沈 稚年歇乳进谷。脾胃气馁少运。腹膨目医。是为五疳。夏日中土司令。久病投以补气。恰合
调其脾胃。近日呕吐泄泻身热。乃寒暄失和。致食不易化。小溲既少。腑气不和。余幼科久疏。
忆钱氏每以调中为主而驱邪都主轻法。深虑脾土伤。则延惊痫耳。（脾胃虚腑气不和）
益智仁 焦术 茯苓 广皮 藿香梗 浓朴 楂肉 泽泻
张（四岁） 五疳。腹胀数月。法当疏补。
人参 茯苓 麦芽 炒楂肉 广皮 半夏 湖莲
又 照前方去半夏湖莲加泽泻。
陈（五岁） 官人自汗。短气咳嗽。风温见症。肌腠有痤痱之形。与疹喑腑病不同。但幼稚
生阳充沛。春深入夏。形质日减。色脉是虚。而补脾辛甘不应。腹满。按之自 。二便原得通利。
腹痛时发时止。痛已即能饮食。考幼科五疳。与大方五劳相类。疳必因郁热为积为虫。此饮食不充肌肤
也。病来非暴。攻之由渐。再论疳热虫积。古人治肝治胃恒多。而洁古东垣。于内伤夹滞。每制
丸剂以缓治。取义乎渣质有形。与汤饮异歧。刻下温邪扰攘之余。聊以甘凉之属。清养胃阴。
以化肺热。其辛气泄表不宜进。（内伤夹滞虫积）
甜杏仁 麦冬 地骨皮 生甘草 冬桑叶 玉竹 和入青甘蔗汁一酒杯。
（丸方）仿治疳热羸瘦。从阳明厥阴疏通消补兼施。
人参 黄连 芦荟 川楝子 使君子 茯苓 白芍 广皮 胡黄连 南山楂
某（七岁） 食物不节。脾胃受戕。腹膨。大便不调。此属脾疳。（食伤脾胃）
焦术 茯苓 广皮 益智仁 大腹皮 木瓜 炮姜 炒神曲
吴（九岁） 能食。色枯形瘦。暮热泄泻。此皆口腹不慎。值长夏温热。脾胃受伤。将成五疳。
青蒿梗 枳实炭 胡黄连 炒谷芽 炒白芍 炒山楂 广皮 茯苓 泽泻
王 五疳已久。脾胃受伤。食物不运。腹膨溏泻。此积聚未清。中焦先馁。完谷不化。肿胀皆至。难
治之症。七香饼。
疳者。干也。小儿肠胃柔嫩。若乳食失调。甘肥不节。运化不及。停积发热。热久津干。此因积
成疳者也。或五脏偏热。或因病后。或医药误下。致亡失津液。脾不输化。积滞不行。此因干
致积者也。故五疳不离乎脾胃。其治法。胃滞当消。脾弱宜补。热者用苦寒清火。冷者宜辛
温健运。有虫者。兼用杀虫之品。其虚者。各随本脏补其母。总宜丸剂缓调。不能旦夕速功。
或用鸡肝纳入治疳药炖食。最为有效。（陆履安）
徐评 此老幼科痘症。不仅名家。可称大家矣。敬服敬服。
沈姓患儿，年幼时断奶后开始进食谷物。因脾胃之气虚弱，运化功能减退，出现腹部膨隆、眼睛干涩（目医）的症状，这属于五疳病。夏季是土气当令的季节，对于久病体虚者，采用补气的方法治疗，恰好符合调理脾胃的原则。近日出现呕吐、泄泻和身热的症状，这是由于寒暑气候失调，导致食物难以消化，小便量少，腑气不通畅。我从事儿科诊疗时间较短，回忆起钱乙（钱氏）的医案，多以调中焦为主，驱邪多用轻灵之法，深深担忧脾土受损后会引发惊痫之症。（辨证：脾胃虚弱，腑气不和）
处方：益智仁、炒白术、茯苓、陈皮、藿香梗、厚朴、山楂肉、泽泻。
张姓患儿，四岁。患有五疳，腹胀持续数月，治法应当疏理与补益并用。
陈姓患儿，五岁。官人自汗，短气咳嗽，呈现风温病的症状，肌肤腠理有痤疮痱子的形态。这与疹病音哑及腑病不同。但幼儿生机充沛，春末夏初时节，形体日渐消瘦，面色和脉象显示为虚证，而使用补脾的辛甘药物无效。腹部胀满，按压时感觉舒适（按之自舒），大小便原本通畅。腹痛时发时止，疼痛停止后就能进食。考察儿科五疳，与大方的五劳病相似。疳病必定是因为郁热形成积滞或虫积，导致饮食不能滋养肌肤。此病来势不猛，攻伐需循序渐进。再论疳热虫积，古人治疗肝胃多法，而洁古（张元素）、东垣（李杲）在内伤夹滞的情况下，常制作丸剂以缓治，取义在于药渣有形，与汤饮不同。目前温热邪气扰乱之后，暂用甘凉性质的药物，清养胃阴，以化解肺热。辛散透表的药物不宜使用。（辨证：内伤夹滞，虫积）
处方：甜杏仁、麦冬、地骨皮、生甘草、冬桑叶、玉竹，兑入青甘蔗汁一杯。
（丸方）仿照治疗疳热羸瘦的方法，从阳明经和厥阴经疏通，消补兼施。
处方：人参、黄连、芦荟、川楝子、使君子、茯苓、白芍、陈皮、胡黄连、南山楂。
某姓患儿，七岁。饮食不节制，脾胃受损，腹部膨隆，大便不调，这属于脾疳。（辨证：食伤脾胃）
处方：炒白术、茯苓、陈皮、益智仁、大腹皮、木瓜、炮姜、炒神曲。
吴姓患儿，九岁。食欲旺盛，但面色枯槁，形体消瘦，傍晚发热，伴有泄泻，这都是因为口腹不慎，正值长夏温热季节，脾胃受伤，即将形成五疳。
处方：青蒿梗、枳实炭、胡黄连、炒谷芽、炒白芍、炒山楂、陈皮、茯苓、泽泻。
王姓患儿。患五疳已久，脾胃受伤，食物无法运化，腹部膨隆，大便溏稀，这是积聚未清，中焦先虚，完谷不化，肿胀皆至，属于难治之症。使用七香饼。
