巢元方曰。小儿暴泻者。由肠胃虚。卒为冷热之气所伤而成。热则色黄赤。冷则色青白。若冷热相交。则变为赤白
滞痢也。宜龙骨散。小儿久泻者。大法补虚消积。宜华佗久利神验方。
张元素曰。乳食不消。初病。忽然气出冷。四肢亦冷。面白无光泽。精神不定。乃胃气不和。可以大温药治之。使
君子丸、益黄散。若病泄泻日久不瘥。乳食不化。是脾胃有风冷。先服益黄散二帖。后用宣风散导之。再大补胃。
曾氏曰。论泻之原。有冷泻。热泻。伤食泻。水泻。积泻。惊泻。风泻。脏寒泻。疳积KT 泻。种种不同。冷泻
多是白水。泻密而出少。腹痛而鸣。眉皱目慢。面带白色。额有汗。冲和饮、当归散、参苓白术散。热泻者。大便黄色。
如筒吊水。泻过即止。半日复然。心烦口渴。小便黄少。乳食必粗。先用五苓散。或大顺饮。次钱氏白术散、香薷散。
伤食泻者。乃脾胃素弱。复伤生冷。故大便不聚而泻。或因母餐生冷肥腻。亦能作泻。面唇俱白。泻稀而少。或如败卵
臭。身形黄瘦。宜固脾和中散、醒脾散。水泻者。即洞泄。乃阴阳不顺。水谷不分。泻黄水而小便少。次多无度。夏秋
之际。昼则解衣取凉。夜则失盖感冷。冷热相激。清浊混乱。或因母热与乳。令儿脾胃不和。水谷交杂而下。宜五苓散。
加苡仁、车前、半夏。分正阴阳。或白术散、六和汤。积泻者。脾气虚弱。乳食入胃不消。久又伤冷食。传之大肠。遂
成泄泻。诸药无效。盖以积在脾胃未除。何由得愈。先三棱散除积。次沉香槟榔丸、参苓白术散。再和中散。惊泻者。
粪青如苔。稠粘如胶。不可便止。但镇心抑肝。和脾胃。消乳食。先五苓散。次三棱散。风泻者。慢惊大病后有之。粪
稀。黄褐色。或夹食而下。因脾虚所致。或夹黑褐色者。属脾虚而肾水乘之也。若久则惊搐。先五苓散加苡仁以疏肾水。
次泻黄散以去脾风。再参苓白术散以补脾气。脏寒泻者。粪青不稀不稠。或下清水。未泻腹痛而鸣。啼哭方泻。生三五
月内有此。周岁则无。因断脐风冷外逼而成。先冲和饮加葱白。次当归散加煨姜。及匀气散、理中汤。疳积KT 泻者。
面黄肚胀脚弱。头大项小。发稀而竖。肌瘦不食。朝凉夜热。腹有症癖。泻无定色。恶臭。自泻自止。先三棱散加陈皮。
次乌犀丸、芦荟丸、快肠汤。凡泻痢色青甚而淡黄夹白。寒多热少。此阴邪胜阳。宜守中汤、胃苓汤扶表救里。方进当
归散加陈皮、紫苏、生姜、糯米。寒甚者。理中汤。加附子、姜、枣。次南星腹皮饮。若泻泄色青淡。有沫。黄稠。热
多寒少。亦致黄瘦烦躁。宜五苓加苡仁、车前、生姜。解散余邪。仍用茵陈山栀汤送五苓散。退黄色。或万安饮、四神
丸。
鳌按。疳积KT 泻。KT 者胀也。其症必目胞肿。腹胀。喜饮水。利色无常。日见消瘦。
巢元方说：小儿突发腹泻，是由于肠胃虚弱，突然受到冷或热邪气的侵袭所致。热邪导致的腹泻，大便颜色黄赤；寒邪导致的腹泻，大便颜色青白。如果冷热邪气相互交争，就会转变为赤白相间的滞痢。适宜使用龙骨散。小儿长期腹泻，治疗的大法是补虚消积，适宜使用华佗久利神验方。
张元素说：乳食不消化，初发病时，忽然气息变冷，四肢也冷，面色苍白无光泽，精神不安定，这是胃气不和，可以用大温性的药物来治疗，如使君子丸、益黄散。如果泄泻日久不愈，乳食不化，这是脾胃有风冷，先服用益黄散两帖，然后用宣风散疏导。之后再大补胃气。
