第十六章．治霍乱方

Chapter 16. Herbs for acute vomit and diarrhea (such as cholera)

1．急救回生丹

1. Jijiu Huisheng Dan (Jijiu here means to save urgently; Huisheng means to bring back life; Dan means big pills, in Chinese).

治霍乱吐泻转筋，诸般痧证暴病，头目眩晕，咽喉肿疼，赤痢腹疼，急性淋证。
This formula is used for cholera-like condition with acute diarrhea and vomit; or disease with skin bleeding, dizziness, sour throat, bleeding diarrhea, stomach pain, and acute infection in urine tract.

朱砂（顶高者一钱五分） 冰片（三分） 薄荷冰（二分） 粉甘草（一钱细末）
Zhusha (cinnabar) 4.5 gram, Bingpian (borneol) 0.9 gram, Bohe (peppermint) 0.6 gram, Gancao 3 gram (powder).

上药四味共研细，分作三次服，开水送下，约半点钟服一次。若吐剧者，宜于甫吐后急服之。若于将吐时服之，恐药未暇展布即吐出。服后温复得汗即愈。服一次即得汗者，后二次仍宜服之。若服完一剂未全愈者，可接续再服一剂。若其吐泻已久，气息奄奄有将脱之势，但服此药恐不能挽回，宜接服后急救回阳汤。
Grind the herbal ingredients into powder. Drink it by three times with hot water, once every half hour. If the vomit is severe, drink it right after vomit. If drink it at the time the person is about to vomit, the herbs would be vomit out the movement the herbal powder is unfolded. After drink the herbal powder, cover the body to get sweat to cure. If the body has sweat after the first drinking, it should continue for the second and the third drinking. If the one dose does not improve the disease, try the second dose. If the body Qi is to escaping, due to long time of vomiting and diarrhea, this herbal powder might be be strong enough to solve the severe condition, try to drink the later Jijiu Huiyan Tang.

朱砂能解心中窜入之毒，且又重坠，善止呕吐，俾服药后不致吐出。此方中冰片，宜用樟脑炼成者。因樟脑之性，原善振兴心脏，通活周身血脉，尤善消除毒菌。特其味稍劣，炼之为冰片，味较清馥，且经炼，而其力又易上升至脑，以清脑中之毒也。薄荷冰善解虎列拉之毒，西人屡发明之。且其味辛烈香窜，无窍不通，无微不至，周身之毒皆能扫除。矧与冰片，又同具发表之性，服之能作汗解，使内蕴之邪由汗透出。且与冰片皆性热用凉，无论症之因凉因热，投之咸宜也。粉甘草最善解毒，又能调和中宫，以止吐泻。且又能调和冰片、薄荷冰之气味，使人服之不致过于苛辣也。
In the formula, Zhusha can solve the poison that rushes into the heart. For its heavy nature, it can stop the vomit to make the herbs not vomit out after drinking of herbal tea. The Bingpian (borneol) should be produced from camphor. The nature of the camphor can originally stimulate and activate the function of heart, to promote the blood circulation in the body, especially to clear the bacteria or virus. The only weakness for it is its bad smell. After processed into Borneol, the smell is better. Also, the processed borneol is also able to rise into the brain, to clear the poison in the brain. The Bohe (peppermint) is good at cleansing the poison of cholera, which was the funding by western people. Its smell is spicy and strong fragrant, is able to rush about anywhere in the body to clear poison everywhere. Together with the Bingpian, both of them have dispersing property, to create sweat, to bring the inside poison out of the body through the sweat. They both are hot but also cold in herbal nature, so that they can be used in either Hot or Cold condition in the body. Gancao is good to cleanse various toxic, to harmony the middle stomach system, and to stop vomit and diarrhea. It can also adjust and calm the smell of the Bingpian and Bohe, to reduce their spicy taste.  

