天津王××，年三十八岁，于季冬得霍乱证。
病因 厂中腊底事务烦杂，劳心过度，暗生内热，又兼因怒激动肝火，怒犹未歇，遽就寝睡，至
一点钟时，觉心中扰乱，腹中作疼，移时则吐泻交作，遂成霍乱。
证候 心中发热而渴，恶心怔忡，饮水须臾即吐，腹中时疼时止，疼剧时则下泻，泻时异常
觉热，偶有小便，热亦如斯，有时两腿筋转，然不甚剧，其脉象无力，却无闭塞之象。
诊断 霍乱之证，恒有脉象无火而其实际转大热者，即或脉闭身冷显露寒凉之象，亦不可遽
以凉断。此证脉象不见有热，而心中热而且渴，二便尤甚觉热，其为内蕴实热无疑。至其脉
不见有热象者，以心脏因受毒麻痹，而机关之启闭无力也。拟用大剂寒凉清其内热，而辅
以解毒消菌之品。
处方 生石膏（三两捣细） 生杭芍（八钱） 清半夏（五钱温水淘三次） 生怀山药（五钱）
嫩竹茹（三钱碎的） 甘松（二钱） 甘草（三钱）
共煎汤三盅，分三次温服下。每次送服卫生防疫宝丹五十粒。
方载后方中。甘松亦名甘松香，即西药中之缬草也。《本草纲目》谓马氏《开宝本草》，载
其主恶气，卒心腹痛满。西
人谓其善治转筋，是以为治霍乱要药。且其性善熏劳瘵，诚有解毒除菌之力也。
复诊 将药分两次服完，吐泻、腹疼、转筋诸证皆愈。惟心中犹觉热作渴，二便仍觉发热。诊其脉
较前有力，显呈有火之象。盖其心脏至此已不麻痹，启闭之机关灵活，是以脉象更改也。其犹觉热
与渴者，因系余火未清，而吐泻之甚者最足伤阴，阴分伤损，最易生热，且善作渴，此不可但治以泻火
之凉药也，拟兼投以大滋真阴之品。
处方 生怀山药（一两） 大甘枸杞（一两） 北沙参（一两） 离中丹（五钱）
药共四味，将前三味煎汤一大盅，送服离中丹一半，迟四点钟再将药渣煎汤一大盅，送服其余一半。
效果 将药分三次服完，热退渴止，病遂全愈。
帮助 霍乱之证，原阴阳俱有。然愚五十年经验以来，知此证属阳，而宜治以凉药者十居其八；此
证属阴，而宜治以热药者十居其一；此证属半阴半阳，当凉热之药并用，以调剂其阴阳者，又十
居其一。而后世论者，恒以《伤寒论》所载之霍乱为真霍乱，至于以凉药治愈之霍乱，皆系假霍乱，不知
《伤寒论》对于霍乱之治法亦非专用热药也。有如其篇第七节云，霍乱头痛、发热、身疼痛、热多，
欲饮水者五苓散主之。寒多，不用水者理中丸主之。夫既明言热多寒多，是显有寒热可分也。
虽所用之五苓散中亦有桂枝而分量独轻，至泽泻、茯苓、猪苓其性皆微凉，其方原不可以热论也。且用
显微镜审察此病之菌，系弯曲杆形，是以此证无论凉热，惟审察其传染之毒菌，现弯曲杆形即
为霍乱无疑也。至欲细审此病之凉热百不失一，当参观霍乱方，及论霍乱治法篇，自能临证无误。
天津人王××，三十八岁，在冬季末尾患霍乱证。
病因 工厂年底事务繁杂，用心过度，暗中产生内热，又加上因发怒引动肝火，怒气尚未平息，就急忙上床睡觉，到凌晨一点钟时，感觉心中烦乱，腹部疼痛，过了一会儿则呕吐和腹泻同时发作，于是形成霍乱。
证候 心中发热且口渴，恶心、心悸，喝水片刻后即吐出，腹部有时疼痛有时停止，疼痛剧烈时则发生腹泻，腹泻时异常感觉热，偶尔有小便，小便也感觉热，有时两条腿的筋脉拘挛抽搐，但程度不严重，其脉象无力，却没有脉搏闭塞不通的迹象。
诊断 霍乱的病证，常常有脉象显示无火（热象），而实际病情转为大热的情况；即使出现脉搏闭阻、身体发冷等显露寒凉之象，也不可立刻断定为寒证。此证脉象不见有热象，但心中热而且渴，大小便尤其感觉热，这肯定是体内蕴藏实热。至于脉象不见有热象的原因，是因为心脏受到毒素麻痹，导致气血运行的机关开启和关闭无力。拟用大剂量的寒凉药物清除内热，并辅以解毒杀菌的药物。
处方 生石膏（三两，捣细） 生杭芍（八钱） 清半夏（五钱，用温水淘洗三次） 生怀山药（五钱） 嫩竹茹（三钱，切碎） 甘松（二钱） 甘草（三钱）
共同煎煮成汤药三盅，分三次温服。每次送服卫生防疫宝丹五十粒。
方剂记载在后文方剂中。甘松又名甘松香，即西药中的缬草。《本草纲目》引用马氏《开宝本草》，记载其主治恶气，突然的心腹疼痛胀满。西方人认为它善于治疗转筋（肌肉痉挛），因此将其作为治疗霍乱的要药。而且它的性质善于熏治劳瘵（肺结核等消耗性疾病），确实具有解毒除菌的力量。
