小儿呕吐。多因乳食之伤得之。非若大人有寒有热也。然因于寒者亦有之。
呕乳。溢乳。 乳。当分作三证治之。
呕乳者。初生小儿。胃小而脆。容乳不多。为乳母者。量饥而与之。勿令其太饱可也。
胃小而脆。母之乳多而急。子纵饮之则胃不能容。大呕而出。呕有声。而乳多出。如瓶注水
。满而溢也。
溢乳者。小儿初生筋骨弱。左倾右侧。前俯后仰。在人怀抱扶持之也。乳后太饱。儿身
不正。必溢出二三口也。如瓶注水。倾而出也。
乳者。小儿无时乳常流出。口角唇边常见。如瓶之漏。而水渗出也。即哺露。
呕乳者。节之可也。溢乳者。正抱其身可也。皆不必治。 乳者。胃病虚也。宜补之。
理中汤丸。加藿香木瓜主之。
先翁治小儿呕吐。只用胃苓丸研碎。以生姜煨热煎汤调下。即止。
理中汤治呕吐。或有不止者。呕家不喜甘故也。必去甘草加藿香之辛。木瓜之酸。用之
伤冷乳者。所出清冷。面 白者是也。宜益黄散。煨生姜煎汤调服。
伤热乳者。物出热。面赤唇燥者是也。宜六一散。煨生姜煎汤调服。
伤乳食。物出作馊酸气者是也。宜胃苓丸。煨生姜煎汤研碎调服。
本县儒学教官陶。有一子生八月病吐。诸医治之不止。汤丸入口即吐。诸医云。食入即
是有火也。欲作火治。用泻火药又不效。众医不能治。其吐益剧。即请予至议治。予曰。理
中汤。师曰。服此方不得入也。予曰。用法不同。时有生员蔡一山。素与吾不睦。在傍笑云
。不必多言。且看汝法何如也。予曰。汝亦不必多言。明早来问。始见吾之能也。此非试宏
词博学科。何相忌耶。作理中汤剂。用 猪胆汁童便各半。拌之炒焦。以水煎服。药入立止
。次早蔡生来问。师曰。果效。问是何方。曰理中汤。蔡子又问何法。予曰。此在伤寒论中
猪胆人溺白通汤方下。兄归读之。自理会出来。师又问予曰。吾闻蔡子常妒汝。今信之。请
言其法。予曰。吐本寒邪。当用理中汤热药以止之。内寒已甚。格拒其阳。故热药入喉。被
寒所拒。不得入也。今胆汁之苦寒。童便之咸寒。下喉之后。两寒相得。故不复出。须臾之
间。阴气渐消。阳气乃发。此热药须冷服。以主治格拒之寒。以止呕哕者是也。宋理宗呕吐
不止。召医杨吉老治之。问用何方。曰辛热药也。帝曰。服之不效。吉老奏曰。热药冷服。
药成放井中良久。澄冷进服。一啜而吐止。即此法也。师闻而喜之。后以六君子汤作丸调之
王少峰次子。三个月病吐。请医治之。药乳不纳。予见其儿在乳母怀中。以身伸弩。上窜。
呃呃作声。有发惊之意。乃取理中汤丸末子一分。用猪胆汁童便各半匙。调分三服。初一次
少停。略以乳喂一二口即止。又进一次。又乳之。其儿睡一觉。醒则呕止。不伸弩。不呃呃
作声矣。予以是法教诸子止吐。活人甚多。乃良法也。
英山郑孔韶一女。辛丑三月患呕吐。请予往。视其证。乃伤食吐乳也。家人云无。乃用
汤。去甘草加丁香藿香不效。又作胆汁童便法。亦不效。四日后吐出饭半碗。予谓家人曰。
此女数日不食。何以有此完饭也。吾言伤食。汝固曰无。劳吾心力。不得见效。遂取脾积丸
投之。取下恶粪如靛。询之。果五日前外翁王宅归。所吐出之饭。即所食之饭也。壅塞肠胃
。格拒饮食。所以作吐。下之即愈。
予思小儿呕哕不止。多是肝胆二经之病。故仲景猪胆人溺白通。方在厥阴病中。
新制一方。治呕吐不止之病。
