疳证。此小儿科之极病也。虽有五脏之不同。其实皆脾胃之病也。幼科书论诸疳。
太多。法无经验。无可取者。唯钱氏分肥瘦冷热四者。庶为近理。而以初病者为肥热疳。久
病者为瘦冷疳。似有虚实之分。不知疳为虚证。曾有实者乎。至于治瘦冷疳。方上有续随子
。未免虚实之失。故予尝曰。钱氏方论。非先生之亲笔。乃门人附会之说也。今乃推先生之
意以补之。曰儿太饱则伤胃。太饥则伤脾。肥热疳。其食多太饱之病乎。瘦冷疳。其食少太
饥之病乎。如审其食少者肥儿丸。食多者集圣丸主之。
小儿乳少者。父母常以他物饲之。儿之性只求一饱。或食太多。或食太少。所以脾胃受
伤。生此疳病也。
蕲水陆陈巷李广之妻。程希南之女也。新寡。止有一女。初病疟又病痢。瘦。发热少食
啖莲肉五六枚。请予往治之。予与集圣丸。时有江西一医万鼎在彼。曰难治。鼎尝问予运气
之说。予详教之。彼本不知。唯唯耳。予谓鼎曰。明年二三月。来看此女之长大也。次年三
月半。其母在程氏宅。请予谢之。命其女拜。云。小女服后。一日改变一日。非昔日比也。
庠生王闲一子周岁。因食猪肉受伤。肢体瘦削。使人求药。予问其详。乃食积疳。似有
余。取脾积丸五粒与之。教以猪肉汤吞下。果下一块如小指头大。涎沫夹裹。其子顿安。
集圣丸 治疳通用。丹溪心法。黄连干蟾三钱。余味皆二钱。
黄连 干蟾（炙存性） 青皮 陈皮 莪术 使君子 砂仁（各一钱八分） 芦荟 夜明砂
五灵脂（各二钱三分） 归身（疳痨加） 川芎（各三钱） 木香（一钱八分）
又集圣丸方。使君子 干蟾 黄连 前胡 莪荟 木香 青皮 灵脂 夜明砂 缩砂
二钱） 当归（钱半） 川芎（一钱二分） 增胆汁 粟米糊丸。米饮吞。脾弱加肥儿丸并为末。粟米
粉作糊丸。入猪胆汁。丸如粟米大。米饮下。
王三峰长子患疳瘦。请予治之。见之曰。此乳少病也。父曰。乳极多。予即辞退。归谓
胡三溪云。王子病疳。乃乳少也。彼云乳多。不听吾言。今成疳矣。时胡会川在座。闻言而
退。后三溪云。病者会川之婿。闻兄之言。不悦而归。予曰。非也。必往邀三峰兄同来也。
少顷果同至。三峰自诉云。我南监坐监时。一子病疳死。今此子病。我心甚虑。今特来登问
。此儿讨个乳母养。有乳无乳。实不知也。今夜归家看子细。明日来报。果无乳也。日则嚼
饭喂。夜则一壶冷米汤灌之。柰何。予曰。不易乳母。治之无功。易之则儿恋其乳母之爱。
母根据其儿衣食之计。请权择乳母佐之。昼则抱之。夜则乳之。自然日久情熟。事两全矣。乃
作肥儿丸一料服之。两月而安。
肥儿丸
人参 白术 白茯苓 炙甘草 陈皮 青皮 山药 莲肉 当归 川芎 使君子 为末
。神曲糊丸。米饮下。
胡凤崖子病疳。但多食则腹痛。请予治之。予曰。人以谷为本。谷入作痛。岂新谷作痛
必有旧谷为积。未能消去。故与新谷相持也。岂有绝谷食之理。乃作养脾消积丸服之。安。
养脾消积丸
钱氏异功散（即四君子汤加陈皮）加木香 青皮 砂仁 使君子 枳实（炒） 黄连（炒）
上共为末。神曲糊丸。米饮下。
疳证。这是小儿科中最为严重的疾病。虽然涉及五脏的不同表现，但本质上都是脾胃的疾病。儿科书籍中关于各种疳证的论述太多，治疗方法缺乏实效，没有值得采纳的。只有钱乙将疳证分为肥、瘦、冷、热四类，比较接近医理。他将初病者归为肥热疳，久病者归为瘦冷疳，似乎有虚实之分。却不知道疳证属于虚证，哪里会有实证呢？至于治疗瘦冷疳的方剂中含有续随子，未免犯了虚实辨治的错误。所以我曾说：钱乙的方论，不是他亲笔所写，而是门人附会之说。现在我推演钱乙的本意来补充说明：婴儿吃得太饱则伤胃，太饿则伤脾。肥热疳，难道是吃得多、过饱导致的疾病吗？瘦冷疳，难道是吃得少、过饥导致的疾病吗？如果仔细审察，饮食少的用肥儿丸（Fei'er Wan, Fatty Child Pill），饮食多的用集圣丸（Jisheng Wan, Jisheng Pill）为主治之。
乳汁不足的小儿，父母常用其他食物喂养。孩子的天性只求吃饱，或者吃得太多，或者吃得太少，因此脾胃受伤，生出这种疳病。
蕲水陆陈巷李广的妻子，是程希南的女儿。刚守寡，只有一个女儿。起初患疟疾又患痢疾，身体消瘦，发热，食欲减退。她只吃五六枚莲子，请我去诊治。我给了集圣丸。当时江西有一位医生万鼎在那里，说难治。万鼎曾向我请教五运六气的理论，我详细地教了他。他本来不懂，只是点头称是。我对万鼎说：“明年二三月，来看这个女孩长大。”次年三月半，她的母亲在程家宅邸，请我去致谢，让女儿拜谢。她说：“小女服药后，一天比一天好转，与往日不同。”
庠生王闲的儿子周岁时，因吃猪肉受伤，肢体瘦削，派人求药。我问明详情，原来是食积疳（Food Accumulation Gan Syndrome），看似有余邪，给他五粒脾积丸（Pi Ji Wan, Spleen Accumulation Pill），教他用猪肉汤吞服。果然排出一块如小指头大小的积滞物，裹挟着涎沫，孩子顿时安宁。
集圣丸：治疗疳证通用。出自《丹溪心法》。黄连三钱，干蟾三钱，其余药材均为二钱。
黄连、干蟾（炙至存性）、青皮、陈皮、莪术、使君子、砂仁（各一钱八分）、芦荟、夜明砂、五灵脂（各二钱三分）、当归身（疳痨加）、川芎（各三钱）、木香（一钱八分）。
