凡暑月霪雨之后。日气煦照。湿浊上腾。人在湿热蒸淫中感之。则暑湿交受。兼溷
秽浊之气。人中之。即痧毒也。夫人之正气一虚。暑湿秽浊之邪。俱从口鼻吸入。流
布三焦。上乘于心。为中痧。中入于胃。为霍乱。踞于膜原。为寒热。归于肠胃。为泄泻。
盖暑湿之邪。骤发而重者。为湿温。为伤寒。迟发而轻者。为寒热。为晚发。触邪随时
即发者。为寒热。为泄泻。伏邪遇秋始发者。则为疟为痢矣。一邪之染。为病非一。临
症者可不探本穷源为治哉。
论云。霍乱头痛发热。身疼痛。又云。呕吐而利。名霍乱。又云。头痛身疼。恶寒吐利。名
曰霍乱。合观之。则霍乱之症始备。盖亦伤寒之类耳。其治法则云。热多欲饮水者。
五苓散主之。寒多不用水者。理中汤主之。按此皆由阴阳不和。上下拒格不通所
致。五苓所以分其清浊。理中所以壮其阳气。皆中焦治法也。（参类方注）
凡霍乱腹痛吐泻。脉见结促代。或隐伏。或洪大。皆不可断为死。果脉来微细欲绝。
少气不语。舌卷囊缩者。不治。
内经云。阴阳易位曰霍。升降失常曰乱。按此症四时俱有。夏秋尤多。大抵中宫必
有饮食停滞。外犯暑湿痧秽之邪。阻塞中焦。以致清不得升。浊不得降。阴阳错乱。
得而成斯症。或吐泻并作。或吐而不泻。或利而不吐。或先吐后泻。总属中焦之病。
邪上越则吐。下泄则泻。不必分属三焦。
感寒 六脉沉迟。口不渴。小便清利。吐泻并作。或兼腹痛。此名湿霍乱。寒邪重也。
宜藿香正气散出入。若大吐大泻。六脉俱伏。手足厥冷。舌苔黑滑者。太阴中寒也。
作阴霍乱治。理中汤加附子。
吸暑 面赤口渴。或干呕。或吐泻。舌苔微黄而燥。或白中兼红。胸闷腹痛。此口鼻
吸入秽暑而成也。宜辰砂六一散。加枳实、浓朴、川连、郁金之类。
暑湿兼秽 如触暑湿痧秽而成霍乱。腹中绞痛。呕恶吐泻。宜清暑湿。兼芳香逐
秽。如广藿梗、川郁金、浓朴、枳实、菖蒲、槟榔、赤苓、滑石、腹皮、通草之类。
湿热 嗜酒之人。湿热内着。中宫阻塞而成霍乱。吐泻不得。二便俱秘。呕恶不止。
宜泻心法。如半夏、橘红、川连、枳实、栀子、豆豉、滑石粉、茯苓皮、茵陈、泽泻之类。须戒
其断米饮甜腻物。以待中宫清肃。否。虽药弗效也。
食挟暑秽 如胃中已停饮食。更兼吸入暑秽。其势必剧。腹痛饱闷。吐泻不得。绞
肠大痛。舌黄燥浓。烦渴便闭。急宜清疏中宫。如藿梗、浓朴、川连、枳实、楂肉、麦芽、郁
金、青皮、草蔻、滑石之类主之。如未效。腹中板实。大痛难忍。二便不通。舌苔浓黄燥
刺。脉弦滑有力。此邪结于肠胃中也。大承气汤下之。如年高气弱。须用枳实、槟榔、
生大黄、生梨、鲜生地等。以养肠胃之阴。缓下之可也。便通之后。仍戒其勿进米饮
甜腻之物。只用芦稷汤养之和之。恐余邪未清故也。
胃伤生冷 如过食生冷。以致心腹胀满。痛泻不已。宜理中加青陈、浓朴、木香。必
舌润。口不渴。右脉沉迟是也。
凡霍乱症。无非暑湿痧秽饮食凝结而成。忌一切甘腻之物。更忌热油气。犯之必
复。患者须远庖厨坑厕等处。使不犯油气秽气。方可调治。
凡霍乱症。大忌饮食。即米饮下咽亦死。热汤亦忌。并忌一切甜腻滋补。及辛辣之
物。惟清爽松利之物可食。如花红、枇杷、生梨、嫩藕之类。
霍乱因伤暑热痧秽者。当以荞麦炒熟作汤服。最妙。既能通利。以去暑秽。又能和
中。环头芦稷汤。能去秽痧。止呕吐。尤能养胃和中。
凡是暑天连绵阴雨之后，阳光温暖照耀，湿浊之气上升。人在湿热蒸腾淫溢的环境中感受邪气，就会同时感染暑湿和混杂的秽浊之气。人一旦吸入这些邪气，就是痧毒。当人的正气虚弱时，暑湿秽浊之邪都会从口鼻吸入，流布于三焦。上乘于心，称为中痧；侵入胃中，称为霍乱；滞留于膜原，表现为寒热往来；归于肠胃，导致泄泻。
大概暑湿之邪，突然发作且病情重的，属于湿温或伤寒；延迟发作且病情轻的，属于寒热或晚发；触邪后立即发作的，属于寒热或泄泻；伏邪遇到秋天才发作的，则成为疟疾或痢疾。一种邪气感染，引发的病症不止一种。临证施治的人怎能不探究本源、穷究病因来治疗呢？
医论说：霍乱伴有头痛发热、身体疼痛。又说：呕吐而腹泻，称为霍乱。还说：头痛身疼、恶寒、呕吐腹泻，称为霍乱。综合来看，霍乱的症候这才完备。这也算是伤寒的一类病罢了。其治疗法则说：热象多、想喝水的，用五苓散主治；寒象多、不想喝水的，用理中汤主治。按此分析，这都是由于阴阳不和，上下格拒不通所致。五苓散的作用是分清泌浊，理中汤的作用是壮旺阳气，都属于中焦的治疗方法。（参考《类方注》）
凡是霍乱出现腹痛吐泻，脉象出现结、促、代脉，或者脉象隐伏，或者洪大，都不能断定为死证。如果脉象微细欲绝，气息微弱不能言语，舌体卷缩、阴囊收缩的，属于不治之症。
《内经》说：阴阳位置颠倒称为“霍”，升降功能失常称为“乱”。按此症四季都有，夏秋季节尤其多。大抵中焦脾胃必然有饮食停滞，外感暑湿痧秽之邪，阻塞中焦，导致清气不得上升，浊气不得下降，阴阳错乱，从而形成此症。有的呕吐腹泻并作，有的只吐不泻，有的只泻不吐，有的先吐后泻，总归属于中焦的疾病。邪气向上越出则呕吐，向下排泄则腹泻，不必强行分属三焦。
【感寒型】六脉沉迟，口不渴，小便清利，呕吐腹泻并作，或者兼有腹痛，这名叫湿霍乱，是寒邪较重。适宜使用藿香正气散加减。如果大吐大泻，六脉俱伏，手足厥冷，舌苔黑滑的，属于太阴中寒。当作阴霍乱治疗，用理中汤加附子。
【吸暑型】面色红赤，口渴，或者干呕，或者吐泻，舌苔微黄而干燥，或者白色中兼见红色，胸闷腹痛，这是口鼻吸入秽浊暑邪所形成的。适宜使用辰砂六一散，加入枳实、厚朴、黄连、郁金等药。
【暑湿兼秽型】如触冒暑湿痧秽而形成的霍乱，腹中绞痛，恶心呕吐腹泻。适宜清解暑湿，兼用芳香药物驱逐秽浊。如广藿梗、川郁金、厚朴、枳实、石菖蒲、槟榔、赤茯苓、滑石、大腹皮、通草等药。
