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The patient presents with fever in the body, coldness in the feet, stiffness and tension in the neck and nape, aversion to cold, occasional heat in the head, redness of the face and eyes, isolated shaking of the head, sudden lockjaw (trismus), and opisthotonos (arching of the back). This is known as Jing disease (Spasm disorder). If sweating methods are induced erroneously, cold and dampness contend with each other, the exterior becomes more deficient, leading to severe aversion to cold. After inducing sweating, the pulse resembles a snake winding.

[Commentary] Various schools list Gang-Jing (Stiff Spasm) and Rou-Jing (Soft Spasm) as the first items. The reason for listing this item as the first here is that the distinction between Gang and Rou stems from this item. Since this item presents the most complete syndrome of Jing disease, it should be placed at the beginning. Furthermore, the six sentences "If inducing sweating..." under "Jing disease" do not connect logically with the preceding text but relate to the later sentence in Item 11: "For resolution, if the pulse remains unchanged but becomes hidden and wiry, it is Jing." These should be moved there.

[Annotation] Fever and aversion to cold in the patient indicate Taiyang syndrome; stiffness in the neck and nape, along with redness of the face and eyes, indicate Yangming syndrome. Heat in the head signifies Yang Qi constrained above; coldness in the feet signifies Yin Qi stagnant below. The Taiyang meridian runs along the back and head; the Yangming sinews run up to flank the mouth. When Wind-Cold pathogens invade these two meridians, symptoms such as head shaking, lockjaw, opisthotonos, and rigidity occur. These are all manifestations of Jing disease, hence revealed first as the key principle.

[Collected Commentaries] Li said: The sinews of the three Hand-Yang meridians knot into the jaw and cheeks. The sinew of the Foot-Yangming meridian runs up to flank the mouth. When Wind-Cold enters the sinews due to deficiency, they contract, causing tightness of the jaw and lockjaw.

Regarding the pulse of Jing disease, when pressed, it feels tight like a string, running straight up and down.

[Annotation] The condition of Jing disease involves stiff, urgent, and rigid symptoms; thus, its pulse is also stiff, urgent, and rigid. Feeling tight upon pressure is the image of urgency; feeling like a straight string is the image of straight movement.

The *Mai Jing* (Pulse Classic) states: In patients prone to spasms, the pulse is hidden and firm, running straight up and down.

[Annotation] A tight and wiry pulse running straight up and down indicates that Jing disease belongs to the Taiyang exterior. The "hidden and firm" pulse mentioned in the *Mai Jing* indicates that Jing disease belongs to the Yangming interior. Generally, Jing disease involves both meridians; therefore, treatment may involve sweating via Gegen Tang (Kudzu Decoction) for the Taiyang aspect or purging via Dachengqi Tang (Major Order the Qi Decoction) for the Yangming aspect. "Hidden and firm" refers to deep and solid; "straight up and down" refers to wiry and straight, i.e., a deep, solid, wiry, and straight pulse.

In Taiyang disease, if there is fever, no sweating, and paradoxical aversion to cold, it is named Gang-Jing (Stiff Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is named Rou-Jing (Soft Spasm).

[Commentary] The character "paradoxically" (fan) in "paradoxical aversion to cold" is likely an interpolation. Examining the Jing disease clauses reveals that aversion to cold should naturally be present.

[Annotation] Since Jing disease belongs to Taiyang, it should be classified by Taiyang deficiency and excess. Thus, Taiyang disease with fever, no sweating, and aversion to cold represents Excess pathogen, named Gang-Jing, meaning strong and forceful rigidity. Fever, sweating, and lack of aversion to cold represent Deficient pathogen, named Rou-Jing, meaning weak rigidity.

In Taiyang disease, if there is no sweating, urination is surprisingly scanty, Qi rushes upward to the chest, there is lockjaw preventing speech, and Gang-Jing is about to develop, Gegen Tang (Kudzu Decoction) is the primary treatment.

