夫凡发汗后。饮水。水灌之。其人必喘。水药不得入口。则为逆。
伤寒结胸。为无热证者。宜与平和之药。若以水灌之。益令热不得出。当汗而不汗。即
烦。
夫寸口脉浮大。医反下之。此为大逆。浮则无血。大则为寒。寒气相搏。即为腹鸣。医
不知
夫伤寒五六日。而渴欲饮。未宜与也。为腹中热气尚少。不能消之。便更作病深矣。若
大渴
大法。冬宜热药。
夫凡病发热头痛。脉浮数。身有疼痛。宜温其表。
夫病腹满。下利。呕吐。身体疼痛者。宜温其里。
夫太阳病。下利不渴。其脏有寒。当宜温之。其人饮食入。则吐。手足寒。脉弦迟。此
为中
夫少阴病。其脉沉者。急当温之。下利不欲食者。当宜温之。下利脉迟紧。为痛未止。
下利
夫凡脉浮革者。自腹鸣。若渴之与水者。必哕。宜温之。
夫病下之后。续得下利。水谷不止。身体疼痛。急当救里。宜温之。与治中四逆附子汤。
诸
问曰。病有霍乱者何。答曰。呕吐而利。名霍乱。
（三焦者。水谷之道路。邪在上焦。则吐而不利。邪在下焦。则利而不吐。邪在中焦。
则既
者挥
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。
（发热头痛。身疼恶寒者。本是伤寒。因邪入里。伤于脾胃。上吐下利。令为霍乱。利
止里
伤寒其脉微涩者。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
者。
（微为亡阳。涩为亡血。伤寒脉微涩。则本是霍乱。吐利亡阳亡血。吐利止。伤寒之邪
未
利
若欲似大便。而反失气。仍不利者。利为虚。不利为实。欲大便而反失气。里气热也。此属
阳明。便必硬也。十三日愈者。伤寒六日传过三阴三阳。后六日。再传经尽。则阴阳之气和
。大邪之气去而愈也。）
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
（下利后。亡津液。当便硬能食。为胃和。必自愈。不能食者。为未和。到后经中。为
复过一经。言七日后再经也。颇能食者。胃气方和。过一日当愈。不愈者。暴热使之能食。
非阳
恶寒脉微而复利。利止而亡血也。四逆加人参汤主之。
（恶寒脉微而利者。阳虚阴胜也。利止则津液内竭。故云亡血。金匮玉函曰。水竭则无
血。
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。
（头痛发热。则邪自风寒而来。中焦为寒热相半之分。邪稍高者。居阳分。则为热。热
多欲
理中丸方
人参（甘温） 甘草（甘平炙） 白术（甘温） 干姜（辛热以上各三两）
（内经曰。脾欲缓。急食甘以缓之。用甘补之。人参、白术、甘草之甘。以缓脾气调中。
寒
沸
法
加减法
若脐上筑者。肾气动也。去术。加桂四两。
（脾虚。肾气动者。脐上筑动。内经曰。甘者令人中满。术甘壅补。桂泄奔豚。是相易
也。）
吐多者。去术。加生姜三两。
（呕家不喜甘。故去术。呕家多服生姜。以辛散之。）
下多者。还用术。悸者。加茯苓二两。
（下多者。用术以去湿。悸加茯苓。以导气。）
渴欲得水者。加术足前成四两半。
（津液不足。则渴。术甘以缓之。）
腹中痛者。加人参。足前成四两半。
（里虚则痛。加人参以补之。）
寒者加干姜。足前成四两半。
（寒淫所胜。平以辛热。）
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。
（胃虚。则气壅腹满。甘令人中满。是去术也。附子之辛。以补阳散壅。）
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。里和也。身痛不休。表未解也。与桂枝汤小和之。外台云。里和表病。汗之
则愈
吐利汗出。发热恶寒。四肢拘急。手足厥冷者。四逆汤主之。
（上吐下利。里虚。汗出。发热恶寒。表未解也。四肢拘急。手足厥冷。阳虚阴胜也。
与四
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。
（吐利亡津液。则小盒饭少。小便复利。而大汗出。津液不禁。阳气大虚也。脉微为亡
阳。
吐已下断。汗出而厥。四肢拘急不解。脉微欲绝者。通脉四逆加猪胆汁汤主之。
（吐已下断。津液内竭。则不当汗出。汗出者。不当厥。今汗出而厥。四肢拘急不解。
脉微
与
曰
吐利发汗。脉平小烦者。以新虚不胜谷气故也。
（内经曰。食入于阴。长气于阳。新虚不胜谷气。是生小烦。）
凡是发汗之后，饮水或用冷水浇灌身体，病人一定会气喘。水药无法入口，这就属于逆证。
伤寒结胸证，如果没有热象的，应当给予平和的药物。如果用冷水浇灌，会使热气更加无法散发，本该出汗却不出汗，就会导致烦躁。
