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In pediatric vomiting and diarrhea syndromes, deficiency-cold patterns account for eight or nine out of ten cases, while excess-heat patterns account for only one or two. If the pulse and symptoms show no signs of fire/heat, the complexion is clear and white, breathing is calm, limbs are cool, or there is mental fatigue, these are all deficiency-cold patterns. One must not recklessly use cooling medicines. As the ancients said: "Spleen deficiency leads to retching (ou), Stomach deficiency leads to vomiting (tu)." This refers to the fact that when food enters the Stomach but cannot be transformed and transported, leading to vomiting, it is due to Spleen Qi deficiency and its inability to transport. When cold-cool substances enter the Stomach, causing nausea and vomiting, it is because the Yang Qi of the Middle Jiao has been damaged and cannot transform. If the pathogenic factor is in the Middle Jiao, it results only in vomiting; if it extends to the Lower Jiao, it manifests as both vomiting and diarrhea. Therefore, for conditions located in the Upper and Middle Jiao, treatment should focus on the Spleen and Stomach; for conditions involving the Lower Jiao, regulation of the Spleen and Kidney is appropriate. If excess heat-fire pathogens are present but cold-cooling purgatives are used recklessly, death is inevitable.

1. For pediatric deficiency-cold vomiting, where vomiting and diarrhea occur without obvious cause and show no signs of heat, it is invariably caused by raw/cold foods damaging the Stomach Qi. Most pediatric diseases today fall into this category. The primary treatments should be Yangzhong Decoction (Nourish the Middle Decoction) or Wenwei Yin (Warm the Stomach Drink). Secondary options include Wujunzi Decoction (Five Gentlemen Decoction), Lizhong Tang (Regulate the Middle Decoction), or Dongzhu Decoction (Winter Atractylodes Decoction). If accompanied by Blood deficiency with dryness and thirst, add Danggui (Angelica Sinensis) to Wujunzi Decoction. If accompanied by Spleen-Kidney deficiency-cold, excessive phlegm-fluids, or panting, Liyin Decoction (Nourish Yin Decoction) is indicated. In severe cases, Renshen (Ginseng Radix) and Fuzi (Aconite Lateralis Radix Praeparata) combined with Liyin Decoction are most effective; do not assume Shudi Huang (Rehmanniae Radix Preparata) is contraindicated in vomiting. If the Spleen Qi is not cold, or if vomiting occurs due to occasional irritation but is mild, Siwu Yigong San (Four Agents Extra-Effort Powder) is suitable. If there is cold-stagnation in the Spleen with Qi obstruction causing vomiting, Huoxiang Angwei San (Agastache Stomach-Calming Powder) is appropriate. If the Upper Jiao is unclear with excessive phlegm and stagnation, Liujunzi Tang (Six Gentlemen Decoction) is indicated, possibly augmented with Sharen (Amomi Fructus), Paojiang (Prepared Ginger Rhizome), or Muxiang (Aucklandiae Radix).

2. For pediatric food-stagnation vomiting, if inappropriate foods are consumed or food retention and turbidity cause vomiting, there will inevitably be chest/diaphragm fullness or abdominal pain, indicating residual pathogenic factors. He Wei Yin (Harmonize the Stomach Drink) and Yihuang San (Yellow Protect Powder) are indicated. If there is only food stagnation without Stomach cold, Dahezhong Yin (Great Harmonize the Middle Drink) or Xiaohezhong Yin (Small Harmonize the Middle Drink) are suitable. If food stagnation is complicated by phlegm causing vomiting, Erchen Tang (Two Aged Ingredients Decoction), Liu'an Decoction (Six Peaceful Decoction), or Lingzhu Erchen Jian (Poria-Atractylodes Two Aged Ingredients Decoction) are appropriate. If food stagnation exists but is due to Spleen deficiency failing to transform, the focus must be on the Spleen Qi rather than the food itself. Only Yangzhong Decoction, Wenwei Yin, Liyin Decoction, or Shengzhu Decoction (Holy Atractylodes Decoction) should be used to nourish the root. One must not directly use digestive-purgative agents simply because of dietary indiscretion.

