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Wan Mizhai treated a one-year-old infant who presented with simultaneous vomiting and diarrhea. At that time, the weather was extremely cold. The physician prescribed Lizhong Wan (Cinnamon Twig and Atractylodes Macrocephala Pill) and Weiling Wan (Stomach and Five Ling Pill), but there was no effect after administration. Wan said: "This is due to cold pathogens in both the exterior and interior that have not been dispersed." He then administered Yihuang San (Yellow Protecting Powder). That night, the child sweated profusely, and the condition ceased.

Another girl, aged half a year, also presented with simultaneous vomiting and diarrhea, which was caused by food stagnation (accumulation of undigested food). She had previously contracted wind pathogens externally; therefore, Yihuang San was used to warm and disperse the cold in the exterior and interior. This case involved only food stagnation, so Weiling Wan (Stomach and Five Ling Pill) and Yili Dan (One Pill Elixir) were administered with Chenbitu Decoction (Decoction of Old Wall Soil) to regulate the spleen and stomach, eliminate food stagnation, resulting in the cessation of both vomiting and diarrhea.

An infant suffered from sudden severe vomiting and diarrhea, expelling undigested milk through both upper and lower orifices. Lizhong Wan (Cinnamon Twig and Atractylodes Macrocephala Pill) was administered with good effect.

Another infant suffered from sudden severe vomiting and diarrhea, expelling yellow watery stool containing milk curds. Erchen Tang (Two-Cured Decoction) was modified with Huanglian (Rhizoma Coptidis) stir-fried with ginger juice, decocted and administered with good effect. Someone asked: "The two diseases present similarly, yet the treatments differ. Why?" The answer was: "When undigested milk is expelled, it indicates cold in the stomach; thus, Lizhong Wan (Cinnamon Twig and Atractylodes Macrocephala Pill) is used to urgently warm it. When undigested milk curds are expelled, it indicates pathogenic heat in the stomach; pathogenic heat fails to digest grain, so Banxia (Rhizoma Pinelliae) and Huanglian (Rhizoma Coptidis) are suitable to resolve it. This illustrates the principle of treating the same disease with different methods."

Zhang Jingyue's youngest son was born in the Yan region. By the time of Bailu (White Dew solar term), he was just half a year old. He accidentally contracted cold, leading to severe vomiting and diarrhea. Medicines for warming the stomach and harmonizing the spleen were ineffective. Subsequently, Lizhong Wan (Cinnamon Twig and Atractylodes Macrocephala Pill) at standard doses was also ineffective. After three days, Ren Shen (Radix Ginseng) 3 qian, along with Shengjiang (Rhizoma Zingiberis Recens), Rougui (Cortex Cinnamomi), Wuzhuyu (Fructus Evodiae), and Roudoukou (Nucis Arecae Semina) were added, but still without effect. By the fourth or fifth day, he vomited half of whatever milk he drank and defecated the other half; nothing remained in his abdomen. Desperately, Ren Shen (Radix Ginseng) 5-6 qian, Zhi Fuzi (Prepared Radix Aconiti Lateralis), Shengjiang (Rhizoma Zingiberis Recens), and Rougui (Cortex Cinnamomi) 1-2 qian each were given. However, upon swallowing, he vomited immediately, retaining not a drop. The excreted milk was white, odorless, and unchanged. His physical form and qi were critically endangered, with no hope of survival. It was deduced that cold pathogens had invaded the stomach; apart from Ren Shen (Radix Ginseng), Shengjiang (Rhizoma Zingiberis Recens), Rougui (Cortex Cinnamoni), and Fuzi (Radix Aconiti Lateralis), what else could be used? Then it was realized that his stomach qi was extremely deficient; even slight mismatch in the flavor and aroma of medicines would cause rejection and vomiting. Moreover, Fuzi (Radix Aconiti Lateralis) has a salty taste and can induce vomiting, which might be the cause. Medicines with sweet and spicy flavors acceptable to the palate were needed to calm the stomach qi. Thus, Hu Jiao (Piperis Longi Fructus) 3 qian was crushed, and Wei Jiang (Roasted Rhizoma Zingiberis) 1 liang were decocted in 2 zhong of water until reduced to 0.8 zhong. Separately, Ren Shen (Radix Ginseng) 2 liang were decocted in 2 zhong of water until reduced to 1 zhong. These two decoctions were mixed using a tea spoon to balance their flavors. For every ten parts of Ren Shen (Radix Ginseng) decoction, one part of Hu Jiao (Piperis Longi Fructus) and Wei Jiang (Roasted Rhizoma Zingiberis) decoction was added. The mixture was sweet and spicy, perfectly palatable. It was warmed and slowly administered with a tea spoon. After about an hour, all of it was swallowed. Thereafter, milk and medicine were tolerated well, although diarrhea persisted. In half a day, 2 liang of Ren Shen (Radix Ginseng) had been consumed. After the Ren Shen (Radix Ginseng) was exhausted, the child suddenly became restless and moaned, suffering severely. The family believed this was caused by internal burning from hot medicines. Thinking further: if the medicine were incorrect, why was there initial tolerance? This must be due to several days of fasting, new recovery of stomach qi, empty storage organs, and extreme hunger. Porridge was shown to him, and he indeed showed anxiety and desire to eat, urgently so. A small cup was given, which he finished in one sip. He wanted more, so half a bowl was given, which was insufficient. Another half bowl was given, after which he lay down quietly. The next day, Zhi Fuzi (Prepared Radix Aconiti Lateralis) was added, and the diarrhea stopped, leading to full recovery. Analyzing the depth of the disease, although the treatment was appropriate, the mismatch in flavor and aroma prevented efficacy. Regarding the restlessness caused by hunger, if not understood correctly, cooling medicines would have been wrongly used, ruining all efforts in one dose, and blame would still fall on those using Ren Shen (Radix Ginseng) and Shengjiang (Rhizoma Zingiberis Recens). (Ye Tianshi commented: For a six-month-old infant, such large doses of hot medicines like Shengjiang (Rhizoma Zingiberis Recens) and Rougui (Cortex Cinnamomi), plus 3 qian of Hu Jiao (Piperis Longi Fructus) and 2 liang of Ren Shen (Radix Ginseng), though due to cold invasion, need not be so large. Fortunately, survival was achieved thanks to the porridge. The Classics state: Those with five deficiencies die; those who consume porridge and fluids live. If one strictly advocates using hot tonifying medicines, how can the intestines and stomach endure? Zhang Jingyue used his own three sons to demonstrate the efficacy of hot tonifying medicines, causing later generations to believe his theory. Although Xue Lizhai favored warm tonification, he never went to such extremes. Pediatricians should not rigidly adhere to this method and harm patients.)

Xue Lizhai treated a child of several years old who, whenever food stagnation occurred, took harsh purgative medicines. Later, he developed abdominal distension, sometimes accompanied by vomiting and diarrhea. Liujunzi Tang (Six Gentlemen Decoction) was first used, and various symptoms gradually improved. Then, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, and stomach qi gradually recovered.

Liu Congzhou, a physician from Shaozhou, discussed pediatric vomiting, diarrhea, and convulsions. If phlegm was suspected, only Wuling San (Five Ling Powder) decocted with Shengjiang (Rhizoma Zingiberis Recens) and Banxia (Rhizoma Pinelliae) should be administered. Once phlegm was vomited out, diarrhea would stop, and fright/convulsions would subside naturally. (From *Baibai Fang*.)