六气为病，皆能发热。然寒与热相因，暑与湿相从，独燥与湿相
反。风寒温暑皆因天气，而湿病多得之地气，燥病多得之内因，此病因之殊同也。《内经》病机十九条，其分属
六气者，火居其八，风寒湿各居其一，燥症独无。若诸痉项强，皆属于湿，愚尝疑其属燥。今本论有痉、湿之分，
又曰∶“太阳病发汗太多，因致痉，”则痉之属燥无疑也。夫痉以状命名，因血虚而筋急耳。六气为患，皆足以
致痉，然不热则不燥，不燥则不成痉矣。六经皆有痉病，须审部位以别之。身以后者属太阳，则凡头项强急，项
背KT KT ，脊强反张，腰似折，髀不可以曲， 如结，皆其症也。身之前者属阳明，头面动摇，口噤齿 ，缺盆纽
痛，脚挛急，皆其症也。身之侧者属少阳，口眼 斜，手足牵引，两胁拘急，半身不遂，皆其症也。若腹内拘急，
因吐利而四肢拘急，是太阴痉。恶寒蜷卧，尻以代踵，脊以代头，俯而不能仰者，是少阴痉。睾丸上升，宗筋下
注，少腹里急，阴中拘挛，膝胫拘急者，厥阴痉也。若痉之挟风寒者，其症发热无汗而恶寒，气上冲胸而小便少，
其脉必坚紧，其状必强直而口噤，此得之天气，《内经》所云“诸暴强直，皆属于风”者是也。其势勇猛，故曰
刚痉。病因外来，当逐邪而解外。痉有挟本邪而为患者，其邪从内出，故发热汗出而不恶寒，其脉沉迟，其状则
项背强KT KT ，此得之地气，《内经》云“诸痉项强，皆属于湿”者是也。其势弱 ，故名柔痉。病因于内，当滋
阴以和内。要知属风之痉，不因风而因热；属湿之痉，不因湿而因燥。治风君葛根，治湿君栝蒌根者，非以治风，
实以生津，非以治湿，实以润燥耳。夫痉之始也，本非正病，必夹杂于他病之中。人之病此者，世医悉指为风，
所以不明其理。善医者，必于他症中审察而预防之。如头项强痛，即痉之一端，是太阳之血虚，故筋急也。今人
但知风寒，不惜津液，所以发汗太多，因致痉者多矣。夫痉之征，本有由来，一经妄治，即奇形毕现。项背强KT
KT，是痉之征兆，故用葛根；身体强，是痉状已着，故用栝蒌根；卧不着席，脚挛急，口噤齿 ，是痉之极甚，
故用大黄、芒硝。无非取多津多液之品，以滋养阴血，不得与当汗不汗者同例也。观伤寒脉浮，自汗心烦恶寒，
而见脚挛急，是痉势已成，盒饭滋阴存液，不得仍作伤寒主治。故与桂枝汤则厥，与芍药甘草汤，其脚即伸，此
明验矣。第以表症未除，不得用承气，若谵语者，少与调胃承气，是又与不着席者与大承气汤，同一机彀也。凡
痉之为病，因外邪伤筋者少，因血虚筋急者多。如误作风治，用辛散以助阳，则真阴愈虚，用燥剂以驱风，
则血液愈涸。故痉得之暴起者少，妄治而致者多。虚而不补，不死何待？非参、 、归、地，调治营卫，未易平
痉而奏捷也。
《内经》曰∶“诸湿肿满，皆属于脾。”又曰∶“湿胜则濡泄。”此指湿伤于内者言也。又曰∶“地之湿气，
感则害人皮肉筋骨。”又曰∶“因于湿，首如裹。”此指湿伤于外者言也。若湿而兼热，则大筋 短而为拘，小
筋弛长而为痿，即柔痉之变见矣。阳明篇有湿热发黄之症，叔和不为别论，独取太阳之风湿相搏者，尚遗数条，
亦搜采之疏失也。《内经》曰∶“身半以上者，风中之也；身半以下者，湿中之也。中阳则溜于经，中阴则溜于
府。”又曰∶“阳受风气，阴受湿气。故伤于风者，上先受之；伤于湿者，下先受之。”皆风湿对言，本论则风
湿合言也。风湿相合，则阴阳相搏，上下内外交病矣。所以身体烦疼，不能转侧，骨节掣痛，不能屈伸，小便不
利，大便反快也。《内经》曰∶“风湿之伤人也，血气与邪并客于分腠之间，其脉坚大，故曰实；寒湿之中人也，
皮肤不收，肌肉坚固，营血涩，卫气去，故曰虚。”此又以湿家虚实，因风寒而分也。本论伤寒发汗，寒湿在里
不解，身目为黄，与阳明之热不得越，瘀热在里，身体发黄者，当下不当下，亦以寒湿湿热分虚实矣。《内经》
以风寒湿三气合而成痹，本论又合风寒湿热四气而名湿痹。当知痹与痉，皆由湿变。夫同一湿也，湿去燥极则为
痉，久留而着则为痹。痹为实，痉为虚，痉痹异形，虚实亦殊。固不得妄以痉属风，亦不得因于湿、而竟视痉为
湿矣。
六气致病，都能引起发热。然而寒与热相互关联，暑与湿相互伴随，唯独燥与湿性质相反。风寒温暑多因天气（外感）所致，而湿病多因地气（环境潮湿）所致，燥病多因内因（津液亏损）所致，这是病因的异同之处。《内经》病机十九条中，归属于六气的病症里，火邪占了八条，风、寒、湿各占一条，唯独没有燥症。至于“各种痉挛、项背强直，都归属于湿”，我曾怀疑这应归属于燥。如今《伤寒论》中有痉病和湿病的区分，又说：“太阳病发汗过多，因而导致痉病”，那么痉病归属于燥是毫无疑问的。痉病是以症状命名的，是因为血虚导致筋脉拘急。六气为患，都足以导致痉病，然而不热就不会燥，不燥就不会形成痉病。六经都有痉病，必须审查部位来辨别它。身体后侧的属于太阳经，所以凡是头项强急，项背僵硬不舒，脊柱强直反张，腰部像折断一样，大腿不能弯曲，腘窝像被捆绑结扎一样，都是它的症状。身体前侧的属于阳明经，头面动摇，牙关紧闭咬齿，缺盆部疼痛，脚部挛急，都是它的症状。身体侧面的属于少阳经，口眼歪斜，手足牵引，两胁拘急，半身不遂，都是它的症状。如果腹部拘急，因为吐泻而导致四肢拘急，这是太阴痉。恶寒蜷缩而卧，臀部着地脚跟抬起代替行走，脊背弯曲头部低下代替抬头，只能俯身不能仰身的，这是少阴痉。睾丸上提，宗筋向下注滞，小腹部拘急紧迫，阴部拘挛，膝胫部拘急的，这是厥阴痉。如果是痉病兼夹风寒的，其症状是发热无汗且恶寒，气向上冲胸且小便少，脉象必定坚紧，形态必定强直且牙关紧闭，这是因天气（外感）所致，《内经》所说的“各种突然发生的强直，都归属于风”就是这种情况。其病势勇猛，所以称为刚痉。病因来自外部，应当祛除邪气以解表。痉病有夹杂本邪（湿邪）而为患的，其邪气从内部发出，所以发热汗出且不恶寒，脉象沉迟，形态则是项背僵硬不舒，这是因地气（内伤/环境）所致，《内经》说“各种痉挛项强，都归属于湿”就是这种情况。其病势较弱，所以名叫柔痉。病因在于内部，应当滋阴以调和内在。要知道归属于风的痉病，不是因为风而是因为热；归属于湿的痉病，不是因为湿而是因为燥。治疗风邪为主用葛根做君药，治疗湿邪为主用栝蒌根做君药，并不是为了治风，实在是为了生津液；并不是为了治湿，实在是为了润燥罢了。痉病刚开始时，本来不是正病，必然夹杂在其他疾病之中。患此病的人，世俗医生都指认为风邪，所以不明白其中的道理。善于治病的医生，一定在其他症状中审察并预防它。比如头项强痛，就是痉病的一个端绪，这是因为太阳经血虚，所以筋脉拘急。现在的人只知道风寒，不惜惜津液，所以发汗过多，因而导致痉病的很多。