Library

A practitioner of the Dao, having no deep insight into the learning of the Sages, yet harboring such aspirations since youth, finds a kindred spirit. I have paid close attention to the condition of *Gan* (Infantile Malnutrition). Onset after the age of sixteen is termed "Lao" (Consumption); onset before the age of sixteen is termed "Gan". The symptoms include dry and rough scalp, scorched and sparse hair, sunken cheeks, dry nose, protruding spine, emaciated body, teeth grinding, nail biting, irritability, thirst, spontaneous sweating, redness of the mouth, nose, and urine, abdominal distension, tidal fever, intense craving for fruits, vegetables, mud, and charcoal, and sores on the limbs. These are the signs of Gan.

The general principles of Gan are categorized into five: Pi Gan (Spleen), Fei Gan (Lung), Xin Gan (Heart), Gan Gan (Liver), and Shen Gan (Kidney). The specific subtypes are too numerous to record exhaustively; here we mention only the main ones: Ji Gan (Spine), Hui Gan (Roundworm), Nao Gan (Brain), Ding Xi Gan, Wu Gu Gan, and Bu Lu Gan. Although there are hundreds of names, the underlying principle is one: the manifestations differ, but the etiology boils down to Heat, Accumulation, and Parasites. Ancient famous formulas include Ta Qi Wan (Collapse Qi Pill), Long Dan Tang (Gentian Decoction), Lu Hui Wan (Aloe Pill), Mu Xiang Wan (Costus Pill), Hu Huang Lian Wan (Coptis and Picrorhiza Pill), and various Fei Er Wan (Fatten Child Pills). Their rationale is sound, their meaning profound, and their efficacy miraculous; indeed, they are not transmitted except by immortals. However, later medical texts discuss these conditions ambiguously. Although the formulas are passed down, no one dares to use them. For instance, Zhang Jingyue argued that if there is deficiency of both Qi and Blood, massive tonification is necessary; this is undoubtedly speculation by an outsider. Even Qian Zhongyang, a renowned master in pediatrics, attributed all cases of Gan to damage of the Spleen and Stomach, which is merely cliché and irrelevant to the true nature of Gan. If Qian was like this, others can be imagined. I do not spare my tongue in detailed analysis; once the source of the disease is clear, the painstaking efforts of those who created the formulas may be elucidated to the world. Yang said, "Gan means dry." I say, "Gan means sweet/greasy." It arises because excessive indulgence in rich and sweet foods leads to stagnation transforming into Heat, steaming and generating Parasites, which over time form Accumulations, thus giving rise to Gan. Because of Heat, body fluids are scorched, causing muscles to waste away; because of Accumulation, the abdomen becomes distended, leading to reduced appetite; because of Parasites sucking on the Zang-Fu organs, there is pica (craving for strange objects); eroding the limbs causes itchy sores without pain. Such symptoms mostly occur in wealthy families enjoying rich diets, while only one or two out of ten among those eating coarse food suffer from it. Since my travels, I have often seen children of noble houses less vigorous and full of spirit than those living in thatched huts. This is entirely due to irregular diet, unrelated to the flourishing or decline of Yuan Qi (Primal Qi) or the strength of the Spleen and Stomach. This is a manifest fact.

In famous formulas, Coptis Rhizome (*Huanglian*) is often used as the sovereign herb to resolve the toxic heat caused by scorching; Aloe (*Lu Hui*), Rehmannia Root (*Shengdi*), Gardenia Fruit (*Shanzhi*), Indigo Naturalis (*Qingdai*), Gentian Root (*Danchao*), and Phellodendron Bark (*Huangbai*) are used to clear Fire; Turmeric Seed (*Wuyi*), Torrey Seed (*Junzi*), Toosendan Fruit (*Chuanliann*), Polyporus (*Leiwuan*), Chrysanthemum Seed (*Heshi*), and Mume Fruit (*Wumei*) are used to kill parasites; Curcuma Tuber (*Ezhu*), Medicated Leaven (*Shenqu*), Hawthorn Fruit (*Shanzha*), Barley Sprout (*Maiya*), Tangerine Peel (*Qingpi*), and Aucklandia Root (*Muxiang*) are used to resolve accumulation; Dried Toad (*Gan Xia Ma*) and Toad Venom (*Chansu*) are used to attack toxicity with toxicity; Owl Droppings (*Yeming Sha*) and Trogopterus Dung (*Wulingzhi*) are used to remove stasis and generate new blood. Where there are symptoms, there are corresponding medicines; what doubt could there be regarding the cold nature and toxicity of these herbs? I have seen patients with this condition consult illiterate doctors. Someone might guess, "Could it be Gan?" and prescribe a formula for Gan passed down by teachers, sometimes succeeding by chance, though the doctor knows nothing of the cold nature of Coptis or the toxicity of Turmeric Seed. Conversely, when consulting a literate physician who understands principles, knowing it is Gan, he opens his mouth saying, "The Spleen and Stomach are severely deficient; drastic tonification is required. How can a withered body withstand the cold of Coptis and the toxicity of Turmeric Seed?" The owner says, "This is safe." Unaware that tonification will intensify Heat, solidify Accumulation, and multiply Parasites, leading to untreatable conditions, they then say, "It is fate." This is not the fault of reading books, but of those who do not read well. As the saying goes, "When the Dao rises one foot, the demon rises ten feet," which applies here. So, can Gan be treated without attacking Heat, Accumulation, and Parasites? No. The Five Gans have specific visible symptoms, and various Gans have different manifestations; changes arise from the mind, how can one be rigid? One must have the bamboo in mind before painting it. So, should Gan be treated solely with attacking methods and no tonification? Also no. The Classics state: "When using highly toxic drugs to treat disease, stop when 50-60% of the disease is gone." Observe when Heat recedes, Accumulation reduces, and Parasites calm; do not pursue a desperate enemy excessively. Instead, regulate the Spleen and Stomach, nourish the Kidney, and level the Liver, leaving the application to the physician's discretion.

