伤食者，必恶食嗳腐，吞酸痞胀，腹满倦怠气急。或腹痛，或吐泻，或秘结，或发热，皆为伤食
之候。经曰∶饮食自倍，肠胃乃伤。虞天民云∶凡伤食者，皆原中气不足，宜以补益为要，但治法有
先后，不可倒施。故物伤之际，积食未行，遽用补益，则滋其壅塞，病必增剧。必先用顺气消食化痰
之药，待宿食消行，然后平调，继以补益，始治之有序，而获宁矣。又沈氏云∶治伤食而但用消导，
庸愚尽晓，须审致病有寒热虚实之不同，或挟外感，或挟气挟痰，或久病，或产后，治各有异。如寒
者热之，热者寒之，虚者补而消之。若血虚者，兼养血而食自行；若气虚者，兼补气而食自化。实者
削而消之。如食在上，胸膈饱闷不安者，探吐之；如食在下，绕脐疼痛，手不可按者，攻下之。
挟外感者，当以解散表邪为主，而带和中；挟痰气者，当以开痰行气为主，而兼消导。久病产后，皆
宜调补脾胃为主，
而佐以顺气消食之剂，不可专行克削攻下，恐宿食未消，而元气顿削，以致变幻不测。余每见世人，
以伤食为小疾，而医者亦遂轻忽以施治，故死于伤食者甚多。经曰∶脾胃为后天之根本，根本既伤，
而又不善治之，安望其得生耶！
保和丸〔见泄泻。〕
伤生冷而挟寒者，去连翘加香、砂、沉、蔻之属。口苦舌干而内热者，去半夏，加枳实、黄连、
麦冬之属。胀满腹痛，按之坚硬，或有块者，加枳、朴、槟、莪之属。此方顺气消食化痰，治伤食之要
剂也。加减以用，实者宜之。
大承气汤〔见伤寒。〕《金匮》云∶病者腹满，按之不痛者为虚，痛者为实，可下之。舌黄
未去者，下之黄自去。又云∶痛而闭者，当下之。又云∶下利不欲食者，此有宿食也，当下之。又云∶脉
滑而数者，实也，此有宿食下之愈。又云∶人病有宿食，寸口脉浮而大，〔谷气壅而盛，亦能为浮
大。〕按之反涩，〔饮食不节，则阴受之，而血先伤，故按之反涩，涩在浮大中，故知宿食。〕尺中
亦微而涩，〔中焦食阻，气不宣通，而下失化源之主，故亦微而涩。〕当下之。〔恐津精血液转瞬涸竭，
愈难开解。〕俱此方主之。
此攻下荡涤之剂，果如上症，必宿食在下，绕脐疼痛拒按者，方可用之，芒硝或去之，或玄明粉代
之，或礞石滚痰丸，象胆丸，随宜采用。古方有备急丸，用巴霜〔一
钱。〕大黄 干姜〔各五钱。〕蜜丸绿豆大，每服只一丸，以利为度云。寒积用此下之，备此法以俟
临症酌用。
疳积散 治小儿乳食不节，过饱伤脾，面黄腹大，小便浊如米泔，大便黄泄酸臭，皮毛
枯索，甚而双目羞明生翳，形骸骨立，夜热昼凉等症。
浓朴〔消食积，姜汁炒，一两。〕 橘红〔通滞气，八钱。〕 甘草〔和中。〕
真芦荟 芜荑〔各五钱。〕 青黛〔皆杀虫。除疳热。〕 百草霜〔化积滞，〕 旋复花
〔消坚痰，各二钱。〕 〔八味共为细末，小儿每一岁用药一分，灯心汤空心调服。积消其半，再用
肥儿丸调治。〕
肥儿丸 治小儿疳积神效。
人参〔三钱。〕 白芍 茯苓 甘草〔同砂仁各五钱，余各一两。〕 扁豆 莲肉〔健
脾。〕 山楂 麦芽 红曲 橘红 砂仁〔消食。〕 黄连 使君子肉 芜荑 青黛〔除
热杀虫。〕 滑石〔清热导滞，共十六味。炼蜜丸，如弹子大，每服一丸，空心白汤化下。〕
十宝丸 治男妇因食积黄病，及小儿疳积。
平胃散加楂肉 麦芽 槟榔 茯苓〔各二两。〕 绿矾〔善消食积，能疗诸黄，醋 红色，
四两。终身忌食荞麦河豚，犯之即死。枣肉为丸，如桐子大，每服一钱，白汤送，日三服，服后即以饮
食压之。〕
此三方治小儿疳积之神剂，累试辄应。
异功散 归脾汤 六君子汤〔俱见中风。〕
或再加香、砂、沉、蔻、楂、芽之属。
资生丸〔见虚劳。〕
此四方补而兼消之法也。加减以用，虚者宜之。按《医
贯》云∶胃中元气盛，能食而不伤，过时而不饥，若元气不足，致易伤食，纯用曲、朴、楂、芽之类，
取快于一时，独不思脾既已受伤，而复经此一番消化，愈虚其虚，而益易伤食矣。故膏粱之人，与藜藿
之人不同。藜藿壮实者，可用保和、承气之属；膏粱虚弱者，概以此法施之，贻害不小。
《广笔记方》 治老人伤冷食，及难化之物。
生姜 紫苏〔煎浓汤，置浴锅中，令病患乘热浸汤内熨之。〕
此法取辛温以通气，气通则食自化也。
伤食病，必然出现厌恶食物、嗳气带有腐臭味、吞酸、胸脘痞闷胀满、腹部胀满、疲倦乏力、呼吸急促等症状。或者出现腹痛，或者呕吐腹泻，或者大便秘结，或者发热，这些都是伤食的征候。《内经》说：“饮食过量一倍，肠胃就会受伤。”虞天民说：“凡是伤食的人，根源都在于中气不足，治疗应当以补益为关键，但是治疗方法有先后顺序，不可颠倒施行。所以在食物刚受伤、积滞尚未运行的时候，如果立刻使用补益药，就会加重壅塞，病情必定加剧。必须先用顺气、消食、化痰的药物，等到宿食消除运行之后，再平和调理，接着进行补益，这样治疗才有秩序，才能获得安宁。”另外沈氏说：“治疗伤食而仅仅使用消导法，这是庸医愚夫都知道的浅显道理；必须审察致病原因有寒、热、虚、实的不同，或者兼夹外感邪气，或者兼夹气滞或痰湿，或者是久病之后，或者是产后，治疗方法各有差异。如寒证用热药治之，热证用寒药治之，虚证用补益兼消导的方法治之。如果是血虚的人，兼用养血药，食物自然能消化；如果是气虚的人，兼用补气药，食物自然能化除。实证则用攻削消导的方法治之。如果食物停滞在上焦，导致胸膈饱闷不安的，用探吐法；如果食物停滞在下焦，绕脐疼痛、手不能按压的，用攻下法。兼夹外感的，应当以解散表邪为主，兼带调和脾胃；兼夹痰气的，应当以开痰行气为主，兼用消导法。久病和产后，都应当以调补脾胃为主，佐以顺气消食的药物，不可专门使用克削攻下的方法，恐怕宿食未消，元气却突然受损，从而导致变幻莫测的变证。我常见世人把伤食当作小病，医生也于是轻忽对待进行治疗，所以死于伤食的人很多。《内经》说：‘脾胃是后天的根本，根本既然受伤，如果不善于治疗，怎么指望他能生存呢！’
保和丸（见泄泻章节）。
