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Zhu Danxi stated: The zang-fu organs of infants and children are delicate, and they are easily injured when overfed. Regarding breastfeeding and diet, if there is any irregularity, few will not develop gan syndrome (pediatric malnutrition). This is all caused by dietary imbalance and lack of restraint in consuming rich, sweet, and fatty foods. Or, due to insufficient breast milk in infancy or introducing porridge and rice too early, the physical form and qi are depleted. Consequently, the root of gan syndrome extends over years, leading to the formation of five types of gan involving the zang organs. Qian Yi stated: Gan syndromes are all caused by the depletion of the spleen and stomach and the loss of body fluids. Therefore, because the zang-fu organs of infants and children are soft and brittle, diseases should not be treated with harsh purgation; severe purging will inevitably lead to the loss of body fluids. Whenever purgation is indicated, one must weigh the size and constitution (deficiency or excess) before administering it, so as to avoid inducing gan syndrome. One should observe signs such as dry eyes or the appearance of a white membrane on the cornea, red lips and yellowish skin, a preference for lying on cool ground, pica (eating dirt), irregular diarrhea or dysentery, abdominal distension and fullness, sores on the ears and nose, hair matted into tufts, weak legs and a thin neck, extreme emaciation, excessive thirst, and even conditions known as Dingxi gan (severe wasting with distended abdomen) or Bulu gan (wasting with exposed ribs). Some are called Wugu gan (innocent gan); these are all manifestations of gan syndrome.

Zeng Shirong stated: There are five types of pediatric gan syndrome: those affecting the Heart, Liver, Spleen, Lung, and Kidney. Differentiating by cold and heat: if the child was plump at the onset of illness, it is classified as Heat Gan; if the child becomes progressively emaciated after a long duration of illness, it is classified as Cold Gan.
Heart Gan manifests as grinding teeth and protruding the tongue, sores on the tongue, a desire to drink cold water, red lips and flushed face, and a preference for lying on the ground.
Liver Gan manifests as excessive eye discharge and tearing, bluish discoloration of the eyelids, slightly yellowish eyeballs, and diarrhea of clear fluid resembling moss color.
Spleen Gan manifests as craving dirt and cold substances, uncontrolled eating, yellowing of the whole body and face, sparse hair matted into tufts, large head with a thin neck, abdominal distension and weak legs, sometimes progressing to chronic diarrhea and muscle wasting, night fever, and anorexia for milk and food.
Lung Gan manifests as blackened and ulcerated skin under the nose, foul breath, or wheezing and coughing, and a pale, shiny right cheek.
Kidney Gan manifests as sores inside and outside both ears, legs resembling "crane's knees" (knee joint swelling with thigh atrophy), unfused cranial sutures, inability to walk, delayed tooth eruption, and foul-smelling, rotting sutures, which may transmit to become Gangrenous Gum Disease (Zouma Yagan).
Heat Gan mostly presents externally, characterized by foul-smelling ulcers under the nose, sores around the ears on the head that do not scab over.
Cold Gan mostly presents internally, characterized by swollen eyes, abdominal distension, variable colors in dysenteric stools, or passage of clear frothy stool, and emaciation.