霍乱一病，经文具存，唯干霍乱为经所未言，宜取而补者。但后世诸说，概涉多歧，今仅摘其要，以着于篇。
名义 霍乱，言其病挥霍之间，便致撩乱也。（《病源论》）
若止呕吐而利，经止谓之吐利。必也上吐下利，躁扰烦乱，乃谓之霍乱，其与但称吐利者，所以异也。
（《明理论》）
源由 凡所以得霍乱者，多起饮食。或饮食生冷杂物，以肥腻酒 ，而当风履湿，薄衣露坐，或夜卧
失覆之所致。（《肘后》）
霍乱者，由人温凉不调，阴阳清浊二气，有相干乱之时。其乱在于肠胃之间者，因遇饮食而变，发则心腹
绞痛。其有先心痛者，则先吐。先腹痛者，则先利。心腹并痛者，则吐利俱发。挟风而实者，身发热，头痛体
疼而复吐利；虚者。但吐利，心腹刺痛而已。亦有饮酒食肉，腥脍生冷过度，因居处不节，或露卧湿地，或当风
取凉，而风冷之气，归于三焦，传于脾胃，脾胃得冷则不磨，不磨则水谷不消化，亦令清浊二气相干。脾胃虚
弱，便为吐利，水谷不消，则心腹胀满，皆成霍乱。（《病源论》）
原夫霍乱之为病也，皆因饮食，非关鬼神。夫饱食肫除，复餐乳酪，海陆百品，无所不啖，眠卧冷席，多饮
寒浆，胃中诸食，结而不消，阴阳二气，拥而反戾，阳气欲升，阴气欲降，阴阳乖隔，变成吐利，头痛如破，百节如
解，遍体诸筋，皆为回转，论时虽小，卒病之中，最为可畏，虽临深履危，不足以谕之也。养生者，宜达其旨
趣。庶可免于夭横矣。（《千金》）
冒伤暑毒，露卧卑湿，当风取凉，风冷邪气入于肠胃，加以嗜好肥腥，饮啖生冷，居处不节，激而发焉。
于是邪正相干，中脘即闭，气不得通，吐利暴作，所谓脾受贼邪，木来胜土者此也。（《直指》）
内有所积，外有所感，致成吐泻。（《丹溪》）
霍乱证，虽有风寒湿热之异，大抵伤暑居多。盖由夏暑内伤元气，脾胃俱虚，必因饮冷停寒酒色所伤，外
因受凉，邪气所郁，不得发越，而霍乱之证作矣。故此证多作于秋凉之时，从可知矣。（《医统》）
病邪在中焦 三焦者，水谷之道路，气之所终始也。因风冷或饮食伤胃，致中焦不和，则正气不守，
而邪得以干，挥霍之间，便致撩乱。（《圣济》）
霍乱吐利者，以三焦气不升降，而清浊相干于胃间。治此者当以中焦为本，中焦既和，则清浊自分而吐利
止矣。（同上）
邪在上焦者，但吐而不利。邪在下焦者，但利而不吐。若邪在中焦，胃气不治，为邪所伤，使阴阳乖隔，
遂上吐而下利。（《明理论》）
脉候 伏者霍乱。（《脉经》）
诊其脉来代者，霍乱。又脉代而绝者，亦霍乱也。（按∶《圣济》曰∶脉必代者，以气不足也。说互见下。）
霍乱，脉大可治（《脉诀》曰三部浮洪必救得），微细不可治。霍乱吐下，脉微迟，气息劣，口不欲言者。不
可治。（《病源论》）
滑而不匀，必是吐泻，霍乱之候，脉代勿讶。（《崔氏脉诀》）
霍乱脉多结促，皆不可断以死。（《医统》）
若见代脉，因一时清浊混乱，故脉不接续，非死脉也。（《必读》）
霍乱者，挥霍撩乱，不能自持，阴阳乖离，上下亟夺，是时脉或代止，勿惊讶也。乃卒吐暴下，谷神顿委，
暂不接续故耳。若手足厥冷，脉复迟微，是则大为可怕。盖手足为诸阳之本，迟微为纯阴之脉，阳衰阴盛，真元
渐绝之象也。是故暴脱者能渐生，而渐绝者又何能暴起哉。（《续焰》）
微弱渐绝死，脉渐大者生。（《玉案》）
如大痛时，脉多伏，不宜渐迟。（《简明医彀》）
凡结脉、促脉、代脉、滑脉，皆霍乱之脉也。故霍乱脉洪滑而大则易治，沉涩而细则难治耳。（《医约》）
脉细者死，弦甚者死。（《本草权度》）
证治诸说 霍乱吐泻者，有冷热二证∶寒多不渴者，可与理中丸、姜附汤、来复丹；霍乱吐泻有热烦
躁而渴者，可服香薷散、五苓散、嘉禾散、参苓白术散、四君子汤。霍乱吐泻后，调理脾胃，可与服参苓白术
散、五苓散、四君子汤、调气散之类。（《和剂指南》）（按∶仲景霍乱之冷热，为就病邪之未化寒与既化寒者
而为辨，此说犹不失其意。如明清诸家，往往划然分析，与伤寒之寒热同例。然验之事为，殊不见其当。今姑
列数说于下，以俟识者论定。）
其证有冷有热∶冷者面惨不光，口气冷，息微不欲语言，肌肤寒，肢节清冷，汗时出，肚腹疼痛，口不渴而
喜饮热，脉必沉迟，或微而欲绝是也。热者，面色如故，口气热，息粗，烦躁闷乱，肌肤热，肢节温，肚腹绞痛，或自
汗，或无汗，口干渴而喜饮冷，脉必浮洪，或沉而伏是也。（《会解》）
因寒者，不烦少渴，或吐利后乃见烦渴，以津液外亡也。因暑者，大烦大渴，吐利清水，未吐利前预见
烦渴，以暑邪内扰也。（《汇补》）
甚者脐腹绞痛，厥逆脉脱，举体转筋，当温补回阳复脉。若暑月多餐生冷瓜果泉水，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。（《指掌》）
吐利转筋，胁下痛，脉弦者，木克土也，故痛甚，建中加柴胡、木瓜。吐利四肢厥冷，脉微缓，属厥阴，
建中加归、附。（《玉机》引《保命集》）（按∶当是云岐子书。）
吐利不止，元气耗散，病势危笃，或水粒不下，或口渴喜冷，或恶寒战掉，手足逆冷，或发热烦躁，欲去
衣被，此盖内虚阴盛，却不可以其喜冷欲去衣被为热，宜理中汤，甚则附子理中汤，不效则四逆汤，并宜放十
分冷服。霍乱并诸吐泻后，胸膈高起，痞塞欲绝，理中汤加枳实半钱，茯苓半钱，名枳实理中汤。吐泻已愈，
而力怯精神未复者，十补汤（按∶即十全大补汤）。夏月感暑吐泻如霍乱者，六和汤、香薷汤皆是要药。人于