[Annotation] This clarifies that Gang-Jing is on the exterior to define its treatment. Taiyang disease involves headache, neck stiffness, fever, etc. No sweating indicates Cold Damage. In Taiyang Cold Damage, urination should not be scanty; if it is, it is due to excessive Cold Qi causing contraction. Qi should not rush to the chest; if it does, it is due to excessive Cold Qi reversing upward. Lockjaw should not occur; if it does, it is due to excessive Cold Qi causing severe jaw tension. Given these signs of violent upward rush and urgency in Taiyang Cold Damage, the disease is developing into Gang-Jing. Mahuang Tang (Ephedra Decoction) treats Taiyang but not Yangming; therefore, Gegen Tang is used to treat both meridians, serving as the standard method for Gang-Jing without sweating.

In Jing disease, if there is chest fullness, lockjaw, inability to lie flat (severe opisthotonos), leg cramps, and teeth grinding, Dachengqi Tang (Major Order the Qi Decoction) may be administered.

[Annotation] This clarifies that Jing disease has entered the interior to define its treatment. Chest fullness indicates stagnation of Interior Qi; inability to lie flat indicates severe opisthotonos; leg cramps indicate severe urgency; teeth grinding indicates severe jaw tension. These are images of Yangming Heat flourishing and scorching the sinews, causing severe tension. Therefore, Dachengqi Tang is used to directly attack the Heat, not necessarily the Excess of the Yangming organ. The phrase "may be administered" implies caution rather than absolute certainty.

Dachengqi Tang Formula
Dahuang (Rhubarb Root, wine-washed, 4 liang) Houpo (Magnolia Bark, roasted, skin removed, 8 liang) Zhishi (Immature Bitter Orange, roasted, 5 pieces) Mangxiao (Mirabilite, 3 he)
These four ingredients are boiled in 10 sheng of water. First boil the first two ingredients to obtain 5 sheng, remove dregs, add Dahuang, boil to obtain 2 sheng, remove dregs, add Mangxiao, boil briefly over fire, divide into two warm doses. Stop taking after defecation occurs.

In Taiyang disease, when symptoms are complete, the body is stiff and rigid ("jijiran," describing difficulty in bending and extending), and the pulse is surprisingly deep and slow, this is Jing disease. Gualou Guizhi Tang (Trichosanthes Twig Decoction) is the primary treatment.

[Annotation] "Symptoms complete" means headache, neck stiffness, fever, and aversion to wind-cold are all present. The additional body stiffness with "jijiran" appearance indicates Jing disease. However, the pulse is surprisingly deep and slow (a Taiyin pulse), unlike the floating, tight, non-sweating pulse of Taiyang Gang-Jing. Therefore, Gegen Tang is not given; instead, Gualou Guizhi Tang is used to harmonize the Taiyang exterior and clear the Taiyin interior.

Guolou Guizhi Tang Formula
Gualougen (Trichosanthes Root, 2 liang) Guizhi (Cinnamon Twig, 3 liang) Shaoyao (Peony Root, 3 liang) Gancao (Licorice Root, roasted, 2 liang) Shengjiang (Fresh Ginger, 3 liang) Dazao (Jujube, 12 pieces)
These six ingredients are boiled in 9 sheng of water to obtain 3 sheng. Divide into three warm doses to induce slight sweating. If sweating does not occur, drink hot porridge shortly after to assist.

In Taiyang disease, if there is fever and the pulse is deep and fine, it is named Jing, and is difficult to treat.

[Annotation] Fever indicates Taiyang disease. A deep and fine pulse indicates Shaoyin meridian involvement. It is named Jing only if specific Gang or Rou symptoms appear. Having Taiyang Jing symptoms with a Shaoyin pulse indicates simultaneous Exterior and Interior disease. Exterior constraint of Taiyang causes fever; Interior stagnation of Shaoyin causes the deep and fine pulse. While a wiry-tight pulse is typical for Jing (and even deep-slow might be treatable), a deep and fine pulse suggests pathogen entering Shaoyin and declining Yang Qi, making it difficult to treat. Hence, "difficult."

In Wind disease, using purgatives leads to spasm; re-inducing sweating will cause severe cramping.

[Annotation] The previous discussions on Jing involved external Wind, Cold, and Dampness. However, some cases arise from Wind pathology where inappropriate purgation damages fluids, or inappropriate sweating damages Jin-Ye, leading to dryness and loss of nourishment to the sinews, resulting in Jing. Thus, "Wind disease purged leads to spasm; re-sweating causes cramping." This cannot be treated as external Jing disease; the focus must be on nourishing fluids.

