丙戌秋。定海霍乱盛行。有用雷公散纳脐灸者。百有一活。鲍姓妇年三十许。亦患是症。泻五六次。即目眶陷而大
肉脱。大渴索饮。频饮频吐。烦躁反复。肢厥脉伏。舌苔微白而燥。舌尖有小红点。余曰。此暑秽之邪。伏于募原。乃
霍乱之热者。勿误作寒治。而灸以雷公散等药也。盖暑秽之邪。从口鼻吸受。直趋中道。伏于募原。脏腑经络皆为壅
塞。故上下格拒。而上吐下泻。如分两截。此即误。又可所云疫毒伏于募原也。夫募原乃人身之脂募。内近胃腑。外
通经脉。热毒之邪。壅塞于里。则外之经络血脉皆为凝塞。故肢冷脉伏。内真热而外假寒也。当先用针按入法流
注之刺法。以开其外之关窍。其头面之印堂人中。手弯之曲池。脚弯之委中。及十指少商、商阳、中冲、少冲。皆刺出
血。以宣泄其毒。服以芳香通神利窍之汤丸。方用黄连、黄芩、藿香、郁金、石菖蒲、花粉、竹茹、陈皮、枳实、木瓜、
木香汁、蚕矢等。调服紫雪丹。一剂而吐泻止。肢和脉起。诸恙皆安。
又丁姓妪患是症。脉濡数虚大。以藿香、芩、连、半夏、竹茹、木瓜、陈皮、薏苡、滑石为剂。此乃暑邪挟湿。而
脉未伏。肢未厥。故治法略有区别耳。
又项姓子年十二。脉伏肢冷。舌白不渴。目直神昏。此内伏暑邪。外感寒凉。而本元又虚。若骤用芳香开达。必至
元气暴脱。乃参、附茯苓、白芍、藿香、冬术。九制倭硫黄、木瓜等。先为扶脾固元。吐泻果止。而肢温脉起。次日舌
旁及尖现红点。目赤口渴。此元阳已复。外寒去而内热乃现。改用知母、石膏、竹叶、花粉、木瓜、藿香、郁金、陈皮、
银花、滑石等。
服两剂而脉象渐和。惟觉惫甚。而胃少纳食。乃余热未清。胃络不和。以轻清之剂清养胃阴。如西洋参、石斛、竹茹、
荷叶、麦冬、茯苓、生扁豆、西瓜皮、乌梅、山栀、木瓜、绿豆衣等。出入为方。调理数剂而愈。
又一妇。舌苔灰滑。肢冷脉伏。面色青惨。口不渴饮。身亦安静。此真太阴中寒。用附子理中汤。加藿香、半夏、
陈皮。一剂而愈。
又一人。腹痛如绞。上吐下泻。面目俱赤。舌苔老黄。舌尖赤而起刺。肢冷脉伏。烦躁如狂。饮不解渴。吐泻之物。
酸臭不可近。此暑秽之毒。深入于里。仿凉膈散法加石膏、银花。化其在里之暑毒。一剂而吐泻定。舌苔转为鲜赤。略
带紫色。脉出洪大。此为热转血分。以竹叶石膏汤加细生地、丹皮、银花、山栀一剂而愈。此等症不概见。必须审症明
确。方可用之。一或稍误。祸不旋踵。
又一妇转筋四肢厥冷。筋抽则足肚坚硬。痛苦欲绝。诊之浮中二部无脉。重按至骨。细如蛛丝。然其往来之势。坚
劲搏指。先以三棱针刺委中出血。血黑不流。用力挤之。血出甚少。再针昆仑、承山。针刺毕。腿筋觉松。再用食盐艾
绒炒热。用布包裹。熨摩委中及足肚上下。方用三棱、莪术、归须、红花、桃仁、僵蚕、山甲、地龙、牛膝、薏苡、木
瓜。服下一时许。筋乃不抽。而吐泻亦止。次日改用丝瓜络、莱菔子、桃仁、竹茹、薏苡、滑石、蚕砂、木瓜、刺蒺藜、
山栀皮等清暑湿而宣通脉络。后以西洋参、麦冬、石斛、橘皮、竹茹、薏苡、丝瓜络、茯苓等出入加减。调理旬余始痊。
又一农夫史姓。年四十许。偶入城患干霍乱。腹痛如绞。不吐不泻。倒地欲绝。四肢厥冷而脉伏。与立生二服不效。
又急制独胜散。用热酒冲服。仍不效。唇面青惨。鼻尖寒冷。痛益剧。其势甚危。不得已与外台走马汤。巴豆霜用五
分。服下半时许。腹中大鸣而大便乃下。臭秽难闻。痛乃稍缓。扶至城内亲戚家将息。次日竟能缓行归家矣。
丙戌年秋天，定海地区霍乱盛行。有人使用雷公散敷于脐部并施以艾灸，一百人中有一人存活。有一位姓鲍的妇女，三十岁左右，也患上了这种病。腹泻五六次后，眼眶凹陷，大肉消瘦，极度口渴想要饮水，但频繁饮水又频繁呕吐，烦躁不安，四肢厥冷，脉搏伏匿不见，舌苔微白而干燥，舌尖有小红点。我说：这是暑秽之邪，潜伏在募原，属于霍乱中的热证。不要误当作寒证治疗，也不要用雷公散等药物进行艾灸。因为暑秽之邪，从口鼻吸入，直趋中道，潜伏在募原，脏腑经络都被壅塞，所以上下格拒，出现上吐下泻，如分为两截。这就是吴又可所说的疫毒潜伏在募原。募原是人身体的脂膜，内近胃腑，外通经脉。热毒之邪壅塞在体内，则外面的经络血脉都凝滞不通，所以四肢冰冷，脉搏伏匿，这是内真热而外假寒。应当先用针刺法，按照《针灸大成》中的刺法，来开通体表的关窍。头面部的印堂、人中穴，手肘弯曲处的曲池穴，膝盖弯曲处的委中穴，以及十个手指尖的少商、商阳、中冲、少冲穴，都要针刺放血，以宣泄毒邪。服用芳香通神、利窍的汤剂或丸药。方子用黄连、黄芩、藿香、郁金、石菖蒲、天花粉、竹茹、陈皮、枳实、木瓜、木香汁、蚕砂等。调服紫雪丹。一剂药后，吐泻停止，四肢温和，脉搏恢复，各种病症都安宁了。
