第十六卷缺。此遗逸于元之初也。
仲景曰。伤寒所致太阳病 湿 三种。宜应别论。以为与伤寒
相似。故此见之。雍曰。自此以下二卷。皆论似伤寒非伤寒之疾。
湿盖其首也。三者皆在太阳一经。与伤寒为难辨。故仲景论于伤
寒之先。以不能先别此三者。则必不能辨伤寒也。孙真人亦同此言。
近世方论。列于杂病疑似诸疾之中。然疑似诸病。非太阳所感。所以
仲景独先 湿 者。为其与伤寒同为一经。根源不异。症亦多同。误
治则杀人。是以不得不先之。今讨论既详。复恐乱伤寒症治之法。不
免根据近世所述。与霍乱等项别为一卷。其疑似诸疾。又附之后卷。庶
几有所区别乎。
雍曰。先兄子若明医道。常疑医经中 痉二字。当只是一字传
写之误。盖汉晋之书皆作 。如仲景言。结胸病。项亦强。如柔 状。
千金载之曰。项亦强。如柔痉状。其二字传写之误明矣。然素问灵枢
二经。亦有 痉一病。不同。则自仲景以来。诸书皆有当为 当为痉
者。后世传录者。俱不复辨别也。政和间。先人客京师。有家人病。招
东平刘寅诊视。刘曰。此 病也。治之愈。因问 痉之别。刘曰。病以
时发者谓之痉。不以时发者谓之 。后归洛。有兄病伤寒。汗后。以时
作痉者。先兄因刘医语。用庞氏葛根加麻黄汤治之而愈。刘医之言。
不见于诸书。东平昔多名医。必有由来。后雍颇读医经。始悟刘医之
言。虽当而不尽也。盖二字之误。固多有之。在汉晋之书中。有当为
者。亦有当为痉者。在隋唐之书中。亦有当为 。当为痉者。方知
痉必竟二字。盖 者病名。如曰中风伤寒之类也。痉者症名。如结
胸痞气之类也。如此言 湿 三病。则 是病名。不可作痉也。仓公
当归汤方云。主贼风口噤角弓反张痉者。则是痉病中一症之名。不
可作 也。盖痉是经脉与筋强直反张之病。故为病中之一症。所以
诸风有痉。伤寒亦有痉。 病之中亦有痉不痉者。大抵 为轻。痉为
重。 而又痉者尤为重。刘氏虽不分病名与症名有异。而 病不以
时发。故有累日不知人事者。痉病则随发随止。孙真人所谓须臾有
十数发者。则又与病以时发不以时发之言相应也。故雍谓 病名痉
症名者。究其源也。刘谓以时发不以时发者。别其流也。活人书又
曰。阴阳二 者。此言非古。恐出于后世。雍以意度之。刚 之 名
阳。柔 之 名阴 。朱氏虽言阴阳二 。而终不明辨。第曰阳
属刚。阴 属柔而已。其症与药。俱不详言之。
仲景曰。太阳病。脉沉而细者。名曰 。
又曰。太阴病。发热无汗。反恶寒者。名曰刚 。
又曰。太阳病。发热汗出而不恶寒。名曰柔 。巢氏曰。柔 恶
寒。雍曰。详刚 。即与太阳伤寒症同。柔 。即与太阳中风症同。然
伤寒脉浮紧。中风脉浮缓。 病脉沉细。当以脉别之。
又曰。病身热足寒。颈项强急。恶寒。时头热面赤。目脉赤。独头
动摇。卒口噤。背反张者。痉病。雍曰。此病为 症字误。
问曰。 病何由而感也。素问三十七篇曰。肺移热于肾。传为柔
。仲景曰。太阳病。发汗太多。因致 。
又曰。疮家虽身疼痛。不可
发汗。汗出则 。在叔和曰。风病下之 。复发其汗。必拘急。此皆致
之由也。千金曰。先因伤风。后感寒湿。则致 。故柔 亦有不恶
寒而恶风者。
问曰。 脉如何。仲景曰。脉沉而细。叔和曰。其脉伏坚直上下。
又曰。脉来。按之筑筑而弦。直上下行。巢氏曰。策策而弦。直上下行
者。风 脉也。伏坚直上下。 而加痉之脉也。筑筑而弦。策策而弦。
皆病脉。筑策亦疑一字误。
问曰。治 如何。叔和曰。太阳病。无汗。而小便反少。气上冲
胸。口噤不得语。欲作刚 。葛根汤主之。雍曰。叔和既论治刚 。次
当言柔 。今乃不言。及再论刚 为病。胸满口噤。卧不着席。脚挛
急。其人必 齿。可与大承气汤。雍以仲景伤寒本论。无此一症。故
疑此亦非叔和之言。误从之杀人。大承气汤的非治刚 之药。纵是
诸。皆不可用。盖 太阳中风。再感寒湿之疾。太阳属表。中风在
表。及寒湿之疾。皆不可下。其脉沉细伏弦。亦不可下。今又言胸满。
非寒则虚痞。口噤。卧不着席。又太阳中风之症。脚挛急者。脚蜷也。
胞中有寒也。皆不当行承气汤。用之必死。庞朱二氏不明改之去之
者。意其是叔和之言。不敢削也。朱氏之言。加审之二字。盖亦有疑
矣。尝见庸愚下此以杀人。知而不言。不为无罪。然则柔 用何药以
治之。曰。庞氏治刚柔 。加减葛根麻黄汤。 无汗者。加麻黄。 自
汗者。去麻黄加葛根。朱氏治柔 。以桂枝加葛根汤。皆其药治切当
者也。王叔和曰。太阳病。其症备。身体强KT KT 。然脉反沉迟。此为
。栝蒌桂枝汤主之。庞氏曰。栝蒌不主项强KT KT 。其意以治肺热。
令不移于肾也。桂枝汤内加栝蒌四两。雍曰。审如庞言。则移热之
。乃柔 也。独未知疮家风家二 亦同治乎。更当审其症而用之。
常见太阳伤寒。出汗多致 。服此亦愈。
千金曰。其重者。患耳中策策痛。此风入肾经中也。不治。流入
肾。喜卒然体痉直。如此。皆服小续命汤两三剂。雍曰。亦须无汗。乃
可服。
又曰。针耳前动脉及风府神良。雍曰。二穴亦难取。动脉在客主
人之下。误刺陷脉。则为内漏为聋。风府在脑户喑门之间。误刺亦
死。一喑门风府。又禁不可刺。能者互审之。
又曰。刚柔 。宜加减葛根麻黄汤。 自汗者。去麻黄。更加葛
根。雍曰。此汤诸家未见。惟庞氏载之。
