〔丹〕白文举儿五岁，身面皆肿，尿多。
山栀（炒） 桑皮（炒。各一钱） 黄芩（二钱半） 白术 苏梗（各一钱半）
上 咀。作三帖，水一盏半，煎至半盏，食前温服。
〔汤〕 退肿散气方
赤小豆 陈皮 萝卜子 甘草（炙。各半两） 木香（炮，七分）
上为粗末。姜枣煎服，大小加减。
又方
白术（炒） 木香（炮） 甘草（炙） 茴香（炒） 青皮（各半两，巴豆三十粒、去膜，同青皮炒，去巴豆不用）
上为末。米饮调下。
又方
用钱氏益黄散加木香，去丁香，加萝卜子，去诃子，为末，大小加减，米饮调下。
《内经》曰∶数食肥，令人内热。数食甘，令人中满。盖其病因肥甘所致，故命名曰疳。若夫襁褓中
之乳子，与四五岁之孩提，乳哺未息，胃气未全，而谷气尚未充也，父母不能调将，惟务姑息，舐犊之爱，
遂令恣食肥甘，与夫瓜果生冷，及一切烹饪调和之味，朝飧暮啖，渐成积滞胶固，以致身热体瘦，面色痿
黄，或肚大青筋，虫痛泻利，而诸疳之证作矣。〔钱〕诸疳皆脾胃之病，内亡津液之所作也，因大病或吐泻后，
医又以药吐下，致脾胃虚弱，亡失津液。且小儿病疳，皆愚医之所坏病，假如潮热，是一脏虚、一脏实、而内
发虚热也，法当补母而泻本脏则愈，假令日中发潮热，是心虚热也，肝为心母，法宜先补肝母，肝实而后泻心，
心得母气则内平而潮热自愈，医见潮热，妄谓其实，乃以大黄、牙硝、辈诸冷药利之，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，胁下有形硬痛，法当用药渐消磨之，医反以巴
豆、 砂辈快药下之，小儿易虚易实，下之既过，胃中津液耗损，渐成疳瘦。又有病伤寒五六日间，有下
证，以冷药下之太过，致脾胃虚而津液少，即便引饮不止而生热也，热气内耗，肌肉外消，他邪相干，证变诸
端，亦成疳病。又有吐泻久病，或医妄下之，其虚益甚，津液烦躁，亦能成疳也。小儿病癖，由乳食不消，伏
在腹中，乍凉乍热，饮水不止，或喘而嗽，与潮热相类，若不早治，必成劳疳，以其有癖症，则令儿不食，致
脾胃虚而发热，故引饮也，饮多，即荡涤脾胃，亡失津液，不能传化水谷，其脉沉细，益不能饮食，致脾胃虚衰，
四肢不举，诸邪遂生，羸瘦而成疳矣。（杨）儿童二十岁以下，其病为疳，二十岁以上、其病为痨，疳与痨，皆
气血虚惫，肠胃受伤致之，同出而异名也。何者？小儿脏腑娇嫩，饱则易伤，乳哺饮食，一或失常，不为疳者
鲜矣。疳皆乳食不调，甘肥无节而作也，或婴幼阙乳，粥饭太早，耗伤形气，则疳之根生。或三两 后，乳
食稍多，过饱无度，则疳以伤得。或恣食甘肥粘腻，生冷咸醋，以滞中脘，则疳因
积成。或乳母寒暄失理，饮食乖常，喜怒房劳，即与儿乳，则疳因母患传气而入，
此非病家不能调适之过乎。疳皆脾胃受病，内无津液而作也，有因吐泻之后，妄施
吐下，津液虚竭得之者。有因潮热、大下利无禁约，胃中焦燥得之者。有因伤寒里
证，冷快太过，渴引水浆，变而生热，热气未散，复于他邪得之者。又有病癖寒热，
胁下痛硬，或者不能渐与消磨，遽以 、巴峻决，津液暴伤得之者，此非医家轻
药壤病之过乎。疳之为候，头皮光急，毛发焦稀，腮缩鼻干，口馋唇白，两眼昏烂，
揉鼻 眉，脊耸体黄，斗牙咬甲，焦渴自汗，尿白泻酸，肚胀肠鸣，癖结潮热，酷
嗜瓜果咸酸，炭米泥土而欲饮水者，皆其候也。
〔肝疳〕亦名风疳，亦名筋疳。〔钱〕肝疳白膜遮睛，筋疳泻血而瘦。〔汤〕肝
疳眼白青，眼睛涩痒。《圣惠》摇头揉目，流汗遍身，合面而卧，面色青黄，发竦
头焦，筋青脑热，浑身疮癣，腹中积聚，下痢频多，久而不痊，转甚羸瘦。〔曾氏〕
目生眵粪，发际、左脸多青或白，睛微黄，泻利夹水，或如苔色。
〔心疳〕亦名惊疳。钱氏，面黄颊赤，身壮热。汤氏，口内生疮。《圣惠》浑
身壮热，吐利无常，颊赤面黄，胸膈烦满，鼻干心躁，口舌生疮，痢久不痊，多下
脓血，有时盗汗，或乃虚惊。杨氏，小便赤涩，五心皆热。曾氏，切牙舒舌，爱
饮冷水，喜伏眠于地。
脾疳亦名食疳。钱氏∶面黄，腹大，食泥土。汤氏∶脾疳，食不消。胃疳，
多吐。《圣惠》腹多筋脉，喘促气粗，乳食不多，心腹胀满，多啼咳逆，面色痿黄，
骨立毛焦，形枯力劣，胸膈壅闷，水谷不消，口鼻常干，情意不悦，爱暗憎明，肠
胃不和，利多酸臭。曾氏，爱食冷物，引饮无度，身面俱黄，发稀作穗，头大项
小，腹胀脚弱，间或酿泻，肌瘦目慢，昼凉夜热，不思乳食。钱氏又云∶肥疳，即
脾疳也，身瘦虚黄，干而有疮，其候不一，种种异端，今略举之，目涩或生白膜，
唇赤身干黄或黑，喜卧冷地、或食泥土，身有疮疥，泻青白黄沫，水痢色变、易腹
满，身耳鼻皆有疮，发鬓作穗，头大项细，极瘦饮水，皆其证也。
按∶此言脾疳证候，多与余疳相滥，盖疳为脾经本病，固应兼之。
肺疳亦名气疳。钱氏，气喘，口鼻生疮。《圣惠》咳嗽气逆，皮毛干焦，饶涕
多啼，咽喉不利，揉鼻咬甲，壮热憎寒，唇边赤痒，腹内气胀，乳食渐稀，大肠不
调，频频泄利，粪中米出，皮上粟生。曾氏，鼻下赤烂，手足枯细，口有腥气，右腮 白。
肾疳亦名急疳，亦名骨疳。钱氏，肾疳极瘦，身有疮疥。骨疳，喜卧冷地。
汤氏，齿爪黑。《圣惠》肌骨消瘦，齿龈生疮，寒热作时，口鼻干燥，脑热如火，
脚冷如冰，吐逆既增，乳食减少，泻利频并，下部开张，肛门不收，疳疮痒痛。曾
氏，两耳内外生疮，脚如鹤膝，头缝不合，或未能行，牙齿生迟，其缝臭烂，传作
走马疳之类。
〔杨〕五脏疳伤，大抵然尔，析而论之，曰五疳出虫，曰蛔疳，曰脊疳，曰脑疳，
