霍乱一病，经文具存，唯干霍乱为经所未言，宜取而补者。但后世诸说，概涉多歧，今仅摘其要，以着于篇。
名义 霍乱，言其病挥霍之间，便致撩乱也。（《病源论》）
若止呕吐而利，经止谓之吐利。必也上吐下利，躁扰烦乱，乃谓之霍乱，其与但称吐利者，所以异也。
（《明理论》）
源由 凡所以得霍乱者，多起饮食。或饮食生冷杂物，以肥腻酒 ，而当风履湿，薄衣露坐，或夜卧
失覆之所致。（《肘后》）
霍乱者，由人温凉不调，阴阳清浊二气，有相干乱之时。其乱在于肠胃之间者，因遇饮食而变，发则心腹
绞痛。其有先心痛者，则先吐。先腹痛者，则先利。心腹并痛者，则吐利俱发。挟风而实者，身发热，头痛体
疼而复吐利；虚者。但吐利，心腹刺痛而已。亦有饮酒食肉，腥脍生冷过度，因居处不节，或露卧湿地，或当风
取凉，而风冷之气，归于三焦，传于脾胃，脾胃得冷则不磨，不磨则水谷不消化，亦令清浊二气相干。脾胃虚
弱，便为吐利，水谷不消，则心腹胀满，皆成霍乱。（《病源论》）
原夫霍乱之为病也，皆因饮食，非关鬼神。夫饱食肫除，复餐乳酪，海陆百品，无所不啖，眠卧冷席，多饮
寒浆，胃中诸食，结而不消，阴阳二气，拥而反戾，阳气欲升，阴气欲降，阴阳乖隔，变成吐利，头痛如破，百节如
解，遍体诸筋，皆为回转，论时虽小，卒病之中，最为可畏，虽临深履危，不足以谕之也。养生者，宜达其旨
趣。庶可免于夭横矣。（《千金》）
冒伤暑毒，露卧卑湿，当风取凉，风冷邪气入于肠胃，加以嗜好肥腥，饮啖生冷，居处不节，激而发焉。
于是邪正相干，中脘即闭，气不得通，吐利暴作，所谓脾受贼邪，木来胜土者此也。（《直指》）
内有所积，外有所感，致成吐泻。（《丹溪》）
霍乱证，虽有风寒湿热之异，大抵伤暑居多。盖由夏暑内伤元气，脾胃俱虚，必因饮冷停寒酒色所伤，外
因受凉，邪气所郁，不得发越，而霍乱之证作矣。故此证多作于秋凉之时，从可知矣。（《医统》）
病邪在中焦 三焦者，水谷之道路，气之所终始也。因风冷或饮食伤胃，致中焦不和，则正气不守，
而邪得以干，挥霍之间，便致撩乱。（《圣济》）
霍乱吐利者，以三焦气不升降，而清浊相干于胃间。治此者当以中焦为本，中焦既和，则清浊自分而吐利
止矣。（同上）
邪在上焦者，但吐而不利。邪在下焦者，但利而不吐。若邪在中焦，胃气不治，为邪所伤，使阴阳乖隔，
遂上吐而下利。（《明理论》）
脉候 伏者霍乱。（《脉经》）
诊其脉来代者，霍乱。又脉代而绝者，亦霍乱也。（按∶《圣济》曰∶脉必代者，以气不足也。说互见下。）
霍乱，脉大可治（《脉诀》曰三部浮洪必救得），微细不可治。霍乱吐下，脉微迟，气息劣，口不欲言者。不
可治。（《病源论》）
滑而不匀，必是吐泻，霍乱之候，脉代勿讶。（《崔氏脉诀》）
霍乱脉多结促，皆不可断以死。（《医统》）
若见代脉，因一时清浊混乱，故脉不接续，非死脉也。（《必读》）
霍乱者，挥霍撩乱，不能自持，阴阳乖离，上下亟夺，是时脉或代止，勿惊讶也。乃卒吐暴下，谷神顿委，
暂不接续故耳。若手足厥冷，脉复迟微，是则大为可怕。盖手足为诸阳之本，迟微为纯阴之脉，阳衰阴盛，真元
渐绝之象也。是故暴脱者能渐生，而渐绝者又何能暴起哉。（《续焰》）
微弱渐绝死，脉渐大者生。（《玉案》）
如大痛时，脉多伏，不宜渐迟。（《简明医彀》）
凡结脉、促脉、代脉、滑脉，皆霍乱之脉也。故霍乱脉洪滑而大则易治，沉涩而细则难治耳。（《医约》）
脉细者死，弦甚者死。（《本草权度》）
证治诸说 霍乱吐泻者，有冷热二证∶寒多不渴者，可与理中丸、姜附汤、来复丹；霍乱吐泻有热烦
躁而渴者，可服香薷散、五苓散、嘉禾散、参苓白术散、四君子汤。霍乱吐泻后，调理脾胃，可与服参苓白术
散、五苓散、四君子汤、调气散之类。（《和剂指南》）（按∶仲景霍乱之冷热，为就病邪之未化寒与既化寒者
而为辨，此说犹不失其意。如明清诸家，往往划然分析，与伤寒之寒热同例。然验之事为，殊不见其当。今姑
列数说于下，以俟识者论定。）
其证有冷有热∶冷者面惨不光，口气冷，息微不欲语言，肌肤寒，肢节清冷，汗时出，肚腹疼痛，口不渴而
喜饮热，脉必沉迟，或微而欲绝是也。热者，面色如故，口气热，息粗，烦躁闷乱，肌肤热，肢节温，肚腹绞痛，或自
