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This is an error for "Jing" (Spasm), and the predecessors' establishment of separate meanings is incorrect; "Jing" originally belongs to Dryness disease, while Huangfu Mi occasionally mentioned Cold-Dampness, and later scholars' rigid adherence to this is also incorrect; "Jing" attracts external pathogens due to internal Dryness, and various schools dividing it into two separate syndromes of internal and external are even more mistaken. Essentially, this disease is quite rare, so predecessors inevitably speculated to form theories, or else merely plagiarized old words without innovation. The reason why this compilation selects few cases is indeed due to this.

**Nomenclature** It should be written as "Jing" (Spasm); "Zhi" (痓) is a transcription error. "Zhi" means evil/malicious, not stiffness. (*Commentary on Shanghan Lun*)
The characters "Jin" (Strength) and "Jing" share similar forms and sounds. Since the symptoms of "Jing" involve stiffness in the neck and back and opisthotonos, there is no doubt it should use the character "Jing". If "Zhi" is used, its meaning is unintelligible, so "Jing" should be considered correct. (*Jiyin Gangmu*)

**Etiology: Blood Loss and Pathogen Invasion** Tracing the cause, it mostly arises from blood loss, leaving tendons and vessels without nourishment, thus allowing pathogens to invade. Therefore, excessive sweating or purgation in *Shanghan* (Cold Damage), patients with sores/ulcers, and postpartum women developing this condition can all be understood. (*San Yin Fang*)
Medical texts generally attribute it to Wind-Dampness invasion, using many Wind-dispelling herbs. Upon careful examination, I fear this is still incomplete. It should be regarded as caused by internal deficiency of Qi and Blood, disturbed by external factors. Generally, the body's hundred bones and nine orifices rely on Qi and Blood for nourishment to enable movement. As stated in *Neijing*: "The feet walk when nourished by blood; the palms grasp when nourished by blood; the eyes see when nourished by blood." Thus, if tendons and vessels lack blood nourishment, they become stiff and immobile, which is the manifestation of "Zhi/Jing" disease. However, causes vary: some arise from Qi and Blood failing to guide, and fluids failing to nourish tendons; some from insufficient fluids and blood failing to nourish tendons; some from Phlegm-Fire blocking meridians, preventing fluid and blood nourishment; some from original Yuan Qi deficiency, where Six Excesses invade, causing blood failure to nourish. Despite different causes, the commonality is the deficiency of fluids and blood, unable to nourish meridians. Detailed examination of ancient sages' views shows that excessive sweating/purgation, postpartum states, and diseases consuming essence and blood can all cause "Zhi", making their intent clear. Scholars should not rigidly stick to established formulas or exclusively use Wind-dispelling herbs, but rather differentiate causes before prescribing. (*Yuanli*) (Note: This discussion of multiple causes is slightly tedious; retained for reference.)

**Etiology: Blood Dryness** I believe "Jing" is a disease of stiffness and opisthotonos. The pathology lies in tendons and vessels; tendon spasm causes opisthotonos. The pathology lies in blood; blood dryness causes tendon contraction. Zhang Zhongjing said: "Taiyang disease, excessive sweating leads to Jing. Wind disease, purgation leads to Jing. Patients with sores must not sweat; if sweated, it becomes Jing." These few sentences show that Jing is mostly a complication of mis-treatment, revealing its nature as both deficient and excess clearly. After Zhang Zhongjing, only Chen Wuzhe understood the cause, stating it mostly results from blood loss, leaving tendons without nourishment, hence forming Jing. This covers it well. However, his statement that "internal deficiency of Qi and Blood, combined with external invasion of Wind-Cold-Damp-Heat, causes Jing" is flawed. This implies Wind-Dampness is the pathogen, with deficiency secondary. One must realize that Wind disperses with sweat; after sweating, why mention Wind again? Dampness descends; after purgation, why mention Dampness again? Mis-sweating damages blood; mis-purgation damages True Yin. Injury to Yin-Blood leads to blood dryness; blood dryness deprives tendons of nourishment; deprived tendons contract, leading inevitably to opisthotonos and stiffness, without waiting for Wind-Cold-Damp-Heat invasion. Moreover, Zhang Zhongjing referred to inappropriate sweating and purgation. Once these errors occur, Jing results from mis-treatment. Does one need further pathogen invasion after mis-treatment to form Jing? Without pathogens, is there no Jing? Chen's words not only miss Zhang's intent but confuse later generations, leading to hesitation. Thus, modern practitioners focus on dispelling Wind and removing Dampness, unaware whether blood-dryness and Yin-deficiency syndromes can withstand such dispersing and draining methods. This requires clarification. (*Jingyue Quanshu*) (Note: Although this argument is辨析, it is not entirely appropriate. Why? Zhang Zhongjing describes Jing under Taiyang disease, and his three formulas are designed to expel pathogens. Without pathogen invasion, how could these symptoms exist? Therefore, I trust Zhang Zhongjing over Jingyue. Jingyue also discusses Jing caused by Yin deficiency and blood shortage without mis-treatment, stating acute cases with opisthotonos, upward-gazing eyes, locked jaw, and spasms are all Jing. However, these symptoms resemble epilepsy or convulsions, not true Jing. But Jingyue's reasoning on tendon tension has some merit, so I cite his symptoms and clarify them.)

