又治一妇。因肝脾郁滞。而不饮食二年。面部微黄浮肿。仍能步履。但肢体倦怠。肝脾二脉
浮弦。按之微而结滞。用六君子加吴茱萸。下痰积甚多。饮食顿进。形体始瘦。卧床月余。仍以
六君子加减。调理而安。
周慎斋治一人。饮食如常。每遇子时即吐。大便秘。询其人必有苦虑忧思。脾气郁结。故幽
门不通。宜扶脾开窍为主。用人参、白术以苍术拌炒、茯苓各一钱。炙甘草五分。附子煮乌药三
分。水煎服愈。
石顽疗吴江署篆张公。年壮体丰。恒有呕逆痰涎之恙。六脉每带濡滑。惟二陈加枳、术、石
斛辈。服之应手。良由政务繁冗。心力俱劳所致耳。
经云。清气在阴。浊气在阳。营气顺行。卫气逆行。清浊相干。乱于肠胃。则为霍乱。厥气
上逆则霍乱。
伤寒吐利。由邪气所伤。霍乱吐利。由饮食所伤。其有兼伤寒之邪。内外不和。加之头痛发
热而吐利者。是伤寒霍乱也。原仲景之意。岂非在饮食。如为是病。彼以寒邪传入下焦。胃气因
之不和。阴阳痞膈者。安得不有以致之乎。不然。何以用理中、四逆治之耶。此病多发于夏秋之
交。在寒月亦间有之。昔人云。多由伏暑所致。然亦未必皆尔。大抵湿土为风木所克则为是证。
故呕吐泻泄者。湿土之变也。转筋者。风木之变也。合诸论而求之始为活法。然多有郁结伤脾。
饮食停滞。一时停塞。气不升降而然。夏月霍乱吐泻作渴。胃苓汤加半夏、藿香。面赤口干。加
炒川连。春夏秋三
时。饮食后触冒暴寒成此证者。藿香正气散。若吐利转筋。为风木行脾。平胃散加木瓜。夏秋感
冒。吐泻霍乱。六和汤为要药。身热烦渴。气粗喘闷。或吐泻厥逆躁扰者。此伤暑霍乱。宜香薷
饮沉冷服。甚则手足厥逆少气。唇面爪甲皆青。六脉俱伏。而吐出酸秽。泻下臭恶。便溺黄赤者。
此火伏于厥阴也。为热极似阴之候。急作地浆。煎竹叶石膏汤。误作寒治必死。夏秋霍乱。多食
冷水瓜果所致。宜木香、藿香、陈皮、浓朴、苏叶、生姜。四肢重着。骨节烦疼。此兼湿也。二
术、二苓、浓朴、陈皮、泽泻。七情郁结。宜乌药、香附、木香、浓朴、枳壳、陈皮、紫苏。夏
秋之交。伤暑霍乱。大忌术、附、姜、桂种种燥热之药。误服必死。凡夏秋霍乱。有一毫口渴。
即是伏热。不可用温理脾胃药。如燥渴小便不利。五苓散为主。本方中肉桂亦宜酌用。惟泄泻不
渴。二便清利。不甚臭秽者。方可用理中温之。吐泻不止。元气耗散。病势危笃。或水粒不入。
或口渴喜冷。或恶寒战栗。手足逆冷。或发热烦躁。揭去衣被。此内虚阴盛。不可以其喜冷去被
为热。宜理中汤。甚则四逆汤。加食盐少许。若暴泻如水。周身汗出尽冷。脉弱不能言语。急投
浆水散。并须冷服。若冒暑伏热。腹痛作泻。或利或呕者。木瓜、吴茱萸。食盐同炒。煎汤温服。
胎前产后霍乱。另详本门。凡霍乱新定。周时内慎勿便与谷气。多致杀人。以胃气反逆。不能平
复也。如吐泻已多。元气耗极。审无邪者。方与米饮补养。举世治霍乱吐利。不问虚实寒热。概
用藿香正气。不知此方专主胃气不和。阴阳错乱。或夏秋寒热交加。饮食冷热并进。及水土不伏
之吐利霍乱。固为合剂。如见厥逆冷汗。虚烦喘哕。面赤戴阳。脉来虚微。弦细无力。此脾肾俱
虚。火衰不能生土。虚阳失守之候。在严冬见之。尤为最剧。猛进理中、四逆。尚恐不救。况堪
从事藿香正气等耗气之剂乎。
〔诊〕脉伏或微涩者霍乱。脉长为阳明本病。霍乱脉洪大吉。虚微迟细兼喘者凶。气口脉滑。乃膈间有宿食。虽吐
犹当以盐汤探吐之。吐尽。用和中药。凡吐泻脉见结促代伏。皆不可便断为死。霍乱之后。阳气
已脱。或遗尿不知。或气怯不语。或膏汗如珠。如躁欲入水。或四肢不收。舌卷囊缩。皆为死候。
干霍乱 心腹胀痛。欲吐不吐。欲泻不泻。烦躁闷乱。俗名搅肠痧。此土郁不能发泄。火热
内炽。阴阳不交之故。或问方论皆言宿食与寒气相搏。何以独指为火耶。曰。昏乱躁闷。非诸躁
狂越之属火者乎。每致急死。非暴病暴死之属火者乎。但攻之太过则脾愈虚。温之太过则火愈炽。
寒之太过则反捍格。须反佐以治。然后火可散耳。古法有盐煎童便。非但用之降火。且兼取其行
