呕吐皆主脾胃，古人谓脾虚则呕，胃虚则吐是也。呕者有声无物，吐者有物无声也。盖乳哺
过饱，则胃不能受而溢出，衔乳多食睡，则脾不能运而作泻，脾胃渐伤，疾病缠绵，甚至慢
惊之患矣。若手足指热，喜饮热汤，或睡而露睛，皆胃气虚弱也，用异功散。若手足指热饮
冷，或睡不露睛，属胃经实热也，用泻黄散。若作泻少食，或小便色赤，胃经虚热也，用七
味白术散。大凡婴儿，在乳母尤当节饮食。若乳母停食，亦能致儿吐泻，故不可不慎也。
治验
一小儿伤食呕吐，发热面赤，服消导清热之剂，饮食已消，热赤未退，余以为胃经虚热，用
六君、升麻、柴胡，四剂而痊。
一小儿伤食呕吐，服克伐之药，呕中见血；用清热凉血，反大便下血，唇色白而或青。余谓
脾土亏损，肝木所乘。令空心服补中益气汤，食远服异功散，使涎血各归其源，果愈。
一小儿吐酸乳食，用四君、吴萸、黄连、木香，补脾平肝而愈。后口中有酸水，仍用前药随
愈。后吐苦水，而口亦苦，用龙胆汤，以清肝火；四君子汤，以补脾土而痊。
一小儿吐黄水，所食之物，悉皆甘味，用泻黄散，清其胃火而愈。后因停食，服克伐之药，
口甘不食，形气殊弱，用补中益气汤，养其中气而痊。
一小儿伤食嗳腐，用平胃散一服，宿滞顿化。余云∶不必多药，但节其饮食自愈。不信，别
用克滞之药，更加吐泻，以致不救。
一小儿伤食，发热面赤，抽搐呕吐，气喘唾痰，此饮食伤脾，肺气虚弱所致，用六君子汤，
炒黑黄连、山栀各二分，一剂顿愈。
消乳丸 治呕吐消乳食，脉沉者，伤食不化也。
香附子（炒） 宿砂仁 陈皮（去白） 甘草（炙） 神曲（炒） 麦芽（炒。各等分）
上为末，米糊丸，黍米大。每服二十丸，姜汤下。
又方∶治百 内，呕吐乳奶，或大便青色，用少妇乳汁一盏，入丁香十粒、陈皮一钱，瓷器
内煮数沸稍热，空心以绵球吮服。
杨氏消食丸 治乳食过多，胃气不能消化。
宿砂 橘皮 三棱 蓬术 神曲（炒） 麦芽（炒。各半两） 香附（炒，一两）
上为末，曲糊丸，麻子大，白汤送下，量儿加减。
局方观音散 治外感风寒，内伤脾胃，呕逆吐泻，不进饮食，渐至羸食。
人参（一两） 神曲（炒） 茯苓 甘草（炒） 木香 绵黄 白扁豆 白术（各一钱） 石莲肉（去心，二
钱半）
上为末，每服一钱，入藿香三叶，枣水煎服。
香附散 治积冷呕吐。
藿香叶 陈皮 浓朴（姜汁制。各七钱） 半夏（一两，汤泡七次） 甘草（炙，一钱）
上每服三钱，姜枣水煎，泻甚加木香、肉豆蔻。
香薷散 治寒温不适，饮食不调；或外因风寒暑邪致吐利，心腹疼痛，霍乱气逆，发热头痛
；或转筋拘急；或疼痛呕哕，四肢逆冷。
香薷（一两） 茯苓 白扁豆（炒） 浓朴（姜汁制。各五钱）
上每服二三钱，水煎，加酒半杯，冷服立效。
竹茹汤 治胃受邪热，心烦喜冷，呕吐不止。
葛根（七钱半） 半夏（炮，半两） 甘草（炙，三钱）
上每服一二钱，入竹茹枣许，大姜水煎，取清汁，微冷细细服，加茯苓三钱尤妙。
苏合香丸 治传尸骨蒸 肺痿，疰忤鬼气，卒心痛，霍乱吐痢，惊痫客忤等症。
苏合香油（入安息香膏内） 熏陆香（另研） 龙脑（研） 木香 白术 白檀香 丁香 朱砂（研水飞）
沉香 香附子（炒） 乌犀屑 荜茇安息膏（另为末，用无灰酒梓膏） 麝香（研） 诃黎勒（煨取皮。各
二两）
上为末，研匀，用安息香膏并蜜和丸，桐子大。井花水空心化服一二丸，温酒亦得，更用蜡
纸
青州白丸子 治惊风吐乳。
天南星（三两） 白附子（一两） 半夏（浸洗七次） 川乌头（去皮脐，半两）
上用井花水浸晒，过次日早晨，再换新水，春五日，夏三日，秋七日，冬十日，晒干为末，
以糯米粉煎粥清为丸，绿豆大，薄荷汤调下。
泻白散（方见脾脏）
白术散（方见积痛）
异功散
六君子汤
四君子汤（三方见内钓）
千金龙胆汤（方见噤风）
平胃散（方见脾胃虚冷）
补中益气汤（方见虚羸）
呕吐的病机主要归属于脾胃。古人所说的“脾虚则呕，胃虚则吐”正是此意。其中，“呕”指有声无物，“吐”指有物无声。若是乳食喂养过饱，胃无法容纳而溢出，就会发生呕吐；若是吃奶过多且睡后未消化，脾无法运化而导致腹泻。若脾胃逐渐受损，疾病便会缠绵难愈，甚至引发慢惊风（一种慢性惊厥病症）的祸患。
