霍乱者，挥霍撩乱，起于仓卒，心腹大痛，呕吐泻痢，或憎寒壮热，头痛眩晕，先心痛，则先
吐，先腹痛，则先泻，心腹俱痛，则吐泻交作。吐泻躁扰烦乱者，方为霍乱。不烦乱者，止名吐泻。经
言∶岁土不及，风乃大行，民病霍乱。此脾弱肝强之所致也。又言∶土郁之发，民病霍乱。此郁极则
发之所致也。又言∶太阴所至，为中满霍乱。此湿
伤之所致也。又言∶热至则身热霍乱。此火热之所致也。又言∶足太阴厥气上逆则霍乱。又言∶清浊
相干，乱于肠胃，则为霍乱。此因厥气上逆，清浊不分，饮食不节之所致。《内经》所论致病之因
如此。而张戴人则谓霍乱由风、湿、 三气合邪为病。盖脾湿、土为风木所克，郁则为热乃发，
发则火上炎故吐，吐者， 也。脾湿下注故泻，泻者湿也。风鱼甚故转筋，转筋者，风也。是统内经
风郁湿火合发为言。惟河间则专主火热，而谓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。俗只谓停食者，误也。转筋者，热气燥灼于筋，故筋挛而痛，并非寒也。巢氏论霍乱，
谓由阴阳二气相干，乱于肠胃间，因遇饮食而变。是即《内经》厥气上逆之条也。考之《金匮》以呕
吐而利，名曰霍乱。是专指内伤饮食之病。以发热恶寒，头疼身痛吐利为霍乱者，是兼表邪之所发。
又以热多欲饮水者为热，寒多不用水，汗出恶寒、四肢拘急，手足厥冷者为寒。辨表里寒热分治，诸
论不同。自余观之。霍乱每起于夏秋之间，皆由外受暑热，内伤饮食，郁遏正气，不得宣行，陡然而
发者为多，纵冬月患之，亦由夏月伏暑所致，不可泥《金匮》有属寒之条，而遂投理中、四逆等剂。
王宇泰云∶治霍乱当从《内经》随宜施治，不可执一。余谓凡病皆然，庶不致误。
加减桂苓甘露饮 治中暑霍乱、齿燥、烦渴、小便短赤。
石膏 滑石 寒水石〔清暑除热。吐泻则脾胃大伤，石膏寒水宜酌量用。〕茯苓〔止吐
定泻。〕泽泻〔和水除湿。〕原方有桂枝〔嫌其辛热。〕白术〔嫌其闭气，为霍乱家所
忌，并忌温补酸收。〕猪苓〔中暑必多汗，勿过利小便，故去之。〕宜加薄荷〔辛散外邪，开
气通窍。〕石斛〔清胃除热，浓肠止泻。〕扁豆〔和中消暑，化清降浊。〕橘红〔和胃调
脾，理气通滞。〕引用白扁豆叶。〔捣汁一杯，和服一味，单服有神。〕有食加砂仁、谷芽。转筋
加木瓜。如兼见头痛发热，恶寒无汗，〔此寒包暑症。〕加香薷、紫苏。
此方消暑、除湿、和中、利气为主，随兼症，加药治之。
香薷饮〔见暑。〕治外感风寒，内伤饮食，霍乱吐泻。
宜合回生散。〔藿香、橘红，和中理气，二味为主。原治中气不和，霍乱吐泻。〕
此夏月解表而兼和里之剂，宜参暑门加减用之。
霍乱，是指病情突然发作、令人手忙脚乱的症状，起病急骤，表现为心腹剧烈疼痛，呕吐和腹泻，或者伴有怕冷高热、头痛眩晕。如果先出现心痛，则先呕吐；如果先出现腹痛，则先腹泻；如果心腹都痛，则呕吐和腹泻同时发生。只有当呕吐腹泻伴随烦躁不安、扰乱心神时，才称为霍乱。如果不烦躁，仅称为吐泻。
《内经》说：“岁土不及，风乃大行，民病霍乱。”这是脾虚肝旺所致。又说：“土郁之发，民病霍乱。”这是湿气郁结至极而爆发所致。又说：“太阴所至，为中满霍乱。”这是湿邪损伤所致。又说：“热至则身热霍乱。”这是火热邪气所致。又说：“足太阴厥气上逆则霍乱。”又说：“清浊相干，乱于肠胃，则为霍乱。”这是因为厥气上逆，清浊之气不分，加上饮食不节制所致。《内经》论述的致病原因就是这样。
而张戴人则认为霍乱是由风、湿、火三气合邪为病。脾湿被风木克制，郁结则化热而发，火性炎上所以呕吐，呕吐属于火邪；脾湿下注所以腹泻，腹泻属于湿邪；风邪严重所以转筋（肌肉痉挛），转筋属于风邪。这是综合《内经》中风、郁、湿、火合发的观点。
只有刘河间专门主张火热论，认为三焦是水谷传化的道路，热气过盛则传化失常，导致吐泻霍乱。因为火性躁动。世俗只认为是停食（食物停滞）造成的，这是错误的。转筋是因为热气燥灼筋脉，导致筋脉挛缩疼痛，并不是寒邪所致。
巢元方论述霍乱，认为是阴阳二气相互干扰，乱于肠胃之间，因饮食不当而诱发。这就是《内经》中“厥气上逆”的条文。考察《金匮要略》，将呕吐兼腹泻称为霍乱，这是专指内伤饮食的病证。将发热恶寒、头疼身痛、吐利并见称为霍乱的，是兼有表邪引发的。又将以热多欲饮水者归为热证，以寒多不用水、汗出恶寒、四肢拘急、手足厥冷者归为寒证。辨别表里寒热分别治疗，各家论述有所不同。
从我个人的观察来看，霍乱多发生在夏秋之间，大多是由于外受暑热，内伤饮食，郁遏正气，不能宣通运行，突然发作。即使在冬季患病，也是由夏季伏藏的暑邪所致。不可拘泥于《金匮要略》中有属寒的条文，就随意投用理中汤、四逆汤等温补药剂。
王宇泰说：治疗霍乱应当遵循《内经》的原则，随宜施治，不可固执一端。我认为所有疾病都是如此，这样才能避免误诊。
加减桂苓甘露饮：治疗中暑引起的霍乱，牙齿干燥，心烦口渴，小便短赤。
药物组成：石膏、滑石、寒水石（具有清暑除热功效。但吐泻会导致脾胃大伤，石膏和寒水石需酌情减量使用）。茯苓（止吐定泻）。泽泻（调和水分，祛除湿气）。原方中有桂枝（因其辛热，故嫌其不宜）。白术（因其闭气，为霍乱患者所忌，同时也忌讳温补和酸收类药物）。猪苓（中暑必多汗，不宜过度利尿，故去掉）。建议加入薄荷（辛散外邪，开通气机，通达窍道）。石斛（清胃除热，厚肠止泻）。扁豆（和中消暑，化清降浊）。橘红（和胃调脾，理气通滞）。引用白扁豆叶（捣汁一杯，配合服用一味药，或单服均有神效）。如果有食积，加砂仁、谷芽。如果出现转筋，加木瓜。如果兼见头痛发热、恶寒无汗（这是寒包暑症），加香薷、紫苏。
