脉
代者霍乱；代而绝者，亦霍乱。又关脉滑，为霍乱吐泻。气口脉弦滑，膈间有宿食留饮。宜顺其性，
以盐汤探之。脉结促大，皆不可断以死脉。洪大则易治，脉微细，气少不语，舌卷囊缩者；皆不治也。
滑而不匀，必是吐泻霍乱之候，脉大勿讶。
证
夫霍乱者，挥霍变乱也。盖因内有所积，外有所伤，阳不升，阴不降，乖膈而成。故心腹卒痛，呕
吐下痢，发热恶寒，头痛眩晕，或泻而不吐，或吐而不泻。先心痛，则先吐；先腹痛，则先利；心
腹齐痛，吐利并作。甚则转筋入腹，四肢厥冷而毙。
治
急用蓼汤泡洗，艾灸脐中。盖阴阳反戾，清浊相干，治之惟宜
藿香正气散，加生姜为上。不惟可以温散风寒，抑亦可以调理脾胃。如身热口渴者，则以薷苓汤加减治之。
霍乱之后，不可早与饮
食，恐胃中邪物，吐泻未尽，其新谷入胃，不能传化，必致不救。吐候吐泻过一、二时，饥甚，方与稀
粥少食，以渐而将息可也。其有不吐不泻者，名干霍乱，急以盐汤多灌，引其大吐，令宿食殆
尽，随证用药调之。既愈之后，若烦热多渴者，以麦门冬汤主之。
一霍乱转筋，用大蓼一把，煎汤荡洗。北人以麦糠代之。使腠理开泄，阳气散则愈也。河间云∶热
气燥烁于筋，则挛 而痛也。
一霍乱已死，而腹中尚有暖气者，以盐纳脐中，以艾灸莫计其数。
一霍乱心腹卒痛，炒盐二碗，绢包顿于胸上，并腹肚再以熨斗火熨，气
透则苏。续以炒盐绢包乘热烙其背，则万无一失也。
方
藿香正气散 治四时不正之气，寒温时疫，山岚瘴气，雨湿熏蒸；或中寒腹痛吐利，中暑冒风，中湿
身重泄泻；或不服水土，脾胃不和；或饮食停滞，复感外邪，头痛发热，战栗恶寒，或呕吐恶
心，膈膈满闷，一切气逆不安之症，并能调治。
藿香（二钱） 紫苏（一钱五分） 陈皮（一钱） 浓朴（姜制，一钱） 半夏（姜制，一
钱） 白术（一钱，炒） 茯苓（一钱） 大腹皮（一钱） 桔梗（一钱） 白芷（一钱） 甘草（炙，一钱）
上锉一剂，生姜三片，枣二枚，水煎热服。霍乱转筋，加木瓜。腹痛，加炒白芍药；寒痛，加桂；冷甚，
加干姜。饮食不化，加香附、砂仁；米谷不消，加神曲、麦芽。心下痞满，加桔梗、枳壳、枳实。肉食不化，
加山楂。湿面停积，加萝卜子。中暑冒风，加香藿、白扁豆。时气憎寒发热，加柴胡、干葛。
口干，加麦门冬。小便不利，合五苓散。湿相搏，霍乱转
筋，烦渴闷乱，合黄连香薷饮。心腹绞痛，加木香。若频欲登圊，不通利者，加槟榔、枳壳。按霍乱之疾，
未有不由内伤生冷，外感风寒而致也。余用藿香正气散治之，百发百中。一岁之内，常治百人，未有不效者。
但有热者，须加姜炒黄连；寒甚，加干姜；万无一失。又腹痛者，加桂；痛甚者，去藿香，加吴茱萸；小便不
利，加茯苓；如干霍乱，加枳壳，茯苓、肉桂，最佳。
加减薷苓汤〔批〕（按此方治霍乱属热者宜之） 治霍乱身热口渴，此热暑中也。
猪苓（七分） 泽泻（七分） 白术（五分） 赤茯苓（一钱） 黄连（五分） 香薷（一钱）
干葛（七分） 天花粉（一钱） 甘草（五分） 扁豆（十四粒）
上锉一剂，生姜煎服。如热极，加石膏、知母。泄泻，加升麻、黄芩、滑石。腹痛，加炒白芍药、桂。
理中丸〔批〕（按此方治霍乱属虚寒者宜之） 治转筋霍乱，上吐下利，心
腹疼痛，及干霍乱，俗名绞肠沙，并真阴证，手足厥冷。嘉靖甲子年间，梁宋之地，人多患此，自脚
心麻至膝，死者不计其数。时大方赵公出示此方，患者咸蒙其惠，因述以广其传。
人参（一钱） 干姜（炒，一钱） 茯苓（一钱） 甘草（炙，一钱）
上为末，炼蜜为丸，每丸重一钱。取一丸细嚼，淡姜汤送下。
忌食米汤，此即理中汤改为丸，取土能塞水之义。若仍煎汤，则不效矣。
阴阳汤 治霍乱吐利腹痛，服药即吐，无法可施，用百沸活河水，及冷井泉水各半碗，合而服之。
百沸汤 治霍乱吐泻，因饮冷或冒寒，或失饥，或大怒，或乘
舟车，伤动冒气，令人吐利交作，目眩头旋，手足转筋，四肢厥冷，用药迟缓，须臾不救。
吴茱萸 木瓜 食盐（各五钱）
上三味同炒焦，用百沸汤煎，随病患服之。
干霍乱者，俗名绞肠沙。其症因宿食不消，心腹绞痛，欲吐不吐，欲泻不泻，挥霍撩乱，所伤之物不得
出泄故也。死在顷刻，急宜多灌盐汤探吐之。令物出尽，却服理中汤，更刺十井出血，并委中出血。
盐姜汤 治干霍乱欲吐不吐，欲泻不泻垂毙者。
盐（一两） 生姜（切，五钱）
上二味，同炒色变，以童子溺二盏，煎一盏，温服。
麦门冬汤 治霍乱愈后，烦热多渴，小便不利。
人参（一钱） 白术（炒，一钱） 茯苓（八分） 陈皮（八分） 半夏（制，八分） 小
麦（一百粒） 麦冬（去心，二钱） 甘草（七分）
上乌梅三个，生姜三片，水二钟，煎八分，食远服。
Pulse Diagnosis
