钱乙曰。春冬之治宜从表。如伤寒吐泻身温。乍凉乍热。睡多气粗。大便青白。呕吐。乳下不消。时咳嗽。更有五
脏兼现症。当煎入脏君臣药。先服大青膏。后服益黄散。如先曾下。或无下症。慎不可下。此乃脾肺受寒也。若伤风吐
泻。身热多睡。能食乳。饮水不止。吐痰。大便黄水。此为胃虚热渴吐泻也。当生胃中津液。以止其渴。白术散。后用
发散。大青膏。伤风吐泻。身凉吐沫。泻青白。闷乱不渴。哽气。长出气。睡露眼。此伤风荏苒轻怯。因成吐泻。专先
补脾。益黄散。后用发散。大青膏。此伤风二症。多病于春冬也。夏秋之治宜从里。儿生三日内壮热。不思乳食。大便
乳食不消。或白色。是伤寒。当下之。白饼子。并和胃。益黄散。儿生三日至十日。吐泻身温凉。不思乳食。大便青白。
乳食不消。上实下虚也。更有五脏兼见症。肺则睡露睛。喘气。心则惊悸饮水。脾则困倦多睡。肝则呵欠烦闷。肾则不
语畏明。当视其兼脏症。先泻其所实而补其虚。如脾虚。益黄散主之。此二症多病于夏秋也。再如五月夏至后吐泻。身
壮热者。此热也。盖小儿脏腑。十分中九分热也。或因伤热。乳食不消。泻深黄色。玉露饮。六月大暑后吐泻。身大温
而似热。脏腑中六分热四分冷也。吐呕。乳食不消。泻黄白色。似渴。或乳或不乳。食前少服益黄散。食后多服玉露饮。
立秋后吐泻身温。脏腑中三分热七分冷也。不能食乳。多似睡。闷乱。哽气。长出气。睡露睛。唇白多哕。欲大便。不
渴。食前多服益黄散。食后少服玉露饮。八月秋分后吐泻身冷。无阳也。不能食乳。干呕哕。泻青褐水。当补脾。益黄
散。不可下也。凡治小儿吐泻。大法。五月内九分下而一分补。八月内。九分补而一分下。切勿混治。
万全曰。小儿盛暑吐泻。邪热在下焦则泻。在上焦则吐。亡津必渴。用玉露散。虽吐时时与啜之。过三日必愈。如
身热脉大溺黄。五苓、益元各半。汤调温服。如身凉脉细。尿清。早晨益黄散。后玉露散。如过四五日困弱。异功散。
或用和中散。
曾氏曰。小儿盛夏初秋。遇夜乘凉。渴而饮水。过食生冷。攻击肠胃。遂乃暴吐暴泻。传作手足俱痹。筋挛而痛。
痛则神志不宁。若以惊症治之。误矣。
张元素曰。如有风而泻。用防风、羌活。谓吐泻兼肝病。风搐拘急。如有热而泻。用大黄、黄连。谓吐泻兼心病。
身热也。有寒而泻。用附子。谓吐泻兼肾病。身冷。或足胫寒而逆也。有湿而泻。用白术、茯苓。谓吐泻兼本脏脾病。
多睡体重昏倦也。有肺病而泻。用白芍、桂心。定喘麦冬、人参。甚者用槟榔。大便不通加大黄。谓吐泻兼肺病。咳嗽
也。
钱乙说：春季和冬季治疗应当从表证入手。例如伤寒引起的吐泻，身体温暖，忽冷忽热，嗜睡且呼吸粗重，大便呈青白色，呕吐，乳汁消化不良，时常咳嗽，更有五脏兼见的症状，应当在煎药时加入调理脏腑的主药和辅药。先服用大青膏，后服用益黄散。如果之前已经使用过泻下法，或者没有需要泻下的症状，千万不可再用泻下法。这是脾肺受寒所致。如果是伤风引起的吐泻，身体发热，嗜睡，能吃乳，喝水不止，呕吐痰液，大便呈黄色水样，这是胃虚、内热、口渴引起的吐泻。应当滋生胃中的津液以止渴，用白术散，之后用发散风邪的方法，配合大青膏。如果是伤风引起的吐泻，身体发凉，口吐涎沫，大便青白，烦躁不安且不口渴，打嗝，长叹气，睡觉时眼睛半睁，这是伤风迁延不愈导致体质虚弱而形成的吐泻，专门先补脾，用益黄散，之后用发散风邪的方法，配合大青膏。这两种伤风吐泻的症状，多在春冬季节发病。
夏季和秋季的治疗应当从里证入手。婴儿出生后三日内出现高热，不思饮食，大便中有未消化的乳食，或者颜色发白，这是伤寒，应当用泻下法，用白饼子，并调和胃气，用益黄散。婴儿出生第三日至第十日，吐泻且身体温度正常或偏凉，不思饮食，大便青白，乳食不消化，这是上实下虚的证候。更有五脏兼见的症状：肺病则睡觉时眼睛半睁，气喘；心病则惊悸、想喝水；脾病则困倦、嗜睡；肝病则打哈欠、烦躁闷乱；肾病则不说话、怕光。应当根据兼见的脏腑症状，先泻其实邪，再补其虚损。如脾虚，用益黄散主治。这两种证候多在夏秋季节发病。
又如五月夏至后出现的吐泻，身体高热，这是热证。因为小儿脏腑，十分中有九分是热的。可能是因为受热损伤，乳食不消化，泻出深黄色的粪便，用玉露饮。六月大暑后出现的吐泻，身体大温但似有热象，脏腑中六分热四分冷，呕吐，乳食不消化，泻出黄白色的粪便，似有渴感，有时吃乳有时不吃，饭前少量服用益黄散，饭后大量服用玉露饮。立秋后出现的吐泻，身体温暖，脏腑中三分热七分冷，不能进食乳食，多似嗜睡，烦躁闷乱，打嗝，长叹气，睡觉时眼睛半睁，嘴唇发白，频繁呃逆，想解大便但不口渴，饭前大量服用益黄散，饭后少量服用玉露饮。八月秋分后出现的吐泻，身体寒冷，这是阳气不足（无阳），不能进食乳食，干呕呃逆，泻出青褐色的水样便，应当补脾，用益黄散，不可用泻下法。
凡是治疗小儿吐泻的大法：五月以内，十分之中九分用泻下法，一分用补法；八月以内，十分之中九分用补法，一分用泻下法。千万不要混淆治疗。
