（附∶伤食）
总括 头痛身热腹微胀，足冷神昏只爱眠；因食所伤脾气弱，下宜迟缓表为先。
脉法 右手气口脉大于人迎一二倍为伤食，宿食不消，则右关脉沉而滑，虎口脉纹而黄色为脾家有积，小儿脉沉者
为乳不消。
《内经》曰∶饮食自倍，脾胃乃伤。小儿所患积症皆因乳哺不节，过食生冷坚硬之物，脾胃不能克化，停积中脘，
外为风寒所伤，或因夜卧失盖，致头疼面黄身热，眼胞微肿，腹痛膨胀，足冷肚热，喜睡神昏，不思饮食，或呕或哕，
口噫酸气，大便酸臭，此皆为积所伤。有食饱伤脾，脾气稍虚，拘留难化，停而不去，遂成其积，积败为痢。
仁斋曰∶小儿有积，面目黄肿，肚热胀满，覆睡多困，叫啼不食或大肠闭涩，小便如油，或便利不噤，粪白而酸臭，
皆积症也，然有乳积、食积、气积、惊积，须当辨明。吐乳、泻乳，其气酸臭，此由啼叫未已，以乳与儿，停积不化，
是为乳积。肚皮带热，渴泻或呕，此由饮食无度，多餐过饱，饱后即睡得之，是为食积。腹痛叫啼，痢如 渤，此
因触忤其气，营卫不和，淹涎日久得之，是为气积。有时时泻下清水，如生草汁，是受惊而后有积，烦闷啾唧，常似生
嗔，名为惊积，因受病日久而积成之。或额上有汗，喘息烦渴，潮热往来，肚腹有热，睡中觉腹内有物跳动者是也。然
积有虚有实，虚则浑身微热，不思饮食，昏昧神缓，抱起如睡；实则吐热粪闭，囟肿喉塞，痰壅涎鸣，热毒发疮，推此
可见矣。其伤乳伤食而身热者，惟肚腹之热为甚。人知伤积足冷肚热，粪酸极臭，而夜间有热，伤积之明验，人所不知
也。其或变症，面黑，泻黑，久泻未已，肚腹胀满，气出粗大，手心生疮，瘦弱柔软，皆不可疗。小儿消积多用青皮，
然青皮最能发汗，有汗者切勿多与之。小儿诸疾皆乳食无度，过于伤饱，以致不能克化，留而成积。初得之时，不问乳
积、食积、气积，进以消积丸，其惊以辰砂膏或青龙丸，量轻重而疏导之，仍以调气和脾胃取愈。盖脾胃已伤，又以药
伤之，使营运之气减削，食愈难消，故致深剧。《五常政大论》曰∶大毒治病，十去其六；小毒治病，十去其七；常毒
治病，十去其八；无毒治病，十去其九。谷肉果瓜菜食养之，物必无使过之，伤其正也。凡人以胃气为本，惟治病亦然。
小儿脾胃有虚有实，虚则呕吐不食之症，实则痞满内实之症。虚者益之，实者损之，欲得其平则可矣。胃虚用木香丁皮
浓朴肉豆蔻之类，胃实用桔梗枳壳柴胡大黄等剂。若夫胃中停寒则停，姜官桂丁香，又不可缺，贵在酌量。但以大小分
剂与之，夫是谓之平。盖心者脾之母，进食不止于和脾，益火能生土，当以心药入于脾胃中，庶几得之，古人进食方剂
多用益智者此也。
【附：伤食】
总括：头痛、身体发热、腹部轻微胀满，脚部发冷、神志昏沉、只想睡觉；因饮食所伤导致脾气虚弱，治疗上应当先解表，随后再行缓下。
脉法：右手气口脉比人迎脉大一两倍，是伤食的表现；宿食不消化，则右关脉呈现沉而滑的脉象；虎口脉纹呈黄色，说明脾家有积滞；小儿脉象沉，是因为乳食不消。
《内经》说：“饮食过量一倍，脾胃就会受伤。”小儿患的积症，都是因为哺乳喂养没有节制，吃过多的生冷坚硬食物，脾胃无法运化，停滞在中脘部位。外受风寒侵袭，或者夜间睡觉未盖好被子，导致头疼、面色发黄、身体发热、眼睑微肿、腹痛腹胀、脚冷肚热、喜欢睡觉、神志昏沉、不想吃东西，或者呕吐、呃逆、口中嗳出酸气、大便酸臭，这些都是被积滞所伤。有的因为吃得太饱伤了脾，脾气稍微虚弱，食物滞留难以消化，停聚不去，于是形成积滞，积滞败坏后变成痢疾。
仁斋说：小儿有积滞，表现为面目黄肿，肚子热且胀满，趴着睡且多困倦，哭闹不吃东西，或者大肠闭塞涩滞，小便像油一样浑浊，或者大便失禁，粪便白色且酸臭，这都是积症。然而积症分为乳积、食积、气积、惊积，必须辨别清楚。吐奶、泻奶，气味酸臭，这是因为啼哭不止时喂奶给孩子，乳汁停积不化，这叫作乳积。肚皮皮带热，口渴腹泻或呕吐，这是因为饮食无度，多吃过饱，吃饱后就睡着导致的，这叫作食积。腹痛哭闹，痢疾如泥状，这是因为触犯其气机，营卫不和，流涎日久所致，这叫作气积。有时时时泻下清水，像生草汁一样，这是受惊之后产生积滞，烦躁闷乱、低声呻吟，常好像生气一样，名叫惊积，是因为患病日久积滞而成。或者额头有汗，喘息烦躁口渴，寒热往来，肚腹有热，睡觉中觉得腹内有物跳动，就是这种情况。然而积症有虚有实，虚证则浑身微热，不想吃东西，神志昏昧迟缓，抱起来像睡着了一样；实证则呕吐、热结便秘，囟门肿胀喉部堵塞，痰多涎鸣，热毒发疮，推想这些情况就可以明白了。那些伤乳伤食而身体发热的，只有肚腹的热感特别严重。人们知道伤积表现为脚冷肚热，粪便酸极臭，以及夜间发热，这是伤积的明显验证，但人们不知道的是……（注：此处原文似有缺漏或语意未尽，按现有文本翻译）如果发生变症，面色发黑，泻下黑色粪便，久泻不止，肚腹胀满，呼吸粗大，手心生疮，身体瘦弱柔软，都不可治愈。小儿消除积滞多用青皮，然而青皮最能发汗，有汗者千万不要多给。小儿各种疾病都是由于乳食无度，过于伤饱，以致不能运化，留滞而成积。初得病时，不论乳积、食积、气积，先用消积丸，对于惊积用辰砂膏或青龙丸，根据轻重程度进行疏导，仍然以调和气机、健脾和胃来求得痊愈。