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Chen stated: "Tendon spasms (muscle cramping and twitching) occur because the Yangming channel nourishes the 'Zongjin' (major tendons), which belongs to the Stomach and Large Intestine. Now, sudden severe vomiting and diarrhea cause a rapid loss of body fluids. Combined with external contraction of the Four Qi (Wind, Cold, Summerheat, Dampness), internal accumulation of the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright), and dietary sweetness/greasiness causing Qi obstruction, the vessels become withered and emaciated. The Zongjin loses nourishment, inevitably leading to contraction; in severe cases, it may even present with retraction of the testes and curling of the tongue, which is difficult to treat."

Commentary: This refers to patients with Huoluan (cholera-like syndrome) who often experience tendon spasms. Generally, this is due to imbalance between cold and heat, with Yin and Yang clashing, causing tendon cramping and pain. In severe cases, the entire body undergoes spasms. This is essentially a reversal of Yin and Yang Qi, where Wind-Cold pathogens take advantage of the deficiency. The tendons lose the nourishment of Qi and Blood, resulting in contraction and acute pain.

Chen stated: "Dry Huoluan (a severe form of cholera characterized by inability to vomit or defecate) manifests as sudden abdominal distension and fullness, twisting stabbing pain, mental distress and grievance, desire to vomit but unable to, desire to defecate but unable to. The condition resembles possession by spirits, leading to suffocation and coma within moments. This involves the Three Causes (external, internal, non-internal/non-external). It may be due to visceral deficiency or originally thick/turbid intestines and stomach, thus preventing vomiting and diarrhea."

Commentary: This describes individuals whose intestines and stomach are originally thick/turbid and whose physical Qi is substantial. When contracting the Four Qi pathogens, vomiting and diarrhea do not occur, resulting in Dry Huoluan with chaotic symptoms. Generally, if Heat prevails and Phlegm stagnates, it causes mental confusion; if Dampness prevails and Fluids stagnate, it leads to vomiting and diarrhea. For those with deficient Physical Qi, disaster strikes swiftly. Yan stated that various foods in the Stomach condense and fail to digest, while Yin and Yang Qi become congested and reversed, turning into vomiting and diarrhea in an instant. However, cases caused by diet can involve excess or deficiency. For instance, excessive food intake combined with external Dampness causing Dry Huoluan should be treated with emesis or purgation. For injuries from over-treatment, digestion-promoting methods are suitable. For Phlegm syndromes, use phlegm-dispersing methods; for Cold, warming methods; for Heat, clearing methods. The key is to act appropriately according to the specific situation.

Chen stated: "Vexation and thirst (mental restlessness and dry mouth/thirst) occur because Yin and Yang are reversed, and Clear and Turbid Qi interfere with each other. Water and Grain move together, urine becomes obstructed and scanty. Since body fluids have been lost, the Kidney must become dry. The body draws water to save itself, inevitably leading to vexation and thirst."

Commentary: Vomiting and diarrhea inevitably deplete fluids, let alone Kidney Water depletion. When administering fluids, warm agents should only be used. If Heat is severe, Tianshui San (Cool Heaven Powder, referring to formulas like Liu Yi San with cooling properties) should be used to soothe Fire with Sweetness.

Baoming Ji records: For Huoluan presenting as Yangming Syndrome, harmonizing agents such as Pingwei San, Jianzhong Tang, or Sijunzi Tang are suitable. If the pulse is floating with spontaneous sweating, use Sijunzi Tang plus Guizhi (Cinnamon Twig); if floating without sweating, use Sijunzi Tang plus Mahuang (Ephedra). If vomiting/diarrhea accompanied by tendon spasms, hypochondriac pain, and a wiry pulse (indicating Wood overcoming Earth, hence severe pain), use Pingwei San plus Mugua (Chaenomeles Fruit, 5 qian) or Jianzhong Tang plus Chaihu (Bupleuri Radix) and Mugua. If vomiting/diarrhea accompanied by tendon spasms, abdominal pain, heavy body, and deep-thin pulse, use Sijunzi Tang plus Baishao (Paeoniae Radix Alba) and Liangjiang (Alpiniae Officinarum Rhizoma). If vomiting/diarrhea accompanied by limb stiffness/spasms and deep-slow pulse, this is Shaoyin Huoluan; use Sijunzi Tang plus Jiang (Ginger) and Fuzi (Aconiti Lateralis Radix Praeparata) plus Houpo (Magnoliae Officinalis Cortex). If vomiting/diarrhea accompanied by cold limbs and faint-slow pulse, belonging to Jueyin Huoluan, use Jianzhong Tang plus Danggui (Angelicae Sinensis Radix) and Fuzi. If vomiting/diarrhea accompanied by headache and fever, with more heat and desire to drink water, use Wuling San; if more cold and no desire to drink water, Lizhong Wan is the primary treatment. Yuan Rong stated that for Taiyin Syndrome Huoluan, add Juhong (Citri Reticulatae Pericarpium Rubrum) to Lizhong Tang, named Zhizhong Tang. If after vomiting there is heart/abdominal pain and cold extremities, remove Baizhu from Lizhong Tang and add Shu Fuzi (Prepared Aconite), named Sishun Tang. If tendon spasms occur after vomiting/diarrhea, add Shigao (Gypsum Fibrosum, 1 liang) to Lizhong Tang.

Treatment Methods for Huoluan:
Harmonizing agents.