The Six Qi causing illness all generate fever. Cold and Heat interact; Summerheat and Dampness follow each other; only Dryness opposes Dampness. Damp diseases often stem from Earth Qi (external/environmental); Dryness diseases often stem from internal causes. This distinguishes their etiologies. In the Nineteen Pathogenesis Formulas, Dryness symptoms are absent. Regarding "All spasms and neck stiffness belong to Dampness," I privately doubt it. The current treatise distinguishes Jing and Dampness. It also says: "Taiyang disease, excessive sweating leads to Jing." Thus, Jing undoubtedly belongs to Dryness. Jing is named by its shape, resulting from blood deficiency causing tendon tension. The Six Qi can all cause Jing. However, without Heat, there is no Dryness; without Dryness, there is no Jing. Initially, Jing is not a primary disease but mixed with others. Physicians usually attribute it to Wind, failing to understand the principle. Good physicians must examine and prevent it among other symptoms. (*Shanghan Lun Yi*)

**Pathology Specific to Meridians** Jing disease is a meridian disease, not a Zang-Fu disease. Pulses are the pathways of righteous Qi and blood. When mixed with Evil Wind, Dampness, or Cold, the pulse pathways become blocked and stagnant, manifesting as spasms and curling. This disease manifests in the body's meridians and tunnels. Although related to Zang-Fu, it differs fundamentally from Zang-Fu disease, hence called "Meridian Disease." (*Jinkui Benyi*)

**Pulse Diagnosis** In Taiyang Dampness Strike, the pulse is deep and level with the tendons. Gang-Jing (Yang Spasm) is Taiyang Wind Strike complicated by Cold-Dampness; the pulse advances and retreats, being deep, slow, and thin, differing from Cold Damage and Heat diseases. (*Jiayi Jing*)
If the pulse is deep, wiry, and slow, or tight, this is a bad omen; most are incurable. If the pulse scatters like rain splashing beyond the fingers, death occurs within a day or two. (*Huoren Zongkuo*)
Postpartum blood deficiency and excessive bleeding from metal wounds can both cause Jing. Only a deficient and small pulse is treatable; a full and large pulse indicates difficult recovery. (*Shanghan Xulun*)

