经云∶诸痉项强，皆属于湿。又云∶诸暴强直，皆属于风。论曰∶太阳病，发汗太多，因成痉。夫六气皆
足以致痉，不专在湿也；六经皆有痉证，亦不专在太阳一经也。盖身以后，属太阳，凡头项强急，项背KT KT ，
脊强反张，腰似折，髀不可以曲， 如结，皆太阳痉也。身以前属阳明，头面动摇，口噤齿 ，缺盆纽痛，脚
挛急，皆阳明痉也。身之侧属少阳，口眼 邪，手足牵引，两胁拘急，半身不遂，皆少阳痉也。至若腹内拘急，
因吐利后而四肢挛急者，未尝非太阴痉也。恶寒蜷卧，尻以代踵，脊以代头，俯而不能仰者，未尝非少阴痉也。
睾丸上升，宗筋下注，少腹里急，阴中拘挛，膝胫拘急者，未尝非厥阴痉也。大抵痉以状名，而痉因筋急，故
凡六经筋病，皆得以痉称之。其因于风寒者，必发热恶寒而无汗，其脉浮紧，其状身强直而口噤，即经所云∶
诸病强直，皆属于风者也。其势劲急，故名曰刚痉。其因于风湿者，发热汗出，不恶寒，其脉浮缓，其状项强
KTKT ，而身不强直，即经所云∶诸痉项强，皆属于湿者也。其势濡弱，故名曰柔痉。若夫因误汗亡阳，津
竭无以养筋而致痉者，即本论所云∶太阳病，发汗太多而成痉，又非因湿因风，而却因燥者也。盖痉之始，本
非正病，多杂于他病之中，如妇人之脱血，跌扑之破伤，俱能致痉。今见患此者，悉指为风，殊非确论。学人
当于证中审察风、寒、湿、燥、内外、虚实之因，分别施治，庶不致误，慎勿概指为风也。
伤寒所致太阳病，痉、湿、 ，此三种，宜应别论，以为与伤寒相似，故此见之。
【按】“伤寒所致”四字，甚无所谓，衍文也。
【注】伤寒，太阳经中之一病，非谓太阳经惟病伤寒也。盖以六气外感之邪，人中伤之者，未有不由太阳
之表而入者也。痉，风邪也。湿，湿邪也。 ，暑邪也。夫风寒暑湿之病，固皆统属太阳，然痉、湿、 三种，
虽与伤寒形证相似，但其为病传变不同，故曰宜应别论也。
【集注】方有执曰∶痉、湿、 三者，皆风寒之变证。既成变证，则当别为立论。然自风寒变来，本属太
阳，犹有风寒涉似之疑，须当并为辨论。
病身热足寒，颈项强急，恶寒，时头热面赤，目脉赤，独头面摇，卒口噤，背反张者，痉病也。
【注】病患身热恶寒，太阳证也。颈项强急、面赤目赤，阳明证也。头热，阳郁于上也；足寒，阴凝于下也
。太阳之脉，循背上头；阳明之筋，上挟于口。风寒客于二经，则有头摇、口噤、反张、拘强之证，故名痉病也。
【集注】方有执曰∶此以痉之具证。言身热头热，面赤目脉赤，阳邪发于阳也。足寒，阴邪逆于阴也。独
头面摇，风行阳而动于上也。卒，忽然也。噤，寒而口闭也，言忽然唇口吻合，噤急而饮食不通也。背反张者，
太阳之脉挟背，寒则筋急而拘挛，热则筋缓而纵驰也。然刚、柔二痉，则各见证之一偏，惟风寒俱有而致证者，
则具见也。
郑重光曰∶此总论痉之经俞皆病，气血并伤，而为强急反张之证也。风湿俱有，故为痉之具证也。
太阳病，发热，脉沉而细者，名曰痉。
【注】太阳病发热，脉当浮大，脉若沉细，兼少阴也。今发热脉沉细，而名曰痉者，何也？以其已病痉证，
而得沉细脉，不可名太阳、少阴伤寒之脉，当名太阳风湿痉病之脉也。因风邪郁于阳，故病发热也。湿邪凝于
阴，故脉沉细也。此承上条痉病得沉细脉之义，非谓太阳病发热，脉沉细，即名之曰痉病也。
【集注】方有执曰∶发热，太阳未除也。沉，寒也。细，湿也。
程知曰∶脉沉细，法宜救里，而痉又为燥热之病，故《金匮》谓难治。谓未可轻同于太阳发热脉反沉之例也。
张璐曰∶发热脉当浮数，而反沉细，知邪风为湿气所着，所以身虽发热，而脉不能浮数，是阳证见阴脉，故
《金匮》指为难治也。
程应旄曰∶痉病有同有独，固以其独者名之矣。然脉在太阳，更有独而无同，以头面摇，口噤背反张之证，
合沉细之脉，虽有太阳发热等证，不致为伤寒所溷，乃可定其名曰痉也。
太阳病，发热无汗，反恶寒者，名曰刚痉。太阳病，发热汗出，而不恶寒，名曰柔痉。
【按】反恶寒之“反”字，衍文也。刚痉证应恶寒，非反也。
【注】痉病既属太阳，当以太阳虚实例之。故曰∶太阳病发热无汗，恶寒，为实邪，名曰刚痉；发热汗出，
不恶寒，为虚邪，名曰柔痉。此详申上二条痉病虚实，非谓太阳病，发热无汗、恶寒，汗出不恶寒，即名之曰
刚、柔痉病之证也。
【集注】程知曰∶太阳病，发热，无汗，恶寒，为伤寒；发热，汗出，恶风，为伤风；发热，汗出，不
恶寒，为温热。以证有颈项强急，甚则反张，故不谓之风寒、温热病，而谓之痉也。
张璐曰∶《金匮》云∶太阳病无汗，而小便反少，气上冲胸，口噤不能言，欲作刚痉，葛根汤主之。即
是申明此条之义，而补其治法也。无汗而小便少者，以太阳、阳明二经之热，聚于胸中，延伤肺金清肃之气，
内外不能宣通故也。又云∶太阳病，其证备，身体强KT KT 然脉反沉迟，此为痉，栝蒌桂枝汤主之，即是申
明此条之义，而补其治法也。其证备，则发热汗出等证，《金匮》已详，不必赘矣。
太阳病，项背强KT KT ，无汗恶风，葛根汤主之。
【注】此略其证脉，单举痉之颈项强急者，以明其治也。太阳脉，下项循肩挟脊；阳明脉循喉咙，入缺
盆，贯膈、下乳内廉。太阳主后，前合阳明；阳明主前，后合太阳。今邪壅于二经之中，故有KT KT 拘强之
貌也。太阳之强，不过颈项强；此痉之强，则不能俯仰，项连胸背而俱强，故曰项背强KT KT 也。无汗恶风，
