治霍乱吐泻已极，精神昏昏，气息奄奄，至危之候。
潞党参（八钱） 生山药（一两） 生杭芍（五钱） 山萸肉（八钱，去净核） 炙甘草（三钱） 赭石（四钱，
研细） 朱砂（五分，研细）
先用童便半盅炖热，送下朱砂，继服汤药。
以上二方，皆为治霍乱之要药矣。然彼以祛邪为主，此以扶正为主。诚以得此证者，往往因治不如法，致
日夜吐泻不已，虚极将脱，危在目前。病势至此，其从前之因凉因热皆不暇深究，惟急宜重用人参以回阳，山
药、芍药以滋阴，山萸肉以敛肝气之脱（此证吐泻之始肝木助邪侮土，吐泻之极而肝气转先脱），炙甘草以和
中气之漓，此急救回阳汤所以必需也。用赭石者，不但取其能止呕吐，俾所服之药不致吐出，诚以吐泻已久，
阴阳将离，赭石色赤入心，能协同人参，助心气下降。而方中山药，又能温固下焦，滋补真阴，协同人参以回
肾气之下趋，使之上行也。用朱砂且又送以童便者，又以此时百脉闭塞，系心脏为毒瓦斯所伤，将熄其鼓动之机，
故用朱砂直入心以解毒，又引以童便使毒瓦斯从尿道泻出，而童便之性又能启发肾中之阳上达，以应心脏也。是
此汤为回阳之剂，实则交心肾和阴阳之剂也。服此汤后，若身温脉出，觉心中发热有烦躁之意者，宜急滋其阴分
，若玄参、生芍药之类，加甘草以和之，煎一大剂，分数次温饮下。此《伤寒论》太阳篇，先用甘草干姜汤继用
甘草芍药汤之法也。
门人高××，曾治一少妇。吐泻一昼夜，甚是困惫，浓煎人参汤，送服益元散而愈。盖独参汤能回阳，益
元散能滋阴，又能和中（滑石甘草能和中以止吐泻）解毒（甘草朱砂能解毒），且可引毒瓦斯自小便出，是以应
手奏效。此亦拙拟急救回阳汤之意也。
此证之转筋者，多因吐泻不已，肝木乘脾气之虚而侮土。故方书治转筋多用木瓜，以其酸能敛肝，即所
以平肝也。然平肝之药，不必定用木瓜。壬寅秋际，霍乱流行，曾单用羚羊角三钱。治愈数人。因羚羊角善解
热毒，又为平肝之妙药也。又曾有一人，向愚询治泄泻之方。告以酸石榴连皮捣烂，煎汤服之。后值霍乱发生，
其人用其方治霍乱初起之泄泻者，服之泻愈，而霍乱亦愈。由是观之，石榴亦为敛肝之要药，而敛肝之法，又
实为治霍乱之要着也。
霍乱之证，有实热者居多，其真寒凉者，不过百中之一二。即百脉闭塞，周身冰冷，但其不欲复被，思
饮凉水，即不可以凉断，当先少少与以凉水，若饮后病增重者，其人虽欲复饮，而不至急索者，凉水可勿与也。
若饮后病不增重，须臾不与，有不能忍受之状，可尽量与之，任其随饮随吐，借凉水将内毒换出，亦佳方也。
曾遇有恣饮凉水而愈者，问之，言当病重之时，若一时不饮凉水，即觉不能复活，则凉水之功用可知矣。然凉
水须用新汲井泉水方效，无井泉水处，可以冰水代之，或吞服小冰块亦佳。
王孟英曰∶鸡矢白散，为《金匮》治霍乱转筋入腹之方。愚仿其意，拟得蚕矢汤，治霍乱转筋、腹疼、
口渴、烦躁，危急之证甚效。方用晚蚕砂、木瓜各三钱，生薏仁、大豆芽（如无可代以生麦芽）各四钱，川黄
连、炒山栀各二钱，醋炒半夏、酒炒黄芩、吴茱萸各一钱，以阴阳水煎，稍凉，徐徐服之。丁酉八九月间，吾
杭盛行霍
乱转筋之证。有沈氏妇者，夜深患此，继即音哑肢寒。比晓，其夫皇皇求为救治。诊其脉弦细以涩，两尺如无，
口极渴而沾饮即吐不已，腓坚硬如石，其时疼楚异常。因拟此方治之，徐徐凉饮，药入口竟得不吐。外以好烧