霍乱之证，西人所谓虎列拉也。因空气中有时含有此毒，而地面积秽之处，又酿有毒气与之混合（观此证起点多在大埠不洁之处可知），随呼吸之气入肺，由肺传心胞（即心肺相连之脂膜），由心胞传三焦（上焦心下膈膜，中焦包脾连胃脂膜，下焦络肠包肾脂膜），为手厥阴、少阳脏腑之相传。然其毒入三焦，其人中气充盛，无隙可乘，犹伏而不动。有时或饮食过量，或因寒凉伤其脾胃，将有吐泻之势，毒即乘虚内袭，盘据胃肠，上下不通，遂挥霍撩乱，而吐泻交作矣。吐泻不已，其毒可由肠胃而入心，更由心而上窜于脑，致脑髓神经与心俱病。左心房输血之力与右心房收血之力，为之顿减，是以周身血脉渐停，而通体皆凉也。其证多发于秋际者，因此毒气酿成多在夏令。人当暑热之时，周身时时有汗，此毒之伏于三焦者，犹得随汗些些外出。迨至秋凉汗闭，其毒不得外出，是以蓄极而动，乘脾胃之虚而内攻也。故治此症者，当以解毒之药为主，以助心活血之药为佐，以调阴阳奠中土之药为使。爰拟此方，名之曰急救回生丹。
… this condition is usually found in the autumn, since the poison Qi is accumulated in the body in summer. During the hot summer, the body has sweat from time to time, some amount of the poison can be expelled out of the body through the sweat. Upon the autumn, the weather becomes cold, the sweat discontinues, so the poison cannot be expelled out. After accumulation in the body more and more, it would attack the body when the Spleen-Stomach system is weak for any reason. Therefore, to treat such condition, the main therapy should be cleanse the poison, with help of other herbs to activate the heart function, as well as some herbs to supply the middle Spleen-Stomach system. For this aim, this formula is termed Jijiu Huisheng Dan.

附录：

Appendix:

直隶故城县袁××来函：
Letter from Mr. Yuan, Gu city, Zhili Province: 

前次寄来急救回生丹方，不知何以斟酌尽善。初故城闹疫，按方施药六十剂，皆随手辄效。后故城外镇郑家口闹疫，又施药二百剂，又莫不全活。

The herbal formula Jijiu Huisheng Dan that you send to me previously worked marvelously. In the beginning of the outbreak of epidemic disease in Gu city, I used 60 doses to people, all worked very soon. Later, there was epidemic disease in a village out of the city, I also used 200 doses. All patients were saved.

2．卫生防疫宝丹

2.Weisheng Fangyi Bao Dan (Weishen here means to clear poison, in Chinese; Fangyi means to prevent a disease; Bao: very valuable stuff; Dan: big pills).

治霍乱吐泻转筋，下痢腹疼，及一切痧症。平素口含化服，能防一切疠疫传染。
This formula is used also to treat acute vomit and diarrhea, pain in stomach, as well as various epidemic diseases with skin rash, such as measles. If hold it in mouth, it can help to prevent such infectious diseases.

粉甘草（十两，细末） 细辛（两半，细末） 香白芷（一两，细末） 薄荷冰（四钱，细末） 冰片（二钱，细末） 朱砂（三两，细末）
Gancao powder 300 gram, Xixin4.5 gram (powder), Baizhi 30 gram (powder), Bohe (peppermint) 12 gram, Bingpian (borneol) 6 gram, and Zhusha 90 gram (cinnabar powder).

