万密斋治朱氏子，年七岁，脾胃虚弱，食多则伤，食少则困，形瘦面黑。医者因其伤食，则与枳术保和丸以消导之。
因其困倦，则与参术茯苓丸以补之。时补时消，精神日瘁，将成疳矣。万曰∶脾胃素虚，不能消谷，故食易伤也。伤食
而后消导之，则脾益虚。虚而复补，脾未得实，而伤者又至矣，岂良法哉。今专以补脾为主，内兼消导，名肥儿丸。用
四君子加陈皮、青皮、木香、砂仁、山药、莲肉、使君子肉、神曲、麦芽、山楂肉，共为细末，荷叶包粳米，煮烂捣为
丸，米饮下。自此不复伤食，肌肉渐肥。
教谕许浓子，年十四，吐血，医作痰火治不效。脉之，两尺右关皆不足，曰∶年未二八，脉当沉紧，今反不足，当
作胎禀怯弱之病。然观宗师体浓，何以有此？必夫人当有虚病，或乳少得之也。（父母脏腑有病，儿多禀之，临症之工，
宜留心也。）许曰∶其母孕时果病，产后无乳。问治法，曰∶十六岁后病此者曰劳，十五岁前病此者曰疳，即劳也。（数
语儿医不可不知。）宜用六味地黄丸以补肾，参茯白术丸以补脾，病自安矣。如言服之，一月而愈。
一女五岁，因感冒不愈变为疟，疟止变为痢，痢止成疳，肌肉消瘦，饮食减少，日啖莲肉十数枚。万视之曰∶疳病
也。形色虽衰，幸胃气尚存，可愈也。以集圣丸，调理三月而安。
胡氏子一岁，病脑后哑门穴（在风腑穴之下，天柱两穴之中。）生一毒，如桃大，已溃，白脓不干。万视之曰∶此无
辜疳也，法不能治。或问何谓无辜疳？曰∶此《全幼金鉴》所载也。有妖鸟名睢，一名夜行游女，白昼不出，夜则出飞，
此鸟无雄，飞入人家，遇襁褓衣晒晾未收者，则布毒其上，儿着此则病而死，掠取其魂，化为己子，是名无辜疳，亦传
尸之类也。其病头上有核，破之内有白粉，况项下之疽，又九不治中之一症也，故云难治。五日果死。
孙文垣族孙女，年十岁，大便脱肛，鼻中时常出血，夜多切牙，肚热面黄，将成疳症，以山楂、青蒿、枳实、升麻、
酒连、滑石各一两，甘草、芦荟、干蟾各五钱为末，神曲为丸，一料全愈。
龚子才治一小儿，四肢消瘦，肚腹胀大，行步不能，颇能饮食，作渴发热，去后臭秽。此脾脏伤也，用异
功服肥儿丸调理而愈。
薛立斋治一小儿，面色萎黄，眼胞微肿，作渴腹胀，饮食少思，腹中一块或移动，小便澄白，大便不实。
此脾疳之患，用四君子加山栀、芜荑，兼肥儿丸而愈。
一小儿尿浊如米泔，（疳之候也。）以江南做酒小曲，炒为末，酒调下，三服愈。
孝伯有女曰止者，病疳，发于目，啼不可止，以视李绍伯，乃取十饼投之，未半而瘥。（钱氏云∶疳在肝则
膜遮睛，法当补肝，地黄丸主之。）
又孝若之乳母，弃其子，乳他姓子，其子骨立矣，又不任见日。（肝肾枯稿。）绍伯曰∶渴乳伤食，亟治
之，必服羊肝散一具活矣。某谓绍伯，某即不知医，是儿于望闻二法，俱无生理。绍伯曰∶固也，吾药能主胸
突腹凹骨开者，此症未见，何得勿活乎？（《笔谈》。）
万密斋治一小儿五岁，腹大善食。初见之，谓其父母曰∶乳多必损胃，食壅必伤脾，腹大如是，又纵其口
腹，恐肠胃乃伤，不成肠癖，必成疳也。后果成疳，肚大青筋，以集圣丸调理而安。
胡凤 子病疳，但多食则腹痛。曰∶人以食为本，谷入作痛，岂新谷为患乎？必有旧谷为积，未能消去，
故新谷相持也。乃与养脾消积丸，服之而安。
一儿八岁，形气甚弱，其父责令读书。谓曰∶此儿禀弱，宜怀保之，不可一于严也。留养脾丸、肥儿丸与
之。后半年，病成疳矣。一医谓伤食，以一粒金丹服之，病乃剧。延治问前药，则未服也。曰∶不可治矣，一
粒金丹内有草乌、巴豆大毒之品，此儿素性弱，食少而瘦，故与前丸调理，乃舍此而服彼，此犯虚虚之戒也。
后果殁。
朱丹溪治一富家子，年十四，面黄，善啖易饥，非肉不饱，泄泻一月。脉之，两手皆大，不甚瘦倦。以为
湿热，当脾困而食少，今反形健而多食，且不渴，意其疾必虫作痢也。取大便视之，果蛔虫所为。适欲他往，
令儿医用治虫药治之，禁其勿用去积药，待再诊而止痢也。后勿果，至次年春夏之交，其泻复作，腹不痛而口
渴。曰∶此去年治虫，而不治疳故也。遂以去疳之药，浓煎白术汤下，三日后而泻止。月后乃甚瘦，教以白术
为君，白芍为臣，川芎、陈皮、黄连、胡黄连，入少芦荟为丸，白术汤服之，半月而止。禁其勿食肉与甜物，
三年当自愈。
马铭鞠治张守为幼郎，患痨疳，嗜食易饥，腹如蜘蛛，过数日一泻，泻则无度，面目黧黑，指节中亦几无
剩肉矣。其母亦病，诊脉紧数，骨蒸劳热，大渴引饮，淋闭，腹若蜘蛛。曰∶儿病实母病也。用麦冬、枇杷叶、
生地、白芍、青蒿、鳖甲之属以治母。用干蟾为君，加羚羊角、犀角、白芙蓉花、牛黄，每用分许，日入鸡肝
内，饭上蒸服以治儿。再用滑石、扁豆、茯苓、车前、山楂、五谷虫等分为末，拌人乳晒干七次，略入砂仁末，
陈米汤丸弹子大，日进两丸。不二十日，子母俱痊。二方绝无药气，故儿喜啖之。（《广笔记》。）
《说约》云∶予表侄二三岁间，患疳积症，头大身瘦，发热，溺如米泔，诸治不效。后闻药气即吐，束手无
策。偶遇异人传此红燕丹方，和于糖果粥饮中与之，数服全愈。后以此济人，无不效矣。
魏玉横曰∶俞氏儿四岁，痘后失调，致成疳疾，猛啖而频泻，腹大皮急，夜哭切牙。因其母病延诊，药殊
无效。适见医至，见所用药皆香、砂、楂、枳、车前、扁豆、茯苓、豆蔻类，皆消积渗利之品，儿益困惫，其
母哭泣，至目肿流血。乃谓曰∶今以母病托予，而子病不痊，则母病亦进，必先愈子，而后母可愈也。问当奈
何？曰∶无已，请以母所服分饮之，则两病俱愈矣。其家非素封，既难资费，又无旁议，遂如言治之，不逾旬，
母子皆安。盖其母由产后，儿缘痘后，母则寒热往来，面足俱肿，恶露逾月不止，头痛不眠，食难下咽，与儿
之症同为血虚生火，木盛克土而然。彼儿医者，乌能用生熟地黄、沙参、杞子、黄连、麦冬，以愈是疾哉？
凌表侄孙四龄，予尝见之，曰∶儿将病疳，不以为意也。逾半年，则疳已甚，天柱倾侧，脐突筋青，毛发
脱落，股肉亦消，嗜食而泄，利亦极秽，多怒多啼，似难为矣。但其皮未急，目尚有神，乃与生地、杞子、沙
参、麦冬、枣仁、米仁，病不减，心亦疑之。少加木香、砂仁，则泻益甚。西席黄澹翁，通人也，谓泄益甚，
得毋香、砂为害乎？予曰∶然。遂去之，益以熟地、川连，十余剂乃全愈。予女八九岁时，疳病枯瘠如柴矣，
以六味加减，熟地用八钱，十剂而痊。向后，但以前方治，效者不可枚举。
小儿诸疳，使君子肉二钱，雷丸、槟榔各一钱，黑丑头末各五分，俱生晒研末，每服三分。以鸡卵一枚，
打破空头，内药纸封，饭上蒸熟食之，药完即愈。
