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Yang Shi stated: The five types of Gan syndrome (pediatric malnutrition with parasitic infection) originate from worms and involve the five Zang organs; the others are referred to as Roundworm Gan, Spinal Gan, Brain Gan, Dry Gan, Gan Thirst, Gan Diarrhea, Gan Dysentery, Gan Swelling, Gan Consumption, Innocent Gan, Ding Xi (severe emaciation), and Bu Lu (infantile wasting). Their manifestations vary greatly, so it is essential to summarize their key points and analyze them item by item.

The origin of Gan injury lies in the five Gan syndromes caused by worms. Although it stems from improper breastfeeding or feeding, long-standing accumulation and stagnation in the Zang-Fu organs inevitably transform into worms. These worms may be as fine as silk threads or as thick as horse tails, mostly appearing between the head, neck, abdomen, and back. Those that are yellowish-white are treatable, whereas those that are bluish-black are difficult to cure.

Roundworm Gan: Caused by premature weaning or early introduction of rice and meat, or stomach injury leading to food retention. Sweet and greasy foods transform into roundworms. Symptoms include frowning and frequent crying, vomiting clear foam, abdominal pain, distended abdomen with visible blue veins, purplish-black lips and mouth, head shaking, and itchy teeth.

Spinal Gan: Worms erode the spine. Symptoms include fever, emaciation, and sallow complexion; heat generated from stagnation causing irritability, thirst, and diarrhea; a drum-like sound when tapping the back; protruding vertebrae resembling sawteeth; ulcers on all ten fingers; and frequent nail-biting.

Brain Gan: Caused by internal wind-heat present during fetal development and excessive breastfeeding after birth. Symptoms include tight and shiny scalp, widespread "pancake sores" (a type of skin ulcer), brain heat feeling like fire, matted hair resembling tassels, profuse sweating over the body, swollen cheeks, and bulging fontanelle.

Dry Gan: Emaciation, blood deficiency, and dry tongue indicate pathology in the Heart; fixed gaze, dry crying with few tears indicates pathology in the Liver; fever, scanty dark urine, and cold extremities indicate pathology in the Kidney; hoarse voice, dry skin, and constipation indicate pathology in the Lung; angular cheilitis, somnolence, and dryness/thirst in the chest and epigastrium indicate pathology in the Spleen. Collectively, these constitute the Five Gan syndromes.

Gan Thirst: Internal Gan qi combined with the nursing mother's consumption of pungent spices (garlic, scallions, chives, etc.), alcohol, wheat products, and fried/roasted foods causes congestion and heat in the Heart and Lungs. The infant experiences daytime irritability and thirst for water, refuses milk and food, but thirst ceases at night.

Gan Diarrhea: Brittle hair, pale lips, greenish lines on the forehead, abdominal distension with borborygmus, and passage of undigested residue.

Gan Dysentery: Complicated by exogenous Wind-Cold, Summerheat-Dampness, or imbalance of Cold and Heat; or due to retained old stagnation where grains and fluids fail to consolidate, requiring the expulsion of foul matter.

Gan Swelling: Deficiency with underlying stagnation, where toxic vapors interact, causing abdominal distension. Subsequently, the Spleen is affected by Dampness, leading to puffy swelling of the face, head, hands, and feet.

Gan Consumption: Alternating tidal fever, heat in the five centers (palms, soles, and chest), heat in palms, soles, and chest accompanied by sores, night sweats, bone-steaming fever, coughing, wheezing, and emaciation. Alternatively, thirst followed by diarrhea, aversion to cold despite drinking water, rock-hard abdomen, and silvery-white complexion render the condition incurable.

Innocent Gan: Nodules like peas appear behind the ears and on the neck side; they are movable upon pressure, soft, and painless, containing worm-like substances resembling rice flour. If not promptly punctured, the worms disperse with heat qi, invading the Zang-Fu organs, leading to limb abscesses, purulent bloody stools, high fever, emaciation, and exposed skull bones. Treatment involves puncturing with a needle and applying ointment. Alternatively, washing an infant's clothes and hanging them under the eaves may lead to contamination by feathers from female birds; if the infant wears such clothes, worms enter the skin and hair, causing Innocent Gan. Infants' clothes should be dried and gently warmed over a low fire.

