师曰。病趺蹶。其人但能前。不能却。刺 入二寸。此太阳经伤也。
趺、蹲踞也。蹶、颠踬也。趺蹶者。盖言立则能持。若蹲踞而趺。则颠踬而蹶。从俯覆矣。与诸经之言蹶者大殊。
旧
注。引痿厥、踝厥。误甚。其人能前不能却二句。正言所以趺蹶之故。刺 入二寸两句。又言所以能前不能却
之因也。前却。指一身之可以曲折处而言。前如脚凹环跳。凡能曲而折向前者即是。却如腿弯项后。凡能曲
而折向后者即是。盖谓趺而致蹶之故。因其人之脚凹环跳。但能前折。而腿弯项后。不能却折。故欲趺下。则
腿弯强直。但任其能前者而蹶。从俯覆矣。所以然者。太阳之经脉。由项后历背部。而下行腿肚。缠足外 之
后侧者也。太阳之经气通畅。则和软而能却。今不能却者。此必刺足肚之 肉诸穴。深入二寸。以致伤其经
血经气。故强直趺蹶。则芍药附子。芍药甘草诸汤。可变通加减。而施其治矣。以其不能却。故知伤在身后之
太阳。以其蹶由下部。故知刺伤太阳之 肉。仲景诊法之细密何如哉。俗解以刺 入二寸。谓是趺蹶之
治法。诚如所言。以仲景之文例推之。当曰。此太阳经伤也。刺 云云矣。且按王太仆所注针刺。及针灸大成。
除环跳肉浓穴深。刺入经寸之外。余无有至二寸者。若以为治例。则误人无限矣。足肚之白肉曰 。凡委
中、承山、飞扬、等穴。其附于 者。俱以深入为禁可知。
病患常以手指臂肿动。此人身体 者。藜芦甘草汤主之。（方缺）
此经络之气上虚。而胃中湿热之火外贯之候也。盖经络之气上虚。故手指及臂俱肿。湿热之火外贯。故气
机流注而自动也。然必其人身体 跳动。当有流移薄疾之候。方为确切。以大寒善吐之藜芦为主。而以
甘浮之甘草托之。则寒能去火。吐能去湿。且一吐而提其气以上实外实。则经络之因虚而肿动。及 者俱愈矣。
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。
鸡屎白散方 鸡屎白。
上一味。为末。取方寸匕。以水六合和。温服。
阳气之柔者养筋。阳虚故筋如纽转而坚痛。又阳亲于上。足下阳气尝少。故转筋之病。臂少而足多也。脉上
下行。气虚不能外鼓。但从寸及尺。伏行往来之谓。气衰则微。气削则弦。故上下行之脉体。微而且弦也。腹为
肠胃之所托。悍气之根蒂也。转筋入腹。则其气更虚可知。鸡于卦为巽。而立东南之位。得生气向明之用。鸡
屎通肠胃之气。而其白尤为阳气之所化。以之主转筋之入腹。则通肠胃之精悍。以柔养筋脉之义也。
阴狐疝气者。偏有大小。时时上下。蜘蛛散主之。
蜘蛛散方 蜘蛛（十四枚熬焦） 桂枝（半两）
上二味。为散。取八分一匕。饮和服。日再服。蜜丸亦可。
疝详寒疝下。狐疝者。言其出没无定。如妖狐之象。即下文大小上下之义。曰阴狐疝者。单指前阴之睾丸而
言。所以分别五脏之疝也。肾为水脏。阳气最贵。而与阴寒相召。阳气偏有虚实。虚者寒气贯之而偏大。实者
阳气自治而偏小矣。又阳主提挚。气虚不能自举。故卧则上入少腹。起则下坠囊中矣。蜘蛛腹大。为下入少
腹之专药。且性主提携束缚。以辛温生气之桂枝为配。则温补关元气海之阳神。以驱客寒。得升举收煞之
功用。以坚弛坠。阴狐疝病宁有不愈者哉。
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。
此言病虫之脉也。盖谓腹痛之因颇多。若因病虫而痛。其脉当以何者为分别也。师言沉为在里。腹中病。其
脉当以沉应。又弦为急痛。腹中痛。其脉当以沉而且弦应。今不沉弦而反洪大。洪大者。气乱之诊。故知有虫。
以扰乱其气而作痛。与风寒积滞之脉不同也。
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） 粉（一两） 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。