又有一位姓丁的老妇人患此病，脉象濡数虚大。用藿香、黄芩、黄连、半夏、竹茹、木瓜、陈皮、薏苡仁、滑石为药方。这是暑邪挟带湿邪，而且脉象没有伏匿，四肢没有厥冷，所以治疗方法略有区别罢了。
又有一位姓项的男孩十二岁，脉伏肢冷，舌苔白不渴，眼睛直视，神志昏迷。这是体内潜伏暑邪，外部感受寒凉，而且本元又虚弱。如果骤然使用芳香开达的药物，必然导致元气暴脱。于是用人参、附子、茯苓、白芍、藿香、冬术（白术）、九制硫黄、木瓜等。先用来扶助脾气，固护元气。吐泻果然停止，四肢温暖，脉搏恢复。第二天舌旁及舌尖出现红点，眼睛发红，口渴。这是元气阳气已经恢复，外寒去除而内热显现。改用知母、石膏、竹叶、天花粉、木瓜、藿香、郁金、陈皮、金银花、滑石等。
服用两剂后脉象逐渐平和，只是觉得非常疲惫，胃口少，进食不多。这是余热未清，胃络不和。用轻清的药剂清养胃阴，如西洋参、石斛、竹茹、荷叶、麦冬、茯苓、生扁豆、西瓜皮、乌梅、山栀、木瓜、绿豆衣等。根据情况加减处方，调理几剂后痊愈。
又有一位妇女，舌苔灰滑，四肢冷，脉伏，面色青惨，口不渴饮，身体也安静。这是真正的太阴中寒。用附子理中汤，加藿香、半夏、陈皮。一剂药后痊愈。
又有一个人，腹痛如绞，上吐下泻，面目都红赤，舌苔老黄，舌尖红赤且有芒刺，四肢冷，脉伏，烦躁如狂，喝水不能解渴，吐泻之物酸臭不可靠近。这是暑秽之毒，深入体内。仿照凉膈散的方义，加石膏、金银花，化解体内的暑毒。一剂药后吐泻停止，舌苔转为鲜红色，略带紫色，脉象出洪大。这是热邪转入血分。用竹叶石膏汤加细生地、牡丹皮、金银花、山栀，一剂药后痊愈。这类病症不常见，必须审症明确，才可以应用。一旦稍有错误，灾祸立刻降临。
又有一位妇女转筋，四肢厥冷。抽筋时小腿肚坚硬，痛苦欲绝。诊察发现浮中二部无脉，重按至骨，细如蛛丝。然而其往来之势，坚劲搏指。先用三棱针刺委中穴放血，血黑不流，用力挤压，出血很少。再针昆仑穴、承山穴。针刺完毕后，腿筋感觉放松。再用食盐和艾绒炒热，用布包裹，熨摩委中穴及小腿肚上下。方子用三棱、莪术、当归须、红花、桃仁、僵蚕、穿山甲、地龙、牛膝、薏苡仁、木瓜。服用约一小时后，抽筋停止，吐泻也止住了。第二天改用丝瓜络、莱菔子、桃仁、竹茹、薏苡仁、滑石、蚕砂、木瓜、刺蒺藜、山栀皮等清暑湿而宣通脉络。后来用西洋参、麦冬、石斛、橘皮、竹茹、薏苡仁、丝瓜络、茯苓等加减调理，十几天后才痊愈。
又有一位姓史的农夫，四十岁左右，偶然进城患上干霍乱。腹痛如绞，不吐不泻，倒地痛苦欲绝，四肢厥冷而脉伏。给服立生散两剂无效。又紧急制作独胜散，用热酒冲服，仍然无效。嘴唇面部青惨，鼻尖寒冷，疼痛加剧，形势很危险。不得已用了外台走马汤，巴豆霜用五分。服下半时许，腹中大鸣而大便才下来，气味臭秽难闻，疼痛才稍微缓解。扶到城内亲戚家调养。第二天竟然能缓行回家了。
In the autumn of Bingxu year, cholera was prevalent in Dinghai. Some used Leigong San (Thunder God Powder) applied to the navel with moxibustion; one out of a hundred survived. A woman surnamed Bao, about thirty years old, also suffered from this disease. After five or six episodes of diarrhea, her eye sockets sunken and muscles wasted away, she experienced extreme thirst and craved drinks, but drank frequently only to vomit frequently. She was restless and irritable, with cold limbs and a hidden pulse. Her tongue coating was slightly white and dry, with small red spots on the tip. I said: This is pathogenic heat-dampness miasma latent in the Mu