甲、概况
小儿吐泻兼作，肠胃交病也。先吐而后泻者，病由胃及肠，先泻而后吐者，病由肠及胃。盖吐则中焦之
气失和，胃中浊阴，下侵及肠，吐有可以致泻者，泻则阑门传化失职，肠中浊阴，上干及胃，泻有可以致吐
者。然吐泻交作，其病又莫不关涉乎脾，盖脾运不健，致水湿不循正道，或横决而上，或注泻而下。向使
脾能统率有权，则肠胃又何致交病哉！故治吐泻之病，无论其为吐宜治胃，无论其为泻宜治肠，无论其为吐泻
交作宜胃肠并治，然皆必须顾其脾，脾运则统率有权，肠胃自调而吐泻自止矣。然此病之起，原因不一，在小
儿患之，大都宿食滞留，挟感而发，或脾胃素弱，感受时邪，亦足致此，因身体之不同而所感之互异
也。故吐泻一证，有夹食、夹湿、夹热、夹寒之别，凡夹食积者，泻多渣滓而吐多不化；夹湿滞者，泻多臭秽
而吐多浊水；夹热者，自汗面垢，吐泻热利而小便少；夹寒者，四肢厥冷，吐泻清谷而小便利。此其大端也。
此证在夏月秋令患之最多，盖以人当炎令，肠胃最弱而感受最易。其重者亦名霍乱，以其证状为挥
霍扰乱也。然真霍乱一证，初起必腹中绞痛，继则吐泻无度，终至手足挛急，罗纹陷瘪者乃是。若仅为吐泻，
皆似霍乱也。亦有小儿脾胃虚弱，每食辄易致吐致泻者，是为因虚弱而作，与夹积、夹感暴起之吐泻，迥不相
同。更有吐泻频作，欲生惊风者，是为脾胃衰败之吐泻，尤非夹积夹感之吐泻可比。故吐泻一证，
其源虽一，而证情之各别，虚实之迥殊。有如此者，欲明源流，讵又可不详为分辨乎。
乙、治法
吐泻交作，勃然而起，其远因为肠胃本不清肃，一旦伤食、伤暑或感冒风寒，清浊之气，交乱于中，遂为
引动。此证腹中胃脘大都作痛，痛一阵则泻一阵，复吐一阵，由于伤食者，腹中坚硬绕痛，频泻则渐减，治宜
行滞化积，升清降浊，用冲和汤；由于伤暑者，泻利多水，身体发热，暑必夹湿，治宜暑湿兼顾，用
燃照汤；由于感冒风寒者，恶寒身热，治宜行滞化积之中，寓以解表，用藿香正气丸；泻多吐少，湿盛者宜
胃苓汤；吐泻不多，热甚脘闷者，宜竹叶石膏汤或桂苓甘露饮；泻少吐多，口渴欲饮，水逆于上，饮后即呕
者，宜五苓散加半夏。凡因泄水过多，筋不能荣，而为拘急转筋之状者，酌加木瓜、白芍以舒之。由于
受寒者，四肢清冷，吐泻秽浊而不致洞泻如注者，治宜温中以行其寒湿，用理中汤加苏梗、吴萸；下寒上热
者、酌加黄连。以上诸恙，虽为平时所皆有，而在暑令为独多，世俗亦称之为霍乱者也。偏于湿者，则名湿霍
乱，偏于热者，则名热霍乱。亦有名之为暑霍乱者，其实皆有类于霍乱耳，其有暑令发生之真霍乱，为
他时所无而为暑令之所独有者，其证状为心腹绞痛，吐利清谷，小便利，口不渴，手足拘急，甚者手足罗纹
麻瘪，脉微欲绝，寒象毕露者，是为正候，宜急用附子理中汤或四逆汤救之，迟则每不及挽。亦有初起腹中扰
乱，而欲吐不吐，欲泻不泻，转筋而危急欲绝者为干霍乱，宜先以盐一撮放刀上，用火炙透，温水送下，
用鸡翎扫喉以探吐，或服明矾少许以探吐，上得吐下即可泻，或不探其吐而先用大黄泻之亦可，或以雷公救
疫散灸之亦可，俟吐泻齐作，再以前方治之。尚有吐泻不禁而腹中不痛者，肠胃之门户洞开，收摄无权，亦为
危候，均宜以前法为治。而当其泻下过多之时，罗纹麻瘪，耗水过甚，用盐水注射以增其水而利其肾，
亦为急救之一助。至于吐泻之非暴起而由渐来者，非属疳积，必由脾胃虚弱所致。治宜培补脾胃，用异功散及
六君子汤等。吐泻昏睡露睛欲生风候者，宜钱氏白术散，或参苓白术散加白附子、天麻、钩藤之属。平时宜
以八仙糕调理之。总治吐泻交作之病，实者宜渗泄，而虚者宜温化，毋使脾家受困，统率无权，则大端为不谬矣。
附方
（一）冲和汤（自制） 治小儿饮食不化，发为吐泻，行气化积，使臻冲和，四时均宜。
浓朴 神曲 白芍 黄芩（各钱半） 半夏 豆豉 佩兰（各二钱）
滑石 赤苓（各三钱） 甘草（五分）
（二）燃照汤 治暑秽挟湿霍乱，吐下脘痞，烦渴，恶寒肢冷。
草果 豆豉 山栀 省头草 川朴 半夏 黄芩 滑石
（三）藿香正气丸 治外感风寒，内伤饮食，憎寒，壮热，头痛，呕逆，胸闷，腹胀，痰嗽，气喘，
伤冷，伤湿，伤暑，霍乱，吐泻，疟痢，山岚瘴疠，不服水土等证。
藿香 大腹皮 白芷 茯苓 紫苏 陈皮 白术 浓朴 桔
梗半复 甘草 加姜、枣。
（四）胃苓汤 见本章节三节。
（五）竹叶石膏汤 治伤寒胃虚而热，烦渴作呕。
竹叶 石膏 半夏 人参 甘草（炙） 粳米 麦冬（去芯）
（六）桂苓甘露饮 见本章第三节。
（七）五苓散 见第三章第五节。
（八）理中汤 见第一章第四节。
（九）附子理中汤 见第五章第四节。
（十）四逆汤 治少阴病，表热里寒，下利清谷，四肢拘急，手足厥冷，脉微欲绝者。
甘草 干姜 附子
（十一）四苓散，治湿热霍乱，胸闷胀痛，溺涩烦渴。
茯苓 猪苓 泽泻 陈皮（各等分）
研为细末，每服二三钱。此方从五苓散中化出，去肉桂之温，以陈皮易白术，有利气之功，而无实中
之弊，治湿热霍乱之良方也。
（十二）雷公救疫散 外用。治霍乱脐腹绞痛，四肢挛急。
桂心 丁香 硫黄 吴茱萸 加当门子（少许）