痉病的征象，本来是有来源的，一经误治，奇形怪状就全部显现。项背僵硬不舒，是痉病的征兆，所以用葛根；身体强直，是痉病的症状已经明显，所以用栝蒌根；卧床时背部不能贴席，脚部挛急，牙关紧闭咬齿，是痉病极其严重的表现，所以用大黄、芒硝。无非是取用富含津液的药材，来滋养阴血，不能与应当发汗却未发汗的情况混为一谈。看伤寒脉浮，自汗心烦恶寒，而出现脚部挛急，说明痉势已经形成，应当滋阴存留津液，不能仍按伤寒主治。所以如果用桂枝汤就会导致四肢厥冷，如果用芍药甘草汤，脚就能伸直，这是明确的验证。只是由于表证未除，不能用承气汤，如果有谵语的话，少量给予调胃承气汤，这又与病情严重到卧床不着席者给予大承气汤，是同一机理。大凡痉病这种病，因外邪损伤筋脉的少，因血虚筋脉拘急的多。如果误作风邪治疗，用辛散药物助长阳气，则真阴更加虚弱；用燥烈药物驱风，则血液更加枯竭。所以痉病突然发作的少，因误治导致的居多。虚证而不补益，不死还等什么？不用人参、黄芪、当归、地黄等药调理营卫，很难平息痉病并取得捷效。
《内经》说：“各种湿气引起的肿胀满闷，都归属于脾。”又说：“湿气胜则导致濡泄（大便稀溏）。”这是指湿邪伤害于内的情况。又说：“地的湿气，感受了就会伤害人的皮肉筋骨。”又说：“因为湿气，头部像被包裹一样沉重。”这是指湿邪伤害于外的情况。如果湿邪兼夹热邪，则大筋缩短而表现为拘挛，小筋弛长而表现为痿废，这就是柔痉的变证。阳明篇有湿热发黄的症状，王叔和不为这些单独论述，只选取太阳经风湿相搏的情况，还遗漏了几条，这也是搜集采录时的疏漏。《内经》说：“身体半以上的，受风邪侵袭；身体半以下的，受湿邪侵袭。中伤阳分则流注于经络，中伤阴分则流注于腑。”又说：“阳经受风气，阴经受湿气。所以受风邪伤害的，上部先受之；受湿邪伤害的，下部先受之。”这些都是风湿对举而言，《伤寒论》则是风湿合言。风湿相合，则阴阳相互搏击，上下内外同时患病。所以身体烦疼，不能转侧，骨节掣痛，不能屈伸，小便不利，大便反而通畅快利。《内经》说：“风湿伤害人，血气与邪气并聚在分肉腠理之间，脉象坚大，所以叫实证；寒湿伤害人，皮肤松弛不收，肌肉坚固，营血涩滞，卫气离去，所以叫虚证。”这里又是以湿家（湿病患者）的虚实，因风寒不同而区分。《伤寒论》中伤寒发汗后，寒湿在里不解，身目发黄，与阳明之热不得宣泄，瘀热在里，身体发黄的，该下法不下法，也是以寒湿、湿热来区分虚实。《内经》认为风寒湿三气合而成痹，《伤寒论》又合风寒湿热四气命名为湿痹。应当知道痹病与痉病，都是由湿邪变化而来。同样是湿邪，湿去而燥极就成为痉病，久留附着就成为痹病。痹病属实，痉病属虚，痉病与痹病形态不同，虚实也有差异。固然不能妄将痉病归属于风，也不能因为源于湿，就将痉病完全视为湿病。
When the Six Qi (Six Climatic Factors: Wind, Cold, Summer-heat, Dampness, Dryness, Fire) cause disease, they can all lead to fever. However, Cold and Heat are interrelated, and Summer-heat follows Dampness; only Dryness is contrary to Dampness. Wind, Cold, Warmth, and Summer-heat are mostly caused by Heavenly Qi (external climatic factors), whereas Dampness diseases are mostly caused by Earthly Qi (environmental dampness), and Dryness diseases are mostly caused by internal factors (deficiency of body fluids). This constitutes the difference and similarity in etiology. In the Nineteen Pathogenesis Formulas of *Nei Jing* (Inner Canon), among those attributed to the Six Qi, Fire accounts for eight, while Wind, Cold, and Dampness each account for one; there is no specific mention of Dryness symptoms. Regarding "various spasms and neck stiffness belong to Dampness," I have often suspected that this should be attributed to Dryness. Now, *Shanghan Lun* (Treatise on Cold Damage) distinguishes between Spasm (Jing) and Dampness, and states: "In Taiyang disease, excessive sweating leads to Spasm." Thus, it is beyond doubt that Spasm belongs to Dryness. Spasm is named after its manifestation, which arises from blood deficiency causing tendon tension. The affliction of the Six Qi is sufficient to cause spasm; however, without Heat there is no Dryness, and without Dryness, Spasm cannot form. Spasm disease exists in all six meridians; one must examine the location to differentiate them. Those affecting the posterior