夏月，多食瓜果及饮冷乘风，以致食留不化，因食成痞，隔绝上下，遂成霍乱，六和汤倍藿香煎熟，调苏合
香丸。（《要诀》）
吐泻若已透畅，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。（《医通》）
干湿辨异（宜参涌吐及泻下诸方） 霍乱者，多吐利也，干霍乱者，是冷气搏于肠胃，致饮食不消，
但腹满烦乱，绞痛短气，其肠胃先挟实，故不吐利，名为干霍乱也。（《病源论》）
许仁则云∶此病有两种∶一名干霍，一名湿霍。干霍死者多，湿霍死者少，俱繇饮食不节，将息失宜。
干霍之状，心腹胀满，搅刺疼痛，烦闷不可忍，手足逆冷，甚者流汗如水，大小便不通，求吐不出，求利不下，
须臾不救，便有性命之虑。湿霍之状，心腹亦搅痛，诸候有与干同，但吐利无限。此病始得，有与天行相似者，
亦令头痛，骨肉酸楚，手足逆冷，四体发热。（《外台》）（按∶原疗干霍有巴豆等三味丸，今见后。）
许仁则云∶病有干霍乱，有湿霍乱。干霍乱死者多，湿霍乱死者少。盖吐利则所伤之物得以出泄，虽霍乱
甚，则止于胃，若水谷泄尽，则止矣，所以死者少。及其干霍乱死多者，以其上不得吐，下不得利，则所伤之
物不得出泄，拥闭正气，关隔阴阳，烦扰闷乱，躁无所安，喘胀，干霍乱而死。（《明理论》）
心腹绞痛，冷汗出，胀闷欲绝，俗谓搅肠沙，今考之此证乃名干霍乱。此亦由山岚瘴气，或因饥饱失时，
阴阳暴乱而致，急用盐汤吐法。（《得效》）（按∶此本出《经验良方》，曰∶绞肠沙，痛不可忍，或辗转在
地，或起或仆，其肠绞缩在腹，此是中毒之深，须臾能令人死，古方名干霍乱。《要诀》亦曰∶近世俗医谓之
搅肠沙，人多信之，殊不知即是霍乱，侥幸而愈者，一时之功耳。）
干霍乱证，最为危候，其证则上欲吐而不能出，下欲泻而不能行，胸腹搅痛，胀急闷乱，此必内有饮食停
阻，外有寒邪闭遏。盖邪浅者，易于行动，故即见吐利；邪深者，阴阳格拒，气道不通，故为此证，若不速治，
多致暴死。（《景
岳》）
如欲吐不吐，欲利不利，上下不通，腹满痛而头疼发热者，桂枝大黄汤，此干霍乱。（《伤寒缵论》）
委中穴出血，或十指头出血，皆是良法。（《正传》）
干霍乱若吐泻不出，胸腹胀硬，面唇青黑，手足冷过肘膝，六脉伏绝，气喘急，舌短囊缩者，死证也。
（《回春》）
转筋（宜参外治法） 夫霍乱大吐下之后，阴阳俱虚，其血气虚极，则手足逆冷而荣卫不理。冷搏于
筋，则筋为之转。冷入于足之三阴三阳，则脚筋转。入于手之三阴三阳，则手筋转。随冷所入之筋，筋则转。
转者皆由邪冷之气，击动其筋而移转也。（《病源论》）
转筋者，以阳明养宗筋，属于大肠。今暴下暴吐，津液顿亡（按∶原此下有“外伤四气，内积七情，饮食
甜腻，攻闭诸脉，刮削于筋”五句，《必读》芟却，今从之），宗筋失养，必致挛急，甚则卵缩舌卷，为难治。
（《三因》）（按∶景岳举此说，以驳河间转筋属火之谬，文繁不录。）
甚则转筋入腹则毙，霍乱恶证，无越于斯。（同上）
霍乱转筋，理中汤加冻胶锉炒一钱，仍令其系缚腿胫，若筋入腹及通身转筋者，不可治。筋转者，以造曲
蓼汁暖热浸，或用浓盐汤浸。（《要诀》）
死证 霍乱之后，阳气已脱，或遗尿而不知，或气少而不语，或膏汗如珠，或大躁欲入水，或四肢不
收，皆不可治。（《要诀》）
治宜救正为急 风雨寒暑之邪直为霍乱，若吐利太过而生气内伤，手足厥冷，脉微欲绝，皆宜四逆汤
主之，无分寒与暑也。盖正气受伤，止救正而不论邪，后人补正藿香正气散以治吐利，此治微邪在胃，正气不伤，
如此之证，弗药亦
愈，即阴阳汤（按∶此谓生熟水）、黄土汤（按∶此谓地浆）皆能疗之。若霍乱里虚，上古止立四逆、理中二
方，为急救正气之法。有谓藿香正气散治暑霍乱者，亦非也。愚每见暑月病霍乱，四肢逆冷，无脉而死。藿香正
气，不过宽表解表之剂，恶能治之。况夏月元气发泄在外，中气大虚，外邪卒至，救正犹迟。夫邪正相持，有
风雨寒暑之分。正受邪伤，止论正气之虚实，入脏即为不治之死证，非风暑为阳而寒雨为阴也。此为霍乱之大
纲，学人宜服膺而弗失。（《伤寒论集注》）
治宜和胃健脾 邪之易受者，必其脾气本柔，而既吐且泻，则脾气不能更虚矣。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，正多藏寒之病。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，而藏寒之内寒难见，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。（《景岳》）
回阳散寒诸方 四顺汤，治霍乱，转筋肉冷，汗出呕 者。（范汪云∶利甚加附子二两，妙。）（《千
金》）（按∶即四逆加人参汤。）
《仲景论》霍乱，四逆吐少呕多者，附子粳米汤主之。一方有干姜一两。（《外台》）（按，《千金》有干姜。）
姜附汤，治霍乱转筋，手足厥冷，多汗呕逆。（《济生》）姜附汤，清煎沉冷，服之大效，热因寒用之法也。
（《得效》）
霍乱，或有寒，腹满痛，或四肢拘急，下利脚转筋，理中汤加附子一枚生用，并粗末，作汤服之。（《活人》）
霍乱转筋，吐泻不止，头目昏眩，须臾不救者，以吴茱萸汤主之。（《原病集》）（按∶即仲景原方。
《外台·霍乱干呕》∶《肘后》干姜茱萸汤，盖自此方变来。）
《僧深方》霍乱呕吐，水药不下，茱萸汤法。
