疳者，干也，脾胃津液干涸而成。又甘也，恣食甘甜，成积生虫。积者，疳之母，有而不治乃成疳候。积久不除，
脏虚成疳。又久病后不节饮食，或泻后脾虚，积热布五脏，积湿生虫亦成疳。儿为五疳，大人为五劳也。劳瘵肾虚，
津髓枯竭。疳症脾虚，津液枯干，病久相传，五脏皆损。疳病眼涩，多因爱吃泥土、生米、桴炭等，喜卧冷地，身
多疥癣，下痢青白及沫血，腹大青筋，耳鼻口生疮，虫痛叫哭，发穗，头大项小，脚手垂 瘦瘠，饮水筋痿骨重，体骨
如柴等，皆内无津液，脾胃受伤。又大病后或吐或泻，后妄施吐下，津液枯竭而得之。有因热症大汗大痢无禁，胃中
焦燥得之。有因伤寒里症冷驶太过，渴饮水浆变而成热，热气未散复于他染得之。又有癖病寒邪热胁下痛硬，不渐消
磨，以 砂巴豆峻攻津液，暴伤得之者。又有肝疳则膜遮睛，当补肝。心疳面颊赤，壮热；脾疳体黄，腹大好吃泥土；
肺疳气喘，口鼻生疮，此虚者当补其母。肾疳体瘦，生疮疥。筋疳泻血，瘦弱；骨疳喜卧冷地；肉疳目肿腹胀，痢青
色白色或沫，渐瘦弱，外症鼻下赤烂，自搔鼻头，疮不结痂，绕目生疮。诸疳皆根据本脏而补母，则子自安。积久生虫，
皱眉多啼吐沫，腹痛肚大，青筋，唇紫黑，肠头痒为蛔疳，宜川楝、鹤虱等。头皮光，急生疮，脑热发穗，多汗囟高
为脑疳，宜龙胆草、苦楝皮、芦荟、黄连、青黛等。心肺壅热，烦渴乳食少，夜则渴止，为渴疳，宜龙胆草、乌梅、黄
连等。毛焦唇白，额上青纹，腹胀肠鸣，泄下糟粕为疳泻，至于频下恶物为疳痢，宜白术、桔梗、浓朴、白芍等。虚
中有积，肚胀，头面四肢皆肿，痢下腥臭为疳肿，宜芦荟、大腹皮、卜子、滑石、车前子等。潮
热，五心烦热，盗汗，喘嗽，骨蒸枯悴为疳劳，宜黄 、白芍、川芎、肉蔻、生地、人参、白术、鳖甲等。疳虫上
蚀齿龈，口疮出血，齿色紫黑，下蚀肠胃，下痢肚烂，湿痒生疮，齿属肾，肾虚热，疳气直奔上焦，名走马疳。初
日息臭齿黑，名崩砂。甚则龈烂，名溃糟。热血迸出，名宣露。更甚者牙落，名腐根。腐根虽活，齿不生矣，而况
焉能活乎？手足细，项小骨高，尻削体痿，腹大脐突，号哭胸陷，是为丁奚，虚热食哕，颅开骨槁如柴，引饮，虫
从口出，日渐枯槁，是为哺露，又重于丁奚。消疳，芦荟、干蟾、五灵脂、鳖甲。化积，枳实、蓬术、青皮、山楂、
三棱、神曲、麦芽。健脾，人参、白术、浓朴、香附。清热，柴胡、黄连、胡黄连、银柴胡、龙胆草、地骨皮、连
翘、青黛。杀虫，雷丸、芜荑、苦楝根、鹤虱、使君子。疳泻，木香、肉蔻、诃子、砂仁。五脏疳方虽见论中，然
亦当用前药，佐以五脏本药，不必拘安神地黄丸方也。五脏本药开后。
心疳∶茯神、黄连、远志、琥珀、芦荟、钩藤、石菖蒲。
肝疳∶生地、熟地、青黛、地骨皮、龙胆草。
脾疳∶白术、陈皮、黄连。
肺疳∶黄芩、桔梗、连翘、天冬、麦冬、防风、桑白皮。
肾疳∶熟地、泽泻、山茱萸、牡丹皮。
疳症，名称源于“干”，是指脾胃津液枯竭而形成的病症。又通“甘”，指恣意食用甘甜食物，导致积滞并滋生虫邪。积滞是疳症的根源，有积滞而不加治疗就会演变为疳症候。积滞日久不除，导致脏腑虚弱而成疳症。此外，久病之后饮食不节制，或腹泻后脾气虚弱，积热散布于五脏，积湿生虫，也会形成疳症。小儿患五疳，大人患五劳。劳瘵（虚劳结核）因肾虚，导致津液和骨髓枯竭。疳症因脾虚，导致津液枯干，病情长久传变，五脏皆受损。
疳病的症状包括眼睛干涩，多因爱吃泥土、生米、草木灰等异物，喜欢睡在冷地上，身上多有疥癣，下痢排出青色白色及泡沫带血的粪便，腹部胀大且可见青筋暴露，耳鼻口生疮，因虫痛而叫哭，头发稀疏如穗状，头大项细，手脚瘦弱，身体消瘦，饮水后筋脉萎软、骨骼沉重，身体骨瘦如柴等，这些都是因为体内缺乏津液，脾胃受到损伤所致。另外，大病之后或呕吐或腹泻，随后误用催吐或泻下的药物，导致津液枯竭而得此病。有的因热证大汗淋漓或严重腹泻没有禁忌，胃中焦燥而得病。有的因伤寒里证冷泻太过，口渴饮水浆后转化为热，热气未散又感染其他邪气而得病。还有因癖病寒邪导致胁下疼痛硬结，不能逐渐消磨，使用巴豆等峻烈药物攻伐津液，突然受伤而得病。
又有肝疳，表现为白膜遮盖瞳孔，应当补肝。心疳，表现为面颊红赤，高热；脾疳，表现为身体发黄，腹部胀大，喜欢吃泥土；肺疳，表现为气喘，口鼻生疮，此类虚证应当补其母脏（脾）。肾疳，表现为身体消瘦，生疮疥。筋疳，表现为便血，身体瘦弱；骨疳，喜欢睡在冷地上；肉疳，表现为目肿腹胀，下痢青色白色或泡沫样物，逐渐消瘦虚弱，外症见鼻下红肿糜烂，自己搔抓鼻头，疮口不结痂，眼睛周围生疮。各种疳症都应根据本脏情况来补益其母脏，则子脏自然安宁。
