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Gan syndrome (Pediatric wasting disease). This is the most severe condition in pediatrics. Although it manifests differently across the five Zang organs, its essence is a disorder of the Spleen and Stomach. Pediatric texts contain excessive discussions on various types of Gan, and their treatment methods lack empirical efficacy, leaving nothing worthy of adoption. Only Qian Yi’s classification of Gan into four categories—plump (Fei), thin (Shou), cold (Leng), and hot (Re)—is relatively close to medical logic. He categorized early-stage cases as Plump-Hot Gan and late-stage cases as Thin-Cold Gan, seemingly distinguishing between excess and deficiency. However, one must not forget that Gan is a deficiency syndrome; where could there be an excess syndrome? Furthermore, the prescription for treating Thin-Cold Gan contains Euphorbia lathyris (Xusui Zi), which inevitably commits an error in distinguishing between excess and deficiency. Thus, I have often stated: Qian Yi’s prescriptions and theories were not written by him personally but are later interpolations by his disciples. Now, inferring Qian Yi’s original intent to supplement this, we say: If an infant eats too much, the Stomach is injured; if it eats too little, the Spleen is injured. Is Plump-Hot Gan caused by overeating and satiety? Is Thin-Cold Gan caused by undereating and hunger? Upon careful examination, Gan caused by insufficient food intake should be treated primarily with Fei'er Wan (Fatty Child Pill), while Gan caused by excessive food intake should be treated primarily with Jisheng Wan (Jisheng Pill).

For infants with insufficient breast milk, parents often feed them other substances. Children’s nature seeks only satiety; thus, they may eat too much or too little. Consequently, the Spleen and Stomach are injured, giving rise to this Gan disease.

The wife of Li Guang from Luchenchang, Qishui, was the daughter of Cheng Xinan. Having recently become a widow, she had only one daughter. Initially suffering from malaria and then dysentery, the child became emaciated, developed fever, and had poor appetite. She consumed only five or six lotus seeds. Her mother requested my treatment. I prescribed Jisheng Wan. At that time, a physician named Wan Ding from Jiangxi was present, stating that the case was difficult to treat. Wan Ding had previously asked me about the theory of Five Movements and Six Qi (Wu Yun Liu Qi), and I instructed him in detail. He originally knew nothing of it and merely nodded in agreement. I told Wan Ding, "Come back in February or March next year to see how this girl has grown." In mid-March of the following year, her mother invited me to her residence at the Cheng family estate to express gratitude and had her daughter pay respects. The mother said, "After taking the medicine, my daughter improved day by day; she is no longer like before."

The son of Xiangsheng Wang Xian, aged one year, suffered injury from eating pork, resulting in emaciation of the limbs. His family sent for medicine. Upon inquiry, I determined it was Food Accumulation Gan Syndrome, appearing as an excess pattern. I gave him five pills of Pi Ji Wan (Spleen Accumulation Pill) and instructed him to swallow them with pork soup. Indeed, he passed a piece of accumulation the size of a little finger, wrapped in saliva, and the child immediately felt relief.

Jisheng Wan: A general prescription for treating Gan. From *Danxi Xinfa*. Coptis Rhizome (Huanglian) 3 qian, Dried Toad Skin (Ganchan) 3 qian; all other ingredients are 2 qian.
Coptis Rhizome (Huanglian), Dried Toad Skin (Ganchan) [roasted until carbonized but retaining nature], Citrus Peel (Qingpi), Tangerine Peel (Chenpi), Curcuma Tuber (Ezhu), Quassia Fruit (Shijunzi), Amomum Fruit (Sharen) [each 1.8 qian], Aloe (Luhui), Owl Droppings (Yeming Sha), Trogopterus Dung (Wulingzhi) [each 2.3 qian], Angelica Sinensis Root (Guishen) [add for Gan Lao], Ligusticum Rhizome (Chuanxiong) [each 3 qian], Aucklandia Root (Muxiang) [1.8 qian].

Another formula for Jisheng Wan: Quassia Fruit (Shijunzi), Dried Toad Skin (Ganchan), Coptis Rhizome (Huanglian), Peucedanum Root (Qianhu), Curcuma Tuber (Ezhu), Aucklandia Root (Muxiang), Citrus Peel (Qingpi), Trogopterus Dung (Lingzhi), Owl Droppings (Yeming Sha), Amomum Fruit (Suosha) [2 qian], Angelica Sinensis Root (Danggui) [1.5 qian], Ligusticum Rhizome (Chuanxiong) [1.2 qian]. Add pig bile. Form pills using millet paste. Administer with rice water. For weak Spleen, add Fei'er Wan. Grind all into powder. Use millet flour paste to form pills. Add pig bile. Make pills the size of millet grains. Administer with rice water.

The eldest son of Wang Sanfeng suffered from Gan-related emaciation and requested treatment. Upon examination, I said, "This is caused by insufficient breast milk." The father replied, "There is abundant milk." I then withdrew. Later, I told Hu Sanxi, "Prince Wang’s illness is due to insufficient milk. He claims there is plenty and did not listen to me; now he has developed Gan." At that time, Hu Huichuan was present and left upon hearing this. Later, Hu Sanxi reported, "The patient is Hu Huichuan’s son-in-law. He heard your words and returned displeased." I said, "Incorrect. He will certainly come to invite Brother Sanfeng." Shortly after, they arrived together. Wang Sanfeng confessed, "When I was detained at the Nanjing Imperial Academy, one of my sons died of Gan. Now that this son is ill, I am deeply worried. I came specifically to inquire. I wish to find a wet nurse for this child. Whether there is milk or not, I truly do not know." That night, I checked carefully and reported the next day that indeed, there was no milk. During the day, chewed rice was fed; at night, a pot of cold rice soup was poured in. What should be done? I said, "Without changing the wet nurse, treatment will be ineffective. If changed, the child will cling to the affection of the new wet nurse, and the wet nurse will consider the livelihood provided by the child. Please temporarily select a wet nurse to assist. Hold the child during the day and breastfeed at night. Naturally, through time, affection will deepen, achieving a perfect outcome." Thus, one dose of Fei'er Wan was prescribed. After two months, the child recovered.

Fei'er Wan: Ginseng Radix (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), Poria (Baifuling), Licorice Root (Zhi Gancao), Tangerine Peel (Chenpi), Citrus Peel (Qingpi), Chinese Yam (Shanyao), Lotus Seed (Lianrou), Angelica Sinensis Root (Danggui), Ligusticum Rhizome (Chuanxiong), Quassia Fruit (Shijunzi). Grind into powder. Form pills using Medicated Leaven (Shenqu) paste. Administer with rice water.

The son of Hu Fengya suffered from Gan but experienced abdominal pain when eating too much. He requested treatment. I said, "Humans rely on grain as their foundation. Pain upon ingestion implies that new grain is clashing with old accumulated residue that has not been eliminated. There is no rationale for abstaining from grain entirely." Thus, I prepared Yangpi Xiaoji Wan (Spleen-Nourishing and Accumulation-Resolving Pill) for him to take, and he recovered.

Yangpi Xiaoji Wan: Qian’s Yigong San (which is Si Jun Zi Tang plus Chenpi), added with Aucklandia Root (Muxiang), Citrus Peel (Qingpi), Amomum Fruit (Sharen), Quassia Fruit (Shijunzi), Immature Bitter Orange (Zhishi) [stir-fried], Coptis Rhizome (Huanglian) [stir-fried]. Grind all above into powder. Form pills using Medicated Leaven (Shenqu) paste. Administer with rice water.