乳积之儿，其候睡卧不宁，不时啼叫，口中气热，频吐乳
片，肚胀腹热，大便酸臭，古法主消乳丸（方见伤乳吐）。
〔真按〕小儿乳积，因伤乳而停积，自与伤乳即吐者有别，脏腑娇嫩，不宜妄攻，方用炒麦芽一钱，六神曲
八分，云茯苓二钱，炒莱菔子五分，炒枳壳八分，炙甘草三分，引用生姜一片。
小儿恣意肥甘生冷，不能运化，则肠胃皆有积滞。其证头温腹热，大便酸臭，嗳气恶食，烦不安眠，口干作
渴，积轻者，古法主木香大安丸以消导之（如木香、黄连、陈皮、土炒白术、炒枳实、山楂、连翘、炒神曲、炒
麦芽、砂仁、莱菔子，共为细末，神曲糊为丸）。每服一钱，陈仓米汤下。
积重便秘者，古法主小承气汤以攻下之（方见前）。
〔真按〕小儿食积，轻者但用麸炒枳实一钱，制野术一钱，引用缩砂仁三分。食积重者，本方加炒神曲八分，
炒麦芽八分，山楂肉钱半，焙莱菔子五分，引用香连丸十粒。便秘者，再加更衣丸五粒。
凡饮食之积，其初积者不过偶伤饮食，必在肠胃之内，可行可逐，治之不难。惟历久饮食无节，渐留滞垢，遂
成癖疾。其积在左胁膈膜之间，此阳明宗气所出之道也。《经》曰∶胃之大络，名曰虚里，贯膈络肺，出于左乳
下，其动应衣脉宗气也。结而横有积矣。人苟平日饥饱失时，饮食叠进，以致阳明胃气一有所逆，则阴寒之气得
以乘之，而脾不及化，则余滞并肠外汁沫，团聚不散，渐成症结，始如鸡卵，坚硬成块，渐如覆盆之形，过
脐则证危矣。然其初起甚微，人多不觉，既久根深蒂固，则药力难达病所。今西北小儿多有此疾，尤以食面之乡
村为最多，因留积于皮里膜外，所以不易治也。治宜缓消，不宜急攻，要详察之，因作癖疾解。
乳积的患儿，其表现为睡眠不安稳，不时啼哭叫喊，口中气息发热，频繁吐出未消化的奶块，腹部胀满且腹壁发热，大便气味酸臭。古法主张使用消乳丸（方剂见“伤乳吐”章节）。
〔陈守真按语〕小儿乳积，是因为损伤乳汁而导致停滞积聚，这与受伤后立即呕吐的情况有所不同。由于小儿脏腑娇嫩，不适宜盲目使用峻猛攻伐的药物。处方用炒麦芽一钱，六神曲八分，云茯苓二钱，炒莱菔子五分，炒枳壳八分，炙甘草三分，煎药时加入生姜一片作为引经药。
小儿如果肆意食用肥腻、甘甜及生冷食物，导致脾胃无法运化，则肠胃中都会产生积滞。其症状表现为头部温热、腹部发热，大便酸臭，嗳气且厌恶进食，烦躁不安难以入睡，口干口渴。积滞较轻者，古法主张使用木香大安丸以消除导滞（药物组成如木香、黄连、陈皮、土炒白术、炒枳实、山楂、连翘、炒神曲、炒麦芽、砂仁、莱菔子，共研为细末，用神曲糊制成丸剂）。每次服用一钱，用陈仓米汤送服。
积滞严重且伴有便秘者，古法主张使用小承气汤以攻下通便（方剂见前文）。
〔陈守真按语〕小儿食积，轻症仅需用麸炒枳实一钱，制苍术一钱，煎药时加入缩砂仁三分作为引经药。食积重症者，在本方基础上加炒神曲八分，炒麦芽八分，山楂肉一钱半，焙干莱菔子五分，煎药时加入香连丸十粒作为引经药。若伴有便秘，再加服更衣丸五粒。
凡是饮食造成的积滞，初期的积滞不过是偶然损伤饮食，必然停留在肠胃之内，可以通过行气或逐邪的方法治疗，并不困难。只有长期饮食无节制，逐渐留下滞留污垢，才形成癖疾。这种积滞位于左侧胁肋与膈膜之间，这是阳明宗气运行的通道。《黄帝内经》说：“胃的大络，名叫虚里，贯穿膈肌联络肺脏，出于左乳下方，其搏动可应衣襟，反映宗气的盛衰。”如果气机结聚而横逆，就会产生积滞。人如果平时饥饱失调，饮食连续进补，导致阳明胃气一旦有逆乱，阴寒之气便能乘虚而入，脾脏来不及运化，于是剩余的滞浊连同肠外的津液泡沫，团聚不散，逐渐结成症块，起初像鸡蛋大小，坚硬成块，渐渐变成倒扣盆子的形状，如果肿块越过肚脐，病情就危险了。然而疾病初起时非常微小，人们大多没有察觉，时间久了便根深蒂固，药力难以到达病所。现在西北地区的儿童多有此疾，尤其在以面食为主的乡村最为多见，因为积滞停留在皮里膜外，所以不容易治愈。治疗应当缓慢消散，不宜急于攻伐，必须详细诊察，因此撰写了这篇《癖疾解》。
For infants suffering from **milk accumulation** (Ru Ji), the manifestations include restless sleep, frequent crying and calling, hot breath from the mouth, frequent vomiting of undigested milk curds, abdominal distension with heat in the abdomen, and sour, foul-smelling stools. Ancient methods primarily recommend *Xiaoru Wan* (Milk-Dissolving Pill) (see formula under "Vomiting due to Damaged Milk").