曰干疳，曰疳渴，曰疳泻，曰疳痢，曰疳肿胀，曰疳劳，曰无辜疳，曰丁奚，曰哺
露。证状非一，可不举宏撮要而条析之乎。五疳出虫者，疳伤之源，虽起于乳 不
调，然脏腑停积已久，莫不化而为虫，其虫或如丝发，或如马尾，多出于头项腹背
之间，黄白或赤者，可医，青黑则难疗也。蛔疳者，失乳饭早，食肉太早，或肠胃
停蓄甜腻，化为蛔虫，皱眉多啼，呕吐清沫，腹中乍痛，肚胀青筋，唇口紫黑，肠
头齿痒是也（蛔虽食虫，虫不可动，从口鼻出者难治）。脊疳者，虫蚀脊膂，身热羸黄，积中生热，
烦温下痢，拍背如鼓鸣，脊骨如锯齿，或十指皆疮，频啮爪甲是也。脑疳者，胎中
素挟风热，生下乳哺越常，头皮光急，满头饼疮，脑热如火，发结如穗，遍身多汗，
腮肿囟高是也（临产多欲亦然易损儿眼）。干疳者，瘦悴少血、舌干多啼，其病在心，目不转
睛、干啼少泪，其病在肝，身热尿干、手足清冷，其病在肾，声焦皮燥、大便干结，
其病在肺，搭口痴眠、胸脘干渴，其病在脾，总为五干疳是也。疳渴者，脏中夙有
疳气，加之乳母恣食五辛、酒面、炙爆，使小儿心肺壅热，日则烦渴引水，乳食不
进，夜则渴止是尔。疳泻者，毛干唇白，额上青纹，肚胀肠鸣，泄下糟粕是尔（勿用热
药止之）。疳痢者，挟受风寒暑湿，或冷热不调，或停积宿滞，水谷不聚，频下恶物是
尔。疳肿胀者，虚中有积，其毒与气交并，故令腹肚紧胀，由是脾复受湿，故令头
面、脚手、虚浮是尔（法当磨积调气）。疳劳者，潮热往来，五心烦热，手足心及胸前，热
而发疮，盗汗骨蒸，嗽喘枯悴是尔，或渴而复泻，饮水恶食，肚硬如石，面色如银，
断不可活。无辜疳者，脑后项边，有核如弹，按之转动，软而不疼，其间有虫如米
粉，不速破之，则虫随热气流散，淫蚀脏腑以致肢体痈疮，便利脓血，壮热羸瘦，
头露骨高是尔（针刺破膏药贴），或浣濯儿衣，露于檐下，为雌鸟落羽所污，儿着此衣，虫
入皮毛，亦致无辜之疾，儿衣已晒，须微火烘之。其若手足极细，项小骨高，尻削
体痿，腹大脐突，号哭胸陷，或生谷 ，是为丁奚。虚热来往，头骨分开，翻食吐
虫，烦渴呕哕，是为哺露。丁奚哺露，皆因脾胃久虚，不能化水谷以荣血气，故肌
肉消铄，肾气不足，复为风冷所伤，使柴骨枯露，亦有胎中受毒，脏腑少血致之，此
皆无辜种类之疾，病而至此，不几殆哉。又有小儿久患肾疳，内虚不食，甚者天柱
骨倒，治法当用钱氏地黄丸加驱疳等剂，仍与贴项强筋，若不识证，谓之五软，非
也。天柱骨倒，凡有三种，有吐泻日久，羸弱成者；有肝胆伏热，面赤唇红，忽变
此者；有伤寒不及发表成者；是皆风邪入肝，以致筋络舒弛，吐泻者当调胃气，肝
热者随轻重以凉肝，并与强筋贴项。惟伤寒天柱骨倒者难疗，故并及之。
《庄氏家传》小儿二十四候 第一候，泻脓血，日渐瘦，是冷热疳。第二候，
脚细肚高，胸前骨生，爱吃泥土酸咸，日久通身黄，时时吐逆下痢，腹内疼痛，是
脾疳。第三候，鼻下赤烂，爱揉眼，兼血痢，是肺疳，乃因吃着承热物，或病奶所
损心肺，加之咳嗽，更以服凉冷药过多，便上热下冷，渐渐昏沉，日夜烦哭。第四
候，皮虚皱，面无颜色，身上燥痒，心烦。第五候，毛发稀疏，鼻生疮，是肺疳。
第六候，头生疮，毛发稀焦，是肝疳。第七候，牙变黄赤不定，是肾疳。第八候，
头发焦干，鼻下疮生，是肺疳。第九候，咬指甲，毛发作穗，四肢沉重，是心疳。
第十候，肚上筋生，齿虫蚀，是骨槽疳。第十一候，吐逆腹胀是胃疳，又名奶疳。
第十二候，齿断臭烂，面无颜色，心不思食，是脾疳，又名口疳。第十三候，爱合
面卧，多睡如醉，腹胀气急，盖是因曾吃生肉如此，腹内有虫，是心脾疳。第十四
候，鼻内干痛，口中臭气，齿根有鲜血，是肝肺疳。第十五候，脚细肚高，并肚上
有青脉，是脾疳。第十六候，非时生疮，爱吃冷水，是热疳。第十七候，皮肤上
生粟子，粪中米出，是脾冷疳。第十八候，气满腹胀及口干，是心胃疳。第十九
候，爱餐生米面炭砖瓦，是脾胃疳。第二十候，揉鼻揩眼，及咬指甲，爱饮水，是
肝渴疳。第二十一候，多寒热，爱卧不起，是骨热疳。第二十二候，爱饮水，眼
目不开，是肝疳。第二十三候，肌体或热或凉，发渴无时，是急疳。第二十四候，
齿龈黑，唇懒开，开则赤，是心疳积热。
《圣惠》凡小儿疳在内，眼涩腹胀，痢色无常，或如泔淀，日渐羸瘦，此候可疗。
若鼻下赤烂自揉，鼻头上有疮生痂痛痒，渐渐流引，绕于两耳，时时目赤，头发稀
疏，脑皮光紧，头大项细，肌体羸瘦，亦可治也。若唇口被蚀，齿龈作五色，或尽
峭黑，舌下有白疮，上 有窍子，口中时有臭气，齿龈渐染欲烂，亦可治也。若下
部开张，有时赤烂，痒不可忍，下痢无常，亦可治也。若疳蚀脊膂，十指皆痒，自
咬指甲，头发作穗，脊骨如锯，有时腹胀，有时下痢，若急治之，无不瘥也。
《圣惠》凡小儿肝藏疳，若目睛带青脉，左胁下硬，多吐涎沫，眼角左右有黑气
所冲，不可治也。心藏疳，若爱惊啼，常好饮水，便食辛味，耳边有脉，舌上有黑
靥者，不可治也。脾藏疳，若肚大唇无血色，人中平满，下痢无度，水谷不消，好
吃泥土，皮枯骨露，不可治也。肺藏疳，若咳逆气促，多泻白沫，身上有斑生如粟
米大，色若黑者，不可治也。肾藏疳，若爱食酸咸，饮水无度，小便如乳，牙齿青
黑，耳脑干燥，肩竦骨枯，不可治也。又五疳有五绝候，一，衬着脚中指底，不觉
疼。二，抱着，手足垂 无力。三，病未退，遍身不暖。四，脏腑泻青涎，及沫不
止。五，项筋舒展无力。如此之候，皆不可治也，凡医用药，切在审详也。
