为虚实，脾虚不受寒温，服寒则生冷，服温则生热，当识此而勿误。是果非幼幼之
网领乎。上医处此，消积和胃，滋血调气，随顺药饵以扶之，淡薄饮食以养之，荣
卫调和，脏腑自然充实，一或过焉，君子未保其往也。取积之法，又当权衡，积者，
疳之母，由积而虚，谓之疳极，诸有积者，无不肚热脚冷，须酌量虚实而取之，若
积而虚甚，则先与扶胃，使胃气内充，然后为之微利，若积胜乎虚，则先与利
导，才得一泄，急以和胃之剂为之扶虚，然取积虽当疏利，如白豆蔻、萝卜子、缩
砂、蓬术、消积等辈，亦不可无。胁间癖痛，亦虚中之积也，先寒后热，饮水不食，
或因饮水以致喘嗽，钱氏有癖为潮热之说，治法解散寒热，即与下癖。合是而观，
发作不同，疗治不一，又可无权度于此哉。〔曾〕大抵疳之为病，皆因过餐饮食，
于脾家一脏有积不治，传之余脏而成五疳之疾，若脾家病去，则余脏皆安，苟失其
治，日久必有传变，然脾家病，宜芦荟丸、沉香槟榔丸（积），或水晶丹（积）、乌犀丸（积），
更察虚实疗之。有虫者投使君子丸（腹痛）、化虫饮（腹痛）。如心腹痛，吐清水，虫自下，
多投二圣丸（腹痛）。诸疳证皆宜用《局方》五疳保童丸或万应丸常服，化积治疳，仍各
投本脏调理之剂，宁心用茯神汤（惊悸），调肝用 归汤，调脾用参苓白术散（不乳食），补肺
用补肺散（咳嗽），补肾用调元散，庶各得其宜，则前证不致再作。〔演山〕积是疳之
母，所以有积不治，乃成疳候。又有治积不下其积，存而脏虚，成疳尤重。大抵小
儿所患疳证，泄泻无时，不作风候者何？惟疳泻名热泻，其脏腑转动有限，所以不
成风候，虽泻不风，亦转他证，作渴虚热，烦躁下痢，肿满喘急，皆疳候虚证，古
云疳虚用补虚，是知疳之为疾，不可更利动脏腑。发作之初名曰疳气。腹大胀急名
曰疳虚。泻痢频并名曰疳积。五心虚烦名曰疳热。毛焦发穗，肚大青筋，好吃异物，
名曰疳极（受病传脏已极）。热发往来，形体枯槁，面无神采，无血色，名曰疳劳。手足细
小，项长骨露，尻臀无肉，肚胀脐突，名曰丁奚。食加呕哕，头骨分开，作渴引饮，
虫从口出，名曰哺露。此皆疳候。又因多食生冷，甘粘肥腻，积滞中脘不化，久亦
成疳。治疳之法，量候轻重，理其脏腑，和其中脘，顺其三焦，使胃气温而纳食，
益脾元壮以消化，则脏腑自然调贴，令气脉与血脉相参，壮筋力与骨力俱健，神清
气爽，疳消虫化，渐次安愈。若以药攻之五脏，疏却肠胃，下去积毒，取出虫子，
虽曰医疗，即非治法，盖小儿脏腑虚则生虫，虚则积滞，虚则疳羸，虚则胀满，何
更利下，若更转动肠胃致虚，由虚成疳，疳虚证候，乃作无辜，无辜之孩，难救矣。
〔薛〕疳者，干也，因脾胃津液干涸而患，在小儿为五疳，在大人为五劳，总以调补胃气为主。
后列诸方，其证候庞杂，不能名为何等疳者，即于通治诸疳方内检之，若证候
的与五疳等条下证候对者，即检本疳方，分寒热虚实，择而用之，常须识此，勿令误也。
辨别虚实，脾虚则不能耐受寒性或温性的药物，服用寒性药会产生生冷之弊，服用温性药会产生热性之弊，应当明白这一点而不要误治。这难道是《幼幼新书》的纲领吗？高明的医生处理这种情况，采用消积导滞、调和胃气的方法，滋养血液、调理气机，顺应药性来扶助正气，用清淡饮食来调养身体，使营卫调和，脏腑自然充实，一旦过度治疗，君子也不能保证病情不恶化。消除积滞的方法，又应当权衡利弊，积滞是疳证的母病，由积滞导致虚弱，称为疳极，所有有积滞的患者，无不出现肚热脚冷的症状，必须斟酌虚实情况来消除积滞，如果积滞伴随极度虚弱，则先给予扶正养胃的药物，使胃气内部充盈，然后才进行轻微的通利；如果积滞胜过虚弱，则先给予通利引导的药物，刚获得一次排泄，立即用和胃的药物来扶助虚弱。然而消除积滞虽然应当疏利，如白豆蔻、萝卜子（莱菔子）、缩砂仁、蓬术（莪术）、消积散等类药物，也不可缺少。胁肋间有癖块疼痛，也是虚证中的积滞，先恶寒后发热，饮水但不进食，或者因为饮水导致喘咳，钱乙有癖证引起潮热的说法，治疗方法是解散寒热，随即给予攻下癖块的方剂。综合这些情况来看，发作不同，治疗各异，又怎能在这里没有权衡标准呢？〔曾氏〕大抵疳证这种病，都是因为过食饮食，在脾脏这一脏有积滞不治疗，传变到其他脏腑而形成五疳的疾病，如果脾脏的病去除了，那么其他脏腑都安宁，假如失去治疗，日久必然会有传变，然而脾脏的病，适宜用芦荟丸、沉香槟榔丸（针对积滞），或者水晶丹（针对积滞）、乌犀丸（针对积滞），再观察虚实情况进行治疗。有虫者投用使君子丸（针对腹痛）、化虫饮（针对腹痛）。如果心腹疼痛，吐出清水，虫子自行排出，多投用二圣丸（针对腹痛）。各种疳证都适宜服用《局方》的五疳保童丸或万应丸常服，以化积治疳，同时分别投用调理本脏的方剂，宁心用茯神汤（针对惊悸），调肝用四物汤，调脾用参苓白术散（针对不乳食），补肺用补肺散（针对咳嗽），补肾用调元散，这样各得其宜，前面的证候就不会再次发作。〔演山〕积滞是疳证的母病，所以有积滞不治疗，就形成疳证候。又有治疗积滞不能消除其积滞，反而留存且导致脏腑虚弱，形成的疳证尤其严重。大抵小儿所患疳证，泄泻无时，为什么不表现为风证候呢？只有疳泻称为热泻，其脏腑转动有限，所以不成风证候，虽然腹泻但不生风，也会转变成其他证候，出现口渴、虚热、烦躁、下痢、肿满、喘急等症状，都是疳证的虚证表现，古人说疳虚用补虚法，这是知道疳这种病，不可再使用利下法扰动脏腑。发作之初名为疳气。腹部胀大紧急名为疳虚。泻痢频繁并见名为疳积。五心烦热名为疳热。毛发焦枯发穗状，肚子大青筋暴露，喜欢吃异物，名为疳极（受病传脏已至极点）。热势往来，形体枯槁，面无神采，无血色，名为疳劳。手足细小，脖子长骨头露出，尻臀无肉，肚子胀脐部突出，名为丁奚。进食加重呕吐哕逆，头骨分开，口渴引饮，虫子从口出，名为哺露。这些都是疳证候。又因为多吃生冷、甘甜粘腻肥厚之物，积滞在中脘不消化，久了也形成疳证。治疗疳证的方法，衡量证候轻重，调理其脏腑，和中脘，顺三焦，使胃气温和而能纳食，增强脾元壮实以助消化，则脏腑自然调顺，令气脉与血脉相参合，强壮筋力与骨力俱健，神清气爽，疳消虫化，逐渐安愈。如果用药物攻伐五脏，疏泄肠胃，下去积毒，取出虫子，虽然说是在医疗，但这并非正确的治法，大概小儿脏腑虚弱则生虫，虚弱则积滞，虚弱则疳羸瘦，虚弱则胀满，为何还要再用利下法，如果再转动肠胃导致更虚，由虚成疳，疳虚证候，就变成无辜疳，无辜疳的小孩，难以救治了。〔薛己〕疳，就是干的意思，因为脾胃津液干涸而患病，在小儿为五疳，在大人为五劳，总以调补胃气为主。后面列举的各种方剂，其证候庞杂，不能命名为何种疳的，就在通治诸疳的方剂内查找，如果证候确实与五疳等条下的证候对应的，就查找本疳的方剂，分寒热虚实，选择而用之，常常需要明白这一点，不要令误治。
