钱某患霍乱自汗。肢冷脉无。平日贪凉饮冷。人谓寒证。欲用大剂热药。孟英曰∶苔虽白。
然浓而边绛。且渴甚。头大痛。不可因寒凉致病。不察其有暑热之伏也。遂以五苓去术。加
黄连浓朴黄芩竹茹木瓜扁豆叶。服后脉稍出。汗渐收。吐利亦缓。即去肉桂。加桑枝滑石甘
草。头痛吐利皆止。苔色转黄。随用清暑和中而愈。（木猪苓三钱。生泽泻三钱。云苓一钱
半。姜炒川连二钱。姜炒枯芩一钱。制浓朴一钱。姜竹茹三钱。陈木瓜二钱。扁豆叶七片。
肉桂心二分。嗣去肉桂。加姜炒桑枝二钱。西滑石先煎四钱。生粉草一钱。)
吴竹溪时感将瘥。患呃三日。声闻于邻。人皆危之。予通腑行气法。便行痰吐而痊。（通腑
行气用酒炒枯芩一钱半。酒炒川连一钱。鲜芦根二两。鲜枇叶刷包三钱。制半夏一钱。姜竹
茹三钱。旋复包先三钱。苦桔梗次入三钱。石菖蒲次入一钱。淡海 先煎一两。鲜芦菔切一
两。炒枳实一钱半。)
朱浦香年五十六。自幼患童劳。继以吐血。三十外即绝欲。得延至此。而平素便如羊矢。其
血分之亏如是。今秋陡患呃忒。连服滋镇温纳之药。势濒于危。延孟英诊。脉至弦滑搏数。
苔黄浓而腻。口苦溺赤。主大剂凉润。如雪羹蒌仁竹沥枇杷叶芦根元参紫菀射干兜铃菖蒲等
多剂。连下赤矢始瘳。如此衰年虚体。尚因痰热致呃。故虚寒之呃。殊不多见。（大剂凉润
用淡海 先煎二两。整荸荠一两。姜蒌仁研四钱。姜竹沥一大酒杯冲。姜枇叶刷包三钱。鲜
芦根二两。元参片泡冲去渣八钱。紫菀茸一钱半。姜射干三钱。马兜铃三钱。石菖蒲次入二
钱。)
蒋循庵媳患霍乱转筋。交三日矣。厥逆目窜。膈闷无溺。苔黄苦渴。脉极弦细。屡进桂附姜
术。气逆欲死。予昌阳泻心汤加减。煎成徐服。外以吴萸研末。卤调贴涌泉穴。服二剂。吐
止足温。去苏朴。加楝斛蒲公英。多剂始痊。盖伏暑挟素盛之肝阳为病。误服温补。以致遽
难廓清也。（昌阳泻心汤方。治霍乱后胸前痞塞。汤水碍下。或渴或呃。石菖蒲黄芩酒炒。
制
半夏各一钱。川连姜汁炒。五六分。苏叶三四分。制川朴八分。鲜竹茹枇杷叶刷。各二钱。
芦根一两。天雨水急火煎。徐徐温服。小溲秘涩者加紫菀。加减用酒炒枯芩三钱。姜竹茹四
钱。姜枇叶刷包三钱。芦根二两。制朴一钱。生苏子一钱半。海 先煎二两。菖蒲次一钱。
)
谢氏妇怀孕五月。便泻四日。医投姜附桂朴药一帖。遂四肢麻冷。气塞神昏。溺闭汗淋。大
渴呕吐。延孟英诊。脉未全伏。先饮以酱油汤。吐渐止。随予参连芩柏茹斛银花扁豆叶蒲桃
干芦根绿豆。以冬瓜汤煎。徐徐温服。外用炭醋熏之。各恙皆瘥。次日脉弦滑。泻未止。以
白头翁汤加参草银花扁豆蒲公英蒲桃干砂仁。两剂而痊。（西洋参三钱。酒炒川连八分。酒
炒枯芩一钱半。酒炒川柏二钱。姜竹茹三钱。石斛先煎一两。银花一两五钱。扁豆叶十片。
蒲桃干一钱。芦根一两。整绿豆先煎五钱。整冬瓜二两。煨汤煎药。)
詹耀堂子年二十。患霍乱。服姜桂数剂。泻不止。素吸鸦片。疑为虚漏。补之泻益甚。孟英
视之。大渴而脉弦数。幸而起病不因暑热。然阴分素亏。虽饮冷贪凉。热药岂堪过剂。设无
便泻以分其药力。则津液早枯矣。予白头翁汤合封髓丹。加银花绿豆石斛。一剂知。二剂已
。（方义甘凉救阴。苦寒泻暑。酒炒白头翁一钱半。酒炒川柏三钱。酒炒川连一钱。大生地
八钱。明天冬切六钱。开水泡煎去渣。济银花一两五钱。生绿豆先煎五钱。石斛先煎一两。
)
蒋敬堂母年七十四。陡患呕泻。身热腹痛。神思不清。孟英诊之。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。（酒炒枯芩一钱半。酒炒川连一钱。酒
炒川柏三钱。西滑石先煎四钱。济银花一两五钱。鲜竹叶二钱。酒炒枇叶刷包三钱。五爪红
一钱半。冬瓜二两。煨汤煎药。)
罗吉人立冬前。患霍乱转筋。某知其阴分素亏。病由伏暑。服药已得转机。数日后渐有呃忒
。孟英视之。脉弦数左甚。苔焦而渴。龈衄脘闷。便溏色酱。小便短赤。皆伏暑未清。气机
阻塞之象。既失清肃。当脐尚贴回阳膏。屡嘱揭去不从。后闻不起。
某新秋陡患洞泻如注。
即浑身汗出如洗。恹恹一息。孟英往勘。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。（木猪苓三钱。生泽泻三钱。云
苓一钱半。生石膏先煎一两二钱。西滑石先煎五钱。制浓朴次入一钱。)
余杭纸客在舟次病此。至乞孟英诊之。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。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。且细绎仲圣书。
亦未尝不微露其意也。如太阳与少阳合病。自下利者予黄芩汤。若呕者黄芩加半夏生姜汤主
之。张石顽注云∶温病始发。即当用黄芩汤去热为主。若伤寒必传至少阳。热邪渐入里。方
可用黄芩佐柴胡解之。盖黄芩汤乃温病之主方。即桂枝汤以黄芩易桂枝而去生姜。以桂枝主
在表风寒。黄芩主在里风热。乃不易之定法。其生姜辛散。非温热所宜。故去之。此表里寒
热之不可不知者也。周禹载注云∶明言太少二阳。何不用二经药。非伤寒也。伤寒由表入里
。此则自内发外。无表何以知。或胁满。或头痛。或口苦引饮。或不恶寒而即热。故不得谓
之表也。如伤寒合病。皆表病也。今不但无表。且有下利里证。伤寒协热利。必自传经而入
。不若此之即利也。温何以即利。其人中气本虚。内伏已深。不能尽泄于外。势必下走利也
。孟英谓此论温邪外发未久。即可下走为利。本文更有若呕者句。岂非温病可转霍乱。早逗
端倪于此乎。曩纂温热经纬。于此条下附注云。少阳胆木。挟火披猖。呕是上冲。利由下迫
。何必中虚始利。饮聚而呕。半夏生姜。专开饮结。如其热炽。宜易连茹。
辛酉秋。盛行霍乱转筋之证。一男子胸次拒按。孟英以芦菔子枳实槟榔等导之。（此证系寒
霍乱挟食。)
某赤膊不容盖复。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。适孟英至。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。（此证可治在苔黄大渴。得饮即吐。生石膏先煎一两二钱。酒炒川连一钱
。酒炒知母五钱。鲜枇叶刷包三钱。鲜芦根二两。石斛先煎一两。南花粉四钱。西滑石先煎
五钱。旋复包先三钱。陈木瓜一钱半。石菖蒲次入二钱。)
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。（酒炒川连一钱。酒炒楝核杵先四钱。乌梅肉杵先三钱。姜竹茹三钱。生苡仁杵八钱
