《经脉篇》曰∶足太阴厥气上逆，则霍乱。
《气交变大论》曰∶岁土不及，民病飧泄、霍乱。
《六元正纪大论》曰∶不远热则热至，热至则身热，吐下霍乱。太阴所至，为中满、霍
乱、吐下。土郁之发，为呕吐、霍乱。
霍乱一证，以其上吐下泻，反复不宁而挥霍撩乱，故曰霍乱，此寒邪伤脏之病也。盖有
外受风寒，寒气入脏而病者；有不慎口腹，内伤食饮而病者；有伤饥失饱，饥时胃气已伤，
过饱食不能化而病者；有水土气令，寒湿伤脾而病者；有旱潦豪雨，清浊相混，误中沙气阴
毒而病者，总之皆寒湿伤脾之证。邪在脾胃，则中焦不能容受，故从上而出则为吐，从下而
出则为泻，且凡邪之易受者，必其脾气本柔，而既吐既泻，则脾气不无更虚矣。故凡治霍乱
者，必宜以和胃健脾为主。健者，培补之谓，因其邪气已去，而胃气受伤，故非培补不可也
。和者，调和之谓，以其胃气虽伤，而邪犹未尽，故非察其邪正，而酌为调和不可也。若其
寒少滞多，则但以温平之剂调之可也；若滞因于寒，则非温热之剂不能调也。而诸家有言为
火者，谓霍乱之病多在夏秋之间，岂得为之伤寒乎？吁！谬亦甚矣。不知夏秋之交，正多脏寒
之病，盖一以盛暑将杀，新凉初起，天人易气，寒之由也；一以酷暑当令，生冷不节，疾病
因时寒之动也。人以夏秋之外热易见，而脏腑之内寒难见，故但知用热远热，而不知用寒远
寒，见之浅陋，多有如此，此所以多致误也。学人于此，当熟察之。
一、转筋霍乱证，以其足腹之筋拘挛急痛，甚至牵缩阴丸，痛迫小腹，最为急候，此足
阳明厥阴气血俱伤之候也。观河间曰∶转筋，经云反戾也，热气燥烁于筋，则挛螈而痛，火
主燔烁燥动故也。或以为寒客于筋者，误也，盖寒虽主于收引，然止为厥逆、禁固、屈伸不
便，安得为转筋也。所谓转者，动也，阳动阴静，热证明矣。丹溪亦曰∶转筋属血热。余谓
此二子之言，总属一偏之见，不可从也。试以《内经》质之，不有曰∶经筋之病，寒则反折
筋急，热则筋弛纵不收。此转筋者，谓非反折筋急之病乎，而何以谓之热也？夫所谓转者，
以其坚强急痛，有如扭转之状，是谓转筋，今西北方以转字作去声者，即其义也。而河间曰
∶转者，动也，则不为强矣。且凡患转筋者，必于大吐大泻之后，乃有此证，未闻于吐泻之
前，而先见转筋者也。若转于吐泻之前而谓之火，犹可云因火而病也，既转于吐泻之后，则
上下皆已火去，岂因吐泻而反生火耶？又何以吐泻之前火不转耶？河间其何以解之。盖阳明为
五脏六腑之海，主润宗筋，此证以阳明血气骤损，筋急而然，本非火也。观无择陈氏曰∶转
筋者，以阳明养宗筋，属胃与大肠。今暴吐下，津液顿亡，外感四气，内伤七情，攻闭诸脉
，枯削于筋，宗筋失养，必致挛缩，甚则卵缩、舌卷，为难治。此说始为切当。若从河间而
作火治，能无误乎？余故曰不可从也。
一、夏秋新凉之交，或疾风豪雨，或乍寒乍暖之时，此皆阴阳相驳之际，善养生者，最
于此时宜慎，凡外而衣被，内而口腹，宜增则增，宜节则节，略为加意，则却疾亦自不难。
其或少有不调，而为微寒所侵，则霍乱吐泻、搅肠腹痛、疟痢之类，顷刻可至，此其所忽者
微，而所害者大也。且膏粱与藜藿不同，薄弱与强壮迥异。矧强者犹不可恃强，而弱者顾可
以忘弱耶，此自珍者之不可忽也。
《灵枢·经脉篇》中说：足太阴脾经的厥逆之气上冲，就会发生霍乱。
《素问·气交变大论》中说：如果岁运土气不足，百姓就会患完谷不化的泄泻和霍乱病。
《素问·六元正纪大论》中说：如果不远离热邪则热邪会至，热邪至则身体发热，出现呕吐、下利及霍乱。太阴湿土之气所至之时，会出现中焦痞满、霍乱、呕吐和下利。土气郁结而发时，会出现呕吐和霍乱。
霍乱这一病证，是因为患者上吐下泻，反复不安，挥霍撩乱，所以称为霍乱，这是寒邪损伤脏腑的疾病。大概有外受风寒，寒气侵入脏腑而发病的；有不慎饮食，内伤食饮而发病的；有饥饱失常，饥饿时胃气已伤，过饱后食物不能消化而发病的；有水土气候令节变化，寒湿损伤脾脏而发病的；有旱涝暴雨，清浊之气相混，误中沙气阴毒而发病的，总之都是寒湿损伤脾脏的病证。邪气在脾胃，导致中焦不能容纳受纳，所以从上而出就是呕吐，从下而出就是泄泻。而且凡是容易感受邪气的，必定是其脾气本来柔弱，而在既吐又泻之后，脾气没有不更加虚弱的。所以凡是治疗霍乱的，必须以和胃健脾为主。所谓“健”，是指培补，因为邪气已经去除，而胃气受到损伤，所以非培补不可。所谓“和”，是指调和，因为胃气虽然受伤，但邪气尚未完全清除，所以必须观察邪正盛衰的情况，斟酌进行调和才行。如果是寒邪少而停滞多，那么只用温平的药剂来调理就可以了；如果是停滞由于寒邪引起，那么非用温热的药剂不能调理。然而有些医家说是火邪所致，认为霍乱病多在夏秋之间，怎么能说是伤寒呢？唉！这种错误也太严重了。不知道夏秋之交，正是内脏寒病的多发季节，一方面是因为盛夏将尽，新凉初起，天人之气转换，寒邪由此产生；另一方面是因为酷暑当令，生冷饮食不节制，疾病因时令之寒而动。人们只看到夏秋外在的热象容易察觉，而脏腑内部的寒象难以察觉，所以只知道夏天要慎用热药（用热远热），却不知道此时更要慎用寒药（用寒远寒），见识浅陋，大多如此，这就是导致很多误治的原因。学习中医的人对此应当仔细考察。
