治霍乱恶寒。脉微而复利。利止亡血也。此方主之。
四逆汤原方加人参（一两）
歌曰 四逆原方主救阳。加参一两救阴方。利虽已止知亡血。须取中焦变化乡。（内经
谓中焦取汁变化而赤是谓血。方用人参滋中焦之汁。非取其回阳也。）
蔚按。论云。恶寒脉微而复利。利止无血也。言霍乱既利而复利。其证恶寒。其脉又微。
可
则亡阴之义也。金匮曰。水竭则无血。即为津液内竭。故以四逆汤救其阳气。又加人参生其
津液。柯韵伯疑四逆汤原有人参。不知仲景于回阳方中迸绝此味。即偶用之。亦是制热药之
太过。惟救阴方中乃加之。韵伯此言。可知未尝梦见本草经也。
治霍乱病呕吐泄利。寒多不饮水者。
人参（三两） 甘草（三两） 白术（三两） 干姜（三两）
上四味。捣筛为末。蜜和为丸。如鸡子黄大。以沸汤数合和一丸。研碎。温服之。日三
四夜一服。腹中未热。益至三四丸。然不及汤。汤法以四物根据两数切。用水八升。煮取三升。
去
两。下多者。还用术。悸者。加茯苓二两。渴欲得水者。加术足前成四两半。腹中痛者。加
人参足前成四两半。寒者。加干姜足前成四两半。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。勿揭衣被。（按与服桂枝汤同法。可知伤寒不忌食也。）
歌曰 吐利腹疼用理中。丸汤分两各三同。术姜参草刚柔济。服后还余啜粥功。
加减歌曰 脐上筑者白术忌。去术加桂四两治。吐多白术亦须除。再加生姜三两试。若
还下多术仍留。输转之功君须记。悸者心下水气凌。茯苓二两堪为使。渴欲饮水术多加。共
投四两五钱饵。腹中痛者加人参。四两半兮足前备。寒者方内加干姜。其数亦与加参类。（足
前
灵胎云。桂枝汤之饮热粥。欲其助药力外散。此饮热粥。欲其助药力以内温。）
蔚按。论云。霍乱头痛发热身疼痛。热多饮水者。五苓散主之。寒多不用水者。理中丸
主之。曰霍乱者。呕吐而利也。头痛发热身疼痛者。内霍乱而外伤寒也。热渴者。以五苓散
助脾土以滋水津之四布。寒而不渴者。用理中丸理中焦而交上下之阴阳。盖以上吐下利。不
论寒热。治宜专顾其中也。王晋三云。人参、甘草甘以和阴。白术、干姜辛以和阳。辛甘相
辅以处中。则阴阳自然和顺矣。 此为温补第一方。论中言四逆辈。则此汤俱在其中。又治
大病瘥后喜唾。善读书者。于喜唾二字推展之。凡脾胃虚皆是。便可悟调理之善方矣。
程郊倩曰。参、术、炙草。所以固中州。干姜守中。必假之焰釜薪而腾阳气。是以谷入
于阴。长气于阳。上输华盖。下摄州都。五脏六腑。皆以受气矣。此理中之旨也。
治疗霍乱伴有恶寒，脉象微弱且再次出现下利。下利停止是因为阴血津液耗竭所致。此方主治此证。
四逆汤原方加入人参（一两）。
歌诀说：四逆汤原方主要用来挽救阳气，加入人参一两成为挽救阴液的方剂。虽然下利已经停止，但知道是阴血津液亡失，必须从中焦脾胃化生气血的地方获取生机。（《内经》中说中焦摄取水谷精微，变化而成赤色血液称为血。方中使用人参是为了滋养中焦的汁液，并非取其回阳的作用。）
蔚按：《伤寒论》中说，恶寒、脉微弱且再次下利，下利停止意味着无血可下。说的是霍乱既已下利又再次下利，其症状表现为恶寒，脉象又微弱，这可以理解为亡阴的含义。《金匮要略》说：津液枯竭则无血生成，这就是津液内竭的意思。所以用四逆汤来挽救其阳气，又加入人参以滋生津液。柯韵伯怀疑四逆汤原方中有人参，不知道张仲景在回阳救逆的方剂中摒弃了这味药，即使偶尔使用，也是为了防止热药太过猛烈。只有在救阴的方剂中才加入它。柯韵伯的这种说法，可知他未曾梦见过《神农本草经》。
治疗霍乱病，呕吐泄泻，寒气重而不想喝水的患者。
人参（三两） 甘草（三两） 白术（三两） 干姜（三两）
以上四味药，捣碎过筛成粉末，用蜂蜜调和做成丸药，大小如鸡蛋黄。用几合沸水将一丸药溶化，研碎，温服。每日三四次，夜间一次。如果腹中没有温热感，增加到每次三四丸。然而，效果不如汤剂好。汤剂的用法是将四味药按照上述重量切碎，用水八升，煮取三升，去渣。如果下利多者，仍保留白术；心悸者，加茯苓二两；口渴想喝水者，增加白术至前量的四两半；腹中痛者，增加人参至前量的四两半；寒气重者，增加干姜至前量的四两半；腹部胀满者，去掉白术，加附子一枚。服药后大约一顿饭的时间，喝热粥约一升，使身体微微温暖，不要揭开衣被。（按：这与服用桂枝汤的方法相同，可知伤寒病患者并不忌食。）
歌诀说：呕吐、下利、腹痛使用理中丸，丸剂和汤剂的各药分量都是三两相同。白术、干姜、人参、甘草刚柔相济，服药后还剩下喝热粥的功效。
加减歌诀说：脐上跳动不安者禁用白术，去掉白术加桂枝四两治疗。呕吐多者也要去掉白术，再加生姜三两试试。如果下利多者白术仍保留，输转津液之功务必记住。心悸者是心下水气凌犯，加茯苓二两可以作为佐使药。口渴想喝水者增加白术用量，共投四两五钱服用。腹中痛者加人参，达到四两半以满足前方需求。寒气重者在方中加入干姜，其数量也与加人参类似。（灵胎云：桂枝汤饮用热粥，是想帮助药力向外发散；这里饮用热粥，是想帮助药力向内温煦。）
