张涣曰。小儿痉病。所受肝风。怯弱。致筋脉挛缩。两手拳。伸展无力。是名拘挛。宜薏苡丹。
古称儿病。惊疳最大。惊得心肝。疳得脾胃。脏腑因由。各不相蔽。童稚之时。病则为疳。弱冠而后。病成痨瘵。
同出异名。惟年齿计。元气亏伤。气血虚惫。其原则一。非有他疠。曰惟小儿。脏腑娇脆。饱固易伤。饥亦为害。热则
熏蒸。冷则凝滞。故疳之来。必有伊芳始。或幼阙乳。耗伤形气。此疳之根。积渐生蒂。或两三岁。乳食无制。此疳由脾。
过饱反瘁。或喜生冷。甘肥粘腻。此疳由积。肠胃气闭。或母自养。一切无忌。喜怒淫劳。即与乳吮。此疳由母。传气
为戾。或因病余。妄行转泄。胃枯液亡。虚热渐炽。此疳由医。冒昧错治。大抵疳病。缘此等弊。然而古人。五脏分隶。
各有症形。各有方剂。肝心肾肺。脾总多累。二十四候。更宜体会。庄氏家传。最为详备。总之疳候。必先贪嗜。盐酸
炭米。好吃泥块。口渴且馋。形体憔悴。潮热肠鸣。面黄便秽。渐渐腹胀。牙干目眯。揉鼻 眉。脊高项细。甚至缩
腮。头皮光异。肚大筋青。发焦毛萃。龈烂腿枯。周身疥癞。种种恶候。讵必齐逮。约略形神。实惟危殆。
为语病家。毋徒嗟喟。失治于前。今亦无奈。
钱乙曰。大抵疳病。当辨寒热肥瘦。其初病者为肥热疳。久病者为瘦冷疳。冷热交作者为冷热疳。当分治之。诸疳
皆当补其母。假令日中发潮热。是心虚热也。肝为心母。法当先补肝母。肝实而后泻心。心得母气。则内平而潮热自愈
矣。
危亦林曰。疳者干也。瘦瘁少血也。皆由气血虚惫。脏腑受伤。故有五脏疳。外有蛔疳、脊疳、脑疳、干疳、疳渴、
疳泻、疳痢、疳肿、疳疮、疳劳、无辜疳、丁奚、哺露。治之各有方。其病多因乳哺失常。肥甘不节。肠胃积滞而得之。
惟肾疳害人最速。盖肾虚受邪。疳奔上焦。故以走马为喻。初作口臭。次传齿黑龈烂。热血迸出。甚则齿脱。宜急治之。
才得全活。然齿不复生矣。
张元素曰。疳者。小儿受癖。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。腹胀利色无常。渐加瘦瘠。久不痊可。是肠胃有风。宜宣风散导之。后则各根据
本脏补其母。
圣惠方曰。凡小儿疳在内。眼涩腹胀。利色无常。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。肌体瘦羸。亦可治也。若唇口被蚀。
齿龈五色。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。下利无常。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。惟五疳有绝候。皆不可治。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。
初虞世曰。有热疳。有冷疳。有冷热疳。此其要也。热疳者。病多在外。鼻下赤烂。头痒湿痒。五心烦热。掀衣气
粗。渴引冷水。烦躁卧地。肚热脚冷。潮热往来。皆热疳也。冷疳者病多在内。利色无常。其沫青白。肢体软弱。目肿
面黧。又一症躁渴卧地。似有热状。惟饮食不进。滑泄无已。亦冷疳也。其有泻多脓血。日加瘦弱。此则谓之冷热疳。
大抵疳之受病。皆虚使然。热者虚中之热。冷者虚中之冷。治热不可妄表过凉。治冷不可峻温骤补。故曰小儿易为虚实。
脾虚不受寒温。服寒则生冷。服温则生热。当识此勿误。
曾氏曰。大抵疳之为病。皆因过餐饮食。于脾家一脏。有积不治。传之余脏。而成五疳之疾。若脾家病去。则余脏
皆安。苟失其治。日久必有传变。脾家病。宜沉香槟榔丸、乌犀丸。更察虚实疗之。有虫者。使君子丸。心腹痛。吐清
水。虫自下者。二圣丸。诸疳症。皆宜用五疳保童丸、万应丸。常服化积治疳。仍各投本脏调理之剂。宁心、
