。病者闻之，益形馁惫。其叔岳许杏书茂才，骇难主药。适族人许芷卿茂才过彼，遂与商之。芷
卿云∶此药岂容轻试，而病象甚危，必延半痴决之。时已乙夜，余往视，面色垢滞，苔腻唇
红，是既受暑热，骤为冷冻饮料冰伏，大气不能转旋，故肢冷脉伏，二便不行。所谓闭证也，何
脱之云。亟取六一散一两，以淡盐汤搅之，澄去滓，调下紫雪一钱。翼日再诊，脉见痛蠲，
溺
行肢热，口干舌绛，暑象毕呈，化而为疟，与多剂白虎法而痊。丙午举于乡，杏书多才尚义
，与余称莫逆，庚申春，闻其骂贼而死，呜呼荣矣。
（认证既确，治法用辛香以通冰伏之气，用意又极精妙，真可为万世法程。素园。）
室人徐氏素无病，胃亦强，且善作劳。丙午八月朔夜，犹镫下针黹，伴余勘书，
夜分忽泻二次，晨起为余疏发未毕，又泻一次。因诊之，脉七至而细促不耐按，略无病苦，
此脉病患不病，殆不始于今日，不可救药也。未便明言，即令安歇，密禀先慈。函致乃兄友珊
，请医商治，既而泻颇缓。且食山东挂面一小碗，先慈谓余太矜持矣，余方踌躇，面即吐出
，灌以参药亦不受，泻较紧，午刻医来，亦云无法，然尚能以乳哺女，而既吸之后，乳即瘪
而不起矣，形亦渐削，汗亦渐多，脉亦渐脱，音亦渐嘶，戌刻遽逝，斯人也性极贤淑，且隔
屏一听，即知客之贤否，一旦抱此绝证，知者无不悼惜，乃中气卒然溃散，绝无仅有之候也
。
戊申秋仲，张春桥令弟陡患腹痛。适饱啖羊肉面条之后，初作痧治，继作食治，痛愈甚而大
渴，然啜饮辄吐，二便不行。又作寒结治，其痛益加，呻吟欲绝，已交四日。余诊脉弦数
，苔干微黄，按腹不坚，非痧非食，特肝火郁而不宣耳。以海
烊频灌，果不吐，将余汁煎栀、连、茹、楝、知、芩、延
、旋覆、柿蒂、枇杷叶为剂，吞当归龙荟丸。投已，即溲行痛减，次日更衣，不劳余药而瘳
。
朱留耕忽于饱食后，大吐而厥，冷汗息微，厥甫回而腹痛异常，乃翁湘槎以为急痧霍乱之候
也。速余往勘，脉至弦缓，口极苦渴，二便不行，乃痰滞而热伏厥阴，肝气无从疏泄也，
予雪羹、萸、连、栀、楝、旋、茹、橘、核、元胡、苁蓉为剂，加芦菔汁和服，一剂痛减，
再服便行而愈。
（痧证霍乱挟食者，必先去食，伤寒亦然，秦氏论之详矣。然竟有病始饱食之余，
初非因食为患者，半痴尝云∶既无枵腹待病之理，岂可专以攻消为治，故临证必审问慎思而
明辨之，庶免颟顸贻误之弊。上二案，病皆起于食后，朱证已得大吐，不从食治，人或能之
。
，已非人所能及矣。余门人沈南台，癸丑冬患病，亦啖羊肉面条而起，势濒于危，得半痴治
愈，至四十余日，始更衣，则尤奇也，用药如用兵，岂徒读父书者之可为哉，仁和赵梦龄菊斋
陈妪年已七旬，辛亥秋，患霍乱转筋甚危。亟延余诊，已目陷形消，肢冷，音飒
，脉伏、无溺，口渴、汗多，腹痛、苔黄，自欲投井。因先取西瓜汁命与恣饮，方用石膏、
知母、麦冬、黄柏、芩、连、竹茹、木瓜、威灵仙，略佐细辛分许，煎成徐服，覆杯而瘥。
（医者能知少加细辛之何故，则可以言医矣。素园。
此方得效，可见辨证之的。若无汗而渴者，又当别论。谢城。）
姊丈李华甫继室，陡患霍乱，而兼溺血如注，头痛如劈，自汗息微，势极危殆，
速余诊视。脉甚弦 ，此肝火内炽，暑热外侵。以犀角、木通、滑
石、栀子、竹茹、薏苡、银花、茅根、菊叶
为大剂，和入藕汁，送当归龙荟丸，而吐泻即已，溺血亦减。惟小便时，头犹大痛，必使人
紧抱其头，重揿其巅，始可略耐。尚是风阳僭极，肺胃不清也。以苇茎汤去桃仁，加百合、
白薇、元参、小蓟、蒲公英、竹叶、西瓜翠衣、莲子心为方，和入童溺，仍吞龙荟丸，服旬
日全愈。
陈楚珍仲媳，陡患霍乱。云昨晚曾食冷鱼，夜分病作，想因寒致病也。然脐间贴以回阳膏而
不效，故敢求诊。余按脉滑数，右甚，口渴苔黄，令揣胸下，果坚硬而痛，曰∶吐泻虽多，
食尚恋膈，非寒证也，回阳膏亟宜揭去，以菖、枳、苏、连、芩、桔、茹、牛、海
、芦菔为剂，一服而瘳。
妇兄吴绿园，癸丑仲夏，陡患发热呕吐，茎缩腹痛。亟招余诊，脉弦软而数，苔色黄
腻，宜清厥阴蕴热，非痧也。予楝、茹、连、斛、栀、柏、银花、通草、丝瓜络为方，一
剂知，数剂愈。
沈HT 扬令妹，年逾五旬，体极瘦弱，始则数夜不能眠，忽一日目张不能阖，泪则常流，口闭
不能开，舌不能伸，语难出声，饮不下咽，足冷便秘，筋螈而疼，身硬
不柔，胸膈板闷，或谓暑痧重感，虑即虚脱。余视之，苔黄不渴，脉来弦细
软涩，重按如无，然神气不昏，身不发热，非暑痧也。二便艰涩，咽膈阻闷，非脱证也。殆
由情志郁结，怒木直升，痰亦随之，堵塞华盖，故治节不行，脉道不利也。但宜宣肺，气行
自愈。以紫菀、白前、兜铃、射干、菖蒲、枇杷叶、丝瓜络、白豆蔻为方，一剂知，四剂愈
。
（证者，证也，如断案之有证据也。然证有真有伪，有似是而非，以致恒为所眩，
如此案辨暑脱，则得其证矣。素园。证极危而方甚轻，其效乃如神，全由辨证之的。谢城。）
蒋敬堂令堂，年七十四，陡患呕泻，身热腹痛，神思不清。或以为霍乱，或虑其
虚脱。迎余诊之，脉微弱而数。曰∶暑脉自虚，不可以高年而畏脱，辛散痧药，则不免耗
伤
其津液，爰定芩、连、滑、斛、茹、柏、银花、竹叶、橘皮、枇杷叶之方，冬瓜汤煎，一剂
而热退神清，再剂霍然，敬堂慷慨多情，知医施药，余契友也。庚申春，闻其争先拒兵，竟
以被戕。惜哉。
徐德生家一婢，年十七矣。陡患腹痛，稍一言动，则痛不可支，以为急痧中恶，遍治不应。
飞请余往，尚以丹雄鸡强伏其心下，然神色如常，并不吐泻，脉来牢涩，苔色腻黄，乃多食
酸甘而汛阻也。询之果然，以桃仁、红花、生蒲黄、灵脂、香附、延胡、芍药、海
、芦菔为方，送龙荟丸，遂愈。
陈堂令郎子堂，甲寅春，连日劳瘁奔驰之后，忽然大便自遗，并非溏泻，继言腹痛，俄
即倦卧不醒，及唤醒，仍言腹痛，随又沉沉睡去，或以为痧，或以为虚，邀余决之，身不发
热，二便不行，舌无苔而渴，脉弦涩不调，非痧非虚，乃事多谋虑而肝郁，饥饱、劳瘁而脾
困，困而食滞于中也。予槟、枳、橘、半、楂、曲、菔、楝、元胡、海
，服二剂，痛移脐下，稍觉
知饥，是食滞下行矣。去楂、曲，加栀、芍，服一剂，更衣而愈。
（此证不难于认食滞，而难于认肝郁，且当劳倦后见嗜卧证，不以为痧，必以为虚
，而兼用参术以顾脾胃，如此则肝愈不舒，而变证作矣。半痴用药至轻，而奏效至捷，良
由手眼双绝。素园。
余尝问半痴曰，既肝郁于上，而食不下行矣，何以干矢自遗而不觉乎。半痴谓胃与大肠，
原一气相贯，惟其食滞于胃而不化，似与大肠气不相贯。故广肠宿粪出而不觉，经云∶中气
不足，溲便为之变，是亦变也。所谓不足者，非言中气虚也。以中气为病所阻，则不足于降
浊升清之职，故溲便为之改常也，余闻而折服其善读古书，宜乎临证之神明变化，令人莫测也
。因思霍乱之吐泻无度，干霍乱之便秘不行，皆变也，皆中气为病所阻，而不足于降浊升清
之职也，设泥不足为虚，则诸霍乱皆当补中气为治矣，于是益叹半痴阐发经旨为不诬。菊斋。
