总括 病患霍乱事堪惊，吐利交并又转筋；心腹痛疼时眩晕，宜分干湿审三因。
脉法 脉来浮洪者可治，微而迟者难生。
《内经》曰∶太阴所至为中满，霍乱吐下有土郁之发，民病呕吐霍乱注下（湿土霍乱即仲景五苓散、理中汤之类）。
有水土不及，风乃大行，民病霍乱飧泻。体重腹痛筋骨强并（土虚风胜霍乱，即罗谨甫桂苓散、白术散之类）。有热至
则身热霍乱吐下（热霍乱即《活人书》香薷饮之类）。
仲景曰∶邪在上焦则吐，在下焦则泻，邪在中焦则既吐且泻。夫小儿霍乱之候，皆因饮食内有所伤，外有所感，阳
不升，阴不降，乘膈而成，故卒然吐泻并作，挥霍撩乱矣。为病之源有三∶吐者 也，心火炎上之疾也；泻者湿也，湿
土注下之疾也；转筋者风也，木火挠乱之疾也。由夏秋之间，湿热大作，风凉乘之，入于脾胃。三气俱作所以上吐下泻
而转筋也。治法以生姜细切，渍以新汲水，调益元散顿服之可愈，或五苓散、桂苓甘露饮。切勿与谷食米饮，如饮下咽
立死。待泻后饥甚可与稀粥。
霍乱亦有病症不同，有心腹卒痛、吐利寒热、头痛眩晕，先心痛则先吐，先腹痛则先利，心腹并痛则吐利俱作，甚
则转筋入腹则毙。盖阴阳反戾，清浊相干，阳气暴升，阴气顿坠，阴阳痞膈，上下奔趋。治之惟宜温暖，更详其所因而
调之。因风则恶风有汗，因寒则恶寒无汗；湿则重着；暑则热烦，此外因所致。元气不足，郁聚痰饮，痞膈满闷，随其
肠泻而作，此内因所致。其或饱餐恣饮填胀停凝而发，此非内外因也。
小儿夏日多食生冷，因脾虚不能运化，加以外感风寒，则挥霍撩乱，上吐下泻也，令人仓卒，躁扰痛闷，似有鬼神，
然实非鬼神，乃饮食痞膈，上下不通，将欲吐泻，故如是也。（批∶霍乱死者胸中尚有暖气，急以盐填脐内，灸之不计
壮数，此法灸之立苏。）
钱仲阳谓吐乳泻黄是伤热乳，吐乳泻青是伤冷乳，皆当下之。详夫此理，乃迎夺之法也。不若伤热者用五苓散以导
其逆，伤冷者用理中汤以温其中，自然平复。（批∶干霍乱吐、泻不通，最为难治，用软鸡翎蘸清油探喉中即吐，或盐
汤白矾汤灌之亦可。）
《经》云∶湿霍乱死者少，干霍乱死者多。夫干霍乱者，忽然心腹胀满，胸胁刺痛，欲吐不吐，欲利不利，是俗谓
之绞肠痧，最难治，死在须臾，升降不通故也。治法先疏利，或吐提其气，最是良法。更宜刺委中并十指出血妙，委中
在足膝腕内约纹中动脉便是。
〔附方〕
益元散（即天水散加朱砂） 滑石（六两） 甘草（一两） 朱砂
桂苓甘露饮 即五苓散加滑石 甘草 寒水石 白汤调服。
桂苓白术散 即甘露饮加滑石。
玉露散 治口渴身热大小便不利。
寒水石（二两） 石膏（二两） 甘草（三钱）
为细末飞过，麦冬汤下。
香薷饮 见诸吐症内。
丹溪方
苍术 浓朴 陈皮 干姜（各一钱半） 滑石（三钱） 白术（二钱） 木通（一钱） 炙甘草 姜
煎服。
General Overview: The symptoms of Huoluan (cholera-like syndrome with sudden vomiting and diarrhea) in patients are alarming, characterized by simultaneous vomiting and diarrhea accompanied by muscle spasms; epigastric and abdominal pain often occurs with dizziness. Treatment requires distinguishing between wet Huoluan and dry Huoluan, and examining the etiology regarding the three causes (wind, cold, dampness).
Pulse Diagnosis: A floating and surging pulse indicates a treatable condition, whereas a faint and slow pulse suggests a difficult prognosis.
The *Neijing* states: "When Taiyin [Spleen] is affected, it leads to fullness in the center; Huoluan with vomiting and downward discharge is the manifestation of Earth Qi stagnation. People suffer from vomiting, Huoluan, and profuse diarrhea (This type of Damp-Earth Huoluan can be treated with formulas such as Wuling San or Lizhong Tang from Zhang Zhongjing). If Earth and Water Qi are insufficient, Wind Qi prevails, causing people to suffer from Huoluan and undigested stool diarrhea, heavy body, abdominal pain, and stiffness of bones and sinews (This type of Huoluan due to Earth deficiency and Wind excess can be treated with formulas such as Guiling San or Baizhu San by Luo Jinpu). If Heat Qi arrives, the body becomes hot with Huoluan vomiting and diarrhea (This type of Hot Huoluan can be treated with Xiangru Yin from Zhu Gong's *Ren Shu*).
