@@@
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，寒湿相搏，其表益虚，即恶寒甚，发其汗已，其脉如蛇
。
【按】
诸家以刚、柔二痉，列为首条，今以此为第一条者，盖刚、柔之辨，俱从此条分出，
痉病之最备者，宜冠诸首。再痉病也之下，「若发其汗…」六句，与上文义不属，与
后之十一条中「为欲解，脉如故，反伏弦者痉」句，文义相属，宜分于彼。
【注】
病人身热恶寒，太阳证也；颈项强急，面赤目赤，阳明证也。头热，阳郁于上也；足
寒，阴凝于下也。太阳之脉循背上头，阳明之筋上挟于口，风寒客于二经，则有头摇
口噤，反张拘强之证矣。此皆痉病之形证，故首揭之，以为要领。
【集注】
李□曰：手三阳之筋，结入结颔颊。足阳明之筋，上挟于口。风寒乘虚，入其筋则挛
，故牙关急而口噤。
@@@
夫痉脉，按之紧如弦，直上下行。
【注】
痉之为病，其状劲急强直，故其脉亦劲急强直。按之紧，劲急之象也，如弦直行之象
也。
@@@
『脉经』云：痉家，其脉伏坚，直上下。
【注】
痉家其脉紧弦，直上下者，以痉病属太阳表也。『脉经』所云：其脉伏坚，直上下者
，以痉病属阳明里也。盖痉家原属二经，故有太阳葛根汤汗之，阳明大承气汤下之之
治也。伏坚，沉实也；直上下，弦直也，即沉实弦直之脉也。
@@@
太阳病发热无汗，反恶寒者，名曰刚痉。太阳病发热汗出，而不恶寒，名曰柔痉。
【按】反恶寒之「反」字，衍文也。玩痉病之条自知当恶寒也。
【注】
痉病既属太阳，当以太阳虚实例之，故曰：太阳病发热、无汗、恶寒为实邪名曰刚痉
者。强而有力也。发热汗出，不恶寒为虚邪，名曰柔痉者。强而无力也。
@@@
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。
【注】
此申明刚痉在表，以明其治也。太阳病，为头项强痛、发热等证也。无汗，谓伤寒也
。太阳伤寒，小便不当少，今反少者，是寒气盛而收引也。不当气上冲胸，今气上冲
胸，是寒气盛而上逆也。不当口噤不得语，今口噤不得语，是寒气盛，牙关紧急而甚
也。以太阳伤寒，而有此冲击劲急之象，是欲作刚痉之病也。麻黄汤能治太阳，而不
能治阳明，故以葛根汤兼太阳、阳明两经之治，为刚痉无汗之正法也。
@@@
痉为病，胸满口噤，卧不着席，脚挛急，必齘齿，可与大承气汤。
【注】此申痉病入里，以明其治也。痉病而更胸满，里气壅也；卧不着席，反张甚也
；脚挛急，劲急甚也；必齘齿，牙紧甚也。此皆阳明热盛灼筋，筋急而甚之象。故以
大承气汤直攻其热，非攻阳明之实也。其曰可与，非尽言其可与，有慎重之意。
患者身体发热，双脚发凉，颈项僵硬拘急，怕冷，有时头部发热，面色发红，眼睛发红，只有头部摇动，突然牙关紧闭，背部向后反折的，是痉病。如果误用发汗法治疗，寒湿相互搏结，体表更加虚弱，就会极度怕冷；发汗之后，脉象像蛇一样蜿蜒曲折。
【按语】
各家将刚痉、柔痉列为第一条，现在将其作为第一条的原因，是因为刚痉和柔痉的辨别都从此条分出，这是关于痉病论述最完备的一条，所以适宜放在篇首。另外，“若发其汗……”这六句在“痉病也”之下，与上文文意不连贯，而与后文第十一条中“为欲解，脉如故，反伏弦者痉”一句文意相属，应当将其划分到那一部分去。
【注释】
病人身体发热、怕冷，是太阳经证候；颈项僵硬拘急，面红目赤，是阳明经证候。头部发热，是阳气郁结于上；脚部发凉，是阴气凝滞于下。太阳经脉循行背部并上头，阳明经筋上行挟持口角，风寒邪气客居在这两条经脉，就会出现头部摇动、牙关紧闭、身体反张拘强的证候。这些都是痉病的形态和证候表现，所以首先揭示出来，作为纲领。
【集注】
李□说：手三阳经的筋，结聚于下颌脸颊。足阳明经的筋，上行挟持口角。风寒乘虚侵入筋脉，导致筋脉挛缩，所以牙关紧急而牙关紧闭。
痉病的脉象，重按感觉紧硬如琴弦，笔直上下贯通。
【注释】
痉病这种病，其症状强劲紧急、强直，所以它的脉象也是强劲紧急、强直的。重按时感觉紧，是强劲紧急的征象；像琴弦一样直行，是直行的征象。
《脉经》说：患痉病的人，其脉象沉伏坚劲，笔直上下贯通。
【注释】
患痉病的人脉象紧弦，笔直上下贯通，是因为痉病属于太阳表证。《脉经》所说的脉象沉伏坚劲，笔直上下贯通，是因为痉病属于阳明里证。大概患痉病的人原本涉及这两条经脉，所以有使用葛根汤发汗治疗太阳经证，使用大承气汤泻下治疗阳明里证的治法。“伏坚”，即沉实；“直上下”，即弦直，也就是沉实弦直的脉象。
太阳病，发热无汗，反而怕冷的，名叫刚痉。太阳病，发热出汗，而不怕冷的，名叫柔痉。
【按语】“反恶寒”中的“反”字，是衍文（多余的字）。研读痉病的条文自然知道应当是怕冷的。
【注释】
痉病既然属于太阳经，就应当以太阳经的虚实来分类，所以说：太阳病发热、无汗、恶寒，属于实证，名叫刚痉。“刚”意为强而有力。发热出汗，不怕冷，属于虚证，名叫柔痉。“柔”意为强而无力。
太阳病，无汗且小便反而减少，气向上冲撞胸部，牙关紧闭不能说话，将要发作刚痉，用葛根汤主治。
【注释】
这里阐明刚痉在表，以明确其治疗方法。太阳病，是指头痛项强、发热等证候。无汗，指伤寒。太阳伤寒，小便本不应少，现在反而少，是因为寒气盛而收敛牵引。本不应气上冲胸，现在气上冲胸，是因为寒气盛而上逆。本不应牙关紧闭不能说话，现在牙关紧闭不能说话，是因为寒气盛，牙关紧急严重。因为太阳伤寒，而有这种冲击强劲紧急的现象，是即将发作刚痉的病证。麻黄汤能治疗太阳经病，但不能治疗阳明经病，所以用葛根汤兼治太阳、阳明两经，这是治疗刚痉无汗的正法。
