咳嗽
咳嗽须分痰与声，痰声俱有肺脾经；
咳因气动为声，嗽乃血化为痰，肺气动则咳，脾湿动则嗽，脾肺俱动，则咳嗽俱
作。然以肺为主，故多言咳，则包嗽在其中。
实者痰稠声且重，虚者声利痰亦清。
咳必先审肺脉虚实，实者，浮大有力，若沉而滑，则痰气盛也；虚者，弦大无力
，若沉细带数，则火郁极也。
外因四气随时令，
风乘肺，咳则鼻塞声重，口干喉痒，语未竟而咳，参苏饮加桑白皮、杏仁，或柴
胡半夏汤，后用诸咳丸。如久咳、夜咳、冬咳，风入肺窍者，宜熏之。寒乘肺，咳则胸紧
声哑，二陈汤加麻黄、杏仁，或苏沉九宝饮、华盖散、单生姜丸。有寒热者，小柴胡汤。又
有一种，遇寒则咳者，谓之寒暄，乃寒包热也，解表则除，枳梗汤加麻黄、防风、杏仁、陈
皮、紫苏、木通、黄芩。如风寒郁热夜咳者，三拗汤加知母、黄芩。暑乘肺，咳则口燥声嘶
吐沫，六一散加辰砂，见血者，枇杷叶散。湿乘肺，咳则身重，骨节烦疼洒淅，五苓散、不
换金正气散。大概春气上升，润肺抑肝；夏火上炎，清金降火；秋湿热甚，清热泻湿；冬风
寒重，解表行痰。
内伤火郁劳食情；
火咳，声多痰少。五更咳多者，食积湿热，火流肺中，泻白散加知母，或古二母
散；上半午咳多者，胃有实火，单石膏丸加知母、贝母，便闭喘渴痰稠者，凉
膈散、败毒散
、古芩半丸；下半午咳多者，阴虚，四物汤合二陈汤，加知母、黄柏、麦门冬，顺而下之。
如阴虚火燥，寒热盗汗，遗精见血者，四物汤加竹沥，或滋阴降火汤、加味二母丸。黄昏咳
多者，火浮于肺，润肺丸以敛之，不可纯用凉药。通用二陈汤去半夏，加贝母、栝蒌、青黛
、山栀、黄芩、桑白皮。郁咳，即火咳久者。干咳无痰，乃肾水焦枯，邪火独炎于肺，泻白
散加苦梗为君以开之。久者，诃黎丸；虚者，肾气丸；不得志者，霞天膏；如肺燥，皮枯疮
痒，便闭者，活血润燥生津饮。劳咳，五劳虚咳也。疲极伤肝，咳而左胁疼引小腹者，二陈
汤，加芎、归、芍药、青皮、柴胡、草龙胆、黄芩、竹茹，或黄 建中汤；劳神伤心，咳而
咽
干咯血者，劫劳散、梦授天王补心丹；劳倦伤脾，咳而气短无力者，调中益气汤、补中益气
汤；叫呼伤肺，咳而呕吐白沫，口燥声嘶者，润肺丸、人参清肺饮；房劳伤肾，咳而腰背痛
、
寒热者，二陈芎归汤。又有一种传证痨咳，即干咳，痨咳久者，宜蛤蚧、天灵盖、雄黄、朱
砂之类，须于痨瘵条参之。食咳，因食积生痰，痰气冲胸，腹满者，二陈汤加浓朴、山楂、
麦芽；伤生冷，以致肺胃不清、嗳酸吐泻，恶风寒者，五积散、理中汤、异攻
散；伤煎炒热
物者，葶苈散，或三补丸加知母、贝母；伤酒食积者，香附栝蒌青黛丸。七情，脏气不平则
咳，久不已则入六腑。怒伤肝咳，两胁下满，入胆则呕吐苦汁；喜伤心咳，心痛咽肿，入小
肠则咳与气俱失，思伤脾咳，右胁引肩背痛，甚则不可以动，入胃则呕吐痰沫长虫；忧伤肺
咳，喘息唾血，入大肠则遗粪；恐伤肾咳，唾涎，腰背引痛，入膀胱则遗尿，入三焦则腹
满不欲食。始则关于肺，终则聚于胃故也。宜二陈汤加栝蒌仁、萝卜子，加味泻白散、参苏
饮、四七汤、苏子降气汤、团参饮子、古橘甘散、古橘姜丸、加减三奇汤选用。
痰咳胸满水咳悸，
痰咳，痰出咳止，胸膈多满。经曰∶秋伤于湿，冬必咳嗽。湿在心，谓之热痰；
湿在肝，谓之风痰；湿在肺，谓之气痰；湿在肾，谓之寒痰。惟湿痰入胃，上干于肺，则必
作咳，宜千缗汤、坠痰丸、半瓜丸选用。痰郁肺经，咳则涎多，或结胸者，二陈汤加枳、梗
、栝蒌、黄芩、贝母，甚者鹤顶丹。痰积流入肺脘，久咳不得睡者，兜铃丸。痰因火动者
，二陈汤加芩、连，或清气化痰丸。痰因宿食者，化痰丸。痰因酒湿者，蜂姜丸。全因酒者
，瓜连丸。如痰甚，能食便闭者，小承气汤下之；不能食便闭者，浓朴汤，或滚痰丸疏导之
。水咳，因饮茶水停蓄为涎上涌，身热胸满，怔悸者，小青龙汤；身寒胁硬者，玄武汤；结
胸者，小半夏汤；大便闭者，十枣汤；小便涩者，五苓散（详伤寒水证）。
瘀血碍气胀且腥；
瘀血咳，则喉间常有腥气。轻者，泻白散加生地、山栀、牡丹皮、麦门冬、桔梗
；重者，桃仁、大黄。姜汁为丸服。或因打损劳力伤肺，遇风寒则咳，或见
血紫黑色者，四
物汤去芎，加大黄、苏木为末，酒调服，利去心肺间瘀血即止，后服人参养荣汤调理。肺胀
满，即痰与瘀血碍气，所以动则喘急，或左或右，眠一边不得者是，四物汤加桃仁、诃子、
青皮、竹沥、姜汁。若虚胀喘者，单人参膏、古百花膏。有水停蓄胀者，饮水则逆转不入，
三白汤加泽泻、桔梗、五倍子。若因火伤极，无水以升而胀者，必干咳无痰，诃黎丸含化，
以诃子有收敛降火之功，危哉！
治分新久求其本，
新咳，有痰者，外感随时解散；无痰者，便是火热，只宜清之。久咳，有痰者，
燥脾化痰；无痰者，清金降火。盖外感久则郁热，内伤久则火炎，俱宜开郁润燥。其又有
七情气逆者，则以枳壳、香附顺气为先；停水宿食者，则以南星、槟榔分导为要。气血虚者
，补之、敛之。苟不治本，而浪用兜铃、粟壳涩剂，反致缠绵。况肺为娇
脏，易寒易热，虽
人参平药，惟气虚最宜，若肺热有火，及风邪初盛者，俱宜沙参或玄参代之
，故咳不拘于寒
也。
久甚还将脾肾宁。
久咳曾经利下及劳倦饥饱，以致肺胃寒而饮食少进者，只理脾而咳自止。然肾为
气脏，咳嗽动引百骸，自觉气从脐下逆奔而上者，乃肾虚气不归元，宜所服药中加补骨脂、
五味子，或三味安肾丸。阳虚者，肾气丸；阳虚者，黑锡丹以镇之。凡咳至肺胀及咽疮失音
者，必死。
霍乱
霍乱暑湿干三种，
一种暑霍乱，即湿霍乱，但此疾夏秋惟甚，纵寒月亦多由伏暑，故名。一种湿霍
乱，有声有物。一种干霍乱，有声无物。治见三卷。
病本中焦湿热壅；
标因外感四气，或日间感热、夜间受冷，或内素郁热，外又感寒，一时阴阳错乱
；然病本因饮食失节，或酥酪酒浆生冷，以致湿热内甚，中焦脾土失运，当升不升，当降不
降，是以上吐下泻，脉多伏绝。又有挟七情郁气，痰涎聚膈，痞塞不通者，外见痰喘眩晕
，亦必由伤饮食为之根也。
心腹卒痛或热寒，
先心痛者，则先吐；先腹痛者，则先泻；心腹俱痛者，则吐泻俱作。轻则吐泻而
已。凡吐泻时，切不可与谷食，虽米汤，一呷咽立死，必待吐泻尽，过半日饥甚，方可渐
食稀粥。偏阳分，则多热而渴；偏阴分，则多寒而不渴。
痰喘烦渴却可恐；
痰喘、二陈汤、加味半硫丸。虚烦不眠，既济汤。烦渴，九君子汤、桂苓甘露饮
。大渴大躁大汗遗尿者死，回生散、养正丹救之。
转筋舌卷囊缩危，
阳明胃与大肠，以养宗筋。暴吐暴泻，津液骤亡，小筋失其所养，故轻者两脚转
筋而已，重者遍体转筋，手足厥冷，若欲绝者，仓卒之际，宜以盐填脐中，灼艾不计壮数，
虽已死，而胸中有暖气者，立苏，急用茱萸散加小茴、甘草、苏叶煎服，再研生蒜涂脚掌心