汗，或无汗，口干渴而喜饮冷，脉必浮洪，或沉而伏是也。（《会解》）
因寒者，不烦少渴，或吐利后乃见烦渴，以津液外亡也。因暑者，大烦大渴，吐利清水，未吐利前预见
烦渴，以暑邪内扰也。（《汇补》）
甚者脐腹绞痛，厥逆脉脱，举体转筋，当温补回阳复脉。若暑月多餐生冷瓜果泉水，以致食郁于中而成霍
乱者，宜辛温散其标寒，次以寒凉清其暑热可也，渴甚者冰水解之。（《指掌》）
吐利转筋，胁下痛，脉弦者，木克土也，故痛甚，建中加柴胡、木瓜。吐利四肢厥冷，脉微缓，属厥阴，
建中加归、附。（《玉机》引《保命集》）（按∶当是云岐子书。）
吐利不止，元气耗散，病势危笃，或水粒不下，或口渴喜冷，或恶寒战掉，手足逆冷，或发热烦躁，欲去
衣被，此盖内虚阴盛，却不可以其喜冷欲去衣被为热，宜理中汤，甚则附子理中汤，不效则四逆汤，并宜放十
分冷服。霍乱并诸吐泻后，胸膈高起，痞塞欲绝，理中汤加枳实半钱，茯苓半钱，名枳实理中汤。吐泻已愈，
而力怯精神未复者，十补汤（按∶即十全大补汤）。夏月感暑吐泻如霍乱者，六和汤、香薷汤皆是要药。人于
夏月，多食瓜果及饮冷乘风，以致食留不化，因食成痞，隔绝上下，遂成霍乱，六和汤倍藿香煎熟，调苏合
香丸。（《要诀》）
吐泻若已透畅，人困弱，脉虚软，是邪已去而正虚也；若吐泻未透，脉仍涩滞有力，人仍烦躁不宁，是邪
尚未尽也，须别之。（《医通》）
干湿辨异（宜参涌吐及泻下诸方） 霍乱者，多吐利也，干霍乱者，是冷气搏于肠胃，致饮食不消，
但腹满烦乱，绞痛短气，其肠胃先挟实，故不吐利，名为干霍乱也。（《病源论》）
许仁则云∶此病有两种∶一名干霍，一名湿霍。干霍死者多，湿霍死者少，俱繇饮食不节，将息失宜。
干霍之状，心腹胀满，搅刺疼痛，烦闷不可忍，手足逆冷，甚者流汗如水，大小便不通，求吐不出，求利不下，
须臾不救，便有性命之虑。湿霍之状，心腹亦搅痛，诸候有与干同，但吐利无限。此病始得，有与天行相似者，
亦令头痛，骨肉酸楚，手足逆冷，四体发热。（《外台》）（按∶原疗干霍有巴豆等三味丸，今见后。）
许仁则云∶病有干霍乱，有湿霍乱。干霍乱死者多，湿霍乱死者少。盖吐利则所伤之物得以出泄，虽霍乱
甚，则止于胃，若水谷泄尽，则止矣，所以死者少。及其干霍乱死多者，以其上不得吐，下不得利，则所伤之
物不得出泄，拥闭正气，关隔阴阳，烦扰闷乱，躁无所安，喘胀，干霍乱而死。（《明理论》）
心腹绞痛，冷汗出，胀闷欲绝，俗谓搅肠沙，今考之此证乃名干霍乱。此亦由山岚瘴气，或因饥饱失时，
阴阳暴乱而致，急用盐汤吐法。（《得效》）（按∶此本出《经验良方》，曰∶绞肠沙，痛不可忍，或辗转在
地，或起或仆，其肠绞缩在腹，此是中毒之深，须臾能令人死，古方名干霍乱。《要诀》亦曰∶近世俗医谓之
搅肠沙，人多信之，殊不知即是霍乱，侥幸而愈者，一时之功耳。）
干霍乱证，最为危候，其证则上欲吐而不能出，下欲泻而不能行，胸腹搅痛，胀急闷乱，此必内有饮食停
阻，外有寒邪闭遏。盖邪浅者，易于行动，故即见吐利；邪深者，阴阳格拒，气道不通，故为此证，若不速治，
多致暴死。（《景
岳》）
如欲吐不吐，欲利不利，上下不通，腹满痛而头疼发热者，桂枝大黄汤，此干霍乱。（《伤寒缵论》）
委中穴出血，或十指头出血，皆是良法。（《正传》）
干霍乱若吐泻不出，胸腹胀硬，面唇青黑，手足冷过肘膝，六脉伏绝，气喘急，舌短囊缩者，死证也。
（《回春》）
转筋（宜参外治法） 夫霍乱大吐下之后，阴阳俱虚，其血气虚极，则手足逆冷而荣卫不理。冷搏于
筋，则筋为之转。冷入于足之三阴三阳，则脚筋转。入于手之三阴三阳，则手筋转。随冷所入之筋，筋则转。
转者皆由邪冷之气，击动其筋而移转也。（《病源论》）
转筋者，以阳明养宗筋，属于大肠。今暴下暴吐，津液顿亡（按∶原此下有“外伤四气，内积七情，饮食
甜腻，攻闭诸脉，刮削于筋”五句，《必读》芟却，今从之），宗筋失养，必致挛急，甚则卵缩舌卷，为难治。
（《三因》）（按∶景岳举此说，以驳河间转筋属火之谬，文繁不录。）
甚则转筋入腹则毙，霍乱恶证，无越于斯。（同上）
霍乱转筋，理中汤加冻胶锉炒一钱，仍令其系缚腿胫，若筋入腹及通身转筋者，不可治。筋转者，以造曲
蓼汁暖热浸，或用浓盐汤浸。（《要诀》）
