刘河间云∶吐下霍乱，三焦为水谷转化之道路，热气甚，则传化失常，而为吐泻霍乱。
火性急速，火性躁动故也。世俗止谓停食者，特一端耳。转筋者，亦是肝木自甚，肝热烁燥
于筋，故筋急而挛痛，实非寒主收引之谓，此发火热霍乱一门也。巢氏云∶霍乱者，由阴阳
清浊二气相干，乱于肠胃之间，因遇饮食太过，忽然心腹绞痛，挟外邪者，身发寒热，头痛
身疼，无外邪者，但见心腹绞痛吐泻而已。又有饮酒食肉，浓味稠粘。又或生冷不禁，露庭
当风，入于三焦，传于脾胃，皆成霍乱，此发饮食霍乱一门也。张戴人曰∶风湿 三气，
合而为邪，脾土得风，则热乃发。发则火炎上，故呕吐者， 也。脾土得湿则下注，故注
泄者，湿也。风急甚则转筋，故转筋者，风也。此申明《内经》运气之风湿热三条也。王海
藏云∶风湿热外至，生冷食内加，内外合病，乃成霍乱。总括外感内伤霍乱致病之由也。
陈无择云∶转筋者，以阳明养宗筋，属大肠，今因感六淫之邪；内伤饮食油腻，暴吐
下，津液顿亡，宗筋失养，必致挛缩，甚则囊缩甲青而难治也。刘宗浓云∶冷热不调，阴阳
相搏，风寒乘之，而为挛缩急痛也。河间云∶转筋皆属于火，内有郁火，外束风寒。丹溪又
谓属血热，血中有热，外被风寒，皆能霍乱转筋也。准绳云∶霍乱之症，多由伏暑而作
，病之将作，必先腹中 痛，吐泻之后，若见转筋者，此阳明经内有积热，外有风寒，必
须发散表邪。故曰转筋者，风也。手足厥冷者，表邪内伏也。身热烦渴多汗者，暑也。四肢
重，骨节烦痛者，湿也。故霍乱转筋，有汗脉出者，方可清热。若无汗脉伏，四肢厥冷，必
秦子曰∶霍乱之症，多有转筋，多有四肢厥冷。若厥冷无脉，而兼见转筋者，悉属阳火
抑遏，并非阴寒之症。盖厥冷而不转筋，则有阴寒阳火之分。若厥冷而神志清爽，手足不能
动移，乃是阴厥。若神志昏沉，手足虽冷，仍能扬动，悉是阳厥。故夏秋霍乱，四肢厥冷，
本是暑热内伏，然虽是暑热，既经内伏，不用寒凉。若以寒凉抑遏，则手足何由得温，六脉
何由得出，理宜升散表邪，疏通经络，则手足得暖，六脉得出。凡此皆是表有风寒，一经吐
泻，表邪乘虚内陷，外见假寒，则手足厥冷，外邪不得作汗，此热深厥亦深也。误认脉伏为
阴厥，遽投热药，死不旋踵。即知其热厥，误用寒凉，则外邪愈伏，到底亦死。故余缔思升
阳散火，则邪汗自来，表邪自解而愈。更有手足温，六脉出，又现紫 而愈者。再按夏秋外
感疫痢，内伏暑热，外被风寒雨湿，束其肌表，恶寒身痛，下痢纯血，或下血水，或下黑色
，胸前满闷，呕吐不食，误用芩连大黄，则在表之疫邪内陷，不死不休。余亦用升阳散火汤
，败毒散，有汗大出而愈者，有发紫斑而愈者，若汗不出，则病不愈而斑不化矣，此又以发
汗为化斑者也。夫痢疾中夹带外感，人人知矣。夹带发斑，人所不知也。霍乱中夹带表邪，
人知之者，霍乱中夹带发斑，人所不知也。夫发斑而忌苦寒。人知之矣。化斑而忌寒凉，人
所不知也。总之，有表症，无汗脉浮，或脉伏，发表即是发斑。斑出而不化，热不解，表症
尚在者，散表即是化斑。有汗，无表症，脉沉数，清里即是发斑，斑出后，表解而里热，清
刘河间说：呕吐和腹泻并作的霍乱，是因为三焦作为水谷转化的通道，若热气过盛，导致传化功能失常，从而引发呕吐、腹泻的霍乱。火性急速且躁动，这就是原因所在。世俗之人只认为是停食所致，这只是一方面的情况。出现转筋（肌肉痉挛），也是由于肝木之气过旺，肝热灼伤津液使筋脉干燥，导致筋脉拘急挛缩疼痛，实际上并非寒邪主司收敛牵引所致，这是论述火热性质的霍乱这一门类。巢元方说：霍乱，是由于阴阳清浊二气相互干扰，在肠胃之间发生紊乱，如果因为饮食过量，突然感到心腹绞痛；兼感外邪的，身体会出现寒热交替、头痛、全身疼痛；没有外邪的，仅表现为心腹绞痛、呕吐和腹泻罢了。又有因饮酒吃肉、食用浓味粘稠食物，或者不能耐受生冷，或在露天处当风受凉的，病邪侵入三焦，传导至脾胃，都会形成霍乱，这是论述饮食不当引起的霍乱这一门类。张戴人说：风、湿、热三种邪气，合在一起成为致病因素，脾土受到风邪侵袭，热邪就会发作。发作时火势炎上，所以出现呕吐，这是风邪的表现。脾土受到湿邪侵袭则向下注泄，所以出现泄泻不止，这是湿邪的表现。风邪急迫严重时会导致转筋，所以转筋是风邪所致。这是在阐明《内经》中关于运气学说中风、湿、热三条病因。王海藏说：风湿热从外部侵袭，生冷食物从内部损伤，内外合病，才形成霍乱。这总括了外感和内伤导致霍乱的病因。
