汤氏云∶小儿热泻者，大便黄赤有沫，乃脏中有积，或蕴结所致。若小便赤少，口干烦躁，
当用四苓散，热甚者四逆散。右腮色赤饮冷，胃经实热也，用泻黄丸。恶冷喜热，胃经虚热
也，用白术散。右腮及额间俱赤，心脾翕热也，用泻黄散加炒黑黄连。若左颊右腮俱赤，肝
火乘脾土也，用四君子汤加柴胡。若儿暴伤乳食，用保和丸，乳母尤当忌浓味，节饮食。若
乳母停食所伤，致儿吐泻等病，当治其母。大抵始病而热者，邪气胜则实也；终变为寒者，
真气夺则虚也；久病而热者，内真寒而外假热也。久泻元气虚寒，当参前症治之。
治验
一小儿夏间食粽伤胃，吐而腹痛，余用保和丸，彼以为缓，另用重剂，吐泻并作，腹痛益甚
，按其腹却不痛。余曰∶此食已消，而脾胃虚也，当温补之。仍行消导，昏愦发搐，余用异
功散加木香治之，渐愈。后复伤食，另用去积丸，吐泻不食，手足并冷，睡而露睛，变为疟
疾，余用六君、木香、炮姜，治之而愈。
一小儿泻而大便热赤，小便涩少。此热蕴于内也，先用四苓散加炒黄连一剂，其热顿退；又
用白术散去木香二剂，热渴顿止；以四君、升麻调理而痊。
一小儿食炙 甘甜之物，常作泻，大便热痛，小便赤涩，此膏粱积热所致，用四苓散、清胃
散，各四服，诸症稍退，乃用四味肥儿丸而瘥。
一小儿九岁，食炙 之物，作泻饮冷，诸药不应，肌体消瘦，饮食少思，余用黄连一两，酒
拌炒焦为末，入人参末四两，粥丸小豆大，每服四五十丸，不拘时，白汤下，服讫渐愈；又
用五味异功散加升麻，服月余而瘥。后不戒浓味，患疳积消瘦，少食发热作渴，用九味芦荟丸
为主，以四味肥儿丸为佐，疳症渐退；却以四味肥儿丸为主，以五味异功散为佐而痊。后又
不禁浓味，作泻饮冷，仍服肥儿丸、异功散而愈。
一小儿侵晨泄泻，服消疳清热之剂，不应。余谓脾肾虚，用二神丸治之。不信，仍服前药，
形体骨立，复求治。用四神、六味二丸治之寻愈。停药数日，饮食渐减，泄泻仍作。至十七
岁毕姻，泻渴顿作，用前药治之无效，乃用补中益气汤、八味丸而始应。
一小儿因母怒气，停食患泄泻，服消导之剂，更加吐乳。先用养胃汤加炒黑黄连一钱、吴茱
萸二分、木香四分治其母，子亦灌一二匙悉愈。后母伤食患血痢腹痛，其子亦然，治以四君
子加前三味，母子俱服，因惑于人言，但令母服，子另服治痢之药，加作呕不乳，手足并冷
，余用五味异功散加木香、炮姜、漏芦，母子并服而愈。
一小儿患泻，身热作渴，泻下秽气，此为内热而泻也，用香连丸一服而愈。后患泻，服黄连
香薷饮益甚，余用六君、木香、肉果而愈。
一小儿患泻，作渴饮冷，手足并热，睡而露睛，此为热泻，用黄芩汤一剂而愈，又用白术散
二服而安。
一小儿患泻，面赤饮冷，小便赤色，先用四苓散、香连丸各一服，而便利势减，又用异功散
加木香、黄连各二分、吴茱萸一分，二服而愈。
一小儿泻而腹痛，按之不痛，用异功散加升麻而愈。后复泻，服消乳丸，益加腹痛，余谓脾
气伤也，复用异功散加木香而痊。
一小儿吐泻腹痛，睡而露睛，小腹重坠，手足并冷，先用六君、升麻、干姜四服而痛坠愈；
又用异功散加升麻、木香而悉愈。后又伤食腹痛，别服祛逐之剂，虚症悉具，余用理中丸、
六君子汤而寻愈。但噫气下气，口角流涎，此脾胃虚寒也，复用理中、六君子二汤而愈。
黄芩汤 治下痢头痛，胸满口干，或寒热胁痛，不时呕吐。其脉浮大而弦。
黄芩（一两五钱） 芍药 甘草（炒。各一两）
上每服二三钱，姜水煎，呕加半夏二钱。
玉露散 治吐泻黄色。
寒水石 石膏（各半两） 甘草（一钱）
上为末，每服半钱，白滚汤调服。
四味肥儿丸（方见呕吐）
异功散（方见内钓）
二神丸
四神丸（二方见惊泻）
八味丸（即六味丸加肉桂、五味，方见肾脏）
调中丸（即理中汤，方见咳嗽）
白术散（方见积痛）
四苓散（即五苓散去桂，方见五淋）
四逆散（方见积滞）
胃苓汤（方见吐泻）
养胃汤（方见疟症）
清胃散
四君子汤
六君子汤（三方见内钓）
保和丸（方见虚羸）
香连丸（方见诸痢）
