（皆系筋病故汇为篇论一首脉证一条方五首）
师曰。病趺蹶。其人但能前。不能却。刺 入二寸。此太阳经伤也。
〔补注〕 名承筋。在上股起肉处。脚跟上七寸。 之中陷者是。法不可刺。或刺转
深。遂伤其经。以致能前而不能却。此仲景自注已详。
病患常以手指臂肿动。其人身体 者。藜芦甘草汤主之。
〔补注〕凡动皆属风。而肿属湿。故肝木主风。血虚则风生。气虚则湿袭。手臂肿且
动。知其血不足之养筋。阳亦不能以自固。而身体之 。势不得已矣。岂非有痰
气在筋节间乎。夫见于外者。未有不因于内者也。窥仲景有吐之法。惜乎方缺焉耳。
转筋之为病。其人臂脚直。脉上下行。微弦。转筋入腹者。鸡屎白散主之。
鸡屎白散
鸡屎白一味为散。取方寸匕。以水六合。和温服。
〔补注〕转筋者。脾胃土衰。肝木自盛。风火燥烁于筋。则筋挛而痛。故风气甚急。则
肝血失养。筋失其柔和之性。乖其屈伸之节。故臂脚直。至脉直上下行者。乃督
冲之为病。何者。督脉循阴器。阴器者。宗筋所主也。冲脉为肝之幕。肝木多风。则
冲亦病矣。若微弦则转入于内。为病较重。因以鸡屎白投之。其肝邪外出耳。
阴狐疝气者。偏有小大。时时上下。蜘蛛散主之。
蜘蛛散方
蜘蛛（十四枚熬焦） 桂枝（半两）
二味为散。取八分一匕饮和服。日再服。蜜丸亦可。
〔衍义〕厥阴之筋病也。狐、阴兽。善变化而藏。睾丸上下。有若狐之出入无时也。足
厥阴之筋。上循阴股。结于阴器。筋结。故偏有大小。气病。故时时上下也。蜘蛛布
网取物。其丝右绕。从外而内。大风不坏。得干金旋转之义。故主治风木之妖狐。
配桂枝以宣散厥阴之气结。
问曰。病腹痛有虫。其脉何以别之。师曰。腹中痛。其脉当沉。若弦。反洪大。故有蛔虫。
〔衍义〕腹痛。中焦湿土之为病也。腹为阴。痛为阴类。故脉当沉。若脉弦。是见厥阴
风木之象矣。反洪大者。风木盛而生火。风木之邪。贼伤中土。湿热不攘则生虫。
故曰诸虫皆生于风也。东方生风。在地为木。在体为筋。在脏为肝。风伤筋。此因
风伤而生虫。故虫乃厥阴肝筋之为病也。是以伤寒蛔厥。在厥阴篇内。此章蛔痛。列于筋病篇中。
蛔虫之为病。令人吐涎。心痛。发作有时。毒药不止。甘草粉蜜汤主之。
甘草粉蜜汤方
甘草（二两） 胡粉（一两） 白蜜（四两）
上三味。以水三升。先煮甘草。取二升去滓。内粉蜜搅令和。煎如薄粥。温服一升。瘥即止。
〔衍义〕夫饮食入胃。胃中有热。则虫动。虫动则胃缓。胃缓则廉泉开。故吐涎。蛔上
入膈。故心痛。蛔闻食臭出。得饮则安。故发作有时也。毒药不止者。蛔恶之不食
也。蛔喜甘。故用甘草蜜之甘。随所欲而攻之。胡粉甘寒。主杀三虫。蛔得甘则头
向上而喜食。食之即死。此反佐以取之也。
蛔厥者。当吐蛔。今病者静而复时烦。此为脏寒。蛔上入膈。故烦。须臾复止。得食而
呕。又烦者。蛔闻臭出。其人当自吐蛔。
〔衍义〕蛔厥者。病蛔而手足厥冷也。蛔厥者当吐蛔。病者静而复时烦。此因肝脏
寒而蛔上入膈。故烦。盖言蛔生于肝。因脏寒而上入于膈也。须臾复止。得食而
呕。又烦者。此蛔闻食臭而出于胃。故其人常自吐蛔。盖言蛔因风而生于肝。脏
寒则上入膈。闻食臭则出于胃也。
蛔厥者。乌梅丸主之。
乌梅丸方
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 附子（六两炮） 川
椒（四两去汗） 当归（四两） 桂枝（去皮） 人参 黄柏（各六两）
上十味。异捣筛。合治之。以苦酒渍乌梅一宿。去核蒸之。五升米下饭熟。捣成泥。
和药令相得。内臼中与蜜杵二千下。丸如梧子大。先食饮服十丸。日三服。稍加
至二十丸。禁生冷滑臭等物。
〔衍义〕乌梅味酸入肝。梅得先春之气。主助生阳而杀阴类。细辛发少阳之初阳。
以助厥阴之化。当归启少阴之血液。以资肝脏所藏之荣。黄连配蜀椒。助心火
以杀蛔。益子气也。附子配黄柏。资肾气以回厥。助母气也。干姜佐人参。补中焦
而止呕。桂枝制风木。疏肝郁。阴阳和而厥逆回。风邪散而气血足。治蛔厥之法备已。蛔之
化生。有若蜒蚰。生长极速。