，虽昏危入腹者，亦效。如血热转筋不已者，四物汤加黄芩、红花，或苍术、南星。水药
不入者，古椒豆散。转筋不住，男子以手挽其阴，女子以手牵乳近两边。如舌卷囊缩转筋入
腹者，死。
分利升降消食冗。
霍乱乃湿热兼风木为害，治宜散风寒，利湿降火，故四时通用藿香正气散，为散
风寒湿之要药。寒月厥冷，脉沉不渴者，五积散、理中汤、古姜附汤；暑月烦渴者，黄连香
薷散冷服，俱宜合五苓散，以分消上下，或更合益元散降火尤妙，此皆分利法也。又当引清
气上升，使浊气自然下降。吐泻未彻者，宜用二陈汤加芎、芷、苍术、防风，探吐以提其气
。如吐涌不止，宜所服药中加木瓜、槟榔，以降其气。又有可下者，但不可纯用凉药。挟七
情者，七气汤、古参萸汤。伤饮食者，红丸子、保和丸，俱姜汤送下。通用四君子汤，有汗
，加桂枝；无汗，加麻黄；吐利转筋，腹痛体重，脉沉细，加白芍、良姜；四肢拘急，脉沉
迟，属少阴，加姜、附、浓朴；吐利转筋，胁痛脉弦者，木克土也，平胃散加木瓜，或小建
中汤加柴胡、木瓜；四肢厥冷，脉微缓，属厥阴者，小建中汤，加当归、附子。
心脾痛
厥心痛先问久新，
真心痛，因内外邪犯心君，一日即死。厥心痛，因内外邪犯心之胞络，或他脏邪
犯心之支脉，谓之厥者，诸痛皆少阴、厥阴气逆上冲，又痛极则发厥也。新者，身既受寒，
口又伤冷，郁遏元阳，宜草豆蔻丸、鸡舌香散温散之，或神保丸温利之。
稍久寒郁为热，或
因七情者，始终是火，此古方多以苦寒泻火为主，辛热行气为向导也。
痛甚发厥有二因；
寒厥，外因风寒客背之血脉，背俞与心引痛，暴发手足厥逆，冷汗甲青，似伤寒
阴厥，古姜附汤、三味玄胡散；热痛，内因酒食积热，痰郁发厥，手足虽冷而身热，甚则
烦躁吐逆额汗，古玄金散、三味川楝散、莎芎散，甚者，大承气汤下之，后服枳术丸。
七情怔悸虫不定，
九种∶悸痛、虫痛、来去痛、疰痛、饮痛、食痛、风痛、冷痛、热痛。悸痛，内
因七情，轻则怔忡惊悸，似痛非痛，妙香散、四七汤、小草丸，热者连附六一汤；重则两
目赤黄，手足青至食，即真痛，不治。虫痛，湿热生虫攻心，痛发难当，
痛定能食，饥则临
沐，灵槟散、乌梅丸、化虫丸选用。
痰火来去疰昏神。
来去痛，肺郁痰火，劳心则发热者，栀姜饮、蜡矾丸；痰积，白螺壳丸；痰火，
坠痰丸。疰痛，卒感恶忤尸疰，素虚者，肾经阴气上攻，神昏卒倒，苏合香丸；痛引痛伛偻
者，沉香降气汤，或五苓散倍桂，韭汁为丸，小茴煎汤下；素实者，肾火上攻，小承气汤；
痨瘵尸疰者，紫河车丹。
胃脘脾痛伤饮食，腹胀便闭呕频频；
胃脘当心而痛，脾脏连心而痛，《局方》云∶即心痛。盖厥痛亦少，脾胃痛多。
且七情四气归脾，虫痛，攻脾入胃；痰瘀，脾胃所主；但心痛，因伤思虑；脾胃痛，因伤饮
食。胃痛，善噎两胁咽膈不利；脾痛，舌强喜呕腹胀，二便不通。古方，实痛
以黄连治心，山
栀治胃；虚痛以参、归、小草治心，丁、砂、豆蔻治胃，亦未尝混。大概，伤水饮聚涎，心
痛如刺者，温胆汤加白术；伤食生冷，遇热食暂散者，香苏散加生姜、菖蒲、半夏、枳壳，
或人参养胃汤加肉桂、吴萸，或木香化滞汤、感应丸。凡心痛，数日不食无妨，痛止恣食即
发。胃火，栀姜饮；胃寒，乌药沉香汤；上热下寒者，古栀附汤。脾痛，海石散、古二胡散
；风冷，抽刀散、蟠葱散、烧脾散、二炒香良散；湿者，小胃丹；噎呕，五膈宽中散；腹胀
，浓朴温中汤；连胁痛，复元通气散；痰滞便闭，顺气导痰汤；气聚便闭，三和散、四磨汤
；小便闭，通灵散。又有心脾俱痛者，手拈散。
外感三般风冷热；连胁腰背少舒伸。
风，因肝邪乘心，痛则两胁引小腹阴股，桂枝汤加附子，便闭入蜜一匙同煎；或
分心气饮加浓朴、枳壳、萝卜子、木香；或阿魏撞气丸。冷，因形寒饮冷卧凉，肾气乘心，
痛则心悬若饥，腰痛，下重泄痢，五积散，便闭加大黄；或肺寒乘心，痛则短气，季肋空痛
者，流气饮子、盐煎散；或脾寒乘心，痛则腹胀便难者，藿香正气散，挟湿者，除湿汤。
热，因心胞络暑毒乘心，痛彻背俞，掌热，黄连香藿散加蓼草，或单黄连丸。凡诸经心痛引
背，多属风冷；诸腑心痛，难以俯仰，呕泻
，多属热
。
气血虚劳按则止，
虚痛，按之暂止。素虚多劳，或误服攻耗心气药多者，酸枣仁汤、归脾汤；心无
血辅者，四物汤去地黄加干姜；心气不足者，六君子汤加肉桂；气血俱虚者，古归术散；挟
痰火食积者，二六丸。
大实胸高瘀呃嗔；
实痛，素有瘀热顽痰，或因恼怒而发者，栀萸丸，木香、槟榔煎汤下，或香棱丸
；大实痛，因怒后饮食，卒痛注闷，心胸高起，手不可按，便闭者，大陷胸汤，或煮黄丸下
之，后服古 苍汤，以去余邪。瘀血痛，饮汤水咽下作呃，乃素食热物，血死胃脘，桃仁
承气汤；轻者，四物汤加桃仁、红花，或玄胡索丸、失笑散。妇人瘀血入心脾痛甚者，五积
散加三棱、莪术。经行未尽，血冲心痛，加桃仁、红花；经行已住作痛者，七气汤加当归。
产后痛者，桂心汤、木槟汤。
化痰消积气已降，
凡痛，皆痰粘胃，通用二陈汤。风寒初起，无汗，加麻黄；有汗，加桂枝；里寒
，加
草豆蔻；湿，加苍术、川芎；热，加山栀、锅煤、童便，或少加炒干姜反佐之；冷，加丁香
咳嗽必须区分痰与声，痰和声都与肺、脾二经有关；咳是因为气机运动而发出的声音，嗽则是血液转化为痰液。肺气运动则产生咳，脾湿运动则产生嗽，如果脾肺同时受动，那么咳和嗽就会一起发作。然而以肺为主，所以常说“咳”，这就包含了“嗽”在内。
实证表现为痰稠厚且声音沉重，虚证表现为声音清利且痰液稀薄。
治疗咳嗽必须先审察肺脉的虚实：实证脉象浮大有力，如果脉沉而滑，说明痰气盛实；虚证脉象弦大无力，如果脉沉细且带数象，说明火邪郁结至极。
外感因素由四时气候（风、寒、暑、湿）随季节变化引起：
风邪侵袭肺脏，咳嗽伴有鼻塞、声音重浊、口干、喉咙痒，话没说完就咳嗽，可用参苏饮加桑白皮、杏仁，或者柴胡半夏汤，之后服用各种治咳丸剂。如果是久咳、夜间咳、冬季咳，属于风邪侵入肺窍，适宜用熏法治疗。寒邪侵袭肺脏，咳嗽伴有胸部紧束、声音嘶哑，可用二陈汤加麻黄、杏仁，或者苏沉九宝饮、华盖散、单生姜丸。如果有寒热往来症状，用小柴胡汤。又有一种情况，遇到寒冷就咳嗽的，称为“寒暄”，这是寒包热的病机，解表即可消除，可用枳梗汤加麻黄、防风、杏仁、陈皮、紫苏、木通、黄芩。如果是风寒郁热导致的夜间咳嗽，可用三拗汤加知母、黄芩。暑邪侵袭肺脏，咳嗽伴有口燥、声音嘶哑、吐沫，如果见血，可用枇杷叶散加辰砂。湿邪侵袭肺脏，咳嗽伴有身体沉重、骨节烦痛、洒淅恶寒，可用五苓散、不换金正气散。大概春季气机上升，宜润肺抑肝；夏季火气上炎，宜清金降火；秋季湿热盛行，宜清热泻湿；冬季风寒严重，宜解表行痰。
内伤因素由火郁、劳倦、饮食、情志引起：
