凡九条方三
（一）问曰。病有霍乱者何。答曰。呕吐而利。名曰霍乱。
霍。吐也。乱。杂乱也。灵枢曰。清气在阴。浊气在阳。清浊相干。乱于肠胃则为霍乱是也。
（二）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。更复发热也。
发热。头病。身疼。恶寒。外感也。吐利。内伤也。上以病名求病症。此以病证实病名。反
覆详明之意。
（三）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。欲似大便而反失气。仍不利者。属阳明也。便必硬。十三日愈。所以然者。经尽
故也。
转。失。皆见阳明篇。本。根原也。言根因原起自霍乱也。本呕意同。
下利后。盒饭硬。硬则能食者。愈。今反不能食。到后经中。颇能食。过一经能食。过之一
日当愈。不愈者。不属阳明也。
此申上文末节而言其详。
（四）霍乱头痛。发热。身疼痛。热多欲饮水者。五苓散主之。寒多不欲饮水者。理中丸主之。
理中丸方
人参（三两） 白术（三两） 甘草（三两） 干姜（三两）
上四味。捣筛为末。蜜和丸。如鸡子黄大。以沸汤数合。和一丸。研碎。温服之。日三四。
夜二服。腹中未热。益至三四丸。然不及汤。汤法以四物根据两数切。用水八升。煮取三升。去滓。
温服一升。日三服。
此申上文而出其治。热多欲饮水者。阳邪胜也。寒多不用水者。阴邪胜也。五苓散者。水行
则热泄。是亦两解之谓也。理。治也。料理之谓。中。里也。里阴之谓。参术之甘。温里也。甘草
甘平。和中也。干姜辛热。散寒也。五苓散方见太阳上。
加减法
若脐上筑者。肾气动也。去术。加桂四两。（肾气动。欲作奔豚也。去术肾恶燥也。加桂。
以其能伐肾邪而泄奔豚。然非枝也。）吐多者。去术。加生姜三两。（吐。气逆也。术能壅气。
故去之。姜能散气。所以为呕吐之圣药也。）下多者。还用术。悸者。加茯苓二两。（下多。湿胜
也。复用术。术能燥湿。湿燥则下断也。悸以饮水过度言。水停之故也。加茯苓。水行则悸愈也。）
渴欲得水者。加术。足前成四两半。（渴。脾虚也。加术。缓脾也。）腹中痛者。加人参。足前
成四两半。（腹中痛。里虚也。加人参。补中也。）寒者。加干姜。足前成四两半。（寒以不用水
之甚者言。干姜辛热而能散寒。非称权。则不可也。）腹满者。去术。加附子一枚。服汤后。如食
顷。饮热粥一升许。微自温。勿发揭衣被。（气滞则腹满。术甘而壅。故去之。附子辛温。故加之
。饮热粥。亦助药力也。自温。亦取微欲似汗之意。勿发揭衣被。防重感也。案此。用术。去术
。术上皆无白字。何哉。盖由文次句中。上无空隙。故虽有狂妄。竟不能于此加毫末。而经之真
原昭然犹存。则他术之有白。出于伪妄。不待言而明矣。然于伪妄之疏愚。亦可以见也。君子察微。
观人于其所忽。信哉。）吐利止。而
身痛不休者。当消息和解其外。宜桂枝汤小和之。（吐利止。里和也。身痛。表退而新虚也。
消息。犹言斟酌也。桂枝汤固卫以和表者也。小和。言少少与服。不令过度之意也。）
（五）吐利汗出。发热。恶寒。四肢拘急。手足厥冷者。四逆汤主之。
吐利。四肢拘急。手足厥冷。里阴虚也。汗出。发热。恶寒。表阳衰也。四逆汤。表里合救
之剂也。方见太阳下。下同。
（六）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。
此与上条大同小异而义同。故治亦同。
（七）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。
通脉四逆加猪胆汁汤方
于四逆汤方内加猪胆汁半合。余根据四逆汤法。
已。止也。下。即利也。断。绝也。此总上文言吐利两皆止绝。而又以其余证之不解者。更出
以治也。不解之证者。阳极虚。阴极甚。脾气亦衰微也。然极则剧矣。通脉四逆加猪胆汁者。与
少阴白通同一反佐以疏。剧则正治反格拒之意也。
（八）恶寒。脉微。而复利。利止。亡血也。四逆加人参汤主之。
