丹溪云∶ 当作痉，传写之误耳。考之诸书，亦未有能辩之。有云病以时发者谓
之痉，不以时发者谓之 ，及按《灵》、《素》、仲景以下诸书，云 云痉，字虽有
两般，治多雷同，殆亦不必犁而为二也。大抵 乃病之名，痉乃病之状，原其有刚柔
二种，以病发之时，而经筋脉络僵劲，角弓反张，故曰痉 ，是劲急也，是以其病发
之状象而名之也，不然，何历代诸公，或以治 之方治痉，或以治痉之方治 也。诸
皆能效，治既同而不殊，则症当一而不二。更有劳风者，因劳汗遇风，其候其治，与
同法，但须审其劳损何脏，如因肾气虚损者，即为肾劳风也，宜随症施治。
按∶ 症发作，则通身战掉，皆因气虚血虚，挟痰火所致，正犹火炎而旋转也。
火能燥物，而使气液之不足，世人不谙，误认为风而用风药，风能胜湿，是不足之中而
又不足矣。多因病后汗后而血不能养筋而然，切不可作风治，而纯用风药也。《玉匮
密钥》曰∶休治风，休治燥，治了火时风燥了。夫火为风燥之本，能治其火，则是散风
而润燥，何风燥之有哉！此 症所以宜补气液而兼散痰火，（张）常以十全大补，少
佐附子，行参 之性以补卫，引归地之性以养荣，则内起之风火潜消，而 不治自愈
矣。
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，以风散气，故
有汗而不恶寒，曰柔 。血寒泣无汗而恶寒，曰刚 。原其所因，多由亡血，筋无
所营，邪得以袭之，所以伤寒汗下过多，与病疮人发汗，产后过汗，致成斯疾者，概可
见矣。诊其脉皆沉伏弦紧，但阳缓阴急，则久久拘挛；阴缓阳急，则反张强直，二证各
异，不可不别。
书曰∶风病下之则 ，复发汗，必拘急。又曰∶疮家虽身疼痛，不可发汗，汗出
则。可见多因汗下而致 ，皆由坏证而成，则不专于风寒湿之外传明矣。若属风寒
湿所伤，有汗者脉必浮缓，无汗者脉必浮紧。若脉沉细者，湿所伤也。
按∶风搐一症，本与 症不同。夫 症属湿，然土极必兼风木动摇之化。风搐属
木，木旺必见金燥紧敛之形，故曰诸风掉眩，曲直摇动皆风木之用。阳主动，阴主
静，由火盛制金，金衰不能平木，木旺而自病，此宜吐下之。是虽不可与 同论，然
可引以证 之风热内作者。
伤寒发汗太过，多成 症。若身热足寒，项强恶寒，头热面肿，目赤头摇口噤，
背反张者，太阳 也。若头低视下，手足
牵引，肘胁相构，阳明 也。若一目左右邪视，并一手足搐搦者，少阳 也。治法
在表无汗汗之，有汗止之；阳明 属里下之∶少阳 半表半里和之，所谓各随其经也。
丹溪说：应当写作“痉”，是传抄过程中的错误。考察各类书籍，也没有人能辨析清楚。有人说发作有定时称为“痓”，没有定时称为“瘛”，但查阅《灵枢》、《素问》以及张仲景以下的诸书，都说“瘛”与“痉”，虽然字形有两种，但治疗方法大多雷同，大概也不必强行分为两类。大体上，“瘛”是病名，“痉”是病的症状。原本有刚、柔两种类型，因为发病时经筋脉络僵硬强劲，身体像弓一样反折（角弓反张），所以叫作“痉”，这是指劲急的意思，是根据发病时的形态来命名的。否则，为什么历代名医，有的用治“瘛”的方子治“痉”，有的用治“痉”的方子治“瘛”呢？各种方法都有效，治疗既然相同而没有区别，那么症状应当是一致的而不是两个。另外还有“劳风”，是因为劳累出汗后受风所致，其证候和治疗，与“瘛”相同，但必须审察是哪一脏因劳损而虚，如果是肾气虚损，就是肾劳风，应当根据症状施治。
按语：“瘛”症发作时，全身颤抖抖动，都是因为气虚血虚，挟带痰火所致，正如火焰燃烧导致物体旋转一样。火能燥物，导致气和液的不足，世人不明白这一点，误认为是风而使用祛风药，风能胜湿，这是在不足之中又造成不足。多是因为病后或汗后，血不能滋养筋脉而导致。切不可当作风证治疗，而单纯使用祛风药。《玉匮密钥》说：不要只治风，不要只治燥，治好火的时候，风和燥也就好了。火是风和燥的根本，如果能治好火，那就是散风并润燥，哪里还有风和燥呢！这就是“瘛”症适宜补气液兼散痰火的原因。（张）常以十全大补汤为基础，少量加入附子，发挥人参的作用以补卫气，引导当归、地黄的作用以养营血，那么内部产生的风火就会潜消，瘛症不治自愈。
人的筋脉，各自随着经络分布显露于身体，如果气血内虚，外部被风寒湿热所侵袭，风会耗散气，所以有汗但不怕冷，这叫“柔瘛”。血寒则血液凝涩无汗且怕冷，这叫“刚瘛”。推究其原因，多由失血引起，筋脉无所营养，邪气得以侵袭，所以伤寒发汗、攻下过多，以及疮疡病人发汗，产后发汗过多，导致形成这种疾病的，概可见一斑了。诊察他们的脉象都是沉伏弦紧，但如果阳缓阴急，就会久久拘挛；阴缓阳急，就会反张强直，这两种证候各不相同，不可不加以辨别。
医书说：风病如果用攻下法，会导致“瘛”，如果再发汗，必定拘挛。又说：患疮疡的人虽然身体疼痛，不可发汗，如果发汗，就会导致“瘛”。可见多因发汗、攻下而导致“瘛”，都是由坏证演变而成，这就明确说明不仅仅局限于风寒湿的外传。如果属于风寒湿所伤，有汗的脉象必浮缓，无汗的脉象必浮紧。如果脉象沉细，则是湿邪所伤。
