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The Master said: In cases of *Fu Jue* (falling and stumbling disorder), the patient can only move forward but cannot step backward. This is due to injury of the Taiyang Meridian caused by acupuncture insertion into the calf muscles at a depth of two cun.

"Fu" refers to squatting, and "Jue" refers to tripping or falling. *Fu Jue* implies that while standing, one can maintain balance, but if one squats down, they will trip and fall, collapsing forward. This differs significantly from other types of "Jue" mentioned in various meridians.

Old annotations incorrectly cite *Wei Jue* (flaccid paralysis with cold limbs) and *Huai Jue* (ankle inversion). The phrase "the patient can move forward but not backward" explains the cause of *Fu Jue*, while "acupuncture inserted two cun deep" explains the mechanism behind this inability to step backward. "Forward and backward" refer to parts of the body capable of flexion and extension. "Forward" includes areas like the heel and Huantiao (GB30), where bending occurs towards the front; "backward" includes the popliteal fossa and the back of the neck, where bending occurs towards the rear. Thus, the cause of falling is that the heel and Huantiao allow forward flexion, but the popliteal fossa and neck do not allow backward flexion. Therefore, when attempting to squat, the knee becomes stiff and straight, allowing only forward collapse, leading to a forward fall. This happens because the Taiyang Meridian runs from the back of the neck, over the back, down the calf, and wraps around the posterior lateral aspect of the foot. When Taiyang Qi is unobstructed, the muscles are soft and capable of backward flexion. The current inability to flex backward indicates that acupuncture points in the calf muscles were needled too deeply (two cun), damaging the meridian blood and Qi, resulting in stiffness and *Fu Jue*. In such cases, formulas such as Shaoyao Fuzi Tang (Peony and Aconite Decoction) or Shaoyao Gancao Tang (Peony and Licorice Decoction) can be modified and applied for treatment. Since backward flexion is impaired, the injury is identified in the posterior Taiyang Meridian; since the fall originates from the lower body, it is known that the muscle tissue of the Taiyang Meridian was damaged by needling. How meticulous is Zhang Zhongjing's diagnostic method! Popular interpretations mistakenly claim that "inserting the needle two cun deep" is a treatment for *Fu Jue*. If this were true, following Zhang Zhongjing's textual style, it should read: "This is an injury to the Taiyang Meridian; [one should] needle..." Moreover, according to Wang Bing's commentary on acupuncture and the *Zhenjiu Dacheng* (Great Compendium of Acupuncture and Moxibustion), except for a few points like Huantiao (GB30) and Chengfu (BL36) which may reach a depth of one cun, no other points are needled to a depth of two cun. Treating this as a general rule would mislead countless people. The white flesh of the calf is called "Shuan". For points located in the Shuan region, such as Weizhong (BL40), Chengshan (BL57), and Feiyang (BL58), it is evident that deep needling is strictly prohibited.

When a patient frequently experiences swelling and tremors in the fingers and arms, accompanied by involuntary trembling of the body, this condition is treated with Lili Gancao Tang (Veratrum and Licorice Decoction). (Formula missing)

This represents a pattern where Qi in the upper extremities of the meridians is deficient, while damp-heat fire from the Stomach penetrates outward. Due to the deficiency of Qi in the upper meridians, the fingers and arms swell. Because damp-heat fire penetrates outward, the flow of Qi becomes turbulent, causing spontaneous movement. However, for an accurate diagnosis, the patient must also exhibit migratory and urgent trembling of the body. Using Veratrum (*Lili*), which is extremely cold and induces vomiting, as the principal herb, supported by Licorice (*Gancao*), which is sweet and floating, allows the cold nature to clear heat and the vomiting action to resolve dampness. Furthermore, inducing vomiting lifts the Qi to fill the exterior and upper body, thereby curing the swelling and trembling caused by meridian deficiency.

In cases of *Zhuan Jin* (muscle cramp/tetany), the patient's arms and legs become rigid and straight, the pulse travels up and down, and is slightly wiry. If the cramps extend into the abdomen, Jishi Bai San (Chicken Droppings White Powder) is indicated.

**Jishi Bai San Formula**: Chicken droppings white part.
Process the single ingredient into a fine powder. Take one *fangcun bi* (a square-inch measure), mix with six *he* of water, and take warm.

The gentle aspect of Yang nourishes the sinews. Yang deficiency causes the sinews to twist, becoming hard and painful. Since Yang tends to reside in the upper body, there is often less Yang Qi in the feet; thus, *Zhuan Jin* affects the legs more than the arms. The pulse traveling up and down indicates that Qi deficiency prevents external expansion, so the pulse moves internally from Cun to Chi. Qi decline makes the pulse faint (*Wei*), and Qi depletion makes it wiry (*Xian*); hence, the pulse traveling up and down is both faint and wiry. The abdomen is the residence of the intestines and stomach, and the root of *Han Qi* (vigorous Wei Qi). If cramps extend into the abdomen, it indicates severe Qi deficiency. In the Bagua, the chicken corresponds to Xun (Wind), situated in the Southeast, embodying the generating Qi facing the light. Chicken droppings promote the flow of Qi in the intestines and stomach, and its white part is particularly transformed from Yang Qi. Using it to treat cramps extending into the abdomen utilizes its ability to unblock the vigorous Qi of the gut, thereby nourishing the sinews with gentleness.