痉病，出现胸满、牙关紧闭，睡觉时背部反张不能着席，脚部拘挛急促，必定磨牙，可以用大承气汤。
【注释】这里阐明痉病入里，以明确其治疗方法。痉病又出现胸满，是里气壅滞；睡觉时背部反张不能着席，说明反张很严重；脚部拘挛急促，说明强劲紧急很严重；必定磨牙，说明牙齿咬合很紧。这些都是阳明热盛灼伤筋脉，筋脉紧急严重的征象。所以用大承气汤直接攻逐热邪，并非攻逐阳明经的实邪。说“可与”，并非完全肯定可以使用，含有慎重的意思。
The patient presents with fever in the body, coldness in the feet, stiffness and tension in the neck and nape, aversion to cold, occasional heat in the head, redness of the face, redness of the eyes, isolated shaking of the head, sudden lockjaw (trismus), and opisthotonos (backward arching of the back). This is Jing disease (Spasm disorder). If sweating therapy is induced, cold and dampness contend with each other, the exterior becomes more deficient, leading to severe aversion to cold. After inducing sweating, the pulse resembles a snake winding.
[Commentary]
Various schools list Gang-Jing (Rigid Spasm) and Rou-Jing (Soft Spasm) as the first item. The reason for listing this passage as the first item here is that the distinction between rigid and soft spasms branches out from this passage. As the most comprehensive description of Jing disease, it is appropriate to place it at the beginning. Furthermore, the six sentences following "Jing disease..." ("If sweating therapy is induced...") do not connect logically with the preceding text but align with the later passage in Article 11: "For resolution, if the pulse remains unchanged but becomes hidden and wiry, it is Jing." Therefore, these sentences should be moved there.
[Annotation]
The patient's fever and aversion to cold are Taiyang syndrome manifestations; stiffness and tension in the neck and nape, along with facial and ocular redness, are Yangming syndrome manifestations. Heat in the head indicates Yang Qi constrained upward; coldness in the feet indicates Yin Cold stagnating downward. The Taiyang meridian runs along the back to the head, and the Yangming sinews run up to flank the mouth. When Wind-Cold pathogenic factors invade these two meridians, symptoms such as head shaking, lockjaw, and opisthotonos with stiffness occur. These are all morphological and symptomatic presentations of Jing disease, hence they are presented first as the guiding principle.
