小儿初生，其身有如汤泼火伤者，此皆乳母过食膏粱所致也。其母宜服清胃散及逍遥散，以
清其气血，儿亦饮数滴可也。有身无皮肤而不 赤者，皆由产母脾气不足也，用粳米粉敷之
。赤发热者，皆由产母胃中火盛也，用石膏敷之。经谓∶脾主肌肉，肺主皮毛。故知病脾
肺也。如脑额生疮者，火土相合，遂成湿热，下流攻击肾水也，难治。如脚上有疮者，阴虚
火盛也，此不满五岁而毙。如未盈月而撮口握拳，腰软如随者，此肝肾中邪胜正弱所致也，
三日内必不治。如男指向里，女指向外，尚可治。眉红亦不可治，可治者用全蝎散、钩藤散
等类治之。若因大病亏损胃气，而诸脏虚弱所致者，用补中益气汤、钱氏地黄丸。若面唇赤
色，正属肾水不足，肝经阴虚火动，而内生风热尔，当滋肾水以制阳光。其身软者，内禀气
不足，肌肉未坚也，当参五软而施治之。
清胃散
逍遥散（二方见内钓）
全蝎散（方见口噤）
钩藤散（方见慢惊）
补中益气汤（方见虚羸）
钱氏地黄丸（方见肾脏）
五软者，头项手足肉口是也。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，源其要总归于胃。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，凡此症必须多用二药。仍令壮年乳母饮之，兼慎风寒，调饮食，多能全角。
治验
吴江史万湖子七岁，患吐泻，囟目顿陷，天柱骨倒，兼面赤色。余适在彼，先用补中益气汤
加附子一剂，其泻止，而诸症愈。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，诸症顿除，囟顶顿起而安。小儿易
虚易实，故虽危症，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，诸症稍愈，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，而手足不冷；又月余其首能举。后饮食停滞，患吐泻，项乃痿软，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，三月余元气复而诸症退，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，诸症渐愈。后梦遗诸症复作，手足时冷，痰气上急，用十全大补汤、加味八
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。
星附膏 治项软。
天南星 附子（各等分）
上为末，用生姜自然汁调敷项间，干则润之。
六君子汤（方见天钓）
加减八味丸（即六味丸加肉桂、五味子，方见肾脏）
补中益气汤（方见虚羸）
地黄丸（方见肾脏）
五味子散
小儿刚出生时，身体像被热水浇过或烫伤一样红肿，这都是因为乳母吃了过多油腻厚味的食物导致的。母亲应当服用清胃散和逍遥散，来清除体内的热邪，调理气血，婴儿也可以喝几滴。如果婴儿身上没有皮肤且不发红的，都是由于产母脾气不足造成的，可以用粳米粉外敷。如果发红且发热的，都是由于产母胃中火气旺盛造成的，可以用石膏外敷。《内经》说：脾主管肌肉，肺主管皮毛。所以知道这是脾肺的病变。如果额头长疮，是火与土（湿热）相结合，形成湿热，向下流注攻击肾水，难以治疗。如果脚上长疮，是阴虚火旺，这种病不满五岁就会死亡。如果未满月就出现撮口、握拳、腰软如垂的状态，这是肝肾中邪气盛而正气弱的表现，三天内必定无法治愈。如果男婴手指向内弯曲，女婴手指向外弯曲，还可以治疗。眉毛发红也不可治，可治的用全蝎散、钩藤散等方剂治疗。如果是因大病亏损了胃气，导致五脏虚弱引起的，用补中益气汤、钱氏地黄丸。如果面唇颜色赤红，正属于肾水不足，肝经阴虚火动，从而内生风热，应当滋补肾水以制约亢盛的阳火。身体柔软的，是因为先天禀赋之气不足，肌肉不坚实，应当参照“五软”症来施治。
清胃散
逍遥散（这两个方子见“内钓”章节）
全蝎散（方子见“口噤”章节）
钩藤散（方子见“慢惊”章节）
补中益气汤（方子见“虚羸”章节）
钱氏地黄丸（方子见“肾脏”章节）
所谓“五软”，是指头项、手足、肌肉、口这五个部位软弱无力。头项软，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。手足软，是因为脾主四肢，是中州之气不足，不能营养四肢，所以肌肉少、皮肤宽弛，饮食不能转化为肌肤。口软，是因为口是脾之窍，上下牙龈属于手阳明大肠经和足阳明胃经，阳明经主管胃，脾胃气虚，舌头不能收摄，所以经常伸出口外。心主血，肝主筋，脾主肉，肺主气，肾主骨，这五种功能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，追究其根本原因，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，以滋生化源。头项、手足三处软，兼服地黄丸，凡是这种病症必须多用这两种药。仍让壮年的乳母服用，同时注意防风寒，调节饮食，大多能痊愈。
