Vomiting, Diarrhea, Cramps and Near-Collapse — How Doctor Wang Mengying Saved His Friend Zhou Guangyuan Twice: Cholera with Cramps (Huo Luan Zhuan Jin) and a Yearly Malaria Ended by One Old Prescription
Patient search terms: vomiting and diarrhea / cramps / shaking with chills and fever / malaria that returns every year / near collapse / cold hands and feet / sunken eyes Medical terms: cholera with cramps (huo luan zhuan jin) · cholera (a virulent infectious disease) · malaria (damp malaria of the foot taiyin channel) · severe damage to fluids · yang qi on the verge of collapse
The opening: one man, two grave illnesses, each nearly fatal — both times saved by the same friend
There was a man who suffered at least two grave illnesses in his lifetime, and each one brought him to the very edge of death. The first time, he wasted away to skin and bone, burning and freezing by turns for over a month. The second time was even more dangerous: vomiting and diarrhea, cramping, ice-cold hands and feet, eyes sunken into their sockets — his life hung like morning dew, ready to vanish the moment the sun rose. And yet, both times, the same man dragged him back from the gates of death.
💬 Note from Doctor Luo: This man was Zhou Guangyuan, and his rescuer was Doctor Wang Mengying, the great Qing-dynasty master of warm (heat) diseases. Zhou and Wang were close friends for decades, and it was Zhou Guangyuan who personally compiled Wang Mengying’s medical cases into a book that has been passed down to this day. Today I want to tell the story of Zhou’s repeated serious illnesses together — especially the most dangerous one, cholera with cramps (huo luan zhuan jin) — and show you how Wang Mengying, in a moment of mortal crisis, snatched a man’s life back with his bare hands.
Who was the patient: the salt administrator of Wuzhou, who followed Doctor Wang all his life
First, how did the two men meet? Wang Mengying was from Hangzhou, and his family had worked in the salt administration for generations — in ancient China salt was a government monopoly, and anyone working in that system came from a family of some means. His grandfather even understood medicine and wrote medical books. But when Wang Mengying was fourteen, his father died and the family fortune collapsed overnight — rather like the Cao family in Dream of the Red Chamber.
💬 Note from Doctor Luo: The young Wang Mengying had to go out and earn a living. He found work as an assistant in the salt administration in Wuzhou — present-day Jinhua in Zhejiang. And Zhou Guangyuan was precisely the salt administrator of Wuzhou, the official in charge of the local salt monopoly — part official, part merchant, selling salt on behalf of the emperor. That was how the two met. Zhou was very young then, in his twenties, and his first recorded illness was a sudden fainting spell in which he nearly collapsed — saved by none other than Wang Mengying. From that moment on, Zhou was utterly devoted to Wang Mengying. He even stopped caring much about his lucrative salt post: wherever Wang Mengying went, Zhou followed, and every time he fell ill, Wang Mengying treated him.
The first grave illness: malaria in autumn, made worse by an unskilled doctor
That autumn, Zhou Guangyuan came down with malaria in Jinhua — an infection by the malaria parasite. The ancients called malaria a “grave illness,” and even today the worldwide death toll from malaria is astronomical — it is still a scourge in Africa. Don’t underestimate this disease. But the worst part was that he was first mishandled by a doctor.
💬 Note from Doctor Luo: That doctor first assumed it was an external-contraction illness and prescribed herbs to induce sweating and dispel the pathogen — no result. Then he decided the patient must be deficient in upright qi and prescribed tonics — still no result. This dragged on for over a month. Zhou Guangyuan’s flesh wasted away until he was skin and bone, and he suffered endless alternations of chills and fever — that is the signature of malaria: burning hot one moment, shivering cold the next, attacking at set times, which the Chinese call “da bai zi” (striking like a metronome). He also felt constantly nauseous, wanted no food, his urine turned dark red, and he feared cold and chill. Zhou was wrecked: if he stayed in Jinhua any longer, he thought, this treatment would kill him! So he hired a little boat and hurried straight from Jinhua to Hangzhou to find Wang Mengying. Wang looked at him — this man who had once been plump and pampered, now reduced to skin and bone — and immediately invited him in for a consultation.