小儿积滞，海蜇、凫茈，常煮食之，兼治大人痰哮，及肝乘胃痛。浸烧酒饮之，能消大人胸中痞块。又
绍兴青腐乳汁作下饭，能消疳积，治腹胀身黄。
小儿疳气攻目，鸡肝一具不落水，竹刀切片，用牡蛎粉八分，飞辰砂少许，拌匀糁入，饭锅上蒸熟食之。
如此十次，翳即退净，当时忌食茶汤油腻。
治小儿疳病，用鸡肫皮二十个勿落水，瓦焙干研末，车前子四两炒研末，二物和匀，以米糖溶化，拌入与
食，食完即愈。忌油腻面食煎炒。又方取田鸡白水煮熟，姜末少许亦效。
仲淳肥儿丸∶人参三钱，芜荑、使君子肉、白芍、黄连、白茯苓、滑石、扁豆、青黛各一两，橘红八钱，
甘草、砂仁各五钱，红曲、麦芽、山楂肉各七钱，莲肉二两，炼蜜为丸如弹子大，每服一丸，空心白汤化下。
又《集验良方》肥儿丸∶山药炒二两，白茯苓、白芍药、白扁豆、麦芽炒、五谷虫炒、神曲炒、山楂肉炒、当
归各一两五钱，白术土炒、陈皮、使君子肉煨一两，生甘草、胡黄连姜汁炒各七钱，蜜丸绿豆大，每服一钱。
《奇效》肥儿丸∶陈皮一两，青皮醋炒、神曲炒、槟榔、使君子肉煨各五钱，木香、黄连姜炒各三钱，饴糖丸绿
豆大，每服五六分。皆治疳病方也，汇录于此，以便选用。又《广笔记》疳积散，治小儿面黄腹大，小便浊如
米泔，大便黄泄酸臭，皮毛枯索，甚至双目羞明生翳，夜热昼凉等证。用浓朴去皮切片，姜汁炒热，净末二两；
广陈皮去白，净末八钱；粉甘草去皮，炙七分；真芦荟净末七钱；芜荑净末五钱；青黛取颜料铺浮碎花青，淘
净末二钱；百草霜，即山庄人家锅底煤二钱五；旋复花净末一钱五分。匀和成剂，小儿每一岁用药一分，灯心
汤空心调服。服后病愈，再用肥儿丸调理。又脾气未实，用启脾丸，或大健脾丸。如疳气未尽，用陈皮一两，
白木香三钱，白茯苓五钱，加平胃散三钱，为末，陈米汤调下。若疳泻痢见红白积者，用前散加黄连姜汁土炒，
肉豆蔻二味，灯心汤，少入熟蜜调服。若食积重者，前散用砂仁汤调服。若疳眼，用鸡肝一具，不拘大小雌雄，
一二岁儿只用半具，外去衣，内去筋膜，研极细，入前末调极匀，入前末浓薄相和，隔汤顿热空心服。或用甜
酒，少加熟白汤调服。
凡小儿疳在内，目肿腹胀，泻痢青白，体瘦羸弱。疳在外，鼻下赤烂，频揉鼻耳，或肢体生疮。鼻疮用兰
香散，兰香叶烧灰二钱，铜青、轻粉各五分，为末干贴。诸疳疮，用白粉散，海螵蛸三分，白芨二分，轻粉一
分。上为末，先用浆水洗拭干贴。肝疳一名筋疳，白膜遮睛，或泻血面瘦。心疳，面黄颊赤，身体壮热。脾疳
一名肥疳，体黄瘦削，皮肤干涩，而有疮疥，腹大嗜土。肾疳一名骨疳，肢体瘦削，遍生疮疥，喜卧湿地。肺
疳一名气疳，喘嗽气促，口鼻生疮。若患潮热，当先补肝，后泻心，勿妄以硝、黄诸药利之。若患癖，当消磨。
若误以巴豆、硼砂下之，及伤寒误下，皆能成疳。其初病者为热疳，久病者为冷疳。冷热相兼者，津液短少者，
皆因大病脾胃亏损，内亡津液所致，当固脾胃为主，早为施治，则不变败症也。
叶天士曰∶稚年五疳，犹大方之五劳。虽方书有五脏之分，是症夏令为多，咸从脾胃。盖小儿乳食杂进，
运化不及，初断乳后，果腥杂进，气伤滞聚，致热积于里，肌肉消瘦，腹大肢细，名曰丁奚。或善食，或不嗜
食，或浊饮无度，或便泻白色，久延不已，多致凶危，宜忌食生冷腥肥凝滞。治法即用清热和中分利，次则疏
补佐运。常有继病，治之无效，待妊妇产过自愈者。徐灵胎曰∶小儿为孕妇所抱，则生继病，虽不尽然，实有
此病，理不可解。
幼儿断乳纳食，值夏月脾胃主气，易于肚膨泄泻，手足心热，形体日瘦。或烦渴善食，渐成五疳积聚，当
审形体之强弱，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，（徐灵胎曰∶最多。）导滞驱虫微下之，缓调用肥儿丸之属。
藜按∶肥儿丸方最多，《景岳全书》有四方，一，四味肥儿丸，芜荑炒、神曲炒、麦芽炒、黄连炒分为
末，猪胆和丸黍米大，每服二三十丸，木通汤下。二，六味肥儿丸，黄连、陈皮、川楝子肉炒、神曲炒、
麦芽炒各一两，白芜荑半两，为末，糊丸麻子大，每服一二十丸，空心米饮下。三，七味肥儿丸，黄连炒、
神曲炒、广木香各一两五钱，槟榔二十个，肉豆蔻泡二两，使君子酒浸，麦芽炒，每四两，为末，面糊丸
麻子大，每服三五十丸，米饮下。良久用五味异功散一服，以助胃气。四，芦荟肥儿丸，芦荟、龙胆草、
木香、人参、使君子肉、蚵 、（酥炙去头足。即土鳖虫。）麦芽炒各二钱，槟榔、黄连酒炒、白芜荑
各三钱，胡黄连五钱。上为细末，猪胆汁为丸黍米大，每服五六十丸，米饮下。又《医宗金鉴》肥儿丸，
人参三钱半，白术五钱，茯苓三钱，黄连二钱，胡黄连五钱，使君子肉四钱，神曲炒、麦芽炒、山楂肉
各三钱半，炙甘草钱半，芦荟煨二钱半。上为末，黄米糊丸黍米大，每服二三十丸，米饮下。《金鉴》
芦荟肥儿丸，五谷虫炒二两，生芦荟、胡黄连炒、川黄连姜炒各一两，银柴胡炒一两二钱，扁豆炒、山
药炒各二两，南山楂二两半，虾蟆 四个，肉豆蔻煨七钱，槟榔五钱，使君子肉炒二两半，神曲炒二两，
麦芽炒一两六钱，鹤虱炒八钱，芜荑炒一两，飞净朱砂二两，麝香二钱。其为末，醋糊为丸，黍米大，
每服一钱，米饮下。
万密斋诊治朱氏的儿子，七岁，脾胃虚弱，吃多了就伤食，吃少了就困倦，身体消瘦，面色发黑。医生因为他是伤食，便给予枳术保和丸来消导积滞。
因为他感到困倦，又给予参术茯苓丸来补益。时而补益时而消导，精神日益憔悴，快要形成疳病了。万密斋说：“脾胃素来虚弱，不能消化谷物，所以食物容易损伤。在伤食之后才进行消导，会使脾气更加虚弱。在虚弱的情况下又进行补益，脾脏尚未恢复充实，而新的损伤又来了，这难道是好的治疗方法吗？现在专门以补脾为主，同时兼顾消导，名为肥儿丸。使用四君子汤加上陈皮、青皮、木香、砂仁、山药、莲肉、使君子肉、神曲、麦芽、山楂肉，共同研成细末，用荷叶包裹粳米，煮烂后捣成药丸，用米汤送服。从此不再伤食，肌肉逐渐丰满。”
教谕许浓的儿子，十四岁，吐血，医生当作痰火治疗无效。诊脉时，两尺脉和右关脉都显得不足，万密斋说：“年龄不到十六岁（二八之年），脉象应当沉紧，现在反而不足，应当当作先天禀赋怯弱的疾病看待。然而观察许宗师的身体状况，怎么会这样呢？必定是孩子的母亲当时有虚病，或者是乳汁少导致的。（父母的脏腑如果有病，孩子多会禀受，临症的医生应该留心这一点。）”许浓说：“他母亲怀孕时确实生病，产后没有乳汁。”询问治疗方法，万密斋说：“十六岁以后患此病的叫劳证，十五岁以前患此病的叫疳病，也就是劳证。（这几句话是儿科医生不可不知道的。）”适宜使用六味地黄丸来补肾，参茯白术丸来补脾，病自然就会痊愈。按照这个方法服用，一个月就好了。
