经义
岁土不及民，民病飧泄霍乱。○太阴所至为中满，霍乱吐下。○土郁之发，为呕吐霍乱。○清气在阴，
浊气在阳，营气顺行，卫气逆行，清浊相干，乱于肠胃，则为霍乱。（《素问》）
足太阴厥气上逆则霍乱。（《灵枢》）
哲言
病有霍乱者何？曰∶呕吐而利，名曰霍乱。（张仲景）
病有干霍乱、湿霍乱。干霍乱死者多，湿霍乱死者少。盖吐利则所伤之物得以泄出，泄尽则止矣，所以
死者少。干霍乱以其上不得吐，下不得利，则所伤之物不得泄出，壅闭正气，隔绝阴阳，烦扰闷躁，喘胀而死
者多矣。（成无己）
上吐下利，烦扰躁乱，谓之霍乱，与但称吐利者有异。盖暴于旦夕者为霍乱，可延至数日者为吐利。○伤
寒吐利，由邪气所伤。霍乱吐利，由饮食所伤。此病多发于夏秋之交，寒月亦间有之。昔人云∶多由伏暑所致，
未必皆然。大抵湿土为风木所克，故呕泻者，湿土之变也；转筋者，风木之变也。（《张氏医通》）
霍乱者，以其上吐下泻，反复不定，而挥霍撩乱故名。此寒邪伤脏之病也。尽有外受风寒，寒气入脏而
病者；有不慎口腹，内伤食饮而病者；有伤饥失饱而病者；有水土气令寒湿伤脾而病者；有旱潦豪雨，清浊相
混，误中沙气阴毒而病者，总皆寒湿伤脾之证。邪在脾胃，则中焦不能容受，故从上而出则为吐，从下而出则
为泻。且凡邪之易受者，以其脾气本柔，既吐既泻，则脾气更虚。故凡治此证者，必以和胃健脾为主。若寒少
滞多，则但以温平调
之；若滞因于寒，则非温热之剂不能调也。而诸家有言为火者，谓霍乱多在夏秋之间，岂得为寒？不知夏秋之
交，正多脏寒之病。盖一以盛暑将杀，新凉初起，天人易气，寒之由也。一以酷燥当令，生冷不节，疾病因时，
寒之动也。人以夏秋之外热易见，而脏腑之内寒难窥，故但知用热远热，而不知用寒远寒，多致误也。○霍乱
转筋，甚至牵缩阴丸，痛迫少腹，最为危急，此足阳明、厥阴气血俱伤之候也。观河间曰转筋，《经》云反戾
也。热气燥灼于筋，则挛 而痛，火主燔灼燥动故也；或以为寒客于筋者，误也。盖寒虽主于收引，然止为厥
逆禁固，屈伸不便，安得为转筋乎？所谓转者，动也。阳动阴静，热证明矣。丹溪亦曰∶转筋属于血热。余谓
此言，总属偏见。试以《内经》质之曰∶经筋之病，寒则反折筋急，热则筋弛纵不收，此非反折筋急之病乎！
而何以谓之热也？夫所谓转者，以其坚强急痛，有如扭转之状。而河间曰，转者，动也。则可谓强矣。且凡患
者必于吐泻之后乃有此证，未闻吐泻之前而先见转筋者也。若转于吐泻之前而谓之火，犹可云因火而病也。既
转于吐泻之后，则上下皆已火去，岂因吐泻而反生火耶？盖阳明为脏腑之海，主润宗筋。此证以阳明血气骤
损筋急而然，本非火也。陈无择曰∶转筋者，以阳明养宗筋，今暴吐下，津液顿亡，宗筋失养，必致挛急，甚
则卵缩舌卷，此说始为切当。（张景岳）
暑月痉证与霍乱同出一源。风自火生，火随风转，乘入阳明则呕，戕及太阴则泻，是名霍乱。窜入筋中则
挛急，流入脉络则反张，是名痉。但痉证多厥，霍乱少厥。盖痉证风火闭郁，郁则邪势内炽，不免逼乱神明，
故多厥。霍乱风火外泄，泄则邪势外解，不致循经内走，故少厥。此痉与霍乱之分别也。然痉证邪滞三焦，三焦
乃火化；风得火而愈煽，则逼入膻中而暴厥。霍乱邪走脾胃，脾胃乃湿化，邪由湿而停留，则淫及诸筋而转筋。
又痉之挛急，乃湿热生风。霍乱之转筋，乃风来胜湿。总由湿热与风
淆乱清浊，升降失常之故。夫湿多热少，则风入土中而霍乱；热多湿少，则风乘三焦而痉厥。厥而不反者死。
胃液干枯，火邪盘踞也。转筋入腹者死，胃液内涸，风邪独劲也。厥证用辛，开泄胸中无形之邪也；干霍乱用
探吐，泄胃中有形之滞也。然泄邪而胃液不上升者，热邪益炽；探吐而胃液不四布者，风邪更张，终成死候，
不可不知。（薛生白）
霍乱新定，不可即与谷食。恐中焦未清，反助邪气，必待过一、二时，饥甚方可渐与米饮。若遽进谷食，
下咽立毙。（《证治汇补》）
补编
霍乱，头疼发热，身疼痛，热多欲饮水者，五苓散主之。寒多不用水者，理中丸主之。（张仲景）
冒暑之霍乱吐泻，以治暑为主。避暑之霍乱吐泻，以和中温中为主。（喻嘉言）
霍乱，乃湿土兼风木为害，治宜疏风散寒，利湿降火。邪在上者宜吐，以提其气。惟吐利不止，元气耗散，
病势危笃或大渴喜冷，或恶寒逆冷，或发热烦躁，欲去衣被，此阴盛格阳，不可误认热证，妄投凉药，宜四逆
理中汤冷服。（《证治汇补》）
夏秋感冒，吐泻霍乱，六和汤为要药。其有身热烦渴，气粗喘闷，或吐泻厥逆躁扰者，此伤暑霍乱也，宜
香薷饮冷服。甚则厥逆少气，唇面爪甲皆青，六脉俱伏，吐出酸秽，泻下臭恶，便溺黄赤者，此火伏于厥阴，
为热极似阴之候，急作地浆煎竹叶石膏汤，误作寒治必死。○举世治霍乱，不问虚实寒热，概用藿香正气散。
不知此方专主胃气不和，阴阳错乱；或夏秋寒热交加，饮食冷热并进；及水土不服之霍乱，固为合剂。如见厥
逆冷汗，虚烦喘哕，面赤戴阳，脉虚细无力者，此脾肾俱虚，虚阳失守之候，猛进理中四逆，尚恐不救，况堪
从事耗气之剂乎？○凡夏秋霍乱，有一毫口渴，即是伏热，切不可用温药。如燥渴，小便不利，五
苓散为主，方中肉桂亦宜酌用。惟泄泻不渴，二便清利者，方可用理中温之。○干霍乱者，心腹胀痛，欲吐不
吐，欲泻不泻，烦躁闷乱，俗名搅肠沙。此土郁不能发泄，火热内炽，阴阳不交之故。或问方书皆言宿食与寒气
相搏，何以独指为火耶？曰∶昏乱躁闷，非诸躁狂越之属火者乎？每致急死，非暴病暴死之属火者乎？但攻之
太过，则脾愈虚；温之太过，则火愈炽；寒之太过，则反捍格；治须反佐，然后火可散耳。古法有盐煎童便，
非但用之降火，且兼取其行血。又法盐汤探吐，并用盐填脐中，以艾灸二七壮，屡效。（《张氏医通》）
夏月不头痛发热，但少腹疼痛，或心腹俱痛，不能屈伸，医疑为阴证，不知皆缘暑火流注脏腑。治宜六和
汤解之；或四苓散加香薷、木瓜、紫苏、半夏之类和之；或正气散或二陈汤加浓朴、山栀，或炒盐和滚汤吐之。
大抵此证以吐法为上，若用热药，去生远矣。○暑气入腹，恶心腹痛，上吐下泄，泄如水注，此暑火暴发，升
降不利，清浊不分。宜用五苓散或胃苓汤，分阴阳，去暑气。○更有上下关闭，竟不吐泻者为干霍乱。惟心腹绞
痛，令人立毙急行吐法，通则可救。（《瘟疫暑热全书》）
肝虽主筋，而转筋则因风寒湿热袭伤脾胃所致。转筋必起于足腓，腓及宗筋，皆属阳明。用木瓜治转筋者，
取其理脾以伐肝也。土病则金衰而木盛，故用酸以收脾肺之耗散，而藉其走筋以平肝邪，乃土中泻木以助金也。（李时珍）
脉候
脉伏或微涩者霍乱。霍乱脉得洪大者吉，虚微迟细者凶。脉见结促代伏者，不可便断为死。其有吐泻后，
阳气已脱，或遗尿不语，膏汗如珠，躁欲入水，舌卷囊缩者，乃为死候。（《张氏医通》）
附方
治霍乱方 用食盐炒热绢包，令病患仰卧，将盐包放脐上，盐锅入水一碗煎滚，候冷冻饮料下。至脐寒热合而
阴阳和矣。
又方 用阴阳水浸汗脚布服之效。○又法地浆饮之即愈。
霍乱急救方 令病患偃卧，将膝腕内以手蘸温水，轻轻急拍，待紫红筋见出，用瓷锋刺出血立愈。
治转筋法 男子以手牵其阴，女子以手牵其乳，皆验。
[Classic Theories]
When the annual earth qi is insufficient, people are prone to suffer from undigested diarrhea and Huoluan (cholera-like disease). ○ When Taiyin damp-earth qi prevails, it leads to abdominal fullness, Huoluan, vomiting, and diarrhea. ○ When earth qi is stagnant and erupts, symptoms such as vomiting and Huoluan occur. ○ When clear qi resides in the yin aspect and turbid qi in the yang aspect, Ying (nutritive) qi flows smoothly while Wei (defensive) qi moves counter-currently, causing clear and turbid qi to interfere with each other and disrupt the intestines and stomach, resulting in Huoluan. (From *Suwen*)
