其症脉多伏或绝，内有所积，外有所感，邪正相干，阴阳乖隔，留于中脘，阳不升，阴不
降，吐利暴作。病在上焦，心痛而吐。病在下焦，腹痛而泻。病在中焦，心腹俱痛，吐泻并
作。偏阳多热，偏阴多寒，甚则转筋，腹痛，手足厥逆。又足阳明胃经以养宗筋，暴吐暴泻，
宗筋失养，故挛急，甚则舌卷囊缩。脾受贼邪，木来侮土也。吐泻尽，阴阳顺而愈矣。此症乃
饮食所伤，切勿与谷食、姜椒等，必待吐尽泻尽，过一二时方与稀粥。若干霍乱，最是急症，
不得吐利，阴阳闭而死矣。此干霍乱乃立见安
危，惟用盐水灌之，令其大吐，或掘地穴以新汲水投之，搅取澄清饮之，或用手挖喉中探吐尤捷。有宜吐者，
虽已吐利，仍用二陈汤吐之，以提其气，又刺委中及十指出血。
凡霍乱用吐泻本方，因风加柴胡、防风，因寒倍半夏，因湿倍苍术、防风，因暑加藿香、扁豆，因食多用
枳实、青皮。（治泄泻用益元散加白术末一两，每服一二钱，米汤调服。）
积者，停蓄之总名。诸书皆分五积属脏，六聚属腑。腑病不治自愈，脏病宜治，而脾脏尤难。丹溪只言积
块有形之物在左为血积，在右为痰积，在中为食积；儿则有食积、乳积、气积、虚积、实积、惊积、热积、寒
积，甚则为 癖，为痞结，为 瘕。又肝积为肥气，脾积为痞气，肺积为息贲，心积为伏梁，肾积为奔豚，治
各不同。小儿只是去脾家食积而已。夫胃水谷之海，脾即夹肝附上，脾热则磨速而食易化，脾寒则磨迟而食难
消，不消则变为冷积矣。大抵消食行气，开痰化血为主，只宜消之化之磨之，无下积之理。若积泻先当小黑丸
下之，后即宜补，以人参、白术，磨以槟榔、枳实、山棱、蓬术辈。小儿只是食积多，痰与血少，其余更少。
然食积为疳积之根，未至疳时不可用胡黄连、银柴胡、芦荟等寒药，只宜温和药化之开之，余家小黑丸可用。
若常服则用肥儿丸。
肥儿丸
炒陈皮（四两） 浓朴（米泔水浸炒） 麸炒枳实 炒卜子 炒青皮 姜炒黄连 白术 槟榔（各二两）
山楂 炒神曲 炒焦麦芽 连翘 龙胆草 蓬术（各一两半） 甘草（一两半） 米泔水浸炒香附（四两）
为末，蜜丸圆眼大，米汤化下。
若疳积，加芦荟、胡黄连、柴胡，名玉疳深道丸，又名芦荟丸。必夜间发热，骨瘦如柴者方可加。
儿有积滞，面目黄肿，夜间身热，肚热尤甚，腹痛覆卧，或大便闭塞，小便如油发黄，泄泻粪白酸臭，吐逆
宜化积健脾汤。
化积健脾汤（又名消积化聚汤）
陈皮 浓朴 苍术 半夏 香附 枳实 青皮 山楂 槟榔 茯苓 甘草
积甚加山棱、蓬术、草果，腹痛加砂仁、木香，积块而泻先用小黑丸，后服本方去半夏、槟榔，加白术、白
芍。有痰去苍术，加海石、石碱；血积去浓朴、苍术、半夏，加当归梢、桃仁、红花，甚则穿山甲；气积倍香附
，加桔梗、砂仁。实热加黄连，冷加木香、丁香，虚冷或下后积不除加丁香、肉蔻。若泻而至虚黄积，去枳
壳、槟榔、青皮、白术，虚甚加人参，小便不利而肿加泽泻、猪苓。 癖皆宜前方，惟痞乃腹胀胸满，营卫不得
流行，宜小黑丸微利，甚则备急丸，后宜用白术补。或在皮里膜外亦宜本方。又用人参白术药间服。 则伤食得之，
宜消食，用本方；瘕则伤血得之，宜破血，是久积所致，药俱见前。余家肥儿丸是消积药，轻则可服，重则加山
棱、蓬术，然当详其痰血而增入。
消积化聚丸
山棱 白术 黄连 茯苓 木香 归尾 麦芽 砂仁 红花 麦冬 枳壳 青皮 神曲 柴胡 蓬术 槟榔
制香附 桃仁 鳖甲 干漆 益智
蜜丸，米饮汤下三钱，空心服。
其症状表现为脉象多沉伏或摸不到，体内有积滞，体外受邪气侵袭，邪气与正气相互干扰，阴阳之气乖违阻隔，停滞在中脘部位，导致阳气不能上升，阴气不能下降，突然发生呕吐和腹泻。病位在上焦，表现为心痛且呕吐；病位在下焦，表现为腹痛且腹泻；病位在中焦，心部和腹部都疼痛，呕吐和腹泻同时发作。偏向阳证的多为热证，偏向阴证的多为寒证，严重时会出现筋脉拘挛（转筋）、腹痛、手脚冰凉厥逆。另外，足阳明胃经负责滋养宗筋，突然剧烈呕吐和腹泻，导致宗筋失去滋养，所以发生痉挛紧缩，严重时出现舌头卷缩、阴囊收缩。这是因为脾脏受到贼邪侵害，是肝木反侮脾土所致。待呕吐和腹泻排尽后，阴阳之气调和即可痊愈。这种病症是由于饮食损伤引起的，千万不要给予谷物食物、生姜、花椒等，必须等到吐尽泻尽之后，过一两个时辰再给予稀粥。如果是干霍乱，是最危急的病症，患者无法呕吐也无法腹泻，会导致阴阳闭塞而死亡。对于干霍乱，情况危急，只能用盐水灌服，使其大量呕吐，或者挖掘地穴用新汲水投入其中，搅拌后取澄清液饮用，或者用手探喉催吐更为快捷。如果有适宜催吐的情况，即使已经呕吐腹泻，仍使用二陈汤进行催吐，以提举其气机，另外针刺委中穴及十宣穴放血。