如果患儿手足指尖发热，喜欢喝热汤，或者睡觉时眼睛半睁（露睛），这属于胃气虚弱，应使用异功散（Yichong San, Five-Ingredient Powder with Atractylodes Macrocephala）。如果手足指尖发热却想喝冷饮，或者睡觉时眼睛紧闭不露睛，这属于胃经实热证，应使用泻黄散（Xiehuang San, Decoction to Drain the Spleen/Stomach Heat）。如果出现腹泻、食欲减退，或小便颜色深赤，这属于胃经虚热证，应使用七味白术散（Qiwei Baizhu San, Seven-Ingredient Bupleurum and Atractylodes Powder）。
大凡婴儿护理中，乳母尤其应当节制饮食。如果乳母饮食停滞不化，也会导致婴儿出现呕吐和腹泻，因此不可不谨慎对待。
【治疗验案】
有一个小儿因伤食导致呕吐，伴有发热、面色发红。服用消导清热药物后，饮食积滞已消，但发热和面赤症状未退。我认为这是胃经虚热，于是使用六君子汤（Liujunzi Tang, Six-Gentleman Decoction）加入升麻（Shengma, Cimicifugae Rhizoma）、柴胡（Chaihu, Bupleuri Radix），服用四剂后痊愈。
另一个小儿因伤食呕吐，服用攻伐性质的药物后，呕吐物中带血；随后改用清热凉血药物，反而导致大便下血，嘴唇颜色发白或发青。我认为是脾土亏损，导致肝木乘虚克制脾土。令其空腹服用补中益气汤（Buzhong Yiqi Tang, Tonify the Middle and Augment the Qi Decoction），饭后稍远时间服用异功散，使离经之血各归其源，果然痊愈。
还有一个小儿呕吐酸腐乳食，使用四君子汤（Sijunzi Tang, Four-Gentleman Decoction）、吴茱萸（Wuzhuyu, Evodiae Fructus）、黄连（Huanglian, Coptidis Rhizoma）、木香（Muxiang, Aucklandiae Radix），通过补脾平肝而痊愈。后来口中仍有酸水，仍用前方随症加减而愈。之后又呕吐苦水，口亦觉苦，使用龙胆汤（Longdan Tang, Gentian Decoction）以清肝火，配合四君子汤以补脾土，从而痊愈。
还有一个小儿呕吐黄水，所食之物均为甘甜口味，使用泻黄散，清泄胃火而痊愈。后来因停食（饮食积滞），服用攻伐药物，导致口甜不欲饮食，形体气息非常虚弱，使用补中益气汤，滋养其中气而痊愈。
还有一个小儿因伤食出现嗳气且有腐臭味，服用一剂平胃散（Pingwei San, Stomach-Pacifying Powder），宿食积滞顿时化解。我说：不必多用药物，只要节制饮食即可自愈。他不听信，另用消滞攻伐的药物，导致更加严重的呕吐和腹泻，最终导致死亡。
还有一个小儿因伤食，出现发热、面赤、抽搐、呕吐、气喘、唾痰等症状，这是饮食损伤脾土，导致肺气虚弱所致，使用六君子汤，加入炒黑黄连、山栀（Shanzhi, Gardeniae Fructus）各二分，服用一剂即痊愈。
【方剂】
消乳丸：治疗呕吐、消化不良乳食，脉象沉者，属于伤食不化。
组成：香附子（炒）、宿砂仁、陈皮（去白）、甘草（炙）、神曲（炒）、麦芽（炒）。以上各等分。
制法与用法：研为细末，用米糊制成丸药，大小如黍米。每次服用二十丸，姜汤送服。
又一方：治疗百日内的婴儿，呕吐乳奶，或大便呈青色。取少妇乳汁一盏，加入丁香十粒、陈皮一钱，在瓷器内煮沸数次，待稍热后，空腹时用棉球吮服。
杨氏消食丸：治疗乳食过多，胃气不能消化。
组成：宿砂、橘皮、三棱、蓬术、神曲（炒）、麦芽（炒）。以上各半两；香附（炒）一两。