酒令人用力摩擦转筋坚硬之处，擦将一时许，其硬块始渐软散，而筋不转吐泻亦减。甫时复与前药半剂，夜间
居然安寐矣。后治相类者多人，悉以是法获效。
陆九芝曰∶霍乱一证，有寒有热，热者居其九，寒者居其一。凡由高楼大厦，乘凉饮冷而得之者，仲景则
有理中、四逆诸方，后世亦有浆水、大顺、复元、冷香饮子诸方，病多属寒，药则皆宜热。若夫春分以后，秋
分以前，少阳相火，少阴君火，太阴湿土，三气合行其令。天之热气则下降，地之湿气则上腾，人在气交之中，
清气在阴，浊气在阳，阴阳反戾，清浊相干，气乱于中，而上吐下泻。治此者，宜和阴阳，厘清浊，以定其乱，
乱定即无不愈。此则病非寒也，而亦非尽用寒药也。即如薷藿、平陈、胃苓等汤习用之剂，亦皆温通，特不用
姜附丁萸之大辛大热者耳。又有不吐不泻而挥霍撩乱者，则多得之饱食之后。凡夏月猝然冒暑，惟食填太阴，
亦曰饱食填息。此证为病最速，为祸最酷，而人多忽之。即有知者，亦仅以停食为言，绝不信其为闭证之急者。
闭则手足肢冷，六脉俱伏，甚则喜近烈日。此乃邪闭而气道不宣，其畏寒也正其热之甚也。此等证，只欠一吐
法耳。自吐法之不讲，本属一吐即愈之病，而竟不知用也。此外更有四肢厥逆，甚至周身如冰，而竟不恶寒，
反有恶热者，此更是内真热，外假寒，即厥阴中热深厥深之象。岂独不可用四逆、理中，即姜汤、米饮及五苓
散中之桂枝，亦不可用。而且宜苦寒之剂，佐以挑痧、刮痧等法，刺出其恶血以泄热毒者。同治壬戌，江苏沪
渎，时疫盛行，绵延而至癸亥。余尝以石膏、芩、连，清而愈之者，则暑湿热之霍乱也。以凉水调胆矾吐而愈
之者，则饱食填息之霍
乱也。其肢皆冷，而其脉皆伏，维时大医，竞用丁萸桂附，日误数人，而竟不知改图，岂不深可惜哉。
上所录二则，皆于霍乱之证，有所发明，故详志之，以备采择。
霍乱之证，宜兼用外治之法，以辅药饵所不逮。而外治之法，当以针灸为最要。至应针之处，若十宣、
中脘、尺泽、足三里、阴陵、承山、太溪、太仓、太冲、公孙等穴（约略举之，未能悉数），习针灸者大抵皆
知。惟督脉部分，有素 穴，刺同身寸之三分出血，最为治霍乱之要着。凡吐泻交作，心中撩乱者，刺之皆效。
诸针灸之书，皆未言其能治霍乱。世之能针灸者，间有知刺其处者，而或刺鼻准之尖，或刺鼻柱中间，又多不
能刺其正穴。两鼻孔中间为鼻柱，《内经》王注，谓此穴在鼻柱之上端，则非鼻准之尖，及鼻柱中间可知。然
刺未中其正穴者，犹恒有效验，况刺中其正穴乎。盖此穴通督脉，而鼻通任脉，刺此一处，则督、任二脉，可
互相贯通，而周身之血脉，亦因之可贯通矣。
又宜佐以刮痧之法。盖此证病剧之时，周身冰冷，回血管之血液凝滞不行。当用细口茶碗，将碗边一处少
涂香油，两手执定其无油之处，先刮其贴脊两旁，脊椎上亦可轻刮，以刮处尽红为度。盖以脏腑之系皆连于脊，
而诸脏腑 穴，亦贴脊两旁，故以刮此处为最要。而刮时，又宜自上而下挨次刮之，可使毒瓦斯下行。次刮其胸
与胁，次刮其四肢曲处（尺泽委中）及腿内外 ，至头额项肩，亦可用钱刮之。又当兼用放痧之法∶将四肢回
血管之血，用手赶至腿臂曲处，用带上下扎紧，于尺泽、委中两旁回血管，用扁针刺出其血，以助其血脉之流
通，且又放出炭气，俾霍乱之毒菌，从此轻减也。
