吐出上焦。泻出下焦。乃肠胃之病也。脾在中焦。管摄乎上下之间。吐泻互作者。
乃脾之病也。
夫人身之中。足阳明胃脉之气。自上而下。足太阴脾脉之气。自下而上。上下循环。阴
接。谓之顺而无病也。故胃气逆而为上。则为呕吐。脾气逆而为下。则为泄泻。吐泻之病。
脾胃为之总司也。
发挥云。胃在上焦主内而不出。呕吐则不纳矣。肠在下焦。主出而不入。有积泄泻。出
积矣。观李知先活人书括云。胃家有热难留食。胃冷无缘纳水浆。则吐泻之出于上焦也明矣
。又张长沙伤寒论云。下利服理中不止。理中者。理中焦也。治泄不利小便。非其治也。五
苓散主之。不止者在下焦。赤石脂禹余粮汤主之。则泄泻出于下焦也明矣。
赤石脂（一斤） 禹余粮（一斤） 上水六升。煮取二升。去渣。分三服。
又按治泄利者。有四法焉。有用理中汤。以治其中气者。有用五苓散。以利其小便者。
真武汤。以温其肾者。有用赤石脂禹余粮。以固涩其大肠者。不可不知其要也。盖肾开窍于
二阴。主蛰藏者也。如门户然。泄泻不止。门户不固也。故用姜附以温之。闭其门户也。肠
胃者。容受水谷之气。犹仓廪然。脾司出纳。乃仓廪之官也。吐泻不止。乃仓廪之不藏。官
之失其职也。故用参术以补之。封其仓廪也。下焦者。水谷注下之路。如沟渎然。小便不利
者。沟渎之不能别也。故用猪苓泽泻以利之。疏通其水渎也。大
故用赤石脂禹余粮以涩之。塞其决也。
真武汤
茯苓 芍药 生姜（各一两） 附子（一枚炮破八片） 白术（二两） 上用水八升。煮取三
升。温服七合。日三。
祖训治吐泻者。只用胃苓丸。吐以煨生姜汤。泄以一粒丹和之。炒米汤下。
一粒丹（亦名白玉丹） 此家传十三方也。
寒水石（ 二两） 白矾（枯一两） 上为末。水糊丸。小豆大。每一丸米汤下。
钱氏曰。脾主困。谓疲惫也。非嗜卧也。吐泻久则生风。饮食伤则成疳。易至疲惫也
。此与肾主虚同。
论肾者。元气之主。肾虚则为禀赋不足之病。脾者谷气之主。脾虚则为津液不足之病。
故小儿五脏之病。脾肾最多。肝心次之。肺又次之。
小儿吐泻。多因伤乳食得之。
如吐泻时不啼哭。不喜饮食。此伤乳食也。初得之不可遽止。宿食未尽去也。宜换乳食
。勿令重伤。吐泻益甚。非医之咎也。益黄散主之。
有热者胃苓丸。用东向陈壁土。和生姜少许炒焦。入水煎汤。澄清吞下。泻不止。以胃
苓丸一粒丹合而服之。煎汤下效。
如吐泻时不恶风寒。喜人怀抱。此伤风吐泻也。宜发散。惺惺散。
如吐泻时啼哭。其身俯仰不安者。必腹中有痛。此藿乱也。内伤乳食。外感风寒得之。
先治其里。宜理中汤加藿香。后治其表。桂枝汤。表里通治。藿香正气散。
一儿周岁。吐泻并作。时天大寒。医用理中胃苓丸。服之不效。予曰。此表里有寒邪。
未得发散也。取益黄散与之。其夜得大汗而止。
一女岁半。与前儿同症。吐泻。此伤食也。前有外感风邪。故用益黄散。温其表里之寒
。此只是伤食。用胃苓丸一粒丹陈壁土汤下。调其脾胃。消其食积。而吐泻俱止。
一儿暴吐泻。上下所出皆乳不化。用理中丸服之效。
一儿暴吐泻。上下所出皆黄水。中有乳片不化者。用二陈汤。加黄连姜汁炒煎服效。
或问。二病同。而治之异者。何也。曰。所出之乳不化者。胃有寒也。故以理中丸急温
之。所出乳片不化者。胃有热邪。热不杀谷。宜半夏黄连以解之。此同病异治法也。
呕吐的病位在上焦。腹泻的病位在下焦。这属于肠胃的疾病。脾脏位于中焦，统摄调节上下之间。呕吐与腹泻同时发作的，是脾脏的疾病。
人体之中，足阳明胃经的气机自上而下运行，足太阴脾经的气机自下而上运行。上下循环，阴阳相接，称为顺，则没有疾病。所以胃气上逆导致向上呕吐，脾气下陷导致向下泄泻。呕吐和腹泻这两种病，脾胃是总的掌管者。
《幼科发挥》说：胃在上焦，主要功能是受纳食物而不外泄，发生呕吐就不能受纳了。肠在下焦，主要功能是排泄而不摄入，如果有积滞导致的泄泻，就是排出积滞。看李知先《活人书括》说：“胃中有热难以留住食物，胃寒冷无缘接受水浆”，那么呕吐和腹泻出于上焦就很明白了。又张仲景《伤寒论》说：“下利（腹泻）服用理中汤不止，理中汤是调理中焦的，治疗泄泻如果不通利小便，不是正确的治法，用五苓散主治。如果服后仍不止，是因为病在下焦，用赤石脂禹余粮汤主治。”那么泄泻出于下焦就很明白了。