Ancient Famous Formulas:
(Ta Qi Wan for treating abdominal distension: White Cardamom Seed (*Baidoukou*), Barley Sprout (*Maiya*), Trogopterus Dung (*Wulingzhi*), Amomum Fruit (*Sharen*), Curcuma Tuber (*Ezhu*), Green Tangerine Peel (*Qingpi*), Aged Tangerine Peel (*Chenpi*), Torrey Seed (*Junzi*) 2 qian, Dried Toad (*Xia Ma*) 3 qian, made into pills with rice paste. Xia Chong Wan (Expel Parasite Pill): Bitter Prunus Root Bark (*Kuilanzi Pi*) soaked in wine and baked, Cyathula Root (*Guanzhong*), Areca Seed (*Binglang*), Peach Kernel (*Taoren*), Aucklandia Root (*Muxiang*), Chrysanthemum Seed (*Heshi*), made into pills with rice paste. Muxiang Wan treats Gan Dysentery: Coptis Rhizome (*Huanglian*), Aucklandia Root (*Muxiang*), Magnolia Bark (*Nongpu*), Owl Droppings (*Yeming Sha*), made into pills with ginger water. Da Wuyi Tang treats pediatric fever with thirst, poor appetite, constipation, yellowing, and hair loss: Turmeric Seed (*Wuyi*), Gardenia Fruit (*Shanzhi*), Angelica Sinensis (*Qin Gui*), Atractylodes Macrocephala Rhizome (*Baizhu*), Poria (*Yunling*), Bupleurum Root (*Chaihu*), Ephedra Stem (*Mahuang*), Notopterygium Rhizome (*Qianghuo*), Saposhnikovia Root (*Fangfeng*), Coptis Rhizome (*Huanglian*), Phellodendron Bark (*Huangbai*), Honey-fried Licorice Root (*Zhigancao*) each 2 qian. Si Wei Fei Er Wan treats pediatric food accumulation and Five Gans, cataracts on eyes, and rotting gums: Turmeric Seed (*Wuyi*), Medicated Leaven (*Shenqu*), Barley Sprout (*Maiya*), Coptis Rhizome (*Huanglian*), ground equally into powder, made into pills with pig bile, size of mung beans. Lu Hui Fei Er Wan treats Heat Gan: Aloe (*Lu Hui*), Gentian Root (*Longdancao*), Aucklandia Root (*Muxiang*), Ginseng Root (*Renshen*), Torrey Seed (*Junzi*), Barley Sprout (*Maiya*) each 2 qian, Eupolyphaga Steleophaga (*Tubie*) roasted with butter after removing head and feet, Areca Seed (*Binglang*), Coptis Rhizome (*Huanglian*) each 3 qian, Turmeric Seed (*Wuyi*), Picrorhiza Rhizome (*Huhuanglian*) 1 qian, made into pills with pig bile, size of millet seeds. Long Dan Wan treats Gan Brain Heat Sores: Gentian Root (*Longdancao*), Cimicifuga Rhizome (*Shengma*), Bitter Prunus Root Bark (*Kuilian Genpi*), Red Poria (*Chifuling*), Saposhnikovia Root (*Fangfeng*), Aloe (*Lu Hui*), Burnt Human Hair Oil (*Youfa Hui*), Indigo Naturalis (*Qingdai*), Coptis Rhizome (*Huanglian*), made into pills with refined honey. Chansu Wan treats pediatric cervical lymphadenitis, sallow and thin complexion, poor appetite, abdominal distension with fever: Two or three Toads (*Chanshu*), put a scoop of fly larvae in a bucket, soak in urine, beat the toads to death, throw them into the larvae to eat for one day and night, collect in a cloth bag, place in a swift stream overnight, take out, bake on tiles until dry, grind into powder, add a little Musk (*Shexiang*), make into pills with rice.)