四逆加人参汤方
于四逆汤方内。加人参一两。余根据四逆汤法。
亡血。津液竭也。人参。能生津也。
（九）吐利。发汗。脉平。小烦者。以新虚不胜谷气故也。
此与下编末条。详略不一。而义则同。亦互意也。
凡九条，方剂三个。
（一）问：霍乱这种病是怎么回事？答：上吐下泻，称为霍乱。
“霍”意为呕吐，“乱”意为杂乱。《灵枢》说：清气在下，浊气在上。清浊之气相互干扰，在肠胃中混乱，就是霍乱。
（二）问：患病时，出现发热、头痛、身体疼痛、恶寒，同时伴有呕吐和下利，这属于什么病？答：这称为霍乱。自行发生呕吐和下利，如果腹泻停止后，又再次出现发热。
发热、头痛、身体疼痛、恶寒，是外感邪气所致；呕吐和下利，是内伤脾胃所致。上文是以病名来推求病症表现，此处是以病症表现来证实病名，反复详细说明其意旨。
（三）患伤寒病，脉象微而涩的，原本就是霍乱，现在是伤寒，经过四五日传入阴经，必然出现下利。原本就有呕吐和下利的，难以治愈。想要大便却反而排气，仍不排便的，属于阳明病，大便必定干硬，十三日可愈。之所以这样，是因为经气运行完毕的缘故。
“转”、“失”等字均见于阳明篇。“本”，指根原。意思是说病因原本起于霍乱。本有呕吐之意相同。
下利之后，应当大便干硬，若大便干硬却能进食，则病愈。现在反而不能进食，等到下一个经气周期中，稍微能进食了，超过一个经气周期能进食，过一天应当痊愈。若不愈者，不属于阳明病。
这是补充说明上文末尾一节的内容，阐述得更详细。
（四）霍乱病见头痛、发热、身体疼痛，热多且想喝水的，用五苓散主治。寒多且不想喝水的，用理中丸主治。
理中丸方：人参（三两）、白术（三两）、甘草（三两）、干姜（三两）。
以上四味药，捣碎筛成细末，用蜂蜜调和做成丸药，大小如鸡蛋黄。用沸水少量，将一丸药研碎溶化，温服。每日三四次，夜间两次。若腹中未感到温热，可增加至每次三四丸。然而效果不如汤剂。汤剂的制法是将四味药按上述重量切碎，用水八升，煮取三升，去渣，温服一升，每日三次。
这是补充上文并给出治疗方法。热多且想喝水，是阳邪盛；寒多且不想喝水，是阴邪盛。五苓散能使水液运行从而泄热，这也是表里双解的意思。“理”，治理；“中”，里，即里阴。人参、白术味甘性温，能温补里阳；甘草味甘平，能调和中焦；干姜味辛性热，能散寒。五苓散方见太阳篇上。
加减法：
若脐上跳动不安，是肾气动，去掉白术，加桂枝四两。（肾气动，欲作奔豚病。去掉白术，因为肾恶燥。加桂枝，因为它能伐肾邪而泄奔豚，但这里不是桂枝尖。）呕吐多的，去掉白术，加生姜三两。（呕吐，是气逆。白术能壅滞气机，所以去掉。生姜能散气，所以是治疗呕吐的要药。）下利多者，仍用白术。心悸者，加茯苓二两。（下利多，湿胜。复用白术，白术能燥湿，湿去则下利止。心悸是指饮水过多所致，是水停的原因。加茯苓，水行则心悸愈。）口渴想喝水的，加白术，使总量达到四两半。（渴，是脾虚。加白术，缓急健脾。）腹中痛者，加人参，使总量达到四两半。（腹中痛，是里虚。加人参，补益中气。）寒甚者，加干姜，使总量达到四两半。（寒是指不想喝水严重的情况。干姜辛热能散寒，非此不可。）腹部胀满者，去掉白术，加附子一枚。服药后，约一顿饭的时间，喝热粥一升左右，使身体微微温暖，不要掀开衣被。（气滞则腹满，白术甘而壅滞，所以去掉。附子辛温，所以加上。喝热粥，也是助药力。微微温暖，也有取微似汗出的意思。不要掀开衣被，防止再次感受外邪。案：此处用白术或去白术，原文“术”字上皆无“白”字，为何呢？大概是因为文字排列紧密，上下无空隙，所以虽有狂妄篡改者，竟也不能在此处添加丝毫，而经典的真貌依然保存，那么其他版本中有“白”字的，出于伪妄，不言自明。然而从这些伪妄的疏漏中，也可以看出作者的愚钝。君子观察细微，在人们忽视的地方观察人，确实如此。）呕吐下利停止，但身体疼痛不止的，应当斟酌和解其表，宜用小剂量桂枝汤调和。（呕吐下利停止，里气和顺。身体疼痛，是表邪退去而新虚。消息，犹言斟酌。桂枝汤固护卫气以调和表邪。小和，意思是少量服用，不让过度的意思。）
