霍，言其手足之扰动，如挥霍也；乱，言其内之邪正变乱也。其证心腹卒痛，
或吐或泻，或吐泻交作，甚则两足转筋，转筋甚而从足入腹，或通身筋皆转，舌卷
囊缩者死。若无吐泻，而止转筋腹痛者，名干霍乱，即俗所谓搅肠痧也。病由邪气
结滞中焦，阻隔上下，正气不通。上之阳气不得下通于阴，则上壅，故吐。下之阴
气不得上通于阳，则下迫，故泻也。（此言阳上阴下之阻隔也，亦有阴上阳下者，
又有阴阳参错，清浊
邪正混淆，寒热互争，彼此拒格不通者，于是血气营卫之行失次，彼顺此逆，
搏击于中矣。）上吐下泻，则中
焦之邪得以分消，有不药亦愈者。若邪气炽盛，吐泻适足虚其正气，邪愈结而不运
矣。转筋由筋中素蕴火邪，血液久虚所致，然未遽然也。若因霍乱吐泻，顿亡津液，
则血液之虚者愈虚。或不因吐泻，而外冒风寒，腠理闭密，热气怫郁激发，则火邪
之烈者愈烈，（干霍乱之转筋，及寻常转筋以此。）于是挛缩急痛，而不可忍矣。
观其情形急暴，
属火无疑。或以为寒，谓寒则收引，不知收引特拘急牵强耳，与转筋之挛痛异常者
不同，乌可混哉。或疑转筋多在足，明属阴寒。盖足居下部，属阴多寒，又感
风寒，筋脉收引劲急。霍乱不论寒证热证，皆邪结中焦，阳气不能下达，两足必冷，
故每转筋。若果由火热，则是筋皆转矣，何独足乎？此论足独转筋由于寒，亦有理，
然谓一于寒，而中无火邪，则非矣。若无火邪，则阴凝而静，断无躁急转戾之理。
且霍乱乃脾胃病，故足独转筋，不可谓必由于寒也。丹溪治遍身转筋入肚，作极咸
盐汤于槽中暖浸，以润其燥。（血热也，寒而劲急者，亦可用以软坚。）治霍乱当审其为何邪。河
间谓为热甚所致，火性躁暴也。凡暴病暴死，皆属于火也。《准绳》谓以脾湿为
本，脾湿盛则亦郁而生热也。张子和则以风湿热三气合而为邪，盖脾湿土，为肝风
木所克，（肝木清气，为湿所遏，不得升，不升则湿愈不行，若受木克者然。）
郁为热而暴发，发则心火
上炎，故吐，脾湿下流，故泻也。王海藏亦谓，风湿热与食相合为邪。《明理
论》则谓他病霍乱，多由饮食所伤，若伤寒霍乱，则由邪入中焦，胃气不和，因之
阴阳痞隔而致。诸公之论，当兼采之，不可执一说以误人也。大抵夏秋之交，
最多此证。盖夏月人多食冷冻饮料水，其寒湿之气，与暑热之气，交抟胃中，是为寒热
不和，即无所郁遏，亦将久而病发。若外感风寒，内伤饮食，则闭滞不行，其发也
暴矣。病之将作，必先腹中 痛，痛高近心则先吐，痛下近脐则先泻。因冒风则恶
风有汗，因冒寒则恶寒无汗，冒湿则身体重着，伤暑则心神烦躁。问其曾否食过
何物，曾否七情动气，更分寒热虚实治之。气少唇青肉寒，四肢拘急，畏冷喜热，
脉沉迟，人事清醒者，寒也，（霍乱暴证，原属于火，但火由寒激，发则火泄而寒
独存也。）理中汤（见中
寒。）脉绝者，通脉四逆汤（见厥）。吐利不止，元气耗散，格阳于外，或口渴喜冷，得水
则不能饮，或发热烦躁，欲去衣被，不可误以为热，宜理中汤，甚则附子理中汤，
（并见中寒。）不效则四逆汤（见厥），并宜放十分冷服。转筋者，理中汤去术，加生附子一枚。
或理中汤加冻胶锉炒一钱。（血为寒凝，状如冻胶，故加此治之，且以润其燥。）
或煎浓盐汤浸，仍
缚系其腿胫，勿令入腹。或灸承山二十七壮，神效。（一法，男子手挽其阴，女子手牵乳近两旁。）
身热烦渴，气粗口燥，喜冷畏热，心神闷乱，脉洪数者，热也。若更四肢重着，骨
节烦疼者，兼湿也。中暑霍乱，宜香薷饮（见中暑），井底沉极冷顿服，桂苓白
术散亦妙。
湿盛者，除湿汤（见中湿）、诃子散。暑湿相搏者，二香散。热多饮水者，五苓散（见伤湿）。
转筋者，木瓜煮汁饮之，或香薷煮汁亦可，或烧栀子二十枚为末，熟水调下。烦渴
者，吐泻后津竭也，止渴汤、增损缩脾饮、茯苓泽泻汤、小麦门冬汤。霍乱后，下
利不止，腹中 痛，恐作痢，宜黄连丸。霍乱后，下利见血，止血汤、赤石脂汤。
按寒热诸症，疑似难决，必参诸脉。然霍乱气闭，脉多沉伏不见，或涩滞歇至，（须
辨其应指有力无力）。则亦难辨矣。切不可妄投药，且先以阴阳水分理之，刮痧法最妙，干
霍乱尤宜。法用瓷碗之精细者，汤温之，香油抹边令滑，不伤肉，刮脊两旁俞穴，
引出脏腑之邪，又刮手足湾，引之四散，热血随刮透出，起红紫疙瘩，红者轻，紫
者重，黑者更甚。盖气结则血凝，血凝而气愈滞，血散气行，则立愈矣。七情
郁结者，七气汤。胁下痛者，木克土也，建中加柴胡木瓜汤。兼外感风邪者，
六和汤（见伤暑）。倍藿香，煎熟调苏合香丸（见诸中）。大抵苏合香丸、藿香正气散
（见中风），最
能通关理气，所必用也。霍乱非有邪不致，有邪即为实，虽虚人亦不得纯补，惟吐
泻后当细察之。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。吐泻不止，头目晕眩，肢冷
转筋，须臾不救者，吴茱萸汤。汗出厥逆不解者，四逆汤（见厥）。吐泻后，小便利，汗
出者，即内外热，亦宜温之。吐泻后，二便不通，胃中实痛者，结粪留滞，四君子
（见气）加大黄一两。吐泻后，胸膈高起，痞塞欲绝，理中汤（见中寒）加枳实、茯苓。吐泻
已透，而余吐余泻未止，腹有余痛，宜一味报秋豆叶煎服，干者尤佳。罗谦
甫治一人伤酒肉潼乳，霍乱吐泻，脉沉数，（热未去也。）按之无力。（所伤之物已去。）以新汲
水半碗，调桂苓白术散，徐服之。少安，又于墙阴掘地二尺许，入新汲水搅之，澄
清，名地浆，再调服之而愈。墙阴土，重阴也，暑热躁甚，非此不除。又治一人，
年八十，中暑霍乱，吐泻昏迷，头热如火，足冷。以桂苓甘露饮泻热补气，坠浮火
以安神明，加茯苓以分阴阳，冰水调灌之而愈。再以参术调中汤，调理平复。妊娠
产后霍乱，不外上法，但须顾胎防虚。
干霍乱不得吐泻，则邪结中焦，用温热立死。炒盐入新汲水乘热多饮，探吐之，
不吐更服，吐乃饮，三吐乃止。（大抵邪尽即止，勿泥。）此法极妙，凡欲吐而不得吐，及吐
