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Gan syndrome (Malnutrition) located internally presents with swollen eyes, abdominal distension, and diarrhea of variable color, sometimes with greenish-white froth in the stool. The body gradually becomes emaciated and weak; this is a cold pattern. Gan syndrome located externally presents with redness and ulceration under the nose, dry eyes, sores on the nasal tip that do not form scabs, and sores spreading around the ears. For treating nasal sores and ulceration, Lanxiang San (Orchid Fragrance Powder) is used. For various other sores, Baifen San (White Powder) is the primary treatment.

Liver Gan syndrome presents with a white membrane obscuring the pupils; the Liver should be tonified, treated primarily with Dihuang Wan (Rehmannia Pill). Heart Gan syndrome presents with a yellow face, red cheeks, and high fever; the Heart should be tonified, treated primarily with Anshen Wan (Spirit-Calming Pill). Spleen Gan syndrome presents with a yellow body, large abdomen, and pica for eating dirt; the Spleen should be tonified, treated primarily with Yihuang San (Yellow-Boosting Powder). Kidney Gan syndrome presents with extreme emaciation and skin sores/scratches; the Kidney should be tonified, treated primarily with Dihuang Wan (Rehmannia Pill). Tendon Gan syndrome presents with bloody diarrhea and emaciation; the Liver should be tonified, treated primarily with Dihuang Wan (Rehmannia Pill). Lung Gan syndrome presents with wheezing and sores in the mouth and nose; the Spleen and Lung should be tonified, treated primarily with Yihuang San (Yellow-Boosting Powder). Bone Gan syndrome presents with a preference for lying on cool ground; the Kidney should be tonified, treated primarily with Dihuang Wan (Rehmannia Pill).

For all types of Gan syndrome (Malnutrition), treatment should follow the principle of tonifying the mother organ relative to the affected organ and administering specific Gan-treating herbs. For cold patterns, Muxiang Wan (Aucklandia Pill) is used; for heat patterns, Huhuanglian Wan (Coptis Pill) is used. Gan syndrome (Malnutrition) is fundamentally a disease of the Spleen and Stomach, caused by the depletion of Body Fluids. It arises after severe illness or vomiting and diarrhea, when physicians mistakenly use emetics or purgatives, leading to Spleen and Stomach weakness and loss of Body Fluids. Moreover, pediatric Gan syndrome (Malnutrition) is often iatrogenic, resulting from incompetent medical treatment. For instance, tidal fever indicates one organ is deficient and another is excess, generating internal deficiency heat. The method should be to tonify the mother organ and drain the affected organ to achieve cure. If tidal fever occurs at noon, it is Heart deficiency heat. Since the Liver is the mother of the Heart, one should first tonify the Liver. After the Liver is filled, drain the Heart. Once the Heart receives Qi from its mother, internal balance is restored, and the tidal fever resolves. Physicians seeing tidal fever may wrongly assume it is an excess pattern and use cold medicines like Dahuang (Rhubarb Root and Rhizome) and Yaxiao (Mirabilite) to purge. Excessive purging leads to uncontrollable loss of Body Fluids, resulting in Gan syndrome (Malnutrition). Another condition is Pi accumulation (Abdominal Masses). When this disease attacks, the patient experiences alternating chills and fever, thirst, and hard, painful masses under the ribs. The treatment for Pi accumulation (Abdominal Masses) should be gradual dissipation. However, physicians mistakenly use harsh purgatives like Badou (Croton Seed) and Naosha (Ammonium Chloride). Children’s constitutions are prone to both deficiency and excess; excessive purging depletes Stomach Body Fluids, gradually leading to emaciation due to Gan syndrome (Malnutrition). Furthermore, in cases of Taiyang Disease (Exogenous Cold Damage), if there are indications for purgation on the fifth or sixth day, but the physician uses cold purgatives excessively, it reduces Spleen and Stomach Body Fluids. This causes unquenchable thirst and generates internal heat. Internal consumption by heat and external wasting of muscles, combined with interference from other pathogens, leads to varied symptoms and eventually Gan syndrome (Malnutrition).

Also, prolonged vomiting and diarrhea, or mistaken purgation by physicians, exacerbates deficiency and dries up Body Fluids, also forming Gan syndrome (Malnutrition). There is also Fei Gan (Obesity-type Malnutrition), which is essentially Spleen Gan (Spleen Malnutrition). The body is thin and yellow, skin is dry, and there are sores and scratches. Symptoms vary widely; here are the main guidelines: dry eyes or white membranes, red lips, yellow/dry/blackish body, preference for lying on cool ground, pica for dirt, skin sores, diarrhea with green/white/yellow froth, variable urine color, easy abdominal distension, sores on the body/ears/nose, hair matted into tufts, large head with a thin neck, extreme emaciation, and thirst are all symptoms.

Generally, Gan syndrome (Malnutrition) must be differentiated into cold/heat and obesity/emaciation. Early-stage disease manifests as Obese-Heat Gan; late-stage disease manifests as Emaciated-Cold Gan. Cold patterns are treated with Muxiang Wan (Aucklandia Pill); heat patterns are treated with Huanglian Wan (Coptis Pill). For both cold and heat Gan, Rusheng Wan (Like-Sage Pill) is particularly suitable. Therefore, children’s Zang-Fu organs are delicate and cannot withstand harsh attacks; drastic purgation will inevitably deplete Body Fluids and cause Gan syndrome (Malnutrition). Whenever purgation is indicated, it must be dosed according to age, size, and deficiency/excess status to avoid causing Gan syndrome (Malnutrition). In early stages with low Body Fluids, one should generate Stomach Body Fluids using Baizhu San (Atractylodes Macrocephala Powder). More is better. See below for more.