经曰∶五脏之积曰积，六腑之积曰聚。凡小儿积滞或作痛，皆由乳哺不节，过餐生冷，脾胃
不能克化，停滞中脘，久而成积。或因饱食即卧，脾失运化，留而成积。其症面目黄肿，腹
痛膨胀，壮热足冷，嗜卧不思乳食，大便馊臭或秘涩，小便如油。若吐乳泻乳所出酸臭者，
为乳积。腹胀作泻，呕吐哕气者，为食积。初患元气未损之时，或腹胀作痛，大小便不利者
，先用白饼子或木香槟榔丸下之；下后以白术散或五味异功散和之，渴加干葛，吐加半夏。
下而热不退，或作呕作泻，饮食不思，此脾胃俱伤也，用六君子汤。手足指冷，喜饮热汤，
此脾胃虚寒也，前方加炮姜、木香。面色黄白，目无精光，脾肺俱虚也，用四君子加柴胡、
升麻。腹痛泄利下重，或小便不利者，用四逆散。发热晡热，或泻不已，脾气下陷也；潮热
口渴，大便不调，欲变疳症也，并用补中益气汤，佐以肥儿丸。经云∶邪之所凑，其气必虚
。留而不去，其病乃实。必以调脾为主，而以消导佐之。古人所谓养正积自除，正此意也。
治验
一小儿每停食，身发赤晕，用清中解郁汤而愈。后患摇头切牙，痰盛发搐，吐出酸腐，待其
吐尽，翌日先与七味白术散，次与参苓白术散，遂不复作。若吐后儿安，更不必服药也。
一小儿饮食积滞，患呕吐发热，服消导等剂，饮食已消，而热未退，余以为胃经虚热，用六
君、升麻、柴胡各二分，四剂而愈。
一小儿七岁，停食后腹痛，服克伐之剂而益加，按之不痛，此脾气复伤也，用六君子汤而愈
。后复伤食，服保和丸及三棱、槟榔之类，而更腹痛；服泻黄散，体重善噫，此脾气虚而下
陷也，仍用六君、升麻、柴胡、木香而愈。
一小儿数岁间，每停食辄服峻利之药，后肚腹膨胀，呕吐泄泻，先用六君子汤，诸症渐愈；
又用补中益气汤而安。
一小儿腹胀，饮食后即泻，手足逆冷，此脾气虚寒也，先用人参理中丸，后用六君子汤而愈
。
一小儿腹痛，以手按之痛益甚，此乳食停滞也。用保和丸末一钱、槟榔末三分，下酸臭粪而
安。后患腹痛，别服峻利之剂，其痛益甚，手按则已，面色黄白，此因饮食失宜，脾气不调
，土虚不能生金也，用六君子汤而愈。
一小儿久患腹痛，诊其母，右关脉弦缓，乃木克土也，用六君子汤加木香、柴胡，母子并服
而愈。
一小儿停食腹痛，面色白，黑睛少，手足常冷，大便不实，口鼻吸气，腹中阴冷。此禀命门
火衰，不能温蒸中州之气，故脾胃虚寒也，用八味丸、补中益气汤而愈。
一小儿患前症，服驱逐之剂，更恶寒发热，余朝用补中益气汤，夕用五味异功散寻愈。后饮
食停滞，腹痛便秘，别用疏导之剂，朝寒暮热，大便频数，余用五味异功散，月余饮食渐进，乃佐以
八珍汤，内芍药炒焦，川芎些少，又两月，寒热渐愈。后又伤风，服参苏饮，汗出喘嗽发热
，服清热化痰之剂，更烦热不寐，寻衣撮空，先用六味地黄丸料，水煎服，诸症顿退，再剂
而安；却用五味异功散、八珍汤而痊。后因伤食吐泻，大便欲去而不去，欲了而不了，先用
补中益气汤，数剂不应；改用人参五钱，白术三钱，陈皮、甘草各七分，升麻四分，干葛五
分，三剂，又手足并冷，急用人参一两，附子五分，姜枣水煎，一日服二剂，手足始温，又二剂，诸
症渐退。仍用前人参五钱之方，治之而愈。
七味白术散 治吐泻作渴。
人参（二钱五分） 白茯苓 白术 藿香叶（各半两） 木香（二钱） 甘草（一钱） 干葛（半两，渴加一两）
上每服一二钱，水煎，热渴甚去木香，肚痛加芍药。
四逆散 治少阴病，或腹中痛，泄痢下重。
枳实（炒黄） 甘草（炒） 柴胡 芍药
上为细末，每服二钱，空心米饮调下。
白饼子（方见发搐）
木香槟榔丸（方见积滞）
五味异功散
六君子汤（二方见内钓）
补中益气汤（方见虚羸）
古籍记载：五脏的积块称为“积”，六腑的积块称为“聚”。凡是小儿出现积滞或发作疼痛，都是由哺乳喂养不节制，过量食用生冷食物，导致脾胃无法消化运化，食物停滞在中脘部位，久而久之形成积块。或者因为饱食后立即躺卧，脾脏失去运化功能，食物停留而形成积块。其症状表现为面目黄肿，腹部疼痛且胀满，高热但足部发冷，嗜睡不想吃奶或进食，大便酸臭或便秘涩滞，小便如油状。如果呕吐乳汁或腹泻时排出的物质带有酸臭味，这属于乳积（乳汁积滞）。如果腹胀并伴有腹泻、呕吐及呃逆嗳气，这属于食积（食物积滞）。在初患病、元气尚未受损之时，如果出现腹胀疼痛、大小便不通利的情况，先用白饼子或木香槟榔丸进行攻下治疗；攻下之后，用白术散或五味异功散来调和脾胃，口渴加干葛，呕吐加半夏。如果攻下后热势不退，或者出现呕吐、腹泻、不思饮食，这是脾胃俱伤的表现，使用六君子汤。如果手足指头发冷，喜欢喝热汤，这是脾胃虚寒的表现，在前方的基础上加炮姜、木香。如果面色黄白，眼睛缺乏神采，这是脾肺俱虚的表现，使用四君子汤加柴胡、升麻。如果腹痛、泄利且肛门有重坠感，或者小便不利，使用四逆散。如果发热，特别是傍晚时分发热，或者腹泻不止，这是脾气下陷的表现；如果是潮热口渴，大便不调，想要转变为疳症（营养不良综合征），均使用补中益气汤，配合肥儿丸服用。经书说：邪气聚集的地方，正气必定虚弱。病邪留滞不去，病情就会变得实证。必须以调理脾胃为主，以消食导滞为辅。古人所说的培养正气，积滞自然消除，就是这个意思。
治验案例：
有一个小孩每次停食（消化不良），身上会出现红色晕斑，使用清中解郁汤而痊愈。后来出现摇头、咬牙，痰多并发出抽搐，吐出酸腐之物，等待其吐尽后，第二天先用七味白术散，接着用参苓白术散，从此不再发作。如果呕吐后孩子平安，更不必再服药。
有一个小孩因饮食积滞，患呕吐发热，服用消导等药剂，饮食已消化，但热未退，我认为这是胃经虚热，使用六君子汤、升麻、柴胡各二分，服用四剂而痊愈。
