论
《内经》曰∶岁土不及，风乃大行，民病飧泄霍乱，体重腹痛，筋骨繇复。陈无择曰∶霍乱者，心腹卒痛，呕吐下
利，憎寒壮热，头痛眩晕，先心痛则先吐，先腹痛则先利，心腹齐痛，吐利并作，甚则转筋，入腹即死。盖阴阳反戾，
清浊相干，阳气暴升，阴气顿坠，阴阳痞隔，上下奔趋。河间曰∶吐泻不止者，其本在于中焦，或因渴而大饮，饮而过
量，或因饥而始食，食而过饱，以致湿热内甚，故阴阳交错而不和，是为吐泻。仲景曰∶邪在上焦则吐，邪在下焦则泻，
邪在中焦则既吐且泻。此为急病也，然吐泻为患，十死其一、二，如挥霍撩乱而不得吐泻者，此名干霍乱也，多死。法
日既有其入，必有所出。今有其入而不得其出者，痞塞也。故转筋吐泻者，其气有三∶一曰火，二曰风，三曰湿。大抵
霍乱吐泻之证，皆风火湿热之为害耳。治法宜分利阴阳，散风行湿而降火也。又当引清气上升，使浊气下降，无有不安。
仲景又曰∶热多欲饮水，五苓散；寒多不饮水，理中丸。河间亦曰∶凡觉此证，急用五苓益元散、桂苓甘露饮，乃吐泻
之圣药也。慎勿与粟米粥汤，入胃必死。丹溪曰∶内有所积，外有所感，阳不升，阴不降，乖隔而成，非因鬼邪，皆饮
食所致，此先哲确论也。切勿与谷食，虽米汤一呷，下咽立死。必待吐泻止，过半日饥甚，方可与稀粥少食，以渐而将
息也。学人详之。
脉法
脉微而涩，或代而散，或隐而伏，或大而虚。
脉右关滑，为霍乱吐泻。
脉结促代者，不可断以死。脉大者生。脉微弱渐迟者死。
脉洪者为热。脉弦者为饮。气口脉弦滑，膈间有宿食留饮，宜顺其性以盐汤探吐之。
方法
丹溪曰∶大法，生姜理中汤最好。有宜吐者，虽自吐利，还须以吐法提其气，用二陈汤探吐，或樟木屑煎汤，或盐
汤，皆可吐之。
一方∶苍术、浓朴、陈皮、干葛各一钱五分，水煎服。
或用姜汤下保和丸四、五十粒。
转筋属血热，四物汤加酒芩、红花、苍术、南星，煎服。
转筋，男子以手挽其阴，女子以手牵乳近两傍，此千金妙法也。
干霍乱（忽然心腹痛 ，欲吐不吐，欲泻不泻者是也，俗名 肠痧即是），难治，死在须臾，升降不通故也。宜吐以
提其气，最是良法。内有物所伤，外为邪气所遏，大法宜发汗，有用吐法者，即兼发散之义。有用温药解散者，二陈汤
加川芎、苍术、防风、白芷等解散药也。
委中穴出血，或十指头出血，皆是良法。
（以上丹溪方法凡七条）
桂苓甘露饮（河间）
五苓散（二方并见中暑门。）
半夏汤 治霍乱转筋，吐泻不止。
半夏曲 茯苓 白术（各五钱） 淡桂（二钱五分） 甘草（炙，一钱）
上为细末，每服二钱，渴者以凉水调下，不渴者以温水调下，不拘时候。
理中丸（仲景）
白术 人参 干姜 甘草（各等分）
上为细末，炼蜜为丸，如弹子大，每服一丸，凉水化下。
六和汤（河间） 治霍乱，吐泻不止。
白术 半夏（泡） 砂仁（炒） 杏仁（泡去皮尖） 人参 甘草（各五分） 赤茯苓 藿香（洗去土） 白扁豆
（姜汁拌炒） 木瓜（各一钱） 香薷 浓朴（姜汁制炒，各二钱）
上细切，加生姜三片，大枣一枚，水二盏，煎至一盏，温服。
浆水散（机要） 治暴泄如水，周身汗出尽冷，脉弱不能言语，甚而吐逆不止。
半夏（二钱） 附子 干生姜 炙甘草 桂心（各五分） 良姜（三分半）
上细切，作一服，浆水煎服之。
姜附汤（活人） 治霍乱，吐泻转筋，手足厥冷，多汗。（方见伤寒门。）
理中汤（局方） 治过食生冷，遂成霍乱吐泻，食不消，心腹满闷不快。加青皮、陈皮，名治中汤。更加丁香、
附子，名丁香治中汤。宜临病斟酌施治。（方见伤寒门。）
（祖传方）
灸法∶治霍乱已死而胸中尚有暖气者，灸之立苏。
其法，以盐填满脐孔，灸之不计壮数。
又法 治霍乱吐泻不止，灸天枢、气海、中脘四穴，立愈。
天枢二穴，在脐心两傍各开二寸。气海一穴，在脐下一寸半。中脘一穴，在脐上四寸。
洗法 治霍乱转筋。
用大蓼一握，水煮熏洗，立效。
（丹溪活套）云∶凡霍乱不渴，用生姜理中汤。如渴，用五苓散加五味子、麦门冬、滑石。转筋，用四物汤加酒芩、
红花、南星、苍术。又云∶冬月，用理中汤。夏月，用黄连香薷散，放井中浸冰冷，顿服乃效。
一方 治吐泻，用藿香、苍术、浓朴、陈皮、砂仁、白芷、甘草、半夏、茯苓、人参、炒神曲各等分，水煎。遇寒
加干姜，寒甚加附子。
论
