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[Appendix: Food Injury]

General Principles: Headache, feverish body, slight abdominal distension, cold feet, drowsiness and lethargy; when injured by food leading to Spleen Qi deficiency, treatment should prioritize releasing the exterior before employing gentle purgation.

Pulse Diagnosis: If the Qi Kou pulse at the right hand is one to two times larger than the Ying Yang pulse, it indicates food injury. If retained food fails to digest, the Guan position on the right hand presents a deep and slippery pulse. A yellowish hue in the Tiger's Mouth vein pattern indicates accumulation in the Spleen. A deep pulse in children indicates undigested milk.

The *Nei Jing* (Inner Canon) states: "When food and drink intake doubles, the Spleen and Stomach are injured." The accumulation disorders suffered by children are all due to unregulated nursing and feeding, overconsumption of raw, cold, hard, or tough substances, which the Spleen and Stomach cannot transform. This leads to stagnation in the Zhong Wan region. Externally, they may be injured by wind-cold, or suffer from sleeping without adequate covering at night, resulting in headache, sallow complexion, fever, slightly swollen eyelids, abdominal pain and distension, cold feet with a hot abdomen, excessive sleepiness, mental confusion, loss of appetite, vomiting, hiccups, sour belching, and sour-smelling stool. All these are injuries caused by accumulation. Some cases involve spleen damage from overeating, where Spleen Qi becomes slightly deficient, causing difficult-to-digest food to remain stagnant and not disperse, eventually forming an accumulation. If the accumulation deteriorates, it transforms into dysentery.

Ren Zhai stated: Children with accumulation present with yellowish swelling of the face and eyes, a hot and distended abdomen, prone sleeping with much fatigue, crying while refusing food, or constipation with dry stool, oily urine, or involuntary diarrhea with white, sour-smelling feces. These are all accumulation disorders. However, one must distinguish between Milk Accumulation, Food Accumulation, Qi Accumulation, and Shock Accumulation. Vomiting milk or having milky diarrhea with a sour smell occurs when milk is given while the child is still crying; the milk stagnates and fails to transform, known as Milk Accumulation. A warm abdominal wall, thirst, diarrhea, or vomiting results from unregulated diet, overeating, and falling asleep immediately after fullness, known as Food Accumulation. Abdominal pain with crying and dysenteric stools resembling mud occur due to emotional disturbance affecting Qi mechanism, disharmony of Ying and Wei, and prolonged salivation, known as Qi Accumulation. Frequent passage of clear water like crushed grass juice, accompanied by irritability, whimpering, and apparent anger, occurring after fright, is named Shock Accumulation, formed by prolonged illness leading to accumulation. Other signs include sweat on the forehead, panting with irritability and thirst, alternating chills and fever, heat in the abdomen, and a sensation of movement within the abdomen during sleep. Accumulation can be either Deficient or Excess. Deficiency manifests as slight whole-body heat, anorexia, dull and slow spirit, and appearing asleep when held. Excess manifests as vomiting, heat with constipation, bulging fontanelle, throat obstruction, phlegm congestion, wheezing saliva, and heat-toxin sores. Regarding milk or food injury with fever, the heat is most severe in the abdomen. People know that foot injury presents with cold feet and hot abdomen, extremely sour-smelling feces, and night fever, which are clear signs of accumulation injury. However, if complications arise—such as black complexion, black diarrhea, persistent diarrhea, abdominal distension, coarse breathing, palm sores, and emaciated softness—the condition is incurable. To resolve accumulation in children, Qing Pi (Green Tangerine Peel) is often used, but since it strongly induces sweating, it should not be given in excess to those who already have sweat. Most childhood diseases stem from unregulated nursing and feeding, overeating, leading to failure of transformation and retention as accumulation. At the onset, regardless of whether it is Milk, Food, or Qi accumulation, Xiao Ji Wan (Accumulation Resolving Pill) should be administered. For Shock accumulation, Chen Sha Gao (Cinnabar Paste) or Qing Long Wan (Azure Dragon Pill) should be used, guided by severity to promote drainage. Ultimately, healing is achieved by harmonizing Qi and regulating the Spleen and Stomach. Since the Spleen and Stomach are already injured, further drug toxicity reduces the circulating Qi, making digestion even harder and worsening the condition. The *Wu Chang Zheng Da Lun* (Great Discourse on the Five Regular Policies) states: "For drugs with great toxicity, remove six-tenths of the disease; for small toxicity, seven-tenths; for common toxicity, eight-tenths; for non-toxic drugs, nine-tenths. Nourish with grains, meats, fruits, and vegetables. Do not let the medicinal force exceed limits, lest it injure healthy Qi." All people rely on Stomach Qi as the root, and treating disease is no different. Children's Spleen and Stomach can be Deficient or Excess. Deficiency presents with vomiting and anorexia; Excess presents with stuffiness, fullness, and internal solidity. Deficiency requires tonification; Excess requires reduction. Balance is the goal. For Stomach Deficiency, use Mu Xiang (Aucklandiae Radix), Ding Pi (Eugeniae Caryophyllati Cortex), Hou Po (Magnoliae Officinalis Cortex), and Rou Dou Kou (Myristicae Semen). For Stomach Excess, use Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus), Chai Hu (Bupleuri Radix), and Da Huang (Rhei Radix et Rhizoma). If cold stagnates in the Stomach, Gan Jiang (Zingiberis Rhizoma), Guan Gui (Cinnamomi Cortex), and Ding Xiang (Eugeniae Flos) are indispensable, requiring careful dosage adjustment based on age and size. This is called balancing. Since the Heart is the mother of the Spleen, promoting digestion involves more than just harmonizing the Spleen; supplementing Fire generates Earth. Therefore, Heart-related herbs should be incorporated into Spleen and Stomach formulas. This explains why ancient digestive formulas frequently used Yi Zhi Ren (Alpiniae Oxyphyllae Fructus).