How Doctor Wang reasoned: damp malaria of the foot taiyin — the root was the spleen, not the parasite
Doctor Wang’s diagnosis came in four characters: 足太阴湿疟 — zu taiyin shi nue, damp malaria of the foot taiyin channel. Malaria is an external infection, but external pathogens react differently in different bodies — and reading that difference was Wang Mengying’s signature skill in treating malaria.
💬 Note from Doctor Luo: What is damp malaria of the foot taiyin? It means the external pathogen has entered the foot taiyin spleen channel and disturbed the spleen. This pattern appears when the spleen is deficient, its yang insufficient, and its earth weakened, so that dampness floods the body — and malaria presenting on this foundation is called damp malaria of the foot taiyin. Wang Mengying’s approach to malaria was unlike anyone else’s: he did not aim at the parasite directly; instead he adjusted the internal environment of the body. He once declared that he had never met a malaria case he found difficult — and this was exactly how: if I determine that your spleen earth is insufficient and dampness is flooding, I remove and scatter that dampness, change your internal environment, and see whether your own body can recover — once the upright qi is strong, the body kills the external pathogen by itself.
A Song-dynasty formula: Bu Huan Jin Zheng Qi San (the Upright Qi Powder Worth More Than Gold)
Which formula did he use? 不换金正气散 — Bu Huan Jin Zheng Qi San, the Upright Qi Powder Worth More Than Gold. Zhou Guangyuan, who knew little of medicine, remembered the name backwards as “Jin Bu Huan Zheng Qi San,” but the true name is “Bu Huan Jin” — meaning this formula is so good you would not trade it even for gold.
💬 Note from Doctor Luo: Bu Huan Jin Zheng Qi San is a Song-dynasty formula, most famously recorded in the Taiping Huimin Heji Jufang (Formulary of the Pharmacy Service for Benefiting the People in the Taiping Era) — the collection of folk prescriptions that the Song emperor had published across the empire, where it sits right beside Huoxiang Zheng Qi San (Agastache Upright Qi Powder). It is a very meaningful book. The formula contains: huo xiang (agastache) to disperse outward, scattering external cold and dispelling damp; cang zhu (atractylodes lancea) to drain damp downward; hou po (magnolia bark) to dry damp and move qi; ju pi (tangerine peel) to regulate qi; ban xia (pinellia) to transform phlegm-damp; plus gan cao (licorice), sheng jiang (fresh ginger) and da zao (Chinese dates). How does it differ from Huoxiang Zheng Qi San? Fewer herbs — it drops da fu pi (areca husk, which drains water-damp), jie geng (platycodon, which disperses upward) and fu ling (poria, which promotes urination), and swaps bai zhu for cang zhu. Taken together, it is a formula that moves qi, transforms damp, harmonizes the stomach, stops vomiting and stops diarrhea — very effective when dampness is heavy in the spleen and stomach. Its force is a bit gentler than Huoxiang Zheng Qi San, which is why it is less popular today — Huoxiang Zheng Qi has real punch, and when cold-damp is the culprit it works immediately. But whenever you are sure the problem is dampness leaning toward cold-damp, Bu Huan Jin Zheng Qi San works beautifully too.
What was the result? Three doses and he was calm — after three doses, the malaria stopped attacking. Still, because Zhou had swallowed all sorts of disorderly medicines in Jinhua, his vital qi had been wounded by the mistaken drugs, and Wang Mengying had to tonify and regulate him from many angles before he finally recovered his health.
The next autumn, it came back: one old prescription, cured in three days
The following autumn, Zhou Guangyuan caught malaria again in Wuzhou — at exactly the same time of year as the year before.
