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Qian Yi stated: Generally, gan disease (childhood malnutrition syndrome) should be differentiated by cold, heat, fatness, and emaciation. Those in the early stage of illness are typically "fat-heat gan," while those with prolonged illness are typically "cold-emaciated gan." Heat gan often manifests as foul-smelling erosion under the external nose, with the child rubbing their nose; sores on the head that crust over and gradually spread to cause sores around the ears. Cold gan often manifests as swelling of the inner canthus, abdominal distension, diarrhea with variable color, or frothy greenish-white stools, leading to gradual emaciation.

Yang Shiyi stated: Liver diseases are all caused by deficiency. Heat is heat within deficiency, and cold is cold within deficiency. When treating heat, one must not recklessly use diaphoretic methods nor excessively use cold-cooling herbs; when treating cold, one must not use harsh warming tonics nor excessive supplementation. Moreover, children's constitutions easily shift between deficiency and excess. If the spleen is deficient, it cannot tolerate cold-dampness; taking cold herbs generates cold, while taking warm herbs generates heat. One must heed this and avoid errors.

For heat gan, Hu Huang Lian Wan (Coptis Rhizome Pill) is the primary formula; for cold gan, Mu Xiang Wan (Aucklandia Pill) is the primary formula; for mixed cold-heat gan, Tong Shen Wan (Spirit-Penetrating Pill) is the primary formula. For gan sores appearing on the external ears and nose, Lan Xiang San (Orchid Powder) and Zhu Chuang Bai Fen San (All Sores White Powder) are used.

Heart gan arises from irregular breastfeeding and diet causing heat in the heart. Since a child's qi and blood are not yet settled, injury from nursing easily leads to stagnation. Internal stagnant heat fails to circulate, causing the heart spirit to become startled and depressed, resulting in symptoms of startled gan. External signs include high fever, red cheeks, red lips, mouth and tongue ulcers, chest oppression, dark and scanty urination, heat in the five centers (both palms, both soles, and the epigastrium), night sweats, thirst, teeth grinding, and susceptibility to fright. It should be treated with Fu Ling Wan (Poria Pill) and Qian Yi's An Shen Wan (Calming Spirit Pill).

Liver gan arises from irregular breastfeeding and diet causing heat in the liver. If the lactating mother has improper temperature regulation or dietary indiscretion, or if exposed to external wind-cold or internal emotional injury, and the pathogenic factors have not dissipated before resuming nursing, it often results in wind gan. The liver opens into the eyes; latent heat and phlegm-fluids cause stagnation, leading to liver wind entering the eyes, causing redness, swelling, pain, pterygium formation, excessive discharge and tearing, orbital ulceration, pain and itching, blurred vision, nyctalopia (night blindness), and even keeping the eyes closed for months, also known as gan eye. External signs include shaking the head, rubbing the eyes, white membrane covering the pupil, bluish sclera with tears, dry scalp with erect hair, cyanotic tendons, brain heat, itchy nails, tendon spasms, dryness and thirst, profuse sweating, dysentery, sores, and tinea. It should be treated with Tian Ma Wan (Gastrodia Pill) and Sheng Shu Di Huang Tang (Raw and Prepared Rehmannia Decoction).

Spleen gan arises from irregular diet injuring the spleen and stomach. This may result from the lactating mother consuming excessive raw, cold, fatty, or greasy foods, or the infant being overfed, or feeding milk after meals causing vomiting, or excessive milk intake leading to long sleep, transforming into milk accumulation (ru pi), forming masses in the abdomen and hypochondrium, also called milk gan. External signs include sallow complexion, body heat, large abdomen with weak legs, vomiting and regurgitation, epigastric fullness, fatigue, crying, indigestion of food and fluids, sour-smelling diarrhea, sleeping face-down, reduced appetite, and pica (eating dirt). It should be treated with Ling Zhi Wan (Lipase Pill) and Qian Yi's Yi Huang San (Strengthen Spleen Powder).

Lung gan arises from irregular breastfeeding and diet causing stagnant heat injuring the lungs. The lung governs qi, and the nose is the opening of the lung. When lung qi is disordered, wind-dampness invades the skin and hair due to deficiency, entering the blood vessels. Thus, redness, itching, sores, and dampness appear on both sides below the nose, named nasal gan. These sores are painless, and wherever the exudate flows, new sores form, also called gan. External signs include coughing and wheezing, high fever with aversion to cold, cutaneous papules, nasal sores with runny nose, throat obstruction, chin ulceration, hemoptysis, abdominal distension, dry and brittle hair, and frequent dysentery. It should be treated with Qing Fei Yin (Clear Lung Infusion), Hua Zhen Wan (Resolve Masses Pill), and Qian Yi's E Jiao San (Donkey-Hide Gelatin Powder).

