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[Danxi] Bai Wenju's son, aged five, had swelling all over his body and face, with frequent urination.
Zhi Zi (Gardeniae Fructus, stir-fried) [1 qian], Sang Bai Pi (Mori Cortex, stir-fried) [1 qian], Huang Qin (Scutellariae Radix) [2.5 qian], Bai Zhu (Atractylodis Macrocephalae Rhizoma), Su Geng (Perillae Caulis) [1.5 qian each].
The above herbs are cut into pieces. Prepare three doses. Decoct with one and a half cups of water until half a cup remains. Take warm before meals.

[Tang Shi] Tui Zhong San Qi Fang (Edema-Reducing and Qi-Dispersing Formula)
Chi Xiao Dou (Adzuki Bean), Chen Pi (Citri Reticulatae Pericarpium), Luo Bo Zi (Raphani Semen), Gan Cao (Licorice Root, honey-fried) [0.5 liang each], Mu Xiang (Aucklandiae Radix, roasted) [7 fen].
The above are ground into a coarse powder. Decoct with fresh ginger and jujube. Adjust dosage according to age and condition.
Another prescription:
Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Mu Xiang (Aucklandiae Radix, roasted), Gan Cao (Licorice Root, honey-fried), Hui Xiang (Foeniculi Fructus, stir-fried), Qing Pi (Citri Reticulatae Pericarpium Viride) [0.5 liang each]. Add Ba Dou (Crotonis Semen, 30 grains, membrane removed), stir-fry together with Qing Pi, then remove Ba Dou and do not use it.
Grind into fine powder. Take with rice water.
Another prescription:
Use Qian Yi Huang San (Benefit Yellow Powder) from Qian Yi, add Mu Xiang (Aucklandiae Radix), remove Ding Xiang (Caryophylli Flos), add Luo Bo Zi (Raphani Semen), remove He Zi (Terminaliae Chebulae Fructus). Grind into fine powder. Adjust dosage according to age. Take with rice water.