吴茱萸 黄连（各等分锉） 上用向东壁土一块。杵碎。用药放在铫中炒焦。入水煎一二
沸。澄清服之。
凡治小儿呕吐。止后不可便与乳。其吐复作。非医之咎也。吐后多渴。禁与汤水。须使
忍一时。渴自止也。若与汤水。转渴转吐不可止也。大人同。
有吐蛔者。胃寒甚也。宜理中丸。用乌梅与椒煎汤。调服神效。
寒水石（ 飞二两） 半夏（泡七次七钱五分） 白枯矾（五钱） 上为末。水糊为丸。麻子
大。姜汤下。此家传十三方也。
因于寒者。食久则吐。其乳不化。宜理中汤加藿香砂仁主之。
因于热者。食入则吐。其乳成片。宜理中汤加黄连竹茹主之。
因于食积者。吐出馊酸气味。恶食。宜养脾消积丸。甚者丁香脾积丸主之。吐止后。胃
苓丸主之。
因于虫者。吐多清水。腹痛多啼。宜理中汤加木香槟榔丸主之。
呕吐药食不得入者。此胃中有寒。阴盛格阳也。宜理中汤入童便猪胆汁主之。
一儿初生即吐。医欲用钱氏木瓜丸。予阻之曰。不可。小儿初生。胃气甚微。初饮乳或
多过饱而吐者。当令乳母缓缓与之。或因浴时客寒犯胃而吐者。当取其乳汁一杯。用姜葱同
煎。少与服之。或因恶露涉水。停在腹中而吐者。宜以炙甘草煎汤而吐去之。如何敢用木瓜
丸。以铁粉槟榔之剂。重犯其胃中初生中和之气耶。故常语人曰。钱氏小儿方。非先生亲笔
。乃门人附会说也。
一儿自盈月后常吐乳。父母忧之。诸医不能止。一日问予。予曰。呕吐者。非常有之病
今常吐乳。非病也。然孩儿赖乳以生。频吐乳者。非所宜也。恐伤气。不可不求其故。有母
气壮乳多者。唯恐儿饥。纵儿饱足。饱则伤胃。所食之乳涌而出。此名呕乳。如瓶之注水。
满而溢也。宜损节之。更服肥儿丸。儿之初生。筋骨软弱。为乳母者。常怀抱护持可也。不
然则左右倾侧。其乳流出。此名溢乳。如瓶之侧。其水流出也。能紧护持。则不吐也。有胃
弱者。不能受乳而变化之。无时吐出。所吐不多。此名哺露。如瓶之漏。不能容受也。当
补其脾胃。助其变化可也。亦以肥儿丸主治。
小儿呕吐，多因乳食损伤所致。这与大人有寒证、热证不同。然而，因寒邪引起的呕吐也是存在的。
所谓“呕乳”，是指初生婴儿，因为胃体小且脆弱，容纳乳汁的能力有限。做母亲的人，应根据婴儿的饥饿程度给予哺乳，不要让它吃得太饱即可。
如果婴儿胃小而脆，母亲的乳汁又多又急，即使婴儿拼命喝，胃也无法容纳，就会大口呕吐出来。呕吐时发出声音，乳汁大量涌出，就像往瓶子里倒水，满了就会溢出来一样。
所谓“溢乳”，是指初生婴儿筋骨柔弱，身体容易向左倾斜、向右歪倒，向前俯身或向后仰躺，需要人在怀抱中扶持。如果在喂奶后吃得过饱，加上婴儿身体姿态不正，必然会出现吐出两三口乳汁的情况。这就像往瓶子里倒水，瓶子倾斜了水就会流出来。
所谓“哺露”（即文中简写的“乳者”），是指婴儿不分时候，乳汁经常流出，在口角唇边常见。这就像瓶子漏水，水慢慢渗出一样。也就是“哺露”。
对于“呕乳”，只要节制喂养就可以了；对于“溢乳”，只要端正抱持婴儿的身体就可以了。这两种情况都不必专门用药治疗。“哺露”则是由于胃气虚弱所致，适宜采用补益的方法。可以用理中汤丸，加入藿香和木瓜为主进行治疗。
先父曾治疗小儿呕吐，只用胃苓丸研碎，用生姜煨热后煎汤调服，呕吐立刻停止。
