小儿肠胃受伤，变生诸证，以疳证为最剧，亦最为复杂难治。推其起因，实由初生调护无方，其后饮
食失节所致。一由小儿一面吃乳，一面恣食肥甘，积郁既久，热伤肠胃；一由小儿食不运化，积久生虫，虫
既内生，虽能食而不肥；一由小儿数岁，犹恋乳食，生养不足，脾胃之气暗耗；一由小儿吐泻之后，妄施
攻伐之药，津液枯竭，肠胃疲惫；一由乳母喜怒失常，饮食乖度，或交合之后以乳哺儿，均足致此。疳证之
初起，常现身体发热、面黄肌瘦之象，及时治之，十愈八九；其已成者，多见头皮光急，毛发焦稀，腮缩
鼻干，口馋唇白，两眼昏烂，揉鼻 眉，脊耸体黄，斗牙咬甲，焦渴自汗，尿浊泻酸，腹胀肠鸣，癖结潮
热，酷嗜瓜果、咸酸、炭、米、泥土等物，诸般证状，此时按证施治，亦可十愈六七。若因循坐误，或治
失其法，则生生之气日薄，未有不由重而危，由危而不救者。或日在大人为痨，在小儿为疳，疳者干也，明
为精血败竭之病，故疳之一证，其造因虽为肠胃受伤，而其流所及，变化无穷，若病至脚指触物不知痛，手
足垂 无力，身无暖气，泻青涎或沫不止，项筋舒展无力者，均
属不治。兹将疳之类别如五疳、疳积、杂疳各证，条列于后。
一、五疳
疳证名目繁多，而治法总不离乎脾胃。曰五疳者，有心疳、脾疳、肝疳、肺疳、肾疳等症，其病状
虽间有出入，而其源初无大异也，心疳者，多见身体壮热，面赤唇红，口舌生疮，胸膈烦
闷，口渴饮冷，喜眠于地，下痢脓血，时有盗汗、啮齿、虚惊等状；脾疳者，多见面色痿黄，头大项小，
喘促气粗，多啼咳逆，困倦喜睡，乳食懒进，目生白膜，唇赤发焦，口鼻常干，胸膈壅
满，喜暗憎明，昼凉夜热，口渴引饮，腹胀脚弱，吐逆乏力，水谷不消，泄下酸臭，喜食泥土，合面覆卧等状
；肝疳者，多见摇头揉目，流汗遍身，合面而卧，面色青黄，发竦头焦，筋青脑热，周身疮癣，腹中积
聚，膈上伏热，痰涎壅塞，下利频仍，或下鲜血，或下青苔，若肝风入目，则赤肿翳生，眵泪烂眶，昏暗
雀盲，痛痒揉擦等状；肺疳者，多见咳嗽气逆，皮毛干焦，多涕时啼，咽喉不利，壮热憎寒，唇边赤
痒，腹内气胀，乳食渐稀，口有腥气，面色 白，手足枯细，皮肤起粟，肠胃不和，频频泄
利，鼻下生疮等症；肾疳者，多见肌骨消瘦，齿龈生疮，寒热时作，口鼻干燥，脑热如火，脚冷如冰，遍身
疮疥，喜卧冷地，乳食减少，泻利频仍，肛门溃烂，或生湿疮，牙缝溃烂，传为走马疳等状。兹将其治法述下。
二、五疳之治法
疳证之治法，初起宜健脾消积，清热杀虫，及其已成，体实者宜正本清源，先用攻下杀虫之剂，后用培
本养元之法，体虚者宜攻补兼施，慎用峻利之药，此中消息，则寒热之辨别，以及虚
多实少、实多虚少之分，尤宜详察。大概健运以扶持脾胃之剂，宜用白术、鸡内金、豆蔻、木香、砂仁之
类；消积之剂，宜用莪术、三棱、槟榔、浓朴、麦芽、神曲之类；清热之剂，宜用川黄
连、胡黄连、淡芩、青皮、柴胡之类；杀虫之剂，宜使君子、芜荑、川楝子、芦荟之类；补益之剂，宜人
参、潞党、山药、扁豆、莲心、生地、熟地、萸肉、当归、阿胶之类。通治之方有集
圣丸加减、五疳保童丸、五疳消积丸、万应丸之属。至于心、脾、肝、肺、肾五疳，各因肠胃受伤，脾运
不健，而致五脏交受其病，兼病于心者，即谓之心疳，治宜安神丸以治心，异功散以补脾，余如张涣参黄丹及真
珠散、茯苓丸、茯神汤、桃花丸，均可酌用。大凡心经有实热之见象者宜酌加黄连、犀角、羚羊、牛
黄、天竺黄之类；心经有虚热之见象者，宜加茯神、远志、枣
仁、玄参、人参之类。心疳而至惊啼口渴，嗜食辛味，耳边有脉，舌下有黑靥者不治。兼病于脾者，谓
之脾疳，治宜四味肥儿丸以治疳，五味异功散以养脾，余如钱氏益黄散、参苓白术散、神效换肌丸、大胡黄
连丸、芦荟丸、张涣木香散均可酌用。大凡脾经有热者，宜加黄连、地黄、三棱、莪术之类；脾经有湿
者，宜加半夏、白术、陈皮、苡米、甘遂、商陆之类；脾气虚寒者，宜加于术、补骨脂、干姜、肉豆
蔻、肉桂之类。脾疳而至腹大如鼓，唇无血色，人中平满，下痢无度者不治。兼病于肝者，
谓之肝疳，治宜地黄丸， 归汤、天麻丸、生熟地黄汤、熊胆天麻丹、芦荟丸均可酌用。大凡肝经有实热之
见象者，宜加龙胆草、菊花、柴胡、连翘、栀子、青皮、白芍之类；肝经有虚热之见象者，宜加川芎、天麻
、熟地、牡蛎、龙骨、萸肉、五味之类。肝疳而至目有青脉，左胁硬痛，多吐涎沫，眼角左右有黑气
者不治。兼病于肺者，谓之肺疳，治宜先用地黄清肺饮以治肺，次用益气丸以补肺，余如益黄散、化 丸、
补肺散、张涣麝香丹、阿胶散、胡黄连丸之类，均可酌用。大凡肺经有热者宜加桑皮、桔梗、前胡、鲜生
地、竹茹、竹沥、麻黄、杏仁之类；肺气虚寒者，宜加人参、黄 、党参、麦冬、山药、熟地之类。肺疳
而至频泻白沫，身有黑斑如粟米大者不治。兼病于肾者，谓之肾疳，治宜钱氏地黄丸或生脉散多加黄 以
