巢氏，先贤也，固不当非。然其说有误者，人命所系，不可不辨也。今之医者，
家置本以为绳墨。呜呼！何今之人信巢氏，而不信《素问》也？此，予不得不为之说。且巢氏论
霍乱、吐泻，皆由温凉不调，阴阳清浊，二气相干，致肠胃之间，变而为霍乱。寒气客于脾则泻，
寒气客于胃则吐。亦由饮酒食肉，腥脍生冷过度；或因居处坐卧湿地，当风取凉，风之气归
于三焦，传于脾胃，脾胃得冷，水谷不消，皆成霍乱。其名有三∶一曰胃反，胃气虚逆，反
吐饮食；二曰霍乱，言其病挥霍之间，便致撩乱也；三曰晡食变逆者也。霍乱者，脉必代。
又云∶七月间食蜜，令人暴下霍乱。此皆巢氏霍乱之论也。
予以为不然。夫医之治病，犹书
生之命题。如秋伤于湿，冬生咳嗽，是独以湿为主，此书生之独脚题也；风湿
三气合而成霍乱，吐泻转筋，此犹书生之鼎足题也。风者，风木也，
内应足厥阴肝木；湿者，雨化也，内应于足太阴脾土；
者，火热也，内应于手少阴心火。此风、湿、 三气之所生
也。《内经》曰∶土气之下，木气乘之。是肝木乘脾土也。又曰∶厥阴所至为胁痛呕泄，
少阳所至为呕涌。注云∶食不下也。太阴所至为中满；霍乱吐下，太阴所至为濡化也。注云∶湿化
也。又曰∶太阴所至为湿生，终为注雨。故转筋者，风主肝，肝主筋，风急甚，故转筋也。
吐者， 也。火主心，心主炎上，故呕吐也。泄注者，土
主湿，湿主脾，湿下注，故泄注也。此三者，岂非风、湿、 ？如书生鼎足
题耶？脾湿土气，为风木所克，土化不行矣。亢无雨，火盛过极，土怒发焉。极
则为雷霆、骤雨、烈风。盖土气在上，木气乘之故也。是以大水横流，山崩岸落，石迸沙飞
，岂非太阴湿土怒发之象耶？故人病心腹满胀，肠鸣而为数便，甚则心痛胁
，呕吐霍乱，厥发则注下、 肿、身重。启玄子云∶已上病证，皆脾热所生也。乃知巢氏所论，正与《素问》、
启玄子相违。
故《内经》治法，
病急则治其标，缓则治其本。先可用淡剂流其湿，辛凉以退其风，咸苦以解其
，冰水以救其内涸，大忌食粟米粥，饮者立死。伟哉，王冰之言！脾热一句，可以为方。
世俗止知取其头巾而濯之，以饮其水，亦取黑豆皂矾，头垢寒凉，然
近似终不足以制其甚也。又有以寒水沃其手足者，大非也。四肢已厥，更以寒水沃之，则益
厥矣！曷若以寒水沃其心之为愈也。
泰和间，余亲见陈下广济禅院，其主僧病霍乱。一方士
用附子一枚及两者，干姜一两（炮），水一碗，同煎，放冷服之，服讫，呕血而死，顷合流
镇李彦甫，中夜忽作吐泻，自取理中丸而服之，医者至，以为有食积，以巴豆下之，三、五丸药亦
不动，至明而死，可不哀哉！遂平李仲安，携一仆一佃客，至郾城，夜宿邵辅之书斋中。是夜，
仆逃，仲安觉，其逃也，骑马与佃客往临颖急追之。时七月，天大热，炎风如箭，埃尘幔天，
至辰时而还，曾不及三时，往返百二十里。既不获其人，复宿于邵氏斋。忽夜间闻呻呼之声，
但言救我，不知其谁也。执火寻之，乃仲安之佃客也。上吐下泄，目上视而不下，胸胁痛不
可动摇，口欠而脱臼，四肢厥冷。此正风、湿、 三者，俱
合之证也。其婿曾闻余言，乃取六一散，以新汲水锉生姜而调之，顿服半升，其人复吐。乃
再调半升，而令徐服之，良久方息。至明，又饮数服，遂能调养，三日平复而去。呜呼！若
此三人，其生死岂不如反掌哉？彼世医往往以谓六一散，治得其病，此无学之辈也，可胜恨哉！
巢元方是先贤，本来不应受到非议。然而他的学说中有错误之处，这关系到人的性命，不能不加以辨析。现在的医生，家家把《诸病源候论》当作准则。唉！为什么现在的人相信巢元方，却不相信《素问》呢？对此，我不得不进行解说。况且巢元方论述霍乱、吐泻，都认为是由温凉不调，阴阳清浊二气相互干扰，导致肠胃之间发生变化而成为霍乱。寒气客居在脾则导致腹泻，寒气客居在胃则导致呕吐。也有的因为饮酒吃肉，生腥冷食过度；或者因为居住在坐卧潮湿之地，对着风取凉，风气归于三焦，传送到脾胃，脾胃受冷，水谷不能消化，都形成霍乱。它的名称有三种：一是胃反，胃气虚逆，反而吐出饮食；二是霍乱，说它发病挥霍之间，便导致撩乱；三是晡食变逆者。患霍乱的，脉象必定出现代脉。又说：七月间吃蜂蜜，使人突发下利霍乱。这些都是巢元方关于霍乱的论述。
我认为不是这样。医生治病，就像书生做文章命题。如“秋伤于湿，冬生咳嗽”，这是独以湿邪为主，这是书生做的独脚题（单一主题的题目）；风湿热三气合而成霍乱，出现吐泻转筋，这就像书生做的鼎足题（三个并列主题的题目）。风，属于风木，内应足厥阴肝木；湿，属于雨化，内应于足太阴脾土；火，属于火热，内应于手少阴心火。这就是风、湿、火三气产生的原因。《内经》说：土气之下，木气乘之。这是肝木乘袭脾土。又说：厥阴所至为胁痛呕泄，少阳所至为呕涌。注解说：食物不下。太阴所至为中满；霍乱吐下，太阴所至为濡化。注解说：湿化。又说：太阴所至为湿生，终为注雨。所以转筋的，是风主肝，肝主筋，风急甚，所以转筋。呕吐的，是火主心，心主炎上，所以呕吐。泄泻的，是土主湿，湿主脾，湿下注，所以泄泻。这三者，难道不是风、湿、火吗？如同书生的鼎足题一样。脾湿土气，被风木所克，土化不行。亢旱无雨，火盛过极，土怒发焉。极则为雷霆、骤雨、烈风。盖因土气在上，木气乘之的缘故。所以大水横流，山崩岸落，石迸沙飞，难道不是太阴湿土怒发之象吗？所以人患病心腹满胀，肠鸣而为数便，甚则心痛胁痛，呕吐霍乱，厥发作则注下、浮肿、身重。启玄子（王冰）说：以上病证，都是脾热所生。由此可知巢元方的论述，正与《素问》、启玄子相违背。
所以《内经》的治疗法则，病急则治其标，缓则治其本。先用淡剂流通其湿，辛凉以退其风，咸苦以解其火，冰水以救其内涸，大忌食粟米粥，饮者立死。王冰的话真伟大啊！“脾热”一句，可以作为处方依据。世俗之人只知道取其头巾来洗涤，用洗头的水给病人喝，也是取黑豆皂矾、头垢等寒凉之物，虽然近似，但终究不足以制伏其严重的病情。又有用冷水浇泼手足的，这非常不对。四肢已经厥冷，再用冷水浇泼，则更加厥冷！不如用冷水浇泼心脏更为适宜。