陈无择说：转筋，是因为阳明经滋养宗筋，归属于大肠，如今因为感受六淫邪气，内伤于油腻饮食，导致剧烈呕吐和腹泻，津液瞬间亡失，宗筋失去滋养，必然导致挛缩，严重时甚至阴囊收缩、指甲青紫而难以治疗。刘宗浓说：冷热不调，阴阳相互搏结，风寒乘虚而入，从而导致挛缩和急痛。河间说：转筋都属于火，内有郁积之火，外被风寒束缚。丹溪又说属于血热，血中有热，外被风寒侵袭，都能导致霍乱和转筋。《医学准绳》说：霍乱的病症，多由伏暑引起，疾病将要发作时，必定先出现腹部绞痛，呕吐腹泻之后，如果出现转筋，这是阳明经内有积热，外有风寒束缚，必须发散表邪。所以说转筋是风邪所致。手足厥冷的，是表邪内伏。身体发热、烦躁口渴、多汗的，是暑邪。四肢沉重、骨节烦痛的，是湿邪。所以霍乱转筋，如果有汗且脉搏显现，才可以清热。如果没有汗且脉搏潜伏，四肢厥冷，必须……（原文此处似有缺漏或断句问题，根据上下文逻辑补全意译）秦子说：霍乱的病症，多有转筋，多有四肢厥冷。如果厥冷无脉，并且兼见转筋的，全都属于阳火被抑遏，并不是阴寒的病症。大概厥冷而不转筋的，才有阴寒和阳火的区别。如果厥冷且神志清爽，手足不能移动，这是阴厥。如果神志昏沉，手足虽然冷，仍能扬动，全都是阳厥。所以夏秋季节的霍乱，四肢厥冷，本是暑热内伏，虽然是暑热，既然已经内伏，就不宜用寒凉药。如果用寒凉药抑遏，那么手足怎么能温暖，六脉怎么能显现？理应当升散表邪，疏通经络，这样手足就能回暖，六脉就能显现。凡是这些情况都是表有风寒，一经呕吐腹泻，表邪乘虚内陷，外表呈现假寒象，所以手足厥冷，外邪不能通过发汗排出，这就是热深厥亦深。误认脉伏为阴厥，急忙投用热药，病人很快就会死亡。即使知道是热厥，误用寒凉药，那么外邪会更加内伏，最终也会死亡。所以我深思后认为，升阳散火，则邪气和汗液自然出来，表邪自然解除而痊愈。更有手足温暖，六脉显现，又出现紫斑而痊愈的。再按夏秋季节的外感疫痢，内伏暑热，外被风寒雨湿束缚肌表，恶寒身痛，下痢纯血，或者下血水，或者下黑色粪便，胸前满闷，呕吐不食，误用黄芩、黄连、大黄，那么在表的疫邪就会内陷，不死不休。我也用升阳散火汤、败毒散，有大汗出而痊愈的，有发紫斑而痊愈的，如果汗不出，则病不愈且斑不化，这也是以发汗来化斑的方法。痢疾中夹杂外感，人人都知道。夹杂发斑，人们不知道。霍乱中夹杂表邪，人们知道的，霍乱中夹杂发斑，人们不知道的。发斑而忌用苦寒药，人们知道。化斑而忌用寒凉药，人们不知道。总之，有表症，无汗脉浮，或者脉伏，发表即是发斑。斑出而不化，热不解，表症还在的，散表即是化斑。有汗，无表症，脉沉数，清里即是发斑，斑出后，表解而里热，清……（原文截断）
Liu Hejian stated: In cholera with simultaneous vomiting and diarrhea, the Sanjiao (Triple Burner) serves as the pathway for the transformation of food and fluids. When heat qi is excessive, transmission and transformation become abnormal, resulting in vomiting, diarrhea, and cholera. The nature of fire is rapid and restless; this is the reason. The common people only attribute it to retained food, which is merely one aspect. Tendon cramping (Zhuanjin) also occurs due to the excess of Liver Wood; Liver heat scorches and dries the tendons, causing them to become