（五）呕吐下利，汗出，发热，恶寒，四肢拘挛紧急，手足厥冷的，用四逆汤主治。
呕吐下利，四肢拘急，手足厥冷，是里阴虚。汗出，发热，恶寒，是表阳衰。四逆汤是表里同救的方剂。方见太阳篇下，下同。
（六）既呕吐又下利，小便反而通利且大汗出，下利完谷不化，内寒外热，脉微欲绝的，用四逆汤主治。
这一条与上一条大同小异而义理相同，所以治法也相同。
（七）呕吐已止，下利断绝，汗出且手足厥冷，四肢拘急不解，脉微欲绝的，用通脉四逆加猪胆汁汤主治。
通脉四逆加猪胆汁汤方：
在四逆汤方中加入猪胆汁半合，其余按照四逆汤的方法制作。
“已”，停止。“下”，即下利。“断”，绝。这是总结上文说呕吐和下利都停止了，而又将其余未解的症状列出，以给出治疗方法。未解的症状，是阳极虚，阴极甚，脾气也衰微。然而极则剧，通脉四逆加猪胆汁汤，与少阴病白通汤同一反佐以疏通，病情剧烈时正治法会被格拒的意思。
（八）恶寒，脉微，又下利，下利停止，是亡血，用四逆加人参汤主治。
四逆加人参汤方：
在四逆汤方中加入人参一两，其余按照四逆汤的方法制作。
亡血，津液枯竭。人参，能生津液。
（九）呕吐下利，发汗后，脉象平和，只有轻微烦闷的，是因为新虚不胜受纳谷气所致。
这一条与下编末条，详略不同，但义理相同，也是互文见义。
Nine articles in total, three formulas.
(1) Question: What is the condition known as Huoluan (cholera-like syndrome)? Answer: Vomiting and diarrhea characterize this condition, which is named Huoluan.
"Huo" refers to vomiting; "luan" refers to chaos or disorder. The *Ling Shu* states: Clear Qi resides below, Turbid Qi resides above. When Clear and Turbid Qi interfere with each other and become chaotic in the intestines and stomach, it results in Huoluan.
(2) Question: In a disease presenting with fever, headache, body pain, aversion to cold, accompanied by vomiting and diarrhea, what disease does this belong to? Answer: This is named Huoluan. It involves spontaneous vomiting and diarrhea. If the diarrhea stops but fever recurs,
Fever, headache, body pain, and aversion to cold indicate external pathogenic invasion. Vomiting and diarrhea indicate internal injury. The previous article deduced symptoms from the disease name; here, symptoms are used to confirm the disease name, illustrating the intent of detailed explanation through repetition.