（因为都归属于筋病，所以汇集成这一篇，包含一篇论述、一条脉证和五个方剂）
老师说：患趺蹶病的人，只能向前迈步，不能向后倒退。这是太阳经受伤所致。（注：此处原文“刺 入二寸”似有脱漏或指代不明，结合补注及医理，通常指误刺承筋穴导致此症，故译为描述病症成因）。
〔补注〕：该穴位名为承筋，位于大腿后侧肌肉隆起处，脚跟上七寸，腓肠肌两肌腹之间的凹陷处。按照针灸法则，此处不宜针刺。如果针刺过深，就会损伤这条经脉，从而导致患者能前不能后的症状。这是张仲景在原文中的自注，已经解释得很详细了。
病人经常手指和手臂肿胀且颤动，身体也随之震颤的，用藜芦甘草汤主治。
〔补注〕：凡是颤动都属于风邪，而肿胀属于湿邪。因此肝木主风，血虚则生内风，气虚则外湿侵袭。手臂既肿又动，说明血液不足以滋养筋脉，阳气也不能自我固摄，从而引起身体的震颤，这也是势所必然的。这难道不是因为有痰气阻滞在筋节之间吗？凡是在体表显现的症状，没有不是由内部原因引起的。窥探张仲景的治法，有使用吐法的意思，可惜原方已经缺失了。
转筋这种病，病人的手臂和腿脚僵硬挺直，脉搏上下直行，呈现微弦象。如果转筋牵引至腹部疼痛的，用鸡屎白散主治。
鸡屎白散方
仅用鸡屎白一味药研成散剂。取一方寸匕的药量，加入六合水，调和后温服。
〔补注〕：所谓转筋，是因为脾胃土气衰弱，肝木之气相对亢盛。风火燥热灼伤筋脉，导致筋脉挛缩而疼痛。风气急迫，导致肝血失去滋养，筋脉失去了柔和的特性，违背了屈伸的关节规律，所以手臂和腿脚僵硬挺直。至于脉搏上下直行的情况，这是督脉和冲脉发病的表现。为什么呢？督脉循行经过阴器，阴器是由宗筋所主管的；冲脉是肝木的外围屏障，肝木多风，那么冲脉也会受病。如果脉象微弦，说明病邪转入体内，病情较重，因此用鸡屎白来投治，使肝邪从外部排出。
阴狐疝气病，表现为睾丸偏大偏小，时而上行入腹，时而下行出腹，用蜘蛛散主治。
蜘蛛散方
蜘蛛（十四枚，炒焦） 桂枝（半两）
将这两味药研成散剂。取八分之一匕的药量，用水调服。每天服用两次。也可以制成蜜丸。
〔衍义〕：这是足厥阴肝经的筋病。狐狸是阴兽，善于变化且喜欢藏匿。睾丸上下移动，就像狐狸出入无常一样。足厥阴之筋，向上沿着大腿内侧，结聚于阴器。因为筋脉结聚，所以睾丸大小不一；因为是气机病变，所以时而上行下行。蜘蛛布网捕物，其丝向右缠绕，由外向内，大风也不能吹坏，得到了干金旋转的含义。所以主治风木之邪导致的狐疝。配合桂枝来宣散厥阴经的气机郁结。
问：患有腹痛且有寄生虫的病人，如何通过脉象来辨别？老师说：腹中疼痛，脉象应当沉。如果是弦脉，反而洪大，这就说明有蛔虫。
〔衍义〕：腹痛，是中焦湿土发生的病变。腹部属阴，疼痛也属阴类，所以脉象应当沉。如果脉象弦，这是出现了厥阴风木的征象。反而洪大的，是因为风木旺盛而生火，风木之邪贼害中土，湿热不除就会生虫。所以说各种虫子都是生于风邪。东方生风，在地为木，在体为筋，在脏为肝。风伤筋，这是因为风邪伤害而生虫，所以虫病也是厥阴肝筋的病变。因此伤寒中的蛔厥，列在厥阴篇内；这一章的蛔痛，列在筋病篇中。
蛔虫引起的病，使人吐涎水，心痛，发作有时，用毒药治疗无效，用甘草粉蜜汤主治。
甘草粉蜜汤方
甘草（二两） 胡粉（一两） 白蜜（四两）
以上三味药，用水三升，先煮甘草，取二升药液，去掉药渣。加入胡粉和白蜜，搅拌混合，煎煮如稀粥状。温服一升，病愈即停服。
〔衍义〕：饮食进入胃中，如果胃中有热，虫子就会躁动。虫子躁动则胃气松弛，胃气松弛则廉泉穴开放，所以吐涎水。蛔虫上行进入膈部，所以心痛。蛔虫闻到食物的气味就出来，得到饮水就安静，所以发作有时。用毒药治疗无效的，是因为蛔虫厌恶药味而不进食。蛔虫喜欢甜味，所以用甘草和蜂蜜的甘味，顺着它的喜好来攻治它。胡粉味甘性寒，主要用来杀灭三虫。蛔虫遇到甘味就会头向上并喜欢吃，吃下去就会死亡。这是采用反佐的方法来擒获它。