先将前五味和匀，用水为丸如桐子大，晾干（不宜日晒）。再用朱砂为衣，勿令余剩。装以布袋，杂以琉珠，来往撞荡，务令光滑坚实。如此日久，可不走气味。若治霍乱证，宜服八十丸，开水送服。余证宜服四五十丸。服后均宜温复取微汗。若平素含化以防疫疠，自一丸至四五丸皆可。此药又善治头疼、牙疼（含化），心下、胁下及周身关节经络作疼，气郁、痰郁、食郁、呃逆、呕哕。醒脑养神，在上能清，在下能温，种种利益，不能悉数。
Mix the first five powders. Prepare into pills with water as 1 cm in diameter each. Dry naturally (not under sunshine). Use Zhusha to fold the pill, not let any Zhusha left. Save the pill in cloth bag, put glass pearl in it, shack the bag to make the pill smooth on surface. By this way, it can prevent escaping of the herbal smell out. For Cholera-like condition, drink 80 pills, with hot water to swallow. For other diseases, take 40 to 50 pills. After take of the pills, cover the body to get sweat. For prevention, take one to four or five pills. This pill can also treat headache, teethache (hold in mouth), pain in the stomach area, side of abdomen, or joints in whole body, as well as various stagnation conditions due to Qi, Phlegm, food, hiccup, or burping. It can wake up the brain and to increase energy level, and can clear the Xie Qi in the Upper Jiao; warm the middle stomach, with lots of functions. Its function is hard to count.

以上二方，后方较前方多温药两味。前方性微凉，后方则凉热平均矣。用者斟酌于病因，凉热之间，分途施治可也。后方若临证急用，不暇为丸，可制为散，每服一钱，效更速。
For the above two formula, the later is two ingredients more than the previous one. The former one is slightly cold; the later is even in its Hot and Cold nature. The doctors need to verify the body condition to choose the proper one to take. If want to use the later one for emergency treatment, and have not time to prepare it into pill, use it as powder. Take 3 gram each time. The effect is even faster.

附录：
Appendix:

直隶盐山孙××来函：
Letter from Mr. Song, Yanshan city, Zhili province:

一九二四年六月，友人杜××之母得霍乱证，上吐下泻，转筋腹疼，六脉闭塞。生诊视后，为开卫生防疫宝丹方，共研作粉，每次服一钱。服第一次，吐泻稍止。服第二次，病即痊愈。
In the June of year 1924, the mother of my friend Mr. Du got cholera. She had vomit and diarrhea, spasm in the stomach. Her pulse could not be felt at all. After assessment, I prescribed her this Weisheng Fangyi Bao Dan. The herbs were prepared into powder. It was taken 3 gram each time. After the first drink, the vomit and diarrhea reduced little bit. After second drink, the condition was calm and solved completely.

斯年初冬，邓××之儿媳得霍乱证，时已夜半，请为诊视。吐泻转筋，六脉皆无，心中迷乱，时作谵语。治以卫生防疫宝丹，初服仍吐，服至二次，脉即徐出而愈。

In an early winter, the daughter-in-law of Mr. Dang got cholera. It was middle night. I was invited to have a look. The patient had vomit and diarrhea and spasm in the calf. Her pulse could be felt at all on both sides. She felt confused and cloudy in the heart, with delirious speech from time to time. She was given this Weisheng Fangyi Bao Dan. In the first drink, she still vomited. At the second time, the condition was completely solved.

3．急救回阳汤

3. Jijiu Huiyang Tang (Jijiu here means to have emergency treatment, or to save life urgently; Huiyang means to restore the body Yangqi)

治霍乱吐泻已极，精神昏昏，气息奄奄，至危之候。
This formula is used for the treatment of cholera. The person has extreme heavy vomit and diarrhea; his mind/spirit is cloudy; his breath is very weak to die.

潞党参（八钱） 生山药（一两） 生杭芍（五钱） 山萸肉（八钱，去净核） 炙甘草（三钱） 赭石（四钱，研细） 朱砂（五分，研细）
Lu Dangshen 24 gram, Shanyao 30 gram, Baishao 15 gram, Shanyurou 24 gram (remove kernel), Zhi Gancao 9 gram, Daizheshi 12 gram, Zhusha 1.5 gram (in powder).

先用童便半盅炖热，送下朱砂，继服汤药。
Collect child urine about 100 ml, warm it. Drink the Zhusha with the warm urine, then drink the herbal tea from other ingredients. 