[Commentary by Chen Shouzhen] Infant milk accumulation arises from damaged milk causing stagnation and accumulation; this differs from cases where vomiting occurs immediately upon damage to the milk. Since children's **zang-fu organs** (Zang-Fu Organs) are delicate and tender, one should not recklessly use harsh purgative attacks. The prescription consists of stir-fried *Maiya* (Hordei Fructus Germinatus, 麦芽) 1 qian, *Liushen Qu* (Six-God Leaven, 六神曲) 8 fen, *Yun Fuling* (Poria, 茯苓) 2 qian, stir-fried *Laifuzi* (Radish Seed, 莱菔子) 5 fen, stir-fried *Zhike* (Aurantium Fructus, 枳壳) 8 fen, and honey-fried *Gancao* (Licorice Root, 甘草) 3 fen, using one slice of fresh ginger as a guiding agent.
If children indulge in rich, sweet, fatty, and raw/cold foods without restraint, leading to an inability of the spleen and stomach to transform and transport, **accumulation and stagnation** (Ji Zhi) will occur in the intestines and stomach. The symptoms present as warmth in the head, heat in the abdomen, sour and foul-smelling stools, belching with aversion to food, irritability and inability to sleep peacefully, dry mouth, and thirst. For mild accumulation, ancient methods recommend *Muxiang Da'an Wan* (Wood-Aromatic Great Peace Pill) to eliminate and guide out stagnation (ingredients include *Muxiang* (Aucklandiae Radix, 木香), *Huanglian* (Coptidis Rhizoma, 黄连), *Chenpi* (Citri Reticulatae Pericarpium, 陈皮), earth-stir-fried *Baizhu* (Atractylodis Macrocephalae Rhizoma, 白术), stir-fried *Zhishi* (Aurantii Fructus, 枳实), *Shanzha* (Crataegi Fructus, 山楂), *Lianqiao* (Forsythiae Fructum, 连翘), stir-fried *Shenqu* (Massa Medicata Fermentata, 神曲), stir-fried *Maiya* (Hordei Fructus Germinatus, 麦芽), *Sharen* (Amomi Fructus, 砂仁), and *Laifuzi* (Radish Seed, 莱菔子); these are ground into fine powder and formed into pills using a paste made from Shenqu). Each dose is 1 qian, taken down with rice water from stored grain.
For severe accumulation accompanied by constipation, ancient methods recommend *Xiao Chengqi Tang* (Minor Order the Qi Decoction) to purge downward (see formula mentioned previously).
[Commentary by Chen Shouzhen] For mild infant food accumulation, simply use bran-stir-fried *Zhishi* (Aurantii Fructus, 枳实) 1 qian and processed *Yezhu* (Atractylodis Rhizoma, 苍术) 1 qian, with *Suosharen* (Amomi Fructus, 缩砂仁) 3 fen as a guiding agent. For severe food accumulation, add to this base formula: stir-fried *Shenqu* (Massa Medicata Fermentata, 神曲) 8 fen, stir-fried *Maiya* (Hordei Fructus Germinatus, 麦芽) 8 fen, *Shanzha Rou* (Crataegi Fructus, 山楂肉) 1.5 qian, and baked *Laifuzi* (Radish Seed, 莱菔子) 5 fen, using ten pills of *Xianglian Wan* (Fragrant-Coptis Pill, 香连丸) as a guiding agent. If constipation is present, add five pills of *Gengyi Wan* (Change Toilet Pill, 更衣丸).
Any accumulation caused by diet initially results merely from occasional dietary injury and remains within the intestines and stomach; it can be treated by promoting qi movement or expelling pathogens, making treatment not difficult. However, only when there has been long-term lack of dietary moderation, gradually leaving behind stagnant filth, does it become *Pi Ji* (Pi Disease/Abdominal Mass). This accumulation lies between the left hypochondrium and the diaphragm, which is the pathway through which the **Yangming Zongqi** (Summing-up Qi of Yangming) emerges. The *Classic* states: "The great collateral of the Stomach is named Xuli, piercing through the diaphragm and connecting to the Lung, emerging below the left breast; its pulsation corresponds to the garment, reflecting the Zongqi." If qi knots and moves horizontally, accumulation forms. If a person usually suffers from irregular hunger and fullness, continuously consuming food, causing the Yangming Stomach qi to reverse once, yin-cold qi can take advantage of this weakness. If the Spleen fails to transform, the remaining stagnation combines with juices and foam outside the intestines, gathering and not dispersing, gradually forming a mass. Initially like a chicken egg, hard and lumpy, it gradually takes the shape of an inverted basin. If it crosses the umbilicus, the condition becomes critical. However, at its onset, it is very subtle, often unnoticed by people; after a long time, it becomes deeply rooted and firmly established, making medicinal power difficult to reach the disease site. Currently, many children in the northwest suffer from this disease, especially most frequently in rural areas where wheat noodles are the staple, because the accumulated stagnation resides between the skin and membranes, making it difficult to treat. Treatment should aim for slow resolution rather than urgent attack; careful observation is required. Therefore, I have composed this explanation on Pi Disease.