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Neck stiffness (Xiang Qiang) presents with distinctions between Shanghan (Cold Damage) and Jingbing (Spasm Disease). To discuss neck stiffness caused by Shanghan, one must reference neck stiffness caused by Jingbing to mutually elucidate the details.

As stated in the general discussion of Shanghan regarding neck stiffness: The primary characteristics of Taiyang disease are a floating pulse, headache and neck stiffness, and aversion to cold. In its specific discussion: If Taiyang disease presents with fever, neck stiffness, sweating, and a slow pulse, it is Wind Strike (Zhong Feng); if Taiyang disease presents with headache, neck stiffness, fever, body pain, lower back pain, aversion to cold, no sweating, and a floating-tight pulse, it is Cold Damage (Shang Han). Regarding Jingbing in the *Jin Gui Yao Lue*, the general discussion states: Taiyang disease with a stiff and rigid body (KT KT ran), a pulse that is surprisingly deep and slow, fever in the body but coldness in the hands and feet, acute neck stiffness, isolated head shaking, sudden lockjaw (Kou Jin), and opisthotonos (Bei Fan Zhang) is named Jingbing. Its specific discussion states: Taiyang disease with fever, no sweating, head and neck stiffness, and paradoxical aversion to cold is named Gang Jing (Stiff Spasm); Taiyang disease with fever, sweating, and absence of aversion to cold is named Rou Jing (Soft Spasm). Analyzing the meridians, neck stiffness in Shanghan belongs to the exterior syndromes of the Three Yang meridians, whereas neck stiffness in Jingbing involves various entries across the interior and exterior of the Three Yang and Three Yin meridians; this constitutes the distinction of the syndrome. Analyzing the pulse qualities, the Shanghan section mentions: floating-tight pulse, floating-slow pulse; the Jingbing section mentions: deep-thin pulse, deep-slow pulse; this constitutes the distinction of the pulse. Analyzing the treatment methods, in the Shanghan section, Zhang Zhongjing addresses Taiyang disease with stiff and rigid neck and back (KT KT ran), no sweating, aversion to cold, and floating-tight pulse by using Mahuang Jia Gange Tang (Ephedra Decoction plus Pueraria) in winter, while Tao Shi extended this to use Fangfeng Qianghuo Tang (Saposhnikovia and Notopterygium Decoction) for the other three seasons. Currently, I replace it with Qianghuo Jia Gan Gen Tang (Notopterygium plus Pueraria Decoction) to treat neck stiffness from Shanghan without sweating using exterior-releasing herbs. If Taiyang disease presents with stiff and rigid neck and back (KT KT ran), paradoxical sweating and aversion to wind, and a floating-slow pulse, Guizhi Jia Gange Tang (Cinnamon Twig Decoction plus Pueraria) is used in winter; Tao Shi extended this to Ji Jian Chonghe Tang (Modified Harmonizing Decoction). Currently, I replace it with Fangfeng Jia Gegen Tang (Saposhnikovia plus Pueraria Decoction) to treat neck stiffness from Wind Strike with sweating using wind-dispelling herbs. In the Yangming stage, with eye pain, nasal dryness, and insomnia, Tiaomai Gange Tang (Regulating Pulse Pueraria Decoction) is the primary treatment. In the Shaoyang stage, with body heat, aversion to wind and cold, head and neck stiffness, and chest and hypochondriac fullness, Qianghuo Fangfeng Chaihu Tang (Notopterygium, Saposhnikovia, and Bupleurum Decoction) is the primary treatment. For neck stiffness due to Wind-Warmth, Fangfeng Shigao Tang (Saposhnikovia and Gypsum Decoction) is used. For neck stiffness due to Wind-Dampness, Cangfang Tang (Atractylodes and Saposhnikovia Decoction) is used. For neck stiffness due to Damp-Warmth, Shenzhu Tang (Divine Atractylodes Decoction) is used. The above outlines the distinctions in treatment methods for various types of neck stiffness in Shanghan.

