王先生云∶小儿久患疳疾体虚，久不进饮食，患来日久，诸候退，只是天柱骨
倒，医者不识，谓之五软候。须进金灵散、生筋散。《形证论》歌∶天柱才倒道难
医，算来此病非心脾，若患先须因吐泻，不曾调气至 羸，大患伤寒无汗脉（凤髓经此
一句云∶却被伤寒无浮脉），定应妙药疗他迟，无此卒然生此患，又兼不辨四肢肥，身软难堪
头似石，面红唇赤脸如绯，此病多应伤肾热，后来因热病相随（此两句在凤髓经即云∶此患只
应伤胆热，后来伏热又相随。）肝受热风天柱倒，但将凉药与维持，贴须性热筋方缓，立见
温和请莫疑，吐泻项软唯调气，伤寒柱倒不须医。此或伤寒或吐或泻，乘虚邪毒
透入肝脉，热邪所侵，是致令筋软长，或手足软而不解举，或项颈软而不解举，若
有前证，即须凉膈，若吐泻，则先调胃气，贴项并服凉肝胆药，不可太热，亦恐过冷。
金灵散
上，用白僵蚕不拘多少，直者，去丝炒，为末。每服半钱一钱，薄荷酒调下，
一日三服。更须用生筋散贴之。
生筋散
木鳖子（三个） 蓖麻子（三十个）
上各取肉同研。每用一钱许，津唾调贴，急抱揩项上令热，贴之。
四十八候贴项药方
川乌头 白芷 地龙 五灵脂 赤小豆（各等分）
上末，生姜自然汁与酒同调贴在项上。更服竹茹散。
竹茹散
菊花（三钱） 黄芩 人参（各一钱） 大黄（半两） 甘草（二钱）
上为末，竹叶煎汤下。
三十六种贴项药方
草乌头 赤小豆（各等分）
上为末，姜汁调摊帛子上，贴经宿，项立起。
贴头起项膏(吉氏) 治小儿肝热胆冷，头项软倒。
川乌（末） 肉桂（末） 芸苔子 天南星 蓖麻子（各一钱） 黄丹（炒，一钱匕）
上大蒜一头，煨熟去皮，乳钵内研和，药细，每用一钱，入米醋和匀，贴项上一日许。
野狼毒丸（吉氏） 治小儿胆热肝风，天柱倒折，宜服此药，更用前起头贴项药。
野狼毒（酒浸，焙） 白附子 大附子（尖） 天麻 防风 羌活（以上各一分） 朱砂 地龙（去土。各
一钱） 麝香（半字）
上为细末，法酒煮糊为丸，如小豆大。每服七丸至十五丸，用黑豆薄荷汤入酒一滴，吞下。
王先生说：小儿长期患有疳疾（一种以形体消瘦、饮食异常为特征的慢性消耗性疾病），身体虚弱，长时间不能进食，患病时间已久，其他症状消退后，只剩下天柱骨（指颈部脊柱上部，此处代指颈项软弱无力）倒伏。医生不认识这种病症，称之为“五软候”（指头项、口、手、足、肌肉等部位痿软无力的证候）。必须服用金灵散、生筋散。《形证论》中的歌诀说：天柱骨刚出现倒伏迹象时说道难以医治，想来此病并非源于心脾二脏。如果患病起初是因为吐泻，没有及时调理气机导致身体极度虚弱，又恰好患伤寒且无汗脉象不浮（《凤髓经》对此句记载为：却被伤寒无浮脉），定当认为用药治疗太迟了。如果没有上述情况却突然发生此病，再加上四肢肥壮，身体柔软难堪，头部沉重如石，面色红赤嘴唇绯红，此病多因肾热所致，后来因热病相随（这两句在《凤髓经》中记载为：此患只应伤胆热，后来伏热又相随）。肝受热风侵袭导致天柱骨倒伏，只需给予凉性药物来维持平衡。贴敷的药物性质必须温热，筋脉才能舒缓，立刻见到温和效果，请不要怀疑。如果是吐泻导致的项部软弱，只需调理胃气；如果是伤寒导致的项部软弱，则不必特别治疗。这或者是伤寒，或者是吐泻，乘虚而入的邪毒透入肝脉，被热邪所侵，致使筋脉松弛变长，或者手足软弱无法抬起，或者颈项软弱无法抬起。如果有前述症状，就必须使用凉膈散（清上泄下之剂）；如果是吐泻，则先调理胃气，同时贴敷颈部并服用凉肝胆的药，药性不可太热，也恐怕过于寒凉。
金灵散
以上药材，取白僵蚕不拘多少，选取直直的，去掉丝茧炒制，研为粉末。每次服用半钱至一钱，用薄荷酒调服，一天服用三次。还需要配合使用生筋散外贴。
生筋散
木鳖子（三个） 蓖麻子（三十个）
以上各取果肉共同研磨。每次取约一钱，用唾液调和后贴敷，迅速抱住擦拭颈部使其发热，然后贴敷。
四十八候贴项药方
川乌头 白芷 地龙 五灵脂 赤小豆（各等分）
以上研为粉末，用生姜自然汁与酒调和后贴在颈部。再服用竹茹散。
竹茹散
菊花（三钱） 黄芩 人参（各一钱） 大黄（半两） 甘草（二钱）
以上研为粉末，用竹叶煎汤送服。
三十六种贴项药方
草乌头 赤小豆（各等分）
以上研为粉末，用姜汁调和摊在帛子上，贴敷一夜，颈部即可立起。
贴头起项膏（吉氏） 治疗小儿肝热胆冷，头项软弱倒伏。
川乌（末） 肉桂（末） 芸苔子 天南星 蓖麻子（各一钱） 黄丹（炒，一钱匕）
以上取一头大蒜，煨熟去皮，在乳钵内研磨混合药粉，使药细匀。每次取一钱，加入米醋调和均匀，贴在颈部约一天。
野狼毒丸（吉氏） 治疗小儿胆热肝风，天柱骨倒折，适宜服用此药，并配合使用前文提到的起头贴项药。
野狼毒（酒浸，焙干） 白附子 大附子（尖部） 天麻 防风 羌活（以上各一分） 朱砂 地龙（去土。各一钱） 麝香（半字）
以上研为细末，用法制酒煮糊制作成丸，如小豆大小。每次服用七丸至十五丸，用黑豆薄荷汤加一滴酒吞服。
