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Fever, aversion to wind, and stiffness of the neck belong to Taiyang disease (for the formula discussion, see "Taiyang Disease with Fever"). In Taiyang disease, if there is stiffness and discomfort in the neck and back, accompanied by sweating and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction) is the primary treatment. If there is stiffness and discomfort in the neck and back, without sweating but with aversion to wind, Gegen Tang (Kudzu Root Decoction) is the primary treatment. Both are agents for dispersing the exterior, but their intensity differs. This is because fever, sweating, and aversion to wind indicate a Deficient Exterior syndrome, which can be treated with the method of resolving the muscle layer (Jie Ji). Aversion to wind without sweating indicates an Excess Exterior syndrome, which can be treated with the method of inducing sweating (Fa Han). Thus, the treatments differ.

In Taiyang Cold Damage with stiffness of the neck and back, or when Taiyang Wind Strike is complicated by cold-dampness leading to Jing disease (Spasm), stiffness of the neck also occurs. The Classics state: When a patient has body heat, cold feet, stiff and urgent neck and back, aversion to wind, occasional heat in the head, red face, red eye vessels, only the head and face tremble, sudden lockjaw, and opisthotonos (backward arching of the back), this is Jing disease (Spasm). The *Jin Gui Yao Lue* states: In Taiyang disease, if there is stiffness and discomfort in the neck and back, and the pulse is unexpectedly deep and slow, this is Jing disease (Spasm), treated primarily with Guizhi Jia Gualou Gen Tang (Cinnamon Twig plus Trichosanthes Root Decoction).

After taking Guizhi Tang (to induce sweating) or after purgation, if there remains headache and neck stiffness, mild fever as if covered by feathers, no sweating, fullness in the epigastrium, slight pain, and difficulty in urination, Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractodes Decoction) is the primary treatment. (Zhang Jingyue asked: The aforementioned text mentions headache and neck stiffness, indicating that the pathogenic factor is still at the exterior. Although it has not resolved after sweating and purgation, one should ideally continue to disperse the exterior. Why remove Guizhi (Cinnamon Twig) and use Fuling (Poria) and Baizhu (Atractodes) decoction? This seems to ignore the exterior syndrome. I reply: This is not a Guizhi Tang syndrome, but belongs to patients with internal fluid retention. Since the headache and neck stiffness have not resolved after sweating and purgation, combined with epigastric fullness, slight pain, and difficulty in urination, this indicates water-fluid retention internally, and the pathogen is not at the exterior. Hence, Guizhi is removed, and Fuling and Baizhu are added. If urination becomes smooth, the water-fluid moves, abdominal fullness subsides, and heat is naturally eliminated, then the headache and neck stiffness will all heal. Moreover, in cases like Shizao Tang (Ten Date Pill) syndrome, headache also occurs due to internal accumulation of pathogenic heat and latent fluid retention. If headache is caused by drinking water, attacking the exterior is unnecessary; one should only expel the fluid. Once the fluid is exhausted, the disease will be safe.)

In Shanghan (Cold Damage) on the fourth or fifth day, if there is body heat, aversion to wind, headache and neck stiffness, hypochondriac fullness, warm hands and feet, and thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment. If after purgation, the patient cannot eat, develops jaundice, and has difficulty urinating, giving Chaihu Tang (Bupleurum Decoction) will likely worsen the condition (for formula discussions, see "Hypochondriac Pain").

Jie Xiong (Chest Binding) syndrome (see "Purgation" section) presents with neck stiffness resembling Rou Jing (Soft Spasm); Da Xianxiong Wan (Major Draining the Chest Pill) is used for purgation (for formula discussion, see "Chest Binding").

When Taiyang disease and Shaoyang disease occur together (Bing Bing), presenting with headache and neck stiffness, or dizziness and vertigo, sometimes feeling like Jie Xiong with hardness and fullness in the epigastrium, acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated. Sweating must not be induced. If sweating is induced, delirium will occur, and the pulse will be wiry. If delirium persists beyond five to six days, Qimen (LR14) should be acupunctured. (Cheng Wuji notes: The Taiyang meridian passes through the head and neck; headache and neck stiffness are Taiyang exterior syndromes. The Shaoyang meridian traverses the chest and connects to the hypochondrium; symptoms like Jie Xiong with epigastric hardness and fullness are Shaoyang interior syndromes. When Taiyang and Shaoyang combine, the disease is not purely exterior, hence the neck is not only stiff and painful but may also involve dizziness and vertigo; nor has it fully entered the interior, hence sometimes resembling Jie Xiong with epigastric hardness and fullness. This indicates the pathogen is between the exterior and interior. Acupuncture at Dazhui (first interspace) and Feishu drains Taiyang pathogens; acupuncture at Ganshu drains Shaoyang pathogens. Pathogens at the exterior can be dispersed by sweating; pathogens between the exterior and interior cannot. Sweating consumes body fluids and damages stomach Qi. The Shaoyang pathogen invades the Stomach Earth, Wood overacts on Earth, causing delirium, with a wiry pulse. By the fifth or sixth day, the transmission cycle ends, pathogenic heat retreats, and delirium should cease. If it does not cease, Shaoyang pathogenic heat is severe; acupuncture at Qimen drains Liver and Gallbladder Qi. Suitable formulas include Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) or Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction)).

When Taiyang and Shaoyang diseases occur together, with hardness and fullness in the epigastrium, stiff neck, and dizziness, acupuncture at Dazhui (GV14) and Feishu (BL13) is indicated. Purging must be strictly avoided. (Cheng Wuji notes: Epigastric hardness/fullness with dizziness is a Shaoyang syndrome; stiff neck is a Taiyang syndrome. Acupuncture at Dazhui and Feishu drains Taiyang pathogens because the Taiyang meridian descends along the neck and flanks the spine; acupuncture at Ganshu drains Shaoyang pathogens because the Gallbladder is the Fu organ of the Liver. Taiyang is exterior, Shaoyang is interior, constituting a half-exterior half-interior syndrome. The previous text stated that sweating causes delirium; this refers to attacking Taiyang pathogens via sweating, causing Shaoyang pathogens to intensify in the Stomach, inevitably leading to delirium. Here, it states strictly avoiding purgation; purging Shaoyang pathogens allows Taiyang pathogens to enter the interior due to deficiency, inevitably forming Jie Xiong. The Classics state: When Taiyang and Shaoyang diseases combine, improper purgation leads to Jie Xiong. Chaihu Jia Guizhu Tang (Bupleurum plus Cinnamon Twig Decoction) may also be used.)

**Guizhi Qu Gui Jia Fuling Baizhu Tang Formula:**
Shaoyao (Peony Root), Shengjiang (Fresh Ginger), Baifuling (White Poria), Baizhu (Atractodes Rhizome) (each 1.5 liang), Gancao (Licorice Root) (1 liang), Dazao (Jujube) (6 pieces). Chop the above ingredients. Take 5 qian per dose, decoct with water, and take warm. When urination becomes smooth, the disease heals. Epigastric fullness and pain with smooth urination indicate Jie Xiong; difficulty in urination indicates fluid retention, hence Fuling and Baizhu are added to promote fluid metabolism.

Stiff neck, sudden lockjaw, and opisthotonos constitute Jing disease (Spasm) (for formula discussion, see "Miscellaneous Diseases - Spasm Section").