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See "Zabing Zhunsheng" (Standardized Diagnosis and Treatment of Miscellaneous Diseases) for details.

Wu Ruan (Five Softnesses) refers to softness of the head and neck, hands and feet, muscles, and mouth. If a child cannot lift their head without cause, it is a disease of Kidney Gan (Rickets due to Kidney deficiency), where the neck meridians are weak and difficult to support the head; although treatment may temporarily improve the condition, it will inevitably recur in later years. Hand and foot softness manifests as drooping hands and limbs with no strength, and reluctance to raise the eyebrows; if the voice is clear and the child can eat, this indicates Slow Spleen Wind (Man Pi Feng), which is still treatable. Muscle softness presents as little flesh and loose skin, where food intake fails to build muscle; Qian Yi's Jutian Wan (Citrus and Coptis Pill) can be taken for emaciation, but frequent diarrhea must be avoided as it becomes difficult to treat. Foot softness refers to a five-year-old child being unable to walk; due to emaciation, the feet are soft, small, and thin. As long as Ying and Wei (Defensive and Nutritive Qi) are not affected, taking herbs such as Ginseng Radix et Rhizoma along with Qian Yi's Dihuang Wan (Rehmannia Pill) will naturally result in full muscles upon growth. Mouth softness involves the tongue protruding frequently; excessive Yang requires caution, and treating the Diaphragm is necessary, though generally harmless; however, cyanotic lips and panting indicate a difficult-to-treat condition.

[Xue Ji] Head and neck softness occurs because the Zang-Fu organs, bones, and vessels are all deficient, and the Qi of all Yang channels is insufficient, leading to weakness of the Tianzhu Bone (Tibia/Neck pillar). The Kidney governs bones, so deficiency in the Foot Shaoyin and Foot Taiyang meridians causes this. Hand and foot softness occurs because the Spleen governs the four limbs; deficiency of Middle Jiao Qi fails to nourish the limbs, resulting in little flesh, loose skin, and food failing to transform into muscle and flesh. Mouth softness 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 and Stomach Qi deficiency causes the tongue to fail to retract and remain protruded. 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 due to congenital weakness of the Five Zang Qi, failing to nourish and reach the extremities, causing strong bones and vessels to become weak and limbs to atrophy. Tracing the root, it all returns to the Stomach, as the Stomach is the Sea of Water and Grain, the root of the Five Zang, and the great source of the Six Fu organs. Treatment methods must prioritize the Spleen and Stomach, using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to nourish the source of transformation. For head/neck and hand/foot softness, Dihuang Wan is taken concurrently. For these conditions, both medicines must be taken extensively. It is also advised that a healthy wet nurse drink them, while avoiding wind and cold and regulating diet; most cases will recover fully.

[Zeng Shirong] Dai Shi discusses Wu Ruan as Tai Que (Fetal Frailty), truly caused by insufficiency of the father's Essence and chronic depletion of the mother's Blood. This statement is profound. In my opinion, some cases arise from the mother's Blood Sea being cold for a long time, requiring medicinal supplementation before conception; others occur when the mother is ill during pregnancy; or when the father indulges in lust and alcohol, has a weak constitution, or is advanced in age when siring children; or when the fetus is born prematurely; or when abortifacients fail to terminate the pregnancy, merely depleting True Qi. Those who survive are like grass in shallow soil: they sprout but rarely flourish, akin to trees whose roots have been shaken—few survive. Thus, infants are frail and intolerant of cold and heat. Even if they reach adulthood, they often suffer from diseases. After birth, Essence and Marrow are insufficient, sinews and bones are weak, muscles are emaciated, and spirit/color is dull and slow. Once invaded by the Six Excesses (pathogenic factors), head, neck, hands, feet, and body become soft, named Wu Ruan. Treatment uses Tiaoyuan San (Regulate Origin Powder) and Bushen Dihuang Wan (Kidney-Tonifying Rehmannia Pill), gradually conditioning until stability is achieved over time. If medication fails, the child may become disabled.

In cases where a child appears robust and fat but suddenly suffers from neck collapse, this is called Xia Chuan (Lower Prostration). It is caused by Liver and Kidney Qi deficiency, allowing exogenous pathogens to invade the Fengfu acupoint and transmit to sinews and bones. Since the Liver governs sinews and the Kidney governs bones, weakness in both leads to drooping neck and inability to hold the head up, also known as Tianzhu Dao (Collapse of the Neck Pillar). This is similar to Wu Ruan and treated with the same formulas.