调肺，余如调元散、九味地黄丸、张涣熊胆散之类，均可酌用。大凡肾经有热者，宜加
车前、茯苓、泽泻、通草、猪苓、木通、黄柏之类；肾气虚寒者，宜加附子、熟地、山萸肉、胡卢巴、巴
戟、黄 之类。肾疳而至嗜食酸咸，饮水无度，小便如乳，牙齿青黑，耳脑干燥，肩
耸骨枯者不治。此五疳证治之一斑也。
三、疳积
疳积者，因疳而成积也。夫疳证之远源，起于肠胃之受伤，肠胃既伤，食不易化于是乎成积至易。动
辄成积，疳证非但有难愈之望，抑且有加重之势，是故疳积一证，为患亦深，轻治之则积不能行，重攻之则
每致泄泻，或变化为疳痢，或变化为疳胀，身体益瘦，脾胃益疲，亦可积渐以成不治，故非可忽视也。疳积
之证状，面色青黄，身瘦脘胀，发立身热，腹中微痛，疳痢则泻痢赤白，或青色如冻，日久不愈，腹痛或胀。
疳胀则身体日瘦，腹大不行，发竖发热，气短而急。之数证者，虚中有实，实中有
虚，稍不中病，即无益而反增其害。兹将其治法述下。
四、疳积之治法
疳积成于运化不良，故治法宜化积行滞而不伤其正，积重者虽宜峻攻，然宜佐以保脾胃之药，造积滞
既下仍宜常服健脾扶胃之药，俾食不再停积不再聚，方可有效，否则徒事攻伐，则旋行
旋积，固无济于事也。通治方宜先用匀气散或醒脾散调补，后用青金丹取下疳积，并宜常服保童丸、醒脾散
或疳积散之属。疳痢由积聚腐化，肠中受病益深而致，治宜先以杀虫行滞，次则保养脾胃，滞未全行，碍难
兜塞，通治方有青黛散、杀疳丸、肉豆蔻丸、芜荑丸、白龙骨丸等。痢行无度者，《简易方》用樗根白
皮、仓粳米、葱白、甘草、豆豉煮服极妥；腹痛不已者，宜白术散或胡黄连丸，《秘方》有用龙眼肉一枚，
包入苦参子七粒，日日吞之，治疳痢有效，再以保脾胃之品加而用之，尤为妥善。疳胀由积滞既久，浊气
凝聚，因而成胀，治宜行气化滞，温中去积，通治方有肥儿丸、六神丸、褐丸、五疳保童丸、肥气丸、分
气饮等，但方药中有攻伐过峻者，宜慎用之，或一用即止。初起
以胡黄连二钱，阿魏一两，神曲、黄连各二钱，麝香一钱，为末，每服少许，白术汤送下，亦妥。
五、诸疳
小儿疳证之重要者为五疳疳积，然有因疳病之后，发为其
他合并之病者，以病状之互异，或部位之不同，遂有种种之名称。至论其治法，固与五疳等无大差别也。合
而并之，固属一类，惟进一层言之。昔人既为之特立一名，则于治法方面，亦属不厌求详之意，立意既属
可取，方亦未可偏废，爰特摘录蛔疳、脊疳、干疳、内疳、口齿疳、鼻疳、眼疳、脑疳、无辜疳、丁奚
疳、哺露疳、癖病等诸疳逐条述之，以便治疳者得为郑重之考查。
（一）蛔疳 因小儿饭食太早，或多食甜腻，停蓄肠胃，以致腹中化生蛔虫，证状多见皱眉多啼，
呕吐清沫，腹中作痛，外见青筋，齿痒鼻痒，唇口紫黑。
（二）脊疳 因虫食脊膂所致。证状多见身热羸黄，击背如
鼓鸣，脊骨如锯齿，或十指皆疮，频啮爪甲，烦渴下痢。
（三）干疳 因胃火过亢，消烁津液所致。证状多见身体壮热，时或憎寒，舌涩口干，睡多盗汗，
皮肤枯燥，发立毛焦，乳食虽多，肌肉消瘦，四肢无力，好睡昏昏。大抵憔悴少血，舌干
多啼者，其病在心；目不转睛，虽啼无泪者，其病在肝；身热尿干，手足清冷者，其病在肾；声焦皮燥，
大便干结者，其病在肺；闭口酣睡，胸脘干渴者，其病在脾。
（四）内疳 因虫蚀肛肠所致。疳之在内者，所以别于疳之在外者（外疳如走马疳、口齿疳、鼻疳、
眼疳等），证状多见眼目涩痒，体热皮枯，肠胃不调，乳食不化，心腹虚胀，痢下五色，久而不止，日渐羸瘦。
（五）口齿疳∶即走马牙疳之轻者（走马牙疳见本章第三节及第四章第三节），因脾胃传化失常，
热毒蕴蓄，血分不清所致。证状多见唇口痒痛，牙齿焦黑，龈肉赤烂，颊肿舌痛，口多臭气。
（六）鼻疳 固乳食不调，上焦壅滞，疳虫上蚀所致。证状
多见鼻中赤痒，连唇生疮，壮热多啼，皮毛干焦，肌肤消瘦，咳
嗽上气，下痢不已。
（七）眼疳 因脏腑风热壅滞，不得宣通，或乳食过多，胸膈痰结，邪热上攻于目所致。证状多见脑热
目痒，或赤烂生疮，或生翳膜，渐渐遮睛。
（八）脑疳 因胎中禀受风热所致。证状多见头皮光急，满头生疮，脑热如火，发结如穗，遍身多汗，
腮肿囟高，哺乳越常，睡喜合面。
（九）无辜疳 因小儿衣席，夜露不收，沾染邪气，或因饮食不节，寒暖不匀所致。证状多见脑后有
核如弹丸，按之则动，初生时软而不痛，中有虫如米粉，得热气则渐长大，虫随气血流
散，子母相生，侵蚀脏腑，令儿肌肉作疮，便泄脓血，头大发竖，手足细弱。
（十）丁奚疳 因脾胃受伤，不能运化，血衰气滞所致。证状多见肿胀而腹无青筋，面色惨淡，潮热
往来，手足细小，项长骨露，尻臀无肉，腹胀脐突。
（十一）哺露疳 因脏气虚冷所致。证状多与丁奚疳相似，食则吐逆，泄泻无度，粪中有虫。
（十二）癖病 因饮食失节，伤及脾胃，积滞不化，久而成癖，其形坚结，藏于隐癖。证状多见生