以上二方，皆为治霍乱之要药矣。然彼以祛邪为主，此以扶正为主。诚以得此证者，往往因治不如法，致日夜吐泻不已，虚极将脱，危在目前。病势至此，其从前之因凉因热皆不暇深究，惟急宜重用人参以回阳，山药、芍药以滋阴，山萸肉以敛肝气之脱（此证吐泻之始肝木助邪侮土，吐泻之极而肝气转先脱），炙甘草以和中气之漓，此急救回阳汤所以必需也。用赭石者，不但取其能止呕吐，俾所服之药不致吐出，诚以吐泻已久，阴阳将离，赭石色赤入心，能协同人参，助心气下降。而方中山药，又能温固下焦，滋补真阴，协同人参以回肾气之下趋，使之上行也。用朱砂且又送以童便者，又以此时百脉闭塞，系心脏为毒气所伤，将熄其鼓动之机，故用朱砂直入心以解毒，又引以童便使毒气从尿道泻出，而童便之性又能启发肾中之阳上达，以应心脏也。是此汤为回阳之剂，实则交心肾和阴阳之剂也。服此汤后，若身温脉出，觉心中发热有烦躁之意者，宜急滋其阴分，若玄参、生芍药之类，加甘草以和之，煎一大剂，分数次温饮下。此《伤寒论》太阳篇，先用甘草干姜汤继用甘草芍药汤之法也。
The above two herbal formula are both very important in the treatment of cholera and cholera-like diseases. However, the former one is mostly to expel the Xie Qi, and this later one is focused on support the body defense system. Gegerally speaking, the patient with such disease, due to improper treatment, has continuous vomit and diarrhea, as as to cause failure and risk life. Upon this time, it should not pay too much attention to where the previous condition is due to Hot or Cold, but pay much attention to use herb Renshen to restore the Yang Qi, Shanyao and Shaoyao to restore the Yin, Shanyurou to restrain the escaping Liver Qi (For this condition, in the beginning, the Liver Wood helps the Xie Qi to hurt the Spleen-Stomach. When the vomit and diarrhea is in extreme, the Liver Qi is to escape first). Gancao is used to harmony the middle Qi. Daizheshi is to suppress the vomit, to prevent the vomit out of the drinked herbal tea. After long time vomit and diarrhea, the Yin and Yang is to separate away. The Daizheshi is red in color, so it goes into the heart, and to help the herb Renshen to promote the heart Qi down. The herb Shanyao can warm the Kidney, to nourish the Yin, as well as to help the Renshen to make the Kidney Qi up to meet the heart Qi. At this time, due to the heart is hurt by the poison and it would be to stop function. Herb Zhusha goes directly into the heart to cleanse the poison in the heart. The child urine makes the poison leave out of the body through urine. It can also activate the Kidney Qi moving up to meet the Heart Qi. For all of these reasons, this formula is to restore the Yang Qi. It is actually also a formula to conduct the Heart and the Kidney. After drink of this formula, the person feels warm in the body, and the pulse starts to feel, and if the person starts to feel annoying and hot in the heart, supply the body Yin as soon as possible, such as the use of Shaoyao and Xuanshen, together with the herb Gancao. Cook it and drink separately for several times. This is the similar way as used in book 《Shan Han Lun》, to use the Gancao Ganjiang Tang first, then use Shaoyao Gancao Tang later.

门人高××，曾治一少妇。吐泻一昼夜，甚是困惫，浓煎人参汤，送服益元散而愈。盖独参汤能回阳，益元散能滋阴，又能和中（滑石甘草能和中以止吐泻）解毒（甘草朱砂能解毒），且可引毒气自小便出，是以应手奏效。此亦拙拟急救回阳汤之意也。

My student, Mr. Gao, treated a young lady. She vomited and had diarrhea for whole day and night, and felt very tired. She was given Renshen Tang, and Yiyuan San, and the condition was cured. The Yiyuan San can nourish the Yin, and can harmony the middle part of the body (the herb Huashi and Gancao in it can harmony the Middle part of the body and to stop vomit and diarrhea), cleanse poison (the Gancao and Zhusha can cleanse poison), and can direct the poison Qi leave the body through urine. That is the reason this formula works. This is also the idea of my Jijiu Huiyang Tang here.

