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Then the sinews will become soft; if the sinews are soft, they can bind the bones and facilitate joint movement, so how could there be spasms and tremors? Using herbs such as *Acanthopanacis Senticosi Cortex* (Wujiapi), *Coicis Semen* (Yiren), *Carthami Flos* (Honghua), *Ginseng Radix et Rhizoma* (Renshen), *Cornu Cervi Gelatinum* (Lujiaojiao), *Testudinis Carapax et Plastrum* (Guiban), *Ossis Tigris* (Hugu), *Angelicae Sinensis Radix* (Danggui), *Salviae Miltiorrhizae Radix* (Danshen), *Rehmanniae Radix* (Digu), *Drynariae Rhizoma* (Gusuibu), and *Xanthii Fructus* (Cangerzi), after two months of administration, muscles gradually grew, dietary intake significantly increased, and the spasms and tremors of both hands were cured.

Huang Lvsu said: In the summer of the Jiyi year, I went to Nanjing for the imperial examinations. I formed a study society with my sister's husband, Gongfu, and noticed that his gait was slightly inconvenient. He complained of severe leg pain, although his spirit was originally fine. Listening to quacks, he believed it was wind-dampness and exclusively took wind-dispelling and dampness-drying formulas. His appearance became increasingly emaciated. In August, hemoptysis occurred, muscles wasted away completely, and he died in winter. From this case, it is further confirmed that leg and foot soreness and pain cannot generally be treated as wind diseases. The legs and feet belong to the Three Yin meridians and mostly involve Liver-Kidney Yin deficiency; the appropriate method is tonification. Instead, taking wind drugs depletes the body, hastening death!

Zhang Sanxi treated a thin man who could not rise after sitting. His left pulse was weak, while the right Guan and Cun positions were distinctly wiry, rapid, and powerless, caused by excessive alcohol and sexual indulgence. He used Danxi's Modified Siwu Decoction and recovered in less than twenty doses. Later, he took Cornu Cervi Gelatin for conditioning.

Another person was obese, had difficulty walking, and suffered from frequent dizziness. A large dose of Erchen Decoction added with Arisaematis Rhizoma (Nanxing), Atractylodis Rhizoma (Baizhu), Atractylodis Macrocephalae Rhizoma (Cangzhu), Phellodendri Cortex (Huangbai), and Scutellariae Radix (Huangqin), along with Bamboo Juice (Zhuli) and Ginger Juice (Jiangzhi), cured him in a few doses. (Treated as phlegm.)

Another person felt intense heat in both feet as if burning, radiating from the ankles up to the knees and thighs, accompanied by flaccidity, weakness, and pain. The pulse was soggy and rapid, indicating damp-heat with deficiency. The prescription used Atractylodis Rhizoma and Phellodendri Cortex as sovereign herbs (4 liang each), Achyranthis Bidentatae Radix (2 liang), Testudinis Carapax et Plastrum, Ossis Tigris Tibiae, and Stephaniae Tetrandrae Radix (1 liang each), Angelicae Sinensis Radix and Ginseng Radix et Rhizoma (2 liang each). These were made into pills with yam paste, sized like wisteria seeds. Each dose was 100 pills, taken on an empty stomach with salted water. Aconiti Lateralis Radix Preparata (Fuzi) was added to the above formula.

An elderly patient with flaccidity and cold limbs did not respond to Huqian Wan. Later, adding Aconiti Lateralis Radix Preparata to Huqian Wan cured him. This is because Fuzi has a counter-assisting effect.

Another person had heavy legs unable to lift, with all six pulses deep and rapid. Inquiry revealed a habit of heavy drinking, so it was treated as damp-heat. Siling Powder and Sanmiao Powder, added with Achyranthis Bidentatae Radix, Akebiae Caulis (Mutong), and Stephaniae Tetrandrae Radix, reduced symptoms after several doses. Jianbu Wan was then used for conditioning.

Xue Lizhai treated Yu Shangzhi, a Jinshi degree holder, who had chronic Kidney deficiency and overwork, resulting in leg flaccidity preventing walking, aphasia, and dark complexion. Xue diagnosed this as Kidney Qi deficiency and cold, failing to transport energy to the extremities, and cured him with Dihuang Yinzi. After relapse due to poor care, others used Niuhuang Qingxin Wan, causing urinary retention and dry mouth/tongue. Xue reverted to Dihuang Yinzi and Jiaban Bawei Wan, leading to gradual recovery, followed by full cure with Buzhong Yiqi Tang.

Zhongzai Liu Ziyan suffered lower body weakness and pain, fever, and profuse phlegm due to overwork. Qingzao Tang with Bamboo Juice and Ginger Juice halved the fever and pain after one dose, and cured him after two doses.

