经曰岁土不及风乃大行(云云)民病飧泄霍乱体重腹痛筋骨繇并
按此言土运不及木乃太过木乘土而为病宜详玩本文
内经曰脉伏者霍乱
伤寒论曰病呕吐而利名曰霍乱或发热头痛身疼恶寒吐利或自吐下又利止复更发热也皆是
霍
乱证伤寒其脉微涩者本是霍乱今是伤寒却四五日至阴经上转入阴必利本呕下利者不可治也
保命集云伤寒霍乱转筋身热脉长阳明本病也脾胃受湿热中焦气滞或因冷冻饮料或伤冷水或感
湿气冷
热不调水火相干阴阳相搏上下相离荣卫不能相维故转筋挛痛经络乱行暴热吐泻中焦胃气所主
也
谨按伤寒传变为霍乱者殊少惟夏秋之间暄热人腠理疏感风湿 之气而生此证多有阴阳虚
实不同脉来浮洪者可治微而迟气少不语者为难治
陈无择曰霍乱者心腹卒痛呕吐下利增寒壮热头痛眩晕先心痛则先吐先腹痛则先利心腹俱
痛吐
利并作甚则转筋入腹则毙霍乱恶证无越于斯盖阴阳反戾清浊相干阳气暴升阴气顿坠阴阳痞膈
上下奔逸治之惟宜温暖更详别三因以调之外因诸风则恶风有汗伤寒则恶寒无汗胃湿则重着伤
暑则热烦内因九气所致郁聚痰涎饮痞膈不通遂致满闷随其胜复必作吐利或诸饱食脍炙恣飧乳
酪冰脯寒浆旨酒胃既 胀脾脏停凝必内郁发遂成吐利当从不内外因也
按此具霍乱三因稍备但立方未能以尽其变学人自宜推格
《黄帝内经》说：岁运土气不足，风气就会大行（等等），百姓容易患完谷不化的泄泻、霍乱，身体沉重，腹痛，筋骨拘急。
对此按语认为：这里说的是土运不及，导致木气太过，木气乘袭脾土而致病，应当详细研读原文。
《黄帝内经》说：脉象伏匿的，是霍乱病。
《伤寒论》说：患病后呕吐且腹泻的，称为霍乱；或者伴有发热、头痛、身体疼痛、恶寒，出现呕吐和腹泻；或者起初自行呕吐腹泻，后来腹泻停止，却又再次发热的，这些都是霍乱的证候。
《伤寒论》又说：伤寒病脉象微涩的，原本就是霍乱，现在是伤寒，经过四五日传入阴经，必然出现下利；如果原本就呕吐并下利的，属于难治之证。
《保命集》记载：伤寒引起的霍乱出现转筋，身体发热，脉象长，这是阳明本经的病。由于脾胃受到湿热侵袭，中焦气机阻滞；或者因为食用冷冻饮料，或损伤冷水，或感受湿气，冷热不调，水火相干，阴阳相搏，上下分离，营卫不能相互维系，所以导致转筋挛痛，经络运行紊乱。暴热导致的呕吐腹泻，主要与中焦胃气有关。
谨按：由伤寒传变而成的霍乱特别少，大多是在夏秋之间，天气炎热，人体腠理疏松，感受风湿之气而产生此证。多有阴阳虚实不同的情况，脉象浮洪的可以治愈，脉象微迟、气息微弱、不能说话的则难以治愈。
陈无择说：霍乱是心腹突然疼痛，呕吐腹泻，怕冷且高热，头痛眩晕。先心痛的就先呕吐，先腹痛的就先腹泻，心腹都痛则呕吐和腹泻同时发作。严重的会出现转筋，如果转筋入腹（向上蔓延至腹部）就会死亡。霍乱的恶证没有超过这种情况的。这是因为阴阳逆乱，清浊之气相互干扰，阳气突然上升，阴气骤然下降，阴阳痞塞阻隔，上下奔逸。治疗只宜温补，更要详细辨别三因来调理。外因方面：诸风所致则恶风有汗；伤寒所致则恶寒无汗；胃湿所致则身体重着；伤暑所致则烦热。内因方面：由九气所致，郁结聚积痰涎，饮食痞塞不通，导致满闷，随着胜复变化必然出现呕吐腹泻；或者是饱食肥甘厚味，恣意进食乳酪、冰镇肉脯、寒凉浆液、美酒，胃既胀满，脾脏停凝，必然内部郁结发作，从而成为呕吐腹泻。这应当归属于不内外因。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "When the Earth Qi of the year is insufficient, Wind Qi will prevail excessively... The people suffer from undigested diarrhea, Huoluan (cholera-like acute gastroenteritis), heavy body sensation, abdominal pain, and spasms of the sinews and bones."