不透者，并宜之。须极咸乃妙。吐后心腹 痛，频欲登圊，苦于不通，藿香正气散
（见中风）加枳壳一钱，（生者更速。）多下来复丹。（见中暑。若泻则不可用此丹。）
不效，须用神保丸，
（见伤饮食。）但此丸必到大肠乃行。若隔于上，则转服转秘，须用来复丹研末，汤
调，吞养正丹（见气）百粒，庶可引前药到下。戴复庵法，先服浓盐汤探吐，次调苏合香
丸吞来复丹，仍进藿香正气散加木香、枳壳。浓朴汤、活命散、冬葵子汤。顶心有
红发急拔之，取青蒿汁和水饮愈。或刺委中穴，并十指头出血亦妙。火甚者，药须
反佐。古方煎盐汤调童便入药，取其下降以通阴也，兼能行血。
凡霍乱，切不可与粥饮。盖邪滞未化，谷食一入，益结滞不行，往往致死。并
忌酒、姜汤、蒜、乌梅、梅酱、热汤，一切收敛温热之药。
霍，指手足躁动不安，如同挥霍无度；乱，指体内邪气与正气相互扰乱。其症状表现为心腹突然疼痛，或呕吐，或腹泻，或吐泻同时发作，严重时出现双脚抽筋，抽筋严重且从足部向上蔓延至腹部，或者全身筋脉都发生抽搐，舌体卷缩、阴囊收缩的属于死证。如果没有吐泻，仅有抽筋和腹痛的情况，称为干霍乱，也就是民间所说的“搅肠痧”。此病是由于邪气结滞在中焦，阻隔了上下气机的通畅，导致正气运行受阻。上方的阳气不能向下通达于阴分，就会在上部壅塞，所以发生呕吐；下方的阴气不能向上通达于阳分，就会在下部逼迫，所以发生腹泻。（这里讲的是阳气在上、阴气在下的阻隔情况，也有阴气在上、阳气在下的情况，还有阴阳交错，清浊之气、邪正之气混淆，寒热互相争斗，彼此格拒不通的情况，于是气血营卫的运行失去次序，有的顺行有的逆行，在中焦相互搏击。）上吐下泻，中焦的邪气得以分散消除，有时即使不吃药也能痊愈。如果邪气炽盛，吐泻刚好耗伤了正气，邪气就更加结滞而不能运化。抽筋是因为筋脉中原本蕴藏着火邪，加上血液长期亏虚所致，但这还不是立刻发生的。如果因为霍乱吐泻，突然亡失津液，那么血液的亏虚就会更加严重。或者不是因为吐泻，而是外感风寒，腠理闭塞严密，热气郁结激发，那么火邪的猛烈程度就会加剧，（干霍乱的抽筋，以及普通的抽筋多属这种情况。）于是出现筋脉挛缩、急剧疼痛，难以忍受。观察其病情急骤暴烈，属于火邪无疑。有人认为是寒邪，说寒性收引，却不知道收引只是拘谨紧急、牵强而已，与普通抽筋那种异常挛痛不同，怎么可以混淆呢？有人怀疑抽筋多在足部，明明属于阴寒。大概因为足部位于下部，属阴多寒，又感受风寒，导致筋脉收引劲急。霍乱不论寒证还是热证，都是邪气结聚在中焦，阳气不能下达，两脚必然发冷，所以经常抽筋。如果真的由火热引起，应该是全身筋脉都抽搐，为什么唯独足部呢？这种认为足部单独抽筋是由于寒邪的说法，也有一定道理，但如果说完全是寒邪，而中没有火邪，那就错了。如果没有火邪，阴气凝结而静止，绝对没有躁急转戾的道理。而且霍乱是脾胃的病，所以足部单独抽筋，不能说一定是由于寒邪。朱丹溪治疗遍身抽筋入肚，用极咸的盐汤放在槽中温暖浸泡，以滋润其燥热。（如果是血热，或者是寒邪导致的劲急，也可以用此法来软坚散结。）治疗霍乱应当审察是何种邪气所致。刘河间认为是热甚所致，因为火性躁暴。凡是暴病暴死，都属于火。《准绳》认为以脾湿为本，脾湿盛则也会郁结而生热。张子和则认为风湿热三气合而为邪，大概是脾属湿土，被肝属风木所克制，（肝木的清气被湿气遏制，不能上升，不升则湿气更不行，就像受到木克一样，）郁结为热而暴发，发作时心火上炎，所以呕吐，脾湿下流，所以腹泻。王海藏也说，风湿热与食物相结合成为邪气。《明理论》则认为其他疾病引起的霍乱，多由饮食损伤所致，如果是伤寒引起的霍乱，则是邪气进入中焦，胃气不和，因此导致阴阳痞塞阻隔而引发。各位医家的论述，应当兼采并蓄，不可固执一说而误导人。大抵夏秋之交，最多出现这种病症。大概夏季人们多吃冷冻饮料水，其寒湿之气，与暑热之气，交结在胃中，这是寒热不和，即使没有郁遏，时间久了也会发病。如果外感风寒，内伤饮食，则闭滞不行，发病就会很急骤。病将要发作时，必定先腹痛，痛处靠近心窝则先呕吐，痛处靠近肚脐则先腹泻。因冒风则恶风有汗，因冒寒则恶寒无汗，冒湿则身体沉重，伤暑则心神烦躁。询问患者是否吃过什么东西，是否有七情动气，再分寒热虚实进行治疗。气少、嘴唇青紫、肌肉寒冷、四肢拘急、畏冷喜热、脉沉迟、人事清醒的，属于寒证，（霍乱暴证，原本属于火，但火由寒激，发作后火泄而寒独存。）用理中汤（见中寒）。脉绝的，用通脉四逆汤（见厥）。吐利不止，元气耗散，格阳于外，或者口渴喜冷，得水则不能饮，或者发热烦躁，想脱去衣被，不可误以为是热证，宜用理中汤，严重时用附子理中汤，（均见中寒。）无效则用四逆汤（见厥），并且适宜放凉十分后冷服。抽筋的，用理中汤去掉白术，加生附子一枚。或者理中汤加冻胶锉炒一钱。（血液被寒凝，状如冻胶，所以加此治疗，且用以滋润其燥。）或者煎浓盐汤浸泡，仍然绑缚其腿胫，不让寒气入腹。或者灸承山穴二十七壮，神效。（另一种方法，男子手挽其阴部，女子手牵乳房旁边。）身热烦渴，气粗口燥，喜冷畏热，心神闷乱，脉洪数的，属于热证。如果再加上四肢重着，骨节烦疼的，兼有湿邪。中暑霍乱，宜用香薷饮（见中暑），井底沉至极冷顿服，桂苓白术散也很好。湿盛的，用除湿汤（见中湿）、诃子散。暑湿相搏的，用二香散。热多饮水的，用五苓散（见伤湿）。抽筋的，煮木瓜汁饮用，或者煮香薷汁也可以，或者烧栀子二十枚研末，熟水调下。烦渴的，是吐泻后津液枯竭，用止渴汤、增损缩脾饮、茯苓泽泻汤、小麦门冬汤。霍乱后，下利不止，腹中痛，恐怕变成痢疾，宜用黄连丸。霍乱后，下利见血，用止血汤、赤石脂汤。
