师曰。病趺蹶。其人但能前。不能却。刺 入二寸。此太阳经伤也。（徐沈金鉴。趺。作跌。篇目同。是。）
〔沈〕此趺蹶。当辨经络而治也。人身足阳明脉络于腿外
之前。太阳脉络于腿外侧之后。少阳脉络于腿外侧之中也。夫跌而致蹶者。足不能行也。然不能行。又当辨
其前后治之。但能前者。阳明无伤也。不能却者。乃不能后抵。太阳经脉受伤也当刺 入二寸。 即小腿
肚。本属阳明。乃太阳经络所过之处。与阳明经气。会合于飞阳承筋间。故刺之使太阳
阳明气血和而无滞。则前后如常矣。
案扬子方言。跌。蹶也。说文。蹶。僵也。程云。趺。
足背也。趺蹶。即痹厥之属。恐非。金鉴云。证刺俱未详。必有缺文不释。此说近是。
病患常以手指臂肿动。此人身体 者。藜芦甘草汤主之。
〔尤〕湿痰凝滞关节则肿。风邪袭伤经络则动。手指臂肿动。身体 者。风痰在膈。攻走肢体。陈
无择所谓痰涎留在胸膈上下。变生诸病。手足项背。牵引钓痛。走易不定者
是也。藜芦吐上膈风痰。甘草亦能取吐。方虽未见。然大略是涌剂耳。（李氏）
案程云。证未详。方亦缺。不释。金鉴同。此固然。然尤引李 。其义略通。故姑仍之。
藜芦甘草汤方（〔原注〕未见。）
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。（此条脉经。载霍乱篇末。）
〔沈〕此木土不和。风邪而转筋也。风邪乘于脾胃。风湿相搏。以故表里皆病。若风湿盛于经表。则臂
脚直。脉上下行而微弦。经谓诸暴强直。皆属于风。亦风淫末疾之义也。或中气虚而木邪内逆。直攻于脏。则
转筋入腹。当以鸡屎白。下气消积。去风安脾之治。非治臂脚直之方也。
〔魏〕直上下行。全无和柔之象。亦同于痉病中直上下行之意也。
案金鉴云。臂同背。古通用。臂脚直。谓足背强直。不能屈伸。是转筋之证也。误。转筋不必足背。故
肘后。有疗两臂脚及胸胁转筋之方。巢源云。冷入于足之三阴三阳。则脚转筋。入于手之三阴三阳。则手筋
转。随冷所入之筋。筋则转。转者。由邪冷之气。击动其筋而移转也。
鸡屎白散方（外台。引肘后云。若转筋入腹中转者方。仲景。经心录。备急。集验。必效同。出于
霍乱转筋门。）
鸡屎白
上一味为散。取方寸匕。以水六合。和温服。（肘后云。以水六合。煮三沸。顿服之。勿令病者知之。外台同。）
案鸡屎白。别录云。治转筋利小便。故取而用之。素问用鸡屎醴。治鼓胀。通利大小便。验之虽本草
云微寒无毒。然泻下之力颇峻。用者宜知之。况霍乱转筋。多津液虚燥者。恐非所宜。
阴狐疝气者。偏有小大。时时上下。蜘蛛散主之。
〔尤〕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。蜘蛛有毒。服之能令人利。合桂枝辛温。入阴而逐其寒湿之气也。
灵经脉篇云。肝足厥阴所生病者。狐疝。葛氏伤寒直格
云。狐疝。言狐者。疝气之变化。隐见往来。不可测如狐也。
陈氏三因云。寒疝之气。注入 中。名曰狐疝。亦属 病。
蜘蛛散方
蜘蛛（十四枚熬焦） 桂枝（半两）
上二味。为散。取八分一匕。饮和服。日再服。蜜丸亦可。
〔程〕别录云。蜘蛛。治大人小儿 。 。疝也。其性有毒。服之能使人利。得桂枝。引入厥阴肝经。而治狐疝。
雷 炮炙论云。蜘蛛凡使勿用五色者。兼大身上有刺毛生者。并薄小者。以上皆不堪用。须用屋西南
有网。身小尻大。腹内有苍黄脓者真也。凡用去头足了。研如膏。投药中用之。今之方法。若仲景炒焦用。全
无功矣。王氏古方选注云。蜘蛛。性阴而厉。其功在壳。能泄下焦结气。桂枝。芳香入肝。专散沉阴结疝。阴
狐疝偏有大小。时时上下。如狐之出入无定。四时刺逆从论云。厥阴滑。为狐疝气。推仲景
之意。亦谓阴狐疝气。是阴邪挟肝风。而上下无时也。治以蜘蛛。如批却导 。蜘蛛。本草言有毒。人咸畏
之。长邑宰林公讳瑛。山海卫人。壮年调理。方用之多年。炙熟其味鲜
美。恒得其功。本草言有毒者。南北所产不同耳。
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。
〔尤〕腹痛脉多伏。阳气内闭也。或弦者。邪气入中也。若反洪大。则非正气与外邪为病。乃蛔动
而气厥也。然必兼有吐涎心痛等证。如下条所云。乃无疑耳。
蛔虫之为病。令人吐涎。心痛发作有时。毒药不止者。甘草粉蜜汤主之。
〔程〕巢元方曰。蛔虫长五寸。至一尺。发则心腹作痛。口喜唾涎及清水。贯伤心则死。灵枢经曰。虫
