【纲】仲景金匮曰。狐惑之为病。状如伤寒。默默欲眠。目不得闭。卧起不安。蚀于喉为惑。蚀于
阴为狐。不欲饮食。恶闻食臭。其面目乍赤乍白乍黑。蚀于上部。则声哑。甘草泻心汤主之。蚀于
下部。则咽干。苦参汤洗之。蚀于肛者。雄黄熏之。
【目】朱肱曰。狐惑与湿 皆虫症。初得状如伤寒。或因伤寒变成。大抵伤寒病。腹内食入少。
肠胃空虚。三虫行作求食。蚀人五脏及下部。为 病。其候齿无色。舌上白。甚者唇黑有疮。四
肢沉重。忽忽喜眠。虫蚀其肛。烂见五脏。则死。当数看其上下唇。上唇有疮。虫蚀其脏。下唇有
疮。虫蚀其肛。杀人甚急。多因下利而得。治 。桃仁汤、黄连犀角汤、雄黄锐散。
少阴症。口燥咽干者。急下之。病患嘿嘿欲眠。目不能闭。起居不安。其声哑。或咽干者。即
当作狐惑治之。
徐彬曰。狐惑。虫也。虫非狐惑。因病以名之。大抵皆湿热毒所为之病。故状如伤寒。蚀者若
有食之而不见其形。如日月之蚀也。面者。阳明之标。目者。厥阴之标。内有毒瓦斯乘之。故乍赤白
黑。变现不一也。上部毒盛。则所伤在气。而声哑。下部毒盛。故所伤在血。而咽干也。
鳌按。狐惑病。有专由湿热而生者。有由伤寒后。湿热未清而成者。状如伤寒句。须看得活。
【纲】仲景金匮曰。病者脉数。无热。微烦。默默但欲卧。汗出。初得之三四日。目赤如鸠眼。
七八日。目四 黑。若能食者。脓已成也。赤豆当归散主之。
【目】李中梓曰。狐惑症。失汗所致也。以清热为主。
鳌按。此条非言狐惑病。乃湿热侵阴。有似狐惑而更甚者。首曰病者。乃概言之辞。非专指病
狐惑者。故用赤豆、当归。与治狐惑之药异。其病总由阴分热极。故现症如是也。
【纲】张仲景在《金匮要略》中说：狐惑病的症状，像伤寒病一样。患者沉默寡言想睡觉，但眼睛无法闭合，躺下坐起都感到不安。口腔咽喉被腐蚀称为“惑”，外阴部被腐蚀称为“狐”。患者不想吃东西，厌恶食物的气味，面色时而发红、时而发白、时而发黑。如果腐蚀发生在上部（咽喉），声音就会嘶哑，用甘草泻心汤主治。如果腐蚀发生在下部（前阴），就会咽喉干燥，用苦参汤清洗。如果腐蚀发生在肛门，用雄黄熏蒸治疗。
【目】朱肱说：狐惑病与疳病都是虫证。刚发病时症状像伤寒，有时是因为患伤寒后转化而成。大抵来说，伤寒病患者，因为腹内进食少，肠胃空虚，体内的三虫活动寻找食物，侵蚀人的五脏及下部，形成疳病。其征候是牙齿颜色无光泽，舌苔发白，严重的嘴唇发黑并生疮，四肢沉重，精神恍惚喜欢睡觉。如果虫子侵蚀肛门，导致腐烂甚至可见内脏，就会死亡。应当经常查看上下嘴唇，上唇有疮，说明虫子侵蚀了内脏；下唇有疮，说明虫子侵蚀了肛门，这种病情杀人非常急迫，多因腹泻痢疾而得病。治疗疳病，可用桃仁汤、黄连犀角汤、雄黄锐散。
如果是少阴病，出现口燥咽干的症状，应当紧急使用攻下法。如果病人沉默寡言想睡觉，眼睛不能闭合，起居不安，声音嘶哑或咽喉干燥的，就应当当作狐惑病来治疗。
徐彬说：狐惑，指的是虫。虫本身不是狐惑，而是因为疾病特征以之命名。大抵这都是由湿热毒邪造成的疾病，所以症状像伤寒。所谓“蚀”，就像有东西在吃却看不见形状，如同日食月食一样。面部是阳明经的标部，眼睛是厥阴经的标部，内部有毒气侵袭，所以面色忽红忽白忽黑，表现不一。上部毒邪旺盛，伤害的是气分，所以声音嘶哑；下部毒邪旺盛，伤害的是血分，所以咽喉干燥。
沈金鳌按语：狐惑病，有的是专门由湿热产生的，有的是在伤寒之后，湿热未清除干净而形成的。“状如伤寒”这句话，需要灵活理解。
【纲】张仲景在《金匮要略》中说：患者脉象数，身体没有发热，只有轻微烦躁，沉默只想躺着，出汗。刚得病三四天，眼睛红得像斑鸠的眼睛一样；到了七八天，眼四角发黑。如果能吃东西的，说明脓已经形成了，用赤小豆当归散主治。
【目】李中梓说：狐惑症，是由于误用发汗法导致的，治疗应以清热为主。
沈金鳌按语：这一条讲的并不是狐惑病，而是湿热侵犯阴分，症状类似狐惑但更严重。开头说的“病者”，是泛指的说法，并非专指患狐惑病的人。所以使用赤小豆、当归，与治疗狐惑病的药物不同。这个病总归是由阴分热极引起的，所以出现上述症状。
[General Principle] Zhang Zhongjing stated in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): The disease of Hu Huo (Fox and Charm, characterized by mucosal ulceration) presents with symptoms resembling Taiyang Cold Damage Disease (a syndrome caused by pathogenic cold invading the Taiyang channel). The patient is taciturn and desires sleep, yet cannot close their eyes, feeling restless when lying down or sitting up. Ulceration in the throat is termed "Huo" (Charm), while ulceration in the yin organs (genitals) is termed "Hu" (Fox). The patient has no appetite and dislikes the smell of food; their complexion alternates between red, white, and black. If ulceration occurs in the upper part (throat), hoarseness ensues, treated primarily with Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium). If ulceration occurs in the lower part (genitals), dryness of the throat results, treated by washing with Kushen Tang (Sophora Root Decoction). If ulceration occurs at the anus, treatment involves fumigation with Xionghuang (Realgar).