实邪也，宜葛根汤发之，即桂枝汤加麻黄、葛根，两解太阳、阳明之邪也。
【集注】方有执曰∶KT KT ，鸟之短羽者，动则引颈KT KT 然。形容病患之颈项俱病者，俯仰不能
自如之貌。
太阳病，项背强KT KT ，反汗出恶风者，桂枝加葛根汤主之。
【注】太阳病，项背强KT KT ，无汗恶风者，实邪也。今反汗出恶风者，虚邪也，宜桂枝加葛根汤，
解太阳之风，发阳明之汗也。
【集注】汪琥曰∶太阳病项背强矣，复KT KT 然，颈不得舒，颈之经属阳明，项背与颈KT KT 然，
其状当无汗，今反汗出、恶风，仲
景法∶太阳病汗出恶风者，桂枝汤主之。今因其KT KT 然，故加葛根于桂枝汤中，以兼祛阳明经之风也。
桂枝加葛根汤方
于桂枝汤内，加葛根三两，余根据桂枝汤法。
太阳病，发汗太多，因致痉。
【注】以上论痉，皆外感风、寒、湿而为病也。若太阳病发汗太多，津液大亡，表气不固，邪风乘虚而入，
因成痉者，乃内虚之所致也，不可以柔痉、刚痉例之，宜以桂枝加附子汤，以固表祛风为主治。由此推之，凡
病出汗过多，新产亡血过多，而变生此证者，皆类此也。
【集注】程应旄曰∶即此一端推之，则知此病得之亡津亡血，而因虚致寒，因虚致燥者不少。盖阳气者，
柔则养筋，发汗太多，则亡其阳，而损其经脉之血液故也。
湿家之为病，一身尽疼，发热，身色如似熏黄。
【注】湿家，谓病湿之人。湿之为病，或因外受湿气，则一身尽痛，或因内生湿病，则发热身黄。若内外
同病，则一身尽痛发热，身色如熏黄也。熏黄者，湿盛之发黄，属脾之瘀湿，故其色暗如烟熏也。不似伤寒热
盛之发黄，属阳明之郁热，故其色明如橘子色也。
【集注】张璐曰∶湿证发黄，须分阴阳表里，阳湿在里，茵陈蒿汤；在表，麻黄连招赤小豆汤。阴湿在里，
白术附子汤；在表，麻黄白术汤，此阴湿在表而发黄也。《金匮》有云∶湿家身烦痛，可与麻黄加术汤。盖寒
与湿合，不宜大汗，故加白术。以麻黄得术，则汗不致于骤发；白术得麻黄，则湿滞得以宣通也。
湿家病，身上疼痛，发热，面黄而喘，头痛鼻塞而烦，其脉大，自能饮食，腹中和无病，病在头中寒湿，
故鼻塞，纳药鼻中则愈。
【注】此申上条，详其证出其脉，以别其治也。湿家病，身上疼痛发热，面黄而喘，此内生外受之湿病也。
外宜羌活胜湿汤，内宜茵陈五苓散，喘甚大陷胸丸。若更头痛鼻塞而烦，其脉大，证类伤寒，但其人里和能食，
知非伤寒，不可发汗，乃湿邪之病在头，故头痛鼻塞，惟宜纳药鼻中，取黄水从涕出，自可愈也。所纳之药，
即瓜蒂散类也。
【集注】郑重光曰∶身上疼痛发热，面黄而喘，头痛鼻塞，则寒湿之邪客于上焦。经曰∶因于湿，首如裹
是也。用瓜蒂散吹鼻，此在上者，因而越之之法也。
太阳病，关节疼痛而烦，脉沉而细者，此名湿痹。湿痹之候，其人小便不利，大便反快。但当利其小便。
【注】湿家脉浮细，湿在外也，当汗之。今太阳病，关节疼痛而烦，小便不利，大便反快，脉不浮细而沉
细，是湿邪内盛而为湿痹不通之候也。故但当利其小便，使湿从小便而去，乃湿淫于内之正治也。
【集注】成无己曰∶湿盛则濡泄。小便不利，大便反快者，湿气内流也。但当利其小便，以宣泄腹中湿气。
古云∶治湿不利小便，非其治也。
方有执曰∶此以湿之入里者言也。关节疼痛者，寒湿之气，走注内渗，所以脉沉而细也。痹以疼痛言。小
便不利，大便反快者，湿即水，水不外渗，则横流不遵故道。利其小便者，导其遵故道而行也。
张志聪曰∶关节者，腰背肘膝之大关，大筋之所统属，不同于骨节也。湿流关节，大筋不和。故疼痛痹闭
也。湿伤太阳，筋脉涩滞，故名湿痹，利其小便，则水道行而决渎无愆，湿邪去而筋脉调和矣。
湿家，其人但头汗出，背强，欲得被覆、
向火。若下之早则哕，胸满，小便不利，舌上如苔者；以丹田有热，胸中有寒，渴欲得水，而不能饮，口燥烦也。
【注】湿家但头汗出，乃湿气上淫之汗，非阳明之热不得越也。湿家背强，乃湿气涩滞之重强，非痉病之
拘强也。欲得覆被向火，非外恶寒，乃湿盛生内寒也。若误以湿淫之头汗，为阳明瘀热之头汗而下之，寒湿之
气，乘虚入胸则胸满，入胃则哕矣。寒湿不化，故小便不利。胸中有寒，故舌上滑白如苔。丹田有热，故口燥
渴。欲得水而不能饮，由胸中有寒湿故也。
【集注】成无己曰∶伤寒则无汗，湿家虽有汗而不能周身，故但头汗出也。
程应旋曰∶虽渴欲得水似热，而不能饮可辨，则只是口燥烦，而实非胸中燥烦可知，证同病别也。
湿家下之，额上汗出，微喘，小便利者死；若下利不止者，亦死。
【注】此承上条湿家误下之逆也。湿家误下，胸满而哕，小便不利，舌上如苔，口燥渴不能饮，已属逆矣，
尚在可治。此误下后，额汗不已，微喘不止，是阳脱于上也；小便反利，下利不止，是阴脱于下也。阴阳相离，
故死也。
【集注】方有执曰∶治湿当利其小便，而以小便利主死，何也？误治而阴阳散亡也。
程知曰∶湿之中人，阴先受之，故本经湿证，多从助阳温散为治，若妄下，则阳虚阴盛而不可救矣。额上
汗出微喘，虚阳欲上脱也；二便不禁，盛阴欲下脱也。阴阳离决，死矣！
病者一身尽疼，发热，日晡所剧者，此名风湿。此病伤于汗出当风，或久伤取冷所致也。
【注】病者，谓一身尽痛之病患也。湿家一身尽痛，风湿亦一身尽痛。然湿家之痛，则重着不能转侧；
