【纲】仲景曰。太阳病。发汗太多。因致痉。脉沉而细。身热足寒。头项强急。恶寒。时头热。
面赤。目脉赤。独头面摇。卒口噤。背反张者。痉病也。
【目】徐彬曰。痉病。概为风寒湿所中。然原其因。多由亡血。筋无所荣。邪得以袭之。故仲
景原痉病之由。而曰太阳病果寒多。本宜发汗。太多则血伤。不能荣筋而成痉也。古人以强直为痉。外症与伤寒相类。
但其脉沉迟弦细。而项背反张。强硬如发痫为异耳。仲景
既以无汗有汗。分辨刚柔。此则以脉沉细为辨。谓太阳病发热。是表中风矣。复加以湿。缠绵经中。
内挟寒气。今筋脉抽急而项背强直。脉反沉细。沉细者寒湿用事。邪欲侵阴之象也。于是项背强
直。故名痉。痉脉本伏。弦细则元气惫。即难治。中风症。多角弓反张类痉者。但中风强直。其先必无太阳形症。脉亦
必浮大而非沉细弦迟。故
内经曰。诸暴强直。皆属于风。但阳主动。阴主静。是当以强直而安静主湿。强直而搐搦主风。此
治中风辨法也。千金谓湿病热入肾中亦为痉。小儿痫症热盛亦为痉。亦中风类也。前人云。伤寒痉
症有五。皆属太阳。若头低视下。手足牵引。肘膝相搐。阳明痉也。若一目或左或右。并一手一足
搐搦者。少阳痉也。太阳固属风寒。阳明少阳亦风火热之内作。中风类也。皆当兼养阴清热为治。
若此所论痉。虽外感风寒湿不同。然由亡阳筋燥则一矣。如无汗反恶寒为刚痉。有汗不恶寒为柔痉。此辨症之法。非痉
家本症也。此乃举痉症之最备者。
以详病时之形状。且言治之不得过汗。而脉有常体也。身热。太阳表邪本盛。乃因血液衰少。寒邪复
挟湿抟结。卫中阳气不下。而寒湿随太阳经下项。稍侵阳明而颈项强急。真阳不达于表而恶寒。于
是太阳经无非寒热。而格热于上。为头热
面赤目赤独头动摇。太阳主开。寒湿抟之。开阖不利。不能发声。而卒口噤。液衰邪盛。筋失所养。
失养而背反张。此痉病本然之形症也。
【纲】仲景曰。太阳病。发热无汗。反恶寒者。名曰刚痉。太阳病。汗出不恶寒者。名曰柔痉。
【目】李 曰。太阳病。纯伤风。纯伤寒。则不发痉。惟先伤风而又感寒。先伤风而又感湿。
过汗俱能发痉。重发太阳汗。大发湿家汗。皆能发痉。外症寒热类伤寒。但脉沉迟弦细。摇头露眼
口噤。手足搐搦。项强背反张。如发痫。终日不醒为异。风性劲为刚痉。因重感寒或冷。故无汗。
宜葛根汤加羌独活、防风。湿性缓为柔痉。因先伤风。故有汗。宜桂枝汤加花粉、葛根。其或痰塞
气盛。则茯苓、星、夏以消痰。枳实、陈皮、紫苏以顺气。痰消气盛。然后分刚柔治之。通用小续
命汤。有热去附子。自汗去麻黄。刚痉二三日。仰面壮热。胸满如结胸状。便闭。脚蜷。卧不着席
者。大承气汤下之。轻者败毒散、小柴胡汤。柔痉二三日不瘥。汗多厥冷。筋脉拘急者。附子防风
汤。时发时止。危者附术散。又有刚柔不分之痉。身热谵语似刚。微厥便滑似柔。宜小续命汤加生
附子。有汗下后。乍静乍躁。偏左眼左手足牵搦者。少阳痉也。小柴胡加防风。又虚血之人。及产
后伤风过汗。破伤风症发痉。俱不可纯作风治。四物汤加防风。或八物汤去茯苓。加羌、防、黄
救之。凡痉脉如雨溅出指外者。立死。又戴眼反折。螈 。汗出如珠。或反张离席一掌许。小儿离
席二指许者。无不死。
徐彬曰。此二条即辨寒伤营风伤卫法也。取以为痉病刚柔之别。盖痉即 。强直之谓也。痉病
必有背项强直等的症。但治痉病。刚柔之辨。最为吃紧。故特首拈无汗反恶寒为刚。有汗不恶寒为
柔。以示辨症之要领。谓发热无汗恶寒。本伤寒家症。若痉而项强背直者见之。乃卫阳与肾中真阳。
气本相通。今太阳经寒湿相抟。而气侵少阴。真阳不达。故反恶寒也。寒性劲切。故曰刚。有汗
