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Cholera (Huo Luan) mostly occurs at the transition between summer and autumn. Its symptoms include mental restlessness, abdominal distension and pain, vomiting above and diarrhea below, headache, feverish sensation in the body, sudden chaotic changes causing distress, and in severe cases, muscle cramps (Zhuan Jin) extending from the calves to the abdomen, with cold extremities. This is largely due to irregular living habits regarding temperature, and improper consumption of raw or cold food and drink, leading to interference between clear and turbid Qi, and failure of water and grain to transform. If pathogenic factors are in the Upper Jiao (Upper Burner), vomiting occurs; if in the Lower Jiao (Lower Burner), diarrhea occurs; if in the Middle Jiao (Middle Burner), both vomiting and diarrhea occur simultaneously, termed Damp Cholera (Shi Huo Luan). If there is severe colic in the chest and abdomen, desire to vomit but unable to do so, desire to defecate but unable to do so, and irritability with confusion, commonly known as "Intestine-Twisting Sha" (Jiao Chang Sha), this is Dry Cholera (Gan Huo Luan). Thus, the classics state: Clear Qi resides in Yin, Turbid Qi resides in Yang, Ying Qi (Nutritive Qi) flows smoothly, Wei Qi (Defensive Qi) flows reversely; when Clear and Turbid Qi interfere and disturb the intestines and stomach, Cholera results. It also states: Rebellious Qi moving upward results in Cholera. Ancient and modern theories on treatment vary. Generally, it is because Damp Earth is overcome by Wind Wood, and steamed/oppressed by hot summer heat. Therefore, vomiting is a transformation of Summer-heat Heat; diarrhea is a transformation of Damp Earth; muscle cramps are a transformation of Wind Wood. Additionally, much of it arises from food stagnation and failure of Qi mechanism to ascend and descend. The classics state: When Taiyin (Spleen/Stomach dampness) prevails, there is central fullness, Cholera, vomiting and downward discharge; this refers to the outbreak of Earth depression, where people suffer vomiting, Cholera, and profuse diarrhea, indicating Damp Cholera caused by dampness. It also states: When the annual Earth Qi is insufficient, Wind prevails greatly, and people suffer Cholera and undigested stool diarrhea, indicating Cholera caused by Wind Wood overcoming Earth. It also states: When heat arrives, there is body heat, Cholera, vomiting and diarrhea, indicating Cholera caused by heat. Regarding the treatment of Cholera: Liu Hejian emphasized Fire-Heat; Sun Simiao emphasized Food Stagnation; Zhu Danxi believed it was external contraction combined with internal accumulation, with Yang failing to ascend and Yin failing to descend; Zhang Zihe emphasized Wind-Dampness and Cold combining into pathogenic factors; Zhang Jingyue emphasized Cold pathogen damaging the Zang organs; Li Shicai emphasized both Damp-Heat, Wind, Summer-heat, Deficiency and Excess, treating them separately; Luo Qianfu specialized in Disharmony of Qi, using Earth Slurry Water (Di Jiang Shui); Dai Fu'an focused on Phlegm based on the origin of pathogenic factors and the patient's deficiency or excess, using Su He Xiang Wan (Styrax Pill) to unblock obstruction, followed by Huo Xiang Zheng Qi San (Agastache Powder to Rectify the Qi) swallowing Lai Fu Dan to control phlegm-saliva. At the onset, when Yin and Yang are chaotic, first administer Salted Boiled Water (Shao Yan Tang) to induce vomiting, incorporating dispersing action within the vomiting method. Commonly used formulas include Huo Xiang San (Patchouli Powder) and Hui Sheng San (Revival Powder). If there is distension, pain, vomiting, and diarrhea, observe if the pathogen is predominant in the upper part; Ping Wei San (Calm the Stomach Powder) or Shen Xiang San (Aromatic Powder) or He Wei Yin (Harmonize the Stomach Decoction) are suitable. If the pathogen is predominant in the lower part, Wu Ling San (Five-Ingredient Powder with Poria) or Wei Ling Tang (Stomach-Poria Decoction) are suitable. If there is no distension or pain, only vomiting and nausea, Er Chen Tang (Two-Cured Decoction) combined with Ding Xiang San (Clove Powder), adding Bai Kou Ren (White Cardamom Seed) and Sha Ren (Amomum Fruit). In summer months, contracting coolness causing Cholera with vomiting and diarrhea, use Wei Ling Tang adding Huo Xiang (Patchouli) and Ban Xia (Pinellia Rhizome). After eating, contracting cold causing abdominal pain, vomiting and diarrhea, use Huo Xiang Zheng Qi San adding Shen Qu (Medicated Leaven). Injury from raw/cold food causing abdominal pain, vomiting and diarrhea, use Liu He Tang (Six-Harmony Decoction). Summer-heat injury causing body heat, irritability, thirst, vomiting and diarrhea, use Huang Lian Xiang Ru Yin (Coptis and Elsholtzia Decoction); mild cases use Wu Wu Xiang Ru Yin (Five-Ingredient Elsholtzia Decoction). Summer-heat and Dampness struggling, causing irritability, thirst, fullness and oppression, use Er Xiang San (Two-Aromatic Powder). Dampness injury causing heavy limbs and painful joints, use Cang Zhu (Atractylodes Rhizome), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Zhu Ling (Polyporus), Hou Po (Magnolia Bark), Chen Pi (Tangerine Peel), Ze Xie (Alisma Rhizome), or Chu Shi Tang (Remove-Dampness Decoction). If vomiting, diarrhea, and muscle cramps occur, it is Wind Wood punishing Spleen Earth; use Ping Wei San adding Mu Gua (Chaenomeles Fruit), or Mu Gua Tang (Chaenomeles Decoction). Muscle cramps and abdominal pain, use Mu Gua Jian Zhong Tang (Chaenomeles Decoction to Strengthen the Middle). Food stagnation abdominal pain, use Xiang Sha Zhi Zhu Wan (Costus and Amomum Pill to Break Up Accumulation) adding Shen Qu and Gu Ya (Sprouted Grain). Seven Emotions depression, use Qi Qi Tang (Seven-Qi Decoction) adding Wu Yao (Lindera Root), Mu Xiang (Aucklandia Root), Chen Pi, and Zhi Ke (Bitter Orange). If vomiting and diarrhea persist, Yuan Qi (Primal Qi) dissipates; or there is thirst preferring cold drinks, or aversion to cold with cold extremities, or fever with irritability desiring to remove clothing/bedding—this is not Heat, but Yin Excess repelling Yang (Yin Sheng Ge Yang). Do not mistakenly use Cold/Cool herbs. Use Li Zhong Tang (Regulate the Middle Decoction); for severe cases, Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) or Si Ni Tang (Four-Reversal Decoction), adding a little salt, taken cold. Sudden profuse watery diarrhea, cold sweat, faint pulse, urgently use Jiang Shui San (Grain Water Powder) taken cold.