If the limbs are extremely thin, the cranial sutures are prominent, the sacrum is wasted, the body is flaccid, the abdomen is large with a protruding umbilicus, crying causes chest depression, or "Grain Syndrome" (extreme skeletal emaciation) occurs, this is Ding Xi. Alternating deficient heat, separated cranial sutures, regurgitation with worm expulsion, irritability, thirst, vomiting, and hiccups constitute Bu Lu. Both Ding Xi and Bu Lu result from severe Spleen-Stomach deficiency, inability to digest grains and fluids, depletion of spirit and essence, failure to nourish Qi and Blood, muscle wasting, insufficient Kidney Qi, and subsequent invasion by Wind-Cold, leading to withered form and exposed bones. Some cases arise from prenatal toxicity and blood deficiency in the Zang-Fu. All these fall under Innocent Gan injuries. Diseases progressing to this stage are perilous. It is advisable to administer Fei'er Wan, Da Lushui Wan, Wu Gan Wan, Huhuanglian Wan, Zhisheng Wan, Fushen Wan, Tianma Wan, Dihuang Wan, Shiquan Dan, Xiangkou Wan, He Wanzi, Xiaoshi Wan, Biejia Wan, Xia Chong Wan, Jisheng Wan, Huangji Jian Wan, etc., for early treatment to achieve optimal results.

Another condition is chronic dysentery due to Gan injury and dampness in the intestines and stomach. Symptoms resemble Huhuo disease (oral and genital ulcers) or dental erosion seen in Cold Damage. It is sometimes called "Running Horse Dental Gangrene" because the teeth belong to the Kidneys; when Kidney deficiency allows heat pathogens to invade, Gan qi rushes to the Upper Jiao. Hence, "Running Horse" is used as a metaphor for its rapid progression. Initially, there is bad breath, termed "Chouxi"; subsequently, teeth turn black; severely, gums rot and bleed profusely, termed "Xuanlu"; ultimately, teeth fall out completely. Treatment involves grinding Copper Green (Tonglv) and live spiders finely, adding a small amount of Moschus (Shexiang), mixing, and applying to the teeth. If spiders are unavailable, their shells may be used.

Fei'er Wan, Da Lushui Wan, Wu Gan Wan, Huhuanglian Wan, Jisheng Wan, Tianma Wan, Dihuang Wan: See Question 79.
Fushen Wan: See Fuling Wan in Question 79.

Shiquan Dan: Treats Ding Xi and Bu Lu.
Ingredients: Qingpi (Aurantii Fructus Immaturus), Chenpi (Aurantii Fructus Pericarpium), Chuanxiong (Chuanxiong Rhizoma), Wulingzhi (Trogopteri Dung), Ezhu (Curcumae Rhizoma), Baudoukou (Amomi Fructus Rotundus), Binglang (Arecae Semen), Lushui (Aloe) (each 1.5g); Shijunzi (Quisqualis Fructus, roasted), Xiamahui (Bufo Skin Ash), Muxiang (Vladimiriae Root) (each 0.9g).
Preparation and Administration: Grind into powder. Soak cake in Pig Bile, make pills the size of hemp seeds. Take 20 pills per dose with rice drink. For heat conditions, take with Mint Decoction.

Tang Shi Shiquan Dan: Treats Ding Xi and Bu Lu.
Explanation: Bu Lu results from improper breastfeeding damaging the Spleen and Stomach, leading to weakness, gradual loss of appetite, depletion of Qi and Blood, lack of nourishment to muscles, resulting in emaciation with visible ribs. Obstruction of Zang-Fu Qi causes urgent heat sensation, termed Bu Lu. Administer Shexiang Jinshi Wan.
Ingredients: Binglang (Arecae Semen), Zhike (Aurantii Fructus), Qingpi (Aurantii Fructus Immaturus, pith removed), Chenpi (Aurantii Fructus Pericarpium), Sanleng (Sparganii Rhizoma, baked), Ezhu (Curcumae Rhizoma, baked), Sharen (Amomi Fructus, stir-fried) (each 1.5g); Dingxiang (Caryophylli Flos) (0.8g), Muxiang (Vladimiriae Root) (0.6g), Xiangfu (Cyperi Rhizoma, stir-fried) (3g).
Preparation and Administration: Grind into powder. Make pills with Shenqu (Medicated Leaven) paste, size of millet seeds. Take 100 pills on an empty stomach before meals.

