凡脾虚则泻，胃虚则吐，脾胃俱虚，吐泻并作。先吐而后泻者，是中焦之气不和，
不能消纳，必面赤唇红，烦渴溲短，厥脉洪数，乃受热之征也。先泻而后吐者，或饮食
乍加，夜睡肚冷，或寒湿伤脾，脾伤胃弱而成，必面白神倦，不热不渴，厥脉沉濡，是
虚寒之可征矣。又有夏月，外伤于暑，内伤于食，阴阳不能升降，乃乖膈而陡发者。又
有阳气不振，而吐泻不止者，亦有乳母冒
暑，儿饮热乳而然者。凡黄赤红色为热，白色为寒，青黑为痛。然吐则伤气，泻则伤
血，气虚则发厥，血虚则发热，气血俱虚，则身热而手足厥，继此必成慢风，可不慎
欤！惟疳泻不成风候，久则亦患无辜，终为虚乏。如泻注而脉浮大数者，死。或泻而腹
胀脉弦者，死。唇赤生疮，眼多赤脉者，死。久痢作呕，有声无物，唇鲜渴逆者，
死。洞泻不止者，死。如屋漏水而不止，食入则呕，昏沉眼窜，手足口鼻皆冷者，死。
舌黑有芒刺，此阴竭而孤阳上浮也。大渴不止者，此肾败也。俱死。
霍乱者，多得之于夏月，外感湿热风暑，内伤饮食生冷，阴阳痞膈，清浊相干，
上下奔迫，气乱肠胃之间，阳不降，阴不升，邪正相逆，中脘节闭，击搏于中，卒然
吐泻，而挥霍变乱，心腹大痛，呕吐泻利，憎寒壮热，头痛眩晕。邪在上焦，先心痛则
先吐；邪在下焦，先腹痛则先泻；邢在中焦，心腹并痛，则吐泻齐作。阳明润养宗
筋，吐泻骤亡津液，失其所养，甚则转筋入腹而毙。在小儿脾胃虚弱，乳食易停，兼外
冒寒暑，则邪正相攻，脾虚则泻，胃虚则吐，脾胃俱虚，吐泻并作，亡阳变风者有
焉。治法则宜定吐安胃为先，次以随症止泻为要。然湿霍乱死者少，干霍乱死者多。干
霍乱者，忽然胀满，心腹绞痛，上不得吐，下不得泻，躁乱昏愦，关格阴阳，遍体转
筋，手足厥冷，痰壅腹胀，顷刻之间，升降不通，便致闷绝，误迸饮食，立致杀人，此
乃寒湿太甚，脾被绊而不能动，气被郁而不能行，脾土郁极，不能发越，以致火热内
扰，所以卒痛，手足厥冷，恶心呕哕，俗名搅肠沙者，言其痛之甚也。不可过于攻，过
攻则脾愈虚；不可过于热，过热则火愈炽；不可过于寒，过寒则失捍格，须反佐以治，
然后郁可开，火可散也。北方刺青筋以出气血，南方括手足以行气血，俱能散病。然出
气血，又不若行气血之为愈，况霍乱乃气病，而非血病，刺青筋固能散气，然血亦因
之以伤，人之一身，气常有余，血常不足，今不足者，又从而伤之，是不足之中又不足
矣。少壮之人，幸或得免，衰老之人，多致于死，何则？夫气为血之先导，血为气之根据
附，今阴血既虚，则阳失其所根据，必然躁越，不死何待？况阳虚必恶寒，阴虚必发
热，热则阴血愈消。《经》曰∶阴虚则病，阴竭则死。惟宜以热童便入浇盐少许，三饮
而三吐之，宣提其气，盐涌于上，溺泄于下，则中通矣。或有单用淡盐汤探吐之，总
不出宣通发越之义，盖既有其人，必有其出，今有其入，而不得其出者，痞塞也，多
死。得吐后，方可用药调理，《脉诀》曰∶滑数为呕，代者霍乱；微滑者生，涩数凶
断。又曰∶滑而不匀，必是吐泻霍乱之侯。脉代勿讶，故凡吐泻，脉见结促代，或隐伏
或洪大，皆不可断以为死。果脉来微细欲绝，少气不语，舌倦囊缩者，方为不治。
夫气者，上下四旁之枢机，若中脘之气健旺有余，则驱下脘之气于大小肠，从前后
二阴而出。惟其不足，则无力运之下行，反受下脘之浊气，以致胃中清浊混乱，为痛为
胀之所由也。《经》曰∶太阴所至为中满，霍乱吐下，清气在阴，浊气在阳，营气顺
脉，卫气逆行，清浊相干，乱于肠胃，则为霍乱，呕吐泻之后，甚则转筋，此兼风也。
手足厥冷，气少唇青，此兼寒也。身热烦渴，气粗口燥，此暑病也。四肢重着，骨节
烦疼，此兼湿也。脚转筋者，以脘肺养宗所属，胃与大肠，今暴吐下，津液顿亡，内外
伤感，冷热不调，阴阳相搏而攻闭，诸脉枯削，宗筋失养，必致挛缩，甚则舌卷囊缩
者，难治也。凡遍身转筋，肢冷膈痛欲绝，脉洪者，易治。脉微弱渐迟者，死。及阳气
已脱，或遗尿不知，或气少不语，或膏汗如
珠或人躁欲入水，或四肢不收者，皆死。
如吐利不止，元气耗散，病势危笃，或口渴喜冷，或恶寒逆冷，或发热烦躁，欲去
衣被，此阴盛格阳也。不可以其喜冷欲去衣被为热症，当以理中汤。甚者，附子理中
汤；不效，则四逆汤，并宜冷服。
恶心者，无声无物，心中欲吐不吐，欲呕不呕。虽曰恶心实非心经之病，皆在胃口
之上，有痰、有热、有虚，皆宜用生姜，随症佐药，盖以生姜能开胃豁痰也。
凡是脾气虚弱就会腹泻，胃气虚弱就会呕吐，脾胃都虚弱，则呕吐和腹泻同时发生。先呕吐而后腹泻的，是中焦之气不和，不能消化食物，必然出现面色红赤、嘴唇发红、烦躁口渴、小便短少，脉象洪大而数，这是受热的征象。先腹泻而后呕吐的，或者是饮食突然增加，夜间睡觉腹部发冷，或者是寒湿损伤了脾脏，导致脾伤胃弱而形成，必然出现面色苍白、精神疲倦，没有发热也不口渴，脉象沉而濡软，这是虚寒的征象了。又有在夏季，外感暑邪，内伤饮食，阴阳之气不能升降，于是阴阳格拒而突然发作的。又有阳气不振，导致呕吐腹泻不止的，也有乳母感受暑邪，婴儿喝了热奶而导致的。凡是黄色、赤色、红色属于热证，白色属于寒证，青色、黑色属于痛证。然而呕吐会损伤气，腹泻会损伤血，气虚就会发生厥逆，血虚就会发热，气血都虚弱，就会出现身体发热而手脚冰凉，此后必然演变成慢惊风，能不谨慎吗！只有疳积引起的腹泻不会发展成惊风，但时间久了也会患上无辜病（一种儿科危重病症），最终导致身体极度虚弱。如果腹泻如水注下且脉象浮大数的，主死。或者腹泻而腹部胀满、脉象弦硬的，主死。嘴唇红赤生疮，眼睛有很多红血丝的，主死。久痢导致呕吐，有声音但没有东西吐出，嘴唇鲜红、口渴且气逆的，主死。洞泄（严重的水样腹泻）不止的，主死。像屋漏水滴落一样不止，吃进去就吐，神志昏沉、眼球上翻、手脚口鼻都冰冷的，主死。舌苔黑且有芒刺的，这是阴液枯竭而孤阳上浮。极度口渴不止的，这是肾脏败坏。这些情况都主死。
