沈 稚年歇乳进谷。脾胃气馁少运。腹膨目医。是为五疳。夏日中土司令。久病投以补气。恰合
调其脾胃。近日呕吐泄泻身热。乃寒暄失和。致食不易化。小溲既少。腑气不和。余幼科久疏。
忆钱氏每以调中为主而驱邪都主轻法。深虑脾土伤。则延惊痫耳。（脾胃虚腑气不和）
益智仁 焦术 茯苓 广皮 藿香梗 浓朴 楂肉 泽泻
张（四岁） 五疳。腹胀数月。法当疏补。
人参 茯苓 麦芽 炒楂肉 广皮 半夏 湖莲
又 照前方去半夏湖莲加泽泻。
陈（五岁） 官人自汗。短气咳嗽。风温见症。肌腠有痤痱之形。与疹喑腑病不同。但幼稚
生阳充沛。春深入夏。形质日减。色脉是虚。而补脾辛甘不应。腹满。按之自 。二便原得通利。
腹痛时发时止。痛已即能饮食。考幼科五疳。与大方五劳相类。疳必因郁热为积为虫。此饮食不充肌肤
也。病来非暴。攻之由渐。再论疳热虫积。古人治肝治胃恒多。而洁古东垣。于内伤夹滞。每制
丸剂以缓治。取义乎渣质有形。与汤饮异歧。刻下温邪扰攘之余。聊以甘凉之属。清养胃阴。
以化肺热。其辛气泄表不宜进。（内伤夹滞虫积）
甜杏仁 麦冬 地骨皮 生甘草 冬桑叶 玉竹 和入青甘蔗汁一酒杯。
（丸方）仿治疳热羸瘦。从阳明厥阴疏通消补兼施。
人参 黄连 芦荟 川楝子 使君子 茯苓 白芍 广皮 胡黄连 南山楂
某（七岁） 食物不节。脾胃受戕。腹膨。大便不调。此属脾疳。（食伤脾胃）
焦术 茯苓 广皮 益智仁 大腹皮 木瓜 炮姜 炒神曲
吴（九岁） 能食。色枯形瘦。暮热泄泻。此皆口腹不慎。值长夏温热。脾胃受伤。将成五疳。
青蒿梗 枳实炭 胡黄连 炒谷芽 炒白芍 炒山楂 广皮 茯苓 泽泻
王 五疳已久。脾胃受伤。食物不运。腹膨溏泻。此积聚未清。中焦先馁。完谷不化。肿胀皆至。难
治之症。七香饼。
疳者。干也。小儿肠胃柔嫩。若乳食失调。甘肥不节。运化不及。停积发热。热久津干。此因积
成疳者也。或五脏偏热。或因病后。或医药误下。致亡失津液。脾不输化。积滞不行。此因干
致积者也。故五疳不离乎脾胃。其治法。胃滞当消。脾弱宜补。热者用苦寒清火。冷者宜辛
温健运。有虫者。兼用杀虫之品。其虚者。各随本脏补其母。总宜丸剂缓调。不能旦夕速功。
或用鸡肝纳入治疳药炖食。最为有效。（陆履安）
徐评 此老幼科痘症。不仅名家。可称大家矣。敬服敬服。
Shen, a young child, began eating grain after weaning. Due to deficiency of Spleen and Stomach Qi (Spleen-Stomach Qi Deficiency) and reduced transportive function, abdominal distension and dry eyes (Mu Yi) occurred, constituting the Five Kan diseases (Five Malnutrition Syndromes). Summer is when Earth Qi commands; for chronic illness, administering tonifying Qi methods coincides with regulating Spleen and Stomach. Recently, vomiting, diarrhea, and fever appeared due to disharmony of cold and warm climates, causing indigestion. Urine output is low, and Fu-organ Qi is unharmonious. I have been distant from pediatric practice for a long time, recalling that Qian Shi (Qian Yi) always focused on regulating the Middle Jiao and used light methods to expel pathogens, deeply fearing that damage to Spleen Earth would lead to convulsions and epilepsy. (Syndrome: Spleen-Stomach Deficiency, Fu-organ Qi Disharmony)
Prescription: Yizhi Ren (Alpinia Oxyphylla Fruit), Jiao Zhu (Charred Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Guang Pi (Tangerine Peel), Huo Xiang Geng (Agastache Stem), Hou Po (Magnolia Bark), Zha Rou (Hawthorn Flesh), Ze Xie (Alisma Rhizome).
Zhang, four years old. Suffering from Five Kan diseases, abdominal distension for several months. The method should be to disperse and tonify.
Prescription: Ren Shen (Ginseng Radix et Rhizoma), Fu Ling (Poria), Mai Ya (Hordeum Germinatum), Chao Zha Rou (Stir-fried Hawthorn Flesh), Guang Pi (Tangerine Peel), Ban Xia (Pinellia Tuber), Hu Lian (Nelumbinis Semen).
Follow-up: Remove Ban Xia and Hu Lian from the previous prescription, add Ze Xie (Alisma Rhizome).