风湿之痛，则轻掣不可屈伸，此痛之有别者也。至于发热，湿家之热，早暮不分微甚；风湿之热，则日晡必剧。
此得之于汗出当风，或久伤湿，复受风冷所致也。
【集注】张志聪曰∶汗出当风，则为风湿；久伤取冷，则为寒湿。
张锡驹曰∶发热日晡所剧者，日晡而阳气衰，阴气盛，湿为阴邪，故主旺时而甚也。
问曰∶风湿相抟，一身尽疼痛，法当汗出而解。值天阴雨不止，医云此可发汗。汗之病不愈者，何也？
答曰∶发其汗，汗大出者，但风气去，湿气在，是故不愈也。若治风湿者，发其汗，但微微似欲汗出者，风湿
俱去也。
【注】此详风湿相抟，一身尽痛，不惟不可下，即发汗亦不可失其宜也。风阳邪，湿阴邪，风湿相抟，
阴阳受邪，故一身尽痛也。法当汗出而解，值天阴雨不止，则湿气盛，虽发其汗，汗大出而病不愈者，但以风
气去，湿气在，是故不愈也。以其值湿盛之时，发其汗，大汗出，此汗之不如法，所以不解也。若治风湿者，
必俟天气晴明发其汗，但令其汗微微似欲出状，则风与湿俱去，而病自解矣。
【集注】方有执曰∶阴雨不止，则湿不除，所以益当发汗也。然风湿本由汗出当风而得，则汗之大出者，
必反湿转加甚，微微似欲汗出，而不见出，则湿消而风散矣。此发汗之微机，后之人动辄以大汗为言者，去道远矣。
张璐曰∶风湿相抟，法当汗出而解，合用桂枝加术，使微微蒸发，表里气和，风湿皆去。正如湿家身烦
The *Neijing* (Inner Canon) states: "All spasms with neck stiffness are attributed to dampness." It also states: "All sudden stiffness and rigidity are attributed to wind." The treatise says: "In Taiyang disease, excessive sweating leads to spasms." In fact, all six qi can cause spasms, not just dampness; spasms can occur in all six meridians, not exclusively in the Taiyang meridian. Generally, the posterior aspect of the body belongs to the Taiyang meridian. Any case of stiff and rigid neck and head, tightness and stiffness in the neck and back (*jǐn jǐn*), rigid spine with opisthotonos, waist feeling as if broken, thighs unable to bend, and the popliteal fossa feeling bound or knotted, are all Taiyang spasms. The anterior aspect of the body belongs to the Yangming meridian. Any case of shaking of the head and face, trismus (locked jaw) and teeth grinding, pain in the supraclavicular fossa (Jianjing/Quepen area), and cramping of the feet, are all Yangming spasms. The lateral aspect of the body belongs to the Shaoyang meridian. Any case of facial paralysis (deviation of mouth and eyes), traction and convulsions of the hands and feet, stiffness and tension in both hypochondria, and hemiplegia, are all Shaoyang spasms. As for abdominal stiffness and tension, followed by cramping of the four limbs after vomiting and diarrhea, this may well be a Taoyin spasm. Aversion to cold, curling up and lying down, using the buttocks instead of the heels, bending the spine forward so that the head is lower than the back, being able to bend but not straighten, may well be a Shaoyin