脉诀云小儿脉沉缓为伤食○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○经云脉滑者有宿食也○虎口脉纹黄色为脾家有积○脉经云小儿脉沉者为乳不消
活幼心书云小儿所患积证皆因乳哺不节过餐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 臭此为沉积所伤有食饱伤脾脾气稍虚物难消化留而不去遂成其积积败为痢仁斋云
小儿有积面目黄肿肚热胀痛复睡多困叫啼不食或肠闭涩小便如油或便利无禁粪白而酸此等皆
积证也然有乳积有食积有气积要当明辨吐乳泻乳其气酸臭此由啼叫未已以乳与儿停滞不化是
为乳积肚硬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啼叫利如蟹渤此
因触忤其气荣卫不和淹延日久得之是为气积有时时泄下青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惊日久而积成之或额上有汗喘息烦渴潮热往来肚皮有热睡中觉腹内
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
塞壅盛涎鸣热毒发疮推此可见矣其伤乳伤食而身热者惟腹肚之热为甚人知伤积肚热粪酸极臭
而夜间有热伤积之明验人所不知也其或变证面黑泻黑久泻不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汗者勿多与之
《脉诀》中说:小儿脉象沉缓,是伤食的表现。○右手气口脉比人迎脉大一两倍,也是伤食。○宿食不消化,则右关脉呈现沉滑之象。○《内经》说:脉象滑利的,是有宿食。○虎口脉纹呈黄色,是脾家有积滞。○《脉经》说:小儿脉象沉的,是因为乳食不消。
《活幼心书》说:小儿所患的积证,都是因为哺乳喂养没有节制,过食生冷坚硬之物,脾胃不能运化,导致停积在中脘。外受风寒侵袭,或者夜间睡觉没有盖好被子,导致头疼、面色发黄、身体发热、眼睑微肿、腹痛腹胀、脚冷肚子热、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、大便臭秽。这是被沉积(积滞)所伤。有因吃饱了伤及脾气,脾气稍虚,食物难以消化,停留不去,从而形成积滞。积滞败坏变成痢疾。仁斋说:小儿有积滞,表现为面目黄肿、肚子热胀痛、嗜睡多困、哭闹不吃东西,或者肠道闭塞不通、小便如油,或者大便失禁、粪便白而酸。这些都属于积证的范畴。然而,积证分为乳积、食积、气积,必须仔细辨别。吐奶、泻奶,气味酸臭,这是因为啼哭未止就喂奶,乳汁停滞在体内无法消化,这叫做乳积。肚子硬且带热、口渴腹泻或呕吐,这是因为饮食无度,吃得过多过饱,饱后立即睡觉所致,这叫做食积。腹痛哭闹,大便像蟹渤(指大便稀薄如蟹沫),这是因为受到惊扰,导致营卫不和,拖延日久所致,这叫做气积。有时时时泄下青色水样便,像生草汁一样,这是受了惊吓之后又有积滞,烦躁闷乱、低声呻吟,常常好像生气一样,这叫做惊积,是因为长期受惊而后形成积滞。或者额头出汗、喘息烦躁、口渴、潮热往来、肚皮发热、睡觉时觉得腹内有物跳动,就是这种情况。然而,积证有虚有实。虚证则浑身微热、不思饮食、神志昏昧迟缓、抱起时像睡着了一样;实证则呕吐、热粪闭结、囟门肿胀、喉间壅盛、痰鸣、热毒发疮。推究这些情况就可以明白了。那些伤乳伤食而导致身体发热的,只有腹部肚子的热感特别严重。人们知道伤积会导致肚子热、粪便酸臭极难闻,以及夜间发热,这是伤积的明显验证。但人们不知道的是,如果变证出现面色发黑、泻下黑色粪便、久泻不止、肚子腹胀满、呼吸气粗、手心生疮、身体瘦弱柔软,这些都是不可治疗的。小儿消除积滞多用青皮,然而青皮最能发汗,所以不要给小儿过多服用。
The *Mai Jue* (Pulse Classic) states: A deep and slow pulse in children indicates food injury. ○ The Qi Kou pulse on the right hand being one to two times larger than the Ying Yang pulse also indicates food injury. ○ When retained food fails to digest, the Right Guan pulse presents as deep and slippery. ○ The *Jing* (Classic of Changes/Inner Canon) states: A slippery pulse indicates the presence of retained food. ○ A yellowish hue in the Tiger Mouth vein pattern indicates accumulation in the Spleen. ○ The *Mai Jing* (Pulse Classic) states: A deep pulse in children is due to undigested milk.
The *Huoyou Xinshu* (New Book for Infant Care) states: The accumulation syndromes suffered by children are all caused by irregular feeding, overconsumption of cold, raw, hard, or solid foods. The Spleen and Stomach fail to transform and transport them, leading to stagnation in the Zhongwan (CV12). Externally, they are injured by wind-cold, or internally, by sleeping uncovered at night, resulting in headache, sallow complexion, fever, slightly swollen eyelids, abdominal pain and distension, cold feet but a hot abdomen, excessive sleepiness, mental confusion, anorexia, vomiting, hiccups, sour belching, and foul-smelling stool. This is injury caused by accumulated stagnation. If one overeats, it injures the Spleen; the Spleen Qi becomes slightly deficient, making it difficult to digest food. If the food remains and does not go, it eventually forms an accumulation. When the accumulation deteriorates, it becomes dysentery. Ren Zhai stated: Children with accumulation present with yellowish swelling of the face and eyes, heat and painful distension in the abdomen, excessive sleepiness and lethargy, crying without eating, intestinal blockage, urine resembling oil, or incontinence with white and sour feces. All these belong to accumulation syndromes. However, there are Milk Accumulation, Food Accumulation, and Qi Accumulation, which must be clearly distinguished. Vomiting milk and diarrhea of milk with a sour and foul odor occurs when milk is given while the child is still crying, causing the milk to stagnate and fail to digest; this is called Milk Accumulation. A hard abdomen with heat, thirst, diarrhea, or vomiting occurs due to unregulated diet, overeating, and sleeping immediately after fullness; this is called Food Accumulation. Abdominal pain and crying with stools like crab foam occurs due to disturbance, leading to disharmony of Ying and Wei fluids, persisting for a long time; this is called Qi Accumulation. Occasional passage of green watery stools resembling raw grass juice indicates that after fright, accumulation has formed; restlessness, whimpering, and appearing angry is called Fright Accumulation, resulting from long-term fright leading to accumulation. Alternatively, sweating on the forehead, panting, restlessness, thirst, alternating tidal fever, heat in the belly, and feeling movement inside the abdomen during sleep are signs of this. However, accumulations can be Deficient or Excess. In deficiency, there is slight whole-body heat, anorexia, dull and sluggish spirit, and the child appears asleep when held. In excess, there is vomiting, constipation with hot feces, bulging fontanelle, throat obstruction, phlegm rattle, heat toxin causing sores. From this, we can understand. For those with body heat due to milk or food injury, the heat in the abdomen is particularly severe. People know that accumulation causes abdominal heat, extremely sour and foul-smelling feces, and nighttime fever, which are clear signs of accumulation injury. What people do not know is that if transformation syndromes occur, such as black complexion, black diarrhea, persistent diarrhea, abdominal distension and fullness, coarse breathing, sores on the palms, emaciation, and softness, these are incurable. To eliminate accumulation in children, Qingpi (Exocarpium Citri Reticulatae Viride) is often used. However, Qingpi is potent in inducing sweating, so it should not be administered in large doses to children.