强直反张之病,名痉病。按痉病与伤寒相类,但多项背反张为异。治分表里阴阳、虚实寒
热。《金匮》以太阳发热,无汗恶寒,名刚痉,发热有汗不恶寒,名柔痉。此以有汗无汗,
别寒湿伤营、风湿伤卫而定名者,虽不明言发汗解肌,然细玩首章原文,以有汗无汗立说,
仍暗度金针于太阳伤寒发汗解肌同条处治。但痉病不独在冬月,三时皆有者,故不明示麻桂
辛温,发汗解肌。又因痉劲强直,多有营卫不充,外冒外淫致病,用不得大汗发表。故下章
云∶太阳病,发热脉沉而细者,名曰痉,为难治。盖言太阳发热之痉,惟以散表为正治。今
以脉沉而细,用不得散表,则难治矣。是此可见太阳发热之痉,设脉浮紧而大者,仍可用散
表方法而不曰难治矣。下文又言太阳病发热无汗之病,本宜发汗,若脉沉而细,大发其
汗,因汗太多,亦能致痉。若发热有汗之中风症,脉沉而细者,下之亦能致痉。疮家虽身疼
痛,若脉沉而细者,误发汗亦成痉。即太阳病症备,若脉沉迟,止用栝蒌桂枝汤。再三告戒
脉沉而细者,汗下俱禁者也。然下文云∶太阳病无汗,而小便反少,气上冲胸,口噤不得
语,欲作刚痉,葛根汤主之。按此条但言无汗,不言脉沉细,故仍用葛根、麻黄,以发太阳
阳明之表,明示首章发热无汗反恶寒之刚痉,若脉不沉细,仍用发表治法。下文云∶痉为
病,胸满口噤,卧不着席,脚挛急,必介齿,可与大承气汤。按此条不言无汗,不言脉沉
细,明示首章发热有汗之柔痉,若脉不沉细而实大,仍可用大承气汤以下者。首章恐痉病之
脉有沉细者,即无汗表症之刚痉,亦用不得麻黄汤。即有汗发热之柔痉,亦用不得桂枝汤。
此章恐发热无汗,脉大不沉细之刚痉,应汗失汗,故复立葛根麻黄汤。又恐发热有汗,脉数
不沉细之柔痉,应下失下,故复立大承气汤。两面告诫,可见仲景惟以病之无汗有汗,脉之
浮细浮大,沉细沉实,端在表里虚实,详示发表攻里者也。海藏有口噤,背反张,名太阳痉。
低头下视,名阳明痉。一目左右斜视,手足搐搦,名少阳痉。其意欲以背为太阳,胸前为阳
明,目之斜视左右为少阳,以定经络。然项强之症,属阳明者多,而阳明之脉入目,阳明之
脉左右交加。两目亦能斜视,未可以此为定论。丹溪有人参、竹沥主治者,此因内伤痉病,
血液枯燥,经络不润成之故耳。薛新甫有泻青丸、异攻散、六味丸、逍遥散、四物、归脾、
三乙承气,家秘用舒筋汤等,此皆内伤痉病,分别虚实补泻,而非外感六淫致痉之条也。今
余详注仲景之痉病于前,次述三公之论于后,则外感六淫,内伤致痉诸条皆全矣。余读《伤
寒论》,见仲景以冬月伤寒立论,但榜及风湿、风温,而不及三时之寒热等病,读《金匮》痉
病论,见以中湿、湿热、中 等症,次列于后。余今着《伤寒大白》,比例《金匮》痉病论,
先以伤寒、寒热、温热病立论卷首,兼以发 、夹食、痉病。次附于后,则外感致病诸条皆
全矣。
The disease characterized by stiffness and opisthotonos (backward arching of the body) is named Jing Disease (Spasm). Upon examination, Jing Disease resembles Shanghan (Cold Damage), but differs in that it predominantly features backward arching of the back. Treatment must differentiate between exterior/interior, yin/yang, deficiency/excess, and cold/heat. The *Jingui Yaolue* states that Taiyang disease presenting with fever, anhidrosis (absence of sweating), and aversion to cold is named Gang Jing (Stiff Spasm); fever with sweating and no aversion to cold is named Rou Jing (Soft Spasm). This nomenclature distinguishes between Cold-Dampness injuring the Ying (Nutritive) level and Wind-Dampness injuring the Wei (Defensive) level based on the presence or absence of sweating. Although the text does not explicitly mention diaphoresis (sweating-inducing therapy) or releasing the muscle layer, careful study of the original text of the first chapter reveals that establishing the theory based on sweating versus non-sweating implicitly suggests treating Taiyang Shanghan via both diaphoresis and releasing the muscle layer under the same principles. However, Jing Disease occurs not only in winter but also in spring, summer, and autumn; therefore, acrid-warm herbs like those in Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) for inducing sweat and releasing the muscle layer are not explicitly prescribed. Furthermore, because Jing Disease involves rigid spasms, often due to insufficiency of Ying and Wei levels and invasion by external pathogens, drastic diaphoresis to release the exterior is contraindicated. Hence, the next chapter states: "Taiyang disease, with fever and a deep, thin pulse, is named Jing Disease, and is difficult to treat." This implies that for Jing Disease caused by Taiyang fever, dispersing the exterior is the correct treatment. If the pulse is deep and thin, dispersing the exterior cannot be used, hence it is difficult to treat. From this, we can see that if Taiyang fever-induced Jing Disease presents with a floating, tight, and large pulse, dispersing the exterior method can still be used, and it would not be termed difficult to treat. The following text further states: For Taiyang disease with fever and anhidrosis, sweating should originally be induced; however, if the pulse is deep and thin, inducing heavy sweating may lead to Jing Disease due to excessive fluid loss. For wind-strike syndrome with fever and sweating, if the pulse is deep and thin, purgation may also induce Jing Disease. Patients with sores who experience body pain, if the pulse is deep and thin, mistaken diaphoresis will also result in Jing Disease. Even if all Taiyang disease symptoms are present, if the pulse is deep and slow, only Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) should be used. The repeated warning regarding deep and thin pulses indicates that both diaphoresis and purgation are prohibited. However, the following