霍乱多发于夏秋之交，其症烦满腹痛，上吐下利、头痛身热、挥霍撩乱，甚则转筋入腹，四肢逆冷。良
由起居冷热不调，饮食生冷失节，清浊相干，水谷不化。邪在上焦则吐，在下焦则利，在中焦则吐利交作，
谓之湿霍乱。若胸腹绞痛，欲吐不吐，欲泻不泻，烦躁闷乱，俗名搅肠痧，即为干霍乱也。故经曰∶清气在
阴，浊气在阳，营气顺行，卫气逆行，清浊相干，乱于肠胃，则为霍乱。又曰∶厥气上逆，则为霍乱。古今
论治不一，大约因湿土为风木所克，又为炎暑蒸郁。故呕吐者，暑热之变。泄泻者，湿土之变。转筋者，风木之
变。其间更多饮食停滞，气不升降而
成。经曰∶太阴所至，为中满霍乱吐下，土郁之发，民病呕吐霍乱注下，此言受湿霍乱。又曰∶岁土不及，
风乃大行，民病霍乱飧泄，此言风木克土为霍乱。又曰∶热至则身热霍乱吐下，此言受热霍乱。论治霍乱者，
刘河间主火热。孙真人主食积。丹溪以为外感内积，阳不升，阴不降，张子和主风湿 三气，合而为邪。张景
岳主寒邪伤脏。李士材兼主湿热风暑虚实，分别治。罗谦甫专主气不和，用地浆治。戴复庵随病之缘感，人
之虚实而大旨重痰，故用苏合香丸通痞塞，次用藿香正气散吞来复丹，以控痰涎。初起阴阳搅乱，先服烧盐汤
探吐之，以吐中即寓发散也。通用藿香散、回生散。若胀痛呕泻，察其邪甚于上，宜平胃散、神香散，或和胃
饮。邪甚于下，宜五苓散、胃苓汤。无胀痛，但呕恶者，二陈汤合丁香散，加白蔻、砂仁。暑月感凉，霍乱吐
利，胃苓汤加藿香、半夏。食后感寒，腹痛吐利，藿香正气散加神曲。伤生冷腹痛吐利，六和汤。伤暑身热，
烦渴呕利，黄连香薷饮，轻者五物香薷饮。暑湿相搏，烦渴满闷，二香散。伤湿肢重，骨节烦痛，二术、二苓、
浓朴、陈皮、泽泻，或除湿汤。若吐利转筋，为风木刑脾，平胃散加木瓜，或木瓜汤。转筋腹痛，木瓜建中汤。
食滞腹痛，香砂枳术丸加神曲、谷芽。七情郁结，七气汤加乌药、木香、陈皮、枳壳。吐利不止，元气耗散，
或口渴喜冷，或恶寒肢厥，或发热烦躁，欲去衣被，此并非热，乃阴盛格阳，不可误用寒凉。宜理中汤，甚则
附子理中汤、四逆汤，加食盐少许，并冷服。暴泻如水，汗冷脉微，急用浆水散冷服。
〔吐利〕夏月泄泻或呕吐，生姜汁调天水散。冒暑腹痛，呕泻转筋，木瓜、吴萸、食盐各半两，同炒煎汤，温
服。吐利头痛，身热而渴，五苓散。吐利口干，烦渴引饮，麦门冬汤。吐利虚烦不眠，参胡三白汤。异乡初到，
不伏水土吐利，加减正气散。
〔干霍乱〕上不得吐，下不得泻，胸腹搅痛，乃土郁不能发泄，或宿食与寒气交搏而成。盖邪浅易得吐
利，邪深则阴阳格拒，气道不通，不速治，多致暴死。急于委中穴刺出血，先用盐汤探吐，或热童便和烧盐
少许，三饮三吐。宜提其气，但清气得升，则浊气可降而出，治宜温中破气散滞之剂。内用排气散加减，或
神香散、七气汤。外以吴萸、青盐各两许，略研，炒热熨脐下。如小便不通，冬葵子汤。二便不通，浓朴汤。
或已得吐泻，症势略定，宜二陈汤、藿香散。凡霍乱初定，不可急与粥汤，恐邪滞未尽复聚，且胃气逆，不
能和降也。
〔转筋〕《千金方》曰∶阳明属胃大肠，以养宗筋。吐泻津液暴亡，宗筋失养，轻者两脚转筋而已，重
者遍体转筋入腹，手足逆冷，危甚风烛矣。仓猝间急以盐填脐中，炮艾不计壮数，虽已死，胸有暖气者立醒。
急用木萸散∶木瓜、食盐、吴萸各五钱，同炒。再加茴香、苏叶、甘草煎服。捣蒜涂两足心。虽昏危转筋入腹，
亦效。
霍乱多发于夏秋交替之时，其症状表现为心烦胀满、腹痛，上吐下泻，伴有头痛和身体发热，病情急剧变化令人慌乱，严重时出现小腿抽筋并向腹部牵引，四肢厥冷。这大多是由于起居冷热不调，饮食生冷失节，导致清浊之气相互干扰，水谷无法正常运化。邪气在上焦则引起呕吐，在下焦则引起腹泻，在中焦则呕吐与腹泻同时发作，称为湿霍乱。如果胸腹绞痛，想吐吐不出，想拉拉不出，烦躁闷乱，俗称搅肠痧，这就是干霍乱。所以医经说：清气在阴分，浊气在阳分，营气顺行，卫气逆行，清浊之气相互干扰，扰乱肠胃，就形成霍乱。又说：厥逆之气上逆，就会形成霍乱。古今对于霍乱的论治观点不一，大抵是因为湿土被风木所克制，又受到炎暑的蒸郁。所以呕吐，是暑热变化的结果；泄泻，是湿土变化的结果；转筋（抽筋），是风木变化的结果。其间更多因为饮食停滞，气机不升降而形成的。医经说：太阴湿气盛行时，会出现中满、霍乱、呕吐和下利，这是土气郁结发作时，百姓患病呕吐、霍乱、注下，这是指感受湿邪导致的霍乱。又说：岁运土气不足，风气就会大行，百姓患霍乱和完谷不化的泄泻，这是指风木克制脾土导致的霍乱。又说：热气到来则身体发热、霍乱、呕吐和下利，这是指受热导致的霍乱。论述治疗霍乱的医家中，刘河间主张火热论；孙真人主张食积论；朱丹溪认为外感内积，阳气不升，阴气不降；张子和主张风湿三气合而为邪；张景岳主张寒邪伤脏；李士材兼主湿热风暑虚实，分别治疗；罗谦甫专主气机不和，用地浆水治疗；戴复庵根据病邪来源和人的虚实情况，大旨重视痰证，所以用苏合香丸通开痞塞，再用藿香正气散吞服来复丹，以控制痰涎。初起时阴阳搅乱，先服用烧盐汤探吐，以在吐法中寓含发散之意。通用方剂有藿香散、回生散。如果有胀痛呕吐腹泻，观察邪气偏重于上部，适宜平胃散、神香散，或和胃饮。邪气偏重于下部，适宜五苓散、胃苓汤。没有胀痛，只是呕吐恶心的，用二陈汤合丁香散，加白蔻仁、砂仁。暑月感受凉邪，霍乱吐利，用胃苓汤加藿香、半夏。进食后感受寒邪，腹痛吐利，用藿香正气散加神曲。损伤生冷食物致腹痛吐利，用六和汤。伤暑身热，烦渴呕利，用黄连香薷饮，轻症用五物香薷饮。暑湿相搏，烦渴满闷，用二香散。伤湿肢体沉重，骨节烦痛，用苍术、白术、茯苓、猪苓、厚朴、陈皮、泽泻，或除湿汤。如果出现吐利转筋，是风木刑克脾土，用平胃散加木瓜，或木瓜汤。转筋腹痛，用木瓜建中汤。食滞腹痛，用香砂枳术丸加神曲、谷芽。七情郁结，用七气汤加乌药、木香、陈皮、枳壳。吐利不止，元气耗散，或者口渴喜冷饮，或者恶寒肢厥，或者发热烦躁，想要去掉衣被，这并不是热证，而是阴盛格阳，不可误用寒凉药物。适宜理中汤，重症则用附子理中汤、四逆汤，加少许食盐，并冷服。暴泻如水，冷汗出脉微细，急用浆水散冷服。
