秘旨云。小儿便如米泔。或溺停少顷。变作泔浊者。此脾胃湿热也。若大便泔白色。或如鱼
冻。或带红黄黑者。此湿热积滞也。宜理脾消滞。去湿热。节饮食。若忽然变青。即变蒸也。不
必用药。若久不愈。用补脾制肝药。若母因七情。致儿小便如泔。肥儿丸。大便色青。日久不复。
或兼泄泻色白。或腹痛者。六君子加木香。仍审乳母饮食七情主之。
小儿食积者。因脾胃虚寒。乳食不化。久而成积。其证至夜发热。天明后凉。腹痛膨胀。呕
吐吞酸。足冷壮热。喜睡神昏。大便酸臭。甚则下血是也。若兼寒热者。为食积发热。若食在胃
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。参苏饮。热甚便秘者。先利之。大柴胡汤。如无外感。但只
伤食。不至于甚。保和丸调之。盖脾为至阴之脏。故凡脾病者。至夜必热。热而兼寒。则又见所
胜者侮所不胜矣。食未消者消之。则寒热止。食既消者补之。则寒热痊。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。脾肾俱虚
也。四神丸。手足并热。作渴饮水者。脾胃实热也。泻黄散。大便秘结。大柴胡汤。手足虽热。
口不作渴。大便不实者。白术散。大便下血者。理中汤去参加枳实、黄连、红曲。
《秘旨》中说：小儿的大便像米泔水一样，或者小便停放片刻后，变成浑浊的米泔状，这是脾胃湿热所致。如果大便呈白色如米泔，或者像鱼冻，或者带有红、黄、黑色，这是湿热积滞所致。应当调理脾胃、消除积滞、去除湿热，并节制饮食。如果突然变为青色，就是“变蒸”（婴幼儿生长发育过程中的生理现象），不必用药。如果久治不愈，使用补脾制肝的药物。如果母亲因七情内伤，导致小儿小便如米泔，用肥儿丸治疗；如果大便色青，日久不恢复，或者兼有泄泻且颜色发白，或者腹痛，用六君子汤加木香治疗。仍须审察乳母的饮食和情绪状态来主治。
小儿食积证，是因为脾胃虚寒，乳汁和食物不能消化，久而久之形成积滞。其症状是到了夜间发热，天亮后转凉，腹痛腹胀，呕吐吞酸，脚冷身热，喜欢睡觉且神志昏沉，大便气味酸臭，严重时甚至便血。如果兼有恶寒发热，属于食积引起的发热。如果食积在胃，就用消导法；如果腹痛痞胀，按压时疼痛加剧，就用攻下法；攻下之后仍然疼痛，但按压时疼痛缓解，就用补益法。夹带食积的伤寒病，先用解表散邪法，方用参苏饮。如果热势严重且大便秘结，先用通利法，方用大柴胡汤。如果没有外感，只是单纯伤食，病情不严重的，用保和丸调治。因为脾是至阴之脏，所以凡是脾病，到了夜间必然发热。发热而兼有恶寒，则是所胜之气（脾土）反侮所不胜之气（肾水）的表现。食积未消的，用消导法，则寒热停止；食积已消的，用补益法，则寒热痊愈。如果手脚都冷，喜欢热饮食，这是中焦脾胃虚寒，应当温补。如果大便想排却排不出，是脾气下陷，应当升提。如果在夜间或清晨泄泻，是脾肾俱虚，用四神丸治疗。如果手脚都热，口渴饮水，是脾胃实热，用泻黄散治疗。如果大便秘结，用大柴胡汤。如果手脚虽热，但口不渴，大便不成形，用白术散治疗。如果大便下血，用理中汤去掉干姜，加入枳实、黄连、红曲。
The *Secret Principles* state: If a child's stool resembles rice-washing water, or if urine becomes turbid like rice-washing water after standing for a short while, this is due to damp-heat in the Spleen and Stomach. If the stool is white like rice-washing water, or resembles fish mucus (gelatinous), or contains red, yellow, or black colors, this indicates damp-heat with food stagnation. Treatment should involve regulating the Spleen, resolving stagnation, clearing damp-heat, and moderating diet. If the color suddenly turns green, it is *Bianzheng* (a physiological developmental process in infants); medication is not necessary. If it persists for a long time without cure, use formulas that tonify the Spleen and subdue the Liver. If the mother suffers from emotional disturbances causing the child's urine to resemble rice-washing water, treat with *Fei'er Wan* (Child-Nourishing Pill). If the stool is green and remains so for a long time, or is accompanied by diarrhea with white color, or abdominal pain, treat with *Liuzijunzi Tang* (Six Gentlemen Decoction) added with *Muxiang* (Aucklandiae Radix). One must still examine the wet nurse's diet and emotional state as the primary cause.
Pediatric food stagnation arises from deficiency-cold of the Spleen and Stomach, where milk and food fail to digest, eventually forming stagnation. The symptoms include fever at night that subsides after dawn, abdominal pain and distension, vomiting with acid regurgitation, cold feet with high body heat, excessive sleepiness with mental confusion, sour-smelling stool, and in severe cases, hematochezia. If accompanied by aversion to cold and fever, it is classified as fever caused by food stagnation. If the food stagnation is in the Stomach, employ the method of digestion/resolution. If there is abdominal pain and fullness that worsens upon pressure, employ the purgative method. If pain persists after purgation but alleviates upon pressure, employ the tonifying method. For Taiyang disease complicated by food stagnation, first resolve the exterior using *Shensu Yin* (Ginseng and Perilla Drink). If heat is severe with constipation, first purge using *Dachaihu Tang* (Major Bupleurum Decoction). If there is no external contraction, but only simple food injury without severity, regulate with *Baohe Wan* (Preserve Harmony Pill). Since the Spleen is an organ of extreme Yin, any Spleen pathology inevitably causes fever at night. Fever accompanied by chills indicates that the conquered element (Spleen Earth) is insulting the conquering element (Kidney Water). If food has not yet digested, apply digestion; then the chills and fever cease. If food has already digested, apply tonification; then the chills and fever are cured. If both hands and feet are cold and the patient prefers hot drinks, this is deficiency-cold of the Middle Jiao; apply warming methods. If there is a sensation of defecation but inability to pass stool, this is sinking of Spleen Qi; apply lifting methods. If diarrhea occurs at night or early morning, this is deficiency of both Spleen and Kidney; treat with *Sishen Wan* (Four Spirits Pill). If both hands and feet are hot with thirst and desire to drink, this is excess-heat in the Spleen and Stomach; treat with *Xiehuang San* (Drain Yellow Powder). If there is severe constipation, use *Dachaihu Tang*. If hands and feet are hot but there is no thirst and stools are unformed, use *Baizhu San* (Atractylodes Macrocephala Powder). If there is blood in the stool, use *Lizhong Tang* (Regulate the Middle Decoction) with *Ganjiang* (Zingiberis Rhizoma) removed, and *Zhishi* (Aurantii Fructus), *Huanglian* (Coptidis Rhizoma), and *Hongqu* (Red Yeast Rice) added.