师曰∶病跗蹶，其人但能前，不能却。刺 入二寸。此太阳经伤也。
【按】证刺俱未详，必有缺文，不释。
病患，常以手指臂肿动，此人身体 者，藜芦甘草汤主之。
【按】证未详，方亦缺，不释。
藜芦甘草汤方（缺）
转筋之为病，其人臂脚直，脉上下行，微弦，转筋入腹者，鸡屎白散主之。
【注】臂同背，古通用。臂脚直，谓足背强直不能屈伸，是转筋之证也。脉上下行，谓
迢迢长直，微弦不和，是转筋之脉也。中寒之人，外寒盛则手足拘急转筋，痛不能忍，甚
者入腹，则牵连少腹拘急而痛也。主之鸡屎白散，以治风寒痹气之在筋也。
鸡屎白散方
鸡屎白
上一味为散，取方寸匕，以水六合和，温服。
阴狐疝气者，偏有大小，时时上下，蜘蛛散主之。
【注】偏有大小，谓睾丸左右有大小也。时时上下，谓睾丸入腹，时出时入也。疝，厥
阴之病也，以与狐情状相类，故名之也。主之蜘蛛散，入肝以治少腹拘急而痛也。
【集注】赵良曰∶睾丸上下，有若狐之出入无时也，故曰狐疝。
李 曰∶偏有大小，以睾丸言。时时上下，以睾丸入小腹出囊中言。
尤怡曰∶阴狐疝气者，寒湿袭阴而睾丸受病，或左或右，大小不同；或上或下，出
没无时，故名狐疝。
蜘蛛散方
蜘蛛（熬煎，十四枚） 桂枝（半两）
上二味为散，取八分一匕，饮和服，日再服，蜜丸亦可。
【集解】尤怡曰∶蜘蛛有毒，服之能令人利，合桂枝辛温，入阴而逐其寒湿之气也。
问曰∶病腹痛有虫，其脉何以别之？师曰∶腹中痛，其脉当沉，若弦，反洪大，故
有蛔虫。
【按】腹痛有虫，以洪大脉别之，未详，必有缺文，不释。
蛔虫之为病，令人吐涎，心痛，发作有时，毒药不止，甘草粉蜜汤主之。
【注】蛔虫，即今之人所名食虫也。蛔虫之为病，发作有时，发则令人吐涎，心痛欲
死，即服攻下毒药，非积之痛，乃虫之痛，故不能止也。主之甘草粉蜜汤者，以虫得甘蜜
而上，得铅粉而杀，从治之法也。
【集注】徐彬曰∶发作有时，谓不恒痛也，则与虚寒之绵绵而痛者异矣。毒药不止，则
必治气治血，攻寒逐积之药，俱不应矣，故以甘草粉蜜主之，白粉杀虫，甘草与蜜既以
和胃，又以诱蛔也。
李 曰∶《灵枢》云∶蛔动则胃缓，胃缓则廉泉开，故涎下，令人吐涎也。蛔上入膈，
心在膈上，故心痛，须臾下膈，则痛止，故发作有时也。廉泉任脉穴名，在颔下骨尖
中。
甘草粉蜜汤方
甘草（二两） 粉（一两） 蜜（四两）
上三味，以水三升，先煮甘草，取二升，去滓，内粉蜜，搅令和。煎如薄粥，温服一
升，瘥即止。
【集解】李 曰∶蛔得甘则动，其性喜故也。胡粉有毒能杀虫，置粉于甘草蜜汤中，诱
蛔食之也。
蛔厥者，当吐蛔，今病者静而复时烦，此为脏寒，蛔上入膈，故烦，须臾复止，得食
而呕又烦者，蛔闻食臭出，其人当自吐蛔。蛔厥者，乌梅丸主之。
【按】此为脏寒之“此”字，当是“非”字，若是“此”字，即是脏厥，与辨蛔厥之
义不属。
【注】蛔厥者，谓蛔痛手足厥冷也。若脏寒痛厥，则不吐蛔，此蛔厥、脏寒之所由分
也。静而时烦，乃蛔上入其膈，故烦，须臾复止，得食又吐又烦，是蛔闻食臭出故也。主
之乌梅丸者，以蛔得酸则静，得辛则伏，得苦则下，方中大酸，大辛、大苦，信为治虫
之要剂也。
乌梅丸方
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归（四两） 附子（炮，
六两） 川椒（去汗，四两） 桂枝（六两） 人参（六两） 黄柏（六两）