茱萸（一升） 黄连（二两） 附子（一两） 甘草（一两） 生姜（三两）
凡五物，以水七升，煮取三升，分三服。（《医心》）
《短剧方》霍乱多寒，手足寒厥，脉绝，茱萸四逆汤主之方。
吴茱萸（二升） 当归（三两） 芍药（二两） 桂
心（四两） 细辛（二两） 生姜（半斤） 通草（二两）
甘草（一两）
凡八物，以水四升，清酒四升，合煮取三升，分四服。（同上）旧方用枣三十枚，今以霍乱病法多痞，故除
之。如退枣，入葛根二两佳。霍乱四逆，加半夏一合，附子小者一枚，恶寒乃与大附子。（《千金》）（按∶
方中有大枣二十五枚，可疑。）《济生》通脉四逆汤，加附子。（亦有枣。）
治霍乱呕吐，及下后腹中干痛，手足逆冷，宜服此方。
当归（一两） 干姜（半两） 甘草（半两） 人参 附子（各一两）
上件药捣筛为散，每服三钱，以水一中盏，煎至六分，去滓热服之。（《圣惠》）
霍乱这一疾病，医经中已有记载，唯独“干霍乱”在经典中未曾提及，应当选取相关论述来补充完善。但后世的种种说法，大多分歧不一，现在仅摘录其要点，记录于本篇之中。
【名义】
所谓“霍乱”，是指发病时挥霍之间，便导致身体撩乱不安。（出自《诸病源候论》）
如果只是单纯的呕吐或腹泻，医经中只称为“吐利”。必须是上吐下泻，且伴有躁动烦乱的症状，才称之为“霍乱”，这与仅仅称为“吐利”的情况是不同的。（出自《伤寒明理论》）
【源由】
凡是导致霍乱的原因，多起于饮食不当。比如食用生冷杂物，或者因肥腻、饮酒，又当风受寒、踩踏湿地，穿着单薄露天而坐，或者夜间睡觉没有盖好被子所致。（出自《肘后备急方》）
霍乱，是由于人体温凉调节失调，阴阳清浊二气相互干扰混乱的时候发生的。如果这种混乱发生在肠胃之间，就会因为遇到饮食而诱发，发作时心腹绞痛。如果先感到心痛，就先呕吐；先感到腹痛，就先腹泻；心腹都痛，就呕吐和腹泻同时发生。兼有风邪且体质实盛的，身体发热，头痛身疼而又呕吐腹泻；体质虚弱的，只是呕吐腹泻，心腹刺痛而已。也有因为饮酒吃肉，生腥冷食过度，加上起居不节制，或者露天睡在潮湿地方，或者对着风取凉，导致风寒之气归于三焦，传送到脾胃，脾胃受冷就不能消化食物，不能消化则水谷无法运化，也会导致清浊二气相互干扰。脾胃虚弱，就会发生吐泻，水谷不消，就会导致心腹胀满，这些都形成霍乱。（出自《诸病源候论》）
起初霍乱这种病，都是由于饮食引起的，与鬼神无关。吃饱了之后，又吃乳酪海鲜等百种食物，无所不吃，睡在冷席上，多喝冷饮，胃中的各种食物凝结而不消化，阴阳二气壅滞而逆乱，阳气想上升，阴气想下降，阴阳乖隔，变成呕吐腹泻，头痛欲裂，全身关节像散开一样，遍体筋脉都发生扭转。虽然这只是小病，但在突发疾病中，最为可怕，即使面临深渊险境，也不足以形容它的危险。养生的人，应该明白其中的旨趣，或许可以避免横死。（出自《千金要方》）
冒犯暑毒，露天睡在低洼潮湿处，对着风取凉，风寒邪气进入肠胃，再加上嗜好肥甘腥味，饮用生冷，起居不节制，激发而发病。于是邪气与正气相干，中脘闭塞，气机不通，突然发生剧烈呕吐腹泻，这就是所谓的脾受贼邪，木气来克伐土气（肝木乘脾土）。（出自《医学六要·直指》）
体内有积滞，体外有感邪，导致呕吐腹泻。（出自朱丹溪）
霍乱的证候，虽然有风寒湿热的不同，但大抵多是伤暑居多。这是因为夏季暑热内伤元气，脾胃俱虚，必然因为饮冷、停寒、酒色所伤，外因受凉，邪气郁结，不得发散，从而霍乱的证候发作。所以这个证候多在秋凉之时发作，由此可知。（出自《医统》）
【病邪在中焦】
三焦，是水谷运行的道路，气机终结和起始的地方。因为风寒或饮食损伤胃，导致中焦不和，那么正气就不能固守，而邪气得以干扰，在挥霍之间，便导致撩乱。（出自《圣济总录》）
霍乱吐泻，是因为三焦气机升降失常，清浊之气在胃间相互干扰。治疗此病应当以中焦为本，中焦调和了，清浊自然分开，吐泻就会停止。（同上）
邪气在上焦的，只呕吐而不腹泻。邪气在下焦的，只腹泻而不呕吐。如果邪气在中焦，胃气失治，被邪气伤害，使阴阳乖隔，于是向上呕吐而向下腹泻。（出自《伤寒明理论》）
【脉候】
脉象伏匿的，是霍乱。（出自《脉经》）
诊察脉象出现代脉的，是霍乱。另外脉象代而断绝的，也是霍乱。（按：《圣济总录》说：脉必现代脉，是因为气不足。详见下文。）
霍乱，脉象大的可以治疗（《脉诀》说三部脉浮洪必定能救活），脉象微细的不可治疗。霍乱吐泻，脉象微迟，气息微弱，不想说话的，不可治疗。（出自《诸病源候论》）
脉滑而不均匀，必定是吐泻，这是霍乱的征候，脉象出现代脉不要惊讶。（出自《崔氏脉诀》）
霍乱的脉象多有结脉、促脉，都不能断定必死。（出自《医统》）
如果见到代脉，是因为一时清浊混乱，所以脉气不接续，这不是死脉。（出自《医宗必读》）
霍乱，挥霍撩乱，不能自持，阴阳分离，上下急剧夺损，这时脉象可能有时停顿，不要惊讶。这是因为突然剧烈呕吐暴泻，谷神顿时委顿，暂时不接续的缘故。如果手足厥冷，脉象又变迟缓微弱，这才是非常可怕的。因为手足是诸阳之本，迟微是纯阴之脉，这是阳衰阴盛，真元逐渐断绝的迹象。所以暴脱者还能逐渐恢复，而逐渐断绝者又怎么能突然兴起呢？（出自《续焰》）
脉微弱逐渐断绝为死证，脉逐渐变大者为生证。（出自《玉案》）
如在大痛时，脉象多伏匿，不宜逐渐变迟。（出自《简明医彀》）
