腹满时痛吐利不渴者太阴病（论见腹满活人云理中汤主之）病患脉阴阳俱紧反汗出者亡阳也此属少阴法当咽痛而复
吐利（桂枝干姜汤）少阴病吐利手足厥冷烦躁欲死者吴茱萸汤主之少阴病吐利手足不逆冷反发热者不死脉不至者灸少阴
七壮（庞云在内踝后跟骨上动脉陷中发热谓其身发热也余按少阴之络非特一穴今曰少阴而不指某穴者针法当随四时随运
气以取井荣俞经合不可执泥也庞氏定以为太溪恐非仲景本旨）少阴病吐利烦躁四逆者死少阴病下利咳而呕渴心烦不得眠
者猪苓汤主之（论见下利）少阴病腹痛小便不利四肢重痛自下利或呕者真武去附子加生姜汤（论见下利）少阴病下利脉
微涩呕而汗出者当温其上灸之（论见欲寐温其上谓下有寒气当温其上以助阳气也）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（王叔和入霍乱篇）
太阳与少阳合病头痛胁痛往来寒热自利而呕者黄芩加半夏生姜汤（论见合病）发热汗出不解心中痞硬呕吐下利者宜
大柴胡汤（论见痞）发汗后水浆不得入口者为逆若更发汗必吐下不止呕吐而利者名曰霍乱病发热头痛身疼恶寒吐利者此
名霍乱自吐下又利止复更发热也霍乱头疼发热身疼痛热多饮水者五苓散主之寒多不饮水者宜理中汤
理中汤方
人参 干姜（炮） 甘草（灸各一两） 白术（二两）上锉每服四钱水煎去滓温服如寒甚者加干姜一两半渴欲得水
者加白术一两半脐上筑筑者肾气动也去白术加桂枝二两吐多者去白术加生姜四两下利多者倍用白术悸者加茯苓二两腹
满去白术加附子一枚服汤后如食顷者饮热粥一升许自温勿发揭衣被（活人云或四肢拘急或转筋者亦去术加附子）
吐利汗出发热恶寒四肢拘急手足厥冷者四逆汤主之吐利止而身痛不休者当消息和解其外宜桂枝汤恶寒脉微利止者
四逆加人参汤（方论见恶寒）
吐已下断汗出而厥四肢拘急不解脉微欲绝者通脉四逆汤加猪胆汁主之
甘草（炙二两） 干姜（三两） 附子（大者一枚去皮破八片） 猪胆汁（半合）上三味 咀水三盏煎至二盏去滓
纳猪胆汁分作二次温服其脉即来
吐利发汗脉平不烦者以新虚不胜谷气故也干呕而利兼胁痛而表解者宜十枣汤心下痞硬而烦者宜甘草泻心汤兼厥逆
脉微者通脉四逆汤白通加猪胆汁汤（详见前干呕门）
诊 脉阴阳俱紧至于吐利其脉独不解紧人惟安静者是为欲解若脉迟至六七日不欲食此为晚发水停故也此为未解食自可者为欲解
霍乱证治已详杂病门中兹不赘
腹部胀满，时而疼痛，呕吐腹泻，口不渴的，属于太阴病（相关论述见“腹满”篇）。《活人书》说用理中汤主治。
患者脉象寸关尺三部都紧，反而出汗的，这是亡阳证。这属于少阴病，按照法度应当出现咽痛并且又呕吐腹泻的症状（用桂枝干姜汤治疗）。
少阴病，呕吐腹泻，手脚冰冷，烦躁得快要死去的，用吴茱萸汤主治。
少阴病，呕吐腹泻，手脚不冷，反而发热的，不会死亡。如果脉搏摸不到，就灸少阴经穴位七壮（庞安常说在内踝后方跟骨上方的动脉凹陷处发热，指的是身体发热。我按：少阴经络并非只有一个穴位，这里只说少阴而不指定某个穴位，是因为针刺方法应当随四季、随运气变化来选取井、荥、俞、经、合穴，不可拘泥固执。庞氏将其定为太溪穴，恐怕不符合张仲景的本意）。
少阴病，下利，咳嗽，呕吐，口渴，心烦，不能入睡的，用猪苓汤主治（相关论述见“下利”篇）。
少阴病，腹痛，小便不利，四肢沉重疼痛，自行下利，或者呕吐的，用真武汤去掉附子加上生姜汤治疗（相关论述见“下利”篇）。
少阴病，下利，脉微涩，呕吐且出汗的，应当温补上部并施以艾灸（相关论述见“欲寐”篇。“温其上”是指下部有寒气，应当温补上部以助长阳气）。
既呕吐又腹泻，小便也通利，而且大汗出，腹泻排出未消化的食物，内部寒冷外部发热，脉微细几乎要断绝的，用四逆汤主治（王叔和将其归入霍乱篇）。
太阳经与少阳经合病，头痛，胁痛，忽冷忽热，自行下利且呕吐的，用黄芩加半夏生姜汤治疗（相关论述见“合病”篇）。
发热，出汗后病邪不解，心中痞塞坚硬，呕吐，下利的，适宜用大柴胡汤（相关论述见“痞”篇）。
发汗之后，水浆都无法入口的，属于逆证；如果再发汗，必定导致呕吐腹泻不止。呕吐而腹泻的，名叫霍乱病。发热，头痛，身体疼痛，恶寒，呕吐腹泻的，这也名叫霍乱。如果是自己呕吐腹泻，后来腹泻停止却又再次发热的，也是霍乱。
霍乱病，头疼，发热，身体疼痛，热多且想喝水的，用五苓散主治。寒多且不想要喝水的，适宜用理中汤。
理中汤方剂组成：
人参、干姜（炮制）、甘草（炙，各一两）、白术（二两）。以上药物切碎，每次服用四钱，用水煎煮，去渣滓，温服。如果寒气特别重的，加干姜一两半；口渴想喝水的，加白术一两半；脐上跳动不安的，是肾气发动，去掉白术，加桂枝二两；呕吐多的，去掉白术，加生姜四两；腹泻多的，加倍使用白术；心悸的，加茯苓二两；腹部胀满的，去掉白术，加附子一枚。服药后大约一顿饭的时间，喝热粥一升左右，保持温暖，不要掀开衣被（《活人书》说：如果出现四肢拘急或转筋的，也去掉白术加附子）。
呕吐腹泻，出汗，发热，恶寒，四肢拘急，手脚冰冷的，用四逆汤主治。
呕吐腹泻停止但身体疼痛不休的，应当斟酌情况调和其表证，适宜用桂枝汤。
恶寒，脉微，腹泻停止的，用四逆加人参汤（方剂论述见“恶寒”篇）。
呕吐腹泻已止，但出汗且手脚厥冷，四肢拘急不缓解，脉微细几乎要断绝的，用通脉四逆汤加猪胆汁主治。
甘草（炙二两）、干姜（三两）、附子（大者一枚，去皮，破成八片）、猪胆汁（半合）。以上三味药切碎，用水三盏，煎至两盏，去渣滓，纳入猪胆汁，分两次温服，脉象就会恢复。
呕吐腹泻后发汗，脉象平和且不烦躁的，是因为新近体虚，承受不住谷气的缘故。