制法与用法：研为细末，用曲糊制成丸药，大小如麻子。用白开水送服，根据患儿情况增减剂量。
局方观音散：治疗外感风寒，内伤脾胃，引起的呕逆、吐泻，不能进食，逐渐导致身体消瘦。
组成：人参（一两）、神曲（炒）、茯苓、甘草（炒）、木香、绵黄（注：原文如此，通常指黄芪或黄耆，此处依原文保留或理解为补气药，结合语境多为黄芪，但严格按原文提取实体）、白扁豆、白术（以上各一钱）、石莲肉（去心，二钱半）。
制法与用法：研为细末，每次服用一钱，加入藿香三叶，枣水煎服。
香附散：治疗积冷引起的呕吐。
组成：藿香叶、陈皮、浓朴（姜汁制，以上各七钱）、半夏（一两，汤泡七次）、甘草（炙，一钱）。
制法与用法：每次服用三钱，姜枣水煎服。若腹泻严重，加木香、肉豆蔻。
香薷散：治疗寒温不适，饮食不调；或因外感风寒暑邪导致的吐利，心腹疼痛，霍乱气逆，发热头痛；或转筋拘急；或疼痛呕哕，四肢逆冷。
组成：香薷（一两）、茯苓、白扁豆（炒）、浓朴（姜汁制，以上各五钱）。
制法与用法：每次服用二三钱，水煎，加酒半杯，冷服，立竿见影。
竹茹汤：治疗胃受邪热，心烦喜冷，呕吐不止。
组成：葛根（七钱半）、半夏（炮，半两）、甘草（炙，三钱）。
制法与用法：每次服用一二钱，加入枣许大小的竹茹，大姜水煎，取清汁，微冷后细细服用。加入茯苓三钱效果更佳。
苏合香丸：治疗传尸骨蒸（肺结核类消耗性疾病）、肺痿、疰忤鬼气（中恶邪气）、卒心痛、霍乱吐痢、惊痫客忤等症。
组成：苏合香油（入安息香膏内）、熏陆香（另研）、龙脑（研）、木香、白术、白檀香、丁香、朱砂（研水飞）、沉香、香附子（炒）、乌犀屑、荜茇、安息膏（另为末，用无灰酒梓膏调制）、麝香（研）、诃黎勒（煨取皮，以上各二两）。
制法与用法：研为细末，混合均匀，用安息香膏和蜜调和制成丸药，大小如梧桐子。空腹时井花水化服一二丸，温酒送服亦可。更需用蜡纸包裹保存。
青州白丸子：治疗惊风吐乳。
组成：天南星（三两）、白附子（一两）、半夏（浸洗七次）、川乌头（去皮脐，半两）。
制法与用法：用井花水浸泡日晒，次日早晨换上新水，春季五日，夏季三日，秋季七日，冬季十日，晒干后研为细末。用糯米粉煎粥清作为粘合剂制成丸药，大小如绿豆。薄荷汤调下。
泻白散（方见脾脏章节）
白术散（方见积痛章节）
异功散
六君子汤
四君子汤（三方见内钓章节）
千金龙胆汤（方见噤风章节）
平胃散（方见脾胃虚冷章节）
补中益气汤（方见虚羸章节）
Vomiting is primarily attributed to the Spleen and Stomach. The ancients stated that "deficiency of the Spleen leads to retching (Ou), while deficiency of the Stomach leads to vomiting (Tu)." Retching (Ou) is characterized by sound without matter, whereas vomiting (Tu) involves matter without sound. If feeding is excessive, the Stomach cannot accommodate it, leading to overflow; if milk intake is too high and digestion fails during sleep, the Spleen cannot transport it, resulting in diarrhea. Gradual injury to the Spleen and Stomach causes lingering diseases, potentially even leading to slow convulsions (Man Jing).
