汤氏云∶小儿热泻者，大便黄赤有沫，乃脏中有积，或蕴结所致。若小便赤少，口干烦躁，
当用四苓散，热甚者四逆散。右腮色赤饮冷，胃经实热也，用泻黄丸。恶冷喜热，胃经虚热
也，用白术散。右腮及额间俱赤，心脾翕热也，用泻黄散加炒黑黄连。若左颊右腮俱赤，肝
火乘脾土也，用四君子汤加柴胡。若儿暴伤乳食，用保和丸，乳母尤当忌浓味，节饮食。若
乳母停食所伤，致儿吐泻等病，当治其母。大抵始病而热者，邪气胜则实也；终变为寒者，
真气夺则虚也；久病而热者，内真寒而外假热也。久泻元气虚寒，当参前症治之。
治验
一小儿夏间食粽伤胃，吐而腹痛，余用保和丸，彼以为缓，另用重剂，吐泻并作，腹痛益甚
，按其腹却不痛。余曰∶此食已消，而脾胃虚也，当温补之。仍行消导，昏愦发搐，余用异
功散加木香治之，渐愈。后复伤食，另用去积丸，吐泻不食，手足并冷，睡而露睛，变为疟
疾，余用六君、木香、炮姜，治之而愈。
一小儿泻而大便热赤，小便涩少。此热蕴于内也，先用四苓散加炒黄连一剂，其热顿退；又
用白术散去木香二剂，热渴顿止；以四君、升麻调理而痊。
一小儿食炙 甘甜之物，常作泻，大便热痛，小便赤涩，此膏粱积热所致，用四苓散、清胃
散，各四服，诸症稍退，乃用四味肥儿丸而瘥。
一小儿九岁，食炙 之物，作泻饮冷，诸药不应，肌体消瘦，饮食少思，余用黄连一两，酒
拌炒焦为末，入人参末四两，粥丸小豆大，每服四五十丸，不拘时，白汤下，服讫渐愈；又
用五味异功散加升麻，服月余而瘥。后不戒浓味，患疳积消瘦，少食发热作渴，用九味芦荟丸
为主，以四味肥儿丸为佐，疳症渐退；却以四味肥儿丸为主，以五味异功散为佐而痊。后又
不禁浓味，作泻饮冷，仍服肥儿丸、异功散而愈。
一小儿侵晨泄泻，服消疳清热之剂，不应。余谓脾肾虚，用二神丸治之。不信，仍服前药，
形体骨立，复求治。用四神、六味二丸治之寻愈。停药数日，饮食渐减，泄泻仍作。至十七
岁毕姻，泻渴顿作，用前药治之无效，乃用补中益气汤、八味丸而始应。
一小儿因母怒气，停食患泄泻，服消导之剂，更加吐乳。先用养胃汤加炒黑黄连一钱、吴茱
萸二分、木香四分治其母，子亦灌一二匙悉愈。后母伤食患血痢腹痛，其子亦然，治以四君
子加前三味，母子俱服，因惑于人言，但令母服，子另服治痢之药，加作呕不乳，手足并冷
，余用五味异功散加木香、炮姜、漏芦，母子并服而愈。
一小儿患泻，身热作渴，泻下秽气，此为内热而泻也，用香连丸一服而愈。后患泻，服黄连
香薷饮益甚，余用六君、木香、肉果而愈。
一小儿患泻，作渴饮冷，手足并热，睡而露睛，此为热泻，用黄芩汤一剂而愈，又用白术散
二服而安。
一小儿患泻，面赤饮冷，小便赤色，先用四苓散、香连丸各一服，而便利势减，又用异功散
加木香、黄连各二分、吴茱萸一分，二服而愈。
一小儿泻而腹痛，按之不痛，用异功散加升麻而愈。后复泻，服消乳丸，益加腹痛，余谓脾
气伤也，复用异功散加木香而痊。
一小儿吐泻腹痛，睡而露睛，小腹重坠，手足并冷，先用六君、升麻、干姜四服而痛坠愈；
又用异功散加升麻、木香而悉愈。后又伤食腹痛，别服祛逐之剂，虚症悉具，余用理中丸、
六君子汤而寻愈。但噫气下气，口角流涎，此脾胃虚寒也，复用理中、六君子二汤而愈。
黄芩汤 治下痢头痛，胸满口干，或寒热胁痛，不时呕吐。其脉浮大而弦。
黄芩（一两五钱） 芍药 甘草（炒。各一两）
上每服二三钱，姜水煎，呕加半夏二钱。
玉露散 治吐泻黄色。
寒水石 石膏（各半两） 甘草（一钱）
上为末，每服半钱，白滚汤调服。
四味肥儿丸（方见呕吐）
异功散（方见内钓）
二神丸
四神丸（二方见惊泻）
八味丸（即六味丸加肉桂、五味，方见肾脏）
调中丸（即理中汤，方见咳嗽）
白术散（方见积痛）
四苓散（即五苓散去桂，方见五淋）
四逆散（方见积滞）
胃苓汤（方见吐泻）
养胃汤（方见疟症）
清胃散
四君子汤
六君子汤（三方见内钓）
保和丸（方见虚羸）
香连丸（方见诸痢）
Tang Shi stated: In cases of pediatric heat diarrhea, the stool is yellowish-red and frothy, caused by accumulation in the zang-fu organs or constraint of pathogenic factors. If urination is dark red and scanty, accompanied by dry mouth and irritability, Siling San (Four-Ling Powder) should be used; for severe heat, Sixini San (Four-Reversal Powder) is indicated. Redness on the right cheek with a preference for cold drinks indicates excess heat in the Stomach channel; Xiehuang Wan (Drain Yellow Pill) is prescribed. Aversion to cold and preference for warmth indicate deficiency heat in the Stomach channel; Baizhu San (Atractylodes Macrocephala Powder) is used. Redness on both the right cheek and forehead indicates internal heat in the Heart and Spleen; Xiehuang San (Drain Yellow Powder) added with stir-burned Coptidis Rhizoma (Huanglian, 黄连) is applied. Redness on both the left cheek and right cheek indicates Liver fire invading the Spleen earth; Sijunzi Tang (Four-Gentlemen Decoction) added with Bupleuri Radix (Chaihu, 柴胡) is used. For sudden injury from milk and food, Baohe Wan (Preserve Harmony Pill) is employed; the nursing mother must particularly avoid rich flavors and regulate her diet. If the nursing mother suffers from food stagnation causing vomiting and diarrhea in the infant, the mother should be treated. Generally, heat at the onset of disease indicates an excess pattern due to strong pathogenic qi; transformation into cold at the end indicates a deficiency pattern due to depletion of true qi; heat persisting in chronic illness indicates true cold internally with false heat externally. Chronic diarrhea leading to deficiency-cold of Yuan Qi should be treated according to the preceding symptoms.
