问曰、病有霍乱者何。答曰、呕吐而利。名曰霍乱。
此设为问答。以明霍乱之病。谓邪在上者。多吐。邪在下者。多利。邪邪中焦。上逆为呕吐。复下
注而利者。
则为霍乱。霍乱、挥霍撩乱。成于顷刻。变动不安。而其发热恶寒。亦与阳明相类也。
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。
此即上条之意而详言之。盖霍乱之病。本自外来。以其人中气不足。邪得乘虚入里。伤于
脾胃而作吐利。所以有发热头痛。身疼恶寒之证。或邪气直侵脾胃。先自吐下。迨利止里和。则邪
气复还之表。而为发热。今人吐利之后。往往发热烦渴者是也。
伤寒。脉微而涩者。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。
脉微为少气。涩为无血。伤寒脉不应微涩。而反微涩者。以其为霍乱吐下之后也。本是霍乱。今是
伤寒者。吐下止而复更发热。如上条所云也。热则邪还于表。当从阳而解矣。乃四五日。至阴经上
转入阴必利者。邪气不从阳而解。而复入阴为利也。夫霍乱之时。既呕且利。里气已伤。今邪转入
里而复作利。则里气再伤。故不可治。若欲大便而反失气仍不利者。胃、气复而成实。邪气衰而欲
退也。故可期之十三日愈。所以然者。十二日经气再周。大邪自解。更过一日。病必愈耳。
下利
后。当便硬。硬则能食者。愈。今反不能食。到后经中颇能食。复过一经能食。过之一日当愈。不
愈者。不属阳明也。
下利后。便硬者。病后太阴而转属阳明也。阳明病。能食者为胃和。不能食者为胃未和。是以下
利后。便硬而能食者。愈。或始先不能食。继复转而能食者。过于前一日亦愈。其不愈者。则病不
属阳明。虽能食。不得为胃和。故病不愈也。
恶寒脉微而利。利止。亡血也。四逆加人参汤主之。
恶寒脉紧者。寒邪在外也。恶寒脉微者。阳虚而阴胜也。则其利为阴寒而非阳热。其止亦非邪
尽而为亡血矣。故当与四逆以温里。加人参以补虚益血也。按此条本非霍乱证。仲景以为霍乱之后
。多有里虚不足而当温养者。故特隶于此欤。
四逆加人参汤方
于四逆汤方内加人参一两。余根据四逆汤法服。
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。
霍乱该吐下而言。头痛发热。身疼痛。则霍乱之表证也。而有热多寒多之分。以中焦为阴阳之
交。故或从阳而多热。或从阴而多寒也。热多则渴欲饮水。故与五苓散去水而泄热。寒多则不能胜
水而不欲饮。故与理中丸燠土以胜水。
理中丸方
人参（三两） 甘草（三两） 白术（三两） 干姜（三两）
上四味。捣筛为末。蜜和丸。如鸡黄大。以沸汤数合。和一丸。碎研温服之。日三。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。
加减法
若脐上筑者。肾气动也。去术。加桂四两。
脐上筑者。脐上筑筑然跳动。肾气上而之脾也。脾方受气。术之甘能壅脾气。故去之。桂之辛
能下肾气。故加之。
吐多者。去术。加生姜三两。
吐多者。气方上壅。甘能壅气。故去术，辛能散气。故加生姜。
下多者。还用术。悸者。加伏苓二两。
下多者。脾气不守。故须术以固之。悸者。肾水上逆。故加茯苓以导之。
渴欲得水者。加术。足前成四两半。
渴欲得水者。津液不足。白术之甘。足以生之。
腹中痛者。加人参。足前成四两半。
腹中痛者。里虚不足。人参之甘。足以补之。
寒者。加干姜。足前成四两半。
寒者。腹中气寒也。干姜之辛。足以温之。
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。
腹满者。气滞不行也。气得甘则壅。得辛则行。故去术加附子。
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。里已和也。身痛不休者。表未解也。故须桂枝和解其外。所谓表病里和。汗之则愈
也。曰消息。曰小和之者。以吐利之余。里气已伤。故必消息其可汗而后汗之。亦不可大汗。而可
小和之也。
