经义
诸痉项强，皆属于湿。○诸暴强直，皆属于风。○督脉为病，脊强反折。○肺移热于肾，传为柔痉。（《素问》）
足太阳之筋病，脊反折，项筋急，肩不举，腋支缺盆中纽痛，不可左右摇。○足少阴之筋病，主痫螈及
痉，在外者不能俯，在内者不能仰。故阳病者，腰反折不能俯；阴病者，不能仰。○经筋之病，寒则反折筋急；
热则筋弛纵不能收，阴痿不用。阳急则反折，阴急则俯不伸。○膀胱足太阳也，是动则病冲头痛，目似脱，项
似拔，脊痛，腰似折，髀不可以曲， 如结， 如裂，是为踝厥，是主筋所生病者。（《灵枢》）
哲言
太阳病，发热无汗，反恶寒者，名曰刚痉。○太阳病，发热汗出，而不恶寒者，名曰柔痉。○太阳病，发
汗太多，因致痉。○夫风病，下之则痉，复发汗，必拘急。○疮家虽身疼痛，不可发汗，汗出则痉。○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。○太阳病，其证备，身体
强KT KT 然，脉反沉迟，此为痉，栝蒌桂枝汤主之。○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。○痉为病，胸满口噤，卧不着席，脚挛急，必 齿，可与大承气汤。（《金匮》）
按反恶寒之反字，衍文也。玩痉病之条，自知当恶寒。（《医宗金鉴》）
夫痉者，强也。《素问》谓诸痉项强，皆属于湿，是病机颛主于湿矣。《千金》推展其义，谓太阳中风，
重感寒湿则变痉。见太阳中风，身必多汗。或衣被不更，寒湿内袭；或重感天时之寒，地气之湿，因而变痉，
是合风、寒、湿三者以论痉也。《金匮》以痉湿 名篇，又合热、暑、湿三者言之。然所谓刚痉、柔痉，未尝
不兼及风寒。且亦云发汗过多因致痉，见夏月人本多汗，尤不可过发其汗也。古今言痉之书止此。后世王海藏
论痉，知宗仲景，虽识有未充，要亦识大之贤矣。《伤寒论》载痉病五条，《尚论篇》中已明之。兹复详《金
匮》所增十条，其旨已悉。诚以仲景论痉病所举者，太阳一经耳。后之治此病者，谓太阳行身之背，故颈项强，
背反张，属在太阳，而用《金匮》桂枝、葛根二方，茫不应手，每归咎仲景之未备。不思外感六淫之邪，由
太阳而传六经，乃自然之行度。邪不尽，传即不已，故三阳、三阴皆足致痉。仲景之书，通身手眼虽未明言，
其引而不发之旨，未尝不跃然心目。如太阳之传阳明，项背KT KT ，少阳之颈项强，是知三阳皆有痉矣。而三阴
岂曰无之？海藏谓三阳、太阴皆病痉，独不及少阴、厥阴？然其制附子散、桂心白术汤、附子防风散，意原有
在。观其白术汤下云∶上解三阳，下安太阴，一种苦心，无非谓传入少阴、厥阴，必成死证耳。讵知传经之邪，
如风雨之来，而画地以限其不至，岂可得乎？况足少阴、厥阴之痉，不死者亦多。《灵枢》谓足少阴之经筋，
循脊内侠膂上至项，与足太阳筋合，病主痫螈及痉，在外阳病者不能俯，在内阴病者不能仰。是则足少阴之脏，
与足太阳之腑，两相联系，而以不能俯者，知为太阳主外；不能仰者，知为少阴主内，其辨精矣。《素问》亦
谓太阳者，一日而主外，则二日阳明，三日少阳之主外，从可识矣。少阴主内，则太阴、厥阴之主内，从可识
矣。仲景之所以头强、脊强不能俯者，指为太阳之痉，原以该三阳也；以身蜷、足蜷不能仰者，指为少阴之痉，
以该三阴。实则所谓引而不发，跃然心目者也。《素
问》谓肾痹者善胀，尻以代踵，脊以代头。形容少阴病俯而不能仰之状更着。海藏谓低头视下，肘膝相构，正
不能仰之阴病，及指为阳明之痉，立言殊有未确。况仲景谓∶少阴病下利，若利自止，恶寒蜷卧，手足温者可
治。又谓∶少阴病，恶寒而蜷，时自烦，欲去衣被者可治。言可用温以治之也。然仲景于太阳证独见背恶寒者，
无俟其身蜷，早以从阴急温，而预救其不能仰。于少阴证而见口燥咽干，及下利纯清水者，无俟背项牵强，早
已从阳急下，而预救其不能俯。此皆神而明之之事。后代诸贤，非不心维其义，究莫能口赞一辞。即如小儿之
体脆神怯，不耐外感壮热，多成痉病。后世妄以惊风立名，凿说不治外淫之邪，反投金石、脑、麝之药，千中
千死而不悟也。又如产妇血舍空虚，外风袭入而成痉病，辄称产后惊风，妄投汤药，亦千中千死而不悟也。（喻嘉言）
痉病者，风湿合病也。风兼乎湿，则为柔痉，以风阳合湿阴而风多，为阳盛之柔病也。风兼乎湿，又感乎
寒，则为刚痉，以风一阳合寒湿二阴，为阴盛之刚病也。阳本刚而阴本柔，以反言之，乃就其质而言之也。气
本乎天，故阳刚而阴柔；质本乎地，故阴刚而阳柔，一定之理也。是柔痉固有风，而刚痉亦有风，无风则非痉
病矣。若无风而寒湿相合感人，是另有湿痹之证在矣。凡痉病俱见风象，无风无痉，不容疑焉。○再痉病者，
三阳经病也。感于身之后，太阳所行也；感于身之前，阳明所行也。以人身之胸背为阴阳，而非以六经分阴阳
也。凡言三阴有痉证者，非仲景原文所有，不敢信也。○再痉病，经病；非脏腑病也。风湿之邪，中于太阳，
虽在卫，而脉之外为湿所濡滞矣；风湿挟寒之邪，中于太阳，虽在营，而脉之内为湿所浸淫矣。脉者，人之正
气、正血所行之道路也。杂错乎邪风、邪湿、邪寒，则脉行之道路，必阻塞壅滞，而拘急HT 挛之证见矣。是病
悉在人经络隧道中为患耳，虽与脏腑相属，而究不同于病在脏腑，故曰经病也。凡言及脏腑内阴阳亏足者，止
可推求本原而论之，若竟言为脏腑
病，非仲景原文所有，不敢信也。○再痉病仍终在三阳，虽有里证应下之条，而并无传经之痉病也。痉病有
戚施终身患之者，若言传经，何日为经尽乎？若如所云递传三阳三阴，亦同伤寒，则何经可以支吾病邪至于一
生不匮？可知为无据之言也。其里证应下者，乃风寒挟湿，郁阳于表，而内热生焉。如太阳外感风寒，内郁生
热之义，经谓湿上甚为热是也。热甚于里，不容不下。下者，下其瘀塞之热，沾滞之湿，并与阳明胃腑无涉也。
所以仲景言证，全无由脏腑而发者，皆就筋络肢体间示人，何得云痉病同于伤寒之传经，动关脏腑乎？故有终
身为患之痉病，必无经久不匮之伤寒。伤寒传经之邪入脏腑，旦夕不可待，岂痉病传经之邪，独能久延耶？此
传经之说，不本于仲景，尤不可信者也。○或谓痉病无属于脏腑。然风热盛而阴必亏，寒湿盛而阳亦微，不理
其脏腑，将终从经络为治乎？答曰∶阴亏者济阴，阳微者扶阳，凡病皆然，何独于痉有异焉？独是济阴扶阳，
虽属治脏腑，不过从其本治，俾治标易为力耳。若夫标治，则仍以驱风寒、除湿热为义，不外用法于经而已。
仲景所以言痉病，必就标病定名、分证，而于脏腑之本未尝言及，是究不可谓痉病为脏腑之病，故仲景终不从
脏腑立论也。倘明理者详审标本之间，以痉病为在经、为标病，而治其标；以脏腑为在里、为本病，而治其本。
治其本正所以治其标，又何脏腑之不可通言耶。（魏荔彤）
痉者，强直之名，即秋时燥金之邪，入于经筋而为病也。长夏之时，湿热内淫，经筋受病，更遇秋金干燥
肃杀之气乘之，则颈项强急矣。邪在表故身热，热上逼故足寒，阳虚邪乘于表故恶寒，燥热之气上逼故头热面
赤，颈项强急故头面摇动。阳明之筋脉，内结胃口，外行胸中，过人迎环口；太阳之筋脉，循项背上
头。燥热伤阳明，则筋脉牵引而口噤不得语；燥热伤太阳，则背反张如弓。盖燥热之时，汗多而表虚，故津液
少而筋脉易于强直也。此证世多误作惊风治之，妇人、小儿坐此殒命者多矣，总缘不识痉病故也。○燥者天之
气，湿者地之气。燥之与湿，天壤悬矣。而《内经》谓诸痉项强，皆属于湿，从其受病之本而言也。夏秋之交，
本湿而标燥。湿则伤阳明而热蒸于内，燥则伤太阳而热侵于外。邪逼两经之界，故颈项因而强急，为湿热兼燥
化之病。《经》曰∶湿热不攘，大筋 短，小筋弛长。谓湿热伤筋也。又曰∶赫曦之纪，上羽其病痉。言热为
寒抑，无汗之痉也。又曰∶肺移热于肾，传为柔痉。言湿蒸于热，有汗之痉也。《千金》谓温病热入于肾，则
为痉；小儿病痫，热甚亦为痉。惜乎痉之名义详于圣经，后世俱不识为何病也。（程扶生）
六气为病，皆能发热。然寒与湿相因，暑与湿相从，独燥与湿相反。湿病多得之地气，燥病多得之内因，
此病因之殊同也。病机十九条燥证独无，若诸痉项强，皆属于湿，愚窃疑之。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，则头强急，项背KT KT ，脊强
反张，腰似折，髀不可以曲， 如结，皆其证也。身之前者属阳明，头面动摇，口噤齿 ，缺盆扭痛，脚挛急，
皆其证也。身之侧者属少阳，口眼 斜，手足牵引，两胁拘急，半身不遂，皆其证也。若腹内拘急，因吐利而