Regarding the discussion of neck stiffness in Jingbing, the *Jin Gui Yao Lue* states: When a patient has body heat, cold feet, acute neck stiffness, aversion to cold with simultaneous head heat, red face and eyes, isolated head movement, sudden lockjaw, and opisthotonos, it is Jingbing. If sweat-inducing methods are mistakenly applied, cold and dampness combine, further weakening the exterior, leading to severe aversion to cold; after sweating, the pulse becomes wiry and winding like a snake. For neck stiffness in Shanghan with body heat, cold feet, and aversion to cold, Mahuang Tang (Ephedra Decoction) is the primary treatment. However, for current cases of Jingbing neck stiffness with red eyes, lockjaw, and opisthotonos, where blood fluids are exhausted and tendons lose nourishment, presenting with a thin pulse, Mahuang Tang must not be mistakenly used. Therefore, the text later states: Taiyang disease with complete symptoms and a stiff, rigid body (KT KT ran) closely resembles Taiyang Shanghan; however, if the pulse is not floating, urgent, and large, it is not Shanghan, and Mahuang should not be used. If the pulse is surprisingly deep and slow, it is Jingbing, and Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) should be used. The text further states: In Taiyang disease, if there is no sweating but urination is surprisingly scanty, qi rushes upward to the chest, and there is lockjaw preventing speech, indicating impending Gang Jing, Gegen Tang (Pueraria Decoction) is the primary treatment. Neck stiffness in Taiyang without sweating is originally an indication for sweating via Mahuang Tang; however, because qi rushes to the chest and lockjaw prevents speech, it also involves Yangming symptoms. Thus, Gegen Tang is used to simultaneously release pathogens from both the Taiyang and Yangming meridians. If Gegen is neglected to clear Yangming exterior pathogens, and cold-cooling herbs are used to clear the interior instead, lockjaw and muteness may progress to grinding teeth (Jie Chi). This shows that Jingbing without sweating can sometimes be treated with sweating, but due to the deep-slow pulse, Mahuang cannot be easily used for sweating. Nevertheless, neck stiffness in Jingbing can also have indications for purging. The text later states: For Jingbing with chest fullness, lockjaw, inability to lie flat (opisthotonos), leg cramps, and grinding teeth, Da Chengqi Tang (Major Order of the Qi Decoction) can be used. This indicates that in Jingbing, if exterior pathogens are fully resolved and only chest fullness, lockjaw, inability to lie flat, leg cramps, and grinding teeth remain—a pattern of interior heat accumulation—Da Chengqi Tang can be administered. According to this, the *Jin Gui Yao Lue* establishes Gualou Guizhi Tang to harmonize Ying and Wei, clear phlegm, and purge heat, serving as a muscle-relaxing and harmonizing formula; it establishes Gegen Tang to scatter exterior pathogens in Taiyang and Yangming, serving as an exterior-releasing formula for non-sweating Gang Jing; and it establishes Chengqi Tang to clear interior heat after the resolution of exterior pathogens in Yangming, serving as a purgative formula for sweating Rou Jing. In this way, the methods of sweating, purging, and harmonizing are all complete. This outlines the distinctions in treatment methods for various types of neck stiffness in Jingbing.

By comparing Jingbing neck stiffness with Shanghan neck stiffness, it becomes clear that neck stiffness should primarily be treated from the perspective of Taiyang exterior pathogens, utilizing the method of inducing sweating. Conversely, by comparing Shanghan neck stiffness with Jingbing neck stiffness, it becomes clear that neck stiffness can also be treated from the perspective of Yangming interior pathogens, utilizing the descending method of Chengqi Tang. Examining the miscellaneous diseases section, neck stiffness and pain with inability to look back, accompanied by a rapid and large right pulse, has been treated with Erchen Tang (Two-Cured Decoction) plus Qianghuo and Huangqin. Currently, I extend this to cases of neck stiffness accompanied by chest fullness, lockjaw, grinding teeth, and muteness, which may also be caused by phlegm stagnation and food retention, with a slippery and forceful pulse, treatable with Erchen Daotan Tang (Two-Cured Phlegm-Draining Decoction) or Pingwei Baohe San (Peace the Stomach and Preserve Harmony Powder). Lockjaw and grinding teeth often result from middle-jiao stagnation suppressed by cold-cooling herbs. Further examining the *Nei Jing*, which divides acupoints among the twelve meridians and establishes needling methods for treatment, it is known that neck stiffness can occur in all meridians and is not limited solely to Taiyang-Yangming exterior pathogens and interior heat.

Taiyang disease with stiff and rigid neck and back (KT KT ran), paradoxical sweating, and aversion to wind is treated with Guizhi Jia Gegen Tang (Cinnamon Twig plus Pueraria Decoction).
It is called Taiyang, not Yangming, yet adding Gegen implies involvement of Yangming without saying so. It does not explicitly say "wind injures Wei," yet using Guizhi Gegen Tang clarifies the syndrome of wind injuring Wei.

Taiyang disease with stiff and rigid neck and back (KT KT ran), no sweating, and aversion to cold is treated with Mahuang Jia Gegen Tang (Ephedra plus Pueraria Decoction).
It does not explicitly say "cold injures Ying," yet using Mahuang Gegen Tang clarifies that it is cold injuring Ying.