又宜佐以温体之法。用滚水煮新砖八个，以熨腋下及四肢曲处，及两脚涌泉穴。或水煮粗浓之布，乘热迭
数层，复于转筋之
处。即不转筋者，亦可复于少腹及腿肚之上，凉则易之。或以茶壶及水笼袋，满贮热水，以熨各处。或醋炒葱
白（切丝）、或醋炒干艾叶（揉碎）熨之。或用手醮火酒或烧酒，急速擦摩其周身及腿肚发硬之处。种种助暖
之法不一，临证者随事制宜可也。
治疗霍乱吐泻极其严重，精神昏沉，气息微弱，处于极度危险的状况。
潞党参（八钱） 生山药（一两） 生杭芍（五钱） 山萸肉（八钱，去净核） 炙甘草（三钱） 赭石（四钱，研细） 朱砂（五分，研细）
以上两个方子，都是治疗霍乱的重要药物。然而前者以祛除病邪为主，此方以扶助正气为主。确实因为患此证的人，往往因为治疗不得法，导致日夜吐泻不停，正气极度虚弱即将脱失，危险就在眼前。病情发展到这种地步，之前是因为受寒还是受热都不暇深究，只应当紧急重用党参来回阳救逆，山药、芍药来滋阴，山萸肉来收敛肝气的脱失（此证在吐泻开始时，肝木助长邪气克制脾土；吐泻极严重时，肝气反而先脱失），炙甘草来调和中气的耗散，这就是急救回阳汤所必需的原因。使用赭石，不仅取它止呕吐的作用，使服下的药不至于吐出，确实因为吐泻时间已久，阴阳即将分离，赭石色赤入心，能协同人参，帮助心气下降。而方中的山药，又能温固下焦，滋补真阴，协同人参使肾气不致下趋，使其上行。使用朱砂且又用童子尿送服，是因为此时百脉闭塞，心脏受到毒瓦斯伤害，心跳鼓动的机能即将熄灭，所以用朱砂直入心脏解毒，又用童子尿引导毒瓦斯从尿道排出，而童子尿的性质又能激发肾中的阳气上达，以应合心脏。因此这个汤剂是回阳的药剂，实际上也是交通心肾、调和阴阳的药剂。服用此汤后，如果身体变暖脉搏显现，感觉心中发热有烦躁之意，应当紧急滋养阴分，如玄参、生芍药之类，加甘草来调和，煎一大剂，分几次温饮下。这是《伤寒论》太阳篇中，先用甘草干姜汤继用甘草芍药汤的方法。
门人高××，曾治疗一位少妇。吐泻了一昼夜，非常困倦疲惫，浓煎人参汤，送服益元散而痊愈。大概独参汤能回阳，益元散能滋阴，又能和中（滑石、甘草能和中以止吐泻）解毒（甘草、朱砂能解毒），且可引导毒瓦斯从小便排出，所以应手奏效。这也是我拟定的急救回阳汤的本意。
此证出现转筋（肌肉痉挛），多因吐泻不止，肝木乘脾气之虚而克制脾土。所以医书治疗转筋多用木瓜，因为它的酸味能收敛肝气，也就是平抑肝气的方法。然而平肝的药物，不一定非要用木瓜。壬寅年秋季，霍乱流行，我曾单用羚羊角三钱，治愈了几个人。因为羚羊角善于解热毒，又是平肝的妙药。又曾有一人，向我询问治疗泄泻的方子。我告诉他用酸石榴连皮捣烂，煎汤服用。后来遇到霍乱发生，那人用这个方子治疗霍乱初起的泄泻，服用后腹泻停止，霍乱也好了。由此看来，石榴也是收敛肝气的重要药物，而收敛肝气的方法，确实是治疗霍乱的关键措施。
霍乱的证候，大多属于实热，真正属于寒凉的，不过百分之一二。即使百脉闭塞，周身冰冷，但只要患者不想盖被子，想喝凉水，就不可以断然禁止，应当先少量给予凉水，如果饮用后病情加重，其人虽然想再喝，但不至于急切索要的，凉水就不要给。如果饮用后病情不加重，片刻不给，就有不能忍受的样子，可以尽量给予，任凭其随饮随吐，借凉水将体内毒素换出，也是好方法。曾遇到有人恣意喝凉水而痊愈的，问其原因，他说当病情严重的时候，如果一时不喝凉水，就觉得不能复活，那么凉水的功用就可以知道了。然而凉水必须用新汲取的井泉水才有效，没有井泉水的地方，可以用冰水代替，或者吞服小冰块也很好。
