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At 260 days after birth, the knee bones of infants mature, enabling them to walk; this is the normal physiological timeline. If a child cannot walk at several years of age, it is due to insufficient congenital Kidney Yuan Qi (Kidney primordial energy). Bones belong to the Kidney and are nourished by Marrow. When Kidney Qi is deficient, it cannot fill the Marrow and bones, resulting in weak legs and an inability to walk. Others may live in deep curtains, exposed to neither wind nor sunlight, or be held all day long, causing their sinews and bones to remain unrelaxed, thus making walking difficult. Still others may suffer from multiple illnesses after weaning, leading to deficiency in both Liver and Kidney; Liver deficiency causes weak sinews, while Kidney deficiency causes soft bones, preventing walking. Overconsumption of rich and sweet foods can damage the Spleen and Stomach, leading to Infantile Malnutrition Syndrome (Gan syndrome), where Qi and Blood become increasingly exhausted, also preventing walking. With symptom-based regulation and treatment, recovery is possible. (Feng Chuzhan)

If a child has thick flesh on the head, face, chest, and back, but thin arms and calves, with delayed walking, it is caused by being carried excessively during infancy. (*Luxin Jing*)

Five Softnesses and Five Stiffnesses
The "Five Softnesses" refer to weakness in the hands, feet, waist, back, and neck. The "Five Stiffnesses" refer to stiffness in the hands, feet, waist, back, and neck. The "Five Coldnesses" refer to coldness in the hands, feet, Qi Sea (lower abdomen), lips, and face. The "Five Contractures" refer to contraction of the hands, feet, tongue, lips, and genitals. The "Five Reversions" refer to opisthotonos or retroflexion of the eyes, lips, tongue, neck, and feet. The "Five Tightnesses" refer to tightness of the throat, lips, eyes, hands and feet, and scrotum. The "Five Depressions" refer to depression of the fontanelle, Taiyang acupoints, eye sockets, lower chest, and Jianjing acupoint. The "Five Swellings" refer to swelling of the palms, Renzhong point, tongue, penis, and knees/shins. The "Five Pantings" refer to panting caused by smallpox, convulsions, vomiting, diarrhea, or dysentery. The "Five Blindnesses" refer to blindness caused by prolonged smallpox, convulsions, malnutrition, diarrhea, or dysentery. Regardless of the underlying disease, these are all ominous signs. (*Feng Shi Jin Nang*)

Head weakness occurs because the Kidney governs bones; weakness of the Tianzhu bone (cervical spine) indicates deficiency in the organs, bones, and vessels, insufficiency of Yang Qi, and deficiency of the Foot Shaoyin and Foot Taiyang meridians. Hand and foot weakness occur because the Spleen governs the four limbs; insufficiency of Middle Jiao Qi fails to nourish the limbs, resulting in little muscle and loose skin, where food intake does not translate into flesh. Mouth/lip weakness occurs because the mouth is the orifice of the Spleen, and the upper and lower gums belong to the Hand and Foot Yangming meridians, which govern the Stomach; Spleen-Stomach Qi deficiency prevents the tongue from being retained, causing it to protrude constantly. The Heart governs Blood, the Liver governs Sinews, the Spleen governs Flesh, the Lung governs Qi, and the Kidney governs Bones. These five aspects are all due to weak congenital Qi of the Zang organs, failing to nourish and reach the extremities, leading to weak bones/vessels and flaccid limbs. However, the key lies in the Stomach. The Stomach is the Sea of Water and Grain, the root of the Five Zang, and the great source of the Six Fu. Treatment must prioritize the Spleen and Stomach, using Buzhong Yiqi Tang (Spleen-Raising Qi-Boosting Decoction) to nourish the source of transformation, combined with Dihuang Wan (Rehmannia Pill). Breastfeeding by a healthy young wet nurse often leads to full recovery. (Xue Lizhai)

