承示救时要略一书，久欲奉还，以便刊布。然有难焉者。方至刊布，人必深信，设有差池，则辗转贻误，必
得于寒热两症，一见即可人人了然，然后可以活人而全生命。即如救时要略一书，其方法审症，悉遵
王孟英霍乱论原文，删繁就简，并未窜改。霍乱论云、热症多，寒症少，若寒症不过十中之一二耳。孟英
原有一定之据，如热症则于未病前数日，先有目中流火、肛门灼热等象预先知觉，则既病之后，更无
论矣。然溯同治元二三四年间，修在常熟之梅里镇，后又迁于荡口镇，此处人烟幅集，四月至八九月，
霍乱之症，沿门阖境，每日多则治二三十人，少则十数人，历见发作之时，一吐一泻，无不四肢厥冷，冷
汗粘指，脉伏不起，大烦大渴，罗纹绉陷，甚则目陷失音。虽投白虎得生之热症，未必于未病之前，先显
火象，既病后亦未必皆目中流火、肛门灼热也。投理中四逆得生之寒症，未必不烦不渴，神情未必安
静，与热症亦相近似。盂英辨寒热二证，笔之于书，深觉其简明之极矣。然竟有村医见肢冷脉伏，不问
其口渴如何，舌色如何，乱投四逆而霍乱向愈者。亦有肢冷脉伏，大烦大渴，渴而能饮，一派火热之状，
投白虎及地浆而竟毙者。三十年亲经阅历，则知热痧于未病之前，先见有火象之说，殊难为信。唯一
经芳开，热象发现，然后按热痧用药，此言最确。特热象未必门门见到，有数项即足为据耳。盖热症必
有湿邪外遏，寒症本属阴寒闭塞阳气，如行军散、红灵丹、苏合丸、紫雪、玉枢丹等芳开之品，一遇病起
即脉伏肢冷，或汗出淋淋，即急选用。虽有清开温开之异，设逢热症，投以苏合之温开，亦能见效。夫以
温治热，固属抱薪救火，然能开发其抑遏，则火热可以透露，故以热治热，亦可回生。寒症而投以清开，
则阴邪凝涩，便使开药不能应手，大能为祸也。大抵初起之时，不问寒热，概用芳开，芳开之后，随所见
之象治之，是当生者能使起矣。施送药饵，似宜备以上所列温开之药，使火热之气，透于湿外，阴凝之
气，宣畅营运。然后给以病情单一纸，单上开明服开药之后，若见书中所载诸热象，是为热痧，轻则以
地浆水调六一散不时服，重则以理中白虎汤，或白虎汤，或竹叶石膏汤进之，方药即载于病情之后。
若见书中所载诸寒象，则以理中汤，或附子理中汤、吴茱萸汤、四逆汤进之，方药亦载于病情之后。或
即以病情单作包纸，与开药相附送人亦可。最可恶者，随便呼名，如绞肠痧烂喉痧吊脚痧瘪螺痧之
类。霍乱之甚者，罗纹无有不瘪，经云、卫气者所以温分肉，充皮肤，肥腠理，司开合者也。既经霍乱，则卫
气闭塞，自致分肉不温而肢冷，皮肤不充而罗纹瘪陷，开合失司而汗出淋淋，万病一律。譬如以手入
水浸多时，湿气抑遏，则卫气闭阻，罗纹即瘪矣。而妄立瘪螺吊脚等名目，苟司命者识见不定，即为所
惑。临症而无所折衷，以为一年有一年之时症殊不知霍乱二字，统概一切。凡医能究心于此辨认无
差，自可十全为上。臆见如左，不揣愚昧，敬以缕陈。
承蒙您出示《救时要略》一书，我长久以来就想归还给您，以便将其刊印出版。然而其中存在困难之处。因为一旦刊布流传，人们必定深信不疑；倘若书中内容出现差错，就会辗转误导他人，造成严重后果。因此，必须确保对于寒证和热证这两种病症，医生在初次见到时就能一目了然、人人皆知，这样才能挽救生命、保全性命。
就拿《救时要略》这本书来说，其辨证方法完全遵循王孟英《霍乱论》的原文，只是删减了繁杂的内容使之简明，并没有擅自篡改。王孟英在《霍乱论》中说：热证多，寒证少，寒证大概只占十分之一二。王孟英的观点是有一定依据的，例如热证患者在发病前几天，预先会有眼中感觉如火烧、肛门灼热等征兆，那么发病之后的情况就更不用说了。
然而，追溯同治元年至三年（1862-1864年）期间，我在常熟的梅里镇行医，后来又迁居到荡口镇。这些地方人口密集，从四月到八九月间，霍乱病症沿门遍户流行，我每天诊治的患者多的达二三十人，少的也有十数人。我亲眼目睹发作时的症状：上吐下泻，无一例外地四肢厥冷，冷汗粘手，脉象伏匿不起，极度烦躁口渴，皮肤皱纹深陷，甚至眼球凹陷、失音。虽然有些属于投用白虎汤后能治愈的热证，但未必在发病前就显现出火象；发病后也未必都表现为眼中流火、肛门灼热。同样，有些属于投用理中汤、四逆汤后能治愈的寒证，也未必就不烦躁、不口渴，患者的神情也未必安静，这些表现与热证也有相似之处。
王孟英将寒热两证辨析并记录在书中，确实觉得极其简明扼要。然而，竟然有乡村医生见到患者四肢冰冷、脉象伏匿，就不问其是否口渴、舌色如何，胡乱投用四逆汤，结果霍乱反而痊愈了。也有患者四肢冰冷、脉象伏匿，却极度烦躁口渴，且能饮水，呈现一派火热之状，投用白虎汤及地浆水后竟然死亡。这三十年亲身经历的阅历告诉我，“热痧在发病前先见火象”的说法，实在难以令人信服。只有“一经芳香开窍，热象随即显现”，然后按照热痧用药，这种说法最为确切。特别是热象未必家家户户都能见到，只要有几项表现就足以作为依据。
