二十以上其症为痨，二十以下其症为疳，总皆气血虚损，同出而异名也。有因幼
少乳食，肠胃未充，食物太早，耗伤真气而成者；有因肥甘肆进，饮食过餐，积滞日
久，面黄肌削而成者；有因乳母寒热不调，或喜怒房劳之后，乳哺而成者；有因病后失
调，元气未复而成者；如身体虽肥润，而内气如火，善饥善渴，小便赤色，此为骨蒸。
继此朝凉夜热而即成疳。若平时小便变色，或黄赤恶臭，淋闭溺难，混浊如米泔者，此
为漫白。于此失治，则阴阳不分，为泻为痢；渴热不去，为疟为淋，而变成疳。论脏
则有五疳，成疳又有时候。如春日眼目多痛，吐痢频频，疮虫泻痢，白膜遮睛，筋青
脑热，此乃风瘠之候。风疳者，肝脏受热所致，甚至肉削骨露，眼成雀盲，左胁结硬，
频频吐涎，眼角有黑气者，死。如夏日身发壮热，脸赤唇红，舌疮眼赤，五心昏热，胸
膈烦闷，盗汗频渴。小便赤涩，口中苦燥，此乃惊疳之候。惊疳者，心脏受热所致，甚
至热消津液，饮水不已，食则惊啼，舌上黯黑，形容柘枯槁者，死。如面黄肢热，泻下
酸臭减食餐泥，腹大脚细，吐逆中满，水谷不化，睛黄眼肿，合面昏睡，此乃食疳之
候。食疳者，脾经受伤所致，又名肥疳。甚至吃土不已，泻痢频频，水谷难消，饮食恶
进，面黄肌削，唇白腹高，人中平满者，死。如秋日发热恶寒，鼻下两傍湿疮赤痒，
咳嗽不已，咽喉哑痛，毛焦气胀，喘急多饥，此乃气疳之候。气疳者，壅热伤肺所
致，甚至面加枯骨，咳逆气促，泻频白沫，身上粟生斑黑者，死。如内症，则脑热肚
痛，寒热往来，滑泄频频，口臭干湿，耳内疮脓，外症则身体壮热，足冷如冰，面黧爪
黑，疮疥肌削齿断口疮，俗名走马，盖齿属肾，肾气一虚，则虚火壅于上焦，故乃口
臭，名曰臭息。继此齿黑，名曰崩砂，更若龈烂，名曰溃槽。如热血逆出，名曰宣露。
甚至牙为脱落，名曰腐根。其根既腐，病纵得痊，齿不可再，此乃急疳之候。急疳者，
肾疳也。一名骨疳，乃肾脏久受伤损所致，甚至饮水好咸，小便如乳，耳焦牙黑骨枯
者，死。又有冷疳者，多渴溏泻，好卧冷地，减食咳逆，目肿面黧，体软唇坚，肚大
筋青，眼膜羞明，身瘦肢冷是也。又有肥热疳者，身体肥热，焦渴自汗，酷喜瓜果，肚
胀肠鸣，尿白泻酸睡多啼，善食灰土炭米等物是也。精液既耗，脏腑枯槁，则燥渴不
已，名为疳渴。中气不足健运失常，泻痢久作，名为疳泻、疳痢。五心烦躁，毛长皮
枯，胸骨高起，时时咳嗽，名为疳嗽。又有烟疳，是因乳哺不调，食肉太早，停蓄肠胃
而为虫，其候皱眉多啼，腹痛吐沫，肚胀青筋，唇口紫黑，肠头作痒，然症类似脾疳。
又有脊疳，乃虫食脊膂身热羸瘦，烦痛下痢，齿啮爪甲，肚腹如鼓鸣，脊骨如锯齿，
十指生疮，其症类似肚疳。又有脑疳，头皮光急，头疮如饼，头热如火，发结如穗，囟
门肿高，是因脑中素受风热，或难产，或临产多欲所致耳，然症类似心疳。又疳肿胀
者，是因虚中有积，故令肚胀紧胀，脾又受湿，故四肢头面皆浮也。又疳痨者，肚胀脐
突，肉削骨露，潮热往来，五心烦热，盗汗喘嗽，骨蒸枯悴，而生疮疥是也，又有干疳
者，谓五脏津液枯竭也。又有无辜疳者，因浣衣夜露，为无辜落羽所污，小儿服之令身
体发热，日渐黄瘦，便痢脓血者是也。《心鉴》曰∶其脑后项边有核如弹，按之转动，
软而不痛，其间有虫如米粉，如有速破而去之，则虫随热气流散，遍体主疮，一入脏
腑，便痢脓血，须以银针刺破，贴以膏药可也。其自然疳者，起于久痢久泄，久热久
寒，久渴久吐久汗久疟，久嗽久血久淋而成也，其丁奚者，手足极细，项小骨高，尻削
体痿，腹大脐突，号哭胸陷，乃生谷HT ，其哺露者，虚热往来，头骨分开，翻食吐
虫，烦渴呕哕，柴骨枯露，总因脾胃虚弱，不能传水谷以资精血，是以精血枯涸，肌肤
桔黯而成也。更有疳虫或如发丝，或如马尾，出于头顶腹背之间，黄白及赤者，生。
紫黑青者，死。又有冷热疳者，外则卧地烦躁，内则滑泄无时，肌肉日削，饮食渐减是
也，然治寒以温，治热以凉，此用药之常法，殊不知疳之受病，皆虚所致，即热者，
亦虚中之热，寒者，亦虚中之寒，积者，亦虚中之积。故治积不可峻取，治寒不可骤
温，治热不可过凉。虽积者，疳之母，而治疳先于去积，然遇虚极者而迅攻之，则积未
去，而疳愈危矣。故壮者，先去积而后扶胃气；衰者，先扶胃气而后利之。书曰∶壮人
无积，虚则有之。可见虚为积之本，积反为虚之标也。如恶食滑泻，脚心不知痛痒，乳
食直下，牙龈黑烂，头项软倒，舌白喘促，四肢厥冷，干呕寒噎，下痢肿胀，刺痛气短
耳。焦肩耸面，色如银肚，硬如石皮发紫疮，鹤膝解颅，粪门如筒，肌肉青黑，口舌
臭烂，口吐黑血，吐利蛔虫，流涎臭秽者，并皆不治。
二十岁以上发病称为“痨”，二十岁以下发病称为“疳”，总归都是气血虚损，只是名称不同罢了。有的因为年幼时乳食不当，肠胃尚未充实，过早进食固体食物，耗伤真气而形成的；有的因为肥甘厚味肆意进补，饮食过量，积滞日久，导致面色发黄、肌肉消瘦而形成的；有的因为乳母寒热不调，或在喜怒、房事之后哺乳，从而形成的；有的因为病后调理失当，元气未恢复而形成的。如果身体虽然肥胖润泽，但体内热气如火，容易饥饿且口渴，小便颜色红赤，这叫做“骨蒸”。接着出现早晨凉爽、夜间发热，随即形成疳症。如果平时小便颜色改变，或黄赤恶臭，淋漓闭塞、排尿困难，浑浊如米泔水，这叫做“漫白”。在此阶段治疗失误，则阴阳失调，表现为泄泻或痢疾；渴热不退，表现为疟疾或淋证，进而演变成疳症。