血。不可废也。一法。以盐汤探吐。并用盐填脐中。以艾灸二七壮屡效。
吐利 吐利者。言呕吐而利是也。上吐下利。烦扰躁乱。乃谓之霍乱。与但称吐利者有异。
盖暴于旦夕者为霍乱。可延至数日者为吐利耳。有吐泻及痢疾。进汤药太骤。以致呕逆。二陈加
豆蔻、砂仁。甚则加沉香。有热。加姜汁炒川连。干呕而利者。黄芩加半夏生姜汤。上吐下泻不
止。当渴而反不渴。脉微细而弱者。理中汤。或渴不能饮。脉细数。连理汤。夏月泄泻。或呕吐。
生姜汁调天水散。有痰积泄利不止。甚则呕而欲吐。利下不能饮食。由风痰羁绊脾胃之间。导痰
汤加羌、防。泻属脾。宜升胃。补中益气汤。吐属胃。宜醒脾。六君子加香、砂。吐泻并作。宜
升胃醒脾。二汤各半和服。
又治疗一位妇女。因为肝脾郁滞，导致两年不能进食。面部微黄且浮肿，仍能行走，只是肢体倦怠无力。肝脉和脾脉都呈现浮弦之象，重按则感觉微弱且结滞不畅。使用六君子汤加入吴茱萸，排出大量痰积后，饮食突然增加，身体开始消瘦。卧床休息一个多月后，仍以六君子汤加减进行调理而痊愈。
周慎斋治疗一个人。饮食正常，但每到子时（夜间11点至凌晨1点）就呕吐，大便秘结。询问此人必有忧虑思虑之事，脾气郁结，所以幽门不通畅。适宜以扶脾开窍为主治法。用人参、白术（用苍术拌炒）、茯苓各一钱，炙甘草五分，附子煮乌药三分，水煎服而愈。
石顽治疗吴江署理县令张公。年纪壮实，身体丰满，常有呕吐逆气、痰涎的毛病。六脉每带濡滑之象，只用二陈汤加入枳实、白术、石斛之类药物，服用后立刻见效。这主要是因为政务繁忙冗杂，心力俱劳所致。
经书说：清气在阴分，浊气在阳分，营气顺行，卫气逆行，清浊之气相互干扰，乱于肠胃，就形成霍乱。厥逆之气上逆也会引起霍乱。
伤寒引起的吐利，是由邪气伤害所致；霍乱引起的吐利，是由饮食所伤。如果有兼感伤寒邪气的情况，内外不和，加上头痛发热而吐利的，这是伤寒霍乱。推究仲景的本意，难道不是在饮食方面吗？如果是这种病，那是寒邪传入下焦，胃气因此不和，阴阳痞塞阻隔，怎么能不导致这种情况呢？否则，为什么用理中汤、四逆汤来治疗呢？这种病多发于夏秋之交，在寒冷的月份也有偶尔发生的。古人说，多由伏暑所致，然而也未必全都是这样。大体上是湿土被风木克制就产生这种证候。所以呕吐泻泄，是湿土的病变；转筋，是风木的病变。综合各种论述来探求，才是灵活的方法。然而多有因郁结伤脾，饮食停滞，一时停塞，气机不升降而导致的。夏季霍乱吐泻作渴，用胃苓汤加半夏、藿香；面赤口干，加炒黄连。春夏秋三季，饮食后触犯暴寒而成此证的，用藿香正气散。如果吐利转筋，是风木克伐脾土，用平胃散加木瓜。夏秋感冒，吐泻霍乱，六和汤是主要药物。身热烦渴，气粗喘闷，或吐泻厥逆躁扰的，这是伤暑霍乱，宜用香薷饮沉冷服用。严重时手足厥逆少气，唇面爪甲皆青，六脉俱伏，吐出酸秽之物，泻下臭恶，小便黄赤的，这是火伏于厥阴经，属于热极似阴的证候。急做地浆水，煎竹叶石膏汤。误作寒证治疗必死。夏秋霍乱，多因多吃冷水瓜果所致，宜用木香、藿香、陈皮、厚朴、苏叶、生姜。四肢沉重，骨节烦疼，这是兼有湿邪，用苍术、白术、茯苓、猪苓、厚朴、陈皮、泽泻。七情郁结，宜用乌药、香附、木香、厚朴、枳壳、陈皮、紫苏。夏秋之交，伤暑霍乱，大忌用白术、附子、干姜、肉桂等种种燥热药物，误服必死。凡是夏秋霍乱，有一毫口渴，就是伏热，不可用温理脾胃的药物。如果燥渴小便不利，以五苓散为主方，本方中的肉桂也应当酌情使用。只有泄泻不渴，大小便清利，不甚臭秽的，才可用理中汤温补。吐泻不止，元气耗散，病势危笃，或者水米不进，或者口渴喜冷，或者恶寒战栗，手足逆冷，或者发热烦躁，揭开衣被，这是内虚阴盛，不可以因为他喜欢冷、去掉衣被就认为是热证，宜用理中汤，严重时用四逆汤，加少许食盐。如果暴泻如水，周身汗出尽冷，脉弱不能言语，急投浆水散，并且必须冷服。如果冒受暑热伏邪，腹痛作泻，或利或呕的，用木瓜、吴茱萸与食盐同炒，煎汤温服。
