。病者闻之，益形馁惫。其叔岳许杏书茂才，骇难主药。适族人许芷卿茂才过彼，遂与商之。芷
卿云∶此药岂容轻试，而病象甚危，必延半痴决之。时已乙夜，余往视，面色垢滞，苔腻唇
红，是既受暑热，骤为冷冻饮料冰伏，大气不能转旋，故肢冷脉伏，二便不行。所谓闭证也，何
脱之云。亟取六一散一两，以淡盐汤搅之，澄去滓，调下紫雪一钱。翼日再诊，脉见痛蠲，
溺
行肢热，口干舌绛，暑象毕呈，化而为疟，与多剂白虎法而痊。丙午举于乡，杏书多才尚义
，与余称莫逆，庚申春，闻其骂贼而死，呜呼荣矣。
（认证既确，治法用辛香以通冰伏之气，用意又极精妙，真可为万世法程。素园。）
室人徐氏素无病，胃亦强，且善作劳。丙午八月朔夜，犹镫下针黹，伴余勘书，
夜分忽泻二次，晨起为余疏发未毕，又泻一次。因诊之，脉七至而细促不耐按，略无病苦，
此脉病患不病，殆不始于今日，不可救药也。未便明言，即令安歇，密禀先慈。函致乃兄友珊
，请医商治，既而泻颇缓。且食山东挂面一小碗，先慈谓余太矜持矣，余方踌躇，面即吐出
，灌以参药亦不受，泻较紧，午刻医来，亦云无法，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，斯人也性极贤淑，且隔
屏一听，即知客之贤否，一旦抱此绝证，知者无不悼惜，乃中气卒然溃散，绝无仅有之候也
。
戊申秋仲，张春桥令弟陡患腹痛。适饱啖羊肉面条之后，初作痧治，继作食治，痛愈甚而大
渴，然啜饮辄吐，二便不行。又作寒结治，其痛益加，呻吟欲绝，已交四日。余诊脉弦数
，苔干微黄，按腹不坚，非痧非食，特肝火郁而不宣耳。以海
烊频灌，果不吐，将余汁煎栀、连、茹、楝、知、芩、延
、旋覆、柿蒂、枇杷叶为剂，吞当归龙荟丸。投已，即溲行痛减，次日更衣，不劳余药而瘳
。
朱留耕忽于饱食后，大吐而厥，冷汗息微，厥甫回而腹痛异常，乃翁湘槎以为急痧霍乱之候
也。速余往勘，脉至弦缓，口极苦渴，二便不行，乃痰滞而热伏厥阴，肝气无从疏泄也，
予雪羹、萸、连、栀、楝、旋、茹、橘、核、元胡、苁蓉为剂，加芦菔汁和服，一剂痛减，
再服便行而愈。
（痧证霍乱挟食者，必先去食，伤寒亦然，秦氏论之详矣。然竟有病始饱食之余，
初非因食为患者，半痴尝云∶既无枵腹待病之理，岂可专以攻消为治，故临证必审问慎思而
明辨之，庶免颟顸贻误之弊。上二案，病皆起于食后，朱证已得大吐，不从食治，人或能之
。
，已非人所能及矣。余门人沈南台，癸丑冬患病，亦啖羊肉面条而起，势濒于危，得半痴治
愈，至四十余日，始更衣，则尤奇也，用药如用兵，岂徒读父书者之可为哉，仁和赵梦龄菊斋
陈妪年已七旬，辛亥秋，患霍乱转筋甚危。亟延余诊，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。因先取西瓜汁命与恣饮，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。
（医者能知少加细辛之何故，则可以言医矣。素园。
此方得效，可见辨证之的。若无汗而渴者，又当别论。谢城。）
姊丈李华甫继室，陡患霍乱，而兼溺血如注，头痛如劈，自汗息微，势极危殆，
速余诊视。脉甚弦 ，此肝火内炽，暑热外侵。以犀角、木通、滑
石、栀子、竹茹、薏苡、银花、茅根、菊叶
为大剂，和入藕汁，送当归龙荟丸，而吐泻即已，溺血亦减。惟小便时，头犹大痛，必使人
紧抱其头，重揿其巅，始可略耐。尚是风阳僭极，肺胃不清也。以苇茎汤去桃仁，加百合、
白薇、元参、小蓟、蒲公英、竹叶、西瓜翠衣、莲子心为方，和入童溺，仍吞龙荟丸，服旬
日全愈。
陈楚珍仲媳，陡患霍乱。云昨晚曾食冷鱼，夜分病作，想因寒致病也。然脐间贴以回阳膏而
不效，故敢求诊。余按脉滑数，右甚，口渴苔黄，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。
妇兄吴绿园，癸丑仲夏，陡患发热呕吐，茎缩腹痛。亟招余诊，脉弦软而数，苔色黄
腻，宜清厥阴蕴热，非痧也。予楝、茹、连、斛、栀、柏、银花、通草、丝瓜络为方，一
剂知，数剂愈。
沈HT 扬令妹，年逾五旬，体极瘦弱，始则数夜不能眠，忽一日目张不能阖，泪则常流，口闭
不能开，舌不能伸，语难出声，饮不下咽，足冷便秘，筋螈而疼，身硬
不柔，胸膈板闷，或谓暑痧重感，虑即虚脱。余视之，苔黄不渴，脉来弦细
软涩，重按如无，然神气不昏，身不发热，非暑痧也。二便艰涩，咽膈阻闷，非脱证也。殆
由情志郁结，怒木直升，痰亦随之，堵塞华盖，故治节不行，脉道不利也。但宜宣肺，气行
自愈。以紫菀、白前、兜铃、射干、菖蒲、枇杷叶、丝瓜络、白豆蔻为方，一剂知，四剂愈
。
（证者，证也，如断案之有证据也。然证有真有伪，有似是而非，以致恒为所眩，
如此案辨暑脱，则得其证矣。素园。证极危而方甚轻，其效乃如神，全由辨证之的。谢城。）
蒋敬堂令堂，年七十四，陡患呕泻，身热腹痛，神思不清。或以为霍乱，或虑其
虚脱。迎余诊之，脉微弱而数。曰∶暑脉自虚，不可以高年而畏脱，辛散痧药，则不免耗
伤
其津液，爰定芩、连、滑、斛、茹、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，敬堂慷慨多情，知医施药，余契友也。庚申春，闻其争先拒兵，竟