After taking Guizhi Tang, or after purgation, if headache and neck stiffness persist, with mild fever (Xi Xi Fa Re), no sweating, epigastric fullness, slight pain, and difficulty urinating, Guizhi Tang minus Guizhi plus Fuling and Baizhu Tang is used.
Headache and neck stiffness, mild fever: taking Guizhi Tang should induce sweating and reduce fever. Now, with persistent headache and neck stiffness, fever, no sweating, epigastric fullness and pain, and difficulty urinating, this indicates internal water-fluid retention, hence this formula is used.

In Shanghan on the fourth or fifth day, with body heat, aversion to wind, head and neck stiffness, hypochondriac fullness, warm hands and feet, and thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) is used.
Shanghan on the fourth or fifth day corresponds to the Shaoyang period. Body heat, neck stiffness, and hypochondriac fullness are Shaoyang symptoms. Warm hands and feet with thirst indicate the need to clear the Shaoyang interior and exterior, hence this formula is used.

Jie Xiong (Chest Binding) syndrome also presents with neck stiffness, resembling Rou Jing. After purgation, harmony is achieved, using Da Xianxiong Wan (Major Draining the Chest Pill).
This states that in Jie Xiong, neck stiffness also occurs, meaning Jie Xiong is complicated by neck stiffness. Resembling Rou Jing implies sweating exists without exterior pathogens, hence Da Xianxiong Wan is used.

When Taiyang and Shaoyang diseases occur together, with headache and neck stiffness, occasional dizziness resembling Jie Xiong, and epigastric hardness, needling the first space of Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated.
Sweating is contraindicated; sweating leads to delirium. If the pulse is wiry for five to six days and delirium persists, needling Qimen (LR14) is indicated.
Headache and neck stiffness are Taiyang symptoms. Dizziness resembling Jie Xiong and epigastric hardness are Shaoyang branch-binding symptoms, hence Taiyang and Shaoyang concurrent disease. Needling Feishu drains Taiyang pathology; needling Ganshu drains Shaoyang pathogens.

When Taiyang and Shaoyang diseases occur together, with epigastric hardness, neck stiffness, and dizziness, needling Dazhui (GV14) and Feishu (BL13) is indicated. Purging is strictly contraindicated.
In the previous entry, Shaoyang symptoms were predominant, hence Feishu and Ganshu were needled; here, Taiyang symptoms are predominant, hence only Feishu is needled to drain Taiyang. In the previous entry, Shaoyang symptoms were predominant, hence sweating was forbidden; here, Taiyang symptoms are predominant, hence purging is forbidden.

Mahuang Jia Gegen Tang (Ephedra plus Pueraria Decoction)
Gegen (Puerariae Radix), Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma), Shaoyao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Ziziphi Jujubae Fructus).
This is Zhongjing's formula for Taiyang syndrome with stiff and rigid neck and back (KT KT ran) and no sweating. Gegen is added because the neck is the intersection of the Three Yang meridians, and Yangming also governs this area.
However, since the acrid-warm nature is excessive, in the hot seasons of spring, summer, and autumn, a method of acrid-cool exterior release was established.

Guizhi Jia Gegen Tang (Cinnamon Twig plus Pueraria Decoction)
Guizhi (Cinnamomi Ramulus), Gegen (Puerariae Radix), Shaoyao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Ziziphi Jujubae Fructus).
This is Zhongjing's formula for Taiyang disease with stiff and rigid neck and back (KT KT ran) and sweating. Since both formulas add Gegen, neck stiffness indicates involvement of both Taiyang and Yangming. In the southern hot season, Qianghuo and Fangfeng can replace Guizhi.

Fangfeng Qianghuo Tang (Saposhnikovia and Notopterygium Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Chaihu (Bupleuri Radix), Gan Ge (Puerariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
Tao Shi uses this formula to replace Zhongjing's Mahuang Gan Ge Tang for Taiyang disease with stiff and rigid neck and back (KT KT ran), no sweating, and aversion to cold. In winter, add Shengjiang; in summer, add Shigao; if there is internal accumulated heat, add Chuanlian; if there is chest fullness and oppression, add Zhike and Houpo.

Qianghuo Jia Gegen Tang (Notopterygium plus Pueraria Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Gegen (Puerariae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Chuanxiong (Chuanxiong Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
For Taiyang stiff and rigid neck and back (KT KT ran), no sweating, and aversion to cold, Zhongjing used Mahuang Gegen Tang, and Tao Shi used Fangfeng Qianghuo Tang. Currently, I use this decoction to treat individuals in the southern hot season with internal accumulated heat who have contracted exterior pathogens.

