病者身热足寒。颈项强急。恶寒。时头热面赤。目赤。独头动摇。卒口噤。背反张者。痉病也。
邵评∶痉病风邪在表。则身热恶寒。痉为风强。筋脉受之。则口噤项强。反张强直
也。头热足寒。面目赤。头动摇者。风为阳邪。挟湿上行。风湿化热而上淫也。此痉
病之形症也。盖因风湿热邪。乘虚而入于筋之故也。
又评∶诸暴强直。皆属于风。但阳主动。阴主静。是当以强直而安静者主湿。强直
而搐搦者主风。千金方谓湿热入于肾中亦为痉。小儿痫热盛亦为痉。王海藏谓反张太阳痉也。低头视。
手足牵引。肘膝相构。阳明痉也。一目或左或右斜视。
一手一足搐搦。少阳痉也。太阳固属风寒。阳明少阳。亦风火热之内作。皆当以存阴驱热为治。
夫痉脉。按之紧如弦。直上下行。
邵评∶痉脉按之紧如弦。邪气坚实也。直上下行。阳邪盛也。上条揭痉之主症。此条揭痉之主脉。
痉脉沉而细者。为难治。
邵评∶脉细则易亡阴。痉病见之则难治。
太阳病发热无汗。反恶寒者。名曰刚痉。太阳病。发热汗出。而不恶寒。名曰柔痉。
邵评∶无汗为表实。反恶寒者。风邪挟寒也。以其表实有寒。故曰刚痉。若汗出为
表虚。不恶寒者。风变而外伤筋脉也。以其表虚自汗。故曰柔痉。
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。（
此刚痉无汗反恶寒主方）
邵评∶邪在太阳阳明之界。热并胸中。津不布而无汗。肺不行水而小便少。热气
上冲于胸。则口噤不得语。驯至面赤头摇。项背强直之症。此欲作刚痉。用葛根汤治。表实无汗之
痉也。因葛根汤。即桂枝汤加麻葛。风邪挟寒而表实。此汤为治刚痉无汗者之正法。
太阳病。其证备。身体强KT KT 然。脉反沉迟。此为柔痉。栝蒌桂枝汤主之。（此柔痉汗出不
恶寒主方 KT KT 即颈项强之貌）
邵评∶太阳病者。太阳一经之症悉具也。脉沉迟。乃津液少而营卫之行不利也。
风淫于外。汗出而消伤于内。用桂枝去风。加栝蒌根。兼滋其内也。
痉为病胸满口噤。卧不着席。脚挛急。必介齿。可与大承气汤。（初病在太阳仅背项强直若
不早治则转入阳明而病更剧脚挛齿介者以阳明之脉起于脚而络于齿也承气是下其热非下其食也）
邵评∶此痉病之属阳明瘀热者。阳明之筋起于足。结于跗。阳明之脉入齿中。挟
口环唇。循喉下膈。阳明热极。故见是诸症。用大承气涤其热以救其阴。亦急下存阴之治也。乃治阳
明热盛之痉。用大承气汤。然可与二字甚活。临症酌而用之。初非定法也。
太阳病发汗太多。因致痉。夫风病下之则痉。复发汗。必拘急。
邵评∶发汗太多。津液伤而不涵养筋脉。故致痉。此为液亏致痉。病由内虚所致。
邵评∶风病应肝而主筋。妄下伤胃液。液不养筋而痉。复汗以耗其阴。阴液燥则
拘急也。此条因妄下而伤阴致痉。亦内虚也。
疮家虽身疼痛。不可发汗。汗出则痉。（以上述金匮法）
邵评∶疮家身痛。是营虚筋脉失养。故戒发汗。汗之则津液越出。筋虚燥。亦挛急
而为痉矣。此疮家发痉。亦由液耗而内虚使然。
经云。诸暴强直。皆属于风。其势勇猛。故曰刚痉。又云。诸痉项强。皆属于湿。其势弱
软。故名柔痉。柯韵伯以痉之属风者。不因风而因热。属湿者。不因湿而因燥。虽似
太凿。然戒人不可以劫液之品治痉。实属良工苦心。
邵评∶一由火热内盛。热极化风而成痉。一由湿热挟风内灼。伤阴化燥而成痉。
痉虽因于风湿外邪。其伤阴劫液之药。总当慎用。
愚按 症。即痉症也。其因有二。一属风湿之邪。合而为痉。即内经所云属风属湿是也。一属
过表汗多。耗其津液而成痉。即仲景所云发汗太多。因致 是也。分属之。则治法庶无悖谬。
邵评∶痉症有外邪内伤虚实二因。若外着风湿之邪。入于筋脉而成痉者。此实症也。可用金匮
诸方治之。若汗下误施。产后亡血。津液伤耗。筋脉失养而痉者。
此内伤虚症也。宜滋液熄风和络治之。
如太阳未曾表汗而发痉。明系风湿之邪混扰于太阳。风湿相持而不解。则湿热交并。留滞经络。
营卫不和。津液不行。筋脉失所养而作也。此是伤寒类症。非伤寒变症也。其证背反张。头摇。口噤。
项强。拘急。转侧艰难。身热足冷。当审其风湿甚者。
则有汗而为柔痉。风寒甚者。则无汗而为刚痉。金匮法以栝蒌桂枝汤治太阳柔
痉。以葛根汤治太阳刚痉。以大承气汤治阳明刚痉。金鉴法。均以小续命汤为主治。刚痉去附子。柔痉
