小儿疳病。诸论丛杂。唯五疳之说为当。其证候外则传变不同。内则悉属五脏。一曰肝疳。其候摇头揉目。
白膜遮睛。遍身多汗。喜覆面而卧。眼中涩痒。色泽青黄。发竖头焦。筋青胸热。腹中积聚。下痢频多。日渐
羸瘦。二曰心疳。其候浑身壮热。颊赤面黄。心胸膈脘烦燥满闷。口舌生疮。盗汗多惊。下痢脓血。神彩衰
耗。三曰脾疳。其候腹大如鼓。上多筋脉。喘促气粗。心腹壅胀。多啼咳逆。水谷不消。唇口干燥。好食泥土。
情意不乐。憎明好暗。痢多酸臭。肌肉内消。形枯力劣。甚则大肉陷下。四曰肺疳。其候咳嗽气逆。皮毛焦落。
咽喉不利。揉鼻咬甲。口鼻生疮。腹内气胀。乳食不进。大肠不调。泄痢不常。憎寒体栗。粪中米出。洞下白
泔。五曰肾疳。其候上热下冷。寒热
时作。齿 生疮。耳焦胸热。手足逆冷。吐逆滑泄。下部生 。脱肛不收。夜啼饶哭。渐成困重。甚则高骨乃
败。小儿疳疾。乃与大人劳瘵相似。故亦名疳劳。大人劳者。因肾脏虚损。精髓衰枯。小儿疳者。因脾脏虚损。
津液消亡。病久相传。至五脏皆损也。大人劳疾。骨削而气耗。小儿疳疾。腹鼓而神羸。以其病之始也。其脏之
传受不同故也。至于传久。五脏皆损则一也。故五损者。经言一损于皮毛。皮聚毛落。肺也。二损于肌肉。肌肉
消瘦。饮食不为肌肉。脾也。三损于血脉。血脉虚少。不能荣于脏腑。心也。四损于筋。筋缓不能白收持。肝
也。五损重于骨。骨痿不能起于床。肾也。病极则大肉陷下。高骨败坏。以至死矣。凡小儿疳疾。多是下药
所坏。小儿脏腑嫩软。易虚易实。一切于诸病误行转下。致脾胃虚弱。津液内耗。皆能成疳。且如
潮热。日中时发者。是脾藏虚。心藏实。（日中乃心用事之时）而内发其热。法当先补其肝母。（肝乃心之母
也）肝实而后泻心。心得母气则平。而潮热乃愈。医见潮热。妄谓其实。便以大黄牙硝等冷药利之。利既多而不
能禁。则津液内亡。渐成疳也。又如癖病发作。寒热饮水。胁下有形而硬痛。法当用药渐消磨之。医见有癖。便
以巴豆 砂辈 药下之。下既多而津液耗。则渐成疳也。又如伤寒五六日之后。有下证。因以冷药下之太过。致
脾胃虚而津液耗。即便引饮不止而热生。如此则热气内耗于津液。肌肉外消而羸瘦。他邪相干。证变百端。亦因
成疳也。又如吐泻病久。津液耗亡。亦能成疳也。又如小儿食肥甘物多。因伤为积。则蕴利发热。津液内耗。亦
能作疳。故甘为疳也。圣济经云。肥甘之过。积为疳黄。乃谓是矣。故诸病皆能成疳也。甘疳之候。眼涩多困。
或生白膜。唇口淡白。身色黄黑。食泥土生米。喜卧冷地。疥癣头疮。洞泄青白黄沫。下痢脓血。腹满喘咳。耳
鼻生疮。发稀作穗。头大项细。肚大青筋。脚手垂 。瘦瘠饮水。筋痿骨重。形劣 羸。皆其证也。本因脾虚津
耗。久则传变而成。传缓者则为慢疳。传紧者则为急疳。又当辨认冷热肥瘦。其肥热疳者。乃因食肥甘。积聚生
热而作。故多病于初也。钱乙治用黄连丸。其瘦冷疳者。乃因转下泻痢生冷而作。故多病于久也。钱乙用木香
丸。通治冷热疳者。钱乙用如圣丸。凡治小儿之病。必量虚实冷热。不可妄行转下。恐变生疳也。若病初之脾
虚津少。发渴欲饮者。当生胃中津液。
煎钱乙白术散与服。惟多则才好。其钱乙诸方。本集载之。
又有一证。其候腹中有块。身体羸瘦。毛发焦稀。腹大气喘。冷痢脱肛。吃食爱吐。俗曰无辜。宝鉴云。按
玄中记有无辜之禽。一名姑护。一名钧星鬼。但喜夜飞。人有暴露小儿衣袂 包。其禽飞立在上。令儿患此疾
也。予性好寻阅异书。十余年间。竟不知玄中记之所出。又此禽既云夜飞。必有形状。世间亦莫之曾见。是必巫
觋假以鬼名而伪言者也。今鲜其证。而对其病。实乃疳疾之候耳。特为破其邪说。以祛惑乱矣。
小儿疳病，各种论述繁杂，唯有“五疳”的说法最为恰当。其证候在外部表现传变不同，在内部则都归属于五脏。
第一种是肝疳。其症状表现为摇头揉眼，白膜遮蔽瞳孔，全身多汗，喜欢蒙面而卧，眼中干涩发痒，面色青黄，头发竖起且干枯焦黄，筋脉显露青色，胸部发热，腹中有积块，腹泻频繁，日渐消瘦。
第二种是心疳。其症状表现为浑身高热，两颊红赤面色发黄，心胸膈脘烦闷燥热胀满，口舌生疮，盗汗且易受惊吓，下痢脓血，神采衰败消耗。
第三种是脾疳。其症状表现为腹部膨大如鼓，上面可见筋脉，气喘急促气粗，心腹胀满，多啼哭咳嗽气逆，水谷不消化，嘴唇口腔干燥，喜欢吃泥土，情绪不快乐，厌恶光亮喜好昏暗，腹泻多有酸臭味，肌肉内部消损，形体枯槁力气衰弱，严重时大肉陷下。
第四种是肺疳。其症状表现为咳嗽气逆，皮毛干枯脱落，咽喉不利，揉鼻子咬指甲，口鼻生疮，腹内气胀，乳食不进，大肠功能不调，泄泻痢疾无常，怕冷身体颤抖，粪便中夹有未消化的米粒，泻下白色米泔样便。
第五种是肾疳。其症状表现为上部热下部冷，寒热交替发作，牙齿牙龈生疮，耳朵焦枯胸部发热，手足逆冷，呕吐气逆滑泄，下部生疮，脱肛不能收回，夜间啼哭不止，逐渐变得困重，严重时高骨（指脊椎或肩胛等突出之骨）败坏。
小儿的疳疾，与成人的劳瘵（虚劳结核病）相似，所以也叫做疳劳。成人的劳病，是因为肾脏虚损，精髓衰枯；小儿的疳病，是因为脾脏虚损，津液消亡。病情日久相互传变，导致五脏都受损。成人的劳疾，是骨骼削瘦而气耗散；小儿的疳疾，是腹部鼓胀而神气羸弱。这是因为疾病起始阶段，脏腑传受不同的缘故。至于传变很久，五脏都受损的情况则是一样的。所以五种损耗，医经说：一损在皮毛，皮肤聚拢毛发脱落，这是肺的病变；二损在肌肉，肌肉消瘦，饮食不能转化为肌肉，这是脾的病变；三损在血脉，血脉虚少，不能滋养脏腑，这是心的病变；四损在筋，筋脉弛缓不能自主收持，这是肝的病变；五损重于骨，骨痿不能起床，这是肾的病变。病情极重时大肉陷下，高骨败坏，以至于死亡。