茯神汤。调肝、 归汤。调脾、参苓白术散。补肺、补肺散。补肾、调元散。庶各得其宜。前症不致再作。
叶桂曰。幼儿断乳纳食。值夏月脾胃主气。易于肚膨泄泻。头及手足心热。形体日瘦。或烦渴善食。渐成五疳积聚。
当审体之强弱。病之新久。有余者当疏胃清热。食入粪色白。或不化。当健脾佐消导清热。若湿热内郁。虫积腹痛。导
滞驱虫。微下之。缓调。用肥儿丸之属。稚年五疳。犹大方五痨。虽方书有五脏之分。是症夏令为多。固从脾胃。盖小
儿乳食杂进。运化不及。初断乳后。果腥杂进。气伤滞聚。致热蒸于里。肌肉消瘦。腹大肢细。
名曰丁奚。或善食。或不嗜食。或渴饮无度。或便泻白色。久延不已。多致凶危。宜忌食生冷腥肥凝滞。治法初用清热
和中分利。次则疏补化运。一定之理。
张涣说：小儿的痉病，是由于感受了肝风，加之体质怯弱，导致筋脉挛缩。表现为双手握拳，伸展无力，这叫做拘挛。适宜使用薏苡丹治疗。
古人称儿童疾病中，惊疳最为严重。惊证影响心肝，疳证损伤脾胃。脏腑受病的缘由，各有不同，互不掩盖。童稚时期患病多成疳疾，成年后患病则多成痨瘵。虽然名称不同，但根源在于年龄差异导致的元气亏伤、气血虚衰，其根本原则是一致的，并非有其他特殊的疫病。只是小儿脏腑娇嫩脆弱，过饱容易受伤，饥饿也是危害。受热则熏蒸体内，受寒则凝滞气机。所以疳疾的产生，必有其起始原因。有的因幼年断奶过早，耗伤了形体和正气，这是疳疾的根本；积渐形成病灶。有的两三岁时，乳食没有节制，这种疳疾源于脾脏；吃得过饱反而导致身体憔悴。有的喜欢生冷食物，或嗜食甘甜肥腻、粘硬难化之物，这种疳疾源于积滞；导致肠胃气机闭塞。有的母亲在哺乳期间不加禁忌，喜怒过度、纵欲劳累时立即给孩子喂奶，这种疳疾源于母亲；母体之气传变为戾气。有的因病后余邪未清，医生妄行攻下泄泻之法，导致胃液枯竭、阴液亡失，虚热逐渐炽盛，这种疳疾源于医生鲁莽错误的治疗。大抵疳病，都是缘于这些弊端。然而古人将五脏疳分别归类，各有症状表现，各有对应方剂。肝、心、肾、肺四脏相对较少累及，而脾脏总多受到牵连。对于二十四种疳候，更应当仔细体会。庄氏家传医书对此记载最为详备。总之，疳候的症状，必定先有贪吃酸咸、炭米，喜欢吃泥土块，口渴且嘴馋，形体憔悴，午后潮热，肠鸣，面色发黄，大便秽臭，渐渐腹胀，牙齿干燥，眼睛眯缝，揉鼻子眉毛，脊背高耸，颈部细瘦，甚至腮部收缩，头皮光亮异常，肚子大且青筋暴露，头发焦枯，毛发稀疏，牙龈腐烂，腿部干枯，周身疥疮癞癣等种种恶候。难道这些症状一定会全部出现吗？大致观察其形神状态，实际上已经非常危殆。告诉病患家属，不要只是叹息，如果前期失治，现在也无可奈何了。
钱乙说：大抵疳病，应当辨别寒热以及肥瘦。初起患病者多为肥热疳，久病者多为瘦冷疳，寒热交错发作的为冷热疳。应当分别治疗。各种疳病都应当补益其“母”脏（根据五行相生理论，生我者为母）。例如白天发潮热，这是心虚热。肝为心之母，按照法则应当先补肝母。待肝气充实后再泻心火。心得母脏之气滋养，则内部平和，潮热自然痊愈。
危亦林说：疳，就是干枯的意思，指身体消瘦、血液不足。这都是由于气血虚衰、脏腑受伤所致。因此有五脏疳，此外还有蛔疳、脊疳、脑疳、干疳、疳渴、疳泻、疳痢、疳肿、疳疮、疳劳、无辜疳、丁奚、哺露等。治疗各有方药。这些病症多因乳哺喂养不当，肥甘厚味不节制，导致肠胃积滞而形成。其中肾疳害人最快。因为肾虚受邪，疳毒奔向上焦，所以用“走马”来比喻其迅速。起初口臭，接着牙齿变黑、牙龈腐烂，热血迸出，严重时牙齿脱落。应当紧急治疗，才能保全性命，然而牙齿再也长不出来了。
张元素说：疳病，是小儿受了癖积，或者长期吐泻，医生胡乱投用攻转过猛的药物，小儿体质容易虚实变化，导致胃虚而津液亡失，内部产生虚热，外部消耗肌肉。一脏虚弱则诸脏皆弱。其症状表现为眼睑肿胀，腹胀，腹泻颜色无常，渐渐消瘦。久久不能痊愈，这是因为肠胃有风邪，适宜用宣风散导泻。之后则各根据本脏补益其母脏。
