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The *Suwen: Qiaobi Bian Dalun* (Treatise on the Great Changes of Qi Intercourse in the Basic Questions) states: If the annual Earth Qi is insufficient, the people will suffer from undigested stool diarrhea and Huoluan (cholera-like syndrome).

When the annual Earth Qi is insufficient, individuals with originally weak Spleen and Stomach will appear even more deficient due to celestial movements (abnormal climate). Once the Middle Jiao Yang Qi is deficient, Cold-Dampness naturally becomes prevalent, leading to morning intake and evening evacuation, resulting in undigested stool diarrhea; if vomiting is added, it becomes Huoluan. Observing its mention alongside undigested stool diarrhea, we know that such diarrhea must contain undigested food rather than foul-smelling excrement; vomitus must also be clear and transparent rather than sour and turbid. The presence of free urination and absence of thirst can also be inferred thus. Only in this manner is it Cold-Damp Huoluan, which can be treated with formulas such as Lizhong Tang (Regulate the Middle Decoction) or Wuling San (Five-Ingredient Poria Pill). Therefore, when studying texts, one must use one's mind to deduce the underlying principles, thereby achieving clarity everywhere and universal understanding. Moreover, Cold-type Huoluan is often seen in people living a comfortable life. Because they dwell in quiet places, their Yang Qi cannot extend; they sit and lie in cool breezes, and live arbitrarily. They consume iced melons and fruits at will as a routine. Even in midsummer, what they suffer from is mostly not Summerheat disease. Wang Andao discussed this in detail. For mild cases, Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi) or Pingwei San (Calm the Stomach Powder) plus Muxiang (Aucklandiae Radix), Huoxiang (Patchouli Herba), Shengjiang (Zingiberis Rhizoma Recens), Banxia (Pinelliae Tuber), etc., are used. If Dampness is heavy and limbs feel heavy, bones and joints are painful, headache occurs, body odor is present, feet are cold, or there is irritability, fever, and restlessness causing the patient to remove clothes and bedding, but observing that the stool is not foul-smelling, this indicates Interior Deficiency with Yin Excess forcing Yang outward (Yin Excess Repelling Yang). Lizhong Tang is appropriate; for severe cases, Sini Tang (Frigid Extremities Decoction) with a little salt is indicated. In cases of sudden watery diarrhea, cold sweat all over, cold extremities, weak pulse, and inability to speak, Jiangshui San (Fermented Rice Water Powder) should be administered urgently for rescue, and it is suitable to take it cold.

However, these patients actually contracted illness by trying to avoid summer heat but instead being injured by Cold. If one adheres rigidly to the season and mistakenly administers Summerheat-clearing agents, further aiding Yin-Cold, Yang collapse will occur instantly and become irretrievable. Some predecessors cured this condition but were unsure it was a Cold disease. Thus, they claimed that Summerheat diseases in summer generally require hot medicines. They recklessly established the category of "Yin Summerheat," misleading later generations. This was a misidentification due to accidental success. I have detailed this refutation in my book *Wenre Jingwei* (Comprehensive Analysis of Warm Diseases).

The *Suwen: Zhen Yao Da Lun* (Great Treatise on the Most Essential and Necessary Questions) states: All bodily fluids that are clear, cold, and chilly belong to Cold.

Someone said: A physician who masters pulse diagnosis, understands drug properties, possesses knowledge of classics and history, and is familiar with prescriptions can save the world. I say: No, one must be able to differentiate syndromes (Bianzheng). If one does not differentiate syndromes but relies solely on pulses to prescribe, even citing ancient precedents with classical basis, one risks being mocked by the disease spirits. Only the Sages anticipated this, explicitly writing down methods of syndrome differentiation for posterity, detailing them thoroughly. Was it merely to distinguish Cold and Heat in Huoluan?

The *Shanghan Lun* (Treatise on Cold Damage) states: In Huoluan, if accompanied by headache, fever, and body pain, with more Heat and desire for water, Wuling San governs it; if more Cold and no desire for water, Lizhong Wan governs it.