上十味，异捣筛，合治之，以苦酒渍乌梅一宿，去核蒸之五升米下，饭熟捣成泥，和
药令相得，内臼中，与蜜杵二千下，丸如梧子大。先食饮，服十丸，日三服，稍加至二
十丸，禁生冷滑臭等食。
【集解】李 曰∶乌梅味酸，黄连、黄柏味苦，桂枝、蜀椒、干姜、细辛味辛，以蛔得酸则
止，得苦则安，得甘则动于上，得辛则伏于下也。然胃气虚寒，人参、附子以温补之，吐亡津
液，当归以辛润之，则蛔厥可愈矣。
老师说：患跗蹶病的人，只能向前迈步，不能向后撤步。针刺时进针二寸。这是太阳经受损的缘故。
【按语】症状和刺法记载都不详细，必定有缺漏的文字，不予解释。
病人经常手指和手臂肿胀跳动，如果这个人身体沉重，用藜芦甘草汤主治。
【按语】症状不详，方剂也缺失，不予解释。
藜芦甘草汤方（缺失）
转筋这种病，病人的手臂和脚部僵硬挺直，脉象上下直行且微带弦象，如果转筋牵引至腹部疼痛的，用鸡屎白散主治。
【注释】“臂”同“背”，古文中通用。“臂脚直”，指的是足背部僵硬挺直，不能屈伸，这就是转筋的症状。脉象上下直行，指脉象长而直，微微弦急而不调和，这是转筋的脉象。中寒体质的人，外感寒邪盛则手足拘急转筋，疼痛难以忍受，严重的会牵引至腹部，导致少腹拘急疼痛。主治用鸡屎白散，用来治疗风寒痹阻之气在筋脉的情况。
以上一味药研为散剂，取一方寸匕的量，用六合水调和，温服。
阴狐疝气病，表现为睾丸左右大小不一，时时上下移动，用蜘蛛散主治。
【注释】偏有大小，指的是睾丸左右大小不同。时时上下，指的是睾丸有时缩入腹腔，有时出于阴囊。疝是厥阴经的病证，因为与狐狸的情状相似，所以叫它狐疝。主治用蜘蛛散，入肝经以治疗少腹拘急疼痛。
【集注】赵良说：睾丸上下移动，像狐狸出入没有定时，所以叫狐疝。
李 说：偏有大小，是指睾丸而言。时时上下，是指睾丸进入小腹或出于阴囊而言。
尤怡说：阴狐疝气，是寒湿侵袭阴部导致睾丸受病，或左或右，大小不同；或上或下，出没无常，所以名叫狐疝。
以上两味药研为散剂，取八分之一匕的量，用水送服，每天服两次，做成蜜丸也可以。
【集解】尤怡说：蜘蛛有毒，服用后能使人腹泻，配合桂枝的辛温之性，入阴分以驱逐寒湿之气。
问：患有腹痛且有虫积的病人，其脉象如何辨别？老师说：腹中痛，脉象应当沉，如果是弦脉，反而洪大，所以是有蛔虫。
【按语】腹痛有虫，仅凭洪大脉来辨别，依据不详，必定有缺漏的文字，不予解释。
蛔虫病，会导致人吐涎沫，心痛，发作有定时，服用攻下的毒药无效，用甘草粉蜜汤主治。
【注释】蛔虫，就是现在人们所说的食虫。蛔虫病发作有定时，发作时让人吐涎沫，心痛欲死，即使服用攻下毒药，也不是积聚引起的疼痛，而是虫扰引起的疼痛，所以不能止住。主治用甘草粉蜜汤，是因为虫子喜欢甜味而上行，遇到铅粉就会被杀死，这是顺从其习性进行治疗的方法。
【集注】徐彬说：发作有定时，指不是持续疼痛，这就与虚寒导致的绵绵作痛不同了。服用毒药无效，那么治疗气、血、寒、积的药物都不见效，所以用甘草粉蜜主治，白粉杀虫，甘草和蜂蜜既能和胃，又能引诱蛔虫。
李 说：《灵枢》说：蛔动则胃缓，胃缓则廉泉穴开，所以流涎，让人吐涎。蛔虫上行进入膈部，心在膈上，所以心痛，须臾之后蛔虫下行离开膈部，疼痛就停止，所以发作有定时。廉泉是任脉的穴位名，位于下巴骨尖中间。