**General Symptoms** (Differentiation from Epilepsy and Cold Damage) Feng-Jing (Wind Spasm): Jaw locked open, back stiff and straight, resembling epilepsy. Severe cases have throbbing pain in the ears; sudden total body rigidity leads to death. (*Bingyuan Lun*)
Jing: Jaw locked, back stiff and straight, resembling epilepsy, head shaking, horse-like neighing, waist bending backward, occurring ten times in a moment, breath seeming to stop, sweating profusely, occasional collapse. Those prone include new mothers, those with metal wound blood exhaustion, infants with umbilical wind, adults with cold-dampness contracting Jing-Wind; all die. In Warm Diseases with high heat entering Kidney, or infantile epilepsy with high heat, Jing occurs. Jing, aphonia, syncope, and mania are similar; prolonged syncope leads to mania. Examining closely, severe cases have ear pain, indicating Wind entering Kidney meridian. If untreated, flowing into Kidney, it prefers sudden body rigidity as if dead. (*Qianjin*)
Taiyang Wind-Jing syndrome: Initially fever and abdominal pain, wheezing and floating phlegm; then teeth grinding, head shaking, slight finger movement; gradually neck and back stiffness, inability to turn; severely, coma, loss of voice, fixed gaze, uncontrollable diarrhea, back arching. In such cases, nine out of ten die. (*Huoren Zongkuo*)
Early onset often includes abdominal pain. (Same source)
When the disease starts with a soft body and intermittent consciousness, it is called Epilepsy; when the body is stiff, straight, and arched like a bow, with no intermittent consciousness, it is called Jing. (*Bingyuan Lun*) (Note: "Bow" was originally "Corpse", corrected per *Qianjin*.)
External symptoms of fever and aversion to cold resemble Cold Damage, but the pulse is deep, slow, wiry, and thin, with neck/back arching and stiffness resembling epilepsy; this is the difference. (*Huoren*)

**Gang-Rou (Hard-Soft)** Taiyang disease: Fever, no aversion to cold, no sweating is Yang-Jing (Hard Spasm); fever, aversion to cold, sweating is Yin-Jing (Soft Spasm). (*Shenqiao*)
Observe presence or absence of sweat to distinguish Gang-Jing and Rou-Jing. No sweat: Gegen Tang (Kudzu Decoction) governs; Sweating: Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) governs. (*Huoren*)
How do Gang-Rou Jing relate to Yin-Yang Jing? "Zhi" is also written as "Jing". Yang-Jing belongs to Gang-Zhi; Yin-Jing belongs to Rou-Zhi. (Same source)
Wang Chaofeng's Gang-Rou Jing: *Jinkui* Gualou Guizhi Tang (Sweating, weak, belongs to Yin); Guizhi Jia Gegen Gualou Tang (Same indications); *Jinkui* Gegen Tang (No sweat, Gang-Jing, belongs to Yang). (*Rongmeng*)
Sleeping face-down is Yin-Jing; looking up is Yang-Jing. (*Shanghan Jiehuo Lun*) (Note: Based on *Shenghui*, which adds: Yang-Jing heals easily; Yin-Jing heals with difficulty.)
If fever, aversion to cold, no sweating, eyes open lying supine, dry mouth/thirst, floating-tight-rapid pulse, this belongs to Yang, named Gang-Jing. If spontaneous sweating, no aversion to cold, eyes closed face-down, limbs flaccid, normal mouth sensation, deep-thin-choppy pulse, this belongs to Yin, named Rou-Jing. Both types have spasms, jaw locking, and teeth grinding. But Gang-Jing has violent limb jerking, very frightening; Rou-Jing has flaccid limbs, occurring intermittently. (*Shanghan Zhengzhi Mingtiao*)
The main treatise defines Taiyang disease with sweating and exterior deficiency as Rou-Jing, and no sweating/exterior excess as Gang-Jing. Determining Hard/Soft by Deficiency/Excess is the most accurate differentiation. Later authors wrongly defined Hard as opisthotonos and Soft as looking down; this is greatly erroneous. (*Jinkui Bianzhu*)