To distinguish between deficiency and excess: when the Spleen is deficient, it cannot tolerate cold or warm properties in herbs; administering cold-natured herbs generates coldness, while warm-natured herbs generate heat. One must understand this to avoid errors. Is this not the guiding principle of *Youyou Xinshu* (New Book for Infants and Children)? A superior physician handling this situation employs methods to resolve accumulation and harmonize the Stomach, nourish Blood and regulate Qi, supporting the body with appropriate medicinal aids and nurturing it with bland diets. When Ying and Wei (Nutritive and Defensive Qi) are harmonized, the Zang-Fu organs naturally become full and robust. If treatment is excessive, even a gentleman cannot guarantee that the condition will not deteriorate. The method for removing accumulation requires weighing pros and cons. Accumulation is the mother of Gan syndrome (malnutrition due to malabsorption); when accumulation leads to deficiency, it is called "Gan Ji" (Extreme Gan). All patients with accumulation exhibit hot abdomen and cold feet. One must assess deficiency and excess to remove accumulation. If accumulation coexists with severe deficiency, first administer herbs to support the Stomach and fill its Qi internally, then proceed with mild purgation. If accumulation outweighs deficiency, first use directing and purging agents; immediately after one evacuation, urgently apply stomach-harmonizing formulas to support deficiency. Although resolving accumulation requires疏导 and purgation, herbs such as Bai Dou Kou (Cardamomi Fructus Albus), Luo Bo Zi (Raphani Semen), Suo Sha (Amomi Fructus Rotundus), Peng Zhu (Curcumae Rhizoma), and Xiao Ji San (Accumulation-Resolving Powder) should not be omitted. Pain from masses in the hypochondrium is also an accumulation within deficiency, presenting with initial chills followed by fever, drinking but not eating, or wheezing and coughing induced by drinking water. Qian Yi stated that masses cause tidal fever; the treatment involves dispersing cold and heat, followed by purging the mass. Observing