吐利汗出。发热恶寒。四肢拘急。手足厥逆者。四逆汤主之。
此阳虚霍乱之候。发热恶寒者。身虽然而恶寒。身热为阳格之假象。恶寒为虚冷之真谛也。四
肢拘急
手足厥逆者。阳气衰少。不柔于筋。不温于四末也。故宜四逆汤助阳气而驱阴气。
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。
此亦虚冷霍乱之候。四肢拘急。手足厥逆。虚冷之着于外者也。下利清谷。脉微欲绝。虚冷之
着于里者也。而其为霍乱则一。故吐利汗出。内寒外热。与上条同。而其用四逆驱内胜之阴。复外
散之阳。亦无不同也。
吐已下断。汗出而厥。四肢拘急。脉微欲绝者。通脉四逆加猪胆汁汤主之。
吐下已止。阳气当复。阴邪当解。乃汗出而厥。四肢拘急。而又脉微欲绝。则阴无退散之期。阳
有散亡之象。于法为较危矣。故于四逆加干姜一倍。以救欲绝之阳。而又虑温热之过。反为阴气所
拒而不入。故加猪胆汁之苦寒。以为向导之用。内经盛者从之之意也。
四逆加猪胆汁汤方
于四逆汤方内加入猪胆汁半合。余根据前法服。如无猪胆。以羊胆代之。
吐利发汗。脉平。小烦者。以新虚不胜谷气故也。
吐利之后。发汗已。而脉平者。为邪已解也。邪解则不当烦而小烦者。此非邪气所致。以吐下后
胃气新虚。不能消谷。谷盛气衰。故令小烦。是当和养胃气。而不可更攻邪气者也。
这是通过设问来阐明霍乱病的概念。意思是邪气在上焦的，多表现为呕吐；邪气在下焦的，多表现为腹泻；邪气在中焦，向上逆则导致呕吐，向下注则导致腹泻，这就形成了霍乱。霍乱，意指发病迅速、病情混乱，顷刻间形成，变动不安，其发热恶寒的症状，也与阳明病相似。
问：如果病人出现发热、头痛、身体疼痛、恶寒，同时又有呕吐和腹泻，这属于什么病？答：这称为霍乱。病人先自行呕吐和腹泻，后来腹泻停止，却又再次出现发热。
这是对上一条内容的详细阐述。霍乱之病，本由外邪引起，因为人体中气不足，邪气乘虚入里，损伤脾胃从而引发呕吐和腹泻。所以会出现发热、头痛、身体疼痛、恶寒等症状。或者邪气直接侵犯脾胃，先出现呕吐和腹泻，等到腹泻停止、里气调和后，邪气又返回体表，从而引起发热。现在人吐利之后，往往出现发热、烦躁、口渴的情况，就是这种道理。
伤寒病，脉象微而涩的，原本就是霍乱。现在是伤寒，过了四五天，邪气传入阴经，转入阴经必然出现腹泻。原本有呕吐和腹泻的，不可治愈。如果想解大便却反而放屁，仍然没有腹泻的，属于阳明病。大便必定干硬，十三天会痊愈。之所以这样，是因为经气运行周期结束的缘故。
脉微表示少气，脉涩表示无血。伤寒病的脉象不应该是微涩的，反而出现微涩，是因为经历了霍乱呕吐和腹泻之后。原本是霍乱，现在是伤寒（指吐利止而复更发热），如上条所说。热则邪气回归体表，应当从阳分解除。然而过了四五天，邪气传入阴经，转入阴经必然出现腹泻，这是因为邪气不从阳分解除，反而入阴导致腹泻。在霍乱期间，既呕吐又腹泻，里气已经受伤。现在邪气转入里部又再次作泻，里气再次受伤，所以不可治愈。如果想解大便却反而放屁，仍然没有腹泻，说明胃气恢复并形成实证，邪气衰退想要退去。所以可以期待十三天痊愈。之所以这样，是因为十二天经气再周流一遍，大邪自然解除，再过一天，病必痊愈。
下利停止后，大便应当变硬。大便变硬且能吃东西的，是痊愈的表现。现在反而不能吃，到了下一个经气周期稍微能吃，再过一个经气周期能吃，过了一天应当痊愈。如果不愈，则不属于阳明病。
下利停止后，大便变硬的，是病后太阴转属阳明。阳明病，能吃东西的是胃气调和，不能吃东西的是胃气未调和。所以下利后，大便变硬且能吃东西的，是痊愈。或者起初不能吃，后来转而能吃的，超过前一天也会痊愈。那些不愈的，则病不属阳明，虽然能吃，也不能算作胃气调和，所以病不愈。
恶寒脉紧，是寒邪在表。恶寒脉微，是阳虚而阴盛。那么其腹泻为阴寒而非阳热，其停止也不是邪气尽除而是亡血所致。所以应当用四逆汤温里，加人参补虚益血。按此条本来不是霍乱证，张仲景认为霍乱之后，多有里虚不足而需要温养的，所以特别归类于此吧。
