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Qian Zhongyang stated: Various types of Gan syndrome (wasting-accumulation syndrome) in children all result from spleen and stomach damage after illness, or over-treatment that injures healthy qi, leading to an inability to transform and transport milk and food. This causes internal depletion of body fluids and reckless movement of deficient fire. Alternatively, it may be caused by the wet nurse being affected by the six excesses (wind, cold, summerheat, dampness, dryness, fire) and seven emotions, with improper diet and daily routine, which then harms the infant. When Gan is internal, symptoms include swollen eyes, abdominal distension, diarrhea and dysentery with greenish-white stools, and gradual emaciation. When Gan is external, symptoms include redness and ulceration under the nose, frequent rubbing of the nose and ears, or sores on the limbs. Generally, although there are many manifestations, they all pertain to the five zang organs. Since Gan differs among the five zang organs, each must be differentiated and treated separately.

Liver Gan, also known as Jin Gan (sinew Gan) or Feng Gan (wind Gan), presents with a white membrane covering the pupil, or bloody diarrhea with emaciation. It should be treated with Dihuang Wan (Rehmannia Pill) to nourish the kidney. Heart Gan presents with a sallow complexion, red cheeks, and high fever. It should be treated with Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) to calm the heart, and Yigong San (Yi Gong Powder) to tonify the spleen. Spleen Gan, also known as Fei Gan (fat Gan), presents with a yellow, thin body, dry and rough skin with sores and scabies, a large abdomen, and geophagia (craving earth). It should be treated with Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) for Gan, Wuwei Yigong San (Five-Ingredient Yi Gong Powder) to generate earth, or Yihuang San (Yi Huang Powder). Lung Gan, also known as Qi Gan (qi Gan), presents with wheezing, coughing, shortness of breath, and sores in the mouth and nose. It should be treated with Renshen Qingfei Tang (Ginseng Lung-Clearing Decoction) to treat the lung, and Yiqi Tang (Qi-Boosting Decoction) to generate metal. Kidney Gan, also known as Gu Gan (bone Gan), presents with emaciated limbs, widespread sores and scabies, and a preference for lying on damp ground. It should be treated with Dihuang Wan. Nasal sores should be treated with Lanxiang San (Orchid Fragrance Powder). Various sores should be treated with Baifen San (White Powder). If tidal fever occurs, one should first tonify the liver and then drain the heart. If nitre (xiaoshi) and rhubarb (dahuang) are wrongly used to purge, it will become Gan. If pi accumulation (masses) occurs, it should be dissipated. If mistaken use of croton seed (badou) or borax (pengsha) for purging, or mistaken purging in cold damage, can lead to Gan. Early-stage heat Gan is treated with Huanglian Wan (Coptis Pill). Long-standing cold Gan is treated with Muxiang Wan (Aucklandia Pill). Mixed cold and heat Gan is treated with Rusheng Wan (Like-Sage Pill). Shortage of body fluids is treated with Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder). All these arise from spleen and stomach damage after severe illness and internal fluid depletion. The primary approach should be to secure the spleen and stomach; treating early prevents transformation into fatal syndromes.

Yang Shi stated: Wugu Gan (Innocent Gan) presents with nodules like beans behind the neck and at the nape, which move upon pressure, are soft and painless, containing worms. If not promptly pricked to release them, the worms will internally consume the viscera, leading to limb carbuncles, pus and blood in stool and urine, high fever, emaciation, and prominent skull bones. It should be treated with Da Wuyi Tang (Large Coptis Decoction) and Chanchu Wan (Toad Pill). Dingxi Gan presents with extremely thin hands and feet, a small neck with protruding bones, a shrunken buttocks and weak body, a large abdomen with protruding umbilicus, chest depression when crying loudly. It should be treated with Fei'er Wan (Child-Nourishing Pill) and Daluhui Wan (Large Aloe Pill). Bulu Gan presents with alternating deficiency heat, separated cranial sutures, vomiting of worms, irritability, thirst, vomiting, and hiccups. It should be treated with Fei'er Wan and Daluhui Wan. Zouma Gan (Running Horse Gan) involves erosion and rotting of the teeth. Teeth belong to the kidney; kidney deficiency with heat causes phlegm-fire to flare upward, resulting in bad breath and blackened teeth, and even gum erosion and exposed tooth roots. It should be externally applied with Xionghuang San (Realgar Powder) and internally administered with Chanchu Wan. For symptoms such as thirst, diarrhea, dysentery, swelling, and consumption, treatment should follow detailed formula discussions. Gan means "dryness," caused by the drying up of spleen and stomach fluids. In children, it is called Five Gan; in adults, it is called Five Lao (consumption). The general principle is to regulate and tonify stomach qi.