💬 Note from Doctor Luo: What is this? A concept from time medicine: some illnesses attack at a certain hour every day, some on a certain day every month, and some in a certain season every year. Many people with asthma or chronic cough leave a root of disease behind, and every year at that exact season they start coughing again — very punctual. It means the body was never fully regulated; the root of the illness is still there. So when autumn came, Zhou relapsed. This time, because he managed the salt trade and had many friends, everyone rushed to recommend doctors. Zhou said: forget it, forget it — last year I saw what that was like, a doctor reduced me to skin and bone. I don’t need your recommendations this year! He dug out the prescription Wang Mengying had written the year before — Bu Huan Jin Zheng Qi San — drank it exactly as written for three days, and the illness was cured. Everyone who heard about it marveled: how brilliant of you — curing yourself with the old prescription!
Doctor Wang heard the story and sensed something wrong: “I fear it will recur by the year”
Later, when Zhou Guangyuan came to Hangzhou and met Wang Mengying, he told the story as a triumph. Wang listened — and felt uneasy.
💬 Note from Doctor Luo: Wang said: however you look at it, it attacked again at the same time of year — “nue qing ru shi, kong qi an nian er zuo”: the malaria is behaving exactly like this, and I fear it will go on recurring year by year. If a root of the disease remains, next year it will likely strike again! So Wang Mengying wrote him a convalescent pill formula — one that tonifies the spleen earth and dispels damp — and instructed him: beginning next summer, take it in advance as prevention. Zhou followed the instruction, and sure enough, that autumn nothing happened — and in the end he never caught malaria again. You see: curing the illness is not the end of the job; you also have to pull out the root. That is Wang Mengying’s skill — and it is the big lesson of this whole story: rescuing a crisis is a skill, but aftercare that supports the upright qi is even more crucial.
The most dangerous night: cholera with cramps, life hanging by a thread
Several years later, on the night of the eighteenth day of the seventh month, Zhou Guangyuan was in trouble again — he had contracted huo luan zhuan jin, cholera with cramps, and it was extremely severe.
💬 Note from Doctor Luo: The “huo luan” of the old days is exactly what we call cholera, the virulent infectious disease, today — once Vibrio cholerae enters the body and multiplies, there is hardly time to treat it. When cholera swept through a community, many people would suddenly start vomiting and having diarrhea, their eyes would sink in, their voices would fail, and they would be gone — the death rate was very high, because the unrestrained draining emptied out all the body’s fluids. Worse still, Zhou Guangyuan had mistakenly taken Qing Ling Wan — the “Clear and Agile Pill,” a heat-clearing medicine containing bitter-cold herbs like da huang (rhubarb), huang qin (baical skullcap) and huang bai (phellodendron). Now, dispelling damp also requires telling cold from heat: for damp-heat, a bitter-cold medicine like Qing Ling Wan is right. But Zhou’s condition was cold-damp — taking it was completely wrong. That mistake made the illness far worse.
The next morning, the family hastily summoned Wang Mengying. He looked and found: the pulse was so weak it was almost absent — faint as if it were not there; deafness and blurred vision — the ears could no longer hear; sunken eye sockets — from dehydration; sweating with cold limbs — hands and feet like ice; a hoarse voice — he could barely speak. The case record notes at this point: “wei xiang bi cheng” — every sign of crisis is on display.
A biased annotation: it was not that Zhejiang people are constitutionally weak
There is an annotation in the book at this point, saying: “You can see that Zhejiang people have too thin a constitution and too weak a physique. If this were a sturdy Hebei man, a few bowls of Qing Ling Wan would never have brought him to such a state.” Doctor Luo thinks this remark is not quite objective.
💬 Note from Doctor Luo: Why? First, the medicine was simply wrong — a cold-damp person taking heat-clearing medicine is heading in the opposite direction. Second, cholera is itself a virulent infectious disease: unless it is properly treated, nothing you eat or drink will help; the body fails rapidly no matter what. This also reminds us: hygiene matters in summer. Cholera erupts in epidemic waves precisely because of unclean drinking water and food. When Vibrio cholerae enters a healthy stomach, the gastric acid usually kills it quickly. Why does cholera strike so often in summer? Because in summer people eat ice-cold watermelon and drink cold water — the gastric acid is diluted, and the cold, raw things depress the spleen and stomach, reducing acid secretion. When an external pathogen arrives at that moment, it multiplies very easily. So in people in a cold-damp state, the cholera vibrio finds it easy to breed. Once this disease arrives, the patient is at death’s door within hours — what to do?