一、转筋霍乱证，是因为小腿腹部的筋脉拘挛急痛，甚至牵引睾丸收缩，疼痛迫近小腹，是最为紧急的候症，这是足阳明胃经和足厥阴肝经气血都受损的表现。看刘河间说：转筋，经书中称为反戾，热气燥烁于筋脉，就会导致痉挛抽搐而疼痛，因为火性主燔灼、燥动。有人认为是寒邪客居筋脉，这是错误的，因为寒邪虽然主收引，但只是导致四肢厥冷、僵硬、屈伸不便，怎么会是转筋呢？所谓的“转”，是指动，阳主动阴主静，这显然是热证明显。朱丹溪也说：转筋属于血热。我认为这两位先生的言论，都属于片面的见解，不可听从。试着用《内经》来验证，难道没有说：经筋生病，寒则反而折损筋脉使其紧急，热则筋脉弛缓纵散不收。这个转筋，难道不是指筋脉紧急折损的病吗？为什么说是热证呢？所谓的“转”，是因为筋脉坚强急痛，好像扭转的样子，这就叫转筋，现在西北地区把“转”字读作去声，就是这个意思。而刘河间说：转，就是动，这样就不显得强急了。而且凡是患转筋的，一定是在大吐大泻之后，才出现这个症状，没听说过在吐泻之前，先出现转筋的。如果在吐泻之前就转筋而说是火邪，还可以说是因火致病，既然在吐泻之后才转筋，那么上下焦的火邪都已经去了，难道会因为吐泻反而生火吗？又为什么在吐泻之前火邪不引起转筋呢？刘河间你如何解释？大概阳明胃经是五脏六腑的海，主要滋润宗筋，这个症状是因为阳明气血突然受损，筋脉紧急所致，本来就不是火邪。看陈无择陈氏说：转筋，是因为阳明滋养宗筋，归属于胃与大肠。现在暴吐暴下，津液瞬间亡失，外感四气，内伤七情，攻闭诸脉，使筋脉枯瘦削弱，宗筋失去滋养，必然导致挛缩，严重时甚至睾丸收缩、舌头卷曲，属于难治之症。这种说法才算是恰当。如果按照刘河间的观点当作火邪来治疗，能不犯错吗？所以我说不可以听从。
一、夏秋新凉交替之时，或者疾风暴雨，或者忽冷忽暖的时候，这些都是阴阳之气相互冲突驳杂的时节，善于养生的人，最应该在这个时候谨慎，凡是外在的衣服被褥，内在的口腹饮食，应该增加保暖的就增加，应该节制饮食的就节制，稍微多加注意，那么预防疾病也不难。如果稍有不调，被微寒所侵袭，那么霍乱吐泻、搅肠腹痛、疟疾痢疾之类的病，顷刻间就可以到来，这是所忽视的很微小，但危害却很大的情况。而且富贵人家吃的膏粱厚味与普通百姓吃的粗茶淡饭不同，体质薄弱与强壮的人截然不同。况且强壮的人尚且不可以倚仗强壮而忽视保养，体弱的人难道可以忘记自己的虚弱吗？这是自我珍重的人不可忽视的。
The *Ling Shu: Jing Mai* (Meridian Chapter) states: When the rebellious Qi of the Foot-Taiyin Spleen channel ascends, Huoluan (acute vomiting and diarrhea) occurs.
The *Su Wen: Qi Jiao Bian Da Lun* (Great Treatise on Changes in Atmospheric Interactions) states: If the Yearly Earth Qi is insufficient, the people will suffer from Sundigestion (undigested food in stool) and Huoluan.
The *Su Wen: Liu Yuan Zheng Ji Da Lun* (Great Treatise on the Six Principal Epochs) states: If one does not keep away from Heat, Heat will arrive; when Heat arrives, the body becomes hot, accompanied by vomiting, diarrhea, and Huoluan. When Taiyin Dampness prevails, it causes Middle-Jiao fullness, Huoluan, vomiting, and diarrhea. When Earth Qi is depressed and erupts, it causes vomiting and Huoluan.
Huoluan is a syndrome characterized by simultaneous vomiting and diarrhea, causing restlessness and turmoil ("huohuo liaoluan"), hence the name. It is a disease caused by Cold pathogenic factors injuring the Zang organs. Generally, there are cases where external Wind-Cold invades, with Cold Qi entering the Zang to cause illness; cases where dietary indiscretion leads to internal injury from food and drink; cases of irregular eating