于胁下，坚硬成块，初作之时，午后潮热，口渴饮冷，腹大筋青，渐如鸡卵，不时作痛。
此诸疳之证状也。此外因疳而发为疮疥者谓之疳疮，亦同类而附入之。兹将其治法述下。
六、诸疳之治法
（一）蛔疳 因积滞化虫，治宜使君子散、芦荟丸以取蛔虫，后用益黄散之属以调脾胃，余如张
涣三根散、下虫丸之属，均可酌用。
（二）脊疳 因虫食脊膂，治宜圣惠金蟾散、地骨皮丸、杀
疳丸、芦荟丸、青黛丸之属。泻血不止者，用定粉少许，大枣十
枚，头发少许，共聚一处，火 通赤，细研，每服五分，米饮下。
（三）干疳 因水津亏耗，热自内生，治宜圣惠天竺黄散、青黛丸、牛黄丸、胡黄连丸之属。
（四）内疳 因虫蚀肛肠，治宜使君子丸以杀虫，余如东垣浓肠丸、圣惠木香丸、芦荟丸、胡粉丸
之属，俱可酌用；或神曲、麦芽、三棱、青皮、香附、山楂、浓朴、甘草、藿香、枳
实、地黄、砂仁、黄连、枣子各等分，研为末，熟汤调服。
（五）口齿疳 因热毒蕴蓄，血分不清，治宜清血解毒，内服用清胃散、甘露饮等，外敷用青霞散、
黄矾散之属；或百药煎、胭脂各等分，为细末掺之；或用米泔水洗疮，以黄丹（飞
过）、乳香、白矾（飞过）、胭脂各一钱，轻粉、麝香，各少许，共为细末，挹干掺之。
（六）鼻疳 因疳热熏蒸，鼻痒生疮，治宜汤氏五福化毒丹、泽泻散、枇杷叶散之属，外用甘草白矾
汤洗净，后以芦荟、黄连、黄柏为末敷之，或青金散敷之，或蝉壳散吹之，或青黛一
钱，麝香少许，熊胆末五分，临睡时掺之。
（七）眼疳 因疳热熏蒸，上攻于目，治宜泻肝散、杀疳散。退翳丸、羚羊角丸、
消疳无价散，外用蕤仁膏之属。
（八）脑疳 因疳热熏蒸，上侵及脑，治宜龙脑丸、龙胆丸之属，或用吹鼻龙脑散，或用黄葵花、菊花、
釜下墨、硝石、柏叶各等分，共为散，吹入鼻中，良久，鼻中有恶物似泥者泄下数条，此即病根，下后可愈。
（九）无辜疳 因热生虫，颈项生疮，治宜柴胡饮先清其热，芦荟肥儿丸再消其积，或圣惠鳖甲散、张
涣蝎虎丹、蓝叶汤、漏芦散之属，颈项有核内有虫如米粉者宜破取之，再以芦荟、黄连、黄柏粉末敷患处。
（十）丁奚疳 因脾胃气虚，大腹膨胀，治宜先投万应丸，
[Background Information]
Book: Pediatric Essentials (Erke Yaolue)
Chapter: Section 6 - Gan Syndrome (Part 1/4)
Category: Gynecology and Pediatrics
The damage to the intestines and stomach in children gives rise to various syndromes, among which Gan syndrome (a chronic consumptive disease characterized by emaciation, sallow complexion, dry hair, and abnormal diet) is the most severe and complex to treat. Tracing its origin, it is actually caused by improper care after birth and subsequent irregular diet. There are five specific causes: First, while nursing, the child indulges in rich and sweet foods; long-standing accumulation leads to heat damaging the intestines and stomach. Second, the child's food fails to be transported and transformed; long-standing accumulation generates parasites. Once parasites are generated internally, although the child may have a good appetite, they do not gain weight. Third, at an age of several years, the child still clings to breast milk, resulting in insufficient nutrition and the hidden consumption of Spleen and Stomach Qi. Fourth, after