痉，强直也，谓筋之收引紧急，而不舒纵也。其所以致此者有二∶一曰寒，筋
得寒则血冻而坚凝，故紧急，观物之寒凝者必强硬可见，所谓寒则收引也。湿亦寒
之属，故《经》谓诸痉皆属于湿也。一曰热，热甚则灼其血液干枯，干枯则短缩，
观物之干者必缩可见也。又《经》谓诸强直皆属于风者，风有内外，内风则从乎热，
外风则从乎寒也。《经》言痿属湿热，是湿与热合，故筋脉缓纵。（详痿门。）痉则湿与
热分，故筋脉短缩。盖湿有寒湿，有热湿，寒湿如水之冰凝，故坚强；热湿如胶饴
之熔化，故柔软。无湿而热则筋干，有热而湿则筋润也。
《金匮》痉证谓∶身热恶寒，（伤寒证。）颈项强急，面赤目赤，（阳明证。）头热足寒，
（阳性
上升也。）独头动摇，（此下乃痉证所独有，故用独字以别之。）卒口噤，背反张者，
痉病也。（太阳脉循
背上头，阳明脉挟口，寒客二经，故筋脉急致此。按此乃以寒则收引言。然热为寒郁，而
伤血液筋枯，致此者多矣。）
又谓∶太阳病，无汗恶寒，为刚痉；（此寒伤营，寒胜血凝，筋脉收引之证也。）
有汗不恶寒，为
柔痉。（汗出不恶寒，温病也，此血枯筋干缩之证。）又谓∶太阳病，无汗而小便反少，（
内气虚寒，不
化液也。）气上冲胸，（寒气上逆。）口噤不得语，（寒气盛，故牙关紧急。）欲作刚痉，
葛根汤主之。（以
发散太阳、阳明之寒。）又谓∶胸满，（里热壅也。）口噤，卧不着席，（反张甚也。）
脚挛急， 齿，（牙
紧甚也。）可与大承气汤。（见大便不通。攻其热以救液。）又谓∶太阳病，其证备，身体强，
KTKT 然，（俯仰不能自如之象。）脉反沉迟，（应浮数，而反沉迟，是表里皆寒矣。加栝蒌根
何为？迟当作
数为是，不浮而沉数，则内热津干，故加栝蒌根也。）此为痉，栝蒌桂枝汤主之。（解太阳之表，加栝蒌根
以生津润燥。）又谓∶太阳病，项背强KT KT ，（太阳脉下项，循肩挟脊，阳明脉循喉咙，
入缺盆。）无汗恶
风，（此寒伤营证。）葛根汤主之。有汗恶风，（此风伤卫证。）桂枝加葛根汤主之。（较葛根
汤少麻黄一
味。以上身体强，背项强，将欲成痉，故用解表之剂，使郁热得伸，以免焚灼筋缩也。）又谓∶
太阳病发汗太
多，因致痉。又谓∶风病下之则痉。又谓∶疮家不可发汗，（指溃后言。）汗出则痉。（皆血
液伤损涸燥意。）又谓∶痉病有灸疮，难治。（血被灸益枯也。）合而观之，不出寒热二端，虚实
两途，治者取衷焉可也。
按寒热虽皆足以致痉，而多由于热，以热者火之有余也。火之有余，由水之不
足，故血液枯竭之人，（汗下过多，亡其津液，产后，失血后，大病后，血虚，小儿阴血未足。）
多患此。
以水虚无以制火，火盛而水愈亏也，此为内伤之证。若外感风寒湿气，不过为发热
痹痛等证，何遽致筋脉急缩，竟至头摇齿 腰反折之甚哉。仲景所言外感寒证，自
不多见，辛温发散之剂，勿轻用也。
《准绳》谓∶内热因外寒所郁则愈甚，甚则津液干燥而无汗，大小筋俱受热灼而
枯缩，故曰刚痉。若柔痉则为湿热相兼，《经》谓湿热大筋短，小筋长，又谓肺移热
于肾，传为柔痉。注云∶柔谓筋柔无力，痉谓骨强不随。则仲景所谓柔者，岂非小
筋得湿而弛长，所谓项背强反张者，岂非大筋得热而强直乎？后人乃以无
汗为表实，有汗为表虚，而用姜附温热等剂，宁不增大筋之热欤？其说虽未
尽合仲景之意，亦自可取。
《医宗金鉴》云∶六经皆有痉，身背属太阳，凡项背强急，脊腰反张，髀不可以
前曲， 如结者，太阳也。身前属阳明，头面动摇，口噤齿 ，缺盆纽痛，肘膝相
构，阳明也。身侧属少阳，口眼 斜，手足搐搦，两胁拘急，半身不遂，少阳
也。至若腹内拘急，因吐利后而四肢挛急，非太阴乎？尻以代踵，脊以代头，（脚挛不
能行，背曲不能伸意。）俯而不能仰者，非少阴乎？睾丸上升，少腹里急，囊缩舌卷，非厥
阴乎？按《经》言，足少阴之筋，主痫螈及痉，在外者（外，背也，肾筋之行于背者）不能俯，
在内者（内，身前也，肾筋之行于身前者）不能仰。又曰∶肾脉为病，脊强反折，
然则反张亦属
肾痉，（不独太阳为然矣。）不独能俯不能仰也。仲景谓∶痉脉按之紧如弦，直上下行。又
谓∶寒湿相搏，发汗已，其脉如蛇，（柔曲而不弦直。）为欲解。脉如故，反伏弦者，痉。
（从《金鉴》订定。）
治法∶火盛血虚者，当归、芍药、生地、红花、黄连、钩藤钩。兼气虚加人参，
