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

The "Five Softnesses" refer to softness of the head and neck, softness of the hands and feet, softness of muscles, and softness of the mouth. If a child cannot lift their head without cause, this is a disease of *Shen Gan* (Rickets of the Kidney); the neck vessels are weak and difficult to support, and although treatment may temporarily alleviate symptoms, they will inevitably recur in subsequent years. Softness of the hands and feet manifests as drooping hands and lack of strength in the four limbs, along with reluctance to raise the eyebrows; if the voice is clear and the child can eat, it indicates the syndrome of *Man Pi Feng* (Slow Spleen Wind), which is still treatable. Softness of muscles presents as little flesh and loose, separating skin; eating does not build muscle mass. One may administer Qian Shi's Jutian Wan (Tangerine and Coptis Pill) for deficiency and emaciation, ensuring frequent diarrhea does not occur, as that would make treatment difficult. Softness of the legs refers to a five-year-old child unable to walk; with deficiency, emaciation, and small, weak legs, provided Ying and Wei Qi are not compromised, one should administer herbs such as Renshen (Ginseng) and Qian Shi's Dihuang Wan (Rehmannia Pill) to tonify the Kidney; naturally, the muscles will become full upon growth. Softness of the mouth involves the tongue protruding constantly; if Yang is excessive, caution is required, and treating the Diaphragm is necessary but generally harmless; however, cyanotic lips and panting indicate a difficult prognosis.

[Xue Ji] Softness of the head and neck arises from deficiency in the Zang-Fu organs, bones, and vessels, and insufficiency of the Yang Qi of all channels, resulting in weakness of the Tianzhu Bone (Cervical Spine). The Kidney governs bones, so deficiency in the Foot Shaoyin and Foot Taiyang meridians is the cause. Softness of the hands and feet occurs because the Spleen governs the four limbs; insufficiency of Qi in the Central Region (Zhongzhou) fails to nourish the limbs, leading to little flesh and loose skin, where diet fails to transform into muscle and flesh. Softness of the mouth occurs because the mouth is the orifice of the Spleen, and the upper and lower gums belong to the Hand-Yangming and Foot-Yangming meridians, which govern the Stomach. Deficiency of Spleen and Stomach Qi causes the tongue to fail to remain concealed, thus protruding constantly. The Heart governs Blood, the Liver governs Sinews, the Spleen governs Flesh, the Lungs govern Qi, and the Kidneys govern Bones. These five conditions stem from congenital weakness of the Five Zang Qi, failing to nourish and reach the extremities, resulting in weak bone-vessels and flaccid limbs. Tracing the root, it all归结s 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 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 softness of the head/neck, hands, and feet, combine with Dihuang Wan (Rehmannia Pill). Such cases require prolonged administration of these two formulas. Additionally, a healthy wet nurse should consume them, while avoiding wind and cold and regulating diet; most patients will recover fully.

[Zeng] Dai Shi discussed the Five Softnesses, naming it Taqie (Fetal Frailty), truly caused by insufficient Jing (Essence) of the father and chronic depletion of Xue (Blood) of the mother. This statement is accurate. In my view, some cases arise because the mother’s Blood Sea was long cold, requiring medicinal supplementation to conceive; others involve mothers who were frequently ill during pregnancy; or fathers who indulged in lust and alcohol, possessing weak constitutions, or were advanced in age when conceiving; some were born prematurely; or pregnancies persisted despite abortifacient attempts, wasting True Qi. Those who survive are like grass in shallow, shady soil: sprouting but rarely flourishing; or like trees whose roots have been disturbed, few of which mature. Thus, infants are frail and intolerant of cold and heat; even if they reach adulthood, they often suffer from diseases. From birth, Jing and Marrow are insufficient, sinews and bones are flaccid, muscles are thin, and spirit/color is dull and slow. Upon invasion by the Six Excesses (pathogenic factors), head, neck, hands, feet, and body become soft—this is the Five Softnesses. Treatment uses Tiaoyuan San (Regulate Origin Powder) and Bushen Dihuang Wan (Tonify Kidney Rehmannia Pill), gradually conditioning until stability is achieved over time. If medication fails, the child may become disabled.

Some children appear robust and plump but suddenly exhibit neck collapse, termed Xia Chuan (Descending Collapse). This is due to deficiency of Liver and Kidney Qi, allowing pathogenic factors to invade the Fengfu acupoint and transmit to sinews and bones. Since the Liver governs sinews and the Kidney governs bones, dual weakness leads to drooping, powerless necks, also called Tianzhu Dao (Collapsing Pillar). It is similar to the Five Softnesses and treated with the same formulas.

