成无己云∶若止呕吐而利，经谓之吐利是也。上吐下利，躁扰烦乱，乃谓之霍
乱。其与但称吐利者有异也。盖暴于旦夕者为霍乱，可数日久者为吐利。《纲目》以
霍乱与伤寒吐利合为一门，今仍分为二，而以徐而日久者入此门。《脉经》云∶心乘
肝必吐利。《内经》云∶厥阴所至，为呕泄。又云∶木太过曰发生，发生之纪，上征
则气逆，其病吐利，是风木之为吐利者也。又云∶水太过曰流衍，流衍之纪，其动漂泄
沃涌，是寒水之为吐利者也。（漂泄谓泻利，沃涌为吐沫也。）《金匮》云∶干呕而利者，
黄芩加半夏、生姜汤主之。黄芩汤亦主之。海藏云∶上吐下泻不止，当渴而反不渴，脉微
细而弱者，理中汤主之。丹溪云∶泄泻或呕吐，生姜汁汤调六一散服。洁古云∶有
痰而泄利不止，甚则呕而欲吐，利下而不能食，由风痰羁绊脾胃之间，水煮金花丸
主之。
陈无择曰∶霍乱者，心腹卒痛，呕吐下利，憎寒壮热，头痛眩晕，先心痛则先
吐，先腹痛则先利，心腹俱痛，吐利并作，甚则转筋入腹则毙。盖阴阳反戾，清浊
相干，阳气暴升，阴气顿坠，阴阳痞膈，上下奔迫，宜详别三因以调之。外因，伤
风则恶风有汗，伤寒则恶寒无汗，冒湿则重着，伤暑则烦热。内因，九气所致，郁
聚痰涎，痞膈不通，遂致满闷，随其胜复，必作吐利。或饱食脍炙，恣餐乳酪、冰
脯、寒浆、旨酒，胃既 胀，脾脏停凝，必因郁发，遂成吐利，当从不内外因也。
或问霍乱病，亦复有他论者乎，曰尝考之《内经》，有太阴所至，为中满霍乱吐下。
有土郁之发，民病呕吐霍乱注下。（上湿土霍乱，即仲景五苓散、理中丸之类。）有岁土不
及，风乃大行，民病霍乱餐泄。（上土虚风胜霍乱，即罗谦甫桂苓白术散之类。）有热至则身热
霍乱吐下。（上热霍乱，即《活人书》香薷散之类。）《灵枢》有足太阴之别，名曰公孙，去本节
后一寸，别走阳明；其别者，入络肠胃。厥气上逆则霍乱，实则肠中切痛，虚则蛊胀，取之所别。有
清气在阴，浊气在阳，营气顺脉，卫气逆行，清浊相干，乱于肠胃，则为霍乱。取之足太
阴、阳明，不下，取之三里。巢氏因此一条，乃云霍乱者，由阴阳清浊二气相干，
乱于肠胃间，因遇饮食而变，发则心腹绞痛。挟风而实者，身发热，头痛体疼。虚
者但心腹痛而已。亦有因饮酒食肉腥脍，生冷过度，居处不节，或露卧湿地，或当
风取凉，风冷之气归于三焦，传于脾胃，水谷不化，皆成霍乱。自巢氏之说行，后
世守之以为法，无复知《内经》诸条者矣。至刘河间乃云吐下霍乱，三焦为水谷传
化之道路，热气甚则传化失常，而吐泻霍乱，火性躁动故也。世俗止谓是停食者误
也。转筋者，亦是脾胃土衰，肝木自甚，热气燥烁于筋，则筋挛而痛，亦非寒也。
张戴人则以风湿 三气合而为邪。盖脾湿土为风木所克，郁则热乃发，发则心火炎
上故呕吐，呕吐者 也。脾湿下注故注泄，注泄者湿也。风急甚故筋转，转筋者风
也。可谓善推病情者乎。王海藏亦谓风湿热外至，生冷物内加，内外合病者，此条
殆似之矣。凡治病当从《内经》随宜施治，安可执一端而已哉。然则此病当以何为
要，曰脾胃之湿为本，诸邪感动者为病之由。然其间脾胃有虚有实，邪有阴阳相干
之孰甚，皆宜消息处治。至若《明理论》谓伤寒吐利者，由邪气所伤。霍乱吐利者，
由饮食所伤。其有兼伤寒之邪，内外不和者，加之头痛发热而吐利者，是霍乱伤寒
也。原仲景之意，岂必在饮食始为是病，彼于寒邪传入中焦，胃气因之不和，阴阳
痞膈者，安得不有以致之乎。不然，何以用理中、四逆等汤治之。此疾多生夏秋之
交，纵寒月有之，亦多由伏暑而然，病之将作，必先腹中 痛，吐泻之后，甚则转
筋，此兼风也。手足厥冷，气少唇青，此兼寒也。身热烦渴，气粗口燥，此兼暑也。
四肢重着，骨节烦疼，此兼湿也。伤风、伤寒，当于伤寒吐利门中求之。若风暑合
病，宜石膏理中汤。暑湿相搏，宜二香散。夏月中暑霍乱，上吐下利，心腹撮痛，
大渴烦躁，四肢逆冷，汗自出，两脚转筋，宜香薷饮，井底沉极冷，顿服之。桂苓
白术汤亦妙。罗谦甫治蒙古人，因食酒肉、饮潼乳，得吐泻霍乱症，脉沉数按之无
力，所伤之物已出矣。即以新汲水半碗调桂苓白术散，徐徐服之，稍得安静，又于
墙阴掘地约二尺许，入新汲水搅之澄清，名曰地浆，用清一杯再调服之，渐渐气和，
吐泻遂止。翼日微烦渴，却以钱氏白术散，时时服之良愈。或问用地浆者何也？曰
坤为地，地属阴土，平曰静顺，感至阴之气，又于墙阴贮新汲水，取重阴之气也。
阴中之阴能泄阳中之阳，霍乱症由暑热内伤而得之，故痹论云∶阴气者，静则神脏，
躁则消亡。又加暑热，七神迷乱，非至阴之气何由息乎。又治提学侍其公七十九岁，
中暑霍乱吐泻，昏冒不知人，脉七八至洪大无力，头热如火，足寒如冰，半身不遂，
牙关紧急，此年高气弱，不任暑气，阳不维阴则泻，阴不维阳则吐，阴阳不相维则
既吐且泻矣。前人见寒多以理中汤，热多以五苓散，作定法冶之。今暑气极盛，阳
明得时之际，况因动而得之，中暑明矣。非甘辛大寒之剂不能泄其暑热，坠浮焰之
火而安神明也。遂以甘露散甘辛大寒泻热补气加茯苓以分阴阳，冰水调灌之，
渐省人事，诸症悉去后，慎言语，节饮食三日，以参术调中汤以意增减服之，理其
正气，逾旬方平复。戴氏云∶人于夏月多食瓜果及饮冷乘风，以致食留不化，因食
成痞，隔绝上下，遂成霍乱。六和汤倍藿香煎熟，调苏合香丸。湿霍乱，除湿汤、
诃子散。七情郁结，五脏六腑互相刑克，阴阳不和，吐利交作，七气汤。霍乱转筋，
吐泻不止，头目昏眩，须臾不救者，吴茱萸汤。霍乱吐利转筋，四肢逆冷，须臾不
救，急以茱萸食盐汤。霍乱多寒，肉冷脉绝，宜通脉四逆汤。有宜吐者，虽已自吐
利，还用吐以提其气，用二陈汤探吐，或樟木煎汤亦可吐，或白矾汤亦可吐。《三因》
吐法，用极咸盐汤三升，热饮一升，刺口令吐，宿食便尽，不吐更服，吐讫仍饮，
三吐乃止，此法胜他法远矣。俗人鄙而不用，坐观其毙，哀哉。吐后随证调理，亦
有可下者。《保命集》云∶夫伤寒霍乱者，其本在于阳明胃经也。胃者水谷之海，主
禀四时，皆以胃气为本，与脾脏为表里，皆主中焦之气，腐熟水谷。脾胃相通，湿
热相合，中焦气滞，或因寒饮，或因饮水，或伤水毒，或感湿气，冷热不调，水火