曾氏说：论述腹泻的根源，有冷泻、热泻、伤食泻、水泻、积泻、惊泻、风泻、脏寒泻、疳积KT泻等，种种不同。冷泻多是白水样便，排泄稠密但量少，腹痛且肠鸣，皱眉眼神迟缓，面色发白，额头出汗，可用冲和饮、当归散、参苓白术散。热泻者，大便黄色，像从筒中吊下的水一样，泻过即止，半天后又发作，心烦口渴，小便黄少，乳食必然粗糙，先用五苓散，或大顺饮，再用钱氏白术散、香薷散。伤食泻者，是因为脾胃素来虚弱，又损伤了生冷食物，所以大便不成形而泻。或者因为母亲吃了生冷肥腻的食物，也能导致腹泻。面唇都白，泻下稀薄量少，或者像败卵一样的臭味，身形黄瘦，适宜用固脾和中散、醒脾散。水泻者，就是洞泄，是阴阳不顺，水谷不分，泻下黄水而小便少，次数多没有节制。夏秋之际，白天脱衣取凉，晚上失去覆盖感受寒冷，冷热相激，清浊混乱。或者因为母亲体内有热而喂奶，令孩子脾胃不和，水谷混杂而下，适宜用五苓散，加薏苡仁、车前子、半夏，以分清阴阳。或者用白术散、六和汤。积泻者，脾气虚弱，乳食入胃不消化，久了又损伤冷食，传导到大肠，遂成泄泻。各种药物无效，是因为积滞在脾胃未除，怎么能痊愈呢？先用三棱散消除积滞，再用沉香槟榔丸、参苓白术散，最后用和中散。惊泻者，粪便青色如苔藓，稠粘如胶，不可立即止泻，只需镇心安神、抑制肝风，调和脾胃，消化乳食。先用五苓散，再用三棱散。风泻者，多见于慢惊大病之后，粪便稀薄，呈黄褐色，或者夹杂食物而下，因脾虚所致。或者夹杂黑褐色的，属于脾虚而肾水乘袭。如果时间久了会出现惊厥抽搐，先用五苓散加薏苡仁以疏泄肾水，再用泻黄散以去除脾风，最后用参苓白术散以补脾气。脏寒泻者，粪便青色，不稀也不稠，或者排出清水，未泻之前腹痛肠鸣，啼哭后才泻，生后三五个月内的婴儿有此症状，周岁则无。这是因为断脐时风冷外逼而成。先用冲和饮加葱白，再用当归散加煨姜，以及匀气散、理中汤。疳积KT泻者，面色黄，肚子胀，脚弱，头大项小，头发稀疏且竖立，肌肉消瘦，不吃东西，早晨凉晚上热，腹部有症癖，泻下颜色不定，恶臭，自泻自止。先用三棱散加陈皮，再用乌犀丸、芦荟丸、快肠汤。凡是泻痢颜色青甚而淡黄夹白，寒多热少，这是阴邪胜阳，适宜用守中汤、胃苓汤扶表救里。方剂应当进服当归散加陈皮、紫苏、生姜、糯米。寒邪严重的，用理中汤，加附子、姜、枣。再用南星腹皮饮。如果泻泄颜色青淡，有泡沫，黄稠，热多寒少，也会导致黄瘦烦躁，适宜用五苓散加薏苡仁、车前子、生姜，解散余邪。仍然用茵陈山栀汤送服五苓散，退去黄色。或者用万安饮、四神丸。
Chao Yuanfang stated: Sudden diarrhea in infants and children arises from deficiency of the intestines and stomach, suddenly injured by cold or hot pathogenic qi. If caused by heat, the stool color is yellow and red; if caused by cold, the stool color is greenish-white. If cold and heat interact, it transforms into dysentery with red and white mucus (Chi Bai Zhi Li). Longgu San (Dragon Bone Powder) is suitable. For chronic diarrhea in infants and children, the general principle is to tonify deficiency and eliminate accumulation. Huatuo Jiu Li Shen Yan Fang (Huatuo's Miraculous Efficacy Formula for Chronic Dysentery) is suitable.
