小儿吐泻证，虚寒者居其八九，实热者十中一二。但察其脉证无火，面色清白，气息平缓，肢
体清凉，或神气疲倦，则悉是虚寒之证，不得妄用凉药，古人云∶脾虚则呕，胃虚则吐者是也。盖
饮食入胃，不能运化而吐者，此脾气虚弱，所以不能运也。寒凉入胃，恶心而吐者，此中焦阳气受
伤，所以不能化也。若邪在中焦，则止于呕吐，若连及下焦，则并为泻矣。故在中上二焦者，宜治
脾胃，连及下焦者，宜调脾肾。若非实热火邪，而妄用寒凉消伐者，无有不死。
一、小儿虚寒呕吐，凡无故吐泻，察其无火者，必生冷寒气伤胃所致，今小儿所病，大约皆是
此证，宜养中煎，或温胃饮为主治，其次则五君子煎、理中汤、冬术煎。若兼血虚燥渴者，宜五君
子加当归。若兼脾肾虚寒，或多痰涎，或兼喘促，宜理阴煎；甚者，人参、附子、理阴煎为最妙，
勿谓呕吐不宜熟地也。若脾气无寒，或偶有所触，虽吐而不甚者，宜五味异功散。若脾中寒滞，气
有不顺而呕吐者，宜藿香安胃散。若上焦不清，多痰兼滞者，宜六君子汤，或更加砂仁、炮姜、木
香。
一、小儿伤食呕吐，若误会不宜之物，或停积滞浊以致吐者，必胸膈胀满，或肚腹作痛，此其
中必有余邪，宜和胃饮、益黄散。若但有食滞而胃不寒者，宜大和中饮、小和中饮。若食滞兼痰而
吐者，宜二陈汤、六安煎苓术二陈煎。若饮食虽滞，而因脾虚不能运化者，此其所重在脾气，不在
饮食，止宜养中煎、温胃饮，或理阴煎、圣术煎之类，以培其本，不可因饮食之故，而直行消伐也
。
一、小儿胃热呕吐者，其证最少，盖内热者多不致吐，即亦有之，其必多食炙爆甘甜之物，以
致滞积胃口，或夏间冒暑，及脏气素热者乃有之。凡治热证，必须详辨的确，勿得以假热作真热也
。凡胃火内热呕吐者，察其证必烦热，作渴喜冷，察其脉息必洪大滑数。火之甚者，宜泻黄散、玉
泉散、或竹叶石膏汤。若有痰食之滞兼火作吐者，宜二陈汤加石膏、黄连、山栀，或加山楂、麦芽
之类。若脾胃虚弱而兼火者，宜人参安胃散，或橘皮竹茹汤。若胃火呕吐作渴者，宜竹茹汤。若夏
月胃热，阳暑伤胃者，必烦热大渴，吐泻并作，宜五味香薷饮，或十味香薷饮，或竹茹汤，或橘皮
竹茹汤。若内热之甚者，宜益元散、玉泉散主之。然暑有阴阳之辨，若因天气暑热，过用生冷，以
致伤胃而为吐泻者，此属阴暑，则宜暖胃温中，如前虚寒治法，或用五苓散亦妙，凡本条之药绝不
可用。
薛氏曰∶凡暑令吐泻，手足发热，作渴饮冷者，属阳证，宜清凉之剂。若手足并冷，作渴饮汤
者，属阴证，宜温补之剂。故病有属阴者，误用寒凉之药，死后手足青黯，甚则遍身皆然，于此可
验。
一、小儿吐泻并作者，本属内伤，然有因寒气自外而入，内犯脏气而然者；有因生冷不慎，致伤
胃气而然者；有因中气本弱，饮食失宜而然者。邪伤阳分则为吐，邪伤阴分则为泻，若吐泻并作，
则阴阳俱伤之证也。此当察其有滞无滞，详辨其虚实而治之。若吐泻初起，邪滞未清者，必有胸腹
胀闷实滞等证，此宜先用和胃饮、苓术二陈煎之类，以清上焦之气。若吐泻初起，腹胀腹痛而拒按
者，宜先用胃苓汤，或五苓散加干姜、木香之类，以分下焦之清。若上无胀滞，或所吐既多而呕恶
不已，此其上焦岂尚有物？但察其形气困倦，总惟胃虚而然。若虚寒不甚者，宜五味异功散。然无
寒不作吐，故惟五君子煎、六味异功煎，及养中煎、温胃饮之类，皆最宜也。若下腹虽痛而可按可
揉，或腹寒喜熨，或所泻既多而泄仍不止，此其下焦必空虚已极，惟脾肾虚寒不能固摄而然，非胃
关煎不可；其稍轻者，或用四君子加肉豆蔻、补骨脂、丁香之属；若虚中兼滞者，或助胃膏亦可酌
用。其或果由胃火，则火逆于上，热蓄于下，亦能为吐为泻，然必有火证火脉者，方是其证，乃宜
大小厘清饮，或用香连丸，或如前胃热呕吐条参而治之。然此证最少，不得轻易混用。
