经曰∶饮食自倍，肠胃乃伤。东垣云∶饮者，无形之气也；食者，有形之血也。由此推之，乳为血液，饮之
类也；谷有糟粕，食之类也。乳之与食，原非同类，岂可不辨乎哉？
凡小儿饮食伤脾之证，非可一例而论。有寒伤、有热伤；有暂病、有久病；有虚证、有实证。但热者、暂
者、实者，人皆易知；而寒者、久者、虚者，人多不识。如今之小儿，以生冷瓜果，致伤胃气而为腹痛泻利者，
人犹以为火热，而治以寒凉，是不识寒证也。有偶因停滞而为胀痛，人皆知其实也，然脾胃之素强者，即滞亦易
化，惟其不能化者，则恒有胀满之证。又或有不食亦知饥，少食即作胀，或有无饥无饱，全不思食，或因病有
伤胃气，久不思食，本非有余之证。时医遇此，无论有余不足，鲜有不用开胃消导之剂者，是不知虚证也。盖脾
胃原有运化之功用，今既不能化食，则运用之职已失其权，而尚
可专意克削，以益其困乎！故凡欲治病，必先藉胃气以为行药之主。若胃气强者，攻之则去，而疾常易愈，此
以胃气强而药力易行也；胃气虚者，攻之亦不去，此非药不去病，以胃气本弱，攻之则益弱，而药力愈不行，
胃愈伤病亦愈甚矣。若乃体质贵贱，尤有不同。凡藜藿之儿，壮健之质，及新暴之病，自宜消伐，惟速去为善；
如以弱质弱病，而罔顾虚实，概施欲速攻治之法，则无有不危矣。
凡素喜冷食者，内必多热；素喜热食者，内必多寒。故内寒者，不喜寒；内热者，不喜热。然热者嗜寒，
多生中寒，寒者喜热，多生内热。《内经》所谓久而增气，物化之常，气增而久，夭之由也。凡治病者，又当
于素禀中察其嗜好偏胜之弊。
凡饮食致病，伤于热者多为火证，而停滞者少；伤于寒者多为停滞，而全非火证。大都饮食之伤，必因于
寒物者居多，而温平者次之。盖热则易于腐化流通，所以停滞者少。
冯楚瞻曰∶凡小儿伤食，皆由胃气怯弱。今时之医，以平胃散为脾胃之准绳，孰知平胃者，胃中有高阜，
则能使平之，使一平即止，不可过剂，过则平地反成坎矣。又不若枳实丸为胜，方为洁古老人所制，用枳实一
两、白术二两，补多于消，先补而后消也。但此丸原为伤食者设，今若专以为补脾药，又误矣。夫枳实有推墙
倒壁之功，用之不当，能无克削？即如山楂、神曲、麦芽，举世所常用者，然山楂能化肉积，凡多年母猪肉之
不烂，但入山楂一撮，登时皮肉即糜；又产妇儿枕痛，以山楂煎服，儿枕立化，可见其破滞之功，岂可轻用！
曲、麦者，以米饭在瓷缸中，必藉曲以酿酒，必藉 以成糖。脾胃在人身中非瓷缸比，原有化食之功，今食不
化，因其所司者病也，只补其运用之能，而食自化，何必用此消克药哉？
大凡小儿原气完固，脾胃素强者，多食不伤，过时不饥。若儿先因本气不足，脾胃素亏者，多食易伤，如
攻伐一用，饮食虽消，
而脾气复经此一番消伐，愈虚其虚；后日食复不化，犹谓前药已效，汤丸叠进，展转相害，羸瘦日增，良可悲
矣！故医有贫贱之医，有富贵之医，膏粱子弟与藜藿不同，太平之民与疮痍自别。乡村里巷，顽夫壮士，暴有
所伤，攻伐之剂，一投可愈；倘膏粱幼稚，禀受怯弱，娇养柔脆，一例施之，贻害不小矣。
楚瞻曰∶人之脾胃虽能化食，实由于水火二气运用其间，非脾胃之所专能也。内火盛则脾胃燥，水盛则脾
胃湿，皆不能健运，乃生诸病。如消渴证，火偏盛而水不能制；水肿证，水偏盛而火不能化。惟制其偏而使之
平，则善矣。制者，非谓去水去火之意。人身水火，本自均平，偏者病也。火偏多者，补水配火，不必去火；
水偏多者，补火配水，不必去水。譬之天平，此重则彼轻，一边重者，只补足轻之一边，决不凿去马子，盖马子一
定之数。今人见水利水，见火泻火，是凿马子者也。
小儿之病，伤食最多，故乳食停滞，中焦不化而成病者，必发热恶食，或噫气作酸，或恶闻食气，或欲吐
不吐，或吐出酸水，或气短痞闷，或腹痛啼叫。此皆伤食之候也，便宜损之。损之者，谓姑止之，勿与食也，
使其自运。经谓伤之轻者，损谷则愈矣。损之不减，则用胃苓丸以调之；调之不减，则用保和丸以导之；导之
不去，则攻下之。轻则木香槟榔丸，重则消积丸。
伤食一证，最关利害。如迁延不治，则成积成癖；治之不当，则成疳成痨。故小儿之强壮者，脾胃素实，