理中汤治疗呕吐，有时效果不佳，是因为呕吐患者不喜欢甘味药物。必须去掉甘草，加入藿香的辛味和木瓜的酸味。如果是食用了受冷的乳汁，吐出的东西清冷，面色苍白，这就是此类情况，适宜用益黄散，用煨生姜煎汤调服。
如果是食用了受热的乳汁，吐出的东西感觉热，面色红赤、嘴唇干燥，这就是此类情况，适宜用六一散，用煨生姜煎汤调服。
如果是伤于乳食，吐出的东西带有馊酸气味，这就是此类情况，适宜用胃苓丸，用煨生姜煎汤研碎调服。
本县儒学教官陶某，有一个八个月大的儿子患呕吐病，多位医生治疗无效，汤药和丸药入口即吐。众医生说：“食物进去就吐，说明体内有火。”想要按火证治疗，使用泻火药却又不见效。众医束手无策，他的呕吐反而更加剧烈。于是请我前去商议治疗方案。我说：“应该用理中汤。”老师（指其父万全）说：“服用这个方子肯定进不去。”我说：“用法不同。”当时有一位生员蔡一山，平时与我关系不和，在旁边笑着说：“不必多言，且看你的方法如何。”我说：“你也不必多言，明天早上再来问，才能见识到我的本事。这又不是考宏词博学制的考试，何必如此嫉妒呢？”于是我制作理中汤剂，用猪胆汁和童便各一半，拌入药中炒焦，用水煎服。药液入口，呕吐立刻停止。第二天早上蔡生来询问，老师说：“果然有效。”问是什么方子？我说：“是理中汤。”蔡生又问是什么方法？我说：“这在《伤寒论》中猪胆人溺白通汤方的注解里有记载，你回去读一下，自然能明白。”老师又问我：“我听说蔡生常嫉妒你，现在我相信了。请说说其中的道理。”我说：“呕吐本是寒邪所致，应当用理中汤这样的热药来止住它。但体内寒气极盛，格拒阳气，所以热药进入喉咙，被寒气拒绝，无法进入体内。现在利用胆汁的苦寒和童便的咸寒，药液下喉之后，两种寒性相合，所以不再吐出。片刻之间，阴寒之气逐渐消退，阳气得以发散。这就是‘热药冷服’的方法，用来主治格拒之寒，从而止住呕吐呃逆。宋理宗呕吐不止，召见医生杨吉老诊治。问用什么方子？杨吉老说是辛热药。皇帝说：‘服用无效。’杨吉老奏道：‘将热药冷服。药煮好后放入井中很久，澄清变冷后再进服。’结果一口喝完，呕吐就停止了。就是这种方法。”老师听后很高兴。后来用六君子汤制成丸药进行调理。
王少峰的次子，三个月大时患呕吐病，请医生治疗，吃药和吃奶都接受不了。我看见那婴儿在乳母怀中，身体伸展僵硬，向上窜动，发出呃呃的声音，有惊风发作的迹象。于是取理中汤丸末一分，用猪胆汁和童便各半匙，调和分成三次服用。第一次喂完后稍停片刻，稍微喂一两口乳汁，呕吐就停止了。再喂第二次，又喂了乳汁。婴儿睡了一觉，醒来后呕吐停止，不再身体伸展僵硬，也不发出呃呃声了。我用这个方法教导我的学生们来止住呕吐，救活了很多孩子，这确实是良法。
英山郑孔韶的女儿，在辛丑年三月患呕吐病，请我去诊治。观察她的症状，是伤食导致的吐乳。家人却说没有伤食。于是我用汤药，去掉甘草，加入丁香、藿香，但无效。又用了猪胆汁和童便的方法，也无效。四天后，她吐出了半碗饭。我对家人说：“这个女儿几天没吃东西，怎么会有完整的饭吐出来呢？我说的是伤食，你们坚持说没有，劳费我的心力，才没能见效。”于是给她服用脾积丸，排下了像靛蓝颜色一样的恶臭粪便。询问后得知，果然五天前从外公王家回来，所吐出的饭，就是当时吃的饭。食物壅塞肠胃，格拒饮食，所以导致呕吐。通便后就好了。
