吐泻在五月中以后。身壮热者。此热也。小儿脏腑中十分中九分热。此因伤热乳。或胃热入内。吐乳不消。
泻深赤色。宜与解热。钱乙用玉露散。
吐泻在六月中以后。身大温而似热。脏腑中六分热。四分冷也。
呕吐乳食不消。泻色黄多白少似褐。或食乳。或不食乳。宜少补脾。而大解热。钱乙少用益黄散。多用玉露散。
更宜审察冷热。如儿大热。泻色赤黄者。此热多。根据五月中后治之。昔钱乙治广亲北宅四大王宫五太尉。六月中
吐泻。米谷不化。众医用温药。一日而加喘吐不定。乙曰。当用凉药治之。谓伤热在内也。众医皆言吐泻多而
米谷不化。当补脾胃。何得用凉药。王信众医。又用补脾温药。乙曰。不可服。此三日外必腹满身热。饮水吐
逆。三日外一如所言。谓六月热甚。伏入腹中。而令引饮。热伤脾胃。即大吐泻。他医又行温药。即上焦
亦热。故喘而引饮。三日当死。众医不能治。复召乙。乙见有热证。以白虎汤三服。更以白饼子下之。一日减药
二分。二三日又与白虎汤二服。四日用石膏汤。及旋复麦门冬黄芩脑子牛黄天竺黄茯苓。以朱砂为衣。竹叶汤下
五丸。热退而愈。乙所用方。本集载之。
吐泻在七月中以后。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。昏睡露睛。唇
白。多 而不渴。钱乙于食前令多服补脾益黄散。于食后少服解热玉露散。更宜相度冷热。若身大温。泻后黄
者。根据六月中以后为治也。昔钱乙治广亲七大尉七岁吐泻。是时七月。其证全不食而昏睡。睡觉而闷乱。哽气干
呕。大便或有或无不渴。众医疑睡。作惊治之不愈。乙曰。当先补脾而后退热。与使君子丸补脾。石膏汤退热。
次日以水银硫黄二物末之。生姜水调下一字。乙曰。凡吐泻。五月内九分下而一分补。八月内十分补而无一分
下。此皆是脾虚泻。医妄治之。至于虚损。下之即死。故只当补脾。若以使君子丸恐缓。已又留温胃益脾药止
之。有一李医问曰。何食而哕。乙曰。脾虚不能食。津液少即 逆。又曰。何泻青褐水。乙曰。肠胃至虚。冷极
故也。乙治而愈。其方本集载之。
吐泻在八月中以后。身冷。无阳也。不能食乳。干 泻青褐水。钱乙只用益黄散补脾。不可下。
吐泻所论冷热时月。此钱乙以中原之地言也。今较之江浙。则气候不同。今江浙之地。二三月尚寒。四五月
温暖。六月入伏之后才热。七月热盛。八月热尚未退。虽冬月晴多便暖。虽夏月阴多便寒。不可概以中原冷热时
候。便为定论。经所谓东西南北之异地。温凉寒热之异宜。况每岁寒热。自随时令早晚。难以拘定月日也。候之
者
乘其至也。谓至其热则从热治。至其温则从温治。至其寒则从寒治。至其凉则从凉治。此乃随四时之气。各适其
宜。
吐泻于夏秋大热之时。伏暑伤冷。则心藏烦躁。小便不利。清浊不分。阴阳二气相干。名曰气乱。乱于肠胃
之间。名曰霍乱。其证乘热伤冷。气逆而喘。腹胁胀满。身热脉乱。头痛体疼。如伤寒之状。上即大吐。下即大
泻。重者四肢厥冷。脚胫转筋。法当调顺其气。分别清浊。升降阴阳。若只伏暑吐泻者。则小便不利。其证虽与
上证稍同而轻。非霍乱比。泻色赤黄。此但只名伏暑吐泻。不为霍乱也。治霍乱吐泻。若热多而渴者。五苓散。
寒多不渴。而心腹身体疼痛。及烦躁渴不能饮者。可服理中汤。寒甚腹痛转筋。四肢拘急者。理中汤加附子。汗
出恶寒。手足厥冷。下利清谷。内寒外热。脉微欲绝者。并四逆汤。以上诸证。并可与香薷散服之。以他药不能
疗此证也。治伏暑吐泻。若小便不利。与五苓散利小便。及与香薷散解伏暑。坯莲散救生丹止吐。
吐泻不拘何时。则令脾胃虚弱。多致生风。而为脾风慢惊也。以脾土衰而肝木来刑故尔。当先补脾胃。不
