罗谦甫治蒙古百户，因食酒肉饮潼乳，得霍乱吐泻证，从朝至午，精神昏愦，已困急来告，罗视之，脉皆浮数，按
之无
力，所伤之物已出矣。即以新汲水半碗，调桂苓白术散，徐服之，稍得安静，又于墙阴掘地约二寸，贮以新
水，在内搅动，待一时澄定，用清者一杯，再调服之，渐渐气调，吐泻遂止，至夜安卧，翌日微烦渴，遂煎钱氏白术散，
时
时服良愈。或曰用
地浆者何也？坤属地，地属阴，土平曰静，烦感至阴之气，又于墙阴贮新汲水，以收重阴之气也。阴中之阴，能泻阳
中之阳，阳霍乱因暑热内伤所得，故用地浆之意也。
提举父年近八十，六月中暑毒，霍乱吐泻，昏冒终日，不省人事，时夜参半。请罗视之，脉七八至，洪大有力，
头热如火，足冷如冰，半身不遂，牙关紧急，盖年高气弱，当暑气极盛，阳明得令之际，为阴得而动之中暑明
矣，非甘辛大寒之剂，不能泻其暑热，坠浮溜之火，安神明也。遂以甘露散，甘辛大寒泻热补气，加茯苓以分阴阳，约
一两，水调灌之，渐渐省事，诸证悉去，慎言语，节饮食三日，以参术补中汤，以意增减，旋服理正气愈，十日平复。
滑伯仁治一人病，自汗如雨，面赤身热，口燥心烦，当盛暑帷幕周密，自以虚亡阳，服术附数剂，脉虚而洪数，舌
上
苔黄。伯仁曰∶前药误矣，热病热治，医者死之。《素问》云∶必先岁气，毋伐天和，术附岂可轻用？以犯时令。又
云∶脉虚身热，得之伤暑，暑家本多汗，加刚剂脉洪数而汗甚，乃令撤幔开窗，少顷渐觉清爽，以黄连人参白虎汤，三
进
而汗止大半，诸证亦减，兼以既济汤，渴用冰水调天水散，二日而愈。
孙兆治一人自汗，两足冷至膝下，腹满不省事。孙诊六脉小弱而急，问其所服药，取视，皆阴病药也。孙曰∶此非
受
病重，药能重病耳。遂用五苓散、白虎汤十余贴，病少苏，再服全愈。或问治法，孙曰∶病患伤暑也。始则阳微厥而脉
小
无力，医谓阴病，遂误药，其病厥用五苓散，利小便则腹消，白虎汤解利邪热则病愈。凡阴证胫冷则臂亦冷，汝今胫冷
臂
不冷，则下厥上行，是如阳之微厥也。此证乃先伤湿，后伤暑，为湿之证也。
丹溪治一人夏大发热谵语，肢体莫举，喜冷冻饮料，脉洪大而数。以黄 、茯苓浓煎如膏，用凉水调服，三四次后，昏
卧如
死，气息如常，次日方醒而愈。
一人夏发大热大汗，恶寒战栗，不自禁持，且烦渴，此暑病也。脉虚微细弱而数，其人好赌，致功而虚，以人参、
竹叶
作汤，调辰砂四苓散，数剂而安。
项彦章治一人病甚，医皆以为瘵，尽愕束手，项诊之脉细数而且实，细数者暑也。暑伤气宜虚，今不虚而反实，乃
热伤血，药为之也，家问死期。曰∶何得死？为作白虎汤，饮即瘥。
吴茭山治一妇人，冬月偶感，患洒洒恶寒，翕翕发热，恶食干呕，大便欲去不去。诸医皆以虚弱痰饮治之，以二陈
补心等药服不效。延及半月，吴诊其脉，虚而无力，类乎伤暑，众不然之，究问其病因，其妇曰∶因天寒换着绵
衣，取绵套一床盖之，须臾烦渴，寒热呕吐，绵延至今耳。吴曰∶诚哉伤暑也。盖绵套晒之盛暑，夹热收入笥中，必有
暑气，尚未开泄，今人体虚，得之易入，故病如是。其妇曰然，遂制黄连香薷饮，连进二服而愈。
逢年岁热甚，凡道路城市，昏作而死者，此皆虚人劳人，或饥饱失节，或素有病，一为暑气所中不得泄，即关窍皆
窒，非暑气使然，气闭塞而死也。古方治暑无他，但用辛甘发散，疏导心气，与水流行，则无害矣。崇宁乙酉，吴为书
局，时一马夫驰马出局下，忽仆地绝，急以五苓大顺散灌之，皆不验。已超时，同舍王相，使取大蒜一握，道上热土杂
研烂，以新水和之，滤去渣，决其齿灌之，少顷即苏，至暮此仆为吴御马而归。乃知药病相对，有如此者。此方本徐州
沛县门，忽有板书钉其上，或传神仙救人者，沈存中王圣美皆着其说，而吴亲验之，出石林老人《避暑录》。
汪希说治一壮男子，形色苍黑，暑月客游舟回，患呕哕，颠倒不得眠，粒米不入六日矣，脉沉细虚豁，诸医杂投藿
香、柴、苓、等药不效，危殆。汪曰∶此中暑也。进人参白虎汤人参五钱，服下呕哕即止，鼾睡五鼓，方醒索粥，连进
二三服，乃减参稍轻，调理数剂而愈。
霖按∶治暑之案甚多，此于千百中只有其一，附选数则，以补其不足。
许叔微治一人头痛身热，心烦燥渴，诊其脉大而虚，授以白虎汤数服愈。仲景云∶脉虚身热，得之伤暑。又云∶
其脉弦细芤迟何也？《素问》曰∶寒伤形，热伤气，盖伤气不伤形，则气消而脉虚弱，所谓弦细芤迟者，皆虚脉也。
仲景以弦为阴，朱庞亦云中暑脉微细，则虚可知。
霖按∶白虎汤数服愈者，其脉大而虚也。若弦细芤迟，则中含濡象，暑伤气而中挟湿故也。非白虎汤所宜，亦
不可泥执补气全作虚治也。凡医案须发明其脉证之所以然，方可为后学程法，惟许学士其庶几乎。
万密斋治县丞李天泉，六月中暑腹痛，渠有婢外家，医谓病寒，进理中汤一剂痛止，乃发热，一身骨节尽痛，又进
十神汤，发汗热退身不痛矣。万候之，李称病愈，观其面色带赤，知病未解，请脉之，洪滑而数。（色脉相对。）经曰∶
大则病进。今汗后脉犹洪数，病方进也，而彼自称愈，万去。食顷而病作矣，满腹急痛，状如奔豚，上下左右，举手按
摩，亟延万至曰∶汝先诊脉，不言而去，知我病也，幸急救我。万曰无伤，乃进建中汤一服而痛定。次日有省祭官万
朴来问疾，朴善医诊之，且骇且顾，李亦疑惧，万诊之，谓朴曰∶汝怪其脉之促止乎？盖心下怔忡，故脉如是耳。李即
应曰∶我心下跳乱不宁，即命取药方，用人参、麦冬、甘草、白芍、生地、五味、 猪心，煮汤煎一服，心跳止，脉不
促矣。盖心恶热，用热治热，向服理中、十神俱犯禁，故病复作也。
霖按∶面赤脉洪数，色脉相参，自是暑病方进，以建中定痛然矣。但暑先入心，伤其营血，况以理中、十神用热治
热者乎？万以尚未清理暑热，故见脉数歇止，则知其热伤心营，虚而跳止也。西士言由肺入心之血，从心入脉
管，以荣养脏腑经脉皮毛，血由心左房落脉管一次，则脉跳一次，西医听心血之声，知脉有病变，而营卫循行之道，六
气标本之理，莫不由此悟入，总在细心体察耳。粗工视人命同草菅，乌足与言此。
江应宿治其岳母年六十余，六月中旬，劳倦中暑，身热如火，口渴饮冷，头痛如破，脉虚豁二三至一止，投人参白
虎汤三贴，渴止热退，惟头痛，用白萝卜汁吹入鼻中良愈。
孙子华赴试南都，六月初旬梦遗，畏寒惊惧，重裘浓被，取汗过多，身热，六脉滑数无力。与清暑益气汤，次日舌