The *Neijing* states: Frequent consumption of fatty foods causes internal heat. Frequent consumption of sweet foods causes fullness in the middle jiao. Generally, the etiology of this disease is caused by fatty and sweet foods, hence it is named "Gan" (Malnutrition Syndrome). As for infants in swaddling clothes, and toddlers of four or five years old, their breastfeeding has not ceased, their Stomach Qi is not yet complete, and their Grain Qi is not yet abundant. Parents cannot regulate and nurture them properly, only indulging them out of affection, allowing them to eat indiscriminately fatty and sweet foods, as well as raw fruits, cold foods, and all kinds of cooked and seasoned flavors, morning and night. This gradually forms stubborn accumulation, leading to fever, emaciation, sallow complexion, or a large abdomen with visible veins, abdominal pain due to parasites, diarrhea, and thus various manifestations of Gan syndrome appear. [Qian Yi] All Gan syndromes are diseases of the Spleen and Stomach, caused by the loss of body fluids internally. It occurs after severe illness or vomiting and diarrhea, when physicians mistakenly use emetics or purgatives, causing Spleen and Stomach deficiency and fluid depletion. Moreover, pediatric Gan syndromes are often iatrogenic errors by ignorant doctors. For instance, tidal fever indicates one organ is deficient and another is excess, generating internal deficient heat. The treatment should tonify the mother organ and drain the affected organ to achieve cure. If tidal fever occurs at noon, it is Heart deficient heat. Since Liver is the mother of Heart, the method should first tonify the Liver mother; after the Liver becomes sufficient, then drain the Heart. Once the Heart receives the Qi of its mother, it will be balanced internally, and tidal fever will heal spontaneously. Physicians seeing tidal fever wrongly assume it is an excess pattern and use cold medicines like Da Huang (Rhei Radix et Rhizoma) and Ya Xiao (Natrii Sulfas) to purge. Excessive purging leads to internal fluid loss, gradually forming Gan syndrome. Similarly, for Pi syndrome (abdominal mass), which presents with alternating chills and fever, thirst, and hard painful masses under the hypochondrium, the treatment should gradually dissipate it with medicine. Physicians instead use harsh purgatives like Ba Dou (Crotonis Semen) and Niu Bang Zi (Arctii Fructus) to purge. Children's constitutions are prone to both deficiency and excess; excessive purging consumes Stomach fluids, gradually forming Gan emaciation. Furthermore, if a child suffers from Shang Han (Cold Damage) for five to six days and has indications for purgation, using cold purgatives excessively damages the Spleen and Stomach, reducing fluids. This leads to incessant drinking and generation of heat. Internal heat consumption and external muscle wasting, combined with other pathogens, cause various symptom changes, also resulting in Gan syndrome. Long-term vomiting and diarrhea, or mistaken purgation by doctors, exacerbates deficiency, fluid loss, and irritability, also leading to Gan syndrome. Pediatric Pi syndrome arises from undigested milk and food stagnating in the abdomen, causing alternating cold and heat, incessant thirst, or wheezing and coughing, resembling tidal fever. If not treated early, it inevitably becomes Lao Gan (Consumptive Gan). Because the Pi syndrome prevents eating, Spleen and Stomach become deficient and generate heat, causing thirst. Excessive drinking washes away Stomach fluids, impairing the transformation and transportation of water and grain. The pulse becomes deep and fine, appetite decreases further, Spleen and Stomach decline, limbs become immobile, various pathogens arise, leading to emaciation and Gan syndrome. [Yang Shi] In children under twenty, the disease is called Gan; over twenty, it is called Lao (Consumption). Gan and Lao both result from Qi and Blood exhaustion and intestinal damage; they share the same origin but have different names. Why? Children's Zang-Fu organs are delicate; overeating easily causes injury. Any irregularity in milk or diet rarely fails to produce Gan. Gan arises from improper feeding, unregulated sweet and fatty foods. Infants lacking breast milk fed porridge too early consume their form and Qi, creating the root of Gan. After two or three years, excessive milk or food intake without limit causes Gan through injury. Indulgence in sweet, fatty, sticky, cold, salty, or sour foods obstructs the Middle Jiao, causing Gan through accumulation. If the nursing mother fails to regulate temperature or diet, or experiences emotional turmoil or sexual activity immediately before nursing, Gan can transmit via maternal Qi. Is this not the fault of the family failing to adjust properly? Gan is fundamentally a Spleen-Stomach disease involving internal fluid loss. Causes include: post-vomiting/diarrhea misuse of emetics/purgatives depleting fluids; tidal fever and uncontrollable diarrhea causing Stomach dryness; Shang Han interior patterns where excessive cold purgatives lead to thirst and heat generation; Pi syndrome with hypochondriac pain where harsh purgatives like Niu Bang Zi and Ba Dou violently injure fluids. These are faults of physicians using light-minded treatments to ruin diseases. Manifestations of Gan include: shiny/tight scalp, sparse/brittle hair, retracted cheeks/dry nose, craving mouth/white lips, dim/cloudy eyes, rubbing nose/frowning, hunched spine/yellow body, grinding teeth/biting nails, intense thirst/sweating, white urine/sour stool, abdominal distension/bowel sounds, Pi nodules/tidal fever, craving for fruits/sour/salty foods, charcoal/rice/clay, and desire to drink—all are signs.

[Liver Gan] Also known as Feng Gan (Wind Gan) or Jin Gan (Tendon Gan). [Qian Yi] Liver Gan features white membrane covering the pupil; Jin Gan involves bloody diarrhea and emaciation. [Tang Shi] Liver Gan shows blue-white sclera, dry/itchy eyes. *Shenghui*: Head shaking, eye rubbing, profuse sweating, sleeping face down, green-yellow complexion, erect/scorched hair, blue tendons/hot brain, body-wide sores/lichen, abdominal accumulation, frequent dysentery, chronic non-healing leading to severe emaciation. [Zeng Shi] Eye discharge, blue or white patches on hairline/left cheek, slightly yellow eyes, watery diarrhea or moss-colored stool.

[Heart Gan] Also known as Jing Gan (Fright Gan). Qian Shi: Sallow face/red cheeks, high fever. Tang Shi: Mouth sores. *Shenghui*: High fever throughout body, irregular vomiting/diarrhea, red cheeks/sallow face, chest oppression/restlessness, dry nose/irritable heart, mouth/tongue sores, chronic dysentery with pus/blood, occasional night sweats, or false fright. Yang Shi: Red/astringent urine, hot palms/soles/chest. Zeng Shi: Teeth grinding/tongue protrusion, preference for cold water, lying prone on floor.