。石斛先煎一两。酒炒枯芩一钱半。紫苏叶次入四分。)
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。投匕而瘥。（镑犀角先煎四钱。益母
草五钱。紫地丁三钱。鲜茅根五钱。生绿豆先煎一两。银花一两五钱。酒炒枯芩一钱半。酒
炒川连一钱。酒炒川柏三钱。藕二两打汁冲。石菖蒲次入一钱。)
张二梅年逾六旬。秋间患霍乱转筋。医见高年而厥逆多汗。拟进温补。张不敢服。但用平淡
单方及外治法而瘥。然从此大便不坚。时时自汗。遍身疮疥。畏热异常。立冬后。孟英诊之
。脉甚滑数。口渴苔黄。便溺皆热。犹着夹衣。是赋质偏阳。湿热内盛。幸而畏进温补。得
以引年。予大剂清化法渐愈。（酒炒西茵陈三钱。酒炒枯芩一钱半。酒炒栀皮三钱。冬瓜皮
四钱。蚕砂五钱。芦根二两。生苡仁杵八钱。鲜枇叶刷包三钱。西滑石先煎五钱。淡海 先
煎二两。)
某传一方颇佳。以麻黄（一两) 川椒（五钱) 蛇床子（五钱) 斑蝥（七枚) 雄猪油或地沥青熬
透去渣。另用明矾黄柏（各一两) 蓖麻子大枫子各四十粒共研末。调入油内。绢包擦患处。
能拔蕴毒伏邪。未出旬日可愈。无后患。比予火酒摩转筋之义正同。（以麻黄等之辛烈。行
使明矾黄柏苦寒也。)
石雨田母年近五旬。陡患霍乱转筋。苔黄大渴。神情烦躁。证属伏暑。脉颇不恶。而浑身冷
汗。摇扇不停。已为阳越之象。不敢予方。寻即告殒。此证书不凭脉也。朱巽泉父年已六旬
。患霍乱转筋。证不甚剧。问答音清。而脉微欲绝。亦决其不治。已而果然。此凭脉不证书
也。某丙夜患此证。刺
出黑血。侵晓孟英往视。形脉两脱。大汗如淋。目陷音嘶。溺无苔腻。平素嗜饮少谷。好善
忘劳。暑湿蕴中。正气溃散。勉投参药。竟不能救。孟英次女。八月二十三日忽患痛泻。肢
冷脉伏。崔某进附子理中汤加减。泻不止而苔黑唇燥。颇露热象。改投犀斛生脉散等药。形
渐脱。又用附桂八味汤。遂于二十九日舌焦如炭而逝。噫。据此病情。是伏暑也。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。
李华甫继室。陡患霍乱兼溺血如注。头疼如劈。自汗息微。势极危殆。速孟英诊视。脉甚弦
驶。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。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。（镑犀角先煎四钱。细木通一
钱。滑石先煎五钱。黑栀皮三钱。姜竹茹三钱。生苡仁八钱。银花一两五钱。鲜茅根五钱。
鲜菊叶二钱。藕二两打汁冲药送龙荟丸三钱。次方清肺胃佐息风阳。肺胃清。风阳始有下降
之机。鲜芦根二两。生冬瓜子四钱。生苡仁杵八钱。百合花三钱。香白薇一钱。元参片泡冲
去渣八钱。蒲公英一两。小蓟一钱半。鲜竹叶二钱。西瓜皮四钱。莲子心一钱。童便煎去头
尾冲一大酒杯。仍药送龙荟丸三钱。)
吴绿园仲夏陡患发热呕吐。茎缩腹痛。孟英诊脉。弦 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。（辨厥阴蕴热。在茎缩腹痛
。酒炒楝核杵先二钱。姜竹茹三钱。酒炒川连一钱。酒炒川柏三钱。石斛先煎一两。黑栀皮
三钱。济银花一两五钱。方通草三钱。丝瓜络三钱。)
或问半痴曰∶既肝郁于土而食不下行矣。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。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。此说与前释邪
之所凑其气必虚之说。可以互证。
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。孟英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。盐水调涂涌泉穴。服后吐泻渐止。噫气不舒。呃忒胁痛
。汗减口燥。脘下拒按。脉 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。去郁苑通楝。加沙参石
斛兰叶藕鲜稻头。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。半痴游刃有余。治标而不犯其本。用
药与病机宛转相赴。（北沙参四钱。蚕砂五钱。生苡仁杵四钱。姜竹茹三钱。制半夏一钱半
。丝瓜络三钱。陈木瓜八分。车前子杵先四钱。扁豆叶十片。药送左金丸一钱。嗣去沙参蚕
矢木瓜车前左金。加紫菀茸一钱半。黄郁金一钱。楝核杵先二钱。方通草三钱。姜枇叶刷包
三钱。二帖后去郁苑通楝。加沙参四钱。石斛先煎五钱。建兰叶三钱。藕肉切五钱。鲜稻头
钱某患霍乱，伴有自汗。四肢冰冷，脉搏微弱至难以触及。他平时喜欢贪凉并饮用冷饮。旁人认为是寒证，打算使用大剂量的温热药物。孟英说：“舌苔虽然发白，但是厚腻且边缘呈绛红色，并且口渴严重，头部剧烈疼痛，不能因为他是因寒凉致病，就不去检查是否有暑热潜伏在内。”于是用五苓散去掉白术，加入黄连、厚朴、黄芩、竹茹、木瓜、扁豆叶。服药后脉搏稍微显现，汗逐渐收敛，呕吐和腹泻也减缓了。随即去掉肉桂，加入桑枝、滑石、甘草。头痛、呕吐和腹泻都停止了，舌苔颜色转为黄色。随后使用清解暑热、调和脾胃的方药而痊愈。（木猪苓三钱，生泽泻三钱，云茯苓一钱半，姜炒川黄连二钱，姜炒枯黄芩一钱，制厚朴一钱，姜竹茹三钱，陈木瓜二钱，扁豆叶七片，肉桂心二分。后来去掉肉桂，加入姜炒桑枝二钱，西滑石先煎四钱，生粉甘草一钱。）
吴竹溪时感病即将痊愈时，出现呃逆三天，声音传到邻居家。大家都认为病情危急。我用通腑行气的方法治疗，大便通畅、痰液吐出后痊愈。（通腑行气法用酒炒枯黄芩一钱半，酒炒川黄连一钱，鲜芦根二两，鲜枇杷叶刷毛包煎三钱，制半夏一钱，姜竹茹三钱，旋覆花包煎先下三钱，苦桔梗次下三钱，石菖蒲次下入一钱，淡海藻先煎一两，鲜芦菔切片一两，炒枳实一钱半。）
朱浦香五十六岁，从小患有童劳（小儿虚损），继而又吐血。三十多岁就断绝房事，才得以活到现在。但他平时大便像羊屎一样干结，说明他的血分亏损如此严重。今年秋天突然患上呃逆，连续服用滋阴、镇潜、温纳的药物，病情接近危险。请孟英诊治。脉象弦滑搏动快速，舌苔黄厚腻，口苦尿赤。主治以大剂量凉润药物，如雪羹汤、瓜蒌仁、竹沥、枇杷叶、芦根、玄参、紫菀、射干、马兜铃、石菖蒲等多剂。连续排出红色粪便后才好转。像这样衰老之年、虚弱体质的人，还因为痰热导致呃逆，所以虚寒性的呃逆，确实很少见。（大剂量凉润法用淡海藻先煎二两，整荸荠一两，姜瓜蒌仁研末四钱，姜竹沥一大酒杯冲服，姜枇杷叶刷毛包煎三钱，鲜芦根二两，玄参片泡后冲去渣八钱，紫菀茸一钱半，姜射干三钱，马兜铃三钱，石菖蒲次下入二钱。）