死证 霍乱之后，阳气已脱，或遗尿而不知，或气少而不语，或膏汗如珠，或大躁欲入水，或四肢不
收，皆不可治。（《要诀》）
治宜救正为急 风雨寒暑之邪直为霍乱，若吐利太过而生气内伤，手足厥冷，脉微欲绝，皆宜四逆汤
主之，无分寒与暑也。盖正气受伤，止救正而不论邪，后人补正藿香正气散以治吐利，此治微邪在胃，正气不伤，
如此之证，弗药亦
愈，即阴阳汤（按∶此谓生熟水）、黄土汤（按∶此谓地浆）皆能疗之。若霍乱里虚，上古止立四逆、理中二
方，为急救正气之法。有谓藿香正气散治暑霍乱者，亦非也。愚每见暑月病霍乱，四肢逆冷，无脉而死。藿香正
气，不过宽表解表之剂，恶能治之。况夏月元气发泄在外，中气大虚，外邪卒至，救正犹迟。夫邪正相持，有
风雨寒暑之分。正受邪伤，止论正气之虚实，入脏即为不治之死证，非风暑为阳而寒雨为阴也。此为霍乱之大
纲，学人宜服膺而弗失。（《伤寒论集注》）
治宜和胃健脾 邪之易受者，必其脾气本柔，而既吐且泻，则脾气不能更虚矣。故凡治霍乱者，必宜
以和胃健脾为主。健者培补之谓，因其邪气已去而胃气受伤，故非培补不可也。和者调和之谓，以其胃气虽伤
而邪犹未尽，故非察其邪正而酌为调和不可也。若其寒少滞多，则但以温平之剂调之可也。若滞因于寒，则非
温热之剂不能调也。而诸家有言为火者，谓霍乱之病，多在夏秋之间，岂得为之伤寒乎。吁！谬亦甚矣。不知
夏秋之交，正多藏寒之病。盖一以盛暑将杀，新凉初起，天人易气，寒之由也。一以酷暑当令，生冷不节，疾
病因时寒之动也。人以夏秋之外热易见，而藏寒之内寒难见，故但知用热远热，而不知用寒远寒。见之浅陋，
多有如此，此所以多致误也。学人于此，当熟察之。（《景岳》）
回阳散寒诸方 四顺汤，治霍乱，转筋肉冷，汗出呕 者。（范汪云∶利甚加附子二两，妙。）（《千
金》）（按∶即四逆加人参汤。）
《仲景论》霍乱，四逆吐少呕多者，附子粳米汤主之。一方有干姜一两。（《外台》）（按，《千金》有干姜。）
姜附汤，治霍乱转筋，手足厥冷，多汗呕逆。（《济生》）姜附汤，清煎沉冷，服之大效，热因寒用之法也。
（《得效》）
霍乱，或有寒，腹满痛，或四肢拘急，下利脚转筋，理中汤加附子一枚生用，并粗末，作汤服之。（《活人》）
霍乱转筋，吐泻不止，头目昏眩，须臾不救者，以吴茱萸汤主之。（《原病集》）（按∶即仲景原方。
《外台·霍乱干呕》∶《肘后》干姜茱萸汤，盖自此方变来。）
《僧深方》霍乱呕吐，水药不下，茱萸汤法。
茱萸（一升） 黄连（二两） 附子（一两） 甘草（一两） 生姜（三两）
凡五物，以水七升，煮取三升，分三服。（《医心》）
《短剧方》霍乱多寒，手足寒厥，脉绝，茱萸四逆汤主之方。
吴茱萸（二升） 当归（三两） 芍药（二两） 桂
心（四两） 细辛（二两） 生姜（半斤） 通草（二两）
甘草（一两）
凡八物，以水四升，清酒四升，合煮取三升，分四服。（同上）旧方用枣三十枚，今以霍乱病法多痞，故除
之。如退枣，入葛根二两佳。霍乱四逆，加半夏一合，附子小者一枚，恶寒乃与大附子。（《千金》）（按∶
方中有大枣二十五枚，可疑。）《济生》通脉四逆汤，加附子。（亦有枣。）
治霍乱呕吐，及下后腹中干痛，手足逆冷，宜服此方。
当归（一两） 干姜（半两） 甘草（半两） 人参 附子（各一两）
上件药捣筛为散，每服三钱，以水一中盏，煎至六分，去滓热服之。（《圣惠》）
Huo Luan (Colic with Vomiting and Diarrhea) is a disease documented in medical classics, except for Gan Huo Luan (Dry Huo Luan), which is not mentioned in the classics and should be supplemented by selecting relevant discussions. However, various theories from later generations are mostly divergent; now only the key points are extracted and recorded in this chapter.
