《活人书》云∶霍乱，呕吐而利，热多而不渴，寒多而不饥，理中丸主之。吐利汗出，
发热恶寒，四肢拘急，手足厥冷，四逆汤主之。吐利已，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。钱氏吐泻问难∶广亲七太尉，七岁病吐泻，是时七月，其证全不
食而昏睡，睡觉而闷乱，吸气干呕，大便或有或无，不渴，众医以惊治之，疑睡故也。钱氏曰∶
先补脾，后退热，石膏汤。次日又以水银、硫黄末，生姜水调一字。八月十五日以后，吐泻身冷
，无阳也，不能乳，干呕，泻清褐水，当补脾，益黄散主之，不可下。守真云∶吐泻霍乱，三焦
为水谷传化道路，热甚则传化失常，而吐泻霍乱，火性燥动故也。或云热无吐泻，只是寒，此说
误也。《素问·至真要大论》云∶诸病喘呕吐酸，暴注下迫，转筋，小便混浊，腹胀大如鼓，
有声如鼓，痈疽疮疹，瘤气结核，吐下霍乱，皆属于火。
《活人书》云∶伤寒，论家方论不一，独伊芳尹、仲景之书，犹六经也，其余诸子百家，时
有一得，要之不可为法。况有好凉药者，附子、硫黄，笑而不喜用，虽隆冬，使人服三黄丸之类
，又有好热药者，如大黄、芒硝，则畏而不敢用，虽盛暑，劝人灸病，服金液之类。非不知罪福
，盖缘偏见所趋然也。又云∶近时用小柴胡汤，不问阴阳表里，凡伤寒之家，皆令服此药。盖
不可轻用，虽不若大柴胡汤、小承气汤紧要之药，病不相当，其为害也同，往往服小柴胡汤而成
阴证者，甚多矣。又云∶阴毒伤寒，心神烦躁，头痛，四肢逆冷，返阳丹主之。此方甚验，喘促
呕逆者，入口便住。若加小便不通，及阴囊缩入，小腹绞痛欲死，脐下二寸灸，仍与返阳丹、当
归四逆加吴茱萸生姜汤，慎勿与寻常利小便之药。寻常利小便之药者，多是冷滑药，此阴毒瓦斯在
小腹所致也。守真云∶大凡治病，必先明此寒暑燥湿风火六气，最为要也。故曰其治病之法，以
寒治热，以热治寒，以清治温，以湿治燥，乃正治之法也，又云∶逆治，所谓药气逆病之气也，
其病轻微，则当如此治。其病重，当从反治之法，其反治者，亦名从治，所谓从顺于病之气也，
是故经曰以热治热，以寒治寒。治热非谓病气热甚，更以热性之药治之，本是寒性之药，反热佐
而服之。所谓病气热甚，药气反寒，病热极甚，而拒其药寒，寒攻不入，寒热相争，则其病转加
也。故用寒药，反热佐而服之，令药气与病气不相违忤，其药性寒，热服下咽之后，热体既消，
寒性乃发，由是病气随愈。其余皆仿此。然正治之法，犹君刑臣过，逆其臣性而刑之矣，故热病
不甚，治之以寒，逆其病气，而病自除矣。反治之法，犹巨谏君非，顺其君性而说之，其始则从
，其终则逆，可以谏君失其邪而归于正也。《素问·至真要大论》云∶寒者热之，热者寒之，
从者
逆之，顺者从之。王冰注云∶病微犹救人火，得木而 ，得火而燔，可以水灭之，故逆其性气
而折之，病之气微，而攻之以寒。病湿犹救龙火，得湿而 ，遇水而燔，不知其性，以水折之，
以湿攻之，适足以光焰诣天，物穷方止矣。识其性者，反常之理，以人火逐之，则焰灼自消，炎
光扑灭。然逆之谓以寒攻热，以热攻寒，从之谓逆难入，从其性用，不必皆同，是以下又曰逆者
正治，从其反治。从小从多，观其事也，此之谓呼。
《活人书》说：霍乱，表现为呕吐且腹泻，热象明显但不口渴，寒象明显但不思饮食，用理中丸主治。若出现呕吐腹泻、出汗、发热恶寒、四肢拘挛紧急、手足冰冷，用四逆汤主治。若呕吐腹泻停止后，仍出汗且四肢厥冷，四肢拘挛未缓解，脉象微弱几乎摸不到，用通脉四逆加猪胆汁汤主治。
钱乙在《小儿药证直诀·吐泻问难》中记载：广亲七太尉，七岁时患吐泻病，当时是七月，症状是完全不吃东西且昏睡，醒来后感到烦闷混乱，吸气时干呕，大便有时有有时没有，不口渴，众医生认为是惊风而治疗，怀疑是因为睡觉导致的。钱乙说：先补脾，后退热，用石膏汤。第二天又用水银、硫黄粉末，用生姜水调服“一字”量。八月十五日以后，吐泻导致身体发冷，这是阳气衰竭的表现，不能吃奶，干呕，泻下清稀褐色的水，应当补脾，用益黄散主治，不可使用泻下药。
刘完素（字守真）说：吐泻霍乱，三焦是水谷传化运行的道路，热邪严重则传化功能失常，从而引起吐泻霍乱，这是因为火性燥动所致。有人说热证不会有吐泻，只是寒证，这种说法是错误的。《素问·至真要大论》说：各种气喘、呕吐、反酸、突然剧烈腹泻伴有里急后重、筋脉抽搐、小便混浊、腹部胀大如鼓、肠鸣有声、痈疽疮疹、肿瘤气块结核、以及吐下霍乱，都归属于火。