If the infant's fingertips are hot, they prefer warm drinks, or their eyes remain half-open during sleep (Lu Jing), this indicates weak Stomach Qi. Use Yichong San (Five-Ingredient Powder with Atractylodes Macrocephala). If the fingertips are hot but the infant desires cold drinks, or their eyes remain closed during sleep, this indicates Excess Heat in the Stomach Meridian. Use Xiehuang San (Decoction to Drain the Spleen/Stomach Heat). If accompanied by diarrhea, poor appetite, or dark red urine, this indicates Deficient Heat in the Stomach Meridian. Use Qiwei Baizhu San (Seven-Ingredient Bupleurum and Atractylodes Powder).
Generally, for infants, the nursing mother must strictly regulate her diet. If the mother suffers from food stagnation, it can also cause vomiting and diarrhea in the infant; thus, caution is essential.
[Case Records]
An infant suffered from vomiting due to food stagnation, accompanied by fever and flushed face. After administering herbs for resolving stagnation and clearing heat, the food stagnation resolved, but the fever and facial flushing persisted. I diagnosed this as Deficient Heat in the Stomach Meridian and prescribed Liujunzi Tang (Six-Gentleman Decoction) with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix). The infant recovered after four doses.
Another infant vomited due to food stagnation. After taking harsh purgative herbs, blood appeared in the vomitus. Subsequently, using heat-clearing and blood-cooling herbs resulted in bloody stools, with white or bluish lips. I reasoned that the Spleen Earth was depleted, allowing Liver Wood to overact upon it. I instructed the parents to administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) on an empty stomach and Yichong San shortly after meals, so that the dispelled blood would return to its source. The infant recovered.
An infant vomited sour, undigested milk and food. Treatment with Sijunzi Tang (Four-Gentleman Decoction), Wuzhuyu (Evodiae Fructus), Huanglian (Coptidis Rhizoma), and Muxiang (Aucklandiae Radix) supplemented the Spleen and pacified the Liver, leading to recovery. Later, when sour fluid appeared in the mouth, the previous formula was used again with modifications, resulting in recovery. Subsequently, bitter water was vomited, and the mouth tasted bitter. Longdan Tang (Gentian Decoction) was used to clear Liver Fire, combined with Sijunzi Tang to tonify Spleen Earth, leading to recovery.
An infant vomited yellow fluid after consuming sweet foods. Xiehuang San was used to clear Stomach Fire, resulting in recovery. Later, due to food stagnation and the use of harsh purgatives, the infant experienced a sweet taste in the mouth, loss of appetite, and significant weakness in form and Qi. Buzhong Yiqi Tang was used to nourish the Central Qi, leading to recovery.
An infant suffered from belching with a rotten odor due to food stagnation. One dose of Pingwei San (Stomach-Pacifying Powder) instantly resolved the old stagnation. I advised: "No need for multiple herbs; simply regulate the diet, and self-healing will occur." Disregarding this, other stagnation-resolving herbs were used, worsening the vomiting and diarrhea, ultimately leading to death.
An infant with food stagnation presented with fever, flushed face, convulsions, vomiting, wheezing, and profuse sputum. This was caused by dietary injury to the Spleen, leading to weak Lung Qi. Liujunzi Tang was administered with fried black Huanglian and Shanzhi (Gardeniae Fructus), each 2 fen. Recovery occurred after one dose.
[Formulas]
Xiaoru Wan: Treats vomiting and indigestion of milk/food, with a deep pulse, indicating food stagnation not transforming.
Ingredients: Xiangfuzi (Fried), Su Sharen, Chenpi (Pith removed), Gancao (Honey-fried), Shenqu (Fried), Maiya (Fried). Equal parts.
Preparation and Administration: Grind into powder, make pills with rice paste, size of Setaria italica seeds. Take 20 pills per dose, washed down with Ginger Decoction.
Another Prescription: For infants within 100 days, treating vomiting of milk or green stools. Take one cup of breast milk from a young woman, add 10 cloves (Dingxiang) and 1 qian of Chenpi. Boil in a porcelain vessel for several boils until slightly warm. On an empty stomach, suck up using a cotton ball.
Yangshi Xiaoshi Wan: Treats excessive milk/food intake where Stomach Qi cannot digest.
