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The onset is irregular, treatments vary, and prescriptions differ; they cannot be fully recorded. One must weigh the severity of the condition and formulate prescriptions accordingly.

Discussion: The term "Gan" (Pediatric Malnutrition Syndrome) implies "sweetness." Gan disease arises from accumulation in the Spleen leading to deficiency. Because the accumulation is not resolved, and the child consumes sticky, sweet, cold, raw, roasted, or fried foods, it is named "Gan." Initially, as a disease name, it is called "Gan Qi" (Gan Qi Syndrome). This results from unregulated diet, intake of cold/raw items, long-standing injury from accumulation, stagnation, and failure to transform. Over time, "Gan Qi" transmits to the Five Zang Organs; this transmission is named "Gan Ji Hou" (Critical Stage of Gan). If it transmits in reverse, it is named "Gan Ni Hou" (Rebellious Stage of Gan). Although eating occurs, muscles do not grow, thirst and irritability are present; this is named "Gan Xu Hou" (Deficiency Stage of Gan). Occasional tidal fever and night sweats are named "Gan Lao Hou" (Consumption Stage of Gan). Abdominal distension, thin throat, and fleshless limbs are named "Ding Xi Hou" (Ding Xi Syndrome). Vomiting worms after turning over food, with fluctuating deficiency-heat, is named "Bu Lu Hou" (Feeding Dew Syndrome). Under ten years old is called "Gan"; over ten years old is called "Lao" (Consumption).

The principle for treating "Lao" completely avoids using Gan medicines. Generally, because the disease progresses rapidly and abnormally, the method for treating Gan involves regulating Qi deficiency, harmonizing Blood weakness, strengthening the pulse, eliminating parasites, dissipating Gan heat, and smoothly harmonizing the San Jiao (Triple Burner), stopping only after detailed examination. Do not use urgent, forceful attack methods, nor forcibly administer drugs. One should follow the syndrome patterns to set prescriptions and must not exceed the dosage. Cold medicines easily disturb the Zang-Fu organs; dry medicines easily damage the San Jiao. After examining the exact situation, prepare pills and powders according to severity, thus avoiding regret over errors.

In the methodology of medicinal treatment, only the symptom of coughing is difficult to exhaustively explore. Infants within one month are difficult to treat; infants at one hundred days are also difficult. There are gains and losses; students of medicine should know this.

Discussion: The reason why coughing in infants ("Ya Er") and babies is difficult to treat is that upon birth, their Qi and Blood are weak, the Five Zang Organs are not full, the body is not solid, and the physiological changes of "Ying Zheng" (growth and development cycles) are not complete. When such children contract Cold Evil, it attacks the Cou Li (interstitial spaces), causing internal and external interference, struggle between Pathogenic and Righteous factors, and disharmony of Yin and Yang. One must not forcefully attack; rash use of emetic, purgative, diaphoretic, or tonifying methods will cause the child's illness to worsen, doing no good and causing harm. Coughing in young children is the fault of the wet nurse; reckless use of pills and powders is the sin of quack doctors. Is it only infants and babies that are hard to regulate? The hidden worry is that when a child has coughing, one dare not lightly promise that taking one or two doses of medicine will bring peace and health. Even if symptoms of Taiyang Shang Han (Cold Damage) or Shang Feng (Wind Strike) have subsided, if coughing persists, it remains an issue. Generally, investigating the root, does pediatric coughing involve heat and phlegm initially? If heat is on the Exterior, without heat it may transmit inward, or it may not have transmitted yet (nearby then not transmitted, distant then transmitted). With excessive phlegm and heat, obstruction leads to vomiting; it is suitable to take Bu Fei Tang (Lung-Tonifying Decoction) [Ren Shen, Fu Ling, Ma Huang, Bai Zhu, Xing Ren, Gan Cao, E Jiao, Ke Zi, Di Gu Pi, Sang Bai Pi, Jie Geng]. Add Ban Xia if there is phlegm; add Fang Feng and Tian Ma if there is Wind-Heat. After administration, phlegm naturally transforms, heat dissipates, and cough gradually heals. Do not directly use coarse, astringent medicines like Bai Fan, Nan Xing, Shi Gao, Xiong Huang, Zhu Sha, or Pi Fen. First, moisten the Spleen and Lungs; second, use Wang Shi Jin Hua San (Wang's Golden Flower Powder), administering small amounts frequently. Or use Bai Wan Zi (White Pills) containing Xiong Huang, Zhu Sha, and Nao Zi, made into pills according to size. Whenever a child suffers from coughing, one must investigate the Interior and Exterior; do not solely attack the cough. If metal and stone medicines enter the Stomach directly, they may form Ti Pi Feng Hou (Splee-Raising Wind Syndrome), causing flexion of hands and feet, which benefits nothing. Ba Dou, Qing Fen, and Pi Shuang, if used as purgatives, will overwhelm the intestines and stomach, leading to wind convulsions shortly thereafter; what benefit is there? Use only warm and neutral medicines to release the Exterior, assist Qi, moisten the Lung Meridian, and harmonize the San Jiao. Phlegm will gradually resolve, and heat will recede without need for aggressive attack. Regarding managing coughing, one should temporarily tonify Qi, transform phlegm, benefit the Lung, and generate the Stomach. When the Stomach opens and Qi strengthens, cough decreases; when the Stomach is correct, phlegm is not produced; when the Lung is moistened, cough ceases. During breastfeeding, dietary taboos are not strictly necessary; as they grow older, fathers should use preservation methods, avoid wind, nourish, avoid toxins, and be cautious with cold. However, children have weak Qi; their coughs generating heat are similar to adults, but the medication regulation is truly different. There is also seasonal epidemic coughing, attributed to improper temperature fluctuations in the weather, affecting many vulnerable children. Their coughing continues day and night, with vomiting or wheezing, severe phlegm-heat obstruction. In critical cases, purging brings cure. This refers to using Da Huang, Pu Xiao, Zhi Shi, Chen Pi, Ban Xia, Ren Shen, Hou Po, and Chai Hu. If there is mental restlessness and chest/epigastric discomfort, this formula is suitable. If there is no heat or phlegm, purgation is not appropriate. Please examine and distinguish carefully to avoid errors.