以上三味药，用三升水，先煮甘草，取二升药液，去渣，加入粉和蜜，搅拌调和。煎煮如薄粥状，温服一升，病愈即停服。
【集解】李 说：蛔虫得甘味则躁动，这是它的本性。胡粉有毒能杀虫，将粉放在甘草蜜汤中，是为了引诱蛔虫吃下去。
蛔厥病，应当吐出蛔虫，现在病人安静但时不时心烦，这是因为内脏寒冷，蛔虫上行进入膈部，所以心烦，一会儿又停止，吃东西后呕吐并且心烦，是因为蛔虫闻到食物的气味而出来的缘故，这个人应当会自动吐出蛔虫。蛔厥病，用乌梅丸主治。
【按语】这里的“脏寒”的“此”字，应该是“非”字，如果是“此”字，那就是脏厥，与辨别蛔厥的意义不符。
【注释】蛔厥，指的是因蛔虫疼痛导致手足厥冷。如果是脏寒引起的痛厥，就不会吐蛔虫，这是蛔厥与脏寒的区别所在。安静而偶尔心烦，是蛔虫上行进入膈部，所以心烦，一会儿又停止，吃东西后又吐又烦，是蛔虫闻到食物气味出来的缘故。主治用乌梅丸，是因为蛔虫得酸味则安静，得辛味则潜伏，得苦味则下行，方中用了大量的酸、辛、苦味，确实是治疗虫病的要剂。
乌梅丸方
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归（四两） 附子（炮制，六两） 川椒（去汗，四两） 桂枝（六两） 人参（六两） 黄柏（六两）
以上十味药，分别捣碎过筛，混合在一起。用醋浸泡乌梅一夜，去核，在五升米下蒸熟，饭熟后捣成泥状，与药物混合均匀，放入臼中，加蜜杵捣两千下，制成梧桐子大小的丸药。饭前服药，每次服十丸，每天三次，逐渐增加到二十丸，禁止食用生冷、滑腻、腥臭等食物。
【集解】李 说：乌梅味酸，黄连、黄柏味苦，桂枝、蜀椒、干姜、细辛味辛，因为蛔虫得酸味则止，得苦味则安，得甘味则动于上，得辛味则伏于下。然而胃气虚寒，用人参、附子来温补，吐泻亡失津液，用当归来辛润，这样蛔厥就可以痊愈了。
The Master said: In cases of Fu Jue (cramp and stiffness), the patient can only move forward but not backward. Acupuncture insertion depth is two cun. This is an injury to the Taiyang channel.
[Commentary] The symptoms and acupuncture methods are not detailed; there must be missing text, so no explanation is provided.
If a patient frequently experiences swelling and tremors in the fingers and arms, and if this person also suffers from heaviness of the body, Lili Caoshao Tang (Veratrum and Licorice Decoction) should be administered.
[Commentary] The symptoms are not detailed, and the formula is missing; no explanation is provided.