疳病，就是“干”的意思。小儿肠胃柔嫩，如果乳食失调，甘甜肥腻不节制，运化不及，停积发热，热久则津液干枯，这是因积而成疳。或者五脏偏热，或者因病后，或者医药误下，导致津液亡失，脾不输布运化，积滞不行，这是因干致积。所以五疳离不开脾胃。其治疗方法，胃中有滞应当消导，脾气虚弱应当补益，有热的用苦寒药清火，有冷的用辛温药健运，有虫的兼用杀虫药，虚证的各随本脏补其母脏。总宜用丸剂缓慢调理，不能期望旦夕之间速效。或者用鸡肝纳入治疳药炖食，最为有效。（陆履安评）
徐评：这位老医生在儿科痘症方面，不仅是名家，可称为大家了。敬佩，敬佩。
Shen, a young child, began eating grain after weaning. Due to deficiency of Spleen and Stomach Qi (Spleen-Stomach Qi Deficiency) and reduced transportive function, abdominal distension and dry eyes (Mu Yi) occurred, constituting the Five Kan diseases (Five Malnutrition Syndromes). Summer is when Earth Qi commands; for chronic illness, administering tonifying Qi methods coincides with regulating Spleen and Stomach. Recently, vomiting, diarrhea, and fever appeared due to disharmony of cold and warm climates, causing indigestion. Urine output is low, and Fu-organ Qi is unharmonious. I have been distant from pediatric practice for a long time, recalling that Qian Shi (Qian Yi) always focused on regulating the Middle Jiao and used light methods to expel pathogens, deeply fearing that damage to Spleen Earth would lead to convulsions and epilepsy. (Syndrome: Spleen-Stomach Deficiency, Fu-organ Qi Disharmony)
Prescription: Yizhi Ren (Alpinia Oxyphylla Fruit), Jiao Zhu (Charred Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Guang Pi (Tangerine Peel), Huo Xiang Geng (Agastache Stem), Hou Po (Magnolia Bark), Zha Rou (Hawthorn Flesh), Ze Xie (Alisma Rhizome).
Zhang, four years old. Suffering from Five Kan diseases, abdominal distension for several months. The method should be to disperse and tonify.
Prescription: Ren Shen (Ginseng Radix et Rhizoma), Fu Ling (Poria), Mai Ya (Hordeum Germinatum), Chao Zha Rou (Stir-fried Hawthorn Flesh), Guang Pi (Tangerine Peel), Ban Xia (Pinellia Tuber), Hu Lian (Nelumbinis Semen).
Follow-up: Remove Ban Xia and Hu Lian from the previous prescription, add Ze Xie (Alisma Rhizome).
