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The *Classic of Difficult Issues* (or *Neijing*) states: Liver deficiency, Kidney deficiency, and Foot deficiency all cause heaviness in the body and inner vexation/depression.

Heaviness of the body mostly belongs to Dampness (Shi). It is appropriate to use formulas that strengthen the Spleen and move Dampness, such as Chushi Tang (Dampness-Removing Decoction), Shenshi Tang (Dampness-Penetrating Decoction), or Weiling Tang (Stomach-Cinnamon Decoction). For deficient individuals, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can be used with added Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Fuling (Poria), and Zexie (Alismatis Rhizoma), adjusted according to convenience. Zhang Zhongjing said: In Wind-Dampness diseases, if the pulse is floating, the body is heavy, there is sweating, and aversion to wind, Fangji Huangqi Tang (Stephaniae Tetrandrae and Astragali Decoction) should be used. In summer, when suffering from Summerheat combined with Wind-Dampness, where the body feels heavy as if sitting in mountains and turning is impossible, Xiaoshu Shiquan San (Ten Complete Powders for Resolving Summerheat) with added Qianghuo and Cangzhu (Atractylodis Rhizoma) is indicated. For Shen Zhuo disease (a condition characterized by cold-dampness stagnating in the lower back/back region) with body heaviness, Ganjiang Lingzhu Tang (Ginger, Poria, Atractylodes, and Licorice Decoction) is used.

Shiweng stated: Heaviness of the body is nothing but a Dampness syndrome. Dampness syndromes are mostly attributed to the Earth element of the Spleen, so attributing it to Spleen disease is correct. Furthermore, the Kidney is the Water organ; when Kidney deficiency occurs, pathogenic Water dominates, thus it is also primarily attributed to Kidney deficiency. As for Liver deficiency causing body heaviness and inner vexation, why is this? Because when the Liver is deficient, it cannot control the Earth element. Without the Wind energy (Liver Wood qi) to disperse, the Earth will inevitably become stagnant and transform into Heat that steams upward, causing disease. However, Liver deficiency emphasizes vexation and depression, Spleen deficiency emphasizes swelling and heaviness, and Kidney deficiency emphasizes flaccidity and weakness. These must not fail to be distinguished.

[Explanation] A slow and choppy pulse at the Chi position is called "Jie Xie" (lethargy and physical weakness). It is also said: An excessive Kidney pulse causes Jie Xie. When Kidney Qi is stagnant and transforms into Heat, Essence fails to circulate, leading to lethargy and lassitude, accompanied by vexation, heat, fatigue, and reluctance to speak. This indicates excess of deficient Heat in the Kidney meridian. Hejian (Liu Wansu) using Lishen Tang (Kidney-Draining Decoction) is a major error. Instead, Hujian Wan (Tiger-Hiding Pill) or Qingzao Tang (Clearing Dryness Decoction) should be used. Obese people often suffer from this in summer, all caused by Damp-Heat.

Shiweng said: I once read in the *Neijing* about the diseases of Tuoying (Depletion of Nutritive Qi) and Shijing (Loss of Essence), but few physicians discuss them. Recently, only Chen Yuren, in his *Illustrated Images of Carbuncles and Ulcers*, mentions the name "Shiying" (Loss of Ying/Nutritive Qi), but ultimately provides no formula or theoretical treatment. Thus, crude practitioners encountering this condition invariably make arbitrary diagnoses, causing significant harm. What is called Tuoying involves the internal deprivation of Ying Qi (Nutritive Qi), where the Fire of the Five Emotions (Wu Zhi) scorches and pressures, causing frequent vexation, depression, panting, and shortness of breath. The Five Fires stir internally, manifesting externally only after a long duration. When it manifests, it becomes hard as stone. As Chen Yuren described, it initially resembles phlegm nodules, gradually enlarging to be hard as stone later. After rupture, there is no pus, only bloody fluid. This is a critical condition with a high mortality rate ("one life in a hundred deaths"). Therefore, he did not establish formulas or theories, which is justified. The manifestation sites vary: some appear on the chest, breasts, axillae, or hypochondrium; others on elbows, wrists, shins, or knees. They gather wherever Yin-Yang obstruction creates flaws. If prolonged without resolution, the Five Qi linger, and diseases merge, connecting up and down like Liuzhu (Flowing Abscesses). One cannot rigidly adhere to Chen Yuren’s description limiting Shiying to areas around the ears, neck, etc. At the onset, there is no redness or pain, and symptoms are minimal, so patients pay little attention. Only when it swells, becomes hard and painful, and forms complex roots does it reach an extreme state. Why wait until rupture without pus to consider it a critical condition?

Tracing the origin of Tuoying, it stems from emotional depression/stagnation. If stagnation occurs within the Zang-Fu organs, it leads to conditions like Ye Ge (Dysphagia). This pathology arises internally, sharing the same source but having different manifestations compared to Liuzhu, Jiehe (Scrofula/Tuberculous lymphadenitis), and Ru Yan (Breast Cancer). Regarding treatment, at the initial stage when it can still be saved, the priority is to harmonize Ying Qi and resolve stagnation. Resolving stagnation entirely relies on the strength of Stomach Qi to transport medicinal power. Formulas like Yiqi Yangying (Tonifying Qi and Nourishing Ying) should be taken consistently over a long period to hope for recovery. If one focuses on attacking hardness, detoxifying, clearing Heat, and resolving Phlegm, it will inevitably lead to ulceration and weeping fluids. At this stage, daily administration of Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) merely aids the continuous leakage. The appearance of the ulcer resembles a pomegranate split open externally or lotus seeds embedded in a pod, similar to Fanhua Chuang (Fungating Wounds). This differs from Liuzhu or Jiehe, which may still be treatable after ulceration, and is unlike Shijing, which presents as tendon and vessel flaccidity. Although the *Neijing* lists Tuoying and Shijing together, their severity and prognosis differ greatly. Tuoying results from a fall from nobility to baseness; although not infected by external pathogens, vital essence depletes daily. With Ying Qi lost internally and pathological masses gathering externally, both attacking and tonifying methods are frustrating, and skilled physicians cannot easily alter the patient's emotional state. Shijing results from a fall from wealth to poverty; although not injured by pathogens, the body wastes away daily. Internally there is stagnation, but externally no masses form. Medicinal administration faces little obstruction, allowing physicians to apply their therapeutic benevolence. However, both diseases are fundamentally related to emotions and often occur together, presenting a dilemma akin to allies becoming enemies, difficult to separate. Hence, Chen Yurin summarized them under "Shiying." Regrettably, he only initiated the concept but concealed the key therapeutic techniques. No wonder crude practitioners mistake errors for truth and recklessly use Bian stones (Bian Shi, lithic needles), incurring the faults of the "Five Errors and Four Losses."