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Qian Yi stated: Gan syndrome (Pediatric Malnutrition) is a disease of the Spleen and Stomach, caused by the depletion of body fluids. (Omitted text) When Gan is internal, symptoms include swollen eyelids, abdominal distension, diarrhea, variable complexion, or spitting out blue-white froth, with gradual emaciation and weakness; this is a Cold syndrome. When Gan is external, the nose is not red or ulcerated, the child rubs their nose, sores appear on the tip of the nose without forming scabs, and sores gradually develop around the ears. For nasal ulcers, Lanxiang San (Orchid Fragrance Powder) is used; for other sores, Baifen San (White Powder) is used. Zang-Fu Gan, Sinew Gan, and Bone Gan are described in detail in the main treatise.

Zhang Yuansu (Jiegu) stated: Gan syndrome occurs in children with Pi accumulation (Abdominal Masses), or due to prolonged vomiting and diarrhea, where physicians erroneously administer purgative drugs. Children are prone to deficiency-excess patterns, leading to Stomach Qi deficiency and loss of body fluids. This generates internal Deficient Heat and causes external muscle wasting. If one Zang-Fu is deficient, all others become weak. Symptoms include swollen eyelids, abdominal distension, diarrhea, variable complexion, and gradual emaciation and decline. If it persists without cure, it indicates Wind accumulation in the intestines and stomach. The treatment method should first use Xuanfeng San (Disperse Wind Powder) to guide out stagnation, followed by tonifying the mother organ according to the specific deficient Zang-Fu.

Generally speaking, pediatric Gan syndrome involves emaciated muscles and insufficient Qi and Blood, similar to Tuberculous Consumption (Lao Zhai) in adults.

Note: Among discussions on Gan syndrome, Qian Yi's treatise is the most detailed (the original text should be studied carefully).

Qian Yi stated: Accumulation pain presents with warm breath, yellowish-white complexion, dull eyesight, excessive sleepiness, aversion to food, or sour-smelling stool. In such cases, digestion should be promoted using Xiaoji Wan (Eliminate Accumulation Pill). For severe cases, Baixingzi (White Cake) should be used to purge, followed by harmonizing the Stomach. Worm pain presents with pale complexion, heart and abdominal pain, spitting of froth and clear fluid, and intermittent pain. Anchong San (Calming Worms Powder) is the primary prescription. Children with naturally timid constitutions are prone to this disease. Accumulation pain, Food stagnation pain, and Deficiency pain are largely similar, whereas Worm pain is characterized by a bland taste in the mouth and spontaneous flow of saliva.

Note: Pediatric abdominal pain can also result from cold food or milk injury, damp-heat impending dysentery, or eruptive diseases like sand-rash; these must be distinguished in detail.

Qian Yi stated: Abdominal Pi accumulation manifests as refusal to eat solid food but willingness to drink breast milk. It should be gradually treated with Baixingzi (White Cake) to purge. Pediatric Pi accumulation arises from undigested milk and food lodging in the abdomen, causing alternating chills and fever, drinking water, or wheezing and coughing, resembling tidal fever. If not treated early, it will inevitably develop into Gan syndrome. Because Pi accumulation prevents eating, Spleen and Stomach deficiency leads to fever, causing excessive thirst and drinking. This washes out the Spleen and Stomach, depleting body fluids. The Spleen and Stomach fail to transform and transport water and grain, resulting in a deep and fine pulse and further anorexia. With Spleen and Stomach deficiency and collapse, the limbs cannot move, various pathogenic factors arise, leading to emaciation and the formation of Gan syndrome.