此说与前释邪之所凑，其气必虚之说，可以互证，谢城。）
姜秋农疟泻初痊，遽劳奔走，陡患霍乱转筋，面臂色紫，目陷音嘶，胸闷苔黄，
汗多口腻，神疲溲秘，脉细而弦。余以沙参、蚕矢、苡仁、竹茹、半夏、丝瓜络、木瓜、车前子、扁
豆叶，阴阳水煎，送左金丸一钱，外以吴萸一两研末，调涂涌泉穴，服后吐泻渐止。噫气不
舒，呃忒胁痛，汗减口燥，脘下拒按，脉软而弦，以素多肝郁也。去沙参、蚕矢、木瓜、车前
、左金，加紫菀、郁金、楝实、通草、枇杷叶，二帖。溲行呃止，苔退足温，腰胀腿痛，手紫
渐淡，去郁、菀、通、楝，加沙参、石斛、兰叶、鲜藕、稻露，亦二帖。脉和胀减，啜粥口
咸，体素阴亏也，去半夏、扁豆叶，加归身、花粉、橘皮，又二帖。大解行而安谷，腰酸少寐
，为易西洋参，加麦冬、羊藿以调之。数帖后，又加枸杞、杜仲而愈。
（此本虚标实之证，须看其先后用药之法。琴仙。
此证颇急，浅术必至张皇失措，半痴游刃有余，治标而不犯其本，用药与病机宛转相赴，
于此服其识之老。素园。）
仲韶弟主于叶氏，乙卯新秋，陡患洞泻如注，即浑身汗出如洗，恹恹一息。夤夜
速余往勘，脉来沉细，身不发热，俨似虚寒之证，惟苔色黄腻，小溲全无，乃湿热病也。予
桂苓甘露饮加浓朴，投匕而瘳。
丙辰仲夏，游武林，仁和胡次瑶孝廉妇，陡患肢麻昏晕，以为急痧，速余视之。面微红，
音低神惫，睛微赤，苔色微黄，足微冷，身微汗，胸微闷，脉微弦。乃本元
素
弱，谋虑萦思，心火上炎，内风随以上僭。岂可误作痧闭，妄投香散之药哉。以人参、龙、
蛎、菖、连、石英、麦冬、小麦、竹叶、莲子心为方，两啜而瘥。寻予平补善其后。次瑶醇
谨博学，与余交最深，久欲卜居结邻而未果，庚申之变，率妻外家登舟，将来海昌，城闭不能
出，与兵遇，并一幼女殉节于河，可哀也已。
季杰之外家，秋夜陡患霍乱，腹痛异常，诊其脉细数而弦，肢冷畏寒，盖覆甚浓，询其口不渴
，而泻亦不热，然小便全无，吐者极苦，舌黄甚赤。新凉外束，伏暑内发也。绛雪、玉枢丹
灌之皆不受。泻至四五次，始觉渐热，而口大渴，仍不受饮，语言微蹇。余令捣生藕汁徐灌
之，渐能受。随以芩、连、苡、楝、栀、斛、桑、茹、蒲公英煎服，痛即减，吐泻亦止。改
用轻清法而愈。
丁巳秋，三侄寿和甫六岁，陡患凛寒身热，筋螈面红，谵妄汗频，四肢厥冷，苔色黄腻，口
渴唇红，时邪夹食也。以枳实栀豉汤加菖蒲，及冬干芦菔菜。煎成，调入玉枢丹五分灌之。
次日谵螈皆减，而腹痛吐泻，邪欲转霍乱以外泄也。余尝谓不但伤寒可转霍乱，而温热暑
湿，皆可转霍乱也。治当迎刃而导之，于前方加苏叶一分，黄连二分，同炒煎服。连吐三五
次，泻六七次，痛即减。第三日神始爽慧，然去疾莫如尽，再服原方一剂，遂愈。凡小儿之
病，因于食滞者多，胃不和则卧不安，阳明实则谵螈。若吐泻乃病之出路，而世人动辄以惊
风药治之，每致偾事。昧者更惑于巫瞽，而祭非其鬼，尤可嗤也。余居
溪七载，家人虽屡患大证，未尝一用巫瞽，亦未伤人，乡人目以为异。庚申
秋，季杰之病甚危，寿萱侄求签于观音，大凶，其外家欲事祈祷，余力止之，卒以治愈。附识
之，以戒我后人。
辛酉秋，余息濮院，盛行霍乱转筋之证。一男子胸次拒按，余以芦菔子、枳实、槟榔等导
之
。又某赤膊不容盖覆，犹云五内如焚，目陷音嘶，苔黄大渴，而啜饮即吐，肢厥脉伏。市
医
令服姜汤一杯，幸不受。适余至，亟取冷雪水，命将小匙徐灌之，遂不吐。更以石膏、黄连
、知母，泻其逆冲之火而愈。
钱某患霍乱，兼吐蛔十余条，而口干脉细，是暑伏厥阴，以犯中也。以连、梅、茹、楝、苡
、斛、苏、芩清之而愈。
陈某患霍乱，而所下皆血，苔黄大渴，而舌色紫黯，乃暑毒深伏。起病时，又饮烧酒也。用
犀
角、益母、地丁、茅根、菖蒲、绿豆、银花、芩、连、黄柏、藕汁大剂灌之。皆投匕而瘥。
一妇积虚患时症，汗出如浴，形脱声嘶，脉微欲绝，为亡阳之候。予附子理中汤加白芍、茯
苓、木瓜、苡仁、蚕沙。而汗收脉起，随去姜、附，加黄 ，证渐平。去蚕沙，加橘、半，
调补而安。
刘氏妇患病，已两月不纳谷矣。忽吐泻转筋，舌光声哑，气液两亡也。亟以人参、炙草、石
脂、余粮、龙、牡、斛、芍、木瓜、乌梅、冬虫夏草为方，服两剂，音开脉续，诸证皆平。所
亲
沈则甫，按法调补而瘳。吴氏子患此，脉微弱，舌色淡红，口微渴，此本虚邪不盛也。宜清
解药中，加参以扶正气，则甫亦如法施治而愈。
今年三月间，吕君慎庵言一童子在邻嬉戏，陡然吐泻转筋，归家即毙。余以为偶然有此一证
耳，既而闻患此证者渐多。四月初，有余杭纸客，在舟次病此，抵濮院，乞余诊。已舌卷囊
缩，形脱神离，不可救药矣。口开苔黑，询中途并未服药。窃谓此病之盛行，多在夏秋暑湿之
时，何以今春即尔。谛思其故，暑湿既可伏至深秋而发为霍乱，则冬伤于寒者，至春不为
温病，亦可变为霍乱也。虽为温病之变证，而温即热也，故与伏暑为病，不甚悬殊。或曰∶此揣
度当然耳。仲圣但有五苓、理中治伤寒转霍乱法，未有治温病转霍乱之法，何耶？余谓古书
病人听到这话，更加显得疲惫不堪。他的叔岳许杏书（秀才），对主治医生感到惊骇和为难。恰逢族人许芷卿（秀才）路过那里，于是与他商量。许芷卿说：“这药怎么可以轻易尝试？而且病象非常危险，必须请半痴（王士雄号）来决断。”当时已是深夜，我去诊视，病人面色污浊晦滞，舌苔腻而唇红，这是既受了暑热，又突然被冷冻饮料冰伏，导致大气不能转旋，所以四肢冰冷、脉伏，大小便不通。这就是所谓的闭证，怎么能说是脱证呢？急忙取六一散一两，用淡盐汤搅匀，澄清去渣，调服紫雪一钱。第二天再诊，脉象疼痛消失，小便通利，肢体发热，口干舌绛，暑热之象完全显露，转化为疟疾，给予多剂白虎汤法治疗而痊愈。丙午年许杏书中举人，他多才且崇尚义气，与我称兄道弟，感情深厚。庚申春，听说他因骂贼而死，唉，真是光荣啊。
（辨证既然准确，治法用辛香药物以通达冰伏之气，用意又极其精妙，真可以作为万世的法则。素园评。）
我的妻子徐氏平时没有病，胃气也强，而且善于劳作。丙午八月初一夜，还在灯下做针线活，陪伴我校对书籍，半夜忽然腹泻两次，早晨起来为我梳理未完成的头发，又腹泻一次。因此为她诊脉，脉象七至而细促，不耐重按，她略微没有什么病苦感觉，这种脉象是“病患不病”（指脉象显示病情危重但患者无自觉症状），大概不是从今天才开始的，是不可救药的。不便明说，就让她安歇，秘密禀告先母。写信给她的哥哥友珊，请医生商量治疗，后来腹泻稍微缓解。而且吃了一小碗山东挂面，先母说我太拘谨了，我正犹豫不决时，食物随即吐出，灌服参药也不能接受，腹泻变得紧迫，中午医生来了，也说没有办法，然而她还能用乳汁喂养女儿，但在吸吮之后，乳房立即瘪陷而不充盈了，形体也逐渐消瘦，汗出逐渐增多，脉象逐渐虚脱，声音逐渐嘶哑，戌刻突然去世。这个人性格极贤惠淑良，而且隔着屏风听人说话，就能知道客人的贤良与否，一旦患上这种绝症，知情者无不哀悼惋惜，这是中气突然溃散，绝无仅有的征候啊。
