吐出上焦。泻出下焦。乃肠胃之病也。脾在中焦。管摄乎上下之间。吐泻互作者。
乃脾之病也。
夫人身之中。足阳明胃脉之气。自上而下。足太阴脾脉之气。自下而上。上下循环。阴
接。谓之顺而无病也。故胃气逆而为上。则为呕吐。脾气逆而为下。则为泄泻。吐泻之病。
脾胃为之总司也。
发挥云。胃在上焦主内而不出。呕吐则不纳矣。肠在下焦。主出而不入。有积泄泻。出
积矣。观李知先活人书括云。胃家有热难留食。胃冷无缘纳水浆。则吐泻之出于上焦也明矣
。又张长沙伤寒论云。下利服理中不止。理中者。理中焦也。治泄不利小便。非其治也。五
苓散主之。不止者在下焦。赤石脂禹余粮汤主之。则泄泻出于下焦也明矣。
赤石脂（一斤） 禹余粮（一斤） 上水六升。煮取二升。去渣。分三服。
又按治泄利者。有四法焉。有用理中汤。以治其中气者。有用五苓散。以利其小便者。
真武汤。以温其肾者。有用赤石脂禹余粮。以固涩其大肠者。不可不知其要也。盖肾开窍于
二阴。主蛰藏者也。如门户然。泄泻不止。门户不固也。故用姜附以温之。闭其门户也。肠
胃者。容受水谷之气。犹仓廪然。脾司出纳。乃仓廪之官也。吐泻不止。乃仓廪之不藏。官
之失其职也。故用参术以补之。封其仓廪也。下焦者。水谷注下之路。如沟渎然。小便不利
者。沟渎之不能别也。故用猪苓泽泻以利之。疏通其水渎也。大
故用赤石脂禹余粮以涩之。塞其决也。
真武汤
茯苓 芍药 生姜（各一两） 附子（一枚炮破八片） 白术（二两） 上用水八升。煮取三
升。温服七合。日三。
祖训治吐泻者。只用胃苓丸。吐以煨生姜汤。泄以一粒丹和之。炒米汤下。
一粒丹（亦名白玉丹） 此家传十三方也。
寒水石（ 二两） 白矾（枯一两） 上为末。水糊丸。小豆大。每一丸米汤下。
钱氏曰。脾主困。谓疲惫也。非嗜卧也。吐泻久则生风。饮食伤则成疳。易至疲惫也
。此与肾主虚同。
论肾者。元气之主。肾虚则为禀赋不足之病。脾者谷气之主。脾虚则为津液不足之病。
故小儿五脏之病。脾肾最多。肝心次之。肺又次之。
小儿吐泻。多因伤乳食得之。
如吐泻时不啼哭。不喜饮食。此伤乳食也。初得之不可遽止。宿食未尽去也。宜换乳食
。勿令重伤。吐泻益甚。非医之咎也。益黄散主之。
有热者胃苓丸。用东向陈壁土。和生姜少许炒焦。入水煎汤。澄清吞下。泻不止。以胃
苓丸一粒丹合而服之。煎汤下效。
如吐泻时不恶风寒。喜人怀抱。此伤风吐泻也。宜发散。惺惺散。
如吐泻时啼哭。其身俯仰不安者。必腹中有痛。此藿乱也。内伤乳食。外感风寒得之。
先治其里。宜理中汤加藿香。后治其表。桂枝汤。表里通治。藿香正气散。
一儿周岁。吐泻并作。时天大寒。医用理中胃苓丸。服之不效。予曰。此表里有寒邪。
未得发散也。取益黄散与之。其夜得大汗而止。
一女岁半。与前儿同症。吐泻。此伤食也。前有外感风邪。故用益黄散。温其表里之寒
。此只是伤食。用胃苓丸一粒丹陈壁土汤下。调其脾胃。消其食积。而吐泻俱止。
一儿暴吐泻。上下所出皆乳不化。用理中丸服之效。
一儿暴吐泻。上下所出皆黄水。中有乳片不化者。用二陈汤。加黄连姜汁炒煎服效。
或问。二病同。而治之异者。何也。曰。所出之乳不化者。胃有寒也。故以理中丸急温
之。所出乳片不化者。胃有热邪。热不杀谷。宜半夏黄连以解之。此同病异治法也。
Vomiting originates in the Upper Jiao (Upper Burner). Diarrhea originates in the Lower Jiao (Lower Burner). These are diseases of the intestines and stomach. The Spleen is located in the Middle Jiao (Middle Burner) and regulates the upper and lower sections. When vomiting and diarrhea occur simultaneously, it is a disease of the Spleen.