**Several Types of Jing** These two diseases often coexist (Guo believed Zhi is mild, Jing is severe, hence "two diseases"). Treated as Cold Damage or Wind, they don't heal; Wind treatment is close but not precise. Yong saw several cases personally, briefly describing them. One case initially resembled Cold Damage; after 3-4 days, unconscious, seemingly soft, not very stiff, only forgetting/jaw-locking inconsistently; Yong called this Zhi. Another case initially like Cold Damage; after days, intermittent opisthotonos, jaw-locked unconscious during attacks, slightly conscious but tired between attacks; Yong called this Jing. Another case: after sweating in Cold Damage, while sitting and talking, suddenly stared eyes and locked jaw, still sitting but limbs stiff/unbendable, resolving shortly after, recurring dozens of times; speech normal between attacks; Yong attributed this to excessive sweating, calling it Cold Damage Jing, cured by Guizhi Gualou. Another infant like Wind-Cold; after 1-2 days, unconscious, lying dully, silent/not eating; this is Zhi. Suddenly limbs stiff, jaw-locked, dorsal hands swollen, fingers splayed, resolving shortly, becoming softer but still dull; Yong called this Zhi complicated by Jing. Another villager: after 2-3 days, jaw-locked, body stiff/opisthotonos, feeling arms/legs longer than usual, slightly conscious, making sounds through teeth gaps, unclear speech, preferring fire moxibustion despite drinking cold water, picking at clothes/sheets, doing everything strange; Yong thought it was just Jing, used Dayami Tang to rub teeth, mouth opened shortly, cured by several doses of Xuming Tang. The villager endured the disease; had he been wealthy, would he not have died? Another father and son sat indoors; people said they had Lock-Jaw Wind. Investigating, they sat facing each other, pulling a horizontal wood beam with both hands. When the disease struck, hands released, lying flat, waking to sit again, repeating rising/falling. Cured by Cangong Danggui Tang; son recovered, father too frail to survive. Asked about Wind arrival: started from feet, ascended Taiyang meridian, passed calf to thigh, splitting into two branches: one ascending outer thigh to waist, causing sudden pulling and side-falling; one ascending inner thigh to lower abdomen. Checking classics, Taiyang has no such branch; likely entered Shaoyin. Another person walking looked up three times; crowd thought he was looking at something, then fell, carried home with opisthotonos, died days later. Symptoms vary greatly; some mild, cannot record all. Experience shows initial slight softness, becoming extremely stiff during Jing. Predecessors didn't describe this fully; Yong added details but order is chaotic. (*Shanghan Bumang Lun*)

**Postpartum Jing** (See formulas in Exterior-Releasing section for reference.) Postpartum Wind Strike Jing: Childbirth injures blood vessels, Zang-Fu exhaust, diet not restored, within month, Ying-Wei deficient/injured, Wind Qi enters Five Zang, injuring Taiyang meridian, compounded by Cold-Dampness. Cold binds tendons causing Jing. Symptoms: jaw tight, back stiff/straight, head shaking, horse neighing, waist bending backward, occurring ten times in a moment, breath急促 as if stopping, sweating like rain, wiping hands unable to keep up—all die. (*Bingyuan Lun*)
Postpartum opisthotonos and Wind diseases must not use toxic drugs, only single herbs, no heavy sweating, specifically avoid purgation/diarrhea/vomiting which ensure death. Da Dou Zi Tang is excellent for postpartum. (*Qianjin*)
Postpartum excessive sweating or anger-induced syncope can cause this disease. (*San Yin*)
Postpartum sweating changing to Zhi, also prescribing Xuming Tang is hard to believe. With excessive sweating, how can one take Ephedra, Cassia Twig, Stephania, Scutellaria? Da Dou Zi Tang is better; Dasheng San from *Taiyiju Fang* is also good medicine. (Same source)
Generally, postpartum fever with tongue stiffness/lip tension, slight finger movement, urgency should be treated as Feng-Zhi. (*Huoren Zongkuo*)
Postpartum excessive blood loss causing Zhi: Liuhe Tang governs. (*Yuanbing Ji*) (Note: This is Siwu Tang plus Qianghuo, Qinjiao, Fangfeng.)
Postpartum Zhi due to excessive blood loss, extreme Yuan Qi deficiency, or external pathogen conflict. Symptoms: jaw tight, limbs stiff, or back arching, limb convulsions. Caused by excessive blood loss, tendons un-nourished. Greatly tonifying Qi and Blood ensures safety; attacking Wind pathogens ensures death. (*Nuke Cuoyao*)

**Death Signs** For all opisthotonos, if an adult's spine gap fits a sideways hand, or a child's fits three fingers, it is incurable. (*Qianjin*)
Lying without touching the mat, child's back gap from mat is two fingers, adult's sideways palm, is difficult to treat. (*Zongbing Lun*) (Note: *Bumang Lun* says: Difficult to treat means still treatable, not incurable. Also: Some recover even with opisthotonos exceeding palm width.)
After medication, sweating and body comfort is auspicious. If pulse is deep-slow or tight-thin, with spontaneous diarrhea, all are death signs. (*Xulun*)
Regardless of Yin/Yang/Hard/Soft pulse types, this syndrome always involves righteous decline and pathogen excess, making rescue difficult. (Same source)

