有男子脾肾气虚，腰膝无力、目眩、耳鸣、形体憔悴、溏泄无度、饮食少进、步履艰难
，似乎阴虚弱症而非也。何以辨之？曰∶不咳嗽，不内热、骨蒸，不潮热、吐红是也。然其
脉必软缓微弱，虚寒之极。治法当回阳返本、健脾益胃、交补心肾为主，则寒谷阳回，万物
发生。
有一种软懒之症，四肢倦怠，面色淡黄；或膈中气满，不思饮食。其脉沉迟涩滞，软弱
无力。或表气不清，恶寒发热，当其寒，则脉愈加沉涩；当其热，则脉微见细数。或传里内
热，则脉气沉洪或洪数。总之，定带软弱不清之象。此内伤兼外感，其邪只在肌表筋骨
之间，未深入脏腑，其所感尚轻，故不成伤寒、疟、痢等疾，而为此软弱因循之症也。
久久不治，成硬头黄者居多。若脾虚湿胜者，则成黄肿；若肺气不足者，流入清虚之腑
，则壅为痰嗽；若血少者，迁延岁月，则成内热，或五心烦热，日晡潮热，渐似骨蒸劳热矣。
此症大都得诸藜藿穷檐之辈，间有膏粱之人，因房劳不节，或窃玉偷香，恐惧忧惊，或埋首芸
窗，用心过度，或当风取凉，好食生冷，致风寒传染，郁而不散，乃内伤兼外感而成。其外象
酷似弱症，若察症不的，初起遽投以凉剂、补药，则邪正混淆，不得清彻，以致寒邪闭遏，郁
于经络，而为内热，遂成真病。人家子弟患此，类多讳疾忌医，不便直告人，自认虚弱，见医
者投以清理散邪之品，反不肯服，所以难治，亦难辨也。然则何以辨之？曰∶头不痛，身不热
，不烦嗽，不唾血，但腿酸脚软，蒸蒸内热，胸中邪气隔紧，食不易饥，与之食则食，不与亦
不思，或今日思此物，明日即不喜，又思别物适口，如怯症之尝食劳也。治法∶当其未入里时
，宜和解分消，托之使出，用八物汤加减，去黄芩，加前胡、山楂、陈皮之类。湿胜有痰者，
重以二陈汤，禀气浓者，加枳壳。用此数剂，邪自解散。若邪已入里，难从肌表散去，则宜重在
分消，使邪从小便而出。表里既清之后，以养气、养血之品，培其本源。若起于忧惊思虑者，以
交固心肾之药要其终，则霍然矣。玉芝云∶外感软懒之症，切不可发汗，汗之则虚晕欲倒，以其兼
内伤重也。治宜柴胡、防风、葛根、苏梗、陈皮、山楂、枳壳、泽泻等味主之。小便不利者，加
车前。质弱者，去枳壳。数剂后加丹参，再后加当归。若脾虚下泄者，稍加燥味。若血虚内热者
，少加丹皮、地
有一位男子，脾脏和肾脏的气虚，导致腰部和膝盖没有力气、头晕眼花、耳朵鸣响、身体消瘦憔悴、大便稀溏且次数无度、饮食摄入减少、行走困难。这看起来像是阴虚虚弱证，但并非如此。如何辨别呢？回答说：不咳嗽，没有内热、骨蒸（一种自觉骨头里发热的症状），没有潮热（定时发热）、咳血就是辨别的关键。然而他的脉象必定是软缓微弱，这是极度虚寒的表现。治疗方法应当以回阳救逆、恢复元气、健脾益胃、心肾双补为主，这样就像寒冷的山谷中阳气回归，万物得以生发一样。
有一种叫做“软懒”的病证，表现为四肢倦怠无力，面色淡黄；或者胸膈部位气机胀满，不想吃东西。其脉象沉迟涩滞，软弱无力。或者表气不清爽，出现怕冷发热的症状，当处于怕冷阶段时，脉象更加沉涩；当处于发热阶段时，脉象微微显现细数。如果病邪传入体内产生内热，则脉气变得沉洪或洪数。总之，脉象一定带有软弱不清的特征。这是内伤兼有外感，病邪只在肌肉、皮肤、筋骨之间，没有深入脏腑，所以感受尚轻，因此不会形成伤寒、疟疾、痢疾等疾病，而是形成这种软弱拖延的病症。如果长久不治疗，大多会发展成头部僵硬、面色萎黄的病症。如果是脾虚湿气过胜的人，则会发展成黄肿病；如果是肺气不足的人，病邪流入清虚的肺腑，就会壅滞成为痰嗽；如果是血少的人，拖延岁月，就会形成内热，或者五心烦热（手心、脚心和心口发热），下午定时发热，逐渐类似骨蒸劳热了。
这种病证大多得自于吃粗茶淡饭、住在简陋屋檐下的贫穷百姓，偶尔也有富贵之人，因为房事不节制，或者偷香窃玉（指不正当的性行为），恐惧忧虑惊恐，或者埋头苦读，用脑过度，或者对着风纳凉，喜欢吃生冷食物，导致风寒传染，郁结而不散，从而形成内伤兼外感的病症。其外在表现酷似虚弱证，如果察症不确切，初起就急忙投用凉药、补药，那么邪气和正气混淆，不能清除透彻，以致寒邪闭阻遏制，郁结在经络中，而变成内热，遂成为真正的重病。人家子弟患此病，大多隐瞒疾病忌讳就医，不便直接告诉别人，自己承认是虚弱，见到医生投用清理散邪的药物，反而不肯服用，所以难治，也难辨别。那么如何辨别呢？回答说：头不痛，身体不热，不烦躁咳嗽，不吐血，只是腿酸脚软，蒸蒸内热（持续的内热感），胸中邪气隔阂紧绷，吃饭不容易感到饥饿，给他吃他就吃，不给也不想吃，或者今天想吃这个，明天就不喜欢了，又想吃别的合口的东西，像怯症（虚劳）患者尝试进食劳累的样子。治疗方法：当病邪尚未入里时，适宜和解分消，托举病邪使其排出，使用八物汤加减，去掉黄芩，加入前胡、山楂、陈皮之类的药物。湿气过胜且有痰的，重用二陈汤，禀赋厚实的人，加入枳壳。使用这几剂药，邪气自然解散。如果邪气已经入里，难以从肌表散去，则应该重在分消，使邪气从小便排出。表里既已清净之后，用养气、养血的药物，培补本源。如果是因忧惊思虑引起的，用交通固摄心肾的药物来善后，那么就会霍然痊愈了。玉芝说：外感引起的软懒之症，切不可发汗，发汗则会导致虚晕欲倒，因为它兼有严重的内伤。治疗适宜用柴胡、防风、葛根、苏梗、陈皮、山楂、枳壳、泽泻等味为主。小便不利的，加车前子。体质弱的，去掉枳壳。几剂药后加丹参，再后来加当归。如果是脾虚下泄的，稍加燥湿的药物。如果是血虚内热的，少加牡丹皮、地骨皮……
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)...