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Fever, aversion to wind, and stiffness of the neck belong to Taiyang disease (for formula discussion, see "Taiyang Disease with Fever").

In Taiyang disease, if there is stiffness and tightness in the neck and back, accompanied by sweating and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction) is the primary treatment. In Taiyang disease, if there is stiffness and tightness in the neck and back, accompanied by absence of sweating and aversion to wind, Gegen Tang (Kudzu Root Decoction) is the primary treatment. Both are agents for dispersing the exterior, but their intensity differs. Generally, fever, sweating, and aversion to wind indicate a deficiency of the exterior (Biao Xu); such cases can be treated with the method of resolving the muscle layer (Jie Ji). Absence of sweating and aversion to wind indicate an excess of the exterior (Biao Shi); such cases can be treated with the method of inducing sweating (Fa Han). Therefore, the treatments differ.

In Taiyang Shanghan (Cold Damage), stiffness of the neck and back may occur; or it may develop into Jing disease (Spasm disease) due to Taiyang Zhongfeng (Wind Strike) complicated by cold-dampness, also presenting with neck stiffness. The Classics state: When a patient has body heat, cold feet, stiff and urgent neck and back, aversion to wind, intermittent heat in the head, red face, red eye vessels, only the head and face tremble, sudden lockjaw, and opisthotonos (backward arching of the back), this is Jing disease (Spasm disease). *Jin Gui Yao Lue* states: In Taiyang disease, if there is stiffness and tightness in the neck and back, but the pulse is instead deep and slow, this is Jing disease (Spasm disease), treated primarily with Guizhi Jia Gualou Gen Tang (Cinnamon Twig plus Trichosanthes Root Decoction).

After taking Guizhi Tang (to induce sweating) or after purgation, if headache, neck stiffness and pain, mild fever as if covered by feathers, absence of sweating, fullness in the epigastrium, slight pain, and difficulty in urination persist, Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the primary treatment. (Zhang Jingyue asked: Regarding the aforementioned clause mentioning headache and neck stiffness, this indicates that pathogenic factors remain in the exterior. Although sweating and purgation have been applied, the condition remains unresolved, so one should still use methods to disperse the exterior. Why remove Cinnamon Twig and use Poria and Atractylodes Macrocephala? This seems to ignore the exterior syndrome. I replied: This is not a Guizhi Tang pattern, but belongs to patients with internal fluid retention. Since headache and neck stiffness persist despite sweating and purgation, combined with epigastric fullness, slight pain, and difficulty in urination, this indicates internal accumulation of water-fluids, and the pathogen is not in the exterior. Hence, Cinnamon Twig is removed, and Poria and Atractylodes Macrocephala are added. If urination becomes smooth, fluids move, abdominal fullness subsides, and heat is naturally eliminated, then headache and neck stiffness will completely resolve. Moreover, in the Shizao Tang pattern where headache occurs, it is due to internal accumulation of pathogenic heat and latent fluids causing headache. For headaches caused by drinking water, attacking the exterior is unnecessary; one should only expel the fluids. Once fluids are expelled, the disease resolves.)

In Shanghan (Cold Damage), on the fourth or fifth day, if there is body heat, aversion to wind, neck and back stiffness, hypochondriac fullness, warm hands and feet, and thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment. If after purgation, the patient cannot eat, develops jaundice, and has difficulty urinating, administering Chaihu Tang will likely worsen the condition (formula discussions are found under "Hypochondriac Pain").

In Jie Xiong (Chest Binding, a complication from incorrect purgation), the neck is stiff, resembling the state of Rou Jing (Soft Spasm). In this case, Da Xianxiong Wan (Major Draining the Chest Pill) should be used for purgation (formula discussion is found under "Chest Binding").

When Taiyang disease and Shaoyang disease occur simultaneously (Bing Bing), presenting with neck and back stiffness, or dizziness and vertigo, and sometimes feeling like Jie Xiong with hardness and fullness in the epigastrium, acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated. Sweating must not be induced. If sweating is induced, delirium will occur, and the pulse will be wiry. If delirium persists beyond five to six days, Qimen (LR14) should be needled. (Cheng Wuji notes: The Taiyang meridian passes through the head and neck; neck and back stiffness indicates a Taiyang exterior disease. The Shaoyang meridian circulates through the chest and flanks; hardness and fullness in the epigastrium resembling Jie Xiong indicates a Shaoyang interior disease. When Taiyang and Shaoyang diseases combine, the pathogen is not purely in the exterior, hence the neck and back are not only stiff and painful but may also present with dizziness and vertigo; the pathogen has not fully entered the interior, hence sometimes feeling like Jie Xiong with epigastric hardness and fullness. This is pathogen located between the exterior and interior. Needling Dazhui (GV14), Feishu (BL13) drains Taiyang pathogen; needling Ganshu (BL18) drains Shaoyang pathogen. Pathogen in the exterior can be dispersed by sweating; pathogen between exterior and interior cannot. Sweating consumes body fluids and damages stomach Qi. Shaoyang pathogen invades Stomach Earth, Wood overacts on Earth, causing delirium. A wiry pulse appearing at five to six days indicates transmission is complete; as pathogenic heat leaves, delirium should stop. If it does not stop, Shaoyang pathogenic heat is severe; needling Qimen (LR14) drains Liver and Gallbladder Qi. Suitable formulas include Chaihu Guizhi Ganjiang Tang or Chaihu Jia Longgu Muli Tang.)

When Taiyang and Shaoyang diseases occur simultaneously, presenting with hardness and fullness in the epigastrium, neck stiffness, and dizziness, acupuncture at Dazhui (GV14) and Feishu (BL13) is indicated. Purging must be strictly avoided. (Cheng Wuji notes: Epigastric hardness/fullness with dizziness is Shaoyang; neck stiffness is Taiyang. Needling Dazhui and Feishu drains Taiyang pathogen because the Taiyang meridian descends along the neck and spine; needling Ganshu (BL18) drains Shaoyang pathogen because Gallbladder is the paired organ of Liver. Taiyang is in the exterior, Shaoyang is in the interior, constituting a half-exterior half-interior syndrome. The previous text stated sweating causes delirium; this means attacking Taiyang pathogen via sweating makes Shaoyang pathogen worse in the Stomach, inevitably causing delirium. This text states purging must be avoided; attacking Shaoyang pathogen via purging allows Taiyang pathogen to enter the interior due to deficiency, inevitably forming Jie Xiong. The Classics state: In Taiyang-Shaoyang simultaneous disease, incorrect purging leads to Jie Xiong. Chaihu Tang plus Guizhi may also be used.)

**Guizhi Qu Gui Jia Fuling Baizhu Tang Formula:**
Shaoyao (Peony Root), Shengjiang (Fresh Ginger), Baifuling (Poria with Hostwood), Baizhu (Atractylodes Macrocephala Rhizome) (each 1.5 liang), Gancao (Licorice Root) (1 liang), Dazao (Jujube Fruit) (6 pieces). Prepare the herbs by chopping. Take 5 qian per dose, decoct in water, and take warm. Recovery occurs when urination becomes smooth.
(Cheng Wuji notes: Epigastric fullness and pain with smooth urination indicates Jie Xiong; difficulty in urination indicates retained fluids, hence Poria and Atractylodes are added to promote fluid metabolism.)

Neck stiffness, sudden lockjaw, and opisthotonos constitute Jing disease (Spasm disease) (formula discussion is found under Miscellaneous Diseases, Spasm Section).