道光元年冬，金履思丈，念祖父之劳 ，命余佐理鹾务于婺州之孝顺街。公余之
暇
，辄披览医书，焚膏继晷，乐此不疲。三年夏间，主政周光远先生，年二十七，体极腴皙，
登厕后，忽体冷自汗，唇白音低，佥以为痧，欲进开窍等药。时余年十七，窃握其臂以诊之
，
脉已微软欲绝，因力排众议曰∶此阳气之欲脱，非痧邪之内闭，再投香散，殆速其危也。人
皆以童子何知而笑之，幸先生闻而首肯者再，仓卒不及购药，余适有戚氏前所贻三年女佩姜
一块，约重四五钱，急煎而灌之，即安。后用培补，率以参、 、术、草为主。盖阳气偏虚
之体也，先生甚德之，视余若弟，且逢人说项，遂以浪得虚名。癸卯为余刊治案，余愧无以报
也。
先生年五十岁，无疾而逝，犹是阳虚暴脱耳。无子，一女适蔡氏，其夫人年逾六旬，杭垣
再陷后，未知下落，无从探访，追录是案，抱憾滋深。
又癸卯冬至前一日，管椒轩大中丞，忽于溺后汗淋气短，色夺言微。余适往灵隐送葬，三
遣弁丁速余至署，已痧药进之屡矣，莫可挽回。凡阳气极虚之人，便溺后忽然欲脱，是急宜
参附回阳之证，误认为痧，多致决裂，治霍乱者，须明辨之。
孝顺一仓夫，丙戌春，忽患急证，扒床拉席，口不能言，问其所苦，惟指心抓舌而已。人皆
以
为干霍乱，余谓干霍乱，何至遽不能言，且欲抓舌，似中毒耳。或云∶同膳数人，何彼中
毒
，然刮之淬之皆不验。余以夤夜无从购药，令取绿豆二升，急火煎清汤，澄冷灌之，果愈。
越日询之，始言久患痹痛，因饵草头药一服，下咽后即心闷不可耐，舌麻不能言，而旁人不
知也。
一伎自幼喜食蚕蛹，游上江者数年，久不食此。比旋杭，得与家人畅啖，正欢笑间，腹痛陡
作
，随地乱滚。或以为绞肠痧，亟请余勘之，脉色皆和，非痧非食也。若以为中毒，则共食老
少皆无恙。谛思之，虽以椒蒜炙熟，与人同啖。恐其中有一二枚或异者，亦未可知。蚕，动物
也，与马同气，其性热，更益以椒蒜之辛。姑仿中马肉毒例治之，命吸人乳，果饮下即安。
己丑五月，天气骤热，先慈陡患霍乱，肢冷自汗，脉微苔白，腹大痛，欲重按，是中虚有素
，因热而受寒侵也。进大剂理中汤加桂枝、白芍，覆杯而愈，此所谓舍时从证也。
丁酉八九月间，杭州盛行霍乱转筋之证，有沈氏妇者，夜深患此，继即音哑厥逆。比晓，其
夫皇皇求
治，余诊其脉，弦细以涩，两尺如无，口极渴而沾饮即吐不已，足腓坚硬如石，转时痛楚欲
绝，乃暑湿内伏，阻塞气机，宣降无权，乱而上逆也。为仿《金匮》鸡矢白散例，而处蚕矢
汤一
方，令以阴阳水煎成，候凉徐服。此药入口竟不吐，外以烧酒，令人用力摩擦其转戾坚硬之
处
，擦及时许，郁热散而筋结始软。再以盐卤浸之，遂不转戾，吐泻渐止。晡时复与前药半剂
，夜得安寐。次日但觉困极耳，与致和汤数服而痊。后治相类者多人，悉以是法出入获效，
惟误服附子者，最难救疗。
（此证火酒摩之时许，郁热散而筋渐舒，则转筋虽因火炽，必兼外寒郁遏而始反戾
也。大抵霍乱寒热相搏者多，虽知其为寒为热，亦须反佐以治，盖即此理。谢城。）
郑凤梧年六十余，秋间患霍乱，凛寒厥逆，烦闷躁扰，口不甚渴。或以为寒，
余察脉细欲伏，苔白而浓，乃暑湿内蕴未化也。须具燃犀之照，庶不为病所蒙。因制燃照汤
与之，一饮而厥逆凛寒皆退，脉起而吐泻渐止，随以清涤法而愈。
一妇年少体瘦，初秋患霍乱转筋，舌绛目赤，大渴饮冷，脉左弦强而右滑大，此肝胃之火素
盛
而热复侵营也。以白虎汤去米、草，加生地、蒲公英、益母草、黄柏、木瓜、丝瓜络、薏
苡，一剂知，二剂已。丹溪云∶转筋由于血热，此证是矣。
一丁姓者患霍乱，苔色白薄而不渴，但觉口中粘腻。彼自知医，欲从寒湿治。余曰∶中焦原
有寒湿，所以不渴。然而粘腻，岂非暑入而酿其湿为热乎？以胃苓汤去甘术，加苡仁、川连
、半夏、枇杷叶，二剂而瘳。
钱某患霍乱，自汗肢冷脉无，平日贪凉饮冷，人皆谓寒证，欲用大剂热药。余曰∶苔虽白，
然浓而边绛，且渴甚，头大痛，不可因寒凉致病，而竟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，服后脉稍出，汗渐收，吐利亦缓。即去肉桂、
加桂枝、滑石、甘草，头痛吐利皆止，苔色转黄，随用清暑和中而愈。
一少年体肥畏热，因酷暑，晨餐酒肉后，以席铺砖地而卧。觉即饱啖西瓜，至晚觉头重恶寒
；夜分吐
泻大作，四肢拘急，汗冷息微，时时发躁。黎明速余勘之，脉沉弱。予浆水散加吴茱萸、浓
朴，投匕即瘥，改授浓朴生姜半夏甘草人参汤，数服而愈。
陆叟年七十余，仲秋患霍乱，自服单方二三日，呕吐虽已，利犹不止，且频频作哕，声不甚
扬，面赤目闭，小便不通。医云∶高年戴阳，证原不治，且延已数日。纵投大剂回阳，亦
恐
不及。余视之，脉虽虚软，并无脱象，况舌赤而干，利下臭恶，气分伏暑，业扰及营，虑其
络闭神昏，胡可再投热剂。闻所煎之药，桂气扑鼻，试之必死。迫令将药倾泼，遂以紫雪三
分，用竹茹、枇杷叶、通草、丹参、连翘、石菖蒲、桔梗、黄芩、芦根煎汤，候凉调而徐服
。
次日复诊，目开哕止，小溲稍行。于前方裁紫雪，加石斛、苡仁，服二剂利减。能啜米饮矣
。随用致和汤，十余服而瘳。
戊戌夏，倪怀周室新产数日，患呕吐泄泻，时时自汗，人皆危之。余曰∶此非真霍乱也。然
较
真霍乱尤险，以其犯产后三禁，而脉微欲绝，亟宜峻补，迟恐无济也。予东洋参、龙、牡、
、术、木瓜、扁豆、茯神、石英、酒炒白芍、橘皮为剂，四服而痊。
（新产后用参、 大补，而又当盛夏之时，非有真知灼见者，不能也。诚以天下之病
，千变万化，原无一定之治，奈耳食之徒，惟知执死方以治活病，岂非造孽无穷，亦何苦人
人皆欲为医，而自取罪戾耶。钱塘周熔光远此证正
，放胆参、 ，犹人所能及，须看其余药，一一合拍，盖得效不仅在参、 也。至此方可云
峻补，然惯服补剂者，必嫌其轻。加鹿角、五味等，必贻害矣。古来多少佳方，为妄人加减，
王某久患吐血，体极孱易。沈琴痴拉余治之，甫得渐愈，乃庚子夏酷热之时，陡
患霍乱转筋，大汗如雨，一息如丝，人皆谓无生理矣。余不忍轻弃，勉用西洋参、枇杷叶、