赤石脂（一斤） 禹余粮（一斤） 以上药材加水六升，煮取二升药液，去渣，分三次服用。
另外按：治疗泄利的，有四法。有用理中汤来治疗中气虚寒的，有用五苓散来通利小便的，有用真武汤来温补肾阳的，有用赤石脂禹余粮汤来固涩大肠的。不可不知道这些要点。肾开窍于前后二阴，主蛰藏封固，就像门户一样。泄泻不止，是门户不坚固。所以用干姜、附子来温补，封闭其门户。肠胃容纳接受水谷之气，就像仓库一样。脾主管出纳，是仓库的官员。吐泻不止，是仓库不能储藏，官员失职。所以用人参、白术来补益，封闭其仓库。下焦是水谷注下的通道，像沟渠一样。小便不利，是沟渠不能分别清浊。所以用猪苓、泽泻来通利，疏通其水道。大便滑脱不禁，所以用赤石脂、禹余粮来涩止，堵塞其决口。
真武汤
茯苓 芍药 生姜（各一两） 附子（一枚，炮制后破成八片） 白术（二两） 以上用水八升，煮取三升，温服七合，每日三次。
祖先的训诫治疗吐泻，只用胃苓丸。呕吐时用煨生姜汤送服，腹泻时用一粒丹配合，炒米汤送下。
一粒丹（又名白玉丹） 这是家传的十三方之一。
寒水石（二两） 白矾（枯矾一两） 以上研为细末，用水糊制作丸剂，如小豆大小。每一丸用米汤送下。
钱乙说：脾主困，指的是疲惫无力，不是嗜睡。吐泻久了会生风，饮食损伤则形成疳积，容易变得疲惫。这与肾主虚是一样的道理。
论述肾脏，它是元气的根本。肾虚则是先天禀赋不足的病。脾是谷气的根本。脾虚则是津液不足的病。所以小儿五脏的疾病，脾肾最多，肝心次之，肺又次之。
小儿吐泻，多因伤食乳食而得。
如果在吐泻时不啼哭，不喜欢饮食，这是伤乳食。初得病时不可立即止住，因为宿食未尽去除。应该更换乳食，不要让它再次重伤。吐泻更加严重，不是医生的过错。宜用益黄散主治。
有热象的，用胃苓丸。用向东生长的老墙土，加少许生姜炒焦，入水煎汤，澄清后吞服药丸。腹泻不止，将胃苓丸和一粒丹合在一起服用，煎汤送下有效。
如果在吐泻时不怕风寒，喜欢被人抱着，这是伤风引起的吐泻。宜发散表邪，用惺惺散。
如果在吐泻时啼哭，身体俯仰不安，必定腹中有疼痛，这是霍乱。内伤乳食，外感风寒所致。先治其里证，宜用理中汤加藿香。后治其表证，用桂枝汤。表里同治，用藿香正气散。
一个患儿周岁，吐泻并作，当时天气大寒。医生用理中丸和胃苓丸，服用无效。我说：这是表里有寒邪，没有得到发散。给予益黄散。当夜出大汗而病止。
一个女孩一岁半，与前儿症状相同，吐泻。这是伤食。之前有外感风邪，所以用益黄散，温散表里之寒。这个只是伤食，用胃苓丸和一粒丹，陈壁土汤送下，调理脾胃，消除食积，吐泻都停止了。
一个患儿突发吐泻，上下排出的都是未消化的乳汁。用理中丸服用有效。
一个患儿突发吐泻，上下排出的都是黄水，其中有未消化的乳片。用二陈汤，加黄连用姜汁炒后煎服有效。
有人问：两种病相同，而治疗方法不同，为什么呢？回答说：排出的是未消化的乳汁，是胃有寒邪。所以用理中丸紧急温中。排出的是未消化的乳片混在黄水中，是胃有热邪，热邪不能腐熟水谷。宜用半夏、黄连来解之。这是同病异治的方法。
Vomiting originates in the Upper Jiao (Upper Burner). Diarrhea originates in the Lower Jiao (Lower Burner). These are diseases of the intestines and stomach. The Spleen is located in the Middle Jiao (Middle Burner) and regulates the upper and lower sections. When vomiting and diarrhea occur simultaneously, it is a disease of the Spleen.