火邪咳嗽，声音多而痰少。五更时分咳嗽多的，是食积湿热，火流注于肺中，可用泻白散加知母，或者古二母散；上午咳嗽多的，是胃有实火，可用单石膏丸加知母、贝母，如果伴有大便闭结、气喘口渴、痰稠，可用凉膈散、败毒散、古芩半丸；下午咳嗽多的，是阴虚，可用四物汤合二陈汤，加知母、黄柏、麦门冬，顺势而下。如果是阴虚火燥，伴有寒热盗汗、遗精、见血，可用四物汤加竹沥，或者滋阴降火汤、加味二母丸。黄昏咳嗽多的，是火浮于肺，用润肺丸来收敛它，不可纯用凉药。通用方为二陈汤去掉半夏，加贝母、栝蒌、青黛、山栀、黄芩、桑白皮。郁咳，即火咳日久者。干咳无痰，是肾水焦枯，邪火独炎于肺，用泻白散加苦梗为君药以开宣肺气。病程久的，用诃黎丸；虚证的，用肾气丸；心情不得志的，用霞天膏；如果是肺燥，皮肤干枯疮痒，大便闭结的，用活血润燥生津饮。劳咳，即五劳虚损引起的咳嗽。疲劳过度伤肝，咳嗽且左胁疼痛牵引小腹的，用二陈汤，加川芎、当归、芍药、青皮、柴胡、草龙胆、黄芩、竹茹，或者黄芪建中汤；劳神伤心，咳嗽且咽干咯血的，用劫劳散、梦授天王补心丹；劳倦伤脾，咳嗽且气短无力的，用调中益气汤、补中益气汤；叫呼伤肺，咳嗽且呕吐白沫、口燥声嘶的，用润肺丸、人参清肺饮；房劳伤肾，咳嗽且腰背疼痛、寒热往来的，用二陈芎归汤。又有一种传变证候的痨咳，即干咳，痨咳日久的，适宜用蛤蚧、天灵盖、雄黄、朱砂之类药物，须参考痨瘵条目的内容。食咳，因食积生痰，痰气冲胸，腹部胀满的，用二陈汤加厚朴、山楂、麦芽；因吃生冷食物，导致肺胃不清、嗳酸吐泻、恶风寒的，用五积散、理中汤、异攻散；因吃煎炒热物损伤的，用葶苈散，或者三补丸加知母、贝母；因酒食积滞的，用香附栝蒌青黛丸。七情致病，脏腑气机不平则咳嗽，久不愈则传入六腑。怒伤肝咳，两胁下胀满，传入胆则呕吐苦汁；喜伤心咳，心痛咽肿，传入小肠则咳嗽与失气并见；思伤脾咳，右胁牵引肩背痛，严重时不能活动，传入胃则呕吐痰沫及蛔虫；忧伤肺咳，喘息唾血，传入大肠则遗粪；恐伤肾咳，唾涎，腰背牵引疼痛，传入膀胱则遗尿，传入三焦则腹部胀满不欲食。这是因为起初病变关乎肺，最终汇聚于胃的缘故。适宜选用二陈汤加栝蒌仁、萝卜子，加味泻白散、参苏饮、四七汤、苏子降气汤、团参饮子、古橘甘散、古橘姜丸、加减三奇汤等。
痰咳伴有胸满，水咳伴有心悸怔忡：
痰咳，痰出后咳嗽停止，胸膈部多感胀满。医经说：秋伤于湿，冬天必定咳嗽。湿气在心，称为热痰；湿气在肝，称为风痰；湿气在肺，称为气痰；湿气在肾，称为寒痰。只有湿痰入胃，上干犯肺，则必然引起咳嗽，适宜选用千缗汤、坠痰丸、半瓜丸。痰郁于肺经，咳嗽则涎多，或者形成结胸证的，用二陈汤加枳实、桔梗、栝蒌、黄芩、贝母，严重的用鹤顶丹。痰积流入肺脘，久咳无法入睡的，用兜铃丸。痰因火动引起的，用二陈汤加黄芩、黄连，或者清气化痰丸。痰因宿食引起的，用化痰丸。痰因酒湿引起的，用蜂姜丸。完全因酒引起的，用瓜连丸。如果痰很严重，能进食但大便闭结的，用小承气汤攻下；不能进食且大便闭结的，用浓朴汤，或者滚痰丸疏导。水咳，因饮水茶水停蓄化为涎沫上涌，身体发热、胸部胀满、心悸怔忡的，用小青龙汤；身体发冷、胁部硬满的，用玄武汤；形成结胸证的，用小半夏汤；大便闭结的，用十枣汤；小便涩滞的，用五苓散（详见伤寒水证章节）。
瘀血阻碍气机，腹胀且有腥臭味：
瘀血咳嗽，喉间常有腥气。轻症的，用泻白散加生地、山栀、牡丹皮、麦门冬、桔梗；重症的，用桃仁、大黄，姜汁制丸服用。或者是因打损伤、劳力伤肺，遇到风寒就咳嗽，或者咳出紫黑色血的，用四物汤去掉川芎，加大黄、苏木研末，酒调服，利去心肺间的瘀血即止，之后服用人参养荣汤调理。肺胀满，即痰与瘀血阻碍气机，所以动则喘急，或者左侧或右侧，只能睡一边不能平躺的是此证，用四物汤加桃仁、诃子、青皮、竹沥、姜汁。如果是虚胀气喘的，用单人参膏、古百花膏。有水停蓄导致胀满的，喝水则反逆不入，用三白汤加泽泻、桔梗、五倍子。如果是因火邪损伤极甚，无水可升而导致胀满的，必定干咳无痰，用诃黎丸含化，因为诃子有收敛降火的功效，这非常危险！
治疗要分新久，求其根本：
新咳，有痰的，属外感，随季节不同解散表邪；无痰的，便是火热，只宜清之。久咳，有痰的，燥脾化痰；无痰的，清金降火。大概外感久了则郁热，内伤久了则火炎，都适宜开郁润燥。其中又有因七情气逆的，则以枳壳、香附顺气为先；停水宿食的，则以南星、槟榔分消导滞为要。气血虚的，补益、收敛。如果不治本，而滥用兜铃、粟壳等涩剂，反而导致病情缠绵。况且肺为娇脏，易寒易热，虽然人参是平和的药物，惟独气虚最适宜，如果肺热有火，以及风邪初盛者，都适宜用沙参或玄参代替，所以咳嗽不拘泥于寒证。
久咳甚则还需调理脾肾：
久咳曾经经过泻下及劳倦饥饱失调，导致肺胃寒而饮食减少的，只需调理脾胃，咳嗽自然停止。然而肾为气之根，咳嗽动引全身，自觉气从脐下逆奔而上者，乃肾虚气不归元，适宜在所服药物中加入补骨脂、五味子，或者三味安肾丸。阳虚的，用肾气丸；阳虚严重的，用黑锡丹以镇摄。凡是咳嗽发展到肺胀及咽疮失音的，必死无疑。
霍乱由暑、湿、干三种类型组成：
一种暑霍乱，即湿霍乱，但这种疾病夏秋季节尤其严重，即使在寒冬月也多由伏暑引起，所以命名如此。一种湿霍乱，有声响且有吐泻物。一种干霍乱，有声响而无吐泻物。治疗方法见第三卷。
病本在于中焦湿热壅滞：
标症因外感四时之气，或者日间感受热邪、夜间受冷，或者体内素来有郁热，外部又感受寒邪，一时之间阴阳错乱；然而病本因饮食失节，或者酥酪酒浆生冷，导致湿热内盛，中焦脾土失去运化功能，当升不升，当降不降，所以上吐下泻，脉象多伏绝。又有挟带七情郁气，痰涎聚于膈部，痞塞不通的，外部表现痰喘眩晕，也必定是由伤饮食作为根源。
心腹突然疼痛，或热或寒：
先心痛者，则先呕吐；先腹痛者，则先腹泻；心腹俱痛者，则吐泻并作。轻症则只是吐泻而已。凡是在吐泻期间，切不可给予谷食，即使是米汤，喝一口立刻致死，必须等到吐泻停止，过了半天非常饥饿时，才可以逐渐食用稀粥。偏于阳分，则多热而口渴；偏于阴分，则多寒而不渴。
痰喘、烦渴却可恐惧：
痰喘，用二陈汤、加味半硫丸。虚烦不眠，用既济汤。烦渴，用九君子汤、桂苓甘露饮。大渴、大躁、大汗、遗尿的死亡，用回生散、养正丹抢救。
转筋、舌卷、囊缩危重：
阳明胃与大肠，用以滋养宗筋。暴吐暴泻，津液骤然亡失，小筋失去其所养，所以轻者两脚转筋而已，重者遍体转筋，手足厥冷，好像要断气一样，仓促之际，适宜用盐填满脐中，灼烧艾灸不计壮数，即使已经死亡，而胸中有暖气存在的，立即苏醒，急用茱萸散加小茴、甘草、苏叶煎服，再研碎生蒜涂脚掌心，即使是昏迷危重入腹的，也有效。如果是血热转筋不止的，用四物汤加黄芩、红花，或者苍术、南星。水药不能入口的，用古椒豆散。转筋不止，男子用手挽住其阴部，女子用手牵拉乳房两边。如果舌卷、囊缩、转筋入腹的，死亡。
