（即痉也）
【脉】 太阳发热，脉反沉细，难愈。太阳证备，脉沉迟，此为痉。寸口脉直上
下行，伏坚紧如弦。沉弦，沉紧。少阴脉紧，暴微者，欲解。
【因】 血气内虚，四气外袭。因湿，诸痉项强，皆属于湿。寒、湿同性，故湿
可伤太阳。
《三因》论状 身热足寒，头强项急，恶寒，时头热，面赤，目赤脉，独头摇动
，卒噤，角弓反张。皆因血虚筋无所养，邪因入之。故寒则紧缩，热则弛张，风则弦急，湿
则胀缓。又有因疮口未合，风入之，为破伤风；湿入之，为破伤湿。与痉同，但少头强项急
，余并相如。又有因汗、下过多，又有产后怒气致此病者，项强亦有痰者。
【证】 有汗而不恶寒，名柔痉；无汗，口噤脚挛，名刚痉。
【治】 宜流湿祛风缓表而安。详有无汗而药之。柔痉，葛根加桂汤；刚痉，大
承气汤。葛根汤汗之，有表证可用。大承气下之，有里证可用。
【脉】 浮而大，浮虚大热；滑而大，滑痰大虚；洪而缓，洪热缓虚。
【因】 肾水不能胜心火，火上烁肺金，六叶皆焦，皮毛虚弱，急而薄着者，则
生痿 。皆因贪欲好色之故。湿痰亦能为之。
经论 有由悲哀太甚，阳气内动，数溲血，大经空虚，热起于心。病则枢纽如折
，名曰脉痿。有思想无穷，入房太甚，宗筋弛纵，热入于肝。病则筋急而爪枯，名曰筋痿。
有由湿地，以水为事，热生于脾。病则胃干而渴，肌肉不仁，名曰肉痿。有因远行劳倦，遇
大热而渴，阳气内乏，热舍于肾。病则腰脊不举，骨枯而髓减，名曰骨痿。然此皆热熏于肺
之为也。火上炎，肺治节不行而痿 矣。
【证】 面黄，身热，肌瘦，往来寒热，涎嗽喘满，面浮弱而不用者，为痿。外
有痿即软风也。柔风脚弱，病同而证各异。
【治】 治独取阳明。阳明者，胃脉也。五脏六腑之海，主润宗筋，宗筋主束骨
利机关也。故阳明虚而然。
张，以黄连解毒汤加归等剂治之。
李，以甘寒泻火，苦寒泻湿热。四君子补阳明虚，清暑益气治之。湿痿之为病，宜二陈
汤加术、苓、柏治之。
清暑益气汤 治热伤肺，气虚成痿。
黄 （一钱，汗少减半。暑邪干卫，身热自汗，甘温补之） 人参（救火伤气） 白术（各
半钱） 白苍术（一钱，除湿） 甘草（炙，三钱，益气） 当归（三钱） 升麻（一钱，酒润，甘
平，润肌热，风胜湿） 葛根（二钱） 陈皮（半钱） 泽泻（半钱渗湿） 神曲（半钱，消食去痞
）五味（九分，酸寒，收暑伤金） 麦门冬（三钱） 青皮（二钱半） 黄柏（三钱，补水泻热）
或加知母、黄芩。
健步丸 治湿热成痿。
羌活 防风 柴胡 滑石 炙甘草 生姜（酒洗，各半两） 泽泻（五钱） 防己（酒制一
两） 川乌 苦参（酒洗） 肉桂（一钱）
愈风汤下。
秘方 气虚，四君子加苍、白术、苓、柏。痰，加竹沥。血虚，四物汤。湿痰，
二陈汤加苍白术、苓、柏、竹沥。下补阴丸。
经论 喑痱 乃肾虚也。舌不语，肾脉挟舌本，肾气厥不至；足不行，肾气不顺。
(That is, Jing disease [Spasm])
[Pulse] Taiyang (Sun) channel pathogenesis presents with fever, but the pulse is unexpectedly deep and fine, indicating a difficult cure. If all Taiyang syndrome symptoms are present, yet the pulse is deep and slow, this constitutes Jing disease [Spasm]. The Cun Kou (Radial artery at wrist) pulse moves straight up and down, deep, firm, tight, and hard like a string. The pulse may be deep and wiry, or deep and tight. The Shaoyin (Kidney) channel pulse is tight; if it suddenly becomes faint, it indicates the desire for resolution.
