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Volume 16 is originally missing. This content was lost during the circulation in the early Yuan Dynasty.

Zhang Zhongjing stated: Among the Taiyang diseases caused by Shanghan (Cold Damage), there are three types: Zhongfeng (Wind Strike), Zhongshi (Dampness Strike), and Jing (Spasm). They should theoretically be discussed separately because their symptoms resemble those of Shanghan, hence they are listed together. Guo Yong said: The following two volumes discuss diseases that resemble Shanghan but are not true Shanghan. Zhongshi (Dampness Strike) is listed first. All three conditions occur in the Taiyang channel and are difficult to distinguish from Shanghan. Therefore, Zhang Zhongjing discusses them before Shanghan, because if one cannot first distinguish these three conditions, one certainly cannot distinguish Shanghan. Sun Simiao also held this view. Recent medical theories have categorized these diseases among miscellaneous diseases with suspected similarities. However, these suspected diseases are not contracted via the Taiyang channel. Thus, Zhang Zhongjing placed Zhongshi (Dampness Strike) first because it shares the same channel as Shanghan, has the same root cause, and presents many similar symptoms. Misdiagnosis and mistreatment can lead to death, so it is necessary to address it first. After detailed discussion here, to avoid confusing the treatment methods of Shanghan, I have followed recent descriptions to place Zhongshi (Dampness Strike) and similar items in a separate volume, while attaching other suspected diseases to the subsequent volume, thereby distinguishing them.

Guo Yong said: My elder brother, Ziruoming, who was proficient in medicine, often suspected that the character "Jing" (Spasm) in medical classics was a transcription error for a single character. Books from the Han and Jin dynasties all wrote it as "Chi" (Stiffness/Tetanus-like state). For example, Zhang Zhongjing said: "In Jie Xiong (Chest Binding) disease, the neck is also stiff, resembling the state of Rou Chi (Soft Stiffness)." *Qianjin Fang* records: "The neck is also stiff, resembling the state of Rou Jing (Soft Spasm)." The transcription error between these two characters is evident. However, both *Suwen* and *Lingshu* mention "Chi" as a disease, which is different from "Jing". Since Zhang Zhongjing's time, various books have instances where "Chi" should be used or "Jing" should be used. Later transcribers ceased to distinguish them. During the Zhenghe era, my father was residing in the capital when a servant fell ill. Liu Yin from Dongping diagnosed him. Liu said: "This is Chi disease." It was cured after treatment. When asked about the difference between Chi and Jing, Liu said: "When it occurs at regular intervals, it is called Jing; when it does not occur at regular intervals, it is called Chi." Later, upon returning to Luoyang, my elder brother suffered from Shanghan. After sweating, he experienced spasms at regular intervals. Following Liu's advice, my elder brother used Pang Shi's Gegen Plus Mahuang Decoction and recovered. Liu's words do not appear in various medical books. Dongping was formerly home to many famous doctors, so his words must have a source. Later, after Guo Yong read extensively through medical classics, he realized that Liu's words were reasonable but incomplete. Generally, the confusion between these two characters is common. In Han and Jin books, some instances should be "Chi" and others "Jing". In Sui and Tang books, there are also cases for both. Only then did I realize that "Jing" ultimately refers to two distinct concepts. "Chi" is a disease name, like Zhongfeng (Wind Strike) or Shanghan. "Jing" is a symptom name, like Jie Xiong (Chest Binding) or Pi Qi (Abdominal Fullness). When referring to the three diseases of Zhongfeng, Zhongshi, and Jing, "Chi" is the disease name and cannot be substituted with "Jing". Cang Gong's Danggui Decoction states: "Mainly treats Zei Kou (Thief's Mouth/Jaw Lock), trismus, opisthotonos, and Jing." Thus, "Jing" is a symptom within the disease of spasm, not "Chi". Generally, "Jing" refers to the disease of meridians and sinews being stiff and causing opisthotonos, so it is a symptom within a disease. Therefore, various Wind diseases have Jing, Shanghan has Jing, and Chi diseases may or may not have Jing. Generally, Chi is mild, Jing is severe, and Chi accompanied by Jing is even more severe. Although Liu did not distinguish between disease names and symptom names, Chi does not occur at fixed times, so patients may remain unconscious for days. Jing occurs and stops spontaneously. Sun Simiao's statement about "occurring dozens of times in a short while" corresponds to the distinction between occurring and not occurring at fixed times. Thus, Guo Yong considers "Chi" as the disease name and "Jing" as the symptom name, exploring the origin. Liu's distinction based on timing explores the manifestation. *Huren Shu* also mentions "Yin Yang Er Chi". This statement is not ancient and likely originated later. Guo Yong speculates that the "Chi" in Gang Chi (Hard Stiffness) is named Yang, and the "Chi" in Rou Chi (Soft Stiffness) is named Yin. Zhu Shi mentioned Yin Yang Er Chi but did not clearly distinguish them, merely stating that Yang belongs to Gang and Yin belongs to Rou. He did not detail the symptoms and prescriptions.

