【纲】仲景曰。太阳病。发汗太多。因致痉。脉沉而细。身热足寒。头项强急。恶寒。时头热。
面赤。目脉赤。独头面摇。卒口噤。背反张者。痉病也。
【目】成无己曰。此以风盛于上。风主动摇故也。头者。诸阳之会。诸阳之脉。皆上于头。诸
阴之脉。皆至颈胸中而还。阳脉不治。则头为之摇矣。
柯琴曰。阳气者。精则养神。柔则养筋。汗多则无液养筋。筋伤则挛急而反张矣。太阳主筋
所生病也。要知痉非无因。因伤寒发汗不如法耳。今头痛虽止。而颈项强急恶寒之症未罢。更见面
赤目赤。是将转属阳明。然诸症皆与伤寒
相似而非痉。独头面摇动口噤背反张。与伤寒不相似。故名曰痉。此汗多亡液不转属阳明而成者。
治当滋阴以和其里。用炙甘草汤。金匮用桂枝汤加栝蒌根。恐不胜任。
【纲】仲景曰。摇头言者。里痛也。
【目】成无己曰。里有痛者。言语则剧。欲言则头为之战摇也。里痛。非邪也。痛使之然。痉
病非逆也。风使之然。
【纲】仲景曰。阳反独留。形体如烟熏。直视摇头者。此为心绝也。
【目】许叔微曰。心藏神而为阴之本。阳根于阴。阴根于阳。阴阳相根。则荣卫和。上下相随
矣。绝则神去。而阴竭阳无根者。则不能自主持。故头为摇也。心绝者。真病也。风痉里痛者。邪
气也。观其头摇。又当明其否藏焉。
【纲】仲景曰。衄家不可发汗。汗出必额上陷。脉急紧。目直视。不能 。不得眠。
【目】戴原礼曰。直视者。视物而目睛不转动也。水之精为志。火之精为神。目者。心之使也。
神所寓焉。肝之外候也。精神荣焉。针经云。五脏六腑之气。皆上注于目而为之精。精之窠为眼。
骨之精为瞳子。筋之精为黑睛。血之精为络。气之精为白睛。肌肉之精为约束裹撷。筋骨血气之
精与脉并为系。上属于脑。五脏血气调和。精气充足。则目和而明矣。伤寒目直视者。邪气壅盛。
冒其正气。使神智不慧。藏精之气。不上荣于目。则目为之直视。伤寒至于直视。为邪气已极。症
候已逆。多难治。人以肝受血而能视。今衄家亡血。肝气已虚。目气已弱。又发汗亡阳。阴阳俱虚
所致。虞抟曰。目睛上视。名戴眼。此足太阳经之症。盖太阳目之上纲。而与少阴为表里。少阴之肾
气大亏。则太阳之阴虚血少。故其筋脉燥急。牵引而上。若直视不转者。尤为凶候。速当以培阴养
血为主。今人不知。俱云是风。若用风药。则阴愈虚。血愈燥矣。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel), excessive sweating may lead to Jing disease (a condition characterized by stiffness of the neck and back, and opisthotonos). The pulse is deep and fine; there is fever in the body but coldness in the feet; stiffness and tension in the head and neck; aversion to cold; occasional heat in the head; redness of the face; congestion of the vessels in the eyes; isolated shaking of the head and face; sudden locking of the jaw; and opisthotonos (backward arching of the back) indicate Jing disease.
[Commentary] Cheng Wuji stated: This occurs because wind pathogen is abundant in the upper part. Since wind is characterized by movement, it causes shaking. The head is the meeting place of all Yang channels; all Yang meridians ascend to the head, while all Yin meridians reach only to the neck and chest before returning. If Yang Qi fails to govern properly, the head will shake.
