@@@
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。若发其汗者，寒湿相搏，其表益虚，即恶寒甚，发其汗已，其脉如蛇
。
【按】
诸家以刚、柔二痉，列为首条，今以此为第一条者，盖刚、柔之辨，俱从此条分出，
痉病之最备者，宜冠诸首。再痉病也之下，「若发其汗…」六句，与上文义不属，与
后之十一条中「为欲解，脉如故，反伏弦者痉」句，文义相属，宜分于彼。
【注】
病人身热恶寒，太阳证也；颈项强急，面赤目赤，阳明证也。头热，阳郁于上也；足
寒，阴凝于下也。太阳之脉循背上头，阳明之筋上挟于口，风寒客于二经，则有头摇
口噤，反张拘强之证矣。此皆痉病之形证，故首揭之，以为要领。
【集注】
李□曰：手三阳之筋，结入结颔颊。足阳明之筋，上挟于口。风寒乘虚，入其筋则挛
，故牙关急而口噤。
@@@
夫痉脉，按之紧如弦，直上下行。
【注】
痉之为病，其状劲急强直，故其脉亦劲急强直。按之紧，劲急之象也，如弦直行之象
也。
@@@
『脉经』云：痉家，其脉伏坚，直上下。
【注】
痉家其脉紧弦，直上下者，以痉病属太阳表也。『脉经』所云：其脉伏坚，直上下者
，以痉病属阳明里也。盖痉家原属二经，故有太阳葛根汤汗之，阳明大承气汤下之之
治也。伏坚，沉实也；直上下，弦直也，即沉实弦直之脉也。
@@@
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。
【按】反恶寒之「反」字，衍文也。玩痉病之条自知当恶寒也。
【注】
痉病既属太阳，当以太阳虚实例之，故曰：太阳病发热、无汗、恶寒为实邪名曰刚痉
者。强而有力也。发热汗出，不恶寒为虚邪，名曰柔痉者。强而无力也。
@@@
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。
【注】
此申明刚痉在表，以明其治也。太阳病，为头项强痛、发热等证也。无汗，谓伤寒也
。太阳伤寒，小便不当少，今反少者，是寒气盛而收引也。不当气上冲胸，今气上冲
胸，是寒气盛而上逆也。不当口噤不得语，今口噤不得语，是寒气盛，牙关紧急而甚
也。以太阳伤寒，而有此冲击劲急之象，是欲作刚痉之病也。麻黄汤能治太阳，而不
能治阳明，故以葛根汤兼太阳、阳明两经之治，为刚痉无汗之正法也。
@@@
痉为病，胸满口噤，卧不着席，脚挛急，必齘齿，可与大承气汤。
【注】此申痉病入里，以明其治也。痉病而更胸满，里气壅也；卧不着席，反张甚也
；脚挛急，劲急甚也；必齘齿，牙紧甚也。此皆阳明热盛灼筋，筋急而甚之象。故以
大承气汤直攻其热，非攻阳明之实也。其曰可与，非尽言其可与，有慎重之意。
The patient presents with fever in the body, coldness in the feet, stiffness and tension in the neck and nape, aversion to cold, occasional heat in the head, redness of the face, redness of the eyes, isolated shaking of the head, sudden lockjaw (trismus), and opisthotonos (backward arching of the back). This is Jing disease (Spasm disorder). If sweating therapy is induced, cold and dampness contend with each other, the exterior becomes more deficient, leading to severe aversion to cold. After inducing sweating, the pulse resembles a snake winding.
[Commentary]
Various schools list Gang-Jing (Rigid Spasm) and Rou-Jing (Soft Spasm) as the first item. The reason for listing this passage as the first item here is that the distinction between rigid and soft spasms branches out from this passage. As the most comprehensive description of Jing disease, it is appropriate to place it at the beginning. Furthermore, the six sentences following "Jing disease..." ("If sweating therapy is induced...") do not connect logically with the preceding text but align with the later passage in Article 11: "For resolution, if the pulse remains unchanged but becomes hidden and wiry, it is Jing." Therefore, these sentences should be moved there.
[Annotation]
The patient's fever and aversion to cold are Taiyang syndrome manifestations; stiffness and tension in the neck and nape, along with facial and ocular redness, are Yangming syndrome manifestations. Heat in the head indicates Yang Qi constrained upward; coldness in the feet indicates Yin Cold stagnating downward. The Taiyang meridian runs along the back to the head, and the Yangming sinews run up to flank the mouth. When Wind-Cold pathogenic factors invade these two meridians, symptoms such as head shaking, lockjaw, and opisthotonos with stiffness occur. These are all morphological and symptomatic presentations of Jing disease, hence they are presented first as the guiding principle.