Spleen Gan also known as Shi Gan (Food Gan). Qian Shi: Sallow face, large abdomen, pica (eating dirt). Tang Shi: Spleen Gan—indigestion. Stomach Gan—frequent vomiting. *Shenghui*: Visible abdominal veins, rapid breathing/coarse qi, poor milk/food intake, chest/abdominal fullness, frequent crying/coughing/reversal, sallow complexion, bony prominence/brittle hair, withered form/weak strength, chest oppression, indigestion, dry mouth/nose, depressed mood, preferring darkness/light aversion, Spleen-Stomach disharmony, frequent sour-smelling stools. Zeng Shi: Craving cold foods, unquenchable thirst, yellow face/body, sparse tufted hair, large head/small neck, abdominal distension/weak legs, intermittent loose stools, thin muscles/lagging eyes, cool days/hot nights, no desire for milk/food. Qian Shi adds: Fei Gan (Fat Gan) is Spleen Gan, characterized by emaciation, sallow dry skin with sores. Symptoms vary: dry eyes/white membrane, red lips/dry yellow/black body, lying on cool ground/eating dirt, body sores/itching, green/white/yellow frothy stool, color-changing watery diarrhea/easy abdominal distension, sores on body/ears/nose, tufted hair, large head/thin neck, extreme emaciation/thirst—all are signs.
Note: The described Spleen Gan symptoms overlap with other Gans because Gan is essentially a Spleen meridian disease and naturally includes these signs.

Lung Gan also known as Qi Gan. Qian Shi: Asthma, mouth/nose sores. *Shenghui*: Cough/reverse qi, dry/scorched skin/hair, excessive runny nose/frequent crying, throat obstruction, nose rubbing/nail biting, high fever/chills, red/itchy lip edges, abdominal bloating, decreasing milk/food intake, Large Intestine dysfunction, frequent diarrhea with undigested rice, millet-like bumps on skin. Zeng Shi: Red/rotten area below nose, thin/dry hands/feet, fishy breath, white patches on right cheek.

Kidney Gan also known as Ji Gan (Urgent Gan) or Gu Gan (Bone Gan). Qian Shi: Kidney Gan—extreme emaciation, body sores. Bone Gan—prefers lying on cool ground. Tang Shi: Black teeth/claws. *Shenghui*: Emaciated muscles/bones, gum sores, intermittent chills/fever, dry mouth/nose, brain heat like fire, cold feet like ice, increased vomiting/reduced milk/food, frequent diarrhea, open lower orifice/incompetent anus, Gan sores with itching/pain. Zeng Shi: Sores inside/outside ears, knee-like feet, unclosed cranial sutures, inability to walk, delayed teething, foul/rotten sutures, transmitting to Ma Chu Gan (Running Horse Gan) type.