此与下文两条。俱言病虫之治例。但下条责在脏寒。脏寒而蛔上膈上。故烦而厥。温之而蛔下安。则愈。故乌
梅丸除温脏之外。但用辛辣酸苦等味。令其俯首蜷缩而已。此为饮食相犯而生之蛔。责在虫多。虫多则胃
系缓而廉泉开。故吐涎。上扰胃脘。胃脘上当心部。故如心痛。虫动而自疲。则伏为休养。故发作有时。毒药、虫
所不食。故不止。是非去其虫不可也。胡粉、（粉系黑铅所化者。）体重。而性能杀虫。与甘草、蜂蜜。共煮。虫为
脾胃之土气化生。而性嗜甘。因甘中粉。则强重而死。故瘥。脏不寒。故于杀虫之外。无余药也。
蛔厥者。当吐蛔。令病者静而复自烦。此为脏寒。蛔上入膈。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。乌梅丸主之。
乌梅丸方
乌梅（三百个） 人参（六两） 当归（四两） 桂枝（六两） 附子（六两炮） 干姜（十两） 细辛
（六两） 川椒（四两去汗） 黄连（十六两） 黄柏（六两）
上十味。异捣筛。合治之。以苦酒浸乌梅一宿。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。丸如桐子大。先食饮服十丸。日三服。稍加二十丸。禁生冷滑臭等物。
论文方意。注见伤寒厥阴。
老师说：患趺蹶病的人，只能向前迈步，不能向后撤步。这是因为针刺足肚肌肉穴位过深（达二寸），损伤了太阳经。
“趺”意为蹲踞，“蹶”意为跌倒。所谓趺蹶，是指站立时还能支撑，但如果像蹲踞那样俯身向下，就会因重心不稳而跌倒，身体前倾覆倒。这与各经脉中提到的其他类型的“厥”有很大不同。
旧注引用痿厥、踝厥来解释，错误很大。“其人能前不能却”这两句，正是说明导致趺蹶的原因；“刺入二寸”这两句，则是说明之所以能前不能后的机理。“前却”指的是身体可以弯曲折叠的部位。向前如脚后跟、环跳穴处，凡是能弯曲折叠向前的都叫“前”；向后如膝盖弯、颈后部，凡是能弯曲折叠向后的都叫“后”。意思是说，因为跌倒是由于脚后跟和环跳处只能向前弯曲，而膝盖弯和颈后部不能向后弯曲所致。所以想要蹲下时，膝盖僵硬挺直，只能任由其向前弯曲而导致跌倒，身体前倾覆倒。之所以这样，是因为太阳经脉从颈后经过背部，下行至小腿肚，缠绕在足外侧的后方。如果太阳经气通畅，肌肉就会柔和并能向后弯曲。现在不能向后弯曲，一定是因为针刺了小腿肚肌肉中的各个穴位，深入二寸，从而损伤了经血和经气，导致僵硬挺直而发生趺蹶。此时可以使用芍药附子汤、芍药甘草汤等方剂进行加减治疗。因为不能向后弯曲，所以知道损伤的是身后的太阳经；因为跌倒是从下部引起的，所以知道是针刺损伤了太阳经的肌肉。张仲景的诊断方法何等细致严密啊！世俗的解释认为“刺入二寸”是治疗趺蹶的方法，如果真的像他们所说的那样，按照张仲景的行文惯例，应该说“这是太阳经受伤，应当刺……”才对。况且根据王冰（王太仆）所注的《黄帝内经》及《针灸大成》，除了环跳穴、承扶穴等少数穴位进针较深达到一寸外，其余没有达到二寸的。如果把这当作治疗的常规，那就会误导无数人。小腿肚上白色的肉称为“腨”。凡是在腨部的委中、承山、飞扬等穴位，都知道严禁深刺。
病人经常手指和手臂肿胀跳动，并且身体也出现不由自主的跳动，这是藜芦甘草汤主治的证候。（原方缺失）
这是经络之气上部虚弱，而胃中湿热之火向外贯通的表现。因为经络之气上部虚弱，所以手指和手臂都会肿胀；湿热之火向外贯通，所以气机流注并自动跳动。但是，必须结合病人身体出现游走性、急迫性的跳动症状，才能确切诊断。以大寒且善于催吐的藜芦为主药，配合甘缓浮散的甘草来托举，那么寒性能清除火热，吐法能去除湿气，而且通过一次吐法可以提升气机使其上部充实，那么因虚而导致的经络肿胀跳动以及身体的跳动症状都会痊愈。
转筋这种病，病人的手臂和腿脚伸直，脉象上下行，微带弦象。如果转筋延伸到腹部，用鸡屎白散主治。
鸡屎白散方：鸡屎白。