以被戕。惜哉。
徐德生家一婢，年十七矣。陡患腹痛，稍一言动，则痛不可支，以为急痧中恶，遍治不应。
飞请余往，尚以丹雄鸡强伏其心下，然神色如常，并不吐泻，脉来牢涩，苔色腻黄，乃多食
酸甘而汛阻也。询之果然，以桃仁、红花、生蒲黄、灵脂、香附、延胡、芍药、海
、芦菔为方，送龙荟丸，遂愈。
陈堂令郎子堂，甲寅春，连日劳瘁奔驰之后，忽然大便自遗，并非溏泻，继言腹痛，俄
即倦卧不醒，及唤醒，仍言腹痛，随又沉沉睡去，或以为痧，或以为虚，邀余决之，身不发
热，二便不行，舌无苔而渴，脉弦涩不调，非痧非虚，乃事多谋虑而肝郁，饥饱、劳瘁而脾
困，困而食滞于中也。予槟、枳、橘、半、楂、曲、菔、楝、元胡、海
，服二剂，痛移脐下，稍觉
知饥，是食滞下行矣。去楂、曲，加栀、芍，服一剂，更衣而愈。
（此证不难于认食滞，而难于认肝郁，且当劳倦后见嗜卧证，不以为痧，必以为虚
，而兼用参术以顾脾胃，如此则肝愈不舒，而变证作矣。半痴用药至轻，而奏效至捷，良
由手眼双绝。素园。
余尝问半痴曰，既肝郁于上，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，余闻而折服其善读古书，宜乎临证之神明变化，令人莫测也
。因思霍乱之吐泻无度，干霍乱之便秘不行，皆变也，皆中气为病所阻，而不足于降浊升清
之职也，设泥不足为虚，则诸霍乱皆当补中气为治矣，于是益叹半痴阐发经旨为不诬。菊斋。
此说与前释邪之所凑，其气必虚之说，可以互证，谢城。）
姜秋农疟泻初痊，遽劳奔走，陡患霍乱转筋，面臂色紫，目陷音嘶，胸闷苔黄，
汗多口腻，神疲溲秘，脉细而弦。余以沙参、蚕矢、苡仁、竹茹、半夏、丝瓜络、木瓜、车前子、扁
豆叶，阴阳水煎，送左金丸一钱，外以吴萸一两研末，调涂涌泉穴，服后吐泻渐止。噫气不
舒，呃忒胁痛，汗减口燥，脘下拒按，脉软而弦，以素多肝郁也。去沙参、蚕矢、木瓜、车前
、左金，加紫菀、郁金、楝实、通草、枇杷叶，二帖。溲行呃止，苔退足温，腰胀腿痛，手紫
渐淡，去郁、菀、通、楝，加沙参、石斛、兰叶、鲜藕、稻露，亦二帖。脉和胀减，啜粥口
咸，体素阴亏也，去半夏、扁豆叶，加归身、花粉、橘皮，又二帖。大解行而安谷，腰酸少寐
，为易西洋参，加麦冬、羊藿以调之。数帖后，又加枸杞、杜仲而愈。
（此本虚标实之证，须看其先后用药之法。琴仙。
此证颇急，浅术必至张皇失措，半痴游刃有余，治标而不犯其本，用药与病机宛转相赴，
于此服其识之老。素园。）
仲韶弟主于叶氏，乙卯新秋，陡患洞泻如注，即浑身汗出如洗，恹恹一息。夤夜
速余往勘，脉来沉细，身不发热，俨似虚寒之证，惟苔色黄腻，小溲全无，乃湿热病也。予
桂苓甘露饮加浓朴，投匕而瘳。
丙辰仲夏，游武林，仁和胡次瑶孝廉妇，陡患肢麻昏晕，以为急痧，速余视之。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。次瑶醇
谨博学，与余交最深，久欲卜居结邻而未果，庚申之变，率妻外家登舟，将来海昌，城闭不能
出，与兵遇，并一幼女殉节于河，可哀也已。
季杰之外家，秋夜陡患霍乱，腹痛异常，诊其脉细数而弦，肢冷畏寒，盖覆甚浓，询其口不渴
，而泻亦不热，然小便全无，吐者极苦，舌黄甚赤。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，语言微蹇。余令捣生藕汁徐灌
之，渐能受。随以芩、连、苡、楝、栀、斛、桑、茹、蒲公英煎服，痛即减，吐泻亦止。改
用轻清法而愈。
丁巳秋，三侄寿和甫六岁，陡患凛寒身热，筋螈面红，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。
次日谵螈皆减，而腹痛吐泻，邪欲转霍乱以外泄也。余尝谓不但伤寒可转霍乱，而温热暑
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，阳明实则谵螈。若吐泻乃病之出路，而世人动辄以惊
风药治之，每致偾事。昧者更惑于巫瞽，而祭非其鬼，尤可嗤也。余居
溪七载，家人虽屡患大证，未尝一用巫瞽，亦未伤人，乡人目以为异。庚申
秋，季杰之病甚危，寿萱侄求签于观音，大凶，其外家欲事祈祷，余力止之，卒以治愈。附识
之，以戒我后人。
辛酉秋，余息濮院，盛行霍乱转筋之证。一男子胸次拒按，余以芦菔子、枳实、槟榔等导
之
。又某赤膊不容盖覆，犹云五内如焚，目陷音嘶，苔黄大渴，而啜饮即吐，肢厥脉伏。市
医
令服姜汤一杯，幸不受。适余至，亟取冷雪水，命将小匙徐灌之，遂不吐。更以石膏、黄连
、知母，泻其逆冲之火而愈。
钱某患霍乱，兼吐蛔十余条，而口干脉细，是暑伏厥阴，以犯中也。以连、梅、茹、楝、苡
、斛、苏、芩清之而愈。
陈某患霍乱，而所下皆血，苔黄大渴，而舌色紫黯，乃暑毒深伏。起病时，又饮烧酒也。用
犀
角、益母、地丁、茅根、菖蒲、绿豆、银花、芩、连、黄柏、藕汁大剂灌之。皆投匕而瘥。
一妇积虚患时症，汗出如浴，形脱声嘶，脉微欲绝，为亡阳之候。予附子理中汤加白芍、茯