Zhang Zhongjing said: "Pathogenic factors in the Upper Jiao cause vomiting, those in the Lower Jiao cause diarrhea, and those in the Middle Jiao cause both vomiting and diarrhea." The syndrome of pediatric Huoluan arises from internal injury due to diet and external contraction of pathogens, leading to failure of Yang Qi to ascend and Yin Qi to descend. Pathogens obstruct the Diaphragm, causing sudden onset of vomiting and diarrhea, chaotic and turbulent. There are three sources of disease: Vomiting is a disease caused by Heart Fire flaming upward; Diarrhea is a disease caused by Damp-Earth flowing downward; Muscle spasms are a disease caused by Wind disturbing. During summer and autumn, Damp-Heat flourishes, and Cool-Wind takes advantage of this to enter the Spleen and Stomach. The combination of these three pathogens causes upper vomiting, lower diarrhea, and muscle spasms. The treatment method involves finely chopping fresh ginger, soaking it in newly drawn water, and administering Yiyuan San orally at once for recovery, or using Wuling San or Guiling Ganlu Yin. Do not give grain food or rice water; if ingested, death will occur immediately. After diarrhea stops, if the child is very hungry, thin porridge may be given.
Huoluan also presents with different symptoms: sudden heart and abdominal pain, vomiting and diarrhea with chills and fever, headache, and dizziness. If heart pain precedes, vomiting occurs first; if abdominal pain precedes, diarrhea occurs first; if both heart and abdomen hurt, vomiting and diarrhea occur simultaneously. In severe cases, spasms entering the abdomen lead to death. This is due to reversal of Yin and Yang, interference between clear and turbid Qi, sudden rise of Yang Qi, and sudden fall of Yin Qi, resulting in Yin-Yang obstruction at the diaphragm and rushing of Qi up and down. Treatment should focus on warming and regulating based on the specific cause. Caused by Wind: aversion to wind with sweating; Caused by Cold: aversion to cold without sweating; Caused by Dampness: heaviness; Caused by Summerheat: heat and restlessness. These are due to external causes. Insufficient Yuan Qi, accumulation of phlegm-fluids, obstruction and fullness, occurring with intestinal disorders, are due to internal causes. Alternatively, overeating and excessive drinking causing distension and stagnation are neither internal nor external causes.
Children eating too much raw and cold food in summer, combined with Spleen deficiency failing to transform and transport, plus external contraction of Wind-Cold, leads to chaotic vomiting and diarrhea, causing panic, restlessness, pain, and distress, resembling possession by spirits, but actually it is dietary stagnation and obstruction preventing upper and lower flow, attempting to vomit or defecate but unable to do so. (Commentary: For those who died of Huoluan, warmth remains in the chest. Immediately fill the umbilicus with salt and moxa-burn it, regardless of the number of cones. This method brings immediate revival.)
Qian Zhongyang stated: Vomiting milk with yellow stool indicates injury from hot milk; vomiting milk with green stool indicates injury from cold milk. Both should be treated with purgatives. Upon careful consideration, this is a method of attacking and seizing. It is better to use Wuling San to guide the rebellious Qi downward for heat injury, and Lizhong Tang to warm the Middle Jiao for cold injury, allowing natural recovery. (Commentary: Dry Huoluan with inability to vomit or defecate is most difficult to treat. Use a soft chicken feather dipped in clear oil to probe the throat to induce vomiting, or administer salt water or alum water.)
The *Classic* says: Few die from Wet Huoluan, many die from Dry Huoluan. Dry Huoluan is characterized by sudden abdominal distension and fullness, stabbing pain in the chest and hypochondrium, desire to vomit but cannot, desire to defecate but cannot. This is commonly known as Jiaochang Sha (intestinal cramping plague), which is hardest to treat and leads to death within moments due to obstruction of ascending and descending Qi. The treatment method is to first promote unblocking and draining, or use emesis to lift the Qi, which is an excellent method. Pricking Weizhong BL-40 and the ten fingertips to bleed is also wonderful. Weizhong is located in the popliteal crease where the artery beats.
[Attached Formulas]
Yiyuan San (Tianshui San added with Cinnabar) Talcum (6 liang) Licorice Root (1 liang) Cinnabar
Guiling Ganlu Yin: Same as Wuling San added with Talcum, Licorice Root, and Halloysitum Rubrum. Mix with plain boiled water.
Guiling Baizhu San: Same as Ganlu Yin added with Talcum.
Yulu San: Treats thirst, body heat, and difficulty in urination and defecation.
Halloysitum Rubrum (2 liang) Gypsum Fibrosum (2 liang) Licorice Root (3 qian)
Grind into fine powder, sift, and take with Ophiopogon Decoction.
Xiangru Yin: See under various vomiting syndromes.
Danxi Formula
Atractylodes Rhizoma (1.5 qian each) Magnoliae Officinalis Cortex (1.5 qian) Citri Reticulatae Pericarpium (1.5 qian) Zingiberis Radix Preparata (1.5 qian) Talcum (3 qian) Atractylodis Macrocephalae Rhizoma (2 qian) Akebia Caulis (1 qian) Glycyrrhizae Radix et Rhizoma Praeparata Ginger
Decoct and take orally.