不恶寒。本伤风而并阳明症。若痉而项强背直者见之。是太阳阳明伤湿而
兼风。非寒邪内侵之比也。风性温和。故曰柔。非止项强。而身体则软。为柔痉也。栝蒌桂枝汤。
乃治柔痉主方也。
李中梓曰。此太阳中风。重感寒湿而致也。仰面开目为阳。合面闭目为阴。燥渴为阳。口中和
为阴。脉浮紧数为阳。沉细涩为阴。阳痉易治。阴痉难治。通用小续命汤。阳痉去附子。阴痉去麻
黄。
柯琴曰。此以表气虚实分刚柔。原其本而名之也。亦可以知其人初病之轻重。禀气之强弱而施
治矣。金匮用葛根汤。则谬。
【纲】仲景曰。疮家身虽疼。不可发汗。汗出则痉。
【目】徐彬曰。疮家血本虚燥。以疼痛为风而发其汗。则液亡筋燥而不能和调。乃亦为痉。虽
汗下后。或有邪乘。然总以阴虚液脱为主。故特详其致痉之因如此。
鳌按。疮家病。与风寒不同。风寒外症。必头项痛。身腰痛。骨节痛。非痛偏一处。风寒内症。
必呕逆。或干呕。不得饮食。故发热恶寒。虽亦相同。而辨其内外症。则可知彼此之异。不得误
认痈脓为风寒而错治矣。
此仲景借疮家以明治伤寒之法当发汗。非论伤寒而杂及疮家也。其旨当明。
【纲】仲景曰。太阳病。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。
【目】徐彬曰。刚痉之背项强直。而无汗发热。又反恶寒。原属寒湿居中。阴阳两伤之象。有
如发热而太阳病矣。无汗乃寒伤营本症也。此时邪尚在表。不在里。而小便反少。气上冲胸。明是
太阳随经之邪。自腑侵脏。动其冲气。且口噤不语。是太阳主开而反阖。声不得发。则阴阳两伤。
势必强直恶寒。所不待言。故曰欲作。药用桂枝全方加葛根、麻黄。风寒兼治也。然足阳明脉起于
鼻交 中。旁纳太阳之脉。故自太阳而侵及阳明。势将头项强不已。而渐胸满。特以葛根主之。以
杜兼并之势。为无汗刚痉主方。且桂枝原能治冲气也。
李中梓曰。阴痉厥逆筋脉拘急汗多。宜桂心白术散。闭目合眼。附子防风散。胸满口噤。卧不
着席。切牙挛急。大承气汤。头项强。小腹满。小便不利。五苓散。风盛血燥。防风当归汤。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），如果发汗过多，因而导致痉病（以项背强直、角弓反张为主要特征的病证）。脉象沉而细，身体发热但脚部发凉，头项僵硬拘急，怕冷，有时头部发热，面色发红，眼部血脉充血，只有头部摇动，突然牙关紧闭，背部向后反折呈弓形，这是痉病。
【目】徐彬说：痉病，概是由风寒湿邪侵袭所致。然而推究其病因，多由亡血（失血或阴血亏虚）引起，筋脉失去濡养，邪气得以乘袭。所以张仲景探究痉病的成因，指出如果是太阳病且寒邪较重，原本应当发汗，但如果发汗太多，就会损伤血液，不能濡养筋脉，从而形成痉病。古人将肢体强直称为痉，外在症状与伤寒相似，但其脉象沉迟弦细，且出现项背反张、强硬如同癫痫发作，这是不同之处。张仲景既然以无汗和有汗来分辨刚痉和柔痉，这里则以脉象沉细作为辨别依据，认为太阳病发热，是表中风邪了，再加上湿气，缠绵于经络之中，内挟寒气，如今筋脉抽缩紧急而项背强直，脉象反而沉细，沉细是寒湿主导、邪气欲侵入阴分的征象。于是出现项背强直，所以命名为痉。痉病的脉象本应伏匿，若见弦细则表示元气衰竭，即属难治之症。中风病症中，多有角弓反张类似痉病的，但中风引起的强直，起初必定没有太阳病的表象，脉象也必定浮大而非沉细弦迟。所以《内经》说：“各种暴发的强直，都归属于风。”但阳主动，阴主静，因此应当以强直而安静为主湿，强直而抽搐为主风，这是治疗中风时的辨别方法。