师曰。（得）病（因）跌（而致）蹶。其人但能前（步而）不能（后）却。（当）
刺（肠）入二寸。此太阳经伤也。
人身经络。阳明行身之前。太阳行身之后。太阳伤。故不能却也。太阳之脉。下贯
内。刺之所以和利其经脉也。 。足肚也。然太阳经甚多。而必刺 肠者。以此穴本
属阳明。乃太阳经络所过之处。与阳明经气会合。阳承筋间。故刺之。使太阳阳明气血
相贯通利。则前后如意矣。
病患常以手指臂肿动。（盖以肿而知其为湿。动而知其为风。湿盛生痰。风从火发。
不易之理也。若）此人身体 者。（风痰在膈。逼处于心肺。以致心为君主。不行其所
令。肺为相傅。不行其治节。泛泛无以制群动也。以）藜芦甘草汤主之。（方未见）
此为手臂肿动而出其方治也。手之五指。乃心肺包络大小肠三焦之所属。当根据经治
之。若臂外属三阳。臂内属三阴。须按其外内而分治之。然亦有不必分者。取手足之太
阴。以金能制木而风平。土能胜
湿而痰去。又取之阳明。以调和其肌肉之气。是为握要之法。师用藜芦甘草。大抵为风
痰之盛初起。出其涌剂也。
转筋之为病。其人臂脚直。（不能屈伸。是转筋之证也。）脉（长直而）上下行。
微（中不和而）弦。（是转筋之脉也。）转筋（痛不能忍。甚而）入腹者。（牵连少腹。
拘急而剧痛。为肝邪直攻脾脏。以）鸡屎白散主之。（是方也。取其捷于去风下气。
消积安脾。先清其内。徐以治其余也。）
此为转筋入腹而出其方治也。
鸡屎白散方
鸡屎白为末。取方寸匕。以水六合和。温服。
（凡痛连少腹。皆谓之疝。古有心疝肝疝等名。上卷有寒疝。皆是也。而此独见之
外肾睾丸肿大。因前阴之间。有狐臭之气。遂别其名为）阴狐疝气者。（其睾丸或）偏
（左。或偏右。）有小大。（病发时。则坠而下。病息时。则收而上。因发）时（息）
时（而）上下。（以）蜘蛛散主之。
此言寒湿袭阴。为阴狐疝气者。出其方治也。后人分为七疝。曰寒疝水疝筋疝血疝
气疝 疝狐疝之不同。狐疝。似止七疝之一。而不知师言狐疝。以病气之腥臭。如狐之
臊。所以别上卷寒疝也。方书于时时上下句误解。遂有许多附会也。
蜘蛛散方
蜘蛛（十四枚熬煎） 桂枝（半两）
上二味为散。取八分一匕。饮和服。日再服。蜜丸亦可。
问曰。病腹痛有虫。其脉何以别之。师曰。腹中痛。（多由寒触其正。所谓邪正相
搏。即为寒疝。寒属阴。）其脉当沉。若（病甚而卫气必结。脉更兼）弦。（兹）反洪大。
（则非正气与外邪为病。乃蛔动而气厥也。）故（于此脉。而参其吐涎心痛证。而知其
）有蛔虫。
此言蛔虫腹痛之脉也。
蛔虫之为病。令人吐涎心痛。发作有时。毒药不止者。甘草粉蜜汤主之。
此为脏燥而为蛔痛者。出其方治也。
尤在泾云、吐涎。吐出清水也。心痛。痛如咬啮。时时上下是也。发作有时者。蛔
饱而静。则痛立止。蛔饥求食。则痛复发也。毒药。即锡粉雷丸等杀虫之药。毒药者。
折之以其所恶也。甘草粉蜜汤者。诱之以其所喜也。白粉即铅白粉。能杀三虫。而杂于
甘草白蜜之中。诱使虫食。甘味既尽。毒性旋发。而虫患乃除。此医药之巧也。
甘草粉蜜汤方
甘草（二两） 白粉（二两） 白蜜（四两）
上三味。以水三升。先煮甘草取二升。去滓。纳粉蜜。搅令和。煮如薄粥。温服一
升。瘥即止。
蛔厥者。（蛔动而手足厥冷。）其人当吐蛔。今病者静。而复时烦。此为脏
寒。蛔上入（其）膈。故烦。须臾复止。得食而呕。又烦者。蛔闻食臭出。其人当自吐蛔。
蛔厥者。（以）乌梅丸主之。
此为脏寒之蛔厥。而出其方治也。 谨考御纂医宗金鉴注。此为脏寒之此字。当是
非字。
乌梅丸方
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归 川椒（各
四两） 附子（炮） 桂枝 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。稍增
至二十丸。禁生冷滑臭等食。
老师说：（有人）因为跌倒而导致的厥逆。这个人只能向前迈步，不能向后退步。（应当）针刺腘窝（委中穴附近）入二寸深。这是太阳经受伤的缘故。