龙、牡、蚕沙、木瓜、扁豆、苡仁、滑石、桑叶、石斛、豆卷，地浆煎服之，良愈。调理旬
日，仍服滋补以治宿恙。
倡女蔼金，年二十七，患时疫
颇危，余为治痊矣。忽又求诊，云患急痧。及察其脉甚细，而按之数紧，神极委顿，气喘欲
呕，腮红腹痛，舌润。似房劳太过，寒袭奇经之男劳复也。询得其情，遂以胡桃肉、破故纸
、龙、牡、鹿角霜、菟丝、覆盆、枸杞、茯苓、小茴、当归、韭子为方。一剂知，二剂已。
若贸贸然竟作干霍乱治，当何如耶。干霍乱而误投此法，又当何如耶。
（临证如神，叙证如绘，佛心仙手，其言蔼然。而一片灵光，传之纸上，效颦不
易，洵是天才。仁和胡耀曾荣甫。）
戚媪者，年六十余矣。自幼佣食于杭州黄莲泉家，忠勤敏干，老而弥甚，主仆之
谊
，胜于亲戚也。壬寅秋，患霍乱转筋。余视之，暑也。投蚕矢汤，两服而瘥。三日后，忽
倦卧
不能反侧，气少不能语言，不食不饮，莲泉惶惧。就近邀一老医诊之，以为霍乱皆属于寒，
且
昏沉欲脱，定附子理中汤一方。莲泉知药猛烈，不敢遽投，商之王君安伯。安伯云∶且勿服
也。若谓寒证，则前日之药，下咽即毙，吐泻安能渐止乎？莲泉大悟，仍着人飞刺招余往勘
。余曰∶此高年之体，元气随吐泻而虚，治宜用补。第余暑未清，热药在所禁耳？若在孟浪
之家，必以前之凉药为未当，今日温补为极是。纵下咽不及救，亦惟归罪于前手寒凉之误也
。设初起即误死于温补，而举世亦但知霍乱转筋是危险之病，从无一人知此证有阴阳之异，
治法有寒热之殊，而一正其得失者。况一老年仆媪，非贤主人，亦焉肯如是之悉心访治乎，
此病之所以不可为也。今莲泉见姜附而生疑，安伯察病机之已转，主人恺恻而心虚，客亦多
才而有识。二美相济，遂使病者跳出鬼门关，医者卸脱无妄罪。幸矣！幸矣！乃以高丽参、
麦冬、知
母、葳蕤、木瓜、扁豆、石斛、白芍、苡仁、甘草、茯苓等，服六剂，始能言动，渐进饮食
，
调理月余而健。 斋谓余云∶此余热未清，正气大虚者之治法。更有不因虚而余焰复燃者，
须用炼雄丹治之。
（是证以半痴之学问，莲泉之浓德，安伯之见识，三美相济，始能起九死于一生。
世之执死方治活病，视仆婢如草芥，不分皂白，信口雌黄者，读此能无愧死耶？
周光远先生归杭定省，七月十八夜，患霍乱转筋甚剧，仓卒间，误服青麟丸钱许
，势益甚。侵晓召余诊∶脉微弱如无，耳聋目陷，汗出肢冷，音哑肉脱，危象毕呈，药恐
迟
、苡仁、莲实为方。终剂。即各证皆减。盖气分偏虚之体，不禁吐泻之泄夺。误饵苦寒，微
阳欲绝，故以真武、理中合法以复脾肾之阳。诘朝再视，脉起肢和，即裁附、桂、干姜，
加黄 、石斛，服旬日全愈。凡吐泻甚而津液伤，筋失其养，则为之转。故治转筋者，最要
。顾其津液，若阳既回，而再投刚烈，则津液不能复，而内风动矣，此寒霍乱之用附、桂，亦
贵有权衡，而不可漫无节制，致堕前功也。
（余此番之病，危同朝露，若非半痴，恐不能救，尝闻张柳吟先生云，使病者听半
痴论病之无微不入，用药之无处不到，源源本本，信笔成章，已觉疾瘳过半。古云∶檄愈头
风，良有以也。光远。案中议论极精微，凡用药皆宜具此权衡，方无过当之言。否则药虽中病，而服之不止，反受
其害，不但热药尔也。定州杨照藜素园。霍乱之霍，即霍疾之义，谓乱之最速者也。尝见体素丰腴之人，一病半日，仅
存皮骨，其伤
陈艺圃亦知医，其室人于仲秋患霍乱转筋，自诊以为寒也。投热剂，势益甚，招
朱椒亭视之，亦同乎主人之见也。病尤剧，乃延余勘，曰∶此寒为外束之新邪，热是内伏之
真
病，口苦而渴，姜附不可投矣。与河间法，人皆不信，再与他医商之，仍用热剂，卒至口
鼻出血而死。
（霍乱一证，近来时有，而医皆不甚识得清楚，死于误治极多。半痴特着专论，辨
析简当，实今日医家首要之书。以其切于时用，不可不亟为熟读而研究也。光远。）
甲辰五月下旬，天即酷热异常，道路卒死者甚多，有腹痛者，有不痛者。人率以
香燥痧丸投之，辄无效。盖香燥反以益热，而此证并非阴寒湿毒之邪，即古所谓中 也。
不出户庭之人，亦有病此者，必其人阴分素亏，内热较甚，或居处饮食之失宜也。往往延医不
及，医多不识其病，虽死身不遽冷，亦有口鼻流血者，是暑从吸入，直犯心脏也。时余居钱
塘之髦儿桥，尝禀先慈，令家人慎起居，薄滋味，乃六月初二日午膳后。季杰弟妇，腹忽微
痛，平日贪凉，自谓受寒也。私嘱女仆沽烧酒饮之，即狂瞀不安。先慈知之，命仆从四路速
余回，日晡 也。病者已口鼻出血死矣。其时
死者尤多，以阴血大去，暑热易侵。而昧者不知因时制宜，尚扃其窗户，幕以帘帏，环侍多
人，饮以糖酒故也。粗工亦不察天时人禀之不齐，动辄生化汤，虽热象已显，犹误信产后宜
温
之俗说，而不知因证制方之活法，以致覆杯而毙者比比。或问当此热地如炉，恶露不行而腹
痛者，生化汤既不可服，宜用何方？余谓六一散最佳。既行瘀血，又能清热也。设暑热重
感，虽石膏犀角，对证皆为良药，古人何尝禁用。余案中治愈诸条，皆可参阅，然难与浅人
言也。
盔头巷姚氏妇，妊已临月，腹中陡痛。家人谓其欲娩，急煎参汤以助其力，服后痛益甚。忙
唤稳婆至，妇已浑身赤斑，喘逆昏狂，始知受暑，顷刻云亡。宝佑坊曹氏妇，亦怀妊临月
腹痛，家人以为将产而煎参汤，迨汤成痛已止，察其情景，知不即娩，然炎威甚烈，参汤久
存欲坏。其姑云，妇既未娩，岂可服参以滞胎气，我体素弱，常服补剂，参汤定亦相宜，遂
饮之。甫下咽，即觉气闷躁扰，霎时危殆，逾刻而终。后丙午、壬子、丙辰，皆酷热伤人，不
胜
缕述。古人以燥热为暑，故曰∶流金烁石，况人非金石之质乎？惜世人多不察耳。不但酷暑
时，胎前产后之腹痛，当细审其有无别故也。
潘红茶方伯之孙翼廷，馆于外氏，酷热异常，因啜冷石花一碗，遂腹痛痞闷，四肢渐冷，上
过肘膝，脉伏自汗，神困懒言，方某诊谓阳虚阴暑，脱陷在即。用大剂姜、附、丁、桂以
回阳
