论曰霍乱欲死者，真气厥而邪气盛也，或邪气暴争而未得吐利，或吐利虽极而邪气犹胜
，故真气为之困乏。其证烦闷痞满，四逆自汗，脉微若绝者是也，此由阴阳痞隔，不得升降
。内经所谓出入废则神机化减，升降息则气立孤危也。
治霍乱吐利已止，汗出而厥，四肢拘急不解，脉微欲绝。通脉四逆汤方
附子（炮裂去皮脐一枚） 甘草（炙一两半） 干姜（炮三分）
上三味。锉如麻豆，每服三钱匕，水一盏半，煎至一盏，去滓温服，脉出即愈。若面色
赤者，每服加葱白三寸，腹中痛者，每料加芍药二两，仍去葱白，呕逆者，每服加生姜五片，
咽痛者，去芍药加桔梗一两，利止脉不出者，去桔梗加人参二两，皆与方相应，乃服之。
（仲景用通脉四逆加猪胆汁汤）
治霍乱吐利，烦呕转筋，肉冷汗出，手足指肿，喘息垂死，语音不出，脉不通。人参汤
方
人参 附子（炮裂去皮脐） 浓朴（去粗皮生姜汁炙） 白茯苓（去黑皮）甘草（炙） 陈
橘皮（汤浸去
上一十味。锉如麻豆，每服三钱匕，水一盏，煎至七分，去滓温服不拘时。
治霍乱吐利不止，腹痛转筋，烦闷欲死。赤茯苓汤方
赤茯苓（去黑皮） 五味子 藿香叶（各半两） 黄 （锉） 当归（切焙） 白术（炒
各一分） 干木瓜 人参（各一两）
上八味。粗捣筛，每服三钱匕，水一盏，煎至七分，去滓温服，不拘时。
治霍乱不吐不利，气胀满闷欲绝者。阿魏丸方
阿魏 青橘皮（汤浸去白焙各一分） 酸石榴皮 五味子（各半两） 陈曲（炒一两）
上五味。先捣后四味。细罗为末，与阿魏同研令匀，用糯米糊丸，如梧桐子大。每服二
十丸，温熟水下，如脚转筋绝甚者，研开、温熟水调下。
治霍乱吐不止欲死。生姜散方
生姜（二两切焙） 陈橘皮（汤浸去白焙） 干木瓜（各一两）
上三味。捣罗为散，每服二钱匕，温水调下，连三五服。
治饮食伤饱，取凉过度，霍乱胀闷欲死，上下不通。雄雀粪散方
雄雀粪（二十一粒炒）
上一味。研细，用暖酒半盏调服，未效再服。
治霍乱多寒，手足厥冷脉绝。吴茱萸汤方
吴茱萸（半升洗焙炒） 当归（切焙） 桂（去粗皮） 芍药（各三分） 细辛（去苗
叶） 木通（锉） 甘草
上七味。 咀，如麻豆大，每服五钱匕，水一盏，酒半盏，入生姜一枣大拍碎，枣二枚
劈，煎至一盏，去滓温服，如气痞，加葛根半两，去枣。
论述：所谓霍乱欲死，是指人体真气衰竭而邪气亢盛。或者是邪气突然剧烈交争，导致患者尚不能呕吐或腹泻；或者是虽然呕吐和腹泻已经极度严重，但邪气依然强盛，因此导致真气困乏无力。其临床表现包括心烦闷乱、胸脘痞塞胀满、四肢逆冷、自汗出、脉象微弱似有若无等，这是由于阴阳之气痞塞阻隔，无法正常升降所致。《内经》所说的“出入废则神机化减，升降息则气立孤危”正是此意。
治疗霍乱呕吐腹泻已停止，但仍有出汗且四肢厥冷，四肢拘挛紧急未能缓解，脉象微弱几乎摸不到的情况。通脉四逆汤方：
附子（炮制裂开，去皮及脐，一枚） 甘草（炙，一两半） 干姜（炮制，三分）
以上三味药。切碎如麻豆大小，每次服用三钱匕，加水一盏半，煎煮至一盏，去渣后温服，若脉象复出则病愈。如果面色发红，每服加葱白三寸；如果腹中疼痛，每料加芍药二两，同时去掉葱白；如果呕吐逆气，每服加生姜五片；如果咽喉疼痛，去掉芍药加桔梗一两；如果腹泻停止但脉象不出，去掉桔梗加人参二两，这些加减法都与方义相应，然后才服用。（张仲景使用通脉四逆加猪胆汁汤）
治疗霍乱呕吐腹泻，心烦呕吐，转筋，肌肉冷汗出，手指脚趾肿胀，喘息垂危，声音发不出，脉道不通。人参汤方：
人参 附子（炮制裂开，去皮及脐） 浓朴（去除粗皮，用生姜汁炙） 白茯苓（去除黑皮） 甘草（炙） 陈橘皮（汤浸，去白焙）
以上十味药。切碎如麻豆大小，每次服用三钱匕，加水一盏，煎煮至七分，去渣后随时温服。
治疗霍乱呕吐腹泻不止，腹痛转筋，心烦闷乱欲死。赤茯苓汤方：
赤茯苓（去除黑皮） 五味子 藿香叶（各半两） 黄芪（切碎） 当归（切片焙干） 白术（炒，各一分） 干木瓜 人参（各一两）
以上八味药。粗捣筛过，每次服用三钱匕，加水一盏，煎煮至七分，去渣后随时温服。
治疗霍乱不吐也不泻，气胀满闷欲绝的情况。阿魏丸方：
阿魏 青橘皮（汤浸去白焙，各一分） 酸石榴皮 五味子（各半两） 陈曲（炒，一两）
以上五味药。先将后四味药捣碎，细筛为末，与阿魏一同研磨均匀，用糯米糊制作成梧桐子大小的丸剂。每次服用二十丸，用温熟水送下；如果脚部转筋极其严重的，将药丸研开，用温熟水调服。
治疗霍乱呕吐不止欲死。生姜散方：
生姜（二两，切片焙干） 陈橘皮（汤浸去白焙） 干木瓜（各一两）
以上三味药。捣碎过筛为散剂，每次服用二钱匕，用温水调服，连续服用三五次。
治疗因饮食过饱、贪凉过度导致的霍乱，胀闷欲死，上下气机不通。雄雀粪散方：
雄雀粪（二十一粒，炒）
以上一味药。研细，用暖酒半盏调服，若无效再服。
治疗霍乱多寒证，手足厥冷，脉绝。吴茱萸汤方：
吴茱萸（半升，洗净焙炒） 当归（切片焙干） 桂枝（去除粗皮） 芍药（各三分） 细辛（去苗叶） 木通（切碎） 甘草
以上七味药。切碎如麻豆大，每次服用五钱匕，加水一盏，酒半盏，放入生姜一块（大枣大小，拍碎），大枣两枚（劈开），煎煮至一盏，去渣后温服；如果出现气痞，加葛根半两，去掉大枣。