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服用。
霍乱，出现头痛、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。
霍乱包括呕吐和腹泻而言。头痛、发热、身体疼痛，是霍乱的表证。而有热多和寒多的区别，因为中焦是阴阳交汇之处，所以有的从阳化热而多热，有的从阴化寒而多寒。热多则渴欲饮水，所以给予五苓散去水泄热；寒多则不能胜水而不想饮，所以给予理中丸温土以胜水。
理中丸方
人参（三两） 甘草（三两） 白术（三两） 干姜（三两）
以上四味药，捣碎筛成粉末，用蜂蜜和丸，如鸡子黄大小。用沸水少许，溶化一丸，研碎温服。每日三次，夜间两次服用。腹中未觉温热，增加至三四丸。然而不如汤剂效果好。汤剂用法：将四味药按原重量切碎，用水八升，煮取三升，去渣，温服一升，每日三次。
加减法
如果脐上跳动，是肾气动，去掉白术，加桂枝四两。
脐上筑者，指脐上跳动不安，肾气上冲至脾。脾正受气，白术的甘味容易壅滞脾气，所以去掉它。桂枝的辛味能降肾气，所以加上它。
呕吐多的，去掉白术，加生姜三两。
呕吐多，说明气机向上壅滞，甘味容易壅气，所以去掉白术；辛味能散气，所以加生姜。
腹泻多的，仍用白术。心悸的，加茯苓二两。
腹泻多，脾气不守，所以需要白术来固摄。心悸，是肾水上逆，所以加茯苓来导引。
渴欲饮水的，加白术，补足至四两半。
渴欲饮水，是津液不足，白术的甘味足以生津。
腹中痛的，加人参，补足至四两半。
腹中痛，是里虚不足，人参的甘味足以补益。
怕冷的，加干姜，补足至四两半。
怕冷，是腹中寒气，干姜的辛味足以温煦。
腹部胀满的，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，微微保暖，不要掀开衣被。
腹部胀满，是气滞不行。气得甘味则壅滞，得辛味则通行，所以去掉白术加附子。
吐利停止，但身体疼痛不止的，应当斟酌情况，和解其表，宜用小剂量桂枝汤调和。
吐利停止，里气已调和。身体疼痛不止，是表证未解。所以需要桂枝汤和解表邪。所谓表病里和，发汗则愈。说“斟酌”、“小和”，是因为吐利之后，里气已伤，所以必须斟酌是否可以发汗而后发汗，也不可大汗，只需小和即可。
吐利伴出汗，发热恶寒，四肢拘急，手足厥逆的，用四逆汤主治。
这是阳虚霍乱的证候。发热恶寒，身体虽然发热却恶寒，身热是阳气格拒的假象，恶寒是虚冷的真谛。四肢拘急、手足厥逆，是阳气衰少，不能柔养筋脉，不能温煦四肢末端。所以宜用四逆汤助阳气而驱阴气。
既呕吐又腹泻，小便反利，且大汗出，下利清谷，内寒外热，脉微欲绝的，用四逆汤主治。
这也是虚冷霍乱的证候。四肢拘急、手足厥逆，是虚冷表现于外。下利清谷、脉微欲绝，是虚冷表现于内。其为霍乱则相同，所以吐利汗出、内寒外热，与上一条相同，而其使用四逆汤驱逐内盛的阴气，回复外散的阳气，也没有不同。
呕吐腹泻停止，但出汗且厥逆，四肢拘急，脉微欲绝的，用通脉四逆加猪胆汁汤主治。
吐下已止，阳气应当恢复，阴邪应当解散。现在却出汗且厥逆，四肢拘急，而且脉微欲绝，说明阴气没有退散的时候，阳气有散亡的迹象，这在治法上较为危重。所以在四逆汤基础上加倍干姜，以救欲绝之阳。而又担心温热太过，反被阴气拒绝而不入，所以加入猪胆汁的苦寒，作为向导之用。符合《内经》“盛者从之”的意思。
四逆加猪胆汁汤方
在四逆汤方内加入猪胆汁半合，其余按照前法服用。如果没有猪胆，可以用羊胆代替。
吐利发汗后，脉象平和，轻微烦闷的，是因为新虚的胃气不胜受纳谷气所致。
吐利之后，发汗已毕，脉象平和，说明邪气已解。邪气已解则不应烦闷，而出现轻微烦闷，这不是邪气所致，而是因为吐下后胃气新虚，不能消化谷气，谷盛气衰，所以导致轻微烦闷。此时应当调和养胃气，而不可再攻伐邪气。
Question: What is Huoluan disease? Answer: Vomiting accompanied by diarrhea is called Huoluan.