兼痰加竹沥。金衰木旺，（壮火食气也。）先用泻青丸（见中风），后用异功散（见气）。独
肝火旺者，先用加味小柴胡汤，（见寒热。）次用四物汤（见血）。加柴胡、丹皮、山栀。郁热
用加味逍遥散（见郁）。若脾土受克，补中益气（见气）加芍药、山栀。脾土湿热，三一承气
汤（见大便不通）。肾虚，六味丸（见虚损）。太阴寒湿凝结腹痛，桂枝加芍药防己防风汤。手足
厥逆，附子散、桂心白术汤。
痉，即强直，是指筋脉收缩牵引、紧急拘挛，而不能舒展放松。导致这种情况的原因主要有两个：一是寒邪，筋脉遇到寒邪则血液冻结而坚凝，所以变得紧急；观察物体受寒凝固时必然僵硬强硬，就可以明白，这就是所谓的“寒性收引”。湿也属于寒的范畴，所以《黄帝内经》说各种痉病都归属于湿。二是热邪，热邪极盛会灼烧血液使其干枯，干枯则筋脉短缩，观察物体干枯时必然收缩，就可以明白。另外，《黄帝内经》说各种强直都归属于风，风有内风和外风之分，内风多由热产生，外风多由寒引起。《黄帝内经》说痿证属于湿热，是因为湿与热结合，所以筋脉松弛纵缓。（详见痿证章节。）而痉病则是湿与热分离，所以筋脉短缩。大概湿有寒湿和热湿之分，寒湿像水结冰一样凝结，所以筋脉坚强；热湿像糖稀熔化一样，所以筋脉柔软。没有湿只有热则筋脉干燥，有热又有湿则筋脉滋润。
《金匮要略》论述痉证时说：身体发热且怕冷，（这是伤寒证候。）颈项强直紧急，面部发红眼睛发红，（这是阳明证候。）头部发热脚部发凉，（这是因为阳气上升所致。）唯独头部摇动，（以下这些是痉证所独有的特征，所以用“独”字来区别它。）突然牙关紧闭，背部反张如弓形的，就是痉病。（太阳经脉循行于背部和头部，阳明经脉挟持口唇，寒邪客居这两条经脉，导致筋脉紧急从而出现上述症状。按此乃引用“寒性收引”的理论。然而热邪被寒邪郁遏，损伤血液使筋脉干枯，导致此类情况的也很多。）
又说：太阳病，无汗且怕冷，称为刚痉；（这是寒邪损伤营血，寒邪偏胜导致血液凝滞，筋脉收缩牵引的证候。）有汗且不害怕寒冷，称为柔痉。（出汗且不恶寒，属于温病，这是血液枯竭、筋脉干枯收缩的证候。）又说：太阳病，无汗而小便反而量少，（体内正气虚寒，不能化生津液。）气向上冲撞胸部，（寒气上逆。）牙关紧闭不能说话，（寒气盛，所以牙关紧急。）将要发作刚痉，用葛根汤主治。（用来发散太阳、阳明二经的寒邪。）又说：胸中胀满，（里热壅滞。）牙关紧闭，睡觉时背部反张不能着席，（反张程度很严重。）小腿抽筋拘急，牙齿咬紧，（牙关紧咬得很厉害。）可以给予大承气汤。（针对大便不通的情况。攻下热邪以救阴液。）又说：太阳病，证候具备，身体强直，俯仰动作不自然，（形容俯仰不能自如的样子。）脉象反而沉迟，（应当浮数，反而沉迟，说明表里皆寒。为什么要加栝蒌根？这里的“迟”字当作“数”字理解才对，如果不浮而呈沉数之象，则是内热津液干枯，所以要加栝蒌根。）这属于痉病，用栝蒌桂枝汤主治。（解太阳经表邪，加栝蒌根以生津润燥。）又说：太阳病，项背部强直不适，（太阳经脉下行至项部，沿肩胛挟脊而行，阳明经脉循喉咙，进入缺盆。）无汗且怕风，（这是寒邪损伤营血的证候。）用葛根汤主治。有汗且怕风，（这是风邪损伤卫气的证候。）用桂枝加葛根汤主治。（比葛根汤少一味麻黄。以上提到的身体强直、背项强直，都是即将形成痉病的征兆，所以使用解表的方剂，使郁积的热邪得以宣泄，以免火热焚烧灼伤导致筋脉收缩。）又说：太阳病发汗过多，因而导致痉病。又说：风病误用泻下法会导致痉病。又说：患有疮疡的人不可发汗，（指疮疡溃破之后而言。）如果发汗则会导致痉病。（这些都是因为血液受损枯竭干燥的意思。）又说：痉病患者如果有灸疮，难以治疗。（因为血液被艾灸进一步耗竭枯槁。）综合来看，不出寒热两个方面，虚实两条途径，治疗者以此为准绳即可。
按语：虽然寒和热都能导致痉病，但大多由于热邪，因为热是火气有余的表现。火气有余，是由于肾水不足，所以血液枯竭的人，（因发汗、泻下过多，丧失津液，产后，失血后，大病后，血虚，小儿阴血未充足等情形。）容易患此病。因为水虚无以制约火，火盛而水更加亏损，这属于内伤证候。如果是外感风寒湿气，不过表现为发热、痹痛等证候，怎么会迅速导致筋脉紧急收缩，甚至发展到头摇、齿紧、腰部反折这么严重的程度呢？仲景所说的外感寒证，其实并不常见，辛温发散的方剂不要轻易使用。
