（第五）
泄泻乃脾胃颛病，凡饮食寒热，三者不调，此为内因，必致泄泻。又经所论∶春伤风，夏飧泄，夏伤暑，
秋伤湿，皆为外因，亦致泄泻。医者当于各类求之，毋徒用一止泻之方而云概可施治，此
则误儿岂浅云耳。若不治本，则泻皆暂止而复泻，耽误既久，脾胃益虚，变生他证，良医莫救。
脉弦者，食积泻；脉微小，虚寒泻。小儿泄泻，微缓者生，洪大急数者危。初生及未满三岁看虎口脉纹。
小儿泄泻证非一端，有冷泻，有热泻，有伤食泻，有风泻，有惊泻，当详辨其证而治之。
冷泻者，脾胃受冷，肚痛，谷不化，小便清，大便黄白或如糟粕，手足厥冷，当服理中汤、
益黄散、人参藿香等散。
热泻者，大便黄赤，小便赤少，口渴烦躁。医者不明，但用豆蔻、诃子等服之，如水浇石，
用钱氏白术散去木香、五苓散去桂服之。热甚者，四逆散、黄连丸、调中汤去大黄加黄连、枳壳
治之，如挟热而太阳与少阳合病自下利者黄芩汤，呕加半夏。又挟热泻痢而小便闭涩赤甚者，加
减四顺清凉饮服之。
伤食泻者，由乳食过饱，坐卧风冷之所，伤食油腻之物遂成食泻，宜先服紫霜丸，取下其
积，不可便补。经云∶食泻重，当取疳。虚用补虚进食丸、感应丸、紫霜丸。量虚实先取其积
尽，次以加减益黄散、异功散、四君子汤调理之。
惊泻者，由慢惊病后，或吐胃虚，或气弱因惊，眼白如淡墨，大便青黄，此泻宜至圣保命
丹、钩藤饮主之。或乳随粪下，消乳热，进食丸主之。或微渴，心脾喘燥狂热，此泻尤难治，朱
砂五苓散主之。冷者，定命饮子，服后与温惊朱君散、睡惊太乙丹等药治之。大要散风邪，
消积滞，开胃进食，养脾之药。惟伤食泄泻者必恶食，
发热，心腹胀痛，下酸臭，先以疏利其食，服消积丸、鹤顶丹微疏导，不可峻取，后消食药治之。
食积泄泻者，积聚停饮，痞膈中满，胁肋疼痛，夜热昼凉，口吐酸水，呕逆注泻，脉实者，
先利而后补，服消积丸、鹤顶丹，下后服消导药，虚者先补而后下。
伤风泄泻者，脾脏虚怯也。当初若脾实者，先解风热，服藿香散。风热已退，微热者，参术
散、褐丸子。脾虚者，服醒脾散、实脾散。
假令春月间多有伤风、咳嗽、泄泻者，表里俱虚，服藿香正气散，倍加茯苓去皮、白术、
生姜、枣去核同煎。痰嗽发热微泻者，服人参羌活散，加半夏曲同煎，后服加味四君子汤、
参术散止泻治之。
夏月伤暑泄泻者，其证面垢，烦躁作渴，饮水浆，头热，呕吐泄泻，服丁香丸，定吐紫金
核先定吐，后用参术散。发热，渴不止者，参术散加天水散，滚白汤调。
秋月痰嗽泄泻者，六和汤。
冬月感寒泄泻者，助胃膏、益黄散加肉豆蔻、生姜、枣去核煎服。寒极者附子理中汤。
吐泻，脾胃俱虚，欲作慢惊，服乌蝎四君子汤，生姜、枣去核煎服，或实脾散、全蝎观音散治
之。
中湿泄泻者，着冷肠鸣，肚腹痛，手足寒，服理中汤、大养脾丸、藿香正气散，腹痛加桂
、干姜，伏暑加藿香，寒暑同用。
(5)
Diarrhea (Xie Xie) is primarily a disease specific to the Spleen and Stomach. Any imbalance in the cold and heat of food and drink, where the three factors are not harmonious, constitutes an internal cause that inevitably leads to diarrhea. Furthermore, as discussed in medical classics: wind injury in spring leads to undigested stool diarrhea (Sun Xie) in summer; summer heat injury in summer leads to dampness injury in autumn. These are external causes that also result in diarrhea. Physicians should seek treatment based on these various categories, rather than merely using a single anti-diarrheal formula and claiming it can be applied universally. Such errors could cause significant harm to children. If the root cause is not treated, diarrhea may temporarily cease but will recur. Prolonged delay will further weaken the Spleen and Stomach, leading to other complications that even skilled physicians may find difficult to rescue.