Formula for Lili Caoshao Tang (Missing)
In cases of Zhuan Jin (muscle cramp/spasm), the patient's arms and legs become stiff and straight, the pulse runs vertically up and down with a slight wiry quality. If the spasm extends into the abdomen, Jishi Bai San (Chicken Dropping White Powder) should be administered.
[Annotation] "Bi" (arm/back) is interchangeable with "Bei" (back) in ancient texts. "Bi jiao zhi" refers to the stiffness and straightness of the dorsum pedis, preventing flexion and extension, which characterizes the symptom of muscle cramp. The pulse running vertically up and down indicates a long, straight, slightly wiry and discordant pulse, characteristic of muscle cramp. In individuals with internal cold, when external cold is excessive, the limbs become cramped and spasmodic, with unbearable pain. Severe cases involve the spasm extending to the abdomen, causing tension and pain in the lower abdomen. Jishi Bai San is used to treat wind-cold bi syndrome affecting the sinews.
Formula for Jishi Bai San
Jishi Bai (White part of chicken droppings)
Grind the single ingredient into a powder. Take one fangcun bi (a square-inch measure), mix with six he of water, and take warm.
Yin Hu Shan Qi (Yin Fox Hernia) is characterized by asymmetry in size, with the mass moving up and down intermittently. Zhizhu San (Spider Powder) should be administered.
[Annotation] Asymmetry in size refers to the difference in size between the left and right testicles. Moving up and down intermittently refers to the testicles retracting into the abdomen and protruding out at times. Shan (hernia) is a disease of the Jueyin channel. It is named "Fox Hernia" because its behavior resembles that of a fox. Zhizhu San enters the Liver channel to treat tension and pain in the lower abdomen.
[Collected Annotations] Zhao Liang said: The movement of the testicles up and down is like a fox entering and exiting without fixed timing, hence called Fox Hernia.
Li [Name obscured] said: Asymmetry in size refers to the testicles. Moving up and down refers to the testicles entering the lower abdomen or emerging into the scrotum.
You Yi said: Yin Fox Hernia occurs when cold-dampness invades the yin region, affecting the testicles. They may differ in size on the left or right, and move up or down unpredictably, hence named Fox Hernia.
Formula for Zhizhu San
Zhizhu (Spider, roasted/fried, 14 pieces) Guizhi (Cinnamon Twig, half liang)
Grind the two ingredients into a powder. Take one-eighth of a fangcun bi, mix with water and take orally. Administer twice daily. It can also be made into honey pills.
[Collected Explanations] You Yi said: Spiders are toxic; ingestion causes purging. Combined with the acrid-warm nature of Cinnamon Twig, it enters the yin regions to expel cold-dampness.
Question: How can one distinguish the pulse in abdominal pain caused by parasites? The Master said: In abdominal pain, the pulse should be deep. If it is wiry and instead becomes flooding and large, it indicates the presence of roundworms (Ascaris).
[Commentary] Distinguishing parasitic abdominal pain solely by a flooding-large pulse is unclear; there must be missing text, so no explanation is provided.
Roundworm disease causes salivation, heart pain, and intermittent attacks. If antiparasitic drugs fail to stop the pain, Gancao Fenmi Tang (Licorice, Flour, and Honey Decoction) should be administered.
[Annotation] Roundworms are what people today call "food worms." Roundworm disease attacks intermittently. During an attack, it causes salivation and severe heart pain. Even if purgative drugs are taken, the pain persists because it is caused by worm disturbance rather than accumulation. Gancao Fenmi Tang is used because worms are attracted to sweetness and rise, and are killed by lead powder. This is a method of treating according to the parasite's nature.
[Collected Annotations] Xu Bin said: Intermittent attacks mean the pain is not constant, differing from the lingering pain of deficiency-cold. If antiparasitic drugs fail, treatments targeting qi, blood, cold, and accumulation will also fail. Therefore, Gancao Fenmi Tang is used. Bai Fen (white flour/lead powder) kills worms, while Licorice and Honey harmonize the stomach and lure the roundworms.
