里详尽，始无遗此失彼之患矣。（《赤水玄珠》）
愚谓痉之为病，强直反张病也。其病在筋脉，筋脉拘急，所以反张；其病在血液，血液枯燥，所以筋挛。
观仲景曰∶太阳病，发汗太多，因致痉；风病下之则成痉；疮家不可发汗，汗之亦成痉。只此数言，可见病此
者，多由误治之坏证，其虚、其实，可了然矣。自仲景后，惟陈无择能知所因，曰∶多由亡血，筋无所荣，因
而成痉。但惜其言之既善，而复有未善者。曰∶血气内虚，外为风、寒、湿、热所中则痉。斯言不无又误。若
其所云，则仍是风湿为邪，而虚反次之矣。不知风随汗散，而既汗之后，何复言风？湿随下行，而既下之后，
何反致湿？盖误汗者必伤血液，误下者必伤真阴，阴伤则血燥，血燥则筋失所滋，为拘为挛，反张强直之病，
势所必至，又何待风、寒、湿、热之相袭，而后为痉
耶？且仲景所言，言不当汗而汗也，不当下而下也。既因误治而成痉矣，岂误治之外必再受邪而后成痉，无邪
则无痉哉？此言不惟失仲景之意，而用持两端。故凡今人之治此者，未有不以散风、去湿为事，亦焉知血燥阴
虚之证，尚能堪此散削否？○仲景言痉，止属太阳，而不及他经者，何也？盖痉必反张，其病在背，背之经络，
惟太阳督脉耳。言太阳，则督脉在其中矣。然仲景止言其表，未详其里。考《经脉篇》曰∶足少阴之脉，贯脊
属贤，其直者，从肾上贯肝膈。《经筋篇》曰∶足少阴之筋，循脊内挟膂上至项，结于枕骨，与足太阳之筋合。
又曰∶足太阳之筋病，脊反折，项筋急；足少阴之筋病，主痫螈及痉。阳病者，腰反折不能俯；阴病者，不能
仰。由此观之，则痉乃太阳、少阴之病也。盖肾与膀胱为表里，膀胱为津液之腑，而肾为藏精之脏。病在二经，
水亏可知，治此当以真阴为主。○痉病甚多，人多不识。盖凡以暴病而见反张、戴眼、口噤、拘急之类，皆痉
病也。观仲景以汗、下为言，谓其误治亡阴，所以然也。常见有不因误治，而凡属阴虚血少之辈，不能荣养筋
脉，以致拘挛僵仆者，皆是此证。如中风之有此者，必以年力衰残，阴之败也；产妇之有此者，必以去血过多，
冲任竭也；疮家之有此者，必以血随脓出，营气涸也；小儿之有此者，或以风热伤阴，遂为急惊；或以汗泻亡
阴，遂为慢惊。凡此总属阴虚之证。盖精血不亏，虽有邪干，亦断无筋脉拘急之病，而病至坚强，其枯可知。
故治此者，当以血气为主。（张景岳）
痉病，虚为本，风为标，不可纯用风药。盖血虚则火旺，火旺则风生，风胜则燥作。能滋其阴，则风自散
而燥自润矣。（《医学入门》）
阳气者，精则养神，柔则养筋。故治气虚筋惕，当用参、 以补之。手得血而能握，足得血而能步。故治
血虚筋惕，当用归、地以润之。（《证治汇补》）
湿热证，三、四日，口噤，四肢牵引拘急，甚则角弓反张，此湿热侵入经络脉隧中，宜地龙、秦艽、灵仙、
滑石、丝瓜藤、
海风藤、川连。○湿热证，壮热口渴，舌黄或焦红，发痉，神昏，谵语或笑，邪灼心包，营血已耗。宜犀角、
羚角、连翘、生地、元参、钩藤、银花露、鲜菖蒲、至宝丹。○湿热证，发痉神昏笑妄，脉洪数有力，开泄不效，
湿热蕴结胸膈，宜凉膈散。若大便不通，热邪闭结肠胃，宜仿承气微下之例。○或问∶仲景治痉，原有桂枝汤
加栝蒌根，及葛根汤二方，岂宜于古而不宜于今耶？今之痉者，与厥相连，仲景不言及厥，岂《金匮》有遗文
耶？余曰∶非也。药因病用，病原既异，治法自殊。《伤寒》之痉自外来，证属太阳，治以散外邪为主。湿热
之痉自内出，波及太阳，治以熄内风为主。盖三焦与肝、胆同司相火，中焦湿热不解，则热甚于里。火动则风