This type of Huoluan arises from Cold Damage, hence accompanied by exterior symptoms like headache, fever, and body pain. Although there is a desire for water, the exterior syndrome remains unresolved, so Wuling San is used as a method to resolve both interior and exterior. Both formulas are designed for Wind-Cold. "More Heat" refers to unresolving exterior Heat; "More Cold" refers to prevailing interior Cold. Within one disease, one observes the severity of interior and exterior, differentiates the aggregation and dispersion of pathogenic factors, and applies treatment accordingly. The Sage’s differentiation is so exhaustive. Later generations, however, are confused and misunderstand. Whenever patients with Hot Huoluan in summer and autumn have thirst, Wuling San is used, often leading to failure. One must know that Guizhi (Cinnamon Twig) and Baizhu (Atractylodis Macrocephalae Rhizoma) are contraindicated for those with thirst. They are only applicable when Wind-Cold pathogens obstruct Qi mechanism, causing fluid metabolism failure and thirst, to promote Qi movement and fluid transformation.

(Analysis is very clear, revealing insights previously undiscovered. "More Heat" does not mean intense interior-exterior Heat, and "desire for water" differs greatly from extreme thirst craving large amounts.)

It also states: If vomiting and diarrhea cease but body pain persists, one should carefully assess and harmonize the exterior; Guizhi Tang (Cinnamon Twig Decoction) in small doses is appropriate.

Cease of vomiting and diarrhea indicates Interior harmony. Persistent body pain indicates the exterior is unresolved. Thus, Guizhi Tang is needed to harmonize the exterior, known as "Exterior disease, Interior harmony," where sweating leads to recovery. However, this applies only to Cold Huoluan complicated by Wind-Cold exterior pathogen. For Hot Huoluan caused by Warmth, Summerheat, or Epidemic Toxins with unresolved exterior, this formula should not be casually applied. I devised Jiaying Tang (Driving Light Decoction), which is most suitable, yet its intent stays within the Sage’s scope. The terms "carefully assess" and "harmonize slightly" imply that after vomiting and diarrhea, Interior Qi is damaged; thus, one must judge if sweating is possible before inducing it, avoiding excessive sweating. Especially after Hot Huoluan, where Fluids are particularly depleted, how can sweating be rashly applied? Hence, I formulate with light and clear herbs.

It also states: After vomiting and diarrhea, if sweating occurs, pulse is peaceful but slight irritability exists, it is because new deficiency cannot withstand grain Qi.

Sweating after vomiting/diarrhea applies to Cold Damage Huoluan. Peaceful pulse means pathogens are resolved. Slight irritability results from new Stomach Qi deficiency post-evacuation, unable to digest grains. During Huoluan, diet should not be introduced immediately; one must wait for Stomach Qi to descend smoothly and digestive function to recover. In Summerheat-Hot Huoluan, Stomach Fluids are severely depleted; sweet-cool nourishment naturally restores appetite.