Zhang Zhongjing said: In Taiyang disease, if the pulse is deep and fine, it is named Chi.
He also said: In Taiyin disease, with fever, no sweat, and aversion to cold, it is named Gang Chi.
He also said: In Taiyang disease, with fever, sweating, and no aversion to cold, it is named Rou Chi. Chao Yuanfang said: Rou Chi involves aversion to cold. Guo Yong said: Upon detailed examination, Gang Chi is identical to Taiyang Shanghan symptoms, and Rou Chi is identical to Taiyang Zhongfeng symptoms. However, Shanghan presents with a floating and tight pulse, Zhongfeng with a floating and slow pulse, and Chi disease with a deep and fine pulse. They should be distinguished by pulse.
He also said: If a patient has body heat, cold feet, stiff and urgent neck and back, aversion to cold, occasional head heat and red face, red eye vessels, only head trembling, sudden trismus, and opisthotonos, it is Jing disease. Guo Yong said: Here, "Chi" is a typo for "Jing".

Question: How is Chi disease contracted? *Suwen* Chapter 37 states: Lung transferring heat to Kidney transforms into Rou Chi. Zhang Zhongjing said: In Taiyang disease, excessive sweating leads to Chi.
He also said: Patients with sores, even if experiencing body pain, should not induce sweating; if sweated, Chi will result. Wang Shuhe said: In Wind disease, purgation followed by sweating causes stiffness. These are all causes of Chi. *Qianjin Fang* states: Previous wind injury followed by cold-dampness invasion causes Chi. Thus, Rou Chi may also present without aversion to cold but with aversion to wind.

Question: What is the pulse of Chi disease? Zhang Zhongjing said: Deep and fine. Wang Shuhe said: Hidden, firm, straight up and down.
He also said: The pulse feels pounding and wiry when pressed, moving straight up and down. Chao Yuanfang said: Crisp and wiry, moving straight up and down, is the Wind Chi pulse. Hidden, firm, straight up and down, is the Chi pulse accompanied by Jing. Pounding and wiry, crisp and wiry, are both disease pulses. "Zhu" and "Ce" might be errors for the same character.

Question: How to treat Chi disease? Wang Shuhe said: In Taiyang disease, with no sweat, yet urine is scanty, qi rushes to the chest, trismus prevents speech, indicating impending Gang Chi, use Gegen Decoction. Guo Yong said: Since Wang Shuhe discussed the treatment for Gang Chi, he should next discuss Rou Chi, but he does not. When discussing Gang Chi again, with chest fullness, trismus, inability to lie flat, leg cramps, and teeth grinding, Da Chengqi Decoction may be given. Guo Yong believes this symptom is not in Zhang Zhongjing's original *Shanghan Lun*, suspecting it is not Wang Shuhe's words. Blindly following it could be fatal. Da Chengqi Decoction is not for treating Gang Chi. Even for various Jing conditions, it is contraindicated. Generally, Chi is Taiyang Zhongfeng complicated by cold-dampness. Taiyang is exterior, Zhongfeng is exterior, and cold-dampness is exterior. Purging is contraindicated. The pulse is deep, fine, hidden, and wiry, also contraindicating purging. Chest fullness suggests cold or deficiency bloating; trismus and inability to lie flat are Taiyang Zhongfeng symptoms; leg cramps indicate curling of legs and cold in the bladder. None warrant Da Chengqi Decoction; using it would be fatal. Pang Shi and Zhu Shi failed to correct this, likely fearing to delete Wang Shuhe's words. Zhu Shi added "cautiously," showing doubt. I have seen ignorant physicians use this formula to kill people. Silence is culpable. So, what medicine treats Rou Chi? Answer: Pang Shi uses Modified Gegen Plus Mahuang Decoction for Gang and Rou Chi. Add Mahuang for no sweat; remove Mahuang and add more Gegen for spontaneous sweating. Zhu Shi uses Guizhi Plus Gegen Decoction for Rou Chi. These are appropriate treatments. Wang Shuhe said: In Taiyang disease, with complete symptoms, body stiffness, yet pulse is deep and slow, this is Chi. Use Gualou Guizhi Decoction. Pang Shi said: Gualou does not treat neck stiffness directly; its purpose is to clear Lung heat to prevent transfer to Kidney. Add four liang of Gualou to Guizhi Decoction. Guo Yong said: If Pang is correct, then the condition involving heat transfer is Rou Chi. Do sore-patients and wind-patients with Chi respond similarly? One must examine symptoms carefully. I have seen Taiyang Shanghan patients with excessive sweating developing Chi, who recovered with this formula.