又曰。 病不宜大发汗及针灸。宜小汗之。叔和曰。 病有灸
疮。难疗。雍曰。大抵疮家忌灸。惟孙真人云。若耳痛肿生汁作痈疖
者。乃无害也。惟风宜防耳。此定为耳能泄肾气故也。痉亦同。
活人书云。柔 。桂枝加葛根汤主之。雍曰。此即仲景治太阳病有
汗之药。朱氏以叔和缺治 药。故取而用之。若然。则刚 正宜用庞氏
葛根麻黄也。又朱氏论二 。取千金说云。并宜服小续命汤。此皆可为
定法。其热甚而欲移于肾者。必加痉。宜以叔和桂枝加栝蒌汤主之。
叔和曰。 病。发其汗已。其脉 如蛇。暴腹胀大者。为欲解
也。其脉如故。反伏弦者。必 。既曰 病。又曰必 。何也。雍曰。必
当作必痉。则义通也。此谓 病加痉者也。
问曰。 病其详何如。孙真人曰。太阳中风。重感于寒湿。则变
。 者口噤不开。背张而直。如发痫之状。摇头马鸣。腰反折。须臾
十数发。气息如丝。汗出如雨。时有脱。易得之。雍曰。此即正谓之痉
也。痉同他病而有。初无本病。或因中风而痉。或因伤寒而痉。或因
而加痉。其用药皆相类。大抵葛根续命也。
问曰。妇人小儿多作 。何也。孙真人曰。新产妇人。及金疮血
脉虚竭。小儿脐风。大人湿温。得痉风者。皆死。又热病。热入肾中为
。小儿病痫。热甚亦为 。雍曰。此二者。可治之 也。
问曰。风喑似痉何如。孙真人曰。凡风喑。暴尸厥。及鬼魇不寤。
久厥或癫。皆与痉相类。宜精察之。雍曰。风喑暴尸厥。鬼魇不寤。皆
冥冥不知人。皆似 。癫痫似痉。贼风口噤而痉者。为风痉也。仓公
当归汤主之。庞氏曰。 病卧不着席。小儿腰背去席二指。大人身侧
掌。为难治。雍曰。难治。尚可治。非不治也。 虽强直。不至加痉。则
幸矣。亦见有反张过掌而愈者。尝见口噤似痉。略知人事。但坐而顺
掣腰脊仰倒者。亦风 也。服仓公当归汤而愈。
问曰。 痉二字相混。以经别之何如。雍曰。素问四十五篇曰。
手阳明少阳厥逆。发喉痹。嗌痛肿痉。此非足太阳之疾而言痉。故全
元起本作痉。盖诸经有痉。独足太阳有 也。
问曰。巢氏分风 。伤寒 。何也。雍曰。灵枢云。热病不可刺者
九。二曰。热而痉者死。腰折螈 噤 也。此伤寒 也。
又曰。风痉。
身反折见。取足太阳及 中及血络出血。此风 也。灵枢有 二。故
巢氏亦分二 。尝见热病汗后发 。亦服桂枝加栝蒌汤而愈。经言
热而 者死。必谓未汗而 。其热甚有异耳。
雍曰。庞氏言若汗出太多。因而熟寐。汗为冷湿之气。复着太阳
经。故发 。朱氏言先因伤风。后感寒湿而致痉。二者皆谓先因病变
而为 者。皆痉之一症。如前仲景言。太阳病。发热无汗。反恶寒。发
热汗出。不恶寒者。乃 之正病也。
朱氏又曰。术附散、桂心白术汤、
附子防风散、八味白术散、桂枝煮散。可选而用之。其感疾既非一
端。固当根据症选用也。然 痉二病。终缘二字差误。诸书鲜有晓然无
疑者。所以近世无端确之论。幸而用药二病不甚相远。不然。大误
也。雍深取朱氏治柔 。用桂枝加葛根汤。庞氏治刚 。用葛根加麻
黄汤。叔和治太阳病。欲作刚 。用葛根汤。热甚而 。用栝蒌桂枝
汤。大抵皆宜续命汤。而千金以此治痉。朱氏以治二 。不同。此复
不须疑。 痉皆用。惟无汗者可用也。
雍曰。二病亦多有之。各为伤寒治。或为风治。故不愈。风犹近
之而未的也。雍亲见者数人。略言其状。一人初如伤寒。三数日后。
冥冥不知人。亦似柔软。不甚强直。惟忘记口噤不口噤。雍谓此
也。又一人初亦如伤寒。数日后。时作角弓反张。作则口噤不知人。
罢则略知人而困。雍谓此痉也。
又有伤寒汗后。方坐谈语次。忽瞠目口噤。虽坐如故。而四肢僵
硬不可屈折。少顷即罢。罢而复作。正所谓须臾数十发者。罢则言语
如故。雍谓此缘出汗多所致。伤寒痉也。时服桂枝栝蒌而愈。
又一儿如伤风。一二日后不知人。冥冥卧。不语不食。此 也。
忽四肢强直。口噤。手足皆如策肿。手足指皆HT 开。少顷即定。复稍
柔。但冥冥然。雍谓此为 病而加痉者也。
又一村人。病二三日后。口噤。身强直反张。觉臂腿长于常日。
略知人事。齿缝中能作声。不甚明晓。饮冷水。反要火炙。寻衣缝。摸
床撮空。无所不至。其症甚怪。时雍思之。只是痉。用大岩蜜汤擦其
齿。须臾口得开。数进续命汤。遂愈。村人耐疾。使富贵安得不死。
又一家父子闭户坐。不出门。人云患锁牙风。使侦之。父子对
坐。各用两手板面前一横木。少顷病来。则两手俱脱偃仆。后苏而复
坐。父子更起更偃仆。以仓公当归汤主之。其子遂愈。父羸老不救。
问风来之状。则自足起。循太阳经而上。过 中。至股分两支。一支
循股外而上入腰。则猛掣便侧起。一支循股内而上入少腹。考之于
经。太阳无此别支。应是入少阴也。
又有一人行次。仰面顾者三。众谓仰面有所视。少顷即倒。舁归
反张。数日而没。此疾症甚不一。亦有间者。不能具记。历验之。 似
微柔软。发痉则极强硬。前人叙此未能尽。雍虽加详。而次第紊乱耳。
第十六卷原书已缺。这是元朝初年流传过程中遗失的内容。