另一集圣丸方：使君子、干蟾、黄连、前胡、莪术、木香、青皮、五灵脂、夜明砂、缩砂仁（二钱）、当归（一钱半）、川芎（一钱二分）。增加猪胆汁，用粟米糊制成丸剂，米饮送服。若脾弱，加肥儿丸，共为细末，用粟米粉做糊丸，加入猪胆汁，丸如粟米大，米饮送下。
王三峰的长子患疳瘦，请我去诊治。我看后说：“这是乳汁不足导致的疾病。”父亲说：“乳汁极多。”我便告辞离去。回家后对胡三溪说：“王子患疳，是因为乳汁不足。他说乳汁多，不听我的话，现在已成疳证了。”当时胡会川在座，听后便退席离开。后来胡三溪说：“患病者是胡会川的女婿，听到我的话，不高兴就回去了。”我说：“不对，他一定会去邀请王三峰兄一起来。”过了一会儿，果然一同到来。王三峰自己诉说：“我在南京国子监坐监时，一个儿子患疳死了。现在这个儿子病了，我心里非常忧虑。今天特意来登门询问。想给这孩子找个乳母抚养，有没有乳汁，实在不知道。”当晚回家看仔细，第二天来报告，确实没有乳汁。白天嚼饭喂，晚上灌一壶冷米汤。怎么办？我说：“不更换乳母，治疗不会有效果。换了的话，孩子依恋乳母的爱，乳母也顾及孩子的衣食生计。请暂时选择一位乳母辅助照顾。白天抱着，晚上喂奶。自然日久情熟，两全其美。”于是开了一料肥儿丸服用，两个月后痊愈。
肥儿丸：人参、白术、白茯苓、炙甘草、陈皮、青皮、山药、莲肉、当归、川芎、使君子。为细末，用神曲糊制成丸剂，米饮送服。
胡凤崖的儿子患疳，但多吃则腹痛，请我去诊治。我说：“人以谷物为本，谷物入腹作痛，这一定是新吃的谷物与旧的积滞相持，未能消除。哪有绝食的道理。”于是制作养脾消积丸（Yangpi Xiaoji Wan, Spleen-Nourishing and Accumulation-Resolving Pill）让他服用，痊愈。
养脾消积丸：钱氏异功散（即四君子汤加陈皮），加木香、青皮、砂仁、使君子、枳实（炒）、黄连（炒）。以上共为细末，用神曲糊制成丸剂，米饮送服。
Gan syndrome (Pediatric wasting disease). This is the most severe condition in pediatrics. Although it manifests differently across the five Zang organs, its essence is a disorder of the Spleen and Stomach. Pediatric texts contain excessive discussions on various types of Gan, and their treatment methods lack empirical efficacy, leaving nothing worthy of adoption. Only Qian Yi’s classification of Gan into four categories—plump (Fei), thin (Shou), cold (Leng), and hot (Re)—is relatively close to medical logic. He categorized early-stage cases as Plump-Hot Gan and late-stage cases as Thin-Cold Gan, seemingly distinguishing between excess and deficiency. However, one must not forget that Gan is a deficiency syndrome; where could there be an excess syndrome? Furthermore, the prescription for treating Thin-Cold Gan contains Euphorbia lathyris (Xusui Zi), which inevitably commits an error in distinguishing between excess and deficiency. Thus, I have often stated: Qian Yi’s prescriptions and theories were not written by him personally but are later interpolations by his disciples. Now, inferring Qian Yi’s original intent to supplement this, we say: If an infant eats too much, the Stomach is injured; if it eats too little, the Spleen is injured. Is Plump-Hot Gan caused by overeating and satiety? Is Thin-Cold Gan caused by undereating and hunger? Upon careful examination, Gan caused by insufficient food intake should be treated primarily with Fei'er Wan (Fatty Child Pill), while Gan caused by excessive food intake should be treated primarily with Jisheng Wan (Jisheng Pill).