寸口脉浮大，医生反而使用攻下法，这是大逆之治。脉浮说明血虚，脉大说明有寒。寒气相互搏结，就会引起腹中鸣响。医生不知道这一点……
伤寒病五六天，口渴想喝水，暂时不宜给饮。因为腹中热气尚少，不能消化水分，如果强行给水，会使病情加深。如果极度口渴……
治疗大法：冬季适宜使用温热药物。
凡是疾病表现为发热、头痛、脉浮数、身体疼痛的，适宜温解表邪。
凡是疾病表现为腹部胀满、腹泻、呕吐、身体疼痛的，适宜温补里虚。
太阳病，腹泻但不口渴，说明内脏有寒，应当温补。病人饮食入胃则呕吐，手足寒冷，脉象弦迟，这属于中焦寒盛……
少阴病，脉沉的，应当紧急温补。腹泻且不想进食的，应当温补。腹泻脉象迟而紧，说明疼痛未止……
凡是脉象浮革的，自感腹中鸣响，如果口渴给水喝，一定会发生呃逆（哕），应当温补。
凡是病后经过攻下，接着出现腹泻，水谷食物不止，身体疼痛，应当紧急救里，适宜温补。给予治中汤、四逆汤或附子汤等方剂。
三焦是水谷运行的道路。邪气在上焦，则只吐不泻；邪气在下焦，则只泻不吐；邪气在中焦……
问：患发热、头痛、身疼、恶寒、呕吐腹泻的病，这是什么病？答：这叫霍乱。自行呕吐腹泻后，如果腹泻停止……
（发热、头痛、身疼、恶寒，本是伤寒症状，因邪气入里，损伤脾胃，上吐下泻，从而形成霍乱。腹泻停止后……）
伤寒脉象微涩的，原本就是霍乱，现在是伤寒。过了四五日，邪气传入阴经，必然腹泻。原本呕吐，现转为腹泻……
（脉微表示亡阳，脉涩表示亡血。伤寒脉微涩，说明原本是霍乱，因吐利导致亡阳亡血。吐利停止后，伤寒的邪气尚未……）
如果想大便，反而放屁，仍不解大便的，腹泻属虚，不解大便属实。想大便却反而放屁，说明里气有热，这属于阳明病，大便必定干硬。十三天痊愈的，是因为伤寒六天传遍三阴三阳，再过六天，再次传经结束，则阴阳之气调和，大邪之气去除而痊愈。）
腹泻之后，大便应当变硬。大便硬并能吃东西的会痊愈。现在反而不能吃，到了下一个病程阶段稍微能吃，再过一个病程阶段能吃，过了一天……
（腹泻之后，津液亏损，大便应当变硬且能吃东西，说明胃气调和，必自愈。不能吃东西，说明胃气未和。到了下一个病程阶段，说明又经过一个周期，指七天后再经。稍微能吃，说明胃气刚开始调和，过一天应当痊愈。如果不愈，是暴热导致暂时能食，并非阳气恢复……）
（恶寒、脉微且腹泻，是阳虚阴盛。腹泻停止则津液内竭，所以说亡血。《金匮玉函》说：水枯竭则无血。）
霍乱病，头痛、发热、身体疼痛，热多、想喝水的，用五苓散主治。寒多、不想喝水的，用理中丸主治。
（头痛发热，说明邪气来自风寒。中焦是寒热相半的分野。邪气偏高的，居于阳分，则为热。热多欲……）
理中丸方：
人参（甘温） 甘草（甘平，炙） 白术（甘温） 干姜（辛热，以上各三两）
（《内经》说：脾喜缓，急食甘味以缓和它，用甘味补益它。人参、白术、甘草的甘味，用来缓和脾气、调理中焦。寒……）
沸……
法……
加减法：
（脾虚，肾气动者，脐上筑动。《内经》说：甘味令人中满。白术甘壅补，桂枝泄奔豚，所以互相替换。）
腹中痛的，加人参，增至四两半。
（里虚则痛，加人参以补之。）
寒重的加干姜，增至四两半。
（寒淫所胜，用辛热平抑。）
腹部胀满的，去掉白术，加附子一枚。服药后，约一顿饭工夫，喝热粥一升左右，微微保暖，不要掀开衣被。
（胃虚，则气壅导致腹满，甘味令人中满，所以去白术。附子的辛味，用来补阳散壅。）
吐利停止，但身体疼痛不休的，应当斟酌和解其表邪，宜用小剂量桂枝汤调和。
（吐利停止，里气已和。身体疼痛不休，表邪未解。给予桂枝汤小和之。《外台秘要》说：里和表病，发汗则愈……）
（上吐下利，里虚。汗出、发热恶寒，表未解。四肢拘急、手足厥冷，阳虚阴盛。给予四逆……）
既吐且利，小便反而通利，大汗出，下利清谷（完谷不化），内寒外热，脉微欲绝的，用四逆汤主治。
（吐利亡失津液，则小便应当减少。现在小便反利，且大汗出，津液不禁，阳气大虚。脉微为亡阳……）
呕吐腹泻停止，但汗出且四肢厥冷，四肢拘急不缓解，脉微欲绝的，用通脉四逆加猪胆汁汤主治。
（吐利停止，津液内竭，本不应汗出。汗出者，本不应厥。现在汗出而厥，四肢拘急不缓解，脉微……）
与……
曰……
Translation of the original text into modern vernacular Chinese, then into academic English based on WHO standards.
Any person who drinks water or is washed with cold water after sweating will certainly suffer from asthma (wheezing). If water and medicine cannot enter the mouth, it is considered a counter-indication (Ni syndrome).
