【歌】霍乱须分湿与干，吐空泻尽始能安。若还关格阴阳逆，生死分明反掌间。甚则转筋仍厥逆，理中姜
附可驱寒。热多而渴五苓散，暑证香薷藿朴堪。
【论】夫霍乱者，挥霍撩乱也。外有所感，内有所伤，阴阳乖隔，上吐下利，躁扰闷痛是也。偏阳则多
热，偏阴则多寒。卒然而成，危如风烛，得吐利者，名曰湿霍乱，为可治，盖所伤之物尽出故也。若上不得吐，
下不得利，所伤之物不得出，壅闷正气，关格阴阳，其死甚速，须用盐汤探吐，得出则宽。轻者手足温和，甚
者脐腹绞痛，厥逆脉脱，举体转筋，当温补回阳复脉。若暑月多食瓜果、泉水，以致食郁于中而成霍乱者，宜
辛温散其标寒，次以寒凉清其暑热可也。渴甚者，冰水解之。
【脉】霍乱吐泻，滑而不匀。或微而涩，或伏惊人。热多洪滑，弦滑食论。
湿霍乱（即吐泻）
霍乱吐利，藿香正气散。腹痛厥冷脉沉，理中汤。转筋不已，木瓜散；膝、腕内红筋刺出紫血；炒盐熨脐。
藿香正气散
治四时不正之气，不服水土，脾胃不和，吐利腹痛，饮
食停滞，恶心胸满者主之。
藿香（二钱） 白芷（一钱） 桔梗（一钱） 半夏（一钱，姜制） 紫苏（一钱） 陈皮（一
钱） 白术（一钱，炒） 大腹皮（一钱） 茯苓（一钱） 浓朴（一钱，姜炒） 甘草（五分，炙）
上锉，一剂，加姜三片，枣二枚，水煎温服。
转筋加木瓜。腹痛加炒芍药，寒痛加桂。食不化加香附、砂仁、神曲、麦芽。中暑加香薷、扁豆。时气
憎寒恶热加柴胡、干葛。小便不利合五苓散。若频欲登圊，不通者，加枳壳。
理中汤（方见中寒。）
木瓜散
木瓜（二钱） 茴香（三分半） 甘草（二分，炙） 吴茱萸（一钱半） 紫苏（十叶） 生姜（五片）
上锉，一剂，水二盏，煎八分，空心温服。
干霍乱（俗名绞肠痧）
不得吐利，脐腹痛甚，躁扰闷痛欲绝，以盐汤灌下一碗许探吐，若不得吐，不治。更以吴茱萸三、四两，
用盐数两，炒热熨脐下。
暑霍乱
暑月霍乱，六和汤。热而燥渴烦闷，五苓散，或以凉水调益元散，或桂苓甘露饮，或藿薷汤冷服。
六和汤
治冒暑伏热烦闷，气不升降，霍乱转筋，呕吐泄泻，寒热交作，痰喘咳嗽，胸膈痞满，头目昏痛，肢体浮
肿，小便赤涩，怠惰嗜卧，及中酒烦渴畏食并用此汤，随证加减。
缩砂（一两） 半夏（一两） 杏仁（一两） 白扁豆（二两） 人参（一两） 甘草（炙，一两） 赤
茯苓（二两） 藿香叶（二两） 木瓜（二两） 香薷（四两） 浓朴（姜炒，四两）
上锉，每服一两，姜、枣水煎。
按∶六和者，和六腑也。脾胃者，六腑之总司，故凡六腑不和之病，先于脾胃而调之。是方有藿香、砂仁，
香能开胃窍也。半夏、生姜辛能散逆气也。茯苓、木瓜淡能利湿窍也。参、术、扁豆甘能调脾胃也。脾胃一治，
则水精四布，五经并行，虽四肢百骸九窍，皆太和矣，况于六腑乎？
五苓散（方见中湿。）
益元散 又名六一散
滑石（六两，水飞） 甘草（一两）
上为细末，水调服。
桂苓甘露饮
治夏月引饮过多，肚腹膨胀，霍乱泄利，小便赤涩，口干燥渴。
白术（二两，炒） 白茯苓（二两） 猪苓（二两） 泽泻（二两，去毛） 滑石（研，二两） 寒水
石（研，一两） 甘草（炙，一两） 肉桂（去皮，五钱）
上锉，每服一两五钱，水二钟，煎八分，温服。
按∶上方以五苓利三焦之湿。二石清六腑之热，此河间治湿热之简便者。张子和加人参，因其脉虚故也。
【歌诀】霍乱必须区分湿证与干证，只有呕吐和腹泻将病邪排尽后才能安宁。如果发生关格（上下不通）且阴阳之气逆乱，生死就在转念之间。严重时出现转筋（肌肉痉挛）甚至四肢厥冷，可用理中汤加生姜、附子来驱散寒邪。若热象明显且口渴，宜用五苓散；若是暑证，可用香薷、藿香、厚朴等药物。
【论述】所谓霍乱，是指病情发作时挥霍撩乱的状态。外感邪气，内伤饮食，导致阴阳之气乖违阻隔，表现为上吐下泻，烦躁闷痛。偏于阳盛则多热，偏于阴盛则多寒。此病突然发作，危险程度如同风中残烛。凡是出现呕吐和腹泻的，称为湿霍乱，属于可治之症，因为所伤之物得以排出。如果上不能吐，下不能泻，所伤之物无法排出，壅塞正气，导致关格阴阳，死亡速度极快，此时需用盐汤催吐，使病邪排出后病情才能缓解。轻者手足温和，重者脐腹绞痛，四肢厥冷，脉象微弱欲绝，全身转筋，应当采用温补回阳复脉的方法。若在夏季因多食瓜果、泉水，导致食积郁结在中焦而成霍乱的，适宜先用辛温药物发散表寒，再用寒凉药物清解暑热。口渴严重的，可用冰水缓解。
【脉诊】霍乱引起的呕吐腹泻，脉象滑利但不均匀。或者脉微细而涩，或者脉伏匿令人惊骇。热多者脉洪滑，弦滑脉提示有食积。
湿霍乱（即伴有呕吐和腹泻的霍乱）