强，语言不清如癫，目瞪不识人。江曰∶此为暑风，与人参白虎汤，加胆星、僵蚕、秦艽、天麻、竹沥、姜汁渐愈，数
日后，舌心黑如墨，与黄连解毒汤、凉膈散不退，与犀角地黄汤而愈。
一人瘦长而脆，暑月过劳，饥饮烧酒，遂身热汗出，昏懵语乱。江视之，脉皆浮小而缓，按之虚豁，曰暑伤心，劳
伤脾也。盖心藏神，脾藏意，二脏俱伤，宜有是证，法宜清暑益脾，用八物汤，加麦冬、山栀、陈皮，十余贴而愈。
霖按∶江公三案，平正可法，其第二案解毒凉膈不应，易犀角地黄汤始愈。同一凉药，有对与不对之别，读者最宜
深思。
张路玉治金鲁公触热，劳形醉饱不谨，后受凉，遂发热头痛，胀满喘逆，大汗如蒸，面赤戴阳，足冷阳缩，脉弦数
无力，
曰∶此伤暑夹食而复夹阴也。与大顺散一服不应，转胀急不安，因与枳实、理中，加浓朴、大黄，是夜更衣
二次，身凉足暖而痊。
霖按∶此案于不谨后受凉，而见面赤阳缩，足冷汗多且喘，最易作阴证，其辨在发热头痛胀满，与阴证不合，更察
其不
谨之前，有醉饱之病因，故大顺散不应，即用枳实、理中加浓朴、大黄，得更衣而愈。若误以白通、四逆，殆矣。此暑
天变
证，非暑证也，要亦不可不知。
汪石山治一人年三十八余，形瘦弱，忽病上吐下泻，水浆不入口七日，自分死矣。诊脉八至而数，曰当夏而得是脉，
暑
邪深入也。吐泻不纳水谷，邪气自盛也。遂以人参白虎汤进半杯，良久复进一杯，觉稍安，三服后减去石
膏、知母，而人参渐次加至四五钱，黄柏、橘皮、麦冬等随其所兼之病而佐使。一月后平
复。
霖按∶此暑热霍乱之轻者，吐泻至七八日而不死，亦由未服温补燥热之剂故耳。汪公制剂固当，而进退操纵有法，
暑盛气伤之治，此案可师。
一人病霍乱，欲吐不吐，欲泻不泻，心腹 痛，脉之沉伏如无，此干霍乱也。急令盐汤探吐宿食痰涎碗许遂泻，
与六和汤愈。
霖按∶痛脉多伏，以盐汤探吐，乃开其上窍，上窍开则下窍自通，而得吐泻，即可治矣。
孙文垣治程氏子，先醉酒，后入房，次早四肢冷，胃腕痛极，脉仅四至，或以郁火治，投以寒凉，痛更甚。三日前
所食西瓜，吐出未化，乃翁以为阴证伤寒，欲用附子理中汤不决。逆孙视之，面色青惨，叫痛而声不扬，坐卧烦乱，
是霍乱兼蛔厥证也，先当止痛安蛔，后理霍乱，可免死也，迟则误事矣。急用醋炒五灵脂三钱，苍术一钱五分，乌梅三
个，川椒、炮姜、桂心各五分，水煎饮下，痛减大半，下午以大腹皮、藿香、半夏、橘皮、山楂、茯苓、五灵脂，两贴
全安。
霖按∶此人以纵欲贪凉，恣食生冷致病，而又误设寒凉之剂，故以温胃安蛔，和中化滞而效，其霍乱亦不甚重。
张石顽云∶一少年新婚，陡然腹痛麻瞀，或令饮火酒半杯，腹痛转剧，旋增颅胀，身发红点，与芦根汁得吐痛解。
复有
鼻衄口燥，胸腹略见红斑，啜童子小便稍安，又浓煎葱豉汤，仍入童便，续续与之，得大吐汗出而痊。
霖按∶此证即夏日之暑沙伏毒，得酒愈炽，先以芦根汁清热解毒，以杀其势。继进葱豉汤，倍用童便解秽清营，仍
从宣
达分消而愈，治法稳当。
怀抱奇治一男子，恣饮梅水，吐泻无度，手足厥逆，面色惨晦，声音不出，而脉沉伏小水点滴不通，服药入口即吐，
医告技穷，怀思梅味酸主收，故小便癃闭，而果得麝则败，麝又香窜走窍，乃取麝半入脐中，半入鼻孔，病者即以手拂
其鼻曰∶此何物也？少顷小水大下二三行，忽如醉而醒，梦而觉，越日索粥渐安。
霖按∶此亦暑厥，而无外因者，以败果通窍，即能奏效，然其巧思，正不可及。
童 庐治陈氏妇，盛夏病霍乱吐泻，腹中 痛，四肢厥冷，冷汗溱溱，转筋戴眼，烦躁大渴，喜冷冻饮料，饮已即吐，
六脉皆伏，虽曰霍乱，实脏厥也。经云∶大气入脏，腹痛下注，可以致死，不可以致生，速宜救阳为急，迟则肾阳绝
矣。以四逆汤、姜、附各三钱，炙甘草、吴茱萸各一钱，木瓜四钱，煎成冷服，日夜连进三剂，四肢始和，危象皆退，
口渴反喜沸汤，寒象始露。即于方中佐以生津存液之品，两服而安。
霖按∶肢冷脉伏，大渴喜冷冻饮料，此霍乱属乎热者，但喜冷冻饮料而饮已即吐，服热药后反喜沸汤，此真寒假热证也。故
宜四逆汤，然而小溲必清白，吐出泻出，必无秽浊气味，方是真寒的候，否则真假莫辨，杀人事矣。
倪姓患霍乱吐泻，审知始不作渴，四肢不逆，脉不沉细。一医用大顺散两帖，渐至于此，因见四逆，复加附子，脉
证更剧。童曰∶此病一误再误，命将殆矣。若果属寒，投热病已，今反四逆，脉转沉细欲伏，乃酿成热深厥深，与热
邪传入厥阴者何异？即以竹叶石膏汤，人参易西洋参，加黄连、滑石，两剂而安。同时有陆姓患此，医用回阳之剂，日
夜兼进，厥逆烦躁日增，病患欲得冷水，禁绝不与，甚至病者自起拾地上痰涎以解渴，迁延旬日而死。噫！即使
真属阴寒，阳回躁渴如是，热药之性，郁而无主，以凉药和之，病亦立起，不学无术，曷胜浩叹？
霖按∶此非真热霍乱，然其证甚轻，医者药误，致酿热深厥深。竹叶石膏汤，人参易西洋参极是。即使寒证回阳后
躁渴，亦当参以凉润和之。此千古不刊之论也。
罗谦甫治疗一位蒙古百户，因食用酒肉和潼乳（一种乳制品），患上了霍乱吐泻证。从早晨到中午，精神昏沉迷糊，病情危急前来求助。罗谦甫诊察发现，其脉象浮数，但重按无力，说明导致疾病的饮食之物已经排出体外。于是立即取半碗新汲取的井水，调和桂苓白术散，慢慢服用，患者稍感安静。接着在墙根背阴处挖地约两寸深，装入新汲的水，在水中搅动，待片刻后澄清，取上层清水一杯，再次调药服用。患者气息逐渐平稳，吐泻停止，当晚安稳入睡。次日清晨略有烦渴，便煎煮钱氏白术散，时时服用，很快痊愈。有人问：为什么要用地浆（烧过的泥土兑水）呢？坤卦代表地，地属阴，土性平和则静，烦躁是因为感受了至阴之气；又在墙阴处储存新汲水，以收敛重阴之气。阴中之阴，能清泻阳中之阳。这种霍乱是因暑热内伤所致，所以使用地浆的道理就在这里。
提举的父亲年近八十，六月时中了暑毒，出现霍乱吐泻，整天昏迷不醒，人事不知，当时已是半夜。请罗谦甫诊治，脉搏跳动七八次一息，脉象洪大有力，头部发热如火，双脚冰冷如冰，半身不遂，牙关紧闭。这是因为年老气弱，正值暑气极盛、阳明经当令之时，被阴邪触动而中暑，这是很明显的。如果不是用甘辛大寒的药剂，不能清泻暑热，压制上浮之火，安定神志。于是使用甘露散，此方甘辛大寒，既能泻热又能补气，加入茯苓以分利阴阳，用量约一两，用水调匀灌服。患者渐渐苏醒，各种症状全部消除。嘱咐慎言语、节饮食三天，随后服用参术补中汤，根据情况加减，很快服药后正气恢复痊愈，十天完全康复。