苓、木瓜、苡仁、蚕沙。而汗收脉起，随去姜、附，加黄 ，证渐平。去蚕沙，加橘、半，
调补而安。
刘氏妇患病，已两月不纳谷矣。忽吐泻转筋，舌光声哑，气液两亡也。亟以人参、炙草、石
脂、余粮、龙、牡、斛、芍、木瓜、乌梅、冬虫夏草为方，服两剂，音开脉续，诸证皆平。所
亲
沈则甫，按法调补而瘳。吴氏子患此，脉微弱，舌色淡红，口微渴，此本虚邪不盛也。宜清
解药中，加参以扶正气，则甫亦如法施治而愈。
今年三月间，吕君慎庵言一童子在邻嬉戏，陡然吐泻转筋，归家即毙。余以为偶然有此一证
耳，既而闻患此证者渐多。四月初，有余杭纸客，在舟次病此，抵濮院，乞余诊。已舌卷囊
缩，形脱神离，不可救药矣。口开苔黑，询中途并未服药。窃谓此病之盛行，多在夏秋暑湿之
时，何以今春即尔。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。或曰∶此揣
度当然耳。仲圣但有五苓、理中治伤寒转霍乱法，未有治温病转霍乱之法，何耶？余谓古书
The patient, upon hearing this, appeared even more exhausted. His uncle-in-law, Xu Xingshu (a Shengyuan degree holder), was horrified and reluctant to prescribe medication. Coincidentally, a clansman, Xu Zhiqing (also a Shengyuan), passed by, so they consulted him. Zhiqing said, "How can this medicine be tried lightly? Moreover, the pathological manifestations are critical; one must invite Ban Chi [Wang Shixiong's pseudonym] to make the decision." It was already late at night. I went to examine him: his complexion was dull and greasy, with a greasy tongue coating and red lips. This indicated that he had contracted Summerheat-Heat, which was then suddenly frozen by cold beverages, causing the Great Qi to fail in its rotation. Consequently, his limbs were cold, the pulse was hidden (Fu), and both urination and defecation were obstructed. This is what is called a Closed Syndrome (Bi Zheng). How could it be described as a Collapsing Syndrome (Tuo Zheng)? I urgently took Liuyi San (Six-to-One Powder) in an amount of 30g, stirred it with light salt water, clarified it to remove the dregs, and mixed it with 3g of Zixue (Purple Snow). On the following day, during the second consultation, the pain in the pulse disappeared, urination resumed, and the limbs became warm. Dry mouth and a crimson tongue fully revealed the Summerheat pattern, which transformed into Malaria. After administering several doses of Baihu Tang (White Tiger Decoction), he recovered. In the Bingwu year, Xu Xingshu passed the provincial examination. He was talented and righteous, and we were bosom friends. In the spring of the Gengshen year, I heard that he died cursing the rebels; alas, what an honorable death!