《活人书》又说：伤寒，各家方论不一，只有伊尹、张仲景的著作，如同六经体系一样规范，其余诸子百家，偶尔有一得之见，但终究不能作为法则。况且有好凉药的人，对附子、硫黄等热药，嘲笑而不喜欢使用，即使在隆冬，也让人服用三黄丸之类的寒凉药；又有好热药的人，对大黄、芒硝等寒下药，畏惧而不敢使用，即使在盛夏，也劝人艾灸治病，服用金液丹之类的温热药。他们并非不知道罪福因果，大概是由于偏执的观念所驱使罢了。又说：近来人们用小柴胡汤，不问阴阳表里，凡是患伤寒的人，都让他们服用此药。这不可轻易使用，虽然不如大柴胡汤、小承气汤那样峻猛紧要的药，但如果病情与药物不相适应，其危害是一样的，往往有人服用小柴胡汤后反而变成阴证，这种情况非常多。又说：阴毒伤寒，心神烦躁，头痛，四肢逆冷，用返阳丹主治。此方非常灵验，若有喘促呕逆的症状，药入口即止。如果加上小便不通，以及阴囊收缩入腹，小腹绞痛欲死，应在脐下二寸处施灸，同时给予返阳丹、当归四逆加吴茱萸生姜汤，千万不要给寻常利小便的药物。寻常利小便的药物，多是寒滑性质的药，这是阴毒之气积聚在小腹所致。刘完素说：大凡治病，必须先明白寒暑燥湿风火这六气，最为重要。所以说治病的方法，以寒治热，以热治寒，以清治温，以湿治燥，这是正治法。又说：逆治，所谓药气与病气相反，病情轻微时，应当这样治疗。如果病情严重，应当采用反治法。所谓的反治，也叫从治，所谓顺从病气的性质，所以经典说以热治热，以寒治寒。治疗热证，并不是说病气热甚，就用热性的药去治它，而是本是寒性的药，反过来用热药佐助而服用。所谓病气热甚，药气反而寒凉，病热极甚，而排斥寒凉的药，寒攻不入，寒热相争，那么病情就会加重。所以使用寒药，反而用热药佐助而服用，使药气与病气不相违背，药性虽然是寒的，但在热服下咽之后，体内的热气既已消除，寒性才发作，因此病气随之痊愈。其余情况都仿照这个原理。然而正治法，就像君主惩罚臣子的过错，违背臣子的本性来惩罚他，所以热病不严重时，用寒药治疗，违背病气，病自然除去。反治法，就像大臣直言规劝君主的过失，顺从君主的性情来说服他，开始是顺从，最终是纠正，可以谏正君主的邪僻而回归正道。《素问·至真要大论》说：寒者热之，热者寒之，从者逆之，顺者从之。王冰注释说：病势轻微就像救被火烧的人，得到木头就会燃烧，得到火就会更旺，可以用水熄灭它，所以违背它的性质气势来挫败它，病的气微，用寒药攻击它。病湿就像救龙火，遇到湿气就会旺盛，遇到水就会燃烧，如果不了解它的本性，用水去折损它，用湿去攻击它，恰好足以让光焰冲天，直到物体烧尽才停止。认识它本性的人，运用反常的道理，用人火去驱逐它，那么火焰灼烧自然消失，炎光扑灭。然而逆治是指用寒攻热，用热攻寒；从治是指当病气难以直接对抗时，顺从其性质用药，不必完全相同，所以下面又说逆者是正治，从者是反治。从小处看或从多处看，观察事情的本质，这就是所说的道理。
The *Huoren Shu* (Book of the Living) states: Huoluan (cholera-like syndrome with vomiting and diarrhea), characterized by vomiting and diarrhea, with predominant heat but no thirst, or predominant cold but no appetite, is primarily treated with Lizhong Wan (Regulate the Middle Pill). If accompanied by vomiting and diarrhea, sweating, fever, aversion to cold, spasticity of the four limbs, and coldness of the hands and feet, Sini Tang (Frigid Extremities Decoction) is primarily used. If vomiting and diarrhea have ceased, yet sweating and cold extremities persist, spasticity of the limbs remains unresolved, and the pulse is faint and nearly imperceptible, Tongmai Sini Jia Zhudanshi Tang (Pulse-Reviving Sini Decoction with Pig Bile) is primarily indicated.
