汤氏曰∶小儿乳哺,须要得法,乳者、你也,哺者、食也,乳后不得便与食,
哺后不得便与乳,小儿脾胃怯弱,乳食相并,难以克化,周岁以上,必成乳癖食癖,
于腹中作疼作热,疳病从此起也。丹溪曰∶血气俱盛,食物易消,故食无时,然肠
胃尚脆而窄,若稠粘干硬,酸咸甜辣,一切鱼肉,水果,湿面,烧炙煨炒,俱是发
热难化之物,皆宜禁绝,只与熟菜白粥,非惟无病,且不纵口,可以养德,此外,
生栗味咸,干柿性凉,可为长阴之助,然栗太补,柿太涩,俱为难化,亦宜少与,
妇人无知,惟务姑息,畏其啼哭,无所不与,积成痼疾,虽悔何及,所以富贵骄养,
有子多病,迨至成人,筋骨柔弱,有食则不能忌口以自养,居丧则不能食素以尽礼,
小节不谨,大义亦亏,可不慎欤。至于乳母,尤宜谨节,饮食下咽,乳汁便通,情
欲中动,乳脉便应,病气到乳,汁必凝滞,儿得此乳,疾病立至,不吐则泻,不疮
则热,或为口糜,或为惊搐,或为夜啼,或为腹痛,病之初来,其溺必少,便须询
问,随证治母,母安亦安,可消息于未形也。
凡乳母血气,为乳汁也,五情善恶,悉血气所生,宜戒喜怒,一切禁忌,不用
狐臭、瘿 、气嗽病者,及身体疥癣,头疮发少,紧唇耳聋,音哑 鼻,痫病等,
方可乳儿。夏中盛热时,乳母浴后,或儿啼,不可与你,能使儿成胃毒,秋成赤白
痢,浴后可令定息,良久,热燥乳之,故无患也。聂氏曰∶盛啼,不可食乳,恐气
逆不顺,聚而为 ,亦能成惊风也。《千金》论曰∶凡乳儿不可过饱,饱则溢
而成呕吐,若乳来多猛,取出、 后再乳,切须乳时,合先令捏去宿热乳,然后乳
之,如乳母欲卧寐,当以臂枕之,令乳与儿头平,母欲睡着时,即夺其乳,恐其不
知饱足,亦成呕吐,父母交合之间,儿卧于侧,或惊起,不可乳儿,盖气乱未定,
必能杀儿也。巢氏云∶小儿啼未定,气息不调,母不可以乳饮,盖恐乳不得下,停
滞胸膈,则为呕吐也。《颅囟经》曰∶夏不去热乳,令儿呕吐,冬不去寒乳,令儿
泄泻复痢,尤不可不谨。夜间乳儿,母起身坐,抱儿喂之。每清早欲饮乳,
皆须捏去宿乳。乳汁勿投于地,虫蚁食之,令乳无汁,可沃东壁上佳。
汤氏说:给小儿哺乳喂养,必须讲究方法。“乳”指的是母乳,“哺”指的是辅食。喂奶之后不能立刻喂食,喂辅食之后不能立刻喂奶。因为小儿的脾胃功能怯弱,如果奶和食物同时进入体内,难以消化。到了周岁以后,必然形成“乳癖”(因乳食停滞形成的积块)和“食癖”,在腹中引起疼痛和发热,疳病(小儿慢性营养不良性疾病)就是从这种原因产生的。
丹溪先生说:人的血气旺盛时,食物容易消化,所以饮食没有固定的时间限制。然而婴儿的肠胃仍然脆弱且狭窄,像稠粘、干硬、酸咸甜辣的食物,一切鱼肉、水果、湿面、烧烤煨炒的食物,都是容易引发内热且难以消化的东西,都应该禁止食用。只给孩子吃熟蔬菜和白粥,不仅不会生病,而且能防止孩子放纵口腹之欲,有助于培养品德。此外,生栗子味道咸,干柿子性质凉,可以作为滋养阴液的辅助,但是栗子过于滋补,柿子过于涩滞,都难以消化,也应该少量给予。有些妇人无知,只知道姑息溺爱,害怕孩子啼哭,什么都给,结果积成顽固的疾病,即使后悔也来不及了。所以富贵人家骄纵养育子女,导致孩子多病,等到成年后,筋骨柔弱,有食物时不能忌口来保养身体,守丧时不能吃素食来尽礼,小节不谨慎,大义也会亏损,能不慎重吗?