spasm. Retraction of the testicles, downward flow of the Zongjin (converging sinews), urgency in the lower abdomen, cramping in the genitalia, and stiffness and tension in the knees and shins, may well be a Jueyin spasm. Broadly speaking, "spasm" is named according to its manifestations, and the cause of spasm is sinew tension. Therefore, any disease of the sinews of the six meridians can be called spasm. Those caused by wind-cold must present with fever, aversion to cold, and anhidrosis, with a floating-tight pulse, and symptoms of body rigidity and trismus. This corresponds to the classic statement: "All stiffness and rigidity diseases are attributed to wind." Because the condition is vigorous and urgent, it is named Gang Jing (Yang Spasm). Those caused by wind-damp present with fever, sweating, no aversion to cold, and a floating-slow pulse, with symptoms of neck stiffness and tightness (*jǐn jǐn*) but without full-body rigidity. This corresponds to the classic statement: "All spasms with neck stiffness are attributed to dampness." Because the condition is soft and weak, it is named Rou Jing (Yin Spasm). If spasm is caused by erroneous sweating leading to loss of Yang, exhaustion of fluids, and inability of fluids to nourish the sinews, this is what the treatise refers to as: "Taiyang disease, excessive sweating leads to spasm." This is neither due to dampness nor wind, but due to dryness. Generally, spasm is not a primary disease at its onset but often complicates other diseases, such as postpartum blood loss in women or traumatic injuries, all of which can cause spasm. Currently, those suffering from this are all attributed to wind, which is certainly not an accurate conclusion. Students should carefully examine the causes of wind, cold, damp, dryness, interior, exterior, deficiency, and excess within the syndromes and treat them accordingly to avoid errors. Do not simply attribute everything to wind.
Taiyang disease caused by Cold Damage involves three types: Spasm (Jing), Dampness (Shi), and Heatstroke/Yu (Ye). These should be discussed separately because they resemble Cold Damage, hence their appearance here.