张仲景说：伤寒导致的太阳病，有中风、中湿、痉三种情况。本应当分别论述，因为它们与伤寒症状相似，所以一并列出。郭雍说：从这一节以下的两卷内容，都是讨论那些类似伤寒但并非真正伤寒的疾病。中湿排在首位。这三种病都发生在太阳一经，与伤寒难以区分。所以张仲景在论述伤寒之前先论述它们，因为如果不能先辨别这三种病，就一定无法辨别伤寒。孙思邈真人也持有相同的观点。近世的方论将这些病列在杂病疑似诸疾之中。然而，这些疑似疾病并非由太阳经受邪引起，所以张仲景唯独将中湿放在前面，是因为它与伤寒同属一经，根源相同，症状也多相似。误治会致人死亡，因此不得不将其置于前列。如今经过详细讨论，又担心扰乱伤寒症治的方法，不免依据近世所述，将中湿等项单独列为一个卷次，而那些疑似疾病又附在后卷，以此来加以区别。
郭雍说：我的兄长子若精通医道，常常怀疑医经中的“痉”字，应该是传抄时的一个字之误。因为汉晋时期的书籍都写作“痓”。例如张仲景说：“结胸病，项部也强直，像柔痓的状态。”《千金方》记载说：“项部也强直，像柔痉的状态。”这两个字的传抄错误是明显的。然而，《素问》和《灵枢》二书中，也有“痓”这种病，与“痉”不同。那么自张仲景以来，各书中都有应当作“痓”或应当作“痉”的情况。后世传录的人，都不再辨别了。政和年间，先父客居京城，有家仆生病，请东平刘寅诊治。刘寅说：“这是痓病。”治疗后痊愈。于是询问“痓”与“痉”的区别。刘寅说：“按时发作的叫痉，不按时发作的叫痓。”后来回到洛阳，哥哥患伤寒，发汗后，按时出现痉挛症状。先兄根据刘医生的话，使用庞氏葛根加麻黄汤治疗而痊愈。刘医生的言论不见于各种医书。东平过去有很多名医，这话必有渊源。后来郭雍广泛阅读医经，才领悟到刘医生的话，虽然有理但不全面。大概这两个字的误用，确实有很多情况。在汉晋的书中，有的应当作“痓”，有的应当作“痉”。在隋唐的书中，也有应当作“痓”，应当作“痉”的情况。这才知道“痉”终究是两个不同的字。大概“痓”是病名，就像中风、伤寒之类；“痉”是症状名，就像结胸、痞气之类。如果说“中风、中湿、痉”这三种病，那么“痓”是病名，不能当作“痉”。仓公当归汤方中说：“主治贼风口噤、角弓反张的痉病。”那么“痉”是痉病中的一种症状名称，不能当作“痓”。大概“痉”是经脉和筋脉强直反张的病，所以是病中的一种症状。所以各种风病有痉，伤寒也有痉，痓病之中也有痉和不痉的情况。大体上，“痓”较轻，“痉”较重，“痓”而又出现“痉”的症状则更为严重。刘氏虽然没有区分病名与症状名的不同，但“痓”病不按时发作，所以有连续几天不知人事的情况；“痉”病则是随发随止。孙真人所说的“一会儿发作十几次”，这与“痓”病以时发、不以时发的说法相应。所以郭雍认为，“痓”是病名，“痉”是症状名，这是探究其本源；刘氏说的以时发、不以时发，是辨别其流变。《活人书》又说：“阴阳二痓。”这种说法不符合古义，恐怕出于后世。郭雍推测，“刚痓”的“痓”名为阳，“柔痓”的“痓”名为阴。朱氏虽然说了阴阳二痓，但最终没有明确辨别，只是说阳属于刚，阴属于柔而已。其症状与用药，都没有详细说明。
张仲景说：太阳病，脉象沉而细的，名叫痓。
又说：太阴病，发热无汗，反而恶寒的，名叫刚痓。
又说：太阳病，发热汗出而不恶寒的，名叫柔痓。巢元方说：柔痓恶寒。郭雍说：详细考察刚痓，即与太阳伤寒症相同；柔痓，即与太阳中风症相同。然而，伤寒脉浮紧，中风脉浮缓，痓病脉沉细，应当通过脉象来区别。
又说：病人身体发热，足部发凉，颈项强直紧急，恶寒，有时头部发热、面色发红，眼脉络赤红，只有头部动摇，突然口噤，背反张的，是痉病。郭雍说：这里的“痓”字是“痉”字的误写。
问：痓病是如何感受外邪引起的？《素问》第三十七篇说：肺将热邪移于肾，传变为柔痓。张仲景说：太阳病，发汗过多，因而导致痓。
又说：疮家即使身体疼痛，也不可发汗，如果发汗，就会引发痓。王叔和说：风病误用下法，又复发其汗，必然拘急。这些都是导致痓的原因。《千金方》说：先前因伤风，后感寒湿，就会导致痓。所以柔痓也有不恶寒而恶风的。
问：痓病的脉象如何？张仲景说：脉沉而细。王叔和说：脉伏坚直上下。
又说：脉来，按之筑筑然且弦，直上下行。巢元方说：策策然且弦，直上下行的，是风痓脉。伏坚直上下，是痓而兼痉的脉。筑筑然且弦，策策然弦，都是病脉。“筑”、“策”二字或许是一个字的误写。
问：如何治疗痓病？王叔和说：太阳病，无汗，而小便反而少，气上冲胸，口噤不能说话，想要形成刚痓，用葛根汤主治。郭雍说：王叔和既然论述了刚痓的治疗，接下来应当说柔痓的治疗，现在却不提。等到再次论述刚痓为病，胸满口噤，卧不着席，脚挛急，其人必定齘齿（磨牙），可给予大承气汤。郭雍认为张仲景《伤寒论》本论中没有这一条症状，所以怀疑这也不是王叔和的话，误信它会杀人。大承气汤并不是治疗刚痓的药物，即使是各种痉病，也不可用。大概痓是太阳中风，再感寒湿的疾病。太阳属表，中风在表，以及寒湿之疾，都不可用下法。其脉沉细伏弦，也不可用下法。现在又说胸满，如果不是寒就是虚痞；口噤，卧不着席，又是太阳中风的症状；脚挛急，是脚蜷缩，胞中有寒。这些都不应当使用承气汤，用了必死。庞氏、朱氏两位先生不明白这一点，不改去这些内容，大概是认为是王叔和的话，不敢删削。朱氏的话中加了“审慎”二字，大概也是有疑虑了。曾见庸医使用此方杀人，明知却不言语，不是没有罪过的。那么柔痓用什么药治疗呢？回答说：庞氏治疗刚柔痓，用加减葛根麻黄汤。无汗者，加麻黄；自汗者，去麻黄加葛根。朱氏治疗柔痓，用桂枝加葛根汤。这都是药物对症恰当的治疗方法。王叔和说：太阳病，症状具备，身体强直KT KT（形容僵硬貌），然而脉反而沉迟，这是痓。用栝蒌桂枝汤主治。庞氏说：栝蒌不主治项强KT KT，他的意思是用它清肺热，使热邪不转移至肾。在桂枝汤内加栝蒌四两。郭雍说：如果像庞氏所说，那么转移热邪的，乃是柔痓。只是不知道疮家、风家这两种痓是否也同样治疗？更应当审慎其症状而使用。常见太阳伤寒，出汗多导致痓，服用此方也痊愈。