积滞日久生虫，表现为皱眉多啼哭、吐沫、腹痛肚大、青筋暴露、唇色紫黑、肛门瘙痒，这是蛔疳，宜用川楝子、鹤虱等药。头皮光亮，急生疮，脑部发热、头发稀疏如穗、多汗、囟门高突，这是脑疳，宜用龙胆草、苦楝皮、芦荟、黄连、青黛等药。心肺壅塞有热，烦躁口渴、乳食减少，夜间口渴停止，这是渴疳，宜用龙胆草、乌梅、黄连等药。毛发焦枯、嘴唇苍白、额上有青纹、腹胀肠鸣、泄下未消化食物为疳泻，至于频繁排出恶臭物质则为疳痢，宜用白术、桔梗、厚朴、白芍等药。虚证中有积滞，肚子胀，头面四肢皆肿，下痢腥臭为疳肿，宜用芦荟、大腹皮、莱菔子、滑石、车前子等药。潮热，五心烦热，盗汗，喘咳，骨蒸消瘦为疳劳，宜用黄芩、白芍、川芎、肉豆蔻、生地、人参、白术、鳖甲等药。
疳虫向上侵蚀齿龈，口疮出血，牙齿颜色紫黑，向下侵蚀肠胃，下痢肚烂，湿痒生疮。齿属肾，肾虚有热，疳气直奔上焦，名为走马疳。初起口臭齿黑，名为崩砂。严重时牙龈腐烂，名为溃糟。热血迸出，名为宣露。更严重的牙齿脱落，名为腐根。即使腐根愈合，牙齿也不再生长，何况人还能存活吗？手足细小，项细骨高，臀部削瘦身体痿软，腹部胀大脐部突出，号哭时胸部凹陷，称为丁奚。虚热、进食呃逆，颅骨开裂骨骼干枯如柴，引水自饮，虫从口中出来，日渐枯槁，称为哺露，这比丁奚更严重。
消疳药：芦荟、干蟾、五灵脂、鳖甲。化积药：枳实、蓬术、青皮、山楂、三棱、神曲、麦芽。健脾药：人参、白术、厚朴、香附。清热药：柴胡、黄连、胡黄连、银柴胡、龙胆草、地骨皮、连翘、青黛。杀虫药：雷丸、芜荑、苦楝根、鹤虱、使君子。治疳泻药：木香、肉豆蔻、诃子、砂仁。五脏疳方虽然已在论述中提到，但也应当使用前文所列药物，佐以五脏本脏的药物，不必拘泥于安神地黄丸的方子。五脏本脏用药如下：
心疳：茯神、黄连、远志、琥珀、芦荟、钩藤、石菖蒲。
肝疳：生地、熟地、青黛、地骨皮、龙胆草。
脾疳：白术、陈皮、黄连。
肺疳：黄芩、桔梗、连翘、天冬、麦冬、防风、桑白皮。
肾疳：熟地、泽泻、山茱萸、牡丹皮。
Gan syndrome (Pediatric Malnutrition Syndrome) derives its name from "dryness," referring to a condition formed by the depletion of stomach and spleen fluids. It is also associated with "sweetness," indicating that excessive consumption of sweet foods leads to food accumulation and the generation of parasites. Accumulation is the mother of Gan; if left untreated, it evolves into Gan syndrome. Prolonged accumulation without removal causes visceral deficiency, resulting in Gan. Additionally, after prolonged illness, irregular diet, or spleen deficiency following diarrhea, accumulated heat spreads through the five zang organs, and accumulated dampness generates parasites, also forming Gan. Children suffer from the Five Gans, while adults suffer from the Five Labors (Chronic Debility). Labor disease due to kidney deficiency results in the exhaustion of fluids and marrow. Gan syndrome, due to spleen deficiency, leads to dry fluids; prolonged transmission damages all five zang organs.