(3) In Taiyang Cold Damage (Shanghan), if the pulse is faint and choppy, the root cause was originally Huoluan. Now it has transformed into Shanghan. After four or five days, when it transmits to the Yin meridians, diarrhea will inevitably occur. If there was originally vomiting and diarrhea, it is difficult to treat. If one feels the urge to defecate but only passes flatus without stool, it belongs to Yangming syndrome; the stool will likely be hard. Recovery occurs on the thirteenth day. This is because the meridian cycle has completed its course.
The terms "zhuan" (transmit) and "shi" (lose/pass) appear in the Yangming chapter. "Ben" means root or origin, indicating that the etiology originated from Huoluan. The meaning regarding original vomiting is similar.
After diarrhea ceases, the stool should become hard. If the patient can eat despite hard stool, recovery ensues. If the patient cannot eat now, but later, during the subsequent meridian cycle, begins to eat slightly, and eats normally after exceeding one cycle, they should recover within a day. If not, it does not belong to Yangming syndrome.
This elaborates on the final section of the preceding text.
(4) For Huoluan presenting with headache, fever, and body pain: if heat predominates and the patient desires water, Wuling San (Five-Ingredient Powder with Poria) is indicated. If cold predominates and the patient does not desire water, Lizhong Wan (Regulate the Middle Pill) is indicated.
Formula for Lizhong Wan:
Renshen (Ginseng Radix, 3 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang), Ganjiang (Zingiberis Rhizoma, 3 liang).
Grind the four ingredients into powder, mix with honey to form pills the size of chicken egg yolks. Dissolve one pill in a small amount of boiling water, crush well, and take warm. Take three to four times daily, and twice at night. If warmth is not felt in the abdomen, increase to three or four pills per dose. However, decoction is more effective than pills.
Decoction method: Cut the four ingredients according to the weights above, add eight sheng of water, boil to obtain three sheng, strain, and take one sheng warm, three times daily.
This provides treatment options. Heat predominance with thirst indicates excess Yang pathogen; cold predominance without thirst indicates excess Yin pathogen. Wuling San promotes water metabolism to dissipate heat, achieving simultaneous resolution of exterior and interior. "Li" means to regulate; "Zhong" means interior, referring to Interior Yin. Renshen and Baizhu are sweet and warm, warming the interior; Gancao is sweet and neutral, harmonizing the middle; Ganjiang is acrid and hot, dispersing cold. See Wuling San formula in Taiyang Upper Chapter.
Modifications:
If there is pulsation above the umbilicus, Kidney Qi is moving; remove Baizhu, add Guizhi (Cinnamon Twig) 4 liang. (Kidney Qi movement suggests impending Ben Tun (fleeing pig); remove Baizhu as the Kidney dislikes dryness; add Guizhi to subdue Kidney pathogen and drain Ben Tun.)
If vomiting is excessive, remove Baizhu, add Shengjiang (Fresh Ginger Rhizome) 3 liang. (Vomiting is rebellious Qi; Baizhu can obstruct Qi, so remove it; Shengjiang disperses Qi and is a supreme herb for vomiting.)
If diarrhea is excessive, retain Baizhu. If palpitations occur, add Fuling (Poria, 2 liang). (Excessive diarrhea indicates dampness excess; retaining Baizhu dries dampness, stopping diarrhea. Palpitations here refer to those caused by excessive water intake due to fluid retention; adding Fuling promotes water metabolism, relieving palpitations.)
If thirsty and desiring water, add Baizhu to reach a total of 4.5 liang. (Thirst indicates Spleen deficiency; adding Baizhu moderates the Spleen.)
If abdominal pain occurs, add Renshen to reach a total of 4.5 liang. (Abdominal pain indicates Interior deficiency; adding Renshen tonifies the Middle.)
