时稍苏，而号痛声彻四邻。诸医皆云∶脉细如丝不治（痛极脉多细伏），
越日，门外来一丐僧，家人辞以有病。僧云∶何不问我？家人苦无策，姑令入。僧一望即
曰∶是误食
蛇精也（神乎伎矣，世有饱读医书而不识一证，自命为儒医者，人因信其学问而
并信其医，彼此贸贸。虽日杀人而不悔悟，宜乎畸人
逸
士之晦迹以遁也.可慨也夫）。于破囊中取药一丸，以水研灌，移
时病者起，呕如雀卵者
数枚。僧曰∶未也，复呕秽野狼藉，出一物如鸡子大。僧曰∶是矣，剖视乃血裹中蟠一小蛇
，
见人遽动，作势上下，病已若失，举家惊服（我亦拜服）。叩其所以。曰
∶
多年陈谷，蛇交其上，余沥粘着，误入腹中，乃成此物。少停即洞胸腹出矣。僧径裹蛇而
去。案挥霍撩乱，已不易平，必辨阴阳，始能奏绩。此证虽非霍乱，而病去迅疾，俨似食滞
之干霍乱，且证势之撩乱，较霍乱为尤乱也。苟无破敌之才，徒有虚名之学，焉能平此大乱
哉。用药如用兵，丐僧有之矣，采此以为拨乱反正者告，勿以资格用人也。凡腹中卒然大痛
，在饮食后，而无别证可凭者，多系误食毒物。重用紫金丹，或玉枢丹研灌，似亦有效。
杨素园治其仲郎，壬子夏患干霍乱，身热不渴，口燥无苔，六脉俱伏，痛在胃脘，连及胸胁
，势甚汹涌，先与地浆一碗，势少定，少顷复作，因径投大承气汤一帖，其痛即下行至脐间
，又一帖痛又下行，伏于少腹右角，按之则痛，不按则与平人无异。起病至此，已历周时，
思食甚急，乃以绿豆煮粥与之。食后一切如常。惟少腹右角，按之仍有小块，隐隐作痛，遂
重用当归、枸杞、蒌仁，佐以桃仁、红花，少加牛膝以导之。服一时许，腹中 有声，下
紫黑血一块，若五寸许，而少腹之痛块若失。此病治法原出一时臆见，然竟以获痊，特录出
，质之半痴，不知以为何如。按霍乱证，因于暑热者多，故感受稍重，极易入营。古人刺以
泄
血，及内服益母汤、藕汁、童溺，皆所以治营分之邪也。杨公子舌燥无苔而不渴，痛又及胁，
必
平日偶有络伤未觉，乃邪遂乘瑕而入也。承气之硝黄，并是血药，气行则瘀降，故痛得渐下
。
迨块在而按之始痛，且知饥能食，益见气分之病已蠲，而血分之邪尚匿。毋庸承气之直攻，
改从濡化而曲导，操纵有法，余服其手眼之超。
景岳谓饮食下行之道，必由少腹下右角而后出于广肠，自夸阅历而知，古人并未言及。盖渠
尝治一人食面角，杂投巴豆、大黄而不效也。魏柳洲曰∶就此观之，景岳平生临证，遗憾
多
矣。夫面角由胃入肠，既至少腹之角，岂能作痛如是。而又如拳如卵，必其人素有疝病，偶
因食面而发，或兼当日之房劳，遂乃决张如是，故推荡之药不应，得木香火酒一派辛热香窜
而痛始止也。至谓食由少腹下右角而后出广肠，更堪捧腹，经谓大小肠皆盘屈十六曲，则左
旋右折可知，岂如筒如袋，而直下乎。嘻！案杨公子少腹右角之痛，设非乃翁卓识，时医
必误认食滞，特附录魏语以广其义，为崇尚景岳者告。
山阴田雪帆明经晋元，着《时行霍乱指迷》，辨正世俗所称吊脚痧一证，以为此真寒直中厥
阴肝
经，即霍乱转筋是也。初起先腹痛，或不痛，泻利清水，顷刻数十次，少者十余次，未几即
手足抽掣，呕逆口遏，厥逆声嘶，脉微欲绝，舌短目眶陷，眼上视，手足青紫色，或遍身青
筋硬凸如索，汗出脉绝。急者，旦发夕死。缓者，二三日或五六日而死。世医或认为暑湿
，妄投
凉泻。或认为痧气，妄投痧药，鲜有不毙。宜用当归四逆加吴茱萸生姜汤，水煎冷服。轻
者，
二三剂即愈；重者，多服几剂，立可回生，真神方也。如呕者，加制半夏三钱，淡干姜一钱
。