我思考小儿呕吐呃逆不止，大多是肝胆二经的病变。所以张仲景的猪胆人溺白通汤，方剂列在厥阴病篇中。
新创制一方，治疗呕吐不止的病。
吴茱萸、黄连（各等分锉碎）。取东面墙壁上的一块土，捣碎，将药放在铫中炒焦，加水煎煮一二沸，澄清后服用。
凡是治疗小儿呕吐，止吐后不可立即给乳，否则呕吐会复发，这不是医生的过错。呕吐后大多口渴，禁止给汤水，必须让患儿忍耐一时，口渴自然会停止。如果给汤水，越喝越渴，越渴越吐，就无法停止了。大人也是如此。
有吐出蛔虫的，是胃寒严重所致，适宜用理中丸，用乌梅和花椒煎汤调服，效果神妙。
寒水石（飞研二两）、半夏（泡七次七钱五分）、白枯矾（五钱）。以上药物研为细末，用水糊做成丸药，如麻子大小，用姜汤送服。这是家传的十三方之一。
因于寒邪的，进食很久后才吐，乳汁不消化，适宜用理中汤加藿香、砂仁为主治疗。
因于热邪的，食物刚吃下去就吐，乳汁成片吐出，适宜用理中汤加黄连、竹茹为主治疗。
因于食积的，吐出馊酸气味，厌恶进食，适宜用养脾消积丸，严重的用丁香脾积丸为主治疗。呕吐停止后，用胃苓丸为主调理。
因于虫积的，呕吐多清水，腹痛且多啼哭，适宜用理中汤加木香槟榔丸为主治疗。
呕吐剧烈，药食不能进入体内的，这是胃中有寒，阴盛格阳所致，适宜用理中汤加入童便、猪胆汁为主治疗。
一个婴儿刚出生就呕吐，医生想用钱乙的木瓜丸。我阻止说：“不行。小儿初生，胃气非常微弱。初饮乳汁或因过多过饱而呕吐的，应当让乳母缓缓给予。或者因为洗澡时客寒侵犯胃部而呕吐的，应当取乳汁一杯，用姜葱同煎，少量给患儿服用。或者因为恶露涉水，停在腹中而呕吐的，适宜用炙甘草煎汤来去除呕吐。怎么敢用木瓜丸这种含有铁粉、槟榔的药剂，再次重伤其初生时中和的胃气呢？”所以我常对人说：“钱氏的小儿方剂，如果不是先生亲笔所写，乃是门人附会之说。”
一个婴儿满月后经常吐乳，父母为此担忧，各位医生都不能止住。有一天来问我。我说：“呕吐是偶尔发生的疾病。现在经常吐乳，并不是病。然而孩子依靠乳汁生存，频繁吐乳是不适宜的，恐怕会伤气，不可不探究其原因。有的母亲体质壮实，乳汁过多，唯恐孩子饥饿，任凭孩子吃饱。吃饱则伤胃，所食的乳汁涌出而出，这叫‘呕乳’，就像往瓶子里倒水，满了就溢出来。应当节制喂养，并服用肥儿丸。婴儿初生，筋骨软弱，做母亲的应当经常怀抱护持。如果不这样，导致身体左右倾斜，乳汁流出，这叫‘溢乳’，就像瓶子侧放，水流出来一样。如果能紧紧护持，就不会吐了。有的胃气虚弱，不能承受乳汁并进行运化，不时吐出，吐出的量不多，这叫‘哺露’，就像瓶子漏水，不能容纳。应当补益脾胃，帮助其运化，也可以用肥儿丸主治。”
Infantile vomiting is mostly caused by injury from milk and food. This differs from adults who may have cold or heat syndromes. However, vomiting due to cold pathogens does exist.
