道人于圣学，本无所窥，而少者怀之，雅有同志。窃于疳症，三致意焉。十六岁以后，谓之痨；十六岁以
前，谓之疳。其症头皮枯涩，毛发焦稀，腮缩鼻干，脊耸体削，斗牙
咬甲，烦渴自汗，口鼻溺赤，肚胀潮热，酷嗜瓜果、泥炭等物，外则肢体生疮，是其候也。疳之纲领有五∶脾
、肺、心、肝、肾。至于条目，不可穷纪，姑举其要，曰脊疳、曰蛔疳、曰脑疳、曰丁奚疳、曰无辜疳、曰哺
露疳。名有百端，理唯一致，惟见症不同，不外热、积、虫三者而已。考古名方，有塌气丸、龙胆汤、芦荟丸
、木香丸、胡黄连丸及各种肥儿丸。其理正、其义深、其效神，信非仙家莫传。因方书论症支吾，虽传其方，
无人敢用。如景岳论中，其或气血两虚，有非大补不可，固属门外之揣摩。即钱仲阳为小儿科中一代名医，而
以为皆因脾胃虚损，亦是老生常谈，与疳症何涉？钱氏如此，其他可知。道人不惜苦口饶舌，细为分析，病源
既明，则作方者之苦心，庶得以阐明于世。杨氏曰∶“疳者，干也。”道人则曰∶“疳者，甘也”。因奉养太
过，肥甘之味，郁而为热，蒸而生虫，久而成积，而疳以是名焉。惟其为热，煎熬津液，肌肉为之消削；惟其
成积，肚腹胀大，饮食为之减少，惟其生虫，吮脏
腑，则偏嗜异物；蚀肢体，则疮痒不痛，种种症候。大半得之膏粱之家，饫藜藿者，十居一二。道人云游以来，
每见朱门子弟，反不如居茅屋者之神完气足。总由饮食不节之故，何关乎元气之盛衰，脾胃之强弱。此其大彰
明较着者也。名方中不离黄连为君者，解其煎熬之热毒也；用芦荟、生地、山栀、青黛、胆草、黄柏者，清
其火也；用芜荑、君子、川楝、雷丸、鹤虱、乌梅者，杀其虫也；用莪术、神曲、山楂、麦芽、青皮、木香者，
消其积也，用干虾蟆、蟾酥者，以毒攻其毒也；用夜明砂、灵脂者，去瘀而生新也。有是症则有是药，性味之寒
与毒，夫复何疑。尝见患是症者，请一目不识丁之医，或揣之曰∶“莫不是疳？”将师所传治疳之方，隧撮一
帖，犹或幸中，彼原不知黄连之寒，芜荑之毒。请一读书明理之医，明知是疳，开口便曰∶“脾胃大亏，非峻
补不可。枯瘦之躯，何堪此黄连之寒，芜荑之毒。”主人曰∶“稳当。”不知热得补而益炽；积得补而益坚；虫
得补而更多，至于不救。则曰∶“有命”此非读书之过，不善读书者之过也。道高一尺，魔高一丈，其是之谓
欤？然则，非攻热、积、虫，遂可以治疳乎？非也。五疳有所见之症，诸疳又各有所见之症，变化生心，岂可
胶柱鼓瑟。不过胸有成竹，而后能画竹。然则，治疳一于攻而全无补法乎？亦非也。经曰∶“大毒治病，十
去五六。”相其热退、积减、虫安，穷寇勿追，或调脾理胃，滋肾平肝，一任医之运用。
考古名方∶（治腹胀大塌气丸∶白豆蔻、麦芽、五灵脂、砂仁、莪术、青皮、陈皮、君子二钱，虾蟆三钱，
米糊为丸。下虫丸∶苦楝子皮、酒浸焙，贯众、槟榔、桃仁、木香、鹤虱、米糊为丸。木香丸治疳痢∶黄连、
木香、浓朴、夜明砂，生姜水为丸。大芜荑汤治小儿发热作渴，少食，大便不利，发黄脱落∶芜荑、山栀、秦
归、白术、云苓、柴胡、麻黄、羌活、防风、黄连、黄柏、炙草各二钱。四味肥儿丸治小儿食积五疳，目生云
翳，牙龈腐烂∶芜荑、神曲、麦芽、黄连，等分为末，猪胆汁为丸，绿豆大。芦荟肥儿丸治热疳∶芦荟、龙胆草
、木香、人参、君子、麦芽各二钱，土鳖去头足酥炙、槟榔、黄连各三钱，芜荑、胡黄连一钱，猪胆汁为丸，