Commentary: This refers to the insufficiency of the Earth transport, leading to an excess of Wood Qi. Wood overacts on Earth causing disease. One should carefully study the original text.
The *Huangdi Neijing* states: "A deep, hidden pulse indicates Huoluan."
The *Shanghan Lun* (Treatise on Cold Damage) states: "Disease presenting with vomiting and diarrhea is named Huoluan. Or accompanied by fever, headache, body pain, and aversion to cold, with vomiting and diarrhea; or initially self-induced vomiting and purging, followed by cessation of diarrhea but recurrence of fever. These are all Huoluan syndromes."
The *Shanghan Lun* further states: "In cold damage, if the pulse is faint and choppy, it was originally Huoluan. Now it is cold damage. After four or five days, when it transmits to the Yin meridians, diarrhea must occur. If there was originally vomiting and diarrhea, it is difficult to treat."
The *Baoming Ji* (Collection for Preserving Life) records: "Cold damage transforming into Huoluan with muscle cramps, fever, and a long pulse is a disease of the Yangming channel itself. It arises because the Spleen and Stomach are affected by damp-heat, causing Qi stagnation in the Middle Jiao. Or it results from consuming frozen drinks, injuring oneself with cold water, or contracting dampness. When cold and heat are unbalanced, Water and Fire interfere, Yin and Yang contend, Upper and Lower separate, and Ying and Wei cannot maintain each other, thus causing muscle cramps and spasms, and chaotic meridian circulation. Acute heat causing vomiting and diarrhea is primarily governed by the Qi of the Middle Jiao Stomach."
Respectfully noted: Transformation of cold damage into Huoluan is rare. It mostly occurs in summer and autumn when the weather is hot, the pores are open, and one contracts wind-dampness Qi. There are often differences in Yin-Yang deficiency and excess. A floating and surging pulse is curable; a faint and slow pulse with shortness of breath and inability to speak is difficult to treat.
Chen Wuyue stated: "Huoluan involves sudden heart and abdominal pain, vomiting, diarrhea, aversion to cold, high fever, headache, and dizziness. If heart pain precedes, vomiting comes first; if abdominal pain precedes, diarrhea comes first. If both heart and abdomen hurt, vomiting and diarrhea occur simultaneously. Severe cases involve muscle cramps entering the abdomen, leading to death. No evil syndrome of Huoluan exceeds this. It is due to the reversal of Yin and Yang, interference between clear and turbid Qi, sudden rising of Yang Qi, and sudden falling of Yin Qi. Yin and Yang become obstructed and blocked, rushing up and down. Treatment should only use warming methods, and one must carefully distinguish the Three Causes to regulate."
External causes: Caused by various winds, there is aversion to wind and sweating; caused by cold damage, there is aversion to cold and no sweating; caused by stomach dampness, there is heaviness; caused by summerheat, there is heat and vexation. Internal causes: Caused by the Nine Qi, depression and accumulation of phlegm-fluids, food stagnation and obstruction lead to fullness and stuffiness. Depending on the victory and revenge cycles, vomiting and diarrhea inevitably occur. Or after overeating rich foods, indulging in milk, cheese, iced meat, cold beverages, and fine wine, the Stomach becomes distended, and the Spleen stagnates. Internal depression erupts, resulting in vomiting and diarrhea. This belongs to the Non-internal and Non-external causes.
Commentary: This thoroughly covers the Three Causes of Huoluan. However, the formulated prescriptions do not exhaust all variations. Students should deduce and explore accordingly.