[Etiology] Internal deficiency of Blood and Qi, with external invasion by the Four Qi (Wind, Cold, Summer-heat, Dampness). Due to Dampness, various Jing diseases [Spasms] causing neck stiffness belong to Dampness. Cold and Dampness share similar natures, so Dampness can injure the Taiyang (Sun) channel.
*San Yin Fang* discusses the manifestations: Body heat with cold feet, head stiffness and neck tension, aversion to cold, occasional head heat, red face, red eyes, only the head shaking, sudden lockjaw, and opisthotonos. All these result from Blood deficiency leading to malnourishment of the sinews, allowing pathogens to enter. Thus, Cold causes contraction, Heat causes relaxation, Wind causes tension, and Dampness causes swelling and laxity. There is also "Broken Injury Wind" caused by wind entering unhealed wounds, and "Broken Injury Dampness" caused by dampness entering; these resemble Jing disease [Spasm] but lack head and neck stiffness, while other symptoms are identical. Additionally, excessive sweating or purgation, and postpartum anger can cause this disease; neck stiffness can also be caused by Phlegm.
[Syndrome] Those with sweating and no aversion to cold are named Rou Jing (Soft Spasm); those without sweating, with lockjaw and leg cramping, are named Gang Jing (Hard Spasm).
[Treatment] One should drain Dampness, expel Wind, and relax the exterior to bring peace. Detailed differentiation based on the presence or absence of sweating guides medication. For Rou Jing (Soft Spasm), use Gegen Jia Gui Tang (Kudzu and Cinnamon Twig Decoction); for Gang Jing (Hard Spasm), use Dachengqi Tang (Major Order the Qi Decoction). Gegen Tang (Kudzu Decoction) induces sweating and is usable for Exterior syndromes. Dachengqi Tang (Major Order the Qi Decoction) promotes purgation and is usable for Interior syndromes.
[Pulse] Floating and large indicates Floating (Deficiency) and Large (Heat); Slippery and large indicates Slippery (Phlegm) and Large (Severe Deficiency); Surging and slow indicates Surging (Heat) and Slow (Deficiency).
[Etiology] Kidney Water fails to control Heart Fire; Fire flares upward, scorching Lung Metal, causing the six lobes of the lungs to become scorched. The skin and hair become weak, tightening against the bones, thereby generating Wei Syndrome (Atrophy Syndrome). This is all due to lust and excessive sexual activity. Damp-Phlegm can also cause this condition.
Classical discussions state: Some cases arise from excessive grief, causing internal movement of Yang Qi, frequent bleeding in urine, emptiness of the major channels, and Heat arising from the Heart. The joints become like broken hinges, named Mai Wei (Vessel Atrophy). Some cases arise from endless thoughts and excessive intercourse, causing the Zong Jin (Gathering Sinews) to relax and sag, with Heat entering the Liver. The sinews become tense and nails wither, named Jin Wei (Sinew Atrophy). Some cases arise from living in damp places or working with water, generating Heat in the Spleen. The stomach becomes dry with thirst, muscles become insensible, named Rou Wei (Flesh Atrophy). Some cases arise from long journeys and fatigue, encountering great heat and thirst, leading to internal deficiency of Yang Qi and Heat lodging in the Kidney. The waist and spine cannot lift, bones become withered and Marrow decreases, named Gu Wei (Bone Atrophy). However, all these are caused by Heat steaming the Lungs. Heart Fire flares upward, Lung governance fails, resulting in Wei Syndrome (Atrophy Syndrome).
[Syndrome] Yellow complexion, body heat, emaciation, alternating chills and fever, salivation, cough, asthma, and chest fullness, facial edema with weakness and inability to move, constitute Wei Syndrome (Atrophy Syndrome). External Wei is also known as Ruan Feng (Soft Wind). Ruan Feng causes weak legs; the pathology is the same, but the syndromes differ.
[Treatment] Treatment should exclusively focus on the Yangming (Yang Brightness) channel. Yangming is the Stomach meridian. It is the Sea of the Five Zang and Six Fu organs, primarily moistening the Zong Jin (Gathering Sinews), which bind the bones and facilitate joint movement. Therefore, it arises from Yangming deficiency.