人体的经络中，阳明经行走在身体前面，太阳经行走在身体后面。太阳经受伤，所以不能向后倒退。太阳经的脉气，向下贯穿腘窝。针刺是为了调和疏通其经脉。腘窝（此处指腘窝部位）。然而太阳经很多，但一定要刺腘窝的原因，是因为这个穴位本属于阳明经，却是太阳经络经过的地方，与阳明经的气血会合。阳承筋间（此处指穴位所在解剖位置），所以针刺它，使太阳和阳明的气血相互贯通流利，那么前后活动就自如了。
病人经常手指和手臂肿胀跳动。（大概因为肿胀知道是湿邪，因为跳动知道是风邪。湿盛则生痰，风从火发，是不变的道理。如果）这个人身体沉重困倦。（这是因为风痰停留在膈上，逼迫处于心肺之间，导致心作为君主之官，不能行使它的命令；肺作为相傅之官，不能行使它的治节功能，泛泛无力以控制各种躁动。）用藜芦甘草汤主治。（此方未见原文记载）
这是针对手臂肿胀跳动而提出的方剂治疗方法。手的五指，分别属于心、肺、心包络、大肠、小肠、三焦。应当根据经络来治疗。如果臂外侧属于三阳经，臂内侧属于三阴经，必须按照内外分别治疗。然而也有不必严格区分的，取用手足太阴经，因为金能制木从而风平，土能胜湿从而痰去。又取用阳明经，以调和肌肉之气。这是抓住要领的方法。老师使用藜芦和甘草，大抵是为了风痰初起盛大时，采用涌吐法来祛除病邪。
转筋这种病，病人的手臂和脚僵硬挺直。（不能屈伸，这就是转筋的症状。）脉象长直且上下流行，微带弦象。（这是转筋的脉象。）转筋（疼痛难以忍受，严重时）牵连到腹部者。（牵连少腹，拘急而剧痛，这是肝邪直接攻击脾脏，用鸡屎白散主治。（这个方子，取其迅速祛风下气，消除积滞安顿脾胃，先清除内部邪气，再慢慢治疗其余部分的意思。））
这是针对转筋牵连腹部而提出的方剂治疗方法。
鸡屎白散方
将鸡屎白研成粉末，取一方寸匕的量，用六合水调和，温服。
（凡是疼痛牵连少腹的，都称为疝。古代有心疝、肝疝等名称，上卷提到的寒疝，都是这类。但这里特别见到的是外肾睾丸肿大，因为前阴之间有类似狐臊的气味，于是将其命名为）阴狐疝气。（其睾丸有时）偏左，或偏右。）有大有小。（发病时，则下垂向下；病止时，则收缩向上。因为发作）时（候）停（息时）上下移动。（用蜘蛛散主治。
这里说的是寒湿侵袭阴部，形成阴狐疝气的情况，提出其方剂治疗方法。后人将疝分为七种，即寒疝、水疝、筋疝、血疝、气疝、㿗疝、狐疝等不同。狐疝，似乎只是七疝中的一种，但不知道老师所说的狐疝，是以病气的腥臭气味，像狐狸的臊味一样，以此来区别上卷中的寒疝。后世医书对“时时上下”这一句产生误解，于是有许多牵强附会的解释。
以上两味药研成散剂，取八分之一匕的量，用水送服。每天服用两次。也可以做成蜜丸。
问：患有腹痛且有虫的病人，其脉象如何辨别？老师说：腹中疼痛。（多由寒气触动正气所致，所谓邪正相搏，即为寒疝。寒属阴。）其脉象应当沉。如果（病情严重而卫气郁结，脉象更兼）弦象。（这）反而洪大。（这就不是正气与外邪致病，而是蛔虫扰动导致气机厥逆。）因此（通过这种脉象，并结合吐涎、心痛等症状，就能知道）体内有蛔虫。
这里讲的是蛔虫引起腹痛的脉象。
蛔虫引起的病，使人吐口水、心痛，发作有定时。服用一般杀虫毒药无效的，用甘草粉蜜汤主治。
这是针对脏燥引起的蛔痛而提出的方剂治疗方法。
尤在泾说：吐涎，吐出清水。心痛，疼痛如同被咬啮，痛处时时上下移动。发作有定时的原因是，蛔虫吃饱后安静，疼痛立即停止；蛔虫饥饿求食，疼痛便复发。毒药，即锡粉、雷丸等杀虫药物。使用毒药，是用它们厌恶的味道来折服蛔虫。甘草粉蜜汤，是用它们喜欢的味道来引诱。白粉即铅白粉，能杀灭三虫，混杂在甘草和白蜜之中，引诱蛔虫食用，甘味吃完后，毒性随即发作，蛔虫病患也就消除了。这是医药运用的巧妙之处。
以上三味药，用三升水，先煮甘草取二升，去掉药渣，加入粉和蜜，搅拌调和，煮成稀粥状，温服一升，病愈即停药。
