详见杂病准绳
五软者，头软项软、手软脚软、肌肉软、口软是也。无故，不举头，肾疳之
病，项脉软而难收，治虽暂瘥，他年必再发。手软则手垂，四肢无力，亦懒抬眉，
若得声圆，还进饮食，乃慢脾风候也，尚堪医治。肌肉软则肉少，皮宽自离，吃食
不长肌肉，可服钱氏橘连丸（虚羸），莫教泻利频并，却难治疗。脚软者，五岁儿不能行，
虚羸脚软细小，不妨荣卫，但服参 等药，并服钱氏地黄丸（肾），长大自然肌肉充满。
口软则虚舌退场门，阳盛更须堤防，必须治膈，却无妨，唇青气喘，则难调治也。
〔薛〕夫头软者，脏腑骨脉皆虚，诸阳之气不足也，乃天柱骨弱，肾主骨，足少阴、
太阳经虚也。手足软者，脾主四肢，乃中州之气不足，不能营养四肢，故肉少皮宽，
饮食不为肌肤也。口软者，口为脾之窍，上、下龈属手、足阳明，阳明主胃，脾胃
气虚，舌不能藏而常舒出也。夫心主血，肝主筋，脾主肉，肺主气，肾主骨，此五
者皆因禀五脏之气虚弱，不能滋养充达，故骨脉不强，肢体痿弱，原其要，总归于
胃，盖胃水谷之海，为五脏之本，六腑之大源也，治法必先以脾胃为主，俱用补中
益气汤以滋化源，头项、手、足三软，兼服地黄丸。凡此证必须多服二药，仍令壮
年乳母饮之，兼慎风寒，调饮食，多能全角。〔曾〕戴氏论五软证，名曰胎怯，良
由父精不足，母血素衰而得。诚哉是言，以愚推之，有因母血海久冷，用药强补有
孕者，有受胎而母多疾者，或其父好色贪酒、气体虚弱，或年事已迈，而后见子，
有日月不足而生者，或投堕胎之剂不去而竟成孕者，徒尔耗伤真气，苟或有生，譬
诸阴地浅土之草，虽有发生，而畅茂者少，又如培植树木，动摇其根，而成者鲜矣，
由是论之，婴孩怯弱，不耐寒暑，纵使成人，亦多有疾，爰自降生之后，精髓不充，
筋骨痿弱，肌肉虚瘦，神色昏慢，才为六淫所侵，便致头项手足身软，是名五软。
治法用调元散、补肾地黄丸，渐次调养，日久乃安，若投药不效，亦为废人。有
小儿体肥容壮，不为瘦瘁，忽然项软倾倒，此名下窜，皆因肝肾气虚，客邪侵袭风
府，传于筋骨，故成斯疾，盖肝主乎筋，肾主乎骨，筋骨俱弱，则项软垂下无力，
又名天柱倒，与五软相类不远，治同前药。吴江史万湖子七岁，患吐泻，囟目顿
陷，天柱骨倒，兼面赤色，先用补中益气汤加附子一剂，吐泻止而诸证愈，又用钱
氏地黄丸料煎服顿安。一小儿七岁，夏间过食生冷之物，早间患吐泻，面赤作渴，
手足并热，项软囟陷，午后面色顿白，手足并冷，脉微欲绝。急以六君子汤加附子
一剂，诸证顿退，囟顶顿起而安，小儿元气易虚易实，故虽危证，若能速用对病之
药，亦可回生者。一小儿九岁，因吐泻后项软面白，手足并冷，脉微细，饮食喜
热。余先用六君子汤加肉桂五剂，未应，更加炮姜四剂，诸证稍愈，面色未复，尺
脉未起，佐以八味丸，月余面色微黄，稍有胃气矣，再用前药，又月余饮食略增，
热亦大减。乃朝用补中益气汤，食前用八味丸，又月余元气渐复，饮食举首如常，
又月余而肌肉充盛，诸病悉愈。一小儿十二岁，疟疾后项软手足冷，饮食少思，
粥汤稍离火食之，即腹中觉冷。用六君子汤加肉桂、干姜，饮食渐加，每饮食中加
茴香胡椒之类，月余粥食稍可离火。又用前药百剂，饮食如常，手足不冷，又月余
其首能举。后饮食停滞，患吐泻，项仍痿软，朝用补中益气汤，夕用六君子汤及加
减八味丸，两月余而项复举。毕姻后眼目昏花，项骨无力，头自觉大，用八味丸、
补中益气汤、三月余，元气复而诸证退。后每入房劳役，形气殊倦，盗汗发热，服
后二药即愈。一小儿十五岁，手足痿软，齿不能嚼坚物，内热晡热，小便涩滞如