Zhang Yuansu stated: When milk and food are not digested, at the onset of illness, there is sudden expulsion of cold breath, coldness of the four limbs, a pale face lacking luster, and unsettled spirit. This indicates disharmony of Stomach Qi, which can be treated with strongly warming medicines such as Shijunzi Wan (Quisqualis Pill) and Yihuang San (Yellow-Protecting Powder). If diarrhea persists for a long time without recovery, and milk/food remains undigested, this indicates wind-cold in the Spleen and Stomach. First administer two doses of Yihuang San, then guide/drain using Xuanfeng San (Dispersing Wind Powder). Subsequently, strongly tonify Stomach Qi.
Zeng Shi discussed the origins of diarrhea, categorizing them into cold diarrhea, heat diarrhea, food-injury diarrhea, water diarrhea, accumulation diarrhea, fright diarrhea, wind diarrhea, visceral cold diarrhea, and Ganji KT diarrhea, among others, all distinct. Cold diarrhea often presents as clear white water, frequent but scanty passage, abdominal pain with borborygmus, furrowed brows, slow/dull eyes, pale complexion, and sweating on the forehead. Chonghe Yin (Harmonizing Decoction), Danggui San (Angelica Powder), and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) are indicated. Heat diarrhea presents with yellow stool, flowing like water from a tube, stopping immediately after passage but recurring half a day later, accompanied by vexation, thirst, and scanty yellow urine. The diet must be coarse. First use Wuling San (Five-Ingredient Powder with Poria), or Dashun Yin (Great Harmony Decoction), followed by Qian's Baizhu San (Baizhu Powder by Dr. Qian) or Xiangru San (Mosla Powder). Food-injury diarrhea occurs due to inherent weakness of the Spleen and Stomach combined with injury from raw/cold foods, resulting in unformed stools. It can also result from the mother consuming raw/cold or greasy/rich foods, leading to diarrhea. The face and lips are pale, stools are thin and scanty, or smell like spoiled eggs. The body is yellow and emaciated. Gupi Hezhong San (Spleen-Solidifying and Middle-Harmonizing Powder) and Xingpi San (Spleen-Awakening Powder) are suitable. Water diarrhea, also known as Dongxie (Cave Diarrhea), results from disharmony of Yin and Yang and failure to separate fluids and grains. It presents with yellow watery stools, scanty urine, frequent uncontrolled passage. In summer and autumn, exposing oneself to cool air during the day and losing cover causing cold exposure at night leads to conflict between cold and heat, confusing clear and turbid qi. Alternatively, maternal internal heat transmitted through breast milk causes Spleen-Stomach disharmony and mixing of fluids and grains. Wuling San (Five-Ingredient Powder with Poria) added with Yiren (Coix Seed), Cheqian Cao (Plantago Seed), and Banxia (Pinellia Tuber) is used to differentiate Yin and Yang. Alternatively, Baizhu San (Baizhu Powder) or Liuhe Tang (Six-Harmonies Decoction) may be used. Accumulation diarrhea stems from Spleen Qi deficiency where ingested milk/food fails to digest, compounded by prolonged consumption of cold foods transmitting to the Large Intestine, resulting in diarrhea. Various medicines fail because the accumulation in the Spleen and Stomach has not been removed. First use Sanleng San (Sparganium Powder) to remove accumulation, then Chenxiang Binglang Wan (Aquilaria and Betel Nut