邑北境刘氏妇，年近四旬，得霍乱暴脱证。
病因 受妊五六个月，时当壬寅秋令，霍乱盛行，因受传染，吐
泻一昼夜，病似稍愈，而胎忽滑下。自觉精神顿散，心摇摇似不能支持。遂急延为诊视。
证候 迨愚至欲为诊视，则病势大革，殓服已备，着于身将舁诸床，病家辞以不必入视。愚曰∶此
系暴脱之证，一息尚存，即可挽回。遂入视之，气息若无，大声呼之亦不知应，脉象
模糊如水上浮麻，莫辨至数。
诊断 此证若系陈病状况，至此定难挽回，惟因霍乱吐泻已极，又复流产，则气血暴脱，
故仍可用药挽救。夫暴脱之证，其所脱者元气也。凡元气之上脱必由于肝（所以人之将脱者，肝风先动），
当用酸敛之品直趋肝脏以收敛之。即所以杜塞元气上脱之路，再用补助气分之药辅之。虽病势垂
危至极点，亦可挽回性命于呼吸之间。
处方 净杭萸肉（二两） 野党参（一两） 生怀山药（一两）
共煎汤一大盅，温服
方虽开就而药局相隔数里，取药迫不及待，幸其比邻刘××是愚表兄，有愚所开药方，取药二
剂未服，中有萸肉共六钱，遂急取来暴火煎汤灌之。
效果 将药徐徐灌下，须臾气息稍大，呼之能应，又急煎渣灌下，较前尤明了。问其心中何如，
言甚难受，其音惟在喉间，细听可辨。须臾药已取到，急煎汤两茶杯，此时已自能服药。俾分三次温
服下，精神顿复，可自动转。继用生山药细末八钱许，煮作茶汤，调以白糖，令其适口当点心服之。
日两次，如此将养五六日以善其后。
帮助 按人之气海有二，一为先天之气海，一为后天之气海。《内经》论四海之名，以膻中
（即膈上）为气海，所藏者大气，即宗气也，养生家及针灸家皆以脐下为气海，所藏者元气，
即养生家所谓祖气也。此气海之形状，若倒提鸡冠花形，纯系脂膜结成而中空（剖解猪腹者，
名之为鸡冠油），肝脏下垂之脂膜与之相连，是以元气之上行，原由肝而敷布，而元气之上脱，亦即
由肝而疏泄也（《内经》谓肝主疏泄）。惟重用萸肉以酸敛防其疏泄，借以杜塞元气上脱之路，
而元气即可不脱矣。所最足明征者，若初次即服所开之方以治愈此证，鲜不谓人参之功居多，乃
因取药不及，遂单服萸肉，且所服者只六钱即能建此奇功。由此知萸肉救脱之力，实远胜人参。
盖人参以救无气之下脱，犹足恃，而以救元气之上脱，若单用之转有气高不返之弊（说见俞氏《寓意
草》），以其性温而兼升也。至萸肉则无论上脱下脱，用之皆效。盖元气之上脱由于肝，其下脱
亦由于肝，诚以肝能为肾行气（《内经》谓肝行肾之气），即能泻元气自下出也。为其
下脱亦由于肝，故亦可重用萸肉治之也。
或问 同为元气之脱何以辨其上脱下脱？答曰∶上脱与下脱，其外现之证可据以辨别者甚多。今
但即脉以论，如此证脉若水上浮麻，此上脱之征也。若系下脱其脉即沉细欲无矣。且元气上脱
下脱之外，又有所谓外脱者。周身汗出不止者是也。萸肉最善敛汗，是以萸肉亦能治之。来复
汤及山萸肉解后载有治验之案数则，可参观也。
【背景信息】
书名：医学衷中参西录 作者：张锡纯 朝代：清 章节：4．霍乱暴脱证 类别：医论
【待处理原文翻译】
县北境刘姓妇女，年龄接近四十岁，患上了霍乱暴脱证（因剧烈吐泻导致元气骤然衰竭的危重证候）。
病因 她怀孕五六个月时，正值壬寅年秋季，当时霍乱盛行，她因此受到传染。呕吐和腹泻持续了一昼夜，病情似乎稍有好转，但胎儿突然流产滑下。她自觉精神瞬间涣散，心脏摇摇欲坠，仿佛无法支撑。于是急忙请我为其诊治。
证候 等我到达想要诊视时，病情已发生巨大变化，寿衣已经备好，穿在身上正准备抬到床上，家属以不必再诊视为由拒绝我进入。我说：“这是暴脱之证，只要还有一口气在，就可以挽回。”于是进去诊视，患者气息微弱若无，大声呼喊也没有反应，脉象模糊不清，如同水面上漂浮的麻粒，难以辨别至数（脉搏跳动的次数/节律）。
诊断 如果此证是慢性旧疾发展到这种地步，确实难以挽回；但因为霍乱导致的吐泻极其严重，加上又发生了流产，导致气血骤然脱失，所以仍然可以用药物挽救。所谓暴脱之证，所脱失的是元气（人体最根本的生命活动能量）。凡是元气向上脱失，必定是由于肝脏（所以人即将脱绝时，肝风先动），应当使用酸味收敛的药物直接作用于肝脏以收敛元气。这就是为了堵塞元气上脱的路径，再配合补益气分的药物辅助治疗。虽然病势危急到了极点，也可以在呼吸之间挽回性命。
处方 净杭萸肉（山茱萸，二两） 野党参（一两） 生怀山药（一两）
共同煎煮成一大盅汤剂，温服。
方子虽然开好了，但药局相隔数里，取药迫不及待。幸好她的邻居刘某是我的表兄，家里有我曾开过的药方，取了两剂未服用的药，其中含有山茱萸共六钱，于是急忙取来，用猛火急煎汤剂灌服。
效果 将药徐徐灌下，片刻之后气息稍粗，呼喊能有回应，又急忙煎煮药渣灌服，神志较前更加清楚。询问她心中感觉如何，她说非常难受，声音仅在喉间，仔细听可以分辨。片刻后药取到了，急忙煎成两茶杯汤剂，此时患者已能自行服药。让她分三次温服下去，精神顿时恢复，可以自己转动身体。随后用生山药细末约八钱，煮成茶汤，调入白糖，使其适口作为点心服用。每天两次，如此调养五六日以善其后。