汤氏说：小儿热泻，表现为大便黄赤且带有泡沫，这是由于脏腑中有积滞，或邪气蕴结所致。如果小便颜色红赤、量少，口干烦躁，应当使用四苓散；热势严重的，使用四逆散。右侧面颊发红且喜饮冷水的，是胃经实热证，使用泻黄丸。厌恶寒冷而喜欢温暖的，是胃经虚热证，使用白术散。右侧面颊及额头都发红的，是心脾有翕翕发热（内热），使用泻黄散加炒至黑色的黄连。如果左侧面颊和右侧面颊都发红，是肝火乘袭脾土，使用四君子汤加柴胡。如果孩子突然因乳食损伤，使用保和丸，乳母尤其应当忌食浓味食物，节制饮食。如果乳母因停食受伤，导致孩子出现呕吐腹泻等疾病，应当治疗母亲。大抵来说，初起病时发热的，是邪气盛则实证；最终转变为寒证的，是正气被夺则虚证；久病而发热的，是内部真寒而外部假热。久泻导致元气虚寒的，应当参考前面的症状进行治疗。
治验案例
一个孩子在夏天吃粽子伤了胃，呕吐且腹痛，我用保和丸治疗，他认为药力太缓，另外用了重剂量的药物，结果吐泻并作，腹痛更加严重，按压腹部却不痛。我说：这是食积已经消散，但脾胃虚弱了，应当温补。如果继续行消导之法，会导致昏愦抽搐，我改用异功散加木香治疗，逐渐痊愈。后来再次伤食，另用去积丸，导致吐泻不食，手足冰冷，睡觉时眼睛半睁（露睛），变为疟疾，我用六君子汤、木香、炮姜治疗，治愈。
一个孩子腹泻，大便热赤，小便涩少。这是热邪蕴结在体内，先用四苓散加炒黄连一剂，热势顿时减退；又用白术散去木香两剂，热渴顿时停止；再用四君子汤、升麻调理而痊愈。
一个孩子吃了烤制的甘甜食物，经常腹泻，大便热痛，小便赤涩，这是膏粱厚味积热所致，用四苓散、清胃散，各服四次，各种症状稍退，然后用四味肥儿丸而痊愈。
一个九岁的孩子，吃了烤制的食物，腹泻且想喝冷水，各种药物无效，身体消瘦，饮食减少不想进食，我用黄连一两，酒拌炒焦研末，加入人参末四两，用米粥做成小豆大小的丸药，每次服用四五十丸，不限时间，用白开水送下，服完后逐渐好转；又用五味异功散加升麻，服用一个多月而痊愈。后来不忌口浓味食物，患上疳积消瘦，少吃发热口渴，以九味芦荟丸为主药，以四味肥儿丸为佐药，疳症逐渐消退；却以四味肥儿丸为主药，以五味异功散为佐药而痊愈。后来又不禁忌浓味食物，再次腹泻喝冷水，仍然服用肥儿丸、异功散而痊愈。
一个孩子清晨泄泻，服用消疳清热的药剂，无效。我认为他是脾肾虚，用二神丸治疗。他不相信，仍服前药，形体骨瘦如柴，又来求治。我用四神丸、六味地黄丸治疗，不久痊愈。停药几天后，饮食逐渐减少，泄泻再次发作。到了十七岁结婚后，泄泻口渴突然发作，用前药治疗无效，于是用补中益气汤、八味丸才见效。
一个孩子因为母亲生气，停食患泄泻，服用消导药剂，更加吐乳。先给母亲用养胃汤加炒黑黄连一钱、吴茱萸二分、木香四分治疗，给孩子灌服一二匙也全部痊愈。后来母亲伤食患血痢腹痛，孩子也一样，治疗用四君子汤加前三味药，母子都服用，但因受他人言语迷惑，只让母亲服用，孩子另服治痢的药，加上呕吐不吃奶，手足冰冷，我用五味异功散加木香、炮姜、漏芦，母子一起服用而痊愈。
一个孩子患腹泻，身热口渴，泻下秽臭气味，这是内热导致的腹泻，用香连丸一服而愈。后来患腹泻，服用黄连香薷饮反而加重，我用六君子汤、木香、肉果治疗而愈。
一个孩子患腹泻，口渴想喝冷水，手足都热，睡觉时眼睛半睁，这是热泻，用黄芩汤一剂而愈，又用白术散两剂而安定。
一个孩子患腹泻，面赤想喝冷水，小便颜色红，先用四苓散、香连丸各一服，大小便通畅之势减轻，又用异功散加木香、黄连各二分、吴茱萸一分，两服而愈。
一个孩子腹泻且腹痛，按压腹部不痛，用异功散加升麻而愈。后来再次腹泻，服用消乳丸，更加腹痛，我认为脾气受伤，复用异功散加木香而痊愈。
一个孩子吐泻腹痛，睡觉时眼睛半睁，小腹沉重下坠，手足冰冷，先用六君子汤、升麻、干姜四服而疼痛下坠感痊愈；又用异功散加升麻、木香而全部痊愈。后来又伤食腹痛，别服祛逐药剂，虚症全部具备，我用理中丸、六君子汤而不久痊愈。只是打嗝排气，口角流涎，这是脾胃虚寒，复用理中汤、六君子汤而痊愈。
黄芩汤 治疗下痢头痛，胸满口干，或有寒热胁痛，不时呕吐。其脉浮大而弦。
黄芩（一两五钱） 芍药 甘草（炒。各一两）
以上每服二三钱，姜水煎煮，呕吐加半夏二钱。
玉露散 治疗吐泻黄色。
寒水石 石膏（各半两） 甘草（一钱）
以上研为末，每服半钱，用白滚汤调服。
四味肥儿丸（方见呕吐）
异功散（方见内钓）
二神丸
四神丸（二方见惊泻）
八味丸（即六味丸加肉桂、五味子，方见肾脏）
调中丸（即理中汤，方见咳嗽）
白术散（方见积痛）
四苓散（即五苓散去桂枝，方见五淋）
四逆散（方见积滞）
胃苓汤（方见吐泻）
养胃汤（方见疟症）
清胃散
