《素问·六元正纪大论》曰∶土郁之发，为呕吐霍乱。
诸郁之发，必从热化。土郁者，中焦湿盛，而升降之机乃窒。其发也，每因吸受暑秽，或饮
食停滞，遂至清浊相干，乱成顷刻，而为上吐下泻。治法，如燃照汤，宣土郁而分阴阳。
连
虽吐，犹当以盐汤探吐，吐尽其食，然后以驾轻、致和等汤调之。
又云∶不远热则热至，热至则身热吐下霍乱。
此明指霍乱有因热而成者。奈《病源》《三因》等书，咸谓霍乱本于风冷，遂致后人印定眼
目。凡患热霍乱者，率为药误，且不远热三字，亦非但以药食为言。如劳役于长途田野之间，则暑邪
自外而入。所谓热地如炉，伤人最速，宜白虎汤、六一散之类，甘寒以清之。或安享乎醇
酒膏
。
其有暑入伤元，白虎汤可以加参。气虚招感，用参术必佐清邪。昔贤成法，自可比例而施。
奈昧者，妄谓劳伤之病宜补，膏粱之体必虚。知其一，不知其二，信手温补，动辄残生，可
哀也已。
《至真要大论》曰∶诸热瞀螈，诸逆冲上，诸躁狂越，皆属于火。
瞀，昏闷也，螈，抽掣也。热伤神则瞀，火迫血则螈。火性炎上，故逆而冲上。躁，烦躁不安
也。狂，狂乱也。越失常度也。热盛于外，则肢体躁扰。热盛于内，则神志烦乱。盖火主动
，凡病之动者，皆属于火。霍乱而见此等证候者，皆为热邪内盛之的据也。
又曰∶诸转反戾，水液混浊；诸呕吐酸，暴注下迫，皆属于热。
诸转反戾，转筋拘挛也。热气燥烁于筋，则挛螈为痛，火主燔灼，躁动故也。水液，小便
也
热盛，则迫逆而上冲也。土爰稼穑，而味变酸者，肝热内燔，故从而化也。暴注，卒暴注泄也
。肠胃热盛而传化失常，火性疾速，故如是也。下迫，后重里急迫痛也。火性急速，而能燥物故也。
此
麻痧等俗名，而贸贸然妄投燥热之药，以促人天年，抑何不思之甚耶！
《千金要方》曰∶中热霍乱暴利，心烦脉数，欲得冷水者，以新汲井水，顿服一升。
郭白云曰∶治霍乱之法，惟《千金要方》，最为详备。
《治暑全书》曰∶暑气入腹，恶心腹痛，上吐下泻，泻如水注。
春分以后，秋分以前，少阳相火，少阴君火，太阴湿土，三气合行其政。故天之热气下，
地之湿气上。人在气交之中，受其蒸淫之气，由口鼻入而扰其中，遂致升降失司，清浊不
分。所泻者皆五脏之津液，急宜止之，然止非通因塞用之谓也。湿甚者，胃苓汤分利阴阳，
暑亦自去；热甚者，桂苓甘露饮清其暑火，湿亦潜消。若火盛之体，内本无湿，而但吸暑邪者
，白虎汤之类宜之。且脏性有阴阳之别。阴虚者火旺，虽病发之时，适犯生冷，而橘、朴等
只宜暂用；阳虚者湿胜，虽寒润之品，非其所宜，如胃苓汤已为合法。纵使体极虚羸，亦
不过补气清邪并用。若因其素禀之亏，而忘其现病之暑，进以丁、附、姜、桂之剂，真杀
人不转睫矣。凡伤暑霍乱，有身热烦渴，气粗喘闷，而兼厥逆躁扰者，慎勿认为阴证。但察其小便
必黄赤，舌苔必粘腻，或白浓，宜燃照汤，澄冷服
浑身青紫而死矣。甚或手足厥冷少气，唇面爪甲皆青，腹痛自汗，六脉皆伏，而察其吐出酸
秽，泻下臭恶，小便黄赤热短，或吐下皆系清水，而泻出如火，小便点滴，或全无者，皆是
热伏厥阴也。热极似阴，急作地浆，煎竹叶石膏汤服之。又有吐泻后，身冷如冰，脉沉欲
绝，汤药不下，或发哕，亦是热伏于内，医不能察，投药稍温，愈服愈吐，验其口渴，以凉水
与之即止，后以驾轻汤之类投之，脉渐出者生。然暑之为病，伤之骤，则发之暴；伤之渐，
则发之缓。故九月时候，犹多伏暑霍乱之证，医者不可不知。
《金匮》曰∶转筋之为病，其人臂脚直，脉上下行，微弦，转筋入腹者，鸡矢白散主之。
刘守真曰∶转反戾也，热烁于筋，则挛螈而痛。或以为寒客于筋者误也。盖寒主收引，然止
为厥逆禁固，屈伸不利，安得为转也。所谓转者，动也。阳动阴静，热证明矣。夫转筋者，
多由热甚，霍乱吐利所致。以脾胃土衰，则肝木自盛，而热烁于筋，故转筋也。夫发渴则为热，凡
霍乱转筋而不渴者，未之有也。
尤拙吾曰∶肝主筋，上应风木，肝病生风，则为转筋。其人臂脚直，脉上下行，微弦。经云
∶诸暴强直，皆属于风也。转筋入腹者，脾土虚而肝木乘之也。鸡为木畜，其矢微寒，而能
祛风湿以利脾气，故取以治是病焉。
张石顽曰∶呕吐泄泻者，湿土之变也，转筋者，风木之变也。
湿土为风木所克，则为霍乱转筋，平胃散加木瓜主之。有一毫口渴，即是伏热。凡术、附、
姜、桂，种种燥热之药，误服即死，虽五苓散之桂，亦宜慎用。雄案∶张氏此言，可谓先获
我心矣。盖仲圣虽立热多欲饮水者，五苓散主之之法，然上文有头痛恶寒之表证，仍是伤寒之
霍乱，故用两解之法，其虽兼表证而非风寒之邪，或本无表证而热甚口渴者，岂可拘泥成法
，不知变通，而徒藉圣人为口实哉。（透彻古人用法之意，是真读书人语。定州，杨照
藜识）
薛一瓢曰∶风自火生，火随风转，乘入阳明则呕，贼及太阴则泻，是名霍乱。窜
入筋中则挛急，流入脉络则反张，是名痉。故余曰，痉与霍乱，同出一源，但痉证多厥，霍
乱少厥。盖痉证风火闭郁，郁则逆势愈横，不免逼乱神明，故多厥。霍乱风火外泄，泄则邪
势外宣，不至循经而走，故少厥。此痉与霍乱之分别也。然痉证邪滞三焦，三焦乃火化，风
得火而愈扇，则逼入膻中而暴厥。霍乱邪走脾胃，脾胃乃湿化，邪由湿而停留，则淫及诸经
而拘挛，火郁则厥，火窜则挛，又痉与厥之遗祸也。痉之挛急，乃湿热生风，霍乱之转筋，乃
风来胜湿。（木克土也）痉则由经及脏而厥，霍乱则由脏及经而挛，总
由湿热与风
痉厥。
厥而不返者死。胃液干枯 ，火邪盘踞也。转筋入腹者死。胃液内涸，风邪独劲也。然
则胃中津液所关，顾不钜哉。厥证用辛开，泄胸中无形之邪也。干霍乱用探吐，泄胃中有形
之滞也。然泄邪而胃液不上升者，热邪益炽。探吐而胃液不四布者，风邪更张。终成死候，不
可不知。
雄案∶霍乱湿多热少，道其常也，至于转筋，已风自火出，而有胜湿夺津之势矣。余自髫年
，
必剧。自夏末秋初而起，直至立冬后始息。夫彤彤徂暑，湿自何来？
只缘今人蕴湿者多，暑邪易于深伏，迨一朝卒发，渐至
阖户沿村，风行似疫，医者不知原委，理中、四逆，随手乱投，殊可叹也！余每治愈此证，必
