霍乱之候。其来暴疾。腹中绞痛。扰乱不宁。自吐泻交作。有吐而不泻。泻而
不吐。有不得吐。又不得泻。则邪有上下浅深之分。而总以得吐为愈。邪有
入必有出。盐汤探吐。上妙法门。然后调其胃气可也。盖霍乱每伤于胃。虽
风寒暑湿。四气相乘。而中必先虚。故邪入焉。至饮食失和。秽邪触感者尤
多。胃气一伤。清浊相干。邪不去则正不安。所以攻邪尤要于扶正也。即至
肢冷脉伏。转筋声哑。亦必驱邪至尽。盖邪去则正安。非比他症养正而邪
自除也。及大吐泻后。元气既乏。手足厥冷。脉微欲脱者。参附理中汤。仍为
吃紧。若早投之。则邪反固而难愈矣。所以当其发时。不可用米饮。先哲谆
谆戒之。岂无谓哉。观于干霍乱。上不得吐。下不得泻。亦因邪不能出。所以
为甚。治者愈可思其故矣。
治验
一男子恣饮梅水。吐泻无度。手足厥逆。面色惨晦。声音不出。而脉沉伏。小
水点滴不通。服药入口即吐。医告技穷。余熟思半日。忽悟及梅者果属
也。其味酸主收。故小便癃闭。因思果得麝则败。酒得麝则坏二语。且麝
性香窜走窍。乃取麝半入脐中。半入鼻孔。病者即以手拂其鼻。曰此何
物也。少顷小水大下二三行。忽如醉而醒。梦而觉。越日索粥渐安。
一女子大吐泻后。四肢厥逆。六脉俱无。头面带阳。而反红赤。凡药入口即
吐。余曰。此阴盛格阳。以仲景通脉四逆汤连剂。脉出肢暖始愈。
藿香汤 治霍乱吐利交作。
藿香 紫浓朴（姜制） 茯苓 木瓜 车前子（焙研二钱） 泽泻 枳壳 广皮 葛根（各一钱）
加生姜三片。有食。加砂仁末一钱。烦渴。去藿香。加紫苏一钱。面食。入莱
菔一钱。着气。入青皮七分。木香三分。切戒米饮。直待痛止觉饥。方可与之。
霍乱的证候，发病急骤迅猛。腹部剧烈绞痛，身体扰乱不安宁。出现呕吐与腹泻同时发作的情况；也有只呕吐不腹泻的，或只腹泻不呕吐的；还有既不能呕吐也不能腹泻的。这表明病邪在体内的位置有上下的区别，病位有浅深的不同，但总体上以能够吐出病邪为痊愈的标志。病邪既然进入体内，必然有排出的途径。用盐汤催吐探引，是上等的治疗方法。之后才能调理胃气。因为霍乱大多损伤胃气，虽然风寒暑湿四种外邪相互侵袭，但人体内部必须先有虚损，所以邪气才能乘虚而入。至于饮食失调、感受秽浊邪气的情况尤其多见。胃气一旦受损，清阳与浊阴相互干扰，邪气不去除则正气不得安宁，所以在治疗上驱除邪气比扶助正气更为紧要。即使发展到四肢冰冷、脉搏伏匿、小腿转筋、声音嘶哑等危重症状，也必须将邪气彻底驱除干净。因为邪气去除后正气才能安宁，这不同于其他病症通过养护正气而邪气自然消除的情况。等到剧烈呕吐腹泻之后，元气已经匮乏，出现手足厥冷、脉象微弱几乎要断绝的情况时，使用参附理中汤，仍然是非常关键的治疗手段。如果过早投用此方，反而会使邪气固结难愈。所以当疾病发作时，不可饮用米汤，先贤们反复告诫这一点，难道没有道理吗？观察干霍乱这种病症，上面不能呕吐，下面不能腹泻，也是因为邪气无法排出，所以病情尤为严重。治疗者由此可以深思其中的缘故了。
治验案例：
有一个男子放纵饮用梅子水，导致呕吐腹泻无度，手足厥冷逆乱，面色惨暗晦涩，声音发不出，脉象沉伏不起，小便点滴不通。服药入口即吐，医生表示无计可施。我仔细思考了半天，忽然领悟到梅子属于果实类，其味酸主收敛，所以导致小便癃闭不通。于是想到“果实遇到麝香就会败坏，酒遇到麝香就会变坏”这两句话，况且麝香性味芳香窜透，能走窍通络。于是取半钱麝香放入肚脐中，半钱放入鼻孔内。病人随即用手拂拭鼻子，问这是什么东西。过了一会儿，小便大量排出两三次，忽然像从醉梦中醒来一样。第二天索要粥喝，逐渐安定好转。
有一个女子在大吐大泻之后，四肢厥冷逆乱，六部脉象全部摸不到，头部面部呈现阳气浮越之象，反而红赤。凡药物入口即吐。我说，这是阴寒内盛格拒阳气于外的证候。给予张仲景的通脉四逆汤连续服用，直到脉象复出、四肢回暖才痊愈。
藿香汤：治疗霍乱呕吐与腹泻同时发作。
药材组成：藿香、紫浓朴（姜制）、茯苓、木瓜、车前子（焙干研碎二钱）、泽泻、枳壳、广皮、葛根（各一钱）。
加生姜三片。如果有食积，加砂仁末一钱。如果烦渴，去掉藿香，加紫苏一钱。如果吃了面食，加入莱菔一钱。如果气滞，加入青皮七分、木香三分。切记禁止饮用米汤，直到疼痛停止且感到饥饿时，才可以进食。
The syndrome of Huoluan (cholera-like disease with sudden vomiting and diarrhea) presents with a rapid and violent onset. There is severe colicky pain in the abdomen, accompanied by restlessness and agitation. Vomiting and diarrhea occur simultaneously; there are cases where only vomiting occurs without diarrhea, or only diarrhea without vomiting; and there are cases where neither vomiting nor diarrhea can occur. This indicates that the pathogenic factor has different levels of depth and location within the body. Generally, recovery is marked by the ability to vomit out the pathogen. Since pathogens enter the body, they must also have a way to exit. Using salt water to induce vomiting is an excellent method. Afterward, the stomach qi can be regulated. Huoluan often damages the stomach qi. Although it may be caused by the invasion of wind-cold, summer-heat, and dampness (the four climatic factors), internal deficiency must exist first for the pathogen to enter. Cases involving dietary irregularity and infection by turbid pathogens are particularly common. Once the stomach qi is damaged, clear yang and turbid yin interfere with each other. If the pathogen is not expelled, the healthy qi cannot be at peace; therefore, expelling the pathogen is more urgent than supporting the healthy qi. Even if the condition progresses to cold limbs, hidden pulse, muscle twitching (charley-horse), and hoarseness, the pathogen must still be completely driven out. Because only when the pathogen is gone can the healthy qi be at peace; this