汤氏云∶凡此泻不宜便补，先用消食药，或用紫霜丸（变蒸热）取其积尽，然后可补。经云∶食泻重，
当取疳虚，用补虚。治食泻与香橘饼子加减，观音散、调中汤散、以意加减。凡伤食泻，难止，亦不宜补，
再伤又泻，宜节饮食，当用进食丸（痞）取下食积令尽，次以钱氏加减益黄散，只一味止，此乃切要治法。
然后异功散、四君子汤（俱吐泻）调理，必取全安。有腹中雷鸣下痢者，生姜泻心汤主之。如冷积酿泻，用
香朴散止之，白术散以和气调胃，调中散、保安丸、能止伤食泻，感应丸、沉香煎、三棱丸（癖积）皆可服也。
东垣云∶伤食则恶食，小儿食泻者，因饮食伤脾，脾气不能健运，故乳食不化而出，若嗳臭吞酸，胸膈胀满，
腹痛按之益痛者，虽作泻而所停滞之物尚未消也，用保和丸。腹痛按之不痛者，乳食已消也，用异功散。脾
气伤而未复，不思饮食者，用六君子汤，所伤生冷之物，及喜热者，并加木香、干姜。乳食已消，腹痛已止，
泻尚未止者，脾失清升之气也，用补中益气汤。余有别证，当参各门。〔钱〕黄承务子二岁，病伤食而泻。众
医与止之，十余日，便青白，乳食不消，身凉，加哽气昏睡，咸谓困笃，召钱。钱先与益黄散、补肺散、各
三服，三日，身温而不哽气，后以白饼子微下之，又与益脾散三服，利止。何以然？利本脾虚伤食，初不与
下之，留连十日，上实下虚，脾气弱则引肺亦虚，脾肺子母故也，今先补脾，则肺病自退，即身温不哽气也，
然后下其所伤。或曰何不先下后补？曰便青为下脏冷，若先下，必大虚，今先实脾而后下，则不虚矣，后
更与补之，乃安。
香橘饼 止积泻伤冷。
木香 青皮（各一钱） 陈皮（二钱半） 浓朴（姜汁制） 神曲 麦 （各半两）
上为末，蜜丸为饼。紫苏米饮调下。
加减观音散 止吐泻，截虚风。
黄 人参（各二钱五分） 木香 甘草（炙） 石莲（去心） 扁豆（炒） 茯苓 白术 全蝎 羌
活（各一钱） 防风 天麻（各二钱）
上锉散。姜枣煎。
调中散 治伤食泻，凡此泻不宜便补，先用食药，或紫霜丸取其积尽，然后可补。
经云∶食泻重，当取疳虚，用补虚。良医明妙理，何虑疾难除。
人参（去芦） 白茯苓 白术 木香 干姜（炮） 藿香叶 香附子（炒，去毛） 缩砂仁 甘
草（炙） 丁香（各等分）
上为末。每服一钱，姜枣汤调下。肚痛，白汤下。量大小加减。
生姜泻心汤 治伤寒汗出解后，胃中不和，心下痞硬，胁下有水气，腹中雷鸣下利者。
黄芩 甘草（炙） 人参（各一两半） 干姜（炮） 黄连（各半两） 半夏（一两一钱，汤泡）
上锉散。每服三钱，水一盏，生姜三片，枣一枚，煎七分，去滓温服。
保安丸 治小儿 泻，伤食泻。
香附子（净） 砂仁（各一两） 白姜（炮） 青皮（去穣） 陈皮（去白） 三棱（炮） 莪术（炮
）甘草（炙。各半两）
上为末，麦 面糊丸，绿豆大。每服三丸，白汤下，食前温服。
杏霜丸 治小儿食积作泻、并痢证。
杏仁（三两，去皮尖，麸炒） 巴豆（一两，去壳油，炒焦，却入杏仁、同炒） 黄蜡（二两，酒煮、绵滤）
百草霜（炒、为末，二两，用油六钱，炒匀）
上，将杏仁、巴豆研极细，却入草霜令匀，熔蜡和丸，如绿豆大。赤痢，甘草汤，白痢，生姜汤，先进三四
服，腹胀者，十余服，效验如神。
《医局》开胃丸 治小儿腑脏怯弱，内受风冷，腹胁胀满，肠鸣泄利，或青或白，乳
食不化，又治脏冷夜啼，胎寒腹痛。
木香 蓬莪术 白术 人参（去芦头） 当归（锉，微炒。各半两） 麝香（细研） 白芍药（各一分）
上件，捣罗为末，都研令匀，汤浸炊饼、和丸如黍米大。每服十五丸，温米饮下。新生儿腹痛夜啼，可服五丸，
并乳食前服。
汤氏说：凡是这类腹泻不宜立即进补，应先用消食药，或者使用紫霜丸（用于变蒸期发热）以消除积滞，待积滞排尽后，才可以进行补益。《内经》说：食积引起的腹泻较重，应当考虑疳积虚损的情况，采用补虚的方法治疗。治疗食积腹泻可用香橘饼子加减，或选用观音散、调中汤散，根据具体情况灵活加减。凡是伤食引起的腹泻，难以止住，也不宜急于进补；如果再次受伤又导致腹泻，应当节制饮食，当用进食丸（用于痞块）攻下食积使其排尽，随后使用钱乙的加减益黄散，仅用一味药即可止泻，这是关键的治疗方法。之后再用异功散、四君子汤（均适用于呕吐腹泻）进行调理，必定能完全康复。如果有腹中肠鸣如雷并伴有下痢者，用生姜泻心汤主治。如果是冷积酿成的腹泻，用香朴散来止泻，用白术散调和气机、调理胃气，调中散、保安丸都能治疗伤食腹泻，感应丸、沉香煎、三棱丸（用于癖积）也都可以服用。
