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。若无故不能抬头，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，但日后必定复发。手足软弱则表现为手垂无力，四肢乏力，也懒得抬眉，如果声音圆润，还能进食，这是慢脾风的征兆，尚可医治。肌肉软弱则表现为肉少皮松，饮食无法转化为肌肉，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，指五岁儿童不能行走，因虚羸导致脚软细小，只要不影响营卫之气，只需服用人参等药物，并配合服用钱乙的地黄丸（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，阳气过盛更需提防，必须治疗膈部问题，通常无大碍；但若出现嘴唇青紫、气喘，则难以调治。
〔薛己〕头项软弱，是因为脏腑骨脉皆虚，诸阳之气不足，导致天柱骨虚弱。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，中焦脾胃之气不足，不能营养四肢，所以肉少皮宽，饮食不能化为肌肤。口软弱，是因为口为脾之窍，上下牙龈属于手阳明和足阳明经，阳明经主胃，脾胃气虚，舌头不能收敛而常舒出。心主血，肝主筋，脾主肉，肺主气，肾主骨，这五脏都因禀受的五脏之气虚弱，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，仍让壮年的乳母饮用，同时注意防风寒，调理饮食，大多能痊愈。
〔曾世荣〕戴氏论述五软证，名为胎怯，确实是由于父亲精气不足，母亲血液素来衰弱而导致的。这话很有道理。依我推测，有的因为母亲血海久冷，用药强行滋补后怀孕；有的在受孕期间母亲多病；或者父亲好色贪酒、体质虚弱，或年事已高才生子；有的胎儿月份不足而生；或者服用堕胎药未去反而成孕者，徒然耗伤真气，侥幸生下的，就像浅土中的草，虽有发生，但茂盛者少；又如培植树木，动摇其根，成活者很少。由此看来，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，筋骨痿弱，肌肉虚瘦，神色昏沉缓慢，一旦受到六淫邪气侵袭，便导致头项手足身体软弱，这就是五软。治疗方法用调元散、补肾地黄丸，逐渐调养，日久才能安定，如果用药无效，也会成为废人。
有小儿身体肥壮，不显瘦弱，忽然项软倾倒，这名叫“下窜”，都是因为肝肾气虚，客邪侵袭风府穴，传于筋骨，所以形成此疾。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，天柱骨倒塌，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，囟顶顿起而安。小儿元气易虚易实，所以虽然是危重证候，若能速用对症的药物，也可以救活。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，稍有胃气矣，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。又用前药百剂，饮食如常，手足不冷，又月余其首能举。后来饮食停滞，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。后来每次入房劳役，形气殊倦，盗汗发热，服用后二药即愈。
一个十五岁小儿，手足痿软，牙齿不能嚼坚物，内热晡热（午后潮热），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，正谓此也。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。后来梦遗，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。这是脾胃受伤也。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。早上服用补中益气汤，晚上服用六君子汤加木香、干姜而痊。
一个老年得子的父亲，四肢痿软，而恶风寒，见日则喜，令乳母每日服用加减八味丸三次，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。一个小儿项软，服前二药而愈，毕姻后患解颅（囟门迟闭），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。
See "Zabing Zhunsheng" (Standardized Diagnosis and Treatment of Miscellaneous Diseases) for details.
Wu Ruan (Five Softnesses) refers to softness of the head and neck, hands and feet, muscles, and mouth. If a child cannot lift their head without cause, it is a disease of Kidney Gan (Rickets due to Kidney deficiency), where the neck meridians are weak and difficult to support the head; although treatment may temporarily improve the condition, it will inevitably recur in later years. Hand and foot softness manifests as drooping hands and limbs with no strength, and reluctance to raise the eyebrows; if the voice is clear and the child can eat, this indicates Slow Spleen Wind (Man Pi Feng), which is still treatable. Muscle softness presents as little flesh and loose skin, where food intake fails to build muscle; Qian Yi's Jutian Wan (Citrus and Coptis Pill) can be taken for emaciation, but frequent diarrhea must be avoided as it becomes difficult to treat. Foot softness refers to a five-year-old child being unable to walk; due to emaciation, the feet are soft, small, and thin. As long as Ying and Wei (Defensive and Nutritive Qi) are not affected, taking herbs such as Ginseng Radix et Rhizoma along with Qian Yi's Dihuang Wan (Rehmannia Pill) will naturally result in full muscles upon growth. Mouth softness involves the tongue protruding frequently; excessive Yang requires caution, and treating the Diaphragm is necessary, though generally harmless; however, cyanotic lips and panting indicate a difficult-to-treat condition.
