〔薛〕小儿食积者，因脾胃虚寒，乳食不化，久而成积，其证至夜发热，天明复
凉，腹痛膨胀，呕吐吞酸，足冷肚热，喜睡神昏，大便酸臭是也。有前证而兼寒热
者，名曰食积寒热，若食在胃之上口者吐之，胃之下口者消之，腹痛痞胀，按之益痛
者下之，下后仍痛按之则止者补之。夹食伤寒者，先散之用参苏饮。热甚便秘者，
先利之用大柴胡汤。如无外感，但只伤食，不至于甚，保和丸调之。盖脾为至阴之
脏也，故凡脾病者，至夜必热，热而兼寒，则又见所胜者侮所不胜矣。食未消者，
消之则寒热自止。食既消者，补之则寒热自痊。若手足并冷喜热饮食，此中州虚寒
也，宜温之。大便欲去不去，脾气下陷也，宜升之。若夜间或侵晨泄泻者，脾肾俱
虚也，用四神丸（泻）。手足并热作渴饮水者，脾胃实热也，用泻黄散（脾）。大便秘结用
大柴胡汤（潮热）。手足虽热，口不作渴、大便不实者，用白术散（渴）。仍参腹痛腹胀，积
痛积滞治之。
〔曾〕有食饱伤脾，脾气稍虚，物难消化，留而成积，积败为痢，腹肚微痛，先
调胃气，次理积，却止痢，则病根自除。和中散（吐泻）理虚养胃。三棱散（见前）、乌犀丸（积）
助脾化积。沉香槟榔丸（积）、守中汤（泻）进食止痢。仍忌生冷粘腻等物，不致复作。
《千金》治小儿食不知饥饱方
用鼠屎二七枚，烧为末。服之。
【薛己】小儿食积，是由于脾胃虚寒，乳食不能消化，日久形成积滞。其症状表现为夜间发热，天亮后恢复凉爽，腹痛腹胀，呕吐吞酸，脚冷肚热，嗜睡且神志昏沉，大便气味酸臭。如果有上述症状并伴有寒热往来，称为“食积寒热”。若食物停滞在胃的上口，应采用吐法；若停滞在胃的下口，应采用消导法；若腹痛痞胀，按压时疼痛加剧，应采用下法（泻下）；若泻下后疼痛仍在，但按压时疼痛缓解，应采用补法。兼夹伤食的伤寒患者，先用参苏饮疏散表邪。热势严重且大便秘结者，先用大柴胡汤通利攻下。若无外感，仅是伤食且病情不重，用保和丸调理。因为脾是至阴之脏，所以凡是脾病，到了夜间必然发热；若发热兼有恶寒，则是脾土受侮（五行中木克土，此处指肝木乘脾或反侮，原文意指相胜关系紊乱）。食积未消者，通过消导使寒热自止；食积已消者，通过补益使寒热自愈。如果手足俱冷且喜欢热饮食，这是中焦脾胃虚寒，应当温补。如果大便想排却排不出，这是脾气下陷，应当升提。如果在夜间或清晨泄泻，这是脾肾两虚，应用四神丸治疗。如果手足俱热且口渴饮水，这是脾胃实热，应用泻黄散治疗。大便秘结者，用大柴胡汤治疗（针对潮热）。如果手足虽热，但口不渴、大便不成形，应用白术散治疗（针对口渴）。同时需参考腹痛腹胀的症状，按积痛、积滞的方法治疗。
【曾世荣】有因饱食损伤脾胃，导致脾气稍虚，食物难以消化，停留而成积滞，积滞败坏进而变成痢疾。此时腹部轻微疼痛，应先调理胃气，其次处理积滞，最后止痢，这样病根自然去除。使用中和中散治疗吐泻，以理虚养胃。使用三棱散、乌犀丸帮助脾脏化解积滞。使用沉香槟榔丸、守中汤进食止痢。同时忌食生冷、粘腻等食物，以免复发。《千金方》治疗小儿不知饥饱的方子：用鼠屎十四枚，烧成粉末。服用即可。
[Xue Ji] Pediatric food retention arises from deficiency-cold of the Spleen and Stomach, where milk and food fail to transform, leading to accumulation over time. The manifestations include fever at night with cooling upon dawn, abdominal pain and distension, vomiting with acid regurgitation, cold feet with a hot abdomen, excessive sleepiness with mental confusion, and sour-smelling stool. When these symptoms are accompanied by alternating chills and fever, it is termed "food retention with chills and fever." If food stagnates at the upper orifice of the Stomach, emesis (吐法) should be used; if at the lower orifice, digestion-promoting methods (消法) should be employed. For abdominal pain and fullness that worsens upon pressure, purgation (下法) is indicated; if pain persists after purgation but subsides upon pressure, tonification (补法) is required. In cases of Cold Damage complicated by food retention, Shen Su Yin (Ginseng and Perilla Decoction) is first used to disperse the exterior. For severe heat with constipation, Da Chai Hu Tang (Major Bupleurum Decoction) is initially used for purgation. If there is no external contraction but only food injury without severity, Bao He Wan (Preserve Harmony Pill) is used for regulation. Since the Spleen is the organ of extreme Yin, diseases of the Spleen inevitably cause fever at night. If fever is accompanied by chills, it indicates a disorder in the generating/restraining cycles (specifically, the defeated overcoming the invincible). For unresolved food retention, promoting digestion stops the chills and fever spontaneously; for resolved retention, tonification cures them. If both hands and feet are cold and the child prefers warm drinks, this indicates deficiency-cold of the Middle Jiao, requiring warming. If there is an urge to defecate but inability to do so, it signifies sinking of Spleen Qi, requiring lifting. Diarrhea occurring at night or early morning indicates deficiency of both Spleen and Kidney, treated with Si Shen Wan (Four Spirits Pill). Hot hands and feet with thirst and desire to drink indicate excess-heat in the Spleen and Stomach, treated with Xie Huang San (Drain Yellow Powder). Constipation is treated with Da Chai Hu Tang (for tidal fever). Although hands and feet are hot, if there is no thirst and stools are unformed, Bai Zhu San (Atractylodes Macrocephala Powder) is used (for thirst). Treatment should also consider abdominal pain and distension, managing them as accumulation pain and stagnation.
[Zeng Shirong] Overeating damages the Spleen, causing slight Spleen Qi deficiency, making food difficult to digest and leading to retention. If the retention deteriorates, it transforms into dysentery, characterized by mild abdominal pain. One should first regulate Stomach Qi, then resolve the retention, and finally stop the dysentery, thereby eliminating the root cause. He Zhong San (Harmonize Middle Powder) treats vomiting and diarrhea by nourishing deficiency and protecting the Stomach. San Leng San (Burreed Rhizome Powder) and Wu Xi Wan (Black Rhinoceros Horn Pill) assist the Spleen in transforming retention. Chen Xiang Bing Lang Wan (Aquilaria and Betel Nut Pill) and Shou Zhong Tang (Guard the Middle Decoction) promote appetite and stop dysentery. Avoid raw, cold, and sticky/greasy foods to prevent recurrence. The *Qian Jin Fang* formula for pediatric lack of awareness of hunger and satiety: Use fourteen rat feces pellets, burn them to powder, and administer orally.