蒋循庵的儿媳患霍乱转筋，已经三天了。四肢厥冷，眼球上窜，胸膈闷塞无小便，舌苔黄且口苦口渴，脉极弦细。多次进服桂枝、附子、干姜、白术等药，气逆欲死。我用昌阳泻心汤加减，煎好后慢慢服用。外用吴茱萸研末，卤水调匀贴敷涌泉穴。服用两剂后，呕吐停止，脚变暖。去掉苏叶、厚朴，加入川楝子、石斛、蒲公英，多剂后才痊愈。这是伏暑挟带素来旺盛的肝阳为病，误服温补药物，导致病情迅速难以清除。（昌阳泻心汤方，治霍乱后胸前痞塞，汤水难以下咽，或渴或呃。石菖蒲、黄芩酒炒、制半夏各一钱，川黄连姜汁炒五六分，苏叶三四分，制川厚朴八分，鲜竹茹、枇杷叶刷毛，各二钱，芦根一两，天雨水急火煎，徐徐温服。小溲秘涩者加紫菀。加减方用酒炒枯黄芩三钱，姜竹茹四钱，姜枇杷叶刷毛包煎三钱，芦根二两，制厚朴一钱，生苏子一钱半，海藻先煎二两，菖蒲次下一钱。）
谢氏妇人怀孕五个月，腹泻四天。医生投用干姜、附子、桂枝、厚朴等药一帖，随即四肢麻木冰冷，气塞神昏，小便闭塞，出汗淋漓，极度口渴呕吐。请孟英诊治。脉象未完全伏匿，先饮以酱油汤，呕吐逐渐停止。随后给予人参、黄连、黄芩、黄柏、竹茹、石斛、金银花、扁豆叶、蒲桃干、芦根、绿豆，用冬瓜汤煎煮，徐徐温服。外用炭醋熏蒸，各种症状都好了。第二天脉象弦滑，腹泻未止，用白头翁汤加人参、甘草、金银花、扁豆、蒲公英、蒲桃干、砂仁，两剂后痊愈。（西洋参三钱，酒炒川黄连八分，酒炒枯黄芩一钱半，酒炒川黄柏二钱，姜竹茹三钱，石斛先煎一两，金银花一两五钱，扁豆叶十片，蒲桃干一钱，芦根一两，整绿豆先煎五钱，整冬瓜二两，煨汤煎药。）
詹耀堂的儿子二十岁，患霍乱。服用干姜、桂枝几剂，腹泻不止。他平时吸食鸦片，被怀疑为虚漏，补益后腹泻更加严重。孟英看他，极度口渴且脉象弦数。幸好起病不是因为暑热，然而阴分素来亏损，虽然贪饮冷饮、贪凉，温热药物岂能过量？假如没有便泻来分散药力，那么津液早就枯竭了。给予白头翁汤合封髓丹，加金银花、绿豆、石斛，一剂见效，两剂痊愈。（方义甘凉救阴，苦寒泻暑。酒炒白头翁一钱半，酒炒川黄柏三钱，酒炒川黄连一钱，大生地八钱，明天冬切六钱，开水泡煎去渣，济金银花一两五钱，生绿豆先煎五钱，石斛先煎一两。）
蒋敬堂的母亲七十四岁，突然患呕吐腹泻，身体发热腹痛，神志不清。孟英诊察，脉象微弱而数。说：“暑邪致脉自虚，不可以因为是高龄就害怕脱证。辛散痧药，则不免耗伤其津液。”于是定下黄芩、黄连、滑石、石斛、竹茹、黄柏、金银花、竹叶、橘皮、枇杷叶的方子。用冬瓜汤煎煮，一剂后热退神清，再剂后霍然痊愈。（酒炒枯黄芩一钱半，酒炒川黄连一钱，酒炒川黄柏三钱，西滑石先煎四钱，济金银花一两五钱，鲜竹叶二钱，酒炒枇杷叶刷毛包煎三钱，五爪红一钱半，冬瓜二两，煨汤煎药。）
罗吉人在立冬前，患霍乱转筋。某人知道他的阴分素来亏损，病由伏暑引起，服药已得转机。几天后渐渐有呃逆。孟英诊视，脉象弦数左侧更甚，舌苔焦黑且口渴，牙龈出血，胃脘闷塞，大便溏泄色酱，小便短赤，都是伏暑未清，气机阻塞的现象。既然失去了清肃之机，肚脐上还贴着回阳膏，多次嘱咐揭去却不听从，后来听说去世了。
某人新秋突然患洞泻如注，随即浑身出汗如洗，气息奄奄。孟英前往勘察，脉来沉细，身体不发热，俨然是虚寒之证。只有舌苔色黄腻，小便全无，乃是湿热病。给予桂苓甘露饮加厚朴，投药即愈。（木猪苓三钱，生泽泻三钱，云茯苓一钱半，生石膏先煎一两二钱，西滑石先煎五钱，制厚朴次下入一钱。）
余杭纸客在船途中患此病，来乞求孟英诊治。已经舌卷囊缩，形体脱失神志离散，不可救药了。口开苔黑，询问中途并未服药。仔细思考其原因，暑湿既可以潜伏到深秋而发为霍乱，那么冬天受寒的人，到了春天不为温病，也可以变为霍乱。虽然是温病的变证，而温就是热，所以与伏暑为病，相差无几。况且细细推究仲景的书，也未尝不微露其意。如太阳与少阳合病，自下利的给予黄芩汤，如果呕吐的用黄芩加半夏生姜汤主治。张石顽注释说：温病始发，即当用黄芩汤去热为主。若伤寒必传至少阳，热邪渐入里，方才可用黄芩佐柴胡解之。盖黄芩汤乃温病之主方，即桂枝汤以黄芩易桂枝而去生姜，以桂枝主在表风寒，黄芩主在里风热，是不易之定法。其生姜辛散，非温热所宜，故去之。这是表里寒热不可不知的。周禹载注释说：明言太少二阳，何不用二经药？非伤寒也。伤寒由表入里，此则自内发外，无表何以知？或胁满，或头痛，或口苦引饮，或不恶寒而即热，故不得谓之表也。如伤寒合病，皆表病也。今不但无表，且有下利里证。伤寒协热利，必自传经而入，不若此之即利也。温何以即利？其人中气本虚，内伏已深，不能尽泄于外，势必下走利也。孟英谓此论温邪外发未久，即可下走为利，本文更有“若呕者”句，岂非温病可转霍乱，早逗端倪于此乎？曩纂《温热经纬》，于此条下附注云：少阳胆木，挟火披猖，呕是上冲，利由下迫，何必中虚始利？饮聚而呕，半夏生姜，专开饮结。如其热炽，宜易连茹。
辛酉年秋天，盛行霍乱转筋之证。一男子胸次拒按，孟英以萝卜子、枳实、槟榔等导滞。（此证系寒霍乱挟食。）
某人赤膊不容遮盖，还说五脏如火烧，目陷音嘶，舌苔黄大渴，但喝水即吐，四肢厥冷脉伏。市医令服姜汤一杯，幸亏没喝。适逢孟英到，急忙取冷雪水命用小匙慢慢灌下，遂不吐。更以石膏、黄连、知母泻其逆冲之火而愈。（此证可治在苔黄大渴，得饮即吐。生石膏先煎一两二钱，酒炒川黄连一钱，酒炒知母五钱，鲜枇杷叶刷毛包煎三钱，鲜芦根二两，石斛先煎一两，南花粉四钱，西滑石先煎五钱，旋覆花包煎先下三钱，陈木瓜一钱半，石菖蒲次下入二钱。）
钱某患霍乱，兼吐蛔虫十余条，而口干脉细，是暑邪伏于厥阴侵犯中焦。用黄连、乌梅、竹茹、川楝子、薏苡仁、石斛、苏叶、黄芩清解而愈。（酒炒川黄连一钱，酒炒川楝核杵碎先下四钱，乌梅肉杵碎先下三钱，姜竹茹三钱，生苡仁杵碎八钱，石斛先煎一两，酒炒枯黄芩一钱半，紫苏叶次下入四分。）
陈某患霍乱，而下利全是血，舌苔黄大渴，而舌色紫黯，乃暑毒深伏，起病时又饮烧酒。用犀角、益母草、紫地丁、茅根、菖蒲、绿豆、金银花、黄芩、黄连、黄柏、藕汁大剂灌之，投药即愈。（镑犀角先煎四钱，益母草五钱，紫地丁三钱，鲜茅根五钱，生绿豆先煎一两，金银花一两五钱，酒炒枯黄芩一钱半，酒炒川黄连一钱，酒炒川黄柏三钱，藕二两打汁冲，石菖蒲次下入一钱。）