治验案例
吴江人史万湖的儿子七岁，患吐泻，囟门和眼睛突然凹陷，天柱骨倒伏，兼见面部赤色。我正好在那里，先用补中益气汤加附子一剂，腹泻停止，各种症状痊愈。又用钱氏地黄丸料煎服，顿时安宁。
一个七岁小儿，夏天过量食用生冷食物，早晨患吐泻，面部赤红且口渴，手足并发热，项软囟陷，午后面色突然变白，手足并冷，脉搏微弱几乎摸不到，急忙用六君子汤加附子一剂，各种症状顿时消除，囟顶顿时鼓起而安宁。小儿容易虚也容易实，所以虽然是危重病症，如果能迅速使用对症的药物，也可以救活。
一个九岁小儿，因为吐泻后，项软面白，手足并冷，脉微细，喜欢热饮食。我先用六君子汤加肉桂五剂，没有见效，再加炮姜四剂，各种症状稍有好转，面色未恢复，尺脉未起，佐以八味丸，一个多月后面色微黄，稍有胃气了。再用前面的药，又过了一个月，饮食略微增加，热象也大大减轻。于是早上服用补中益气汤，饭前服用八味丸。又过了一个月元气逐渐恢复，饮食正常，头部能抬起。又过了一个月肌肉充盛，各种疾病全部痊愈。
一个十二岁小儿，疟疾后项软，手足冷，饮食少想，粥汤稍微离开火，吃下去就觉得腹中冷。用六君子汤加肉桂、干姜，饮食逐渐增加，每次饮食中加入茴香、胡椒之类，一个多月后粥食可以稍微离开火；又用前面的药一百剂，饮食如常，而手足不冷；又过了一个月头部能抬起。后来饮食停滞，患吐泻，项才痿软，早上服用补中益气汤，晚上服用六君子汤，以及加减八味丸，两个多月后颈部又能抬起。结婚后眼目昏花，项骨无力，头自觉变大。用八味丸、补中益气汤，三个多月元气恢复而各种症状消退，后来每因房事劳累，形体气息非常疲倦，盗汗发热，服用后面两种药即愈。
一个十五岁小儿，手足痿软，牙齿不能咀嚼坚硬物体，内热及傍晚发热，小便涩滞像淋证一样。服用分利小便的药物，小便像淋证；服用滋阴的药物，内热更严重；服用燥湿的药物，大便沉重下坠。我认为：这是禀受肾气不足，过早犯色欲导致的。所以《精血篇》说：男子精气未满而御女以通泄其精，五脏有不满的地方，日后会有难以形容的疾病；老人阴已痿废，却思慕色欲以泄精，则精不出而在体内败坏，小便涩痛像淋证。如果阴精已耗损而又竭尽它，则大小便牵拉疼痛，越痛就越想排便，越排便就越痛，正是说的这种情况。于是早上服用补中益气汤，晚上服用六味丸加五味子煎服，各三十多剂，各种症状逐渐痊愈。后来梦遗等各种症状复发，手足时常发冷，痰气上逆急促，用十全大补汤、加味八味丸料各八剂，二便稍微通畅，手足稍微温暖，仍用前面两种药，三个多月元气逐渐恢复，饮食如常。又因饮食停滞，吐泻腹痛，按压不疼，这是脾胃受伤，用六君子汤加木香、肉豆蔻治疗，呕吐未止，左尺右关两脉轻按浮大，重按如无。《内经》说：肾开窍于二阴。用五味子散服四次，大便顿时停止。后来又伤食咽酸作泻，大便沉重下坠，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。
一位老年人得子，四肢痿软，且恶风寒，见到阳光就高兴。我让乳母每天服用加减八味丸三次，十全大补汤一剂，同时给儿子服用，一年多肢体逐渐强壮，到两周岁就能行走。
一个五岁小儿，禀受父亲腿软，行走不便，早年丧失天真，到了十七岁，结婚后，腿软头囟自觉开大，幸好他谨慎，寄居在道观舍里，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，一年多而健康。
一个小儿项软，服用前面两种药而痊愈。结婚后患解颅，口渴发热，用这两种药做大剂量，煎熟代替茶随意饮用，两个多月后渴热减退，一年多后颅囟闭合，又一年多后肢体强壮，如果不是谨慎治病，虽然用药也救不了。
星附膏 治疗项软。
天南星 附子（各等分）
上面研为末，用生姜自然汁调匀敷在颈部，干了就润湿它。
六君子汤（方子见“天钓”章节）
加减八味丸（即六味丸加肉桂、五味子，方子见“肾脏”章节）
补中益气汤（方子见“虚羸”章节）
地黄丸（方子见“肾脏”章节）
五味子散
