Pulse Diagnosis

The presence of a Dai pulse (a pulse with regular intermittent pauses) indicates Huoluan (cholera-like syndrome); if the Dai pulse is accompanied by a faint and nearly imperceptible beat, it also signifies Huoluan. Furthermore, a slippery pulse at the Guan position (middle position on the radial artery) suggests vomiting and diarrhea associated with Huoluan. A wiry and slippery pulse at the Qikou position (cun position on the radial artery) indicates retained food and phlegm-fluid in the chest and diaphragm. Treatment should follow the nature of the pathogen by using salt water to induce vomiting and expel the pathogen. Pulses presenting as Jie (knotted), Cu (hasty), or large are not necessarily fatal pulses. A Hongda (surging and large) pulse is easy to treat; however, a Weixi (fine and minute) pulse accompanied by shortness of breath, inability to speak, tongue retraction, and testicular retraction indicates an untreatable condition. A slippery but irregular pulse is definitely a sign of Huoluan with vomiting and diarrhea; do not be alarmed by a large pulse in this context.

Symptoms

Huoluan refers to a sudden onset of disorder. It arises from internal accumulation and external injury, causing Yang Qi to fail to ascend and Yin Qi to fail to descend, resulting in a disruption of the interaction between Yin and Yang. Consequently, there is sudden pain in the heart and abdomen, vomiting and dysentery, fever and aversion to cold, headache and dizziness. There may be diarrhea without vomiting, or vomiting without diarrhea. If heart pain precedes, vomiting occurs first; if abdominal pain precedes, diarrhea occurs first; if both heart and abdomen hurt simultaneously, vomiting and diarrhea occur together. In severe cases, muscle spasms (Zhuanjin) may extend into the abdomen, leading to cold limbs and death.

Treatment

Urgently wash with Polygonum persicarium (Liao) decoction and moxibustion on the umbilicus. This is because Yin and Yang are inverted, and clear and turbid Qi interfere with each other. The appropriate treatment is Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi), preferably with added fresh ginger. This not only warms and disperses wind-cold but also regulates the Spleen and Stomach. For those with body heat and thirst, use Shenling Tang (Artemisia and Poria Decoction) with modifications.

After suffering from Huoluan, one should not eat early, lest the pathogenic factors in the stomach have not been fully expelled through vomiting and diarrhea. If new food enters the stomach before transformation and transportation are restored, it will inevitably lead to untreatable deterioration. Only after vomiting and diarrhea have ceased for one or two shichen (2-4 hours), and when extreme hunger sets in, should one consume a small amount of thin rice gruel, gradually resuming normal diet. Cases without vomiting or diarrhea are called Gan Huoluan (Dry Cholera). Urgently administer large amounts of salt water to induce vigorous vomiting, ensuring the retention of food is completely expelled, then medicate according to symptoms. After recovery, if restlessness, heat, and excessive thirst persist, Mai Men Dong Tang (Ophiopogon Decoction) is the primary formula.

For Huoluan with muscle spasms, boil a handful of Polygonum persicarium (Da Liao) and wash the affected area. People in the North substitute wheat bran. This opens the interstices (Couli), allowing Yang Qi to disperse, leading to recovery. Hejian stated: "When hot-dryness scorches the sinews, they contract and cause pain."

If a patient has died from Huoluan but warmth remains in the abdomen, place salt in the umbilicus and apply moxibustion without limiting the number of applications.

For sudden heart and abdominal pain due to Huoluan, wrap two bowls of fried salt in silk cloth, place them on the chest and abdomen, and apply heat with a warming iron until the qi penetrates and consciousness returns. Then, continue applying hot fried salt wrapped in silk to the back for safety.

Formulas

Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) treats abnormal Qi of the four seasons, epidemic cold-warmth diseases, mountain miasma, and damp-heat steaming; or abdominal pain with vomiting and diarrhea due to cold invasion; stroke from summerheat and wind; heaviness and diarrhea due to dampness; disharmony of Spleen and Stomach due to unfamiliar environment; food stagnation compounded by external pathogens; headache, fever, chills, nausea, chest fullness, and all symptoms of rebellious Qi.

Ingredients: Huoxiang (Agastache Herba, 2 qian), Zisu (Perilla Folium, 1.5 qian), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Houpo (Magnoliae Officinalis Cortex, processed with ginger, 1 qian), Banxia (Pinelliae Rhizoma, processed with ginger, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 1 qian), Fuling (Poria, 1 qian), Dafupi (Arecae Pericarpium, 1 qian), Jiegeng (Platycodonis Radix, 1 qian), Baizhi (Angelicae Dahuricae Radix, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 qian).

