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A male patient presented with Qi deficiency of the Spleen and Kidney, resulting in weakness of the lower back and knees, dizziness, tinnitus, emaciation, uncontrolled loose stools, reduced appetite, and difficulty walking. This appears to be a Yin-deficiency weak syndrome, but it is not so. How to differentiate it? The answer is: absence of cough, absence of internal heat, bone-steaming fever (a sensation of heat emanating from the bones), tidal fever, and hemoptysis. However, his pulse must be soft, slow, and faint, indicating extreme deficiency-cold. The treatment method should focus on restoring Yang and returning to the root, strengthening the Spleen and benefiting the Stomach, and mutually supplementing the Heart and Kidney. In this way, like the return of Yang energy in a cold valley allowing all things to flourish, recovery will occur.

There is a syndrome called "Softness and Laziness" (Ruan Lan), characterized by fatigue and weakness of the four limbs, and a pale yellow complexion; or qi fullness in the diaphragm and loss of appetite. The pulse is deep, slow, choppy, and stagnant, appearing weak and powerless. There may also be unclear exterior Qi, manifesting as aversion to cold and fever. During the aversion-to-cold phase, the pulse becomes more deep and choppy; during the fever phase, the pulse subtly shows thin and rapid qualities. If the pathogen transmits inward causing internal heat, the pulse energy becomes deep and surging or surging and rapid. In summary, the pulse always carries a weak and unclear quality. This is an internal injury combined with external contraction. The pathogen remains only between the muscles, skin, and sinews, without deeply entering the Zang-Fu organs. Thus, the contraction is relatively mild, failing to form diseases such as Shanghan (Cold Damage), malaria, or dysentery, but instead forming this lingering syndrome of weakness and laziness. If left untreated for a long time, most cases develop into hard-headed and sallow conditions. If the Spleen is deficient with excessive dampness, it develops into yellow edema; if Lung Qi is insufficient, the pathogen flows into the clear and empty organ (Lung), becoming congested into phlegm and cough; if Blood is scanty, after dragging on for years, it forms internal heat, or five-palm heat (heat in the palms, soles, and chest), and afternoon tidal fever, gradually resembling bone-steaming consumption.

This syndrome mostly affects those who eat coarse food and live in humble dwellings, though occasionally it occurs in wealthy individuals due to immoderate sexual activity, illicit affairs, fear, anxiety, or excessive mental exertion from studying. It can also result from cooling oneself in the wind, preferring raw and cold foods, leading to Wind-Cold transmission where stagnation fails to disperse, thus forming internal injury combined with external contraction. Its external appearance closely mimics a weak syndrome. If the symptoms are not accurately observed and cool or tonifying medicines are administered prematurely at the onset, the pathogenic factor and healthy Qi become confused and cannot be thoroughly cleared. This leads to Cold pathogen being closed and suppressed, stagnating in the collaterals and meridians, transforming into internal heat, thereby becoming a true serious disease. Young men of families suffering from this often conceal their illness and avoid doctors, unwilling to admit their condition directly. When doctors prescribe herbs to clear and disperse pathogens, they refuse to take them. Hence, it is difficult to treat and difficult to differentiate. So how to differentiate it? The answer is: no headache, no body heat, no irritable cough, no hemoptysis, but rather sore legs and weak feet, persistent internal heat, tight obstruction of pathogenic Qi in the chest, lack of easy hunger, eating when offered but no desire to eat otherwise, changing food preferences daily, similar to the tentative eating habits of patients with Qie Zheng (consumptive weakness). Treatment method: When the pathogen has not yet entered the interior, harmonization and dispersion are appropriate to push the pathogen outwards. Use Ba Wu Tang (Eight Substance Decoction) with modifications: remove Huang Qin (Scutellariae Radix), add Qian Hu (Peucedani Radix), Shan Zha (Crataegi Fructus), Chen Pi (Citri Reticulatae Pericarpium), etc. For excessive dampness with phlegm, heavily use Er Chen Tang (Two Aged Substances Decoction); for those with robust constitution, add Zhi Ke (Aurantii Fructus). After several doses, the pathogen will naturally disperse. If the pathogen has already entered the interior and cannot be dispersed from the muscle layer, focus on differentiation and dispersion, allowing the pathogen to exit via urination. After the exterior and interior are cleared, use Qi-nourishing and Blood-nourishing herbs to cultivate the source. If caused by worry, fright, and overthinking, use herbs that connect and secure the Heart and Kidney to conclude the treatment, and the patient will recover abruptly. Yu Zhi stated: For softness and laziness caused by external contraction, sweating therapy must strictly be avoided; sweating will cause dizziness and collapse due to the severe underlying internal injury. Treatment should prioritize Chai Hu (Bupleuri Radix), Fang Feng (Saposhnikoviae Radix), Ge Gen (Puerariae Lobatae Radix), Su Geng (Perillae Caulis), Chen Pi, Shan Zha, Zhi Ke, Ze Xie (Alismatis Rhizoma), etc. For difficult urination, add Che Qian Zi (Plantaginis Semen). For weak constitutions, remove Zhi Ke. After several doses, add Dan Shen (Salviae Miltiorrhizae Radix), and subsequently Dang Gui (Angelicae Sinensis Radix). For Spleen deficiency with downward discharge, slightly add drying agents. For Blood deficiency with internal heat, slightly add Mu Dan Pi (Moutan Cortex) and Di Gu Pi (Lycii Cortex)...