口渴恣饮，舌黄，加姜汁炒川连五分，为反佐，经所谓热因寒用也。腹中绞痛，名转筋入腹
，
加酒炒木瓜三钱。手足冷过肘膝，色见青紫，加制附子三钱。此证种种，皆肝经见证耳。缘
坎中真阳，为邪寒所逼，因之外越，所谓内真寒而外假热也。但以脉辨之，自无游移矣。
寒犯厥阴而为霍乱转筋者，容或有之，岂可以概论时行之证耶？果系寒犯厥阴，而吐利汗出
，则当用吴茱萸汤加减，或乌梅丸法，不当用当归四逆加吴茱萸生姜汤。以当归四逆，本
桂
枝汤加当归、通草、细辛，通血脉以疏肌表，非汗出脉绝之证所可轻尝。至脉不可凭，必
以口渴、舌黄、喜冷冻饮料，为辨真热假寒之确据。竟敢颠倒其说，曲为妄解，何欺人之太甚
哉
？书生纸上谈兵，好发想当然之议论，惑世诬民，大率类是，不可不辨也。故附录于此。
病人稍许清醒，但哀号剧痛的声音传遍四邻。各位医生都说：脉象细如丝线，无法救治（疼痛极度剧烈时，脉象多表现为细弱伏匿）。
过了一天，门外来了一位乞丐僧人，家人以家中有人生病为由拒绝接待。僧人说：“为什么不问我？”家人苦于没有对策，只好让他进去。僧人看了一眼就说：“这是误食了蛇精所致。”（技艺真是神妙啊！世间有饱读医书却认不得一个证候的人，自命为儒医，人们因为相信他的学问而连带相信他的医术，彼此糊里糊涂。虽然每天杀人却不悔改醒悟，难怪那些特立独行的隐士要隐藏行迹遁世了。真是令人感慨啊。）他从破旧的囊袋中取出一丸药，用水研磨后灌服，过了一会儿，病人坐起，呕吐出几枚像麻雀蛋一样的东西。僧人说：“还没完呢。”接着又呕吐出污秽之物，遍地狼藉，吐出一个像鸡蛋大小的物体。僧人说：“这就对了。”剖开查看，原来是血包裹着一条小蛇，见到人就立刻蠕动，做出上下翻滚的姿态。病势已消失，全家震惊佩服（我也拜服）。询问其缘由。僧人说：“是多年的陈谷，蛇交配在上面，残留的粘液附着在谷物上，误入腹中，才形成这个物体。稍停片刻就会从胸腹排出。”僧人径直包好蛇离开了。此案病情挥霍撩乱，已经不易平复，必须辨别阴阳，才能奏效。此证虽然不是霍乱，但病去迅疾，俨然像是食滞引起的干霍乱，而且病势的撩乱程度，比霍乱更为严重。如果没有破敌的才干，只有虚名之学，怎么能平定这种大乱呢？用药如同用兵，这位丐僧做到了。采纳此案例作为拨乱反正的告诫，不要以资历资格来用人。凡是腹中突然剧烈疼痛，发生在饮食之后，而没有其他症状可凭据的，多是误食毒物所致。重用紫金丹，或玉枢丹研磨灌服，似乎也有疗效。
杨素园治疗他的次子，壬子年夏天患干霍乱，身体发热但不口渴，口燥无苔，六脉俱伏，疼痛在胃脘部，牵连到胸胁，病势非常汹涌。先给一碗地浆水，病势稍定，一会儿又发作，于是直接投予大承气汤一帖，疼痛随即下行至脐间；又一帖，疼痛又下行，潜伏在少腹右侧角落，按压则痛，不按则与常人无异。从发病至此，已经过了一个时辰（两小时），想吃饭非常急切，就用绿豆煮粥给他吃。吃完后一切恢复正常。只有少腹右侧角落，按压仍有小块，隐隐作痛，于是重用当归、枸杞、瓜蒌仁，佐以桃仁、红花，少量加入牛膝以引导药力。服用约一小时左右，腹中有声响，排出一块紫黑色的血块，长约五寸，于是少腹的痛块消失。此病治法原本出于一时的主观见解，然而竟然因此痊愈，特意记录出来，请教半痴先生，不知他认为如何。按：霍乱证，因暑热引起的居多，所以感受稍重，极易侵入营分。古人采用刺络放血，以及内服益母草汤、藕汁、童便，都是用来治疗营分的邪气。杨公子舌燥无苔且不渴，疼痛又波及胁肋，必定是平日偶尔有经络损伤而未察觉，于是邪气趁机乘虚而入。承气汤中的硝石、大黄，也都是血分药，气行则瘀血下降，所以疼痛得以逐渐下行。等到肿块存在且按压才痛，并且知道饥饿能进食，更可见气分之病已除，而血分之邪尚隐匿。无需再用承气汤直攻，改为滋润化解并曲折引导，操纵有法度，我佩服他手法和眼界的超群。
