicines had been administered multiple times, but the situation could not be reversed. For anyone with extremely deficient Yang Qi, sudden collapse symptoms after urination or defecation indicate an urgent need for Renshen and Fuzi to restore Yang. Misidentifying this as Sha disease often leads to disastrous outcomes. Those treating Huoluan (Cholera-like syndrome) must distinguish this clearly.

In the spring of the Bing Xu year (1866), a granary worker in Xiaoshun Street suddenly suffered an acute condition. He grabbed the bed and mats, could not speak, and when asked where he hurt, he only pointed to his heart and scratched his tongue. People thought it was Dry Huoluan (Huoluan without vomiting or diarrhea). I said, "How can Dry Huoluan cause immediate inability to speak and scratching of the tongue? It seems like poisoning." Someone said, "Several people ate the same meal; why did only he get poisoned?" However, scraping the tongue and inducing vomiting were ineffective. Since it was late at night and I could not buy medicine, I ordered two sheng of mung beans to be boiled rapidly into a clear soup, clarified, cooled, and administered. He recovered. The next day, upon inquiry, he revealed he had long suffered from Bi pain (painful obstruction syndrome). After taking a dose of herbal medicine, he felt unbearable chest stuffiness, tongue numbness, and inability to speak, which others did not know.

A courtesan loved eating silkworm pupae since childhood. She traveled to the upper rivers for several years and hadn't eaten them for a long time. Upon returning to Hangzhou, she enjoyed them with her family. While laughing and chatting, abdominal pain suddenly erupted, and she rolled on the ground. Some thought it was Intestinal Colic Sha (Jiaochang Sha) and urgently requested my examination. Her pulse and complexion were harmonious; it was neither Sha nor food stagnation. If it were poisoning, the elders and children who ate together would also be unharmed. Upon careful consideration, although they were roasted with Sichuan pepper and garlic and eaten together, perhaps one or two pupae were abnormal. Silkworms are animals, sharing affinity with horses, and their nature is hot, further enhanced by the pungency of pepper and garlic. I tentatively treated it following the example of horse meat poisoning, ordering human milk to be sucked. Indeed, after drinking it, she stabilized.

In the fifth month of the Ji Chou year (1829), the weather became suddenly hot. My mother suddenly suffered Huoluan. Her limbs were cold, she sweated spontaneously, the pulse was faint, the coating was white, abdominal pain was severe and relieved by pressure. This indicated chronic Spleen deficiency complicated by cold invasion due to heat. I administered a large dose of Lizhong Tang (Regulate the Middle Decoction) added with Guizhi (Cinnamon Twig) and Baishao (White Peony Root). She recovered after finishing one cup. This is what is called "abandoning the season to follow the syndrome."

Between the eighth and ninth months of the Ding You year (1837), Huoluan with tendon twitching prevailed in Hangzhou. A woman surnamed Shen suffered from this late at night, followed by hoarseness and cold extremities. At dawn, her husband sought treatment in panic. I diagnosed her pulse as wiry, fine, and choppy, with the Chi positions (kidney pulse) feeling absent. Her mouth was extremely thirsty, but any sip caused immediate vomiting. Her calf muscles were hard as stone, and the twitching caused excruciating pain. This was Summer-heat and Dampness internally latent, obstructing Qi mechanism, losing the power of diffusion and descent, causing chaotic upward reversal. I imitated the Jigeshibai San (Chicken Dropping White Powder) example from *Jingui Yaolue* and prescribed Can Shi Tang (Mulberry Leaf and Earthworm Decoction). It was to be decocted with Yin-Yang Water and taken slowly when cool. The medicine stayed down without vomiting. Externally, liquor was applied while someone rubbed the hardened, twitching area vigorously. After about one hour, the stagnant heat dissipated, and the tendon knots softened. Then, brine was applied, stopping the twitching, and vomiting/diarrhea gradually ceased. At dusk, half a dose of the previous medicine was given again, allowing peaceful sleep. The next day, she only felt exhausted. 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 took Fuzi (Aconite Root) were difficult to save.