戊申年秋初，张春桥的弟弟突然患腹痛。恰好是在饱食羊肉面条之后，起初当作痧证治疗，继而又当作食积治疗，疼痛更加厉害且大渴，然而喝水就吐，大小便不通。又当作寒结治疗，疼痛加剧，呻吟欲绝，已经过了四天。我诊察脉象弦数，舌苔干微黄，按压腹部不坚硬，不是痧也不是食积，只是肝火郁结而不能宣发罢了。用海蜇（烊化）频频灌服，果然不吐，将剩下的汁液煎煮栀子、黄连、竹茹、川楝子、知母、黄芩、延胡索、旋覆花、柿蒂、枇杷叶为剂，吞服当归龙荟丸。服药后，小便即通，疼痛减轻，第二天大便通畅，不需其他药物而痊愈。
朱留耕忽然在饱食后，剧烈呕吐并出现厥逆，冷汗出，气息微弱，厥逆刚回而腹痛异常，他的父亲湘槎认为是急痧霍乱的征候。急忙请我去诊视，脉象弦缓，口极苦渴，大小便不通，这是痰滞而热伏于厥阴，肝气无法疏泄所致，给予雪羹汤（海蜇、荸荠）、山茱萸、黄连、栀子、川楝子、旋覆花、竹茹、橘皮、橘核、元胡、肉苁蓉为剂，加入芦菔汁调和服用，一剂后疼痛减轻，再服则二便通利而痊愈。
（痧证霍乱挟有食积的，必定先去食积，伤寒也是如此，秦氏论述得很详细了。然而竟有病起于饱食之余，最初并非因为饮食致病的情况，半痴曾说：“既然没有空腹等待生病的道理，怎么能专门以攻消作为治疗方法，所以在临证时必须审问慎思而明辨之，这样才能避免糊涂贻误的弊端。以上两案，病都起于食后，朱某的证候已经得到剧烈呕吐，不从食积治疗，别人或许能做到。[此处原文似有缺漏或排版错误，结合语境应指另一案例的治疗难度]，已非一般人所能达到。我的门人沈南台，癸丑冬患病，也是吃羊肉面条而起，病势濒临危险，得半痴治愈，直到四十多天，才大便通畅，这尤其奇特啊。用药如用兵，岂是只读父书的人所能做到的吗？仁和赵梦龄菊斋陈妪，年已七十岁，辛亥秋，患霍乱转筋非常危险。急忙请我诊视，已经目陷形消，肢冷，声音飒飒，脉伏、无尿，口渴、汗多，腹痛、苔黄，自己想要投井自尽。因此先取西瓜汁命令她恣意饮用，方用石膏、知母、麦冬、黄柏、黄芩、黄连、竹茹、木瓜、威灵仙，略佐细辛少许，煎成后慢慢服用，喝完一杯就痊愈了。
（医者能知道少加细辛的缘故，就可以谈论医学了。素园评。此方得效，可见辨证确切。若无汗而渴者，又当别论。谢城评。）
姐夫李华甫的继室，突然患霍乱，兼见溺血如注，头痛如劈，自汗气息微弱，病势极危殆，急忙请我诊视。脉象甚弦，这是肝火内炽，暑热外侵。用犀角、木通、滑石、栀子、竹茹、薏苡仁、银花、茅根、菊叶为大剂，调入藕汁，送服当归龙荟丸，而呕吐腹泻即止，溺血也减少。只是在小便时，头仍然剧痛，必须让人紧紧抱住他的头，重按头顶，才可以稍微忍受。还是风阳僭越至极，肺胃不清所致。用苇茎汤去掉桃仁，加百合、白薇、玄参、小蓟、蒲公英、竹叶、西瓜翠衣、莲子心为方，调入童便，仍吞服龙荟丸，服用十天全愈。
陈楚珍的二儿媳，突然患霍乱。说昨晚曾吃过冷鱼，半夜发病，想是因为寒邪致病。然而在脐间贴上回阳膏而没有效果，所以才敢求诊。我按脉滑数，右侧更甚，口渴苔黄，令其揣摸胸下，果然坚硬而痛，说：“呕吐腹泻虽然多，食物尚留恋膈间，不是寒证，回阳膏应当赶快揭去，用石菖蒲、枳实、苏梗、黄连、黄芩、桔梗、竹茹、牛膝、海蜇、芦菔为剂，一服而痊愈。
妻子的哥哥吴绿园，癸丑年仲夏，突然患发热呕吐，阴茎收缩腹痛。急忙招我诊视，脉象弦软而数，舌苔色黄腻，宜清厥阴蕴热，不是痧证。给予川楝子、竹茹、黄连、石斛、栀子、黄柏、银花、通草、丝瓜络为方，一剂见效，数剂痊愈。
沈扬之妹，年过五十，身体极瘦弱，开始几夜不能睡眠，忽一日眼睛张开不能闭合，流泪常流，嘴巴闭合不能张开，舌头不能伸出，说话难出声，饮水不下咽，脚冷便秘，筋脉抽搐而疼，身体僵硬不柔，胸膈板闷，有人说暑痧重感，担心立即虚脱。我看她，舌苔黄但不渴，脉来弦细软涩，重按如无，然而神气不昏，身体不发热，不是暑痧。二便艰涩，咽膈阻闷，不是脱证。大概是由情志郁结，怒伤肝木直升，痰也随之而上，堵塞肺脏（华盖），所以治节不行，脉道不利。只宜宣肺，气行自愈。用紫菀、白前、款冬花、射干、石菖蒲、枇杷叶、丝瓜络、白豆蔻为方，一剂见效，四剂痊愈。
（所谓证者，证据也，如同断案需要有证据一样。然而证有真有伪，有似是而非，以致常常被迷惑，像此案辨别暑脱，就得到了确切的证据。素园评。证候极危而方药很轻，其疗效乃如神，全由辨证确切。谢城评。）
蒋敬堂的母亲，年七十四岁，突然患呕吐腹泻，身热腹痛，神思不清。有人以为是霍乱，有人担心其虚脱。请我诊视，脉象微弱而数。说：暑脉自然虚弱，不可以因为高龄而畏惧脱证，辛散痧药，则不免耗伤其津液，于是定黄芩、黄连、滑石、石斛、竹茹、黄柏、银花、竹叶、橘皮、枇杷叶之方，用冬瓜汤煎服，一剂而热退神清，再剂霍然痊愈。敬堂慷慨多情，懂医施药，是我的契友。庚申春，听说他争先抵抗敌军，竟然被杀害。可惜啊。
徐德生家一婢女，年十七岁。突然患腹痛，稍一言动，则痛不可支，以为是急痧中恶，遍治不应。飞马请我去，还以丹雄鸡强压其心下，然而神色如常，并不吐泻，脉来牢涩，苔色腻黄，这是多食酸甘之物而月经阻滞所致。询问后确实如此，用桃仁、红花、生蒲黄、五灵脂、香附、延胡索、芍药、海蜇、芦菔为方，送服龙荟丸，遂痊愈。
陈堂的儿子子堂，甲寅春，连日劳瘁奔驰之后，忽然大便自遗，并非溏泻，继言腹痛，俄顷即倦卧不醒，及唤醒，仍言腹痛，随又沉沉睡去，有人以为是痧，有人以为是虚，邀我决断，身体不发热，二便不行，舌无苔而渴，脉弦涩不调，不是痧也不是虚，乃是事多谋虑而肝郁，饥饱、劳瘁而脾困，困而食滞于中。给予槟榔、枳实、橘皮、半夏、山楂、神曲、萝卜、川楝子、元胡、海蜇，服二剂，痛移脐下，稍觉知饥，这是食滞下行矣。去掉山楂、神曲，加栀子、芍药，服一剂，大便通畅而痊愈。
（这个证候不难于认出食滞，而难于认出肝郁，且在劳倦后见到嗜卧证候，不以为是痧，必以为是虚，而兼用参术以顾脾胃，这样则肝愈不舒，而变证作矣。半痴用药至轻，而奏效至捷，良由手眼双绝。素园评。
我曾问半痴说：“既然肝郁于上，而食不下行矣，何以干矢自遗而不觉乎？”半痴说：“胃与大肠，原一气相贯，惟其食滞于胃而不化，似与大肠气不相贯。故广肠宿粪出而不觉，《内经》云：‘中气不足，溲便为之变’，这也是变证。所谓不足者，并非言中气虚也。以中气为病所阻，则不足于降浊升清之职，故溲便为之改常也。”我听了而折服其善读古书，难怪临证的神明变化，令人莫测啊。因而想到霍乱的吐泻无度，干霍乱的便秘不行，都是变证，都是中气为病所阻，而不足于降浊升清之职也，如果拘泥于“不足”为虚，则诸霍乱皆当补中气为治矣，于是更加赞叹半痴阐发经旨为不诬。菊斋评。此说与前释“邪之所凑，其气必虚”之说，可以互证。谢城评。）