张景岳说饮食下行的道路，必然经过少腹右下侧角然后出于广肠（大肠末端），自夸是从阅历中得知，古人并未提及。大概他曾治疗一个人吃了面角（面食点心），杂用巴豆、大黄治疗无效。魏柳洲说：就此看来，张景岳平生临证，遗憾很多啊。面角由胃进入肠，既然到了少腹的角落，怎么可能疼痛如此剧烈。又像拳头又像鸡蛋，必定是此人素有疝气病，偶然因为吃面食而诱发，或者兼当日房事劳累，于是胀大如此，所以推荡的药不应验，得到木香火酒一派辛热香窜的药物疼痛才停止。至于说食物由少腹右下侧角而后出广肠，更让人捧腹大笑，《内经》说大小肠都盘曲十六个弯，那么左旋右折可知，难道像筒子像袋子一样直下吗？唉！关于杨公子少腹右侧角的疼痛，如果不是他父亲见识卓越，当时的医生一定会误认为是食滞，特别附录魏先生的话以扩大其义理，告诫那些崇尚张景岳的人。
山阴人田雪帆（名晋元）撰写《时行霍乱指迷》，辨正世俗所称的“吊脚痧”这一证候，认为这是真寒直中厥阴肝经，也就是霍乱转筋。初起先是腹痛，或者不痛，泻下清水，顷刻间数十次，少的十余次，不久即手足抽搐掣动，呕逆口噤，四肢厥冷声音嘶哑，脉微欲绝，舌头短缩眼眶凹陷，眼睛向上视，手足呈青紫色，或者遍身青筋硬凸如绳索，出汗脉绝。急性的，早晨发病晚上死亡。缓慢的，两三天或五六天死亡。世间的医生有的认为是暑湿，妄投凉泻药。有的认为是痧气，妄投痧药，几乎没有不致死的。适宜使用当归四逆加吴茱萸生姜汤，水煎后冷服。轻症，二三剂即可痊愈；重症，多服几剂，立即可以回生，真是神方啊。如果有呕吐的，加制半夏三钱，淡干姜一钱。如果口渴恣意饮水，舌苔黄，加姜汁炒黄连五分，作为反佐，这就是《内经》所说的“热因寒用”。腹中绞痛，名叫转筋入腹，加酒炒木瓜三钱。手足冷过肘膝，颜色见青紫，加制附子三钱。此证种种表现，都是肝经见证罢了。原因是坎中真阳，被邪寒逼迫，因而外越，所谓内真寒而外假热。只要通过脉象来辨别，自然不会有犹豫不决了。
寒邪侵犯厥阴导致霍乱转筋的情况，或许存在，岂可以以此概论时行疫病呢？果真是寒犯厥阴，而出现吐利汗出，则应当使用吴茱萸汤加减，或者乌梅丸法，不应当使用当归四逆加吴茱萸生姜汤。因为当归四逆汤，原本是桂枝汤加上当归、通草、细辛，作用是通血脉以疏肌表，不是汗出脉绝的证候所可以轻易尝试的。至于脉象不可凭信，必须以口渴、舌黄、喜欢冷冻饮料，作为辨别真热假寒的确凿依据。竟然敢颠倒其说法，曲解妄论，为何欺人太甚呢？书生纸上谈兵，喜欢发表想当然的议论，惑世诬民，大体都类似这样，不可不辨析清楚。所以附录于此。
The patient regained slight consciousness, but the sound of wailing and severe pain penetrated to neighboring homes. All physicians stated: "The pulse is fine as a silk thread; it is incurable" (When pain is extreme, the pulse often becomes fine and hidden).