蛔厥症。（蛔虫扰动导致手足冰冷。）病人应当吐蛔。现在病人安静，却又时常心烦，这是因为内脏虚寒，蛔虫上行进入膈部，所以心烦。一会儿又停止。进食后呕吐，又心烦的，是因为蛔虫闻到食物气味而出动，病人应当自己吐出蛔虫。蛔厥症，用乌梅丸主治。
这是针对内脏虚寒引起的蛔厥而提出的方剂治疗方法。谨考《御纂医宗金鉴》注解说，这里的“此为脏寒”的“此”字，应当是“非”字。
乌梅丸方
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归 川椒（各四两） 附子（炮制） 桂枝 人参 黄柏（各六两）
以上十味药，分别捣碎筛细，混合在一起。用苦酒浸泡乌梅一夜，去核，放在五升米饭上蒸熟，捣成泥状，与药末混合均匀，放入臼中，加蜂蜜杵打两千下，制成梧桐子大小的丸药。饭前，饮水送服十丸，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。
The Master said: (A patient) suffers from jue-ni (a condition characterized by cold extremities and altered consciousness) due to a fall. This person can only step forward but cannot step backward. (One should) needle the popliteal fossa area to a depth of two cun. This is an injury to the Taiyang Meridian (Taiyang Channel).
In the human body's meridians, the Yangming Meridian runs along the anterior aspect of the body, while the Taiyang Meridian runs along the posterior aspect. Because the Taiyang Meridian is injured, backward movement is impaired. The pulse of the Taiyang Meridian descends through the popliteal fossa. Needling serves to harmonize and unblock the meridian. The popliteal fossa (here referring to the popliteal region). Although there are many pathways of the Taiyang Meridian, one must specifically needle this point because it originally belongs to the Yangming Meridian but is also a passage for the Taiyang Collateral, where Qi and Blood of the Yangming and Taiyang meridians converge. Located between the tendons at Yangcheng, needling here allows the Qi and Blood of the Taiyang and Yangming meridians to flow freely and interconnect, thereby restoring free movement in both forward and backward directions.