道光元年冬天，金履思先生考虑到祖父的辛劳，让我协助他在婺州孝顺街管理盐务。在公务之余，我便翻阅医书，日夜苦读，乐此不疲。三年夏天，主政周光远先生，年仅二十七岁，身体非常丰腴白皙，上完厕所后，突然感到身体发冷、自汗、嘴唇发白、声音低微，大家都认为是痧症，想要使用开窍的药物。当时我十七岁，私下握住他的手臂诊脉，发现脉象已经微弱欲绝，于是极力反驳众人的意见说：“这是阳气即将脱失，不是痧邪内闭，如果再投用香散类药物，恐怕会加速其危险。”众人都因为我是少年无知而嘲笑我，幸好周先生听了两次都点头认可。由于仓促来不及买药，我恰好有一块亲戚之前赠送的三年陈佩姜，大约重四五钱，急忙煎汤灌服，病情立即安定。后来使用培补之法，主要以人参、茯苓、白术、甘草为主。这是因为先生体质属于阳气偏虚，先生对我非常感激，视我为弟弟，并且逢人便称赞我，于是我因此得了虚名。癸卯年，先生为我刊印治疗医案，我感到惭愧，无以为报。
先生五十岁时，无病而逝，其实也是阳虚暴脱罢了。他没有儿子，只有一个女儿嫁给了蔡家，其夫人年过六十，在杭州城再次陷落后，不知下落，无法探访，追录这个医案，心中遗憾更深。
又在癸卯年冬至前一天，管椒轩大中丞，忽然在小便后大汗淋漓、气短、面色改变、言语微弱。我正好去灵隐送葬，三次派人催促我回到官署，此时已经多次使用了治痧的药物，无法挽回。凡是阳气极虚的人，大小便后忽然出现欲脱之象，这是急需用人参、附子回阳的证候，误认为是痧症，大多导致病情恶化，治疗霍乱的人，必须明辨这一点。
孝顺街的一个粮仓夫役，丙戌年春天，突然患急症，抓床拉席，口不能言，问他哪里痛苦，只是指着心口抓舌头而已。人们都认为是干霍乱，我认为干霍乱怎么会立刻不能说话，而且还要抓舌头，像是中毒了。有人说：“一起吃饭的好几个人，为什么只有他中毒？”然而刮舌、催吐等方法都不见效。我在深夜无法买药，让人取绿豆二升，急火煎成清汤，澄清冷却后灌服，果然痊愈。第二天询问他，才说是久患痹痛，因为吃了一次草头药，咽下后即心闷难忍，舌麻不能说话，而旁人并不知道。
一个歌妓从小喜欢吃蚕蛹，在上江游玩几年，很久没吃这个。等到回杭州，得以与家人尽情品尝，正在欢笑间，腹痛突然发作，在地上乱滚。有人以为是绞肠痧，急忙请我诊断，脉色皆平和，不是痧也不是食积。如果认为是中毒，那么一起吃的老少都安然无恙。仔细思考，虽然是用花椒、大蒜烤熟后与人同吃，但恐怕其中有一两枚有所不同，也未可知。蚕是动物，与马同气，性热，再加上花椒大蒜的辛味。姑且模仿中马肉毒的例子治疗，让人吸吮人乳，果然喝下后就安定了。
己丑年五月，天气骤然炎热，先母突然患霍乱，四肢冰冷、自汗、脉微、苔白、腹部大痛、喜欢重按，这是素来中焦虚弱，因热而受寒侵袭所致。进服大剂量的理中汤加桂枝、白芍，喝完药碗就痊愈了，这就是所谓的“舍时从证”。
丁酉年八九月间，杭州盛行霍乱转筋的病症，有个沈姓妇人，深夜患此病，随即声音嘶哑、四肢厥逆。到了天亮，她的丈夫惊慌失措地求治，我诊察她的脉象，弦细而涩，两尺脉几乎摸不到，口极渴但沾饮即吐不止，小腿肚坚硬如石，转筋时疼痛欲绝，这是暑湿内伏，阻塞气机，宣降功能丧失，气乱而上逆所致。于是仿照《金匮要略》鸡矢白散的例子，处方蚕矢汤一方，令用阴阳水煎成，待凉后慢慢服用。这药入口竟然不吐，外面用烧酒，让人用力摩擦其转筋坚硬的地方，摩擦了一时许，郁热散去，筋结才开始变软。再用盐卤浸泡，于是不再转筋，吐泻逐渐停止。傍晚时分又给服了半剂前药，夜里得以安睡。第二天只觉得很困倦，给服几剂致和汤而痊愈。后来治疗类似病例多人，都用这个方法加减获得疗效，只有误服附子的，最难救治。
（此证用火酒按摩一时许，郁热散去而筋渐舒，则转筋虽然是因火炽引起，必定兼有外寒郁遏才反常拘挛。大抵霍乱寒热相搏的情况多，即使知道它是寒是热，也必须反佐以治疗，大概就是这个道理。谢城评。）
郑凤梧六十多岁，秋天患霍乱，怕冷四肢厥逆，烦闷躁扰，口不太渴。有人认为是寒证，我观察脉细欲伏，苔白而厚，这是暑湿内蕴未化。需要具备犀角照妖般的洞察力，才不被疾病蒙蔽。于是制作燃照汤给他，一饮而厥逆怕冷都退了，脉起而吐泻渐止，随后用清涤法而愈。
一个年轻体瘦的妇人，初秋患霍乱转筋，舌绛目赤，大渴饮冷，脉左弦强而右滑大，这是肝胃之火素盛而热邪又侵入营分。用白虎汤去掉米、草，加生地、蒲公英、益母草、黄柏、木瓜、丝瓜络、薏苡仁，一剂见效，二剂痊愈。丹溪说：“转筋由于血热”，这个证候就是这样。
一个姓丁的人患霍乱，苔色白薄而不渴，只觉口中粘腻。他自己懂医，想从寒湿治疗。我说：“中焦原有寒湿，所以不渴。然而粘腻，难道不是暑邪进入而酿湿为热吗？”用胃苓汤去掉甘松和白术，加薏苡仁、黄连、半夏、枇杷叶，二剂而愈。
钱某患霍乱，自汗肢冷脉无，平日贪凉饮冷，人们都说是寒证，想用大剂量热药。我说：“苔虽白，但是厚而边红，而且口渴严重，头痛剧烈，不能因为寒凉致病，就不察觉其中有暑热潜伏。”于是用五苓散去掉白术，加黄连、厚朴、黄芩、竹茹、木瓜、扁豆，服后脉稍出，汗渐收，吐利也缓。随即去掉肉桂，加桂枝、滑石、甘草，头痛吐利都止，苔色转黄，随后用清暑和中法而愈。
一个少年体胖怕热，因酷暑，晨餐酒肉后，用席子铺在砖地上睡觉。醒来后立即大吃西瓜，到晚上觉得头重恶寒；半夜吐泻大作，四肢拘急，冷汗息微，时时发躁。黎明急忙请我诊断，脉沉弱。给予浆水散加吴茱萸、厚朴，投药即愈，改授浓朴生姜半夏甘草人参汤，数服而愈。
陆老先生七十多岁，仲秋患霍乱，自己服用单方两三天，呕吐虽已停止，腹泻仍不止，且频频打嗝，声音不高，面赤目闭，小便不通。医生说：高龄戴阳证，原是不治之症，且拖延了好几天。即使投用大剂量回阳药，恐怕也来不及了。我看他脉虽虚软，并无脱象，况且舌赤而干，下利臭恶，气分伏暑，已经扰动及营，担心经络闭塞神志昏迷，怎么可以再投热剂。听说所煎的药，桂皮气味扑鼻，试一下必死无疑。强迫他把药倒掉，遂用紫雪三分，用竹茹、枇杷叶、通草、丹参、连翘、石菖蒲、桔梗、黄芩、芦根煎汤，待凉调匀后慢慢服用。