《医学准绳六要》说：内热因外寒郁遏则更加严重，严重时津液干燥而无汗，大小筋脉都受热邪灼烧而干枯收缩，所以称为刚痉。如果柔痉则是湿热相兼，《黄帝内经》说湿热导致大筋缩短、小筋伸长，又说肺将热邪转移给肾，传变为柔痉。注解说：柔是指筋脉柔弱无力，痉是指骨骼强直不受控制。那么仲景所说的“柔”，难道不是小筋得湿而弛长吗？所谓项背强直反张，难道不是大筋得热而强直吗？后人却认为无汗是表实，有汗是表虚，而使用姜附等温热药剂，岂不是增大大筋的热势吗？这种说法虽然不完全符合仲景的本意，但也自有可取之处。
《医宗金鉴》说：六经都会发生痉病，身背属于太阳经，凡是项背强直紧急，脊柱腰部反张，大腿不能向前弯曲，足跟如结聚般的，属于太阳经。身前属于阳明经，头面摇动，牙关紧闭牙齿咬紧，缺盆处扭结疼痛，肘膝相互靠拢，属于阳明经。身侧属于少阳经，口眼歪斜，手足抽搐，两胁拘急，半身不遂，属于少阳经。至于腹部拘急，在呕吐腹泻后出现四肢挛急，难道不是太阴经吗？臀部代替脚跟行走，脊柱代替头部前倾，（意思是脚挛缩不能行走，背部弯曲不能伸直。）只能俯不能仰的，难道不是少阴经吗？睾丸上缩，小腹内部拘急紧迫，阴囊收缩舌头卷曲，难道不是厥阴经吗？按《黄帝内经》所说，足少阴之筋，主司痫证抽搐及痉病，在外侧的（外，指背部，肾经之筋行于背部者）不能俯身，在内侧的（内，指身前，肾经之筋行于身前者）不能仰身。又说：肾脉为病，脊柱强直反折，那么反张也属于肾痉，（不仅仅局限于太阳经了。）不仅仅是能俯不能仰的问题。仲景说：痉病的脉象，按之紧如弦，上下直行。又说：寒湿相搏，发汗后，脉象如蛇般柔和弯曲（柔曲而不弦直），这是将要解除的迹象。脉象依旧，反而伏而弦直的，是痉病。（根据《医宗金鉴》订正。）
治疗方法：火盛血虚者，用当归、芍药、生地、红花、黄连、钩藤钩。兼气虚加人参，兼痰加竹沥。金衰木旺（壮火消耗元气），先用泻青丸（见中风章节），后用异功散（见气虚章节）。单纯肝火旺者，先用加味小柴胡汤（见寒热章节），次用四物汤（见血证章节）。加柴胡、丹皮、山栀。郁热用加味逍遥散（见郁证章节）。若脾土受克，用补中益气汤（见气虚章节）加芍药、山栀。脾土湿热，用三一承气汤（见大便不通章节）。肾虚，用六味丸（见虚损章节）。太阴寒湿凝结腹痛，用桂枝加芍药防己防风汤。手足厥冷逆乱，用附子散、桂心白术汤。
Jing (Spasm), meaning stiffness and rigidity, refers to the contraction, tension, and tightness of tendons and vessels, preventing them from relaxing and extending. There are two main causes for this condition: one is Cold. When tendons encounter Cold, the blood freezes and coagulates, becoming hard and rigid; thus, they become tense. Observing objects that freeze in the cold reveals their stiffness and rigidity, which illustrates the principle that "Cold causes contraction." Dampness also belongs to the category of Cold; therefore, the *Classic* states that all cases of Jing belong to Dampness. The second cause is Heat. Excessive Heat scorching the blood leads to dryness and withering; when dry, tissues shorten. Observing dried