滑伯仁治疗一位病人，自汗如雨，面色红赤，身体发热，口燥心烦。正值盛夏，帷帐严密，病人自以为虚脱亡阳，服用了附子等温阳药物几剂，结果脉象虚而洪数，舌苔发黄。滑伯仁说：“之前的药误治了。热病应当用热法治疗（指清热），医生这样治会害死人的。《素问》说：必须顺应岁气，不要破坏天和，附子这类刚燥之药岂可轻用？这违背了时令。又说：脉虚身热，是伤暑所致。暑病患者本来就容易出汗，加上使用了刚燥的药物，导致脉象洪数且大汗不止。”于是让人撤去帷幔，打开窗户，过了一会儿，病人渐渐觉得清爽。使用黄连人参白虎汤，连续服用三次，汗止大半，其他症状也减轻。兼用既济汤，口渴时用冰水调天水散，两天后痊愈。
孙兆治疗一位自汗的病人，两脚冷至膝盖以下，腹部胀满，神志不清。孙兆诊察六脉细小虚弱而急迫，询问所服用的药物，拿来查看，都是治疗阴病的药。孙兆说：“这不是病重，而是药物加重了病情。”于是使用五苓散、白虎汤十余帖，病情稍有好转，再服用后完全痊愈。有人询问治疗方法，孙兆说：“这位病人是伤暑。起初阳气微弱，四肢厥冷，脉小无力，医生误认为是阴病，于是误用药物。对于厥逆证，用五苓散利小便，腹部胀满消退；用白虎汤解利邪热，病就好了。凡是阴证，小腿冷则手臂也冷；你现在小腿冷但手臂不冷，这是下部厥逆而上行，类似于阳气的轻微厥逆。这个病症是先伤湿，后伤暑，属于湿证的范畴。”
丹溪治疗一位夏天大发热、谵语、肢体无法抬举、喜欢冷饮的病人，脉象洪大而数。用黄芪、茯苓浓煎成膏状，用凉水调服，三四次后，病人昏睡如死，呼吸正常，第二天醒来痊愈。
另一位病人夏天发大热、大汗，恶寒战栗，无法自控，且烦躁口渴，这是暑病。脉象虚微细弱而数。此人喜好赌博，耗损精力导致体虚。用人参、竹叶煮汤，调辰砂四苓散，服用几剂后安宁。
项彦章治疗一位病情严重的病人，医生们都认为是痨病（肺结核类消耗性疾病），大家都惊愕束手无策。项彦章诊脉，脉细数而且实。细数是暑邪的表现。暑邪伤气应当表现为虚，现在不虚反而实，这是热邪伤了血，也是药物造成的。家属询问死期。项彦章说：“怎么会死？”为他开白虎汤，喝下后病愈。
吴茭山治疗一位妇人，冬天偶然受感，患洒洒恶寒，翕翕发热，厌恶食物，干呕，大便想拉拉不出。众医生都当作虚弱痰饮治疗，服用二陈汤、补心汤等药无效。拖延半个月，吴茭山诊脉，脉虚而无力，类似伤暑，众人不信。追问病因，妇人说：“因为天冷换了棉衣，拿了一床晒过的棉套盖在身上，一会儿就烦渴，寒热呕吐，绵延至今。”吴茭山说：“确实是伤暑。因为棉套是在盛暑时晒的，夹带着热气收入箱中，必有暑气未散发，现在人体虚弱，暑气容易侵入，所以病成这样。”妇人说是这样，于是制作黄连香薷饮，连续服用两剂而愈。
每逢年份炎热，凡是在道路城市间，昏倒而死的人，这都是体虚劳累之人，或者饥饱失常，或者素有疾病，一旦为暑气所中，不得宣泄，就会关窍闭塞，不是暑气直接致死，而是气机闭塞而死。古方治暑没有别的，只是用辛甘发散的药物，疏导心气，使水液运行，就没有危害了。崇宁乙酉年，吴任书局官职时，一名马夫骑马冲出局门，突然倒地昏迷，急忙用五苓大顺散灌服，都不见效。过了很久，同舍的王相，让人取一把大蒜，与路上热土混合研烂，用新水调和，滤去渣滓，撬开牙齿灌服，过了一会儿就苏醒，到了傍晚，这名仆人已替吴驾车归来。这才知道药与病相对，有如此神奇的效果。此方原本出自徐州沛县门口，忽然有人板书钉在上面，或是传说神仙救人的说法，沈存中、王圣美都记载了这个说法，而吴亲自验证过，出自石林老人《避暑录》。
汪希说治疗一位壮年男子，肤色苍黑，暑月客居舟中返回，患呕吐呃逆，辗转不得睡眠，六天粒米不进，脉象沉细虚豁，众医杂投藿香、柴胡、茯苓等药无效，病情危殆。汪希说：“这是中暑。”进服人参白虎汤，人参五钱，服下后呕吐呃逆即止，鼾睡至五更才醒，醒来索要粥喝，连续服用二三剂，然后减少人参用量，稍作减轻，调理数剂而愈。
霖按：治疗暑症的医案很多，这里在千百案中只选其一，附录几则，以补充不足。
许叔微治疗一位头痛身热、心烦燥渴的病人，诊脉大而虚，给予白虎汤，服用几剂后痊愈。张仲景说：“脉虚身热，得之伤暑。”又说：“为什么脉弦细芤迟？”《素问》说：“寒伤形，热伤气。”既然是伤气不伤形，那么气消而脉虚弱，所谓弦细芤迟，都是虚脉。张仲景以弦为阴，朱庞也说中暑脉微细，可知是虚证。
霖按：白虎汤数服痊愈者，是因为脉大而虚。如果是弦细芤迟，则脉中含濡象，是暑伤气而中挟湿的缘故。不适合用白虎汤，也不可拘泥于补气全作虚证治疗。凡是医案必须阐明脉证之所以然，才能作为后学的法式，只有许学士差不多做到了。
万密斋治疗县丞李天泉，六月中暑腹痛。他家里有个婢女来自外家，医生说是寒病，进服理中汤一剂痛止，却发热，全身骨节尽痛，又进服十神汤，发汗后热退身不痛了。万密斋诊察，李天泉自称病愈，观察其面色带赤，知道病未解除，请脉，脉洪滑而数。（色脉不符。）《内经》说：“大则病进。”现在发汗后脉仍洪数，病势正在进展，而他自称痊愈，万密斋离去。不久，病发作了，满腹急痛，状如奔豚，上下左右，举手按摩，急忙延请万密斋，说：“你先前诊脉，不说话就走了，知道我的病吧，幸急救我。”万密斋说：“无妨。”于是进服建中汤一剂，疼痛定住。次日有省祭官万朴来探病，万朴擅长医术，诊脉后既惊讶又回头看来，李天泉也怀疑恐惧。万密斋诊脉，对万朴说：“你奇怪他的脉有促止吗？这是因为心下怔忡，所以脉象如此。”李天泉随即应声说：“我心下跳乱不宁。”万密斋立刻命取药方，用人参、麦冬、甘草、白芍、生地、五味子、猪心，煮汤煎服一剂，心跳停止，脉不再促止。因为心恶热，用热药治热病，之前服的理中汤、十神汤都犯了禁忌，所以病复发。
霖按：面赤脉洪数，色脉相参，自然是暑病进展，用建中汤定痛是对的。但暑邪先入心，伤其营血，何况用理中、十神用热治热呢？万密斋认为尚未清理暑热，所以见到脉数歇止，就知道热伤心营，虚而跳止。西方医学说由肺进入心脏的血，从心脏进入脉管，以荣养脏腑经脉皮毛，血由心脏左房落入脉管一次，则脉搏跳动一次，西医听心脏血液的声音，知道脉有病变，而营卫循行的道理，六气标本的理论，无不由此悟入，总在于细心体察罢了。粗劣的医生视人命如草芥，哪里足以谈论这些。