凡是治疗霍乱使用吐泻本方时，因风邪加柴胡、防风，因寒邪加倍半夏用量，因湿邪加倍苍术、防风用量，因暑邪加藿香、扁豆，因食积多加枳实、青皮。（治疗泄泻使用益元散加白术末一两，每次服用一二钱，用米汤调服。）
“积”是停蓄积聚的总称。各种医书都将五积归属于脏，六聚归属于腑。腑的病不治也能自愈，脏的病需要治疗，而脾脏的病尤其难治。朱丹溪只说积块是有形的物体，在左侧的是血积，在右侧的是痰积，在中间的是食积；小儿则有食积、乳积、气积、虚积、实积、惊积、热积、寒积，严重时发展为癖、痞结、瘕。另外，肝积称为肥气，脾积称为痞气，肺积称为息贲，心积称为伏梁，肾积称为奔豚，治疗方法各不相同。小儿只是去除脾家的食积罢了。胃是水谷之海，脾附着在肝脏旁边，脾热则消化快而食物容易化解，脾寒则消化慢而食物难以消除，不消化就会变成冷积。大抵治疗原则是以消食行气、开痰化血为主，只适合消导、化解、磨碎的方法，没有攻下积滞的道理。如果是积滞导致的泄泻，应当先用小黑丸攻下，之后宜用补法，用人参、白术，配合槟榔、枳实、三棱、莪术等药物磨积。小儿多是食积，痰和血积较少，其余更少。然而食积是疳积的根本，未到疳证阶段时不可使用胡黄连、银柴胡、芦荟等寒凉药物，只宜用温和的药物化解开通，我家的小黑丸可以使用。如果常服则使用肥儿丸。
肥儿丸：炒陈皮（四两），浓朴（用米泔水浸泡后炒），麸炒枳实，炒莱菔子，炒青皮，姜炒黄连，白术，槟榔（各二两），山楂，炒神曲，炒焦麦芽，连翘，龙胆草，蓬术（各一两半），甘草（一两半），米泔水浸泡炒香的香附（四两）。研为细末，用蜂蜜制成如桂圆大小的丸药，用米汤送服化下。
如果是疳积，加入芦荟、胡黄连、柴胡，名为玉疳深道丸，又名芦荟丸。必须是夜间发热、骨瘦如柴的患者才可以加入这些药物。
小儿有积滞，表现为面目黄肿，夜间身体发热，肚子热尤其严重，腹痛喜欢俯卧，或者大便闭塞，小便像油一样发黄，泄泻粪便发白酸臭，呕吐逆乱，适宜使用化积健脾汤。
化积健脾汤（又名消积化聚汤）：陈皮，浓朴，苍术，半夏，香附，枳实，青皮，山楂，槟榔，茯苓，甘草。积滞严重加三棱、蓬术、草果，腹痛加砂仁、木香，积块且腹泻先服用小黑丸，随后服用本方去掉半夏、槟榔，加入白术、白芍。有痰去掉苍术，加海浮石、石碱；血积去掉浓朴、苍术、半夏，加当归梢、桃仁、红花，严重时加穿山甲；气积加倍香附，加桔梗、砂仁。实热加黄连，寒冷加木香、丁香，虚寒或攻下后积滞未除加丁香、肉豆蔻。如果泄泻导致虚黄积，去掉枳壳、槟榔、青皮、白术，极度虚弱加人参，小便不利且浮肿加泽泻、猪苓。癖证都适宜前方，只有痞证是腹胀胸满，营卫之气不能流通，适宜用小黑丸轻微通利，严重时用备急丸，之后宜用白术补益。如果在皮里膜外也有积滞也适宜本方。另外在服用人参白术药之间间隔服用。伤食导致的，适宜消食，使用本方；瘕证是伤血导致的，适宜破血，这是久积所致，药物都在前面提到过。我家的肥儿丸是消积药，轻症可以服用，重症加三棱、蓬术，但应当详细辨别是否有痰血而增加相应药物。
消积化聚丸：三棱，白术，黄连，茯苓，木香，归尾，麦芽，砂仁，红花，麦冬，枳壳，青皮，神曲，柴胡，蓬术，槟榔，制香附，桃仁，鳖甲，干漆，益智仁。蜜丸，米饮汤送服三钱，空腹服用。
Its symptoms present with a pulse that is mostly deep and hidden (Fu, 伏) or imperceptible. There is accumulation internally and pathogenic invasion externally; pathogens and healthy qi interfere with each other, causing Yin and Yang to become disjointed and separated. Stagnation occurs in the Zhongwan area (CV12), where Yang fails to ascend and Yin fails to descend, leading to sudden onset of vomiting and diarrhea. If the disease is in the Upper Jiao (Upper Burner), it presents as heart pain accompanied by