objects shows their shrinkage, illustrating this point. Furthermore, the *Classic* states that all stiffness and rigidity belong to Wind. Wind has internal and external aspects: internal Wind arises from Heat, while external Wind arises from Cold. The *Classic* states that Wei syndrome (flaccidity) belongs to Damp-Heat because Dampness and Heat combine, causing tendons and vessels to relax and slacken. (See detailed discussion in the Wei chapter.) In contrast, in Jing syndrome, Dampness and Heat are separated, leading to the shortening of tendons and vessels. Generally, there is Cold-Dampness and Heat-Dampness. Cold-Dampness congeals like ice water, resulting in hardness and strength; Heat-Dampness melts like syrup, resulting in softness. Without Dampness but with Heat, tendons become dry; with both Heat and Dampness, tendons remain moist.
The *Jin Gui Yao Lue* discusses Jing syndrome as follows: Body fever accompanied by aversion to cold (indicating a Shanghan/Taoyang pattern); stiff and urgent neck and occiput, red face, and red eyes (indicating a Yangming pattern); heat in the head and cold in the feet (due to the ascending nature of Yang Qi); isolated shaking of the head (the term "isolated" distinguishes these unique features of Jing syndrome); sudden lockjaw (trismus), and opisthotonos (back arching backward). This constitutes Jing disease. (The Taiyang meridian runs along the back and head, and the Yangming meridian flanks the mouth. When Cold pathogens invade these two meridians, tendons and vessels become tense, causing these symptoms. This interpretation relies on the principle that "Cold causes contraction." However, many cases arise where Heat is constrained by Cold, damaging the blood and drying the tendons.)