Five Stiffnesses present as upward gaze with inhalation, difficulty moving, Qi stagnation causing pain radiating to the chest and diaphragm, and cold, stiff limbs. This indicates Yang Qi failing to circulate to the four extremities. The Classics state: "The Spleen governs the four limbs" and "The Spleen governs all Yin." Now, cold and stiff hands and feet indicate pure Yin without Yang. This condition arises from pathology in the Liver and Spleen; treatment should tonify the Spleen and soothe the Liver. (*Zhengzhi Zhunsheng*)

Jie Lu (Split Skull), Cranial Distension, Fontanelle Depression, and Fontanelle Bulging
Infants may suffer from Jie Lu (split skull), unclosed fontanelle, or depressed fontanelle; these three conditions are largely similar with minor differences. Jie Lu refers to an older infant whose fontanelle should have closed but remains open, with splitting of the skull sutures. Since the Kidney governs bones and the brain is the Sea of Marrow, insufficient Kidney Qi leads to an inadequate Sea of Marrow, causing the bone sutures to split. Unclosed or depressed fontanelles, although caused by heat in the Zang organs rushing upward, fundamentally stem from insufficient Kidney Qi. (*Wan Quan Fang*)

The Kidney governs bones; when Bone Qi is solid, the brain marrow is full, and the fontanelle closes early. When Kidney Qi is timid/weak, brain marrow is empty, and the fontanelle remains unclosed. This results from insufficient essence and blood of the parents; Dihuang Wan (Rehmannia Pill) should be used for tonification. If the infant is still breastfeeding, the mother should also be treated. Additionally, the head should be tightly bound with soft cloth to facilitate closure. Fontanelle bulging and depression are also due to congenital Kidney Qi insufficiency and improper feeding damaging the Spleen and Stomach. The Spleen governs flesh; rebellious Qi rushing upward causes bulging; sinking of Primordial Qi causes depression. Both are treated with Buzhong Yiqi Tang (Spleen-Raising Qi-Boosting Decoction) and Dihuang Wan (Rehmannia Pill), and applying powdered roasted dog skull mixed with egg white to the fontanelle. Cases following diarrhea where Qi and Blood are deficient and fail to ascend upward are also treated similarly. If hands and feet are cold and previous decoctions fail, this indicates extreme deficiency-cold; Aconite (Fuzi) must be added urgently, otherwise it will be untreatable. (Xue Lizhai)

Cranial distension differs from fontanelle bulging: Fontanelle bulging involves a protruding fontanelle, belonging to excessive Fire in the Heart channel; Qian Yi used Xiexin Tang (Drain Heart Decoction). Cranial distension features shiny, tight scalp and enlarged frontal angles, caused by deficient Heat from the Liver and Kidney rushing upward; it is treated with a heavy dose of Dihuang Tang (Rehmannia Decoction) to suppress it. ○ Unclosed fontanelle with separated skull bones is called Jie Lu. The child has a pale complexion, white sclerae, and large pupils; this is due to congenital insufficiency. Treatment requires dual tonification of Yin and Yang, using Liuwei Tang (Six-Ingredient Decoction) plus Deer Antler (Lurong) and Turtle Shell (Guiban). (Xu Xuanzhi)

Tortoise Back and Tortoise Chest
Tortoise Back is caused by Wind pathogens invading the spine and penetrating the bone marrow after birth; treatment uses Xiao Xuming Tang (Minor Continuation of Life Decoction) minus Fuzi (Aconite) plus Fangfeng (Saposhnikovia). Tortoise Chest is caused by Wind-Heat attacking the lungs and invading the chest/diaphragm; treatment uses Guixiong Wan (Tortoise Chest Pill) and applying turtle urine to the joints, often resulting in cure. For those with congenital Liver-Kidney deficient Heat, use Liuwei Wan (Six-Ingredient Pill); for Kidney Qi insufficiency, use Bawei Wan (Eight-Ingredient Pill); add Lurong (Deer Antler) for the back and Guiban (Turtle Shell) for the chest. Early treatment is crucial; delay renders it ineffective. (*Zhangshi Yitong*)

