钱乙曰。积痛。口中气温。面色黄白。目无睛光。或白睛多。及多睡畏食。或大便酸臭者。当磨积而痛自除。宜下
积丸。甚者白饼子下之。后和胃气。用白术散。又有食积肚痛。有热者。芍药甘草汤。加葛根。吐者。加生姜、半夏。
或加枳实。亦效。其有积而潮热寒热。心腹胀满疼痛者。良方妙香丸。
李杲曰。凡小儿失乳。以食饷之。未有食肠。不能克化。致成食积。腹胀而痛。利色无常。日久瘦弱。
鳌按。有寒积腹痛者。由日渐受寒。兼吃冷物凉饮。寒邪结于脾经。遂致作痛。始犹数日一发。继则一二日发。或
日日发。发则面青白。吐清水。喜人手按。或将物抵住。方得稍可。宜用棉子仁八两炒令烟尽。加入枳壳炒、鸟药炒各
一两。木香生研五钱。神曲糊丸。空心淡姜汤下。数日当下白物。渐愈。
王汉东曰。小儿积病。可医者九。面上虚肿是积。积者。脾之所系。脾主身之肌肉。故应于面。故知是脾积。其脾
系土。土无正形。故早晚浮肿不定。多则早浮。其睡则脾不磨。上面作肿。若病后此症。则是虚中积。宜用补脾消积行
气等药。又面合地卧是积。何以合地。其受积在脾。是冷积。何以知之。其脾好土。故知在脾。其冷者属阴。故知伤冷
硬物得之。宜下热药耳。又腹胀是积。其积在肺。何以知之。其肺主于气。才受积。其气便冷。腹胀满。气急。故知在
肺。如腹胀。先宜调气。后用转。转后更宜调气。又小便如油是积。其积在小肠。何以知之。积受于脾。脾当传心。心
不受触。则入小肠。小肠是心之腑。故知在小肠。则积其水道。小便如米泔。油相似也。又发黄是积。是积气伤心。
心主血脉。润遍身毛发。被积气所干。则发黄。故知是积伤心。宜下空心散。及取积药。此人必时复发热也。又赤白痢
是积。其积在肺。受传大肠。及有外伤而得。何以知之。肺主金。色白。后赤则是外邪。故知肺传大肠。则为赤痢也。
宜取后调气。又两眼黄赤睛青是积在肝。何以知之。肝主木。色青。却被气所干即黄赤。睛青者。眼属肝。若受积。故
令睛青。是肝受积。若传胆。必口苦不要吃物。宜凉药退之。又遍身虚肿是积。其积不在脏。只在腑。何以知之。为其
积曾取后。被药发动。即不在脏。故出皮肤之间为肿也。只宜下取虚中积。药后补之。又多泻白粪是积。是受冷。积在
脾。何以知之。脾主化。受冷积在脾。冷滑而泻白屎。故知在脾。宜先转。后热药补之。以上皆可治者也。积病不可治
者六。喘急是肺积。肺主气。喘急则肺绝。当面白全无血色。故不可医。又面黑是肾积。盖面黑者。肾绝也。当不辨好
恶。眼直无光。只一日而死。又吐热气是荣积。其不可医者。是血绝也。血主于心。心不能管。故出热气不止耳。又手
脚心生疮。是卫积。卫者。气也。胃气不生。故手足生疮。若卫绝。则气不回。只半日死也。又恶心吐干呕。是胃
绝。何以不医。胃主化食。热则恶吐。故不治。当食乳不化。不食。亦干呕吐。面色青黄无血色也。又泻久住了又泻。
是积咬脾烂。何以知其脾烂。当泻白粪而食不消。住了却放粪赤黑而死。故知脾烂。以上皆不可治者也。
钱乙说：积痛，口中气息温热，面色黄白相间，眼神无光彩，或者眼白部分较多，以及嗜睡、畏食，或者大便有酸臭味的，应当使用磨积药物，疼痛自然消除。适宜用下积丸。病情严重的，用白饼子攻下。之后调和胃气，使用白术散。又有因食积导致的肚痛，有热象的，用芍药甘草汤，加入葛根；伴有呕吐的，加入生姜、半夏，或者加入枳实，也有效。那些有积滞且出现潮热、寒热往来，心腹胀满疼痛的，用良方妙香丸。
李杲说：凡是小儿断奶后，用食物喂养他们，因为肠胃尚未发育成熟，不能消化，导致形成食积。腹部胀满而疼痛，排泄物颜色无常，日久身体瘦弱。
沈金鳌按语：有寒积腹痛的情况，是由于日渐受寒，兼吃冷物凉饮，寒邪结聚于脾经，于是导致疼痛。开始还是几天发作一次，后来变成一两天发作，或者每天发作。发作时面色青白，吐出清水，喜欢让人手按压，或者用物体抵住，才稍微缓解。适宜用棉子仁八两炒至烟尽，加入炒枳壳、炒乌药各一两，生研木香五钱，用神曲糊制成丸药，空腹时用淡姜汤送服。数日后会排出白色物质，逐渐痊愈。
王汉东说：小儿积病，可以治疗的有九种。面上虚肿是积滞。积滞，与脾脏有关。脾主司身体的肌肉，所以反映在面部。因此知道这是脾积。脾属土，土没有固定的形状，所以早晚浮肿不定。多的时候早晨浮肿。睡觉时脾不运化，上面就作肿。如果是病后出现这种症状，则是虚中夹积。适宜用补脾、消积、行气等药物。另外，脸贴着地面躺卧是积滞。为什么脸贴地？因为积滞在脾，是冷积。怎么知道是冷积？因为脾喜好土性，所以知道病在脾。冷的属于阴，所以知道是吃了生冷硬物导致的。适宜用热性药物治疗。还有腹部胀满是积滞。积滞在肺，怎么知道？肺主气，刚受到积滞影响，气就变冷，导致腹胀满、气急，所以知道病在肺。如果是腹胀，先宜调气，然后用消导药。消导后更宜调气。还有小便像油一样是积滞。积滞在小肠，怎么知道？积滞受于脾，脾当传于心，心不受触，则传入小肠。小肠是心的腑，所以知道病在小肠。那么积滞阻碍水道，小便像米泔水，像油相似。还有发黄是积滞，是积气伤心。