It further states: In Taiyang disease, absence of sweating with aversion to cold is called Gang Jing (Rigid Spasm). (This is a pattern where Cold injures the Ying level, Cold predominates, blood coagulates, and tendons contract.) Presence of sweating without aversion to cold is called Rou Jing (Soft Spasm). (Sweating without aversion to cold indicates a Wenbing/Warm Disease pattern, representing blood depletion and tendon dryness/shrinkage.) It also states: In Taiyang disease, if there is no sweating but urination is surprisingly scanty (indicating deficiency-cold internally failing to transform fluids), Qi rushes upward to the chest (Cold Qi rebelling upward), and the patient has lockjaw and cannot speak (excessive Cold causing jaw tension), impending Gang Jing should be treated with Gegen Tang (Pueraria Decoction) to disperse Cold in the Taiyang and Yangming meridians. If there is chest fullness (internal Heat stagnation), lockjaw, severe opisthotonos such that the back cannot touch the bed during recumbency, calf cramping, and severe teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be administered to address constipation by purging Heat to preserve Yin fluids. Regarding Taiyang disease where all symptoms are present, body stiffness, and awkward movement in flexion and extension (unable to move freely), with a pulse that is unexpectedly deep and slow (normally floating and rapid; a deep-slow pulse suggests interior-exterior Cold. Why add Gualou Gen? The character "slow" here likely implies "rapid"; a non-floating, deep-rapid pulse indicates internal Heat and fluid dryness, hence the addition of Gualou Gen). This is Jing syndrome, treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) to release the Taiyang exterior and generate fluids/moisten dryness using Gualou Gen. Regarding Taiyang disease with stiffness in the neck and back (Taiyang meridian descends to the neck, runs along the shoulders and spine; Yangming meridian follows the throat into the supraclavicular fossa), absence of sweating with aversion to wind (Cold injuring Ying level), Gegen Tang is indicated. Presence of sweating with aversion to wind (Wind injuring Wei level) is treated with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria). This formula lacks Mahuang compared to Gegen Tang. In cases of body stiffness or neck/back stiffness approaching spasm, exterior-releasing agents are used to vent constrained Heat, preventing it from scorching and contracting the tendons. It also states: Excessive sweating in Taiyang disease can induce Jing. Purging in Wind diseases can induce Jing. Patients with sores/ulcers should not undergo sweating therapy (referring to post-ulceration); inducing sweat will cause Jing. (All these scenarios involve damage, depletion, and drying of Blood.) If a Jing patient has moxibustion scars, the prognosis is poor (Moxibustion further depletes the Blood). Synthesizing these points, the etiology falls within Cold and Heat, and the pathology within Deficiency and Excess. Practitioners should judge accordingly.
Note: Although both Cold and Heat can cause Jing, most cases stem from Heat, as Heat represents excess Fire. Excess Fire arises from insufficiency of Water. Therefore, individuals with depleted Blood (due to excessive sweating/purging losing body fluids, postpartum state, after hemorrhage, after severe illness, blood deficiency, or insufficient Yin-Blood in children) are prone to this condition. Since Water fails to control Fire, Fire becomes excessive while Water diminishes further; this is an internal injury pattern. External contraction of Cold, Wind, or Dampness typically manifests only as fever, bi-syndrome (painful obstruction), etc., and does not rapidly lead to severe tendon contraction, head shaking, teeth grinding, or lumbar opisthotonos. Cases of external Cold described by Zhang Zhongjing are actually rare; practitioners should avoid lightly using acrid-warm dispersing formulas.