Clinical Cases
A child injured his stomach by eating zongzi (sticky rice dumplings) in summer, presenting with vomiting and abdominal pain. I used Baohe Wan (Preserve Harmony Pill), but he considered it too slow and used a heavy-dose preparation instead. This resulted in simultaneous vomiting and diarrhea, with worsened abdominal pain, yet pressing the abdomen elicited no pain. I said: "The food accumulation has already dissipated, but the Spleen and Stomach are deficient; warming and tonification are required." Continuing with digestion-promoting methods would lead to stupor and convulsions. I switched to Yigong San (Extra-Ability Powder) added with Aucklandiae Radix (Muxiang, 木香), and he gradually recovered. Later, upon re-injury from food, he took Quji Wan (Remove Accumulation Pill), resulting in vomiting, diarrhea, anorexia, cold limbs, and sleeping with eyes half-open (exposing the eyeballs), transforming into malaria. I treated him with Liujunzi Tang (Six-Gentlemen Decoction), Muxiang, and Paojiang (Prepared Ginger), curing him.
A child presented with diarrhea, hot reddish stools, and scanty, difficult urination. This indicated heat constrained internally. Initially, Siling San (Four-Ling Powder) added with stir-burned Huanglian was given for one dose, immediately reducing the heat. Then, Baizhu San (Atractylodes Macrocephala Powder) without Muxiang was given for two doses, stopping the heat and thirst. Finally, Sijunzi Tang (Four-Gentlemen Decoction) and Cimicifugae Rhizoma (Shengma, 升麻) were used for regulation, leading to recovery.
A child frequently suffered from diarrhea after consuming roasted sweet foods, with hot painful stools and dark, difficult urination. This was caused by heat accumulation from rich foods. Siling San (Four-Ling Powder) and Qingwei San (Clear Stomach Powder) were each administered four times, slightly alleviating symptoms, followed by Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) for complete recovery.
A nine-year-old child suffered from diarrhea and desire for cold drinks after eating roasted foods, unresponsive to various medicines, with emaciation and poor appetite. I used one liang of Huanglian (Coptidis Rhizoma), stir-fried with wine until charred, powdered, and mixed with four liang of Ginseng Radix et Rhizoma (Renshen, 人参) powder. These were made into pills the size of adzuki beans using congee. Each dose was 40-50 pills, taken anytime with warm water. He gradually improved. Subsequently, Wuyi Yigong San (Five-Ingredient Extra-Ability Powder) added with Shengma was taken for over a month, leading to recovery. Later, failing to avoid rich foods, he developed malnutrition syndrome (Gan Ji) with emaciation, low intake, fever, and thirst. Jiawei Lushen Wan (Nine-Ingredient Wormwood Pill) was used as the principal formula, assisted by Siwei Fei'er Wan, gradually resolving the Gan syndrome. Then, Siwei Fei'er Wan became the principal formula, assisted by Wuyi Yigong San, leading to recovery. Again, failing to avoid rich foods, he had diarrhea and desired cold drinks; taking Fei'er Wan and Yigong San cured him.