动则胃缓。胃缓则廉泉开。故涎下。是以令人吐涎也。心痛者。非蛔虫贯心。乃蛔虫上入胃脘。即痛。下入
胃中即止。是以发作有时也。若毒药不能止。用甘草粉蜜汤。从其性以治之。
〔尤〕吐涎。吐出清水也。心
痛。痛如咬啮。时时上下是也。发作有时者。蛔饱而静则痛立止。蛔饥求食则痛复发也。毒药。即
锡粉雷丸等。杀虫之药。毒药者折之。以其恶也。甘草粉蜜
汤诱之。以其所喜也。
甘草粉蜜汤方
甘草（二两） 粉（一两重○赵及诸本无重字） 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。
案粉。诸注以为铅粉。尤云。诱使虫食甘味既尽。毒性旋发。而虫患乃除。此医药之变诈也。此解
甚巧。然古单称粉者。米粉也。释名云。粉。分也。研米使分散也。说文。粉。敷面者也。徐曰。古敷面。亦
用米粉。伤寒论。猪肤汤。所用白粉。亦米粉耳。故万氏保命歌括。载本方云。治虫啮
心痛毒药不止者。粉。乃用粳米粉。而千金诸书。借以治药毒。并不用铅粉。盖此方非杀虫之剂。乃不过用甘
平安胃之品。而使蛔安。应验之于患者。始知其妙而已。甘味蛔所喜。东方朔神异经云。南方有甘蔗之林。其
高百丈。围三尺八寸。促节多汁。甜如蜜。咋啮其汁。令人润泽。可以节蛔虫。人腹中蛔虫。其状如蚓。此
消谷虫也。多则伤人。少则谷不消。是甘蔗能减多益少。凡蔗亦然。此所以得甘味而平也。
千金方。解鸩毒。及一切毒药不止。烦懑方。
即本方。粉。用粱米粉。（千金翼同。外台。引翼。作白粱粉。圣济总
录。用葛粉。杨氏家藏方。用绿豆粉。圣济。名甘草饮。）
蛔厥者。当吐蛔。令病者静而复时烦。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。（案柯氏来苏集。作此非脏寒。蛔上入膈。非也。）
〔尤〕蛔厥。蛔动而厥。心痛吐涎手足冷也。蛔动而上逆。则当吐蛔。蛔暂安而复动。则病亦静而复
时烦也。然蛔之所以时安而时上者何也。虫性喜温。脏寒则虫不安而上膈。虫
喜得食。脏虚则蛔复上而求食。故以人参姜附之属。益虚温
胃为主。而以乌梅椒连之属。苦酸辛气味。以折其上入之势也。
蛔厥者。乌梅丸主之。
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
（六两炮） 川椒（四两去汗） 桂枝（六两） 人参 黄柏（各六两）
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。禁生冷滑臭等物。
〔鉴〕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。（详伤寒论辑义厥阴篇。）
案此方。主胃虚而寒热错杂。以致蛔厥者。故药亦用寒热错杂之品治之。而有胃虚以偏于寒而动蛔者。
陶华用立安蛔理中汤主之。（即理中汤。加乌梅花椒。出全生集。）而有胃不虚以偏于
热而动蛔者。汪琥因制清中安蛔汤主之。（黄连。黄柏。枳实。乌梅。
川椒。出伤寒辨注。）此各取本方之半。而治其所偏也。对证施之。皆有奇效。
老师说道：患趺蹶病的人，只能向前迈步，不能向后倒退。治疗时应在小腿肚针刺，进针二寸。这是太阳经受伤所致。（徐灵胎、沈金鉴认为，“趺”应作“跌”，篇目相同，此说正确。）
〔沈〕这种趺蹶病，应当辨别经络进行治疗。人体足阳明胃经的脉络行于大腿前外侧；足太阳膀胱经的脉络行于大腿后外侧；足少阳胆经的脉络行于大腿外侧中间。所谓因跌倒导致筋脉拘急不能行走，虽然都不能行走，但治疗时需根据前后情况加以辨别。如果只能向前不能向后，说明阳明经没有受伤；不能向后倒退，是因为不能向后抵步，这是太阳经脉受伤的表现。应当在腓肠肌（即小腿肚）处针刺，进针二寸。该部位本属阳明经所过，也是太阳经络经过的地方，与阳明经气在飞扬穴、承筋穴之间会合。因此针刺此处可使太阳、阳明两经气血调和而无阻滞，前后活动就能恢复正常。
案语：扬子《方言》说：“跌，就是蹶。”《说文解字》说：“蹶，僵仆也。”程知说：“趺，是足背。”趺蹶属于痹厥一类，恐怕不是这个意思。金鉴说：“症状和刺法记载都不详细，必定有缺文未解释。”这种说法比较接近事实。
病人经常手指和手臂肿胀跳动，身体沉重麻木的，用藜芦甘草汤主治。