vomiting and diarrhea, inappropriate purgative medicines are administered, leading to exhaustion of body fluids and fatigue of the intestines and stomach. Fifth, the nursing mother experiences abnormal emotions or improper diet, or nurses the infant immediately after sexual intercourse; all these can lead to this condition.
In the early stage of Gan syndrome, symptoms often include fever, sallow complexion, and emaciation. If treated promptly, eight or nine out of ten cases can be cured. In established cases, common signs include tight and shiny scalp, sparse and brittle hair, retracted cheeks and dry nose, craving for food with white lips, dim and ulcerated eyes, rubbing of the nose and eyebrows, hunched spine with yellowish body, teeth grinding and nail biting, intense thirst with spontaneous sweating, turbid urine with sour-smelling stool, abdominal distension with borborygmus, accumulation of masses with tidal fever, and extreme cravings for fruits, vegetables, salty/sour items, charcoal, rice, clay, etc. At this stage, treating according to the syndrome allows for six or nine out of ten cures. However, if one delays treatment or applies incorrect methods, the vital energy will gradually diminish, inevitably progressing from severe to critical, and finally incurable. It is said that in adults, this is called Lao disease (consumption), while in children, it is called Gan syndrome. "Gan" means dryness, clearly indicating a disease of exhausted essence and blood. Thus, although the cause of Gan syndrome lies in intestinal and gastric injury, its progression is infinite. If the disease progresses to the point where the toes cannot feel pain upon touch, the limbs hang limp and weak, the body lacks warmth, there is continuous discharge of green saliva or foam, and the neck tendons lack strength, these are considered incurable. The categories of Gan syndrome, such as Five Gans, Gan Accumulation, and Miscellaneous Gans, are listed below.