The next day, a beggar monk came to the door. The family declined him, citing illness in the household. The monk said, "Why not ask me?" The family, having no other strategy, reluctantly allowed him entry. After one glance, the monk declared, "This is caused by accidentally ingesting snake essence." (His skills are truly miraculous! In the world, there are those who have read medical books thoroughly yet fail to recognize a single syndrome, claiming to be Confucian physicians. People, trusting their scholarship, consequently trust their medical skill, leading to mutual confusion. Although they kill daily without repentance or awakening, it is no wonder that eccentric hermits hide their tracks and retreat. It is truly lamentable.) He took a pill from his broken pouch, ground it with water, and administered it. After a short while, the patient sat up and vomited several objects resembling sparrow eggs. The monk said, "It is not finished yet." Subsequently, he vomited filth everywhere, expelling an object the size of a chicken egg. The monk said, "Now it is correct." Upon dissection, it was found to be a small snake coiled within blood clots. Seeing people, it immediately moved, making upward and downward motions. The illness had vanished, astonishing and subduing the entire family (I too am convinced). When asked for the reason, he replied, "It is old grain from many years ago; snakes mated upon it, and residual slime adhered to it. Accidentally entering the abdomen, this object formed. Soon it will be expelled through the chest and abdomen." The monk simply wrapped the snake and left. This case presented chaotic and turbulent symptoms, which were difficult to stabilize; only by distinguishing Yin and Yang could success be achieved. Although this syndrome was not Cholera (Huo Luan), the disease departed rapidly, resembling Dry Cholera (Gan Huo Luan) caused by food stagnation. Moreover, the turbulence of the condition was even more severe than that of Cholera. Without the talent to defeat enemies, possessing only empty scholarly fame, how could one quell such great chaos? Using medicine is like using troops; the beggar monk possessed this ability. I cite this case as a warning for restoring order, advising against employing personnel based solely on seniority or qualifications. Whenever sudden severe abdominal pain occurs after eating, without other corroborating symptoms, it is mostly due to accidental ingestion of toxic substances. Heavy use of Zijin Dan (Purple Gold Pill) or Yushu Dan (Jade Pivot Pill) ground and administered seems also effective.
Yang Suyuan treated his second son, who suffered from Dry Cholera in the summer of the Renzi year. Symptoms included fever without thirst, dry mouth with no tongue coating, all six pulses hidden, pain in the epigastrium radiating to the chest and hypochondrium, with a surging intensity. Initially, a bowl of Earth Slurry (Di Jiang) was given, slightly stabilizing the condition, but shortly after, it recurred. Therefore, Da Cheng Qi Tang (Major Order the Qi Decoction) was administered directly. One dose caused the pain to descend to the umbilicus; a second dose caused it to descend further, settling in the right corner of the lower abdomen. Pressing elicited pain; non-pressing felt normal compared to a healthy person. From onset to this point, two hours had passed. The patient urgently desired food, so Mung Bean Porridge was cooked and given. After eating, everything returned to normal. Only in the right corner of the lower abdomen did pressing reveal a small lump with dull pain. Consequently, heavy doses of Dang Gui (Angelicae Sinensis Radix), Gou Qi Zi (Lycii Fructus), and Gua Lou Ren (Trichosanthis Semen) were used, assisted by Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos), with a small amount of Niu Xi (Achyranthis Bidentatae Radix) to guide the action. After about an hour, sounds were heard in the abdomen, and a purple-black blood clot, approximately five cun long, was passed. The painful lump in the lower abdomen disappeared. This treatment method originated from a momentary subjective opinion, yet it resulted in recovery. It is recorded here to consult Mr. Ban Chi, asking for his opinion. Note: Most Cholera cases arise from Summerheat-Heat; thus, even slight exposure easily allows pathogens to enter the Ying (Nutritive) level. Ancients used pricking to release blood, and internally administered Yi Mu Cao Tang (Leonurus Decoction), Lotus Root Juice, and Child's Urine, all to treat pathogens in the Ying level. Yang Gongzi had a dry tongue with no coating and no thirst, and pain extended to the hypochondrium. This implies he likely had undetected collateral damage previously, allowing pathogens to exploit the flaw. Xiao Yao San's Rhubarb and Mirabilite are also blood-invigorating agents; when Qi moves, stasis descends, so the pain gradually subsided. When the mass remained and only hurt upon pressure, and hunger/ability to eat returned, it further indicated that Qi-level pathology had been cleared, while Blood-level pathogens remained latent. Direct attack with Da Cheng Qi Tang was unnecessary; instead, moistening transformation and indirect guidance were adopted. With proper manipulation, I admire his superior clinical insight.
