（《伤寒论》）
治寒霍乱，口不渴者。
人参 甘草 白术 干姜（各三两）
四味捣筛为末，蜜和丸，鸡子黄大。以沸汤数合，和一丸碎研，温服之，日三夜二，腹中未
热，益至三四丸，然不及汤，汤法以味根据两数切，用水八升，煮取三升，去滓，温服一升，日三。
加减法∶若脐上筑者，肾气动也，去术加桂四两。
尤氏云∶脐上筑者，脐上筑筑然跳动，肾气上而之脾也。脾方受气，术之甘能壅脾气，故去
之。桂之辛能下肾气，故加之。
按∶此阳虚之肾气动，欲作奔豚也。故去术加桂，以杜其上凌之萌。若阴虚而脐上筑筑者，
大忌刚燥之剂，非峻滋肝肾之阴不可。盖一为水动，一为火动也。
吐多者，去术，加生姜三两。
尤氏云∶吐多者，气方上壅，甘能壅气，故去术。辛能散气，故加生姜。
按∶邹润安云∶即吐且利，有属太阴者，有属少阴者。在少阴，则无用术之理。在太阴，亦
在可用不可用之列。以术能治脾胃虚，不能治脾胃实。故吐多者，去之。下多者，还用之。盖术能举
脾之
矣。尚有如此细密加减之法，何今人既不议病，又不议药，轻于一试，何异以不教之民，而
使之战耶。吁，可哀已。
下多者，还用术。悸者，加茯苓二两。
尤氏云∶下多者，脾气不守，故须术以固之。悸者，肾水上逆，故加茯苓以导之。
按∶今人治霍乱，既不辨其证之虚实寒热，亦不察其吐多下多。温补率投，漫无忌惮者
，吾不知其何心也。
渴欲得水者加术，足前成四两半。
尤氏云∶渴欲得水者，津液不足，白术之甘，足以生之。
按∶此渴因脾虚不能为胃行其津液，故加术以补脾而致其津夜也。所谓白术能生津液者，其
义如此，岂热烁津液而渴者，所堪一试哉。
腹中痛，加人参，足前成四两半。
尤氏云∶腹中痛者，里虚不足。人参之甘，足以补之。
按∶里虚腹痛，必喜温按。
寒者，加干姜，足前成四两半。
尤氏云∶寒者，腹中气寒也。干姜之辛，足以温之。
按∶五苓，主热多，谓表有热也。理中，主寒多，谓里有寒也。故方下既有腹中未热，益至
三四丸之法。此复云∶寒者加干姜，是腹中尚未热。故独于此味，又加重也。盖腹中寒，为寒之真
谛。
故仲圣不嫌烦复，而琐琐教人，以此为辨证之法。顾昧者一见吐下肢寒，略不察其腹中光景
何如，擅以姜、附、丁、桂欲其转热，遂至从此而一身皆冷。呜呼！岂未闻热深厥深之圣训
乎。
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。
尤氏云∶腹满者，气滞不行也。气得甘则壅，得辛则行，故去术加附子。
按∶饮热粥一升许，固是助药力，亦是辨证法。设时行热霍乱，不但热粥在所大忌，即使不
忌
不知今，是房 之以车战也。
按∶原方加附子，名附子理中汤。加青皮、陈皮，名治中汤。加枳实、茯苓，名枳实理中汤
。加黄连，名连理汤。合五苓，名理苓汤。
（出自《伤寒论》）
治疗寒性霍乱，口不感到口渴的患者。
人参、甘草、白术、干姜（各三两）
将这四味药捣碎过筛成粉末，用蜂蜜调和制成丸剂，大小如鸡蛋黄。用沸水几合（约200毫升），将一丸药研碎后调入，温服，每日三次，夜间两次。如果腹部没有感到温热，增加到每次三到四丸。然而，这种方法不如汤剂效果好。汤剂的煎煮方法依据上述药物的分量，用水八升，煮取三升，滤去药渣，温服一升，每日三次。
加减法：如果感觉脐上部位跳动不安，这是肾气发动的表现，应去掉白术，加入桂枝四两。
尤氏说：所谓脐上跳动，是指脐上有一种筑筑然的跳动感，是肾气向上侵犯脾脏。脾脏正在接受气机，白术的甘味容易壅滞脾气，所以去掉它。桂枝的辛味能够下行肾气，所以加入它。
按语：这是阳虚导致的肾气发动，即将形成奔豚病（一种以气从少腹上冲心胸为特征的病症）。因此去掉白术加入桂枝，以杜绝其向上凌犯的趋势。如果是阴虚导致脐上跳动，则绝对禁忌使用刚燥的药物，必须峻补肝肾之阴。因为一个是水气妄动，一个是火气妄动。
呕吐剧烈的，去掉白术，加入生姜三两。
尤氏说：呕吐剧烈时，气机正向上壅滞，甘味药物容易壅滞气机，所以去掉白术。辛味药物能够散气，所以加入生姜。
按语：邹润安说：既呕吐又腹泻，有的属于太阴病，有的属于少阴病。在少阴病中，就没有使用白术的道理。在太阴病中，也处于可用与不可用的界限之间。因为白术能治疗脾胃虚弱，但不能治疗脾胃实证。所以呕吐剧烈时，去掉白术。腹泻剧烈时，还要重新使用它。因为白术能提升脾气的清阳之气。还有如此细致严密的加减法则，为什么现在的人既不辨析病情，也不斟酌药物，轻易尝试，这和不训练百姓却让他们去打仗有什么区别呢？唉，真是令人悲哀啊。
腹泻剧烈的，还要重新使用白术。心中悸动的，加入茯苓二两。
尤氏说：腹泻剧烈时，脾气不能固守，所以需要白术来固摄它。心悸时，是肾水上逆，所以加入茯苓来引导水气下行。
按语：现在的人治疗霍乱，既不辨别证候的虚实寒热，也不观察是呕吐多还是腹泻多。盲目投用温补药物，毫无顾忌，我不知道他们是什么心思。
口渴想喝水的，增加白术用量，使总量达到四两半。
尤氏说：口渴想喝水，是因为津液不足，白术的甘味足以生津液。
按语：这种口渴是因为脾虚不能为胃传输津液，所以增加白术以补益脾气从而生成津液。所谓白术能生津液的道理就是这样，难道是热邪灼伤津液导致的口渴，可以随意尝试的吗？
腹部疼痛的，增加人参用量，使总量达到四两半。
尤氏说：腹部疼痛，是因为里虚不足。人参的甘味足以补益它。
按语：里虚引起的腹痛，一定喜欢温暖和按压。
感到寒冷的，增加干姜用量，使总量达到四两半。
尤氏说：感到寒冷，是因为腹中寒气盛。干姜的辛味足以温散它。
