【纲】仲景金匮曰。狐惑之为病。状如伤寒。默默欲眠。目不得闭。卧起不安。蚀于喉为惑。蚀于
阴为狐。不欲饮食。恶闻食臭。其面目乍赤乍白乍黑。蚀于上部。则声哑。甘草泻心汤主之。蚀于
下部。则咽干。苦参汤洗之。蚀于肛者。雄黄熏之。
【目】朱肱曰。狐惑与湿 皆虫症。初得状如伤寒。或因伤寒变成。大抵伤寒病。腹内食入少。
肠胃空虚。三虫行作求食。蚀人五脏及下部。为 病。其候齿无色。舌上白。甚者唇黑有疮。四
肢沉重。忽忽喜眠。虫蚀其肛。烂见五脏。则死。当数看其上下唇。上唇有疮。虫蚀其脏。下唇有
疮。虫蚀其肛。杀人甚急。多因下利而得。治 。桃仁汤、黄连犀角汤、雄黄锐散。
少阴症。口燥咽干者。急下之。病患嘿嘿欲眠。目不能闭。起居不安。其声哑。或咽干者。即
当作狐惑治之。
徐彬曰。狐惑。虫也。虫非狐惑。因病以名之。大抵皆湿热毒所为之病。故状如伤寒。蚀者若
有食之而不见其形。如日月之蚀也。面者。阳明之标。目者。厥阴之标。内有毒瓦斯乘之。故乍赤白
黑。变现不一也。上部毒盛。则所伤在气。而声哑。下部毒盛。故所伤在血。而咽干也。
鳌按。狐惑病。有专由湿热而生者。有由伤寒后。湿热未清而成者。状如伤寒句。须看得活。
【纲】仲景金匮曰。病者脉数。无热。微烦。默默但欲卧。汗出。初得之三四日。目赤如鸠眼。
七八日。目四 黑。若能食者。脓已成也。赤豆当归散主之。
【目】李中梓曰。狐惑症。失汗所致也。以清热为主。
鳌按。此条非言狐惑病。乃湿热侵阴。有似狐惑而更甚者。首曰病者。乃概言之辞。非专指病
狐惑者。故用赤豆、当归。与治狐惑之药异。其病总由阴分热极。故现症如是也。
[General Principle] Zhang Zhongjing stated in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): The disease of Hu Huo (Fox and Charm, characterized by mucosal ulceration) presents with symptoms resembling Taiyang Cold Damage Disease (a syndrome caused by pathogenic cold invading the Taiyang channel). The patient is taciturn and desires sleep, yet cannot close their eyes, feeling restless when lying down or sitting up. Ulceration in the throat is termed "Huo" (Charm), while ulceration in the yin organs (genitals) is termed "Hu" (Fox). The patient has no appetite and dislikes the smell of food; their complexion alternates between red, white, and black. If ulceration occurs in the upper part (throat), hoarseness ensues, treated primarily with Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium). If ulceration occurs in the lower part (genitals), dryness of the throat results, treated by washing with Kushen Tang (Sophora Root Decoction). If ulceration occurs at the anus, treatment involves fumigation with Xionghuang (Realgar).
[Detailed Discussion] Zhu Gong said: Hu Huo disease and Gan disease (pediatric malnutrition syndrome often involving parasites) are both parasitic syndromes. Initially, symptoms resemble Taiyang Cold Damage Disease, sometimes arising as a transformation from it. Generally, patients with Taiyang Cold Damage Disease eat little due to abdominal discomfort, leaving the stomach and intestines empty. The "Three Parasites" within move about seeking food, eroding the five zang organs and the lower part of the body, leading to Gan disease. Signs include colorless teeth, white tongue coating, severe cases showing black lips with sores, heavy limbs, mental confusion, and excessive sleepiness. If worms erode the anus causing rotting visible to the viscera, death occurs. One should frequently inspect the upper and lower lips: sores on the upper lip indicate worm erosion of the viscera; sores on the lower lip indicate worm erosion of the anus. This condition is rapidly fatal and often arises following dysentery. Treatments for Gan disease include Tao Ren Tang (Peach Kernel Decoction), Huanglian Xijiao Tang (Coptis and Rhinoceros Horn Decoction), and Xionghuang Ruisan (Realgar Acute Powder).
If Shaoyin Syndrome (syndrome of the Heart and Kidney channels) presents with dry mouth and throat, urgent purgation is indicated. If a patient is taciturn, desires sleep, cannot close their eyes, is restless in daily activities, and has hoarseness or dry throat, it should be treated as Hu Huo disease.
Xu Bin said: "Hu Huo" refers to worms. The worms themselves are not Hu Huo; the disease is named after its characteristics. Generally, this is a disease caused by damp-heat toxicity. Thus, symptoms resemble Taiyang Cold Damage Disease. The term "erosion" implies something consuming tissue invisibly, like solar or lunar eclipses. The face is the superficial manifestation of the Yangming channel, and the eyes are the superficial manifestation of the Jueyin channel. Internal toxic vapors invade these areas, causing the complexion to alternate between red, white, and black. When toxicity is abundant in the upper part, it damages the Qi level, resulting in hoarseness; when toxicity is abundant in the lower part, it damages the Blood level, resulting in dry throat.
Shen Jin'ao's commentary: Hu Huo disease may arise solely from damp-heat, or it may develop after Taiyang Cold Damage Disease if damp-heat remains uneliminated. The phrase "resembling Taiyang Cold Damage Disease" must be interpreted flexibly.
[General Principle] Zhang Zhongjing stated in the *Jin Gui Yao Lue*: The patient has a rapid pulse, no fever, slight irritability, taciturnity with a desire to lie down, and sweating. Within three to four days of onset, the eyes become red like those of a turtledove. By the seventh or eighth day, the corners of the eyes turn black. If the patient can eat, it indicates that pus has formed. This is treated primarily with Chidou Danggui San (Adzuki Bean and Angelica Sinensis Powder).
[Detailed Discussion] Li Zhongzi said: Hu Huo syndrome is caused by improper use of diaphoresis (sweating therapy); treatment should focus on clearing heat.
Shen Jin'ao's commentary: This passage does not describe Hu Huo disease, but rather damp-heat invading the Yin aspect, presenting similarly to Hu Huo but more severely. The opening phrase "the patient" is a general reference, not specifically pointing to Hu Huo disease. Therefore, the use of Adzuki Bean and Angelica Sinensis differs from herbs used for treating Hu Huo disease. The pathology stems fundamentally from extreme heat in the Yin division, hence the presentation of these symptoms.