小儿吐泻者，皆由脾胃虚弱。乳哺不调。风寒暑湿。邪干于正之所致也。其证不一。今条叙之。
吐逆自生下便吐者。此是儿初生之时。拭掠口中秽血不尽。因咽入喉故也。
吐逆胸膈满闷气急者。此因儿啼哭未定。气息未匀。乳母忽遽以乳饲之。儿气尚逆。乳不得下。停滞于胸
膈之间。因更饮乳。前后相沓。气不宣通。故气逆而乳随出之为吐也。宜调其气而止吐。古书亦曰。大哭之后
食乳者。多成吐泻也。
吐逆腹胀喘息。乳不化。夹青水。面青唇白者。此因乳母冒寒取凉。食冷冻饮料寒。致冷气入乳。变坏其汁。
而不捻去。仍以饲儿。或能食者，因以冷物饲之。其冷乳冷食入腹。与气相搏。伤于脾胃。则气逆而吐也。其证
若此。宜温胃止吐调气。若伤重有停滞者。以稳药磨化。不可快下。恐脾胃愈虚而生风也。凡风冷变坏之乳。当
捻去之。暂断乳儿。令乳母服药温腹。然后饲儿。若不捻去。非只令儿吐逆。肠胃虚者。冷因得入。亦不利也。
吐逆身热。吐奶成片子者。胃有热也。此因乳母冒热。或因饮酒。热入其乳。变坏其汁。而不捻出。仍以饲
儿。或儿乘热哺啜。致热气入胃。与气相搏。致气逆而吐也。其证若此。如久有积热者。必四肢生疮。多渴而面
黄。宜微下之。虚者以稳药磨化。后调其气。
吐逆身热。鼻青呵欠顿闷。口中气热，夜间发躁者。此伤风吐也。因解脱失宜。风冷袭之。搏于血气。故身
热呵欠顿闷。口中气热也。气不得顺。故逆而作吐也。宜调气止吐。发散风冷。
吐逆唇黑。面黄多啼。有痰吐气臭者。此脾胃有伤也。宜先下之。后调其气。
吐逆早晚发热，睡卧不安者。此惊吐也。心热则生惊。故睡卧不
安。而神不宁也，心神不宁。则气血逆乱而吐也。宜与镇惊去热止吐。
吐逆面 白无精光。口中气冷。口频撮。不思乳食。吐水者。胃气不和也。宜补脾胃。
吐逆痰涎色黄。稠粘上壅者。胃热也。若吐痰涎白渌。或吐沫者。胃虚冷也。热者宜微利之。冷者宜温补
之。
吐逆痰涎及有血者。此肺热也。久则肺虚成痿。昔钱乙治段斋郎子四岁。身热吐痰。嗽数日而咯血。他医
以桔梗汤防己丸治之不愈。涎上攻。吐喘不止。遂请乙治。乙下褊银丸一大服。复以补肺汤补脾散为治。乙曰。
此子咯血。肺虚也。肺虽咯血。有热故也。久则虚痿，今涎上潮而吐。当下其涎。若不吐涎。则为甚便。盖吐涎
能虚。又生惊也。痰实上次。亦能发搐。根据法只宜先下痰而后补脾肺。必涎止而吐愈。为顺治也。若先补肺为逆
耳。乙所用药方。本集载之。此所谓识病之轻重先后为治也。
者。比吐逆异也。吐者乃邪搏胃气。逆而上行。谷不能传化。随气出也。 者但气逆而欲吐。吐则谷
无所出。故俗谓干呕也。 者乃儿因吮乳汁过多。胃满而上溢出也。故俗呼谓之噫奶。当便与空乳令吮。即定。
若频久吮之。亦能为病。
Vomiting and diarrhea in infants are all caused by the deficiency of the Spleen and Stomach, improper breastfeeding, and the invasion of pathogenic factors such as Wind, Cold, Summer-heat, and Dampness interfering with the healthy Qi. The symptoms vary; they are described below item by item.
Vomiting that occurs immediately after birth is due to the failure to completely clear the foul blood from the infant's mouth at birth, which is then swallowed into the throat.
Vomiting accompanied by fullness and oppression in the chest and diaphragm, and rapid breathing, is caused by the mother feeding the infant hastily while the infant is still crying and its breath is uneven. At this time, the infant's Qi is still rebellious, preventing the milk from descending, causing it to stagnate between the chest and diaphragm. If more milk is given subsequently, the accumulation exacerbates the obstruction of Qi flow, leading to rebellious Qi and the expulsion of milk, which constitutes vomiting. Treatment should focus on regulating Qi to stop vomiting. Ancient texts also state that feeding an infant immediately after a loud cry often results in vomiting and diarrhea.
