（第二）
丹溪曰∶小儿脏腑娇嫩，饱则易伤。乳哺、饮食，一或失常，不为疳者鲜矣。皆因饮食
不调，肥甘无节而作也。或婴幼乳缺，粥饭太早，耗伤形气，则疳之根延及岁月，五疳病成。钱
氏曰∶疳皆脾胃耗伤，亡津液之所作也。故小儿脏腑柔脆，有疾不可痛击，大下必亡津液。凡有
可下，置量大小、虚实而下之，则不致为疳也。但见目涩或生白膜，唇赤身黄，喜冷地，
爱食泥土，泻痢无常，肚腹胀满，耳鼻生疮，头发作穗，脚弱项小，
极瘦，饮水，甚至丁奚哺露，有曰无辜，至于疳证，皆其候。
曾氏曰∶小儿疳证有五∶心、肝、脾、肺、肾是也。冷热者，初病尚肥，为热疳；久病
渐瘦，为冷疳。心疳者，切牙舒舌，舌上生疮，爱饮凉水，唇红面赤，喜卧地上是也。肝疳者，
目多眵泪，在脸多青，或目睛微黄，泄泻清水如苔色是也。脾疳者，爱吃泥土冷物，饮食无度，
身面俱黄，发稀作穗，头大项小，腹胀脚软，间或酿泻肌瘦，夜热，不思乳食是也。肺疳者，
鼻下黑烂，口有腥气，或作喘嗽，右腮光白是也。肾疳者，两耳内外生疮，脚如鹤膝，头缝
不合，或不能行，牙齿生迟，其缝臭烂，传为走马牙疳之类是也。热疳多在外鼻下臭烂，头上
有疮绕耳，不结痂是也。冷疳多在内，目肿，腹胀，痢色无常，或泻清沫，削瘦是也。
（第二条）
朱丹溪说：小儿的脏腑娇嫩，饱食后容易受伤。哺乳和饮食，一旦失去节制，不患疳证的很少了。这都是因为饮食不调，肥甘厚味没有节制而造成的。或者婴幼儿乳食不足，过早食用粥饭，耗伤形体和气，那么疳证的根源就会延续岁月，形成五脏疳病。钱乙说：疳证都是脾胃耗伤，津液亡失所导致的。所以小儿脏腑柔脆，有病时不可猛烈攻下，如果峻下必然导致津液亡失。凡是可以用下法的情况，要斟酌大小、虚实来使用下法，就不会导致疳证了。只要见到眼睛干涩或生白膜，嘴唇红赤身体发黄，喜欢睡凉地，爱吃泥土，腹泻痢疾无常，肚腹胀满，耳鼻生疮，头发结成穗状，脚弱项细，极度消瘦，饮水不止，甚至出现丁奚疳、哺露疳，有的称为无辜疳，至于疳证的各种表现，都是这些征候。
曾世荣说：小儿疳证有五种：心、肝、脾、肺、肾是也。分冷热者，初起病时身体尚胖，属于热疳；久病逐渐消瘦，属于冷疳。心疳的表现是：咬牙伸舌，舌上生疮，爱喝凉水，嘴唇红面颊赤，喜欢躺在地上。肝疳的表现是：眼屎多且流泪，眼睑颜色发青，或者眼珠微黄，腹泻清水如苔色。脾疳的表现是：爱吃泥土和冷物，饮食无度，全身面目俱黄，头发稀疏结成穗状，头大项小，腹胀脚软，有时酿成泄泻肌肉消瘦，夜间发热，不想吃奶和食物。肺疳的表现是：鼻子下方黑烂，口中有腥气，或者出现气喘咳嗽，右腮光白。肾疳的表现是：两耳内外生疮，脚像鹤膝，头骨缝不合，或者不能行走，牙齿生长迟缓，骨缝处臭烂，传染成为走马牙疳之类。热疳多在外部，表现为鼻下臭烂，头上有疮绕耳，不结痂。冷疳多在内部，表现为目肿，腹胀，痢疾颜色无常，或者泻出清稀泡沫，消瘦。
(Second)
Zhu Danxi stated: The zang-fu organs of infants and children are delicate, and they are easily injured when overfed. Regarding breastfeeding and diet, if there is any irregularity, few will not develop gan syndrome (pediatric malnutrition). This is all caused by dietary imbalance and lack of restraint in consuming rich, sweet, and fatty foods. Or, due to insufficient breast milk in infancy or introducing porridge and rice too early, the physical form and qi are depleted. Consequently, the root of gan syndrome extends over years, leading to the formation of five types of gan involving the zang organs. Qian Yi stated: Gan syndromes are all caused by the depletion of the spleen and stomach and the loss of body fluids. Therefore, because the zang-fu organs of infants and children are soft and brittle, diseases should not be treated with harsh purgation; severe purging will inevitably lead to the loss of body fluids. Whenever purgation is indicated, one must weigh the size and constitution (deficiency or excess) before administering it, so as to avoid inducing gan syndrome. One should observe signs such as dry eyes or the appearance of a white membrane on the cornea, red lips and yellowish skin, a preference for lying on cool ground, pica (eating dirt), irregular diarrhea or dysentery, abdominal distension and fullness, sores on the ears and nose, hair matted into tufts, weak legs and a thin neck, extreme emaciation, excessive thirst, and even conditions known as Dingxi gan (severe wasting with distended abdomen) or Bulu gan (wasting with exposed ribs). Some are called Wugu gan (innocent gan); these are all manifestations of gan syndrome.
Zeng Shirong stated: There are five types of pediatric gan syndrome: those affecting the Heart, Liver, Spleen, Lung, and Kidney. Differentiating by cold and heat: if the child was plump at the onset of illness, it is classified as Heat Gan; if the child becomes progressively emaciated after a long duration of illness, it is classified as Cold Gan.
Heart Gan manifests as grinding teeth and protruding the tongue, sores on the tongue, a desire to drink cold water, red lips and flushed face, and a preference for lying on the ground.
Liver Gan manifests as excessive eye discharge and tearing, bluish discoloration of the eyelids, slightly yellowish eyeballs, and diarrhea of clear fluid resembling moss color.
Spleen Gan manifests as craving dirt and cold substances, uncontrolled eating, yellowing of the whole body and face, sparse hair matted into tufts, large head with a thin neck, abdominal distension and weak legs, sometimes progressing to chronic diarrhea and muscle wasting, night fever, and anorexia for milk and food.
Lung Gan manifests as blackened and ulcerated skin under the nose, foul breath, or wheezing and coughing, and a pale, shiny right cheek.
Kidney Gan manifests as sores inside and outside both ears, legs resembling "crane's knees" (knee joint swelling with thigh atrophy), unfused cranial sutures, inability to walk, delayed tooth eruption, and foul-smelling, rotting sutures, which may transmit to become Gangrenous Gum Disease (Zouma Yagan).
Heat Gan mostly presents externally, characterized by foul-smelling ulcers under the nose, sores around the ears on the head that do not scab over.
Cold Gan mostly presents internally, characterized by swollen eyes, abdominal distension, variable colors in dysenteric stools, or passage of clear frothy stool, and emaciation.