泰和年间，我亲眼见到陈州下广济禅院，其主持僧人患霍乱。一位方士用附子一枚及二两，干姜一两（炮制），水一碗，同煎，放冷后服用，服完后，呕血而死。不久，合流镇李彦甫，半夜忽然发生吐泻，自己取理中丸服用，医生到了，认为有食积，用巴豆攻下，三、五丸药也不动，到第二天早晨死亡，岂不可哀！遂平人李仲安，带着一名仆人和一名佃客，到郾城，夜间住宿在邵辅之书斋中。这天夜里，仆人逃跑，李仲安发觉，他起床，骑马与佃客前往临颖紧急追赶。当时是七月，天气大热，热风如箭，埃尘漫天，到辰时才回来，总共不到三个时辰，往返一百二十里。既然没抓到那人，又宿在邵氏书斋。忽然夜间听到呻吟呼救之声，只说救我，不知是谁。拿着火把寻找，原来是李仲安的佃客。上吐下泻，眼球上视而不向下看，胸胁痛不可动摇，张口且脱臼，四肢厥冷。这正是风、湿、火三者俱合的证候。他的女婿曾听过我的话，于是取六一散，用新汲水切碎生姜调和后给他服用，一次性服用半升，病人又呕吐。于是再调半升，让他慢慢服用，很久才停止。到第二天早上，又喝了几服，于是能够调养，三天后痊愈离去。唉！像这三个人，他们的生死难道不像翻手掌那样快吗？那些世间的医生往往认为六一散治对了病，这是无学问之辈，怎能不令人痛恨呢！
Chao Yuanfang was a sage of the past, and originally should not have been criticized. However, his theories contain errors; since human life is at stake, these must be distinguished and clarified. Physicians today take his work as their standard in every household. Alas! Why do people of today trust Chao Yuanfang but not the *Suwen* (Basic Questions)? On this matter, I feel compelled to offer an explanation. Chao Yuanfang discusses Huoluan (cholera-like syndrome with vomiting and diarrhea) and vomiting/diarrhea, attributing them all to imbalance of warmth and cold, and the mutual interference of yin and yang, clear and turbid qi, causing changes in the intestines and stomach that result in Huoluan. When cold qi lodges in the Spleen, it causes diarrhea; when cold qi lodges in the Stomach, it causes vomiting. It can also arise from excessive consumption of alcohol, meat, raw fish, and cold foods; or from living, sitting, or lying on damp ground, seeking coolness by facing the wind. The pathogenic wind qi returns to the Sanjiao (Triple Burner), transmits to the Spleen and Stomach, where the Spleen and Stomach become cold, failing to digest water and grain, all resulting in Huoluan. There are three names for it: first, Weifan (Stomach Reversal), where Stomach qi is deficient and rebellious, causing food and drink to be vomited up; second, Huoluan, describing how the disease causes chaos suddenly and swiftly; third, Bushi Bianni (Reversal after evening meal). In cases of Huoluan, the pulse must be Dai (intermittent). He also stated: Eating honey in the seventh month causes sudden severe diarrhea and Huoluan. These are all Chao Yuanfang’s theories on Huoluan.