四肢拘急者，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，其证发热、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，其脉则沉迟，其状则项背强KT KT ，此得之地气，《内经》所
云诸痉项强，皆属于湿者是也。其势软弱，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，必夹杂于他证之中。人之病此者，世医但指为风，所以不明其理。善医者，必于他证
中审察而预防之。如项强痛，即痉之一端，是太阳之血虚，故筋急也。治风寒不惜津液，所以发汗太多，因致
痉者多矣。夫痉本有由来，一经妄治，即奇形毕见。项背强KT KT ，是痉之征兆，故用葛根；身体强是痉之已着，
故用栝蒌根；卧不着席，脚挛急，口噤齿 ，是痉之剧甚，故用大黄、芒硝。无非取多津液之品，以滋养阴血。
观伤寒脉浮自汗，心烦恶寒，而见脚挛急，是痉之势成。盒饭滋阴存液，故与桂枝汤则厥作，芍药甘草汤其脚
即伸，此明验矣。若谵语者，少与调胃承气，是又与不着席者与大急气汤，同此机彀也。凡痉之为病，因外邪
伤筋者少，因血虚筋急者多。误作风治，则辛散助阳，真阴愈虚；燥剂驱风，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？非调治营卫，未易奏捷也。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，痉湿异形，虚实亦殊。固不得妄以痉属风，亦不得以因于湿而竟视痉为湿矣。（柯韵伯）
夫人之筋，各随经络退出于身。血气内虚，外为风、寒、湿、热之邪所中则痉。盖风散气，故有汗而不恶
寒，曰柔痉；寒泣血，故无汗而恶寒，曰刚痉。其因多由亡血，筋无所荣，故邪得以袭之。所以伤寒汗、下过
多，与夫病疮及产后致斯疾者，概可知矣。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。（陈无择）
生生子曰∶丹溪云， 当作痉，传写之误耳。考之诸书，未
有能辨之详确者，惟郭雍氏云，痉与 ，当是二病。以时发者谓之痉，不以时发者谓之 ，似亦未能详悉。愚
按《灵》、《素》、仲景诸书，云 、云痉，字虽两般，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。痉者，劲急也，是以其
病发之状而名之也。不然，何历代诸公或以治 之方治痉，或以治痉之方治 ，诸皆能效。治既同而不殊，证
当一而不二。○《经》云∶肺移热于肾，传为柔 。 古云痉，劲切之谓也。仲景《伤寒》书以为太阳风湿所
致，亦有兼阳明经者。又谓汗、下过多，及疮家发汗过度，皆成痉。此指外感之邪，原系伤寒家法也。陈无择、
张子和诸公云∶亦有风、火、痰、热之内因者。谓此病多由亡血，筋无所荣，故邪得以所袭。丹溪谓比痫为虚，
此皆指内伤之证也。观刚、柔二字，则亦当有虚、实之别。大抵刚者多从外感，柔者多从内伤。故治斯疾者，
但明知从外感而来，则用仲景《伤寒》家法；若从杂证而来，则用无择、丹溪、宗浓、子和诸家之法。庶几表
【经文原义】
各种痉病出现颈项强直，大都归属于湿邪。○突然发生的肢体强直，大都归属于风邪。○督脉发生病变，会出现脊柱强直、身体向后反折。○肺部的热邪转移至肾脏，传变成为柔痉。（出自《素问》）
足太阳膀胱经的筋脉发生病变，会出现脊柱向后反折，颈项部筋脉拘急，肩膀不能抬起，腋下及锁骨上窝部位牵拉疼痛，头部不能左右转动。○足少阴肾经的筋脉发生病变，主要导致癫痫抽搐和痉病，在体表的阳分发病则身体不能前俯，在体内的阴分发病则身体不能后仰。所以阳分发病者，腰部向后反折而不能前俯；阴分发病者，身体不能后仰。○经筋发生病变，受寒则筋脉拘挛反折；受热则筋脉松弛纵缓而不能收缩，导致阳痿不用。阳气侧拘急则身体向后反折，阴气侧拘急则身体前俯而不能伸展。○膀胱属于足太阳经，如果经脉变动，就会发生冲头痛，眼睛像要脱出，颈项像被拔起，脊柱疼痛，腰部像折断，大腿不能弯曲，小腿肚像被捆绑一样僵硬，又像撕裂一样疼痛，这称为踝厥，这是该经主治的筋脉所生的疾病。（出自《灵枢》）
【名家论述】
太阳病，发热且无汗，反而恶寒的，称为刚痉。○太阳病，发热且有汗出，但不恶寒的，称为柔痉。○太阳病，发汗过多，因此导致痉病。○患有风病的人，如果误用攻下法会导致痉病，如果再发汗，必然导致肢体拘急。○患有疮疡的人，即使身体疼痛，也不可以发汗，如果发汗导致津液亏损，就会引发痉病。○患者身体发热而脚冷，颈项强直拘急，恶寒，有时头部发热、面色发红、眼睛发红，只有头部动摇，突然牙关紧闭，背部向后反张的，这是痉病。○太阳病，症状具备，身体强直僵直，脉象反而沉迟，这是痉病，用栝蒌桂枝汤主治。○太阳病，无汗且小便反而量少，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。○痉病表现为胸满、牙关紧闭，睡觉时背部不能接触床席，脚部抽筋拘急，必定磨牙，可以给予大承气汤。（出自《金匮要略》）
按：原文中“反恶寒”的“反”字，是衍文（多余的字）。研读痉病的条文，自然知道应当是恶寒的。（出自《医宗金鉴》）
所谓痉，就是强直的意思。《素问》说各种痉病颈项强直都归属于湿，说明病机主要在于湿。《千金方》推展其含义，认为太阳中风证，如果再感受寒湿就会变成痉病。看到太阳中风证，身体必然多汗。或者衣服被子不更换，寒湿从内部侵袭；或者再次感受天气的寒冷、地气的湿气，因而变成痉病，这是结合风、寒、湿三者来论述痉病。《金匮要略》以“痉湿暍”名篇，又结合了热、暑、湿三者来说明。然而所谓的刚痉、柔痉，未尝不涉及风寒。并且也说发汗过多导致痉病，说明夏季人们本来就容易出汗，尤其不可过度发汗。古今关于痉病的书籍仅此而已。后世王海藏论述痉病，知道尊崇张仲景，虽然见识不够全面，但也算是具有宏大见识的贤者了。《伤寒论》记载了五条痉病条文，《尚论篇》中已经阐明。这里再详细列举《金匮要略》增加的十条，其主旨已经完全知晓。确实因为张仲景论述痉病所举出的例子，只涉及太阳一经罢了。后来治疗此病的人，认为太阳经行于人体背部，所以颈项强直、背部反张，属于太阳经，于是使用《金匮要略》中的桂枝汤、葛根汤两方，却茫然无效，往往归咎于张仲景的理论不完善。却不思考外感六淫之邪，由太阳经传入其他六经，这是自然的传变规律。邪气不除，传变就不会停止，所以三阳经、三阴经都足以导致痉病。张仲景的书中，通篇的手眼虽未明言，但其引而不发的旨意，未尝不在心中清晰可见。如太阳经传入阳明经，出现项背强直；少阳经出现颈项强直，这就知道三阳经都有痉病了。那么三阴经难道就没有吗？海藏说三阳经、太阴经都会病痉，唯独不及少阴经、厥阴经？然而他制定的附子散、桂心白术汤、附子防风散，意图原本就在这里。看他的白术汤下面说：“上解三阳，下安太阴”，一片苦心，无非是说邪气传入少阴、厥阴，必然成为死证罢了。哪里知道传经的邪气，像风雨一样袭来，却画地为牢限制它不到达，怎么可能呢？况且足少阴、厥阴经的痉病，不死的情况也很多。《灵枢》说足少阴经的经筋，沿着脊柱内侧夹着脊肉上行至项部，与足太阳经的筋汇合，病变主要导致癫痫抽搐和痉病，在体表阳分发病则不能前俯，在体内阴分发病则不能后仰。这说明足少阴脏与足太阳腑，两者相互联系，通过不能前俯，知道是太阳主外；通过不能后仰，知道是少阴主内，这种辨析非常精微。《素问》也说太阳经一天主表外，那么第二天阳明、第三天少阳主表外，就可以推知了。少阴主里内，那么太阴、厥阴主里内，也可以推知了。张仲景之所以将头强、脊强不能前俯指为太阳痉，原本是为了涵盖三阳经；将身体蜷缩、脚蜷缩不能后仰指为少阴痉，是为了涵盖三阴经。这实际上是所谓引而不发，在心中清晰可见的道理。《素问》说肾痹的人善于腹胀，屁股代替脚跟走路，脊柱代替头部直立。形容少阴病俯身不能仰起的状况更加明显。海藏说低头向下看，手肘膝盖相碰，正是不能仰起的阴病，却将其指为阳明痉，立论特别不准确。况且张仲景说：少阴病下利，如果腹泻自止，恶寒蜷卧，手足温暖的可以治疗。又说：少阴病，恶寒而蜷缩，时常自觉烦躁，想要去掉衣被的可以治疗。说的是可以用温法来治疗。然而张仲景在太阳证中唯独见到背恶寒的，不需要等到身体蜷缩，早就从阴寒急温，预先挽救其不能仰起的状况。在少阴证中见到口燥咽干，以及下利纯清水的，不需要等到背项牵强，早就从阳热急下，预先挽救其不能俯身的状况。这些都是神妙明察的事情。后代的贤人，并非不心中思考其义理，终究不能口头称赞一句。就像小儿体质脆弱神气怯懦，不耐受外感壮热，多形成痉病。后世胡乱以惊风立名，不探究治疗外淫之邪，反而投用金石、冰片、麝香等药物，千次治疗千次死亡而不醒悟。又如产妇血室空虚，外风侵入而成痉病，辄且称为产后惊风，胡乱投药，也是千次治疗千次死亡而不醒悟。（喻嘉言）