〔洁〕疳者，小儿病癖或久吐泻，医者妄投转过之药，小儿易为虚实，致令胃虚
而亡津液，内发虚热，外消肌肉，一脏虚则诸脏皆弱，其病目胞肿，腹胀，痢色无
常，渐加瘦瘠，久不痊可，是肠胃有风积，法当宣风散（痘发热）导之，后各根据本脏，补其母。
〔钱〕诸疳，皆根据本脏补其母，及与治疳药，冷则木香丸，热则胡黄连丸主之。
疳在内，目肿，腹胀，利色无常，或沫青白，渐瘦弱，此冷证也，使君子丸主之。
疳在外，鼻下臭烂自揉、鼻头上有疮不着痂，渐绕耳生疮，治鼻疮烂兰香散，诸疮
白粉散主之。肝疳，当补肝，地黄丸主之。心疳，当补心，安神丸主之。脾疳，
当补脾，益黄散主之。肾疳，当补肾，地黄丸主之。筋疳，当补肝，地黄丸主之。
肺疳，当补脾肺，益黄散主之。骨疳，当补肾，地黄丸主之。大抵疳病当辨冷热
肥瘦，其初病者，为肥热疳，久病者，为瘦冷疳，冷者木香丸，热者胡黄连丸，冷
热之疳，尤宜如圣丸（疳泻）。故小儿之脏腑柔弱，不可痛击大下，必亡津液而成疳，凡
【丹溪】白文举的儿子五岁，全身和面部都浮肿，小便频多。
山栀（炒） 桑皮（炒。各一钱） 黄芩（二钱半） 白术 苏梗（各一钱半）
以上药材切碎。制成三帖药，用水一盏半，煎至半盏，饭前温服。
【汤氏】退肿散气方
赤小豆 陈皮 萝卜子 甘草（炙。各半两） 木香（炮，七分）
以上研为粗末。用生姜、大枣煎服，根据年龄大小调整剂量。
又一方
白术（炒） 木香（炮） 甘草（炙） 茴香（炒） 青皮（各半两，巴豆三十粒、去膜，同青皮炒，去巴豆不用）
以上研为细末。米汤调服。
又一方
用钱氏益黄散加木香，去丁香，加萝卜子，去诃子，研为细末，根据年龄大小调整剂量，米汤调服。
《内经》说：经常吃肥腻食物，使人内热。经常吃甘甜食物，使人中焦胀满。大概其病因由肥甘所致，所以命名为疳病。至于襁褓中的婴儿，以及四五岁的幼儿，哺乳未停，胃气未全，而谷气尚未充足。父母不能妥善调养，只一味姑息迁就，出于舐犊情深，遂让孩子恣意食用肥甘厚味，以及瓜果生冷，和一切烹饪调和的味道，早晚进食，逐渐形成积滞胶固，导致身体发热、形体消瘦，面色萎黄，或者肚子大、青筋暴露，虫痛腹泻，于是各种疳病的证候就产生了。【钱乙】各种疳病都是脾胃的病，是体内津液亡失所导致的，因为大病或吐泻后，医生又用药催吐攻下，致使脾胃虚弱，津液亡失。而且小儿患疳病，都是愚医造成的坏病。假如潮热，是一脏虚、一脏实，而内部产生虚热，治法应当补母脏而泻本脏则痊愈。假令日中发潮热，是心虚热，肝为心之母，治法宜先补肝母，肝实而后泻心，心得母气则内部平和而潮热自愈。医生见到潮热，妄以为是实证，就用大黄、牙硝等寒凉药利之，利下过多而不能禁止，则津液内亡，逐渐形成疳病。又如癖病，发作时寒热饮水，胁下有形硬痛，治法应当用药逐渐消磨它，医生反而用巴豆、牵牛子等峻猛药攻下，小儿体质易虚易实，攻下太过，胃中津液耗损，逐渐形成疳瘦。又有患伤寒五六日间，有可下的证候，用冷药攻下太过，致使脾胃虚而津液少，便引水不止而生热，热气内耗，肌肉外消，其他邪气相干，证候变化多端，也形成疳病。又有吐泻久病，或医生妄用攻下，其虚更甚，津液亡失烦躁，也能成疳病。小儿患癖病，由乳食不消化，伏在腹中，乍凉乍热，饮水不止，或喘而咳嗽，与潮热相似，若不早治，必成劳疳，因为有癖症，则令孩子不吃饭，致使脾胃虚而发热，所以引水饮用，饮多，即荡涤脾胃，亡失津液，不能传化水谷，其脉沉细，更加不能饮食，致使脾胃虚衰，四肢不能举动，各种邪气遂生，羸瘦而成疳病。（杨氏）儿童二十岁以下，其病称为疳，二十岁以上，其病称为痨，疳与痨，都是气血虚惫，肠胃受伤导致的，同源而异名。为什么呢？小儿脏腑娇嫩，饱食容易受伤，乳哺饮食，一旦失常，不患疳病的很少了。疳病都是乳食不调，甘肥无节制而发生的，或者婴幼儿缺乳，过早喂粥饭，耗伤形气，则疳的根源产生。或者两三岁后，乳食稍多，过饱无度，则疳因伤食得之。或者恣食甘肥粘腻，生冷咸醋，以阻滞中脘，则疳因积滞而成。或者乳母寒暑调理失当，饮食乖常，喜怒房劳，立即给孩子喂奶，则疳因母体患病传气而入，这不是病家不能调适的过错吗？疳病都是脾胃受病，体内无津液而发生的，有因吐泻之后，妄施吐下，津液虚竭得之的。有因潮热、大下利无禁约，胃中焦燥得之的。有因伤寒里证，冷快药太过，渴引水浆，变而生热，热气未散，复于他邪得之的。又有患癖病寒热，胁下痛硬，有人不能逐渐给予消磨，遽用牵牛、巴豆峻猛攻决，津液暴伤得之的，这不是医家轻率用药毁坏疾病的过错吗？疳病的征候，头皮光急，毛发焦稀，腮缩鼻干，口馋唇白，两眼昏烂，揉鼻皱眉，脊耸体黄，斗牙咬甲，焦渴自汗，尿白泻酸，肚胀肠鸣，癖结潮热，酷嗜瓜果咸酸，炭米泥土而欲饮水者，都是它的征候。
〔肝疳〕也叫风疳，也叫筋疳。【钱乙】肝疳白膜遮睛，筋疳泻血而瘦。【汤氏】肝疳眼白青，眼睛涩痒。《圣惠》摇头揉目，流汗遍身，合面而卧，面色青黄，发竦头焦，筋青脑热，浑身疮癣，腹中积聚，下痢频多，久而不痊，转甚羸瘦。【曾世荣】目生眵粪，发际、左脸多青或白，睛微黄，泻利夹水，或如苔色。
〔心疳〕也叫惊疳。钱氏，面黄颊赤，身壮热。汤氏，口内生疮。《圣惠》浑身壮热，吐利无常，颊赤面黄，胸膈烦满，鼻干心躁，口舌生疮，痢久不痊，多下脓血，有时盗汗，或乃虚惊。杨氏，小便赤涩，五心皆热。曾氏，切牙舒舌，爱饮冷水，喜伏眠于地。