分利升降，消食除冗杂：
霍乱乃湿热兼风木为害，治疗适宜散风寒，利湿降火，所以四季通用藿香正气散，为散风寒湿的要药。寒冬月四肢厥冷，脉沉不渴的，用五积散、理中汤、古姜附汤；暑月烦渴的，用黄连香薷散冷服，都适宜合用五苓散，以分消上下，或者更合用益元散降火尤其妙，这都是分利法。又应当引导清气上升，使浊气自然下降。吐泻未彻底的，适宜用二陈汤加川芎、白芷、苍术、防风，探吐以提举其气。如果吐涌不止，适宜在所服药物中加入木瓜、槟榔，以降其气。又有可以攻下的，但不可纯用凉药。挟带七情的，用七气汤、古参萸汤。伤饮食的，用红丸子、保和丸，都用姜汤送下。通用四君子汤，有汗的，加桂枝；无汗的，加麻黄；吐利转筋，腹痛体重，脉沉细的，加白芍、良姜；四肢拘急，脉沉迟，属少阴经，加姜、附、厚朴；吐利转筋，胁痛脉弦的，木克土也，用平胃散加木瓜，或者小建中汤加柴胡、木瓜；四肢厥冷，脉微缓，属厥阴经的，用小建中汤，加当归、附子。
厥心痛先问新久：
真心痛，因内外邪气侵犯心君，一天即死。厥心痛，因内外邪气侵犯心的胞络，或者其他脏邪气侵犯心的支脉，称为厥的，是因为诸痛皆因少阴、厥阴气逆上冲，又因痛极则发生厥逆。新发的，身体既受寒，口又伤冷，郁遏元阳，适宜用草豆蔻丸、鸡舌香散温散之，或者神保丸温利之。稍久寒郁化为热，或者因七情引起的，始终是火，这些古方多以苦寒泻火为主，辛热行气为向导。
痛甚发厥有两个原因：
寒厥，外因风寒客于背部血脉，背俞与心牵引疼痛，突发手足厥逆，冷汗指甲青紫，似伤寒阴厥，用古姜附汤、三味玄胡散；热痛，内因酒食积热，痰郁发厥，手足虽冷但身体发热，甚至烦躁吐逆额汗，用古玄金散、三味川楝散、莎芎散，严重的，用大承气汤攻下，之后服枳术丸。
七情、怔悸、虫痛不定：
九种：悸痛、虫痛、来去痛、疰痛、饮痛、食痛、风痛、冷痛、热痛。悸痛，内因七情，轻则怔忡惊悸，似痛非痛，用妙香散、四七汤、小草丸，热者用连附六一汤；重则两目赤黄，手足青至食指，即真痛，不治。虫痛，湿热生虫攻心，痛发难当，痛定能食，饥饿时临沐，用灵槟散、乌梅丸、化虫丸选用。
痰火、来去、疰痛昏神：
来去痛，肺郁痰火，劳心则发热者，用栀姜饮、蜡矾丸；痰积，用白螺壳丸；痰火，用坠痰丸。疰痛，卒感恶忤尸疰，素体虚弱者，肾经阴气上攻，神昏卒倒，用苏合香丸；痛引痛伛偻者，用沉香降气汤，或者五苓散倍桂，韭汁为丸，小茴煎汤下；素体实者，肾火上攻，用小承气汤；痨瘵尸疰者，用紫河车丹。
胃脘脾痛伤饮食，腹胀便闭呕频频：
胃脘当心而痛，脾脏连心而痛，《局方》说：即心痛。大概厥痛较少，脾胃痛较多。而且七情四气归于脾，虫痛攻脾入胃；痰瘀，脾胃所主；但心痛，因伤思虑；脾胃痛，因伤饮食。胃痛，善噎两胁咽膈不利；脾痛，舌强喜呕腹胀，二便不通。古方，实痛以黄连治心，山栀治胃；虚痛以参、归、小草治心，丁香、砂仁、豆蔻治胃，也未尝混淆。大概，伤水饮聚涎，心痛如刺的，用温胆汤加白术；伤食生冷，遇热食暂散的，用香苏散加生姜、菖蒲、半夏、枳壳，或者人参养胃汤加肉桂、吴萸，或者木香化滞汤、感应丸。凡心痛，数日不食无妨，痛止恣食即发。胃火，用栀姜饮；胃寒，用乌药沉香汤；上热下寒者，用古栀附汤。脾痛，用海石散、古二胡散；风冷，用抽刀散、蟠葱散、烧脾散、二炒香良散；湿者，用小胃丹；噎呕，用五膈宽中散；腹胀，用浓朴温中汤；连胁痛，用复元通气散；痰滞便闭，用顺气导痰汤；气聚便闭，用三和散、四磨汤；小便闭，用通灵散。又有心脾俱痛的，用手拈散。
外感三般风冷热；连胁腰背少舒伸。
风，因肝邪乘心，痛则两胁引小腹阴股，用桂枝汤加附子，大便闭结入蜜一匙同煎；或者分心气饮加厚朴、枳壳、萝卜子、木香；或者阿魏撞气丸。冷，因形寒饮冷卧凉，肾气乘心，痛则心悬若饥，腰痛，下重泄痢，用五积散，大便闭结加大黄；或者肺寒乘心，痛则短气，季肋空痛者，用流气饮子、盐煎散；或者脾寒乘心，痛则腹胀便难者，用藿香正气散，挟湿者，用除湿汤。热，因心胞络暑毒乘心，痛彻背俞，掌热，用黄连香藿散加蓼草，或者单黄连丸。凡诸经心痛引背，多属风冷；诸腑心痛，难以俯仰，呕泻，多属热。
气血虚劳按则止：
虚痛，按之暂时停止。素体虚弱多劳，或者误服攻耗心气药多者，用酸枣仁汤、归脾汤；心无血辅者，用四物汤去地黄加干姜；心气不足者，用六君子汤加肉桂；气血俱虚者，用古归术散；挟痰火食积者，用二六丸。
大实胸高瘀呃嗔：
实痛，素有瘀热顽痰，或者因恼怒而发者，用栀萸丸，木香、槟榔煎汤下，或者香棱丸；大实痛，因怒后饮食，卒痛注闷，心胸高起，手不可按，大便闭结的，用大陷胸汤，或者煮黄丸下之，之后服古苍汤，以去余邪。瘀血痛，饮汤水咽下作呃，乃素食热物，血死胃脘，用桃仁承气汤；轻者，用四物汤加桃仁、红花，或者玄胡索丸、失笑散。妇人瘀血入心脾痛甚的，用五积散加三棱、莪术。经行未尽，血冲心痛，加桃仁、红花；经行已住作痛的，用七气汤加当归。产后痛的，用桂心汤、木槟汤。
化痰消积气已降：
凡痛，皆因痰粘胃，通用二陈汤。风寒初起，无汗，加麻黄；有汗，加桂枝；里寒，加草豆蔻；湿，加苍术、川芎；热，加山栀、锅煤、童便，或少加炒干姜反佐之；冷，加丁香
Cough
Cough must be distinguished by phlegm and sound; both are related to the Lung and Spleen meridians. Cough (Ke) arises from Qi movement producing sound, while Su (expectoration) results from blood transforming into phlegm. When Lung Qi moves, cough occurs; when Spleen dampness moves, expectoration occurs. If both Spleen and Lung are affected simultaneously, both cough and expectoration manifest together. However, since the Lung is primary, speaking of "cough" generally encompasses "expectoration."