姜秋农疟疾腹泻初愈，遽然劳顿奔走，突然患霍乱转筋，面臂色紫，目陷音嘶，胸闷苔黄，汗多口腻，神疲溲秘，脉细而弦。我用沙参、蚕矢、薏苡仁、竹茹、半夏、丝瓜络、木瓜、车前子、扁豆叶，阴阳水煎服，送左金丸一钱，外用吴茱萸一两研末，调涂涌泉穴，服后吐泻渐止。噫气不舒，呃逆胁痛，汗减口燥，脘下拒按，脉软而弦，因为素多肝郁。去掉沙参、蚕矢、木瓜、车前子、左金丸，加紫菀、郁金、川楝实、通草、枇杷叶，二帖。小便通利呃止，苔退足温，腰胀腿痛，手紫渐淡，去掉郁金、紫菀、通草、川楝子，加沙参、石斛、兰叶、鲜藕、稻露，亦二帖。脉和胀减，喝粥口咸，体质素来阴亏，去掉半夏、扁豆叶，加归身、花粉、橘皮，又二帖。大便通畅而安谷，腰酸少寐，换用西洋参，加麦冬、淫羊藿以调之。数帖后，又加枸杞、杜仲而痊愈。
（这是本虚标实的证候，须看其先后用药之法。琴仙评。此证颇急，浅薄医术必至张皇失措，半痴游刃有余，治标而不犯其本，用药与病机宛转相赴，于此佩服其见识老练。素园评。）
仲韶的弟弟寄宿在叶氏家，乙卯年新秋，突然患洞泻如注，即浑身汗出如洗，奄奄一息。深夜急忙请我去诊视，脉来沉细，身不发热，俨似虚寒之证，惟舌苔色黄腻，小溲全无，这是湿热病。给予桂苓甘露饮加厚朴，投匕而痊愈。
丙辰年仲夏，游历武林，仁和胡次瑶孝廉的妻子，突然患肢麻昏晕，以为是急痧，急忙请我诊视。面微红，音低神惫，睛微赤，苔色微黄，足微冷，身微汗，胸微闷，脉微弦。这是本元素质弱，谋虑萦思，心火上炎，内风随之以上僭。岂可误作痧闭，妄投香散之药哉。用人参、龙骨、牡蛎、石菖蒲、黄连、紫石英、麦冬、小麦、竹叶、莲子心为方，两啜而痊愈。随后给予平补善其后。次瑶醇谨博学，与我交最深，久欲卜居结邻而未果，庚申之变，率妻外家登舟，将来海昌，城闭不能出，与兵遇，并一幼女殉节于河，可哀也已。
季杰的外家，秋夜突然患霍乱，腹痛异常，诊其脉细数而弦，肢冷畏寒，盖覆甚浓，询其口不渴，而泻亦不热，然小便全无，吐者极苦，舌黄甚赤。新凉外束，伏暑内发也。绛雪、玉枢丹灌之皆不受。泻至四五次，始觉渐热，而口大渴，仍不受饮，语言微蹇。我令捣生藕汁慢慢灌之，渐能受。随即用黄芩、黄连、薏苡仁、川楝子、栀子、石斛、桑叶、竹茹、蒲公英煎服，痛即减，吐泻亦止。改用轻清法而痊愈。
丁巳秋，三侄寿和甫六岁，突然患凛寒身热，筋脉抽搐面红，谵妄汗频，四肢厥冷，苔色黄腻，口渴唇红，时邪夹食也。用枳实栀豉汤加石菖蒲，及冬干芦菔菜。煎成，调入玉枢丹五分灌之。次日谵妄抽搐皆减，而腹痛吐泻，邪欲转霍乱以外泄也。我曾谓不但伤寒可转霍乱，而温热暑湿，皆可转霍乱也。治当迎刃而导之，于前方加苏叶一分，黄连二分，同炒煎服。连吐三五次，泻六七次，痛即减。第三日神始爽慧，然去疾莫如尽，再服原方一剂，遂愈。凡小儿之病，因于食滞者多，胃不和则卧不安，阳明实则谵妄抽搐。若吐泻乃病之出路，而世人动辄以惊风药治之，每致偾事。昧者更惑于巫瞽，而祭非其鬼，尤可嗤也。我居住溪上七载，家人虽屡患大证，未尝一用巫瞽，亦未伤人，乡人目以为异。庚申秋，季杰之病甚危，寿萱侄求签于观音，大凶，其外家欲事祈祷，我极力阻止之，卒以治愈。附识之，以戒我后人。
辛酉秋，我居住在濮院，盛行霍乱转筋之证。一男子胸次拒按，我用芦菔子、枳实、槟榔等导之。又某赤膊不容盖覆，犹云五内如焚，目陷音嘶，苔黄大渴，而啜饮即吐，肢厥脉伏。市医令服姜汤一杯，幸不受。适余至，亟取冷雪水，命将小匙慢慢灌之，遂不吐。更以石膏、黄连、知母，泻其逆冲之火而痊愈。
钱某患霍乱，兼吐蛔十余条，而口干脉细，是暑伏厥阴，以犯中也。用黄连、乌梅、竹茹、川楝子、薏苡仁、石斛、苏梗、黄芩清之而痊愈。
陈某患霍乱，而所下皆血，苔黄大渴，而舌色紫黯，乃暑毒深伏。起病时，又饮烧酒也。用犀角、益母草、地丁、茅根、石菖蒲、绿豆、银花、黄芩、黄连、黄柏、藕汁大剂灌之。皆投匕而痊愈。
一妇人积虚患时症，汗出如浴，形脱声嘶，脉微欲绝，为亡阳之候。给予附子理中汤加白芍、茯苓、木瓜、薏苡仁、蚕沙。而汗收脉起，随去姜、附，加黄芪，证渐平。去蚕沙，加橘皮、半夏，调补而安。
刘氏妇患病，已两月不纳谷矣。忽然吐泻转筋，舌光声哑，气液两亡也。紧急用人参、炙甘草、赤石脂、禹余粮、龙骨、牡蛎、石斛、芍药、木瓜、乌梅、冬虫夏草为方，服两剂，音开脉续，诸证皆平。所亲沈则甫，按法调补而痊愈。吴氏子患此，脉微弱，舌色淡红，口微渴，此本虚邪不盛也。宜清解药中，加参以扶正气，则甫亦如法施治而痊愈。
今年三月间，吕君慎庵言一童子在邻嬉戏，陡然吐泻转筋，归家即毙。我以为偶然有此一证耳，既而闻患此证者渐多。四月初，有余杭纸客，在舟次病此，抵濮院，乞余诊。已舌卷囊缩，形脱神离，不可救药矣。口开苔黑，询中途并未服药。窃谓此病之盛行，多在夏秋暑湿之时，何以今春即尔。谛思其故，暑湿既可伏至深秋而发为霍乱，则冬伤于寒者，至春不为温病，亦可变为霍乱也。虽为温病之变证，而温即热也，故与伏暑为病，不甚悬殊。或曰：此揣度当然耳。仲圣但有五苓、理中治伤寒转霍乱法，未有治温病转霍乱之法，何耶？余谓古书
The patient, upon hearing this, appeared even more exhausted. His uncle-in-law, Xu Xingshu (a Shengyuan degree holder), was horrified and reluctant to prescribe medication. Coincidentally, a clansman, Xu Zhiqing (also a Shengyuan), passed by, so they consulted him. Zhiqing said, "How can this medicine be tried lightly? Moreover, the pathological manifestations are critical; one must invite Ban Chi [Wang Shixiong's pseudonym] to make the decision." It was already late at night. I went to examine him: his complexion was dull and greasy, with a greasy tongue coating and red lips. This indicated that he had contracted Summerheat-Heat, which was then suddenly frozen by cold beverages, causing the Great Qi to fail in its rotation. Consequently, his limbs were cold, the pulse was hidden (Fu), and both urination and defecation were