江应宿治疗他的岳母，六十多岁，六月中旬，劳倦中暑，身热如火，口渴饮冷，头痛如破，脉虚豁，二三至一止。投服人参白虎汤三帖，渴止热退，唯独头痛，用白萝卜汁吹入鼻中，良愈。
孙子华赴南京应试，六月初旬梦遗，畏寒惊惧，穿厚裘盖厚被，取汗过多，身热，六脉滑数无力。给予清暑益气汤，次日舌强，语言不清如癫狂，目瞪不识人。江应宿说：“这是暑风。”给予人参白虎汤，加胆星、僵蚕、秦艽、天麻、竹沥、姜汁，渐渐痊愈。数日后，舌心黑如墨，给予黄连解毒汤、凉膈散不退，给予犀角地黄汤而愈。
另一位病人瘦长而脆，暑月过度劳累，饥饿时饮烧酒，于是身热汗出，昏懵语乱。江应宿视之，脉皆浮小而缓，按之虚豁，说：“暑伤心，劳伤脾。”因为心藏神，脾藏意，二脏俱伤，应该有这些症状，治法宜清暑益脾，用八物汤，加麦冬、山栀、陈皮，十余帖而愈。
霖按：江公三案，平正可法，其第二案解毒凉膈不应，易犀角地黄汤始愈。同样是凉药，有对与不对的区别，读者最宜深思。
张路玉治疗金鲁公触热，劳形醉饱不谨，后受凉，遂发热头痛，胀满喘逆，大汗如蒸，面赤戴阳，足冷阳缩，脉弦数无力，说：“这是伤暑夹食而复夹阴也。”给大顺散一服不应，转胀急不安，因而用枳实、理中汤，加浓朴、大黄，这一夜排便两次，身凉足暖而痊。
霖按：此案在不谨后受凉，而见面赤阳缩，足冷汗多且喘，最容易当作阴证，其辨别关键在于发热头痛胀满，与阴证不合，更察其不谨之前，有醉饱的病因，所以大顺散不应，即用枳实、理中加浓朴、大黄，得更衣而愈。若误用白通、四逆，危险了。这是暑天的变证，非暑证本身，也要不可不知。
汪石山治疗一位年三十八岁的男子，形体瘦弱，忽病上吐下泻，水浆不入口七日，自己认为必死无疑。诊脉八至而数，说：“正当夏季而得此脉，暑邪深入也。吐泻不纳水谷，邪气自盛也。”于是给人参白虎汤进半杯，良久复进一杯，觉稍安，三服后减去石膏、知母，而人参渐次加至四五钱，黄柏、橘皮、麦冬等随其所兼之病而佐使。一月后平复。
霖按：这是暑热霍乱的轻症，吐泻至七八日而不死，也是因为未服温补燥热之剂的原因。汪公制剂得当，而进退操纵有法度，暑盛气伤的治法，此案可作为师法。
另一位病人患霍乱，欲吐不吐，欲泻不泻，心腹绞痛，脉之沉伏如无，这是干霍乱。急令盐汤探吐宿食痰涎碗许，遂泻，与六和汤愈。
霖按：痛脉多伏，以盐汤探吐，乃开其上窍，上窍开则下窍自通，而得吐泻，即可治矣。
孙文垣治疗程氏之子，先醉酒，后入房，次早四肢冷，胃腕痛极，脉仅四至，或以郁火治，投以寒凉，痛更甚。三日前所食西瓜，吐出未化，乃翁以为阴证伤寒，欲用附子理中汤不决。逆孙视之，面色青惨，叫痛而声不扬，坐卧烦乱，是霍乱兼蛔厥证也，先当止痛安蛔，后理霍乱，可免死也，迟则误事矣。急用醋炒五灵脂三钱，苍术一钱五分，乌梅三个，川椒、炮姜、桂心各五分，水煎饮下，痛减大半，下午以大腹皮、藿香、半夏、橘皮、山楂、茯苓、五灵脂，两贴全安。
霖按：此人以纵欲贪凉，恣食生冷致病，而又误设寒凉之剂，故以温胃安蛔，和中化滞而效，其霍乱亦不甚重。
张石顽说：一少年新婚，陡然腹痛麻瞀，或令饮火酒半杯，腹痛转剧，旋增颅胀，身发红点，与芦根汁得吐痛解。复有鼻衄口燥，胸腹略见红斑，啜童子小便稍安，又浓煎葱豉汤，仍入童便，续续与之，得大吐汗出而痊。
霖按：此证即夏日之暑沙伏毒，得酒愈炽，先以芦根汁清热解毒，以杀其势。继进葱豉汤，倍用童便解秽清营，仍从宣达分消而愈，治法稳当。
怀抱奇治疗一男子，恣饮梅水，吐泻无度，手足厥逆，面色惨晦，声音不出，而脉沉伏小水点滴不通，服药入口即吐，医告技穷，怀思梅味酸主收，故小便癃闭，而果得麝则败，麝又香窜走窍，乃取麝半入脐中，半入鼻孔，病者即以手拂其鼻曰：“此何物也？”少顷小水大下二三行，忽如醉而醒，梦而觉，越日索粥渐安。
霖按：此亦暑厥，而无外因者，以败果通窍，即能奏效，然其巧思，正不可及。
童庐治疗陈氏妇，盛夏病霍乱吐泻，腹中绞痛，四肢厥冷，冷汗溱溱，转筋戴眼，烦躁大渴，喜冷冻饮料，饮已即吐，六脉皆伏，虽曰霍乱，实脏厥也。经云：“大气入脏，腹痛下注，可以致死，不可以致生，速宜救阳为急，迟则肾阳绝矣。”以四逆汤、姜、附各三钱，炙甘草、吴茱萸各一钱，木瓜四钱，煎成冷服，日夜连进三剂，四肢始和，危象皆退，口渴反喜沸汤，寒象始露。即于方中佐以生津存液之品，两服而安。
霖按：肢冷脉伏，大渴喜冷冻饮料，此霍乱属乎热者，但喜冷冻饮料而饮已即吐，服热药后反喜沸汤，此真寒假热证也。故宜四逆汤，然而小溲必清白，吐出泻出，必无秽浊气味，方是真寒的候，否则真假莫辨，杀人事矣。
倪姓患霍乱吐泻，审知始不作渴，四肢不逆，脉不沉细。一医用大顺散两帖，渐至于此，因见四逆，复加附子，脉证更剧。童曰：“此病一误再误，命将殆矣。若果属寒，投热病已，今反四逆，脉转沉细欲伏，乃酿成热深厥深，与热邪传入厥阴者何异？”即以竹叶石膏汤，人参易西洋参，加黄连、滑石，两剂而安。同时有陆姓患此，医用回阳之剂，日夜兼进，厥逆烦躁日增，病患欲得冷水，禁绝不与，甚至病者自起拾地上痰涎以解渴，迁延旬日而死。噫！即使真属阴寒，阳回躁渴如是，热药之性，郁而无主，以凉药和之，病亦立起，不学无术，曷胜浩叹？
霖按：此非真热霍乱，然其证甚轻，医者药误，致酿热深厥深。竹叶石膏汤，人参易西洋参极是。即使寒证回阳后躁渴，亦当参以凉润和之。此千古不刊之论也。
