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。
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.