中暑吐泻，四肢逆冷，吐蛔者，用乌梅安胃丸，
肝胃两和也。
按仲景谓蛔厥无阳症(1)。又厥阴篇云：气上撞心，饥不
欲食，食则吐蛔者，亦由中阳大损，厥浊上泛而然。故蛔乃
平人皆有，惟胃气调和，不得上涌，且邪不犯厥阴，亦不上
出。玆因吐泻已多，四肢厥冷，中焦阳气大伤，厥浊乘虚上
泛，故蛔自吐出。凡厥阴为病，必错染不一，用药亦难纯
粹，故用栋、连之苦寒降其逆，梅、芍之酸寒至其肝，又合
椒、姜之辛辣驱其阴浊，参、归，桂、附之甘温温补真阳
也。
中暑吐泻后，汗多肢冷，舌润而黑，并不渴饮，
此水极如火。宜用回阳救急汤，驱阴复阳也。
此条全以辨舌为要，不可以舌黑而遽为热极。盖凡黑而
焦者，果火极如水。今吐泻之后，汗多肢冷，阴症昭然。况
虽黑而润，并不渴饮，的是水极如火，系阴盛既剧，一线之
阳，杳杳欲脱，非借六君子汤补中州，兼姜、附、归、桂，
助阳驱阴，其不致危殆者几希矣。
中暑吐泻后，身反热，舌焦赤无苔，口渴不欲
食，此邪去阴伤。宜用（金柜）麦门冬汤加白芍，乌
(1)蛔厥无阳症：今本仲景（伤寒论）中无此语。唯《辨太阳病脉症并治
下》有"脏结无阳症；一语。当系作者记误。
梅、谷芽、荷夜等味，两济其阴也。
吐泻伤阴，故身反热，舌干赤无苔，口渴不欲食，皆胃
津大伤，不得化液上升。且胃为阳土，非柔莫济，"故用（金
柜）麦门冬汤，合乌梅、白芍之酸，谷、米之甘，化阴和阳
也。
中暑引起的呕吐腹泻，四肢逆冷，吐出蛔虫的，使用乌梅安胃丸，（这是为了）调和肝胃。
按：张仲景说蛔厥没有阳证(1)。又在《厥阴病篇》中说：“气向上冲撞心胸，饥饿但不想吃东西，吃东西就吐出蛔虫”，这也是因为中焦阳气大损，厥阴浊气上泛所致。所以蛔虫是普通人身体里都有的，只是因为胃气调和，不能向上涌出；而且邪气不侵犯厥阴经，也不会向上排出。现在因为呕吐腹泻已经很多，四肢厥冷，中焦阳气大伤，厥阴浊气乘虚上泛，所以蛔虫自然吐出。凡是厥阴经为病，必定症状错综复杂，用药也难以纯粹，所以用黄连、黄芩的苦寒之性来降逆，乌梅、白芍的酸寒之性来入肝，又配合花椒、生姜的辛辣来驱除阴浊，人参、当归、肉桂、附子的甘温之性来温补真阳。
中暑呕吐腹泻后，汗多肢冷，舌苔润而黑，并不口渴饮水，这是水极似火（阴盛格阳）。适宜使用回阳救急汤，驱散阴寒，恢复阳气。
这一条全以辨别舌象为关键，不可以因为舌黑就立刻认为是热极。大概凡是舌黑而焦燥的，确实是火极像水（热极似水）。现在在呕吐腹泻之后，汗多肢冷，阴证非常明显。况且虽然舌黑但湿润，并不口渴饮水，确实是水极似火，属于阴气盛极严重，一线阳气，隐隐约约快要脱失，如果不借助六君子汤补益中焦脾胃，兼用干姜、附子、当归、肉桂，帮助阳气驱散阴寒，那么不导致危殆的情况就很少了。
中暑呕吐腹泻后，身体反而发热，舌面焦赤无苔，口渴但不想进食，这是邪气已去但阴液受伤。适宜使用（金匮要略中的）麦门冬汤加白芍、乌梅、谷芽、荷叶等药物，同时滋养阴液。
呕吐腹泻损伤阴液，所以身体反而发热，舌干赤无苔，口渴不想进食，都是胃津大伤，不能化生津液上升。而且胃属阳土，非柔和滋润之物不能救济，所以使用（金匮要略中的）麦门冬汤，配合乌梅、白芍的酸味，谷芽、粳米的甘味，化生阴液，调和阴阳。
For heatstroke accompanied by vomiting and diarrhea, cold extremities, and expulsion of roundworms (Ascaris), use Wumei Angwei Wan (Plum Pill to Pacify the Stomach) to harmonize the Liver and Stomach.