I believe this is incorrect. Treating diseases is like a scholar composing an essay based on a topic. For example, “Autumn injury by dampness leads to winter cough” focuses solely on dampness; this is like a single-legged topic (a single-theme prompt). However, Huoluan caused by the combination of Wind, Dampness, and Fire, presenting with vomiting, diarrhea, and muscle cramps, is like a tripod topic (a three-part parallel theme). Wind belongs to Wood, internally corresponding to Foot Jueyin Liver Wood; Dampness belongs to Rain transformation, internally corresponding to Foot Taiyin Spleen Earth; Fire belongs to Heat/Fire, internally corresponding to Hand Shaoyin Heart Fire. This is the origin of Wind, Dampness, and Fire. The *Neijing* states: “When Earth qi is below, Wood qi overcomes it.” This means Liver Wood overcomes Spleen Earth. It also states: “Jueyin arrival manifests as hypochondriac pain, vomiting, and diarrhea; Shaoyang arrival manifests as vomiting and gurgling.” The commentary notes: “Inability to eat.” “Taiyin arrival manifests as abdominal fullness; Huoluan with vomiting and downward discharge, Taiyin arrival manifests as moist transformation.” The commentary notes: “Damp transformation.” It further states: “Taiyin arrival generates dampness, ultimately manifesting as pouring rain.” Therefore, muscle cramps are governed by Wind and the Liver; the Liver governs tendons, and extreme Wind causes cramping. Vomiting is governed by Fire and the Heart; the Heart governs upward flaming, causing vomiting. Diarrhea is governed by Earth and Dampness; Dampness governs the Spleen, and downward-flowing Dampness causes diarrhea. Are these three not Wind, Dampness, and Fire? Like a scholar’s tripod topic? Spleen Damp-Earth is overcome by Wind-Wood, so Earth transformation fails. In drought without rain, Fire becomes excessively strong, causing Earth to rage. Extreme rage manifests as thunder, sudden rain, and fierce winds. Because Earth qi is above and Wood qi overcomes it. Thus, floods flowing horizontally, mountains collapsing, banks falling, stones bursting, and sand flying—are these not images of Taiyin Damp-Earth raging? Therefore, when humans suffer from heart and abdominal distension, borborygmus, and frequent stools, progressing to heart pain and hypochondriac pain, vomiting, Huoluan, and when Jue occurs, there is profuse diarrhea, edema, and heaviness of the body. Qixuanzi (Wang Bing) said: “The above symptoms are all generated by Spleen Heat.” Thus, we know Chao Yuanfang’s discussion contradicts the *Suwen* and Qixuanzi.