text states: "Taiyang disease with anhidrosis, accompanied by scanty urination, qi rushing upward to the chest, trismus (lockjaw), and inability to speak, indicating impending Gang Jing, is treated with Gegen Tang (Kudzu Decoction)." This clause mentions only anhidrosis, not a deep/thin pulse; thus, Gegen and Mahuang are still used to release the exterior of the Taiyang and Yangming channels. This clearly indicates that for Gang Jing with fever, anhidrosis, and aversion to cold from the first chapter, if the pulse is not deep and thin, exterior-releasing methods remain applicable. The following text states: "In Jing Disease, if there is chest fullness, trismus, inability to lie flat (body does not touch the bed), calf cramping, and teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be given." This clause mentions neither anhidrosis nor a deep/thin pulse, clearly indicating that for Rou Jing with fever and sweating from the first chapter, if the pulse is not deep and thin but rather solid and large, Da Chengqi Tang can still be used for purgation. The first chapter warns that if Jing Disease presents with a deep/thin pulse, even Gang Jing with exterior signs cannot use Mahuang Tang. Similarly, Rou Jing with fever and sweating cannot use Guizhi Tang. This chapter warns that for Gang Jing with fever, anhidrosis, and a large, non-deep/thin pulse, if sweating was indicated but missed, Gegen Tang and Mahuang-containing formulas are re-established. It also warns that for Rou Jing with fever, sweating, and a rapid, non-deep/thin pulse, if purgation was indicated but missed, Da Chengqi Tang is re-established. These dual warnings show that Zhang Zhongjing relies on the presence or absence of sweating, and whether the pulse is floating/thin, floating/large, deep/thin, or deep/solid, to determine interior/exterior and deficiency/excess, thereby detailing exterior-releasing and interior-purging methods. Haizang (Zhang Yuansu) defines mouth locking and opisthotonos as Taiyang Jing; head drooping and downward gaze as Yangming Jing; unilateral strabismus and limb convulsions as Shaoyang Jing. His intent seems to be assigning the back to Taiyang, the anterior chest to Yangming, and eye deviation to Shaoyang to define meridian involvement. However, neck stiffness frequently belongs to Yangming; the Yangming meridian enters the inner canthus, and its pathways cross bilaterally. Both eyes can deviate, so this cannot be taken as an absolute conclusion. Danxi (Zhu Zhenheng) advocated Ren Shen (Ginseng Radix) and Zhu Li (Bambusa Textilis Sap) for treatment, which applies to internal injury-induced Jing Disease where blood dryness fails to nourish the meridians. Xue Xinpu (Xue Ji) utilized Xie Qing Wan (Drain Green Pill), Yi Gong San (Differentiated Attack Powder), Liuwei Wan (Six-Ingredient Pill), Xiaoyao San (Free and Easy Wanderer Powder), Siwu Tang (Four Substance Decoction), Guipi Tang (Restore the Spleen Decoction), San Yi Chengqi Tang, and his family secret Shujin Tang (Relax Tendons Decoction). These are all for internal injury-induced Jing Disease, differentiating deficiency/excess for tonification/purgation, and do not apply to Jing Disease caused by external Six Evils. Now, I have detailed Zhongjing’s discussion on Jing Disease previously, and subsequently described the theories of these three masters, thereby covering all aspects of external Six Evils and internal injuries causing Jing Disease. Reading the *Shanghan Lun*, I saw Zhongjing established his theory on winter Shanghan, mentioning Wind-Damp and Wind-Warmth, but omitting cold/heat diseases of other seasons. Reading the *Jingui Yaolue* Jing Disease chapter, I saw Zhongshi (Damp Strike), Damp-Heat, and Zhongshu (Heat Stroke) listed later. In my work *Shanghan Dabai*, comparing the *Jingui Yaolue* Jing Disease chapter, I first establish the opening volume with theories on Shanghan, Cold-Heat, and Warm-Thermal diseases, supplementing with Ban (Maculae/Rash), Jia Shi (Food Retention), and Jing Disease appended afterward, thus completing the coverage of all externally contracted pathogenic conditions.