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Vomiting and diarrhea occurring after the fifth month, accompanied by high fever, indicates a heat syndrome. In children's internal organs, nine-tenths are hot; this is due to injury from hot milk or stomach heat entering internally, causing vomited milk to remain undigested.

Stool is deep red in color; clearing heat is appropriate. Qian Yi used Yulu San (Jade Dew Powder).

Vomiting and diarrhea occurring after the sixth month, with the body feeling very warm but resembling heat, indicate that six-tenths of the internal organs are hot and four-tenths are cold.

Vomiting of undigested milk and food, with stool being mostly yellow with little white, resembling brown. Sometimes the child takes milk, sometimes does not; slight spleen supplementation combined with strong heat-clearing is appropriate. Qian Yi used small amounts of Yihuang San (Yellow Elixir Powder) and large amounts of Yulu San (Jade Dew Powder).

One must carefully examine the balance of cold and heat. If the child has high fever and stool is red-yellow, indicating more heat, treat according to the methods for after the fifth month. Previously, Qian Yi treated the Fifth Taivwei of the Great King Palace at Guangqin Beizhai, who suffered vomiting and diarrhea in the sixth month with undigested rice and grain. Other physicians used warming medicines, resulting in worsened condition with panting and uncertain vomiting within one day. Qian Yi said, "Cooling medicines should be used," attributing it to internal heat injury. The other physicians argued, "Severe vomiting and diarrhea with undigested food require spleen and stomach tonification; how can cooling medicines be used?" The Prince trusted the other physicians and administered spleen-tonifying warming medicines again. Qian Yi said, "Do not take this. Within three days, abdominal distension, body heat, thirst, and vomiting with reflux will occur." Three days later, his prediction came true. He explained, "The heat in June is intense, lying dormant in the abdomen, inducing thirst. Heat damages the spleen and stomach, leading to severe vomiting and diarrhea." Other physicians continued using warming medicines, causing heat in the upper jiao, hence panting and thirst. Death would occur within three days. Unable to cure him, they summoned Qian Yi again. Seeing heat signs, Qian Yi administered Baihu Tang (White Tiger Decoction) three doses, followed by Baixingzi (White Pill) to purge. On the first day, the dosage was reduced by two fen. After two to three days, another two doses of Baihu Tang were given. On the fourth day, Shigao Tang (Gypsum Decoction), along with Xuanfuhua (Inulae Flos), Maidong (Ophiopogonis Radix), Huangqin (Scutellariae Radix), Bingpian (Borneolum Syntheticum), Niuhuang (Calculus Bovis), Tianzhuhuang (Bambusae Caulis in Taenia), and Fuling (Poria), coated with Zhusha (Cinnabaris), were taken as five pills with Zhu Ye (Bambusae Folium) decoction. The heat subsided, and he recovered. The formulas used by Qian Yi are recorded in this collection.

Vomiting and diarrhea occurring after the seventh month, with the body feeling warm, indicate three-tenths heat and seven-tenths cold in the internal organs. The child cannot eat much milk, appears sleepy yet restless, sighs deeply, sleeps drowsily with eyes open, lips are white, drools excessively without thirst. Qian Yi instructed taking large amounts of Yihuang San (Yellow Elixir Powder) for spleen tonification before meals, and small amounts of Yulu San (Jade Dew Powder) for heat clearing after meals. One must further assess cold and heat. If the body is very warm and stool is yellow after purging, treat according to the methods for after the sixth month. Previously, Qian Yi treated the Seventh Taivwei of Guangqin, aged seven, suffering vomiting and diarrhea in July. His symptoms included complete anorexia and drowsiness, waking up restless, dry heaving, intermittent stools without thirst. Other physicians suspected convulsions and treated accordingly without success. Qian Yi said, "Tonify the spleen first, then clear heat." He gave Shijunzi Wan (Quisqualis Pill) to tonify the spleen and Shigao Tang (Gypsum Decoction) to clear heat. The next day, he administered powdered Mercury and Sulfur mixed with Ginger Juice. Qian Yi stated, "For all vomiting and diarrhea, in May, nine parts purgation and one part tonification; in August, ten parts tonification and no purgation. These are all spleen-deficiency diarrheas. Physicians treating them wrongly lead to deficiency damage; purgation causes death. Therefore, only spleen tonification is appropriate." Suspecting Shijunzi Wan might be too slow, he also retained warming stomach and spleen tonifying medicines to stop the diarrhea. A physician named Li asked, "Why does regurgitation occur after eating?" Qian Yi replied, "Spleen deficiency prevents digestion; low fluids cause regurgitation." Another question: "Why is there green-brown watery stool?" Qian Yi replied, "Intestines and stomach are extremely deficient, and cold is extreme." Qian Yi cured him. The formula is recorded in this collection.