此证之转筋者，多因吐泻不已，肝木乘脾气之虚而侮土。故方书治转筋多用木瓜，以其酸能敛肝，即所以平肝也。然平肝之药，不必定用木瓜。壬寅秋际，霍乱流行，曾单用羚羊角三钱。治愈数人。因羚羊角善解热毒，又为平肝之妙药也。又曾有一人，向愚询治泄泻之方。告以酸石榴连皮捣烂，煎汤服之。后值霍乱发生，其人用其方治霍乱初起之泄泻者，服之泻愈，而霍乱亦愈。由是观之，石榴亦为敛肝之要药，而敛肝之法，又实为治霍乱之要着也。

In the cholera, the reason for spasm in calf is: the heavy vomit and diarrhea cause the Liver Wood hurts the Spleen Soil, when the Spleen Soil is weak. In the medical books, it is the herb Mugua, that is used to solve the calf spasm, for its sour in herbal nature, which can restrain the Liver, so as to calm down the Liver. However, to calm down the Liver, it is not needed to only use the Mugua. In an autumn, there was cholera spreading. Lingyang horn (antelope) had been used to save several persons’ lives. The antelope horn is good at cleansing hot poison and is a good herb to calm down the Liver. There has been a person, who asked me formula for the treatment of diarrhea. I told him to use the peel of sour pomegranate. Grind it into mud, cook and drink it. Later, when the cholera had outbreak, he used this method and solved the early cases. After drinking, the diarrhea stopped and the cholera stopped too. Now you see, the pomegranate is also a good herb to calm down the Liver. To restrain the Liver is actually the principle for the treatment of cholera.

霍乱之证，有实热者居多，其真寒凉者，不过百中之一二。即百脉闭塞，周身冰冷，但其不欲复被，思饮凉水，即不可以凉断，当先少少与以凉水，若饮后病增重者，其人虽欲复饮，而不至急索者，凉水可勿与也。若饮后病不增重，须臾不与，有不能忍受之状，可尽量与之，任其随饮随吐，借凉水将内毒换出，亦佳方也。
Fo cholera, most patients were with sthenic Hot condition. Only one to two percent of the person had real Cold condition. If the person’s body is as ice, but he do not want to cover his body, but want to drink cold water, this condition should not be regarded as Cold. He should be given little cold water to drink first. If the condition is worse after the cold water drink, and if he still wants to drink but not in a hurry, he should no longer be given the cold drink. If the condition is not worse after cold water drink, and if he is still urgent to drink more cold water and he appears hard to wait for the cold water more, the cold water can be given again and again. Allow him to drink and to vomit. This is to take the advantage of the cold water to bring the inside poison out. This is a good way.

曾遇有恣饮凉水而愈者，问之，言当病重之时，若一时不饮凉水，即觉不能复活，则凉水之功用可知矣。然凉水须用新汲井泉水方效，无井泉水处，可以冰水代之，或吞服小冰块亦佳。
There has been person who got cured after drink of large amount of the cold water. Later, when asked, he told that, when he was very sick, he felt hard to live, the movement if he could not drink the cold water. Apparently the cold water worked to save his life. However, the cold water had better to be the newly one from wells or spring. If there is no spring or well, use ice water, or swallow small pieces of ice.