淋，服分利之剂，小便如淋；服滋阴之剂，内热益甚；服燥湿之剂，大便重坠。余
谓此禀肾气不足，早犯色欲所致，故精血篇云∶男子精未满而御女以通其精，五脏
有不满之处，异日有难状之疾，老人阴已痿，而思色以降其精，则精不出而内败，
小便涩痛如淋，若阴已耗而复竭之，则大小便牵痛，愈痛则愈便，愈便则愈痛，正
谓此也。遂朝用补中益气汤，夕用六味丸加五味子煎服，各三十余剂，诸证渐愈。
后梦遗，诸证复作，手足时冷，痰气上急，用十全大补汤、加减八味丸料、各八剂，
二便稍利，手足稍温，仍用前二药三月余，元气渐复，饮食如常。又饮食停滞，吐
泻腹痛，按之不疼。此脾胃受伤也。用六君子汤加木香、肉豆蔻治之，其吐未已，
左尺右关二脉轻诊浮大，按之如无，经云∶肾开窍于二阴。用五味子散四服，大便
顿止。后又伤食，咽酸作泻，大便重坠。朝用补中益气汤，夕用六君子汤加木香、
干姜而痊。一老年得子四肢痿软，而恶风寒，见日则喜，余令乳母日服加减八
味丸三次，十全大补汤一剂，兼与其子，年余肢体渐强，至二周而能行。一小儿
五岁，禀父腿软，不便于行，早丧天真，年至十七毕姻后，腿软，头囟自觉开大，
喜其自谨，寓居道舍，遂朝服补中益气汤，夕用地黄丸料加五味子、鹿茸煎服，
年余而健。一小儿项软，服前二药而愈，毕姻后患解颅，作渴发热，以二药作大
剂，煎熟代茶，恣饮两月余而渴热减，年余而颅囟合，又年余而肢体强，若非慎疾，虽药不起。
详见《杂病准绳》。
五软，是指头项软弱、手足软弱、肌肉软弱、口部软弱这四种症状。如果无故不能抬头，这是肾疳的病证，颈部经脉软弱难以支撑头部，治疗虽然暂时好转，但其他年份必定复发。手足软弱则表现为手垂无力，四肢没有力气，也懒得抬眉，如果能发出圆润的声音，还能进食，这是慢脾风的征候，还可以医治。肌肉软弱则表现为肉少，皮肤松弛分离，吃东西不长肌肉，可以服用钱乙的橘连丸（针对虚羸），不要让腹泻频繁发生，否则就难治疗了。脚软弱，指五岁的孩子不能行走，身体虚弱消瘦、脚软细小，只要不影响营卫之气，只需服用人参等药物，并服用钱乙的地黄丸（补肾），长大后自然肌肉丰满。口软弱则表现为舌头松弛常伸出口外，阳气偏盛更须提防，必须治疗膈部问题，倒也无妨；但如果出现嘴唇青紫、气喘，那就难调治了。
〔薛己〕头项软弱，是因为脏腑骨脉都虚弱，诸阳之气不足，也就是天柱骨柔弱。肾主骨，足少阴经和足太阳经虚弱所致。手足软弱，是因为脾主四肢，中州之气不足，不能营养四肢，所以肉少皮宽，饮食不能转化为肌肤。口软弱，是因为口是脾之窍，上下牙龈属于手阳明和足阳明经，阳明经主胃，脾胃气虚，舌头不能收藏而经常舒出。心主血，肝主筋，脾主肉，肺主气，肾主骨，这五种情况都是因为禀受五脏之气虚弱，不能滋养充达，所以骨脉不强，肢体痿弱。追究其根本，总归于胃，因为胃是水谷之海，是五脏的根本，六腑的大源头。治疗方法必须先以脾胃为主，全部使用补中益气汤来滋生化源，头项、手、足三软，兼服地黄丸。凡是这些病症必须多服用这两种药，仍让壮年的乳母服用，同时注意防风寒，调理饮食，大多能痊愈。
〔曾〕戴氏论述五软证，名叫胎怯，确实是由于父亲精气不足，母亲血液素来衰弱而导致的。这话确实有道理。依我推测，有的因为母亲血海长久寒冷，用药强行进补才怀孕的；有的受孕后母亲多病；或者父亲好色贪酒、体质虚弱，或者年纪已大，后来才有孩子；有的月份不足就出生；或者用了堕胎药没去掉反而成孕的，白白耗伤真气，侥幸生下来的，就像阴地浅土中的草，虽然有发生，但茂盛者很少；又如同培植树木，动摇其根，能成活的很少。由此而论，婴儿怯弱，不耐寒暑，即使长大成人，也多疾病。自从降生之后，精髓不充实，筋骨痿弱，肌肉虚瘦，神色昏沉缓慢，刚被六淫邪气侵袭，就会导致头项手足身软，这就是五软。治疗方法用调元散、补肾地黄丸，渐渐调养，日久才能安宁，如果用药无效，也会成为废人。