I. Five Gans
There are many names for Gan syndrome, but the treatment always revolves around the Spleen and Stomach. "Five Gans" refers to Heart Gan, Spleen Gan, Liver Gan, Lung Gan, and Kidney Gan. Although their symptoms vary slightly, their origins are essentially the same.
Heart Gan: Often presents with high fever, red face and lips, mouth and tongue ulcers, chest oppression, thirst for cold drinks, preference for sleeping on the ground, dysentery with pus and blood, night sweats, teeth grinding, and fright.
Spleen Gan: Often presents with sallow complexion, large head with thin neck, panting and coarse breathing, frequent crying and coughing, fatigue and sleepiness, reluctance to eat, white membrane over the eyes, red lips and burnt hair, dry mouth and nose, chest fullness, preference for darkness, coolness by day and heat by night, thirst, abdominal distension with weak legs, vomiting and weakness, indigestion, sour-smelling diarrhea, craving for dirt, and sleeping face down.
Liver Gan: Often presents with head shaking and eye rubbing, whole-body sweating, sleeping face down, blue-yellow complexion, upright hair and burnt head, visible blue veins and hot brain, skin sores and tinea, abdominal masses, latent heat above the diaphragm, phlegm obstruction, frequent diarrhea (sometimes with fresh blood or green moss). If liver wind enters the eyes, it causes redness, swelling, pterygium, discharge, blindness, and itching.
Lung Gan: Often presents with cough and reversed qi, dry and brittle skin/hair, excessive nasal discharge and crying, throat discomfort, high fever with aversion to cold, itchy red lips, abdominal bloating, reduced milk intake, fishy breath, pale face, thin and dry extremities, millet-like skin bumps, gastrointestinal disharmony, frequent diarrhea, and ulcers under the nose.
Kidney Gan: Often presents with muscle and bone emaciation, gum ulcers, alternating chills and fever, dry mouth and nose, burning brain sensation, icy cold feet, widespread sores, preference for cold surfaces, reduced milk intake, frequent diarrhea, anal ulceration, wet sores, interdental ulceration, potentially progressing to Running Horse Gan. The treatments are described below.
II. Treatments for Five Gans
For Gan syndrome, early treatment should strengthen the Spleen, resolve accumulation, clear heat, and kill parasites. For established cases in robust patients, one should address the root first using purgatives to kill parasites, followed by tonifying methods. For deficient patients, attack and tonification should be combined, avoiding harsh purgatives. Key points involve distinguishing cold from heat and determining whether deficiency or excess predominates. Generally, formulas to support the Spleen and Stomach use Atractylodis Rhizoma (Baizhu), Endospermum Cruciatae (Jineijin), Cardamomi Fructus Rotundus (Doukou), Aucklandiae Radix (Muxiang), and Amomi Fructus (Sharen). Formulas to resolve accumulation use Curcumae Zedoariae Rhizoma (Ezhu), Sparganii Rhizoma (Sanleng), Arecae Semen (Binglang), Magnoliae Officinalis Cortex (Houpo), Hordei Fructus Germinatus (Maiya), and Massae Fermentatae Medicinalis (Shenqu). Heat-clearing formulas use Coptidis Rhizoma (Huanglian), Picrorhizae Rhizoma (Huhuanglian), Scutellariae Radix (Danqin), Tangerinis Pericarpium Viride (Qingpi), and Bupleuri Radix (Chaihu). Parasite-killing formulas use Quisqualis Fructus (Shijunzi), Chromolaenae Herba (Wuyi), Toosendan Fructus (Chuannianzi), and Aloe (Luhui). Tonifying formulas use Ginseng Radix et Rhizoma (Renshen), Codonopsis Radix (Ludangshen), Dioscoreae Rhizoma (Shanyao), Dolichoris Semen (Biandou), Nelumbinis Plumula (Lianxin), Rehmanniae Radix (Disheng/Shudi), Corni Fructus (Yurou), Angelicae Sinensis Radix (Danggui), and Asini Corii Colla (Ejiao). General formulas include Jisheng Wan modified, Wugan Baotong Wan, Wugan Xiaoji Wan, and Wanying Wan.
Regarding the Five Gans, since they stem from intestinal/gastric injury affecting the Spleen's transport function, impacting the Five Zang organs:
- Heart Gan: Treat the Heart with Anshen Wan and the Spleen with Yigong San. Other options include Zhang Huan's Shenhuang Dan, Zhenzhu San, Fuling Wan, Fushen Tang, and Taohua Wan. For Heart Excess Heat, add Huanglian, Rhinocerotis Cornu (Xijiao), Antelopis Cornu (Lingyangjiao), Bovis Calculus (Niuhuang), and Bambusae Concretio Silicea (Tianzhuhuang). For Heart Deficiency Heat, add Fushen, Polygalae Radix (Yuanzhi), Ziziphi Spinosomi Semen (Zaoren), Scrophulariae Radix (Xuanshen), and Renshen. Incurable signs: frightful crying, thirst, craving spicy food, palpable pulse behind the ear, black spots under the tongue.