(Mr. Xie Cheng commented: During the alcohol massage for one hour, as stagnant heat dissipates and tendons relax, although twitching is caused by intense fire, it must be accompanied by external cold constraint to cause spasm. Generally, Huoluan involves struggle between cold and heat. Even knowing whether it is cold or heat, one must use counteracting agents. This principle applies here.)

Zheng Fengwu, over sixty years old, suffered Huoluan in autumn. He had aversion to cold, cold extremities, irritability, restlessness, and little thirst. Some considered it a cold syndrome. I examined his pulse: fine and nearly hidden, with a thick white coating. This was Summer-heat and Dampness internally accumulated but not transformed. One needs the insight of a rhinoceros horn to see through the illness. I prepared Ran Zhao Tang (Burning Mirror Decoction) for him. After one drink, cold extremities and aversion to cold receded, the pulse rose, and vomiting/diarrhea stopped. He was subsequently cured with a clearing and purging method.

A young, thin woman suffered 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 pre-existing excess Fire in Liver and Stomach, compounded by Heat invading the Ying level. I prescribed Baihu Tang (White Tiger Decoction) removing rice and licorice, adding Shengdi (Rehmanniae Radix), Pugongying (Dandelion), Yimucao (Motherwort Herb), Huangbai (Phellodendri Cortex), Mugua (Chaenomelis Fructus), Sigualuo (Luffae Retinervae Fructus), and Yiyiren (Coicis Semen). She improved after one dose and recovered after two. Danxi said, "Tendon twitching arises from Blood Heat," which fits this case.

A man surnamed Ding suffered Huoluan. His coating was thin and white, with no thirst, but a sticky sensation in the mouth. Being knowledgeable in medicine himself, he wished to treat it as Cold-Damp. I said, "The Middle Jiao originally has Cold-Damp, hence no thirst. But stickiness suggests Summer-heat entering and fermenting dampness into Heat." I prescribed Weiling Tang (Stomach-Ling Decoction) removing Gancao and Baizhu, adding Yiyiren, Chuanlian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma), and Pipaye (Loquat Leaf). He recovered in two doses.

Qian Mou suffered Huoluan with spontaneous sweating, cold limbs, and faint pulse. He usually indulged in cold foods and drinks. People considered it a cold syndrome and wanted large doses of hot medicine. I said, "Although the coating is white, it is thick with red edges, and he is extremely thirsty with severe headache. Do not let the history of cold-inducing illness blind you to latent Summer-heat." I prescribed Wuling San (Five-Ingredient Powder with Poria) removing Baizhu, adding Huanglian (Coptidis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taeniam), Mugua, and Bidou (Vigna Radiata Seed). After taking it, the pulse emerged slightly, sweating stopped, and vomiting/diarrhea eased. I then removed Rougui (Cinnamon Bark), added Guizhi, Shihui (Talcum), and Gancao. Headache and vomiting/diarrhea ceased, the coating turned yellow, and he recovered with Summer-heat clearing and Middle Jiao harmonizing methods.

A young, fat man who feared heat lay on a brick floor covered with a mat after a morning meal of wine and meat during intense summer heat. Upon waking, he ate watermelon. By evening, he felt heavy head and aversion to cold. At midnight, violent vomiting and diarrhea occurred, with limb stiffness, cold sweat, faint breathing, and occasional irritability. At dawn, I examined him: the pulse was deep and weak. I gave Jiangshui San (Grain Water Powder) added with Wuzhuyu (Evodiae Fructus) and Houpo. He recovered immediately. I then switched to Nongpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction), curing him in a few doses.