共为细末纳脐中，用老姜一大片盖于脐上，再用蕲艾放在姜片上烧灸，轻者一次，重者二三次，然后除
去姜片，粘贴暖脐膏，使药气不致外泄。
（十三）异功散 见第三章第六节。
（十四）六君子汤 见第五章第三节。
（十五）钱氏白术散 治吐泻已久，虚热而渴。
白术 人参 白茯苓 藿香 木香 甘草（炙。各五分） 干葛（一钱）
共为细末，清水煎服。
（十六）参苓白术散 治脾胃虚弱，饮食不进，多困少气，胸中痞满，噫呕腹逆，喘咳消渴，大便不实及
久泻，痈疽溃后不思食者。
人参 白茯苓 于术 山药 石莲肉（去心，炒） 白扁豆（去皮，
姜汁浸炒） 桔梗 砂仁 薏苡仁（炒） 甘草（炙）
（十七）八仙糕 治脾胃虚弱，食少体倦，易吐易泻。
人参 茯苓 山药 芡实 莲子肉（各六两）
研为细末，加糯米粉三升，粳米粉七升，和匀，以白蜜一斤，白糖二斤八两，用水熬化，拌药粉中，
置笼上蒸熟，切成条糕，火上烘干，瓷器收贮。
（十八）十滴水 治暑令上吐下泻，霍乱腹痛。
大黄酒 樟脑油 薄荷油 生姜酒
混和，每服三滴至五滴。此方为吐泻初起之配剂。
生姜酒 辣椒酒 樟脑油 薄荷油、肉桂油
另加大黄酒 鸦片酒少许，混和，每服三滴至五滴。此方为吐泻过多之配剂。
（十九）揩擦法 外用。治霍乱四肢厥冷。
生附子捣烂，揩擦四肢及手足心，或用烧酒、白兰地酒亦可。
A. Overview
When infants and children experience simultaneous vomiting and diarrhea, it indicates a concurrent disease of the stomach and intestines. If vomiting precedes diarrhea, the pathogen spreads from the stomach to the intestines; if diarrhea precedes vomiting, the pathogen spreads from the intestines to the stomach. Generally, vomiting disrupts the harmony of Qi in the Middle Jiao (the middle section of the body, primarily involving the spleen and stomach), causing turbid Yin fluids in the stomach to invade downward into the intestines, thus vomiting can lead to diarrhea. Diarrhea impairs the transmission function of the Lanmen (the junction between the small and large intestines), causing turbid Yin fluids in the intestines to attack upward into the stomach, thus diarrhea can also lead to vomiting. However, when vomiting and diarrhea occur alternately, the pathology invariably involves the Spleen. This is because impaired Spleen transportation leads to water-dampness failing to follow its proper course, either overflowing upward or pouring downward. If the Spleen could maintain its controlling authority, how would the stomach and intestines suffer concurrently? Therefore, in treating vomiting and diarrhea, whether the focus is on the stomach for vomiting, the intestines for diarrhea, or both for alternating symptoms, one must always protect the Spleen. When Spleen transportation is normal, controlling authority is maintained, the stomach and intestines harmonize naturally, and vomiting and diarrhea cease.