干呕而腹泻，兼有胁痛且表证已解的，适宜用十枣汤。心下痞塞坚硬且烦躁的，适宜用甘草泻心汤。兼有四肢厥冷，脉微的，用通脉四逆汤或白通加猪胆汁汤（详见前文“干呕”门）。
诊脉：脉象寸关尺三部都紧，到了呕吐腹泻的时候，唯独脉象没有解除紧象，只有脉象变得迟缓安静的，这才是将要解除病邪的表现。如果脉迟，到了六七天不想吃东西，这是晚发，因为水饮停聚的缘故，这表示病未解除。如果能正常进食的，表示将要解除病邪。
霍乱的证治已在杂病门中详细论述，此处不再赘述。
Abdominal fullness, occasional pain, vomiting and diarrhea, with no thirst, constitutes Taiyin disease (the discussion is found in the section on "Abdominal Fullness"). *Huoren Shu* states it should be primarily treated with Lizhong Tang.
If a patient's pulse is tight at all three positions (cun, guan, chi) but there is sweating, this indicates Yang collapse. This belongs to Shaoyin disease; according to the principles, one should expect sore throat accompanied by vomiting and diarrhea (treated with Guizhi Ganjiang Tang).
In Shaoyin disease, if there is vomiting and diarrhea, cold limbs, and restlessness bordering on death, Wuzhuyu Tang should be used.
In Shaoyin disease, if there is vomiting and diarrhea, but the limbs are not cold and there is fever, the prognosis is not fatal. If the pulse cannot be felt, moxibustion should be applied to the Shaoyin meridian for seven moxa cones (Pang Anchang stated that "fever" refers to body heat, located in the depression of the arterial pulse behind the medial malleolus and above the calcaneus. I note: the Shaoyin collaterals are not limited to a single acupoint; here, only "Shaoyin" is mentioned without specifying an acupoint because acupuncture methods should select Jing-River, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points according to the seasons and Qi dynamics, rather than being rigid. Pang's specification of Taixi may not align with Zhang Zhongjing's original intent).
In Shaoyin disease, if there is vomiting and diarrhea, restlessness, and cold limbs extending upwards (Si Ni), it is a fatal condition.
In Shaoyin disease, if there is diarrhea, cough, vomiting, thirst, irritability, and inability to sleep, Zhu Ling Tang should be used (the discussion is found in the section on "Diarrhea").
In Shaoyin disease, if there is abdominal pain, difficulty urinating, heaviness and pain in the four limbs, spontaneous diarrhea, or vomiting, Zhenwu Tang with Fuzi removed and Shengjiang added should be used (the discussion is found in the section on "Diarrhea").
