项强症，有伤寒痉病之别。欲论伤寒项强，必以痉病项强，互相发明，始得详悉。如伤寒总
论项强曰∶太阳之为病，脉浮，头项强痛而恶寒。其分论项强曰∶太阳病，发热项强，汗出
脉缓者为中风，太阳病头痛项强，发热身疼，腰痛恶寒，无汗，脉浮紧，为伤寒。《金匮》痉
病，总论项强曰∶太阳病身体强KT KT 然，脉反沉迟，身虽热，手足冷，颈项强急，独摇头，
卒口噤，背反张，名痉病。其分论痉病曰∶太阳病，发热无汗，头项强，反恶寒，名曰刚
痉；太阳病，发热汗出，而不恶寒，名曰柔痉。详其经络，伤寒项强属三阳表症，痉病项
强，则有三阳三阴表里各条，此症之分别也。详其脉象，伤寒门则曰∶脉浮而紧，脉浮而
缓；痉病门则曰∶脉沉细，脉沉迟，此脉之分别也。详其治法，伤寒门仲景以太阳病，项背
强KT KT ，无汗恶寒脉浮紧，冬月麻黄加干葛汤，余三时陶氏推展防风羌活汤，今余改用羌活
加干根汤，以表药而治无汗之伤寒项强。若太阳病，项背强KT KT ，反汗出恶风，脉浮缓，冬
月桂枝加干葛汤；陶氏推展加减冲和汤。今余改用防风加葛根汤，以风药而治有汗之中风项
强。其在阳明，目痛鼻干，不眠，调脉干葛汤主之。其在少阳，身热恶风寒，头项强，胸胁
满，羌活防风柴胡汤主之。风温项强，防风石膏汤。风湿项强，苍防汤。湿温项强，神术
汤。以上言伤寒项强各条治法之分别也。至论痉病项强，《金匮》则曰∶病者身热足寒，颈项
强急，恶寒时头热，面赤目赤，独头动摇，卒口噤，背反张者，痉病也。若发其汗者，寒湿
相得，其表益虚，即恶寒甚，发其汗已，其脉如蛇。伤寒项强，身热足寒，又见恶寒者，用
麻黄汤主治。今痉病项强，目赤口噤，背反张，血液干竭，筋失所养，脉细之症，又不可误
用麻黄汤。故下文云∶太阳病，其症备，身体强KT KT 然。确似太阳伤寒症，若脉不浮紧急
大，即非伤寒而不可用麻黄。若脉反沉迟，此是痉病，当用栝蒌桂枝汤主之。下文又云∶太
阳病，若无汗而小便反少，气上冲胸，口噤不得语，欲作刚痉，葛根汤主之。夫太阳无汗之
项强，本是麻黄汤发汗症；以其气上冲胸，口噤不得语，又是阳明之症，故以葛根汤双解太
阳阳明两经之邪。若失用葛根清解阳明表邪，即用寒凉清里，则口噤不语之后，又变介齿。
是此可见痉病无汗，亦有可汗者，但因其脉沉迟，难用麻黄发汗耳。然痉病项强亦有当下
者，故下文又云∶痉为病，胸满口噤，卧不着席，脚挛急，必介齿，可以大承气汤。此言痉
病，若表邪尽解，惟存胸满口噤，卧不着席，脚挛急，介齿，一派里热内结，亦可与大承
气。按此则《金匮》一立栝蒌桂枝汤，和营卫，清痰涤热，而为解肌和解之方；一立葛根汤，
散阳明太阳在表之邪，而为无汗刚痉发表之方；一立承气汤，以清阳明表解里热，有汗柔痉
攻下之方。如是则汗、下、和解、三法全矣。此言痉病项强各条治法之分别也。余以痉病项
强，参以伤寒项强，则明项强症应从太阳表邪主治，而有发汗法门。今以伤寒项强，参以痉
病项强，则明项强症亦有阳明里邪主治，而有承气下行法门。考之杂症门，颈项强痛，不能
回顾，右脉数大，有用二陈汤加羌活、黄芩而治者。今余推展项强而兼胸满口噤、介齿不语
等症，亦有痰凝食滞，脉滑有力，可用二陈导痰汤、平胃保和散而治者。以口噤介齿，中焦
凝滞，寒凉抑遏者不少。再考《内经》分十二经俞穴，立刺法主治，则知各经皆有项强之症，
原非太阳阳明表邪里热二条可尽者。
太阳病，项背强KT KT ，反汗出恶风者，桂枝加葛根汤。
曰太阳，不曰阳明，然加葛根，兼阳明不待言矣。不曰风伤卫，然用桂枝葛根汤，则风伤
卫之症明矣。
太阳病，项背强KT KT ，无汗恶寒者，麻黄加葛根汤。
不曰寒伤营，然用麻黄葛根汤，其为寒伤营亦明矣。
服桂枝汤后，或下之，仍头项强痛，翕翕发热，无汗心下满，微痛，小便不利者，桂枝汤去
桂加茯苓白术汤。
头项强痛，翕翕发热，服桂枝汤，当汗出热减。今仍头项强痛，发热无汗，心下满痛，小
便不利，乃是水饮内结，故以此方治之。
伤寒四五日，身热恶风，头项强，胁下满，手足温而渴者，小柴胡汤。
伤寒四五日，少阳时也。身热项强，胁下满，少阳症也。手足温而渴，故以此方清少阳之表里。
结胸者，项亦强，如柔痉之状。下之则和，大陷胸丸。
言结胸者，项亦强，是结胸又兼项强等症。言如柔痉之状，则有汗出而无表邪，故用大陷胸丸。
太阳与少阳并病，头项强痛，或弦冒，时如结胸，心下痞硬者，当刺大椎第一间肺俞肝俞。
不可汗，汗则谵语。脉弦五六日，谵语不止，刺期门。
头项强痛，太阳症也。眩冒如结胸，心下痞硬，少阳支结症也，故曰太阳与少阳并病。刺
肺俞，则泄太阳之病；刺肝俞，则泄少阳之邪。
太阳少阳并病，心下硬，颈项强而眩者，当刺大椎肺俞。慎不可下之。
上条少阳症多，故刺肺俞、肝俞；此条太阳症多，故但刺肺俞，以泄太阳。上条少阳症
多，故禁汗；此条太阳症多，故禁下。
麻黄加葛根汤
葛根 麻黄 桂枝 甘草 芍药 生姜 大枣
此仲景治太阳症，项背强KT KT ，无汗之方。加葛根者，以颈项三阳交会，阳明亦所主者。
然辛温太过，三时热令，化立辛凉解表方法。
桂枝加葛根汤
桂枝 葛根 芍药 甘草 生姜 大枣
