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Zhang Zhongjing asked, "What is Huoluan (cholera-like disease)?" The answer was, "Vomiting and diarrhea; this is named Huoluan."

Another question was raised: "If a patient presents with fever, headache, body ache, aversion to cold, along with vomiting and diarrhea, what disease does this belong to?" The answer was, "This is also named Huoluan. Specifically, vomiting and diarrhea followed by the reappearance of fever." (An alternative version states: originally spontaneous vomiting or diarrhea, which then ceased, followed by recurrent fever.) Guo Yong commented, "The symptoms of Huoluan described here resemble those of Shanghan (Cold Damage)."

It is further stated: "In cases of Shanghan, if the pulse is faint and choppy, it was originally Huoluan but has now transformed into Shanghan. After four or five days, when the pathogen enters the Yin meridians, diarrhea will certainly occur." (Alternative version: vomiting and diarrhea). "If there was originally vomiting and now diarrhea appears, it is difficult to treat. If the patient feels the urge to defecate but instead passes flatus and does not stool, this belongs to Yangming disease. The stool will likely be hard. Recovery will occur on the thirteenth day. This is because the meridian cycle has completed its course. After diarrhea stops, the stool should become hard; if the patient can eat when the stool is hard, recovery ensues. If the patient cannot eat now, but slightly regains appetite during the next meridian cycle, and normal eating resumes after one more cycle, recovery should occur one day later. If not, it does not belong to Yangming. If there is aversion to cold, a faint pulse, and recurring diarrhea, and the diarrhea stops due to depletion of blood/fluids, Si Ni Jia Ren Shen Tang (Four Counterflow Decoction plus Ginseng) should be administered." Guo Yong commented, "This passage discusses symptoms where Shanghan is currently present, hence stating that 'original vomiting and diarrhea' are difficult to treat. If discussing Huoluan itself, it must involve both vomiting and diarrhea. One scenario is Shanghan not belonging to Yangming, presenting with aversion to cold, faint pulse, and diarrhea; if diarrhea stops, Si Ni Jia Ren Shen Tang is indicated. This decoction can also be used for Huoluan symptoms. Qianjin Yi Fang combined these two discussions, suggesting missing text in the original scripture."

Another question asks: "How is Huoluan caused?" Guo Yong answered, "It is caused by rebellious Qi in the chest. Initially without disease, improper diet often leads to rebellious Qi in the chest. Thus, in Shanghan complicated by Huoluan, the Yin and Yang Qi are chaotic in the chest. Ling Shu, Chapter 34, states: 'Clear Qi descends while turbid Qi ascends; Ying Qi flows smoothly with the vessels, while Wei Qi moves in reverse. Clear and turbid Qi interfere with each other, causing great chaos in the chest.' It further says, 'Chaos in the intestines and stomach results in Huoluan.' The scripture mentions 'Five Chaos,' of which Huoluan is one. Chaos in the chest causes vomiting; chaos in the intestines causes diarrhea. Sun Simiao said: 'Indulgence in food and drink, consumption of dairy and rich foods from land and sea, sleeping on cold mats, and drinking excessive cold fluids cause food stagnation in the stomach. Yin and Yang Qi become obstructed and generate phlegm. Yang Qi desires to ascend, Yin Qi desires to descend; their separation leads to vomiting and diarrhea. Headache feels like splitting, joints feel as if dislocating, and tendons throughout the body twist. Although the illness is acute, among sudden diseases, it is most terrifying. Even facing life-threatening danger, it is not surprising. Therefore, ancients treated this by slow insertion and withdrawal of needles, merely guiding Qi, not using tonification or sedation. Medicinal treatment involves harmonizing Yin and Yang Qi, without inducing sweating or purging. This is the method to quell chaotic Qi.'"

Zhang Zhongjing stated: "For Huoluan with headache, fever, body pain, predominant heat, and thirst, Wu Ling San (Five-Ingredient Powder with Poria) is indicated. For predominant cold and no thirst, Li Zhong Wan (Regulate the Middle Pill) is indicated."

It is also stated: "If vomiting and diarrhea cease but body pain persists, one should assess the exterior and harmonize it; Gui Zhi Tang (Cinnamon Twig Decoction) in a small dose is appropriate."

