治行迟。一方加羚羊角、黄 。
虎胫骨（酥油炙） 白茯苓 肉桂（去皮） 防风 当归（酒洗） 干地黄（酒洗）
酸枣仁 牛膝（酒洗） 川芎（各五钱）
为末，蜜丸，黍米大，每三十丸，木瓜汤，食前服。
五加皮 川牛膝（酒浸二日） 木瓜（各等分） 为末，米饮下。
人参地黄丸
方见解颅门。
（儿科）
五软者，手脚腰背颈软是也。五硬者，手脚腰背颈硬是也。五冷者，手香港脚唇面冷
是也。五缩者，手脚舌唇阴缩是也。五反者，眼唇舌项脚反是也。五紧者，咽喉口唇
眼睛手脚阴囊紧是也。五陷者，囟门太阳眼轮胸下肩并陷是也。五肿者，手心人中舌头
阴胫膝胫肿是也。五喘者，痘疮惊风虚喘吐泻下痢喘是也。五肓者，疮痘惊风久渴久痢
久泻肓是也。不论何病，总皆恶候。
又谓五软者，胎怯也。有因父精不足，母血衰少而得者，有因母之血海既冷，用药
强补而孕者。有因受胎，母多痰病，或年迈而有子者，或日月不足而生者，或服坠胎之
剂不去，而耗伤真气者。是以生下怯弱，不耐寒暑，少为六淫侵犯，便尔头项软，手足
软，身软口软，肌肉软，名曰五软。然头软者，肾肝之病也。盖肝主筋，肾主骨。肝肾
若虚，项软无力，治难渐痊，他年必发。手足软者，四肢无力，而手垂，懒于举物，五
岁而不能行，脚软细小是也。身软者，阳虚髓怯，六淫易攻，遍体羸弱谓耳。口软者，
虚舌退场门，肌内软者，肉少反宽，不长肌肉，大概本于先天不足，而治独重于胃，盖
胃为水谷气血之海，五脏六腑之大源也。五硬者，仰头取气，难以动摇，气壅疼痛，连
胸膈间，手心脚心冰冷而硬，此阳气不营于四末也。《经》曰∶脾主四肢；又曰∶脾主
诸阴。手足冷而硬者，独阴无阳也。故难治，肚筋青急者，木乘土位也。急用六君子
汤，加炮姜桂升柴，补脾平肝。若面青而小腹硬者，性命难保矣。
小儿禀受肾气不足，而有五迟五软，解颅鹤膝诸候，当以六味丸加鹿茸补之。若精
气未满而御女，致有头眩吐痰，发热盗汗诸候，当用六味八味二丸，及补中汤加减用
之，然节斋谓，小儿无补肾法，盖以男子二八而精始满，既满之后，妄用亏损，则可补
之，如先天禀受不足，理无可补，禀之。若足，何待于补，孰知诸脏有虚有实，而肾脏
有虚无实，凡小儿之阴气未成，即肾虚之日也。或父母多欲，而所禀复亏，更肾虚之候
也。阴气不足，而不知补之，则阴绝而孤阳亦灭矣。何谓可无补耶？此义惟立斋先生深
知其奥，况小儿因天禀不足，致疾者，恒多，则先天之不足，难以或阴或阳为定论，
张以六味八味二丸，以救小儿禀受阴虚阳虚者，全活甚众，岂止阴气不足而已哉！凡小
儿面青 白，其出痘必主内溃不出，此即禀受肾中元阳不足也。久服八味丸方可挽
回。若进肥儿丸，反速其毙矣。
虎胫骨（用酥油炙烤） 白茯苓 肉桂（去除外皮） 防风 当归（用酒清洗） 干地黄（用酒清洗）
酸枣仁 牛膝（用酒清洗） 川芎（各五钱）
研磨成粉末，用蜂蜜制成丸剂，大小如黍米，每次服用三十丸，用木瓜汤送服，饭前服用。
五加皮 川牛膝（用酒浸泡两天） 木瓜（各等分） 研磨成粉末，用米汤送服。
人参地黄丸
方剂解释见“解颅”章节。
（儿科）
所谓五软，是指手脚、腰背、颈部软弱无力。所谓五硬，是指手脚、腰背、颈部僵硬。所谓五冷，是指手、脚、唇、面寒冷。所谓五缩，是指手脚、舌头、嘴唇、阴部收缩。所谓五反，是指眼睛、嘴唇、舌头、项部、脚部向后反张。所谓五紧，是指咽喉、口唇、眼睛、手脚、阴囊紧缩。所谓五陷，是指囟门、太阳穴、眼轮、胸下、肩部凹陷。所谓五肿，是指手心、人中、舌头、阴部、小腿、膝盖肿胀。所谓五喘，是指痘疮、惊风、虚喘、吐泻、下痢引起的喘息。所谓五肓，是指疮痘、惊风、久渴、久痢、久泻导致的昏聩无知。不论何种疾病，这些统统属于恶候（预后不良的征象）。
