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[Dai Yuanli] Vomiting accompanied by diarrhea is called Huoluan (cholera-like syndrome). The etiology of this disease stems from deficiency-cold in the stomach and intestines, excessive food intake, and exposure to wind-cold pathogens. This disrupts the harmony of Yin and Yang, causing turbid and clear Qi to interfere with each other, resulting in sudden chaotic vomiting and diarrhea. Some patients experience heart pain followed by vomiting; some have abdominal pain followed by diarrhea; some present with simultaneous vomiting and diarrhea; some exhibit headache, high fever, and a floating-hong (floating and full) pulse; others suffer from sudden collapse of Yang Qi, cold extremities, and a faint pulse nearly imperceptible. Treatment requires distinguishing between Yin and Yang, assessing excess and deficiency, differentiating heat and cold, and examining the pulse. Heat patterns are treated with cooling agents, cold patterns with warming agents, aiming for balance. *Baiwen* states: For Huoluan with vomiting and diarrhea where heat predominates and thirst is present, use Wuling San (Five-Ingredient Powder with Poria). Where cold predominates and there is no desire to drink, use Lizhong Wan (Regulate the Middle Pill). After vomiting and diarrhea cease, if sweating occurs with cold extremities, persistent limb stiffness, and a faint pulse, use Tongmai Sini Jia Zhudanshi Tang (Pulse-Reviving Four Reversal Decoction with Pig Bile). In summer, for Huoluan caused by heatstroke presenting with severe restlessness and thirst, cold extremities, cold sweat, and calf cramps, use Xiangru San (Elsholtzia Powder) decocted strongly and taken cold after cooling. (Generally, a floating-hong pulse in Huoluan indicates an easier prognosis, whereas a faint-slow pulse with shortness of breath indicates a difficult prognosis.)

