痉病项强背反张，有汗为柔无汗刚，生产血多过汗后，溃疮犬咬破风伤。
【注】痉病之证，详在《伤寒心法》，有汗为柔痉，无汗为刚痉。产后去血过多，伤
寒发汗过多，则为内因。溃疡破伤、狗咬，则为外因。皆风邪乘虚入太阳经而成此病也。
痉证脉散多应死，反张离席一掌亡，眼小目瞪昏不语，额汗如珠命必伤。
【注】反张离席一掌，谓离席四五指许也。眼小，谓目睫紧小也。目瞪，谓眼珠不转也。
葛根汤 桂枝加葛根汤 小续命汤 桂枝加附子汤 当归补血汤 大承气汤 桃仁承气汤
刚痉葛根汤发汗，柔痉桂枝加葛良，若兼杂因小续命，过汗桂枝加附汤，伤血桂枝
合补血，里实瘀血承气方，溃疡十全加风药，破伤狗咬另参详。
【注】刚痉用葛根汤，即桂枝汤加麻黄、葛根。柔痉用桂枝加葛根汤，即桂枝汤加葛
根汗之。杂因，谓风寒湿杂揉为病，用小续命汤，随风寒湿轻重治之。过汗表虚，汗出
不止，因而成痉，用桂枝加附子汤，即桂枝汤加附子也。伤血，谓产后金疮大伤血后，用
桂枝汤合补血汤，即当归黄 也。里实，谓痉病腹满二便闭，以大承气汤。及产后恶露
不尽，少腹硬急，以桃仁承气汤下之。溃疡去脓血过多，为风所袭者，用十全大补汤加
祛风之药治之。
Spasm disease presents with stiffness of the neck and back arching backward. Those with sweating are classified as Rou Jing (Soft Spasm), while those without sweating are classified as Gang Jing (Hard Spasm). Etiologies include excessive blood loss after childbirth or excessive diaphoresis, as well as wind-pathogen invasion through ulcerated wounds or dog bites.
[Note] The manifestations of spasm disease are detailed in *Shanghan Xinfa*. Cases with sweating are termed Rou Jing (Soft Spasm), and those without sweating are termed Gang Jing (Hard Spasm). Excessive blood loss postpartum or excessive sweating during the treatment of Cold Damage constitute internal causes. Ulcerated wounds and dog bites constitute external causes. In all these cases, Wind-Pathogen invades the Taiyang Meridian (Taiyang Jing) due to deficiency, resulting in this disease.
If the pulse is scattered in patients with spasm, death is likely. If the body arches backward such that it lifts off the bed by the width of a palm, prognosis is poor. If the eyes appear small, the eyeballs are fixed and unresponsive, the patient is comatose and unable to speak, and beads of sweat form on the forehead, death is inevitable.
[Note] "Arching backward lifting off the bed by a palm" refers to a gap of approximately four to five finger-widths between the back and the bed. "Eyes appearing small" refers to tightly contracted eyelids. "Fixed eyes" refers to eyeballs that do not rotate.
Formulas mentioned: Ge Gen Tang (Kudzu Root Decoction), Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root Decoction), Xiao Xuming Tang (Minor Continuation Life Decoction), Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root Decoction), Danggui Buxue Tang (Angelica Sinensis Blood-Nourishing Decoction), Da Chengqi Tang (Major Order the Qi Decoction), Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction).
For Gang Jing (Hard Spasm), use Ge Gen Tang (Kudzu Root Decoction) to induce sweating and release the muscle layer. For Rou Jing (Soft Spasm), use Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root Decoction). If complicated by mixed etiologies, use Xiao Xuming Tang (Minor Continuation Life Decoction). If caused by excessive sweating leading to exterior deficiency, use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root Decoction). If blood is injured, combine Guizhi Tang (Cinnamon Twig Decoction) with Danggui Buxue Tang (Angelica Sinensis Blood-Nourishing Decoction). If there is interior excess and blood stasis, use formulas from the Chengqi category (Order the Qi Decoctions). For ulcerated wounds, use Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) added with wind-dispelling herbs. For dog bites, separate detailed differentiation is required.
[Note] For Gang Jing (Hard Spasm), Ge Gen Tang (Kudzu Root Decoction) is used, which is Guizhi Tang (Cinnamon Twig Decoction) plus Mahuang (Ephedrae Herba) and Gegen (Puerariae Lobatae Radix). For Rou Jing (Soft Spasm), Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root Decoction) is used, which is Guizhi Tang (Cinnamon Twig Decoction) plus Gegen (Puerariae Lobatae Radix) to induce sweating. "Mixed etiology" refers to diseases caused by the intermingling of Wind, Cold, and Dampness; Xiao Xuming Tang (Minor Continuation Life Decoction) is used, treating according to the severity of Wind, Cold, and Dampness. Excessive sweating leads to exterior deficiency and continuous sweating, eventually causing spasm; Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root Decoction) is used, which is Guizhi Tang (Cinnamon Twig Decoction) plus Fuzi (Aconiti Lateralis Radix Praeparata). "Blood injury" refers to massive blood loss after childbirth or metal weapon injuries (Jinchuang); Guizhi Tang (Cinnamon Twig Decoction) is combined with Danggui Buxue Tang (Angelica Sinensis Blood-Nourishing Decoction), consisting of Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Membranacei Radix). "Interior excess" refers to abdominal fullness and constipation in spasm disease; Da Chengqi Tang (Major Order the Qi Decoction) is used. For postpartum lochia retention with hardness and urgency in the lower abdomen, Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction) is used to purge. For ulcers where pus and blood have been excessively lost and invaded by Wind, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) added with wind-dispelling herbs is used for treatment.