恃其能食，父母纵之，以致太过，停留不化。此食伤脾胃，真伤食也，可用前法治之。如小儿之怯弱者，脾胃
素虚，所食原少，或因略加，即停滞而不化。此乃脾虚不能消谷，转运迟耳，非真伤食，作伤食治则误矣。惟
宜六君子汤，助其健运，多服自愈。
凡小儿脾胃实者，倘纵其口腹，不知节制，则饮食自倍，肠胃乃伤，而实者必致为
虚矣。其体之虚怯者，能节其饮食，则肠胃不伤，谷气渐长，而虚者终变为实矣。
凡伤食吐泻后，则其所伤之物俱去，只与和其胃气，或异功散，或六神丸。
《内经》说：饮食过量一倍，肠胃就会受到损伤。李东垣说：饮水，属于无形的“气”；进食，属于有形的“血”。由此推论，乳汁属于血液一类，是饮品的范畴；谷物含有糟粕，属于食物的范畴。乳汁与谷物，原本不是同类，怎么能不加以辨别呢？
凡是小儿因饮食损伤脾胃的证候，不能一概而论。有的因寒邪所伤，有的因热邪所伤；有的是急性病，有的是慢性病；有的是虚证，有的是实证。但是，属于热证、急性病、实证的情况，人们容易知晓；而属于寒证、慢性病、虚证的情况，很多人却不认识。比如现在的小儿，因为吃了生冷瓜果，导致胃气受损而出现腹痛腹泻，人们还以为是火热之证，用寒凉药物治疗，这是不认识寒证的表现。有的偶尔因食物停滞而出现胀痛，人们都知道这是实证，然而脾胃素来强健的人，即使有停滞也很容易化解，只有那些无法化解的，才会经常有胀满的症状。又有的人虽然不吃饭也知道饿，稍微吃点东西就腹胀，或者没有饥饿感也没有饱腹感，完全不想吃东西，或者因为生病损伤了胃气，长期不想吃东西，这些本来都不是有余（实证）的证候。当时的医生遇到这种情况，不管是有余还是不足，很少有不使用开胃消导药物的，这是不认识虚证的表现。大概脾胃本来具有运化食物的功能，现在既然不能消化食物，那么它运用的职权已经丧失，此时如果还专心使用攻伐克削的药物，岂不是更加增加它的困境吗！所以凡是想要治病，必须先借助胃气作为行药的主宰。如果胃气强盛，攻伐则病邪能去，疾病常容易痊愈，这是因为胃气强盛而药力容易发挥作用；如果胃气虚弱，攻伐则病邪也不能去，这并不是药物不能去除病邪，而是因为胃气本来虚弱，攻伐则使胃气更弱，药力更无法运行，胃气越受伤，疾病也就越严重了。至于体质上的贵贱差异，尤其有所不同。凡是平民百姓的孩子，体质壮健，以及新近暴发的疾病，自然适宜使用消伐之法，以迅速祛除病邪为善；如果是体质虚弱且患病的孩子，如果不顾虚实情况，一概施用急于攻治的方法，就没有不危险的。
凡是平时喜欢吃冷食的人，体内必然多有热邪；平时喜欢吃热食的人，体内必然多有寒邪。所以体内有寒的人，不喜欢寒冷；体内有热的人，不喜欢温热。然而，喜吃寒凉的人，多会生中焦寒证；喜吃温热的人，多会生内热证。《内经》所说的“久而增气，物化之常，气增而久，夭之由也”，就是这个道理。凡是治病的人，又应当在平时的禀赋中观察其嗜好偏胜的弊端。
凡是饮食致病，伤于热邪的多表现为火证，而食物停滞的情况较少；伤于寒邪的多表现为食物停滞，而完全没有火证。大抵饮食之伤，大多是因为寒性食物引起的，温平性质的食物次之。大概因为热性食物易于腐熟消化和流通，所以停滞的情况较少。
冯楚瞻说：凡是小儿伤食，都是因为胃气怯弱。现在的医生，把平胃散作为治疗脾胃病的准则，谁知道平胃散的作用，是当胃中有高阜（指积滞不平）时，能使它变平，一旦变平就要停止，不可过量，过量则平地反而变成坑坎（指损伤正气）。这还不如枳实丸效果好，这个方子是洁古老人制作的，用枳实一两、白术二两，补益多于消导，先补而后消。但是这个丸药原本是专门为伤食者设计的，如果现在专门把它当作补脾药来用，又是错误的了。枳实有推墙倒壁的功力，使用不当，难道不会造成克削伤害吗？就像山楂、神曲、麦芽，是举世常用的药物，然而山楂能化解肉积，凡是多年的母猪肉煮不烂的，只要放入一撮山楂，立刻皮肉就会糜烂；还有产妇的儿枕痛，用山楂煎服，儿枕立时化解，可见其破滞的功效，怎么可以轻率使用呢！神曲、麦芽，是因为米饭在瓷缸中，必须借助酒曲来酿酒，必须借助麦芽来成糖。脾胃在人体中不能与瓷缸相比，本来就有化食的功能，现在食物不化，是因为主管消化的脏腑生病了，只需要补益其运用的能力，食物自然会消化，何必使用这种消克药物呢？
