Cut the pork spare ribs into 1-inch pieces, rinse with diluted salt water, then rinse with cold water and drain.
- Tie the beef shank tightly with kitchen twine (this helps the meat keep its shape while cooking). Clean and cut the beef tendon into bite-sized pieces.
- Bring a pot of water to a boil. Blanch the bones, beef shank, beef tendon, and pork hock (if using). Skim off any foam for a clear broth.
- Wash and bruise the lemongrass and ginger. Finely chop some Vietnamese coriander, green onion, cilantro, and thinly slice the onion.
- Mix 1/2 cup water with Hue-style shrimp paste and stir well.

Marinate all the meat with 2 tablespoons sugar, 1 tablespoon salt, 1/2 tablespoon MSG, 1 tablespoon diluted shrimp paste, 2 tablespoons minced shallots, 2 tablespoons minced garlic, and 2 tablespoons minced lemongrass.
- Wash and slice the water spinach, shred the banana blossom, pick the bean sprouts and herbs. Rinse everything and drain in a colander.
- Bring water to a boil and briefly blanch the rice vermicelli noodles. Drain in a colander.

To cook the meat and bones:
Line the bottom of a pressure cooker with 3 stalks of lemongrass and half the ginger. Add the pork bones and pork hock, pour in enough water to just cover the meat, seal the lid, bring to a boil, then reduce heat and cook for 5 minutes after it starts to whistle. Remove the spare ribs and place them in a bowl of cold water. Reserve the broth (this keeps the meat firm and not mushy).
- In the same pressure cooker, line the bottom with the remaining lemongrass and ginger, add the beef shank and tendon, pour in enough water to just cover the meat. Seal the lid, bring to a boil, then reduce heat and cook for 20 minutes after it starts to whistle.

To serve, arrange the noodles, spare ribs, beef shank, tendon, and sausage in a bowl. Sprinkle with herbs and sliced onion, then ladle the hot broth over. Serve with water spinach, banana blossom, bean sprouts, fresh herbs, lime, and chili on the side. Enjoy hot!