痉病，是风湿合病。风兼夹湿，就称为柔痉，因为风属阳合湿属阴而风多，属于阳盛之柔病。风兼夹湿，又感受寒，就称为刚痉，因为风一阳合寒湿二阴，属于阴盛之刚病。阳本来刚强而阴本来柔和，反过来这样说，是从其性质而言的。气本乎天，所以阳刚而阴柔；质本乎地，所以阴刚而阳柔，这是一定的道理。所以柔痉固有风邪，而刚痉也有风邪，没有风邪就不是痉病了。如果没有风邪而寒湿相结合感人，那是另外有湿痹的病证存在。凡是痉病都见到风象，无风无痉，不容怀疑。○再说痉病，是三阳经的病。邪气感受于人身之后，是太阳经所行的部位；邪气感受于人身之前，是阳明经所行的部位。以人身的前胸后背为阴阳，而不是以六经来分阴阳。凡是说三阴有痉证的，不是张仲景原文所有，不敢相信。○再说痉病，是经络病，不是脏腑病。风湿之邪，中于太阳经，虽然在卫分，但脉管之外被湿邪濡滞；风湿挟寒之邪，中于太阳经，虽然在营分，但脉管之内被湿邪浸淫。脉，是人体正气、正血运行的道路。混杂了邪风、邪湿、邪寒，那么脉运行的道路，必然阻塞壅滞，而出现拘急痉挛的症状。这个病全是在人的经络隧道中为患罢了，虽然与脏腑相关联，但终究不同于病在脏腑，所以说它是经病。凡是提到脏腑内阴阳亏虚不足的，只可以推求本源来论述它，如果竟说是脏腑病，不是张仲景原文所有，不敢相信。○再说痉病最终仍在三阳，虽然有里证应当攻下的条文，但并没有传经的痉病。痉病有终身患病的人，如果说传经，哪一天才算经尽呢？如果像所说的那样递传三阳三阴，也同伤寒一样，那么哪一经可以支撑病邪直到一生不穷尽？可知这是没有根据的话。那些里证应当攻下的，乃是风寒挟湿，郁遏阳气于体表，从而产生内热。如太阳外感风寒，内部郁而生热的意义，经文说湿邪在上部严重就会化热。热势在内部严重，不容不下。下法，是下其瘀塞的热，沾滞的湿，这与阳明胃腑无关。所以张仲景论述证候，完全没有由脏腑发出的，都是就在筋络肢体间示人，怎么能说痉病同于伤寒的传经，动不动就关系到脏腑呢？所以有终身为患的痉病，必定没有经久不穷尽的伤寒。伤寒传经的邪气入脏腑，旦夕之间不可等待，难道痉病传经的邪气，独能长久拖延吗？这个传经的说法，不基于张仲景，尤其不可信。○有人说痉病不属于脏腑。然而风热盛则阴必亏，寒湿盛则阳亦微，不调理其脏腑，将始终从经络治疗吗？回答说：阴亏者济补阴，阳微者扶持阳，凡病都是这样，为何唯独对痉病有差异呢？只是济阴扶阳，虽然属于治脏腑，不过是顺从其根本治疗，使治疗标症容易用力罢了。至于标症治疗，仍然以驱除风寒、除湿清热为义，不外乎用法于经络而已。张仲景之所以论述痉病，一定就标病定名、分证，而对于脏腑的根本未曾提及，这终究不可以说痉病是脏腑的病，所以张仲景最终不从脏腑立论。如果明白事理的人详细审察标本之间，以痉病为在经、为标病，而治其标；以脏腑为在里、为本病，而治其本。治其本正是为了治其标，又有什么脏腑不可通说的呢？（魏荔彤）
痉，是强直的名词，即秋季燥金之邪，进入经筋而为病。长夏之时，湿热内淫，经筋受病，更遇到秋季金气干燥肃杀之气乘虚而入，就会颈项强直拘急。邪气在表所以身体发热，热气上逼所以脚冷，阳虚邪气乘于表所以恶寒，燥热之气上逼所以头部发热、面色红、眼睛红，颈项强直所以头面摇动。阳明经的筋脉，内部结聚胃口，外部行于胸中，过人迎环绕口唇；太阳经的筋脉，循行项背到头。燥热损伤阳明，则筋脉牵引而牙关紧闭不能说话；燥热损伤太阳，则背部反张像弓一样。大概燥热之时，汗多而表虚，所以津液少而筋脉易于强直。这个病症世人多误作惊风治疗，妇人、小儿因此丧命的很多，总缘于不认识痉病。○燥是天之气，湿是地之气。燥与湿，天地悬殊。而《内经》说各种痉病颈项强直都归属于湿，是从其受病的本源来说的。夏秋之交，本湿而标燥。湿则损伤阳明而热蒸于内，燥则损伤太阳而热侵于外。邪气逼迫两经的界限，所以颈项因而强直，这是湿热兼燥化的病。《经》说：湿热不除，大筋缩短，小筋弛长。说的是湿热伤筋。又说：赫曦之纪（火运太过之年），上羽（水气制约），其病为痉。说的是热被寒抑制，无汗的痉病。又说：肺移热于肾，传为柔痉。说的是湿蒸于热，有汗的痉病。《千金方》说温病热入于肾，则为痉；小儿患痫病，热甚也为痉。可惜痉的名义在圣经中详备，后世都不认识这是什么病。（程扶生）
六气致病，都能发热。然而寒与湿相因，暑与湿相从，唯独燥与湿相反。湿病多得之地气，燥病多得之内因，这是病因的不同。病机十九条中燥证独缺，我私下怀疑“诸痉项强，皆属于湿”这句话。现在本论有痉湿之分，又说：太阳病，发汗太多，因此致痉。那么痉属于燥无疑了。夫痉以状态命名，是因为血虚而筋急。六气为患，都足以导致痉病，然而不热则不燥，不燥则不成痉。六经都有痉病，须审察部位来区别。身体以后者属太阳，则头强急，项背强直，脊强反张，腰像折断，大腿不能弯曲，小腿肚像被捆绑，都是其证候。身体以前者属阳明，头面动摇，牙关紧闭磨牙，缺盆扭痛，脚抽筋拘急，都是其证候。身体侧面者属少阳，口眼歪斜，手足牵引，两胁拘急，半身不遂，都是其证候。如果腹内拘急，因吐利而导致四肢拘急的，是太阴痉。恶寒蜷卧，屁股代替脚跟，脊柱代替头部，俯身不能仰起的，是少阴痉。睾丸上升，宗筋下注，少腹里急，阴中拘挛，膝胫拘急的，是厥阴痉。如果痉病挟风寒，其证候发热、无汗而恶寒，气上冲胸而小便少，其脉必坚紧，其状必强直而牙关紧闭，这是得之于天气，《内经》所说的“诸暴强直，皆属于风”就是这样。其势勇猛，所以叫刚痉。病因外来，当驱逐邪气而解表。痉有病邪从内生而为患的，其邪从内出，所以发热、汗出而不恶寒，其脉则沉迟，其状则项背强直，这是得之于地气，《内经》所说的“诸痉项强，皆属于湿”就是这样。其势软弱，故名柔痉。病因于内，当滋阴以调和内在。要知道属风的痉，不因风而因热；属湿的痉，不因湿而因燥。治风以葛根为主药，治湿以栝蒌根为主药，不是为了治风，实在是为了生津；不是为了治湿，实在是为了润燥。夫痉的开始，本来不是正病，必须夹杂在其他证候之中。人得此病，世医只指为风，所以不明白其理。善医者，必须在其他证候中审察而预防它。如项强痛，就是痉的一个端绪，这是太阳经血虚，所以筋急。治疗风寒不惜津液，所以发汗太多，因此致痉的很多。夫痉本有由来，一经误治，就奇形毕现。项背强直，是痉的征兆，所以用葛根；身体强直是痉已显著，所以用栝蒌根；卧不着席，脚抽筋拘急，牙关紧闭磨牙，是痉的剧烈严重，所以用大黄、芒硝。无非取多津液的物品，以滋养阴血。看伤寒脉浮自汗，心烦恶寒，而见脚抽筋拘急，是痉的形势已成。应当滋阴存液，所以给桂枝汤则厥逆发作，给芍药甘草汤其脚即刻伸展，这是明显的验证。如果谵语的，少量给予调胃承气汤，又是与给卧不着席者以大承气汤，同样的机理。凡痉之为病，因外邪伤筋的少，因血虚筋急的多。误作风治，则辛散助阳，真阴愈虚；燥剂驱风，血液愈枯竭。所以痉得之暴起的少，误治而致的多。虚而不补，不死何待？不调治营卫，不容易见效。同一湿邪，湿去燥极则为痉，久留附着则为痹，痹为实，痉为虚，痉湿形态不同，虚实也殊异。固然不能妄以痉属风，也不能因为因于湿而竟视痉为湿。（柯韵伯）
人的筋，各自随着经络显露于身体。血气内部虚弱，外部被风、寒、湿、热之邪所中则成痉。大概风散气，所以有汗而不恶寒，叫柔痉；寒凝血，所以无汗而恶寒，叫刚痉。其原因多由亡血，筋脉无所荣养，所以邪气得以侵袭。所以伤寒汗、下过多，以及患疮疡及产后导致此疾的，概可知道了。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。两种证候各异，不可不辨别。（陈无择）
