里详尽，始无遗此失彼之患矣。（《赤水玄珠》）
愚谓痉之为病，强直反张病也。其病在筋脉，筋脉拘急，所以反张；其病在血液，血液枯燥，所以筋挛。
观仲景曰∶太阳病，发汗太多，因致痉；风病下之则成痉；疮家不可发汗，汗之亦成痉。只此数言，可见病此
者，多由误治之坏证，其虚、其实，可了然矣。自仲景后，惟陈无择能知所因，曰∶多由亡血，筋无所荣，因
而成痉。但惜其言之既善，而复有未善者。曰∶血气内虚，外为风、寒、湿、热所中则痉。斯言不无又误。若
其所云，则仍是风湿为邪，而虚反次之矣。不知风随汗散，而既汗之后，何复言风？湿随下行，而既下之后，
何反致湿？盖误汗者必伤血液，误下者必伤真阴，阴伤则血燥，血燥则筋失所滋，为拘为挛，反张强直之病，
势所必至，又何待风、寒、湿、热之相袭，而后为痉
耶？且仲景所言，言不当汗而汗也，不当下而下也。既因误治而成痉矣，岂误治之外必再受邪而后成痉，无邪
则无痉哉？此言不惟失仲景之意，而用持两端。故凡今人之治此者，未有不以散风、去湿为事，亦焉知血燥阴
虚之证，尚能堪此散削否？○仲景言痉，止属太阳，而不及他经者，何也？盖痉必反张，其病在背，背之经络，
惟太阳督脉耳。言太阳，则督脉在其中矣。然仲景止言其表，未详其里。考《经脉篇》曰∶足少阴之脉，贯脊
属贤，其直者，从肾上贯肝膈。《经筋篇》曰∶足少阴之筋，循脊内挟膂上至项，结于枕骨，与足太阳之筋合。
又曰∶足太阳之筋病，脊反折，项筋急；足少阴之筋病，主痫螈及痉。阳病者，腰反折不能俯；阴病者，不能
仰。由此观之，则痉乃太阳、少阴之病也。盖肾与膀胱为表里，膀胱为津液之腑，而肾为藏精之脏。病在二经，
水亏可知，治此当以真阴为主。○痉病甚多，人多不识。盖凡以暴病而见反张、戴眼、口噤、拘急之类，皆痉
病也。观仲景以汗、下为言，谓其误治亡阴，所以然也。常见有不因误治，而凡属阴虚血少之辈，不能荣养筋
脉，以致拘挛僵仆者，皆是此证。如中风之有此者，必以年力衰残，阴之败也；产妇之有此者，必以去血过多，
冲任竭也；疮家之有此者，必以血随脓出，营气涸也；小儿之有此者，或以风热伤阴，遂为急惊；或以汗泻亡
阴，遂为慢惊。凡此总属阴虚之证。盖精血不亏，虽有邪干，亦断无筋脉拘急之病，而病至坚强，其枯可知。
故治此者，当以血气为主。（张景岳）
痉病，虚为本，风为标，不可纯用风药。盖血虚则火旺，火旺则风生，风胜则燥作。能滋其阴，则风自散
而燥自润矣。（《医学入门》）
阳气者，精则养神，柔则养筋。故治气虚筋惕，当用参、 以补之。手得血而能握，足得血而能步。故治
血虚筋惕，当用归、地以润之。（《证治汇补》）
湿热证，三、四日，口噤，四肢牵引拘急，甚则角弓反张，此湿热侵入经络脉隧中，宜地龙、秦艽、灵仙、
滑石、丝瓜藤、
海风藤、川连。○湿热证，壮热口渴，舌黄或焦红，发痉，神昏，谵语或笑，邪灼心包，营血已耗。宜犀角、
羚角、连翘、生地、元参、钩藤、银花露、鲜菖蒲、至宝丹。○湿热证，发痉神昏笑妄，脉洪数有力，开泄不效，
湿热蕴结胸膈，宜凉膈散。若大便不通，热邪闭结肠胃，宜仿承气微下之例。○或问∶仲景治痉，原有桂枝汤
加栝蒌根，及葛根汤二方，岂宜于古而不宜于今耶？今之痉者，与厥相连，仲景不言及厥，岂《金匮》有遗文
耶？余曰∶非也。药因病用，病原既异，治法自殊。《伤寒》之痉自外来，证属太阳，治以散外邪为主。湿热
之痉自内出，波及太阳，治以熄内风为主。盖三焦与肝、胆同司相火，中焦湿热不解，则热甚于里。火动则风
生，而筋挛脉急；风煽则火炽，而识乱神迷。身中之气，随风火上炎，而有升无降，常度尽失，由是而形若尸
厥。正《内经》所谓血之与气，并走于上，则为暴厥者是也。外窜经脉则成痉，内并膻中则为厥。痉厥并见，
正气犹存，则气复返而生；胃津不支，则厥不回而死矣。（《湿热条辨》）
脉候
太阳病，发热，脉沉而细者，名曰痉，为难治。○夫痉脉，按之紧如弦，直上下行。○若发其汗者，寒湿
相得，其表益虚，即恶寒甚。发其汗已，其脉如蛇，腹暴胀大者，为欲解。脉如故，反伏弦者痉。（《金匮》）
按腹暴胀大者五字，衍文也，当删之。（《医宗金鉴》）
Thoroughly understanding the interior allows one to avoid the hazard of losing sight of either aspect. (from *Chishui Xuanzhu*)
I believe that Jing disease (Spasm) is a condition characterized by stiffness, rigidity, and opisthotonos (backward arching of the body). Its pathology lies in the sinews and vessels; because the sinews and vessels are contracted and tense, opisthotonos occurs. Its root cause lies in the blood; because the blood is dry and depleted, sinew spasms result.
