于四逆汤方内，加人参一两，余根据四逆汤方
@@@
吐利发汗、脉平，小烦者，以新虚不胜谷气故也。
【注】
霍乱，吐已利断，汗出已止，脉平和者，内外俱解也，法当食，食之小烦者，以吐下
后新虚，不胜谷气故也，节其饮食，自可愈矣。
【集注】
郑重光曰：吐、利、发汗、脉平，阴退阳回，乃有此象，犹以新虚不胜谷气，而致小
烦。盖霍乱吐、利，晬时不可便与饮食，以胃气逆反，仓廪未固，不可便置米耳！
张锡驹曰：霍乱一病，夏秋最多，是风寒暑湿之邪，中人皆能病霍乱，非止一寒邪也
。若吐、利过甚，损伤中焦之气，以致阴阳间隔，手足厥冷，脉微欲绝，不多饮水者
，无分寒暑，皆宜四逆理中治之。盖邪盛而正实者，当泻其邪；邪盛而正衰者，宜扶
其正。况夏月之时，阳气浮于外，阴气伏于内，复以冷风寒其形，冷水寒其胃，内外
皆寒，风暑之邪，未有不乘虚入于阴经者。所以夏月只有阴证，而无伤寒，今人患暑
证死，而手足指甲皆青者，阴证也。古人以大顺治暑，良有以也。
@@@
夫以为疾病至急，仓卒寻按，要者难得，故重集诸可与、不可方治，比之三阴三阳篇
中，此易见也。又时有不止是三阴三阳，出在诸可与不可中也。
【注】
夫以疾病至急，仓卒寻求，治法难得，其要者，汗、吐、下也。故重集汗、吐、下诸
可与、不可与之法，比之三阴三阳篇中，则易见也。又时有不止是三阴三阳篇中者，
亦出在诸可与、不可与中也。
@@@
大法，春夏宜发汗。
【注】
春夏阳气舒畅，故宜发汗，医治常道，此大法也。
【集注】
程应旄曰：春夏宜发汗者，发汗有助宣阳气之功，等于春夏发生长育之义。今人多以
麻、桂二汤，作春夏之禁药，其轻于畔经者，由其未明天道也。
凡发汗，欲令手足俱周时出，以□□然，一时间许，亦佳，不可令如水淋漓。若病不
解，当重发汗，汗多者必亡阳，阳虚不得重发汗也。
【注】
凡发汗，令手足俱周时出，是欲汗缓出周遍，则邪气悉去，正气不伤也。以□□然，
不得令如水淋漓为度，不欲汗急出过多也。若急出过多，则邪气不尽，正气反伤矣，
倘若病不解，当重发汗，但前汗已多，更汗必亡其阳，阳虚即病不解，故不敢再发其
汗也。
【集注】
成无己曰：汗缓缓出，则表里之邪悉去。汗大出，则邪气不除，但亡阳也。阳虚为无
津液，故不可重发汗。
方有执曰：此叮咛发汗之节度也。
张锡驹曰：汗乃津液，汗多则亡津液，何以又谓亡阳也？经云：上焦开发腠理，薰肤
、充身、泽毛，若雾露之溉。盖汗虽津液，必借阳气之薰蒸宣发而后出，故汗多亡津
液，而阳亦随之俱亡也。
@@@
凡服汤发汗，中病即止，不必尽剂也。
【注】
服汤发汗，汗出病解，便可止再服，不必定然尽剂。
【集注】
程应旄曰：中病即止，亦麻黄、桂枝互举之词，示撙节于「中」字，所以严不中之禁
也。
@@@
凡云可发汗，无汤者，丸散亦可用，要以汗出为解。然不如汤，随证良验。
【注】
凡云可发汗无汤者，一时仓卒无汤，以丸散代之亦可，要不过以汗出为解耳。然丸散
乃定剂，不如汤可随证而进，其验甚准，故曰良也。
【集注】
程应旄曰：丸散仅可从权，随证则不如汤。
@@@
夫病脉浮大，问病者，言但便□耳，设利者为大逆，□为实，汗出而解，何以故？脉
浮当以汗解。
【注】
脉浮大，属表未解，虽有便□里实，亦不可利下，何以故？因脉浮也。当先解其外，
表解热除，内外和谐，而大便自通矣。设用利药，是为大逆也。
【集注】
成无己曰：结胸虽急，脉浮大尤不可下，下之即死，况此便□乎？论中有云：本发汗
而复下之，此为逆；若先发汗，治不为逆，此之谓也。
在四逆汤的方剂组成中，加入人参一两，其余药物及煎服方法均依照四逆汤方执行。
@@@
出现呕吐、腹泻并伴有发汗症状，且脉象趋于平和，但仍有轻微心烦不适的情况，这是因为病后脾胃之气新近虚弱，无法承受食物运化所产生的谷气所致。
【注】
霍乱病患者，若呕吐与腹泻已停止，出汗也已止住，脉象平和，说明体内外的邪气都已解除，按照常理应当进食。如果进食后出现轻微心烦，是因为经过吐泻之后，脾胃正气新近虚弱，不能耐受食物的运化。此时只需节制饮食，身体自然能够痊愈。
【集注】
郑重光说：呕吐、腹泻、发汗后，脉象平和，这是阴邪退去、阳气回复的表现，才会出现这种景象。但由于脾胃新近虚弱，不能耐受谷气，所以导致轻微心烦。大概霍乱病在呕吐、腹泻后的二十四小时内，不可以立即给予饮食，因为胃气上逆，肠胃功能尚未稳固，不可立即放入米食！
张锡驹说：霍乱这一疾病，在夏秋季节最为多见。风寒暑湿等邪气侵袭人体都能导致霍乱，并不仅仅是寒邪一种。如果呕吐、腹泻过于严重，损伤了中焦脾胃之气，导致阴阳之气隔绝，出现手脚冰凉、脉搏微弱几乎摸不到的情况，无论寒暑季节，都适宜用四逆汤或理中汤治疗。大概邪气盛而正气实者，应当祛除邪气；邪气盛而正气衰者，应当扶持正气。况且夏季之时，阳气浮越于体表，阴气潜伏于体内，再加上冷风侵袭形体，冷水寒凉胃部，内外皆寒，风暑之邪，没有不乘虚侵入阴经的。所以夏季只有阴证，而没有典型的伤寒（此处指外感热病中的太阳伤寒），现在有人患暑证死亡，而手足指甲发青的，属于阴证。古人用大顺散来治疗暑证，是有道理的。
@@@
认为疾病发作十分紧急，仓促之间寻找治疗方法，关键要点难以获得，所以重新汇编各种可以发汗、不可以发汗的方治原则，相比于三阴三阳篇中的内容，这里更容易看清。另外，有时病情不止局限于三阴三阳范畴，也出现在这些“可与”和“不可与”的原则之中。
【注】
由于疾病发作极其紧急，仓促间寻求治法，关键点难以把握，其要点在于汗法、吐法、下法。所以重新汇编汗、吐、下诸法中哪些可以使用、哪些不可以使用的原则，相比于三阴三阳篇中的内容，则更容易看清。另外，有时病情不止局限于三阴三阳篇中所述，也出现在这些“可与”和“不可与”的原则之中。
@@@
一般法则，春夏季节适宜使用发汗法。
【注】
春夏季节阳气舒畅升发，所以适宜使用发汗法，这是医治的常规道理，属于基本大法。
【集注】