In Cold Damage (Shanghan) with chest binding (Jie Xiong), if there are no heat signs, mild and balanced medicines should be administered. If washed with cold water, the heat will be further prevented from exiting. If sweating should occur but does not, irritability (Fan) will result.
If the Cun Kou pulse is floating and large, and the physician inappropriately uses purgation, this is a major contraindication. Floating indicates blood deficiency; large indicates cold. When cold qi combats, abdominal borborygmus occurs. The physician, unaware of this...
In Cold Damage lasting five to six days, if the patient is thirsty and desires water, it is not yet appropriate to give it. This is because the warm qi in the abdomen is still insufficient to transform the fluids. Giving water prematurely will deepen the disease. If extreme thirst...
The general principle: In winter, hot/warm medicines are suitable.
For diseases presenting with fever, headache, floating and rapid pulse, and body pain, warming the exterior is appropriate.
For diseases presenting with abdominal fullness, diarrhea, vomiting, and body pain, warming the interior is appropriate.
In Taiyang disease, if there is diarrhea without thirst, it indicates cold in the zang organs, and warming is indicated. If food intake leads to vomiting, cold hands and feet, and a wiry and slow pulse, this belongs to middle jiao cold excess...
In Shaoyin disease, if the pulse is deep, urgent warming is required. If there is diarrhea with loss of appetite, warming is indicated. If diarrhea presents with a slow and tight pulse, it indicates that pain has not ceased...
For any case where the pulse is floating and革 (ge, like a drum skin), accompanied by abdominal borborygmus, if the patient is thirsty and given water, hiccups (Yue) will definitely occur. Warming is indicated.