询其人。曰∶岂未病之先，毫无所苦耶。或曰∶病前数日，手足心如烙。或曰∶未病之前
，睹物皆红如火。噫！岂非暑热内伏，欲发而先露其机哉。智者苟能早为曲突徙薪之计，何至燎原
莫救乎？以胃液之存亡，决病情之生死，尤为精识；昧者肆行燥烈，助虐烁津，徒读父书，
可为痛哭。（道光元年，直省此证大作，一觉转筋即死。京师至棺木卖尽，以席裹身
而葬，卒未有识为何证者，俗传食西瓜者即死，故西瓜贱甚。余时年十一，
辄与同学人日日饱啖之，卒无恙。今读此论，则医学之陋，不独今日为然也
。素园杨照藜识）
（杨氏之论极是。余于是年亦日食西瓜，而阖家无染病者，即其验也。然是年霍乱，间有误
食西瓜而死者，为友人董铸范所亲见。盖宜服香薷之证，误信乩坛之
语，以致寒凉遏抑而毙也，是亦不可不知。故处方论治，非辨证不可。本论第二篇治法、西
瓜汁证法，有汗频二字最的。乌程汪曰桢谢城。）
王清任曰∶道光元年，病吐泻转筋者数省，都中尤甚，伤人过多。贫不能埋葬
者，国家发帑施棺，月余间，费数十万金。彼时医工，或云阴寒，或云火毒。余谓不分男、
妇、老、少，众人同病，即疫也（卓识名言）。或曰∶既是疫，何以芩、连、姜、
附
而得愈者，试看所流之血，尽是紫黑。岂不是疫火之毒，深入于营分哉？以疫邪自口鼻，由气管
达
名曰津门，津门上有一管，名曰津管，是由胃出精汁水液之道路。）水不得出，故上吐下
泻。初得病时，宜即用针刺尺泽穴，出紫黑血，则毒瓦斯外泄矣。盖人身气管，周身贯通，血
管周身亦贯通，尺泽左右四五根血管，刺之皆出血，皆可愈。尺泽上下刺之，亦可愈。一面
针刺，一面以解毒活血之药治之。
雄案∶王氏亲见脏腑而善针法，所论皆凿凿可信，非悬揣虚拟可比。
虽用药非其所长，而以解毒活血四字为纲，亦具有卓见。
《补亡论》曰∶《灵枢》五乱之证，惟乱于肠胃一证，名霍乱，故作吐利。其余四证，皆不
作吐利，只谓之乱气。昔柳州之疾，盖乱气干心之证，非霍乱也。
谓为干霍乱者虽谬，然尚不失为五乱之一，今则无复知乱气之名矣。
《治法汇》曰∶干霍乱，俗名搅肠痧。其状欲吐不吐，欲泻不泻，撩乱挥霍是也。急宜探吐
，得吐方可，不吐则死。《法》曰∶既有其入，必有其出，今有其入而不得其出者，痞塞也
，多死。得吐后，方可理气和中，随证调治。《医通》曰∶干霍乱，是土郁不能发泄，火热内炽，阴阳
不交之故。
或问∶方书皆言宿食与寒气相搏，何以独指为火耶？曰∶昏乱躁闷，非诸躁狂越之属火者乎
每致急死，非暴病暴死之属火者乎！但攻之太过，则脾愈虚；温之太过，则火愈炽；寒之太
过
也。
此证，病因非一。骤伤饮食者，宜探吐。宿食为患者，宜消导。气郁感邪者，宜宣豁。暑
火直侵者，宜清解。诸法并列于后，用者审之。
（虑其格拒，反佐以治，真精语也。桂苓甘露饮，治热证而用桂；通脉四
逆汤，治寒证而用猪胆汁，皆即此义。《梦影》中治陈妪一案，石膏、芩、连，加细辛少
许，燃照汤之用蔻仁，亦此义也。若寒证而用芩、连，热证而用姜、附，则正与病反，非反佐之
义矣。谢城。）
又曰∶脾胃喜香燥而恶臭湿。若素多湿滞而犯臭气，则正气郁遏，腹痛乃作。或
上连头额俱痛，或下连腰腿俱痛。有痛死不知人，少间复苏者；有腹痛不时上攻，水浆不入
，数日不已者。甚至欲吐不吐，欲泻不泻，或四肢厥逆，面青脉伏，或遍体壮热，面紫脉坚
，俱与生黄豆嚼之，觉香甜者，是臭毒也。急以烧盐探吐，或以童便制香附四五钱为末，
停汤顿服最效。举世有用水搭肩背及臂者，有以苎麻水湿刮之者，有以瓷碗油润刮之者，有
以
瓷锋针刺委中出血者，总欲使腠理开通之意耳。其脉多伏，或细小紧涩，或坚劲搏指，中带
促结，皆是阴逆阳伏之象。不可误认阴寒而投热药，虽砂仁之辛温香窜，亦不可轻用。若见面
青唇黑，脉劲搏指，厥逆喘促，多不可救也。
又曰∶触犯臭秽，而腹痛呕逆，刮其脊背，随发红斑者，俗谓之痧。甚则欲吐不吐，欲泻不
泻，干呕 痛者，曰绞肠痧。更有感恶毒异气而骤发黑痧，俗名番痧。卒然昏倒，腹
痛，面
汗出，或隐隐发斑，此毒邪 发于表也。亦有发即泻利厥逆，腹胀无脉者，此毒邪内伏，不能外发也。所患最
多有不及见斑而死者。经谓大气入于脏腑，虽不病而卒死是也。初觉，先将纸捻点淬头额，
即以荞麦焙燥，去壳取末三钱，凉开水调服；重者少顷再服即安。盖
荞麦能炼肠胃滓秽，降气
宽胸，而治浊滞，为痧毒之专药。其毒甚面黑者，急于两膝后委中穴，砭出黑血，以泄毒邪
。凡骤发之病，勿虑其虚，非此急夺，束手待毙。原夫此病与臭毒相类，与霍乱相似，乃疫
疠之最剧者。初起昏愦不省，脉多沉匿不显，或浑浑不清。勿以腹痛足冷而与温药，如荞
宜理气为先，如香苏散加薄荷、荆芥，辛凉透表；次则辟邪为
要，栀子豉汤加牛蒡、生甘草，解毒和中。表热势甚，清热为急，黄芩汤加连翘、木通，分利
阴阳。若见烦扰腹胀，脉来数疾，急投凉膈散，以竹叶易生姜，则毒从下夺。热剧神昏，虽
合三黄，多不可救。烦渴引饮，遗溺，速清阳明，白虎汤加葱豉，使毒从表化。斑点深赤，毒
在血分者，浓煎益母草，少投生蜜，放温恣服，取效最捷。以其专下恶血也，或加生莱菔汁半
杯，总取散血之功。以上诸法，在未经误药，庶可挽回一二。曾见一商，初到吴会，畅饮酣
歌，席间，霎时不安，索生姜汤一啜而逝。又有朔客，到枫觅汤澡浴，忽然眩晕呕逆，到舟
即毙（凡感受暑热秽疫诸邪者，大忌热汤澡身也）。更有误认伤寒，而
与发
（亦有误认寒证而与热剂，口鼻流血而死者）。变生反掌，不似时行，犹可迁
延数日也。
上海，特海陬一邑耳。二十年来，屡遭兵燹，乃沧海渐变桑田，外国之经营日广，苏省又
以
都会矣。然人烟繁萃，地气愈热，室庐稠密，秽气愈盛，附郭之河，藏垢纳污，水皆恶浊
不堪。今夏，余避地来游，适霍乱臭毒番痧诸证盛行，而臭毒二字，切中此地病因。奈医者
《素问·六元正纪大论》说：土气郁结发作时，会出现呕吐和霍乱。
各种郁结的发作，必然从热化生。土郁（中焦湿邪盛极），是因为中焦湿气过盛，导致气机升降受阻。其发作，往往因为吸入暑天秽浊之气，或饮食停滞不化，致使清浊之气相互干扰，顷刻间混乱，从而出现上吐下泻。治疗方法，如使用燃照汤，宣通土郁并分理阴阳。