Rebellious qi of the Foot-Taiyin Spleen meridian moving upward causes Huoluan. (From *Linghu*)
[Masters' Discourses]
What is Huoluan? It is said: Vomiting accompanied by diarrhea is named Huoluan. (Zhang Zhongjing)
Huoluan is divided into Gan Huoluan (dry Huoluan) and Shi Huoluan (wet Huoluan). Mortality is higher in Gan Huoluan and lower in Shi Huoluan. This is because vomiting and diarrhea allow the pathogenic factors to be expelled; once expelled, the condition stops, hence fewer deaths. In Gan Huoluan, since one cannot vomit above nor defecate below, the pathogenic factors cannot be expelled, blocking Zheng Qi (healthy qi), isolating yin and yang, leading to restlessness, stifling sensation, distension, and often death due to panting. (Cheng Wuji)
Upper vomiting and lower diarrhea with restlessness and agitation are called Huoluan, which differs from simple vomiting and diarrhea. Acute onset within a day or night is Huoluan, whereas prolonged duration over several days is vomiting and diarrhea. ○ Vomiting and diarrhea caused by Cold Damage (Shanghan) result from pathogenic invasion; those caused by Huoluan result from dietary injury. This disease mostly occurs during the transition between summer and autumn, occasionally in winter. Ancients claimed it was mostly due to latent summer-heat, but this is not always true. Generally, when damp-earth is overcome by wind-wood, vomiting and diarrhea represent the disorder of damp-earth, while muscle cramps (Zhuanjin) represent the disorder of wind-wood. (*Zhangshi Yitong*)
Huoluan is so named because of its upper vomiting and lower diarrhea, occurring repeatedly and chaotically ("huohuo liaoluan"). It is a disease where cold pathogens damage the zang organs. Some cases arise from external contraction of wind-cold with cold entering the zang; some from improper diet damaging the interior; some from irregular eating habits; some from cold-damp climate affecting the spleen and stomach; and some from contaminated water or toxic vapors mixing clear and turbid qi. All these are essentially cold-damp damaging the spleen and stomach. When pathogens reside in the spleen and stomach, the middle jiao cannot accept or transform them, leading to vomiting from above and diarrhea from below. Since the spleen qi is naturally soft and vulnerable, vomiting and diarrhea further weaken it. Therefore, treatment must focus on harmonizing the stomach and strengthening the spleen. If cold is slight and stagnation is predominant, warm and neutral herbs should be used for regulation; if stagnation is due to cold, only warm-hot herbs can regulate it. Some claim it is a fire syndrome because Huoluan occurs in summer and autumn, asking how it can be cold. However, the transition between summer and autumn is precisely when internal organ cold diseases are common. First, as intense heat wanes and coolness begins, heaven and human qi change, introducing