大抵热证必然有湿邪外遏，寒证本属阴寒闭塞阳气。像行军散、红灵丹、苏合丸、紫雪、玉枢丹等芳香开窍的药物，一遇到疾病发作，出现脉伏肢冷，或者汗出淋漓的情况，就应立即选用。虽然有清热开窍和温通开窍的区别，但如果遇到热证，投用苏合丸这类温开药，也能见效。以温热药治疗热证，固然像是抱薪救火，但若能开发被郁遏的气机，则火热之气可以透发出来，所以“以热治热”，也可以使病人起死回生。若是寒证投用清热开窍药，则阴邪凝滞涩阻，会使开窍药不能奏效，反而会造成祸患。
大致在初起之时，不论寒热，一概使用芳香开窍药；芳香开窍之后，再根据所见到的症状进行针对性治疗，这样该生的病就能治好。施送药物时，似乎应该备齐上述所列的温开药物，使火热之气透出于湿邪之外，使阴凝之气宣畅营运。然后给病人一张病情诊断单，单子上写明服用开窍药之后，如果见到书中记载的各种热象，这就是热痧，轻症用地浆水调服六一散不时服用，重症则服用理中白虎汤，或白虎汤，或竹叶石膏汤，方药即记载在病情单之后。如果见到书中记载的各种寒象，则服用理中汤，或附子理中汤、吴茱萸汤、四逆汤，方药也记载在病情单之后。或者直接将病情单用作包药纸，随开窍药一起送给病人也可以。
最可恶的是随意命名，如绞肠痧、烂喉痧、吊脚痧、瘪螺痧之类。霍乱严重的，皮肤皱纹没有不瘪陷的。《内经》说：卫气是用来温煦肌肉、充实皮肤、肥润腠理、主管开合的。既然患了霍乱，卫气就会闭塞，自然导致肌肉不温而四肢冷，皮肤不充而皱纹瘪陷，开合功能失调而汗出淋漓，万病一律。譬如把手浸入水中很久，湿气郁遏，卫气闭阻，皱纹就会瘪陷。而妄立“瘪螺”、“吊脚”等名目，如果掌人生死的医生见识不坚定，就会被所迷惑。临证时没有折衷的标准，认为一年有一年的时症，殊不知“霍乱”二字统括了一切。凡是医生能深入研究于此，辨认无误，自然可以达到十全的效果。以上是我的浅见，不敢隐瞒愚昧，恭敬地陈述如上。
Having received your presentation of the book *Jiu Shi Yao Lue* (Essentials for Saving Lives in Emergencies), I have long intended to return it to you so that it may be published. However, there are difficulties. Once published and disseminated, people will surely believe it deeply; if there are any errors, they will lead to widespread misunderstanding and misguidance. Therefore, it is essential that upon first encountering both Cold Syndrome (Han Zheng) and Heat Syndrome (Re Zheng), physicians can clearly understand them at a glance, thereby saving lives and preserving health.
Take the book *Jiu Shi Yao Lue* as an example: its method of syndrome differentiation strictly follows the original text of Wang Mengying's *Huo Luan Lun* (Treatise on Cholera), merely deleting complexity to simplify, without any unauthorized alteration. In *Huo Luan Lun*, Wang Mengying stated that Heat Syndromes are common, while Cold Syndromes are rare, accounting for only one or two out of ten cases. Mengying’s viewpoint was based on certain evidence: for instance, patients with Heat Syndromes often perceive premonitory signs such as a sensation of fire flowing in the eyes and burning heat in the anus several days before onset; thus, symptoms after onset would naturally follow.