(Once the syndrome differentiation is accurate, using acrid-aromatic herbs to unblock the frozen Qi is extremely ingenious. It truly serves as a model for all generations. Comment by Suyuan.)
My wife, Lady Xu, had no prior illness, possessed strong Stomach Qi, and was accustomed to hard labor. On the night of the first day of the eighth month in the Bingwu year, she was still doing needlework under the lamp, accompanying me in proofreading books. At midnight, she suddenly had two episodes of diarrhea. In the morning, while combing my unfinished hair for me, she had another episode. Upon examining her pulse, it was rapid (seven beats per breath), fine, and hurried, and could not withstand pressure. She felt little discomfort. This pulse presentation indicates that the disease is severe while the patient feels well, suggesting the condition likely did not start today and is incurable. I did not dare to say this openly but told her to rest and secretly informed my late mother. I wrote to her brother, You Shan, asking him to consult a physician. Subsequently, the diarrhea slowed down somewhat. She even ate a small bowl of Shandong wheat noodles. My late mother thought I was being too cautious. While I was hesitating, she vomited the food. Even when ginseng decoction was forced down, she rejected it. The diarrhea intensified. The doctor arrived at noon and also declared there was no treatment available. However, she was still able to breastfeed her daughter, but after nursing, her breasts collapsed and did not refill. Her body gradually emaciated, sweating increased, the pulse became increasingly deficient, and her voice grew hoarse. Suddenly, she passed away at Xu hour. This woman was extremely virtuous and kind; even listening through a screen, she could discern the character of guests. To fall victim to such a terminal illness, knowing people could not help but mourn her. This was a rare occurrence of sudden collapse of Middle Qi.
In early autumn of the Wushen year, the younger brother of Zhang Chunqiao suddenly suffered from abdominal pain. This occurred shortly after a heavy meal of mutton noodles. Initially treated as Sha syndrome (sand/summerheat stroke), then as food stagnation, the pain worsened accompanied by intense thirst. However, every sip of water caused vomiting, and both urination and defecation were blocked. Treated as Cold Knotting, the pain increased further, with groaning almost to the point of death. It had been four days. I examined his pulse: wiry and rapid. The tongue coating was dry and slightly yellow. Palpation of the abdomen revealed no hardness. This was neither Sha nor food stagnation, but rather Liver Fire constrained and unable to disperse. I frequently administered jellyfish (dissolved/hyalinized), which stopped the vomiting. The remaining juice was decocted with Gardenia, Coptis, Bamboo Shavings, Melia Azedarach, Anemarrhena, Scutellaria, Corydalis, Inula Flower, Persimmon Calyx, and Loquat Leaf as a formula, along with swallowing Danggui Longhui Wan (Angelica Sinensis and Dragon Gallbladder Pill). After administration, urination commenced, and pain decreased. The next day, bowel movement occurred, and he recovered without further medication.
Zhu Liugeng suddenly experienced severe vomiting and syncope after a full meal, with cold sweat and faint breathing. As syncope resolved, abnormal abdominal pain ensued. His father, Xiangcha, believed it to be acute Sha or Cholera. I was summoned urgently. The pulse was wiry and slow. His mouth was extremely bitter and thirsty, with no urination or defecation. This was Phlegm stagnation with Heat concealed in the Jueyin channel, preventing the free flow of Liver Qi. I prescribed Xue Geng Tang (Snow Soup - Jellyfish and Water Chestnut), Cornus, Coptis, Gardenia, Melia Azedarach, Inula, Bamboo Shavings, Tangerine Peel, Tangerine Seed, Corydalis, and Cistanche, mixed with Radish Juice. After one dose, pain decreased; after the second dose, urination and defecation resumed, and he recovered.