〔吐利〕夏季泄泻或呕吐，用生姜汁调天水散。冒暑腹痛，呕吐腹泻转筋，用木瓜、吴茱萸、食盐各半两，同炒煎汤，温服。吐利伴头痛，身热而渴，用五苓散。吐利口干，烦渴引饮，用麦门冬汤。吐利虚烦不眠，用参胡三白汤。异乡初到，不服水土引起的吐利，用加减正气散。
〔干霍乱〕上不能吐，下不能泻，胸腹搅痛，这是土气郁结不能发泄，或者是宿食与寒气交搏而成。邪气浅表容易通过吐泻排出，邪气深重则阴阳格拒，气道不通，如果不迅速治疗，多导致暴死。急于在委中穴刺出血，先用盐汤探吐，或者热童便加少许烧盐，喝三次吐三次。应当提举清气，只要清气得升，浊气就可以下降而出，治疗适宜用温中破气散滞的方剂。内服排气散加减，或者神香散、七气汤。外用吴茱萸、青盐各一两许，略研，炒热熨烫脐下。如果小便不通，用冬葵子汤。二便不通，用厚朴汤。或者已经得到吐泻，症状势头略微稳定，适宜用二陈汤、藿香散。凡是霍乱刚刚稳定，不可急于给予粥汤，恐怕邪滞未尽再次聚结，而且胃气上逆，不能和降。
〔转筋〕《千金方》说：阳明经属胃和大肠，用来滋养宗筋。吐泻导致津液突然亡失，宗筋失去滋养，轻者只是两脚转筋，重者全身转筋牵引入腹，手足厥冷，危险程度胜过风中残烛。仓促之间，急忙用盐填满脐中，用炮艾灸不计壮数，即使已经死亡，胸部还有暖气的，立刻苏醒。急用木萸散：木瓜、食盐、吴茱萸各五钱，同炒。再加小茴香、紫苏叶、甘草煎服。捣蒜涂在两足心。即使是昏迷危重、转筋入腹的情况，也有效。
Cholera (Huo Luan) mostly occurs at the transition between summer and autumn. Its symptoms include mental restlessness, abdominal distension and pain, vomiting above and diarrhea below, headache, feverish sensation in the body, sudden chaotic changes causing distress, and in severe cases, muscle cramps (Zhuan Jin) extending from the calves to the abdomen, with cold extremities. This is largely due to irregular living habits regarding temperature, and improper consumption of raw or cold food and drink, leading to interference between clear and turbid Qi, and failure of water and grain to transform. If pathogenic factors are in the Upper Jiao (Upper Burner), vomiting occurs; if in the Lower Jiao (Lower Burner), diarrhea occurs; if in the Middle Jiao (Middle Burner), both vomiting and diarrhea occur simultaneously, termed Damp Cholera (Shi Huo Luan). If there is severe colic in the chest and abdomen, desire to vomit but unable to do so, desire to defecate but unable to do so, and irritability with confusion, commonly known as "Intestine-Twisting Sha" (Jiao Chang Sha), this is Dry Cholera (Gan Huo Luan). Thus, the classics state: Clear Qi resides in Yin, Turbid Qi resides in Yang, Ying Qi (Nutritive Qi) flows smoothly, Wei Qi (Defensive Qi) flows reversely; when Clear and Turbid Qi interfere and disturb the intestines and stomach, Cholera results. It also states: Rebellious Qi moving upward results in Cholera. Ancient and modern theories on treatment vary. Generally, it is because Damp Earth is overcome by Wind Wood, and steamed/oppressed by hot summer heat. Therefore, vomiting is a transformation of Summer-heat Heat; diarrhea is a transformation of Damp Earth; muscle