李东垣说：伤食会导致厌恶食物，小儿食积腹泻，是因为饮食损伤了脾胃，脾气不能正常运化，所以乳汁和食物不消化而排出。如果出现嗳气有臭味、吞酸、胸膈胀满、腹痛且按压时疼痛加剧的情况，虽然表现为腹泻，但停滞的食物尚未消化，应用保和丸。如果腹痛且按压时不痛，说明乳食已经消化，应用异功散。如果脾气受损尚未恢复，不想吃东西，应用六君子汤；如果是因食用生冷之物所致，且患者喜热，可加入木香、干姜。如果乳食已消化，腹痛已停止，但腹泻仍未停止，这是脾失清阳上升之气所致，应用补中益气汤。其余有其他证候的，应当参考各章节内容。
〔钱乙〕黄承务的儿子两岁，患伤食腹泻。众医生给予止泻药治疗，十多天后，大便呈青白色，乳食不消化，身体发凉，伴有呃逆、昏睡，大家都认为病情危重，于是请钱乙诊治。钱乙先给予益黄散、补肺散，各服三剂，三天后，身体转温且不再呃逆，随后用白饼子轻微攻下，又给予益脾散三剂，腹泻停止。为什么这样呢？腹泻本是由于脾虚伤食引起，起初如果不给予攻下法，拖延了十天，导致上实下虚，脾气虚弱进而引致肺气也虚，因为脾与肺是母子关系。现在先补脾，则肺病自然消退，即身体转温、不再呃逆，然后再攻下所伤之物。有人问：为什么不先攻下再补益？回答说：大便青色表明下焦脏寒，如果先攻下，必然导致正气大虚；现在先充实脾气然后再攻下，就不会造成虚损了，之后再给予补益，才能安稳。
香橘饼：治疗积滞腹泻和受冷腹泻。
组成：木香、青皮（各一钱），陈皮（二钱半），浓朴（姜汁制），神曲，麦芽（各半两）。
制法：以上药物研为细末，用蜂蜜制成丸剂如饼状。服用时用紫苏米饮送服。
加减观音散：治疗呕吐腹泻，截断虚风。
组成：黄芪、人参（各二钱五分），木香，甘草（炙），石莲（去心），扁豆（炒），茯苓，白术，全蝎，羌活（各一钱），防风，天麻（各二钱）。
制法：以上药物切碎成散剂。加生姜、大枣煎煮服用。
调中散：治疗伤食腹泻。凡是这类腹泻不宜立即进补，应先用消食药，或用紫霜丸消除积滞，然后才可补益。
经文说：食积腹泻较重，应当针对疳积虚损，采用补虚方法。良医通晓精妙道理，何必担忧疾病难除。
组成：人参（去芦头），白茯苓，白术，木香，干姜（炮制），藿香叶，香附子（炒，去毛），缩砂仁，甘草（炙），丁香（各等分）。
用法：以上药物研为细末。每次服用一钱，用姜枣汤调服。若肚痛，用白开水送服。根据患儿年龄大小酌情加减。
生姜泻心汤：治疗伤寒发汗后表证已解，但胃中不和，心下痞硬，胁下有水气，腹中肠鸣如雷并伴下利的情况。
组成：黄芩，甘草（炙），人参（各一两半），干姜（炮制），黄连（各半两），半夏（一两一钱，汤泡）。
制法：以上药物切碎成散剂。每次服用三钱，用水一盏，生姜三片，大枣一枚，煎至七分，去渣温服。
保安丸：治疗小儿泄泻、伤食腹泻。
组成：香附子（净选），砂仁（各一两），白姜（炮制），青皮（去瓤），陈皮（去白），三棱（炮制），莪术（炮制），甘草（炙，各半两）。
制法：以上药物研为细末，用小麦面糊制成丸剂，如绿豆大小。每次服用三丸，用白开水送服，饭前温服。
杏霜丸：治疗小儿食积作泻、以及痢疾证候。
组成：杏仁（三两，去皮尖，麸炒），巴豆（一两，去壳去油，炒焦，再放入杏仁同炒），黄蜡（二两，酒煮，绵布过滤），百草霜（炒，研为细末，二两，用油六钱，炒匀）。
制法：先将杏仁、巴豆研至极细，再加入百草霜令其均匀，熔化黄蜡和丸，如绿豆大小。赤痢用甘草汤送服，白痢用生姜汤送服，先进服三四次，若有腹胀者，服十余次，疗效神奇。
《医局》开胃丸：治疗小儿脏腑怯弱，内受风冷，腹胁胀满，肠鸣泄利，大便或青或白，乳食不化；又治疗脏冷夜啼，胎寒腹痛。
组成：木香，蓬莪术，白术，人参（去芦头），当归（切碎，微炒，各半两），麝香（细研），白芍药（各一分）。
制法：以上药物捣碎过筛为细末，充分研磨均匀，用热水浸湿炊饼，和丸如黍米大小。每次服用十五丸，用温米饮送服。新生儿腹痛夜啼，可服用五丸，并在乳食前服用。