至于乳母,尤其应该谨慎节制。饮食咽下后,乳汁就会通畅;情欲发动时,乳脉就会响应。如果病气传到乳房,乳汁必然凝滞,孩子吃到这样的乳汁,疾病就会立即到来,不是呕吐就是腹泻,不是生疮就是发热,或者成为口糜(口腔黏膜溃疡),或者惊厥抽搐,或者夜间啼哭,或者腹痛。疾病刚发生时,孩子的尿量一定很少,必须询问清楚,根据症状治疗乳母,母亲安好,孩子也就安好了,这可以在疾病未显现时就加以斟酌处理。
凡是乳母的血气,构成了乳汁。人的五种情绪(喜、怒、忧、思、恐)的好坏,都是由血气产生的。因此乳母应该戒除喜怒,一切禁忌事项都要遵守。如果有狐臭、瘿病(甲状腺肿大)、气嗽病的人,以及身上患有疥癣、头部有疮疡、头发稀少、嘴唇紧绷、耳聋、声音嘶哑、鼻塞、癫痫等疾病的人,才允许哺乳婴儿。夏季盛热的时候,乳母洗澡后,或者孩子啼哭时,不要立即喂奶,否则能使孩子患上胃毒,秋季发展成赤白痢疾。洗澡后可以让孩子平静呼吸很久,待热燥之气消退后再喂奶,这样就没有祸患了。聂氏说:孩子剧烈啼哭时,不可以吃奶,恐怕气逆不顺,积聚而成喘促,也能引发惊风。《千金方》论述说:凡是喂养婴儿不可过饱,饱了就溢出而成为呕吐。如果乳汁来得又多又猛,要挤出一些,等平缓后再喂。切须在喂奶时,先让母亲捏去积存的余热乳汁,然后再喂。如果乳母想睡觉,应当用胳膊垫着,使乳头与孩子头部持平。母亲快要睡着时,就要把乳头抽出来,恐怕孩子不知道吃饱,也会造成呕吐。父母行房事之间,孩子睡在旁边,或者受惊起来,不可以喂奶,因为此时气息混乱未定,必定会害死孩子。巢元方说:小儿啼哭未停,气息不调和,母亲不可以喂奶,恐怕乳汁不下,停滞在胸膈,就会成为呕吐。《颅囟经》说:夏天不去除热性乳汁,会使孩子呕吐;冬天不去除寒性乳汁,会使孩子泄泻并再次患痢疾,尤其不可不谨慎。夜间喂奶,母亲起身坐好,抱着孩子喂。每天清晨想要喝奶前,都必须捏去积存的旧乳汁。乳汁不要倒在地下,如果被虫蚁吃了,会导致乳汁减少,可以浇在东边的墙壁上为好。
Tang Shuo: Breastfeeding and feeding infants must be done with proper method. "Ru" (Breast milk) refers to breast milk, and "Bu" (Complementary food) refers to solid food. After breastfeeding, one must not immediately give solid food; after giving solid food, one must not immediately breastfeed. Because the spleen and stomach of infants are weak, if milk and food enter the body simultaneously, they are difficult to digest. By the age of one year, this will inevitably lead to "Ru Pi" (accumulation due to milk stagnation) and "Shi Pi" (accumulation due to food stagnation), causing pain and heat in the abdomen. The disease of "Gan" (infantile malnutrition syndrome) originates from such causes.