霍乱这种病，大多发生在夏季，外感湿热风暑，内伤饮食生冷，导致阴阳痞塞阻隔，清浊之气相互干扰，上下奔迫，气机紊乱于肠胃之间，阳气不降，阴气不升，邪正相逆，中脘闭塞，气机搏击于中，突然发生呕吐腹泻，挥霍变乱，心腹剧烈疼痛，呕吐泻利，憎恶寒冷且高热，头痛眩晕。邪气在上焦，先心痛则先呕吐；邪气在下焦，先腹痛则先腹泻；邪气在中焦，心腹都痛，则呕吐和腹泻同时发生。阳明经润养宗筋，呕吐腹泻骤然导致津液亡失，失去滋养，严重时会出现转筋（肌肉痉挛）入腹而死亡。对于小儿来说，脾胃虚弱，乳食容易停滞，加上外感寒暑，则邪正相攻，脾虚则腹泻，胃虚则呕吐，脾胃都虚弱，呕吐腹泻同时发生，甚至有亡阳而转化为惊风的。治疗法则应当以止吐安胃为先，其次根据症状止泻为要。然而湿霍乱死亡的少，干霍乱死亡的多。干霍乱，突然感到胀满，心腹绞痛，上不得吐，下不得泻，躁动混乱、神志昏愦，阴阳格拒，全身转筋，手脚冰冷，痰多腹胀，顷刻之间，升降不通，导致闷绝，误食饮食，立即致死，这乃是寒湿太甚，脾被束缚而不能运化，气被郁结而不能运行，脾土郁结至极，不能发散，以致火热内扰，所以突然疼痛，手脚冰冷，恶心呕吐，俗称“搅肠沙”，是说疼痛非常剧烈。不可过于攻下，过用攻下药则脾更虚；不可过于温热，过热则火更盛；不可过于寒凉，过寒则失去护卫，必须反佐用药来治疗，然后郁结可开，火热可散。北方用针刺青筋放出气血，南方用手足按摩行气活血，都能消散病邪。然而放出血气，不如行气活血更好，况且霍乱是气病，而不是血病，刺青筋固然能散气，但血也会因此受伤，人的身体，气常有余，血常不足，现在血已不足，又从而伤害它，这是不足之中又不足。年轻力壮的人，侥幸或许能免于一死，年老体衰的人，多会导致死亡，为什么呢？因为气是血的先导，血是气的依附，现在阴血既已虚弱，则阳气失去所依附，必然躁动越出，不死还等什么？况且阳虚必定怕冷，阴虚必定发热，发热则阴血更加消耗。《内经》说：阴虚则生病，阴竭则死亡。只适宜用热童便加入少许盐，喝三次吐三次，宣提其气，盐涌于上，溺泄于下，则中焦通畅了。或者有单用淡盐水探吐的，总不出宣通发散的义理，既然有了人（指病人），就一定有出路，现在有摄入，却没有排出，就是痞塞，多会死亡。得吐之后，才可以用药调理，《脉诀》说：滑数为呕吐，代脉为霍乱；微滑者生，涩数者凶断。又说：滑而不匀，必然是吐泻霍乱的征候。脉见代脉不要惊讶，所以凡是吐泻，脉见结促代，或隐伏或洪大，都不能断定为主死。果然脉来微细欲绝，少气不语，舌头卷缩、睾丸收缩的，才是不治之症。气，是上下四旁的枢纽，如果中脘之气健旺有余，则驱赶下脘之气进入大小肠，从前阴和后阴排出。正因为气不足，则无力运之下行，反而受到下脘浊气的侵袭，导致胃中清浊混乱，这就是产生疼痛和胀满的原因。《内经》说：太阴所致为中满、霍乱吐下，清气在阴分，浊气在阳分，营气顺脉而行，卫气逆行，清浊相互干扰，乱于肠胃，就形成霍乱，呕吐腹泻之后，严重时转筋，这是兼夹风邪。手脚冰冷，气少唇青，这是兼夹寒邪。身体发热烦渴，气粗口燥，这是暑病。四肢沉重，骨节烦疼，这是兼夹湿邪。脚部转筋的，因为肺与大肠相表里，胃与大肠相连，现在暴吐下，津液顿时亡失，内外伤感，冷热不调，阴阳相搏而闭阻，诸脉枯削，宗筋失去滋养，必然导致挛缩，严重时舌头卷缩、睾丸收缩的，难治。凡是遍身转筋，肢冷膈痛欲绝，脉象洪大的，易治。脉微弱逐渐变迟的，主死。以及阳气已脱，或者遗尿不知，或者气少不语，或者汗出如珠，或者人躁动想进水里，或者四肢不收的，都主死。
如果吐利不止，元气耗散，病势危笃，或者口渴喜冷饮，或者恶寒逆冷，或者发热烦躁，想要去掉衣被，这是阴盛格阳（真寒假热）。不可以因为他喜欢冷饮、想要去衣被就认为是热证，应当用理中汤。严重的，用附子理中汤；无效，则用四逆汤，并且宜冷服。
恶心，是没有声音也没有东西吐出，心中想吐却吐不出来，想呕却呕不出来。虽然叫恶心，实际上不是心经的病，都在胃口之上，有痰、有热、有虚，都适宜用生姜，随症配合药物，因为生姜能开胃豁痰。
Whenever Spleen Qi deficiency occurs, diarrhea ensues; when Stomach Qi is deficient, vomiting results; if both Spleen and Stomach are deficient, vomiting and diarrhea occur simultaneously. If vomiting precedes diarrhea, it indicates disharmony of the Qi in the Middle Jiao (Middle Burner), leading to an inability to digest and absorb food. This presents with a red face, red lips, irritability, thirst, short urine, and a flooding and rapid pulse, which are signs of heat accumulation. If diarrhea precedes vomiting, it may be due to sudden overeating, cold abdomen during sleep, or damage to the Spleen by cold-dampness, resulting in Spleen injury and Stomach weakness. This presents with a pale face, mental fatigue, absence of fever or thirst, and a deep and soggy pulse, indicating deficiency-cold. Additionally, in summer, external exposure to summer-heat and internal damage from food can cause the Yin and Yang to fail in their ascending and descending functions, leading to sudden onset due to Yin-Yang rejection (Ge Jue). There are also cases where weak Yang Qi leads to unceasing vomiting and diarrhea, or where a wet nurse contracts summer-heat, and the infant drinks hot milk, causing the condition. Generally, yellow, red, or crimson colors indicate heat; white indicates cold; green or black indicates pain. However, vomiting damages Qi, while diarrhea damages Blood. Qi deficiency leads to Jue syndrome (cold extremities/collapse); Blood deficiency leads to fever. If both Qi and Blood are deficient, there is body heat with cold extremities, which