生生子说：丹溪说“痓”当作“痉”，是传写之误。考证诸书，未有能辨别的详细确切的，只有郭雍氏说，痉与痓，应当是两种病。按时发作的叫痉，不按时发作的叫痓，似乎也不能详尽。我考察《灵枢》、《素问》、张仲景诸书，说痓、说痉，字虽两样，治疗大多雷同，大概也不必强行分为二种。大概痓是病名，痉是病状，原本有刚、柔两种。以病发之时，而经筋脉络僵劲，角弓反张，所以叫痉。痉，就是劲急的意思，是以其病发之状来命名的。不然，为什么历代诸公有的用治痓的方子治痉，有的用治痉的方子治痓，都有效验。治疗既然相同而没有区别，证候应当一致而不二。○《经》说：肺移热于肾，传为柔痓。古云痉，是劲切的意思。张仲景《伤寒论》认为是太阳风湿所致，也有兼阳明经的。又说汗、下过多，及疮家发汗过度，都成痉。这是指外感之邪，原本是伤寒家的法度。陈无择、张子和诸公说：也有风、火、痰、热的内因。说此病多由亡血，筋脉无所荣养，所以邪气得以侵袭。丹溪说比痫病为虚，这都是指内伤的证候。看刚、柔二字，则也应该有虚、实的区别。大概刚者多从外感，柔者多从内伤。所以治此疾的人，只要明知从外感而来，就用张仲景《伤寒论》家法；若从杂证而来，就用无择、丹溪、宗浓、子和诸家的方法。这样就可以表里兼顾……
[Scriptural Meaning]
Various cases of Jing disease (spasm) presenting with neck and nape stiffness are generally attributed to Dampness. ○ Sudden onset of limb rigidity is generally attributed to Wind. ○ When the Du vessel (Governing Vessel) is diseased, it causes spinal stiffness and opisthotonos (backward bending of the body). ○ Heat in the Lung transferring to the Kidney transmits into Rou Jing (Soft Spasm) [characterized by sweating]. (From *Su Wen*)
Diseases of the sinews of the Foot-Taiyang (Bladder) meridian cause backward bending of the spine, stiffness of the neck sinews, inability to raise the shoulders, pulling pain in the axilla and supraclavicular fossa, and inability to turn the head left or right. ○ Diseases of the sinews of the Foot-Shaoyin (Kidney) meridian primarily manifest as epilepsy, convulsions, and Jing disease. When affecting the exterior (Yang aspect), the body cannot bend forward; when affecting the interior (Yin aspect), the body cannot lean back. Thus, Yang diseases result in lumbar hyperextension preventing flexion; Yin diseases result in inability to extend backwards. ○ Sinew diseases caused by Cold lead to reversed bending and tendon cramping; those caused by Heat lead to flaccid relaxation of tendons preventing contraction, resulting in impotence and dysfunction. Cramping on the Yang side causes backward bending; cramping on the Yin side causes forward flexion preventing extension. ○ The Bladder belongs to the Foot-Taiyang meridian. If the meridian moves abnormally, it causes headache striking upward, eyes feeling as if protruding, neck feeling as if being pulled, spinal pain, waist feeling as if broken, thighs unable to bend, calf muscles feeling bound like a knot and torn like a split, known as Huai Jue (Ankle Reversal). This governs the diseases generated by the sinews. (From *Ling Shu*)
[Masters' Discourses]
Taiyang disease, with fever and no sweat, yet paradoxically aversion to cold, is named Gang Jing (Hard Spasm). ○ Taiyang disease, with fever and sweating, but without aversion to cold, is named Rou Jing (Soft Spasm). ○ In Taiyang disease, excessive sweating leads to Jing disease. ○ For patients with Wind disease, purgation induces spasm; subsequent sweating causes inevitable cramping. ○ Patients with sores/ulcers, even if experiencing body pain, must not be sweated; inducing sweat leads to spasm. ○ A patient with body heat but cold feet, stiff and rigid neck, aversion to cold, occasional head heat, red face, red eyes, isolated head tremor, sudden lockjaw, and opisthotonos has Jing disease. ○ Taiyang disease with complete symptoms, stiff body, and a pulse that is unexpectedly deep and slow indicates Jing disease, treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction). ○ Taiyang disease with no sweat and unusually scanty urination, Qi rushing to the chest, lockjaw preventing speech, indicating impending Gang Jing, is treated with Gegen Tang (Kudzu Decoction). ○ Jing disease presenting with chest fullness, lockjaw, inability to lie flat (back touching the bed), leg cramps, and teeth grinding can be treated with Dachengqi Tang (Major Order the Qi Decoction). (From *Jin Gui Yao Lue*)