脾疳也叫食疳。钱氏∶面黄，腹大，食泥土。汤氏∶脾疳，食不消。胃疳，多吐。《圣惠》腹多筋脉，喘促气粗，乳食不多，心腹胀满，多啼咳逆，面色萎黄，骨立毛焦，形枯力劣，胸膈壅闷，水谷不消，口鼻常干，情意不悦，爱暗憎明，肠胃不和，利多酸臭。曾氏，爱食冷物，引饮无度，身面俱黄，发稀作穗，头大项小，腹胀脚弱，间或酿泻，肌瘦目慢，昼凉夜热，不思乳食。钱氏又说∶肥疳，就是脾疳，身瘦虚黄，干而有疮，其征候不一，种种异端，现在略举之，目涩或生白膜，唇赤身干黄或黑，喜卧冷地、或食泥土，身有疮疥，泻青白黄沫，水痢色变、易腹满，身耳鼻皆有疮，发鬓作穗，头大项细，极瘦饮水，都是它的证候。
按∶这里说的脾疳证候，多与其他疳病相混杂，大概疳为脾经本病，理应兼有这些症状。
肺疳也叫气疳。钱氏，气喘，口鼻生疮。《圣惠》咳嗽气逆，皮毛干焦，饶涕多啼，咽喉不利，揉鼻咬甲，壮热憎寒，唇边赤痒，腹内气胀，乳食渐稀，大肠不调，频频泄利，粪中米出，皮上粟生。曾氏，鼻下赤烂，手足枯细，口有腥气，右腮白。
肾疳也叫急疳，也叫骨疳。钱氏，肾疳极瘦，身有疮疥。骨疳，喜卧冷地。汤氏，齿爪黑。《圣惠》肌骨消瘦，齿龈生疮，寒热作时，口鼻干燥，脑热如火，脚冷如冰，吐逆既增，乳食减少，泻利频并，下部开张，肛门不收，疳疮痒痛。曾氏，两耳内外生疮，脚如鹤膝，头缝不合，或未能行，牙齿生迟，其缝臭烂，传作走马疳之类。
〔杨氏〕五脏疳伤，大体如此，分析而论，有五疳出虫，曰蛔疳，曰脊疳，曰脑疳，曰干疳，曰疳渴，曰疳泻，曰疳痢，曰疳肿胀，曰疳劳，曰无辜疳，曰丁奚，曰哺露。证状不一，可不举宏撮要而条析之乎。五疳出虫者，疳伤之源，虽起于乳食不调，然脏腑停积已久，莫不化而为虫，其虫或如丝发，或如马尾，多出于头项腹背之间，黄白或赤者，可医，青黑则难疗也。蛔疳者，失乳饭早，食肉太早，或肠胃停蓄甜腻，化为蛔虫，皱眉多啼，呕吐清沫，腹中乍痛，肚胀青筋，唇口紫黑，肠头齿痒是也（蛔虽食虫，虫不可动，从口鼻出者难治）。脊疳者，虫蚀脊膂，身热羸黄，积中生热，烦温下痢，拍背如鼓鸣，脊骨如锯齿，或十指皆疮，频啮爪甲是也。脑疳者，胎中素挟风热，生下乳哺越常，头皮光急，满头饼疮，脑热如火，发结如穗，遍身多汗，腮肿囟高是也（临产多欲亦然易损儿眼）。干疳者，瘦悴少血、舌干多啼，其病在心，目不转睛、干啼少泪，其病在肝，身热尿干、手足清冷，其病在肾，声焦皮燥、大便干结，其病在肺，搭口痴眠、胸脘干渴，其病在脾，总为五干疳是也。疳渴者，脏中夙有疳气，加之乳母恣食五辛、酒面、炙爆，使小儿心肺壅热，日则烦渴引水，乳食不进，夜则渴止是尔。疳泻者，毛干唇白，额上青纹，肚胀肠鸣，泄下糟粕是尔（勿用热药止之）。疳痢者，挟受风寒暑湿，或冷热不调，或停积宿滞，水谷不聚，频下恶物是尔。疳肿胀者，虚中有积，其毒与气交并，故令腹肚紧胀，由是脾复受湿，故令头面、脚手、虚浮是尔（法当磨积调气）。疳劳者，潮热往来，五心烦热，手足心及胸前，热而发疮，盗汗骨蒸，嗽喘枯悴是尔，或渴而复泻，饮水恶食，肚硬如石，面色如银，断不可活。无辜疳者，脑后项边，有核如弹，按之转动，软而不疼，其间有虫如米粉，不速破之，则虫随热气流散，淫蚀脏腑以致肢体痈疮，便利脓血，壮热羸瘦，头露骨高是尔（针刺破膏药贴），或浣濯儿衣，露于檐下，为雌鸟落羽所污，儿着此衣，虫入皮毛，亦致无辜之疾，儿衣已晒，须微火烘之。其若手足极细，项小骨高，尻削体痿，腹大脐突，号哭胸陷，或生谷 ，是为丁奚。虚热来往，头骨分开，翻食吐虫，烦渴呕哕，是为哺露。丁奚哺露，皆因脾胃久虚，不能化水谷以荣血气，故肌肉消铄，肾气不足，复为风冷所伤，使柴骨枯露，亦有胎中受毒，脏腑少血致之，此皆无辜种类之疾，病而至此，不几殆哉。又有小儿久患肾疳，内虚不食，甚者天柱骨倒，治法当用钱氏地黄丸加驱疳等剂，仍与贴项强筋，若不识证，谓之五软，非也。天柱骨倒，凡有三种，有吐泻日久，羸弱成者；有肝胆伏热，面赤唇红，忽变此者；有伤寒不及发表成者；是皆风邪入肝，以致筋络舒弛，吐泻者当调胃气，肝热者随轻重以凉肝，并与强筋贴项。惟伤寒天柱骨倒者难疗，故并及之。
《庄氏家传》小儿二十四候 第一候，泻脓血，日渐瘦，是冷热疳。第二候，脚细肚高，胸前骨生，爱吃泥土酸咸，日久通身黄，时时吐逆下痢，腹内疼痛，是脾疳。第三候，鼻下赤烂，爱揉眼，兼血痢，是肺疳，乃因吃着承热物，或病奶所损心肺，加之咳嗽，更以服凉冷药过多，便上热下冷，渐渐昏沉，日夜烦哭。第四候，皮虚皱，面无颜色，身上燥痒，心烦。第五候，毛发稀疏，鼻生疮，是肺疳。第六候，头生疮，毛发稀焦，是肝疳。第七候，牙变黄赤不定，是肾疳。第八候，头发焦干，鼻下疮生，是肺疳。第九候，咬指甲，毛发作穗，四肢沉重，是心疳。第十候，肚上筋生，齿虫蚀，是骨槽疳。第十一候，吐逆腹胀是胃疳，又名奶疳。第十二候，齿断臭烂，面无颜色，心不思食，是脾疳，又名口疳。第十三候，爱合面卧，多睡如醉，腹胀气急，盖是因曾吃生肉如此，腹内有虫，是心脾疳。第十四候，鼻内干痛，口中臭气，齿根有鲜血，是肝肺疳。第十五候，脚细肚高，并肚上有青脉，是脾疳。第十六候，非时生疮，爱吃冷水，是热疳。第十七候，皮肤上生粟子，粪中米出，是脾冷疳。第十八候，气满腹胀及口干，是心胃疳。第十九候，爱餐生米面炭砖瓦，是脾胃疳。第二十候，揉鼻揩眼，及咬指甲，爱饮水，是肝渴疳。第二十一候，多寒热，爱卧不起，是骨热疳。第二十二候，爱饮水，眼目不开，是肝疳。第二十三候，肌体或热或凉，发渴无时，是急疳。第二十四候，齿龈黑，唇懒开，开则赤，是心疳积热。
