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The *Ling Shu: Jing Mai* (Meridian Chapter) states: When the rebellious Qi of the Foot-Taiyin Spleen channel ascends, Huoluan (acute vomiting and diarrhea) occurs.
The *Su Wen: Qi Jiao Bian Da Lun* (Great Treatise on Changes in Atmospheric Interactions) states: If the Yearly Earth Qi is insufficient, the people will suffer from Sundigestion (undigested food in stool) and Huoluan.
The *Su Wen: Liu Yuan Zheng Ji Da Lun* (Great Treatise on the Six Principal Epochs) states: If one does not keep away from Heat, Heat will arrive; when Heat arrives, the body becomes hot, accompanied by vomiting, diarrhea, and Huoluan. When Taiyin Dampness prevails, it causes Middle-Jiao fullness, Huoluan, vomiting, and diarrhea. When Earth Qi is depressed and erupts, it causes vomiting and Huoluan.

Huoluan is a syndrome characterized by simultaneous vomiting and diarrhea, causing restlessness and turmoil ("huohuo liaoluan"), hence the name. It is a disease caused by Cold pathogenic factors injuring the Zang organs. Generally, there are cases where external Wind-Cold invades, with Cold Qi entering the Zang to cause illness; cases where dietary indiscretion leads to internal injury from food and drink; cases of irregular eating where stomach Qi is damaged during hunger, and subsequent overeating prevents digestion; cases where climatic changes bring Cold-Dampness that injures the Spleen; and cases where heavy rains mix clear and turbid Qi, leading to accidental poisoning from sand or Yin-Toxins. In summary, these are all syndromes of Cold-Dampness injuring the Spleen. When the pathogen resides in the Stomach and Spleen, the Middle Jiao cannot accept or contain it, so expulsion upwards results in vomiting, and expulsion downwards results in diarrhea. Furthermore, those susceptible to pathogens usually have inherently weak Spleen Qi, which becomes even more deficient after vomiting and diarrhea. Therefore, treating Huoluan must primarily focus on harmonizing the Stomach and strengthening the Spleen. "Strengthening" refers to tonification; since the pathogen has been expelled but Stomach Qi is injured, tonification is essential. "Harmonizing" refers to regulating; although Stomach Qi is injured, the pathogen may not be fully cleared, so one must assess the balance of pathogen and healthy Qi and regulate accordingly. If Cold is slight and stagnation is predominant, mild and neutral formulas can be used for regulation; if stagnation is due to Cold, only warm and hot formulas can effect regulation. Some physicians claim it is a Fire syndrome, arguing that Huoluan often occurs in summer and autumn, so how can it be considered Cold damage? Alas, this error is severe. They fail to realize that the transition between summer and autumn is precisely when internal organ Cold diseases are common. This is because, first, as intense heat wanes and cool air begins, the Qi of Heaven and Humanity shifts, giving rise to Cold; second, during peak heat, improper consumption of cold and raw items triggers diseases driven by seasonal Cold. People easily perceive external heat in summer and autumn but fail to see internal organ Cold. Thus, they know to avoid hot remedies in summer ("use hot far from hot") but do not know to avoid cold remedies at this time ("use cold far from cold"). Such shallow understanding leads to frequent misdiagnosis. Students should examine this carefully.

1. Huoluan with tendon contraction (Zhuanjin): This involves spasmodic cramping and pain in the calf muscles, potentially pulling the testicles inward and causing pain pressing against the lower abdomen. It is a critical condition indicating injury to the Qi and Blood of both the Foot-Yangming Stomach channel and Foot-Jueyin Liver channel. Liu Hejian stated: Tendon contraction is described in classics as "fanli" (reversal/spasm). Dry Heat scorching the tendons causes spasms and pain, as Fire governs burning and agitation. Others attribute it to Cold lodging in the tendons, which is incorrect. Although Cold governs contraction, it typically causes limb coldness, stiffness, and difficulty moving, not tendon twisting. The term "zhuan" (turn/twist) implies movement; Yang moves, Yin is still, clearly indicating a Heat syndrome. Zhu Danxi also stated: Tendon contraction belongs to Blood Heat. I consider these views one-sided and unacceptable. Let us verify with the *Nei Jing*: "When meridional sinews are diseased, Cold causes them to reverse and become tight; Heat causes them to relax and hang loose." Is this tendon contraction not a disease of reversed, tight sinews? Why call it Heat? The term "zhuan" describes the stiff, painful, twisted appearance of the tendon. In Northwest China, "zhuan" is pronounced with the falling tone, reflecting this meaning. Liu Hejian’s definition of "zhuan" as mere movement lacks this sense of tension. Moreover, patients with tendon contraction always develop it after severe vomiting and diarrhea; it is unheard of for it to precede them. If it occurred before vomiting/diarrhea, one might argue it was caused by Fire. But since it appears after, the Fire in the upper and lower jiao has already dissipated; could vomiting and diarrhea generate Fire? Why did Fire not cause contraction before the vomiting/diarrhea? How does Liu explain this? The Yangming Stomach is the sea of the five zang and six fu organs, primarily nourishing the Zong Jin (general sinews). This condition arises from sudden depletion of Yangming Qi and Blood, causing tendon tightness, not Fire. Chen Wuyue stated: Tendon contraction relates to Yangming nourishing Zong Jin, belonging to the Stomach and Large Intestine. Sudden vomiting and purging cause instant loss of fluids; combined with external Four Qi pathogens and internal Seven Emotions injuries blocking the vessels, the sinews become withered and lose nourishment, leading to spasm. Severe cases involve testicular retraction and tongue curling, making it difficult to treat. This explanation is accurate. Treating it as Fire based on Liu’s theory would surely lead to error. Hence, I say it is unacceptable.

1. During the transition from summer to early autumn, amidst fierce winds, heavy rains, or fluctuating temperatures, Yin and Yang Qi are conflicting. Those skilled in health preservation must be cautious. Externally, adjust clothing and bedding; internally, regulate diet—increasing warmth or restricting intake as needed. With slight attention, preventing illness is easy. However, minor imbalance allowing slight Cold invasion can instantly trigger Huoluan with vomiting/diarrhea, intestinal colic, malaria, or dysentery. What is neglected slightly causes great harm. Note that diets of the rich (rich foods) differ from those of the poor (coarse grains), and constitutions of the frail differ vastly from the robust. Even the robust should not rely on strength to neglect care; how much less should the frail ignore their weakness? This is crucial for self-preservation.