When a newborn infant's body appears swollen and red as if scalded by hot water or burned, this is caused by the wet nurse consuming too much rich and greasy food. The mother should take Qingwei San (Clear Stomach Powder) and Xiaoyao San (Free and Easy Wanderer Powder) to clear heat from the qi and blood; the infant may also drink a few drops. If the infant has no skin and is not red, it is due to the mother's deficiency of Spleen Qi; rice flour can be applied externally. If the skin is red and feverish, it is due to excessive fire in the mother's Stomach; gypsum can be applied externally. The Classics state: "The Spleen governs muscles, and the Lung governs skin and hair." Thus, we know this involves pathology of the Spleen and Lung. If sores appear on the forehead, it is the combination of Fire and Earth (damp-heat), flowing downward to attack Kidney Water, which is difficult to treat. If sores appear on the feet, it is Yin deficiency with hyperactive fire; such infants will die before reaching five years of age. If within one month the infant exhibits mouth puckering, clenched fists, and a limp neck hanging down, this is caused by pathogenic factors prevailing over righteous Qi in the Liver and Kidneys; it is incurable within three days. If the fingers of a male infant curl inward, or those of a female infant curl outward, it is still treatable. Red eyebrows are also an untreatable sign. Treatable cases should be managed with Quanxie San (Scorpion Powder) or Gouteng San (Uncaria Decoction). If caused by damage to Stomach Qi due to severe illness, leading to weakness of the Five Zang organs, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Qian Shi Dihuang Wan (Dr. Qian's Rehmannia Pill). If the face and lips are red, this indicates insufficient Kidney Water and Yin deficiency with hyperactive fire in the Liver Meridian, generating internal wind-heat; one should nourish Kidney Water to restrain hyperactive Yang. Softness of the body is due to congenital insufficiency of Qi and unfirm muscles; treatment should follow the principles for "Five Softnesses."
