Library

[Background Information]
Book: Yizong Jinjian (Golden Mirror of the Medical Tradition)
Author: Wu Qian
Dynasty: Qing Dynasty
Chapter: Treatise on Pulse, Syndrome, and Treatment of Spasm, Dampness, and Heatstroke
Category: Medical Discourse

[Original Text Translation]
The Classic states: All spasms and neck stiffness belong to dampness. It also states: All sudden rigidity belongs to wind. The commentary says: In Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang meridian), excessive sweating leads to spasm (a disease characterized by neck stiffness, trismus, and opisthotonos). The six qi (wind, cold, summer-heat, dampness, dryness, fire) can all cause spasm, not solely dampness; the six meridians (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) all have spasm syndromes, not limited only to the Taiyang meridian.

Generally, the posterior aspect of the body belongs to the Taiyang meridian. Any case of neck stiffness, tightness in the nape and back, rigid spine with backward arching (opisthotonos), sensation of the waist breaking, inability to flex the thighs, and knotting sensation in the popliteal fossa constitutes a Taiyang spasm. The anterior aspect belongs to the Yangming meridian. Any case of head and face tremors, trismus (lockjaw), teeth grinding, pain in the supraclavicular fossa, and leg cramps constitutes a Yangming spasm. The lateral aspect belongs to the Shaoyang meridian. Any case of facial paralysis (deviation of mouth and eyes), traction of hands and feet, bilateral hypochondriac tension, and hemiplegia constitutes a Shaoyang spasm. As for abdominal tension and limb cramps following vomiting and diarrhea, this may be considered a Taiyin spasm. Aversion to cold, curling up in bed, sitting on the buttocks instead of standing on heels, bending the spine forward instead of lifting the head, and inability to extend the trunk may be considered a Shaoyin spasm. Retraction of the testes, downward flow of the Zongjin (tendons converging at the genitalia), urgency in the lower abdomen, constriction in the yin region, and cramping of the knees and calves may be considered a Jueyin spasm. Generally, spasm is named after its manifestations, and its etiology lies in tendon tension; therefore, any pathology of the tendons of the six meridians can be termed spasm.

Those caused by wind-cold must present with fever, aversion to cold, and anhidrosis, with a floating and tight pulse, and symptoms of body rigidity and trismus. This corresponds to the Classic’s statement: "All rigidity belongs to wind." Due to its forceful and urgent nature, it is called Gangjing (Yang spasm, characterized by aversion to cold and anhidrosis). Those caused by wind-damp present with fever, sweating, no aversion to cold, a floating and moderate pulse, and symptoms of neck stiffness without full-body rigidity. This corresponds to the Classic’s statement: "Spasm with neck stiffness belongs to dampness." Due to its soft and weak nature, it is called Roujing (Yin spasm, characterized by sweating and aversion to wind). If spasm results from erroneous sweating leading to yang exhaustion and fluid depletion failing to nourish the tendons, as stated in this treatise: "Taiyang disease, excessive sweating leads to spasm," this is not due to damp or wind, but rather due to dryness.

In essence, spasm is not originally an independent primary disease but often complicates other diseases, such as postpartum blood loss in women or traumatic injuries, all of which can induce spasm. Currently, those suffering from this are all attributed to wind, which is not an accurate conclusion. Scholars must carefully examine the causes—wind, cold, damp, dry, internal, external, deficiency, and excess—within the syndromes and treat them accordingly to avoid errors. Do not indiscriminately attribute all cases to wind.

@@@
Sunshang (Cold Damage) resulting in Taiyang disease includes Spasm, Dampness, and He (Heatstroke). These three conditions should be discussed separately because they resemble Sunshang, hence their appearance here.
[Note]
The four characters "resulting from Sunshang" are meaningless and are likely interpolations.
[Annotation]
Sunshang is one type of disease within the Taiyang meridian, implying that the Taiyang meridian does not only suffer from Sunshang. Generally, pathogenic factors from the six qi invading humans do so via the exterior of the Taiyang meridian. Spasm is caused by wind pathogen; Dampness by damp pathogen; He by summer-heat pathogen. Although diseases of wind, cold, summer-heat, and damp are generally categorized under Taiyang, the transmission and progression of Spasm, Dampness, and He differ from Sunshang; thus, it is said they should be discussed separately.
[Collected Notes]
Fang Youzhi stated: Spasm, Dampness, and He are all variations of wind-cold. Once they become variations, separate discussions are warranted. However, since they originate from wind-cold and belong to Taiyang, there remains suspicion of similarity to wind-cold, requiring combined differentiation.

