问曰∶项脊强，何以是太阳证？答曰∶项脊者，太阳经所过之地，太阳病，则项脊强也
又问曰∶仲景云结胸症，项脊强，如柔痉状，何谓也？答曰∶本太阳病，为医误下而成结
胸，胸中胀痛，俯仰不舒，有似于项强，非真项强也。盖太阳项强，强在项后，经脉拘挛而
疼痛，胸无病也。结胸项强，强在项前，胸中俯仰不舒，项无病也。且结胸证，误下而后成
太阳病初起而即见，自不同耳。
问曰∶身痛何以是太阳证？答曰∶人身之中，气为卫，血为荣，风则伤卫，寒则伤荣。
风寒客之，则荣卫不通，故身痛。经云寒甚则痛，热甚则肉消咽破。凡《内经》举痛诸证
皆以寒名，未有以热而曰痛者也。故见身痛，即宜用辛甘发散，令气血流通而痛愈耳。又
问曰∶身痛既为表证，诸书言里证亦有身痛，何也？答曰∶里证身痛，属直中而不属传经也
寒邪直侵脏腑，阳气衰微，气血凝滞，致有身痛，宜急温之。若传经里证，则属热，热主
血行，则无身痛。总之外有头痛发热，而身痛如绳束者，太阳表证也；无头痛发热而身痛如
受杖者，直中寒证也。一发散，一温中，若误投之，终难取效，可不辨乎！
问曰∶四肢拘急，何以是太阳证？答曰∶寒主收引，热主舒伸，天道之常，秋冬则万物
敛藏，春夏则万物发舒，此定理也。《内经》曰∶寒则筋挛骨痛，热则筋弛肉缓。故拘急为
太阳感寒证。又问曰∶里证亦有拘急，何也？答曰∶直中阴证，脏受寒侵，经脉因而敛束。
若传经入里，则为热，热则体舒，又焉得拘急乎？总之发热头痛而拘急者，太阳证也；无发
热头痛而拘急者，直中证也。仲景治法，太阳表证及风湿相搏而见挛急者，皆处以桂枝加附
子汤、甘草附子汤之类，矧三阴直中者乎！亦有汗、吐、下后，四肢拘急者，此津液内竭，
血不能荣润筋骨，或补，或温，相机而行也。又问曰∶拘急属寒，固无疑矣，常见内热极甚
身如枯柴，四肢僵硬，不能屈伸者，何也？答曰∶此热甚血枯，肝脏将绝之候，名曰搐搦
非拘急也。仲景云四肢 习，唇吻反青，为肝绝，此之谓也。
问：项部及脊柱僵硬，为什么属于太阳病证？答：项部和脊柱是足太阳膀胱经循行经过的部位，患太阳病时，就会出现项脊僵硬的症状。
又问：张仲景说结胸证也有项脊僵硬，像柔痉病的表现，这是什么意思？答：原本患有太阳病，被医生误用攻下法治疗，从而形成结胸证。此时胸中胀满疼痛，低头仰头都不舒服，看起来有点像项强，但并不是真正的项强。因为太阳病的项强，僵硬部位在项后，是由于经脉拘挛而疼痛，胸部并没有病变。而结胸证的项强，僵硬感主要在项前，是因为胸中俯仰不适牵连所致，项部本身并无病变。况且结胸证是在误用攻下法之后才形成的，而太阳病在初起时就会见到，两者自然不同。
问：身体疼痛为什么属于太阳病证？答：在人体内部，气分为卫气，血分为营气，风邪容易损伤卫气，寒邪容易损伤营气。风寒邪气侵袭人体，导致营卫之气运行不通畅，所以出现身体疼痛。《内经》说：“寒气盛则疼痛，热气盛则肌肉消瘦、咽喉破裂。”凡是《内经》中列举的各种痛证，大多都归因于寒邪，没有将疼痛归因于热邪的。因此，见到身体疼痛，就应当使用辛甘发散的药物，使气血流通，疼痛自然痊愈。
又问：既然身痛属于表证，但许多书籍记载里证也有身痛，这是怎么回事？答：里证的身痛，属于寒邪直中脏腑，而不属于由表传里的经证。寒邪直接侵入脏腑，导致阳气衰微，气血凝滞，从而引起身痛，应当紧急温补阳气。如果是传经入里的里证，则属于热证，热邪主推动血液运行，所以不会出现身痛。总之，如果外部有头痛发热，且身体疼痛像被绳子捆绑一样紧束，这是太阳表证；如果没有头痛发热，且身体疼痛像受杖刑打击一样沉重，这是寒邪直中的里证。前者宜用发散法，后者宜用温中法，如果误用，终究难以见效，怎么能不加以辨别呢！
问：四肢拘挛紧急，为什么属于太阳病证？答：寒邪具有收敛牵引的特性，热邪具有舒展伸长的特性，这是自然的规律。秋冬季节万物收敛闭藏，春夏季节万物发荣舒展，这是确定的道理。《内经》说：“寒邪会导致筋脉拘挛、骨骼疼痛，热邪会导致筋脉松弛、肌肉缓纵。”因此，四肢拘急属于太阳感受寒邪的证候。
又问：里证也有拘急，这是怎么回事？答：如果是寒邪直中阴经，脏腑受到寒邪侵袭，经脉因此收缩束缚。如果是传经入里，则转化为热证，热邪会使身体舒展，又怎么会出现拘急呢？总之，如果伴有发热头痛且四肢拘急，这是太阳证；如果不伴发热头痛而仅见拘急，这是寒邪直中证。张仲景的治疗法则，对于太阳表证以及风湿相搏导致的拘挛紧急，都使用桂枝加附子汤、甘草附子汤之类的方剂，更何况是三阴经直中寒邪的情况呢！也有在发汗、催吐、攻下之后，出现四肢拘急的，这是因为体内津液枯竭，血液不能濡养滋润筋骨，需要根据情况采用补益或温阳的方法进行治疗。
又问：拘急属于寒邪，这毫无疑问了，但常见到内热极盛、身体干枯如柴、四肢僵硬不能屈伸的情况，这是什么原因？答：这是由于热邪极盛导致血液枯涸，肝脏即将衰竭的表现，这种症状名叫“搐搦”，而不是拘急。张仲景说：“四肢抽搐颤动，口唇发青，这是肝气绝灭的表现”，指的就是这种情况。
Question: Why is stiffness of the neck and spine considered a Taiyang (Greater Yang) syndrome? Answer: The neck and spine are areas traversed by the Foot-Taiyang Bladder Meridian. When suffering from a Taiyang disease, stiffness of the neck and spine occurs.