cramps are a transformation of Wind Wood. Additionally, much of it arises from food stagnation and failure of Qi mechanism to ascend and descend. The classics state: When Taiyin (Spleen/Stomach dampness) prevails, there is central fullness, Cholera, vomiting and downward discharge; this refers to the outbreak of Earth depression, where people suffer vomiting, Cholera, and profuse diarrhea, indicating Damp Cholera caused by dampness. It also states: When the annual Earth Qi is insufficient, Wind prevails greatly, and people suffer Cholera and undigested stool diarrhea, indicating Cholera caused by Wind Wood overcoming Earth. It also states: When heat arrives, there is body heat, Cholera, vomiting and diarrhea, indicating Cholera caused by heat. Regarding the treatment of Cholera: Liu Hejian emphasized Fire-Heat; Sun Simiao emphasized Food Stagnation; Zhu Danxi believed it was external contraction combined with internal accumulation, with Yang failing to ascend and Yin failing to descend; Zhang Zihe emphasized Wind-Dampness and Cold combining into pathogenic factors; Zhang Jingyue emphasized Cold pathogen damaging the Zang organs; Li Shicai emphasized both Damp-Heat, Wind, Summer-heat, Deficiency and Excess, treating them separately; Luo Qianfu specialized in Disharmony of Qi, using Earth Slurry Water (Di Jiang Shui); Dai Fu'an focused on Phlegm based on the origin of pathogenic factors and the patient's deficiency or excess, using Su He Xiang Wan (Styrax Pill) to unblock obstruction, followed by Huo Xiang Zheng Qi San (Agastache Powder to Rectify the Qi) swallowing Lai Fu Dan to control phlegm-saliva. At the onset, when Yin and Yang are chaotic, first administer Salted Boiled Water (Shao Yan Tang) to induce vomiting, incorporating dispersing action within the vomiting method. Commonly used formulas include Huo Xiang San (Patchouli Powder) and Hui Sheng San (Revival Powder). If there is distension, pain, vomiting, and diarrhea, observe if the pathogen is predominant in the upper part; Ping Wei San (Calm the Stomach Powder) or Shen Xiang San (Aromatic Powder) or He Wei Yin (Harmonize the Stomach Decoction) are suitable. If the pathogen is predominant in the lower part, Wu Ling San (Five-Ingredient Powder with Poria) or Wei Ling Tang (Stomach-Poria Decoction) are suitable. If there is no distension or pain, only vomiting and nausea, Er Chen Tang (Two-Cured Decoction) combined