Library

Those over twenty years of age manifest as *Lao* (Consumption Disease), while those under twenty manifest as *Gan* (Childhood Malnutrition Syndrome); both are fundamentally due to deficiency and damage of Qi and Blood, differing only in name. Some arise from improper breastfeeding or early introduction of solid foods in infancy, when the intestines and stomach are not yet fully developed, leading to consumption of true Qi; some result from excessive intake of rich and sweet foods, causing long-standing stagnation, yellowish complexion, and emaciation; some stem from the nursing mother's imbalance of cold and heat, or nursing after emotional turmoil or sexual activity; others occur due to inadequate post-illness recovery where Yuan Qi has not restored. If the body appears plump but internal heat burns like fire, with polyphagia and polydipsia, and dark red urine, this is called *Gu Zheng* (Bone-steaming Fever). This progresses to morning coolness and night fever, eventually forming *Gan*. If urine color changes, becoming yellow-red, foul-smelling, difficult to pass, or turbid like rice water, this is called *Man Bai* (Diffuse White). Failure to treat at this stage leads to Yin-Yang disharmony, resulting in diarrhea or dysentery; persistent thirst and heat lead to malaria or strangury, transforming into *Gan*.

Regarding the Zang organs, there are Five *Gans*, each associated with specific seasons. In spring, eye pain, frequent vomiting and dysentery, parasitic diarrhea, white membranes covering the eyes, cyanotic tendons, and head heat indicate *Feng Gan* (Wind Gan). *Feng Gan* is caused by liver heat; severe cases show muscle wasting, bone exposure, nyctalopia (night blindness), hard masses in the left hypochondrium, frequent salivation, and black qi at the eye corners, which is fatal. In summer, high fever, flushed face and lips, tongue sores, red eyes, heat in the five centers, chest oppression, spontaneous night sweats, frequent thirst, dark scanty urine, and bitter dry mouth indicate *Jing Gan* (Startle Gan). *Jing Gan* is caused by heart heat; severe cases involve fluid depletion, incessant drinking, startled crying upon eating, dark tongue, and withered appearance, which is fatal. In autumn, yellowish face, limb heat, sour-smelling diarrhea, anorexia, pica (eating dirt), distended abdomen with thin legs, vomiting, epigastric fullness, undigested food, yellow sclera, swollen eyelids, and side-sleeping coma indicate *Shi Gan* (Food Gan). *Shi Gan* results from spleen meridian injury, also known as *Fei Gan* (Fat Gan). Severe cases involve compulsive earth-eating, frequent dysentery, indigestion, aversion to food, yellow face, emaciation, white lips, distended abdomen, and flat philtrum, which is fatal.

In late autumn, fever with aversion to cold, wet sores on both sides of the nose, chronic cough, hoarse painful throat, brittle hair, abdominal distension, wheezing, and polyphagia indicate *Qi Gan* (Qi Gan). *Qi Gan* is caused by obstructive heat damaging the lungs; severe cases show a skeletal face, cough with shortness of breath, frequent white frothy diarrhea, and millet-like black spots on the body, which is fatal. Internal symptoms include head heat, abdominal pain, alternating chills and fever, frequent slippery diarrhea, halitosis, ear abscesses; external symptoms include high fever, ice-cold feet, sallow complexion, black nails, skin sores, emaciation, broken teeth, and oral ulcers, commonly called *Zou Ma Gan* (Running Horse Gan). Since teeth belong to the Kidney, Kidney Qi deficiency allows deficient fire to congest the Upper Jiao, causing halitosis (*Chou Xi*). Subsequent blackening of teeth is *Beng Sha*; gum erosion is *Kui Cao*; bleeding gums are *Xuan Lu*; tooth loss is *Fu Gen*. Once roots rot, teeth cannot regrow even if cured; this is *Ji Gan* (Urgent Gan), also *Shen Gan* (Kidney Gan) or *Gu Gan* (Bone Gan), caused by long-term kidney damage. Severe cases involve craving salty water, milky urine, burnt ears, black teeth, and dry bones, which is fatal.