Luo Qianfu treated a Mongolian Hundred Household Officer who, after consuming alcohol, meat, and Tongru (a type of dairy product), developed Huoluan (acute gastroenteritis with vomiting and diarrhea) syndrome. From morning until noon, his spirit was confused and dazed, and the condition became critical as he sought help. Luo observed that the pulse was floating and rapid, but powerless upon deep pressure, indicating that the offending food had already been expelled. He immediately took half a bowl of freshly drawn well water, mixed it with Guiling Baizhu San (Cassia Twig, Poria, and Atractylodes Macrocephala Powder), and administered it slowly. The patient felt slightly relieved. Then, Luo dug about two inches deep in the shade of a wall, filled it with fresh water, stirred it, waited for it to settle, and used one cup of the clear supernatant liquid to mix another dose. Gradually, the patient's breathing regulated, and vomiting and diarrhea stopped. He slept peacefully that night. The next day, he had slight irritability and thirst, so Luo decocted Qianshi Baizhu San (Childhood Diseases Baizhu Powder) for him to take occasionally, leading to a good recovery. Someone asked: "Why use Dipu (earth slurry)?" Kun represents the earth, which belongs to Yin. Earth is calm when balanced. Irritability arises from sensing extreme Yin qi; storing fresh water in the shady wall gathers heavy Yin qi. Yin within Yin can drain Yang within Yang. This Huoluan resulted from internal injury by summer-heat, hence the rationale for using Dipu.
The father of the Tiju (Director) was nearly eighty years old. In June, he contracted summer-toxin, suffering from Huoluan with vomiting and diarrhea, unconscious all day long, unaware of his surroundings, at around midnight. Luo was invited to examine him. The pulse beat seven or eight times per breath, appearing surging and large yet forceful. His head was hot as fire, feet cold as ice, hemiplegia occurred, and the jaw was clenched. Because of his advanced age and weak Qi, during the peak of summer heat when the Yangming channel was dominant, he was moved by Yin pathogens to contract summer-heat, which was evident. Only a formula of sweet, acrid, and great cold nature could drain the summer-heat, suppress the floating fire, and calm the spirit. Thus, Ganlu San (Sweet Dew Powder) was used. Being sweet, acrid, and great cold, it drains heat and tonifies Qi. Fuling (Poria) was added to separate Yin and Yang, approximately one liang. It was mixed with water and forced down his throat. Gradually, he regained consciousness, and all symptoms disappeared. He was advised to speak little and regulate his diet for three days. Subsequently, Shenzhu Buzhong Tang (Ginseng and Atractylodes Decoction to Tonify the Middle) was prescribed with modifications. After taking it, his righteous Qi recovered, and he healed completely, regaining full health in ten days.