@@@
If a patient presents with fever in the body, cold in the feet, neck stiffness and tension, aversion to cold, occasional fever in the head, red face, red eye vessels, isolated head tremor, sudden trismus, and opisthotonos, it is a spasm disease.
[Annotation]
Body fever and aversion to cold indicate a Taiyang syndrome. Neck stiffness, red face, and red eyes indicate a Yangming syndrome. Head fever indicates yang qi stagnating in the upper part; foot cold indicates yin qi coagulating in the lower part. The Taiyang meridian runs along the back to the head; the Yangming tendon runs up to flank the mouth. When wind-cold lodges in these two meridians, symptoms such as head tremor, trismus, opisthotonos, and tension occur, hence named spasm disease.
[Collected Notes]
Fang Youzhi stated: This lists the complete symptoms of spasm. Body heat, head heat, red face, and red eye vessels indicate yang pathogen manifesting in yang aspects. Foot cold indicates yin pathogen reversing into yin aspects. Isolated head and face tremors indicate wind acting dynamically in the upper part. "Sudden" means abruptly. "Trismus" refers to mouth closure due to cold, meaning lips and mouth suddenly close, jaw becomes tight, and eating/drinking is impossible. Opisthotonos occurs because the Taiyang meridian flanks the back; cold causes tendon tension and contraction, while heat causes tendon relaxation and extension. However, Gangjing and Roujing each show only one side of the syndrome; only when both wind and cold are present are all these symptoms fully manifested.
Zheng Zhongguang stated: This generally discusses how spasm affects meridians and acupoints, injuring both qi and blood, resulting in rigidity and opisthotonos. The presence of both wind and damp makes these the complete symptoms of spasm.

In Taiyang disease, if there is fever and the pulse is deep and fine, it is named spasm disease.
[Annotation]
In Taiyang disease with fever, the pulse should be floating and large. If the pulse is deep and fine, it involves the Shaoyin meridian. Why is fever with a deep and fine pulse named spasm? Because the patient already has a spasm syndrome presenting with a deep and fine pulse, it cannot be named the pulse of Taiyang or Shaoyin Sunshang. It should be named the pulse of Taiyang wind-damp spasm. Wind pathogen stagnating in the yang aspect causes fever. Damp pathogen coagulating in the yin aspect causes a deep and fine pulse. This continues the meaning of the previous clause regarding spasm presenting with a deep and fine pulse; it does not mean that any Taiyang disease with fever and a deep/fine pulse is automatically named spasm.
[Collected Notes]
Fang Youzhi stated: Fever indicates Taiyang syndrome persists. Deep indicates cold. Fine indicates damp.
Cheng Zhi stated: A deep and fine pulse typically warrants treating the interior, but spasm is a disease of dryness and heat, so the *Jinkui Yaolue* states it is difficult to treat. It implies one should not lightly equate this with the example of Taiyang fever with a contrary deep pulse.
Zhang Lu stated: Fever usually presents with a floating and rapid pulse. A contrary deep and fine pulse indicates wind pathogen is adhered to by dampness. Thus, although the body is hot, the pulse cannot be floating and rapid. This is a yang syndrome showing a yin pulse, hence the *Jinkui Yaolue* points to it as difficult to treat.
Cheng Yingmao stated: Spasm has common and unique features. It is named by its unique features. However, if the pulse is in the Taiyang position, showing uniqueness without commonality—combining symptoms like head tremor, trismus, and opisthotonos with a deep and fine pulse—even with Taiyang fever symptoms, it will not be confused with Sunshang, allowing it to be definitively named spasm.