Elder Lu, over seventy, suffered Huoluan in mid-autumn. After self-medicating with folk remedies for two to three days, vomiting stopped, but diarrhea persisted, accompanied by frequent hiccups with low voice, red face, closed eyes, and urinary retention. Doctors said, "High-age Dai Yang syndrome (floating Yang), incurable, and delayed for days. Even large doses of Yang-restoring medicine may be too late." I observed: the pulse was weak and soft, but no collapse signs. Moreover, the tongue was red and dry, stools foul-smelling. Summer-heat was latent in the Qi level, disturbing the Ying level. I feared meridian closure and confusion. How could hot medicine be used? Hearing his decoction smelled strongly of cinnamon, I warned it would be fatal. I forced them to discard it and prescribed Zixue (Purple Snow) 3 fen, decocted with Zhuru, Pipaye, Tongcao (Akebia Caulis), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Lianqiao (Forsythiae Fructus), Shichangpu (Acori Tatarinowii Rhizoma), Jiegeng (Platycodonis Radix), Huangqin, and Lugeng (Reed Rhizome). Taken slowly when cool.

Next day, eyes opened, hiccups stopped, urination resumed. Zixue was removed from the formula, adding Shihu (Dendrobii Caulis) and Yiyiren. Diarrhea reduced after two doses. He could drink rice water. Zhihe Tang was then used, curing him after ten-plus doses.

In the summer of the Wu Xu year (1838), Mrs. Ni Huaizhou, a few days postpartum, suffered vomiting and diarrhea with spontaneous sweating. People deemed it critical. I said, "This is not true Huoluan. Yet it is more dangerous than true Huoluan because she violated the three prohibitions of postpartum care, and the pulse was faint and nearly absent. Urgent strong tonification is needed; delay may be futile." I prescribed Dongyangshen (Korean Ginseng), Longgu (Fossil Bones), Muli (Oyster Shell), Ganjiang, Baizhu, Mugua, Bidou, Fushen (Poria with Hostwood), Shiyingshi (Hematitum), Jiuchaobaishao (Wine-fried White Peony Root), and Juapi (Tangerine Peel). She recovered in four doses.

(Mr. Zhou Guangyuan commented: Using Renshen and Ganjiang for strong tonification immediately postpartum during midsummer requires true insight. Illnesses vary infinitely; there are no fixed treatments. Ignorant practitioners stick to dead prescriptions for living patients, creating endless karma. Why become a doctor and invite blame? Mr. Zhou saw this case correctly, boldly using Renshen and Ganjiang, supported by other well-matched herbs. Effectiveness lies not just in these two. True strong tonification might require Deer Horn and Schisandra, but habitual tonic users might find this light. Adding these could harm. Many good formulas are ruined by reckless modifications. Wang Mou suffered chronic hematemesis and was very frail. Shen Qinci asked me to treat him. He was improving when, in the hot summer of Gengzi (1840), he suddenly got Huoluan with tendon twitching, profuse sweating, and thread-like pulse. People said he was dying. I refused to give up. I used Xiyangshen (American Ginseng), Pipaye, Longgu, Muli, Can Sha (Mulberry Leaf residue), Mugua, Bidou, Yiyiren, Huashi (Talcum), Sangye (Mori Folium), Shihu, Doujuan (Soybean Sprout), decocted with Dijiang (Earth Slurry). He recovered well. After ten days of conditioning, he resumed tonic herbs for his chronic condition.)

Ai Jin, a courtesan aged twenty-seven, suffered a severe epidemic febrile disease, which I cured. She returned claiming acute Sha. Her pulse was fine, rapid and tight upon pressure, spirit exhausted, panting with urge to vomit, red cheeks, abdominal pain, moist tongue. This resembled Nan Laofu (Male Recurrence after Sexual Exhaustion) where cold attacks the奇经 (Extraordinary Vessels) due to excessive sexual activity. Confirming this, I prescribed Hetaoren (Walnut Kernel), Pogu Zhi (Psoraleae Fructus), Longgu, Muli, Lujiaoshuang (Deer Antler Glaze), Tusizi (Cuscutae Semen), Fupenzi (Rubiae Fructus), Gouqi (Lycii Fructus), Fuling (Poria), Xiaohui (Foeniculi Fructus), Danggui (Angelicae Sinensis Radix), and Jiu Zi (Allii Tuberosi Semen). She improved in one dose and recovered in two. What if we rashly treated it as Dry Huoluan? And what if Dry Huoluan were treated this way?