Vomiting of milk (Ou Ru), spilling of milk (Yi Ru), and leakage of milk (Bu Lu) should be treated as three distinct syndromes.
"Vomiting of milk" refers to newborn infants whose stomachs are small and fragile, with limited capacity for milk. Mothers should feed according to the infant's hunger and avoid overfeeding.
If the infant's stomach is small and fragile, but the mother's milk flow is abundant and rapid, even if the infant drinks greedily, the stomach cannot accommodate it, leading to forceful vomiting accompanied by sound and large amounts of milk ejection. This is like pouring water into a bottle until it overflows.
"Spilling of milk" refers to newborns with weak bones and tendons, prone to tilting left or right, bending forward or backward, requiring support in the arms. If fed too full and held improperly, two or three mouthfuls of milk will spill out. This is like water spilling from a tilted bottle.
"Leakage of milk" (also called Bu Lu) refers to milk constantly flowing from the corners of the mouth without specific timing, resembling water leaking from a cracked bottle.
For "vomiting of milk," dietary regulation suffices; for "spilling of milk," proper holding posture suffices. Neither requires specific medication. "Leakage of milk" results from deficiency of Stomach Qi and should be tonified. Lizhong Tang Wan (Cinnamon Twig Decoction Pill) added with Huoxiang (Agastache Herba) and Mugua (Chaenomeles Fructus) is indicated.
My late father treated infantile vomiting using only Weiling Wan (Atractylodes Macrocephala and Poria Pill) crushed and mixed with decoction of roasted fresh ginger, which stopped the vomiting immediately.
Lizhong Tang treats vomiting, but sometimes fails because patients who vomit dislike sweet flavors. One must remove Gancao (Licorice Root) and add the pungency of Huoxiang and the sourness of Mugua. For cases caused by consuming cold milk, characterized by clear/cold vomitus and pale complexion, Yihuang San (Yellow Benefiting Powder) taken with roasted ginger decoction is appropriate.
For cases caused by consuming hot milk, characterized by warm vomitus, red face, and dry lips, Liuyi San (Six-to-One Powder) taken with roasted ginger decoction is appropriate.
For cases caused by food stagnation, characterized by sour/fermented odor of vomitus, Weiling Wan taken with roasted ginger decoction is appropriate.
The son of Tao, an instructor at the county Confucian school, aged eight months, suffered from persistent vomiting unresponsive to various treatments. Physicians diagnosed internal fire and prescribed cooling herbs without effect. I suggested Lizhong Tang. My father doubted its efficacy due to potential rejection by cold pathogens. I prepared Lizhong Tang decoction, mixing it with pig bile and child's urine (tongbian), stir-frying until scorched, then decocting with water. The vomiting ceased immediately upon administration. When asked about the method, I explained it follows the principle of "Baitong Tang with Pig Bile and Child's Urine" from the *Shanghan Lun* (Treatise on Cold Damage). The bitter-cold bile and salty-cold urine allow the hot medicine to enter without being rejected by the severe internal cold. Once inside, the cold dissipates, and Yang energy recovers. This technique of taking hot medicine cold is also recorded in the treatment of Emperor Lizong by physician Yang Jilao. Subsequently, Liu Junzi Tang (Six Gentlemen Decoction) pills were used for maintenance.