有一个五岁的女孩，因为感冒久治不愈变成疟疾，疟疾停止后变成痢疾，痢疾停止后形成疳病，肌肉消瘦，饮食减少，每天吃十几枚莲肉。万密斋看后说：“这是疳病啊。虽然形色衰败，幸好胃气还在，可以治愈。”使用集圣丸，调理三个月后安然无恙。
胡家的儿子一岁时，脑后哑门穴（位于风府穴之下，天柱两穴之间）生了一个毒疮，像桃子大小，已经溃破，白色脓液不干涸。万密斋看后说：“这是无辜疳，按常规方法无法治愈。”有人问什么是无辜疳？万密斋说：“这在《全幼金鉴》中有记载。有一种妖鸟名叫睢，又名夜行游女，白天不出来，晚上出来飞翔，这种鸟没有雄性，飞入人家，遇到襁褓中的婴儿晾晒未收的衣服，就在上面散布毒气，婴儿穿上就会生病而死，它掠取婴儿的灵魂，化作自己的孩子，这就叫无辜疳，也属于传尸类的疾病。这种病头上有核，破开后里面有白粉，况且颈项下的疽疮，也是九种不治之症中的一种，所以说难治。五天后果然死了。”
孙文垣的族孙女，十岁，大便脱肛，鼻中经常出血，夜里磨牙，肚子热，面色黄，快要形成疳症，用山楂、青蒿、枳实、升麻、酒黄连、滑石各一两，甘草、芦荟、干蟾各五钱研成末，神曲做丸，一料药全部治愈。
龚子才治疗一个小孩，四肢消瘦，肚腹胀大，行走困难，很能吃东西，口渴发热，排便气味臭秽。这是脾脏受伤，用异功散配合肥儿丸调理而痊愈。
薛立斋治疗一个小孩，面色萎黄，眼睑微肿，口渴腹胀，饮食减少，腹中有一块状物或移动，小便清澈如白水，大便不成形。
这是脾疳的病患，用四君子汤加山栀、芜荑，兼服肥儿丸而痊愈。
一个小孩尿浑浊像米泔水（这是疳病的征候），用江南酿酒的小曲，炒成末，用酒调服，三次服药后痊愈。
孝伯有个女儿叫止的，患疳病，发作于眼睛，啼哭不止，请李绍伯诊治，于是取了十饼给她吃，还没吃完一半就好了。（钱乙说：疳病在肝则白膜遮睛，法当补肝，用地黄丸主治。）
另外，孝若的乳母，抛弃了自己的孩子，去哺乳别人家的孩子，她的孩子瘦骨嶙峋，而且受不了日晒。（肝肾枯竭。）李绍伯说：“渴乳伤食，赶快治疗，必定要服用羊肝散一具才能活命。”某人跟李绍伯说，我即使不懂医，对这个孩子通过望闻二法来看，都没有生机了。李绍伯说：“固然如此，我的药能主治胸突腹凹骨开的症状，这个病症还没出现，怎么能说不能活呢？”（出自《笔谈》。）
万密斋治疗一个五岁的小孩，腹部大，食欲好。刚见到时，对他的父母说：“乳汁过多必损胃，食物壅滞必伤脾，腹部这么大，又放纵他的口腹，恐怕肠胃乃至于受伤，如果不成为肠癖，必定会成为疳病。”后果然成了疳病，肚子大且青筋暴露，用集圣丸调理后安然无恙。
胡凤的儿子患疳病，只是吃多了就腹痛。万密斋说：“人以食物为本，谷食进入却疼痛，难道是新的谷物造成祸患吗？必定是有旧的谷物积滞，未能消除，所以新的谷物与之相持。”于是给予养脾消积丸，服用后安然无恙。
一个八岁的孩子，形体气息非常虚弱，他的父亲责令他读书。万密斋说：“这个孩子禀赋弱，应该呵护养育，不可以一味严厉。”留给他养脾丸、肥儿丸服用。半年后，病发展成疳病。一个医生说是伤食，给服一粒金丹，病情反而加重。延请治疗时问及之前的药，则说没服用。万密斋说：“不可治了，一粒金丹内有草乌、巴豆等大毒之物，这个孩子素性虚弱，吃得少且瘦，所以之前给他的是调理的丸子，他却舍弃那个而服用这个，这是犯了‘虚虚’（使虚者更虚）的戒律。”后果然死亡。
朱丹溪治疗一个富家子弟，十四岁，面色黄，爱吃且易饥，不吃肉就不饱，腹泻一个月。诊脉，两手脉象都大，不是很瘦倦。认为是湿热，通常脾困会导致食少，现在反而形体健壮且多食，且不口渴，推测其病必定是虫作祟引起的痢疾。取大便查看，果然是蛔虫所致。恰逢他要出远门，让儿科医生用治虫药治疗，禁止使用去积药，等待他再诊时停止痢疾。后来情况并非如此，到了次年春夏之交，腹泻复发，腹部不痛但口渴。万密斋说：“这是因为去年只治虫，而不治疳的缘故。”于是用去疳的药，浓煎白术汤送服，三天后腹泻停止。一个月后身体甚为消瘦，教导他以白术为君药，白芍为臣药，川芎、陈皮、黄连、胡黄连，加入少量芦荟做成丸药，用白术汤送服，半个月后停止。禁止吃肉和甜食，三年应当自愈。
马铭鞠治疗张守为的幼子，患痨疳，嗜食易饥，腹部像蜘蛛一样大，过几天泻一次，泻下无度，面目黧黑，指节中也几乎没剩什么肉了。他的母亲也病了，诊脉紧数，骨蒸劳热，大渴引饮，淋闭，腹部像蜘蛛。马铭鞠说：“儿子的病实际上是母亲的病造成的。”用麦冬、枇杷叶、生地、白芍、青蒿、鳖甲等药物治疗母亲。用干蟾为君药，加羚羊角、犀角、白芙蓉花、牛黄，每次用少许，放入鸡肝内，饭上蒸熟服用以治疗儿子。再用滑石、扁豆、茯苓、车前子、山楂、五谷虫等分研末，拌入人乳晒干七次，略入砂仁末，陈米汤做成弹子大的丸药，每天进服两丸。不到二十天，母子都痊愈了。这两个方子完全没有药气，所以孩子喜欢吃。（出自《广笔记》。）
《说约》中说：我的表侄在两三岁时，患疳积症，头大身瘦，发热，尿像米泔水，各种治疗无效。后来闻到药气就呕吐，束手无策。偶然遇到异人传授这个红燕丹方，混在糖果粥饮中给他喝，几次服用后完全痊愈。后来用这个方子救济他人，无不有效。
魏玉横说：俞家的孩子四岁，痘疹后调养不当，导致成疳疾，猛吃且频繁腹泻，腹部大皮肤紧绷，夜里哭闹磨牙。因为他的母亲生病而延请诊治，药殊无效果。恰好看见医生到来，看到所用的药都是香附、砂仁、山楂、枳实、车前子、扁豆、茯苓、豆蔻之类，都是消积渗利的药物，孩子更加困惫，他的母亲哭泣，以至于眼睛肿得流血。于是对他说：“现在因为母亲的病托付给我，而孩子的病没好，那么母亲的病也会加重，必须先治好孩子，然后母亲才可痊愈。”问该怎么办？说：“不得已，请把母亲所服的药分给孩子喝，那么两种病都会痊愈。”那家人不是富裕之家，既难以承担费用，又没有旁人的建议，于是照此治疗，不超过十天，母子都安康了。大概是因为母亲由产后，孩子因痘后，母亲则是寒热往来，面足俱肿，恶露超过一个月不止，头痛失眠，饮食难以下咽，与孩子的症状同为血虚生火，木盛克土所致。那些儿科医生，哪里能用生熟地黄、沙参、杞子、黄连、麦冬来治愈这种病呢？