Kidney gan arises from irregular breastfeeding causing latent heat in the zang-fu organs. Sweet flavors enter the spleen and stir parasites; when parasites move, they erode the intestines and stomach, causing dysentery and anal ulceration with excessive dampness. Due to chronic gan damage and prolonged dysentery, the intestines and stomach are affected by dampness, compounded by external pathogens. External signs include brain heat, muscle wasting, ice-cold hands and feet, alternating chills and fever, slippery diarrhea, abdominal pain, bad breath, dryness and thirst, gum ulcers, blackened nails, dark complexion, and numerous sores and scabies on the body. It should be treated with Di Huang Wan (Rehmannia Pill).

Ascaris gan arises from irregular breastfeeding, early introduction of meat, organ damage, and accumulation of sweet/greasy substances transforming into parasites. Symptoms include frowning and frequent crying, vomiting clear foam, abdominal pain, distended abdomen with visible blue veins, purplish-black lips and mouth, protruding anus, and itchy teeth. In cases of spine gan alone, parasites eat the spinal column, causing body heat, emaciation with yellowish hue, internal heat from accumulation, irritability, thirst, dysentery, drum-like sound upon patting the back, serrated appearance of the spine, sores on all ten fingers, and frequent nail-biting. It is treated with Xia Chong Wan (Expel Parasites Pill).

Ding Xi (Stick-like Emaciation) and Bu Lu (Nursing Dew) arise from chronic spleen-stomach deficiency failing to transform food and fluids to nourish qi and blood, leading to muscle wasting and insufficient kidney qi, further damaged by wind-cold, resulting in skeletal exposure. Some cases stem from prenatal toxin exposure and deficient zang-fu blood. If limbs are extremely thin, neck small with prominent bones, flat buttocks, emaciated body, large abdomen with protruding umbilicus, loud crying, and high chest, or formation of grain masses, it is Ding Xi. If there is alternating deficiency-heat, separated cranial sutures, regurgitation of undigested food and worms, irritability, thirst, vomiting, and belching, it is Bu Lu. Both are treated with Shi Quan Dan (Ten Perfections Pill) and Da Lu Hui Wan (Large Aloe Pill).

Gan dysentery arises from exposure to wind-cold, summer-heat, and dampness, imbalance of cold and heat, retention of old stagnation, failure of food and fluids to aggregate, and frequent passage of foul matter. Gan diarrhea presents with dry hair, white lips, blue lines on the forehead, abdominal distension and borborygmus, and passage of undigested food. Do not use hot astringent herbs; instead, treat with Xiang Kou Wan (Amomum Pill) and Mu Xiang Wan (Aucklandia Pill).

Gan consumption presents with tidal fever, alternating chills and fever, heat in the five centers, sores on palms, soles, and chest, night sweats, bone-steaming fever, coughing and wheezing, emaciation, thirst followed by diarrhea, aversion to drinking/eating, rock-hard abdomen, and silvery complexion. This condition is considered incurable. It is treated with Huang Qi Tang (Astragalus Decoction) and Bie Xue Jian (Turtle Blood Decoction). Gan edema arises from deficiency with accumulation, where toxicity and qi intertwine, causing tight abdominal distension. Spleen-stomach dampness causes puffiness of the head, face, hands, and feet. The method requires resolving accumulation and regulating qi, treated with He Wan Zi (Brown Pill).

Wugu Gan (Innocent Gan) presents with nodules behind the ears and at the nape like beans, movable upon pressure, soft and painless. Over time, limb abscesses form, pus and blood pass in stool, high fever occurs, emaciation sets in, and bones protrude. Ancient texts claim this results from exposing children's clothes under eaves, where birds defecate on them, and the child contracts evil qi from wearing these clothes. This explanation is likely incorrect, akin to Mencius' saying, "To believe everything in books is worse than having no books." It should be treated with Ke Pi Wan (Oyster Shell Pill).

Gan thirst arises from gan wind-pathogen in the zang-fu, or from the lactating mother consuming pungent spices, alcohol, wheat products, and roasted/fried foods, causing lung-heart heat congestion. During the day, there is irritability, thirst, drinking water, and refusal of milk/food; at night, thirst ceases. This is named gan thirst, treated with Huang Lian Wan (Coptis Pill).

Zou Ma Gan (Riding-Horse Gan) often arises from qi deficiency with cold invasion and lingering stagnation, accumulating warmth to generate heat, with deficient-heat steaming upward. Or, consumption of sweet, sour, salty, and greasy foods causes spleen-stomach stagnation to accumulate heat over time, steaming upward to the mouth, causing teeth to turn black and rot, intermittent clear bleeding, blood coagulating into pus, foul-smelling pus generating parasites that erode teeth and gums, even penetrating cheeks, making breastfeeding difficult, flushed face, panting, and heat attacks. This is named zou ma gan, treated with Lu Hui Wan (Aloe Pill). Externally, apply Shao Yan San (Burnt Salt Powder) and Tong Qing San (Malachite Green Powder). If unhealed for a long time, spreading to upper and lower lips forms Beng Sha Zheng (Falling Sand Syndrome); if teeth fall out, bones expose, food intake decreases, and breathing becomes rapid with rattling phlegm, it will inevitably lead to critical danger.