Crush these ingredients for one dose, add three slices of fresh ginger and two dates, decoct in water, and take warm. For Huoluan with muscle spasms, add Mugua (Chaenomelis Fructus). For abdominal pain, add Chao Baishao (Stir-fried Paeoniae Radix Alba). For cold pain, add Guizhi (Cinnamomi Ramulus). For severe cold, add Ganjiang (Zingiberis Rhizoma). For indigestion, add Xiangfu (Cyperi Rhizoma) and Sharen (Amomi Fructus). For undigested grains, add Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus). For epigastric fullness, add Jiegeng, Zhike (Aurantii Fructus Immaturus), and Zhishi (Aurantii Fructus). For undigested meat, add Shanzha (Crataegi Fructus). For stagnant damp noodles, add Luobozhongzi (Raphani Semen). For summerheat-stroke with wind, add Xianghuo and Bai Biandou (Dolichos Lablab Seed). For epidemic chills and fever, add Chaihu (Bupleuri Radix) and Genge (Puerariae Radix). For dry mouth, add Maidong (Ophiopogonis Radix). For difficult urination, combine with Wuling San (Five-Ingredient Poria Powder). For dampness clashing with Huoluan and spasms, restlessness, and thirst, combine with Huanglian Xiangru Yin (Coptis and Mosla Decoction). For severe heart/abdominal colic, add Muxiang (Aucklandiae Radix). For frequent urge to defecate without relief, add Binglang (Arecae Semen) and Zhike. Note: Huoluan is invariably caused by internal injury from raw/cold foods and external contraction of wind-cold. I have treated hundreds of cases with Huoxiang Zhengqi San with 100% efficacy. However, if heat signs are present, add Jiangchao Huanglian (Ginger-fried Coptidis Rhizoma); for severe cold, add Ganjiang. For abdominal pain, add Guizhi; for severe pain, remove Huoxiang and add Wuzhuyu (Evodiae Fructus); for difficult urination, add Fuling. For Dry Huoluan, add Zhike, Fuling, and Rougui (Cinnamomi Cortex), which is optimal.

Jiajian Shenling Tang (Modified Artemisia and Poria Decoction) [Commentary: Suitable for Huoluan of the Heat type] treats Huoluan with body heat and thirst, caused by summerheat.

Ingredients: Zhuling (Polypori Umbilicati Sclerotium, 7 fen), Zexie (Alismatis Rhizoma, 7 fen), Baizhu (Atractylodis Macrocephalae Rhizoma, 5 fen), Chi Fuling (Red Poria, 1 qian), Huanglian (Coptidis Rhizoma, 5 fen), Xiangru (Moslae Herba, 1 qian), Genge (Puerariae Radix, 7 fen), Tianhuafen (Trichosanthis Radix, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 5 fen), Biandou (Dolichos Lablab Seed, 14 seeds).

Crush for one dose, decoct with fresh ginger. If heat is extreme, add Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma). For diarrhea, add Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix), and Huashi (Talcum). For abdominal pain, add Chao Baishao and Guizhi.

Lizhong Wan (Regulate the Middle Pill) [Commentary: Suitable for Huoluan of the Deficiency-Cold type] treats Huoluan with spasms, vomiting and diarrhea, heart/abdominal pain, Dry Huoluan (colloquially known as Jiaochangsha/intestinal twisting sand), and True Yin Syndrome with cold limbs. During the Jiazi year of the Jiajing era, many in the Liang-Song region suffered from this, with numbness spreading from the soles to the knees, causing countless deaths. Physician Zhao presented this formula, saving many lives; thus, it is recorded for dissemination.

Ingredients: Renshen (Ginseng Radix et Rhizoma, 1 qian), Ganjiang (Zingiberis Rhizoma, stir-fried, 1 qian), Fuling (Poria, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 qian).

Grind into powder, form pills with refined honey, each pill weighing 1 qian. Chew one pill thoroughly and swallow with light ginger soup.

Avoid rice soup; this is Lizhong Tang converted to pills, utilizing the principle that Earth controls Water. If decocted as a liquid, it loses efficacy.

Yinyang Tang (Yin-Yang Decoction) treats Huoluan with vomiting, diarrhea, and abdominal pain where medication is immediately vomited up. Use boiling living river water and cold well water, half bowl each, mixed and taken.

Baifei Tang (Boiling Decoction) treats Huoluan vomiting and diarrhea caused by drinking cold liquids, exposure to cold, starvation, anger, or travel sickness, leading to simultaneous vomiting and diarrhea, dizziness, limb spasms, and cold extremities. Delayed treatment can be fatal within moments.

Ingredients: Wuzhuyu (Evodiae Fructus, 5 qian), Mugua (Chaenomelis Fructus, 5 qian), Yanshi (Halitum, 5 qian).

Stir-fry the three ingredients until scorched, decoct in Baifei Tang, and administer to the patient.

Gan Huoluan (Dry Huoluan), colloquially known as Jiaochangsha, is caused by undigested food leading to severe abdominal colic, inability to vomit or defecate, and chaotic distress. Death occurs instantly. Urgently灌 (irrigate/administer) large amounts of salt water to induce vomiting. Once the pathogen is expelled, administer Lizhong Tang, and prick the Ten Jing-Well points and Weizhong (BL40) to bleed.

Yanjiang Tang (Salt and Ginger Decoction) treats Dry Huoluan with impending death, characterized by inability to vomit or defecate.

Ingredients: Yan (Halitum, 1 liang), Shengjiang (Zingiberis Rhizoma Recens, sliced, 5 qian).

Stir-fry until color changes, decoct in two cups of child's urine (Tongzi Niao) to yield one cup, and take warm.

Mai Men Dong Tang (Ophiopogon Decoction) treats post-Huoluan restlessness, heat, excessive thirst, and difficult urination.

Ingredients: Renshen (Ginseng Radix et Rhizoma, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 1 qian), Fuling (Poria, 8 fen), Chenpi (Citri Reticulatae Pericarpium, 8 fen), Banxia (Pinelliae Rhizoma, processed, 8 fen), Xiaomai (Tritici Fructus, 100 grains), Maidong (Ophiopogonis Radix, core removed, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 7 fen).

Add three dark plums (Wumei) and three slices of fresh ginger. Decoct in two zhong of water to yield 0.8 zhong. Take far from meals.