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Gan syndrome (Pediatric Malnutrition Syndrome) derives its name from "dryness," referring to a condition formed by the depletion of stomach and spleen fluids. It is also associated with "sweetness," indicating that excessive consumption of sweet foods leads to food accumulation and the generation of parasites. Accumulation is the mother of Gan; if left untreated, it evolves into Gan syndrome. Prolonged accumulation without removal causes visceral deficiency, resulting in Gan. Additionally, after prolonged illness, irregular diet, or spleen deficiency following diarrhea, accumulated heat spreads through the five zang organs, and accumulated dampness generates parasites, also forming Gan. Children suffer from the Five Gans, while adults suffer from the Five Labors (Chronic Debility). Labor disease due to kidney deficiency results in the exhaustion of fluids and marrow. Gan syndrome, due to spleen deficiency, leads to dry fluids; prolonged transmission damages all five zang organs.

Symptoms of Gan include dry eyes, often caused by pica (eating dirt, raw rice, charcoal), preference for lying on cold surfaces, frequent scabies, dysentery with green/white stools and bloody mucus, abdominal distension with visible epigastric veins, sores around ears/nose/mouth, crying due to parasitic pain, sparse hair ("hair tuft"), large head with thin neck, emaciated limbs, skeletal heaviness despite drinking water, and body like firewood—all indicating internal fluid depletion and spleen/stomach injury. Other causes include post-illness vomiting/diarrhea followed by improper use of emetics or purgatives, leading to fluid exhaustion; severe sweating or diarrhea from heat syndromes causing gastric dryness; cold diarrhea from Taiyang disease transforming into heat upon drinking water, compounded by external pathogens; or harsh purgation (e.g., Crotonis Fructus/Bad Dou) for phlegm-fluid retention, damaging fluids abruptly.

Specific types include: Liver Gan, characterized by leukoma obscuring vision, treated by tonifying the liver; Heart Gan, with red cheeks and high fever; Spleen Gan, with yellowish body, abdominal distension, and pica; Lung Gan, with asthma and oral/nasal sores, treated by tonifying the mother organ (Spleen); Kidney Gan, with emaciation and skin sores; Sinew Gan, with bloody stool and weakness; Bone Gan, preferring cold surfaces; Flesh Gan, with swollen eyes, abdominal distension, dysentery, gradual wasting, nasal erosion, itching, and periocular sores. All Gans should be treated by tonifying the mother organ of the affected zang to ensure the child organ's peace.

Parasitic Gan presents with frowning, crying, frothy vomiting, abdominal pain/distension, visible veins, purple-black lips, and anal itching, treated with Jiegeng Fructus (Chuan Lian Zi) and Chrysanthemi Indici Flos (He Shi). Brain Gan features shiny scalp, acute sores, brain heat, sparse hair, hyperhidrosis, and bulging fontanelle, treated with Gentianae Radix (Long Dan Cao), Meliae Cortex (Ku Liu Pi), Aloe (Lu Hui), Coptidis Rhizoma (Huang Lian), and Indigo Naturalis (Qing Dai). Thirst Gan involves heart/lung heat, irritability, thirst, reduced feeding, and nocturnal cessation of thirst, treated with Long Dan Cao, Mume Fructus (Wu Mei), and Huang Lian. Diarrhea Gan shows brittle hair, white lips, blue forehead veins, abdominal distension, borborygmus, and undigested stool; Dysentery Gan involves frequent foul discharge, treated with Atractylodis Macrocephalae Rhizoma (Bai Zhu), Platycodonis Radix (Jie Geng), Magnoliae Officinalis Cortex (Hou Po), and Paeoniae Radix Alba (Bai Shao). Edema Gan features vacuity with accumulation, generalized swelling, and foul dysentery, treated with Lu Hui, Arecae Pericarpium (Da Fu Pi), Raphani Semen (Lai Fu Zi), Talcum (Hua Shi), and Plantaginis Semen (Che Qian Zi). Consumption Gan presents with tidal fever, five-palm heat, night sweats, cough, and bone-steaming emaciation, treated with Scutellariae Radix (Huang Qin), Bai Shao, Ligustici Chuanxiong Rhizoma (Chuan Xiong), Myristicae Semen (Rou Dou Kou), Rehmanniae Radix (Sheng Di), Ginseng Radix et Rhizoma (Ren Shen), Bai Zhu, and Testudinis Carapax et Plastrum (Bie Jia).

Running Horse Gan (Zou Ma Gan) occurs when parasites erode gums (bleeding, purple-black teeth) and intestines, driven by kidney deficiency heat rising to the upper jiao. Stages include: initial bad breath/black teeth (Beng Sha); severe gum rot (Kui Zao); bleeding gums (Xuan Lu); tooth loss (Fu Gen). Even if healed, teeth do not regrow, and life is endangered. Ding Xi syndrome features small extremities, thin neck, prominent bones, wasted buttocks, distended abdomen with protruding umbilicus, chest depression during crying. Bu Lu syndrome is more severe, with cranial splitting, skeletal emaciation, polydipsia, and worms exiting the mouth.

Formulas and herbs:
Eliminate Gan: Aloe, Dry Toad Skin, Trogopteri Dung, Turtle Shell.
Resolve Accumulation: Immature Bitter Orange, Curcuma Zedoaria, Tangerine Peel, Hawthorn Fruit, Samolus Root, Fermented Wheat Leaven, Malt.
Strengthen Spleen: Ginseng, Atractylodes, Magnolia Bark, Cyperus Rhizome.
Clear Heat: Bupleurum, Coptis, Picrorhiza, Silverleaf Bupleurum, Gentian, Phellodendron Bark, Forsythia, Indigo Naturalis.
Expel Parasites: Omphalia Mushroom, Cornus Seed, Melia Root Bark, Chrysanthemum Seed, Quisqualis Fruit.
Treat Gan Diarrhea: Aucklandia Root, Nutmeg, Terminalia Chebula, Amomum Fruit.
Although five-zang Gan formulas are discussed, these base herbs should be used with specific zang-targeting herbs, not limited to Anshen Dihuang Wan.

Heart Gan: Polyporus (Fushen), Coptis, Polygala, Amber, Aloe, Uncaria, Acorus.
Liver Gan: Rehmannia Raw/Roasted, Indigo Naturalis, Phellodendron, Gentian.
Spleen Gan: Atractylodes, Tangerine Peel, Coptis.
Lung Gan: Scutellaria, Platycodon, Forsythia, Asparagus Root, Ophiopogon, Saposhnikovia, Mulberry Root Bark.
Kidney Gan: Rehmannia Roasted, Alisma, Cornus, Moutan Bark.