*Qianjin Fang* states: Severe cases suffer from crisp pain in the ears, indicating wind entering the Kidney channel. If untreated, wind enters Kidney, causing sudden body stiffness and spasm. Such cases should take Xiao Xuming Decoction for two to three doses. Guo Yong said: It can only be taken if there is no sweat.
He also said: Needle the arterial pulse in front of the ear and Fengfu point for good results. Guo Yong said: These two points are difficult to locate accurately. The arterial pulse is below Kezhuren; accidental puncture into the vessel causes internal bleeding and deafness. Fengfu is between Naohu and Yanmen; accidental puncture can be fatal. Yanmen and Fengfu are forbidden for needling. Practitioners must exercise caution.
He also said: For Gang and Rou Chi, use Modified Gegen Plus Mahuang Decoction. Remove Mahuang and add more Gegen for spontaneous sweating. Guo Yong said: This formula is only recorded by Pang Shi.
He also said: Chi disease should not be treated with heavy sweating or acupuncture; light sweating is suitable. Wang Shuhe said: Chi disease with moxibustion scars is difficult to treat. Guo Yong said: Generally, sore-patients avoid moxibustion. Only Sun Simiao said that if ear pain swells with pus forming an abscess, it is harmless. Wind should be prevented from affecting the ears, as ears can drain Kidney qi. Jing is similar.
*Huren Shu* states: Rou Chi is treated with Guizhi Plus Gegen Decoction. Guo Yong said: This is Zhang Zhongjing's formula for Taiyang disease with sweating. Zhu Shi adopted it because Wang Shuhe lacked treatment formulas for Chi. If so, Gang Chi should properly use Pang Shi's Gegen Plus Mahuang Decoction. Zhu Shi, citing *Qianjin Fang*, recommends Xiao Xuming Decoction for both Chi types. This can be a standard method. For severe heat threatening to enter Kidney, leading to Jing, use Wang Shuhe's Gualou Guizhi Decoction.
Wang Shuhe said: After sweating in Chi disease, if the pulse moves like a snake and sudden abdominal distension occurs, it indicates resolution. If the pulse remains unchanged but becomes hidden and wiry, it will definitely transform into Jing. Why say it transforms into Jing? Guo Yong said: "Bi" (must) should be "Bi Jing" (must become Jing) for the meaning to make sense. This refers to Chi disease complicating with Jing.

Question: What are the details of Chi disease? Sun Simiao said: Taiyang Zhongfeng complicated by cold-dampness transforms into Chi. Chi presents with trismus, straight back, resembling epilepsy, head shaking, horse neighing sound, waist hyperextension, occurring dozens of times in a short while, breath like a thread, profuse sweating, occasional collapse. It is easily contracted. Guo Yong said: This is precisely what is called Jing. Jing co-occurs with other diseases without a primary disease itself; it may arise from Zhongfeng, Shanghan, or Chi. Treatments are similar, generally using Gegen Xuming Decoction.

Question: Why do women and children often suffer from Chi? Sun Simiao said: Postpartum women, patients with metal wounds and depleted blood vessels, infants with umbilical wind, adults with damp-warmth, contracting Jing-feng, all die. Also, heat diseases entering Kidney cause Chi. Infants with epilepsy and high fever also develop Chi. Guo Yong said: These two types are treatable Chi.

Question: How does Feng Yin (Wind Aphasia) resemble Jing? Sun Simiao said: Feng Yin, sudden corpse-cold, ghost oppression with unconsciousness, prolonged coma, or mania all resemble Jing. Careful differentiation is needed. Guo Yong said: Feng Yin, sudden corpse-cold, and ghost oppression involve unconsciousness, resembling Chi. Epilepsy resembles Jing. Thief's mouth with trismus and spasm is called Wind Jing, treated with Cang Gong Danggui Decoction. Pang Shi said: Chi patients unable to lie flat, infants with back arching two fingers off the bed, adults with hands extending beyond palms, are difficult to treat. Guo Yong said: Difficult but treatable, not incurable. If Chi stiffness does not progress to Jing, it is fortunate. I have seen opisthotonos extending beyond palms recover. I have seen trismus resembling Jing, with slight consciousness, sitting and jerking backward, also Wind Chi, recovered with Cang Gong Danggui Decoction.