相干，阴阳相搏，上下相离，荣卫不能相维，故转筋挛痛，经络乱行，暴热吐泻。
中焦、胃气所主也。有从标而得之者，有从本而得之者，有从标本而得之者。六经
之变，治各不同，察其色脉，知犯何经，随经标本各施其冶，此治霍乱之法也。如
头痛发热，邪自风寒而来，中焦为热相半之分，邪稍高者居阳分，则为热，热多饮
水者，五苓散以散之。如邪稍下者居阴分，则为寒，寒多不饮水者，理中丸以温之。
如吐利后，有表者解之，汗出厥者温之。如既吐且利，小便利，大汗出，内外热者，
亦温之。如吐下后汗出，厥逆不解，脉欲绝者，四逆等汤治之。伤寒吐泻转筋，身
热脉长，阳明本病也。宜和中平胃散、建中汤，或四君子汤。脉浮自汗者，四君子
加桂五钱主之。脉浮无汗者，四君子加麻黄五钱主之。伤寒吐泻转筋、胁下痛，脉
弦者，木克土也，故痛甚。平胃散加木瓜五钱，亦可治宜建中加柴胡、木瓜汤。伤
寒吐泻后，大小便不通，胃中实痛者，四君子加大黄一两主之。伤寒吐泻转筋，腹
中痛，体重，脉沉而细者，宜四君子加芍药高良姜汤。伤寒吐泻，四肢拘急，脉沉
而迟，此少阴霍乱也。宜四君子加姜附浓朴汤。厥阴霍乱，必四肢逆冷，脉微缓，
宜建中加附子当归汤。戴复庵云∶霍乱之病，挥霍变乱，起于仓卒，与中恶相似，
但有吐利为异耳。其证胸痞腹 ，气不升降，甚则手足厥逆，冷汗自出，或吐而不
泻，或泻而不吐，或吐泻兼作，或吐泻不透，宜苏合香丸以通其痞塞，继进藿香正
气散加木香半钱，仍以苏合香丸调吞来复丹。若果泻已甚，则不可用来复丹，泻而
不吐，胸膈痞满，先以阴阳汤，或浓盐汤顿服，以导其吐。已吐未吐，并藿香正气
散，间进苏合香丸。吐而不泻，心腹 痛，频欲登圊，苦于不通，藿香正气散加枳
壳一钱，多下来复丹。欲捷则用生枳壳。若更不能作效，逼迫已甚，其势不容不用
神保丸，但神保虽能通利，亦入大肠而后有功。若隔于上而不能下，转服转秘，须
用来复丹研末汤调，吞下养正丹百粒，庶可引前药到下。吐泻兼作，心腹缠扰未安
者，藿香正气散加官桂、木香各半钱，不愈则投四顺汤。吐利不止，元气耗散，病
势危笃，或水粒不入，或口渴喜冷，或恶寒战掉，手足逆冷，或发热烦躁欲去衣被，
此盖内虚阴盛，却不可以其喜冷欲去衣被为热，宜理中汤，甚则附子理中汤，不效
则四逆汤，并宜放十分冷服。霍乱已透，而余吐余泻未止，腹有余痛，宜一味报秋
豆叶煎服，干者尤佳。霍乱并诸吐泻后，胸膈高起，痞塞欲绝，理中汤加枳实半钱，
茯苓半钱，名枳实理中汤。吐泻已愈，而力怯精神未复者，十补散。
【转筋】陈氏云∶
转筋者，以阳明养宗筋，属胃与大肠。今暴吐下津液顿亡，外感四气，内伤七情，
饮食甜腻，攻闭诸脉，枯削于筋，宗筋失养，必致挛缩。甚则舌卷囊缩者，难治也。
刘宗浓云∶冷热不调，阴阳相搏，故转筋挛痛，甚者遍体转筋，此实阴阳之气反戾，
风寒乘之，筋失血气所荣，而为挛缩急痛也。又河间论转筋皆属火。丹溪谓属血热。
二公之论转筋，非因于霍乱者也。其不因霍乱而转筋者，诚如二公之言。亦有血虚
筋失所养，则转而急痛不能舒也。若夫霍乱而转筋，则陈氏、刘氏备矣。亦有荣血中
素有火热，卒然霍乱而风寒外束，荣中之热内郁，而其势猖狂，则筋亦为之转动也。
大抵霍乱见此症，甚者多不可救，宜急治之，木瓜煮汁饮之。香薷煮汁饮之。烧栀
子二十枚，研末熟水调下。（热者宜之。）理中汤去术，加生附子一枚。或理中汤加冻胶锉
炒一钱，或以造曲蓼汁暖热浸，或用浓盐汤浸，仍令其絷缚腿胫，若筋入腹及通
身转筋者，不可治。（寒者宜之。）《直指》木瓜汤。皂角末一小豆许，入鼻中取嚏。蓼
花一把，去两头，以水二升半，煮一升半，顿服之。灸承山二十七壮，神效。
【烦渴】陈氏云∶阴阳反戾，清浊相干，水与谷并，小便闭涩，既走津液，肾必枯燥，引饮
自救，烦渴必矣。止渴汤主之。霍乱烦渴，以增损缩脾饮主之，能解伏热，消暑毒，
止吐利。霍乱之后，服热药太多，烦躁作渴，尤宜服之。霍乱吐泻后，烦渴饮水，
宜茯苓泽泻汤。霍乱已愈，烦热多渴，小便不利，宜小麦门冬汤。霍乱后，恶心懒
食，口干多渴，宜白术散。霍乱后，利不止，冷汗出，腹胁胀，宜乌梅散。霍乱后，
下利无度，腹中 痛，宜黄连丸。霍乱后，下利见血，宜止血汤，赤石脂汤。洁古
老人云∶霍乱转筋，吐泻不止，病在中焦，阴阳交而不和，发为疼痛。此病最急，
不可与分毫粥饮，谷气入胃则必死矣。《保命集》云∶凡霍乱慎勿与粟米粥汤，入胃
即死。如吐泻已多，欲住之后，宜以稀粥渐渐补养，以迟为妙。
【诊】霍乱，遍身转筋，肚痛，四肢厥冷欲绝者，其脉洪大易治。脉微囊缩舌
卷不治。霍乱之后，阳气已脱，或遗尿而不知，或气少而不语，或膏汗如珠，或大
躁欲入水，或四肢不收，皆不可治也。
【干霍乱】忽然心腹胀满搅痛，欲吐不吐，欲泻不泻，燥乱愦愦无奈，俗名搅肠沙者是也。
此由脾土郁极而不得发，以致火热内扰，阴阳不交，或表气发为自汗，或里气不通
而作腹痛。然膈上为近阳也，膈下为近阴也。若欲阴阳之气行，必先自近从上开之，
阳气得通，则先下之阳也。若欲阴阳之气行，必死于其火也。曰方论皆谓脾胃有宿
食，与冷气相搏，子何言为火耶？曰神志昏冒，烦躁闷乱，非诸躁狂越之为属火者
乎。不急治即死，非暴病暴死之属火者乎。但处治不可过于攻，攻之过则脾愈虚，
亦不可过于热，热之过则内火愈炽，不可过于寒，寒之过则火必与捍格，须反佐以
治。然后郁可升，食可出，而火可散矣。古方有用盐熬，调以童便，非独用其降阴
之不通，阴既不通，其血亦不行，兼用行血药也。此诚良法，足可为处方者比类矣。
丹溪云∶吐提其气，最是良法，吐中兼有发散之义。有用解散者，不用凉药，但二
陈汤加川芎、苍术、防风、白芷。戴复庵法∶先以浓盐汤顿服，次调苏合香丸，吞
下来复丹，仍进藿香正气散加木香、枳壳各半钱。浓朴汤、活命散、冬葵子汤。刺