The presence of a Dai pulse (a pulse with regular intermittent pauses) indicates Huoluan (cholera-like syndrome); if the Dai pulse is accompanied by a faint and nearly imperceptible beat, it also signifies Huoluan. Furthermore, a slippery pulse at the Guan position (middle position on the radial artery) suggests vomiting and diarrhea associated with Huoluan. A wiry and slippery pulse at the Qikou position (cun position on the radial artery) indicates retained food and phlegm-fluid in the chest and diaphragm. Treatment should follow the nature of the pathogen by using salt water to induce vomiting and expel the pathogen. Pulses presenting as Jie (knotted), Cu (hasty), or large are not necessarily fatal pulses. A Hongda (surging and large) pulse is easy to treat; however, a Weixi (fine and minute) pulse accompanied by shortness of breath, inability to speak, tongue retraction, and testicular retraction indicates an untreatable condition. A slippery but irregular pulse is definitely a sign of Huoluan with vomiting and diarrhea; do not be alarmed by a large pulse in this context.
Symptoms
Huoluan refers to a sudden onset of disorder. It arises from internal accumulation and external injury, causing Yang Qi to fail to ascend and Yin Qi to fail to descend, resulting in a disruption of the interaction between Yin and Yang. Consequently, there is sudden pain in the heart and abdomen, vomiting and dysentery, fever and aversion to cold, headache and dizziness. There may be diarrhea without vomiting, or vomiting without diarrhea. If heart pain precedes, vomiting occurs first; if abdominal pain precedes, diarrhea occurs first; if both heart and abdomen hurt simultaneously, vomiting and diarrhea occur together. In severe cases, muscle spasms (Zhuanjin) may extend into the abdomen, leading to cold limbs and death.
Treatment
Urgently wash with Polygonum persicarium (Liao) decoction and moxibustion on the umbilicus. This is because Yin and Yang are inverted, and clear and turbid Qi interfere with each other. The appropriate treatment is Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi), preferably with added fresh ginger. This not only warms and disperses wind-cold but also regulates the Spleen and Stomach. For those with body heat and thirst, use Shenling Tang (Artemisia and Poria Decoction) with modifications.