上一味药，研成细末，取一方寸匕的药量，用六合水调和，温服。
阳气中柔和的部分滋养筋脉，阳虚则筋脉像扭转一样坚硬疼痛。又因为阳气亲于上部，足下的阳气常常较少，所以转筋的病，手臂少而腿部多。脉象上下行，是因为气虚不能向外鼓动，只是从寸口到尺部伏行往来。气衰则脉微，气削则脉弦，所以上下行的脉体既微又弦。腹部是肠胃所在，也是悍气（卫气之剽疾者）的根本。转筋进入腹部，说明气更虚可知。鸡在八卦中属巽卦，位于东南方位，具有生气向阳的作用。鸡屎能通利肠胃之气，而其白色部分更是阳气所化。用它来治疗转筋入腹，就是利用它通利肠胃的精悍之气，以达到柔养筋脉的目的。
阴狐疝气病，表现为睾丸偏大偏小，时时上下移动，用蜘蛛散主治。
蜘蛛散方：蜘蛛（十四枚，炒焦）、桂枝（半两）。
上两味药，研成散剂，取八分之一匕的药量，用水送服，每日两次。也可以做成蜜丸。
疝气详见寒疝篇之下。狐疝，是说它出没不定，像狐狸的样子，即下文所说的偏大偏小、上下移动的意思。称为“阴狐疝”，单指前阴的睾丸而言，以此来区分五脏的疝病。肾是水脏，阳气最宝贵，容易与阴寒相召。阳气偏于虚实，虚的地方寒气侵入而偏大，实的地方阳气自持而偏小。又因为阳主提举，气虚不能自举，所以躺下时睾丸缩入少腹，站起来时下坠入囊中。蜘蛛腹部大，是专治睾丸缩入少腹的药物，且其性主提携束缚，配合辛温生气的桂枝，就能温补关元、气海的阳气，驱除客寒，获得升举收敛的功效，使松弛下坠的睾丸坚实，阴狐疝病哪有不好的道理呢？
问：腹痛有虫的病人，如何从脉象上辨别？老师说：腹中痛，脉象应当沉或弦，反而洪大，所以是有蛔虫。
这是在讲病虫的脉象。意思是说，腹痛的原因很多，如果是因虫病而痛，脉象应该用什么来区别呢？老师说，沉脉主里，腹中病，脉象应当应沉；弦脉主急痛，腹中痛，脉象应当沉而且弦。现在不沉不弦反而洪大，洪大是气乱的表现，所以知道有虫，因为虫扰乱了气机而作痛，这与风寒积滞的脉象不同。
蛔虫引起的病，使人吐涎沫，心痛，发作有时，服用毒药无效，用甘草粉蜜汤主治。
甘草粉蜜汤方：甘草（二两）、粉（一两）、蜜（四两）。
上三味药，用水三升，先煮甘草，取二升，去渣，加入粉和蜜，搅拌调和，煎成稀粥状，温服一升，病愈即停服。
这与下面两条都是讲治疗虫病的例子，但下一条责在于脏寒，脏寒导致蛔虫上膈，所以心烦且四肢厥冷，温补后蛔虫下行安定，病就好了，所以乌梅丸除了温脏之外，只用辛辣酸苦等味道，让蛔虫低头蜷缩而已。这是因饮食相犯而生成的蛔虫，责在于虫多。虫多则胃系松弛而廉泉开，所以吐涎沫；蛔虫上扰胃脘，胃脘正当心部，所以感觉像心痛。虫子活动后自己疲劳，就潜伏休息，所以发作有时。毒药是虫子不吃的，所以无效。这不是去掉虫子不行。胡粉（粉是由黑铅转化而成的），体重，且性能杀虫，与甘草、蜂蜜一起煮，虫子是脾胃土气化生的，且性嗜甜，因为吃了含粉的甜食，变得沉重而死，所以病愈。因为脏不寒，所以在杀虫之外没有其他药物。
蛔厥病，应当吐蛔虫，让病人安静下来却又自行感到心烦，这是因为脏寒，蛔虫上入膈部，所以心烦，一会儿又停止。吃东西后呕吐又心烦的，是因为蛔虫闻到食物气味出来，这个人应当会自己吐出蛔虫。蛔厥病，用乌梅丸主治。
乌梅丸方：乌梅（三百个）、人参（六两）、当归（四两）、桂枝（六两）、附子（六两，炮制）、干姜（十两）、细辛（六两）、川椒（四两，去汗）、黄连（十六两）、黄柏（六两）。
上十味药，分别捣碎筛过，混合在一起。用醋浸泡乌梅一夜，去核蒸熟，放在五升米饭下煮熟，捣成泥，与药末混合均匀，放入臼中与蜜杵两千下，制成梧桐子大小的丸药。饭前饮服十丸，每日三次，逐渐增加到二十丸。禁止吃生冷、滑腻、臭秽等食物。
关于方义的论述，注解见《伤寒论》厥阴篇。
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*.