凌表的侄孙四岁，我曾经见过他，说：“孩子将患疳病，我没在意。”过了半年，则疳病已经很严重，天柱骨倾斜，脐突筋青，毛发脱落，大腿肌肉也消退，嗜食且泄泻，排泄物极臭秽，多怒多啼，似乎很难救治了。但是他的皮还没有绷紧，眼睛还有神，于是给予生地、杞子、沙参、麦冬、枣仁、薏苡仁，病不减，心里也怀疑。稍加木香、砂仁，则腹泻更严重。西席黄澹翁，是个通达的人，说腹泻更严重，莫非是香附、砂仁造成的危害吗？我说：“是的。”于是去掉它们，增加熟地、川连，十余剂后完全痊愈。我的女儿八九岁时，疳病枯瘦如柴，用六味地黄丸加减，熟地用到八钱，十剂后痊愈。此后，只要用前方治疗，有效的不可胜数。
小儿各种疳病，使君子肉二钱，雷丸、槟榔各一钱，黑丑头末各五分，都生晒研末，每服三分。用一个鸡蛋，打破一头空，放入药，用纸封住，饭上蒸熟食之，药完即愈。
小儿积滞，海蜇、凫茈，常煮食之，兼治大人痰哮，及肝乘胃痛。浸烧酒饮之，能消大人胸中痞块。又绍兴青腐乳汁作下饭，能消疳积，治腹胀身黄。
小儿疳气攻目，鸡肝一具不落水，竹刀切片，用牡蛎粉八分，飞辰砂少许，拌匀糁入，饭锅上蒸熟食之。如此十次，翳即退净，当时忌食茶汤油腻。
治小儿疳病，用鸡肫皮二十个勿落水，瓦焙干研末，车前子四两炒研末，二物和匀，以米糖溶化，拌入与食，食完即愈。忌油腻面食煎炒。又方取田鸡白水煮熟，姜末少许亦效。
仲淳肥儿丸：人参三钱，芜荑、使君子肉、白芍、黄连、白茯苓、滑石、扁豆、青黛各一两，橘红八钱，甘草、砂仁各五钱，红曲、麦芽、山楂肉各七钱，莲肉二两，炼蜜为丸如弹子大，每服一丸，空心白汤化下。
又《集验良方》肥儿丸：山药炒二两，白茯苓、白芍药、白扁豆、麦芽炒、五谷虫炒、神曲炒、山楂肉炒、当归各一两五钱，白术土炒、陈皮、使君子肉煨一两，生甘草、胡黄连姜汁炒各七钱，蜜丸绿豆大，每服一钱。
《奇效》肥儿丸：陈皮一两，青皮醋炒、神曲炒、槟榔、使君子肉煨各五钱，木香、黄连姜炒各三钱，饴糖丸绿豆大，每服五六分。皆治疳病方也，汇录于此，以便选用。又《广笔记》疳积散，治小儿面黄腹大，小便浊如米泔，大便黄泄酸臭，皮毛枯索，甚至双目羞明生翳，夜热昼凉等证。用浓朴去皮切片，姜汁炒热，净末二两；广陈皮去白，净末八钱；粉甘草去皮，炙七分；真芦荟净末七钱；芜荑净末五钱；青黛取颜料铺浮碎花青，淘净末二钱；百草霜，即山庄人家锅底煤二钱五；旋复花净末一钱五分。匀和成剂，小儿每一岁用药一分，灯心汤空心调服。服后病愈，再用肥儿丸调理。又脾气未实，用启脾丸，或大健脾丸。如疳气未尽，用陈皮一两，白木香三钱，白茯苓五钱，加平胃散三钱，为末，陈米汤调下。若疳泻痢见红白积者，用前散加黄连姜汁土炒，肉豆蔻二味，灯心汤，少入熟蜜调服。若食积重者，前散用砂仁汤调服。若疳眼，用鸡肝一具，不拘大小雌雄，一二岁儿只用半具，外去衣，内去筋膜，研极细，入前末调极匀，入前末浓薄相和，隔汤顿热空心服。或用甜酒，少加熟白汤调服。
凡小儿疳在内，目肿腹胀，泻痢青白，体瘦羸弱。疳在外，鼻下赤烂，频揉鼻耳，或肢体生疮。鼻疮用兰香散，兰香叶烧灰二钱，铜青、轻粉各五分，为末干贴。诸疳疮，用白粉散，海螵蛸三分，白芨二分，轻粉一分。上为末，先用浆水洗拭干贴。肝疳一名筋疳，白膜遮睛，或泻血面瘦。心疳，面黄颊赤，身体壮热。脾疳一名肥疳，体黄瘦削，皮肤干涩，而有疮疥，腹大嗜土。肾疳一名骨疳，肢体瘦削，遍生疮疥，喜卧湿地。肺疳一名气疳，喘嗽气促，口鼻生疮。若患潮热，当先补肝，后泻心，勿妄以硝、黄诸药利之。若患癖，当消磨。若误以巴豆、硼砂下之，及伤寒误下，皆能成疳。其初病者为热疳，久病者为冷疳。冷热相兼者，津液短少者，皆因大病脾胃亏损，内亡津液所致，当固脾胃为主，早为施治，则不变败症也。
叶天士说：稚龄儿童的“五疳”，犹如同大人的“五劳”。虽然方书有五脏之分，但这种病症夏季较多，都归属于脾胃。大概因为小儿乳食杂进，运化不及，初断乳后，果腥杂进，气伤滞聚，致热积于里，肌肉消瘦，腹大肢细，名叫丁奚。或者善食，或者不嗜食，或者浊饮无度，或者便泻白色，久延不已，多致凶危，宜忌食生冷腥肥凝滞。治法即用清热和中分利，次则疏补佐运。常有继病，治之无效，待妊妇产过自愈者。徐灵胎说：小儿被孕妇抱着，则生继病，虽然不尽然，实有此病，理不可解。
幼儿断乳纳食，值夏月脾胃主气，易于肚膨泄泻，手足心热，形体日瘦。或烦渴善食，渐成五疳积聚，当审形体之强弱，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，（徐灵胎说：最多。）导滞驱虫微下之，缓调用肥儿丸之属。
藜按：肥儿丸方最多，《景岳全书》有四方，一，四味肥儿丸，芜荑炒、神曲炒、麦芽炒、黄连炒分为末，猪胆和丸黍米大，每服二三十丸，木通汤下。二，六味肥儿丸，黄连、陈皮、川楝子肉炒、神曲炒、麦芽炒各一两，白芜荑半两，为末，糊丸麻子大，每服一二十丸，空心米饮下。三，七味肥儿丸，黄连炒、神曲炒、广木香各一两五钱，槟榔二十个，肉豆蔻泡二两，使君子酒浸，麦芽炒，每四两，为末，面糊丸麻子大，每服三五十丸，米饮下。良久用五味异功散一服，以助胃气。四，芦荟肥儿丸，芦荟、龙胆草、木香、人参、使君子肉、蚵 （酥炙去头足。即土鳖虫。）麦芽炒各二钱，槟榔、黄连酒炒、白芜荑各三钱，胡黄连五钱。上为细末，猪胆汁为丸黍米大，每服五六十丸，米饮下。又《医宗金鉴》肥儿丸，人参三钱半，白术五钱，茯苓三钱，黄连二钱，胡黄连五钱，使君子肉四钱，神曲炒、麦芽炒、山楂肉各三钱半，炙甘草钱半，芦荟煨二钱半。上为末，黄米糊丸黍米大，每服二三十丸，米饮下。《金鉴》芦荟肥儿丸，五谷虫炒二两，生芦荟、胡黄连炒、川黄连姜炒各一两，银柴胡炒一两二钱，扁豆炒、山药炒各二两，南山楂二两半，虾蟆 四个，肉豆蔻煨七钱，槟榔五钱，使君子肉炒二两半，神曲炒二两，麦芽炒一两六钱，鹤虱炒八钱，芜荑炒一两，飞净朱砂二两，麝香二钱。其为末，醋糊为丸，黍米大，每服一钱，米饮下。