《黄帝内经》说：如果岁运土气不足，风气就会大行，百姓容易患完谷不化的泄泻和霍乱，身体沉重、腹痛，筋骨拘急或弛缓。陈无择说：霍乱这种病，表现为心腹突然疼痛，呕吐和下利，怕冷且高热，头痛眩晕。如果先心痛则先呕吐，先腹痛则先下利；心腹同时疼痛，则呕吐和下利同时发作，严重的会出现转筋（小腿肌肉痉挛），如果邪气深入腹部就会导致死亡。这是因为阴阳逆乱，清浊之气相互干扰，阳气暴升，阴气顿坠，阴阳痞塞阻隔，上下气机奔趋紊乱。刘河间说：吐泻不止的病，根本在于中焦，可能是因为口渴而大量饮水，饮水过量；或者因为饥饿才开始进食，吃得过饱，导致湿热内盛，所以阴阳交错而不调和，这就形成了吐泻。张仲景说：邪气在上焦就会呕吐，邪气在下焦就会腹泻，邪气在中焦就会既吐又泻。这是急症，然而因吐泻致死的概率只有十分之一二；如果出现挥霍撩乱但无法呕吐或腹泻的情况，这叫做干霍乱，大多会导致死亡。医法说：既然邪气有入，必然有出。现在有邪气进入却无法排出的情况，就是痞塞不通。所以出现转筋、呕吐和腹泻的症状，其病因主要有三种：一是火，二是风，三是湿。大体上霍乱的吐泻症状，都是风、火、湿、热造成的危害。治疗方法应当分利阴阳，疏散风邪、祛除湿气并降火。还应当引导清气上升，使浊气下降，这样就没有不安稳的。张仲景又说：热多且想喝水的，用五苓散；寒多且不渴的，用理中丸。刘河间也说：凡是感觉有此症状，紧急时使用五苓益元散、桂苓甘露饮，这是治疗吐泻的神效药物。千万不要给患者喝粟米粥汤，进入胃里必然致死。朱丹溪说：体内有积滞，体外受外感，阳气不升，阴气不降，乖隔而成此病，并非因为鬼邪，都是由饮食引起的，这是前代哲人的确切结论。千万不要给予谷物食物，即使是喝一口米汤，咽下去也会立即死亡。必须等到吐泻停止，过了半天感到极度饥饿时，才可以少量喝稀粥，逐渐调养。学习中医的人要详细研究。
脉法
脉搏微细而涩，或者间歇停顿且散乱，或者隐伏难寻，或者大而虚弱。
右手关脉滑，是霍乱吐泻的脉象。
脉搏出现结、促、代象的，不能断定必死。脉大的可以生。脉微弱且逐渐变迟的会死。
脉洪大的属于热证。脉弦的属于饮邪。气口脉弦滑，说明膈间有宿食和留饮，应当顺应其势，用盐汤催吐。
方法
朱丹溪说：大法中，生姜理中汤最好。有的适合用吐法，即使患者自行呕吐下利，还需要用吐法提举气机，使用二陈汤探吐，或者用樟木屑煎汤，或者盐汤，都可以用来催吐。
或者用姜汤送服保和丸四五十粒。
转筋属于血热，用四物汤加酒炒黄芩、红花、苍术、天南星，煎服。
转筋，男子用手牵引阴部，女子用手牵拉乳房旁边，这是《千金方》中的妙法。
干霍乱（忽然心腹疼痛，想吐吐不出，想拉拉不出，俗称肠痧），难以治疗，片刻之间就会死亡，是因为升降不通的缘故。适宜用吐法来提举气机，是最好的方法。内有实物损伤，外被邪气遏制，大法宜发汗，有用吐法的，就兼有发散的意义。有用温药解散的，如二陈汤加川芎、苍术、防风、白芷等发散药物。
委中穴放血，或者十指尖放血，都是良法。
（以上丹溪的方法共七条）
半夏汤 治疗霍乱转筋，吐泻不止。
半夏曲 茯苓 白术（各五钱） 淡桂（二钱五分） 甘草（炙，一钱）
以上研为细末，每次服用二钱，口渴的用凉水调服，不渴的用温水调服，不拘时间。
理中丸（张仲景创制）
白术 人参 干姜 甘草（各等分）
以上研为细末，炼蜜为丸，如弹子大小，每次服用一丸，用凉水化开服用。
六和汤（刘河间创制） 治疗霍乱，吐泻不止。
白术 半夏（泡） 砂仁（炒） 杏仁（泡去皮尖） 人参 甘草（各五分） 赤茯苓 藿香（洗去泥土） 白扁豆（姜汁拌炒） 木瓜（各一钱） 香薷 浓朴（姜汁制炒，各二钱）
以上细切，加生姜三片，大枣一枚，水两盏，煎至一盏，温服。
浆水散（出自《卫生宝鉴·机要》） 治疗暴注下泄如水，周身出汗且四肢冰冷，脉弱不能言语，甚至呕吐逆止不住。
半夏（二钱） 附子 干生姜 炙甘草 桂心（各五分） 良姜（三分半）
以上细切，作一服，用浆水煎服。
姜附汤（出自《伤寒百问·活人书》） 治疗霍乱，吐泻转筋，手足厥冷，多汗。（方剂见伤寒门。）
理中汤（出自《太平惠民和剂局方》） 治疗过食生冷，遂成霍乱吐泻，食物不消化，心腹满闷不适。加入青皮、陈皮，名叫治中汤。再加入丁香、附子，名叫丁香治中汤。应当根据病情斟酌施治。（方剂见伤寒门。）
（祖传方）
灸法：治疗霍乱看似已死但胸中尚有余温者，艾灸后可立即苏醒。
其方法是，用盐填满肚脐孔，艾灸不计壮数。
又一种方法：治疗霍乱吐泻不止，灸天枢、气海、中脘四个穴位，可立即痊愈。
天枢两个穴位，在肚脐两旁各开二寸。气海一个穴位，在脐下一寸半。中脘一个穴位，在脐上四寸。
（朱丹溪的灵活变通之法）说：凡是霍乱不口渴的，用生姜理中汤。如果口渴，用五苓散加五味子、麦门冬、滑石。转筋的，用四物汤加酒炒黄芩、红花、天南星、苍术。又说：冬季，用理中汤。夏季，用黄连香薷散，放入井水中浸冷，一次性服用才有效。