The son of Shi Wanhu from Wujiang, aged seven, suffered from vomiting and diarrhea, with sudden sinking of the fontanelle and eyes, and collapse of the Tianzhu bone, accompanied by a red face. Initially, one dose of Buzhong Yiqi Tang plus Aconite Root (Prepared) stopped the vomiting/diarrhea and resolved other symptoms. Subsequently, decocting Qian Yi's Dihuang Wan material brought immediate relief. Another seven-year-old child, after overeating raw/cold food in summer, developed morning vomiting/diarrhea, red face, thirst, hot hands/feet, soft neck, and sunken fontanelle. By noon, the face turned pale, hands/feet cold, and pulse faint and nearly absent. Urgently administering one dose of Liujunzi Tang (Six Gentlemen Decoction) plus Aconite Root reversed the symptoms immediately, and the fontanelle rose back to normal. Children's Yuan Qi is easily depleted or excessed; thus, even in critical conditions, prompt use of appropriate medicine can restore life.

A nine-year-old child, after vomiting/diarrhea, presented with soft neck, pale face, cold hands/feet, fine/faint pulse, and preference for hot drinks. I initially used Liujunzi Tang plus Cinnamon Bark for five doses with no effect, then added Roasted Ginger for four doses. Symptoms improved slightly, but the face remained pale and the Chi pulse did not rise. I supplemented with Shiwu Wan (Eight-Ingredient Pill with Gold and Pearl), and after a month, the face became slightly yellow, indicating slight return of Stomach Qi. Using the previous prescription for another month increased appetite and reduced heat. Then, Buzhong Yiqi Tang was taken in the morning, and Shiwu Wan before meals. After another month, Yuan Qi gradually recovered, eating normalized, and the child could lift their head. After yet another month, muscles became full, and all diseases healed.

A twelve-year-old child, after malaria, had soft neck, cold hands/feet, poor appetite, and abdominal coldness when food was not hot. Liujunzi Tang plus Cinnamon Bark and Dried Ginger increased appetite. Adding Fennel and Pepper to meals allowed porridge to be eaten without heating after a month. Taking the previous prescription for 100 doses normalized diet and warmed hands/feet. After another month, the head could be lifted. Later, food stagnation caused vomiting/diarrhea and persistent neck flaccidity. Morning Buzhong Yiqi Tang and evening Liujunzi Tang plus Ji Jian Shiwu Wan (Modified Eight-Ingredient Pill) restored neck strength after two months. After marriage, blurred vision, weak neck, and sensation of large head occurred. Shiwu Wan and Buzhong Yiqi Tang for three months restored Yuan Qi and resolved symptoms. Post-coital fatigue, night sweats, and fever were cured by these two medicines.

A fifteen-year-old child had flaccid hands/feet, inability to chew hard objects, internal heat, afternoon tidal fever, and dysuria resembling strangury. Diuretics worsened strangury; Yin-nourishing herbs intensified internal heat; drying-dampness herbs caused heavy stool. I diagnosed congenital Kidney Qi deficiency due to early sexual activity. As stated in the Jingxue Pian (Chapter on Essence and Blood): "If a man engages in sex before his Essence is full, the Five Zang will have unmet needs, leading to difficult diseases later." For elderly men with impotence seeking release, Essence remains inside and rots, causing painful dysuria. If Yin is exhausted further, bowel/bladder pain worsens defecation/urination, creating a vicious cycle. Morning Buzhong Yiqi Tang and evening Liuwei Wan (Six-Ingredient Pill) plus Schisandra Berry for over 30 doses each gradually improved symptoms. Later, nocturnal emissions recurred symptoms, with cold hands/feet and urgent phlegm-Qi. Shiquan Dabu Tang (Ten Great Tonics Decoction) and Ji Jian Shiwu Wan material for eight doses each improved urination/bowel movements and warmed limbs. Continuing these for three months restored Yuan Qi and diet. Food stagnation caused vomiting/diarrhea and non-tender abdominal pain, indicating Spleen/Stomach injury. Liujunzi Tang plus Costus Root and Myristica Seed stopped vomiting. However, left Chi and right Guan pulses were floating/large on light palpation but empty on deep pressure. The Classic states: "The Kidney opens into the two yin orifices." Wuweizi San (Schisandra Powder) for four doses stopped diarrhea immediately. Later, food injury caused sour belching, diarrhea, and heavy stool. Morning Buzhong Yiqi Tang and evening Liujunzi Tang plus Costus Root and Dried Ginger cured the case.

An elderly father who had a late child presented with flaccid limbs, aversion to wind/cold, and preference for sunlight. The wet nurse took Ji Jian Shiwu Wan three times daily and Shiquan Dabu Tang once daily, shared with the child. After a year, limbs strengthened, and by age two, walking was possible. A five-year-old boy, inheriting his father's leg weakness, lost his natural vitality early. At seventeen, after marriage, legs weakened, and fontanelle felt open. Living ascetically, he took Buzhong Yiqi Tang in the morning and Dihuang Wan material plus Schisandra and Deer Antler in the evening. After a year, health was restored. Another child with soft neck cured by the previous two medicines developed Xie Lu (Delayed Closure of Fontanelle), thirst, and fever after marriage. Drinking large doses of these medicines as tea for two months reduced thirst/fever. After a year, the fontanelle closed; after another year, limbs strengthened. Without careful lifestyle management, medicine would have failed.