《千金方》说：病情重的，耳朵里感到策策痛，这是风邪侵入肾经。如果不治疗，风邪流入肾，喜欢突然身体痉挛强直。像这种情况，都服用小续命汤两三剂。郭雍说：也必须是无汗的情况下，才可以服用。
又说：针刺耳前动脉及风府穴，效果很好。郭雍说：这两个穴位也很难取。动脉在客主人穴之下，误刺陷入血脉，会导致内漏和耳聋。风府穴在脑户、喑门之间，误刺也会致死。喑门、风府，又禁止不可刺。能针灸的人要互相审慎。
又说：刚柔痓，宜用加减葛根麻黄汤。自汗者，去麻黄，更加葛根。郭雍说：这个方子各家未见，只有庞氏记载。
又说：痓病不宜大发汗及针灸，宜用小汗法。王叔和说：痓病有灸疮，难治。郭雍说：大体上疮家忌灸，只有孙真人说：如果耳痛肿生汁作痈疖的，才无害。只有风邪宜防耳，这定为耳朵能泄肾气的原因。痉病也一样。
《活人书》说：柔痓，桂枝加葛根汤主治。郭雍说：这就是张仲景治疗太阳病有汗的药。朱氏因为王叔和缺少治疗痓药的记载，所以取来使用。如果是这样，那么刚痓正应该用庞氏的葛根麻黄汤。另外朱氏论述二痓，引用《千金方》的说法，都说宜服小续命汤。这都可以作为定法。其热甚而欲移于肾的，必然加痉，宜用王叔和的桂枝加栝蒌汤主治。
王叔和说：痓病，发汗后，其脉如蛇般蠕动，突然腹胀大的，是想要解除了。其脉如故，反而伏弦的，必然转为痉。既然说是痓病，又说必然转为痉，为什么呢？郭雍说：“必”应当是“必痉”，这样意义就通顺了。这是指痓病加上痉的症状。
问：痓病的详情是怎样的？孙真人说：太阳中风，重感于寒湿，则变为痓。痓表现为口噤不开，背张而直，像发痫的样子，摇头马鸣，腰反折，须臾发作十数次，气息如丝，汗出如雨，时有脱证，容易得病。郭雍说：这就是正称为痉的病。痉与其他病同时存在，起初没有本病，或因中风而痉，或因伤寒而痉，或因痓而加痉。其用药都相类似。大体上多用葛根续命汤。
问：为什么妇人小儿多患痓？孙真人说：新产妇人，以及金疮血脉虚竭，小儿脐风，大人湿温，得痉风的，都死。还有热病，热入肾中为痓。小儿病痫，热甚也为痓。郭雍说：这两种，是可以治疗的痓病。
问：风喑似痉怎么样？孙真人说：凡是风喑，暴尸厥，及鬼魇不寤，久厥或癫，都与痉相类似，应仔细察辨。郭雍说：风喑、暴尸厥、鬼魇不寤，都是冥冥中不知人事，都像痓。癫痫似痉，贼风口噤而痉的，称为风痉。用仓公当归汤主治。庞氏说：痓病卧不着席，小儿腰背离席二指，大人身侧掌，为难治。郭雍说：难治，尚可治，不是不治。痓虽强直，不至加痉，那就万幸了。也曾见过反张过掌而痊愈的。曾见口噤似痉，略知人事，但坐而顺掣腰脊仰倒的，也是风痓。服用仓公当归汤而愈。
问：痓、痉二字相混，如何用经典来区别？郭雍说：《素问》第四十五篇说：手阳明、少阳厥逆，发喉痹，嗌痛肿痉。这里不是说足太阳的疾病而言痉，所以全元起本作“痉”。大概各经都有痉，唯独足太阳有痓。
问：巢元方区分风痓、伤寒痓，为什么呢？郭雍说：《灵枢》说：热病不可刺者九种。第二种是：热而痉者死，腰折螈疭、口噤。这是伤寒痓。
又说：风痉，身反折见，取足太阳及膻中及血络出血。这是风痓。《灵枢》有痓两种，所以巢元方也分二痓。曾见热病发汗后发痓，也服用桂枝加栝蒌汤而痊愈。经文说热而痓者死，一定是谓未发汗而痓。其热势很盛，有所不同罢了。
郭雍说：庞氏说如果汗出太多，因而熟睡，汗液变成冷湿之气，又附着于太阳经，所以发痓。朱氏说先前因伤风，后感寒湿而导致痉。这两者都说先前因病邪变化而为痓的，都是痉的一种症状。如前文张仲景所说，太阳病，发热无汗，反恶寒，发热汗出，不恶寒的，乃是痓的正病。
朱氏又说：术附散、桂心白术汤、附子防风散、八味白术散、桂枝煮散，可选而用之。其感疾既然不是一端，固当根据症状选用。然而痓、痉二病，终究因为二字差误，各书很少有晓然无疑的。所以近世没有确切的理论，幸好用药二病不甚相远，不然，就是大误了。郭雍深取朱氏治柔痓，用桂枝加葛根汤；庞氏治刚痓，用葛根加麻黄汤；王叔和治太阳病，欲作刚痓，用葛根汤；热甚而痓，用栝蒌桂枝汤。大体上都宜用续命汤，而《千金方》以此治痉，朱氏以此治二痓，不同之处，这也不必怀疑。痓、痉都用续命汤，只有无汗者可用。
郭雍说：二病也多有发生，各按伤寒治，或按风治，所以不愈。风邪接近但未确切。郭雍亲眼见到的有好几个人，略述其状。一人起初像伤寒，三数日后，冥冥中不知人事，也似柔软，不甚强直，惟忘记口噤或不口噤。郭雍认为这是痓。又一人起初也像伤寒，数日后，时常出现角弓反张，发作时口噤不知人事，停止时略知人事而困倦。郭雍认为这是痉。
又有伤寒发汗后，正坐着谈话时，忽然瞪目口噤，虽然坐姿如故，而四肢僵硬不可屈折，少顷即停止，停止后又发作。正所谓须臾数十发的情况。停止时言语如故。郭雍认为这是因为出汗多所致，是伤寒痉。时常服用桂枝栝蒌汤而愈。