with Ding Xiang San (Clove Powder), adding Bai Kou Ren (White Cardamom Seed) and Sha Ren (Amomum Fruit). In summer months, contracting coolness causing Cholera with vomiting and diarrhea, use Wei Ling Tang adding Huo Xiang (Patchouli) and Ban Xia (Pinellia Rhizome). After eating, contracting cold causing abdominal pain, vomiting and diarrhea, use Huo Xiang Zheng Qi San adding Shen Qu (Medicated Leaven). Injury from raw/cold food causing abdominal pain, vomiting and diarrhea, use Liu He Tang (Six-Harmony Decoction). Summer-heat injury causing body heat, irritability, thirst, vomiting and diarrhea, use Huang Lian Xiang Ru Yin (Coptis and Elsholtzia Decoction); mild cases use Wu Wu Xiang Ru Yin (Five-Ingredient Elsholtzia Decoction). Summer-heat and Dampness struggling, causing irritability, thirst, fullness and oppression, use Er Xiang San (Two-Aromatic Powder). Dampness injury causing heavy limbs and painful joints, use Cang Zhu (Atractylodes Rhizome), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Zhu Ling (Polyporus), Hou Po (Magnolia Bark), Chen Pi (Tangerine Peel), Ze Xie (Alisma Rhizome), or Chu Shi Tang (Remove-Dampness Decoction). If vomiting, diarrhea, and muscle cramps occur, it is Wind Wood punishing Spleen Earth; use Ping Wei San adding Mu Gua (Chaenomeles Fruit), or Mu Gua Tang (Chaenomeles Decoction). Muscle cramps and abdominal pain, use Mu Gua Jian Zhong Tang (Chaenomeles Decoction to Strengthen the Middle). Food stagnation abdominal pain, use Xiang Sha Zhi Zhu Wan (Costus and Amomum Pill to Break Up Accumulation) adding Shen Qu and Gu Ya (Sprouted Grain). Seven Emotions depression, use Qi Qi Tang (Seven-Qi Decoction) adding Wu Yao (Lindera Root), Mu Xiang (Aucklandia Root), Chen Pi, and Zhi Ke (Bitter Orange). If vomiting and diarrhea persist, Yuan Qi (Primal Qi) dissipates; or there is thirst preferring cold drinks, or aversion to cold with cold extremities, or fever with irritability desiring to remove clothing/bedding—this is not Heat, but Yin Excess repelling Yang (Yin Sheng Ge Yang). Do not mistakenly use Cold/Cool herbs. Use Li Zhong Tang (Regulate the Middle Decoction); for severe cases, Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) or Si Ni Tang (Four-Reversal Decoction), adding a little salt, taken cold. Sudden profuse watery diarrhea, cold sweat, faint pulse, urgently use Jiang Shui San (Grain Water Powder) taken cold.