This sets up a question-and-answer format to clarify the concept of Huoluan disease. It means that when pathogenic factors are in the Upper Jiao (Upper Burner), vomiting predominates; when they are in the Lower Jiao (Lower Burner), diarrhea predominates; when they are in the Middle Jiao (Middle Burner), upward rebellion causes vomiting, and downward pouring causes diarrhea, thus forming Huoluan. Huoluan implies sudden onset and chaotic symptoms, developing in an instant with restless changes. Its symptoms of fever and aversion to cold are also similar to Yangming disease.
Question: If a patient presents with fever, headache, body pain, aversion to cold, along with vomiting and diarrhea, what disease does this belong to? Answer: This is named Huoluan. The patient initially vomits and has diarrhea, then the diarrhea stops, but fever recurs.
This elaborates on the meaning of the previous clause. Huoluan disease originates from external pathogens. Because the person's Middle Qi (Central Energy) is deficient, pathogens take advantage of the deficiency to enter the interior, damaging the Spleen and Stomach, thereby causing vomiting and diarrhea. Hence, symptoms such as fever, headache, body pain, and aversion to cold appear. Alternatively, pathogens directly invade the Spleen and Stomach, causing initial vomiting and diarrhea. When the diarrhea stops and the interior harmonizes, the pathogens return to the exterior, causing fever. Currently, after vomiting and diarrhea, patients often experience fever, restlessness, and thirst, which illustrates this principle.
In Shaoyang Cold Damage (Shanghan), if the pulse is faint and choppy, it was originally Huoluan. Now it is Shanghan. After four or five days, when the pathogen enters the Yin meridians and transitions into the Yin level, diarrhea must occur. If there was originally vomiting and diarrhea, it is difficult to treat. If one feels the urge to defecate but instead passes flatus and still does not have diarrhea, it belongs to Yangming. The stool will likely be hard. Recovery is expected on the thirteenth day. The reason for this is that the meridian cycle has completed its course.
A faint pulse indicates a lack of Qi, and a choppy pulse indicates a lack of Blood. In Shanghan, the pulse should not be faint and choppy; rather, it appears so because of the aftermath of Huoluan vomiting and diarrhea. Originally Huoluan, now Shanghan (referring to the recurrence of fever after vomiting and diarrhea cease), as mentioned in the previous clause. Heat implies pathogens returning to the exterior, where they should resolve via the Yang level. However, after four or five days, if the pathogen enters the Yin meridians and transitions into the Yin level, diarrhea occurs because the pathogen did not resolve via the Yang level but instead entered the Yin level causing diarrhea. During Huoluan, both vomiting and diarrhea occur, injuring the Interior Qi. Now, if the pathogen transitions inward and causes diarrhea again, the Interior Qi is injured a second time, making it difficult to treat. If one feels the urge to defecate but only passes flatus without diarrhea, it indicates that Stomach Qi has recovered and formed excess, while pathogens are declining and retreating. Thus, recovery can be expected on the thirteenth day. This is because after twelve days, the meridian Qi circulates twice, resolving major pathogens; after one more day, the illness must heal.
After diarrhea ceases, the stool should become hard. If the stool is hard and the patient can eat, it indicates healing. If currently unable to eat, but able to eat slightly during the next meridian cycle, and able to eat after another cycle, recovery is expected one day later. If not healed, it does not belong to Yangming.