The *Zhun Sheng* states: Internal Heat exacerbated by external Cold constraint leads to severe dryness of body fluids and absence of sweat. Both large and small tendons are scorched by Heat, becoming dry and shortened, termed Gang Jing. Rou Jing involves a combination of Dampness and Heat. The *Classic* states that Damp-Heat causes large tendons to shorten and small tendons to lengthen. It also states that transferring Heat from Lung to Kidney results in Rou Jing. Annotations explain: "Rou" means tendons are weak and powerless; "Jing" means bones are rigid and uncontrolled. Thus, isn't Zhongjing's "Rou" referring to small tendons lengthening due to Dampness? And isn't the neck/back stiffness/opisthotonos referring to large tendons becoming rigid due to Heat? Later authors considered absence of sweat as Exterior Excess and presence of sweat as Exterior Deficiency, using warming agents like Ginger and Aconite. Would this not increase the Heat in the large tendons? Although this view does not fully align with Zhongjing's intent, it has merit.
The *Yi Zong Jin Jian* states: Jing can occur in all six meridians. The back belongs to Taiyang; any stiffness in neck/back, lumbar opisthotonos, inability to bend thighs forward, or heel-like knotting indicates Taiyang involvement. The front belongs to Yangming; head/facial shaking, lockjaw, supraclavicular pain, elbows/knees drawing together indicate Yangming involvement. The sides belong to Shaoyang; facial deviation, limb convulsions, hypochondriac tension, hemiplegia indicate Shaoyang involvement. Abdominal tension with limb cramping after vomiting/diarrhea indicates Taiyin involvement. Walking on buttocks instead of heels, spinal curvature replacing the head (inability to walk due to leg cramps, inability to straighten back), and inability to extend (only flex) indicates Shaoyin involvement. Testicular retraction, lower abdominal urgency, scrotal contraction, and tongue rolling indicate Jueyin involvement. According to the *Classic*, the Foot-Shaoyin tendon governs epilepsy spasms and Jing. The external part (back, where Kidney tendons run) cannot flex; the internal part (front, where Kidney tendons run) cannot extend. It also says: Kidney meridian disease causes spinal stiffness and opisthotonos. Thus, opisthotonos also belongs to Kidney Jing (not limited to Taiyang), involving more than just inability to extend. Zhongjing states: Jing pulses feel tight like a string, running straight up and down. He also notes: After sweating for Cold-Damp binding, if the pulse becomes snake-like (flexible, not string-taut), resolution is imminent. If the pulse remains unchanged, becoming hidden and string-tight, it is Jing. (Corrected per *Yi Zong Jin Jian*).
Treatment methods: For Fire excess and Blood deficiency, use Danggui (Angelica Sinensis), Shaoyao (Peony), Shengdi (Rehmannia), Honghua (Safflower), Huanglian (Coptis), and Gouteng (Uncaria). Add Renshen (Ginseng) for Qi deficiency; add Zhuli (Bamboo Sap) for Phlegm. For Metal deficiency and Wood hyperactivity (Strong Fire consumes Qi), first use Xieqing Wan (Drain Green Pill, see Stroke), then Yigong San (Benefit Power Powder, see Qi deficiency). For isolated Liver Fire hyperactivity, first use Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction, see Cold/Heat), then Siwu Tang (Four Substances Decoction, see Blood disorders), adding Chaihu (Bupleurum), Danpi (Moutan), and Shanzhi (Gardenia). For constrained Heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder, see Constraint). If Spleen Earth is suppressed, use Buzhong Yiqi Tang (Middle-Boosting Qi-Supplementing Decoction, see Qi deficiency) with Shaoyao and Shanzhi. For Spleen Earth Damp-Heat, use Sanyi Chengqi Tang (Three-One Order the Qi Decoction, see Constipation). For Kidney deficiency, use Liuwei Wan (Six-Ingredient Pill, see Deficiency). For Taiyin Cold-Damp coagulation with abdominal pain, use Guizhi Jia Shaoyao Fangji Fengfeng Tang (Cinnamon Twig Plus Peony, Stephania, and Saposhnikovia Decoction). For cold extremities/reversal, use Fuzi San (Aconite Powder) or Guixin Baizhu Tang (Cinnamon Heart and Atractylodes Macrocephala Decoction).