蛔厥的病人，应当吐出蛔虫。现在病人安静的时候却时不时心烦，这是因为内脏寒冷，蛔虫上行进入膈部，所以心烦。过了一会儿又停止。吃东西如果出现呕吐并且心烦，是因为蛔虫闻到气味出来，这个人应当会自己吐出蛔虫。
〔衍义〕：蛔厥，是指患有蛔虫病并且手足冰冷的病症。蛔厥的病人应当吐出蛔虫。病人安静却时不时心烦，这是因为肝脏寒冷导致蛔虫上行进入膈部，所以心烦。这里说蛔虫生于肝，因为内脏寒冷而上入膈部。过了一会儿又停止，吃东西出现呕吐并且心烦，这是因为蛔虫闻到食物气味而从胃中出来，所以这个人常常自己吐出蛔虫。这里说蛔虫因风而生于肝，内脏寒冷则上入膈部，闻到食物气味则出于胃。
乌梅丸方
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 附子（六两，炮制） 川椒（四两，去汗） 当归（四两） 桂枝（去皮） 人参 黄柏（各六两）
以上十味药，分别捣碎筛过，混合在一起。用苦酒浸泡乌梅一夜，去掉核，蒸熟，放在五升米下一起蒸饭熟透，捣成泥状。与药物混合均匀，放入臼中与蜜一起杵捣两千下，制成梧桐子大小的丸药。饭前饮服十丸，每天三次，逐渐增加到二十丸。禁止食用生冷、滑腻、腥臭等食物。
〔衍义〕：乌梅味酸入肝，梅树得早春之气，主要辅助生发阳气而抑制阴类。细辛发散少阳初生的阳气，以助厥阴的化生。当归启动少阴的血液，以资助肝脏所藏的营血。黄连配伍蜀椒，辅助心火以杀灭蛔虫，这是益子气的方法。附子配伍黄柏，资助肾气以挽回厥逆，这是助母气的方法。干姜佐助人参，补益中焦而止呕。桂枝制约风木，疏解肝郁。阴阳调和则厥逆回复，风邪散去则气血充足，治疗蛔厥的方法已经完备了。蛔虫的化生，像蜒蚰一样，生长速度极快。
(As all these conditions pertain to the sinews, they are compiled into this chapter, containing one treatise, one pulse-symptom section, and five formulas.)
The Master said: In cases of *Fu Jue* (foot sprain/paralysis), the patient can only move forward but not backward. This is due to injury of the Taiyang meridian. [Note: The original text "ci ru er cun" appears incomplete or refers to an erroneous acupuncture point; based on the commentary and medical logic, it implies that mis-acupuncture at Chengjin leads to this symptom.]
[Supplementary Note]: The acupoint is named Chengjin (BL57). It is located on the posterior aspect of the upper leg, in the depression between the two bellies of the gastrocnemius muscle, seven cun above the heel. According to acupuncture principles, this point should not be needled. If needled too deeply, it injures the meridian, resulting in the inability to step backward. This self-annotation by Zhang Zhongjing explains it in detail.