Hua Bren treated a patient with profuse sweating like rain, red face, body heat, dry mouth, and irritability. It was midsummer, and the curtains were tightly closed. The patient believed himself to be suffering from deficiency collapse of Yang and took several doses of Zhufu (Prepared Aconite Root). However, the pulse became deficient, surging, and rapid, and the tongue coating turned yellow. Hua said, "The previous treatment was erroneous. Heat diseases should be treated with heat-clearing methods; doing otherwise will kill the patient. The *Suwen* states: 'One must first consider the seasonal climate and not violate the harmony of heaven.' How can Zhufu be used lightly? This violates the season. It also says: 'Deficient pulse with body heat indicates injury by summer-heat.' Summer-heat patients naturally sweat more. Adding harsh, warm drugs caused the pulse to become surging and rapid with excessive sweating." He ordered the curtains removed and windows opened. Soon, the patient felt refreshed. Huanglian Renshen Baihu Tang (Coptis, Ginseng, and White Tiger Decoction) was administered three times. Sweating stopped significantly, and other symptoms subsided. Jiji Tang (Ji Ji Decoction) was used concurrently. For thirst, Bing Shui (Ice Water) was used to mix Tianshui San (Sky and Water Powder). Recovery occurred in two days.
Sun Zhao treated a patient with spontaneous sweating, coldness of both legs down to the knees, abdominal fullness, and confusion. Sun examined the six pulses, finding them small, weak, and urgent. He asked about the medications taken and saw they were all for Yin syndromes. Sun said, "This is not severe illness; the medicine has aggravated the condition." He prescribed Wuling San (Five-Ling Powder) and Baihu Tang (White Tiger Decoction) for over ten doses. The condition improved slightly, and full recovery followed after further administration. When asked about the method, Sun explained, "The patient suffered from summer-heat. Initially, Yang was weak, limbs were cold, and the pulse was small and powerless. The doctor mistakenly diagnosed it as a Yin disease and used wrong medicines. For the cold limbs, Wuling San promotes urination, reducing abdominal fullness. Baihu Tang clears pathogenic heat, curing the disease. In Yin syndromes, if the calves are cold, the arms are also cold. Here, only the calves are cold while the arms are not, indicating lower coldness rising upward, resembling mild Yang coldness. This case involves initial dampness injury followed by summer-heat injury, belonging to dampness syndromes."
Danxi treated a patient in summer with high fever, delirium, inability to move limbs, and preference for cold drinks. The pulse was surging and rapid. Huangqi (Astragalus Root) and Fuling (Poria) were decocted thickly into a paste, mixed with cool water, and taken. After three or four doses, the patient fell into a coma-like sleep with normal breathing, waking up the next day cured.
Another patient in summer had high fever, profuse sweating, aversion to cold, shivering, uncontrollable trembling, irritability, and thirst. This was a summer-heat disease. The pulse was deficient, minute, fine, weak, and rapid. The patient enjoyed gambling, leading to exhaustion and deficiency. Renshen (Ginseng Root) and Zhuye (Bamboo Leaf) were decocted as soup, mixed with Chensha Siling San (Cinnabar and Five-Ingredient Powder), resulting in peace after several doses.
Xiang Yanzhang treated a severely ill patient whom doctors considered to have consumption (phthisis). Everyone was bewildered. Xiang found the pulse fine, rapid, and solid. Fine and rapid indicate summer-heat. Summer-heat injures Qi, suggesting deficiency, but here it is solid, indicating heat injuring blood, likely due to medication. The family asked about the time of death. Xiang replied, "How could there be death?" He prescribed Baihu Tang (White Tiger Decoction), and the patient recovered upon drinking it.
Wu Jiaoshan treated a woman who, in winter, accidentally caught a chill, experiencing chills, low-grade fever, anorexia, dry retching, and difficulty defecating. Doctors treated her as deficiency with phlegm-fluid retention, using Erchen Tang (Two-Aged Decoction) and Xinbao Wan (Heart-Nourishing Pill) without effect. Half a month later, Wu found the pulse deficient and powerless, resembling summer-heat injury. Others disagreed. Upon inquiry, the woman said she changed into cotton clothes due to cold weather, covered herself with a cotton quilt dried in the intense summer sun, and soon felt irritable, thirsty, with alternating chills and fever and vomiting, lasting until then. Wu said, "Indeed, it is summer-heat injury. The quilt was dried in summer heat, trapping heat inside the box. With the body's deficiency, the pathogen easily entered." The woman agreed. Wu prepared Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction), administered twice consecutively, resulting in recovery.
In years of extreme heat, people collapsing and dying on roads and in cities are usually those with deficiency or overwork, irregular eating, or pre-existing conditions. Once struck by summer-heat without release, orifices become blocked. Death is caused by Qi blockage, not directly by summer-heat. Ancient formulas for summer-heat use acrid-sweet dispersing agents to guide Heart Qi and promote fluid movement, causing no harm. In the Yiyi year of Chongning, Wu served as a book bureau official. A groom riding a horse out of the gate suddenly collapsed. Wuling Dashun San (Five-Ling Great Harmony Powder) was forced down but failed. Later, Wang Xiang, a roommate, instructed taking a handful of garlic mixed with hot road dirt, ground and mixed with fresh water, filtered, and poured into the mouth after prying teeth open. The patient revived shortly after and drove the carriage back by evening. This proved the precise match between medicine and disease. This formula originated from a notice posted on a door in Peixian, Xuzhou, attributed to immortals. Shen Cunzhong and Wang Shengmei recorded it. Wu verified it personally, citing *Bushu Lu* (Records of Summer Retreat) by Shilin Laoren.
Wang Xishuo treated a robust man with dark complexion. Returning from a boat trip in summer, he suffered from vomiting and hiccuping, unable to sleep, having eaten nothing for six days. The pulse was deep, fine, deficient, and hollow. Various doctors used Huoxiang (Patchouli), Chaihu (Bupleurum), Lingzhi (Poria), etc., without effect, leaving him critical. Wang said, "This is summer-heat strike." He administered Renshen Baihu Tang (Ginseng White Tiger Decoction) with five qian of Renshen. Vomiting and hiccuping stopped immediately. He slept soundly until dawn, then asked for porridge. After two or three doses, Renshen dosage was reduced slightly. Several doses of regulation led to recovery.
Lin notes: There are many cases of treating summer-heat. Only one is selected here from thousands, with a few appended to supplement.
