（痉之为言。强也。其证颈项强急。头热足寒。目赤头摇。口噤背反。
详于下文。初起不外太阳。）太阳病（病在标阳。则）发热（邪在肤表。则肤表实而）
无汗。（既在标阳。不宜恶寒。而）反恶寒者。（本亦病也。以其表实。）名曰刚痉。
太阳病（病在标阳。则）发热（邪在肌腠。则肌腠实。而肤表反虚。故
）汗出（标病而本不病。故但发热）而不恶寒。（以其表虚。）名曰柔痉。
此言太阳病有刚柔二痉。推原痉之所自始。为辨痉之法。非痉家之本证也。刚痉脉
宜紧弦。柔痉脉宜浮弦。仲景未言。可以悟出。
、充至切。诸去声。恶也。痉、其颈切。音敬。风强病也。旧本以痉为 。传
写之误也。今改正之。其病皆由血枯津少。不能养筋所致。燥之为病也。然内经谓诸痉
强直。皆属于湿。何其相反若是乎。而不知湿为六淫之一。若中于太阴。则从阴化为寒
湿。其病流于关节而为痹。若中于阳明。则从阳化为湿热。热甚而阳明燥化之气愈烈。
其病烁筋强直而为痉。是言湿者。言其未成痉之前。言燥者。言其将成痉之际也。经又
云、赫曦之纪上羽。其病痉。言热为寒抑。无汗之痉也。又云、肺移热于肾。传为柔痉。
言湿蒸为热。有汗之痉也。千金谓温病热入肾中则为痉。小儿痫热盛亦为痉。圣经贤
训可据。其为亡阴筋燥无疑。
（然而太阳底面。即是少阴。入脏即死。入腑即愈。首篇
言之详矣。兹）太阳病发（于标阳。无有不）热。（发热则脉不宜沉细矣。今反）脉沉
而细者。（是证见太阳。脉见少阴。而背项强直等证并见。）名（之）曰痉。为难治。
此一节言太阳之里为少阴。痉病在少阴。最重之证也。故于辨其刚柔之后。特笔
以提撕。欲人之知所重也。
（病在太阳。未必遽成痉也。而太阳之接壤。即是阳明。太阳之里面。即是少阴。
阳明少阴。两关津液。津液伤则筋失所养而成痉。此痉病之由也。今）太阳病发汗太多。
（津液外脱。则少阴伤。阳明亦燥。筋失所养。）因致痉。夫风病（不知用桂枝汤解
之。而以下药）下之。（下多则亡阴。阴亡阳无所制。）则（灼筋而成）痉。（若下后
）复发（其）汗。（汗多则亡阳。经云。阳气者。精则养神。柔则养筋。今下而复汗。身
）必拘急。疮家（脓血出多。津液将涸。）虽身疼痛。（表证未净。亦）不可发汗。汗
出则（津液愈竭。筋失所养而成）痉。
此推致痉之由。从太阳而推到阳明少阴。言汗下疮家。三者致痉。皆由脱液伤津。
皆兼此二经而言也。妇人产后亡血过多。因而成痉。亦可以此说括之。
（痉有本证。可以备言其形状。亦有误治之变证变脉。可以略陈其大概。今请先言
其本证。经云。因于风者。上先受之。故）病（痉）者（上而）身热。（未及于下。故
下而）足寒。（风伤太阳之经。故）颈项强急。（风伤太阳之气。故通身）恶寒。（阳
气上行于头面。故）时头热面赤。（太阳之脉。起于目内 。风热伤于经脉。故）目赤。
（头项皆强急而不能动。）独头（呈风象而）动摇。（强急则筋不舒。而牙关紧闭。且
风客会厌。而语言不出。所以）。卒（然）口噤。背反张者。（风邪入于经输也。此）痉
病（本证之形状）也。若（不知其为痉。而误）发其汗者。（汗之沾濡衣被则为湿。湿
之陆续不干而生寒。）寒湿相得。其表（因汗而）益虚。（虚甚）即恶寒甚。（盖痉之
未成。太阳原有恶寒之证。而痉之既成。阳邪用事。热甚灼筋。何至恶寒之甚。此为误
治而一变也。）发其汗已。（不独证之一变。而）其（强直之）脉（亦变屈曲）如蛇。
此论痉家之本证。而并及于误治之变证变脉也。
（脉如蛇。阴之象也。君子正有履霜坚冰至之忧。乃）暴（然见其）腹胀大者。（
遂转忧而为喜。冀其）为欲解。（即首篇入腑即愈之义。况胀为有形之实证。大承气
汤即对病之良方矣。乃诊其）脉如故。（仍是如蛇之象。而）反（加）伏弦者（此为变
而又变之）痉。
此一节承上节汗后变证变脉外。又变一脉证也。师不出方。余于伤寒论发汗后腹胀
条。悟出浓朴生姜甘草人参半夏汤。俟其胀稍愈。再以法治之。
（痉家之本证。既已备言。即变证变脉。亦复明示矣。痉家之本脉何如。）夫痉（
为劲急强直之病。其）脉（亦劲急强直。）按之紧如弦。（谓其自寸至尺。）直上下行。
（与督病之脉相似。但督浮而此沉耳。）
此一节补出痉病之本脉也。自病者身热足寒至此三节。合作一大节读。
痉（为太阳中风之）病（风为阳邪。误
用烧针。则为逆。若见）有灸疮。（则风火交煽。真阴立亡。）难治。
此一即言痉病误灸之难治也。师不出方。伤寒论火逆诸方。亦恐其过温。余用风引
汤减去桂枝干姜一半。研末煮服。往往获效。
太阳病（头项强痛。发热恶风。自汗。论所谓桂枝证也。）其证备。（但）身体强
KTKT 然。（为风邪入于经输。内经云。邪入于输。腰脊乃强是也。然经输之病。脉应浮
数。今按其）脉反沉迟。（盖沉为痉之本脉。迟为津液不足。营卫之行不利。虽痉证尚
未全备。而痉脉先已见端。）此（不为伤寒而）为痉（以）栝蒌桂枝汤主之。
此一节为痉病之将成未成者。出其方也。然细按方法。必是中风自汗之变证。柔痉
用此。刚痉用葛根汤。
栝蒌桂枝汤方
栝蒌根（三两） 桂枝（三两） 芍药（三两） 甘草（二两） 生姜（三两）
大枣（十二枚）
上六味。以水九升。煮取三升。分温三服。微汗。汗不出。食顷啜热粥发之。
太阳病。（头项强痛。发热恶寒等证悉备。表实既已）无汗。而（邪气不得外达。
）小便反少。（邪气又不得下行。正不胜邪。其）气（遂逆）上（而）冲胸。口噤不得