《圣惠方》说：凡是小儿疳病在内，表现为眼涩腹胀，腹泻颜色无常，或者像米泔水沉淀物一样，日渐消瘦。这种候症是可以治疗的。如果鼻下赤烂，自己揉鼻子，头上有疮，结痂痛痒，渐渐流脓牵引，绕到两耳，时时眼睛发红，头发稀疏，头皮光亮紧绷，头大项细，肌体瘦弱，也是可以治疗的。如果嘴唇口腔被蚀烂，齿龈呈现五色，或者全呈峭黑色，舌下有白疮，上颚有窍洞，口中时常有臭气，齿龈渐渐染黑欲烂，也是可以治疗的。如果下部开张，有时赤烂，痒得不可忍受，下利无常，也是可以治疗的。如果疳毒侵蚀脊柱，十指都痒，自己咬指甲，头发结成穗状，脊骨如锯齿状，有时腹胀，有时下痢，如果紧急治疗，没有不痊愈的。只有五种疳病属于绝症，都无法治疗。一是脚中指底部衬着鞋子不觉疼痛；二是抱着手脚下垂无力；三是病未退却遍身不温暖；四是脏腑泻出青色涎沫不止；五是筋脉舒展无力。这样的候症，都是无法治疗的。
初虞世说：有热疳，有冷疳，有冷热疳，这是关键所在。热疳，病多在外，表现为鼻下赤烂，头痒湿痒，五心烦热，掀衣气粗，想喝冷水，烦躁卧地，肚热脚冷，潮热往来，这些都是热疳。冷疳，病多在内，表现为腹泻颜色无常，泡沫青白，肢体软弱，目肿面黑。还有一种症状躁渴卧地，看似有热的样子，只是饮食不进，滑泄无度，这也是冷疳。如果有泻下多脓血，日渐瘦弱，这就叫做冷热疳。大抵疳病的发生，都是因为虚所致。热者是虚中之热，冷者是虚中之冷。治疗热疳不可妄用发散或过于寒凉，治疗冷疳不可峻用温补。所以说小儿容易虚实变化，脾虚既不耐寒也不耐热，服用寒药则生冷，服用温药则生热。应当明白这一点以免误治。
曾世荣说：大抵疳病，都是因为过量饮食，在脾脏这一脏形成积滞而不治疗，传给其余脏腑，从而形成五疳之疾。如果脾脏的病去除了，那么其余脏腑都能安宁。如果失去治疗，日久必然发生传变。脾脏患病，适宜用沉香槟榔丸、乌犀丸，再察虚实进行治疗。有虫者，使用使君子丸。心腹痛，吐清水，虫子自行排出的，使用二圣丸。各种疳症，都适宜服用五疳保童丸、万应丸，常服以化积治疳。同时分别投喂调理本脏的药剂：宁心用茯神汤，调肝用当归汤，调脾用参苓白术散，补肺用补肺散，补肾用调元散。这样庶几能各得其宜，前症不再复发。
叶桂说：幼儿断乳进食时，正值夏季脾胃主令之气，容易出现肚胀泄泻，头和手足心发热，形体日渐消瘦。或者烦渴善食，渐渐形成五疳积聚。应当审察体质的强弱、病程的新久。有余邪者应当疏胃清热。如果食入后粪便色白，或不消化，应当健脾佐以消导清热。若湿热内郁，虫积腹痛，则导滞驱虫，轻微通下，缓缓调理，使用肥儿丸之类的方剂。稚龄儿童的疳病，犹如同大人的五痨。虽然方书中有五脏之分，但这种病症夏令较多，固本应从脾胃论治。因为小儿乳食杂进，运化不及，初断乳后，水果腥物杂进，气伤滞聚，导致热蒸于里，肌肉消瘦，腹大肢细，名叫丁奚。或者善食，或者不嗜食，或者渴饮无度，或者便泻白色，久延不已，多致凶危。应当忌食生冷腥肥凝滞之物。治法初期用清热和中分利，次则疏补化运，这是一定的道理。
Zhang Huan stated: Pediatric spasm disease results from contracting liver wind, compounded by physical weakness, leading to tendon and vessel contraction. It manifests as clenched fists with weak extension, termed "Ju Luan" (Contraction). Yi Yi Dan (Coix Seed Pill) is appropriate for treatment.