第二天复诊，眼睛睁开，打嗝停止，小便稍通。在前方中去掉紫雪，加石斛、薏苡仁，服二剂腹泻减少。能喝米汤了。随后用致和汤，十余剂而愈。
戊戌年夏天，倪怀周的妻子新产数日，患呕吐泄泻，时时自汗，人们都认为危险。我说：“这不是真霍乱。然而比真霍乱更险，因为她犯了产后三禁，而脉微欲绝，亟宜峻补，迟恐无济于事。”给予东洋参、龙骨、牡蛎、茯苓、白术、木瓜、扁豆、茯神、石英、酒炒白芍、橘皮为剂，四服而痊愈。
（新产后用人参、茯苓大补，而又当盛夏之时，非有真知灼见者，不能做到啊。诚然天下的病，千变万化，原本没有固定的治法，无奈那些耳食之徒，只知道拿着死方的治活病，岂不是造孽无穷？何必人人都想做医生，而自己招致罪责呢。钱塘周熔光远对这个证候看得很准，大胆用人参、茯苓，还是常人能做到的，须看他其余药物，一一合拍，大概得效不仅在于人参、茯苓。至此才可称为峻补，然而惯服补剂的人，必嫌其轻。加鹿角、五味子等，必贻害了。古来多少佳方，被妄人加减，王某久患吐血，身体极虚弱。沈琴痴拉我去治，刚得渐愈，乃庚子夏酷热之时，突然患霍乱转筋，大汗如雨，气息如丝，人们都说没救了。我不忍心轻易放弃，勉强用西洋参、枇杷叶、龙骨、牡蛎、蚕沙、木瓜、扁豆、薏苡仁、滑石、桑叶、石斛、大豆卷，用地浆煎服，很好痊愈。调理十天，仍服滋补以治旧疾。
倡女蔼金，年二十七，患时疫颇危，我为她治好了。忽然又来求诊，说患急痧。及察其脉甚细，而按之数紧，神极委顿，气喘欲呕，腮红腹痛，舌润。像是房劳太过，寒袭奇经的男劳复证。询问得知实情，遂以胡桃肉、破故纸、龙骨、牡蛎、鹿角霜、菟丝子、覆盆子、枸杞子、茯苓、小茴香、当归、韭子为方。一剂见效，二剂痊愈。如果贸然竟作干霍乱治疗，该当如何呢？干霍乱而误投此法，又当如何呢？
（临证如神，叙证如绘，佛心仙手，其言和蔼。而一片灵光，传之纸上，效颦不易，确实是天才。仁和胡耀曾荣甫评。）
戚老妇，年六十多岁了。自幼在杭州黄莲泉家佣工，忠勤敏干，年老更加厉害，主仆情谊，胜过亲戚。壬寅年秋天，患霍乱转筋。我看她是暑症。投蚕矢汤，两服而愈。三天后，忽然疲倦卧床不能翻身，气少不能语言，不食不饮，莲泉惶恐害怕。就近邀请一位老医诊断，认为霍乱都属于寒，且昏沉欲脱，定下附子理中汤一方。莲泉知道药猛烈，不敢立即投用，商量于王君安伯。安伯说：“暂且不要服用。如果说是寒证，则前天的药，下咽即毙，吐泻怎么能逐渐停止呢？”莲泉大悟，仍派人飞马召唤我前往诊断。我说：“这是高年体质，元气随吐泻而虚，治宜用补。只是余暑未清，热药在所禁忌耳？如果在鲁莽之家，必以前面的凉药为不当，今天温补为极对。即使下咽不及救，也只归罪于前面寒凉的错误。假如初起即误死于温补，而举世也只知霍乱转筋是危险之病，从无一人知道此证有阴阳之异，治法有寒热之殊，而没有纠正其得失的人。何况一个老年仆妇，若非贤主人，又怎肯如此悉心访治呢，这个病之所以不可为也。现在莲泉见到姜附而生疑，安伯察病机之已转，主人恺恻而心虚，客人也有才识。二美相济，遂使病者跳出鬼门关，医者卸脱无妄罪。幸矣！幸矣！于是以高丽参、麦冬、知母、玉竹、木瓜、扁豆、石斛、白芍、薏苡仁、甘草、茯苓等，服六剂，始能言动，渐进饮食，调理月余而健壮。斋谓我说：这是余热未清，正气大虚者的治法。更有不因虚而余焰复燃者，须用炼雄丹治疗。
（这个证候以半痴的学问，莲泉的厚德，安伯的见识，三美相济，才能起九死于一生。世上那些执死方治活病，视仆婢如草芥，不分皂白，信口雌黄的人，读此能无愧死吗？
周光远先生回杭州探亲，七月十八夜，患霍乱转筋甚剧，仓卒间，误服青麟丸一钱许，势益甚。侵晓召我诊：脉微弱如无，耳聋目陷，汗出肢冷，音哑肉脱，危象毕呈，药恐迟。予人参、附子、白术、茯苓、干姜、桂枝、白芍、甘草、薏苡仁、莲子为方。终剂。即各证皆减。盖气分偏虚之体，不禁吐泻之泄夺。误饵苦寒，微阳欲绝，故以真武、理中合法以复脾肾之阳。诘朝再视，脉起肢和，即裁附子、桂枝、干姜，加黄芪、石斛，服旬日全愈。凡吐泻甚而津液伤，筋失其养，则为之转。故治转筋者，最要顾其津液，若阳既回，而再投刚烈，则津液不能复，而内风动矣，此寒霍乱之用附子、桂枝，亦贵有权衡，而不可漫无节制，致堕前功也。
（我这次的病，危同朝露，若非半痴，恐怕不能救，曾听张柳吟先生说，让病人听半痴论病之无微不入，用药之无处不到，源源本本，信笔成章，已觉疾瘳过半。古云：檄愈头风，良有以也。光远评。案中议论极精微，凡用药皆宜具此权衡，方无过当之言。否则药虽中病，而服之不止，反受其害，不但热药尔也。定州杨照藜素园评。霍乱的霍，即霍疾之义，谓乱之最速者也。曾见体素丰腴之人，一病半日，仅存皮骨，其伤……
陈艺圃也懂医，其妻于仲秋患霍乱转筋，自诊以为寒也。投热剂，势益甚，招朱椒亭视之，亦同乎主人之见也。病尤剧，乃延我勘，曰：此寒为外束之新邪，热是内伏之真病，口苦而渴，姜附不可投矣。与河间法，人皆不信，再与他医商之，仍用热剂，卒至口鼻出血而死。
（霍乱一证，近来时有，而医皆不甚识得清楚，死于误治极多。半痴特着专论，辨析简当，实今日医家首要之书。以其切于时用，不可不亟为熟读而研究也。光远评。）
甲辰五月下旬，天即酷热异常，道路卒死者甚多，有腹痛者，有不痛者。人们都用香燥痧丸投之，辄无效。盖香燥反以益热，而此证并非阴寒湿毒之邪，即古所谓中暑也。不出户庭之人，亦有病此者，必其人阴分素亏，内热较甚，或居处饮食之失宜也。往往延医不及，医多不识其病，虽死身不遽冷，亦有口鼻流血者，是暑从吸入，直犯心脏也。当时我居住在钱塘之髦儿桥，曾禀告先母，令家人慎起居，薄滋味，乃六月初二日午膳后。季杰弟妇，腹忽微痛，平日贪凉，自谓受寒也。私嘱女仆沽烧酒饮之，即狂瞀不安。先母知之，命仆从四路速我回，日晡时我也死了。病者已口鼻出血死矣。其时死者尤多，以阴血大去，暑热易侵。而昧者不知因时制宜，尚扃其窗户，幕以帘帏，环侍多人，饮以糖酒故也。粗工亦不察天时人禀之不齐，动辄生化汤，虽热象已显，犹误信产后宜温之俗说，而不知因证制方之活法，以致覆杯而毙者比比。或问当此热地如炉，恶露不行而腹痛者，生化汤既不可服，宜用何方？我谓六一散最佳。既行瘀血，又能清热也。设暑热重感，虽石膏犀角，对证皆为良药，古人何尝禁用。我案中治愈诸条，皆可参阅，然难与浅人言也。