虽然已经发生呕吐，仍应当用盐汤催吐，将胃中积食吐尽，然后再用驾轻汤、致和汤等方剂调理。
又说：不远离热邪则热邪至，热邪至则身体发热、呕吐腹泻并发霍乱。
这明确指出了霍乱有因热邪引起的。无奈《诸病源候论》《三因极一病证方论》等书，都称霍乱本源于风冷，导致后人眼光被固定。凡是患热霍乱的，大多被药物误治，而且“不远热”这三个字，也不仅仅是指药物和食物而言。如在长途田野间劳作，暑邪便从外侵入。所谓“热地如炉，伤人最速”，适宜用白虎汤、六一散之类甘寒之品来清热。或者安享醇酒厚味。
若有暑邪侵入损伤元气，白虎汤可以加入人参。气虚招致感邪，用人参、白术必须佐以清解邪气的药物。前贤的成法，自然可以类比施行。
无奈愚昧之人，胡乱认为劳伤之病宜用补法，膏粱厚味之体必定虚弱。知其一不知其二，信手施用温补，动辄残害生命，真是可悲啊。
《素问·至真要大论》说：各种热病导致的昏闷抽搐，各种气逆冲上的症状，各种烦躁狂乱失常的表现，都归属于火。
瞀（mào），是昏闷的意思；螈（yuán），是抽搐掣动的意思。热邪伤神则昏闷，火邪迫血则抽搐。火性炎上，所以气逆冲上。躁，是烦躁不安。狂，是狂乱。越，是失常度。热盛于外，则肢体躁扰；热盛于内，则神志烦乱。大概火性主动，凡是有动象的病，都归属于火。霍乱如果出现这些证候，都是热邪内盛的确凿证据。
又说：各种筋脉转侧反折拘挛，小便浑浊；各种呕吐酸水，急性暴注下迫，都归属于热。
诸转反戾，是指转筋拘挛。热气燥烁筋脉，则抽搐疼痛，火主燃烧灼热，故躁动。水液，指小便。热盛，则逼迫气逆而上冲。土爰稼穑（土的特性是种植和收获），而味道变酸的，是因为肝热在内焚烧，所以随之化酸。暴注，是突然剧烈的泄泻。肠胃热盛而传导功能失常，火性疾速，所以如此。下迫，是里急后重腹痛。火性急速且能燥物，所以如此。
这是麻痧等俗名，却贸然妄投燥热之药，加速人的死亡，是何等不思量啊！
《千金要方》说：中热霍乱导致剧烈腹泻，心烦脉数，想要喝冷水的，用新打的井水，一次性服用一升。
《治暑全书》说：暑气进入腹部，恶心腹痛，上吐下泻，泻下如水注。
春分以后，秋分以前，少阳相火、少阴君火、太阴湿土，三气共同行使政令。所以天之热气下降，地之湿气上升。人处于天地气交之中，受其蒸腾淫溢之气，由口鼻进入扰乱中焦，致使升降失司，清浊不分。所泻出的都是五脏的津液，急需止住，然而止泻并非指“通因通用”的反面那种堵塞之法。湿邪重的，用胃苓汤分利阴阳，暑邪自然去除；热邪重的，用桂苓甘露饮清解暑火，湿邪也潜消。如果是火旺体质，体内本无湿，只是吸入暑邪的，适宜用白虎汤之类。而且脏腑性质有阴阳之别。阴虚者火旺，即使发病时恰好吃了生冷，橘皮、厚朴等辛温燥湿之品只宜暂时使用；阳虚者湿胜，即使是寒润之品也不适宜，如胃苓汤已属合法。纵使身体极度虚弱羸瘦，也不过是补气与清邪并用。如果因其素体亏虚，而忘记当下的暑病，进用丁香、附子、干姜、肉桂的药剂，真是眨眼间就杀人了。凡是伤暑霍乱，有身热烦渴、气粗喘闷，兼见四肢厥冷躁扰的，千万不要认为是阴证。只要观察其小便必黄赤，舌苔必粘腻，或白而浓浊，适宜用燃照汤，澄清冷却后服用。
若浑身青紫而死。甚至手足厥冷、少气、唇面爪甲皆青、腹痛自汗、六脉皆伏，但察其吐出酸秽之物，泻下臭恶，小便黄赤短热，或吐下皆是清水，而泻出如火，小便点滴全无的，这都是热邪伏于厥阴经。热极似阴，急忙制作地浆，煎服竹叶石膏汤。又有吐泻后，身冷如冰，脉沉欲绝，汤药不下，或发呃逆，这也是热伏于内，医生不能察觉，投药稍温，越服越吐，验其口渴，给凉水喝即止，后用驾轻汤之类投服，脉渐出的可生。然而暑之为病，伤之骤则发之暴，伤之渐则发之缓。所以九月时候，还有很多伏暑霍乱的证候，医者不可不知。
《金匮要略》说：转筋这种病，病人手臂脚部僵硬挺直，脉象上下行，微弦，转筋入腹的，用鸡矢白散主治。
刘守真说：转反戾，是热邪灼烁筋脉，则抽搐疼痛。有人以为是寒邪客于筋脉是错误的。大概寒主收引，但只是导致四肢厥冷僵硬，屈伸不利，怎么能说是转筋呢？所谓转，是动。阳动阴静，这是热证明显。夫转筋，多由热甚，霍乱吐利所致。因为脾胃土衰，则肝木自盛，而热邪灼烁筋脉，所以转筋。夫发渴则为热，凡霍乱转筋而不渴的，从未有过。
尤拙吾说：肝主筋，上应风木，肝病生风，则出现转筋。其人手臂脚直，脉上下行，微弦。经文说：各种暴发的强直，都归属于风。转筋入腹，是脾土虚而肝木乘袭。鸡为木畜，其粪便微寒，能祛风湿以利脾气，所以取用它来治疗此病。
湿土被风木克制，则成为霍乱转筋，用平胃散加木瓜主治。有一毫口渴，就是伏热。凡白术、附子、干姜、肉桂等种种燥热之药，误服即死，即使是五苓散中的桂枝，也应慎用。王士雄按语：张氏这番话，可谓深得我心。大概仲景虽然立下“热多欲饮水者，五苓散主之”的法则，然而上文有头痛恶寒的表证，仍是伤寒之霍乱，所以用两解之法。那些虽兼表证而非风寒之邪，或本无表证而热甚口渴的，岂可拘泥成法，不知变通，而徒借圣人之言作为借口呢？（透彻古人用法之意，是真读书人的话语。定州，杨照藜识）
薛一瓢说：风自火生，火随风转，乘入阳明则呕吐，贼及太阴则腹泻，这叫霍乱。窜入筋中则拘挛，流入脉络则反张，这叫痉证。所以说，痉与霍乱，同出一源，但痉证多见厥逆，霍乱少见厥逆。大概痉证风火闭郁，郁则逆势更横，不免逼乱神明，所以多厥。霍乱风火外泄，泄则邪势外宣，不至循经而走，所以少厥。这是痉与霍乱的区别。然而痉证邪滞三焦，三焦乃火化，风得火而愈扇，则逼入膻中而暴厥。霍乱邪走脾胃，脾胃乃湿化，邪由湿而停留，则淫及诸经而拘挛，火郁则厥，火窜则挛，又是痉与厥的遗祸。痉的挛急，是湿热生风；霍乱的转筋，是风来胜湿。（木克土）。痉则由经及脏而厥，霍乱则由脏及经而挛，总由湿热与风……