obstructed. This is what is called a Closed Syndrome (Bi Zheng). How could it be described as a Collapsing Syndrome (Tuo Zheng)? I urgently took Liuyi San (Six-to-One Powder) in an amount of 30g, stirred it with light salt water, clarified it to remove the dregs, and mixed it with 3g of Zixue (Purple Snow). On the following day, during the second consultation, the pain in the pulse disappeared, urination resumed, and the limbs became warm. Dry mouth and a crimson tongue fully revealed the Summerheat pattern, which transformed into Malaria. After administering several doses of Baihu Tang (White Tiger Decoction), he recovered. In the Bingwu year, Xu Xingshu passed the provincial examination. He was talented and righteous, and we were bosom friends. In the spring of the Gengshen year, I heard that he died cursing the rebels; alas, what an honorable death!
(Once the syndrome differentiation is accurate, using acrid-aromatic herbs to unblock the frozen Qi is extremely ingenious. It truly serves as a model for all generations. Comment by Suyuan.)
My wife, Lady Xu, had no prior illness, possessed strong Stomach Qi, and was accustomed to hard labor. On the night of the first day of the eighth month in the Bingwu year, she was still doing needlework under the lamp, accompanying me in proofreading books. At midnight, she suddenly had two episodes of diarrhea. In the morning, while combing my unfinished hair for me, she had another episode. Upon examining her pulse, it was rapid (seven beats per breath), fine, and hurried, and could not withstand pressure. She felt little discomfort. This pulse presentation indicates that the disease is severe while the patient feels well, suggesting the condition likely did not start today and is incurable. I did not dare to say this openly but told her to rest and secretly informed my late mother. I wrote to her brother, You Shan, asking him to consult a physician. Subsequently, the diarrhea slowed down somewhat. She even ate a small bowl of Shandong wheat noodles. My late mother thought I was being too cautious. While I was hesitating, she vomited the food. Even when ginseng decoction was forced down, she rejected it. The diarrhea intensified. The doctor arrived at noon and also declared there was no treatment available. However, she was still able to breastfeed her daughter, but after nursing, her breasts collapsed and did not refill. Her body gradually emaciated, sweating increased, the pulse became increasingly deficient, and her voice grew hoarse. Suddenly, she passed away at Xu hour. This woman was extremely virtuous and kind; even listening through a screen, she could discern the character of guests. To fall victim to such a terminal illness, knowing people could not help but mourn her. This was a rare occurrence of sudden collapse of Middle Qi.
