郑氏云∶小儿吐泻，因外伤风冷，内伤乳食，或儿啼未定，气息未调，以乳饲之，气逆于上则停滞胸膈，
致令呕吐，气逆于下则伤脾胃，致令泄泻，上下气逆，吐泻俱作。凡小儿只吐不泻者逆，其吐，必有痰发惊者，
十无一生。若只泻不吐，或吐泻俱发者，日久不退，亦变阴痫。治之当暂断其乳，轻者周时，重者三日，宜
频与稀粥，服药速效，十全八九。或者不信是言，以小儿藉乳为命，不肯暂断，然乳固不可断也，殊不知因乳
所伤得之者，若再以所伤之乳乳之，如抱薪救火，药何功之有。其间有不断服药得安者，盖轻患也，亦有因轻致
重，夭横者多矣。《活幼心书》云∶小儿吐泻不止，大要节乳，徐徐用药调治必安，节者，撙节之义，一日
但三次或五次，每以乳时不可过饱，其吐自减，及间以稀粥投之，亦能和胃，屡见不明此理，惟欲进药以求速效，
动辄断乳三四日，致馁甚而胃虚，啼声不已，反激他证。盖人以食为命，孩非乳不活，岂容全断其乳，然乳即血
也，血属阴，其性冷，吐多胃弱，故节之，医者切须知此。乳母亦宜服和气血、调脾胃、等药。愚意，不
若儿大能食者全断之，待其平复。儿小不能饮食者，但节之可也。
〔薛〕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，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。若作渴少食，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。〔曾〕论吐之原，难以枚举，有冷吐，热吐，积吐，伤风嗽吐，伤乳吐，其吐则
同，其证有异，各述于后。冷吐，乳片不消，多吐而少出，脉息沉微，面白眼慢，气缓神昏，额上汗出，此因风
寒入胃，或食生冷，或伤宿乳，胃虚不纳而出，宜温胃去风，除宿冷，用当归散，水煨姜、陈皮煎服，
或间投冲和饮、理中汤及姜橘汤、定吐饮，如诸药不效，以参香饮治之。热吐，面
赤唇红，吐次少而出多，乳片消而色黄，遍体热甚，或因暑气在胃，或食热物，精
神不慢，而多烦躁，此热吐也，宜解热毒，用大顺饮，温熟水空心调下，并五苓散、小柴胡汤，并加姜汁缓服，及香
薷散主之，误服热药，先投绿豆饮解之，次服止吐之剂。积吐，眼胞浮，面微黄，足冷肚热，昼轻夜重，儿大
者脉沉缓，此宿冷滞脾，故吐黄酸水，或有清痰，脉实而滑，为食积所伤，吐酸 气，或宿食并出，儿小者
乳不化是也，先用五苓散姜汁温汤调下和解，次以乌犀丸主之，最小者投三棱散、化癖丸。伤风嗽吐，有热生风，
有风生痰，痰结胸中，肺气不顺，连嗽不止，和痰吐出，此为嗽吐痰壅而作，乃为实证，宜去风化痰，先投清肺饮，
次小柴胡汤为治。若嗽久而肺虚，土不生金，故面白唇燥，干嗽干呕而无痰，可温补为上，用茯苓浓
朴汤、惺惺散、如意膏为治。伤乳吐，才乳哺后即吐，或少停而吐，此因乳饮无度，脾气弱不能运化，故有此证，
譬如小器盛物，满则溢，治法宜节乳，投三棱散。此外，又有风痰吐，乃是伤风不解，吐乳夹痰，若多时必要生风，
宜服青州白丸子、半夏散，疏风下痰之剂皆可服之。毒瓦斯吐，出《巢氏病源》。挟惊吐，张涣三香丹
之类。疳积吐，出《本事方》。凡霍乱吐不止者，伏龙肝细末二钱，以芦稷米炒黄煎汤调下，立止。或用白扁豆炒过，
煎汤调下亦好，若白扁豆嫩苗更好。
郑氏说：小儿出现呕吐和腹泻，是因为外感风冷邪气，内伤乳食；或者是婴儿啼哭尚未停止，气息还未调匀时，就立即喂奶。这样会导致气机上逆停滞在胸膈部位，从而引起呕吐；气机下逆损伤脾胃，从而引起腹泻。上下气机同时逆乱，呕吐和腹泻就会一起发作。凡是小儿只呕吐不腹泻的，属于逆证（预后不良），如果呕吐伴有痰涎引发惊风症状的，十例中无一能存活。如果是只腹泻不呕吐，或者呕吐腹泻同时发生且日久不愈的，也会转变为阴痫。治疗时应当暂时断绝乳汁，轻症停乳一天，重症停乳三天，期间应频繁给予稀粥，服药后见效快，治愈率可达八九成。如果不相信这种说法，认为小儿依靠乳汁维持生命，不肯暂时断奶，然而乳汁确实不能随意中断，殊不知因乳汁所伤导致的疾病，如果再喂导致受伤的那种乳汁，就像抱着柴草去救火一样，药物又有什么功效呢？其中有不间断服药而痊愈的，那是病情轻微；也有因为病情轻反而加重，导致夭折横死的很多。《活幼心书》说：小儿呕吐腹泻不止，关键在于节制乳汁，慢慢用药调理必定能安愈。“节”的意思是节制、限制，每天只喂三次或五次，每次喂奶时不要过饱，呕吐自然会减少，中间穿插喂一些稀粥，也能调和胃气。多次见到不明白这个道理的人，只想通过进药来求取速效，动辄断绝乳汁三四天，导致婴儿极度饥饿而胃气虚弱，啼哭不止，反而激发其他病症。大概人以食物为生命根本，婴儿没有乳汁就不能存活，怎么可以完全断绝乳汁呢？然而乳汁就是血转化来的，血属阴，性质寒冷，呕吐过多则胃气虚弱，所以要节制它，医生必须知晓这一点。乳母也应当服用调和气血、调理脾胃的药物。我的意见是，不如对于已经较大能够进食的婴儿完全断绝乳汁，等待其恢复平静；对于年幼还不能饮食的婴儿，只要节制乳汁即可。
薛己说：呕吐都主要与脾胃有关，古人说：脾虚就会呕，胃虚就会吐，就是这个道理。呕的特点是只有声音没有实物吐出，吐的特点是有实物吐出而没有声音。如果手足指尖发热，喜欢喝热汤，或者睡觉时眼睛半睁露出眼珠，这都是胃气虚弱的表现，使用异功散。如果手足指尖发热，喜欢喝冷饮，或者睡觉时眼睛紧闭不露睛，属于胃经实热证，使用泻黄散。如果出现口渴、食欲减退，或者小便颜色赤红，属于胃经虚热证，使用七味白术散。大凡婴儿，尤其要注意乳母的饮食节制，如果乳母停食积滞，也会导致婴儿呕吐腹泻，所以不可不谨慎。