A child suffered from morning diarrhea. Digestion-promoting and heat-clearing agents were ineffective. I diagnosed Spleen and Kidney deficiency and prescribed Ershen Wan (Two-Gods Pill). Disbelieving this, he continued previous medications, becoming emaciated, and sought treatment again. I used Sishen Wan (Four-Gods Pill) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), and he recovered soon. After stopping medication for a few days, food intake decreased, and diarrhea recurred. At age seventeen, after marriage, diarrhea and thirst suddenly intensified. Previous treatments failed; only Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Bawei Wan (Eight-Ingredient Pill) proved effective.
A child suffered from diarrhea due to maternal anger and food stagnation. Digestion-promoting agents worsened vomiting of milk. The mother was first treated with Yangwei Tang (Nourish Stomach Decoction) added with stir-burned Huanglian (one qian), Evodiae Fructus (Wuzhuyu, 吴茱萸) (two fen), and Muxiang (four fen). The infant was also given one or two spoonfuls, resulting in complete recovery. Later, the mother suffered from bloody dysentery and abdominal pain due to food stagnation, and the infant exhibited similar symptoms. Treatment involved Sijunzi Tang added with the aforementioned three herbs, taken by both mother and infant. However, influenced by others' words, only the mother took it, while the infant took separate dysentery medicine, leading to vomiting, refusal to nurse, and cold limbs. I used Wuyi Yigong San (Five-Ingredient Extra-Ability Powder) added with Muxiang, Paojiang, and Lulu (Radix Agrimoniae, 漏芦), administered to both, curing them.
A child presented with diarrhea, fever, thirst, and foul-smelling stools, indicating internal heat diarrhea. Xianglian Wan (Coptis and Aucklandia Pill) cured him in one dose. Later, diarrhea worsened with Huanglian Xiangru Yin (Coptis and Elsholtzia Drink). I treated him with Liujunzi Tang (Six-Gentlemen Decoction), Muxiang, and Myristicae Semen (Rouguo, 肉果), achieving recovery.
A child presented with diarrhea, thirst for cold drinks, hot limbs, and sleeping with eyes half-open, indicating heat diarrhea. Huangqin Tang (Scutellaria Decoction) cured him in one dose, followed by Baizhu San for stabilization.
A child presented with diarrhea, red face, desire for cold drinks, and red urine. Initially, Siling San (Four-Ling Powder) and Xianglian Wan were each given once, reducing bowel and urinary urgency. Then, Yigong San (Extra-Ability Powder) added with Muxiang, Huanglian (each two fen), and Wuzhuyu (one fen) cured him in two doses.
A child presented with diarrhea and abdominal pain, but no pain upon pressure. Yigong San added with Shengma cured him. Later, recurrence of diarrhea after taking Xiaoru Wan (Digest Milk Pill) worsened abdominal pain. I diagnosed Spleen Qi injury and reused Yigong San added with Muxiang, leading to recovery.
A child presented with vomiting, diarrhea, abdominal pain, sleeping with eyes half-open, heavy sensation in the lower abdomen, and cold limbs. Initially, Liujunzi Tang (Six-Gentlemen Decoction), Shengma, and Ganjiang (Dried Ginger) were given for four doses, relieving pain and heaviness. Then, Yigong San added with Shengma and Muxiang completely cured him. Later, food stagnation caused abdominal pain; taking expulsion agents led to full deficiency symptoms. Lizhong Wan (Regulate the Middle Pill) and Liujunzi Tang cured him soon. Belching, flatulence, and drooling indicated Spleen-Stomach deficiency-cold; Lizhong Tang and Liujunzi Tang cured him.
Huangqin Tang (Scutellaria Decoction) treats dysentery with headache, chest fullness, dry mouth, alternating chills and fever with hypochondriac pain, and frequent vomiting. The pulse is floating, large, and wiry.
Huangqin (Coptidis Rhizoma) (1 liang 5 qian) Shaoyao (Paeoniae Radix) Gancao (Licorice Root) (stir-fried, each 1 liang).
Take 2-3 qian per dose, decoct with ginger water. Add Banxia (Pinelliae Rhizoma) 2 qian if vomiting occurs.
Yulu San (Jade Dew Powder) treats yellow vomiting and diarrhea.
Hanshuishi (Calcitum) Shigao (Gypsum Fibrosum) (each half liang) Gancao (1 qian).
Powder these. Take half a qian per dose, mixed with boiling water.
Siwei Fei'er Wan (See Vomiting for formula)
Yigong San (See Internal Hook for formula)
Ershen Wan
Sishen Wan (See Fright Diarrhea for formulas)
Bawei Wan (i.e., Liuwei Wan added with Rougui and Wuweizi, see Kidney Disease for formula)
Tiaozhong Wan (i.e., Lizhong Tang, see Cough for formula)
Baizhu San (See Accumulation Pain for formula)
Siling San (i.e., Wuling San minus Guizhi, see Five Stranguries for formula)
Sixini San (See Food Stagnation for formula)
Weiling Tang (See Vomiting and Diarrhea for formula)
Yangwei Tang (See Malaria for formula)
Qingwei San
Sijunzi Tang
Liujunzi Tang (Three formulas see Internal Hook)
Baohe Wan (See Emaciation for formula)
Xianglian Wan (See Various Dysenteries for formula)