王孟英说：鸡矢白散，是《金匮要略》治疗霍乱转筋入腹的方子。我仿照他的意思，拟定蚕矢汤，治疗霍乱转筋、腹痛、口渴、烦躁，危急的证候非常有效。方用晚蚕砂、木瓜各三钱，生薏仁、大豆芽（如果没有可用生麦芽代替）各四钱，川黄连、炒山栀各二钱，醋炒半夏、酒炒黄芩、吴茱萸各一钱，用阴阳水煎煮，稍凉，慢慢服用。丁酉年八九月间，杭州盛行霍乱转筋的证候。有一位沈姓妇女，深夜患此病，随即声音嘶哑四肢寒冷。等到天亮，她的丈夫惊慌失措请求救治。诊察她的脉象弦细而涩，两尺脉像没有一样，口极渴但沾水即吐不止，小腿坚硬如石头，当时疼痛异常。于是拟定这个方子治疗她，慢慢凉服，药入口竟然不吐。外用好烧酒让人用力摩擦转筋坚硬之处，擦了一个小时左右，硬块才开始逐渐软化消散，筋不转了，吐泻也减少了。过了一会儿又给前药半剂，夜间居然安稳入睡了。后来治疗类似的人很多，都用这个方法获得疗效。
陆九芝说：霍乱这一证候，有寒有热，热的占十分之九，寒的占十分之一。凡是由高楼大厦，乘凉饮冷而得的，张仲景则有理中汤、四逆汤等方子，后世也有浆水散、大顺散、复元汤、冷香饮子等方子，病多属寒，药则都宜热。如果是春分以后，秋分以前，少阳相火、少阴君火、太阴湿土，三气共同行使令行。天的热气下降，地的湿气上腾，人在气交之中，清气在阴位，浊气在阳位，阴阳乖戾，清浊相干，气乱于中，而上吐下泻。治疗这个，应当调和阴阳，厘清清浊，以安定紊乱，紊乱安定就没有不愈的。这病不是寒证，但也并非完全用寒药。就像藿香正气散、平胃散、胃苓汤等常用方剂，也都是温通的，只是不用干姜、附子、丁香、吴茱萸等大辛大热的药物罢了。又有不吐不泻而挥霍撩乱（突然发作扰乱）的，多得之于饱食之后。凡是夏天突然中暑，只有食物填塞太阴脾经，也叫饱食填息。此证发病最快，危害最酷烈，而人们多忽视它。即使有知道的，也只说是停食，绝不信它是闭证的急症。闭证则手足肢冷，六脉俱伏，甚至喜欢靠近烈日。这是邪气闭阻而气道不宣通，其怕冷正是热势极盛的表现。这类证候，只欠一个吐法而已。自从吐法不被重视，本属一吐即愈的病，竟然不知道使用。此外更有四肢厥逆，甚至周身如冰，却并不恶寒，反而恶热的，这更是内真热外假寒，就是厥阴病中热深厥深的现象。岂独不可用四逆汤、理中汤，就连姜汤、米饮以及五苓散中的桂枝，也不可用。而且应当用苦寒的药剂，佐以挑痧、刮痧等方法，刺出恶血以泄热毒。同治壬戌年，江苏上海一带，时疫盛行，延续到癸亥年。我曾经用石膏、黄芩、黄连，清热而治愈的，是暑湿热引起的霍乱。用凉水调胆矾催吐而治愈的，是饱食填息引起的霍乱。那些肢体皆冷，脉象皆伏的，当时的大医，竞相用丁香、吴茱萸、桂枝、附子，每天误治几个人，竟然不知道改变方案，难道不可惜吗。
上面收录的两则，都对霍乱的证候有所发明，所以详细记录，以备采择。