Excess patterns present with thick phlegm and heavy sounds, while deficiency patterns present with clear sounds and thin phlegm.
When treating cough, one must first examine the pulse of the Lung for excess or deficiency. In excess patterns, the pulse is floating, large, and forceful; if it is deep and slippery, it indicates abundant Phlegm-Qi. In deficiency patterns, the pulse is wiry, large, and weak; if it is deep, fine, and rapid, it indicates extreme Fire constraint.
External causes involve the Four Qi (Wind, Cold, Summerheat, Dampness) according to the seasons:
Wind invading the Lung causes cough with nasal congestion, heavy voice, dry mouth, and itchy throat, where the patient coughs before finishing a sentence. Treat with Shen Su Yin (Ginseng and Perilla Decoction) plus Sang Bai Pi (Morus Bark) and Xing Ren (Apricot Seed), or Chai Hu Ban Xia Tang (Bupleurum and Pinellia Decoction), followed by various cough pills. For chronic cough, night cough, or winter cough due to Wind entering the Lung orifices, fumigation is appropriate. Cold invading the Lung causes cough with chest tightness and hoarseness. Treat with Er Chen Tang (Two-Cured Decoction) plus Ma Huang (Ephedra) and Xing Ren (Apricot Seed), or Su Chen Jiu Bao Yin (Perilla and Amber Nine-Treasures Decoction), Hua Gai San (Flower Cover Powder), or Dan Sheng Jiang Wan (Single Ginger Pill). If there are alternating chills and fever, use Xiao Chai Hu Tang (Minor Bupleurum Decoction). Another type is cough triggered by cold, called "Han Xuan," which is Cold wrapping Heat; resolving the exterior eliminates it. Use Zhi Geng Tang (Akebia and Platycodon Decoction) plus Ma Huang, Fang Feng (Saposhnikovia), Xing Ren, Chen Pi (Tangerine Peel), Zi Su (Perilla Leaf), Mu Tong (Akebia), and Huang Qin (Scutellaria). For night cough due to Wind-Cold constraining Heat, use San Ao Tang (Three Unbinding Decoction) plus Zhi Mu (Anemarrhena) and Huang Qin. Summerheat invading the Lung causes cough with dry mouth, hoarseness, and spitting saliva; if blood is present, use Pi Ye San (Loquat Leaf Powder) plus Chen Sha (Cinnabar). Dampness invading the Lung causes cough with heavy body, painful joints, and aversion to wind/cold. Use Wu Ling San (Five-Ingredient Powder with Poria) or Bu Huan Jin Zheng Qi San (Non-Replacing Golden Righteous Qi Powder). Generally, in Spring when Qi rises, moisten the Lung and suppress the Liver; in Summer when Fire flares up, clear Metal and descend Fire; in Autumn when Damp-Heat is prevalent, clear Heat and drain Dampness; in Winter when Wind-Cold is severe, resolve the exterior and move Phlegm.
Internal injuries involve Fire constraint, overwork, diet, and emotions:
Fire cough presents with much sound but little phlegm. Cough occurring mostly at dawn (5-7 AM) is due to food stagnation and Damp-Heat, with Fire flowing into the Lung; treat with Xie Bai San (Drain White Powder) plus Zhi Mu, or Gu Er Mu San (Ancient Two-Mother Powder). Cough mostly in the morning is due to Excess Fire in the Stomach; treat with Dan Shi Gao Wan (Single Gypsum Pill) plus Zhi Mu and Bei Mu (Fritillaria). If accompanied by constipation, asthma, thirst, and thick phlegm, use Liang Ge San (Cool the Diaphragm Powder), Bai Du San (Eliminate Toxicity Powder), or Gu Qin Ban Wan (Ancient Scutellaria and Pinellia Pill). Cough mostly in the afternoon is due to Yin Deficiency; treat with Si Wu Tang (Four Substances Decoction) combined with Er Chen Tang, plus Zhi Mu, Huang Bo (Phellodendron), and Mai Men Dong (Ophiopogon) to guide downward. If Yin Deficiency with Fire Dryness presents with alternating chills/fever, night sweats, spermatorrhea, or hemoptysis, use Si Wu Tang plus Zhu Li (Bamboo Sap), or Zi Yin Jiang Huo Tang (Nourish Yin and Descend Fire Decoction) / Jia Wei Er Mu Wan (Modified Two-Mother Pill). Cough mostly at dusk is due to Fire floating in the Lung; use Run Fei Wan (Moisten Lung Pill) to astringe it; do not use purely cooling medicines. The general formula is Er Chen Tang minus Ban Xia, plus Bei Mu, Gua Lou (Trichosanthes), Qing Dai (Indigo Naturalis), Shan Zhi (Gardenia), Huang Qin, and Sang Bai Pi. Yu Ke (Constraint Cough) is long-standing Fire cough. Dry cough without phlegm is due to scorching and drying of Kidney Water, with Evil Fire blazing solely in the Lung; use Xie Bai San plus Ku Jing (Platycodon) as the chief herb to open the Lung. For long-standing cases, use He Li Wan (Poppy Capsule); for deficiency, use Shen Qi Wan (Kidney Qi Pill); for frustration/depression, use Xia Tian Gao (Cloud Sky Paste); for Lung Dryness with dry skin, sores, itching, and constipation, use Huo Xue Run Zao Sheng Jin Yin (Invigorate Blood, Moisten Dryness, Generate Fluids Decoction). Lao Ke (Labor Cough) is cough due to the Five Labors' deficiency. Extreme fatigue injuring the Liver causes cough with left hypochondriac pain radiating to the lower abdomen; treat with Er Chen Tang plus Xiong (Ligusticum), Gui (Angelica), Shao Yao (Peony), Qing Pi (Citrus Peel), Chai Hu (Bupleurum), Cao Long Dan (Gentian), Huang Qin, and Zhu Ru (Bamboo Shavings), or Huang Qi Jian Zhong Tang (Astragalus and Middle-Warming Decoction). Mental labor injuring the Heart causes cough with dry throat and hemoptysis; treat with Jie Lao San (Stop Labor Powder) or Meng Shou Tian Wang Bu Xin Dan (Dream-Given Heavenly King Nourishing Heart Pill). Physical labor injuring the Spleen causes cough with shortness of breath and weakness; treat with Tiao Zhong Yi Qi Tang (Regulate Middle and Boost Qi Decoction) or Bu Zhong Yi Qi Tang (Tonify Middle and Boost Qi Decoction). Shouting injuring the Lung causes cough with vomiting white foam, dry mouth, and hoarseness; treat with Run Fei Wan or Ren Shen Qing Fei Yin (Ginseng Clearing Lung Decoction). Sexual exhaustion injuring the Kidney causes cough with backache, alternating chills/fever; treat with Er Chen Xiong Gui Tang (Er Chen, Ligusticum, and Angelica Decoction). Another type is Transmitted Tuberculosis Cough (Lao Ke), i.e., dry cough; for long-standing tuberculosis cough, use Ge Jie (Gecko), Tian Ling Gai (Human Skull Cap), Xiong Huang (Realgar), and Zhu Sha (Cinnabar); refer to the Tuberculosis section. Shi Ke (Food Cough) is caused by food stagnation generating Phlegm, with Phlegm-Qi rushing to the chest and abdominal fullness; treat with Er Chen Tang plus Hou Po (Magnolia Bark), Shan Zha (Hawthorn), and Mai Ya (Barley Sprout). Injury from raw/cold foods causing unclear Lung/Stomach, acid belching, vomiting/diarrhea, and aversion to wind/cold; treat with Wu Ji San (Five Accumulations Powder), Li Zhong Tang (Regulate the Middle Decoction), or Yi Gong San (Assist Attack Powder). Injury from fried/hot foods; treat with Ting Li San (Descurainia Powder) or San Bu Wan (Three Tonify Pills) plus Zhi Mu and Bei Mu. Injury from alcohol/food stagnation; treat with Xiang Fu Gua Lou Qing Dai Wan (Cyperus, Trichosanthes, and Indigo Pill). Seven Emotions cause cough due to uneven Zang Qi; if prolonged, it enters the Six Fu organs. Anger injuring the Liver causes cough with fullness under both hypochondria; if entering the Gallbladder, bitter fluid is vomited. Joy injuring the Heart causes cough with heart pain and swollen throat; if entering the Small Intestine, cough accompanies flatus. Thought injuring the Spleen causes cough with right hypochondriac pain radiating to shoulder/back, severe immobility; if entering the Stomach, vomiting of phlegm and roundworms occurs. Sorrow injuring the Lung causes cough with panting and spitting blood; if entering the Large Intestine, fecal incontinence occurs. Fear injuring the Kidney causes cough with salivation, back pain; if entering the Bladder, urinary incontinence occurs; if entering the San Jiao (Triple Burner), abdominal fullness and anorexia occur. This is because initially the Lung is involved, ultimately gathering in the Stomach. Select from Er Chen Tang plus Gua Lou Ren (Trichosanthes Seed), Luo Bo Zi (Radish Seed), Jia Wei Xie Bai San, Shen Su Yin, Si Qi Tang (Four Qi Decoction), Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction), Tuan Shen Yin Zi, Gu Ju Gan San (Ancient Tangerine and Licorice Powder), Gu Ju Jiang Wan (Ancient Tangerine and Ginger Pill), or Jia Jian San Qi Tang (Modified Three Wonders Decoction).