My commentary: Tortoise Chest is treatable, but Tortoise Back is considered incurable. Previous discussions on treatment were imperfect. Although they attribute it to external Wind entering the bone, early sitting causing strain, or chronic cough lung deficiency, they failed to identify the root cause, speaking only of symptoms. I have seen children with strong congenital Yuan Qi sit naked in the wind and dew; after six months, sitting in barriers, never hearing of Wind entering the bone or early sitting causing Tortoise Back. This condition is mostly due to insufficient essence/blood from parents and loss of Mingmen (Gate of Life) Yang. Observe that Tortoise Back manifests between the Mingmen area, with gradually exposed vertebrae and an arched waist, truly due to bone flaccidity unable to support the body, not Wind pathogens. Previous authors forcibly created Songrui Dan, using Mahuang (Ephedra), Dahuang (Rhubarb), Duhuo (Angelica Pubescens), and Fangfeng (Saposhnikovia)—a batch of attacking drugs—which merely accelerates death. One should use Liuwei Wan plus Rougui (Cinnamon Bark) and Lurong (Deer Antler) to rescue the Congenital aspect, then use Liujunzi Tang (Six-Gentlemen Decoction) etc. to support Stomach Qi; perhaps one in ten cases can be saved. (Chen Feixia)

Crane Joint
When infant muscles are thin and joints protrude, resembling a crane's knee, it is due to insufficient congenital essence/marrow. Urgently treat with Liuwei Wan (Six-Ingredient Pill) plus Lurong (Deer Antler) and Niuxi (Achyranthes). Delay will result in permanent disability. (*Ciyou Fa*)

Tian Zhu Bone Collapse
Infants with Tian Zhu Bone Collapse may appear fat and robust, not emaciated. However, excessive external fatness implies internal weakness—abundant externally but deficient internally. ○ After prolonged illness or chronic diarrhea, sudden tilting of the neck is a critical sign; urgently rescue Yuan Qi with Shiquan Dabu Tang (Perfect Fourteen-Ingredient Tonifying Decoction) plus Lurong (Deer Antler). ○ Infants born with soft necks have insufficient fetal Qi, stemming from the father's deficient Kidney Yuan; strongly tonify the Congenital aspect. Use Bushen Dihuang Wan (Kidney-Tonifying Rehmannia Pill) and Liujunzi Tang (Six-Gentlemen Decoction) alternately. ○ Tian Zhu Bone Collapse generally signifies severe failure of True Yang, an ominous pediatric condition; preserving Yuan Qi is paramount. Apply Shengjin San (Generate Tendons Powder) externally. (*Youyou Jicheng*)

Bulu (Nursing Deficiency/Spiritual Drain)
The symptoms are slight diarrhea, alternating chills and fever, coarse hair, and melancholy. *Qianjin Fang* states: Bulu is a "ghost disease" of infants. When the son cannot yet walk and the mother is pregnant again, the child becomes emaciated, skeletal, and hair-thin; this is Bulu disease. First use Zishuang Wan (Purple Frost Pill) to purge accumulated milk/stagnation, then use Yihuang San (Yellow-Protecting Powder) to tonify. Weaning brings relief. I argue that maternal nursing involves emotional connection; when pregnant, vital Qi flows to the fetus, so nursing offers no benefit. *Huainanzi* states: A man cultivating orchids produces flowers that are beautiful but unscented; a Bulu child receiving milk becomes withered and dull. This is profound truth. Ghost theories are unfounded; immediate weaning is correct. (*Yitang Sanji*)

After birth, if the mother becomes pregnant again, causing the child's spirit to be unclear and body to wither, it is named Bulu disease. Burn Futyi (bat) to ash, grind finely, and administer half a qian with rice water, 4-5 times daily; or roast until fragrant, chew warm, and feed to the child; this is also effective. Futyi is the bat. (*Shenghui Fang*)