霍乱的证候，应当兼用外治之法，以辅助药物所不及。而外治之法，应当以针灸为最重要。至于应针的部位，如十宣穴、中脘穴、尺泽穴、足三里穴、阴陵泉穴、承山穴、太溪穴、太仓穴（即中脘）、太冲穴、公孙穴等（粗略列举，未能全部列出），学习针灸的人大抵都知道。惟独督脉部分，有素髎穴，针刺同身寸三分出血，是最为治疗霍乱的关键措施。凡是吐泻交作，心中烦乱者，针刺此穴都有效。各种针灸书籍，都没有说它能治霍乱。世间懂针灸的人，偶尔有知道刺此处的，但有的刺鼻准之尖，有的刺鼻柱中间，又多不能刺中正穴。两鼻孔中间为鼻柱，《内经》王冰注，谓此穴在鼻柱之上端，则不是鼻准之尖，也不是鼻柱中间可知。然而刺未中正穴的，还常常有效验，何况刺中正穴呢？因为这个穴位通督脉，而鼻子通任脉，刺这一处，则督、任二脉，可以互相贯通，而周身血脉，也因此可以贯通了。
又应当佐以刮痧之法。因为这个证候病情剧烈时，周身冰冷，静脉血液凝滞不行。应当用细口茶碗，将碗边一处少涂香油，两手执定无油之处，先刮其贴脊两旁，脊椎上亦可轻刮，以刮处尽红为度。因为脏腑的联系都连于脊，而诸脏腑腧穴，也在贴脊两旁，所以刮此处最为重要。而刮时，又宜自上而下挨次刮之，可使毒瓦斯下行。其次刮其胸与胁，再次刮其四肢曲处（尺泽、委中）及腿内外侧，至头额项肩，也可以用铜钱刮。还应当兼用放痧之法：将四肢静脉的血，用手赶至腿臂曲处，用带上下扎紧，于尺泽、委中两旁静脉，用扁针刺出其血，以助其血脉之流通，且又放出炭气，使霍乱的毒菌，从此轻减。
又应当佐以温体之法。用滚水煮新砖八个，以熨腋下及四肢曲处，及两脚涌泉穴。或者用水煮粗厚的布，趁热叠数层，敷于转筋之处。即使不转筋者，也可敷于少腹及腿肚之上，凉了则更换。或者用茶壶及水袋，满贮热水，以熨各处。或者用醋炒葱白（切丝）、或醋炒干艾叶（揉碎）熨之。或者用手蘸火酒或烧酒，急速擦摩其周身及腿肚发硬之处。种种助暖的方法不一，临证者根据具体情况制宜即可。
Treats the critical condition of cholera with extreme vomiting and diarrhea, where the spirit is lethargic and breath is faint, indicating a perilous state.
Lupang Shen (Codonopsis Pilosae Radix) (8 qian), Raw Shanyao (Dioscoreae Oppositae Rhizoma) (1 liang), Raw Hangshao (Paeoniae Radix Alba) (5 qian), Shanzhrou (Corni Fructus) (8 qian, pits removed completely), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) (3 qian), Zheshi (Hematitum) (4 qian, ground fine), Zhusha (Cinnabaris) (5 fen, ground fine).
First, heat half a cup of child's urine in a steamer, use it to administer the Zhusha, then follow with the decoction.