小儿的吐泻病症中，属于虚寒证的占八九成，属于实热证的仅占一二成。只要诊察其脉象和证候没有火热之象，面色清白，气息平缓，肢体清凉，或者精神疲倦，这些都是虚寒证的表现，不可随意使用寒凉药物。古人说：“脾虚则呕吐，胃虚则反胃”，说的就是这个道理。饮食进入胃中，如果不能运化而吐出，这是脾气虚弱，所以不能运化的缘故。寒凉之物进入胃中，引起恶心而呕吐，这是中焦阳气受损，所以不能消化的缘故。如果病邪在中焦，就只表现为呕吐；如果波及下焦，就会同时出现腹泻。因此，病位在中上二焦的，应当治疗脾胃；病位连及下焦的，应当调理脾肾。如果不是实热火邪，却妄用寒凉攻伐的药物，没有不导致死亡的。
一、小儿虚寒呕吐，凡是无故发生吐泻，诊察发现没有火热之象的，必定是生冷寒气损伤了胃气所致。如今小儿所患的疾病，大都是这种证型，适宜以养中煎，或温胃饮为主治方剂，其次可用五君子煎、理中汤、冬术煎。如果兼有血虚燥渴的症状，宜在五君子煎中加入当归。如果兼有脾肾虚寒，或多痰涎，或兼有气喘急促，适宜用理阴煎；病情严重的，用人参、附子配合理阴煎最为巧妙，不要认为呕吐就不宜使用熟地黄。如果脾气没有受寒，或者是偶尔受到刺激，虽然呕吐但不严重的，适宜用五味异功散。如果脾中有寒湿停滞，气机不顺而导致呕吐的，适宜用藿香安胃散。如果上焦不清爽，多痰且兼有积滞的，适宜用六君子汤，或者再加砂仁、炮姜、木香。
一、小儿伤食呕吐，如果是误食了不宜的食物，或者食物停积、浊气内阻导致呕吐的，必定伴有胸膈胀满，或者肚腹疼痛，这说明体内有余留的病邪，适宜用和胃饮、益黄散。如果只是有食积停滞而胃中没有寒气的，适宜用大和中饮、小和中饮。如果食积停滞兼有痰湿而导致呕吐的，适宜用二陈汤、六安煎或苓术二陈煎。如果饮食虽然停滞，但因为脾气虚弱不能运化的，治疗的重点在于脾气，而不在于饮食，只适宜用养中煎、温胃饮，或理阴煎、圣术煎之类，来培补根本，不可因为饮食的原因，就直接使用消食攻伐的药物。
一、小儿胃热呕吐的情况最少，因为内热的人大多不会导致呕吐，即使有，也一定是吃了过多的烧烤甘甜之物，导致积滞停留在胃口，或者是夏天中暑，以及脏腑之气素来偏热的才会有这种情况。凡是治疗热证，必须详细辨别确切，不要把假热当作真热。凡是胃火内热导致的呕吐，诊察其证候必定烦热，口渴喜欢冷饮，诊察其脉息必定洪大滑数。火邪严重的，适宜用泻黄散、玉泉散，或竹叶石膏汤。如果有痰食停滞兼有火邪导致呕吐的，适宜用二陈汤加入石膏、黄连、山栀，或者加入山楂、麦芽之类。如果脾胃虚弱而兼有火邪的，适宜用人参安胃散，或橘皮竹茹汤。如果胃火呕吐并伴有口渴的，适宜用竹茹汤。如果夏天胃热，阳暑损伤胃气的，必定烦热大渴，吐泻同时发作，适宜用五味香薷饮，或十味香薷饮，或竹茹汤，或橘皮竹茹汤。如果内热严重的，适宜用益元散、玉泉散主治。然而暑邪有阴阳的区别，如果是因为天气暑热，过用生冷食物，导致损伤胃气而发生吐泻的，这属于阴暑，则适宜暖胃温中，如前面虚寒证的治疗方法，或者用五苓散也很好，本条所列的热证药物绝对不可使用。
薛氏说：凡是暑令期间的吐泻，手足发热，口渴想喝冷水的，属于阳证，适宜用清凉的药剂。如果手足都冷，口渴想喝热水的，属于阴证，适宜用温补的药剂。所以病有属阴的，如果误用寒凉药物，死后手足青黯，甚至全身都变黑，从这里可以验证。
一、小儿吐泻同时发作的，本来属于内伤，但是也有因为寒气从外侵入，内犯脏气而导致的；有因为不慎食用生冷，导致损伤胃气而导致的；有因为中气本来虚弱，饮食不当而导致的。病邪伤害阳分就会导致呕吐，病邪伤害阴分就会导致腹泻，如果吐泻同时发作，就是阴阳两伤的证候。这时应当诊察是否有积滞，详细辨别虚实然后进行治疗。如果吐泻初起，邪气和积滞尚未清除的，必定有胸腹胀闷、实证积滞等症状，这时适宜先用和胃饮、苓术二陈煎之类，来清利上焦的气机。如果吐泻初起，腹胀腹痛且拒绝按压的，适宜先用胃苓汤，或五苓散加入干姜、木香之类，来分清下焦的清浊。如果上部没有胀滞，或者呕吐已经很多但恶心不止，这说明上部哪里还有实物？只要诊察到形体和气力困倦，总归是胃虚导致的。如果虚寒不严重的，适宜用五味异功散。