Note: The character "fan" (paradoxically/reversely) in "fan ewhan" (paradoxically aversion to cold) is a superfluous character. Studying the clauses on Jing disease reveals that aversion to cold should naturally be present. (From *Yi Zong Jin Jian*)
Jing refers to stiffness. *Su Wen* states that all neck stiffness in Jing belongs to Dampness, implying the pathogenesis is primarily Dampness. *Qian Jin Fang* expands on this, stating that Taiyang Wind-stroke, compounded by Cold-Dampness, transforms into Jing. Observing Taiyang Wind-stroke involves profuse sweating. If clothing/bedding is not changed, Cold-Dampness invades internally; or if exposed to climatic Cold and Earthly Dampness, Jing ensues. This combines Wind, Cold, and Dampness to discuss Jing. *Jin Gui Yao Lue* titles its chapter "Jing, Shi, and Yue," combining Heat, Summer-heat, and Dampness. However, Gang Jing and Rou Jing do involve Wind-Cold. It also notes excessive sweating causes Jing, implying that in summer, when people naturally sweat, one must not induce excessive sweating. Ancient and modern texts on Jing are limited to these. Later, Wang Haizang discussed Jing, respecting Zhang Zhongjing; although his understanding was incomplete, he possessed broad insight. *Shang Han Lun* records five clauses on Jing, clarified in *Shang Lun Pian*. Here, we detail the ten additional clauses from *Jin Gui*, whose purport is now clear. Indeed, Zhang Zhongjing’s discussion of Jing focuses solely on the Taiyang meridian. Later practitioners, noting Taiyang runs along the back, attribute neck stiffness and opisthotonos to Taiyang, using Guizhi Tang and Gegen Tang from *Jin Gui*, yet fail clinically, blaming Zhang for incompleteness. They fail to realize that external Six Excesses transmit from Taiyang through the Six Meridians naturally. If pathogens remain, transmission continues; thus, all Three Yang and Three Yin meridians can cause Jing. Although Zhang does not explicitly state this, his implicit meaning is clear. Transmission from Taiyang to Yangming presents with neck/back stiffness; Shaoyang presents with neck stiffness, proving all Three Yang have Jing. Do not Three Yin lack it? Haizang mentions Taiyang, Shaoyang, Yangming, and Taiyin causing Jing, omitting Shaoyin and Jueyin. Yet his formulas—Fuzi San, Guixin Baizhu Tang, Fuzi Fengxin San—imply intent. His note on Baizhu Tang says "resolve Three Yang above, stabilize Taiyin below," showing his concern that transmission to Shaoyin/Jueyin becomes fatal. But how can one limit spreading pathogens like wind and rain? Moreover, many Shaoyin/Jueyin Jing cases survive. *Ling Shu* states Foot-Shaoyin sinews run along the spine to the neck, merging with Foot-Taiyang. Disease manifests as epilepsy/spasm; exterior/Yang disease prevents flexion, interior/Yin disease prevents extension. This shows Foot-Shaoyin organ and Foot-Taiyang腑 are connected; inability to flex indicates Taiyang exterior; inability to extend indicates Shaoyin interior. This distinction is precise. *Su Wen* says Taiyang governs exterior on day one; thus, Yangming/Shaoyang governing exterior on days two/three is inferred. Shaoyin governs interior; thus, Taiyin/Jueyin governing interior is inferred. Zhang attributes head/spine stiffness preventing flexion to Taiyang Jing to encompass Three Yang; body/leg curling preventing extension to Shaoyin Jing to encompass Three Yin. This is his method of leading without revealing fully. *Su