Qingwei San (See "Neidiao" section)
Xiaoyao San (See "Neidiao" section)
Quanxie San (See "Koujin" section)
Gouteng San (See "Manjing" section)
Buzhong Yiqi Tang (See "Xu Lei" section)
Qian Shi Dihuang Wan (See "Shen Zang" section)
The "Five Softnesses" refer to softness of the head and neck, hands and feet, flesh, and mouth. Softness of the head and neck indicates deficiency of the Zang-Fu organs, bones, and vessels, and insufficiency of Yang Qi. This manifests as weakness of the Tianzhu bone (neck); since the Kidney governs bones, it implies deficiency of the Foot Shaoyin and Foot Taiyang meridians. Softness of the hands and feet occurs because the Spleen governs the four limbs; insufficiency of Central Earth Qi fails to nourish the limbs, resulting in little muscle and loose skin, where food intake does not transform into flesh. Softness of the mouth arises because the mouth is the orifice of the Spleen; the upper and lower gums belong to the Hand-Yangming and Foot-Yangming meridians, which govern the Stomach. Spleen-Stomach Qi deficiency causes the tongue to fail to retract, often protruding. The Heart governs Blood, the Liver governs sinews, the Spleen governs flesh, the Lung governs Qi, and the Kidney governs bones. These five functions depend on the Qi of the Five Zang organs; when deficient, they cannot nourish and reach their limits, leading to weak bones and vessels and flaccid limbs. The root cause lies in the Stomach, which is the Sea of Grain and Water, the foundation of the Five Zang and the great source of the Six Fu organs. Treatment must prioritize the Spleen and Stomach, using Buzhong Yiqi Tang to nourish the source of transformation. For softness of the head/neck and hands/feet, combine with Dihuang Wan. Both medicines must be used extensively. The wet nurse should also consume them, while avoiding wind-cold and regulating diet; most cases will recover.
Case Records
The seven-year-old son of Shi Wanhu from Wujiang suffered from vomiting and diarrhea, with sudden depression of the fontanelle and eyes, collapse of the Tianzhu bone, and facial redness. I was present and first prescribed Buzhong Yiqi Tang with one dose of Fuzi (Aconite Root). The diarrhea stopped, and all symptoms resolved. Subsequently, Qian Shi Dihuang Wan decoction was administered, bringing immediate relief.
A seven-year-old child, after overeating cold and raw foods in summer, developed morning vomiting and diarrhea, facial redness, thirst, and heat in both hands and feet, along with neck softness and depressed fontanelle. By afternoon, the face turned pale, hands and feet became cold, and the pulse was faint and nearly imperceptible. Urgently, Liujunzi Tang (Six Gentlemen Decoction) with one dose of Fuzi was given, instantly eliminating symptoms, raising the fontanelle, and restoring peace. Children are prone to both deficiency and excess; thus, even in critical conditions, prompt administration of appropriate medicine can save life.
A nine-year-old child, following vomiting and diarrhea, presented with neck softness, pale face, cold extremities, fine and faint pulse, and preference for hot drinks. Initially, Liujunzi Tang with Rougui (Cinnamon Bark) was given for five doses without effect. Four doses of Paojiang (Prepared Ginger) were added, slightly improving symptoms, but the face remained pale and the Chi pulse undetectable. Bazui Wan (Eight-Flavor Pill) was then added. After more than a month, the face showed slight yellow color, indicating the return of Stomach Qi. Continuing previous prescriptions for another month, food intake increased slightly, and heat significantly decreased. Morning administration of Buzhong Yiqi Tang and pre-meal Bazui Wan were continued. After another month, Yuan Qi gradually recovered, eating normalized, and the head could be lifted. After yet another month, muscles became full, and all diseases healed.
A twelve-year-old child, post-malaria, exhibited neck softness, cold extremities, poor appetite, and abdominal coldness upon eating warm congee. Liujunzi Tang with Rougui and Ganjiang (Dried Ginger) was used; food intake gradually increased. Anise and pepper were added to meals; after over a month, congee could be eaten without heating. One hundred doses of previous prescriptions normalized diet and warmed extremities; after another month, the head could be lifted. Later, food stagnation led to vomiting and diarrhea, causing neck flaccidity. Morning Buzhong Yiqi Tang, evening Liujunzi Tang, and Jiawei Bazui Wan (Modified Eight-Flavor Pill) were used for over two months, restoring neck strength. Post-marriage, blurred vision, weak neck bones, and sensation of head enlargement occurred. Bazui Wan and Buzhong Yiqi Tang were taken for over three months, recovering Yuan Qi and resolving symptoms. Subsequent sexual exertion caused fatigue, night sweats, and fever; these two medicines cured him again.