按寒热诸症，疑似难决，必须参考脉象。然而霍乱气闭，脉多沉伏不见，或者涩滞歇至，（须辨别应指有力无力。）这就很难辨别了。切不可妄投药物，且先用阴阳水分调理之，刮痧法最妙，干霍乱尤其适宜。方法是用精细的瓷碗，用温水烫过，香油抹边使其光滑，不伤皮肤，刮脊两旁俞穴，引出脏腑之邪，又刮手足肘膝关节，引邪四散，热血随刮透出，起红紫疙瘩，红的轻，紫的重，黑的更甚。因为气结则血凝，血凝而气愈滞，血散气行，则立即痊愈。七情郁结的，用七气汤。胁下痛的，是木克土，用建中加柴胡木瓜汤。兼外感风邪的，用六和汤（见伤暑）。倍用藿香，煎熟调苏合香丸（见诸中）。大抵苏合香丸、藿香正气散（见中风），最能通关理气，是必用的。霍乱非有邪气不会致病，有邪即为实证，即使是虚人也不得纯补，只有在吐泻后才当仔细察辨。如果已经透畅，人困弱，脉虚软，是邪已去而正虚。如果吐泻未透，脉仍涩滞有力，人仍烦躁不宁，是邪尚未尽，须加以区别。吐泻不止，头目晕眩，肢冷抽筋，片刻间不救者，用吴茱萸汤。汗出厥逆不解者，用四逆汤（见厥）。吐泻后，小便利，汗出的，即内外热，也宜温之。吐泻后，二便不通，胃中实痛者，是结粪留滞，用四君子（见气）加大黄一两。吐泻后，胸膈高起，痞塞欲绝，用理中汤（见中寒）加枳实、茯苓。吐泻已透，而余吐余泻未止，腹有余痛，宜一味报秋豆叶煎服，干者尤佳。罗谦甫治疗一人伤酒肉潼乳，霍乱吐泻，脉沉数，（热未去也。）按之无力。（所伤之物已去。）用新汲水半碗，调桂苓白术散，慢慢服用。稍安，又在墙阴掘地二尺许，入新汲水搅之，澄清，名地浆，再调服之而愈。墙阴土，重阴也，暑热躁甚，非此不除。又治一人，年八十，中暑霍乱，吐泻昏迷，头热如火，足冷。用桂苓甘露饮泻热补气，坠浮火以安神明，加茯苓以分阴阳，冰水调灌之而愈。再用参术调中汤，调理平复。妊娠产后霍乱，不外上述方法，但须顾胎防虚。
干霍乱不得吐泻，则邪结中焦，用温热药立死。炒盐入新汲水乘热多饮，探吐之，不吐更服，吐乃饮，三吐乃止。（大抵邪尽即止，勿泥。）此法极妙，凡欲吐而不得吐，及吐不透者，并宜之。须极咸乃妙。吐后心腹痛，频欲登圊，苦于不通，用藿香正气散（见中风）加枳壳一钱，（生者更速。）多下来复丹。（见中暑。若泻则不可用此丹。）无效，须用神保丸，（见伤饮食。）但此丸必到大肠乃行。若隔于上，则转服转秘，须用来复丹研末，汤调，吞养正丹（见气）百粒，庶可引前药到下。戴复庵法，先服浓盐汤探吐，次调苏合香丸吞来复丹，仍进藿香正气散加木香、枳壳。浓朴汤、活命散、冬葵子汤。顶心有红发急拔之，取青蒿汁和水饮愈。或刺委中穴，并十指头出血亦妙。火甚者，药须反佐。古方煎盐汤调童便入药，取其下降以通阴也，兼能行血。
凡霍乱，切不可与粥饮。盖邪滞未化，谷食一入，益结滞不行，往往致死。并忌酒、姜汤、蒜、乌梅、梅酱、热汤，一切收敛温热之药。
Huo (sudden turmoil) refers to the restless movement of hands and feet, like reckless spending; Luan (chaos) refers to the disorder between pathogenic factors and healthy qi within the body. The symptoms include sudden pain in the heart and abdomen, vomiting alone, diarrhea alone, or simultaneous vomiting and diarrhea. In severe cases, there is convulsion of the two legs, which may spread from the feet to the abdomen if severe, or convulsion of all tendons in the body. If the tongue curls up and the scrotum retracts, it is a fatal condition. If there is no vomiting or diarrhea, but only convulsions and abdominal pain, it is called Gan Huoluan (Dry Cholera), also known in common parlance as "Jiaochang Sha" (Intestine-Twisting Miasma). This disease is caused by pathogenic factors stagnating in the Middle Jiao (Middle Burner), blocking the flow of Qi between the upper and lower parts, preventing the smooth circulation of Healthy Qi. When the Yang Qi above cannot descend to connect with Yin below, it obstructs upward, causing vomiting. When the Yin Qi below cannot ascend to connect with Yang above, it presses downward, causing diarrhea. (This describes the obstruction where Yang is above and Yin is below; there are also cases where Yin is above and Yang is below, or where Yin and Yang are intermixed, Clear and Turbid Qi, Pathogenic and Healthy Qi are