Vomiting accompanied by abdominal distension, panting, undigested milk, greenish fluid, cyanosis of the face, and pale lips is caused by the nursing mother exposing herself to cold or seeking coolness, consuming frozen drinks or cold foods, thereby allowing cold Qi to enter the breast milk and spoil it. If these spoiled portions are not discarded and are still fed to the infant, or if the infant is fed cold food when capable of eating, the cold milk and food enter the abdomen, contend with the body's Qi, damage the Spleen and Stomach, cause rebellious Qi, and result in vomiting. For such symptoms, one should warm the Stomach to stop vomiting and regulate Qi. If the injury is severe with stagnation, mild resolving agents should be used to disperse the accumulation; harsh purgatives must be avoided lest they further weaken the Spleen and Stomach and generate Wind. Any breast milk spoiled by Wind-Cold must be discarded. Breastfeeding should be temporarily suspended while the mother takes medication to warm her abdomen before resuming feeding. Failure to discard spoiled milk not only causes infant vomiting but also allows cold pathogens to invade the weak intestines and stomach, which is detrimental.
Vomiting accompanied by fever and the expulsion of milk in sheet-like curds indicates Heat in the Stomach. This arises when the nursing mother is exposed to heat or consumes alcohol, allowing Heat to enter the breast milk and spoil it. If not discarded and fed to the infant, or if the infant suckles during hot weather, Heat enters the Stomach, contends with Qi, causes rebellious Qi, and leads to vomiting. In cases of prolonged accumulated Heat, sores may appear on the limbs, excessive thirst may occur, and the complexion may become yellow. A mild purgative approach is indicated. For deficient patients, mild resolving agents should be used first, followed by Qi regulation.
Vomiting accompanied by fever, blueness of the nose, yawning, sudden chest oppression, hot breath, and nighttime restlessness indicates vomiting due to Wind-Cold injury. This results from improper care, where Wind-Cold invades and contends with Blood and Qi, causing fever, yawning, oppression, and hot breath. The obstruction of smooth Qi flow leads to rebellious Qi and vomiting. Treatment should regulate Qi to stop vomiting and dissipate Wind-Cold.
Vomiting accompanied by blackened lips, yellowish complexion, frequent crying, phlegm, and foul breath indicates damage to the Spleen and Stomach. One should first use purgatives, followed by Qi regulation.
Vomiting accompanied by fever in the morning and evening, and restless sleep indicates vomiting due to fright. Heart Heat generates fright, causing restless sleep and unsettled Shen (Spirit). When the Heart-Shen is unsettled, Blood and Qi become chaotic and rebellious, leading to vomiting. Treatment should calm fright, clear Heat, and stop vomiting.
Vomiting accompanied by a pale, lusterless complexion, cold breath, frequent puckering of the mouth, loss of appetite, and vomiting of clear water indicates disharmony of Stomach Qi. Treatment should tonify the Spleen and Stomach.
Thick, sticky, yellow phlegm and saliva expelled during vomiting indicate Stomach Heat. Clear, white, watery phlegm or frothy vomit indicates Deficient-Cold of the Stomach. Heat patterns require mild purgation, while Cold patterns require warming and tonification.
Vomiting of phlegm and blood indicates Lung Heat. Prolonged illness leads to Lung Deficiency and flaccidity syndrome (Wei Syndrome). Previously, Qian Yi treated the four-year-old son of Du Zhaolang, who presented with fever, vomiting of phlegm, coughing for several days, and hemoptysis. Other physicians failed to cure him using Jiegeng Tang (Platycodon Decoction) and Fangji Wan (Stephania Pill). The condition worsened with phlegm attacking upward, continuous vomiting, and panting. Qian Yi was consulted and administered a large dose of Pianyin Wan (Pian Silver Pill) to purge, followed by Bulfei Tang (Lung-Tonifying Decoction) and Bupi San (Spleen-Supporting Powder). Qian Yi stated: "This child's hemoptysis is due to Lung Deficiency. Although there is bleeding, it is caused by Heat. Prolonged Heat leads to deficiency and flaccidity. Currently, phlegm is surging upward causing vomiting; one must purge the phlegm. If the phlegm is not expelled, the condition will worsen, as vomiting phlegm causes further deficiency and may generate fright. Phlegm-Excess obstructing the upper jiao can also trigger convulsions. According to the principles, one must first purge phlegm and then tonify the Spleen and Lung. Only when the phlegm stops and vomiting ceases is this considered a favorable treatment course. Tonifying the Lung first would be an adverse approach." The formulas used by Qian Yi are recorded in this collection. This illustrates the principle of treating diseases based on their severity and prioritizing the order of intervention.
Yue (Dry Heaving) differs from vomiting. Vomiting involves pathogenic factors contending with Stomach Qi, causing it to rebel and move upward; food cannot be transformed and is expelled along with the Qi. Yue merely involves rebellious Qi and the urge to vomit, but nothing is expelled, hence commonly called dry heaving. Yi (Belching) occurs when an infant sucks too much milk, causing gastric fullness and overflow. It is commonly called "belching milk." Providing an empty nipple for sucking usually resolves it. However, frequent and prolonged sucking can lead to pathology.