A wiry pulse (Xian Mai) indicates diarrhea due to food stagnation (Shi Ji Xie); a minute and faint pulse (Wei Xiao Mai) indicates diarrhea due to deficiency-cold (Xu Han Xie). In pediatric diarrhea, a slightly moderate pulse (Wei Huan Mai) suggests a favorable prognosis, while a surging, large, rapid, and frequent pulse (Hong Da Ji Shu Mai) indicates critical danger. For infants and children under three years old, observe the finger vein pattern at the Tiger's Mouth (Hu Kou).
Pediatric diarrhea manifests in various patterns, including cold diarrhea, heat diarrhea, food-stagnation diarrhea, wind diarrhea, and fright diarrhea. One must carefully differentiate the syndrome before treating.
Cold diarrhea results from cold invading the Spleen and Stomach, characterized by abdominal pain, undigested food in stool, clear urine, yellowish-white or residue-like stool, and cold extremities. Treatment should involve Li Zhong Tang (Regulate the Middle Decoction), Yi Huang San (Yellow-Enhancing Powder), or Ren Shen Huo Xiang San (Ginseng and Pogostemon Powder).
Heat diarrhea presents with yellow-red stool, scanty dark urine, thirst, and irritability. If physicians fail to understand the pathology and use only cardamom (Dou Kou) or chebula (He Zi), it is like pouring water on stone (ineffective). Instead, use Qian Shi Bai Zhu San (Master Qian’s Atractylodes Powder) without Mu Xiang, or Wu Ling San (Five-Ling Powder) without Gui Zhi. For severe heat, use Si Ni San (Frigid Extremities Powder), Huang Lian Wan (Coptis Pill), or Tiao Zhong Tang (Regulate the Middle Decoction) with Da Huang removed and Huang Lian and Zhi Ke added. If accompanied by heat and simultaneous Taiyang and Shaoyang syndrome with spontaneous diarrhea, use Huang Qin Tang (Scutellaria Decoction); add Ban Xia if vomiting occurs. If accompanied by heat-induced dysentery with obstructed, painful, and dark red urination, use Jia Jian Si Shun Qing Liang Yin (Modified Four-Shun Cooling Drink).
Food-stagnation diarrhea arises from overeating milk or food, sitting or lying in windy/cold places, or consuming greasy foods. Initially, Zi Shuang Wan (Purple Frost Pill) should be taken to purge the accumulation; tonification should not be administered immediately. The classics state: for severe food diarrhea, treat the malnutrition (Gan) syndrome. For deficiency patterns, use Bu Xu Jin Shi Wan (Tonify Deficiency and Promote Appetite Pill), Gan Ying Wan (Responsive Pill), or Zi Shuang Wan. Assess deficiency and excess first to completely remove the accumulation, then regulate with Jia Jian Yi Huang San (Modified Yellow-Enhancing Powder), Yi Gong San (Yi-Gong Powder), or Si Jun Zi Tang (Four Gentlemen Decoction).