令困弱。则风不生。而病易愈也。
吐泻已定未定烦渴者。皆津液内耗也。不问新久。宜煎钱乙白术散。使满意取足饮之。多即愈好。不尔即津
液内耗。而引饮不止。内生其热。外邪相干。则证变百端。以成他病。渐至危困也。
吐泻发生在五月以后，身体高热者，属于热证。小儿脏腑中十分之九为热，这是因为伤于热乳，或者胃热入内，导致呕吐出的乳汁无法消化。
吐泻发生在六月以后，身体大温而似有热象，脏腑中六分为热，四分为冷。
呕吐出未消化的乳食，大便颜色黄多白少，类似褐色。有时吃乳，有时不吃乳，适宜少量补脾，同时大力清热。钱乙少量使用益黄散，大量使用玉露散。
更应当审察冷热情况。如果小儿大热，大便色赤黄，这是热多，按照五月以后的方法治疗。从前钱乙治疗广亲北宅四大王宫五太尉，在六月出现吐泻，米谷不化，众医生用温药治疗，一天后病情加重，出现气喘、呕吐不定。钱乙说：“应当用凉药治疗。”认为这是内伤热邪所致。众医生说：“吐泻严重且米谷不化，应当补脾胃，怎么能用凉药？”王爷信任众医生，又用了补脾温药。钱乙说：“不可服用。三天外必定会出现腹部胀满、身体发热、想喝水、呕吐逆乱的症状。”三天后果然如他所言。他说：“六月天气炎热，热邪潜伏入腹中，导致引水自救。热邪损伤脾胃，于是发生大吐泻。”其他医生又用温药，导致上焦也热，所以气喘并想喝水。三天后会死亡。众医生不能治愈，再次请钱乙诊治。钱乙看到有热证，用白虎汤服三剂，再用白饼子攻下。第一天减少药量二分，二三天后又给白虎汤两剂，第四天用石膏汤，以及旋复花、麦门冬、黄芩、冰片、牛黄、天竺黄、茯苓，以朱砂为衣，竹叶汤送服五丸。热退而痊愈。钱乙所用的方剂，原本收录在本集中。
吐泻发生在七月以后，身体温和，脏腑中三分热，七分冷。不能多吃乳食，似睡非睡，烦闷扰乱，哽气长叹，昏睡露睛，嘴唇白，多流涎而不渴。钱乙让在饭前多服补脾的益黄散，饭后少服解热的玉露散。更应当衡量冷热情况。如果身体大温，泻后大便黄，按照六月以后的方法治疗。从前钱乙治疗广亲七大尉七岁时的吐泻，当时是七月，症状是完全不进食且昏睡，醒来后烦闷扰乱，干呕，大便有时有有时没有，不渴。众医生怀疑是惊风，按惊风治疗但未愈。钱乙说：“应当先补脾而后退热。”给予使君子丸补脾，石膏汤退热。第二天用水银和硫黄两物研末，生姜水调下一字。钱乙说：“凡是吐泻，五月内十分之九攻下而一分补脾，八月内十分补脾而无一分攻下。这都是脾虚泻，医生误治，导致虚损，攻下就会死亡。所以只应当补脾。”如果用使君子丸恐怕见效慢，于是又留下温胃益脾的药来止泻。有一位李医生问：“为什么吃东西会呃逆？”钱乙说：“脾虚不能进食，津液少就会呃逆。”又问：“为什么泻青褐色水？”钱乙说：“肠胃极度虚弱，寒气极盛所致。”钱乙治疗后痊愈。其方剂原本收录在本集中。
吐泻发生在八月以后，身体寒冷，没有阳气。不能进食乳食，干呕，泻青褐色水。钱乙只用益黄散补脾，不可攻下。
关于吐泻论述的冷热时节，这是钱乙针对中原地区而言的。现在与江浙相比，气候不同。现在的江浙地区，二三月尚寒，四五月温暖，六月入伏之后才热，七月热盛，八月热气尚未消退。即使是冬天晴天多便暖和，即使是夏天阴天多便寒冷。不能一概以中原的冷热时令作为定论。经书所说东西南北之地不同，温凉寒热各有适宜之处。况且每年的寒热，自然随着时令早晚变化，难以拘泥于具体的月日。观察的人要顺应时机到来之时。谓到了热的时候就从热治，到了温的时候就从温治，到了寒的时候就从寒治，到了凉的时候就从凉治。这才是顺应四时之气，各得适宜。