Wan Mizhai treated the son of the Zhu family, aged seven. His spleen and stomach were weak; excessive eating caused food stagnation, while insufficient eating led to fatigue. He was emaciated with a dark complexion. The physician, attributing his condition to food stagnation, prescribed Zhizhu Baohe Wan (Atractylodes and Immature Bitter Orange Pill for Harmonizing the Stomach) to promote digestion. When he appeared fatigued, Shenqi Fuling Wan (Ginseng, Atractylodes, and Poria Pill) was given to tonify him. Alternating between tonification and purging, his spirit deteriorated daily, approaching the formation of Gan disease (Pediatric Malnutrition). Wan said: "The spleen and stomach have been inherently weak and unable to digest grains, hence food easily causes injury. After food stagnation occurs, using digestive methods further weakens the spleen. Tonifying when already weak fails to strengthen the spleen before new injuries occur. Is this a good method? Now, I will focus primarily on tonifying the spleen, while simultaneously addressing stagnation. This is named Fei'er Wan (Child-Nourishing Pill). It uses Sijunzi Tang (Four Gentlemen Decoction) plus Chenpi (Tangerine Peel), Qingpi (Green Tangerine Peel), Muxiang (Aucklandia Root), Sharen (Amomum Fruit), Shanyao (Chinese Yam), Lianrou (Lotus Seed Flesh), Shijunzi Rou (Seed of Quisqualis), Shenqu (Medicated Leaven), Maiya (Sprouted Barley), and Shanzha Rou (Hawthorn Flesh). These are ground into fine powder. Rice is wrapped in lotus leaves, boiled until soft, and mashed together with the powder to form pills. They are taken with rice water. From then on, he no longer suffered from food stagnation, and his muscles gradually became plump."
Xu Nong, a Jiaoxue (Educational Official), had a son aged fourteen who vomited blood. Physicians treated it as phlegm-fire without effect. Upon pulse diagnosis, both Chi (Cunming) pulses and the Right Guan (Cun) pulse were deficient. Wan said: "At an age not yet sixteen (two times eight years), the pulse should be deep and tight. That it is now deficient suggests a congenital weakness. However, observing Master Xu's constitution, how could this be? It must be that the mother had a deficiency illness during pregnancy, or perhaps due to insufficient breast milk. (If parents' zang-fu organs have diseases, children often inherit them; physicians should pay attention.)" Xu said: "His mother indeed fell ill during pregnancy and had no breast milk after birth." Asked for treatment, Wan said: "Those who develop this condition after sixteen are called Lao (Consumption); those under fifteen are called Gan, which is essentially Lao. (Physicians of pediatrics must know these few words.)" It is appropriate to use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify the kidney, and Shenqi Baizhu Wan (Ginseng, Poria, and Atractylodes Pill) to tonify the spleen. The illness will naturally resolve. Following this advice, he recovered in one month.
