问曰。病有霍乱者何。答曰。呕吐而利。名曰霍乱。
三焦者。水谷之道路。邪在上焦。则吐而不利。邪在下焦。则利而不吐。邪在中焦。
则既吐且利。以饮食不节。寒热不调。清浊相干。阴阳乖隔。遂成霍乱轻者止曰吐利。
重者挥霍撩乱。名曰霍乱。
问曰。病发热头痛。身疼恶寒。吐利者。此属何病。答曰。此名霍乱。自吐下。又
利也。复更发热也。
发热头痛。身疼恶寒者。本是伤寒。因邪入里。伤于脾胃。上吐下利。令为霍乱。利
止里和。复更发热者。还是伤寒。必汗出而解。
伤寒其脉微涩者。本是霍乱。今是伤寒。却四五日。至阴经上转入阴。必利。本呕
下利者。不可治也。欲似大便。而反失气。仍不利者。属阳明也。便必硬。十三日愈所
以然者。经尽故也。
微为亡阳。涩为亡血。伤寒脉微涩。则本是霍乱。吐利亡阳亡血。吐利止。伤寒之
邪未已。还是伤寒。却四五日邪传阴经之时。里虚遇邪。必作自利。本呕者。邪甚于上。
又利者。邪甚于下。先霍乱。里气太虚。又伤寒之邪。再传为吐利。是重虚也。故为不
治。若欲似大便而反失气。仍不利者。利为虚。不利为实。欲大便而反失气。里气热也。
此属阳明便必硬也。十三日愈者。伤寒六日。传遍三阴三阳后六日再传经尽。则阴阳之
气和。大邪之气去而愈也。
下利后。当便硬。硬则能食者愈。今反不能食。到后经中颇能食。复过一经能食。过
之一日当愈。不愈者。不属阳明也。
下利后。亡津液。当便硬。能食为胃和。必自愈。不能食者为未和。到后经中。为
复过一经。言七日后再经也。颇能食者。胃气方和。过一日当愈。不愈者。暴热使之能
食。非阳明气和也。
恶寒脉微而复利。利止亡血也。四逆加人参汤主之。
恶寒脉微而利者。阳虚阴胜也。利止则津液内竭。故云亡血。金匮玉函曰。水竭则无
血。与四逆汤。温经助阳。加人参。生津液益血。
霍乱头痛发热。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。
头痛发热。则邪自风寒而来。中焦为寒热相半之分。邪稍高者居阳分。则为热。热多欲
饮水者。与五苓散以散之。邪稍下者。居阴分。则为寒。寒多不用水者。与理中丸温之。
Question: What is Huoluan (cholera-like disease)? Answer: Vomiting accompanied by diarrhea is named Huoluan.
The Sanjiao (Triple Burner) is the pathway for water and grain. When pathogenic factors are in the Upper Jiao, there is vomiting without diarrhea; when in the Lower Jiao, there is diarrhea without vomiting; when in the Middle Jiao, there is both vomiting and diarrhea. This results from irregular diet and disharmony of cold and heat, causing turbid Qi to interfere with clear Qi, and Yin and Yang to become separated and disordered, thus forming Huoluan. Mild cases are merely called vomiting and diarrhea, while severe cases involve violent tossing and turning, named Huoluan.
Question: A patient presents with fever, headache, body ache, aversion to cold, vomiting, and diarrhea. To which disease does this belong? Answer: This is named Huoluan. There was originally vomiting and purging, and now there is recurrent fever.
Fever, headache, body ache, and aversion to cold are originally Shanghan (Cold Damage). Because the pathogen enters the interior and damages the Spleen and Stomach, causing upper vomiting and lower diarrhea, it transforms into Huoluan. If the diarrhea stops, the interior harmonizes. If fever recurs, it remains Shanghan, and will surely resolve through sweating.
In Shanghan, if the pulse is faint and choppy, it indicates that the condition was originally Huoluan, but is now Shanghan. After four or five days, when the pathogen transfers to the Yin meridians, diarrhea must occur. If there was originally vomiting and diarrhea, it is difficult to treat. If one feels the urge to defecate but instead passes flatus and still cannot defecate, it belongs to Yangming disease, and the stool will certainly be hard. It will heal in thirteen days because the meridian cycle has completed.
A faint pulse indicates loss of Yang Qi, and a choppy pulse indicates loss of Blood. In Shanghan, a faint and choppy pulse suggests the condition was originally Huoluan, where vomiting and diarrhea led to the loss of Yang Qi and Blood. Once vomiting and diarrhea stop, the Shanghan pathogen has not yet ceased; it remains Shanghan. When, after four or five days, the pathogen transmits to the Yin meridians, the deficiency in the interior encounters the pathogen, inevitably causing spontaneous diarrhea. Originally vomiting indicates the pathogen is excessive in the upper part; having diarrhea indicates the pathogen is excessive in the lower part. First suffering from Huoluan, the interior Qi is already too deficient; then contracting Shanghan again leading to vomiting and diarrhea constitutes double deficiency. Therefore, it is considered untreatable. If one desires to defecate but instead passes flatus and still cannot defecate, diarrhea stems from deficiency, while inability to defecate stems from excess. Desiring to defecate but passing flatus indicates heat in the interior. This belongs to Yangming, and the stool will certainly be hard. Healing in thirteen days occurs because, after six days of transmission through all Yin and Yang meridians, another six days complete the second cycle, harmonizing Yin and Yang Qi, eliminating the major pathogen, and resulting in recovery.
After diarrhea stops, the stool should become hard. If the patient can eat, they will recover. If they currently cannot eat, but later, during the next meridian cycle, can eat slightly, and after another full cycle can eat, they should recover after one day. If they do not recover, it does not belong to Yangming.
After diarrhea stops, body fluids are depleted, and the stool should become hard. The ability to eat indicates harmony of the Stomach Qi and implies self-recovery. Inability to eat indicates disharmony. During the next meridian cycle (referring to seven days later), slight appetite indicates that Stomach Qi is beginning to harmonize, and recovery should occur after one day. If not recovered, the temporary ability to eat is caused by sudden heat, not by the harmony of Yangming Qi.
Aversion to cold, faint pulse, and recurrent diarrhea, followed by cessation of diarrhea due to blood depletion, should be treated with Si Ni Jia Ren Tang (Four Counterflow Decoction plus Ginseng).
Aversion to cold, faint pulse, and diarrhea indicate Yang deficiency and Yin excess. Cessation of diarrhea means internal exhaustion of body fluids, hence described as blood depletion. As stated in Jin Gui Yu Han, "when water is exhausted, blood is absent." Si Ni Tang (Four Counterflow Decoction) is given to warm the meridians and assist Yang, adding Ren Shen (Ginseng Root) to generate fluids and benefit blood.
For Huoluan presenting with headache, fever, body pain, abundant heat, and thirst desiring water, Wu Ling San (Five-Ingredient Powder with Poria) is indicated. For those with abundant cold who do not desire water, Li Zhong Wan (Regulate the Middle Pill) is indicated.
Headache and fever indicate the pathogen comes from Wind-Cold. The Middle Jiao is the boundary where cold and heat are equal. Pathogens situated higher occupy the Yang aspect, manifesting as heat; abundant heat with thirst for water is treated with Wu Ling San to dissipate the pathogen. Pathogens situated lower occupy the Yin aspect, manifesting as cold; abundant cold without desire for water is treated with Li Zhong Wan to warm the interior.