Danxi stated: When blood and qi are abundant, food is easily digested, so there is no fixed time for eating. However, the intestines and stomach are still fragile and narrow. Foods that are thick, sticky, dry, hard, sour, salty, sweet, or spicy, as well as all meat, fish, fruits, wet noodles, roasted, baked, simmered, or fried foods, are items that generate heat and are difficult to digest; these should be strictly prohibited. Only provide cooked vegetables and plain white porridge. This not only prevents illness but also avoids indulging the mouth, thereby cultivating virtue. Additionally, raw chestnuts are salty in flavor, and dried persimmons are cool in nature, which can assist in nourishing yin. However, chestnuts are too tonifying, and persimmons are too astringent; both are difficult to digest and should be given sparingly. Some women, lacking knowledge, only indulge and spoil their children, fearing their crying, giving them anything they want. This accumulates into chronic diseases, making regret futile. Therefore, those raised in luxury and spoiled often suffer from illnesses in childhood. Upon reaching adulthood, their bones and sinews remain weak; when food is available, they cannot restrict their diet to maintain health, and during mourning, they cannot eat vegetarian food to fulfill ritual propriety. Neglecting minor details leads to a deficit in major principles. Can one not be cautious?
As for the wet nurse, she must be particularly disciplined. Once food is swallowed, the milk flow becomes smooth; when emotional desires arise, the milk meridians respond. If pathogenic factors reach the breasts, the milk will become stagnant. If an infant consumes such milk, disease will manifest immediately: either vomiting or diarrhea, sores or fever, aphthous stomatitis (mouth ulcers), convulsions, night crying, or abdominal pain. At the onset of illness, the infant's urine output will likely be low. One must inquire carefully and treat the mother according to her symptoms. If the mother is well, the child will be well; this requires foresight before symptoms appear.
The blood and qi of the wet nurse constitute the breast milk. The five emotions (joy, anger, worry, thought, fear) are generated by blood and qi. Therefore, the wet nurse should avoid excessive joy and anger and observe all taboos. Women suffering from bromhidrosis (fox odor), goiter (thyroid enlargement), or qi-related coughs, as well as those with scabies, tinea capitis (scalp ringworm), alopecia (hair loss), tight lips, deafness, hoarseness, nasal obstruction, or epilepsy, are unfit to nurse. During the intense heat of summer, after a wet nurse bathes, or if the infant is crying, do not breastfeed immediately, as this may cause "stomach toxin" in the child, leading to dysentery (red and white diarrhea) in autumn. After bathing, allow the wet nurse to calm her breathing for a while until the heat and dryness subside before breastfeeding, thus avoiding harm. Nie stated: Do not feed milk while the infant is crying violently, as this may cause qi reversal and accumulation, potentially leading to wind-stroke (convulsions). The *Qianjin Fang* states: Infants should not be overfed; overfeeding leads to regurgitation and vomiting. If the milk flow is too forceful, express some out first, wait for it to settle, then breastfeed. Before nursing, the mother should squeeze out any retained hot milk. If the wet nurse wishes to sleep, she should prop herself up with her arm so that the nipple is level with the infant's head. As the mother feels drowsy, remove the nipple to prevent the infant from overeating and vomiting. If parents engage in intercourse while the infant sleeps nearby, or if the infant startles awake, do not breastfeed. The qi is chaotic and unsettled, which could be fatal to the infant. Chao Yuanfang stated: If an infant has not stopped crying and breath is irregular, the mother should not breastfeed, lest the milk fail to descend and stagnate in the chest and diaphragm, causing vomiting. The *Lunxin Jing* states: In summer, failing to eliminate hot milk causes vomiting; in winter, failing to eliminate cold milk causes diarrhea and subsequent dysentery. Caution is essential. For nighttime feeding, the mother should sit up and hold the infant while nursing. Every morning before the first feed, the mother must squeeze out retained old milk. Do not spill milk on the ground; if insects or ants consume it, it is believed to reduce milk production. It is better to pour it onto the eastern wall.