闻人 曰。有食饱伤脾。脾气稍虚。物难消化。留而成积。积败为痢。肚腹微痛。先调胃气。次理积。却止痢。则
病根自除。和中散理虚养胃。三棱散、乌犀丸助脾化积。沉香槟榔丸、守中汤进食止痢。
张涣曰。吐乳泻黄。是伤热乳。吐乳泻青。是伤冷乳。皆当下之。此迎而夺之之法也。不若伤热者。用五苓散以导
其逆。伤冷者。用理中汤以温其中。自然平复也。脾经积滞未除。再为饮食所伤。不吐则泻。不泻则吐。宜以三棱散化
积。守胃散和中。
鳌按。痢与吐泻各有 门。二条列于此者。以 由食积也。
吐病伤胃。泻病伤脾。吐上焦郁。泻下焦衰。脏腑部分。各不相移。论吐之原。病非一机。或由胃虚。睡必露 。
或由胃冷。其脉沉微。或由胃热。凉饮是怡。或胃虚热。渴而溺稀。或胃有积。肚热面黧。或胃有痰。嗽逆声嘶。挟惊
挟毒。吐亦
相随。和中助胃。止吐之基。论泻之原。五脏兼推。脾受木克。面黄神疲。脾为水侮。洞泄如筛。心脾气虚。泻黄多噫。
肺脾气拂。沫出多啼。脾气虚寒。冷及四肢。脾家积热。心烦口糜。脾为湿滞。浮肿脉迟。脾气下陷。腹坠如遗。脾中
虚痞。胀满难支。清神益气。止泻应施。吐泻交作。霍乱维危。或心先痛。吐难自持。或腹先痛。泻必淋漓。中焦闭隔。
上下气暌。挥霍撩乱。方书慎之。曰搅肠痧。俗名甚奇。开通疏利。乃是正治。吐泻之故。调护多非。儿生幼稚。六气
尚亏。乳食不节。外感侵欺。清浊相干。蕴作疮痍。先泻后吐。由虚冷兮。先吐后泻。其实热治。详其轻重。审厥参差。
维吐之属。呕则类齐。维泻之属。痢则同归。其分别处。未可或迷。再参岁气。更辨四时。勿轻心掉。才可言医。
闻人氏说：有因饱食损伤脾脏的情况。脾气稍微虚弱，食物难以消化，停留体内形成积滞。积滞腐败则变为痢疾。此时腹部轻微疼痛。治疗应先调理胃气，其次化解积滞，最后止住痢疾，这样病根自然得以清除。使用中散来调理虚损、养护胃气；使用三棱散、乌犀丸来辅助脾脏化解积滞；使用沉香槟榔丸、守中汤来促进进食并止住痢疾。
张涣说：呕吐乳汁且大便色黄，是伤于热乳（过热或受热的乳汁）。呕吐乳汁且大便色青，是伤于冷乳（过冷或受寒的乳汁）。这两种情况都应当采用攻下法。这是“迎而夺之”的治疗法则。但不如对于伤热者，使用五苓散来引导逆乱之气下行；对于伤冷者，使用理中汤来温补中焦。如此自然能够平复痊愈。如果脾经的积滞尚未清除，再次被饮食所伤，就会出现要么呕吐要么腹泻的症状，不吐就泻，不泻就吐。适宜使用三棱散来化解积滞，使用守胃散来调和胃气。
沈金鳌按语：痢疾与吐泻各有独立的门类。将这两条内容列在此处，是因为它们都由食积引起。
呕吐的病证损伤胃腑，腹泻的病证损伤脾脏。呕吐源于上焦气机郁滞，腹泻源于下焦功能衰退。脏腑部位不同，各不相混。论述呕吐的起因，病因并非单一。有的因为胃虚，睡觉时必定露出眼睛；有的因为胃冷，脉象沉微；有的因为胃热，喜欢喝凉饮；有的是胃虚热，口渴但小便清稀；有的是胃中有积滞，肚子发热面色黧黑；有的是胃中有痰，咳嗽气逆声音嘶哑。兼夹惊风或毒邪，呕吐也会随之而来。调和胃气、辅助胃功能是止吐的基础。论述腹泻的起因，需推究五脏。脾受肝木克制，面色发黄精神疲乏；脾为水湿所侮，泄泻如水筛漏；心脾气虚，腹泻色黄多打嗝；肺脾气机拂逆，口水流出且啼哭不止；脾气虚寒，四肢发冷；脾家积热，心烦口舌生疮；脾为湿邪停滞，身体浮肿脉象迟缓；脾气下陷，腹部坠胀如失禁感；脾中虚痞，胀满难以支撑。清神益气是止泻应当施用的治法。吐泻同时发作，属于霍乱危重证候。有的先心痛，呕吐难以自持；有的先腹痛，腹泻必定淋漓不尽。中焦闭塞阻隔，上下气机分离。挥霍撩乱，方书中对此谨慎对待，称为搅肠痧，俗名非常奇特。开通疏利才是正确的治疗方法。导致吐泻的原因，往往是由于调护不当。小儿年幼，六气尚且亏虚。乳食没有节制，外邪侵袭。清浊之气相互干扰，蕴结成为疮痍。先腹泻后呕吐，是由虚冷引起；先呕吐后腹泻，属于实热证。要详细辨别轻重，审察其差异。关于呕吐的类别，呕与吐类似；关于腹泻的类别，痢与泻同归一类。其中的区别之处，不可混淆。再参考岁运之气，进一步辨别四季变化。不可轻忽大意，才可以谈论医学。
Wenren stated: There are cases where overeating damages the Spleen. When Spleen Qi is slightly deficient, food is difficult to digest and remains in the body forming accumulation (food stagnation). When the accumulation deteriorates, it transforms into dysentery. At this time, there is slight abdominal pain. Treatment should first regulate Stomach Qi, then resolve the accumulation, and finally stop the dysentery, so that the root of the disease is naturally eliminated. Use Hezhong San (Harmonizing Middle Powder) to regulate deficiency and nourish Stomach Qi; use Sanleng San (Curcuma Longa Rhizome Powder) and Wuxi Wan (Black Rhinoceros Horn Pill) to assist the Spleen in resolving accumulation; use Chenxiang Binglang Wan (Aucklandia and Areca Seed Pill) and Shouzhong Tang (Middle-Keeping Decoction) to promote appetite and stop dysentery.
