小儿食积者，因脾胃虚寒，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；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，用大柴胡汤；如无外
感，但只伤食不致于甚，保和丸调之。盖脾为至阴之脏也，故凡脾病者，至夜必热，热而兼
矣。食未消者消之，则寒热自止；食既消者补之，则寒热自痊。
若手足并冷，喜热饮食，此中州虚寒也，宜温之；大便欲去不去，脾气下陷也，宜升之。若
夜间或侵晨泄泻者，脾胃俱虚也，用四神丸。手足并热，作渴饮水者，脾胃实热也，用泻黄
散。大便秘结，用大柴胡汤。手足虽热，口不作渴，大便不实者，用白术散。仍参腹痛腹胀
，积痛积滞治之。
治验
一小儿伤食腹胀，胸满有痰，余用异功散而痊。后复伤食，腹胀作痛，或用药下之，痛虽止
而胀益甚，更加喘粗，此脾气伤而及于肺也，用六君、桔梗调补而痊。
一小儿腹胀恶食，寒热恶心，症类外感。余曰∶气口脉大于人迎，此饮食停滞也。用保和丸
一服，诸症顿退。但腹胀未已，用异功散而痊。
一小儿伤风，咳嗽痰涌，用六君、桔梗、桑皮、杏仁而愈。后饮食停滞，腹泻胀痛，又用六
君加山楂、浓朴而安。腹停食作呕，或用药下之，更加咳嗽，余谓此脾肺益虚，欲行调补，
彼以为缓，乃服发表克滞之药，前症益甚，更加摇头，余用天麻散倍加钩藤钩及异功散而愈
。
一小儿胸腹胀痛，寒热顿闷，以手按腹即哭，此饮食停滞也，先用保和丸一服，前症即愈，
更加烦渴，按其腹不哭，此宿食去而脾气未复也，用五味异功散加柴胡治之而瘳。
一小儿饮食停滞，服消导之剂，饮食既消，热尚未退，此胃经虚热也。用六君子加升麻、柴
胡，四剂而愈。
一小儿先因饮食停滞，服克伐之剂，更加腹痛，按之则止，余用六君子汤而愈。后腹伤食，
服保和丸及三棱、槟榔之类，更加腹重善噫，此脾气虚而下陷也，仍用前汤加升麻、柴胡、
一小儿面色青白，饮食难化，大便频泄，或用消积化痰等药，久不愈，余谓脾胃虚弱也，用
六君子汤渐愈。或以为食积，宜驱逐之，遂反作泻，痰喘发搐。余谓∶脾气复伤，不能生肺
，肺虚不能平肝，而作是症。先用六君加钩藤钩，饮食少进，又用五味异功散加升麻而愈。
一小儿患前症腹痛，服攻下之剂，发热不已，大便不化，按其腹不痛，与冷水不饮，此食积
去而脾气虚也，用五味异功散加当归、升麻而愈。
三黄枳术丸 治伤肉湿面辛辣味浓之物，致填塞闷乱不快。
枳实（面炒，五钱） 黄连（酒浸炒） 大黄（湿纸裹煨） 白术（各一两） 黄芩（五钱）
上为末，汤浸 饼为丸，如绿豆大。每服五十丸，白汤下，临时量所伤多少，加减服之。
大柴胡汤（方见痉症）
四神丸（方见惊泻）
六君子汤
五味异功散（二方见内钓）
泻黄散（方见脾脏）
白术散（方见积滞）
保和丸（方见虚羸）
加减肾气丸（方见腹胀）
天麻散（方见百 内嗽，即天麻丸）
小儿食积，是由于脾胃虚寒，导致乳食无法消化，日久形成积滞。其症状表现为夜间发热，天亮后体温恢复正常，伴有腹痛、腹部胀满，呕吐酸水，脚部发冷而腹部发热，嗜睡且神志昏沉，大便气味酸臭。若出现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，应采用催吐法；若停滞在胃的下口，应采用消导法；若腹痛且痞块胀满，按压时疼痛加剧，应采用泻下法；若泻下后疼痛仍在，但按压时疼痛缓解，则应采用补益法。
若夹带外感伤寒，先采用发散解表法，使用参苏饮；若内热严重且大便秘结，先采用通利攻下法，使用大柴胡汤；若无外感，仅是饮食损伤且不严重，用保和丸调理即可。因为脾脏属于至阴之脏，所以凡是脾病，往往在夜间发热，这种热象常夹杂其他病机。食物未消者予以消导，寒热自止；食物已消但正气未复者予以补益，寒热自愈。
若手足俱冷，喜欢热饮食，这是中焦（脾胃）虚寒，适宜温补；若大便欲解不得解，是脾气下陷，适宜升提。若在夜间或清晨发生泄泻，是脾胃俱虚，使用四神丸。若手足俱热，口渴想喝水，是脾胃实热，使用泻黄散。若大便秘结，使用大柴胡汤。若手足虽热，但口不渴，大便稀溏不成形，使用白术散。同时需参考腹痛腹胀、积滞疼痛的治法进行综合治疗。