此仲景治太阳病，项背强KT KT ，有汗之方。按二方俱加葛根，则项背强，太阳与阳明症
矣。若热令南方，用羌、防易桂枝。
防风羌活汤
羌活 防风 荆芥 柴胡 干葛 甘草
陶氏以此方，代仲景太阳病项背强KT KT ，无汗恶寒之麻黄干葛汤者，冬令，加生姜；夏
令，加石膏、里有积热，加川连，胸前饱闷，加枳壳、浓朴。
羌活加葛根汤
羌活 葛根 防风 荆芥 柴胡 前胡 川芎 广皮 甘草
太阳项背强KT KT ，无汗恶寒，仲景用麻黄葛根汤，陶氏用防风羌活汤。今余以此汤治南方
热令积热之人，外冒表邪之症。
加减冲和汤
防风 羌活 黄芩 石膏 广皮 甘草
此方陶氏治太阳项背强KT KT ，汗出反恶风者。前条以无汗恶寒，故不加凉药。此条因有汗
项强，故用黄芩、石膏。然再加葛根，不失仲景本意。
防风加葛根汤
防风 干葛 甘草 黄芩 山栀 广皮
仲景有汗项强，以桂枝加葛根汤治之。今余以防风易去桂枝，加入葛根，更名防风葛根
汤。恶寒身痛者，加羌活、独活；时寒时热，加柴胡；头痛，加川芎；湿胜身重者，加苍
术、白芷；汗多者，加白芍药。
羌活防风柴胡汤
羌活 防风 柴胡 黄芩 甘草 广皮 半夏
此方即以柴胡汤加羌活、防风，治太阳、少阳两经表邪项强者也。然热令，宜加知母、石
膏；寒令，宜加生姜、苏叶。
防风石膏汤
防风 石膏 干葛 白芷
风温之症，多有项强，故以防风散风，石膏治温。然此治阳明者，症兼太阳，加羌活；兼少阳，加柴胡。
苍防汤
苍术 防风 白芷 川芎
项强症，风湿居多，故用燥湿散风。若兼热者，加石膏、黄芩；兼太阳表症，加羌活；少
阳寒热，加柴胡。
神术汤
苍术 石膏 防风 干葛
湿热见风，则发项强，故以苍术、防、葛散风胜湿。然此皆治阳明，若症兼太阳少阳，加
羌活、柴胡。
栝蒌桂枝汤
栝蒌根 桂枝 甘草 白芍药 生姜 大枣
痰结中脘，亦发项强之症。此即小建中汤加栝蒌根，助中州化痰涎。痰多呕逆，加半夏、
广皮；胸前凝滞，加砂仁。以中气虚，不能运化，必宜建中涤痰耳。
调脉葛根汤
葛根 前胡 防风 甘草
此治阳明表邪项强之症。若太阳见症，加羌活；少阳见症，加柴胡；里有积热，唇焦口
渴，加知母、石膏。
大承气汤 见大便结。
二陈导痰汤 即二陈汤导痰汤同煎。
项背强直之症，多以痰饮主治。盖中焦凝滞，则心胸头背颈项强直，以阳明主乎项。故此方涤痰化滞，清理阳明之
里。
平胃保和散 即平胃散保和丸同研。
中焦食滞，每多项背强直不得卧下之症，故用此方。
二陈羌芩汤 即二陈汤加羌活黄芩。
内有痰饮热结，外冒风热，以致项背强直，用此方。
项强症，有伤寒痉病之别。想要论述伤寒引起的项强，必须以痉病引起的项强作为参照，互相阐发，才能详尽细致。
如《伤寒论》总论项强时说：太阳病的主要特征是脉浮，头项强痛且恶寒。其分论项强时说：太阳病，发热、项强、汗出、脉缓的，属于中风；太阳病，头痛、项强、发热、身疼、腰痛、恶寒、无汗、脉浮紧的，属于伤寒。《金匮要略》中关于痉病的总论项强时说：太阳病身体强直僵劲（KT KT 然，形容僵硬不柔和的样子），脉象反而沉迟，身体虽然发热，但手足冷，颈项强急，独自摇头，突然牙关紧闭，角弓反张，这叫做痉病。其分论痉病时说：太阳病，发热无汗，头项强直，反而恶寒的，叫做刚痉；太阳病，发热汗出，且不恶寒的，叫做柔痉。详细分析经络，伤寒项强属于三阳表证，而痉病项强，则涉及三阳三阴表里各个条目，这是病症的区别。详细分析脉象，伤寒门中说：脉浮而紧，脉浮而缓；痉病门中说：脉沉细，脉沉迟，这是脉象的区别。详细分析治法，伤寒门中仲景针对太阳病，项背强直僵劲（KT KT 然），无汗恶寒脉浮紧的情况，冬季用麻黄加干葛汤，其余三个季节陶氏推广使用防风羌活汤，如今我改用羌活加干根汤，以解表药治疗无汗的伤寒项强。如果是太阳病，项背强直僵劲（KT KT 然），反而汗出恶风，脉浮缓，冬季用桂枝加干葛汤；陶氏推广使用加减冲和汤。如今我改用防风加葛根汤，以祛风药治疗有汗的中风项强。如果在阳明经，出现目痛鼻干、不眠，用调脉干葛汤主治。如果在少阳经，出现身热恶风寒、头项强直、胸胁满闷，用羌活防风柴胡汤主治。风温项强，用防风石膏汤。风湿项强，用苍防汤。湿温项强，用神术汤。以上说的是伤寒项强各条治法的区别。
至于论述痉病项强，《金匮要略》说：病人身体发热足部寒冷，颈项强直急迫，恶寒时头部发热，面色红赤眼睛红赤，只有头部动摇，突然牙关紧闭，角弓反张的，是痉病。如果误用发汗法，寒湿相合，体表更加虚弱，就会极度恶寒，发汗后，脉象像蛇行一样蜿蜒不利。伤寒项强，身体发热足部寒冷，又见恶寒的，用麻黄汤主治。如今痉病项强，目赤口噤，角弓反张，血液干竭，筋脉失去滋养，脉细弱的症状，又不可误用麻黄汤。所以下文说：太阳病，症状具备，身体强直僵劲（KT KT 然）。确实像太阳伤寒症，但如果脉象不浮紧急大，就不是伤寒，不可用麻黄汤。如果脉象反而沉迟，这是痉病，应当用栝蒌桂枝汤主治。下文又说：太阳病，如果没有汗而小便反而少，气上冲胸部，牙关紧闭不能说话，将要发作刚痉，用葛根汤主治。太阳无汗的项强，本是麻黄汤发汗的适应症；但因为气上冲胸，牙关紧闭不能说话，又是阳明的症状，所以用葛根汤双解太阳和阳明两经的邪气。