如果是伤生冷且兼夹寒邪的，去掉连翘，加入香附、砂仁、沉香、白蔻仁之类的药物。口苦舌干且有内热的，去掉半夏，加入枳实、黄连、麦冬之类的药物。胀满腹痛，按压时坚硬，或者有结块的，加入枳壳、厚朴、槟榔、莪术之类的药物。这个方剂具有顺气、消食、化痰的功效，是治疗伤食的重要方剂。根据症状加减使用，实证适宜使用。
大承气汤（见伤寒章节）。《金匮要略》说：病人腹部胀满，按压不痛的属于虚证，痛的属于实证，可以用攻下法。舌苔黄而未退去的，攻下后黄苔自然会去除。又说：腹痛且大便闭结的，应当攻下。又说：腹泻但不想进食的，这是有宿食，应当攻下。又说：脉象滑而数的，属于实证，这是有宿食，攻下后痊愈。又说：人患有宿食，寸口脉浮而大（谷气壅盛也能表现为浮大），重按反而涩（饮食不节制，阴血先受损伤，所以重按反涩，涩象出现在浮大之中，所以知道是宿食），尺部脉也微而涩（中焦食物阻滞，气机不宣通，而下焦失去化源之主，所以也微而涩），应当攻下（恐怕津液精血转瞬枯竭，更加难以开通化解）。以上情况都用此方主治。
这是一个攻下荡涤的方剂，果然像上述症状，必须是宿食在下焦，绕脐疼痛拒按的，才可以应用。芒硝可以去除，或者用玄明粉代替，或者用礞石滚痰丸、象胆丸，根据适宜情况选用。古方中有备急丸，用巴豆霜一钱，大黄、干姜各五钱，蜜丸如绿豆大，每次只服一丸，以大便通畅为度。寒积用此法攻下，记录此法以备临症时斟酌使用。
疳积散：治疗小儿乳食不节，过饱伤脾，面色发黄、腹部膨大，小便浑浊如米泔水，大便黄色泄泻且酸臭，皮肤毛发枯槁稀疏，甚至双目畏光生翳，身体消瘦如骨立，夜间发热白天凉爽等症状。
厚朴（消食积，姜汁炒，一两）、橘红（通滞气，八钱）、甘草（调和脾胃）、真芦荟、芜荑（各五钱）、青黛（皆能杀虫、清除疳热）、百草霜（化解积滞）、旋复花（消散坚痰，各二钱）。（以上八味共研为细末，小儿每岁用药一分，灯心草汤空腹调服。积滞消除一半后，再用肥儿丸调理。）
肥儿丸：治疗小儿疳积神效。
人参（三钱）、白芍、茯苓、甘草（同砂仁各五钱，其余各一两）、扁豆、莲肉（健脾）、山楂、麦芽、红曲、橘红、砂仁（消食）、黄连、使君子肉、芜荑、青黛（清热杀虫）、滑石（清热导滞），共十六味。炼蜜为丸，如弹子大，每次服一丸，空腹用白开水化下。
十宝丸：治疗男女因食积导致的黄病，以及小儿疳积。
平胃散加山楂肉、麦芽、槟榔、茯苓（各二两）、绿矾（善于消食积，能疗各种黄病，醋淬红色，四两）。终身忌食荞麦和河豚，犯了就会死亡。枣肉为丸，如梧桐子大，每次服一钱，白开水送服，每日三次，服完后立即以饮食压住药力。
这三个方子是治疗小儿疳积的神效方剂，多次尝试都有效。
异功散、归脾汤、六君子汤（均见中风章节）。
或者再加香附、砂仁、沉香、白蔻仁、山楂、麦芽之类的药物。
资生丸（见虚劳章节）。
这四个方子是补益兼消导的方法。根据症状加减使用，虚证适宜使用。按《医贯》说：胃中元气旺盛，能进食而不受伤，过了饭点也不觉得饿；如果元气不足，容易导致伤食，如果纯粹使用神曲、厚朴、山楂、麦芽之类的药物，只求一时的痛快，却不曾想到脾脏已经受伤，如果再经过这番消化消耗，会使虚弱更虚弱，从而更容易再次伤食。所以吃精细食物的人和吃粗劣食物的人是不同的。吃粗劣食物且体质壮实的人，可以使用保和丸、大承气汤之类的方剂；吃精细食物且体质虚弱的人，一概用这种方法治疗，带来的危害不小。
《广笔记方》：治疗老人伤冷食，以及难消化的食物。
生姜、紫苏（煎浓汤，放入浴锅中，让病人趁热浸泡在汤中并熨烫）。
此法取辛温之性以通行气机，气机通畅则食物自然消化。
Shangshi (Food Injury) inevitably presents with aversion to food, belching with a putrid odor, acid regurgitation, chest and epigastric stuffiness and distension, abdominal fullness, fatigue, and shortness of breath. It may also manifest as abdominal pain, vomiting and diarrhea, constipation, or fever; all these are signs of Shangshi. The *Classic of Internal Medicine* states: "If food and drink exceed normal intake by double, the intestines and stomach will be injured." Yu Tianmin said: "The root cause of all cases of Shangshi is deficiency of Middle Qi; treatment should prioritize tonification. However, therapeutic methods must follow a specific sequence and cannot be reversed. When food injury first occurs and accumulation has not yet moved, if tonifying medicines are used immediately, they will exacerbate stagnation, and the condition will surely worsen. One must first use herbs that promote Qi circulation, digest food, and resolve phlegm. Only after the retained food has been