按语 人的气海有两个，一个是先天之气海，一个是后天之气海。《内经》论述四海之名，以膻中（即横膈以上）为气海，所藏的是大气，也就是宗气（积聚于胸中的正气）；养生家及针灸家都以脐下为气海，所藏的是元气，也就是养生家所谓的祖气。这个气海的形状，像倒提着的鸡冠花，完全由脂膜结成且中空（解剖猪腹的人，称之为鸡冠油），它与肝脏下垂的脂膜相连，所以元气的上行，原本是由肝脏敷布，而元气的上脱，也是通过肝脏疏泄（《内经》说肝主疏泄）。只有重用山茱萸以酸味收敛防止其疏泄，借以堵塞元气上脱的路径，元气就不会脱失了。最足以证明这一点的是，如果初次就服用我所开的方子治愈此证，人们很少不认为人参的功效居多；但因为取药不及，于是单服山茱萸，而且只服用了六钱就能建立如此奇功。由此可知，山茱萸救脱的力量，实在远胜于人参。大概人参用来救治无气之下脱（气陷于下），尚且值得依靠，但以救治元气之上脱，如果单用人参反而有气高不返（气机上逆不能下降）的弊端（说法见于俞氏《寓意草》），因为人参性温兼有升提之性。至于山茱萸，无论上脱还是下脱，使用都有效。大概元气上脱由于肝脏，其下脱也由于肝脏，诚然因为肝脏能为肾脏行气（《内经》说肝行肾之气），也就是能引导元气从下排出。正因为下脱也由于肝脏，所以也可以重用山茱萸来治疗它。
或问 同为元气之脱，如何辨别其上脱和下脱？答曰：上脱与下脱，其外在表现的症状可以根据以辨别者很多。现在仅就脉象而论，如本证脉象若水上浮麻，这是上脱的征象。如果是下脱，其脉象就会沉细几乎摸不到了。而且在元气上脱、下脱之外，还有所谓外脱的情况。就是周身汗出不止，这就是外脱。山茱萸最善于收敛汗液，所以山茱萸也能治疗它。《来复汤》及《山萸肉解后》记载有几则治疗验证的案例，可以参考阅读。
[Background Information]
Book: *Yixue Zhongzhong Canxi Lu* (Record of Medical Studies Integrating Chinese and Western Medicine)
Author: Zhang Xichun
Dynasty: Qing
Chapter: 4. Cholera with Sudden Collapse Syndrome
Category: Medical Discourse
[English Translation]
A woman surnamed Liu in the northern part of the county, approaching forty years of age, suffered from Cholera with Sudden Collapse Syndrome (a critical condition characterized by sudden exhaustion of Yuan Qi due to severe vomiting and diarrhea).
**Etiology:** She was five or six months pregnant when, during the autumn of the Renyin year, cholera was prevalent. She contracted the disease, experiencing vomiting and diarrhea for a full day and night. The illness seemed to improve slightly, but the fetus suddenly miscarried. She felt her spirit instantly dissipate, her heart trembling as if unable to sustain itself. Consequently, she urgently summoned me for consultation.
**Symptoms:** When I arrived to examine her, the condition had drastically worsened. Funeral clothes were already prepared and worn on her body, ready to be carried onto a bed. The family refused my entry, stating that further examination was unnecessary. I said, "This is a case of Sudden Collapse. As long as there is still one breath remaining, it can be reversed." I then entered to examine her. Her breathing was faint as if nonexistent; even loud calls elicited no response. Her pulse was indistinct and blurry, resembling hemp seeds floating on water, making it impossible to distinguish the rate or rhythm.