如果失于使用葛根清解阳明表邪，就使用寒凉药清里热，那么在口噤不语之后，又会变成咬紧牙齿磨牙（介齿）。由此可见，痉病无汗，也有可以发汗的情况，只是因为脉象沉迟，难以使用麻黄发汗罢了。然而痉病项强也有应当攻下的情况，所以下文又说：痉病，胸满口噤，睡觉时背部不着席（角弓反张严重），脚挛急，必定咬紧牙齿磨牙，可以用大承气汤。这说明痉病，如果表邪完全解除，只残留胸满口噤，睡觉时背部不着席，脚挛急，咬紧牙齿磨牙，一派里热内结的症状，也可以给予大承气汤。按照这个意思，《金匮要略》设立栝蒌桂枝汤，调和营卫，清痰涤热，作为解肌和解的方剂；设立葛根汤，发散阳明太阳在表的邪气，作为无汗刚痉发表的方剂；设立承气汤，清解阳明表解后的里热，作为有汗柔痉攻下的方剂。这样汗、下、和解三种方法就齐全了。这是说痉病项强各条治法的区别。
我将痉病项强与伤寒项强参合比较，就明白项强症应从太阳表邪主治，而有发汗的方法。如今将伤寒项强与痉病项强参合比较，就明白项强症也有从阳明里邪主治的，而有承气汤下行的方法。考证杂病门，颈项强痛，不能回顾，右脉数大，有用二陈汤加羌活、黄芩治疗的。如今我推展项强兼见胸满口噤、咬紧牙齿磨牙不语等症状，也有因痰凝食滞，脉滑有力，可用二陈导痰汤、平胃保和散治疗的。因为口噤咬齿，多因中焦凝滞，被寒凉药抑制遏阻的情况不少。再考证《内经》划分十二经俞穴，确立刺法主治，就知道各经都有项强的症状，原本不是仅靠太阳阳明表邪里热两条就能概括完全的。
太阳病，项背强直僵劲（KT KT 然），反而汗出恶风的，用桂枝加葛根汤。
说是太阳病，不说阳明病，但是加了葛根，兼治阳明是不言而喻的。不说风伤卫，但是用桂枝葛根汤，那么风伤卫的症状就明确了。
太阳病，项背强直僵劲（KT KT 然），无汗恶寒的，用麻黄加葛根汤。
不说寒伤营，但是用麻黄葛根汤，其为寒伤营也是明确的。
服用桂枝汤后，或者经过攻下，仍然头项强痛，翕翕发热（形容发热轻微），无汗心下满，微痛，小便不利的，用桂枝汤去桂加茯苓白术汤。
头项强痛，翕翕发热，服用桂枝汤，应当汗出热减。现在仍然头项强痛，发热无汗，心下满痛，小便不利，这是水饮内结，所以用这个方子治疗。
伤寒四五日，身热恶风，头项强，胁下满，手足温而渴的，用小柴胡汤。
伤寒四五日，是少阳主令的时候。身热项强，胁下满，是少阳症。手足温而渴，所以用这个方子清解少阳的表里。
结胸症，项也强直，像柔痉的状态。攻下后就会平和，用大陷胸丸。
说结胸症，项也强直，是结胸又兼项强等症状。说像柔痉的状态，则有汗出而无表邪，所以用大陷胸丸。
太阳与少阳并病，头项强痛，有时头晕目眩如结胸状，心下痞硬的，应当针刺大椎第一间、肺俞、肝俞。
不可发汗，发汗则会谵语。脉弦五六日，谵语不止，针刺期门。
头项强痛，是太阳症。眩晕如结胸，心下痞硬，是少阳支结症，所以说太阳与少阳并病。针刺肺俞，则泄太阳的病；针刺肝俞，则泄少阳的邪。
太阳少阳并病，心下硬，颈项强而眩晕的，应当针刺大椎、肺俞。千万不要攻下。
上一条少阳症多，所以刺肺俞、肝俞；这一条太阳症多，所以只刺肺俞，以泄太阳。上一条少阳症多，所以禁汗；这一条太阳症多，所以禁下。
麻黄加葛根汤
葛根 麻黄 桂枝 甘草 芍药 生姜 大枣
这是仲景治疗太阳症，项背强直僵劲（KT KT 然），无汗的方子。加葛根，是因为颈项是三阳经交会之处，阳明经也主管这里。
但是辛温太过，在春夏秋三季热令之时，确立了辛凉解表的方法。
桂枝加葛根汤
桂枝 葛根 芍药 甘草 生姜 大枣
这是仲景治疗太阳病，项背强直僵劲（KT KT 然），有汗的方子。按这两个方子都加了葛根，那么项背强直，就是太阳与阳明的症候了。如果在南方热令时节，用羌活、防风代替桂枝。
防风羌活汤
羌活 防风 荆芥 柴胡 干葛 甘草
陶氏用这个方子，代替仲景治疗太阳病项背强直僵劲（KT KT 然），无汗恶寒的麻黄干葛汤。冬季，加生姜；夏季，加石膏；里有积热，加川连；胸前饱闷，加枳壳、浓朴。
羌活加葛根汤
羌活 葛根 防风 荆芥 柴胡 前胡 川芎 广皮 甘草
太阳项背强直僵劲（KT KT 然），无汗恶寒，仲景用麻黄葛根汤，陶氏用防风羌活汤。如今我用这个汤治疗南方热令时节体内有积热的人，外感表邪的症状。
加减冲和汤
防风 羌活 黄芩 石膏 广皮 甘草
这个方子是陶氏治疗太阳项背强直僵劲（KT KT 然），汗出反恶风的。前一条因为无汗恶寒，所以不加凉药。这一条因为有汗项强，所以用黄芩、石膏。然而再加葛根，不失仲景的本意。
防风加葛根汤
防风 干葛 甘草 黄芩 山栀 广皮
仲景对有汗项强，用桂枝加葛根汤治疗。如今我用防风替换掉桂枝，加入葛根，更名为防风葛根汤。恶寒身痛的，加羌活、独活；时寒时热的，加柴胡；头痛的，加川芎；湿胜身重的，加苍术、白芷；汗多的，加白芍药。
羌活防风柴胡汤
羌活 防风 柴胡 黄芩 甘草 广皮 半夏
这个方子就是以柴胡汤加羌活、防风，治疗太阳、少阳两经表邪项强的。但是在热令时节，宜加知母、石膏；在寒令时节，宜加生姜、苏叶。
防风石膏汤
防风 石膏 干葛 白芷