digested and moved can one proceed to harmonize and regulate, followed by tonification. This ensures an orderly treatment process and leads to recovery." Additionally, Mr. Shen stated: "Merely using digestive and guiding methods for Shangshi is knowledge known even to mediocre physicians; one must examine whether the etiology involves Cold, Heat, Deficiency, or Excess, or if it is complicated by external pathogens, Qi stagnation, or Phlegm, or if it occurs after prolonged illness or postpartum. Treatments vary accordingly. For Cold patterns, treat with Heat; for Heat patterns, treat with Cold; for Deficiency patterns, treat with Tonification combined with digestion. If Blood is deficient, nourish Blood alongside digestion so that food transforms naturally; if Qi is deficient, tonify Qi alongside digestion so that food transforms naturally. For Excess patterns, use reduction and digestion. If food stagnates in the Upper Jiao, causing chest and diaphragmatic fullness and discomfort, induce vomiting; if food stagnates in the Lower Jiao, causing periumbilical pain and tenderness upon palpation, use purgatives. If complicated by external pathogens, focus on releasing the exterior while harmonizing the middle; if complicated by Phlegm and Qi stagnation, focus on resolving Phlegm and moving Qi while assisting digestion. For prolonged illness and postpartum conditions, prioritize regulating and tonifying the Spleen and Stomach, assisted by herbs that move Qi and digest food. Do not exclusively use harsh reducing or purgative methods, lest the retained food remain undigested while Yuan Qi is suddenly depleted, leading to unpredictable complications. I often see people regard Shangshi as a minor ailment, and physicians consequently treat it lightly; thus, many die from Shangshi. The *Classic of Internal Medicine* says: 'The Spleen and Stomach are the foundation of the Post-Heaven. If the foundation is injured and not treated properly, how can one expect survival?'
Baohe Wan (see Diarrhea).
For cold damage accompanied by Cold, remove Lianqiao (Forsythiae Fructus) and add Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus Rotundus), Chenxiang (Aquilariae Lignum Resinatum), and Baixiaoren (Amomi Fructus).
For bitter taste in the mouth, dry tongue, and internal Heat, remove Banxia (Pinelliae Rhizoma Preparatum) and add Zhishi (Aurantii Fructus Immaturus), Huanglian (Coptidis Rhizoma), and Maidong (Ophiopogonis Radix).