〔尤〕湿痰凝滞关节则肿胀，风邪侵袭损伤经络则跳动。手指手臂肿胀跳动，身体沉重麻木，这是风痰停留在膈间，攻窜走注于肢体。正如陈无择所说：痰涎留在胸膈上下，变生各种疾病，手足项背牵引掣痛，游走不定，就是这个道理。藜芦能涌吐上膈的风痰，甘草也能催吐。方剂虽然未见原文，但大体上是涌吐剂的范畴。（李氏按语）
案语：程知说：“症状不详，方剂也缺失，不予解释。”金鉴观点相同。这固然有理，但尤怡引用了李东垣的观点，其义理大致通顺，所以姑且保留。
藜芦甘草汤方（〔原注〕未见。）
转筋病，表现为手臂和脚僵硬挺直，脉象上下直行且微带弦象。如果转筋蔓延至腹部，用鸡屎白散主治。（此条内容在《脉经》中载于霍乱篇末。）
〔沈〕这是木土不和，风邪导致的转筋。风邪乘袭脾胃，风湿相搏，因此表里都发病。如果风湿盛于经络体表，就会出现手臂和脚僵硬挺直，脉象上下直行而微弦。医经说“所有的暴发性强直，都属于风”，这也是风邪侵害四肢末端疾病的含义。或者是中气虚弱，肝木之邪内逆，直接攻犯内脏，就会导致转筋入腹。应当用鸡屎白来下气消积，祛风安脾。这不是治疗手臂脚直的方子。
〔魏〕“直上下行”，完全没有柔和之象，也与痉病中“直上下行”的意思相同。
案语：金鉴说：“臂”同“背”，古时通用。“臂脚直”是指足背强直，不能屈伸，这就是转筋的症状。这种解释是错误的。转筋不一定发生在足背，所以《肘后备急方》中有治疗两臂、脚及胸胁转筋的方子。巢元方说：“寒气侵入足的三阴三阳经，就会脚部转筋；侵入手的三阴三阳经，就会手部筋脉转筋。随着寒气侵入哪条筋，那条筋就会转筋。所谓的‘转’，是由于邪冷之气击动筋脉使其移位转动。”
鸡屎白散方（《外台秘要》引《肘后方》说：如果是转筋入腹中转筋的方子，《仲景经心录》、《备急千金要方》、《集验方》、《必效方》均相同，出自霍乱转筋门。）
以上一味药研为散剂。取一方寸匕，用水六合，调和后温服。（《肘后方》说：用水六合，煮三沸，一次性服下，不要让病人知道。《外台秘要》相同。）
案语：《名医别录》说鸡屎白能治疗转筋并利小便，所以取用它。《素问》用鸡屎醴治疗鼓胀，通利大小便。验证起来，虽然《本草》说它微寒无毒，但泻下的力量相当猛烈，使用者应该知晓。况且霍乱转筋患者，多有津液虚燥的情况，恐怕不适合使用。
〔尤〕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。蜘蛛有毒，服用能使人腹泻。配合桂枝的辛温之性，进入阴分以驱逐寒湿之气。
《灵枢·经脉篇》说：足厥阴肝经所生的疾病中，有狐疝。葛洪《伤寒卒病论》说：狐疝，说它是“狐”，是因为疝气的变化隐现往来，不可预测，像狐狸一样。
陈言《三因极一病证方论》说：寒疝之气，注入阴囊中，名叫狐疝，也属于疝病。
蜘蛛散方
以上两味药，研为散剂。取八分之一匕，用温水送服，每日两次。也可以做成蜜丸。
〔程〕《名医别录》说：蜘蛛能治疗大人小儿的瘕积聚、疝气。它的性质有毒，服用能使人腹泻。得到桂枝的配合，引入厥阴肝经，从而治疗狐疝。
雷斅《炮炙论》说：使用蜘蛛时，不要用五色的，身上长有刺毛的，以及体形薄小的，这些都不堪使用。必须选用屋檐西南角结网，体型小屁股大，腹内有苍黄色脓液的才是真品。使用时去掉头足，研磨成膏，投入药中使用。现在的方法，如果像张仲景那样炒焦使用，完全无效。王晋三《古方选注》说：蜘蛛，性质阴厉，功效在于外壳，能泄下焦结气。桂枝，芳香入肝，专门疏散沉阴结疝。阴狐疝偏大偏小，时时上下，像狐狸出入无常。《素问·四时刺逆从论》说：厥阴脉滑，主狐疝气。推测张仲景的本意，也是认为阴狐疝气是阴邪挟带肝风，上下无常。治疗用蜘蛛，如同批却导窾（比喻顺势引导）。蜘蛛，本草说有毒，人们都害怕它。长邑县令林公讳瑛，是山海卫人，壮年调理身体时，方剂中使用它多年，烤熟后味道鲜美，常常取得疗效。本草说有毒，是因为南北产地不同罢了。
问：腹痛有虫的病人，脉象如何区别？老师说：腹中疼痛，脉象应当沉，如果反而洪大，所以是有蛔虫。
〔尤〕腹痛脉多伏匿，是阳气内闭。或者脉弦，是邪气入中。如果反而洪大，那就不是正气与外邪致病，而是蛔虫扰动导致的气机厥逆。然而必须兼有吐涎、心痛等症状，如下条所述，才毫无疑问。
蛔虫病，令人吐涎水，心痛发作有时，用毒药治疗无效的，用甘草粉蜜汤主治。
〔程〕巢元方说：蛔虫长五寸到一尺，发作时心腹作痛，口喜唾涎及清水，贯穿心脏就会死。《灵枢经》说：虫动则胃缓，胃缓则廉泉开，所以唾液流出，因此令人吐涎。心痛，并不是蛔虫贯穿心脏，而是蛔虫上入胃脘就痛，下入胃中就止，所以发作有时。如果用毒药不能制止，就用甘草粉蜜汤，顺着它的习性来治疗。