然而没有寒气就不会呕吐，所以只有五君子煎、六味异功煎，以及养中煎、温胃饮之类，才是最适宜的。如果下腹部虽然疼痛但可以按压揉摩，或者腹部怕冷喜欢热敷，或者腹泻已经很多但泄泻仍不止，这说明下焦已经极度空虚，只是由于脾肾虚寒不能固摄而导致的，非胃关煎不可用；病情稍轻的，可以用四君子汤加入肉豆蔻、补骨脂、丁香之类的药物；如果虚证中兼有积滞的，助胃膏也可以酌情使用。如果确实是由胃火引起的，那么火气逆乱于上，热邪蓄积于下，也能导致呕吐和腹泻，但必须有火证的征象和火脉的表现，这才是该证候，才适宜用大小厘清饮，或用香连丸，或参照前面胃热呕吐的条目来治疗。然而这种情况最少，不得轻易混用。
In pediatric vomiting and diarrhea syndromes, deficiency-cold patterns account for eight or nine out of ten cases, while excess-heat patterns account for only one or two. If the pulse and symptoms show no signs of fire/heat, the complexion is clear and white, breathing is calm, limbs are cool, or there is mental fatigue, these are all deficiency-cold patterns. One must not recklessly use cooling medicines. As the ancients said: "Spleen deficiency leads to retching (ou), Stomach deficiency leads to vomiting (tu)." This refers to the fact that when food enters the Stomach but cannot be transformed and transported, leading to vomiting, it is due to Spleen Qi deficiency and its inability to transport. When cold-cool substances enter the Stomach, causing nausea and vomiting, it is because the Yang Qi of the Middle Jiao has been damaged and cannot transform. If the pathogenic factor is in the Middle Jiao, it results only in vomiting; if it extends to the Lower Jiao, it manifests as both vomiting and diarrhea. Therefore, for conditions located in the Upper and Middle Jiao, treatment should focus on the Spleen and Stomach; for conditions involving the Lower Jiao, regulation of the Spleen and Kidney is appropriate. If excess heat-fire pathogens are present but cold-cooling purgatives are used recklessly, death is inevitable.
