钱乙曰。春冬之治宜从表。如伤寒吐泻身温。乍凉乍热。睡多气粗。大便青白。呕吐。乳下不消。时咳嗽。更有五
脏兼现症。当煎入脏君臣药。先服大青膏。后服益黄散。如先曾下。或无下症。慎不可下。此乃脾肺受寒也。若伤风吐
泻。身热多睡。能食乳。饮水不止。吐痰。大便黄水。此为胃虚热渴吐泻也。当生胃中津液。以止其渴。白术散。后用
发散。大青膏。伤风吐泻。身凉吐沫。泻青白。闷乱不渴。哽气。长出气。睡露眼。此伤风荏苒轻怯。因成吐泻。专先
补脾。益黄散。后用发散。大青膏。此伤风二症。多病于春冬也。夏秋之治宜从里。儿生三日内壮热。不思乳食。大便
乳食不消。或白色。是伤寒。当下之。白饼子。并和胃。益黄散。儿生三日至十日。吐泻身温凉。不思乳食。大便青白。
乳食不消。上实下虚也。更有五脏兼见症。肺则睡露睛。喘气。心则惊悸饮水。脾则困倦多睡。肝则呵欠烦闷。肾则不
语畏明。当视其兼脏症。先泻其所实而补其虚。如脾虚。益黄散主之。此二症多病于夏秋也。再如五月夏至后吐泻。身
壮热者。此热也。盖小儿脏腑。十分中九分热也。或因伤热。乳食不消。泻深黄色。玉露饮。六月大暑后吐泻。身大温
而似热。脏腑中六分热四分冷也。吐呕。乳食不消。泻黄白色。似渴。或乳或不乳。食前少服益黄散。食后多服玉露饮。
立秋后吐泻身温。脏腑中三分热七分冷也。不能食乳。多似睡。闷乱。哽气。长出气。睡露睛。唇白多哕。欲大便。不
渴。食前多服益黄散。食后少服玉露饮。八月秋分后吐泻身冷。无阳也。不能食乳。干呕哕。泻青褐水。当补脾。益黄
散。不可下也。凡治小儿吐泻。大法。五月内九分下而一分补。八月内。九分补而一分下。切勿混治。
万全曰。小儿盛暑吐泻。邪热在下焦则泻。在上焦则吐。亡津必渴。用玉露散。虽吐时时与啜之。过三日必愈。如
身热脉大溺黄。五苓、益元各半。汤调温服。如身凉脉细。尿清。早晨益黄散。后玉露散。如过四五日困弱。异功散。
或用和中散。
曾氏曰。小儿盛夏初秋。遇夜乘凉。渴而饮水。过食生冷。攻击肠胃。遂乃暴吐暴泻。传作手足俱痹。筋挛而痛。
痛则神志不宁。若以惊症治之。误矣。
张元素曰。如有风而泻。用防风、羌活。谓吐泻兼肝病。风搐拘急。如有热而泻。用大黄、黄连。谓吐泻兼心病。
身热也。有寒而泻。用附子。谓吐泻兼肾病。身冷。或足胫寒而逆也。有湿而泻。用白术、茯苓。谓吐泻兼本脏脾病。
多睡体重昏倦也。有肺病而泻。用白芍、桂心。定喘麦冬、人参。甚者用槟榔。大便不通加大黄。谓吐泻兼肺病。咳嗽
也。
Qian Yi stated: The treatment in spring and winter should focus on the exterior. For example, in vomiting and diarrhea caused by cold damage (Shanghan), with a warm body, alternating chills and fever, excessive sleepiness, coarse breathing, greenish-white stools, vomiting, indigestion of milk, occasional coughing, and additional symptoms involving the five zang organs, decoctions should include the sovereign and minister herbs for regulating the zang organs. First administer Daqing Gao (Great Blue Paste), followed by Yihuang San (Yellow Protection Powder). If purgatives have already been used, or if there are no indications for purgation, one must strictly avoid using them. This is due to cold invading the spleen and lungs. In cases of vomiting and diarrhea caused by wind injury, with fever, excessive sleepiness, ability to take milk, incessant drinking, vomiting phlegm, and yellow watery stools, this indicates stomach deficiency heat with thirst and vomiting/diarrhea. One should generate fluids in the stomach to quench thirst, using Baizhu San (Atractylodes Macrocephala Powder), followed by dispersing methods and Daqing Gao. In cases of vomiting and diarrhea from wind injury, with a cool body, foaming at the mouth, greenish-white stools, restlessness without thirst, hiccupping, long sighs, and sleeping with eyes partially open, this is a mild and lingering condition resulting from wind injury causing vomiting and diarrhea. The primary approach is to tonify the spleen using Yihuang San, followed by dispersing methods and Daqing Gao. These two types of wind-injury vomiting and diarrhea mostly occur in spring and winter.