[Collected Notes]
Li [Name Redacted] stated: The sinews of the three Hand-Yang meridians converge into the mandible and cheeks. The sinews of the Foot-Yangming meridian run up to flank the mouth. When Wind-Cold takes advantage of deficiency and enters the sinews, causing contraction, the jaw becomes tight resulting in lockjaw.
The pulse of Jing disease, when pressed firmly, feels tight and wiry, extending straight up and down.
[Annotation]
In Jing disease, the physical state is strong, urgent, and stiff; therefore, its pulse is also strong, urgent, and stiff. Feeling tight upon pressure is the image of urgency and strength; feeling like a straight string is the image of directness.
The *Mai Jing* (Pulse Classic) states: For patients prone to Jing disease, the pulse is deep, firm, and extends straight up and down.
[Annotation]
When the pulse of a Jing disease patient is tight and wiry, extending straight up and down, it is because the disease belongs to the Taiyang exterior. When the *Mai Jing* describes the pulse as deep, firm, and extending straight up and down, it is because the disease belongs to the Yangming interior. Generally, Jing disease involves both meridians; thus, treatments include using Gegen Tang (Kudzu Root Decoction) to induce sweating for the Taiyang aspect, and Dachengqi Tang (Major Order the Qi Decoction) to purge for the Yangming aspect. "Deep and firm" refers to deep and solid; "straight up and down" refers to wiry and straight, i.e., a deep, solid, wiry, and straight pulse.
In Taiyang disease, if there is fever, no sweat, and paradoxically aversion to cold, it is called Gang-Jing (Rigid Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is called Rou-Jing (Soft Spasm).
[Commentary] The character "paradoxically" (fan) in "paradoxically aversion to cold" is a superfluous character. Studying the passages on Jing disease reveals that aversion to cold should naturally be present.
[Annotation]
Since Jing disease belongs to the Taiyang, it should be classified according to Taiyang deficiency or excess patterns. Thus: Taiyang disease with fever, no sweat, and aversion to cold represents an Excess pattern, named Gang-Jing (Rigid Spasm). "Gang" implies strength and power. Fever with sweating and no aversion to cold represents a Deficiency pattern, named Rou-Jing (Soft Spasm). "Rou" implies weakness and lack of force.
In Taiyang disease, if there is no sweat and urination is surprisingly scanty, with Qi rushing upward to the chest, lockjaw preventing speech, indicating impending Gang-Jing (Rigid Spasm), Gegen Tang (Kudzu Root Decoction) is the primary treatment.
[Annotation]
This clarifies that Gang-Jing is at the exterior level to explain its treatment. Taiyang disease refers to symptoms such as headache, neck stiffness, and fever. "No sweat" indicates Cold Damage (Shanghan). In Taiyang Cold Damage, urination should not be scanty; if it is, it is due to excessive Cold Qi causing contraction and drawing inward. Qi should not rush to the chest; if it does, it is due to excessive Cold Qi rebelling upward. Lockjaw preventing speech should not occur; if it does, it is due to excessive Cold Qi causing severe emergency of the jaw muscles. Because Taiyang Cold Damage presents with these signs of violent upward surge and urgency, it indicates impending Gang-Jing. Mahuang Tang (Ephedra Decoction) can treat Taiyang disorders but cannot treat Yangming disorders; therefore, Gegen Tang (Kudzu Root Decoction) treats both Taiyang and Yangming meridians, serving as the standard method for treating Gang-Jing without sweat.
In Jing disease, if there is chest fullness, lockjaw, inability to lie flat with the back touching the bed (opisthotonos), cramping of the legs, and teeth grinding (bruxism), Dachengqi Tang (Major Order the Qi Decoction) may be administered.
[Annotation]
This clarifies that Jing disease has entered the interior to explain its treatment. Chest fullness in Jing disease indicates stagnation of Interior Qi; inability to lie flat indicates severe opisthotonos; leg cramping indicates severe urgency and stiffness; teeth grinding indicates severe clenching of the teeth. These are all images of Yangming Heat excess scorching the sinews, causing severe sinus tension. Therefore, Dachengqi Tang (Major Order the Qi Decoction) is used to directly attack the Heat, rather than attacking Yangming Excess per se. The phrase "may be administered" (ke yu) does not imply absolute permission but carries a tone of caution.