大凡小儿元气完固，脾胃素来强健的，多吃也不会受伤，过了饭点也不觉得饿。如果孩子本来因为正气不足，脾胃素来亏虚的，多吃就容易受伤，如果一旦使用攻伐药物，虽然饮食被消除了，但脾气又经过这一番消伐，会更加虚弱；日后饮食再次不化，还认为前面的药有效，汤药丸剂接连进服，辗转相害，身体日益消瘦，实在令人悲哀！所以医生有对待贫贱患者的医道，有对待富贵患者的医道，膏粱子弟与平民百姓不同，太平时期的民众与战乱创伤者自当有别。乡村里巷中的强壮男子，突然有所损伤，使用攻伐药剂，一次投服即可痊愈；如果是膏粱子弟，禀受怯弱，娇养柔脆，如果一例施以攻伐，留下的危害就不小了。
楚瞻说：人的脾胃虽然能消化食物，实际上是由于水火二气在其中运用，并不是脾胃单独能完成的。内火旺盛则脾胃燥，水湿旺盛则脾胃湿，都不能健运，从而产生各种疾病。如消渴证，是火偏盛而水不能制约；水肿证，是水偏盛而火不能气化。只有制约其偏颇使之平衡，就好了。所谓“制”，不是说要去掉水或去掉火的意思。人身的水火，本来是均衡的，偏颇就是病。火偏多的，补水以配火，不必去火；水偏多的，补火以配水，不必去水。这就好比天平，这边重那边就轻，一边重了，只补足轻的一边，绝不会凿去砝码，因为砝码是一定的数量。现在的人见到水利水，见到火泻火，这就是在凿去砝码啊。
小儿的疾病，伤食最多，所以乳食停滞，中焦不化而成病的，必定发热恶食，或者嗳气作酸，或者厌恶闻到食物的气味，或者想吐吐不出来，或者吐出酸水，或者气短痞闷，或者腹痛啼叫。这些都是伤食的征候，应当暂时减少饮食。所谓“损之”，是指暂时停止喂食，不要给吃的，让它自行运化。《内经》说：“伤之轻者，损谷则愈矣。”如果减少饮食后症状不减，就用胃苓丸来调理；调理后症状不减，就用保和丸来导滞；导滞后病邪不去，就使用攻下法。轻症用木香槟榔丸，重症用消积丸。
伤食这一证候，最关乎利害。如果拖延不治，就会形成积证、癖块；治疗不当，就会发展成疳证、痨证。所以小儿中强壮的，脾胃素实，倚仗自己能吃，父母放纵他，以致吃得太多，停留不化。这是食物损伤了脾胃，是真的伤食，可以用前面的方法治疗。如果是小儿中怯弱的，脾胃素虚，原来吃得少，或者稍微增加一点，就停滞不化。这是脾虚不能消化谷物，转运迟缓罢了，不是真的伤食，按伤食治疗就错了。只宜用六君子汤，帮助其健运，多服自然痊愈。
凡是小儿脾胃实盛的，如果放纵口腹，不知节制，就会饮食自倍，肠胃乃伤，而实证的体质必然会导致变为虚证。其体质虚怯的，如果能节制饮食，就会肠胃不受损伤，谷气逐渐增长，而虚证的体质最终会变为实证。
The *Classic of Internal Medicine* states: "When food and drink intake doubles, the intestines and stomach are injured." Li Dongyuan said: "Drinking belongs to formless Qi (vital energy); eating belongs to formed Blood (nutritive substance)." From this, we can deduce that milk belongs to the category of blood and is a type of drink; grains contain dregs and belong to the category of solid food. Milk and grains are originally not of the same category; how can they not be distinguished?