程应旄说：春夏季节适宜发汗，是因为发汗有助于宣通阳气，这等同于春夏季节万物生长发育的意义。现在很多人将麻黄汤、桂枝汤作为春夏季节的禁忌药物，那些轻视违背经典理论的人，是因为他们不明白天道运行的规律。
凡是发汗，希望让手足周身微微持续出汗，以濈然（形容汗出连绵不断的样子）为度，大约一个时辰左右，也是可以的，不可以让汗水像水一样淋漓流出。如果病邪未解，应当再次发汗，但如果汗出过多必然会耗伤阳气，阳气虚弱者不得再次发汗。
【注】
凡是发汗，要让手足周身均匀地出汗，这是希望汗液缓慢排出且遍及全身，这样邪气就能全部去除，正气也不会受伤。以濈然（形容汗出连绵不断的样子）为度，不让汗水像水一样淋漓流出为标准，不希望汗液急出且过多。如果汗液急出且过多，那么邪气不能完全去除，正气反而受损。倘若病邪仍未解除，应当再次发汗，但前一次汗出已经很多，再次发汗必然耗伤阳气，阳气虚弱即会导致病邪不解，所以不敢再发汗。
【集注】
成无己说：汗液缓缓流出，则表里之邪都能去除。汗液大量流出，则邪气不能清除，只会耗伤阳气。阳气虚弱意味着津液枯竭，所以不可再次发汗。
张锡驹说：汗是津液，汗多就会耗伤津液，为什么又说耗伤阳气呢？《内经》说：上焦开发腠理，熏蒸皮肤，充实身体，润泽毫毛，就像雾露灌溉一样。大概汗虽然是津液，但必须借助阳气的熏蒸宣发才能排出，所以汗多耗伤津液，阳气也随之一起耗伤。
@@@
凡是服用汤药发汗，只要病症消除就停药，不必一定要喝完整个药方。
【注】
服用汤药发汗，如果汗出后病症解除，就可以停止再服药，不必一定要喝完所有药剂。
【集注】
程应旄说：“中病即止”，也是麻黄汤、桂枝汤互举的例子，意在强调“中”字的重要性，以此来严格禁止用药不当（不中病）的禁忌。
@@@
凡是说可以发汗的，如果没有汤药，丸剂和散剂也可以使用，关键在于通过出汗来解除病邪。然而，不如汤药那样能随证候变化灵活调整，疗效更好。
【注】
凡是说可以发汗但没有汤药的，一时仓促间没有汤药，用丸剂或散剂替代也可以，关键不过是通过出汗来解除病邪罢了。然而丸剂和散剂是固定剂量的制剂，不如汤药可以根据证候变化随时调整剂量，其疗效非常准确，所以说疗效好。
【集注】
程应旄说：丸剂和散剂仅可权宜使用，随证调治方面不如汤药。
@@@
如果病人脉象浮大，询问病人，他说只是大便不通畅，假设出现腹泻就是大逆（错误的治法），大便通畅为实证，通过发汗可以解除病邪，为什么呢？因为脉浮应当用发汗法解除。
【注】
脉象浮大，属于表证未解，即使有大便不通的里实证，也不可以使用攻下法，为什么呢？因为脉象浮。应当先解除表邪，表解热除，内外和谐，大便自然通畅。假如使用泻下药，这就是大逆（严重的错误）。
【集注】
成无己说：结胸证虽然急迫，但脉象浮大尤其不可攻下，攻下就会导致死亡，何况这只是大便不通呢？论中有云：本来应该先发汗却反而攻下，这是逆治；如果先发汗，治疗就不算逆治，说的就是这个道理。
In the prescription of Sini Tang (Four Reversal Decoction), add Ren Shen (Ginseng Radix) 1 liang, and follow the preparation and administration method of Sini Tang for the rest.
@@@
When vomiting, diarrhea, and sweating occur, and the pulse becomes level/normal, but slight restlessness persists, this is because the spleen and stomach qi are newly deficient and cannot withstand the grain qi generated from food digestion.
[Annotation]
In Huoluan (Cholera-like disease with sudden vomiting and diarrhea), if vomiting and diarrhea have ceased, sweating has stopped, and the pulse is peaceful, it indicates that pathogenic factors inside and outside have been resolved. According to standard practice, one should eat. If slight restlessness occurs after eating, it is because the middle jiao (middle burner) is newly deficient following vomiting and purging, and cannot tolerate the grain qi. By regulating diet, recovery will naturally occur.
[Collected Annotations]
Zheng Zhongguang stated: After vomiting, diarrhea, and sweating, a normal pulse indicates the retreat of yin pathogens and the return of yang qi, resulting in this manifestation. However, due to new deficiency, the body cannot withstand grain qi, leading to slight restlessness. Generally, in Huoluan, food and drink should not be given within twenty-four hours after vomiting and diarrhea, as the stomach qi is rebellious and the digestive system is not yet stable; rice should not be introduced immediately.