此方以消暑、除湿、和中、利气为主，根据兼症加减药物治疗。
香薷饮（见于暑病章节）：治疗外感风寒，内伤饮食，霍乱吐泻。
适宜配合回生散使用。（藿香、橘红，和中理气，这两味药为主。原主治中气不和，霍乱吐泻。）
Huo Luan (acute vomiting and diarrhea) refers to a condition that arises suddenly, causing chaos and distress. It is characterized by severe pain in the heart and abdomen, vomiting, and diarrhea, or accompanied by aversion to cold with high fever, headache, and dizziness. If heart pain occurs first, vomiting precedes; if abdominal pain occurs first, diarrhea precedes; if both heart and abdomen hurt, vomiting and diarrhea occur simultaneously. Only when vomiting and diarrhea are accompanied by restlessness and mental disturbance is it termed Huo Luan. If there is no restlessness, it is merely called vomiting and diarrhea.
The *Nei Jing* (Inner Canon) states: "When the year lacks Earth qi, wind prevails greatly, and the people suffer from Huo Luan." This is caused by Spleen deficiency and Liver excess. It also states: "When Earth qi is depressed and erupts, the people suffer from Huo Luan." This is due to extreme depression of dampness leading to eruption. It further states: "Where Taiyin manifests, it leads to abdominal fullness and Huo Luan." This is caused by injury from dampness. It says: "When heat arrives, body heat and Huo Luan occur." This is caused by fire-heat pathogenic factors. It also states: "When Jue qi of Foot-Taiyin rebels upward, Huo Luan occurs." And again: "When clear and turbid qi interfere with each other and disrupt the intestines and stomach, Huo Luan results." This is due to rebellious Jue qi, failure to distinguish between clear and turbid qi, and irregular diet. Thus, the causes of disease discussed in the *Nei Jing* are as follows.
Zhang Dairen, however, believed that Huo Luan is caused by the combination of Wind, Dampness, and Fire pathogens. Spleen dampness is controlled by Wind-Wood; when depressed, it transforms into heat and erupts. Since fire nature flares upward, vomiting occurs; vomiting belongs to Fire. Spleen dampness flows downward, causing diarrhea; diarrhea belongs to Dampness. Severe Wind causes muscle twitching (transverse spasms); twitching belongs to Wind. This comprehensively discusses the combined eruption of Wind, Depression, Dampness, and Fire from the *Nei Jing*.