However, the causes of this disease vary. In children, it is mostly due to retained food stagnation complicated by external contraction, or due to inherent weakness of the Spleen and Stomach contracting seasonal pathogens. These differences arise from variations in the body's constitution and the specific pathogens contracted. Thus, the syndrome of vomiting and diarrhea is categorized into those complicated by Food Stagnation, Dampness, Heat, or Cold. Cases with Food Stagnation present with feces containing undigested residue and vomitus of unprocessed food. Cases with Dampness Stagnation present with foul-smelling feces and turbid watery vomitus. Cases with Heat present with spontaneous sweating, greasy facial complexion, hot diarrhea, and scanty urination. Cases with Cold present with cold limbs, vomiting and diarrhea of clear undigested grains, and free urination. These are the general principles.
This condition is most prevalent in summer and autumn because during hot weather, the stomach and intestines are weakest and most susceptible to pathogens. Severe cases are also named Huoluan (Cholera-like illness characterized by severe vomiting and diarrhea) due to the chaotic nature of the symptoms. However, true Huoluan begins with severe abdominal colic, followed by incessant vomiting and diarrhea, eventually leading to limb spasms and sunken fingernail beds (a pediatric diagnostic sign). Mere vomiting and diarrhea are merely similar to Huoluan. Some children with weak Spleen and Stomach vomit and diarrhea easily after every meal; this is due to deficiency and differs significantly from the acute onset caused by food stagnation or external pathogens. Furthermore, frequent vomiting and diarrhea that threaten to induce Jingfeng (Pediatric Convulsions) indicate Spleen and Stomach collapse, which is incomparable to vomiting and diarrhea caused by stagnation or external pathogens. Thus, although the origin of vomiting and diarrhea is singular, the syndromes vary greatly, and the distinction between Deficiency and Excess is profound. To understand the source and flow, detailed differentiation is essential.
B. Treatment Methods
Sudden onset of alternating vomiting and diarrhea stems remotely from the lack of clarity and purity in the stomach and intestines. Once triggered by food injury, summerheat, or wind-cold invasion, the Clear and Turbid Qi become chaotic in the Middle Jiao. The abdomen and epigastrium usually hurt; pain triggers diarrhea, which is followed by vomiting. For cases due to food injury, the abdomen is hard with periumbilical pain, which gradually decreases with frequent diarrhea. Treatment should promote Qi movement, resolve stagnation, ascend the Clear, and descend the Turbid, using Chonghe Tang. For cases due to summerheat, there is watery diarrhea, fever, and dampness complicating summerheat. Treatment should address both summerheat and dampness, using Ranzhao Tang. For cases due to wind-cold invasion with aversion to cold and fever, treatment should promote Qi movement and resolve stagnation while incorporating exterior-releasing methods, using Huoxiang Zhengqi Wan. For profuse diarrhea with scanty vomiting and excess dampness, Weiling Tang is suitable. For mild vomiting and diarrhea with severe heat and epigastric stuffiness, Zhuye Shigao Tang or Guiling Ganlu Yin is suitable. For scanty diarrhea with profuse vomiting, thirst, water rebellion upwards, and immediate vomiting after drinking, Wuling San plus Banxia is suitable. In cases where excessive fluid loss fails to nourish the sinews, leading to cramping and tendon twitching, add Mugua and Baishao to soothe them. For cases due to cold invasion with cold limbs and turbid vomiting/diarrhea but not profuse watery stools, treatment should warm the Middle and dispel cold-dampness, using Lizhong Tang plus Sugen and Wuyu. For lower cold and upper heat, add Huanglian.