王孟英曰：鸡矢白散，为《金匮》治霍乱转筋入腹之方。愚仿其意，拟得蚕矢汤，治霍乱转筋、腹疼、口渴、烦躁，危急之证甚效。方用晚蚕砂、木瓜各三钱，生薏仁、大豆芽（如无可代以生麦芽）各四钱，川黄连、炒山栀各二钱，醋炒半夏、酒炒黄芩、吴茱萸各一钱，以阴阳水煎，稍凉，徐徐服之。丁酉八九月间，吾杭盛行霍乱转筋之证。有沈氏妇者，夜深患此，继即音哑肢寒。比晓，其夫皇皇求为救治。诊其脉弦细以涩，两尺如无，口极渴而沾饮即吐不已，腓坚硬如石，其时疼楚异常。因拟此方治之，徐徐凉饮，药入口竟得不吐。外以好烧酒令人用力摩擦转筋坚硬之处，擦将一时许，其硬块始渐软散，而筋不转吐泻亦减。甫时复与前药半剂，夜间居然安寐矣。后治相类者多人，悉以是法获效。
Dr. Wang Menyin said: the Jishibai San, is the herbal formula introduced in book《Jin Kui》 to treat the spasm of calf into the abdomen. I followed the idea of that formula to set up a formula called Canshi Tang. It works very well to treat the calf spasm in cholera, pain in abdomen, thirsty, annoying, such dangerous conditions. The formula contains Wan Cansha 9 gram, Mugua 9 gram, Yiyiren 12 gram, Soya bean spring 12 gram (if no soya bean spring, use wheat spring), Chuan Huanglian 6 gram, Shanzhi 6 gram (fry), Banxia 3 gram (fry with vinegar), Huangqin 3 gram (fry with liquor), Wuzhuyu 3 gram. Cook the ingredients with Yin-Yang water. Drink the herbal tea gradually. In one summer, there was spread of cholera in Hangzhou city. A lady, Mrs. Shen, got this disease on middle night. She felt soon loss of voice and cold in extremes. In the early morning, her husband hurried to ask for help. Her pulse was string, thin, and not smooth. The pulse could not be felt on the Chi position both sides. She felt very thirsty but had vomit after drink little bit. Her calf was very hard as stone with very much pain. She was given this formula to drink gradually. It was surprised that she did not vomit out this herbal tea. Her calf was massaged with warm liquor. After about one hour, the hard calf started to become soft and the vomit and diarrhea also became less. The remaining half of the herbal tea was given again. The night, she had a nice sleep. Later, several patients were treated with similar way. All are saved.

陆九芝曰：霍乱一证，有寒有热，热者居其九，寒者居其一。凡由高楼大厦，乘凉饮冷而得之者，仲景则有理中、四逆诸方，后世亦有浆水、大顺、复元、冷香饮子诸方，病多属寒，药则皆宜热。若夫春分以后，秋分以前，少阳相火，少阴君火，太阴湿土，三气合行其令。天之热气则下降，地之湿气则上腾，人在气交之中，清气在阴，浊气在阳，阴阳反戾，清浊相干，气乱于中，而上吐下泻。治此者，宜和阴阳，厘清浊，以定其乱，乱定即无不愈。此则病非寒也，而亦非尽用寒药也。即如薷藿、平陈、胃苓等汤习用之剂，亦皆温通，特不用姜附丁萸之大辛大热者耳。
Dr. Lu Jiuzhi said: for the cholera, there are Cold and Hot condition. Most cases are the Hot and only one out of ten cases is the Cold condition. If the person got this disease, when he/she lived in a high building, or after he/she drinks cold beverages, Master Zhang Zhongjing has Lizhong Tang and Sini Tang to treat. Later doctors have formulas of  Jiangshui, Dashun, Fuyuand and Lenxiang Yizi to treat. If the disease belongs to the Cold, the herbs should be Hot. After Chunfen (spring equnox) and before Qiufen (autumnal equinox), it is the Shaoyang Xiang Fire, Shaoyin Jun Fire and Taiyin Wetness Soil dominate. The sky hot Qi falls and the earth Wetness Qi rises. The human being is inside the Qi conduction. The clear Qi is in the Yin, while the murky Qi in the Yang. They are totally dislocated and in disorder. In the human body, there is so vomit in the upper and diarrhea in the lower. To solve this condition, it should be to harmony the Yin and the Yang, and to separate and to clear the Qi separate. Such condition is not due to either Cold, so the herbs needed are not always the Cold herbs. The herbal formula should be such as Ruhuo, Pingchen, Weiling and so on. All belong to Warm-conducting formula. Especially the strong spicy, and strong Hot herbs, such as ginger, Fuzi, Dingxiang, and Shanyurou, are not to use.