〔尤〕吐涎，吐出清水。心痛，痛如咬啮，时时上下移动。发作有时，是因为蛔虫吃饱了安静下来疼痛就立即停止，蛔虫饿了求食疼痛就复发。毒药，即锡粉、雷丸等杀虫药。毒药是用来折服它的，因为它厌恶毒药；甘草粉蜜汤是用来引诱它的，因为它喜欢甜味。
甘草（二两） 粉（一两重○赵开美本及诸本无“重”字） 蜜（四两）
以上三味药，用水三升，先煮甘草，取二升，去渣，加入粉、蜜，搅拌调和，煎如薄粥状。温服一升，病愈即停服。
案语：粉，各家注释认为是铅粉。尤怡说：引诱虫子吃尽甘味后，毒性随即发作，虫患乃除。这是医药的权变之计。这种解释很巧妙，但是古代单称“粉”的，通常是米粉。《释名》说：粉，是分的意思，研米使其分散。《说文解字》说：粉，敷面的东西。徐锴说：古代敷面也用米粉。《伤寒论》猪肤汤所用的白粉，也是米粉。所以万密斋《保命歌括》记载本方说：治疗虫咬心痛，毒药不止者，粉是用粳米粉。而《千金方》诸书，借用来治药毒，也不使用铅粉。大概此方并非杀虫之剂，不过是利用甘平安胃的药物，使蛔虫安定，应验在患者身上，才知道它的妙处。甘味是蛔虫喜欢的，《神异经》说：南方有甘蔗林，高百丈，围三尺八寸，节促多汁，甜如蜜，咀嚼其汁，令人润泽，可以节制蛔虫。人腹中的蛔虫，形状像蚯蚓，这是消化谷物的虫。多了伤人，少了谷物不消化。所以甘蔗能减多余补不足，凡是蔗类都是如此。这就是得甘味而平和的道理。
《千金方》解鸩毒及一切毒药不止烦闷方，就是本方。粉，用粱米粉。（《千金翼方》相同。《外台秘要》引《翼方》，作白粱粉。《圣济总录》用葛粉。《杨氏家藏方》用绿豆粉。《圣济总录》名为甘草饮。）
蛔厥病，应当吐蛔虫，让病人安静却又时不时心烦，这是因为脏寒，蛔虫上入膈间，所以心烦。一会儿又停止。进食后呕吐，又心烦的，是因为蛔虫闻到食物气味出来，其人应当自己吐出蛔虫。（案：柯琴《来苏集》改为“此非脏寒，蛔上入膈”，不对。）
〔尤〕蛔厥，是蛔虫扰动导致厥逆，伴有心痛、吐涎、手足冷。蛔虫动而上逆，就会吐蛔虫。蛔虫暂时安定又再动，病症也就静而复时烦。然而蛔虫之所以时而安时而上逆是什么原因呢？虫性喜温，脏寒则虫不安而上入膈。虫喜得食，脏虚则蛔复上而求食。所以用人参、姜、附之类，以益虚温胃为主，而以乌梅、椒、连之类，用苦酸辛的气味，来遏制其上入的趋势。
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（六两，炮） 川椒（四两，去汗） 桂枝（六两） 人参 黄柏（各六两）
以上十味药，分别捣筛，混合在一起。用苦酒（醋），浸泡乌梅一夜，去核，放在五升米下蒸，饭熟后捣成泥，与药末调和均匀，放入臼中，加蜜杵两千下，制成梧桐子大小的丸药。饭前饮服十丸，每日三次，逐渐增加到二十丸。禁食生冷、滑腻、臭秽等物。
〔金鉴〕李时珍说：乌梅味酸，黄连、黄柏味苦，桂枝、蜀椒、干姜、细辛味辛。因为蛔虫得酸则止，得苦则安，得甘则动于上，得辛则伏于下。然而胃气虚寒，用人参、附子来温补。吐亡津液，用当归来辛润。这样蛔厥就可以痊愈了。（详见《伤寒论辑义》厥阴篇。）
案语：此方主治胃虚而寒热错杂，导致蛔厥，所以用药也是寒热错杂之品。而有胃虚偏于寒而动蛔的，陶华用立安蛔理中汤主治。（即理中汤，加乌梅、花椒，出自《全生集》。）而有胃不虚偏于热而动蛔的，汪琥因制清中安蛔汤主治。（黄连、黄柏、枳实、乌梅、川椒，出自《伤寒辨注》。）这是各取本方的一半，而治疗其偏颇之处。对证施用，都有奇效。
The Master said: In cases of *Fu Jue* (foot paralysis/convulsion), the patient can only move forward but not backward. Acupuncture should be applied to the calf muscle, penetrating two cun. This is an injury to the Taiyang meridian. (Xu Lingtai and Shen Jinjian argue that "Fu" should be read as "Die" [fall], consistent with the chapter title, which is correct.)
