钱氏曰疳者皆脾胃病亡津液之所作也(云云)疳在内目肿腹胀利色无常或沫青白渐瘦弱此
冷证
也疳在外鼻不赤烂自揉鼻头上有疮不着痂渐绕耳生疮治鼻疮烂兰香散诸疮白粉散治之五脏
疳筋疳骨疳(形证详见本论)
洁古曰疳者小儿病癖或久吐泻医者妄投转过之药小儿易为虚实致之胃虚而亡失津液内发
虚热
外消肌肉一脏虚则诸脏皆弱其病目胞肿腹胀利色无常渐加瘦瘁久不痊可是肠胃有风积法当用
宣风散导之后各根据本脏补其母
大抵小儿疳病肌羸血气不足同大人痨瘵之疾
按疳证惟钱氏论中最详(宜玩本文)
钱氏曰积痛口中气温面黄白目无精光或白睛多及多睡畏食或大便酸臭者当磨积宜消积丸
甚者
当白饼子下之后和胃 虫痛面 白心腹痛口中沫及清水出发痛有时安虫散主之小儿本怯者多
此病积痛食痛虚痛大同小异惟虫痛当口淡而沫自出
按小儿腹痛亦有伤冷食乳物及湿热欲作痢而痛或发痧疹痛者皆宜详悉
钱氏曰腹中有癖不食但饮乳是也当渐用白饼子下之小儿病癖由乳食不消伏在腹中乍凉乍
热饮水或
喘嗽与潮热相类不早治必成疳以其有癖则令儿不食致脾胃虚而发热故引饮水过多即荡涤脾胃
亡失津液脾胃不能传化水谷其脉沉细益不食脾胃虚衰四肢不举诸邪遂生羸瘦而成疳矣
钱乙说：疳证都是脾胃病变，因津液耗伤而形成的。（原文省略部分）疳证病位在里的，表现为眼睑肿胀、腹部胀满、腹泻、面色无常或口吐青白色泡沫，身体逐渐消瘦虚弱，这属于寒证。疳证病位在外的，表现为鼻子不红烂，患儿自行揉搓鼻子，鼻头上长疮且不结痂，逐渐蔓延至耳周生疮，治疗鼻部疮烂用兰香散，其他疮疡用白粉散治疗。五脏疳、筋疳、骨疳（具体形证详见本论）。
张元素（洁古）说：疳证是小儿患癖积，或因长期呕吐腹泻，医生误投攻伐药物，导致小儿虚实错杂，致使胃气虚弱而津液丧失，内发虚热，外消肌肉。一脏虚弱则诸脏皆弱。其病症表现为眼睑肿胀、腹部胀满、腹泻、面色无常，逐渐消瘦憔悴，久治不愈。这是肠胃有风积，治法应当先用宣风散导滞，之后根据本脏情况补益其母脏。
钱乙说：积痛表现为口中气温、面色黄白、目光无神、嗜睡、畏食，或大便酸臭者，应当磨积，宜用消积丸。病情严重的，当用白饼子攻下，之后调和胃气。虫痛表现为面色苍白、心腹疼痛、口中流沫及清水，发作有时，安虫散主治。小儿体质怯弱者多患此病。积痛、食痛、虚痛大同小异，只有虫痛表现为口淡且口水自出。
按语：小儿腹痛也有因伤冷食乳物，以及湿热欲作痢疾而痛，或发痧疹而痛者，都应当详细辨别。
钱乙说：腹中有癖积，表现为不吃饭只喝奶，这就是癖积。应当逐渐用白饼子攻下。小儿患癖积是因为乳食不消化，伏滞在腹中，出现乍凉乍热、饮水或喘嗽，症状与潮热相似。如果不早治，必成疳证。因为有癖积导致小儿不进食，致使脾胃虚弱而发热，所以引饮过多，进而荡涤脾胃，耗失津液。脾胃不能传化水谷，脉象沉细，更加不进食。脾胃虚衰，四肢无力举动，各种邪气遂生，身体羸瘦而成疳证。
Qian Yi stated: Gan syndrome (Pediatric Malnutrition) is a disease of the Spleen and Stomach, caused by the depletion of body fluids. (Omitted text) When Gan is internal, symptoms include swollen eyelids, abdominal distension, diarrhea, variable complexion, or spitting out blue-white froth, with gradual emaciation and weakness; this is a Cold syndrome. When Gan is external, the nose is not red or ulcerated, the child rubs their nose, sores appear on the tip of the nose without forming scabs, and sores gradually develop around the ears. For nasal ulcers, Lanxiang San (Orchid Fragrance Powder) is used; for other sores, Baifen San (White Powder) is used. Zang-Fu Gan, Sinew Gan, and Bone Gan are described in detail in the main treatise.
Zhang Yuansu (Jiegu) stated: Gan syndrome occurs in children with Pi accumulation (Abdominal Masses), or due to prolonged vomiting and diarrhea, where physicians erroneously administer purgative drugs. Children are prone to deficiency-excess patterns, leading to Stomach Qi deficiency and loss of body fluids. This generates internal Deficient Heat and causes external muscle wasting. If one Zang-Fu is deficient, all others become weak. Symptoms include swollen eyelids, abdominal distension, diarrhea, variable complexion, and gradual emaciation and decline. If it persists without cure, it indicates Wind accumulation in the intestines and stomach. The treatment method should first use Xuanfeng San (Disperse Wind Powder) to guide out stagnation, followed by tonifying the mother organ according to the specific deficient Zang-Fu.
Generally speaking, pediatric Gan syndrome involves emaciated muscles and insufficient Qi and Blood, similar to Tuberculous Consumption (Lao Zhai) in adults.
Note: Among discussions on Gan syndrome, Qian Yi's treatise is the most detailed (the original text should be studied carefully).
Qian Yi stated: Accumulation pain presents with warm breath, yellowish-white complexion, dull eyesight, excessive sleepiness, aversion to food, or sour-smelling stool. In such cases, digestion should be promoted using Xiaoji Wan (Eliminate Accumulation Pill). For severe cases, Baixingzi (White Cake) should be used to purge, followed by harmonizing the Stomach. Worm pain presents with pale complexion, heart and abdominal pain, spitting of froth and clear fluid, and intermittent pain. Anchong San (Calming Worms Powder) is the primary prescription. Children with naturally timid constitutions are prone to this disease. Accumulation pain, Food stagnation pain, and Deficiency pain are largely similar, whereas Worm pain is characterized by a bland taste in the mouth and spontaneous flow of saliva.
Note: Pediatric abdominal pain can also result from cold food or milk injury, damp-heat impending dysentery, or eruptive diseases like sand-rash; these must be distinguished in detail.
Qian Yi stated: Abdominal Pi accumulation manifests as refusal to eat solid food but willingness to drink breast milk. It should be gradually treated with Baixingzi (White Cake) to purge. Pediatric Pi accumulation arises from undigested milk and food lodging in the abdomen, causing alternating chills and fever, drinking water, or wheezing and coughing, resembling tidal fever. If not treated early, it will inevitably develop into Gan syndrome. Because Pi accumulation prevents eating, Spleen and Stomach deficiency leads to fever, causing excessive thirst and drinking. This washes out the Spleen and Stomach, depleting body fluids. The Spleen and Stomach fail to transform and transport water and grain, resulting in a deep and fine pulse and further anorexia. With Spleen and Stomach deficiency and collapse, the limbs cannot move, various pathogenic factors arise, leading to emaciation and the formation of Gan syndrome.