In early autumn of the Wushen year, the younger brother of Zhang Chunqiao suddenly suffered from abdominal pain. This occurred shortly after a heavy meal of mutton noodles. Initially treated as Sha syndrome (sand/summerheat stroke), then as food stagnation, the pain worsened accompanied by intense thirst. However, every sip of water caused vomiting, and both urination and defecation were blocked. Treated as Cold Knotting, the pain increased further, with groaning almost to the point of death. It had been four days. I examined his pulse: wiry and rapid. The tongue coating was dry and slightly yellow. Palpation of the abdomen revealed no hardness. This was neither Sha nor food stagnation, but rather Liver Fire constrained and unable to disperse. I frequently administered jellyfish (dissolved/hyalinized), which stopped the vomiting. The remaining juice was decocted with Gardenia, Coptis, Bamboo Shavings, Melia Azedarach, Anemarrhena, Scutellaria, Corydalis, Inula Flower, Persimmon Calyx, and Loquat Leaf as a formula, along with swallowing Danggui Longhui Wan (Angelica Sinensis and Dragon Gallbladder Pill). After administration, urination commenced, and pain decreased. The next day, bowel movement occurred, and he recovered without further medication.
Zhu Liugeng suddenly experienced severe vomiting and syncope after a full meal, with cold sweat and faint breathing. As syncope resolved, abnormal abdominal pain ensued. His father, Xiangcha, believed it to be acute Sha or Cholera. I was summoned urgently. The pulse was wiry and slow. His mouth was extremely bitter and thirsty, with no urination or defecation. This was Phlegm stagnation with Heat concealed in the Jueyin channel, preventing the free flow of Liver Qi. I prescribed Xue Geng Tang (Snow Soup - Jellyfish and Water Chestnut), Cornus, Coptis, Gardenia, Melia Azedarach, Inula, Bamboo Shavings, Tangerine Peel, Tangerine Seed, Corydalis, and Cistanche, mixed with Radish Juice. After one dose, pain decreased; after the second dose, urination and defecation resumed, and he recovered.
(For Sha and Cholera complicated by food stagnation, food must be eliminated first, just as in Taiyang Cold Damage. Qin’s discussion on this is detailed. However, there are cases where illness begins after a full meal, not caused by diet. Ban Chi once said: 'Since one does not wait for illness with an empty stomach, how can treatment focus solely on attacking and resolving stagnation?' Therefore, in clinical practice, one must inquire carefully, think deeply, and distinguish clearly to avoid errors due to ignorance. In the above two cases, the illnesses began after eating. In Zhu’s case, severe vomiting had already occurred, so treating the food stagnation was unnecessary; others might achieve this. [Text missing/corrupted here], but it implies a level of skill beyond ordinary reach. My disciple Shen Nantai fell ill in winter of the Guichou year, also triggered by eating mutton noodles. The condition was critical, cured by Ban Chi. It took over forty days for bowel movements to resume, which is particularly remarkable. Prescribing medicine is like deploying troops; it is not something those who merely read their fathers' books can do. Zhao Mengling Juzhai's grandmother Chen, aged seventy, in autumn of the Xinhai year, suffered from critical Cholera with tendon retraction. I was summoned urgently. She had sunken eyes, emaciation, cold limbs, raspy voice, hidden pulse, no urine, thirst, profuse sweating, abdominal pain, and yellow tongue coating. She wanted to throw herself into a well. I first ordered her to drink watermelon juice freely. The prescription included Gypsum, Anemarrhena, Ophiopogon, Phellodendron, Scutellaria, Coptis, Bamboo Shavings, Chaenomelos, and Clematis, with a trace of Asarum. Decocted and taken slowly, she recovered after one cup.
(Clinicians who understand the reason for adding a small amount of Asarum can speak of medicine. Comment by Suyuan. The efficacy of this formula shows precise syndrome differentiation. If there is no sweat but thirst exists, the approach would differ. Comment by Xie Cheng.)
My sister-in-law, the second wife of Li Huafu, suddenly developed Cholera accompanied by massive hematuria, splitting headache, spontaneous sweating, and faint breathing. The condition was extremely critical. Upon examination, the pulse was very wiry. This indicated blazing Liver Fire internally and invading Summerheat externally. A large dose was prepared with Rhinoceros Horn (substitute), Akebia, Talc, Gardenia, Bamboo Shavings, Coix Seed, Honeysuckle, Imperata Rhizome, and Chrysanthemum Leaves, mixed with Lotus Root Juice, and administered with Danggui Longhui Wan. Vomiting and diarrhea ceased immediately, and hematuria reduced. However, during urination, the headache persisted severely, requiring someone to hold her head tightly and press the vertex to endure it slightly. This indicated extreme hyperactivity of Wind-Yang and unclear Lung-Stomach Qi. I prescribed Weijing Tang (Reed Shoot Decoction) removing Peach Kernel, adding Lily Bulb, Anemarrhena, Scrophularia, Small Thistle, Dandelion, Bamboo Leaf, Watermelon Rind, and Lotus Plumule, mixed with child's urine, and continued Danggui Longhui Wan. After ten days, she fully recovered.
The second daughter-in-law of Chen Chuzhen suddenly developed Cholera. She reported eating cold fish the previous night, and the illness started at midnight, suggesting a cold-induced etiology. However, applying Huiyang Plaster (Restore Yang Plaster) to the navel was ineffective, hence she sought consultation. Her pulse was slippery and rapid, stronger on the right. She was thirsty with a yellow tongue coating. Palpation below the chest revealed hardness and pain. I said, "Despite frequent vomiting and diarrhea, food remains stuck in the epigastrium. This is not a Cold pattern. Remove the Huiyang Plaster immediately." The prescription consisted of Acorus, Immature Bitter Orange, Perilla Stem, Coptis, Scutellaria, Platycodon, Bamboo Shavings, Achyranthes, Jellyfish, and Radish. One dose resulted in recovery.
My wife's brother, Wu Lvyuan, in mid-summer of the Guichou year, suddenly developed fever, vomiting, penile retraction, and abdominal pain. Examination revealed a wiry, soft, and rapid pulse with a yellow-greasy tongue coating. This required clearing latent heat in the Jueyin channel, not Sha syndrome. The prescription included Melia Azedarach, Bamboo Shavings, Coptis, Dendrobium, Gardenia, Phellodendron, Honeysuckle, Tongcao, and Silk Gourd Network. One dose brought improvement, and several doses led to recovery.