凡是结脉、促脉、代脉、滑脉，都是霍乱的脉象。所以霍乱脉象洪滑而大则容易治疗，沉涩而细则难治。（出自《医原》）
脉细的为死证，脉弦甚的为死证。（出自《本草权度》）
【证治诸说】
霍乱吐泻，有冷、热两种证候：寒多且不口渴的，可以给予理中丸、姜附汤、来复丹；霍乱吐泻有热、烦躁且口渴的，可以服用香薷散、五苓散、嘉禾散、参苓白术散、四君子汤。霍乱吐泻后，调理脾胃，可以服用参苓白术散、五苓散、四君子汤、调气散之类。（出自《和剂指南》）（按：张仲景关于霍乱冷热之分，是针对病邪未化寒与已化寒而言的，这种说法仍不失其意。如明清诸家，往往截然分析，与伤寒的寒热同例。然而验证实际情况，殊不见得当。现在暂列数说如下，以待识者论定。）
其证候有冷有热：冷证的表现为面色惨淡无光泽，口气冷，气息微弱不想说话，肌肤寒冷，肢节清冷，时而出汗，肚腹疼痛，口不渴而喜欢喝热水，脉象必沉迟，或微细欲绝。热证的表现为面色如常，口气热，呼吸粗重，烦躁闷乱，肌肤热，肢节温暖，肚腹绞痛，或自汗，或无汗，口干渴而喜欢喝冷水，脉象必浮洪，或沉而伏匿。（出自《类证治裁·会解》）
因寒邪引起的，不烦躁或少渴，或在吐泻后才出现烦渴，这是因为津液向外亡失。因暑邪引起的，大烦大渴，吐泻清水，在未吐泻前就预见烦渴，这是因为暑邪内扰。（出自《症因脉治·汇补》）
严重的脐腹绞痛，四肢厥逆，脉象摸不到，全身转筋，应当温补回阳复脉。如果在暑月多吃生冷瓜果泉水，导致食积郁结在中焦而成霍乱的，适宜用辛温药疏散表寒，其次用寒凉药清解暑热即可，口渴严重的用冰水解渴。（出自《医门指掌》）
吐泻转筋，胁下痛，脉弦的，是木克土，所以疼痛剧烈，用建中汤加柴胡、木瓜。吐泻四肢厥冷，脉微缓，属厥阴经，用建中汤加当归、附子。（出自《玉机微义》引《保命集》）（按：应当是云岐子的书。）
吐泻不止，元气耗散，病势危重，或者水米不进，或者口渴喜冷，或者恶寒战栗，手足逆冷，或者发热烦躁，想要去掉衣被，这大概是内虚阴盛，不可以因为他喜欢冷、想要去衣被就认为是热证，适宜用理中汤，严重的用附子理中汤，无效则用四逆汤，并且都宜放凉到十分冷再服用。霍乱及诸吐泻后，胸膈高起，痞塞欲绝，用理中汤加枳实半钱，茯苓半钱，名为枳实理中汤。吐泻已愈，但体力怯弱精神未恢复的，用十补汤（按：即十全大补汤）。夏季感暑吐泻如霍乱的，六和汤、香薷汤都是重要药物。人在夏季，多吃瓜果及饮冷乘风，导致食物停留不化，因食成痞，隔绝上下，遂成霍乱，用六和汤倍加藿香煎熟，调服苏合香丸。（出自《杂病广要·要诀》）
如果吐泻已经透畅，人困弱，脉虚软，这是邪气已去而正气虚；如果吐泻未透畅，脉仍涩滞有力，人仍烦躁不宁，这是邪气尚未尽，必须辨别清楚。（出自《医学入门·医通》）
【干湿辨异】（宜参考涌吐及泻下诸方）
霍乱，多是吐泻；干霍乱，是冷气搏结于肠胃，导致饮食不消，只是腹部胀满烦乱，绞痛短气，其肠胃先挟实邪，所以不吐不泻，命名为干霍乱。（出自《诸病源候论》）
许仁则说：此病有两种：一名干霍，一名湿霍。干霍乱死者多，湿霍乱死者少，都由于饮食不节，调养失宜。
干霍乱的症状，心腹胀满，搅刺疼痛，烦闷不可忍受，手足逆冷，严重的流汗如水，大小便不通，想吐吐不出，想拉拉不下，片刻不救治，就有性命之忧。湿霍乱的症状，心腹也搅痛，诸症状有的与干霍乱相同，只是吐泻无限量。此病刚开始，有的与天行（流行性传染病）相似，也会令头痛，骨肉酸楚，手足逆冷，四肢发热。（出自《外台秘要》）（按：原疗干霍乱有巴豆等三味丸，见后文。）
许仁则说：病有干霍乱，有湿霍乱。干霍乱死者多，湿霍乱死者少。因为吐泻则所伤之物得以排出，虽然霍乱严重，也只限于胃，如果水谷泄尽，也就停止了，所以死者少。至于干霍乱死的多，是因为上不能吐，下不能利，所伤之物不得出泄，壅闭正气，关隔阴阳，烦扰闷乱，躁动无所安，气喘胀满，死于干霍乱。（出自《伤寒明理论》）
心腹绞痛，冷汗出，胀闷欲绝，俗谓“搅肠沙”，现在考证此证名为干霍乱。这也是由山岚瘴气，或因饥饱失时，阴阳暴乱而致，急用盐汤催吐法。（出自《袖珍方·得效方》）（按：此本出《经验良方》，说：绞肠沙，痛不可忍，或辗转在地，或起或仆，其肠绞缩在腹，这是中毒之深，片刻能令人死，古方名干霍乱。《要诀》也说：近世俗医谓之搅肠沙，人多信之，殊不知即是霍乱，侥幸而愈者，是一时的功效罢了。）
干霍乱证候，最为危重，其证候是上想吐而不能出，下想泻而不能行，胸腹搅痛，胀急闷乱，这必定内有饮食停阻，外有寒邪闭遏。邪浅的，易于行动，所以立即见吐利；邪深的，阴阳格拒，气道不通，所以有此证，若不速治，多致暴死。（出自《景岳全书》）
如果想吐不吐，想拉拉不下，上下不通，腹满痛而头疼发热的，用桂枝大黄汤，这是干霍乱。（出自《伤寒缵论》）
委中穴出血，或十个手指头出血，都是良法。（出自《丹溪心法·正传》）
干霍乱如果吐泻不出，胸腹胀硬，面唇青黑，手足冷过肘膝，六脉伏绝，气喘急，舌短囊缩的，是死证。（出自《外科正宗·回春》）
【转筋】（宜参考外治法）
霍乱大吐大泻之后，阴阳俱虚，其血气虚极，则手足逆冷而营卫不调理。冷邪搏结于筋，则筋为之扭转。冷邪进入足部的三阴三阳经，则脚筋扭转。进入手部的三阴三阳经，则手筋扭转。随着冷邪进入的筋，筋就会扭转。扭转都是由邪冷之气，击动其筋而移转。（出自《诸病源候论》）
