经曰∶足太阴厥气上逆，则霍乱。又曰∶连热则热至，热至则身热吐下霍乱。陈飞霞曰∶夫霍乱之病，起于
仓卒，其证挥霍扰乱，无有宁止，故名霍乱。多因夹食伤寒，阴阳乖隔，上吐下泻，而烦躁闷乱者是也。盖人有
三焦，上焦受纳水谷，主入而不出，中焦腐化水谷，流行于五脏六腑，下焦分别水谷，主出而不纳。故邪在上焦
则吐，邪在下焦则泻，邪在中焦则上吐下泻。凡霍乱得吐泻，则邪气上下得出，陈 尽出，而吐泻自止。乃有上不
得吐，下不得泻，为干霍乱，又名绞肠痧。其病因脾胃之邪，无从而出。若加喘满作搐者，十不救一。其有上吐
下泻者，当分寒热治之，亦宜止其乳食，恐其增痰也。故霍乱饮水汤，不必与之，以其助胃邪故也。宜藿香正气散。
有先泻后吐者，乃脾胃虚寒，故先泻白水，而吐亦不多，气缓而神色不慢，额上有汗，六脉沉细，此为虚冷，宜
温之，六君子汤；不愈，则理中汤，加藿香、木瓜各一钱。有先吐后泻者，乃脾胃有热，故喘促唇红，面赤口渴，
脉洪而数，宜和之，五苓散加藿香。其干霍乱，上不得吐，下不得泻，最为危迫。速用盐汤探吐之，必待其吐出宿
食积痰，然后用药。或以针刺十指甲旁，令出血，或刺
膝中名委中穴，出血即解。然后用藿香正气散。
《集成》藿香正气散（见前呕吐方内）
六君子汤（见前咳嗽方内）
仲景理中汤（见前泄泻方内）
五苓散（见咳嗽方内）
涂蔚生曰∶五苓散为治寒水不化之热剂，义已见前。飞霞引治热症霍乱，仍为误也，医者须当审慎。查上吐
下泻为霍乱，吐泻不得为干霍乱，吐泻而兼腹痛者，方为绞肠痧，宜用针刺法，刺手十二井最效。手少商在大指
内侧，离甲爪角如韭叶许。手商阳在食指内侧，去爪甲角如韭叶许。手中冲在正面中指端，去爪甲韭叶许。手关
冲在无名指外侧，去爪甲角韭叶许。手少冲在小指内侧，去爪甲角如韭叶许。手少泽在小指外侧，去爪甲角五
分。两手合共十二穴，故名十二井穴。夫霍乱虽由于实邪扰害中土者多，而虚寒侵犯中土者，亦复不少。藿香
正气散，既纯系一派消导攻散之药，靡不误事。欲求其一明 稳健之法，则莫如折中于仲景，仲景之霍乱论曰∶
霍乱，头痛、发热、身疼痛、热多欲饮水者，五苓散主之；寒多而不用水者，理中丸主之。虽其后随出四逆汤
与通脉四逆加猪胆汁法，而霍乱之提纲治法，究不外是。余本此法以为延医，从未误事。盖脾土既因寒邪上下
分争之剧，而发生泄泻。则正气自虚，而寒邪愈实。扶土以安中宫，则邪退而吐泻自止。其热多欲饮水者，以脾
土不能化水，水津不能四布也，故主苓泽以利之，桂枝以化之。使其津生水布，而渴自止。其寒多不用水，而
用理中汤者，以水津虽能上升，而温化之力太差，尚使水液下注也。故主白术以燥之，干姜以温之，使虚寒消
尽，而吐泻自愈。若其所谓先吐后泻，乃脾胃有热，而主以五苓散加藿香，是诚为盲人引渡者也。夫既曰有热，
则宜治以清凉。而五苓散为治寒水不能利化，水阴不能上达，始行发热作渴之热剂，岂可以之治有热作呕者乎？
即加藿香，而藿香亦为宣去恶气之药，
于热毫无干涉。余遇此症颇多，其寒湿兼滞者，则用五苓散理中汤以治之。其为上热下寒之霍乱，每以六君子
汤，加黄连生姜治之得愈，轻者则只以小半夏汤加黄连。其黄连分量，亦须与参术相等。盖热在上，而治热宜求
乎上，寒在下，而治寒宜求乎于下。虽热寒互相为用，而药性各循其经，不相冲突，斯则亦相克相济之道也。
仲景四逆汤
干姜（一钱） 附子（五分） 甘草（一钱）
仲景通脉四逆加猪胆汁汤
甘草（一钱） 附子（三分） 干姜（一钱） 将药煎好，以猪胆汁入尿掺入服之。
六君子汤（见上）
小半夏汤（见前咳嗽方内）
《黄帝内经》说：足太阴脾经的厥逆之气上冲，就会发生霍乱。又说：如果热邪盛则热象显现，热象显现则身体发热、呕吐、腹泻并见，这就是霍乱。陈飞霞说：霍乱这种病，起病突然，症状表现为挥霍撩乱，没有片刻安宁，所以称为霍乱。多因夹带饮食停滞而感受伤寒，导致阴阳之气乖违阻隔，出现上吐下泻，并且烦躁闷乱的情况。大概人有上、中、下三焦，上焦接受和容纳水谷，主要功能是受纳而不外泄；中焦腐熟和消化水谷，其精气流行于五脏六腑；下焦分别清浊的水谷，主要功能是排泄而不受纳。所以邪气在上焦则引起呕吐，邪气在下焦则引起腹泻，邪气在中焦则既呕吐又腹泻。凡是霍乱患者出现呕吐和腹泻，说明邪气可以从上下排出，陈氏认为邪气尽出，那么呕吐和腹泻自然停止。然而有那种不能呕吐、不能腹泻的，称为干霍乱，又名绞肠痧。这是因为脾胃中的邪气没有出路。如果再加上气喘胸满、抽搐等症状，十个人里救不活一个。那些有上吐下泻症状的，应当区分寒证和热证来治疗，同时也应该停止给予乳食，恐怕会增加痰湿。因此，不要给霍乱患者喝饮水汤，因为它会助长胃中的邪气。适宜使用藿香正气散。
如果有先腹泻后呕吐的，这是脾胃虚寒，所以先排出白水样的大便，呕吐也不剧烈，气息缓和且神色不乱，额头出汗，六脉沉细，这属于虚冷证，适宜用温法治疗，方用六君子汤；如果不见效，则用理中汤，加入藿香、木瓜各一钱。如果有先呕吐后腹泻的，这是脾胃有热，所以呼吸急促、嘴唇红赤、面色发红、口渴，脉象洪大而数，适宜用和解法治疗，方用五苓散加藿香。至于干霍乱，上不得吐，下不得泻，最为危急紧迫。迅速用盐汤催吐，必须等到吐出宿食积痰之后，然后再用药。或者针刺十个手指甲旁边的穴位，令其出血，或者针刺膝盖中间的委中穴，令其出血，病症即可解除。然后用藿香正气散。