语。（面赤头摇项背强直。势所必至。此）欲作刚痉。（以）葛根汤主之。
此一节为刚痉之将成未成者。出其方也。究为太阳之治法。非痉证之正治法。
葛根汤方
葛根（四两） 麻黄（三两去节） 桂枝（二两） 甘草（二两炙） 芍药（二两
）生姜（三两） 大枣（十二枚）
上七味。以水一斗。先煮麻黄葛根减二升。去沫。内诸药。煮取三升。去滓。温服
一升。覆取微似汗。不须啜粥。余如桂枝汤法将息及禁忌。
痉（之）为病。（至于入里。而）胸满（气闭而）口噤。卧不着席。（反张甚也。
筋为热灼。下为）脚挛急。（上）必（牙关紧而） 齿。（此或为少阴火亢。或为阳明
燥化。救焚在此顷刻。起死即在此须臾。）可与大承气汤。（以急下之。为下其热以
救阴。非下其便以宽胀。）
此一节为痉之既成。出一救治之正方。大旨在泻阳明之燥气。而救其津液。清少阴
之热气。而复其元阴。大有起死回生之神妙。或问凡曰可与。则犹有相酌之意。岂因大
承气之过峻而云然乎。而不知此证。舍大承气并无他法。犹恐服大承气之后。重证犹未
尽除。还当审其缓急。而商其再服与否。此际全凭医家之定识定力也。或一下之后。病
势已减。审系阳明。以白虎加人参汤滋阳明之燥。审系少阴。以黄连阿胶汤救少阴之阴。
二汤可以频服。服后又以竹叶石膏汤收功。抑或以三汤用于大承气之前。全要心灵手
敏。此仲师可与二字言外之意也。男（元犀）禀按、竹叶石膏汤去粳米之逗留热气。并
以竹沥半杯易竹叶。可从古法而变通之。
大承气汤方
大黄（四两酒冼） 浓朴（半斤去皮） 枳实（五枚炙） 芒硝（三合）
上四味。以水一斗。先煮枳朴取五升。去滓。内大黄。煮二升。去滓。内芒硝。更
上火微一两沸。分温再服。得下余勿服。
（湿者六淫之一也。亦如中风伤寒自太阳始。但风寒之太阳病。病在肌表。湿之）太阳病。
（病在关节。关者机关之室。真气之所过也。节者骨节之交。神气之所游行出入者也。
今病湿。则神真之气。为湿邪所伤。故）关节疼痛而烦。（湿为阴邪。故）脉沉而细
者。（湿不在外而在内。）此名中湿。亦名湿痹。（痹之为言闭也。）湿痹之候。（闭
气不化。则）小便不利。（闭湿于内。则）大便反快。（治者）但当利其小便。（则湿
从小便而去矣。）
此言湿流关节之病也。然湿者六气之一也。但一气中犹有分别。雾露之气。为湿中
之清。伤人皆中于上。雨水之湿。为湿中之浊。伤人皆中于下。亦称太阳者。病由营卫
而入。营卫皆属太阳也。此条论地气之湿。乃湿之浊者。故曰但当利其小便。若雾露之
邪。当以微似汗解之。
湿家之为病。（湿盛于外者。阳必郁于内。湿盛于外。则）一身尽疼。（阳郁于内。
则）发热。（湿热郁于肌肉之间。则）身色如（烟之）熏黄（而带黑）也。
上节言湿邪痹于内。而不能化热。此节言湿邪郁于内而发于外。化热而为黄也。
湿家。（病在太阳。太阳之脉。上额交巅。夹脊背而行于两旁。雾露之湿。清邪中
上。着太阳。阳气聚而不行。故）其人（他处无汗。）但头汗出。（湿邪滞碍。而其经
输不利。故）背强。（湿为阴邪。阴气盛于表。故）欲得被覆（而喜）向火。（病尚
在表。）若下之（太）早。则（寒湿之邪陷于胃。而为）哕。（胃病则上下二焦亦病。
上焦之气不降。则气道壅塞。而）或胸满。（下焦之气不升。则气化不行。而）小便不
利。舌上如苔者。（乃湿滑而白。似苔而非苔也。总由寒湿之邪。陷于胸膈。命门之阳。
郁在下焦。）以丹田有热。胸上有寒。（八个字为不易勘语。丹田有热。故）渴欲得饮。
（胸上有寒。故欲饮）而不能饮。则（其）口燥（似喜水而又恶水。其懊 不可明言之意。则为）
烦也。
此言清邪中上。病在上而误下之。其变证有如此之多也。
（湿家误下。变证既如此之多。若不明言其死证。恐医者犹执迷不悟也。）湿家（
误）下之。（头汗已后而）额上汗出。（以阳明之脉交额中。此阳明之气脱绝。而真
液上泄也。且见）微喘。（以太阳之气。与肺相合。而主皮毛。此太阳之气绝。而真气
上脱也。且见）小便利者。（以少阳三焦。司决渎而出水道。此少阳之气绝。而阴津下
注也。三阳气绝。上下离脱。故）死。若下利不止者。（中土败而地气陷。不必三阳气
绝。而）亦（主）死。
此承上若下之三字。而备言误下之死证。而为医者大加警觉也。
（湿又别其为风湿者。不可不知。风为阳。湿为阴。内有湿而外感于风。则为）风
湿（不和而两）相搏。（以致）一身尽疼痛。（若阴阳和。则雨露降。）法当（微似）
汗（自）出而解。（然阳之汗。以天之雨名之。）值天阴雨不止。医（者不知所以然之
理。竟）云此可发（其）汗。汗之病（犹）不愈者。何也。盖（汗者。所以利阴阳也。若）发其汗。汗大
出者。（风为阳邪。）但风气（从大汗而）去。（大汗而阳衰。阳衰则阴转盛。而阴）
湿（之邪）气（仍）在。是故不愈也。若治风湿者。发其汗。但微微似欲汗出者。（则阴阳两不相负。而）风湿俱去也。
此于湿证中别出风湿之病。明其治法。而不遽出其方者。即引而不发之妙也。盖宇
是答辞。周秦多用此笔法。
（湿又别其为寒湿者。亦不可不知。雾露之湿为清邪。自上受之。）湿家病。身（虽）疼（
而无一身皆疼。不过疼在身之上半。而）发热。（止见）面黄（而身色不似熏黄。肺司气
而主皮毛。湿袭于皮毛。故气不顺）而喘。（阴证无头痛。湿未入阴。故）头痛（湿袭皮毛。
内壅肺气。故）鼻塞（湿气