Qian Yi, in his discussion on vomiting and diarrhea, records: The Seventh Taivwei of the Guangqin family, aged seven, suffered from vomiting and diarrhea in July. His symptoms included complete anorexia, lethargy, and upon waking, he felt irritable and confused, with dry heaving upon inhalation. Stool was intermittent, and there was no thirst. Other physicians treated it as Jingfeng (wind-stroke/convulsion), suspecting the lethargy was the cause. Qian Yi stated: First tonify the Spleen, then clear heat, using Shigao Tang (Gypsum Decoction). The next day, powder of Mercury and Sulfur was mixed with Ginger Juice and administered in a dose of "one character" (a small measure). After August 15th, due to vomiting and diarrhea, the body became cold, indicating Yang exhaustion; he could not take milk, experienced dry heaving, and passed clear brown watery stool. The Spleen should be tonified with Yihuang San (Yellow Protecting Powder); purgatives must not be used.
Liu Wansu (courtesy name Shouzhen) stated: In cases of vomiting, diarrhea, and Huoluan, the Sanjiao (Triple Burner) is the pathway for the transmission and transformation of food and fluids. When Heat is severe, this transformation function becomes abnormal, leading to vomiting, diarrhea, and Huoluan, because the nature of Fire is dry and agitated. Some claim that Heat does not cause vomiting and diarrhea, attributing it only to Cold; this view is erroneous. The *Suwen: Zhi Zhen Yao Da Lun* (Essential Questions: Great Treatise on the Most Important Principles) states: All conditions involving wheezing, vomiting, sour regurgitation, sudden violent diarrhea with tenesmus, muscle cramps, turbid urine, abdominal distension like a drum, borborygmus, carbuncles, sores, rashes, tumors, phlegm nodules, and vomiting/diarrhea Huoluan all belong to Fire.