风温症，多有项强，所以以防风散风，石膏治温。但是这个方子主要治阳明，如果症兼太阳，加羌活；兼少阳，加柴胡。
苍防汤
苍术 防风 白芷 川芎
项强症，风湿居多，所以用燥湿散风。如果兼热的，加石膏、黄芩；兼太阳表症，加羌活；少阳寒热，加柴胡。
神术汤
苍术 石膏 防风 干葛
湿热见风，则发项强，所以以苍术、防风、葛根散风胜湿。但是这都是治阳明，如果症兼太阳少阳，加羌活、柴胡。
栝蒌桂枝汤
栝蒌根 桂枝 甘草 白芍药 生姜 大枣
痰结在中脘，也会发项强的症状。这就是小建中汤加栝蒌根，助中州化痰涎。痰多呕逆的，加半夏、广皮；胸前凝滞的，加砂仁。因为中气虚，不能运化，必须宜建中涤痰。
调脉葛根汤
葛根 前胡 防风 甘草
这是治疗阳明表邪项强的症状。如果有太阳见症，加羌活；少阳见症，加柴胡；里有积热，唇焦口渴，加知母、石膏。
大承气汤 见大便结。
二陈导痰汤 即二陈汤导痰汤同煎。
项背强直的症，多以痰饮主治。因为中焦凝滞，则心胸头背颈项强直，因为阳明主乎项。所以这个方子涤痰化滞，清理阳明的里。
Neck stiffness (Xiang Qiang) presents with distinctions between Shanghan (Cold Damage) and Jingbing (Spasm Disease). To discuss neck stiffness caused by Shanghan, one must reference neck stiffness caused by Jingbing to mutually elucidate the details.
As stated in the general discussion of Shanghan regarding neck stiffness: The primary characteristics of Taiyang disease are a floating pulse, headache and neck stiffness, and aversion to cold. In its specific discussion: If Taiyang disease presents with fever, neck stiffness, sweating, and a slow pulse, it is Wind Strike (Zhong Feng); if Taiyang disease presents with headache, neck stiffness, fever, body pain, lower back pain, aversion to cold, no sweating, and a floating-tight pulse, it is Cold Damage (Shang Han). Regarding Jingbing in the *Jin Gui Yao Lue*, the general discussion states: Taiyang disease with a stiff and rigid body (KT KT ran), a pulse that is surprisingly deep and slow, fever in the body but coldness in the hands and feet, acute neck stiffness, isolated head shaking, sudden lockjaw (Kou Jin), and opisthotonos (Bei Fan Zhang) is named Jingbing. Its specific discussion states: Taiyang disease with fever, no sweating, head and neck stiffness, and paradoxical aversion to cold is named Gang Jing (Stiff Spasm); Taiyang disease with fever, sweating, and absence of aversion to cold is named Rou Jing (Soft Spasm). Analyzing the meridians, neck stiffness in Shanghan belongs to the exterior syndromes of the Three Yang meridians, whereas neck stiffness in Jingbing involves various entries across the interior and exterior of the Three Yang and Three Yin meridians; this constitutes the distinction