弥沦。摄乱心主）而（发）烦。（湿邪止在上焦。未尝犯里。故）其脉大。（不犯胃气。）自能饮食。
（能饮食则）腹中（尚）和（而）无病。（其）病在头中寒湿。故鼻塞。（病浅不必深
求。止）内（辛香之）药（于）鼻中。（宣泄头中之寒湿。）则愈。
此于湿证中。又别出寒湿之病。寒湿不止雾露之清邪。而举一邪伤高表者。以为隅。
则邪伤通身者。包在言外。举一外法通其空窍者以为隅。则内服调其经络脏腑者。包
在言外。下节诸方。按脉证而求其丝丝入扣。则得矣。
（前言中湿。但当利其小便者。以湿之在内言之也。若）湿家（之表证。其）身烦
疼。（而不发黄。可知未郁于内而为热也。且无小便不利。可知未入于里而为痹也。表
则宜汗。而不宜大汗。斟酌其适）可（者。当）与麻黄加术汤。发其（微似）汗为宜。
慎不可以火攻之。（致火气逼汗过多而变证也。况又有湿与热合致衄增黄之虑乎。）
此为湿之属表无汗者。出一至当不易之方也。喻氏谓麻黄得术。虽发汗而不至多汗。
术得麻黄。行里湿而并可行表湿。止此一味加入。所谓方外之神方。法中之良法也。
麻黄加术汤方
麻黄（三两去节） 桂枝（二两） 甘草（一两炙） 白术（四两） 杏仁（七十个去皮
尖）
[Chapter 2: Pulse, Syndrome, and Treatment of Spasm and Dampness]
The term "Jing" (Spasm) means stiffness. Its symptoms manifest as stiffness and tension in the neck and nape, heat in the head with coldness in the feet, redness of the eyes, shaking of the head, lockjaw (trismus), and opisthotonos (backward arching of the back). (Detailed descriptions follow below.) Initially, it does not go beyond the Taiyang (Greater Yang) channel.
If one suffers from a Taiyang disease (pathology in the Biao-Yang aspect), presenting with fever (due to pathogenic factors at the skin surface causing the surface to be solid and full) and absence of sweating (since it is in the Biao-Yang, chills should not be present; however, if there are contrary chills, it is because the exterior is solid), this is called Gang Jing (Yang Spasm or Rigid Spasm).
If one suffers from a Taiyang disease (pathology in the Biao-Yang aspect), presenting with fever (due to pathogenic factors in the muscle interstices causing them to be solid, while the skin surface becomes relatively deficient, thus) sweating occurs (because the Biao pathology exists but the Ben-Zang is unaffected, so there is only fever) without chills (because the exterior is deficient), this is called Rou Jing (Yin Spasm or Flaccid Spasm).
This passage discusses that Taiyang disease has two types of spasm: Gang Jing and Rou Jing. Tracing the origin of spasm serves as a method for differentiation, rather than describing the complete syndrome of a patient already suffering from spasm. The pulse for Gang Jing should be tight and wiry (Jin-Xian); the pulse for Rou Jing should be floating and wiry (Fu-Xian). Zhang Zhongjing did not explicitly state this, which readers can deduce.