吐泻在夏秋大热之时，因伏暑伤冷，则心藏烦躁，小便不利，清浊不分，阴阳二气相干扰，名叫气乱。乱于肠胃之间，名叫霍乱。其症状是乘热伤冷，气逆而喘，腹胁胀满，身体发热脉象紊乱，头痛体痛，像伤寒的样子。向上则大吐，向下则大泻。重者四肢厥冷，脚胫转筋。法当调顺其气，分别清浊，升降阴阳。如果只是伏暑引起的吐泻，则小便不利，其症状虽然与上述症状稍同但较轻，不是霍乱可比。大便色赤黄，这仅仅名叫伏暑吐泻，不称为霍乱。治疗霍乱吐泻，如果热多而口渴，用五苓散；寒多不渴，且心腹身体疼痛，及烦躁渴但不能饮水者，可服理中汤；寒甚腹痛转筋，四肢拘急者，理中汤加附子；汗出恶寒，手足厥冷，下利清谷，内寒外热，脉微欲绝者，都用四逆汤。以上诸证，都可以配合香薷散服用，因为其他药不能治疗此证。治疗伏暑吐泻，如果小便不利，用五苓散利小便，以及用香薷散解伏暑，坯莲散救生丹止吐。
吐泻不拘何时，都会令脾胃虚弱，多导致生风，成为脾风慢惊。因为脾土衰败而肝木来克制它。应当先补脾胃，不让其困弱，则风不生，病就容易痊愈。
吐泻已定或未定，伴有烦渴者，都是津液在内耗损。不问新久，宜煎煮钱乙的白术散，让其满意地喝足。多喝即好。否则津液在内耗损，导致引饮不止，内生热邪，外邪相干扰，则病症变化百端，形成他病，逐渐至危困。
Vomiting and diarrhea occurring after the fifth month, accompanied by high fever, indicates a heat syndrome. In children's internal organs, nine-tenths are hot; this is due to injury from hot milk or stomach heat entering internally, causing vomited milk to remain undigested.
Stool is deep red in color; clearing heat is appropriate. Qian Yi used Yulu San (Jade Dew Powder).
Vomiting and diarrhea occurring after the sixth month, with the body feeling very warm but resembling heat, indicate that six-tenths of the internal organs are hot and four-tenths are cold.
Vomiting of undigested milk and food, with stool being mostly yellow with little white, resembling brown. Sometimes the child takes milk, sometimes does not; slight spleen supplementation combined with strong heat-clearing is appropriate. Qian Yi used small amounts of Yihuang San (Yellow Elixir Powder) and large amounts of Yulu San (Jade Dew Powder).
