〔《活》〕吐有冷热二症，寸口脉数，手心热，烦渴而吐，以有热在胃脘，五苓散主之。
寒多不饮水而吐者，理中汤去术加生姜主之。
阴症喘促及吐逆者，返阴丹入口便住。
大橘皮汤 治动气在下，不可发汗，发又无汗，心烦，骨节疼痛，目晕恶寒，食则反吐，谷不得入。先服
大橘皮汤，吐止后宜建中汤。
陈皮（一两半） 生姜（一两） 枣子（八枚） 甘草（炙，半两） 人参（一钱） 竹茹（半升）
上水三大盏，煮取一盏，分二服。
病患直患呕吐，而脚弱或疼，乃是香港脚，当作香港脚治之。（治见厥痹。）
腹满时痛，吐利不渴者，太阴病。论见腹瞒。（《活人》云∶理中汤中之。）病患脉阴阳俱紧，反汗
出者，亡阳也，此属少阴，法当咽痛而复吐利。少阴病吐利，手足厥冷，烦躁欲死者，吴茱萸汤主之。少阴
病吐利，手足不逆冷，反热者不死。脉不至者，灸少阴七壮。少阴病，吐利烦躁，四逆者死。少阴病下利，咳
而呕渴，心烦变不得眠者，
宜猪苓汤。（论见下利。）少阴病腹痛，小便不利，四肢重痛，自下利或呕者，真武去附子加生姜汤。（论见
下利。）少阴病下利，脉微涩，呕而汗出者，当温其上，灸之。（论见欲寐。温其上，谓下有寒气当温其上
以助阳气也。）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。（王叔和入
霍乱篇。）
太阳与少阳合病，头痛胁痛，往来寒热，自利而呕者，黄芩加半夏生姜汤。（论见合病。）发热汗出不
解，心中痞硬，呕吐下利者，宜大柴胡汤。（论见痞。）发汗后，水浆不得入口者为逆。若更发汗，必吐下
不止。呕吐而利者，名曰霍乱。病发热头痛身疼，恶寒吐利者，此名霍乱，自吐下，又利止，复更发热也。
霍乱头疼发热，身疼痛，热多饮水者，五苓散主之。
寒多不饮水者，宜理中汤。
人参 干姜（炮） 甘草（炙。各一两） 白术（二两）
上锉，每服四钱，水煎去渣，温服。如寒甚者，加干姜一两半。渴欲得水者，加白术一两半。脐上筑者，
肾气动也，去白术加桂枝二两。吐多者去白术，加生姜四两。下利多者，倍用白术。悸者加茯苓二两。腹满
者去白术，加附子一枚。服汤后，如食顷，饮热粥一升许，自温，勿发揭衣被。（《活人》云∶或四肢拘急，
或转筋者，亦去术加附子。）
吐利汗出，发热恶寒，四肢拘急，手足厥冷者，四逆汤主之。
〔《素》〕土郁之发，民病呕吐，霍乱注下。（六元正纪篇）太阴所至，为中满霍乱吐下。
上湿土霍乱，即仲景五苓散、理中丸之类是也。
岁土不及，风乃大行，民病霍乱飧泄。（气交变论）
上土虚风胜霍乱，即罗谦甫桂苓白术散之类是也。
热至则身热霍乱吐下。（六元正纪篇）
上热霍乱，即《活人书》香薷散之类是也。
〔《灵》〕足太阴之别，名曰公孙，去本节后一寸，别走阳明。其别者，入络肠胃，厥气上逆则霍乱，实则
肠中切痛，虚则蛊胀，取之所别也。（经脉篇）气乱于肠胃，则为霍乱，取之足太阴阳明，不下，取之三
里。（五乱篇东垣云∶足太阴期门穴也，足阳明中脘穴也。）
吐利止而身痛不休者，当消息和解其外，宜桂枝汤。恶寒脉微利止者，四逆加人参汤。（方论见恶寒。）
吐已下断，汗出而厥，四肢拘急不解，脉微欲绝者，通脉四逆汤加猪胆汁下之。
甘草（炙，二两） 干姜（三两） 附子（大一枚，去皮尖） 猪胆汁（半合）
上三味， 咀，水三盏，煎至二盏，去渣，纳猪胆汁，分作二次温服，其脉即来。
吐利发汗，脉平不烦者，以新虚不胜谷气故也。干呕而利，兼胁痛而表解者，宜十枣汤。心下痞硬而烦者，
宜甘草泻心汤。兼厥逆脉微者，通脉四逆汤、白通加猪胆汁汤。（详见干呕门。）
〔《脉》〕阴阳俱紧，至于吐利，其脉独不解，紧去人安，此为欲解。若脉迟至六七日不欲食，此为晚发，
水停故也，为未解。食自可者，为欲解。
【《活人书》】呕吐分为寒证和热证两种。如果寸口脉数，手心发热，心烦口渴且呕吐，这是因为胃脘有热，用五苓散主治。
大橘皮汤：治疗动气在下焦，不可发汗，若强行发汗则无汗，伴有心烦，骨节疼痛，头晕目眩，恶寒，进食后反而呕吐，食物无法进入体内。先服用大橘皮汤，待呕吐停止后，适宜服用建中汤。
配方：陈皮（一两半）、生姜（一两）、大枣（八枚）、甘草（炙，半两）、人参（一钱）、竹茹（半升）。