心主血脉，润泽全身毛发，被积气干扰，则发黄。所以知道是积气伤心。适宜用空心散，以及取积药物。这个人必定时常发热。还有赤白痢疾是积滞，积滞在肺，受传到大肠，以及有外伤而得。怎么知道？肺主金，色白，便血赤则是外邪所致。所以知道肺传大肠，则为赤痢。适宜通调后调气。还有两眼黄赤、眼珠发青是积滞在肝。怎么知道？肝主木，色青，却被气干扰即现黄赤。眼珠发青，因为眼属肝，若受积滞，所以令眼珠发青。这是肝受积滞。如果传胆，必定口苦不想吃东西。适宜用凉性药物治疗。还有遍身虚肿是积滞。积滞不在脏，只在腑。怎么知道？因为积滞曾经过攻下治疗，被药物发动，就不在脏，而出现在皮肤之间为肿。只适宜用下法取虚中积滞，用药后补益。还有多泻白色粪便的是积滞，是受冷，积滞在脾。怎么知道？脾主运化，受冷积滞在脾，冷滑而泻白色屎，所以知道病在脾。适宜先消导，后用热药补益。以上都是可以治疗的。积病不可治疗的有六种。喘急是肺积。肺主气，喘急则肺气绝。面色苍白全无血色，所以不可医。还有面黑是肾积。面黑者，是肾气绝的表现。应当辨不清好坏，眼睛直视无光，只一天就会死亡。还有吐热气是营（血）积。不可医治的，是血绝。血主于心，心不能统摄，所以出热气不止。还有手脚心生疮，是卫（气）积。卫就是气，胃气不生，所以手足生疮。如果卫气绝，则气不回，只半天就会死。还有恶心干呕，是胃绝。为什么不医治？胃主消化食物，热则恶吐，所以不治。应当吃乳不化，不吃也干呕吐，面色青黄无血色。还有腹泻久停后又腹泻，是积滞咬噬脾烂。怎么知道脾烂？应当泻白色粪便且食物不消化，停止后却排赤黑色粪便而死。所以知道脾烂。以上都是不可治疗的。
Qian Yi said: In cases of accumulation pain (Ji Tong), the breath from the mouth is warm, the complexion is yellowish-white, the eyes lack luster or have excessive white sclera, and the child is lethargic with poor appetite. If the stool has a sour odor, one should use medications to grind down accumulations, after which the pain will naturally subside. The appropriate formula is Xia Ji Wan (Downward Accumulation Pill). For severe cases, Bai Bing Zi (White Cake Pills) should be used to purge. Afterwards, harmonize the Stomach Qi using Baizhu San (Atractylodes Macrocephala Powder). Regarding abdominal pain caused by food accumulation with heat signs, Shaoyao Gancao Tang (Peony and Licorice Decoction) added with Gegen (Kudzu Root) is indicated. If vomiting occurs, add Shengjiang (Fresh Ginger) and Banxia (Pinellia Tuber), or Zhishi (Immature Bitter Orange), which is also effective. For those with accumulations presenting with tidal fever, alternating chills and fever, chest and abdominal distension, fullness, and pain, Liangfang Miaoxiang Wan (Excellent Formula Wonderful Fragrance Pill) is suitable.
Li Gao stated: Whenever infants are weaned and fed solid foods, if their intestines and stomach are not yet mature enough to digest them, it leads to food accumulation. This results in abdominal distension and pain, irregular stool colors, and emaciation over time.
