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Zhou Mengjue said: "I have no deep insight into the learning of the Sages, but the young hold expectations for me, and we share similar aspirations. Therefore, I have paid special attention to *Gan* syndrome (a chronic wasting disease in children) repeatedly. After the age of sixteen, it is called *Lao* (consumptive disease); before the age of sixteen, it is called *Gan*. Its symptoms include dry and rough scalp, scorched and sparse hair, sunken cheeks and dry nose, hunched spine and emaciated body, grinding teeth and biting nails, irritability, thirst, and spontaneous sweating, reddish discharge from the mouth and nose and urine, abdominal distension with tidal fever, extreme craving for fruits, vegetables, mud, charcoal, and other foreign substances, and sores on the limbs externally. These are its signs. The general principles of *Gan* are categorized into five, corresponding to the Spleen, Lung, Heart, Liver, and Kidney. As for specific items, they cannot be exhaustively listed; I will briefly mention the main ones: Ji Gan (Spine *Gan*), Hui Gan (Roundworm *Gan*), Nao Gan (Brain *Gan*), Ding Xi Gan, Wu Gu Gan, and Bu Lu Gan. Although there are hundreds of names, the underlying principle is consistent. Although the manifested symptoms differ, they essentially fall into three categories: Heat, Accumulation, and Parasites.

Examining ancient famous prescriptions, there are Ta Qi Wan (Collapse Qi Pill), Long Dan Tang (Gentian Decoction), Lu Hui Wan (Aloe Pill), Mu Xiang Wan (Costus Root Pill), Hu Huang Lian Wan (Coptis/Picrorhiza Pill), and various Fei Er Wan (Fatten Child Pills). Their principles are correct, their meanings profound, and their effects miraculous; indeed, only immortals could transmit them. Because medical texts discuss symptoms ambiguously, although the prescriptions are transmitted, no one dares to use them. For instance, Zhang Jingyue argued in his discussions that if there is deficiency of both Qi and Blood, major tonification is indispensable, which is undoubtedly speculation by outsiders. Even Qian Yi (courtesy name Zhongyang), a renowned master of pediatrics, believed that all cases were due to Spleen and Stomach deficiency damage, which is also an old cliché and irrelevant to the essence of *Gan* syndrome. If Qian was like this, others can be imagined. I do not spare my bitter words and tedious explanations; once the source of the disease is clear, the painstaking efforts of the formulators may hopefully be elucidated to the world.

Yang Shi said: '*Gan' means 'dry'. I say: '*Gan' actually means 'sweet/greasy'. It arises because of excessive indulgence in rich and sweet foods, which stagnate and transform into Heat, steaming and generating Parasites. Over time, Accumulations form, and thus the name *Gan* comes about. Because it boils away Body Fluids, muscles are consumed. Because Accumulations form, the abdomen becomes distended, and food intake decreases. Because Parasites are generated, they suckle the Zang-Fu organs, leading to cravings for foreign substances; they erode the limbs, causing sores and itching without pain. Various symptoms mostly occur in wealthy families accustomed to rich diets, while only one or two out of ten occur in those eating coarse food. Since my travels, I have often seen that children of noble houses are less robust and full of vital energy than those living in thatched cottages. This is entirely due to irregular diet, having nothing to do with the flourishing or decline of Yuan Qi (Original Qi) or the strength or weakness of the Spleen and Stomach. This is manifestly obvious.

