干霍乱心腹绞痛，欲吐不吐，欲泻不泻，俗名绞肠痧，不急救即死，治法宜饮盐汤探吐
，外治刺委中穴亦妙。此证王宇泰《证治准绳》谓由脾土郁极不得发，以致火热内扰，阴阳不交
，而吴鞠通《温病条辨》谓由伏阴与湿相搏，证有阴而无阳，方用蜀椒、附子、干姜等药。
窃谓干霍乱，亦如湿霍乱，有寒有热，当审证施治，不得专主热剂，吴氏书阐发治温病之法
，辨论详晰，卓然成一家言，惟此论尚局于偏，恐误来学，特正之。
（炳章）按∶干霍乱每多挟食挟痰，兼中温秽，探吐以通其上膈，针刺以通其经络，宣达
二便以通下焦之塞，上下内外皆通畅，则病自愈矣。凡阴寒多是绵绵腹痛，暴痛甚少，临证宜审
鸦胆子治休息痢，歙《程杏轩文囿医案》甚称其功效，用三十粒去壳取仁，外包龙眼肉捻丸
，每晨米汤送下一二服，或三四服即愈。此药味大苦而寒，力能至大肠曲折之处，搜逐湿热
，《本草》不载，见于《幼幼集成》，称为至圣丹，即苦参子也，药肆多有之。吾里名医张
云寰先生李瀛，亦尝以此方传人，吾母周太孺人，喜施方药，以治休息痢，无不应验，兼治
肠风便血，凡热痢色赤，久不愈者，亦可治，惟虚寒下痢忌之。
（炳章）按∶苦参子仁治肠热便血，及热痢久不愈，余亦治验多人，惟余用每次十四粒，
龙眼肉七枚，分包吞服，两服即愈。
干霍乱表现为心腹剧烈绞痛，想吐却吐不出来，想拉却拉不出来，俗称绞肠痧，如果不紧急救治就会死亡，治疗方法适宜饮用盐汤催吐，外治法针刺委中穴也很有效。此证王宇泰在《证治准绳》中认为是由脾土郁结至极无法发泄，导致火热内扰，阴阳不能交通；而吴鞠通在《温病条辨》中认为是由伏匿的阴寒与湿气相互搏结，证候只有阴寒而没有阳气，方剂使用蜀椒、附子、干姜等药物。
我私下认为干霍乱也像湿霍乱一样，有寒证也有热证，应当审查证候来施治，不能专门主张使用热性药剂。吴氏的书阐发了治疗温病的方法，辨析论述详细清晰，卓越地自成一家之言，只是这一论点还局限于偏颇，恐怕误导后学，特此纠正。
（炳章）按语：干霍乱往往多兼夹食积和痰饮，同时感受温热秽浊之气，用探吐的方法来疏通上膈，用针刺的方法来疏通经络，宣通下达二便以疏通下焦的闭塞，上下内外都通畅了，病自然就好了。凡是阴寒证多是绵绵不断的腹痛，突然剧痛很少见，临证时应当仔细审察。
鸦胆子治疗休息痢，歙县程杏轩的《文囿医案》非常称赞其功效，用法是用三十粒去壳取仁，外包龙眼肉搓成丸，每晨用米汤送服一二丸，或者三四丸即可痊愈。此药味道大苦且性寒，力量能到达大肠曲折之处，搜逐湿热，《本草》未记载，见于《幼幼集成》，称为至圣丹，也就是苦参子，药店里多有售卖。我们乡里的名医张云寰先生李瀛，也曾以此方传授给人，我的母亲周太孺人，喜欢施赠方药，用它治疗休息痢，没有不灵验的，兼治肠风便血，凡是热痢颜色红赤，久治不愈的，也可以治疗，唯独虚寒下痢禁忌使用。
（炳章）按语：苦参子仁治疗肠热便血，以及热痢久治不愈，我也治愈过多人，只是我每次使用十四粒，配七枚龙眼肉，分包吞服，两服即痊愈。
Dry Huoluan (Jueyu) presents with severe colicky pain in the heart and abdomen, a desire to vomit but inability to do so, and a desire to defecate but inability to do so. It is commonly known as "Intestinal Cramping Sha" (Jiaochang Sha). If not treated urgently, it leads to death. The treatment method involves drinking salt water to induce vomiting; external treatment by needling the Weizhong (BL40) acupoint is also effective. Regarding this syndrome, Wang Yutai in *Zhengzhi Zhunsheng* (Standard of Diagnosis and Treatment) attributes it to extreme stagnation of Spleen Earth failing to vent, leading to internal disturbance by fire-heat and failure of Yin and Yang to interact. Wu Jutong in *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) attributes it to latent Yin clashing with dampness, resulting in a syndrome characterized solely by Yin cold without Yang. The prescribed formula uses Sichuan Pepper (Shu Jiao), Aconite Root (Fuzi), and Dried Ginger (Ganjiang), among other herbs.
I personally believe that Dry Huoluan, like Wet Huoluan, can present as either Cold or Heat syndromes. Treatment must be based on careful pattern differentiation, and one should not exclusively advocate for hot-natured formulas. Although Mr. Wu’s book excellently elucidates methods for treating Warm Diseases with detailed and clear differentiation, establishing a unique school of thought, his argument on this specific point remains biased and may mislead future practitioners. I hereby correct this view.
(Bingzhang) Note: Dry Huoluan often complicates with food retention and phlegm, combined with invasion by warm-turbid pathogens. Inducing vomiting via probing opens the upper jiao; acupuncture unblocks the meridians; promoting urination and defecation clears blockage in the lower jiao. When the upper, lower, interior, and exterior are all unblocked, the disease resolves spontaneously. Yin-cold syndromes typically manifest as lingering, dull abdominal pain; sudden severe pain is rare. Clinical examination requires careful scrutiny.
Yadanzi (Brucea javanica Seed) treats Xixili (Dysentery with intermittent course). Cheng Xingxuan's *Wenyu Yi'an* highly praises its efficacy. The dosage is thirty seeds, shelled to extract the kernel, wrapped in Longan Aril (Longyan Rou), rolled into pills, and taken orally once or twice daily with rice gruel, or three to four times daily until recovery. This herb is extremely bitter and cold in nature. Its potency reaches the convoluted parts of the Large Intestine to search out and expel damp-heat. It is not recorded in the *Bencao* (Materia Medica) but appears in *Youyou Jicheng*, where it is called "Supreme Holy Pill," which is also known as Kushenzi (Bitter Seed). It is widely available in pharmacies. My hometown's renowned physician, Mr. Zhang Yunhuan (Li Ying), also transmitted this prescription. My mother, Lady Zhou, who enjoyed distributing prescriptions, used it to treat Xixili with consistent success. It also treats Changfeng Bianxue (Blood in stool due to intestinal wind). For heat-dysentery presenting with red color and chronic non-resolution, it is also applicable, except in cases of deficiency-cold dysentery, which is contraindicated.
(Bingzhang) Note: I have also successfully treated multiple cases of intestinal-heat hematochezia and chronic heat-dysentery using Kushenzi kernels. However, my dosage is fourteen kernels per administration, paired with seven pieces of Longan Aril, taken separately in packets. Recovery occurs after two doses.