《医宗集成》记载的藿香正气散（见前文呕吐方剂内）
六君子汤（见前文咳嗽方剂内）
张仲景的理中汤（见前文泄泻方剂内）
五苓散（见前文咳嗽方剂内）
涂蔚生说：五苓散是治疗寒水不化的热性方剂，义理已在前文提及。陈飞霞引用它来治疗热症霍乱，仍然是错误的，医者必须审慎。查考可知，上吐下泻为霍乱，吐泻不通为干霍乱，吐泻兼有腹痛的，才称为绞肠痧，适宜用针刺法，针刺手部的十二井穴效果最好。手少商穴在大指内侧，距离指甲角如韭菜叶宽处。手商阳穴在食指内侧，距离指甲角如韭菜叶宽处。手中冲穴在正面中指端，距离指甲如韭菜叶宽处。手关冲穴在无名指外侧，距离指甲角如韭菜叶宽处。手少冲穴在小指内侧，距离指甲角如韭菜叶宽处。手少泽穴在小指外侧，距离指甲角五分。两手合共十二个穴位，所以叫十二井穴。霍乱虽然多由实邪扰乱中土所致，但虚寒侵犯中土的也不少。藿香正气散，既然纯粹是一派消导攻散的药，往往误事。想要寻求一种明确稳健的方法，不如折中于张仲景。张仲景关于霍乱的论述说：霍乱，头痛、发热、身体疼痛，热多且想喝水的，用五苓散主治；寒多且不想用水的，用理中丸主治。虽然后面又提出了四逆汤与通脉四逆加猪胆汁法，但霍乱的提纲治法，终究不出这些范围。我依据此法延请医生治病，从未误事。大概脾土因为寒邪上下分争剧烈，而发生泄泻。那么正气自然虚弱，而寒邪更加实盛。扶助脾土以安定中宫，那么邪气退却，吐泻自然停止。那些热多且想喝水的，是因为脾土不能化水，水津不能布散到全身，所以主用茯苓、泽泻以利水，桂枝以化气行水。使津液生成并布散，口渴自然停止。那些寒多且不用水的，而用理中汤的，是因为水津虽然能上升，但温化的力量太差，仍然使水液下注。所以主用白术以燥湿，干姜以温中，使虚寒消尽，吐泻自愈。如果说先吐后泻，是脾胃有热，而主用五苓散加藿香，这确实是盲人引路。既然说是热证，就适宜用清凉法治之。而五苓散是治疗寒水不能利化，水阴不能上达，才开始出现发热作渴的热性方剂，怎么可以用来治疗有热作呕的病呢？即使加上藿香，而藿香也是宣散恶气的药，对热证毫无关系。我遇到这类病症很多，如果是寒湿兼有积滞的，就用五苓散或理中汤来治疗。如果是上热下寒的霍乱，常用六君子汤加黄连、生姜治疗而痊愈，轻的则只用小半夏汤加黄连。其中黄连的分量，也必须与人参、白术相等。因为热在上部，治热宜求之于上；寒在下部，治寒宜求之于下。虽然热与寒互相为用，但药性各循其经脉，互不冲突，这也是相克相济的道理。
The *Yellow Emperor's Inner Canon* states: When the rebellious Qi of the Foot-Taiyin (Spleen Meridian) ascends, Huoluan (Cholera-like disease with sudden vomiting and diarrhea) occurs. It also states: If heat is excessive, heat manifestations appear; when heat manifests, the body becomes feverish, accompanied by vomiting and diarrhea, which constitutes Huoluan. Chen Feixia stated: This disease of Huoluan arises suddenly; its symptoms are chaotic and turbulent, without any respite, hence named Huoluan. It is mostly caused by cold damage complicated by food stagnation, leading to a discordance and separation of Yin and Yang, resulting in upper vomiting and lower diarrhea, along with restlessness and confusion. Generally, humans have the Upper, Middle, and Lower Jiao (Triple Burner). The Upper Jiao receives and accepts water and grain, primarily functioning to receive but not excrete; the Middle Jiao rots and ferments water and grain, circulating its essence to the Five Zang and Six Fu organs; the Lower Jiao separates water and grain, primarily functioning to excrete but not receive. Therefore, if pathogenic factors are in the Upper Jiao, vomiting occurs; if in the Lower Jiao, diarrhea