有一个七岁小孩，停食后腹痛，服用克伐（攻伐）之剂后疼痛加剧，按压腹部不痛，这是脾气再次受伤的表现，使用六君子汤而痊愈。后来再次伤食，服用保和丸及三棱、槟榔之类药物，反而腹痛更甚；服用泻黄散后，身体沉重且爱打嗝，这是脾气虚而下陷的表现，仍然使用六君子汤加升麻、柴胡、木香而痊愈。
有一个几岁的小孩，这几年间每次停食就服用峻烈通利之药，后来肚腹膨胀，呕吐泄泻，先用六君子汤，各种症状逐渐痊愈；又用补中益气汤而安顿。
有一个小孩腹胀，饮食后即腹泻，手足逆冷，这是脾气虚寒的表现，先用人参理中丸，后用六君子汤而痊愈。
有一个小孩腹痛，用手按压时疼痛更加严重，这是乳食停滞的表现。使用保和丸末一钱、槟榔末三分，排出酸臭粪便后安宁。后来患腹痛，另外服用峻烈通利之剂，疼痛更加严重，手按则痛止，面色黄白，这是因为饮食不当，脾气不调，土虚不能生金（脾虚影响肺），使用六君子汤而痊愈。
有一个小孩长期患腹痛，诊察其母亲，右关脉弦缓，这是木克土（肝木乘脾土）的表现，使用六君子汤加木香、柴胡，母子同服而痊愈。
有一个小孩停食腹痛，面色白，黑睛少，手足常冷，大便不成形，口鼻吸气，腹中阴冷。这是禀受命门火衰，不能温蒸中焦之气，所以是脾胃虚寒，使用八味丸、补中益气汤而痊愈。
有一个小孩患前述病症，服用驱逐之剂后，更出现恶寒发热，我早上用补中益气汤，晚上用五味异功散，不久痊愈。后来饮食停滞，腹痛便秘，另外用疏导之剂，早晨怕冷傍晚发热，大便频数，我用五味异功散，一个多月饮食逐渐恢复，于是配合八珍汤，其中芍药炒焦，川芎少许，又过了两个月，寒热症状逐渐痊愈。后来又伤风，服用参苏饮，出汗后气喘咳嗽发热，服用清热化痰之剂后，更加烦热不寐，出现寻衣撮空（无意识动作），先用六味地黄丸料，水煎服，各种症状顿时消退，再服两剂而安宁；却改用五味异功散、八珍汤而痊愈。后来因伤食吐泻，大便想拉拉不出，想结束却结束不了，先用补中益气汤，数剂没有反应；改用人参五钱，白术三钱，陈皮、甘草各七分，升麻四分，干葛五分，三剂后，又出现手足并冷，急用人参一两，附子五分，姜枣水煎，一天服两剂，手足才温暖，又两剂，各种症状逐渐消退。仍用前人参五钱的方子，治疗而痊愈。
七味白术散 治疗呕吐腹泻伴口渴。
人参（二钱五分） 白茯苓 白术 藿香叶（各半两） 木香（二钱） 甘草（一钱） 干葛（半两，口渴加一两）
以上每服一二钱，水煎，热渴严重时去掉木香，肚子痛加芍药。
The classics state: Accumulations in the five zang organs are called "Ji" (Accumulation), while accumulations in the six fu organs are called "Ju" (Gathering). In children, stagnation or pain arising from food retention is caused by irregular breastfeeding or feeding, excessive consumption of raw and cold foods, leading to the spleen and stomach's inability to digest and transform, causing food to stagnate in the Zhongwan region. Over time, this forms an accumulation. Alternatively, lying down immediately after a full meal causes the spleen to lose its transformative function, leaving food behind to form an accumulation. Symptoms include yellowish swelling of the face and eyes, abdominal pain and distension, high fever with cold feet, lethargy, and refusal to breastfeed or eat. Stools may be sour-smelling or constipated and difficult to pass, and urine may resemble oil. If milk is vomited or diarrhea produces sour-smelling discharge, it is classified as Milk Retention (stagnation of milk). If abdominal distension is accompanied by diarrhea, vomiting, and belching, it is classified as Food Retention (stagnation of solid food). In the early stage, when vital qi has not yet been damaged, if there is abdominal distension and pain with difficulty in urination and defecation, first administer Baibing Zi (White Pill) or Muxiang