[Shen] In such cases of *Fu Jue*, treatment must distinguish the affected meridians. The Foot-Yangming Stomach Meridian passes along the anterior-lateral aspect of the thigh; the Foot-Taiyang Bladder Meridian passes along the posterior-lateral aspect; and the Foot-Shaoyang Gallbladder Meridian passes along the middle lateral aspect. Falling leading to convulsive paralysis results in inability to walk. However, when treating this inability to walk, one must differentiate based on anterior-posterior movement. If the patient can only move forward but not backward, it indicates no injury to the Yangming Meridian. The inability to step backward indicates an injury to the Taiyang Meridian. One should needle the gastrocnemius (calf muscle), penetrating two cun. Although this area belongs to the Yangming pathway, it is also traversed by the Taiyang collaterals, where Qi converges with the Yangming at Feiyang (BL62) and Chengjin (BL57). Needling here harmonizes the Qi and Blood of both Taiyang and Yangming, removing stagnation, thereby restoring normal movement in both directions.
Commentary: Yang Xiong's *Fangyan* states: "Die is Jue." The *Shuowen Jiezi* states: "Jue means to fall stiffly." Cheng Zhi states: "Fu refers to the dorsum of the foot." *Fu Jue* belongs to the category of Bi-Jue (obstruction-convulsion); it is unlikely to refer merely to the dorsum of the foot. Jinjian states: "The symptoms and acupuncture methods are not detailed; there must be missing text unexplained." This view is close to the truth.
Patients who frequently experience swelling and tremors in their fingers and arms, accompanied by a heavy and numb sensation in the body, should be treated with Licorice and Veratrum Decoction (*Lilu Gancao Tang*).
