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。
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.