(For Sha and Cholera complicated by food stagnation, food must be eliminated first, just as in Taiyang Cold Damage. Qin’s discussion on this is detailed. However, there are cases where illness begins after a full meal, not caused by diet. Ban Chi once said: 'Since one does not wait for illness with an empty stomach, how can treatment focus solely on attacking and resolving stagnation?' Therefore, in clinical practice, one must inquire carefully, think deeply, and distinguish clearly to avoid errors due to ignorance. In the above two cases, the illnesses began after eating. In Zhu’s case, severe vomiting had already occurred, so treating the food stagnation was unnecessary; others might achieve this. [Text missing/corrupted here], but it implies a level of skill beyond ordinary reach. My disciple Shen Nantai fell ill in winter of the Guichou year, also triggered by eating mutton noodles. The condition was critical, cured by Ban Chi. It took over forty days for bowel movements to resume, which is particularly remarkable. Prescribing medicine is like deploying troops; it is not something those who merely read their fathers' books can do. Zhao Mengling Juzhai's grandmother Chen, aged seventy, in autumn of the Xinhai year, suffered from critical Cholera with tendon retraction. I was summoned urgently. She had sunken eyes, emaciation, cold limbs, raspy voice, hidden pulse, no urine, thirst, profuse sweating, abdominal pain, and yellow tongue coating. She wanted to throw herself into a well. I first ordered her to drink watermelon juice freely. The prescription included Gypsum, Anemarrhena, Ophiopogon, Phellodendron, Scutellaria, Coptis, Bamboo Shavings, Chaenomelos, and Clematis, with a trace of Asarum. Decocted and taken slowly, she recovered after one cup.
(Clinicians who understand the reason for adding a small amount of Asarum can speak of medicine. Comment by Suyuan. The efficacy of this formula shows precise syndrome differentiation. If there is no sweat but thirst exists, the approach would differ. Comment by Xie Cheng.)
My sister-in-law, the second wife of Li Huafu, suddenly developed Cholera accompanied by massive hematuria, splitting headache, spontaneous sweating, and faint breathing. The condition was extremely critical. Upon examination, the pulse was very wiry. This indicated blazing Liver Fire internally and invading Summerheat externally. A large dose was prepared with Rhinoceros Horn (substitute), Akebia, Talc, Gardenia, Bamboo Shavings, Coix Seed, Honeysuckle, Imperata Rhizome, and Chrysanthemum Leaves, mixed with Lotus Root Juice, and administered with Danggui Longhui Wan. Vomiting and diarrhea ceased immediately, and hematuria reduced. However, during urination, the headache persisted severely, requiring someone to hold her head tightly and press the vertex to endure it slightly. This indicated extreme hyperactivity of Wind-Yang and unclear Lung-Stomach Qi. I prescribed Weijing Tang (Reed Shoot Decoction) removing Peach Kernel, adding Lily Bulb, Anemarrhena, Scrophularia, Small Thistle, Dandelion, Bamboo Leaf, Watermelon Rind, and Lotus Plumule, mixed with child's urine, and continued Danggui Longhui Wan. After ten days, she fully recovered.
The second daughter-in-law of Chen Chuzhen suddenly developed Cholera. She reported eating cold fish the previous night, and the illness started at midnight, suggesting a cold-induced etiology. However, applying Huiyang Plaster (Restore Yang Plaster) to the navel was ineffective, hence she sought consultation. Her pulse was slippery and rapid, stronger on the right. She was thirsty with a yellow tongue coating. Palpation below the chest revealed hardness and pain. I said, "Despite frequent vomiting and diarrhea, food remains stuck in the epigastrium. This is not a Cold pattern. Remove the Huiyang Plaster immediately." The prescription consisted of Acorus, Immature Bitter Orange, Perilla Stem, Coptis, Scutellaria, Platycodon, Bamboo Shavings, Achyranthes, Jellyfish, and Radish. One dose resulted in recovery.
My wife's brother, Wu Lvyuan, in mid-summer of the Guichou year, suddenly developed fever, vomiting, penile retraction, and abdominal pain. Examination revealed a wiry, soft, and rapid pulse with a yellow-greasy tongue coating. This required clearing latent heat in the Jueyin channel, not Sha syndrome. The prescription included Melia Azedarach, Bamboo Shavings, Coptis, Dendrobium, Gardenia, Phellodendron, Honeysuckle, Tongcao, and Silk Gourd Network. One dose brought improvement, and several doses led to recovery.
Sister of Mr. Shen [Name obscured], over fifty years old, extremely emaciated. Initially, she suffered insomnia for several nights. Suddenly, her eyes opened but could not close, tears flowed constantly, mouth closed but could not open, tongue could not extend, speech was difficult, swallowing was impossible, feet were cold, constipation occurred, tendons twitched and hurt, the body was stiff and inflexible, and the chest/diaphragm felt board-like. Some suggested severe Summerheat-Sha, fearing immediate collapse. I observed a yellow tongue coating but no thirst. The pulse was wiry, fine, soft, and choppy, disappearing upon deep pressure. However, her spirit was clear, and she had no fever. This was not Summerheat-Sha. Difficulty in urination/defecation and obstruction in the throat/chest did not indicate collapse. It was likely due to emotional constraint causing Liver Wood to rise violently, carrying Phlegm upward to block the Lungs (Huagai), thus impairing regulatory functions and pulse flow. Treatment should focus on diffusing the Lungs; once Qi moves, health returns. The prescription included Aster, Cynanchum, Kopsia, Belamcanda, Acorus, Loquat Leaf, Silk Gourd Network, and White Cardamom. One dose improved symptoms, four doses cured her.