Regarding syndromes in children where diet injures the spleen and stomach, one cannot generalize. There are injuries caused by cold, injuries caused by heat; there are acute diseases and chronic diseases; there are deficiency syndromes and excess syndromes. However, cases of heat, acute onset, and excess are easily understood by people; whereas cases of cold, chronicity, and deficiency are often unrecognized. For example, modern children who suffer from abdominal pain and diarrhea due to consuming raw, cold fruits and vegetables damaging the Stomach Qi are still treated as having heat-fire syndromes with cold-natured drugs. This is a failure to recognize cold syndromes. Some experience distension and pain due to occasional stagnation, which everyone knows is an excess syndrome. Yet, those whose Spleen and Stomach are inherently strong will easily transform even if there is stagnation; only those unable to transform it will frequently present with fullness and distension. Others may feel hungry without eating but become bloated after eating little, or have no sense of hunger or satiety and completely lose their appetite, or fail to desire food for a long time due to illness damaging Stomach Qi. These are essentially not excess syndromes. When physicians encounter such cases, regardless of whether there is excess or deficiency, few refrain from using digestive and guiding agents. This is a failure to recognize deficiency syndromes. The Spleen and Stomach originally possess the function of transportation and transformation. Now that they cannot digest food, their functional authority has been lost. Can one still focus on using harsh draining and reducing methods, thereby increasing their distress? Therefore, to treat disease, one must first rely on Stomach Qi as the master to guide the action of medicines. If Stomach Qi is strong, attacking pathogens removes them, and diseases heal easily because strong Stomach Qi facilitates the movement of medicinal power. If Stomach Qi is weak, attacking pathogens does not remove them. This is not because the medicine fails to remove the disease, but because the Stomach Qi is inherently weak; attacking further weakens it, causing medicinal power to fail to move, the Stomach to be more injured, and the disease to worsen. Furthermore, differences in constitution exist. Children of commoners, with robust constitutions, and those with newly acquired acute diseases, are suitable for clearing and draining methods, aiming for rapid removal of pathogens. Conversely, applying urgent attacking treatments indiscriminately to children with weak constitutions and illnesses, without considering deficiency or excess, leads to danger.
Those who habitually prefer cold foods necessarily have internal heat; those who habitually prefer hot foods necessarily have internal cold. Thus, those with internal cold dislike cold; those with internal heat dislike heat. However, those who crave cold often develop middle-jiao cold, and those who crave heat often develop internal heat. As stated in the *Inner Canon*: "Prolonged influence increases Qi, which is the normal transformation of things; increased Qi lasting long is the cause of premature death." Physicians must observe the drawbacks of habitual preferences within the patient's innate constitution.
Diseases caused by diet resulting from heat often manifest as fire syndromes with less stagnation; those caused by cold often manifest as stagnation without any fire syndrome. Generally, dietary injuries are mostly due to cold-natured foods, followed by neutral-warm foods. Heat facilitates decomposition and circulation, so stagnation is rare.
Feng Chuzhan said: "All childhood food stagnation stems from weak Stomach Qi. Contemporary physicians use Pingwei San (Stomach-Pacifying Powder) as the standard for treating Spleen and Stomach disorders. Who realizes that Pingwei San acts like leveling high ground? Once leveled, stop; do not overdose, or flat land becomes a pit." It is superior to Zhishi Wan (Immature Bitter Orange Pill), formulated by Elder Jiegu, using 1 liang of Zhishi (Aurantii Fructus Immaturus) and 2 liang of Baizhu (Atractylodis Macrocephalae Rhizoma). It tonifies more than it drains, tonifying first then draining. However, this pill was originally designed for food stagnation; using it solely as a Spleen-tonifying medicine today is erroneous. Zhishi has the power to push down walls; improper use causes excessive depletion. Consider Shan Zha (Crataegi Fructus), Shen Qu (Massa Medicata Fermentata), and Mai Ya (Hordei Fructus Germinatus), commonly used worldwide. Shan Zha resolves meat accumulation; even tough old sow meat disintegrates instantly with a pinch of Shan Zha. It also resolves postpartum uterine lochia pain (Zhen Tong). Its ability to break stagnation is potent; how can it be used lightly? Shen Qu and Mai Ya are used because rice in a porcelain jar requires Qu (fermented starter) to make wine and Mai Ya to make sugar. The human Spleen and Stomach are not like a porcelain jar; they naturally digest food. When food does not digest, the organ responsible is diseased. Tonify its functional capacity, and food will digest naturally. Why use such draining medicines?