Symptoms of Gan include dry eyes, often caused by pica (eating dirt, raw rice, charcoal), preference for lying on cold surfaces, frequent scabies, dysentery with green/white stools and bloody mucus, abdominal distension with visible epigastric veins, sores around ears/nose/mouth, crying due to parasitic pain, sparse hair ("hair tuft"), large head with thin neck, emaciated limbs, skeletal heaviness despite drinking water, and body like firewood—all indicating internal fluid depletion and spleen/stomach injury. Other causes include post-illness vomiting/diarrhea followed by improper use of emetics or purgatives, leading to fluid exhaustion; severe sweating or diarrhea from heat syndromes causing gastric dryness; cold diarrhea from Taiyang disease transforming into heat upon drinking water, compounded by external pathogens; or harsh purgation (e.g., Crotonis Fructus/Bad Dou) for phlegm-fluid retention, damaging fluids abruptly.
Specific types include: Liver Gan, characterized by leukoma obscuring vision, treated by tonifying the liver; Heart Gan, with red cheeks and high fever; Spleen Gan, with yellowish body, abdominal distension, and pica; Lung Gan, with asthma and oral/nasal sores, treated by tonifying the mother organ (Spleen); Kidney Gan, with emaciation and skin sores; Sinew Gan, with bloody stool and weakness; Bone Gan, preferring cold surfaces; Flesh Gan, with swollen eyes, abdominal distension, dysentery, gradual wasting, nasal erosion, itching, and periocular sores. All Gans should be treated by tonifying the mother organ of the affected zang to ensure the child organ's peace.