胎前产后霍乱，另详在本门其他章节。凡是霍乱刚刚安定，一周之内千万不要立即给予谷食，多会导致死亡，因为胃气反而逆乱，不能平复。如果吐泻已经很多，元气耗竭，确认没有邪气的，才给予米饮补养。举世治疗霍乱吐利，不问虚实寒热，一概使用藿香正气散，不知道此方专门主治胃气不和，阴阳错乱，或夏秋寒热交加，饮食冷热并进，以及水土不服的吐利霍乱，固然合适。如果见到厥逆冷汗，虚烦喘哕，面赤戴阳，脉来虚微，弦细无力，这是脾肾俱虚，火衰不能生土，虚阳失守的证候。在严冬见到，尤为严重。猛进理中汤、四逆汤尚恐不能救活，何况能从事使用藿香正气散等耗气药剂呢？
〔诊法〕脉伏或微涩的是霍乱。脉长是阳明本病。霍乱脉洪大是大吉之兆，脉虚微迟细兼喘的是凶兆。气口脉滑，说明膈间有宿食，虽然呕吐，仍应当用盐汤探吐。吐尽后，用调和中药。凡是吐泻脉见结、促、代、伏，都不可立即断定为死证。霍乱之后，阳气已脱，或者遗尿不知，或者气怯不语，或者膏脂般的汗珠如珠，或者躁动想入水，或者四肢不收，舌卷囊缩，都是死候。
干霍乱：心腹胀痛，想吐吐不出，想拉拉不出，烦躁闷乱，俗名搅肠痧。这是土郁不能发泄，火热内炽，阴阳不交的缘故。有人问方论都说宿食与寒气相搏，为什么唯独指为火呢？回答说：昏乱躁闷，不是属于诸躁狂越之火证吗？每每导致急死，不是属于暴病暴死之火证吗？但是攻伐太过则脾更虚，温补太过则火更炽，寒凉太过则反而格拒，必须反佐以治疗，然后火才能消散。古法有用盐煎童便，不仅用来降火，而且兼取其行血作用，不可废弃。另一种方法，用盐汤探吐，并用盐填满脐中，用艾灸十四壮，屡获效验。
吐利：吐利，说的是呕吐而腹泻。上吐下利，烦扰躁乱，才称为霍乱。与单纯称吐利是有区别的。大概暴发于旦夕之间的是霍乱，可延续数日的是吐利罢了。有吐泻及痢疾，进汤药太急，以致呕逆，用二陈汤加豆蔻、砂仁，严重时加沉香。有热的，加姜汁炒黄连。干呕而腹泻的，用黄芩加半夏生姜汤。上吐下泻不止，当渴反而不渴，脉微细而弱的，用理中汤。或者渴但不能饮水，脉细数的，用连理汤。夏季泄泻，或呕吐，用生姜汁调天水散。有痰积泄利不止，甚至呕而欲吐，利下不能饮食，是由于风痰羁绊在脾胃之间，用导痰汤加羌活、防风。泻属脾，宜升胃气，用补中益气汤。吐属胃，宜醒脾，用六君子汤加香附、砂仁。吐泻并作，宜升胃醒脾，两方各半合服。
Also treated a woman. Due to liver and spleen qi stagnation (Liver and Spleen Qi Stagnation), she had been unable to eat for two years. Her face was slightly yellow and puffy, yet she could still walk, though her limbs were fatigued and weak. The Liver and Spleen pulses were floating and wiry (Floating and Wiry Pulses); upon deep pressure, they felt faint and knotted/stagnant. Six Gentlemen Decoction (Liuzi Junzi Tang) with Evodia Fruit (Wuzhuyu) was prescribed. After expelling a large amount of phlegm accumulation, her appetite suddenly improved, and her body began to emaciate. After lying in bed for over a month, she continued to be regulated with modified Six Gentlemen Decoction until she recovered.