成无己说：如果只有呕吐而没有腹泻，医经称之为“吐利”。上吐下泻，伴有躁动不安、心烦意乱，这才称为“霍乱”。这与单纯称为“吐利”的情况是不同的。一般来说，突然发作于早晚之间的称为霍乱，可以持续数日之久的称为吐利。《本草纲目》将霍乱与伤寒引起的吐利合并为一门，现在仍将其分为两门，而将缓慢发作且病程较长的归入本门。《脉经》说：心气乘袭肝气必然导致吐利。《黄帝内经》说：厥阴风木之气所致，会出现呕吐和泄泻。又说：木气太过称为“发生”，在“发生”的年份，若遭遇火气克制则气机逆乱，其病症为吐利，这是风木之气导致的吐利。又说：水气太过称为“流衍”，在“流衍”的年份，其变动表现为漂荡泄泻、涌溢翻腾，这是寒水之气导致的吐利。（“漂泄”指腹泻，“沃涌”指呕吐出泡沫。）《金匮要略》说：干呕兼有腹泻的，用黄芩加半夏生姜汤主治。黄芩汤也可以主治。张元素（洁古）说：上吐下泻不止，应当口渴反而不渴，脉象微细而弱的，用理中汤主治。朱丹溪说：泄泻或呕吐，用生姜汁调服六一散服用。李杲（东垣）说：有痰湿导致泄泻不止，严重时呕吐想吐，腹泻且不能进食，这是由于风痰羁绊在脾胃之间，用水煮金花丸主治。
陈无择说：霍乱的病症，是心腹突然疼痛，呕吐并伴有腹泻，怕冷且高热，头痛眩晕。如果先心痛则先呕吐，先腹痛则先腹泻，心腹都痛，则呕吐和腹泻同时发作，严重时筋脉拘挛牵引至腹部就会死亡。这是因为阴阳之气乖逆，清浊之气相互干扰，阳气突然上升，阴气骤然下降，阴阳痞塞阻隔，上下奔迫冲撞，应当详细辨别三因（外因、内因、不内外因）来调理治疗。外因方面，伤风则怕风且有汗，伤寒则怕冷且无汗，冒受湿气则身体沉重，伤暑则烦热。内因方面，由九种情志之气所致，郁结聚积痰涎，痞塞阻隔不通，于是导致胀闷，随着邪气的胜复变化，必然引起吐利。或者饱食肉类烧烤食物，恣意食用乳酪、冰镇肉脯、冷饮、美酒，胃既已胀满，脾脏停滞凝涩，必然因为郁结而发作，遂成吐利，这应当归属于不内外因。有人问霍乱病，还有其他的论述吗？回答说：我曾考证《黄帝内经》，其中有太阴湿土之气所致，出现中满、霍乱、吐下的记载。有土气郁结发作时，百姓患病呕吐、霍乱、注下。（上述湿土霍乱，即张仲景的五苓散、理中丸之类。）有岁运土气不及，风气大行，百姓患霍乱、餐泄。（上述土虚风胜霍乱，即罗谦甫的桂苓白术散之类。）有热气到来则身热、霍乱、吐下。（上述热霍乱，即《活人书》香薷散之类。）《灵枢》记载足太阴脾经的别络，名叫公孙，距离本节后一寸，别走阳明经；其分支，进入联络肠胃。厥逆之气上逆则发为霍乱，实证则肠中剧烈疼痛，虚证则腹部蛊胀，取用该别络穴位治疗。有清气在阴分，浊气在阳分，营气顺行于经脉，卫气逆行，清浊之气相互干扰，扰乱于肠胃，就发为霍乱。取用足太阴、阳明经穴，若不愈，取用足三里穴。巢元方因此一条经文，就说霍乱是由于阴阳清浊二气相互干扰，扰乱于肠胃之间，因而遇到饮食而发病，发作时心腹绞痛。挟带风邪且属实的，身体发热，头痛体痛。属虚的只是心腹痛而已。也有因为饮酒、吃肉、生腥食物，生冷过度，居住生活不节制，或者露天睡在潮湿地方，或者对着风纳凉，风冷之气归于三焦，传于脾胃，水谷不能消化，都成为霍乱。自从巢元方的说法流行后，后世遵守它作为法则，不再知道《黄帝内经》中的各种条文了。到了刘完素（河间）却说吐下霍乱，三焦是水谷传化的道路，热气很盛则传化失常，而吐泻霍乱，是因为火性躁动的缘故。世俗只认为是停食造成的，这是错误的。转筋的症状，也是由于脾胃土气衰弱，肝木气自盛，热气燥烁于筋脉，则筋脉挛缩而痛，也不是寒邪所致。张从正（戴人）则认为风湿寒三气合而为邪。因为脾湿土被风木所克，郁结则热乃发作，发作则心火炎上所以呕吐，呕吐的是火。脾湿下注所以泄泻，泄泻的是湿。风急甚所以筋脉转动，转筋的是风。这可以说是善于推究病情的人啊。王海藏也说风湿热从外部侵入，生冷之物从内部添加，内外合病，这条论述大概类似这种情况。凡是治病应当根据《黄帝内经》随宜施治，怎么能固执一端呢？然而这种病应当以什么为关键？回答说：脾胃之湿为本，各种邪气感动它是致病的原因。然而其中脾胃有虚有实，邪气有阴阳相干谁更严重，都应当斟酌处理治疗。至于《明理论》说伤寒吐利，是由邪气所伤；霍乱吐利，是由饮食所伤。如果有兼夹伤寒邪气，内外不和的，加上头痛发热而吐利的，这就是霍乱伤寒。推究张仲景的本意，难道一定是在饮食之后才得这个病吗？他在寒邪传入中焦，胃气因此不和，阴阳痞塞阻隔的情况下，怎么不会导致这种病呢？否则，为什么用理中汤、四逆汤等来治疗它呢？这种病多发生在夏秋之交，即使在寒冷的月份有，也多由伏暑引起。病将要发作时，必先腹中绞痛，吐泻之后，严重时转筋，这是兼夹风邪。手足厥冷，气短唇青，这是兼夹寒邪。身热烦渴，气粗口燥，这是兼夹暑邪。四肢沉重，骨节烦疼，这是兼夹湿邪。伤风、伤寒，应当在伤寒吐利门中寻找治疗方法。如果风暑合病，宜用石膏理中汤。暑湿相搏，宜用二香散。夏季中暑霍乱，上吐下利，心腹撮痛，大渴烦躁，四肢逆冷，汗自出，两脚转筋，宜用香薷饮，放在井底沉至极冷，一次性服用。桂苓白术汤也很好。罗谦甫治疗蒙古人，因为吃酒肉、喝潼乳，得了吐泻霍乱症，脉沉数按之无力，所伤的食物已经吐出。立即用新汲水半碗调服桂苓白术散，慢慢服用，稍微安静，又在墙阴挖地约二尺深，放入新汲水搅动澄清，名叫地浆，用清液一杯再调服，渐渐气和，吐泻停止。第二天轻微烦渴，却用钱乙的白术散，时时服用，很好痊愈。有人问用地浆的原因是什么？回答说：坤为地，地属阴土，平时静顺，感至阴之气，又在墙阴贮存新汲水，取重阴之气。阴中之阴能泄阳中之阳，霍乱症由暑热内伤而得，所以《痹论》说：阴气者，静则神脏，躁则消亡。又加暑热，七神迷乱，不是至阴之气怎么能平息呢？又治疗提学侍其公，七十九岁，中暑霍乱吐泻，昏冒不知人，脉七八至洪大无力，头热如火，足寒如冰，半身不遂，牙关紧急，这是年高气弱，不胜暑气，阳不能维系阴则泻，阴不能维系阳则吐，阴阳不相维系则既吐且泻。前人见寒多用理中汤，热多用五苓散，作为定法治疗。现在暑气极盛，阳明得时的之际，况且因为活动而得的，明显是中暑。不是甘辛大寒的药剂不能泄其暑热，坠浮焰之火而安神明。于是用甘露散甘辛大寒泻热补气加茯苓以分阴阳，冰水调灌之，渐渐省人事，诸症悉去后，慎言语，节饮食三日，以参术调中汤以意增减服之，理其正气，逾旬方平复。戴氏说：人在夏季多吃瓜果及饮冷乘风，以致食留不化，因食成痞，隔绝上下，遂成霍乱。六和汤倍藿香煎熟，调苏合香丸。