小儿五疳者,肝疳心疳脾疳肺疳肾疳也。其说创于钱氏,皆因脏腑柔弱,气血未充,或
病后
失调,或饮食饥饱,致伤脾胃而成疳症。津液内亡,虚火妄动,伤于何脏,发为何病,形症
各殊。肝疳者,一名风疳,白膜遮睛,泻血而瘦。心疳者,两 红障,面黄颊赤。脾疳者,
一名肥疳,上胞肿胀,腹大嗜甘。肺疳者,一名气疳,白珠绉翳,喘嗽气促。肾疳者,一名
骨疳,瞳神凹凸,喜卧湿地。五脏治法繁多,不能概述,大要不离乎补脾健运,则清浊自分
,中土有权,生机日盛,以异功散为君,随症加减。如枸杞白芍以补肝,山药阿胶以补肺,
归身枣仁以补心,黄 红枣以补脾,熟地菟丝以补肾,使脾胃稍旺,阴血渐充,继进地黄汤
,以养阴收功,岂非善治?夫疳者,干也,皆由内热熏蒸,消烁津液。然不可因其热而用苦
寒之药,再困脾阳,重伤胃气。世俗呼为疳积,谓疳必兼积,概用消导,不知疳乃虚症,补
之尚恐不及,而妄行攻伐,安有愈期乎。又有虫疳者,其虫如丝,出于头项腹背之间,黄白
赤者易治,青黑者难治。蛔疳者,眉绉多啼,呕吐清沫。脊疳者,拍背有声,脊骨如龟。脑
疳者,头皮光急,脑热如火。其症虽多,不出于五脏,宜以前法治之。然五疳之中,心肾二
疳甚少,肝脾肺三疳常常有之。虫疳者,余亦屡见也。姑举其要,以备后学人留意焉。
小儿五疳,指的是肝疳、心疳、脾疳、肺疳和肾疳。这一理论由钱乙(钱氏)创立,认为皆因小儿脏腑柔弱,气血尚未充盈,或因病后调养失当,或饮食饥饱无度,导致脾胃受损而形成疳症。体内津液耗亡,虚火妄动,邪气损伤哪一脏腑,便发作为何种病症,其形态与症状各不相同。
肝疳,又名风疳,表现为白膜遮蔽瞳孔,伴有泻血且身体消瘦。
心疳,表现为两目红障,面色黄而两颊赤红。
脾疳,又名肥疳,表现为上眼睑肿胀,腹部膨大且嗜食甘甜之物。
肺疳,又名气疳,表现为白眼球起皱且有翳膜,气喘咳嗽且呼吸急促。
肾疳,又名骨疳,表现为瞳神形态凹凸不平,喜欢卧于潮湿之地。
五脏的治疗法则繁多,无法一一概述,但大体原则不离补脾健运。只要脾胃功能强健,清浊之气自然分离,中焦土气有权衡之力,生机日渐旺盛。以异功散为君药,根据具体症状进行加减。如用枸杞、白芍来补肝,山药、阿胶来补肺,当归身、酸枣仁来补心,黄芪、红枣来补脾,熟地黄、菟丝子来补肾。使脾胃稍旺,阴血逐渐充盈,随后继服地黄汤,以滋养阴精收功,这难道不是善于治疗吗?
所谓“疳”,意为干枯,皆由内热熏蒸,消烁津液所致。然而不可因为其有热象就使用苦寒药物,以免再次困阻脾阳,重伤胃气。世俗称之为“疳积”,认为疳症必然兼有积滞,一概使用消导攻伐之法,却不知道疳症乃是虚证,补益尚恐不及,若妄行攻伐,怎能有痊愈的日期呢?