《千金方》说湿病热入肾中也会成为痉病，小儿痫症热盛也会成为痉病，也都属于中风类。前人曾说，伤寒痉症有五种，都属于太阳经。如果头低垂视下，手足牵引，肘膝相互抽搐，是阳明痉。如果一只眼睛或左或右，并伴有一只手一只足抽搐的，是少阳痉。太阳经固然属于风寒，阳明、少阳也是风火热邪在内作祟，属于中风类。都应当兼用滋养阴液、清热的治疗方法。至于此处所论述的痉病，虽然外感风寒湿有所不同，但都由亡阳导致筋脉干燥这一根本原因相同。如无汗反而怕冷的是刚痉，有汗不怕冷的是柔痉，这是辨证的法则，并非痉病患者本来的症状表现。这是列举最完备的痉症，以详细描述发病时的形状，并且说明治疗时不可过度发汗，以及脉象有常规体例。身体发热，是太阳表邪本来旺盛，但因为血液衰少，寒邪又挟带湿气搏结凝聚，卫气中的阳气不能下行，而寒湿随着太阳经下行至项部，稍微侵犯阳明经而导致颈项强急，真阳不能通达于体表而怕冷，于是太阳经无非寒热之气，而格拒热气于上部，出现头部发热、面色红赤、眼目红赤、只有头部动摇；太阳主开，被寒湿搏结，开阖不利，不能发声，因而突然牙关紧闭；津液衰少邪气亢盛，筋脉失去滋养，因失养而导致背部反张，这是痉病本来的症状表现。
【纲】张仲景说：太阳病，发热无汗，反而怕冷的，名叫刚痉。太阳病，出汗而不怕冷的，名叫柔痉。
【目】李姓医家说：太阳病，纯伤风或纯伤寒，都不会引发痉病。只有先伤风而又感受寒邪，或先伤风而又感受湿邪，过度发汗都能引发痉病。重复发太阳经的汗，大发湿病患者的汗，都能引发痉病。外在症状寒热类似伤寒，但脉象沉迟弦细，摇头露眼，牙关紧闭，手足抽搐，项强背反张，如同癫痫发作，终日不醒，这是不同之处。风性劲急为刚痉，因为再次感受寒邪或冷邪，所以无汗，适宜用葛根汤加羌活、独活、防风。湿性缓滞为柔痉，因为先伤风，所以有汗，适宜用桂枝汤加天花粉、葛根。如果有痰浊阻塞、气机壅盛的情况，则用茯苓、天南星、半夏来消除痰浊，枳实、陈皮、紫苏来顺气。痰消气顺之后，再分别按刚痉和柔痉治疗。通用小续命汤。有热象去掉附子，自汗去掉麻黄。刚痉二三天，仰面壮热，胸部胀满如同结胸状，大便闭结，脚蜷曲，卧床时背部不着席者，用大承气汤攻下。轻症用败毒散、小柴胡汤。柔痉二三天不好转，汗多四肢厥冷，筋脉拘急的，用附子防风汤。时发时止，危重者用附术散。又有刚柔不分的痉病，身热谵语似刚痉，轻微厥冷大便滑泄似柔痉，宜用小续命汤加生附子。有经过发汗或攻下后，突然安静突然烦躁，左侧眼睛左手足牵拉抽搐的，是少阳痉，用小柴胡汤加防风。还有虚血之人，以及产后伤风过汗，破伤风症发痉，都不可单纯按中风治疗，用四物汤加防风，或八物汤去掉茯苓，加羌活、防风、黄芪救治。凡是痉病脉象如雨溅出指外的，立即死亡。又有戴眼（眼球固定向上）、反折、抽搐、汗出如珠，或者背部反张离席一掌许，小儿离席二指许的，无不死亡。
徐彬说：这两条即是辨别寒伤营分、风伤卫分的法则，取此作为痉病刚柔的区别。大概“痉”就是强直的意思。痉病必有项背强直等症状，但治疗痉病，刚柔的辨别最为关键，所以特别首先提出无汗反恶寒为刚，有汗不恶寒为柔，以示辨证的要领。认为发热无汗恶寒，本是伤寒家的症状，如果痉病出现项强背直，这是卫阳与肾中真阳气本相通，如今太阳经寒湿相搏，气侵少阴，真阳不能通达，所以反而怕冷。寒性劲切，所以叫刚。有汗不恶寒，本是伤风并兼阳明症状，如果痉病出现项强背直，这是太阳阳明伤湿而兼风，不是寒邪内侵的情况。风性温和，所以叫柔，不仅项强，而且身体柔软，为柔痉。栝蒌桂枝汤，是治疗柔痉的主方。