It is also stated: "For Huoluan with vomiting and diarrhea, sweating, fever, aversion to cold, tetany of the limbs, and cold extremities, Si Ni Tang (Four Counterflow Decoction) is indicated."

It is also stated: "For simultaneous vomiting and diarrhea, free urination, profuse sweating, diarrhea with undigested food, internal cold with external heat, and a faint pulse nearly imperceptible, Si Ni Tang (Four Counterflow Decoction) is indicated."

It is also stated: "After vomiting and diarrhea have stopped, if sweating and cold extremities persist, limb tetany remains unresolved, and the pulse is faint and nearly imperceptible, Tong Mai Si Ni Tang Jia Zhu Dan Ye (Pulse-Unblocking Four Counterflow Decoction plus Pig Bile Juice) is indicated. Qianjin Yi Fang notes: if pig bile is unavailable, sheep bile may substitute. Qian Jin Fang provides additional modification methods."

It is also stated: "After Huoluan vomiting and diarrhea, if sweating occurs and the pulse becomes calm, with only slight restlessness, this is due to recent deficiency failing to handle grain Qi. Guo Yong comments: Do not administer medicine; reducing food intake will lead to recovery."

Wang Shuhe stated: "For tetany, the arms and legs are stiff and straight, the pulse runs vertically up and down with a slight wiry quality. If tetany extends to the abdomen, Ji Shi Bai San (Chicken Dropping White Powder) is indicated."

Qian Jin Yao Fang states: "For all Huoluan, gentle care and warming are essential. Cold exposure causes generalized tetany. Ideally, fast for the first day. For three days, consume small amounts of rice gruel. After three days, resume normal diet. Avoid mixed foods for seven days to nourish Spleen Qi."

It is also stated: "For all types of Huoluan, avoid rice water. Rice in the stomach induces continuous vomiting. Instead, provide Hou Po Ge Gen Yin (Magnolia Bark and Kudzu Root Drink) or Dong Gua Ye Yin (Winter Melon Leaf Drink), moistening the throat only, not giving large quantities. If vomiting occurs upon ingestion, stop until vomiting ceases. If the pulse is absent, use Gui Zhi He Ge Gen Yin (Cinnamon Twig and Kudzu Root Drink). For post-vomiting/diarrhea restlessness, internal heat, anhidrosis, no tetany, and rapid/tight pulse, Xi Jiao He Ge Gen Yin (Rhinoceros Horn and Kudzu Root Drink) is suitable. For persistent vomiting/diarrhea, sweating-induced restlessness, and thirst, small amounts of rice flour juice are best. If ineffective, Ge Gen Qi Yin (Kudzu and Shepherd's Purse Drink) may be given."

It is also stated: "Huoluan with predominant vomiting causes tetany and lack of thirst, accompanied by palpitations above the navel. Huoluan with palpitations above the navel indicates Kidney Qi movement; treat the palpitations first with Zhi Zhong Tang (Regulate the Middle Decoction). Remove Bai Zhu (Atractylodes Macrocephala Rhizome) and add Gui Xin (Cinnamon Bark). Bai Zhu is removed due to Kidney deficiency; Gui Xin is added to prevent Ben Tun (Running Piglet) syndrome. For Huoluan with abdominal palpitations and heavy vomiting, or heavy diarrhea, or palpitations, or thirst, or abdominal pain, or vomiting with diarrhea, or vomiting/diarrhea with thirst, Zhi Zhong Tang is universally indicated."

It is also stated: "Zhi Zhong Tang treats Huoluan vomiting and diarrhea, distension, indigestion, and heart/abdominal pain."

It is also stated: "For Huoluan with tetany, cold sweat, vomiting, and hiccups, Si Shun Tang (Four Smooth Decoction) is indicated."

It is also stated: "For Huoluan with predominant cold, cold extremities, and absent pulse, Dang Gui Si Ni Jia Wu Zhu Yu Tang (Angelica Sinensis Four Counterflow Decoction plus Evodia Fruit) is appropriate. Old formulas use thirty dates; however, since Huoluan often involves obstruction, dates are omitted. Replacing dates with Er Liang Ge Gen (two taels of Kudzu Root) is better. For Huoluan, Si Ni Tang adds Ban Xia (Pinellia Tuber) one he and one small Fu Zi (Aconite Lateral Root). For severe aversion to cold, use a large Fu Zi. (Zhu's medical book lacks these modifications, so they are recorded in detail.)"