Shen Jin'ao commented: There are cases of cold accumulation abdominal pain, caused by gradual exposure to cold and consumption of cold foods and drinks. Cold pathogens congeal in the Spleen Meridian, leading to pain. Initially, it may occur once every few days, then every one or two days, or daily. During an episode, the face appears cyanotic and pale, clear fluid is vomited, and the child prefers pressure from hands or objects against the abdomen for slight relief. It is appropriate to use 8 liang of Cottonseed Kernel (Mianziren) stir-fried until smoke ceases, mixed with 1 liang each of stir-fried Zhiqiao (Bitter Orange Peel) and Chui Wuyao (Stir-fried Litsea Fruit), along with 5 qian of raw ground Muxiang (Aucklandia Root). Form these into pills using Shenqu (Medicated Leaven) paste as a binder, taken on an empty stomach with light ginger soup. After several days, white matter will be discharged, and the condition will gradually improve.
Wang Handong stated: Among pediatric accumulation diseases, nine types are treatable. Facial puffiness indicates accumulation. Accumulation is related to the Spleen. The Spleen governs the muscles of the body, thus manifesting on the face; hence, this is known as Spleen accumulation. The Spleen corresponds to Earth, which has no fixed shape, so facial edema fluctuates between morning and evening. When severe, it swells in the morning. During sleep, the Spleen fails to transform, causing swelling above. If this symptom appears after illness, it is deficiency with accumulation. Medications that tonify the Spleen, resolve accumulation, and move Qi should be used. Additionally, lying with the face pressed to the ground indicates accumulation. Why? Because the accumulation is in the Spleen, specifically cold accumulation. How do we know? The Spleen favors Earth nature, indicating the pathology lies in the Spleen. Cold belongs to Yin, indicating injury from cold, hard foods. Hot-natured drugs should be used. Abdominal distension indicates accumulation located in the Lung. How do we know? The Lung governs Qi; upon receiving accumulation, the Qi becomes cold, causing distension and rapid breathing. Thus, the pathology is in the Lung. For abdominal distension, first regulate Qi, then use transforming/purging methods, and afterward, regulate Qi again. Urine resembling oil indicates accumulation in the Small Intestine. How do we know? Accumulation originates in the Spleen and transmits to the Heart. If the Heart does not accept the pathogen, it enters the Small Intestine, which is the Fu organ of the Heart. Thus, the accumulation obstructs water pathways, making urine resemble rice washings or oil. Yellowing of the skin indicates accumulation affecting the Heart. The Heart governs blood vessels and moistens hair; when disturbed by accumulation Qi, yellowing occurs. Hence, it is Heart accumulation. Kongxin San (Empty Heart Powder) and accumulation-resolving drugs are indicated. Such patients likely experience recurrent fevers. Red and white dysentery indicates accumulation in the Lung, transmitting to the Large Intestine, possibly due to external trauma. How do we know? The Lung governs Metal and color White; red stool indicates external pathogens. Thus, Lung transmission to the Large Intestine causes red dysentery. Regulating Qi after purging is indicated. Yellow-red eyes with cyanotic pupils indicate Liver accumulation. How do we know? The Liver governs Wood and color Cyan; disturbance by Qi causes yellow-red hues. Since eyes belong to the Liver, accumulation causes cyanotic pupils. If it transmits to the Gallbladder, bitter taste and anorexia will occur. Cooling drugs should be used. Generalized puffy edema indicates accumulation in the Fu organs rather than Zang organs. How do we know? Previous purging treatments may have stirred the accumulation, moving it from the Zang to the skin/subcutaneous tissue. Only mild purging for deficiency-accumulation followed by tonification is suitable. Frequent passage of white feces indicates cold accumulation in the Spleen. How do we know? The Spleen governs transformation; cold accumulation causes slippery white stools. First transform, then tonify with hot drugs. All the above are treatable. Six types of accumulation disease are untreatable. Rapid panting indicates Lung accumulation. The Lung governs Qi; rapid panting signifies Lung exhaustion. With a completely pale, bloodless face, it is incurable. Black facial complexion indicates Kidney accumulation. Blackness signifies Kidney exhaustion. The patient cannot distinguish good from bad, has staring eyes without luster, and will die within one day. Vomiting hot air indicates Ying (Blood) accumulation. Incurability here signifies Blood exhaustion. Blood is governed by the Heart; if the Heart cannot control it, hot air exits continuously. Sores on palms and soles indicate Wei (Qi) accumulation. Wei refers to Qi; failure of Stomach Qi generation causes sores. If Wei Qi exhausts, Qi cannot return, and death occurs within half a day. Nausea and dry retching indicate Stomach exhaustion. Why incurable? The Stomach governs digestion; heat causes aversion and vomiting. Milk undigested, anorexia, dry retching, and cyanotic-yellow bloodless complexion confirm this. Chronic diarrhea that stops and resumes indicates accumulation eroding the Spleen. How do we know Spleen erosion? Passage of white feces with undigested food, followed by cessation and then passage of black-red feces before death, confirms Spleen erosion. All the above are untreatable.