My late great-grandfather Bingheng Gong said: Cold Damage is the general term for external contraction; *Shanghan Lun* discusses external contractions comprehensively. My late grandfather Yongjia Gong said: *Nanjing* states "Cold Damage has five types." Thus, the ancients called all five external contractions Cold Damage. *Shanghan Lun* contains methods for treating Wind, Warmth, Dampness, etc., so it is not exclusively about one type of Cold Damage. Yang Suyuan Dayin noted: Dozens of commentators view it as exclusive to Cold Damage, finding it fragmented and impractical. I once said Cold Damage has five types, just as Malaria has five types; it is merely a difference in severity. True Cold Damage occurs when Cold invades the exterior immediately; treatment requires warming and dispersing. If pathogen is in half-exterior/half-interior or is mild, manifesting as true Malaria, the pulse is wiry, requiring harmonization. If Winter Cold is retained without immediate onset, it becomes Spring-Warmth or Summer-Heat diseases. Milder forms are Warm Malaria or Dan Malaria. Contracting Wind-Warmth, Damp-Warmth, or Summerheat leads to seasonal infections (heavy) or seasonal malaria (light). Today, Warm diseases are common, Cold rare; thus, seasonal malaria is common, true malaria rare. Only Mr. Ye Tianshi mastered Warmth and Damp-Heat, applying consistent logic to malaria treatment. I follow his intent: for seasonal malaria, I differentiate Wind-Warmth, Damp-Warmth, Summerheat, or latent pathogens, clearing the source via seasonal infection protocols. For forty years, no malaria case was incurable. Extending this principle, Wind, Cold, Summerheat, and Dampness can all cause Huoluan. Winter Cold latent inside may manifest as Huoluan in Spring/Summer rather than Warmth disease, though rarely seen, never mentioned before. This spring/summer, in Puyuan, I encountered such cases. Before Mangzhong solar term, traveling near the sea, households were filled with epidemic Huoluan. Last winter’s deep freeze caused severe Cold injury; displaced persons had depleted Spirit and weak Middle Qi. This spring was too cold, summer too cool; killing Qi persisted, generating Qi was sluggish. Latent pathogens could not vent as Warmth, hiding deeply like criminals. Triggered by lifestyle imbalance or minor external invasion, they suddenly attacked the center, causing Huoluan, often without abdominal pain. Post-recovery waves differed from typical Summer/Damp Huoluan, though symptoms resembled, pathology diverged, requiring distinct treatment. Latent Heat emerging from interior matches latent Summerheat logic; patients are thirsty, bloodletting yields dark purple blood. Ignorant practitioners, thinking Summerheat hasn't arrived, boldly use Ginger and Aconite, harming people. Is this fate? Pitiable. Zhou Caishan of Zhenhai accepted this theory, printed it, spreading it widely. Jin Zhai, Zhou Erjiao, Lu Shen’an, Wang Xiecheng, Lu Dingpu all approved it. I append this to Huoluan chapters to inform future readers.

It also states: With vomiting, diarrhea, sweating, fever, aversion to cold, limb stiffness, and cold extremities, Sini Tang governs it.

This is Yang-deficient constitution allowing Cold to enter directly, causing Huoluan. Fever with aversion to cold: body heat is false (Yang repelled outward); aversion to cold is true (Interior deficiency-cold). Limb stiffness and cold extremities indicate Yang deficiency failing to nourish tendons and warm extremities. Prominent sweating signals Yang escaping externally; thus, Sini Tang is used to expel invading Cold and salvage departing Yang. If only cold extremities, aversion to cold, limb stiffness, deep-thin/tight pulse, dusty complexion, non-foul stool exist without sweating, Lengxiang Yinzi (Cold Fragrant Drink) is appropriate. Cold causes contraction; limb stiffness here means tendon rigidity preventing flexion/extension, distinct from Heat-induced muscle cramps. Differentiation is crucial; error brings swift disaster.

It also states: Vomiting and diarrhea, frequent urination, profuse sweating, undigested stool evacuation, interior Cold with exterior Heat, faint pulse nearly imperceptible: Sini Tang governs it.

This is also deficiency-cold Huoluan. Limb stiffness/cold extremities show Cold outside; undigested stool/faint pulse show Cold inside. Severe interior Cold forces Yang outward, creating false Heat signs: irritability removing clothes, red face preferring cold but not swallowing, large-empty-wiry pulse unpressable. These indicate Yuan Qi depletion and floating Yang loss, worsened by wheezing/belching—critical danger. Only Sini Tang drives out excess Yin and restores scattered Yang. The emphasis on frequent urination and undigested stool highlights the gravity. Readers must pay attention. As Huoxi said, if one symptom is missing, scrutinize carefully. If Hot Huoluan mimics Cold via Summerheat blocking collaterals (fine pulse, cold limbs), true signs include dark urine, foul stool, thirst, yellow coating. Do not ignore these.

It also states: Vomiting/diarrhea stopped, sweating with cold extremities, limb stiffness, faint pulse: Tongmai Sini Tang plus Pig Gallbladder Bile governs it.

You Zhuowu said: Cessation of vomiting/diarrhea suggests Yang recovery and Yin resolution. Yet sweating, cold extremities, stiffness, and faint pulse indicate Yin persistence and Yang collapse—critical. Doubling Ganjiang (Dried Ginger) in Sini Tang saves dying Yang. Pig bile (bitter-cold) is added as a guide to prevent rejection by Yin, following *Neijing*'s "follow the excess" principle.

It also states: Shaoyin disease with vomiting/diarrhea, cold extremities, severe irritability: Wuzhuyu Tang governs. Shaoyin disease with vomiting/diarrhea, irritability, cold extremities: death.