霍乱吐泻，使用藿香正气散。若腹痛、四肢厥冷、脉沉，使用理中汤。若转筋不止，使用木瓜散；并在膝部、腕部内侧刺出紫血；用炒热的盐熨烫肚脐。
藿香正气散
主治四时不正之气，水土不服，脾胃不和，呕吐腹泻腹痛，饮食停滞，恶心胸满等症状。
组成：藿香（二钱）、白芷（一钱）、桔梗（一钱）、半夏（一钱，姜制）、紫苏（一钱）、陈皮（一钱）、白术（一钱，炒）、大腹皮（一钱）、茯苓（一钱）、浓朴（一钱，姜炒）、甘草（五分，炙）。
以上药材切碎，一剂药，加生姜三片、大枣二枚，用水煎煮，温服。
加减法：转筋加木瓜。腹痛加炒芍药，寒痛加桂枝。食不消化加香附、砂仁、神曲、麦芽。中暑加香薷、扁豆。时气憎寒恶热加柴胡、干葛。小便不利合用五苓散。若频繁想上厕所但排不出，加枳壳。
木瓜散
组成：木瓜（二钱）、茴香（三分半）、甘草（二分，炙）、吴茱萸（一钱半）、紫苏（十叶）、生姜（五片）。
以上药材切碎，一剂药，加水两盏，煎至八分，空腹温服。
干霍乱（俗称绞肠痧）
既不能吐也不能泻，脐腹疼痛剧烈，烦躁闷痛欲死，用盐汤灌下一碗左右以探吐，如果不能吐出，则难治。再用吴茱萸三、四两，配盐数两，炒热后熨烫脐下部位。
暑霍乱
夏季霍乱，使用六和汤。若热盛、燥渴、烦闷，使用五苓散，或用凉水调服益元散，或桂苓甘露饮，或藿薷汤冷服。
六和汤
主治冒受暑邪、伏热烦闷，气机升降失常，霍乱转筋，呕吐泄泻，寒热交替，痰喘咳嗽，胸膈痞满，头目昏痛，肢体浮肿，小便赤涩，倦怠嗜卧，以及饮酒后烦渴畏食等症，随证加减。
组成：缩砂（一两）、半夏（一两）、杏仁（一两）、白扁豆（二两）、人参（一两）、甘草（炙，一两）、赤茯苓（二两）、藿香叶（二两）、木瓜（二两）、香薷（四两）、浓朴（姜炒，四两）。
以上药材切碎，每次服用一两，加生姜、大枣，用水煎煮。
按语：所谓“六和”，是调和六腑的意思。脾胃是六腑的总司，所以凡是六腑不和的疾病，先从调理脾胃入手。此方中有藿香、砂仁，香气能开胃窍；半夏、生姜辛味能散逆气；茯苓、木瓜淡味能利湿窍；人参、白术、扁豆甘味能调补脾胃。脾胃一旦调理好，则水谷精微四处布散，五脏经脉并行，虽然四肢百骸九窍都能达到太和状态，何况六腑呢？
益元散 又名六一散
组成：滑石（六两，水飞）、甘草（一两）。
以上研为细末，用水调服。
桂苓甘露饮
主治夏季饮水过多，腹部膨胀，霍乱泄利，小便赤涩，口干燥渴。
组成：白术（二两，炒）、白茯苓（二两）、猪苓（二两）、泽泻（二两，去毛）、滑石（研，二两）、寒水石（研，一两）、甘草（炙，一两）、肉桂（去皮，五钱）。
以上药材切碎，每次服用一两五钱，加水两钟，煎至八分，温服。
按语：上方利用五苓散利去三焦之湿。两种石头（滑石、寒水石）清解六腑之热，这是刘河间治疗湿热的简便方法。张子和加入人参，是因为患者脉虚的缘故。
[Song] Huoluan (Acute Vomiting and Diarrhea) must be distinguished into damp type and dry type; peace can only be restored after vomiting and diarrhea have expelled the pathogenic factors. If Guan-Ge (obstruction of upper and lower orifices) occurs with reversal of Yin and Yang, life and death are decided in an instant. In severe cases, muscle cramps (Zhuanjin) and even cold extremities occur; Lizhong Tang (Regulate the Middle Decoction) with Ginger and Aconite can dispel cold. If heat is prominent with thirst, Wuling San (Five-Ingredient Poria Powder) should be used; for summerheat patterns, Moslae Herba (Xiangru), Pogostemonis Patchouli Herba (Huoxiang), and Magnoliae Officinalis Cortex (Houpo) are suitable.