Nuan Bing (Warmth Disease)
The proverb says: To keep an infant safe, maintain one-third hunger and cold. Infants are Pure Yang bodies, intolerant of suppression. In wealthy homes, red stoves and sealed rooms, layered curtains and heavy quilts brew disease. If the mother neglects sleep, covering the head traps Qi. Being held wrapped in heavy cotton steams with the mother's body heat, causing fever, red face, irritability, and crying. This is neither exterior invasion nor interior injury; it is called Nuan Bing. Physicians recognizing the cause should use light, clear herbs to gently disperse, and slowly remove heavy clothing/quilts; the heat will subside naturally. (*Xiao'er Zhure Bian*)

Zhu Xia (Summerworm Summer)
The Spleen is Kun Earth, preferring dryness and hating dampness. Those with Spleen-Stomach insufficiency, encountering the humid Longxia (late summer) season, cannot raise Clear Yang or fortify Middle Qi. During the time of Shaoyang Ministerial Fire, Heat damages Yuan Qi, causing lethargy, weak legs,嗜卧 (desire to lie down), fever, mental fatigue, poor appetite, shallow breathing, blurred vision, dark frequent urination, and irregular bowels; this is Zhu Xia. It is a pattern of congenital Yin deficiency and insufficient Yuan Qi. Treat with Buzhong Tang (Middle-Raising Decoction) removing Shengma and Chaihu, adding Huangbai (Phellodendron). For Blood deficiency, use Buxue Tang (Tonify Blood Decoction); for Qi-Blood dual deficiency, use Bazhen Tang (Eight-Treasure Decoction); for Liver-Kidney Yin deficiency, use Dihuang Wan (Rehmannia Pill); for diarrhea, use Lizhong Tang (Regulate Middle Decoction). Children's illnesses often stem from maternal emotional imbalance; avoid anger, regulate diet, and adapt to temperature changes to prevent disease. (Xue Lizhai)

Summer is the Fire season; when Fire is prosperous, Metal is depleted. Thus, Yin-deficient individuals cannot endure summer. Internal heat and reduced food intake cause emaciation, like insects devouring objects. Treatment should derive from ancient formulas: Heat damaging Qi calls for Qingshu Yiqi Tang (Clear Summerheat Boost Qi Decoction) to support Righteous Qi against Summerheat Evil; Fire scorching Metal calls for *Qianjin* Shenmai Tang (Ginseng-Ophiopogon Decoction) to protect Lung Metal; Water unable to overcome Fire calls for Shenmai Dihuang Tang (Ginseng-Ophiopogon-Rehmannia Decoction). All are appropriate. Without understanding the principle, focusing solely on the Spleen/Stomach uses drying herbs; dryness strengthens Earth but depletes Water further, worsening the disease. Dongyuan and Xue stated this is congenital Yin deficiency and insufficient Yuan Qi; taking Dihuang Wan (Rehmannia Pill) prophylactically prevents future issues. (*Xiao'er Zhure Bian*)

Teeth Grinding in Sleep
Infants grinding teeth or biting nipples during wakefulness/sleep are often attributed to fright, but causes vary. Fever, thirst, and crying indicate Excess Heat in the Heart; use Xiexin Tang (Drain Heart Decoction). Sleepiness, palpitations, and sleeping with eyes closed indicate Deficient Heat in the Heart; use Daochi San (Guide Out Red Powder). Green face, crossed eyes, neck stiffness, and irritability indicate Excess Heat in the Liver; use Chaihu Qinggan San (Bupleurum Clear Liver Powder). Grasping clothes and fumbling objects indicate Deficient Heat in the Liver. Convulsions, green eyes, and red face indicate Wind-Heat in the Liver; use Liuwei Wan (Six-Ingredient Pill) for all. (*Zhangshi Yitong*)