【湿热型】嗜酒之人，湿热内着，中焦阻塞而形成霍乱。呕吐腹泻不通，大小便都闭塞，恶心不止。适宜采用泻心法。如半夏、橘红、黄连、枳实、栀子、豆豉、滑石粉、茯苓皮、茵陈、泽泻等药。必须戒除断绝米饮及甜腻食物，以等待中焦恢复清肃。否则，虽然用药也不会见效。
【食挟暑秽型】如胃中已有停积的饮食，又兼吸入暑秽，其势必然剧烈。腹痛饱闷，呕吐腹泻不通，肠绞剧痛，舌苔黄燥浓厚，烦躁口渴，大便闭结。急需清疏中焦，如藿梗、厚朴、黄连、枳实、山楂肉、麦芽、郁金、青皮、草蔻、滑石等药为主。如果无效，腹部板硬坚实，剧痛难忍，大小便不通，舌苔浓黄干燥起刺，脉象弦滑有力，这是邪气结聚在肠胃中。用大承气汤攻下。如果是年老气弱的人，须用枳实、槟榔、生大黄、生梨、鲜生地等药，以滋养肠胃之阴，缓下即可。大便通畅之后，仍然要戒除不要进食米饮甜腻之物，只用芦稷汤调养调和，恐怕余邪未清的缘故。
【胃伤生冷型】如过食生冷，导致心腹胀满，疼痛腹泻不已。适宜理中汤加青皮、陈皮、厚朴、木香。必须是舌润、口不渴、右脉沉迟的情况适用。
凡是霍乱症，无非是由暑湿痧秽饮食凝结而成。忌食一切甘腻之物，更忌热油气。触犯必定复发。患者须远离厨房、坑厕等处，使不接触油气秽气，才可以调治。
凡是霍乱症，大忌饮食，即使是米饮咽下也会致死，热汤也忌，并忌一切甜腻滋补及辛辣之物。只有清爽松利的食物可以吃，如花红果、枇杷、生梨、嫩藕等类。
霍乱因伤暑热痧秽引起的，应当用荞麦炒熟煮汤服用，最为奇妙。既能通利，以去除暑秽，又能和中。环头芦稷汤，能去秽痧，止呕吐，尤其能养胃和中。
In the summer months, after continuous heavy rains, when the sun shines warmly, damp-turbid qi ascends. If a person is exposed to this steaming and overflowing damp-heat environment, they will contract both Summerheat-Dampness and mixed turbid filth. Once inhaled by humans, this constitutes Sha Du (Sha Poison). When a person's healthy qi is deficient, the pathogens of Summerheat-Dampness and turbid filth are all inhaled through the mouth and nose, spreading throughout the San Jiao (Triple Burner). If it rises to affect the Heart, it is called Zhong Sha (Central Sha); if it enters the Stomach, it is called Huoluan (Cholera/Vomiting and Diarrhea Syndrome); if it lodges in the Mo Yuan (Membrane Source), it manifests as alternating chills and fever; if it returns to the Intestines and Stomach, it causes diarrhea.
Generally, Summerheat-Dampness pathogens that erupt suddenly and severely belong to Shi Wen (Damp-Warmth) or Shang Han (Cold Damage); those that erupt late and mildly belong to Han Re (Chills and Fever) or Wan Fa (Late Onset); those that erupt immediately upon exposure belong to Han Re or diarrhea; those where latent pathogens erupt only in autumn become Nue (Malaria) or Li (Dysentery). A single pathogen infection can cause various diseases. Clinicians must certainly investigate the root cause and exhaust the source to treat accordingly.
Medical theories state: Huoluan accompanied by headache, fever, and body pain. It also states: Vomiting and diarrhea constitute Huoluan. Furthermore: Headache, body pain, aversion to cold, vomiting, and diarrhea constitute Huoluan. Synthesizing these, the symptoms of Huoluan are complete. This is essentially a category of Shang Han. The treatment principle states: For cases