黍米大。龙胆丸治疳脑热疮∶龙胆草、升麻、苦楝根皮、赤茯苓、防风、芦荟、油发灰、青黛、黄连、炼蜜
为丸。蟾酥丸治小儿头顶结核，面色黄瘦，饮食不甘，腹大发热∶蟾蜍二三个，将粪蛆一杓，置桶中，以尿浸
之，即将蟾蜍打死，投于蛆食，一昼夜，用布袋盛起，置急流中宿取出，瓦上焙干为末，入麝香少许，米为丸。）
修道之人对于圣人之学，本无深入探究，但年少时便心怀向往，恰好志趣相投。我私下对疳症这一疾病，多次深思熟虑。十六岁以后发病，称为“痨”；十六岁以前发病，称为“疳”。其症状表现为头皮干枯涩滞，毛发焦黄稀疏，面颊凹陷，鼻梁干燥，脊柱隆起，身体消瘦，磨牙咬指甲，烦躁口渴，自汗出，口鼻及尿液发红，腹部胀大，午后潮热，极度嗜好瓜果、泥土、炭块等异物，体表则肢体生疮，这些都是疳症的征候。
疳症的纲领分为五类：脾疳、肺疳、心疳、肝疳、肾疳。至于具体的条目，无法详尽记录，姑且列举其主要类型，如脊疳、蛔疳、脑疳、丁奚疳、无辜疳、哺露疳。名称虽有上百种，但道理只有一种，只是表现出的症状不同，不外乎热、积、虫这三种病因罢了。查阅古代名方，有塌气丸、龙胆汤、芦荟丸、木香丸、胡黄连丸以及各种肥儿丸。这些方剂的理法端正，义理深远，疗效神奇，确实非仙家不能传授。因为后世医书在论述病症时含糊其辞，虽然流传了这些方子，却无人敢使用。比如张景岳在论述中认为，如果是气血两虚，必须大补，这固然是门外汉的胡乱揣测。即便是钱仲阳作为小儿科中的一代名医，却认为疳症都是因为脾胃虚损所致，这也是老生常谈，与疳症的本质有何关联？钱氏尚且如此，其他医者可想而知。我不惜苦口婆心，细细分析，既然病源已经明确，那么创制方剂者的苦心，或许得以向世人阐明。杨氏说：“疳者，干也。”我却说：“疳者，甘也。”因为奉养太过，肥甘厚味之物，郁结化为热邪，蒸腾而生虫，日久形成积滞，因此疳症由此得名。正因为有热邪，煎熬津液，肌肉因此消削；正因为形成积滞，肚腹胀大，饮食因此减少；正因为生出虫体，吮吸脏腑，所以偏嗜异物；侵蚀肢体，所以疮痒而不痛，种种症候，大半得之于富贵膏粱之家，吃粗茶淡饭的人，十中仅有一二。我云游以来，每见朱门子弟，反而不如居住在茅屋中的人精神饱满、元气充足。总归是饮食不节的缘故，何关乎元气的盛衰和脾胃的强弱。这是非常显著的事实。
在名方中，不离以黄连为君药，是为了清除其煎熬的热毒；使用芦荟、生地、山栀、青黛、胆草、黄柏，是为了清泻火邪；使用芜荑、榧子、川楝、雷丸、鹤虱、乌梅，是为了杀灭虫体；使用莪术、神曲、山楂、麦芽、青皮、木香，是为了消除积滞；使用干虾蟆、蟾酥，是以毒攻毒；使用夜明砂、五灵脂，是为了祛除瘀血而生成新血。有什么样的症状就使用什么样的药物，药性的寒凉与毒性，又有什么可怀疑的呢？我曾见到患此症的患者，请一个目不识丁的医生，有人猜测说：“莫不是疳症？”于是抓了一帖老师所传的治疳方子，侥幸奏效，但他原本不知道黄连的寒性，也不知道芜荑的毒性。又请一位读书明理的医生，明知是疳症，开口便说：“脾胃大亏，必须峻补。枯瘦的身体，怎能承受黄连的寒性和芜荑的毒性。”主人说：“这样稳妥。”却不知道热邪得到补益会更加炽盛；积滞得到补益会更加坚固；虫体得到补益会更多，以至于无法救治。这时却说：“这是命该如此。”这不是读书人的过错，是不善于读书人的过错。道高一尺，魔高一丈，说的就是这种情况吧？那么，不通过攻伐热、积、虫，就可以治疗疳症吗？不行。五疳有各自可见的症状，各种疳症又各有不同的表现，变化由心生，岂可拘泥固执。不过是胸有成竹，然后才能画好竹子。那么，治疗疳症只用攻法而完全没有补法吗？也不是。经书说：“用大毒药物治疗疾病，病去五六分即可。”观察热退、积减、虫安之后，对于穷途末路的病邪不要过分追击，或者调理脾胃，滋肾平肝，任由医生运用。