tight, cramped, and painful. This is actually not due to cold causing contraction and traction. This section discusses the category of Fire-Heat Cholera. Chao Yuanfang stated: Cholera arises from the interference between Yin-Yang, Clear-Turbid Qi, causing chaos within the intestines and stomach. If caused by overeating, sudden severe pain in the heart and abdomen occurs. Those accompanied by external pathogens will exhibit alternating chills and fever, headache, and body aches. Those without external pathogens will only show severe abdominal pain, vomiting, and diarrhea. Furthermore, drinking alcohol, eating meat, consuming rich and sticky foods, or failing to tolerate raw and cold items, or being exposed to wind in open areas, allows pathogens to enter the Sanjiao and transmit to the Spleen and Stomach, all forming cholera. This section discusses the category of Dietary Cholera. Zhang Dairen stated: Wind, Dampness, and Heat three pathogens combine to form evil. When Spleen Earth is affected by Wind, Heat erupts. When Heat erupts, Fire flares upward, causing vomiting; thus, vomiting is related to Wind. When Spleen Earth is affected by Dampness, it flows downward, causing profuse diarrhea; thus, diarrhea is related to Dampness. When Wind is urgent and severe, it causes tendon cramping; thus, tendon cramping is related to Wind. This clarifies the three paths of Wind, Dampness, and Heat in the *Neijing*’s theory of climatic influences. Wang Haicang stated: External invasion of Wind, Dampness, and Heat, combined with internal consumption of raw and cold food, results in an internal-external combined disease, forming cholera. This summarizes the etiology of cholera from both external contraction and internal injury.