with more heat and thirst for water, Wu Ling San (Five-Ingredient Poria Pill) is the primary formula; for cases with more cold and no desire for water, Li Zhong Tang (Regulate the Middle Decoction) is the primary formula. Analysis shows these result from disharmony of Yin and Yang, causing rejection and blockage between upper and lower jiao. Wu Ling San separates clear from turbid, while Li Zhong Tang strengthens Yang Qi; both are treatments targeting the Middle Jiao. (Refer to *Lei Fang Zhu*).
In cases of Huoluan with abdominal pain, vomiting, and diarrhea, if the pulse presents as Jie (intermittent), Cu (rapid intermittent), Dai (knotted intermittent), or is hidden/faint, or surging-large, one cannot definitively diagnose it as fatal. However, if the pulse is faint and fine, nearly absent, with shortness of breath and inability to speak, tongue retraction, and testicular retraction, it is incurable.
*Nei Jing* (Inner Canon) states: Inversion of Yin and Yang positions is called "Huo"; dysfunction of ascending and descending mechanisms is called "Luan". This syndrome occurs in all seasons, especially summer and autumn. Generally, there must be food stagnation in the Middle Palace (Spleen/Stomach), combined with external invasion of Summerheat-Dampness and Sha Filth, blocking the Middle Jiao. This prevents clear qi from ascending and turbid qi from descending, leading to chaotic Yin and Yang, resulting in this syndrome. Symptoms may include simultaneous vomiting and diarrhea, vomiting without diarrhea, diarrhea without vomiting, or vomiting followed by diarrhea. All belong to diseases of the Middle Jiao. Pathogens moving upward cause vomiting; those moving downward cause diarrhea. There is no need to forcibly assign them to specific Jiao levels.
[Contracting Cold] Six pulses are deep and slow, mouth is not thirsty, urination is clear and profuse, vomiting and diarrhea occur together, possibly with abdominal pain. This is named Shi Huoluan (Damp Huoluan), indicating severe Cold pathogen. Use Huo Xiang Zheng Qi San (Agastache Powder to Rectify the Qi) with modifications. If there is severe vomiting and diarrhea, all six pulses are hidden, extremities are cold, and the tongue coating is black and slippery, this is Taiyin Zhong Han (Cold invading Taiyin). Treat as Yin Huoluan using Li Zhong Tang added with Fu Zi (Aconite Root).