Both of the above formulas are essential medicines for treating cholera. However, the former focuses on expelling pathogens, while this one focuses on supporting healthy qi. Indeed, patients with this condition often suffer from improper treatment, leading to incessant vomiting and diarrhea day and night, resulting in extreme deficiency and impending collapse, with danger imminent. At this stage of the disease, there is no time to deeply investigate whether the initial cause was cold or heat; the priority is to urgently use a heavy dose of Renshen (Ginseng Radix) to restore yang, Shanyao and Shaoyao to nourish yin, Shanzhrou to consolidate the leakage of liver qi (at the onset of vomiting and diarrhea, Liver Wood assists pathogens and insults Spleen Earth; at the extreme of vomiting and diarrhea, Liver Qi tends to leak first), and Zhi Gancao to harmonize the dissipation of middle qi. This explains why Jiuj Huiyang Tang is necessary. The use of Zheshi not only utilizes its ability to stop vomiting so that ingested medicine is not vomited out, but also because prolonged vomiting and diarrhea lead to the separation of yin and yang. Zheshi, being red and entering the Heart, cooperates with Renshen to assist Heart Qi in descending. Meanwhile, Shanyao in the formula warms and secures the lower jiao and nourishes true yin, cooperating with Renshen to prevent Kidney Qi from sinking and guiding it upward. The use of Zhusha administered with child's urine is because at this time, the hundred vessels are blocked, the heart is damaged by toxic vapors, and its pulsating mechanism is about to extinguish. Therefore, Zhusha enters the Heart directly to detoxify, and child's urine guides the toxic vapors out through the urethra. Furthermore, the nature of child's urine can stimulate Kidney Yang to ascend and reach the Heart. Thus, this decoction is an agent to restore yang, but in reality, it is an agent to communicate between the Heart and Kidney and harmonize yin and yang. After taking this decoction, if the body becomes warm and the pulse appears, and the patient feels heat in the chest with irritability, one should urgently nourish the yin aspect, using herbs such as Xuanshen (Scrophulariae Radix) and raw Shaoyao, adding Gancao to harmonize. Decoct a large dose and drink it warm in several portions. This follows the method in the Taiyang Chapter of Shanghan Lun: first using Gancao Ganjiang Tang, followed by Gancao Shaoyao Tang.
My disciple Gao XX once treated a young woman. She suffered from vomiting and diarrhea for a day and night, feeling extremely exhausted. A concentrated decoction of Renshen was prepared, and Yiyuan San was administered with it, resulting in recovery. Generally, Dushen Tang (Single Ginseng Decoction) restores yang, while Yiyuan San nourishes yin, harmonizes the middle (Huashi and Gancao harmonize the middle to stop vomiting and diarrhea), and detoxifies (Gancao and Zhusha detoxify), and can guide toxic vapors out through urination. Hence, it produced prompt effects. This reflects the intention behind my proposed Jiuj Huiyang Tang.
The muscle spasms (zhuanjin) occurring in this condition are mostly due to incessant vomiting and diarrhea, where Liver Wood takes advantage of Spleen Qi deficiency to insult Spleen Earth. Therefore, medical books often use Mugua (Chaenomelis Fructus) to treat spasms, as its sour taste can astringe Liver Qi, thereby pacifying the Liver. However, herbs that pacify the Liver do not necessarily have to be Mugua. In the autumn of Renyin year, during a cholera epidemic, I used Lingyangjiao (Saigae Tataricae Cornu) alone, 3 qian, curing several cases. This is because Lingyangjiao is good at clearing heat toxins and is an excellent herb for pacifying the Liver. Once, a person asked me for a prescription to treat diarrhea. I advised him to crush Sour Pomegranate (Shiliu) with the peel and decoct it for drinking. Later, when cholera occurred, he used this prescription to treat the initial diarrhea of cholera. After taking it, the diarrhea stopped, and the cholera also resolved. From this, we see that Pomegranate is also an important herb for astringing Liver Qi, and the method of astringing Liver Qi is indeed a key measure in treating cholera.