vomiting. If in the Lower Jiao (Lower Burner), it presents as abdominal pain accompanied by diarrhea. If in the Middle Jiao (Middle Burner), both the epigastrium and abdomen hurt, with simultaneous vomiting and diarrhea. Predominantly Yang patterns tend toward heat, while predominantly Yin patterns tend toward cold. In severe cases, muscle spasms (Zhuanjin, 转筋 - tendon contraction/cramps), abdominal pain, and cold extremities (Jizhi Jueni, 手足厥逆) occur. Furthermore, the Foot-Yangming Stomach Meridian nourishes the Zongjin (General Tendons); sudden violent vomiting and diarrhea cause the Zongjin to lose nourishment, resulting in spasm and tightening. In severe cases, tongue retraction and scrotal retraction occur. This is because the Spleen is invaded by "thief pathogens," representing Wood overacting on Earth (Mu Lai Wu Tu). Once vomiting and diarrhea cease, Yin and Yang harmonize, and recovery ensues. This condition results from dietary injury. One must strictly avoid grains, ginger, pepper, etc. Only after vomiting and diarrhea have completely ceased, and after one or two hours have passed, should thin rice gruel be administered. Dry Huoluan (Dry Cholera) is the most critical condition; the patient cannot vomit nor defecate, leading to closure of Yin and Yang and death. For dry Huoluan, which presents immediate danger, only salt water should be灌 (administered orally) to induce profuse vomiting. Alternatively, dig a pit, pour in fresh well water, stir, take the clarified liquid, and drink it. Or, use fingers to probe the throat to induce vomiting, which is even more effective. If vomiting is indicated, even if vomiting and diarrhea have already occurred, Erchen Tang (Two-Cured Decoction) should still be used to induce vomiting, thereby lifting the Qi mechanism. Additionally, needle Weizhong (BL40) and the ten Shixuan points (EX-UE11) to bleed.