In various prescriptions, Coptis Rhizome (Huanglian) is invariably used as the Sovereign herb to resolve the toxic heat caused by boiling. Aloe (Lu Hui), Rehmannia Root (Sheng Di), Gardenia Fruit (Shan Zhi), Indigo Naturalis (Qing Dai), Gentian Root (Dan Cao), and Phellodendron Bark (Huang Bo) are used to clear Fire. Coix Seed (Wuyi), Quinine Tree Fruit (Shijunzi), Toosendan Fruit (Chuan Lian Zi), Ophiopogon Tuber (Leiwang - *Note: Text likely refers to a parasitic herb like Wollemi Pine or similar antiparasitic, but literal translation of Leiwang usually points to Ophiopogon or specific antiparasitic context here implies antiparasitic action*), Carrot Weed (Heshi), and Mume Fruit (Wumei) are used to kill parasites. Curcuma Tuber (Ezhu), Medicated Leaven (Shenqu), Hawthorn Fruit (Shanzha), Barley Sprout (Maiya), Green Tangerine Peel (Qingpi), and Costus Root (Muxiang) are used to dissipate Accumulation. Dried Toad (Gan Xiamu) and Toad Venom (Chansu) are used to attack toxicity with toxicity. Night-shining Sand (Yeming Sha) and Trogopterus Dung (Wulingzhi) are used to remove stasis and generate new blood. Where there are symptoms, there are medicines; what doubt remains regarding the cold nature and toxicity of these herbs?

I have seen patients suffering from this condition consult an illiterate doctor, who might guess, 'Could it be *Gan*?' and then prescribe a packet of a master's *Gan*-treating formula, sometimes accidentally succeeding, because he did not know the cold nature of Coptis Rhizome or the toxicity of Coix Seed. Conversely, when consulting a literate and rational doctor who knows it is *Gan*, he immediately says, 'The Spleen and Stomach are severely damaged; drastic tonification is required.' A withered body cannot withstand the cold of Coptis and the toxicity of Coix Seed. The owner thinks this is safe. Yet, Heat becomes more intense with tonification, Accumulation becomes harder with tonification, and Parasites multiply with tonification. When death ensues, they say it is fate. This is not the fault of reading books, but the fault of those who do not read well enough. Virtue rises one foot, demons rise ten feet; this is what is meant.

Then, can *Gan* be treated solely by attacking Heat, Accumulation, and Parasites? No. The Five *Gans* have their specific manifestations, and each type of *Gan* has its own symptoms. Changes arise from the mind; how can one be rigid and inflexible? One must have the bamboo in mind before painting it. So, is treatment of *Gan* purely offensive with no tonifying methods? Also no. The Classics state: 'When using highly toxic drugs to treat disease, stop when 50-60% of the disease is gone.' Observe when Heat recedes, Accumulation diminishes, and Parasites are pacified; do not pursue a desperate enemy. Alternatively, regulate the Spleen and Stomach, nourish the Kidney, and calm the Liver, leaving it to the physician's discretion.

Tu Weisheng said: "Mengjue's analysis of this section is precise in discussing symptoms and concise in treatment methods, like setting up lightning lamps on a dark path or providing a compass for navigators. His contribution to saving lives is far from insignificant. However, regarding his statement 'stagnation transforms into Heat, steaming generates Parasites, and over time Accumulations form,' I believe the order should be Accumulation first, Heat second, and Parasites third. There must be Accumulation before Heat, Heat before Parasites, and Parasites before the behavior of craving fruits, mud, and charcoal. Consider summer: if we place food and meat on the ground, maggots easily appear. Regarding parasites sucking Zang-Fu organs causing cravings for foreign substances, Mengjue's explanation does not fully help. In my estimation, it is likely that after a specific Zang-Fu organ is eroded by parasites, its Yin fluids are depleted, forcing it to seek substances related to its nature for supplementation. For example, Spleen *Gan* craves mud, and Kidney *Gan* craves raw salt.

Examining ancient prescriptions:

Ta Qi Wan: Made into pills with rice paste. Treats abdominal distension.
Cardamom Seed (Ba Dou Kou), Barley Sprout (Mai Ya), Trogopterus Dung (Wu Ling Zhi), Amomum Fruit (Sha Ren), Curcuma Tuber (E Zhu), Tangerine Peel (Chen Pi), Green Tangerine Peel (Qing Pi), Quinine Tree Fruit (Shi Jun Zi) (2 qian each), Toad (Laixama) (3 qian).

Xia Chong Wan: Made into pills with rice paste.
Quinine Tree Fruit (Kuan Lian Zi) (1 qian, soaked in rice water, baked), Millettia Stem (Guan Zhong) (1 qian), Areca Nut (Bing Lang) (1 qian), Peach Kernel (Tao Ren) (1 qian), Coix Seed (Wuyi) (1 qian), Costus Root (Mu Xiang) (1 qian), Carrot Weed (He Shi) (1 qian).