因为脾胃已经受伤，再用药物损伤它，会使营运之气减损，食物更加难消，所以导致病情深重。《五常政大论》说：“用大毒药物治疗疾病，病去十分之六；用小毒药物治疗疾病，病去十分之七；用常毒药物治疗疾病，病去十分之八；用无毒药物治疗疾病，病去十分之九。剩下的用谷肉果菜等食物调养，物品一定不要让药力过度，以免伤害正气。”凡是人都以胃气为本，治病也是如此。小儿脾胃有虚有实，虚证表现为呕吐不食的症状，实证表现为痞满内实的症状。虚证要补益，实证要攻损，想要达到平衡就可以了。胃虚用木香、丁香皮、浓朴、肉豆蔻之类的药；胃实用桔梗、枳壳、柴胡、大黄等剂型。如果胃中停留寒气，则需干姜、官桂、丁香，又不可缺少，贵在斟酌度量。只是根据大小给予剂量，这就叫作平调。因为心是脾的母亲，进食不仅仅是调和脾，补火能生土，应当用心经的药物进入脾胃中，这样才能得到疗效，古人进食方剂中多用益智仁，就是这个原因。
[Appendix: Food Injury]
General Principles: Headache, feverish body, slight abdominal distension, cold feet, drowsiness and lethargy; when injured by food leading to Spleen Qi deficiency, treatment should prioritize releasing the exterior before employing gentle purgation.
Pulse Diagnosis: If the Qi Kou pulse at the right hand is one to two times larger than the Ying Yang pulse, it indicates food injury. If retained food fails to digest, the Guan position on the right hand presents a deep and slippery pulse. A yellowish hue in the Tiger's Mouth vein pattern indicates accumulation in the Spleen. A deep pulse in children indicates undigested milk.
The *Nei Jing* (Inner Canon) states: "When food and drink intake doubles, the Spleen and Stomach are injured." The accumulation disorders suffered by children are all due to unregulated nursing and feeding, overconsumption of raw, cold, hard, or tough substances, which the Spleen and Stomach cannot transform. This leads to stagnation in the Zhong Wan region. Externally, they may be injured by wind-cold, or suffer from sleeping without adequate covering at night, resulting in headache, sallow complexion, fever, slightly swollen eyelids, abdominal pain and distension, cold feet with a hot abdomen, excessive sleepiness, mental confusion, loss of appetite, vomiting, hiccups, sour belching, and sour-smelling stool. All these are injuries caused by accumulation. Some cases involve spleen damage from overeating, where Spleen Qi becomes slightly deficient, causing difficult-to-digest food to remain stagnant and not disperse, eventually forming an accumulation. If the accumulation deteriorates, it transforms into dysentery.
