霍乱之治，尝考之《内经》，有太阳所致，为中满霍乱吐下。有土郁之发，民病呕吐霍
乱注
下。有岁土不及，风乃大行，民病霍乱餐泄。有热至则身热霍乱吐下。《灵枢》曰∶足太阳
之别，名曰公孙，去本节后一寸，别走阳明。其别者，入络肠胃，厥气上逆则霍乱。实则肠
中切痛，虚则蛊胀。有清气在阴，浊气在阳，营卫顺行，卫气逆行，清浊相干，乱于肠胃为
霍乱。至《巢氏病源》，因此一条乃云∶霍乱者，由清浊二气相干于肠胃间，因遇饮食而变
，发则心腹绞痛，挟风而实者，发热头痛体疼，虚则但心腹痛而已。亦有因饮酒食肉腥脍生
冷过多，居处不节，或露卧湿地，或当风取凉，冷风之气，归于三焦，伤于脾胃，水谷不化
，皆成霍乱。自巢氏之说行，后世守之为法，无复知有《内经》诸条者矣。至河间云，吐下
霍乱，三焦为水谷传化之道路，热气盛则传化失常，而吐泻霍乱，火性燥动故也。世俗止谓
是停食者，误也。转筋者，亦是脾胃土衰，热气燥烁。夫筋则筋挛而动，非寒也。夫论病当
从《内经》随宜施治，安可执一端而已哉？张戴人则以风湿 三气合而为邪，以脾湿土为风
木所克，郁则热乃发，发则心火炎上，故呕吐，呕吐者， 也。脾湿下注故注泻。注泻者，
湿也。风急则转筋，转筋者，风也。可谓善推病情者乎？海藏亦谓风湿热外至，生冷内加，
内外合病者，此条殆似之矣。然则此病当何以为要，谓脾胃之湿为本，诸邪感动者，为病之
由。而其间脾胃有虚有实，邪有阴阳相感之孰甚者，皆宜消息处治。至若明理论谓伤寒吐利
者，由邪气所伤。霍乱吐利者，饮食所伤，其有兼伤寒之邪，内外不和，加之头痛发热而吐
利者，是霍乱伤寒也。原仲景之意，岂必在饮食始为病哉？由寒邪传入中焦，胃久因之不和
，阴阳否隔，故得至此耳。不然何以用理中、四逆等汤治之？然病有干霍乱、湿霍乱，干霍
乱死者多，湿霍乱死者少。盖湿者上吐下利，则所伤之物得以出泄，胸中水谷尽则止，所以
死者少。干者上不得吐，下不得利，则所伤之物不得出泄，拥闭正气，乖隔阴阳，烦扰闷乱
，喘胀而死者多矣。嗟乎！饮食有节，起居有常，宁有此证耶！
治疗霍乱，我曾考证《内经》，其中有因太阳经邪气所致，表现为中焦胀满、霍乱吐泻的记载。有因土气郁结发作时，百姓患呕吐霍乱、腹泻不止的病证。有因岁运土气不足，风气大行，百姓患霍乱、完谷不化的泄泻。有因热气至则身体发热、霍乱吐下的情况。《灵枢》说：足太阳膀胱经的别络，名叫公孙穴，位于本节后一寸处，别走阳明经。其分支进入联络肠胃，若厥逆之气上逆则导致霍乱。实证表现为肠中剧烈疼痛，虚证表现为腹部胀满如蛊。有清气滞留于阴分，浊气滞留于阳分，营卫之气顺行正常，若卫气逆行，清浊之气相互干扰，扰乱肠胃而成为霍乱。到了《诸病源候论》，根据这一条论述便说：霍乱，是由于清浊二气在肠胃间相互干扰，因为遇到饮食不当而引发变化，发作时心腹绞痛，兼夹风邪且体质壮实者，出现发热、头痛、身体疼痛；体质虚弱者仅有心腹疼痛罢了。也有因饮酒、吃肉、生鱼片及生冷食物过多，起居生活不节制，或者露天睡在潮湿之地，或者对着风口乘凉，冷风之气归于三焦，损伤脾胃，水谷不能消化，都形成霍乱。自从巢元方的说法流行后，后世坚守其为法则，不再知道《内经》中的其他条文了。到了刘河间（刘完素）说，吐泻霍乱，三焦是水谷传化通行的道路，热气旺盛则传化功能失常，从而发生吐泻霍乱，这是火性燥动的原因。世俗人只认为是停食造成的，这是错误的。转筋（肌肉痉挛），也是脾胃土气衰弱，热气燥烁所致。所谓筋脉拘挛而动，并非寒邪所致。讨论疾病应当依据《内经》随宜施治，怎么可以固执一端呢？张从正（张戴人）则认为风湿热三气合而为邪，以脾湿土被风木所克制，郁结则热气发作，发作则心火炎上，所以呕吐，呕吐就是火的表现。脾湿下注所以导致注泻（急迫的腹泻）。注泻就是湿的表现。风急则导致转筋，转筋就是风的表现。这可以说是善于推究病情的人吧？王海藏（张元素弟子）也说风湿热外袭，生冷内伤，内外合病的情况，这条论述大概类似于此。然而这种病应当以什么为关键，我认为以脾胃之湿为本，各种邪气触动为发病的原因。而其中脾胃有虚有实，邪气有阴阳相感谁更严重，都应当斟酌处理治疗。至于《明理论》说伤寒吐利，是由邪气所伤；霍乱吐利，是由饮食所伤，如果有兼夹伤寒邪气，内外不和，加上头痛发热而吐利的，这就是霍乱伤寒。推究张仲景的本意，难道一定是在饮食后才致病吗？是因为寒邪传入中焦，胃久已不和，阴阳痞塞阻隔，所以才导致这种情况。不然为什么用理中汤、四逆汤等来治疗它呢？然而病有干霍乱、湿霍乱之分，干霍乱死亡的多，湿霍乱死亡的少。大概湿霍乱上吐下泻，那么所伤之物得以排出，胸中水谷排尽则停止，所以死亡者少。干霍乱上不得吐，下不得泻，那么所伤之物不得排出，壅闭正气，乖隔阴阳，烦扰闷乱，喘胀而死的人多了。唉！饮食有节制，起居有规律，怎么会有这种病证呢！
The treatment of Huoluan (Acute Gastroenteritis/Vomiting and Diarrhea Syndrome) has been examined in the *Neijing* (*Inner Canon*), which records cases caused by Taiyang (Greater Yang) pathogenic factors, presenting with middle jiao fullness and Huoluan with vomiting and diarrhea. It also mentions that when Earth qi is depressed and erupts, the people suffer from vomiting Huoluan and profuse diarrhea. When the annual Earth qi is insufficient and Wind qi prevails greatly, the people suffer from Huoluan and unformed stools (Wangu Xie). When Heat qi arrives, it causes body heat and Huoluan with vomiting and diarrhea. The *Lingshu* states: The collateral branch of Foot-Taiyang Bladder Meridian is named Gongsun (SP4), located one cun distal to the base of the first metatarsophalangeal joint, diverging to connect with Yangming. Its branch enters and connects with the intestines and stomach; if Jueqi (Rebellious Qi) rebels upward, it results in Huoluan. Excess patterns manifest as severe cutting pain in the intestines, while deficiency patterns manifest as abdominal distension resembling Gu (Abdominal Mass/Ascites). If Clear Qi remains in the Yin and Turbid Qi remains in the Yang, and while Ying and Wei Qi circulate normally, if Wei Qi rebels, Clear and Turbid Qi interfere with each other, disrupting the intestines and stomach to cause Huoluan. In the *Chisheng Bingyuan* (*Source Book of Diseases and Syndromes*), based on this passage, it is stated: Huoluan arises from the interference of Clear and Turbid Qi between the intestines and stomach, triggered by dietary irregularities. Upon onset, there is severe colic in the heart and abdomen; if accompanied by Wind