will subsequently develop into slow wind (chronic convulsions). One must be cautious! Only gan-xie (malnutrition diarrhea) does not lead to wind syndromes, but prolonged cases may result in "Wu Gu" disease (a pediatric critical condition), ultimately causing severe debility. If diarrhea is like water pouring and the pulse is floating, large, and rapid, death is imminent. If diarrhea is accompanied by abdominal distension and a wiry pulse, death is imminent. If lips are red with sores and eyes have many red vessels, death is imminent. If chronic dysentery leads to vomiting with sound but no substance, bright red lips, thirst, and rebellious Qi, death is imminent. If hole-like diarrhea (profuse watery stool) does not stop, death is imminent. If it resembles leaking roof water without stopping, food intake causes vomiting, consciousness is clouded, eyes roll upward, and hands, feet, mouth, and nose are all cold, death is imminent. A black tongue with prickles indicates exhaustion of Yin with floating solitary Yang. Unceasing extreme thirst indicates kidney failure. All these conditions are fatal.
Huo Luan (cholera-like illness) is mostly contracted in summer, due to external contraction of damp-heat, wind, and summer-heat, and internal damage from raw, cold, or improper diet. This causes Yin-Yang blockage, interference between clear and turbid Qi, and chaotic movement up and down. Qi becomes disordered in the intestines and stomach; Yang fails to descend, Yin fails to ascend, evil and righteous Qi oppose each other, the middle epigastrium closes, and Qi strikes internally, suddenly causing vomiting and diarrhea, turmoil, severe heart and abdominal pain, vomiting and loose stools, aversion to cold with high fever, headache, and dizziness. If the pathogen is in the Upper Jiao, heart pain precedes vomiting; if in the Lower Jiao, abdominal pain precedes diarrhea; if in the Middle Jiao, both heart and abdominal pain occur, leading to simultaneous vomiting and diarrhea. The Yang Ming channel moistens and nourishes the Zong Jin (tendons). Sudden loss of body fluids from vomiting and diarrhea deprives them of nourishment, potentially leading to tendon spasms extending into the abdomen and death. In infants, with weak Spleen and Stomach, milk and food easily stagnate. Combined with external exposure to cold and heat, evil and righteous Qi attack each other. Spleen deficiency causes diarrhea, Stomach deficiency causes vomiting, and dual deficiency causes simultaneous vomiting and diarrhea, potentially leading to Yang collapse and transformation into wind. The treatment principle should prioritize stopping vomiting and calming the Stomach, followed by symptom-specific cessation of diarrhea. Wet Huo Luan has fewer deaths, while dry Huo Luan has more. Dry Huo Luan