After a disease treated with purgation, if diarrhea continues with undigested food and water, and body pain persists, urgent rescue of the interior is needed, using warming methods. Administer Zhi Zhong Tang, Si Ni Tang, or Fu Zi Tang.
Q: What is Huoluan? A: Vomiting accompanied by diarrhea is called Huoluan.
The San Jiao (Triple Burner) is the pathway for food and fluids. If pathogenic factors are in the Upper Jiao, there is vomiting without diarrhea. If in the Lower Jiao, there is diarrhea without vomiting. If in the Middle Jiao...
Q: A patient has fever, headache, body ache, aversion to cold, vomiting, and diarrhea. What disease is this? A: This is named Huoluan. After spontaneous vomiting and diarrhea, if the diarrhea stops...
(Fever, headache, body ache, and aversion to cold are originally symptoms of Shanghan. Due to pathogens entering the interior and damaging the Spleen and Stomach, upper vomiting and lower diarrhea occur, forming Huoluan. After diarrhea stops...)
In 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 transfers to Yin, diarrhea must occur. Originally vomiting, now turning into diarrhea...
(A faint pulse indicates Yang collapse; a choppy pulse indicates Blood exhaustion. In Shanghan, a faint and choppy pulse suggests it was originally Huoluan, leading to Yang and Blood exhaustion through vomiting and diarrhea. After vomiting and diarrhea stop, the Shanghan pathogen has not...)
If one feels the urge to defecate but instead passes gas, and still does not defecate, diarrhea indicates deficiency, while constipation indicates excess. Feeling the urge to defecate but passing gas indicates Heat in the interior. This belongs to the Yangming stage, and the stool will likely be hard. Recovery in thirteen days occurs because Shanghan transmits through the Three Yin and Three Yang meridians in six days, and after another six days, the transmission cycle completes, harmonizing Yin and Yang Qi, eliminating the major pathogen, and resulting in recovery.)
After diarrhea, the stool should become hard. If it becomes hard and the patient can eat, they will recover. If currently unable to eat, but able to eat slightly in the next cycle, and able to eat fully after passing one more cycle, and recovering one day later...
(After diarrhea, Jin Ye (Body Fluids) are depleted, so the stool should become hard and the patient should be able to eat, indicating Harmonized Stomach Qi and inevitable self-recovery. Inability to eat means Qi is not yet harmonized. Arriving at the next cycle implies passing another period, referring to seven days plus another cycle. Being able to eat slightly means Stomach Qi is beginning to harmonize; recovery should occur in one day. If not recovered, the temporary ability to eat is caused by sudden Heat, not Yang restoration...)
Aversion to cold, faint pulse, and diarrhea; if diarrhea stops due to Blood exhaustion, Si Ni Jia Ren Shen Tang (Four Reversals Plus Ginseng Decoction) is the primary treatment.
(Aversion to cold, faint pulse, and diarrhea indicate Yang deficiency and Yin excess. Cessation of diarrhea means internal depletion of fluids, hence "Blood exhaustion." *Jin Gui Yu Han* states: When water is exhausted, there is no blood.)
For Huoluan with headache, fever, body pain, predominance of heat, and desire for water, Wu Ling San (Five Ingredient Powder with Poria) is the primary treatment. For predominance of cold and no desire for water, Li Zhong Wan (Regulate the Middle Pill) is the primary treatment.
(Headache and fever indicate pathogens from Wind-Cold. The Middle Jiao is the division where Cold and Heat meet. Pathogens higher up reside in the Yang aspect, causing Heat. Predominance of heat leads to...)
**Li Zhong Wan Formula:**
Ren Shen (Ginseng Root, Sweet and Warm), Gan Cao (Licorice Root, Sweet and Neutral, roasted), Bai Zhu (Atractylodes Rhizome, Sweet and Warm), Gan Jiang (Dried Ginger, Acrid and Hot; each 3 liang).
(*Nei Jing* states: The Spleen desires relaxation; urgently use Sweet flavors to relax it. Use Sweet to tonify it. The Sweetness of Ren Shen, Bai Zhu, and Gan Cao relaxes Spleen Qi and regulates the Middle. Cold...)
Boiling method...
