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[Outline] Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), if sweating is induced excessively, it may consequently lead to Jing disease (a syndrome characterized by stiffness and spasm of the neck and back, and opisthotonos). The pulse is deep and fine; the body is hot while the feet are cold; there is stiffness and tension in the head and neck; aversion to cold; sometimes heat in the head; redness of the face; congestion of the vessels in the eyes; only the head trembles; sudden locking of the jaw; and backward arching of the back like a bow. This is Jing disease.

[Commentary] Xu Bin said: Jing disease is generally caused by invasion of wind-cold-dampness. However, investigating its etiology, it mostly arises from loss of blood (hemorrhage or deficiency of yin-blood), causing the sinews to lose nourishment, allowing pathogens to invade. Thus, Zhang Zhongjing explored the origin of Jing disease, stating that if Taiyang disease involves heavy cold, sweating should originally be induced; but if sweating is excessive, it damages the blood, preventing it from nourishing the sinews, thereby forming Jing disease. The ancients referred to limb stiffness as Jing. The external symptoms resemble Shanghan (cold damage), but differ in that the pulse is deep, slow, wiry, and fine, and there is backward arching of the neck and back, with stiffness resembling epilepsy. Since Zhang Zhongjing distinguished Gang-Jing (rigid Jing) and Rou-Jing (soft Jing) based on the presence or absence of sweating, here the distinction is made based on a deep and fine pulse. It is stated that fever in Taiyang disease indicates wind attacking the exterior; when combined with dampness lingering in the meridians and internal cold, the sinews become spasmodic and stiff, leading to neck and back rigidity. The pulse being deep and fine indicates dominance of cold-dampness and the tendency of pathogens to invade the Yin. Hence, neck and back rigidity occurs, hence named Jing. The pulse of Jing disease is typically hidden; if wiry and fine, it indicates exhaustion of Yuan Qi (original qi), making it difficult to treat. In Wind-stroke syndromes, many cases present with opisthotonos resembling Jing, but Wind-stroke stiffness initially lacks Taiyang manifestations, and the pulse is floating and large rather than deep, fine, wiry, and slow. Therefore, the *Neijing* states: "All sudden stiffness belongs to Wind." Yang governs movement, Yin governs stillness; thus, stiffness with stillness is attributed to Dampness, while stiffness with convulsions is attributed to Wind. This is the method for distinguishing Wind-stroke. The *Qianjin Fang* states that dampness-heat entering the Kidney can also cause Jing, and high fever in pediatric epilepsy can also cause Jing, both belonging to the Wind-stroke category. Predecessors stated that there are five types of Shanghan Jing syndromes, all belonging to the Taiyang meridian. If the head hangs low looking down, limbs are pulled, and elbows/knees twitch, it is Yangming Jing. If one eye moves left or right, accompanied by twitching of one hand and foot, it is Shaoyang Jing. Taiyang certainly involves wind-cold, but Yangming and Shaoyang involve internal wind-fire-heat, belonging to Wind-stroke categories. Treatment should generally include nourishing Yin and clearing heat. Regarding the Jing discussed here, although external wind-cold-dampness differs, the root cause is the same: loss of Yang leading to dry sinews. Absence of sweat with aversion to cold is Gang-Jing; presence of sweat without aversion to cold is Rou-Jing. This is a method of differentiation, not the inherent symptom of Jing patients per se. This lists the most comprehensive Jing syndromes to detail their presentation during onset, and notes that treatment must not induce excessive sweating, and pulses have standard characteristics. Body heat indicates strong Taiyang exterior pathogens, but due to blood deficiency, cold pathogens combine with dampness. Wei Qi (defensive qi) yang cannot descend, while cold-dampness follows the Taiyang meridian down to the neck, slightly invading the Yangming meridian causing neck stiffness. True Yang fails to reach the exterior, causing aversion to cold. Thus, the Taiyang meridian lacks normal heat/cold regulation, trapping heat upward, causing head heat, facial redness, eye redness, and isolated head tremor. Taiyang governs opening; blocked by cold-dampness, opening and closing are impaired, preventing speech, leading to sudden jaw locking. Fluid deficiency and pathogen excess cause sinew malnourishment, resulting in back arching. These are the inherent symptoms of Jing disease.