[You] Damp-phlegm stagnating in the joints causes swelling; wind-pathogens invading and damaging the collaterals cause tremors. Swelling and tremors in the fingers and arms, along with a heavy and numb body, indicate Wind-Phlegm lodged in the diaphragm, attacking the limbs. As Chen Wuyue stated: When phlegm-saliva remains above and below the chest and diaphragm, it generates various diseases, causing牵引ing pain in the hands, feet, neck, and back, moving unpredictably. Veratrum induces vomiting to expel Wind-Phlegm from the upper diaphragm; Licorice also has emetic properties. Although the original formula is lost, it is broadly considered an emetic preparation. (Li's commentary)
Commentary: Cheng Zhi states: "Symptoms are unspecified, and the formula is missing; thus, no explanation is given." Jinjian agrees. While valid, You cites Li Dongyuan’s perspective, which makes logical sense, so it is retained tentatively.
Licorice and Veratrum Decoction Formula ([Original Note]: Not seen.)
In cases of *Zhuan Jin* (muscle cramp/spasm), the patient’s arms and legs become rigid and straight, with pulses running vertically up and down and slightly wiry. If the spasm extends into the abdomen, Chicken Droppings White Powder (*Ji Shi Bai San*) is indicated. (This passage is recorded at the end of the Huoluan [Stomach-Intestine Turmoil] chapter in the *Mai Jing*.)
[Shen] This is disharmony between Wood and Earth, with Wind-Pathogen causing spasms. Wind attacks the Spleen and Stomach, combining with Dampness, affecting both interior and exterior. If Wind-Dampness dominates the channels and surface, the arms and legs become rigid and straight, with vertical, slightly wiry pulses. The classics state: "All sudden rigidity belongs to Wind," which aligns with the principle of Wind causing diseases of the extremities. Alternatively, if Middle Qi is deficient and Liver-Wood evil rebels internally, attacking the zang organs directly, spasms extend into the abdomen. One should use Chicken Droppings White to descend Qi, resolve accumulation, dispel Wind, and calm the Spleen. This is not a formula for treating rigid arms and legs.
[Wei] "Straight up and down" lacks any flexibility, similar to the meaning in Jingbing (Spasm Disease) regarding "straight up and down."
Commentary: Jinjian claims: "Bi" is interchangeable with "Bei" [back] in ancient texts. "Arm and leg straight" refers to the rigid dorsum pedis unable to flex or extend, constituting Zhuan Jin. This is incorrect. Spasms do not necessarily occur in the dorsum pedis; thus, *Zhou Hou Bei Ji Fang* contains formulas for spasms in both arms, legs, chest, and hypochondrium. Chao Yuanyuan states: "Cold entering the Three Yin and Three Yang meridians of the foot causes foot spasms; entering the hand meridians causes hand spasms. Wherever cold enters, the corresponding tendon spasms. 'Spasm' occurs because pathogenic cold qi strikes the tendons, causing them to twist and shift."
Chicken Droppings White Powder Formula (*Wai Tai Mi Yao* cites *Zhou Hou*: For spasms extending into the abdomen... *Zhongjing Jing Xin Lu*, *Bei Ji Qian Jin Yao Fang*, *Ji Yan Fang*, *Bi Xiao Fang* are identical, originating from the Huoluan Zhuan Jin section.)
Chicken Droppings White (White part of feces)
Process one ingredient into powder. Take one fang-cun bi [approx. 5-10g], mix with six li [approx. 1200ml] of water, stir, and take warm. (*Zhou Hou* says: Boil six li of water for three boils, take all at once, without letting the patient know. *Wai Tai* agrees.)
Commentary: *Bie Lu* states Chicken Droppings White treats spasms and promotes urination, hence its use. *Su Wen* uses Chicken Droppings Wine to treat Gu Zhang [Drum Distension], promoting bowel and bladder movements. Verification shows that although *Ben Cao* describes it as slightly cold and non-toxic, its purgative power is quite harsh; users should be aware. Moreover, patients with Huoluan spasms often have deficient and dry fluids, making this unsuitable.
Yin Hu Shan Qi [Yin Fox Hernia] presents with asymmetrical size changes in the testicles, moving up and down intermittently. Spider Powder (*Zhi Zhu San*) is indicated.
[You] Yin Hu Shan Qi results from Cold-Damp invading the yin region, affecting the testicles. They may differ in size left or right, or move up and down unpredictably, hence named "Fox Hernia." Spiders are toxic; ingestion causes diarrhea. Combined with Cinnamon Twig’s acrid-warm nature, it enters the yin to drive out Cold-Damp.
*Ling Shu · Jing Mai Pian* states: Diseases generated by the Foot-Jueyin Liver Meridian include Fox Hernia. Ge Hong’s *Shang Han Zhi Ge* states: "Fox Hernia" implies the hernia’s changes are hidden, appearing and disappearing unpredictably, like a fox.