复诊 将药物分两次服完，呕吐、腹泻、腹痛、转筋等症状都痊愈了。只是心中仍然觉得热且口渴，大小便仍然感觉发热。诊察其脉象比之前有力，明显呈现出有火的征象。大概因为此时心脏不再麻痹，气血运行的机关灵活，所以脉象发生改变。之所以仍然觉得热与渴，是因为残余的火邪未清，而且严重的呕吐和腹泻最足以损伤阴液，阴分受损，最容易产生虚热，并且容易引发口渴，这种情况不能仅仅使用泻火的寒凉药物治疗，拟兼用大补真阴的药物。
处方 生怀山药（一两） 大甘枸杞（一两） 北沙参（一两） 离中丹（五钱）
四种药物，将前三味煎煮成一大盅汤药，送服一半的离中丹，过四个小时再将药渣煎煮成一大盅汤药，送服剩下的一半。
效果 将药物分三次服完，热退去，口渴止，疾病完全痊愈。
按语 霍乱的病证，原本阴阳两种类型都有。然而我五十年的经验以来，知道此证属于阳证，适宜用凉药治疗的占十分之八；此证属于阴证，适宜用热药治疗的占十分之一；此证属于半阴半阳证，应当凉热药物并用，以调和阴阳的，又占十分之一。而后世论述者，常常认为《伤寒论》所载的霍乱才是真霍乱，至于用凉药治愈的霍乱，都是假霍乱，不知道《伤寒论》对于霍乱的治疗方法也并非专用热药。就像该篇第七节所说：“霍乱头痛、发热、身疼痛、热多，欲饮水者，五苓散主之。寒多，不用水者，理中丸主之。”既然明确说明热多寒多，显然是有寒热可以区分的。虽然所用的五苓散中也有桂枝，但分量很轻，至于泽泻、茯苓、猪苓，它们的性质都是微凉的，这个方子原本就不能说是热性方剂。而且用显微镜观察这种病的细菌，是弯曲杆状，因此此证无论凉热，只要审察其传染的毒菌呈现弯曲杆状，就是霍乱无疑。至于想要细致辨别此病的凉热而不失准确，应当参考霍乱方剂，以及论述霍乱治疗方法的篇章，自然能在临证时不出错误。
Wang XX, aged thirty-eight, from Tianjin, contracted cholera (Huoluan) at the end of winter.
Etiology: The affairs in the factory were complicated at the year's end, leading to excessive mental exertion and secretly generating internal heat (Nei Re). Additionally, anger stirred up Liver Fire (Gan Huo). Before the anger subsided, he went to bed abruptly. At one o'clock in the morning, he felt disturbance in the heart region and abdominal pain. After a while, vomiting and diarrhea occurred simultaneously, thus forming cholera.
Symptoms: There was feverish sensation and thirst in the heart region, nausea, and palpitations (Zheng Chong). Water vomited out shortly after drinking. Abdominal pain came and went; when severe, diarrhea ensued. During defecation, there was an abnormal sensation of heat. Occasionally, there was slight urination, which also felt hot. Sometimes, the tendons in both legs cramped (Zhuan Jin), but not severely. The pulse was weak but showed no signs of obstruction or closure.