Chen Wuyue stated: Tendon cramping occurs because the Yangming Meridian nourishes the Zongjin (Major Tendons), which belong to the Large Intestine. Now, due to contracting the Six Excesses (Six Pathogens) and internal injury from greasy diet, leading to violent vomiting and diarrhea, body fluids are suddenly lost. The Zongjin lose nourishment, inevitably leading to contraction. In severe cases, retraction of the scrotum and cyanosis of the nails occur, making it difficult to treat. Liu Zongnong stated: Imbalance of cold and heat, mutual struggle of Yin and Yang, with Wind-Cold taking advantage, leads to contraction and acute pain. Hejian stated: Tendon cramping all belongs to Fire; there is internal stagnant Fire bound externally by Wind-Cold. Danxi further stated it belongs to Blood Heat; heat within the blood, combined with external Wind-Cold, can both cause cholera and tendon cramping. *Yixue Zhunsheng* stated: Cholera symptoms are mostly caused by latent Summerheat. Before the disease manifests, there must be abdominal colic. After vomiting and diarrhea, if tendon cramping appears, it indicates accumulated Heat in the Yangming Meridian bound externally by Wind-Cold. It is necessary to disperse the exterior pathogens. Hence, it is said that tendon cramping is due to Wind. Cold extremities indicate interior retention of exterior pathogens. Fever, irritability, thirst, and sweating indicate Summerheat. Heavy limbs and painful joints indicate Dampness. Therefore, in cholera with tendon cramping, only when there is sweating and the pulse is visible can Heat-clearing methods be used. If there is no sweating and the pulse is hidden, with cold extremities... Qin Zi stated: Cholera symptoms often involve tendon cramping and cold extremities. If there is cold extremities without a pulse, accompanied by tendon cramping, it all belongs to suppressed Yang Fire, not Yin Cold. Generally, cold extremities without tendon cramping distinguish between Yin Cold and Yang Fire. If cold extremities are accompanied by clear consciousness and immobility of hands and feet, it is Yin Jue (Cold Extremity). If consciousness is clouded, and although hands and feet are cold, they can move restlessly, it is all Yang Jue. Thus, in summer and autumn cholera, cold extremities are originally due to latent Summerheat. Although it is Summerheat, since it is latent, cold-cooling herbs should not be used. If cold-cooling herbs suppress it, how can the hands and feet warm up, and how can the six pulses emerge? The principle should be to raise and disperse exterior pathogens, and unblock meridians, so that hands and feet warm up and pulses emerge. All these situations involve exterior Wind-Cold. After vomiting and diarrhea, exterior pathogens sink inward due to deficiency, presenting false cold externally, hence cold extremities. Exterior pathogens cannot sweat out; this is "the deeper the heat, the deeper the cold." Mistaking hidden pulse for Yin Jue and hastily administering hot medicines will lead to death quickly. Even knowing it is Heat Jue, misusing cold-cooling medicines will cause exterior pathogens to sink deeper, ultimately leading to death. Therefore, I have pondered that raising Yang and dispersing Fire will naturally bring out pathogens and sweat, resolving the exterior pathogen and curing the disease. There are cases where hands and feet become warm, pulses emerge, and purple spots appear, leading to recovery. Regarding summer and autumn epidemic dysentery contracted externally, with latent Summerheat internally and bound externally by Wind-Cold, rain, and Dampness, presenting chills, body pain, pure bloody stool, bloody water, black stool, chest fullness, vomiting, and loss of appetite, misusing Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Dahuang (Rhubarb Root) will cause exterior epidemic pathogens to sink inward, refusing to cease until death. I also use Shengyang Sanhuo Tang (Raise Yang Disperse Fire Decoction) and Baidu San (Resist Toxicity Powder). Some recover with heavy sweating, some with the appearance of purple spots. If sweat does not come out, the disease will not resolve and spots will not transform. This is using sweating to transform spots. Everyone knows that dysentery can be complicated by exterior contraction. Few know it can be complicated by spot eruption. Everyone knows that cholera can be complicated by exterior pathogens. Few know that cholera can be complicated by spot eruption. Everyone knows that spot eruption contraindicates bitter-cold herbs. Few know that transforming spots contraindicates cold-cooling herbs. In summary, if there are exterior symptoms, no sweating, floating or hidden pulse, releasing the exterior is equivalent to inducing spots. If spots appear but do not transform, heat does not resolve, and exterior symptoms remain, dispersing the exterior is equivalent to transforming spots. If there is sweating, no exterior symptoms, and deep-rapid pulse, clearing the interior is equivalent to inducing spots. After spots appear, if the exterior is resolved but interior heat remains, clear... [Text cuts off]