张子和治一妇。年三十。病风搐目眩。角弓反张。数日不食。诸医作惊风风痫治之。用
南星、乌、附等不效。子和曰。诸风掉眩。皆属肝木。曲直摇动。风之用也。阳主动。阴主
静。由火盛制金。金衰不能平木。肝木茂而自病故也。先涌风涎二三升。次以寒剂下十余行
又以 针刺百会穴。出血二杯。立愈。
虞恒德治一妇。年三十余。身小形瘦。月经后。忽发痉口噤。手足挛缩。角弓反张。虞
知其去血过多。风邪乘虚而入。用四物加羌、防、荆芥。少加附子行经。二帖病减半。六帖
震按子和论痉。最为妙解。而法惟汗下。终嫌粗厉。如丹溪治少年痘后发痉。腹痛冷汗
痛定汗止。时止时作。脉弦紧而急。如真弦状。知其极勤苦。劳倦伤血。疮后血愈虚。风
寒乘虚而入。法当养血散风。以芎、归、芍、青皮、钩藤、陈皮、本草。再佐桂枝、黄连、
木香。加红花少许。此正治也。予乡文选司莘之金公劳倦而伤寒发斑。斑出迎风遽阴。遂发
痉。手足搐掉。不时跳跃。浑身震动。神欲晕去。予用牛蒡、天虫、土贝、荆、防、钩藤。
不应。其脉细而弦劲带数。乃用虎、膝、归、芍、生地、钩钩、秦艽、荆芥、桑枝。痉跳减
半。未能全愈。因思病属厥阴。当寒热并用。乃以桂枝、羚羊角为君。仍佐血药。加竹沥、
姜汁。一服而愈。此实效颦于丹溪。幸不至学步于邯郸耳。
一人身热至六七日。医用地黄汤。遂致身体强硬。六脉沉伏。目定口呆。气喘不能吸入
周慎斋曰。此能呼不能吸。病在中焦实也。中焦实。脾不运耳。方用远志、白茯神各一钱
附子四分。去白广皮六钱。磁石、苏梗各一钱五分。沉香二分。一帖身和。六帖而安。盖
脾者为胃行其津液者也。脾不运则胃阳不行于肌肉。肌肉无阳。所以强耳。醒其脾。则胃阳
通而身和矣。
震按此非痉证。因身体强硬与痉相似。故附于此。观其议论亦佳。然不能解其制方之义
Zi Hezi treated a woman, aged thirty. She suffered from wind-induced convulsions, dizziness, and opisthotonos (body bent backward like a bow). She had not eaten for several days. Other physicians treated her as having Jingfeng (startle wind) or Fengxian (wind epilepsy), using herbs such as Arisaema Cum Bile (Nanxing), Aconitum Carmichaelii Lateralis Radix Praeparata (Wutou), and Aconitum Carmichaelii Radix Praeparata (Fuzi), but to no avail. Zi Hezi said: "All wind diseases characterized by tremors and dizziness belong to Liver Wood. The swaying and trembling are the function of Wind. Yang governs movement; Yin governs stillness. This condition arises because excessive Fire restricts Metal (Lung), causing Metal Qi to weaken and fail to balance Wood (Liver). Consequently, Liver Wood becomes overly vigorous and diseased." First, he induced vomiting to expel two to three sheng of wind-phlegm. Next, he administered cold-natured purgatives, resulting in more than ten bowel movements. He then punctured the Baihui (GV20) acupoint, releasing two cups of blood. She recovered immediately.
Yu Hengde treated a woman, over thirty years old. She was small and thin. After menstruation, she suddenly developed Spasm (Jing), with locked jaw (koujin), contracture of hands and feet, and opisthotonos. Yu Hengde knew that excessive blood loss had allowed Wind pathogen to enter due to deficiency. He used Siwu Tang (Four Substances Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Jingjie (Schizonepetae Herba), with a small amount of Fuzi (Aconitum Carmichaelii Radix Praeparata) to promote circulation through the collaterals. After two doses, the illness reduced by half; after six doses, she recovered.
Commentary by Yu Zhen: Zi Hezi’s discussion on Spasm is the most brilliant and thorough, yet his methods rely solely on sweating and purging, which ultimately seem coarse and harsh. For instance, Zhu Danxi treated a young man who developed Spasm after smallpox. He had abdominal pain and cold sweat, which ceased when the pain stopped, occurring intermittently. His pulse was wiry, tight, and rapid, resembling a true wiry pulse. Zhu knew that extreme diligence and fatigue had damaged the Blood, and post-smallpox Blood deficiency allowed Wind-Cold to enter. The treatment principle should be to nourish Blood and disperse Wind, using Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix Alba), Qingpi (Citri Reticulatae Pericarpium Viride), Gouteng (Uncariae Ramulus cum Uncis), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), assisted by Guizhi (Cinnamomi Ramulus), Huanglian (Coptidis Rhizoma), and Muxiang (Aucklandiae Radix), with a little Honghua (Carthami Flos). This is the correct treatment approach. My hometown official Jin Zhizhi, suffering from fatigue and contracting Shanghan (Cold Damage) with macules, contracted Wind upon exposure after the macules appeared, leading to Spasm. His hands and feet twitched and trembled, he jumped frequently, his whole body shook, and he felt faint. I used Niubangzi (Arctii Fructus), Jiangcan (Bombyx Batryticatus), Tubei Mu (Fritillariae Thunbergii Bulbus), Jingjie, Fangfeng, and Gouteng, but without effect. His pulse was fine, wiry, firm, and rapid. I then changed to Huzhang (Polygoni Cuspidati Rhizoma et Radix), Nixi (Cyathulae Radix), Danggui, Shaoyao, Shengdi (Rehmanniae Radix), Gouteng, Qinjiao (Gentianae Macrophyllae Radix), Jingjie, and Sangzhi (Mori Ramulus). The spasms and jumping reduced by half, though full recovery was not achieved. Reflecting that the disease belonged to Jueyin (Liver/Pericardium), I decided to use both cold and hot methods. I used Guizhi and Lingyangjiao (Saiga Tataricae Cornu) as the sovereign herbs, assisted by blood-nourishing herbs, and added Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis Recens Juice). One dose resulted in recovery. This was indeed emulating Danxi, fortunately avoiding the pitfall of learning steps in Handan.
A patient had fever for six or seven days. The physician used Dihuang Tang (Rehmannia Decoction), which led to body stiffness, deep and hidden pulses in all six positions, fixed eyes, open mouth, panting, and inability to inhale deeply. Zhou Shenzhai said: "The ability to exhale but not inhale indicates an Excess pattern in the Middle Jiao. Due to Middle Jiao Excess, the Spleen fails to transport. The formula uses Yuanzhi (Polygalae Radix) and Baifushen (Poria with Hostwood) each one qian, Fuzi four fen, Chenpi (Citri Reticulatae Pericarpium) six qian (peeled), Cishi (Dawsoniae Lapis) and Sugen (Perillae Caulis) each one qian five fen, and Chenxiang (Aquilariae Lignum Resinatum) two fen. After one dose, the body harmonized; after six doses, peace was restored. The Spleen transports fluids for the Stomach. If the Spleen fails to transport, Stomach Yang cannot reach the muscles. Without Yang, the muscles become stiff. Awakening the Spleen allows Stomach Yang to flow freely, harmonizing the body."
Commentary by Yu Zhen: This is not a Spasm syndrome; rather, the body stiffness resembles Spasm, so it is appended here. His reasoning is excellent, yet he fails to explain the rationale behind his prescription.