又有不吐不泻而挥霍撩乱者，则多得之饱食之后。凡夏月猝然冒暑，惟食填太阴，亦曰饱食填息。此证为病最速，为祸最酷，而人多忽之。即有知者，亦仅以停食为言，绝不信其为闭证之急者。闭则手足肢冷，六脉俱伏，甚则喜近烈日。此乃邪闭而气道不宣，其畏寒也正其热之甚也。此等证，只欠一吐法耳。自吐法之不讲，本属一吐即愈之病，而竟不知用也。

In another cases, the person has no vomit or diarrhea, but feels cloudy mind and tired. This condition is mostly after heavy eating. In summer, the person got sudden Hot attack.

It is called food-filling to the Taiyin meridian. This condition changes very fast and is very dangerous, but it is very easy to neglect. Even if it is known by some doctors, they thought it is an accumulation of food on the stomach, not an emergency condition, e.g. the shock condition. In the shock condition, the hands and feet are cold; the pulse is hidden and hard to feel. The person likes to expose to the Sunshine. This is a condition, in which the Xie Qi blocks the Qi channels in the body. Its chilly means its hot on peak. For such shock condition, simple vomiting therapy is enough to solve the problem. Since the vomiting therapy is no longer mentioned in the medical society, when there is such disease that can be solved by vomiting therapy, no one knows to use it.

此外更有四肢厥逆，甚至周身如冰，而竟不恶寒，反有恶热者，此更是内真热，外假寒，即厥阴中热深厥深之象。岂独不可用四逆、理中，即姜汤、米饮及五苓散中之桂枝，亦不可用。而且宜苦寒之剂，佐以挑痧、刮痧等法，刺出其恶血以泄热毒者。同治壬戌，江苏沪渎，时疫盛行，绵延而至癸亥。余尝以石膏、芩、连，清而愈之者，则暑湿热之霍乱也。以凉水调胆矾吐而愈之者，则饱食填息之霍乱也。其肢皆冷，而其脉皆伏，维时大医，竞用丁萸桂附，日误数人，而竟不知改图，岂不深可惜哉。

There is also another condition, in which the hands and feet are cold, even the whole body is as ice cold, but the person does not feel chilly, but dislike hot. This is true Hot inside while false cold outside, e.g. the deep-hot and deep-cold condition in the Jueyin disease. Not only the Sini Tang, Lizhong Tang should not be used, even the ginger soup, rise soup or the Gtuizhi in the Wuling San, should not be used. It needs Bitter-Cold herbs, with help of bleeding and Guasha therapy, to bleed the bad blood or hot-poison blood out. One year, there was epidemic disease around the Shanghai city. For the cholera that belongs to Summer-Wetness-Hot, I used Shigao, Huangqin, Huanglian to clear the Hot. For the cholera that belongs to food-filling in the stomach, I sued cold water to dissolve Danfan (Blue vitriol) to create vomit for healing. The person had cold in the hands and feet. The pulse could hardly be felt. There had been a famous doctor, who mis-used Dingxiang, Wuzhuyu, Guizhi and Fuzi for several patients, but did not realize his mistake. It is really pity.

上所录二则，皆于霍乱之证，有所发明，故详志之，以备采择。
The cases cited above is a further discussion beyond the cholera diagnosis and treatment. They are cited here for reference.