Sister of Mr. Shen [Name obscured], over fifty years old, extremely emaciated. Initially, she suffered insomnia for several nights. Suddenly, her eyes opened but could not close, tears flowed constantly, mouth closed but could not open, tongue could not extend, speech was difficult, swallowing was impossible, feet were cold, constipation occurred, tendons twitched and hurt, the body was stiff and inflexible, and the chest/diaphragm felt board-like. Some suggested severe Summerheat-Sha, fearing immediate collapse. I observed a yellow tongue coating but no thirst. The pulse was wiry, fine, soft, and choppy, disappearing upon deep pressure. However, her spirit was clear, and she had no fever. This was not Summerheat-Sha. Difficulty in urination/defecation and obstruction in the throat/chest did not indicate collapse. It was likely due to emotional constraint causing Liver Wood to rise violently, carrying Phlegm upward to block the Lungs (Huagai), thus impairing regulatory functions and pulse flow. Treatment should focus on diffusing the Lungs; once Qi moves, health returns. The prescription included Aster, Cynanchum, Kopsia, Belamcanda, Acorus, Loquat Leaf, Silk Gourd Network, and White Cardamom. One dose improved symptoms, four doses cured her.
(The term 'Zheng' (Syndrome/Evidence) refers to evidence, like proof in a legal case. However, syndromes can be true or false, or seemingly correct yet incorrect, often leading to confusion. In this case, distinguishing Summerheat-Collapse yielded the correct evidence. Comment by Suyuan. The syndrome was critical, yet the prescription was mild; the effect was miraculous, entirely due to precise differentiation. Comment by Xie Cheng.)
Mother of Jiang Jingtang, aged 74, suddenly developed vomiting, diarrhea, fever, abdominal pain, and mental confusion. Some suspected Cholera, others feared collapse. Upon examination, the pulse was weak and rapid. I stated: "Summerheat pulses are naturally deficient. One should not fear collapse solely due to advanced age. Acrid-diffusing Sha medicines would consume Yin fluids." I prescribed Scutellaria, Coptis, Talc, Dendrobium, Bamboo Shavings, Phellodendron, Honeysuckle, Bamboo Leaf, Tangerine Peel, and Loquat Leaf, decocted in Winter Melon Soup. After one dose, fever subsided, and clarity returned. After two doses, she recovered completely. Jingtang was generous and knowledgeable about medicine; he was a close friend. In spring of Gengshen year, I heard he died resisting soldiers. What a pity.
A maid in Xu Desheng's household, aged 17, suddenly developed abdominal pain. Any movement or speech exacerbated the pain. Suspected as acute Sha or Evil Invasion, various treatments failed. I was summoned urgently. They had tried pressing a rooster on her epigastrium, but her expression was normal, with no vomiting or diarrhea. The pulse was firm and choppy, with a yellow-greasy coating. This was caused by excessive consumption of sour/sweet foods leading to menstrual obstruction. Inquiry confirmed this. The prescription included Peach Kernel, Safflower, Raw Polygonatum, Lygodium Spores, Cyperus, Corydalis, Peony, Jellyfish, and Radish, administered with Longhui Wan. She recovered.
Son of Chen Tang, Zitang, in spring of Jiayin year, after days of exhaustion and travel, suddenly experienced involuntary defecation (not loose stool), followed by abdominal pain. He soon lay down exhausted and unconscious. Upon waking, he complained of abdominal pain again and fell asleep. Some suspected Sha, others deficiency. Examination showed no fever, no urination/defecation, coated tongue absent but thirsty, and wiry-choppy irregular pulse. This was neither Sha nor deficiency. It was Liver constraint due to excessive worry/planning, and Spleen fatigue due to irregular meals and exertion, leading to food stagnation in the Middle. Prescription: Areca Nut, Immature Bitter Orange, Tangerine Peel, Pinellia, Hawthorn, Medicated Leaven, Radish, Melia Azedarach, Corydalis, Jellyfish. After two doses, pain moved below the umbilicus, and hunger sensations returned, indicating downward movement of stagnation. Removed Hawthorn and Leaven, added Gardenia and Peony. After one dose, bowel movement occurred, and he recovered.
(This syndrome is easy to identify as food stagnation but difficult to recognize Liver constraint. Seeing lethargy after fatigue, one usually suspects Sha or deficiency and uses Ginseng/Atractylodes to support Spleen/Stomach. This would further constrain the Liver and cause complications. Ban Chi used light prescriptions with rapid effects, demonstrating exceptional skill. Comment by Suyuan.
I once asked Ban Chi: 'If Liver Qi is constrained above and food cannot descend, why is there involuntary passage of dry stool without sensation?' He replied: 'Stomach and Large Intestine share one Qi. When food stagnates in the Stomach and fails to transform, it seems disconnected from Large Intestine Qi. Thus, feces in the rectum pass out without sensation. The Classic states: 'Deficiency of Middle Qi causes changes in urination and defecation.' This is also a change. 'Deficiency' here does not mean Middle Qi is weak. Rather, pathogenic factors obstruct Middle Qi, impairing its function of descending turbidity and ascending clarity, thus altering excretion.' I was convinced by his profound understanding of classics, explaining his divine clinical variations. Considering Cholera's uncontrolled vomiting/diarrhea and Gan Cholera's constipation, these are all changes caused by obstruction of Middle Qi, impairing descent/ascent functions. If 'deficiency' were interpreted strictly as weakness, all Choleras would require tonifying Middle Qi. Thus, I admire Ban Chi's elucidation of classic principles. Comment by Juzhai. This theory corroborates the statement 'Where evil gathers, Qi must be deficient.' Comment by Xie Cheng.)
Jiang Qiunong, recovering from malaria-diarrhea, suddenly exerted himself, developing Cholera with tendon retraction. Face and arms were purple, eyes sunken, voice hoarse, chest tightness, yellow tongue coating, profuse sweating, greasy mouth, mental fatigue, urinary retention, and fine-wiry pulse. I prescribed Glehnia, Vicia Faba, Coix Seed, Bamboo Shavings, Pinellia, Silk Gourd Network, Chaenomelos, Plantago Seed, and Ficus Leaf, decocted in Yin-Yang Water, with Zuojin Pill (Left Metal Pill). Externally, Evodia powder mixed with water was applied to Yongquan (KI-1). Vomiting and diarrhea gradually stopped. Belching, hiccups, and hypochondriac pain persisted, with reduced sweating, dry mouth, and epigastric tenderness. Pulse was soft and wiry, indicating chronic Liver constraint. Removed Glehnia, Vicia Faba, Chaenomelos, Plantago, and Zuojin Pill. Added Aster, Curcuma, Melia Azedarach, Tongcao, and Loquat Leaf. Two doses: urination resumed, hiccups stopped, coating faded, feet warmed. Lower back distension and leg pain remained, hand purple fading. Removed Curcuma, Aster, Tongcao, Melia. Added Glehnia, Dendrobium, Orchid Leaf, Fresh Lotus Root, and Rice Dew. Two doses: pulse harmonized, distension reduced. Eating porridge made mouth salty, indicating innate Yin deficiency. Removed Pinellia and Ficus Leaf. Added Angelica Root, Trichosanthes Root, and Tangerine Peel. Two doses: bowel movement regular, appetite restored. Lower back soreness and insomnia prompted substitution of American Ginseng, adding Ophiopogon and Epimedium for regulation. After several doses, adding Goji Berry and Eucommia led to recovery.
(This is a syndrome of root deficiency and branch excess. Observe the sequence of treatments. Comment by Qinxian. This case was urgent; superficial practitioners would panic. Ban Chi handled it with ease, treating the branch without harming the root. Medications matched the pathogenesis perfectly. I admire his mature insight. Comment by Suyuan.)