(The term 'Zheng' (Syndrome/Evidence) refers to evidence, like proof in a legal case. However, syndromes can be true or false, or seemingly correct yet incorrect, often leading to confusion. In this case, distinguishing Summerheat-Collapse yielded the correct evidence. Comment by Suyuan. The syndrome was critical, yet the prescription was mild; the effect was miraculous, entirely due to precise differentiation. Comment by Xie Cheng.)
Mother of Jiang Jingtang, aged 74, suddenly developed vomiting, diarrhea, fever, abdominal pain, and mental confusion. Some suspected Cholera, others feared collapse. Upon examination, the pulse was weak and rapid. I stated: "Summerheat pulses are naturally deficient. One should not fear collapse solely due to advanced age. Acrid-diffusing Sha medicines would consume Yin fluids." I prescribed Scutellaria, Coptis, Talc, Dendrobium, Bamboo Shavings, Phellodendron, Honeysuckle, Bamboo Leaf, Tangerine Peel, and Loquat Leaf, decocted in Winter Melon Soup. After one dose, fever subsided, and clarity returned. After two doses, she recovered completely. Jingtang was generous and knowledgeable about medicine; he was a close friend. In spring of Gengshen year, I heard he died resisting soldiers. What a pity.
A maid in Xu Desheng's household, aged 17, suddenly developed abdominal pain. Any movement or speech exacerbated the pain. Suspected as acute Sha or Evil Invasion, various treatments failed. I was summoned urgently. They had tried pressing a rooster on her epigastrium, but her expression was normal, with no vomiting or diarrhea. The pulse was firm and choppy, with a yellow-greasy coating. This was caused by excessive consumption of sour/sweet foods leading to menstrual obstruction. Inquiry confirmed this. The prescription included Peach Kernel, Safflower, Raw Polygonatum, Lygodium Spores, Cyperus, Corydalis, Peony, Jellyfish, and Radish, administered with Longhui Wan. She recovered.
Son of Chen Tang, Zitang, in spring of Jiayin year, after days of exhaustion and travel, suddenly experienced involuntary defecation (not loose stool), followed by abdominal pain. He soon lay down exhausted and unconscious. Upon waking, he complained of abdominal pain again and fell asleep. Some suspected Sha, others deficiency. Examination showed no fever, no urination/defecation, coated tongue absent but thirsty, and wiry-choppy irregular pulse. This was neither Sha nor deficiency. It was Liver constraint due to excessive worry/planning, and Spleen fatigue due to irregular meals and exertion, leading to food stagnation in the Middle. Prescription: Areca Nut, Immature Bitter Orange, Tangerine Peel, Pinellia, Hawthorn, Medicated Leaven, Radish, Melia Azedarach, Corydalis, Jellyfish. After two doses, pain moved below the umbilicus, and hunger sensations returned, indicating downward movement of stagnation. Removed Hawthorn and Leaven, added Gardenia and Peony. After one dose, bowel movement occurred, and he recovered.
(This syndrome is easy to identify as food stagnation but difficult to recognize Liver constraint. Seeing lethargy after fatigue, one usually suspects Sha or deficiency and uses Ginseng/Atractylodes to support Spleen/Stomach. This would further constrain the Liver and cause complications. Ban Chi used light prescriptions with rapid effects, demonstrating exceptional skill. Comment by Suyuan.
I once asked Ban Chi: 'If Liver Qi is constrained above and food cannot descend, why is there involuntary passage of dry stool without sensation?' He replied: 'Stomach and Large Intestine share one Qi. When food stagnates in the Stomach and fails to transform, it seems disconnected from Large Intestine Qi. Thus, feces in the rectum pass out without sensation. The Classic states: 'Deficiency of Middle Qi causes changes in urination and defecation.' This is also a change. 'Deficiency' here does not mean Middle Qi is weak. Rather, pathogenic factors obstruct Middle Qi, impairing its function of descending turbidity and ascending clarity, thus altering excretion.' I was convinced by his profound understanding of classics, explaining his divine clinical variations. Considering Cholera's uncontrolled vomiting/diarrhea and Gan Cholera's constipation, these are all changes caused by obstruction of Middle Qi, impairing descent/ascent functions. If 'deficiency' were interpreted strictly as weakness, all Choleras would require tonifying Middle Qi. Thus, I admire Ban Chi's elucidation of classic principles. Comment by Juzhai. This theory corroborates the statement 'Where evil gathers, Qi must be deficient.' Comment by Xie Cheng.)