After diarrhea ceases, if the stool becomes hard, it indicates the disease transitioning from Taiyin to Yangming. In Yangming disease, the ability to eat indicates harmonious Stomach Qi, while inability to eat indicates unharmonious Stomach Qi. Therefore, after diarrhea ceases, if the stool is hard and the patient can eat, it indicates healing. If initially unable to eat but later able to eat, recovery occurs after surpassing the previous day. Those who do not heal do not belong to Yangming; even if they can eat, it does not signify harmonious Stomach Qi, so the illness does not heal.
Aversion to cold, faint pulse, and diarrhea, where diarrhea stops due to loss of Blood, should be treated with Sini Decoction plus Ginseng (Sini Jia Renshen Tang).
Aversion to cold with a tight pulse indicates cold pathogens on the exterior. Aversion to cold with a faint pulse indicates Yang deficiency and Yin excess. Thus, the diarrhea is due to Yin-cold rather than Yang-heat, and its cessation is not due to the exhaustion of pathogens but due to loss of Blood. Therefore, Sini Decoction (Four Counterflow Decoction) should be used to warm the interior, and Ginseng added to tonify deficiency and benefit blood. Note: This clause originally does not describe a Huoluan syndrome. Zhang Zhongjing considered that after Huoluan, there are often cases of interior deficiency requiring warming and nourishment, hence it is specifically classified here.
Formula for Sini Decoction plus Ginseng (Sini Jia Renshen Tang):
Add one qian of Ginseng (Renshen) to the formula for Sini Decoction. Prepare and administer according to the method for Sini Decoction.
For Huoluan presenting with headache, fever, and body pain, if heat predominates and there is desire to drink water, Wuling San (Five-Ling Powder) should be used. If cold predominates and there is no desire to drink water, Lizhong Wan (Regulate the Middle Pill) should be used.
Huoluan encompasses vomiting and diarrhea. Headache, fever, and body pain are the exterior syndromes of Huoluan. There is a distinction between predominant heat and predominant cold because the Middle Jiao is the intersection of Yin and Yang. Thus, some transform from Yang with predominant heat, and some transform from Yin with predominant cold. Predominant heat leads to thirst and desire to drink, so Wuling San is given to drain water and clear heat. Predominant cold leads to inability to manage water and no desire to drink, so Lizhong Wan is given to warm Earth (Spleen/Stomach) to overcome water.
Formula for Lizhong Wan (Regulate the Middle Pill):
Ren Shen (Ginseng Root) (3 liang), Gan Cao (Licorice Root) (3 liang), Bai Zhu (Atractylodes Rhizome) (3 liang), Gan Jiang (Dried Ginger) (3 liang).
Grind the above four ingredients into powder. Mix with honey to form pills the size of a chicken egg yolk. Dissolve one pill in a small amount of boiling water, crush and take warm. Take three times daily and twice at night. If warmth is not felt in the abdomen, increase to three or four pills. However, decoctions are superior to pills. Method for decoction: Cut the four ingredients according to the weights listed. Boil in eight sheng of water until three sheng remain. Strain. Take one sheng warm, three times daily.
Modifications:
If there is throbbing above the navel, indicating Kidney Qi moving, remove Bai Zhu and add Gui Zhi (Cinnamon Twig) four liang.
"Throbbing above the navel" refers to pulsation above the navel, where Kidney Qi rises to the Spleen. Since the Spleen is receiving Qi, the sweetness of Bai Zhu may obstruct Spleen Qi, so it is removed. The pungency of Gui Zhi can descend Kidney Qi, so it is added.
If vomiting is excessive, remove Bai Zhu and add Sheng Jiang (Fresh Ginger) three liang.
Excessive vomiting indicates Qi stagnating upward. Sweetness obstructs Qi, so remove Bai Zhu; pungency disperses Qi, so add Sheng Jiang.
If diarrhea is excessive, continue using Bai Zhu. If palpitations occur, add Fu Ling (Poria) two liang.
Excessive diarrhea indicates Spleen Qi failing to hold; thus, Bai Zhu is needed to secure it. Palpitations indicate Water of the Kidney rebelling upward; thus, Fu Ling is added to guide it downward.
If there is thirst and desire to drink water, increase Bai Zhu to four and a half liang total.
Thirst and desire to drink water indicate insufficient Body Fluids. The sweetness of Bai Zhu is sufficient to generate fluids.
If there is abdominal pain, increase Ren Shen to four and a half liang total.
Abdominal pain indicates interior deficiency. The sweetness of Ren Shen is sufficient to tonify it.