aspect of the body belong to the Taiyang Meridian; thus, any case involving stiff neck and back, rigidity of the nape and back (*gang jiang*), spinal rigidity with opisthotonos, waist feeling like it is broken, thighs unable to bend, and popliteal fossa feeling bound or knotted, are its symptoms. Those affecting the anterior aspect belong to the Yangming Meridian; thus, trembling of the head and face, trismus (locked jaw), pain in the supraclavicular fossa, and cramping of the feet are its symptoms. Those affecting the lateral aspect belong to the Shaoyang Meridian; thus, facial paralysis (deviation of mouth and eye), traction of hands and feet, hypochondriac tension, and hemiplegia are its symptoms. If there is abdominal tension, accompanied by limb tension due to vomiting and diarrhea, this is Taiyin Spasm. Aversion to cold, curling up to sleep, sitting on the buttocks with heels raised as if walking, spine bent forward with head lowered as if looking down, able to flex but not extend, is Shaoyin Spasm. Elevation of the testicles, downward flow of the Zongjin (major tendons), urgency and tension in the lower abdomen, cramping in the genital area, and tension in the knees and shins constitute Jueyin Spasm. If Spasm is complicated by Wind and Cold, the symptoms include fever, anhidrosis, and aversion to cold; qi rushing upward to the chest and scanty urination; the pulse must be firm and tight, and the posture rigid with trismus. This results from Heavenly Qi (external invasion), corresponding to what *Nei Jing* calls "sudden rigidity belongs to Wind." Its momentum is fierce, hence it is called Gang Spasm (Yang Spasm). Since the pathogen is external, one should dispel the evil and release the exterior. For Spasm complicated by its original pathogen (Dampness), the evil emerges from within; thus, there is fever and sweating without aversion to cold, the pulse is deep and slow, and the manifestation is rigidity of the nape and back. This results from Earthly Qi (internal/environmental factor), corresponding to *Nei Jing*'s statement "spasms and neck stiffness belong to Dampness." Its momentum is weak, hence it is called Rou Spasm (Yin Spasm). Since the cause is internal, one should nourish Yin to harmonize the interior. It must be understood that Spasm attributed to Wind is not caused by Wind per se, but by Heat; Spasm attributed to Dampness is not caused by Dampness per se, but by Dryness. Using Puerariae Radix (Gegen) as the sovereign herb for treating Wind-related Spasm, and Trichosanthis Radix (Gualou Gen) for Dampness-related Spasm, is not primarily to treat Wind or Dampness, but truly to generate fluids and moisten Dryness. At the