巢元方曰。小儿暴泻者。由肠胃虚。卒为冷热之气所伤而成。热则色黄赤。冷则色青白。若冷热相交。则变为赤白
滞痢也。宜龙骨散。小儿久泻者。大法补虚消积。宜华佗久利神验方。
张元素曰。乳食不消。初病。忽然气出冷。四肢亦冷。面白无光泽。精神不定。乃胃气不和。可以大温药治之。使
君子丸、益黄散。若病泄泻日久不瘥。乳食不化。是脾胃有风冷。先服益黄散二帖。后用宣风散导之。再大补胃。
曾氏曰。论泻之原。有冷泻。热泻。伤食泻。水泻。积泻。惊泻。风泻。脏寒泻。疳积KT 泻。种种不同。冷泻
多是白水。泻密而出少。腹痛而鸣。眉皱目慢。面带白色。额有汗。冲和饮、当归散、参苓白术散。热泻者。大便黄色。
如筒吊水。泻过即止。半日复然。心烦口渴。小便黄少。乳食必粗。先用五苓散。或大顺饮。次钱氏白术散、香薷散。
伤食泻者。乃脾胃素弱。复伤生冷。故大便不聚而泻。或因母餐生冷肥腻。亦能作泻。面唇俱白。泻稀而少。或如败卵
臭。身形黄瘦。宜固脾和中散、醒脾散。水泻者。即洞泄。乃阴阳不顺。水谷不分。泻黄水而小便少。次多无度。夏秋
之际。昼则解衣取凉。夜则失盖感冷。冷热相激。清浊混乱。或因母热与乳。令儿脾胃不和。水谷交杂而下。宜五苓散。
加苡仁、车前、半夏。分正阴阳。或白术散、六和汤。积泻者。脾气虚弱。乳食入胃不消。久又伤冷食。传之大肠。遂
成泄泻。诸药无效。盖以积在脾胃未除。何由得愈。先三棱散除积。次沉香槟榔丸、参苓白术散。再和中散。惊泻者。
粪青如苔。稠粘如胶。不可便止。但镇心抑肝。和脾胃。消乳食。先五苓散。次三棱散。风泻者。慢惊大病后有之。粪
稀。黄褐色。或夹食而下。因脾虚所致。或夹黑褐色者。属脾虚而肾水乘之也。若久则惊搐。先五苓散加苡仁以疏肾水。
次泻黄散以去脾风。再参苓白术散以补脾气。脏寒泻者。粪青不稀不稠。或下清水。未泻腹痛而鸣。啼哭方泻。生三五
月内有此。周岁则无。因断脐风冷外逼而成。先冲和饮加葱白。次当归散加煨姜。及匀气散、理中汤。疳积KT 泻者。
面黄肚胀脚弱。头大项小。发稀而竖。肌瘦不食。朝凉夜热。腹有症癖。泻无定色。恶臭。自泻自止。先三棱散加陈皮。
次乌犀丸、芦荟丸、快肠汤。凡泻痢色青甚而淡黄夹白。寒多热少。此阴邪胜阳。宜守中汤、胃苓汤扶表救里。方进当
归散加陈皮、紫苏、生姜、糯米。寒甚者。理中汤。加附子、姜、枣。次南星腹皮饮。若泻泄色青淡。有沫。黄稠。热
多寒少。亦致黄瘦烦躁。宜五苓加苡仁、车前、生姜。解散余邪。仍用茵陈山栀汤送五苓散。退黄色。或万安饮、四神
丸。
鳌按。疳积KT 泻。KT 者胀也。其症必目胞肿。腹胀。喜饮水。利色无常。日见消瘦。
Chao Yuanfang stated: Sudden diarrhea in infants and children arises from deficiency of the intestines and stomach, suddenly injured by cold or hot pathogenic qi. If caused by heat, the stool color is yellow and red; if caused by cold, the stool color is greenish-white. If cold and heat interact, it transforms into dysentery with red and white mucus (Chi Bai Zhi Li). Longgu San (Dragon Bone Powder) is suitable. For chronic diarrhea in infants and children, the general principle is to tonify deficiency and eliminate accumulation. Huatuo Jiu Li Shen Yan Fang (Huatuo's Miraculous Efficacy Formula for Chronic Dysentery) is suitable.
Zhang Yuansu stated: When milk and food are not digested, at the onset of illness, there is sudden expulsion of cold breath, coldness of the four limbs, a pale face lacking luster, and unsettled spirit. This indicates disharmony of Stomach Qi, which can be treated with strongly warming medicines such as Shijunzi Wan (Quisqualis Pill) and Yihuang San (Yellow-Protecting Powder). If diarrhea persists for a long time without recovery, and milk/food remains undigested, this indicates wind-cold in the Spleen and Stomach. First administer two doses of Yihuang San, then guide/drain using Xuanfeng San (Dispersing Wind Powder). Subsequently, strongly tonify Stomach Qi.