以上药材用水三大盏，煮取一盏药液，分两次服用。
患者单纯患呕吐，但脚部软弱或疼痛，这是香港脚（脚气病），应当按香港脚治疗。（治法见厥痹篇。）
腹部胀满，时而疼痛，呕吐腹泻且不口渴的，属于太阴病。相关论述见“腹满”条。（《活人书》说：理中汤中包含于此证中。）
患者脉象阴阳两部都紧，反而出汗的，是亡阳的表现，这属于少阴病，按照法则应当出现咽痛并伴有呕吐腹泻。少阴病出现呕吐腹泻，手足冰冷，烦躁欲死的，用吴茱萸汤主治。少阴病出现呕吐腹泻，手足不冰冷，反而发热的，不会死亡。脉搏摸不到的，灸少阴经穴位七壮。少阴病出现呕吐腹泻、烦躁、四肢厥冷的，预后不良致死。少阴病出现下利，咳嗽兼呕吐、口渴，心烦难以入睡的，适宜猪苓汤。（相关论述见“下利”条。）少阴病出现腹痛，小便不利，四肢沉重疼痛，自行下利或呕吐的，用真武汤去掉附子加入生姜汤。（相关论述见“下利”条。）少阴病出现下利，脉微涩，呕吐且出汗的，应当温补上部，进行艾灸。（相关论述见“欲寐”。温其上，是指下部有寒气，当温补上部以助阳气。）既呕吐又腹泻，小便通畅且大汗出，下利排出未消化的食物，内寒外热，脉微几乎摸不到的，用四逆汤主治。（王叔和将其归入霍乱篇。）
太阳经与少阳经合病，头痛胁痛，忽冷忽热，自行下利且呕吐的，用黄芩加半夏生姜汤。（相关论述见“合病”条。）发热出汗但病不解，心中痞塞坚硬，呕吐下利的，适宜大柴胡汤。（相关论述见“痞”条。）发汗后，水浆都无法入口的为逆证。如果再次发汗，必定导致呕吐腹泻不止。呕吐且腹泻的，称为霍乱。患病发热头痛身疼，恶寒呕吐腹泻的，这也称为霍乱，自行呕吐腹泻后，即使腹泻停止，又会再次发热。
配方：人参、干姜（炮制）、甘草（炙，各一两）、白术（二两）。
以上切碎，每次服用四钱，用水煎煮去渣，温服。如果寒邪严重的，增加干姜一两半。口渴想喝水的，增加白术一两半。脐上跳动不安的，是肾气动，去掉白术加入桂枝二两。呕吐多的，去掉白术，加入生姜四两。腹泻多的，加倍使用白术。心悸的，加入茯苓二两。腹部胀满的，去掉白术，加入附子一枚。服药后，约一顿饭的时间，喝热粥一升左右，保持体温，不要掀开衣被。（《活人书》说：或者四肢拘急，或者转筋的，也去掉白术加入附子。）
呕吐腹泻出汗，发热恶寒，四肢拘急，手足冰冷的，用四逆汤主治。
【《素问》】土气郁结发作时，百姓发病呕吐，霍乱泄泻。（出自六元正纪大论篇）太阴湿土之气所至，表现为中满、霍乱、吐下。
岁运土气不及，风气大行，百姓发病霍乱、完谷不化的泄泻。（出自气交变大论）
【《灵枢》】足太阴脾经的别络，名叫公孙，距离本节下一寸，别走阳明经。其分支，进入联络肠胃，厥气上逆则发生霍乱，实证则肠中剧烈疼痛，虚证则腹部蛊胀，取该别络穴治疗。（出自经脉篇）气乱于肠胃，则发生霍乱，取足太阴、足阳明经穴，若不愈，取足三里穴。（出自五乱篇 东垣注：足太阴期门穴，足阳明中脘穴。）
呕吐腹泻停止但身体疼痛不休的，应当斟酌情况调和表邪，适宜桂枝汤。恶寒脉微、腹泻停止的，用四逆加人参汤。（方论见恶寒条。）
呕吐腹泻已断绝，但出汗且手足冰冷，四肢拘急不缓解，脉微几乎摸不到的，用通脉四逆汤加入猪胆汁送服。
配方：甘草（炙，二两）、干姜（三两）、附子（大一枚，去皮尖）、猪胆汁（半合）。
以上三味药，捣碎，用水三盏，煎至二盏，去渣，纳入猪胆汁，分两次温服，脉搏就会恢复。
呕吐腹泻后发汗，脉象平和且不烦躁的，是因为新虚之体不胜受纳谷气所致。干呕且腹泻，兼有胁痛且表证已解的，适宜十枣汤。心下痞塞坚硬且烦躁的，适宜甘草泻心汤。兼有四肢厥冷、脉微的，用通脉四逆汤、白通加猪胆汁汤。（详见干呕门。）
【《脉经》】脉象阴阳俱紧，以至于出现呕吐腹泻，如果脉象独独不解，紧脉消失则人安适，这是将要痊愈。如果脉迟至六七日不欲饮食，这是晚发，因水饮停聚所致，为病未解。如果能正常进食的，为将要痊愈。