Yuan (semi-interior semi-exterior region), representing the heat type of cholera. Do not mistakenly treat it as cold, nor use Leigong San for moxibustion. Pathogenic heat-dampness miasma enters through the mouth and nose, goes directly to the middle jiao, and lies latent in the Mu Yuan, causing obstruction in the zang-fu organs and meridians. Thus, upper and lower rebellion occurs, leading to vomiting above and diarrhea below, as if separated into two parts. This is what Wu Keyi described as epidemic toxin latent in the Mu Yuan. The Mu Yuan is the fatty tissue of the body, close internally to the stomach and externally connecting to the meridians. When heat-toxin obstructs the interior, the exterior meridians and blood vessels become stagnant, resulting in cold limbs and a hidden pulse; this is true heat inside and false cold outside. One should first use acupuncture according to the needling methods in Zhen Jiu Da Cheng (Great Compendium of Acupuncture and Moxibustion) to open the external gateways. Needling Yintang (Ex-HN3), Renzhong (GV26), Quchi (LI11), Weizhong (BL40), Shaoshang (LU11), Shangyang (LI1), Zhongchong (PC9), and Shaochong (HT9) to release blood, thereby venting the toxin. Administer aromatic decoctions or pills that unblock the spirit and open orifices. The formula uses Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Huoxiang (Agastaches Herba), Yujin (Curcumae Radix), Shichangpu (Acori Tatarinowii Rhizoma), Tianhuafen (Trichosanthis Radix), Zhuru (Bambusae Caulis in Taenia), Chenpi (Citri Reticulatae Pericarpium), Zhishi (Aurantii Fructus Immaturus), Mugua (Chaenomelis Fructus), Muxiang juice (Aucklandiae Radix juice), and Can Shi (Bombyx Batryticatus). Mix with Zixue Dan (Purple Snow Pill). After one dose, vomiting and diarrhea ceased, limbs became warm, pulse returned, and all ailments were resolved.