湿霍乱，除湿汤、诃子散。七情郁结，五脏六腑互相刑克，阴阳不和，吐利交作，七气汤。霍乱转筋，吐泻不止，头目昏眩，须臾不救者，吴茱萸汤。霍乱吐利转筋，四肢逆冷，须臾不救，急以茱萸食盐汤。霍乱多寒，肉冷脉绝，宜通脉四逆汤。有宜吐者，虽已自吐利，还用吐以提其气，用二陈汤探吐，或樟木煎汤亦可吐，或白矾汤亦可吐。《三因方》吐法，用极咸盐汤三升，热饮一升，刺口令吐，宿食便尽，不吐更服，吐讫仍饮，三吐乃止，此法胜他法远矣。俗人鄙而不用，坐观其毙，哀哉。吐后随证调理，亦有可下者。《保命集》说：夫伤寒霍乱者，其本在于阳明胃经也。胃者水谷之海，主禀四时，皆以胃气为本，与脾脏为表里，皆主中焦之气，腐熟水谷。脾胃相通，湿热相合，中焦气滞，或因寒饮，或因饮水，或伤水毒，或感湿气，冷热不调，水火相干，阴阳相搏，上下相离，荣卫不能相维，故转筋挛痛，经络乱行，暴热吐泻。中焦、胃气所主也。有从标而得之者，有从本而得之者，有从标本而得之者。六经之变，治各不同，察其色脉，知犯何经，随经标本各施其冶，此治霍乱之法也。如头痛发热，邪自风寒而来，中焦为热相半之分，邪稍高者居阳分，则为热，热多饮水者，五苓散以散之。如邪稍下者居阴分，则为寒，寒多不饮水者，理中丸以温之。如吐利后，有表者解之，汗出厥者温之。如既吐且利，小便利，大汗出，内外热者，亦温之。如吐下后汗出，厥逆不解，脉欲绝者，四逆等汤治之。伤寒吐泻转筋，身热脉长，阳明本病也。宜和中平胃散、建中汤，或四君子汤。脉浮自汗者，四君子加桂五钱主之。脉浮无汗者，四君子加麻黄五钱主之。伤寒吐泻转筋、胁下痛，脉弦者，木克土也，故痛甚。平胃散加木瓜五钱，亦可治宜建中加柴胡、木瓜汤。伤寒吐泻后，大小便不通，胃中实痛者，四君子加大黄一两主之。伤寒吐泻转筋，腹中痛，体重，脉沉而细者，宜四君子加芍药高良姜汤。伤寒吐泻，四肢拘急，脉沉而迟，此少阴霍乱也。宜四君子加姜附浓朴汤。厥阴霍乱，必四肢逆冷，脉微缓，宜建中加附子当归汤。戴复庵说：霍乱之病，挥霍变乱，起于仓卒，与中恶相似，但有吐利为异耳。其证胸痞腹满，气不升降，甚则手足厥逆，冷汗自出，或吐而不泻，或泻而不吐，或吐泻兼作，或吐泻不透，宜苏合香丸以通其痞塞，继进藿香正气散加木香半钱，仍以苏合香丸调吞来复丹。若果泻已甚，则不可用来复丹，泻而不吐，胸膈痞满，先以阴阳汤，或浓盐汤顿服，以导其吐。已吐未吐，并藿香正气散，间进苏合香丸。吐而不泻，心腹绞痛，频欲登圊，苦于不通，藿香正气散加枳壳一钱，多下来复丹。欲捷则用生枳壳。若更不能作效，逼迫已甚，其势不容不用神保丸，但神保虽能通利，亦入大肠而后有功。若隔于上而不能下，转服转秘，须用来复丹研末汤调，吞下养正丹百粒，庶可引前药到下。吐泻兼作，心腹缠扰未安者，藿香正气散加官桂、木香各半钱，不愈则投四顺汤。吐利不止，元气耗散，病势危笃，或水粒不入，或口渴喜冷，或恶寒战掉，手足逆冷，或发热烦躁欲去衣被，此盖内虚阴盛，却不可以其喜冷欲去衣被为热，宜理中汤，甚则附子理中汤，不效则四逆汤，并宜放十分冷服。霍乱已透，而余吐余泻未止，腹有余痛，宜一味报秋豆叶煎服，干者尤佳。霍乱并诸吐泻后，胸膈高起，痞塞欲绝，理中汤加枳实半钱，茯苓半钱，名枳实理中汤。吐泻已愈，而力怯精神未复者，十补散。
【转筋】陈氏说：转筋，是因为阳明经滋养宗筋，属于胃与大肠。现在暴吐下津液顿亡，外感四气，内伤七情，饮食甜腻，攻闭诸脉，枯削于筋，宗筋失养，必致挛缩。严重时舌卷囊缩的，难治。刘宗浓说：冷热不调，阴阳相搏，所以转筋挛痛，严重时遍体转筋，这是实性的阴阳之气反戾，风寒乘之，筋失血气所荣，而为挛缩急痛也。又河间论转筋皆属火。丹溪谓属血热。二公之论转筋，非因于霍乱者也。其不因霍乱而转筋者，诚如二公之言。亦有血虚筋失所养，则转而急痛不能舒也。若夫霍乱而转筋，则陈氏、刘氏备矣。亦有荣血中素有火热，卒然霍乱而风寒外束，荣中之热内郁，而其势猖狂，则筋亦为之转动也。大抵霍乱见此症，甚者多不可救，宜急治之，木瓜煮汁饮之。香薷煮汁饮之。烧栀子二十枚，研末熟水调下。（热者宜之。）理中汤去术，加生附子一枚。或理中汤加冻胶锉炒一钱，或以造曲蓼汁暖热浸，或用浓盐汤浸，仍令其絷缚腿胫，若筋入腹及通身转筋者，不可治。（寒者宜之。）《直指》木瓜汤。皂角末一小豆许，入鼻中取嚏。蓼花一把，去两头，以水二升半，煮一升半，顿服之。灸承山二十七壮，神效。
【烦渴】陈氏说：阴阳反戾，清浊相干，水与谷并，小便闭涩，既走津液，肾必枯燥，引饮自救，烦渴必矣。止渴汤主之。霍乱烦渴，以增损缩脾饮主之，能解伏热，消暑毒，止吐利。霍乱之后，服热药太多，烦躁作渴，尤宜服之。霍乱吐泻后，烦渴饮水，宜茯苓泽泻汤。霍乱已愈，烦热多渴，小便不利，宜小麦门冬汤。霍乱后，恶心懒食，口干多渴，宜白术散。霍乱后，利不止，冷汗出，腹胁胀，宜乌梅散。霍乱后，下利无度，腹中绞痛，宜黄连丸。霍乱后，下利见血，宜止血汤，赤石脂汤。洁古老人说：霍乱转筋，吐泻不止，病在中焦，阴阳交而不和，发为疼痛。此病最急，不可与分毫粥饮，谷气入胃则必死矣。《保命集》说：凡霍乱慎勿与粟米粥汤，入胃即死。如吐泻已多，欲住之后，宜以稀粥渐渐补养，以迟为妙。
【诊】霍乱，遍身转筋，肚痛，四肢厥冷欲绝者，其脉洪大易治。脉微囊缩舌卷不治。霍乱之后，阳气已脱，或遗尿而不知，或气少而不语，或膏汗如珠，或大躁欲入水，或四肢不收，皆不可治也。
【干霍乱】忽然心腹胀满搅痛，欲吐不吐，欲泻不泻，燥乱愦愦无奈，俗名搅肠沙者是也。此由脾土郁极而不得发，以致火热内扰，阴阳不交，或表气发为自汗，或里气不通而作腹痛。然膈上为近阳也，膈下为近阴也。若欲阴阳之气行，必先自近从上开之，阳气得通，则先下之阳也。若欲阴阳之气行，必死于其火也。曰方论皆谓脾胃有宿食，与冷气相搏，子何言为火耶？曰神志昏冒，烦躁闷乱，非诸躁狂越之为属火者乎。不急治即死，非暴病暴死之属火者乎。但处治不可过于攻，攻之过则脾愈虚，亦不可过于热，热之过则内火愈炽，不可过于寒，寒之过则火必与捍格，须反佐以治。然后郁可升，食可出，而火可散矣。古方有用盐熬，调以童便，非独用其降阴之不通，阴既不通，其血亦不行，兼用行血药也。此诚良法，足可为处方者比类矣。丹溪说：吐提其气，最是良法，吐中兼有发散之义。有用解散者，不用凉药，但二陈汤加川芎、苍术、防风、白芷。戴复庵法：先以浓盐汤顿服，次调苏合香丸，吞下来复丹，仍进藿香正气散加木香、枳壳各半钱。浓朴汤、活命散、冬葵子汤。刺