又一小孩像伤风，一二日后不知人事，冥冥中躺着，不语不食，这是痓。忽然四肢强直，口噤，手足都像肿胀，手足指都张开，少顷即安定，复稍柔和，但冥冥然。郭雍认为这是痓病而加痉。
又一村民，病二三日后，口噤，身强直反张，觉得手臂腿比常日长，略知人事，牙齿缝中能发声，不甚明晓，饮冷水，反而要火炙，寻衣缝，摸床撮空，无所不至。其症状很奇怪。当时郭雍思考，这只是痉。用大岩蜜汤擦其齿，须臾口得开，数次进服续命汤，遂痊愈。村民耐病，使得富贵之人安得不死？
又一家父子闭门而坐，不出门。人说患锁牙风。派人侦察，父子对坐，各用两手扳面前一横木，少顷病来，则两手俱脱偃仆，后苏醒而复坐，父子更起更偃仆。用仓公当归汤主治。其子遂愈，父亲羸老不救。问风来的形状，则从足起，循太阳经而上，过膻中，至股部分两支，一支循股外而上入腰，则猛掣便侧起；一支循股内而上入少腹。考之于经，太阳无此别支，应是入少阴也。
又有一人行走途中，仰面顾视三次，众人谓仰面有所视，少顷即倒，抬回反张，数日而死。此疾症状很不一致，也有间隔的，不能全部记录。历验之，痓似微柔软，发痉则极强硬。前人叙述此未能尽，郭雍虽加详，而次第紊乱耳。
Volume 16 is originally missing. This content was lost during the circulation in the early Yuan Dynasty.
Zhang Zhongjing stated: Among the Taiyang diseases caused by Shanghan (Cold Damage), there are three types: Zhongfeng (Wind Strike), Zhongshi (Dampness Strike), and Jing (Spasm). They should theoretically be discussed separately because their symptoms resemble those of Shanghan, hence they are listed together. Guo Yong said: The following two volumes discuss diseases that resemble Shanghan but are not true Shanghan. Zhongshi (Dampness Strike) is listed first. All three conditions occur in the Taiyang channel and are difficult to distinguish from Shanghan. Therefore, Zhang Zhongjing discusses them before Shanghan, because if one cannot first distinguish these three conditions, one certainly cannot distinguish Shanghan. Sun Simiao also held this view. Recent medical theories have categorized these diseases among miscellaneous diseases with suspected similarities. However, these suspected diseases are not contracted via the Taiyang channel. Thus, Zhang Zhongjing placed Zhongshi (Dampness Strike) first because it shares the same channel as Shanghan, has the same root cause, and presents many similar symptoms. Misdiagnosis and mistreatment can lead to death, so it is necessary to address it first. After detailed discussion here, to avoid confusing the treatment methods of Shanghan, I have followed recent descriptions to place Zhongshi (Dampness Strike) and similar items in a separate volume, while attaching other suspected diseases to the subsequent volume, thereby distinguishing them.