Zhang Huan stated: Vomiting milk with yellow stool indicates injury from hot milk (milk that is too warm or heated). Vomiting milk with green stool indicates injury from cold milk (milk that is too cool or chilled). Both conditions should be treated with purgation. This is the method of "meeting and depriving" (attacking the pathogen directly). However, it is better to use Wuling San (Five-Ingredient Poria Decoction) for those injured by heat to guide rebellious Qi downward, and use Lizhong Tang (Regulate the Middle Decoction) for those injured by cold to warm the Middle Jiao. In this way, recovery will occur naturally. If the stagnation in the Spleen Meridian has not been cleared and the child is again injured by diet, symptoms will manifest as either vomiting or diarrhea; if not vomiting, then diarrhea; if not diarrhea, then vomiting. It is appropriate to use Sanleng San to resolve accumulation and Shouwei San (Stomach-Keeping Powder) to harmonize the Stomach.
Shen Jin'ao's note: Dysentery and vomiting/diarrhea each have their own categories. These two items are listed here because they originate from food accumulation.
Vomiting diseases injure the Stomach, while diarrhea diseases injure the Spleen. Vomiting arises from stagnation in the Upper Jiao, while diarrhea arises from decline in the Lower Jiao. The locations of the Zang-Fu organs are distinct and do not shift. Discussing the origin of vomiting, the pathology is not singular. It may be due to Stomach deficiency, where the eyes remain open during sleep; or due to Stomach cold, with a deep and faint pulse; or due to Stomach heat, where the patient desires cold drinks; or due to Stomach deficiency-heat, characterized by thirst but clear urine; or due to food accumulation in the Stomach, with a hot abdomen and dark complexion; or due to phlegm in the Stomach, with coughing, counterflow Qi, and hoarseness. Accompanied by fright or toxicity, vomiting also follows. Harmonizing the middle and assisting the Stomach is the foundation for stopping vomiting. Discussing the origin of diarrhea, one must consider all five Zang organs. If the Spleen is controlled by Liver Wood, the face is yellow and spirit is fatigued; if the Spleen is invaded by Water, there is profuse watery diarrhea like a sieve; if Heart and Spleen Qi are deficient, there is yellow diarrhea with frequent belching; if Lung and Spleen Qi are disordered, there is drooling and excessive crying; if Spleen Qi is deficient and cold, the four limbs become cold; if there is accumulated heat in the Spleen, there is mental restlessness and mouth ulcers; if the Spleen is stagnant with dampness, there is edema and a slow pulse; if Spleen Qi sinks, there is abdominal heaviness as if incontinence; if there is deficiency-fullness in the Spleen, there is distension that is hard to bear. Clearing the spirit and benefiting Qi is the treatment to be applied for stopping diarrhea. Simultaneous vomiting and diarrhea constitute Huoluan (Cholera-like syndrome), which is critical. Sometimes heart pain precedes, making vomiting uncontrollable; sometimes abdominal pain precedes, making diarrhea dripping continuously. The Middle Jiao is blocked, and the Qi of the upper and lower parts separates. With sudden turmoil, physicians must be cautious in case books, referring to it as Jiaochang Sha (Intestine-Stirring Miasma), a name that is quite peculiar. Opening and draining is the correct treatment. The causes of vomiting and diarrhea often lie in improper care. Infants are young, and the Six Qi are still deficient. Irregular nursing and diet invite external pathogens. Clear and turbid Qi interfere with each other, accumulating to cause sores. Diarrhea preceding vomiting is caused by deficiency-cold; vomiting preceding diarrhea belongs to excess-heat. One must carefully examine the severity and differences. Regarding vomiting types, Ou (vomiting) and Tu (spitting up) are similar; regarding diarrhea types, Li (dysentery) and Xie (diarrhea) return to the same category. The distinctions must not be confused. Further reference should be made to the annual Qi and differentiation of the four seasons. Do not be careless, only then can one speak of medicine.