Younger brother of Zhongshao, staying at Ye's residence, in early autumn of Yimao year, suddenly developed profuse watery diarrhea, followed by profuse sweating, leaving him barely alive. Summoned urgently at night. Pulse was deep and fine. No fever. Resembled Deficient-Cold. Only yellow-greasy coating and complete absence of urine indicated Damp-Heat. Prescribed Guiling Ganlu Yin (Cassia Twig, Poria, and Sweet Dew Drink) plus Magnolia Bark. One dose cured him.
In mid-summer of Bingchen year, traveling in Wulin, I was summoned for the wife of Hu Ciyao (Xiaolian degree holder) who suddenly developed limb numbness and dizziness. Suspected acute Sha. Examination: slightly red face, low voice, exhausted spirit, slightly red eyes, slightly yellow coating, slightly cold feet, slight sweating, slight chest stuffiness, slightly wiry pulse. This was constitutional weakness, mental strain, Heart Fire flaring up, with internal Wind rising. Mistaking this for Sha closure and prescribing aromatic-diffusing drugs would be erroneous. Prescription: Ginseng, Dragon Bone, Oyster Shell, Acorus, Coptis, Purple Quartz, Ophiopogon, Wheat, Bamboo Leaf, and Lotus Plumule. Two doses led to recovery. Followed up with mild tonification. Ciyao was honest, rigorous, and learned; we were closest friends. I long wished to live near him, but it never happened. In the Gengshen turmoil, he fled with his wife and relatives by boat to Haichang. The city gates closed, and he encountered soldiers, dying with his young daughter for chastity. Truly sorrowful.
Relatives of Ji Jie, in autumn night, suddenly developed Cholera with severe abdominal pain. Pulse was fine, rapid, and wiry. Cold limbs, aversion to cold, heavy coverings. Mouth not thirsty, diarrhea not hot. Complete urinary retention. Vomitus extremely bitter. Tongue yellow and very red. External coolness constrained, latent Summerheat erupted. Jiangxue and Yushu Dan were refused. After 4-5 diarrheal episodes, warmth returned, intense thirst, refusal of drinks, slurred speech. I ordered fresh lotus root juice slowly administered. Gradually accepted. Then Scutellaria, Coptis, Coix, Melia, Gardenia, Dendrobium, Mulberry Leaf, Bamboo Shavings, and Dandelion were decocted. Pain decreased, vomiting/diarrhea stopped. Switched to light-clearing method for recovery.
Autumn of Dingsi year, third nephew Shouhefu, aged six, suddenly developed chills, fever, tendon twitching, red face, delirium, frequent sweating, cold limbs, yellow-greasy coating, thirst, and red lips. This was seasonal pathogen combined with food stagnation. Prescription: Zhi Shi Zhi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) plus Acorus and dried winter radish greens. Decocted, mixed with 0.15g Yushu Dan, and administered. Next day, delirium and twitching decreased, but abdominal pain, vomiting, and diarrhea occurred, indicating pathogens attempting to exit via Cholera pathway. I have always said that not only Cold Damage can transform into Cholera, but Warmth, Summerheat, and Dampness can too. Treatment should guide the pathogens. Added Perilla Leaf and Coptis to the previous formula, stir-fried and decocted. After 3-5 vomits and 6-7 diarrheas, pain decreased. Third day, mind cleared. To eliminate disease completely, one more dose of original formula cured him. Pediatric illnesses are often due to food stagnation. "When Stomach is discordant, sleep is restless." Yangming excess causes delirium/twitching. Vomiting/diarrhea are pathways for disease elimination. Worldly people often use Convulsion-Stop drugs, causing failure. Ignorant people are confused by shamans, worshipping wrong spirits, which is laughable. Living in Xi for seven years, my family suffered serious illnesses, but I never used shamans, nor did anyone get hurt. Locals found this strange. In autumn of Gengshen year, Ji Jie's illness was critical. Nephew Shouxuan sought fortune sticks from Guanyin, receiving a bad omen. Relatives wanted to pray. I strongly opposed it, and he recovered. I record this to warn future generations.
Autumn of Xinyou year, residing in Puyuan, Cholera with tendon retraction was prevalent. A man had epigastric tenderness. I used Radish Seed, Immature Bitter Orange, and Areca Nut to guide stagnation. Another man, shirtless, refusing covers, claimed inner burning, with sunken eyes, hoarse voice, yellow coating, intense thirst, vomiting upon drinking, cold limbs, and hidden pulse. City doctors prescribed ginger soup, fortunately rejected. Upon my arrival, I ordered cold snow water slowly administered with a small spoon, stopping vomiting. Then Gypsum, Coptis, and Anemarrhena were used to drain counterflowing Fire, curing him.
Mr. Qian suffered Cholera with vomiting of over ten roundworms, dry mouth, and fine pulse. This indicated Summerheat concealed in Jueyin invading the Middle. Cleared with Coptis, Sour Plum, Bamboo Shavings, Melia, Coix, Dendrobium, Perilla, and Scutellaria. Recovered.
Mr. Chen suffered Cholera with bloody stools, yellow coating, intense thirst, and purplish-dark tongue. This indicated deep-seated Summerheat-Toxin. He drank liquor at onset. Large dose of Rhinoceros Horn substitute, Motherwort, Clematis, Imperata, Acorus, Mung Bean, Honeysuckle, Scutellaria, Coptis, Phellodendron, and Lotus Root Juice cured him.
A woman with chronic deficiency contracted a seasonal illness. Sweating profusely, emaciation, hoarseness, pulse faint/almost absent. Indicated Yang Collapse. Prescribed Fuzi Lizhong Tang plus White Peony, Poria, Chaenomelos, Coix, and Silkworm Sand. Sweating stopped, pulse returned. Removed Ginger and Aconite, added Astragalus. Condition stabilized. Removed Silkworm Sand, added Tangerine Peel and Pinellia. Tonified and regulated for safety.
Mrs. Liu had not eaten for two months. Suddenly developed vomiting, diarrhea, and tendon retraction. Smooth tongue, hoarse voice. Qi and Fluids exhausted. Urgently prescribed Ginseng, Roasted Licorice, Red Halloysite, Yu Liang Stone, Dragon Bone, Oyster Shell, Dendrobium, Peony, Chaenomelos, Sour Plum, and Cordyceps. Two doses: voice returned, pulse resumed, symptoms平息. Relative Shen Zefu followed this method for recovery. Son of Wu family had similar symptoms: weak pulse, pale-red tongue, slight thirst. Root deficiency with mild pathogen. Added Ginseng to clearing/resolving herbs to support healthy Qi. Shen Zefu treated similarly with success.
In March this year, Mr. Lv Shen'an reported a child playing next door who suddenly developed vomiting, diarrhea, and tendon retraction, dying upon returning home. I thought it an isolated case. Later, more cases appeared. Early April, a paper merchant from Yuhang fell ill on a boat, arriving in Puyuan for consultation. Tongue curled, scrotum retracted, emaciation, spirit departed. Incurable. Mouth open, black coating. No medication taken en route. I pondered: this disease prevails in Summer-Autumn Damp-Heat. Why now in Spring? Deep reflection: if Damp-Heat can lie dormant until late Autumn to cause Cholera, then Winter Cold damage, failing to become Warm Disease in Spring, may also transform into Cholera. Although a variation of Warm Disease, Warm equals Heat, so it is not vastly different from latent Summerheat. Some say: "This is mere speculation. Master Zhang Zhongjing only has Wuling San and Lizhong Tang for Cold Damage transforming into Cholera, but no method for Warm Disease transforming into Cholera. Why?" I say ancient texts...