Zhang Xiju stated: Huoluan is most common in summer and autumn. Pathogens such as wind, cold, summerheat, and dampness can all attack humans and cause Huoluan, not just cold pathogens alone. If vomiting and diarrhea are excessive, damaging the qi of the middle jiao, causing an interruption of yin and yang, cold limbs, and a faint pulse nearly imperceptible, Sini Tang or Lizhong Tang should be used regardless of cold or heat seasons. Generally, when pathogens are strong and healthy qi is solid, one should drain the pathogens; when pathogens are strong and healthy qi is weak, one should support the healthy qi. Moreover, in summer, yang qi floats on the exterior while yin qi hides within. Coupled with cold wind chilling the body and cold water chilling the stomach, both interior and exterior become cold. Wind and summerheat pathogens inevitably enter the yin meridians by taking advantage of this deficiency. Therefore, in summer, there are only yin syndromes, no typical Shanghan (Cold Damage). When people die from summerheat syndromes with cyanosis of the fingernails and toenails, it is a yin syndrome. The ancients used Dashun San (Great Harmony Powder) to treat summerheat, which was well-founded.
@@@
Considering that diseases often arise urgently, and key treatments are difficult to locate in haste, I have recompiled the principles of what methods are permissible and impermissible. Compared to the chapters on the Three Yin and Three Yang meridians, these are easier to understand. Additionally, sometimes conditions extend beyond the scope of the Three Yin and Three Yang chapters, appearing within these principles of permissibility and impermissibility.
[Annotation]
Since diseases arise urgently, and essential treatments are hard to find in haste, the key lies in diaphoresis (sweating), emesis, and purgation. Thus, I have recompiled the principles regarding which methods of diaphoresis, emesis, and purgation are permissible and which are not. Compared to the Three Yin and Three Yang chapters, these are easier to grasp. Sometimes conditions do not strictly fit within the Three Yin and Three Yang chapters but appear in these principles of permissibility and impermissibility.