四君子汤
六君子汤（三方见内钓）
保和丸（方见虚羸）
香连丸（方见诸痢）
Tang Shi stated: In cases of pediatric heat diarrhea, the stool is yellowish-red and frothy, caused by accumulation in the zang-fu organs or constraint of pathogenic factors. If urination is dark red and scanty, accompanied by dry mouth and irritability, Siling San (Four-Ling Powder) should be used; for severe heat, Sixini San (Four-Reversal Powder) is indicated. Redness on the right cheek with a preference for cold drinks indicates excess heat in the Stomach channel; Xiehuang Wan (Drain Yellow Pill) is prescribed. Aversion to cold and preference for warmth indicate deficiency heat in the Stomach channel; Baizhu San (Atractylodes Macrocephala Powder) is used. Redness on both the right cheek and forehead indicates internal heat in the Heart and Spleen; Xiehuang San (Drain Yellow Powder) added with stir-burned Coptidis Rhizoma (Huanglian, 黄连) is applied. Redness on both the left cheek and right cheek indicates Liver fire invading the Spleen earth; Sijunzi Tang (Four-Gentlemen Decoction) added with Bupleuri Radix (Chaihu, 柴胡) is used. For sudden injury from milk and food, Baohe Wan (Preserve Harmony Pill) is employed; the nursing mother must particularly avoid rich flavors and regulate her diet. If the nursing mother suffers from food stagnation causing vomiting and diarrhea in the infant, the mother should be treated. Generally, heat at the onset of disease indicates an excess pattern due to strong pathogenic qi; transformation into cold at the end indicates a deficiency pattern due to depletion of true qi; heat persisting in chronic illness indicates true cold internally with false heat externally. Chronic diarrhea leading to deficiency-cold of Yuan Qi should be treated according to the preceding symptoms.