In Shaoyin disease, if there is diarrhea, a faint and choppy pulse, vomiting, and sweating, the upper part should be warmed and treated with moxibustion (the discussion is found in the section on "Desire to Sleep". "Warming the upper part" means warming the upper body to assist Yang Qi because of cold Qi below).
If there is both vomiting and diarrhea, along with free urination, profuse sweating, diarrhea of undigested food, internal cold with external heat, and a faint pulse nearly imperceptible, Sini Tang should be used (Wang Shuhe included this in the Huoluan chapter).
When Taiyang and Shaoyang diseases combine, presenting with headache, hypochondriac pain, alternating chills and fever, spontaneous diarrhea, and vomiting, Huangqin Jia Banxia Shengjiang Tang should be used (the discussion is found in the section on "Combined Diseases").
If there is fever, sweating that does not resolve the condition, epigastric stuffiness and hardness, vomiting, and diarrhea, Da Chaihu Tang is appropriate (the discussion is found in the section on "Stagnation").
After sweating therapy, if neither water nor grain can be taken, it is a adverse reaction (Ni); if sweating is applied again, it will inevitably lead to incessant vomiting and diarrhea. Vomiting accompanied by diarrhea is named Huoluan disease. Fever, headache, body ache, aversion to cold, vomiting, and diarrhea also constitute Huoluan. If one vomits and has diarrhea, and then the diarrhea stops but fever recurs, it is still Huoluan.
In Huoluan disease, if there is headache, fever, body ache, significant heat sensation, and desire for water, Wuling San should be used. If there is significant cold sensation and no desire for water, Lizhong Tang is appropriate.
**Lizhong Tang Formula:**
Renshen (Ginseng Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma Preparatum), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) each 1 liang, Baizhu (Atractylodis Macrocephalae Rhizoma) 2 liang. The above ingredients are crushed. Take 4 qian per dose, decoct in water, remove dregs, and take warm. If cold is severe, add Ganjiang 1.5 liang. If thirsty and desiring water, add Baizhu 1.5 liang. If there is palpitation/throbbing above the navel (indicating Kidney Qi movement), remove Baizhu and add Guizhi 2 liang. If vomiting is frequent, remove Baizhu and add Shengjiang 4 liang. If diarrhea is frequent, double the amount of Baizhu. If there is palpitations (Ji), add Fuling 2 liang. If there is abdominal fullness, remove Baizhu and add Fuzi 1 piece. After taking the decoction, approximately after the time it takes to eat a meal, drink about 1 sheng of hot porridge to maintain warmth; do not uncover clothes or blankets (*Huoren Shu* notes: if there is limb contracture or muscle twitching/cramping, also remove Baizhu and add Fuzi).
In cases of vomiting and diarrhea with sweating, fever, aversion to cold, limb contracture, and cold hands and feet, Sini Tang should be used.
If vomiting and diarrhea stop but body pain persists, one should assess and harmonize the exterior; Guizhi Tang is appropriate.
If there is aversion to cold, a faint pulse, and cessation of diarrhea, Sini Jia Renshen Tang should be used (formula discussion found in the section on "Aversion to Cold").
If vomiting and diarrhea have ceased, but there is sweating, cold limbs, unrelieved limb contracture, and a faint pulse nearly imperceptible, Tongmai Sini Tang with Zhuyedan (Porcinis Bile) should be used.
Gancao (Praeparata cum Melle) 2 liang, Ganjiang 3 liang, Fuzi (large) 1 piece (peeled, broken into eight pieces), Zhuyedan 0.5 he. The above three ingredients are crushed, decocted in 3 zhan of water until 2 zhan remain, dregs removed, and Zhuyedan added. Divide into two doses and take warm; the pulse will return.
After vomiting and diarrhea, if sweating occurs and the pulse becomes normal without irritability, it is due to recent deficiency being unable to handle the energy from grain.
If there is dry heaving and diarrhea, accompanied by hypochondriac pain and resolved exterior syndrome, Shizao Tang is appropriate. If there is epigastric stuffiness, hardness, and irritability, Gancao Xiexin Tang is appropriate. If accompanied by cold limbs and a faint pulse, Tongmai Sini Tang or Baitong Jia Zhuyedan Tang should be used (see detailed discussion in the previous "Dry Heaving" section).
**Pulse Diagnosis:** If the pulse is tight at all three positions, and upon vomiting and diarrhea, the tightness remains unresolved, only becoming slow and quiet indicates resolution. If the pulse is slow, and after six or seven days there is loss of appetite, this is a late onset due to fluid retention, indicating the disease is not yet resolved. If the patient can eat normally, it indicates resolution.
The diagnosis and treatment of Huoluan have been detailed in the Miscellaneous Diseases section; thus, no further elaboration is provided here.