Binglang Wan (Aucklandia and Betel Nut Pill) to purge. After purging, harmonize the spleen and stomach using Baizhu San (Atractylodes Powder) or Wuyi Yigong San (Five-Ingredient Powder for Extraordinary Efficacy). Add Ge Gen (Kudzu Root) for thirst, and Ban Xia (Pinellia Tuber) for vomiting. If heat persists after purging, or if vomiting, diarrhea, and loss of appetite occur, this indicates damage to both the spleen and stomach; use Liujunzi Tang (Six-Gentleman Decoction). If the fingers and toes are cold and the child prefers hot drinks, this indicates deficiency-cold of the spleen and stomach; add Pao Jiang (Prepared Ginger) and Mu Xiang (Aucklandia Root) to the previous formula. If the complexion is yellowish-white and the eyes lack luster, this indicates deficiency of both the spleen and lung; use Sijunzi Tang (Four-Gentleman Decoction) added with Chai Hu (Bupleurum Root) and Sheng Ma (Cimicifuga Rhizome). If there is abdominal pain, dysentery with a sensation of heaviness in the anus, or difficulty in urination, use Sini San (Frigid Extremities Powder). If there is fever, particularly in the late afternoon, or persistent diarrhea, this indicates sinking of spleen qi; if there is tidal fever, thirst, and irregular bowel movements suggesting a transition into Infantile Malnutrition (Gan Syndrome), use Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) assisted by Fei'er Wan (Child-Nourishing Pill). The classics say: Where pathogenic factors gather, vital qi must be deficient. If they remain and do not depart, the disease becomes excess. Treatment must focus primarily on regulating the spleen, assisting with digestion and elimination. This aligns with the ancient principle that nurturing the upright qi will naturally eliminate stagnation.
Clinical Cases:
A child who suffered from food stagnation developed red rashes on the body and was cured using Qingzhong Jieyu Tang (Decoction to Clear the Middle and Resolve Depression). Later, the child exhibited head shaking, teeth grinding, profuse phlegm, and convulsions, vomiting sour and putrid matter. After waiting for the vomiting to cease completely, Qiw Wei Baizhu San (Seven-Ingredient Atractylodes Powder) was administered the next day, followed by Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). The condition did not recur. If the child is stable after vomiting, no further medication is necessary.