In the human body, the Qi of the Foot-Yangming Stomach Meridian flows from top to bottom, while the Qi of the Foot-Taiyin Spleen Meridian flows from bottom to top. Their continuous circulation and connection of Yin and Yang constitute "Shun" (Smoothness/Compliance), resulting in health without disease. Therefore, when Stomach Qi rebels upward, it causes vomiting; when Spleen Qi sinks downward, it causes diarrhea. The Stomach and Spleen are the primary controllers of vomiting and diarrhea.
*Youke Fahui* states: The Stomach, located in the Upper Jiao, is responsible for receiving food but not expelling it; vomiting implies an inability to receive. The Intestines, located in the Lower Jiao, are responsible for excretion but not reception; diarrhea with accumulation involves the expulsion of accumulated matter. Observing Li Zhixian's *Huoren Shuokuo*, which says, "Heat in the Stomach makes it difficult to retain food; Cold in the Stomach makes it impossible to accept water or gruel," it is clear that vomiting and diarrhea originate from the Upper Jiao. Furthermore, Zhang Zhongjing's *Shanghan Lun* states: "For dysentery/diarrhea, if Lizhong Tang does not stop it... Lizhong Tang regulates the Middle Jiao. Treating diarrhea without promoting urination is incorrect; Wuling San should be used. If it still does not stop, the pathology is in the Lower Jiao, and Chishizhi Yuyuliang Tang should be used." Thus, it is clear that diarrhea can originate from the Lower Jiao.
Chishizhi (Red Halloysite, 1 jin) Yuyuliang (Yucheng Stone, 1 jin). Add six sheng of water, boil to obtain two sheng of decoction, remove dregs, and divide into three doses.
Furthermore, regarding the treatment of diarrhea/dysentery, there are four methods: using Lizhong Tang to treat Middle Qi deficiency/cold; using Wuling San to promote urination; using Zhenwu Tang to warm the Kidney; and using Chishizhi Yuyuliang Tang to astringe the Large Intestine. One must understand these key points. The Kidney opens into the two yin orifices (anterior and posterior) and governs storage and consolidation, acting like a gate. Persistent diarrhea indicates an unsecured gate. Therefore, Ginger (Jiang) and Aconite (Fu Zi) are used to warm and close the gate. The intestines and stomach hold and receive the Qi of water and grain, like granaries. The Spleen manages entry and exit, serving as the official of the granary. Persistent vomiting and diarrhea indicate the granary cannot store and the official has failed duties. Therefore, Ginseng (Renshen) and Atractylodes (Baizhu) are used to tonify and secure the granary. The Lower Jiao is the pathway for water and grain to descend, like ditches. Difficulty in urination indicates the ditches fail to separate clear from turbid. Therefore, Polyporus (Zuling) and Alisma (Zexie) are used to promote urination and dredge the waterways. Fecal incontinence requires astringency; therefore, Chishizhi and Yuyuliang are used to stop leakage and plug the breaches.