[Xue Ji] Mr. Jia Yuanliang stated: Summerheat is the manifestation of Ministerial Fire in command. When humans contract summerheat in summer, it enters through the mouth and nose, damaging the meridians of the Pericardium. Symptoms include headache, dry mouth, greasy complexion with spontaneous sweating, fatigue, and shortness of Qi; or aversion to cold on the back but aversion to heat; severely, coma and loss of consciousness; or Huoluan with vomiting and diarrhea, vomiting phlegm, abdominal pain, bloody stools, jaundice, and skin sores. The treatment principle focuses on clearing Heart Fire and promoting urination. If there is spontaneous sweating and severe heat, use Baihu Tang (White Tiger Decoction). If there is headache and aversion to cold, use Shiwei Xiangru San (Ten-Ingredient Elsholtzia Powder). If there is diarrhea, restlessness, thirst, drinking water leading to vomiting and reflux, use Wuling San. If heat is severe with restlessness and thirst, use Yiyuan San (Benefit Origin Powder) to clear heat. If the exterior pattern is resolved but interior heat is severe, use Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity). If the pulse is faint with diarrhea, thirst preferring warmth, or cold extremities with unconsciousness, use Zhuye Shigao Tang (Leaf of Bamboo and Gypsum Decoction) plus half a prepared Aconite root, taken chilled; subsequently treat with Laifu Dan (Restoring Vitality Pellet) and Wuling San. Thus, Li Dongyuan said: With Spleen-Stomach deficiency, during continuous summer rains, one may experience heavy body, shortness of breath, and even flaccidity of limbs, foot deviation, and blacking out of eyes. One should nourish Lung Qi to supplement the source of Water; hence, in May, one often takes formulas containing Wuweizi (Schisandra), Renshen (Ginseng), and Maimendong (Ophiopogon) because heat damages Yuan Qi. This aligns with Zhu Danxi’s concept of "latent Yin inside during summer." Essentially, the human abdomen corresponds to Earth. In the Si month, all Six Yang energies emerge above ground; similarly, human Yang Qi floats to the muscle surface and disperses into the skin and hair, leaving the internal Yang deficient. Added to this are behaviors like seeking cool pavilions, using large fans, drinking cold spring water, eating fruits, and consuming icy substances. These cold factors act from within and without. Without the use of warming herbs, disease arises. Chen Wuzhe stated: For heatstroke, one must absolutely not use cold medicines; only warm nourishment should be used. Exposure to cold leads to death. If hot water is unavailable on the road, apply hot earth to the umbilicus and pour hot urine to revive consciousness, illustrating this point. *Neijing* states: Faint pulse and body heat result from Summerheat injury. *Nanjing* states: Summerheat injury is a direct pathogen, fire originating from the disease itself. The patient dislikes odors; symptoms include body heat, irritability, heart pain, and a floating-large-dispersed pulse. *Shanghan Lun* states: Taiyang Zhongyue (Summerheat in Taiyang) presents with body heat, headache, and a weak pulse, or fever with aversion to cold and a string-tiny-hollow-slow pulse. Generally, Cold damages the Form, while Heat damages Qi. Damaging Qi without damaging Form leads to Qi consumption and a weak pulse. Therefore, ancient sages established that summer is suitable for tonification, which is well-founded. For the aforementioned patterns, if there is internal accumulation and external contraction, use Erchen Tang (Two-Aged Decoction) with modifications; or crush Radish seeds, ingest them to induce vomiting. Drinking rice soup causes death, as discussed previously. If cramps persist, men should pull their genitals, and women should pull their breasts near the sides; this is a wonderful method from *Qianjin Fang*. Gan Huoluan (Dry Cholera) prevents ascending and descending, leading to death shortly; induce vomiting with salt water, then administer Erchen Tang modified with Chuanxiong, Cangzhu, Fangfeng, Baizhi, and Ginger. If defecation is obstructed despite urgency, add Zhiqiao. For Huoluan caused by eating melons/fruits, drinking cold liquids, or exposure to wind, use Liuhe Tang (Six-Harmony Decoction) with doubled Huoxiang. Generally, death from heatstroke occurs because Yuan Qi is weak, allowing Summerheat to invade, causing diarrhea and sudden Yang collapse. This is essentially a Yin-Cold pattern; urgently tonify Yang to preserve life. Delay means no rescue. Others stubbornly attribute it to Summerheat and administer cold medicines, rarely avoiding error. Therefore, I follow with formulas for restoring Yang and securing the Root.

Modified Lizhong Wan: Main formula for acute Huoluan, also applicable to men.
Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger), Gancao (Licorice Root) (each 1 liang).
Grind into fine powder, make pills with refined honey. Each liang makes five pills. Take one pill dissolved in decoction, three times daily. For more vomiting and less diarrhea, take three roasted Zhisshi (Immature Bitter Orange), remove seeds, cut into four pieces, boil in 3 sheng water to obtain 1 sheng, dissolve one pill. For less vomiting and more diarrhea, add 1 liang Ganjiang. For vomiting, diarrhea, and dry heaving, take 0.5 liang Banxia (Pinellia Tuber), soak and wash to remove slipperiness, boil in 2 sheng water to obtain 1 sheng, dissolve one pill. For unbearable body pain, take three dates, boil in 2 sheng water to obtain 1 sheng, dissolve one pill. For extreme vomiting/diarrhea with cramps, wash the abdomen and kidney area with Leizhi juice (Chinese chive juice) from chest to ankle without reversing direction to stop symptoms. For cold body with slight sweat and cold abdomen, take one Paofu Zi (Prepared Aconite Root), peel, cut into four pieces, boil in 2 sheng water to obtain 1 sheng, dissolve one pill. If vomiting/diarrhea cease, pulse is absent, and body remains cold, various tonic decoctions may be used.