Rescue move number one: concentrated Korean ginseng decoction — grab hold of the upright qi first
Wang Mengying said: forget everything else for the moment — have Zhou Guangyuan’s mother concentrate a Korean ginseng decoction by long, slow simmering, and pour it down his throat immediately, to catch the failing upright qi and hold it in place. Otherwise, he said, we are in real trouble.
💬 Note from Doctor Luo: When a person is on the verge of death, the first task is to secure the upright qi. The ginseng decoction holds that last breath in place. Then Wang Mengying wrote the prescription: ren shen (ginseng), bai zhu (atractylodes), bai shao (white peony), fu ling (poria), fu zi (aconite), rou gui (cinnamon bark), gan jiang (dried ginger), mu gua (papaya), yi ren (coix seed), bian dou (white hyacinth bean) and lian zi (lotus seed) — one dose, and the various dangerous signs gradually eased. Where does this formula come from? Zhen Wu Tang (True Warrior Decoction) with additions, and inside it runs the logic of Lizhong Tang (Center-Regulating Decoction) — ren shen and bai zhu are straight out of Lizhong Tang. What do Zhen Wu Tang and Lizhong Tang combined do? They tonify the yang qi of the spleen and stomach and dispel water-damp; yi ren, bian dou and lian zi all tonify the spleen. So this is a formula to tonify spleen yang and dispel damp. Someone may ask: why not Bu Huan Jin Zheng Qi San? Bu Huan Jin Zheng Qi San is strong at dispelling damp, but it is not strong at warming yang or tonifying spleen qi. At this moment Zhou Guangyuan was nearly gone — tonification must lead. In the tonification, you warm yang and dispel damp, but the core is tonifying spleen yang and spleen earth — each formula has its own emphasis. Malaria can drag on half a year and still be survived, but not cholera — the eyes were already sunken, which means the fluids were severely damaged; one or two more days of diarrhea and the man would be gone. So tonification had to come at once. One dose, and the crisis gradually receded.
The second day’s weighing of options: the fierce herbs should be withdrawn, and the fluids must be protected
On the second day’s follow-up visit, Wang Mengying said: the qi aspect is on the deficient side, and with all this vomiting and diarrhea, how can the body bear it? On top of that, bitter-cold medicine was mistakenly taken — wei yang yu jue: the last thread of yang was nearly cut off. Yesterday’s Zhen Wu Tang combined with Lizhong Tang was right, and now the yang of the spleen and kidneys is beginning to return — the fierce herbs like fu zi (aconite) can be withdrawn.
💬 Note from Doctor Luo: Why withdraw the fu zi? Because in cholera with its vomiting and diarrhea, the fluids (jin ye) are severely damaged. When the fluids are damaged, the sinews lose their nourishment — sinews are nourished by the body fluids; once the fluids are injured, the sinews cramp. That is why cholera patients cramp so terribly. Sunken eyes, failing hearing — all are tied to fluid damage, and it is often what kills the patient. Here is the contradiction: he has cold-damp cholera, a yin-cold condition that calls for warming yang — yet warming herbs tend to injure the fluids further. So when treating cholera, warming-yang herbs like rou gui (cinnamon) and fu zi (aconite) absolutely must be weighed for benefit against harm — this is a real skill; you have to know when to add and when to remove, or everything you accomplished earlier will be ruined. So Wang Mengying removed the dried ginger, fu zi and rou gui from the formula, and added huang qi (astragalus) to tonify the qi and shi hu (dendrobium) to replenish the fluids — shi hu nourishes yin. Regulated in this way for about ten days, the illness was cured.
“As perilous as morning dew”: Zhou Guangyuan’s own words, and his friends’ verdict
After he recovered, Zhou Guangyuan said something memorable: “Yu wei ci fan zhi bing wei tong chao lu” — this illness of mine was as perilous as morning dew.