Zhenwu Tang
Fuling (Poria) Shaoyao (White Peony Root) Shengjiang (Fresh Ginger) (each 1 liang) Fuzi (Prepared Aconite Root, 1 piece, processed and broken into 8 slices) Baizhu (Atractylodes Macrocephala Rhizome, 2 liang). Add eight sheng of water, boil to obtain three sheng, take seven he warm, three times daily.
Ancestral instructions for treating vomiting and diarrhea prescribe only Weiling Wan. For vomiting, administer with roasted ginger soup; for diarrhea, combine with Yili Dan and take with fried rice soup.
Yili Dan (Also known as Baiyu Dan). This is one of the thirteen family-prescribed formulas.
Hanshuishi (Calcitum, 2 liang) Baifan (Alumen, dried/ku, 1 liang). Grind into powder, make pills with water paste, size of small beans. Take one pill with rice soup.
Qian Yi stated: The Spleen governs "Kun" (Lethargy/Stagnation), referring to physical exhaustion, not drowsiness. Prolonged vomiting and diarrhea may generate wind; dietary injury may lead to Gan syndrome (malnutrition), leading to exhaustion. This is similar to the Kidney governing deficiency.
Regarding the Kidney, it is the master of Yuan Qi (Original Qi). Kidney deficiency results in diseases of congenital insufficiency. The Spleen is the master of Grain Qi. Spleen deficiency results in diseases of insufficient Jin Ye (Body Fluids). Therefore, among pediatric five-zang diseases, Spleen and Kidney disorders are most common, followed by Liver and Heart, and then Lung.
Pediatric vomiting and diarrhea are mostly caused by damage from milk and food.
If during vomiting and diarrhea the child does not cry and dislikes eating, this is damage from milk and food. In the initial stage, do not abruptly stop the symptoms, as undigested food remains. Change the diet/milk to prevent further injury. If vomiting and diarrhea worsen, it is not the physician's fault. Use Yihuang San as the main treatment.
For cases with Heat signs, use Weiling Wan. Use old wall soil facing east, stir-fry with a little fresh ginger until scorched, decoct in water, clarify, and swallow the pill with the liquid. For persistent diarrhea, combine Weiling Wan and Yili Dan and take with decoction; this is effective.
If during vomiting and diarrhea the child fears neither wind nor cold and likes being held, this is wind-damage causing vomiting and diarrhea. Use dispersing methods, such as Xingxing San.
If during vomiting and diarrhea the child cries and tosses restlessly, indicating abdominal pain, this is Huoluan (Cholera-like disorder). Caused by internal damage from milk/food and external contraction of wind-cold. First treat the interior with Lizhong Tang plus Huoxiang. Then treat the exterior with Guizhi Tang. For simultaneous exterior-interior treatment, use Huoxiang Zhengqi San.
Case 1: A one-year-old child presented with simultaneous vomiting and diarrhea during severe cold weather. The physician used Lizhong Wan and Weiling Wan with no effect. I said: "There is cold pathogen in both the exterior and interior that has not been dispersed." I administered Yihuang San. The child sweated profusely that night, and the condition ceased.
Case 2: A one-and-a-half-year-old girl presented with the same symptoms as the previous case: vomiting and diarrhea. This was due to food damage. Previously, there was an external wind pathogen, so Yihuang San was used to warm and disperse the exterior-interior cold. This case involved only food damage. Weiling Wan and Yili Dan were administered with Chenbitu (Old Wall Soil) soup to regulate the Spleen and Stomach and eliminate food stagnation, stopping both vomiting and diarrhea.
Case 3: A child had sudden vomiting and diarrhea, expelling undigested milk both upwards and downwards. Lizhong Wan was effective.
Case 4: A child had sudden vomiting and diarrhea, expelling yellow fluid containing undigested milk flakes. Erchen Tang added with Huanglian (Coptis Rhizome) stir-fried with Jiangzhi (Ginger Juice) was effective.
Question: Why are the treatments different for these two similar conditions? Answer: When expelled milk is undigested, it indicates Cold in the Stomach. Therefore, Lizhong Wan is used to urgently warm the interior. When expelled milk appears as flakes mixed with yellow fluid, it indicates Heat pathogen in the Stomach; heat fails to "kill" (digest/cook) the grain. Banxia (Pinellia Tuber) and Huanglian should be used to resolve it. This is the method of treating the same disease with different therapies.