Another elderly woman surnamed Ding suffered from this disease with a soggy, rapid, deficient, and large pulse. The prescription consisted of Huoxiang (Agastaches Herba), Huangqin (Scutellariae Radix), Lian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma Praeparatum), Zhuru (Bambusae Caulis in Taenia), Mugua (Chaenomelis Fructus), Chenpi (Citri Reticulatae Pericarpium), Yiyiren (Coicis Semen), and Huashi (Talcum). This indicates summer-heat pathogen combined with dampness, where the pulse had not yet become hidden and limbs were not cold, hence the treatment method differed slightly.
A twelve-year-old boy surnamed Xiang presented with a hidden pulse, cold limbs, white tongue coating without thirst, fixed gaze, and coma. This indicated internal latent summer-heat pathogen, external contraction of cold, and deficiency of original qi. Sudden use of aromatic opening agents would likely cause sudden collapse of original qi. Therefore, Renshen (Ginseng Radix et Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Fuling (Poria), Baishao (Paeoniae Radix Alba), Huoxiang (Agastaches Herba), Dongzhu (Atractylodis Macrocephalae Rhizoma), Jiuzhi Wosuhuang (Prepared Realgar processed nine times - *Note: Text says 倭硫黄 which usually refers to sulfur, specifically processed sulfur*), Mugua (Chaenomelis Fructus) were used first to strengthen spleen and consolidate original qi. Vomiting and diarrhea stopped, limbs warmed, and pulse returned. The next day, red spots appeared on the sides and tip of the tongue, eyes turned red, and thirst emerged. This indicated recovery of yuan yang (original yang), dissipation of external cold, and manifestation of internal heat. The prescription changed to Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Zhuye (Bambusae Folium), Tianhuafen (Trichosanthis Radix), Mugua (Chaenomelis Fructus), Huoxiang (Agastaches Herba), Yujin (Curcumae Radix), Chenpi (Citri Reticulatae Pericarpium), Yinhua (Lonicerae Japonicae Flos), and Huashi (Talcum).
After two doses, the pulse gradually harmonized, though fatigue remained and appetite was poor. This suggested residual heat not cleared and disharmony of stomach collaterals. Light and clear herbs were used to nourish stomach yin, such as Xiyangshen (American Ginseng Radix), Shihu (Dendrobii Caulis), Zhuru (Bambusae Caulis in Taenia), Heye (Nelumbinis Folium), Maidong (Ophiopogonis Radix), Fuling (Poria), Sheng Bian Dou (Vigna Radiata Seed), Xigua Pi (Citrulli Fructus Pericarpium), Wumei (Mume Fructus), Shanzhi (Gardeniae Fructus), Mugua (Chaenomelis Fructus), and Lüdouyi (Vigna Radiata Testa). Adjusted according to condition, several doses led to recovery.
Another woman presented with gray-slippery tongue coating, cold limbs, hidden pulse, blue-pale complexion, no thirst, and quiet demeanor. This was true Taiyin cold damage. Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle) was used, added with Huoxiang (Agastaches Herba), Banxia (Pinelliae Rhizoma Praeparatum), and Chenpi (Citri Reticulatae Pericarpium). One dose resulted in cure.