张二梅年过六十，秋天患霍乱转筋。医生见其高龄而四肢厥冷多汗，拟进温补。张不敢服，只用平淡单方及外治法而愈。然而从此大便不坚，时时自汗，遍身疮疥，畏热异常。立冬后，孟英诊视，脉甚滑数，口渴苔黄，便溺皆热，还穿着夹衣，是禀赋偏阳，湿热内盛，幸亏畏惧进服温补，得以延年。给予大剂清化法渐愈。（酒炒西茵陈三钱，酒炒枯黄芩一钱半，酒炒栀皮三钱，冬瓜皮四钱，蚕砂五钱，芦根二两，生苡仁杵碎八钱，鲜枇杷叶刷毛包煎三钱，西滑石先煎五钱，淡海藻先煎二两。）
某人传一方颇佳，以麻黄（一两）、川椒（五钱）、蛇床子（五钱）、斑蝥（七枚）、雄猪油或地沥青熬透去渣。另用明矾、黄柏（各一两）、蓖麻子、大枫子各四十粒共研末，调入油内，绢包擦患处。能拔蕴毒伏邪，不出十日可愈，无后患。比予火酒摩转筋之义正同。（以麻黄等的辛烈，行使明矾、黄柏的苦寒。）
石雨田的母亲年近五十，突然患霍乱转筋，舌苔黄大渴，神情烦躁，证属伏暑，脉象颇不恶，而浑身冷汗，摇扇不停，已是阳气外越之象。不敢给方，随即去世。此证书不凭脉。朱巽泉的父亲年已六十，患霍乱转筋，证不甚剧，问答声音清晰，而脉微欲绝，也断定其不治，后来果然。此凭脉不证书。某人丙夜患此证，刺出黑血，侵晓孟英往视，形脉两脱，大汗如淋，目陷音嘶，无小便苔腻，平素嗜饮少谷，好善忘劳，暑湿蕴中，正气溃散，勉投参药，竟不能救。孟英次女，八月二十三日忽患痛泻，肢冷脉伏，崔某进附子理中汤加减，泻不止而苔黑唇燥，颇露热象。改投犀角、石斛、生脉散等药，形渐脱，又用附桂八味汤，遂于二十九日舌焦如炭而逝。噫，据此病情，是伏暑也。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。
李华甫继室，突然患霍乱兼溺血如注，头疼如劈，自汗息微，势极危殆。速请孟英诊视，脉甚弦驶。此肝火内炽，暑热外侵。以犀角、木通、滑石、栀子、竹茹、薏苡仁、金银花、茅根、菊叶为大剂，和入藕汁，送服当归龙荟丸，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、玄参、小蓟、蒲公英、竹叶、西瓜翠衣、莲子心为方，和入童便，仍吞龙荟丸，服旬日全愈。（镑犀角先煎四钱，细木通一钱，滑石先煎五钱，黑栀皮三钱，姜竹茹三钱，生苡仁八钱，金银花一两五钱，鲜茅根五钱，鲜菊叶二钱，藕二两打汁冲药送龙荟丸三钱。次方清肺胃佐息风阳，肺胃清，风阳始有下降之机。鲜芦根二两，生冬瓜子四钱，生苡仁杵碎八钱，百合花三钱，香白薇一钱，玄参片泡冲去渣八钱，蒲公英一两，小蓟一钱半，鲜竹叶二钱，西瓜皮四钱，莲子心一钱，童便煎去头尾冲一大酒杯，仍药送龙荟丸三钱。）
吴绿园仲夏突然患发热呕吐，阴茎收缩腹痛。孟英诊脉，弦细而数，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、金银花、通草、丝瓜络为方，一剂见效，数剂痊愈。（辨厥阴蕴热，在阴茎收缩腹痛。酒炒川楝核杵碎先下二钱，姜竹茹三钱，酒炒川黄连一钱，酒炒川黄柏三钱，石斛先煎一两，黑栀皮三钱，济金银花一两五钱，方通草三钱，丝瓜络三钱。）
有人问半痴说：既然肝郁于土而食物不下行，为什么干屎自遗而不觉呢？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。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。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。此说与前释“邪之所凑其气必虚”之说，可以互证。
姜秋农疟疾腹泻初愈，遽劳奔走，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。孟英以沙参、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。外用吴茱萸一两研末，盐水调涂涌泉穴。服后吐泻渐止，噫气不舒，呃逆胁痛，汗减口燥，脘下拒按，脉涩而弦，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，去郁金、通草、川楝，加沙参、石斛、兰叶、藕、鲜稻头，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。半痴游刃有余，治标而不犯其本，用药与病机宛转相赴。（北沙参四钱，蚕砂五钱，生苡仁杵碎四钱，姜竹茹三钱，制半夏一钱半，丝瓜络三钱，陈木瓜八分，车前子杵碎先下四钱，扁豆叶十片，药送左金丸一钱。嗣去沙参、蚕矢、木瓜、车前、左金，加紫菀茸一钱半，黄郁金一钱，川楝核杵碎先下二钱，方通草三钱，姜枇杷叶刷毛包煎三钱。二帖后去郁金、通草、川楝，加沙参四钱，石斛先煎五钱，建兰叶三钱，藕肉切五钱，鲜稻头）
Mr. Qian suffered from cholera with spontaneous sweating. His limbs were cold and his pulse was imperceptible. He usually indulged in cooling foods and drinks. Others considered it a cold syndrome and intended to use large doses of hot medicines. Mengying said, "Although the tongue coating is white, it is thick and greasy with crimson edges, and he is extremely thirsty with severe headache. We cannot fail to examine for latent summerheat pathogen just because he was caused by cold and coolness." Thus, Wu Ling San (Five-Ingredient Powder with Poria) was used with Poria removed, added with Coptis Rhizome (Huanglian), Magnolia Bark (Houpo), Scutellaria Root (Huangqin), Bamboo