Fright diarrhea occurs after slow convulsion disease, or due to vomiting/stomach deficiency, or Qi weakness triggered by fright. Symptoms include eyes with whites resembling pale ink and green-yellow stool. Treat with Zhi Sheng Bao Ming Dan (Supreme Life-Preserving Pill) or Gou Teng Yin (Uncaria Decoction). If milk passes with feces, indicating milk-heat, use Jin Shi Wan (Appetite-Promoting Pill). If there is slight thirst, Spleen/Heart panting, dryness, fever, and mania, which is particularly difficult to treat, use Zhu Sha Wu Ling San (Cinnabar Five-Ling Powder). For cold types, use Ding Ming Yin Zi (Life-Stabilizing Decoction), followed by Wen Jing Zhu Jun San (Warm Fright Cinnabar Lord Powder) or Shui Jing Tai Yi Dan (Sleep-Fright Supreme One Pill). The general principle is to disperse wind pathogens, eliminate stagnation, open the stomach to promote appetite, and nourish the Spleen. Only in food-stagnation diarrhea does one see aversion to food, fever, epigastric/abdominal distension and pain, and sour-smelling stools. First, use mild疏导 (guiding/dredging) with Xiao Ji Wan (Eliminate Accumulation Pill) or He Ding Dan (Crane Crown Pill); do not use harsh purgatives. Follow with food-digestion herbs.
Accumulation-food diarrhea involves stagnant fluid and phlegm, chest/epigastric fullness, hypochondriac pain, night fever/day coolness, acid regurgitation, vomiting, and projectile diarrhea. With a solid pulse, treat with purgation first, then tonification: use Xiao Ji Wan or He Ding Dan, followed by digestion-promoting herbs after evacuation. For deficiency, tonify first, then purge.
Wind-injury diarrhea stems from Spleen deficiency and timidity. If the Spleen was initially solid, resolve wind-heat first with Huo Xiang San (Pogostemon Powder). After wind-heat resolves, if slight heat remains, use Shen Zhu San (Ginseng and Atractylodes Powder) or He Wan Zi (Brown Pill). For Spleen deficiency, use Xing Pi San (Awaken Spleen Powder) or Shi Pi San (Solidify Spleen Powder).
Assume in spring, many cases involve wind-injury, cough, and diarrhea, indicating exterior and interior deficiency. Use Huo Xiang Zheng Qi San (Pogostemon Rectifying Qi Powder), doubling Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala), Sheng Jiang (Fresh Ginger), and Qu He Zao (Pitted Jujube) for decoction. For phlegm-cough, fever, and slight diarrhea, use Ren Shen Qiang Huo San (Ginseng and Notopterygium Powder) with Ban Xia Qu (Pinellia Fermented Paste); follow with Jia Wei Si Jun Zi Tang (Modified Four Gentlemen Decoction) and Shen Zhu San to stop diarrhea.
Summer heat-injury diarrhea presents with a dirty complexion, irritability, thirst for fluids, head heat, vomiting, and diarrhea. Use Ding Xiang Wan (Clove Pill); use Ding Tu Zi Jin He (Stabilize Vomiting Purple Gold Kernel) to first stop vomiting, then use Shen Zhu San. For persistent fever and thirst, use Shen Zhu San plus Tian Shui San (Heavenly Water Powder), mixed with Gun Bai Tang (Rolling White Decoction).
Autumn phlegm-cough and diarrhea: use Liu He Tang (Six-Harmony Decoction).
Winter cold-injury diarrhea: use Zhu Wei Gao (Stomach-Assisting Ointment) or Yi Huang San with Rou Dou Kou (Nutmeg), Sheng Jiang, and Qu He Zao. For extreme cold, use Fu Zi Li Zhong Tang (Aconite Regulate-Middle Decoction).
Vomiting and diarrhea with dual Spleen/Stomach deficiency, impending slow convulsion: use Wu Xie Si Jun Zi Tang (Black Scorpion Four Gentlemen Decoction) with Sheng Jiang and Qu He Zao. Alternatively, use Shi Pi San or Quan Xie Guan Yin San (Whole Scorpion Guanyin Powder).
Dampness-obstruction diarrhea, caused by cold exposure, features borborygmus, abdominal pain, and cold extremities. Use Li Zhong Tang, Da Yang Pi Wan (Great Nourish-Spleen Pill), or Huo Xiang Zheng Qi San. Add Gui Zhi and Gan Jiang for abdominal pain; add Huo Xiang for latent summer-heat; use both for combined cold-heat.