去麻黄。表实去参附。加二活。里实去参附。加硝黄。
邵评∶风寒湿邪。留滞经络。未经表汗而发痉。此是外邪实症。可用金匮诸方治。若伤寒过表。
汗多而成痉。乃是伤寒变症。治分两途。盖汗多则血液干枯。筋无所养。而痉作也。非湿非风。不得妄施
前药。故凡伤寒汗下后。痈疽溃脓后。妇人新产后。而见身体角弓反张。手足挛搐者。都是气血大亏。
液不荣筋所致。治法汇。均以八珍汤加枸杞、川断、钩藤、桂枝主之。以养筋脉。不可纯作风治。
柯韵伯以复脉汤治痉。救阴液也。
邵评∶过表汗多。阴液伤耗。筋脉失养而成痉。此是误治后变症。并无风湿外邪。
与上条之内因邪致痉者。有虚实之不同。故宜分途施治。上条邪实发痉。故用驱风散邪之方。此因误治
伤津血枯。而筋脉拘急。非风非湿。是为虚痉。治当滋液养营。熄风和络为主。切忌驱风散邪之剂也。
若汗下后。溃疡。及新产后。三者皆伤耗血。血虚生风。筋失滋养。以致反张挛搐等症。是虚痉也。
治用气血两调。和络化风之法。乃阴虚致痉之正治也。至于复脉救阴。阴回则虚风自熄。痉亦
止矣。此阴液亏乏。血不营筋而痉。是内伤虚痉。与上条外感实痉不同。滋液养正治法最合。
按过汗表虚成痉。汗出不止者。桂枝汤加归、 、人参。产后血虚成痉。归 建中
汤。溃疡去脓血过多。为风所袭成痉者。八珍汤加黄 、桂枝、川羌、防风。
邵评∶此承上条汗后溃疡新产三症而言。过汗不止。则表虚液脱。阳不附阴而
痉。养营固卫治之。产后血虚。血不营筋而痉。调营补气治之。溃疡之后。气血两伤。外风乘虚而入于
经脉。则成痉。宜气血两补。略佐化风治之。此与上条。均误治后变症而成虚痉。
又评∶金匮论痉病十二条。曰风曰寒曰热曰湿。皆是正伤寒之痉。及小儿痫热盛之痉。相去
霄壤。其所用之药。皆麻、桂、葛根。若温热暑疫之痉。亦误以此等方治之。其害甚于操刃矣。
The patient has a feverish body but cold feet. There is stiffness and tension in the neck and nape. There is aversion to cold. Sometimes there is heat in the head, redness of the face, and redness of the eyes. Only the head trembles or shakes. There is sudden trismus (lockjaw). The back arches backward like a bow. This is Jingspasm (Spasm Disease).
Shao's Commentary: In Jingspasm, if Wind pathogen is on the exterior, there is fever and aversion to cold. Jingspasm is caused by strong Wind invading the tendons and vessels, leading to trismus, stiff neck, and hyperextension of the back. Heat in the head and cold in the feet, redness of the face and eyes, and shaking of the head occur because Wind is a Yang pathogen that carries Dampness upward; Wind-Damp transforms into Heat and harasses the upper body. These are the manifestations and symptoms of Jingspasm. Generally, this is due to Wind-Damp-Heat pathogens entering the tendons when the body's resistance is deficient.