一方：治疗吐泻，用藿香、苍术、浓朴、陈皮、砂仁、白芷、甘草、半夏、茯苓、人参、炒神曲各等分，水煎。遇寒加干姜，寒甚加附子。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Earth element of the year is deficient, wind qi will prevail greatly, and the people will suffer from undigested diarrhea (Sunxie) and Huoluan (cholera-like syndrome), heavy body, abdominal pain, and spasms or flaccidity of the sinews and bones. Chen Wuyue said: Huoluan is characterized by sudden pain in the heart and abdomen, vomiting and diarrhea, aversion to cold with high fever, headache, and dizziness. If heart pain occurs first, vomiting occurs first; if abdominal pain occurs first, diarrhea occurs first. If both heart and abdomen hurt simultaneously, vomiting and diarrhea occur together. In severe cases, muscle cramps (Zhuanjin) occur, and if the pathogen enters the interior, death ensues. This is due to the reversal of yin and yang, the interference of clear and turbid qi, the violent rising of yang qi, and the sudden sinking of yin qi, causing yin-yang obstruction and chaotic movement of qi up and down. Liu Wan-su said: The root of persistent vomiting and diarrhea lies in the Middle Jiao. It may be caused by drinking excessively when thirsty, or eating too much when hungry, leading to severe internal damp-heat. Thus, yin and yang are disordered and not harmonious, resulting in vomiting and diarrhea. Zhang Zhongjing said: Pathogens in the Upper Jiao cause vomiting; pathogens in the Lower Jiao cause diarrhea; pathogens in the Middle Jiao cause both vomiting and diarrhea. This is an acute condition. However, among those suffering from vomiting and diarrhea, only one or two out of ten die. If there is chaotic turmoil but no ability to vomit or defecate, this is called Dry Huoluan (Gan Huoluan), which often leads to death. Medical laws state: "Since there is entry, there must be exit." Now, if there is entry but no exit, it is blockage. Therefore, the causes of muscle cramps, vomiting, and diarrhea are threefold: Fire, Wind, and Dampness. Generally, the symptoms of Huoluan vomiting and diarrhea are all harmful effects of Wind, Fire, Dampness, and Heat. The treatment method should involve separating and regulating yin and yang, dispersing wind