- Spleen Gan: Treat with Siwei Fei'er Wan and Wuwei Yigong San. Others include Qian's Yihuang San, Shenling Baizhu San, Shenxiao Huanji Wan, Da Huhuanglian Wan, Luhui Wan, and Zhang Huan's Muxiang San. For Spleen Heat, add Huanglian, Dihuang, Sanleng, Ezhu. For Spleen Dampness, add Pinelliae Rhizoma (Banxia), Baizhu, Citri Reticulatae Pericarpium (Chenpi), Coicis Semen (Yimi), Kansui Radix (Gansui), and Phytolaccae Radix (Shanglu). For Spleen Qi Deficiency Cold, add Baizhu, Psoraleae Fructus (Buguzhi), Zingiberis Rhizoma (Ganjiang), Myristicae Semen (Roudoukou), and Cinnamomi Cortex (Rougui). Incurable signs: drum-like abdomen, colorless lips, flat philtrum, uncontrolled dysentery.
- Liver Gan: Treat with Dihuang Wan, Siwu Tang, Tianma Wan, Shengshu Dihuang Tang, Xiongdan Tianma Dan, and Luhui Wan. For Liver Excess Heat, add Gentianae Radix (Longdancao), Chrysanthemi Flos (Juhua), Chaihu, Forsythiae Fructus (Lianqiao), Gardeniae Fructus (Zhizi), Qingpi, Paeoniae Radix Alba (Baishao). For Liver Deficiency Heat, add Chuanxiong Rhizoma (Chuanxiong), Gastrodiae Rhizoma (Tianma), Shudi, Ostreae Concha (Muli), Longgu, Yurou, and Wuweizi. Incurable signs: blue vessels in eyes, hard painful left hypochondrium, excessive salivation, black aura around eye corners.
- Lung Gan: Treat first with Dihuang Qingfei Yin, then with Yiqi Wan. Others include Yihuang San, Huazheng Wan, Bufei San, Zhang Huan's Shexiang Dan, Ejiao San, and Huhuanglian Wan. For Lung Heat, add Morus Albae Cortex (Sangpiai), Platycodonis Radix (Jiegeng), Peucedani Radix (Qianhu), Fresh Rehmanniae Radix (Xianshengdi), Bamboo Leaves (Zhuru), Bamboo Sap (Zhuli), Ephedrae Herba (Mahuang), and Armeniacae Semen Amarum (Xingren). For Lung Qi Deficiency Cold, add Renshen, Astragali Radix (Huangqi), Codonopsis Radix (Dangshen), Ophiopogonis Tuber (Maidong), Shanyao, and Shudi. Incurable signs: frequent white frothy diarrhea, black millet-sized spots on body.
- Kidney Gan: Treat with Qian's Dihuang Wan or Shengmai San plus Huangqi to regulate the Lung. Others include Tiaoyuan San, Jiwei Dihuang Wan, and Zhang Huan's Xiongdan San. For Kidney Heat, add Plantaginis Seed (Cheqianzi), Fungi Polyporus (Fuling), Alismatis Rhizoma (Zexie), Tectona Grandis Stem (Tongcao), Polyporus (Zhuling), Akebia Caulis (Mutong), and Phellodendri Cortex (Huangbai). For Kidney Qi Deficiency Cold, add Aconiti Lateralis Radix Praeparata (Fuzi), Shudi, Yurou, Fenugreek Seed (Huluba), Morinda Officinalis Radix (Baji), and Huangqi. Incurable signs: craving sour/salty, excessive drinking, milky urine, black teeth, dry ears/brain, shrugging shoulders with withered bones. This covers the general treatment of the Five Gans.
III. Gan Accumulation
Gan Accumulation arises from Gan syndrome. Since Gan originates from intestinal/gastric injury, digestion is impaired, leading easily to accumulation. Accumulation worsens Gan, making it harder to cure and more likely to progress. Thus, Gan Accumulation is serious: mild treatment fails to move accumulation, while aggressive treatment causes diarrhea, potentially transforming into Gan Dysentery or Gan Distension, further emaciating the patient and exhausting the Spleen/Stomach, eventually becoming incurable. Symptoms include blue-yellow complexion, emaciated body with abdominal distension, erect hair with fever, and mild abdominal pain. Gan Dysentery involves bloody/mucous or green jelly-like stools, persistent over time, with pain/distension. Gan Distension involves progressive emaciation, massive abdomen, erect hair, fever, shortness of breath, and rapid breathing. These conditions involve both deficiency and excess; improper treatment increases harm. Treatments follow.