In Taiyang disease, excessive sweating can lead to Jing disease.

[Annotation] This elaborates on how excessive sweating causes Jing. Taiyang disease requires sweating, but if done excessively, pores open widely, exterior Qi fails to secure, and Wind pathogens enter due to internal deficiency, causing Jing. This is caused by internal deficiency inviting external pathogens. Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) should be used to secure the exterior and warm the meridians. By analogy, any condition involving excessive sweating, postpartum hemorrhage, or traumatic bleeding leading to this syndrome falls into this category.

Sudden abdominal distension indicates impending resolution; if the pulse remains unchanged but becomes hidden and wiry, it is Jing disease.

[Commentary] The six sentences "If inducing sweating..." under the first item of this chapter should be moved to the beginning of this item for logical coherence. The phrase "Sudden abdominal distension" in this item is likely an interpolation and should be deleted.

[Annotation] Not only does excessive sweating in Wind disease cause Jing, but it also causes Jing in Cold-Damp contention diseases. Excessive sweating makes the exterior more deficient, leading to severe aversion to cold. After sweating out Cold-Damp, if the pulse is not tight-straight but wavy like a snake, it indicates pathogen retreat and resolution. If the pulse remains tight-straight or becomes hidden-firm and wiry-urgent, the pathogen has not retreated, and Jing disease develops.

Patients with chronic sores, despite body pain, should not undergo sweating therapy; sweating will cause spasm.

[Annotation] Initially, when sore toxins have not matured, sweating is indicated to disperse them. After ulceration, Blood and Qi are damaged. Even with body pain and exterior signs, sweating is contraindicated to prevent further depletion of Blood and loss of nourishment to sinews, which could cause spasm or allow Wind pathogens to invade.

Jing disease combined with moxibustion sores is difficult to treat.

[Annotation] Moxibustion is suitable for Jing disease. However, if moxa sores are present and fail to suppurate, it indicates exhaustion of Ying and Wei Qi, hence "difficult to treat."

Patients with Dampness disease experience whole-body pain, fever, and a sallow, dark yellow complexion (like smoked yellow).

[Annotation] "Shi-jia" refers to those suffering from Dampness. Dampness disease may result from external exposure to dampness (causing whole-body pain) or internal generation (causing fever and jaundice). If both internal and external factors combine, symptoms include whole-body pain, fever, and a sallow, dark yellow complexion. Unlike Cold Damage jaundice, Dampness jaundice lacks Six Meridian syndromes.

[Collected Commentaries] Xu Bin stated: This describes pure Dampness long-stagnated transforming into Heat. If Dampness carries Wind, pain is limited to joints due to Wind's nature. Pure Dampness permeates the body, causing widespread pain. Long-standing Dampness stagnates and generates Heat, causing fever. Prolonged Heat steams the skin, so pain locations correspond to Dampness and Heat. The "smoked yellow" color results from Dampness being scorched by Fire-Qi, appearing yellow-black and dull.

In Dampness disease, if there is body pain, fever, yellowish face, wheezing, headache, nasal congestion, and irritability, with a large pulse, yet the patient can eat and the interior is harmonious, the pathology is Cold-Damp in the head causing nasal congestion. Medication inserted into the nose will cure it.

[Annotation] This elaborates on the previous clause, detailing the etiology, pulse, and treatment. Body pain, fever, yellow face, and wheezing indicate internal and external Dampness. External treatment uses Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness); internal treatment uses Ychen Wuling San (Artemisia Capillaris Five-Ingredient Powder); severe wheezing requires Daxiexion Wan (Major Collapse the Chest Pill). If accompanied by headache, nasal congestion, irritability, and a large pulse, resembling Cold Damage but with a harmonious interior and appetite, it is not Cold Damage. It is Cold-Damp in the head. Sweating is contraindicated. Instead, medication (such as Gua Di San) should be inserted into the nose to drain turbid fluids, expelling Cold-Damp.

[Collected Commentaries] Wei Litong stated: The head is the summit of all Yang meridians, not easily invaded by Cold-Damp. Its presence there implies Heat carrying it upward, driven by internal Damp-Heat. Heat draws Dampness upward to obstruct clear orifices, causing nasal congestion. Nasal medication ventilates Clear Qi, curing the disease.

