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Jing (Spasm), meaning stiffness and rigidity, refers to the contraction, tension, and tightness of tendons and vessels, preventing them from relaxing and extending. There are two main causes for this condition: one is Cold. When tendons encounter Cold, the blood freezes and coagulates, becoming hard and rigid; thus, they become tense. Observing objects that freeze in the cold reveals their stiffness and rigidity, which illustrates the principle that "Cold causes contraction." Dampness also belongs to the category of Cold; therefore, the *Classic* states that all cases of Jing belong to Dampness. The second cause is Heat. Excessive Heat scorching the blood leads to dryness and withering; when dry, tissues shorten. Observing dried objects shows their shrinkage, illustrating this point. Furthermore, the *Classic* states that all stiffness and rigidity belong to Wind. Wind has internal and external aspects: internal Wind arises from Heat, while external Wind arises from Cold. The *Classic* states that Wei syndrome (flaccidity) belongs to Damp-Heat because Dampness and Heat combine, causing tendons and vessels to relax and slacken. (See detailed discussion in the Wei chapter.) In contrast, in Jing syndrome, Dampness and Heat are separated, leading to the shortening of tendons and vessels. Generally, there is Cold-Dampness and Heat-Dampness. Cold-Dampness congeals like ice water, resulting in hardness and strength; Heat-Dampness melts like syrup, resulting in softness. Without Dampness but with Heat, tendons become dry; with both Heat and Dampness, tendons remain moist.

The *Jin Gui Yao Lue* discusses Jing syndrome as follows: Body fever accompanied by aversion to cold (indicating a Shanghan/Taoyang pattern); stiff and urgent neck and occiput, red face, and red eyes (indicating a Yangming pattern); heat in the head and cold in the feet (due to the ascending nature of Yang Qi); isolated shaking of the head (the term "isolated" distinguishes these unique features of Jing syndrome); sudden lockjaw (trismus), and opisthotonos (back arching backward). This constitutes Jing disease. (The Taiyang meridian runs along the back and head, and the Yangming meridian flanks the mouth. When Cold pathogens invade these two meridians, tendons and vessels become tense, causing these symptoms. This interpretation relies on the principle that "Cold causes contraction." However, many cases arise where Heat is constrained by Cold, damaging the blood and drying the tendons.)

It further states: In Taiyang disease, absence of sweating with aversion to cold is called Gang Jing (Rigid Spasm). (This is a pattern where Cold injures the Ying level, Cold predominates, blood coagulates, and tendons contract.) Presence of sweating without aversion to cold is called Rou Jing (Soft Spasm). (Sweating without aversion to cold indicates a Wenbing/Warm Disease pattern, representing blood depletion and tendon dryness/shrinkage.) It also states: In Taiyang disease, if there is no sweating but urination is surprisingly scanty (indicating deficiency-cold internally failing to transform fluids), Qi rushes upward to the chest (Cold Qi rebelling upward), and the patient has lockjaw and cannot speak (excessive Cold causing jaw tension), impending Gang Jing should be treated with Gegen Tang (Pueraria Decoction) to disperse Cold in the Taiyang and Yangming meridians. If there is chest fullness (internal Heat stagnation), lockjaw, severe opisthotonos such that the back cannot touch the bed during recumbency, calf cramping, and severe teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be administered to address constipation by purging Heat to preserve Yin fluids. Regarding Taiyang disease where all symptoms are present, body stiffness, and awkward movement in flexion and extension (unable to move freely), with a pulse that is unexpectedly deep and slow (normally floating and rapid; a deep-slow pulse suggests interior-exterior Cold. Why add Gualou Gen? The character "slow" here likely implies "rapid"; a non-floating, deep-rapid pulse indicates internal Heat and fluid dryness, hence the addition of Gualou Gen). This is Jing syndrome, treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) to release the Taiyang exterior and generate fluids/moisten dryness using Gualou Gen. Regarding Taiyang disease with stiffness in the neck and back (Taiyang meridian descends to the neck, runs along the shoulders and spine; Yangming meridian follows the throat into the supraclavicular fossa), absence of sweating with aversion to wind (Cold injuring Ying level), Gegen Tang is indicated. Presence of sweating with aversion to wind (Wind injuring Wei level) is treated with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria). This formula lacks Mahuang compared to Gegen Tang. In cases of body stiffness or neck/back stiffness approaching spasm, exterior-releasing agents are used to vent constrained Heat, preventing it from scorching and contracting the tendons. It also states: Excessive sweating in Taiyang disease can induce Jing. Purging in Wind diseases can induce Jing. Patients with sores/ulcers should not undergo sweating therapy (referring to post-ulceration); inducing sweat will cause Jing. (All these scenarios involve damage, depletion, and drying of Blood.) If a Jing patient has moxibustion scars, the prognosis is poor (Moxibustion further depletes the Blood). Synthesizing these points, the etiology falls within Cold and Heat, and the pathology within Deficiency and Excess. Practitioners should judge accordingly.

