罗谦甫治一人。年近八十。六月。中暑霍乱。吐泻昏冒。终日不省人事。时夜半。请罗
治。脉七八至。洪大有力。头热如火。足冷如冰。半身不遂。牙关紧急。盖年高气弱。当暑
气极盛。阳明得令之际。中暑明矣。用桂苓甘露饮。甘辛大寒。泻热补气。加茯苓以分阴阳
约一两。水调灌之。渐渐省事。三日后。诸证悉去。换人参补中汤。以意增减。十日后平
又治蒙古百户昔良海。于戊午春。攻襄阳回。住夏曹州界。因食酒肉。多饮潼乳。得霍
乱吐泻证。从朝至午。精神昏愦。已困急。来告。罗视之。脉皆浮数。按之无力。所伤之物
已出矣。即以新汲水。调桂苓白术散。徐徐服之。稍得安静。又于墙阴掘地约二尺许。贮新
水在内。搅动。待一时。澄定。用清者一杯。再调服之。吐泻渐止。至夜安卧。翌日微烦渴
遂煎钱氏白术散。时时服。良愈。或问用地浆者。何也。曰。坤属土。土平曰静顺。感至
阴之气。又于墙阴贮新汲水。以收重阴之气。阴中之阴。能泻诸阳中之阳。霍乱由暑热内伤
所得。故用地浆而愈。
震按此案重在所伤之物已出。故其用药全不以多食酒肉过饮潼乳为治也。
汪石山治一人。年三十余。形瘦弱。忽病上吐下泻。水浆不入口者七日。自分死矣。汪
诊脉八至。曰。当夏而得是脉。暑邪深入也。用人参白虎汤进一杯。稍安。后减去知母、石
膏。加人参至四五钱。以黄柏、陈皮、麦冬等。随所兼病而佐使。一月平复。
江篁南治一人。于七月间得霍乱证。吐泻转筋。足冷多汗。囊缩。医以伤寒治之。增剧
江诊之。左右寸关皆伏不应。尺极微。口渴欲饮冷水。乃以五苓散与之。觉稍定。向午犹
渴。以五苓加麦冬、五味、滑石投之。更以黄连香薷饮。冷进一服。次早脉稍出。按之无根
形脱。且呃。手足厥逆。饮食不入。入则吐。大便稍不禁。为灸丹田八九壮。囊缩稍舒。手
足稍温。继以理中汤。渴犹甚。咽疼热不解。时或昏沉。饮以竹叶石膏汤而愈。
江应宿治一妇人。六月中旬。病霍乱吐泻转筋。医投霍香正气散。加烦躁面赤。揭衣卧
地。江诊之。脉虚无力。身热引饮。此得之伤暑。宜辛甘大寒之剂泻其火热。以五苓散。加
石膏、滑石。吐泻定。再与桂苓甘露饮而愈。
震按霍乱乃最轻之病。何以仲景于伤寒后列为一门。岂北五省之霍乱重于江浙耶。就江
浙论。则霍乱因暑湿者多。香薷饮加苓、半、霍香、苍术、木瓜等即效。黄连、石膏不可轻
用。人参尤不可轻用。石山篁南二案。不得不用人参。然汪案纯是寒证。一用理中。即热渴
咽疼。可知暑月难投温补也。若冬月霍乱。固有因寒者。香薷又在所戒。予生平于盛暑时。
曾以真武汤治霍乱。其人吐泻腹痛。四肢冷。脉微细。恶寒不渴。故敢用之。取效甚速。亦
未尝用人参也。
Luo Qianfu treated a patient who was nearly eighty years old. In the sixth month, he suffered from heatstroke-induced Huoluan (acute gastroenteritis with vomiting and diarrhea), presenting with vomiting, diarrhea, and coma, remaining unconscious throughout the day. It was midnight when Luo Qianfu was summoned for treatment. The pulse was rapid, beating seven to eight times per breath, large (Hong) and forceful; the head felt hot as fire, while the feet were cold as ice; there was hemiplegia and lockjaw. This was due to the patient's advanced age and weak constitution, coinciding with the peak of summer heat and the dominance of the Yangming channel, clearly indicating heatstroke. He prescribed Guiling Ganlu Yin (Cassia Twig, Poria and Talcum Decoction), which is sweet, acrid, and greatly cold in nature, designed to drain heat and tonify Qi. Fuling (Poria) was added to separate Yin and Yang, with an approximate dosage of one tael. The medicine was mixed with water and administered via gavage. The patient gradually regained consciousness, and after three days, all symptoms disappeared. Subsequently, Renshen Buzhong Tang (Ginseng and Spleen-Regulating Decoction) was used with modifications based on clinical judgment. After ten days, the patient recovered.