The treatment in summer and autumn should focus on the interior. Infants within three days of birth presenting with high fever, loss of appetite for milk and food, and undigested milk/food in stools, or white stools, indicate cold damage (Shanghan) and require purgation using Baibing Zi (White Pill), along with harmonizing the stomach using Yihuang San. Infants from the third to the tenth day of life presenting with vomiting and diarrhea, normal or cool body temperature, loss of appetite, greenish-white stools, and undigested milk/food, indicate excess above and deficiency below. Additional symptoms involving the five zang organs may appear: lung involvement presents as sleeping with eyes half-open and wheezing; heart involvement presents as palpitations and desire for water; spleen involvement presents as fatigue and excessive sleepiness; liver involvement presents as yawning and irritability; kidney involvement presents as muteness and photophobia. One should assess the concurrent zang symptoms, first draining the excess and then tonifying the deficiency. For spleen deficiency, Yihuang San is the primary formula. These two conditions mostly occur in summer and autumn.
Furthermore, vomiting and diarrhea occurring after the Summer Solstice in May, accompanied by high fever, indicate heat. This is because children's internal organs are nine parts heat to one part cold. It may be due to heat injury causing indigestion of milk/food and deep yellow stools, treated with Yulu Yin (Jade Dew Decoction). After the Great Heat in June, vomiting and diarrhea present with significant warmth resembling heat, with six parts heat and four parts cold in the organs. Symptoms include vomiting, indigestion of milk/food, yellowish-white watery stools, apparent thirst, variable feeding habits. Administer small amounts of Yihuang San before meals and large amounts of Yulu Yin after meals. After Start of Autumn, vomiting and diarrhea present with warm bodies, with three parts heat and seven parts cold in the organs. Symptoms include inability to feed, lethargy, restlessness, hiccupping, long sighs, sleeping with eyes half-open, pale lips, frequent hiccups, urge to defecate without thirst. Administer large amounts of Yihuang San before meals and small amounts of Yulu Yin after meals. After the Autumn Equinox in August, vomiting and diarrhea present with cold bodies, indicating lack of yang (Wu Yang). Symptoms include inability to feed, dry heaving/hiccups, and greenish-brown watery stools. Tonify the spleen using Yihuang San; do not use purgation.
The general principle for treating pediatric vomiting and diarrhea is: within May, use nine parts purgation and one part tonification; within August, use nine parts tonification and one part purgation. Do not mix these approaches indiscriminately.
Wan Quan stated: In pediatric vomiting and diarrhea during intense summer heat, pathogenic heat in the lower jiao causes diarrhea, while heat in the upper jiao causes vomiting. Loss of body fluids leads to thirst. Use Yulu San (Jade Dew Powder). Even if vomiting occurs, administer it frequently in small sips. Recovery is expected after three days. If there is fever, large pulse, and yellow urine, use equal parts of Wuling San (Five-Ingredient Poria Powder) and Yiyuan San (Benefit Origin Powder), mixed with decoction and taken warm. If the body is cool, pulse is fine, and urine is clear, administer Yihuang San in the morning, followed by Yulu San. If weakness persists after four or five days, use Yigong San (Extraordinary Merit Powder) or Hezhong San (Harmonize Middle Powder).
Zeng Shi stated: During midsummer and early autumn, if children cool off at night, drink water when thirsty, and overconsume raw/cold foods, attacking the intestines and stomach, sudden violent vomiting and diarrhea ensue. This can transmit to cause paralysis of hands and feet, muscle spasms, and pain. Pain leads to restless spirit. Treating this as a convulsion disorder would be an error.
Zhang Yuansu stated: For diarrhea caused by wind, use Fangfeng (Saposhnikovia Root) and Qianghuo (Notopterygium Rhizome), indicating vomiting and diarrhea combined with liver disease, featuring wind-induced spasms and rigidity. For diarrhea caused by heat, use Dahuang (Rhubarb Root) and Huanglian (Coptis Rhizome), indicating vomiting and diarrhea combined with heart disease, featuring body heat. For diarrhea caused by cold, use Fuzi (Prepared Aconite Root), indicating vomiting and diarrhea combined with kidney disease, featuring body coldness or cold/reversed limbs. For diarrhea caused by dampness, use Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria), indicating vomiting and diarrhea combined with spleen disease (the organ itself), featuring excessive sleepiness, heavy body, and drowsiness. For diarrhea caused by lung disease, use Baishao (White Peony Root) and Guixin (Cinnamon Twig), plus Dingchuan (likely Asarum or similar for asthma), Maidong (Ophiopogon Tuber), and Renshen (Ginseng). For severe cases, use Binglang (Areca Seed); if stool is blocked, add Dahuang. This indicates vomiting and diarrhea combined with lung disease, featuring coughing.