厥而不返者死。胃液干枯，是火邪盘踞。转筋入腹者死。胃液内涸，是风邪独劲。然而胃中津液的关系，难道不重要吗？厥证用辛开，是泄胸中无形之邪。干霍乱用探吐，是泄胃中有形之滞。然而泄邪而胃液不上升的，热邪更炽。探吐而胃液不四布的，风邪更张。终成死候，不可不知。
王士雄按语：霍乱湿多热少，是其常态，至于转筋，已是风自火出，而有胜湿夺津之势了。我自幼年……必剧。自夏末秋初而起，直至立冬后始息。夫彤彤徂暑，湿自何来？
只缘今人蕴湿者多，暑邪易于深伏，待一朝卒发，渐至阖户沿村，风行似疫，医者不知原委，理中汤、四逆汤随手乱投，殊可叹也！我每治愈此证，必询问其人。说：难道未病之前，毫无所苦吗？有的说：病前数日，手足心如烙。有的说：未病之前，睹物皆红如火。噫！岂不是暑热内伏，欲发而先露其机哉。智者若能早为曲突徙薪之计，何至燎原莫救乎？以胃液的存亡，决病情的生死，尤为精识；昧者肆行燥烈，助虐烁津，徒读父书，可为痛哭。（道光元年，直省此证大作，一觉转筋即死。京师至棺木卖尽，以席裹身而葬，卒未有识为何证者，俗传食西瓜者即死，故西瓜贱甚。余时年十一，辄与同学人日日饱啖之，卒无恙。今读此论，则医学之陋，不独今日为然也。素园杨照藜识）
（杨氏之论极是。余于是年亦日食西瓜，而阖家无染病者，即其验也。然是年霍乱，间有误食西瓜而死者，为友人董铸范所亲见。盖宜服香薷之证，误信乩坛之语，以致寒凉遏抑而毙也，是亦不可不知。故处方论治，非辨证不可。本论第二篇治法、西瓜汁证法，有汗频二字最的。乌程汪曰桢谢城。）
王清任说：道光元年，病吐泻转筋者数省，都中尤甚，伤人过多。贫不能埋葬者，国家发帑施棺，月余间，费数十万金。彼时医工，或云阴寒，或云火毒。余谓不分男、妇、老、少，众人同病，即疫也（卓识名言）。或曰：既是疫，何以芩、连、姜、附而得愈者？试看所流之血，尽是紫黑。岂不是疫火之毒，深入于营分哉？以疫邪自口鼻，由气管达……名曰津门，津门上有一管，名曰津管，是由胃出精汁水液之道路。）水不得出，故上吐下泻。初得病时，宜即用针刺尺泽穴，出紫黑血，则毒瓦斯外泄矣。盖人身气管，周身贯通，血管周身亦贯通，尺泽左右四五根血管，刺之皆出血，皆可愈。尺泽上下刺之，亦可愈。一面针刺，一面以解毒活血之药治之。
王士雄按语：王氏亲见脏腑而善针法，所论皆凿凿可信，非悬揣虚拟可比。虽用药非其所长，而以解毒活血四字为纲，亦具有卓见。
《补亡论》说：《灵枢》五乱之证，惟乱于肠胃一证，名霍乱，故作吐利。其余四证，皆不作吐利，只谓之乱气。昔柳州之疾，盖乱气干心之证，非霍乱也。
谓为干霍乱者虽谬，然尚不失为五乱之一，今则无复知乱气之名矣。
《治法汇》说：干霍乱，俗名搅肠痧。其状欲吐不吐，欲泻不泻，撩乱挥霍是也。急宜探吐，得吐方可，不吐则死。《法》曰：既有其入，必有其出，今有其入而不得其出者，痞塞也，多死。得吐后，方可理气和中，随证调治。《医通》说：干霍乱，是土郁不能发泄，火热内炽，阴阳不交之故。
有人问：方书皆言宿食与寒气相搏，何以独指为火耶？回答说：昏乱躁闷，不是属于火的诸躁狂越吗？每致急死，不是属于火的暴病暴死吗！但攻之太过，则脾愈虚；温之太过，则火愈炽；寒之太过……
此证，病因非一。骤伤饮食者，宜探吐。宿食为患者，宜消导。气郁感邪者，宜宣豁。暑火直侵者，宜清解。诸法并列于后，用者审之。
（虑其格拒，反佐以治，真精语也。桂苓甘露饮，治热证而用桂；通脉四逆汤，治寒证而用猪胆汁，皆即此义。《梦影》中治陈妪一案，石膏、芩、连，加细辛少许，燃照汤之用蔻仁，亦此义也。若寒证而用芩、连，热证而用姜、附，则正与病反，非反佐之义矣。谢城。）
又说：脾胃喜香燥而恶臭湿。若素多湿滞而犯臭气，则正气郁遏，腹痛乃作。或上连头额俱痛，或下连腰腿俱痛。有痛死不知人，少间复苏者；有腹痛不时上攻，水浆不入，数日不已者。甚至欲吐不吐，欲泻不泻，或四肢厥逆，面青脉伏，或遍体壮热，面紫脉坚，俱与生黄豆嚼之，觉香甜者，是臭毒也。急以烧盐探吐，或以童便制香附四五钱为末，停汤顿服最效。举世有用水搭肩背及臂者，有以苎麻水湿刮之者，有以瓷碗油润刮之者，有以瓷锋针刺委中出血者，总欲使腠理开通之意耳。其脉多伏，或细小紧涩，或坚劲搏指，中带促结，皆是阴逆阳伏之象。不可误认阴寒而投热药，虽砂仁之辛温香窜，亦不可轻用。若见面青唇黑，脉劲搏指，厥逆喘促，多不可救也。
又说：触犯臭秽，而腹痛呕逆，刮其脊背，随发红斑者，俗谓之痧。甚则欲吐不吐，欲泻不泻，干呕痛者，曰绞肠痧。更有感恶毒异气而骤发黑痧，俗名番痧。卒然昏倒，腹痛，面……汗出，或隐隐发斑，此毒邪发于表也。亦有发即泻利厥逆，腹胀无脉者，此毒邪内伏，不能外发也。所患最多有不及见斑而死者。经谓大气入于脏腑，虽不病而卒死是也。初觉，先将纸捻点淬头额，即以荞麦焙燥，去壳取末三钱，凉开水调服；重者少顷再服即安。盖荞麦能炼肠胃滓秽，降气宽胸，而治浊滞，为痧毒之专药。其毒甚面黑者，急于两膝后委中穴，砭出黑血，以泄毒邪。凡骤发之病，勿虑其虚，非此急夺，束手待毙。原夫此病与臭毒相类，与霍乱相似，乃疫疠之最剧者。初起昏愦不省，脉多沉匿不显，或浑浑不清。勿以腹痛足冷而与温药，如荞……宜理气为先，如香苏散加薄荷、荆芥，辛凉透表；次则辟邪为要，栀子豉汤加牛蒡、生甘草，解毒和中。表热势甚，清热为急，黄芩汤加连翘、木通，分利阴阳。若见烦扰腹胀，脉来数疾，急投凉膈散，以竹叶易生姜，则毒从下夺。热剧神昏，虽合三黄，多不可救。烦渴引饮，遗溺，速清阳明，白虎汤加葱豉，使毒从表化。斑点深赤，毒在血分者，浓煎益母草，少投生蜜，放温恣服，取效最捷。以其专下恶血也，或加生莱菔汁半杯，总取散血之功。以上诸法，在未经误药，庶可挽回一二。曾见一商，初到吴会，畅饮酣歌，席间，霎时不安，索生姜汤一啜而逝。又有朔客，到枫觅汤澡浴，忽然眩晕呕逆，到舟即毙（凡感受暑热秽疫诸邪者，大忌热汤澡身也）。更有误认伤寒，而与发……（亦有误认寒证而与热剂，口鼻流血而死者）。变生反掌，不似时行，犹可迁延数日也。