Ancient texts state that among pediatric diseases, Jing Gan (Startling Malnutrition) is the most severe. Startling affects the Heart and Liver, while Gan damages the Spleen and Stomach. The origins of organ pathology differ and do not obscure one another. In childhood, illness often becomes Gan; in adulthood, it becomes Lao Zhai (Consumption Disease). Though names differ due to age, the principle remains the same: depletion of Yuan Qi (Original Qi), deficiency and exhaustion of Qi and Blood. There is no other epidemic pathogen involved. Children's organs are delicate and fragile; overeating easily causes injury, and hunger is also harmful. Heat steams internally, cold stagnates qi. Thus, the onset of Gan must have an initial cause. Some suffer from early weaning, deforming body and depleting Qi, forming the root of Gan. Others aged two or three lack dietary restraint, causing Gan originating from the Spleen; overeating leads to emaciation. Some prefer raw/cold foods or sweet/greasy/sticky items, causing Gan from accumulation; this blocks intestinal and gastric qi. Some mothers nurse without restraint, nursing while angry, lustful, or fatigued, transmitting pathological qi to the child, causing Gan originating from the mother. Some cases arise from improper medical intervention after illness, where reckless purgatives dry the stomach and deplete fluids, intensifying deficient heat, causing Gan originating from the doctor. Generally, Gan arises from these faults. However, ancients categorized Gan by the Five Zang organs, each with specific symptoms and formulas. The Spleen is most frequently implicated compared to Liver, Heart, Kidney, and Lung. One should carefully study the twenty-four types of Gan. Zhuang's family transmission records are the most detailed. In summary, Gan symptoms include craving sour/salty foods, charcoal rice, eating mud, thirst, emaciation, tidal fever, borborygmus, yellow complexion, foul stool, abdominal distension, dry teeth, squinting eyes, rubbing nose/eyebrows, high spine, thin neck, sunken cheeks, shiny scalp, large abdomen with visible veins, brittle hair, sparse body hair, rotten gums, withered legs, and generalized scabies. Do all these symptoms necessarily appear? Observing the form and spirit reveals extreme danger. Inform families not to merely sigh; if treated too late, it is now helpless.
Qian Yi stated: Generally, Gan must be differentiated by cold/heat and fat/thin. Early-stage Gan is Fat-Heat Gan; long-term Gan is Thin-Cold Gan; mixed cold/heat is Cold-Heat Gan. Treat accordingly. All Gans require tonifying the "Mother" organ (based on Five Element generation cycle). For example, daytime tidal fever indicates Heart Deficient Heat. Since Liver is the Mother of Heart, one must first tonify the Liver. After Liver excess is resolved, drain the Heart. With maternal support, the Heart harmonizes, and tidal fever resolves spontaneously.
Wei Yilin stated: "Gan" means dryness, referring to emaciation and blood deficiency caused by Qi/Blood exhaustion and organ damage. Thus, there are Five Zang Gans, plus Roundworm Gan, Spine Gan, Brain Gan, Dry Gan, Gan Thirst, Gan Diarrhea, Gan Dysentery, Gan Swelling, Gan Sores, Gan Consumption, Innocent Gan, Ding Xi (Rib-like Protrusion), and Bu Lu (Breast-missing). Each has specific treatments. These illnesses mostly stem from improper feeding, excessive rich/sweet foods, and intestinal/gastric accumulation. Kidney Gan is the most rapid in killing, as Kidney deficiency allows Gan pathogens to rush to the Upper Jiao, likened to a running horse. Initially bad breath, then black teeth and rotten gums, bleeding, eventually tooth loss. Urgent treatment is needed to save life, though teeth will not regrow.
Zhang Yuansu stated: Gan results from pediatric accumulation or chronic vomiting/diarrhea, exacerbated by doctors' reckless use of harsh purgatives. Children's bodies easily shift between deficiency and excess, leading to Stomach deficiency and fluid loss, internal deficient heat, and external muscle wasting. One Zang deficiency weakens all others. Symptoms include swollen eyelids, abdominal distension, variable stool color, and progressive emaciation. If unhealed, it indicates Wind in intestines/stomach; Xuan Feng San (Disperse Wind Powder) should guide the pathogen out. Subsequently, tonify the Mother organ of each affected Zang.
