吐泻者，乃挥霍扰乱之证。霍者吐，乱者泻。有心痛而先吐者，有腹痛而先泻者，莫
不由中焦而作。上焦主纳。而不出，中焦主腐化水谷而生荣卫，灌溉百骸，下焦分别水
谷，主出而不纳。此三才成式，日用常行，故脾居中州，胃为水谷之海，浮哺入胃，脾能
克化，然后水谷分在脐上一寸，名分水穴，分其清浊，传受得宜，则无吐泻之患。凡婴孩
上吐不止下泻不停，皆因六气（六气者，筋骨血肉积气是也）未完，六淫（六淫者，风火暑湿燥寒是也）易侵，
兼以调护失常，乳食不节，遂使脾胃虚弱，清浊相干，蕴作而然。有先泻而后吐者，乃脾
胃虚冷，其候先泻白水或白冻，吐亦不多，口气缓而神色慢，额前有汗，六脉沉濡，此为
冷也。先吐而后泻者，乃脾胃有热，气促唇红，吐来面赤，脉洪而数，渴饮水浆，此为
热也。冷热之分，要须详审。有数岁者，亦患此证。始自夏秋，昼近极热之地，解衣乘
凉，夜卧当风之所，失盖感冷，阴阳相搏，气射中焦，名为霍乱。《活人书》用香薷散调治，
以其能分别水谷，升降阴阳。又曰∶热多欲饮水者，五苓散。寒多不饮水者，理中丸。详
究治法，得非欲平中焦乎。又有脾经积滞未除，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，必自安矣。钱仲阳议曰∶吐乳泻黄，是伤热乳；吐乳泻青，
是伤冷乳。皆当下之。详夫此理，乃迎夺之法也，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。有小儿盛夏初秋，遇夜乘风，渴而饮水，过餐生冷果
物，攻激肠胃，遂乃暴吐暴泻，传作手足俱痹，筋挛而痛，痛则神志不宁，以惊证治之
误矣。所谓筋遇寒则引缩，又以阳明养宗筋，属胃与大肠，因内伤生冷冻饮料食，外感风邪，吐
泻交作，胃气固虚，不能养其宗筋，亦致挛急。此证口气温，面色惨，脉沉缓，再以手
按两膝腕下，见筋缩而引于皮间，是其候也。治以理中汤，加附子半生半炮，水、姜熟煎，
空心温服，更详虚实冷热为治可也。
吐泻，是一种突然发作、扰乱肠胃的证候。“霍”指呕吐，“乱”指腹泻。有的患者先出现心痛然后呕吐，有的先出现腹痛然后腹泻，这些情况没有不是从中焦（脾胃）引发的。上焦主管受纳食物而不外泄；中焦主管消化腐熟水谷，从而生成营卫之气，灌溉全身骨骼形体；下焦负责分别清浊的水谷，主管排泄而不受纳。这三者构成了人体的基本模式，是日常生理活动的常态。因此，脾位居于中州（人体中央），胃是水谷汇聚的海港，饮食进入胃中，脾能够运化消化，然后水谷精微在脐上一寸处（名为分水穴）分清别浊，传输接受得当，就不会发生吐泻的祸患。
凡是婴幼儿上吐不止、下泻不停，都是因为六气（此处指筋骨血肉等先天禀赋之气）尚未完善，六淫（风、火、暑、湿、燥、寒六种外感病邪）容易侵袭，再加上护理不当，乳食没有节制，致使脾胃虚弱，清气与浊气相互干扰，郁结蕴蒸而致病。
有先腹泻后呕吐的，这是脾胃虚冷。其症状表现为先泻出白水或白色粘液，呕吐也不剧烈，口气缓和且神色倦怠，额头前有汗出，六脉沉而濡软，这属于寒证。
有先呕吐后腹泻的，这是脾胃有热。症状表现为呼吸急促、嘴唇发红，呕吐时面色潮红，脉象洪大而数，口渴想喝水浆，这属于热证。寒证与热证的区分，必须仔细审察。
也有几岁的孩子患这种证候。起初在夏秋季节，白天靠近极热的地方，脱衣乘凉，夜晚睡觉时对着风口，失去覆盖感受寒冷，导致阴阳相搏，寒气冲击中焦，称为霍乱。《活人书》使用香薷散来调治，因为它能分别水谷，升降阴阳。又说：热盛多欲饮水的，用五苓散；寒盛不饮水的，用理中丸。详细探究治疗方法，难道不是为了平复中焦吗？
又有脾经积滞未除，再次被饮食所伤，不吐就泻，不泻就吐，适宜用三棱散化解积滞，用守胃散调和胃气，必然自行安宁。
钱仲阳议论说：呕吐乳汁且大便色黄，是伤了热乳；呕吐乳汁且大便色青，是伤了冷乳。这两种情况都应该用攻下法治疗。详细推究这个理论，这是“迎夺”（顺势攻下）的方法，不如伤热者用五苓散来引导逆气下行，伤冷者用理中汤来温补中焦，自然就能平复恢复。
还有小儿在盛夏初秋，夜间吹到风，口渴时饮水，过量食用生冷瓜果，刺激肠胃，于是突然剧烈呕吐和腹泻，进而发展为手足麻痹，筋脉拘挛疼痛。疼痛时神志不安，如果按惊风证治疗就错了。
所谓筋遇寒就会牵引收缩，又因为阳明经滋养宗筋，归属于胃与大肠。由于内伤生冷冻饮料食，外感风邪，导致吐泻交作，胃气本就虚弱，不能滋养宗筋，也会导致筋脉拘急。此证候表现为口气温热，面色惨淡，脉象沉缓，再用手指按压两膝和手腕下方，可见筋脉收缩并牵连皮肤，这就是其特征。治疗用理中汤，加入半生半炮制的附子，用水和生姜煮熟煎服，空腹温服，再根据虚实寒热具体情况调整治疗即可。
Touxie (Vomiting and Diarrhea) is a syndrome characterized by sudden onset and gastrointestinal disturbance. "Huo" refers to vomiting, and "Luan" refers to diarrhea. Some patients experience heart pain followed by vomiting, while others experience abdominal pain followed by diarrhea; none of these arise without originating from the Middle Jiao (Middle Burner, primarily referring to the Spleen and Stomach). The Upper Jiao governs reception and does not allow leakage outwards; the Middle Jiao governs the digestion and transformation of food and fluids, thereby generating Ying and Wei (Nutritive and Defensive Qi), irrigating the bones and body; the Lower Jiao separates the clear and turbid aspects of food and fluids, governing excretion rather than reception. These three constitute the fundamental pattern of the human body, representing daily physiological functions. Therefore, the Spleen resides in the Central Earth (Middle Jiao), and the Stomach is the Sea of Food and Fluids. When food enters the Stomach, the Spleen can transform and digest it. Then, at one cun above the umbilicus (known as the Fen Shui Acupoint), the clear and turbid are separated, and transmission and reception are appropriate, thus preventing the disaster of vomiting and diarrhea.