Diagnosis: In cases of cholera, it is common for the pulse to show no signs of heat while the actual condition involves significant internal heat. Even if symptoms like closed pulse and cold body reveal a cold pattern, one should not hastily diagnose it as cold. In this case, although the pulse shows no heat signs, the patient feels heat and thirst in the heart region, and especially feels heat in both urine and stool. This undoubtedly indicates substantial internal heat accumulation. The reason the pulse lacks heat signs is that the heart has been paralyzed by toxins, causing weakness in the opening and closing mechanisms of the vessels. I propose using a large dose of cold-natured herbs to clear the internal heat, assisted by substances that detoxify and eliminate bacteria.
Prescription: Raw Gypsum (Sanliang, crushed fine), Raw Hang Shaoyao (Baeckea frutescens / Paeonia lactiflora var. albiflora - Eight Qian), Clear Banxia (Pinellia ternata - Five Qian, rinsed three times with warm water), Raw Huai Shanyao (Dioscorea opposita - Five Qian), Tender Zhuru (Bambusa textilis - Three Qian, chopped), Gan Song (Nardostachys jatamansi - Two Qian), Gancao (Glycyrrhiza uralensis - Three Qian).
Decoct together to make three bowls of soup, taken warm in three doses. Each time, take fifty pills of Weisheng Fangyi Baodan along with the decoction.
The formula is recorded in the subsequent section. Gan Song, also known as Gan Song Xiang, is Valerian officinalis in Western medicine. *Bencao Gangmu* cites Ma Shi's *Kaibao Bencao*, stating it treats foul odors and sudden epigastric/abdominal pain and fullness. Westerners believe it effectively treats muscle cramps, hence it is considered a key herb for treating cholera. Furthermore, its nature is suitable for fumigating against tuberculosis (Lao Zhai), truly possessing power to detoxify and eliminate bacteria.
Follow-up Visit: After taking the medicine in two doses, symptoms such as vomiting, diarrhea, abdominal pain, and muscle cramps all resolved. However, the patient still felt heat and thirst in the heart region, and heat in urine and stool. Palpation revealed the pulse was stronger than before, clearly showing signs of fire. This is because the heart had ceased to be paralyzed, and the regulatory mechanisms became flexible, hence the change in pulse. The remaining heat and thirst are due to residual fire not yet cleared. Severe vomiting and diarrhea severely damage Yin fluids. Damage to the Yin level easily generates deficiency heat and causes thirst. Therefore, one cannot treat this merely with cooling herbs that purge fire. I propose adding substances that greatly nourish True Yin (Zhen Yin).
Prescription: Raw Huai Shanyao (One Liang), Da Gan Gouqi (Lycium barbarum - One Liang), Bei Shashen (Adenophora stricta - One Liang), Lizhong Dan (Five Qian).
Take the first three herbs, decoct them into one large bowl of soup, and take half of the Lizhong Dan with it. Four hours later, decoct the dregs again into one large bowl of soup, and take the remaining half of the Lizhong Dan.
Outcome: After taking the medicine in three doses, the heat receded, thirst stopped, and the illness was completely cured.
Commentary: Cholera cases involve both Yin and Yang patterns. However, based on my fifty years of experience, I know that eight-tenths of these cases belong to Yang patterns and should be treated with cooling medicines; one-tenth belongs to Yin patterns and should be treated with warming medicines; and one-tenth belongs to semi-Yin semi-Yang patterns, requiring the combination of cooling and warming medicines to harmonize Yin and Yang. Later commentators often claim that only the cholera described in *Shanghan Lun* is true cholera, and those cured with cooling medicines are false cholera. They do not realize that *Shanghan Lun*'s treatment methods for cholera do not exclusively use warming medicines. For instance, Section 7 of that chapter states: "For cholera with headache, fever, body ache, more heat than cold, and desire to drink water, Wuling San governs it. For more cold than heat and no desire to drink water, Lizhong Wan governs it." Since it explicitly mentions distinguishing between more heat and more cold, it clearly indicates that cold and heat can be differentiated. Although Guizhi (Cinnamon Twig) is present in Wuling San, its dosage is light. Meanwhile, Zexie (Alisma rhizome), Fuling (Poria), and Zhuling (Polyporus) have slightly cool natures; thus, this formula cannot be classified as warming. Moreover, examining the bacteria of this disease under a microscope reveals curved rod shapes. Therefore, regardless of whether the clinical presentation is cold or heat, if the infectious pathogenic bacteria appear as curved rods, it is undoubtedly cholera. To accurately distinguish the cold or heat nature of this disease without error, one should refer to the formulas for cholera and the chapters discussing cholera treatment methods, thereby ensuring accuracy in clinical practice.