Commentary: The condition described as "Cholera Morbus approaching death" refers to a state where the True Qi (Zheng Qi, vital energy) is depleted while pathogenic factors are exuberant. This may occur because pathogenic factors suddenly and violently contend with healthy qi, preventing vomiting or diarrhea; or even if vomiting and diarrhea have reached an extreme severity, the pathogenic factors remain dominant, thereby exhausting the True Qi. Clinical manifestations include mental restlessness and oppression, chest and epigastric fullness and stuffiness, cold extremities, spontaneous sweating, and a faint pulse that seems almost absent. These symptoms arise from the obstruction of Yin and Yang, leading to the failure of their ascending and descending movements. As stated in the *Nei Jing* (Inner Canon): "When exit and entry cease, the Spirit mechanism diminishes; when ascending and descending stop, the Qi establishment stands in solitary peril."
For treating Cholera Morbus where vomiting and diarrhea have ceased, yet sweating and cold extremities persist, with spasms and tightness of the four limbs unresolved, and a faint pulse nearly imperceptible, use Tongmai Sini Tang (Pulse-Reviving Four Reversals Decoction).
Ingredients: Fuzi (Prepared Aconite Lateralis Radix Preparata, cracked, skin and umbilicus removed, one piece), Gancao (Prepared Licorice Root Preparata, roasted, 1.5 liang), Ganshengjiang (Dried Ginger, prepared, 3 fen).
Preparation: The above three herbs are chopped like hemp seeds. Each dose consists of 3 qianbi, boiled in 1.5 sheng of water until reduced to 1 sheng. Strain and take warm. Recovery is indicated by the reappearance of the pulse. If the facial complexion is red, add 3 cun of Congbai (Scallion White) per dose. If there is abdominal pain, add Shaoyao (Peony Root) 2 liang to the total prescription, removing the Congbai. If there is vomiting and rebellious qi, add 5 slices of Shengjiang (Fresh Ginger) per dose. If there is sore throat, remove Shaoyao and add Jiegeng (Platycodon Root) 1 liang. If diarrhea stops but the pulse does not emerge, remove Jiegeng and add Renshen (Ginseng Root) 2 liang. These modifications correspond to the formula's principles; administer accordingly. (Zhang Zhongjing used Tongmai Sini Jia Zhu Dan Tang [Pulse-Reviving Four Reversals Decoction with Pig Bile]).