李中梓说：这是太阳中风，再次感受寒湿而导致的。仰面睁眼为阳，合面闭眼为阴，燥渴为阳，口中和润为阴，脉浮紧数为阳，沉细涩为阴。阳痉易治，阴痉难治。通用小续命汤。阳痉去附子，阴痉去麻黄。
柯琴说：这是以表气的虚实来区分刚柔，推究其本源而命名。也可以据此了解病人初病时的轻重、禀赋气质的强弱而施治。《金匮要略》用葛根汤，则是错误的。
【纲】张仲景说：患有疮疡的人，身体虽然疼痛，不可发汗，发汗就会导致痉病。
【目】徐彬说：疮家（长期患疮疡的人）血液本来虚燥，因为疼痛认为是风邪而发其汗，则津液亡失，筋脉干燥而不能调和，也会形成痉病。即使是汗下之后，或有邪气乘虚而入，但总以阴虚液脱为主，所以特别详细阐述导致痉病的原因如此。
沈金鳌按：疮家的病，与风寒不同。风寒的外症，必定头痛项痛，身腰痛，骨节痛，不是疼痛局限于一处。风寒的内症，必定呕吐逆气，或干呕，不能饮食，所以发热恶寒。虽然也有相同之处，但辨别其内外症状，就可以知道彼此的不同，不得误认痈脓为风寒而错误治疗。
这是张仲景借疮家来说明治伤寒的方法应当发汗，并非讨论伤寒而杂及疮家。其旨意应当明确。
【纲】张仲景说：太阳病，无汗，而小便反而少，气上冲胸，牙关紧闭不能说话，将要发作刚痉，用葛根汤主治。
【目】徐彬说：刚痉的背项强直，而无汗发热，又反恶寒，原本属于寒湿居中，阴阳两伤的征象。有如发热而表现为太阳病。无汗乃是寒伤营分的本症。此时邪气尚在表，不在里，而小便反而少，气上冲胸，明显是太阳随经之邪，从腑侵入脏，触动冲气，况且牙关紧闭不能说话，是太阳主开而反阖，声音不能发出，则阴阳两伤，势必强直恶寒，是不言而喻的。所以说“欲作”。药用桂枝全方加葛根、麻黄，风寒兼治。然而足阳明脉起于鼻交頞中，旁纳太阳之脉，所以从太阳而侵及阳明，势必将导致头项强直不止，而逐渐胸满，特别用葛根来主治，以杜绝兼并之势，这是无汗刚痉的主方，而且桂枝原本能治疗冲气。
李中梓说：阴痉厥逆筋脉拘急汗多，宜用桂心白术散。闭目合眼，用附子防风散。胸满口噤，卧床时背部不着席，切牙挛急，用大承气汤。头项强，小腹满，小便不利，用五苓散。风盛血燥，用防风当归汤。
[Outline] Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), if sweating is induced excessively, it may consequently lead to Jing disease (a syndrome characterized by stiffness and spasm of the neck and back, and opisthotonos). The pulse is deep and fine; the body is hot while the feet are cold; there is stiffness and tension in the head and neck; aversion to cold; sometimes heat in the head; redness of the face; congestion of the vessels in the eyes; only the head trembles; sudden locking of the jaw; and backward arching of the back like a bow. This is Jing disease.