上海，特海陬一邑耳。二十年来，屡遭兵燹，乃沧海渐变桑田，外国之经营日广，苏省又以……都会矣。然人烟繁萃，地气愈热，室庐稠密，秽气愈盛，附郭之河，藏垢纳污，水皆恶浊不堪。今夏，余避地来游，适霍乱臭毒番痧诸证盛行，而臭毒二字，切中此地病因。奈医者……
The *Suwen: Liuyuan Zhengji Dalun* states: "When the Qi of Earth is stagnant and erupts, it manifests as vomiting and cholera."
The eruption of all types of stagnation must transform into heat. Stagnation of Earth (excessive dampness in the Middle Jiao) occurs when dampness in the Middle Jiao is excessive, obstructing the mechanism of ascending and descending. Its eruption is often caused by inhaling summer-heat turbid pathogens or by food stagnation, leading to the interference between clear and turbid Qi, causing chaos within moments, resulting in upper vomiting and lower diarrhea. The treatment method involves using formulas like Ran Zhao Tang (Illuminating the View Decoction) to vent Earth stagnation and separate Yin and Yang.
Although vomiting has already occurred, one should still use salt water to induce vomiting, expelling all accumulated food from the stomach, and then regulate with formulas such as Jia Qing Tang (Light Riding Decoction) or Zhi He Tang (Harmonizing Harmony Decoction).
It also states: "If one does not stay away from heat, heat will arrive; when heat arrives, the body becomes hot, accompanied by vomiting, diarrhea, and cholera."
This clearly indicates that there is cholera caused by heat pathogens. Regrettably, texts such as *Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Symptoms of All Diseases) and *Sanyin Jiyi Bingzheng Fanglun* (Formulas for the Three Causes of Diseases) all claim that cholera originates from wind-cold, thereby fixing the perspective of later generations. Those suffering from Heat Cholera are mostly misdiagnosed and mistreated with drugs. Moreover, the phrase "do not stay away from heat" does not refer only to medicines and food. For instance, laboring in long-distance fields allows summer-heat pathogens to enter from the exterior. As the saying goes, "hot ground like a furnace, harming people most rapidly," it is appropriate to use sweet-cold herbs like Baihu Tang (White Tiger Decoction) or Liu Yi San (Six-to-One Powder) to clear heat. Or, enjoying rich wine and fatty foods.
If summer-heat enters and damages the Yuan Qi, Ginseng can be added to Baihu Tang. If Qi deficiency attracts pathogens, Ren Shen (Ginseng Root) and Bai Zhu (Atractylodis Rhizoma) must be assisted by herbs that clear pathogens. The established methods of past sages can naturally be applied by analogy.