Ke Qin stated: Yang Qi nourishes the Shen (Spirit) when refined and nourishes the sinews when soft. Excessive sweating depletes fluids, failing to nourish the sinews; damaged sinews become spasmodic and result in opisthotonos. The Taiyang channel governs diseases of the sinews. It must be understood that Jing disease has a cause: it results from improper sweating therapy for Shanghan (Cold Damage). Although the headache has ceased, symptoms such as neck stiffness, tension, and aversion to cold persist. Furthermore, facial redness and eye redness suggest a potential transition to Yangming disease (disease of the Yangming channel). However, these symptoms resemble Shanghan rather than Jing disease. Only the shaking of the head and face, locked jaw, and opisthotonos differ from typical Shanghan, hence it is named Jing disease. This condition arises from fluid depletion due to excessive sweating, not from a transition to Yangming. Treatment should focus on nourishing Yin to harmonize the interior, using Zhi Gancao Tang (Honey-fried Licorice Decoction). The *Jin Gui Yao Lue* suggests adding Gualou Gen (Trichosanthes Root) to Guizhi Tang (Cinnamon Twig Decoction), which may be insufficient.
[General Principle] Zhang Zhongjing stated: Shaking the head while speaking indicates internal pain.
[Commentary] Cheng Wuji stated: When there is internal pain, speaking exacerbates it; the desire to speak causes the head to tremble and shake. Internal pain is not caused directly by pathogens but by the pain itself causing this reaction. Jing disease is not a critical reversal syndrome but is caused by wind.
[General Principle] Zhang Zhongjing stated: When Yang Qi remains exclusively in the upper part, the complexion appears dark like smoke, with fixed staring gaze and head shaking, this indicates Heart Qi exhaustion.
[Commentary] Xu Shuwei stated: The Heart stores the Shen and is the root of Yin. Yang roots in Yin, and Yin roots in Yang. When Yin and Yang are mutually rooted, Ying and Wei (Nutritive and Defensive Qi) are harmonious, and the upper and lower parts follow each other. When exhausted, the Shen departs; when Yin is depleted and Yang loses its root, self-control is lost, resulting in head shaking. Heart exhaustion is a true organ failure, whereas shaking due to wind or internal pain is due to pathogenic factors. Observing head shaking requires distinguishing the state of the Zang organs.
[General Principle] Zhang Zhongjing stated: Individuals prone to epistaxis (nosebleeds) should not undergo sweating therapy. If sweating is induced, it will inevitably lead to depression of the arteries in the forehead, a tight and tense pulse, fixed staring gaze, inability to close the eyes, and insomnia.
[Commentary] Dai Yuanli stated: Fixed staring gaze refers to looking at objects without moving the eyeballs. Water's essence is Zhi (Willpower), and Fire's essence is Shen (Spirit). The eyes are the messengers of the Heart, where the Shen resides, and they are the external manifestation of the Liver. Spirit and Qi nourish them. The *Ling Shu* states: The Qi of the five Zang and six Fu organs all ascend to the eyes to form visual clarity. The socket surrounds the eye; the essence of bone manifests as the pupil; the essence of sinew manifests as the black part of the eye; the essence of blood manifests as the collateral vessels; the essence of Qi manifests as the white part of the eye; the essence of muscle manifests as the eyelid constraints. The essences of sinew, bone, blood, and Qi merge with the meridians to form the optic nerve system, connecting upward to the brain. When the Qi and Blood of the five Zang organs are harmonious and Jing Essence is sufficient, the eyes are clear and bright. In Shanghan, fixed staring gaze indicates excess pathogenic Qi obstructing healthy Qi, clouding mental clarity, preventing the essence Qi of the Zang organs from nourishing the eyes. When Shanghan progresses to fixed staring gaze, pathogenic Qi is extreme, and the condition is critical and difficult to treat. Humans rely on the Liver receiving blood to see. In individuals prone to nosebleeds, blood loss has already weakened Liver Qi and Eye Qi. Inducing sweating further depletes Yang, resulting in deficiency of both Yin and Yang. Yu Tun stated: Upward fixation of the eyeballs is called Daiyan (eyes rolling up), a symptom of the Foot-Taiyang Bladder Channel. Since Taiyang governs the exterior and is externally-interiorly related to Shaoyin Kidney, severe depletion of Shaoyin Kidney Qi leads to Yin deficiency and blood scarcity in Taiyang, causing dry and tense sinews that pull the eyes upward. Fixed staring gaze is an especially ominous sign. Treatment should urgently prioritize tonifying Yin and nourishing blood. Modern practitioners often mistake this for wind and use wind-dispelling herbs, which further depletes Yin and dries the blood.