1. For pediatric deficiency-cold vomiting, where vomiting and diarrhea occur without obvious cause and show no signs of heat, it is invariably caused by raw/cold foods damaging the Stomach Qi. Most pediatric diseases today fall into this category. The primary treatments should be Yangzhong Decoction (Nourish the Middle Decoction) or Wenwei Yin (Warm the Stomach Drink). Secondary options include Wujunzi Decoction (Five Gentlemen Decoction), Lizhong Tang (Regulate the Middle Decoction), or Dongzhu Decoction (Winter Atractylodes Decoction). If accompanied by Blood deficiency with dryness and thirst, add Danggui (Angelica Sinensis) to Wujunzi Decoction. If accompanied by Spleen-Kidney deficiency-cold, excessive phlegm-fluids, or panting, Liyin Decoction (Nourish Yin Decoction) is indicated. In severe cases, Renshen (Ginseng Radix) and Fuzi (Aconite Lateralis Radix Praeparata) combined with Liyin Decoction are most effective; do not assume Shudi Huang (Rehmanniae Radix Preparata) is contraindicated in vomiting. If the Spleen Qi is not cold, or if vomiting occurs due to occasional irritation but is mild, Siwu Yigong San (Four Agents Extra-Effort Powder) is suitable. If there is cold-stagnation in the Spleen with Qi obstruction causing vomiting, Huoxiang Angwei San (Agastache Stomach-Calming Powder) is appropriate. If the Upper Jiao is unclear with excessive phlegm and stagnation, Liujunzi Tang (Six Gentlemen Decoction) is indicated, possibly augmented with Sharen (Amomi Fructus), Paojiang (Prepared Ginger Rhizome), or Muxiang (Aucklandiae Radix).
2. For pediatric food-stagnation vomiting, if inappropriate foods are consumed or food retention and turbidity cause vomiting, there will inevitably be chest/diaphragm fullness or abdominal pain, indicating residual pathogenic factors. He Wei Yin (Harmonize the Stomach Drink) and Yihuang San (Yellow Protect Powder) are indicated. If there is only food stagnation without Stomach cold, Dahezhong Yin (Great Harmonize the Middle Drink) or Xiaohezhong Yin (Small Harmonize the Middle Drink) are suitable. If food stagnation is complicated by phlegm causing vomiting, Erchen Tang (Two Aged Ingredients Decoction), Liu'an Decoction (Six Peaceful Decoction), or Lingzhu Erchen Jian (Poria-Atractylodes Two Aged Ingredients Decoction) are appropriate. If food stagnation exists but is due to Spleen deficiency failing to transform, the focus must be on the Spleen Qi rather than the food itself. Only Yangzhong Decoction, Wenwei Yin, Liyin Decoction, or Shengzhu Decoction (Holy Atractylodes Decoction) should be used to nourish the root. One must not directly use digestive-purgative agents simply because of dietary indiscretion.