However, ignorant people rashly believe that diseases of fatigue and injury should be treated with tonification, and bodies accustomed to rich food are necessarily deficient. Knowing one aspect but not the other, they casually administer warming and tonifying treatments, often causing death, which is truly pitiable.
The *Suwen: Zhizhen Yao Dalun* states: "All heat conditions causing mental confusion and convulsions, all rebellious upward rushing of Qi, all restlessness, mania, and deviation from normal conduct, belong to Fire."
"Mao" refers to mental confusion; "yuan" refers to convulsive twitching. Heat damaging the Spirit causes confusion; Fire forcing blood causes convulsions. Fire nature is flaming upward, so Qi rebels and rushes upward. "Zao" is restlessness and unease. "Kuang" is mania. "Yue" is deviation from normal conduct. Heat excess in the exterior causes limb restlessness; heat excess in the interior causes mental disturbance. Generally, Fire nature is active; any disease with movement belongs to Fire. When cholera presents with these symptoms, it is definitive evidence of internal excess of heat pathogens.
It also states: "All cases of turning, twisting, and rigidity with turbid fluids; all vomiting of sour fluid, sudden violent diarrhea with tenesmus, belong to Heat."
"Turning, twisting, and rigidity" refers to muscle cramps and spasms. Heat drying and scorching the sinews leads to spasms and pain; Fire governs burning and scorching, hence restlessness. "Fluids" refer to urine. Heat excess forces Qi to rebel and rush upward. Earth's nature is planting and harvesting, but when the taste becomes sour, it is because Liver Heat is burning internally, transforming accordingly. "Bao zhu" is sudden violent diarrhea. Intestinal and gastric heat excess disrupts transmission and transformation; Fire nature is rapid, hence this condition. "Xia po" is tenesmus and urgent abdominal pain. Fire nature is rapid and desiccating, hence this.
These are colloquial names for Ma Sha (Plague Sha), yet people rashly administer drying and heating drugs, hastening death, which is extremely thoughtless!
*Qianjin Yaofang* states: "For Heat Cholera with severe diarrhea, mental irritability, rapid pulse, and desire for cold water, drink one sheng of newly drawn well water at once."
Guo Baiyun said: "Among methods for treating cholera, *Qianjin Yaofang* is the most comprehensive."
*Zhishu Quan Shu* states: "When summer-heat Qi enters the abdomen, causing nausea, abdominal pain, upper vomiting, and lower diarrhea with watery stools..."
After Spring Equinox and before Autumn Equinox, Shaoyang Ministerial Fire, Shaoyin Sovereign Fire, and Taiyin Damp Earth jointly exercise their functions. Thus, Heaven's heat descends, and Earth's moisture ascends. Humans exist in the intersection of these Qi, receiving its steaming and overflowing influence, entering via mouth and nose to disturb the center, causing loss of ascending and descending control, and failure to distinguish clear and turbid. The expelled substances are the Jin-Ye (body fluids) of the five Zang organs; stopping them urgently is necessary, but this does not mean blocking due to free-flowing symptoms (opposite of Tong Yin Yong Tong). For severe dampness, Weiling Tang (Stomach Calming Decoction) separates Yin and Yang, and summer-heat naturally dissipates; for severe heat, Guiling Ganlu Yin (Cassia Seed and Lingzhi Sweet Dew Drink) clears summer-heat fire, and dampness quietly消 (dissipates). For those with Fire-excess constitutions who have no internal dampness but merely inhale summer-heat pathogens, Baihu Tang (White Tiger Decoction) is suitable. Furthermore, Zang organs differ in Yin and Yang natures. Those with Yin deficiency have Fire hyperactivity; even if cold/raw food is consumed during onset, Chen Pi (Citri Reticulatae Pericarpium) and Hou Po (Magnoliae Officinalis Cortex) should only be used temporarily. Those with Yang deficiency have Damp excess; even cold/moistening items are unsuitable, making Weiling Tang appropriate. Even if the body is extremely emaciated, one should only combine Qi tonification with pathogen clearing. If one ignores the current summer-heat disease due to constitutional deficiency and administers Ding (Caryophylli Flos), Fu Zi (Aconiti Lateralis Radix Preparata), Jiang (Zingiberis Rhizoma), or Gui (Cinnamomi Cortex) formulas, it kills people in the blink of an eye. For summer-heat cholera presenting with fever, irritability, thirst, coarse breathing, panting, and accompanied by cold limbs and restlessness, do not mistake it for a Yin syndrome. Observe that urine must be yellow-red, tongue coating sticky, or white and thick; Ran Zhao Tang (Illuminating the View Decoction) cooled is appropriate.
If the whole body turns blue-purple and death ensues. Even if hands and feet are cold, Qi is short, lips/face/nails are cyanotic, abdominal pain with spontaneous sweating, and six pulses are hidden, but vomit is sour/foul, stool is foul, urine is yellow/red/hot/short, or vomit/stool is clear water but stool burns like fire, or urine is scant/non-existent, these are all Heat hiding in the Jueyin channel. Extreme Heat mimics Yin; quickly prepare Di Jiang (Earth Slurry) and decoct Ye Zhu Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) to take. After vomiting/diarrhea, if the body is ice-cold, pulse deep/almost absent, unable to keep down medicine, or hiccups occur, this is also Heat hiding internally. If doctors fail to notice and administer slightly warm medicine, vomiting worsens. Check for thirst; giving cool water stops it. Then administer Jia Qing Tang (Light Riding Decoction); if pulses gradually emerge, survival is possible. However, summer-heat disease: acute injury causes sudden onset; gradual injury causes slow onset. Thus, in September, many cases of latent summer-heat cholera remain; doctors must know this.
*Jingui Yaolue* states: "Regarding the disease of muscle cramps, if arms and legs are straight, pulses run up and down, slightly wiry, and cramps extend to the abdomen, Ji Shi Bai San (Chicken Droppings White Powder) is the main treatment."
Liu Shouzhen said: "Turning and twisting is caused by heat scorching sinews, leading to spasms and pain. To attribute it to cold invading sinews is wrong. Cold governs contraction and pulling, causing cold limbs and stiffness, limiting flexion and extension, but how can it cause 'turning'? Turning implies movement. Yang moves, Yin is still; this proves Heat. Muscle cramps are mostly caused by severe Heat from cholera vomiting/diarrhea. Because Spleen/Stomach Earth declines, Liver Wood overacts, and heat scorches sinews, causing cramps. Thirst indicates Heat; there has never been a case of cholera cramps without thirst."
You Zhuowu said: "Liver governs sinews, corresponding to Wind-Wood. Liver disease generates Wind, causing cramps. Arms/legs straight, pulses running up/down, slightly wiry. The Classic says: 'All sudden strong rigidity belongs to Wind.' Cramps extending to the abdomen indicate Spleen Earth deficiency allowing Liver Wood to invade. Chicken is a Wood animal; its droppings are slightly cold and can dispel wind-damp to benefit Spleen Qi, hence used for this disease."