occurs; if in the Middle Jiao, both vomiting and diarrhea occur. Whenever Huoluan patients experience vomiting and diarrhea, it indicates that pathogenic factors can be expelled from above and below. Chen believed that once pathogens are fully expelled, vomiting and diarrhea will naturally cease. However, there are cases where one cannot vomit nor defecate, known as Dry Huoluan, also called Intestinal Colic Sha (Jiaochangsha). This is because the pathogens in the Spleen and Stomach have no outlet. If accompanied by panting, chest fullness, and convulsions, fewer than one in ten can be saved. For those with upper vomiting and lower diarrhea, treatment should distinguish between Cold and Heat patterns. One should also suspend milk and food intake to avoid increasing phlegm-dampness. Therefore, do not give patients drinking water decoctions, as they may assist the stomach pathogens. Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi) is suitable.
If diarrhea precedes vomiting, this indicates Spleen-Stomach Deficiency-Cold. Thus, watery stools appear first, vomiting is mild, breath is slow, complexion is calm, sweat appears on the forehead, and all six pulses are deep and fine. This is a Deficiency-Cold pattern, suitable for warming treatment using Liujunzi Tang (Six Gentlemen Decoction); if ineffective, Lizhong Tang (Regulate the Middle Decoction) with Huoxiang (Patchouli) and Mugua (Papaya), each one qian, is used. If vomiting precedes diarrhea, this indicates Heat in the Spleen and Stomach. Symptoms include panting, red lips, flushed face, thirst, and a surging and rapid pulse. Harmonization is indicated, using Wuling San (Five-Ingredient Powder with Poria) plus Huoxiang. As for Dry Huoluan, where neither vomiting nor defecation is possible, the condition is most critical and urgent. Quickly induce vomiting using salt water solution. Only after the retained food and accumulated phlegm are expelled should medication be administered. Alternatively, prick the acupoints beside the ten fingernails to cause bleeding, or prick Weizhong (BL-40) located in the center of the knee to cause bleeding, which will resolve the condition. Then administer Huoxiang Zhengqi San.