[From *Huoren Shu*] Vomiting is divided into two syndromes: cold and heat. If the Cun (inch) position of the pulse is rapid, the palms are hot, accompanied by irritability, thirst, and vomiting, this indicates heat in the Wei (Stomach) cavity; it is primarily treated with Wuling San (Five-Ingredient Poria Decoction).
For those who vomit due to excess cold without desire to drink water, Lizhong Tang (Regulate the Middle Decoction) with Bai Zhu (Atractodis Rhizoma) removed and Sheng Jiang (Fresh Ginger) added is primarily used.
For Yin syndromes presenting with panting and shortness of breath along with vomiting and reversal, Fanyin Dan (Return to Yin Pill) stops symptoms upon ingestion.
Daju Pi Tang (Large Tangerine Peel Decoction): Treats "moving qi" located in the lower jiao where sweating is contraindicated. If forced sweating occurs resulting in no sweat, accompanied by vexation, pain in bone joints, dizziness, aversion to cold, and postprandial vomiting preventing food intake, first administer Daju Pi Tang. After vomiting ceases, Jianzhong Tang (Establish the Middle Decoction) is appropriate.
Ingredients: Chen Pi (Tangerine Peel, 1.5 liang), Sheng Jiang (Fresh Ginger, 1 liang), Zao Zi (Jujube, 8 pieces), Gan Cao (Licorice Root, processed/honey-fried, 0.5 liang), Ren Shen (Ginseng Radix, 1 qian), Zhu Ru (Bamboo Shavings, 0.5 sheng).
Take three large bowls of water, decoct to obtain one bowl, divide into two doses.
If a patient suffers solely from vomiting but has weak or painful legs, this is Hongxiangjiao (Hongxiangjiao/Foot Qi), and should be treated as such. (Treatment see Jue Bi syndrome.)
Abdominal fullness with intermittent pain, vomiting and diarrhea without thirst belongs to Taiyin Bing (Taiyin Disease). The discussion is found under "Abdominal Fullness". (*Huoren Shu* states: Lizhong Tang is included in this context.)
