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When a newborn infant's body appears swollen and red as if scalded by hot water or burned, this is caused by the wet nurse consuming too much rich and greasy food. The mother should take Qingwei San (Clear Stomach Powder) and Xiaoyao San (Free and Easy Wanderer Powder) to clear heat from the qi and blood; the infant may also drink a few drops. If the infant has no skin and is not red, it is due to the mother's deficiency of Spleen Qi; rice flour can be applied externally. If the skin is red and feverish, it is due to excessive fire in the mother's Stomach; gypsum can be applied externally. The Classics state: "The Spleen governs muscles, and the Lung governs skin and hair." Thus, we know this involves pathology of the Spleen and Lung. If sores appear on the forehead, it is the combination of Fire and Earth (damp-heat), flowing downward to attack Kidney Water, which is difficult to treat. If sores appear on the feet, it is Yin deficiency with hyperactive fire; such infants will die before reaching five years of age. If within one month the infant exhibits mouth puckering, clenched fists, and a limp neck hanging down, this is caused by pathogenic factors prevailing over righteous Qi in the Liver and Kidneys; it is incurable within three days. If the fingers of a male infant curl inward, or those of a female infant curl outward, it is still treatable. Red eyebrows are also an untreatable sign. Treatable cases should be managed with Quanxie San (Scorpion Powder) or Gouteng San (Uncaria Decoction). If caused by damage to Stomach Qi due to severe illness, leading to weakness of the Five Zang organs, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Qian Shi Dihuang Wan (Dr. Qian's Rehmannia Pill). If the face and lips are red, this indicates insufficient Kidney Water and Yin deficiency with hyperactive fire in the Liver Meridian, generating internal wind-heat; one should nourish Kidney Water to restrain hyperactive Yang. Softness of the body is due to congenital insufficiency of Qi and unfirm muscles; treatment should follow the principles for "Five Softnesses."

Qingwei San (See "Neidiao" section)
Xiaoyao San (See "Neidiao" section)
Quanxie San (See "Koujin" section)
Gouteng San (See "Manjing" section)
Buzhong Yiqi Tang (See "Xu Lei" section)
Qian Shi Dihuang Wan (See "Shen Zang" section)

The "Five Softnesses" refer to softness of the head and neck, hands and feet, flesh, and mouth. Softness of the head and neck indicates deficiency of the Zang-Fu organs, bones, and vessels, and insufficiency of Yang Qi. This manifests as weakness of the Tianzhu bone (neck); since the Kidney governs bones, it implies deficiency of the Foot Shaoyin and Foot Taiyang meridians. Softness of the hands and feet occurs because the Spleen governs the four limbs; insufficiency of Central Earth Qi fails to nourish the limbs, resulting in little muscle and loose skin, where food intake does not transform into flesh. Softness of the mouth arises because the mouth is the orifice of the Spleen; the upper and lower gums belong to the Hand-Yangming and Foot-Yangming meridians, which govern the Stomach. Spleen-Stomach Qi deficiency causes the tongue to fail to retract, often protruding. The Heart governs Blood, the Liver governs sinews, the Spleen governs flesh, the Lung governs Qi, and the Kidney governs bones. These five functions depend on the Qi of the Five Zang organs; when deficient, they cannot nourish and reach their limits, leading to weak bones and vessels and flaccid limbs. The root cause lies in the Stomach, which is the Sea of Grain and Water, the foundation of the Five Zang and the great source of the Six Fu organs. Treatment must prioritize the Spleen and Stomach, using Buzhong Yiqi Tang to nourish the source of transformation. For softness of the head/neck and hands/feet, combine with Dihuang Wan. Both medicines must be used extensively. The wet nurse should also consume them, while avoiding wind-cold and regulating diet; most cases will recover.

Case Records

The seven-year-old son of Shi Wanhu from Wujiang suffered from vomiting and diarrhea, with sudden depression of the fontanelle and eyes, collapse of the Tianzhu bone, and facial redness. I was present and first prescribed Buzhong Yiqi Tang with one dose of Fuzi (Aconite Root). The diarrhea stopped, and all symptoms resolved. Subsequently, Qian Shi Dihuang Wan decoction was administered, bringing immediate relief.

A seven-year-old child, after overeating cold and raw foods in summer, developed morning vomiting and diarrhea, facial redness, thirst, and heat in both hands and feet, along with neck softness and depressed fontanelle. By afternoon, the face turned pale, hands and feet became cold, and the pulse was faint and nearly imperceptible. Urgently, Liujunzi Tang (Six Gentlemen Decoction) with one dose of Fuzi was given, instantly eliminating symptoms, raising the fontanelle, and restoring peace. Children are prone to both deficiency and excess; thus, even in critical conditions, prompt administration of appropriate medicine can save life.