Chen Yi’s *San Yin Fang* states: Cold Hernia Qi injecting into the scrotum is named Fox Hernia, belonging to hernia diseases.
Spider Powder Formula
Spider (14 pieces, roasted until charred) Cinnamon Twig (Ban liang / approx. 7.5g)
Process two ingredients into powder. Take one-eighth of a fang-cun bi, mix with water and take orally, twice daily. Honey pills are also acceptable.
[Cheng] *Bie Lu* states: Spiders treat abdominal masses and hernias in adults and children. It is toxic and induces diarrhea. With Cinnamon Twig, it guides the action into the Jueyin Liver Meridian to treat Fox Hernia.
Lei Xiao’s *Pao Zhi Lun* states: Do not use five-colored spiders, those with prickly hairs, or small/thin ones. Use only those found on the southwest side of houses, with webs, small bodies, large hindquarters, and containing pale-yellow pus inside. Remove head and feet, grind into paste, and add to medicine. Modern methods, such as roasting like Zhongjing, are ineffective. Wang Jinshan’s *Gu Fang Xuan Zhu* states: Spiders are yin and harsh; efficacy lies in the shell, resolving lower jiao knotting. Cinnamon Twig is aromatic, enters the Liver, and disperses deep yin knot-hernias. Yin Fox Hernia varies in size and moves up/down unpredictably. *Si Shi Ni Cong Lun* states: Jueyin pulse slippery indicates Fox Hernia Qi. Inferring Zhongjing’s intent, Yin Fox Hernia is Yin Evil carrying Liver Wind, moving up and down unpredictably. Treatment uses Spiders, akin to "guiding through the gap." Spiders are toxic, feared by many. Lin Ying, magistrate of Changyi, used them for years in his youth for regulation; roasted, they taste good and work well. Toxicity varies by north/south origin.
Question: How to differentiate the pulse in abdominal pain caused by parasites? The Master said: Abdominal pain usually presents with a sunken pulse. If it is instead flooding and large, it indicates Roundworms.
[You] Abdominal pain pulses are often hidden due to internal closure of Yang Qi. Or wiry, indicating pathogen entering the center. If flooding and large, it is not Zheng Qi fighting external pathogens, but Qi reversal caused by Roundworm agitation. However, symptoms like salivation and heart pain must accompany it, as described in the next passage, to be certain.
Roundworm disease causes salivation, intermittent heart pain, and resistance to toxic drugs. Licorice, Rice Flour, and Honey Decoction (*Gancao Fenmi Tang*) is indicated.
[Cheng] Chao Yuanyuan states: Roundworms are 5 cun to 1 chi long. Upon activation, they cause heart and abdominal pain, excessive saliva/clear fluid. Penetrating the heart leads to death. *Ling Shu* states: Worm movement relaxes the Stomach; relaxed Stomach opens Lianquan, causing salivation, hence the spitting. Heart pain is not worms piercing the heart, but worms entering the stomach cavity causing pain; when they descend, pain stops, hence intermittent occurrence. If toxic drugs fail, use Licorice, Rice Flour, and Honey Decoction to treat according to their nature.
[You] Salivation refers to clear fluid. Heart pain feels like biting/nipping, moving up and down intermittently. Intermittent occurrence happens because worms stop moving when full (pain stops) and move when hungry seeking food (pain recurs). "Toxic drugs" refer to insecticides like Tin Powder or Polyporus. Toxic drugs attack via aversion; Licorice, Rice Flour, and Honey Decoction attracts via preference for sweetness.
Licorice, Rice Flour, and Honey Decoction Formula
Licorice Root (Liang / approx. 30g) Rice Flour (Liang / approx. 30g [Zhao Kai Mei edition omits 'weight']) Honey (Liang / approx. 60g)
Process three ingredients. Add three sheng [approx. 600ml] of water. First decoct Licorice, reduce to two sheng. Strain, add Rice Flour and Honey, stir well. Simmer until thin porridge consistency. Take one sheng warm. Stop when cured.