After suffering from Huoluan, one should not eat early, lest the pathogenic factors in the stomach have not been fully expelled through vomiting and diarrhea. If new food enters the stomach before transformation and transportation are restored, it will inevitably lead to untreatable deterioration. Only after vomiting and diarrhea have ceased for one or two shichen (2-4 hours), and when extreme hunger sets in, should one consume a small amount of thin rice gruel, gradually resuming normal diet. Cases without vomiting or diarrhea are called Gan Huoluan (Dry Cholera). Urgently administer large amounts of salt water to induce vigorous vomiting, ensuring the retention of food is completely expelled, then medicate according to symptoms. After recovery, if restlessness, heat, and excessive thirst persist, Mai Men Dong Tang (Ophiopogon Decoction) is the primary formula.
For Huoluan with muscle spasms, boil a handful of Polygonum persicarium (Da Liao) and wash the affected area. People in the North substitute wheat bran. This opens the interstices (Couli), allowing Yang Qi to disperse, leading to recovery. Hejian stated: "When hot-dryness scorches the sinews, they contract and cause pain."
If a patient has died from Huoluan but warmth remains in the abdomen, place salt in the umbilicus and apply moxibustion without limiting the number of applications.
For sudden heart and abdominal pain due to Huoluan, wrap two bowls of fried salt in silk cloth, place them on the chest and abdomen, and apply heat with a warming iron until the qi penetrates and consciousness returns. Then, continue applying hot fried salt wrapped in silk to the back for safety.
Formulas
Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) treats abnormal Qi of the four seasons, epidemic cold-warmth diseases, mountain miasma, and damp-heat steaming; or abdominal pain with vomiting and diarrhea due to cold invasion; stroke from summerheat and wind; heaviness and diarrhea due to dampness; disharmony of Spleen and Stomach due to unfamiliar environment; food stagnation compounded by external pathogens; headache, fever, chills, nausea, chest fullness, and all symptoms of rebellious Qi.
Ingredients: Huoxiang (Agastache Herba, 2 qian), Zisu (Perilla Folium, 1.5 qian), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Houpo (Magnoliae Officinalis Cortex, processed with ginger, 1 qian), Banxia (Pinelliae Rhizoma, processed with ginger, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 1 qian), Fuling (Poria, 1 qian), Dafupi (Arecae Pericarpium, 1 qian), Jiegeng (Platycodonis Radix, 1 qian), Baizhi (Angelicae Dahuricae Radix, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 qian).
Crush these ingredients for one dose, add three slices of fresh ginger and two dates, decoct in water, and take warm. For Huoluan with muscle spasms, add Mugua (Chaenomelis Fructus). For abdominal pain, add Chao Baishao (Stir-fried Paeoniae Radix Alba). For cold pain, add Guizhi (Cinnamomi Ramulus). For severe cold, add Ganjiang (Zingiberis Rhizoma). For indigestion, add Xiangfu (Cyperi Rhizoma) and Sharen (Amomi Fructus). For undigested grains, add Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus). For epigastric fullness, add Jiegeng, Zhike (Aurantii Fructus Immaturus), and Zhishi (Aurantii Fructus). For undigested meat, add Shanzha (Crataegi Fructus). For stagnant damp noodles, add Luobozhongzi (Raphani Semen). For summerheat-stroke with wind, add Xianghuo and Bai Biandou (Dolichos Lablab Seed). For epidemic chills and fever, add Chaihu (Bupleuri Radix) and Genge (Puerariae Radix). For dry mouth, add Maidong (Ophiopogonis Radix). For difficult urination, combine with Wuling San (Five-Ingredient Poria Powder). For dampness clashing with Huoluan and spasms, restlessness, and thirst, combine with Huanglian Xiangru Yin (Coptis and Mosla Decoction). For severe heart/abdominal colic, add Muxiang (Aucklandiae Radix). For frequent urge to defecate without relief, add Binglang (Arecae Semen) and Zhike. Note: Huoluan is invariably caused by internal injury from raw/cold foods and external contraction of wind-cold. I have treated hundreds of cases with Huoxiang Zhengqi San with 100% efficacy. However, if heat signs are present, add Jiangchao Huanglian (Ginger-fried Coptidis Rhizoma); for severe cold, add Ganjiang. For abdominal pain, add Guizhi; for severe pain, remove Huoxiang and add Wuzhuyu (Evodiae Fructus); for difficult urination, add Fuling. For Dry Huoluan, add Zhike, Fuling, and Rougui (Cinnamomi Cortex), which is optimal.