**Diagnosis:** If this condition were the result of a chronic old disease reaching such a stage, it would indeed be irrecoverable. However, because the vomiting and diarrhea from cholera were extreme, compounded by the miscarriage, causing a sudden depletion of Qi and Blood, medication can still be used to save her. In cases of Sudden Collapse, what is depleted is Yuan Qi (the fundamental vital energy of the human body). Whenever Yuan Qi collapses upward, it is necessarily due to the Liver (therefore, when a person is about to collapse, Liver Wind moves first). One should use sour, astringent herbs that act directly on the Liver to consolidate it. This serves to block the pathway of upward collapse of Yuan Qi, supplemented by herbs that tonify the Qi aspect. Although the condition is critically dangerous, life can be saved within the span of a breath.
**Prescription:**
Jing Hang Yurou (Processed Cornus Officinalis Fruit, 2 liang)
Ye Dangshen (Wild Codonopsis Pilosula Root, 1 liang)
Sheng Huai Shanyao (Raw Dioscorea Oppata Rhizome, 1 liang)
Decoct together in a large cup, take warm.
Although the prescription was written, the pharmacy was several miles away, and obtaining the medicine could not wait. Fortunately, her neighbor, Mr. Liu, was my cousin, who possessed copies of my prescriptions. He had two doses of unmedicated herbs, containing a total of 6 qian of Cornus Officinalis Fruit. These were hurriedly obtained, decocted rapidly over high heat, and administered as a soup.
**Effect:** The medicine was slowly administered. After a short while, her breathing became slightly stronger, and she responded to calls. The dregs were quickly decocted and administered again, after which her consciousness became clearer than before. When asked how she felt in her chest, she said it was very uncomfortable, her voice confined to her throat, discernible only upon close listening. Shortly after, the rest of the medicine arrived. It was quickly decocted into two teacups of soup. At this point, she was able to take the medicine herself. She took it in three divided doses, warm. Her spirit instantly recovered, and she could move her body voluntarily. Subsequently, approximately 8 qian of fine powder from Raw Dioscorea Oppata Rhizome was boiled into a tea-like soup, sweetened with white sugar, and taken as a snack to suit her palate. Taken twice daily, this regimen continued for five or six days to ensure recovery.
**Commentary:** There are two "Qi Seas" in the human body: one is the Pre-Heaven Qi Sea, and the other is the Post-Heaven Qi Sea. The *Neijing* discusses the Four Seas, identifying Danzhong (located above the diaphragm) as the Qi Sea, which stores Da Qi (Great Qi), also known as Zong Qi (Gathering Qi). Health cultivators and acupuncturists identify the area below the navel as the Qi Sea, which stores Yuan Qi, also referred to by health cultivators as Zu Qi (Ancestral Qi). The shape of this Qi Sea resembles an inverted cockscomb flower, formed entirely of fatty membrane and hollow in the center (those who dissect pig bellies call this cockscomb oil). It connects to the fatty membrane hanging from the liver. Therefore, the upward movement of Yuan Qi originally spreads via the Liver, and its upward collapse also occurs through Liver Shuxie (dispersing and draining) (as stated in the *Neijing*: "The Liver governs Shuxie"). Only by heavily using Cornus Officinalis Fruit to astringe via its sour taste can we prevent this dispersal, thereby blocking the pathway of upward collapse of Yuan Qi, so that Yuan Qi does not collapse. The most convincing evidence is this: if the prescribed formula had been taken initially to cure this case, few would not attribute the merit largely to Codonopsis Pilosula Root. However, due to the delay in obtaining medicine, she took only Cornus Officinalis Fruit, and merely 6 qian achieved this miraculous effect. From this, we know that the power of Cornus Officinalis Fruit to rescue collapse far surpasses that of Codonopsis Pilosula Root. Generally, Codonopsis Pilosula Root is reliable for rescuing downward collapse of Qi (Qi sinking), but for rescuing upward collapse of Yuan Qi, using it alone has the drawback of causing Qi to rise and not return (as discussed in Yu Shi's *Yuyi Cao*), because its nature is warm and ascending. In contrast, Cornus Officinalis Fruit is effective for both upward and downward collapse. This is because upward collapse of Yuan Qi is due to the Liver, and downward collapse is also due to the Liver. Indeed, the Liver conducts Qi for the Kidneys (as the *Neijing* states: "The Liver conducts the Qi of the Kidney"), meaning it can guide Yuan Qi to exit from below. Since downward collapse is also due to the Liver, heavy use of Cornus Officinalis Fruit can also treat it.
**Q&A:**
Question: Since both are collapses of Yuan Qi, how do we distinguish between upward and downward collapse?
Answer: There are many external symptoms that can distinguish between upward and downward collapse. For now, let us discuss based on the pulse. If the pulse resembles hemp seeds floating on water, as in this case, it is a sign of upward collapse. If it were downward collapse, the pulse would be deep, thin, and nearly imperceptible. Furthermore, besides upward and downward collapse of Yuan Qi, there is what is called "External Collapse," manifested as incessant sweating all over the body. Cornus Officinalis Fruit is best at astringing sweat, thus it can also treat this. Several verified cases treating these conditions are recorded in *Laifu Tang* and the commentary following *Shanzhuru*, which can be consulted.