医案记录：
有一个小儿因伤食导致腹胀，胸部满闷且有痰，我用异功散治愈。后来再次伤食，腹胀且疼痛，有人用药攻下，虽然疼痛停止，但腹胀更加严重，并出现呼吸急促粗重，这是脾气受伤波及肺脏，我用六君子汤加桔梗调补而治愈。
有一个小儿腹胀、厌恶进食，伴有寒热和恶心，症状类似外感。我说：“气口脉大于人迎脉，这是饮食停滞所致。”服用一剂保和丸，所有症状顿时消退。但腹胀仍未消除，改用异功散而痊愈。
有一个小儿患伤风，咳嗽且痰多涌出，用六君子汤加桔梗、桑白皮、杏仁治愈。后来饮食停滞，出现腹泻、腹胀疼痛，又用六君子汤加山楂、厚朴而安定。腹部停食导致呕吐，有人用药攻下，反而加重咳嗽，我认为这是脾肺更加虚弱，本想进行调补，患者家属认为见效慢，于是服用了发表克滞的药物，导致前症加重，并出现摇头症状，我用天麻散加倍钩藤钩及异功散而治愈。
有一个小儿胸腹胀痛，寒热突然发作且感到烦闷，用手按压腹部就哭，这是饮食停滞所致，先用一剂保和丸，前症即愈。随后出现烦躁口渴，但按压腹部不再哭闹，这是宿食已去但脾气尚未恢复，用五味异功散加柴胡治疗而好转。
有一个小儿饮食停滞，服用消导药剂，食物虽已消化，但发热仍未退去，这是胃经虚热。用六君子汤加升麻、柴胡，服用四剂而愈。
有一个小儿起初因饮食停滞，服用克伐（攻伐）药物，导致腹痛加重，按压则疼痛缓解，我用六君子汤治愈。后来腹部再次伤食，服用保和丸及三棱、槟榔等药，导致腹部沉重且频繁打嗝，这是脾气虚而下陷，仍用前方加升麻、柴胡。
有一个小儿面色青白，饮食难以消化，大便频繁泄泻，有人用消积化痰等药，久治不愈，我认为这是脾胃虚弱，用六君子汤逐渐治愈。有人认为是食积，宜用驱逐之法，结果反而导致泄泻加重，出现痰喘、抽搐。我认为这是脾气再次受伤，不能生养肺金，肺虚不能制约肝木，从而产生这些症状。先用六君子汤加钩藤钩，饮食稍进，又用五味异功散加升麻而痊愈。
有一个小儿患前述腹痛症状，服用攻下药物，发热不止，大便不化，按压腹部不痛，不给冷水也不喝，这是食积已去但脾气虚弱，用五味异功散加当归、升麻而愈。
三黄枳术丸：治疗因食用肉类、湿面、辛辣浓味之物，导致填塞胸闷、烦乱不适。
配方：枳实（面粉炒，五钱）、黄连（酒浸炒）、大黄（湿纸包裹煨制）、白术（各一两）、黄芩（五钱）。
制法：以上药材研为细末，用米汤浸泡面饼制成丸药，大小如绿豆。每次服用五十丸，白开水送下，根据所伤食物的多少，临时增减剂量服用。
大柴胡汤（方剂见痉症章节）
四神丸（方剂见惊泻章节）
六君子汤
五味异功散（两方剂见内钓章节）
泻黄散（方剂见脾脏章节）
白术散（方剂见积滞章节）
保和丸（方剂见虚羸章节）
加减肾气丸（方剂见腹胀章节）
天麻散（方剂见百日内嗽，即天麻丸）
Pediatric food stagnation arises from deficiency-cold of the Spleen and Stomach, leading to the failure of milk and food to digest, which over time forms stagnation. Its symptoms include fever at night with normalization of temperature at dawn, abdominal pain and distension, vomiting of sour fluid, cold feet with a hot abdomen, lethargy with clouded consciousness, and sour-smelling stool. When these symptoms are accompanied by alternating chills and fever, it is termed "Food Stagnation with Alternating Chills and Fever."