Although these conditions can occur at any time, they are most common in the summer season and are commonly referred to as Huoluan by laypeople. Those biased towards dampness are named Shi Huoluan (Damp Huoluan); those biased towards heat are named Re Huoluan (Heat Huoluan). Some are called Shu Huoluan (Summerheat Huoluan), all resembling Huoluan. True Huoluan occurring only in summer presents with heart/abdominal colic, vomiting/diarrhea of clear undigested grains, free urination, no thirst, limb stiffness, severe cases showing numb/sunken nail beds, faint pulse, and full manifestation of cold signs. This is the standard presentation requiring urgent administration of Fuzi Lizhong Tang or Sini Tang; delay may be fatal. Dry Huoluan presents with abdominal chaos, inability to vomit or defecate despite urges, and critical tendon twitching. Treat first by heating salt on a knife with fire, taking with warm water, or stimulating vomiting with chicken feathers dipped in alum. Once vomiting and diarrhea commence, treat with previous formulas. If vomiting/diarrhea is uncontrollable without abdominal pain, indicating open gates of the stomach/intestines and loss of retention control, it is also critical; use previous methods. When excessive diarrhea causes numb/sunken nail beds and severe fluid depletion, saline injection to replenish fluids and benefit the Kidney is an emergency aid.
For gradual onset of vomiting/diarrhea, excluding Ganic accumulation (pediatric malnutrition), it is caused by Spleen/Stomach weakness. Treatment should tonify the Spleen and Stomach using Yigong San or Liujunzi Tang. For vomiting/diarrhea with lethargy, protruding eyes, and threat of wind syndrome, use Qian's Baizhu San or Shenling Baizhu San plus Baifuzi, Tianma, and Gouteng. Maintenance should use Baxian Gao. Generally, Excess patterns require leaching and draining, while Deficiency patterns require warming and transforming. Avoid trapping the Spleen and losing controlling authority; then the major principles will not be erroneous.
Attached Formulas
(1) Chonghe Tang (Self-made): Treats indigestion leading to vomiting/diarrhea. Promotes Qi movement and resolves stagnation to achieve harmony. Suitable for all seasons.
Magnoliae Officinalis Cortex (Houpo), Medicated Leaven (Shenqu), White Peony Root (Baishao), Scutellaria Root (Huangqin) [each 1.5 qian]; Pinellia Tuber (Banxia), Fermented Soybean (Douchi), Eupatorium Fortunei (Peilan) [each 2 qian]; Talcum (Huashi), Red Poria (Chiling) [each 3 qian]; Licorice Root (Gancao) [0.5 qian].
(2) Ranzhao Tang: Treats summer-heat turbidity with dampness Huoluan, vomiting/diarrhea, epigastric fullness, irritability/thirst, aversion to cold, and cold limbs.
Tsaoko Cardamom Fruit (Caoguo), Fermented Soybean (Douchi), Gardenia Fruit (Shanzhi), Aromatic Mint (Shengtoucao), Magnoliae Officinalis Cortex (Chuanpu), Pinellia Tuber (Banxia), Scutellaria Root (Huangqin), Talcum (Huashi).
(3) Huoxiang Zhengqi Wan: Treats exterior wind-cold and interior food injury, chills/high fever, headache, retching, chest oppression, abdominal distension, phlegm cough, asthma, cold injury, damp injury, summerheat injury, Huoluan, vomiting/diarrhea, malaria/dysentery, mountain miasma, and acclimatization issues.
Patchouli Herb (Huoxiang), Tangerine Peel (Dafupi), Angelica Dahurica (Baizhi), Poria (Fuling), Perilla Leaf (Zisu), Tangerine Peel (Chenpi), Atractylodes Macrocephala Rhizome (Baizhu), Magnoliae Officinalis Cortex (Houpo), Platycodon Root (Jiegeng), Pinellia Tuber (Banxia), Licorice Root (Gancao). Add Ginger and Jujube.
(4) Weiling Tang: See Section 3 of this chapter.
(5) Zhuye Shigao Tang: Treats post-febrile disease with Stomach deficiency and heat, irritability/thirst, and vomiting.
Bamboo Leaf (Zhuye), Gypsum Fibrosum (Shigao), Pinellia Tuber (Banxia), Ginseng Radix (Renshen), Licorice Root (Gancao, roasted), Rice (Jingmi), Ophiopogon Tuber (Maidong, core removed).