Cheng Wuji stated: If there is only vomiting without diarrhea, the medical classics refer to this as "vomiting and diarrhea" (Tou Li). When there is both upper vomiting and lower diarrhea, accompanied by restlessness, agitation, and mental confusion, it is termed "Huo Luan" (Colic with Vomiting and Diarrhea). This differs from cases simply called "vomiting and diarrhea." Generally, conditions that strike suddenly within a day or night are called Huo Luan, whereas those persisting for several days are called Tou Li. *Bencao Gangmu* (Compendium of Materia Medica) grouped Huo Luan together with vomiting and diarrhea caused by Shang Han (Cold Damage), but now they are separated into two categories, with slow-onset and long-duration cases included in this section. *Mai Jing* (Pulse Classic) states: "When Heart Qi overacts on Liver Qi, vomiting and diarrhea inevitably occur." *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "The arrival of Jueyin [Liver/Wood] qi manifests as vomiting and diarrhea." It further states: "Excessive Wood qi is called 'Fa Sheng' [Sprouting]. In years of Fa Sheng, if attacked by Fire qi, the qi becomes rebellious, causing vomiting and diarrhea; this is vomiting and diarrhea due to Wind-Wood qi." It also states: "Excessive Water qi is called 'Liu Yan' [Overflowing]. In years of Liu Yan, its movement causes flooding, leakage, and surging; this is vomiting and diarrhea due to Cold-Water qi. ('Piao Xie' refers to diarrhea, 'Wo Yong' refers to vomiting foam.)" *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: "For dry retching accompanied by diarrhea, Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction with Pinellia and Fresh Ginger) is the primary treatment. Huang Qin Tang (Scutellaria Decoction) may also be used." Zhang Yuansu (Jiegu) stated: "For unceasing upper vomiting and lower diarrhea, where thirst is expected but absent, and the pulse is faint, fine, and weak, Li Zhong Tang (Regulate the Middle Decoction) is indicated." Zhu Zhenheng (Danxi) stated: "For diarrhea or vomiting, mix Liu Yi San (Six-to-One Powder) with ginger juice and take orally." Li Gao (Dongyuan) stated: "When phlegm-dampness causes unceasing diarrhea, severe retching, inability to eat, and diarrhea, it is due to wind-phlegm binding the Spleen and Stomach; boiled Jin Hua Wan (Golden Flower Pill) is indicated."