[Commentary] Xu Bin said: Jing disease is generally caused by invasion of wind-cold-dampness. However, investigating its etiology, it mostly arises from loss of blood (hemorrhage or deficiency of yin-blood), causing the sinews to lose nourishment, allowing pathogens to invade. Thus, Zhang Zhongjing explored the origin of Jing disease, stating that if Taiyang disease involves heavy cold, sweating should originally be induced; but if sweating is excessive, it damages the blood, preventing it from nourishing the sinews, thereby forming Jing disease. The ancients referred to limb stiffness as Jing. The external symptoms resemble Shanghan (cold damage), but differ in that the pulse is deep, slow, wiry, and fine, and there is backward arching of the neck and back, with stiffness resembling epilepsy. Since Zhang Zhongjing distinguished Gang-Jing (rigid Jing) and Rou-Jing (soft Jing) based on the presence or absence of sweating, here the distinction is made based on a deep and fine pulse. It is stated that fever in Taiyang disease indicates wind attacking the exterior; when combined with dampness lingering in the meridians and internal cold, the sinews become spasmodic and stiff, leading to neck and back rigidity. The pulse being deep and fine indicates dominance of cold-dampness and the tendency of pathogens to invade the Yin. Hence, neck and back rigidity occurs, hence named Jing. The pulse of Jing disease is typically hidden; if wiry and fine, it indicates exhaustion of Yuan Qi (original qi), making it difficult to treat. In Wind-stroke syndromes, many cases present with opisthotonos resembling Jing, but Wind-stroke stiffness initially lacks Taiyang manifestations, and the pulse is floating and large rather than deep, fine, wiry, and slow. Therefore, the *Neijing* states: "All sudden stiffness belongs to Wind." Yang governs movement, Yin governs stillness; thus, stiffness with stillness is attributed to Dampness, while stiffness with convulsions is attributed to Wind. This is the method for distinguishing Wind-stroke. The *Qianjin Fang* states that dampness-heat entering the Kidney can also cause Jing, and high fever in pediatric epilepsy can also cause Jing, both belonging to the Wind-stroke category. Predecessors stated that there are five types of Shanghan Jing syndromes, all belonging to the Taiyang meridian. If the head hangs low looking down, limbs are pulled, and elbows/knees twitch, it is Yangming Jing. If one eye moves left or right, accompanied by twitching of one hand and foot, it is Shaoyang Jing. Taiyang certainly involves wind-cold, but Yangming and Shaoyang involve internal wind-fire-heat, belonging to Wind-stroke categories. Treatment should generally include nourishing Yin and clearing heat. Regarding the Jing discussed here, although external wind-cold-dampness differs, the root cause is the same: loss of Yang leading to dry sinews. Absence of sweat with aversion to cold is Gang-Jing; presence of sweat without aversion to cold is Rou-Jing. This is a method of differentiation, not the inherent symptom of Jing patients per se. This lists the most comprehensive Jing syndromes to detail their presentation during onset, and notes that treatment must not induce excessive sweating, and pulses have standard characteristics. Body heat indicates strong Taiyang exterior pathogens, but due to blood deficiency, cold pathogens combine with dampness. Wei Qi (defensive qi) yang cannot descend, while cold-dampness follows the Taiyang meridian down to the neck, slightly invading the Yangming meridian causing neck stiffness. True Yang fails to reach the exterior, causing aversion to cold. Thus, the Taiyang meridian lacks normal heat/cold regulation, trapping heat upward, causing head heat, facial redness, eye redness, and isolated head tremor. Taiyang governs opening; blocked by cold-dampness, opening and closing are impaired, preventing speech, leading to sudden jaw locking. Fluid deficiency and pathogen excess cause sinew malnourishment, resulting in back arching. These are the inherent symptoms of Jing disease.
[Outline] Zhang Zhongjing said: Taiyang disease with fever, no sweat, and aversion to cold is called Gang-Jing (Rigid Jing). Taiyang disease with sweating and no aversion to cold is called Rou-Jing (Soft Jing).
