【歌】吐泻须知热与寒，泻黄吐乳热邪干；泻青吐逆为寒候，更把天时月日参。
【论】经云∶脾虚则泻，胃虚则吐，脾胃不和，阴阳不顺，清浊相干，则吐泻兼作。钱孔纯云∶小儿吐泻，
有湿、有热、有寒、有惊，宜详察而分治之。如夏月中暑发渴引饮，霍乱吐泻，脸赤唇红，去后黄沫色，小便
赤涩者，为热，可用香薷、五苓等药治之。冬时中寒，腹痛厥逆，吐泻白色，不渴，面微青色，唇紫，大便如
冻汁，或米谷不化，先战栗而小便去者，为寒，可用香附、砂仁、煨姜、木香等药治之。面微黑黄，眼亦黄，
手、足及肾囊稍肿，腹胀脐凸，小便短少，善呕而无食，痰多，唇白气促，爱坐畏眠者，为湿，可用苍术、浓
朴、薏苡、木瓜等药治之。面赤身热，睡卧不宁，目睛斜定，颈仰身摇，不时悸动，舌碎唇疮， 乳便青者，
为惊，可用天麻、川芎、茯苓、肉果等药治之。吐泻乳食不化，因伤粘腻难消之物，滞于中脘，不上不下，但
食即吐，面色青白，发热，四肢逆冷，不可便投止吐泻药，当先取积消导，宽利胸膈，次用调脾和胃之剂，此
皆合而言之也。愚谓有吐无泻者，胃必热，然亦有寒而吐者；有泻无吐者，胃必寒，然亦有热而泻者。何以辨
之？盖吐清凉，顺而易出者为寒；吐苦酸，逆而难出者为热；泻青白，小便
利者为寒；泻黄赤，肛门如烧者为热。又，泻利发哕者为虚，只吐不泻者为逆，各随其所属治之可也。
和中清热饮
治热吐。
黄连（姜炒，一钱） 半夏（姜制，一钱） 茯苓（一钱五分） 陈皮 藿香 砂仁（各七分）
水煎，徐徐服。
温中止吐汤
治寒吐
白豆蔻 茯苓（各一钱） 半夏（五分） 生姜（五片）
水煎，磨沉香四分，热服。
清热止泻汤
治热泻。
白茯苓 滑石（各一钱） 白术（六钱） 泽泻（七分） 川黄连（姜炒，四分）
加生姜，煎服。
温脾止泻汤
治寒泻。
白术（土炒） 白茯苓（各一钱） 桂（三分） 肉果（五分） 甘草（二分）
加生姜，煎服。
安胃醒脾汤
治吐泻兼作，脾胃俱受病者。
白术 白茯（各一钱） 滑石（水飞） 砂仁（炒，各七分） 木香（煨，五分）
姜、枣，煎服。
停食加枳实、山楂、曲 ；挟惊加胆星、天麻；风加防风、干葛；暑加香薷、扁豆；虚加人参；内有热加黄连；
口渴加乌梅肉；吐不止加藿香；泻不止加升麻。
【歌诀】
治疗吐泻必须分辨热证与寒证，大便色黄、呕吐乳食是热邪干扰所致；大便色青、呕吐逆气属于寒证表现，还需结合当时的天时气候和月日干支来综合参详。
【论述】
《内经》说：脾虚就会发生泄泻，胃虚就会发生呕吐，脾胃功能不和，阴阳之气不顺，清阳与浊阴相互干扰，就会导致呕吐和泄泻同时发作。钱乙（字仲阳，世称钱孔纯）说：小儿的吐泻，有因湿邪、热邪、寒邪、惊风引起的，应当详细察辨并分别治疗。例如夏季中暑导致口渴想喝水，出现霍乱样的剧烈呕吐和泄泻，面色红赤、嘴唇红润，排泄物为黄色粘液，小便短少涩痛，这属于热证，可以使用香薷饮、五苓散等药物治疗。冬季感受寒邪，腹痛且四肢厥冷，呕吐物和排泄物呈白色，口不渴，面色微青，嘴唇发紫，大便像冻汁一样稀薄，或者含有未消化的米谷，先出现战栗然后小便排出，这属于寒证，可以使用香附、砂仁、煨姜、木香等药物治疗。如果面色微黑黄，眼睛也发黄，手、足及阴囊稍微肿胀，腹部胀满肚脐突出，小便短少，容易干呕但无食物吐出，痰多，嘴唇苍白气促，喜欢坐着害怕睡觉，这属于湿证，可以使用苍术、厚朴、薏苡仁、木瓜等药物治疗。如果面色红赤身体发热，睡卧不安宁，眼球斜视固定，颈部僵硬身体摇晃，不时心悸跳动，舌头溃烂嘴唇生疮，乳汁和大便发青，这属于惊风证，可以使用天麻、川芎、茯苓、肉豆蔻等药物治疗。如果是吐泻出的乳食不消化，因为损伤了粘腻难消化的食物，停滞在中脘部位，不上不下，一吃东西就吐，面色青白，发热，四肢逆冷，此时不可立即投用止吐止泻的药物，应当先用消积导滞的方法，宽利胸膈，然后再使用调理脾胃的方剂，这些都是将各种情况合在一起论述的。我认为只有呕吐没有泄泻的，胃中一定有热，但也有因寒而呕吐的；只有泄泻没有呕吐的，胃中一定有寒，但也有因热而泄泻的。如何辨别呢？大概呕吐物清凉、顺畅易出的是寒证；呕吐物味苦酸、逆阻难出的是热证；大便色青白、小便通利的是寒证；大便色黄赤、肛门感觉如火烧的是热证。另外，泄泻并发呃逆的是虚证，只呕吐不泄泻的是逆证，各自根据所属的病机进行治疗即可。
和中清热饮
治疗热性呕吐。
黄连（用姜炒，一钱） 半夏（用姜制，一钱） 茯苓（一钱五分） 陈皮 藿香 砂仁（各七分）
加水煎煮，慢慢服用。
温中止吐汤
治疗寒性呕吐。
白豆蔻 茯苓（各一钱） 半夏（五分） 生姜（五片）
加水煎煮，磨入沉香四分，热服。
清热止泻汤
治疗热性泄泻。
白茯苓 滑石（各一钱） 白术（六钱） 泽泻（七分） 川黄连（用姜炒，四分）
加入生姜，煎煮后服用。
温脾止泻汤
治疗寒性泄泻。
白术（用土炒） 白茯苓（各一钱） 桂枝（三分） 肉豆蔻（五分） 甘草（二分）
加入生姜，煎煮后服用。
安胃醒脾汤
治疗呕吐和泄泻同时发作，脾胃都受病的情况。
白术 白茯苓（各一钱） 滑石（水飞法处理） 砂仁（炒，各七分） 木香（煨，五分）
加生姜、大枣，煎煮后服用。
若停食则加枳实、山楂、神曲；挟带惊风则加胆南星、天麻；夹风则加防风、干葛根；夹暑则加香薷、扁豆；体虚则加人参；内有热则加黄连；口渴则加乌梅肉；呕吐不止则加藿香；泄泻不止则加升麻。
[Verse]
In treating vomiting and diarrhea, one must distinguish between heat and cold. Yellow stool and vomiting of milk indicate interference by pathogenic heat; green stool and regurgitation indicate a cold syndrome. One must also take into account the seasonal climate and the heavenly stems and earthly branches of the month and day.
[Dissertation]
The *Classic of Internal Medicine* states: Spleen deficiency leads to diarrhea, Stomach deficiency leads to vomiting. When the Spleen and Stomach are disharmonious, and Yin and Yang qi are not smooth, clear turbid qi interferes with each other, leading to simultaneous vomiting and diarrhea. Qian Yi (courtesy name Zhongyang, known as Qian Kongchun) stated: In children, vomiting and diarrhea may be caused by dampness, heat, cold, or fright. These should be carefully