Cold invading Shaoyin causes alternating vomiting/diarrhea; Yin excess overwhelms Yang. Preceding cold then irritability suggests Yang returning to fight; Wuzhuyu Tang warms interior, Renshen/Jujube tonifies deficiency. Preceding irritability then cold indicates Yang defeat/death—fatal. These are Shaoyin Cold patterns, not Huoluan, but similar. Listing them clarifies differential diagnosis.

It also states: Shaoyin disease, spontaneous clear watery stool, pure green color, epigastric pain, dry mouth: urgent purgation with Dachengqi Tang.

Cold transforming to Heat enters Shaoyin, forcing fluids into spontaneous diarrhea. Clear quality, green color without turbidity/yellow-red mix shows extreme Yang Fire resembling Yin. Pathogen from Upper Jiao causes epigastric pain and dry mouth. Yin pathogen would cause fullness without pain. Given Shaoyin signs (dry mouth, pain, clear stool), urgent purgation is needed. For non-Cold Damage Huoluan with confusion, thirst, epigastric tenderness, can燥热 (hot-dry) drugs be used? *Neijing* says clear/cold fluids are Cold. This clear stool is likely hot, not cold, possibly with dark scant urine. Careful inquiry distinguishes them. Zhongjing uses thirst to distinguish Warm vs. Cold treatments for diarrhea—simple and effective. Clinicians should follow this compass.

(This case requires careful differentiation. I saw a mild Huoluan case treated with Liangge San; patient died of bloody stool next day. Recorded by Xiecheng.)

*Qianjin Yaofang* states: Huoluan with cold extremities, less vomiting more retching: Fuzi Jingmi Tang governs. Zhizhong Tang treats Huoluan vomiting/diarrhea, distension, indigestion.

Between Stomach and Intestines, vomiting/diarrhea occur together. Wind-complicated excess presents with fever, headache, body ache, vomiting/diarrhea. Deficiency presents only with vomiting/diarrhea and stabbing heart/abdominal pain. Alcohol damaging Spleen/Stomach, combined with Cold impairing digestion, causes turbid/clear Qi conflict. Weak Spleen/Stomach leads to vomiting/diarrhea, indigestion, distension—all becoming Huoluan.

Hot Huoluan, epidemic-like, is common to all; Cold Huoluan, occasional injury, is individual. Chao Yuanfang’s detailed discussion covers ordinary Cold Huoluan only. Applying this to epidemic Huoluan is like an inept scholar commanding troops—failure is likely.

It also states: Huoluan with muscle cramps results from Cold Qi entering tendons. Cold entering foot meridians causes leg cramps; hand meridians cause arm cramps. Cramping follows Cold entry, driven by pathogenic Cold striking tendons.

Cramps differ by Heat/Cold etiology; differentiate via accompanying symptoms and pulses.

(People without disease sometimes get cramps from minor foot chill, not pathological. Modern doctors assume cramps always involve Three Yin meridians, ignoring Three Yang involvement. Chao’s theory is clear. Recorded by Xiecheng.)

It also states: Gan Huoluan (Dry Huoluan) is Cold Qi clashing in intestines/stomach, causing food stagnation, abdominal distension, irritability, chest pain, shortness of breath. Prior intestinal excess prevents vomiting/diarrhea, hence "Dry."

Gan Huoluan can be Cold-Damp, Food-stagnation, or Cold-Damp mixed with foul/toxic qi. Treatment must confirm it is not Summerheat-Fire before avoiding cooling agents. Use aromatic-acrid dispersants to open pathways. Do not blindly trial strong agents like Ginger, Aconite, Pepper, or Croton seed.

Medical之道 parallels governance: rulers examine public sentiment; judges examine legal facts; generals examine enemy intelligence; physicians examine disease conditions. Understanding public sentiment enables good governance; legal facts ensure justice; enemy intelligence ensures victory (few against many, rested against weary). Disease condition mastery secures life, wards off plagues, reverses fate. Alas! Treating Huoluan without distinguishing Deficiency/Excess or Cold/Heat is like abandoning land/people to discuss defense. Hence, examining disease conditions comes first.