3. Pediatric Stomach-heat vomiting is rare. Internal heat rarely causes vomiting; if it does, it is usually due to excessive consumption of roasted/fried sweet foods causing stagnation at the stomach opening, summer heatstroke, or inherent organ heat. Treating heat syndromes requires precise differentiation to avoid mistaking false heat for true heat. For Stomach fire/internal heat vomiting, symptoms include irritability, heat sensation, thirst preferring cold drinks, and a pulse that is洪大 (Hóng Dà, large and surging), 滑数 (Huá Shuò, slippery and rapid). Severe fire cases warrant Xiehuang San (Drain Yellow Powder), Yuquan San (Jade Spring Powder), or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). If phlegm-food stagnation combines with fire to cause vomiting, Erchen Tang augmented with Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), or Zhizi (Gardeniae Fructus), or adding Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus), is suitable. If Spleen-Stomach weakness coexists with fire, Renshen Angwei San (Ginseng Stomach-Calming Powder) or Chupi Zhuru Tang (Tangerine Peel and Bamboo Juice Decoction) are indicated. For Stomach fire vomiting with thirst, Zhuru Tang (Bamboo Juice Decoction) is used. For summer Stomach heat from Yang heatstroke damaging the Stomach, characterized by irritability, intense thirst, and simultaneous vomiting/diarrhea, Siwei Xiangru Yin (Four-Agent Mosla Drink), Shiwei Xiangru Yin (Ten-Agent Mosla Drink), Zhuru Tang, or Chupi Zhuru Tang are appropriate. For severe internal heat, Yi Yuan San (Benefit Origin Powder) or Yuquan San are main treatments. However, summer heat has Yin-Yang distinctions. If vomiting/diarrhea results from overconsumption of cold/raw foods during hot weather, damaging the Stomach, this is Yin Summer Heat. Treatment should warm the Stomach and Middle Jiao, following deficiency-cold protocols, or using Wuling San (Five-Ingredient Poria Powder); none of the heat-clearing herbs listed above should be used.

Mr. Xue stated: During summer months, vomiting/diarrhea with hot hands/feet and thirst for cold drinks indicates a Yang syndrome, treated with cooling agents. Cold hands/feet with thirst for hot drinks indicate a Yin syndrome, treated with warming-tonifying agents. Thus, Yin syndromes misdiagnosed and treated with cold-cooling medicines may result in cyanotic dark hands/feet post-mortem, or even whole-body discoloration, which serves as verification.

4. Simultaneous vomiting and diarrhea in children originally stem from internal injury. Causes include external cold invading and damaging Zang-Qi; careless consumption of raw/cold foods damaging Stomach Qi; or weak Middle Qi combined with improper diet. Pathogens injuring Yang levels cause vomiting; those injuring Yin levels cause diarrhea. Simultaneous occurrence indicates damage to both Yin and Yang. Differentiation must assess presence of stagnation and determine deficiency/excess. If early-stage vomiting/diarrhea presents with chest/abdominal distension and excess stagnation, He Wei Yin or Lingzhu Erchen Jian should be used first to clear Upper Jiao Qi. If early-stage vomiting/diarrhea involves abdominal distension/pain with tenderness (refusal to press), Weiling Tang (Gastro-Ling Decoction) or Wuling San augmented with Ganjiang (Zingiberis Rhizoma) and Muxiang is indicated to separate Lower Jiao clarity/turbidity. If there is no upper distension, or persistent nausea after profuse vomiting, the upper Jiao is likely empty; fatigue indicates Stomach deficiency. For mild deficiency-cold, Siwu Yigong San is suitable. Since cold causes vomiting, Wujunzi Decoction, Liuyi Yigong Jian (Six Agents Extra-Effort Decoction), Yangzhong Decoction, or Wenwei Yin are most appropriate. If lower abdominal pain is mild (pressable/rubable), or abdomen prefers warmth/moxibustion, or profuse diarrhea persists, the Lower Jiao is extremely empty due to Spleen-Kidney deficiency-cold failing to secure. Weiguan Decoction (Stomach Gate Decoction) is essential. Mild cases may use Sijunzi Tang augmented with Roudoukou (Myristicae Semen), Buguzhi (Psoraleae Fructus), or Dingxiang (Caryophylli Flos). If deficiency coexists with stagnation, Zhuwei Gao (Assist Stomach Paste) may be considered. If truly caused by Stomach fire, rebellious fire upward and heat accumulation downward can cause vomiting/diarrhea, but only if fire symptoms and pulses are evident. Then, Da/Xiao Liqing Yin (Great/Small Clear Separation Drinks) or Xianglian Wan (Aucklandia-Coptis Pills) are indicated, or treat according to Stomach-heat vomiting protocols. This case is rare and must not be confused with others.