Wen* describes Shen Bi (Kidney Bi) as frequent bloating, sitting on buttocks instead of heels, spine replacing head, describing Shaoyin inability to extend. Haizang identifies bowing head, elbows/knees touching as Yin disease unable to extend, yet labels it Yangming Jing, which is inaccurate. Zhang says: Shaoyin disease with diarrhea stopping, aversion to cold, curling up, warm hands/feet is treatable. Also: Shaoyin with aversion to cold, curling, occasional irritability, wanting to remove covers is treatable with warmth. However, in Taiyang, only back aversion to cold requires immediate warming to prevent inability to extend. In Shaoyin, dry mouth/throat or pure water diarrhea requires immediate purging to prevent inability to flex. These are divine insights. Later sages pondered but could not articulate. For example, children with fragile constitutions often develop Jing from high fever. Later doctors wrongly call it "Wind Shock," ignoring external pathogens, using mineral/musk drugs, causing death. Similarly, postpartum women with blood deficiency contracting Wind develop Jing, wrongly called "Postpartum Wind Shock," leading to death. (Yu Jiayan)
Jing disease is a combination of Wind and Dampness. Wind combining with Dampness is Rou Jing (Soft Spasm); Wind (Yang) dominates Damp (Yin), making it Yang-excess Soft disease. Wind combining with Damp and Cold is Gang Jing (Hard Spasm); Wind (One Yang) combines with Cold/Damp (Two Yins), making it Yin-excess Hard disease. Yang is inherently Hard, Yin Soft; conversely, discussing nature: Qi (Heaven) is Yang-Hard/Yin-Soft; Substance (Earth) is Yin-Hard/Yang-Soft. Thus, Rou Jing has Wind, and Gang Jing has Wind; without Wind, it is not Jing. Without Wind, Cold-Damp causes Bi syndrome, not Jing. All Jing shows Wind signs; no Wind, no Jing. ○ Jing is a disease of the Three Yang meridians. Exterior posterior (back) is Taiyang; anterior (front) is Yangming. Front/back define Yin/Yang here, not the Six Meridians. Claims of Three Yin Jing are unverified by Zhang. ○ Jing is a meridian disease, not an organ disease. Wind-Damp affects Taiyang; even in Wei level, damp stagnates outside vessels; Wind-Cold-Damp affects Ying level, damp infiltrates inside vessels. Vessels carry Zheng Qi/Blood. Pathogenic Wind/Damp/Cold block vessels, causing cramping. The pathology lies in meridians/tunnels, related to organs but distinct from organ disease. Claims of Yin/Yang deficiency in organs as primary cause are speculative; Zhang does not label them organ diseases. ○ Jing ultimately remains in Three Yang. Though internal excess warrants purging, there is no "transmission" Jing. Some suffer lifelong Jing; if transmitted, when would it end? If transmitting through Six Meridians like Shanghan, which meridian withstands lifelong pathogens? This claim is baseless. Internal excess requiring purging is Wind-Cold-Damp trapping Yang externally, generating internal heat. Like Taiyang external Cold/Wind causing internal heat ("Damp rising severely generates heat"). Severe internal heat requires purging to remove stagnant heat/damp, unrelated to Yangming Stomach. Zhang describes Jing via sinews/limbs, not organs. Thus, lifelong Jing differs from acute Shanghan transmission. Shanghan enters organs urgently; Jing lingers. This transmission theory contradicts Zhang and is unreliable. ○ Some say Jing doesn't involve organs. But severe Wind-Heat depletes Yin; severe Cold-Damp weakens Yang. Must we ignore organs? Response: Tonify Yin/Yang as needed for any disease. Tonifying Yin/Yang treats the root, aiding symptom treatment. Symptom treatment still expels Wind-Cold/removes Damp-Heat via meridians. Zhang names Jing by symptoms/signs, ignoring organ roots. Thus, Jing is not an organ disease. Wise practitioners distinguish root/symptom: treat Jing (meridian/symptom) as branch; treat organs (interior/root) as root. Treating root aids treating branch. Why not discuss organs? (Wei Litong)