[Discussion] Huoluan refers to a state of chaotic turmoil upon onset. External pathogens combined with internal dietary injury cause a disruption of Yin and Yang, manifesting as vomiting above and diarrhea below, accompanied by restlessness, stifling sensation, and pain. Predominance of Yang leads to more heat, while predominance of Yin leads to more cold. The disease strikes suddenly, as precarious as a candle in the wind. Cases presenting with vomiting and diarrhea are named Damp Huoluan (Wet Huoluan); they are treatable because the ingested harmful substances are expelled. If one cannot vomit above nor defecate below, the harmful substances remain trapped, obstructing healthy Qi and causing Guan-Ge with reversal of Yin and Yang, leading to rapid death. In such cases, salt water should be used to induce vomiting; relief follows once the obstruction is cleared. Mild cases present with warm hands and feet; severe cases involve colicky abdominal pain, cold extremities, faint pulse, generalized muscle cramps, and require warming, tonifying, restoring Yang, and reviving the pulse. If Huoluan results from excessive consumption of melons, fruits, or spring water during summer, causing food stagnation in the middle Jiao, it is appropriate to first use acrid-warm herbs to disperse exterior cold, followed by cool-cold herbs to clear summerheat. For severe thirst, ice water may be used to resolve it.
[Pulse Diagnosis] Pulses in Huoluan with vomiting and diarrhea are slippery but irregular. They may be fine and choppy, or deep and hidden, which is alarming. Prominent heat presents with surging and slippery pulses; wiry and slippery pulses indicate food retention.
Damp Huoluan (i.e., Huoluan with vomiting and diarrhea)
For Huoluan with vomiting and diarrhea, Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi) is indicated. For abdominal pain, cold extremities, and deep pulse, Lizhong Tang (Regulate the Middle Decoction) is used. For persistent muscle cramps, Mugua San (Papaya Powder) is used; prick purple blood from red veins inside the knees and wrists; apply hot fried salt to the umbilicus.
Huoxiang Zhengqi San
Indicated for maladaptation to climate, intolerance to local conditions, spleen-stomach disharmony, vomiting, diarrhea, abdominal pain, food stagnation, nausea, and chest fullness.
Ingredients: Pogostemonis Patchouli Herba (Huoxiang, 2 qian), Angelicae Dahuricae Radix (Baizhi, 1 qian), Platycodonis Radix (Jiegeng, 1 qian), Pinelliae Rhizoma Preparatum (Banxia, 1 qian, prepared with ginger), Perillae Folium (Zisu, 1 qian), Citri Reticulatae Pericarpium (Chenpi, 1 qian), Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian, stir-fried), Arecae Pericarpium (Dafupi, 1 qian), Poria (Fuling, 1 qian), Magnoliae Officinalis Cortex (Nongpo/Houpo, 1 qian, stir-fried with ginger), Glycyrrhizae Radix et Rhizoma (Gancao, 0.5 qian, honey-fried).
Crush the herbs. For one dose, add three slices of ginger and two jujubes, decoct in water, and take warm.
Modifications: Add Papaya (Mugua) for muscle cramps. Add stir-fried Peony Root (Shaoyao) for abdominal pain; add Cinnamon Twig (Guizhi) for cold pain. Add Cyperi Rhizoma (Xiangfu), Amomi Fructus (Sharen), Medicated Leaven (Shenqu), and Hordeum Vulgare Germinatum (Maiya) for indigestion. Add Moslae Herba (Xiangru) and Dolichos Lablab Seed (Bian Dou) for summerheat. Add Bupleuri Radix (Chaihu) and Puerariae Radix (Gegen) for seasonal qi with aversion to cold and heat. Combine with Wuling San if urination is difficult. Add Aurantii Fructus Immaturus (Zhike) if there is frequent urge to defecate without passage.