转筋，是因为阳明经滋养宗筋，归属于大肠。现在暴下暴吐，津液顿时亡失（按：原文此处下有“外伤四气，内积七情，饮食甜腻，攻闭诸脉，刮削于筋”五句，《医宗必读》删去，今从之），宗筋失养，必致挛急，严重的甚至睾丸收缩、舌头卷曲，为难治。（出自《三因极一病证方论》）（按：张景岳举此说，以驳斥刘河间认为转筋属火的谬误，文字繁多不录。）
严重的转筋入腹则毙命，霍乱恶证，没有超过这个的。（同上）
霍乱转筋，用理中汤加冻胶锉炒一钱，仍让他系缚腿胫，如果筋入腹及全身转筋的，不可治。筋转的，用造曲蓼汁暖热浸泡，或用浓盐汤浸泡。（出自《杂病广要·要诀》）
【死证】
霍乱之后，阳气已脱，或者遗尿而不知晓，或者气少而不语，或者汗出如珠，或者大躁动想入水，或者四肢不收摄，都不可治疗。（出自《杂病广要·要诀》）
【治宜救正为急】
风雨寒暑之邪直中而为霍乱，如果吐利太过而生气内伤，手足厥冷，脉微欲绝，都适宜用四逆汤主治，不分寒证与暑证。因为正气受伤，只需救正而不论邪气，后人补充的藿香正气散用来治疗吐利，这是治疗微邪在胃，正气未伤，这样的证候，不吃药也能好，即使是阴阳汤（按：指生水和熟水混合）、黄土汤（按：指地浆水）都能治疗它。如果霍乱里虚，上古只设立四逆、理中两方，作为急救正气的方法。有人说藿香正气散治疗暑霍乱，也不对。我常见暑月患霍乱，四肢逆冷，无脉而死。藿香正气散不过是宽中解表的药剂，怎能治疗它呢？况且夏季元气发泄在外，中气大虚，外邪猝然到来，救正还嫌迟。邪正相持，有风雨寒暑之分。正气受邪伤，只讨论正气的虚实，邪入脏即为不治的死证，不是风暑为阳而寒雨为阴。这是霍乱的大纲，学人应当铭记而不丢失。（出自《伤寒论集注》）
【治宜和胃健脾】
邪气容易侵袭的，必然是脾气本柔，而既吐且泻，则脾气不能再虚了。所以凡是治疗霍乱，必须以和胃健脾为主。健，是培补的意思，因为邪气已去而胃气受伤，所以非培补不可。和，是调和的意思，因为胃气虽伤而邪气未尽，所以非观察邪正情况而斟酌调和不可。如果寒少滞多，则只用温平的药剂调理即可。如果滞因于寒，则非温热药剂不能调理。而诸家有说是火证的，说霍乱之病，多在夏秋之间，难道能当作伤寒吗？唉！错误也太大了。不知道夏秋之交，正是多藏寒之病。一方面是因为盛暑将尽，新凉初起，天人易气，寒由此而生。一方面是因为酷暑当令，生冷不节，疾病因时令之寒而动。人们因为夏秋之外热易见，而藏寒之内寒难见，所以只知道用热远热，而不知道用寒远寒。见识浅陋，多有如此，这就是多导致误治的原因。学人于此，应当仔细考察。（出自《景岳全书》）
【回阳散寒诸方】
四顺汤，治疗霍乱，转筋肌肉冷，出汗呕吐的。（范汪说：利甚加附子二两，妙。）（出自《千金要方》）（按：即四逆加人参汤。）
《仲景论》霍乱，四逆汤证见呕吐少而呕多的，用附子粳米汤主治。一方有一两干姜。（出自《外台秘要》）（按，《千金要方》中有干姜。）
姜附汤，治疗霍乱转筋，手足厥冷，多汗呕逆。（出自《济生方》）姜附汤，清煎后沉冷服用，效果极大，这是热因寒用的方法。（出自《太平惠民和剂局方·得效方》）
霍乱，或有寒，腹满痛，或四肢拘急，下利脚转筋，用理中汤加附子一枚生用，并粗末，作汤服用。（出自《类证活人书》）
霍乱转筋，吐泻不止，头目昏眩，片刻不救的，用吴茱萸汤主治。（出自《原病集》）（按：即仲景原方。《外台秘要·霍乱干呕》：《肘后备急方》干姜茱萸汤，大概是从此方变来的。）
《僧深方》治疗霍乱呕吐，水药不下，用茱萸汤法。
吴茱萸（一升） 黄连（二两） 附子（一两） 甘草（一两） 生姜（三两）
共五味药，用水七升，煮取三升，分三次服用。（出自《医心方》）
《短剧方》治疗霍乱多寒，手足寒厥，脉绝，用茱萸四逆汤主治。
吴茱萸（二升） 当归（三两） 芍药（二两） 桂心（四两） 细辛（二两） 生姜（半斤） 通草（二两） 甘草（一两）
共八味药，用水四升，清酒四升，合煮取三升，分四次服用。（同上）旧方用枣三十枚，现在因为霍乱病法多痞，所以除去。如果退去枣，加入葛根二两较好。霍乱四逆，加半夏一合，附子小者一枚，恶寒乃给大附子。（出自《千金要方》）（按：方中有大枣二十五枚，可疑。）《济生方》通脉四逆汤，加附子。（也有枣。）
治疗霍乱呕吐，及下后腹中干痛，手足逆冷，适宜服用此方。
当归（一两） 干姜（半两） 甘草（半两） 人参 附子（各一两）
以上药材捣筛为散，每次服三钱，用水一中盏，煎至六分，去滓热服。（出自《太平圣惠方》）
Huo Luan (Colic with Vomiting and Diarrhea) is a disease documented in medical classics, except for Gan Huo Luan (Dry Huo Luan), which is not mentioned in the classics and should be supplemented by selecting relevant discussions. However, various theories from later generations are mostly divergent; now only the key points are extracted and recorded in this chapter.