[Naming]
"Huo Luan" refers to the condition where, within a moment of sudden onset, the body becomes chaotic and disordered. (From *Zhu Bing Yuan Hou Lun*)
If there is only vomiting or diarrhea, it is simply called "Tu Li" (Vomiting and Diarrhea) in the classics. It must involve both upper vomiting and lower diarrhea, accompanied by restlessness and agitation, to be called "Huo Luan"; this distinguishes it from cases merely termed "Tu Li". (From *Shang Han Ming Li Lun*)
[Origins]
The causes of Huo Luan mostly arise from dietary impropriety. For instance, consuming raw, cold, or miscellaneous foods, or eating fatty/rich foods and drinking alcohol, while exposed to wind and dampness, sitting naked outdoors, or sleeping at night without adequate covering. (From *Zhou Hou Bei Ji Fang*)
Huo Luan occurs when the body's regulation of warmth and coolness is dysregulated, causing the Qi of Yin-Yang and Clear-Turbid to interfere and become chaotic. If this chaos occurs between the stomach and intestines, it is triggered by food intake, resulting in severe colic in the heart and abdomen. 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. With concurrent Wind pathogen and excess constitution, there is fever, headache, body ache, plus vomiting and diarrhea; with deficiency constitution, there is only vomiting and diarrhea with stabbing pain in the heart and abdomen. Also, excessive consumption of alcohol, meat, raw fish, and cold foods, combined with irregular living habits, such as sleeping outdoors on wet ground or exposing oneself to wind for cooling, leads to Cold-Wind Qi returning to the San Jiao (Triple Burner) and transmitting to the Spleen and Stomach. The Spleen and Stomach, being cold, fail to digest food; inability to digest causes water and grain to fail to transform, leading to interference between Clear and Turbid Qi. Spleen-Stomach weakness results in vomiting and diarrhea; undigested food causes abdominal distension and fullness, all forming Huo Luan. (From *Zhu Bing Yuan Hou Lun*)
Originally, Huo Luan is caused by diet, not by ghosts or spirits. After overeating, followed by consuming dairy, cheese, seafood, and various other foods, sleeping on cold mats, and drinking heavily chilled fluids, the food in the stomach condenses and fails to digest. The Yin and Yang Qi become stagnant and rebellious; Yang Qi desires to ascend, Yin Qi desires to descend. Due to Yin-Yang separation, vomiting and diarrhea ensue, accompanied by splitting headaches, joints feeling as if dislocated, and tendons throughout the body twisting. Although considered a minor illness, among acute diseases, it is most terrifying, more so than facing deep abysses or precarious heights. Those who practice health preservation should understand its principles to avoid premature death. (From *Qian Jin Yao Fang*)
Exposure to summer-heat toxicity, sleeping outdoors in low-lying damp areas, fanning oneself against the wind, allows Wind-Cold pathogens to enter the stomach and intestines. Added to a preference for fatty/fishy foods and cold drinks, and irregular living, these factors trigger the disease. Thus, pathogenic and healthy Qi interfere, the Middle Jiao closes, Qi cannot circulate freely, and violent vomiting and diarrhea erupt. This is what is meant by the Spleen receiving thief-pathogens, where Wood overacts on Earth. (From *Zhi Zhi*)
Internal accumulation combined with external contraction leads to vomiting and diarrhea. (From Zhu Danxi)
Although Huo Luan syndromes vary by Wind, Cold, Dampness, and Heat, they are mostly due to Summer-Heat injury. This is because summer heat internally damages Yuan Qi, leaving the Spleen and Stomach weak. It inevitably involves injury from drinking cold, stagnation of cold, wine, and sexual indulgence, compounded by external cold exposure. Pathogenic Qi becomes depressed and cannot vent, causing Huo Luan symptoms. Hence, this syndrome often manifests during autumn cooling. (From *Yi Tong*)
[Pathogen in the Middle Jiao]
The San Jiao is the pathway for water and grain, and the beginning and end of Qi circulation. Due to Wind-Cold or dietary injury to the Stomach, the Middle Jiao becomes disharmonious, causing Healthy Qi to lose its post and allowing Pathogenic Qi to interfere. Within moments, chaos ensues. (From *Sheng Ji Zong Lu*)
Huo Luan with vomiting and diarrhea results from the failure of San Jiao Qi to ascend and descend, causing Clear and Turbid Qi to interfere in the Stomach. Treatment should focus on the Middle Jiao as the root; once the Middle Jiao is harmonized, Clear and Turbid separate naturally, and vomiting and diarrhea cease. (Ibid.)
