王履曰。仲景云。寸口脉浮而大。按之反涩。故知有宿食。下之宜大承气汤。然同一发热。而伤食者惟肚腹之热为
甚。且粪极酸臭。夜间潮热。尤伤食之明验也。小儿宿食不消者。胃纳水谷而脾化之。儿初不知樽节。胃之所纳。脾气
不足以胜之。故不消也。钱氏论食不消。由脾胃冷。当补脾。益黄散主之是也。
初虞世曰。小儿食积者。因脾胃虚冷。乳食不化。久而成积。其症至夜发热。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。有前症而兼寒热者。名曰食积寒热。若食在胃之上口者。吐之。在胃之下口者。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。大柴胡汤。如无外感。只伤食。不至于甚。保和丸调之。盖脾为至阴之脏。故凡脾病者。至夜必热。热而兼寒。
则又见所胜者侮所不胜者矣。食未消者消之。则寒热自止。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。皆温之。大便欲去不去。脾气下陷也。宜升之。若夜间或清晨泄泻者。脾肾俱虚也。四神丸。手足热。作渴饮
水者。脾胃实热也。泻黄散。手足虽热。不渴大便不实者。白术散。仍参腹痛腹胀积痛积滞治之。
王履说：张仲景提到，寸口脉象浮而大，重按反而涩滞，因此可以判断体内有积存的食物。治疗应当使用攻下法，适宜选用大承气汤。然而同样是发热，伤食引起的发热以腹部热感最为明显，并且大便气味极酸臭，夜间出现潮热，这更是伤食的明确证据。小儿宿食不消化，是因为胃负责受纳水谷，脾负责运化。小儿起初不懂得节制饮食，胃所摄入的食物量超过了脾气所能运化的限度，所以导致食物无法消化。钱乙论述食积不消，认为是由于脾胃虚冷所致，应当采用补脾的方法，使用益黄散主治，这是正确的。
初虞世说：小儿食积，是由于脾胃虚寒，乳食不能消化，久而久之形成积滞。其症状表现为夜间发热，天亮后体温恢复正常；腹痛且腹部胀满；呕吐并伴有吞酸；脚部发冷而腹部发热；喜欢睡觉且精神昏沉；大便气味酸臭。如果有上述症状并兼有寒热往来，称为“食积寒热”。如果食物停滞在胃的上口，应当采用催吐法；如果食物停滞在胃的下口，应当采用消导法。如果腹痛痞满胀闷，按压时疼痛加剧，应当采用攻下法。攻下之后仍然疼痛，但按压时疼痛缓解的，应当采用补益法。如果是夹带饮食积滞的伤寒，应当先解表散邪，使用参苏饮。如果热势严重且大便秘结，应当先通利大便，使用大柴胡汤。如果没有外感病邪，仅是伤食，且病情不至于严重，使用保和丸调理即可。因为脾属于至阴之脏，所以凡是脾病的患者，到了夜间必然发热。如果发热兼有恶寒，则是出现了“所胜者侮所不胜”（即相乘或反侮）的病机变化。对于食积未消的情况，采用消导法，寒热症状自然停止；对于食积已消但正气受损的情况，采用补益法，寒热症状自然痊愈。如果手足全部冰冷，喜欢温热饮食，这是中焦脾胃虚寒的表现，都应当采用温补法。如果大便想排却排不出，是脾气下陷所致，应当采用升提法。如果在夜间或清晨出现泄泻，是脾肾两虚所致，宜用四神丸。如果手足发热，口渴想喝水，这是脾胃实热的表现，宜用泻黄散。如果手足虽然发热，但不口渴且大便不成形，宜用白术散。同时还需参考腹痛、腹胀、积痛、积滞等病症进行综合治疗。
Wang Lü stated: Zhang Zhongjing mentioned that if the Cun Kou (inch position) pulse is floating and large, but feels choppy upon deep pressure, one can deduce the presence of retained food. The treatment should involve purgation, and Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate. However, although both present with fever, in cases of food injury, the heat sensation in the abdomen is most prominent, and the feces have an extremely sour and foul odor. Tidal fever at night is also a clear sign of food retention. In children, retained food fails to digest because the Stomach receives water and grain, while the Spleen transforms and transports them. Children initially do not know how to moderate their intake; the amount of food received by the Stomach exceeds the capacity of the Spleen Qi to transform it, thus leading to indigestion. Qian Yi discussed food retention failing to digest, attributing it to cold deficiency of the Spleen and Stomach, and advocated tonifying the Spleen, using Yi Huang San (Benefit Yellow Powder) as the primary formula, which is correct.
Chu Yushi stated: Pediatric food accumulation arises from deficiency-cold of the Spleen and Stomach, where milk and food fail to digest, eventually forming accumulation over time. Its symptoms include fever at night with normalization of temperature at dawn; abdominal pain and distension; vomiting with acid regurgitation; cold feet and a hot abdomen; a preference for sleep and mental lethargy; and sour, foul-smelling stools. If these symptoms are accompanied by alternating chills and fever, it is named "Food Accumulation with Chills and Fever." If food stagnates at the upper opening of the Stomach, emesis should be induced; if it stagnates at the lower opening of the Stomach, digestion-promoting methods should be used. If there is abdominal pain and fullness that worsens upon pressure, purgation should be employed. If pain persists after purgation but is relieved by pressure, tonification should be applied. For Taiyang disease complicated by food accumulation, exterior-releasing methods should be used first, such as Shen Su Yin (Ginseng and Perilla Decoction). If heat is severe accompanied by constipation, purgation should be used first, such as Da Chai Hu Tang (Major Bupleurum Decoction). If there is no external pathogenic invasion, only food injury, and the condition is not severe, Bao He Wan (Preserve Harmony Pill) should be used for regulation. Since the Spleen is an organ of extreme Yin, patients with Spleen diseases inevitably experience fever at night. If fever is accompanied by chills, it indicates that the conquered element is insulting the unconquered element (a pathological interaction in Five Phase theory). For undigested food, applying digestion-promoting methods will naturally stop the chills and fever; for resolved accumulation requiring recovery, applying tonification will naturally cure the chills and fever. If all four extremities are cold and the patient prefers warm drinks, this indicates deficiency-cold of the Middle Jiao, and warming methods should be applied uniformly. If there is an urge to defecate but inability to do so, it is due to sinking of Spleen Qi, and lifting methods should be applied. If diarrhea occurs at night or early morning, it indicates deficiency of both the Spleen and Kidney, and Si Shen Wan (Four Spirit Pill) is indicated. If the extremities are hot and accompanied by thirst and desire to drink water, this indicates excess-heat of the Spleen and Stomach, and Xie Huang San (Drain Yellow Powder) is indicated. If the extremities are hot but without thirst and with loose stools, Bai Zhu San (Atractylodes Macrocephala Powder) is indicated. Treatment should still refer to the management of abdominal pain, abdominal distension, accumulation pain, and food stagnation.