又有虫疳,其虫状如丝线,出于头项腹背之间,黄色、白色、红色的容易治疗,青色、黑色的难以治疗。蛔疳,表现为眉头皱缩、多啼哭,呕吐清稀泡沫。脊疳,拍打背部有声,脊骨隆起如龟背。脑疳,表现为头皮光亮紧绷,脑部发热如火。这些症状虽然繁多,但不超出五脏范畴,适宜用前述方法治疗。然而在五疳之中,心和肾的疳症很少见,肝、脾、肺三疳则常常出现。虫疳我也屡次见到。姑且列举其主要内容,以备后学者留意。
The "Five Gan Syndromes" in children refer to Liver Gan, Heart Gan, Spleen Gan, Lung Gan, and Kidney Gan. This theory was initiated by Qian Yi (Qianshi), attributing the condition to the tenderness of the Zang-Fu organs and the insufficiency of Qi and Blood in infants. It arises from improper care after illness or irregular diet (overeating or hunger), which damages the Spleen and Stomach, leading to Gan syndrome. The internal depletion of Body Fluids causes deficient Fire to flare up randomly. Depending on which Zang-Fu organ is damaged, different diseases manifest with distinct physical signs and symptoms.
Liver Gan, also known as Wind Gan, presents with a white membrane obscuring the pupil, bloody diarrhea, and emaciation.
Heart Gan presents with red obstructions in both eyes, a sallow complexion, and flushed cheeks.
Spleen Gan, also known as Fat Gan, presents with swelling of the upper eyelids, abdominal distension, and a craving for sweet foods.
Lung Gan, also known as Qi Gan, presents with wrinkling and opacities on the sclera, wheezing, coughing, and shortness of breath.
Kidney Gan, also known as Bone Gan, presents with irregular shapes of the pupil and a preference for lying on damp ground.
The treatment methods for the five Zang organs are numerous and cannot be fully summarized here. However, the general principle does not deviate from tonifying the Spleen and strengthening its transportive function. When the Spleen and Stomach are robust, clear and turbid Qi separate naturally, the Middle Earth (Spleen) maintains its authority, and vital energy increases daily. Yi Gong San (Isogong Decoction) is used as the principal formula, modified according to specific symptoms. For example, Gouqi (Lycii Fructus) and Baishao (Paeoniae Radix Alba) are used to tonify the Liver; Shanyao (Dioscoreae Rhizoma) and Ejiao (Colla Corii Asini) to tonify the Lungs; Danggui Shen (Angelicae Sinensis Radix) and Zaoren (Ziziphi Spinosae Semen) to tonify the Heart; Huangqi (Astragali Radix) and Hongzao (Jujubae Fructus) to tonify the Spleen; Shudi (Rehmanniae Radix Preparata) and Tusizi (Cuscutae Semen) to tonify the Kidney. Once the Spleen and Stomach are slightly strengthened and Yin-Blood gradually replenished, Dihuang Tang (Rehmannia Decoction) is administered subsequently to nourish Yin and conclude the treatment. Is this not an excellent approach?
The term "Gan" implies dryness, caused by internal heat steaming and consuming Body Fluids. However, one must not use bitter-cold herbs merely because of the presence of heat, as this would further hinder Spleen-Yang and severely damage Stomach-Qi. The lay public often refers to it as "Gan Accumulation," assuming that Gan always involves accumulation, and indiscriminately using digestive and purgative methods. They fail to realize that Gan is a deficiency syndrome; even tonification may fall short, so reckless attack and depletion will surely prevent recovery.
There is also Worm Gan, where worms resembling silk threads emerge between the head, neck, abdomen, and back. Those that are yellow, white, or red are easy to treat, while those that are green or black are difficult. Roundworm Gan presents with furrowed eyebrows, frequent crying, and vomiting of clear froth. Spine Gan presents with a resonant sound upon patting the back and a spine protruding like a turtle's shell. Brain Gan presents with tight, shiny scalp skin and brain heat feeling like fire. Although these symptoms are varied, they do not exceed the scope of the Five Zang organs and should be treated with the aforementioned methods. Among the Five Gan syndromes, Heart and Kidney Gan are rare, whereas Liver, Spleen, and Lung Gan are common. I have also frequently encountered Worm Gan. I list only the essentials here for the attention of future students.