又认为五软，即是胎怯（先天体弱）。有的因父亲精气不足，母亲血液衰少而得病；有的因母亲血海寒冷，用药强行进补后怀孕所致；有的因受孕时母亲多痰病，或年事已高才生子；有的因妊娠月份不足而生；有的因服用堕胎药未去，耗伤了真气。因此生下后怯弱，不耐寒暑，稍微受到六淫（风、寒、暑、湿、燥、火六种外感病邪）侵犯，便出现头项软、手足软、身体软、口软、肌肉软，名为五软。然而头软，是肾肝的疾病。因为肝主筋，肾主骨。肝肾若虚弱，项部软弱无力，治疗难以逐渐痊愈，日后必定发病。手足软，是四肢无力，手下垂，懒得举物，五岁还不能行走，脚软细小。身软，是阳虚髓怯，六淫容易侵袭，遍体瘦弱。口软，是虚证导致舌头退缩。肌肉软，是肉少且宽，不长肌肉，大概根本在于先天不足，而治疗特别重视胃，因为胃是水谷气血的海源，是五脏六腑的大源头。
五硬，表现为仰头呼吸，难以动摇，气机壅滞疼痛，牵连胸膈间，手心脚心冰冷而硬，这是阳气不能通达四肢末端。《内经》说：脾主四肢；又说：脾主诸阴。手足冷而硬，是独阴无阳。所以难治，肚筋青紫紧急，是木（肝）乘土（脾）位。急用六君子汤，加入炮姜、肉桂、升麻、柴胡，补脾平肝。如果面色青而小腹硬，性命就难保了。
小儿禀受肾气不足，而有五迟五软、解颅、鹤膝等证候，应当用六味丸加鹿茸来补益。如果精气未满而行房，导致出现头晕、吐痰、发热、盗汗等证候，应当使用六味丸、八味丸，以及补中益气汤加减使用。然而李立斋曾说，小儿没有补肾的方法，大概是因为男子十六岁精气才满，既满之后，妄用亏损，则可以补之。如先天禀受不足，按理无法补充，既然禀受了，如果充足，何待于补？谁知道各脏腑有虚有实，而肾脏只有虚无实。凡是小儿阴气未成，就是肾虚的时候。或者父母多欲，所禀受的精气又亏虚，更是肾虚的证候。阴气不足，不知道补益，那么阴绝而孤阳也会灭亡。怎么能说不需要补呢？这个道理只有立斋先生深知其奥妙。况且小儿因天禀不足致病的，很多，那么先天的不足，难以单纯以阴或阳作为定论。张景岳用六味丸、八味丸，来救治小儿禀受阴虚阳虚者，保全活命的人很多，岂止是阴气不足而已！凡是小儿面色青白，出痘疮必定主内溃不出，这就是禀受肾中元阳不足。长期服用八味丸才可以挽回。如果进服肥儿丸，反而加速死亡。
Treats delayed walking. Another prescription adds Antelope Horn (Lingyangjiao) and Astragalus Root (Huangqi).
Tiger Tibia Bone (Sujinggu, roasted with butter oil) *Poria* (Baifuling) Cinnamon Twig (Rougui, bark removed) Saposhnikovia Root (Fangfeng) Angelica Sinensis Root (Danggui, washed with wine) Prepared Rehmannia Root (Shengdihuang, washed with wine)
Spiny Jujube Seed (Suanzaoren) Achyranthes Bidentata Root (Niuxi, washed with wine) Szechwan Lovage Rhizome (Chuanxiong) (each five qian)
Grind into powder, make pills with honey, size of millet seeds, take thirty pills each time, swallow with Quince Decoction (Mugua Tang), before meals.
Acanthopanax Bark (Wujiapi) Cyperus Nodose Rhizome (Chuanniuxi, soaked in wine for two days) Quince (Mugua) (equal parts) Grind into powder, swallow with rice water.
Ginseng and Rehmannia Pill (Renshen Dihuang Wan)
See the "Jielu" chapter for the formula explanation.