Shavings (Zhuru), Chaenomeles Fruit (Mugua), and Dolichos Lablab Leaf (Bian Dou Ye). After taking the medicine, the pulse slightly emerged, sweating gradually stopped, and vomiting and diarrhea slowed down. Then, Cinnamon Twig (Rougui) was removed, and Mulberry Twig (Sangzhi), Talcum (Huashi), and Licorice Root (Gancao) were added. The headache, vomiting, and diarrhea all ceased, and the tongue coating turned yellow. Subsequently, he recovered using formulas that cleared summerheat and harmonized the middle jiao. (Zhu Ling 3 qian, Ze Xie 3 qian, Fu Ling 1.5 qian, Jiang-chuan Lian 2 qian, Ku Huang Qin 1 qian, Zhi Hou Po 1 qian, Zhu Ru 3 qian, Chen Mu Gua 2 qian, Bian Dou Ye 7 slices, Rou Gui Xin 0.2 fen. Later, Rou Gui was removed, Sang Zhi 2 qian, Xi Hua Shi 4 qian, Sheng Gan Cao 1 qian.)
Wu Zhuxi, whose seasonal disease was about to heal, suffered from hiccups for three days, audible to neighbors. Everyone considered the condition critical. I used the method of unblocking the bowels and promoting qi circulation; after bowel movement and expectoration of phlegm, he recovered. (Unblocking bowels and promoting qi: Ku Huang Qin 1.5 qian, Chuan Lian 1 qian, Xian Lu Gen 2 liang, Xian Pi Ye 3 qian, Zhi Ban Xia 1 qian, Zhu Ru 3 qian, Xuan Fu 3 qian, Jie Geng 3 qian, Shi Chang Pu 1 qian, Hai Zao 1 liang, Xian Lu Fu 1 liang, Zhi Zhi Shi 1.5 qian.)
Zhu Puxiang, aged fifty-six, had suffered from childhood consumption since youth, followed by hematemesis. He abstained from sexual activity after thirty to survive until now. However, his stool was hard like sheep droppings, indicating severe blood deficiency. In autumn, he suddenly developed hiccups. Continuous administration of nourishing, sedating, warming, and grasping medicines brought him to the brink of death. Mengying diagnosed a wiry, slippery, rapid, and forceful pulse, with a thick, greasy, yellow tongue coating, bitter taste in the mouth, and dark urine. He prescribed large doses of cooling and moistening herbs, such as Xue Geng Tang, Trichosanthes Seed (Lou Ren), Bamboo Sap (Zhu Li), Loquat Leaf (Pi Ye), Reed Rhizome (Lu Gen), Scrophularia Root (Yuan Shen), Aster Root (Zi Wan), Belamcanda Rhizome (She Gan), Thladiantha Fruit (Dou Ling), and Acorus Rhizome (Chang Pu) over multiple doses. Only after passing red stools did he improve. For a person of such advanced age and weak constitution, hiccups caused by phlegm-heat are common, whereas hiccups due to deficiency-cold are indeed rare. (Large dose cooling and moistening: Hai Zao 2 liang, Bi Qi 1 liang, Lou Ren 4 qian, Zhu Li 1 large wine cup, Pi Ye 3 qian, Lu Gen 2 liang, Yuan Shen 8 qian, Zi Wan 1.5 qian, She Gan 3 qian, Dou Ling 3 qian, Chang Pu 2 qian.)