He also treated Xilianghai, a Mongolian Hundred-Household Commander, in the spring of the Wuwu year. Upon returning from the siege of Xiangyang, he stayed in the Caozhou region. Due to consuming alcohol, meat, and drinking large amounts of Camel Milk (Tongru), he developed Huoluan with vomiting and diarrhea. From morning until noon, his spirit was confused and he was in critical distress. Luo Qianfu examined him and found the pulse floating and rapid but empty upon deep pressure, indicating that the offending food had already been expelled. He immediately prepared Xinji Shui (freshly drawn water) to mix with Guiling Baizhu San (Cassia Twig, Atractylodes Macrocephala and Poria Decoction), administering it slowly. The patient felt slightly relieved. Then, Luo dug a pit about two chi deep in the shady wall area, filled it with fresh water, stirred it, and waited for one shichen (two hours). Once the water settled, he took one cup of the clear supernatant liquid to administer again. The vomiting and diarrhea gradually stopped, and he slept peacefully at night. The next day, he experienced slight irritability and thirst, so Qianshi Baizhu San (Qian's Atractylodes Macrocephala Decoction) was decocted and taken frequently, leading to recovery. When asked why Earth Slurry (Dijiang) was used, Luo replied: Kun represents Earth, whose nature is peaceful and yielding. By sensing the extreme Yin Qi and storing fresh water in the shady wall, one gathers heavy Yin Qi. Yin within Yin can drain the Yang within Yang. Since Huoluan results from internal injury by summer heat, using Earth Slurry led to cure.
Yu Zhen commented: The key point of this case is that the offending food has already been expelled; therefore, the medication did not target the overconsumption of wine, meat, or camel milk.
Wang Shishan treated a patient in his thirties, who was thin and weak. Suddenly, he suffered from upper vomiting and lower diarrhea, unable to take any food or fluids for seven days, believing he would die. Wang Shishan diagnosed the pulse as beating eight times per breath and stated: "In summer, such a pulse indicates deep penetration of Summerheat pathogen." He administered Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction), one cup, after which the patient felt slightly better. Later, Zhimu (Anemarrhena Rhizome) and Shigao (Gypsum Fibrosum) were removed, and the dosage of Renshen (Ginseng Root) was increased to four or five qian. Huangbai (Phellodendron Bark), Chenpi (Citrus Reticulatae Pericarpium), and Maidong (Ophiopogon Tuber) were added as assistants according to accompanying conditions. The patient recovered after one month.
Jiang Huangnan treated a patient who contracted Huoluan in July, presenting with vomiting, diarrhea, muscle cramps (Zhuanjin), cold feet, excessive sweating, and retraction of the scrotum. The physician treated it as Shanghan (Cold Damage), causing the condition to worsen. Jiang Huangnan diagnosed the Cun and Guan positions on both sides as hidden and unresponsive, while the Chi position was extremely faint. The patient had thirst and desired cold water. He prescribed Wu Ling San (Poria, Achyranthes Bidentata, Paeonia Lactiflora, Polygalae Radix and Atractylodes Macrocephala Decoction). The patient felt somewhat stabilized. By midday, thirst persisted, so Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Fruit), and Huashi (Talcum) were added to Wu Ling San. Additionally, Huanglian Xiangru Yin (Coptis Chinensis and Elsholtzia splendens Decoction) was administered cold. The next morning, the pulse emerged slightly but was rootless upon palpation. The body showed signs of collapse, accompanied by hiccups, cold hands and feet, inability to eat, vomiting upon intake, and slight loss of bowel control. Jiudandan (Moxibustion on Dantian) was performed for nine moxa cones. The scrotal retraction relaxed slightly, and hands and feet became warm. Subsequently, Lizhong Tang (Gastrointestinal Regulating Decoction) was used. However, thirst remained severe, throat pain persisted, fever did not subside, and occasional drowsiness occurred. Finally, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) was administered, leading to recovery.
Jiang Yingsu treated a woman in mid-June suffering from Huoluan with vomiting, diarrhea, and muscle cramps. The physician prescribed Huoxiang Zhengqi San (Agastache Rugosa and Perillae Decoction), which aggravated her condition, causing irritability, red face, and a desire to throw off clothes and lie on the ground. Jiang Yingsu diagnosed a deficient and powerless pulse, body heat, and intense thirst, identifying it as Summerheat injury. He recommended sweet and acrid, greatly cold agents to drain fire and heat. He used Wu Ling San plus Shigao (Gypsum Fibrosum) and Huashi (Talcum). Vomiting and diarrhea ceased. He then prescribed Guiling Ganlu Yin (Cassia Twig, Poria and Talcum Decoction), resulting in recovery.
Yu Zhen commented: Huoluan is actually a mild disease. Why did Zhang Zhongjing list it as a separate chapter in Shanghan Lun? Is Huoluan more severe in the Five Northern Provinces than in Jiangzhe? Regarding Jiangzhe, Huoluan is mostly caused by Summerheat-Dampness. Xiangru Yin (Elsholtzia splendens Decoction) added with Fuling (Poria), Banxia (Pinelliae Rhizoma), Huoxiang (Agasteghae Herba), Cangzhu (Atractylodis Rhizoma), and Mugua (Chaenomelis Fructus) is effective. Huanglian (Coptidis Rhizoma) and Shigao (Gypsum Fibrosum) should not be used lightly, nor should Renshen (Ginseng Root). In the cases of Wang Shishan and Jiang Huangnan, the use of Renshen was unavoidable. However, Wang's case was purely cold; once Lizhong Tang (Gastrointestinal Regulating Decoction) was used, heat, thirst, and throat pain appeared, demonstrating that warming and tonifying methods are difficult to apply in summer. If winter Huoluan is indeed caused by cold, Xiangru Yin is contraindicated. In my lifetime, during intense summer heat, I once used Zhenwu Tang (True Warrior Decoction) to treat Huoluan. The patient presented with vomiting, diarrhea, abdominal pain, cold limbs, faint and fine pulse, aversion to cold, and no thirst. Thus, I dared to use it, achieving rapid effect, without using Renshen (Ginseng Root).