and drying dampness while descending fire. One should also guide clear qi to rise and turbid qi to descend, ensuring peace and stability. Zhang Zhongjing further stated: For cases with more heat and thirst for water, use Wu Ling San (Five-Ingredient Powder with Poria); for cases with more cold and no thirst, use Li Zhong Wan (Regulate the Middle Pill). Liu Wan-su also said: Whenever these symptoms are felt, urgently use Wu Ling Yi Yuan San (Five-Ingredient Powder Plus Yuan Yin Granules) or Gui Ling Gan Lu Yin (Cinnamon Twig, Poria, and Dew Drink), which are miraculous medicines for vomiting and diarrhea. Do not give millet porridge or soup; entering the stomach, it will certainly cause death. Zhu Danxi said: Internal accumulation combined with external contraction, where yang fails to ascend and yin fails to descend, creates this disorder. It is not due to ghosts or evil spirits, but caused by diet. This is a definitive conclusion from ancient sages. Do not give grain food; even a sip of rice water, once swallowed, will lead to immediate death. Only after vomiting and diarrhea cease, and half a day later when extreme hunger sets in, can one consume a small amount of thin porridge, gradually recuperating. Students of medicine should study this carefully.
Pulse Diagnosis
A pulse that is fine and choppy, or intermittent and scattered, or hidden and deep, or large and empty.
A slippery pulse at the Right Guan position indicates Huoluan with vomiting and diarrhea.
An intermittent (Jie), rapid-intermittent (Cu), or fixed-interval-intermittent (Dai) pulse does not necessarily indicate death. A large pulse suggests survival. A weak, thready pulse that gradually becomes slow indicates death.
A surging (Hong) pulse indicates Heat. A string-taut (Xian) pulse indicates Fluid retention. A string-taut and slippery pulse at the Qi Kou position indicates retained food and fluids in the diaphragm area; one should follow its nature and induce vomiting with salt water.