Li [Name obscured] said: The Ling Shu states: When roundworms move, the stomach relaxes; when the stomach relaxes, the Lianquan acupoint opens, causing salivation. When roundworms ascend into the diaphragm, where the Heart resides, heart pain occurs. When they descend below the diaphragm after a moment, the pain stops, hence the intermittent nature. Lianquan is an acupoint of the Ren Mai, located in the center of the chin bone.
Formula for Gancao Fenmi Tang
Gancao (Licorice Root, 2 liang) Fen (Flour/Lead Powder, 1 liang) Mi (Honey, 4 liang)
Take the three ingredients with 3 sheng of water. First decoct Licorice until 2 sheng remain, then strain. Add the powder and honey, stir well. Simmer until the consistency resembles thin porridge. Take 1 sheng warm. Stop administration once the illness resolves.
[Collected Explanations] Li [Name obscured] said: Roundworms become active with sweetness due to their nature. Hu Fen (basic lead carbonate/lead powder) is toxic and kills worms. Placing the powder in the Licorice-Honey decoction lures the roundworms to ingest it.
Hui Jue (Roundworm Syncope) involves vomiting roundworms. However, if the patient is quiet but occasionally irritable, this is due to interior cold. The roundworms ascend into the diaphragm, causing irritability, which subsides after a moment. If eating triggers vomiting and irritability again, it is because the roundworms emerge upon smelling food. The patient will likely vomit roundworms spontaneously. Hui Jue is treated with Wumei Wan (Mume Pill).
[Commentary] The character "ci" (this) in "this is interior cold" should likely be "fei" (not). If it were "this," it would indicate Zang Jue (Viscus Syncope), which does not align with the differentiation of Hui Jue.
[Annotation] Hui Jue refers to cold extremities caused by roundworm pain. If the syncope were caused by viscus cold, roundworms would not be vomited; this distinguishes Hui Jue from viscus cold. Quietness with occasional irritability indicates roundworms ascending to the diaphragm. Eating triggers vomiting and irritability as roundworms respond to food odors. Wumei Wan is used because roundworms calm with sour flavors, subside with acrid flavors, and descend with bitter flavors. The formula contains significant amounts of sour, acrid, and bitter herbs, making it a crucial agent for treating parasites.
Formula for Wumei Wan
Wumei (Mume Fruit, 300 pieces) Xixin (Asarum, 6 liang) Jiangjiang (Dried Ginger, 10 liang) Huanglian (Coptis Rhizome, 1 jin) Danggui (Angelica Sinensis, 4 liang) Fuzi (Prepared Aconite Root, 6 liang) Chuanjiao (Sichuan Pepper, 4 liang) Guizhi (Cinnamon Twig, 6 liang) Renshen (Ginseng, 6 liang) Huangbai (Phellodendron Bark, 6 liang)
Grind the ten ingredients separately and sift them, then mix. Soak Mume fruits in vinegar overnight. Remove pits and steam over five sheng of rice. Once the rice is cooked, mash the Mume into a paste. Mix with the powdered herbs. Place in a mortar and pound with honey two thousand times to form pills the size of wutong seeds. Take before meals with water, starting with 10 pills, three times daily. Gradually increase to 20 pills. Avoid cold, slippery, and foul-smelling foods.
[Collected Explanations] Li [Name obscured] said: Mume is sour; Coptis and Phellodendron are bitter; Cinnamon, Sichuan Pepper, Dried Ginger, and Asarum are acrid. Roundworms cease with sourness, settle with bitterness, become active upward with sweetness, and subside downward with acridity. However, since the Stomach qi is deficient and cold, Ginseng and Prepared Aconite warm and tonify. Since vomiting depletes fluids, Angelica Sinensis moistens with its acrid nature. Thus, Hui Jue can be cured.