Jiang Xun'an's daughter-in-law suffered from cholera with muscle cramps for three days. She presented with cold extremities, upward staring eyes, chest oppression, anuria, yellow bitter tongue coating, thirst, and an extremely wiry and fine pulse. Repeated administration of Cinnamon Twig, Aconite, Ginger, and Atractylodes caused severe qi rebellion bordering on death. I prescribed Chang Yang Xie Xin Tang with modifications, taken slowly after decoction. Externally, Evodia Fruit (Wu Zhu Yu) powder mixed with brine was applied to Yongquan (KI-1). After two doses, vomiting stopped and feet warmed. Perilla Leaf (Su Ye) and Magnolia Bark (Hou Po) were removed, and Melia Fruit (Lian Zi), Dendrobium (Shi Hu), and Honeysuckle Flower (Pu Gong Ying) were added. Recovery took multiple doses. This was latent summerheat combined with her inherent hyperactive liver yang, worsened by mistaken warm-tonifying treatment. (Chang Yang Xie Xin Tang treats post-cholera chest fullness, difficulty swallowing liquids, thirst, or hiccups. Shi Chang Pu, Huang Qin, Ban Xia each 1 qian, Chuan Lian 0.5-0.6 qian, Su Ye 0.3-0.4 qian, Zhi Chuan Hou Po 0.8 fen, Zhu Ru and Pi Ye each 2 qian, Lu Gen 1 liang. Decoct with rainwater, take warm slowly. Add Zi Wan if urination is obstructed. Modified formula: Ku Huang Qin 3 qian, Zhu Ru 4 qian, Pi Ye 3 qian, Lu Gen 2 liang, Zhi Hou Po 1 qian, Sheng Su Zi 1.5 qian, Hai Zao 2 qian, Chang Pu 1 qian.)
Mrs. Xie, five months pregnant, suffered diarrhea for four days. After one dose of Ginger, Aconite, Cinnamon, and Magnolia Bark, she developed numb and cold limbs, qi obstruction, coma, urinary retention, profuse sweating, extreme thirst, and vomiting. Mengying found the pulse not completely hidden. First, soy sauce soup was given, stopping vomiting. Then, American Ginseng, Coptis, Scutellaria, Phellodendron, Bamboo Shavings, Dendrobium, Honeysuckle, Dolichos Leaf, Raisins, Reed Rhizome, and Mung Bean were decocted in Winter Melon soup and taken warm slowly. Externally, charcoal and vinegar fumigation was used. All symptoms resolved. The next day, the pulse was wiry and slippery, but diarrhea persisted. Bai Tou Weng Tang plus Ginseng, Licorice, Honeysuckle, Dolichos, Polygonatum, Raisins, and Amomum was given for two doses, resulting in recovery. (Xi Yang Shen 3 qian, Chuan Lian 0.8 fen, Ku Huang Qin 1.5 qian, Chuan Bai 2 qian, Zhu Ru 3 qian, Shi Hu 1 liang, Yin Hua 1.5 liang, Bian Dou Ye 10 slices, Pu Tao Gan 1 qian, Lu Gen 1 liang, Lv Dou 5 qian, Dong Gua 2 liang.)
Zhan Yaotang's son, aged twenty, suffered from cholera. After several doses of Ginger and Cinnamon, diarrhea continued. He habitually smoked opium and was suspected of having a deficiency leakage; tonification made diarrhea worse. Mengying observed extreme thirst and a wiry, rapid pulse. Fortunately, the onset was not due to summerheat, but his yin was inherently deficient. Although he drank cold water and sought coolness, how could excessive hot medicines be tolerated? If not for the diarrhea dispersing the medicinal power, his fluids would have been exhausted long ago. Bai Tou Weng Tang combined with Feng Sui Dan, plus Honeysuckle, Mung Bean, and Dendrobium was prescribed. Improvement after one dose, cure after two. (Formula rationale: Sweet-cool to save yin, bitter-cold to drain summerheat. Bai Tou Weng 1.5 qian, Chuan Bai 3 qian, Chuan Lian 1 qian, Da Di Huang 8 qian, Tian Men Dong 6 qian, Yin Hua 1.5 liang, Lv Dou 5 qian, Shi Hu 1 liang.)
Jiang Jingtang's mother, aged seventy-four, suddenly developed vomiting and diarrhea, fever, abdominal pain, and confusion. Mengying diagnosed a weak, rapid pulse, stating, "Summerheat causes a naturally deficient pulse; do not fear collapse merely due to advanced age. Acrid-dispersing sha medicines will consume fluids." He prescribed Scutellaria, Coptis, Talcum, Dendrobium, Bamboo Shavings, Phellodendron, Honeysuckle, Mint Leaf, Tangerine Peel, and Loquat Leaf, decocted in Winter Melon soup. Fever subsided and mind cleared after one dose; complete recovery after two. (Ku Huang Qin 1.5 qian, Chuan Lian 1 qian, Chuan Bai 3 qian, Xi Hua Shi 4 qian, Yin Hua 1.5 liang, Zhu Ye 2 qian, Pi Ye 3 qian, Wu Zhao Hong 1.5 qian, Dong Gua 2 liang.)
Luo Jiren, before Start of Winter, suffered from cholera with muscle cramps. Someone knew his yin was inherently deficient and the disease stemmed from latent summerheat; medication brought improvement. Days later, hiccups appeared. Mengying found a wiry, rapid pulse, stronger on the left, scorched tongue coating, thirst, epistaxis, epigastric oppression, loose saucy-colored stool, and scanty dark urine—all signs of unresolved latent summerheat and qi stagnation. Despite instructions to remove the back-yang-warming plaster from the navel, he refused. He later died.
Another patient suddenly suffered projectile diarrhea in early autumn, followed by profuse sweating and near-death state. Mengying found a deep, fine pulse, no fever, resembling deficiency-cold, except for a yellow-greasy coating and total anuria, diagnosing damp-heat. Gui Ling Gan Lu Yin plus Magnolia Bark cured him immediately. (Zhu Ling 3 qian, Ze Xie 3 qian, Fu Ling 1.5 qian, Sheng Shi Gao 1.2 liang, Xi Hua Shi 5 qian, Zhi Hou Po 1 qian.)