Zhang Luyu treated Lao Junqing, an elderly man with contracture and disability. Half a year of treatment with Papaveris Pericarpium (Mugua), Angelicae Pubescentis Radix (Duohuo), Stephaniae Tetrandrae Radix, and Sparaxis Spica (Weilingxian) rendered him immobile. Bawei Wan was ineffective. His pulse was slightly floating and fine at the Chi position. During midsummer, his knees to feet felt cold as if emerging from water. Diagnosing Kidney deficiency exacerbated by wind and rain, Zhang prescribed Anshen Wan. One dose allowed walking; two courses eliminated flaccidity.

Lu Yangyu treated the mother of Shi Fenggang, aged fifty, with emaciated and slightly swollen limbs, worse at wrists, knees, and finger joints, with exposed blue veins. She historically experienced irritability, hematemesis, or hematochezia for one to two days post-menstruation, controlled only by cooling blood herbs like Moutan Cortex, Rehmanniae Radix, Scutellariae Radix, and Coptidis Rhizoma. Post-menopause, bleeding decreased, but limb symptoms worsened. Shiguo Gong Medicinal Wine was ineffective. Over years, she took Cangzhu, Wutou, Fuzi, Qianghuo, Fangfeng, and various blood-invigorating and wind-damp dispelling formulas. Now, she needed assistance for eating and toileting, suffering unbearable spasmodic pain. All six pulses were faint and choppy, especially slow and weak at the Chi positions. Lu stated: Initial overuse of cold herbs damaged Liver Qi; subsequent wind-dry herbs depleted Liver Blood. Since the Liver governs sinews, current Qi and Blood deficiency left sinews un nourished, causing swelling, exposure, and loss of mobility. He prescribed Ren Shen, Chuanxiong, Dang Gui, and Shou Wu with small amounts of Rou Gui and Qin Jiao as decoction, and Huqian Wan ingredients with doubled Lujiaojiao as pills. Symptoms improved in one month, normal mobility returned in three months, and full cure was achieved in six months. (Xu Lingtai notes: Medication was not optimal.)

Zhu Danxi treated Zheng Anren, aged sixty, with deficiency and phlegm, slow pulse, and weak legs. Banxia Tianma Baizhu Tang combined with Jiuqin Wan cured her.

A scholar sought treatment for weak legs. Both hands showed floating, full, and slightly distended pulses; diet was normal, but he did not respond to questions. White scales appeared on his skin like bran. It was winter, so extreme deficiency was assumed. His brother revealed he had developed carbuncles on his back, arms, and legs from summer to autumn, treated with Wuxiang Liaoqiao Tang and Shixuan San, now scabbed. Zhu prepared a paste of Ren Shen, Baizhu, and Dang Gui, using Erchen Tang to resolve phlegm-fluids. After consuming one jin of medicine in three days, half the scales disappeared, and breathing strengthened. Tonics work slowly, but the family complained and self-treated for wind disease. They ingested Qingmengshi processed with Qingzhou Baiwan. Despite opposition, he died. (Treating flaccidity as wind disease often leads to death.)

Xue Lizhai treated a woman with hemorrhoids and leg soreness resembling bi-syndrome, caused by Yin Blood deficiency failing to nourish sinews. She was cured with Jiabin Sijin Wan after focusing on nourishing blood.

An elderly man with tendon cramps, bone pain, and leg weakness was cured with Huantui Wan from *Jufang*.

A woman with tendon traction, bi-paralysis, and leg weakness was improved with Shengjun Wan from *Sanyinfang*. He Jian noted: Hongkong jiao arises from Kidney deficiency, but women also suffer it due to Blood Sea deficiency and emotional factors. Women's cases resemble men's Kidney deficiency. Treatment is similar, but emotional regulation is essential for efficacy. (Included in flaccidity due to deficiency origin.)

Yao Sengyuan treated Yi Fanglou Mu, Governor of Jinzhou, who felt bound from waist to navel, with loose legs unable to support himself. Yao prescribed three doses of decoction. After the first dose, the upper binding resolved; after the second, the middle; after the third, all bindings resolved. Pain and stiffness remained, so a powder was given, allowing slight flexion. Yao predicted recovery by frost descent. By September, he could walk. (*Book of Zhou*.)

Note: This describes flaccidity worsening in spring/summer and improving in autumn/winter.

Zihe said: Three military officers in Wanqiu suffered from flaccidity for years, with painful swelling below the waist, skin sores, dim vision, dry lips, and tongue. Zihe wanted to use purgatives. Two refused, trusting warm-tonifying doctors, and died. Song Ziyu, similarly ill, changed his mind, accepted Zihe's treatment, and recovered. Zihe stated: "For all flaccidity, treat only the Yangming." Yangming refers to Stomach and Large Intestine. This applies to both acupuncture and herbal medicine.