Pathogen in the Upper Jiao presents with vomiting only, no diarrhea. Pathogen in the Lower Jiao presents with diarrhea only, no vomiting. If the pathogen is in the Middle Jiao, Stomach Qi is unregulated and injured by pathogens, causing Yin-Yang separation, leading to upward vomiting and downward diarrhea. (From *Shang Han Ming Li Lun*)
[Pulse Diagnosis]
A hidden pulse indicates Huo Luan. (From *Mai Jing*)
A moderate pulse (Dai Mai) indicates Huo Luan. A moderate pulse that is also intermittent indicates Huo Luan. (Note: *Sheng Ji Zong Lu* states the pulse must be Dai due to Qi deficiency. See below.)
In Huo Luan, a large pulse is treatable (*Mai Jue* says floating and surging pulses in three positions can be saved); a minute and fine pulse is untreatable. In Huo Luan with vomiting and purging, if the pulse is minute and slow, breathing is poor, and the patient does not wish to speak, it is untreatable. (From *Zhu Bing Yuan Hou Lun*)
A slippery but irregular pulse indicates vomiting and diarrhea; this is a sign of Huo Luan. Do not be alarmed by a Dai pulse. (From *Cui Shi Mai Jue*)
Huo Luan pulses often show Knotted (Jie) or Frequent (Cu) qualities; do not pronounce death based on these alone. (From *Yi Tong*)
If a Dai pulse appears, it is due to temporary chaos of Clear and Turbid Qi, causing discontinuity in the pulse, not necessarily a death pulse. (From *Yi Zong Bi Du*)
Huo Luan involves sudden chaos and loss of self-control, with Yin-Yang separation and rapid depletion of Upper and Lower aspects. At this time, the pulse may pause; do not be surprised. This is because sudden violent vomiting and profuse diarrhea cause the Grain Spirit to collapse temporarily, leading to brief discontinuity. However, if the hands and feet are cold and the pulse becomes slow and minute, this is truly frightening. Hands and feet are the root of Yang Qi; slow and minute pulses indicate pure Yin. This signifies Yang decline and Yin abundance, a sign of gradual extinction of True Yuan. Therefore, those with sudden collapse can gradually recover, but those with gradual extinction cannot suddenly rise. (From *Xu Yan*)
Minute and gradually extinguishing pulses indicate death; gradually enlarging pulses indicate survival. (From *Yu An*)
During severe pain, the pulse is often hidden; it should not gradually become slow. (From *Jian Ming Yi Gou*)
Knotted, Frequent, Moderate, and Slippery pulses are all Huo Luan pulses. Thus, Huo Luan with surging, slippery, and large pulses is easy to treat, while sinking, choppy, and fine pulses are difficult. (From *Yi Yue*)
Fine pulses indicate death; extremely wiry pulses indicate death. (From *Ben Cao Quan Du*)
[Theories on Syndrome and Treatment]
Huo Luan with vomiting and diarrhea has Cold and Hot syndromes: For Cold-dominant cases without thirst, provide Lizhong Wan, Jiang Fu Tang, or Laifu Dan. For Hot cases with irritability and thirst, administer Xiangru San, Wuling San, Jiahe San, Shenling Baizhu San, or Sijunzi Tang. After Huo Luan vomiting and diarrhea, to regulate the Spleen and Stomach, one may take Shenling Baizhu San, Wuling San, Sijunzi Tang, or Tiaoqi San. (From *Heji Zhinan*) (Note: Zhang Zhongjing’s distinction of Cold/Hot in Huo Luan addresses whether the pathogen has transformed into Cold or not; this view retains its intent. Later Ming/Qing scholars often analyzed them distinctly, similar to Cold/Hot in Shanghan. However, clinical verification shows this is not always appropriate. Several views are listed below for experts to judge.)