按语：五苓散主治热多，指的是表有热。理中汤主治寒多，指的是里有寒。所以在方剂下既有“腹部未热，增至三四丸”的方法。这里又说“寒者加干姜”，说明腹中尚未温热。因此唯独对这味药又加重了剂量。因为腹中寒，才是寒证的本质。
所以张仲景不嫌繁琐，细致地教导人们，以此作为辨证的方法。然而愚昧的人一见呕吐和下肢寒冷，完全不考察腹中的情况如何，擅自使用干姜、附子、丁香、肉桂等药希望使其转暖，结果导致全身皆冷。唉！难道没听说过“热深厥亦深”的圣训吗？
腹部胀满的，去掉白术，加入附子一枚。服用汤药后大约一顿饭的时间，喝热粥一升左右，微微保暖，不要掀开衣被。
尤氏说：腹部胀满，是气机阻滞不行。气得到甘味则壅滞，得到辛味则运行，所以去掉白术加入附子。
按语：喝热粥一升左右，既是帮助药力，也是辨证的方法。如果是时令流行的热霍乱，不但热粥是大忌，即使不忌讳……（原文此处似有脱漏或语意未完，依文意理解为：若误治则如同以步兵战车作战般荒谬）。
按语：原方加入附子，名为附子理中汤。加入青皮、陈皮，名为治中汤。加入枳实、茯苓，名为枳实理中汤。加入黄连，名为连理汤。合用五苓散，名为理苓汤。
(From *Shanghan Lun*)
Treats cold-type Huoluan (cholera-like syndrome with sudden vomiting and diarrhea), where the patient has no thirst.
Renshen (Ginseng Radix et Rhizoma), Gancao (Licorice Root), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Dried Ginger) (each 3 liang).
Crush these four herbs, sift into powder, mix with honey to form pills, size of a chicken egg yolk. Take one pill, crushed and mixed in several he (approx. 200ml) of boiling water, take warm. Three times daily, twice at night. If the abdomen does not feel warm, increase to three or four pills per dose. However, this method is inferior to the decoction. The decoction method: based on the quantities above, use eight sheng (approx. 1600ml) of water, boil down to three sheng (approx. 600ml), remove dregs, take one sheng (approx. 200ml) warm, three times daily.
Modifications: If there is a sensation of pounding or throbbing above the navel, it indicates Kidney Qi stirring; remove Baizhu and add Guizhi (Cinnamon Twig) 4 liang.
Mr. You states: "Pounding above the navel" refers to a throbbing sensation above the navel, where Kidney Qi ascends to invade the Spleen. Since the Spleen is receiving Qi, the sweetness of Baizhu can obstruct Spleen Qi, hence its removal. The pungency of Guizhi can direct Kidney Qi downward, hence its addition.
Commentary: This is Kidney Qi stirring due to Yang deficiency, about to manifest as Ben Tun (a condition characterized by gas rushing from the lower abdomen up to the chest/heart). Therefore, Baizhu is removed and Guizhi added to prevent its upward encroachment. If the throbbing above the navel is due to Yin deficiency, rigid and drying agents are strictly contraindicated; one must vigorously nourish the Yin of the Liver and Kidneys. This is because one case involves Water moving abnormally, while the other involves Fire moving abnormally.