Mr. Tang stated: For this type of diarrhea, tonification should not be administered immediately. Instead, food-resolving medicines should be used first, or Zishuang Wan (Purple Frost Pill) can be employed to eliminate stagnation during the Bianzheng fever period. Only after the stagnation is completely cleared can tonification be considered. The *Classic* states: In cases of severe food-stagnation diarrhea, one must consider deficiency due to Gan syndrome and employ methods to tonify deficiency. To treat food-stagnation diarrhea, Xiangju Bingzi (Fragrant Orange Cake) can be modified, or Guanyin San (Guanyin Powder) and Tiaozhong Tang San (Regulate the Middle Decoction Powder) may be selected and adjusted according to clinical presentation. Food-stagnation diarrhea is difficult to stop and is unsuitable for immediate tonification. If re-injury leads to further diarrhea, dietary intake should be regulated. Jinshi Wan (Advance Food Pill) should be used to purge the food accumulation until it is fully expelled, followed by Qian Yi's Modified Yihuang San (Yellow Elixir Powder), where a single herb may suffice to stop the diarrhea; this is a crucial therapeutic method. Subsequently, Yigong San (Yigong Powder) and Sijunzi Tang (Four Gentlemen Decoction) [both indicated for vomiting and diarrhea] should be used for conditioning, ensuring complete recovery. For patients with borborygmus (rumbling in the abdomen) and dysentery, Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction) is the primary treatment. For diarrhea caused by cold accumulation, Xiangpo San (Fragrant Magnolia Bark Powder) is used to stop diarrhea, while Baizhu San (Atractylodes Macrocephala Powder) harmonizes Qi and regulates the Stomach. Tiaozhong San, Baoan Wan, and Yinggan Wan can all treat food-stagnation diarrhea; Chenxiang Jian and Sanleng Wan (for Pi accumulation) are also applicable.