Mu Xiang Wan: Made into pills with ginger juice. Treats *Gan* dysentery.
Coptis Rhizome (Huang Lian) (1 qian), Costus Root (Mu Xiang) (1 qian), Magnolia Bark (Nong Po) (7 fen), Night-shining Sand (Ye Ming Sha) (1 qian).

Da Wuyi Tang: Treats pediatric fever with thirst, poor appetite, difficult defecation, yellowing hair loss.
Coix Seed (Wuyi) (1 qian), Gardenia Fruit (Zi Zi) (1 qian), Angelica Sinensis (Dang Gui) (1 qian), Atractylodes Macrocephala (Bai Zhu) (1 qian), Poria (Fu Ling) (1 qian), Bupleurum (Chai Hu) (1 qian), Ephedra Herb (Ma Huang) (1 qian), Notopterygium Root (Qiang Huo) (6 fen), Saposhnikovia Root (Fang Feng) (1 qian), Coptis Rhizome (Huang Lian) (1 qian), Phellodendron Bark (Huang Bo) (1 qian), Prepared Licorice Root (Zhi Gan Cao) (1 qian).

Si Wei Fei Er Wan: Treats pediatric food accumulation and Five *Gans*, cloudy cornea, rotten gum roots.
Coix Seed (Wuyi) (1 qian), Medicated Leaven (Shen Qu) (1 qian), Barley Sprout (Mai Ya) (1 qian), Coptis Rhizome (Huang Lian) (1 qian).
Grind the above into powder, make pills with pig bile, size of mung beans.

Lu Hui Fei Er Wan: Made into pills with pig bile, size of millet seeds. Treats Heat *Gan*.
Aloe (Lu Hui), Gentian Root (Long Dan Cao), Ginseng Root (Ren Shen), Costus Root (Mu Xiang), Barley Sprout (Mai Ya) (2 qian each), Ground Beetle (Tu Bie) (head and feet removed, fried in butter), Areca Nut (Bing Lang), Quinine Tree Fruit (Shi Jun Zi), Coix Seed (Wuyi) (3 qian each), Picrorhiza Rhizome (Hu Huang Lian) (1 qian), Coptis Rhizome (Huang Lian) (1 qian).

Long Dan Wan: Made into pills with refined honey. Treats *Gan* heat brain sores.
Gentian Root (Long Dan Cao) (1 qian), Cimicifuga Rhizome (Sheng Ma) (6 fen), Quinine Tree Root Bark (Kuan Lian Gen Pi) (1 qian), Red Poria (Chi Fu Ling) (1 qian), Saposhnikovia Root (Fang Feng) (1 qian), Aloe (Lu Hui) (1 qian), Burnt Hair Ash (You Fa Hui) (1 qian), Indigo Naturalis (Qing Dai) (1 qian), Coptis Rhizome (Huang Lian) (1 qian).

Chansu Wan: Treats pediatric cervical lymphadenitis, sallow and thin complexion, aversion to food, abdominal distension with fever.
Take 2-3 toads, put a scoop of fly larvae in a bucket, soak with urine, kill the toads and let the larvae eat them for a day and night. Place in a cloth bag, soak in running water overnight, take out, bake on tiles until dry, grind into powder, add a little Musk (She Xiang), make pills with rice.

Jicheng Jisheng Wan: Treats all types of *Gan* (cold, hot, new, old). Use as base, modify according to symptoms.
Aloe (Lu Hui) (1 qian), Trogopterus Dung (Wu Ling Zhi) (1 qian), Night-shining Sand (Ye Ming Sha) (1 qian), Tangerine Peel (Chen Pi) (6 fen), Curcuma Tuber (E Zhu) (1 qian), Quinine Tree Fruit (Shi Jun Zi) (1 qian), Guang Costus Root (Guang Mu Xiang) (1 qian), Angelica Sinensis (Dang Gui) (1 qian), Ligusticum Rhizome (Chuan Xiong) (1 qian), Ginseng Root (Ren Shen) (1 qian), Coptis Rhizome (Chuan Lian) (1 qian), Dry Toad Venom (Gan Chansu) (1 qian, fried in butter), Western Amomum Fruit (Xi Sha Ren) (wine-fried, 2 fen).