[Yang Shi] Damage to the Five Zang organs by Gan is generally as described. Analyzing specifically: There are Five Gans producing worms, including Hui Gan (Roundworm Gan), Ji Gan (Spine Gan), Nao Gan (Brain Gan), Gan Gan (Dry Gan), Gan Ke (Gan Thirst), Gan Xie (Gan Diarrhea), Gan Li (Gan Dysentery), Gan Zhong Zhang (Gan Swelling), Gan Lao (Gan Consumption), Wu Gu Gan (Innocent Gan), Ding Xi, and Bu Lu. Symptoms are numerous; must we not summarize the essentials and analyze them? "Five Gans producing worms": The source of Gan injury, though starting from improper feeding, involves long-term stagnation in Zang-Fu transforming into worms. Worms may be thread-like or horse-tail-like, mostly appearing between head, neck, abdomen, and back. Yellow/white or red worms are treatable; blue/black are difficult. Hui Gan: Loss of breast milk, early solid food, early meat consumption, or sweet/greasy food stagnation in intestines/stomach transforming into roundworms. Symptoms: frowning/frequent crying, vomiting clear foam, sudden abdominal pain, abdominal distension with blue veins, purple-black lips/mouth, anal/teeth itching (Note: Although roundworms eat feces, if worms move abnormally or exit via nose/mouth, prognosis is poor). Ji Gan: Worms eroding the spine. Symptoms: fever/emaciation/yellowing, heat from accumulation, irritability/warmth/diarrhea, drum-like sound on back percussion, saw-tooth-like spine bones, sores on ten fingers, frequent nail biting. Nao Gan: Congenital wind-heat, excessive breastfeeding post-birth. Symptoms: shiny/tight scalp, widespread crusty sores, brain heat like fire, knotted tufted hair, generalized sweating, swollen cheeks/high fontanelle (Note: Excessive sexual activity during labor also harms the infant's eyes). Gan Gan (Dry Gan): Emaciated/blood-deficient/dry tongue/frequent crying—disease in Heart. Unblinking eyes/dry crying/few tears—disease in Liver. Fever/dry urine/cold hands/feet—disease in Kidney. Hoarse voice/dry skin/constipation—disease in Lung. Mouth-corner paralysis/sleepiness/chest-epigastric dryness/thirst—disease in Spleen. Collectively called Five Dry Gans. Gan Ke: Pre-existing Gan Qi in organs, compounded by nursing mother consuming pungent spices/alcohol/flour/fried foods, causing Heart-Lung heat congestion. Daytime: irritability/thirst/drinking water, refusal of milk/food. Nighttime: thirst stops. Gan Xie: Dry hair/white lips/blue lines on forehead/abdominal distension/bowel sounds/passing undigested matter (Do not use hot medicines to stop). Gan Li: Contraction of Wind-Cold-Damp-Heat, or cold-heat imbalance, or stagnant food/water-grain not aggregating, frequent passage of foul matter. Gan Zhong Zhang: Deficiency with accumulation, toxin and Qi intertwining, causing tight abdominal distension. Spleen absorbs dampness, causing puffiness of head/face/hands/feet (Method: Dissipate accumulation, regulate Qi). Gan Lao: Alternating tidal fever, five-palm heat, sores on palms/chest, night sweats/bone-steaming, cough/wheezing/emaciation. Or thirst followed by diarrhea, aversion to food/water, rock-hard abdomen, silver-like complexion—definitely fatal. Wu Gu Gan: Lumps behind ears/neck side, bean-sized, movable, soft/painless, containing worm-like particles like rice flour. If not punctured quickly, worms scatter with heat flow, corroding Zang-Fu, causing limb abscesses, purulent/bloody stools, high fever/emaciation, exposed skull bones (Method: Puncture with needle, apply plaster). Also, washing children's clothes and exposing them under eaves, contaminated by female bird feathers, allows worms to enter skin/hair upon wearing, causing Innocent Gan. Dried clothes must be warmed slightly over fire. Ding Xi: Extremely thin hands/feet, small neck/high bones, wasted buttocks/atrophy, large abdomen/protruding umbilicus, crying with sunken chest, or grain-like spots. Bu Lu: Alternating deficient heat, separated skull bones, regurgitation/vomiting worms, irritability/thirst/vomiting. Ding Xi and Bu Lu both result from long-term Spleen-Stomach deficiency, inability to transform water/grain to nourish Qi/Blood, muscle wasting, Kidney Qi insufficiency, and Wind-Cold injury causing skeletal exposure. Some result from congenital toxicity or blood deficiency. These are types of Innocent Gan; reaching this stage is perilous. Additionally, children with long-term Kidney Gan, internal deficiency, anorexia, severe cases showing "Heavenly Pillar Bone Collapse" (drooping head). Treatment: Use Qian's Di Huang Wan (Rehmannia Pill) plus anti-Gan agents, apply neck-strengthening paste. Misidentifying this as "Five Softnesses" is incorrect. Heavenly Pillar Collapse has three types: 1. Long-term vomiting/diarrhea leading to weakness; 2. Latent Heat in Liver/Gallbladder, red face/lips, sudden onset; 3. Shang Han failing to release exterior. All involve Wind pathogen entering Liver, causing tendon relaxation. Vomiting/diarrhea type: Regulate Stomach Qi. Liver Heat type: Cool Liver based on severity. Apply neck-strengthening paste. Only Shang Han-induced collapse is difficult to treat, hence mentioned.

*Zhuang Family Collection* Twenty-Four Signs in Children:
1. Purulent/bloody diarrhea, daily emaciation: Cold-Heat Gan.
2. Thin legs/high belly, sternum protrusion, craving dirt/sour/salty, general yellowing over time, vomiting/dysentery, abdominal pain: Spleen Gan.
3. Red/rotten area below nose, eye rubbing, bloody dysentery: Lung Gan. Caused by hot foods, damaged lungs/heart by sick milk, cough, excessive cold meds leading to upper heat/lower cold, drowsiness, day/night crying.
4. Loose/wrinkled skin, pale face, dry itch, irritability.
5. Sparse hair, nasal sores: Lung Gan.
6. Head sores, sparse/scorched hair: Liver Gan.
7. Yellow/red unstable teeth: Kidney Gan.
8. Scorched/dry hair, nasal sores: Lung Gan.
9. Nail biting, tufted hair, heavy limbs: Heart Gan.
10. Abdominal veins, tooth erosion: Bone Socket Gan.
11. Vomiting/abdominal distension: Stomach Gan (also Milk Gan).
12. Broken/foul teeth, pale face, anorexia: Spleen Gan (also Mouth Gan).
13. Face-down sleeping, drunken sleep, distension/rapid breathing: Caused by raw meat, intestinal worms, Heart-Spleen Gan.
14. Dry/painful nose, bad breath, bleeding gums: Liver-Lung Gan.
15. Thin legs/high belly, blue abdominal veins: Spleen Gan.
16. Atypical sores, craving cold water: Heat Gan.
17. Millet-like bumps on skin, rice in stool: Cold Spleen Gan.
18. Qi fullness/abdominal distension/dry mouth: Heart-Stomach Gan.
19. Craving raw rice/flour/charcoal/bricks: Spleen-Stomach Gan.
20. Nose rubbing/eye wiping/nail biting, thirst: Liver-Thirst Gan.
21. Frequent chills/fever, reluctance to rise: Bone Heat Gan.
22. Thirst, eyes unable to open: Liver Gan.
23. Body hot/cool, intermittent thirst: Urgent Gan.
24. Black gums, lazy lips (red when open): Heart Gan Accumulated Heat.