Further Commentary: All sudden stiffness and rigidity belong to Wind. However, Yang governs movement, and Yin governs stillness. Therefore, stiffness accompanied by stillness belongs to Dampness, while stiffness accompanied by convulsions belongs to Wind. *Qianjin Fang* states that Damp-Heat entering the Kidney can also cause Jingspasm. High fever in pediatric epilepsy can also cause Jingspasm. Wang Haicang states that hyperextension of the back is Taiyang Jingspasm; lowering the head to look down, with traction of the limbs and elbows/knees touching, is Yangming Jingspasm; strabismus (looking left or right) with convulsions in one hand and one foot is Shaoyang Jingspasm. Taiyang certainly involves Cold-Wind, but Yangming and Shaoyang involve internal disturbances of Wind-Fire-Heat. Treatment for all should focus on preserving Yin fluids and driving out Heat.
The pulse of Jingspasm feels tight and string-like upon pressure, extending straight up and down.
Shao's Commentary: A Jingspasm pulse feeling tight and string-like indicates solid pathogenic factors. Extending straight up and down indicates abundant Yang pathogen. The previous paragraph highlighted the main symptoms of Jingspasm; this paragraph highlights the main pulse.
If the pulse in Jingspasm is deep and fine, it is difficult to treat.
Shao's Commentary: A fine pulse indicates susceptibility to loss of Yin. If seen in Jingspasm, it is difficult to treat.
In Taiyang disease, if there is fever, no sweating, and paradoxical aversion to cold, it is called Gangspasm (Rigid Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is called Roujspasm (Soft Spasm).
Shao's Commentary: No sweating indicates Exterior Excess. Paradoxical aversion to cold indicates Wind pathogen carrying Cold. Because there is Exterior Excess with Cold, it is called Gangspasm. Sweating indicates Exterior Deficiency. Lack of aversion to cold indicates Wind transforming and injuring the tendons externally. Because there is Exterior Deficiency with spontaneous sweating, it is called Roujspasm.
In Taiyang disease, if there is no sweating, yet urination is surprisingly scanty, Qi rushes upward to the chest, there is trismus preventing speech, and Gangspasm is about to manifest, Gegen Tang (Kudzu Decoction) should be used as the primary formula. (This is the primary formula for Gangspasm with no sweating and paradoxical aversion to cold.)
Shao's Commentary: The pathogen is at the boundary of the Taiyang and Yangming channels. Heat accumulates in the chest, fluids do not distribute causing no sweat, and the Lung fails to move water causing scanty urination. Heat rushing to the chest causes trismus and inability to speak. Gradually, symptoms like red face, head shaking, and stiff neck/back develop. This is impending Gangspasm, treated with Gegen Tang. This is Jingspasm with Exterior Excess and no sweating. Since Gegen Tang is Guizhi Tang (Cinnamon Twig Decoction) plus Mahuang (Ephedra) and Gegen (Kudzu Root), it targets Wind-Cold with Exterior Excess. This decoction is the standard treatment for Gangspasm without sweating.
In Taiyang disease, if all symptoms are present, the body is stiff and rigid, and the pulse is paradoxically deep and slow, this is Roujspasm. Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) should be used as the primary formula. (This is the primary formula for Roujspasm with sweating and no aversion to cold. "KT KT" describes the appearance of stiff neck and nape.)
Shao's Commentary: Taiyang disease here means all symptoms of the Taiyang channel are present. A deep and slow pulse indicates insufficient fluids and poor circulation of Ying and Wei. Wind harasses the exterior, sweating consumes internally. Use Guizhi Tang to dispel Wind and add Gualou Gen (Trichosanthes Root) to nourish internal fluids.
Jingspasm presents with chest fullness, trismus, inability to lie flat with the back touching the bed (opisthotonos), cramped legs, and necessarily clenched teeth. Da Chengqi Tang (Major Order the Qi Decoction) may be given. (Initially, the disease is in Taiyang, showing only stiff neck and back. If not treated early, it transfers to Yangming and worsens. Cramped legs and clenched teeth occur because the Yangming channel originates at the foot and connects to the teeth. Chengqi formulas purge Heat, not food.)
Shao's Commentary: This refers to Jingspasm belonging to Yangming Stagnant Heat. The Yangming tendon originates at the foot and knots at the dorsum. The Yangming channel enters the teeth, surrounds the mouth and lips, follows the throat, and descends through the diaphragm. Extreme Yangming Heat causes these symptoms. Da Chengqi Tang is used to purge Heat and save Yin, which is also an urgent purgation method to preserve Yin. This treats Jingspasm due to extreme Yangming Heat using Da Chengqi Tang. However, the phrase "may be given" is flexible; clinical judgment is required, and it is not a fixed rule.