A paper merchant from Yuhang fell ill on a boat and sought Mengying's diagnosis. He already had tongue retraction and testicular retraction, emaciation, and loss of spirit—untreatable. Mouth open, black tongue coating. He had taken no medicine en route. Reflecting on this, Mengying reasoned: If damp-summerheat can lie dormant until late autumn causing cholera, then winter cold can transform into cholera in spring, even if not becoming a warm disease. Though a variation of warm disease, warmth is heat, so it is not vastly different from latent summerheat. Studying Zhang Zhongjing's texts reveals this intent: Taiyang-Shaoyang combined disease with diarrhea uses Huang Qin Tang; if vomiting, Huang Qin Jie Ban Xia Sheng Jiang Tang. Zhang Shiwang noted: Warm disease should start with Huang Qin Tang to clear heat. Shaoyang transmission involves interior heat, requiring Huang Qin with Chai Hu. Huang Qin Tang is the main formula for warm disease, essentially Guizhi Tang replacing Cinnamon with Scutellaria and removing Ginger, as Cinnamon treats exterior wind-cold while Scutellaria treats interior wind-heat. Ginger is acrid-dispersing, unsuitable for heat, hence removed. Zhou Yuzai noted: Why not use Shaoyang/Taiyang herbs? It is not cold damage. Cold damage moves from exterior to interior; this originates internally. Symptoms like hypochondriac fullness, headache, bitter taste, or immediate fever without aversion to cold indicate it is not exterior. Combined cold damage affects the exterior; here, there is no exterior, only interior diarrhea. Cold damage heat-diarrhea comes via meridian transmission; this is immediate. Why does warm disease cause immediate diarrhea? Middle qi deficiency allows deep-seated pathogens to exit downward. Mengying commented: This theory shows warm pathogens exiting quickly can cause diarrhea. The text mentions vomiting, suggesting warm disease can turn to cholera. In compiling *Wen Re Jing Wei*, I noted: Shaoyang wood carries fire, vomiting is upward rushing, diarrhea is downward pressure. Phlegm-fluid accumulation causes vomiting; Ban Xia and Sheng Jiang resolve fluid knots. If heat is intense, replace with Lian and Ru.
In autumn of Xinyou year, cholera with cramps prevailed. A man had chest tenderness; Mengying used Radish Seed, Immature Bitter Orange, and Areca Nut to guide out stagnation. (This case is cold cholera with food stagnation.)
Another patient, bare-chested despite heat, complained of internal burning, sunken eyes, hoarse voice, yellow coating, extreme thirst, yet vomited upon drinking. Extremities were cold, pulse hidden. City doctors suggested ginger soup, which he fortunately refused. Mengying arrived, ordered cold snow water administered slowly with a small spoon, stopping vomiting. Then, Gypsum, Coptis, and Anemarrhena were used to drain rebellious fire. (Treatable due to yellow coating, thirst, vomiting after drinking. Shi Gao 1.2 liang, Chuan Lian 1 qian, Zhi Mu 5 qian, Pi Ye 3 qian, Lu Gen 2 liang, Shi Hu 1 liang, Hua Fen 4 qian, Xi Hua Shi 5 qian, Xuan Fu 3 qian, Chen Mu Gua 1.5 qian, Shi Chang Pu 2 qian.)
Mr. Qian had cholera with vomiting of over ten roundworms, dry mouth, and fine pulse, indicating summerheat latent in Jueyin invading the center. Lian Mei Ru Lian Yi Hu Su Qin cleared it to cure. (Chuan Lian 1 qian, Chuan Lian He 4 qian, Wu Mei 3 qian, Zhu Ru 3 qian, Yi Yi Ren 8 qian, Shi Hu 1 liang, Ku Huang Qin 1.5 qian, Zi Su Ye 0.4 fen.)
Mr. Chen had cholera with bloody stools, yellow coating, extreme thirst, and purple-dark tongue, indicating deep latent summerheat toxin, exacerbated by drinking liquor at onset. Rhinoceros Horn, Motherwort, Clematis, Imperata, Acorus, Mung Bean, Honeysuckle, Scutellaria, Coptis, Phellodendron, and Lotus Juice were given in large doses, curing him. (Xi Jiao 4 qian, Yi Mu Cao 5 qian, Zi Di Ding 3 qian, Mao Gen 5 qian, Lv Dou 1 liang, Yin Hua 1.5 liang, Ku Huang Qin 1.5 qian, Chuan Lian 1 qian, Chuan Bai 3 qian, Ou 2 liang, Shi Chang Pu 1 qian.)
Zhang Ermei, over sixty, had cholera with cramps in autumn. Doctors saw advanced age, cold extremities, and sweating, intending warm tonification. She refused, using mild single remedies and external treatments instead. Afterwards, she had soft stools, spontaneous sweating, body sores, and extreme heat intolerance. At Start of Winter, Mengying found a slippery, rapid pulse, thirst, yellow coating, hot urination/stool, yet wearing padded clothes. This indicated yang-predominant constitution with internal damp-heat. Avoiding warm tonification allowed longevity. Large-dose clearing and transforming methods gradually healed her. (Yin Chen 3 qian, Ku Huang Qin 1.5 qian, Zhi Pi 3 qian, Dong Gua Pi 4 qian, Can Sha 5 qian, Lu Gen 2 liang, Yi Yi Ren 8 qian, Pi Ye 3 qian, Xi Hua Shi 5 qian, Hai Zao 2 liang.)
A good prescription was transmitted: Ephedra, Sichuan Pepper, Cnidium, Mustard Beetle, and Pig Fat or Asphalt boiled, strained. Alum, Phellodendron, Castor Seed, and Big Maple Seed ground to powder, mixed into oil, applied via silk cloth to rub affected areas. Draws out hidden toxins, cures within ten days without sequelae. Similar to using alcohol for cramp massage. (Using acrid-hot herbs to drive bitter-cold herbs.)
Shi Yutian's mother, nearly fifty, suddenly had cholera with cramps, yellow coating, extreme thirst, restlessness, diagnosed as latent summerheat. Pulse was acceptable, but she had cold sweats and fanned herself constantly, showing yang floating outward. No prescription was given; she died soon. This case relied on symptoms, not pulse.
Zhu Xunquan's father, sixty, had mild cholera with cramps, clear speech, but pulse was faint and nearly absent. Predicted fatal outcome; confirmed. This case relied on pulse, not symptoms.
