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。
王先生说：小儿长期患有疳疾（一种因脾胃虚弱、营养不良导致的慢性消耗性疾病），身体虚弱，长时间无法进食，患病时间很久，其他症状消退后，只剩下天柱骨（指颈项部脊柱）倒伏。医生不认识这种病症，称之为五软候（指头项、口、手、足、肌肉等部位软弱无力的五种证候）。必须服用金灵散、生筋散。《形证论》中的歌诀说：天柱刚出现倒伏迹象时说道难以医治，想来此病并非源于心脾，如果患病起初是因为吐泻，没有调理好气机导致身体羸弱，又患上伤寒且无汗脉象（《凤髓经》中这一句写作：却被伤寒无浮脉），定应使用妙药治疗已经太迟了，如果没有这些情况却突然发生此患，再加上不辨别四肢是否肥胖，身体柔软难耐头部沉重如石，面色红嘴唇赤脸颊绯红，此病多因肾热受伤，后来因热病相随（这两句在《凤髓经》中写作：此患只应伤胆热，后来伏热又相随）。肝受热风侵袭导致天柱骨倒伏，只需将凉性药物给予维持，贴敷处需用性热的药物才能使筋脉舒缓，立刻见到温和效果请不要怀疑，如果是吐泻导致的项部软弱只需调气，如果是伤寒导致的柱倒则不必医治。这或者是伤寒或者是吐泻或者是腹泻，趁着正气虚弱邪毒透入肝脉，热邪所侵，致使筋脉松弛变长，或者手足软弱不能抬起，或者颈项软弱不能抬起，如果有上述前证，就必须使用凉膈散，如果是吐泻，则先调理胃气，贴敷颈部并服用凉肝胆的药物，不可太热，也恐怕过冷。
金灵散
以上药材，用白僵蚕不拘多少，选取直直的，去掉丝线炒制，研为粉末。每次服用半钱到一钱，用薄荷酒调服，一天服用三次。更需要用生筋散贴敷。
生筋散
木鳖子（三个） 蓖麻子（三十个）
以上各取肉同研。每次用一钱左右，用唾液调匀贴敷，急忙抱住擦拭颈部使其发热，进行贴敷。
四十八候贴项药方
川乌头 白芷 地龙 五灵脂 赤小豆（各等分）
以上研末，用生姜自然汁与酒调和贴在项上。再服用竹茹散。
竹茹散
菊花（三钱） 黄芩 人参（各一钱） 大黄（半两） 甘草（二钱）
以上研为粉末，用竹叶煎汤送服。
三十六种贴项药方
草乌头 赤小豆（各等分）
以上研为粉末，姜汁调和摊在帛子上，贴敷过夜，项部即可立起。
贴头起项膏（吉氏） 治疗小儿肝热胆冷，头项软弱倒伏。
川乌（末） 肉桂（末） 芸苔子 天南星 蓖麻子（各一钱） 黄丹（炒，一钱匕）
以上取大蒜一头，煨熟去皮，在乳钵内研和，药细，每次用一钱，加入米醋和匀，贴敷项上一天左右。
野狼毒丸（吉氏） 治疗小儿胆热肝风，天柱倒折，宜服用此药，更用前面的起头贴项药。
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）
以上研为细末，法酒煮糊制成丸药，如小豆大小。每次服用七丸至十五丸，用黑豆薄荷汤加一滴酒，吞服。
Mr. Wang stated: When a child has suffered from malnutrition (a chronic consumptive disease caused by spleen and stomach weakness and nutritional deficiency) for a long time, the body becomes weak, and food intake is prolongedly insufficient. After the illness has persisted for a long period and other symptoms have subsided, only the inversion of the Tianzhu bone (referring to the cervical spine) remains. Physicians unfamiliar with this condition may misdiagnose it as the "Five Softnesses" syndrome (a set of five manifestations characterized by flaccidity in 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* (Treatise on Manifestations and Syndromes) states: When the Tianzhu bone first 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 emaciation, compounded by contracting Cold Damage (Shanghan) with no sweat and a specific pulse pattern (in *Fengsui Jing*, this line reads: "yet Cold Damage presents without a floating pulse"), one should realize that using effective medicine at this stage is already too late. If this condition arises suddenly without these preceding factors, and accompanied by an inability to distinguish whether the limbs are obese, the body is soft and unbearable while the head feels heavy as stone, the face is red, lips are crimson, and cheeks are flushed, this disease is mostly due to injury from Kidney Heat, followed by accompanying heat pathogens (these two lines in *Fengsui Jing* read: "This affliction should only injure Gallbladder Heat, followed by latent heat accompanying"). When Liver Heat-Wind invades causing the Tianzhu bone to invert, cool-natured medicines should be administered to maintain balance. For topical application, hot-natured substances are required to relax the tendons, bringing immediate warmth; do not doubt this. If neck flaccidity results from vomiting/diarrhea, only regulate Qi; if it results from Cold Damage, treatment may not be strictly necessary. This may stem from Cold Damage, vomiting, or diarrhea; exploiting deficiency, evil toxins penetrate the Liver Meridian, and heat pathogens invade, causing tendons to become loose and elongated. This may manifest as flaccid limbs unable to lift, or a neck unable to hold up. If such preceding signs exist, Liangge San (Cool the Chest Powder) must be used. If vomiting/diarrhea occurs, first regulate Stomach Qi, apply patches to the neck, and administer medicines that cool the Liver and Gallbladder; they must not be too hot, nor excessively cold.