Ren Zhai stated: Children with accumulation present with yellowish swelling of the face and eyes, a hot and distended abdomen, prone sleeping with much fatigue, crying while refusing food, or constipation with dry stool, oily urine, or involuntary diarrhea with white, sour-smelling feces. These are all accumulation disorders. However, one must distinguish between Milk Accumulation, Food Accumulation, Qi Accumulation, and Shock Accumulation. Vomiting milk or having milky diarrhea with a sour smell occurs when milk is given while the child is still crying; the milk stagnates and fails to transform, known as Milk Accumulation. A warm abdominal wall, thirst, diarrhea, or vomiting results from unregulated diet, overeating, and falling asleep immediately after fullness, known as Food Accumulation. Abdominal pain with crying and dysenteric stools resembling mud occur due to emotional disturbance affecting Qi mechanism, disharmony of Ying and Wei, and prolonged salivation, known as Qi Accumulation. Frequent passage of clear water like crushed grass juice, accompanied by irritability, whimpering, and apparent anger, occurring after fright, is named Shock Accumulation, formed by prolonged illness leading to accumulation. Other signs include sweat on the forehead, panting with irritability and thirst, alternating chills and fever, heat in the abdomen, and a sensation of movement within the abdomen during sleep. Accumulation can be either Deficient or Excess. Deficiency manifests as slight whole-body heat, anorexia, dull and slow spirit, and appearing asleep when held. Excess manifests as vomiting, heat with constipation, bulging fontanelle, throat obstruction, phlegm congestion, wheezing saliva, and heat-toxin sores. Regarding milk or food injury with fever, the heat is most severe in the abdomen. People know that foot injury presents with cold feet and hot abdomen, extremely sour-smelling feces, and night fever, which are clear signs of accumulation injury. However, if complications arise—such as black complexion, black diarrhea, persistent diarrhea, abdominal distension, coarse breathing, palm sores, and emaciated softness—the condition is incurable. To resolve accumulation in children, Qing Pi (Green Tangerine Peel) is often used, but since it strongly induces sweating, it should not be given in excess to those who already have sweat. Most childhood diseases stem from unregulated nursing and feeding, overeating, leading to failure of transformation and retention as accumulation. At the onset, regardless of whether it is Milk, Food, or Qi accumulation, Xiao Ji Wan (Accumulation Resolving Pill) should be administered. For Shock accumulation, Chen Sha Gao (Cinnabar Paste) or Qing Long Wan (Azure Dragon Pill) should be used, guided by severity to promote drainage. Ultimately, healing is achieved by harmonizing Qi and regulating the Spleen and Stomach. Since the Spleen and Stomach are already injured, further drug toxicity reduces the circulating Qi, making digestion even harder and worsening the condition. The *Wu Chang Zheng Da Lun* (Great Discourse on the Five Regular Policies) states: "For drugs with great toxicity, remove six-tenths of the disease; for small toxicity, seven-tenths; for common toxicity, eight-tenths; for non-toxic drugs, nine-tenths. Nourish with grains, meats, fruits, and vegetables. Do not let the medicinal force exceed limits, lest it injure healthy Qi." All people rely on Stomach Qi as the root, and treating disease is no different. Children's Spleen and Stomach can be Deficient or Excess. Deficiency presents with vomiting and anorexia; Excess presents with stuffiness, fullness, and internal solidity. Deficiency requires tonification; Excess requires reduction. Balance is the goal. For Stomach Deficiency, use Mu Xiang (Aucklandiae Radix), Ding Pi (Eugeniae Caryophyllati Cortex), Hou Po (Magnoliae Officinalis Cortex), and Rou Dou Kou (Myristicae Semen). For Stomach Excess, use Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus), Chai Hu (Bupleuri Radix), and Da Huang (Rhei Radix et Rhizoma). If cold stagnates in the Stomach, Gan Jiang (Zingiberis Rhizoma), Guan Gui (Cinnamomi Cortex), and Ding Xiang (Eugeniae Flos) are indispensable, requiring careful dosage adjustment based on age and size. This is called balancing. Since the Heart is the mother of the Spleen, promoting digestion involves more than just harmonizing the Spleen; supplementing Fire generates Earth. Therefore, Heart-related herbs should be incorporated into Spleen and Stomach formulas. This explains why ancient digestive formulas frequently used Yi Zhi Ren (Alpiniae Oxyphyllae Fructus).