Zhou Shenzhai treated a person whose diet was normal, but who vomited every time at Zi hour (11 PM - 1 AM). There was constipation. Upon inquiry, it was found that the person had likely suffered from worry and overthinking, causing Spleen Qi stagnation, thus blocking the pylorus (Youmen). The treatment should focus on supporting the Spleen and opening orifices. It consisted of Ginseng Root (Renshen), Atractodes Rhizome (Baizhu) stir-fried with Coix Seed (Cangzhu), Poria (Fuling), each 1 qian; roasted Licorice Root (Zhigancao) 0.5 qian; Aconite Root (Fuzi) boiled with Lindera Root (Wuyao) 0.3 qian. Taken as a water decoction, the patient recovered.
Shiwan treated Zhang Gong, acting magistrate of Wujiang. He was young and robust, but constantly suffered from vomiting, regurgitation, and phlegm-saliva. His six pulses often showed a soggy and slippery quality (Soggy and Slippery Pulses). Using Two Gentlemen Decoction (Erchen Tang) added with Immature Bitter Orange (Zhishi), Atractodes Rhizome (Baizhu), and Dendrobium Stem (Shihu), the effect was immediate. This was largely due to the burden of official duties and exhaustion of both physical and mental energy.
The Classics state: Clear Qi resides in the Yin, turbid Qi in the Yang; Ying (Nutritive) Qi flows smoothly, while Wei (Defensive) Qi moves in reverse. When clear and turbid Qi interfere with each other and chaos ensues in the intestines and stomach, Huoluan (Acute Vomiting and Diarrhea Syndrome) occurs. Rebellious Qi moving upward also causes Huoluan.