Phlegm Cough with Chest Fullness, Water Cough with Palpitations:
Phlegm Cough stops after expectoration, with chest fullness. The Classics state: Injury to Dampness in Autumn leads to Cough in Winter. Dampness in the Heart is called Hot Phlegm; in the Liver, Wind Phlegm; in the Lung, Qi Phlegm; in the Kidney, Cold Phlegm. Only when Damp-Phlegm enters the Stomach and harasses the Lung does it cause cough; select Qian Min Tang (Thousand Strings Decoction), Zhui Tan Wan (Phlegm-Descending Pill), or Ban Gua Wan (Half Melon Pill). Phlegm constrained in the Lung meridian causes cough with much saliva or Jie Xiong (Chest Binding); treat with Er Chen Tang plus Zhi Shi (Immature Bitter Orange), Jie Geng (Platycodon), Gua Lou, Huang Qin, and Bei Mu; severe cases use He Ding Dan (Crane Top Pill). Phlegm accumulation flowing into the Lung/Stomach causing chronic cough preventing sleep; treat with Dou Ling Wan (Loquat Seed Pill). Phlegm moved by Fire; treat with Er Chen Tang plus Huang Qin and Lian Lian (Coptis), or Qing Qi Hua Tan Wan (Clear Qi and Transform Phlegm Pill). Phlegm due to retained food; treat with Hua Tan Wan (Transform Phlegm Pill). Phlegm due to alcohol-dampness; treat with Feng Jiang Wan (Honey-Ginger Pill). Purely due to alcohol; treat with Gua Lian Wan (Trichosanthes and Coptis Pill). If Phlegm is severe, able to eat but constipated; purge with Xiao Cheng Qi Tang (Minor Order the Qi Decoction). If unable to eat and constipated; dredge with Hou Po Tang (Magnolia Bark Decoction) or Gun Tan Wan (Rolling Phlegm Pill). Water Cough is caused by retained tea/water turning into saliva surging upward, with fever, chest fullness, and palpitations; treat with Xiao Qing Long Tang (Minor Green Dragon Decoction). If cold body and hard hypochondria; treat with Xuan Wu Tang (Black Tortoise Decoction). If Jie Xiong; treat with Xiao Ban Xia Tang (Minor Pinellia Decoction). If constipation; treat with Shi Zao Tang (Ten Jujube Decoction). If difficult urination; treat with Wu Ling San (See Water Patterns in Cold Damage).
Blood Stasis obstructing Qi, distension, and fishy odor:
Blood Stasis Cough has a persistent fishy smell in the throat. Mild cases: Xie Bai San plus Sheng Di (Rehmannia), Shan Zhi, Mu Dan Pi (Moutan), Mai Men Dong, Jie Geng. Severe cases: Tao Ren (Peach Kernel) and Da Huang (Rhubarb). Form pills with Ginger Juice. Or due to trauma/labor injuring the Lung, coughing upon Wind-Cold exposure, or coughing purple-black blood; use Si Wu Tang minus Xiong, plus Da Huang and Su Mu (Sappan Wood) powdered, taken with wine. Purge the Blood Stasis from Heart/Lung to stop, then tonify with Ren Shen Yang Rong Tang (Ginseng Nourishing Glory Decoction). Lung Distension is due to Phlegm and Blood Stasis obstructing Qi, causing dyspnea on exertion, lateral preference, and inability to lie flat; treat with Si Wu Tang plus Tao Ren, He Zi (Chebula), Qing Pi, Zhu Li, and Ginger Juice. If Deficiency Distension with asthma; use Dan Ren Shen Gao (Single Ginseng Paste) or Gu Bai Hua Gao (Ancient Hundred Flowers Paste). Distension due to water retention, where drinking causes reversal/refusal; treat with San Bai Tang (Three Whites Decoction) plus Ze Xie (Alisma), Jie Geng, and Wu Bei Zi (Gallnut). If distension due to extreme Fire injury, lack of Water to ascend, causing dry cough without phlegm; use He Li Wan for melting, as Chebula has astringent and Fire-descending properties; this is critical!
Treatment distinguishes new vs. old, seeking the root:
New Cough with Phlegm is external; resolve according to season. New Cough without Phlegm is Heat; clear it. Old Cough with Phlegm: dry Spleen and transform Phlegm. Old Cough without Phlegm: clear Metal and descend Fire. Generally, prolonged external pathogenesis leads to constrained Heat; prolonged internal injury leads to flaming Fire; both require opening constraint and moistening dryness. For Seven Emotions causing Qi rebellion, prioritize Zhi Qiao (Aurantii Fructus) and Xiang Fu (Cyperus) to smooth Qi. For retained water/food, prioritize Nan Xing (Arisaema) and Bing Lang (Areca Nut) to separate and guide. For Qi/Blood deficiency, tonify and astringe. If the root is not treated, and indiscriminately used Arenga/Persimmon Sepal astringents, the condition becomes lingering. Since the Lung is a delicate organ, susceptible to cold and heat, although Ren Shen (Ginseng) is mild and suitable only for Qi deficiency, for Lung Heat/Fire or initial Wind-Evil, use Sha Shen (Glehnia) or Xuan Shen (Scrophularia) instead. Thus, cough is not limited to Cold.
Old Cough requires calming Spleen and Kidney:
For old cough following purgatives, labor, or hunger/fullness imbalance, leading to Cold Lung/Stomach and poor appetite, regulate the Spleen and cough will stop. The Kidney is the organ of Qi; cough involving the whole body with sensation of Qi rushing up from below the navel indicates Kidney Deficiency with Qi failing to return to its source. Add Bu Gu Zhi (Psoralea) and Wu Wei Zi (Schisandra) to the prescribed medicine, or San Wei An Shen Wan (Three-Ingredient Calming Kidney Pill). For Yang Deficiency, use Shen Qi Wan; for severe Yang Deficiency, use Hei Xi Dan (Black Tin Pill) to anchor. Cough progressing to Lung Distension, throat sores, and loss of voice is fatal.
