病源霍乱而大吐下后，其肠胃俱虚，乃至汗出，其脉欲绝，手足皆冷，名为四逆，四逆
者，谓阴阳卒厥绝也。（出第二十二卷中）
仲景伤寒论，既吐且痢而大汗出，小便复利，或下利消谷，里寒外热，脉微欲绝，或发
热恶寒，四肢拘急手足厥逆者，四逆汤主之方。
甘草（二两炙） 附子（一枚生） 干姜（一两半）
上三味切，以水三升，煮取一升二合，去滓，温分二服，加减依后法。忌海藻菘菜猪肉
。（千金同）
又吐已下断，汗出厥冷，四肢拘急不解，脉微欲绝者，通脉四逆汤主之方。
甘草（二两炙） 大附子（一枚） 干姜（三两炮）
上三味，以水三升，煮取一升二合，去滓，温分二服，其脉即出愈，若面色赤者，加葱
九茎，若腹中痛者，去葱加芍药二两，若呕者，加生姜二两，若咽痛者，去芍药加桔梗一两，
若利止脉不出者，去桔梗加人参二两，病皆与方相应，乃合服之，若吐利止，身疼痛不休者
，消息和其外伤寒论中，又有疗诸发热霍乱者，审取之。忌海藻菘菜猪肉。（仲景伤寒论上
证合用通脉四逆加猪胆汤又吐利止身痛不休者消息和解其外宜桂枝汤小和之并出第十七卷中
）
短剧扶老理中散，并作丸长服亦得，疗羸老冷气恶心，食饮不化，腹虚满，拘急短气，
及霍乱呕逆，四肢厥冷，心烦气闷流汗，悉主之方。
人参（五两） 干姜（六两） 白术（五两） 麦门冬（三两去心） 附子（三两炮） 茯
苓（三
两） 甘草（五两炙）
上七味作散，临病煮取三合白汤饮和方寸匕，一服不效，又服，常将蜜丸酒服如梧子二
十丸。忌海藻菘菜猪肉桃李雀肉大醋。（千金同出第四卷中）
千金四逆汤，主多寒，手足厥冷，脉绝方。
吴茱萸（二升） 当归（三两） 桂心（三两） 芍药（三两） 细辛（二两） 通草
（二两）
生姜（八两） 甘草（二两炙） 大枣（十二枚）
上九味切，水六升，清酒六升，合煮取三升，分温四服，旧方枣二十五枚，今以霍乱法
多痞，故除之，若除枣入葛根二两佳。忌生葱生菜海藻菘菜。（短剧同仲景伤寒论此方名当
归四逆加吴茱萸生姜汤）
Source: *Wai Tai Mi Yao* (Essential Prescriptions from the Imperial Library), Author: Wang Tao, Dynasty: Tang (Tianbao 11th Year). Chapter: Four Formulas for Pulse Absence and Cold Extremities after Cholera. Category: Formulas.
After severe vomiting and diarrhea in cholera, both the stomach and intestines become deficient, leading to sweating, a pulse that is about to vanish, and cold hands and feet. This is named "Si Ni" (Four Reversals/Cold Extremities Syndrome). "Si Ni" refers to the sudden obstruction of Yin and Yang Qi. (From Volume 22)
According to Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), if there is simultaneous vomiting and dysentery with profuse sweating, urination becomes frequent or clear, or there is diarrhea with undigested food, internal cold with external heat, a faint pulse nearly absent, or fever with aversion to cold, limb stiffness and cramping with cold extremities, Si Ni Tang (Cinnamon Twig Decoction/Recovery Decoction - Note: In this context, it refers to Fu Zi Tang variant for Yang collapse) should be used as the primary formula.
Gancao (Licorice Root, roasted, 2 liang), Fuzi (Aconite Root, raw, 1 piece), Ganjiang (Dried Ginger, 1.5 liang).