曾世荣论述呕吐的成因，难以一一列举，有冷吐、热吐、积吐、伤风咳嗽引起的呕吐、伤乳呕吐等，它们的呕吐现象相同，但伴随的症状各异，分别叙述如下。冷吐：乳汁片状不消化，多吐而少出，脉象沉微，面色苍白、眼睑下垂、眼神呆滞，气息微弱、精神昏沉，额头出汗，这是因为风寒侵入胃腑，或者吃了生冷食物，或者伤了残留的旧乳，胃虚不能容纳而吐出，适宜温胃祛风，去除宿冷，使用当归散，用水煨姜、陈皮煎服，或者间歇投喂冲和饮、理中汤及姜橘汤、定吐饮，如果这些药无效，用参香饮治疗。热吐：面红唇红，呕吐次数少但吐出物多，乳汁片状已消化且颜色发黄，全身发热严重，可能是因为暑气在胃，或者吃了热性食物，精神不呆滞而是多烦躁，这是热吐，适宜清热解毒，使用大顺饮，用温热的熟水空腹调服，并配合五苓散、小柴胡汤，加入姜汁缓慢服用，以及香薷散主治，误服热药者，先投绿豆饮解毒，再服用止吐药剂。积吐：眼睑浮肿，面色微黄，脚冷肚子热，白天轻晚上重，年龄较大的儿童脉象沉缓，这是宿冷滞留脾脏，所以吐出黄酸水，或者有清稀痰液，脉象实而滑，是被食积所伤，吐出酸气，或者宿食一起吐出，年幼的则是乳汁不化，先用五苓散加姜汁用温开水调下以和解，再用乌犀丸主治，最小的婴儿投喂三棱散、化癖丸。伤风咳嗽呕吐：有热生风，有风生痰，痰结聚在胸中，肺气不顺，连续咳嗽不止，带着痰吐出，这是因为咳嗽剧烈导致痰壅而作呕，属于实证，适宜祛风化痰，先投清肺饮，再用小柴胡汤治疗。如果咳嗽日久导致肺虚，土不生金（脾虚不能养肺），所以面白唇燥，干咳干呕而无痰，可以用温补法为上策，使用茯苓浓朴汤、惺惺散、如意膏治疗。伤乳呕吐：刚吃奶后就吐，或者稍停一会儿才吐，这是因为哺乳无度，脾气虚弱不能运化，所以有此症状，好比小容器盛东西，满了就会溢出，治疗方法宜节制乳汁，投喂三棱散。此外，还有风痰呕吐，这是伤风未解，呕吐乳汁夹杂痰液，如果时间过长必然生风，适宜服用青州白丸子、半夏散，疏风降痰的药物都可以服用。毒瓦斯呕吐，出自《巢氏病源》。挟惊呕吐，如张涣的三香丹之类。疳积呕吐，出自《本事方》。凡是霍乱呕吐不止的，用伏龙肝细末二钱，用芦稷米炒黄后煎汤调服，立刻停止。或者用白扁豆炒过后，煎汤调服也很好，如果用白扁豆的嫩苗更好。
Zheng stated: Infantile vomiting and diarrhea result from external contraction of wind-cold pathogens or internal injury from milk and food. Alternatively, if the infant is fed while still crying and their breath has not yet regulated, the qi rebels upward and stagnates in the chest and diaphragm, causing vomiting; if the qi rebels downward, it damages the spleen and stomach, causing diarrhea. When both upper and lower qi rebel simultaneously, vomiting and diarrhea occur together. In cases where infants vomit but do not have diarrhea, this is considered a "reverse" syndrome (indicating poor prognosis). If vomiting is accompanied by phlegm inducing convulsions, fewer than one in ten will survive. If infants have diarrhea without vomiting, or present with both symptoms that persist for a long time without resolution, the condition may transform into Yin epilepsy (Yin Xian). Treatment should involve temporarily withholding breast milk: for mild cases, withhold for one day; for severe cases, for three days. During this period, frequent feeding of thin rice gruel is recommended. Medication acts quickly, with an eight or nine out of ten cure rate. Those who disbelieve this advice, arguing that infants rely on milk for life and cannot bear to stop, fail to realize that although milk is essential, if the illness was caused by milk injury, continuing to feed the offending milk is like carrying firewood to save a fire—what use are medicines? Some infants recover without