[ Vomiting and Diarrhea ] Summer diarrhea or vomiting: Mix Tian Shui San (Heaven-Water Powder) with fresh Ginger Juice. Summer-heat invasion causing abdominal pain, vomiting, diarrhea, and muscle cramps: Stir-fry Mu Gua, Wu Zhu Yu (Evodia Fruit), and Salt (each 1.5 taels) together, decoct in water, take warm. Vomiting/diarrhea with headache, body heat and thirst: Wu Ling San. Vomiting/diarrhea with dry mouth, irritability and excessive drinking: Mai Men Dong Tang (Ophiopogon Decoction). Vomiting/diarrhea with deficiency-irritability and insomnia: Shen Hu San Bai Tang (Ginseng, Bupleurum, and Three Whites Decoction). Arriving in a foreign land, acclimatization issues causing vomiting/diarrhea: Jia Jian Zheng Qi San (Modified Rectify-Qi Powder).

[ Dry Cholera ] Unable to vomit above, unable to defecate below, twisting pain in chest and abdomen. This is Earth depression failing to vent, or old food interacting with Cold pathogen. Pathogens superficial are easily expelled via vomiting/diarrhea; pathogens deep cause Yin-Yang repulsion and blockage of Qi channels. Without rapid treatment, sudden death often ensues. Urgently prick blood from Wei Zhong (BL40) acupoint. First use Salt Soup to induce vomiting, or mix hot Child’s Urine with a little burnt salt; drink three times, vomit three times. Aim to raise Clear Qi; once Clear Qi ascends, Turbid Qi can descend and exit. Treatment should use Warm-Middle, Break-Qi, Disperse-Stagnation agents. Internally, use Pai Qi San (Expel-Qi Powder) modified, or Shen Xiang San, Qi Qi Tang. Externally, stir-fry Wu Zhu Yu and Qing Yan (Green Salt) (approx. 30g each), slightly grind, apply hot compress to below the umbilicus. If urination is blocked, use Dong Kui Zi Tang (Abutilon Seed Decoction). If both urination and defecation are blocked, use Hou Po Tang (Magnolia Bark Decoction). Or if vomiting/diarrhea have occurred and symptoms stabilize slightly, use Er Chen Tang, Huo Xiang San. Once Cholera initially stabilizes, do not urgently give porridge/soup, lest residual pathogens re-aggregate; moreover, Stomach Qi is rebellious and cannot descend harmoniously.

[ Muscle Cramps ] *Qian Jin Fang* states: Yangming Meridian belongs to Stomach and Large Intestine, nourishing Zong Jin (Major Tendons). Violent loss of Body Fluids from vomiting/diarrhea causes Zong Jin to lose nourishment. Mild cases involve only calf cramps; severe cases involve whole-body cramps extending to the abdomen, cold hands and feet, critically dangerous like a candle in the wind. In emergencies, urgently fill the umbilicus with salt, moxibustion with prepared mugwort without counting moxa cones; even if dead, if warmth remains in the chest, the patient will instantly revive. Urgently use Mu Yu San (Chaenomeles and Evodia Powder): Mu Gua, Salt, Wu Zhu Yu (each 15g), stir-fried together. Add Xiao Hui Xiang (Fennel), Zi Su Ye (Perilla Leaf), Gan Cao (Licorice Root), decoct and take. Crush garlic, apply to both sole centers (Yongquan KI1). Even in coma, critical condition, with cramps extending to abdomen, it is effective.