Teeth grinding in dreams is Wind-Heat. Accumulated Heat in the Hand/Foot Yangming meridients generates Wind, causing teeth to strike. It occurs in dreams because Wind is Yang; movement allows Wind to act in Yang, stillness returns it to the interior. ○ Teeth grinding is critical only in the context of variola (smallpox); otherwise, it is harmless. It may also occur due to shivering/chattering from other diseases; treating the root cause stops it. (*Youyou Jicheng*)

Zhi Yi (Drooling)
Zhi Yi is excessive saliva flowing onto the cheeks. Saliva is the fluid of the Spleen; Spleen Qi deficiency and cold cause free-flowing saliva that cannot be controlled. (*Chaoshi Bingyuan*)
According to *Neijing*: Tongue deviation and drooling belong to Heat. Attributing this solely to Spleen Cold is biased. Zhang Huan provided two formulas for Cold and two for Heat, which is appropriate. However, assuming flowing saliva is Cold and non-flowing is Heat is likely inaccurate. (*Zhengzhi Zhunsheng*)

Ba Ri Sou (Hundred-Day Cough)
Phlegm-cough within the first hundred days of nursing is called Ba Ri Sou. It may arise from sudden Wind-Cold exposure at birth, bathing, changing swaddling clothes, or being held out for feeding, allowing Wind-Cold to invade (external cause). Or, it may result from overfeeding causing choking, or feeding while crying causing Qi rebellion (internal cause). Both cause cough. Sweat-inducing and purgative agents are hard to use lightly because the Stomach Qi is newly formed and cannot tolerate strong medicine; hence, it is difficult to treat. I treat many such cases by administering two small doses of Jingfang Baidu San (Aster and Saposhnikovia Detoxifying Powder) to both mother and child; the nursing mother avoids certain foods to purify her milk. Even severe cough resolves within ten days. (*Youyou Jicheng*)

Sweating
Infant Yuan Qi is incomplete, and pores are not dense, making sweating easy. Hot food/drinks and warm clothing induce sweating. Li Dongyuan et al. say this is normal and needs no treatment. However, the root of sweat is Ying Qi (Nutritive Qi); its opening/closing is governed by Wei Qi (Defensive Qi). Infantile hyperhidrosis is ultimately Wei Qi deficiency failing to secure. Profuse sweating damages Ying/Wei and Blood/Qi, leading to gradual emaciation; it must be treated. Method: Prioritize boosting Qi. Securing Yang externally stores Yin internally, stopping sweat naturally. (Zhang Jingyue)

Xu Lei (Emaciation)
Infantile emaciation stems from Spleen-Stomach disharmony, inability to digest milk/food, leading to thin skin/flesh, or post-illness Spleen deficiency failing to transform grain Qi. Deficiency-Cold presents with frequent diarrhea and pale lips/mouth; Deficiency-Heat presents with high fever and slightly yellow muscle. Examine form and color: Red face and frequent crying indicate Heart deficiency; green face and crossed eyes indicate Liver deficiency; lumps behind/in front of ears indicate Liver Deficient Fire; lumps in neck flesh indicate Food Stagnation Deficient Heat; yellow face and distension indicate Spleen deficiency; pale face and asthma indicate Lung deficiency; white sclerae indicate Kidney deficiency. Treat according to the theory of mutual overcoming. (*Zhangshi Yitong*)

Post-Illness Aphonia
After vomiting/diarrhea or major illness, if the child has voice but cannot speak, it is not aphonia, but Kidney timidity failing to connect upward to Yang. Treat with Dihuang Wan (Rehmannia Pill). (Qian Zhongyang)
After epilepsy remission, inability to speak occurs because the Heart's sound is speech, opening via the mouth. Although seizures stop, Wind-Cold lingers in Heart collaterals, disrupting Heart Qi and preventing sound emission. (*Chaoshi Bingyuan*)
After convulsions subside, if the child is hoarse/unable to speak, use processed Tian Nan Xing (Arisaema) powder, one zi dose, mixed with pig bile, restoring speech. (*Zhengzhi Zhunsheng*)