有的小儿身体肥壮，不瘦弱，忽然项软倾倒，这叫下窜，都是因为肝肾气虚，客邪侵袭风府穴，传于筋骨，所以形成这种病。肝主筋，肾主骨，筋骨俱弱，则项软垂下无力，又名天柱倒，与五软相差不远，治疗方法同前药。
吴江史万湖的儿子七岁，患吐泻，囟门眼睛顿时凹陷，天柱骨倒，兼见面赤色，先用补中益气汤加附子一剂，吐泻止而诸证愈，又用钱乙地黄丸料煎服顿安。一个七岁小儿，夏天过食生冷之物，早晨患吐泻，面赤作渴，手足并热，项软囟陷，午后面色顿时变白，手足并冷，脉微欲绝。急用六君子汤加附子一剂，诸证顿退，囟顶顿时鼓起而安。小儿元气易虚易实，所以虽然是危重证，若能速用对病的药，也可以回生。
一个九岁小儿，因吐泻后项软面白，手足并冷，脉微细，饮食喜热。我先用六君子汤加肉桂五剂，未见效，再加炮姜四剂，诸证稍愈，面色未复，尺脉未起，佐以八味丸，月余面色微黄，稍有胃气了，再用前药，又月余饮食略增，热亦大减。于是早上服用补中益气汤，饭前服用八味丸，又月余元气渐复，饮食正常，能抬头如常，又月余而肌肉充盛，诸病悉愈。
一个十二岁小儿，疟疾后项软手足冷，饮食少思，粥汤稍离火食之，即腹中觉冷。用六君子汤加肉桂、干姜，饮食渐加，每饮食中加入茴香胡椒之类，月余粥食稍可离火。又用前药一百剂，饮食如常，手足不冷，又月余其头能举。后饮食停滞，患吐泻，项仍痿软，早上服用补中益气汤，晚上服用六君子汤及加减八味丸，两月余而项复举。结婚后眼目昏花，项骨无力，头自觉大，用八味丸、补中益气汤，三月余，元气复而诸证退。后每次入房劳役，形气殊倦，盗汗发热，服用后两种药即愈。
一个十五岁小儿，手足痿软，牙齿不能嚼坚物，内热晡热，小便涩滞如淋，服用分利之剂，小便如淋；服用滋阴之剂，内热益甚；服用燥湿之剂，大便重坠。我认为这是禀受肾气不足，早犯色欲所致，所以精血篇说：男子精未满而御女以通其精，五脏有不满之处，异日有难状之疾；老人阴已痿，而思色以降其精，则精不出而内败，小便涩痛如淋，若阴已耗而复竭之，则大小便牵痛，愈痛则愈便，愈便则愈痛，正是说的这个意思。于是早上服用补中益气汤，晚上服用六味丸加五味子煎服，各三十余剂，诸证渐愈。后梦遗，诸证复作，手足时冷，痰气上急，用十全大补汤、加减八味丸料，各八剂，二便稍利，手足稍温，仍用前两种药三月余，元气渐复，饮食如常。又饮食停滞，吐泻腹痛，按之不疼。这是脾胃受伤。用六君子汤加木香、肉豆蔻治之，其吐未已，左尺右关二脉轻诊浮大，按之如无，经云：肾开窍于二阴。用五味子散四服，大便顿止。后又伤食，咽酸作泻，大便重坠。早上服用补中益气汤，晚上服用六君子汤加木香、干姜而痊愈。
一个老年得子的四肢痿软，而恶风寒，见日则喜，我令乳母每天服用加减八味丸三次，十全大补汤一剂，兼给其子服用，年余肢体渐强，至两周岁而能行。
一个五岁小儿，禀受父亲腿软，不便于行，早丧天真，年至十七结婚后，腿软，头囟自觉开大，喜其自谨，寓居道舍，于是早上服用补中益气汤，晚上用地黄丸料加五味子、鹿茸煎服，年余而健。
一个小儿项软，服用前两种药而愈，结婚后患解颅，作渴发热，以两种药做大剂，煎熟代茶，恣饮两月余而渴热减，年余而颅囟合，又年余而肢体强，若非慎疾，虽药不起。
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.