"Chi" (an ancient variant/error referring to cold-damp induced rigidity). Old editions mistakenly wrote "Jing" as "Chi"; this is a transcription error and has been corrected here. These diseases are caused by blood depletion and fluid deficiency, failing to nourish the sinews, resulting in dryness. However, the *Neijing* states: "All spasms and stiffness belong to dampness." Why such a contradiction? It is because one fails to realize that dampness is one of the Six Evils. If dampness invades the Taiyin channel, it transforms into cold-damp from the Yin, flowing into the joints to form Bi syndrome (obstruction). If it invades the Yangming channel, it transforms into damp-heat from the Yang. When heat is severe, the drying Qi of Yangming becomes intense, scorching the sinews and causing stiffness, leading to spasm. Thus, when speaking of "dampness," it refers to the stage before spasm forms; when speaking of "dryness," it refers to the moment just before spasm forms. The Classics also say: "In the Ji of He Xi (excessive Fire luck), affecting the upper Yu, the disease is spasm." This describes heat suppressed by cold, resulting in anhidrotic spasm. It also says: "Lung transfers heat to the Kidney, transmitting as Rou Jing." This describes damp steaming into heat, resulting in diaphoretic spasm. *Qianjin Fang* states that warm diseases with heat entering the Kidney cause spasm, and pediatric epilepsy with excessive heat also causes spasm. These classic teachings are reliable evidence that this is undoubtedly due to loss of Yin fluids and dryness of the sinews.
(However, the root of the Taiyang channel is the Shaoyin channel. Disease entering the Zang organs leads to death; entering the Fu organs leads to recovery. This was explained in detail in the first chapter. Here,) in Taiyang disease, onset (on the Biao-Yang side) invariably involves fever. (With fever, the pulse should not be deep and fine; now, if the pulse is instead) deep and fine (indicating the syndrome appears in Taiyang but the pulse reflects Shaoyin, accompanied by symptoms like stiffness of the back and nape), this is named "Jing" (Spasm), and it is difficult to treat.