Clinical Cases
A child injured his stomach by eating zongzi (sticky rice dumplings) in summer, presenting with vomiting and abdominal pain. I used Baohe Wan (Preserve Harmony Pill), but he considered it too slow and used a heavy-dose preparation instead. This resulted in simultaneous vomiting and diarrhea, with worsened abdominal pain, yet pressing the abdomen elicited no pain. I said: "The food accumulation has already dissipated, but the Spleen and Stomach are deficient; warming and tonification are required." Continuing with digestion-promoting methods would lead to stupor and convulsions. I switched to Yigong San (Extra-Ability Powder) added with Aucklandiae Radix (Muxiang, 木香), and he gradually recovered. Later, upon re-injury from food, he took Quji Wan (Remove Accumulation Pill), resulting in vomiting, diarrhea, anorexia, cold limbs, and sleeping with eyes half-open (exposing the eyeballs), transforming into malaria. I treated him with Liujunzi Tang (Six-Gentlemen Decoction), Muxiang, and Paojiang (Prepared Ginger), curing him.
A child presented with diarrhea, hot reddish stools, and scanty, difficult urination. This indicated heat constrained internally. Initially, Siling San (Four-Ling Powder) added with stir-burned Huanglian was given for one dose, immediately reducing the heat. Then, Baizhu San (Atractylodes Macrocephala Powder) without Muxiang was given for two doses, stopping the heat and thirst. Finally, Sijunzi Tang (Four-Gentlemen Decoction) and Cimicifugae Rhizoma (Shengma, 升麻) were used for regulation, leading to recovery.
A child frequently suffered from diarrhea after consuming roasted sweet foods, with hot painful stools and dark, difficult urination. This was caused by heat accumulation from rich foods. Siling San (Four-Ling Powder) and Qingwei San (Clear Stomach Powder) were each administered four times, slightly alleviating symptoms, followed by Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) for complete recovery.
A nine-year-old child suffered from diarrhea and desire for cold drinks after eating roasted foods, unresponsive to various medicines, with emaciation and poor appetite. I used one liang of Huanglian (Coptidis Rhizoma), stir-fried with wine until charred, powdered, and mixed with four liang of Ginseng Radix et Rhizoma (Renshen, 人参) powder. These were made into pills the size of adzuki beans using congee. Each dose was 40-50 pills, taken anytime with warm water. He gradually improved. Subsequently, Wuyi Yigong San (Five-Ingredient Extra-Ability Powder) added with Shengma was taken for over a month, leading to recovery. Later, failing to avoid rich foods, he developed malnutrition syndrome (Gan Ji) with emaciation, low intake, fever, and thirst. Jiawei Lushen Wan (Nine-Ingredient Wormwood Pill) was used as the principal formula, assisted by Siwei Fei'er Wan, gradually resolving the Gan syndrome. Then, Siwei Fei'er Wan became the principal formula, assisted by Wuyi Yigong San, leading to recovery. Again, failing to avoid rich foods, he had diarrhea and desired cold drinks; taking Fei'er Wan and Yigong San cured him.
A child suffered from morning diarrhea. Digestion-promoting and heat-clearing agents were ineffective. I diagnosed Spleen and Kidney deficiency and prescribed Ershen Wan (Two-Gods Pill). Disbelieving this, he continued previous medications, becoming emaciated, and sought treatment again. I used Sishen Wan (Four-Gods Pill) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), and he recovered soon. After stopping medication for a few days, food intake decreased, and diarrhea recurred. At age seventeen, after marriage, diarrhea and thirst suddenly intensified. Previous treatments failed; only Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Bawei Wan (Eight-Ingredient Pill) proved effective.