*Yin Hu Shan* (Yin Fox Hernia) is characterized by asymmetry in size (one side larger than the other) and intermittent upward and downward movement of the testicles. It is treated with Zhizhu San (Spider Powder).

**Zhizhu San Formula**: Spider (14 pieces, roasted until charred), Guizhi (Cinnamon Twig, half liang).
Grind the two ingredients into a powder. Take one-eighth of a *bi*, mixed with water for oral administration, twice daily. Honey pills are also acceptable.

Hernias are detailed under Cold Hernia. *Hu Shan* (Fox Hernia) describes its unpredictable appearance and disappearance, resembling a fox, corresponding to the asymmetry and movement described below. "Yin Hu Shan" specifically refers to the testicles of the external genitalia, distinguishing it from hernias of the five Zang organs. The Kidney is a Water organ, valuing Yang Qi most, yet prone to attracting Yin-Cold. When Yang is deficient, Cold Qi invades, causing enlargement; when Yang is sufficient, it controls itself, resulting in normal size. Since Yang governs lifting, Qi deficiency fails to support the testicles, causing them to retract into the lower abdomen when lying down and descend into the scrotum when standing. Spiders have large abdomens and are specific herbs for retracting testicles into the lower abdomen. Their nature aids in lifting and binding. Combined with Guizhi (Cinnamon Twig), which is acrid, warm, and generates Qi, the formula warms and tonifies the Yang Shen at Guan Yuan and Qi Hai, expels pathogenic Cold, and achieves lifting and contracting effects to firm up laxity. Thus, *Yin Hu Shan* will surely heal.

Question: How can one differentiate abdominal pain caused by parasites via pulse diagnosis?
Master said: In abdominal pain, the pulse should be Deep (*Chen*) or Wiry (*Xian*). If it is instead Surging and Large (*Hong Da*), it indicates Ascaris roundworms.

This discusses the pulse pattern of parasitic disease. Abdominal pain has many causes. If caused by parasites, how should the pulse differ? The Master states that Deep indicates interior pathology; thus, abdominal pain should present with a Deep pulse. Wiry indicates acute pain; thus, abdominal pain should present with a Deep and Wiry pulse. If the pulse is neither Deep nor Wiry but instead Surging and Large, it indicates chaotic Qi, confirming the presence of parasites disturbing the Qi and causing pain, differing from pulses seen in Wind-Cold or food stagnation.

Ascaris infection causes salivation, heart pain, intermittent attacks, and resistance to toxic drugs. It is treated with Gancao Fenmi Tang (Licorice, Flour, and Honey Decoction).

**Gancao Fenmi Tang Formula**: Gancao (Licorice Root, 2 liang), Fen (Flour/Lead White, 1 liang), Mi (Honey, 4 liang).
Boil the three ingredients in three sheng of water. First decoct Licorice to obtain two sheng, strain, then add Flour and Honey. Stir and simmer until resembling thin porridge. Take one sheng warm. Discontinue upon recovery.

These next two sections discuss treatments for parasitic diseases. The subsequent section addresses Cold in the Zang organs, where Ascaris migrates upward due to cold, causing irritability and cold limbs; warming resolves this, hence Wumei Wan (Mume Pill) uses pungent, sour, bitter, and hot flavors to subdue the worms. This specific case involves Ascaris generated by dietary conflict, characterized by excessive worm burden. Excessive worms loosen the stomach ties and open the Lianquan, causing salivation. Worms disturbing the epigastrium (near the heart area) cause heart-like pain. Worms tire after activity and rest, causing intermittent attacks. Toxic drugs are ineffective as worms do not eat them; thus, removing the worms is necessary. Hufen (Lead White) is heavy and insecticidal. Boiled with Licorice and Honey, it exploits the worms' preference for sweetness. The worms ingest the heavy flour, become weighed down, and die, curing the disease. Since there is no Zang Cold, no other herbs are needed besides the insecticide.

*Hui Jue* (Roundworm Syncope) presents with vomiting of roundworms. The patient remains quiet but becomes spontaneously irritable due to Zang Cold causing roundworms to ascend to the Diaphragm. Irritability subsides after a moment. Eating triggers vomiting and renewed irritability because the smell of food attracts the worms upward, leading to self-vomiting of worms. *Hui Jue* is treated with Wumei Wan (Mume Pill).

**Wumei Wan Formula**: Wumei (Mume Fruit, 300 pieces), Renshen (Ginseng, 6 liang), Danggui (Angelica Sinensis, 4 liang), Guizhi (Cinnamon Twig, 6 liang), Fuzi (Prepared Aconite Root, 6 liang, processed), Ganjiang (Dried Ginger, 10 liang), Xixin (Asarum, 6 liang), Chuanjiao (Sichuan Pepper, 4 liang, perspiration removed), Huanglian (Coptis Rhizome, 16 liang), Huangbai (Phellodendron Bark, 6 liang).
Pulverize the ten ingredients separately and mix. Soak Wumei in vinegar overnight, remove pits, steam, and mash with cooked rice. Mix with the powdered herbs. Pounded with honey in a mortar two thousand times to form pills the size of tung seeds. Take ten pills before meals with water, three times daily, gradually increasing to twenty pills. Avoid raw, cold, slippery, and foul-smelling foods.

Commentary on the formula's intent is found in the Jueyin chapter of the *Shanghan Lun*.