论及脏腑，则有五疳，形成疳症也有特定的时令规律。如春季眼睛多痛，频繁呕吐和痢疾，疮虫引起的泄痢，白膜遮盖眼球，筋脉青紫、头脑发热，这是“风疳”的征候。风疳是由肝脏受热所致，严重时肌肉削瘦、骨骼外露，眼睛变成雀盲（夜盲），左胁部结块坚硬，频繁吐涎沫，眼角有黑气的，预后不良致死。如夏季身体发出高热，脸红唇红，舌生疮疡、眼睛发红，手心脚心及心胸昏热，胸膈烦闷，盗汗且频繁口渴，小便赤涩，口中苦燥，这是“惊疳”的征候。惊疳是由心脏受热所致，严重时热邪消耗津液，饮水不止，进食时惊恐啼哭，舌色黯黑，形体枯槁的，预后不良致死。如面色黄、四肢热，排泄物酸臭、食欲减退甚至吃泥土，腹部大、小腿细，呕吐逆气、中脘胀满，水谷不消化，眼珠黄、眼睑肿，侧卧昏睡，这是“食疳”的征候。食疳是由脾经受伤所致，又叫做“肥疳”。严重时不停吃土，频繁泄痢，水谷难消，厌恶饮食，面色黄肌肉瘦，嘴唇白、腹部高突，人中穴平满的，预后不良致死。
如秋季发热恶寒，鼻子两侧湿疮红痒，咳嗽不止，咽喉哑痛，毛发焦枯、气胀，气喘急促且多饥，这是“气疳”的征候。气疳是由壅滞的热邪损伤肺脏所致，严重时面部像枯骨一样，咳嗽气促，频繁腹泻白色泡沫，身上生出粟粒状黑斑的，预后不良致死。如内症表现为头脑热、肚子痛，寒热往来，频繁滑泄，口臭干湿不均，耳内有疮流脓；外症表现为身体高热，脚冷如冰，面色黧黑、指甲发黑，疮疥丛生、肌肉消瘦、牙齿断裂、口舌生疮，俗名“走马疳”。盖因牙齿属于肾，肾气一虚，虚火壅塞于上焦，所以口臭，名叫“臭息”。接着牙齿变黑，名叫“崩砂”；再若牙龈腐烂，名叫“溃槽”；如果热血逆流溢出，名叫“宣露”；甚至牙齿脱落，名叫“腐根”。牙根既已腐烂，即使病愈，牙齿也无法再生，这是“急疳”的征候。急疳就是肾疳，又名“骨疳”，是肾脏长期受伤损耗所致，严重时喜欢喝咸水，小便如乳汁，耳朵焦枯、牙齿黑、骨骼干枯的，预后不良致死。
又有“冷疳”，表现为多渴、稀溏腹泻，喜欢睡在凉地上，食欲减退、咳嗽气逆，眼睛肿、面色黧黑，身体软弱、嘴唇僵硬，肚子大、筋脉青紫，眼睑怕光，身体瘦、四肢冷。又有“肥热疳”，表现为身体肥胖发热，焦渴自汗，酷爱瓜果，肚胀肠鸣，尿白、泻下酸臭、嗜睡啼哭，喜欢吃灰土、炭末、米粒等异物。精液既然耗竭，脏腑枯槁，则燥渴不已，名叫“疳渴”。中气不足，健运失常，泄痢久作，名叫“疳泻”、“疳痢”。五心烦躁，毛发长而皮肤枯，胸骨高起，时时咳嗽，名叫“疳嗽”。
又有“烟疳”，是因为乳哺不调，吃肉太早，停滞蓄积在肠胃化为虫，其征候为皱眉多啼，腹痛吐沫，肚胀青筋，唇口紫黑，肛门瘙痒，然而症状类似脾疳。又有“脊疳”，是虫蚀脊柱，身体发热、羸瘦，烦痛下痢，咬指甲，肚子腹如鼓鸣，脊骨如锯齿，十指生疮，其症状类似肚疳。又有“脑疳”，头皮光亮紧绷，头疮如饼，头热如火，头发结成穗状，囟门肿高，这是因为脑中素受风热，或难产，或临产时母亲纵欲所致，然而症状类似心疳。又有“疳肿胀”，是因为虚中有积，所以令肚子紧胀，脾又受湿，所以四肢头面皆浮肿。又有“疳痨”，表现为肚胀脐突，肉削骨露，潮热往来，五心烦热，盗汗喘嗽，骨蒸枯悴，而生疮疥。又有“干疳”，是指五脏津液枯竭。又有“无辜疳”，是因为浣衣时夜间露水打湿，被无辜鸟落下的羽毛污染，小儿服食后令身体发热，日渐黄瘦，便痢脓血。《心鉴》说：其后脑项边有核如弹丸，按压转动，软而不痛，其中有虫如米粉，如果有此情况应速破去之，则虫随热气流散，遍体主疮，一旦入脏腑，便痢脓血，需用银针刺破，贴以膏药即可。
所谓“自然疳”，起于久痢、久泄、久热、久寒、久渴、久吐、久汗、久疟、久嗽、久血、久淋而成。其中“丁奚疳”，手足极细，脖子小骨头高，臀部削瘦、身体痿弱，腹部大、脐突，号哭时胸部凹陷，乃因脾胃不能运化水谷，名为“生谷疳”。“哺露疳”，虚热往来，头骨分开，翻胃吐虫，烦渴呕哕，柴骨枯露，总因脾胃虚弱，不能传化水谷以滋养精血，是以精血枯涸，肌肤枯暗而成。更有疳虫，或如发丝，或如马尾，出于头顶腹背之间，黄色、白色及红色的，可生；紫色、黑色、青色的，死。又有“冷热疳”，外则卧地烦躁，内则滑泄无时，肌肉日削，饮食渐减。然而治寒用温法，治热用凉法，这是用药的常法，殊不知疳症的致病原因，皆由虚所致，即热者，也是虚中之热；寒者，也是虚中之寒；积者，也是虚中之积。所以治积不可峻猛攻取，治寒不可骤然温补，治热不可过于寒凉。虽然积是疳之母，而治疳先于去积，然而遇到极度虚弱者而迅速攻伐，则积未去，而疳症更危重了。所以体质壮实者，先去积而后扶助胃气；体质衰弱者，先扶助胃气而后利导积滞。书曰：壮人无积，虚则有之。可见虚是积的根本，积反是虚的表现。如厌恶饮食、滑泄，脚心不知痛痒，乳食直下，牙龈黑烂，头项软弱倒伏，舌白喘促，四肢厥冷，干呕寒噎，下痢肿胀，刺痛气短，焦肩耸面，面色如银肚，硬如石皮发紫疮，鹤膝解颅，粪门如筒，肌肉青黑，口舌臭烂，口吐黑血，吐利蛔虫，流涎臭秽者，都属于不治之症。