Syndromes include Cold and Heat: Cold syndrome features a pale, dull complexion, cold breath, weak voice unwilling to speak, cold skin and limbs, occasional sweating, abdominal pain, no thirst but desire for hot drinks, and a sinking-slow or minute-almost-extinct pulse. Heat syndrome features a normal complexion, hot breath, coarse breathing, irritability and confusion, hot skin and warm limbs, abdominal colic, spontaneous sweating or anhidrosis, dry mouth/thirst with desire for cold drinks, and a floating-surging or sinking-hidden pulse. (From *Huijie*)
Caused by Cold: No irritability or slight thirst; irritability and thirst may appear after vomiting/diarrhea due to fluid loss externally. Caused by Summer-Heat: Severe irritability and thirst, vomiting/diarrhea of clear water; irritability and thirst appear before vomiting/diarrhea due to internal disturbance by Summer-Heat pathogens. (From *Huibu*)
Severe cases feature umbilical/abdominal colic, cold limbs, absent pulse, and generalized tendon twitching; treatment requires warming, tonifying, restoring Yang, and regulating the pulse. If Huo Luan results from excessive consumption of cold/raw fruits and spring water in summer, causing food stagnation in the Middle Jiao, use acrid-warm herbs to dissipate superficial Cold, followed by cold-bitter herbs to clear Summer-Heat. For severe thirst, use ice water to resolve it. (From *Zhizhang*)
Vomiting/diarrhea with tendon twitching, hypochondriac pain, and wiry pulse indicate Wood overcoming Earth, causing severe pain; use Jianzhong Tang plus Chaihu and Mugua. Vomiting/diarrhea with cold limbs and slow-moderate pulse indicates Jueyin involvement; use Jianzhong Tang plus Danggui and Fuzi. (From *Yuji*, citing *Baoming Ji*) (Note: Likely from Yun Qizi’s work.)
If vomiting/diarrhea persists, Yuan Qi dissipates, and the condition is critical, with inability to swallow even water/grains, or thirst preferring cold, or aversion to cold with shivering, cold limbs, or fever with irritability desiring to remove covers, this is internal deficiency and Yin abundance. Do not mistake the desire for cold/removing covers as Heat. Use Lizhong Tang; for severe cases, Fuzi Lizhong Tang; if ineffective, Sini Tang. All should be taken cool. After Huo Luan and other vomiting/diarrhea, if the chest/diaphragm is elevated and blocked, use Lizhong Tang plus Zhishi and Fuling, named Zhishi Lizhong Tang. If vomiting/diarrhea has ceased but strength and spirit remain weak, use Shibu Tang (i.e., Shiquan Dabu Tang). For summer Summer-Heat induced vomiting/diarrhea resembling Huo Luan, Liuhe Tang and Xiangru Tang are essential. In summer, excessive fruit/cold drink/wind exposure causes food stagnation, forming Pi (glomus), blocking Upper and Lower, leading to Huo Luan; use Liuhe Tang with doubled Huoxiang, decocted, mixed with Suhexiang Wan. (From *Yaojue*)
If vomiting/diarrhea is thorough, the patient is weak, and the pulse is empty/soft, the pathogen is gone and Zheng Qi is deficient. If vomiting/diarrhea is incomplete, the pulse is choppy/strengthful, and the patient remains irritable/restless, the pathogen remains; distinguish carefully. (From *Yitong*)
[Dry vs. Wet Differentiation] (Refer to emetic and purgative formulas)
Huo Luan usually involves vomiting and diarrhea. Gan Huo Luan (Dry Huo Luan) occurs when Cold Qi combats the stomach/intestines, preventing food digestion. There is only abdominal distension, irritability, colic, and shortness of breath. Because the stomach/intestines are initially filled with Excess, there is no vomiting or diarrhea, hence named Dry Huo Luan. (From *Zhu Bing Yuan Hou Lun*)
Xu Renze states: There are two types: Gan Huo and Shi Huo. Gan Huo has higher mortality; Shi Huo has lower. Both result from dietary irregularity and improper care.
Gan Huo presents with abdominal distension, stabbing pain, unbearable oppression, cold limbs, severe cases with sweat like water, blockage of urination/defecation, inability to vomit or purge, and death within moments if untreated. Shi Huo presents with abdominal pain similar to Gan Huo, but with unlimited vomiting and diarrhea. Early stages may resemble epidemic febrile diseases, with headache, bone/muscle soreness, cold limbs, and limb fever. (From *Waitai Miyao*) (Note: Original treatment for Gan Huo includes a pill with Radix Crotonis etc., see below.)