[Collected Notes]
Li [Name Redacted] stated: The sinews of the three Hand-Yang meridians converge into the mandible and cheeks. The sinews of the Foot-Yangming meridian run up to flank the mouth. When Wind-Cold takes advantage of deficiency and enters the sinews, causing contraction, the jaw becomes tight resulting in lockjaw.
The pulse of Jing disease, when pressed firmly, feels tight and wiry, extending straight up and down.
[Annotation]
In Jing disease, the physical state is strong, urgent, and stiff; therefore, its pulse is also strong, urgent, and stiff. Feeling tight upon pressure is the image of urgency and strength; feeling like a straight string is the image of directness.
The *Mai Jing* (Pulse Classic) states: For patients prone to Jing disease, the pulse is deep, firm, and extends straight up and down.
[Annotation]
When the pulse of a Jing disease patient is tight and wiry, extending straight up and down, it is because the disease belongs to the Taiyang exterior. When the *Mai Jing* describes the pulse as deep, firm, and extending straight up and down, it is because the disease belongs to the Yangming interior. Generally, Jing disease involves both meridians; thus, treatments include using Gegen Tang (Kudzu Root Decoction) to induce sweating for the Taiyang aspect, and Dachengqi Tang (Major Order the Qi Decoction) to purge for the Yangming aspect. "Deep and firm" refers to deep and solid; "straight up and down" refers to wiry and straight, i.e., a deep, solid, wiry, and straight pulse.
In Taiyang disease, if there is fever, no sweat, and paradoxically aversion to cold, it is called Gang-Jing (Rigid Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is called Rou-Jing (Soft Spasm).
[Commentary] The character "paradoxically" (fan) in "paradoxically aversion to cold" is a superfluous character. Studying the passages on Jing disease reveals that aversion to cold should naturally be present.
[Annotation]
Since Jing disease belongs to the Taiyang, it should be classified according to Taiyang deficiency or excess patterns. Thus: Taiyang disease with fever, no sweat, and aversion to cold represents an Excess pattern, named Gang-Jing (Rigid Spasm). "Gang" implies strength and power. Fever with sweating and no aversion to cold represents a Deficiency pattern, named Rou-Jing (Soft Spasm). "Rou" implies weakness and lack of force.
In Taiyang disease, if there is no sweat and urination is surprisingly scanty, with Qi rushing upward to the chest, lockjaw preventing speech, indicating impending Gang-Jing (Rigid Spasm), Gegen Tang (Kudzu Root Decoction) is the primary treatment.
[Annotation]
This clarifies that Gang-Jing is at the exterior level to explain its treatment. Taiyang disease refers to symptoms such as headache, neck stiffness, and fever. "No sweat" indicates Cold Damage (Shanghan). In Taiyang Cold Damage, urination should not be scanty; if it is, it is due to excessive Cold Qi causing contraction and drawing inward. Qi should not rush to the chest; if it does, it is due to excessive Cold Qi rebelling upward. Lockjaw preventing speech should not occur; if it does, it is due to excessive Cold Qi causing severe emergency of the jaw muscles. Because Taiyang Cold Damage presents with these signs of violent upward surge and urgency, it indicates impending Gang-Jing. Mahuang Tang (Ephedra Decoction) can treat Taiyang disorders but cannot treat Yangming disorders; therefore, Gegen Tang (Kudzu Root Decoction) treats both Taiyang and Yangming meridians, serving as the standard method for treating Gang-Jing without sweat.
In Jing disease, if there is chest fullness, lockjaw, inability to lie flat with the back touching the bed (opisthotonos), cramping of the legs, and teeth grinding (bruxism), Dachengqi Tang (Major Order the Qi Decoction) may be administered.
[Annotation]
This clarifies that Jing disease has entered the interior to explain its treatment. Chest fullness in Jing disease indicates stagnation of Interior Qi; inability to lie flat indicates severe opisthotonos; leg cramping indicates severe urgency and stiffness; teeth grinding indicates severe clenching of the teeth. These are all images of Yangming Heat excess scorching the sinews, causing severe sinus tension. Therefore, Dachengqi Tang (Major Order the Qi Decoction) is used to directly attack the Heat, rather than attacking Yangming Excess per se. The phrase "may be administered" (ke yu) does not imply absolute permission but carries a tone of caution.