呕吐而下利者，霍乱也。原疾之由，皆因肠胃虚冷，饮食过度，触冒风冷，使阴阳不和，
清浊相干，致令
挥霍变乱也。或先心痛而吐者，或先腹痛而利者，或吐利俱作者，或头痛、身体壮热而脉浮洪
者，或阳气暴绝而手足逆冷而脉息微绝者。治之当分阴阳，察虚实，辨其冷热，观其脉息，
热者凉之，冷者温之，以平为期。
《百问》云∶凡霍乱吐利，热多而渴者，五苓散。寒多不饮水者，理中丸。吐利已，
汗出而厥，四肢拘急不解，脉微欲绝者，通脉四逆加猪胆汁汤。
夏月中暑霍乱，大烦渴，四肢逆冷，冷汗出，脚转筋者，香茹散浓煎，沉冷服即效。
凡霍乱之脉浮洪者易治；微而迟，并气短者难治。
（《局方》）香薷散 治中暑、霍乱，先因脏腑不调，饮食不节，或食腥 、生冷过度；
或起居不节；或露卧湿地；或当风取凉，致令脾胃不和，邪气相干，便致吐利。心酸疼痛，
虚烦转筋拘急，四肢逆冷，脉微欲绝，或烦闷昏塞欲死者，及妊妇霍乱吐利者，此药悉能主之。
香薷叶（四钱） 白扁豆（炒） 浓朴（制。各二钱）
上水二盏，煎一盏。井中浸冰冷，无时顿服，连并三服，神效。一方有黄连。
（《千金》）四顺汤 治霍乱吐利，腹痛，手足逆冷，脉微欲绝。（方见本门。）
理中丸 治前证。（方见本门。）
胡椒散 治霍乱吐利甚妙。
胡椒（四十九粒） 绿豆（一百四十七粒）
为细末，木瓜煎汤，调下二钱。
Vomiting accompanied by diarrhea is termed Huoluan (Huo Luan, Cholera-like Syndrome). The origin of this disease lies in the deficiency-cold of the stomach and intestines, excessive food intake, and exposure to wind-cold, which causes disharmony between Yin and Yang. The clear and turbid Qi interfere with each other, resulting in sudden chaotic turmoil. Some cases present with heart pain preceding vomiting; some with abdominal pain preceding diarrhea; some with simultaneous vomiting and diarrhea; some with headache, high fever, and a floating-hong (floating and full) pulse; and some with sudden collapse of Yang Qi, cold extremities, and a faint pulse nearly imperceptible. Treatment should differentiate Yin and Yang, examine deficiency and excess, distinguish cold and heat, and observe the pulse. Heat patterns are treated with cooling methods, while cold patterns are treated with warming methods, aiming for balance as the goal of cure.
The *Baiwen* states: For all Huoluan with vomiting and diarrhea, if heat signs predominate with thirst, use Wuling San (Five-Ling Powder). If cold signs predominate without desire to drink, use Lizhong Wan (Regulate the Middle Pill). After vomiting and diarrhea cease, if sweating occurs with cold extremities, limb stiffness and spasm persist, and the pulse is faint and nearly absent, use Tongmai Sini Jia Zhuhuang Dan Decoction (Pulse-Reviving Four Reversals with Pig Bile Decoction).
For summerheat-induced Huoluan characterized by extreme restlessness and thirst, cold extremities, cold sweat, and calf muscle spasms, Xiangru San (Mosla Powder) should be decocted strongly, cooled, and taken at once for immediate effect.
Generally, Huoluan with a floating-hong pulse is easy to treat; Huoluan with a faint, slow pulse accompanied by shortness of breath is difficult to treat.
*Xiangru San* from the *Ju Fang*: Treats summerheat and Huoluan caused initially by internal organ dysfunction and irregular diet, or excessive consumption of fishy, pungent, raw, or cold foods; or irregular daily routine; or sleeping exposed on damp ground; or seeking coolness by facing the wind. These factors lead to spleen-stomach disharmony and interference by pathogenic Qi, causing vomiting and diarrhea. It treats acid pain in the chest, mental restlessness, muscle spasms and stiffness, cold extremities, faint pulse, severe oppression and stupor approaching death, as well as Huoluan with vomiting and diarrhea in pregnant women.
Xiangru Ye (Moslae Herba, 4 qian), Baibian Dou (Faba Seed, stir-fried), Houpo (Magnolia Bark, processed). Each 2 qian.
Decoct these in two cups of water until one cup remains. Immerse in well water to cool thoroughly. Take all at once at any time. Administer three doses consecutively for miraculous efficacy. Another version includes Huanglian (Coptidis Rhizoma).
*Sishun Tang* from *Qianjin Fang*: Treats Huoluan with vomiting and diarrhea, abdominal pain, cold extremities, and faint pulse. (Formula see this section.)
*Lizhong Wan*: Treats the aforementioned syndrome. (Formula see this section.)
*Hujiao San*: Highly effective for treating Huoluan with vomiting and diarrhea.
Hujiao (Piperis Fructus, 49 grains), Lvdou (Phaseoli Semen Mungo, 147 grains).
Grind into fine powder. Mix with decoction of Mugua (Chaenomelis Fructus) and take 2 qian with it.