Mr. Wang stated: When a child has suffered from malnutrition (a chronic consumptive disease characterized by emaciation and abnormal diet) for a long time, the body is weak, food intake has been poor for an extended period, and after the illness has persisted for a long while with other symptoms subsiding, only the inversion of the Tianzhu bone (referring to the upper cervical spine, here symbolizing flaccidity of the neck) remains. Physicians unfamiliar with this condition call it the "Five Flaccidities Syndrome" (a syndrome characterized by flaccidity of the head/neck, mouth, hands, feet, and muscles). It is necessary to administer Jinling San (Golden Spirit Powder) and Shengjin San (Tendon-Generating Powder). The song in *Xingzheng Lun* states: When the Tianzhu bone begins to invert, it is said to be difficult to treat; upon calculation, this disease does not originate from the Heart or Spleen. If the onset was initially due to vomiting and diarrhea, and Qi was not regulated leading to extreme debility, coupled with contracting Cold Damage (Shanghan) without sweating and a non-floating pulse (the *Fengsui Jing* records this line as: "yet Cold Damage presents with no floating pulse"), one should definitely consider that medicinal treatment was too late. If this condition arises suddenly without these preceding factors, and the limbs are plump, the body is soft and unbearable, the head feels heavy like stone, the face is red, lips are crimson, this disease is mostly caused by Kidney Heat, followed by accompanying heat diseases (these two lines in *Fengsui Jing* read: "This affliction only injures Gallbladder Heat, later latent heat follows"). When Liver Heat-Wind invades causing the Tianzhu bone to invert, cool-natured medicines should be given to maintain balance. The topical application must have warm-natured properties so that the tendons can relax, showing immediate mild effects; do not doubt this. If neck flaccidity is due to vomiting and diarrhea, only regulate Stomach Qi; if due to Cold Damage, no special treatment is needed. This may be either Cold Damage, vomiting, or diarrhea; pathogenic toxins enter the Liver Meridian through deficiency, invaded by Heat Pathogens, causing tendons to become loose and elongated, resulting in flaccid hands and feet unable to lift, or a flaccid neck unable to lift. If the aforementioned symptoms exist, Liangge San (Cooling the Diaphragm Powder) must be used; if due to vomiting and diarrhea, first regulate Stomach Qi, apply patches to the neck, and administer medicines that cool the Liver and Gallbladder. The nature should not be too hot, nor excessively cold.