[Commentary] Li said: Taiyang disease caused purely by wind or purely by cold does not lead to Jing. Only when wind is injured first followed by cold, or wind followed by dampness, can excessive sweating induce Jing. Repeatedly inducing sweat in Taiyang disease, or heavily inducing sweat in dampness patients, can both induce Jing. External symptoms of chills and fever resemble Shanghan, but the pulse is deep, slow, wiry, and fine; there is head shaking, exposed eyes, jaw locking, limb convulsions, neck stiffness, and back arching resembling epilepsy, remaining unconscious all day—these are the differences. Wind nature is vigorous, constituting Gang-Jing; due to secondary cold exposure, there is no sweat, suitable for Gegen Tang (Kudzu Decoction) plus Qianghuo (Notopterygii Rhizoma), Duhuo (Angelicae Pubescentis Radix), and Fangfeng (Saposhnikoviae Radix). Damp nature is slack, constituting Rou-Jing; due to prior wind injury, there is sweat, suitable for Guizhi Tang (Cinnamon Twig Decoction) plus Huatfen (Trichosanthis Radix) and Gegen (Puerariae Lobatae Radix). If phlegm obstruction and qi stagnation exist, use Fuling (Poria), Nanxing (Arisaematis Rhizoma), and Banxia (Pinelliae Rhizoma) to resolve phlegm, Zhishi (Aurantii Fructus Immaturus), Chenpi (Citri Reticulatae Pericarpium), and Zisu (Perillae Folium) to regulate qi. After phlegm resolves and qi flows, treat according to Gang or Rou. Xiaoxuming Tang (Minor Continuation of Life Decoction) is commonly used. Remove Fuzi (Aconiti Lateralis Radix Praeparata) if heat is present; remove Mahuang (Ephedrae Herba) if spontaneous sweating occurs. For Gang-Jing after 2-3 days, with supine position, intense fever, chest fullness resembling Jie-Xiong (chest binding), constipation, curled legs, and inability to lie flat on the back, use Dachengqi Tang (Major Order the Qi Decoction) to purge. Mild cases use Baidu San (Poison-Resolving Powder) or Xiaochaihu Tang (Minor Bupleurum Decoction). For Rou-Jing persisting beyond 2-3 days with profuse sweating, cold extremities, and sinew spasm, use Fuzi Fangfeng Tang (Aconite and Saposhnikovia Decoction). For intermittent attacks in critical conditions, use Fuzhu San (Aconite and Atractylodes Powder). For indistinguishable Gang/Rou Jing, with fever and delirium resembling Gang, mild cold extremities and loose stools resembling Rou, use Xiaoxuming Tang plus Sheng Fuzi (Raw Aconite). After sweating or purging, if alternating calmness and agitation occur, with left-sided eye and limb spasms, it is Shaoyang Jing, treated with Xiaochaihu Tang plus Fangfeng. For blood-deficient individuals, postpartum wind injury with excessive sweating, or tetanus-induced Jing, do not treat solely as Wind-stroke. Use Siwu Tang (Four Substances Decoction) plus Fangfeng, or Babu Tang (Eight Substances Decoction) minus Fuling, plus Qianghuo, Fangfeng, and Huangqi (Astragali Radix) to rescue. If the Jing pulse splashes out from under the fingers like raindrops, death is immediate. If eyes are fixed upward, back arches, convulsions occur, sweat beads like pearls, or back arches leaving a palm's width from the bed, or two finger-widths for children, death is inevitable.
Xu Bin said: These two clauses distinguish the methods for cold injuring Ying (nutritive level) and wind injuring Wei (defensive level), using them to differentiate Gang and Rou in Jing disease. "Jing" implies stiffness. Jing disease necessarily presents with neck and back stiffness. Differentiating Gang and Rou is crucial for treatment. Thus, no sweat with aversion to cold is defined as Gang, and sweat without aversion to cold as Rou, to highlight the key diagnostic points. Fever, no sweat, and aversion to cold are typical Shanghan symptoms; if seen with neck stiffness and back straightening in Jing, it indicates that Wei Yang and Kidney True Yang are connected. Cold-dampness in Taiyang invades Shaoyin, blocking True Yang, causing aversion to cold. Cold is vigorous, hence "Gang." Sweat without aversion to cold is typical Wind-stroke combined with Yangming symptoms; if seen with neck stiffness and back straightening, it indicates Taiyang-Yangming dampness combined with wind, not internal cold invasion. Wind is gentle, hence "Rou," where the body is soft despite neck stiffness. Gualou Guizhi Tang (Trichosanthes and Cinnamon Twig Decoction) is the main formula for Rou-Jing.