万全说：小儿在盛暑时节吐泻，邪热在下焦则引起腹泻，在上焦则引起呕吐。亡失津液必然口渴，用玉露散。虽然呕吐，也要时时喂服。过了三天必定痊愈。如果身体发热、脉大、小便黄，用五苓散和益元散各一半，用汤剂调匀温服。如果身体发凉、脉细、小便清，早晨服用益黄散，随后服用玉露散。如果过了四五日变得困弱，用异功散，或者用和中散。
曾氏说：小儿在盛夏初秋，夜间乘凉，口渴饮水，过食生冷食物，攻击肠胃，于是突然剧烈呕吐和腹泻，进而传变为手足麻痹，筋脉拘挛疼痛。疼痛时神志不安。如果按照惊风症治疗，就错了。
张元素说：如果有风邪导致的腹泻，用防风、羌活，这是因为吐泻兼有肝病，伴有风搐、拘急。如果有热邪导致的腹泻，用大黄、黄连，这是因为吐泻兼有心病，伴有身体发热。有寒邪导致的腹泻，用附子，这是因为吐泻兼有肾病，伴有身体寒冷，或者小腿寒冷且逆冷。有湿邪导致的腹泻，用白术、茯苓，这是因为吐泻兼有本脏脾病，伴有嗜睡、身体沉重、昏沉疲倦。有肺病导致的腹泻，用白芍、桂心，定喘、麦冬、人参，严重的用槟榔，大便不通加大黄，这是因为吐泻兼有肺病，伴有咳嗽。
Qian Yi stated: The treatment in spring and winter should focus on the exterior. For example, in vomiting and diarrhea caused by cold damage (Shanghan), with a warm body, alternating chills and fever, excessive sleepiness, coarse breathing, greenish-white stools, vomiting, indigestion of milk, occasional coughing, and additional symptoms involving the five zang organs, decoctions should include the sovereign and minister herbs for regulating the zang organs. First administer Daqing Gao (Great Blue Paste), followed by Yihuang San (Yellow Protection Powder). If purgatives have already been used, or if there are no indications for purgation, one must strictly avoid using them. This is due to cold invading the spleen and lungs. In cases of vomiting and diarrhea caused by wind injury, with fever, excessive sleepiness, ability to take milk, incessant drinking, vomiting phlegm, and yellow watery stools, this indicates stomach deficiency heat with thirst and vomiting/diarrhea. One should generate fluids in the stomach to quench thirst, using Baizhu San (Atractylodes Macrocephala Powder), followed by dispersing methods and Daqing Gao. In cases of vomiting and diarrhea from wind injury, with a cool body, foaming at the mouth, greenish-white stools, restlessness without thirst, hiccupping, long sighs, and sleeping with eyes partially open, this is a mild and lingering condition resulting from wind injury causing vomiting and diarrhea. The primary approach is to tonify the spleen using Yihuang San, followed by dispersing methods and Daqing Gao. These two types of wind-injury vomiting and diarrhea mostly occur in spring and winter.
