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Wan Mizhai stated: Huoluan (Acute Vomiting and Diarrhea) is a disease name of the Yangming Stomach Meridian. It arises because, in daily life, excessive consumption of rich flavors, fatty foods, and fermented beverages leads to rotting and accumulation, forming phlegm turbidity. Coupled with emotional stagnation, where excessive Qi transforms into Fire, these pathogens accumulate in the Stomach. Suddenly, upon exposure to Cold or Heat pathogens, Evil Qi and Righteous Qi contend, and Yin and Yang become mixed, causing severe cramping pain in the heart and abdomen, with simultaneous vomiting and diarrhea, leading to rapid and chaotic changes. If the pathogen is in the Upper Jiao (Stomach Epigastrium), pain occurs at the heart region, and vomiting predominates. If the pathogen is in the Lower Jiao (Stomach below the navel), pain occurs around the umbilicus, and diarrhea predominates. If the pathogen is in the Middle Jiao (Middle Epigastrium), abdominal pain occurs, and both vomiting and diarrhea are frequent. Excessive vomiting injures Qi, while excessive diarrhea injures Blood. When Qi and Blood are injured, they cannot protect and nourish the Fetus. The pathogenic factors agitate and strike the Taiyuan (Fetal Origin), and it is inevitable that the mother will miscarry. This is a critical condition that must be treated urgently; Xiangsu San (Perilla and Cyperus Powder) added with Huoxiang Ye (Patchouli Leaf) is indicated as the primary formula.

Shenzhai commented: The above two passages describe the presentation of Huoluan during pregnancy. In pregnancy, Huoluan characterized by vomiting, diarrhea, and cramping pain is most likely to damage the Fetus. Therefore, for Huoluan during pregnancy, one should differentiate whether the cause is dietary cold/raw food, Summerheat-Dampness, Wind-Cold, or other external pathogens, treating according to the location of the pathogenic factor, with the preservation of the Fetus as the primary principle.

The *Daquan* (General Collection) states: During pregnancy, if diarrhea presents with stool that is either green or white, containing undigested food and water, accompanied by abdominal pain and borborygmus, it is called Dongxie (Cavity Diarrhea). If there is undigested food and water, thirst with a desire to drink, and nausea/vomiting, it is called Xiexia Li (Collateral-Heat Dysentery/Diarrhea). Both conditions should initially be treated with Wuling San (Five-Ingredient Poria Powder) to promote urination, followed by Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill) or Sanhuang Shuai Tang (Three-Yellows Cooked Mugwort Decoction) to stabilize the condition. If the diarrhea is yellow with froth, accompanied by borborygmus, abdominal pain, and a deep, tight, and rapid pulse, Wuji Wan (Wuji Pill) should be used to harmonize. If there is belching with a rotten odor, anorexia, and a deep, tight Stomach pulse, Yinggan Wan (Induction Pill) should be used to purge, followed by harmonizing the Spleen and Stomach. If caused by Wind-Cold, with undigested food resembling bean dregs, Weifeng Tang (Stomach-Wind Decoction) is indicated. If caused by Cold, with a cold sensation below the umbilicus and Dongxie, Lizhong Tang (Regulate the Middle Decoction) or Zhizhong Tang (Govern the Middle Decoction) should be used. If caused by latent Summerheat with irritability, thirst, and watery diarrhea, Siling San (Four-Poria Powder) is indicated. If caused by Dampness injury with free urination, Buhuanjin Zhengqi San (Non-Exchanging Gold Upright Qi Powder) or Weiling Tang (Stomach-Five Decoction) should be used. These represent the general categories of four syndromes.

Shenzhai commented: The etiology of diarrhea is diverse, involving combinations of internal and external pathogens, and differing in deficiency and excess. Particularly for diarrhea during pregnancy, one must carefully examine the cause and detailed symptoms. Can these four categories exhaust all possibilities? Or can one rigidly adhere to these four syndromes and fixed formulas for treatment?