presents with sudden fullness, severe heart and abdominal cramping, inability to vomit or defecate, restlessness, confusion, Yin-Yang rejection, generalized tendon spasms, cold hands and feet, phlegm obstruction, and abdominal distension. Within moments, ascending and descending functions cease, leading to suffocation and unconsciousness. Mismanagement with food/drink leads to immediate death. This is caused by excessive cold-dampness binding the Spleen, preventing movement, and郁结 (stagnation) of Qi, preventing flow. Extreme Spleen Earth stagnation fails to vent, causing internal heat disturbance, sudden pain, cold extremities, nausea, and retching. Commonly known as "Jiao Chang Sha" (Intestine-Turning Sand), referring to the severity of pain. Treatment must avoid excessive purgation (which further weakens the Spleen), excessive heat (which intensifies fire), or excessive cold (which compromises defense). Counter-assisting methods are required to open stagnation and dissipate fire. In the North, pricking blue veins to release Qi and Blood can disperse disease; in the South, manipulating hands and feet to promote Qi and Blood circulation works similarly. However, promoting Qi and Blood circulation is superior to merely releasing blood. Since Huo Luan is a Qi disorder, not a Blood disorder, pricking veins disperses Qi but also injures Blood. The body naturally has excess Qi and deficient Blood. Now, with existing deficiency, further injury creates double deficiency. Young and strong individuals may survive; the elderly often die. Why? Because Qi is the guide for Blood, and Blood is the foundation for Qi. With Yin-Blood deficiency, Yang loses its anchor and becomes restless, inevitably leading to death. Yang deficiency causes aversion to cold; Yin deficiency causes fever, which further consumes Yin-Blood. The Classic states: "Yin deficiency leads to disease; Yin exhaustion leads to death." The appropriate remedy is hot child's urine with a little salt, taken three times inducing vomiting each time. This promotes Qi ascent via salt and descent via urine, clearing the middle. Alternatively, plain salt water to induce vomiting follows this principle of promotion and clearance. If there is intake but no exit, it is blockage, often fatal. After vomiting subsides, medication can regulate the body. The Mai Jue says: "Slippery and rapid indicates vomiting; Intermitting pulse indicates Huo Luan; Micro-slippery indicates survival; Choppy and rapid indicates fatality." It also says: "Slippery but irregular indicates Huo Luan with vomiting and diarrhea." Do not be alarmed by an intermitting pulse. Thus, in vomiting and diarrhea, a knotted, hurried, intermitting, hidden, or flooding pulse does not necessarily indicate death. Only if the pulse is micro-fine and nearly