A five-year-old girl, whose cold had not resolved, developed malaria. After the malaria ceased, she developed dysentery. After the dysentery stopped, she developed Gan disease. Her muscles wasted away, and her appetite decreased, though she ate over ten lotus seeds daily. Wan examined her and said: "This is Gan disease. Although her appearance is depleted, fortunately, her stomach qi remains, so she can be cured." She was treated with Jisheng Wan (Accumulated Sages Pill) and regulated for three months until she recovered.
The Hu family's son, aged one, developed a boil at the Yamen acupoint (located below Fengfu GV16, between Tianzhu BL10) on the back of his head. It was the size of a peach, had ulcerated, and produced non-drying white pus. Wan said: "This is Wugu Gan (Innocent Gan), which cannot be cured by standard methods." Someone asked what Wugu Gan was. Wan replied: "This is recorded in *Quanyou Jinjian*. There is a demon bird named Sui, also known as Yexing Younü (Night-Walking Wanderer Woman). It does not appear by day but flies at night. This bird has no male; it flies into homes and encounters infants' clothes drying out of reach. It deposits poison on them. If the infant wears them, they become ill and die. The bird steals the soul and transforms it into its own child. This is called Wugu Gan, belonging to the category of Chuanshi (Transmitting Corpse) diseases. The disease presents with nodules on the head that, when broken, contain white powder. Furthermore, carbuncles on the neck are among the nine untreatable conditions, hence it is difficult to treat." Five days later, the child indeed died.
Sun Wen Yuan's clan granddaughter, aged ten, suffered from rectal prolapse, frequent epistaxis, nocturnal bruxism, abdominal heat, and yellowish complexion, approaching Gan syndrome. She was treated with Shan Zha (Hawthorn), Qing Hao (Sweet Wormwood), Zhishi (Immature Bitter Orange), Shengma (Cimicifuga), Jiuhelian (Wine-processed Coptis), and Huashi (Talc) each at 1 liang, along with Gancao (Licorice), Lushen (Aloe), and Ganchan (Dried Toad) each at 5 qian. These were ground into powder and formed into pills with Shenqu. One course resulted in complete recovery.
Gong Zicai treated a child with emaciated limbs, distended abdomen, inability to walk, good appetite, thirst, fever, and foul-smelling stools. This was damage to the Spleen organ. He used Yigong San (Extraordinary Power Powder) combined with Fei'er Wan for regulation, resulting in recovery.
Xue Lizhai treated a child with sallow complexion, slightly swollen eyelids, thirst, abdominal distension, poor appetite, movable abdominal masses, clear urine, and loose stools. This was Pi Gan (Spleen Gan). He used Sijunzi Tang (Four Gentlemen Decoction) added with Zhizi (Gardenia) and Wuyi (Chaulmoogra Seed), combined with Fei'er Wan, leading to recovery.
A child had turbid urine resembling rice washings (a sign of Gan). He was treated with fermented grain starter from Jiangnan, roasted and powdered, taken with wine. Three doses resulted in recovery.
Xiao Bo had a daughter named Zhi who suffered from Gan affecting the eyes, crying incessantly. Li Shaobo treated her by giving her ten 'bing' (cakes/pills). Before half were consumed, she improved. (Qian Yi stated: If Gan affects the Liver, white membranes cover the pupils; the method is to tonify the Liver, using Dihuang Wan.)
Additionally, the wet nurse of Xiao Ruo abandoned her own child to nurse another family's child. Her own child became skeletal and could not tolerate sunlight. (Liver and Kidney essence exhausted.) Shaobo said: "Thirst for milk and food injury require urgent treatment. Taking one dose of Yanggan San (Sheep Liver Powder) would save him." Someone told Shaobo, "Even if I don't know medicine, based on inspection and listening, this child has no chance of survival." Shaobo replied, "True, my medicine treats chest protrusion, abdominal concavity, and bone separation. Since these signs are absent, how can you say he won't survive?" (From *Bitan*).
Wan Mizhai treated a five-year-old child with a large abdomen and good appetite. Upon first seeing him, he told the parents: "Excessive milk damages the Stomach; food congestion injures the Spleen. With such a large abdomen, and indulging his appetite, I fear the intestines and stomach will be injured. If it does not become Changpi (Intestinal Fistula/Dysentery), it will surely become Gan." Indeed, Gan eventually developed, characterized by a large abdomen and visible blue veins. He was regulated with Jisheng Wan and recovered.
Hu Feng's son suffered from Gan, experiencing abdominal pain only after eating too much. Wan said: "Humans rely on food. Pain upon ingestion—could it be the new food causing trouble? There must be old food accumulation that hasn't been digested, causing conflict with new food." He prescribed Yangpi Xiaoji Wan (Spleen-Nourishing and Accumulation-Resolving Pill), and he recovered.
An eight-year-old child was very weak in form and qi. His father forced him to study. Wan said: "This child has weak constitution; he should be cherished and protected, not subjected to strictness alone." He left him Yangpi Wan and Fei'er Wan. Half a year later, he developed Gan. A physician attributed it to food stagnation and gave Yili Jin Dan (One-Grain Golden Pill), worsening the condition. Upon inquiry about previous medications, it was found they hadn't been taken. Wan said: "It is incurable. Yili Jin Dan contains Caowu (Aconite) and Badou (Croton), substances of great toxicity. This child is inherently weak, eats little, and is thin. We previously gave regulating pills, but he took these instead. This violates the prohibition against 'making deficiency more deficient.'" He subsequently died.
Zhu Danxi treated a wealthy boy, aged fourteen, with sallow complexion, strong appetite, and easy hunger, requiring meat to feel full, accompanied by diarrhea for one month. Pulse diagnosis showed large pulses in both hands, without significant emaciation or fatigue. He suspected damp-heat. Usually, Spleen distress leads to poor appetite, but here the child was robust and ate much, without thirst. He surmised the disease was likely caused by worms inducing dysentery. Examining the stool confirmed roundworms. As he was about to travel, he instructed the pediatrician to use vermifuge drugs, forbidding the use of purgatives for accumulation, and to stop the dysentery upon his return. Later events differed. In the following spring and summer transition, diarrhea recurred without abdominal pain but with thirst. Zhu said: "This is because last year only worms were treated, not Gan." He then used anti-Gan medicines, decocted strongly in Baizhu Tang (Atractylodes Decoction). Diarrhea stopped after three days. A month later, he was very thin. He taught the formula: Baizhu (Atractylodes Macrocephala) as Sovereign, Baishao (White Peony) as Minister, Chuanxiong (Sichuan Lovage), Chenpi, Huanglian (Coptis), and Huhuanglian (Coptis Chinensis), with a little Lushen (Aloe), made into pills, taken with Baizhu Tang. Stopping after half a month. He forbade meat and sweets, predicting self-healing in three years.