If Taiyang disease involves excessive sweating, Jingspasm results. If Wind disease is treated with purgatives, Jingspasm occurs; if sweating is induced again, limb cramping will definitely result.
Shao's Commentary: Excessive sweating injures fluids, failing to nourish the tendons, thus causing Jingspasm. This is Jingspasm due to fluid deficiency, caused by internal deficiency.
Shao's Commentary: Wind diseases correspond to the Liver and govern the tendons. Improper purgation injures stomach fluids; lack of fluid nourishment causes Jingspasm. Subsequent sweating depletes Yin; dry Yin leads to cramping. This case involves Jingspasm due to improper purgation injuring Yin, which is also internal deficiency.
Patients with chronic sores, although having body pain, must not undergo sweating therapy. Sweating will cause Jingspasm. (This cites the method from *Jin Gui Yao Lue*).
Shao's Commentary: Body pain in patients with sores indicates Ying blood deficiency and lack of tendon nourishment, hence sweating is prohibited. Sweating causes fluids to escape, leading to dry, deficient tendons that cramp and cause Jingspasm. This Jingspasm in sore patients is also due to fluid depletion and internal deficiency.
The Classic states: All sudden stiffness and rigidity belong to Wind. Its momentum is fierce, hence it is called Gangspasm. It also states: All Jingspasm with stiff neck belongs to Dampness. Its momentum is weak and soft, hence it is called Roujspasm. Ke Yunbo argues that Jingspasm attributed to Wind is actually due to Heat, not Wind; Jingspasm attributed to Dampness is actually due to Dryness, not Dampness. Although this seems overly pedantic, it warns against using herbs that劫夺 (rob/deplete) fluids to treat Jingspasm, showing the sincere effort of skilled physicians.
Shao's Commentary: One type arises from internal excess of Fire-Heat, where extreme Heat generates Wind causing Jingspasm. The other arises from Damp-Heat harassing internally with Wind, injuring Yin and transforming into Dryness causing Jingspasm. Although Jingspasm originates from external Wind-Damp, herbs that injure Yin and deplete fluids must always be used with caution.
My Analysis: "Zheng" refers to Jingspasm. There are two causes: one is Wind-Damp pathogens combining to cause Jingspasm, as stated in the *Nei Jing* regarding Wind and Damp; the other is excessive sweating depleting fluids and causing Jingspasm, as Zhongjing stated regarding excessive sweating. Differentiating them ensures correct treatment methods.
Shao's Commentary: Jingspasm has two causes: external pathogens and internal injury, excess and deficiency. If external Wind-Damp invades the tendons causing Jingspasm, it is an Excess syndrome, treatable with formulas from *Jin Gui Yao Lue*. If improper sweating/purgation, postpartum blood loss, or fluid depletion causes tendon malnourishment and Jingspasm, it is an Internal Injury Deficiency syndrome, treatable with methods to nourish fluids, extinguish Wind, and harmonize collaterals.
If Taiyang disease has not undergone sweating therapy but Jingspasm occurs, it is clearly due to Wind-Damp pathogens disturbing the Taiyang channel. Wind and Damp stagnate unresolved, leading to Damp-Heat accumulation in the collaterals, disharmony of Ying and Wei, failure of fluid distribution, and tendon malnourishment causing spasms. This is a Taiyang-type syndrome, not a transformation of Taiyang disease. Symptoms include hyperextension, head shaking, trismus, stiff neck, cramping, difficulty turning, fever, and cold feet. One must assess whether Wind or Damp is predominant.
If there is sweating, it is Roujspasm; if there is no sweating due to severe Cold-Wind, it is Gangspasm. *Jin Gui Yao Lue* uses Gualou Guizhi Tang for Taiyang Roujspasm, Gegen Tang for Taiyang Gangspasm, and Da Chengqi Tang for Yangming Gangspasm. *Yi Zong Jin Jian* primarily uses Xiao Xuming Tang. For Gangspasm, remove Fuzi (Aconite); for Roujspasm, remove Mahuang (Ephedra); for Exterior Excess, remove Renshen (Ginseng) and Fuzi, add Qianghuo (Notopterygium) and Duhuo (Angelica Pubescens); for Interior Excess, remove Renshen and Fuzi, add Xiaoshi (Mirabilite) and Dahuang (Rhubarb).
