小儿鼻疳，因肝热攻肺而成，盖鼻为肺窍，故发时鼻塞，赤痒疼痛，浸淫溃烂，下连唇际成疮，咳嗽气促，
毛发焦枯诸病状，宜分别治之，热盛者，古法主清金散（如生栀子、黄芩、蜜炙枇杷叶、生地黄、花粉、连翘、
麦冬、薄荷、玄参、生甘草、桔梗，引用灯芯）。
虫蚀者，古法主化虫丸（如芜荑、生芦荟、青黛、川芎、白芷梢、胡黄连、川黄连、虾蟆灰各等分，共为细
末，猪胆汁浸糊为丸，如麻子大，每服二十丸，食后杏仁煎汤下）。
外用鼻疳散敷之（如青黛一钱，麝香少许，熊胆五分，共为细末，用猪骨髓调贴，湿者干上）。
〔真按〕鼻疳既因疳热攻肺，应先治肺以除鼻患，然后再清内之疳热，且此证鼻中必有疳虫，亦宜先设法
除之，内服方用连翘二钱，玄参二钱，淡黄芩钱半，马兜铃一钱，寸麦冬一钱，薄荷叶八分，桑白皮八分，生甘
草一钱，生芦荟三分，引用竹沥汁十滴。
外用微炒蝉壳三分，研青黛三分，蛇蜕皮三分，飞滑石三分，真麝香三分，研极细末，每用绿豆大吹入鼻孔，
每日早午晚吹三次，疳虫尽出，则鼻患可除。
小儿脊疳因积热生虫，上触脊膂，以手击其背，必空若鼓鸣，脊骨羸瘦，状若锯齿，乃成此证，外面亦身体发
热，下利烦渴，十指皆疮，频啮指甲，最为可怕，古法主先用芦荟丸杀其虫（如生芦荟、青黛、朱砂、熊胆、胡
黄连、贯众、微炒地龙、川黄连、蝉蜕去足、雷丸各五钱，真麝香一钱，虾蟆一个，酥涂炙焦，共为细末，用蜗
角肉研和丸，如麻子大），每服五丸，粥饮下，量儿大小与之。
继用金蟾散消其疳（如蟾一枚酥涂炙焦、夜明砂炒、桃白皮、樗根白皮、地榆、黄柏、诃黎勒皮煨、百合、
人参、大黄、白芜荑、炒胡粉各三钱、槟榔一钱，丁香三十七粒，共为细末，每服五分，粥饮调下）。
〔真按〕小儿疳疾至于虫食脊膂，发热黄瘦，从前失治，已可概见，凡五疳皆有停食成积，积久生虫，
形如丝发，如马尾，多出于头顶背腹之间，虫色黄白赤者好治，青黑者难治，除虫原为急务，然亦须兼顾其本体，
宜用丸剂，方以苦楝根皮二钱，贯众二钱，芜荑二钱，槟榔二钱，芦荟酒炒钱半，夜明砂钱半，使君子肉二钱，
五灵脂炒二钱，南木香一钱，姜制川连二钱，干蟾蜍二钱，党参炒三钱，共研极细末，以米汤糊丸，仍以米饮送
下，量儿大小酌定丸数与之。
如儿太小，不能吞丸，以米汤调药末送下亦可。
Pediatric nasal gan (nasal ulceration caused by malnutrition/toxic heat) is caused by liver heat attacking the lungs. Since the nose is the orifice of the lungs, symptoms upon onset include nasal congestion, redness, itching, pain, exudation and ulceration spreading to the lips forming sores, accompanied by coughing, shortness of breath, and scorched, dry hair. Treatment should be differentiated: for excessive heat, ancient methods primarily use Qingjin San (Clear Metal Powder), containing Gardenia Fruit (Gardeniae Fructus), Scutellaria Root (Scutellariae Radix), Loquat Leaf fried with honey (Fritillariae Bulbus cum Melle Praeparatus - *Note: Text says Pipa Ye, usually Fritillariae Thunbergii Bulbus or Eriobotryae Folium, here translated as Loquat Leaf*), Rehmannia Root (Rehmanniae Radix), Trichosanthes Root (Trichosanthis Radix), Forsythia Fruit (Forsythiae Fructus), Ophiopogon Tuber (Ophiopogonis Tuber), Mint Herb (Menthae Haplocalycis Herba), Scrophularia Root (Scrophulariae Radix), Licorice Root (Glycyrrhizae Radix et Rhizoma), Platycodon Root (Platycodi Radix), using Juncus Effusus (Junci Medullam) as a guide drug.
For cases caused by worm erosion, ancient methods primarily use Huachong Wan (Worm-Transforming Pill), containing Toosendan Fruit (Toosendan Fructus), Raw Aloe (Aloe), Indigo Naturalis (Indicum), Ligusticum Rhizome (Ligustici Chuanxiong Rhizoma), Angelica Dahurica Root tip (Angelicae Dahuricae Radix), Picrorhiza Rhizome (Picrorhizae Rhizoma), Coptis Rhizome (Coptidis Rhizoma), and Bufo Skin Ash in equal parts, ground into fine powder, mixed with pig bile to form pills the size of hemp seeds. Take 20 pills per dose, administered after meals with an infusion of Apricot Seed (Armeniacae Semen Amarum).