Guo Yong said: My elder brother, Ziruoming, who was proficient in medicine, often suspected that the character "Jing" (Spasm) in medical classics was a transcription error for a single character. Books from the Han and Jin dynasties all wrote it as "Chi" (Stiffness/Tetanus-like state). For example, Zhang Zhongjing said: "In Jie Xiong (Chest Binding) disease, the neck is also stiff, resembling the state of Rou Chi (Soft Stiffness)." *Qianjin Fang* records: "The neck is also stiff, resembling the state of Rou Jing (Soft Spasm)." The transcription error between these two characters is evident. However, both *Suwen* and *Lingshu* mention "Chi" as a disease, which is different from "Jing". Since Zhang Zhongjing's time, various books have instances where "Chi" should be used or "Jing" should be used. Later transcribers ceased to distinguish them. During the Zhenghe era, my father was residing in the capital when a servant fell ill. Liu Yin from Dongping diagnosed him. Liu said: "This is Chi disease." It was cured after treatment. When asked about the difference between Chi and Jing, Liu said: "When it occurs at regular intervals, it is called Jing; when it does not occur at regular intervals, it is called Chi." Later, upon returning to Luoyang, my elder brother suffered from Shanghan. After sweating, he experienced spasms at regular intervals. Following Liu's advice, my elder brother used Pang Shi's Gegen Plus Mahuang Decoction and recovered. Liu's words do not appear in various medical books. Dongping was formerly home to many famous doctors, so his words must have a source. Later, after Guo Yong read extensively through medical classics, he realized that Liu's words were reasonable but incomplete. Generally, the confusion between these two characters is common. In Han and Jin books, some instances should be "Chi" and others "Jing". In Sui and Tang books, there are also cases for both. Only then did I realize that "Jing" ultimately refers to two distinct concepts. "Chi" is a disease name, like Zhongfeng (Wind Strike) or Shanghan. "Jing" is a symptom name, like Jie Xiong (Chest Binding) or Pi Qi (Abdominal Fullness). When referring to the three diseases of Zhongfeng, Zhongshi, and Jing, "Chi" is the disease name and cannot be substituted with "Jing". Cang Gong's Danggui Decoction states: "Mainly treats Zei Kou (Thief's Mouth/Jaw Lock), trismus, opisthotonos, and Jing." Thus, "Jing" is a symptom within the disease of spasm, not "Chi". Generally, "Jing" refers to the disease of meridians and sinews being stiff and causing opisthotonos, so it is a symptom within a disease. Therefore, various Wind diseases have Jing, Shanghan has Jing, and Chi diseases may or may not have Jing. Generally, Chi is mild, Jing is severe, and Chi accompanied by Jing is even more severe. Although Liu did not distinguish between disease names and symptom names, Chi does not occur at fixed times, so patients may remain unconscious for days. Jing occurs and stops spontaneously. Sun Simiao's statement about "occurring dozens of times in a short while" corresponds to the distinction between occurring and not occurring at fixed times. Thus, Guo Yong considers "Chi" as the disease name and "Jing" as the symptom name, exploring the origin. Liu's distinction based on timing explores the manifestation. *Huren Shu* also mentions "Yin Yang Er Chi". This statement is not ancient and likely originated later. Guo Yong speculates that the "Chi" in Gang Chi (Hard Stiffness) is named Yang, and the "Chi" in Rou Chi (Soft Stiffness) is named Yin. Zhu Shi mentioned Yin Yang Er Chi but did not clearly distinguish them, merely stating that Yang belongs to Gang and Yin belongs to Rou. He did not detail the symptoms and prescriptions.
Zhang Zhongjing said: In Taiyang disease, if the pulse is deep and fine, it is named Chi.
He also said: In Taiyin disease, with fever, no sweat, and aversion to cold, it is named Gang Chi.
He also said: In Taiyang disease, with fever, sweating, and no aversion to cold, it is named Rou Chi. Chao Yuanfang said: Rou Chi involves aversion to cold. Guo Yong said: Upon detailed examination, Gang Chi is identical to Taiyang Shanghan symptoms, and Rou Chi is identical to Taiyang Zhongfeng symptoms. However, Shanghan presents with a floating and tight pulse, Zhongfeng with a floating and slow pulse, and Chi disease with a deep and fine pulse. They should be distinguished by pulse.
He also said: If a patient has body heat, cold feet, stiff and urgent neck and back, aversion to cold, occasional head heat and red face, red eye vessels, only head trembling, sudden trismus, and opisthotonos, it is Jing disease. Guo Yong said: Here, "Chi" is a typo for "Jing".
Question: How is Chi disease contracted? *Suwen* Chapter 37 states: Lung transferring heat to Kidney transforms into Rou Chi. Zhang Zhongjing said: In Taiyang disease, excessive sweating leads to Chi.
He also said: Patients with sores, even if experiencing body pain, should not induce sweating; if sweated, Chi will result. Wang Shuhe said: In Wind disease, purgation followed by sweating causes stiffness. These are all causes of Chi. *Qianjin Fang* states: Previous wind injury followed by cold-dampness invasion causes Chi. Thus, Rou Chi may also present without aversion to cold but with aversion to wind.
Question: What is the pulse of Chi disease? Zhang Zhongjing said: Deep and fine. Wang Shuhe said: Hidden, firm, straight up and down.