Zhang Jingyue claimed that the pathway for food digestion must pass through the lower right corner of the lower abdomen before exiting into the Large Intestine (Guang Chang). He boasted this came from experience, though ancients never mentioned it. Presumably, he once treated a person who ate dough knots (Mian Jiao); various attempts with Ba Dou (Croton Seed) and Da Huang (Rhei Radix et Rhizoma) failed. Wei Liuzhou commented: Judging by this, Zhang Jingyue had many regrets in his lifetime clinical practice. Dough knots travel from the Stomach to the Intestines; reaching the lower abdominal corner, how could it cause such intense pain? Furthermore, being fist- or egg-sized suggests the person likely had pre-existing hernia issues, triggered by eating dough or perhaps sexual exertion that day, causing such distension. Hence, purgatives were ineffective, while warm, acrid, aromatic herbs like Wood Fire Incense Wine stopped the pain. As for the claim that food exits via the lower right abdominal corner into the Large Intestine, it is laughable. The Classics state the Small and Large Intestines are coiled sixteen times; thus, twisting left and right is evident. How can they be like tubes or bags going straight down? Alas! Regarding Yang Gongzi's pain in the lower right abdomen, if not for his father's profound insight, contemporary physicians would likely have misdiagnosed it as food stagnation. I append Wei's words to broaden understanding, warning those who revere Zhang Jingyue.
Tian Xuefan (Jin Yuan) from Shanyin wrote *Shi Xing Huo Luan Zhi Mi* (Clarifying Epidemic Cholera), correcting the popular notion of "Diao Jiao Sha" (Hangman's Cholera). He argued this is True Cold directly invading the Jueyin Liver Meridian, i.e., Cholera with muscle cramping. Initial symptoms include abdominal pain (or none), watery diarrhea occurring dozens of times in moments, followed by limb convulsions, vomiting, inability to open the mouth, cold limbs, hoarseness, faint pulse, shortened tongue, sunken eye sockets, upward gaze, cyanotic hands and feet, or hard, rope-like protruding blue veins over the body, sweating, and absent pulse. Acute cases die from morning to evening. Slow cases die in two to three or five to six days. Physicians often mistake it for Summerheat-Dampness, wrongly administering cooling purgatives. Or they mistake it for Sha Qi, wrongly administering Sha medicines. Few survive. The appropriate formula is Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Four Reversal Decoction plus Evodia and Fresh Ginger Decoction), decocted and taken cold. Mild cases heal in two to three doses; severe cases recover instantly with continued dosage. It is a divine prescription. For vomiting, add Zhi Ban Xia (Prepared Pinellia Tuber) 3 qian and Dan Gan Jiang (Lightly Dried Ginger) 1 qian. For excessive thirst and yellow tongue coating, add Jiang Zhi Chuan Lian (Ginger-processed Coptis Rhizome) 5 fen as a counter-agent, following the Classic principle of "treating heat with cold." For colicky abdominal pain named "cramping entering the abdomen," add Jiu Chao Mu Gua (Wine-fried Quince Fruit) 3 qian. For cold limbs extending past elbows and knees with cyanosis, add Zhi Fu Zi (Prepared Aconite Lateral Root) 3 qian. These manifestations are all signs of the Liver Meridian. The reason is that the True Yang in Kan (Kidney/Water) is forced outward by pathogenic cold, known as internal true cold with external false heat. Differentiation by pulse alone removes hesitation.
While Cold invading Jueyin causing Cholera cramps may exist, one cannot generalize epidemic diseases based on this. If it were truly Cold invading Jueyin with vomiting, diarrhea, and sweating, Wu Zhu Yu Tang (Evodia Decoction) modified or Mei Wan Method (Mume Pill) should be used, not Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang. Because Dang Gui Si Ni Tang is originally Gui Zhi Tang (Cinnamon Twig Decoction) plus Dang Gui, Tong Cao (Tetrapanacis Medulla), and Xi Xin (Asari Radix), designed to unblock vessels and release the exterior; it is not suitable for conditions with sweating and absent pulse. When the pulse is unreliable, thirst, yellow tongue coating, and preference for cold drinks are definitive evidence for distinguishing True Heat from False Cold. To reverse this logic and offer wild interpretations is excessively deceptive. Scholars discussing war on paper, fond of presumptuous arguments, confuse the world and deceive the people; this is typical. It must be辨析 (analyzed/clearly distinguished). Hence, it is appended here.