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In cases of severe vomiting and diarrhea where symptoms intensify in waves, the patient will inevitably sweat profusely like rain, feel as cold as ice, have sunken eye sockets, a low and faint voice, cyanosis of the nose, lips, and fingernails, and spasmodic contraction of the hands and feet. In extreme cases, the muscles of the entire body may waste away due to excessive sweating and purging, leaving nothing behind. Alternatively, there may be vomiting without diarrhea, or diarrhea without vomiting. The six pulses (radial arteries) may be deep and hidden, or completely imperceptible. At this juncture, the method of rescue determines life or death within moments. If one encounters mediocre physicians who diagnose this as Huoluan (Cholera-like disease) without clearly distinguishing between Cold and Heat patterns, they might first administer Yin-Yang Tang (Yin-Yang Decoction) for probing, or use standard formulas from the Huoluan category, such as Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi), Liuhe Tang (Six Harmonies Decoction), Buhuanjin Zhengqi San (Indispensable Powder to Rectify the Qi), or mix powdered Wu Zhu Yu (Evodiae Fructus) and Mugua (Chaenomelis Fructus) with roasted salt. They fail to realize that this is a sudden collapse of Yuan Yang (Primary Yang). Whether Yang can be restored depends on the span of a breath. Using the aforementioned formulas would delay treatment by even a moment, making recovery impossible. Furthermore, there are reckless individuals who, upon encountering such cases, insist that the patient first swallow Tangxi Shaya (Tangxi Calamine Medicine). They do not understand that "Sha" (Calamine/Heat Toxin) refers to a condition caused by latent Summerheat, characterized by an urge to vomit but inability to do so, an urge to defecate but inability to do so, severe colic in the heart and abdomen, and blockage of orifices, resembling death by strangulation. Therefore, Tangxi Shaya consists of pungent, aromatic, and penetrating herbs, supplemented by Long Nao (Borneolum Syntheticum) and She Xiang (Moschus), forming a harsh purgative for excess patterns. If applied to a case of upper vomiting and lower diarrhea where the central pivot of the Spleen and Stomach is about to sever, using such medicine would immediately cause death.

I once told my colleagues: During natural disasters and epidemics, these practitioners act as if executing Heaven's orders, which is why patients' families often believe them. Otherwise, treating this condition with Sha medicine is no different from ingesting Arsenic or Zhen poison. Moreover, while accidental ingestion of Arsenic or Zhen poison can sometimes be alleviated with Yellow Earth Water, Mung Bean Paste, or Watermelon Juice, ingestion of Tangxi Shaya leaves no room for rescue. Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) primarily advocates Lizhong Tang (Regulate the Middle Decoction), while Sixi Tang (Four Reversal Decoction), Tongmai Sixi Tang (Pulse-Restoring Four Reversal Decoction), and Tongmai Sixi Jia Zhuyedan Tang (Pulse-Restoring Four Reversal Decoction with Pig Bile) serve to supplement the limitations of Lizhong Tang. For initial stages of vomiting and diarrhea, only Lizhong Tang should be used. If vomiting and diarrhea are severe accompanied by restlessness, Wuzhuyu Tang (Evodia Decoction) should be employed (as noted in the *Taiyin Chapter* of *Shanghan Lun*: "It is appropriate to take the 'lei' [category] of Sixi Tang," implying this decoction falls within that category). If vomiting and diarrhea are accompanied by profuse sweating, fever, aversion to cold, cold limbs, and stiffness, Sixi Tang should be used to rescue Yin. If vomiting and diarrhea occur with normal urination, internal cold with external heat, and a faint pulse nearing extinction, Sixi Tang should be used to rescue Yang. However, fearing insufficient potency, Tongmai Sixi Tang should be the primary choice and administered frequently. I have one more word of advice for enlightened physicians: In cases of Yang Collapse, raw Fuzi (Aconiti Lateralis Radix Preparata) and Ganjiang (Zingiberis Rhizoma) should be used directly to restore Yang. Do not add Renshen (Ginseng Radix et Rhizoma), whose slightly bitter and fluid-rich nature might retard the action of Ginger and Aconite. This is like a prodigal son leaving home; if you try to bring him back to the inn and immediately give him a wife and family before he has decided to return, his resolve to come back will fail. Only after Yang has returned to its residence should one plan for the household, nourishing Yin to sustain Yang, so that Yang does not collapse again. Regarding Tongmai Sixi Jia Zhuyedan Tang, bile should never be added abruptly at the start. It should be administered continuously over half a day, four to five doses. Only when cold limbs show slight improvement, yet hand and foot spasms remain severe, should bile be added to rescue fluids, assisted by Ren Niao (Human Urine). This can be called a miraculous formula. Otherwise, adding Renshen and bile too early may prevent Yang from returning; students must know this.