For all Huoluan cases using this vomiting/diarrhea inducing formula: add Chaihu (Bupleuri Radix) and Fangfeng (Saposhnikoviae Radix) for Wind; double the dosage of Banxia (Pinelliae Rhizoma) for Cold; double the dosage of Cangzhu (Atractylodis Rhizoma) and Fangfeng for Dampness; add Huoxiang (Pogostemonis Herba) and Biandou (Dolichoris Semen) for Summerheat; add Zhishi (Aurantii Fructus Immaturus) and Qingpi (Citri Reticulatae Pericarpium Viride) for excess food retention. (To treat Xie Xie [Diarrhea], use Yiyuan San (Beneficial Primordial Powder) plus 1 liang of Baizhu (Atractylodis Macrocephalae Rhizoma) powder; take 1-2 qian per dose, mixed with rice soup.)
"Ji" (Accumulation) is the general term for stagnation and storage. Various texts classify the Five Ji as belonging to the Zang organs, and the Six Ju as belonging to the Fu organs. Diseases of the Fu organs may heal spontaneously without treatment; diseases of the Zang organs require treatment, with Spleen diseases being particularly difficult. Danxi (Zhu Zhenheng) stated only that accumulations are tangible masses: Blood Accumulation (Xue Ji) on the left, Phlegm Accumulation (Tan Ji) on the right, and Food Accumulation (Shi Ji) in the center. Children may have Food Accumulation, Milk Accumulation, Qi Accumulation, Deficiency Accumulation, Excess Accumulation, Shock Accumulation, Heat Accumulation, and Cold Accumulation. In severe cases, these develop into Pi (Parasitic Masses), Pi Jie (Stagnant Knots), or Xia (Irregular Masses). Additionally, Liver Accumulation is called Feiqi (Fat Qi), Spleen Accumulation is called Piqi (Stagnant Qi), Lung Accumulation is called Xiben (Gasp for Breath), Heart Accumulation is called Fuliang (Hidden Beam), and Kidney Accumulation is called Bentun (Rushing Pig); their treatments differ. For children, the goal is simply to remove Food Accumulation from the Spleen. The Stomach is the Sea of Water and Grain. The Spleen attaches beside the Liver. If the Spleen is hot, digestion is rapid and food transforms easily; if the Spleen is cold, digestion is slow and food is hard to digest. Undigested food becomes Cold Accumulation. Generally, the principle is to eliminate food, move Qi, resolve phlegm, and transform blood. One should only use methods to dissolve, transform, and grind; there is no rationale for purging accumulations downward. If accumulation leads to diarrhea, one should first purge with Xiaohei Wan (Little Black Pill), followed by tonification using Renshen (Ginseng Radix) and Baizhu, combined with Binglang (Arecae Semen), Zhishi, Sanleng (Sparganii Rhizoma), and Pengzhu (Curcumae Rhizoma) to grind away accumulation. Children mostly have Food Accumulation, with little Phlegm or Blood Accumulation, and even less of others. However, Food Accumulation is the root of Ganji (Childhood Malnutrition/Gan Syndrome). Before reaching the stage of Gan, cold medicines like Huhuanglian (Coptidis Rhizoma), Yinchaihu (Cistanchis Herba), and Lvhui (Aloe) should not be used. Only mild and warm medicines should be used to transform and open the accumulation; our family's Xiaohei Wan can be used. For long-term use, Fei'er Wan (Child-Nourishing Pill) is appropriate.
Fei'er Wan: Chao Chenpi (Fried Tangerine Peel, 4 liang), Nongbo (immersed in rice wash water and fried), Fu Chao Zhishi (bran-fried Aurantium Fruit, 2 liang), Chao Bozi (fried Radish Seed, 2 liang), Chao Qingpi (fried Green Tangerine Peel, 2 liang), Jiang Chao Huanglian (ginger-fried Coptis, 2 liang), Baizhu (2 liang), Binglang (Areca Seed, 2 liang), Shanzha (Hawthorn Fruit, 1.5 liang), Chao Shenqu (fried Medicated Leaven, 1.5 liang), Chao Jiao Maiya (charred fried Barley Sprout, 1.5 liang), Lianqiao (Forsythia Fruit, 1.5 liang), Longdancao (Gentian Root, 1.5 liang), Pengzhu (Curcuma Rhizome, 1.5 liang), Gancao (Licorice Root, 1.5 liang), Xiangfu immersed in rice wash water and fried until fragrant (Cyperus Rhizome, 4 liang). Grind into powder, make pills with honey the size of a quail egg, and dissolve/administer with rice soup.