For distension, abdominal pain, hardness upon palpation, or presence of masses, add Zhike (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), and Ezhu (Curcumae Rhizoma).
This formula promotes Qi circulation, digests food, and resolves phlegm; it is a key prescription for treating Shangshi. Use with modifications for Excess patterns.
Da Chengqi Tang (see Cold Damage). The *Jin Gui Yao Lue* states: "When a patient has abdominal fullness, non-tenderness upon palpation indicates Deficiency, while tenderness indicates Excess; purgatives may be used. If yellow coating remains on the tongue, purging will cause the yellow coating to disappear." It further states: "Abdominal pain with constipation requires purging." It also states: "Diarrhea with loss of appetite indicates retained food; purging is required." Additionally: "A slippery and rapid pulse indicates Excess due to retained food; purging leads to cure." Furthermore: "In cases of retained food, the Cun (inch) position pulse is floating and large [abundant Grain Qi can also present as floating and large]. Upon deep pressure, it feels choppy [irregular diet damages Yin and Blood first, hence the choppy feeling amidst the floating-large quality, indicating retained food]. The Chi (cubit) position is also faint and choppy [food obstruction in the Middle Jiao blocks Qi flow, and the Lower Jiao loses its source of transformation, hence faint and choppy]. Purging is indicated [to prevent rapid depletion of fluids, essence, and blood, which would make resolution difficult]. All such cases are managed with this formula.
This is a purgative formula for scouring and cleansing. It should only be used when symptoms match those above, specifically retained food in the Lower Jiao with periumbilical pain and tenderness. Mangxiao (Natrii Sulfas) may be omitted, replaced with Xuánmíngfěn (Natrii Sulfas Depuratus), or alternatively, Mengshi Guntan Wan (Calcareous Schist Phlegm-Rolling Pill) or Xiangdan Wan (Elephant Bile Pill) may be selected according to suitability. An ancient formula, Beijijian Wan (Emergency Prepared Pill), uses Bashuang (Crotonis Seminis Extract) 1 qian, Dahuang (Rhei Radix et Rhizoma) and Ganjiang (Zingiberis Rhizoma) 5 qian each, honey-pilled to the size of mung beans. Take one pill per dose, stopping when bowel movement occurs. This method is for Cold accumulation; record this method for clinical reference.