Externally, apply Bi Gan San (Nasal Gan Powder) to the affected area, consisting of Indigo Naturalis (Indicum) one qian, Musk (Moschus) a small amount, and Bear Bile (Ursi Fel) five fen, ground into fine powder, mixed with pig bone marrow for application; if wet, apply dry powder directly.
[Chen Shouzhen's Commentary] Since nasal gan is caused by gan heat attacking the lungs, one should first treat the lungs to eliminate nasal ailments, and then clear internal gan heat. Furthermore, there must be gan worms in the nose in this condition, which should also be removed first. The internal prescription uses Forsythia Fruit (Forsythiae Fructus) two qian, Scrophularia Root (Scrophulariae Radix) two qian, Light-colored Scutellaria Root (Scutellariae Radix) one and a half qian, Aristolochia Root (Aristolochiae Radix) one qian, Ophiopogon Tuber (Ophiopogonis Tuber) one qian, Mint Herb (Menthae Haplocalycis Herba) eight fen, Mulberry Root Bark (Mori Cortex) eight fen, Licorice Root (Glycyrrhizae Radix et Rhizoma) one qian, Raw Aloe (Aloe) three fen, using Plantain Sap (Plantaginis Juice) ten drops as a guide drug.
Externally, use slightly stir-fried Cicada Slough (Cicadae Periostracum) three fen, ground Indigo Naturalis (Indicum) three fen, Snake Slough (Bombyx Batryticatus) three fen, Calcined Gypsum (Gypsum Fibrosum) three fen, and real Musk (Moschus) three fen, ground into extremely fine powder. Use an amount the size of a mung bean to blow into the nostrils three times daily (morning, noon, evening). Once the gan worms are completely expelled, the nasal ailment can be eliminated.
Pediatric spinal gan is caused by accumulated heat generating worms that ascend to touch the spine. Striking the back with hand produces a hollow sound like a drum. The spinal bones become emaciated, resembling saw teeth, resulting in this condition. Externally, the body presents with fever, diarrhea, irritability, and thirst. Sores appear on all ten fingers, and the child frequently bites their nails, which is most alarming. Ancient methods advise first using Lushui Wan (Aloe Pill) to kill the worms, containing Raw Aloe (Aloe), Indigo Naturalis (Indicum), Cinnabar (Cinnabaris), Bear Bile (Ursi Fel), Picrorhiza Rhizome (Picrorhizae Rhizoma), Cyathula Root (Cyathulae Radix), slightly stir-fried Earthworm (Pheretima), Coptis Rhizome (Coptidis Rhizoma), Cicada Slough without feet (Cicadae Periostracum), and Polyporus (Polyporus Ussuriensis) each five qian, real Musk (Moschus) one qian, one Bufo toad coated with butter and roasted until scorched. These are ground into fine powder, mixed with snail meat to form pills the size of hemp seeds. Take five pills per dose, administered with gruel drink, adjusting dosage according to the child's age and size.
Subsequently, use Jin Chan San (Golden Toad Powder) to eliminate gan, containing one toad coated with butter and roasted until scorched, Night-shining Sand (Collyrium Stercoris Vespertilionis), Peach White Bark (Pruni Persicae Cortex), Tree-of-heaven Root Bark (Ailanthi Radix), Sanguisorba Root (Sanguisorbae Radix), Phellodendron Bark (Phellodendri Chinensis Cortex), roasted Chebula Fruit skin (Terminaliae Chebulae Fructus), Lily Bulb (Lilii Bulbus), Ginseng Radix (Ginseng Radix), Rhubarb (Rhei Radix et Rhizoma), white Toosendan Fruit (Toosendan Fructus), stir-fried Calamine (Calamina), Areca Seed (Arecae Semen) one qian, and Clove (Caryophylli Flos) thirty-seven grains. Ground into fine powder, take five fen per dose, mixed with gruel drink.
[Chen Shouzhen's Commentary] When pediatric gan disease progresses to worms eating the spine, accompanied by fever, yellowish complexion, and emaciation, it is evident from previous mismanagement that treatment was neglected. All five types of gan involve food stagnation leading to accumulation, which over time generates worms resembling silk hairs or horse tails, mostly appearing between the head, back, and abdomen. Worms colored yellow, white, or red are easier to treat; those colored green or black are difficult. While expelling worms is urgent, one must also consider the patient's constitution. Pills are suitable. The formula consists of Melia Root Bark (Meliae Cortex), Cyathula Root (Cyathulae Radix), and white Toosendan Fruit (Toosendan Fructus) each two qian, Areca Seed (Arecae Semen) two qian, Aloe stir-fried with wine one and a half qian, Night-shining Sand (Collyrium Stercoris Vespertilionis) one and a half qian, Quisqualis Seed (Quisqualis Fructus) two qian, stir-fried Trogopterus Dung (Trogopterori Faeces) two qian, Costus Root (Aucklandiae Radix) one qian, Coptis Rhizome processed with ginger (Coptidis Rhizoma) two qian, dried toad (Bufo) two qian, and Codonopsis Root stir-fried (Codonopsis Radix) three qian. Ground into extremely fine powder, formed into pills with rice paste, and administered with rice water. Adjust the number of pills based on the child's age and size.
If the child is too young to swallow pills, mixing the powder with rice water for administration is also acceptable.