If there is cold sensation, increase Gan Jiang to four and a half liang total.
Cold sensation indicates cold Qi in the abdomen. The pungency of Gan Jiang is sufficient to warm it.
If there is abdominal fullness, remove Bai Zhu and add one Fu Zi (Aconite Lateral Root). After taking the decoction, wait about the time it takes to eat a meal, then drink about one sheng of hot porridge to maintain slight warmth. Do not uncover clothes or blankets.
Abdominal fullness indicates stagnant Qi. Qi becomes obstructed by sweetness and moves with pungency; therefore, remove Bai Zhu and add Fu Zi.
If vomiting and diarrhea cease but body pain persists, carefully assess the situation and harmonize the exterior. Guizhi Tang (Cinnamon Twig Decoction) in a small dose should be used to harmonize.
When vomiting and diarrhea cease, the interior is harmonized. Persistent body pain indicates the exterior is unresolved. Therefore, Guizhi Tang is needed to harmonize the exterior. This is referred to as "exterior pathology with interior harmony," where sweating resolves the condition. The terms "carefully assess" and "small harmonization" are used because after vomiting and diarrhea, the interior Qi is injured. One must carefully assess whether sweating is appropriate before inducing sweat. Sweating should not be heavy; gentle harmonization is sufficient.
If vomiting and diarrhea are accompanied by sweating, fever, aversion to cold, spasm and stiffness of the limbs, and cold extremities, Sini Decoction (Four Counterflow Decoction) should be used.
This is a syndrome of Yang-deficient Huoluan. Fever and aversion to cold: although the body feels hot, there is aversion to cold. The body heat is a false appearance caused by Yang repulsion; aversion to cold is the true nature of deficiency-cold. Spasm/stiffness of limbs and cold extremities indicate deficient Yang Qi, unable to soften the sinews and warm the four extremities. Therefore, Sini Decoction should be used to assist Yang Qi and drive away Yin Qi.
If there is simultaneous vomiting and diarrhea, frequent urination, profuse sweating, diarrhea with undigested food (Qinggu), interior cold with exterior heat, and a faint pulse nearly imperceptible, Sini Decoction (Four Counterflow Decoction) should be used.
This is also a syndrome of deficiency-cold Huoluan. Spasm/stiffness of limbs and cold extremities represent deficiency-cold manifesting externally. Diarrhea with undigested food and faint pulse nearly imperceptible represent deficiency-cold manifesting internally. Although it is Huoluan, the presentation of vomiting/diarrhea/sweating, interior cold/exterior heat is identical to the previous clause. The use of Sini Decoction to drive out prevailing Yin and restore scattered Yang is also the same.
If vomiting and diarrhea have ceased, but there is sweating and cold extremities, spasm/stiffness of the limbs, and a faint pulse nearly imperceptible, Tongmai Sini Decoction plus Pig Bile (Tongmai Sini Jia Zhuzhi Dan Tang) should be used.
With vomiting and diarrhea stopped, Yang Qi should recover and Yin pathogens should dissipate. However, now there is sweating and cold extremities, limb stiffness, and a faint pulse nearly imperceptible. This indicates Yin has no time to dissipate, and Yang shows signs of scattering and loss. This is relatively critical in treatment. Therefore, double the amount of Gan Jiang in Sini Decoction to rescue the nearly extinct Yang. Furthermore, fearing that excessive heat might be rejected by Yin, bitter-cold Pig Bile is added as a guide. This aligns with the principle in the Neijing: "Follow the excess."
Formula for Sini Decoction plus Pig Bile (Tongmai Sini Jia Zhuzhi Dan Tang):
Add half he of Pig Bile to the formula for Sini Decoction. Prepare and administer according to the previous method. If Pig Gallbladder is unavailable, Sheep Gallbladder may be substituted.
After vomiting and diarrhea, if sweating occurs, the pulse becomes normal, and there is mild irritability, it is because the newly deficient Stomach Qi cannot withstand the grain Qi.
After vomiting and diarrhea, following sweating, if the pulse is normal, it indicates pathogens have resolved. With pathogens resolved, irritability should not occur. Mild irritability arises not from pathogens, but because after vomiting and diarrhea, the Stomach Qi is newly deficient and cannot digest grain. Excess grain Qi with deficient Stomach Qi causes mild irritability. At this point, one should harmonize and nourish Stomach Qi, and must not attack pathogens further.