盔头巷姚氏妇，妊已临月，腹中陡痛。家人谓其欲娩，急煎参汤以助其力，服后痛益甚。忙唤稳婆至，妇已浑身赤斑，喘逆昏狂，始知受暑，顷刻云亡。宝佑坊曹氏妇，亦怀妊临月腹痛，家人以为将产而煎参汤，迨汤成痛已止，察其情景，知不即娩，然炎威甚烈，参汤久存欲坏。其姑云，妇既未娩，岂可服参以滞胎气，我体素弱，常服补剂，参汤定亦相宜，遂饮之。甫下咽，即觉气闷躁扰，霎时危殆，逾刻而终。后丙午、壬子、丙辰，皆酷热伤人，不胜缕述。古人以燥热为暑，故曰：流金烁石，况人非金石之质乎？惜世人多不察耳。不但酷暑时，胎前产后之腹痛，当细审其有无别故也。
潘红茶方伯之孙翼廷，馆于外氏，酷热异常，因啜冷石花一碗，遂腹痛痞闷，四肢渐冷，上过肘膝，脉伏自汗，神困懒言，方某诊谓阳虚阴暑，脱陷在即。用大剂姜、附、丁香、桂枝以回阳
In the winter of the first year of Daoguang (1821), Mr. Jin Lusi, moved by his grandfather's hardships, ordered me to assist him in managing salt affairs at Xiaoshun Street in Wuzhou. In my spare time from official duties, I would peruse medical books, burning oil late into the night and continuing through the day, deriving joy from this without tiring.
In the summer of the third year (1823), Mr. Zhou Guangyuan, a Chief Administrator, was twenty-seven years old, with a very plump and fair complexion. After using the toilet, he suddenly felt cold, sweated spontaneously, had white lips, and a low voice. Everyone considered it Sha disease (a condition characterized by sudden pain, vomiting, diarrhea, or fainting, often attributed to external pathogens or toxins), and wanted to administer opening-orifice medicines. At that time, I was seventeen years old. Privately holding his arm to diagnose the pulse, I found it already weak and nearly imperceptible. Therefore, I strongly opposed the consensus, saying: "This is Yang Qi about to collapse, not Sha pathogen internal blockage. Administering aromatic dispersants again will likely hasten his peril." Everyone laughed at me for being a child who knew nothing. Fortunately, Mr. Zhou nodded in agreement repeatedly. Due to the urgency, there was no time to purchase medicine. I happened to have a piece of three-year-old female ginger (Peijiang) gifted by a relative, weighing about four or five qian. I hastily decocted it and administered it orally; he immediately stabilized. Later, tonification therapy was used, primarily consisting of Renshen (Ginseng Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma). This was because Mr. Zhou's constitution was one of deficient Yang Qi. He was deeply grateful and regarded me as a younger brother, praising me to everyone, thus I gained a reputation undeservedly. In the Gui Mao year (1843), Mr. Zhou published my medical cases for me. I felt ashamed and had no way to repay him.