[Note] The four characters "caused by Cold Damage" are meaningless and are likely interpolations.
[Annotation] Cold Damage is merely one type of disease in the Taiyang meridian, not implying that the Taiyang meridian only suffers from Cold Damage. Generally, pathogenic factors of the six qi invading humans do so through the exterior of the Taiyang. Spasm is Wind Pathogen; Dampness is Damp Pathogen; Yu is Summerheat Pathogen. Although diseases of wind, cold, summerheat, and dampness all fall under Taiyang, the transmission and progression of Spasm, Dampness, and Yu differ from Cold Damage, hence they should be discussed separately.
[Collected Notes] Fang Youzhi said: Spasm, Dampness, and Yu are all variations of wind-cold. Once they become variation syndromes, separate discussions should be established. However, since they originate from wind-cold and belong to Taiyang, there remains doubt regarding their similarity to wind-cold, so they should be differentiated together.
If a patient has fever, cold feet, stiff and rigid neck, aversion to cold, occasional fever and redness of the head and face, red eye vessels, isolated shaking of the head and face, sudden trismus, and opisthotonos (backward arching of the back), this is Spasm Disease.
[Annotation] Fever and aversion to cold are Taiyang syndromes. Stiff neck, red face, and red eyes are Yangming syndromes. Head fever indicates Yang Qi stagnating upward; foot cold indicates Yin Qi coagulating downward. The Taiyang meridian runs along the back to the head; the Yangming sinews run up to flank the mouth. When wind-cold lodges in these two meridians, symptoms such as head shaking, trismus, opisthotonos, and stiffness occur, hence named Spasm Disease.
[Collected Notes] Fang Youzhi said: This lists the complete symptoms of spasm. Body heat, head heat, red face, and red eye vessels indicate Yang pathogen manifesting in Yang aspects. Foot cold indicates Yin pathogen reversing into Yin aspects. Isolated head and face shaking indicates wind moving in Yang and acting upward. "Sudden" means abruptly. "Trismus" means closure of the mouth due to cold, indicating abrupt locking of lips and teeth, preventing eating. Opisthotonos occurs because the Taiyang meridian flanks the back; cold causes sinew tension and contraction, while heat causes sinew relaxation and extension. Gang Jing and Rou Jing each show only one aspect of the syndrome; only when both wind and cold are present do all symptoms appear fully.
Zheng Zhongguang said: This generally discusses how spasm affects meridians and acupoints, injuring both Qi and Blood, resulting in stiffness and opisthotonos. The presence of both wind and damp makes this the complete syndrome of spasm.
In Taiyang disease, if there is fever and the pulse is deep and fine, it is named Spasm.
[Annotation] In Taiyang disease with fever, the pulse should be floating and large. If the pulse is deep and fine, it involves Shaoyin. Why is fever with a deep-fine pulse named Spasm? Because the patient already has a spasm syndrome presenting with a deep-fine pulse, it cannot be named the pulse of Taiyang or Shaoyin Cold Damage. It should be named the pulse of Taiyang Wind-Damp Spasm. Wind pathogen stagnating in Yang causes fever. Damp pathogen coagulating in Yin causes a deep-fine pulse. This continues the meaning of the previous clause regarding spasm obtaining a deep-fine pulse; it does not mean that any Taiyang fever with a deep-fine pulse is automatically named Spasm.
[Collected Notes] Fang Youzhi said: Fever indicates Taiyang disease is unresolved. Deep indicates Cold. Fine indicates Damp.
Cheng Zhi said: A deep-fine pulse typically warrants treating the Interior, but spasm is a disease of dryness and heat, hence *Jinkui Yaolue* states it is difficult to treat. One should not lightly equate it with the example of Taiyang fever with a reversed deep pulse.
Zhang Lu said: Fever usually presents with a floating-rapid pulse. A reversed deep-fine pulse indicates evil wind is adhered to by dampness. Thus, although the body is hot, the pulse cannot be floating-rapid. This is a Yang syndrome showing a Yin pulse, hence *Jinkui Yaolue* points out it is difficult to treat.
Cheng Yingmao said: Spasm has common and unique features. It is named by its unique features. However, when the pulse is in Taiyang, there are unique features without common ones. Combining symptoms like head shaking, trismus, and opisthotonos with a deep-fine pulse, even if there are Taiyang fever symptoms, it will not be confused with Cold Damage, allowing the name Spasm to be confirmed.
In Taiyang disease, if there is fever, anhidrosis, and reversed aversion to cold, it is named Gang Jing (Yang Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is named Rou Jing (Yin Spasm).
[Note] The character "reversed" (fan) in "reversed aversion to cold" is an interpolation. Gang Jing should present with aversion to cold; it is not reversed.