If the pulse is tight at both Yin and Yang positions but there is spontaneous sweating, this indicates Wang Yang (Loss of Yang Qi); this belongs to Shaoyin Bing (Shaoyin Disease). According to the method, sore throat accompanied by vomiting and diarrhea should occur. For Shaoyin Bing with vomiting and diarrhea, cold extremities, and severe irritability desiring death, Wuzhuyu Tang (Evodia Fruit Decoction) is primarily used. For Shaoyin Bing with vomiting and diarrhea, if extremities are not cold but rather warm, the prognosis is non-fatal. If the pulse is absent, moxa should be applied to Shaoyin points for seven moxibustion cones. For Shaoyin Bing with vomiting, diarrhea, irritability, and cold extremities, the prognosis is fatal. For Shaoyin Bing with diarrhea, cough, vomiting, thirst, and vexation preventing sleep, Zhuling Tang (Polyporus Decoction) is appropriate. (Discussion see Diarrhea.) For Shaoyin Bing with abdominal pain, difficulty urinating, heaviness and pain in limbs, spontaneous diarrhea or vomiting, Zhenwu Tang (True Warrior Decoction) with Fu Zi (Aconite Lateral Root) removed and Sheng Jiang (Fresh Ginger) added is used. (Discussion see Diarrhea.) For Shaoyin Bing with diarrhea, faint and choppy pulse, vomiting, and sweating, the upper part should be warmed via moxibustion. (Discussion see Desire to Sleep. "Warming the upper part" refers to warming the upper body to assist Yang Qi when cold qi resides below.) When both vomiting and diarrhea occur, urine flows freely, profuse sweating ensues, diarrhea contains undigested food, internal cold presents with external heat, and the pulse is faint and nearly imperceptible, Sini Tang (Frigid Extremities Decoction) is primarily used. (Wang Shuhe placed this in the Huoluan chapter.)
When Taiyang Bing (Taiyang Disease) and Shaoyang Bing (Shaoyang Disease) combine, presenting with headache, hypochondriac pain, alternating chills and fever, spontaneous diarrhea, and vomiting, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Decoction with Added Pinellia and Fresh Ginger) is used. (Discussion see Combined Diseases.) With fever and sweating that do not resolve, epigastric fullness and hardness, vomiting, and diarrhea, Dachaihu Tang (Major Bupleurum Decoction) is appropriate. (Discussion see Epigastric Fullness.) After sweating therapy, if fluids cannot enter the mouth, it is considered adverse. Further sweating will cause incessant vomiting and diarrhea. Vomiting accompanied by diarrhea is named Huoluan (Cholera-like disorder). Disease with fever, headache, body ache, aversion to cold, vomiting, and diarrhea is also named Huoluan; after spontaneous vomiting and diarrhea cease, fever may recur.
For Huoluan with headache, fever, body pain, excessive heat, and desire to drink water, Wuling San (Five-Ingredient Poria Decoction) is primarily used.
For excessive cold without desire to drink water, Lizhong Tang (Regulate the Middle Decoction) is appropriate.
Ingredients: Ren Shen (Ginseng Radix), Gan Jiang (Dried Ginger, processed), Gan Cao (Licorice Root, honey-fried, each 1 liang), Bai Zhu (Atractodis Rhizoma, 2 liang).
Crush ingredients. Take 4 qian per dose, decoct in water, strain, and take warm. If cold is severe, add Gan Jiang (Dried Ginger) 1.5 liang. If thirsty and desiring water, add Bai Zhu (Atractodis Rhizoma) 1.5 liang. If pulsation above the umbilicus occurs (indicating Kidney Qi movement), remove Bai Zhu (Atractodis Rhizoma) and add Guizhi (Cinnamon Twig) 2 liang. If vomiting is frequent, remove Bai Zhu (Atractodis Rhizoma) and add Sheng Jiang (Fresh Ginger) 4 liang. If diarrhea is frequent, double the use of Bai Zhu (Atractodis Rhizoma). If palpitations occur, add Fuling (Poria) 2 liang. If abdominal fullness occurs, remove Bai Zhu (Atractodis Rhizoma) and add Fu Zi (Aconite Lateral Root) 1 piece. After taking the decoction, wait about the time of a meal, then drink approximately one liter of hot porridge to maintain warmth; do not uncover clothing or blankets. (*Huoren Shu* states: If there is limb stiffness or muscle twitching/cramping, also remove Bai Zhu (Atractodis Rhizoma) and add Fu Zi (Aconite Lateral Root).)