*Shenghui*: Gan internal signs: dry eyes/abdominal distension, variable dysentery color or like rice wash, daily emaciation—treatable. If red/rotten area below nose self-rubbed, sores/crusts/pain/itch on nose tip spreading to ears, frequent red eyes, sparse hair, shiny/tight scalp, large head/small neck, emaciation—treatable. If lips/mouth eroded, gums multi-colored or black, white sores under tongue, holes in palate, bad breath, gums rotting—treatable. If lower orifice open, red/rotten/unbearable itch, irregular dysentery—treatable. If Gan erodes spine, ten fingers itch, self-nail biting, tufted hair, saw-like spine, intermittent distension/diarrhea—urgent treatment ensures recovery.

*Shenghui*: Liver Gan: Blue veins in eyes, hard left hypochondrium, salivation, black aura around eyes—untreatable. Heart Gan: Frightened crying, constant thirst, craving spicy food, pulse behind ear, black spots on tongue—untreatable. Spleen Gan: Large belly/colorless lips, flat philtrum, uncontrolled dysentery, indigestion, pica, dry skin/exposed bones—untreatable. Lung Gan: Reverse cough/shortness of breath, white frothy diarrhea, millet-sized black spots on body—untreatable. Kidney Gan: Craving sour/salty, unquenchable thirst, milky urine, black teeth, dry ears/brain, shrugging shoulders/bony枯—untreatable. Five Absolute Signs of Five Gans: 1. No pain when pressing middle toe sole. 2. Limbs limp when held. 3. Body not warm while sick persists. 4. Continuous green saliva/froth diarrhea. 5. Neck tendons weak/extended. All untreatable. Physicians must be cautious.

[Luo Tianyi] Gan results from Pi syndrome or long-term vomiting/diarrhea, where physicians wrongly administer turning/purging medicines. Children are prone to deficiency/excess shifts, causing Stomach deficiency and fluid loss, internal deficient heat, external muscle wasting. One Zang deficiency weakens all others. Symptoms: eyelid swelling, abdominal distension, variable dysentery color, progressive emaciation, chronic non-healing. This is Wind accumulation in intestines/stomach. Method: Use Xuan Feng San (Disperse Wind Powder) to guide, then tonify the mother organ of each affected Zang.

[Qian Yi] All Gans: Tonify mother organ of affected Zang, plus anti-Gan medicines. Cold type: Mu Xiang Wan (Aucklandia Pill). Heat type: Hu Huang Lian Wan (Coptis Pill). Gan internal: Eye swelling, abdominal distension, variable stool color/froth, progressive weakness—Cold pattern. Use Shi Jun Zi Wan (Quisqualis Pill). Gan external: Foul/rotten area below nose self-rubbed, sores on nose tip not crusting, spreading to ears. Treat nasal sores with Lan Xiang San (Laurus Powder), other sores with Bai Fen San (White Powder). Liver Gan: Tonify Liver, Di Huang Wan. Heart Gan: Tonify Heart, An Shen Wan. Spleen Gan: Tonify Spleen, Yi Huang San. Kidney Gan: Tonify Kidney, Di Huang Wan. Tendon Gan: Tonify Liver, Di Huang Wan. Lung Gan: Tonify Spleen-Lung, Yi Huang San. Bone Gan: Tonify Kidney, Di Huang Wan. Generally, distinguish Gan by Cold/Heat and Fat/Thin. Early stage: Fat-Heat Gan. Late stage: Thin-Cold Gan. Cold: Mu Xiang Wan. Heat: Hu Huang Lian Wan. Mixed Cold-Heat: Ru Sheng Wan (for Gan Diarrhea). Thus, children's delicate Zang-Fu cannot withstand harsh purgation, which depletes fluids and causes Gan. Generally...