The *Huoren Shu* further states: Regarding Shanghan (Cold Damage), various schools offer differing formulas and theories. Only the works of Yi Yin and Zhang Zhongjing serve as standard references akin to the Six Channels (Liujing); the insights of other schools are occasional and generally cannot serve as universal laws. Moreover, those who favor cooling medicines mock and avoid hot medicines like Fuzi (Aconite Root) and Liuhuang (Sulfur), even in deep winter, prescribing Sanhuang Wan (Three Yellows Pill) instead. Conversely, those who favor hot medicines fear cold-purgative drugs like Dahuang (Rhubarb Root) and Mangxiao (Mirabilite), avoiding them even in midsummer, and instead advise moxibustion and Jin Ye Dan (Golden Elixir Pill). They are not unaware of karmic consequences, but are driven by biased preferences. It is also noted that recently, Xiaochaihu Tang (Minor Bupleurum Decoction) is prescribed indiscriminately for all Shanghan patients, regardless of Yin/Yang or Exterior/Interior differentiation. This should not be used lightly. Although less potent than Daxiehu Tang (Major Bupleurum Decoction) or Xiao Chengqi Tang (Minor Order the Qi Decoction), if the pathology does not match the formula, the harm is similar. Many patients develop Yin syndromes after taking Xiaochaihu Tang. Additionally, for Yindu Shanghan (Yin-Toxin Cold Damage), characterized by mental restlessness, headache, and cold extremities, Fanyang Dan (Yang-Returning Pill) is indicated. This formula is highly effective, stopping wheezing and vomiting immediately upon ingestion. If accompanied by urinary retention, retraction of the scrotum, and excruciating lower abdominal pain, moxibustion should be applied two cun below the umbilicus, along with Fanyang Dan and Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction for Frigid Extremities plus Evodia and Fresh Ginger). Ordinary diuretics must be avoided, as they are typically cold and slippery in nature, which would exacerbate the accumulation of Yin-Toxin Qi in the lower abdomen. Liu Wansu stated: In treating any disease, one must first understand the Six Qi (Cold, Heat, Dryness, Dampness, Wind, Fire), which is paramount. Thus, the method of treatment involves using Cold to treat Heat, Heat to treat Cold, Clarity to treat Warmth, and Moisture to treat Dryness; this is Zhengzhi (Direct Treatment). He also discusses Nizhi (Contrary Treatment): when the pathogenic factor is mild, the medicinal qi opposes the disease qi. However, in severe cases, Fanzi (Reverse Treatment) should be employed. Fanzi is also called Congzhi (Following Treatment), meaning following the apparent nature of the disease qi. Hence, the classics state "treat Heat with Heat, treat Cold with Cold." Treating Heat does not mean using hot herbs for a hot condition; rather, it means using cold herbs but administering them hot, or adding hot adjuvants. If the disease Heat is extreme, it may reject cold medicine, causing a struggle between Cold and Heat that worsens the condition. Therefore, cold medicines are taken hot or with hot adjuvants so that the medicinal qi does not clash with the disease qi. Once swallowed, the initial heat dissipates, allowing the cold nature of the herb to act, thereby resolving the disease. Other scenarios follow this principle. Zhengzhi (Direct Treatment) is like a ruler punishing a minister's fault by opposing their nature; thus, for mild Heat, Cold herbs are used to oppose the disease qi, eliminating the illness. Fanzi (Reverse Treatment) is like a minister remonstrating with a ruler by initially complying with their nature to eventually correct their deviation. The *Suwen: Zhi Zhen Yao Da Lun* states: "Treat Cold with Heat, treat Heat with Cold; Follow implies Contrary, Contrary implies Follow." Wang Bing commented: A mild disease is like saving someone from fire; adding wood makes it burn, adding fire makes it blaze, so water extinguishes it by opposing its nature. For mild disease Qi, attack it with Cold. Dampness is like Dragon Fire; it flares up with dampness and burns with water. Ignoring its nature and attacking with water/wetness causes flames to reach the sky until fuel is exhausted. Those who understand its nature use human fire to drive it away, extinguishing the flames naturally. Thus, Nizhi (Contrary) means attacking Heat with Cold and Cold with Heat; Congzhi (Following) means when direct opposition is difficult, follow the nature of the disease to apply treatment. Hence, "Contrary is Direct Treatment, Following is Reverse Treatment." One observes whether to follow or oppose based on the situation.