Huoxiang Zhengqi San from *Yizong Jicheng* (see Vomiting formulas previously mentioned)
Liujunzi Tang (see Cough formulas previously mentioned)
Zhang Zhongjing's Lizhong Tang (see Diarrhea formulas previously mentioned)
Wuling San (see Cough formulas previously mentioned)
Tu Weisheng stated: Wuling San is a heat-inducing formula for treating untransformed cold-water; its principle was discussed earlier. Chen Feixia's citation of it for treating Heat-pattern Huoluan is still erroneous; physicians must exercise caution. Upon examination, upper vomiting and lower diarrhea constitute Huoluan; inability to vomit or defecate constitutes Dry Huoluan; only when vomiting and diarrhea are accompanied by abdominal pain is it termed Intestinal Colic Sha (Jiaochangsha), for which acupuncture is suitable, specifically pricking the Twelve Jing-Well points of the hands, which is most effective. Shaoshang (LU-11) is on the medial side of the thumb, about the width of a leek leaf from the nail corner. Shangyang (LI-1) is on the medial side of the index finger, about the width of a leek leaf from the nail corner. Zhongchong (PC-9) is at the tip of the middle finger on the palmar side, about the width of a leek leaf from the nail. Guanchong (SJ-1) is on the lateral side of the ring finger, about the width of a leek leaf from the nail corner. Shaochong (HT-9) is on the medial side of the little finger, about the width of a leek leaf from the nail corner. Shaoze (SI-1) is on the lateral side of the little finger, five fen from the nail corner. Together, the two hands comprise twelve points, hence named the Twelve Jing-Well points. Although Huoluan is mostly due to excess pathogens disturbing the Central Earth (Spleen/Stomach), Deficiency-Cold invading the Central Earth is also common. Huoxiang Zhengqi San, being purely composed of resolving and attacking herbs, often causes errors. To seek a clear and steady method, one might compromise with Zhang Zhongjing. Zhang Zhongjing's treatise on Huoluan states: In Huoluan, with headache, fever, body pain, excessive heat, and desire for water, Wuling San governs; with excessive cold and no desire for water, Lizhong Wan governs. Although later methods like Sini Tang and Tongmai Sini Tang plus Pig Bile were introduced, the outline treatment for Huoluan ultimately remains within these scopes. I have followed this method for medical practice without error. Essentially, when Spleen Earth suffers severe contention from Cold pathogens above and below, diarrhea occurs. Righteous Qi becomes deficient, and Cold pathogens become more substantial. Supporting Earth to stabilize the Central Palace allows pathogens to retreat and vomiting/diarrhea to cease. For those with excessive heat and desire for water, it is because Spleen Earth cannot transform water, and fluid essences cannot distribute widely. Thus, Fuling (Poria) and Ze Xie (Alisma) are used to promote urination, and Guizhi (Cinnamon Twig) to transform Qi. Once fluids generate and distribute, thirst stops. For those with excessive cold and no desire for water, Lizhong Tang is used because although fluid essences can ascend, the power of warming and transforming is insufficient, causing fluid to sink downward. Thus, Baizhu (Atractylodes Macrocephala) is used to dry dampness, and Ganjiang (Dried Ginger) to warm the interior. Once deficiency-cold is eliminated, vomiting and diarrhea heal themselves. To claim that vomiting preceding diarrhea indicates Stomach-Spleen Heat, yet prescribing Wuling San plus Huoxiang, is indeed guiding the blind. If it is declared as Heat, cooling treatment is appropriate. But Wuling San is a heat-inducing formula for treating untransformed cold-water where Yin fluids cannot ascend, initially causing fever and thirst. How can it treat vomiting caused by Heat? Even adding Huoxiang, which disperses foul qi, has no relevance to Heat. I encounter many such cases. For Cold-Dampness with stagnation, I use Wuling San or Lizhong Tang. For Huoluan with Upper Heat and Lower Cold, I often use Liujunzi Tang plus Huanglian (Coptis Rhizome) and Shengjiang (Fresh Ginger) with success; for mild cases, Xiaobanxia Tang (Minor Pinellia Decoction) plus Huanglian is used. The dosage of Huanglian must equal that of Renshen (Ginseng) and Baizhu. Since Heat is in the Upper, treating Heat should target the Upper; since Cold is in the Lower, treating Cold should target the Lower. Although Heat and Cold interact, drug properties follow their respective meridians without conflict, embodying the way of mutual restriction and assistance.
Zhang Zhongjing's Sini Tang
Ganjiang (Dried Ginger) (one qian) Fuzi (Prepared Aconite Root) (five fen) Gancao (Licorice Root) (one qian)
Zhang Zhongjing's Tongmai Sini Tang plus Pig Bile
Gancao (Licorice Root) (one qian) Fuzi (Prepared Aconite Root) (three fen) Ganjiang (Dried Ginger) (one qian) Decoct the medicine well, then mix in Pig Bile and urine before administration.
Liujunzi Tang (see above)
Xiaobanxia Tang (see Cough formulas previously mentioned)