按语：风搐一症，本来与“瘛”症不同。“瘛”症属湿，但土极必兼有风木动摇的变化。风搐属木，木旺必然见到金燥紧敛的形态，所以说各种风病引起的震颤眩晕，弯曲伸直摇动都是风木的作用。阳主动，阴主静，由于火盛制约金，金衰不能平抑木，木旺而自己生病，这种情况适宜用吐法和下法。这虽然不能与“瘛”同论，但可以引用它来证明“瘛”症中因风热内生的情况。
伤寒发汗太过，多形成“痉”症。如果身热足寒，项背强直怕冷，头热面肿，眼睛红赤，头部摇动，口噤不开，背部反折，这是太阳经“痉”。如果头低垂视下，手足牵引，肘部与胁部相靠，这是阳明经“痉”。如果一只眼睛向左右斜视，并伴有一只手足抽搐，这是少阳经“痉”。治疗方法在表无汗的用发汗法，有汗的用止汗法；阳明“痉”属里证用攻下法；少阳“痉”在半表半里用和解法，所谓各随其经脉而定。
Danxi stated: It should be written as "Jing" (spasm), which is an error in transcription. Examination of various texts reveals no one has been able to clarify this. Some say that if the disease occurs at fixed times, it is called "Chi" (clonic spasm); if not at fixed times, it is called "Jing". However, consulting the *Ling Shu*, *Su Wen*, and subsequent works by Zhang Zhongjing and others, they all refer to "Chi" and "Jing". Although the characters differ, the treatments are largely similar, so there is probably no need to strictly separate them into two categories. Generally speaking, "Chi" is the name of the disease, while "Jing" describes the symptoms. Originally, there are two types: rigid and flaccid. When the disease manifests, the meridians and sinews become stiff and tense, with the body arching backward like a bow (*jiaogong fanzhang*), hence it is called "Jing", indicating stiffness and urgency. Thus, it is named after its clinical presentation. Otherwise, why have physicians throughout history used formulas for treating "Chi" to treat "Jing", and vice versa? Various methods prove effective; since the treatment is identical without distinction, the symptoms must be unified rather than dual. Additionally, there is "Lao Feng" (Wind due to Exhaustion), caused by wind exposure after sweating from exertion. Its manifestations and treatment are similar to those of "Chi", but one must ascertain which organ is damaged by exhaustion. If it is due to Kidney Qi deficiency, it is termed Kidney Lao Feng, and treatment should be tailored to the specific symptoms.