of the syndrome. Analyzing the pulse qualities, the Shanghan section mentions: floating-tight pulse, floating-slow pulse; the Jingbing section mentions: deep-thin pulse, deep-slow pulse; this constitutes the distinction of the pulse. Analyzing the treatment methods, in the Shanghan section, Zhang Zhongjing addresses Taiyang disease with stiff and rigid neck and back (KT KT ran), no sweating, aversion to cold, and floating-tight pulse by using Mahuang Jia Gange Tang (Ephedra Decoction plus Pueraria) in winter, while Tao Shi extended this to use Fangfeng Qianghuo Tang (Saposhnikovia and Notopterygium Decoction) for the other three seasons. Currently, I replace it with Qianghuo Jia Gan Gen Tang (Notopterygium plus Pueraria Decoction) to treat neck stiffness from Shanghan without sweating using exterior-releasing herbs. If Taiyang disease presents with stiff and rigid neck and back (KT KT ran), paradoxical sweating and aversion to wind, and a floating-slow pulse, Guizhi Jia Gange Tang (Cinnamon Twig Decoction plus Pueraria) is used in winter; Tao Shi extended this to Ji Jian Chonghe Tang (Modified Harmonizing Decoction). Currently, I replace it with Fangfeng Jia Gegen Tang (Saposhnikovia plus Pueraria Decoction) to treat neck stiffness from Wind Strike with sweating using wind-dispelling herbs. In the Yangming stage, with eye pain, nasal dryness, and insomnia, Tiaomai Gange Tang (Regulating Pulse Pueraria Decoction) is the primary treatment. In the Shaoyang stage, with body heat, aversion to wind and cold, head and neck stiffness, and chest and hypochondriac fullness, Qianghuo Fangfeng Chaihu Tang (Notopterygium, Saposhnikovia, and Bupleurum Decoction) is the primary treatment. For neck stiffness due to Wind-Warmth, Fangfeng Shigao Tang (Saposhnikovia and Gypsum Decoction) is used. For neck stiffness due to Wind-Dampness, Cangfang Tang (Atractylodes and Saposhnikovia Decoction) is used. For neck stiffness due to Damp-Warmth, Shenzhu Tang (Divine Atractylodes Decoction) is used. The above outlines the distinctions in treatment methods for various types of neck stiffness in Shanghan.