Mr. Zhou passed away peacefully at the age of fifty, which was actually due to sudden collapse of deficient Yang Qi. He had no sons, only one daughter married to the Cai family. His wife was over sixty years old. After the second fall of Hangzhou city, her whereabouts were unknown, making it impossible to inquire. Recording this case brings deep regret.
On the day before the Winter Solstice in the Gui Mao year (1843), Grand Secretary Guan Jiaoxuan suddenly experienced profuse sweating and shortness of breath after urination, with altered complexion and faint speech. I happened to be attending a funeral at Lingyin Temple. Three times messengers were sent to urgently summon me back to the office. By then, Sha medicines had been administered multiple times, but the situation could not be reversed. For anyone with extremely deficient Yang Qi, sudden collapse symptoms after urination or defecation indicate an urgent need for Renshen and Fuzi to restore Yang. Misidentifying this as Sha disease often leads to disastrous outcomes. Those treating Huoluan (Cholera-like syndrome) must distinguish this clearly.
In the spring of the Bing Xu year (1866), a granary worker in Xiaoshun Street suddenly suffered an acute condition. He grabbed the bed and mats, could not speak, and when asked where he hurt, he only pointed to his heart and scratched his tongue. People thought it was Dry Huoluan (Huoluan without vomiting or diarrhea). I said, "How can Dry Huoluan cause immediate inability to speak and scratching of the tongue? It seems like poisoning." Someone said, "Several people ate the same meal; why did only he get poisoned?" However, scraping the tongue and inducing vomiting were ineffective. Since it was late at night and I could not buy medicine, I ordered two sheng of mung beans to be boiled rapidly into a clear soup, clarified, cooled, and administered. He recovered. The next day, upon inquiry, he revealed he had long suffered from Bi pain (painful obstruction syndrome). After taking a dose of herbal medicine, he felt unbearable chest stuffiness, tongue numbness, and inability to speak, which others did not know.
A courtesan loved eating silkworm pupae since childhood. She traveled to the upper rivers for several years and hadn't eaten them for a long time. Upon returning to Hangzhou, she enjoyed them with her family. While laughing and chatting, abdominal pain suddenly erupted, and she rolled on the ground. Some thought it was Intestinal Colic Sha (Jiaochang Sha) and urgently requested my examination. Her pulse and complexion were harmonious; it was neither Sha nor food stagnation. If it were poisoning, the elders and children who ate together would also be unharmed. Upon careful consideration, although they were roasted with Sichuan pepper and garlic and eaten together, perhaps one or two pupae were abnormal. Silkworms are animals, sharing affinity with horses, and their nature is hot, further enhanced by the pungency of pepper and garlic. I tentatively treated it following the example of horse meat poisoning, ordering human milk to be sucked. Indeed, after drinking it, she stabilized.
In the fifth month of the Ji Chou year (1829), the weather became suddenly hot. My mother suddenly suffered Huoluan. Her limbs were cold, she sweated spontaneously, the pulse was faint, the coating was white, abdominal pain was severe and relieved by pressure. This indicated chronic Spleen deficiency complicated by cold invasion due to heat. I administered a large dose of Lizhong Tang (Regulate the Middle Decoction) added with Guizhi (Cinnamon Twig) and Baishao (White Peony Root). She recovered after finishing one cup. This is what is called "abandoning the season to follow the syndrome."
Between the eighth and ninth months of the Ding You year (1837), Huoluan with tendon twitching prevailed in Hangzhou. A woman surnamed Shen suffered from this late at night, followed by hoarseness and cold extremities. At dawn, her husband sought treatment in panic. I diagnosed her pulse as wiry, fine, and choppy, with the Chi positions (kidney pulse) feeling absent. Her mouth was extremely thirsty, but any sip caused immediate vomiting. Her calf muscles were hard as stone, and the twitching caused excruciating pain. This was Summer-heat and Dampness internally latent, obstructing Qi mechanism, losing the power of diffusion and descent, causing chaotic upward reversal. I imitated the Jigeshibai San (Chicken Dropping White Powder) example from *Jingui Yaolue* and prescribed Can Shi Tang (Mulberry Leaf and Earthworm Decoction). It was to be decocted with Yin-Yang Water and taken slowly when cool. The medicine stayed down without vomiting. Externally, liquor was applied while someone rubbed the hardened, twitching area vigorously. After about one hour, the stagnant heat dissipated, and the tendon knots softened. Then, brine was applied, stopping the twitching, and vomiting/diarrhea gradually ceased. At dusk, half a dose of the previous medicine was given again, allowing peaceful sleep. The next day, she only felt exhausted. Several doses of Zhihe Tang (Harmonizing Decoction) cured her. Subsequently, many similar cases were treated successfully using variations of this method. Only those who mistakenly took Fuzi (Aconite Root) were difficult to save.
(Mr. Xie Cheng commented: During the alcohol massage for one hour, as stagnant heat dissipates and tendons relax, although twitching is caused by intense fire, it must be accompanied by external cold constraint to cause spasm. Generally, Huoluan involves struggle between cold and heat. Even knowing whether it is cold or heat, one must use counteracting agents. This principle applies here.)
Zheng Fengwu, over sixty years old, suffered Huoluan in autumn. He had aversion to cold, cold extremities, irritability, restlessness, and little thirst. Some considered it a cold syndrome. I examined his pulse: fine and nearly hidden, with a thick white coating. This was Summer-heat and Dampness internally accumulated but not transformed. One needs the insight of a rhinoceros horn to see through the illness. I prepared Ran Zhao Tang (Burning Mirror Decoction) for him. After one drink, cold extremities and aversion to cold receded, the pulse rose, and vomiting/diarrhea stopped. He was subsequently cured with a clearing and purging method.
A young, thin woman suffered Huoluan with tendon twitching in early autumn. Her tongue was crimson, eyes red, with extreme thirst for cold drinks. The left pulse was wiry and strong, the right slippery and large. This indicated pre-existing excess Fire in Liver and Stomach, compounded by Heat invading the Ying level. I prescribed Baihu Tang (White Tiger Decoction) removing rice and licorice, adding Shengdi (Rehmanniae Radix), Pugongying (Dandelion), Yimucao (Motherwort Herb), Huangbai (Phellodendri Cortex), Mugua (Chaenomelis Fructus), Sigualuo (Luffae Retinervae Fructus), and Yiyiren (Coicis Semen). She improved after one dose and recovered after two. Danxi said, "Tendon twitching arises from Blood Heat," which fits this case.
A man surnamed Ding suffered Huoluan. His coating was thin and white, with no thirst, but a sticky sensation in the mouth. Being knowledgeable in medicine himself, he wished to treat it as Cold-Damp. I said, "The Middle Jiao originally has Cold-Damp, hence no thirst. But stickiness suggests Summer-heat entering and fermenting dampness into Heat." I prescribed Weiling Tang (Stomach-Ling Decoction) removing Gancao and Baizhu, adding Yiyiren, Chuanlian (Coptidis Rhizoma), Banxia (Pinelliae Rhizoma), and Pipaye (Loquat Leaf). He recovered in two doses.