A child suffering from vomiting and fever due to food stagnation took digestive agents. Although the food stagnation resolved, the fever persisted. I diagnosed this as deficiency-heat in the Stomach meridian and prescribed Liujunzi Tang, Sheng Ma, and Chai Hu, each two fen. After four doses, the child recovered.
A seven-year-old child experienced abdominal pain after food stagnation. Taking harsh purgatives exacerbated the pain, but pressing on the abdomen did not elicit pain, indicating further injury to the spleen qi. The child was cured using Liujunzi Tang. Later, upon re-injuring the stomach with food, the child took Baohe Wan (Harmonize the Stomach Pill) along with San Leng (Curcuma Zedoaria Rhizome) and Bing Lang (Areca Seed), which worsened the abdominal pain. Taking Xiehuang San (Drain Yellow Powder) resulted in heavy limbs and frequent belching, indicating spleen qi deficiency with sinking. The child was cured using Liujunzi Tang added with Sheng Ma, Chai Hu, and Mu Xiang.
A child of several years old had taken harsh purgative drugs every time food stagnated. Subsequently, the abdomen became distended with vomiting and diarrhea. Six-Junzi Tang was used first, gradually resolving the symptoms; then Buzhong Yiqi Tang was used to stabilize the condition.
A child with abdominal distension experienced immediate diarrhea after eating, with inverted coldness in the hands and feet. This indicated deficiency-cold of the spleen qi. Ren Shen Lizhong Wan (Ginseng and Zingiber Pill for Regulating the Middle) was used first, followed by Liujunzi Tang, resulting in recovery.
A child with abdominal pain experienced intensified pain upon manual pressure, indicating stagnation of milk and food. One qian of Baohe Wan powder and three fen of Bing Lang powder were administered. After passing sour-smelling stools, the child was relieved. Later, the child suffered abdominal pain again and took other harsh purgatives, worsening the pain. However, manual pressure alleviated the pain, and the complexion was yellowish-white. This was due to improper diet causing spleen qi dysfunction, where earth deficiency failed to generate metal (spleen deficiency affecting the lung). Liujunzi Tang was used, and the child recovered.