Zhang Shiweng said: "Vomiting and diarrhea are changes of Damp Earth; cramps are changes of Wind Wood."
When Damp Earth is overcome by Wind Wood, it becomes cholera with cramps; Pingwei San (Peace the Stomach Powder) plus Mu Gua (Chaenomelis Fructus) is the main treatment. Any hint of thirst indicates latent Heat. All drying-hot drugs like Bai Zhu, Fu Zi, Jiang, Gui, if taken by mistake, cause death. Even Gui (Cinnamon Twig) in Wuling San should be used cautiously. Wang Shixiong's Note: Zhang's words hit the nail on the head. Although Zhang Zhongjing established the rule "Heat predominance with desire to drink water, Wuling San governs," the preceding text mentions headache and aversion to cold (exterior signs), indicating it is still Typhoid Cholera, thus using a dual-release method. For those with exterior signs but not Wind-Cold pathogens, or no exterior signs but severe heat/thirst, how can one rigidly stick to established methods without flexibility, merely using the Sage as an excuse? (Thorough understanding of ancient usage is true scholar talk. Dingzhou, Yang Zhaoli notes.)
Xue Yipiao said: "Wind is born from Fire; Fire follows Wind. Entering Yangming causes vomiting; attacking Taiyin causes diarrhea; this is named Cholera. Penetrating sinews causes spasms; flowing into collaterals causes opisthotonos; this is named Spasm (Jing). Therefore, I say Spasm and Cholera share the same source, but Spasm often involves Jue (collapse), while Cholera rarely does. Spasm involves Wind-Fire closure/depression; depression makes rebellion more rampant, disturbing the Spirit, hence often Jue. Cholera involves Wind-Fire external release; release spreads evil outward, preventing meridian invasion, hence less Jue. This distinguishes Spasm and Cholera. However, Spasm evil stagnates in Sanjiao (Fire transformation); Wind gets fanned by Fire, pressing into Danzhong causing sudden Jue. Cholera evil travels through Spleen/Stomach (Damp transformation); evil stays due to Damp, spreading to meridians causing cramps. Fire depression causes Jue; Fire wandering causes cramps, further consequences of Spasm and Jue. Spasm cramps are Damp-Heat generating Wind; Cholera cramps are Wind overcoming Damp (Wood overacting on Earth). Spasm goes from Meridian to Zang then Jue; Cholera goes from Zang to Meridian then cramps. Ultimately due to Damp-Heat and Wind..."
Jue without return is death. Dryness of Stomach fluids indicates Fire evil entrenchment. Cramps extending to abdomen is death. Internal depletion of Stomach fluids, Wind evil alone is vigorous. Thus, the role of Stomach Jin-Ye is indeed significant! Jue syndrome uses Acrid-Opening to drain formless evil in Chest. Gan Cholera uses induced vomiting to drain有形 (form-solid) stagnation in Stomach. However, draining evil without rising Stomach fluids intensifies Heat. Induced vomiting without distributing Stomach fluids exacerbates Wind. Both lead to death; this must be known.
Wang Shixiong's Note: Cholera usually has more Damp than Heat; this is the norm. But cramps indicate Wind born from Fire, with momentum to overcome Damp and seize fluids. Since my childhood... must be severe. Starting late summer/early autumn, lasting until after Start of Winter. How can Damp come from lingering summer heat? Only because modern people retain much Damp, allowing summer-heat pathogens to lie deep. When suddenly erupting, it spreads house-to-house/village-to-village like plague. Doctors, unaware of the origin, randomly prescribe Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Reverse the Extremity Decoction), truly lamentable! Whenever I cure this, I ask: "Were you completely healthy before illness?" Some say: "Days before illness, palms/soles felt like burning irons." Others: "Before illness, everything looked red like fire." Alas! Isn't this latent summer-heat revealing itself before eruption? If wise men could plan early (curtail chimney/remove firewood), how would it reach uncontrollable prairie fire? Judging life/death by Stomach fluid survival is profound insight; ignorants recklessly use drying-hot drugs, assisting cruelty in scorching fluids, reading father's books in vain—worth weeping! (Daoguang Year 1, this disease raged across provinces; awareness of cramps meant immediate death. Capital ran out of coffins, bodies wrapped in mats buried. No one knew the disease; folk rumor said eating watermelon caused death, so watermelon was cheap. I was eleven, ate watermelon daily with classmates, remained safe. Reading this now, medical ignorance isn't just today's problem. Suyuan Yang Zhaoli notes.)
(Yang's argument is very correct. I also ate watermelon daily that year, and my family didn't get sick, proving his point. However, some cholera patients that year died after mistakenly eating watermelon, witnessed by friend Dong Zhufan. These were cases suitable for Xiangru, but misled by spirit-writing, causing death by cold suppression. This too must be known. Thus, prescription and treatment require differentiation. In Part 2 of this treatise, 'Frequent Sweating' in treatment/watermelon juice sections is most accurate. Wucheng Wang Yazhen Xie Cheng.)
Wang Qingren said: "In Daoguang Year 1, vomiting/diarrhea/cramps affected several provinces, especially the capital, killing many. The poor couldn't afford burials; state funds provided coffins, costing hundreds of thousands of taels in a month. Doctors then claimed either Yin-Cold or Fire-Toxin. I said: Regardless of gender/age, everyone having the same disease is Plague (Epidemic) (Profound insight). Some asked: If it's plague, why did Huang Qin (Scutellariae Radix), Lian (Scutellariae Baicalensis Radix), Jiang, Fu work? Look at the blood flow—it's purple-black. Isn't this Plague Fire-Toxin penetrating Ying (Nutrient) level? Plague pathogens enter via mouth/nose, travel through air tubes to... named Jinmen (Gate of Fluids). On Jinmen is a tube named Jinguan (Tube of Fluids), the path for Stomach essence/fluids.) Water cannot exit, hence upper vomiting/lower diarrhea. At onset, prick Chize (LU-5) acupoint immediately to bleed purple-black blood, releasing toxin gas. Human air tubes connect throughout body; blood vessels also connect throughout. Pricking 4-5 vessels around Chize bleeding all cures. Pricking above/below Chize also cures. Simultaneously needle and treat with detoxifying/blood-invigorating herbs."
Wang Shixiong's Note: Mr. Wang saw viscera personally and excelled in acupuncture; his theories are credible, not speculative. Though medication wasn't his strength, using "Detoxify and Invigorate Blood" as the guideline shows profound vision.
*Buwang Lun* states: "Of the Five Confusions in *Lingshu*, only confusion in intestines/stomach is named Cholera, causing vomiting/diarrhea. The other four don't cause vomiting/diarrhea, just called Confused Qi. The ailment of Liu Zongyuan was likely Confused Qi affecting Heart, not Cholera."