For example, the seven-year-old son of Shi Wanhu from Wujiang suffered vomiting and diarrhea, with sudden sinking of the fontanelle and eyes, collapsing cervical spine, and red face. Initially, Buzhong Yiqi Tang with one dose of Fuzi (Aconite Root) stopped the vomiting/diarrhea and resolved other symptoms; subsequently, Qian Shi’s Dihuang Wan decoction 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, neck softness, and sunken fontanelle. By afternoon, the face turned pale, hands/feet cold, and pulse faint/almost absent. Urgently administering Liujunzi Tang (Six Gentlemen Decoction) with Fuzi reversed the symptoms instantly, raising the fontanelle. Children’s Yuan Qi (Primal Qi) is prone to both deficiency and excess; thus, even in critical conditions, prompt correct medication can restore life.

A nine-year-old child, post-vomiting/diarrhea, exhibited neck softness, pale face, cold hands/feet, fine/faint pulse, and preference for hot drinks. I first used Liujunzi Tang with Rougui (Cinnamon Bark) for five doses without effect, then added Paojiang (Prepared Ginger) for four doses; symptoms improved slightly, but face remained pale and Chi pulse undetectable. I supplemented with Bawei Wan (Eight-Ingredient Pill). After a month, the face became slightly yellow, indicating returning Stomach Qi. Continuing previous meds for another month increased appetite and reduced heat. Then, morning Buzhong Yiqi Tang and pre-meal Bawei Wan were used. After another month, Yuan Qi recovered, diet normalized, head lifting returned, and muscles filled; all diseases resolved.

A twelve-year-old child, post-malaria, had neck softness, cold hands/feet, poor appetite, and abdominal coldness when food cooled. Liujunzi Tang with Rougui and Ganjiang (Dried Ginger) improved diet; adding Huixiang (Fennel) and Hujiao (Pepper) allowed cooler food within a month. After 100 doses of previous meds, diet normalized, hands/feet warmed, and head lifting returned after another month. Later, food stagnation caused vomiting/diarrhea and neck flaccidity. Morning Buzhong Yiqi Tang and evening Liujunzi Tang plus Ji Jian Bawei Wan (Modified Eight-Ingredient Pill) restored neck lifting in two months. Post-marriage, blurred vision and weak neck/head heaviness were treated with Bawei Wan and Buzhong Yiqi Tang for three months, recovering Yuan Qi and resolving symptoms. Subsequent sexual exertion caused fatigue, night sweats, and fever, resolved by these two pills.

A fifteen-year-old child had flaccid limbs, inability to chew hard objects, internal heat, afternoon tidal fever, and dysuria resembling strangury. Diuretics worsened strangury; Yin-nourishing herbs intensified internal heat; drying-damp herbs caused heavy stool sensation. I diagnosed congenital Kidney Qi deficiency due to early sexual activity. As stated in the Jingxue Pian (Chapter on Essence and Blood): "Men whose Jing is not full yet engage in intercourse deplete their essence, leaving the Five Zang incomplete, leading to difficult-to-describe illnesses later." For elderly men with impotence seeking sex, forcing ejaculation without release causes internal decay, dysuria, and pain. If Yin is exhausted further, bowel/bladder pain ensues, creating a vicious cycle. I prescribed morning Buzhong Yiqi Tang and evening Liuwei Wan (Six-Ingredient Pill) with Wuweizi (Schisandra) for over 30 doses each, gradually resolving symptoms. Later, nocturnal emissions recurred symptoms, with cold limbs and urgent phlegm-Qi. Shiquan Dabu Tang (Ten Complete Tonifying Decoction) and modified Bawei Wan (8 doses each) improved bowels/bladders and warmed limbs. Continuing these for three months restored Yuan Qi and diet. Food stagnation later caused vomiting/diarrhea/abdominal pain (painless on pressure), indicating Spleen/Stomach injury. Liujunzi Tang with Muxiang (Aucklandia) and Roudoukou (Nutmeg) treated it. When vomiting persisted, the Left Chi and Right Guan pulses were floating/large lightly but empty deeply. The Classic states: "The Kidney opens into the two yin orifices." Siweizi San (Schisandra Powder) administered four times stopped diarrhea instantly. Later, food injury caused sour regurgitation, diarrhea, and heavy stool. Morning Buzhong Yiqi Tang and evening Liujunzi Tang with Muxiang and Ganjiang cured him.

An elderly man’s son had flaccid limbs, aversion to wind/cold, and preference for sunlight. I instructed the wet nurse to take Ji Jian Bawei Wan three times daily and Shiquan Dabu Tang once daily, shared with the child. Limbs strengthened over a year, walking achieved at age two.

A five-year-old boy, inheriting his father’s leg weakness, lost his natural vitality early. At seventeen, post-marriage, he had leg weakness and an expanding fontanelle. Living ascetically, he took morning Buzhong Yiqi Tang and evening Dihuang Wan material with Wuweizi and Lurong (Deer Antler) daily, becoming healthy after a year.

Another child cured of neck softness by previous meds developed Jielu (Splitting Skull) with thirst/fever post-marriage. Large doses of the two formulas as tea consumed freely for two months reduced thirst/fever; fontanelles closed in a year, limbs strengthened in another. Without strict health precautions, medicine alone could not save him.