[Xue Ji] Head and neck softness occurs because the Zang-Fu organs, bones, and vessels are all deficient, and the Qi of all Yang channels is insufficient, leading to weakness of the Tianzhu Bone (Tibia/Neck pillar). The Kidney governs bones, so deficiency in the Foot Shaoyin and Foot Taiyang meridians causes this. Hand and foot softness occurs because the Spleen governs the four limbs; deficiency of Middle Jiao Qi fails to nourish the limbs, resulting in little flesh, loose skin, and food failing to transform into muscle and flesh. Mouth softness occurs because the mouth is the orifice of the Spleen, and the upper and lower gums belong to the Hand and Foot Yangming meridians, which govern the Stomach. Spleen and Stomach Qi deficiency causes the tongue to fail to retract and remain protruded. The Heart governs Blood, the Liver governs Sinews, the Spleen governs Flesh, the Lung governs Qi, and the Kidney governs Bones. These five aspects are due to congenital weakness of the Five Zang Qi, failing to nourish and reach the extremities, causing strong bones and vessels to become weak and limbs to atrophy. Tracing the root, it all returns 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 methods 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 head/neck and hand/foot softness, Dihuang Wan is taken concurrently. For these conditions, both medicines must be taken extensively. It is also advised that a healthy wet nurse drink them, while avoiding wind and cold and regulating diet; most cases will recover fully.
[Zeng Shirong] Dai Shi discusses Wu Ruan as Tai Que (Fetal Frailty), truly caused by insufficiency of the father's Essence and chronic depletion of the mother's Blood. This statement is profound. In my opinion, some cases arise from the mother's Blood Sea being cold for a long time, requiring medicinal supplementation before conception; others occur when the mother is ill during pregnancy; or when the father indulges in lust and alcohol, has a weak constitution, or is advanced in age when siring children; or when the fetus is born prematurely; or when abortifacients fail to terminate the pregnancy, merely depleting True Qi. Those who survive are like grass in shallow soil: they sprout but rarely flourish, akin to trees whose roots have been shaken—few survive. Thus, infants are frail and intolerant of cold and heat. Even if they reach adulthood, they often suffer from diseases. After birth, Essence and Marrow are insufficient, sinews and bones are weak, muscles are emaciated, and spirit/color is dull and slow. Once invaded by the Six Excesses (pathogenic factors), head, neck, hands, feet, and body become soft, named Wu Ruan. Treatment uses Tiaoyuan San (Regulate Origin Powder) and Bushen Dihuang Wan (Kidney-Tonifying Rehmannia Pill), gradually conditioning until stability is achieved over time. If medication fails, the child may become disabled.
In cases where a child appears robust and fat but suddenly suffers from neck collapse, this is called Xia Chuan (Lower Prostration). It is caused by Liver and Kidney Qi deficiency, allowing exogenous pathogens to invade the Fengfu acupoint and transmit to sinews and bones. Since the Liver governs sinews and the Kidney governs bones, weakness in both leads to drooping neck and inability to hold the head up, also known as Tianzhu Dao (Collapse of the Neck Pillar). This is similar to Wu Ruan and treated with the same formulas.
The son of Shi Wanhu from Wujiang, aged seven, suffered from vomiting and diarrhea, with sudden sinking of the fontanelle and eyes, and collapse of the Tianzhu bone, accompanied by a red face. Initially, one dose of Buzhong Yiqi Tang plus Aconite Root (Prepared) stopped the vomiting/diarrhea and resolved other symptoms. Subsequently, decocting Qian Yi's Dihuang Wan material 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, soft neck, and sunken fontanelle. By noon, the face turned pale, hands/feet cold, and pulse faint and nearly absent. Urgently administering one dose of Liujunzi Tang (Six Gentlemen Decoction) plus Aconite Root reversed the symptoms immediately, and the fontanelle rose back to normal. Children's Yuan Qi is easily depleted or excessed; thus, even in critical conditions, prompt use of appropriate medicine can restore life.