A child suffered from diarrhea due to maternal anger and food stagnation. Digestion-promoting agents worsened vomiting of milk. The mother was first treated with Yangwei Tang (Nourish Stomach Decoction) added with stir-burned Huanglian (one qian), Evodiae Fructus (Wuzhuyu, 吴茱萸) (two fen), and Muxiang (four fen). The infant was also given one or two spoonfuls, resulting in complete recovery. Later, the mother suffered from bloody dysentery and abdominal pain due to food stagnation, and the infant exhibited similar symptoms. Treatment involved Sijunzi Tang added with the aforementioned three herbs, taken by both mother and infant. However, influenced by others' words, only the mother took it, while the infant took separate dysentery medicine, leading to vomiting, refusal to nurse, and cold limbs. I used Wuyi Yigong San (Five-Ingredient Extra-Ability Powder) added with Muxiang, Paojiang, and Lulu (Radix Agrimoniae, 漏芦), administered to both, curing them.
A child presented with diarrhea, fever, thirst, and foul-smelling stools, indicating internal heat diarrhea. Xianglian Wan (Coptis and Aucklandia Pill) cured him in one dose. Later, diarrhea worsened with Huanglian Xiangru Yin (Coptis and Elsholtzia Drink). I treated him with Liujunzi Tang (Six-Gentlemen Decoction), Muxiang, and Myristicae Semen (Rouguo, 肉果), achieving recovery.
A child presented with diarrhea, thirst for cold drinks, hot limbs, and sleeping with eyes half-open, indicating heat diarrhea. Huangqin Tang (Scutellaria Decoction) cured him in one dose, followed by Baizhu San for stabilization.
A child presented with diarrhea, red face, desire for cold drinks, and red urine. Initially, Siling San (Four-Ling Powder) and Xianglian Wan were each given once, reducing bowel and urinary urgency. Then, Yigong San (Extra-Ability Powder) added with Muxiang, Huanglian (each two fen), and Wuzhuyu (one fen) cured him in two doses.
A child presented with diarrhea and abdominal pain, but no pain upon pressure. Yigong San added with Shengma cured him. Later, recurrence of diarrhea after taking Xiaoru Wan (Digest Milk Pill) worsened abdominal pain. I diagnosed Spleen Qi injury and reused Yigong San added with Muxiang, leading to recovery.
A child presented with vomiting, diarrhea, abdominal pain, sleeping with eyes half-open, heavy sensation in the lower abdomen, and cold limbs. Initially, Liujunzi Tang (Six-Gentlemen Decoction), Shengma, and Ganjiang (Dried Ginger) were given for four doses, relieving pain and heaviness. Then, Yigong San added with Shengma and Muxiang completely cured him. Later, food stagnation caused abdominal pain; taking expulsion agents led to full deficiency symptoms. Lizhong Wan (Regulate the Middle Pill) and Liujunzi Tang cured him soon. Belching, flatulence, and drooling indicated Spleen-Stomach deficiency-cold; Lizhong Tang and Liujunzi Tang cured him.
Huangqin Tang (Scutellaria Decoction) treats dysentery with headache, chest fullness, dry mouth, alternating chills and fever with hypochondriac pain, and frequent vomiting. The pulse is floating, large, and wiry.
Huangqin (Coptidis Rhizoma) (1 liang 5 qian) Shaoyao (Paeoniae Radix) Gancao (Licorice Root) (stir-fried, each 1 liang).
Take 2-3 qian per dose, decoct with ginger water. Add Banxia (Pinelliae Rhizoma) 2 qian if vomiting occurs.
Yulu San (Jade Dew Powder) treats yellow vomiting and diarrhea.
Hanshuishi (Calcitum) Shigao (Gypsum Fibrosum) (each half liang) Gancao (1 qian).
Powder these. Take half a qian per dose, mixed with boiling water.
Siwei Fei'er Wan (See Vomiting for formula)
Yigong San (See Internal Hook for formula)
Ershen Wan
Sishen Wan (See Fright Diarrhea for formulas)
Bawei Wan (i.e., Liuwei Wan added with Rougui and Wuweizi, see Kidney Disease for formula)
Tiaozhong Wan (i.e., Lizhong Tang, see Cough for formula)
Baizhu San (See Accumulation Pain for formula)
Siling San (i.e., Wuling San minus Guizhi, see Five Stranguries for formula)
Sixini San (See Food Stagnation for formula)
Weiling Tang (See Vomiting and Diarrhea for formula)
Yangwei Tang (See Malaria for formula)
Qingwei San
Sijunzi Tang
Liujunzi Tang (Three formulas see Internal Hook)
Baohe Wan (See Emaciation for formula)
Xianglian Wan (See Various Dysenteries for formula)