It is also stated: "If Huoluan vomiting and diarrhea persist despite administering Li Zhong Tang, Si Ni Tang, or Si Shun Tang, Zhu Ye Tang (Bamboo Leaf Decoction) is indicated. (Note: This differs from Zhu Ye Shi Gao Tang)."

It is also stated: "For toxic-cold Huoluan with vomiting, diarrhea, restlessness, vomiting, tetany, cold sweat, swelling of fingers and toes, dyspnea nearing death, aphonia, inefficacy of hundred remedies, and blocked pulse, Ren Shen Tang (Ginseng Decoction) should be taken until recovery. Administer continuously even if vomiting occurs. Combine with moxibustion."

It is also stated: "For frail elderly patients with cold Qi, nausea, indigestion, empty fullness in heart and abdomen, tetany, shortness of breath, Huoluan with vomiting/reversal, cold extremities, restlessness, stifling sensation, and sweating, Fu Lao Li Zhong Tang (Supporting the Aged Regulate-the-Middle Decoction) is used. Originally Li Zhong San, taken regularly as honey pills."

It is also stated: "For Huoluan with cold extremities, less vomiting but more retching, Fu Zi Jing Mi Tang (Aconite and Rice Decoction) is indicated."

It is also stated: "For women with Huoluan, vomiting/reversal, and spitting saliva/phlegm, if physicians mistakenly use purgatives, epigastric oppression results. Treat the spitting/phlegm first with Xiao Qing Long Tang (Minor Green Dragon Decoction). Once phlegm stops, treat the oppression with Gan Cao Xie Xin Tang (Licorice Drain-the-Epigastrium Decoction)."

It is also stated: "For heat-stroke Huoluan with violent diarrhea, restlessness, rapid pulse, and desire for cold water, drink one sheng of fresh well-water at once."

It is also stated: "For all Huoluan, moxibustion may not cure immediately but prevents death. Do not apply moxa inversely. If diarrhea precedes vomiting, moxa according to symptoms. Guo Yong comments: Treatment methods for Huoluan are most comprehensive in Qian Jin Yao Fang. Besides previously recorded items, there are sixteen methods for residual Huoluan symptoms and critical tetany, and eighteen moxibustion methods, which should be consulted and used together."

Huo Ren Shu states: "For summerheat-induced Huoluan with vomiting, diarrhea, cramping abdominal pain, extreme thirst, restlessness, cold extremities, spontaneous sweating, and leg tetany, Xiang Ru San (Mosla Powder) is suitable. It must be chilled in well water and taken at once to be effective. Guo Yong comments: Xiang Ru (Mosla Chinensis Herb), Hou Po (Magnolia Bark), and Dou (likely Bian Dou or similar) are key herbs for Huoluan, making this prescription logical. For summerheat Huoluan, drinking cold water stops vomiting. Sometimes Li Zhong Wan taken with fresh well-water is also good. Ling Yuan Fang suggests boiling Liang Jiang (Galangal) powder, chilling it, and taking it cold; all should be taken cold."

A question asks: "Chuan Xin Fang records that Liu Zongyuan suffered from Gan Huoluan (Dry Cholera) and was cured by emesis. No other schools mention Gan Huoluan. Does it exist?" Guo Yong answered, "It exists, though its mechanism was not fully explored then. Truth contains little falsehood. Modern people especially do not understand it. Huoluan is one of the Five Chaos, always presenting with vomiting and diarrhea; there is no 'dry' form without vomiting/diarrhea. Those without vomiting/diarrhea are termed 'Luan Qi' (Chaotic Qi). According to Ling Shu, only 'chaos in intestines/stomach' is named Huoluan, thus causing vomiting/diarrhea. The other four chaos types do not cause vomiting/diarrhea and are called Chaotic Qi. Liu Zongyuan's condition was likely Chaotic Qi invading the Heart, not Huoluan. Calling it Gan Huoluan is erroneous, yet it remains one of the Five Chaos. Today, the name 'Chaotic Qi' is forgotten."