In the human body, the Qi of the Foot-Yangming Stomach Meridian flows from top to bottom, while the Qi of the Foot-Taiyin Spleen Meridian flows from bottom to top. Their continuous circulation and connection of Yin and Yang constitute "Shun" (Smoothness/Compliance), resulting in health without disease. Therefore, when Stomach Qi rebels upward, it causes vomiting; when Spleen Qi sinks downward, it causes diarrhea. The Stomach and Spleen are the primary controllers of vomiting and diarrhea.
*Youke Fahui* states: The Stomach, located in the Upper Jiao, is responsible for receiving food but not expelling it; vomiting implies an inability to receive. The Intestines, located in the Lower Jiao, are responsible for excretion but not reception; diarrhea with accumulation involves the expulsion of accumulated matter. Observing Li Zhixian's *Huoren Shuokuo*, which says, "Heat in the Stomach makes it difficult to retain food; Cold in the Stomach makes it impossible to accept water or gruel," it is clear that vomiting and diarrhea originate from the Upper Jiao. Furthermore, Zhang Zhongjing's *Shanghan Lun* states: "For dysentery/diarrhea, if Lizhong Tang does not stop it... Lizhong Tang regulates the Middle Jiao. Treating diarrhea without promoting urination is incorrect; Wuling San should be used. If it still does not stop, the pathology is in the Lower Jiao, and Chishizhi Yuyuliang Tang should be used." Thus, it is clear that diarrhea can originate from the Lower Jiao.
Chishizhi (Red Halloysite, 1 jin) Yuyuliang (Yucheng Stone, 1 jin). Add six sheng of water, boil to obtain two sheng of decoction, remove dregs, and divide into three doses.
Furthermore, regarding the treatment of diarrhea/dysentery, there are four methods: using Lizhong Tang to treat Middle Qi deficiency/cold; using Wuling San to promote urination; using Zhenwu Tang to warm the Kidney; and using Chishizhi Yuyuliang Tang to astringe the Large Intestine. One must understand these key points. The Kidney opens into the two yin orifices (anterior and posterior) and governs storage and consolidation, acting like a gate. Persistent diarrhea indicates an unsecured gate. Therefore, Ginger (Jiang) and Aconite (Fu Zi) are used to warm and close the gate. The intestines and stomach hold and receive the Qi of water and grain, like granaries. The Spleen manages entry and exit, serving as the official of the granary. Persistent vomiting and diarrhea indicate the granary cannot store and the official has failed duties. Therefore, Ginseng (Renshen) and Atractylodes (Baizhu) are used to tonify and secure the granary. The Lower Jiao is the pathway for water and grain to descend, like ditches. Difficulty in urination indicates the ditches fail to separate clear from turbid. Therefore, Polyporus (Zuling) and Alisma (Zexie) are used to promote urination and dredge the waterways. Fecal incontinence requires astringency; therefore, Chishizhi and Yuyuliang are used to stop leakage and plug the breaches.
Zhenwu Tang
Fuling (Poria) Shaoyao (White Peony Root) Shengjiang (Fresh Ginger) (each 1 liang) Fuzi (Prepared Aconite Root, 1 piece, processed and broken into 8 slices) Baizhu (Atractylodes Macrocephala Rhizome, 2 liang). Add eight sheng of water, boil to obtain three sheng, take seven he warm, three times daily.