Li Zhongzi said: This results from Taiyang Wind-strike compounded by cold-dampness. Supine with open eyes is Yang; prone with closed eyes is Yin. Dry thirst is Yang; moist mouth is Yin. Floating, tight, rapid pulse is Yang; deep, fine, choppy pulse is Yin. Yang Jing is easier to treat; Yin Jing is harder. Xiaoxuming Tang is general. Remove Fuzi for Yang Jing; remove Mahuang for Yin Jing.
Ke Qin said: This differentiates Gang and Rou based on the deficiency or excess of exterior Qi, naming them by their root causes. It allows assessment of initial disease severity and constitutional strength for treatment. Using Gegen Tang in *Jingui Yaolue* is erroneous.
[Outline] Zhang Zhongjing said: Patients with sores (chronic ulcers/abscesses) who experience body pain should not undergo sweating therapy; inducing sweat will lead to Jing disease.
[Commentary] Xu Bin said: Patients with chronic sores have inherently deficient and dry blood. Treating pain as wind and inducing sweat causes fluid loss and sinew dryness, preventing harmony, thus leading to Jing. Even after sweating or purging, if pathogens invade, the primary issue remains Yin deficiency and fluid depletion. Hence, the causes of Jing are detailed thus.
Shen Jin'ao commented: Sores differ from wind-cold. Wind-cold external symptoms include headache, neck pain, body/lower back pain, and joint pain, not localized pain. Internal symptoms include vomiting, dry heaving, and inability to eat, leading to fever and aversion to cold. Although similar, distinguishing internal/external symptoms reveals differences, preventing misdiagnosing abscesses as wind-cold.
Zhang Zhongjing uses the case of sore-patients to illustrate that Shanghan treatment requires sweating; this is not mixing Shanghan discussion with sore pathology. The intent must be clear.
[Outline] Zhang Zhongjing said: Taiyang disease with no sweat, reduced urination, qi rushing to the chest, jaw locking, and inability to speak indicates impending Gang-Jing. Gegen Tang (Kudzu Decoction) is indicated.
[Commentary] Xu Bin said: Gang-Jing features neck/back stiffness, no sweat, fever, and aversion to cold, indicating cold-dampness occupying the center and injury to both Yin and Yang. Fever resembles Taiyang disease. No sweat is the hallmark of cold injuring Ying. Pathogens remain in the exterior, yet reduced urination and qi rushing to the chest indicate pathogens following the meridian from Fu organs to Zang organs, disturbing Chong Qi. Jaw locking and silence indicate Taiyang failing to open, leading to Yin-Yang injury and inevitable stiffness/aversion to cold. Hence "impending." The prescription is Guizhi Tang (Cinnamon Twig Decoction) whole formula plus Gegen and Mahuang, treating both wind and cold. The Foot-Yangming meridian starts at the nose, intersects with Taiyang, so invasion from Taiyang to Yangming leads to persistent neck stiffness and chest fullness. Gegen is used to prevent this progression, serving as the main formula for no-sweat Gang-Jing. Guizhi also treats Chong Qi disturbances.
Li Zhongzi said: For Yin Jing with cold extremities, sinew spasm, and profuse sweat, use Guixin Baizhu San (Cinnamon Heart and Atractylodes Macrocephala Powder). For closed eyes, use Fuzi Fangfeng San (Aconite and Saposhnikovia Powder). For chest fullness, jaw locking, inability to lie flat, and teeth grinding/spasms, use Dachengqi Tang. For neck stiffness, lower abdominal fullness, and dysuria, use Wuling San (Five-Ingredient Powder with Poria). For wind excess and blood dryness, use Fangfeng Danggui Tang (Saposhnikovia and Angelica Sinensis Decoction).