查阅古代名方：
（治腹胀大的塌气丸：白豆蔻、麦芽、五灵脂、砂仁、莪术、青皮、陈皮、榧子二钱，虾蟆三钱，米糊为丸。下虫丸：苦楝子皮酒浸焙干，贯众、槟榔、桃仁、木香、鹤虱，米糊为丸。木香丸治疳痢：黄连、木香、浓朴、夜明砂，生姜水为丸。大芜荑汤治小儿发热作渴，少食，大便不利，发黄脱落：芜荑、山栀、秦归、白术、云苓、柴胡、麻黄、羌活、防风、黄连、黄柏、炙甘草各二钱。四味肥儿丸治小儿食积五疳，目生云翳，牙龈腐烂：芜荑、神曲、麦芽、黄连，等分为末，猪胆汁为丸，绿豆大小。芦荟肥儿丸治热疳：芦荟、龙胆草、木香、人参、榧子、麦芽各二钱，土鳖虫去头足酥炙、槟榔、黄连各三钱，芜荑、胡黄连一钱，猪胆汁为丸，黍米大小。龙胆丸治疳脑热疮：龙胆草、升麻、苦楝根皮、赤茯苓、防风、芦荟、油发灰、青黛、黄连，炼蜜为丸。蟾酥丸治小儿头顶结核，面色黄瘦，饮食不甘，腹大发热：蟾蜍二三个，将粪蛆一杓，置桶中，以尿浸泡之，即将蟾蜍打死，投入蛆中食用，一昼夜，用布袋盛起，置于急流中过夜取出，瓦上焙干为末，入麝香少许，米为丸。）
A practitioner of the Dao, having no deep insight into the learning of the Sages, yet harboring such aspirations since youth, finds a kindred spirit. I have paid close attention to the condition of *Gan* (Infantile Malnutrition). Onset after the age of sixteen is termed "Lao" (Consumption); onset before the age of sixteen is termed "Gan". The symptoms include dry and rough scalp, scorched and sparse hair, sunken cheeks, dry nose, protruding spine, emaciated body, teeth grinding, nail biting, irritability, thirst, spontaneous sweating, redness of the mouth, nose, and urine, abdominal distension, tidal fever, intense craving for fruits, vegetables, mud, and charcoal, and sores on the limbs. These are the signs of Gan.