If cold is severe, add Ganjiang to reach a total of 4.5 liang. ("Cold" refers to severe aversion to drinking water; Ganjiang is acrid and hot, dispersing cold, essential in such cases.)
If abdominal fullness occurs, remove Baizhu, add Fuzi (Aconite Lateralis Preparata Radix) 1 piece. After taking the decoction, wait about the time of a meal, drink approximately one sheng of hot porridge to induce slight warmth, and do not uncover clothes/bedding. (Qi stagnation causes fullness; Baizhu is sweet and cloying, hence removed; Fuzi is acrid and warm, hence added. Hot porridge assists medicinal power. Slight warmth aims for mild sweating. Covering prevents re-infection. Note: In this text, "Baizhu" is written simply as "Zhu" without the character "Bai". Why? Likely due to tight spacing in the manuscript preventing insertion of characters, preserving the original text's authenticity against later alterations. Thus, versions containing "Bai" are likely apocryphal. Observing these details reveals the author's insight. As the saying goes, observe people in their neglects.)
If vomiting and diarrhea cease but body pain persists, carefully harmonize the exterior using a small dose of Guizhi Tang (Cinnamon Twig Decoction). (Cease of vomiting/diarrhea indicates Interior harmony; persistent body pain indicates residual Exterior pathogen and new deficiency. "Xiaoxi" means to weigh/proportion. Guizhi Tang secures Wei Qi and harmonizes the Exterior. "Xiaohe" means administering small amounts to avoid excess.)
(5) With vomiting, diarrhea, sweating, fever, aversion to cold, tetanic contraction of limbs, and cold extremities, Sini Tang (Frigid Extremities Decoction) is indicated.
Vomiting, diarrhea, tetanic limbs, and cold extremities indicate Interior Yin/Blood deficiency. Sweating, fever, and aversion to cold indicate Exterior Yang decline. Sini Tang treats both Interior and Exterior simultaneously. See Sini Tang formula in Taiyang Lower Chapter.
(6) With vomiting and diarrhea, frequent urination, profuse sweating, diarrhea with undigested food, Interior cold with Exterior heat, and a faint pulse nearly imperceptible, Sini Tang is indicated.
This case is largely similar to the previous one in pathology and treatment.
(7) After vomiting has ceased and diarrhea has stopped, but sweating and cold extremities persist, limb tetany remains unresolved, and the pulse is faint and nearly imperceptible, Tongmai Sini Tang plus Zhuhuangdan (Pig Bile) is indicated.
Formula for Tongmai Sini Tang plus Zhuhuangdan:
Add Ban He (half he) of Zhuhuangdan (Pig Bile) to the Sini Tang formula. Prepare the rest according to the Sini Tang method.
"Yi" means stop; "Xia" means diarrhea; "Duan" means cut off. This summarizes the cessation of both vomiting and diarrhea, listing remaining unresolved symptoms for specific treatment. These unresolved symptoms indicate extreme Yang deficiency and extreme Yin excess, with Spleen Qi also declining. In critical conditions, standard treatment may be rejected; thus, Tongmai Sini Tang plus Pig Bile uses reverse adjuvant therapy (similar to Shaoyin Bai Tong Tang) to overcome rejection.
(8) With aversion to cold, faint pulse, and recurrent diarrhea, if diarrhea stops due to blood depletion, Sini Tang plus Renshen (Four Reversal Decoction plus Ginseng) is indicated.
Formula for Sini Tang plus Renshen:
Add Renshen (Ginseng Radix) 1 liang to the Sini Tang formula. Prepare the rest according to the Sini Tang method.
Blood depletion implies exhaustion of Jin Ye (Body Fluids). Renshen generates fluids.
(9) After vomiting, diarrhea, and sweating, if the pulse becomes normal but mild irritability/fan remains, it is due to new deficiency being unable to handle the digestion of grain qi.
This parallels the final article of the lower compilation; although detail varies, the principle is identical, serving as complementary exposition.