In Dampness disease, if there is vexatious body pain, Mahuang Jia Zhu Tang (Ephedra plus Atractylodes Macrocephala Decoction) may be used to induce sweating. Caution: Do not use Fire Therapy.

[Annotation] For severe external Dampness pain, use Qianghuo Shengshi Tang; for severe internal jaundice, use Ychen Wuling San. For isolated vexatious pain without jaundice (external Cold-Damp), Mahuang Jia Zhu Tang induces sweating to resolve both Cold and Damp. Fire therapy is forbidden because coercive sweating via fire will cause complications.

[Collected Commentaries] Zhao Liang stated: Cold and Damp combined cause body pain. Generally, if Exterior Excess transforms into Heat, sweating is allowed. Lack of Heat suggests weak Yang Qi; sweating might further weaken the exterior. Although this case mentions "vexation" (indicating latent Heat), one must avoid heavy sweating. Dampness cannot be dispersed by violent sweating; gentle sweating via Mahuang Tang (for Cold) plus Atractylodes (for Damp) is appropriate. Fire therapy increases Heat and risks complications.

Yu Chang stated: Mahuang plus Atractylodes induces sweating without excessive fluid loss, and Atractylodes helps move Dampness in both Exterior and Interior. Fire therapy exacerbates Heat.

Mahuang Jia Zhu Tang Formula
Mahuang (Ephedra Stem, nodes removed, 3 liang) Guizhi (Cinnamon Twig, bark removed, 2 liang) Gancao (Licorice Root, roasted, 2 liang) Xingren (Apricot Seed, skin and tips removed, 70 seeds) Baizhu (Atractylodes Macrocephala Rhizome, 4 liang)
These five ingredients are boiled in 9 sheng of water. First boil Mahuang to reduce by 2 sheng, skim off foam, add remaining herbs, boil to obtain 2.5 sheng, remove dregs, take 0.8 sheng warm. Cover to induce slight sweating.

[Commentary] The instruction "bark removed" for Guizhi is erroneous; the active properties reside in the bark. Removing it renders it useless for releasing the muscle layer. This phrase should be deleted.

In Taiyang disease, if joint pain is accompanied by vexation and the pulse is deep and fine, it is named Shi-Bi (Damp Bi). Signs of Shi-Bi include impaired urination and loose stools. Treatment should focus on promoting urination.

[Annotation] This reiterates that Dampness pain should not be treated with sweating but with promoting urination. If Taiyang joint pain has a floating-fine pulse, Dampness is in the Exterior, requiring sweating. If urination is impaired and stools are loose with a deep-fine pulse, Dampness is in the Interior, requiring promotion of urination. Here, Dampness pervades both, causing joint pain, impaired urination, and loose stools, termed Shi-Bi. Since the pulse is not floating-fine, sweating is contraindicated. With a deep-fine pulse, only promoting urination is indicated. If urination improves but pain persists, sweating may then be considered.

[Collected Commentaries] Zhao Liang stated: Bi means pain. Joint pain with deep-fine pulse defines Shi-Bi. Classics state: Excess Dampness causes loose stools. Impaired urination and loose stools indicate internal Dampness excess. Promoting urination drains abdominal Dampness. If Bi persists after urination normalizes, treat from the Exterior.

Li stated: Taiyang governs the exterior and is susceptible to Dampness. Joint pain indicates Dampness lodging in joints. Stagnant Dampness generates Heat, causing vexation. Deep-fine pulses indicate internal Dampness. Bi means obstruction, akin to "Zhuo-Bi" (Fixed Bi) in the *Neijing*. Impaired urination confirms internal Dampness excess. Promoting urination eliminates Dampness, stopping diarrhea and vexation.

In Dampness disease, if the patient sweats only on the head, has back stiffness, desires covering and warmth near fire, but is purged prematurely, symptoms include hiccups, chest fullness, impaired urination, and a tongue coating resembling moss. This is due to Heat in the Dan Tian (Lower Jiao) and Cold in the Chest (Upper/Middle Jiao). The patient feels thirsty for water but cannot drink, resulting in dry mouth and vexation.