Regarding the discussion of neck stiffness in Jingbing, the *Jin Gui Yao Lue* states: When a patient has body heat, cold feet, acute neck stiffness, aversion to cold with simultaneous head heat, red face and eyes, isolated head movement, sudden lockjaw, and opisthotonos, it is Jingbing. If sweat-inducing methods are mistakenly applied, cold and dampness combine, further weakening the exterior, leading to severe aversion to cold; after sweating, the pulse becomes wiry and winding like a snake. For neck stiffness in Shanghan with body heat, cold feet, and aversion to cold, Mahuang Tang (Ephedra Decoction) is the primary treatment. However, for current cases of Jingbing neck stiffness with red eyes, lockjaw, and opisthotonos, where blood fluids are exhausted and tendons lose nourishment, presenting with a thin pulse, Mahuang Tang must not be mistakenly used. Therefore, the text later states: Taiyang disease with complete symptoms and a stiff, rigid body (KT KT ran) closely resembles Taiyang Shanghan; however, if the pulse is not floating, urgent, and large, it is not Shanghan, and Mahuang should not be used. If the pulse is surprisingly deep and slow, it is Jingbing, and Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) should be used. The text further states: In Taiyang disease, if there is no sweating but urination is surprisingly scanty, qi rushes upward to the chest, and there is lockjaw preventing speech, indicating impending Gang Jing, Gegen Tang (Pueraria Decoction) is the primary treatment. Neck stiffness in Taiyang without sweating is originally an indication for sweating via Mahuang Tang; however, because qi rushes to the chest and lockjaw prevents speech, it also involves Yangming symptoms. Thus, Gegen Tang is used to simultaneously release pathogens from both the Taiyang and Yangming meridians. If Gegen is neglected to clear Yangming exterior pathogens, and cold-cooling herbs are used to clear the interior instead, lockjaw and muteness may progress to grinding teeth (Jie Chi). This shows that Jingbing without sweating can sometimes be treated with sweating, but due to the deep-slow pulse, Mahuang cannot be easily used for sweating. Nevertheless, neck stiffness in Jingbing can also have indications for purging. The text later states: For Jingbing with chest fullness, lockjaw, inability to lie flat (opisthotonos), leg cramps, and grinding teeth, Da Chengqi Tang (Major Order of the Qi Decoction) can be used. This indicates that in Jingbing, if exterior pathogens are fully resolved and only chest fullness, lockjaw, inability to lie flat, leg cramps, and grinding teeth remain—a pattern of interior heat accumulation—Da Chengqi Tang can be administered. According to this, the *Jin Gui Yao Lue* establishes Gualou Guizhi Tang to harmonize Ying and Wei, clear phlegm, and purge heat, serving as a muscle-relaxing and harmonizing formula; it establishes Gegen Tang to scatter exterior pathogens in Taiyang and Yangming, serving as an exterior-releasing formula for non-sweating Gang Jing; and it establishes Chengqi Tang to clear interior heat after the resolution of exterior pathogens in Yangming, serving as a purgative formula for sweating Rou Jing. In this way, the methods of sweating, purging, and harmonizing are all complete. This outlines the distinctions in treatment methods for various types of neck stiffness in Jingbing.
By comparing Jingbing neck stiffness with Shanghan neck stiffness, it becomes clear that neck stiffness should primarily be treated from the perspective of Taiyang exterior pathogens, utilizing the method of inducing sweating. Conversely, by comparing Shanghan neck stiffness with Jingbing neck stiffness, it becomes clear that neck stiffness can also be treated from the perspective of Yangming interior pathogens, utilizing the descending method of Chengqi Tang. Examining the miscellaneous diseases section, neck stiffness and pain with inability to look back, accompanied by a rapid and large right pulse, has been treated with Erchen Tang (Two-Cured Decoction) plus Qianghuo and Huangqin. Currently, I extend this to cases of neck stiffness accompanied by chest fullness, lockjaw, grinding teeth, and muteness, which may also be caused by phlegm stagnation and food retention, with a slippery and forceful pulse, treatable with Erchen Daotan Tang (Two-Cured Phlegm-Draining Decoction) or Pingwei Baohe San (Peace the Stomach and Preserve Harmony Powder). Lockjaw and grinding teeth often result from middle-jiao stagnation suppressed by cold-cooling herbs. Further examining the *Nei Jing*, which divides acupoints among the twelve meridians and establishes needling methods for treatment, it is known that neck stiffness can occur in all meridians and is not limited solely to Taiyang-Yangming exterior pathogens and interior heat.
Taiyang disease with stiff and rigid neck and back (KT KT ran), paradoxical sweating, and aversion to wind is treated with Guizhi Jia Gegen Tang (Cinnamon Twig plus Pueraria Decoction).