Xu Renze states: Gan Huo Luan has high mortality; Shi Huo Luan has low. Because vomiting/diarrhea allows expelled pathogens to exit, even severe Huo Luan stops at the Stomach; once food/water is exhausted, it stops, hence low mortality. Gan Huo Luan has high mortality because nothing can be vomited or purged; damaged substances cannot exit, blocking Healthy Qi, separating Yin-Yang, causing irritation, restlessness, panting, and distension, leading to death. (From *Shang Han Ming Li Lun*)
Heart/abdominal colic, cold sweat, oppressive fullness nearing death, commonly called "Jiao Chang Sha" (Intestinal Twisting Sand), is actually Gan Huo Luan. This is caused by mountain miasma, irregular eating/drinking, or sudden Yin-Yang chaos. Urgently use salt-water emesis. (From *De Xiao*) (Note: From *Jingyan Liangfang*: Jiao Chang Sha is unbearable pain, rolling on ground, intestinal twisting in abdomen, deep poisoning, fatal quickly, ancient name Gan Huo Luan. *Yaojue* also notes modern doctors call it Jiao Chang Sha, mistakenly thinking it different from Huo Luan; lucky recovery is just temporary effect.)
Gan Huo Luan is a critical condition: wanting to vomit but unable, wanting to defecate but unable, chest/abdominal twisting pain, distension/oppression. This implies internal food stagnation and external Cold closure. Superficial pathogens move easily, causing immediate vomiting/diarrhea; deep pathogens cause Yin-Yang rejection and blocked Qi channels, resulting in this syndrome. Without rapid treatment, sudden death often occurs. (From *Jingyue Quanshu*)
If wanting to vomit/purge but unable, upper/lower blockage, abdominal distension/pain with headache/fever, use Guizhi Dahuang Tang. This is Gan Huo Luan. (From *Shanghan Zuanchun*)
Bleeding from Weizhong (BL40) or ten fingertips are good methods. (From *Zhengchuan*)
If Gan Huo Luan has no vomiting/purging, chest/abdominal hardness, blue-black lips/face, cold limbs past elbows/knees, absent six pulses, panting, short tongue, retracted scrotum, it is a death syndrome. (From *Huichun*)
[Tendon Twitching] (Refer to external treatments)
After severe Huo Luan vomiting/diarrhea, Yin-Yang are both deficient, Blood-Qi extremely depleted, leading to cold limbs and disharmony of Ying-Wei. Cold combats the tendons, causing them to twist. Cold entering the Foot Three Yin/Yang meridians causes foot tendon twisting; entering Hand Three Yin/Yang causes hand tendon twisting. Tendons twist according to where Cold enters. Twisting is caused by Evil Cold Qi striking and moving the tendons. (From *Zhu Bing Yuan Hou Lun*)
Tendon twisting occurs because the Yangming meridian nourishes the Zongjin (Major Tendons), connected to the Large Intestine. Sudden profuse diarrhea/vomiting causes sudden fluid loss (Note: Original text has five sentences here deleted in *Yibidu*, omitted here), Zongjin loses nourishment, leading to spasms. Severe cases involve testicular retraction and tongue curling, difficult to treat. (From *Sanyin Fangyi*) (Note: Jingyue cites this to refute Hejian’s theory that twisting is Fire-related; text too long to include.)
Severe twisting entering the abdomen leads to death; no worse Huo Luan evil syndrome exists. (Ibid.)
For Huo Luan tendon twitching, use Lizhong Tang plus fried Dongjiao (Gelatin) 1 qian. Bind legs/shins tightly. If tendons twist into abdomen or whole body twists, it is untreatable. For tendon twisting, soak in warm Qu-Liao juice or strong salt water. (From *Yaojue*)
[Death Syndromes]
After Huo Luan, if Yang Qi has collapsed, with incontinence unawareness, sparse speech, bead-like sweat, extreme restlessness desiring water, or flaccid limbs, it is untreatable. (From *Yaojue*)
[Urgency of Restoring Healthy Qi]
Wind/Rain/Cold/Summer-Heat pathogens directly causing Huo Luan, if vomiting/diarrhea is excessive damaging Life Qi, with cold limbs and minute-almost-absent pulse, Sini Tang is indicated regardless of Cold or Summer-Heat. Since Healthy Qi is injured, restore Qi without focusing on pathogens. Later additions like Huoxiang Zhengqi San treat vomiting/diarrhea for mild Stomach pathogens with intact Healthy Qi; such cases heal spontaneously, even with Yin-Yang Tang (raw/cooked water mix) or Huangtu Tang (earth slurry). For Huo Luan with interior deficiency, ancients established only Sini and Lizhong formulas as emergency methods to save Healthy Qi. Claiming Huoxiang Zhengqi San treats Summer-Huo Luan is incorrect. I often