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[Zeng] When infants simultaneously present with vomiting and diarrhea, it is named Huoluan (Cholera-like disease). Some cases involve heart pain preceding vomiting, while others involve abdominal pain preceding diarrhea; none of these arise without originating from the Middle Jiao (Middle Burner). The Upper Jiao governs reception but not excretion. The Middle Jiao governs the decomposition and transformation of food and fluids, generating Ying (Nutritive Qi) and Wei (Defensive Qi), and irrigating the entire body. The Lower Jiao separates clear and turbid fluids, governing excretion but not reception. Spleen resides in the Central Region (Zhongzhou), and Stomach is the Sea of Food and Fluids. Once milk and food enter the Stomach, if the Spleen can transform and transport them, then the separation and transmission of food and fluids proceed appropriately (there is a Fen Shui point one cun above the umbilicus); how could there be afflictions of vomiting and diarrhea? Generally, infant vomiting and diarrhea occur because the Six Qi are not yet fully established, making the child susceptible to invasion by the Six Excesses (Liu Yin). Coupled with improper care and irregular feeding, this leads to Spleen-Stomach deficiency, where clear and turbid energies interfere with each other, causing the condition.

If diarrhea precedes vomiting, it indicates Spleen-Stomach deficiency-cold. The signs include first passing white watery stools, with little vomiting, slow breath, lethargic expression, sweating on the forehead, and deep, soggy pulses throughout. This is cold.

If vomiting precedes diarrhea, it indicates Spleen-Stomach heat. Signs include rapid breathing, red lips, flushed face during vomiting, surging and rapid pulses, and thirst for drinking water or liquids. This is heat. Distinguishing between cold and heat requires careful examination.

[Lou] For vomiting and diarrhea accompanied by drowsiness and eyes partially open (exposing the pupils), it is Stomach deficiency-heat; treat with Qianyi's Baizhu San (Atractylodes Macrocephala Powder) and Hezhong San (Harmonizing Middle Powder). For vomiting and diarrhea accompanied by drowsiness with eyes tightly closed, it is Stomach excess-heat; treat with Qianyi's Yulu San (Jade Dew Powder) and Liu Hejian's Yi Yuan San (Benefit Primordial Powder).

[Xue] Coldness in the fingers and toes indicates Spleen Qi deficiency-cold; use Yigong San (Extraordinary Efficacy Powder) added with Muxiang (Costus Root). Vomiting and diarrhea due to Wind-Cold invasion indicate Wood attacking Earth (Liver wind overacting on Spleen); also use the aforementioned formulas. If yellow diarrhea occurs after drinking hot milk, it indicates damp-heat stagnation; use Siling San (Four-Poria Powder). If the condition does not improve or worsens after medication, it indicates further injury to Yuan Qi (Primal Qi); use Baizhu San. A sensation of heavy dragging in the abdomen during diarrhea indicates Spleen Qi sinking; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If abdominal tightness/discomfort arises after taking resolving and purgative agents, it indicates Spleen Qi deficiency with palpable fullness (Pi); use Liujunzi Tang (Six-Gentlemen Decoction). Yellow complexion with greenish stools indicates Spleen deficiency with Liver overacting; use Liujunzi Tang added with Chaihu (Bupleurum Root), Shengma (Cimicifugae Rhizoma), and Muxiang. Frequent belching with yellow stools indicates Heart and Spleen Qi deficiency; use Liujunzi Tang added with Paojiang (Prepared Ginger) and Shengma. Infants under half a month to ten days old who vomit should only have their mothers treated, as the infant’s Zang-Fu organs are fragile and cannot withstand medicinal herbs.