For infants with insufficient breast milk, parents often feed them other substances. Children’s nature seeks only satiety; thus, they may eat too much or too little. Consequently, the Spleen and Stomach are injured, giving rise to this Gan disease.
The wife of Li Guang from Luchenchang, Qishui, was the daughter of Cheng Xinan. Having recently become a widow, she had only one daughter. Initially suffering from malaria and then dysentery, the child became emaciated, developed fever, and had poor appetite. She consumed only five or six lotus seeds. Her mother requested my treatment. I prescribed Jisheng Wan. At that time, a physician named Wan Ding from Jiangxi was present, stating that the case was difficult to treat. Wan Ding had previously asked me about the theory of Five Movements and Six Qi (Wu Yun Liu Qi), and I instructed him in detail. He originally knew nothing of it and merely nodded in agreement. I told Wan Ding, "Come back in February or March next year to see how this girl has grown." In mid-March of the following year, her mother invited me to her residence at the Cheng family estate to express gratitude and had her daughter pay respects. The mother said, "After taking the medicine, my daughter improved day by day; she is no longer like before."
The son of Xiangsheng Wang Xian, aged one year, suffered injury from eating pork, resulting in emaciation of the limbs. His family sent for medicine. Upon inquiry, I determined it was Food Accumulation Gan Syndrome, appearing as an excess pattern. I gave him five pills of Pi Ji Wan (Spleen Accumulation Pill) and instructed him to swallow them with pork soup. Indeed, he passed a piece of accumulation the size of a little finger, wrapped in saliva, and the child immediately felt relief.
Jisheng Wan: A general prescription for treating Gan. From *Danxi Xinfa*. Coptis Rhizome (Huanglian) 3 qian, Dried Toad Skin (Ganchan) 3 qian; all other ingredients are 2 qian.