Jing means stiffness, caused by Autumn Dryness Metal pathogen entering sinews. Late Summer Damp-Heat infects sinews; Autumn Dryness/Slaughter Qi exacerbates neck stiffness. Pathogen in exterior causes fever; heat forcing down causes cold feet; Yang deficiency/exterior pathogen causes aversion to cold; Dry-Heat forcing up causes head heat/red face/eyes; neck stiffness causes head tremor. Yangming sinews connect to stomach/chest/mouth; Taiyang sinews run neck/back/head. Dry-Heat damages Yangming → lockjaw; damages Taiyang → opisthotonos. During Dry-Heat, sweating depletes fluids, causing tendon stiffness. Misdiagnosed as Wind Shock, killing many women/children due to ignorance. ○ Dryness is Heaven Qi; Dampness is Earth Qi. *Neijing* says Jing belongs to Dampness because it addresses the root. Late Summer/Autumn transition: Root Damp, Surface Dry. Damp damages Yangming (internal heat); Dry damages Taiyang (external heat). Pathogens clash at meridian boundaries, causing neck stiffness. This is Wet-Heat combined with Dry transformation. *Classic*: "Unremoved Wet-Heat shortens large sinews, lengthens small sinews." *Classic*: "Excessive Fire year... disease is Jing" (Heat suppressed by Cold, no sweat). *Classic*: "Lung heat transfers to Kidney... Rou Jing" (Wet steaming Heat, sweating). *Qian Jin*: Warm disease heat entering Kidney causes Jing; pediatric epilepsy with high heat causes Jing. Sadly, Jing's definition is clear in classics, yet unrecognized later. (Cheng Fusheng)
Six Qi cause fever. Cold/Damp associate; Summer-heat/Damp associate; Dryness/Damp oppose. Damp comes from Earth; Dryness from internal causes. Pathogenesis differs. Nineteen Pathogenesis Mechanisms lacks Dryness clause. I doubt "All Jing neck stiffness belongs to Dampness." *Ben Lun* distinguishes Jing/Shi and says "Taiyang excessive sweating causes Jing," proving Jing belongs to Dryness. Jing is named by state: blood deficiency causes tendon cramping. Six Qi can cause Jing, but without Heat, no Dryness; without Dryness, no Jing. All Six Meridians have Jing; distinguish by location. Posterior body = Taiyang (head/neck stiffness, back rigidity, waist pain, thigh immobility, calf binding). Anterior body = Yangming (head tremor, lockjaw, supraclavicular pain, leg cramps). Lateral body = Shaoyang (facial deviation, limb traction, rib cramping, hemiplegia). Abdominal cramping + limb cramping after vomiting/diarrhea = Taiyin Jing. Aversion to cold, curling, buttocks/heel substitution, spine/head substitution, inability to extend = Shaoyin Jing. Testicular ascent, tendon descent, lower abdominal urgency, genital cramping, knee/shin cramping = Jueyin Jing. Jing with Wind-Cold: fever, no sweat, aversion to cold, Qi rushing chest, scant urine, firm/tight pulse, rigidity, lockjaw. From Heaven Qi (*Neijing*: "Sudden rigidity belongs to Wind"). Vigorous momentum = Gang Jing. External cause, resolve exterior. Jing with internal pathogen: fever, sweat, no aversion to cold, deep/slow pulse, neck/back