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The *Huoren Shu* (Book of the Living) states: Huoluan (cholera-like syndrome with vomiting and diarrhea), characterized by vomiting and diarrhea, with predominant heat but no thirst, or predominant cold but no appetite, is primarily treated with Lizhong Wan (Regulate the Middle Pill). If accompanied by vomiting and diarrhea, sweating, fever, aversion to cold, spasticity of the four limbs, and coldness of the hands and feet, Sini Tang (Frigid Extremities Decoction) is primarily used. If vomiting and diarrhea have ceased, yet sweating and cold extremities persist, spasticity of the limbs remains unresolved, and the pulse is faint and nearly imperceptible, Tongmai Sini Jia Zhudanshi Tang (Pulse-Reviving Sini Decoction with Pig Bile) is primarily indicated.

Qian Yi, in his discussion on vomiting and diarrhea, records: The Seventh Taivwei of the Guangqin family, aged seven, suffered from vomiting and diarrhea in July. His symptoms included complete anorexia, lethargy, and upon waking, he felt irritable and confused, with dry heaving upon inhalation. Stool was intermittent, and there was no thirst. Other physicians treated it as Jingfeng (wind-stroke/convulsion), suspecting the lethargy was the cause. Qian Yi stated: First tonify the Spleen, then clear heat, using Shigao Tang (Gypsum Decoction). The next day, powder of Mercury and Sulfur was mixed with Ginger Juice and administered in a dose of "one character" (a small measure). After August 15th, due to vomiting and diarrhea, the body became cold, indicating Yang exhaustion; he could not take milk, experienced dry heaving, and passed clear brown watery stool. The Spleen should be tonified with Yihuang San (Yellow Protecting Powder); purgatives must not be used.

Liu Wansu (courtesy name Shouzhen) stated: In cases of vomiting, diarrhea, and Huoluan, the Sanjiao (Triple Burner) is the pathway for the transmission and transformation of food and fluids. When Heat is severe, this transformation function becomes abnormal, leading to vomiting, diarrhea, and Huoluan, because the nature of Fire is dry and agitated. Some claim that Heat does not cause vomiting and diarrhea, attributing it only to Cold; this view is erroneous. The *Suwen: Zhi Zhen Yao Da Lun* (Essential Questions: Great Treatise on the Most Important Principles) states: All conditions involving wheezing, vomiting, sour regurgitation, sudden violent diarrhea with tenesmus, muscle cramps, turbid urine, abdominal distension like a drum, borborygmus, carbuncles, sores, rashes, tumors, phlegm nodules, and vomiting/diarrhea Huoluan all belong to Fire.

The *Huoren Shu* further states: Regarding Shanghan (Cold Damage), various schools offer differing formulas and theories. Only the works of Yi Yin and Zhang Zhongjing serve as standard references akin to the Six Channels (Liujing); the insights of other schools are occasional and generally cannot serve as universal laws. Moreover, those who favor cooling medicines mock and avoid hot medicines like Fuzi (Aconite Root) and Liuhuang (Sulfur), even in deep winter, prescribing Sanhuang Wan (Three Yellows Pill) instead. Conversely, those who favor hot medicines fear cold-purgative drugs like Dahuang (Rhubarb Root) and Mangxiao (Mirabilite), avoiding them even in midsummer, and instead advise moxibustion and Jin Ye Dan (Golden Elixir Pill). They are not unaware of karmic consequences, but are driven by biased preferences. It is also noted that recently, Xiaochaihu Tang (Minor Bupleurum Decoction) is prescribed indiscriminately for all Shanghan patients, regardless of Yin/Yang or Exterior/Interior differentiation. This should not be used lightly. Although less potent than Daxiehu Tang (Major Bupleurum Decoction) or Xiao Chengqi Tang (Minor Order the Qi Decoction), if the pathology does not match the formula, the harm is similar. Many patients develop Yin syndromes after taking Xiaochaihu Tang. Additionally, for Yindu Shanghan (Yin-Toxin Cold Damage), characterized by mental restlessness, headache, and cold extremities, Fanyang Dan (Yang-Returning Pill) is indicated. This formula is highly effective, stopping wheezing and vomiting immediately upon ingestion. If accompanied by urinary retention, retraction of the scrotum, and excruciating lower abdominal pain, moxibustion should be applied two cun below the umbilicus, along with Fanyang Dan and Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction for Frigid Extremities plus Evodia and Fresh Ginger). Ordinary diuretics must be avoided, as they are typically cold and slippery in nature, which would exacerbate the accumulation of Yin-Toxin Qi in the lower abdomen. Liu Wansu stated: In treating any disease, one must first understand the Six Qi (Cold, Heat, Dryness, Dampness, Wind, Fire), which is paramount. Thus, the method of treatment involves using Cold to treat Heat, Heat to treat Cold, Clarity to treat Warmth, and Moisture to treat Dryness; this is Zhengzhi (Direct Treatment). He also discusses Nizhi (Contrary Treatment): when the pathogenic factor is mild, the medicinal qi opposes the disease qi. However, in severe cases, Fanzi (Reverse Treatment) should be employed. Fanzi is also called Congzhi (Following Treatment), meaning following the apparent nature of the disease qi. Hence, the classics state "treat Heat with Heat, treat Cold with Cold." Treating Heat does not mean using hot herbs for a hot condition; rather, it means using cold herbs but administering them hot, or adding hot adjuvants. If the disease Heat is extreme, it may reject cold medicine, causing a struggle between Cold and Heat that worsens the condition. Therefore, cold medicines are taken hot or with hot adjuvants so that the medicinal qi does not clash with the disease qi. Once swallowed, the initial heat dissipates, allowing the cold nature of the herb to act, thereby resolving the disease. Other scenarios follow this principle. Zhengzhi (Direct Treatment) is like a ruler punishing a minister's fault by opposing their nature; thus, for mild Heat, Cold herbs are used to oppose the disease qi, eliminating the illness. Fanzi (Reverse Treatment) is like a minister remonstrating with a ruler by initially complying with their nature to eventually correct their deviation. The *Suwen: Zhi Zhen Yao Da Lun* states: "Treat Cold with Heat, treat Heat with Cold; Follow implies Contrary, Contrary implies Follow." Wang Bing commented: A mild disease is like saving someone from fire; adding wood makes it burn, adding fire makes it blaze, so water extinguishes it by opposing its nature. For mild disease Qi, attack it with Cold. Dampness is like Dragon Fire; it flares up with dampness and burns with water. Ignoring its nature and attacking with water/wetness causes flames to reach the sky until fuel is exhausted. Those who understand its nature use human fire to drive it away, extinguishing the flames naturally. Thus, Nizhi (Contrary) means attacking Heat with Cold and Cold with Heat; Congzhi (Following) means when direct opposition is difficult, follow the nature of the disease to apply treatment. Hence, "Contrary is Direct Treatment, Following is Reverse Treatment." One observes whether to follow or oppose based on the situation.