see summer Huo Luan patients with cold limbs, absent pulse, and death. Huoxiang Zhengqi San is merely a formula to broaden the exterior and resolve the exterior; how can it treat this? Moreover, in summer, Yuan Qi vents outward, Middle Qi is greatly deficient, and sudden external pathogens make even timely restoration late. When Pathogen and Healthy Qi contend, distinguish Wind/Rain/Cold/Summer-Heat. Injury to Healthy Qi depends only on Healthy Qi deficiency/excess; entry into Zang organs is untreatable death, not determined by Wind/Summer-Heat being Yang and Cold/Rain being Yin. This is the general principle of Huo Luan; students should memorize it. (From *Shanghan Lun Jizhu*)
[Urgency of Harmonizing Stomach and Strengthening Spleen]
Those susceptible to pathogens have inherently soft Spleen Qi; after vomiting and diarrhea, Spleen Qi cannot become more deficient. Thus, treating Huo Luan must focus on harmonizing the Stomach and strengthening the Spleen. "Strengthening" means tonifying, necessary because pathogens are gone but Stomach Qi is injured. "Harmonizing" means adjusting, necessary because Stomach Qi is injured but pathogens remain; one must observe Pathogen/Healthy Qi balance and adjust accordingly. If Cold is slight and stagnation is heavy, mild-warm formulas suffice. If stagnation is due to Cold, warm-hot formulas are required. Some claim it is a Fire syndrome, arguing Huo Luan occurs in Summer/Autumn, so it cannot be Cold-Damage. Alas, this is very erroneous. One must know that Summer/Autumn transitions are prone to Interior Cold diseases. First, intense heat fades, new coolness begins, Heaven/Human Qi changes, generating Cold. Second, peak heat leads to irregular cold/raw food intake, causing disease via seasonal Cold movement. People see external Summer/Autumn heat easily but miss internal Interior Cold, thus knowing to avoid Heat in Heat but not avoiding Cold in Cold. Shallow understanding leads to errors. Students must examine this carefully. (From *Jingyue Quanshu*)
[Formulas for Restoring Yang and Dispelling Cold]
Sishun Tang treats Huo Luan with tendon twitching, cold muscles, sweating, and vomiting. (Fan Wang says: Add 2 liang Fuzi if diarrhea is severe, excellent.) (From *Qianjin Yao Fang*) (Note: i.e., Sini Jia Renshen Tang.)
*Zhongjing Lun* on Huo Luan: For Sini pattern with less vomiting and more retching, use Fuzi Jingmi Tang. One version has 1 liang Ganjiang. (From *Waitai Miyao*) (Note: *Qianjin* has Ganjiang.)
Jiangfu Tang treats Huo Luan tendon twitching, cold limbs, excessive sweating, and retching. (From *Jisheng Fang*) Jiangfu Tang, decocted clearly and taken cold, is highly effective; this is the method of using heat for cold. (From *De Xiao*)
Huo Luan with Cold, abdominal distension/pain, limb stiffness, diarrhea with foot twitching: Use Lizhong Tang plus 1 raw Fuzi, coarsely powdered, decocted and taken. (From *Huo Ren Shu*)
Huo Luan tendon twitching, persistent vomiting/diarrhea, dizziness, imminent death: Use Wuzhuyu Tang. (From *Yuanbing Ji*) (Note: Same as Zhongjing’s original formula. *Waitai* Huo Luan Dry Retching: *Zhouhou* Ganjiang Zhuyu Tang likely derived from this.)
*Sengshen Fang* for Huo Luan vomiting, inability to keep down water/medicine, use Zhuyu Tang method.
Wuzhuyu (1 sheng) Huanglian (2 liang) Fuzi (1 liang) Gancao (1 liang) Shengjiang (3 liang)
Five items, boil in 7 sheng water to 3 sheng, divide into 3 doses. (From *Yixin Fang*)
*Duanju Fang* for Huo Luan with much Cold, cold limbs, absent pulse, use Zhuyu Sini Tang.
Wuzhuyu (2 sheng) Danggui (3 liang) Shaoyao (2 liang) Guixin (4 liang) Xixin (2 liang) Shengjiang (0.5 jin) Tongcao (2 liang) Gancao (1 liang)
Eight items, boil in 4 sheng water and 4 sheng clear wine to 3 sheng, divide into 4 doses. (Ibid.) Old formula used 30 dates; removed here because Huo Luan often involves Pi (blockage). Removing dates, adding 2 liang Gegen is better. For Huo Luan Sini, add Banxia 1 he, small Fuzi 1 piece; give large Fuzi if aversion to cold is present. (From *Qianjin Yao Fang*) (Note: Formula has 25 dates, questionable.) *Jisheng* Tongmai Sini Tang adds Fuzi. (Also has dates.)
For Huo Luan vomiting, and abdominal dry pain after purging, cold limbs: Take this formula.
Danggui (1 liang) Ganjiang (0.5 liang) Gancao (0.5 liang) Renshen Fuzi (1 liang each)
Pulverize these ingredients. Take 3 qian per dose, decoct in 1 zhong zhan water to 0.6 portion, strain, take hot. (From *Shenghui Fang*)