(Hu Yaozeng commented: Clinical wisdom like a god, description vivid as painting, Buddha's heart and immortal hands, gentle words. Spiritual light transmitted on paper, hard to imitate, truly genius.)

Old Madam Qi, over sixty, had worked for Huang Lianquan in Hangzhou since childhood, loyal and diligent. Their master-servant bond exceeded relatives. In autumn of Ren Yin (1842), she suffered Huoluan with tendon twitching. I diagnosed Summer-heat and prescribed Can Shi Tang. She recovered in two doses. Three days later, she lay listless, unable to turn, spoke little, ate and drank nothing. Lianquan panicked. An old doctor diagnosed it as Cold Huoluan with impending collapse and prescribed Fuzi Lizhong Tang. Lianquan, fearing the potent medicine, consulted Wang Jun'anbo. Anbo said, "Do not take it. If it were cold, yesterday's medicine would have killed her; how could vomiting/diarrhea stop?" Lianquan realized the truth and summoned me. I said, "For an elderly person, Yuan Qi is depleted by vomiting/diarrhea; tonification is appropriate. However, residual Summer-heat remains, so hot medicine is contraindicated. In a reckless household, they would blame the previous cooling medicine and praise today's warming tonic. If she died then, they'd blame the previous doctor. If she died initially from wrong warming, no one would realize Huoluan has Yin/Yang and Hot/Cold distinctions. Fortunately, Lianquan doubted the ginger/aconite, Anbo recognized the shift in pathology, and the master was compassionate. These virtues combined saved her. Now, using Gaolishen (Korean Ginseng), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), Weihui (Polygonati Odorati Rhizoma), Mugua, Bidou, Shihu, Baishao, Yiyiren, Gancao, Fuling, she recovered speech and movement after six doses, ate gradually, and healed after a month of conditioning." Mr. Zhai told me, "This is the treatment for residual heat and severe Zheng Qi deficiency. For cases where residual flame reignites not due to deficiency, Lianxiong Dan should be used."

(Zhou Guangyuan commented: With Ban Chi's learning, Lianquan's virtue, and Anbo's insight, three beauties combined saved her from death. Practitioners who use dead prescriptions for living patients, treating servants like grass, reading this should die of shame.)

When Mr. Zhou Guangyuan returned to Hangzhou for family visit, on the night of July 18th, he suffered severe Huoluan with tendon twitching. Mistakenly taking Qinglin Wan (Green Phoenix Pill) about one qian, his condition worsened. At dawn, I diagnosed: pulse faint/absent, deaf, sunken eyes, sweating, cold limbs, hoarse, emaciated, critical signs all present... [Text gap inferred] ...Yiyiren, Lianshi (Nelumbinis Semen) as formula. After finishing the course, all symptoms decreased. His Qi level was deficient, unable to withstand fluid loss from vomiting/diarrhea. Mistaking bitter-cold medicine caused slight Yang to near-collapse. Thus, Zhenwu Tang and Lizhong Tang were combined to restore Spleen/Kidney Yang. Next day, pulse rose, limbs warmed. Fuzi, Guizhi, Ganjiang were removed; Huangqi (Astragali Radix) and Shihu added. He recovered in ten days. Severe vomiting/diarrhea damages fluids; tendons lose nourishment and twitch. Treating twitching requires protecting fluids. Once Yang returns, using acrid-hot herbs prevents fluid recovery and triggers internal wind. Thus, using Fuzi/Guizhi for Cold Huoluan requires balance and restraint.

(Guangyuan commented: My illness was as fleeting as dew. Without Ban Chi, I might not have survived. Mr. Zhang Liuyin said hearing Ban Chi's analysis and prescription logic cures half the disease. As the saying goes, 'A manifesto cures headache,' indeed. The case discussions are subtle; all prescriptions require such balance. Otherwise, even correct medicine harms if overdosed. Not just hot medicines. Yang Zhaoli commented.)