confused, Cold and Heat contend with each other, mutually rejecting and blocking flow. Thus, the movement of Blood, Qi, Ying, and Wei loses its order, some moving forward while others backward, battling in the middle.) Vomiting above and diarrhea below allow the pathogenic factors in the Middle Jiao to be dispersed and eliminated; sometimes recovery occurs even without medication. However, if pathogenic factors are vigorous, vomiting and diarrhea merely deplete Healthy Qi, causing pathogens to become more stagnant and unable to move. Convulsions are caused by latent Fire-evil in the tendons combined with long-term deficiency of Blood, though this does not happen immediately. If due to cholera-induced vomiting and diarrhea, sudden loss of Body Fluids exacerbates the existing Blood deficiency. Or, if not due to vomiting/diarrhea but rather external contraction of Wind-Cold, closing the Cou Li (pores/interstices), trapping heat which then agitates and stimulates, the intensity of the Fire-evil increases. (Convulsions in Dry Cholera and ordinary convulsions often fall into this category.) Thus, tendon contraction and acute pain become unbearable. Observing the urgent and violent nature of the condition, it undoubtedly belongs to Fire. Some attribute it to Cold, arguing that Cold causes contraction and drawing-in. However, "contraction" here refers merely to stiffness and pulling, which differs significantly from the abnormal cramping pain of convulsions; how can they be confused? Some doubt that convulsions mostly occur in the feet, assuming it must be Yin-Cold. Since the feet are located in the lower part, they belong to Yin and are prone to Cold; contracting Wind-Cold causes tendons and vessels to contract and become stiff. Regardless of whether Cholera presents as Cold or Heat syndrome, pathogenic factors always knot in the Middle Jiao, preventing Yang Qi from descending, making both feet cold, hence frequent convulsions. If it were truly caused by Fire-Heat, all tendons would convulse; why only the feet? While the argument that isolated foot convulsions are due to Cold has some merit, claiming it is entirely Cold without any Fire-evil in the interior is incorrect. Without Fire-evil, Yin condenses and remains static; there is absolutely no logic for restlessness and violent twisting. Moreover, Cholera is a Spleen-Stomach disease; thus, isolated foot convulsions cannot be said