Li Dongyuan stated: Food injury leads to aversion to food. In pediatric food-stagnation diarrhea, the spleen and stomach are damaged by diet, causing Spleen Qi to fail in its transporting and transforming functions, resulting in undigested milk and food being excreted. If belching with foul odor, acid regurgitation, chest and diaphragm fullness, and abdominal pain that worsens upon pressure occur, although diarrhea is present, the stagnant material has not yet digested; Baohe Wan should be used. If abdominal pain does not worsen upon pressure, it indicates that the milk and food have already digested; Yigong San should be used. If Spleen Qi is injured and has not recovered, leading to loss of appetite, Liujunzi Tang (Six Gentlemen Decoction) should be used. If the injury was caused by raw or cold foods and the patient prefers warmth, add Muxiang (Costus Root) and Ganjiang (Dried Ginger). If the milk and food have digested, abdominal pain has ceased, but diarrhea persists, this is due to the failure of Spleen Yang to ascend clearly; Buzhong Yiqi Tang (Center-Boosting Qi-Rescuing Decoction) should be used. For other syndromes, refer to respective chapters.
[Qian Yi] The two-year-old son of Huang Chengwu suffered from food-stagnation diarrhea. Other physicians treated him with antidiarrheal agents. After more than ten days, his stool became greenish-white, milk and food remained undigested, his body temperature dropped, and he exhibited hiccups and lethargy. Everyone considered his condition critical and summoned Qian Yi. Qian Yi first administered Yihuang San and Bufei San (Tonify Lung Powder), three doses each. After three days, his body temperature normalized, and hiccups ceased. He then mildly purged the child using Baixing Zi (White Pill) and administered Yipi San (Spleen-Boosting Powder) for three doses, after which the diarrhea stopped. Why was this approach taken? The diarrhea originated from Spleen deficiency and food injury. Initially, purgatives were withheld, allowing the condition to linger for ten days, resulting in excess above and deficiency below. Weak Spleen Qi led to concurrent Lung deficiency due to the mother-child relationship between Spleen and Lung. By tonifying the Spleen first, the Lung pathology receded naturally, normalizing body temperature and stopping hiccups. Only then was the pathogenic food eliminated. One might ask: Why not purge first and tonify later? The answer is that green stool indicates cold in the lower Jiao. Purging first would cause severe deficiency. By solidifying the Spleen Qi before purging, deficiency is avoided. Subsequent tonification ensures stability.
Xiangju Bing (Fragrant Orange Cake): Treats stagnation diarrhea and cold-induced diarrhea.
Ingredients: Muxiang (Costus Root), Qingpi (Green Tangerine Peel) (each 1 qian); Chenpi (Tangerine Peel) (2.5 qian); Houpo (Magnolia Bark) (processed with ginger juice); Shenqu (Medicated Leaven); Maiya (Malt) (each 0.5 liang).
Preparation: Grind into powder, form into cakes with honey. Administer with Perilla seed infusion.
Jiajian Guanyin San (Modified Guanyin Powder): Treats vomiting and diarrhea, intercepts deficiency wind.
Ingredients: Huangqi (Astragalus Root), Renshen (Ginseng Root) (each 2.5 qian); Muxiang (Costus Root); Gancao (Licorice Root) (honey-fried); Shilian (Lotus Seed) (core removed); Bian Dou (Lablab Bean) (stir-baked); Fuling (Poria); Baizhu (Atractylodes Rhizome); Quanxie (Scorpion); Qianghuo (Notopterygium Rhizome) (each 1 qian); Fangfeng (Saposhnikovia Root); Tianma (Gastrodia Rhizome) (each 2 qian).
Preparation: Cut into pieces for decoction. Decoct with fresh ginger and jujube.
Tiaozhong San (Regulate the Middle Powder): Treats food-stagnation diarrhea. For this type of diarrhea, tonification is contraindicated initially; use food-resolving drugs or Zishuang Wan to clear stagnation before tonifying.