Huoluan (Colic-Restriction/Vomiting-Downfall Syndrome)
Huoluan involves three types: Summerheat, Dampness, and Dryness.
One type is Summerheat Huoluan, also called Wet Huoluan, severe in Summer/Autumn, often due to latent Summerheat even in winter. One type is Wet Huoluan, with sound and material (vomiting/diarrhea). One type is Dry Huoluan, with sound but no material. Treatment is in Volume 3.
The root is Damp-Heat obstruction in the Middle Jiao:
The branch is external invasion of Four Qi, or daytime Heat/Nighttime Cold, or internal constrained Heat with external Cold, causing sudden Yin-Yang disorder. The root is dietary irregularity (dairy, alcohol, raw/cold) leading to internal Damp-Heat, Spleen Earth failing to transport, ascending failing, descending failing, resulting in vomiting and diarrhea, with pulse often hidden/extinct. Also, constrained Seven Emotions with Phlegm-Saliva blocking the diaphragm, causing external Phlegm-Asthma/Dizziness, rooted in dietary injury.
Sudden Heart/Abdominal Pain, Hot or Cold:
Heart pain first implies vomiting first; Abdominal pain first implies diarrhea first; both imply simultaneous vomiting/diarrhea. Mild cases are just vomiting/diarrhea. During vomiting/diarrhea, absolutely no grain food; even rice soup, one sip causes immediate death. Wait until vomiting/diarrhea cease, half a day later when very hungry, then gradually eat thin porridge.偏向 Yang Branch: more Heat and thirst.偏向 Yin Branch: more Cold and no thirst.
Phlegm-Asthma, Irritability/Thirst are fearful:
Phlegm-Asthma: Er Chen Tang, Jia Wei Ban Liu Wan (Modified Pinellia and Pepper Pill). Deficient irritability/insomnia: Ji Ji Tang (Ji Ji Decoction). Irritability/Thirst: Jiu Jun Zi Tang (Nine Gentlemen Decoction), Gui Ling Gan Lu Yin (Cinnamon-Poria Sweet Dew Decoction). Great thirst, great restlessness, great sweating, urinary incontinence is fatal; save with Hui Sheng San (Revive Life Powder), Yang Zheng Dan (Nourish Righteous Pill).
Tendon Cramping, Tongue Curling, Scrotal Retraction are critical:
Stomach and Large Intestine nourish the Zong Jin (Major Tendons). Sudden vomiting/diarrhea causes sudden fluid loss, tendons lose nourishment. Mild: leg cramps. Severe: whole body cramps, cold extremities, near death. In emergency, fill umbilicus with salt, moxa indefinitely. Even if dead, if warmth remains in chest, revive immediately. Urgently use Zhu Yu San (Evodia Powder) plus Xiao Hui (Fennel), Gan Cao (Licorice), Su Ye (Perilla Leaf) decocted. Crush raw garlic, apply to sole. Even if coma/deep, effective. If Blood Heat cramping persists: Si Wu Tang plus Huang Qin, Hong Hua (Safflower), or Cang Zhu (Atractylodes), Nan Xing. If water/medicine cannot enter: Gu Jiao Dou San (Ancient Pepper-Bean Powder). Persistent cramping: pull male's genitals, female's breasts. Tongue curling, scrotal retraction, cramping entering abdomen is fatal.
Separate and benefit, ascend and descend, eliminate food, remove redundancy:
Huoluan is harm from Damp-Heat combining with Wind-Wood. Treatment should disperse Wind-Cold, benefit dampness, descend Fire. Huo Xiang Zheng Qi San (Agarwood and Righteous Qi Decoction) is universal for all seasons to disperse Wind-Cold-Dampness. Winter/Cold limbs, deep pulse, no thirst: Wu Ji San, Li Zhong Tang, Gu Jiang Fu Tang (Ancient Ginger-Attisol Decoction). Summer/Irritability-Thirst: Huang Lian Xiang Ru San (Coptis and Elsholtzia Powder) cold; combine with Wu Ling San to separate upper/lower, or add Yi Yuan San (Benefit Origin Powder) to descend Fire—this is separation/benefit method. Guide Clear Qi up, Turbid Qi down. Incomplete vomiting/diarrhea: Er Chen Tang plus Xiong, Bai Zhi (Angelica Dahurica), Cang Zhu, Fang Feng, induce vomiting to lift Qi. If vomiting unceasing: add Mu Gua (Papaya), Bing Lang to descend Qi. Cases suitable for purging, but not purely cooling. Constrained emotions: Qi Qi Tang, Gu Can Yu Tang (Ancient Ginseng-Evodia Decoction). Dietary injury: Hong Wan Zi (Red Pill), Bao He Wan (Protect Harmony Pill), taken with Ginger Soup. Universal Si Jun Zi Tang (Four Gentlemen Decoction): with sweat, add Gui Zhi (Cinnamon Twig); without sweat, add Ma Huang. Vomiting/diarrhea/cramping, abdominal pain/heaviness, deep-fine pulse: add Bai Shao (White Peony), Liang Jiang (Galangal). Limb stiffness, deep-slow pulse, Shaoyin channel: add Ginger, Fu Zi (Aconite), Hou Po. Vomiting/diarrhea/cramping, hypochondriac pain, wiry pulse: Wood overcoming Earth; Ping Wei San (Calm the Stomach Powder) plus Mu Gua, or Xiao Jian Zhong Tang plus Chai Hu, Mu Gua. Cold limbs, micro-slow pulse, Jueyin channel: Xiao Jian Zhong Tang plus Dang Gui (Angelica Sinensis), Fu Zi.
Xin Pi Tong (Heart-Spleen Pain)
Jue Xin Tong (Rebellious Heart Pain): Ask New vs. Old first.
Zhen Xin Tong (True Heart Pain): External/Internal Evil attacking Heart Monarch, death in one day. Jue Xin Tong: External/Internal Evil attacking Heart Pericardium, or other Zang Evil attacking Heart collateral branches. Called "Jue" because all pains involve Shaoyin/Jueyin Qi rebelling upward, and extreme pain causes Jue. New onset: Body exposed to Cold, mouth injured by Cold, suppressing Yuan Yang; use Cao Dou Kou Wan (Cardamom Pill), Ji She Xiang San (Orchid Fragrance Powder) to warm-disperse, or Shen Bao Wan (Spirit Treasure Pill) to warm-purge. Slightly older: Cold constrained transforms to Heat, or due to Seven Emotions, always Fire. Ancient formulas use Bitter-Cold to drain Fire, Pungent-Hot to move Qi as guides.
Severe Pain with Jue has two causes:
Cold Jue: External Wind-Cold in back vessels, Back-Shu points pulling Heart pain, sudden limb cold, cold sweat, blue nails, resembling Cold Damage Yin Jue; use Gu Jiang Fu Tang, San Wei Xuan Hu San (Three-Ingredient Corydalis Powder). Hot Pain: Internal Alcohol/Food Stagnation Heat, Phlegm constraint causing Jue, limbs cold but body hot, even irritability/vomiting/sweating forehead; use Gu Xuan Jin San (Ancient Gold Powder), San Wei Chuan Lian San (Three-Ingredient Melia Powder), Sha Xiong San (Saussurea and Ligusticum Powder), severe: Da Cheng Qi Tang (Major Order the Qi Decoction) to purge, then Zhi Zhu Wan (Aurantii and Atractylodes Pill).
Seven Emotions, Palpitations, Worm Pain uncertain:
Nine Types: Ji Tong (Palpitation Pain), Chong Tong (Worm Pain), Lai Qu Tong (Coming-Going Pain), Zhu Tong (Infectious Pain), Yin Tong (Drink Pain), Shi Tong (Food Pain), Feng Tong (Wind Pain), Leng Tong (Cold Pain), Re Tong (Hot Pain). Ji Tong: Internal Seven Emotions, mild palpitations/fright, pain-like-not-pain; Miao Xiang San (Wonderful Incense Powder), Si Qi Tang, Xiao Cao Wan (Small Grass Pill); Hot: Lian Fu Liu Yi Tang (Coptis-Attisol Six-One Decoction). Severe: red/yellow eyes, blue hands/feet to index finger, True Pain, untreatable. Chong Tong: Damp-Heat generates worms attacking Heart, unbearable pain, eats after pain subsides, bathes when hungry; Ling Bin San (Spirit Areca Powder), Wu Mei Wan (Mume Pill), Hua Chong Wan (Worm-Transforming Pill).