Ingredients: Su Sha, Jupi, Sanleng, Pengze, Shenqu (Fried), Maiya (Fried). Each 0.5 liang; Xiangfu (Fried) 1 liang.
Preparation and Administration: Grind into powder, make pills with yeast paste, size of sesame seeds. Wash down with plain boiled water, adjusting dosage according to the child.
Jufang Guanyin San: Treats external contraction of Wind-Cold and internal injury to Spleen/Stomach, causing retching, vomiting, diarrhea, inability to eat, and gradual emaciation.
Ingredients: Renshen (1 liang), Shenqu (Fried), Fuling, Gancao (Fried), Muxiang, Mian Huang (Note: Text says 'Mian Huang', likely Huangqi/Astragali Radix in context, but extracted as written), Bai Biandou, Baizhu. Each 1 qian; Shilian Rou (Heart removed) 2.5 qian.
Preparation and Administration: Grind into powder. Take 1 qian per dose, add 3 leaves of Huoxiang, decoct with Jujube water.
Xiangfu San: Treats vomiting due to accumulated Cold.
Ingredients: Huoxiang Ye, Chenpi, Houpo (Processed with Ginger Juice). Each 7 qian; Banxia (1 liang, soaked in boiling water seven times), Gancao (Honey-fried, 1 qian).
Preparation and Administration: Take 3 qian per dose, decoct with Ginger and Jujube water. If diarrhea is severe, add Muxiang and Roudoukou.
Xiangru San: Treats discomfort from cold/heat and irregular diet; or vomiting/diarrhea, abdominal pain, Huoluan with rebellious Qi, fever, headache due to external Wind-Cold-Heat pathogens; or muscle cramps/tetany; or painful retching/vomiting with cold extremities.
Ingredients: Xiangru (1 liang), Fuling, Bai Biandou (Fried), Houpo (Processed with Ginger Juice). Each 5 qian.
Preparation and Administration: Take 2-3 qian per dose, decoct in water, add half cup of wine, take cold for immediate effect.
Zhuru Tang: Treats Stomach affected by pathogenic heat, restlessness, preference for cold, and incessant vomiting.
Ingredients: Gegen (7.5 qian), Banxia (Processed, 0.5 liang), Gancao (Honey-fried, 3 qian).
Preparation and Administration: Take 1-2 qian per dose, add a date-sized piece of Zhuru, decoct with large Ginger water. Strain, take the clear liquid slowly while slightly cool. Adding 3 qian of Fuling is especially effective.
Suhe Xiang Wan: Treats Chuanshen Guzheng (consumptive disease like TB), Fei Wei, Zhu Wu Gui Qi (evil qi influence), sudden heart pain, Huoluan with vomiting/diarrhea,惊痫 Ke Wu (startle epilepsy), etc.
Ingredients: Suhe Xiang You (mixed with Anxi Xiang Gao), Xunlu Xiang (separately ground), Longnao (ground), Muxiang, Baizhu, Baitan Xiang, Dingxiang, Zhusha (ground and floated), Chenxiang, Xiangfuzi (Fried), Wuxi Xie, Bibo, Anxi Gao (separately powdered, mixed with pure wine and Zigu), Shexiang (ground), Helile (roasted, peel taken). Each 2 liang.
Preparation and Administration: Grind into fine powder, mix evenly, bind with Anxi Xiang Gao and honey into pills size of Sophora japonica seeds. Dissolve 1-2 pills in well water on an empty stomach; warm wine is also acceptable. Store in wax paper.
Qingzhou Bai Wanzi: Treats convulsions with vomiting of milk.
Ingredients: Tiannanxing (3 liang), Baifuzi (1 liang), Banxia (soaked and washed seven times), Chuan Wutou (skin and umbilicus removed, 0.5 liang).
Preparation and Administration: Soak in well water and sun-dry. Change water every morning. Spring: 5 days; Summer: 3 days; Autumn: 7 days; Winter: 10 days. Dry and grind into powder. Make pills with glutinous rice porridge juice, size of mung beans. Administer with Mint Decoction.
Xiebai San (See Spleen Organ chapter)
Baizhu San (See Accumulation Pain chapter)
Yichong San
Liujunzi Tang
Sijunzi Tang (These three formulas see Neidiao chapter)
Qianjin Longdan Tang (See Jinfeng chapter)
Pingwei San (See Spleen-Stomach Deficient Cold chapter)
Buzhong Yiqi Tang (See Xu Lei chapter)