医宗金鉴卷十四

<<Yi Zong Jin Jian>>  Chapter 14

辨霍乱病脉证并治篇

Huoluan disease, conditions, pulse and treatment

霍乱者，因风寒暑热，饮食生冷之邪，杂揉交病於中，正不能堪，一任邪之挥霍撩乱，故令三焦混淆，清浊相干，乱於肠胃也。表甚，则有头痛身痛，发热恶寒之证；里甚，则有呕吐泻利，腹中大痛之证；寒甚，则转筋厥逆冷汗；暑甚，则大渴引饮不已。病既不同，治亦各异，惟在详审其因，分而疗之，庶卒然之顷，不致有误矣。

The reason for a Huoluan disease is the invasion of Wind, Cold, Hot, Warm, or eating and drinking cold, not cooked food. The outside invasing Xieqi and the inside block of Yangqi all together damages the function of the body, disturbs the normal ascending and descending of the inside organs. If the disturbance is mostly in the out layer of the body, the person feels headache, pain in the body, fever and chilly. If it accumulates mostly in the inside of the body, the person has nausea, vomiting, diarrhea and heavy pain in the abdomen. If the Cold in overwhelming, the person feels spasm in the calf, reverse cold, cold sweat; if the Hot is much more in the body, he feels strong thirsty and keep drinking large volume of water. The clinic conditions can be largely variable, the treatment should also be different accordingly.

01  问曰：病有霍乱者何？答曰：呕吐而利，此名霍乱。

Asked: what is Huoluan disease? Master: Huoluan means the person has vomiting and diarrhea. 

02  问曰：病发热，头痛，身疼，恶寒，吐利者，此属何病？答曰：此名霍乱，自吐下，又利止，复更发热也。(宜用藿香正气汤或香薷饮，散而和之可也。)

Asked: if a person has fever, headache, chilly, vomiting and diarrhea, what disease he has? Master: he has a Huoluan disease[1]. The vomiting and diarrhea can stop by itself but the fever starts again. (In this case, Huoxiang Zhenqi San or Xiangru Yin can be used.)

03  伤寒，其脉微涩者，本是霍乱，今是伤寒，却四、五日至阴经上，转入阴必利，本呕下利者，不可治也。欲似大便而反矢气，仍不利者，此属阳明也，便必硬，十三日愈，所以然者，经尽故也。

If the person has fever, chilly, headache and body pain, vomiting and diarrhea, and his pulse is slight harsh, it is Huoluan. If it is Shanghan, the vomiting and diarrhea should happen on the fourth and fifth day when the Xieqi moves into the Taiyin reridian. The sudden vomit and diarrhea of the Huoluan disease should not be treated as for a Shanghan disease. We should wait for the Huoluan vomit and diarrhea to stop by itself. If the person’s diarrhea stops, he still feels willing to have a bowel movement but only release gas (fart) without stool, the condition belongs to Yangming stage of the Huoluan. In the Yangming stage, the stool should be hard due to the depletion of body Jingye, not due to the Fire in the abdomen so the bowel-cleansing therapy should not be used. It has to be waited for thirteen days when the disease circle completed. At that movement, the stomach Jingye recovered and the stool movement should also be solved. If there is no bowel movement after the thirteen days, a bowel-cleansing therapy can be used.

04  下利後，当便硬，硬则能食者愈。今反不能食，到後经中，颇能食，复过一经能食，过之一日当愈，不愈者，不属阳明也。(理中、脾约，择而用之可矣).

If after diarrhea, the stool turns hard, and the person starts to have appetite to eat, the disease is to recover. If the person cannot eat, it suggests that the Weiqi has not recovered yet. It has to wait for thirteen days. On the thirteenth day, if the person has good appetite, it still indicates a recover. Otherwise, it suggests the Yangming stage is not due to the hard stool, but to the weakness and cold abdomen condition, or to the weak and dryness in the abdomen after vomiting and diarrhea. This is a condition in which the treatment becomes mandatory. Choose Lizhong Tang, or Maziren Wan.   

05  霍乱，头痛发热，身疼痛，热多欲饮水者，五苓散主之，寒多不用水者，理中丸主之。

In Huoluan disease, if the person has more fever and willing to drink more water, use Wuling San. If he has more cold and has no strong willing to drink, use Lizhong Tang. [2]

06  吐利止，而身痛不休者，当消息和解其外，宜桂枝汤小和之。

In Huoluan disease, if the vomit and diarrhea stop, but the person still has continuous body pain, use Guizhi Tang to solve the body surface Xieqi.

07  既吐且利，小便复利，而大汗出，下利清谷，内寒外热，脉微欲绝者，四逆汤主之。

In Huoluan disease, the person has vomiting, diarrhea, but also frequent urine and heavy sweat; the diarrhea contains more non-digested food; and the pulse is weak to disappear, use Sini Tang. [3]

08   吐利汗出，发热恶寒，四肢拘急，手足厥冷者，四逆汤主之。

In Huoluan disease, if the person has vomiting, diarrhea, sweat, fever and chilly, spasm in the arm and legs, has Jue syndrome, use Sini Tang. [4]

09  吐已下断，汗出而厥，四肢拘急不解，脉微欲绝者，通脉四逆加猪胆汁汤主之。

In Huoluan disease, if the vomit and diarrhea have stop, the person has sweat the Jue syndrome, has continuous spasm in the arm and legs, the pulse is very weak to disappear, use Tongmai jia Zhudanzhi Tang.  

10  恶寒脉微而腹利。利不止[5]，亡阳也[6]，四逆加人参汤主之。

In Huoluan disease, if the person feels chilly, diarrhea and the pulse is weak, if his diarrhea continuous, it depletes Yangqi. Use Sini jia Shenshen Tang.[7]

四逆加人参汤方

Sini jia Renshen Tang

於四逆汤方内，加人参一两，馀依四逆汤方

Add 15 gram of Renshen into the standard Sini Tang. Cook and drink it as Sini Tang.

11  吐利发汗、脉平，小烦者，以新虚不胜谷气故也。

Huoluan is more common in the summer and autumn, because Xieqi, the Wind, the Cold, the Hot, and the Wetness, all can cause the Huoluan disease, not only due to a single Xieqi invasion. If the vomiting and diarrhea is too severe, it will damage the middle Weiqi, causes separation of the Yin and Yang in the body, Jue condition, very weak pulse that tends to disappear. If the person does not want to drink water, use Sini Tang or Lizhong Tang kinds of herbs, no matter it is in summer or in winter. In summer, Yangqi is floating on the body surface so the Cold shrinks in the inside of the body. If the person drinks more cold water, or exposes to cold environment (such as stage in cold basement or in air-conditioning rooms), both inside and the surface layer of the body are Cold, that makes the Xieqi easier to invade deep into the Yin meridians of the body. This is why in summer, there is more Yin conditions. If the person with Huoluan stops the vomit and diarrhea, the pulse turns normal and calm but feels mild annoyed, it is due to the weakness of the stomach function, but the person ate relatively more food during the recover period. Therefore for person with the Huoluan disease in the recover period, eat food slowly and little bit by little bit increase in the amount.