The general principles of Gan are categorized into five: Pi Gan (Spleen), Fei Gan (Lung), Xin Gan (Heart), Gan Gan (Liver), and Shen Gan (Kidney). The specific subtypes are too numerous to record exhaustively; here we mention only the main ones: Ji Gan (Spine), Hui Gan (Roundworm), Nao Gan (Brain), Ding Xi Gan, Wu Gu Gan, and Bu Lu Gan. Although there are hundreds of names, the underlying principle is one: the manifestations differ, but the etiology boils down to Heat, Accumulation, and Parasites. Ancient famous formulas include Ta Qi Wan (Collapse Qi Pill), Long Dan Tang (Gentian Decoction), Lu Hui Wan (Aloe Pill), Mu Xiang Wan (Costus Pill), Hu Huang Lian Wan (Coptis and Picrorhiza Pill), and various Fei Er Wan (Fatten Child Pills). Their rationale is sound, their meaning profound, and their efficacy miraculous; indeed, they are not transmitted except by immortals. However, later medical texts discuss these conditions ambiguously. Although the formulas are passed down, no one dares to use them. For instance, Zhang Jingyue argued that if there is deficiency of both Qi and Blood, massive tonification is necessary; this is undoubtedly speculation by an outsider. Even Qian Zhongyang, a renowned master in pediatrics, attributed all cases of Gan to damage of the Spleen and Stomach, which is merely cliché and irrelevant to the true nature of Gan. If Qian was like this, others can be imagined. I do not spare my tongue in detailed analysis; once the source of the disease is clear, the painstaking efforts of those who created the formulas may be elucidated to the world. Yang said, "Gan means dry." I say, "Gan means sweet/greasy." It arises because excessive indulgence in rich and sweet foods leads to stagnation transforming into Heat, steaming and generating Parasites, which over time form Accumulations, thus giving rise to Gan. Because of Heat, body fluids are scorched, causing muscles to waste away; because of Accumulation, the abdomen becomes distended, leading to reduced appetite; because of Parasites sucking on the Zang-Fu organs, there is pica (craving for strange objects); eroding the limbs causes itchy sores without pain. Such symptoms mostly occur in wealthy families enjoying rich diets, while only one or two out of ten among those eating coarse food suffer from it. Since my travels, I have often seen children of noble houses less vigorous and full of spirit than those living in thatched huts. This is entirely due to irregular diet, unrelated to the flourishing or decline of Yuan Qi (Primal Qi) or the strength of the Spleen and Stomach. This is a manifest fact.
In famous formulas, Coptis Rhizome (*Huanglian*) is often used as the sovereign herb to resolve the toxic heat caused by scorching; Aloe (*Lu Hui*), Rehmannia Root (*Shengdi*), Gardenia Fruit (*Shanzhi*), Indigo Naturalis (*Qingdai*), Gentian Root (*Danchao*), and Phellodendron Bark (*Huangbai*) are used to clear Fire; Turmeric Seed (*Wuyi*), Torrey Seed (*Junzi*), Toosendan Fruit (*Chuanliann*), Polyporus (*Leiwuan*), Chrysanthemum Seed (*Heshi*), and Mume Fruit (*Wumei*) are used to kill parasites; Curcuma Tuber (*Ezhu*), Medicated Leaven (*Shenqu*), Hawthorn Fruit (*Shanzha*), Barley Sprout (*Maiya*), Tangerine Peel (*Qingpi*), and Aucklandia Root (*Muxiang*) are used to resolve accumulation; Dried Toad (*Gan Xia Ma*) and Toad Venom (*Chansu*) are used to attack toxicity with toxicity; Owl Droppings (*Yeming Sha*) and Trogopterus Dung (*Wulingzhi*) are used to remove stasis and generate new blood. Where there are symptoms, there are corresponding medicines; what doubt could there be regarding the cold nature and toxicity of these herbs? I have seen patients with this condition consult illiterate doctors. Someone might guess, "Could it be Gan?" and prescribe a formula for Gan passed down by teachers, sometimes succeeding by chance, though the doctor knows nothing of the cold nature of Coptis or the toxicity of Turmeric Seed. Conversely, when consulting a literate physician who understands principles, knowing it is Gan, he opens his mouth saying, "The Spleen and Stomach are severely deficient; drastic tonification is required. How can a withered body withstand the cold of Coptis and the toxicity of Turmeric Seed?" The owner says, "This is safe." Unaware that tonification will intensify Heat, solidify Accumulation, and multiply Parasites, leading to untreatable conditions, they then say, "It is fate." This is not the fault of reading books, but of those who do not read well. As the saying goes, "When the Dao rises one foot, the demon rises ten feet," which applies here. So, can Gan be treated without attacking Heat, Accumulation, and Parasites? No. The Five Gans have specific visible symptoms, and various Gans have different manifestations; changes arise from the mind, how can one be rigid? One must have the bamboo in mind before painting it. So, should Gan be treated solely with attacking methods and no tonification? Also no. The Classics state: "When using highly toxic drugs to treat disease, stop when 50-60% of the disease is gone." Observe when Heat recedes, Accumulation reduces, and Parasites calm; do not pursue a desperate enemy excessively. Instead, regulate the Spleen and Stomach, nourish the Kidney, and level the Liver, leaving the application to the physician's discretion.