where stomach Qi is damaged during hunger, and subsequent overeating prevents digestion; cases where climatic changes bring Cold-Dampness that injures the Spleen; and cases where heavy rains mix clear and turbid Qi, leading to accidental poisoning from sand or Yin-Toxins. In summary, these are all syndromes of Cold-Dampness injuring the Spleen. When the pathogen resides in the Stomach and Spleen, the Middle Jiao cannot accept or contain it, so expulsion upwards results in vomiting, and expulsion downwards results in diarrhea. Furthermore, those susceptible to pathogens usually have inherently weak Spleen Qi, which becomes even more deficient after vomiting and diarrhea. Therefore, treating Huoluan must primarily focus on harmonizing the Stomach and strengthening the Spleen. "Strengthening" refers to tonification; since the pathogen has been expelled but Stomach Qi is injured, tonification is essential. "Harmonizing" refers to regulating; although Stomach Qi is injured, the pathogen may not be fully cleared, so one must assess the balance of pathogen and healthy Qi and regulate accordingly. If Cold is slight and stagnation is predominant, mild and neutral formulas can be used for regulation; if stagnation is due to Cold, only warm and hot formulas can effect regulation. Some physicians claim it is a Fire syndrome, arguing that Huoluan often occurs in summer and autumn, so how can it be considered Cold damage? Alas, this error is severe. They fail to realize that the transition between summer and autumn is precisely when internal organ Cold diseases are common. This is because, first, as intense heat wanes and cool air begins, the Qi of Heaven and Humanity shifts, giving rise to Cold; second, during peak heat, improper consumption of cold and raw items triggers diseases driven by seasonal Cold. People easily perceive external heat in summer and autumn but fail to see internal organ Cold. Thus, they know to avoid hot remedies in summer ("use hot far from hot") but do not know to avoid cold remedies at this time ("use cold far from cold"). Such shallow understanding leads to frequent misdiagnosis. Students should examine this carefully.