In cases where Lizhong Tang, Baitong Tang (White Pass Decoction), or Sixi Tang are used, with Ganjiang increased to 1 liang and Fuzi to 2 liang, if cold limbs warm up and diarrhea stops, but slight continuous sweating persists, it indicates that Yang has returned but lacks Yin to sustain it, meaning Yang may collapse again soon. Yang resides in Yin, just as a prodigal son who returns home without a place to stay may escape again. Zhang Jingyue stated in his *Zhen Yin Lun* (Treatise on True Yin): "A husband without a wife will surely be dissolute." Though coarse, this statement contains subtlety. One should double the dosage of Renshen and Gancao (Licorice Root) in the previous formula, adding Ren Niao or Zhuyedan, to save Yin and consolidate Yang. If diarrhea stops but Qi rebels upwards, causing recurrent vomiting and hiccups, Jupi Zhuru Tang (Tangerine Peel and Bamboo Shave Decoction) with Maidong (Ophiopogonis Radix), or Daizhe Shi (Hematitum) and Xuanshu Hua (Inulae Flos) should be used to suppress the rebellious Qi above. If Fire rebels upwards, causing immediate vomiting upon swallowing liquids, Ganjiang Huanglian Huangqin Renshen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction) should be used, employing great Pungency and Bitterness to open and descend. If there is body heat, thirst, and desire for water, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used for nourishment. This formula is also excellent for treating emaciation, shortness of breath, and frequent vomiting, serving as the premier clearing and tonifying formula after major illnesses. These are methods for concluding treatment as the disease trend turns favorable. Mediocre physicians, copying my verified formulas, mistakenly treat them as initial therapies and add their own subjective speculations, instructing patients to consume cool water, raw plum water, watermelon juice, sugarcane juice, bamboo sap, or Yin-Yang Tang in between, killing countless people. Initially, if the condition is mild, it is easy to treat. However, if symptoms intensify in waves, leading to muscle wasting, cyanotic lips and nails, uncontrollable spontaneous sweating, icy cold body, and upward-gazing eyes unable to move, these are critical signs. If accompanied by rattling phlegm sounds and shoulder-lifting dyspnea, death will occur within moments. If diarrhea stops and hands and feet gradually warm, and the person becomes quiet, recovery may occur without medication. If diarrhea stops but severe restlessness and thirst arise, with a desire for cold water, the pathogen has transferred from Taiyin to Yangming. The *Classic* states: "Above Yangming, Dryness governs." Baihu Tang (White Tiger Decoction) or Zhuye Shigao Tang should be used to clear Dryness. If the initial presentation was Yangming head and neck stiffness, treated improperly with purgatives instead of Guizhi Tang (Cinnamon Twig Decoction) for release, some may experience sudden persistent diarrhea without taking medicine. This occurs because the pathogen attacks inward rather than outward, causing wheezing, which opens the skin pores and induces sweating. The pulse is rapid with occasional pauses, termed "Cu" (Surging/Prompt). This indicates that although the pathogen has sunk inward, the Qi still desires to exit outward. Ge Gen Huang Lian Huang Qin Tang (Kudzu, Coptis, and Scutellaria Decoction) should be used to promote ascending and dispersing, bringing inward pathogens out and lifting sunken Qi. This is one method for cooling and resolving Taiyin concurrent heat diarrhea. Alternatively, if Taiyin head and neck stiffness is not treated with Guizhi Tang for releasing the muscle layer, but repeatedly purged by clumsy physicians, spontaneous diarrhea may occur. Severe diarrhea leads to Stomach deficiency generating Cold, weakening Middle Qi, preventing the pushing out of pathogenic heat via the muscle layer, thus collaborating with heat to cause diarrhea. Persistent diarrhea worsens Stomach deficiency and causes Yin Qi to rebel upwards, resulting in epigastric fullness and hardness. Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) should be used to resolve both exterior and interior. This is one method for warming and supporting Taiyin concurrent heat diarrhea. If diarrhea stops but alternating chills and fever, bitter taste, hypochondriac pain, and frequent vomiting suddenly appear, the pathogen seeks to exit via Shaoyang. Xiaochaihu Tang (Minor Bupleurum Decoction) should be used to guide the pathogen, or Sini San (Frigid Extremities Powder) to harmonize Yin and Yang. After one dose, hands and feet warm, marking the Shaoyang pivot mechanism. The Ancients said: "Exiting Yin into Yang brings life," referring to the Three Yang channels. Conversely, if vomiting and diarrhea persist, limbs remain cold and unresponsive, and formulas like Lizhong Tang, Sixi Tang, or Wuzhuyu Tang pass through immediately without effect (commonly known as rectal洞泄/direct leakage), this indicates failure of both Stomach and Spleen, a collapse of the Two Earths, corresponding to the *I Ching* hexagram Bo (Peeling). This is a fatal syndrome of Taiyin sinking inward. If vomiting stops and diarrhea ceases, but throat pain, hoarseness, and bilateral leg spasms occur, the pathogen has transmitted from Taiyin to Shaoyin. The *Classic* states: "The Shaoyin channel circulates along the throat and wraps around the root of the tongue." And: "The Shaoyin channel runs along the inner thigh." *Shanghan Lun* states: "Shaoyin disease presents with a faint, fine pulse and a desire to sleep." These manifestations apply to both Cold and Heat transformations of Shaoyin. Careful differentiation and large-dose prescriptions may save one or two in ten. If the face is red like cinnabar while the lower body is cold, indicating True Yang floating upward, it is named Daiyang (Floating Yang). If the body is cold with spontaneous sweating, only restless without irritability, desiring to lie in mud or water, indicating internal cold with external dissipating heat, it is named GeYang (Rejecting Yang). Both syndromes represent Excess Yin and Collapse of Yang, appearing as False Cold and True Heat. They cannot be saved without Baitong Tang or Tongmai Sixi Tang, using Jiang (Ginger) and Fu (Aconite) in doses of 1-2 liang, served cold or mixed with Ren Niao/Zhuyedan, taken five to six times daily. If after vomiting and diarrhea, there is empty irritability, insomnia, tossing and turning, and mental anguish, this is Shaoyin failure of Water and Fire interaction. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used. Among combined irritability and restlessness, if Irritability (Fan) outweighs Restlessness (Zao), it is a milder Shaoyin Heat transformation. If irritability prevents lying down and limbs are restless, Huanglian Ejiao Tang (Coptis and Ass-Hide Gelatin Decoction) should be used. Here, Restlessness outweighs Irritability, representing the most severe Shaoyin Heat transformation. If heat episodes stop diarrhea while cold episodes restart it, this is the alternating cold and heat of Jueyin. Timing matters more than days; understanding the principle allows flexibility. Generally, more heat than cold is favorable; more cold than heat is unfavorable. Pure cold without heat is incurable. Refer to *Shanghan Lun*: "Thirst, Qi rushing to the heart, burning pain in the heart, hunger without desire to eat, vomiting roundworms upon eating." These define true Jueyin syndrome. Jueyin is based on Wind-Wood, marked by Yin-Cold, and mediated by Shaoyang Fire. Since Jueyin is the extreme