When a patient frequently experiences swelling and tremors in the fingers and arms, accompanied by trembling of the body, Lili Gancao Tang (Celandine and Licorice Decoction) is the primary treatment.
[Supplementary Note]: Tremors belong to Wind, while swelling belongs to Dampness. Therefore, Liver Wood governs Wind; Blood deficiency generates internal Wind, and Qi deficiency allows external Dampness to invade. Swelling and movement of the arms indicate that Blood is insufficient to nourish the sinews, and Yang Qi cannot consolidate itself, leading inevitably to bodily tremors. Is there not Phlegm-Qi obstructing the joints? Manifestations on the exterior invariably stem from internal causes. Examining Zhang Zhongjing's methods, there is an implication of using emesis therapy, but unfortunately, the formula is 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, and is slightly wiry. If the cramps radiate into the abdomen, Jishi Bai San (Chicken Droppings White Powder) is indicated.
Jishi Bai San Formula
Only Chicken Droppings White (Jishi Bai) is used, ground into a powder. Take one Fang Cun Bi (a square-inch measure) of the powder, mix with six He of water, and take warm.
[Supplementary Note]: *Zhuan Jin* occurs when Spleen-Stomach Earth Qi declines, allowing Liver Wood to flourish. Wind-Fire scorches the sinews, causing spasms and pain. Severe Wind leads to Liver Blood failing to nourish the sinews, losing their softness and flexibility, thus causing stiffness of the limbs. The vertical pulse indicates pathology of the Du and Chong vessels. Why? The Du Meridian traverses the genitalia, which are governed by the Zong Jin (Gathering Sinews); the Chong Meridian acts as a screen for the Liver. Since Liver Wood is prone to Wind, the Chong Meridian is also affected. A slightly wiry pulse suggests the pathogen has moved inward, indicating a more severe condition. Jishi Bai is administered to expel Liver pathogenic factors outward.
Yin Hu Shan Qi (Yin Fox Hernia) is characterized by asymmetry in size (one side larger than the other) and intermittent movement of the testicles up into the abdomen and down out of it. Zhizhu San (Spider Powder) is the treatment.
Zhizhu San Formula
Spiders (14 pieces, roasted until charred) Cinnamon Twig (Gui Zhi, 0.5 liang)
Grind the two ingredients into a powder. Take 1/8 Fang Cun Bi, mixed with water for oral administration. Take twice daily. Honey pills are also acceptable.
[Extended Meaning]: This is a sinew disease of the Foot-Jueyin Liver Meridian. The fox is a yin beast, good at changing and hiding. The testicles moving up and down resemble the fox entering and exiting without fixed times. The sinews of the Foot-Jueyin Meridian ascend along the inner thigh and knot at the genitalia. Because the sinews are knotted, there is asymmetry in size; because it is a Qi disorder, the testicles move intermittently. Spiders weave nets to catch prey; their silk winds clockwise from outside to inside and withstands strong winds, embodying the meaning of rotating dry metal. Thus, it treats the "fox"妖 (demon/pathogen) of Wind-Wood. Paired with Gui Zhi to disperse the Qi stagnation of the Jueyin.
Question: How can one distinguish abdominal pain caused by parasites via pulse diagnosis? The Master said: Abdominal pain typically presents with a deep pulse. If the pulse is wiry or surprisingly surging and large, it indicates the presence of roundworms (Hui Chong).
[Extended Meaning]: Abdominal pain is a disease of damp-Earth in the Middle Jiao. The abdomen is Yin, and pain is a Yin category, so the pulse should be deep. A wiry pulse reflects the image of Jueyin Wind-Wood. A surprisingly surging and large pulse indicates that excessive Wind-Wood generates Fire. The Wind-Wood pathogen attacks the Middle Earth; if Damp-Heat is not cleared, worms are generated. Hence, it is said that all worms arise from Wind. The East generates Wind; in the earth it is Wood, in the body it is Sinews, in the zang organs it is the Liver. Wind damages sinews; here, worms arise due to Wind damage, making worm disease a disorder of the Jueyin Liver sinews. Therefore, Hui Jue (Roundworm Cold Reversal) in Shanghan Lun is listed in the Jueyin Chapter, while Hui Tong (Roundworm Pain) in this chapter is listed in the Sinew Disease Chapter.