Coptis Rhizome (Huanglian), Dried Toad Skin (Ganchan) [roasted until carbonized but retaining nature], Citrus Peel (Qingpi), Tangerine Peel (Chenpi), Curcuma Tuber (Ezhu), Quassia Fruit (Shijunzi), Amomum Fruit (Sharen) [each 1.8 qian], Aloe (Luhui), Owl Droppings (Yeming Sha), Trogopterus Dung (Wulingzhi) [each 2.3 qian], Angelica Sinensis Root (Guishen) [add for Gan Lao], Ligusticum Rhizome (Chuanxiong) [each 3 qian], Aucklandia Root (Muxiang) [1.8 qian].
Another formula for Jisheng Wan: Quassia Fruit (Shijunzi), Dried Toad Skin (Ganchan), Coptis Rhizome (Huanglian), Peucedanum Root (Qianhu), Curcuma Tuber (Ezhu), Aucklandia Root (Muxiang), Citrus Peel (Qingpi), Trogopterus Dung (Lingzhi), Owl Droppings (Yeming Sha), Amomum Fruit (Suosha) [2 qian], Angelica Sinensis Root (Danggui) [1.5 qian], Ligusticum Rhizome (Chuanxiong) [1.2 qian]. Add pig bile. Form pills using millet paste. Administer with rice water. For weak Spleen, add Fei'er Wan. Grind all into powder. Use millet flour paste to form pills. Add pig bile. Make pills the size of millet grains. Administer with rice water.
The eldest son of Wang Sanfeng suffered from Gan-related emaciation and requested treatment. Upon examination, I said, "This is caused by insufficient breast milk." The father replied, "There is abundant milk." I then withdrew. Later, I told Hu Sanxi, "Prince Wang’s illness is due to insufficient milk. He claims there is plenty and did not listen to me; now he has developed Gan." At that time, Hu Huichuan was present and left upon hearing this. Later, Hu Sanxi reported, "The patient is Hu Huichuan’s son-in-law. He heard your words and returned displeased." I said, "Incorrect. He will certainly come to invite Brother Sanfeng." Shortly after, they arrived together. Wang Sanfeng confessed, "When I was detained at the Nanjing Imperial Academy, one of my sons died of Gan. Now that this son is ill, I am deeply worried. I came specifically to inquire. I wish to find a wet nurse for this child. Whether there is milk or not, I truly do not know." That night, I checked carefully and reported the next day that indeed, there was no milk. During the day, chewed rice was fed; at night, a pot of cold rice soup was poured in. What should be done? I said, "Without changing the wet nurse, treatment will be ineffective. If changed, the child will cling to the affection of the new wet nurse, and the wet nurse will consider the livelihood provided by the child. Please temporarily select a wet nurse to assist. Hold the child during the day and breastfeed at night. Naturally, through time, affection will deepen, achieving a perfect outcome." Thus, one dose of Fei'er Wan was prescribed. After two months, the child recovered.
Fei'er Wan: Ginseng Radix (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), Poria (Baifuling), Licorice Root (Zhi Gancao), Tangerine Peel (Chenpi), Citrus Peel (Qingpi), Chinese Yam (Shanyao), Lotus Seed (Lianrou), Angelica Sinensis Root (Danggui), Ligusticum Rhizome (Chuanxiong), Quassia Fruit (Shijunzi). Grind into powder. Form pills using Medicated Leaven (Shenqu) paste. Administer with rice water.
The son of Hu Fengya suffered from Gan but experienced abdominal pain when eating too much. He requested treatment. I said, "Humans rely on grain as their foundation. Pain upon ingestion implies that new grain is clashing with old accumulated residue that has not been eliminated. There is no rationale for abstaining from grain entirely." Thus, I prepared Yangpi Xiaoji Wan (Spleen-Nourishing and Accumulation-Resolving Pill) for him to take, and he recovered.
Yangpi Xiaoji Wan: Qian’s Yigong San (which is Si Jun Zi Tang plus Chenpi), added with Aucklandia Root (Muxiang), Citrus Peel (Qingpi), Amomum Fruit (Sharen), Quassia Fruit (Shijunzi), Immature Bitter Orange (Zhishi) [stir-fried], Coptis Rhizome (Huanglian) [stir-fried]. Grind all above into powder. Form pills using Medicated Leaven (Shenqu) paste. Administer with rice water.