The Classic states: Severe food-stagnation diarrhea requires addressing Gan deficiency with tonification. A skilled physician understands these profound principles and need not worry about the difficulty of curing the disease.
Ingredients: Renshen (Ginseng Root) (rhizome removed); Baifuling (White Poria); Baizhu (Atractylodes Rhizome); Muxiang (Costus Root); Ganjiang (Dried Ginger) (roasted); Huoxiangye (Patchouli Leaf); Xiangfuzi (Cyperi Rhizome) (stir-baked, hairs removed); Suasharen (Amomum Fruit); Gancao (Licorice Root) (honey-fried); Dingxiang (Clove Bud) (equal parts).
Usage: Grind into powder. Take 1 qian per dose, mixed with ginger-jujube decoction. For abdominal pain, take with plain water. Adjust dosage based on age.
Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction): Treats post-sweating syndrome where the exterior is resolved but the Stomach is disharmonious, presenting with epigastric hardness, fluid retention under the hypochondrium, borborygmus, and diarrhea.
Ingredients: Huangqin (Scutellaria Root); Gancao (Licorice Root) (honey-fried); Renshen (Ginseng Root) (each 1.5 liang); Ganjiang (Dried Ginger) (roasted); Huanglian (Coptis Rhizome) (each 0.5 liang); Banxia (Pinellia Tuber) (1.1 qian, soaked in boiling water).
Preparation: Cut into pieces for decoction. Take 3 qian per dose with one cup of water, three slices of fresh ginger, and one jujube. Decoct to 70% volume, strain, and take warm.
Baoan Wan (Security Pill): Treats pediatric diarrhea and food-stagnation diarrhea.
Ingredients: Xiangfuzi (Cyperi Rhizome) (cleaned); Sharen (Amomum Fruit) (each 1 liang); Baijiang (White Ginger) (roasted); Qingpi (Green Tangerine Peel) (pith removed); Chenpi (Tangerine Peel) (albedo removed); Sanleng (Sparganium Rhizome) (roasted); Ezhu (Curcuma Rhizome) (roasted); Gancao (Licorice Root) (honey-fried, each 0.5 liang).
Preparation: Grind into powder, bind with wheat flour paste into pills the size of mung beans. Take 3 pills per dose with warm water before meals.
Xingshuang Wan (Apricot Frost Pill): Treats pediatric food-stagnation diarrhea and dysentery.
Ingredients: Xingren (Apricot Seed) (3 liang, skin and tip removed, stir-fried with bran); Badou (Croton Seed) (1 liang, shell removed, oil extracted, stir-fried until scorched, then added back to apricot seeds for frying); Huangla (Beeswax) (2 liang, boiled in wine, filtered through silk); Baicaoshuang (Soot from Chimneys) (2 liang, stir-fried into powder, mixed with 6 qian of oil).
Preparation: Grind apricot seeds and croton seeds into fine powder, mix evenly with soot powder, melt beeswax, and form pills the size of mung beans. For bloody dysentery, administer with licorice decoction; for white dysentery, with ginger decoction. Start with 3-4 doses; if abdominal distension is present, take over 10 doses. The efficacy is miraculous.
*Yiju* Kaiwei Wan (Stomach-Opening Pill from the Medical Bureau): Treats weak internal organs in children, internal wind-cold invasion, abdominal and hypochondriac distension, borborygmus and diarrhea with green or white stools, undigested milk and food. Also treats night crying due to organ cold and fetal cold abdominal pain.
Ingredients: Muxiang (Costus Root); Peng'e Zhu (Curcuma Rhizome); Baizhu (Atractylodes Rhizome); Renshen (Ginseng Root) (rhizome removed); Danggui (Angelica Sinensis Root) (cut, lightly stir-fried, each 0.5 liang); Shexiang (Musk) (finely ground); Baishaoyao (White Peony Root) (each 1 fen).
Preparation: Pound and sieve into powder, grind uniformly. Mix with steamed dough soaked in hot water to form pills the size of millet seeds. Take 15 pills per dose with warm rice drink. For newborns with abdominal pain and night crying, take 5 pills before feeding.