This section explains that the interior of Taiyang is Shaoyin. Spasm involving Shaoyin is the most critical syndrome. Therefore, after distinguishing between Gang and Rou, a special note is added to emphasize its severity, urging practitioners to recognize its gravity.
(Disease in Taiyang does not necessarily immediately become spasm. However, the border of Taiyang is Yangming, and the interior of Taiyang is Shaoyin. Both Yangming and Shaoyin relate to body fluids; if fluids are injured, the sinews lose nourishment and spasm results—this is the cause of spasm. Now,) if Taiyang disease treatment involves excessive sweating (fluids escape externally, injuring Shaoyin, and drying Yangming, causing the sinews to lose nourishment), it consequently leads to spasm. If wind disease (not treated with Guizhi Tang to resolve the exterior, but instead treated with purgatives) is purged (excessive purging loses Yin; loss of Yin leaves Yang uncontrolled), it will (scorch the sinews and cause) spasm. (If after purging, one again induces) sweating (excessive sweating loses Yang. The Classic states: Yang Qi, in its refined state, nourishes the Shen; in its soft state, it nourishes the sinews. Now, having purged and then sweated, the body) will inevitably become stiff and cramped. Patients with chronic sores (who have lost much pus and blood, depleting fluids) may have body pain even though (the exterior syndrome is not fully resolved, they should not be) sweated. Sweating will (further exhaust fluids, causing the sinews to lose nourishment and result in) spasm.
This deduces the causes of spasm, extending from Taiyang to Yangming and Shaoyin. It states that excessive sweating, purging, and chronic sores all lead to spasm by depleting fluids and damaging Jin-Ye, involving these two channels. Postpartum women who lose excessive blood and subsequently develop spasm can also be understood through this theory.
(Spasm has primary syndromes, whose shapes can be described in detail, and there are also changed syndromes and pulses due to mis-treatment, which can be briefly outlined. Let us first discuss the primary syndrome. The Classic states: "When affected by wind, the upper part is affected first." Therefore,) patients (with spasm) have upper body heat (not yet reaching the lower part, so the lower part) has cold feet. (Wind damages the Taiyang channel, so there is) stiffness and tension in the neck and nape. (Wind damages Taiyang Qi, so there is) aversion to cold throughout the body. (Yang Qi ascends to the head and face, so there is) occasional heat in the head and redness of the face. (The Taiyang channel originates from the inner canthus; wind-heat damages the channel, so there is) redness of the eyes. (The head and neck are stiff and immobile.) Only the head (showing wind characteristics) shakes. (Stiffness prevents sinew relaxation, clenching the jaw; wind lodges in the epiglottis, preventing speech, thus) sudden lockjaw (trismus) and opisthotonos occur. (This is due to wind evil entering the meridians and Shu points. This) is the shape of the primary syndrome of spasm. If (one does not recognize it as spasm and erroneously) induces sweating (sweat wetting clothes creates dampness; persistent dampness generates cold), cold and damp combine, making the exterior (due to sweating) more deficient. (Severe deficiency leads to) severe aversion to cold. (Generally, before spasm forms, Taiyang has aversion to cold; once spasm forms, Yang evil dominates, heat scorches sinews, so why severe aversion to cold? This is a change due to mis-treatment.) After inducing sweating (not only does the syndrome change, but the) pulse (of stiffness) becomes curved like a snake.
This discusses the primary syndrome of spasm patients and includes changed syndromes and pulses due to mis-treatment.
(A pulse like a snake is a Yin image. The gentleman worries about the progression from frost to hard ice. Suddenly appearing abdominal distension and enlargement might seem (like a hope for relief, i.e., resolving via the Fu organs. Since distension is a tangible excess syndrome, Dachengqi Tang would be appropriate. But if the pulse remains unchanged, still showing the snake-like image, and instead becomes hidden and wiry, this is a further changed) spasm.
This section continues from the previous discussion on post-sweating changes, presenting another changed pulse and syndrome. The Master provided no formula; I deduced from the *Shanghan Lun* section on abdominal distension after sweating that Nongpu Shengjiang Gancao Renshen Banxia Tang could be used. Once the distension subsides slightly, treatment can proceed according to other methods.
(The primary syndrome of spasm has been fully described, and changed syndromes/pulses clearly stated. What is the primary pulse of spasm?) Spasm (is a disease of tension and stiffness, and its) pulse (is also tense and stiff.) Pressing it feels tight like a string (extending from Cun to Chi). Straight up and down. (Similar to the pulse of Du vessel disease, but Du pulse is floating while this is sunken.)