Those over twenty years of age manifest as *Lao* (Consumption Disease), while those under twenty manifest as *Gan* (Childhood Malnutrition Syndrome); both are fundamentally due to deficiency and damage of Qi and Blood, differing only in name. Some arise from improper breastfeeding or early introduction of solid foods in infancy, when the intestines and stomach are not yet fully developed, leading to consumption of true Qi; some result from excessive intake of rich and sweet foods, causing long-standing stagnation, yellowish complexion, and emaciation; some stem from the nursing mother's imbalance of cold and heat, or nursing after emotional turmoil or sexual activity; others occur due to inadequate post-illness recovery where Yuan Qi has not restored. If the body appears plump but internal heat burns like fire, with polyphagia and polydipsia, and dark red urine, this is called *Gu Zheng* (Bone-steaming Fever). This progresses to morning coolness and night fever, eventually forming *Gan*. If urine color changes, becoming yellow-red, foul-smelling, difficult to pass, or turbid like rice water, this is called *Man Bai* (Diffuse White). Failure to treat at this stage leads to Yin-Yang disharmony, resulting in diarrhea or dysentery; persistent thirst and heat lead to malaria or strangury, transforming into *Gan*.
Regarding the Zang organs, there are Five *Gans*, each associated with specific seasons. In spring, eye pain, frequent vomiting and dysentery, parasitic diarrhea, white membranes covering the eyes, cyanotic tendons, and head heat indicate *Feng Gan* (Wind Gan). *Feng Gan* is caused by liver heat; severe cases show muscle wasting, bone exposure, nyctalopia (night blindness), hard masses in the left hypochondrium, frequent salivation, and black qi at the eye corners, which is fatal. In summer, high fever, flushed face and lips, tongue sores, red eyes, heat in the five centers, chest oppression, spontaneous night sweats, frequent thirst, dark