cold. Second, dryness prevails, and indulgence in cold/raw foods triggers seasonal cold diseases. People see external heat but miss internal cold, mistakenly avoiding heat therapies in summer ("avoid heat when using heat") while failing to avoid cold therapies in winter ("avoid cold when using cold"), leading to errors. ○ Muscle cramps (Zhuanjin) in Huoluan, especially when pulling the testicles and causing severe lower abdominal pain, are critical signs of blood and qi deficiency in the Foot-Yangming Stomach and Foot-Jueyin Liver meridians. Hejian stated that "zhuan" means convulsion. Heat drying and burning the tendons causes spasms and pain, as fire nature is scorching and agitating. Some attribute it to cold invading tendons, which is wrong. Although cold causes contraction, it leads to cold limbs and stiffness, not twisting. "Zhuan" implies movement. Yang moves, Yin is still; thus, it is clearly a heat syndrome. Danxi also said muscle cramps belong to blood heat. I consider this biased. Verifying with *Neijing*: tendon diseases from cold cause reverse bending and stiffness; from heat, flaccidity and collapse. Is reverse bending stiffness not a cold sign? Why call it heat? "Zhuan" refers to the stiff, painful, twisting state. Hejian said "zhuan" means movement, implying strength. Patients always develop cramps after vomiting and diarrhea; never before. If cramps precede vomiting/diarrhea, it could be fire-induced. But appearing after, both upper and lower fire are gone; how can vomiting/diarrhea generate fire? The Yangming is the sea of the fu and zang organs, moistening the Zongjin (major tendons). This condition arises from sudden loss of Yangming blood and qi causing tendon stiffness, not fire. Chen Wuyue said: Cramps occur because Yangming nourishes Zongjin; sudden vomiting and diarrhea cause sudden fluid loss, depriving Zongjin of nourishment, leading to spasms, possibly testicular retraction and tongue curling. This explanation is accurate. (Zhang Jingyue)
Summer convulsions (Jingzheng) and Huoluan share the same origin. Wind generates from fire, fire turns with wind. Entering Yangming causes vomiting; damaging Taiyin causes diarrhea—this is Huoluan. Entering tendons causes spasms; flowing into collaterals causes opisthotonos—this is Jingzheng. Jingzheng often involves Jue (cold extremities/coma), while Huoluan rarely does. Jingzheng involves wind-fire closure and depression, intensifying internally and disturbing the spirit, causing Jue. Huoluan involves wind-fire exterior release, resolving externally without penetrating inward, hence less Jue. This distinguishes them. Jingzheng pathogens stay in the Sanjiao (Triple Burner), which transforms fire; wind plus fire forces entry into the Chest Center (Danzhong) causing sudden Jue. Huoluan pathogens move in the spleen and stomach, which transform dampness; pathogens linger with dampness, spreading to tendons causing cramps. Jingzheng spasms are damp-heat generating wind; Huoluan cramps are wind overcoming dampness. Both result from damp-heat and wind confusing clear/turbid qi and disrupting ascending/descending functions. More damp than heat: wind enters earth causing Huoluan. More heat than damp: wind attacks