Vomiting and diarrhea caused by Cold Damage (Shanghan) result from pathogenic invasion; vomiting and diarrhea in Huoluan result from dietary injury. If there is a concurrent invasion of Cold Damage pathogens, leading to internal-external disharmony, accompanied by headache, fever, vomiting, and diarrhea, this is Shanghan Huoluan. Tracing Zhongjing's intent, is it not related to diet? In such cases, cold pathogens transmit to the Lower Jiao, causing Stomach Qi disharmony and Yin-Yang obstruction. How else could this happen? Otherwise, why use Lizhong Decoction (Lizhong Wan/Tang) or Sinistral Recovery Decoction (Sini Tang)? This disease mostly occurs during the transition between summer and autumn, though it occasionally happens in cold months. Ancients said it is mostly caused by latent summerheat, but not necessarily always so. Generally, when damp-earth is overcome by wind-wood, this syndrome arises. Thus, vomiting and diarrhea are transformations of damp-earth; muscle twitching (transverse spasm) is a transformation of wind-wood. Integrating various discussions to seek understanding constitutes flexible practice. However, many cases arise from emotional constraint injuring the Spleen, food stagnation, temporary blockage, and failure of Qi to ascend and descend. For summer Huoluan with vomiting, diarrhea, and thirst, Weiling Decoction (Weiling Tang) with Pinellia Tuber (Banxia) and Perilla Leaf (Huoxiang) is used; if the face is red and mouth dry, add fried Coptis Rhizome (Chuanlian). For spring, summer, and autumn, if this syndrome results from sudden exposure to cold after eating, Huoxiang Zhengqi San (Perilla Powder to Rectify the Qi) is indicated. If vomiting, diarrhea, and muscle twitching occur, indicating wind-wood attacking spleen-earth, Pingwei San (Powder to Maintain Stability) with Quince (Mugua) is used. For summer-autumn external contraction with vomiting, diarrhea, and Huoluan, Liuhe Tang (Decoction for Harmonizing the Six) is the essential medicine. If there is body heat, vexation, thirst, coarse breathing, panting, or vomiting/diarrhea with cold extremities and restlessness, this is summerheat-injuring Huoluan; Xiangru Yin (Elsholtzia Decoction) should be taken chilled. If severe, with cold extremities, shortness of breath, cyanosis of lips/face/nails, and all six pulses hidden (deep and faint), vomiting sour/foul matter, and foul-smelling diarrhea with yellow-red urine, this indicates fire latent in the Jueyin channel, presenting as extreme heat resembling yin. Prepare earth slurry water immediately and decoct Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). Misdiagnosing as cold will lead to death. Summer-autumn Huoluan is often caused by excessive consumption of cold water and fruits; Muguxiang (Aucklandia Root), Huoxiang, Chenpi (Tangerine Peel), Houpo (Magnolia Bark), Zisu (Perilla Leaf), and Shengjiang (Fresh Ginger) are suitable. If limbs are heavy and joints ache, dampness is involved; Cangzhu (Atractodes Rhizome), Baizhu, Fuling (Poria), Zhuling (Polyporus), Houpo, Chenpi, and Zexie (Alisma Rhizome) are used. For seven emotions constraint, Wuyao, Xiangfu (Cyperus Rhizome), Muxiang (Aucklandia Root), Houpo, Zhike (Immature Bitter Orange), Chenpi, and Zisu are appropriate. During the summer-autumn transition, for summerheat Huoluan, strictly avoid drying-hot herbs like Baizhu, Fuzi, Ganjiang (Dried Ginger), and Rougui (Cinnamon Bark); misusing them causes death. In any summer-autumn Huoluan, even slight thirst indicates latent heat; warming Spleen-Stomach medicines must not be used. If there is dry thirst and difficult urination, Wuling San (Five-Ingredient Powder with Poria) is primary; Rougui in this formula should be used cautiously. Only if there is diarrhea without thirst, clear urination and defecation, and no strong odor, can Lizhong Decoction be used to warm. If vomiting and diarrhea persist, depleting Yuan Qi, with critical condition, inability to take fluids, thirst preferring cold, aversion to cold with shivering, cold extremities, or fever with irritability removing covers, this is internal deficiency with excess yin. Do not mistake preference for cold and removing covers as heat; use Lizhong Decoction, or Sini Tang if severe, with a pinch of salt. If sudden profuse watery diarrhea, whole-body sweating with coldness, weak pulse, and inability to speak, urgently administer Jiangshui San (Fermented Rice Water Powder) and must be taken cold. If exposed to summerheat and latent fire, causing abdominal pain and diarrhea or vomiting, use Mugua, Wuzhuyu stir-fried with salt, decocted and taken warm.
