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Shang Han Lun · Treatise on Cold Damage
13. Huoluan Vomiting-Diarrhea · Pulses, Signs and Treatment
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382. Question: What is the illness called huoluan?
Answer: Vomiting together with diarrhea is called huoluan. The historical category is retained without identifying it with a single modern disease.
383. Question: Fever, headache, bodily pain, aversion to cold, vomiting and diarrhea belong to which illness?
Answer: This is called huoluan. Huoluan has spontaneous vomiting and downward discharge; after diarrhea stops, fever may arise again.
384. In cold damage with a faint, rough pulse, the condition was originally huoluan and is now cold damage. After another four or five days it reaches the yin channels; turning into yin must cause diarrhea. If vomiting and diarrhea were present originally, the condition is untreatable. An urge resembling the need to defecate, but with flatus instead and still no diarrhea, belongs to Yangming. Stool must be hard, and recovery comes on the thirteenth day because the channel course is complete.
After diarrhea, stool should become hard. Hardness with an ability to eat means recovery. If eating is instead impossible, but becomes somewhat possible during the next channel course, and fully possible after another course, recovery should follow one day beyond that. Failure to recover means the illness does not belong to Yangming.
385. With aversion to cold, a faint pulse and renewed diarrhea, cessation of diarrhea indicates blood loss. Sini Jia Renshen Tang governs.
Sini Jia Renshen Tang formula:
Gancao, two liang, roasted; Fuzi, one piece, raw, peeled and broken into eight pieces; Ganjiang, one and a half liang; Renshen, one liang.
Boil these four ingredients in three sheng of water until one sheng and two he remain. Remove the dregs, divide, and take warm in two doses.
386. In huoluan with headache, fever and bodily pain, predominance of heat and a wish to drink are governed by Wuling San. Predominance of cold without a wish for water is governed by Lizhong Wan.
Lizhong Wan formula:
Renshen, Ganjiang, Gancao roasted, and Baizhu, three liang each.
Pound and sift these four ingredients and combine with honey into pills about the size of an egg yolk. Mix one pill into several he of boiling water, grind it apart and take warm, three or four times by day and twice at night. If the abdomen has not warmed, increase to three or four pills. Even so, pills are inferior to decoction.
Decoction method: cut the four ingredients in the same liang amounts. Boil in eight sheng of water until three sheng remain, remove the dregs and take one sheng warm, three times daily. If there is pounding above the navel, Kidney qi is stirring: remove Zhu and add four liang of Gui. For much vomiting, remove Zhu and add three liang of Shengjiang. For much downward discharge, use Zhu again. For palpitations, add two liang of Fuling. For thirst and a wish for water, increase Zhu, including the original amount, to four and a half liang. For abdominal pain, increase total Renshen to four and a half liang. For cold, increase total Ganjiang to four and a half liang. For abdominal fullness, remove Zhu and add one Fuzi.
About the time needed to eat a meal after taking the decoction, drink roughly one sheng of hot gruel. Keep gently warm and do not open or throw off clothing and covers.
387. If vomiting and diarrhea cease but bodily pain continues, adapt care and harmoniously release the exterior. A small amount of Guizhi Tang is appropriate to harmonize it.
388. Vomiting, diarrhea, sweating, fever, aversion to cold, contraction of the four limbs and reversal cold of the hands and feet are governed by Sini Tang.
389. With both vomiting and diarrhea, further free urination, profuse sweating, diarrhea containing undigested grain, interior cold, exterior heat and a faint pulse on the verge of expiring, Sini Tang governs.
390. After vomiting has ceased and diarrhea stopped, sweating with reversal cold, unresolved contraction of the limbs and a faint pulse on the verge of expiring are governed by Tongmai Sini Jia Zhudanzhi Tang.
Tongmai Sini Jia Zhudanzhi Tang formula:
Gancao, two liang, roasted; Ganjiang, three liang, or four liang for a robust person; Fuzi, one large piece, raw, peeled and broken into eight pieces; pig gall liquid, half a he.
For these four ingredients, use three sheng of water and boil until one sheng and two he remain. Remove the dregs, add the pig gall liquid, divide, and take warm in two doses.
391. After vomiting, diarrhea and induced sweating, a normal pulse with slight agitation is due to recent deficiency being unable to bear grain qi.
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