[ Vomiting and Diarrhea ] Summer diarrhea or vomiting: Mix Tian Shui San (Heaven-Water Powder) with fresh Ginger Juice. Summer-heat invasion causing abdominal pain, vomiting, diarrhea, and muscle cramps: Stir-fry Mu Gua, Wu Zhu Yu (Evodia Fruit), and Salt (each 1.5 taels) together, decoct in water, take warm. Vomiting/diarrhea with headache, body heat and thirst: Wu Ling San. Vomiting/diarrhea with dry mouth, irritability and excessive drinking: Mai Men Dong Tang (Ophiopogon Decoction). Vomiting/diarrhea with deficiency-irritability and insomnia: Shen Hu San Bai Tang (Ginseng, Bupleurum, and Three Whites Decoction). Arriving in a foreign land, acclimatization issues causing vomiting/diarrhea: Jia Jian Zheng Qi San (Modified Rectify-Qi Powder).
[ Dry Cholera ] Unable to vomit above, unable to defecate below, twisting pain in chest and abdomen. This is Earth depression failing to vent, or old food interacting with Cold pathogen. Pathogens superficial are easily expelled via vomiting/diarrhea; pathogens deep cause Yin-Yang repulsion and blockage of Qi channels. Without rapid treatment, sudden death often ensues. Urgently prick blood from Wei Zhong (BL40) acupoint. First use Salt Soup to induce vomiting, or mix hot Child’s Urine with a little burnt salt; drink three times, vomit three times. Aim to raise Clear Qi; once Clear Qi ascends, Turbid Qi can descend and exit. Treatment should use Warm-Middle, Break-Qi, Disperse-Stagnation agents. Internally, use Pai Qi San (Expel-Qi Powder) modified, or Shen Xiang San, Qi Qi Tang. Externally, stir-fry Wu Zhu Yu and Qing Yan (Green Salt) (approx. 30g each), slightly grind, apply hot compress to below the umbilicus. If urination is blocked, use Dong Kui Zi Tang (Abutilon Seed Decoction). If both urination and defecation are blocked, use Hou Po Tang (Magnolia Bark Decoction). Or if vomiting/diarrhea have occurred and symptoms stabilize slightly, use Er Chen Tang, Huo Xiang San. Once Cholera initially stabilizes, do not urgently give porridge/soup, lest residual pathogens re-aggregate; moreover, Stomach Qi is rebellious and cannot descend harmoniously.
[ Muscle Cramps ] *Qian Jin Fang* states: Yangming Meridian belongs to Stomach and Large Intestine, nourishing Zong Jin (Major Tendons). Violent loss of Body Fluids from vomiting/diarrhea causes Zong Jin to lose nourishment. Mild cases involve only calf cramps; severe cases involve whole-body cramps extending to the abdomen, cold hands and feet, critically dangerous like a candle in the wind. In emergencies, urgently fill the umbilicus with salt, moxibustion with prepared mugwort without counting moxa cones; even if dead, if warmth remains in the chest, the patient will instantly revive. Urgently use Mu Yu San (Chaenomeles and Evodia Powder): Mu Gua, Salt, Wu Zhu Yu (each 15g), stir-fried together. Add Xiao Hui Xiang (Fennel), Zi Su Ye (Perilla Leaf), Gan Cao (Licorice Root), decoct and take. Crush garlic, apply to both sole centers (Yongquan KI1). Even in coma, critical condition, with cramps extending to abdomen, it is effective.