Ancient Famous Formulas:
(Ta Qi Wan for treating abdominal distension: White Cardamom Seed (*Baidoukou*), Barley Sprout (*Maiya*), Trogopterus Dung (*Wulingzhi*), Amomum Fruit (*Sharen*), Curcuma Tuber (*Ezhu*), Green Tangerine Peel (*Qingpi*), Aged Tangerine Peel (*Chenpi*), Torrey Seed (*Junzi*) 2 qian, Dried Toad (*Xia Ma*) 3 qian, made into pills with rice paste. Xia Chong Wan (Expel Parasite Pill): Bitter Prunus Root Bark (*Kuilanzi Pi*) soaked in wine and baked, Cyathula Root (*Guanzhong*), Areca Seed (*Binglang*), Peach Kernel (*Taoren*), Aucklandia Root (*Muxiang*), Chrysanthemum Seed (*Heshi*), made into pills with rice paste. Muxiang Wan treats Gan Dysentery: Coptis Rhizome (*Huanglian*), Aucklandia Root (*Muxiang*), Magnolia Bark (*Nongpu*), Owl Droppings (*Yeming Sha*), made into pills with ginger water. Da Wuyi Tang treats pediatric fever with thirst, poor appetite, constipation, yellowing, and hair loss: Turmeric Seed (*Wuyi*), Gardenia Fruit (*Shanzhi*), Angelica Sinensis (*Qin Gui*), Atractylodes Macrocephala Rhizome (*Baizhu*), Poria (*Yunling*), Bupleurum Root (*Chaihu*), Ephedra Stem (*Mahuang*), Notopterygium Rhizome (*Qianghuo*), Saposhnikovia Root (*Fangfeng*), Coptis Rhizome (*Huanglian*), Phellodendron Bark (*Huangbai*), Honey-fried Licorice Root (*Zhigancao*) each 2 qian. Si Wei Fei Er Wan treats pediatric food accumulation and Five Gans, cataracts on eyes, and rotting gums: Turmeric Seed (*Wuyi*), Medicated Leaven (*Shenqu*), Barley Sprout (*Maiya*), Coptis Rhizome (*Huanglian*), ground equally into powder, made into pills with pig bile, size of mung beans. Lu Hui Fei Er Wan treats Heat Gan: Aloe (*Lu Hui*), Gentian Root (*Longdancao*), Aucklandia Root (*Muxiang*), Ginseng Root (*Renshen*), Torrey Seed (*Junzi*), Barley Sprout (*Maiya*) each 2 qian, Eupolyphaga Steleophaga (*Tubie*) roasted with butter after removing head and feet, Areca Seed (*Binglang*), Coptis Rhizome (*Huanglian*) each 3 qian, Turmeric Seed (*Wuyi*), Picrorhiza Rhizome (*Huhuanglian*) 1 qian, made into pills with pig bile, size of millet seeds. Long Dan Wan treats Gan Brain Heat Sores: Gentian Root (*Longdancao*), Cimicifuga Rhizome (*Shengma*), Bitter Prunus Root Bark (*Kuilian Genpi*), Red Poria (*Chifuling*), Saposhnikovia Root (*Fangfeng*), Aloe (*Lu Hui*), Burnt Human Hair Oil (*Youfa Hui*), Indigo Naturalis (*Qingdai*), Coptis Rhizome (*Huanglian*), made into pills with refined honey. Chansu Wan treats pediatric cervical lymphadenitis, sallow and thin complexion, poor appetite, abdominal distension with fever: Two or three Toads (*Chanshu*), put a scoop of fly larvae in a bucket, soak in urine, beat the toads to death, throw them into the larvae to eat for one day and night, collect in a cloth bag, place in a swift stream overnight, take out, bake on tiles until dry, grind into powder, add a little Musk (*Shexiang*), make into pills with rice.)