these cases together, although manifestations differ and treatments vary, how can there be no standard for judgment here? [Zeng] Generally, Gan disease arises from overeating. If accumulation in the Spleen is left untreated, it transmits to other Zang organs, forming the Five Gans. If the Spleen's pathology is resolved, the other organs remain peaceful. Neglecting treatment leads to transmission over time. For Spleen pathology, Lu Hui Wan (Aloe Pill), Chen Xiang Bing Lang Wan (Aucklandia and Areca Nut Pill) for accumulation, Shui Jing Dan (Crystal Pill) for accumulation, or Wu Xi Wan (Black Rhinoceros Horn Pill) for accumulation are suitable, adjusted according to deficiency and excess. For cases with parasites, Shi Jun Zi Wan (Quisqualis Pill) for abdominal pain or Hua Chong Yin (Parasite-Dissolving Drink) for abdominal pain are administered. If epigastric/abdominal pain occurs with vomiting clear fluid and spontaneous expulsion of worms, Er Sheng Wan (Two Sages Pill) for abdominal pain is frequently used. All Gan syndromes benefit from regular intake of Wu Gan Bao Tong Wan (Five Gans Child-Preserving Pill) or Wan Ying Wan (Ten Thousand Responses Pill) from *Ju Fang*. To resolve accumulation and treat Gan, simultaneously administer formulas to regulate the respective organ: Fu Shen Tang (Poria Decoction) for calming the Heart (palpitations/anxiety), Si Wu Tang (Four Substances Decoction) for regulating the Liver, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for regulating the Spleen (failure to nurse/eat), Bu Fei San (Lung-Supplementing Powder) for tonifying the Lung (cough), and Diao Yuan San (Origin-Regulating Powder) for tonifying the Kidney. This ensures appropriateness, preventing recurrence. [Yanshan] Accumulation is the mother of Gan; thus, untreated accumulation becomes Gan syndrome. Furthermore, if accumulation treatment fails to eliminate the accumulation and instead preserves it while weakening the Zang organs, the resulting Gan is particularly severe. Generally, pediatric Gan presents with uncontrolled diarrhea. Why does it not manifest as wind syndrome? Only Gan diarrhea is termed "heat diarrhea"; its Zang-Fu movement is limited, so it does not become wind. Although it causes diarrhea without wind, it may transform into other syndromes: thirst, empty heat, irritability, dysentery, edema, distension, and急促 breathing are all deficiency signs of Gan. Ancient texts