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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.