For vomiting and diarrhea with sweating, fever, aversion to cold, limb stiffness, and cold extremities, Sini Tang (Frigid Extremities Decoction) is primarily used.
[From *Suwen*] When Earth Qi is depressed and erupts, the people suffer from vomiting, Huoluan (Cholera-like disorder), and profuse diarrhea. (Chapter: Six Essential Ordinances) When Taiyin (Great Yin) arrives, it manifests as central fullness, Huoluan (Cholera-like disorder), vomiting, and diarrhea.
The aforementioned damp-Earth Huoluan corresponds to formulas such as Wuling San (Five-Ingredient Poria Decoction) and Lizhong Wan (Regulate the Middle Pill) by Zhang Zhongjing.
When the annual Earth Qi is insufficient, Wind prevails greatly, and the people suffer from Huoluan (Cholera-like disorder) and Sund Xie (undigested food diarrhea). (Chapter: Changes in Qi Intersection)
The aforementioned Earth-deficiency and Wind-excess Huoluan corresponds to formulas such as Guiling Baizhu San (Bupleurum and Atractodes Powder) by Luo Qianfu.
When Heat arrives, body heat, Huoluan (Cholera-like disorder), vomiting, and diarrhea occur. (Chapter: Six Essential Ordinances)
The aforementioned Heat-induced Huoluan corresponds to formulas such as Xiangru San (Mosla Powder) from *Huoren Shu*.
[From *Lingshu*] The collateral branch of Foot-Taiyin Spleen Meridian is named Gongsun (SP4), located one cun distal to the metatarsophalangeal joint, diverging to connect with Yangming. Its branch enters and connects with the intestines and stomach. When Jue Qi (Rebellious Qi) reverses upward, Huoluan (Cholera-like disorder) occurs. In Excess patterns, there is cutting pain in the intestines; in Deficiency patterns, there is abdominal distension like a pot-belly. Treat by selecting the point of divergence. (Chapter: Meridian Collaterals) When Qi is chaotic in the intestines and stomach, Huoluan (Cholera-like disorder) results. Select Foot-Taiyin and Foot-Yangming points. If ineffective, select Zusanli (ST36). (Chapter: Five Chaos; Dongyuan notes: Foot-Taiyin Qimen point, Foot-Yangming Zhongwan point.)
If vomiting and diarrhea cease but body pain persists, assess and harmonize the exterior; Guizhi Tang (Cinnamon Twig Decoction) is appropriate. If there is aversion to cold, faint pulse, and cessation of diarrhea, Sini Jia Renshen Tang (Frigid Extrements Decoction with Added Ginseng) is used. (Formula discussion see Aversion to Cold.)
If vomiting and diarrhea have completely stopped, but sweating and cold extremities persist, limb stiffness does not resolve, and the pulse is faint and nearly imperceptible, Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction) with Zhu Danzhi (Porcine Bile) added is administered.
Ingredients: Gan Cao (Licorice Root, honey-fried, 2 liang), Gan Jiang (Dried Ginger, 3 liang), Fu Zi (Aconite Lateral Root, one large piece, peeled and trimmed), Zhu Danzhi (Porcine Bile, 0.5 he).
Grind the three ingredients. Use three bowls of water, decoct to two bowls, strain, add Porcine Bile, divide into two warm doses. The pulse will return.
After vomiting and diarrhea, if sweating occurs, the pulse becomes level, and there is no vexation, it is because the newly deficient body cannot withstand the grain qi. If there is dry retching and diarrhea, accompanied by hypochondriac pain and resolved exterior syndrome, Shizao Tang (Ten Jujubes Decoction) is appropriate. If there is epigastric fullness, hardness, and vexation, Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is appropriate. If accompanied by cold extremities and faint pulse, Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction) or Baitong Jia Zhu Danzhi Tang (White Passage Decoction with Added Porcine Bile) are used. (See Dry Retching section for details.)
[From *Maiching*] If the pulse is tight at both Yin and Yang positions, leading to vomiting and diarrhea, and the pulse remains unresolved, but the tightness disappears and the person feels comfortable, this indicates impending resolution. If the pulse is slow, extending to the sixth or seventh day, with loss of appetite, this is late onset due to fluid retention, indicating the disease is not yet resolved. If the patient can eat normally, it indicates impending resolution.