scanty urine, and bitter dry mouth indicate *Jing Gan* (Startle Gan). *Jing Gan* is caused by heart heat; severe cases involve fluid depletion, incessant drinking, startled crying upon eating, dark tongue, and withered appearance, which is fatal. In autumn, yellowish face, limb heat, sour-smelling diarrhea, anorexia, pica (eating dirt), distended abdomen with thin legs, vomiting, epigastric fullness, undigested food, yellow sclera, swollen eyelids, and side-sleeping coma indicate *Shi Gan* (Food Gan). *Shi Gan* results from spleen meridian injury, also known as *Fei Gan* (Fat Gan). Severe cases involve compulsive earth-eating, frequent dysentery, indigestion, aversion to food, yellow face, emaciation, white lips, distended abdomen, and flat philtrum, which is fatal.
In late autumn, fever with aversion to cold, wet sores on both sides of the nose, chronic cough, hoarse painful throat, brittle hair, abdominal distension, wheezing, and polyphagia indicate *Qi Gan* (Qi Gan). *Qi Gan* is caused by obstructive heat damaging the lungs; severe cases show a skeletal face, cough with shortness of breath, frequent white frothy diarrhea, and millet-like black spots on the body, which is fatal. Internal symptoms include head heat, abdominal pain, alternating chills and fever, frequent slippery diarrhea, halitosis, ear abscesses; external symptoms include high fever, ice-cold feet, sallow complexion, black nails, skin sores, emaciation, broken teeth, and oral ulcers, commonly called *Zou Ma Gan* (Running Horse Gan). Since teeth belong to the Kidney, Kidney Qi deficiency allows deficient fire to congest the Upper Jiao, causing halitosis (*Chou Xi*). Subsequent blackening of teeth is *Beng Sha*; gum erosion is *Kui Cao*; bleeding gums are *Xuan Lu*; tooth loss is *Fu Gen*. Once roots rot, teeth cannot regrow even if cured; this is *Ji Gan* (Urgent Gan), also *Shen Gan* (Kidney Gan) or *Gu Gan* (Bone Gan), caused by long-term kidney damage. Severe cases involve craving salty water, milky urine, burnt ears, black teeth, and dry bones, which is fatal.