Yi Ru (Spitting Milk)
Infant spitting milk varies in Cold/Heat, but Cold is more common than Heat, and Deficiency is more common than Excess; it generally stems from weak Stomach. Examine form, pulse, and symptoms to distinguish. Heat requires mild clearing; Cold requires warming tonification. Medications for nursing infants need not be complex; select 2-4 key herbs, such as Shenyin (Ginger-Ginseng Drink) or Yigong San (Extraordinary Power Powder). If the infant is small and milk volume exceeds capacity, overflow is normal and stops when milk flows; no treatment needed. (Zhang Jingyue)
Infant vomiting includes Cold, Heat, and Food Injury, all relating to the Stomach. There are also spitting milk, Bulu, retching, Cold-Heat rejection, and worm-pain vomiting. Treat based on detailed symptoms. First, regulate milk/food intake. If vomiting causes thirst, do not give water immediately, as it triggers more vomiting. Force the child to wait 1-2 hours, then offer rice water; vomiting stops. ○ Early Bulu requires immediate treatment. Untreated, Bulu becomes vomiting, vomiting becomes retching, retching becomes hiccupping; Stomach Qi becomes deficient, Spirit dissipates. ○ Vomiting that rejects medication is hardest to treat. Medicine induces vomiting, losing efficacy. Do not force-feed. I treat this by mixing ginger juice with earth into two clay pills, plugging nostrils to block smell, then administering appropriate decoction. Serve lukewarm, one sip, pause 30 mins, another sip, pause briefly; then the child can take it without vomiting. Fools force-feed, causing total expulsion. This method applies to Pediatrics and Internal Medicine alike. (*Youyou Jicheng*)

Vomiting and Diarrhea
Infant vomiting/diarrhea is 80-90% Deficiency-Cold, 10-20% Excess-Heat. If pulse/symptoms show no Fire, pale/blue-white face, calm breath, cool limbs, or fatigue, it is entirely Deficiency-Cold; do not use cooling herbs. Ancient texts say: Spleen deficiency causes retching, Stomach deficiency causes vomiting. Food entering the Stomach not transforming and vomiting indicates Spleen Qi deficiency failing to transport. Cold/Cool herbs entering the Stomach causing nausea/vomiting indicate Middle Jiao Yang Qi injury failing to transform. Pathogens in Middle Jiao cause vomiting; spreading to Lower Jiao causes diarrhea. Thus, Middle/Upper Jiao issues treat Spleen/Stomach; Lower Jiao involvement treats Spleen/Kidney. Using cold/purgative herbs without Excess-Heat Fire is fatal. ○ Simultaneous vomiting/diarrhea is primarily Interior Injury, but may stem from external Cold invading organs, careless raw/cold food damaging Stomach Qi, or weak Middle Qi with improper diet. Pathogens injuring Yang cause vomiting; injuring Yin cause diarrhea; both injure Yin and Yang. Check for stagnation vs. none, and Deficiency vs. Excess, then treat. (Zhang Jingyue)
During Longxia, Summerheat-Damp dominates, Spleen Earth is affected, and epidemic Qi causes fever/vomiting/diarrhea. Vomiting/diarrhea is Interior syndrome; fever is Exterior syndrome; thirst/irritability indicates Exterior-Interior involvement. Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction) is appropriate; one dose calms, two cure. Ignorant physicians use standard dispersing/digestive formulas, mismatching medicine and disease, damaging Righteous Qi. Persistent vomiting/diarrhea with exhaustion, hot forehead/cold fingers, sunken eyes, and dissipated Spirit resembles Slow Convulsion (Man Jing). Some doctors see hot forehead/thirst and use Huanglian (Coptis); others see fever/cold fingers and use Xiangru (Elsholtzia). They do not realize that massive vomiting/diarrhea violently injures Stomach Qi, requiring different treatment than initial illness. Initially, Righteous Qi is intact, so Huanglian Xiangru Yin works. Using it after Stomach Qi is injured is using medicine at the wrong time. In late summer/early autumn, infants...