Zeng Shi discussed the origins of diarrhea, categorizing them into cold diarrhea, heat diarrhea, food-injury diarrhea, water diarrhea, accumulation diarrhea, fright diarrhea, wind diarrhea, visceral cold diarrhea, and Ganji KT diarrhea, among others, all distinct. Cold diarrhea often presents as clear white water, frequent but scanty passage, abdominal pain with borborygmus, furrowed brows, slow/dull eyes, pale complexion, and sweating on the forehead. Chonghe Yin (Harmonizing Decoction), Danggui San (Angelica Powder), and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) are indicated. Heat diarrhea presents with yellow stool, flowing like water from a tube, stopping immediately after passage but recurring half a day later, accompanied by vexation, thirst, and scanty yellow urine. The diet must be coarse. First use Wuling San (Five-Ingredient Powder with Poria), or Dashun Yin (Great Harmony Decoction), followed by Qian's Baizhu San (Baizhu Powder by Dr. Qian) or Xiangru San (Mosla Powder). Food-injury diarrhea occurs due to inherent weakness of the Spleen and Stomach combined with injury from raw/cold foods, resulting in unformed stools. It can also result from the mother consuming raw/cold or greasy/rich foods, leading to diarrhea. The face and lips are pale, stools are thin and scanty, or smell like spoiled eggs. The body is yellow and emaciated. Gupi Hezhong San (Spleen-Solidifying and Middle-Harmonizing Powder) and Xingpi San (Spleen-Awakening Powder) are suitable. Water diarrhea, also known as Dongxie (Cave Diarrhea), results from disharmony of Yin and Yang and failure to separate fluids and grains. It presents with yellow watery stools, scanty urine, frequent uncontrolled passage. In summer and autumn, exposing oneself to cool air during the day and losing cover causing cold exposure at night leads to conflict between cold and heat, confusing clear and turbid qi. Alternatively, maternal internal heat transmitted through breast milk causes Spleen-Stomach disharmony and mixing of fluids and grains. Wuling San (Five-Ingredient Powder with Poria) added with Yiren (Coix Seed), Cheqian Cao (Plantago Seed), and Banxia (Pinellia Tuber) is used to differentiate Yin and Yang. Alternatively, Baizhu San (Baizhu Powder) or Liuhe Tang (Six-Harmonies Decoction) may be used. Accumulation diarrhea stems from Spleen Qi deficiency where ingested milk/food fails to digest, compounded by prolonged consumption of cold foods transmitting to the Large Intestine, resulting in diarrhea. Various medicines fail because the accumulation in the Spleen and Stomach has not been removed. First use Sanleng San (Sparganium Powder) to remove accumulation, then Chenxiang Binglang Wan (Aquilaria and Betel Nut Pill) and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), followed by Hezhong San (Middle-Harmonizing Powder). Fright diarrhea presents with green stool resembling moss, thick and sticky like glue. It should not be stopped abruptly; instead, calm the Heart, suppress Liver wind, harmonize Spleen and Stomach, and digest milk/food. First use Wuling San (Five-Ingredient Powder with Poria), then Sanleng San (Sparganium Powder). Wind diarrhea often follows severe slow convulsion diseases. Stools are thin, yellow-brown, or mixed with undigested food, caused by Spleen deficiency. If mixed with dark brown/black, it indicates Spleen deficiency with Kidney Water overacting. If prolonged, it leads to convulsions. First use Wuling San (Five-Ingredient Powder with Poria) added with Yiren (Coix Seed) to drain Kidney Water, then Xiehuang San (Drain-Yellow Powder) to dispel Spleen wind, finally Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) to tonify Spleen Qi. Visceral cold diarrhea presents with green stool that is neither thin nor thick, or clear water discharge. Abdominal pain and borborygmus occur before defecation, and crying precedes the act. This occurs in infants aged 3-5 months but not after one year, caused by wind-cold invading via the umbilical stump. First use Chonghe Yin (Harmonizing Decoction) added with Congbai (Scallion White), then Danggui San (Angelica Powder) added with Wei Jiang (Baked Ginger), along with Yunqi San (Qi-Balancing Powder) and Lizhong Tang (Regulate the Middle Decoction). Ganji KT diarrhea presents with yellow face, distended abdomen, weak legs, large head with thin neck, sparse upright hair, emaciation, anorexia, morning chill and evening fever, abdominal masses (Zheng Pi), variable stool color, foul odor, and spontaneous start/stop of diarrhea. First use Sanleng San (Sparganium Powder) added with Chenpi (Tangerine Peel), then Wuxi Wan (Rhinoceros Horn Pill), Lushui Wan (Aloe Pill), and Kuchang Tang (Quick-Intestine Decoction). For dysentery/diarrhea with deep green color fading to pale yellow mixed with white, indicating excess cold and deficient heat (Yin pathogen overcoming Yang), Shouzhong Tang (Guard-the-Middle Decoction) and Weiling Tang (Stomach-Five-Ingredient Decoction) are used to support the exterior and rescue the interior. The formula should include Danggui San (Angelica Powder) added with Chenpi (Tangerine Peel), Zisu (Perilla Leaf), Shengjiang (Fresh Ginger), and Nuomi (Glutinous Rice). For severe cold, Lizhong Tang (Regulate the Middle Decoction) added with Fuzi (Prepared Aconite Root), Ginger, and Jujube is used, followed by Nanxing Fupi Yin (Arisaema and Tangerine Peel Drink). If diarrhea is pale green with froth, yellow and thick, indicating excess heat and deficient cold, leading to yellow emaciation and vexation, Wuling San (Five-Ingredient Powder with Poria) added with Yiren (Coix Seed), Cheqian Cao (Plantago Seed), and Shengjiang (Fresh Ginger) is used to dissipate residual pathogens. Then, Yinchenshanzhi Tang (Artemisiae Scopariae and Gardeniae Decoction) is taken with Wuling San (Five-Ingredient Powder with Poria) to resolve yellow discoloration. Alternatively, Wan'an Yin (Ten-Thousand Peace Drink) or Sishen Wan (Four-Spirit Pill) may be used.
Shen Jin'ao noted: In Ganji KT diarrhea, "KT" means distension. Symptoms necessarily include swollen eyelids, abdominal distension, preference for drinking water, irregular stool color, and progressive emaciation.