A child suffered from chronic abdominal pain. Examination of the mother revealed a wiry and moderate pulse at the right guan position, indicating wood overacting on earth (liver wood invading spleen earth). Liujunzi Tang added with Mu Xiang and Chai Hu was administered to both mother and child, resulting in recovery.
A child with food stagnation and abdominal pain had a white complexion, scant black pupils, constant coldness in the hands and feet, loose stools, inhalation through the mouth and nose, and a cold sensation in the abdomen. This indicated congenital deficiency of Mingmen Fire (Fire of the Gate of Life), failing to warm and vaporize the qi of the middle jiao, resulting in spleen-stomach deficiency-cold. Bawei Wan (Eight-Ingredient Pill) and Buzhong Yiqi Tang were used, and the child recovered.
A child with the aforementioned symptoms took expulsive agents, leading to aversion to cold and fever. I prescribed Buzhong Yiqi Tang in the morning and Wuyi Yigong San in the evening, leading to quick recovery. Later, food stagnation caused abdominal pain and constipation. Other draining agents were used, resulting in morning chills and evening fevers, with frequent stools. I used Wuyi Yigong San. Over a month, dietary intake gradually improved, so I supplemented with Bazhen Tang (Eight-Treasure Decoction), with Shaoyao (Peony Root) stir-fried until charred and a small amount of Chuanxiong (Ligusticum Chuanxiong Rhizome). After another two months, the chills and fever gradually resolved. Later, a wind-cold invasion occurred. Can Su Yin (Ginseng and Perilla Drink) was taken, leading to sweating, wheezing, coughing, and fever. Heat-clearing and phlegm-resolving agents were taken, causing increased irritability, insomnia, and aimless picking at clothes/air. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) decocted in water was used first, rapidly retreating all symptoms; two more doses brought peace. Then, Wuyi Yigong San and Bazhen Tang were used for complete recovery. Later, food stagnation caused vomiting and diarrhea, with stool urgency without passage. Buzhong Yiqi Tang was tried first for several doses with no effect. The prescription was changed to Ren Shen (Ginseng Root) 5 qian, Bai Zhu (Atractylodes Macrocephala Rhizome) 3 qian, Chen Pi (Tangerine Peel) and Gan Cao (Licorice Root) 7 fen each, Sheng Ma 4 fen, and Ge Gen 5 fen. After three doses, the hands and feet became cold. Urgently, Ren Shen 1 liang and Fu Zi (Aconite Lateralis Radix Praeparata) 5 fen were decocted with fresh ginger and dates, administered twice daily. The hands and feet warmed up. After two more doses, symptoms gradually receded. The original prescription with Ren Shen 5 qian was resumed, and the child recovered.
Qiw Wei Baizhu San (Seven-Ingredient Atractylodes Powder): Treats vomiting, diarrhea, and thirst.
Ren Shen (2.5 qian), Bai Fu Ling (Poria), Bai Zhu, Huo Xiang Ye (Agastache Leaf) (each 0.5 liang), Mu Xiang (2 qian), Gan Cao (1 qian), Ge Gen (0.5 liang, increase to 1 liang if thirsty).
Take 1-2 qian per dose, decoct in water. Remove Mu Xiang if heat and thirst are severe; add Shaoyao if abdominal pain occurs.
Sini San (Frigid Extremities Powder): Treats Shaoyin disease, or abdominal pain, dysentery with heaviness in the anus.
Zhi Shi (Immature Bitter Orange Fruit, stir-fried until yellow), Gan Cao (stir-fried), Chai Hu, Shaoyao.
Grind into fine powder. Take 2 qian per dose, mix with rice water on an empty stomach.
Baibing Zi (White Pill) (See formula under Convulsions).
Muxiang Binglang Wan (Aucklandia and Betel Nut Pill) (See formula under Food Stagnation).
Wuyi Yigong San (Five-Ingredient Powder for Extraordinary Efficacy).
Liujunzi Tang (Six-Gentleman Decoction) (Both formulas see under Internal Hook).
Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) (See formula under Emaciation).