蔚按：《伤寒论》中说，霍乱头痛、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。所谓霍乱，就是呕吐和泄泻。头痛、发热、身体疼痛，是内有霍乱而外受寒邪。热渴者，用五苓散帮助脾土功能，使水津布散全身。寒而不渴者，用理中丸调理中焦，使上下阴阳相交。大概因为上吐下泻，不论寒热，治疗应当专门顾护中焦。王晋三说：人参、甘草味甘以调和阴液，白术、干姜味辛以调和阳气。辛味与甘味相辅助以处于中焦，那么阴阳自然和谐顺遂了。这是温补的第一方。《伤寒论》中提到四逆汤类方剂，那么这个汤剂也包含在其中。又治疗大病痊愈后喜欢唾涎的情况，善于读书的人可以从“喜唾”二字推展思考，凡是脾胃虚弱都可能出现这种情况，就可以领悟到调理的好方法了。程郊倩说：人参、白术、炙甘草，是用来巩固中州的。干姜守中，必须借助它像釜底薪火一样腾起阳气。因此谷物进入阴分，在阳分生长气机，向上输送到华盖（肺），向下摄纳州都（膀胱）。五脏六腑，都由此接受气化了。这就是理中丸的宗旨。
Treats Huoluan (acute gastrointestinal disorder) with aversion to cold, a faint pulse, and recurrent diarrhea. The cessation of diarrhea indicates the depletion of Yin blood/fluids. This formula is indicated for this condition.
Sini Tang (Four Reversal Decoction) original formula plus Renshen (Ginseng Radix et Rhizoma) (1 liang).
The song states: Sini Tang originally saves Yang Qi; adding one liang of Renshen creates a formula to save Yin fluids. Although diarrhea has stopped, it is known that blood/fluids are depleted; one must seek transformation in the Middle Jiao. (The *Neijing* states that the Middle Jiao extracts juice, transforms it into red, and calls this blood. The formula uses Renshen to nourish the juice of the Middle Jiao, not to retrieve Yang.)
Wei notes: The Treatise says, "Aversion to cold, faint pulse, and recurrent diarrhea; cessation of diarrhea means no blood." It refers to Huoluan where diarrhea recurs. The symptoms include aversion to cold and a faint pulse, which implies the meaning of Yin depletion. The *Jingui Yaolue* states, "When water is exhausted, there is no blood," meaning internal exhaustion of body fluids. Therefore, Sini Tang is used to rescue Yang Qi, and Renshen is added to generate body fluids. Ke Yunbo doubted whether Renshen was originally in Sini Tang, not knowing that Zhang Zhongjing excluded this herb from formulas for retrieving Yang. Even if occasionally used, it was to moderate the excessive heat of other drugs. It is only added in formulas for rescuing Yin. Ke Yunbo's statement shows he had never dreamed of the *Shennong Bencao Jing*.