Jiang Qiunong, recovering from malaria-diarrhea, suddenly exerted himself, developing Cholera with tendon retraction. Face and arms were purple, eyes sunken, voice hoarse, chest tightness, yellow tongue coating, profuse sweating, greasy mouth, mental fatigue, urinary retention, and fine-wiry pulse. I prescribed Glehnia, Vicia Faba, Coix Seed, Bamboo Shavings, Pinellia, Silk Gourd Network, Chaenomelos, Plantago Seed, and Ficus Leaf, decocted in Yin-Yang Water, with Zuojin Pill (Left Metal Pill). Externally, Evodia powder mixed with water was applied to Yongquan (KI-1). Vomiting and diarrhea gradually stopped. Belching, hiccups, and hypochondriac pain persisted, with reduced sweating, dry mouth, and epigastric tenderness. Pulse was soft and wiry, indicating chronic Liver constraint. Removed Glehnia, Vicia Faba, Chaenomelos, Plantago, and Zuojin Pill. Added Aster, Curcuma, Melia Azedarach, Tongcao, and Loquat Leaf. Two doses: urination resumed, hiccups stopped, coating faded, feet warmed. Lower back distension and leg pain remained, hand purple fading. Removed Curcuma, Aster, Tongcao, Melia. Added Glehnia, Dendrobium, Orchid Leaf, Fresh Lotus Root, and Rice Dew. Two doses: pulse harmonized, distension reduced. Eating porridge made mouth salty, indicating innate Yin deficiency. Removed Pinellia and Ficus Leaf. Added Angelica Root, Trichosanthes Root, and Tangerine Peel. Two doses: bowel movement regular, appetite restored. Lower back soreness and insomnia prompted substitution of American Ginseng, adding Ophiopogon and Epimedium for regulation. After several doses, adding Goji Berry and Eucommia led to recovery.
(This is a syndrome of root deficiency and branch excess. Observe the sequence of treatments. Comment by Qinxian. This case was urgent; superficial practitioners would panic. Ban Chi handled it with ease, treating the branch without harming the root. Medications matched the pathogenesis perfectly. I admire his mature insight. Comment by Suyuan.)
Younger brother of Zhongshao, staying at Ye's residence, in early autumn of Yimao year, suddenly developed profuse watery diarrhea, followed by profuse sweating, leaving him barely alive. Summoned urgently at night. Pulse was deep and fine. No fever. Resembled Deficient-Cold. Only yellow-greasy coating and complete absence of urine indicated Damp-Heat. Prescribed Guiling Ganlu Yin (Cassia Twig, Poria, and Sweet Dew Drink) plus Magnolia Bark. One dose cured him.
In mid-summer of Bingchen year, traveling in Wulin, I was summoned for the wife of Hu Ciyao (Xiaolian degree holder) who suddenly developed limb numbness and dizziness. Suspected acute Sha. Examination: slightly red face, low voice, exhausted spirit, slightly red eyes, slightly yellow coating, slightly cold feet, slight sweating, slight chest stuffiness, slightly wiry pulse. This was constitutional weakness, mental strain, Heart Fire flaring up, with internal Wind rising. Mistaking this for Sha closure and prescribing aromatic-diffusing drugs would be erroneous. Prescription: Ginseng, Dragon Bone, Oyster Shell, Acorus, Coptis, Purple Quartz, Ophiopogon, Wheat, Bamboo Leaf, and Lotus Plumule. Two doses led to recovery. Followed up with mild tonification. Ciyao was honest, rigorous, and learned; we were closest friends. I long wished to live near him, but it never happened. In the Gengshen turmoil, he fled with his wife and relatives by boat to Haichang. The city gates closed, and he encountered soldiers, dying with his young daughter for chastity. Truly sorrowful.
Relatives of Ji Jie, in autumn night, suddenly developed Cholera with severe abdominal pain. Pulse was fine, rapid, and wiry. Cold limbs, aversion to cold, heavy coverings. Mouth not thirsty, diarrhea not hot. Complete urinary retention. Vomitus extremely bitter. Tongue yellow and very red. External coolness constrained, latent Summerheat erupted. Jiangxue and Yushu Dan were refused. After 4-5 diarrheal episodes, warmth returned, intense thirst, refusal of drinks, slurred speech. I ordered fresh lotus root juice slowly administered. Gradually accepted. Then Scutellaria, Coptis, Coix, Melia, Gardenia, Dendrobium, Mulberry Leaf, Bamboo Shavings, and Dandelion were decocted. Pain decreased, vomiting/diarrhea stopped. Switched to light-clearing method for recovery.