[Annotation] Head sweating alone results from Upper Damp and Lower Heat steaming upward, not Yangming Interior Excess Heat. Back stiffness is due to the heaviness of Dampness, not Wind-Damp contraction. Desire for warmth indicates temporary Cold generated by Dampness excess, not Cold Damage aversion to cold. Premature purgation causes Dampness to transform into Cold, invading upwards (causing Lung Qi reversal/chest fullness), middle (causing Stomach disharmony/hiccups), or downwards (causing Bladder Qi failure/impaired urination). A white slippery tongue coating indicates Heat sinking due to error, creating Heat in the Lower Jiao and Cold in the Upper Jiao. Thirst without desire to drink arises from Lower Heat causing dryness/vexation and Upper Cold failing to transform fluids.

If Dampness disease is purged, leading to sweating on the forehead, slight wheezing, and free urination, death ensues. If purging leads to unceasing diarrhea, death also ensues.

[Annotation] This details fatal outcomes of erroneous purgation. Forehead sweating and wheezing with impaired urination might not be fatal (indicating Dampness rising). However, free urination indicates Upper Collapse of Yang Qi (forehead sweat/wheeze) and Lower Collapse of Yin Qi (free urination/diarrhea). This separation of Yin and Yang is a sign of death.

[Collected Commentaries] Zhao Liang stated: Erroneous purgation causes rebellion: Yang escapes upward (forehead sweat/wheeze), Yin escapes downward (free urination/diarrhea). Separation of Yin and Yang signals death. If bowel/bladder function remains blocked, Yang root is preserved; if sweating/wheezing are absent despite free excretion, Yin root is preserved. In such cases, treatment based on symptoms is possible.

Li Weixi stated: Previously, promoting urination was advised for internal Dampness stasis. Here, post-purgation internal deficiency leads to spontaneous urination and fluid exhaustion causing death. These cases differ and should not be generalized.

When a patient experiences whole-body pain and fever that worsens in the late afternoon (You period), it is named Feng-Shi (Wind-Damp). This arises from sweating while exposed to wind or prolonged exposure to cold. Mahuang Xingyi Gancao Tang (Ephedra, Apricot Seed, Coix Seed, Licorice Decoction) is indicated.

[Annotation] Both Dampness and Wind-Damp cause whole-body pain. Dampness pain is heavy and immobile; Wind-Damp pain is light and restricts flexion/extension. Dampness fever is constant; Wind-Damp fever worsens in the late afternoon (Shen hour, 3-5 PM) because Wind has periodicity. Etiology includes sweating with wind exposure or cold immersion. Mahuang Xingyi Gancao Tang disperses Wind-Damp.

[Collected Commentaries] Cheng Lin stated: Whole-body pain and fever indicate Wind-Damp in the Exterior. Late afternoon corresponds to Shen hour, when Yangming Earth is prosperous. Earth dislikes Dampness; when Wind-Damp interferes during peak Yangming time, pathogen and healthy Qi clash, worsening symptoms. Sweat is related to Dampness; sweating with wind or cold immersion causes Wind-Damp.

Wei Litong stated: Jing disease requires Wind; even with Cold, it attaches to Wind. Shi-Bi requires Cold; even with Wind, it attaches to Cold. This is a fixed principle.

Mahuang Xingyi Gancao Tang Formula
Mahuang (Ephedra Stem, nodes removed, soaked in boiling water, 0.5 liang) Gancao (Licorice Root, roasted, 1 liang) Yiyiren (Coix Seed, 0.5 liang) Xingren (Apricot Seed, skin/tips removed, roasted, 10 seeds)
Crush to size of hemp seeds. Take 4 qian per dose, boiled in 1.5 cups of water to 0.8 portion. Strain and take warm. Induce slight sweating and avoid wind.

In Wind-Damp, if the pulse is floating, body is heavy, and there is sweating with aversion to wind, Fangji Huangqi Tang (Stephania and Astragalus Decoction) is the primary treatment.

[Annotation] Floating pulse indicates Wind; heaviness indicates Dampness. Cold-Damp pulses are deep; Wind-Damp pulses are floating. If floating with no sweating and aversion to wind, it is Exterior Excess, treated with Mahuang Xingyi Gancao Tang. If floating with sweating and aversion to wind, it is Exterior Deficiency. Fangji Huangqi Tang uses Fangji and Baizhu to dispel Dampness, Huangqi and Gancao to secure the Exterior, and Shengjiang and Dazao to harmonize Ying and Wei.