The treatment in summer and autumn should focus on the interior. Infants within three days of birth presenting with high fever, loss of appetite for milk and food, and undigested milk/food in stools, or white stools, indicate cold damage (Shanghan) and require purgation using Baibing Zi (White Pill), along with harmonizing the stomach using Yihuang San. Infants from the third to the tenth day of life presenting with vomiting and diarrhea, normal or cool body temperature, loss of appetite, greenish-white stools, and undigested milk/food, indicate excess above and deficiency below. Additional symptoms involving the five zang organs may appear: lung involvement presents as sleeping with eyes half-open and wheezing; heart involvement presents as palpitations and desire for water; spleen involvement presents as fatigue and excessive sleepiness; liver involvement presents as yawning and irritability; kidney involvement presents as muteness and photophobia. One should assess the concurrent zang symptoms, first draining the excess and then tonifying the deficiency. For spleen deficiency, Yihuang San is the primary formula. These two conditions mostly occur in summer and autumn.
Furthermore, vomiting and diarrhea occurring after the Summer Solstice in May, accompanied by high fever, indicate heat. This is because children's internal organs are nine parts heat to one part cold. It may be due to heat injury causing indigestion of milk/food and deep yellow stools, treated with Yulu Yin (Jade Dew Decoction). After the Great Heat in June, vomiting and diarrhea present with significant warmth resembling heat, with six parts heat and four parts cold in the organs. Symptoms include vomiting, indigestion of milk/food, yellowish-white watery stools, apparent thirst, variable feeding habits. Administer small amounts of Yihuang San before meals and large amounts of Yulu Yin after meals. After Start of Autumn, vomiting and diarrhea present with warm bodies, with three parts heat and seven parts cold in the organs. Symptoms include inability to feed, lethargy, restlessness, hiccupping, long sighs, sleeping with eyes half-open, pale lips, frequent hiccups, urge to defecate without thirst. Administer large amounts of Yihuang San before meals and small amounts of Yulu Yin after meals. After the Autumn Equinox in August, vomiting and diarrhea present with cold bodies, indicating lack of yang (Wu Yang). Symptoms include inability to feed, dry heaving/hiccups, and greenish-brown watery stools. Tonify the spleen using Yihuang San; do not use purgation.
The general principle for treating pediatric vomiting and diarrhea is: within May, use nine parts purgation and one part tonification; within August, use nine parts tonification and one part purgation. Do not mix these approaches indiscriminately.
Wan Quan stated: In pediatric vomiting and diarrhea during intense summer heat, pathogenic heat in the lower jiao causes diarrhea, while heat in the upper jiao causes vomiting. Loss of body fluids leads to thirst. Use Yulu San (Jade Dew Powder). Even if vomiting occurs, administer it frequently in small sips. Recovery is expected after three days. If there is fever, large pulse, and yellow urine, use equal parts of Wuling San (Five-Ingredient Poria Powder) and Yiyuan San (Benefit Origin Powder), mixed with decoction and taken warm. If the body is cool, pulse is fine, and urine is clear, administer Yihuang San in the morning, followed by Yulu San. If weakness persists after four or five days, use Yigong San (Extraordinary Merit Powder) or Hezhong San (Harmonize Middle Powder).
Zeng Shi stated: During midsummer and early autumn, if children cool off at night, drink water when thirsty, and overconsume raw/cold foods, attacking the intestines and stomach, sudden violent vomiting and diarrhea ensue. This can transmit to cause paralysis of hands and feet, muscle spasms, and pain. Pain leads to restless spirit. Treating this as a convulsion disorder would be an error.
Zhang Yuansu stated: For diarrhea caused by wind, use Fangfeng (Saposhnikovia Root) and Qianghuo (Notopterygium Rhizome), indicating vomiting and diarrhea combined with liver disease, featuring wind-induced spasms and rigidity. For diarrhea caused by heat, use Dahuang (Rhubarb Root) and Huanglian (Coptis Rhizome), indicating vomiting and diarrhea combined with heart disease, featuring body heat. For diarrhea caused by cold, use Fuzi (Prepared Aconite Root), indicating vomiting and diarrhea combined with kidney disease, featuring body coldness or cold/reversed limbs. For diarrhea caused by dampness, use Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria), indicating vomiting and diarrhea combined with spleen disease (the organ itself), featuring excessive sleepiness, heavy body, and drowsiness. For diarrhea caused by lung disease, use Baishao (White Peony Root) and Guixin (Cinnamon Twig), plus Dingchuan (likely Asarum or similar for asthma), Maidong (Ophiopogon Tuber), and Renshen (Ginseng). For severe cases, use Binglang (Areca Seed); if stool is blocked, add Dahuang. This indicates vomiting and diarrhea combined with lung disease, featuring coughing.