Tu Weisheng said: This prescription comes from *Youyou Jicheng*, similar to the previous Lu Hui Fei Er Wan, but Ginseng and Trogopterus Dung are used together. One might worry that Ginseng fears the invasive power of Trogopterus Dung.

Jicheng Shen Ling Bai Zhu San: Treats Spleen and Stomach weakness, poor appetite, vomiting/dysentery, and post-major illness. For replenishing Spleen and Stomach, this prescription is divine.
Ginseng Root (Ren Shen) (1 qian), Atractylodes Macrocephala (Bai Zhu) (1 qian), Poria (Fu Ling) (1 qian), Chinese Yam (Huai Shan Yao) (1 qian), Platycodon Root (Jie Geng) (1 qian), Coix Seed (Yi Ren) (1 qian), Lotus Seed (Jian Lian Rou) (1 qian), Prepared Licorice Root (Zhi Gan Cao) (1 qian).
Grind all into fine powder, take 1-2 qian per dose, mix with Ginger-Jujube decoction.

Jicheng Qing Wei San: Treats Zou Ma Ya Gan (rapidly progressing gingivostomatitis/noma).
Coptis Rhizome (Huang Lian) (1 qian), Angelica Sinensis (Dang Gui) (1 qian), Cimicifuga Rhizome (Sheng Ma) (6 fen), Rehmannia Root (Sheng Di) (1 qian), Moutan Bark (Dan Pi) (1 qian), Angelica Dahurica (Bai Zhi) (1 qian), Asarum (Xi Xin) (5 fen).

Jicheng Da Fei Er Wan: Treats pediatric Spleen and Stomach weakness, diarrhea, bone-steaming fever.
Ginseng Root (Ren Shen), Hawthorn Flesh (Shan Zha Rou, stir-fried), Atractylodes Macrocephala (Bai Zhu, earth-fried), Curcuma Tuber (E Zhu, stir-fried), Magnolia Bark (Chuan Po, ginger juice-fried), Medicated Leaven (Shen Qu, stir-fried), Tangerine Peel (Chen Pi, stir-fried), Picrorhiza Rhizome (Hu Huang Lian, stir-fried), Coptis Rhizome (Chuan Lian, ginger-processed), Green Tangerine Peel (Qing Pi, vinegar-fried), Poria (Fu Ling, milk-steamed), White Peony Root (Hang Shao, wine-fried), Cortex Lycii (Di Gu Pi, wine-fried), Alisma Rhizome (Ze Xie, stir-fried), Nutmeg (Rou Dou Kou), Areca Nut (Bing Lang), Ligusticum Rhizome (Chuan Xiong, stir-fried), Bupleurum (Chai Hu, wine-fried), Quinine Tree Fruit Meat (Shi Jun Zi Rou, stir-fried), Dry Toad (Gan Chan Chu, vinegar-roasted), Prepared Licorice Root (Zhi Gan Cao) (1 qian each), Five-grain Insect (Wu Gu Chong) (2 qian).
Grind all into powder, make pills with refined honey, size of bullet, dissolve in rice drink.

Jicheng Zou Ma Ya Gan Fang: Also treats oral *Gan* ulcers and black/foul-smelling rotten gums. After application, prevent saliva from flowing into the mouth.
Human Urine Deposit (Ren Zhong Bai) (1 liang, calcined), Camelia Seed Tea (Er Cha) (5 qian), Phellodendron Bark (Huang Bo), Mint (Bo He), Indigo Naturalis (Qing Dai) (1 qian each), Borneol (Bing Pian) (3 fen).
Grind all into fine powder for external use.

Jicheng Ji Gan Fang: Treats erosion and rotting of mouth and nose to the point of near death.
Sea Purple Shell (Hai Zhong Zi) (calcined with charcoal ash, commonly known as Nan She Ya Chi, formally Ya Luo, in Lingnan called Gou Zhi Piao.) Grind into powder, mix with wild boar fat for application.