stiffness. From Earth Qi (*Neijing*: "Jing neck stiffness belongs to Dampness"). Weak momentum = Rou Jing. Internal cause, nourish Yin. Note: Wind-Jing is actually Heat-induced; Damp-Jing is actually Dryness-induced. Gegen treats Wind by generating fluids; Gualou Gen treats Damp by moistening Dryness. Jing starts as mixed pathology. Doctors mistake it for Wind, missing the logic. Good doctors prevent it by observing other signs. Neck pain is early Taiyang blood deficiency/tendon cramping. Neglecting fluids during Wind-Cold treatment causes excessive sweating → Jing. Jing has origins; mismanagement reveals deformities. Neck/back stiffness = Jing sign → use Gegen. Body stiffness = Jing established → use Gualou Gen. Opisthotonos/cramps/lockjaw = Jing severe → use Dahuang/Mangxiao. All use fluid-generating herbs to nourish Yin/Blood. Shanghan with floating pulse/sweat/irritability/cold aversion + leg cramps = Jing forming. Nourish Yin/fluids. Guizhi Tang causes厥 (cold extremities); Shaoyao Gancao Tang extends legs. Clear proof. Delirium → minor Tiaowei Chengqi Tang; similar to Dachengqi Tang for opisthotonos. Most Jing is blood deficiency/tendon cramping, less external injury. Mistaking for Wind uses acrid/warm herbs, damaging Yin. Using drying herbs depletes Blood. Acute Jing is rare; iatrogenic Jing is common. Deficiency without tonification leads to death. Regulating Ying/Wei is essential. Same Dampness: removed → extreme Dryness → Jing; lingering → Bi. Bi is Excess; Jing is Deficiency. Forms differ, Excess/Deficiency differ. Do not wrongly attribute Jing to Wind; do not equate Jing with Damp just because Damp is involved. (Ke Yunbo)
Sinews emerge along meridians. Internal Qi/Blood deficiency allows external Wind/Cold/Damp/Heat to invade, causing Jing. Wind disperses Qi → sweat/no aversion to cold = Rou Jing. Cold congeals Blood → no sweat/aversion to cold = Gang Jing. Causes often involve blood loss, leaving sinews un-nourished, susceptible to pathogens. Hence, excessive sweating/purging in Shanghan, sores, postpartum states cause this. Pulse: deep/floating/string-tight. Yang lax/Yin tight → chronic cramping; Yin lax/Yang tight → opisthotonos/rigidity. Two conditions differ; must distinguish. (Chen Wuze)
Shengshengzi says: Danxi claims "Zhi" should be "Jing," a transcription error. No book clarifies this precisely. Guo Yong says Jing and Zhi are two diseases: periodic发作 is Jing; non-periodic is Zhi. This is insufficient. Examining *Ling Shu*, *Su Wen*, Zhang Zhongjing: terms differ, treatments are similar. No need to separate strictly. Zhi is disease name; Jing is disease state. Both have Gang/Rou types. At onset, sinews/meridians stiffen, opisthotonos occurs → named Jing (stiffness). Otherwise, why interchange treatments for Zhi/Jing with efficacy? Treatment same, condition unified. ○ *Classic*: "Lung heat transfers to Kidney... Rou Zhi." Ancient text: Jing means stiffness. Zhang Zhongjing attributes Taiyang Wind-Damp, sometimes Yangming. Also excessive sweating/purging, sore sweating → Jing. This refers to external pathogens, Shanghan methodology. Chen Wuze, Zhang Zihe mention internal Wind/Fire/Phlegm/Heat. Caused by blood loss, sinews un-nourished. Danxi says more deficient than epilepsy. These refer to internal injury. Gang/Rou implies Excess/Deficiency. Generally, Gang from external; Rou from internal. Treat external with Zhang's Shanghan methods; treat internal with Chen/Danxi/Zong Nong/Zhang Zihe methods. Thus, exterior...