张涣曰。小儿痉病。所受肝风。怯弱。致筋脉挛缩。两手拳。伸展无力。是名拘挛。宜薏苡丹。
古称儿病。惊疳最大。惊得心肝。疳得脾胃。脏腑因由。各不相蔽。童稚之时。病则为疳。弱冠而后。病成痨瘵。
同出异名。惟年齿计。元气亏伤。气血虚惫。其原则一。非有他疠。曰惟小儿。脏腑娇脆。饱固易伤。饥亦为害。热则
熏蒸。冷则凝滞。故疳之来。必有伊芳始。或幼阙乳。耗伤形气。此疳之根。积渐生蒂。或两三岁。乳食无制。此疳由脾。
过饱反瘁。或喜生冷。甘肥粘腻。此疳由积。肠胃气闭。或母自养。一切无忌。喜怒淫劳。即与乳吮。此疳由母。传气
为戾。或因病余。妄行转泄。胃枯液亡。虚热渐炽。此疳由医。冒昧错治。大抵疳病。缘此等弊。然而古人。五脏分隶。
各有症形。各有方剂。肝心肾肺。脾总多累。二十四候。更宜体会。庄氏家传。最为详备。总之疳候。必先贪嗜。盐酸
炭米。好吃泥块。口渴且馋。形体憔悴。潮热肠鸣。面黄便秽。渐渐腹胀。牙干目眯。揉鼻 眉。脊高项细。甚至缩
腮。头皮光异。肚大筋青。发焦毛萃。龈烂腿枯。周身疥癞。种种恶候。讵必齐逮。约略形神。实惟危殆。
为语病家。毋徒嗟喟。失治于前。今亦无奈。
钱乙曰。大抵疳病。当辨寒热肥瘦。其初病者为肥热疳。久病者为瘦冷疳。冷热交作者为冷热疳。当分治之。诸疳
皆当补其母。假令日中发潮热。是心虚热也。肝为心母。法当先补肝母。肝实而后泻心。心得母气。则内平而潮热自愈
矣。
危亦林曰。疳者干也。瘦瘁少血也。皆由气血虚惫。脏腑受伤。故有五脏疳。外有蛔疳、脊疳、脑疳、干疳、疳渴、
疳泻、疳痢、疳肿、疳疮、疳劳、无辜疳、丁奚、哺露。治之各有方。其病多因乳哺失常。肥甘不节。肠胃积滞而得之。
惟肾疳害人最速。盖肾虚受邪。疳奔上焦。故以走马为喻。初作口臭。次传齿黑龈烂。热血迸出。甚则齿脱。宜急治之。
才得全活。然齿不复生矣。
张元素曰。疳者。小儿受癖。或久吐泻。医者妄投转过之药。小儿易为虚实。致令胃虚而亡津液。内发虚热。外消
肌肉。一脏虚则诸脏皆弱。其病目胞肿。腹胀利色无常。渐加瘦瘠。久不痊可。是肠胃有风。宜宣风散导之。后则各根据
本脏补其母。
圣惠方曰。凡小儿疳在内。眼涩腹胀。利色无常。或如泔淀。日渐羸瘦。此候可疗。若鼻下赤烂。自揉鼻。头上有
疮。生痂痛痒。渐渐流引。绕于两耳。时时目赤。头发稀疏。脑皮光紧。头大项细。肌体瘦羸。亦可治也。若唇口被蚀。
齿龈五色。或尽峭黑。舌下有白疮。上 有窍子。口中时有臭气。齿龈渐染欲烂。亦可治也。若下部开张。有时赤烂。
痒不可忍。下利无常。亦可治也。若疳蚀脊膂。十指皆痒。自咬指甲。头发作穗。脊骨如锯。有时腹胀。有时下痢。若
急治之。无不瘥也。惟五疳有绝候。皆不可治。一衬着脚中指底不觉疼。二抱着手足垂 无力。三病未退遍身不暖。四
脏腑泻青涎及沫不止。五项筋舒展无力。如此之候。皆不可治也。
初虞世曰。有热疳。有冷疳。有冷热疳。此其要也。热疳者。病多在外。鼻下赤烂。头痒湿痒。五心烦热。掀衣气
粗。渴引冷水。烦躁卧地。肚热脚冷。潮热往来。皆热疳也。冷疳者病多在内。利色无常。其沫青白。肢体软弱。目肿
面黧。又一症躁渴卧地。似有热状。惟饮食不进。滑泄无已。亦冷疳也。其有泻多脓血。日加瘦弱。此则谓之冷热疳。
大抵疳之受病。皆虚使然。热者虚中之热。冷者虚中之冷。治热不可妄表过凉。治冷不可峻温骤补。故曰小儿易为虚实。
脾虚不受寒温。服寒则生冷。服温则生热。当识此勿误。
曾氏曰。大抵疳之为病。皆因过餐饮食。于脾家一脏。有积不治。传之余脏。而成五疳之疾。若脾家病去。则余脏
皆安。苟失其治。日久必有传变。脾家病。宜沉香槟榔丸、乌犀丸。更察虚实疗之。有虫者。使君子丸。心腹痛。吐清
水。虫自下者。二圣丸。诸疳症。皆宜用五疳保童丸、万应丸。常服化积治疳。仍各投本脏调理之剂。宁心、
茯神汤。调肝、 归汤。调脾、参苓白术散。补肺、补肺散。补肾、调元散。庶各得其宜。前症不致再作。
叶桂曰。幼儿断乳纳食。值夏月脾胃主气。易于肚膨泄泻。头及手足心热。形体日瘦。或烦渴善食。渐成五疳积聚。
当审体之强弱。病之新久。有余者当疏胃清热。食入粪色白。或不化。当健脾佐消导清热。若湿热内郁。虫积腹痛。导
滞驱虫。微下之。缓调。用肥儿丸之属。稚年五疳。犹大方五痨。虽方书有五脏之分。是症夏令为多。固从脾胃。盖小
儿乳食杂进。运化不及。初断乳后。果腥杂进。气伤滞聚。致热蒸于里。肌肉消瘦。腹大肢细。
名曰丁奚。或善食。或不嗜食。或渴饮无度。或便泻白色。久延不已。多致凶危。宜忌食生冷腥肥凝滞。治法初用清热
和中分利。次则疏补化运。一定之理。
Zhang Huan stated: Pediatric spasm disease results from contracting liver wind, compounded by physical weakness, leading to tendon and vessel contraction. It manifests as clenched fists with weak extension, termed "Ju Luan" (Contraction). Yi Yi Dan (Coix Seed Pill) is appropriate for treatment.
Ancient texts state that among pediatric diseases, Jing Gan (Startling Malnutrition) is the most severe. Startling affects the Heart and Liver, while Gan damages the Spleen and Stomach. The origins of organ pathology differ and do not obscure one another. In childhood, illness often becomes Gan; in adulthood, it becomes Lao Zhai (Consumption Disease). Though names differ due to age, the principle remains the same: depletion of Yuan Qi (Original Qi), deficiency and exhaustion of Qi and Blood. There is no other epidemic pathogen involved. Children's organs are delicate and fragile; overeating easily causes injury, and hunger is also harmful. Heat steams internally, cold stagnates qi. Thus, the onset of Gan must have an initial cause. Some suffer from early weaning, deforming