Chen Wuzhuo said: Huo Luan is characterized by sudden heart and abdominal pain, vomiting with diarrhea, aversion to cold with high fever, headache, and dizziness. If heart pain precedes, vomiting occurs first; if abdominal pain precedes, diarrhea occurs first. If both heart and abdomen hurt, vomiting and diarrhea occur simultaneously. In severe cases, tendon contraction pulling into the abdomen leads to death. This occurs because Yin and Yang qi become rebellious, clear and turbid qi interfere with each other, Yang qi rises suddenly, and Yin qi drops abruptly. Yin and Yang become blocked and obstructed, rushing up and down. One must carefully distinguish the Three Causes (External, Internal, Non-external/Internal) to regulate the condition. Regarding External Causes: Wind injury causes aversion to wind and sweating; Cold injury causes aversion to cold and no sweating; Dampness exposure causes heaviness; Summerheat injury causes vexation and heat. Regarding Internal Causes: Caused by the Nine Emotions, leading to stagnation and accumulation of phlegm-fluids, obstruction, and fullness/distension. Depending on the excess and deficiency cycles, vomiting and diarrhea will ensue. Alternatively, overeating roasted meats, indulging in dairy, cheese, chilled meat jerky, cold drinks, or rich wine causes stomach distension and Spleen stagnation. This stagnation erupts, resulting in vomiting and diarrhea; this belongs to the Non-external/Internal Causes. Someone asked: Are there other discussions on Huo Luan? I replied: I have examined *Neijing*, which mentions Taiyin Spleen Earth qi causing fullness, Huo Luan, vomiting, and downward discharge. It mentions Earth Qi stagnation erupting, causing people to suffer vomiting, Huo Luan, and profuse diarrhea (This wet-Earth Huo Luan corresponds to Zhang Zhongjing's Wu Ling San and Li Zhong Wan). It mentions years of deficient Earth qi allowing Wind to prevail, causing people to suffer Huo Luan and meal-diarrhea (This Earth-deficiency Wind-excess Huo Luan corresponds to Luo Qianfu's Gui Ling Bai Zhu San). It mentions Heat arrival causing body heat, Huo Luan, vomiting, and diarrhea (This Heat Huo Luan corresponds to *Ren Shu*'s Xiang Ru San). *Lingshu* records the collateral vessel of Foot-Taiyin named Gong Sun, one cun distal to the metacarpophalangeal joint, connecting to Yangming; its branch enters and connects with the intestines and stomach. Rebellious Qi ascending causes Huo Luan; Excess presents as cutting pain in the intestines; Deficiency presents as abdominal distension like a gu-poison swelling; treat the collateral vessel. When Clear Qi resides in the Yin aspect and Turbid Qi in the Yang aspect, Ying Qi flows smoothly in the vessels while Wei Qi rebels against the flow, clear and turbid qi interfere, chaos arises in the intestines and stomach, resulting in Huo Luan. Treat Foot-Taiyin and Yangming; if ineffective, treat Zu San Li. Chao Yuanfang, based on this passage, stated that Huo Luan is caused by the interference of Yin-Yang clear and turbid qi in the intestines and stomach, triggered by diet, manifesting as heart-abdominal colic. With Wind and Excess, there is fever, headache, and body ache. With Deficiency, there is only heart-abdominal pain. Some cases arise from excessive alcohol, meat, raw/cold foods, irregular living, sleeping in damp places, or cooling off in the wind; Wind-Cold Qi returns to the San Jiao, transmits to Spleen and Stomach, water and grain fail to digest, all becoming Huo Luan. Since Chao Yuanfang’s theory became standard, later generations followed it, forgetting the various passages in *Neijing*. Later, Liu Wansu (Hejian) claimed that vomiting/diarrhea Huo Luan occurs because the San Jiao is the pathway for food transformation; excessive Heat disrupts this transformation, and Huo Luan results from the restless nature of Fire. The common belief that it is merely food stagnation is mistaken. Tendon contraction (Zhuan Jin) is also due to Spleen-Stomach Earth weakness allowing Liver Wood to dominate; Heat dries the tendons, causing cramping and pain, not Cold. Zhang Congzheng (Dairen) argued that Wind, Dampness, and Cold combine to form pathogenic factors. Spleen-Damp Earth is controlled by Wind-Wood; stagnation generates Heat, causing Heart Fire to flare upward, resulting in vomiting (Fire). Spleen-Damp sinks downward, causing diarrhea (Dampness). Wind is urgent and severe, causing tendon turning (Wind). This demonstrates skillful disease analysis. Wang Haizang also stated that Wind-Damp-Heat comes from outside, and cold/raw foods from inside, creating an internal-external combined disease, which seems similar. All treatments should follow *Neijing* and adapt appropriately; one cannot stick to a single method. What is key to this disease? Answer: Spleen-Stomach Dampness is the root; various pathogens moving it is the cause. However, Spleen-Stomach can be Deficient or Excess, and pathogens can be Yin or Yang interfering; treatment must be weighed carefully. *Mingli Lun* states Shang Han vomiting/diarrhea is caused by pathogenic invasion; Huo Luan vomiting/diarrhea is caused by dietary injury. If combined with Shang Han pathogens, causing internal-external disharmony, headache, fever, and vomiting/diarrhea, it is Huo Luan-Shang Han. Did Zhang Zhongjing intend that this disease only arises from diet? When Cold pathogens transmit to the Middle Jiao, disturbing Stomach Qi and causing Yin-Yang blockage, how could it not result in this? Otherwise, why use Li Zhong Tang and Si Ni Tang? This disease often occurs at the transition of Summer and Autumn; even in winter, it is often due to latent Summerheat. Before onset, there is abdominal colic; after vomiting/diarrhea, severe tendon contraction indicates Wind complication. Cold extremities, shortness of breath, blue lips indicate Cold complication. Fever, vexation, thirst, coarse breathing, dry mouth indicate Summerheat complication. Heavy limbs, painful joints indicate Dampness complication. Wind/Cold injuries should be sought in the Shang Han vomiting/diarrhea section. For Wind-Summerheat combined disease, Shi Gao Li Zhong Tang is suitable. For Summerheat-Dampness conflict, Er Xiang San is suitable. For Summer Huo Luan with upper vomiting/lower diarrhea, heart-abdominal squeezing pain, great thirst, vexation, cold extremities, spontaneous sweating, and foot tendon contraction, use Xiang Ru Yin, chilled in a well until extremely cold, taken in one dose. Gui Ling Bai Zhu Tang is also excellent. Luo Qianfu treated a Mongolian patient who ate meat/drunk milk/wine, developing vomiting/diarrhea Huo Luan with a deep, rapid, forceless pulse; the offending food had been vomited. He immediately mixed Gui Ling Bai San with half a bowl of fresh water, administered slowly. After slight calm, he dug two chi deep in a shaded wall corner, added fresh water, stirred, and clarified it, naming it "Di Jiang" (Earth Slurry). One cup was used to mix another dose. Gradually, Qi harmonized, and vomiting/diarrhea stopped. The next day, mild vexation/thirst occurred; Qian Yi’s Bai Zhu San was given frequently, leading to good recovery. Why