Commentary: "Fen" [Flour/Powder] is annotated by commentators as Lead Carbonate. You Yi suggests: Attracting worms to eat sweet flavor, then releasing toxicity to eliminate worms. This is a clever medical stratagem. However, ancient single-use "Fen" usually referred to Rice Flour. *Shiming* defines Fen as separating rice grains. *Shuowen* defines it as face powder. Xu Kai notes ancient face powder was rice flour. *Shanghan Lun*’s Pig Skin Decoction uses white fen [rice flour]. Wan Mi’s *Bao Ming Ge Kuo* records this formula using Glutinous Rice Flour for worm-biting heart pain resistant to toxins. *Qian Jin Fang* uses it for drug poisoning, never Lead Carbonate. This formula is not an insecticide but uses sweet, neutral, Stomach-calming herbs to pacify worms. Sweetness pleases worms. *Shen Yi Jing* mentions southern sugarcane forests, high and juicy, sweet as honey, which can regulate worms. Worms in the abdomen resemble earthworms, digesting grain. Too many harm; too few hinder digestion. Sugarcane balances excess and deficiency. Hence, sweetness brings harmony.
*Qian Jin Fang*’s formula for Aconite poison and all drug poisoning with restlessness is this same formula. Fen is Sorghum Rice Flour (*Qian Jin Yi Fang* agrees. *Wai Tai* cites *Yi Fang* as White Sorghum Flour. *Sheng Ji Zong Lu* uses Taro Starch. *Yang Shi Jia Cang Fang* uses Mung Bean Starch. *Sheng Ji* names it Licorice Drink.)
Hui Jue [Roundworm Reversal] involves vomiting roundworms. The patient is quiet but occasionally irritable. This is due to Cold in the Zang organs, causing worms to ascend to the Diaphragm, resulting in irritability. After a moment, it stops. Vomiting after eating, followed by irritability, occurs because worms emerge smelling food odor; the patient will likely vomit roundworms. (Commentary: Ke Qin’s *Lai Su Ji* changes this to "Not Zang Cold, worms ascending diaphragm," which is incorrect.)
[You] Hui Jue is reversal caused by worm agitation, with heart pain, salivation, and cold hands/feet. Agitated worms reverse upward, causing vomiting. Temporary peace followed by agitation causes alternating quietness and irritability. Why do worms alternate between peace and ascent? Worms prefer warmth; Zang Cold makes them uneasy, ascending to the Diaphragm. Worms seek food; Zang Deficiency causes them to ascend seeking nourishment. Thus, use Ginseng, Ginger, and Aconite to tonify deficiency and warm the Stomach. Use Vinegar-Soaked Plum, Sichuan Pepper, and Coptis to use bitter, sour, and acrid flavors to restrain their upward movement.
Hui Jue is treated with Wumei Pill (*Wumei Wan*).
Wumei Pill Formula
Vinegar-Soaked Plum (300 pieces) Fine Seedless Ginger (Liang / approx. 90g) Dried Ginger (Liang / approx. 150g) Coptis Rhizome (Jin / approx. 250g) Angelica Sinensis (Liang / approx. 60g) Prepared Aconite Root (Liang / approx. 90g, processed) Sichuan Pepper (Liang / approx. 60g, dehydrated) Cinnamon Twig (Liang / approx. 90g) Ginseng Phellodendron Bark (Each Liang / approx. 90g)
Process ten ingredients separately, sift, and mix. Soak Vinegar-Soaked Plums in vinegar overnight, remove pits, steam over five sheng of rice until cooked, mash into paste. Mix with powdered herbs. Place in mortar, add honey, pound 2000 times. Form pills the size of wu zi [walnut seeds]. Take 10 pills before meals with water, three times daily. Gradually increase to 20 pills. Avoid raw, cold, slippery, and foul-smelling foods.
[Jinjian] Li Shizhen states: Vinegar-Soaked Plum is sour; Coptis and Phellodendron are bitter; Cinnamon, Sichuan Pepper, Dried Ginger, and Fine Seedless Ginger are acrid. Worms stop with sour, settle with bitter, move upward with sweet, and subside downward with acrid. Since Stomach Qi is deficient and cold, Ginseng and Aconite warm and tonify. For fluid loss from vomiting, Angelica moistens with acridity. Thus, Hui Jue resolves. (See detailed discussion in *Shanghan Lun Ji Yi*, Jueyin Chapter.)
Commentary: This formula treats Hui Jue caused by Stomach Deficiency with mixed Cold and Heat, using mixed Cold/Heat herbs. For Stomach Deficiency leaning toward Cold agitating worms, Tao Hua used Li An Wei Li Zhong Tang (Li Zhong Tang plus Vinegar-Soaked Plum and Sichuan Pepper, from *Quan Sheng Ji*). For Stomach Excess leaning toward Heat agitating worms, Wang Hu created Qing Zhong An Hui Tang (Coptis, Phellodendron, Immature Bitter Orange, Vinegar-Soaked Plum, Sichuan Pepper, from *Shanghan Bian Zhu*). Each takes half the original formula to treat specific biases. Applied correctly, both yield remarkable effects.