body and depleting Qi, forming the root of Gan. Others aged two or three lack dietary restraint, causing Gan originating from the Spleen; overeating leads to emaciation. Some prefer raw/cold foods or sweet/greasy/sticky items, causing Gan from accumulation; this blocks intestinal and gastric qi. Some mothers nurse without restraint, nursing while angry, lustful, or fatigued, transmitting pathological qi to the child, causing Gan originating from the mother. Some cases arise from improper medical intervention after illness, where reckless purgatives dry the stomach and deplete fluids, intensifying deficient heat, causing Gan originating from the doctor. Generally, Gan arises from these faults. However, ancients categorized Gan by the Five Zang organs, each with specific symptoms and formulas. The Spleen is most frequently implicated compared to Liver, Heart, Kidney, and Lung. One should carefully study the twenty-four types of Gan. Zhuang's family transmission records are the most detailed. In summary, Gan symptoms include craving sour/salty foods, charcoal rice, eating mud, thirst, emaciation, tidal fever, borborygmus, yellow complexion, foul stool, abdominal distension, dry teeth, squinting eyes, rubbing nose/eyebrows, high spine, thin neck, sunken cheeks, shiny scalp, large abdomen with visible veins, brittle hair, sparse body hair, rotten gums, withered legs, and generalized scabies. Do all these symptoms necessarily appear? Observing the form and spirit reveals extreme danger. Inform families not to merely sigh; if treated too late, it is now helpless.
Qian Yi stated: Generally, Gan must be differentiated by cold/heat and fat/thin. Early-stage Gan is Fat-Heat Gan; long-term Gan is Thin-Cold Gan; mixed cold/heat is Cold-Heat Gan. Treat accordingly. All Gans require tonifying the "Mother" organ (based on Five Element generation cycle). For example, daytime tidal fever indicates Heart Deficient Heat. Since Liver is the Mother of Heart, one must first tonify the Liver. After Liver excess is resolved, drain the Heart. With maternal support, the Heart harmonizes, and tidal fever resolves spontaneously.
Wei Yilin stated: "Gan" means dryness, referring to emaciation and blood deficiency caused by Qi/Blood exhaustion and organ damage. Thus, there are Five Zang Gans, plus Roundworm Gan, Spine Gan, Brain Gan, Dry Gan, Gan Thirst, Gan Diarrhea, Gan Dysentery, Gan Swelling, Gan Sores, Gan Consumption, Innocent Gan, Ding Xi (Rib-like Protrusion), and Bu Lu (Breast-missing). Each has specific treatments. These illnesses mostly stem from improper feeding, excessive rich/sweet foods, and intestinal/gastric accumulation. Kidney Gan is the most rapid in killing, as Kidney deficiency allows Gan pathogens to rush to the Upper Jiao, likened to a running horse. Initially bad breath, then black teeth and rotten gums, bleeding, eventually tooth loss. Urgent treatment is needed to save life, though teeth will not regrow.