Qian Mou suffered Huoluan with spontaneous sweating, cold limbs, and faint pulse. He usually indulged in cold foods and drinks. People considered it a cold syndrome and wanted large doses of hot medicine. I said, "Although the coating is white, it is thick with red edges, and he is extremely thirsty with severe headache. Do not let the history of cold-inducing illness blind you to latent Summer-heat." I prescribed Wuling San (Five-Ingredient Powder with Poria) removing Baizhu, adding Huanglian (Coptidis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taeniam), Mugua, and Bidou (Vigna Radiata Seed). After taking it, the pulse emerged slightly, sweating stopped, and vomiting/diarrhea eased. I then removed Rougui (Cinnamon Bark), added Guizhi, Shihui (Talcum), and Gancao. Headache and vomiting/diarrhea ceased, the coating turned yellow, and he recovered with Summer-heat clearing and Middle Jiao harmonizing methods.
A young, fat man who feared heat lay on a brick floor covered with a mat after a morning meal of wine and meat during intense summer heat. Upon waking, he ate watermelon. By evening, he felt heavy head and aversion to cold. At midnight, violent vomiting and diarrhea occurred, with limb stiffness, cold sweat, faint breathing, and occasional irritability. At dawn, I examined him: the pulse was deep and weak. I gave Jiangshui San (Grain Water Powder) added with Wuzhuyu (Evodiae Fructus) and Houpo. He recovered immediately. I then switched to Nongpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction), curing him in a few doses.
Elder Lu, over seventy, suffered Huoluan in mid-autumn. After self-medicating with folk remedies for two to three days, vomiting stopped, but diarrhea persisted, accompanied by frequent hiccups with low voice, red face, closed eyes, and urinary retention. Doctors said, "High-age Dai Yang syndrome (floating Yang), incurable, and delayed for days. Even large doses of Yang-restoring medicine may be too late." I observed: the pulse was weak and soft, but no collapse signs. Moreover, the tongue was red and dry, stools foul-smelling. Summer-heat was latent in the Qi level, disturbing the Ying level. I feared meridian closure and confusion. How could hot medicine be used? Hearing his decoction smelled strongly of cinnamon, I warned it would be fatal. I forced them to discard it and prescribed Zixue (Purple Snow) 3 fen, decocted with Zhuru, Pipaye, Tongcao (Akebia Caulis), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Lianqiao (Forsythiae Fructus), Shichangpu (Acori Tatarinowii Rhizoma), Jiegeng (Platycodonis Radix), Huangqin, and Lugeng (Reed Rhizome). Taken slowly when cool.
Next day, eyes opened, hiccups stopped, urination resumed. Zixue was removed from the formula, adding Shihu (Dendrobii Caulis) and Yiyiren. Diarrhea reduced after two doses. He could drink rice water. Zhihe Tang was then used, curing him after ten-plus doses.
In the summer of the Wu Xu year (1838), Mrs. Ni Huaizhou, a few days postpartum, suffered vomiting and diarrhea with spontaneous sweating. People deemed it critical. I said, "This is not true Huoluan. Yet it is more dangerous than true Huoluan because she violated the three prohibitions of postpartum care, and the pulse was faint and nearly absent. Urgent strong tonification is needed; delay may be futile." I prescribed Dongyangshen (Korean Ginseng), Longgu (Fossil Bones), Muli (Oyster Shell), Ganjiang, Baizhu, Mugua, Bidou, Fushen (Poria with Hostwood), Shiyingshi (Hematitum), Jiuchaobaishao (Wine-fried White Peony Root), and Juapi (Tangerine Peel). She recovered in four doses.
(Mr. Zhou Guangyuan commented: Using Renshen and Ganjiang for strong tonification immediately postpartum during midsummer requires true insight. Illnesses vary infinitely; there are no fixed treatments. Ignorant practitioners stick to dead prescriptions for living patients, creating endless karma. Why become a doctor and invite blame? Mr. Zhou saw this case correctly, boldly using Renshen and Ganjiang, supported by other well-matched herbs. Effectiveness lies not just in these two. True strong tonification might require Deer Horn and Schisandra, but habitual tonic users might find this light. Adding these could harm. Many good formulas are ruined by reckless modifications. Wang Mou suffered chronic hematemesis and was very frail. Shen Qinci asked me to treat him. He was improving when, in the hot summer of Gengzi (1840), he suddenly got Huoluan with tendon twitching, profuse sweating, and thread-like pulse. People said he was dying. I refused to give up. I used Xiyangshen (American Ginseng), Pipaye, Longgu, Muli, Can Sha (Mulberry Leaf residue), Mugua, Bidou, Yiyiren, Huashi (Talcum), Sangye (Mori Folium), Shihu, Doujuan (Soybean Sprout), decocted with Dijiang (Earth Slurry). He recovered well. After ten days of conditioning, he resumed tonic herbs for his chronic condition.)
Ai Jin, a courtesan aged twenty-seven, suffered a severe epidemic febrile disease, which I cured. She returned claiming acute Sha. Her pulse was fine, rapid and tight upon pressure, spirit exhausted, panting with urge to vomit, red cheeks, abdominal pain, moist tongue. This resembled Nan Laofu (Male Recurrence after Sexual Exhaustion) where cold attacks the奇经 (Extraordinary Vessels) due to excessive sexual activity. Confirming this, I prescribed Hetaoren (Walnut Kernel), Pogu Zhi (Psoraleae Fructus), Longgu, Muli, Lujiaoshuang (Deer Antler Glaze), Tusizi (Cuscutae Semen), Fupenzi (Rubiae Fructus), Gouqi (Lycii Fructus), Fuling (Poria), Xiaohui (Foeniculi Fructus), Danggui (Angelicae Sinensis Radix), and Jiu Zi (Allii Tuberosi Semen). She improved in one dose and recovered in two. What if we rashly treated it as Dry Huoluan? And what if Dry Huoluan were treated this way?
(Hu Yaozeng commented: Clinical wisdom like a god, description vivid as painting, Buddha's heart and immortal hands, gentle words. Spiritual light transmitted on paper, hard to imitate, truly genius.)