Patient Zhang was treated with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) plus Danggui (Angelica Sinensis) and other agents.
Patient Li was treated with Sweet-Cold herbs to purge Fire and Bitter-Cold herbs to purge Damp-Heat. Sizijunzi Tang (Four Gentlemen Decoction) was used to tonify Yangming deficiency, and Qingshu Yiqi Tang (Clear Summer-heat and Boost Qi Decoction) was used. For Dampness-induced Wei Syndrome (Atrophy Syndrome), Erchen Tang (Two Aged Decoction) plus Baizhu (Atractylodes Macrocephala), Fuling (Poria), and Huangbai (Phellodendron) is suitable.
Qingshu Yiqi Tang (Clear Summer-heat and Boost Qi Decoction): Treats Heat injuring the Lungs, where Qi deficiency leads to Wei Syndrome (Atrophy Syndrome).
Huangqi (Astragali Radix, 1 qian, halve if little sweat): Summer-heat pathogen disturbs Wei Qi, causing body heat and spontaneous sweating; tonify with Sweet-Warm herbs.
Renshen (Ginseng Radix): Saves Qi injured by Fire.
Baizhu (Atractylodis Macrocephalae Rhizoma, half qian each): Tonifies Spleen Qi.
Cangzhu (Atractylodis Rhizoma, 1 qian): Drains Dampness.
Gancao (Licorice Root, roasted, 3 qian): Boosts Qi.
Danggui (Angelicae Sinensis Radix, 3 qian): Nourishes Blood.
Shengma (Cimicifugae Rhizoma, 1 qian, moistened with wine, Sweet-Ping): Moistens muscle heat, Wind overcomes Dampness.
Gegen (Puerariae Lobatae Radix, 2 qian): Releases muscles.
Chenpi (Citri Reticulatae Pericarpium, half qian): Regulates Qi.
Zexie (Alismatis Rhizoma, half qian): Leaches out Dampness.
Shenqu (Massa Medicata Fermentata, half qian): Digests food and removes stagnation.
Wuweizi (Schisandrae Chinensis Fructus, 9 fen, Sour-Cold): Astringes Lung Qi injured by Summer-heat.
Maidong (Ophiopogonis Radix, 3 qian): Nourishes Yin.
Qingpi (Citri Reticulatae Pericarpium Viride, 2.5 qian): Moves Qi.
Huangbai (Phellodendri Cortex, 3 qian): Nourishes Water and purges Heat.
Alternatively, add Zhimu (Anemarrhenae Rhizoma) and Huangqin (Scutellariae Radix).
Jianbu Wan (Leg-Strengthening Pill): Treats Wei Syndrome (Atrophy Syndrome) formed by Damp-Heat.
Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Huashi (Talcum), Zhigancao (Prepared Licorice Root), Shengjiang (Fresh Ginger, washed with wine, half liang each), Zexie (Alismatis Rhizoma, 5 qian), Fangji (Stephaniae Tetrandrae Radix, processed with wine, 1 liang), Chuanwu (Aconiti Radix Preparata), Kushen (Sophorae Flavescentis Radix, washed with wine), Rougui (Cinnamomi Cortex, 1 qian).
Administered with Yufeng Tang (Wind-Extinguing Decoction).
Secret Formula: For Qi deficiency, use Sizijunzi Tang (Four Gentlemen Decoction) plus Cangzhu (Atractylodis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Huangbai (Phellodendri Cortex). For Phlegm, add Zhuli (Bambusae Caulis in Taenia). For Blood deficiency, use Siwu Tang (Four Substances Decoction). For Damp-Phlegm, use Erchen Tang (Two Aged Decoction) plus Cangzhu (Atractylodis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Huangbai (Phellodendri Cortex), and Zhuli (Bambusae Caulis in Taenia). Below is Buyin Wan (Yin-Nourishing Pill).
Classical Discussion: Yinfei (Mutism and Foot Paralysis) is due to Kidney deficiency. Inability to speak is because the Kidney meridian connects to the root of the tongue, and Kidney Qi fails to reach it; inability to walk is because Kidney Qi is not smooth.