《圣惠》凡小儿疳在内，眼涩腹胀，痢色无常，或如泔淀，日渐羸瘦，此候可疗。若鼻下赤烂自揉，鼻头上有疮生痂痛痒，渐渐流引，绕于两耳，时时目赤，头发稀疏，脑皮光紧，头大项细，肌体羸瘦，亦可治也。若唇口被蚀，齿龈作五色，或尽峭黑，舌下有白疮，上腭有窍子，口中时有臭气，齿龈渐染欲烂，亦可治也。若下部开张，有时赤烂，痒不可忍，下痢无常，亦可治也。若疳蚀脊膂，十指皆痒，自咬指甲，头发作穗，脊骨如锯，有时腹胀，有时下痢，若急治之，无不瘥也。
《圣惠》凡小儿肝藏疳，若目睛带青脉，左胁下硬，多吐涎沫，眼角左右有黑气所冲，不可治也。心藏疳，若爱惊啼，常好饮水，便食辛味，耳边有脉，舌上有黑靥者，不可治也。脾藏疳，若肚大唇无血色，人中平满，下痢无度，水谷不消，好吃泥土，皮枯骨露，不可治也。肺藏疳，若咳逆气促，多泻白沫，身上有斑生如粟米大，色若黑者，不可治也。肾藏疳，若爱食酸咸，饮水无度，小便如乳，牙齿青黑，耳脑干燥，肩竦骨枯，不可治也。又五疳有五绝候，一，衬着脚中指底，不觉疼。二，抱着，手足垂 无力。三，病未退，遍身不暖。四，脏腑泻青涎，及沫不止。五，项筋舒展无力。如此之候，皆不可治也，凡医用药，切在审详也。
〔罗天益〕疳者，小儿病癖或久吐泻，医者妄投转过之药，小儿易为虚实，致令胃虚而亡津液，内发虚热，外消肌肉，一脏虚则诸脏皆弱，其病目胞肿，腹胀，痢色无常，渐加瘦瘠，久不痊可，是肠胃有风积，法当宣风散（痘发热）导之，后各根据本脏，补其母。
〔钱乙〕诸疳，皆根据本脏补其母，及与治疳药，冷则木香丸，热则胡黄连丸主之。疳在内，目肿，腹胀，利色无常，或沫青白，渐瘦弱，此冷证也，使君子丸主之。疳在外，鼻下臭烂自揉、鼻头上有疮不着痂，渐绕耳生疮，治鼻疮烂兰香散，诸疮白粉散主之。肝疳，当补肝，地黄丸主之。心疳，当补心，安神丸主之。脾疳，当补脾，益黄散主之。肾疳，当补肾，地黄丸主之。筋疳，当补肝，地黄丸主之。肺疳，当补脾肺，益黄散主之。骨疳，当补肾，地黄丸主之。大抵疳病当辨冷热肥瘦，其初病者，为肥热疳，久病者，为瘦冷疳，冷者木香丸，热者胡黄连丸，冷热之疳，尤宜如圣丸（疳泻）。故小儿之脏腑柔弱，不可痛击大下，必亡津液而成疳，凡
[Danxi] Bai Wenju's son, aged five, had swelling all over his body and face, with frequent urination.
Zhi Zi (Gardeniae Fructus, stir-fried) [1 qian], Sang Bai Pi (Mori Cortex, stir-fried) [1 qian], Huang Qin (Scutellariae Radix) [2.5 qian], Bai Zhu (Atractylodis Macrocephalae Rhizoma), Su Geng (Perillae Caulis) [1.5 qian each].
The above herbs are cut into pieces. Prepare three doses. Decoct with one and a half cups of water until half a cup remains. Take warm before meals.
[Tang Shi] Tui Zhong San Qi Fang (Edema-Reducing and Qi-Dispersing Formula)
Chi Xiao Dou (Adzuki Bean), Chen Pi (Citri Reticulatae Pericarpium), Luo Bo Zi (Raphani Semen), Gan Cao (Licorice Root, honey-fried) [0.5 liang each], Mu Xiang (Aucklandiae Radix, roasted) [7 fen].
The above are ground into a coarse powder. Decoct with fresh ginger and jujube. Adjust dosage according to age and condition.
Another prescription:
Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Mu Xiang (Aucklandiae Radix, roasted), Gan Cao (Licorice Root, honey-fried), Hui Xiang (Foeniculi Fructus, stir-fried), Qing Pi (Citri Reticulatae Pericarpium Viride) [0.5 liang each]. Add Ba Dou (Crotonis Semen, 30 grains, membrane removed), stir-fry together with Qing Pi, then remove Ba Dou and do not use it.
Grind into fine powder. Take with rice water.