[Naming]
"Huo Luan" refers to the condition where, within a moment of sudden onset, the body becomes chaotic and disordered. (From *Zhu Bing Yuan Hou Lun*)
If there is only vomiting or diarrhea, it is simply called "Tu Li" (Vomiting and Diarrhea) in the classics. It must involve both upper vomiting and lower diarrhea, accompanied by restlessness and agitation, to be called "Huo Luan"; this distinguishes it from cases merely termed "Tu Li". (From *Shang Han Ming Li Lun*)
[Origins]
The causes of Huo Luan mostly arise from dietary impropriety. For instance, consuming raw, cold, or miscellaneous foods, or eating fatty/rich foods and drinking alcohol, while exposed to wind and dampness, sitting naked outdoors, or sleeping at night without adequate covering. (From *Zhou Hou Bei Ji Fang*)
Huo Luan occurs when the body's regulation of warmth and coolness is dysregulated, causing the Qi of Yin-Yang and Clear-Turbid to interfere and become chaotic. If this chaos occurs between the stomach and intestines, it is triggered by food intake, resulting in severe colic in the heart and abdomen. If heart pain precedes, vomiting occurs first; if abdominal pain precedes, diarrhea occurs first; if both heart and abdomen hurt, vomiting and diarrhea occur simultaneously. With concurrent Wind pathogen and excess constitution, there is fever, headache, body ache, plus vomiting and diarrhea; with deficiency constitution, there is only vomiting and diarrhea with stabbing pain in the heart and abdomen. Also, excessive consumption of alcohol, meat, raw fish, and cold foods, combined with irregular living habits, such as sleeping outdoors on wet ground or exposing oneself to wind for cooling, leads to Cold-Wind Qi returning to the San Jiao (Triple Burner) and transmitting to the Spleen and Stomach. The Spleen and Stomach, being cold, fail to digest food; inability to digest causes water and grain to fail to transform, leading to interference between Clear and Turbid Qi. Spleen-Stomach weakness results in vomiting and diarrhea; undigested food causes abdominal distension and fullness, all forming Huo Luan. (From *Zhu Bing Yuan Hou Lun*)
Originally, Huo Luan is caused by diet, not by ghosts or spirits. After overeating, followed by consuming dairy, cheese, seafood, and various other foods, sleeping on cold mats, and drinking heavily chilled fluids, the food in the stomach condenses and fails to digest. The Yin and Yang Qi become stagnant and rebellious; Yang Qi desires to ascend, Yin Qi desires to descend. Due to Yin-Yang separation, vomiting and diarrhea ensue, accompanied by splitting headaches, joints feeling as if dislocated, and tendons throughout the body twisting. Although considered a minor illness, among acute diseases, it is most terrifying, more so than facing deep abysses or precarious heights. Those who practice health preservation should understand its principles to avoid premature death. (From *Qian Jin Yao Fang*)
Exposure to summer-heat toxicity, sleeping outdoors in low-lying damp areas, fanning oneself against the wind, allows Wind-Cold pathogens to enter the stomach and intestines. Added to a preference for fatty/fishy foods and cold drinks, and irregular living, these factors trigger the disease. Thus, pathogenic and healthy Qi interfere, the Middle Jiao closes, Qi cannot circulate freely, and violent vomiting and diarrhea erupt. This is what is meant by the Spleen receiving thief-pathogens, where Wood overacts on Earth. (From *Zhi Zhi*)
Internal accumulation combined with external contraction leads to vomiting and diarrhea. (From Zhu Danxi)
Although Huo Luan syndromes vary by Wind, Cold, Dampness, and Heat, they are mostly due to Summer-Heat injury. This is because summer heat internally damages Yuan Qi, leaving the Spleen and Stomach weak. It inevitably involves injury from drinking cold, stagnation of cold, wine, and sexual indulgence, compounded by external cold exposure. Pathogenic Qi becomes depressed and cannot vent, causing Huo Luan symptoms. Hence, this syndrome often manifests during autumn cooling. (From *Yi Tong*)
[Pathogen in the Middle Jiao]
The San Jiao is the pathway for water and grain, and the beginning and end of Qi circulation. Due to Wind-Cold or dietary injury to the Stomach, the Middle Jiao becomes disharmonious, causing Healthy Qi to lose its post and allowing Pathogenic Qi to interfere. Within moments, chaos ensues. (From *Sheng Ji Zong Lu*)
Huo Luan with vomiting and diarrhea results from the failure of San Jiao Qi to ascend and descend, causing Clear and Turbid Qi to interfere in the Stomach. Treatment should focus on the Middle Jiao as the root; once the Middle Jiao is harmonized, Clear and Turbid separate naturally, and vomiting and diarrhea cease. (Ibid.)
Pathogen in the Upper Jiao presents with vomiting only, no diarrhea. Pathogen in the Lower Jiao presents with diarrhea only, no vomiting. If the pathogen is in the Middle Jiao, Stomach Qi is unregulated and injured by pathogens, causing Yin-Yang separation, leading to upward vomiting and downward diarrhea. (From *Shang Han Ming Li Lun*)
[Pulse Diagnosis]
A hidden pulse indicates Huo Luan. (From *Mai Jing*)
A moderate pulse (Dai Mai) indicates Huo Luan. A moderate pulse that is also intermittent indicates Huo Luan. (Note: *Sheng Ji Zong Lu* states the pulse must be Dai due to Qi deficiency. See below.)
In Huo Luan, a large pulse is treatable (*Mai Jue* says floating and surging pulses in three positions can be saved); a minute and fine pulse is untreatable. In Huo Luan with vomiting and purging, if the pulse is minute and slow, breathing is poor, and the patient does not wish to speak, it is untreatable. (From *Zhu Bing Yuan Hou Lun*)
A slippery but irregular pulse indicates vomiting and diarrhea; this is a sign of Huo Luan. Do not be alarmed by a Dai pulse. (From *Cui Shi Mai Jue*)
Huo Luan pulses often show Knotted (Jie) or Frequent (Cu) qualities; do not pronounce death based on these alone. (From *Yi Tong*)
If a Dai pulse appears, it is due to temporary chaos of Clear and Turbid Qi, causing discontinuity in the pulse, not necessarily a death pulse. (From *Yi Zong Bi Du*)
Huo Luan involves sudden chaos and loss of self-control, with Yin-Yang separation and rapid depletion of Upper and Lower aspects. At this time, the pulse may pause; do not be surprised. This is because sudden violent vomiting and profuse diarrhea cause the Grain Spirit to collapse temporarily, leading to brief discontinuity. However, if the hands and feet are cold and the pulse becomes slow and minute, this is truly frightening. Hands and feet are the root of Yang Qi; slow and minute pulses indicate pure Yin. This signifies Yang decline and Yin abundance, a sign of gradual extinction of True Yuan. Therefore, those with sudden collapse can gradually recover, but those with gradual extinction cannot suddenly rise. (From *Xu Yan*)
Minute and gradually extinguishing pulses indicate death; gradually enlarging pulses indicate survival. (From *Yu An*)
During severe pain, the pulse is often hidden; it should not gradually become slow. (From *Jian Ming Yi Gou*)
Knotted, Frequent, Moderate, and Slippery pulses are all Huo Luan pulses. Thus, Huo Luan with surging, slippery, and large pulses is easy to treat, while sinking, choppy, and fine pulses are difficult. (From *Yi Yue*)
Fine pulses indicate death; extremely wiry pulses indicate death. (From *Ben Cao Quan Du*)
[Theories on Syndrome and Treatment]
Huo Luan with vomiting and diarrhea has Cold and Hot syndromes: For Cold-dominant cases without thirst, provide Lizhong Wan, Jiang Fu Tang, or Laifu Dan. For Hot cases with irritability and thirst, administer Xiangru San, Wuling San, Jiahe San, Shenling Baizhu San, or Sijunzi Tang. After Huo Luan vomiting and diarrhea, to regulate the Spleen and Stomach, one may take Shenling Baizhu San, Wuling San, Sijunzi Tang, or Tiaoqi San. (From *Heji Zhinan*) (Note: Zhang Zhongjing’s distinction of Cold/Hot in Huo Luan addresses whether the pathogen has transformed into Cold or not; this view retains its intent. Later Ming/Qing scholars often analyzed them distinctly, similar to Cold/Hot in Shanghan. However, clinical verification shows this is not always appropriate. Several views are listed below for experts to judge.)