One must carefully examine the balance of cold and heat. If the child has high fever and stool is red-yellow, indicating more heat, treat according to the methods for after the fifth month. Previously, Qian Yi treated the Fifth Taivwei of the Great King Palace at Guangqin Beizhai, who suffered vomiting and diarrhea in the sixth month with undigested rice and grain. Other physicians used warming medicines, resulting in worsened condition with panting and uncertain vomiting within one day. Qian Yi said, "Cooling medicines should be used," attributing it to internal heat injury. The other physicians argued, "Severe vomiting and diarrhea with undigested food require spleen and stomach tonification; how can cooling medicines be used?" The Prince trusted the other physicians and administered spleen-tonifying warming medicines again. Qian Yi said, "Do not take this. Within three days, abdominal distension, body heat, thirst, and vomiting with reflux will occur." Three days later, his prediction came true. He explained, "The heat in June is intense, lying dormant in the abdomen, inducing thirst. Heat damages the spleen and stomach, leading to severe vomiting and diarrhea." Other physicians continued using warming medicines, causing heat in the upper jiao, hence panting and thirst. Death would occur within three days. Unable to cure him, they summoned Qian Yi again. Seeing heat signs, Qian Yi administered Baihu Tang (White Tiger Decoction) three doses, followed by Baixingzi (White Pill) to purge. On the first day, the dosage was reduced by two fen. After two to three days, another two doses of Baihu Tang were given. On the fourth day, Shigao Tang (Gypsum Decoction), along with Xuanfuhua (Inulae Flos), Maidong (Ophiopogonis Radix), Huangqin (Scutellariae Radix), Bingpian (Borneolum Syntheticum), Niuhuang (Calculus Bovis), Tianzhuhuang (Bambusae Caulis in Taenia), and Fuling (Poria), coated with Zhusha (Cinnabaris), were taken as five pills with Zhu Ye (Bambusae Folium) decoction. The heat subsided, and he recovered. The formulas used by Qian Yi are recorded in this collection.
Vomiting and diarrhea occurring after the seventh month, with the body feeling warm, indicate three-tenths heat and seven-tenths cold in the internal organs. The child cannot eat much milk, appears sleepy yet restless, sighs deeply, sleeps drowsily with eyes open, lips are white, drools excessively without thirst. Qian Yi instructed taking large amounts of Yihuang San (Yellow Elixir Powder) for spleen tonification before meals, and small amounts of Yulu San (Jade Dew Powder) for heat clearing after meals. One must further assess cold and heat. If the body is very warm and stool is yellow after purging, treat according to the methods for after the sixth month. Previously, Qian Yi treated the Seventh Taivwei of Guangqin, aged seven, suffering vomiting and diarrhea in July. His symptoms included complete anorexia and drowsiness, waking up restless, dry heaving, intermittent stools without thirst. Other physicians suspected convulsions and treated accordingly without success. Qian Yi said, "Tonify the spleen first, then clear heat." He gave Shijunzi Wan (Quisqualis Pill) to tonify the spleen and Shigao Tang (Gypsum Decoction) to clear heat. The next day, he administered powdered Mercury and Sulfur mixed with Ginger Juice. Qian Yi stated, "For all vomiting and diarrhea, in May, nine parts purgation and one part tonification; in August, ten parts tonification and no purgation. These are all spleen-deficiency diarrheas. Physicians treating them wrongly lead to deficiency damage; purgation causes death. Therefore, only spleen tonification is appropriate." Suspecting Shijunzi Wan might be too slow, he also retained warming stomach and spleen tonifying medicines to stop the diarrhea. A physician named Li asked, "Why does regurgitation occur after eating?" Qian Yi replied, "Spleen deficiency prevents digestion; low fluids cause regurgitation." Another question: "Why is there green-brown watery stool?" Qian Yi replied, "Intestines and stomach are extremely deficient, and cold is extreme." Qian Yi cured him. The formula is recorded in this collection.
Vomiting and diarrhea occurring after the eighth month, with a cold body, indicate absence of Yang Qi. The child cannot eat milk, experiences dry heaving, and passes green-brown watery stool. Qian Yi used only Yihuang San (Yellow Elixir Powder) to tonify the spleen; purgation is contraindicated.