*Cold Gan* presents with polydipsia, loose stools, preference for lying on cold surfaces, reduced appetite, cough, edematous eyes, sallow face, flaccid body, stiff lips, large abdomen, cyanotic veins, photophobia, emaciation, and cold limbs. *Fei Re Gan* (Fat-Heat Gan) presents with obesity and heat, intense thirst, spontaneous sweating, craving fruits/vegetables, abdominal distension, borborygmus, white urine, sour diarrhea, lethargy, crying, and pica (eating ash, charcoal, rice). Exhaustion of essence and fluids leads to organ withering and unrelenting thirst, named *Gan Ke* (Gan Thirst). Spleen-Stomach Qi deficiency failing to transport nutrients causes chronic diarrhea/dysentery, named *Gan Xie* (Gan Diarrhea) and *Gan Li* (Gan Dysentery). Five-center irritability, coarse hair, dry skin, prominent sternum, and chronic cough are named *Gan Sou* (Gan Cough).

*Yan Gan* (Smoke Gan) arises from improper feeding and early meat consumption, causing stagnation and parasites; symptoms include frowning, crying, abdominal pain, salivation, distension, cyanotic lips/mouth, and anal itching, resembling Spleen Gan. *Ji Gan* (Spine Gan) involves parasites eating the spine, fever, emaciation, pain, dysentery, nail-biting, drum-like abdomen, serrated spine, and finger sores, resembling Abdominal Gan. *Nao Gan* (Brain Gan) features tight shiny scalp, pancake-like head sores, burning head heat, matted hair, bulging fontanelle, caused by wind-heat in the brain, difficult labor, or maternal excess during pregnancy, resembling Heart Gan. *Gan Zhong Zhang* (Gan Edema) results from deficiency with accumulation causing tight abdominal distension, and spleen dampness causing facial/limb edema. *Gan Lao* (Gan Consumption) features abdominal distension, protruding umbilicus, emaciation, tidal fever, five-center heat, night sweats, cough, bone-steaming, and sores. *Gan Gan* (Dry Gan) refers to exhaustion of fluids in the five Zang organs. *Wu Gu Gan* (Innocent Gan) is caused by contamination from innocent bird feathers during laundry, leading to fever, jaundice, emaciation, and bloody/purulent stool. The *Xin Jian* states: nodules like peas behind the neck, movable, soft, painless, containing rice-flour-like worms, should be punctured quickly to disperse worms via heat flow; otherwise, worms enter organs causing dysentery. Silver needle puncture and plaster application are indicated.

*Natural Gan* arises from chronic conditions: prolonged dysentery, diarrhea, fever, cold, thirst, vomiting, sweating, malaria, cough, blood disorders, or strangury. *Ding Xi Gan* features extremely thin limbs, small neck with prominent bones, wasted buttocks, flaccid body, large abdomen, protruding umbilicus, and sunken chest when crying, due to spleen-stomach failure to transform grain, named *Sheng Gu Gan* (Grain-Generating Gan). *Bu Lu Gan* features alternating deficient heat, separated cranial sutures, regurgitation of worms, irritability, thirst, vomiting, withered ribs, due to spleen-stomach weakness failing to nourish essence/blood, leading to withered skin. Parasites may appear between head and back, resembling hair or horse tails; yellow/white/red indicate survival; purple/black/blue indicate death. *Cold-Heat Gan* features lying on ground irritably externally, frequent slippery diarrhea internally, daily muscle wasting, and reduced diet. While cold is treated with warmth and heat with cooling, Gan pathology is rooted in deficiency: heat is deficient-heat, cold is deficient-cold, accumulation is deficient-accumulation. Thus, accumulation should not be aggressively purged, cold not abruptly warmed, heat not overly cooled. Although accumulation is the mother of Gan, treating Gan requires addressing accumulation; however, in extreme deficiency, rapid attack worsens the condition. Robust patients: purge accumulation then support Stomach Qi; weak patients: support Stomach Qi then drain accumulation. Texts state: robust people have no accumulation, only the deficient do. Deficiency is the root; accumulation is the branch. Symptoms like anorexia, slippery diarrhea, insensitivity of soles, undigested food passage, black rotten gums, flopping head/neck, white tongue, panting, cold limbs, dry heaving, cold shivering, dysenteric swelling, stabbing pain, shortness of breath, hunched shoulders, silver-like face, stone-hard purple skin, genu valgum, craniotabes, tubular anus, black-green muscles, foul oral ulcers, hematemesis, passing roundworms, and foul drooling are all untreatable.