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The *Yellow Emperor's Inner Canon* states: When the rebellious Qi of the Foot-Taiyin (Spleen Meridian) ascends, Huoluan (Cholera-like disease with sudden vomiting and diarrhea) occurs. It also states: If heat is excessive, heat manifestations appear; when heat manifests, the body becomes feverish, accompanied by vomiting and diarrhea, which constitutes Huoluan. Chen Feixia stated: This disease of Huoluan arises suddenly; its symptoms are chaotic and turbulent, without any respite, hence named Huoluan. It is mostly caused by cold damage complicated by food stagnation, leading to a discordance and separation of Yin and Yang, resulting in upper vomiting and lower diarrhea, along with restlessness and confusion. Generally, humans have the Upper, Middle, and Lower Jiao (Triple Burner). The Upper Jiao receives and accepts water and grain, primarily functioning to receive but not excrete; the Middle Jiao rots and ferments water and grain, circulating its essence to the Five Zang and Six Fu organs; the Lower Jiao separates water and grain, primarily functioning to excrete but not receive. Therefore, if pathogenic factors are in the Upper Jiao, vomiting occurs; if in the Lower Jiao, diarrhea occurs; if in the Middle Jiao, both vomiting and diarrhea occur. Whenever Huoluan patients experience vomiting and diarrhea, it indicates that pathogenic factors can be expelled from above and below. Chen believed that once pathogens are fully expelled, vomiting and diarrhea will naturally cease. However, there are cases where one cannot vomit nor defecate, known as Dry Huoluan, also called Intestinal Colic Sha (Jiaochangsha). This is because the pathogens in the Spleen and Stomach have no outlet. If accompanied by panting, chest fullness, and convulsions, fewer than one in ten can be saved. For those with upper vomiting and lower diarrhea, treatment should distinguish between Cold and Heat patterns. One should also suspend milk and food intake to avoid increasing phlegm-dampness. Therefore, do not give patients drinking water decoctions, as they may assist the stomach pathogens. Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi) is suitable.

If diarrhea precedes vomiting, this indicates Spleen-Stomach Deficiency-Cold. Thus, watery stools appear first, vomiting is mild, breath is slow, complexion is calm, sweat appears on the forehead, and all six pulses are deep and fine. This is a Deficiency-Cold pattern, suitable for warming treatment using Liujunzi Tang (Six Gentlemen Decoction); if ineffective, Lizhong Tang (Regulate the Middle Decoction) with Huoxiang (Patchouli) and Mugua (Papaya), each one qian, is used. If vomiting precedes diarrhea, this indicates Heat in the Spleen and Stomach. Symptoms include panting, red lips, flushed face, thirst, and a surging and rapid pulse. Harmonization is indicated, using Wuling San (Five-Ingredient Powder with Poria) plus Huoxiang. As for Dry Huoluan, where neither vomiting nor defecation is possible, the condition is most critical and urgent. Quickly induce vomiting using salt water solution. Only after the retained food and accumulated phlegm are expelled should medication be administered. Alternatively, prick the acupoints beside the ten fingernails to cause bleeding, or prick Weizhong (BL-40) located in the center of the knee to cause bleeding, which will resolve the condition. Then administer Huoxiang Zhengqi San.

Huoxiang Zhengqi San from *Yizong Jicheng* (see Vomiting formulas previously mentioned)
Liujunzi Tang (see Cough formulas previously mentioned)
Zhang Zhongjing's Lizhong Tang (see Diarrhea formulas previously mentioned)
Wuling San (see Cough formulas previously mentioned)