(6) Guiling Ganlu Yin: See Section 3 of this chapter.
(7) Wuling San: See Chapter 3, Section 5.
(8) Lizhong Tang: See Chapter 1, Section 4.
(9) Fuzi Lizhong Tang: See Chapter 5, Section 4.
(10) Sini Tang: Treats Shaoyin disease with exterior heat and interior cold, profuse loose stools with undigested grains, limb stiffness, cold extremities, and faint pulse.
Licorice Root (Gancao), Zingiberis Rhizoma (Ganjiang), Aconiti Lateralis Radix Praeparata (Fuzi).
(11) Siling San: Treats damp-heat Huoluan, chest oppression/pain, difficult urination, irritability/thirst.
Poria (Fuling), Polyporus (Zhuling), Alisma Rhizoma (Zexie), Tangerine Peel (Chenpi) [equal parts]. Grind to fine powder, take 2-3 qian per dose. Derived from Wuling San, removing Cinnamon Twig (Rougui) for warmth, replacing Atractylodes (Baizhu) with Tangerine Peel (Chenpi) to promote Qi movement without causing excess stagnation. An excellent formula for damp-heat Huoluan.
(12) Leigong Jiuyi San: External use. Treats Huoluan with umbilical/abdominal colic and limb spasms.
Cinnamon Bark (Guixin), Clove (Dingxiang), Sulfur (Liuhuang), Evodia Fruit (Wuzhuyu), add Moschus (Dangmenzi, small amount). Grind to fine powder, apply to the navel. Cover with a slice of old ginger, moxibustion with Qiai (Artemisia argyi) on the ginger. Light cases: once; severe cases: 2-3 times. Remove ginger, apply Nuanqi Gao to prevent vapor leakage.
(13) Yigong San: See Chapter 3, Section 6.
(14) Liujunzi Tang: See Chapter 5, Section 3.
(15) Qian's Baizhu San: Treats prolonged vomiting/diarrhea with deficiency-heat and thirst.
Atractylodes Macrocephala Rhizome (Baizhu), Ginseng Radix (Renshen), Poria (Baifuling), Patchouli Herb (Huoxiang), Aucklandia Root (Muxiang), Licorice Root (Gancao, roasted, each 0.5 qian), Kudzu Root (Gange, 1 qian). Grind to powder, decoct in clear water.
(16) Shenling Baizhu San: Treats Spleen/Stomach weakness, poor appetite, fatigue, shortness of breath, chest fullness, belching/vomiting, wheezing/cough, wasting-thirst, loose stools, chronic diarrhea, and anorexia after abscess rupture.
Ginseng Radix (Renshen), Poria (Baifuling), Atractylodes Macrocephala Rhizome (Yushu), Chinese Yam (Shanyao), Nelumbo Nucifera Seed (Shilianrou, core removed, stir-fried), White Hyacinth Bean (Baibiandou, skin removed, soaked in ginger juice and stir-fried), Platycodon Root (Jiegeng), Amomum Fruit (Sharen), Coix Seed (Yiyiren, stir-fried), Licorice Root (Gancao, roasted).
(17) Baxian Gao: Treats Spleen/Stomach weakness, poor appetite, fatigue, easy vomiting/diarrhea.
Ginseng Radix (Renshen), Poria (Fuling), Chinese Yam (Shanyao), Euryale Seed (Qianshi), Lotus Seed (Lianzirou) [each 6 liang]. Grind to powder, mix with 3 sheng glutinous rice flour and 7 sheng japonica rice flour. Dissolve 1 jin white honey and 2.8 jin white sugar in water, mix with powder, steam in a steamer, cut into strips, dry over fire, store in porcelain.
(18) Shidi Shui: Treats summer-heat vomiting/diarrhea and Huoluan abdominal pain.
Da Huang Wine, Camphor Oil, Mentha Oil, Ginger Wine. Mix, take 3-5 drops. Formula for early stage vomiting/diarrhea.
Ginger Wine, Chili Wine, Camphor Oil, Mentha Oil, Cinnamon Oil. Add small amount of Da Huang Wine and Opium Wine. Mix, take 3-5 drops. Formula for excessive vomiting/diarrhea.
(19) Kacaa Method: External use. Treats Huoluan with cold extremities.
Raw Aconite Root (Sheng Fuzi) mashed, rub on limbs and palms/soles. Alternatively, use burning wine or brandy.