[Detailed Discussion] Zhu Gong said: Hu Huo disease and Gan disease (pediatric malnutrition syndrome often involving parasites) are both parasitic syndromes. Initially, symptoms resemble Taiyang Cold Damage Disease, sometimes arising as a transformation from it. Generally, patients with Taiyang Cold Damage Disease eat little due to abdominal discomfort, leaving the stomach and intestines empty. The "Three Parasites" within move about seeking food, eroding the five zang organs and the lower part of the body, leading to Gan disease. Signs include colorless teeth, white tongue coating, severe cases showing black lips with sores, heavy limbs, mental confusion, and excessive sleepiness. If worms erode the anus causing rotting visible to the viscera, death occurs. One should frequently inspect the upper and lower lips: sores on the upper lip indicate worm erosion of the viscera; sores on the lower lip indicate worm erosion of the anus. This condition is rapidly fatal and often arises following dysentery. Treatments for Gan disease include Tao Ren Tang (Peach Kernel Decoction), Huanglian Xijiao Tang (Coptis and Rhinoceros Horn Decoction), and Xionghuang Ruisan (Realgar Acute Powder).
If Shaoyin Syndrome (syndrome of the Heart and Kidney channels) presents with dry mouth and throat, urgent purgation is indicated. If a patient is taciturn, desires sleep, cannot close their eyes, is restless in daily activities, and has hoarseness or dry throat, it should be treated as Hu Huo disease.
Xu Bin said: "Hu Huo" refers to worms. The worms themselves are not Hu Huo; the disease is named after its characteristics. Generally, this is a disease caused by damp-heat toxicity. Thus, symptoms resemble Taiyang Cold Damage Disease. The term "erosion" implies something consuming tissue invisibly, like solar or lunar eclipses. The face is the superficial manifestation of the Yangming channel, and the eyes are the superficial manifestation of the Jueyin channel. Internal toxic vapors invade these areas, causing the complexion to alternate between red, white, and black. When toxicity is abundant in the upper part, it damages the Qi level, resulting in hoarseness; when toxicity is abundant in the lower part, it damages the Blood level, resulting in dry throat.
Shen Jin'ao's commentary: Hu Huo disease may arise solely from damp-heat, or it may develop after Taiyang Cold Damage Disease if damp-heat remains uneliminated. The phrase "resembling Taiyang Cold Damage Disease" must be interpreted flexibly.
[General Principle] Zhang Zhongjing stated in the *Jin Gui Yao Lue*: The patient has a rapid pulse, no fever, slight irritability, taciturnity with a desire to lie down, and sweating. Within three to four days of onset, the eyes become red like those of a turtledove. By the seventh or eighth day, the corners of the eyes turn black. If the patient can eat, it indicates that pus has formed. This is treated primarily with Chidou Danggui San (Adzuki Bean and Angelica Sinensis Powder).
[Detailed Discussion] Li Zhongzi said: Hu Huo syndrome is caused by improper use of diaphoresis (sweating therapy); treatment should focus on clearing heat.
Shen Jin'ao's commentary: This passage does not describe Hu Huo disease, but rather damp-heat invading the Yin aspect, presenting similarly to Hu Huo but more severely. The opening phrase "the patient" is a general reference, not specifically pointing to Hu Huo disease. Therefore, the use of Adzuki Bean and Angelica Sinensis differs from herbs used for treating Hu Huo disease. The pathology stems fundamentally from extreme heat in the Yin division, hence the presentation of these symptoms.