state that Gan deficiency requires tonification, indicating that Gan should not be treated with purgatives that disturb the Zang-Fu. Early onset is called Gan Qi (Gan Qi Syndrome). Abdominal distension and urgency is Gan Xu (Gan Deficiency Syndrome). Frequent diarrhea and dysentery is Gan Ji (Gan Accumulation Syndrome). Empty vexation in the five hearts is Gan Re (Gan Heat Syndrome). Dry, bristly hair, large abdomen with visible veins, and pica are Gan Ji (Extreme Gan, where disease has reached the extremity of transmission). Alternating fever, emaciation, lackluster complexion, and pallor are Gan Lao (Gan Consumption Syndrome). Small hands and feet, long neck with exposed bones, fleshless buttocks, abdominal distension, and protruding umbilicus are Ding Xi (Ding Xi Syndrome). Worsening vomiting/regurgitation upon eating, separated cranial sutures, intense thirst, and worms exiting the mouth are Bu Lu (Bu Lu Syndrome). These are all Gan manifestations. Excessive consumption of raw/cold, sweet/sticky/greasy foods causes stagnation in the Middle Jiao that fails to digest, eventually forming Gan. Treatment of Gan involves assessing severity, regulating Zang-Fu, harmonizing the Middle Jiao, and smoothing the Triple Burner, so that Stomach Qi becomes warm to accept food, and Spleen Yuan is strengthened to aid digestion. Consequently, Zang-Fu harmonize, Qi and Blood vessels integrate, sinews and bones strengthen, spirit clears, Gan resolves, worms dissipate, and gradual recovery ensues. Using drugs to attack the Five Zang, purge intestines, expel toxic accumulation, or extract worms constitutes medical intervention but not correct therapy. Pediatric Zang-Fu deficiency generates worms, stagnation, emaciation, and distension. Why use purgatives again? Further disturbing the intestines increases deficiency, leading to Gan. If Gan deficiency manifests as Wu Gu Gan (Innocent Gan), the child is difficult to save. [Xue] Gan means dryness; it arises from the depletion of Spleen and Stomach fluids. In children, it is the Five Gans; in adults, the Five Labors. The primary approach is always to regulate and tonify Stomach Qi. The following formulas address complex syndromes not fitting specific Gan categories; consult general Gan formulas. If symptoms match those under the Five Gans headings, select the specific Gan formula, differentiating cold, heat, deficiency, and excess. Keep this in mind to avoid errors.