Another patient had this disease at midnight, punctured to release black blood. Mengying visited at dawn: form and pulse both depleted, profuse sweating, sunken eyes, hoarse voice, anuria, greasy coating. Habitual alcoholism, poor diet, kindness, overwork led to damp-summerheat accumulation and righteous qi collapse. Ginseng was tried but failed. Mengying's second daughter suddenly had painful diarrhea on Aug 23rd, cold limbs, hidden pulse. Cui gave Fuzi Lizhong Tang modification; diarrhea continued, tongue black, lips dry, showing heat signs. Changed to Xijiao, Shihu, Sheng Mai San; condition deteriorated. Then Fugui Bawei Tang was given; she died on the 29th with a charcoal-black tongue. Alas, this is latent summerheat. Cholera/sha with food stagnation requires removing food first, as in cold damage. Qin's discussion is detailed. However, some get sick after eating, not due to food. Banchi said: Since one doesn't wait for illness with an empty stomach, one shouldn't treat solely with attacking/digesting methods. Clinical practice requires careful inquiry and differentiation to avoid errors.
Li Huafu's second wife suddenly had cholera with massive hematuria, splitting headache, spontaneous sweating, weak breathing, critical condition. Mengying found a wiry, rapid pulse: internal liver fire blazing, external summerheat invading. Rhinoceros Horn, Wood Vetch, Talcum, Gardenia, Bamboo Shavings, Coix Seed, Honeysuckle, Imperata, Chrysanthemum Leaf, and Lotus Juice were given in large doses, along with Danggui Longhui Wan. Vomiting/diarrhea stopped, hematuria reduced. Headache during urination required holding head tight; wind-yang was hyperactive, lung/stomach unclear. Weijing Tang minus Peach Kernel, plus Lily Bulb, Anemarrhena, Scrophularia, Small Thistle, Polygonatum, Mint Leaf, Watermelon Rind, and Lotus Plumule, mixed with child's urine, still taking Longhui Wan. Cured in ten days. (Xi Jiao 4 qian, Mu Tong 1 qian, Hua Shi 5 qian, Zhi Pi 3 qian, Zhu Ru 3 qian, Yi Yi Ren 8 qian, Yin Hua 1.5 liang, Mao Gen 5 qian, Ju Ye 2 qian, Ou 2 liang, Longhui Wan 3 qian. Second formula clears lung/stomach, calms wind-yang. Lu Gen 2 liang, Dong Gua Zi 4 qian, Yi Yi Ren 8 qian, Bai He 3 qian, Bai Wei 1 qian, Yuan Shen 8 qian, Pu Gong Ying 1 liang, Xiao Ji 1.5 qian, Zhu Ye 2 qian, Xi Gua Pi 4 qian, Lian Zi Xin 1 qian, Tong Bian 1 wine cup, Longhui Wan 3 qian.)
Wu Lvyuan, mid-summer, suddenly had fever, vomiting, penile retraction, abdominal pain. Pulse wiry, thready, rapid; tongue yellow-greasy. Liver-Yin heat needed clearing, not sha. Melia, Bamboo Shavings, Coptis, Dendrobium, Gardenia, Phellodendron, Honeysuckle, Tong Cao, and Loofah Network cured him. (Differentiating Liver-Yin heat: penile retraction/abdominal pain. Chuan Lian 2 qian, Zhu Ru 3 qian, Chuan Lian 1 qian, Chuan Bai 3 qian, Shi Hu 1 liang, Zhi Pi 3 qian, Yin Hua 1.5 liang, Tong Cao 3 qian, Si Gua Luo 3 qian.)
Someone asked Banchi: If liver qi stagnates in spleen preventing food descent, why does dry stool pass unnoticed? Banchi replied: Stomach and Large Intestine share one qi. Food stagnation in stomach seems disconnected from Large Intestine qi, so old feces pass unnoticed. Classics say: Deficiency of middle qi changes urination and defecation. This is a change. "Deficiency" here doesn't mean middle qi weakness, but obstruction preventing descending turbid and ascending clear functions, altering normal excretion. Cholera's endless vomiting/diarrhea and dry cholera's constipation are also changes due to middle qi obstruction. If "deficiency" meant true deficiency, all choleras would be treated by tonifying middle qi. This corroborates "where evil gathers, qi must be deficient."
Jiu Nong, recovering from malaria-diarrhea, exerted himself, suddenly developing cholera with cramps. Purple face/arms, sunken eyes, hoarse voice, chest oppression, yellow coating, profuse sweat, sticky mouth, fatigue, anuria, fine wiry pulse. Mengying used Schisandra, Silkworm Droppings, Coix Seed, Bamboo Shavings, Pinellia, Loofah Network, Chaenomeles, Plantago Seed, Dolichos Leaf, decocted in Yin-Yang water, with Zuojin Wan externally Evodia powder on Yongquan. Vomiting/diarrhea stopped, belching, hiccups, rib pain, dry mouth, epigastric tenderness, choppy wiry pulse indicated chronic liver stagnation. Removed Schisandra, Silkworm Droppings, Chaenomeles, Plantago, Zuojin; added Aster, Curcuma, Melia, Tong Cao, Loquat Leaf. Two doses: urination resumed, hiccups stopped, coating receded, feet warmed, waist/leg pain, hand purple faded. Removed Curcuma, Tong Cao, Melia; added Schisandra, Dendrobium, Orchid Leaf, Lotus, Rice Sprout. Two doses: pulse harmonized, distension reduced, salty taste when drinking porridge indicated inherent yin deficiency. Removed Pinellia, Dolichos Leaf; added Angelica Sinensis, Glehnia, Tangerine Peel. Two doses: bowel movement regular, appetite returned, sore waist, insomnia treated with American Ginseng, Ophiopogon, Epimedium. Several doses later, Goji and Eucommia added for cure. This was root deficiency with branch excess. Banchi skillfully treated the branch without harming the root, matching the pathology. (Sha Shen 4 qian, Can Sha 5 qian, Yi Yi Ren 4 qian, Zhu Ru 3 qian, Ban Xia 1.5 qian, Si Gua Luo 3 qian, Mu Gua 0.8 fen, Che Qian Zi 4 qian, Bian Dou Ye 10 slices, Zuojin Wan 1 qian. Later removed Sha Shen, Can Sha, Mu Gua, Che Qian, Zuojin; added Zi Wan 1.5 qian, Yu Jin 1 qian, Lian He 2 qian, Tong Cao 3 qian, Pi Ye 3 qian. After two doses removed Yu Jin, Tong Cao, Lian; added Sha Shen 4 qian, Shi Hu 5 qian, Lan Ye 3 qian, Ou 5 qian, Dao Tou.)