[Outline] Zhang Zhongjing said: Taiyang disease with fever, no sweat, and aversion to cold is called Gang-Jing (Rigid Jing). Taiyang disease with sweating and no aversion to cold is called Rou-Jing (Soft Jing).

[Commentary] Li said: Taiyang disease caused purely by wind or purely by cold does not lead to Jing. Only when wind is injured first followed by cold, or wind followed by dampness, can excessive sweating induce Jing. Repeatedly inducing sweat in Taiyang disease, or heavily inducing sweat in dampness patients, can both induce Jing. External symptoms of chills and fever resemble Shanghan, but the pulse is deep, slow, wiry, and fine; there is head shaking, exposed eyes, jaw locking, limb convulsions, neck stiffness, and back arching resembling epilepsy, remaining unconscious all day—these are the differences. Wind nature is vigorous, constituting Gang-Jing; due to secondary cold exposure, there is no sweat, suitable for Gegen Tang (Kudzu Decoction) plus Qianghuo (Notopterygii Rhizoma), Duhuo (Angelicae Pubescentis Radix), and Fangfeng (Saposhnikoviae Radix). Damp nature is slack, constituting Rou-Jing; due to prior wind injury, there is sweat, suitable for Guizhi Tang (Cinnamon Twig Decoction) plus Huatfen (Trichosanthis Radix) and Gegen (Puerariae Lobatae Radix). If phlegm obstruction and qi stagnation exist, use Fuling (Poria), Nanxing (Arisaematis Rhizoma), and Banxia (Pinelliae Rhizoma) to resolve phlegm, Zhishi (Aurantii Fructus Immaturus), Chenpi (Citri Reticulatae Pericarpium), and Zisu (Perillae Folium) to regulate qi. After phlegm resolves and qi flows, treat according to Gang or Rou. Xiaoxuming Tang (Minor Continuation of Life Decoction) is commonly used. Remove Fuzi (Aconiti Lateralis Radix Praeparata) if heat is present; remove Mahuang (Ephedrae Herba) if spontaneous sweating occurs. For Gang-Jing after 2-3 days, with supine position, intense fever, chest fullness resembling Jie-Xiong (chest binding), constipation, curled legs, and inability to lie flat on the back, use Dachengqi Tang (Major Order the Qi Decoction) to purge. Mild cases use Baidu San (Poison-Resolving Powder) or Xiaochaihu Tang (Minor Bupleurum Decoction). For Rou-Jing persisting beyond 2-3 days with profuse sweating, cold extremities, and sinew spasm, use Fuzi Fangfeng Tang (Aconite and Saposhnikovia Decoction). For intermittent attacks in critical conditions, use Fuzhu San (Aconite and Atractylodes Powder). For indistinguishable Gang/Rou Jing, with fever and delirium resembling Gang, mild cold extremities and loose stools resembling Rou, use Xiaoxuming Tang plus Sheng Fuzi (Raw Aconite). After sweating or purging, if alternating calmness and agitation occur, with left-sided eye and limb spasms, it is Shaoyang Jing, treated with Xiaochaihu Tang plus Fangfeng. For blood-deficient individuals, postpartum wind injury with excessive sweating, or tetanus-induced Jing, do not treat solely as Wind-stroke. Use Siwu Tang (Four Substances Decoction) plus Fangfeng, or Babu Tang (Eight Substances Decoction) minus Fuling, plus Qianghuo, Fangfeng, and Huangqi (Astragali Radix) to rescue. If the Jing pulse splashes out from under the fingers like raindrops, death is immediate. If eyes are fixed upward, back arches, convulsions occur, sweat beads like pearls, or back arches leaving a palm's width from the bed, or two finger-widths for children, death is inevitable.

Xu Bin said: These two clauses distinguish the methods for cold injuring Ying (nutritive level) and wind injuring Wei (defensive level), using them to differentiate Gang and Rou in Jing disease. "Jing" implies stiffness. Jing disease necessarily presents with neck and back stiffness. Differentiating Gang and Rou is crucial for treatment. Thus, no sweat with aversion to cold is defined as Gang, and sweat without aversion to cold as Rou, to highlight the key diagnostic points. Fever, no sweat, and aversion to cold are typical Shanghan symptoms; if seen with neck stiffness and back straightening in Jing, it indicates that Wei Yang and Kidney True Yang are connected. Cold-dampness in Taiyang invades Shaoyin, blocking True Yang, causing aversion to cold. Cold is vigorous, hence "Gang." Sweat without aversion to cold is typical Wind-stroke combined with Yangming symptoms; if seen with neck stiffness and back straightening, it indicates Taiyang-Yangming dampness combined with wind, not internal cold invasion. Wind is gentle, hence "Rou," where the body is soft despite neck stiffness. Gualou Guizhi Tang (Trichosanthes and Cinnamon Twig Decoction) is the main formula for Rou-Jing.