Therefore, the treatment method in the *Neijing* is: if the disease is acute, treat its branch (symptoms); if chronic, treat its root (cause). Initially, use bland agents to circulate Dampness, acrid-cool agents to dissipate Wind, salty-bitter agents to resolve Fire, and ice-cold water to rescue internal dryness. One must strictly avoid eating millet porridge; those who drink it will die immediately. How great are Wang Bing’s words! The phrase “Spleen Heat” can serve as a prescription basis. Laypeople only know to wash headscarves and give the wash water to patients, or use black beans, iron alum, and head dandruff—cold and cooling substances. Although similar, they are ultimately insufficient to control severe conditions. Some use cold water to pour on hands and feet, which is very wrong. If limbs are already Jue (cold extremities), pouring cold water makes them colder! It would be better to pour cold water on the Heart region.
During the Taihe era, I personally witnessed the abbot of Xiaguangji Zen Temple in Chen Prefecture suffering from Huoluan. A physician used one liang of Fuzi (Prepared Aconite Root) and two liang of Ganjiang (Dried Ginger, processed), boiled in one bowl of water, allowed to cool, and administered orally. After taking it, the patient vomited blood and died. Shortly after, Li Yanfu of Heliu Town suffered sudden vomiting and diarrhea in the middle of the night. He took Lizhong Wan (Regulate the Middle Pill) himself. When the doctor arrived, he diagnosed food stagnation and used Radix Crotonis Fructus (Badou) to purge him. Three to five pills had no effect, and he died by morning. Is this not tragic! Li Zhongan of Suiping, accompanied by a servant and a tenant farmer, traveled to Yancheng. They stayed overnight in Shao Fu’s study. That night, the servant fled. Li Zhongan woke up, mounted a horse, and chased the servant with the tenant farmer toward Linying urgently. It was July, extremely hot, with scorching winds like arrows and dust filling the sky. They returned by Chen hour, taking less than three shichen (six hours), covering 120 li round trip. Having failed to catch the servant, they stayed again at Shao’s study. Suddenly, in the night, groaning and cries for help were heard, saying “Save me,” but the source was unknown. Holding a torch to search, they found Li Zhongan’s tenant farmer. He was vomiting and having diarrhea, eyes fixed upward, unable to look down, severe chest and hypochondriac pain preventing movement, mouth open with dislocated jaw, and cold extremities. This was precisely a syndrome where Wind, Dampness, and Fire combined. His son-in-law, having heard my words, took Liu Yi San (Six-to-One Powder), mixed it with fresh well water and chopped fresh ginger, and administered half sheng at once. The patient vomited again. So another half sheng was prepared and given slowly. After a long time, the symptoms ceased. By morning, after several more doses, he could recover. He recovered completely in three days and left. Alas! For these three individuals, did their lives and deaths not change as quickly as flipping a hand? Worldly physicians often claim that Liu Yi San treated the disease correctly; such unlearned people are truly hateful!