to be necessarily due to Cold. Danxi treated whole-body convulsions spreading to the abdomen by soaking the patient in warm, extremely salty brine to moisten dryness. (If due to Blood-Heat, or stiffness due to Cold, this method can also be used to soften hardness.) When treating Cholera, one must ascertain the specific pathogen. Hejian stated it is caused by excessive Heat, as Fire nature is volatile and violent. All sudden diseases and sudden deaths belong to Fire. *Zhunsheng* stated it is rooted in Spleen-Dampness; when Spleen-Dampness is abundant, it stagnates and generates Heat. Zhang Zihe argued that Wind, Dampness, and Heat combine to form pathogenic factors. Spleen (Earth/Dampness) is controlled by Liver (Wood/Wind); the clear Qi of Liver Wood is suppressed by Dampness, unable to ascend. Failure to ascend leads to further stagnation of Dampness, resembling being overcome by Wood. Stagnation turns into Heat and erupts violently. Upon eruption, Heart Fire flares upward causing vomiting, and Spleen Dampness flows downward causing diarrhea. Wang Haizang also stated that Wind, Dampness, Heat, and food combine to form pathogens. *Mingli Lun* stated that non-Epidemic Cholera is mostly caused by dietary injury, whereas Cholera resulting from Cold Damage is caused by pathogens entering the Middle Jiao, disrupting Stomach Qi, leading to Yin-Yang blockage. The theories of these masters should be adopted comprehensively; one must not adhere to a single theory to mislead people. Generally, during the transition between summer and autumn, this condition is most common. People consume many frozen drinks in summer; the Cold-Damp Qi mixes with Summer-Heat Qi in the stomach, creating Cold-Heat disharmony. Even without stagnation, illness will develop over time. If externally contracted Wind-Cold and internally injured by diet, stagnation prevents movement, and onset is abrupt. Before the disease manifests, abdominal pain usually occurs first. Pain near the heart precedes vomiting; pain near the navel precedes diarrhea. Contracting Wind causes aversion to wind with sweating; contracting Cold causes aversion to cold without sweating; contracting Dampness causes heavy body; injuring Summer-Heat causes mental restlessness. Ask what was eaten and if emotional disturbances occurred, then differentiate treatment based on Cold, Heat, Deficiency, and Excess. Scanty Qi, blue lips, cold flesh, limb