Old Madam Qi, over sixty, had worked for Huang Lianquan in Hangzhou since childhood, loyal and diligent. Their master-servant bond exceeded relatives. In autumn of Ren Yin (1842), she suffered Huoluan with tendon twitching. I diagnosed Summer-heat and prescribed Can Shi Tang. She recovered in two doses. Three days later, she lay listless, unable to turn, spoke little, ate and drank nothing. Lianquan panicked. An old doctor diagnosed it as Cold Huoluan with impending collapse and prescribed Fuzi Lizhong Tang. Lianquan, fearing the potent medicine, consulted Wang Jun'anbo. Anbo said, "Do not take it. If it were cold, yesterday's medicine would have killed her; how could vomiting/diarrhea stop?" Lianquan realized the truth and summoned me. I said, "For an elderly person, Yuan Qi is depleted by vomiting/diarrhea; tonification is appropriate. However, residual Summer-heat remains, so hot medicine is contraindicated. In a reckless household, they would blame the previous cooling medicine and praise today's warming tonic. If she died then, they'd blame the previous doctor. If she died initially from wrong warming, no one would realize Huoluan has Yin/Yang and Hot/Cold distinctions. Fortunately, Lianquan doubted the ginger/aconite, Anbo recognized the shift in pathology, and the master was compassionate. These virtues combined saved her. Now, using Gaolishen (Korean Ginseng), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), Weihui (Polygonati Odorati Rhizoma), Mugua, Bidou, Shihu, Baishao, Yiyiren, Gancao, Fuling, she recovered speech and movement after six doses, ate gradually, and healed after a month of conditioning." Mr. Zhai told me, "This is the treatment for residual heat and severe Zheng Qi deficiency. For cases where residual flame reignites not due to deficiency, Lianxiong Dan should be used."
(Zhou Guangyuan commented: With Ban Chi's learning, Lianquan's virtue, and Anbo's insight, three beauties combined saved her from death. Practitioners who use dead prescriptions for living patients, treating servants like grass, reading this should die of shame.)
When Mr. Zhou Guangyuan returned to Hangzhou for family visit, on the night of July 18th, he suffered severe Huoluan with tendon twitching. Mistakenly taking Qinglin Wan (Green Phoenix Pill) about one qian, his condition worsened. At dawn, I diagnosed: pulse faint/absent, deaf, sunken eyes, sweating, cold limbs, hoarse, emaciated, critical signs all present... [Text gap inferred] ...Yiyiren, Lianshi (Nelumbinis Semen) as formula. After finishing the course, all symptoms decreased. His Qi level was deficient, unable to withstand fluid loss from vomiting/diarrhea. Mistaking bitter-cold medicine caused slight Yang to near-collapse. Thus, Zhenwu Tang and Lizhong Tang were combined to restore Spleen/Kidney Yang. Next day, pulse rose, limbs warmed. Fuzi, Guizhi, Ganjiang were removed; Huangqi (Astragali Radix) and Shihu added. He recovered in ten days. Severe vomiting/diarrhea damages fluids; tendons lose nourishment and twitch. Treating twitching requires protecting fluids. Once Yang returns, using acrid-hot herbs prevents fluid recovery and triggers internal wind. Thus, using Fuzi/Guizhi for Cold Huoluan requires balance and restraint.
(Guangyuan commented: My illness was as fleeting as dew. Without Ban Chi, I might not have survived. Mr. Zhang Liuyin said hearing Ban Chi's analysis and prescription logic cures half the disease. As the saying goes, 'A manifesto cures headache,' indeed. The case discussions are subtle; all prescriptions require such balance. Otherwise, even correct medicine harms if overdosed. Not just hot medicines. Yang Zhaoli commented.)
"Huo" in Huoluan means sudden chaos/disorder. I've seen robust people wasting to skin and bones in half a day...
Chen Yipu knew medicine. His wife suffered Huoluan with tendon twitching in mid-autumn. Self-diagnosing as cold, she took hot medicine, worsening the condition. Zhu Jiaoting agreed with the owner. The illness intensified. I examined her and said, "Cold is the new external constraint; Heat is the internal true pathogen. Bitter mouth and thirst mean Ginger/Aconite are forbidden." I used Liu Wansu's method. Others didn't believe it, consulted other doctors who used hot medicine, leading to death by bleeding from mouth/nose.
(Guangyuan commented: Huoluan is common recently, but doctors don't understand it well, leading to many deaths from mis-treatment. Ban Chi's special treatise is concise and essential for today's physicians. It must be studied urgently.)
In late May of Jia Chen (1844), the weather was exceptionally hot. Many died suddenly on roads, some with abdominal pain, some without. People used aromatic-dry Sha pills, which failed. Aromatic-dry herbs increase heat; this was not Yin-Cold-Damp toxin, but ancient "Zhong Shu" (Summer-heat Stroke). Even those staying indoors got sick, usually due to innate Yin deficiency, internal heat, or improper diet/environment. Doctors often couldn't identify it. Bodies didn't cool immediately after death; some bled from nose/mouth, indicating Summer-heat entered via respiration, attacking the Heart directly. I lived at Maor Bridge in Qiantang. I advised my mother to warn family to live carefully and eat lightly. On June 2nd, after lunch, Sister-in-law Ji Jie had mild abdominal pain. Accustomed to cold, she thought she caught cold. She secretly asked a maid to buy liquor. She became delirious. My mother sent for me urgently. By dusk... [Text gap] ...she had died from nose/mouth bleeding. Many died then because Yin blood was lost, making Summer-heat invasion easy. Ignorant people kept windows closed, hung curtains, surrounded by people, fed sugar/wine. Crude doctors ignored seasonal and constitutional differences, blindly using Shenghua Tang (Generate the Flow Decoction). Even with obvious heat signs, they believed the custom of warming postpartum women, ignoring flexible prescription principles. Death followed quickly. Asked what to use instead of Shenghua Tang for heat-stroke with lochia retention and pain, I said Liuyi San (Six-to-One Powder) is best. It moves blood stasis and clears heat. If Summer-heat is severe, Shigao (Gypsum) and Xijiao (Rhinoceros Horn - now substituted) are effective. Ancient texts never banned them. See my other cases for reference, though hard to explain to shallow minds.
Madam Yao of Kuitou Alley, near term pregnancy, had sudden abdominal pain. Family thought labor was starting, brewed Renshen Tang to boost strength. Pain worsened. Midwife arrived, but she had red spots all over, panting, confused, mad. She died instantly from Summer-heat. Cao Madam of Baoyou Fang, also near term, had abdominal pain. Family brewed Renshen Tang. Pain stopped when tea was ready. They realized labor wasn't imminent. The tea sat too long in heat and spoiled. Mother-in-law said, "Since not delivering, don't use Ginseng to stagnate fetus. I am weak and take tonics, so this is suitable." She drank it. Immediately felt chest stuffiness and irritability, died within minutes. Years Bingwu, Renzi, Bingchen also had deadly heat. Too numerous to list. Ancients defined Summer-heat as Dry-Heat: "Melting metal and scorching stone." Humans are not metal/stone. People fail to observe this. Abdominal pain before/after birth in summer must be carefully distinguished.
Yiting, grandson of Prefect Pan Hongcha, taught at maternal uncle's house. Extreme heat. Drank a bowl of cold Shihua (Gelatinous algae). Abdominal pain/stuffiness ensued. Limbs grew cold up to elbows/knees. Pulse hidden, sweating, spirit tired. Doctor Fang diagnosed Yang deficiency and Yin Summer-heat, impending collapse. Used large dose Ginger, Aconite, Dingxiang (Caryophylli Flos), Guizhi to restore Yang...