Commentary: During the onset of "Chi", the entire body trembles and shakes. This is caused by Qi and Blood deficiency combined with Phlegm-Fire, analogous to fire causing rotation. Fire dries substances, leading to insufficiency of Qi and Body Fluids. People who do not understand this mistake it for Wind and use Wind-dispelling herbs. Since Wind can overcome Dampness, this approach exacerbates the existing deficiency. This condition often arises post-illness or post-sweating, where Blood fails to nourish the sinews. It must never be treated as a Wind disorder using purely Wind-dispelling herbs. The *Yu Kui Mi Yue* states: Do not merely treat Wind, do not merely treat Dryness; once Fire is resolved, Wind and Dryness will also resolve. Fire is the root of Wind and Dryness. By treating Fire, one disperses Wind and moistens Dryness, leaving no room for Wind or Dryness. Therefore, "Chi" should be treated by tonifying Qi and Body Fluids while simultaneously dispersing Phlegm-Fire. [Zhang] frequently uses *Shiquan Dabu Tang* (Complete and Great Tonifying Decoction) with a small addition of *Fuzi* (Prepared Aconite Root). This leverages the properties of *Renshen* (Ginseng Root) to tonify Defensive Qi and guides the properties of *Danggui* (Angelica Sinensis Root) and *Dihuang* (Rehmannia Root) to nourish Nutritive Qi. Consequently, internal Wind and Fire subside spontaneously, and "Chi" heals without direct intervention.
The sinews of the human body follow the meridians and extend throughout the body. When Internal Qi and Blood are deficient, external pathogens such as Wind, Cold, Dampness, and Heat invade. Wind scatters Qi, resulting in sweating without aversion to cold, termed "Rou Chi" (Flaccid Spasm). Cold congeals Blood, resulting in no sweat and aversion to cold, termed "Gang Chi" (Rigid Spasm). Investigating the causes, these often stem from blood loss, leaving sinews without nourishment, allowing pathogens to attack. Thus, excessive sweating or purgation in *Shanghan* (Cold Damage), sweating in patients with sores/ulcers, and excessive sweating postpartum can lead to this disease. Pulse diagnosis typically reveals deep, hidden, wiry, and tight pulses. If Yang is lax and Yin is tense, chronic contracture ensues; if Yin is lax and Yang is tense, opisthotonos and rigidity occur. These two conditions are distinct and must be differentiated.
Medical texts state: Applying purgation to Wind diseases leads to "Chi"; if sweating is induced subsequently, contracture will definitely occur. It also states: Patients with sores/ulcers may have body pain, but sweating should not be induced; if sweating occurs, "Chi" results. This indicates that "Chi" is often caused by improper sweating or purgation, evolving from mismanaged cases, clearly showing it is not solely due to external transmission of Wind, Cold, and Dampness. If caused by Wind, Cold, and Dampness, a floating and moderate pulse indicates sweating, while a floating and tight pulse indicates no sweating. A deep and fine pulse suggests Dampness injury.
Commentary: "Feng Chu" (Wind-induced convulsion) is fundamentally different from "Chi". "Chi" belongs to Dampness, but extreme Earth inevitably involves the transformational movement of Wood (Wind). "Feng Chu" belongs to Wood; when Wood is hyperactive, it exhibits the form of Metal dryness and contraction. Hence, it is said that all Wind diseases causing tremors and vertigo, involving bending, straightening, and shaking, are functions of Wood-Wind. Yang governs movement; Yin governs stillness. When Fire is excessive and controls Metal, Metal becomes weak and cannot pacify Wood, leading to Wood hyperactivity and self-disease. This situation warrants emetic and purgative therapies. Although this cannot be discussed identically to "Chi", it serves as evidence for internal Wind-Heat generating "Chi".
Excessive sweating in *Shanghan* (Cold Damage) often results in "Jing" (Spasm). If there is fever in the body but cold feet, neck stiffness, aversion to cold, heat in the head, facial swelling, red eyes, head shaking, lockjaw, and back arching, it is Taiyang Jing (Spasm of the Taiyang Meridian). If the head is lowered, gaze directed downward, limbs pulled, and elbows meet the ribs, it is Yangming Jing (Spasm of the Yangming Meridian). If one eye deviates laterally, accompanied by convulsions in one hand and foot, it is Shaoyang Jing (Spasm of the Shaoyang Meridian). Treatment principles: For exterior cases with no sweating, induce sweating; with sweating, stop it. Yangming Jing, being interior, requires purgation. Shaoyang Jing, being half-exterior and half-interior, requires harmonization. This follows the principle of treating according to the affected meridian.