"Huo" in Huoluan means sudden chaos/disorder. I've seen robust people wasting to skin and bones in half a day...

Chen Yipu knew medicine. His wife suffered Huoluan with tendon twitching in mid-autumn. Self-diagnosing as cold, she took hot medicine, worsening the condition. Zhu Jiaoting agreed with the owner. The illness intensified. I examined her and said, "Cold is the new external constraint; Heat is the internal true pathogen. Bitter mouth and thirst mean Ginger/Aconite are forbidden." I used Liu Wansu's method. Others didn't believe it, consulted other doctors who used hot medicine, leading to death by bleeding from mouth/nose.

(Guangyuan commented: Huoluan is common recently, but doctors don't understand it well, leading to many deaths from mis-treatment. Ban Chi's special treatise is concise and essential for today's physicians. It must be studied urgently.)

In late May of Jia Chen (1844), the weather was exceptionally hot. Many died suddenly on roads, some with abdominal pain, some without. People used aromatic-dry Sha pills, which failed. Aromatic-dry herbs increase heat; this was not Yin-Cold-Damp toxin, but ancient "Zhong Shu" (Summer-heat Stroke). Even those staying indoors got sick, usually due to innate Yin deficiency, internal heat, or improper diet/environment. Doctors often couldn't identify it. Bodies didn't cool immediately after death; some bled from nose/mouth, indicating Summer-heat entered via respiration, attacking the Heart directly. I lived at Maor Bridge in Qiantang. I advised my mother to warn family to live carefully and eat lightly. On June 2nd, after lunch, Sister-in-law Ji Jie had mild abdominal pain. Accustomed to cold, she thought she caught cold. She secretly asked a maid to buy liquor. She became delirious. My mother sent for me urgently. By dusk... [Text gap] ...she had died from nose/mouth bleeding. Many died then because Yin blood was lost, making Summer-heat invasion easy. Ignorant people kept windows closed, hung curtains, surrounded by people, fed sugar/wine. Crude doctors ignored seasonal and constitutional differences, blindly using Shenghua Tang (Generate the Flow Decoction). Even with obvious heat signs, they believed the custom of warming postpartum women, ignoring flexible prescription principles. Death followed quickly. Asked what to use instead of Shenghua Tang for heat-stroke with lochia retention and pain, I said Liuyi San (Six-to-One Powder) is best. It moves blood stasis and clears heat. If Summer-heat is severe, Shigao (Gypsum) and Xijiao (Rhinoceros Horn - now substituted) are effective. Ancient texts never banned them. See my other cases for reference, though hard to explain to shallow minds.

Madam Yao of Kuitou Alley, near term pregnancy, had sudden abdominal pain. Family thought labor was starting, brewed Renshen Tang to boost strength. Pain worsened. Midwife arrived, but she had red spots all over, panting, confused, mad. She died instantly from Summer-heat. Cao Madam of Baoyou Fang, also near term, had abdominal pain. Family brewed Renshen Tang. Pain stopped when tea was ready. They realized labor wasn't imminent. The tea sat too long in heat and spoiled. Mother-in-law said, "Since not delivering, don't use Ginseng to stagnate fetus. I am weak and take tonics, so this is suitable." She drank it. Immediately felt chest stuffiness and irritability, died within minutes. Years Bingwu, Renzi, Bingchen also had deadly heat. Too numerous to list. Ancients defined Summer-heat as Dry-Heat: "Melting metal and scorching stone." Humans are not metal/stone. People fail to observe this. Abdominal pain before/after birth in summer must be carefully distinguished.

Yiting, grandson of Prefect Pan Hongcha, taught at maternal uncle's house. Extreme heat. Drank a bowl of cold Shihua (Gelatinous algae). Abdominal pain/stuffiness ensued. Limbs grew cold up to elbows/knees. Pulse hidden, sweating, spirit tired. Doctor Fang diagnosed Yang deficiency and Yin Summer-heat, impending collapse. Used large dose Ginger, Aconite, Dingxiang (Caryophylli Flos), Guizhi to restore Yang...