IV. Treatments for Gan Accumulation
Since Gan Accumulation stems from poor transport/transformation, treatment should resolve accumulation and move stagnation without damaging healthy Qi. For heavy accumulation, strong purgation is needed but must be assisted by Spleen/Stomach-protecting herbs. After accumulation is cleared, continue with Spleen-Stomach tonics to prevent recurrence. Otherwise, mere purgation leads to recurring accumulation. General approach: Use Yunqi San or Xingpi San for regulation first, then Qingjin Dan to expel Gan Accumulation. Maintain with Baotong Wan, Xingpi San, or Ganji San.
Gan Dysentery results from rotting accumulation deepening intestinal pathology. Treat by killing parasites and moving stagnation first, then protecting the Spleen/Stomach. General formulas: Qingdai San, Shagan Wan, Myristicae Semen Wan, Wuyi Wan, Bailonggu Wan. For uncontrolled dysentery, *Jianyi Fang* uses Cinchona Bark (Chugenbaipi), Barnyard Rice (Cangjingmi), Scallion White (Congbai), Licorice Root (Gancao), and Fermented Soybean (Douchi) boiled together. For persistent abdominal pain, use Baizhu San or Huhuanglian Wan. *Mifang* suggests swallowing one Longan Aril wrapped with seven Sophora Seed (Kushenzi) daily. Add Spleen-protecting herbs for better results.
Gan Distension results from long-standing stagnation and turbid Qi condensation. Treat by moving Qi, resolving stagnation, warming the Middle, and removing accumulation. General formulas: Fei'er Wan, Liushen Wan, He Wan, Wugan Baotong Wan, Feiqi Wan, Fenqi Yin. Use cautiously if formulas contain harsh purgatives. Early stage: Powder of Huhuanglian (2 qian), Asafetida (Awei, 1 liang), Shenqu and Huanglian (2 qian each), Moschus (Shexiang, 1 qian). Take small amounts with Baizhu Decoction.
V. Miscellaneous Gans
While Five Gans and Gan Accumulation are primary, complications arising from Gan syndrome due to varying symptoms or locations have specific names. Their treatments are similar to the Five Gans. Former physicians named them specifically, implying detailed treatment approaches are valuable. We list specific types: Roundworm Gan, Spine Gan, Dry Gan, Internal Gan, Mouth/Tooth Gan, Nose Gan, Eye Gan, Brain Gan, Innocent Gan, Dingxi Gan, Bulu Gan, and Pi Disease.
(1) Roundworm Gan: Caused by early feeding or excessive sweets/sticky foods accumulating in the gut, generating roundworms. Symptoms: frowning, frequent crying, vomiting clear foam, abdominal pain, visible subcutaneous veins, itchy teeth/nose, purple-black lips/mouth.
(2) Spine Gan: Caused by worms eating the spine. Symptoms: fever, emaciation/yellowing, drum-like sound when tapping back, serrated spine, sores on fingers, nail biting, thirst/dysentery.
(3) Dry Gan: Caused by excessive Stomach Fire consuming fluids. Symptoms: high fever, occasional chills, dry tongue/throat, night sweats, dry skin, brittle hair, excessive eating yet emaciation, limb weakness, lethargy. Specific signs indicate organ involvement: Heart (emaciated, dry tongue, crying); Liver (fixed gaze, no tears when crying); Kidney (fever, dry urine, cold limbs); Lung (hoarse voice, dry skin, constipation); Spleen (closed-mouth sleep, chest/epigastric dryness/thirst).
(4) Internal Gan: Caused by worms eroding intestines/rectum. Differentiates from External Gan (Running Horse, Mouth, Nose, Eye). Symptoms: gritty/itchy eyes, fever/dry skin, GI dysfunction, indigestion, empty abdominal distension, five-colored dysentery, persistent wasting.
(5) Mouth/Tooth Gan: Mild form of Running Horse Gum Gangrene. Caused by Spleen/Stomach dysfunction, heat-toxin accumulation, and blood disorder. Symptoms: itchy/painful lips/teeth, blackened teeth, red/rotten gums, swollen cheeks/tongue, foul breath.
(6) Nose Gan: Caused by dietary imbalance, Upper Jiao congestion, and Gan worms attacking upwards. Symptoms: red/itchy nose, lip ulcers, high fever/crying, dry skin/hair, emaciation, cough/asthma, persistent dysentery.
(7) Eye Gan: Caused by Wind-Heat congestion in Zang-Fu, inability to diffuse, or excessive food causing phlegm-heat attacking the eyes. Symptoms: hot brain/itchy eyes, red/ulcerated eyes, pterygium obscuring vision.