Vomiting and diarrhea occurring after the eighth month, with a cold body, indicate absence of Yang Qi. The child cannot eat milk, experiences dry heaving, and passes green-brown watery stool. Qian Yi used only Yihuang San (Yellow Elixir Powder) to tonify the spleen; purgation is contraindicated.

The discussion on timing of cold and heat in vomiting and diarrhea refers to Qian Yi's observations in the Central Plains. Compared to Jiangzhe, the climate differs. In Jiangzhe, February and March are still cold; April and May are warm; heat begins only after entering the Dog Days in June; July is intensely hot; August remains hot. Even in winter, sunny days are warm; even in summer, cloudy days are cold. One cannot generalize Central Plains seasonal patterns as absolute rules. As the classics state, different regions (East, West, South, North) have different climatic needs regarding warmth, coolness, cold, and heat. Moreover, annual temperature variations follow seasonal shifts, making it difficult to rigidly fix months and days. Observers must adapt to the arrival of conditions: when heat arrives, treat heat; when warmth arrives, treat warmth; when cold arrives, treat cold; when coolness arrives, treat coolness. This aligns with the Qi of the four seasons, ensuring appropriateness.

During the intense heat of summer and autumn, if latent summerheat injures the cold, the Heart organ becomes irritable, urination is difficult, clear and turbid aspects fail to separate, and Yin and Yang Qi interfere with each other, termed Qi Chaos. When chaotic between intestines and stomach, it is termed Huoluan (Cholera-like disorder). Symptoms include panting due to Qi rebellion from heat-cold injury, abdominal and hypochondriac distension, body heat with chaotic pulse, headache, and body pain, resembling Taiyang disease. Upward leads to severe vomiting; downward leads to severe diarrhea. Severe cases present with cold limbs and calf muscle spasms. The method requires regulating Qi, separating clear and turbid, and ascending/descending Yin and Yang. If merely summerheat-induced vomiting and diarrhea occurs, urination is difficult. Although symptoms are slightly similar to the above, they are milder and distinct from Huoluan. Stool is red-yellow; this is merely named Summerheat Vomiting and Diarrhea, not Huoluan. For treating Huoluan vomiting and diarrhea: if heat predominates with thirst, use Wuling San (Five-Ingredient Powder with Poria); if cold predominates without thirst, accompanied by heart/abdominal/body pain, irritability, and inability to drink despite thirst, use Lizhong Tang (Regulate the Middle Decoction); if cold is severe with abdominal pain and spasms, and limb stiffness, add Fuzi (Aconiti Lateralis Radix Praeparata) to Lizhong Tang; if sweating, aversion to cold, cold hands and feet, diarrhea with undigested food, internal cold with external heat, and faint pulse nearing extinction, use Sini Tang (Frigid Extremities Decoction). All above syndromes can be taken concurrently with Xiangru San (Elsholtzia Powder), as other medicines cannot treat these conditions. For treating summerheat vomiting and diarrhea: if urination is difficult, use Wuling San (Five-Ingredient Powder with Poria) to promote urination, and Xiangru San (Elsholtzia Powder) to resolve latent summerheat; Pilian San (Lotus Seed Pod Powder) and Shengdan Zhi Tu (Life-Saving Cinnabar to Stop Vomiting) to stop vomiting.

Vomiting and diarrhea, regardless of timing, weaken the Spleen and Stomach, often generating Wind, becoming Pi Feng Man Jing (Spleen Wind Slow Convulsion). This occurs because Spleen Earth declines and Liver Wood overacts upon it. One must first tonify Spleen and Stomach, preventing weakness, so Wind does not generate, and the illness heals easily.

If vomiting and diarrhea are settled or unsettled, accompanied by irritability and thirst, it indicates internal consumption of Body Fluids. Regardless of new or old onset, boil Qian Yi's Baizhu San (Atractylodis Macrocephalae Powder) and allow the patient to drink sufficient amounts until satisfied. More is better. Otherwise, internal fluid consumption leads to incessant thirst, internal heat generation, external pathogen interference, myriad symptom changes, formation of other diseases, and gradual critical danger.