Parasitic Gan presents with frowning, crying, frothy vomiting, abdominal pain/distension, visible veins, purple-black lips, and anal itching, treated with Jiegeng Fructus (Chuan Lian Zi) and Chrysanthemi Indici Flos (He Shi). Brain Gan features shiny scalp, acute sores, brain heat, sparse hair, hyperhidrosis, and bulging fontanelle, treated with Gentianae Radix (Long Dan Cao), Meliae Cortex (Ku Liu Pi), Aloe (Lu Hui), Coptidis Rhizoma (Huang Lian), and Indigo Naturalis (Qing Dai). Thirst Gan involves heart/lung heat, irritability, thirst, reduced feeding, and nocturnal cessation of thirst, treated with Long Dan Cao, Mume Fructus (Wu Mei), and Huang Lian. Diarrhea Gan shows brittle hair, white lips, blue forehead veins, abdominal distension, borborygmus, and undigested stool; Dysentery Gan involves frequent foul discharge, treated with Atractylodis Macrocephalae Rhizoma (Bai Zhu), Platycodonis Radix (Jie Geng), Magnoliae Officinalis Cortex (Hou Po), and Paeoniae Radix Alba (Bai Shao). Edema Gan features vacuity with accumulation, generalized swelling, and foul dysentery, treated with Lu Hui, Arecae Pericarpium (Da Fu Pi), Raphani Semen (Lai Fu Zi), Talcum (Hua Shi), and Plantaginis Semen (Che Qian Zi). Consumption Gan presents with tidal fever, five-palm heat, night sweats, cough, and bone-steaming emaciation, treated with Scutellariae Radix (Huang Qin), Bai Shao, Ligustici Chuanxiong Rhizoma (Chuan Xiong), Myristicae Semen (Rou Dou Kou), Rehmanniae Radix (Sheng Di), Ginseng Radix et Rhizoma (Ren Shen), Bai Zhu, and Testudinis Carapax et Plastrum (Bie Jia).
Running Horse Gan (Zou Ma Gan) occurs when parasites erode gums (bleeding, purple-black teeth) and intestines, driven by kidney deficiency heat rising to the upper jiao. Stages include: initial bad breath/black teeth (Beng Sha); severe gum rot (Kui Zao); bleeding gums (Xuan Lu); tooth loss (Fu Gen). Even if healed, teeth do not regrow, and life is endangered. Ding Xi syndrome features small extremities, thin neck, prominent bones, wasted buttocks, distended abdomen with protruding umbilicus, chest depression during crying. Bu Lu syndrome is more severe, with cranial splitting, skeletal emaciation, polydipsia, and worms exiting the mouth.
Formulas and herbs:
Eliminate Gan: Aloe, Dry Toad Skin, Trogopteri Dung, Turtle Shell.
Resolve Accumulation: Immature Bitter Orange, Curcuma Zedoaria, Tangerine Peel, Hawthorn Fruit, Samolus Root, Fermented Wheat Leaven, Malt.
Strengthen Spleen: Ginseng, Atractylodes, Magnolia Bark, Cyperus Rhizome.
Clear Heat: Bupleurum, Coptis, Picrorhiza, Silverleaf Bupleurum, Gentian, Phellodendron Bark, Forsythia, Indigo Naturalis.
Expel Parasites: Omphalia Mushroom, Cornus Seed, Melia Root Bark, Chrysanthemum Seed, Quisqualis Fruit.
Treat Gan Diarrhea: Aucklandia Root, Nutmeg, Terminalia Chebula, Amomum Fruit.
Although five-zang Gan formulas are discussed, these base herbs should be used with specific zang-targeting herbs, not limited to Anshen Dihuang Wan.
Heart Gan: Polyporus (Fushen), Coptis, Polygala, Amber, Aloe, Uncaria, Acorus.
Liver Gan: Rehmannia Raw/Roasted, Indigo Naturalis, Phellodendron, Gentian.
Spleen Gan: Atractylodes, Tangerine Peel, Coptis.
Lung Gan: Scutellaria, Platycodon, Forsythia, Asparagus Root, Ophiopogon, Saposhnikovia, Mulberry Root Bark.
Kidney Gan: Rehmannia Roasted, Alisma, Cornus, Moutan Bark.