💬 Note from Doctor Luo: What does morning dew mean? The moment the sun rises, the dew is gone. Cholera is an infectious disease with an extremely high death rate, and at that moment his life truly was like morning dew. Zhou Guangyuan said: “Ruo fei Mengying, wu bu neng jiu” — had it not been for Mengying, no one could have saved me. Their friend Mr. Zhang Liuyin also said: whenever you let a patient hear Wang Mengying analyze his illness — “lun bing zhi wu wei bu ru, yong yao zhi wu chu bu dao, yuan yuan ben ben, xin bi cheng zhang” — his analysis of the illness misses nothing, no corner too small; his prescribing takes everything into account; and he writes it all out fluently, from root to branch, as if the pen wrote by itself. When the patient heard him lay the illness out so clearly, half the illness seemed cured already. The ancients said a polemic could cure a headache — when Chen Lin’s famous denunciation was read aloud, it is said to have eased Cao Cao’s migraine. There is real truth in that; it is no empty saying. Zhou Guangyuan’s life was saved by Wang Mengying several times, and every time he was gravely ill when Wang snatched him back.
Years later: a sudden death without major illness — why?
Years later, Zhou Guangyuan died without any major illness — no great disease, he simply left, suddenly. Reading these cases, you will notice: Zhou Guangyuan’s whole life was marked by insufficient upright qi and insufficient yang qi, and whenever Wang Mengying treated him, the work was basically warming yang, tonifying qi and dispelling damp.
💬 Note from Doctor Luo: People may say: with a master like Wang Mengying as a friend, Zhou Guangyuan should have lived to a ripe old age — why did he end like this? Let me analyze. There are several reasons. The first is war. Those were the years of the Taiping Rebellion. Wang Mengying himself had nowhere to go — he fled as a refugee until he could barely find food; the book Sui Xi Ju Yin Shi Pu (A Dietary Manual for Living at Leisure) was written while Wang Mengying was hungry, eating chaff. Zhou Guangyuan’s family fled by climbing down the city wall on ropes, each person scrambling for himself, unable to look after the others — and so the care collapsed. Do you see it? In the great upheavals of a disordered age, ordinary people’s health — even with a famous doctor like Wang Mengying as a friend — could not be guaranteed. Wang Mengying ranks among the very top physicians of the Qing dynasty, and yet even so, with war raging all around — like shells flying in the Middle East today — what kind of health regimen can you keep? It is peaceful times that let people live and work in peace — and that is the first requirement for health.
Did Doctor Wang neglect supporting the upright qi? Yu Ling Gao is the proof that he did not
The second reason — someone may object: Wang Mengying placed enormous emphasis on clearing heat, transforming phlegm and attacking pathogens. Does that mean he did not value supporting the upright qi?
💬 Note from Doctor Luo: I don’t think so. Formulas like Yu Ling Gao (Jade Spirit Paste) — invented by Wang Mengying to nourish the blood, meant to be taken slowly over a long period — and there are many similar examples in his books, show that Wang Mengying valued supporting the upright qi very highly. When he treated Zhou Guangyuan, he rescued the crisis when rescue was needed, and in aftercare he prescribed pill formulas to prevent the malaria from recurring. So in the end the decisive reason remains the first one: war. People were running everywhere and could not keep up a course of regulation — in my view that is the most important reason.
Landing it on today: people who are plump and white but winded after a short walk need support for their upright qi
What does this story teach us? Doctor Luo says: we should learn from the experiences and lessons of the ancients — otherwise, why do we study these books at all?
💬 Note from Doctor Luo: There are certain constitutions — truly — plump and fair, winded after a short walk, heart racing at the slightest exertion. If that is you, you must support your upright qi. Don’t joke, “I’m fine.” After the pandemic, many people have this problem: someone is playing badminton and suddenly drops dead — it breaks my heart to hear about it. Many people overlook it: they look “healthy,” but something is actually wrong. What is xu tuo (deficiency collapse)? True collapse happens when the body’s upright qi has been insufficient all along and the person is barely holding on; then an abnormal environment arrives — extreme heat with heavy sweating, extreme hunger with nothing to eat, very low air pressure — and the body loses control: qi and blood are insufficient, unable to manage the situation, suddenly disorder and rebellion of qi and blood, the upright qi on the verge of leaving. That is “collapse because of deficiency.” That is how Zhou Guangyuan finally went. In today’s Chinese medicine community, a colleague said: when we treat patients now, we use ren shen (ginseng), xi yang shen (American ginseng), dang shen (codonopsis), dan shen (salvia) and tai zi shen (pseudostellaria) — “all five ginsengs together” — just to prop the upright qi up. Why? Because modern people are deficient in upright qi on a massive scale. So you must learn the various means of supporting the upright qi. In many of Wang Mengying’s formulas the idea of supporting the upright qi is already there — used in treatment when treating, and in aftercare made into little pills and powders to be taken regularly.