Xu Shumi treated a patient with headache, body heat, irritability, restlessness, and thirst. The pulse was large and deficient. He prescribed Baihu Tang (White Tiger Decoction) for several doses, resulting in recovery. Zhang Zhongjing said: "Deficient pulse with body heat results from summer-heat injury." He also asked: "Why the string-tiny, empty, slow pulse?" The *Suwen* states: "Cold injures form, heat injures Qi." Since Qi is injured but not form, Qi dissipates, making the pulse weak. String-tiny, empty, and slow are all deficient pulses. Zhang Zhongjing considers string as Yin. Zhu Pang also stated that summer-heat pulse is micro-fine, indicating deficiency.
Lin notes: Recovery with Baihu Tang occurs when the pulse is large and deficient. If string-tiny, empty, and slow, the pulse contains a soggy image, indicating summer-heat injuring Qi with dampness involvement. Baihu Tang is not suitable, nor should one rigidly treat it solely as Qi deficiency. Medical cases must explain the rationale behind pulses and symptoms to serve as models for students. Only Scholar Xu comes close.
Wan Mizhai treated Li Tianquan, a county deputy director, who suffered summer-heat induced abdominal pain in June. A maid from outside brought a doctor who diagnosed cold syndrome and gave Lizhong Tang (Regulate the Middle Decoction). Pain stopped, but fever started, and whole-body joint pain ensued. Shishen Tang (Ten Divine Decoction) was given, inducing sweating, reducing fever and pain. Wan examined him. Li claimed recovery, but his face was reddish, indicating unresolved disease. Pulse was surging, slippery, and rapid. (Color and pulse mismatch.) The Classic says: "Large pulse indicates disease progression." Post-sweating, the pulse remains surging and rapid, meaning disease advances, despite Li's claim of cure. Wan left. Shortly after, the disease flared up with severe abdominal pain, resembling Ben Tun (running piglet), moving up and down, left and right. Massaging did not help. Wan was urgently summoned. Li said, "You diagnosed my pulse earlier and left silently, knowing my condition. Please save me." Wan said, "No harm." He administered Jianzhong Tang (Establish the Middle Decoction) once, stopping the pain. Next day, Wan Pu, a provincial examiner and skilled physician, visited. He was shocked examining the pulse. Li was suspicious and fearful. Wan told Wan Pu, "Are you surprised by the intermittent pulse? It is due to palpitations in the epigastrium." Li confirmed, "My heart feels chaotic and restless." Wan immediately prescribed a formula with Renshen (Ginseng), Maidong (Ophiopogon Tuber), Gancao (Licorice Root), Shaoyao (Peony Root), Shengdi (Rehmannia Root), Wuweizi (Schisandra Berry), and Pig Heart decocted together. One dose stopped the palpitations and regularized the pulse. The heart dislikes heat; using heat to treat heat violated taboos (Lizhong and Shishen), causing relapse.
Lin notes: Red face and surging-rapid pulse, combined with color, indicate advancing summer-heat. Using Jianzhong to stop pain was correct. However, summer-heat enters the Heart first, damaging Ying-Blood. Using heat to treat heat with Lizhong and Shishen was wrong. Wan realized uncleaned summer-heat damaged Heart Ying, causing vacuous jumping and intermission. Western medicine states blood from lungs enters the heart, then vessels to nourish organs and skin. Blood falling from the left atrium causes one pulse beat. Western doctors hear heart sounds to detect vessel pathology. The circulation of Ying-Wei and the principles of Six Qi and root/branch are understood through this, requiring careful observation. Crude doctors treat human life as worthless grass; how can they discuss this?
Jiang Yingsu treated his mother-in-law, over sixty, who suffered labor-induced summer-heat in mid-June. Body heat like fire, thirst for cold drinks, splitting headache. Pulse was hollow, stopping every two or three beats. Ren Shen Baihu Tang (Ginseng White Tiger Decoction) was given for three doses. Thirst stopped, fever subsided, only headache remained. White radish juice was blown into the nose, leading to excellent recovery.
Sun Zihua went to Nanjing for exams. In early June, he had nocturnal emission, feared cold, trembled, wore thick furs and quilts, sweated excessively, had body heat, and six pulses were slippery, rapid, and powerless. Qing Shu Yi Qi Tang (Clear Summer-Heat and Boost Qi Decoction) was given. The next day, tongue stiffness, unclear speech like madness, staring eyes, unrecognized people. Jiang said, "This is Summer-Wind." He gave Ren Shen Baihu Tang, adding Danxing (Arisaema with Honey), Jiangcan (Silkworm), Qinjiao (Gentiana Macrophylla), Tianma (Gastrodia Rhizome), Zhuli (Bamboo Sap), and Jiangzhi (Ginger Juice). Gradual improvement occurred. Days later, the center of the tongue turned black as ink. Huanglian Jiedu Tang (Coptis Detoxification Decoction) and Liangge San (Cool Chest Powder) failed. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) cured him.
Another patient, thin and fragile, overworked in summer, drank burning wine while hungry. Resulted in body heat, sweating, confusion, and disordered speech. Jiang found pulses floating, small, slow, and hollow upon pressure. He said, "Summer-heat injured the Heart; labor injured the Spleen." Heart houses Spirit; Spleen houses Intent. Both organs injured cause these symptoms. Treatment should clear summer-heat and benefit Spleen. Bayu Tang (Eight-Ingredient Decoction) was used, adding Maidong (Ophiopogon), Shanzhi (Gardenia Fruit), Chenpi (Tangerine Peel). Over ten doses led to recovery.
Lin notes: Jiang's three cases are standard and instructive. In the second case, detoxifying and cooling the chest failed; switching to Xijiao Dihuang Tang worked. Same cooling herbs, but different efficacy. Readers should ponder deeply.
Zhang Luyu treated Jin Lugong who, exposed to heat, labored excessively, ate/drank immoderately, then caught a chill. Resulted in fever, headache, distension, wheezing, profuse steaming sweat, red face (floating Yang), cold feet, retracted genitals. Pulse was string-tense, rapid, and powerless. Zhang said, "This is summer-heat injury with food stagnation and yin-cold." Dasun San (Great Harmony Powder) failed, worsening distension and discomfort. Zhishi (Immature Bitter Orange), Lizhong Tang (Regulate the Middle Decoction), plus N Houpo (Magnolia Bark), Dahuang (Rhubarb Root) were given. Two bowel movements that night, body cooled, feet warmed, and recovery ensued.
Lin notes: After immoderation and catching chill, presenting with red face, retracted genitals, cold feet, sweating, and wheezing, it is easily mistaken for Yin syndrome. Differentiation lies in fever, headache, distension, inconsistent with Yin syndrome. Also, prior immoderate eating/drinking explains why Dasun San failed. Using Zhishi, Lizhong, Houpo, Dahuang led to recovery via bowel movement. Mistaking it for Baitong or Sini Tang would be dangerous. This is a variation of summer heat, not typical summer-heat syndrome, yet crucial to know.