1. Huoluan with tendon contraction (Zhuanjin): This involves spasmodic cramping and pain in the calf muscles, potentially pulling the testicles inward and causing pain pressing against the lower abdomen. It is a critical condition indicating injury to the Qi and Blood of both the Foot-Yangming Stomach channel and Foot-Jueyin Liver channel. Liu Hejian stated: Tendon contraction is described in classics as "fanli" (reversal/spasm). Dry Heat scorching the tendons causes spasms and pain, as Fire governs burning and agitation. Others attribute it to Cold lodging in the tendons, which is incorrect. Although Cold governs contraction, it typically causes limb coldness, stiffness, and difficulty moving, not tendon twisting. The term "zhuan" (turn/twist) implies movement; Yang moves, Yin is still, clearly indicating a Heat syndrome. Zhu Danxi also stated: Tendon contraction belongs to Blood Heat. I consider these views one-sided and unacceptable. Let us verify with the *Nei Jing*: "When meridional sinews are diseased, Cold causes them to reverse and become tight; Heat causes them to relax and hang loose." Is this tendon contraction not a disease of reversed, tight sinews? Why call it Heat? The term "zhuan" describes the stiff, painful, twisted appearance of the tendon. In Northwest China, "zhuan" is pronounced with the falling tone, reflecting this meaning. Liu Hejian’s definition of "zhuan" as mere movement lacks this sense of tension. Moreover, patients with tendon contraction always develop it after severe vomiting and diarrhea; it is unheard of for it to precede them. If it occurred before vomiting/diarrhea, one might argue it was caused by Fire. But since it appears after, the Fire in the upper and lower jiao has already dissipated; could vomiting and diarrhea generate Fire? Why did Fire not cause contraction before the vomiting/diarrhea? How does Liu explain this? The Yangming Stomach is the sea of the five zang and six fu organs, primarily nourishing the Zong Jin (general sinews). This condition arises from sudden depletion of Yangming Qi and Blood, causing tendon tightness, not Fire. Chen Wuyue stated: Tendon contraction relates to Yangming nourishing Zong Jin, belonging to the Stomach and Large Intestine. Sudden vomiting and purging cause instant loss of fluids; combined with external Four Qi pathogens and internal Seven Emotions injuries blocking the vessels, the sinews become withered and lose nourishment, leading to spasm. Severe cases involve testicular retraction and tongue curling, making it difficult to treat. This explanation is accurate. Treating it as Fire based on Liu’s theory would surely lead to error. Hence, I say it is unacceptable.
1. During the transition from summer to early autumn, amidst fierce winds, heavy rains, or fluctuating temperatures, Yin and Yang Qi are conflicting. Those skilled in health preservation must be cautious. Externally, adjust clothing and bedding; internally, regulate diet—increasing warmth or restricting intake as needed. With slight attention, preventing illness is easy. However, minor imbalance allowing slight Cold invasion can instantly trigger Huoluan with vomiting/diarrhea, intestinal colic, malaria, or dysentery. What is neglected slightly causes great harm. Note that diets of the rich (rich foods) differ from those of the poor (coarse grains), and constitutions of the frail differ vastly from the robust. Even the robust should not rely on strength to neglect care; how much less should the frail ignore their weakness? This is crucial for self-preservation.