For Huoluan before or after childbirth, see separate sections. Once Huoluan has stabilized, do not give grain food within a week, as this often leads to death because Stomach Qi rebels and cannot recover. If vomiting and diarrhea have depleted Yuan Qi significantly, and no pathogen remains, rice water may be given for nourishment. Worldwide treatments for Huoluan vomiting/diarrhea indiscriminately use Huoxiang Zhengqi San regardless of deficiency/excess or cold/heat. This formula specifically treats Stomach Qi disharmony, Yin-Yang confusion, summer-autumn alternating cold/heat, mixed hot/cold diet, and水土不服 (acclimatization issues). It is appropriate for these. However, if cold extremities, cold sweat, empty vexation, panting, facial redness (floating yang), and faint/string-tiny/powerless pulses are seen, this indicates dual deficiency of Spleen and Kidney, fire failing to generate earth, and loss of holding of deficient yang. Seen in deep winter, it is particularly severe. Even aggressive use of Lizhong and Sini Decoctions may fail to save; how much less can one use Qi-consuming agents like Huoxiang Zhengqi San?
[Diagnosis] Hidden or faint-choppy pulses indicate Huoluan. Long pulses indicate Yangming disease. A flooding pulse in Huoluan is auspicious; faint, slow, thin pulses with panting are ominous. Slippy pulse at the Qi Kou position indicates retained food in the diaphragm; despite vomiting, salt water should be used to induce vomiting again. After complete vomiting, harmonizing medicines are used. If the pulse shows jie (knotted), cu (rapid-interrupted), dai (intermittent), or fu (hidden) qualities during vomiting/diarrhea, do not immediately declare death. After Huoluan, if Yang Qi has collapsed, with urinary incontinence, fearfulness/silence, bead-like sweat, restlessness wanting to enter water, flaccid limbs, curled tongue, or retracted scrotum, these are signs of death.
Dry Huoluan: Abdominal distension and pain, desire to vomit but unable, desire to defecate but unable, vexation and confusion. Commonly known as "Intestine-Twisting Sha." This is due to earth stagnation failing to vent, intense internal fire, and non-interaction of Yin and Yang. One might ask: formulas discuss retained food clashing with cold, why specify fire? Answer: Confusion and restlessness belong to fire patterns of agitation. Frequent sudden death belongs to acute fire diseases. Over-attacking damages Spleen further; over-warming intensifies fire; over-cooling causes rejection. Counter-assistance (fan zuo) therapy is required to dissipate the fire. Ancient methods include salt-decocted child's urine, which lowers fire and promotes blood circulation; it should not be discarded. Another method: induce vomiting with salt water, fill the navel with salt, and moxa 14 times (2x7); this is frequently effective.
Vomiting and Diarrhea: Refers to vomiting accompanied by diarrhea. Upper vomiting and lower diarrhea with vexation and restlessness constitute Huoluan, distinct from mere vomiting and diarrhea. Acute onset within hours is Huoluan; lasting days is vomiting and diarrhea. For vomiting/diarrhea and dysentery where herbal medicine is administered too rapidly causing regurgitation, Erchen Tang with Cardamom Doukou and Amomum Fructus (Sharen) is used; add Costus Root (Chenxiang) if severe. If heat is present, add Coptis Rhizome stir-fried with ginger juice. For dry retching with diarrhea, Huangqin Banxia Shengjiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction) is used. For unceasing upper vomiting and lower diarrhea, if thirsty but not drinking, with faint-thin-weak pulses, Lizhong Decoction is used. If thirsty but unable to drink, with thin-rapid pulses, Lianli Tang (Coptis and Lizhong Decoction) is used. For summer diarrhea or vomiting, Tian Shui San (Heavenly Water Powder) adjusted with ginger juice. For persistent diarrhea/dysentery due to phlegm accumulation, even vomiting/desire to vomit and inability to eat due to diarrhea, caused by wind-phlegm binding the Spleen-Stomach, Daotan Tang (Phlegm-Guiding Decoction) with Qianghuo and Fangfeng is used. Diarrhea belongs to Spleen; raise Stomach Qi using Buzhong Yiqi Tang (Middle-Boosting and Qi-Enriching Decoction). Vomiting belongs to Stomach; awaken Spleen using Liujunzi Tang (Six Gentlemen Decoction) with Xiangfu and Sharen. For simultaneous vomiting and diarrhea, raise Stomach and awaken Spleen; mix half doses of both decoctions.