Ganji San (Infantile Malnutrition Powder): Treats infantile malnutrition due to irregular breastfeeding/diet, overeating damaging the Spleen, presenting with sallow complexion, distended abdomen, turbid urine resembling rice water, yellow acidic foul-smelling stool, dry and sparse skin and hair, photophobia and corneal opacity in severe cases, emaciation, night fever and daytime coolness, etc.
Houpo (Magnoliae Officinalis Cortex) [digests food accumulation, stir-fried with ginger juice, 1 liang], Juhong (Citri Reticulatae Pericarpium Rubrum) [moves stagnant Qi, 8 qian], Gancao (Glycyrrhizae Radix et Rhizoma) [harmonizes the middle], Zhenlushui (Aloe), Wuyi (Chrysanthemi Indici Flos) [each 5 qian], Qingdai (Indigo Naturalis) [all kill parasites and clear malnutrition heat], Baicaoshuang (Carbonis Herbae) [resolves accumulation], Xuanjinhua (Inulae Flos) [dissolves hard phlegm, each 2 qian]. (Grind these eight ingredients into fine powder. For children, administer 1 fen per year of age, mixed with Dengxincao (Junci Medullae) decoction on an empty stomach. Once half the accumulation is resolved, switch to Fei'er Wan for regulation.)
Fei'er Wan (Spleen-Nourishing Pill): Highly effective for infantile malnutrition.
Renshen (Ginseng Radix et Rhizoma) [3 qian], Baishao (Paeoniae Radix Alba), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma) [mixed with Sharen (Amomi Fructus Rotundus) 5 qian each, others 1 liang each], Bian Dou (Dolichoris Semen), Lianrou (Nelumbinis Semen) [strengthen Spleen], Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), Hongqu (Monascus Rice), Juhong (Citri Reticulatae Pericarpium Rubrum), Sharen (Amomi Fructus Rotundus) [digest food], Huanglian (Coptidis Rhizoma), Shijunzi Rou (Quisqualis Semen), Wuyi (Chrysanthemi Indici Flos), Qingdai (Indigo Naturalis) [clear heat and kill parasites], Huashi (Talcum) [clear heat and guide out stagnation]. Total sixteen ingredients. Honey-pilled to the size of a bullet. Take one pill per dose, dissolved in warm water on an empty stomach.
Shibao Wan (Ten-Treasure Pill): Treats adult and pediatric jaundice due to food accumulation, and pediatric malnutrition.
Pingwei San plus Shan Zha Rou (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), Binglang (Arecae Semen), Fuling (Poria) [each 2 liang], Lüfan (Vitriolum Viride) [effectively digests food accumulation and treats various jaundices, vinegar-treated until red, 4 liang]. Lifelong avoidance of buckwheat and pufferfish is required; ingestion causes death. Form pills with jujube flesh to the size of sophora seeds. Take 1 qian per dose with warm water, three times daily. After administration, press down the medicine with food.
These three formulas are miraculous agents for treating pediatric malnutrition, proven effective through repeated trials.
Yigong San (Benefit the Work Decoction), Guipi Tang (Restore the Spleen Decoction), Liu Junzi Tang (Six Gentlemen Decoction) [see Stroke].
May additionally include Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus Rotundus), Chenxiang (Aquilariae Lignum Resinatum), Baixiaoren (Amomi Fructus), Shanzha (Crataegi Fructus), and Maiya (Hordei Fructus Germinatus).
Zisheng Wan (Life-Nourishing Pill) [see Consumption].
These four formulas employ a method of tonification combined with digestion. Use with modifications for Deficiency patterns. According to *Yi Guan*: "If Yuan Qi in the Stomach is abundant, one can eat without injury and feel no hunger past meal times. If Yuan Qi is deficient, one easily suffers food injury. Using purely Qu (Medicated Leaven), Houpo, Shanzha, and Maiya merely seeks temporary relief. Have they not considered that if the Spleen is already injured, subjecting it to further digestion depletes its deficiency further, making future food injury more likely." Thus, those who consume rich foods differ from those who consume coarse foods. Those eating coarse foods and robust may use Baohe Wan or Da Chengqi Tang; applying these methods indiscriminately to those consuming rich foods who are weak causes significant harm.
Guangbiji Fang (Recorded Notes Formula): Treats elderly patients with cold food injury and indigestible items.
Shengjiang (Zingiberis Rhizoma Recens), Zisu (Perillae Folium) [boil into strong decoction, place in bath tub, let patient soak and steam in the hot liquid].
This method utilizes acrid-warm properties to unblock Qi; once Qi flows freely, food digests naturally.