(Pediatrics)
The so-called "Five Softnesses" refers to softness in hands, feet, waist, back, and neck. The so-called "Five Stiffnesses" refers to stiffness in hands, feet, waist, back, and neck. The so-called "Five Coldnesses" refers to coldness in hands, feet, lips, and face. The so-called "Five Contractures" refers to contraction of hands, feet, tongue, lips, and genitals. The so-called "Five Reversions" refers to backward extension/reversion of eyes, lips, tongue, neck, and feet. The so-called "Five Tightnesses" refers to tightness in throat, lips, eyes, hands, feet, and scrotum. The so-called "Five Depressions" refers to depression of fontanelle, temporal region, eye orbits, below chest, and shoulders. The so-called "Five Swellings" refers to swelling of palms, philtrum, tongue, genitals, shins, and knees. The so-called "Five Pantings" refers to panting caused by smallpox, convulsions, deficiency panting, vomiting and diarrhea, or dysentery. The so-called "Five Blindnesses" refers to obtundation/unconsciousness caused by sores, smallpox, convulsions, prolonged thirst, prolonged dysentery, or prolonged diarrhea. Regardless of the disease, these are all ominous prognostic signs (Ehou).
It is also said that the Five Softnesses constitute "Fetal Frailty" (Taiqie). Some cases arise from insufficient paternal essence and deficient maternal blood; some result from pregnancy conceived after the mother's Blood Sea was cold and forced supplementation was used; some occur when the mother had excessive phlegm during conception, or gave birth at an advanced age; some are born prematurely due to insufficient gestational months; some result from taking abortifacients that failed to expel the fetus but consumed vital qi. Consequently, the infant is born frail, unable to endure cold and heat, and upon slight invasion by the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), develops softness of head and neck, hands and feet, body, mouth, and muscles, named the Five Softnesses. However, head softness is a disease of the Liver and Kidney. Since the Liver governs sinews and the Kidney governs bones, if Liver and Kidney are deficient, the neck becomes weak and powerless; treatment is difficult to cure gradually, and it will inevitably manifest later in life. Hand and foot softness implies weakness in the four limbs, drooping hands, reluctance to lift objects, inability to walk until age five, and thin, weak feet. Body softness indicates Yang deficiency and marrow frailty, susceptibility to the Six Excesses, and general emaciation. Mouth softness involves retraction of the tongue due to deficiency. Muscle softness involves scant flesh and lack of muscle growth; generally rooted in congenital insufficiency, treatment focuses heavily on the Stomach, as the Stomach is the sea of water and grain and the great source of qi and blood for the five zang and six fu organs.
The Five Stiffnesses present as holding the head up to breathe, difficulty moving, qi stagnation causing pain extending to the chest and diaphragm, and cold, stiff palms and soles; this is Yang qi failing to nourish the four extremities. The *Classic* states: "The Spleen governs the four limbs"; and again: "The Spleen governs all Yin." Cold and stiff hands and feet indicate solitary Yin without Yang, making it difficult to treat. Green and tense abdominal veins indicate Wood (Liver) overacting on Earth (Spleen). Urgently use Liu Junzi Tang (Six Gentlemen Decoction), adding Roasted Ginger (Paojiang), Cinnamon Twig (Rougui), Bupleurum Root (Chaihu), and Cimicifuga Rhizome (Shengma) to tonify the Spleen and soothe the Liver. If the face is blue and the lower abdomen is hard, life is difficult to save.
Children with insufficient congenital Kidney Qi may present with Five Delays, Five Softnesses, Fontanelle Delay (Jielu), or Crane Knee (He Xi). These should be treated with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) supplemented with Deer Antler Lu Rong). If sexual activity occurs before essence and qi are full, leading to dizziness, phlegm expectoration, fever, and night sweats, Liuwei Dihuang Wan, Shennan Wan (Eight-Ingredient Pill), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used with modifications. However, Li Lizhai stated that there is no method for tonifying the Kidney in children, reasoning that male essence only matures at sixteen; only after maturity can depletion be replenished. If congenital endowment is insufficient, it cannot theoretically be supplemented; if it were sufficient, why would supplementation be needed? Who knows that while other organs have both deficiency and excess, the Kidney has only deficiency, never excess. Whenever a child's Yin qi is not yet formed, it is a state of Kidney deficiency. Or, if parents have excessive desires, depleting the inherited essence, it is further evidence of Kidney deficiency. If Yin deficiency is not treated, Yin will perish, and the lone Yang will also extinguish. How can one say supplementation is unnecessary? Only Master Lizhai deeply understood this principle. Moreover, since many diseases in children stem from constitutional insufficiency, congenital deficiency cannot be definitively categorized solely as Yin or Yang deficiency. Zhang Jingyue used Liuwei Dihuang Wan and Shennan Wan to save countless children with congenital Yin or Yang deficiency, proving its efficacy beyond just treating Yin deficiency. For children with blue or pale faces, smallpox lesions tend to fail to erupt and collapse internally, indicating insufficient Yuan Yang (Original Yang) in the Kidney. Long-term administration of Shennan Wan can reverse this. Conversely, administering Fei'er Wan (Fat-Making Pill) would accelerate death.