onset, Spasm is not a primary disease but is always mixed with other diseases. Physicians of the world usually attribute it to Wind, failing to understand the underlying principle. Skillful physicians must examine and prevent it amidst other symptoms. For instance, stiff neck and headache are precursors of Spasm, indicating Taiyang blood deficiency leading to tendon tension. Nowadays, people only recognize Wind and Cold, disregarding body fluids; thus, excessive sweating frequently leads to Spasm. The signs of Spasm have their origins; once mismanaged, bizarre manifestations appear. Rigidity of the nape and back is a sign of impending Spasm, so Puerariae Radix is used; general body rigidity indicates established Spasm, so Trichosanthis Radix is used; inability to lie flat on the bed, foot cramps, and trismus indicate extreme Spasm, so Rhizoma Rhei (Dahuang) and Natrii Sulfas (Mangxiao) are used. These are all herbs rich in fluids to nourish Yin and Blood; they cannot be treated similarly to cases where sweating should have been induced but was not. Consider a Shanghan case with floating pulse, spontaneous sweating, vexation, aversion to cold, and foot cramps: the trend of Spasm has already formed. One must nourish Yin and preserve fluids, rather than treating it solely as Shanghan. Therefore, using Guizhi Tang (Cinnamon Twig Decoction) would lead to cold limbs, whereas using Shaoyao-Gancao Tang (Peony and Licorice Decoction) allows the feet to straighten, which is clear evidence. However, since exterior symptoms remain, Chengqi Decoctions cannot be used directly. If delirium occurs, a small amount of Tiaowei Chengqi Tang (Harmonizing the Stomach and Regulating the Bowels Decoction) may be given. This shares the same mechanism as giving Dachengqi Tang (Major Order the Yellow Decoction) to patients whose condition is severe enough that they cannot touch the bed with their backs. Generally, Spasm is rarely caused by external pathogens damaging the tendons, but mostly by blood deficiency causing tendon tension. If mistakenly treated as Wind, using acrid-dispersing herbs to boost Yang will further deplete True Yin; using drying agents to expel Wind will further desiccate the Blood. Thus, sudden onset of Spasm is rare, while that caused by mismanagement is common. In deficiency without tonification, death is inevitable. Without using Ginseng Radix (Renshen), Astragali Radix (Huangqi), Angelicae Sinensis Radix (Danggui), and Rehmanniae Radix (Shu Dihuang) to regulate Ying and Wei Qi, it is difficult to resolve Spasm and achieve quick results.