differs from other syndromes where supporting the healthy qi leads to the spontaneous elimination of the pathogen. After severe vomiting and diarrhea, when the primordial qi is depleted, manifesting as cold extremities and a faint pulse nearly imperceptible, Shenfu Lizhong Tang (Ginseng and Aconite Regulation of the Middle Decoction) remains critically important. However, if administered too early, it may cause the pathogen to become entrenched and difficult to cure. Therefore, during the acute phase, rice drink should not be consumed; this was repeatedly cautioned by past sages, which is certainly not without reason. Observing Gan Huoluan (dry cholera), where one cannot vomit above nor defecate below, the severity arises precisely because the pathogen cannot exit. Practitioners can thus ponder the underlying principles.
Clinical Case 1:
A man indulged in drinking plum juice, resulting in uncontrolled vomiting and diarrhea. His extremities were cold and inverted, his complexion was dull and dark, his voice was absent, and his pulse was deep and hidden. Urine output was scanty and obstructed. Any medicine taken was immediately vomited up, leaving the physician at a loss. After half a day of deep contemplation, I suddenly realized that plums are fruits. Their sour taste has a consolidating/astringent nature, leading to urinary retention (long bi). Recalling the saying that "fruits are spoiled by musk, and wine is ruined by musk," and considering that Musk (She Xiang) has an aromatic, penetrating quality that opens orifices, I took half a qian of Musk, placed half into the umbilicus and half into the nostrils. The patient brushed his nose with his hand and asked what the substance was. Shortly after, urine flowed profusely for two or three times. He suddenly woke up as if from a drunken dream. The next day, he requested porridge and gradually stabilized.
Clinical Case 2:
A woman suffered severe vomiting and diarrhea, followed by cold extremities and an absent pulse in all six positions. Her head and face showed signs of floating yang, appearing red and flushed. All medicines were vomited immediately upon ingestion. I stated, "This is Yin excess repelling Yang." I prescribed Tongmai Sini Tang (Pulse-Recovering Four Reversals Decoction) by Zhang Zhongjing continuously until the pulse returned and the limbs warmed, at which point she recovered.
Huoxiang Tang (Agastache Decoction): Treats Huoluan with simultaneous vomiting and diarrhea.
Ingredients: Huoxiang (Patchouli Herb), Zhi Nong Po (Magnolia Bark processed with ginger), Fuling (Poria), Mugua (Chaenomeles Fruit), Cheqianzi (Plantago Seed, roasted and ground, 2 qian), Zexie (Alisma Rhizome), Zhike (Bitter Orange Fruit), Guangpi (Tangerine Peel), Gegen (Kudzu Root) (each 1 qian).
Add three slices of Shengjiang (Fresh Ginger). If there is food stagnation, add 1 qian of Sharen powder (Amomum Fruit powder). If there is irritability and thirst, remove Huoxiang and add 1 qian of Zisu (Perilla Leaf). If wheat-based foods were consumed, add 1 qian of Laifu (Radish). If there is Qi stagnation, add 0.7 qian of Qingpi (Green Tangerine Peel) and 0.3 qian of Muxiang (Aucklandia Root). Strictly prohibit the consumption of rice drink until the pain stops and hunger is felt, before allowing intake.