Tu Weisheng stated: Wuling San is a heat-inducing formula for treating untransformed cold-water; its principle was discussed earlier. Chen Feixia's citation of it for treating Heat-pattern Huoluan is still erroneous; physicians must exercise caution. Upon examination, upper vomiting and lower diarrhea constitute Huoluan; inability to vomit or defecate constitutes Dry Huoluan; only when vomiting and diarrhea are accompanied by abdominal pain is it termed Intestinal Colic Sha (Jiaochangsha), for which acupuncture is suitable, specifically pricking the Twelve Jing-Well points of the hands, which is most effective. Shaoshang (LU-11) is on the medial side of the thumb, about the width of a leek leaf from the nail corner. Shangyang (LI-1) is on the medial side of the index finger, about the width of a leek leaf from the nail corner. Zhongchong (PC-9) is at the tip of the middle finger on the palmar side, about the width of a leek leaf from the nail. Guanchong (SJ-1) is on the lateral side of the ring finger, about the width of a leek leaf from the nail corner. Shaochong (HT-9) is on the medial side of the little finger, about the width of a leek leaf from the nail corner. Shaoze (SI-1) is on the lateral side of the little finger, five fen from the nail corner. Together, the two hands comprise twelve points, hence named the Twelve Jing-Well points. Although Huoluan is mostly due to excess pathogens disturbing the Central Earth (Spleen/Stomach), Deficiency-Cold invading the Central Earth is also common. Huoxiang Zhengqi San, being purely composed of resolving and attacking herbs, often causes errors. To seek a clear and steady method, one might compromise with Zhang Zhongjing. Zhang Zhongjing's treatise on Huoluan states: In Huoluan, with headache, fever, body pain, excessive heat, and desire for water, Wuling San governs; with excessive cold and no desire for water, Lizhong Wan governs. Although later methods like Sini Tang and Tongmai Sini Tang plus Pig Bile were introduced, the outline treatment for Huoluan ultimately remains within these scopes. I have followed this method for medical practice without error. Essentially, when Spleen Earth suffers severe contention from Cold pathogens above and below, diarrhea occurs. Righteous Qi becomes deficient, and Cold pathogens become more substantial. Supporting Earth to stabilize the Central Palace allows pathogens to retreat and vomiting/diarrhea to cease. For those with excessive heat and desire for water, it is because Spleen Earth cannot transform water, and fluid essences cannot distribute widely. Thus, Fuling (Poria) and Ze Xie (Alisma) are used to promote urination, and Guizhi (Cinnamon Twig) to transform Qi. Once fluids generate and distribute, thirst stops. For those with excessive cold and no desire for water, Lizhong Tang is used because although fluid essences can ascend, the power of warming and transforming is insufficient, causing fluid to sink downward. Thus, Baizhu (Atractylodes Macrocephala) is used to dry dampness, and Ganjiang (Dried Ginger) to warm the interior. Once deficiency-cold is eliminated, vomiting and diarrhea heal themselves. To claim that vomiting preceding diarrhea indicates Stomach-Spleen Heat, yet prescribing Wuling San plus Huoxiang, is indeed guiding the blind. If it is declared as Heat, cooling treatment is appropriate. But Wuling San is a heat-inducing formula for treating untransformed cold-water where Yin fluids cannot ascend, initially causing fever and thirst. How can it treat vomiting caused by Heat? Even adding Huoxiang, which disperses foul qi, has no relevance to Heat. I encounter many such cases. For Cold-Dampness with stagnation, I use Wuling San or Lizhong Tang. For Huoluan with Upper Heat and Lower Cold, I often use Liujunzi Tang plus Huanglian (Coptis Rhizome) and Shengjiang (Fresh Ginger) with success; for mild cases, Xiaobanxia Tang (Minor Pinellia Decoction) plus Huanglian is used. The dosage of Huanglian must equal that of Renshen (Ginseng) and Baizhu. Since Heat is in the Upper, treating Heat should target the Upper; since Cold is in the Lower, treating Cold should target the Lower. Although Heat and Cold interact, drug properties follow their respective meridians without conflict, embodying the way of mutual restriction and assistance.

Zhang Zhongjing's Sini Tang
Ganjiang (Dried Ginger) (one qian) Fuzi (Prepared Aconite Root) (five fen) Gancao (Licorice Root) (one qian)

Zhang Zhongjing's Tongmai Sini Tang plus Pig Bile
Gancao (Licorice Root) (one qian) Fuzi (Prepared Aconite Root) (three fen) Ganjiang (Dried Ginger) (one qian) Decoct the medicine well, then mix in Pig Bile and urine before administration.

Liujunzi Tang (see above)
Xiaobanxia Tang (see Cough formulas previously mentioned)