examined and treated separately. For example, if one contracts summerheat in summer, resulting in thirst and desire to drink, accompanied by cholera-like severe vomiting and diarrhea, red face, red lips, yellow mucus in the stool, and scanty, painful urination, this is a heat syndrome. It can be treated with herbs such as Elsholtzia Herba (Xiangru) and Wuling San (Five-Ingredient Powder with Poria). If one contracts cold in winter, resulting in abdominal pain, cold limbs, white vomitus and stool, no thirst, slightly blueish face, purple lips, thin watery stool resembling frozen juice, or undigested rice and grain, preceded by shivering and then urination, this is a cold syndrome. It can be treated with herbs such as Cyperi Rhizoma (Xiangfu), Amomi Fructus (Sharen), prepared Zingiberis Rhizoma (Weijiang), and Aucklandiae Radix (Muxiang). If the face is slightly dark yellow, eyes are yellow, hands, feet, and scrotum are slightly swollen, abdomen is distended with protruding umbilicus, urine is scanty, there is frequent dry heaving without food expulsion, excessive phlegm, pale lips, rapid breathing, and a preference for sitting while fearing sleep, this is a dampness syndrome. It can be treated with herbs such as Atractylodis Rhizoma (Cangzhu), Magnoliae Officinalis Cortex (Houpo), Coicis Semen (Yiyi), and Chaenomelis Fructus (Mugua). If the face is red, body is hot, sleep is restless, eyes are fixed and deviated, neck is stiff and body sways, palpitations occur frequently, tongue is ulcerated, lips have sores, and milk and stool are green, this is a fright syndrome. It can be treated with herbs such as Gastrodiae Rhizoma (Tianma), Chuanxiong Rhizoma (Chuanxiong), Poria (Fuling), and Myristicae Semen (Rouguo). If vomiting and diarrhea involve undigested milk and food due to injury from sticky, hard-to-digest substances stagnating in the Middle Jiao (Zhongwan), neither ascending nor descending, causing immediate vomiting upon eating, with a blue-white complexion, fever, and cold limbs, one should not immediately administer anti-emetic or antidiarrheal drugs. Instead, one should first use methods to resolve accumulation and promote digestion, open and benefit the chest and diaphragm, and subsequently use formulas to regulate the Spleen and harmonize the Stomach. These are combined discussions. I propose that cases with vomiting but no diarrhea indicate Stomach heat, though cold can also cause vomiting; cases with diarrhea but no vomiting indicate Stomach cold, though heat can also cause diarrhea. How to differentiate? Generally, vomit that is cool and easy to expel indicates cold; vomit that is bitter/sour and difficult to expel indicates heat; stool that is green/white with free urination indicates cold; stool that is yellow/red with a burning sensation at the anus indicates heat. Furthermore, diarrhea accompanied by hiccups indicates deficiency; vomiting without diarrhea indicates an adverse condition. Each should be treated according to its specific pathology.