Note: Although both Cold and Heat can cause Jing, most cases stem from Heat, as Heat represents excess Fire. Excess Fire arises from insufficiency of Water. Therefore, individuals with depleted Blood (due to excessive sweating/purging losing body fluids, postpartum state, after hemorrhage, after severe illness, blood deficiency, or insufficient Yin-Blood in children) are prone to this condition. Since Water fails to control Fire, Fire becomes excessive while Water diminishes further; this is an internal injury pattern. External contraction of Cold, Wind, or Dampness typically manifests only as fever, bi-syndrome (painful obstruction), etc., and does not rapidly lead to severe tendon contraction, head shaking, teeth grinding, or lumbar opisthotonos. Cases of external Cold described by Zhang Zhongjing are actually rare; practitioners should avoid lightly using acrid-warm dispersing formulas.

The *Zhun Sheng* states: Internal Heat exacerbated by external Cold constraint leads to severe dryness of body fluids and absence of sweat. Both large and small tendons are scorched by Heat, becoming dry and shortened, termed Gang Jing. Rou Jing involves a combination of Dampness and Heat. The *Classic* states that Damp-Heat causes large tendons to shorten and small tendons to lengthen. It also states that transferring Heat from Lung to Kidney results in Rou Jing. Annotations explain: "Rou" means tendons are weak and powerless; "Jing" means bones are rigid and uncontrolled. Thus, isn't Zhongjing's "Rou" referring to small tendons lengthening due to Dampness? And isn't the neck/back stiffness/opisthotonos referring to large tendons becoming rigid due to Heat? Later authors considered absence of sweat as Exterior Excess and presence of sweat as Exterior Deficiency, using warming agents like Ginger and Aconite. Would this not increase the Heat in the large tendons? Although this view does not fully align with Zhongjing's intent, it has merit.

The *Yi Zong Jin Jian* states: Jing can occur in all six meridians. The back belongs to Taiyang; any stiffness in neck/back, lumbar opisthotonos, inability to bend thighs forward, or heel-like knotting indicates Taiyang involvement. The front belongs to Yangming; head/facial shaking, lockjaw, supraclavicular pain, elbows/knees drawing together indicate Yangming involvement. The sides belong to Shaoyang; facial deviation, limb convulsions, hypochondriac tension, hemiplegia indicate Shaoyang involvement. Abdominal tension with limb cramping after vomiting/diarrhea indicates Taiyin involvement. Walking on buttocks instead of heels, spinal curvature replacing the head (inability to walk due to leg cramps, inability to straighten back), and inability to extend (only flex) indicates Shaoyin involvement. Testicular retraction, lower abdominal urgency, scrotal contraction, and tongue rolling indicate Jueyin involvement. According to the *Classic*, the Foot-Shaoyin tendon governs epilepsy spasms and Jing. The external part (back, where Kidney tendons run) cannot flex; the internal part (front, where Kidney tendons run) cannot extend. It also says: Kidney meridian disease causes spinal stiffness and opisthotonos. Thus, opisthotonos also belongs to Kidney Jing (not limited to Taiyang), involving more than just inability to extend. Zhongjing states: Jing pulses feel tight like a string, running straight up and down. He also notes: After sweating for Cold-Damp binding, if the pulse becomes snake-like (flexible, not string-taut), resolution is imminent. If the pulse remains unchanged, becoming hidden and string-tight, it is Jing. (Corrected per *Yi Zong Jin Jian*).

Treatment methods: For Fire excess and Blood deficiency, use Danggui (Angelica Sinensis), Shaoyao (Peony), Shengdi (Rehmannia), Honghua (Safflower), Huanglian (Coptis), and Gouteng (Uncaria). Add Renshen (Ginseng) for Qi deficiency; add Zhuli (Bamboo Sap) for Phlegm. For Metal deficiency and Wood hyperactivity (Strong Fire consumes Qi), first use Xieqing Wan (Drain Green Pill, see Stroke), then Yigong San (Benefit Power Powder, see Qi deficiency). For isolated Liver Fire hyperactivity, first use Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction, see Cold/Heat), then Siwu Tang (Four Substances Decoction, see Blood disorders), adding Chaihu (Bupleurum), Danpi (Moutan), and Shanzhi (Gardenia). For constrained Heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder, see Constraint). If Spleen Earth is suppressed, use Buzhong Yiqi Tang (Middle-Boosting Qi-Supplementing Decoction, see Qi deficiency) with Shaoyao and Shanzhi. For Spleen Earth Damp-Heat, use Sanyi Chengqi Tang (Three-One Order the Qi Decoction, see Constipation). For Kidney deficiency, use Liuwei Wan (Six-Ingredient Pill, see Deficiency). For Taiyin Cold-Damp coagulation with abdominal pain, use Guizhi Jia Shaoyao Fangji Fengfeng Tang (Cinnamon Twig Plus Peony, Stephania, and Saposhnikovia Decoction). For cold extremities/reversal, use Fuzi San (Aconite Powder) or Guixin Baizhu Tang (Cinnamon Heart and Atractylodes Macrocephala Decoction).