Most cholera cases involve excess heat; true cold cases account for only one or two percent. Even if the hundred vessels are blocked and the whole body is cold, as long as the patient does not desire covering up and desires drinking cold water, one should not strictly forbid it. One should initially give small amounts of cold water. If the condition worsens after drinking, and although the patient wants more, they do not urgently demand it, cold water should not be given. If the condition does not worsen after drinking, and the patient cannot endure even a short period without it, cold water can be given freely, allowing them to vomit whatever they drink. Using cold water to flush out internal toxins is also a good method. I once encountered someone who recovered by drinking cold water indiscriminately. When asked, he said that during the severe phase of the illness, if he did not drink cold water for a moment, he felt he would not survive. Thus, the efficacy of cold water can be understood. However, cold water must be newly drawn well water to be effective. In places without well water, ice water can be substituted, or swallowing small ice cubes is also good.
Wang Mengying stated: Jishi Bai San (Chicken Droppings Powder) is a formula from Jin Gui Yao Lue for treating cholera with spasms extending into the abdomen. I imitated his idea and formulated Can Shi Tang (Mulberry Worm Faeces Decoction), which is very effective for critical conditions of cholera with spasms, abdominal pain, thirst, and irritability. The formula uses Wancangsha (Bombyx Batryticatus) and Mugua each 3 qian, Sheng Yiren (Coicis Semen) and Dayaoya (Sojae Germen) each 4 qian (if unavailable, Sheng Maiya can be substituted), Chuan Huanglian (Coptidis Rhizoma) and Chao Shanzhi (Gardeniae Fructus Praeparatus) each 2 qian, Cu Chao Banxia (Pinelliae Rhizoma Praeparatum cum Aceto), Jiu Chao Huangqin (Scutellariae Radix Praeparata cum Vino), and Wu Zhu Yu (Evodiae Fructus) each 1 qian. Decoct with Yin-Yang Water, let it cool slightly, and take slowly. In August and September of Dingyou year, cholera with spasms prevailed in our city of Hangzhou. A Mrs. Shen suffered from this late at night, followed by hoarseness and cold limbs. By dawn, her husband sought urgent treatment. Her pulse was wiry, thin, and choppy, with the Chi positions barely perceptible. Her mouth was extremely thirsty, but any fluid intake caused immediate vomiting. Her calves were hard as stone, and she experienced exceptional pain. I prescribed this formula for her. Taken slowly and coolly, the medicine stayed down without vomiting. Externally, good burning wine was applied with vigorous friction to the hardened areas of spasms. After about an hour of friction, the hardness gradually softened and dispersed, the spasms ceased, and vomiting and diarrhea decreased. Half a dose of the previous medicine was given later, and she slept peacefully that night. Subsequently, many similar cases were treated with this method, all achieving success.
Lu Jiuzhi stated: Cholera involves both cold and heat, with heat accounting for nine-tenths and cold for one-tenth. Cases arising from cooling off and drinking cold drinks in tall buildings are treated by Zhang Zhongjing with Lizhong Tang and Sixni Tang, and later generations with Jiangshui San, Dashun San, Fuyuan Tang, and Lengxiang Yinzi. These diseases are mostly cold, and the medicines should be hot. However, from after Spring Equinox to before Autumn Equinox, Shaoyang Ministerial Fire, Shaoyin Sovereign Fire, and Taiyin Damp Earth jointly exert their influence. Heavenly heat descends, earthly moisture ascends. Humans exist in the intersection of qi, where clear qi is in the yin position and turbid qi is in the yang position. Yin and yang become antagonistic, clear and turbid interfere with each other, qi becomes chaotic in the middle, leading to upper vomiting and lower diarrhea. Treatment should harmonize yin and yang, clarify clear and turbid, and stabilize the chaos. Once stabilized, recovery is assured. This disease is not cold, nor does it require exclusively cold medicines. Commonly used agents like Huoxiang Zhengqi Tang, Pingwei San, and Weiling Tang are warming and unblocking, merely avoiding the highly pungent and hot herbs like Ganjiang, Fuzi, Dingxiang, and Wuzhuyu. There are also cases without vomiting or diarrhea but with sudden chaotic disturbance, often occurring after overeating. In summer, sudden exposure to summer heat combined with food stagnation in the Taiyin Spleen, also called "fullness obstructing breath," causes this condition. It develops fastest and is most