总括 小儿吐泻有多般，不可将来一例看；若见神昏目慢候，慢脾惊搐要提防。
脉法 洪者为热，弦者为痛。微弱渐迟者死，渐大者生。若有宿食留饮，气口脉必弦滑。
《内经》曰∶脾虚则泻，胃虚则吐。又曰∶食滞于胃口者为吐，食滞于大小肠者为泻。又曰∶诸呕吐酸，暴注下迫，
皆属于热。
钱仲阳曰∶吐乳泻黄，伤热乳也∶吐乳泻青，伤冷乳也，皆当下之。则知虚实寒热皆能成吐泻之症。又有伤风吐泻，
身温、乍凉乍热、多睡气粗，大便黄白色，呕吐乳食不消，更兼咳嗽。先服大青膏发散，后用益黄散和胃。若吐泻身热
多睡，能乳吐痰，饮水不止，大便黄水，此胃虚之症，先用白术散生津止渴，后用大青膏发散风邪。
钱仲阳曰∶小儿初生三日内吐泻，身热不思乳食，大便青白，乳食不消或白色，是伤乳，当下之，然后和胃。夏至
后吐泻身热，或伤热，或伤乳，吐乳不消，泻深黄色，宜香薷散之类。小儿伤食及湿热作吐泻者，须以胃苓汤进，反
觉平安。
凡遇小儿吐泻，惟恐脾虚生风之患。《心鉴》云∶儿分长幼，察病虚实。有吐泻三五日发风者，有一日半日而发
者，大抵女孩以吐为急，男子以泻为迫。若气虚暴泻暴吐，才作便得之。惟有疳泻不成，风候久则终于虚乏不治矣。但
泻宜实脾为主，吐以生胃为本，截风之药略加用之。凡惊药及寒凉之药初不可用。大热药慎勿妄投。
钱氏不分寒热吐泻，而曰皆当下，恐未妥当，不若伤热者用五苓散以导其逆，伤冷者用理中汤以温其中，自然平复。
〔附方〕
胃苓汤 苍术 白术 猪苓 泽泻 浓朴 陈皮 茯苓 甘草 加桂少许
大青膏 见惊风症内。
益黄散 见疳积症内。
五苓散 去肉桂，用甘草。
理中汤 俱见惊风症内。
总括：小儿的呕吐和腹泻有多种类型，不能一概而论地看待；如果见到精神昏沉、眼睛迟缓的症状，要提防慢脾惊风抽搐的发生。
脉法：脉象洪大属于热证，脉象弦紧属于痛证。脉象微弱且逐渐变迟的预后不良（主死），脉象逐渐增大的预后良好（主生）。如果有宿食停滞或留饮，气口脉（寸口脉中候脾胃的部分）必然呈现弦滑之象。
《黄帝内经》说：脾虚就会引起腹泻，胃虚就会引起呕吐。又说：食物停滞在胃口部位的是呕吐，食物停滞在大肠和小肠部位的是腹泻。又说：各种呕吐酸水，突然发生的急剧泄泻伴有肛门紧迫感的症状，都属于热证。
钱仲阳说：吐奶且大便呈黄色，是伤于热乳；吐奶且大便呈青色，是伤于冷乳，这两种情况都应该用攻下法治疗。由此可知，虚证、实证、寒证、热证都能导致呕吐和腹泻的症状。又有因伤风引起的呕吐和腹泻，表现为身体温热、忽冷忽热、嗜睡、呼吸粗重，大便呈黄白色，呕吐未消化的乳食，并兼有咳嗽。先服用大青膏以发散表邪，后服用益黄散以调和胃气。如果呕吐腹泻且身体发热、嗜睡，能喝奶但吐出痰涎，饮水不止，大便呈黄水状，这是胃虚的症状，先用白术散生津止渴，后用大青膏发散风邪。
钱仲阳说：小儿出生三日内出现呕吐和腹泻，身体发热、不思饮食，大便呈青白色，乳食不消化或呈白色，这是伤乳，应当用攻下法治疗，然后调和胃气。夏至后出现的呕吐和腹泻伴身体发热，或是伤热，或是伤乳，吐出的奶不消化，泻下的粪便呈深黄色，适宜使用香薷散之类的方剂。小儿因伤食以及湿热引起的呕吐和腹泻，必须服用胃苓汤，反而会觉得平安舒适。
凡是遇到小儿呕吐和腹泻，唯独担心脾虚生风的祸患。《心鉴》说：儿童分年龄大小，需察看病证的虚实。有的呕吐腹泻三五日后发生惊风，有的一日半日就发生，大体上女孩以呕吐为急症，男孩以腹泻为迫症。如果是气虚导致的暴发性腹泻和呕吐，刚发病就能察觉。只有疳积引起的腹泻难以治愈，若惊风症状持续，最终会因极度虚弱而无法救治。但是，腹泻应以健脾为主，呕吐以养胃为本，略加使用一些截断风邪的药物。凡是镇惊药及寒凉性质的药物，起初不可使用。大热性质的药物也切勿随意投用。
钱氏（钱乙）不分寒热类型的呕吐和腹泻，都说应该用攻下法，恐怕不够妥当，不如伤热的用五苓散来引导逆气下行，伤冷的用理中汤来温补中焦，自然能够平复康复。
〔附方〕
胃苓汤：苍术、白术、猪苓、泽泻、浓朴、陈皮、茯苓、甘草，加少许桂枝。
大青膏：见惊风症章节内。
益黄散：见疳积症章节内。
五苓散：去掉肉桂，改用甘草。
理中汤：均见惊风症章节内。
General Overview: Infantile vomiting and diarrhea present in various patterns; they should not be viewed uniformly. If one observes symptoms of mental confusion and sluggish eyes, one must guard against the occurrence of slow spleen convulsions (Man Pi Jing Chu).