Phlegm-Fire, Coming-Going, Infectious Pain confusing spirit:
Lai Qu Tong: Lung constrained Phlegm-Fire, fever with mental labor; Zhi Jiang Yin (Gardenia-Ginger Decoction), La Fan Wan (Beeswax-Alum Pill). Phlegm accumulation: Bai Luo Ke Wan (White Snail Shell Pill). Phlegm-Fire: Zhui Tan Wan. Zhu Tong: Sudden evil/infectious Qi, deficient constitution, Kidney Yin Qi attacking, confusion/collapse; Su He Xiang Wan (Styrax Pill). Pain pulling/stooping: Chen Xiang Jiang Qi Tang (Aquilaria Descending Qi Decoction), or Wu Ling San double Gui Zhi, Leek Juice pills, Fennel decoction. Excess constitution: Kidney Fire attacking, Xiao Cheng Qi Tang. Tuberculosis/Infectious: Zi He Che Dan (Placenta Pill).
Wei Wan Pi Tong (Stomach/Spleen Epigastric Pain) due to Diet, Abdominal Fullness, Constipation, Frequent Vomiting:
Epigastric pain center-heart, Spleen pain connects-heart. Ju Fang says: It is Heart Pain. Jue Pain is rare; Spleen-Stomach Pain is common. Seven Emotions/Four Qi belong to Spleen; Worm Pain attacks Spleen entering Stomach; Phlegm/Stasis ruled by Spleen-Stomach. Heart Pain due to Overthinking; Spleen-Stomach Pain due to Dietary Injury. Stomach Pain: difficulty swallowing, hypochondriac/pharyngeal blockage. Spleen Pain: stiff tongue, desire to vomit, abdominal fullness, bowel/bladder obstruction. Ancient formulas: Excess Pain, Huang Lian treats Heart, Shan Zhi treats Stomach. Deficient Pain, Ren/Shen/Xiao Cao treats Heart, Ding/Zhu Dou Kou treats Stomach. Not mixed. Generally, Water/Drink injury with Saliva, Heart Pain like stabbing: Wen Dan Tang (Warm Gallbladder Decoction) plus Bai Zhu (Atractylodes). Food/Raw-Cold injury, temporary relief with hot food: Xiang Su San (Agarwood-Perilla Powder) plus Sheng Jiang, Chang Pu (Acorus), Ban Xia, Zhi Qiao; or Ren Shen Yang Wei Tang (Ginseng Nourish Stomach Decoction) plus Rou Gui (Cinnamon Bark), Wu Zhu Yu (Evodia); or Mu Xiang Hua Zhi Tang (Costus Transform Stasis Decoction), Ying Gan Wan (Responsive Pill). Heart Pain: fasting days is fine, eating freely after pain stops triggers recurrence. Stomach Fire: Zhi Jiang Yin. Stomach Cold: Wu Yao Chen Xiang Tang (Meiastemon-Aquilaria Decoction). Upper Heat/Lower Cold: Gu Zhi Fu Tang (Ancient Gardenia-Attisol Decoction). Spleen Pain: Hai Shi San (Sea Stone Powder), Gu Er Hu San (Ancient Two-Hu Powder). Wind-Cold: Chou Dao San (Drawing Knife Powder), Pan Cong San (Coiled Scallion Powder), Shao Pi San (Roasted Spleen Powder), Er Chao Xiang Liang San (Double-Roasted Fragrant-Galangal Powder). Dampness: Xiao Wei Dan (Minor Stomach Pill). Dysphagia/Vomiting: Wu Ge Kuan Zhong San (Five Diaphragms Widening Middle Powder). Abdominal Fullness: Hou Po Wen Zhong Tang (Magnolia Warming Middle Decoction). Hypochondriac Pain: Fu Yuan Tong Qi San (Restore Origin Smooth Qi Powder). Phlegm Stasis/Constipation: Shun Qi Dao Tan Tang (Smooth Qi Guide Phlegm Decoction). Qi Aggregation/Constipation: San He San (Three Harmonies Powder), Si Mo Tang (Four Grindings Decoction). Urinary Obstruction: Tong Ling San (Penetrating Spirit Powder). Heart-Spleen Both Pain: Shou Nian San (Hand Grasping Powder).
External Invasion: Three Types Wind-Cold-Heat; Hypochondriac/Waist/Back Stiffness.
Wind: Liver Evil attacking Heart, pain radiating from hypochondria to lower abdomen/thighs; Gui Zhi Tang (Cinnamon Twig Decoction) plus Fu Zi, add honey if constipation; or Fen Xin Qi Yin (Divide Heart Qi Decoction) plus Hou Po, Zhi Qiao, Luo Bo Zi, Mu Xiang; or A Wei Zhuang Qi Wan (Asarum Attacking Qi Pill). Cold: Shape Cold/Drink Cold/Cool Bed, Kidney Qi attacking Heart, pain like hunger hanging heart, backache, heaviness/dysentery; Wu Ji San, add Da Huang if constipation; or Lung Cold attacking Heart, shortness of breath, costal emptiness; Liu Qi Yin Zi (Flowing Qi Decoction), Yan Jian San (Salt-Fried Powder); or Spleen Cold attacking Heart, abdominal fullness/difficult stool; Huo Xiang Zheng Qi San, Dampness: Chu Shi Tang (Remove Dampness Decoction). Heat: Pericardium Summer-Toxin attacking Heart, pain through back-shu, palm heat; Huang Lian Xiang Huo San (Coptis-Perilla Powder) plus Liao Cao (Polygonum), or Dan Huang Lian Wan (Single Coptis Pill). All Meridian Heart Pain radiating to back: mostly Wind-Cold. All Fu Organ Heart Pain, difficult bending/stretching, vomiting/diarrhea: mostly Heat.
Qi/Blood Deficiency/Labor: Pressure stops pain:
Deficient Pain: Stops with pressure. Chronic deficiency/labor, or excessive attacking Heart Qi meds: Suan Zao Ren Tang (Sour Jujube Decoction), Gui Pi Tang (Restore Spleen Decoction). Heart lacking Blood support: Si Wu Tang minus Di Huang, add Gan Jiang (Dried Ginger). Heart Qi insufficient: Liu Jun Zi Tang (Six Gentlemen Decoction) plus Rou Gui. Qi/Blood both deficient: Gu Gui Zhu San (Ancient Angelica-Atractylodes Powder). Constrained Phlegm-Fire/Food Stagnation: Er Liu Wan (Two-Six Pill).
Great Excess: High Chest, Stasis, Hiccups, Anger:
Excess Pain: Chronic Stasis-Heat/Stubborn Phlegm, or anger-induced: Zhi Yu Wan (Gardenia-Evodia Pill), Mu Xiang/Bing Lang decoction; or Xiang Leng Wan (Fragrant Grinding Pill). Great Excess Pain: Anger then food, sudden pain/stuffiness, high chest, unpressable, constipation: Da Xian Xiong Tang (Major Binding the Chest Decoction), or Zhu Huang Wan (Boiled Yellow Pill) to purge, then Gu Cang Tang (Ancient Cang Zhu Decoction) to remove residual evil. Blood Stasis Pain: Drinking water causes hiccups, due to hot food, dead blood in epigastrium: Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction). Mild: Si Wu Tang plus Tao Ren, Hong Hua, or Xuan Hu Suo Wan (Corydalis Pill), Shi Xiao San (Shocking Experience Powder). Women Blood Stasis Heart-Spleen severe pain: Wu Ji San plus San Leng (Curcuma Zedoaria), E Zhu (Curcuma Phaeocaulis). Menstruation incomplete, Blood Rush Heart Pain: add Tao Ren, Hong Hua. Menstruation stopped then pain: Qi Qi Tang plus Dang Gui. Postpartum Pain: Gui Xin Tang (Cinnamon Heart Decoction), Mu Bing Tang (Costus-Areca Decoction).
Transform Phlegm, Eliminate Stagnation, Qi Descends:
All Pain due to Phlegm sticking to Stomach; Universal Er Chen Tang. Wind-Cold early, no sweat: add Ma Huang. With sweat: add Gui Zhi. Interior Cold: add Cao Dou Kou. Dampness: add Cang Zhu, Chuan Xiong (Sichuan Lovage). Heat: add Shan Zhi, Gu Mei (Pot Coal), Tong Bian (Child's Urine), or slightly roasted Gan Jiang as counter-agent. Cold: add Ding Xiang (Clove)