Ma Mingju treated Zhang Shouwei's young son suffering from Lao Gan (Consumptive Gan). He had cravings, easy hunger, a spider-like distended abdomen, infrequent but uncontrolled diarrhea, blackened face and eyes, and almost no flesh left on finger joints. His mother was also ill. Her pulse was tight and rapid, with steaming bone disorder, severe thirst, stranguria, and spider-like abdomen. Ma said: "The son's illness stems from the mother's illness." He treated the mother with Maidong (Ophiopogon), Pipaye (Loquat Leaf), Shengdi (Rehmannia), Baishao, Qinghao, and Biejia (Turtle Shell). For the son, he used Ganchan (Toad) as Sovereign, adding Lingyangjiao (Antelope Horn), Xijiao (Rhinoceros Horn - note: modern substitutes used), Bai Furonghua (White Hibiscus Flower), and Niuhuang (Calculus Bovis). Each dose was small, placed inside a chicken liver, and steamed over rice for administration. Additionally, Huashi (Talc), Bian Dou (Lablab Bean), Fuling (Poria), Cheqian Zi (Plantago Seed), Shanzha, and Wuguchong (Mealworm) were powdered equally, mixed with human milk, dried seven times, with a little Sharen powder added, and formed into pill-sized balls with Chenmi Tang (Aged Rice Decoction). Two pills daily. Within twenty days, both mother and son recovered. The two formulas had no medicinal odor, so the child enjoyed eating them. (From *Guang Biji*).
*Shuoyue* states: My cousin's son, aged two or three, suffered from Ganji syndrome (Gan with accumulation), with a large head and thin body, fever, and urine like rice washings. Various treatments failed. Later, he vomited at the smell of medicine, leaving us helpless. An encounter with an unusual person transmitted the Hongyan Dan (Red Swallow Pill) formula. Mixed into candy porridge and given, several doses resulted in complete recovery. Using this to help others proved effective every time.
Wei Yuheng said: Yu's child, aged four, developed Gan disease due to improper care after smallpox. He ate voraciously and had frequent diarrhea, with a large, taut abdomen, nocturnal crying, and bruxism. Because his mother was ill, I was consulted. Previous medicines were ineffective. Seeing the attending physician's prescriptions, they consisted of Xiangfu, Sharen, Shanzha, Zhishi, Cheqian, Bian Dou, Fuling, Doukou, etc.—all resolving accumulation and promoting diuresis. The child grew more exhausted. His mother cried until her eyes swelled and bled. I said: "Since you entrusted me with your illness, and your son's illness is unresolved, your illness will worsen. I must cure the son first, then you can recover." Asked how, I said: "If necessary, let the child drink the medicine intended for the mother. Both illnesses will heal." The family was not wealthy, couldn't afford extra costs, and had no other advice, so they followed this. Within ten days, both mother and son were well. The mother suffered from postpartum alternating chills and fever, facial and foot edema, lochia lasting over a month, headache, insomnia, and difficulty swallowing. Her symptoms, like the child's, were due to Blood deficiency generating fire, and Wood excess overcoming Earth. How could those pediatricians use Sheng Dihuang, Shu Dihuang, Shashen, Qizi, Huanglian, and Maidong to cure this?
Ling's cousin's grandson, aged four, I once saw him and said: "The child is about to develop Gan," but paid no heed. Half a year later, Gan was severe: Tianzhu bone tilted, umbilical herniation, blue veins, hair loss, thigh muscle wasting, craving food but having diarrhea, extremely foul stools, irritability, and crying. It seemed hopeless. However, his skin was not tight, and his eyes still had spirit. I prescribed Shengdi, Qizi, Shashen, Maidong, Zaoren, and Yiyiren. The illness did not subside, and I doubted myself. Adding Muxiang and Sharen worsened the diarrhea. The tutor, Huang Danceng, a knowledgeable man, asked if the worsening diarrhea was due to Muxiang and Sharen. I agreed. Removing them and adding Shudi and Chuanlian (Coptis), he recovered after over ten doses. My daughter, aged eight or nine, was as thin as firewood due to Gan. Using modified Liuwei Dihuang Wan, with Shudi up to 8 qian, she recovered in ten doses. Thereafter, using this formula yielded countless successes.
For various pediatric Gan diseases: Shijunzi Rou (2 qian), Leiwan (1 qian), Binglang (1 qian), Heiqiu Toumo (5 fen). All sun-dried and powdered. Take 3 fen per dose. Crack one chicken egg, remove some yolk/white, insert the medicine, seal with paper, steam over rice, and eat. Cure upon finishing the medicine.
For pediatric stagnation: Hai Zhe (Sea Cucumber) and Fu Ci (Water Caltrop), boiled and eaten regularly. Also treats adult Phlegm-Asthma and Liver invading Stomach pain. Soaked in rice wine, it resolves chest masses in adults. Shaoxing Green Fermented Tofu Juice, eaten with rice, resolves Gan accumulation and treats abdominal distension with jaundice.
For Gan Qi attacking the eyes: One chicken liver, kept dry. Slice with a bamboo knife. Mix with 8 fen Musli Fen (Oyster Shell Powder) and a little Fei Chensha (Prepared Cinnabar). Apply evenly, steam over rice, and eat. Ten times clears the corneal opacity. Avoid tea, coffee, and greasy food during this period.
Treating pediatric Gan: Use 20 Ji Zhun Pi (Chicken Gizzard Linings), keep dry, roast in clay until dry, and powder. Mix with 4 liang Chao Yan Chao Yan Zi (Roasted Plantago Seeds) powder. Blend well, dissolve with brown sugar, mix with food, and eat. Cure upon finishing. Avoid greasy foods, wheat noodles, fried items. Another method: Boil Frog Meat in plain water, add a little ginger powder; also effective.
Zhongchun Fei'er Wan: Ren Shen (3 qian), Wuyi, Shijunzi Rou, Baishao, Huanglian, Baifuling, Huashi, Bian Dou, Qingdai each 1 liang, Juhong (8 qian), Gancao, Sharen each 5 qian, Hongqu, Maiya, Shanzha Rou each 7 qian, Lian Rou (2 liang). Honey-pilled to size of pellets. Take one pill on an empty stomach, dissolved in warm water.
Also *Jiyan Liangfang* Fei'er Wan: Chao Shanyao (2 liang), Baifuling, Baishaoyao, Bai Biandou, Chao Maiya, Chao Wuguchong, Chao Shenqu, Chao Shanzha Rou, Danggui each 1.5 liang, Tu Chao Baizhu, Chenpi, Wei Shijunzi Rou each 1 liang, Sheng Gancao, Jiang Zhi Chao Huhuanglian each 7 qian. Honey-pilled to bean size. Take 1 qian.