Observing Zhang Zhongjing’s statement: "In Taiyang disease (Disease of the Taiyang channel), excessive sweating leads to Jing disease; applying purgation to Wind disease results in Jing disease; patients with sores/ulcers should not be induced to sweat, and if they are, it also leads to Jing disease." From these few words, it can be seen that those suffering from this disease mostly have complex conditions resulting from mismanagement. Their deficiency or excess nature can be clearly understood. After Zhang Zhongjing, only Chen Wuyue understood the etiology, stating: "It mostly arises from loss of blood, where the sinews lose nourishment, thus forming Jing disease." However, his explanation, while good, had imperfections. He said: "When Qi and Blood are internally deficient, and externally attacked by Wind, Cold, Dampness, or Heat, Jing disease ensues." This statement is not without error. If we follow his logic, it still prioritizes Wind and Dampness as pathogens, relegating deficiency to a secondary position. One does not realize that Wind dissipates with sweat; after sweating, why speak again of Wind? Dampness descends with purgation; after purgation, why mention Dampness? Generally, erroneous sweating inevitably damages Blood, and erroneous purgation inevitably damages True Yin. When Yin is damaged, Blood becomes dry; when Blood is dry, the sinews lose their nourishment, leading to contraction, spasm, and opisthotonos. This progression is inevitable. Why wait for Wind, Cold, Dampness, or Heat to attack sequentially before Jing disease forms? Moreover, what Zhang Zhongjing described refers to inducing sweat or purgation when inappropriate. Since Jing disease has already formed due to mismanagement, must there necessarily be further pathogenic invasion outside of mismanagement for Jing disease to form? Is it true that without external pathogens, there is no Jing disease? This view not only deviates from Zhang Zhongjing’s intent but also holds contradictory positions. Therefore, contemporary physicians treating this disease invariably focus on dispersing Wind and eliminating Dampness. How do they know that patterns of Blood dryness and Yin deficiency can withstand such dispersing and draining treatments? ○ Zhang Zhongjing attributes Jing disease solely to the Taiyang channel, excluding other channels. Why? Jing disease necessarily involves opisthotonos, with pathology located in the back. The meridians of the back belong exclusively to the Taiyang channel and the Du vessel. Mentioning Taiyang implies the inclusion of the Du vessel. However, Zhang Zhongjing only discussed the exterior, neglecting the interior. Examining the *Jingmai* chapter: "The Foot Shaoyin channel penetrates the spine and connects to the Kidney; its straight branch ascends from the Kidney, piercing the Liver and Diaphragm." The *Jingjin* chapter states: "The sinews of the Foot Shaoyin channel run along the inner side of the spine, clamping the paraspinal muscles up to the nape, knotting at the occiput, and merging with the sinews of the Foot Taiyang channel." It further states: "Disease of the sinews of the Foot Taiyang channel causes spinal reversal and neck tendon tension; disease of the sinews of the Foot Shaoyin channel primarily governs epilepsy, convulsions, and Jing disease. Yang channel diseases cause spinal reversal preventing flexion; Yin channel diseases prevent extension." From this, it is evident that Jing disease is a disorder of both the Taiyang and Shaoyin channels. The Kidney and Bladder are interior-exterior pairs; the Bladder is the Fu organ of fluids, while the Kidney is the Zang organ storing Essence. Pathology in these two channels indicates Water (Kidney Yin/Essence) deficiency. Treatment should prioritize replenishing True Yin. ○ There are many types of Jing disease, yet most people do not recognize them. Essentially, any acute illness presenting with opisthotonos, fixed upward gaze (Daiyan), trismus (lockjaw), or contracture constitutes Jing disease. Zhang Zhongjing attributed it to erroneous sweating and purgation causing Yin depletion. I often observe cases not caused by mismanagement, but arising in individuals with Yin deficiency and Blood insufficiency who cannot nourish the sinews, leading to contracture and collapse. For instance, in Stroke patients exhibiting this, it is due to declining vitality and failing Yin; in postpartum women, it is due to excessive blood loss exhausting the Chong and Ren vessels; in patients with sores, it is due to blood loss with pus depleting Ying Qi; in children, it may be due to Wind-Heat injuring Yin, leading to Acute Convulsion, or due to sweating/purgation causing Yin loss, leading to Chronic Convulsion. All these belong to Yin deficiency patterns. If Essence and Blood are not depleted, even with pathogenic interference, sinew contracture would absolutely not occur. When the disease reaches a state of rigidity, its dryness and depletion are evident. Thus, treatment should focus on tonifying Qi and Blood. (Zhang Jingyue)