Wang Zhizhong cited *Liezi*: If kidneys fail, legs cannot walk. For this condition, moxa Shenshu. If ineffective, moxa Huantiao, Fengshi, Dubi, Xiguan, Yanglingquan, Yinlingquan, Zusanli, and Taichong. The tender spot upon pressure indicates the diseased area; moxibustion there is always effective. (*Zisheng Jing*.)

Shi Lingxiu's acquaintance, a heavy drinker, was bedridden for three years. Lingxiu asked Zhongchun for a prescription. Zhongchun diagnosed alcohol-induced disease. Alcohol generates damp-heat, which penetrates Yangming. Excess damp-heat descends to Kidneys, causing bone flaccidity. Hence, ancient texts say "treat Yangming alone for flaccidity." The formula used Schisandrae Fructus as sovereign, Coptidis Rhizoma as minister, Ophiopogonis Radix, Puerariae Radix, and Dolichoris Semen as assistants. Cure was achieved. (*Guang Biji*.)

Xue Lizhai treated a man over fifty with soft, flaccid tendons/bones, bedridden for five years, with severe itching worse in the afternoon. Blood-nourishing herbs reduced itching and improved flaccidity slightly. Jiabin Sijin Wan completed the cure after a year of careful conditioning. He Jian commented: Why use warm tonics for internal heat? Because Yin Blood deficiency fails to nourish sinews, causing laxity. Internal Yang dryness/heat requires nourishing Yang and Yin; when Yin is substantial, Water rises and Fire descends.

Qian Guobin treated Shen Shiyan from Longquan, previously healthy but with stagnant Liver Qi. After age forty, legs weakened spontaneously, progressing to paralysis and contracture. Friends suggested: Straightness without bending indicates bone disease; bending without straightness indicates sinew disease. Relaxed sinews mean no disease. *Neijing* states: Heart generates blood; Liver stores blood. Shen's resentment depleted blood, failing to nourish sinews and bind bones, leading to cold bi and contracture. The prescription used Umbilicus (Qidai) and Placenta Humana (Ziheche) as sovereign, Human Milk, Lycii Fructus, and Polygoni Multiflori Radix as ministers, Chuanxiong, Dang Gui, Dihuang, Achyranthis Bidentatae Radix, and Honghua as assistants. Rich blood nourishes sinews; harmonized sinews bind bones. Pills were taken. External therapy: Several liters of infant urine placed in a large bowl. Legs rested above the bowl. Red-hot tiles were quenched in the urine repeatedly. Steam was inhaled and applied to the legs for one hour. (External therapy is exquisite.) Infant urine is salty and cold; salt softens hardness and moves blood/stasis. *Classic* says: Supplement Qi to treat Blood deficiency, implying Yin born from Yang. Heat disperses cold bi in bones/sinews, guided by tiles. Profound method, known only to those who grasp the essence.

Wei Yuheng described Zhang Yushu's son, nearly thirty, with sudden chills, fever, and headache. Doctors treated it as Taiyang disease for a month, leading to confusion and excruciating pain. Upon examination, the patient lay corpse-like, hair covering forehead, face dirty, skin dry, flesh wasted, looking like a demon. Pulse was wiry, firm, choppy, and rapid at Left Guan/Chi. Pain started at the arm side, extending to toes, shoulders, back, and head, with spasms and rigidity. Wei told the father: This is combined sinew-bone flaccidity. Early tonification would have prevented this. Caused by youthful indiscretion, intercourse followed by long-distance travel and labor, damaging Three Yin. Pain starts at Huantiao, extending to Dadun, Yinbai, Yongquan (Liver/Spleen/Kidney points), and shoulder/head (Du Mai injury). Mother confirmed intercourse followed by rushing to the riverbank. Wei advised: Youthful Qi/Blood recovers easily. Needs 100 doses, or permanent limp. Prescribed Roushou Rong, Sheng/Di Huang, Gouqi, Yiren, Dang Gui, Niuxi, Honghua, Danpi, Louren, Maidong. Ten doses allowed sitting; ten more allowed walking with a cane. Father, stingy, stopped medication when improvement began. Result: One leg shortened by 1-2 inches, causing limping.

Wu Taiyi, over sixty, suffered tendon spasms connecting vertex, shoulders, neck, waist, abdomen, chest, and ribs, with back distension, dizziness, dry mouth, palpitations, frequent urination, reduced appetite, and hot hands craving cold water. Pulse was wiry, rapid, and urgent. Diagnosis: Many symptoms stem from excess Liver Fire and deficient Blood, causing dry sinews and eventual flaccidity. Moistening and nourishing would cure quickly. Yangrong Tang with Yiren, Louren, Dang Gui, and Nvzhen cured her in ten doses.