【歌】吐泻须知热与寒，泻黄吐乳热邪干；泻青吐逆为寒候，更把天时月日参。
【论】经云∶脾虚则泻，胃虚则吐，脾胃不和，阴阳不顺，清浊相干，则吐泻兼作。钱孔纯云∶小儿吐泻，
有湿、有热、有寒、有惊，宜详察而分治之。如夏月中暑发渴引饮，霍乱吐泻，脸赤唇红，去后黄沫色，小便
赤涩者，为热，可用香薷、五苓等药治之。冬时中寒，腹痛厥逆，吐泻白色，不渴，面微青色，唇紫，大便如
冻汁，或米谷不化，先战栗而小便去者，为寒，可用香附、砂仁、煨姜、木香等药治之。面微黑黄，眼亦黄，
手、足及肾囊稍肿，腹胀脐凸，小便短少，善呕而无食，痰多，唇白气促，爱坐畏眠者，为湿，可用苍术、浓
朴、薏苡、木瓜等药治之。面赤身热，睡卧不宁，目睛斜定，颈仰身摇，不时悸动，舌碎唇疮， 乳便青者，
为惊，可用天麻、川芎、茯苓、肉果等药治之。吐泻乳食不化，因伤粘腻难消之物，滞于中脘，不上不下，但
食即吐，面色青白，发热，四肢逆冷，不可便投止吐泻药，当先取积消导，宽利胸膈，次用调脾和胃之剂，此
皆合而言之也。愚谓有吐无泻者，胃必热，然亦有寒而吐者；有泻无吐者，胃必寒，然亦有热而泻者。何以辨
之？盖吐清凉，顺而易出者为寒；吐苦酸，逆而难出者为热；泻青白，小便
利者为寒；泻黄赤，肛门如烧者为热。又，泻利发哕者为虚，只吐不泻者为逆，各随其所属治之可也。
和中清热饮
治热吐。
黄连（姜炒，一钱） 半夏（姜制，一钱） 茯苓（一钱五分） 陈皮 藿香 砂仁（各七分）
水煎，徐徐服。
温中止吐汤
治寒吐
白豆蔻 茯苓（各一钱） 半夏（五分） 生姜（五片）
水煎，磨沉香四分，热服。
清热止泻汤
治热泻。
白茯苓 滑石（各一钱） 白术（六钱） 泽泻（七分） 川黄连（姜炒，四分）
加生姜，煎服。
温脾止泻汤
治寒泻。
白术（土炒） 白茯苓（各一钱） 桂（三分） 肉果（五分） 甘草（二分）
加生姜，煎服。
安胃醒脾汤
治吐泻兼作，脾胃俱受病者。
白术 白茯（各一钱） 滑石（水飞） 砂仁（炒，各七分） 木香（煨，五分）
姜、枣，煎服。
停食加枳实、山楂、曲 ；挟惊加胆星、天麻；风加防风、干葛；暑加香薷、扁豆；虚加人参；内有热加黄连；
口渴加乌梅肉；吐不止加藿香；泻不止加升麻。
[Verse]
In treating vomiting and diarrhea, one must distinguish between heat and cold. Yellow stool and vomiting of milk indicate interference by pathogenic heat; green stool and regurgitation indicate a cold syndrome. One must also take into account the seasonal climate and the heavenly stems and earthly branches of the month and day.
[Dissertation]
The *Classic of Internal Medicine* states: Spleen deficiency leads to diarrhea, Stomach deficiency leads to vomiting. When the Spleen and Stomach are disharmonious, and Yin and Yang qi are not smooth, clear turbid qi interferes with each other, leading to simultaneous vomiting and diarrhea. Qian Yi (courtesy name Zhongyang, known as Qian Kongchun) stated: In children, vomiting and diarrhea may be caused by dampness, heat, cold, or fright. These should be carefully examined and treated separately. For example, if one contracts summerheat in summer, resulting in thirst and desire to drink, accompanied by cholera-like severe vomiting and diarrhea, red face, red lips, yellow mucus in the stool, and scanty, painful urination, this is a heat syndrome. It can be treated with herbs such as Elsholtzia Herba (Xiangru) and Wuling San (Five-Ingredient Powder with Poria). If one contracts cold in winter, resulting in abdominal pain, cold limbs, white vomitus and stool, no thirst, slightly blueish face, purple lips, thin watery stool resembling frozen juice, or undigested rice and grain, preceded by shivering and then urination, this is a cold syndrome. It can be treated with herbs such as Cyperi Rhizoma (Xiangfu), Amomi Fructus (Sharen), prepared Zingiberis Rhizoma (Weijiang), and Aucklandiae Radix (Muxiang). If the face is slightly dark yellow, eyes are yellow, hands, feet, and scrotum are slightly swollen, abdomen is distended with protruding umbilicus, urine is scanty, there is frequent dry heaving without food expulsion, excessive phlegm, pale lips, rapid breathing, and a preference for sitting while fearing sleep, this is a dampness syndrome. It can be treated with herbs such as Atractylodis Rhizoma (Cangzhu), Magnoliae Officinalis Cortex (Houpo), Coicis Semen (Yiyi), and Chaenomelis Fructus (Mugua). If the face is red, body is hot, sleep is restless, eyes are fixed and deviated, neck is stiff and body sways, palpitations occur frequently, tongue is ulcerated, lips have sores, and milk and stool are green, this is a fright syndrome. It can be treated with herbs such as Gastrodiae Rhizoma (Tianma), Chuanxiong Rhizoma (Chuanxiong), Poria (Fuling), and Myristicae Semen (Rouguo). If vomiting and diarrhea involve undigested milk and food due to injury from sticky, hard-to-digest substances stagnating in the Middle Jiao (Zhongwan), neither ascending nor descending, causing immediate vomiting