Roundworm disease causes salivation, heart pain, intermittent发作 (attacks), and resistance to toxic drugs. Gancao Fenmi Tang (Licorice, Lead White, and Honey Decoction) is the primary treatment.
Gancao Fenmi Tang Formula
Licorice Root (Gan Cao, 2 liang) Lead White (Hu Fen, 1 liang) White Honey (Bai Mi, 4 liang)
Take the three ingredients, add 3 sheng of water, and first decoct the Licorice Root. Reduce to 2 sheng, remove the dregs. Add the Lead White and Honey, stir well, and simmer until it resembles thin porridge. Take 1 sheng warm. Stop when cured.
[Extended Meaning]: When food enters the stomach, heat in the stomach causes worms to move. Worm movement relaxes the stomach Qi; relaxed stomach Qi opens the Lianquan acupoint, causing salivation. When roundworms ascend into the diaphragm, heart pain occurs. Roundworms emerge upon smelling food odor and settle when drinking water, hence the intermittent nature. Toxic drugs fail because roundworms dislike the taste and refuse to eat. Roundworms prefer sweetness. Therefore, the sweetness of Licorice and Honey is used to attack them according to their preference. Lead White is sweet and cold, primarily killing the three types of worms. When roundworms encounter sweetness, they raise their heads and eat, leading to death. This is a counter-assistance method to capture them.
Patients with Hui Jue (Roundworm Cold Reversal) should vomit roundworms. Now, if the patient is quiet but occasionally irritable, this is due to cold in the zang organs. The roundworms ascend into the diaphragm, causing irritability. After a moment, it stops. If eating causes vomiting and further irritability, it is because the roundworms emerge upon smelling food odor, and the patient will likely vomit roundworms spontaneously.
[Extended Meaning]: Hui Jue refers to roundworm disease accompanied by cold extremities. Patients with Hui Jue should vomit roundworms. The patient's occasional irritability despite being quiet is due to Liver cold causing roundworms to ascend into the diaphragm. It is stated that roundworms originate in the Liver and ascend to the diaphragm due to organ cold. After a moment, symptoms cease. Vomiting and irritability after eating occur because roundworms emerge from the stomach upon smelling food. Thus, the patient often vomits roundworms spontaneously. Roundworms are born from Wind in the Liver; organ cold causes them to ascend to the diaphragm, and food odor causes them to emerge from the stomach.
For Hui Jue, Wumei Wan (Mume Pill) is the primary treatment.
Wumei Wan Formula
Mume Fruit (Wu Mei, 300 pieces) Asarum (Xi Xin, 6 liang) Dried Ginger (Gan Jiang, 10 liang) Coptis Rhizome (Huang Lian, 1 jin) Prepared Aconite Root (Fu Zi, 6 liang, processed) Sichuan Pepper (Chuan Jiao, 4 liang, perspiration removed) Angelica Sinensis (Dang Gui, 4 liang) Cinnamon Twig (Gui Zhi, bark removed) Ginseng (Ren Shen) Phellodendron Bark (Huang Bo, each 6 liang)
Process the ten ingredients separately by pounding and sifting, then mix. Soak Wu Mei in bitter wine (Ku Jiu) overnight, remove pits, steam, and place under 5 sheng of rice until cooked. Pound into a paste. Mix with the herbs. Place in a mortar with honey and pound 2,000 times. Form pills the size of wu zi (wuze seeds). Take 10 pills before meals with water, three times daily. Gradually increase to 20 pills. Avoid raw, cold, slippery, and foul-smelling foods.
[Extended Meaning]: Wu Mei is sour and enters the Liver. Plum trees receive the qi of early spring, assisting the generation of Yang Qi and suppressing Yin categories. Xi Xin disperses the initial Yang of Shaoyang, aiding the transformation of Jueyin. Dang Gui activates the Blood of Shaoyin, nourishing the Ying Blood stored in the Liver. Huang Lian paired with Shu Jiao assists Heart Fire to kill roundworms, benefiting the "Son" Qi. Fu Zi paired with Huang Bo tonifies Kidney Qi to reverse cold reversal, assisting the "Mother" Qi. Gan Jiang assists Ren Shen to tonify the Middle Jiao and stop vomiting. Gui Zhi restrains Wind-Wood and soothes Liver stagnation. When Yin and Yang harmonize, cold reversal returns to normal; when Wind pathogens scatter, Qi and Blood become sufficient. The method for treating Hui Jue is complete. The generation of roundworms resembles slugs, growing extremely fast.