This section supplements the description of the primary pulse of spasm. From "patient has body heat and cold feet" to these three sections, read together as one major section.
Spasm (as a Taiyang Wind Strike) disease (wind is a Yang evil; using burning needles erroneously is counter-indicated. If moxibustion sores are present) (wind and fire interact, causing immediate loss of True Yin), it is difficult to treat.
This section addresses the difficulty of treating spasm with erroneous moxibustion. The Master provided no formula. The formulas for Fire Reversal in *Shanghan Lun* are likely too warming. I use Fengyin Tang, reducing Guizhi and Ganjiang by half, powdered and decocted, often achieving efficacy.
Taiyang disease (head and neck stiffness/pain, fever, aversion to wind, spontaneous sweating—the Guizhi syndrome mentioned in the Treatise). Symptoms are complete. (But) the body is rigid and stiff (due to wind evil entering the meridian Shu points. The *Neijing* states: "When evil enters the Shu, the waist and spine become stiff." However, Shu point diseases should have a floating and rapid pulse; now pressing reveals a pulse that is instead deep and slow. Deep indicates the primary pulse of spasm; slow indicates insufficient fluids and unfavorable Ying-Wei circulation. Although the spasm syndrome is not yet fully complete, the spasm pulse has already shown signs.) This is not Shanghan but Spasm, primarily treated with Gualou Guizhi Tang.
This section provides a formula for spasm that is forming but not yet complete. Careful analysis suggests it must be a variation of Wind Strike with spontaneous sweating. Rou Jing uses this formula; Gang Jing uses Gegen Tang.
**Gualou Guizhi Tang Formula**
Gualou Gen (Trichosanthes Root) - 3 liang
Guizhi (Cinnamon Twig) - 3 liang
Shaoyao (Peony Root) - 3 liang
Gancao (Licorice Root, prepared) - 2 liang
Shengjiang (Fresh Ginger) - 3 liang
Dazao (Jujube) - 12 pieces
These six ingredients are boiled in 9 sheng of water to yield 3 sheng. Divide into three warm doses. Aim for slight sweating. If sweat does not occur, drink hot porridge shortly after eating to induce it.
Taiyang disease. (Symptoms of head/neck pain, fever, aversion to cold are complete; exterior is solid with) absence of sweating, and (pathogen cannot exit outward,) urination is conversely scanty. (Pathogen cannot descend downward; Zheng Qi cannot overcome the Xie Qi, so its) Qi (rebels and) rushes upward to the chest, lockjaw prevents speech. (Red face, head shaking, neck/back stiffness are inevitable consequences. This) is impending Gang Jing. Primarily treated with Gegen Tang.
This section provides a formula for impending Gang Jing. Ultimately, it is a treatment method for Taiyang, not the direct treatment for established spasm.
**Gegen Tang Formula**
Gegen (Pueraria Root) - 4 liang
Mahuang (Ephedra Stem, remove nodes) - 3 liang
Guizhi (Cinnamon Twig) - 2 liang
Gancao (Licorice Root, honey-fried) - 2 liang
Shaoyao (Peony Root) - 2 liang
Shengjiang (Fresh Ginger) - 3 liang
Dazao (Jujube) - 12 pieces
These seven ingredients are boiled in 1 dou of water. First boil Mahuang and Gegen, reducing by 2 sheng, skim off foam, add remaining herbs, boil to yield 3 sheng. Strain, take 1 sheng warm. Cover to obtain slight sweat. No need to drink porridge. Rest and dietary restrictions follow Guizhi Tang methods.
Spasm (disease progressing inward) presents with chest fullness (Qi blockage and) lockjaw, inability to lie flat with back touching the bed (severe opisthotonos). Heat scorches sinews, lower limbs have) cramping of the feet. Upper body)必然 (tight jaw and) grinding of teeth. (This may be due to hyperactive Fire of Shaoyin or drying transformation of Yangming. Saving from disaster happens in an instant. Reviving the dead happens in a moment.) One may administer Dachengqi Tang. (To urgently purge, aiming to clear heat to save Yin, not merely to relieve constipation.)