@@@
In Taiyang disease, fever with anhidrosis and aversion to cold is named Gangjing (Yang Spasm). In Taiyang disease, fever with sweating and no aversion to cold is named Roujing (Yin Spasm).
[Note]
The character "fan" (contrary/reverse) before "aversion to cold" is an interpolation. Gangjing should naturally present with aversion to cold; it is not "contrary."
[Annotation]
Since spasm belongs to the Taiyang meridian, it should be explained using Taiyang deficiency and excess patterns. Therefore: Taiyang disease with fever, anhidrosis, and aversion to cold represents excess pathogen, named Gangjing; fever with sweating and no aversion to cold represents deficient pathogen, named Roujing. This elaborates on the deficiency and excess of spasm mentioned in the previous two clauses; it does not mean that any Taiyang disease with fever/anhidrosis/cold-aversion or fever/sweating/no-cold-aversion is automatically named Gangjing or Roujing.
[Collected Notes]
Cheng Zhi stated: Taiyang disease with fever, anhidrosis, and aversion to cold is Sunshang (Cold Damage); fever, sweating, and aversion to wind is Shangfeng (Wind Strike); fever, sweating, and no aversion to cold is Warm-Heat disease. Because the syndrome includes neck stiffness and even opisthotonos, it is not called wind-cold or warm-heat disease, but spasm.
Zhang Lu stated: The *Jinkui Yaolue* says: "Taiyang disease with anhidrosis, yet urine output is reduced, qi rushes upward to the chest, trismus prevents speech, indicating impending Gangjing, treated with Gegen Tang." This clarifies the meaning of this clause and supplements its treatment. Anhidrosis with reduced urine occurs because heat from the Taiyang and Yangming meridians accumulates in the chest, damaging the lung metal's clearing and descending qi, preventing internal and external circulation. It also says: "Taiyang disease with complete symptoms, body stiffness and tension, yet the pulse is contrary deep and slow, this is spasm, treated with Gualou Guizhi Tang." This clarifies the meaning of this clause and supplements its treatment. The "complete symptoms" refer to fever and sweating, which are detailed in the *Jinkui Yaolue*, so no need to repeat.

@@@
In Taiyang disease, neck and back stiffness and tension with anhidrosis and aversion to wind, Gegen Tang (Pueraria Decoction) is indicated.
[Annotation]
This omits other symptoms and pulses, highlighting only neck stiffness to illustrate treatment. The Taiyang meridian descends to the neck, runs along the shoulders, and flanks the back; the Yangming meridian runs along the throat, enters the supraclavicular fossa, penetrates the diaphragm, and descends to the inner breast. Taiyang governs the posterior, connecting anteriorly with Yangming; Yangming governs the anterior, connecting posteriorly with Taiyang. Now, pathogen obstructs both meridians, causing a stiff and tense appearance. Taiyang stiffness is limited to the neck; spasm stiffness prevents flexion and extension, involving the neck, chest, and back together, hence "neck and back stiffness and tension." Anhidrosis and aversion to wind indicate excess pathogen, suitable for release with Gegen Tang. This is Guizhi Tang (Cinnamon Twig Decoction) plus Mahuang (Ephedrae Herba) and Gegen (Puerariae Radix), resolving pathogen in both Taiyang and Yangming meridians.
[Collected Notes]
Fang Youzhi stated: "Jijiu" describes a bird with short wings stretching its neck when moving. It describes the patient's neck and back being diseased, unable to flex or extend freely.

@@@
In Taiyang disease, neck and back stiffness and tension with sweating and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction Plus Pueraria) is indicated.
[Annotation]
In Taiyang disease, neck and back stiffness with anhidrosis and aversion to wind is excess pathogen. Now, with sweating and aversion to wind, it is deficient pathogen, suitable for Guizhi Jia Gegen Tang to resolve wind in the Taiyang meridian and induce sweat in the Yangming meridian.
[Collected Notes]
Jiang Hu stated: In Taiyang disease, the neck and back are stiff and tense, unable to relax. The neck meridian belongs to Yangming. With neck and back tension, the condition should present with anhidrosis. Now, with sweating and aversion to wind, according to Zhang Zhongjing's method: Taiyang disease with sweating and aversion to wind is treated with Guizhi Tang. Due to the tension, Gegen (Puerariae Radix) is added to Guizhi Tang to simultaneously dispel wind from the Yangming meridian.