Ancestral instructions for treating vomiting and diarrhea prescribe only Weiling Wan. For vomiting, administer with roasted ginger soup; for diarrhea, combine with Yili Dan and take with fried rice soup.
Yili Dan (Also known as Baiyu Dan). This is one of the thirteen family-prescribed formulas.
Hanshuishi (Calcitum, 2 liang) Baifan (Alumen, dried/ku, 1 liang). Grind into powder, make pills with water paste, size of small beans. Take one pill with rice soup.
Qian Yi stated: The Spleen governs "Kun" (Lethargy/Stagnation), referring to physical exhaustion, not drowsiness. Prolonged vomiting and diarrhea may generate wind; dietary injury may lead to Gan syndrome (malnutrition), leading to exhaustion. This is similar to the Kidney governing deficiency.
Regarding the Kidney, it is the master of Yuan Qi (Original Qi). Kidney deficiency results in diseases of congenital insufficiency. The Spleen is the master of Grain Qi. Spleen deficiency results in diseases of insufficient Jin Ye (Body Fluids). Therefore, among pediatric five-zang diseases, Spleen and Kidney disorders are most common, followed by Liver and Heart, and then Lung.
Pediatric vomiting and diarrhea are mostly caused by damage from milk and food.
If during vomiting and diarrhea the child does not cry and dislikes eating, this is damage from milk and food. In the initial stage, do not abruptly stop the symptoms, as undigested food remains. Change the diet/milk to prevent further injury. If vomiting and diarrhea worsen, it is not the physician's fault. Use Yihuang San as the main treatment.
For cases with Heat signs, use Weiling Wan. Use old wall soil facing east, stir-fry with a little fresh ginger until scorched, decoct in water, clarify, and swallow the pill with the liquid. For persistent diarrhea, combine Weiling Wan and Yili Dan and take with decoction; this is effective.
If during vomiting and diarrhea the child fears neither wind nor cold and likes being held, this is wind-damage causing vomiting and diarrhea. Use dispersing methods, such as Xingxing San.
If during vomiting and diarrhea the child cries and tosses restlessly, indicating abdominal pain, this is Huoluan (Cholera-like disorder). Caused by internal damage from milk/food and external contraction of wind-cold. First treat the interior with Lizhong Tang plus Huoxiang. Then treat the exterior with Guizhi Tang. For simultaneous exterior-interior treatment, use Huoxiang Zhengqi San.
Case 1: A one-year-old child presented with simultaneous vomiting and diarrhea during severe cold weather. The physician used Lizhong Wan and Weiling Wan with no effect. I said: "There is cold pathogen in both the exterior and interior that has not been dispersed." I administered Yihuang San. The child sweated profusely that night, and the condition ceased.
Case 2: A one-and-a-half-year-old girl presented with the same symptoms as the previous case: vomiting and diarrhea. This was due to food damage. Previously, there was an external wind pathogen, so Yihuang San was used to warm and disperse the exterior-interior cold. This case involved only food damage. Weiling Wan and Yili Dan were administered with Chenbitu (Old Wall Soil) soup to regulate the Spleen and Stomach and eliminate food stagnation, stopping both vomiting and diarrhea.
Case 3: A child had sudden vomiting and diarrhea, expelling undigested milk both upwards and downwards. Lizhong Wan was effective.
Case 4: A child had sudden vomiting and diarrhea, expelling yellow fluid containing undigested milk flakes. Erchen Tang added with Huanglian (Coptis Rhizome) stir-fried with Jiangzhi (Ginger Juice) was effective.
Question: Why are the treatments different for these two similar conditions? Answer: When expelled milk is undigested, it indicates Cold in the Stomach. Therefore, Lizhong Wan is used to urgently warm the interior. When expelled milk appears as flakes mixed with yellow fluid, it indicates Heat pathogen in the Stomach; heat fails to "kill" (digest/cook) the grain. Banxia (Pinellia Tuber) and Huanglian should be used to resolve it. This is the method of treating the same disease with different therapies.