This section provides a correct rescue formula for established spasm. The main intent is to purge Yangming dryness to save fluids and clear Shaoyin heat to restore True Yin, possessing miraculous life-saving power. Some ask: "Ke Yi" (may be given) implies hesitation, perhaps due to the harshness of Dachengqi Tang? In fact, for this syndrome, there is no other method besides Dachengqi Tang. One might worry that after taking Dachengqi Tang, severe symptoms remain, so one must assess urgency and decide on re-administration. This relies entirely on the physician's discernment and resolve. If symptoms subside after one dose, and it is determined to be Yangming, use Baihu Jia Renshen Tang to moisten Yangming dryness; if Shaoyin, use Huanglian Ejiao Tang to save Shaoyin Yin. These two formulas can be taken frequently, followed by Zhuye Shigao Tang to conclude treatment. Alternatively, these three formulas may be used before Dachengqi Tang. All require mental agility. This is the implicit meaning behind Zhongshi's use of "Ke Yi." Chen Yuanxi notes: In Zhuye Shigao Tang, remove Jingmi to prevent retaining heat, and replace Zhuye with Banbei Zhu Li (Bamboo Juice) to innovate upon ancient methods.
**Dachengqi Tang Formula**
Dahuang (Rhubarb Root, wine-washed) - 4 liang
Nongpu (Magnolia Bark, peeled) - 0.5 jin
Zhishi (Immature Bitter Orange, roasted) - 5 pieces
Mangxiao (Mirabilite) - 3 he
These four ingredients are boiled in 1 dou of water. First boil Zhishi and Nongpu to yield 5 sheng, strain, add Dahuang, boil to yield 2 sheng, strain, add Mangxiao, boil lightly for one or two boils. Divide into two warm doses. If bowel movement occurs, stop taking the remainder.
(Dampness is one of the Six Evils. Like Wind Strike and Cold Damage, it starts from Taiyang. However, while Wind-Cold Taiyang disease affects the muscle surface, Dampness) Taiyang disease. (affects the joints. Guan is the chamber of the joint mechanism, where True Qi passes. Jie is the intersection of bones, where Shen Qi travels in and out. Now, with damp disease, Shen and True Qi are injured by damp evil, so there is) joint pain and vexation. (Dampness is a Yin evil, so the) pulse is deep and fine. (Dampness is internal, not external.) This is called Zhong Shi (Internal Dampness) or Shi Bi (Damp Bi). (Bi means obstruction.) The manifestation of Shi Bi. (Obstructing Qi transformation leads to) dysuria. (Trapping dampness internally leads to) loose stools. (Treatment should) only promote urination. (Then dampness exits via urine.)
This discusses disease where dampness flows into joints. Dampness is one of the Six Qi, but distinctions exist within it. Mist and dew are clear dampness, attacking the upper body. Rainwater dampness is turbid dampness, attacking the lower body. It is also called Taiyang because the disease enters via Ying and Wei, which belong to Taiyang. This clause discusses earthly dampness, the turbid type, hence stating "only promote urination." For mist/dew evil, slight sweating should be used to resolve it.
For patients with chronic dampness (if dampness is excessive externally, Yang must be depressed internally. Excessive external dampness causes) generalized body pain. (Internal Yang depression causes) fever. (Damp-heat stagnating in muscles causes) skin color like smoked yellow (darkened).
The previous section discussed dampness obstructing internally without transforming into heat; this section discusses dampness depressing internally and emerging externally, transforming into heat and jaundice.
Patients with chronic dampness. (Disease in Taiyang; Taiyang channel goes over forehead, crosses vertex, runs along both sides of spine. Mist/dew dampness, clear evil, attacks upper, lodging in Taiyang. Yang Qi gathers and fails to move, so) the person (has no sweat elsewhere.) only head sweating. (Dampness obstructs, meridian Shu points are unfavorable, so) back stiffness. (Dampness is Yin evil, Yin Qi is abundant at the exterior, so) desire to cover up (and prefer) facing fire. (Disease is still at the exterior.) If purged too early, then (cold-damp evil sinks into Stomach, causing) hiccups. (Stomach disease affects Upper and Lower Jiao. Upper Jiao Qi fails to descend, causing Qi blockage and) chest fullness. Lower Jiao Qi fails to ascend, causing failure of Qi transformation and) dysuria. Tongue coating resembling moss. (Slippery white, looking like moss but not true moss. Caused by cold-damp evil sinking into chest/diaphragm, Mingmen Yang depressed in Lower Jiao.) Due to heat in Dantian and cold in Chest (these eight words are profound truth. Heat in Dantian causes) thirst wanting to drink. (Cold in Chest causes desire to drink) but inability to swallow. Then (there is) mouth dryness (liking water yet fearing it, the indescribable vexation is) irritability.
This discusses clear evil attacking the upper, disease in the upper, and the consequences of erroneous purging, resulting in many changes.