Methods
Zhu Danxi said: The general principle favors Sheng Jiang Li Zhong Tang (Fresh Ginger Regulate-the-Middle Decoction). For cases suitable for emesis, even if spontaneous vomiting and diarrhea occur, one must still use emetic methods to lift the qi. Use Er Chen Tang (Two-Cured Decoction) to probe for vomiting, or decocted camphor wood chips, or salt water, all of which can induce vomiting.
Prescription 1: Cang Zhu (Atractylodis Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Chen Pi (Citri Reticulatae Pericarpium), Ge Gen (Puerariae Lobatae Radix) each 1 qian 5 fen. Decoct in water and take orally.
Alternatively, swallow 40-50 Bao He Wan (Preserve Harmony Pills) with ginger water.
Muscle cramps (Zhuanjin) belong to Blood Heat. Use Si Wu Tang (Four-Substance Decoction) plus wine-fried Huang Qin (Scutellariae Radix), Hong Hua (Carthami Flos), Cang Zhu (Atractylodis Rhizoma), and Nan Xing (Arisaematis Rhizoma Praeparatum). Decoct and take.
For muscle cramps, men should pull their genitals with their hands, and women should pull near their breasts with their hands. This is a wonderful method from *Qian Jin Fang*.
Dry Huoluan (Sudden heart and abdominal pain, desire to vomit but unable, desire to defecate but unable, commonly known as Intestinal Sha) is difficult to treat and death occurs within moments due to the failure of ascending and descending mechanisms. Inducing vomiting to lift the qi is the best method. There is internal injury from substances and external constraint by pathogens. The general method favors sweating; using emesis implies dispersing. Using warm medicines to resolve involves formulas like Er Chen Tang (Two-Cured Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma), Fang Feng (Saposhnikoviae Radix), Bai Zhi (Angelicae Dahuricae Radix) and other dispersing drugs.
Bleeding from Wei Zhong (BL40) or the tips of the ten fingers are both good methods.
(Above are seven methods from Danxi.)
Gui Ling Gan Lu Yin (by Liu Wan-su)
Wu Ling San (Both formulas are seen in the Summerheat chapter.)
Ban Xia Tang (Pinellia Decoction) Treats Huoluan with muscle cramps and persistent vomiting and diarrhea.
Ban Xia Qu (Prepared Pinellia Curd), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (each 5 qian), Dan Gui (Light Cinnamon Twig) (2 qian 5 fen), Gan Cao (Licorice Root, honey-fried) (1 qian).
Grind into fine powder. Take 2 qian per dose. If thirsty, mix with cool water; if not thirsty, mix with warm water. Take at any time.
Li Zhong Wan (Regulate-the-Middle Pill) (by Zhang Zhongjing)
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Gan Jiang (Dried Ginger), Gan Cao (Licorice Root) (equal parts).
Grind into fine powder, make pills with refined honey, size of a bullet. Take one pill per dose, dissolve in cool water.
Liu He Tang (Six-Harmony Decoction) (by Liu Wan-su) Treats Huoluan with persistent vomiting and diarrhea.
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ban Xia (Pinelliae Rhizoma Praeparatum), Sha Ren (Amomi Fructus, stir-fried), Xing Ren (Prunus Armeniacae Semen, soaked, skin and tips removed), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Licorice Root, honey-fried) (each 5 fen), Chi Fu Ling (Red Poria), Huo Xiang (Agastaches Herba, washed free of soil), Bai Bian Dou (Dolichos Lablab Seed, stir-fried with ginger juice), Mu Gua (Chaenomelis Fructus) (each 1 qian), Xiang Ru (Moslae Herba), Hou Po (Magnoliae Officinalis Cortex, processed with ginger juice and stir-fried) (each 2 qian).
Cut finely, add 3 slices of fresh ginger and 1 jujube. Decoct in 2 cups of water until 1 cup remains. Take warm.
