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Liu Hejian stated: In cholera with simultaneous vomiting and diarrhea, the Sanjiao (Triple Burner) serves as the pathway for the transformation of food and fluids. When heat qi is excessive, transmission and transformation become abnormal, resulting in vomiting, diarrhea, and cholera. The nature of fire is rapid and restless; this is the reason. The common people only attribute it to retained food, which is merely one aspect. Tendon cramping (Zhuanjin) also occurs due to the excess of Liver Wood; Liver heat scorches and dries the tendons, causing them to become tight, cramped, and painful. This is actually not due to cold causing contraction and traction. This section discusses the category of Fire-Heat Cholera. Chao Yuanfang stated: Cholera arises from the interference between Yin-Yang, Clear-Turbid Qi, causing chaos within the intestines and stomach. If caused by overeating, sudden severe pain in the heart and abdomen occurs. Those accompanied by external pathogens will exhibit alternating chills and fever, headache, and body aches. Those without external pathogens will only show severe abdominal pain, vomiting, and diarrhea. Furthermore, drinking alcohol, eating meat, consuming rich and sticky foods, or failing to tolerate raw and cold items, or being exposed to wind in open areas, allows pathogens to enter the Sanjiao and transmit to the Spleen and Stomach, all forming cholera. This section discusses the category of Dietary Cholera. Zhang Dairen stated: Wind, Dampness, and Heat three pathogens combine to form evil. When Spleen Earth is affected by Wind, Heat erupts. When Heat erupts, Fire flares upward, causing vomiting; thus, vomiting is related to Wind. When Spleen Earth is affected by Dampness, it flows downward, causing profuse diarrhea; thus, diarrhea is related to Dampness. When Wind is urgent and severe, it causes tendon cramping; thus, tendon cramping is related to Wind. This clarifies the three paths of Wind, Dampness, and Heat in the *Neijing*’s theory of climatic influences. Wang Haicang stated: External invasion of Wind, Dampness, and Heat, combined with internal consumption of raw and cold food, results in an internal-external combined disease, forming cholera. This summarizes the etiology of cholera from both external contraction and internal injury.

Chen Wuyue stated: Tendon cramping occurs because the Yangming Meridian nourishes the Zongjin (Major Tendons), which belong to the Large Intestine. Now, due to contracting the Six Excesses (Six Pathogens) and internal injury from greasy diet, leading to violent vomiting and diarrhea, body fluids are suddenly lost. The Zongjin lose nourishment, inevitably leading to contraction. In severe cases, retraction of the scrotum and cyanosis of the nails occur, making it difficult to treat. Liu Zongnong stated: Imbalance of cold and heat, mutual struggle of Yin and Yang, with Wind-Cold taking advantage, leads to contraction and acute pain. Hejian stated: Tendon cramping all belongs to Fire; there is internal stagnant Fire bound externally by Wind-Cold. Danxi further stated it belongs to Blood Heat; heat within the blood, combined with external Wind-Cold, can both cause cholera and tendon cramping. *Yixue Zhunsheng* stated: Cholera symptoms are mostly caused by latent Summerheat. Before the disease manifests, there must be abdominal colic. After vomiting and diarrhea, if tendon cramping appears, it indicates accumulated Heat in the Yangming Meridian bound externally by Wind-Cold. It is necessary to disperse the exterior pathogens. Hence, it is said that tendon cramping is due to Wind. Cold extremities indicate interior retention of exterior pathogens. Fever, irritability, thirst, and sweating indicate Summerheat. Heavy limbs and painful joints indicate Dampness. Therefore, in cholera with tendon cramping, only when there is sweating and the pulse is visible can Heat-clearing methods be used. If there is no sweating and the pulse is hidden, with cold extremities... Qin Zi stated: Cholera symptoms often involve tendon cramping and cold extremities. If there is cold extremities without a pulse, accompanied by tendon cramping, it all belongs to suppressed Yang Fire, not Yin Cold. Generally, cold extremities without tendon cramping distinguish between Yin Cold and Yang Fire. If cold extremities are accompanied by clear consciousness and immobility of hands and feet, it is Yin Jue (Cold Extremity). If consciousness is clouded, and although hands and feet are cold, they can move restlessly, it is all Yang Jue. Thus, in summer and autumn cholera, cold extremities are originally due to latent Summerheat. Although it is Summerheat, since it is latent, cold-cooling herbs should not be used. If cold-cooling herbs suppress it, how can the hands and feet warm up, and how can the six pulses emerge? The principle should be to raise and disperse exterior pathogens, and unblock meridians, so that hands and feet warm up and pulses emerge. All these situations involve exterior Wind-Cold. After vomiting and diarrhea, exterior pathogens sink inward due to deficiency, presenting false cold externally, hence cold extremities. Exterior pathogens cannot sweat out; this is "the deeper the heat, the deeper the cold." Mistaking hidden pulse for Yin Jue and hastily administering hot medicines will lead to death quickly. Even knowing it is Heat Jue, misusing cold-cooling medicines will cause exterior pathogens to sink deeper, ultimately leading to death. Therefore, I have pondered that raising Yang and dispersing Fire will naturally bring out pathogens and sweat, resolving the exterior pathogen and curing the disease. There are cases where hands and feet become warm, pulses emerge, and purple spots appear, leading to recovery. Regarding summer and autumn epidemic dysentery contracted externally, with latent Summerheat internally and bound externally by Wind-Cold, rain, and Dampness, presenting chills, body pain, pure bloody stool, bloody water, black stool, chest fullness, vomiting, and loss of appetite, misusing Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Dahuang (Rhubarb Root) will cause exterior epidemic pathogens to sink inward, refusing to cease until death. I also use Shengyang Sanhuo Tang (Raise Yang Disperse Fire Decoction) and Baidu San (Resist Toxicity Powder). Some recover with heavy sweating, some with the appearance of purple spots. If sweat does not come out, the disease will not resolve and spots will not transform. This is using sweating to transform spots. Everyone knows that dysentery can be complicated by exterior contraction. Few know it can be complicated by spot eruption. Everyone knows that cholera can be complicated by exterior pathogens. Few know that cholera can be complicated by spot eruption. Everyone knows that spot eruption contraindicates bitter-cold herbs. Few know that transforming spots contraindicates cold-cooling herbs. In summary, if there are exterior symptoms, no sweating, floating or hidden pulse, releasing the exterior is equivalent to inducing spots. If spots appear but do not transform, heat does not resolve, and exterior symptoms remain, dispersing the exterior is equivalent to transforming spots. If there is sweating, no exterior symptoms, and deep-rapid pulse, clearing the interior is equivalent to inducing spots. After spots appear, if the exterior is resolved but interior heat remains, clear... [Text cuts off]