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Also treated a woman. Due to liver and spleen qi stagnation (Liver and Spleen Qi Stagnation), she had been unable to eat for two years. Her face was slightly yellow and puffy, yet she could still walk, though her limbs were fatigued and weak. The Liver and Spleen pulses were floating and wiry (Floating and Wiry Pulses); upon deep pressure, they felt faint and knotted/stagnant. Six Gentlemen Decoction (Liuzi Junzi Tang) with Evodia Fruit (Wuzhuyu) was prescribed. After expelling a large amount of phlegm accumulation, her appetite suddenly improved, and her body began to emaciate. After lying in bed for over a month, she continued to be regulated with modified Six Gentlemen Decoction until she recovered.

Zhou Shenzhai treated a person whose diet was normal, but who vomited every time at Zi hour (11 PM - 1 AM). There was constipation. Upon inquiry, it was found that the person had likely suffered from worry and overthinking, causing Spleen Qi stagnation, thus blocking the pylorus (Youmen). The treatment should focus on supporting the Spleen and opening orifices. It consisted of Ginseng Root (Renshen), Atractodes Rhizome (Baizhu) stir-fried with Coix Seed (Cangzhu), Poria (Fuling), each 1 qian; roasted Licorice Root (Zhigancao) 0.5 qian; Aconite Root (Fuzi) boiled with Lindera Root (Wuyao) 0.3 qian. Taken as a water decoction, the patient recovered.

Shiwan treated Zhang Gong, acting magistrate of Wujiang. He was young and robust, but constantly suffered from vomiting, regurgitation, and phlegm-saliva. His six pulses often showed a soggy and slippery quality (Soggy and Slippery Pulses). Using Two Gentlemen Decoction (Erchen Tang) added with Immature Bitter Orange (Zhishi), Atractodes Rhizome (Baizhu), and Dendrobium Stem (Shihu), the effect was immediate. This was largely due to the burden of official duties and exhaustion of both physical and mental energy.

The Classics state: Clear Qi resides in the Yin, turbid Qi in the Yang; Ying (Nutritive) Qi flows smoothly, while Wei (Defensive) Qi moves in reverse. When clear and turbid Qi interfere with each other and chaos ensues in the intestines and stomach, Huoluan (Acute Vomiting and Diarrhea Syndrome) occurs. Rebellious Qi moving upward also causes Huoluan.

Vomiting and diarrhea caused by Cold Damage (Shanghan) result from pathogenic invasion; vomiting and diarrhea in Huoluan result from dietary injury. If there is a concurrent invasion of Cold Damage pathogens, leading to internal-external disharmony, accompanied by headache, fever, vomiting, and diarrhea, this is Shanghan Huoluan. Tracing Zhongjing's intent, is it not related to diet? In such cases, cold pathogens transmit to the Lower Jiao, causing Stomach Qi disharmony and Yin-Yang obstruction. How else could this happen? Otherwise, why use Lizhong Decoction (Lizhong Wan/Tang) or Sinistral Recovery Decoction (Sini Tang)? This disease mostly occurs during the transition between summer and autumn, though it occasionally happens in cold months. Ancients said it is mostly caused by latent summerheat, but not necessarily always so. Generally, when damp-earth is overcome by wind-wood, this syndrome arises. Thus, vomiting and diarrhea are transformations of damp-earth; muscle twitching (transverse spasm) is a transformation of wind-wood. Integrating various discussions to seek understanding constitutes flexible practice. However, many cases arise from emotional constraint injuring the Spleen, food stagnation, temporary blockage, and failure of Qi to ascend and descend. For summer Huoluan with vomiting, diarrhea, and thirst, Weiling Decoction (Weiling Tang) with Pinellia Tuber (Banxia) and Perilla Leaf (Huoxiang) is used; if the face is red and mouth dry, add fried Coptis Rhizome (Chuanlian). For spring, summer, and autumn, if this syndrome results from sudden exposure to cold after eating, Huoxiang Zhengqi San (Perilla Powder to Rectify the Qi) is indicated. If vomiting, diarrhea, and muscle twitching occur, indicating wind-wood attacking spleen-earth, Pingwei San (Powder to Maintain Stability) with Quince (Mugua) is used. For summer-autumn external contraction with vomiting, diarrhea, and Huoluan, Liuhe Tang (Decoction for Harmonizing the Six) is the essential medicine. If there is body heat, vexation, thirst, coarse breathing, panting, or vomiting/diarrhea with cold extremities and restlessness, this is summerheat-injuring Huoluan; Xiangru Yin (Elsholtzia Decoction) should be taken chilled. If severe, with cold extremities, shortness of breath, cyanosis of lips/face/nails, and all six pulses hidden (deep and faint), vomiting sour/foul matter, and foul-smelling diarrhea with yellow-red urine, this indicates fire latent in the Jueyin channel, presenting as extreme heat resembling yin. Prepare earth slurry water immediately and decoct Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). Misdiagnosing as cold will lead to death. Summer-autumn Huoluan is often caused by excessive consumption of cold water and fruits; Muguxiang (Aucklandia Root), Huoxiang, Chenpi (Tangerine Peel), Houpo (Magnolia Bark), Zisu (Perilla Leaf), and Shengjiang (Fresh Ginger) are suitable. If limbs are heavy and joints ache, dampness is involved; Cangzhu (Atractodes Rhizome), Baizhu, Fuling (Poria), Zhuling (Polyporus), Houpo, Chenpi, and Zexie (Alisma Rhizome) are used. For seven emotions constraint, Wuyao, Xiangfu (Cyperus Rhizome), Muxiang (Aucklandia Root), Houpo, Zhike (Immature Bitter Orange), Chenpi, and Zisu are appropriate. During the summer-autumn transition, for summerheat Huoluan, strictly avoid drying-hot herbs like Baizhu, Fuzi, Ganjiang (Dried Ginger), and Rougui (Cinnamon Bark); misusing them causes death. In any summer-autumn Huoluan, even slight thirst indicates latent heat; warming Spleen-Stomach medicines must not be used. If there is dry thirst and difficult urination, Wuling San (Five-Ingredient Powder with Poria) is primary; Rougui in this formula should be used cautiously. Only if there is diarrhea without thirst, clear urination and defecation, and no strong odor, can Lizhong Decoction be used to warm. If vomiting and diarrhea persist, depleting Yuan Qi, with critical condition, inability to take fluids, thirst preferring cold, aversion to cold with shivering, cold extremities, or fever with irritability removing covers, this is internal deficiency with excess yin. Do not mistake preference for cold and removing covers as heat; use Lizhong Decoction, or Sini Tang if severe, with a pinch of salt. If sudden profuse watery diarrhea, whole-body sweating with coldness, weak pulse, and inability to speak, urgently administer Jiangshui San (Fermented Rice Water Powder) and must be taken cold. If exposed to summerheat and latent fire, causing abdominal pain and diarrhea or vomiting, use Mugua, Wuzhuyu stir-fried with salt, decocted and taken warm.