Pill) and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), followed by Hezhong San (Middle-Harmonizing Powder). Fright diarrhea presents with green stool resembling moss, thick and sticky like glue. It should not be stopped abruptly; instead, calm the Heart, suppress Liver wind, harmonize Spleen and Stomach, and digest milk/food. First use Wuling San (Five-Ingredient Powder with Poria), then Sanleng San (Sparganium Powder). Wind diarrhea often follows severe slow convulsion diseases. Stools are thin, yellow-brown, or mixed with undigested food, caused by Spleen deficiency. If mixed with dark brown/black, it indicates Spleen deficiency with Kidney Water overacting. If prolonged, it leads to convulsions. First use Wuling San (Five-Ingredient Powder with Poria) added with Yiren (Coix Seed) to drain Kidney Water, then Xiehuang San (Drain-Yellow Powder) to dispel Spleen wind, finally Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) to tonify Spleen Qi. Visceral cold diarrhea presents with green stool that is neither thin nor thick, or clear water discharge. Abdominal pain and borborygmus occur before defecation, and crying precedes the act. This occurs in infants aged 3-5 months but not after one year, caused by wind-cold invading via the umbilical stump. First use Chonghe Yin (Harmonizing Decoction) added with Congbai (Scallion White), then Danggui San (Angelica Powder) added with Wei Jiang (Baked Ginger), along with Yunqi San (Qi-Balancing Powder) and Lizhong Tang (Regulate the Middle Decoction). Ganji KT diarrhea presents with yellow face, distended abdomen, weak legs, large head with thin neck, sparse upright hair, emaciation, anorexia, morning chill and evening fever, abdominal masses (Zheng Pi), variable stool color, foul odor, and spontaneous start/stop of diarrhea. First use Sanleng San (Sparganium Powder) added with Chenpi (Tangerine Peel), then Wuxi Wan (Rhinoceros Horn Pill), Lushui Wan (Aloe Pill), and Kuchang Tang (Quick-Intestine Decoction). For dysentery/diarrhea with deep green color fading to pale yellow mixed with white, indicating excess cold and deficient heat (Yin pathogen overcoming Yang), Shouzhong Tang (Guard-the-Middle Decoction) and Weiling Tang (Stomach-Five-Ingredient Decoction) are used to support the exterior and rescue the interior. The formula should include Danggui San (Angelica Powder) added with Chenpi (Tangerine Peel), Zisu (Perilla Leaf), Shengjiang (Fresh Ginger), and Nuomi (Glutinous Rice). For severe cold, Lizhong Tang (Regulate the Middle Decoction) added with Fuzi (Prepared Aconite Root), Ginger, and Jujube is used, followed by Nanxing Fupi Yin (Arisaema and Tangerine Peel Drink). If diarrhea is pale green with froth, yellow and thick, indicating excess heat and deficient cold, leading to yellow emaciation and vexation, Wuling San (Five-Ingredient Powder with Poria) added with Yiren (Coix Seed), Cheqian Cao (Plantago Seed), and Shengjiang (Fresh Ginger) is used to dissipate residual pathogens. Then, Yinchenshanzhi Tang (Artemisiae Scopariae and Gardeniae Decoction) is taken with Wuling San (Five-Ingredient Powder with Poria) to resolve yellow discoloration. Alternatively, Wan'an Yin (Ten-Thousand Peace Drink) or Sishen Wan (Four-Spirit Pill) may be used.
Shen Jin'ao noted: In Ganji KT diarrhea, "KT" means distension. Symptoms necessarily include swollen eyelids, abdominal distension, preference for drinking water, irregular stool color, and progressive emaciation.