If Ganji (Malnutrition Accumulation), add Lvhui (Aloe), Huhuanglian (Coptis), and Chaihu (Bupleurum), named Yugan Shendao Wan (Jade Gan Deep Path Pill), also known as Lvhui Wan. These should only be added if the child has night fever and is emaciated like firewood.
Children with accumulation stagnation present with yellowish swollen face and eyes, night fever, severe abdominal heat, abdominal pain preferring prone position, constipation, urine resembling oil and yellow, diarrhea with white sour-smelling stool, and vomiting/regurgitation. Hua Ji Jian Pi Tang (Transform Accumulation Strengthen Spleen Decoction) is suitable.
Hua Ji Jian Pi Tang (also known as Xiao Ji Hua Ju Tang): Chenpi, Nongbo, Cangzhu, Banxia, Xiangfu, Zhishi, Qingpi, Shanzha, Binglang, Fuling (Poria), Gancao. For severe accumulation, add Sanleng, Pengzhu, Caoguo (Black Cardamom). For abdominal pain, add Sharen (Amomum Fruit) and Muxiang (Vladimiria Root). For mass with diarrhea, first use Xiaohei Wan, then take this formula removing Banxia and Binglang, adding Baizhu and Baishao (White Peony Root). If phlegm exists, remove Cangzhu, add Haishi (Floating Quartz) and Shi Jian (Stone Alkali). For Blood Accumulation, remove Nongbo, Cangzhu, Banxia, add Danggui Shao (Tip of Angelica Sinensis Root), Taoren (Peach Kernel), Honghua (Carthamus Flower); in severe cases, add Shanjiajia (Pangolin Scale). For Qi Accumulation, double Xiangfu, add Jiegeng (Platycodon Root) and Sharen. For Excess Heat, add Huanglian; for Cold, add Muxiang and Dingxiang (Clove). For Deficiency Cold, or if accumulation persists after purging, add Dingxiang and Roukou (Nutmeg). If diarrhea leads to deficiency-yellow accumulation, remove Zhike (Aurantium Fruit Mature), Binglang, Qingpi, Baizhu; add Renshen for extreme deficiency. For oliguria and edema, add Zexie (Alisma Rhizome) and Zhuling (Polyporus).
Pi (Parasitic Masses) generally suit the previous formula. Only Pi (Stagnant Knot) presents as abdominal distension and chest fullness, where Ying and Wei (Nutritive and Defensive Qi) fail to circulate; mild purgation with Xiaohei Wan is suitable, or Beiji Wan (Emergency Aid Pill) for severe cases, followed by tonification with Baizhu. If accumulation is in the subcutaneous tissue/membranes, this formula is also suitable. Additionally, alternate administration with Renshen and Baizhu formulas. Shi Shang (Food Injury) requires food transformation using this formula; Xia (Irregular Mass) results from blood injury requiring blood-breaking action, caused by long-standing accumulation; drugs are listed previously. Our family's Fei'er Wan is an accumulation-transforming medicine; it can be taken for mild cases, but for severe cases, add Sanleng and Pengzhu, though one must carefully assess for phlegm and blood to add corresponding herbs.
Xiao Ji Hua Ju Wan (Transform Accumulation Dissolve Aggregation Pill): Sanleng, Baizhu, Huanglian, Fuling, Muxiang, Guiwei (Tail of Angelica Root), Maiya (Barley Sprout), Sharen, Honghua, Maidong (Ophiopogon Tuber), Zhike, Qingpi, Shenqu, Chaihu, Pengzhu, Binglang, Zhi Xiangfu (Prepared Cyperus), Taoren, Biejia (Turtle Shell), Ganqi (Dry Resin), Yizhi (Alpinia Oxyphylla). Honey pills, take 3 qian with rice drink, on an empty stomach.