Whenever infants suffer from incessant upper vomiting and continuous lower diarrhea, it is because their congenital essence (Six Qi, here referring to the foundational energies of tendons, bones, flesh, blood, etc.) is not yet complete, making them susceptible to invasion by the Six Excesses (Six Yin Pathogens: Wind, Fire, Summer-heat, Dampness, Dryness, Cold). Additionally, improper nursing and irregular feeding lead to Spleen and Stomach deficiency, causing Clear and Turbid Qi to interfere with each other, stagnate, and generate pathology.
If diarrhea occurs first followed by vomiting, this indicates Spleen and Stomach Deficiency-Cold. The symptoms include initially passing white water or white mucus, with mild vomiting, slow breath, lethargic expression, sweating on the forehead, and deep, soggy pulses throughout all six positions. This is classified as Cold.
If vomiting occurs first followed by diarrhea, this indicates Heat in the Spleen and Stomach. Symptoms include rapid breathing, red lips, flushed face during vomiting, surging and rapid pulses, thirst for drinking, and desire for fluids. This is classified as Heat. The distinction between Cold and Heat must be carefully examined.
Children of several years old may also suffer from this syndrome. It often begins in summer and autumn. During the day, they stay near extremely hot places and expose themselves to cool air after removing clothes; at night, they sleep in drafty areas without adequate covering, contracting cold. This causes an struggle between Yin and Yang, with cold qi striking the Middle Jiao, named Huoluan (Chaos/Vomiting-Diarrhea Syndrome). The *Huoren Shu* (Book of Living Persons) uses Xiangru San (Elsholtzia Powder) for treatment, as it can separate food and fluids and regulate the ascending and descending of Yin and Yang. It further states: For cases with more heat and desire to drink water, use Wuling San (Five-Ingredient Powder with Poria); for cases with more cold and no desire to drink water, use Lizhong Wan (Regulate the Middle Pill). A detailed examination of treatment methods reveals that the aim is indeed to calm the Middle Jiao.
In cases where Spleen Meridian accumulation/stagnation remains unresolved, and the child is injured again by diet, resulting in alternating vomiting and diarrhea, it is appropriate to use Sanleng San (Sparganium Powder) to resolve accumulation and Shouwei San (Stomach-Guarding Powder) to harmonize the Stomach, ensuring recovery.
Qian Zhongyang discussed: Vomiting milk with yellow stool indicates injury from Hot Milk; vomiting milk with green stool indicates injury from Cold Milk. Both conditions should be treated with purgative methods. However, upon detailed analysis of this principle, which represents the method of "attacking and seizing" (forcing downward), it is preferable to treat heat-injury with Wuling San to guide rebellious Qi downward, and cold-injury with Lizhong Tang (Regulate the Middle Decoction) to warm the Middle Jiao, leading to natural recovery.
Furthermore, in midsummer or early autumn, if children are exposed to wind at night, drink water when thirsty, and overconsume raw and cold fruits, the stomach and intestines are stimulated, leading to sudden violent vomiting and diarrhea. This may progress to numbness of the hands and feet, tendon spasms, and pain. During pain, the spirit and consciousness become unsettled. Treating this as a Convulsion Syndrome (Jing Zheng) would be a mistake.
It is said that tendons contract and shorten when encountering cold. The Yangming Meridian nourishes the Zong Jin (Major Tendons) and belongs to the Stomach and Large Intestine. Due to internal injury from consuming raw, cold drinks and foods, combined with external contraction of Wind Pathogen, vomiting and diarrhea occur alternately. The Stomach Qi is inherently deficient and cannot nourish the Zong Jin, leading to tendon spasms. The signs of this syndrome include warm breath, pale/dull complexion, and deep, slow pulses. Pressing below the knees and wrists reveals tendon contraction pulling against the skin, which confirms the diagnosis. Treatment involves Lizhong Tang, added with half raw and half processed Fuzi (Aconite Lateral Root), decocted with water and fresh ginger, taken warm on an empty stomach. Further adjustments should be made based on deficiency/excess and cold/heat patterns.