*Qixiao* Fei'er Wan: Chenpi (1 liang), Cu Chao Qingpi, Chao Shenqu, Binglang, Wei Shijunzi Rou each 5 qian, Muxiang, Jiang Chao Huanglian each 3 qian. Yi Tang (Maltose) pilled to bean size. Take 5-6 fen. These are all formulas for treating Gan disease, compiled here for selection. Also *Guang Biji* Ganji San: Treats pediatric sallow face, large abdomen, turbid urine like rice washings, yellow sour-smelling stools, dry skin/hair, photophobia, corneal opacity, night fever/day coolness. Use Houpo (peeled, sliced, stir-fried with ginger juice, 2 liang net powder), Guang Chenpi (de-white, 8 qian net powder), Fen Gancao (peeled, honey-roasted, 7 fen), True Lushen (7 qian net powder), Wuyi (5 qian net powder), Qingdai (2 qian net powder), Baicaoshuang (soot from stove bottom, 2.5 qian), Xuanfuhua (1.5 fen net powder). Mix evenly. Dosage: 1 fen per year of age, taken on empty stomach with Dengxin Tang (Juncus Decoction). After recovery, regulate with Fei'er Wan. If Spleen qi is not solid, use Qipi Wan or Da Jianpi Wan. If Gan qi is not exhausted, use Chenpi (1 liang), Baimu Xiang (3 qian), Baifuling (5 qian), plus Pingwei San (3 qian), powdered, taken with aged rice water. If Gan dysentery shows red/white mucus, add Jiang Zhi Tu Chao Huanglian and Rou Doukou to the above powder, taken with Dengxin Tang and a little honey. If food stagnation is heavy, take the powder with Sharen Tang. For Gan Eyes: Use one chicken liver (any sex/size; half for 1-2 year olds), remove skin/fascia, grind finely, mix thoroughly with the above powder, heat over boiling water, take on empty stomach. Or take with sweet wine and a little cooked warm water.
Generally, internal Gan presents with swollen eyes, abdominal distension, green/white dysentery, emaciation. External Gan presents with red/ulcerated nose, frequent rubbing of nose/ears, or limb sores. Nasal sores use Lanxiang San: Lanxiang Ye ash (2 qian), Tongqing, Qingfen each 5 fen, powdered, applied dry. Various Gan sores use Baifen San: Haipiaoxiao (3 fen), Baiji (2 fen), Qingfen (1 fen). Powdered, wash with starch water, dry, and apply. Liver Gan, also called Jin Gan, features white membranes covering pupils, bloody diarrhea, and sallow face. Heart Gan features sallow face, red cheeks, high fever. Spleen Gan, also called Fei Gan, features yellow emaciation, dry/scaly skin with sores, large abdomen, geophagia. Kidney Gan, also called Gu Gan, features emaciated limbs, widespread sores, preference for lying on damp ground. Lung Gan, also called Qi Gan, features wheezing/coughing, shortness of breath, sores around mouth/nose. If tidal fever occurs, first tonify Liver, then drain Heart. Do not recklessly use Xiaoyaos (purges) like Xiaoshi (Mirabilite) and Dahuang (Rhubarb). If Pi (masses) occur, they must be dissipated. Mistaken use of Badou (Croton) or Pengsha (Borax) as purgatives, or mistaken purging in Shanghan (Cold Damage), can all cause Gan. Early stage is Re Gan (Heat Gan); late stage is Leng Gan (Cold Gan). Mixed cold/heat or fluid deficiency cases result from major illnesses damaging Spleen/Stomach and depleting fluids internally. The primary treatment must consolidate Spleen/Stomach. Early intervention prevents deterioration into terminal syndromes.
Ye Tianshi said: Pediatric "Five Gans" in childhood are analogous to "Five Labors" in adults. Although texts divide them by five Zang organs, this syndrome is common in summer and generally originates from Spleen/Stomach. Children consume mixed milk and food, overwhelming transformation and transportation. After weaning, fruits and meats are introduced, injuring Qi and causing stagnation. Heat accumulates internally, leading to emaciation, large abdomen, and thin limbs, named Ding Xi. Appetite may vary, or there may be excessive drinking of turbid fluids, or white stools. Prolonged, it becomes critical. Avoid raw, cold, fishy, fatty, and cloying foods. Treatment involves clearing heat, harmonizing middle, and separating turbidity, followed by dispersing tonification and assisting movement. Sometimes secondary illnesses occur, resistant to treatment, resolving only after the pregnant woman gives birth. Xu Lingtai said: Children carried by pregnant women may develop secondary illnesses. While not always true, this phenomenon exists, though its mechanism is inexplicable.
When toddlers wean and start eating, during summer when Spleen/Stomach qi dominates, they are prone to abdominal bloating, diarrhea, and heat in palms/soles, with daily emaciation. Or they may have thirst, good appetite, gradually forming Five Gans and accumulations. Assess physical strength and disease duration. If excess, disperse Stomach and clear heat. If stools are white or undigested after eating, tonify Spleen, assist with digestion and heat clearing. If damp-heat stagnates internally with worm accumulation and abdominal pain (Xu Lingtai notes: most common), guide stagnation, expel worms, and mildly purge. For slow regulation, use Fei'er Wan type formulas.
Li An: Fei'er Wan formulas are numerous. *Jingyue Quanshu* has four:
1. Siwei Fei'er Wan: Chao Wuyi, Chao Shenqu, Chao Maiya, Chao Huanglian, powdered, mixed with Pig Gallbladder bile, pilled to millet size. Take 20-30 pills with Mutong Tang.
2. Liuwei Fei'er Wan: Huanglian, Chenpi, Chao Chuanlianzi Rou, Chao Shenqu, Chao Maiya each 1 liang, Bai Wuyi 0.5 liang. Powdered, paste-pilled to hemp seed size. Take 10-20 pills on empty stomach with rice water.
3. Qiwei Fei'er Wan: Chao Huanglian, Chao Shenqu, Guang Muxiang each 1.5 liang, Binglang 20 pieces, Paired Roudoukou 2 liang, Shijunzi soaked in wine, Chao Maiya totaling 4 liang. Powdered, flour-paste pilled to hemp seed size. Take 30-50 pills with rice water. Wait, then take Yiwu Yigong San to aid Stomach qi.
4. Lushen Fei'er Wan: Lushen, Longdan Cao, Muxiang, Ren Shen, Shijunzi Rou, E (Roasted Ground Beetle/Tubiechong), Chao Maiya each 2 qian, Binglang, Jiu Chao Huanglian, Bai Wuyi each 3 qian, Huhuanglian 5 qian. Powdered, Pig Gallbladder bile pilled to millet size. Take 50-60 pills with rice water.
Also *Yizong Jinjian* Fei'er Wan: Ren Shen (3.5 qian), Baizhu (5 qian), Fuling (3 qian), Huanglian (2 qian), Huhuanglian (5 qian), Shijunzi Rou (4 qian), Chao Shenqu, Chao Maiya, Shanzha Rou each 3.5 qian, Zhi Gancao (1.5 qian), Wei Lushen (2.5 qian). Powdered, Yellow Millet paste pilled to millet size. Take 20-30 pills with rice water.
*Jinjian* Lushen Fei'er Wan: Chao Wuguchong (2 liang), Sheng Lushen, Chao Huhuanglian, Jiang Chao Chuan Huanglian each 1 liang, Chao Yin Chaihu (1.2 liang), Chao Bian Dou, Chao Shanyao each 2 liang, Nan Shanzha (2.5 liang), Hamo (4 pieces), Wei Roudoukou (7 qian), Binglang (5 qian), Chao Shijunzi Rou (2.5 liang), Chao Shenqu (2 liang), Chao Maiya (1.6 liang), Chao Heshi (8 qian), Chao Wuyi (1 liang), Feijing Zhusha (2 liang), Shexiang (2 qian). Powdered, Vinegar-paste pilled to millet size. Take 1 qian with rice water.