Wang Shishan treated a 38-year-old man, thin and weak, suddenly suffering upper vomiting and lower diarrhea, unable to keep fluids for seven days, expecting death. Pulse was eight beats per breath, rapid. Wang said, "In summer, this pulse indicates deep summer-heat pathogen. Vomiting/diarrhea preventing intake shows strong pathogen." Ren Shen Baihu Tang (Ginseng White Tiger Decoction) was given half a cup, then another cup later. Patient felt slightly better. After three doses, Shigao (Gypsum) and Zhimu (Anemarrhena Rhizome) were removed, Renshen increased gradually to four or five qian. Huangbai (Phellodendron Bark), Chenpi (Tangerine Peel), Maidong (Ophiopogon) were added based on accompanying symptoms. Full recovery after one month.
Lin notes: This is a mild case of summer-heat Huoluan. Surviving 7-8 days of vomiting/diarrhea is due to not taking warm-tonifying dry-heat drugs. Wang's formulation was appropriate, with proper adjustment methods. This case serves as a model for treating summer-heat excess and Qi injury.
Another patient had Huoluan, wanting to vomit but couldn't, wanting to defecate but couldn't, severe heart/abdominal pain. Pulse was deep, hidden, almost absent. This was Gan Huoluan (Dry Huoluan). Salt water was used to induce vomiting of retained food/phlegm, followed by defecation. Liuhe Tang (Six-Harmony Decoction) cured him.
Lin notes: Painful pulses are often hidden. Inducing vomiting opens upper orifices; opening upper allows lower to flow, enabling vomiting/diarrhea, thus curing.
Sun Wen Yuan treated Cheng's son, who got drunk, had intercourse, then woke with cold limbs and extreme stomach pain. Pulse was only four beats. Treated as stagnant fire with cold herbs, pain worsened. Un-digested watermelon eaten three days ago was vomited. Father thought it was Yin-cold Taiyang disease, hesitating to use Fuzi Lizhong Tang. Sun saw greenish-pale face, silent screaming pain, restlessness. Diagnosed Huoluan complicated by Ascaris colic. First stop pain and calm ascaris, then treat Huoluan to avoid death. Delay leads to error. Vinegar-processed Wulingzhi (Trogopterus Dung), Cangzhu (Atractylodes Lancea), Wumei (Mume Fruit), Chuanjiao (Sichuan Pepper), Paojiang (Prepared Ginger), Guixin (Cinnamon Bark) were decocted. Pain reduced significantly. Afternoon: Dafupi (Areca Peel), Huoxiang (Patchouli), Banxia (Pinellia), Chenpi (Tangerine Peel), Shanzha (Hawthorn), Fuling (Poria), Wulingzhi. Two doses brought full peace.
Lin notes: Illness caused by indulgence, cold exposure, and raw/cold food, compounded by wrong cold herbs. Warm stomach, calm ascaris, harmonize middle, resolve stagnation worked. Huoluan was not severe.
Zhang Shiwan said: A young newlywed had sudden abdominal pain and numbness. Given half a cup of fiery wine, pain worsened, head swelled, red spots appeared. Lu Gen汁 (Reed Rhizome Juice) induced vomiting, relieving pain. Another case: Epistaxis, dry mouth, slight red spots on chest/abdomen. Drinking child's urine brought slight relief. Strong Congchi Tang (Scallion and Soybean Decoction) with child's urine continued. Profuse vomiting and sweating led to recovery.
Lin notes: This is summer-heat latent toxin. Wine exacerbates it. Lu Gen juice clears heat/toxin initially. Congchi Tang with child's urine resolves turbidity/clears Ying. Dispersing and draining led to recovery. Method is steady.
Huai Baoqi treated a man who drank plum water excessively, causing endless vomiting/diarrhea, cold limbs, pale/dull face, voice loss, hidden small pulse, no urination. Medicine caused immediate vomiting. Doctors exhausted. Huai reasoned plum is sour/astringent, causing urinary retention. Musk breaks astringency and opens orifices. Half musc placed in navel, half in nostril. Patient touched nose, asked "What is this?" Soon, urine flowed heavily. Patient woke from drunken dream state. Next day, asked for porridge, gradually recovered.
Lin notes: This is summer-jue without external cause. Breaking astringency with musc opened orifices effectively. Ingenious thinking indeed.
Tong Lu treated Mrs. Chen in midsummer with Huoluan vomiting/diarrhea, abdominal cramping, cold limbs, profuse cold sweat, muscle spasms, rolling eyes, irritability, extreme thirst, preference for cold drinks, vomiting immediately after drinking. Six pulses hidden. Though called Huoluan, it is actually Zang Jue (Visceral Cold Collapse). Classic says: "Vital Qi entering viscera causes abdominal pain and downward flow, leading to death, not life. Urgently rescue Yang, else Kidney Yang perishes." Sini Tang (Frigid Extremities Decoction) with Jiang (Fresh Ginger), Fuzi (Aconite) each 3 qian, Zhi Gancao (Honey-fried Licorice), Wuzhuyu (Evodia Fruit) each 1 qian, Mugua (Chaenomeles Fruit) 4 qian. Decocted and taken cold. Three doses day and night. Limbs warmed, danger receded. Thirst reversed to preferring hot soup, revealing true cold signs. Add fluids-generating herbs to formula. Two doses brought peace.
Lin notes: Cold limbs, hidden pulse, extreme thirst for cold drinks suggests hot Huoluan. But vomiting after cold drink and preferring hot soup after hot medicine indicates True Cold False Heat. Sini Tang is indicated. However, urine must be clear, vomit/stool odorless for true cold. Otherwise, distinguishing true/false is fatal.
Mr. Ni had Huoluan vomiting/diarrhea. Initially no thirst, no cold limbs, no deep/fine pulse. Doctor used Dasun San for two doses, progressing to current state. Seeing cold limbs, added Fuzi, worsening pulse/symptoms. Tong said, "Double error, life endangered. If truly cold, heat meds should cure. Now cold limbs, deep/fine hidden pulse indicates deep heat causing deep cold limbs, similar to heat entering Jueyin." Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) was used, replacing Renshen with Xiyangshen (American Ginseng), adding Huanglian (Coptis), Huashi (Calcined Talc). Two doses brought peace. Simultaneously, Mr. Lu had same condition. Doctors used Yang-restoring meds day and night. Cold limbs/irritability worsened. Patient wanted cold water, denied. Even picked up sputum from ground to quench thirst. Died after ten days. Alas! Even if true Yin-cold, after Yang returns, irritability/thirst occurs. Hot drug nature becomes郁 (stagnant) without master. Mixing with cool meds cures instantly. Ignorance is lamentable.
Lin notes: Not true hot Huoluan, but mild case worsened by medical error into deep heat/deep cold. Replacing Renshen with Xiyangshen in Zhuye Shigao Tang is very correct. Even if cold syndrome post-Yang return causes irritability/thirst, mixing with cool-moistening agents is appropriate. This is an unalterable eternal truth.