Patients often experience swelling and tremors in their fingers and arms. (Generally, swelling indicates Dampness, and tremors indicate Wind. Excessive Dampness generates Phlegm, and Wind arises from Fire; this is an immutable principle. If) the patient's body feels heavy and lethargic, (it is because Wind-Phlegm resides in the Diaphragm, pressing upon the Heart and Lungs. Consequently, the Heart, as the Monarch, fails to issue its commands, and the Lung, as the Prime Minister, fails to regulate its governance, resulting in a lack of control over various movements.) Li Lu Gan Cao Tang (Veratrum and Licorice Decoction) is the primary treatment. (The formula is not found in existing texts.)
This addresses the treatment for arm swelling and tremors with a specific formula. The five fingers of the hand belong to the Heart, Lung, Pericardium, Large Intestine, Small Intestine, and Sanjiao (Triple Burner). Treatment should follow the meridians. If the lateral aspect of the arm belongs to the Three Yang meridians and the medial aspect to the Three Yin meridians, treatment must be differentiated accordingly. However, differentiation is not always necessary. One may select the Hand and Foot Taiyin meridians, as Metal controls Wood to calm the Wind, and Earth overcomes Dampness to resolve Phlegm. Additionally, selecting the Yangming Meridian harmonizes the Qi of the muscles. This is a method that grasps the essentials. The Master’s use of Li Lu (Veratrum) and Gan Cao (Licorice) is generally intended for the initial stage of excessive Wind-Phlegm, employing emesis to expel the pathogen.
Jingjin (muscle spasm/tendon contraction) disease presents with stiff and straight arms and legs. (Inability to flex or extend characterizes Jingjin syndrome.) The pulse is long, straight, and flows up and down, slightly wiry. (This is the pulse characteristic of Jingjin syndrome.) When Jingjin pain is unbearable and spreads to the abdomen, (involving the lower abdomen with severe cramping and pain, indicating Liver Pathogen attacking the Spleen directly,) Ji Shi Bai San (Chicken Dropping White Powder) is used. (This formula aims to rapidly dispel Wind, direct Qi downward, eliminate accumulation, and stabilize the Spleen, clearing the interior first before addressing other aspects.)
This provides the treatment for Jingjin spreading to the abdomen.
Ji Shi Bai San Formula
Grind Chicken Dropping White into powder. Take one fangcun bi (square-inch measure), mix with six he of water, and take warm.
(Pain radiating to the lower abdomen is generally termed Shan (Hernia). Ancient texts mention names such as Xin Shan (Heart Hernia) and Gan Shan (Liver Hernia); Han Shan (Cold Hernia) mentioned in Volume I is also included. However, this text specifically describes swelling of the external kidneys (testicles). Due to a fox-like odor in the genital region, it is named) Yin Hu Shan Qi (Yin Fox Hernia Qi). (The testicles may) deviate to the left or right.) varying in size. (During attacks, they descend; during remission, they ascend. Thus, they move up and down intermittently.) Zhi Zhu San (Spider Powder) is the treatment.
This discusses Cold-Damp invading the Yin regions causing Yin Hu Shan Qi, providing its treatment. Later scholars classified hernias into seven types: Han Shan (Cold), Shui Shan (Water), Jin Shan (Tendon), Xue Shan (Blood), Qi Shan (Qi), Chu Shan (Scrotal), and Hu Shan (Fox). Hu Shan seems merely one of these seven, but the Master’s reference to Hu Shan distinguishes it from Han Shan based on the fishy/foul odor resembling a fox’s scent. Misinterpretations of the phrase "moving up and down" led to many forced explanations in later medical books.
Zhi Zhu San Formula
Zhi Zhu (Spider, fourteen pieces, roasted/decocted) Gui Zhi (Cinnamon Twig, half liang)
Grind the above two ingredients into powder. Take one-eighth of a fangcun bi, mixed with water for oral administration. Take twice daily. Honey pills are also acceptable.