Sanjiao causing Jing-Jue. Jue without opisthotonos indicates death. Dry stomach fluids indicate fire accumulation. Cramps entering the abdomen indicate death due to dried stomach fluids and dominant wind. Jue syndrome uses acrid herbs to open invisible chest pathogens; Gan Huoluan uses emesis to expel visible gastric stagnation. However, if expelling pathogens fails to raise stomach fluids, heat intensifies; if emesis fails to distribute fluids, wind worsens, leading to death. (Xue Shengbai)
After Huoluan subsides, do not immediately give solid food. The middle jiao may not be clear, and food might aid pathogens. Wait one or two hours until very hungry, then gradually give rice soup. Immediate solid food intake can be fatal. (*Zhengzhi Huibu*)
[Supplement]
Huoluan with headache, fever, body ache, thirst for water (heat predominant): Treat with Wuling San (Five Ingredient Powder with Poria). Cold predominant with no thirst: Treat with Lizhong Wan (Regulate the Middle Pill). (Zhang Zhongjing)
Huoluan/vomiting-diarrhea from heatstroke: Focus on clearing summer-heat. Huoluan/vomiting-diarrhea from improper cooling: Focus on harmonizing and warming the middle. (Yu Jiayan)
Huoluan is harm from damp-earth and wind-wood. Treatment should dispel wind, scatter cold, drain dampness, and descend fire. Pathogens in the upper jiao require emesis to lift qi. If vomiting/diarrhea persist with qi depletion, critical illness, extreme thirst for cold, aversion to cold, fever with irritability, desire to remove clothes, this is Yin excess repelling Yang. Do not mistake for heat syndrome or use cold drugs blindly. Use Sini Lizhong Tang (Sini and Regulate Middle Decoction) taken cold. (*Zhengzhi Huibu*)
For summer-autumn colds with vomiting/diarrhea/Huoluan, Liuhe Tang (Six Harmonies Decoction) is essential. If fever, irritability, thirst, coarse breathing, panting, or vomiting/diarrhea with Jue and agitation occur, this is Summer-Heat Huoluan. Use Xiangru Yin (Elsholtzia Decoction) cold. Severe cases with Jue, shortness of breath, cyanosis of lips/nails, hidden pulse, sour vomit, foul diarrhea, yellow urine indicate Fire trapped in Jueyin, presenting as extreme heat mimicking Yin. Urgently decoct Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with Earth Slurry Water. Mistaking this for cold leads to death. ○ Universally, Huoluan is treated indiscriminately with Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi). This formula specifically addresses stomach disharmony, yin-yang confusion, mixed hot/cold weather, mixed hot/cold diet, or acclimatization issues. For cases with Jue, cold sweat, empty irritability, panting, red face floating like Yang, weak/thready pulse, indicating Spleen-Kidney deficiency and lost Floating Yang, even aggressive Lizhong and Sini formulas may fail; using Qi-consuming agents is disastrous. ○ Any thirst in summer-autumn Huoluan indicates latent heat; absolutely avoid warm drugs. For dry thirst and difficult urination, Wuling San is primary, with Rougui (Cinnamon Bark) adjusted as needed. Only for non-thirsty diarrhea with clear urine/stool is Lizhong appropriate for warming. ○ Gan Huoluan features abdominal distension/pain, inability to vomit or