[Annotation] Since spasm belongs to Taiyang, it should be verified by Taiyang deficiency and excess. Therefore: Taiyang disease with fever, anhidrosis, and aversion to cold is Excess Evil, named Gang Jing; fever with sweating and no aversion to cold is Deficiency Evil, named Rou Jing. This elaborates on the deficiency and excess of spasm mentioned in the previous two clauses. It does not mean that any Taiyang fever with anhidrosis/aversion to cold or fever/sweating/no aversion to cold is automatically named Gang or Rou Spasm.
[Collected Notes] Cheng Zhi said: Taiyang disease with fever, anhidrosis, and aversion to cold is Cold Damage; fever, sweating, and aversion to wind is Wind Strike; fever, sweating, and no aversion to cold is Warm-Heat disease. Because the syndrome includes stiff neck and even opisthotonos, it is not called Cold Damage, Wind Strike, or Warm-Heat disease, but Spasm.
Zhang Lu said: *Jinkui Yaolue* states: "Taiyang disease with anhidrosis, yet urine is scanty, Qi rushes up to the chest, trismus prevents speech, intending to develop Gang Jing, Ge Gen Tang governs." This clarifies the meaning of this clause and supplements its treatment. Anhidrosis with scanty urine occurs because heat from Taiyang and Yangming gathers in the chest, damaging the clear descending Qi of the Lung, preventing internal and external circulation. It also states: "Taiyang disease, syndromes are complete, body is stiff and rigid (*jin jin*), yet pulse is reversed deep and slow, this is Spasm, Gua Lou Gui Zhi Tang governs." This also clarifies the meaning and supplements treatment. The "complete syndromes" refer to fever and sweating detailed in *Jinkui Yaolue*, so no need to repeat.
In Taiyang disease, if the neck and back are stiff and rigid (*jin jin*), with anhidrosis and aversion to wind, Ge Gen Tang governs.
[Annotation] Here, symptoms and pulse are briefly omitted, focusing solely on the stiff neck of spasm to illustrate treatment. The Taiyang meridian descends to the neck, runs along the shoulders, and flanks the spine; the Yangming meridian runs along the throat, enters the supraclavicular fossa, pierces the diaphragm, and descends to the inner breast. Taiyang governs the posterior, connecting anteriorly with Yangming; Yangming governs the anterior, connecting posteriorly with Taiyang. Now, evil obstructs these two meridians, causing stiffness and rigidity. Taiyang stiffness is limited to the neck; Spasm stiffness prevents flexion and extension, involving the neck, chest, and back, hence "neck and back stiff and rigid (*jin jin*)." Anhidrosis and aversion to wind indicate Excess Evil; Ge Gen Tang should be used to release it. This is Gui Zhi Tang plus Ma Huang and Ge Gen, resolving evil in both Taiyang and Yangming.
[Collected Notes] Fang Youzhi said: *Jin jin* describes a bird with short wings stretching its neck. It depicts patients whose necks are diseased, unable to flex or extend freely.
In Taiyang disease, if the neck and back are stiff and rigid (*jin jin*), with reversed sweating and aversion to wind, Gui Zhi Jia Ge Gen Tang governs.
[Annotation] Taiyang disease with neck/back stiffness, anhidrosis, and aversion to wind is Excess Evil. Now, with reversed sweating and aversion to wind, it is Deficiency Evil. Gui Zhi Jia Ge Gen Tang should be used to resolve Wind in Taiyang and induce sweat in Yangming.
[Collected Notes] Wang Hu said: Taiyang disease with stiff neck and *jin jin* sensation means the neck cannot relax. The neck's meridian belongs to Yangming. With neck/back *jin jin*, the state should be anhidrotic. Now, with reversed sweating and aversion to wind, per Zhang Zhongjing's method: Taiyang disease with sweating and aversion to wind is governed by Gui Zhi Tang. Due to the *jin jin* sensation, Ge Gen is added to Gui Zhi Tang to simultaneously dispel Wind in the Yangming meridian.
Gui Zhi Jia Ge Gen Tang Formula
Add 3 liang of Ge Gen (Puerariae Radix) to Gui Zhi Tang. Follow the rest of the Gui Zhi Tang preparation method.
In Taiyang disease, excessive sweating leads to spasm.
[Annotation] The above discussions on spasm involve external Wind, Cold, and Damp. If Taiyang disease involves excessive sweating, leading to massive fluid loss, insecure exterior Qi, and pathogenic wind entering via deficiency, causing spasm, this is due to internal deficiency. It cannot be treated as Gang or Rou Spasm. Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction plus Prepared Aconite Root) should be used, primarily to secure the exterior and dispel wind. By analogy, any disease with excessive sweating, or new postpartum blood loss, leading to this syndrome, is similar.