It is called Taiyang, not Yangming, yet adding Gegen implies involvement of Yangming without saying so. It does not explicitly say "wind injures Wei," yet using Guizhi Gegen Tang clarifies the syndrome of wind injuring Wei.
Taiyang disease with stiff and rigid neck and back (KT KT ran), no sweating, and aversion to cold is treated with Mahuang Jia Gegen Tang (Ephedra plus Pueraria Decoction).
It does not explicitly say "cold injures Ying," yet using Mahuang Gegen Tang clarifies that it is cold injuring Ying.
After taking Guizhi Tang, or after purgation, if headache and neck stiffness persist, with mild fever (Xi Xi Fa Re), no sweating, epigastric fullness, slight pain, and difficulty urinating, Guizhi Tang minus Guizhi plus Fuling and Baizhu Tang is used.
Headache and neck stiffness, mild fever: taking Guizhi Tang should induce sweating and reduce fever. Now, with persistent headache and neck stiffness, fever, no sweating, epigastric fullness and pain, and difficulty urinating, this indicates internal water-fluid retention, hence this formula is used.
In Shanghan on the fourth or fifth day, with body heat, aversion to wind, head and neck stiffness, hypochondriac fullness, warm hands and feet, and thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) is used.
Shanghan on the fourth or fifth day corresponds to the Shaoyang period. Body heat, neck stiffness, and hypochondriac fullness are Shaoyang symptoms. Warm hands and feet with thirst indicate the need to clear the Shaoyang interior and exterior, hence this formula is used.
Jie Xiong (Chest Binding) syndrome also presents with neck stiffness, resembling Rou Jing. After purgation, harmony is achieved, using Da Xianxiong Wan (Major Draining the Chest Pill).
This states that in Jie Xiong, neck stiffness also occurs, meaning Jie Xiong is complicated by neck stiffness. Resembling Rou Jing implies sweating exists without exterior pathogens, hence Da Xianxiong Wan is used.
When Taiyang and Shaoyang diseases occur together, with headache and neck stiffness, occasional dizziness resembling Jie Xiong, and epigastric hardness, needling the first space of Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated.
Sweating is contraindicated; sweating leads to delirium. If the pulse is wiry for five to six days and delirium persists, needling Qimen (LR14) is indicated.
Headache and neck stiffness are Taiyang symptoms. Dizziness resembling Jie Xiong and epigastric hardness are Shaoyang branch-binding symptoms, hence Taiyang and Shaoyang concurrent disease. Needling Feishu drains Taiyang pathology; needling Ganshu drains Shaoyang pathogens.
When Taiyang and Shaoyang diseases occur together, with epigastric hardness, neck stiffness, and dizziness, needling Dazhui (GV14) and Feishu (BL13) is indicated. Purging is strictly contraindicated.
In the previous entry, Shaoyang symptoms were predominant, hence Feishu and Ganshu were needled; here, Taiyang symptoms are predominant, hence only Feishu is needled to drain Taiyang. In the previous entry, Shaoyang symptoms were predominant, hence sweating was forbidden; here, Taiyang symptoms are predominant, hence purging is forbidden.
Mahuang Jia Gegen Tang (Ephedra plus Pueraria Decoction)
Gegen (Puerariae Radix), Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma), Shaoyao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Ziziphi Jujubae Fructus).
This is Zhongjing's formula for Taiyang syndrome with stiff and rigid neck and back (KT KT ran) and no sweating. Gegen is added because the neck is the intersection of the Three Yang meridians, and Yangming also governs this area.
However, since the acrid-warm nature is excessive, in the hot seasons of spring, summer, and autumn, a method of acrid-cool exterior release was established.
Guizhi Jia Gegen Tang (Cinnamon Twig plus Pueraria Decoction)
Guizhi (Cinnamomi Ramulus), Gegen (Puerariae Radix), Shaoyao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Ziziphi Jujubae Fructus).
This is Zhongjing's formula for Taiyang disease with stiff and rigid neck and back (KT KT ran) and sweating. Since both formulas add Gegen, neck stiffness indicates involvement of both Taiyang and Yangming. In the southern hot season, Qianghuo and Fangfeng can replace Guizhi.
Fangfeng Qianghuo Tang (Saposhnikovia and Notopterygium Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Chaihu (Bupleuri Radix), Gan Ge (Puerariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
Tao Shi uses this formula to replace Zhongjing's Mahuang Gan Ge Tang for Taiyang disease with stiff and rigid neck and back (KT KT ran), no sweating, and aversion to cold. In winter, add Shengjiang; in summer, add Shigao; if there is internal accumulated heat, add Chuanlian; if there is chest fullness and oppression, add Zhike and Houpo.
Qianghuo Jia Gegen Tang (Notopterygium plus Pueraria Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Gegen (Puerariae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Chuanxiong (Chuanxiong Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
For Taiyang stiff and rigid neck and back (KT KT ran), no sweating, and aversion to cold, Zhongjing used Mahuang Gegen Tang, and Tao Shi used Fangfeng Qianghuo Tang. Currently, I use this decoction to treat individuals in the southern hot season with internal accumulated heat who have contracted exterior pathogens.