Preparation method...
Modification rules:
If there is throbbing above the navel, it indicates Kidney Qi moving. Remove Bai Zhu and add Gui Zhi (Cinnamon Twig) 4 liang.
(Spleen deficiency with moving Kidney Qi causes throbbing above the navel. *Nei Jing* states: Sweet flavors cause fullness in the center. Bai Zhu is sweet and cloying; Gui Zhi drains Ben Tun (fleeing tumor). Hence the substitution.)
For excessive vomiting, remove Bai Zhu and add Sheng Jiang (Fresh Ginger) 3 liang.
(Patients with vomiting dislike Sweet flavors, so remove Bai Zhu. Patients with vomiting benefit from Fresh Ginger to disperse with its Acridity.)
For excessive diarrhea, continue using Bai Zhu. For palpitations (Ji), add Fu Ling (Poria) 2 liang.
(For excessive diarrhea, use Bai Zhu to drain Dampness. Add Fu Ling for palpitations to guide Qi.)
For thirst and desire for water, increase Bai Zhu to total 4.5 liang.
(Insufficiency of Jin Ye causes thirst; the Sweetness of Bai Zhu relieves it.)
For abdominal pain, add Ren Shen, increasing to total 4.5 liang.
(Interior deficiency causes pain; add Ren Shen to tonify it.)
For Cold, add Gan Jiang, increasing to total 4.5 liang.
(When Cold prevails, soothe it with Acrid-Hot flavors.)
For abdominal fullness, remove Bai Zhu and add one Fu Zi (Aconite Lateral Root). After taking the decoction, wait about the time of a meal, drink about 1 sheng of hot porridge, keep slightly warm, and do not uncover clothes or blankets.
(Stomach deficiency leads to Qi stagnation and abdominal fullness; Sweet flavors cause central fullness, hence remove Bai Zhu. The Acridity of Fu Zi tonifies Yang and disperses stagnation.)
If vomiting and diarrhea cease but body pain persists, carefully resolve the exterior harmoniously. Use a small dose of Gui Zhi Tang (Cinnamon Twig Decoction) to harmonize.
(Vomiting and diarrhea ceasing means the Interior is harmonized. Persistent body pain means the Exterior is unresolved. Administer Gui Zhi Tang in small doses to harmonize. *Wai Tai Mi Yao* states: When Interior is harmonized and Exterior is diseased, inducing sweat leads to recovery...)
For vomiting, diarrhea, sweating, fever, aversion to cold, limb contracture, and cold extremities, Si Ni Tang (Four Reversals Decoction) is the primary treatment.
(Upper vomiting and lower diarrhea indicate Interior deficiency. Sweating, fever, and aversion to cold indicate the Exterior is unresolved. Limb contracture and cold extremities indicate Yang deficiency and Yin excess. Administer Si Ni...)
For simultaneous vomiting and diarrhea, with urination becoming frequent, profuse sweating, diarrhea with undigested food, interior cold with exterior heat, and a faint pulse nearly imperceptible, Si Ni Tang is the primary treatment.
(Vomiting and diarrhea deplete Jin Ye, so urination should decrease. Frequent urination and profuse sweating indicate uncontrolled Jin Ye and severe Yang deficiency. Faint pulse indicates Yang collapse...)
If vomiting and diarrhea have stopped, but there is sweating and cold limbs, limb contracture remains unresolved, and the pulse is faint and nearly imperceptible, Tong Mai Si Ni Jia Zhu Dan Tang (Pulse-Restoring Four Reversals Plus Pig Bile Decoction) is the primary treatment.
(Cessation of vomiting and diarrhea means internal depletion of Jin Ye, so sweating should not occur. Those who sweat should not have cold limbs. Now, sweating with cold limbs and unresolved limb contracture with a faint pulse...)
With...
Says...
After vomiting, diarrhea, and sweating, if the pulse is normal but there is slight irritability, it is because the newly weakened body cannot tolerate the grain qi.
(*Nei Jing* states: Food enters the Yin and generates Qi in the Yang. New weakness cannot tolerate grain qi, thus generating slight irritability.)