However, tracing back to the years 1862–1864 (the first three years of the Tongzhi reign), when I practiced in Meili Town, Changshu, and later moved to Dangkou Town, these areas were densely populated. From April to August/September, Cholera (Huo Luan) swept through households door by door. I treated dozens of patients daily, ranging from ten to thirty. I witnessed the onset of symptoms: vomiting and diarrhea, invariably accompanied by cold limbs (Zhi Leng), cold sweat sticky to the touch, pulse hidden and unobtainable (Mai Fu), extreme restlessness and thirst, sunken skin wrinkles, and in severe cases, sunken eyes and loss of voice. Although some cases responded to Bai Hu Tang (White Tiger Decoction) as Heat Syndromes, they did not necessarily show fire-like signs before onset, nor did all post-onset cases exhibit eye-fire sensations or anal burning. Similarly, cases responding to Li Zhong Tang (Regulate the Middle Decoction) or Si Ni Tang (Frigid Extremities Decoction) as Cold Syndromes were not necessarily free of restlessness and thirst, nor were their mental states always calm; their presentations could resemble Heat Syndromes.
Mengying’s differentiation of Cold and Heat syndromes recorded in his book is indeed extremely concise. Yet, I have observed village doctors who, seeing cold limbs and a hidden pulse, disregarded questions about thirst and tongue color, blindly administered Si Ni Tang, resulting in recovery from Cholera. Conversely, I have seen patients with cold limbs and hidden pulses, yet exhibiting extreme restlessness, thirst, ability to drink, and a full manifestation of fire-heat, who died after receiving Bai Hu Tang and Di Jiang Shui (Earth Spring Water). Thirty years of personal experience lead me to doubt the claim that "Heat Sha (Sha Disease) always shows fire signs before onset." The statement that "once aromatic opening agents are used, heat signs emerge," followed by treatment according to Heat Sha, is most accurate. Specifically, heat signs may not appear in every household; the presence of a few items is sufficient as evidence.
Generally, Heat Syndromes involve external constraint by Dampness (Shi Xie), while Cold Syndromes belong to Yin-Cold blocking Yang Qi. Aromatic opening agents such as Xing Jun San, Hong Ling Dan, Su He Wan, Zi Xue, and Yu Shu Dan should be urgently selected upon disease onset if the pulse is hidden, limbs are cold, or sweating is profuse. Although there are differences between Clearing-Opening (Qing Kai) and Warming-Opening (Wen Kai) methods, even if Wen Kai agents like Su He Wan are used for Heat Syndromes, efficacy can be achieved. Using warm treatments for heat seems like adding fuel to a fire; however, by developing the constrained Qi, the fire-heat can be vented. Thus, "treating heat with heat" can also revive the dying. If Qing Kai agents are used for Cold Syndromes, Yin-Evil becomes stagnant and obstructive, rendering opening agents ineffective and causing harm.
In general, during the initial stage, regardless of Cold or Heat, aromatic opening agents should be used universally. After opening, treatment should proceed based on observed symptoms, ensuring recovery for those destined to live. When dispensing medicine, it is advisable to prepare the aforementioned Warming-Opening drugs to allow Fire-Heat Qi to penetrate outside the Dampness, and to promote the smooth circulation of Yin-Stagnant Qi. Then, provide a condition sheet specifying: after taking the opening agent, if the heat signs described in the book appear, it is Heat Sha. For mild cases, administer Liu Yi San (Six-to-One Powder) mixed with Di Jiang Shui intermittently; for severe cases, administer Li Zhong Bai Hu Tang, Bai Hu Tang, or Zhu Ye Shi Gao Tang. The prescriptions should be listed on the condition sheet. If the cold signs described in the book appear, administer Li Zhong Tang, Fu Zi Li Zhong Tang, Wu Zhu Yu Tang, or Si Ni Tang. The prescriptions should also be listed on the condition sheet. Alternatively, the condition sheet itself can serve as wrapping paper attached to the opening medicine.
The most objectionable practice is arbitrary naming, such as Jiao Chang Sha (Intestine-Twisting Sha), Lan Hou Sha (Rotting Throat Sha), Diao Jiao Sha (Hanging Leg Sha), and Bie Luo Sha (Shrivelled Snail Sha). In severe Cholera, skin wrinkles inevitably shrivel. The *Classic of Difficult Issues* states: Wei Qi (Defensive Qi) warms the muscles, fills the skin, plumps the interstices, and controls opening and closing. Since Cholera causes Wei Qi obstruction, it naturally leads to unwarmed muscles and cold limbs, unfilled skin and shrivelled wrinkles, and loss of control over opening/closing leading to profuse sweating. All diseases manifest uniformly. For example, immersing hands in water for a long time causes dampness to constrain and Wei Qi to block, resulting in shrivelled wrinkles. Yet, falsely creating names like "Shrivelled Snail" or "Hanging Leg" confuses physicians whose insight is not firm. Without a standard for clinical judgment, believing that each year has its own seasonal disease, one fails to realize that the term "Cholera" encompasses everything. Any physician who studies this thoroughly and distinguishes accurately can achieve perfect results. These are my humble opinions, presented respectfully despite my ignorance.