Xiangkou Wan: See Question 79.
He Wanzi: See Question 45.
Xiaoshi Wan: See Questions 59 and 60.

Biejia Wan: Treats pediatric Innocent Gan, abdominal toxic vapors, and weak limbs.
Ingredients: Biejia (Testudinis Carapax et Plastrum, vinegar-treated and roasted until yellow, membrane removed), Huanglian (Coptidis Rhizoma), Zhike (Aurantii Fructus), Yeming Sha (Phoenicopteris Alumen, lightly roasted) (each 3g); Helile (Terminaliae Fructus) (2 pieces, one raw, one cooked), Shexiang (Moschus) (0.3g), Xiehu (Gekkonis Carapax) (1 piece, male, lightly roasted).
Preparation and Administration: Grind into powder. Make pills with refined honey, size of mung beans. Take 5 pills per dose with porridge drink, three times daily. Adjust dosage according to the infant's age and size.

Zhengji Wan: Treats pediatric Gan Consumption, bone-steaming tidal fever, night sweats, emaciation, abdominal tension, sallow complexion, failure of food to generate flesh, day-and-night crying, excessive thirst, and poor appetite.
Ingredients: Huanglian (Coptidis Rhizoma) (6g); Leser (Pyrrosiae Folium), Wuyi (Euodiae Fructus) (each 1.5g); Yin Chaihu (Stellariae Radix), Da Qinjiao (Gentianae Macrophyllae Radix), Zhimu (Anemarrhenae Rhizoma), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Shijunzi (Quisqualis Fructus, shelled) (each 3g).
Preparation and Administration: Grind into powder. Take one yellow rooster (approx. 500g), confine in a cage, and feed exclusively with Hemp Seeds for five days. Remove feathers, cut a hole in the back, remove viscera, and wipe dry. Place herbs inside the chicken cavity and sew shut. Place in a steamer lined with Black Beans (3 cun thick at bottom), surround the chicken with beans, and cover with beans. Steam from sunrise to sunset. After cooling, extract clean meat, grind and mix thoroughly. If too hard, add wine-flour paste. Form pills the size of adzuki beans. Two-year-olds take 20 pills with rice soup, anytime. Fifteen-year-olds take with warm wine. Avoid pork and yellow hen meat.

Xia Chong Wan: See Question 79.

Jiawei Jingyan Huangji Jian Wan:
Ingredients: Chaihu (Bupleuri Radix), Zhimu (Anemarrhenae Rhizoma), Qinjiao (Gentianae Macrophyllae Radix, washed), Chuanlian Rou (Toosendan Fructus, stir-fried), Xuan Huanglian (Coptidis Rhizoma) (each 3g); Huhuanglian (Coicis Semen? Note: Likely Coptidis Rhizoma var. or similar bitter herb, often associated with clearing deficiency heat), Lushui (Aloe), Leser (Pyrrosiae Folium), Wuyi (Euodiae Fructus), Binglang (Arecae Semen), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Chuanxiong (Chuanxiong Rhizoma), Shenqu (Medicated Leaven, stir-fried), Mai (Hordei Fructus Germinatus, stir-fried), Qingpi (Aurantii Fructus Immaturus), Wulingzhi (Trogopteri Dung) (each 1.5g); Shijunzi (Quisqualis Fructus) (4.5g); Shuiyin Fen (Hydrargyrum) (0.3g); Maziren (Cannabis Fructus) (150g); Heidou (Sojae Semen Nigrum) (1250g).
Preparation and Administration: Prepare according to previous methods.

Meirou Wan: Treats various pediatric Gan syndromes with incessant thirst and drinking.
Ingredients: Longdancao (Gentianae Radix), Dianfen (Amylum), Wumei Rou (Mume Fructus, stir-fried), Huanglian (Coptidis Rhizoma, stir-fried) (equal parts).
Preparation and Administration: Grind into powder. Make pills with refined honey, size of millet seeds. Take 20 pills per dose with warm water.