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Yang stated that "gan" (malnutrition syndrome) refers to intestinal parasites and organ-related parasitic conditions. There are many names for it; I will briefly list the important ones.

Parasitic Gan: The parasites resemble silk threads, emerging from between the head, neck, chest, and back. Cases with yellow or white discoloration are treatable, while those with blue-black discoloration are difficult to cure.

Ascaris Gan: The child frowns and cries frequently, vomits clear froth, experiences pain in the Zhongwan (CV12) region, has abdominal distension with visible subcutaneous veins, purple-black lips and mouth corners, head shaking, and itching teeth.

Spinal Gan: The body is feverish and emaciated, accompanied by irritability, thirst, and diarrhea. Slapping the back produces a hollow sound, and the spinal vertebrae protrude like saw teeth. Ulcers appear on all ten fingers, and the child frequently bites their fingernails.

Cranial Gan: The scalp is smooth and tight, covered with ulcers. The brain feels hot as if on fire, hair matts into tufts, there is excessive sweating over the whole body, swelling of the cheeks, and a bulging fontanelle.

Gan-Thirst: During the day, the child is irritable and thirsty, drinking water but refusing food; at night, the thirst subsides.

Gan-Diarrhea: Hair becomes brittle and dry, lips turn pale, green lines appear on the forehead, the abdomen is distended with borborygmus, and stools contain undigested food residue.

Gan-Dysentery: Food stagnation and retained pathogenic factors prevent the assimilation of water and grain, resulting in the passage of foul-smelling excrement.

Gan-Swelling: Accumulation exists in the stomach, causing tight abdominal distension. If the spleen is affected by dampness, edema appears on the face, head, hands, and feet.

Gan-Labor (Consumption): Alternating tidal fever, five-palm heat (heat sensation in the palms, soles, and chest), night sweats, bone-steaming fever, coughing and wheezing with emaciation, thirst and diarrhea despite drinking water, hardness of the anus like stone, and a silvery-white complexion.

Innocuous Gan: A nodule the size of a bean appears behind the ear and along the neck side; it is movable upon pressure, soft, and painless. Accompanied by high fever and emaciation, prominent skull bones, this condition is caused by a lack of breast milk.

Dingxi Gan: The limbs are extremely thin, the neck is small with prominent bones, the buttocks are wasted, the body is flaccid, the abdomen is large with an everted umbilicus, and crying causes depression of the chest.

Bulu Gan: Alternating deficiency heat, separation of cranial suture lines, regurgitation with vomiting of worms, irritability, thirst, vomiting, and hiccups.

Running-Horse Gan: Gan-heat attacks upward, progressing rapidly like a running horse. Alternatively, toxin from smallpox/variola attacks upward, causing dental erosion. Since teeth belong to the Kidney, Kidney deficiency combined with heat causes Gan-fire to flare upward, leading to halitosis and blackened teeth. Mild cases involve gingival rot and swollen/painful lips, which are treatable. Severe cases involve loss of gums and perforation of the cheeks, which are untreatable.

Although these syndromes are numerous, they ultimately fall within the treatment methods of the Five Zang organs.

Liver Gan: Ulcers appear on the left cheek, eyes are red and ulcerated, skin resembles tinea, lymph node swellings occur around both ears, posterior neck, clavicular fossa (Quepen), inner thighs, or scrotum/testicles. Urination is obstructed or white fluid is discharged. The child may bite nails, shake their head, look sideways, have white membranes covering the pupils, photophobia, abdominal distension with visible veins, dry mouth, and hematochezia. Use Lu Hui Wan (Aloe Pill) to eliminate parasites, and Di Huang Wan (Rehmannia Pill) to nourish the Kidney.

Heart Gan: Oral and lingual erosion, high fever, yellowish complexion with red cheeks, occasional painful swelling, abdominal fullness, chest oppression, palm heat, dry throat, immediate vomiting after drinking water, night sweats, teeth grinding, and fright. Use Hu Huang Lian Wan (Coptis Pill) to treat the Heart, and Yi Gong San (Yi Gong Powder) to tonify the Spleen.

Spleen Gan: Yellowish and emaciated body, dry and rough skin, absence of hair growth or presence of crusts, red/ulcerated philtrum and mouth corners, vomiting of milk/food, geophagia (craving earth), abdominal distension with everted umbilicus, sour/foul diarrhea, turbid white urine, lethargy with closed eyes, and aversion to the sound of water. Use Fei Er Wan (Fatten Child Pill) to treat Gan, and Wu Wei Yi Gong San or Yi Huang San to generate Earth (tonify Spleen).

Lung Gan: Ulcers outside the nose, pharyngeal obstruction, neck swelling, toothache, coughing/wheezing with shortness of breath, alternating chills/fever, Qi deficiency, wrinkled/shedding skin, nasal itching with rhinorrhea, epistaxis, jaundice, and turbid frequent urination. Use Jia Wei Xian Xiong Wan (Modified Chest-Trap Pill) to treat the Lung, and Bu Zhong Yi Qi Tang to generate Metal (tonify Lung).

Kidney Gan: Cranial heat, expectoration, cold extremities, emaciation, mild chills/fever at night, slippery diarrhea with abdominal pain, halitosis/thirst, gingival ulceration, black/dull nails, ulcers on buttocks/ears, or otorrhea. Use Chan Chu Wan (Toad Pill) to remove Gan pathogens, and Di Huang Wan to tonify the Kidney.

For Innocuous Gan, use Bao Yuan Tang and Chan Chu Wan. For Dingxi and Bulu Gan, use Liu Wei Wan and Chan Chu Wan. For Running-Horse Gan, apply Ma Ming San externally and take Chan Chu Wan internally. For symptoms such as thirst, diarrhea, swelling, and consumption-like conditions, refer to detailed formula discussions for treatment.

Generally, "Gan" means "dryness," arising from the depletion of Spleen and Stomach fluids. In children, it is called the Five Gans; in adults, it is called the Five Labors (Wu Lao). The general principle is to regulate and tonify the Spleen and Stomach.

Internal pediatric Gan presents with swollen eyes, abdominal distension, everted umbilicus, thick urine, green/white diarrhea, and gradual emaciation. External pediatric Gan presents with red/ulcerated areas under the nose, frequent rubbing of nose/ears, or limb ulcers.

For nasal ulcers, use Lan Xiang San. For various ulcers, use Bai Fen San. For Heat Gan, use Ru Sheng Wan. For Cold Gan, use Mu Xiang Wan. For mixed cold-heat with chronic Qi/Yuan deficiency, Wen Pi Wan is most suitable.

For Gan affecting the eyes, mix 1 qian each of Yuan Yang Ren (Quisqualis Seed) and Qing Xi Zi (Celosia Seed) into fine powder. Combine with one liver from a castrated rooster not washed with water, mash thoroughly, add rice wine fermentation liquid, steam over rice, and consume. Cure is expected within 5-7 doses.