If food stagnates at the upper opening of the Stomach, emesis (inducing vomiting) should be used; if it stagnates at the lower opening, digestion-promoting methods should be employed; if there is abdominal pain and fullness that worsens upon pressure, purgation should be used; if pain persists after purgation but alleviates upon pressure, tonification should be applied.
In cases complicated by Wind-Cold exogenous pathogen, dispersing methods should be used first, such as Shen Su Yin (Ginseng and Perilla Decoction). If internal heat is severe with constipation, draining methods should be used first, such as Da Chai Hu Tang (Major Bupleurum Decoction). If there is no exogenous contraction, but only mild food injury, Bao He Wan (Preserve Harmony Pill) can be used for regulation. Since the Spleen is the organ of extreme Yin, diseases of the Spleen often manifest with fever at night, where the heat may be complex. For undigested food, promoting digestion stops the chills and fever; for resolved food with deficient Qi, tonification cures the chills and fever.
If both hands and feet are cold and the child prefers hot drinks, this indicates deficiency-cold of the Middle Jiao (Spleen and Stomach), suitable for warming. If there is an urge to defecate but inability to do so, it indicates sinking of Spleen Qi, suitable for lifting. If diarrhea occurs at night or early morning, it indicates deficiency of both Spleen and Stomach, treated with Si Shen Wan (Four Spirits Pill). If both hands and feet are hot with thirst and desire for water, it indicates excess-heat of the Spleen and Stomach, treated with Xie Huang San (Drain Yellow Powder). For constipation, Da Chai Hu Tang is used. If hands and feet are hot but without thirst and with loose stools, Bai Zhu San (Atractylodes Macrocephala Powder) is used. Treatment should also refer to methods for abdominal pain, distension, and stagnation.
Clinical Cases:
One infant had abdominal distension due to food stagnation, chest fullness with phlegm. I cured him with Yi Gong San (Benefit the Work Powder). Later, he suffered food stagnation again with abdominal distension and pain. After someone used purgatives, the pain stopped but distension worsened, accompanied by coarse breathing. This indicated Spleen Qi injury affecting the Lung. I cured him by regulating and tonifying with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Jie Geng (Platycodon Root).
One infant had abdominal distension, anorexia, alternating chills and fever, and nausea, resembling an exogenous pattern. I stated: "The Qi Kou pulse is larger than the Ren Ying pulse, indicating food stagnation." One dose of Bao He Wan caused all symptoms to recede. However, abdominal distension persisted, and he was cured using Yi Gong San.