Jiang Shui San (Fermented Grain Water Powder) (from *Ji Yao*) Treats sudden watery diarrhea, profuse sweating with cold limbs, weak pulse unable to speak, and even persistent vomiting.
Ban Xia (Pinelliae Rhizoma Praeparatum) (2 qian), Fu Zi (Aconiti Lateralis Radix Praeparata), Gan Sheng Jiang (Dried Fresh Ginger), Zhi Gan Cao (Licorice Root, honey-fried), Gui Xin (Cinnamon Twig Heart) (each 5 fen), Liang Jiang (Alpiniae Officinarum Rhizoma) (3 fen 5 li).
Cut finely, prepare as one dose. Decoct in fermented grain water (Jiang Shui) and take.
Jiang Fu Tang (Ginger and Aconite Decoction) (from *Huo Ren*) Treats Huoluan with vomiting, diarrhea, muscle cramps, cold limbs, and excessive sweating. (Formula seen in the Cold Damage chapter.)
Li Zhong Tang (Regulate-the-Middle Decoction) (from *Ju Fang*) Treats Huoluan and diarrhea caused by overeating raw/cold foods, indigestion, and abdominal fullness/discomfort. Add Qing Pi (Tangerine Peel, immature) and Chen Pi (Citri Reticulatae Pericarpium), named Zhi Zhong Tang (Regulate-the-Middle Decoction). Further add Ding Xiang (Caryophylli Flos) and Fu Zi (Aconiti Lateralis Radix Praeparata), named Ding Xiang Zhi Zhong Tang (Clove Regulate-the-Middle Decoction). Adjust treatment according to the disease. (Formula seen in the Cold Damage chapter.)
(Ancestral Prescription)
Moxibustion Method: Treats Huoluan where the patient appears dead but warmth remains in the chest. Moxibustion will revive them immediately.
Method: Fill the navel cavity with salt, then moxa. Number of cones is not limited.
Another Method: Treats persistent Huoluan vomiting and diarrhea. Moxa Tian Shu (ST25), Qi Hai (CV6), and Zhong Wan (CV12). Cure is immediate.
Tian Shu (2 points): 2 cun lateral to the center of the umbilicus. Qi Hai (1 point): 1.5 cun below the umbilicus. Zhong Wan (1 point): 4 cun above the umbilicus.
Washing Method: Treats Huoluan with muscle cramps.
Use a handful of Da Liao (Polygoni Multiflori Caulis), boil in water, steam and wash. Effect is immediate.
(Zhu Danxi's Flexible Methods) states: For Huoluan without thirst, use Sheng Jiang Li Zhong Tang (Fresh Ginger Regulate-the-Middle Decoction). If thirsty, use Wu Ling San (Five-Ingredient Powder with Poria) added with Wu Wei Zi (Schisandrae Chinensis Fructus), Mai Men Dong (Ophiopogonis Tuber), and Hua Shi (Talcum). For muscle cramps, use Si Wu Tang (Four-Substance Decoction) added with wine-fried Huang Qin (Scutellariae Radix), Hong Hua (Carthami Flos), Nan Xing (Arisaematis Rhizoma Praeparatum), and Cang Zhu (Atractylodis Rhizoma). Also states: In winter, use Li Zhong Tang (Regulate-the-Middle Decoction). In summer, use Huang Lian Xiang Ru San (Coptis and Mosla Powder), soak in well water until cold, and take in one dose for efficacy.
Prescription: Treats vomiting and diarrhea. Use Huo Xiang (Agastaches Herba), Cang Zhu (Atractylodis Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Chen Pi (Citri Reticulatae Pericarpium), Sha Ren (Amomi Fructus), Bai Zhi (Angelicae Dahuricae Radix), Gan Cao (Licorice Root), Ban Xia (Pinelliae Rhizoma Praeparatum), Fu Ling (Poria), Ren Shen (Ginseng Radix et Rhizoma), Chao Shen Qu (Stir-fried Massa Medicata Fermentata) in equal parts. Decoct in water. Add Gan Jiang (Dried Ginger) for cold; add Fu Zi (Aconiti Lateralis Radix Praeparata) for severe cold.