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Question: What is Huoluan (cholera-like disease)? Answer: Vomiting accompanied by diarrhea is called Huoluan. (Zhao's edition writes "this is named Huoluan".)

The Sanjiao (Triple Burner) is the pathway for water and grain. When pathogenic factors are in the Upper Jiao, there is vomiting without diarrhea; when in the Lower Jiao, there is diarrhea without vomiting; when in the Middle Jiao, there is both vomiting and diarrhea. Due to irregular diet and disharmony of cold and heat, clear turbid qi interfere with each other, and Yin and Yang qi become disjointed and separated, thus forming Huoluan. In mild cases, it is merely called vomiting and diarrhea; in severe cases, with sudden turmoil and disorder, it is named Huoluan.

Question: A patient presents with fever, headache, body ache, aversion to cold, along with vomiting and diarrhea. To which disease does this belong? Answer: This is named Huoluan. (Zhao's edition contains the characters "Huoluan".)

If after spontaneous vomiting and purging, the diarrhea stops but fever recurs.

Fever, headache, body ache, and aversion to cold originally belong to Shanghan (Cold Damage). Because the pathogen has entered the interior and damaged the Spleen and Stomach, causing upper vomiting and lower diarrhea, it transforms into Huoluan. If the diarrhea stops, indicating that the interior is harmonized, but fever recurs, this remains Shanghan, and recovery will certainly occur through sweating.

In Shanghan, if the pulse is faint and choppy, it was originally Huoluan, now transformed into Shanghan. After four or five days, when the pathogen enters the Yin meridians and transitions into the Yin level, diarrhea must ensue. For those who originally had vomiting and diarrhea, this condition is difficult to treat.

If one feels the urge to defecate but instead passes flatus, and still does not have diarrhea, this belongs to the Yangming stage. The stool will likely be hard. Recovery will occur on the thirteenth day. The reason for this is that the meridian cycle has completed its course.

A faint pulse indicates loss of Yang Qi, while a choppy pulse indicates loss of Blood. In Shanghan with a faint and choppy pulse, it implies the original condition was Huoluan, where vomiting and diarrhea led to the depletion of Yang Qi and Blood. Once vomiting and diarrhea cease, the Shanghan pathogen has not yet resolved, so it remains Shanghan. At the time of four or five days, when the pathogen transmits to the Yin meridians, the deficient interior encounters the pathogen, inevitably causing spontaneous diarrhea. Those who originally vomited had pathogenic excess in the upper part; those who also had diarrhea had pathogenic excess in the lower part. Having first suffered from Huoluan resulting in severe deficiency of interior Qi, and then having the Shanghan pathogen transmit again causing vomiting and diarrhea, represents a double deficiency. Therefore, it is considered untreatable. If one desires to defecate but instead passes flatus and still does not have diarrhea, diarrhea indicates deficiency, while lack of diarrhea indicates excess. Desiring to defecate but passing flatus suggests heat in the interior. This belongs to the Yangming stage, and the stool will definitely be hard. Recovery in thirteen days occurs because, after six days of transmission through all Yin and Yang meridians, another six days complete the second cycle, at which point Yin and Yang Qi harmonize, the major pathogenic factor dissipates, and healing occurs.

After diarrhea ceases, the stool should become hard. If the patient can eat, they will recover; if they cannot eat now, but later, during the next meridian period, can eat slightly, and then after another full meridian cycle can eat, they should recover one day later. If they do not recover, it does not belong to the Yangming stage.

After diarrhea ceases, body fluids are depleted, and the stool should become hard. Ability to eat indicates harmonious Stomach Qi and inevitable self-recovery; inability to eat indicates disharmony. Entering the next meridian period refers to seven days later completing another cycle. Slight ability to eat indicates that Stomach Qi is beginning to harmonize, and recovery should occur within a day. If not, the ability to eat is caused by sudden intense heat, not by the harmony of Yangming Qi.

Aversion to cold, faint pulse, and diarrhea, where the diarrhea stops indicating blood depletion, is treated with Sini Jia Renshen Tang (Four Reversal Decoction plus Ginseng Decoction). (Zhao's edition has "Sini Jia Renshen Tang Formula", see Volume 10.)

Aversion to cold, faint pulse, and diarrhea indicate Yang deficiency and Yin excess. Cessation of diarrhea means internal fluids are exhausted, hence termed "loss of blood." The *Jingui Yufan* states: "When water is exhausted, there is no blood." Administer Sini Tang to warm the meridians and assist Yang, adding Renshen (Ginseng Root) to generate fluids and benefit blood.

For Huoluan presenting with headache, fever, and body pain, if there is more heat and desire for water, Wuling San (Five-Ingredient Powder with Poria) is indicated; if there is more cold and no desire for water, Lizhong Wan (Regulate the Middle Pill) is indicated. (Zhao's edition has "Wuling San Formula", see Volume 3.)

Headache and fever indicate the pathogen comes from Wind-Cold. The Middle Jiao is the division between half-cold and half-heat. Pathogens situated higher reside in the Yang aspect, manifesting as heat; with more heat and desire for water, administer Wuling San to disperse them. Pathogens situated lower reside in the Yin aspect, manifesting as cold; with more cold and no desire for water, administer Lizhong Wan to warm them.

Lizhong Wan Formula:
Renshen (Ginseng Root; Sweet, Warm) Gancao (Licorice Root; Roasted; Sweet, Neutral) Baizhu (Atractylodes Rhizome; Sweet, Warm) Ganjiang (Dried Ginger; All above. Zhao's edition lacks these two characters. Each three liang; Acrid, Hot)

The *Neijing* states: "The Spleen desires relaxation; urgently consume sweet substances to relax it." Use sweet herbs to tonify: the sweetness of Renshen, Baizhu, and Gancao relaxes Spleen Qi and regulates the Middle. When Cold pathogens prevail, use Acrid-Hot substances to pacify them. The acridity of Ganjiang warms the Stomach and disperses Cold.