Another prescription:
Use Qian Yi Huang San (Benefit Yellow Powder) from Qian Yi, add Mu Xiang (Aucklandiae Radix), remove Ding Xiang (Caryophylli Flos), add Luo Bo Zi (Raphani Semen), remove He Zi (Terminaliae Chebulae Fructus). Grind into fine powder. Adjust dosage according to age. Take with rice water.
The *Neijing* states: Frequent consumption of fatty foods causes internal heat. Frequent consumption of sweet foods causes fullness in the middle jiao. Generally, the etiology of this disease is caused by fatty and sweet foods, hence it is named "Gan" (Malnutrition Syndrome). As for infants in swaddling clothes, and toddlers of four or five years old, their breastfeeding has not ceased, their Stomach Qi is not yet complete, and their Grain Qi is not yet abundant. Parents cannot regulate and nurture them properly, only indulging them out of affection, allowing them to eat indiscriminately fatty and sweet foods, as well as raw fruits, cold foods, and all kinds of cooked and seasoned flavors, morning and night. This gradually forms stubborn accumulation, leading to fever, emaciation, sallow complexion, or a large abdomen with visible veins, abdominal pain due to parasites, diarrhea, and thus various manifestations of Gan syndrome appear. [Qian Yi] All Gan syndromes are diseases of the Spleen and Stomach, caused by the loss of body fluids internally. It occurs after severe illness or vomiting and diarrhea, when physicians mistakenly use emetics or purgatives, causing Spleen and Stomach deficiency and fluid depletion. Moreover, pediatric Gan syndromes are often iatrogenic errors by ignorant doctors. For instance, tidal fever indicates one organ is deficient and another is excess, generating internal deficient heat. The treatment should tonify the mother organ and drain the affected organ to achieve cure. If tidal fever occurs at noon, it is Heart deficient heat. Since Liver is the mother of Heart, the method should first tonify the Liver mother; after the Liver becomes sufficient, then drain the Heart. Once the Heart receives the Qi of its mother, it will be balanced internally, and tidal fever will heal spontaneously. Physicians seeing tidal fever wrongly assume it is an excess pattern and use cold medicines like Da Huang (Rhei Radix et Rhizoma) and Ya Xiao (Natrii Sulfas) to purge. Excessive purging leads to internal fluid loss, gradually forming Gan syndrome. Similarly, for Pi syndrome (abdominal mass), which presents with alternating chills and fever, thirst, and hard painful masses under the hypochondrium, the treatment should gradually dissipate it with medicine. Physicians instead use harsh purgatives like Ba Dou (Crotonis Semen) and Niu Bang Zi (Arctii Fructus) to purge. Children's constitutions are prone to both deficiency and excess; excessive purging consumes Stomach fluids, gradually forming Gan emaciation. Furthermore, if a child suffers from Shang Han (Cold Damage) for five to six days and has indications for purgation, using cold purgatives excessively damages the Spleen and Stomach, reducing fluids. This leads to incessant drinking and generation of heat. Internal heat consumption and external muscle wasting, combined with other pathogens, cause various symptom changes, also resulting in Gan syndrome. Long-term vomiting and diarrhea, or mistaken purgation by doctors, exacerbates deficiency, fluid loss, and irritability, also leading to Gan syndrome. Pediatric Pi syndrome arises from undigested milk and food stagnating in the abdomen, causing alternating cold and heat, incessant thirst, or wheezing and coughing, resembling tidal fever. If not treated early, it inevitably becomes Lao Gan (Consumptive Gan). Because the Pi syndrome prevents eating, Spleen and Stomach become deficient and generate heat, causing thirst. Excessive drinking washes away Stomach fluids, impairing the transformation and transportation of water and grain. The pulse becomes deep and fine, appetite decreases further, Spleen and Stomach decline, limbs become immobile, various pathogens arise, leading to emaciation and Gan syndrome. [Yang Shi] In children under twenty, the disease is called Gan; over twenty, it is called Lao (Consumption). Gan and Lao both result from Qi and Blood exhaustion and intestinal damage; they share the same origin but have different names. Why? Children's Zang-Fu organs are delicate; overeating easily causes injury. Any irregularity in milk or diet rarely fails to produce Gan. Gan arises from improper feeding, unregulated sweet and fatty foods. Infants lacking breast milk fed porridge too early consume their form and Qi, creating the root of Gan. After two or three years, excessive milk or food intake without limit causes Gan through injury. Indulgence in sweet, fatty, sticky, cold, salty, or sour foods obstructs the Middle Jiao, causing Gan through accumulation. If the nursing mother fails to regulate temperature or diet, or experiences emotional turmoil or sexual activity immediately before nursing, Gan can transmit via maternal Qi. Is this not the fault of the family failing to adjust properly? Gan is fundamentally a Spleen-Stomach disease involving internal fluid loss. Causes include: post-vomiting/diarrhea misuse of emetics/purgatives depleting fluids; tidal fever and uncontrollable diarrhea causing Stomach dryness; Shang Han interior patterns where excessive cold purgatives lead to thirst and heat generation; Pi syndrome with hypochondriac pain where harsh purgatives like Niu Bang Zi and Ba Dou violently injure fluids. These are faults of physicians using light-minded treatments to ruin diseases. Manifestations of Gan include: shiny/tight scalp, sparse/brittle hair, retracted cheeks/dry nose, craving mouth/white lips, dim/cloudy eyes, rubbing nose/frowning, hunched spine/yellow body, grinding teeth/biting nails, intense thirst/sweating, white urine/sour stool, abdominal distension/bowel sounds, Pi nodules/tidal fever, craving for fruits/sour/salty foods, charcoal/rice/clay, and desire to drink—all are signs.
[Liver Gan] Also known as Feng Gan (Wind Gan) or Jin Gan (Tendon Gan). [Qian Yi] Liver Gan features white membrane covering the pupil; Jin Gan involves bloody diarrhea and emaciation. [Tang Shi] Liver Gan shows blue-white sclera, dry/itchy eyes. *Shenghui*: Head shaking, eye rubbing, profuse sweating, sleeping face down, green-yellow complexion, erect/scorched hair, blue tendons/hot brain, body-wide sores/lichen, abdominal accumulation, frequent dysentery, chronic non-healing leading to severe emaciation. [Zeng Shi] Eye discharge, blue or white patches on hairline/left cheek, slightly yellow eyes, watery diarrhea or moss-colored stool.
[Heart Gan] Also known as Jing Gan (Fright Gan). Qian Shi: Sallow face/red cheeks, high fever. Tang Shi: Mouth sores. *Shenghui*: High fever throughout body, irregular vomiting/diarrhea, red cheeks/sallow face, chest oppression/restlessness, dry nose/irritable heart, mouth/tongue sores, chronic dysentery with pus/blood, occasional night sweats, or false fright. Yang Shi: Red/astringent urine, hot palms/soles/chest. Zeng Shi: Teeth grinding/tongue protrusion, preference for cold water, lying prone on floor.