In Jing disease, deficiency is the root, and Wind is the branch. One must not use purely Wind-dispersing herbs. Blood deficiency leads to Fire hyperactivity; Fire hyperactivity generates Wind; Wind excess causes Dryness. Nourishing the Yin will naturally disperse the Wind and moisten the Dryness. (from *Yixue Rumen*)
Yang Qi, in its refined aspect, nourishes the Spirit; in its soft aspect, it nourishes the sinews. Therefore, for tremors caused by Qi deficiency, use Ginseng (*Ren Shen*) and Astragalus (*Huang Qi*) to tonify. The hand grasps when it receives Blood; the foot walks when it receives Blood. Therefore, for tremors caused by Blood deficiency, use Angelica (*Dang Gui*) and Rehmannia (*Shu Di Huang*) to moisten. (from *Zhengzhi Huibu*)
In Damp-Heat syndrome, after three or four days, trismus, limb traction and contracture, and even opisthotonos may occur. This indicates Damp-Heat invading the collaterals and sinews. Use Earthworm (*Di Long*), Gentian (*Qin Jiao*), Clematis (*Ling Xiao*), Talc (*Hua Shi), Luffa Vine (*Si Gua Teng*), Flammule Vine (*Hai Feng Teng*), and Coptis (*Chuan Lian*). ○ In Damp-Heat syndrome, with high fever, thirst, yellow or scorched-red tongue coating, Jing disease, coma, delirium, or manic laughter, the pathogenic heat is scorching the Pericardium, and Ying Blood has been consumed. Use Rhinoceros Horn (*Xi Jiao* - note: substitute with Buffalo Horn *Shui Niu Jiao* in modern practice), Antelope Horn (*Ling Yang Jiao*), Forsythia (*Lian Qiao*), Rehmannia (*Sheng Di Huang*), Scrophularia (*Yuan Shen*), Uncaria (*Gou Teng*), Honeysuckle Dew (*Yin Hua Lu*), Fresh Acorus (*Xian Chang Pu*), and Zhibao Pill (*Zhibao Dan*). ○ In Damp-Heat syndrome, with Jing disease, coma, and manic speech, and a surging, rapid, and forceful pulse, if opening and draining methods fail, it indicates Damp-Heat accumulating in the chest and diaphragm. Use Liangge San (*Cool the Chest Powder*). If stool is obstructed and Heat pathogens are closed in the intestines and stomach, imitate the mild purgative method of Chengqi Decoction. ○ Question: Zhang Zhongjing treated Jing disease with Guizhi Tang plus Trichosanthes Root (*Gua Lou Gen*) and Gegen Tang (*Kudzu Decoction*). Are these suitable for ancient times but not for today? Modern Jing disease is often linked to Jue syndrome (Fainting/Collapse), yet Zhang Zhongjing did not mention Jue. Was there omitted text in *Jingui Yaolue*? Answer: No. Medications are used according to the disease; since etiologies differ, treatments differ. Jing disease in *Shanghan Lun* originates from external factors, belongs to the Taiyang pattern, and is treated by dispersing external pathogens. Damp-Heat Jing disease originates internally, affects the Taiyang channel, and is treated by extinguishing internal Wind. The Sanjiao (Triple Burner), Liver, and Gallbladder jointly govern Ministerial Fire. If Damp-Heat in the Middle Jiao is unresolved, Heat intensifies internally. Fire agitation generates Wind, causing sinew contraction and vessel urgency; Wind stirring ignites Fire, causing mental confusion and coma. Body Qi follows the ascending Wind and Fire, rising without descending, losing normal regulation, resulting in a corpse-like fainting state. This corresponds to the *Neijing*: "When Blood and Qi rush together upwards, sudden Jue occurs." Externally invading the meridians forms Jing disease; internally merging into the Danzhong (Chest Center) forms Jue syndrome. When Jing and Jue appear together, if Zheng Qi remains, Qi returns and life is preserved; if Stomach Jin (fluids) cannot sustain, Jue does not reverse and death ensues. (from *Shire Tiaobian*)
Pulse Diagnosis
In Taiyang disease, with fever and a deep, fine pulse, it is named Jing disease, and is difficult to treat. ○ The pulse of Jing disease, when pressed, feels tight like a string, running straight up and down. ○ If sweating is induced, Cold and Dampness combine, the exterior becomes more deficient, and aversion to cold becomes severe. After sweating, if the pulse resembles a slithering snake and the abdomen suddenly distends, it indicates resolution. If the pulse remains unchanged and becomes hidden and wiry, it is Jing disease. (from *Jingui Yaolue*)
Note: The five characters "abdomen suddenly distends" are interpolations (derivative text) and should be deleted. (from *Yizong Jinjian*)