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The syndrome of Huoluan (cholera-like disease with sudden vomiting and diarrhea) presents with a rapid and violent onset. There is severe colicky pain in the abdomen, accompanied by restlessness and agitation. Vomiting and diarrhea occur simultaneously; there are cases where only vomiting occurs without diarrhea, or only diarrhea without vomiting; and there are cases where neither vomiting nor diarrhea can occur. This indicates that the pathogenic factor has different levels of depth and location within the body. Generally, recovery is marked by the ability to vomit out the pathogen. Since pathogens enter the body, they must also have a way to exit. Using salt water to induce vomiting is an excellent method. Afterward, the stomach qi can be regulated. Huoluan often damages the stomach qi. Although it may be caused by the invasion of wind-cold, summer-heat, and dampness (the four climatic factors), internal deficiency must exist first for the pathogen to enter. Cases involving dietary irregularity and infection by turbid pathogens are particularly common. Once the stomach qi is damaged, clear yang and turbid yin interfere with each other. If the pathogen is not expelled, the healthy qi cannot be at peace; therefore, expelling the pathogen is more urgent than supporting the healthy qi. Even if the condition progresses to cold limbs, hidden pulse, muscle twitching (charley-horse), and hoarseness, the pathogen must still be completely driven out. Because only when the pathogen is gone can the healthy qi be at peace; this differs from other syndromes where supporting the healthy qi leads to the spontaneous elimination of the pathogen. After severe vomiting and diarrhea, when the primordial qi is depleted, manifesting as cold extremities and a faint pulse nearly imperceptible, Shenfu Lizhong Tang (Ginseng and Aconite Regulation of the Middle Decoction) remains critically important. However, if administered too early, it may cause the pathogen to become entrenched and difficult to cure. Therefore, during the acute phase, rice drink should not be consumed; this was repeatedly cautioned by past sages, which is certainly not without reason. Observing Gan Huoluan (dry cholera), where one cannot vomit above nor defecate below, the severity arises precisely because the pathogen cannot exit. Practitioners can thus ponder the underlying principles.

Clinical Case 1:
A man indulged in drinking plum juice, resulting in uncontrolled vomiting and diarrhea. His extremities were cold and inverted, his complexion was dull and dark, his voice was absent, and his pulse was deep and hidden. Urine output was scanty and obstructed. Any medicine taken was immediately vomited up, leaving the physician at a loss. After half a day of deep contemplation, I suddenly realized that plums are fruits. Their sour taste has a consolidating/astringent nature, leading to urinary retention (long bi). Recalling the saying that "fruits are spoiled by musk, and wine is ruined by musk," and considering that Musk (She Xiang) has an aromatic, penetrating quality that opens orifices, I took half a qian of Musk, placed half into the umbilicus and half into the nostrils. The patient brushed his nose with his hand and asked what the substance was. Shortly after, urine flowed profusely for two or three times. He suddenly woke up as if from a drunken dream. The next day, he requested porridge and gradually stabilized.

Clinical Case 2:
A woman suffered severe vomiting and diarrhea, followed by cold extremities and an absent pulse in all six positions. Her head and face showed signs of floating yang, appearing red and flushed. All medicines were vomited immediately upon ingestion. I stated, "This is Yin excess repelling Yang." I prescribed Tongmai Sini Tang (Pulse-Recovering Four Reversals Decoction) by Zhang Zhongjing continuously until the pulse returned and the limbs warmed, at which point she recovered.

Huoxiang Tang (Agastache Decoction): Treats Huoluan with simultaneous vomiting and diarrhea.
Ingredients: Huoxiang (Patchouli Herb), Zhi Nong Po (Magnolia Bark processed with ginger), Fuling (Poria), Mugua (Chaenomeles Fruit), Cheqianzi (Plantago Seed, roasted and ground, 2 qian), Zexie (Alisma Rhizome), Zhike (Bitter Orange Fruit), Guangpi (Tangerine Peel), Gegen (Kudzu Root) (each 1 qian).
Add three slices of Shengjiang (Fresh Ginger). If there is food stagnation, add 1 qian of Sharen powder (Amomum Fruit powder). If there is irritability and thirst, remove Huoxiang and add 1 qian of Zisu (Perilla Leaf). If wheat-based foods were consumed, add 1 qian of Laifu (Radish). If there is Qi stagnation, add 0.7 qian of Qingpi (Green Tangerine Peel) and 0.3 qian of Muxiang (Aucklandia Root). Strictly prohibit the consumption of rice drink until the pain stops and hunger is felt, before allowing intake.