Chen, five years old. The official has spontaneous sweating, shortness of breath, and cough, presenting Wind-Warmth symptoms. The skin and pores show acne and prickly heat. This differs from rash with aphonia and Fu-organ disease. However, children are full of vital Yang. From late spring to early summer, physical constitution diminishes daily. Complexion and pulse indicate deficiency, yet tonifying Spleen with acrid-sweet herbs failed. Abdominal fullness, comfortable upon pressure, bowel movements and urination were originally free. Abdominal pain comes and goes; after pain subsides, appetite returns. Examining pediatric Five Kan diseases, they resemble the Five Exhaustions in general medicine. Kan must arise from stagnant heat forming accumulation or parasites, leading to diet failing to nourish muscles and flesh. The disease onset is not sudden; attack should be gradual. Regarding Kan heat and parasitic accumulation, ancients treated Liver and Stomach frequently, while Jiegu (Zhang Yuansu) and Dongyuan (Li Dongyuan), in cases of internal injury with stagnation, often prepared pill formulations for slow treatment, deriving meaning from the tangible nature of dregs, differing from decoctions. Currently, after turmoil by warm pathogens, tentatively use sweet-cool substances to clear and nourish Stomach Yin, transforming Lung heat. Acrid dispersants for releasing the exterior are inappropriate. (Syndrome: Internal Injury with Stagnation, Parasitic Accumulation)
Prescription: Tian Xing Ren (Sweet Apricot Seed), Mai Dong (Ophiopogon Tuber), Di Gu Pi (Lycium Cortex), Sheng Gan Cao (Raw Licorice Root), Dong Sang Ye (Mulberry Leaf), Yu Zhu (Polygonatum Odoratum Rhizome), mixed with one wine cup of Qing Zhe Gan Zhi (Green Sugarcane Juice).
(Pill Formula) Imitating treatment for Kan heat and emaciation, dredging from Yangming and Jueyin meridians, combining elimination and tonification.
Prescription: Ren Shen (Ginseng Radix et Rhizoma), Huang Lian (Coptidis Rhizoma), Lu Hui (Aloe), Chuan Li Zi (Toosendan Fruit), Shi Jun Zi (Quisqualis Fruit), Fu Ling (Poria), Bai Shao (White Peony Root), Guang Pi (Tangerine Peel), Hu Huang Lian (Picrorhiza Rhizoma), Nan Shan Zha (Crataegus Pinnatifida).
Certain patient, seven years old. Irregular food intake damaged Spleen and Stomach, causing abdominal distension and irregular bowel movements, belonging to Spleen Kan. (Syndrome: Food Injury to Spleen and Stomach)
Prescription: Jiao Zhu (Charred Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Guang Pi (Tangerine Peel), Yi Zhi Ren (Alpinia Oxyphylla Fruit), Da Fu Pi (Areca Pericarpium), Mu Gua (Chaenomelis Fructus), Pao Jiang (Prepared Ginger), Chao Shen Qu (Stir-fried Medicated Leaven).
Wu, nine years old. Capable of eating, but complexion is withered and body thin, evening fever with diarrhea. All these result from carelessness in mouth and belly, occurring during the long summer warm-heat season, damaging Spleen and Stomach, about to become Five Kan.
Prescription: Qing Hao Geng (Artemisia Annua Stem), Zhi Shi Tan (Charred Immature Bitter Orange), Hu Huang Lian (Picrorhiza Rhizoma), Chao Gu Ya (Stir-fried Rice Sprout), Chao Bai Shao (Stir-fried White Peony Root), Chao Shan Zha (Stir-fried Hawthorn Fruit), Guang Pi (Tangerine Peel), Fu Ling (Poria), Ze Xie (Alisma Rhizome).
Wang. Suffering from Five Kan for a long time, Spleen and Stomach damaged, food not transported, abdominal distension and loose stools. This indicates accumulation not cleared, Middle Jiao first deficient, undigested food passing through, swelling all present, a difficult-to-treat syndrome. Use Seven Fragrance Cake.
Kan means "dry." Children's intestines and stomachs are tender. If milk and food are irregular, and sweet/greasy foods are uncontrolled, transport and transformation fail, leading to retention, accumulation, and fever. Long-standing heat dries fluids; this is Kan formed from accumulation. Or if five organs are biased toward heat, or post-illness, or due to erroneous purgation by physicians causing fluid loss, Spleen fails to distribute and transform, stagnation does not move; this is accumulation caused by dryness. Thus, Five Kan never leaves Spleen and Stomach. Treatment methods: if Stomach has stagnation, eliminate it; if Spleen is weak, tonify it. For heat, use bitter-cold to clear fire; for cold, use acrid-warm to strengthen transport. For parasites, add anti-parasitic agents. For deficiency, supplement the mother organ according to each Zang organ. Generally, use pills for slow regulation; immediate results cannot be expected. Alternatively, stew chicken liver with Kan-treating medicines for consumption, which is most effective. (Lu Lv'an)
Xu's Comment: This old physician, in pediatric smallpox diseases, is not only a famous expert but can be called a grandmaster. Respect, respect.