Sishun Tang: Treats Huoluan with vomiting, diarrhea, abdominal pain, cold extremities, and faint pulse.
Fuzi (Aconite Lateralis Radix Praeparata) (one piece, broken into eight), Ganjiang (three liang), Renshen, Gancao (each one liang).
Cut into pieces, decoct in water and take.

Sini Jia Zhudanshi Tang: Treats cessation of vomiting and diarrhea, sweating with cold extremities, persistent limb stiffness, and faint pulse.
Gancao (two liang), Ganjiang (three liang), Fuzi (one piece, raw), Zhudanshi (Pig Bile) (half he).
Decoct the first three ingredients. Take 5 qian per dose, boil 3 zhan water down to 2 zhan, strain, add Pig Bile, divide into two doses, take warm. Pulse will return.

Xiangru San: Treats disharmony of cold/heat in organs, irregular diet, excessive consumption of raw/cold/fishy foods, irregular lifestyle, sleeping in damp places, or exposure to wind while cooling. Wind-cold Qi returns to the Sanjiao, transmits to Spleen/Stomach. Cold Spleen/Stomach cannot digest food/water, causing true/pathogenic interference, weakening intestines/stomach. Dietary chaos leads to vomiting/diarrhea, heart/abdominal pain, Huoluan with rebellious Qi. Patterns include heart pain before vomiting, abdominal pain before diarrhea, simultaneous vomiting/diarrhea, fever/headache/body ache followed by vomiting/diarrhea with empty irritability, stabbing heart/abdominal pain during vomiting/diarrhea, cramping stiffness/pain, vomiting without material expulsion, cold extremities with faint pulse, or severe oppression/coma threatening death. Pregnant women with Huoluan vomiting/diarrhea can also be treated.
Xiangru Ye (Elsholtzia Leaf) (4 liang), Baibian Dou (White Hyacinth Bean), Houpo (Magnolia Bark) (each 2 liang).
Cut into pieces. Take 0.5 liang per dose, decoct with 1 large zhan water and 1 fen wine over slow fire until 6 fen remains. Strain, immerse in well water until ice-cold. Take in one gulp at any time. Two to three doses yield immediate miraculous effects. (*Su Shen Liang Fang* calls it Xiangrong San; *Baiwen* agrees, adding Huanglian, omitting Baibian Dou).

Hezi San: Treats Huoluan vomiting/diarrhea in old and young, effective in one dose. Also treats nine types of heart pain and unbearable cold pain in heart/Spleen.
Hezi Pi (Chebula Epicarpium), Gancao, Houpo, Ganjiang, Caoguoren (Tsaoko Cardamom Seed), Chenpi (Citrus Reticulata Peel), Liangjiang (Galangal Rhizome), Fuling (Poria), Shenqu (Medicated Leaven), Maimendong (each equal parts).
Grind into fine powder. Take 2 qian per dose. When stabbing pain becomes unbearable, decoct in 1 zhan water to 7 fen, add salt, take immediately.

Hujiao Tang: Excellent for Huoluan vomiting/diarrhea.
Hujiao (Pepper) (49 grains), Ludou (Mung Bean) (149 grains).
Grind into fine powder. Take 2 qian per dose, mixed with Mugua (Chaenomeles Fruit) decoction.

[Supplement] For Huoluan with body heat, floating-hong pulse, and thirst, this indicates Stomach Heat; use Zhuru Tang (Bamboo Shavings Decoction). After vomiting stops, treat with Wuling San, Buhuanjin Zhengqi San, or Liuhe Tang. If Yang Qi suddenly collapses with cold extremities and faint pulse, use Lizhong Tang, Lizhong Wan, or Zhizhong Tang, adding Fuzi for severe cases. For heatstroke Huoluan vomiting/diarrhea, I once used Xiangru San with a little Banxia, mixed with fresh Ginger juice, stir-fried in a copper pot until dry, then added good Red Qu Wine, moistened again, stir-fried dry, added 1.5 zhan water, decocted to 7 fen, strained, cooled in well water, and taken effectively.