Wang Shaofeng's second son, three months old, presented with vomiting, refusal of medicine and milk, body stiffness, upward gaze, and hiccuping sounds, suggesting impending convulsions. I administered Lizhong Tang Wan powder mixed with pig bile and child's urine, divided into three doses. After the first dose and a small amount of milk, vomiting stopped. After sleep, symptoms resolved completely. This method has saved many children.
Zheng Kongsao's daughter from Yingshan, suffering from vomiting in the third month of Xin Chou year, was diagnosed with food stagnation vomiting milk by family members who denied it. Initial treatments with modified decoctions and the bile/urine method failed. Four days later, she vomited half a bowl of intact rice. I identified this as food stagnation causing obstruction and rejection. Pi Ji Wan (Spleen Accumulation Pill) was administered, resulting in the passage of dark, foul stools. The vomiting ceased after purging the stagnation.
I reflect that persistent infantile vomiting often involves the Liver and Gallbladder meridians, hence Zhang Zhongjing's placement of the Pig Bile and Child's Urine formula in the Jueyin disease chapter.
A new prescription for intractable vomiting:
Wuzhuyu (Evodiae Fructus) and Huanglian (Coptidis Rhizoma) in equal parts, crushed. Stir-fry with soil from the east wall of a house until scorched, then decoct in water, filter, and drink.
After stopping vomiting in infants, do not immediately resume feeding milk, or vomiting may recur. Thirst after vomiting should be managed by withholding fluids temporarily; forcing fluids exacerbates thirst and vomiting. This applies to adults as well.
For vomiting of roundworms, indicating severe Stomach cold, Lizhong Wan taken with decoction of Wumei (Mume Fructus) and Huajiao (Zanthoxypi Pericarpium) is highly effective.
Family Prescription No. 13:
Hanshuishi (Calcitum), Banxia (Pinelliae Rhizoma, processed seven times), Baikufan (Alumen). Grind into powder, make pills with water paste, size of hemp seeds. Take with ginger decoction.
For vomiting due to cold: delayed vomiting, undigested milk. Use Lizhong Tang added with Huoxiang and Sharen (Amomi Fructus).
For vomiting due to heat: immediate vomiting, milk curdled in chunks. Use Lizhong Tang added with Huanglian and Zhuru (Bambusae Caulis in Taenia).
For vomiting due to food stagnation: sour/fermented odor, aversion to food. Use Yangpi Xiaoji Wan (Spleen-Nourishing and Accumulation-Resolving Pill); severe cases use Dingxiang Pi Ji Wan. Follow up with Weiling Wan after vomiting stops.
For vomiting due to parasites: copious clear fluid vomiting, abdominal pain, excessive crying. Use Lizhong Tang added with Muxiang Binglang Wan (Costus and Areca Nut Pill).
For vomiting where medicine and food cannot enter, indicating Stomach cold with Yin excess repelling Yang: Use Lizhong Tang added with child's urine and pig bile.
A newborn presenting with immediate vomiting: Physician Qian Yi's Mugua Wan was considered but rejected. Newborns have delicate Stomach Qi. Vomiting due to overfeeding requires slow feeding. Vomiting due to external cold during bathing can be treated with milk boiled with ginger and scallion. Vomiting due to lochia retention can be treated with roasted Licorice decoction. Using heavy/mineral drugs like Mugua Wan would damage the infant's delicate balance. Note: Some attributed formulas of Qian Yi may be apocryphal additions by disciples.
An infant past one month of age frequently spitting up milk: Parents worried, physicians failed. I explained that frequent spitting is not necessarily pathological but indicates underlying issues affecting Qi. Causes include: 1. Maternal hyperlactation leading to overfeeding ("Vomiting Milk"); regulate diet and use Fei'er Wan. 2. Improper handling leading to posture-related spilling ("Spilling Milk"); ensure secure holding. 3. Weak Stomach failing to transform milk ("Leakage Milk"); tonify Spleen and Stomach, use Fei'er Wan.