Only Liu Hejian specifically emphasized Fire-Heat, stating that the Sanjiao (Triple Burner) is the pathway for the transmission and transformation of water and grain. When heat qi is excessive, transmission and transformation become abnormal, leading to vomiting, diarrhea, and Huo Luan, because fire nature is restless. The common belief that it is merely caused by food stagnation is mistaken. Muscle twitching is caused by heat-fire drying and burning the sinews, leading to contraction and pain, not by Cold.
Chao Yuanfang discussed Huo Luan, stating it is caused by the interference of Yin and Yang qi, disrupting the intestines and stomach, triggered by improper diet. This corresponds to the *Nei Jing* passage on rebellious Jue qi. Examining the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), it names vomiting with diarrhea as Huo Luan, referring specifically to internal injury from diet. Those who define Huo Luan by fever, aversion to cold, headache, body ache, vomiting, and diarrhea refer to cases complicated by exterior pathogens. Furthermore, those with more heat and desire for drinking water are classified as Heat patterns; those with more cold, no desire for water, sweating, aversion to cold, limb stiffness, and cold extremities are classified as Cold patterns. Different theories advocate treating based on distinguishing interior/exterior and cold/heat.
From my observation, Huo Luan usually starts in summer and autumn, mostly due to external contraction of summer-heat and internal injury from diet, which stifles healthy qi and prevents its smooth circulation, leading to sudden onset. Even if contracted in winter, it is caused by latent summer-heat from summer. One must not rigidly adhere to the *Jin Gui* mention of Cold patterns and indiscriminately administer formulas like Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction).
Wang Yutai said: "Treating Huo Luan should follow the *Nei Jing*, applying treatment according to circumstances, without being dogmatic." I believe this applies to all diseases, thus avoiding errors.
Modified Guiling Ganlu Yin (Cassia Twig, Poria, and Sweet Dew Decoction): Treats Huo Luan due to summer-heat stroke, dry teeth, vexation and thirst, and scanty dark urine.
Shigao (Gypsum Fibrosum), Huashi (Talcum), Hanshui Shi (Calcitum) [Clear summer-heat and remove heat. Since vomiting and diarrhea severely damage the Spleen and Stomach, Shigao and Hanshui Shi should be used with caution.] Fuling (Poria) [Stop vomiting and stabilize diarrhea.] Zexie (Alisma Rhizoma) [Harmonize water and eliminate dampness.] The original formula contains Guizhi (Ramulus Cinnamomi) [Disliked for its acrid-warm nature.] Baizhu (Atractylodis Macrocephalae Rhizoma) [Disliked for closing qi, contraindicated for Huo Luan patients; warm tonification and sour-astringent herbs are also contraindicated.] Zhuling (Polyporus) [Summer-heat stroke必然 involves profuse sweating; do not over-diurese, hence removed.] It is advisable to add Bohe (Menthae Haplocalycis Herba) [Acridly disperses exterior pathogens, opens qi and unblocks orifices.] Shihu (Dendrobii Caulis) [Clears Stomach heat, thickens intestines, stops diarrhea.] Bian Dou (Dolichoris Semen) [Harmonizes middle, resolves summer-heat, transforms clear and descends turbid.] Ju Hong (Citri Reticulatae Pericarpium Rubrum) [Harmonizes Stomach, regulates Spleen, moves qi and unblocks stagnation.] Use Bai Bian Dou Ye (Leaf of Dolichos Lablab) as the guide [Crush juice, one cup, mix with one herb, or take alone, yields miraculous effects.] Add Ren Chen (Amomi Fructus Rotundus) and Guya (Hordei Fructus Germinatus) if there is food retention. Add Mugua (Chaenomelis Fructus) if there are muscle twitches. If accompanied by headache, fever, aversion to cold, and no sweat [this is Cold enveloping Summer-Heat], add Xiang Ru (Elsholtziae Herba) and Zisu (Perillae Folium).
This formula primarily focuses on resolving summer-heat, eliminating dampness, harmonizing the middle, and promoting qi movement, adding herbs according to accompanying symptoms.
Xiang Ru Yin (Elsholtzia Decoction) [See Summer-Heat section]: Treats Huo Luan with vomiting and diarrhea due to external contraction of Wind-Cold and internal injury from diet.
It is suitable to combine with Huisheng San (Life-Restoring Powder) [Huoxiang (Agastaches Herba) and Ju Hong (Citri Reticulatae Pericarpium Rubrum) harmonize the middle and regulate qi, serving as the main ingredients. Originally treats disharmony of Middle Qi, Huo Luan with vomiting and diarrhea.]
This is a formula for releasing the exterior and harmonizing the interior in summer, suitable for modification reference from the Summer-Heat chapter.