Lizhong Tang (See "Cold Damage to the Middle" chapter for formula)
Mugua San
Ingredients: Papaya (Mugua, 2 qian), Fennel Fruit (Huixiang, 0.35 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 0.2 qian, honey-fried), Evodiae Fructus (Wuzhuyu, 1.5 qian), Perillae Folium (Zisu, 10 leaves), Zingiberis Rhizoma Recens (Shengjiang, 5 slices).
Crush the herbs. For one dose, add two cups of water, decoct until reduced to 0.8 cup, and take warm on an empty stomach.
Dry Huoluan (Colic Sha, colloquially known as Intestinal Twisting Sha)
Inability to vomit or defecate, severe umbilical and abdominal pain, extreme restlessness and stifling pain.灌 down about one bowl of salt water to induce vomiting. If vomiting does not occur, the condition is untreatable. Additionally, stir-fry 3-4 liang of Evodiae Fructus (Wuzhuyu) with several liang of salt until hot, and apply as a compress to the area below the umbilicus.
Summerheat Huoluan
For summer Huoluan, Liuhe Tang (Six-Harmonies Decoction) is used. For heat with dryness, thirst, and restlessness, use Wuling San, or mix Yiyuan San (Benefit Primordial Powder) with cool water, or Gui Ling Gan Lu Yin (Cassia, Poria, and Sweet Dew Drink), or Huo Ru Tang (Patchouli and Mosla Decoction) taken cold.
Liuhe Tang
Indicated for summerheat invasion, latent heat causing restlessness, dysfunction of Qi ascending and descending, Huoluan with muscle cramps, vomiting and diarrhea, alternating chills and fever, phlegm and wheezing, chest diaphragm stuffiness, dizziness and headache, limb edema, dark and scanty urination, lethargy and desire to sleep, as well as post-alcohol thirst and aversion to food. Modify according to symptoms.
Ingredients: Amomi Fructus (Suosha, 1 liang), Pinelliae Rhizoma (Banxia, 1 liang), Prunus Armeniaca Semen (Xingren, 1 liang), Dolichos Lablab Seed (Baidou, 2 liang), Ginseng Radix et Rhizoma (Renshen, 1 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 1 liang, honey-fried), Red Poria (Chifuling, 2 liang), Pogostemonis Patchouli Folium (Huoxiangye, 2 liang), Papaya (Mugua, 2 liang), Moslae Herba (Xiangru, 4 liang), Magnoliae Officinalis Cortex (Nongpo/Houpo, 4 liang, stir-fried with ginger).
Crush the herbs. Take 1 liang per dose, decoct with ginger and jujube in water.
Commentary: "Liuhe" means harmonizing the Six Fu Organs. The Spleen and Stomach are the masters of the Six Fu Organs; thus, for diseases of disharmony in the Six Fu Organs, treatment begins by regulating the Spleen and Stomach. This formula contains Huoxiang and Sharen; their fragrance opens the stomach orifice. Banxia and Shengjiang are acrid and disperse rebellious Qi. Fuling and Mugua are bland and drain dampness. Renshen, Baizhu, and Bian Dou are sweet and regulate the Spleen and Stomach. Once the Spleen and Stomach are regulated, fluids distribute evenly, and the Five Meridians function together, bringing harmony to the limbs, bones, and orifices, let alone the Six Fu Organs.
Wuling San (See "Dampness" chapter for formula)
Yiyuan San, also known as Liuyi San
Ingredients: Talcum (Huashi, 6 liang, water-ground), Glycyrrhizae Radix et Rhizoma (Gancao, 1 liang).
Grind into fine powder, mix with water, and take.
Gui Ling Gan Lu Yin
Indicated for excessive drinking in summer, abdominal distension, Huoluan with diarrhea, dark and scanty urination, dry mouth, and thirst.
Ingredients: Atractylodis Macrocephalae Rhizoma (Baizhu, 2 liang, stir-fried), Poria (Baifuling, 2 liang), Polyporus (Zhuling, 2 liang), Alismatis Rhizoma (Zexie, 2 liang, dehusked), Talcum (Huashi, ground, 2 liang), Halloysit Rubra (Hanshuishi, ground, 1 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 1 liang, honey-fried), Cinnamomi Cortex (Rougui, peeled, 5 qian).
Crush the herbs. Take 1.5 liang per dose, decoct in two zhong of water until reduced to 0.8, and take warm.
Commentary: The above formula uses Wuling San to drain dampness from the Triple Burner. The two stones (Talcum and Halloysit) clear heat from the Six Fu Organs. This is a simple method for treating damp-heat advocated by He Jian. Zhang Zihe added Ginseng because the patient's pulse was deficient.