Syndromes include Cold and Heat: Cold syndrome features a pale, dull complexion, cold breath, weak voice unwilling to speak, cold skin and limbs, occasional sweating, abdominal pain, no thirst but desire for hot drinks, and a sinking-slow or minute-almost-extinct pulse. Heat syndrome features a normal complexion, hot breath, coarse breathing, irritability and confusion, hot skin and warm limbs, abdominal colic, spontaneous sweating or anhidrosis, dry mouth/thirst with desire for cold drinks, and a floating-surging or sinking-hidden pulse. (From *Huijie*)
Caused by Cold: No irritability or slight thirst; irritability and thirst may appear after vomiting/diarrhea due to fluid loss externally. Caused by Summer-Heat: Severe irritability and thirst, vomiting/diarrhea of clear water; irritability and thirst appear before vomiting/diarrhea due to internal disturbance by Summer-Heat pathogens. (From *Huibu*)
Severe cases feature umbilical/abdominal colic, cold limbs, absent pulse, and generalized tendon twitching; treatment requires warming, tonifying, restoring Yang, and regulating the pulse. If Huo Luan results from excessive consumption of cold/raw fruits and spring water in summer, causing food stagnation in the Middle Jiao, use acrid-warm herbs to dissipate superficial Cold, followed by cold-bitter herbs to clear Summer-Heat. For severe thirst, use ice water to resolve it. (From *Zhizhang*)
Vomiting/diarrhea with tendon twitching, hypochondriac pain, and wiry pulse indicate Wood overcoming Earth, causing severe pain; use Jianzhong Tang plus Chaihu and Mugua. Vomiting/diarrhea with cold limbs and slow-moderate pulse indicates Jueyin involvement; use Jianzhong Tang plus Danggui and Fuzi. (From *Yuji*, citing *Baoming Ji*) (Note: Likely from Yun Qizi’s work.)
If vomiting/diarrhea persists, Yuan Qi dissipates, and the condition is critical, with inability to swallow even water/grains, or thirst preferring cold, or aversion to cold with shivering, cold limbs, or fever with irritability desiring to remove covers, this is internal deficiency and Yin abundance. Do not mistake the desire for cold/removing covers as Heat. Use Lizhong Tang; for severe cases, Fuzi Lizhong Tang; if ineffective, Sini Tang. All should be taken cool. After Huo Luan and other vomiting/diarrhea, if the chest/diaphragm is elevated and blocked, use Lizhong Tang plus Zhishi and Fuling, named Zhishi Lizhong Tang. If vomiting/diarrhea has ceased but strength and spirit remain weak, use Shibu Tang (i.e., Shiquan Dabu Tang). For summer Summer-Heat induced vomiting/diarrhea resembling Huo Luan, Liuhe Tang and Xiangru Tang are essential. In summer, excessive fruit/cold drink/wind exposure causes food stagnation, forming Pi (glomus), blocking Upper and Lower, leading to Huo Luan; use Liuhe Tang with doubled Huoxiang, decocted, mixed with Suhexiang Wan. (From *Yaojue*)
If vomiting/diarrhea is thorough, the patient is weak, and the pulse is empty/soft, the pathogen is gone and Zheng Qi is deficient. If vomiting/diarrhea is incomplete, the pulse is choppy/strengthful, and the patient remains irritable/restless, the pathogen remains; distinguish carefully. (From *Yitong*)
[Dry vs. Wet Differentiation] (Refer to emetic and purgative formulas)
Huo Luan usually involves vomiting and diarrhea. Gan Huo Luan (Dry Huo Luan) occurs when Cold Qi combats the stomach/intestines, preventing food digestion. There is only abdominal distension, irritability, colic, and shortness of breath. Because the stomach/intestines are initially filled with Excess, there is no vomiting or diarrhea, hence named Dry Huo Luan. (From *Zhu Bing Yuan Hou Lun*)
Xu Renze states: There are two types: Gan Huo and Shi Huo. Gan Huo has higher mortality; Shi Huo has lower. Both result from dietary irregularity and improper care.
Gan Huo presents with abdominal distension, stabbing pain, unbearable oppression, cold limbs, severe cases with sweat like water, blockage of urination/defecation, inability to vomit or purge, and death within moments if untreated. Shi Huo presents with abdominal pain similar to Gan Huo, but with unlimited vomiting and diarrhea. Early stages may resemble epidemic febrile diseases, with headache, bone/muscle soreness, cold limbs, and limb fever. (From *Waitai Miyao*) (Note: Original treatment for Gan Huo includes a pill with Radix Crotonis etc., see below.)
Xu Renze states: Gan Huo Luan has high mortality; Shi Huo Luan has low. Because vomiting/diarrhea allows expelled pathogens to exit, even severe Huo Luan stops at the Stomach; once food/water is exhausted, it stops, hence low mortality. Gan Huo Luan has high mortality because nothing can be vomited or purged; damaged substances cannot exit, blocking Healthy Qi, separating Yin-Yang, causing irritation, restlessness, panting, and distension, leading to death. (From *Shang Han Ming Li Lun*)
Heart/abdominal colic, cold sweat, oppressive fullness nearing death, commonly called "Jiao Chang Sha" (Intestinal Twisting Sand), is actually Gan Huo Luan. This is caused by mountain miasma, irregular eating/drinking, or sudden Yin-Yang chaos. Urgently use salt-water emesis. (From *De Xiao*) (Note: From *Jingyan Liangfang*: Jiao Chang Sha is unbearable pain, rolling on ground, intestinal twisting in abdomen, deep poisoning, fatal quickly, ancient name Gan Huo Luan. *Yaojue* also notes modern doctors call it Jiao Chang Sha, mistakenly thinking it different from Huo Luan; lucky recovery is just temporary effect.)
Gan Huo Luan is a critical condition: wanting to vomit but unable, wanting to defecate but unable, chest/abdominal twisting pain, distension/oppression. This implies internal food stagnation and external Cold closure. Superficial pathogens move easily, causing immediate vomiting/diarrhea; deep pathogens cause Yin-Yang rejection and blocked Qi channels, resulting in this syndrome. Without rapid treatment, sudden death often occurs. (From *Jingyue Quanshu*)
If wanting to vomit/purge but unable, upper/lower blockage, abdominal distension/pain with headache/fever, use Guizhi Dahuang Tang. This is Gan Huo Luan. (From *Shanghan Zuanchun*)
Bleeding from Weizhong (BL40) or ten fingertips are good methods. (From *Zhengchuan*)
If Gan Huo Luan has no vomiting/purging, chest/abdominal hardness, blue-black lips/face, cold limbs past elbows/knees, absent six pulses, panting, short tongue, retracted scrotum, it is a death syndrome. (From *Huichun*)
[Tendon Twitching] (Refer to external treatments)
After severe Huo Luan vomiting/diarrhea, Yin-Yang are both deficient, Blood-Qi extremely depleted, leading to cold limbs and disharmony of Ying-Wei. Cold combats the tendons, causing them to twist. Cold entering the Foot Three Yin/Yang meridians causes foot tendon twisting; entering Hand Three Yin/Yang causes hand tendon twisting. Tendons twist according to where Cold enters. Twisting is caused by Evil Cold Qi striking and moving the tendons. (From *Zhu Bing Yuan Hou Lun*)
Tendon twisting occurs because the Yangming meridian nourishes the Zongjin (Major Tendons), connected to the Large Intestine. Sudden profuse diarrhea/vomiting causes sudden fluid loss (Note: Original text has five sentences here deleted in *Yibidu*, omitted here), Zongjin loses nourishment, leading to spasms. Severe cases involve testicular retraction and tongue curling, difficult to treat. (From *Sanyin Fangyi*) (Note: Jingyue cites this to refute Hejian’s theory that twisting is Fire-related; text too long to include.)