For Huoluan before or after childbirth, see separate sections. Once Huoluan has stabilized, do not give grain food within a week, as this often leads to death because Stomach Qi rebels and cannot recover. If vomiting and diarrhea have depleted Yuan Qi significantly, and no pathogen remains, rice water may be given for nourishment. Worldwide treatments for Huoluan vomiting/diarrhea indiscriminately use Huoxiang Zhengqi San regardless of deficiency/excess or cold/heat. This formula specifically treats Stomach Qi disharmony, Yin-Yang confusion, summer-autumn alternating cold/heat, mixed hot/cold diet, and水土不服 (acclimatization issues). It is appropriate for these. However, if cold extremities, cold sweat, empty vexation, panting, facial redness (floating yang), and faint/string-tiny/powerless pulses are seen, this indicates dual deficiency of Spleen and Kidney, fire failing to generate earth, and loss of holding of deficient yang. Seen in deep winter, it is particularly severe. Even aggressive use of Lizhong and Sini Decoctions may fail to save; how much less can one use Qi-consuming agents like Huoxiang Zhengqi San?

[Diagnosis] Hidden or faint-choppy pulses indicate Huoluan. Long pulses indicate Yangming disease. A flooding pulse in Huoluan is auspicious; faint, slow, thin pulses with panting are ominous. Slippy pulse at the Qi Kou position indicates retained food in the diaphragm; despite vomiting, salt water should be used to induce vomiting again. After complete vomiting, harmonizing medicines are used. If the pulse shows jie (knotted), cu (rapid-interrupted), dai (intermittent), or fu (hidden) qualities during vomiting/diarrhea, do not immediately declare death. After Huoluan, if Yang Qi has collapsed, with urinary incontinence, fearfulness/silence, bead-like sweat, restlessness wanting to enter water, flaccid limbs, curled tongue, or retracted scrotum, these are signs of death.

Dry Huoluan: Abdominal distension and pain, desire to vomit but unable, desire to defecate but unable, vexation and confusion. Commonly known as "Intestine-Twisting Sha." This is due to earth stagnation failing to vent, intense internal fire, and non-interaction of Yin and Yang. One might ask: formulas discuss retained food clashing with cold, why specify fire? Answer: Confusion and restlessness belong to fire patterns of agitation. Frequent sudden death belongs to acute fire diseases. Over-attacking damages Spleen further; over-warming intensifies fire; over-cooling causes rejection. Counter-assistance (fan zuo) therapy is required to dissipate the fire. Ancient methods include salt-decocted child's urine, which lowers fire and promotes blood circulation; it should not be discarded. Another method: induce vomiting with salt water, fill the navel with salt, and moxa 14 times (2x7); this is frequently effective.

Vomiting and Diarrhea: Refers to vomiting accompanied by diarrhea. Upper vomiting and lower diarrhea with vexation and restlessness constitute Huoluan, distinct from mere vomiting and diarrhea. Acute onset within hours is Huoluan; lasting days is vomiting and diarrhea. For vomiting/diarrhea and dysentery where herbal medicine is administered too rapidly causing regurgitation, Erchen Tang with Cardamom Doukou and Amomum Fructus (Sharen) is used; add Costus Root (Chenxiang) if severe. If heat is present, add Coptis Rhizome stir-fried with ginger juice. For dry retching with diarrhea, Huangqin Banxia Shengjiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction) is used. For unceasing upper vomiting and lower diarrhea, if thirsty but not drinking, with faint-thin-weak pulses, Lizhong Decoction is used. If thirsty but unable to drink, with thin-rapid pulses, Lianli Tang (Coptis and Lizhong Decoction) is used. For summer diarrhea or vomiting, Tian Shui San (Heavenly Water Powder) adjusted with ginger juice. For persistent diarrhea/dysentery due to phlegm accumulation, even vomiting/desire to vomit and inability to eat due to diarrhea, caused by wind-phlegm binding the Spleen-Stomach, Daotan Tang (Phlegm-Guiding Decoction) with Qianghuo and Fangfeng is used. Diarrhea belongs to Spleen; raise Stomach Qi using Buzhong Yiqi Tang (Middle-Boosting and Qi-Enriching Decoction). Vomiting belongs to Stomach; awaken Spleen using Liujunzi Tang (Six Gentlemen Decoction) with Xiangfu and Sharen. For simultaneous vomiting and diarrhea, raise Stomach and awaken Spleen; mix half doses of both decoctions.