Li Zhongzi said: This results from Taiyang Wind-strike compounded by cold-dampness. Supine with open eyes is Yang; prone with closed eyes is Yin. Dry thirst is Yang; moist mouth is Yin. Floating, tight, rapid pulse is Yang; deep, fine, choppy pulse is Yin. Yang Jing is easier to treat; Yin Jing is harder. Xiaoxuming Tang is general. Remove Fuzi for Yang Jing; remove Mahuang for Yin Jing.

Ke Qin said: This differentiates Gang and Rou based on the deficiency or excess of exterior Qi, naming them by their root causes. It allows assessment of initial disease severity and constitutional strength for treatment. Using Gegen Tang in *Jingui Yaolue* is erroneous.

[Outline] Zhang Zhongjing said: Patients with sores (chronic ulcers/abscesses) who experience body pain should not undergo sweating therapy; inducing sweat will lead to Jing disease.

[Commentary] Xu Bin said: Patients with chronic sores have inherently deficient and dry blood. Treating pain as wind and inducing sweat causes fluid loss and sinew dryness, preventing harmony, thus leading to Jing. Even after sweating or purging, if pathogens invade, the primary issue remains Yin deficiency and fluid depletion. Hence, the causes of Jing are detailed thus.

Shen Jin'ao commented: Sores differ from wind-cold. Wind-cold external symptoms include headache, neck pain, body/lower back pain, and joint pain, not localized pain. Internal symptoms include vomiting, dry heaving, and inability to eat, leading to fever and aversion to cold. Although similar, distinguishing internal/external symptoms reveals differences, preventing misdiagnosing abscesses as wind-cold.

Zhang Zhongjing uses the case of sore-patients to illustrate that Shanghan treatment requires sweating; this is not mixing Shanghan discussion with sore pathology. The intent must be clear.

[Outline] Zhang Zhongjing said: Taiyang disease with no sweat, reduced urination, qi rushing to the chest, jaw locking, and inability to speak indicates impending Gang-Jing. Gegen Tang (Kudzu Decoction) is indicated.

[Commentary] Xu Bin said: Gang-Jing features neck/back stiffness, no sweat, fever, and aversion to cold, indicating cold-dampness occupying the center and injury to both Yin and Yang. Fever resembles Taiyang disease. No sweat is the hallmark of cold injuring Ying. Pathogens remain in the exterior, yet reduced urination and qi rushing to the chest indicate pathogens following the meridian from Fu organs to Zang organs, disturbing Chong Qi. Jaw locking and silence indicate Taiyang failing to open, leading to Yin-Yang injury and inevitable stiffness/aversion to cold. Hence "impending." The prescription is Guizhi Tang (Cinnamon Twig Decoction) whole formula plus Gegen and Mahuang, treating both wind and cold. The Foot-Yangming meridian starts at the nose, intersects with Taiyang, so invasion from Taiyang to Yangming leads to persistent neck stiffness and chest fullness. Gegen is used to prevent this progression, serving as the main formula for no-sweat Gang-Jing. Guizhi also treats Chong Qi disturbances.

Li Zhongzi said: For Yin Jing with cold extremities, sinew spasm, and profuse sweat, use Guixin Baizhu San (Cinnamon Heart and Atractylodes Macrocephala Powder). For closed eyes, use Fuzi Fangfeng San (Aconite and Saposhnikovia Powder). For chest fullness, jaw locking, inability to lie flat, and teeth grinding/spasms, use Dachengqi Tang. For neck stiffness, lower abdominal fullness, and dysuria, use Wuling San (Five-Ingredient Powder with Poria). For wind excess and blood dryness, use Fangfeng Danggui Tang (Saposhnikovia and Angelica Sinensis Decoction).