Jinling San (Golden Spirit Powder)
Take Bai Jiangcan (Bombyx Batryticatus, 僵蚕), any quantity, selecting straight ones, remove silk threads, stir-fry, and grind into powder. Take 0.5–1 qian per dose, mixed with Bohe Jiu (Mint Wine), three times daily. Additionally, apply Shengjin San (Tendon-Generating Powder).
Shengjin San (Tendon-Generating Powder)
Mu Bie Zi (Strychnos Semen, 木鳖子) (3 seeds); Bi Ma Zi (Ricini Semen, 蓖麻子) (30 seeds).
Extract the flesh from both and grind together. Use approximately 1 qian each time, mix with saliva, and apply as a patch. Hold tightly and rub the neck until warm before applying.
Forty-Eight Manifestations Neck-Patching Formula
Chuan Wu Tou (Aconiti Lateralis Radix Praeparata, 川乌头); Bai Zhi (Angelicae Dahuricae Radix, 白芷); Di Long (Pheretima, 地龙); Wu Ling Zhi (Trogopteri Dung, 五灵脂); Chi Xiao Dou (Adzuki Bean, 赤小豆) (equal parts).
Grind into powder, mix with fresh Ginger Juice and wine, and apply to the neck. Also take Zhuru San (Bamboo Shavings Powder).
Zhuru San (Bamboo Shavings Powder)
Ju Hua (Dendranthema Flos, 菊花) (3 qian); Huang Qin (Scutellariae Radix, 黄芩); Ren Shen (Ginseng Radix et Rhizoma, 人参) (each 1 qian); Da Huang (Rhei Radix et Rhizoma, 大黄) (0.5 liang); Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草) (2 qian).
Grind into powder, decoct Zhu Ye (Bambusae Folium, 竹叶) in water, and take the powder with the decoction.
Thirty-Six Types of Neck-Patching Formula
Cao Wu Tou (Aconiti Kusnezoffii Radix, 草乌头); Chi Xiao Dou (Adzuki Bean, 赤小豆) (equal parts).
Grind into powder, mix with Ginger Juice, spread on cloth, apply overnight, and the neck will straighten.
Paste to Raise Head and Neck (from Ji's Collection) Treats pediatric Liver Heat and Gallbladder Cold, resulting in flaccid and inverted head and neck.
Chuan Wu (Aconiti Lateralis Radix Praeparata, 川乌) (powder); Rou Gui (Cinnamomi Cortex, 肉桂) (powder); Yun Tai Zi (Brassicae Napus Seed, 芸苔子); Tian Nan Xing (Arisaematis Rhizoma, 天南星); Bi Ma Zi (Ricini Semen, 蓖麻子) (each 1 qian); Huang Dan (Lithargyri, 黄丹) (stir-fried, 1 qian-bi).
Take one clove of garlic, roast until cooked, peel, and grind in a mortar with the fine herbs. Use 1 qian per application, mix with rice vinegar, and apply to the neck for about one day.
Yelangdu Wan (Wolfbane Pill) (from Ji's Collection) Treats pediatric Gallbladder Heat and Liver Wind, causing inversion and collapse of the Tianzhu bone. It is advisable to take this medicine and also use the aforementioned neck-pasting formula.
Ye Lang Du (Radix Stellerae Chamaejasme, 野狼毒) (soaked in wine, dried); Bai Fu Zi (Typhonii Rhizoma, 白附子); Da Fu Zi (Aconiti Lateralis Radix Praeparata, 大附子) (tip); Tian Ma (Gastrodiae Rhizoma, 天麻); Fang Feng (Saposhnikoviae Radix, 防风); Qiang Huo (Notopterygii Rhizoma et Radix, 羌活) (each 1 fen); Zhu Sha (Cinnabaris, 朱砂); Di Long (Pheretima, 地龙) (cleaned of soil, each 1 qian); She Xiang (Moschus, 麝香) (half zi).
Grind into fine powder, make pills using fermented wine paste, size of small beans. Take 7–15 pills per dose, swallow with Black Bean and Mint Decoction plus one drop of wine.