stiffness, aversion to cold preferring warmth, deep and slow pulse, with clear consciousness indicates Cold. (Cholera acute conditions originally belong to Fire, but Fire is triggered by Cold; after eruption, Fire dissipates leaving Cold alone.) Use Lizhong Tang (see Middle Cold). Pulse absent: Tongmai Sini Tang (see Jue). Unstopping vomiting and diarrhea, depletion of Yuan Qi, Yang repelled outward, or thirst preferring cold drinks but inability to swallow water, or fever/restlessness wanting to remove clothes/quilts—do not mistake for Heat syndrome. Use Lizhong Tang; severely use Fuzi Lizhong Tang. If ineffective, use Sini Tang. All should be taken cool (cooled completely). For convulsions: Lizhong Tang minus Atractylodes, add one raw Fuzi. Or Lizhong Tang plus 1 qian of processed Gelatin. (Blood congeals due to Cold, resembling gelatin; adding this treats it and moistens dryness.) Or soak in concentrated salt water, binding legs tightly to prevent cold entering. Or moxa Chengshan point 27 moxibustions (highly effective). (Alternative method: Men hold their genitals; women pull the sides of breasts.) Fever, irritability, thirst, coarse breathing, dry mouth, preference for cold/aversion to heat, mental oppression/confusion, surging and rapid pulse indicates Heat. If accompanied by heavy limbs and painful joints, Dampness is also present. For Summer-Heat Cholera: Xiangru Yin (see Summer-Heat), served ice-cold from the bottom of a well; Guiling Baizhu San is also excellent. For excess Dampness: Chushi Tang (see Dampness), Hezi San. For Summer-Heat and Dampness struggling: Erxiang San. For Heat with excessive thirst: Wuling San (see Injury by Dampness). For convulsions: Drink decoction of Papaya (Mu Gua), or Xiangru decoction, or 20 roasted Gardenia seeds ground to powder mixed with cooked water. For irritability/thirst (due to exhaustion of fluids after vomiting/diarrhea): Zhike Tang, Zengsun Suopi Yin, Fuling Zexie Tang, Xiaomai Maidong Tang. After Cholera, if diarrhea persists with abdominal pain, fearing dysentery: Huanglian Wan. After Cholera, bloody diarrhea: Zhixue Tang, Chishizhi Tang.