Chop the above three ingredients, boil in 3 sheng of water to obtain 1.2 sheng of liquid, remove the dregs, and take warm in two divided doses. Modifications follow the methods below. Avoid seaweed, Chinese cabbage, and pork. (Same as *Qian Jin Fang*)
Furthermore, if vomiting and diarrhea have ceased but sweating persists with cold extremities, limb stiffness and cramping do not resolve, and the pulse is faint and nearly absent, Tong Mai Si Ni Tang (Pulse-Regulating Si Ni Decoction) should be used as the primary formula.
Gancao (Licorice Root, roasted, 2 liang), Da Fuzi (Large Aconite Root, 1 piece), Ganjiang (Dried Ginger, roasted, 3 liang).
Boil the above three ingredients in 3 sheng of water to obtain 1.2 sheng of liquid, remove the dregs, and take warm in two divided doses. If the pulse returns, the patient will recover. If the face is red, add 9 stalks of Congbai (Scallion White). If there is abdominal pain, remove Congbai and add Shaoyao (Peony Root, 2 liang). If there is vomiting, add Shengjiang (Fresh Ginger, 2 liang). If there is a sore throat, remove Shaoyao and add Jiegeng (Platycodon Root, 1 liang). If diarrhea stops but the pulse does not appear, remove Jiegeng and add Renshen (Ginseng Root, 2 liang). When the symptoms correspond to the formula, combine and administer. If vomiting and diarrhea stop but body pain persists, consider harmonizing the exterior. The *Shanghan Lun* also contains formulas for treating various febrile choleras; select them carefully. Avoid seaweed, Chinese cabbage, and pork. (Combined with Tong Mai Si Ni Tang plus Pig Bile Decoction for upper syndromes in *Shanghan Lun*: If vomiting/diarrhea stop and body pain persists, harmonize the exterior with Guizhi Tang (Cinnamon Twig Decoction) gently. Both from Volume 17)
Fu Lao Li Zhong San (Elderly-Supporting Spleen-Harmonizing Powder) from *Duan Ju Fang*, can also be made into pills for long-term use. It treats cold qi, nausea, indigestion, abdominal distension due to deficiency, stiffness, shortness of breath, as well as vomiting and reverse flow of qi from cholera, cold extremities, mental restlessness, chest oppression, and sweating. It addresses all these conditions.
Renshen (Ginseng Root, 5 liang), Ganjiang (Dried Ginger, 6 liang), Baizhu (Atractylodes Macrocephala Rhizome, 5 liang), Maidong (Ophiopogon Tuber, 3 liang, heart removed), Fuzi (Aconite Root, roasted, 3 liang), Fuling (Poria, 3 liang), Gancao (Licorice Root, roasted, 5 liang).
Grind the above seven ingredients into powder. At onset of illness, boil 3 ge of plain water, mix with one cun bi (square inch spoonful) of powder. If one dose is ineffective, take another. For maintenance, make honey pills and take with wine, 20 pills per dose, size of wutong seeds. Avoid seaweed, Chinese cabbage, pork, peaches, plums, sparrow meat, and strong vinegar. (Same as *Qian Jin Fang*, from Volume 4)
Qian Jin Si Ni Tang (Million Gold Si Ni Decoction) from *Qian Jin Fang*, treats excessive cold, cold extremities, and absent pulse.
Wuzhuyu (Evodia Fruit, 2 sheng), Danggui (Angelica Sinensis Root, 3 liang), Guixin (Cinnamon Bark, 3 liang), Shaoyao (Peony Root, 3 liang), Xixin (Asarum Root, 2 liang), Tongcao (Tetrapanax Pith, 2 liang), Shengjiang (Fresh Ginger, 8 liang), Gancao (Licorice Root, roasted, 2 liang), Dazao (Jujube, 12 pieces).
Chop the above nine ingredients, boil in 6 sheng of water and 6 sheng of clear wine to obtain 3 sheng of liquid, divide into four warm doses. The original formula uses 25 jujubes, but they are removed here because cholera often causes stagnation/blockage. Adding Gegen (Kudzu Root, 2 liang) instead of jujubes is better. Avoid raw green onions, raw vegetables, seaweed, and Chinese cabbage. (Same as *Duan Ju Fang*; in *Shanghan Lun*, this formula is named Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang [Angelica Sinensis Pulse-Regulating Decoction plus Evodia and Fresh Ginger])