夫人之筋,各随经络退出于身,血气内虚,外为风寒湿热之所中则 。故寒则紧
缩,热则弛张,风则弦急,湿则胀缓,四气兼并,当如常说。以风散气,故有汗而不恶寒,
曰柔 ;寒泣血,故无汗而恶寒,曰刚 。热消气,故为 纵;湿溢血,故为缓
弱。经中所谓大筋软短,小筋弛长,软短为拘,弛长为痿,皆湿热不攘之所为也。原其所因
,多由亡血,筋无所营,故邪得以袭之。所以伤寒汗下过多,与夫病疮人,及产后致斯病者
,概可见矣。诊其脉皆沉伏弦紧,但阳缓阴急,则KT KT 拘挛;阴缓阳急,则反张强直,二证各异,不可不别。
病者身热足寒,头项强急,恶寒,时头热面赤,目脉赤,独头动摇,卒口噤,背反张。
以发热恶寒不恶寒、有汗无汗分刚柔者,风寒 也;脉沉细,即为湿 。疮疡未
合,风入,为破伤风;湿入,为破伤湿。二者害人最急,仓卒不知其因,甚难忍。痈疽瘰
,脓溃之后,尤宜谨之,产妇汗多,或因怒厥,皆成此病。治之各有方法。
治柔 。身体强,KT KT 然,脉反沉迟,自汗。
栝蒌根(二两) 桂心 白芍药(各三两) 甘草(炙,二两)
上为锉散。每服四大钱,水盏半,姜五片,枣二枚,煎七分,去滓温服;汗不透,食顷,啜热粥发之,
人的筋脉,各自随着经络分布显露于体表。若体内血气亏虚,外部受到风、寒、湿、热邪气的侵袭,就会导致病变。因此,寒邪会使筋脉紧缩收缩,热邪会使筋脉松弛张开,风邪会使筋脉拘急弦紧,湿邪会使筋脉肿胀弛缓。这四种邪气合并致病时,应当遵循通常的说法来理解。风邪善于疏散气机,所以患者有汗出且不恶寒,称为柔痉(一种以汗出、不恶寒为特征的痉病);寒邪使血液凝涩运行不畅,所以患者无汗且恶寒,称为刚痉(一种以无汗、恶寒为特征的痉病)。热邪消耗气机,所以导致筋脉纵缓;湿邪溢于血脉,所以导致筋脉缓弱无力。医经中所谓的大筋变得短缩而柔软,小筋变得松弛而延长,短缩导致拘挛,松弛导致痿废,这些都是湿热之邪未能清除所造成的。追溯其病因,多由失血引起,筋脉失去气血的濡养,所以邪气得以乘虚侵袭。因此,伤寒病患者发汗或攻下过多,以及患有疮疡的病人,还有产后妇女,容易引发这种病症,从这些情况概略可见一斑。诊察这类病人的脉象,大多呈现沉伏、弦紧的特点。如果是阳面筋脉松弛而阴面筋脉紧急,则会出现肢体拘挛抽搐;如果是阴面筋脉松弛而阳面筋脉紧急,则会出现角弓反张、身体强直。这两种证候表现不同,不可不加以区分。
患病者身体发热但足部寒冷,头项僵硬拘急,怕冷,有时头部发热、面色发红,眼结膜充血,只有头部动摇不定,突然牙关紧闭,背部向后反折呈弓形。根据是否恶寒、有汗无汗来区分刚痉和柔痉,这是风寒邪气所致;如果脉象沉细,则是湿邪所致。疮疡伤口未愈合时,风邪侵入,称为破伤风;湿邪侵入,称为破伤湿。这两种病对人体危害最为急迫,如果在仓促间不知道病因,病情非常难以忍受。痈疽瘰疬等病在脓液溃破之后,尤其需要谨慎预防。产妇出汗过多,或者因为愤怒导致气机厥逆,都会形成这种病。治疗它们各有相应的方法。
治疗柔痉。症状表现为身体强直,四肢拘挛不舒,脉象反而沉迟,自汗出。
方药组成:栝蒌根(二两)、桂心、白芍药(各三两)、甘草(炙用,二两)。
将上述药材切碎成散剂。每次服用四大钱,用水一盏半,加入生姜五片、大枣二枚,煎煮至剩余七分药液,滤去药渣,温服;如果汗出不透彻,过一会儿,喝热粥来帮助发汗。
The sinews of the human body follow the meridians and collaterals to emerge on the surface. When the internal blood and qi are deficient, and the exterior is attacked by wind, cold, dampness, or heat pathogens, pathology occurs. Thus, cold causes contraction and shortening; heat causes relaxation and expansion; wind causes tension and rigidity; dampness causes swelling and flaccidity. When these four pathogens combine, one should follow the conventional understanding. Wind disperses qi, so there is sweating without aversion to cold, termed Rou Jing (Soft Spasm); Cold congeals blood, so there is no sweating with aversion to cold, termed Gang Jing (Rigid Spasm). Heat consumes qi, leading to flaccidity; Dampness overflows in the blood vessels, leading to weakness. The classics state that large sinews become soft and short, while small sinews become relaxed and long; soft and short leads to cramping, while relaxed and long leads to atrophy. These are all caused by the failure to dispel damp-heat. Tracing the etiology, it mostly stems from blood loss, where sinews lack nourishment, allowing pathogens to invade. Therefore, excessive sweating or purging in Taiyang disease (Exterior Syndrome), patients with sores, and postpartum women are prone to this condition, which can be generally understood from these scenarios. Their pulses are typically deep, hidden, wiry, and tight. If the Yang aspect is relaxed and the Yin aspect is tense, convulsions and cramps occur; if the Yin aspect is relaxed and the Yang aspect is tense, opisthotonos and rigidity occur. These two presentations differ and must be distinguished.
Patients present with fever in the body but cold feet, stiffness and tension in the head and neck, aversion to cold, occasional fever in the head and redness of the face, redness of the eye vessels, isolated head tremor, sudden lockjaw, and opisthotonos (backward arching of the back). Differentiating between Gang Jing and Rou Jing based on the presence or absence of aversion to cold and sweating indicates Wind-Cold pathogenesis; a deep and fine pulse indicates Dampness. If wind invades an unhealed wound, it is called Po Shang Feng (Broken Wind/Tetanus); if dampness invades, it is called Po Shang Shi (Broken Dampness). Both are extremely dangerous and difficult to endure if the cause is unknown in an emergency. After the pus drains from abscesses or scrofula, one must be especially cautious. Excessive sweating in postpartum women or qi reversal due to anger can also cause this disease. Each has its specific treatment methods.
Treatment for Rou Jing (Soft Spasm): Body stiffness, limb cramping and discomfort, pulse appearing deep and slow, spontaneous sweating.
Gualou Gen (Trichosanthes Radix) (2 liang), Guixin (Cinnamomi Cortex), Baishao Yao (Paeoniae Radix Alba) (each 3 liang), Gancao (Licorice Root, honey-fried) (2 liang).
Grind the above into a coarse powder. Take 4 qian per dose, add 1.5 cups of water, 5 slices of ginger, and 2 dates. Decoct until 0.7 cup remains, strain, and take warm. If sweating is not thorough, after a short while, drink hot porridge to induce sweating.