(Chronic dampness patients mis-purged, with so many changes, if fatal syndromes are not specified, physicians may remain deluded.) Chronic dampness patients (erroneously) purged. (After head sweating ceases,) sweating on the forehead only. (Yangming channel crosses forehead; this indicates exhaustion of Yangming Qi and leakage of True Fluids. Also seeing) slight panting. (Taiyang Qi combines with Lung, governing skin/hair; this indicates exhaustion of Taiyang Qi and upward escape of True Qi. Also seeing) frequent urination. (Shaoyang Sanjiao governs water passages; this indicates exhaustion of Shaoyang Qi and downward leakage of Yin fluids. Exhaustion of Three Yang Qi, separation of upper and lower, leads to) death. If diarrhea persists endlessly. (Central Earth fails, Earth Qi sinks; even without Three Yang Qi exhaustion, it) also indicates) death.
This continues from "if purged," detailing fatal syndromes of erroneous purging to alert physicians.
(Dampness is further distinguished as Wind-Damp, which must be known. Wind is Yang, Dampness is Yin. Internal dampness combined with external wind invasion leads to) Wind-Damp (disharmony and mutual) binding. (Causing) generalized body pain. (If Yin and Yang harmonize, rain and dew fall.) Methodologically, (slight) sweating should occur naturally for resolution. (Yang sweat is likened to heavenly rain.) If rainy weather persists, physicians (not understanding the principle, claim) this can be sweated. Sweating does not cure the disease. Why? Sweat benefits Yin and Yang. If sweating causes profuse output. (Wind is Yang evil.) Only wind Qi (escapes with heavy sweat). (Heavy sweat depletes Yang; depleted Yang allows Yin to prevail, so Yin) dampness (evil) Qi (remains). Hence, no cure. For treating Wind-Damp, inducing sweating should only be slight, as if sweating is desired. (Then Yin and Yang do not harm each other, and) both wind and dampness depart.
This distinguishes Wind-Damp within damp diseases, clarifying treatment without immediately providing a formula, employing the subtle art of leading without revealing the end. This rhetorical style was common in Zhou and Qin dynasties.
(Dampness is further distinguished as Cold-Damp, which must be known. Mist/dew dampness is clear evil, received from above.) Patients with chronic dampness have body (pain) (but not generalized pain, only pain in the upper half, and) fever. (Only showing) yellow face (skin color not like smoked yellow. Lung governs Qi and skin/hair; dampness attacks skin/hair, so Qi is not smooth) and panting. (Yin syndromes lack headache; dampness has not entered Yin, so) headache. (Dampness attacks skin/hair, congests Lung Qi internally, so) nasal congestion. (Dampness permeates, disturbing Heart Master) and (causing) vexation. (Dampness stays in Upper Jiao, does not invade interior, so) pulse is large. (Does not affect Stomach Qi.) Able to eat normally. (Able to eat means) abdomen is (harmonious) and free of disease. (The) disease is cold-damp in the head, causing nasal congestion. (Disease is superficial, no need for deep search; simply insert (acrid-aromatic) medicine (into) the nose. (Ventilate cold-damp in the head.) Then cured.
This distinguishes Cold-Damp within damp diseases. Cold-damp is not just clear mist/dew; citing one case of evil injuring high surfaces serves as an analogy, implying evil injuring the whole body is included. Citing one external method opening orifices serves as an analogy, implying internal regulation of meridians/zang-fu is included. The following formulas, matched precisely to pulse and syndrome, will reveal the truth.
(Prior mention of Zhong Shi, only promoting urination, referred to internal dampness. If) chronic dampness patients (have exterior syndrome, their) body vexation and pain. (Without jaundice,可知 it has not stagnated internally to become heat. Also without dysuria,可知 it has not entered interior to become Bi. Exterior requires sweating, but not profuse sweating. Judging the appropriate amount, one should) give Mahuang Jia Zhu Tang. Inducing (slight) sweating is suitable. Strictly avoid fire therapy. (Causing fire to force excessive sweating and changes. Moreover, concern arises of damp combining with heat causing epistaxis and worsening jaundice.)
This provides an irrefutable formula for dampness at the exterior without sweating. Yu Clan stated: Mahuang with Zhu, although inducing sweat, does not cause profuse sweating; Zhu with Mahuang, moving interior dampness can also move exterior dampness. Adding this single herb is called the divine formula outside formulas, the good method within methods.
**Mahuang Jia Zhu Tang Formula**
Mahuang (Ephedra Stem, remove nodes) - 3 liang
Guizhi (Cinnamon Twig) - 2 liang
Gancao (Licorice Root, honey-fried) - 1 liang
Baizhu (Atractylodes Macrocephala Rhizome) - 4 liang
Xingren (Apricot Seed, peel and remove tips) - 70 seeds