Shao's Commentary: Cold-Wind-Damp stagnating in collaterals causing Jingspasm without prior sweating is an External Pathogen Excess syndrome, treatable with *Jin Gui* formulas. If Taiyang disease involves excessive sweating leading to Jingspasm, it is a Taiyang transformation syndrome, requiring different treatment. Excessive sweating dries blood, leaving tendons un-nourished, causing Jingspasm. This is neither Damp nor Wind, so previous drugs should not be used blindly. Thus, after Taiyang sweating/purgation, after abscess rupture, or after postpartum state, if opisthotonos and limb convulsions appear, it is due to severe Qi and Blood deficiency and fluid failure to nourish tendons. The compiled treatment method uses Bazhen Tang (Eight Treasures Decoction) plus Gouqi (Goji Berry), Chuan Duan (Dipsacus), Gouteng (Uncaria), and Guizhi (Cinnamon Twig) to nourish tendons. Do not treat purely as Wind disease.
Ke Yunbo uses Maishu Tang (Pulse Restoring Decoction) to treat Jingspasm to rescue Yin fluids.
Shao's Commentary: Excessive sweating depletes Yin fluids, causing tendon malnourishment and Jingspasm. This is a transformation syndrome after mis-treatment, with no external Wind-Damp. It differs from the previous case of internal pathogen-induced Jingspasm in terms of excess and deficiency, requiring separate treatments. The previous case was Excess Jingspasm, treated with Wind-dispelling formulas. This case is Deficiency Jingspasm due to mis-treatment injuring fluids and blood, causing tendon cramping without Wind or Damp. Treatment should focus on nourishing fluids, tonifying Ying, extinguishing Wind, and harmonizing collaterals. Avoid Wind-dispelling agents.
After sweating/purgation, ulceration, or postpartum state, all three deplete blood. Blood deficiency generates Wind, tendons lose nourishment, leading to hyperextension and convulsions. This is Deficiency Jingspasm. Treatment uses methods to harmonize Qi and Blood and transform Wind in collaterals, which is the correct treatment for Yin-deficiency Jingspasm. Maishu Tang rescues Yin; once Yin returns, deficient Wind extinguishes naturally, and spasms stop. This is internal injury Deficiency Jingspasm due to fluid deficiency and blood failing to nourish tendons, differing from external Excess Jingspasm. Nourishing fluids and supporting righteousness is the most appropriate method.
Note: For Jingspasm due to excessive sweating causing Exterior Deficiency with continuous sweating, use Guizhi Tang plus Danggui (Angelica Sinensis), Dihuang (Rehmannia), and Renshen (Ginseng). For Jingspasm due to postpartum Blood Deficiency, use Danggui Jianzhong Tang (Angelica Build the Middle Decoction). For Jingspasm caused by Wind invasion after excessive pus and blood loss from ulcers, use Bazhen Tang plus Huangqi (Astragalus), Guizhi (Cinnamon Twig), Chuan Qianghuo (Notopterygium), and Fangfeng (Saposhnikovia).
Shao's Commentary: This continues the discussion of the three conditions: post-sweating, ulceration, and postpartum. Continuous excessive sweating causes Exterior Deficiency and fluid collapse, Yang failing to attach to Yin, causing Jingspasm; treat with nourishing Ying and securing Wei. Postpartum Blood Deficiency causes Jingspasm as blood fails to nourish tendons; treat with regulating Ying and tonifying Qi. After ulceration, both Qi and Blood are injured; external Wind enters the collaterals due to deficiency, causing Jingspasm; treat with dual tonification of Qi and Blood, slightly assisting in transforming Wind. Like the previous case, these are Deficiency Jingspasm transformation syndromes after mis-treatment.
Further Commentary: *Jin Gui Yao Lue* discusses twelve articles on Jingspasm, mentioning Wind, Cold, Heat, and Damp. These are all Jingspasm from proper Cold Damage, as well as Jingspasm from high fever in pediatric epilepsy, which are vastly different. The herbs used are Mahuang (Ephedra), Guizhi (Cinnamon Twig), and Gegen (Kudzu). If Jingspasm from Warm-Heat, Summer-Heat, or Epidemic Toxins is mistakenly treated with these formulas, the harm is worse than wielding a blade.