Question: How can one differentiate the pulse of abdominal pain caused by parasites? The Master said: Abdominal pain. (Often caused by Cold disturbing the Healthy Qi, known as Evil-Healthy Qi interaction, resulting in Han Shan. Cold belongs to Yin.) The pulse should be deep. If (the condition worsens and Wei Qi becomes constrained, the pulse becomes more) wiry. (If it instead appears flooding and large, this is not an illness of Healthy Qi versus External Evil, but rather Qi Jue (reversal) caused by Ascaris movement.) Therefore, (by correlating this pulse with symptoms like salivation and heart pain, one knows there are) Ascaris worms.
This explains the pulse associated with Ascaris-induced abdominal pain.
Ascaris disease causes patients to salivate excessively, suffer from heart pain, and have intermittent attacks. For cases where toxic drugs fail to stop the symptoms, Gan Cao Fen Mi Tang (Licorice, Flour, and Honey Decoction) is the primary treatment.
This provides the treatment for visceral dryness causing Ascaris pain.
You Zaijing stated: Salivation refers to vomiting clear fluid. Heart pain refers to pain like biting or gnawing, moving up and down intermittently. The reason for intermittent attacks is that when Ascaris are full and quiet, pain stops immediately; when hungry and seeking food, pain recurs. Toxic drugs refer to vermifuges like Tin Powder or Polyporus Pill. Using toxic drugs subdues them with what they dislike. Gan Cao Fen Mi Tang entices them with what they like. Bai Fen (White Powder) is Lead Carbonate, which kills three types of parasites. Mixed with Licorice and White Honey, it entices the worms to eat. Once the sweet taste is consumed, the toxicity activates, eliminating the parasitic infestation. This demonstrates the ingenuity of medicine.
Gan Cao Fen Mi Tang Formula
Gan Cao (Licorice Root, two liang) Bai Fen (White Powder/Lead Carbonate, two liang) Bai Mi (White Honey, four liang)
Take the above three ingredients. Add three sheng of water, first decoct the Licorice until two sheng remain, remove the dregs, add the Powder and Honey, stir and mix well, and cook until it resembles thin porridge. Take one sheng warm. Stop taking it once the disease resolves.
Hui Jue (Ascaris Reversal) syndrome. (Ascaris movement causes cold extremities.) The patient should vomit Ascaris. Now, the patient is quiet but occasionally experiences irritability. This is due to Visceral Cold, causing Ascaris to move upward into the Diaphragm, hence the irritability. It subsides after a short while. Vomiting and irritability after eating occur because Ascaris emerge smelling the food odor, leading to spontaneous vomiting of Ascaris. Hui Jue syndrome is treated with Wu Mei Wan (Mume Pill).
This provides the treatment for Hui Jue caused by Visceral Cold. Carefully examining the annotation in *Yu Cuan Yi Zong Jin Jian* (Imperial Compilation of Medical Standard), the character "Ci" (this) in "Ci Wei Zang Han" (This is Visceral Cold) should likely be "Fei" (not).
Wu Mei Wan Formula
Wu Mei (Mume Fruit, three hundred pieces) Xi Xin (Asarum, six liang) Gan Jiang (Dried Ginger, ten liang) Huang Lian (Coptis Rhizome, one jin) Dang Gui (Angelica Sinensis) Chuan Jiao (Sichuan Pepper, four liang each) Fu Zi (Prepared Aconite Root) Gui Zhi (Cinnamon Twig) Ren Shen (Ginseng Root) Huang Bo (Phellodendron Bark, six liang each)
Process the above ten ingredients separately by pounding and sifting, then combine. Soak Wu Mei in Ku Jiu (Bitter Wine) overnight, remove pits, steam over five sheng of rice until cooked, pound into a paste, mix thoroughly with the medicinal powders, place in a mortar, add honey, and pound two thousand times. Form pills the size of wuzi (wu seeds). Take ten pills before meals with water, three times daily. Gradually increase to twenty pills. Avoid raw, cold, slippery, and strong-smelling foods.