3. Pediatric Stomach-heat vomiting is rare. Internal heat rarely causes vomiting; if it does, it is usually due to excessive consumption of roasted/fried sweet foods causing stagnation at the stomach opening, summer heatstroke, or inherent organ heat. Treating heat syndromes requires precise differentiation to avoid mistaking false heat for true heat. For Stomach fire/internal heat vomiting, symptoms include irritability, heat sensation, thirst preferring cold drinks, and a pulse that is洪大 (Hóng Dà, large and surging), 滑数 (Huá Shuò, slippery and rapid). Severe fire cases warrant Xiehuang San (Drain Yellow Powder), Yuquan San (Jade Spring Powder), or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). If phlegm-food stagnation combines with fire to cause vomiting, Erchen Tang augmented with Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), or Zhizi (Gardeniae Fructus), or adding Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus), is suitable. If Spleen-Stomach weakness coexists with fire, Renshen Angwei San (Ginseng Stomach-Calming Powder) or Chupi Zhuru Tang (Tangerine Peel and Bamboo Juice Decoction) are indicated. For Stomach fire vomiting with thirst, Zhuru Tang (Bamboo Juice Decoction) is used. For summer Stomach heat from Yang heatstroke damaging the Stomach, characterized by irritability, intense thirst, and simultaneous vomiting/diarrhea, Siwei Xiangru Yin (Four-Agent Mosla Drink), Shiwei Xiangru Yin (Ten-Agent Mosla Drink), Zhuru Tang, or Chupi Zhuru Tang are appropriate. For severe internal heat, Yi Yuan San (Benefit Origin Powder) or Yuquan San are main treatments. However, summer heat has Yin-Yang distinctions. If vomiting/diarrhea results from overconsumption of cold/raw foods during hot weather, damaging the Stomach, this is Yin Summer Heat. Treatment should warm the Stomach and Middle Jiao, following deficiency-cold protocols, or using Wuling San (Five-Ingredient Poria Powder); none of the heat-clearing herbs listed above should be used.
Mr. Xue stated: During summer months, vomiting/diarrhea with hot hands/feet and thirst for cold drinks indicates a Yang syndrome, treated with cooling agents. Cold hands/feet with thirst for hot drinks indicate a Yin syndrome, treated with warming-tonifying agents. Thus, Yin syndromes misdiagnosed and treated with cold-cooling medicines may result in cyanotic dark hands/feet post-mortem, or even whole-body discoloration, which serves as verification.
4. Simultaneous vomiting and diarrhea in children originally stem from internal injury. Causes include external cold invading and damaging Zang-Qi; careless consumption of raw/cold foods damaging Stomach Qi; or weak Middle Qi combined with improper diet. Pathogens injuring Yang levels cause vomiting; those injuring Yin levels cause diarrhea. Simultaneous occurrence indicates damage to both Yin and Yang. Differentiation must assess presence of stagnation and determine deficiency/excess. If early-stage vomiting/diarrhea presents with chest/abdominal distension and excess stagnation, He Wei Yin or Lingzhu Erchen Jian should be used first to clear Upper Jiao Qi. If early-stage vomiting/diarrhea involves abdominal distension/pain with tenderness (refusal to press), Weiling Tang (Gastro-Ling Decoction) or Wuling San augmented with Ganjiang (Zingiberis Rhizoma) and Muxiang is indicated to separate Lower Jiao clarity/turbidity. If there is no upper distension, or persistent nausea after profuse vomiting, the upper Jiao is likely empty; fatigue indicates Stomach deficiency. For mild deficiency-cold, Siwu Yigong San is suitable. Since cold causes vomiting, Wujunzi Decoction, Liuyi Yigong Jian (Six Agents Extra-Effort Decoction), Yangzhong Decoction, or Wenwei Yin are most appropriate. If lower abdominal pain is mild (pressable/rubable), or abdomen prefers warmth/moxibustion, or profuse diarrhea persists, the Lower Jiao is extremely empty due to Spleen-Kidney deficiency-cold failing to secure. Weiguan Decoction (Stomach Gate Decoction) is essential. Mild cases may use Sijunzi Tang augmented with Roudoukou (Myristicae Semen), Buguzhi (Psoraleae Fructus), or Dingxiang (Caryophylli Flos). If deficiency coexists with stagnation, Zhuwei Gao (Assist Stomach Paste) may be considered. If truly caused by Stomach fire, rebellious fire upward and heat accumulation downward can cause vomiting/diarrhea, but only if fire symptoms and pulses are evident. Then, Da/Xiao Liqing Yin (Great/Small Clear Separation Drinks) or Xianglian Wan (Aucklandia-Coptis Pills) are indicated, or treat according to Stomach-heat vomiting protocols. This case is rare and must not be confused with others.