典藏书目

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: A floating pulse indicates Huoluan (cholera-like disease with sudden vomiting and diarrhea). ○ Liu Zongnong states: In Huoluan, a floating and surging pulse is treatable; a faint and slow pulse accompanied by shortness of breath and inability to speak is difficult to treat. ○ The *Maijue* (Pulse Classic) states: If an infant vomits immediately after breastfeeding and the pulse is disordered, there is no need for worry.

Zhu Danxi states: The onset of Huoluan is sudden, often caused by food retention combined with cold damage (Shanghan), leading to a deviation and blockage of Yin and Yang Qi, resulting in upper vomiting and lower diarrhea, along with restlessness, pain, and distension. This constitutes its clinical presentation. Therefore, if it leans towards Yin, it manifests as Cold; if it leans towards Yang, it manifests as Heat. Zeng states: "Huo" refers to chaotic vomiting, and "Luan" refers to diarrhea. Cases with heart pain preceded by vomiting, or abdominal pain preceded by diarrhea, all originate from the Middle Jiao (Middle Burner). The Upper Jiao governs reception without discharge; the Middle Jiao governs the rotting and ripening of water and grain, generating Ying and Wei Qi to irrigate the hundred bones; the Lower Jiao separates clear and turbid water and grain, governing excretion without reception. These three form the pattern of Heaven, Earth, and Man, representing the daily routine. Thus, the Spleen resides in the Central State (Zhongzhou), and the Stomach is the Sea of Water and Grain. When milk enters the Stomach, the Spleen transforms and transports it, separating the clear and turbid parts. If transmission and transformation are appropriate, vomiting and diarrhea will not occur. Whenever infants suffer from incessant upper vomiting and continuous lower diarrhea, it is because the Six Qi are not yet complete, making them susceptible to invasion by the Six Evils (pathogenic factors). Coupled with improper care and irregular feeding, the Spleen and Stomach become weak, causing clear and turbid Qi to interfere with each other and accumulate. If diarrhea occurs first followed by vomiting, it is due to deficiency-cold of the Spleen and Stomach. Its manifestations include watery white stools, scanty vomiting, slow breath, lethargic expression, sweat on the forehead, and deep, soggy pulses; this is a Cold syndrome. If vomiting occurs first followed by diarrhea, it is due to heat in the Spleen and Stomach. Its manifestations include rapid breathing, red lips, flushed face during vomiting, surging and rapid pulses, thirst, and desire to drink fluids; this is a Heat syndrome. Distinguishing between Cold and Heat requires careful examination.

Zheng states: Infantile vomiting and diarrhea result from external wind-cold and internal injury from milk/food, or feeding while the infant is still crying and breath unregulated. Qi reverses upwards, stagnating in the chest and diaphragm, causing vomiting; Qi reverses downwards, damaging the Spleen and Stomach, causing diarrhea. When both upper and lower Qi reverse, vomiting and diarrhea occur simultaneously. For infants who only vomit but do not have diarrhea, if the vomiting is due to Qi reversal, phlegm is invariably present; if convulsions (Jing) develop, ten out of ten cases are fatal. If they only have diarrhea without vomiting, or if both occur but persist for a long time without improvement, it may transform into Yin Epilepsy (Yin Xian). Treatment should involve temporarily stopping breastfeeding. For mild cases, one day; for severe cases, three days. Frequent administration of thin rice gruel should be provided. Medication taken promptly yields high efficacy (80-90%). Some do not believe this advice, arguing that infants rely on milk for life and cannot stop temporarily. However, while milk cannot be completely stopped indefinitely, one must realize that if the illness was caused by milk, continuing to feed that same milk is like carrying firewood to put out a fire; what use is the medicine? Those who recover without stopping breastfeeding usually have mild conditions. Many cases worsen due to negligence, leading to premature death.

According to the *Huoyou Xinshu* (New Book for Living Infants): For persistent infantile vomiting and diarrhea, the key is to regulate breastfeeding and administer medication gradually to ensure safety. "Regulate" means to restrain. Feed three or five times a day. Do not overfeed at each session; vomiting will naturally decrease. Intermittently offer thin rice gruel to harmonize the Stomach Qi. I have often seen those who do not understand this principle, seeking quick effects through medication, abruptly stopping breastfeeding for three or four days. This leads to extreme hunger and weak Stomach Qi, causing incessant crying and triggering other syndromes. Generally, humans rely on food for life, and infants cannot survive without milk; thus, total cessation is inadvisable. However, milk is blood, and blood belongs to Yin, possessing a cold nature. Since frequent vomiting weakens the Stomach, breastfeeding should be regulated. Physicians must understand this. Nursing mothers should also take herbs to harmonize Qi and Blood and regulate the Spleen and Stomach. My opinion is that for older infants who can eat solid food, complete cessation is better until recovery; for younger infants unable to eat solids, regulation of breastfeeding is sufficient.