(8) Brain Gan: Caused by Wind-Heat inherited in utero. Symptoms: tight/shiny scalp, head sores, burning brain sensation, matted hair like tassels, whole-body sweating, swollen cheeks/high fontanelle, excessive nursing, sleeping face down.
(9) Innocent Gan: Caused by exposure to damp/cold or irregular diet. Symptoms: elastic-like mass behind ear, movable, soft/painless initially, containing worm-like substance resembling rice flour, growing with heat, spreading via Qi/Blood, eroding organs, causing skin sores, purulent/bloody stool, wild hair, weak limbs.
(10) Dingxi Gan: Caused by Spleen/Stomach injury, failure to transform, blood deficiency, and Qi stagnation. Symptoms: swelling without blue veins, pale face, tidal fever, thin limbs, long neck with exposed bones, buttock wasting, abdominal distension with protruding umbilicus.
(11) Bulu Gan: Caused by visceral Qi deficiency and cold. Symptoms similar to Dingxi Gan: vomiting after eating, uncontrolled diarrhea, worms in stool.
(12) Pi Disease: Caused by irregular diet injuring Spleen/Stomach, leading to unresolved stagnation forming masses. Symptoms: hard mass in hypochondrium, afternoon tidal fever, thirst for cold, abdominal distension with blue veins, size of chicken egg, intermittent pain.
These are the symptoms. Sores caused by Gan are called Gan Chuang. Treatments follow.
VI. Treatments for Miscellaneous Gans
(1) Roundworm Gan: Due to stagnation generating worms. Use Shijunzi San or Luhui Wan to expel worms, then Yihuang San to regulate Spleen/Stomach. Others: Zhang Huan's Sangen San, Xiachong Wan.
(2) Spine Gan: Due to worms eating spine. Use Shenghui Jinchan San, Digupi Wan, Shagan Wan, Luhui Wan, Qingdai Wan. For uncontrollable bleeding:少量 Calamine (Dingfen), 10 Jujubae Fructus (Dazao), slight amount of hair. Calcined until red, powdered. Take 5 fen with rice water.
(3) Dry Gan: Due to fluid depletion and internal heat. Use Shenghui Tianzhuhuang San, Qingdai Wan, Niuhuang Wan, Huhuanglian Wan.
(4) Internal Gan: Due to worms eroding rectum. Use Shijunzi Wan to kill parasites. Others: Dongyuan Nongchang Wan, Shenghui Muxiang Wan, Luhui Wan, Hufen Wan. Or equal parts Shenqu, Maiya, Sanleng, Qingpi, Xiangfu, Shanzha, Houpo, Gancao, Huoxiang, Zhishi, Dihuang, Sharen, Huanglian, Zaozi. Powdered, taken with warm water.
(5) Mouth/Tooth Gan: Due to heat-toxin and blood disorder. Clear blood and detoxify. Internally: Qingwei San, Ganlu Yin. Externally: Qingxia San, Huangfan San. Or equal parts Baiyaojian and Rouge, powdered. Or wash with rice water, apply powder of refined Cinnabar (Huandan), Frankincense (Ruxiang), alum (Baifan), Rouge (1 qian each), Calomelas (Qingfen), Moschus (small amount).
(6) Nose Gan: Due to Gan heat steaming, causing itch/sores. Use Tangshi Wufu Huadu Dan, Zexie San, Pipaye San. Wash externally with Gancao and Baifan decoction. Apply powder of Luhui, Huanglian, Huangbai. Or apply Qingjin San, Chanqiao San, or mix Qingdai (1 qian), Shexiang (small amount), Xiongdan (5 fen) before sleep.
(7) Eye Gan: Due to Gan heat attacking eyes. Use Xiegan San, Shagan San. Tuanyi Wan, Lingyangjiao Wan, Xiaogan Wuji San. Externally: Ruiren Gao.
(8) Brain Gan: Due to Gan heat invading brain. Use Longnao Wan, Longdan Wan. Or blow Longnao San into nose. Or equal parts Huangkuihua, Juhua, Fu Xia Mo (soot from pot bottom), Xiaoshi, Bo Ye. Powdered and blown into nose. Bad mud-like matter will discharge, curing the root.
(9) Innocent Gan: Due to heat generating worms, sores on neck. Use Chaihu Yin to clear heat, Luhui Fei'er Wan to resolve accumulation. Others: Shenghui Biejia San, Zhang Huan Xiehu Dan, Lanye Tang, Loulu San. Break open neck mass if worm-like substance exists, apply Luhui, Huanglian, Huangbai powder.
(10) Dingxi Gan: Due to Spleen/Stomach Qi deficiency and abdominal distension. First administer Wanying Wan,