Furthermore, Yang Shi stated: There is also Gan injury, which is worm Gan of the five zang organs, with many names. I will mention only the essentials. Worm Gan features worms like silk threads appearing between the head, neck, abdomen, and back. Yellow, white, and red colors are treatable; blue-black colors are difficult to treat. Hui Gan (Roundworm Gan) presents with frowning and frequent crying, vomiting of green foam, abdominal pain, abdominal distension with visible veins, purple-black lips and mouth, head shaking, and itchy teeth. Ji Gan (Spine Gan) presents with body heat, emaciation, and yellowish color, irritability, thirst, and diarrhea, audible sound upon patting the back, spine resembling sawteeth, sores on all ten fingers, and frequent nail-biting. Nao Gan (Brain Gan) presents with tight, shiny scalp, widespread sores on the head, brain heat like fire, matted hair like tassels, generalized sweating, swollen cheeks, and bulging fontanelle. Gan Ke (Thirst Gan) presents with daytime irritability and thirst, drinking but not eating, and cessation of thirst at night. Gan Xie (Diarrhea Gan) presents with scorched hair, white lips, green lines on the forehead, abdominal distension, borborygmus, and passage of undigested food. Gan Li (Dysentery Gan) presents with retained stagnation, failure of water and grain to consolidate, and passage of foul matter. Gan Zhong (Swelling Gan) presents with deficiency accompanied by accumulation, tight abdominal distension; if the spleen re-acquires dampness, the head, face, hands, and feet become flaccidly swollen. Gan Lao (Consumption Gan) presents with tidal fever, five-palm heat, night sweats, bone-steaming, coughing, asthma, emaciation, thirst, diarrhea, hard abdomen like stone, and silvery-white complexion. Generally, although symptoms are numerous, they do not exceed the five zang organs, and treatment should generally follow methods for the five zang organs.

Jingyue stated: Examining Yang Shi's statement: Gan means "dryness"; in children, it is Five Gan; in adults, it is Five Lao. If it is called "dry" and also "consumption," is it not a syndrome of exhaustion of essence and blood? Observing previous methods, they all treat heat, using mostly cooling agents. Although true heat cases are indeed common, once healthy qi is damaged, false heat cases are particularly numerous. Even the previously mentioned formulas, such as Dihuang Wan, Yigong San, Yihuang San, and Yiqi Tang, may not cover all cases. If both qi and blood are damaged, major tonification is required; if yin deficiency generates false heat with spleen failure and kidney decline, warming tonification is required. The key lies in clinical discretion, referring to methods for treating deficiency and consumption, to achieve perfection.

Xue Shi stated: Examining Gan syndrome: it may result from feeding too early, craving sweet and fatty foods, taking harsh medicines causing severe fluid loss and vigorous deficient fire, or due to constitutional factors, or the wet nurse's rich diet and emotional disturbances. Each case requires internal regulation. If there is oral and lingual erosion, high fever, red cheeks and lips, swelling and pain, chest oppression, palm heat, dry throat, thirst, dark urine, night sweats, bruxism, and fright, this is Heart Meridian internal and external Gan, treated mainly with Anshen Wan (Calming Spirit Pill). If there are sores outside the nose, red and rotten eyes, skin lesions resembling tinea, lymph node swellings behind the ears, at the nape, clavicle, axillae, lower abdomen, inner thighs, penis, scrotum, and testicles, irregular urination, discharge of white fluid, nail-biting, head shaking, squinting, white membrane covering the pupil, photophobia, large abdomen with visible veins, dry mouth, and bloody stools, this is Liver Meridian internal and external Gan, treated mainly with Dihuang Wan and Luhui Wan (Aloe Pill). If there is lack of hair growth, sores and crusts, matted hair, red and rotten philtrum and mouth corners, abdominal pain, vomiting, indigestion, dry mouth, geophagia, sour-smelling diarrhea, turbid white urine, drowsiness with closed eyes, and aversion to wooden sounds, this is Spleen Meridian internal and external Gan, treated mainly with Fei'er Wan. If there are sores outside the nose, throat discomfort, neck swelling, toothache, cough with chills and fever, wrinkled skin, yawning with shortness of breath, nasal itching with runny nose, epistaxis, yellow eyes, and frequent urination, this is Lung Meridian internal and external Gan, treated mainly with Dihuang Qingfei Yin (Rehmannia Lung-Clearing Decoction). If there is brain heat with expectoration, cold extremities, alternating chills and fever, slippery diarrhea with abdominal pain, bad breath and thirst, gum ulceration, black nails, sallow complexion, sores on body and ears, ear discharge, or spontaneously rotting food, this is Kidney Meridian internal and external Gan, treated mainly with Dihuang Wan. Whenever Gan heat attacks upward, or pox toxins rise, causing rapid harm, it is named Zouma Gan (Running Horse Gan). Urgently apply Xionghuang San, Ya Cha San (Teeth-Rubbing Powder), or Ming San (Brightening Powder), choosing one, and administer Chanchu Wan. Mild cases involve gum erosion and lip/mouth swelling/pain, which are treatable; severe cases involve gum necrosis and cheek perforation, which are untreatable.