Spleen Gan also known as Shi Gan (Food Gan). Qian Shi: Sallow face, large abdomen, pica (eating dirt). Tang Shi: Spleen Gan—indigestion. Stomach Gan—frequent vomiting. *Shenghui*: Visible abdominal veins, rapid breathing/coarse qi, poor milk/food intake, chest/abdominal fullness, frequent crying/coughing/reversal, sallow complexion, bony prominence/brittle hair, withered form/weak strength, chest oppression, indigestion, dry mouth/nose, depressed mood, preferring darkness/light aversion, Spleen-Stomach disharmony, frequent sour-smelling stools. Zeng Shi: Craving cold foods, unquenchable thirst, yellow face/body, sparse tufted hair, large head/small neck, abdominal distension/weak legs, intermittent loose stools, thin muscles/lagging eyes, cool days/hot nights, no desire for milk/food. Qian Shi adds: Fei Gan (Fat Gan) is Spleen Gan, characterized by emaciation, sallow dry skin with sores. Symptoms vary: dry eyes/white membrane, red lips/dry yellow/black body, lying on cool ground/eating dirt, body sores/itching, green/white/yellow frothy stool, color-changing watery diarrhea/easy abdominal distension, sores on body/ears/nose, tufted hair, large head/thin neck, extreme emaciation/thirst—all are signs.
Note: The described Spleen Gan symptoms overlap with other Gans because Gan is essentially a Spleen meridian disease and naturally includes these signs.
Lung Gan also known as Qi Gan. Qian Shi: Asthma, mouth/nose sores. *Shenghui*: Cough/reverse qi, dry/scorched skin/hair, excessive runny nose/frequent crying, throat obstruction, nose rubbing/nail biting, high fever/chills, red/itchy lip edges, abdominal bloating, decreasing milk/food intake, Large Intestine dysfunction, frequent diarrhea with undigested rice, millet-like bumps on skin. Zeng Shi: Red/rotten area below nose, thin/dry hands/feet, fishy breath, white patches on right cheek.
Kidney Gan also known as Ji Gan (Urgent Gan) or Gu Gan (Bone Gan). Qian Shi: Kidney Gan—extreme emaciation, body sores. Bone Gan—prefers lying on cool ground. Tang Shi: Black teeth/claws. *Shenghui*: Emaciated muscles/bones, gum sores, intermittent chills/fever, dry mouth/nose, brain heat like fire, cold feet like ice, increased vomiting/reduced milk/food, frequent diarrhea, open lower orifice/incompetent anus, Gan sores with itching/pain. Zeng Shi: Sores inside/outside ears, knee-like feet, unclosed cranial sutures, inability to walk, delayed teething, foul/rotten sutures, transmitting to Ma Chu Gan (Running Horse Gan) type.
[Yang Shi] Damage to the Five Zang organs by Gan is generally as described. Analyzing specifically: There are Five Gans producing worms, including Hui Gan (Roundworm Gan), Ji Gan (Spine Gan), Nao Gan (Brain Gan), Gan Gan (Dry Gan), Gan Ke (Gan Thirst), Gan Xie (Gan Diarrhea), Gan Li (Gan Dysentery), Gan Zhong Zhang (Gan Swelling), Gan Lao (Gan Consumption), Wu Gu Gan (Innocent Gan), Ding Xi, and Bu Lu. Symptoms are numerous; must we not summarize the essentials and analyze them? "Five Gans producing worms": The source of Gan injury, though starting from improper feeding, involves long-term stagnation in Zang-Fu transforming into worms. Worms may be thread-like or horse-tail-like, mostly appearing between head, neck, abdomen, and back. Yellow/white or red worms are treatable; blue/black are difficult. Hui Gan: Loss of breast milk, early solid food, early meat consumption, or sweet/greasy food stagnation in intestines/stomach transforming into roundworms. Symptoms: frowning/frequent crying, vomiting clear foam, sudden abdominal pain, abdominal distension with blue veins, purple-black lips/mouth, anal/teeth itching (Note: Although roundworms eat feces, if worms move abnormally or exit via nose/mouth, prognosis is poor). Ji Gan: Worms eroding the spine. Symptoms: fever/emaciation/yellowing, heat from accumulation, irritability/warmth/diarrhea, drum-like sound on back percussion, saw-tooth-like spine bones, sores on ten fingers, frequent nail biting. Nao Gan: Congenital wind-heat, excessive breastfeeding post-birth. Symptoms: shiny/tight scalp, widespread crusty sores, brain heat like fire, knotted tufted hair, generalized sweating, swollen cheeks/high fontanelle (Note: Excessive sexual activity during labor also harms the infant's eyes). Gan Gan (Dry Gan): Emaciated/blood-deficient/dry tongue/frequent crying—disease in Heart. Unblinking eyes/dry crying/few tears—disease in Liver. Fever/dry urine/cold hands/feet—disease in Kidney. Hoarse voice/dry skin/constipation—disease in Lung. Mouth-corner paralysis/sleepiness/chest-epigastric dryness/thirst—disease in Spleen. Collectively called Five Dry Gans. Gan Ke: Pre-existing Gan Qi in organs, compounded by nursing mother consuming pungent spices/alcohol/flour/fried foods, causing Heart-Lung heat congestion. Daytime: irritability/thirst/drinking water, refusal of milk/food. Nighttime: thirst stops. Gan Xie: Dry hair/white lips/blue lines on forehead/abdominal distension/bowel sounds/passing undigested matter (Do not use hot medicines to stop). Gan Li: Contraction of Wind-Cold-Damp-Heat, or cold-heat imbalance, or stagnant food/water-grain not aggregating, frequent passage of foul matter. Gan Zhong Zhang: Deficiency with accumulation, toxin and Qi intertwining, causing tight abdominal distension. Spleen absorbs dampness, causing puffiness of head/face/hands/feet (Method: Dissipate accumulation, regulate Qi). Gan Lao: Alternating tidal fever, five-palm heat, sores on palms/chest, night sweats/bone-steaming, cough/wheezing/emaciation. Or thirst followed by diarrhea, aversion to food/water, rock-hard abdomen, silver-like complexion—definitely fatal. Wu Gu Gan: Lumps behind ears/neck side, bean-sized, movable, soft/painless, containing worm-like particles like rice flour. If not punctured quickly, worms scatter with heat flow, corroding Zang-Fu, causing limb abscesses, purulent/bloody stools, high fever/emaciation, exposed skull bones (Method: Puncture with needle, apply plaster). Also, washing children's clothes and exposing them under eaves, contaminated by female bird feathers, allows worms to enter skin/hair upon wearing, causing Innocent Gan. Dried clothes must be warmed slightly over fire. Ding Xi: Extremely thin hands/feet, small neck/high bones, wasted buttocks/atrophy, large abdomen/protruding umbilicus, crying with sunken chest, or grain-like spots. Bu Lu: Alternating deficient heat, separated skull bones, regurgitation/vomiting worms, irritability/thirst/vomiting. Ding Xi and Bu Lu both result from long-term Spleen-Stomach deficiency, inability to transform water/grain to nourish Qi/Blood, muscle wasting, Kidney Qi insufficiency, and Wind-Cold injury causing skeletal exposure. Some result from congenital toxicity or blood deficiency. These are types of Innocent Gan; reaching this stage is perilous. Additionally, children with long-term Kidney Gan, internal deficiency, anorexia, severe cases showing "Heavenly Pillar Bone Collapse" (drooping head). Treatment: Use Qian's Di Huang Wan (Rehmannia Pill) plus anti-Gan agents, apply neck-strengthening paste. Misidentifying this as "Five Softnesses" is incorrect. Heavenly Pillar Collapse has three types: 1. Long-term vomiting/diarrhea leading to weakness; 2. Latent Heat in Liver/Gallbladder, red face/lips, sudden onset; 3. Shang Han failing to release exterior. All involve Wind pathogen entering Liver, causing tendon relaxation. Vomiting/diarrhea type: Regulate Stomach Qi. Liver Heat type: Cool Liver based on severity. Apply neck-strengthening paste. Only Shang Han-induced collapse is difficult to treat, hence mentioned.