霍乱之证，宜兼用外治之法，以辅药饵所不逮。而外治之法，当以针灸为最要。至应针之处，若十宣、中脘、尺泽、足三里、阴陵、承山、太溪、太仓、太冲、公孙等穴（约略举之，未能悉数），习针灸者大抵皆知。惟督脉部分，有素髎穴，刺同身寸之三分出血，最为治霍乱之要着。凡吐泻交作，心中撩乱者，刺之皆效。诸针灸之书，皆未言其能治霍乱。世之能针灸者，间有知刺其处者，而或刺鼻准之尖，或刺鼻柱中间，又多不能刺其正穴。两鼻孔中间为鼻柱，《内经》王注，谓此穴在鼻柱之上端，则非鼻准之尖，及鼻柱中间可知。然刺未中其正穴者，犹恒有效验，况刺中其正穴乎。盖此穴通督脉，而鼻通任脉，刺此一处，则督、任二脉，可互相贯通，而周身之血脉，亦因之可贯通矣。
To treat cholera, the inside therapy and the outside therapy should both be used, to prevent the failure or the weakness of the oral herbal therapy. Among the outside therapy, the most important way is the acupuncture. The acupuncture points needed to be used are the Shixuan, Zhongyuan, Chize, Zusanli, Yinlingquan, Chenshan, Taixi, Taichong, Gongsun, etc. Acupuncturists know where they are. The most important point is the Doumai meridian, on which the Suliao point should be bleeded out of blood. This is very important method. In acupuncture books, there was no indication that this point can be used for the cholera. ……

又宜佐以刮痧之法。盖此证病剧之时，周身冰冷，回血管之血液凝滞不行。当用细口茶碗，将碗边一处少涂香油，两手执定其无油之处，先刮其贴脊两旁，脊椎上亦可轻刮，以刮处尽红为度。盖以脏腑之系皆连于脊，而诸脏腑 穴，亦贴脊两旁，故以刮此处为最要。而刮时，又宜自上而下挨次刮之，可使毒气下行。次刮其胸与胁，次刮其四肢曲处（尺泽委中）及腿内外 ，至头额项肩，亦可用钱刮之。又当兼用放痧之法：将四肢回血管之血，用手赶至腿臂曲处，用带上下扎紧，于尺泽、委中两旁回血管，用扁针刺出其血，以助其血脉之流通，且又放出炭气，俾霍乱之毒菌，从此轻减也。
The acupuncture therapy should be accompanied by Guasha therapy. In severe case, the body is very cold, the blood in vein is sticky and hard to return. … First, shave the both side of spine, as well as the middle of the spine (slight force), until the skin turns slight red. It should be shaved from the top to the bottom, to force the poison Qi down. Then shave the chest and the side of abdomen, later the bending position of the arms and the legs, and the inside and the outside of the legs. The head, the neck and the shoulders can also be shaved. In another way, use the Sha-bleeding therapy: press the blood in the major veins in the arms and legs to the elbow or to the back of the knee. Tie the upper and lower part of the arms and legs. Use a needle o pouch the blood to cause bleeding, so to improve the flow of the blood, as well as to expel the poison Qi out of the body.

又宜佐以温体之法。用滚水煮新砖八个，以熨腋下及四肢曲处，及两脚涌泉穴。或水煮粗浓之布，乘热迭数层，复于转筋之处。即不转筋者，亦可复于少腹及腿肚之上，凉则易之。或以茶壶及水笼袋，满贮热水，以熨各处。或醋炒葱白（切丝）、或醋炒干艾叶（揉碎）熨之。或用手醮火酒或烧酒，急速擦摩其周身及腿肚发硬之处。种种助暖之法不一，临证者随事制宜可也。

Beside the above therapies, the body should be warmed up. Pour boiling water on to new bricks (eight of them). Put the bricks to the armpit and the bending points of the arms and legs, as well as the sole of the feet. Or, put the thick clothes in boiling water. Pick it out, fold into several layers. Put it onto the spasm muscle (calf). If there is no spasm, put it on to the lower stomach or the calf. Change it when it is cold. Or, use tea pot, or water bag, with hot water in it. To warm the above places on the body. Or, use veniger-fired Chinese onion (cut into pieces), or vinegar-fried herb Argy wormwood leaves to warm the arms and legs. Of put burning liquor to the hands, apply the hands onto the body or on the spasm calf to massage. There could be various different ways to warm the body. Try whatever way that is available.