*Nei Jing* states: "All dampness-induced swelling and fullness belong to the Spleen." It also says: "Excessive Dampness leads to loose stools." This refers to Dampness injuring the interior. It further states: "Earthly Dampness, when contracted, harms the skin, flesh, sinews, and bones." And: "Due to Dampness, the head feels wrapped." This refers to Dampness injuring the exterior. If Dampness combines with Heat, the large sinews shorten causing constraint, and the small sinews elongate causing flaccidity; this is a variant manifestation of Rou Spasm. The Yangming chapter mentions yellowing due to Damp-Heat. Wang Shuhe did not discuss these separately, focusing only on Wind-Damp interaction in Taiyang, leaving several clauses uncollected, which is an oversight in compilation. *Nei Jing* states: "The upper half of the body is attacked by Wind; the lower half by Dampness. Attacking Yang channels causes flow into the meridians; attacking Yin channels causes flow into the fu organs." It also says: "Yang meridians receive Wind Qi, Yin meridians receive Damp Qi. Therefore, Wind attacks the upper part first; Dampness attacks the lower part first." These statements contrast Wind and Dampness, whereas *Shanghan Lun* discusses them together. When Wind and Damp combine, Yin and Yang clash, and both upper/lower and interior/exterior are affected. Thus, there is bodily restlessness and pain, inability to turn over, joint pulling pain, inability to flex or extend, dysuria, and conversely, rapid bowel movements. *Nei Jing* states: "When Wind-Damp attacks, Qi and Blood merge with the pathogen in the fenli (interstices); the pulse is firm and large, hence termed Excess. When Cold-Damp attacks, the skin relaxes, muscles are firm, Ying Blood is stagnant, and Wei Qi departs, hence termed Deficiency." Here, the excess and deficiency of Dampness patients are differentiated by Cold and Wind. In *Shanghan Lun*, after sweating for Shanghan, if Cold-Damp remains unresolved internally, causing jaundice of the body and eyes, combined with Yangming Heat that cannot vent, leading to stagnant Heat inside and yellowing, the decision to purge or not purges differentiates Excess and Deficiency based on Cold-Damp versus Damp-Heat. *Nei Jing* holds that Bi Syndrome is formed by the combination of Wind, Cold, and Damp; *Shanghan Lun* adds Heat to name it Damp-Bi. One must know that both Bi and Spasm arise from transformations of Dampness. The same Dampness, when dried out to an extreme, becomes Spasm; when lingering and attaching for a long time, it becomes Bi. Bi is Excess, Spasm is Deficiency; their forms differ, and their nature (Excess/Deficiency) differs. One must not rashly attribute Spasm to Wind, nor, because it originates from Dampness, view Spasm entirely as Dampness.