Pulse Diagnosis: A surging pulse indicates heat; a wiry pulse indicates pain. A pulse that is weak and gradually becomes slow suggests a poor prognosis (death), whereas a pulse that gradually enlarges suggests a favorable prognosis (life). If there is retained food or lingering fluid, the Qi Kou pulse (the radial artery position used to diagnose the Spleen and Stomach) will inevitably appear wiry and slippery.
The *Nei Jing* (Inner Canon) states: Spleen deficiency leads to diarrhea; Stomach deficiency leads to vomiting. It also states: Food stagnation at the stomach opening results in vomiting; food stagnation in the large and small intestines results in diarrhea. Furthermore: Various types of vomiting and acid regurgitation, as well as sudden severe diarrhea with tenesmus, all belong to heat.
Qian Zhongyang stated: Vomiting milk with yellow stool indicates injury from hot milk; vomiting milk with green stool indicates injury from cold milk. Both conditions require purgative treatment. This demonstrates that deficiency, excess, cold, and heat can all cause vomiting and diarrhea. There are also cases of vomiting and diarrhea due to wind invasion, characterized by warm body temperature, alternating chills and fever, excessive sleepiness, coarse breathing, yellowish-white stool, vomiting of undigested milk/food, accompanied by coughing. First administer Da Qing Gao (Great Blue Ointment) to disperse the exterior, then use Yi Huang San (Benefit Yellow Powder) to harmonize the Stomach. If vomiting and diarrhea are accompanied by fever, excessive sleepiness, ability to suckle but vomiting phlegm, incessant drinking, and yellow watery stool, this is a Stomach deficiency pattern. First use Bai Zhu San (Atractylodes Macrocephala Powder) to generate fluids and quench thirst, then use Da Qing Gao to disperse wind pathogens.
Qian Zhongyang stated: For infants within three days of birth who exhibit vomiting and diarrhea, fever, refusal to suckle, greenish-white stool, and undigested milk/food (white in color), this is milk injury. Purgatives should be used first, followed by Stomach-harmonizing treatments. After the Summer Solstice, vomiting and diarrhea with fever may result from heat injury or milk injury, with undigested milk vomited and deep yellow stool; formulas such as Xiang Ru San (Moslae Herba Powder) are appropriate. For infantile vomiting and diarrhea caused by food injury and damp-heat, Wei Ling Tang (Stomach-Cinnamon Decoction) must be administered to restore peace and comfort.
In all cases of infantile vomiting and diarrhea, one must fear the complication of wind generation due to Spleen deficiency. The *Xin Jian* (Heart Mirror) states: Children vary in age; one must examine the deficiency or excess of the disease. Some develop wind convulsions after three to five days of vomiting and diarrhea, while others develop them within half a day. Generally, for girls, vomiting is the urgent concern; for boys, diarrhea is the pressing issue. In cases of Qi deficiency leading to sudden severe diarrhea and vomiting, it manifests immediately upon onset. Only gan diarrhea (malabsorption syndrome diarrhea) is difficult to cure; if wind symptoms persist, the patient will ultimately succumb to extreme deficiency and become untreatable. However, for diarrhea, the primary approach should be to solidify the Spleen; for vomiting, the root is to generate the Stomach. Wind-arresting medicines should be added sparingly. Sedatives and cold-natured medicines should not be used initially. Strongly heating medicines must never be recklessly administered.
Qian Shi (Qian Yi) did not differentiate between cold and heat in vomiting and diarrhea, stating that all should be treated with purgatives, which is likely inappropriate. Instead, for heat injury, use Wu Ling San (Five-Ingredient Powder with Poria) to guide rebellious Qi downward; for cold injury, use Li Zhong Tang (Regulate the Middle Decoction) to warm the Middle Jiao, leading to natural recovery.
[Attached Formulas]
Wei Ling Tang (Stomach-Cinnamon Decoction): Cang Zhu (Atractylodis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Nong Po (Magnoliae Officinalis Cortex), Chen Pi (Citri Reticulatae Pericarpium), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), add a small amount of Gui Zhi (Cinnamomi Ramulus).
Da Qing Gao (Great Blue Ointment): See section on Convulsive Disorders.
Yi Huang San (Benefit Yellow Powder): See section on Malnutrition Accumulation.
Wu Ling San (Five-Ingredient Powder with Poria): Remove Rou Gui (Cinnamomi Cortex), use Gan Cao (Glycyrrhizae Radix et Rhizoma).
Li Zhong Tang (Regulate the Middle Decoction): See section on Convulsive Disorders.