Zhang Yuansu stated: Gan results from pediatric accumulation or chronic vomiting/diarrhea, exacerbated by doctors' reckless use of harsh purgatives. Children's bodies easily shift between deficiency and excess, leading to Stomach deficiency and fluid loss, internal deficient heat, and external muscle wasting. One Zang deficiency weakens all others. Symptoms include swollen eyelids, abdominal distension, variable stool color, and progressive emaciation. If unhealed, it indicates Wind in intestines/stomach; Xuan Feng San (Disperse Wind Powder) should guide the pathogen out. Subsequently, tonify the Mother organ of each affected Zang.
*Shenghui Fang* states: Internal pediatric Gan presents with gritty eyes, abdominal distension, variable stool color (like rice water sediment), and daily emaciation; this is treatable. Red/rotten nose, nose-rubbing, head sores with painful/itchy crusts spreading to ears, red eyes, sparse hair, tight/shiny scalp, large head/thin neck, and emaciation are also treatable. Eroded lips/mouth, multi-colored or blackened gums, white sores under tongue, holes in palate, foul breath, and rotting gums are treatable. Open lower orifices, unbearable itching, variable diarrhea are treatable. Gan eroding the spine, itchy fingers, nail-biting, tufted hair, saw-toothed spine, alternating distension/diarrhea are curable if treated urgently. Five Gans are terminal and untreatable: 1. Insensitivity to pain in the big toe sole; 2. Limp limbs when held; 3. Body cold despite illness; 4. Unstopping green/white frothy diarrhea; 5. Weak tendon extension. These are untreatable.
Chu Yushi stated: Key differentiations are Heat Gan, Cold Gan, and Cold-Heat Gan. Heat Gan involves exterior symptoms: red/rotten nose, itchy/wet scalp, five-palm heat, restless breathing, desire for cold water, irritability, lying on floor, hot belly/cold feet, tidal fever. Cold Gan involves interior symptoms: variable stool color, green/white froth, weak limbs, swollen eyes, dark face. A variant shows irritability/thirst/lying on floor (mimicking heat) but with anorexia and endless slippery diarrhea. Mixed Gan features pus/blood in stool and daily weakening. Gan stems from deficiency. Heat is deficiency-heat; Cold is deficiency-cold. Do not use dispersing or overly cooling methods for Heat Gan; do not use harsh warming or sudden tonification for Cold Gan. Children's spleens are vulnerable to both cold and heat; cold drugs cause cold, warm drugs cause heat. Recognize this to avoid error.
Zeng Shirong stated: Gan stems from overeating causing Spleen accumulation, which transmits to other Zang organs, forming Five Zang Gans. If Spleen disease is cured, other organs rest. Untreated, it spreads. Treat Spleen disease with Chen Xiang Bing Lang Wan (Aucklandia and Areca Nut Pill) or Wu Xi Wan (Black Rhinoceros Horn Pill), adjusting for deficiency/excess. For worms, use Shi Jun Zi Wan (Quisqualis Pill). For heart/abdominal pain, clear water vomiting, and worm expulsion, use Er Sheng Wan (Two Sage Pill). For various Gans, regularly use Wu Gan Bao Tong Wan (Five Gan Child-Preserving Pill) or Wan Ying Wan (Ten Thousand Response Pill) to resolve accumulation. Supplement with organ-specific regulators: Fu Shen Tang (Poria Decoction) for Heart, Dang Gui Tang (Angelica Decoction) for Liver, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for Spleen, Bu Fei San (Tonify Lung Powder) for Lung, Tiao Yuan San (Regulate Origin Powder) for Kidney. This ensures appropriateness and prevents recurrence.
Ye Tianshi stated: When toddlers transition from milk to solid food during summer (Spleen/Stomach dominant season), they are prone to abdominal distension, diarrhea, heat in head/hands/feet, and emaciation. Or they may have irritability, polydipsia, and hyperphagia, progressing to Five Gan Accumulation. Assess constitution strength and disease duration. For excess patterns, soothe Stomach and clear heat. If stool is white or undigested, strengthen Spleen with digestion-promoting and heat-clearing herbs. For internal damp-heat and worm-induced abdominal pain, promote stagnation resolution, expel worms, and gently purge, followed by slow regulation using Fei Er Wan (Child-Fattening Pill) type formulas. Pediatric Gan resembles adult Five Consumptions. Though classified by Five Zang, it is common in summer and fundamentally rooted in Spleen/Stomach. Mixed diet overwhelms transformation capacity; post-weaning fruits/fish cause Qi injury and stagnation, generating internal heat, muscle wasting, large abdomen, and thin limbs, named Ding Xi. Whether hyperphagic or anorexic, polydipsic or passing white stool, prolonged cases become critical. Avoid raw/cold/fishy/greasy/sticky foods. Initial treatment clears heat, harmonizes middle, and separates turbidity; subsequent treatment soothes, tonifies, and transforms transport. This is the fixed principle.