小儿有体肥容壮，不为瘦悴，孰知形体过肥，中气愈弱，是盛于外而歉于内也。忽
然项软倾倒者，此名下窜，皆因肝肾气虚，客邪侵入风府，转于筋骨，肝主筋，肾主
骨，肝肾既虚，筋骨俱弱，项垂无力，名天柱倒。然有三因，有因吐泻日久，元阳亏损
者，此宜调补胃气；有因肝经伏热者，治宜轻剂凉肝；有因伤寒失表，壅而热甚，筋热
则舒弛而不收者，总系真阳大败之恶症，极难调理随候加治，外用生筋等散贴项可也。
大抵五硬五软，多由先天，而天柱骨倒，根
乎先天，变生于后天也。颈骨而称天柱者，谓其头以象天，名曰元首，承天之重，故云
天柱也。天柱者，骨所立，而筋所束，肝肾之所属，诸阳之所达，诚紧要重大之部位，
一至骨倒，天象已危，岂小故耶！然因吐泻日久，元阳大败者，乃症之虚者，危者，极
难调治。如因伤寒失表，风邪入肝筋纵者，或肝胆伏热，筋络舒弛者，尚可疏风清热，
仍滋肝肾为主，肝肾之本不拔，筋骨得力，而或有起势也。
治筋软无力，天柱骨倒。
木鳖子（六个） 蓖麻子（六十个，并去壳）
研细，先抱头起，摩顶上。令热津调涂之。
一方
贴项软。
附子（去皮脐，二钱） 天南星（去脐，三钱） 为末，用姜汁调，摊贴患处。
小儿中有身体肥胖、体态壮实，并不显得消瘦憔悴的，谁知道形体过于肥胖，中气反而更加虚弱，这是外表强盛而内部亏虚的表现。忽然出现颈部软弱、头部倾倒的情况，这种病症称为“下窜”，都是因为肝肾之气虚弱，外来的邪气侵入风府穴，进而影响到筋骨。肝主管筋，肾主管骨，既然肝肾已经虚弱，筋和骨都会变得软弱，导致颈部下垂无力，这被称为“天柱倒”（颈椎支撑无力）。然而，其病因有三种：有因长期呕吐腹泻，导致元阳亏损的，这种情况适宜调理补益胃气；有因肝经潜伏热邪的，治疗适宜用轻剂凉肝清热；有因伤寒病未能及时发汗解表，导致邪气壅滞且热势严重，筋脉受热则松弛无法收敛的，这些总体上都属于真阳大败的危重恶症，极难调理。应当随证候变化进行针对性治疗，外用生筋散等药物贴敷于颈部也可以。
大致而言，“五硬”和“五软”多由先天因素引起，而“天柱骨倒”根源于先天，但病变产生于后天。颈部骨骼之所以称为“天柱”，是因为头象天，名为元首，承受天的重任，所以叫作天柱。天柱是骨骼站立、筋脉约束的地方，归属于肝肾，也是诸阳经气血到达之处，确实是紧要重大的部位，一旦骨头倒下，象征天的意象已经危险，难道是小事情吗！然而，如果是因长期呕吐腹泻，导致元阳大败的，这是病症中的虚证，病情危重，极难调治。如果是因伤寒失于解表，风邪侵入肝经导致筋脉纵弛，或者肝胆有伏热导致筋络松弛的，还可以采用疏风清热的方法，仍以滋养肝肾为主，如果肝肾的根本不稳固，筋骨得不到力量，或许还有好转的希望。
治疗筋软无力，天柱骨倒。
木鳖子（六个） 蓖麻子（六十个，去掉外壳）
研磨成细粉，先抱住孩子的头使其抬起，按摩头顶。用热津液调和后涂抹患处。
另一个方子
贴敷颈部软弱处。
附子（去掉皮和脐，二钱） 天南星（去掉脐，三钱）
研为粉末，用姜汁调和，摊开贴敷在患处。
In children, there are those with a fat body and robust appearance, who do not look emaciated. Who would know that excessive physical obesity leads to even weaker Middle Qi (the vital energy of the Spleen and Stomach); this is prosperity on the outside but deficiency on the inside. Suddenly, the neck becomes soft and the head tilts; this condition is named "Xia Cuan" (Descending Drift). It is all due to deficiency of Qi in the Liver and Kidney, where pathogenic factors invade the Fengfu acupoint (GV16), affecting the sinews and bones. The Liver governs the sinews, and the Kidney governs the bones. Since the Liver and Kidney are deficient, both sinews and bones become weak, causing the neck to droop without strength, which is called "Tian Zhu Dao" (Collapse of the Heavenly Pillar). However, there are three causes: some result from prolonged vomiting and diarrhea, leading to damage of Yuan Yang (Primal Yang); for these, it is appropriate to regulate and tonify Stomach Qi. Some result from latent heat in the Liver channel; treatment should employ mild agents to cool the Liver. Some result from Taiyang disease (Exogenous Cold Damage) failing to be released via sweating, leading to stagnation and severe heat; when sinews are heated, they relax and cannot contract. These generally belong to the malignant syndrome of severe defeat of True Yang, which is extremely difficult to regulate. Treatment should follow the specific manifestations, and externally applying San Jin San (Sinew-Generating Powder) or similar powders to the neck is also acceptable.
Generally speaking, "Wu Ying" (Five Stiffnesses) and "Wu Ruan" (Five Softnesses) mostly arise from congenital factors, whereas "Tian Zhu Gu Dao" (Collapse of the Heavenly Pillar Bone) has its root in congenital factors but its changes occur postnatally. The cervical bone is called the "Heavenly Pillar" because the head represents Heaven, named the "Head Chief," bearing the heavy responsibility of Heaven, hence the name. The Heavenly Pillar is where bones stand and sinews bind, belonging to the Liver and Kidney, and is the pathway where all Yang meridians reach. It is indeed a critical and major location. Once the pillar collapses, the celestial image is already in danger; how can this be a trivial matter! However, cases caused by prolonged vomiting and diarrhea leading to severe defeat of Yuan Yang are deficiency syndromes that are critical and extremely difficult to treat. If it is due to Taiyang disease failing to be released, allowing Wind pathogens to enter the Liver sinews causing them to slacken, or if there is latent heat in the Liver and Gallbladder causing sinew collaterals to relax, one may still use methods to disperse Wind and clear Heat, primarily nourishing the Liver and Kidney. If the root of the Liver and Kidney is not established, and the sinews and bones do not gain strength, there might be a chance of recovery.
To treat weak sinews and collapse of the Heavenly Pillar bone:
Mu Bie Zi (Semen Momordicae, six pieces) Bi Ma Zi (Semen Ricini, sixty pieces, shells removed)
Grind into fine powder. First, support the child's head to lift it, and massage the top of the head. Mix with hot saliva/juice and apply to the area.
Another prescription
Apply to the soft neck.
Fu Zi (Radix Aconiti Lateralis Preparata, skin and umbilicus removed, 2 qian) Tian Nan Xing (Rhizoma Arisaematis, umbilicus removed, 3 qian)
Grind into powder, mix with Ginger Juice (Jiang Zhi), spread, and apply to the affected area.