Question: How to distinguish Chi and Jing using classics? Guo Yong said: *Suwen* Chapter 45 states: Hand Yangming and Shaoyang reversal causes throat obstruction, painful throat, swelling, and Jing. This Jing is not related to Foot Taiyang. Quan Yuanqi's version writes "Jing". Generally, all meridians can have Jing, but only Foot Taiyang has Chi.

Question: Why does Chao Yuanfang distinguish Wind Chi and Shanghan Chi? Guo Yong said: *Lingshu* states: Nine heat diseases unsuitable for needling. Second: Heat with Jing is fatal, with waist hyperextension, convulsions, and trismus. This is Shanghan Chi.
He also said: Wind Jing, with body hyperextension, treat by bleeding Foot Taiyang, Danzhong, and blood collaterals. This is Wind Chi. *Lingshu* mentions two types of Chi, so Chao Yuanfang distinguishes them. I have seen heat disease patients developing Chi after sweating, recovering with Gualou Guizhi Decoction. The classic says heat with Chi is fatal, implying pre-sweating Chi. The heat intensity differs.

Guo Yong said: Pang Shi stated that excessive sweating leads to deep sleep, where sweat turns to cold-damp qi, re-attaching to Taiyang channel, causing Chi. Zhu Shi stated previous wind injury followed by cold-dampness causes Jing. Both describe prior disease transformation leading to Chi, which is a symptom of Jing. As Zhang Zhongjing said, Taiyang disease with fever/no sweat/aversion to cold, or fever/sweating/no aversion to cold, are the proper presentations of Chi.
Zhu Shi also said: Shu Fu San, Guixin Baizhu Tang, Fuzi Fangfeng San, Bawei Baizhu San, Guizhi Zhusan can be selected based on symptoms. Since the pathogenic factors vary, selection must be symptom-based. However, due to the confusion between Chi and Jing, few texts clarify this. Recent theories lack precision. Fortunately, treatments for the two are not vastly different; otherwise, it would be a major error. Guo Yong adopts Zhu Shi's Guizhi Plus Gegen Decoction for Rou Chi, Pang Shi's Gegen Plus Mahuang Decoction for Gang Chi, Wang Shuhe's Gegen Decoction for impending Gang Chi, and Gualou Guizhi Decoction for severe heat Chi. Generally, Xuming Decoction is suitable. *Qianjin Fang* uses it for Jing, Zhu Shi for Chi. This difference needs no doubt. Chi and Jing both use it, especially for non-sweating cases.

Guo Yong said: Both diseases occur frequently. Treating them solely as Shanghan or Wind often fails. Wind is closer but not exact. I personally observed several cases. One initially resembled Shanghan; after a few days, became unconscious, seemed soft, not very stiff, occasionally with or without trismus. I considered this Chi. Another resembled Shanghan; after a few days, developed intermittent opisthotonos, with trismus and unconsciousness during attacks, recovering slightly between attacks. I considered this Jing.
Another case: After Shanghan sweating, while sitting and talking, suddenly stared with trismus. Limbs remained stiff and immobile for a moment, then relaxed, repeating dozens of times. Speech returned between episodes. I attributed this to excessive sweating causing Shanghan Jing. Recovered with Guizhou Gualou Decoction.
Another infant resembled wind injury; after one to two days, became unconscious, lying still, silent, refusing food. This was Chi. Suddenly limbs stiffened, trismus occurred, hands and feet swelled and fingers opened, then stabilized and softened, remaining unconscious. I considered this Chi complicating with Jing.
Another villager, after two to three days of illness, had trismus, body stiffness, and opisthotonos. Arms and legs felt longer than usual. Slightly conscious, making sounds through clenched teeth, confused, drinking cold water but seeking fire warmth, picking at clothes and bed air. Symptoms were bizarre. I realized it was Jing. Applied Dayanmi Tang to teeth, opening mouth quickly. Administered Xuming Decoction multiple times, resulting in recovery. The villager endured the illness; imagine how a noble would fare.
A father and son sat indoors, refusing to go out. Neighbors said "Lockjaw Wind". Investigation showed them gripping a horizontal beam. When the illness struck, they released and collapsed, then woke and sat up, repeating this. Treated with Cang Gong Danggui Decoction. The son recovered; the father, frail and old, did not survive. Asked about the wind's path, it started from feet, ascended Taiyang channel, passed Danzhong, split at thighs. One branch went up outer thigh to waist, causing sudden side-falling; the other went up inner thigh to lower abdomen. Classics show no such branch in Taiyang, likely entering Shaoyin.
Another person walking looked up three times, then collapsed. Carried home with opisthotonos, died after days. Symptoms varied greatly, sometimes with intervals. Cannot record all. Experience shows Chi is mildly soft; Jing is extremely stiff. Predecessors did not fully describe this. My detailed account may be disordered.