[Collected Notes] Cheng Yingmao said: From this, we know that many cases arise from loss of fluids and blood, leading to cold and dryness via deficiency. Yang Qi softens and nourishes the sinews. Excessive sweating loses Yang and damages the blood in the meridians.
Patients with Dampness disease experience whole-body pain, fever, and a body color resembling smoked yellow.
[Annotation] "Dampness patient" refers to one suffering from Dampness. Dampness disease, whether externally contracted or internally generated, causes whole-body pain or fever and jaundice. If both interior and exterior are involved, there is whole-body pain, fever, and smoked-yellow discoloration. Smoked yellow indicates severe Dampness causing jaundice, belonging to Spleen stasis-dampness, hence dark like smoke. This differs from Cold Damage heat-excess jaundice, which belongs to Yangming stagnant heat, appearing bright orange.
[Collected Notes] Zhang Lu said: Jaundice in Dampness must be differentiated by Yin/Yang and Interior/Exterior. Yang-Damp in Interior: Yin Chen Hao Tang; in Exterior: Ma Huang Lian Qiao Chi Xiao Dou Tang. Yin-Damp in Interior: Bai Zhu Fu Zi Tang; in Exterior: Ma Huang Bai Zhu Tang (this is Yin-Damp in Exterior causing jaundice). *Jinkui Yaolue* states: "Dampness patient with bodily irritability and pain, Ma Huang Jia Zhu Tang may be given." Cold combined with Damp should not induce heavy sweating, hence Bai Zhu is added. Ma Huang with Bai Zhu prevents sudden sweating; Bai Zhu with Ma Huang promotes dispersion of Damp stagnation.
A Dampness patient experiences body pain, fever, yellow face, wheezing, headache, nasal congestion, and irritability. The pulse is large, digestion is normal, and the abdomen is peaceful. The disease is Cold-Damp in the head, causing nasal congestion. Inserting medicine into the nose cures it.
[Annotation] This elaborates on the previous clause, detailing symptoms and pulse to distinguish treatment. Body pain, fever, yellow face, and wheezing indicate internal and external Dampness. External treatment: Qiang Huo Sheng Shi Tang; Internal treatment: Yin Chen Wu Ling San; severe wheezing: Da Xian Xiong Wan. If accompanied by headache, nasal congestion, and irritability with a large pulse, resembling Cold Damage, but with a peaceful interior and normal appetite, it is not Cold Damage. Sweating is contraindicated. The Damp-Evil is in the head, causing headache and congestion. Only inserting medicine into the nose is suitable, extracting yellow fluid via nasal discharge for cure. The inserted medicine is similar to Gua Di San (Melon Dispersant).
[Collected Notes] Zheng Zhongguang said: Body pain, fever, yellow face, wheezing, headache, and nasal congestion indicate Cold-Damp lodging in the Upper Jiao. The Classic states: "Due to Dampness, the head feels wrapped." Using Gua Di San insufflated into the nose follows the principle of evacuating pathogens from above.
In Taiyang disease, joint pain with irritability and a deep-fine pulse is named Shi Bi (Dampness Bi). In Shi Bi, the patient has difficulty urinating and loose stools. The treatment is to promote urination.
[Annotation] Dampness patients typically have floating-fine pulses, indicating exterior Dampness to be released by sweating. Now, Taiyang disease with joint pain, irritability, difficulty urinating, loose stools, and a deep-fine pulse indicates interior Dampness excess causing Shi Bi obstruction. Therefore, promoting urination is the correct treatment to drain Dampness via the bladder.
[Collected Notes] Cheng Wuji said: Excess Dampness causes loose stools. Difficulty urinating and loose stools indicate Dampness flowing inward. Promoting urination excretes abdominal Dampness. Ancient saying: "Treating Dampness without promoting urination is incorrect treatment."
Fang Youzhi said: This discusses Dampness entering the Interior. Joint pain results from Cold-Damp penetrating inward. Deep-fine pulse reflects this. "Bi" denotes pain. Difficulty urinating and loose stools indicate water failing to follow its proper course. Promoting urination guides it back to the proper path.
Zhang Zicong said: Joints are major connections of the waist, back, elbows, and knees, governed by large sinews, distinct from bone joints. Dampness flowing into joints disrupts large sinews, causing pain and obstruction. Dampness injuring Taiyang causes sinew stagnation, named Shi Bi. Promoting urination unblocks water passages, removes Dampness, and harmonizes sinews.
A Dampness patient sweats only on the head, has a stiff back, and desires covering with blankets or sitting near fire. If purged prematurely, hiccups, chest fullness, difficulty urinating, and a tongue coating resembling moss appear. This is due to Heat in the Dan Tian and Cold in the Chest, thirst wanting water but unable to drink, and oral dryness/irritability.