A fifteen-year-old child had flaccid hands and feet, inability to chew hard objects, internal heat, afternoon fever, and dysuria resembling strangury. Diuretics worsened strangury; yin-nourishing herbs intensified internal heat; drying-dampness herbs caused heavy defecation. I diagnosed congenital Kidney Qi deficiency due to premature sexual activity. As stated in the *Jingxue Pian*: "If men engage in intercourse before essence is full, the Five Zang organs remain unsatisfied, leading to difficult-to-describe diseases later; if elderly men with impotence seek sexual release, essence fails to exit and rots internally, causing painful dysuria. If essence is exhausted further, urinary and fecal pain ensues; the more painful, the more frequent defecation, and vice versa." Morning Buzhong Yiqi Tang and evening Liuwei Wan (Six-Ingredient Pill) with Wuweizi (Schisandra Fruit) were prescribed for over thirty doses each, gradually resolving symptoms. Later, nocturnal emissions recurred with cold extremities and urgent phlegm-Qi. Shiquan Dabu Tang (Ten Complete Tonifying Decoction) and Jiawei Bazui Wan were given for eight doses each, improving bowel/bladder function and warming extremities. Continuing these for over three months restored Yuan Qi and normal diet. Food stagnation later caused vomiting, diarrhea, and non-tender abdominal pain, indicating Spleen-Stomach injury; Liujunzi Tang with Muxiang (Aucklandia Root) and Roudoukou (Nutmeg) treated it. When vomiting persisted, the Left Chi and Right Guan pulses were floating and large lightly, but empty heavily. The Classics state: "The Kidney opens into the two lower orifices." Wuweizi San (Schisandra Powder) for four doses stopped diarrhea immediately. Later, food-induced acid regurgitation and diarrhea with heavy stools were cured by morning Buzhong Yiqi Tang and evening Liujunzi Tang with Muxiang and Ganjiang.
An elderly man who fathered a child presented with flaccid limbs, aversion to wind and cold, and preference for sunlight. I instructed the wet nurse to take Jiawei Bazui Wan three times daily and Shiquan Dabu Tang once daily, shared with the son. After over a year, limbs strengthened, and by age two, he could walk.
A five-year-old boy, inheriting his father's leg weakness and gait difficulty, lost his vitality early. At seventeen, post-marriage, leg weakness and open fontanelle persisted. Living cautiously in a Taoist temple, he took morning Buzhong Yiqi Tang and evening Dihuang Wan decoction with Wuweizi and Lurong (Deer Antler). After over a year, he recovered health.
Another child with neck softness was cured by the previous two medicines. Post-marriage, he developed Jielu (open fontanelle), thirst, and fever. Large doses of these medicines brewed as tea were consumed freely. After over two months, thirst and fever subsided; after over a year, the fontanelle closed; after another year, limbs strengthened. Without careful management, even medicine would fail.
Xingfu Gao (Star and Aconite Plaster) treats neck softness.
Tian Nan Xing (Pinellia Tuber) and Fuzi (Prepared Aconite Root) in equal parts.
Grind into powder, mix with fresh ginger juice, apply to the neck, and moisten when dry.
Liujunzi Tang (See "Tiandiao" section)
Jiawei Bazui Wan (Six-Ingredient Pill plus Rougui and Wuweizi; See "Shen Zang" section)
Buzhong Yiqi Tang (See "Xu Lei" section)
Dihuang Wan (See "Shen Zang" section)
Wuweizi San