凡是小儿疳疾，大多是被误用攻下药所害。小儿脏腑嫩软，容易虚也容易实。一切疾病如果误用攻下法，导致脾胃虚弱，津液内耗，都能形成疳病。比如潮热，在中午时分发作的，这是脾脏虚，心脏实。（中午是心经当令之时）而内部发出热邪，治法应当先补肝木以养心火之母。（肝为心之母）肝气充实后再泻心火，心得到母气的资助则平和，潮热乃愈。医生见到潮热，胡乱认为是实证，就用大黄、牙硝等寒凉药利下。利下过多而不能停止，则津液内亡，逐渐形成疳病。又比如癖病发作，寒热饮水，胁下有形块硬痛，治法应当用药慢慢消磨它。医生见到有癖积，就用巴豆、硇砂之类的药攻下。攻下过多而津液耗伤，则逐渐形成疳病。又比如伤寒五六日之后，有可下的证候，因为用寒凉药攻下太过，导致脾胃虚而津液耗伤，随即引饮不止而生热。这样热气在内耗伤津液，肌肉在外消损而消瘦，其他邪气相干扰，证候变化百端，也是因此形成疳病。又比如吐泻病久，津液耗亡，也能形成疳病。又比如小儿吃肥甘食物多，因损伤而成积滞，则蕴结化热，津液内耗，也能成为疳病。所以甘味食物过多会导致疳病。《圣济经》说：肥甘之过，积滞成为疳黄，说的就是这个道理。所以各种疾病都能形成疳病。
甘疳的症状，眼睛干涩多困倦，或者生白膜，嘴唇口腔淡白，身色黄黑，吃泥土和生米，喜欢睡在冷地上，疥癣头疮，洞泄青白黄沫，下痢脓血，腹部胀满喘咳，耳鼻生疮，头发稀疏结成穗状，头大项细，肚子大青筋暴露，手脚下垂无力，瘦瘠饮水，筋痿骨重，形体劣弱羸瘦，都是它的证候。本因脾虚津耗，日久传变而成。传变缓慢的叫慢疳，传变急迫的叫急疳。还应当辨别冷热肥瘦。肥热疳，是因为吃肥甘食物，积聚生热而作，所以多在病初发生。钱乙治疗用黄连丸。瘦冷疳，是因为误用攻下、泻痢、生冷食物而作，所以多在病久发生。钱乙用木香丸。通治冷热疳，钱乙用如圣丸。凡是治疗小儿疾病，必须衡量虚实冷热，不可妄行攻下，恐怕变生疳病。如果是病初脾虚津少，发渴欲饮的，应当生津液，煎服钱乙的白术散，只有多喝才好。钱乙的这些方剂，原本收录在他的集中。
还有一种证候，症状是腹中有块，身体羸瘦，毛发焦稀，腹大气喘，冷痢脱肛，吃东西爱吐，俗名叫无辜。《宝鉴》说：按《玄中记》记载有无辜之禽，一名姑护，一名钧星鬼，只喜欢夜飞，人有暴露小儿衣袂包裹，那禽鸟飞立在上面，让小儿患此疾。我生性好寻阅异书，十余年间，终究不知道《玄中记》出自哪里。另外这种禽鸟既然说是夜飞，必有形状，世间也没有谁曾见过，这一定是巫觋假借鬼名而伪言的。现在很少见这种证候，而针对这个病，实际上是疳疾的证候罢了。特意破除这种邪说，以消除惑乱。
Pediatric Gan disease, with various discussions being complex and miscellaneous, is best explained by the theory of "Five Gan Syndromes." Its external manifestations vary in transmission, while internally, all belong to the Five Zang Organs.
The first is Liver Gan (Liver Syndrome). Symptoms include shaking the head and rubbing the eyes, a white membrane obscuring the pupils, excessive sweating over the whole body, a preference for sleeping face down covered, dryness and itching in the eyes, greenish-yellow complexion, upright and scorched hair, cyanotic veins and chest heat, abdominal accumulation, frequent diarrhea, progressive emaciation.
The second is Heart Gan (Heart Syndrome). Symptoms include high fever throughout the body, red cheeks and yellowish face, irritability, restlessness, fullness, and oppression in the chest, diaphragm, and epigastrium, sores on the mouth and tongue, night sweats with frequent frights, dysentery with pus and blood, and decline in spirit and vitality.
The third is Spleen Gan (Spleen Syndrome). Symptoms include an abdomen distended like a drum with visible veins above, panting and coarse breathing, heart and abdominal fullness and obstruction, frequent crying, coughing, and counterflow qi, indigestion of water and grain, dry lips and mouth, craving for eating dirt, unhappiness in mood, aversion to light and preference for darkness, sour-smelling diarrhea, internal consumption of muscle tissue, withered form and weak strength, and in severe cases, sinking of the large muscles.