He also said: The pulse feels pounding and wiry when pressed, moving straight up and down. Chao Yuanfang said: Crisp and wiry, moving straight up and down, is the Wind Chi pulse. Hidden, firm, straight up and down, is the Chi pulse accompanied by Jing. Pounding and wiry, crisp and wiry, are both disease pulses. "Zhu" and "Ce" might be errors for the same character.
Question: How to treat Chi disease? Wang Shuhe said: In Taiyang disease, with no sweat, yet urine is scanty, qi rushes to the chest, trismus prevents speech, indicating impending Gang Chi, use Gegen Decoction. Guo Yong said: Since Wang Shuhe discussed the treatment for Gang Chi, he should next discuss Rou Chi, but he does not. When discussing Gang Chi again, with chest fullness, trismus, inability to lie flat, leg cramps, and teeth grinding, Da Chengqi Decoction may be given. Guo Yong believes this symptom is not in Zhang Zhongjing's original *Shanghan Lun*, suspecting it is not Wang Shuhe's words. Blindly following it could be fatal. Da Chengqi Decoction is not for treating Gang Chi. Even for various Jing conditions, it is contraindicated. Generally, Chi is Taiyang Zhongfeng complicated by cold-dampness. Taiyang is exterior, Zhongfeng is exterior, and cold-dampness is exterior. Purging is contraindicated. The pulse is deep, fine, hidden, and wiry, also contraindicating purging. Chest fullness suggests cold or deficiency bloating; trismus and inability to lie flat are Taiyang Zhongfeng symptoms; leg cramps indicate curling of legs and cold in the bladder. None warrant Da Chengqi Decoction; using it would be fatal. Pang Shi and Zhu Shi failed to correct this, likely fearing to delete Wang Shuhe's words. Zhu Shi added "cautiously," showing doubt. I have seen ignorant physicians use this formula to kill people. Silence is culpable. So, what medicine treats Rou Chi? Answer: Pang Shi uses Modified Gegen Plus Mahuang Decoction for Gang and Rou Chi. Add Mahuang for no sweat; remove Mahuang and add more Gegen for spontaneous sweating. Zhu Shi uses Guizhi Plus Gegen Decoction for Rou Chi. These are appropriate treatments. Wang Shuhe said: In Taiyang disease, with complete symptoms, body stiffness, yet pulse is deep and slow, this is Chi. Use Gualou Guizhi Decoction. Pang Shi said: Gualou does not treat neck stiffness directly; its purpose is to clear Lung heat to prevent transfer to Kidney. Add four liang of Gualou to Guizhi Decoction. Guo Yong said: If Pang is correct, then the condition involving heat transfer is Rou Chi. Do sore-patients and wind-patients with Chi respond similarly? One must examine symptoms carefully. I have seen Taiyang Shanghan patients with excessive sweating developing Chi, who recovered with this formula.
*Qianjin Fang* states: Severe cases suffer from crisp pain in the ears, indicating wind entering the Kidney channel. If untreated, wind enters Kidney, causing sudden body stiffness and spasm. Such cases should take Xiao Xuming Decoction for two to three doses. Guo Yong said: It can only be taken if there is no sweat.
He also said: Needle the arterial pulse in front of the ear and Fengfu point for good results. Guo Yong said: These two points are difficult to locate accurately. The arterial pulse is below Kezhuren; accidental puncture into the vessel causes internal bleeding and deafness. Fengfu is between Naohu and Yanmen; accidental puncture can be fatal. Yanmen and Fengfu are forbidden for needling. Practitioners must exercise caution.
He also said: For Gang and Rou Chi, use Modified Gegen Plus Mahuang Decoction. Remove Mahuang and add more Gegen for spontaneous sweating. Guo Yong said: This formula is only recorded by Pang Shi.
He also said: Chi disease should not be treated with heavy sweating or acupuncture; light sweating is suitable. Wang Shuhe said: Chi disease with moxibustion scars is difficult to treat. Guo Yong said: Generally, sore-patients avoid moxibustion. Only Sun Simiao said that if ear pain swells with pus forming an abscess, it is harmless. Wind should be prevented from affecting the ears, as ears can drain Kidney qi. Jing is similar.
*Huren Shu* states: Rou Chi is treated with Guizhi Plus Gegen Decoction. Guo Yong said: This is Zhang Zhongjing's formula for Taiyang disease with sweating. Zhu Shi adopted it because Wang Shuhe lacked treatment formulas for Chi. If so, Gang Chi should properly use Pang Shi's Gegen Plus Mahuang Decoction. Zhu Shi, citing *Qianjin Fang*, recommends Xiao Xuming Decoction for both Chi types. This can be a standard method. For severe heat threatening to enter Kidney, leading to Jing, use Wang Shuhe's Gualou Guizhi Decoction.
Wang Shuhe said: After sweating in Chi disease, if the pulse moves like a snake and sudden abdominal distension occurs, it indicates resolution. If the pulse remains unchanged but becomes hidden and wiry, it will definitely transform into Jing. Why say it transforms into Jing? Guo Yong said: "Bi" (must) should be "Bi Jing" (must become Jing) for the meaning to make sense. This refers to Chi disease complicating with Jing.
Question: What are the details of Chi disease? Sun Simiao said: Taiyang Zhongfeng complicated by cold-dampness transforms into Chi. Chi presents with trismus, straight back, resembling epilepsy, head shaking, horse neighing sound, waist hyperextension, occurring dozens of times in a short while, breath like a thread, profuse sweating, occasional collapse. It is easily contracted. Guo Yong said: This is precisely what is called Jing. Jing co-occurs with other diseases without a primary disease itself; it may arise from Zhongfeng, Shanghan, or Chi. Treatments are similar, generally using Gegen Xuming Decoction.
Question: Why do women and children often suffer from Chi? Sun Simiao said: Postpartum women, patients with metal wounds and depleted blood vessels, infants with umbilical wind, adults with damp-warmth, contracting Jing-feng, all die. Also, heat diseases entering Kidney cause Chi. Infants with epilepsy and high fever also develop Chi. Guo Yong said: These two types are treatable Chi.