and characterized by excess, symptoms include fever, headache, and body ache; in deficiency cases, only heart and abdominal pain occur. There are also cases caused by excessive consumption of alcohol, meat, raw fish, and cold foods, improper daily habits, sleeping exposed in damp places, or seeking coolness in drafts. Cold Wind Qi returns to the Sanjiao (Triple Burner), damaging the Spleen and Stomach, leading to indigestion of water and grain, all resulting in Huoluan. Since Chao Yuanfang’s theory became prevalent, later generations adhered to it as a standard law, forgetting the various passages in the *Neijing*. Later, Liu Hejian (Liu Wansu) stated that vomiting and diarrhea in Huoluan occur because the Sanjiao is the pathway for the transmission and transformation of water and grain; when Heat Qi is vigorous, transmission and transformation become abnormal, causing vomiting and diarrhea due to the dry and agitating nature of Fire. Laypeople mistakenly attribute this solely to food stagnation. Muscle cramps (Zhuanjin) are also caused by the decline of Spleen-Stomach Earth Qi and scorching by Heat Qi. The term "muscle cramping" refers to tendon contraction and movement, not Cold. Disease discussion should follow the *Neijing* and apply treatments according to circumstances; how can one adhere rigidly to a single aspect? Zhang Dairen (Zhang Congzheng) argued that Wind, Dampness, and Heat combine to form pathogens. Spleen-Damp Earth is overcome by Liver-Wood; depression leads to Heat eruption, which causes Heart-Fire to flare upward, resulting in vomiting (Fire manifestation). Spleen-Damp sinking downward causes profuse diarrhea (Damp manifestation). Rapid Wind causes muscle cramps (Wind manifestation). This demonstrates skillful deduction of disease conditions. Haizang (Wang Haizang) also stated that external Wind-Damp-Heat combined with internal Cold-Raw food injury constitutes an internal-external combined disease, which seems similar to this description. However, what is the key to this disease? It is posited that Spleen-Stomach Dampness is the root, and various pathogenic factors triggering it are the cause. Within this, Spleen-Stomach may be deficient or excess, and pathogens may involve Yin-Yang interference with varying severity; thus, careful consideration and treatment are required. Regarding the *Mingli Lun*, it states that vomiting and diarrhea in Shanghan (Cold Damage) are caused by pathogenic invasion, whereas those in Huoluan are caused by dietary injury. If there is a combination with Shanghan pathogens, internal-external disharmony, plus headache, fever, vomiting, and diarrhea, it is termed Huoluan-Shanghan. Tracing Zhang Zhongjing’s intent, must illness necessarily begin with dietary injury? No. It occurs when Cold pathogens transmit to the Middle Jiao, causing long-term Stomach disharmony, blocking Yin and Yang, leading to this condition. Otherwise, why use Lizhong Tang (Regulate the Middle Decoction) and Sini Tang (Reverse the Extremity Decoction) for treatment? Furthermore, there are Dry Huoluan and Wet Huoluan. Dry Huoluan has a higher mortality rate, while Wet Huoluan has a lower one. Wet Huoluan involves upper vomiting and lower diarrhea, allowing the ingested harmful substances to be expelled; once the chest and stomach contents are cleared, it stops, hence fewer deaths. Dry Huoluan prevents both vomiting and defecation, trapping the ingested substances, obstructing Zhengqi (Upright Qi), disrupting Yin-Yang separation, causing restlessness, stifling sensation, distension, and often death. Alas! If diet were regulated and daily life regular, would such diseases exist?