食填太阴，须健脾胃，候胃气转动，自能消化；如用克伐，非惟无益，而元气反耗矣。仲景制理中治中，
实为祖方也。（王协中）
凡饮食不消，胸膈胀闷，须加行气药于消导剂中。予常治胸膈痞滞，饮食胀闷，用白术、陈皮、枳实、楂
肉，加香、砂为丸，服之少顷，呕气数声，胸膈即宽，饮食即进，此皆行气之功。固虽伤于热食，须用芩、连，
亦必加香、砂方效。不然，食方凝结，又益以寒凉，食安得行，气安得化，因成脾泄中满者多矣。（余傅山）
伤食，医多妄下，使清气下陷，则浊气不得下降，反生 胀。故东垣治以补中益气汤，升其下陷之清气，
则浊气自降。○俗有以食消食之法，以饭肉等所伤之物，烧灰为末，用酒或陈皮汤下颇效。此物不甚伤脾，可
用。有以酒药烧灰服者，又有服生酒药者，最为峻厉，不宜用。（《折肱漫录》）
凡消食之药，丸、散优于汤液。盖无形之气，以无形散之；有形之积，以有形消之。（许宣治）
脉候
脉紧如转索无常者，有宿食也。○脉数而滑，实也，此有宿食，下之愈。（《金匮》）
伤食，脉有滑、涩之异。脾虚不能鼓运，胃虚不能熟腐，故其脉不滑而涩。若人迎紧盛，气口滑者，停食
感冒也。（《张氏医通》）
选案
吴成章弟，八岁，发热闷乱，大便不通，医作感证治。予曰∶此得之伤食，因发散太过，遂成虚热，风药
燥血，故不便耳。先用六味汤加苁蓉，下黑矢十数枚；后用补中益气汤，诸证悉除。此伤食妄投发散，血燥肠
枯，所伤之食愈秘而不出也。（高鼓峰）
一人病停食，医投消导药，将食逼坠少腹，其痛异常，便终不出，坐则一囊坠下，卧则倒入腹中，脉沉迟
细，唇舌灰白，用补中益气汤加姜、桂，便出痛愈。○一儿发热七昼夜不退，昏睡不食，幼科看过，总不退热，
虑其动惊。余视其儿，目闭颊红，唇紫舌黄，腹硬拒按，此火邪由食遏而成，清之则食不化，表之徒伤元气，
方用浓朴、枳壳、山楂、麦芽、草果、大黄，服药二时，大解三次，热退卧安，早起即索饮食，嬉戏如常。（吴天士）
When food stagnates in the Taiyin (Spleen) channel, it is necessary to strengthen the Spleen and Stomach. Once the Stomach Qi resumes its movement, digestion will occur naturally; if one uses harsh purgatives or draining methods, not only is there no benefit, but the Yuan Qi (Original Qi) will instead be depleted. Zhang Zhongjing's formulation Lizhong Tang (Regulate the Middle Decoction) for treating middle-jiao deficiency-cold is indeed the ancestral formula for such treatments. (Wang Xiezhong)
Whenever indigestion leads to distension and stuffiness in the chest and diaphragm, qi-moving herbs must be added to the digestive formulas. I frequently treat cases of chest and diaphragm obstruction and postprandial distension using Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Zhishi (Aurantii Fructus Immaturus), and Shazha Rou (Crataegi Fructus), combined with Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus) to make pills. After taking them for a short while, the patient belches several times, the chest and diaphragm immediately feel relaxed, and appetite returns. This is all due to the efficacy of qi-moving herbs. Even if the injury is caused by hot food, requiring Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma) for clearing heat, one must still add Muxiang and Sharen for effectiveness. Otherwise, as the food coagulates, adding cold-natured herbs will prevent the food from descending and the Qi from transforming, leading many to develop Pi Xie (Spleen Diarrhea) and Zhong Man (Middle Jiao Fullness). (Yu Fushan)
In cases of food injury, physicians often recklessly use purgatives, causing Clear Qi to sink downward. Consequently, Turbid Qi cannot descend, resulting in distension. Therefore, Li Dongyuan treated this with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise the sinking Clear Qi, after which the Turbid Qi would naturally descend. ○ Folk medicine employs a method of using food to digest food: burning rice, meat, or other offending foods to ash, grinding them into powder, and administering them with wine or Chenpi decoction, which is quite effective. These substances do not severely damage the Spleen and can be used. Some burn Jiuyao (Medicated Leaven) into ash for consumption, while others take raw Jiuyao, which is extremely harsh and should not be used. (Zhe Gong Man Lu)
For digestive herbs, pills and powders are superior to decoctions. Intangible Qi is dispersed by intangible forms (powders); tangible accumulations are eliminated by tangible forms (pills). (Xu Xuanzhi)
Pulse Diagnosis
A pulse that is tight like a turning rope and irregular indicates the presence of retained food. ○ A rapid and slippery pulse indicates excess; this signifies retained food, which is cured by purgation. (Jin Gui Yao Lue)
In food injury, pulses may differ between slippery and choppy qualities. If the Spleen is deficient and unable to promote transportation and transformation, and the Stomach is deficient and unable to ripen and decompose foodstuffs, the pulse will be choppy rather than slippery. If the Renying (Radial Artery at the Neck) pulse is tight and full, and the Qikou (Radial Pulse at the Wrist) is slippery, it indicates retained food complicated by wind-cold invasion. (Zhang Shi Yi Tong)
Selected Cases
The younger brother of Wu Chengzhang, aged eight, suffered from fever, mental restlessness, and constipation. The physician treated it as an external contraction. I said: "This resulted from food injury. Excessive use of diaphoretic herbs led to deficient heat; wind-dispersing herbs dried the blood, hence the constipation." I first administered Liuwei Tang (Six-Ingredient Decoction) plus Rongrong (Cistanche Herba), resulting in the passage of over ten black stools. Subsequently, I used Buzhong Yiqi Tang, and all symptoms resolved. This case illustrates how reckless use of diaphoretics for food injury causes blood dryness and intestinal desiccation, making the retained food even more constipated and difficult to expel. (Gao Gufeng)
A patient suffered from food retention. The physician administered digestive herbs, forcing the food down into the lower abdomen, causing severe pain. The stool remained unpassed; when sitting, a sac-like mass prolapsed, and when lying down, it retracted into the abdomen. The pulse was deep, slow, and fine; the lips and tongue were grayish-white. I prescribed Buzhong Yiqi Tang plus Ganjiang (Zingiberis Rhizoma) and Guirou (Cinnamomi Cortex). The stool passed, and the pain ceased. ○ Another child had a fever for seven days and nights without relief, sleeping lethargically and refusing food. Pediatricians treated him but failed to reduce the fever, fearing convulsions. Upon examination, I found his eyes closed, cheeks red, lips purple, and tongue coated yellow. His abdomen was hard and tender to pressure. This fire pathogen arose from food stagnation. Clearing heat would hinder digestion, and releasing the exterior would merely deplete the Yuan Qi. I prescribed Houpo (Magnoliae Officinalis Cortex), Zhiqiao (Aurantii Fructus), Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), Caoguo (Tsaoko Fructus), and Dahuang (Rhei Radix et Rhizoma). After two hours of medication, he had three bowel movements, the fever subsided, he slept peacefully, and upon waking, he requested food and played normally. (Wu Tianshi)