of Yin, it follows the intermediate manifestation rather than the root or branch. Differentiating Cold and Heat is crucial. Without intermediate transformation, it is Cold. *Shanghan Lun* says: "Faint pulse, cold limbs, irritability; moxa Jueyin. If cold does not reverse, death ensues." To survive, combine Tongmai Sixi Tang with moxibustion. If intermediate transformation is excessive, it is Heat. *Shanghan Lun* says: "If thirsty for water, give sparingly for cure." Also: "Slippery pulse with cold limbs indicates internal heat; Baihu Tang governs." Also: "Diarrhea with deep-stringy pulse indicates heaviness below." Yu Jiayan borrowed Xiaochaihu Tang. Also: "Hot diarrhea with heaviness below; Beiteng Wang Tang governs." Also: "Diarrhea with desire for water indicates heat; Beiteng Wang Tang governs." Also: "Diarrhea with delirium indicates dry feces; Xiao Chengqi Tang is suitable." Also: "After diarrhea, increased irritability with soft epigastrium indicates empty irritability; Zhizi Chi Tang is suitable." Synthesizing these, Jueyin is the extreme of Yin. Without intermediate transformation, death is twice as fast as other channels. Thus, Wuzhuyu Tang in *Shanghan Lun* treats only dry vomiting, salivation, and headache. However, for severe vomiting/diarrhea with roundworm vomiting and cold limbs, where Wumei Wan (Mume Pill) may be insufficient, I add nine Wumei (Mume Fructus) to Wuzhuyu Tang, often achieving efficacy. This is a method beyond Zhongjing's standard methods. The Ancients said: "Entering Yin from Yang brings death," referring to the Three Yin channels. This principle is subtle; only those versed in the Great Treatise on Yin-Yang and *Shanghan Lun* can discuss it.

A disciple asked: In the years Gengchen and Xinsi, many in Fujian died from this disease, starting in May, peaking in June and July, and easing after Bailu (White Dew). In Gengchen, severe drought and heat led people to blame heat. In Xinsi, heavy rains and cold led people to blame cold. Yet the disease presentation was identical. Why?

I replied: This question is essential. The *Neijing* states: "Wind injury in Spring generates undigested food diarrhea in Summer." And: "Persistent wind generates undigested food diarrhea." This is a latent pathogen manifesting according to time. May corresponds to Wu, where Yin begins to generate. June corresponds to Wei, where Yin peaks. During Late Summer, Spleen Earth is dominant. Spleen is the ultimate Yin within Yin. Excess Yin generates internal Cold. Combined with long-term suppression, the intermediate Qi loses authority, resulting in pure Yin-Cold dominance. Hence, vomiting and diarrhea often start in these two months. Variations in onset timing depend on the speed of Qi arrival. After Bailu, it becomes Da Jia Xie (Major Mass Diarrhea), requiring separate discussion. The reason it isn't distinguished by drought/rain or cold/heat is that the disease originates internally, involving formless Qi transformation, not tangible Cold/Heat types. Similar presentations occurring seasonally are termed Shi Yi (Seasonal Epidemic).

The disciples retired, rejoicing: We have learned the cause of this syndrome from your teaching. From your citation of "Spring wind injury," we now understand that Wuzhuyu Tang is not solely for Jueyin. Spleen is Kun Earth, Stomach is Gen Earth. Uncontrolled vomiting/diarrhea and cold limbs indicate failure of both Spleen and Stomach, a collapse of the Two Earths, resembling the *I Ching* hexagram Bo (Peeling). Now, with Wuzhuyu Tang nourishing the vital Qi of the East (Wood) to harmonize with Foot-Taiyin Spleen and Foot-Yangming Stomach, Wood and Earth no longer conflict, resembling the hexagram Fu (Return). This formula transforms Peeling into Return, making it a miraculous agent for this syndrome.