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Pig fat (Su Gao) and Ginger juice (Jiang Zhi) (each two sheng, boiled down to three sheng, then add wine) Wine (Wu he)
Mix and decoct, divide into three doses.
Beyond the Five Exhaustions (Wu Lao), there is also the concept of the Six Extremities (Liu Ji). The manifestation of Sinew Extremity (Jin Ji) involves frequent muscle spasms (Zhuan Jin), pain in all ten fingernails and toenails, severe fatigue making it impossible to stand for long periods; this formula is indicated for such conditions.
Sinew Extremity refers to the depletion of sinew fluids due to excessive labor of the four limbs, termed "Sinew Extremity." "Extremity" denotes a condition more severe than "Exhaustion." Since the sinews have exhausted their fluids, they lose their moistening and nourishing properties, becoming stiff and tense, thus causing frequent spasms. Nails are considered the surplus of sinews. Sinews belong to Wood in the Five Elements; when Wood reaches its extremity, Metal acts upon it, resulting in pain in all fingernails and toenails, resembling withered branches and fading buds. Severe fatigue preventing prolonged standing occurs because the sinews are too debilitated to bind the bones. This disease, if treated with herbal medicines alone, is difficult to cure quickly. The Master said: Fatty substances nourish sinews, hence Pig fat is used to moisten and nourish them. Ginger juice is added because pungency is required to reach the extremities. Wine is used for decoction because wine has a nature that promotes circulation, allowing Qi and Blood to permeate throughout the body without restriction; thus, it is used as the medium for decoction.

Ren Shen (Ginseng Radix et Rhizoma, remove rhizome) Huang Qi (Astragali Radix, honey-fried) Chen Pi (Citri Reticulatae Pericarpium) Bai Shao Yao (Paeoniae Radix Alba, stir-baked with wine) Dang Gui (Angelicae Sinensis Radix, washed with wine) Gan Cao (Licorice Radix et Rhizoma, honey-fried) Bai Fu Ling (Poria, white part) Wu Wei Zi (Schisandrae Chinensis Fructus, stir-baked) Yuan Zhi (Polygalae Radix, remove heart) Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-baked) Gui Xin (Cinnamomi Ramulus) Shu Di Huang (Rehmanniae Radix Praeparata)
The manifestations of Pulse Extremity (Mai Ji) include mental fogginess, forgetfulness, lackluster complexion, and falling eyebrows and hair; this formula is indicated.
The vessels (Mai) are the reservoirs of blood. Pulse Extremity represents the utmost emptiness of the blood vessels, often caused by blood loss. The Heart governs the blood vessels; when the vessels are at an extreme of emptiness, there is insufficient blood to nourish the Heart, leading to mental fogginess and forgetfulness. When Ying-Blood (Nutritive Blood) is sufficient, it gives a lustrous and healthy complexion; when Ying-Blood is deficient, it results in a sallow and dull complexion. Eyebrows and hair are nourished by blood; deficiency in nourishing blood leads to their loss. Ren Shen, Huang Qi, Bai Zhu, Fu Ling, Gan Cao, and Chen Pi are all Qi-tonifying herbs. Tonifying Qi when Ying-Blood is deficient follows the teaching of the *I Ching* (Book of Changes): Yin arises from Yang. Yin is governed by the Five Viscera; therefore, Dang Gui is used to moisten the Spleen, Bai Shao Yao to regulate the Liver, Shu Di Huang to nourish the Kidney, Wu Wei Zi to benefit the Lung, and Yuan Zhi to calm the Heart. When the Five Viscera are harmonized, Yin-Blood generates naturally. Gui Xin is acrid and hot; heat enters the Heart to augment Fire, and acridity enters the channels to promote blood flow. Moreover, the Heart is the origin of pulse generation; thus, Gui Xin is employed to guide the other herbs into the Heart to nourish Ying-Blood within the vessels.