If vomiting is severe, remove Baizhu and add Shengjiang (Fresh Ginger) 3 liang.
Mr. You states: In cases of severe vomiting, Qi is obstructed upwards; sweetness tends to obstruct Qi, hence Baizhu is removed. Pungency disperses Qi, hence Shengjiang is added.
Commentary: Zou Run'an states: When both vomiting and diarrhea occur, it may belong to Taiyin disease or Shaoyin disease. In Shaoyin disease, there is no rationale for using Baizhu. In Taiyin disease, it falls into a category of debatable applicability. This is because Baizhu treats Spleen-Stomach deficiency but cannot treat Spleen-Stomach excess. Thus, it is removed when vomiting is severe. It is reinstated when diarrhea is severe, as Baizhu can lift the clear Yang of the Spleen. Such meticulous modification methods exist; why do modern practitioners neither analyze the disease nor select herbs appropriately, resorting to trial-and-error? This is akin to sending untrained civilians to war. Alas, how lamentable.
If diarrhea is severe, reinstate Baizhu. If palpitations occur, add Fuling (Poria) 2 liang.
Mr. You states: Severe diarrhea implies Spleen Qi failing to hold; thus Baizhu is needed to consolidate it. Palpitations indicate Kidney Water counterflowing upward; thus Fuling is added to guide it downward.
Commentary: Modern practitioners treating Huoluan often fail to differentiate between deficiency/excess and cold/heat syndromes, nor do they observe whether vomiting or diarrhea predominates. They indiscriminately administer warming and tonifying formulas without restraint. I do not know what their intentions are.
If thirsty and desiring water, increase the dosage of Baizhu so that the total reaches 4.5 liang.
Mr. You states: Thirst and desire for water indicate insufficient Body Fluids; the sweetness of Baizhu is sufficient to generate them.
Commentary: This thirst arises because Spleen deficiency fails to transport Body Fluids for the Stomach. Hence, Baizhu is increased to tonify the Spleen and thereby generate Body Fluids. This is the meaning behind the statement that "Baizhu can generate Body Fluids." It certainly cannot be applied to thirst caused by heat scorching Body Fluids.
If abdominal pain occurs, increase the dosage of Renshen so that the total reaches 4.5 liang.
Mr. You states: Abdominal pain indicates interior deficiency and insufficiency; the sweetness of Renshen is sufficient to tonify it.
Commentary: Abdominal pain due to interior deficiency is always relieved by warmth and pressure.
If feeling cold, increase the dosage of Ganjiang so that the total reaches 4.5 liang.
Mr. You states: Feeling cold indicates cold Qi in the abdomen; the pungency of Ganjiang is sufficient to warm it.
Commentary: Wuling San (Five-Ingredient Powder with Poria) treats cases with more heat, referring to exterior heat. Lizhong Tang (Regulate the Middle Decoction) treats cases with more cold, referring to interior cold. Hence, the formula instructions include the method of increasing pills if the abdomen remains cold. Here, it further states "add Ganjiang for cold," indicating the abdomen is still not warm. Therefore, the dosage of this specific herb is increased alone. Abdominal cold represents the true essence of cold syndromes.
Thus, Zhang Zhongjing did not shy away from being detailed, teaching people meticulously, using this as a method for syndrome differentiation. However, ignorant practitioners, upon seeing vomiting and cold limbs, fail to examine the state of the abdomen, and arbitrarily prescribe Ganjiang, Fuzi (Aconite Lateralis Radix Praeparata), Dingxiang (Caryophylli Flos), and Rougui (Cinnamon Bark) hoping to restore warmth, resulting in the entire body becoming cold. Alas! Have they not heard the sage's instruction: "The deeper the heat, the deeper the cold extremities"?
If abdominal fullness occurs, remove Baizhu and add one Fuzi. After taking the decoction, approximately after a meal interval, drink about one sheng (approx. 200ml) of hot porridge to maintain slight warmth; do not uncover clothing or blankets.
Mr. You states: Abdominal fullness indicates stagnant Qi that fails to move. Qi becomes obstructed by sweetness but moves with pungency; hence Baizhu is removed and Fuzi added.
Commentary: Drinking hot porridge helps the medicinal force but also serves as a diagnostic method. If it were epidemic heat-Huoluan, hot porridge would be strictly contraindicated... [Text implies error in treatment logic].
Commentary: The original formula with added Fuzi is named Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). With Qingpi (Citri Reticulatae Pericarpium Viride) and Chenpi (Citri Reticulatae Pericarpium), it is named Zhizhong Tang (Regulate the Middle Decoction). With Zhishi (Aurantii Fructus Immaturus) and Fuling, it is named Zhishi Lizhong Tang. With Huanglian (Coptidis Rhizoma), it is named Lianli Tang. Combined with Wuling San, it is named Liling Tang.