use Earth Slurry? Kun represents Earth, belonging to Yin Earth, naturally quiet and compliant, absorbing extreme Yin Qi. Storing fresh water in a shaded wall captures heavy Yin Qi. Yin within Yin can vent Yang within Yang. Huo Luan is caused by Summerheat damaging internally; thus *Bi Lun* states: "Yin Qi, when quiet, nourishes the Spirit; when agitated, it dissipates." With added Summerheat, the Seven Spirits become confused; only extreme Yin Qi can quell it. He also treated Scholar Shiqi, aged 79, with Summer Huo Luan vomiting/diarrhea, unconscious, pulse 7-8 beats per breath, large and forceless, head hot as fire, feet cold as ice, hemiplegia, locked jaw. Due to age and Qi weakness, he could not withstand Summerheat; Yang failed to anchor Yin causing diarrhea, Yin failed to anchor Yang causing vomiting, mutual failure led to both. Predecessors used Li Zhong Tang for Cold and Wu Ling San for Heat as fixed methods. Now, with extreme Summerheat and Yangming season, and acquired through activity, it is clearly Summerheat. Only sweet-pungent great-cold agents can vent Summerheat, suppress floating Fire, and calm the Spirit. Thus, Gan Lu San (Sweet Dew Powder), a sweet-pungent great-cold heat-clearing and Qi-tonifying formula, plus Fu Ling to separate Yin/Yang, was mixed with ice water and灌ed. Consciousness gradually returned, symptoms vanished. After three days of speech/diet restriction, Shen Zhu Tiao Zhong Tang was adjusted and taken to regulate Zheng Qi; recovery took ten days. Dai Shi said: People eating melons/fruits and drinking cold air-conditioning in Summer retain undigested food, forming obstruction blocking upper/lower, causing Huo Luan. Liu He Tang with doubled Huo Xiang, boiled, mixed with Su He Xiang Wan. Wet Huo Luan: Chu Shi Tang, He Zi San. Seven Emotions stagnation, Zang-Fu mutual attack, Yin-Yang disharmony, alternating vomiting/diarrhea: Qi Qi Tang. Huo Luan with tendon contraction, unceasing vomiting/diarrhea, dizziness, imminent death: Wu Zhu Yu Tang. Huo Luan vomiting/diarrhea/tendon contraction, cold extremities, imminent death: Zhu Yu Yan Yan Tang. Huo Luan with much Cold, cold flesh, absent pulse: Tong Mai Si Ni Tang. Cases requiring emesis: Even if spontaneous vomiting/diarrhea has occurred, emesis can still lift Qi. Use Er Chen Tang to induce vomiting, or Camphor wood decoction, or Alum decoction. *San Yin Fang* emetic method: Use very salty salt water (3 sheng), drink 1 sheng hot, stimulate throat to vomit. Once old food is out, if not vomiting, administer again; after vomiting, drink more. Repeat three times. This method far surpasses others. Commoners despise and ignore it, watching patients die—tragic! Post-emesis regulation may include purgatives. *Bao Ming Ji* states: Shang Han Huo Luan originates in Yangming Stomach Meridian. Stomach is the Sea of Water and Grain, governing the Four Seasons, rooted in Stomach Qi, exterior-interior with Spleen, governing Middle Jiao Qi, rotting/ripening food. Spleen-Stomach connect, Damp-Heat combine, Middle Jiao Qi stagnates. Due to Cold drinks, water intake, water toxicity, or Dampness sensation, Cold/Heat imbalance, Water/Fire interference, Yin/Yang combat, Upper/Lower separation, Ying/Wei fail to anchor each other, causing tendon contraction/pain, meridian chaos, sudden heat/vomiting/diarrhea. Governed by Middle Jiao/Stomach Qi. Some derive from Biao (Branch), some from Ben (Root), some from both. Six Meridian variations require different treatments; observe color/pulse, identify affected meridian, treat according to meridian root/branch. This is the method for Huo Luan. If headache/fever from Wind-Cold, Middle Jiao is half-heat; pathogen slightly higher in Yang aspect causes Heat; if thirsty, use Wu Ling San to disperse. If pathogen slightly lower in Yin aspect causes Cold; if not thirsty, use Li Zhong Wan to warm. After vomiting/diarrhea, if Exterior exists, resolve it; if sweating/cold extremities, warm it. If vomiting/diarrhea with free urination, heavy sweating, interior/exterior heat, also warm it. If post-vomit/purge sweating, unresolved cold extremities, pulse about to vanish, treat with Si Ni Tang etc. Shang Han vomiting/diarrhea/tendon contraction, body heat, long pulse is Yangming Root disease. Use He Zhong Ping Wei San, Jian Zhong Tang, or Si Jun Zi Tang. Floating pulse with spontaneous sweat: Si Jun Zi Tang + Gui Zhi 5 qian. Floating pulse with no sweat: Si Jun Zi Tang + Ma Huang 5 qian. Shang Han vomiting/diarrhea/tendon contraction, hypochondriac pain, wiry pulse (Wood overacting on Earth, severe pain): Ping Wei San + Mu Gua 5 qian; or Jian Zhong Tang + Chai Hu, Mu Gua. Post-Shang Han vomiting/diarrhea, constipation, solid abdominal pain: Si Jun Zi Tang + Da Huang 1 liang. Shang Han vomiting/diarrhea/tendon contraction, abdominal pain, heavy body, deep/fine pulse: Si Jun Zi Tang + Shao Yao, Gao Liang Jiang. Shang Han vomiting/diarrhea, limb rigidity, deep/slow pulse is Shaoyin Huo Luan: Si Jun Zi Tang + Jiang, Fu, Hou Po. Jueyin Huo Luan, cold extremities, faint/slow pulse: Jian Zhong Tang + Fu Zi, Dang Gui. Dai Fuan said: Huo Luan changes suddenly, resembling Zhong E (Midnight Evil), differing only by vomiting/diarrhea. Symptoms: chest fullness, abdominal distension, Qi failing to ascend/descend, severe cold extremities, cold sweat, or vomiting without diarrhea, or diarrhea without vomiting, or both, or incomplete expulsion. Use Su He Xiang Wan to open obstruction, then Huo Xiang Zheng Qi San + Mu Xiang 0.5 qian, swallowing Lai Fu Dan with Su He Xiang Wan. If diarrhea is severe, do not use Lai Fu Dan. Diarrhea without vomiting, chest diaphragm fullness: first drink Yin Yang Tang or strong salt water to induce vomiting. Vomiting or not, use Huo Xiang Zheng Qi San, occasionally Su He Xiang Wan. Vomiting without diarrhea, heart-abdominal colic, frequent urge to defecate but blocked: Huo Xiang Zheng Qi San + Zhi Ke 1 qian, often passes Lai Fu Dan. For speed, use raw Zhi Ke. If ineffective and pressure is extreme, Shen Bao Wan is necessary, though it acts on Large Intestine. If blocked above and cannot descend, switching medicines increases constipation; use Lai Fu Dan powder mixed with water, swallow 100 Yang Zheng Dan pills to guide previous medicine down. Vomiting/diarrhea both present, heart-abdominal turmoil: Huo Xiang Zheng Qi San + Guan Gui, Mu Xiang 0.5 qian each; if unsuccessful, Si Shun Tang. Unceasing vomiting/diarrhea, Yuan Qi depletion, critical illness, unable to drink, thirst for cold, aversion to cold/shivering, cold extremities, or fever/vexation wanting to remove clothes: This is Internal Deficiency with Yin Excess. Do not mistake thirst for cold/clothing removal as Heat. Use Li Zhong Tang; if severe, Fu Zi Li Zhong Tang; if ineffective, Si Ni Tang. All should be taken very cold. After Huo Luan resolves but residual vomiting/diarrhea/pain persists: Boil Bao Qiu Dou Ye (Faba Bean Leaf); dried is better. Post-Huo Luan vomiting/diarrhea, high chest diaphragm, near-obstruction: Li Zhong Tang + Zhi Shi 0.5 qian, Fu Ling 0.5 qian, named Zhi Shi Li Zhong Tang. Post-vomiting/diarrhea recovery with weakness: Shi Bu San.