The fourth is Lung Gan (Lung Syndrome). Symptoms include coughing and counterflow qi, scorched and falling skin and hair, throat discomfort, rubbing the nose and biting nails, sores in the mouth and nose, abdominal gas distension, refusal of milk and food, irregular large intestine function, intermittent diarrhea and dysentery, aversion to cold with trembling body, rice-like particles in stool, and profuse discharge of white watery fluid.
The fifth is Kidney Gan (Kidney Syndrome). Symptoms include heat in the upper part and cold in the lower part, alternating chills and fever, sores on the teeth and gums, scorched ears and chest heat, cold extremities, vomiting and counterflow qi with slippery diarrhea, sores in the lower region, prolapsed rectum that does not retract, frequent night crying, gradual heaviness and debility, and in severe cases, collapse of the prominent bones.
Pediatric Gan disease is similar to adult Lao Zhai (Consumption/Tuberculosis), hence also called Gan Lao (Gan Consumption). Adult Lao arises from Kidney deficiency and depletion of essence and marrow; Pediatric Gan arises from Spleen deficiency and loss of Jin-Ye (Body Fluids). Prolonged illness transmits through the organs, damaging all Five Zang Organs. Adult Lao presents with emaciated bones and depleted Qi; Pediatric Gan presents with a distended abdomen and weakened Shen (Spirit). This difference stems from the initial stage of organ transmission. However, after prolonged transmission, damage to all Five Zang Organs becomes identical. Thus, the five types of wasting are described in classics: First wasting affects skin and hair, causing skin contraction and hair loss, corresponding to the Lung. Second wasting affects muscles, causing muscle emaciation and inability of food to nourish muscles, corresponding to the Spleen. Third wasting affects blood vessels, causing deficient vessels unable to nourish organs, corresponding to the Heart. Fourth wasting affects sinews, causing flaccid sinews unable to hold or move, corresponding to the Liver. Fifth wasting affects bones, causing bone atrophy and inability to rise from bed, corresponding to the Kidney. When disease reaches its extreme, large muscles sink and prominent bones collapse, leading to death.