**Treatment Methods Various Views** Treatment should not induce sweating; acupuncture is best. Herbal treatment: Gegen Tang can be taken. (*Jiayi Jing*)
Absolutely do not treat as Wind disease or combine with Wind herbs. (*Danxi*)
Jing has Deficiency and Excess; treatment has Tonification and Draining. If exterior pathogens remain, mistaken tonification causes immediate irritability; if Yin-Blood is depleted, mistaken draining causes exhaustion. Today's people don't even know what Jing disease is, let alone differentiate interior/exterior or balance tonification/draining. Impossible. (*Bingji Huilun*)
If excessive sweating loses Yang, excessive purgation loses Yin, causing tendons/vessels to lose nourishment, becoming stiff and Jing, with no external pathogens to resolve, only tonify Qi and Blood. Select Shiquan Dabu Tang, Renshen Yangrong Tang, or Dajianzhong Tang. (*Xulun*) (Note: Ming/Qing physicians treating Jing rarely deviate from this example; unsure if appropriate; retained for future study.)
Common Zhi disease mostly starts postpartum or after Cold Damage sweating/purgation, where Qi/Blood are greatly depleted, unable to nourish tendons, causing stiffness. Requires Shiquan Dabu Tang, with a little Fuzi to move Ginseng's Qi to supplement Wei, guiding Angelica/Achyranthes nature to supplement Ying. Wonderful. Ancient formulas emphasized exterior pathogens, hence using Xuming etc.; modern constitutions differ. (*Dahuan*) (Note: Dabu Tang plus Fuzi for Jing originates from *Nuke Cuoyao*.)
Disease is a complication of Cold Damage. Infants may recover; others, one in a hundred. Excess cases might live via purgation; deficiency cases have no treatment. *Jinkui* formulas rarely effective. (*Lantai Guidfan*)

**Gegen Gualougen** Followers of Zhang Zhongjing only know Gegen Tang for Gang-Jing and Guizhi Jia Gegen Tang for Rou-Jing, not understanding *Jinkui* uses Gualougen instead of Gegen for Rou-Jing with deep-slow pulse. Using Gegen not only clears muscle heat but, due to its light nature, generates fluids in the Exterior-Yang layer to moisten tendon dryness/stiffness. Now with deep-slow pulse: Deep indicates Wei-Qi deficiency, so use Guizhi to harmonize; Slow indicates Ying-Blood deficiency, so use Gualougen. Its heavy nature generates fluids in the Exterior-Yin layer. This is Zhang Zhongjing's method of adjusting drug depth according to pulse floating/sinking. (*Zhunsheng*)

**Exterior-Releasing Formulas** (Including Fluid-Nourishing Formulas)
**Canggong Danggui Tang**: Governs Thief-Wind jaw-locking, opisthotonos, and Jing.
Danggui, Fangfeng (each 18 zhu), Duhuo (1.5 liang), Mahuang (30 zhu), Fuzi (1 piece), Xixin (0.5 liang).
Six ingredients, crushed. Boil in 5 sheng wine and 3 sheng water to obtain 3 sheng. Take 1 sheng. If jaw won't open, force liquid in. First dose revives; second causes slight sweat; third causes heavy sweat. (*Qianjin*) Saw cases of jaw-locking resembling Jing, slightly conscious, sitting with jerking, back arching, also Wind-Zhi, cured by this. (*Shanghan Bumang Lun*) *Shenghui Fang* treats postpartum Wind strike with jaw-locking: Qinjiao San. Remove Mahuang, Xixin from base formula, add Qinjiao, Gegen, Guixin. (No wine. Add ginger to decoct.)

**Gancao Tang**: Treats Wind strike in confinement, back stiffness unable to turn, named Feng-Jing.
Gancao, Dihuang, Maidong, Mahuang (each 2 liang), Chuanxiong, Huangqin, Gualougen (each 3 liang), Xingren (50 pieces), Gegen (0.5 jin).
Nine ingredients, crushed. Boil Gegen in 15 sheng water and 5 sheng wine to obtain 8 sheng. Strain, add remaining herbs, boil to 3 sheng. Strain, divide into two doses. If not healed, prepare another. (*Qianjin*)

**Fangfeng Tang**: Treats postpartum Wind strike, back tension and shortness of breath.