The discussion on timing of cold and heat in vomiting and diarrhea refers to Qian Yi's observations in the Central Plains. Compared to Jiangzhe, the climate differs. In Jiangzhe, February and March are still cold; April and May are warm; heat begins only after entering the Dog Days in June; July is intensely hot; August remains hot. Even in winter, sunny days are warm; even in summer, cloudy days are cold. One cannot generalize Central Plains seasonal patterns as absolute rules. As the classics state, different regions (East, West, South, North) have different climatic needs regarding warmth, coolness, cold, and heat. Moreover, annual temperature variations follow seasonal shifts, making it difficult to rigidly fix months and days. Observers must adapt to the arrival of conditions: when heat arrives, treat heat; when warmth arrives, treat warmth; when cold arrives, treat cold; when coolness arrives, treat coolness. This aligns with the Qi of the four seasons, ensuring appropriateness.
During the intense heat of summer and autumn, if latent summerheat injures the cold, the Heart organ becomes irritable, urination is difficult, clear and turbid aspects fail to separate, and Yin and Yang Qi interfere with each other, termed Qi Chaos. When chaotic between intestines and stomach, it is termed Huoluan (Cholera-like disorder). Symptoms include panting due to Qi rebellion from heat-cold injury, abdominal and hypochondriac distension, body heat with chaotic pulse, headache, and body pain, resembling Taiyang disease. Upward leads to severe vomiting; downward leads to severe diarrhea. Severe cases present with cold limbs and calf muscle spasms. The method requires regulating Qi, separating clear and turbid, and ascending/descending Yin and Yang. If merely summerheat-induced vomiting and diarrhea occurs, urination is difficult. Although symptoms are slightly similar to the above, they are milder and distinct from Huoluan. Stool is red-yellow; this is merely named Summerheat Vomiting and Diarrhea, not Huoluan. For treating Huoluan vomiting and diarrhea: if heat predominates with thirst, use Wuling San (Five-Ingredient Powder with Poria); if cold predominates without thirst, accompanied by heart/abdominal/body pain, irritability, and inability to drink despite thirst, use Lizhong Tang (Regulate the Middle Decoction); if cold is severe with abdominal pain and spasms, and limb stiffness, add Fuzi (Aconiti Lateralis Radix Praeparata) to Lizhong Tang; if sweating, aversion to cold, cold hands and feet, diarrhea with undigested food, internal cold with external heat, and faint pulse nearing extinction, use Sini Tang (Frigid Extremities Decoction). All above syndromes can be taken concurrently with Xiangru San (Elsholtzia Powder), as other medicines cannot treat these conditions. For treating summerheat vomiting and diarrhea: if urination is difficult, use Wuling San (Five-Ingredient Powder with Poria) to promote urination, and Xiangru San (Elsholtzia Powder) to resolve latent summerheat; Pilian San (Lotus Seed Pod Powder) and Shengdan Zhi Tu (Life-Saving Cinnabar to Stop Vomiting) to stop vomiting.
Vomiting and diarrhea, regardless of timing, weaken the Spleen and Stomach, often generating Wind, becoming Pi Feng Man Jing (Spleen Wind Slow Convulsion). This occurs because Spleen Earth declines and Liver Wood overacts upon it. One must first tonify Spleen and Stomach, preventing weakness, so Wind does not generate, and the illness heals easily.
If vomiting and diarrhea are settled or unsettled, accompanied by irritability and thirst, it indicates internal consumption of Body Fluids. Regardless of new or old onset, boil Qian Yi's Baizhu San (Atractylodis Macrocephalae Powder) and allow the patient to drink sufficient amounts until satisfied. More is better. Otherwise, internal fluid consumption leads to incessant thirst, internal heat generation, external pathogen interference, myriad symptom changes, formation of other diseases, and gradual critical danger.