Most pediatric Gan diseases are caused by improper use of purgatives. Children's organs are tender and soft, prone to both deficiency and excess. Misusing purgation for any disease leads to Spleen and Stomach weakness and internal consumption of fluids, resulting in Gan. For example, tidal fever occurring at noon indicates Spleen deficiency and Heart excess. (Noon is when Heart Qi dominates.) The heat originates internally. The treatment should first tonify the Liver (Mother of Heart). Once Liver Qi is sufficient, then drain the Heart. With maternal support, Heart Qi balances, and tidal fever resolves. Physicians seeing tidal fever may wrongly assume excess and use cold purgatives like Da Huang (Rhei Radix et Rhizoma) and Ya Xiao (Natrii Sulfas). Excessive purgation depletes fluids, gradually forming Gan. Similarly, for Pi Bing (Mass/Abdominal Lump) with chills, fever, thirst, and hard painful masses under the ribs, treatment should slowly dissipate the mass. Physicians seeing a mass may use harsh purgatives like Ba Dou (Crotonis Fructus) and Nao Sha (Natrii Chloridi Impurus). Excessive purgation consumes fluids, gradually forming Gan. Also, after five to six days of Shang Han (Cold Damage), if purgatives are used excessively for indicated symptoms, Spleen and Stomach become weak and fluids deplete, leading to incessant thirst and internal heat. Heat consumes fluids internally, muscles waste externally, causing emaciation. Other pathogens interfere, causing myriad symptom changes, also forming Gan. Prolonged vomiting and diarrhea depleting fluids can also cause Gan. Excessive intake of rich and sweet foods causes stagnation, generating heat and consuming fluids, leading to Gan. Hence, excessive sweet flavors cause Gan. The *Sheng Ji Jing* states: "Excess of rich and sweet foods leads to accumulation and Gan Yellow," which is correct. Thus, various diseases can lead to Gan.
Symptoms of Gan due to Sweet flavor include dry and tired eyes, possible white membranes, pale lips and mouth, yellowish-black complexion, eating dirt and uncooked rice, preference for lying on cold ground, scabies, tinea, and scalp sores, profuse diarrhea with green, white, or yellow froth, dysentery with pus and blood, abdominal fullness, panting, and coughing, sores in ears and nose, sparse hair forming tufts, large head with thin neck, large abdomen with exposed blue veins, drooping hands and feet, emaciation with drinking, flaccid sinews and heavy bones, poor physical condition and weakness. These stem from Spleen deficiency and fluid loss, transmitting over time. Slow transmission results in Man Gan (Chronic Gan); fast transmission results in Ji Gan (Acute Gan). One must distinguish between Cold/Hot and Fat/Thin syndromes. Fat-Hot Gan arises from eating rich/sweet foods, accumulating heat, often occurring early. Qian Yi treats this with Huang Lian Wan (Coptis Pill). Thin-Cold Gan arises from misused purgation, dysentery, or raw/cold foods, often occurring late. Qian Yi treats this with Mu Xiang Wan (Aucklandia Pill). To treat both Cold and Hot Gan generally, Qian Yi uses Ru Sheng Wan (Like Sage Pill). In treating pediatric diseases, one must assess deficiency/excess and cold/heat, avoiding reckless purgation to prevent transforming into Gan. If early-stage Spleen deficiency causes fluid shortage, thirst, and desire to drink, generate Stomach fluids by decocting and administering Qian Yi's Bai Zhu San (Atractylodes Macrocephala Powder). More is better. These formulas by Qian Yi are recorded in his collected works.
Another syndrome features abdominal masses, emaciation, scorched and sparse hair, abdominal distension with panting, cold dysentery with rectal prolapse, and vomiting upon eating. Commonly called "Wu Gu" (Guilty Innocent). The *Bao Jian* cites *Xuan Zhong Ji*, describing a bird named Gu Hu or Jun Xing Gui, which flies at night. If children's clothes are exposed, the bird lands on them, causing this disease. I have searched obscure texts for over ten years without finding the source of *Xuan Zhong Ji*. Since the bird is said to fly at night, it must have a shape, yet no one has ever seen it. This is likely a fabrication by shamans using ghost names to deceive. This syndrome is rare now; clinically, it is actually a manifestation of Gan disease. I expose this heresy to dispel confusion.