Library

Whenever Spleen Qi deficiency occurs, diarrhea ensues; when Stomach Qi is deficient, vomiting results; if both Spleen and Stomach are deficient, vomiting and diarrhea occur simultaneously. If vomiting precedes diarrhea, it indicates disharmony of the Qi in the Middle Jiao (Middle Burner), leading to an inability to digest and absorb food. This presents with a red face, red lips, irritability, thirst, short urine, and a flooding and rapid pulse, which are signs of heat accumulation. If diarrhea precedes vomiting, it may be due to sudden overeating, cold abdomen during sleep, or damage to the Spleen by cold-dampness, resulting in Spleen injury and Stomach weakness. This presents with a pale face, mental fatigue, absence of fever or thirst, and a deep and soggy pulse, indicating deficiency-cold. Additionally, in summer, external exposure to summer-heat and internal damage from food can cause the Yin and Yang to fail in their ascending and descending functions, leading to sudden onset due to Yin-Yang rejection (Ge Jue). There are also cases where weak Yang Qi leads to unceasing vomiting and diarrhea, or where a wet nurse contracts summer-heat, and the infant drinks hot milk, causing the condition. Generally, yellow, red, or crimson colors indicate heat; white indicates cold; green or black indicates pain. However, vomiting damages Qi, while diarrhea damages Blood. Qi deficiency leads to Jue syndrome (cold extremities/collapse); Blood deficiency leads to fever. If both Qi and Blood are deficient, there is body heat with cold extremities, which will subsequently develop into slow wind (chronic convulsions). One must be cautious! Only gan-xie (malnutrition diarrhea) does not lead to wind syndromes, but prolonged cases may result in "Wu Gu" disease (a pediatric critical condition), ultimately causing severe debility. If diarrhea is like water pouring and the pulse is floating, large, and rapid, death is imminent. If diarrhea is accompanied by abdominal distension and a wiry pulse, death is imminent. If lips are red with sores and eyes have many red vessels, death is imminent. If chronic dysentery leads to vomiting with sound but no substance, bright red lips, thirst, and rebellious Qi, death is imminent. If hole-like diarrhea (profuse watery stool) does not stop, death is imminent. If it resembles leaking roof water without stopping, food intake causes vomiting, consciousness is clouded, eyes roll upward, and hands, feet, mouth, and nose are all cold, death is imminent. A black tongue with prickles indicates exhaustion of Yin with floating solitary Yang. Unceasing extreme thirst indicates kidney failure. All these conditions are fatal.