Jia Jian Chonghe Tang (Modified Harmonizing Decoction)
Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), Shigao (Gypsi Fibrum), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
This formula is used by Tao Shi for Taiyang stiff and rigid neck and back (KT KT ran), sweating, and paradoxical aversion to wind. The previous entry had no sweating and aversion to cold, so cooling herbs were not added. This entry has sweating and neck stiffness, so Huangqin and Shigao are used. However, adding Gegen again preserves Zhongjing's original intent.

Fangfeng Jia Gegen Tang (Saposhnikovia plus Pueraria Decoction)
Fangfeng (Saposhnikoviae Radix), Gan Ge (Puerariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Guangpi (Citri Reticulatae Pericarpium).
Zhongjing treated sweating neck stiffness with Guizhi Jia Gegen Tang. Currently, I replace Guizhi with Fangfeng, add Gegen, and rename it Fangfeng Gegen Tang. For aversion to cold and body pain, add Qianghuo and Duhuo; for alternating chills and fever, add Chaihu; for headache, add Chuanxiong; for heavy body due to dampness, add Cangzhu and Baizhi; for excessive sweating, add Shaoyao.

Qianghuo Fangfeng Chaihu Tang (Notopterygium, Saposhnikovia, and Bupleurum Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma Preparatum).
This formula is essentially Chaihu Tang plus Qianghuo and Fangfeng, treating neck stiffness caused by exterior pathogens in both Taiyang and Shaoyang meridians. In the hot season, add Zhimu and Shigao; in the cold season, add Shengjiang and Ziye.

Fangfeng Shigao Tang (Saposhnikovia and Gypsum Decoction)
Fangfeng (Saposhnikoviae Radix), Shigao (Gypsi Fibrum), Gan Ge (Puerariae Radix), Baizhi (Angelicae Dahuricae Radix).
Wind-Warmth syndromes often present with neck stiffness, so Fangfeng disperses wind and Shigao treats warmth. This primarily treats Yangming; if complicated by Taiyang, add Qianghuo; if complicated by Shaoyang, add Chaihu.

Cangfang Tang (Atractylodes and Saposhnikovia Decoction)
Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Chuanxiong (Chuanxiong Rhizoma).
Neck stiffness is mostly due to Wind-Dampness, so drying dampness and dispersing wind is used. If complicated by heat, add Shigao and Huangqin; if complicated by Taiyang exterior syndrome, add Qianghuo; for Shaoyang alternating chills and fever, add Chaihu.

Shenzhu Tang (Divine Atractylodes Decoction)
Cangzhu (Atractylodis Rhizoma), Shigao (Gypsi Fibrum), Fangfeng (Saposhnikoviae Radix), Gan Ge (Puerariae Radix).
Damp-heat exposed to wind causes neck stiffness, so Cangzhu, Fangfeng, and Gegen are used to disperse wind and overcome dampness. These primarily treat Yangming; if complicated by Taiyang and Shaoyang, add Qianghuo and Chaihu.

Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction)
Gualougen (Trichosanthis Radix), Guizhi (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Ziziphi Jujubae Fructus).
Phlegm binding in the Middle Jiao can also cause neck stiffness. This is Xiao Jianzhong Tang plus Gualougen, assisting the Middle Jiao to transform phlegm. For excessive phlegm and vomiting, add Banxia and Guangpi; for chest oppression, add Sharen. Due to deficiency of Middle Qi failing to transport and transform, building the Middle and draining phlegm is necessary.

Tiaomai Gegen Tang (Regulating Pulse Pueraria Decoction)
Gegen (Puerariae Radix), Qianhu (Peucedani Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
This treats neck stiffness due to Yangming exterior pathogens. If Taiyang symptoms appear, add Qianghuo; if Shaoyang symptoms appear, add Chaihu; if there is internal accumulated heat with dry lips and thirst, add Zhimu and Shigao.

Da Chengqi Tang (Major Order of the Qi Decoction) See constipation.
Erchen Daotan Tang (Two-Cured Phlegm-Draining Decoction) Same as boiling Erchen Tang with Daotan Tang ingredients.
Neck and back rigidity is often treated by addressing phlegm-fluids. Stagnation in the Middle Jiao causes rigidity in the heart, chest, head, back, and neck, as Yangming governs the neck. Thus, this formula drains phlegm, transforms stagnation, and clears the interior of Yangming.

Pingwei Baohe San (Peace the Stomach and Preserve Harmony Powder) Same as mixing Pingwei San and Baohe Wan powders.
Food stagnation in the Middle Jiao often presents with neck and back rigidity preventing lying down, hence this formula is used.

Erchen Qiangqin Tang (Two-Cured plus Notopterygium and Scutellaria Decoction) Same as Erchen Tang plus Qianghuo and Huangqin.
Internal phlegm-fluid and heat binding, combined with external exposure to wind-heat, causing neck and back rigidity, is treated with this formula.