stopping medication because their condition is mild; however, many others deteriorate from mild to severe, leading to premature death. The *Huoyou Xinshu* states: For persistent infantile vomiting and diarrhea, the key is to regulate milk intake and treat gradually with medication to ensure recovery. "Regulate" means to restrict; feed only three or five times a day, ensuring the infant is not overfed each time, which will naturally reduce vomiting. Interspersing thin rice gruel can also harmonize the stomach. It is often observed that practitioners ignorant of this principle seek rapid results through heavy medication, abruptly withholding milk for three to four days. This leads to extreme hunger and deficiency of stomach qi, causing incessant crying and triggering other syndromes. Generally, humans rely on food for life, and infants cannot live without milk; thus, total cessation is inadvisable. However, milk transforms from blood, and blood belongs to Yin with a cold nature. Excessive vomiting weakens the stomach, so regulation is necessary. 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 capable of eating solid food, complete cessation of milk is preferable until they stabilize. For younger infants unable to eat solids, regulating milk intake is sufficient.
Xue Ji stated: Vomiting is primarily related to the spleen and stomach. As the ancients said, "Spleen deficiency causes Ou (retching), Stomach deficiency causes Tu (vomiting)." Ou is characterized by sound without material expulsion, while Tu involves material expulsion without sound. If the fingertips of the hands and feet are hot, the infant prefers warm drinks, or sleeps with eyes partially open (exposing the eyeballs), these indicate deficiency of Stomach Qi; treat with Yigong San (Extra Efficacy Powder). If fingertips are hot, the infant prefers cold drinks, or sleeps with eyes tightly closed, this indicates Excess Heat in the Stomach Meridian; treat with Xiehuang San (Drain Yellow Powder). If there is thirst, reduced appetite, or reddish urine, this indicates Deficiency Heat in the Stomach Meridian; treat with Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). Generally, for infants, the nursing mother's diet must be strictly regulated. If the mother suffers from food stagnation, it can cause infantile vomiting and diarrhea, so caution is essential.