One infant had Wind-Cold with cough and profuse phlegm, cured by Liu Jun Zi Tang plus Jie Geng, Sang Bai Pi (Morus Bark), and Xing Ren (Apricot Seed). Later, food stagnation caused diarrhea, abdominal distension, and pain, settled by Liu Jun Zi Tang plus Shan Zha (Hawthorn Fruit) and Hou Po (Magnolia Bark). Abdominal food retention caused vomiting; after purgation, cough worsened. I reasoned this was further deficiency of Spleen and Lung, intending to tonify. The family deemed it too slow and administered dispersing and stagnation-breaking herbs, worsening previous symptoms and adding head-shaking. I cured him with Tian Ma San (Gastrodia Powder) with doubled Gou Teng Gou (Uncaria Ramulus cum Uncis) and Yi Gong San.
One infant had chest and abdominal pain, sudden onset of chills and fever with irritability, crying upon abdominal pressure, indicating food stagnation. One dose of Bao He Wan cured previous symptoms. Subsequently, irritability and thirst appeared, but no crying upon pressure, indicating residual food cleared but Spleen Qi not yet recovered. Treated with Wu Wei Yi Gong San (Five-Ingredient Benefit the Work Powder) plus Chai Hu (Bupleurum Root) for improvement.
One infant had food stagnation; after taking digestion-promoting agents, food digested but fever remained, indicating deficiency-heat of the Stomach Meridian. Cured with Liu Jun Zi Tang plus Sheng Ma (Cimicifuga Rhizome) and Chai Hu, four doses.
One infant initially had food stagnation; after taking attacking/deficient-clearing agents, abdominal pain worsened, alleviated by pressure. Cured with Liu Jun Zi Tang. Later, abdominal food stagnation occurred; after taking Bao He Wan and San Leng (Curcuma Zedoaria Rhizome), Bing Lang (Areca Seed), etc., abdominal heaviness and frequent belching ensued, indicating Spleen Qi deficiency and sinking. Still used the former decoction plus Sheng Ma and Chai Hu.
One infant had cyanotic-white complexion, indigestion, and frequent diarrhea. After long-term use of stagnation-resolving and phlegm-transforming drugs without cure, I diagnosed Spleen and Stomach weakness, gradually curing with Liu Jun Zi Tang. Others thought it was food stagnation requiring expulsion, causing worsened diarrhea, phlegm-wheezing, and convulsions. I reasoned: Spleen Qi injured again, failing to generate Lung Metal; Lung deficiency fails to control Liver Wood, causing these symptoms. First used Liu Jun Zi Tang plus Gou Teng Gou; diet improved slightly. Then used Wu Wei Yi Gong San plus Sheng Ma for cure.
One infant had abdominal pain as described; after taking purgatives, fever persisted, stool undigested, no pain on pressure, refusal of cold water. This indicated food stagnation cleared but Spleen Qi deficient. Cured with Wu Wei Yi Gong San plus Dang Gui (Angelica Sinensis Radix) and Sheng Ma.
San Huang Zhi Zhu Wan: Treats discomfort, stuffiness, and mental agitation caused by consuming meat, damp noodles, and strong spicy flavors.
Ingredients: Zhi Shi (Immature Bitter Orange Fruit, stir-fried with flour, 5 qian), Huang Lian (Coptis Rhizome, soaked in wine and stir-fried), Da Huang (Rhubarb Root and Rhizome, wrapped in wet paper and baked), Bai Zhu (Atractylodes Macrocephala Rhizome, each 1 liang), Huang Qin (Scutellaria Root, 5 qian).
Preparation: Grind into powder. Soak wheat cake in decoction to make pills, size of mung beans. Take 50 pills per dose with clear water, adjusting dosage based on the amount of ingested offending food.
Da Chai Hu Tang (See formula in Spasm section)
Si Shen Wan (See formula in Startle Diarrhea section)
Liu Jun Zi Tang
Wu Wei Yi Gong San (Both formulas see Internal Hook section)
Xie Huang San (See formula in Spleen Organ section)
Bai Zhu San (See formula in Food Stagnation section)
Bao He Wan (See formula in Emaciation section)
Jia Jian Shen Qi Wan (See formula in Abdominal Distension section)
Tian Ma San (See formula in Infantile Cough within Hundred Days, i.e., Tian Ma Wan)