Note: Zhang Zhongjing stated that Jueyue (Reversal Cold due to Roundworms) presents without Yang syndromes(1). Furthermore, in the *Jueyin Chapter* it is written: "Qi rushes upward to strike the heart, hunger with no desire to eat, and if one eats, roundworms are expelled." This is also caused by severe damage to the Middle Jiao Yang Qi, leading to the reflux of Jueyin turbid Yin. Therefore, roundworms are present in all normal people; only when Stomach Qi is harmonious do they not surge upward. Moreover, if pathogenic factors do not invade the Jueyin channel, they will not be expelled upward. In this case, due to excessive vomiting and diarrhea and cold extremities, the Yang Qi of the Middle Jiao is severely damaged. The Jueyin turbidity takes advantage of the deficiency to surge upward, causing the roundworms to be expelled. Diseases of the Jueyin channel invariably present with complex and mixed symptoms, making pure and simple medication difficult. Therefore, the bitter-cold properties of Huanglian (Coptidis Rhizoma) and Huangqin (Scutellariae Radix) are used to descend rebellious Qi; the sour-cold properties of Wumei (Mume Fructus) and Baishao (Paeoniae Radix Alba) are used to enter the Liver; combined with the pungent-warm properties of Huajiao (Zanthoxyli Pericarpium) and Shengjiang (Zingiberis Rhizoma Recens) to expel Yin turbidity; and the sweet-warm properties of Renshen (Ginseng Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Rougui (Cinnamomi Cortex), and Fuzi (Aconiti Lateralis Radix Praeparata) are used to warm and tonify True Yang.
After heatstroke-induced vomiting and diarrhea, with profuse sweating and cold limbs, a moist black tongue coating, and no thirst or desire to drink, this indicates Water Extremity resembling Fire (Yin Excess repelling Yang). One should use Huiyang Jiujitang (Decoction to Restore Yang and Save from Crisis) to drive out Yin and restore Yang.
This section emphasizes the differentiation of the tongue above all else; one must not hastily conclude extreme Heat solely based on a black tongue. Generally, a black and scorched tongue indicates extreme Heat resembling Water (Heat Extremity resembling Water). However, following vomiting and diarrhea, with profuse sweating and cold limbs, the Yin syndrome is evident. Furthermore, although the tongue is black, it is moist, and there is no thirst or desire to drink, confirming Water Extremity resembling Fire. This represents severe Yin Excess where a thread of Yang Qi is faintly on the verge of collapse. Without relying on Liujunzi Tang (Six Gentlemen Decoction) to tonify the Middle Jiao, along with Ganjiang (Zingiberis Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Danggui (Angelicae Sinensis Radix), and Rougui (Cinnamomi Cortex) to assist Yang and drive out Yin, the condition would hardly avoid being critical.
After heatstroke-induced vomiting and diarrhea, if the body feels hot instead, the tongue is scorched red without coating, and there is thirst but no desire to eat, this indicates that the pathogen has departed but Yin fluids are injured. One should use Maidong Tang (Ophiopogon Decoction) from the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) added with Baishao (Paeoniae Radix Alba), Wumei (Mume Fructus), Guya (Setariae Semen Germinatum), Heye (Nelumbinis Folium), etc., to simultaneously nourish Yin.
Vomiting and diarrhea injure Yin fluids, hence the body feels hot instead. A dry, scorched red tongue without coating, thirst, and no desire to eat are all signs of severe injury to Stomach Jin (fluids), preventing them from transforming and ascending. Since the Stomach is Yang Earth, it requires softening and moistening for relief. Therefore, Maidong Tang (Ophiopogon Decoction) from the *Jin Gui Yao Lue* is used, combined with the sourness of Wumei (Mume Fructus) and Baishao (Paeoniae Radix Alba), and the sweetness of Guya (Setariae Semen Germinatum) and Jingmi (Oryza Sativa Germen), to generate Yin fluids and harmonize Yin and Yang.