Emperor Qianlong’s Eight-Treasure Cake: a textbook of supporting the upright qi in daily life
Speaking of supporting the upright qi in daily life, Doctor Luo tells a wonderfully vivid example — why did the Qing emperors eat Ba Zhen Gao (Eight-Treasure Cake)?
💬 Note from Doctor Luo: Eight-Treasure Cake carries a little ginseng in every portion, and it was eaten year-round. Emperor Qianlong ate it until he was eighty-nine. One day the cake ran out, and he issued an imperial edict himself: how can it be gone? Make me more at once! The emperor did not skip a single serving of his own regimen — his handwritten order is completely clear: he recites the recipe from memory — the formula is such-and-such; then such-and-such a head eunuch must supervise the Imperial Pharmacy and make it with his own eyes. He ate it every day. Why? To support the upright qi. Qianlong supported his upright qi for eighty-nine years and lived long. You see: Wang Mengying saved Zhou Guangyuan’s life several times, and in the end Zhou still slipped away — yang qi insufficient, qi deficient, gone in a moment — the old root of the disease again. Everything we analyze from the ancients’ experience is material for our own reference today: study it so you know what to look for, and when the time comes to support the upright qi, support the upright qi. I wish you all good health.
What to take away
- Cholera with cramps is a mortal crisis: vomiting and diarrhea drain the fluids, the sinews lose nourishment and cramp, and the yang qi can slip away at any moment. Sunken eyes, deafness, a hoarse voice and cold limbs are all signs that fluids are spent — treat it as an emergency.
- In a crisis, secure the upright qi first. Wang Mengying poured a concentrated Korean ginseng decoction down Zhou Guangyuan’s throat before anything else — holding that last breath of qi in place bought the time needed to treat.
- Weigh warming against fluid loss. For cold-damp cholera you want to warm the yang — but warming herbs can injure the already-drained fluids. Doctor Wang used Zhen Wu Tang combined with Lizhong Tang (ginseng, atractylodes, white peony, poria, aconite, cinnamon, dried ginger, papaya, coix seed, white hyacinth bean, lotus seed) for one dose, then withdrew the fierce warming herbs and added huang qi (astragalus) and shi hu (dendrobium) to rebuild qi and fluids.
- Curing an illness is not the same as pulling out the root. When Zhou’s malaria recurred at the same season two years running, Wang Mengying read it as “recurring by the year” and prescribed a preventive convalescent pill formula to be taken the next summer — after that, the malaria never returned. Rescue is a skill; aftercare that supports the upright qi is even more crucial.
- Support the upright qi in daily life. Plump, pale people who are winded after a short walk, with a racing heart, are a common modern constitution — the same pattern as Zhou Guangyuan’s. The Qing emperors’ Eight-Treasure Cake (with a little ginseng every day) is a gentle, time-tested way to do it; Emperor Qianlong ate it for eighty-nine years.
- Peace is the first requirement for health. In wartime even a top physician could not keep his friend alive. What we can control today is our own regimen: hygiene in summer (cholera thrives when cold drinks dilute the stomach acid), steady regulation, and supporting the upright qi whenever it is lacking.
Compiled from Doctor Luo Dalun’s commentary on Doctor Wang Mengying’s case; the original case comes from the Wang Shi Yi An (The Medical Cases of Wang Mengying), compiled by Zhou Guangyuan, c. 1830s–1860s (Qing dynasty).