Jia Jian Chonghe Tang (Modified Harmonizing Decoction)
Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), Shigao (Gypsi Fibrum), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
This formula is used by Tao Shi for Taiyang stiff and rigid neck and back (KT KT ran), sweating, and paradoxical aversion to wind. The previous entry had no sweating and aversion to cold, so cooling herbs were not added. This entry has sweating and neck stiffness, so Huangqin and Shigao are used. However, adding Gegen again preserves Zhongjing's original intent.
Fangfeng Jia Gegen Tang (Saposhnikovia plus Pueraria Decoction)
Fangfeng (Saposhnikoviae Radix), Gan Ge (Puerariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Guangpi (Citri Reticulatae Pericarpium).
Zhongjing treated sweating neck stiffness with Guizhi Jia Gegen Tang. Currently, I replace Guizhi with Fangfeng, add Gegen, and rename it Fangfeng Gegen Tang. For aversion to cold and body pain, add Qianghuo and Duhuo; for alternating chills and fever, add Chaihu; for headache, add Chuanxiong; for heavy body due to dampness, add Cangzhu and Baizhi; for excessive sweating, add Shaoyao.
Qianghuo Fangfeng Chaihu Tang (Notopterygium, Saposhnikovia, and Bupleurum Decoction)
Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma Preparatum).
This formula is essentially Chaihu Tang plus Qianghuo and Fangfeng, treating neck stiffness caused by exterior pathogens in both Taiyang and Shaoyang meridians. In the hot season, add Zhimu and Shigao; in the cold season, add Shengjiang and Ziye.
Fangfeng Shigao Tang (Saposhnikovia and Gypsum Decoction)
Fangfeng (Saposhnikoviae Radix), Shigao (Gypsi Fibrum), Gan Ge (Puerariae Radix), Baizhi (Angelicae Dahuricae Radix).
Wind-Warmth syndromes often present with neck stiffness, so Fangfeng disperses wind and Shigao treats warmth. This primarily treats Yangming; if complicated by Taiyang, add Qianghuo; if complicated by Shaoyang, add Chaihu.
Cangfang Tang (Atractylodes and Saposhnikovia Decoction)
Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Chuanxiong (Chuanxiong Rhizoma).
Neck stiffness is mostly due to Wind-Dampness, so drying dampness and dispersing wind is used. If complicated by heat, add Shigao and Huangqin; if complicated by Taiyang exterior syndrome, add Qianghuo; for Shaoyang alternating chills and fever, add Chaihu.
Shenzhu Tang (Divine Atractylodes Decoction)
Cangzhu (Atractylodis Rhizoma), Shigao (Gypsi Fibrum), Fangfeng (Saposhnikoviae Radix), Gan Ge (Puerariae Radix).
Damp-heat exposed to wind causes neck stiffness, so Cangzhu, Fangfeng, and Gegen are used to disperse wind and overcome dampness. These primarily treat Yangming; if complicated by Taiyang and Shaoyang, add Qianghuo and Chaihu.
Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction)
Gualougen (Trichosanthis Radix), Guizhi (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Ziziphi Jujubae Fructus).
Phlegm binding in the Middle Jiao can also cause neck stiffness. This is Xiao Jianzhong Tang plus Gualougen, assisting the Middle Jiao to transform phlegm. For excessive phlegm and vomiting, add Banxia and Guangpi; for chest oppression, add Sharen. Due to deficiency of Middle Qi failing to transport and transform, building the Middle and draining phlegm is necessary.
Tiaomai Gegen Tang (Regulating Pulse Pueraria Decoction)
Gegen (Puerariae Radix), Qianhu (Peucedani Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
This treats neck stiffness due to Yangming exterior pathogens. If Taiyang symptoms appear, add Qianghuo; if Shaoyang symptoms appear, add Chaihu; if there is internal accumulated heat with dry lips and thirst, add Zhimu and Shigao.
Da Chengqi Tang (Major Order of the Qi Decoction) See constipation.
Erchen Daotan Tang (Two-Cured Phlegm-Draining Decoction) Same as boiling Erchen Tang with Daotan Tang ingredients.
Neck and back rigidity is often treated by addressing phlegm-fluids. Stagnation in the Middle Jiao causes rigidity in the heart, chest, head, back, and neck, as Yangming governs the neck. Thus, this formula drains phlegm, transforms stagnation, and clears the interior of Yangming.
Pingwei Baohe San (Peace the Stomach and Preserve Harmony Powder) Same as mixing Pingwei San and Baohe Wan powders.
Food stagnation in the Middle Jiao often presents with neck and back rigidity preventing lying down, hence this formula is used.
Erchen Qiangqin Tang (Two-Cured plus Notopterygium and Scutellaria Decoction) Same as Erchen Tang plus Qianghuo and Huangqin.
Internal phlegm-fluid and heat binding, combined with external exposure to wind-heat, causing neck and back rigidity, is treated with this formula.