万密斋曰∶霍乱者，阳明胃经之病名也。因平日五味肥酿，腐积成痰，七情郁结，气盛为火，停蓄胃中，乍
因寒热之感，邪正交争，阴阳相混，故令心腹绞痛，吐痢并作，挥霍变乱。如邪在上胃脘，则当心而痛，其吐
多。邪在下胃脘，则当脐而痛，其利多。邪在中脘，其腹中痛，吐痢俱多。吐多则伤气，利多则伤血。血气受伤，
不能护养其胎，邪气鼓击胎元，母未有不殒者。此危证，不可不亟治，宜香苏散加藿香叶主之。
慎斋按∶以上二条，序胎前有霍乱证也。妊娠霍乱，吐痢绞痛，最易伤胎。故胎前霍乱，宜辨饮食生冷，
暑湿风寒四气之感，随其邪之所凑治之，而以保胎为主也。
《大全》曰∶妊娠泄泻，或青或白，水谷不化，腹痛肠鸣，谓之洞泄。水谷不化，喜
饮呕逆，谓之协热下利。并以五苓散利小便，次以黄连阿胶丸，或三黄熟艾汤以安之。若泻黄有沫，肠鸣腹痛，
脉沉紧数，用戊己丸和之。嗳腐不食，胃脉沉紧，感应丸下之，后调和脾胃。若风冷，水谷不化，如豆汁，用
胃风汤。寒冷，脐下阴冷，洞泄，用理中汤、治中汤。伏暑烦渴，泻水，用四苓散。伤湿泄泻，小便自利，用不
换金正气散、胃苓汤。此四证之大略也。
慎斋按∶泄泻之证多因，有内外之合邪，有虚实之不同。况胎前泄泻，尤宜审因详证。岂四证足以尽之乎？
抑四证可执定数方以施治乎？
万密斋说：霍乱，是阳明胃经的病名。因为平日饮食五味肥腻醇酒，腐败积滞形成痰浊，加上七情郁结，气盛化为火邪，停蓄在胃中，突然因感受寒热之邪，邪气与正气交争，阴阳之气混杂，所以导致心腹绞痛，呕吐和腹泻同时发作，病情变化迅速且混乱。如果邪气在上焦胃脘，则疼痛位于心窝部，呕吐症状较多；邪气在下焦胃脘，则疼痛位于肚脐周围，腹泻症状较多；邪气在中焦胃脘，则腹部疼痛，呕吐和腹泻都多。呕吐过多会损伤气，腹泻过多会损伤血。气血受伤后，不能护养胎儿，邪气鼓动冲击胎元，母亲没有不流产的。这是危重证候，不可不紧急治疗，适宜用香苏散加藿香叶为主方治疗。
慎斋按语：以上两条，叙述了怀孕前（或妊娠期）出现霍乱证候的情况。妊娠期间患霍乱，呕吐腹泻伴绞痛，最容易伤及胎气。因此，妊娠期霍乱，应当辨别是饮食生冷、暑湿、风寒四种外邪所致，根据邪气停留的部位进行治疗，并以保胎为主要原则。
《女科大全》说：妊娠期间泄泻，大便颜色或青或白，水谷不消化，腹痛肠鸣，称为洞泄。水谷不消化，喜欢饮水且有呕逆症状，称为协热下利。这两种情况都用五苓散通利小便，随后用黄连阿胶丸，或者三黄熟艾汤来安定调理。如果泻下黄色稀便带有泡沫，肠鸣腹痛，脉象沉紧数，用戊己丸调和。嗳气有腐臭味且不思饮食，胃脉沉紧，用感应丸攻下，之后调和脾胃。如果是风冷所致，水谷不化，状如豆汁，用胃风汤。如果是寒冷所致，脐下感觉阴冷，发生洞泄，用理中汤、治中汤。如果是伏暑导致的烦渴、泻水，用四苓散。如果是伤湿引起的泄泻，小便自利，用不换金正气散、胃苓汤。这四种证候是大致的分类。
慎斋按语：泄泻的证候成因很多，有内外邪气合病的，有虚实不同的。何况妊娠期的泄泻，尤其应当审察病因、详细辨证。难道这四种证候就足以穷尽所有情况吗？或者可以拘泥于这四种证候固定使用几个方剂来治疗吗？
Wan Mizhai stated: Huoluan (Acute Vomiting and Diarrhea) is a disease name of the Yangming Stomach Meridian. It arises because, in daily life, excessive consumption of rich flavors, fatty foods, and fermented beverages leads to rotting and accumulation, forming phlegm turbidity. Coupled with emotional stagnation, where excessive Qi transforms into Fire, these pathogens accumulate in the Stomach. Suddenly, upon exposure to Cold or Heat pathogens, Evil Qi and Righteous Qi contend, and Yin and Yang become mixed, causing severe cramping pain in the heart and abdomen, with simultaneous vomiting and diarrhea, leading to rapid and chaotic changes. If the pathogen is in the Upper Jiao (Stomach Epigastrium), pain occurs at the heart region, and vomiting predominates. If the pathogen is in the Lower Jiao (Stomach below the navel), pain occurs around the umbilicus, and diarrhea predominates. If the pathogen is in the Middle Jiao (Middle Epigastrium), abdominal pain occurs, and both vomiting and diarrhea are frequent. Excessive vomiting injures Qi, while excessive diarrhea injures Blood. When Qi and Blood are injured, they cannot protect and nourish the Fetus. The pathogenic factors agitate and strike the Taiyuan (Fetal Origin), and it is inevitable that the mother will miscarry. This is a critical condition that must be treated urgently; Xiangsu San (Perilla and Cyperus Powder) added with Huoxiang Ye (Patchouli Leaf) is indicated as the primary formula.