Question: How does Feng Yin (Wind Aphasia) resemble Jing? Sun Simiao said: Feng Yin, sudden corpse-cold, ghost oppression with unconsciousness, prolonged coma, or mania all resemble Jing. Careful differentiation is needed. Guo Yong said: Feng Yin, sudden corpse-cold, and ghost oppression involve unconsciousness, resembling Chi. Epilepsy resembles Jing. Thief's mouth with trismus and spasm is called Wind Jing, treated with Cang Gong Danggui Decoction. Pang Shi said: Chi patients unable to lie flat, infants with back arching two fingers off the bed, adults with hands extending beyond palms, are difficult to treat. Guo Yong said: Difficult but treatable, not incurable. If Chi stiffness does not progress to Jing, it is fortunate. I have seen opisthotonos extending beyond palms recover. I have seen trismus resembling Jing, with slight consciousness, sitting and jerking backward, also Wind Chi, recovered with Cang Gong Danggui Decoction.
Question: How to distinguish Chi and Jing using classics? Guo Yong said: *Suwen* Chapter 45 states: Hand Yangming and Shaoyang reversal causes throat obstruction, painful throat, swelling, and Jing. This Jing is not related to Foot Taiyang. Quan Yuanqi's version writes "Jing". Generally, all meridians can have Jing, but only Foot Taiyang has Chi.
Question: Why does Chao Yuanfang distinguish Wind Chi and Shanghan Chi? Guo Yong said: *Lingshu* states: Nine heat diseases unsuitable for needling. Second: Heat with Jing is fatal, with waist hyperextension, convulsions, and trismus. This is Shanghan Chi.
He also said: Wind Jing, with body hyperextension, treat by bleeding Foot Taiyang, Danzhong, and blood collaterals. This is Wind Chi. *Lingshu* mentions two types of Chi, so Chao Yuanfang distinguishes them. I have seen heat disease patients developing Chi after sweating, recovering with Gualou Guizhi Decoction. The classic says heat with Chi is fatal, implying pre-sweating Chi. The heat intensity differs.
Guo Yong said: Pang Shi stated that excessive sweating leads to deep sleep, where sweat turns to cold-damp qi, re-attaching to Taiyang channel, causing Chi. Zhu Shi stated previous wind injury followed by cold-dampness causes Jing. Both describe prior disease transformation leading to Chi, which is a symptom of Jing. As Zhang Zhongjing said, Taiyang disease with fever/no sweat/aversion to cold, or fever/sweating/no aversion to cold, are the proper presentations of Chi.
Zhu Shi also said: Shu Fu San, Guixin Baizhu Tang, Fuzi Fangfeng San, Bawei Baizhu San, Guizhi Zhusan can be selected based on symptoms. Since the pathogenic factors vary, selection must be symptom-based. However, due to the confusion between Chi and Jing, few texts clarify this. Recent theories lack precision. Fortunately, treatments for the two are not vastly different; otherwise, it would be a major error. Guo Yong adopts Zhu Shi's Guizhi Plus Gegen Decoction for Rou Chi, Pang Shi's Gegen Plus Mahuang Decoction for Gang Chi, Wang Shuhe's Gegen Decoction for impending Gang Chi, and Gualou Guizhi Decoction for severe heat Chi. Generally, Xuming Decoction is suitable. *Qianjin Fang* uses it for Jing, Zhu Shi for Chi. This difference needs no doubt. Chi and Jing both use it, especially for non-sweating cases.
Guo Yong said: Both diseases occur frequently. Treating them solely as Shanghan or Wind often fails. Wind is closer but not exact. I personally observed several cases. One initially resembled Shanghan; after a few days, became unconscious, seemed soft, not very stiff, occasionally with or without trismus. I considered this Chi. Another resembled Shanghan; after a few days, developed intermittent opisthotonos, with trismus and unconsciousness during attacks, recovering slightly between attacks. I considered this Jing.
Another case: After Shanghan sweating, while sitting and talking, suddenly stared with trismus. Limbs remained stiff and immobile for a moment, then relaxed, repeating dozens of times. Speech returned between episodes. I attributed this to excessive sweating causing Shanghan Jing. Recovered with Guizhou Gualou Decoction.
Another infant resembled wind injury; after one to two days, became unconscious, lying still, silent, refusing food. This was Chi. Suddenly limbs stiffened, trismus occurred, hands and feet swelled and fingers opened, then stabilized and softened, remaining unconscious. I considered this Chi complicating with Jing.
Another villager, after two to three days of illness, had trismus, body stiffness, and opisthotonos. Arms and legs felt longer than usual. Slightly conscious, making sounds through clenched teeth, confused, drinking cold water but seeking fire warmth, picking at clothes and bed air. Symptoms were bizarre. I realized it was Jing. Applied Dayanmi Tang to teeth, opening mouth quickly. Administered Xuming Decoction multiple times, resulting in recovery. The villager endured the illness; imagine how a noble would fare.
A father and son sat indoors, refusing to go out. Neighbors said "Lockjaw Wind". Investigation showed them gripping a horizontal beam. When the illness struck, they released and collapsed, then woke and sat up, repeating this. Treated with Cang Gong Danggui Decoction. The son recovered; the father, frail and old, did not survive. Asked about the wind's path, it started from feet, ascended Taiyang channel, passed Danzhong, split at thighs. One branch went up outer thigh to waist, causing sudden side-falling; the other went up inner thigh to lower abdomen. Classics show no such branch in Taiyang, likely entering Shaoyin.
Another person walking looked up three times, then collapsed. Carried home with opisthotonos, died after days. Symptoms varied greatly, sometimes with intervals. Cannot record all. Experience shows Chi is mildly soft; Jing is extremely stiff. Predecessors did not fully describe this. My detailed account may be disordered.