@@@
The general principle is that diaphoresis is suitable in spring and summer.
[Annotation]
In spring and summer, yang qi is smooth and ascending, so diaphoresis is suitable. This is the routine method of treatment and constitutes a fundamental principle.
[Collected Annotations]
Cheng Yingmao stated: Diaphoresis is suitable in spring and summer because sweating helps to disseminate yang qi, analogous to the generative and nurturing functions of spring and summer. Many people today consider Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) as contraindicated in spring and summer. Those who lightly disregard classic theories fail to understand the laws of nature.
Generally, when inducing sweating, one desires sweat to emerge uniformly from the hands and feet, appearing moist and continuous, lasting for about an hour, which is also acceptable. One must not allow sweat to pour out like water. If the disease does not resolve, diaphoresis may be repeated. However, excessive sweating will certainly lead to the loss of yang qi; those with deficient yang must not undergo repeated diaphoresis.
[Annotation]
When inducing sweating, ensuring uniform emergence from the hands and feet implies that sweat should exit slowly and cover the whole body, thereby eliminating pathogenic factors completely without injuring healthy qi. The goal is to avoid excessive, rapid sweating. If sweat exits too rapidly and excessively, pathogenic factors will not be fully eliminated, and healthy qi will be damaged. If the disease remains unresolved, diaphoresis should be repeated. But if previous sweating was already excessive, further sweating will deplete yang qi. Since yang deficiency leads to unresolved disease, one dare not induce sweating again.
[Collected Annotations]
Cheng Wuji stated: Slow sweating eliminates pathogenic factors in both the exterior and interior. Profuse sweating fails to remove pathogens and only leads to the loss of yang qi. Yang deficiency implies a lack of body fluids, so repeated diaphoresis is contraindicated.
Fang Youzhi stated: This is a careful instruction on the degree of diaphoresis.
Zhang Xiju stated: Sweat is body fluid; profuse sweating depletes body fluids. Why is it said to deplete yang qi? The Classic states: The Upper Jiao opens the cou-li (pores and interstices), steams the skin, fills the body, and moistens the hair, like mist and dew. Although sweat is body fluid, it must rely on the steaming and dissemination of yang qi to be excreted. Therefore, profuse sweating depletes body fluids, and yang qi is lost along with it.
@@@
Whenever decoctions are taken to induce sweating, stop medication once the disease is addressed; there is no need to consume the entire dose.
[Annotation]
After taking decoctions to induce sweating, if sweating occurs and the disease resolves, discontinue further administration. There is no need to insist on finishing the entire prescription.
[Collected Annotations]
Cheng Yingmao stated: "Stop when the disease is addressed" applies to both Mahuang Tang and Guizhi Tang, emphasizing the character "zhong" (addressing/hitting the mark) to strictly prohibit improper medication.
@@@
Whenever it is stated that diaphoresis is permissible, if no decoction is available, pills or powders may also be used, provided that sweating occurs to resolve the condition. However, this is inferior to decoctions, which offer better efficacy through flexible adjustment according to symptoms.
[Annotation]
Whenever diaphoresis is indicated but no decoction is available, pills or powders may serve as substitutes in emergencies. The key is achieving sweating to resolve the condition. However, pills and powders have fixed dosages and cannot be adjusted flexibly based on changing symptoms like decoctions can. Their efficacy is therefore less precise, hence described as "good" but inferior to decoctions.
[Collected Annotations]
Cheng Yingmao stated: Pills and powders are merely temporary measures; they cannot match the flexibility of decoctions in treating specific symptoms.
@@@
If a patient presents with a floating and large pulse, and upon inquiry reports only constipation, assuming purgation is used constitutes a major error. Constipation indicates excess; however, diaphoresis resolves the condition. Why? Because a floating pulse requires resolution via diaphoresis.
[Annotation]
A floating and large pulse indicates that the exterior syndrome is unresolved. Even if there is internal excess manifesting as constipation, purgation must not be used. Why? Because the pulse is floating. One must first resolve the exterior. Once the exterior is resolved and heat dissipates, the interior harmonizes, and bowel movements normalize naturally. Using purgatives in this scenario constitutes a major error.
[Collected Annotations]
Cheng Wuji stated: Even in urgent Jie Xiong (Chest Binding) cases, a floating and large pulse absolutely contraindicates purgation; purging leads to death. How much more so for simple constipation? The Treatise states: Originally indicating diaphoresis but instead using purgation is incorrect; initiating with diaphoresis is not incorrect. This refers to such situations.