Zeng Shirong discussed the origins of vomiting, which are too numerous to list exhaustively. There are Cold Vomiting, Heat Vomiting, Accumulation Vomiting, Wind-Cold Cough-induced Vomiting, and Milk-Injury Vomiting. While the act of vomiting is similar, the accompanying symptoms differ, as detailed below. Cold Vomiting: Undigested milk curds appear; there is much retching but little actual expulsion. The pulse is deep and faint. The face is pale, eyelids droop, and the gaze is dull. Qi is weak, spirit is lethargic, and sweat appears on the forehead. This is caused by wind-cold invading the stomach, consumption of raw/cold foods, or injury from residual old milk. The deficient stomach rejects the contents. Treatment should warm the stomach, dispel wind, and remove cold accumulation. Use Danggui San (Angelica Decoction) decocted with water-boiled ginger and Chenpi (Tangerine Peel). Alternatively, intermittently administer Chonghe Yin (Harmonizing Drink), Lizhong Tang (Regulate the Middle Decoction), Jiangju Tang (Ginger and Tangerine Peel Decoction), or Dingtu Yin (Stop Vomiting Drink). If these are ineffective, use Shenxiang Yin (Ginseng and Costus Root Drink). Heat Vomiting: Red face and lips. Fewer episodes but greater volume of expulsion. Milk curds are digested and yellow. Generalized high fever. Caused by summer-heat in the stomach or consumption of hot-natured foods. Spirit is restless and irritable rather than dull. This is Heat Vomiting. Treat by clearing heat and resolving toxicity using Dashun Yin (Great Smoothness Drink), taken on an empty stomach with warm boiled water. Combine with Wuling San (Five-Ingredient Powder) or Xiaochaihu Tang (Minor Bupleurum Decoction), adding ginger juice and administering slowly. Xiangru San (Elsholtzia Powder) is also indicated. If hot herbs were mistakenly administered, first give Mouton Yin (Mung Bean Drink) to resolve toxicity, then administer anti-emetics. Accumulation Vomiting: Eyelids are puffy, complexion slightly yellow, feet are cold while the abdomen is hot. Symptoms are lighter during the day and heavier at night. In older children, the pulse is deep and slow, indicating cold stagnation in the spleen causing expulsion of yellow, sour fluid or clear phlegm. A real and slippery pulse indicates injury from food stagnation, resulting in expulsion of sour gas or undigested food. In younger infants, it manifests as undigested milk. First, harmonize using Wuling San mixed with ginger juice in warm water, followed by Wuxi Wan (Black Rhinoceros Pill). For the youngest infants, use Sanleng San (Curcuma Decoction) or Huapi Wan (Resolve Masses Pill). Wind-Cold Cough Vomiting: Heat generates wind; wind generates phlegm. Phlegm knots in the chest, obstructing Lung Qi, causing continuous coughing and vomiting up phlegm. This is a Excess syndrome due to severe coughing and phlegm obstruction. Treat by dispelling wind and transforming phlegm. First administer Qingfei Yin (Clear Lungs Drink), then Xiaochaihu Tang. If chronic cough leads to Lung deficiency, where Earth fails to generate Metal (Spleen failing to nourish Lung), presenting with pale face, dry lips, dry cough, and dry retching without phlegm, warming tonification is superior. Use Fuling Nongpu Tang (Poria and Magnolia Bark Decoction), Xingxing San (Awakening Powder), or Ruyi Gao (Ruyi Ointment). Milk-Injury Vomiting: Vomiting occurs immediately after feeding or shortly thereafter. This is due to excessive feeding beyond the capacity of the weak Spleen to transform and transport, akin to overflowing a small vessel. Treatment requires regulating milk intake and administering Sanleng San. Additionally, there is Wind-Phlegm Vomiting, where unresolved wind-cold causes vomiting of milk mixed with phlegm. Prolonged duration risks generating wind; treat with Qingzhou Baiwanzi (Qingzhou White Pills) or Banxia San (Pinellia Powder) to disperse wind and descend phlegm. Toxic Gas Vomiting is described in *Chao Shi Bing Yuan*. Convulsion-Associated Vomiting includes formulas such as Zhang Huan's Sanxiang Dan. Malnutrition-Accumulation Vomiting is described in *Benshi Fang*. For persistent vomiting due to Huoluan (Colic and Diarrhea Syndrome), use two qian of fine powder from Fulonggan (Dragon's House Soil), fried with Luzhimi (Sorghum Rice) until yellow, decocted and taken as a suspension; this stops vomiting immediately. Alternatively, fried white kidney beans (Baibian Dou) decocted in water is effective; fresh young shoots are even better.