defecate, restlessness, commonly called "Intestine-Churning Sand." This is earth stagnation failing to vent, internal fire blazing, yin-yang disconnection. Some ask why texts cite food retention/cold conflict but here emphasize fire. Answer: Confusion/agitation belongs to fire syndromes. Sudden death belongs to fire syndromes. Over-attacking damages spleen; over-warming ignites fire; over-cooling causes rejection. Treatment requires adjuvant methods to disperse fire. Ancient method: Salt-decocted child's urine to descend fire and move blood. Another method: Salt-water induced emesis with salt packed in umbilicus and moxibustion (14 cones), frequently effective. (*Zhangshi Yitong*)
Summer cases without headache/fever, but with lower abdominal or heart/abdominal pain, inability to flex/extend, suspected as Yin syndrome, are actually summer-fire flowing into zang-fu. Treat with Liuhe Tang; or Siling San plus Xiangru, Mugua, Zisu, Banxia; or Zhengqi San or Erchen Tang plus Houpo, Shanzhi; or induce emesis with salt and boiling water. Emesis is superior; heat drugs are dangerous. ○ Summer-heat entering abdomen causes nausea, pain, vomiting, watery diarrhea. This is sudden summer-fire outbreak, disrupted ascent/descent, confused clear/turbid. Use Wuling San or Weiling Tang to separate yin/yang and eliminate summer-heat. ○ Cases with closed orifices, no vomiting/diarrhea, are Gan Huoluan. Only severe abdominal pain, potentially fatal, requires urgent emesis to restore flow and save life. (*Wenyi Shure Quan Shu*)
Although Liver governs tendons, cramps (Zhuanjin) result from wind-cold-damp-heat damaging spleen/stomach. Cramps start in the calf, which and Zongjin belong to Yangming. Mugua (Papaya) treats cramps by regulating spleen to subdue liver. Spleen disease weakens Metal, allowing Wood to flourish. Sour herbs astringe Spleen/Lung dispersion and enter tendons to calm Liver evil, draining Wood from Earth to assist Metal. (Li Shizhen)
[Pulse Diagnosis]
Hidden or faint/choppy pulses indicate Huoluan. A洪大 (Surging-Large) pulse in Huoluan is auspicious; Xuwei Cixi (Deficient-Faint-Slow-Fine) pulses are ominous. Knotted, frequent, intermittent, or hidden pulses are not necessarily fatal. Death signs include post-vomit/diarrhea Yang collapse, urinary incontinence, muteness, profuse sweating like pearls, agitation seeking water, tongue retraction, and testicular retraction. (*Zhangshi Yitong*)
[Attached Formulas]
Formula for Huoluan: Stir-fry edible salt until hot, wrap in silk. Have patient lie supine, place salt pack on umbilicus. Boil one bowl of water in the salt pot, let cool, and drink. When umbilical area feels balanced hot/cold, Yin and Yang harmonize.
Another Formula: Soak cloth used for sweaty feet in Yin-Yang Water (mixed hot/cold water) and drink. Effectual. ○ Another Method: Drink Di Jiang Yin (Earth Slurry Decoction) for cure.
Emergency Huoluan Formula: Have patient lie supine. Dip hand in warm water and gently but firmly slap the inner knee/wrist area until purple-red veins appear. Prick with porcelain shard to bleed; immediate relief.
Method for Treating Cramps: For men, pull the genitals with hand; for women, pull the breasts with hand. Both are effective.