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Dingxi (Carp-shaped) Gan syndrome is characterized by extremely thin hands and feet. The neck is slender with prominent bones, the buttocks are emaciated, and the body is flaccid. The abdomen is distended with a protruding umbilicus. When crying, the chest sinks. It is accompanied by bone-steaming tidal fever. Bulu (Leaking) Gan syndrome is characterized by alternating deficiency heat, separated cranial sutures, regurgitation of food, expulsion of roundworms, irritability, thirst, vomiting, and hiccups. Both Dingxi and Bulu Gan syndromes arise from long-term deficiency of the Spleen and Stomach, which fail to transform and transport water and grain. This leads to depletion of spirit and essence, inability to nourish Qi, resulting in muscle wasting. Insufficiency of Kidney Qi, combined with injury from cold wind, causes the bones to become dry and exposed.

For children over fifteen years old, this condition is called "Gan"; for those under fifteen, it is called "Lao" (Consumption). Both result from extreme exhaustion of Qi and Blood and damage to the intestines and stomach; they share the same origin but have different names. Generally, children's constitutions are prone to both deficiency and excess. Any prolonged illness can develop into Gan syndrome. Improper medication, excessive diet, and inappropriate nursing care all lead to Gan syndrome. Treatment involves using Jisheng Wan (Accumulation-Resolving Pill) with modifications.

Children's Zang-Fu organs are delicate and easily injured by fullness. If dietary habits are irregular, few escape developing Gan syndrome. Premature weaning or introducing solid foods too early consumes Shen (Spirit) and Qi, establishing the root of Gan syndrome. Therefore, excessive milk or food intake without restraint causes Gan through injury. Indulgence in rich, sweet, sticky, difficult-to-digest foods, as well as raw, cold, salty, or sour items, obstructs the Middle Jiao (Middle Burner), causing Gan to arise from accumulation.

If the nursing mother sleeps with improper temperature regulation, eats irregularly, experiences emotional extremes (anger or joy), or engages in sexual fatigue, and subsequently nurses the infant, the Gan syndrome may transmit from the mother's pathological state via Qi transmission, injuring the Spleen and Stomach and weakening all Zang organs. Symptoms include dry eyes, possibly with a white membrane forming on the cornea, red lips, yellowish complexion, preference for lying on cool surfaces, pica (eating dirt), irregular diarrhea or dysentery, abdominal distension, sores around the ears and nose, hair matted into tufts, weak legs, slender neck, extreme emaciation with polydipsia, and fluctuating tidal fever. These are all symptoms of Gan. Treatment uses the original formula of Jisheng Wan for regulation, combined with Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), which yields high efficacy.

In cases where severe illness was treated with improper emetic or purgative drugs, leading to deficient Stomach Qi and depletion of Body Fluids, internal deficiency heat arises while external muscles waste away. Treat with Jisheng Wan, removing Ezhu (Curcuma Zedoaria Rhizome) and Qingpi (Aurantii Fructus Pericarpium Viride), and adding Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma).

In cases where febrile diseases persist, causing dryness and depletion of Body Fluids, treat with Jisheng Wan, removing Sharen (Amomi Fructus) and Ezhu, and adding Longdancao (Gentianae Radix).

In cases where Gan results from vomiting, diarrhea, or chronic loose stools, treat with Jisheng Wan, removing Qingpi and Ezhu, and adding Baizhu, Roudoukou (Myristicae Semen), and Hezi (Terminaliae Chebulae Fructus); also combine with Shenling Baizhu San.

In cases where Gan results from persistent malaria, treat with Jisheng Wan, adding Biejia (Trionycis Carapax et Plastrum).

In cases where Gan results from food accumulation accompanied by abdominal pain, treat with Jisheng Wan, removing Danggui (Angelicae Sinensis Radix) and Chuanxiong (Chuanxiong Rhizoma), and adding Chuanlianzi Rou (Semen Toosendan), Xiaohuixiang (Foeniculi Fructus), and Sanleng (Sparganii Rhizoma).

In cases where Gan results from intestinal colic due to parasites, use the base formula, removing Danggui and Chuanxiong, and adding Bai Wuyi (Meliosmae Flos) and Chuanlianzi Rou.

In cases where long-term Spleen and Stomach deficiency fails to transform and transport to nourish Qi, or where toxins were acquired in utero leading to scant blood in the Zang-Fu, resulting in extremely thin limbs, slender neck with prominent bones, and emaciated buttocks resembling Dingxi or Bulu syndromes, treat with Jisheng Wan and Shenling Baizhu San.

In cases where the nursing mother indulges in pungent spices (Wuxin: garlic, onion, chives, etc.), alcohol, wheat products, and roasted/fried foods, the infant may suffer from daytime irritability, thirst, and refusal of milk/food, with thirst ceasing at night. This is named Gan Ke (Gan Thirst). Treat with Jisheng Wan, removing Ezhu and Sharen, and adding Renshen and Baizhu; combine with Renshen Maidong San (Ginseng and Ophiopogon Powder).

Generally, Gan syndrome presents with heat representing "deficiency-type heat" and cold representing "deficiency-type cold." Treating heat requires avoiding harsh cooling agents; treating cold requires avoiding harsh warming agents. One must never recklessly apply diaphoresis (sweating) or purgation methods, as these can be fatal.

Whenever a child shows slight yellowish sallow complexion, emaciation, fever, abdominal distension with pain, and anorexia, immediately administer Wu Gan Xiao Ji Wan (Five Gan Accumulation-Resolving Pill) or Jisheng Wan.

When treating Gan syndrome, there is no need to strictly categorize the Five Types of Gan. Simply tonify if deficient, clear if hot, warm if cold, treat vomiting if present, treat dysentery if present, resolve accumulation if present, and expel parasites if present. All these approaches fall within the scope of modified Jisheng Wan usage, which has proven effective repeatedly.

There is also Gu Gan (Scrotal/Testicular Gan), characterized by a lump behind the ear or on the side of the neck, about the size of a marble, movable upon pressure, soft in texture. Over time, this leads to limb abscesses, dysentery with pus and blood, high fever, emaciation, and exposed skull bones. Upon observing this syndrome, rapidly puncture the lump; rice-paste-like worms may emerge. Apply medicated plaster externally and administer Jisheng Wan internally for regulation.