Children with complete Yuan Qi (Original Qi) and strong Spleen and Stomach can eat much without injury and feel hungry only when overdue. Children with insufficient fundamental Qi and deficient Spleen and Stomach are easily injured by overeating. If attacking methods are used, although food is digested, the Spleen Qi is further depleted by this draining process. Later, food fails to digest again. If one believes previous medicines were effective and continues administering decoctions and pills, the harm compounds, leading to emaciation. This is tragic. Physicians treat the poor and the rich differently. Noble youths differ from commoners; peaceful citizens differ from those with war wounds. Strong men in villages suffering sudden trauma heal quickly with one dose of attacking medicine. However, noble children with weak constitutions, pampered and fragile, should not be treated identically with attacking methods, lest great harm ensue.
Chuzhan said: Although Spleen and Stomach digest food, this relies on the interplay of Water and Fire Qi, not just the organs themselves. Excess internal fire makes Spleen and Stomach dry; excess water makes them damp. Neither can transport and transform effectively, leading to disease. In Xiao Ke (Wasting-Thirst Syndrome), fire is excessive and water cannot control it. In Shui Zhong (Edema Syndrome), water is excessive and fire cannot transform it. One must regulate the imbalance to restore equilibrium. "Regulating" does not mean removing water or fire. Water and Fire in the body are naturally balanced; imbalance is pathology. If fire is excessive, supplement water to balance fire, do not remove fire. If water is excessive, supplement fire to balance water, do not remove water. Like a balance scale, if one side is heavy, add weight to the light side; never remove weights, as they are fixed quantities. Modern practitioners who drain water when seeing edema or purge fire when seeing heat are like those removing weights from a scale.
Childhood diseases most frequently involve food stagnation. When milk and food stagnate and fail to transform in the Middle Jiao, symptoms include fever, aversion to food, belching with sour taste, aversion to food odors, retching without vomiting, vomiting sour fluid, shortness of breath with chest stuffiness, abdominal pain, and crying. These are signs of food stagnation. The appropriate treatment is to reduce intake ("Sun"). "Reducing" means temporarily withholding food to allow self-transportation. The *Classic* states: "For mild injuries, reducing food intake leads to recovery." If reduction does not alleviate symptoms, use Weiling Wan (Stomach-Calm Pill) to regulate. If regulation fails, use Baohe Wan (Preserve Harmony Pill) to guide out stagnation. If guiding fails, use purgative methods. For mild cases, use Muxiang Binglang Wan (Costus and Areca Nut Pill); for severe cases, use Xiaoji Wan (Eliminate Accumulation Pill).
Food stagnation is critical. Untreated, it becomes Ji (accumulations) or Pi (masses). Improperly treated, it develops into Gan (infantile malnutrition) or Lao (consumption). Robust children with strong Spleen and Stomach, indulged by parents, overeat, causing true food stagnation. Treat with the aforementioned methods. Weak children with deficient Spleen and Stomach, who eat little or slightly increase intake and experience stagnation, suffer from Spleen deficiency failing to transform grain and slow transportation. This is not true food stagnation; treating it as such is an error. Use Liu Junzi Tang (Six Gentlemen Decoction) to assist healthy transportation; prolonged use leads to recovery.
Children with strong Spleen and Stomach who indulge their appetites without restraint double their intake, injuring intestines and stomach, turning excess into deficiency. Children with weak constitutions who regulate their diet avoid intestinal and stomach injury, allowing Gu Qi (Grain Qi) to grow, eventually turning deficiency into strength.
After vomiting and diarrhea from food stagnation, the offending matter is expelled. Harmonize Stomach Qi using Yigong San (Extraordinary Power Powder) or Liushen Wan (Six Spirits Pill).