Huo Luan (cholera-like illness) is mostly contracted in summer, due to external contraction of damp-heat, wind, and summer-heat, and internal damage from raw, cold, or improper diet. This causes Yin-Yang blockage, interference between clear and turbid Qi, and chaotic movement up and down. Qi becomes disordered in the intestines and stomach; Yang fails to descend, Yin fails to ascend, evil and righteous Qi oppose each other, the middle epigastrium closes, and Qi strikes internally, suddenly causing vomiting and diarrhea, turmoil, severe heart and abdominal pain, vomiting and loose stools, aversion to cold with high fever, headache, and dizziness. If the pathogen is in the Upper Jiao, heart pain precedes vomiting; if in the Lower Jiao, abdominal pain precedes diarrhea; if in the Middle Jiao, both heart and abdominal pain occur, leading to simultaneous vomiting and diarrhea. The Yang Ming channel moistens and nourishes the Zong Jin (tendons). Sudden loss of body fluids from vomiting and diarrhea deprives them of nourishment, potentially leading to tendon spasms extending into the abdomen and death. In infants, with weak Spleen and Stomach, milk and food easily stagnate. Combined with external exposure to cold and heat, evil and righteous Qi attack each other. Spleen deficiency causes diarrhea, Stomach deficiency causes vomiting, and dual deficiency causes simultaneous vomiting and diarrhea, potentially leading to Yang collapse and transformation into wind. The treatment principle should prioritize stopping vomiting and calming the Stomach, followed by symptom-specific cessation of diarrhea. Wet Huo Luan has fewer deaths, while dry Huo Luan has more. Dry Huo Luan presents with sudden fullness, severe heart and abdominal cramping, inability to vomit or defecate, restlessness, confusion, Yin-Yang rejection, generalized tendon spasms, cold hands and feet, phlegm obstruction, and abdominal distension. Within moments, ascending and descending functions cease, leading to suffocation and unconsciousness. Mismanagement with food/drink leads to immediate death. This is caused by excessive cold-dampness binding the Spleen, preventing movement, and郁结 (stagnation) of Qi, preventing flow. Extreme Spleen Earth stagnation fails to vent, causing internal heat disturbance, sudden pain, cold extremities, nausea, and retching. Commonly known as "Jiao Chang Sha" (Intestine-Turning Sand), referring to the severity of pain. Treatment must avoid excessive purgation (which further weakens the Spleen), excessive heat (which intensifies fire), or excessive cold (which compromises defense). Counter-assisting methods are required to open stagnation and dissipate fire. In the North, pricking blue veins to release Qi and Blood can disperse disease; in the South, manipulating hands and feet to promote Qi and Blood circulation works similarly. However, promoting Qi and Blood circulation is superior to merely releasing blood. Since Huo Luan is a Qi disorder, not a Blood disorder, pricking veins disperses Qi but also injures Blood. The body naturally has excess Qi and deficient Blood. Now, with existing deficiency, further injury creates double deficiency. Young and strong individuals may survive; the elderly often die. Why? Because Qi is the guide for Blood, and Blood is the foundation for Qi. With Yin-Blood deficiency, Yang loses its anchor and becomes restless, inevitably leading to death. Yang deficiency causes aversion to cold; Yin deficiency causes fever, which further consumes Yin-Blood. The Classic states: "Yin deficiency leads to disease; Yin exhaustion leads to death." The appropriate remedy is hot child's urine with a little salt, taken three times inducing vomiting each time. This promotes Qi ascent via salt and descent via urine, clearing the middle. Alternatively, plain salt water to induce vomiting follows this principle of promotion and clearance. If there is intake but no exit, it is blockage, often fatal. After vomiting subsides, medication can regulate the body. The Mai Jue says: "Slippery and rapid indicates vomiting; Intermitting pulse indicates Huo Luan; Micro-slippery indicates survival; Choppy and rapid indicates fatality." It also says: "Slippery but irregular indicates Huo Luan with vomiting and diarrhea." Do not be alarmed by an intermitting pulse. Thus, in vomiting and diarrhea, a knotted, hurried, intermitting, hidden, or flooding pulse does not necessarily indicate death. Only if the pulse is micro-fine and nearly absent, accompanied by shortness of breath, muteness, curled tongue, and retracted testicles, is it incurable. Qi is the pivot of the upper, lower, and four sides. If Middle Epigastric Qi is robust, it drives Lower Epigastric Qi into the small and large intestines for excretion via the anterior and posterior orifices. Due to insufficiency, it lacks power to move downward, instead being invaded by turbid Qi from below, causing confusion of clear and turbid Qi in the Stomach, leading to pain and distension. The Classic states: "Tai Yin manifestations include central fullness, Huo Luan, vomiting, and diarrhea. Clear Qi resides in Yin, Turbid Qi in Yang. Ying Qi flows smoothly in the vessels, Wei Qi moves in reverse. Interference between clear and turbid Qi in the intestines and stomach constitutes Huo Luan." Post-vomiting/diarrhea tendon spasms indicate concurrent Wind Cold. Cold extremities, shortness of breath, and cyanotic lips indicate concurrent Cold. Body heat, irritability, thirst, coarse breathing, and dry mouth indicate Summer-Heat. Heavy limbs and painful joints indicate concurrent Dampness. Tendon spasms in the legs occur because the Lung and Large Intestine govern the tendons connected to the Stomach and Large Intestine. Sudden vomiting and diarrhea cause instant fluid loss, internal/external injury, imbalance of cold and heat, and Yin-Yang conflict blocking the channels. Withered pulses and malnourished Zong Jin lead to spasms. Severe cases with curled tongue and retracted testicles are difficult to treat. Generalized tendon spasms, cold limbs, unbearable chest pain, and a flooding pulse are easy to treat. A micro-weak pulse gradually becoming slow indicates death. Yang collapse with incontinence, muteness, sweat like pearls, restlessness with desire to enter water, or flaccid limbs are all fatal.
If vomiting and diarrhea persist, Yuan Qi (Original Qi) scatters, and the condition is critical. Symptoms may include thirst for cold drinks, aversion to cold with cold extremities, or fever with irritability and desire to remove clothing. This is Yin Excess repelling Yang (True Cold, False Heat). Do not mistake the desire for cold/removal of clothes for a heat syndrome. Use Lizhong Tang (Regulate the Middle Decoction). For severe cases, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction); if ineffective, use Sini Tang (Frigid Extremities Decoction), administered cold.

Nausea (E Xin) is characterized by no sound and no substance expelled, a sensation of wanting to vomit but unable to do so. Although called "Heart Nausea," it is not a Heart meridian disease but located above the Stomach gate. It involves Phlegm, Heat, or Deficiency. Ginger is suitable in all cases, combined with other herbs based on symptoms, as Ginger opens the Stomach and resolves phlegm.