Shenzhai commented: The above two passages describe the presentation of Huoluan during pregnancy. In pregnancy, Huoluan characterized by vomiting, diarrhea, and cramping pain is most likely to damage the Fetus. Therefore, for Huoluan during pregnancy, one should differentiate whether the cause is dietary cold/raw food, Summerheat-Dampness, Wind-Cold, or other external pathogens, treating according to the location of the pathogenic factor, with the preservation of the Fetus as the primary principle.
The *Daquan* (General Collection) states: During pregnancy, if diarrhea presents with stool that is either green or white, containing undigested food and water, accompanied by abdominal pain and borborygmus, it is called Dongxie (Cavity Diarrhea). If there is undigested food and water, thirst with a desire to drink, and nausea/vomiting, it is called Xiexia Li (Collateral-Heat Dysentery/Diarrhea). Both conditions should initially be treated with Wuling San (Five-Ingredient Poria Powder) to promote urination, followed by Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill) or Sanhuang Shuai Tang (Three-Yellows Cooked Mugwort Decoction) to stabilize the condition. If the diarrhea is yellow with froth, accompanied by borborygmus, abdominal pain, and a deep, tight, and rapid pulse, Wuji Wan (Wuji Pill) should be used to harmonize. If there is belching with a rotten odor, anorexia, and a deep, tight Stomach pulse, Yinggan Wan (Induction Pill) should be used to purge, followed by harmonizing the Spleen and Stomach. If caused by Wind-Cold, with undigested food resembling bean dregs, Weifeng Tang (Stomach-Wind Decoction) is indicated. If caused by Cold, with a cold sensation below the umbilicus and Dongxie, Lizhong Tang (Regulate the Middle Decoction) or Zhizhong Tang (Govern the Middle Decoction) should be used. If caused by latent Summerheat with irritability, thirst, and watery diarrhea, Siling San (Four-Poria Powder) is indicated. If caused by Dampness injury with free urination, Buhuanjin Zhengqi San (Non-Exchanging Gold Upright Qi Powder) or Weiling Tang (Stomach-Five Decoction) should be used. These represent the general categories of four syndromes.
Shenzhai commented: The etiology of diarrhea is diverse, involving combinations of internal and external pathogens, and differing in deficiency and excess. Particularly for diarrhea during pregnancy, one must carefully examine the cause and detailed symptoms. Can these four categories exhaust all possibilities? Or can one rigidly adhere to these four syndromes and fixed formulas for treatment?