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(From *Shanghan Lun*)
Treats cold-type Huoluan (cholera-like syndrome with sudden vomiting and diarrhea), where the patient has no thirst.
Renshen (Ginseng Radix et Rhizoma), Gancao (Licorice Root), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Dried Ginger) (each 3 liang).
Crush these four herbs, sift into powder, mix with honey to form pills, size of a chicken egg yolk. Take one pill, crushed and mixed in several he (approx. 200ml) of boiling water, take warm. Three times daily, twice at night. If the abdomen does not feel warm, increase to three or four pills per dose. However, this method is inferior to the decoction. The decoction method: based on the quantities above, use eight sheng (approx. 1600ml) of water, boil down to three sheng (approx. 600ml), remove dregs, take one sheng (approx. 200ml) warm, three times daily.

Modifications: If there is a sensation of pounding or throbbing above the navel, it indicates Kidney Qi stirring; remove Baizhu and add Guizhi (Cinnamon Twig) 4 liang.
Mr. You states: "Pounding above the navel" refers to a throbbing sensation above the navel, where Kidney Qi ascends to invade the Spleen. Since the Spleen is receiving Qi, the sweetness of Baizhu can obstruct Spleen Qi, hence its removal. The pungency of Guizhi can direct Kidney Qi downward, hence its addition.
Commentary: This is Kidney Qi stirring due to Yang deficiency, about to manifest as Ben Tun (a condition characterized by gas rushing from the lower abdomen up to the chest/heart). Therefore, Baizhu is removed and Guizhi added to prevent its upward encroachment. If the throbbing above the navel is due to Yin deficiency, rigid and drying agents are strictly contraindicated; one must vigorously nourish the Yin of the Liver and Kidneys. This is because one case involves Water moving abnormally, while the other involves Fire moving abnormally.

If vomiting is severe, remove Baizhu and add Shengjiang (Fresh Ginger) 3 liang.
Mr. You states: In cases of severe vomiting, Qi is obstructed upwards; sweetness tends to obstruct Qi, hence Baizhu is removed. Pungency disperses Qi, hence Shengjiang is added.
Commentary: Zou Run'an states: When both vomiting and diarrhea occur, it may belong to Taiyin disease or Shaoyin disease. In Shaoyin disease, there is no rationale for using Baizhu. In Taiyin disease, it falls into a category of debatable applicability. This is because Baizhu treats Spleen-Stomach deficiency but cannot treat Spleen-Stomach excess. Thus, it is removed when vomiting is severe. It is reinstated when diarrhea is severe, as Baizhu can lift the clear Yang of the Spleen. Such meticulous modification methods exist; why do modern practitioners neither analyze the disease nor select herbs appropriately, resorting to trial-and-error? This is akin to sending untrained civilians to war. Alas, how lamentable.

If diarrhea is severe, reinstate Baizhu. If palpitations occur, add Fuling (Poria) 2 liang.
Mr. You states: Severe diarrhea implies Spleen Qi failing to hold; thus Baizhu is needed to consolidate it. Palpitations indicate Kidney Water counterflowing upward; thus Fuling is added to guide it downward.
Commentary: Modern practitioners treating Huoluan often fail to differentiate between deficiency/excess and cold/heat syndromes, nor do they observe whether vomiting or diarrhea predominates. They indiscriminately administer warming and tonifying formulas without restraint. I do not know what their intentions are.

If thirsty and desiring water, increase the dosage of Baizhu so that the total reaches 4.5 liang.
Mr. You states: Thirst and desire for water indicate insufficient Body Fluids; the sweetness of Baizhu is sufficient to generate them.
Commentary: This thirst arises because Spleen deficiency fails to transport Body Fluids for the Stomach. Hence, Baizhu is increased to tonify the Spleen and thereby generate Body Fluids. This is the meaning behind the statement that "Baizhu can generate Body Fluids." It certainly cannot be applied to thirst caused by heat scorching Body Fluids.

If abdominal pain occurs, increase the dosage of Renshen so that the total reaches 4.5 liang.
Mr. You states: Abdominal pain indicates interior deficiency and insufficiency; the sweetness of Renshen is sufficient to tonify it.
Commentary: Abdominal pain due to interior deficiency is always relieved by warmth and pressure.

If feeling cold, increase the dosage of Ganjiang so that the total reaches 4.5 liang.
Mr. You states: Feeling cold indicates cold Qi in the abdomen; the pungency of Ganjiang is sufficient to warm it.
Commentary: Wuling San (Five-Ingredient Powder with Poria) treats cases with more heat, referring to exterior heat. Lizhong Tang (Regulate the Middle Decoction) treats cases with more cold, referring to interior cold. Hence, the formula instructions include the method of increasing pills if the abdomen remains cold. Here, it further states "add Ganjiang for cold," indicating the abdomen is still not warm. Therefore, the dosage of this specific herb is increased alone. Abdominal cold represents the true essence of cold syndromes.
Thus, Zhang Zhongjing did not shy away from being detailed, teaching people meticulously, using this as a method for syndrome differentiation. However, ignorant practitioners, upon seeing vomiting and cold limbs, fail to examine the state of the abdomen, and arbitrarily prescribe Ganjiang, Fuzi (Aconite Lateralis Radix Praeparata), Dingxiang (Caryophylli Flos), and Rougui (Cinnamon Bark) hoping to restore warmth, resulting in the entire body becoming cold. Alas! Have they not heard the sage's instruction: "The deeper the heat, the deeper the cold extremities"?

If abdominal fullness occurs, remove Baizhu and add one Fuzi. After taking the decoction, approximately after a meal interval, drink about one sheng (approx. 200ml) of hot porridge to maintain slight warmth; do not uncover clothing or blankets.
Mr. You states: Abdominal fullness indicates stagnant Qi that fails to move. Qi becomes obstructed by sweetness but moves with pungency; hence Baizhu is removed and Fuzi added.
Commentary: Drinking hot porridge helps the medicinal force but also serves as a diagnostic method. If it were epidemic heat-Huoluan, hot porridge would be strictly contraindicated... [Text implies error in treatment logic].
Commentary: The original formula with added Fuzi is named Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). With Qingpi (Citri Reticulatae Pericarpium Viride) and Chenpi (Citri Reticulatae Pericarpium), it is named Zhizhong Tang (Regulate the Middle Decoction). With Zhishi (Aurantii Fructus Immaturus) and Fuling, it is named Zhishi Lizhong Tang. With Huanglian (Coptidis Rhizoma), it is named Lianli Tang. Combined with Wuling San, it is named Liling Tang.