For treating Cholera Morbus with vomiting and diarrhea, mental restlessness and vomiting, muscle cramps (zhuan jin), cold sweat on muscles, swelling of fingers and toes, gasping breath approaching death, inability to speak, and unpalpable pulse, use Renshen Tang (Ginseng Decoction).
Ingredients: Renshen (Ginseng Root), Fuzi (Prepared Aconite Lateralis Radix Preparata, cracked, skin and umbilicus removed), Houpo (Magnolia Bark, coarse skin removed, roasted with ginger juice), Baifuling (White Poria, black skin removed), Gancao (Prepared Licorice Root Preparata, roasted), Chenpi (Aged Tangerine Peel, soaked in water, white pith removed, roasted).
Preparation: The above ten herbs are chopped like hemp seeds. Each dose consists of 3 qianbi, boiled in 1 sheng of water until reduced to 70%. Strain and take warm at any time.
For treating Cholera Morbus with persistent vomiting and diarrhea, abdominal pain and muscle cramps, and severe mental restlessness approaching death, use Chifuling Tang (Red Poria Decoction).
Ingredients: Chifuling (Red Poria, black skin removed), Wuweizi (Schisandra Fruit), Huoxiangye (Patchouli Leaf, each 0.5 liang), Huangqi (Astragalus Root, chopped), Danggui (Angelica Sinensis Root, sliced and roasted), Baizhu (Atractylodes Macrocephala Rhizome, stir-fried, each 1 fen), Ganmugua (Dried Chaenomeles Fruit), Renshen (Ginseng Root, each 1 liang).
Preparation: The above eight herbs are coarsely crushed and sieved. Each dose consists of 3 qianbi, boiled in 1 sheng of water until reduced to 70%. Strain and take warm at any time.
For treating Cholera Morbus without vomiting or diarrhea, characterized by abdominal distension, fullness, and oppression approaching death, use Awei Wan (Asafoetida Pill).
Ingredients: Awei (Asafoetida), Qingjupi (Green Tangerine Peel, soaked in water, white pith removed, roasted, each 1 fen), Suan Shiliupi (Acid Pomegranate Peel), Wuweizi (Schisandra Fruit, each 0.5 liang), Chenqu (Stale Qu, stir-fried, 1 liang).
Preparation: First crush the last four ingredients, sift into fine powder, and mix uniformly with Awei. Form pills using rice paste, sized like paulownia seeds. Each dose consists of 20 pills, taken with warm cooked water. If leg cramps are extremely severe, crush the pill and mix with warm cooked water before administration.
For treating Cholera Morbus with incessant vomiting approaching death, use Shengjiang San (Fresh Ginger Powder).
Ingredients: Shengjiang (Fresh Ginger, 2 liang, sliced and roasted), Chenpi (Aged Tangerine Peel, soaked in water, white pith removed, roasted), Ganmugua (Dried Chaenomeles Fruit, each 1 liang).
Preparation: The above three herbs are crushed and sieved into powder. Each dose consists of 2 qianbi, mixed with warm water. Administer continuously for 3 to 5 doses.
For treating Cholera Morbus caused by overeating and excessive cooling, resulting in distension, oppression approaching death, and blockage of upper and lower qi, use Xiongquefen San (Male Sparrow Droppings Powder).
Ingredients: Xiongquefen (Male Sparrow Droppings, 21 grains, stir-fried).
Preparation: The above single herb is ground into fine powder, mixed with half a sheng of warm wine, and taken orally. If ineffective, repeat the dose.
For treating Cholera Morbus with predominant cold syndrome, cold extremities, and absent pulse, use Wuzhuyu Tang (Evodia Decoction).
Ingredients: Wuzhuyu (Evodia Fruit, half sheng, washed, roasted), Danggui (Angelica Sinensis Root, sliced and roasted), Guizhi (Cinnamon Twig, coarse bark removed), Shaoyao (Peony Root, each 3 fen), Xixin (Asarum Root, seedlings and leaves removed), Mutong (Akebia Stem, chopped), Gancao (Licorice Root).
Preparation: The above seven herbs are chopped like hemp seeds. Each dose consists of 5 qianbi, boiled in 1 sheng of water and half a sheng of wine, with one date-sized piece of Paishengjiang (Crushed Fresh Ginger) and two split Zao (Jujube Dates). Boil until reduced to 1 sheng. Strain and take warm. If there is qi stagnation/stuffiness, add Gegen (Kudzu Root) 0.5 liang and remove the dates.