Another question: Zhang Zhongjing stated that in Jie Xiong (Chest Binding) syndrome, there is also stiffness of the neck and spine, resembling Rou Jing (Soft Spasm). What does this mean? Answer: Originally, the patient had a Taiyang disease, but was mistakenly treated with purgatives by the physician, resulting in Jie Xiong syndrome. There is distension and pain in the chest, and discomfort when bending forward or extending backward, which resembles neck stiffness but is not true neck stiffness. In Taiyang neck stiffness, the rigidity is located at the back of the neck, caused by meridian contraction and pain, while the chest has no pathology. In Jie Xiong neck stiffness, the sensation of rigidity is primarily at the front of the neck due to discomfort in the chest affecting movement, while the neck itself has no pathology. Moreover, Jie Xiong syndrome forms after mistaken purgation, whereas Taiyang disease presents immediately upon onset; thus, they are inherently different.
Question: Why is body pain considered a Taiyang syndrome? Answer: Within the human body, Qi functions as Wei Qi (Defensive Qi), and Blood functions as Ying Qi (Nutritive Qi). Wind pathogen injures Wei Qi, and Cold pathogen injures Ying Qi. When Wind-Cold pathogens invade, the circulation of Ying and Wei becomes obstructed, leading to body pain. The *Nei Jing* (Inner Canon) states: "Excessive Cold causes pain, excessive Heat causes muscle wasting and throat rupture." All pain syndromes listed in the *Nei Jing* are attributed to Cold; none are attributed to Heat. Therefore, when body pain is observed, one should use Acrid-Sweet dispersing methods to promote the free flow of Qi and Blood, thereby relieving the pain.
Another question: Since body pain is a exterior syndrome, why do many texts mention body pain in interior syndromes? Answer: Body pain in interior syndromes belongs to direct invasion (Zhi Zhong) rather than transmission through the meridians. Cold pathogen directly invades the Zang-Fu organs, causing decline of Yang Qi and stagnation of Qi and Blood, resulting in body pain; urgent warming treatment is required. If it is an interior syndrome resulting from meridian transmission, it belongs to Heat. Heat promotes blood circulation, so body pain would not occur. In summary, if there are external symptoms of headache and fever, and body pain feels like being bound by a rope, it is a Taiyang exterior syndrome; if there is no headache or fever, and body pain feels like having been beaten with a staff, it is a Cold direct invasion syndrome. The former requires dispersing methods, the latter requires warming the interior. If mistaken, efficacy will be difficult to achieve; how can one fail to distinguish them!
Question: Why is spasticity and tightness of the four limbs considered a Taiyang syndrome? Answer: Cold has the nature of contracting and drawing inward, while Heat has the nature of relaxing and extending; this is the constant law of nature. In autumn and winter, all things contract and store; in spring and summer, all things grow and expand. This is a fixed principle. The *Nei Jing* states: "Cold causes tendon cramping and bone pain; Heat causes tendon laxity and muscle flaccidity." Therefore, spasticity and tightness belong to Taiyang syndrome caused by Cold pathogen invasion.
Another question: Why is there spasticity in interior syndromes as well? Answer: If Cold pathogen directly invades the Yin meridians, the Zang organs suffer Cold invasion, causing the meridians to contract and bind. If it transmits into the interior via the meridians, it transforms into Heat. Heat causes the body to relax, so how could spasticity occur? In summary, if accompanied by fever and headache with spasticity, it is a Taiyang syndrome; if without fever and headache but with spasticity, it is a Cold direct invasion syndrome. According to Zhang Zhongjing's treatment principles, for Taiyang exterior syndrome and spasticity caused by the binding of Wind-Dampness, formulas such as Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root) and Gancao Fuzi Tang (Licorice and Aconite Decoction) are prescribed. How much more so for direct invasion of the Three Yin meridians! There are also cases where spasticity of the four limbs occurs after sweating, vomiting, or purging; this is due to exhaustion of internal fluids and Blood failing to nourish and moisten the tendons and bones. Treatment should follow the situation using tonifying or warming methods.
Another question: Spasticity undoubtedly belongs to Cold. However, it is common to see cases of extreme internal Heat, where the body is dry like dead wood, and the limbs are stiff and unable to flex or extend. What is the cause? Answer: This is due to extreme Heat causing Blood depletion, a sign that the Liver is about to fail. This condition is named Chu Nuo (Tremors and Convulsions), not Ju Ji (Spasticity). Zhang Zhongjing stated: "Twitching of the four limbs and cyanosis of the lips indicate Liver failure," referring to this condition.