destructive, yet people often ignore it. Even those who recognize it attribute it only to food stagnation, failing to believe it is an acute closure syndrome. Closure syndrome presents with cold extremities and hidden pulses, sometimes preferring proximity to intense sun. This is pathogenic closure blocking the airways; the aversion to cold indicates extreme internal heat. Such cases lack only the emetic method. Since the emetic method has been neglected, diseases that could be cured by one emesis are left untreated. Furthermore, there are cases of limb reversal, even whole-body coldness, without aversion to cold but with aversion to heat. This is true internal heat with false external cold, resembling the deep heat and deep reversal of Jueyin disease. Not only should Sixni Tang and Lizhong Tang be avoided, but also Ginger Decoction, Rice Drink, and even Guizhi in Wuling San should not be used. Instead, bitter-cold agents should be used, assisted by bloodletting (scraping and pricking) to release evil blood and vent heat toxins. In Renxu year of Tongzhi era, an epidemic prevailed in Shanghai, Jiangsu, lasting into Guihai year. I cured some cases of summer-heat-damp-heat cholera using Shigao (Gypsum Fibrosum), Huangqin, and Huanglian to clear heat. I cured others of food-stagnation cholera using cold water mixed with Danfan (Alumen) to induce vomiting. Those with cold limbs and hidden pulses were mistakenly treated by prominent physicians with Dingxiang, Wuzhuyu, Guizhi, and Fuzi, causing daily errors without changing strategy, which is truly regrettable.
The above two excerpts offer insights into cholera, so they are recorded in detail for reference.
Cholera should be treated with external therapies to supplement internal medication. Among external therapies, acupuncture and moxibustion are most important. Common acupoints include Shixuan, Zhongwan, Chi Ze, Zu San Li, Yinlingquan, Chengshan, Taixi, Tai Cang (Zhongwan), Taichong, and Gong Sun. While acupuncturists generally know these, the Su Liao point on the Du Meridian is crucial. Pricking it to bleed at a depth of three fen of identical body inch is a key measure for treating cholera. It is effective for vomiting and diarrhea accompanied by mental restlessness. Most acupuncture texts do not mention its efficacy for cholera. Some practitioners prick the tip of the nose or the middle of the nasal bridge, missing the correct point. The area between the nostrils is the nasal bridge. Wang Bing's commentary on Neijing states this point is at the upper end of the nasal bridge, distinct from the tip or the middle. Even missing the correct point often yields results, so hitting the correct point should be even more effective. This point connects with the Du Meridian, and the nose connects with the Ren Meridian. Stimulating this point allows mutual communication between the Du and Ren meridians, facilitating circulation throughout the body.
Scraping therapy should also be supplemented. During severe stages, the body is cold and venous blood stasis occurs. Use a narrow-mouthed tea bowl, apply a little sesame oil to one edge, hold the oiled part with both hands, and scrape along both sides of the spine. Light scraping on the spine itself is also acceptable, stopping when the skin turns red. Since organ connections attach to the spine and shu points are located along the paravertebral region, scraping here is vital. Scrape from top to bottom to guide toxic vapors downward. Next, scrape the chest and hypochondrium, then the flexures of the limbs (Chi Ze, Wei Zhong) and inner/outer legs. The head, forehead, neck, and shoulders can also be scraped with a coin. Bloodletting (fang sha) should also be employed: push venous blood from limbs to the flexures of arms and legs, tie tightly above and below with a band, and prick the veins beside Chi Ze and Wei Zhong with a flat needle to release blood, aiding circulation and releasing carbon gas, thereby reducing cholera bacteria.
Warming methods should also be supplemented. Boil eight new bricks in rolling water and apply them to the axillae, limb flexures, and Yongquan points on both feet. Alternatively, boil thick cloth in water, stack several layers while hot, and apply to spasmodic areas. Even without spasms, apply to the lower abdomen and calves, replacing when cool. Hot water bottles or bags can also be used. Vinegar-fried scallion whites (sliced) or vinegar-fried dried mugwort leaves (crushed) can be used for warming compresses. Rubbing the body and hardened calves with fire alcohol or burning wine is also effective. Various warming methods can be adapted to clinical situations.