Calling it Gan Cholera is wrong, but it remains one of the Five Confusions; today, no one knows the name Confused Qi.
*Zhifa Hui* states: "Gan Cholera, colloquially Jiao Chang Sha (Intestine-Twisting Sha). Symptoms: desire to vomit but can't, desire to defecate but can't, chaotic turmoil. Urgently induce vomiting; survival depends on vomiting, otherwise death. The Classic says: What enters must exit. Now it enters but can't exit, causing blockage, mostly fatal. After vomiting, regulate Qi and harmonize middle, treating according to syndrome. *YiTong* states: Gan Cholera is Earth stagnation failing to vent, internal blazing fire, Yin/Yang not interacting."
Question: Formulas say old food fights cold Qi, why single out Fire? Answer: Mental confusion/restlessness belongs to Fire's restlessness/manic deviation? Often causing sudden death, belonging to Fire's acute/sudden death? Over-attacking hurts Spleen Qi; over-warming ignites Fire; over-cooling...
This disease has various causes. Sudden dietary injury: induce vomiting. Old food stagnation: resolve/digest. Qi stagnation/pathogen invasion: vent/open. Summer-fire direct invasion: clear/resolve. Methods listed below; users examine carefully.
(Considering rejection, use counter-agent therapy—true refined words. Guiling Ganlu Yin treats Heat but uses Gui; Tongmai Sini Tang treats Cold but uses Pig Bile, both follow this principle. *Mengying* treating Granny Chen: Gypsum, Qin, Lian plus少许 (a little) Xi Xin; Ran Zhao Tang using Dou Kou Ren (Cardamomi Fructus), also this principle. If Cold uses Qin/Lian, Heat uses Jiang/Fu, it opposes the disease, not counter-agent principle. Xie Cheng.)
Also states: Spleen/Stomach likes aromatic-dry, dislikes foul-damp. If prone to Damp-stagnation and encounters foul Qi, Righteous Qi is depressed, abdominal pain arises. Pain may connect to head/forehead or lower back/legs. Some die of pain unconscious, then recover; some have constant upper-rushing abdominal pain, unable to eat/drink, lasting days. Even desire to vomit/defecate but can't, or cold limbs, cyanotic face, hidden pulse, or full-body high fever, purple face, firm pulse—all if chewing raw soybean tastes sweet, it is Foul Toxicity (Chou Du). Urgently induce vomiting with burnt salt, or use Child's Urine processed Xiang Fu (Cyperi Rhizoma) 4-5 qian powder, taken with stopped soup—most effective. Worldly methods include water draping shoulders/back/arms, ramie water scraping, porcelain bowl oil scraping, porcelain needle pricking Weizhong (BL-40) bleeding—all intend to open pores. Pulses mostly hidden, or fine/small/tight/astringent, or firm/beating finger, with intermittent/interrupted beats—all images of Yin rebellion/Yang hiding. Do not mistake for Yin-Cold and give Heat drugs; even Sha Ren (Amomi Fructus) Acrid-Warm-Aromatic should not be lightly used. If face cyanotic, lips black, pulse firm/beating, Jue/panting, mostly incurable.
Also states: Touching foul smell, abdominal pain/vomiting, scraping back reveals red spots, colloquially Sha. Severe cases: desire to vomit/defecate but can't, dry retching/pain, called Jiao Chang Sha. More severely, sensing toxic strange Qi suddenly causes Black Sha, colloquially Fan Sha. Sudden collapse, abdominal pain, face... sweating, or faint spots appear, this is Toxic Evil emerging on Exterior. Also emergence with diarrhea/Jue, abdominal distension/no pulse, this is Toxic Evil hiding internally, unable to emerge externally. Most sufferers die before spots appear. Classic says: Large Qi enters Zang-Fu, sudden death without prior illness. Upon first feeling, dip paper twist in head/forehead, then roast buckwheat, remove husk, take 3 qian powder, mix with cool boiled water; severe cases repeat shortly for relief. Buckwheat refines intestinal waste, descends Qi, widens chest, treats turbid stagnation, specific drug for Sha toxin. Severe toxicity/black face: urgently prick Weizhong (BL-40) behind knees, bleed black blood to drain toxin. For sudden diseases, don't worry about deficiency; without this urgent draining, hands tied waiting for death. Originally this disease resembles Foul Toxicity, similar to Cholera, being the most severe Epidemic. Onset: coma/unconscious, pulses mostly deep/hidden/unclear. Don't give Warm drugs for abdominal pain/cold feet... Prioritize regulating Qi, e.g., Xiang Su San plus Bo He (Menthae Haplocalycis Herba), Jing Jie (Schizonepetae Spica), Acrid-Cool releasing Exterior; next, dispel evil is key, e.g., Zhi Zi Chi Tang plus Niu Bang Zi (Arctii Fructus), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), detoxify/harmonize middle. Strong Exterior Heat urgently clear Heat, e.g., Huang Qin Tang plus Lian Qiao (Forsythiae Fructus), Mu Tong (Akebiae Caulis), separate Yin/Yang. If irritability/abdominal distension, rapid pulse, urgently give Liang Ge San, replace Sheng Jiang (Zingiberis Rhizoma) with Zhu Ye (Phyllostachdis Folium), toxin drains downward. Severe Heat/coma, even San Huang (Three Yellows) mostly incurable. Irritable/thirsty drinking, enuresis, quickly clear Yangming, Baihu Tang plus Cong Chi (Scallion and Soybean Decoction), toxin transforms via Exterior. Deep red spots, toxin in Blood level: decoct Yi Mu Cao (Leonuri Herba) thick, add少许 (a little) raw honey, warm freely, fastest effect. Specifically removes bad blood; or add half cup raw Lu Bo (Raphani Semen) juice, total goal is dispersing blood. Above methods, if no mistaken drugs, maybe save one or two. Saw a merchant, new to Wu-Huai, drank/sang, suddenly uneasy at table, asked for Ginger Soup, drank and died. Another northern traveler, went to Feng for bath, suddenly dizzy/vomited, died on boat (Those sensing summer-heat/foul plague evils strictly avoid hot baths). More mistaking Typhoid, giving Fa Han (Releasing Exterior)... (Also mistaking Cold for Heat, nose/mouth bleeding to death). Changes happen in flip of hand, unlike seasonal流行的 (epidemic), which can linger days.
Shanghai is merely a coastal town. Twenty years, frequent wars, sea changing to mulberry fields, foreign management expanding, Jiangsu becoming metropolis. But dense population, hotter earth Qi, dense houses, stronger foul Qi, rivers near city hide filth, water foul/unbearable. This summer, I fled here,恰逢 (coincidentally) Cholera/Foul Toxicity/Fan Sha prevalent, and "Foul Toxicity" hits this location's cause precisely. Alas, doctors...