*Cold Gan* presents with polydipsia, loose stools, preference for lying on cold surfaces, reduced appetite, cough, edematous eyes, sallow face, flaccid body, stiff lips, large abdomen, cyanotic veins, photophobia, emaciation, and cold limbs. *Fei Re Gan* (Fat-Heat Gan) presents with obesity and heat, intense thirst, spontaneous sweating, craving fruits/vegetables, abdominal distension, borborygmus, white urine, sour diarrhea, lethargy, crying, and pica (eating ash, charcoal, rice). Exhaustion of essence and fluids leads to organ withering and unrelenting thirst, named *Gan Ke* (Gan Thirst). Spleen-Stomach Qi deficiency failing to transport nutrients causes chronic diarrhea/dysentery, named *Gan Xie* (Gan Diarrhea) and *Gan Li* (Gan Dysentery). Five-center irritability, coarse hair, dry skin, prominent sternum, and chronic cough are named *Gan Sou* (Gan Cough).
*Yan Gan* (Smoke Gan) arises from improper feeding and early meat consumption, causing stagnation and parasites; symptoms include frowning, crying, abdominal pain, salivation, distension, cyanotic lips/mouth, and anal itching, resembling Spleen Gan. *Ji Gan* (Spine Gan) involves parasites eating the spine, fever, emaciation, pain, dysentery, nail-biting, drum-like abdomen, serrated spine, and finger sores, resembling Abdominal Gan. *Nao Gan* (Brain Gan) features tight shiny scalp, pancake-like head sores, burning head heat, matted hair, bulging fontanelle, caused by wind-heat in the brain, difficult labor, or maternal excess during pregnancy, resembling Heart Gan. *Gan Zhong Zhang* (Gan Edema) results from deficiency with accumulation causing tight abdominal distension, and spleen dampness causing facial/limb edema. *Gan Lao* (Gan Consumption) features abdominal distension, protruding umbilicus, emaciation, tidal fever, five-center heat, night sweats, cough, bone-steaming, and sores. *Gan Gan* (Dry Gan) refers to exhaustion of fluids in the five Zang organs. *Wu Gu Gan* (Innocent Gan) is caused by contamination from innocent bird feathers during laundry, leading to fever, jaundice, emaciation, and bloody/purulent stool. The *Xin Jian* states: nodules like peas behind the neck, movable, soft, painless, containing rice-flour-like worms, should be punctured quickly to disperse worms via heat flow; otherwise, worms enter organs causing dysentery. Silver needle puncture and plaster application are indicated.
*Natural Gan* arises from chronic conditions: prolonged dysentery, diarrhea, fever, cold, thirst, vomiting, sweating, malaria, cough, blood disorders, or strangury. *Ding Xi Gan* features extremely thin limbs, small neck with prominent bones, wasted buttocks, flaccid body, large abdomen, protruding umbilicus, and sunken chest when crying, due to spleen-stomach failure to transform grain, named *Sheng Gu Gan* (Grain-Generating Gan). *Bu Lu Gan* features alternating deficient heat, separated cranial sutures, regurgitation of worms, irritability, thirst, vomiting, withered ribs, due to spleen-stomach weakness failing to nourish essence/blood, leading to withered skin. Parasites may appear between head and back, resembling hair or horse tails; yellow/white/red indicate survival; purple/black/blue indicate death. *Cold-Heat Gan* features lying on ground irritably externally, frequent slippery diarrhea internally, daily muscle wasting, and reduced diet. While cold is treated with warmth and heat with cooling, Gan pathology is rooted in deficiency: heat is deficient-heat, cold is deficient-cold, accumulation is deficient-accumulation. Thus, accumulation should not be aggressively purged, cold not abruptly warmed, heat not overly cooled. Although accumulation is the mother of Gan, treating Gan requires addressing accumulation; however, in extreme deficiency, rapid attack worsens the condition. Robust patients: purge accumulation then support Stomach Qi; weak patients: support Stomach Qi then drain accumulation. Texts state: robust people have no accumulation, only the deficient do. Deficiency is the root; accumulation is the branch. Symptoms like anorexia, slippery diarrhea, insensitivity of soles, undigested food passage, black rotten gums, flopping head/neck, white tongue, panting, cold limbs, dry heaving, cold shivering, dysenteric swelling, stabbing pain, shortness of breath, hunched shoulders, silver-like face, stone-hard purple skin, genu valgum, craniotabes, tubular anus, black-green muscles, foul oral ulcers, hematemesis, passing roundworms, and foul drooling are all untreatable.