Another person suffered from wringing abdominal pain, vomiting, and diarrhea, with red face and eyes, thick yellow tongue coating, red tongue tip with prickles, cold limbs, hidden pulse, restlessness like madness, inability to quench thirst despite drinking, and sour, foul-smelling vomit and stool. This indicated deep penetration of summer-heat miasma toxin into the interior. Following the principle of Liangge San (Cool the Chest Powder), Shigao (Gypsum Fibrosum) and Yinhua (Lonicerae Japonicae Flos) were added to resolve internal summer-heat toxin. One dose stopped vomiting and diarrhea; the tongue coating turned bright red with slight purple hue, and pulse became surging and large. This indicated heat transferring to the blood level. Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) was used with additions of Xi Shengdi (Rehmanniae Radix Preparata), Danpi (Moutan Cortex), Yinhua (Lonicerae Japonicae Flos), and Shanzhi (Gardeniae Fructus). One dose led to recovery. Such cases are rare and require precise diagnosis before application; even slight error can lead to immediate disaster.
Another woman suffered from muscle spasms and cold limbs. During spasms, the calf muscles became hard, causing unbearable pain. Pulse was absent at superficial and middle depths, fine as spider silk at deep pressure, yet strong and bounding upon arrival. First, Weizhong (BL40) was pricked with a three-edged needle to release blood; the blood was dark and did not flow freely. With forceful squeezing, very little blood came out. Then Kunlun (BL60) and Chengshan (BL57) were needled. After needling, leg muscles relaxed. Hot salt and mugwort wool were wrapped in cloth and applied to moxa/iron over Weizhong (BL40) and the calves. The formula included Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Guixu (Angelicae Sinensis Radix), Honghua (Carthami Flos), Tao Ren (Persicae Semen), Jiangcan (Bombyx Batryticatus), Shan Jia (Manis Squama), Dilong (Pheretima), Niuxi (Achyranthis Bidentatae Radix), Yiyiren (Coicis Semen), and Mugua (Chaenomelis Fructus). After about an hour of ingestion, spasms ceased, and vomiting/diarrhea stopped. The next day, the prescription switched to Sigualuo (Luffae Fructus Retinervus), Laifuzi (Raphani Semen), Tao Ren (Persicae Semen), Zhuru (Bambusae Caulis in Taenia), Yiyiren (Coicis Semen), Huashi (Talcum), Can Sha (Bombyx Batryticatus), Mugua (Chaenomelis Fructus), Cijili (Tribuli Fructus), and Shanzhi Pi (Gardeniae Fructus Cortex) to clear summer-heat dampness and unblock collaterals. Later, adjustments using Xiyangshen (American Ginseng Radix), Maidong (Ophiopogonis Radix), Shihu (Dendrobii Caulis), Jupi (Citri Reticulatae Pericarpium), Zhuru (Bambusae Caulis in Taenia), Yiyiren (Coicis Semen), Sigualuo (Luffae Fructus Retinervus), and Fuling (Poria) led to full recovery after more than ten days.
A farmer named Shi, around forty years old, contracted Gan Huoluan (Dry Cholera) while visiting the city. He had wringing abdominal pain, no vomiting or diarrhea, collapsed in agony, with cold limbs and hidden pulse. Two doses of Lisheng San (Life-Saving Powder) were ineffective. Urgently prepared Dusheng San (Single Victory Powder) administered with hot wine, still ineffective. Lips and face turned blue-pale, nose tip cold, pain intensified, condition critical. Reluctantly, Waitai Zouma Tang (External Classic Running Horse Decoction) was given, containing Badoushuang (Crotonis Seminis Exocarpium Pulveratum) five fen. After half an hour, loud borborygmus occurred, followed by defecation of foul-smelling stool, and pain slightly relieved. Supported to relatives' home in the city to recuperate. The next day, he could walk slowly home.