Regarding ambiguous Cold/Heat symptoms, differentiation relies heavily on pulses. However, in Cholera with Qi closure, pulses are often deep, hidden, choppy, or intermittent. (Must distinguish between forceful and feeble upon pressure.) This makes differentiation difficult. Do not prescribe blindly. First regulate using Yin-Yang Water methods; Scraping (Gua Sha) is best, especially for Dry Cholera. Method: Use a fine porcelain bowl, warm it with hot water, apply sesame oil to the edge to make it slippery and skin-safe. Scrape along the Shu points on both sides of the spine to draw out organ pathogens. Scrape elbows and knees to disperse pathogens. Hot blood emerges through scraping, forming red-purple bumps. Red is mild, purple is severe, black is worse. Qi stagnation causes Blood stasis; Blood stasis worsens Qi stagnation. Once Blood disperses and Qi moves, immediate recovery occurs. For Seven Emotions stagnation: Qi Qi Tang. For hypochondriac pain (Liver Wood overcoming Spleen Earth): Jianzhong Tang plus Chai Hu and Mu Gua. For concurrent external Wind: Liuhe Tang (see Summer-Heat). Increase Huo Xiang, decoct and mix with Suhexiang Wan. Generally, Suhexiang Wan and Huoxiang Zhengqi San are essential for opening passages and regulating Qi. Cholera requires pathogenic factors; presence implies Excess. Even deficient patients should not receive pure tonification until after vomiting/diarrhea subsides, requiring careful observation. If symptoms have cleared, patient is weak with feeble pulse, pathogens are gone and Healthy Qi is deficient. If vomiting/diarrhea hasn't cleared, pulse is choppy/forceful, patient is restless, pathogens remain; distinguish accordingly. For unstopping vomiting/diarrhea, dizziness, cold limbs, convulsions, impending death: Wuzhuyu Tang. For sweating and reversal cold unrelieved: Sini Tang. After vomiting/diarrhea, if urination is free and sweating occurs, even with internal/external heat, warming is appropriate. After vomiting/diarrhea, if bowel/bladder obstruction and solid abdominal pain exist (impacted stool): Sijunzi Tang plus 1 liang Rhubarb. After vomiting/diarrhea, if chest/diaphragm distension and severe blockage: Lizhong Tang plus Zhishi and Fuling. If vomiting/diarrhea has cleared but residual symptoms persist with abdominal pain: Decoct leaves of Baoqiu Dou (Faba bean leaves); dried leaves are better. Luo Qianfu treated a case of alcohol/meat/milk injury causing Cholera. Pulse deep-rapid (Heat remaining), but feeble on pressure (Injured matter expelled). Mixed Guiling Baizhu San with half bowl of fresh spring water, administered slowly. Upon slight relief, dug two chi deep in shady wall soil, added fresh