*Shenghui Fang* states: Internal pediatric Gan presents with gritty eyes, abdominal distension, variable stool color (like rice water sediment), and daily emaciation; this is treatable. Red/rotten nose, nose-rubbing, head sores with painful/itchy crusts spreading to ears, red eyes, sparse hair, tight/shiny scalp, large head/thin neck, and emaciation are also treatable. Eroded lips/mouth, multi-colored or blackened gums, white sores under tongue, holes in palate, foul breath, and rotting gums are treatable. Open lower orifices, unbearable itching, variable diarrhea are treatable. Gan eroding the spine, itchy fingers, nail-biting, tufted hair, saw-toothed spine, alternating distension/diarrhea are curable if treated urgently. Five Gans are terminal and untreatable: 1. Insensitivity to pain in the big toe sole; 2. Limp limbs when held; 3. Body cold despite illness; 4. Unstopping green/white frothy diarrhea; 5. Weak tendon extension. These are untreatable.
Chu Yushi stated: Key differentiations are Heat Gan, Cold Gan, and Cold-Heat Gan. Heat Gan involves exterior symptoms: red/rotten nose, itchy/wet scalp, five-palm heat, restless breathing, desire for cold water, irritability, lying on floor, hot belly/cold feet, tidal fever. Cold Gan involves interior symptoms: variable stool color, green/white froth, weak limbs, swollen eyes, dark face. A variant shows irritability/thirst/lying on floor (mimicking heat) but with anorexia and endless slippery diarrhea. Mixed Gan features pus/blood in stool and daily weakening. Gan stems from deficiency. Heat is deficiency-heat; Cold is deficiency-cold. Do not use dispersing or overly cooling methods for Heat Gan; do not use harsh warming or sudden tonification for Cold Gan. Children's spleens are vulnerable to both cold and heat; cold drugs cause cold, warm drugs cause heat. Recognize this to avoid error.
Zeng Shirong stated: Gan stems from overeating causing Spleen accumulation, which transmits to other Zang organs, forming Five Zang Gans. If Spleen disease is cured, other organs rest. Untreated, it spreads. Treat Spleen disease with Chen Xiang Bing Lang Wan (Aucklandia and Areca Nut Pill) or Wu Xi Wan (Black Rhinoceros Horn Pill), adjusting for deficiency/excess. For worms, use Shi Jun Zi Wan (Quisqualis Pill). For heart/abdominal pain, clear water vomiting, and worm expulsion, use Er Sheng Wan (Two Sage Pill). For various Gans, regularly use Wu Gan Bao Tong Wan (Five Gan Child-Preserving Pill) or Wan Ying Wan (Ten Thousand Response Pill) to resolve accumulation. Supplement with organ-specific regulators: Fu Shen Tang (Poria Decoction) for Heart, Dang Gui Tang (Angelica Decoction) for Liver, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for Spleen, Bu Fei San (Tonify Lung Powder) for Lung, Tiao Yuan San (Regulate Origin Powder) for Kidney. This ensures appropriateness and prevents recurrence.
Ye Tianshi stated: When toddlers transition from milk to solid food during summer (Spleen/Stomach dominant season), they are prone to abdominal distension, diarrhea, heat in head/hands/feet, and emaciation. Or they may have irritability, polydipsia, and hyperphagia, progressing to Five Gan Accumulation. Assess constitution strength and disease duration. For excess patterns, soothe Stomach and clear heat. If stool is white or undigested, strengthen Spleen with digestion-promoting and heat-clearing herbs. For internal damp-heat and worm-induced abdominal pain, promote stagnation resolution, expel worms, and gently purge, followed by slow regulation using Fei Er Wan (Child-Fattening Pill) type formulas. Pediatric Gan resembles adult Five Consumptions. Though classified by Five Zang, it is common in summer and fundamentally rooted in Spleen/Stomach. Mixed diet overwhelms transformation capacity; post-weaning fruits/fish cause Qi injury and stagnation, generating internal heat, muscle wasting, large abdomen, and thin limbs, named Ding Xi. Whether hyperphagic or anorexic, polydipsic or passing white stool, prolonged cases become critical. Avoid raw/cold/fishy/greasy/sticky foods. Initial treatment clears heat, harmonizes middle, and separates turbidity; subsequent treatment soothes, tonifies, and transforms transport. This is the fixed principle.