[Annotation] Head-only sweating in Dampness is due to Dampness steaming upward, not Yangming Heat trapped inside. Back stiffness in Dampness is heavy rigidity from Dampness stagnation, not the cramping of Spasm. Desiring warmth indicates internal Cold generated by severe Dampness, not external aversion to cold. Erroneously purging based on mistaken diagnosis of Yangming Heat leads to Cold-Damp invading the Chest (fullness) and Stomach (hiccups). Untransformed Cold-Damp causes difficulty urinating. Cold in the Chest causes a slippery-white tongue coating. Heat in the Dan Tian causes oral dryness/thirst. Thirst without desire to drink is due to Cold-Damp in the Chest.
[Collected Notes] Cheng Wuji said: Cold Damage presents with anhidrosis. Dampness patients may sweat but not over the whole body, hence only head sweating.
Cheng Yingxuan said: Thirst wanting water resembles Heat, but inability to drink distinguishes it. It is merely oral dryness/irritability, not true Chest dryness/irritability. The syndrome appears similar, but the disease is different.
If a Dampness patient is purged, sweating on the forehead, slight wheezing, and free urination indicate death. If diarrhea persists uncontrollably, it also indicates death.
[Annotation] This continues the adverse effects of erroneous purging in Dampness. Premature purging leads to chest fullness, hiccups, difficulty urinating, tongue coating, and thirst without desire to drink—already adverse but potentially treatable. Post-purging persistent forehead sweating and wheezing indicate Yang collapsing upward. Free urination and persistent diarrhea indicate Yin collapsing downward. Separation of Yin and Yang leads to death.
[Collected Notes] Fang Youzhi said: Treating Dampness requires promoting urination, yet free urination indicates death. Why? Mis-treatment causes scattering of Yin and Yang.
Cheng Zhi said: Dampness invades Yin first. Dampness treatments in this chapter often use warming and dispersing methods to assist Yang. Erroneous purging leads to Yang deficiency and Yin excess, which is incurable. Forehead sweating and slight wheezing indicate deficient Yang attempting to collapse upward. Incontinence indicates abundant Yin attempting to collapse downward. Separation of Yin and Yang leads to death.
A patient with whole-body pain and fever, worsening in the late afternoon, is named Feng Shi (Wind-Damp). This disease results from sweating while exposed to wind, or prolonged exposure to cold/damp.
[Annotation] "Patient" refers to one with whole-body pain. Both Dampness and Wind-Damp cause whole-body pain. However, Dampness pain is heavy and immovable, while Wind-Damp pain is light and restricts flexion/extension. Regarding fever: Dampness fever varies little day and night, whereas Wind-Damp fever worsens significantly in the late afternoon. This results from sweating into wind or prolonged damp-cold exposure.
[Collected Notes] Zhang Zicong said: Sweating into wind causes Wind-Damp; prolonged cold exposure causes Cold-Damp.
Zhang Xiqiu said: Fever worsening in the late afternoon occurs because Yang Qi declines and Yin Qi rises at this time. Dampness is a Yin pathogen, so it exacerbates during its prosperous time (Yin hours).
Q: Wind-Damp binding causes whole-body pain. By law, sweating should resolve it. If it rains continuously, and the doctor suggests sweating, why does the patient not recover after sweating?
A: Heavy sweating expels Wind but leaves Dampness behind, hence no recovery. To treat Wind-Damp, induce only slight, continuous sweating, so both Wind and Damp are expelled.
[Annotation] This details that Wind-Damp binding causing pain cannot be purged, nor should sweating be misapplied. Wind is Yang Evil, Damp is Yin Evil. Binding injures both Yin and Yang, causing whole-body pain. Sweating is indicated. However, during rainy weather, Dampness is abundant. Heavy sweating expels Wind but fails to remove Dampness, hence no recovery. Sweating heavily during high Dampness is improper technique. For Wind-Damp, wait for clear weather and induce only slight, continuous sweating ("like wanting to sweat"), so both Wind and Damp are expelled, and the disease resolves.
[Collected Notes] Fang Youzhi said: Continuous rain means Dampness remains, necessitating sweating. However, since Wind-Damp originates from sweating into wind, heavy sweating worsens Dampness. Slight, continuous sweating dissipates Dampness and scatters Wind. This is the subtle mechanism of sweating; later practitioners advocating heavy sweating are far off track.
Zhang Lu said: Wind-Damp binding requires sweating to resolve. Use Gui Zhi Jia Zhu Tang to induce slight evaporation, harmonizing Interior and Exterior, expelling both Wind and Damp. Just as Dampness patients with bodily irritability...