[Inhaling Summerheat] Face is red, mouth is thirsty, or dry heaving, or vomiting/diarrhea. Tongue coating is slightly yellow and dry, or white with red patches. Chest tightness and abdominal pain. This results from inhaling filth and Summerheat through the mouth and nose. Use Chen Sha Liu Yi San (Cinnabar Six-One Powder) added with Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark), Huang Lian (Coptis Rhizome), Yu Jin (Turmeric Tuber).
[Summerheat-Dampness with Filth] Huoluan caused by exposure to Summerheat-Dampness and Sha Filth, with colicky abdominal pain, nausea, vomiting, and diarrhea. Clear Summerheat-Dampness and use aromatic herbs to expel filth. Examples include Guang Huo Geng (Patchouli Stem), Chuan Yu Jin (Curcuma Aromatica), Hou Po, Zhi Shi, Chang Pu (Acorus), Bing Lang (Areca Seed), Chi Ling (Red Poria), Hua Shi (Talcum), Fu Pi (Buckwheat Hull), Tong Cao (Tetrapanax Pith).
[Damp-Heat] Individuals who consume alcohol excessively have internal Damp-Heat accumulation, blocking the Middle Palace and causing Huoluan. Vomiting and diarrhea are blocked, both urine and stool are constipated, nausea persists. Use the Xie Xin method (Drain the Heart method). Examples include Ban Xia (Pinellia Tuber), Ju Hong (Tangerine Peel), Huang Lian, Zhi Shi, Zhi Zi (Gardenia Fruit), Dou Chi (Prepared Soybean), Hua Shi Fen (Talcum Powder), Fu Ling Pi (Poria Skin), Yin Chen (Artemisia Capillaris), Ze Xie (Alisma Rhizome). Strictly avoid rice drinks and sweet/greasy foods to allow the Middle Palace to restore clarity and purity. Otherwise, medication will be ineffective.
[Food Stagnation with Summerheat-Filth] If food is already stagnant in the Stomach, compounded by inhaling Summerheat-Filth, the condition will be severe. Abdominal pain, fullness, inability to vomit or pass stool, intestinal colic, thick yellow dry tongue coating, irritability, thirst, and fecal impaction. Urgently clear and unblock the Middle Palace. Primary herbs: Huo Geng, Hou Po, Huang Lian, Zhi Shi, Zha Rou (Hawthorn Flesh), Mai Ya (Barley Sprout), Yu Jin, Qing Pi (Green Tangerine Peel), Cao Kou (Black Cardamom), Hua Shi. If ineffective, and the abdomen becomes board-like and solid, unbearable pain, obstruction of urine and stool, thick yellow dry prickly tongue coating, wiry-slippery-forceful pulse, this indicates pathogen binding in the Intestines and Stomach. Use Da Cheng Qi Tang (Major Order the Qi Decoction) to purge. For elderly or weak patients, use Zhi Shi, Bing Lang, Sheng Da Huang (Raw Rhubarb), Sheng Li (Raw Pear), Xian Sheng Di (Fresh Rehmannia) to nourish Intestinal-Stomach Yin, using gentle purgation. After bowel movement, continue to avoid rice drinks and sweet/greasy foods. Use Lu Ji Tang (Reed Juice Decoction) to nourish and harmonize, fearing residual pathogens remain.
[Stomach Damaged by Cold/Raw Foods] Overconsumption of cold/raw foods leads to epigastric/abdominal distension, persistent painful diarrhea. Use Li Zhong Tang added with Qing Pi, Chen Pi (Aged Tangerine Peel), Hou Po, Mu Xiang (Aucklandia Root). Indications: moist tongue, no thirst, deep-slow right pulse.
All Huoluan syndromes result from condensation of Summerheat-Dampness, Sha Filth, and dietary irregularities. Avoid all sweet/greasy foods and hot oil fumes. Violation leads to recurrence. Patients must stay away from kitchens, latrines, etc., to avoid oil and filth odors before treatment can proceed.
For Huoluan, diet is strictly forbidden. Even swallowing rice drink can be fatal. Hot water is also forbidden. Avoid all sweet/greasy tonics and spicy foods. Only fresh, light, and lubricating foods are edible, such as Hua Hong (Chinese Hawthorn fruit variety), Pi Pa (Loquat), Sheng Li (Raw Pear), Nen Ou (Young Lotus Root).
Huoluan caused by Summerheat-Heat-Sha-Filth should be treated with roasted buckwheat decoction, which is excellent. It promotes unblocking to remove Summerheat-Filth and harmonizes the Middle. Huan Tou Lu Ji Tang (Ring-head Reed Juice Decoction) removes filth-Sha, stops vomiting, and particularly nourishes the Stomach and harmonizes the Middle.