Autumn of Dingsi year, third nephew Shouhefu, aged six, suddenly developed chills, fever, tendon twitching, red face, delirium, frequent sweating, cold limbs, yellow-greasy coating, thirst, and red lips. This was seasonal pathogen combined with food stagnation. Prescription: Zhi Shi Zhi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) plus Acorus and dried winter radish greens. Decocted, mixed with 0.15g Yushu Dan, and administered. Next day, delirium and twitching decreased, but abdominal pain, vomiting, and diarrhea occurred, indicating pathogens attempting to exit via Cholera pathway. I have always said that not only Cold Damage can transform into Cholera, but Warmth, Summerheat, and Dampness can too. Treatment should guide the pathogens. Added Perilla Leaf and Coptis to the previous formula, stir-fried and decocted. After 3-5 vomits and 6-7 diarrheas, pain decreased. Third day, mind cleared. To eliminate disease completely, one more dose of original formula cured him. Pediatric illnesses are often due to food stagnation. "When Stomach is discordant, sleep is restless." Yangming excess causes delirium/twitching. Vomiting/diarrhea are pathways for disease elimination. Worldly people often use Convulsion-Stop drugs, causing failure. Ignorant people are confused by shamans, worshipping wrong spirits, which is laughable. Living in Xi for seven years, my family suffered serious illnesses, but I never used shamans, nor did anyone get hurt. Locals found this strange. In autumn of Gengshen year, Ji Jie's illness was critical. Nephew Shouxuan sought fortune sticks from Guanyin, receiving a bad omen. Relatives wanted to pray. I strongly opposed it, and he recovered. I record this to warn future generations.
Autumn of Xinyou year, residing in Puyuan, Cholera with tendon retraction was prevalent. A man had epigastric tenderness. I used Radish Seed, Immature Bitter Orange, and Areca Nut to guide stagnation. Another man, shirtless, refusing covers, claimed inner burning, with sunken eyes, hoarse voice, yellow coating, intense thirst, vomiting upon drinking, cold limbs, and hidden pulse. City doctors prescribed ginger soup, fortunately rejected. Upon my arrival, I ordered cold snow water slowly administered with a small spoon, stopping vomiting. Then Gypsum, Coptis, and Anemarrhena were used to drain counterflowing Fire, curing him.
Mr. Qian suffered Cholera with vomiting of over ten roundworms, dry mouth, and fine pulse. This indicated Summerheat concealed in Jueyin invading the Middle. Cleared with Coptis, Sour Plum, Bamboo Shavings, Melia, Coix, Dendrobium, Perilla, and Scutellaria. Recovered.
Mr. Chen suffered Cholera with bloody stools, yellow coating, intense thirst, and purplish-dark tongue. This indicated deep-seated Summerheat-Toxin. He drank liquor at onset. Large dose of Rhinoceros Horn substitute, Motherwort, Clematis, Imperata, Acorus, Mung Bean, Honeysuckle, Scutellaria, Coptis, Phellodendron, and Lotus Root Juice cured him.
A woman with chronic deficiency contracted a seasonal illness. Sweating profusely, emaciation, hoarseness, pulse faint/almost absent. Indicated Yang Collapse. Prescribed Fuzi Lizhong Tang plus White Peony, Poria, Chaenomelos, Coix, and Silkworm Sand. Sweating stopped, pulse returned. Removed Ginger and Aconite, added Astragalus. Condition stabilized. Removed Silkworm Sand, added Tangerine Peel and Pinellia. Tonified and regulated for safety.
Mrs. Liu had not eaten for two months. Suddenly developed vomiting, diarrhea, and tendon retraction. Smooth tongue, hoarse voice. Qi and Fluids exhausted. Urgently prescribed Ginseng, Roasted Licorice, Red Halloysite, Yu Liang Stone, Dragon Bone, Oyster Shell, Dendrobium, Peony, Chaenomelos, Sour Plum, and Cordyceps. Two doses: voice returned, pulse resumed, symptoms平息. Relative Shen Zefu followed this method for recovery. Son of Wu family had similar symptoms: weak pulse, pale-red tongue, slight thirst. Root deficiency with mild pathogen. Added Ginseng to clearing/resolving herbs to support healthy Qi. Shen Zefu treated similarly with success.
In March this year, Mr. Lv Shen'an reported a child playing next door who suddenly developed vomiting, diarrhea, and tendon retraction, dying upon returning home. I thought it an isolated case. Later, more cases appeared. Early April, a paper merchant from Yuhang fell ill on a boat, arriving in Puyuan for consultation. Tongue curled, scrotum retracted, emaciation, spirit departed. Incurable. Mouth open, black coating. No medication taken en route. I pondered: this disease prevails in Summer-Autumn Damp-Heat. Why now in Spring? Deep reflection: if Damp-Heat can lie dormant until late Autumn to cause Cholera, then Winter Cold damage, failing to become Warm Disease in Spring, may also transform into Cholera. Although a variation of Warm Disease, Warm equals Heat, so it is not vastly different from latent Summerheat. Some say: "This is mere speculation. Master Zhang Zhongjing only has Wuling San and Lizhong Tang for Cold Damage transforming into Cholera, but no method for Warm Disease transforming into Cholera. Why?" I say ancient texts...