Hezhong Qingre Yin (Harmonizing Middle and Clearing Heat Decoction)
For treating heat-type vomiting.
Coptidis Rhizoma (Huanglian) – stir-fried with ginger, 1 qian; Pinelliae Rhizoma (Banxia) – prepared with ginger, 1 qian; Poria (Fuling) – 1.5 qian; Citri Reticulatae Pericarpium (Chenpi); Agastache Herba (Huoxiang); Amomi Fructus (Sharen) – 0.7 qian each.
Decoct in water and take slowly.
Wenzhong Zhi Ou Tang (Warming Middle and Stopping Vomiting Decoction)
For treating cold-type vomiting.
Cardamomi Fructus Albus (Baidoukou); Poria (Fuling) – 1 qian each; Pinelliae Rhizoma (Banxia) – 0.5 qian; Zingiberis Rhizoma Recens (Shengjiang) – 5 slices.
Decoct in water, add 0.4 qian of Aquilariae Lignum Resinatum (Chenxiang) ground from powder, and take hot.
Qingre Zhixie Tang (Clearing Heat and Stopping Diarrhea Decoction)
For treating heat-type diarrhea.
Poria (Baifuling); Talcum (Huashi) – 1 qian each; Atractylodis Macrocephalae Rhizoma (Baizhu) – 6 qian; Alismatis Rhizoma (Zexie) – 0.7 qian; Coptidis Rhizoma (Chuan Huanglian) – stir-fried with ginger, 0.4 qian.
Add Zingiberis Rhizoma Recens (Shengjiang), decoct and take.
Wenpi Zhixie Tang (Warming Spleen and Stopping Diarrhea Decoction)
For treating cold-type diarrhea.
Atractylodis Macrocephalae Rhizoma (Baizhu) – stir-fried with soil; Poria (Baifuling) – 1 qian each; Cinnamomi Ramulus (Gui) – 0.3 qian; Myristicae Semen (Rouguo) – 0.5 qian; Glycyrrhizae Radix et Rhizoma (Gancao) – 0.2 qian.
Add Zingiberis Rhizoma Recens (Shengjiang), decoct and take.
Anwei Xingpi Tang (Calming Stomach and Awakening Spleen Decoction)
For treating simultaneous vomiting and diarrhea where both Spleen and Stomach are diseased.
Atractylodis Macrocephalae Rhizoma (Baizhu); Poria (Baifu) – 1 qian each; Talcum (Huashi) – processed by water flotation; Amomi Fructus (Sharen) – stir-fried, 0.7 qian each; Aucklandiae Radix (Muxiang) – roasted, 0.5 qian.
Add Zingiberis Rhizoma Recens (Jiang) and Jujubae Fructus (Zao), decoct and take.
Modifications: Add Aurantii Fructus Immaturus (Zhishi), Crataegi Fructus (Shanzha), and Malt (Qu) for food stagnation; add Arisaematis Rhizoma Preparatum (Danning) and Gastrodiae Rhizoma (Tianma) for accompanying fright; add Saposhnikoviae Radix (Fangfeng) and Puerariae Radix (Gegen) for wind; add Elsholtzia Herba (Xiangru) and Dolichos Lablab Seed (Biandou) for summerheat; add Ginseng Radix et Rhizoma (Renshen) for deficiency; add Coptidis Rhizoma (Huanglian) for internal heat; add Pruni Mume Semen (Wumei Rou) for thirst; add Agastache Herba (Huoxiang) if vomiting persists; add Cimicifugae Rhizoma (Shengma) if diarrhea persists.