A nine-year-old child, following vomiting and diarrhea, presented with neck softness, pale face, cold extremities, fine and faint pulse, and preference for hot drinks. Initially, Liujunzi Tang with Rougui (Cinnamon Bark) was given for five doses without effect. Four doses of Paojiang (Prepared Ginger) were added, slightly improving symptoms, but the face remained pale and the Chi pulse undetectable. Bazui Wan (Eight-Flavor Pill) was then added. After more than a month, the face showed slight yellow color, indicating the return of Stomach Qi. Continuing previous prescriptions for another month, food intake increased slightly, and heat significantly decreased. Morning administration of Buzhong Yiqi Tang and pre-meal Bazui Wan were continued. After another month, Yuan Qi gradually recovered, eating normalized, and the head could be lifted. After yet another month, muscles became full, and all diseases healed.

A twelve-year-old child, post-malaria, exhibited neck softness, cold extremities, poor appetite, and abdominal coldness upon eating warm congee. Liujunzi Tang with Rougui and Ganjiang (Dried Ginger) was used; food intake gradually increased. Anise and pepper were added to meals; after over a month, congee could be eaten without heating. One hundred doses of previous prescriptions normalized diet and warmed extremities; after another month, the head could be lifted. Later, food stagnation led to vomiting and diarrhea, causing neck flaccidity. Morning Buzhong Yiqi Tang, evening Liujunzi Tang, and Jiawei Bazui Wan (Modified Eight-Flavor Pill) were used for over two months, restoring neck strength. Post-marriage, blurred vision, weak neck bones, and sensation of head enlargement occurred. Bazui Wan and Buzhong Yiqi Tang were taken for over three months, recovering Yuan Qi and resolving symptoms. Subsequent sexual exertion caused fatigue, night sweats, and fever; these two medicines cured him again.

A fifteen-year-old child had flaccid hands and feet, inability to chew hard objects, internal heat, afternoon fever, and dysuria resembling strangury. Diuretics worsened strangury; yin-nourishing herbs intensified internal heat; drying-dampness herbs caused heavy defecation. I diagnosed congenital Kidney Qi deficiency due to premature sexual activity. As stated in the *Jingxue Pian*: "If men engage in intercourse before essence is full, the Five Zang organs remain unsatisfied, leading to difficult-to-describe diseases later; if elderly men with impotence seek sexual release, essence fails to exit and rots internally, causing painful dysuria. If essence is exhausted further, urinary and fecal pain ensues; the more painful, the more frequent defecation, and vice versa." Morning Buzhong Yiqi Tang and evening Liuwei Wan (Six-Ingredient Pill) with Wuweizi (Schisandra Fruit) were prescribed for over thirty doses each, gradually resolving symptoms. Later, nocturnal emissions recurred with cold extremities and urgent phlegm-Qi. Shiquan Dabu Tang (Ten Complete Tonifying Decoction) and Jiawei Bazui Wan were given for eight doses each, improving bowel/bladder function and warming extremities. Continuing these for over three months restored Yuan Qi and normal diet. Food stagnation later caused vomiting, diarrhea, and non-tender abdominal pain, indicating Spleen-Stomach injury; Liujunzi Tang with Muxiang (Aucklandia Root) and Roudoukou (Nutmeg) treated it. When vomiting persisted, the Left Chi and Right Guan pulses were floating and large lightly, but empty heavily. The Classics state: "The Kidney opens into the two lower orifices." Wuweizi San (Schisandra Powder) for four doses stopped diarrhea immediately. Later, food-induced acid regurgitation and diarrhea with heavy stools were cured by morning Buzhong Yiqi Tang and evening Liujunzi Tang with Muxiang and Ganjiang.

An elderly man who fathered a child presented with flaccid limbs, aversion to wind and cold, and preference for sunlight. I instructed the wet nurse to take Jiawei Bazui Wan three times daily and Shiquan Dabu Tang once daily, shared with the son. After over a year, limbs strengthened, and by age two, he could walk.

A five-year-old boy, inheriting his father's leg weakness and gait difficulty, lost his vitality early. At seventeen, post-marriage, leg weakness and open fontanelle persisted. Living cautiously in a Taoist temple, he took morning Buzhong Yiqi Tang and evening Dihuang Wan decoction with Wuweizi and Lurong (Deer Antler). After over a year, he recovered health.

Another child with neck softness was cured by the previous two medicines. Post-marriage, he developed Jielu (open fontanelle), thirst, and fever. Large doses of these medicines brewed as tea were consumed freely. After over two months, thirst and fever subsided; after over a year, the fontanelle closed; after another year, limbs strengthened. Without careful management, even medicine would fail.

Xingfu Gao (Star and Aconite Plaster) treats neck softness.
Tian Nan Xing (Pinellia Tuber) and Fuzi (Prepared Aconite Root) in equal parts.
Grind into powder, mix with fresh ginger juice, apply to the neck, and moisten when dry.

Liujunzi Tang (See "Tiandiao" section)
Jiawei Bazui Wan (Six-Ingredient Pill plus Rougui and Wuweizi; See "Shen Zang" section)
Buzhong Yiqi Tang (See "Xu Lei" section)
Dihuang Wan (See "Shen Zang" section)
Wuweizi San