李 曰。丁奚者。腹大颈细黄瘦是也。丁者。手足与项极小伶仃也。奚者。腹大也。甚者尻高肉削。脐突胸满。或
生谷症。爱吃生米土炭等物。宜十全丹、布袋丸。哺露者。虚热往来。头骨分解。反食吐虫。烦渴呕哕。骨瘦 露形。
盖丁奚哺露。皆因脾胃久虚。形体瘦削。亦由胎禀所成。尽皆无辜种类。并难治。大体相似。宜十全丹、布袋丸。
史演山曰。积是疳之母。所以有积不治。乃成疳候。又有治积不下。其积存而脏虚。成疳尤重。大抵小儿泄泻无时。
作渴虚热。烦躁下利。肿满喘急。皆疳候虚症。古云。疳虚用补。是知疳之为疾。不可更利动脏腑。发作之初。名曰疳
气。肚大胀急。名曰肝虚。泻利频并。名曰疳积。五心烦热。名曰疳热。毛焦发穗。肚大筋青。好吃异物。名曰疳极。
热发往来。形体枯槁。面无神采。名曰疳痨。手足细小。项长骨露。尻臀无肉。腹胀脐突。名曰丁奚。食加呕哕。头骨
分开。作渴引饮。虫从口出。名曰哺露。总皆疳候。
圣惠方曰。五疳久而不瘥。则腹内必有虫。肌体黄瘦。下利不止。宜服药出之。用圣惠干蟾丸。则疳气渐退。其虫
状如丝发。或如马尾。多出于腹背及头项上。若虫色黄白赤者可治。青色者。不可疗也。又有积疳虫。虫蚀脊膂。身热
羸瘦黄色。积中生热。烦渴下利。拍背如鼓鸣。脊骨如锯齿。或十指皆疮。频咬爪甲是也。宜圣惠金蟾散。
Li stated: "Dingxi" refers to the condition characterized by a distended abdomen, a thin neck, sallow complexion, and emaciation. "Ding" describes the hands, feet, and neck being extremely small and appearing solitary and fragile; "Xi" refers to the distended abdomen. In severe cases, the sacrum is prominent, muscles are wasted, the umbilicus protrudes, and the chest is full. It may also present as "Gu syndrome" (pica), where the patient craves raw rice, soil, charcoal, or other foreign substances. The treatment should employ Shiquan Dan (Complete Ten Decoction) and Budai Wan (Sack Pill).
"Bulu" refers to alternating deficiency-heat, splitting of the cranial sutures (fontanelles not closed), regurgitation with vomiting of worms, irritability, thirst, nausea, and retching, resulting in extreme emaciation where bones are exposed through the skin.
Generally, both Dingxi and Bulu result from long-standing Spleen and Stomach deficiency leading to physical wasting, and some are due to congenital endowment. All belong to categories that are difficult to treat and share similar characteristics. The treatment should employ Shiquan Dan (Complete Ten Decoction) and Budai Wan (Sack Pill).
Shi Yanshan said: Accumulation is the mother of Gan disease (Pediatric Malnutrition Syndrome). Therefore, if accumulation is left untreated, it develops into Gan syndrome. Furthermore, if the treatment for accumulation fails to resolve it, the persistence of accumulation leads to Zang-Fu deficiency, resulting in even more severe Gan syndrome. Broadly speaking, pediatric diarrhea occurring at any time, thirst accompanied by deficiency-heat, irritability with diarrhea, swelling and distension, and rapid breathing are all deficiency manifestations of Gan syndrome. Ancient texts state: "Gan syndrome is deficiency, thus use tonification." From this, we know that Gan disease should not be treated with purgative methods that disturb the Zang-Fu organs. At the initial stage of onset, it is called "Gan Qi" (Gan Qi Syndrome); when the abdomen is large, distended, and tense, it is called "Liver Deficiency"; when diarrhea and dysentery occur frequently, it is called "Gan Ji" (Gan Accumulation Syndrome); when there is heat in the five centers (palms, soles, and chest), it is called "Gan Re" (Gan Heat Syndrome); when hair is dry and brittle, the hair tips resemble tassels, the abdomen is distended with visible blue veins, and there is a craving for foreign substances, it is called "Gan Ji" (Extreme Gan Syndrome); when fever comes and goes, the body is withered, and the face lacks luster, it is called "Gan Lao" (Gan Consumption Syndrome); when the hands and feet are small, the neck is long with exposed bones, the buttocks have no flesh, the abdomen is distended, and the umbilicus protrudes, it is called "Dingxi"; when eating leads to vomiting and retching, the cranial sutures split, there is intense thirst requiring drinking, and worms emerge from the mouth, it is called "Bulu". All these are collectively manifestations of Gan syndrome.
The *Shenghui Fang* states: If the five types of Gan syndrome persist without improvement, there must be parasites within the abdomen. The body becomes sallow and emaciated, and diarrhea continues incessantly. It is appropriate to administer medicine to expel them. Using Shenghui Gan Chan Wan (Toad Pill of Shenghui Formulary) will gradually reduce the Gan Qi. These parasites resemble silk threads or horse tails and often emerge from the back, head, and neck. If the parasites are yellow, white, or red, they can be treated; if they are green, they are incurable. There are also parasites associated with Accumulation Gan. These parasites erode the spine, causing fever, emaciation, and sallow complexion. Heat generated from accumulation leads to irritability, thirst, and diarrhea. Percussion of the back produces a sound like drumming, and the spinal vertebrae feel like saw teeth. Alternatively, there may be sores on all ten fingers and frequent biting of the fingernails. This is the manifestation of Accumulation Gan parasites. The appropriate treatment is Shenghui Jin Chan San (Golden Toad Powder of Shenghui Formulary).