A nine-year-old child, after vomiting/diarrhea, presented with soft neck, pale face, cold hands/feet, fine/faint pulse, and preference for hot drinks. I initially used Liujunzi Tang plus Cinnamon Bark for five doses with no effect, then added Roasted Ginger for four doses. Symptoms improved slightly, but the face remained pale and the Chi pulse did not rise. I supplemented with Shiwu Wan (Eight-Ingredient Pill with Gold and Pearl), and after a month, the face became slightly yellow, indicating slight return of Stomach Qi. Using the previous prescription for another month increased appetite and reduced heat. Then, Buzhong Yiqi Tang was taken in the morning, and Shiwu Wan before meals. After another month, Yuan Qi gradually recovered, eating normalized, and the child could lift their head. After yet another month, muscles became full, and all diseases healed.
A twelve-year-old child, after malaria, had soft neck, cold hands/feet, poor appetite, and abdominal coldness when food was not hot. Liujunzi Tang plus Cinnamon Bark and Dried Ginger increased appetite. Adding Fennel and Pepper to meals allowed porridge to be eaten without heating after a month. Taking the previous prescription for 100 doses normalized diet and warmed hands/feet. After another month, the head could be lifted. Later, food stagnation caused vomiting/diarrhea and persistent neck flaccidity. Morning Buzhong Yiqi Tang and evening Liujunzi Tang plus Ji Jian Shiwu Wan (Modified Eight-Ingredient Pill) restored neck strength after two months. After marriage, blurred vision, weak neck, and sensation of large head occurred. Shiwu Wan and Buzhong Yiqi Tang for three months restored Yuan Qi and resolved symptoms. Post-coital fatigue, night sweats, and fever were cured by these two medicines.
A fifteen-year-old child had flaccid hands/feet, inability to chew hard objects, internal heat, afternoon tidal fever, and dysuria resembling strangury. Diuretics worsened strangury; Yin-nourishing herbs intensified internal heat; drying-dampness herbs caused heavy stool. I diagnosed congenital Kidney Qi deficiency due to early sexual activity. As stated in the Jingxue Pian (Chapter on Essence and Blood): "If a man engages in sex before his Essence is full, the Five Zang will have unmet needs, leading to difficult diseases later." For elderly men with impotence seeking release, Essence remains inside and rots, causing painful dysuria. If Yin is exhausted further, bowel/bladder pain worsens defecation/urination, creating a vicious cycle. Morning Buzhong Yiqi Tang and evening Liuwei Wan (Six-Ingredient Pill) plus Schisandra Berry for over 30 doses each gradually improved symptoms. Later, nocturnal emissions recurred symptoms, with cold hands/feet and urgent phlegm-Qi. Shiquan Dabu Tang (Ten Great Tonics Decoction) and Ji Jian Shiwu Wan material for eight doses each improved urination/bowel movements and warmed limbs. Continuing these for three months restored Yuan Qi and diet. Food stagnation caused vomiting/diarrhea and non-tender abdominal pain, indicating Spleen/Stomach injury. Liujunzi Tang plus Costus Root and Myristica Seed stopped vomiting. However, left Chi and right Guan pulses were floating/large on light palpation but empty on deep pressure. The Classic states: "The Kidney opens into the two yin orifices." Wuweizi San (Schisandra Powder) for four doses stopped diarrhea immediately. Later, food injury caused sour belching, diarrhea, and heavy stool. Morning Buzhong Yiqi Tang and evening Liujunzi Tang plus Costus Root and Dried Ginger cured the case.
An elderly father who had a late child presented with flaccid limbs, aversion to wind/cold, and preference for sunlight. The wet nurse took Ji Jian Shiwu Wan three times daily and Shiquan Dabu Tang once daily, shared with the child. After a year, limbs strengthened, and by age two, walking was possible. A five-year-old boy, inheriting his father's leg weakness, lost his natural vitality early. At seventeen, after marriage, legs weakened, and fontanelle felt open. Living ascetically, he took Buzhong Yiqi Tang in the morning and Dihuang Wan material plus Schisandra and Deer Antler in the evening. After a year, health was restored. Another child with soft neck cured by the previous two medicines developed Xie Lu (Delayed Closure of Fontanelle), thirst, and fever after marriage. Drinking large doses of these medicines as tea for two months reduced thirst/fever. After a year, the fontanelle closed; after another year, limbs strengthened. Without careful lifestyle management, medicine would have failed.