Chen, five years old. The official has spontaneous sweating, shortness of breath, and cough, presenting Wind-Warmth symptoms. The skin and pores show acne and prickly heat. This differs from rash with aphonia and Fu-organ disease. However, children are full of vital Yang. From late spring to early summer, physical constitution diminishes daily. Complexion and pulse indicate deficiency, yet tonifying Spleen with acrid-sweet herbs failed. Abdominal fullness, comfortable upon pressure, bowel movements and urination were originally free. Abdominal pain comes and goes; after pain subsides, appetite returns. Examining pediatric Five Kan diseases, they resemble the Five Exhaustions in general medicine. Kan must arise from stagnant heat forming accumulation or parasites, leading to diet failing to nourish muscles and flesh. The disease onset is not sudden; attack should be gradual. Regarding Kan heat and parasitic accumulation, ancients treated Liver and Stomach frequently, while Jiegu (Zhang Yuansu) and Dongyuan (Li Dongyuan), in cases of internal injury with stagnation, often prepared pill formulations for slow treatment, deriving meaning from the tangible nature of dregs, differing from decoctions. Currently, after turmoil by warm pathogens, tentatively use sweet-cool substances to clear and nourish Stomach Yin, transforming Lung heat. Acrid dispersants for releasing the exterior are inappropriate. (Syndrome: Internal Injury with Stagnation, Parasitic Accumulation)
Prescription: Tian Xing Ren (Sweet Apricot Seed), Mai Dong (Ophiopogon Tuber), Di Gu Pi (Lycium Cortex), Sheng Gan Cao (Raw Licorice Root), Dong Sang Ye (Mulberry Leaf), Yu Zhu (Polygonatum Odoratum Rhizome), mixed with one wine cup of Qing Zhe Gan Zhi (Green Sugarcane Juice).
(Pill Formula) Imitating treatment for Kan heat and emaciation, dredging from Yangming and Jueyin meridians, combining elimination and tonification.
Prescription: Ren Shen (Ginseng Radix et Rhizoma), Huang Lian (Coptidis Rhizoma), Lu Hui (Aloe), Chuan Li Zi (Toosendan Fruit), Shi Jun Zi (Quisqualis Fruit), Fu Ling (Poria), Bai Shao (White Peony Root), Guang Pi (Tangerine Peel), Hu Huang Lian (Picrorhiza Rhizoma), Nan Shan Zha (Crataegus Pinnatifida).
Certain patient, seven years old. Irregular food intake damaged Spleen and Stomach, causing abdominal distension and irregular bowel movements, belonging to Spleen Kan. (Syndrome: Food Injury to Spleen and Stomach)
Prescription: Jiao Zhu (Charred Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Guang Pi (Tangerine Peel), Yi Zhi Ren (Alpinia Oxyphylla Fruit), Da Fu Pi (Areca Pericarpium), Mu Gua (Chaenomelis Fructus), Pao Jiang (Prepared Ginger), Chao Shen Qu (Stir-fried Medicated Leaven).
Wu, nine years old. Capable of eating, but complexion is withered and body thin, evening fever with diarrhea. All these result from carelessness in mouth and belly, occurring during the long summer warm-heat season, damaging Spleen and Stomach, about to become Five Kan.
Prescription: Qing Hao Geng (Artemisia Annua Stem), Zhi Shi Tan (Charred Immature Bitter Orange), Hu Huang Lian (Picrorhiza Rhizoma), Chao Gu Ya (Stir-fried Rice Sprout), Chao Bai Shao (Stir-fried White Peony Root), Chao Shan Zha (Stir-fried Hawthorn Fruit), Guang Pi (Tangerine Peel), Fu Ling (Poria), Ze Xie (Alisma Rhizome).
Wang. Suffering from Five Kan for a long time, Spleen and Stomach damaged, food not transported, abdominal distension and loose stools. This indicates accumulation not cleared, Middle Jiao first deficient, undigested food passing through, swelling all present, a difficult-to-treat syndrome. Use Seven Fragrance Cake.
Kan means "dry." Children's intestines and stomachs are tender. If milk and food are irregular, and sweet/greasy foods are uncontrolled, transport and transformation fail, leading to retention, accumulation, and fever. Long-standing heat dries fluids; this is Kan formed from accumulation. Or if five organs are biased toward heat, or post-illness, or due to erroneous purgation by physicians causing fluid loss, Spleen fails to distribute and transform, stagnation does not move; this is accumulation caused by dryness. Thus, Five Kan never leaves Spleen and Stomach. Treatment methods: if Stomach has stagnation, eliminate it; if Spleen is weak, tonify it. For heat, use bitter-cold to clear fire; for cold, use acrid-warm to strengthen transport. For parasites, add anti-parasitic agents. For deficiency, supplement the mother organ according to each Zang organ. Generally, use pills for slow regulation; immediate results cannot be expected. Alternatively, stew chicken liver with Kan-treating medicines for consumption, which is most effective. (Lu Lv'an)
Xu's Comment: This old physician, in pediatric smallpox diseases, is not only a famous expert but can be called a grandmaster. Respect, respect.