Jinling San (Golden Spirit Powder)
Take Bai Jiangcan (Bombyx Batryticatus, Silkworm), any quantity, selecting straight ones, removing silk cocoons, stir-frying, and grinding into powder. Take half a qian to one qian per dose, mixed with Bohe Jiu (Mint Wine), three times a day. Additionally, apply Shengjin San externally.
Shengjin San (Tendon-Generating Powder)
Mu Bie Zi (Strychnos Semmen, Nux Vomica Seed) (three seeds) Bi Ma Zi (Ricini Semen, Castor Bean Seed) (thirty seeds)
Extract the flesh from each and grind together. Use approximately one qian per application, mix with saliva, apply to the affected area, quickly hold and rub the neck to generate heat, then apply.
Forty-Eight Manifestations Neck-Patching Formula
Chuan Wu Tou (Aconiti Lateralis Radix Praeparata, Prepared Lateral Root of Monkshood) Bai Zhi (Angelicae Dahuricae Radix, Dahurian Angelica Root) Di Long (Pheretima, Earthworm) Wu Ling Zhi (Trogopterori Faeces, Trogopterus Dung) Chi Xiao Dou (Adzuki Bean) (equal parts)
Grind all into powder, mix with fresh juice of Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger) and wine, and apply to the neck. Also administer Zhuru San.
Zhuru San (Bamboo Shavings Powder)
Ju Hua (Chrysanthemi Flos, Chrysanthemum Flower) Huang Qin (Scutellariae Radix, Scutellaria Root) Ren Shen (Ginseng Radix et Rhizoma, Ginseng Root) (each one qian) Da Huang (Rhei Radix et Rhizoma, Rhubarb Root) (half liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, Licorice Root) (two qian)
Grind into powder, take with decoction of Zhu Ye (Bambusae Folium, Bamboo Leaf).
Thirty-Six Types of Neck-Patching Formula
Cao Wu Tou (Aconiti Kusnezoffii Radix, Kusnezoff Monkshood Root) Chi Xiao Dou (Adzuki Bean) (equal parts)
Grind into powder, mix with Jiang Zhi (Ginger Juice), spread on cloth, apply overnight, and the neck will stand upright.
Paste Head Raise Neck Ointment (from Ji's Works) Treats pediatric Liver Heat and Gallbladder Cold, causing head and neck flaccidity and inversion.
Chuan Wu (Prepared Lateral Root of Monkshood, powdered) Rou Gui (Cinnamomi Cortex, Cinnamon Bark) Yun Tai Zi (Brassicae Pekinensis Semen, Rape Seed) Tian Nan Xing (Arisaematis Rhizoma Preparatum, Prepared Arisaema Rhizome) Bi Ma Zi (Ricini Semen, Castor Bean Seed) (each one qian) Huang Dan (Minii Oxidum Rubrum, Red Lead) (stir-fried, one qian bi)
Take one head of Da Suan (Allii Sativi Bulbus, Garlic), roast until cooked, peel, and grind in a mortar with the medicine until fine. Use one qian per application, mix with Mi Cu (Oryzae Fermentatum Acetum, Rice Vinegar), apply to the neck for about one day.
Ye Lang Du Wan (Wolfbane Pill) (from Ji's Works) Treats pediatric Gallbladder Heat and Liver Wind, causing Tianzhu bone inversion and fracture. It is suitable to take this medicine and use the previously mentioned head-raising neck patch.
Ye Lang Du (Daphne Genkwa Cortex, Daphne Genkwa Bark) (soaked in wine, dried) Bai Fu Zi (Typhonii Rhizoma, Typhonium Rhizome) Da Fu Zi (Aconiti Lateralis Radix Praeparata, Prepared Lateral Root of Monkshood) (tip part) Tian Ma (Gastrodiae Rhizoma, Gastrodia Rhizome) Fang Feng (Saposhnikoviae Radix, Saposhnikovia Root) Qiang Huo (Notopterygii Rhizoma et Radix, Notopterygium Rhizome) (each one fen above) Zhu Sha (Cinnabaris, Cinnabar) Di Long (Pheretima, Earthworm) (cleaned of soil, each one qian) She Xiang (Moschus, Musk) (half zi)
Grind into fine powder, make pills using prepared wine paste, size of small beans. Take seven to fifteen pills per dose, swallow with Black Bean Mint Decoction with a drop of wine.