water, stirred, clarified as "Di Jiang" (Earth Slurry), mixed and administered for cure. Shady wall earth is heavy Yin, necessary to remove intense Summer-Heat agitation. Another case: 80-year-old male, Summer-Heat Cholera, vomiting/diarrhea coma, head hot as fire, feet cold. Used Guiling Ganlu Yin to drain heat and tonify Qi, settle floating Fire to calm Spirit, added Fuling to separate Yin/Yang, administered with ice water for cure. Followed with Shen Zhu Tiaozhong Tang for recovery. Pregnancy/postpartum Cholera follows similar methods but must protect fetus/prevent deficiency.
For Dry Cholera where vomiting/diarrhea cannot occur, pathogens knot in Middle Jiao; using Warm-Hot herbs causes instant death. Stir-fry salt, dissolve in fresh spring water, drink hot to induce vomiting. If no vomit, take again. Stop after three episodes of vomiting. (Generally stop when pathogens are exhausted; do not rigidly adhere to numbers.) This method is excellent for anyone wanting to vomit but unable, or vomiting incompletely. Must be extremely salty. After vomiting, if abdominal pain and frequent urge to defecate but inability to pass stool: Huoxiang Zhengqi San plus 1 qian Zhike (raw is faster). Take more Laifu Dan. (See Summer-Heat. Do not use if diarrhea is present.) If ineffective, use Shenbao Wan. (See Food Injury.) But Shenbao Wan acts only in Large Intestine. If blocked above, taking it causes constipation. Instead, grind Laifu Dan to powder, mix with water, swallow 100 Yangzheng Dan pills to guide previous medicines downward. Dai Fu'an's method: First drink concentrated salt water to induce vomiting, then mix Suhexiang Wan and swallow Laifu Dan, followed by Huoxiang Zhengqi San plus Muxiang and Zhike. Nongpu Tang, Huoming San, Dongkuizi Tang. If a red hair appears at the top of the head, pluck it urgently; drink Qinghao juice mixed with water for cure. Or prick Weizhong point and ten fingertips to bleed (also effective). For severe Fire, use counter-assistance in herbs. Ancient formulas used salt water mixed with child's urine in decoctions to promote descent and open Yin, also promoting Blood movement.
In all Cholera cases, porridge and drinks must strictly be avoided. As pathogens/stagnation are not resolved, grain food entry increases stagnation, often leading to death. Also avoid alcohol, ginger soup, garlic, dark plum, plum sauce, hot water, and all astringent/warm-hot herbs.