Severe twisting entering the abdomen leads to death; no worse Huo Luan evil syndrome exists. (Ibid.)
For Huo Luan tendon twitching, use Lizhong Tang plus fried Dongjiao (Gelatin) 1 qian. Bind legs/shins tightly. If tendons twist into abdomen or whole body twists, it is untreatable. For tendon twisting, soak in warm Qu-Liao juice or strong salt water. (From *Yaojue*)
[Death Syndromes]
After Huo Luan, if Yang Qi has collapsed, with incontinence unawareness, sparse speech, bead-like sweat, extreme restlessness desiring water, or flaccid limbs, it is untreatable. (From *Yaojue*)
[Urgency of Restoring Healthy Qi]
Wind/Rain/Cold/Summer-Heat pathogens directly causing Huo Luan, if vomiting/diarrhea is excessive damaging Life Qi, with cold limbs and minute-almost-absent pulse, Sini Tang is indicated regardless of Cold or Summer-Heat. Since Healthy Qi is injured, restore Qi without focusing on pathogens. Later additions like Huoxiang Zhengqi San treat vomiting/diarrhea for mild Stomach pathogens with intact Healthy Qi; such cases heal spontaneously, even with Yin-Yang Tang (raw/cooked water mix) or Huangtu Tang (earth slurry). For Huo Luan with interior deficiency, ancients established only Sini and Lizhong formulas as emergency methods to save Healthy Qi. Claiming Huoxiang Zhengqi San treats Summer-Huo Luan is incorrect. I often see summer Huo Luan patients with cold limbs, absent pulse, and death. Huoxiang Zhengqi San is merely a formula to broaden the exterior and resolve the exterior; how can it treat this? Moreover, in summer, Yuan Qi vents outward, Middle Qi is greatly deficient, and sudden external pathogens make even timely restoration late. When Pathogen and Healthy Qi contend, distinguish Wind/Rain/Cold/Summer-Heat. Injury to Healthy Qi depends only on Healthy Qi deficiency/excess; entry into Zang organs is untreatable death, not determined by Wind/Summer-Heat being Yang and Cold/Rain being Yin. This is the general principle of Huo Luan; students should memorize it. (From *Shanghan Lun Jizhu*)
[Urgency of Harmonizing Stomach and Strengthening Spleen]
Those susceptible to pathogens have inherently soft Spleen Qi; after vomiting and diarrhea, Spleen Qi cannot become more deficient. Thus, treating Huo Luan must focus on harmonizing the Stomach and strengthening the Spleen. "Strengthening" means tonifying, necessary because pathogens are gone but Stomach Qi is injured. "Harmonizing" means adjusting, necessary because Stomach Qi is injured but pathogens remain; one must observe Pathogen/Healthy Qi balance and adjust accordingly. If Cold is slight and stagnation is heavy, mild-warm formulas suffice. If stagnation is due to Cold, warm-hot formulas are required. Some claim it is a Fire syndrome, arguing Huo Luan occurs in Summer/Autumn, so it cannot be Cold-Damage. Alas, this is very erroneous. One must know that Summer/Autumn transitions are prone to Interior Cold diseases. First, intense heat fades, new coolness begins, Heaven/Human Qi changes, generating Cold. Second, peak heat leads to irregular cold/raw food intake, causing disease via seasonal Cold movement. People see external Summer/Autumn heat easily but miss internal Interior Cold, thus knowing to avoid Heat in Heat but not avoiding Cold in Cold. Shallow understanding leads to errors. Students must examine this carefully. (From *Jingyue Quanshu*)
[Formulas for Restoring Yang and Dispelling Cold]
Sishun Tang treats Huo Luan with tendon twitching, cold muscles, sweating, and vomiting. (Fan Wang says: Add 2 liang Fuzi if diarrhea is severe, excellent.) (From *Qianjin Yao Fang*) (Note: i.e., Sini Jia Renshen Tang.)
*Zhongjing Lun* on Huo Luan: For Sini pattern with less vomiting and more retching, use Fuzi Jingmi Tang. One version has 1 liang Ganjiang. (From *Waitai Miyao*) (Note: *Qianjin* has Ganjiang.)
Jiangfu Tang treats Huo Luan tendon twitching, cold limbs, excessive sweating, and retching. (From *Jisheng Fang*) Jiangfu Tang, decocted clearly and taken cold, is highly effective; this is the method of using heat for cold. (From *De Xiao*)
Huo Luan with Cold, abdominal distension/pain, limb stiffness, diarrhea with foot twitching: Use Lizhong Tang plus 1 raw Fuzi, coarsely powdered, decocted and taken. (From *Huo Ren Shu*)
Huo Luan tendon twitching, persistent vomiting/diarrhea, dizziness, imminent death: Use Wuzhuyu Tang. (From *Yuanbing Ji*) (Note: Same as Zhongjing’s original formula. *Waitai* Huo Luan Dry Retching: *Zhouhou* Ganjiang Zhuyu Tang likely derived from this.)
*Sengshen Fang* for Huo Luan vomiting, inability to keep down water/medicine, use Zhuyu Tang method.
Wuzhuyu (1 sheng) Huanglian (2 liang) Fuzi (1 liang) Gancao (1 liang) Shengjiang (3 liang)
Five items, boil in 7 sheng water to 3 sheng, divide into 3 doses. (From *Yixin Fang*)
*Duanju Fang* for Huo Luan with much Cold, cold limbs, absent pulse, use Zhuyu Sini Tang.
Wuzhuyu (2 sheng) Danggui (3 liang) Shaoyao (2 liang) Guixin (4 liang) Xixin (2 liang) Shengjiang (0.5 jin) Tongcao (2 liang) Gancao (1 liang)
Eight items, boil in 4 sheng water and 4 sheng clear wine to 3 sheng, divide into 4 doses. (Ibid.) Old formula used 30 dates; removed here because Huo Luan often involves Pi (blockage). Removing dates, adding 2 liang Gegen is better. For Huo Luan Sini, add Banxia 1 he, small Fuzi 1 piece; give large Fuzi if aversion to cold is present. (From *Qianjin Yao Fang*) (Note: Formula has 25 dates, questionable.) *Jisheng* Tongmai Sini Tang adds Fuzi. (Also has dates.)
For Huo Luan vomiting, and abdominal dry pain after purging, cold limbs: Take this formula.
Danggui (1 liang) Ganjiang (0.5 liang) Gancao (0.5 liang) Renshen Fuzi (1 liang each)
Pulverize these ingredients. Take 3 qian per dose, decoct in 1 zhong zhan water to 0.6 portion, strain, take hot. (From *Shenghui Fang*)