absent, accompanied by shortness of breath, muteness, curled tongue, and retracted testicles, is it incurable. Qi is the pivot of the upper, lower, and four sides. If Middle Epigastric Qi is robust, it drives Lower Epigastric Qi into the small and large intestines for excretion via the anterior and posterior orifices. Due to insufficiency, it lacks power to move downward, instead being invaded by turbid Qi from below, causing confusion of clear and turbid Qi in the Stomach, leading to pain and distension. The Classic states: "Tai Yin manifestations include central fullness, Huo Luan, vomiting, and diarrhea. Clear Qi resides in Yin, Turbid Qi in Yang. Ying Qi flows smoothly in the vessels, Wei Qi moves in reverse. Interference between clear and turbid Qi in the intestines and stomach constitutes Huo Luan." Post-vomiting/diarrhea tendon spasms indicate concurrent Wind Cold. Cold extremities, shortness of breath, and cyanotic lips indicate concurrent Cold. Body heat, irritability, thirst, coarse breathing, and dry mouth indicate Summer-Heat. Heavy limbs and painful joints indicate concurrent Dampness. Tendon spasms in the legs occur because the Lung and Large Intestine govern the tendons connected to the Stomach and Large Intestine. Sudden vomiting and diarrhea cause instant fluid loss, internal/external injury, imbalance of cold and heat, and Yin-Yang conflict blocking the channels. Withered pulses and malnourished Zong Jin lead to spasms. Severe cases with curled tongue and retracted testicles are difficult to treat. Generalized tendon spasms, cold limbs, unbearable chest pain, and a flooding pulse are easy to treat. A micro-weak pulse gradually becoming slow indicates death. Yang collapse with incontinence, muteness, sweat like pearls, restlessness with desire to enter water, or flaccid limbs are all fatal.
If vomiting and diarrhea persist, Yuan Qi (Original Qi) scatters, and the condition is critical. Symptoms may include thirst for cold drinks, aversion to cold with cold extremities, or fever with irritability and desire to remove clothing. This is Yin Excess repelling Yang (True Cold, False Heat). Do not mistake the desire for cold/removal of clothes for a heat syndrome. Use Lizhong Tang (Regulate the Middle Decoction). For severe cases, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction); if ineffective, use Sini Tang (Frigid Extremities Decoction), administered cold.
Nausea (E Xin) is characterized by no sound and no substance expelled, a sensation of wanting to vomit but unable to do so. Although called "Heart Nausea," it is not a Heart meridian disease but located above the Stomach gate. It involves Phlegm, Heat, or Deficiency. Ginger is suitable in all cases, combined with other herbs based on symptoms, as Ginger opens the Stomach and resolves phlegm.