upon eating, with a blue-white complexion, fever, and cold limbs, one should not immediately administer anti-emetic or antidiarrheal drugs. Instead, one should first use methods to resolve accumulation and promote digestion, open and benefit the chest and diaphragm, and subsequently use formulas to regulate the Spleen and harmonize the Stomach. These are combined discussions. I propose that cases with vomiting but no diarrhea indicate Stomach heat, though cold can also cause vomiting; cases with diarrhea but no vomiting indicate Stomach cold, though heat can also cause diarrhea. How to differentiate? Generally, vomit that is cool and easy to expel indicates cold; vomit that is bitter/sour and difficult to expel indicates heat; stool that is green/white with free urination indicates cold; stool that is yellow/red with a burning sensation at the anus indicates heat. Furthermore, diarrhea accompanied by hiccups indicates deficiency; vomiting without diarrhea indicates an adverse condition. Each should be treated according to its specific pathology.
Hezhong Qingre Yin (Harmonizing Middle and Clearing Heat Decoction)
For treating heat-type vomiting.
Coptidis Rhizoma (Huanglian) – stir-fried with ginger, 1 qian; Pinelliae Rhizoma (Banxia) – prepared with ginger, 1 qian; Poria (Fuling) – 1.5 qian; Citri Reticulatae Pericarpium (Chenpi); Agastache Herba (Huoxiang); Amomi Fructus (Sharen) – 0.7 qian each.
Decoct in water and take slowly.
Wenzhong Zhi Ou Tang (Warming Middle and Stopping Vomiting Decoction)
For treating cold-type vomiting.
Cardamomi Fructus Albus (Baidoukou); Poria (Fuling) – 1 qian each; Pinelliae Rhizoma (Banxia) – 0.5 qian; Zingiberis Rhizoma Recens (Shengjiang) – 5 slices.
Decoct in water, add 0.4 qian of Aquilariae Lignum Resinatum (Chenxiang) ground from powder, and take hot.
Qingre Zhixie Tang (Clearing Heat and Stopping Diarrhea Decoction)
For treating heat-type diarrhea.
Poria (Baifuling); Talcum (Huashi) – 1 qian each; Atractylodis Macrocephalae Rhizoma (Baizhu) – 6 qian; Alismatis Rhizoma (Zexie) – 0.7 qian; Coptidis Rhizoma (Chuan Huanglian) – stir-fried with ginger, 0.4 qian.
Add Zingiberis Rhizoma Recens (Shengjiang), decoct and take.
Wenpi Zhixie Tang (Warming Spleen and Stopping Diarrhea Decoction)
For treating cold-type diarrhea.
Atractylodis Macrocephalae Rhizoma (Baizhu) – stir-fried with soil; Poria (Baifuling) – 1 qian each; Cinnamomi Ramulus (Gui) – 0.3 qian; Myristicae Semen (Rouguo) – 0.5 qian; Glycyrrhizae Radix et Rhizoma (Gancao) – 0.2 qian.
Add Zingiberis Rhizoma Recens (Shengjiang), decoct and take.
Anwei Xingpi Tang (Calming Stomach and Awakening Spleen Decoction)
For treating simultaneous vomiting and diarrhea where both Spleen and Stomach are diseased.
Atractylodis Macrocephalae Rhizoma (Baizhu); Poria (Baifu) – 1 qian each; Talcum (Huashi) – processed by water flotation; Amomi Fructus (Sharen) – stir-fried, 0.7 qian each; Aucklandiae Radix (Muxiang) – roasted, 0.5 qian.
Add Zingiberis Rhizoma Recens (Jiang) and Jujubae Fructus (Zao), decoct and take.
Modifications: Add Aurantii Fructus Immaturus (Zhishi), Crataegi Fructus (Shanzha), and Malt (Qu) for food stagnation; add Arisaematis Rhizoma Preparatum (Danning) and Gastrodiae Rhizoma (Tianma) for accompanying fright; add Saposhnikoviae Radix (Fangfeng) and Puerariae Radix (Gegen) for wind; add Elsholtzia Herba (Xiangru) and Dolichos Lablab Seed (Biandou) for summerheat; add Ginseng Radix et Rhizoma (Renshen) for deficiency; add Coptidis Rhizoma (Huanglian) for internal heat; add Pruni Mume Semen (Wumei Rou) for thirst; add Agastache Herba (Huoxiang) if vomiting persists; add Cimicifugae Rhizoma (Shengma) if diarrhea persists.