*Zhuang Family Collection* Twenty-Four Signs in Children:
1. Purulent/bloody diarrhea, daily emaciation: Cold-Heat Gan.
2. Thin legs/high belly, sternum protrusion, craving dirt/sour/salty, general yellowing over time, vomiting/dysentery, abdominal pain: Spleen Gan.
3. Red/rotten area below nose, eye rubbing, bloody dysentery: Lung Gan. Caused by hot foods, damaged lungs/heart by sick milk, cough, excessive cold meds leading to upper heat/lower cold, drowsiness, day/night crying.
4. Loose/wrinkled skin, pale face, dry itch, irritability.
5. Sparse hair, nasal sores: Lung Gan.
6. Head sores, sparse/scorched hair: Liver Gan.
7. Yellow/red unstable teeth: Kidney Gan.
8. Scorched/dry hair, nasal sores: Lung Gan.
9. Nail biting, tufted hair, heavy limbs: Heart Gan.
10. Abdominal veins, tooth erosion: Bone Socket Gan.
11. Vomiting/abdominal distension: Stomach Gan (also Milk Gan).
12. Broken/foul teeth, pale face, anorexia: Spleen Gan (also Mouth Gan).
13. Face-down sleeping, drunken sleep, distension/rapid breathing: Caused by raw meat, intestinal worms, Heart-Spleen Gan.
14. Dry/painful nose, bad breath, bleeding gums: Liver-Lung Gan.
15. Thin legs/high belly, blue abdominal veins: Spleen Gan.
16. Atypical sores, craving cold water: Heat Gan.
17. Millet-like bumps on skin, rice in stool: Cold Spleen Gan.
18. Qi fullness/abdominal distension/dry mouth: Heart-Stomach Gan.
19. Craving raw rice/flour/charcoal/bricks: Spleen-Stomach Gan.
20. Nose rubbing/eye wiping/nail biting, thirst: Liver-Thirst Gan.
21. Frequent chills/fever, reluctance to rise: Bone Heat Gan.
22. Thirst, eyes unable to open: Liver Gan.
23. Body hot/cool, intermittent thirst: Urgent Gan.
24. Black gums, lazy lips (red when open): Heart Gan Accumulated Heat.
*Shenghui*: Gan internal signs: dry eyes/abdominal distension, variable dysentery color or like rice wash, daily emaciation—treatable. If red/rotten area below nose self-rubbed, sores/crusts/pain/itch on nose tip spreading to ears, frequent red eyes, sparse hair, shiny/tight scalp, large head/small neck, emaciation—treatable. If lips/mouth eroded, gums multi-colored or black, white sores under tongue, holes in palate, bad breath, gums rotting—treatable. If lower orifice open, red/rotten/unbearable itch, irregular dysentery—treatable. If Gan erodes spine, ten fingers itch, self-nail biting, tufted hair, saw-like spine, intermittent distension/diarrhea—urgent treatment ensures recovery.
*Shenghui*: Liver Gan: Blue veins in eyes, hard left hypochondrium, salivation, black aura around eyes—untreatable. Heart Gan: Frightened crying, constant thirst, craving spicy food, pulse behind ear, black spots on tongue—untreatable. Spleen Gan: Large belly/colorless lips, flat philtrum, uncontrolled dysentery, indigestion, pica, dry skin/exposed bones—untreatable. Lung Gan: Reverse cough/shortness of breath, white frothy diarrhea, millet-sized black spots on body—untreatable. Kidney Gan: Craving sour/salty, unquenchable thirst, milky urine, black teeth, dry ears/brain, shrugging shoulders/bony枯—untreatable. Five Absolute Signs of Five Gans: 1. No pain when pressing middle toe sole. 2. Limbs limp when held. 3. Body not warm while sick persists. 4. Continuous green saliva/froth diarrhea. 5. Neck tendons weak/extended. All untreatable. Physicians must be cautious.
[Luo Tianyi] Gan results from Pi syndrome or long-term vomiting/diarrhea, where physicians wrongly administer turning/purging medicines. Children are prone to deficiency/excess shifts, causing Stomach deficiency and fluid loss, internal deficient heat, external muscle wasting. One Zang deficiency weakens all others. Symptoms: eyelid swelling, abdominal distension, variable dysentery color, progressive emaciation, chronic non-healing. This is Wind accumulation in intestines/stomach. Method: Use Xuan Feng San (Disperse Wind Powder) to guide, then tonify the mother organ of each affected Zang.
[Qian Yi] All Gans: Tonify mother organ of affected Zang, plus anti-Gan medicines. Cold type: Mu Xiang Wan (Aucklandia Pill). Heat type: Hu Huang Lian Wan (Coptis Pill). Gan internal: Eye swelling, abdominal distension, variable stool color/froth, progressive weakness—Cold pattern. Use Shi Jun Zi Wan (Quisqualis Pill). Gan external: Foul/rotten area below nose self-rubbed, sores on nose tip not crusting, spreading to ears. Treat nasal sores with Lan Xiang San (Laurus Powder), other sores with Bai Fen San (White Powder). Liver Gan: Tonify Liver, Di Huang Wan. Heart Gan: Tonify Heart, An Shen Wan. Spleen Gan: Tonify Spleen, Yi Huang San. Kidney Gan: Tonify Kidney, Di Huang Wan. Tendon Gan: Tonify Liver, Di Huang Wan. Lung Gan: Tonify Spleen-Lung, Yi Huang San. Bone Gan: Tonify Kidney, Di Huang Wan. Generally, distinguish Gan by Cold/Heat and Fat/Thin. Early stage: Fat-Heat Gan. Late stage: Thin-Cold Gan. Cold: Mu Xiang Wan. Heat: Hu Huang Lian Wan. Mixed Cold-Heat: Ru Sheng Wan (for Gan Diarrhea). Thus, children's delicate Zang-Fu cannot withstand harsh purgation, which depletes fluids and causes Gan. Generally...