Treats Huoluan disease with vomiting and diarrhea, characterized by excess cold and no desire to drink water.
Renshen (Ginseng Radix et Rhizoma) (3 liang), Gancao (Licorice Root), Baizhu (Atractylodis Macrocephalae Rhizoma) (3 liang), Ganjiang (Dried Ginger) (3 liang).
The above four ingredients are crushed, sifted into powder, mixed with honey, and formed into pills the size of a chicken egg yolk. Dissolve one pill in several he of boiling water, crush, and take warm. Take three or four times daily, and once at night. If the abdomen does not feel warm, increase to three or four pills per dose. However, the decoction is more effective. For the decoction method, cut the four ingredients according to the specified weights, add eight sheng of water, boil to obtain three sheng, and remove the dregs. If diarrhea is severe, retain Baizhu; if palpitations occur, add Fuling (Poria) (2 liang); if thirsty and desiring water, increase Baizhu to 4.5 liang; if abdominal pain occurs, increase Renshen to 4.5 liang; if cold is prevalent, increase Ganjiang to 4.5 liang; if abdominal fullness occurs, remove Baizhu and add Fuzi (Aconiti Lateralis Radix Praeparata) (one piece). About the time of a meal after taking the medicine, drink about one sheng of hot porridge to maintain slight warmth, and do not uncover clothes or blankets. (Note: This is the same method as taking Guizhi Tang, indicating that patients with Shanghan [cold damage] are not restricted from eating.)
The song states: Use Lizhong Wan for vomiting, diarrhea, and abdominal pain; the dosages for both pill and decoction forms are identical at three liang each. Baizhu, Ganjiang, Renshen, and Gancao balance rigidity and softness; drinking hot porridge after administration contributes to the efficacy.
The song for modifications states: If there is beating above the umbilicus, avoid Baizhu; remove Baizhu and treat with Guizhi (Cinnamon Twig) (4 liang). If vomiting is frequent, also remove Baizhu; try adding Shengjiang (Fresh Ginger) (3 liang). If diarrhea is severe, keep Baizhu; remember its function of transporting fluids. Palpitations are caused by water qi harassing the heart; add Fuling (2 liang) as an assistant. If thirsty and desiring water, increase Baizhu; administer together totaling 4.5 qian. If abdominal pain occurs, add Renshen to reach 4.5 liang, sufficient for the previous requirement. If cold is present, add Ganjiang to the formula; the quantity is similar to adding Renshen. (Lingtai said: Drinking hot porridge with Guizhi Tang aims to assist the drug power to disperse outward; here, drinking hot porridge aims to assist the drug power to warm inwardly.)
Wei notes: The Treatise says, "Huoluan with headache, fever, and body pain, with heat predominance and desire to drink water, is treated with Wuling San (Five-Ingredient Powder with Poria)." "With cold predominance and no desire to drink water, Lizhong Wan is indicated." Huoluan is defined as vomiting and diarrhea. Headache, fever, and body pain indicate internal Huoluan combined with external cold injury. For heat and thirst, Wuling San assists the Spleen Earth to distribute fluid juices throughout the body. For cold without thirst, Lizhong Wan regulates the Middle Jiao to connect the upper and lower Yin and Yang. Generally, due to upper vomiting and lower diarrhea, regardless of cold or heat, treatment should focus on protecting the Middle Jiao. Wang Jin-san said: Renshen and Gancao are sweet to harmonize Yin; Baizhu and Ganjiang are acrid to harmonize Yang. Acrid and sweet assisting each other in the center allows Yin and Yang to naturally harmonize. This is the premier warming and tonifying formula. The Treatise mentions Si Ni category formulas, including this decoction. It also treats post-illness spitting of saliva. Those good at reading can deduce from "spitting saliva" that any Spleen-Stomach deficiency applies, revealing a good method for regulation. Cheng Jiaoqian said: Renshen, Baizhu, and Zhi Gancao (Honey-fried Licorice) consolidate the Central State. Ganjiang guards the center, relying on its flame like firewood under a pot to raise Yang Qi. Thus, grain enters the Yin, grows Qi in the Yang, transports upward to the Hua Gai (Lungs), and controls the Zhou Du (Bladder). The five zang and six fu organs all receive Qi. This is the essence of Lizhong.