Grind the above four ingredients into powder, mix with honey to form pills the size of a chicken egg yolk. (Zhao's edition reads: "Grind and sieve, mix with honey to form pills the size of a chicken egg yolk.") Dissolve one pill in several he of boiling water, crush it, and take warm. Take three or four times daily, and twice at night. If warmth is not felt in the abdomen, increase to three or four pills per dose. However, the decoction is superior. For the decoction method, cut the four ingredients according to their weights, add eight sheng of water, boil to obtain three sheng, remove the dregs, and take one sheng warm, three times daily.

Modifications: (Zhao's edition lacks these three characters)
If there is pulsation above the navel, it indicates Kidney Qi moving. Remove Baizhu and add Guizhi (Cinnamon Twig) four liang.
Spleen deficiency leading to moving Kidney Qi manifests as pulsation above the navel. The *Neijing* states: "Sweet substances cause fullness in the center." Baizhu is sweet and cloyingly tonifying, while Guizhi drains Ben Tun (fleeing tumor); thus, they are exchanged.

For excessive vomiting, remove Baizhu and add Shengjiang (Fresh Ginger) three liang.
Those prone to vomiting dislike sweet flavors, so remove Baizhu; those with vomiting often use Shengjiang to disperse using its acridity.

For excessive diarrhea, continue using Baizhu; for palpitations, add Fuling (Poria) two liang.
Excessive diarrhea uses Baizhu to drain dampness; palpitations add Fuling to guide Qi.

For thirst and desire for water, increase Baizhu to total four and a half liang.
Insufficient body fluids cause thirst; Baizhu's sweetness relieves it.

For abdominal pain, add Renshen to total four and a half liang.
Interior deficiency causes pain; add Renshen to tonify.

For Cold conditions, add Ganjiang to total four and a half liang.
When Cold prevails, use Acrid-Hot substances to pacify.

For abdominal fullness, remove Baizhu and add one Fuzi (Aconite Lateral Root). After taking the decoction, similar to the duration of a meal, drink about one sheng of hot porridge to maintain slight warmth. Do not uncover clothes or blankets.
Stomach deficiency leads to Qi stagnation and abdominal fullness; sweet substances cause central fullness, hence Baizhu is removed; Fuzi's acridity tonifies Yang and dissipates stagnation.

If vomiting and diarrhea cease but body pain persists, one should assess and harmonize the exterior; Gui Zhi Tang (Cinnamon Twig Decoction) should be used in a small dose to harmonize. (Zhao's edition has "Gui Zhi Tang Formula", see Volume 2.)
Vomiting and diarrhea ceasing indicates interior harmony; persistent body pain indicates the exterior is unresolved. Administer Gui Zhi Tang in a small dose to harmonize. The *Waitai Misha* states: "When the interior is harmonious and the exterior diseased, sweating will cure it."

With vomiting, diarrhea, sweating, fever, aversion to cold, limb stiffness and urgency, and cold extremities, Sini Tang (Four Reversal Decoction) is indicated. (Zhao's edition has "Sini Tang Formula", see Volume 2.)
Upper vomiting and lower diarrhea, interior deficiency with sweating, fever and aversion to cold, indicate unresolved exterior; limb stiffness and cold extremities indicate Yang deficiency and Yin excess. Administer Sini Tang to assist Yang and retreat Yin.

With both vomiting and diarrhea, frequent urination, profuse sweating, diarrhea with undigested food, interior cold with exterior heat, and a faint pulse nearly imperceptible, Sini Tang is indicated.
Vomiting and diarrhea deplete body fluids, so urine should decrease; frequent urination and profuse sweating indicate uncontrolled fluids and severe Yang deficiency. A faint pulse indicates loss of Yang. Without exterior heat, only interior cold, and diarrhea with undigested food constitutes pure Yin; here, the presence of exterior heat indicates Yang is not yet extinct, so Sini Tang can still be used to rescue.

If vomiting and diarrhea have ceased, but sweating and cold extremities persist, limb stiffness and urgency remain unresolved, and the pulse is faint and nearly imperceptible, Tongmai Sini Jia Zhuyedan Tang (Decoction to Restore the Pulse, Four Reversal plus Pig Bile) is indicated. (Zhao's edition lacks the character "Zhi" [juice].) (Zhao's edition has "Tongmai Sini Jia Zhu Dan Tang Formula", see Volume 10.)
Cessation of vomiting and diarrhea means internal fluids are exhausted, so sweating should not occur; if sweating occurs, cold extremities should not follow. Now, with sweating, cold extremities, unresolved limb stiffness, and a faint, nearly imperceptible pulse, this indicates severe Yang deficiency and exclusive dominance of Yin. If purely administering Yang-tonifying drugs, there is fear that Yin will reject them, potentially causing vomiting or restlessness, preventing the medicine from entering. Administer Tongmai Sini Tang plus Pig Bile. Bile's bitterness enters the Heart to unblock vessels; its cold nature benefits the Liver to harmonize Yin, guiding the Yang medicines so they are not rejected. The *Neijing* states: "For minor conditions, oppose them; for severe conditions, follow them." This is what is meant.

After vomiting, diarrhea, and sweating, if the pulse is calm but there is slight irritability, it is because the newly weakened state cannot withstand the grain qi.
The *Neijing* states: "Food enters the Yin and generates Qi in the Yang." New weakness unable to handle grain qi generates slight irritability.