[Zhuan Jin - Tendon Contraction] Chen Shi said: Tendon contraction occurs because Yangming nourishes Zong Jin (Major Tendons), belonging to Stomach and Large Intestine. Sudden vomiting/diarrhea depletes fluids; external Four Qi, internal Seven Emotions, sweet/greasy diet block meridians, withering tendons, losing nourishment, leading to contraction. Severe tongue retraction/scrotal contraction is difficult to treat. Liu Zongnong said: Cold/Heat imbalance, Yin/Yang combat causes tendon contraction/pain; severe cases involve whole-body contraction. This is real Yin/Yang rebellion, Wind-Cold attacking, tendons losing Blood/Qi nourishment, causing cramping/pain. He Jian argued all tendon contraction belongs to Fire. Danxi attributed it to Blood Heat. Their theories on tendon contraction do not apply to Huo Luan cases. Those not caused by Huo Luan fit their words. Blood Deficiency causing tendon loss of nourishment leads to contraction/pain. However, Huo Luan with tendon contraction is fully covered by Chen and Liu. Also, if Ying Blood has internal Heat, sudden Huo Luan with external Wind-Cold binding traps Ying Heat internally, causing wild movement and tendon turning. Generally, Huo Luan with this symptom is often incurable if severe; treat urgently. Boak Mu Gua (Papaya) juice to drink. Boak Xiang Ru (Mosla) juice to drink. Roast 20 Zhi Zi (Gardenia), grind to powder, mix with cooked water. (Suitable for Heat.) Li Zhong Tang minus Bai Zhu, add 1 raw Fu Zi. Or Li Zhong Tang + Dong Jiao (Donkey-hide Gel) 1 qian fried/crushed. Or soak in warm Liao juice or strong salt water. Bind legs/shins. If tendons pull into abdomen or whole body contracts, it is incurable. (Suitable for Cold.) *Zhi Shi* Mu Gua Tang. Sesame seed-sized Gao Jiao Mo (Gleditsia Sinensis powder) into nose to induce sneezing. One handful of Liao Hua (Smartweed flower), remove ends, boil 2.5 sheng water to 1.5 sheng, take in one dose. Moxibustion on Cheng Shan (BL57), 27 moxa cones, miraculous effect.
[Fan Ke - Vexation and Thirst] Chen Shi said: Yin/Yang rebellion, clear/turbid interference, water/grain mixing, urinary retention, fluid loss, Kidney dryness, self-induced drinking, inevitable vexation/thirst. Zhi Ke Tang is primary. Huo Luan with vexation/thirst: Zeng Sun Su Pi Yin, clears hidden heat, vents summer toxin, stops vomiting/diarrhea. After Huo Luan, too many hot medicines causing vexation/thirst: especially suitable. Post-Huo Luan vomiting/diarrhea with vexation/thirst drinking water: Fu Ling Ze Xie Tang. Post-Huo Luan resolved, vexation/heat/thirst, poor urination: Xiao Mai Men Dong Tang. Post-Huo Luan nausea, poor appetite, dry mouth/thirst: Bai Zhu San. Post-Huo Luan unceasing diarrhea, cold sweat, abdominal/flank distension: Wu Mei San. Post-Huo Luan profuse diarrhea, abdominal colic: Huang Lian Wan. Post-Huo Luan bloody diarrhea: Zhi Xue Tang, Chi Shi Zhi Tang. Jiegu Laoren said: Huo Luan tendon contraction, unceasing vomiting/diarrhea, disease in Middle Jiao, Yin/Yang intersecting but not harmonious, causing pain. This disease is most urgent; do not give any porridge/drink. Grain Qi entering Stomach means certain death. *Bao Ming Ji* states: Never give millet porridge/soup for Huo Luan; entering Stomach means death. If vomiting/diarrhea has ceased, gradually nourish with thin porridge; delay is best.
[Zhen - Diagnosis] Huo Luan with whole-body tendon contraction, abdominal pain, cold extremities near extinction: Pulse large and surging is easy to treat. Pulse faint, scrotal retraction, tongue retraction is untreatable. Post-Huo Luan, Yang Qi has escaped: enuresis unaware, shortness of breath/no speech, sweat like pearls, extreme agitation wanting to enter water, limbs flaccid—all untreatable.
[Gan Huo Luan - Dry Huo Luan] Sudden heart-abdominal fullness/churning pain, desire to vomit but cannot, desire to defecate but cannot, chaotic confusion, helplessness, commonly called "Jiao Chang Sha" (Intestinal Stirring Sand). This is due to extreme Spleen Earth stagnation unable to erupt, causing internal Fire disturbance, Yin/Yang non-interaction. Exterior Qi causing spontaneous sweating, or Interior Qi blocked causing abdominal pain. Diaphragm above is close to Yang, below close to Yin. To move Yin/Yang Qi, must open from above/near first; Yang Qi getting through allows Yang to descend below. To move Yin/Yang Qi, must die from Fire. Question: Formulas claim Stomach/Spleen have retained food clashing with Cold Qi, why say Fire? Answer: Mental confusion, vexation, chaos belong to Fire (restlessness/manic behavior). Not treating urgently leads to death (sudden disease/death belongs to Fire). Treatment must not over-attack (Spleen becomes weaker), not over-warm (Internal Fire intensifies), not over-cool (Fire resists Cold). Must use counter-assistance (Fan Zuo) to treat. Then stagnation can rise, food can exit, Fire can scatter. Ancient formulas used salt frying mixed with child’s urine, not just to descend blocked Yin, but since Yin blockage affects Blood, blood-moving herbs are added. This is a good method for prescription reference. Danxi said: Emesis to lift Qi is the best method, containing dispersing meaning. Some use dispersing formulas, no cold meds, just Er Chen Tang + Chuan Xiong, Cang Zhu, Fang Feng, Bai Zhi. Dai Fuan’s method: First drink strong salt water, then mix Su He Xiang Wan, swallow Lai Fu Dan, continue Huo Xiang Zheng Qi San + Mu Xiang, Zhi Ke 0.5 qian each. Hou Po Tang, Huo Ming San, Dong Kui Zi Tang. Acupuncture...