Jiajian Shenling Tang (Modified Artemisia and Poria Decoction) [Commentary: Suitable for Huoluan of the Heat type] treats Huoluan with body heat and thirst, caused by summerheat.
Ingredients: Zhuling (Polypori Umbilicati Sclerotium, 7 fen), Zexie (Alismatis Rhizoma, 7 fen), Baizhu (Atractylodis Macrocephalae Rhizoma, 5 fen), Chi Fuling (Red Poria, 1 qian), Huanglian (Coptidis Rhizoma, 5 fen), Xiangru (Moslae Herba, 1 qian), Genge (Puerariae Radix, 7 fen), Tianhuafen (Trichosanthis Radix, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 5 fen), Biandou (Dolichos Lablab Seed, 14 seeds).
Crush for one dose, decoct with fresh ginger. If heat is extreme, add Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma). For diarrhea, add Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix), and Huashi (Talcum). For abdominal pain, add Chao Baishao and Guizhi.
Lizhong Wan (Regulate the Middle Pill) [Commentary: Suitable for Huoluan of the Deficiency-Cold type] treats Huoluan with spasms, vomiting and diarrhea, heart/abdominal pain, Dry Huoluan (colloquially known as Jiaochangsha/intestinal twisting sand), and True Yin Syndrome with cold limbs. During the Jiazi year of the Jiajing era, many in the Liang-Song region suffered from this, with numbness spreading from the soles to the knees, causing countless deaths. Physician Zhao presented this formula, saving many lives; thus, it is recorded for dissemination.
Ingredients: Renshen (Ginseng Radix et Rhizoma, 1 qian), Ganjiang (Zingiberis Rhizoma, stir-fried, 1 qian), Fuling (Poria, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 qian).
Grind into powder, form pills with refined honey, each pill weighing 1 qian. Chew one pill thoroughly and swallow with light ginger soup.
Avoid rice soup; this is Lizhong Tang converted to pills, utilizing the principle that Earth controls Water. If decocted as a liquid, it loses efficacy.
Yinyang Tang (Yin-Yang Decoction) treats Huoluan with vomiting, diarrhea, and abdominal pain where medication is immediately vomited up. Use boiling living river water and cold well water, half bowl each, mixed and taken.
Baifei Tang (Boiling Decoction) treats Huoluan vomiting and diarrhea caused by drinking cold liquids, exposure to cold, starvation, anger, or travel sickness, leading to simultaneous vomiting and diarrhea, dizziness, limb spasms, and cold extremities. Delayed treatment can be fatal within moments.
Ingredients: Wuzhuyu (Evodiae Fructus, 5 qian), Mugua (Chaenomelis Fructus, 5 qian), Yanshi (Halitum, 5 qian).
Stir-fry the three ingredients until scorched, decoct in Baifei Tang, and administer to the patient.
Gan Huoluan (Dry Huoluan), colloquially known as Jiaochangsha, is caused by undigested food leading to severe abdominal colic, inability to vomit or defecate, and chaotic distress. Death occurs instantly. Urgently灌 (irrigate/administer) large amounts of salt water to induce vomiting. Once the pathogen is expelled, administer Lizhong Tang, and prick the Ten Jing-Well points and Weizhong (BL40) to bleed.
Yanjiang Tang (Salt and Ginger Decoction) treats Dry Huoluan with impending death, characterized by inability to vomit or defecate.
Ingredients: Yan (Halitum, 1 liang), Shengjiang (Zingiberis Rhizoma Recens, sliced, 5 qian).
Stir-fry until color changes, decoct in two cups of child's urine (Tongzi Niao) to yield one cup, and take warm.
Mai Men Dong Tang (Ophiopogon Decoction) treats post-Huoluan restlessness, heat, excessive thirst, and difficult urination.
Ingredients: Renshen (Ginseng Radix et Rhizoma, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 1 qian), Fuling (Poria, 8 fen), Chenpi (Citri Reticulatae Pericarpium, 8 fen), Banxia (Pinelliae Rhizoma, processed, 8 fen), Xiaomai (Tritici Fructus, 100 grains), Maidong (Ophiopogonis Radix, core removed, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 7 fen).
Add three dark plums (Wumei) and three slices of fresh ginger. Decoct in two zhong of water to yield 0.8 zhong. Take far from meals.