生，而筋挛脉急；风煽则火炽，而识乱神迷。身中之气，随风火上炎，而有升无降，常度尽失，由是而形若尸
厥。正《内经》所谓血之与气，并走于上，则为暴厥者是也。外窜经脉则成痉，内并膻中则为厥。痉厥并见，
正气犹存，则气复返而生；胃津不支，则厥不回而死矣。（《湿热条辨》）
脉候
太阳病，发热，脉沉而细者，名曰痉，为难治。○夫痉脉，按之紧如弦，直上下行。○若发其汗者，寒湿
相得，其表益虚，即恶寒甚。发其汗已，其脉如蛇，腹暴胀大者，为欲解。脉如故，反伏弦者痉。（《金匮》）
按腹暴胀大者五字，衍文也，当删之。（《医宗金鉴》）
里详尽，始无遗此失彼之患矣。（《赤水玄珠》）
我认为痉病，是一种身体强直、角弓反张的疾病。其病变部位在筋脉，因为筋脉拘急挛缩，所以出现角弓反张；其病变根源在血液，因为血液干枯枯竭，所以导致筋脉挛急。
看张仲景说：太阳病（太阳经受邪所致的病证），发汗过多，因此导致痉病；风病误用下法则会形成痉病；患有疮疡的人不可发汗，如果发汗也会形成痉病。仅从这几句话来看，患这种病的人，大多是由于误治导致的坏证，其虚证或实证的性质，就可以一目了然了。自从张仲景之后，只有陈无择能知道病因，他说：大多是由于亡血（大量失血），筋脉失去荣养，因而形成痉病。可惜他的说法虽然好，但又有不完善的地方。他说：气血内部虚弱，外部被风、寒、湿、热等邪气侵袭就会发生痉病。这种说法不无错误。如果按照他所说的，那仍然是以风湿为邪气，而将虚证放在次要地位了。不知道风邪随着汗液发散，既然已经发过汗了，为什么还要再说风邪？湿邪随着下行法排出，既然已经用过下法了，为什么反而会导致湿邪滞留？大概误用汗法必然损伤血液，误用下法必然损伤真阴，阴液受损则血液干燥，血液干燥则筋脉失去滋养，从而产生拘挛、角弓反张强直的病症，这是势所必至的结果，又何须等待风、寒、湿、热等邪气相兼侵袭，才会形成痉病呢？况且张仲景所说的，是指不当汗而误汗，不当下而误下。既然已经因为误治形成了痉病，难道在误治之外，必须再受外邪侵袭才会形成痉病吗？没有外邪就没有痉病吗？这种说法不仅违背了张仲景的本意，而且持两端之说。所以凡是现在医生治疗这种病的人，没有不把散风、祛湿作为主要任务的，又哪里知道血燥阴虚的证候，还能承受这种疏散克伐的药物吗？○张仲景论述痉病，只归属于太阳经，而不涉及其他经络，为什么呢？大概痉病必然出现角弓反张，其病变在背部，背部的经络，只有太阳经和督脉。提到太阳经，就包含了督脉在其中了。然而张仲景只说了表证，没有详细论述里证。考察《经脉篇》说：足少阴肾经的经脉，贯穿脊柱，属于肾脏，其直行者，从肾脏向上穿过肝脏和膈肌。《经筋篇》说：足少阴肾经的筋，沿着脊柱内侧夹着脊旁肌肉上行至项部，结聚于枕骨，与足太阳膀胱经的筋相合。又说：足太阳膀胱经的筋发病，会出现脊柱反折，项部筋脉拘急；足少阴肾经的筋发病，主要主掌癫痫抽搐及痉病。阳经发病，腰部反折不能前俯；阴经发病，不能后仰。由此看来，那么痉病就是太阳经和少阴经的病证了。大概肾与膀胱互为表里，膀胱是津液之腑，而肾是藏精之脏。病变在这两条经络，可知是水液亏损，治疗此病应当以填补真阴为主。○痉病的种类很多，人们大多不认识。大概凡是突发疾病而出现角弓反张、戴眼（眼球固定上视）、口噤（牙关紧闭）、拘急等症状的，都是痉病。看张仲景以汗、下误治来说明，是因为误治导致亡阴的缘故。我常见有不因误治，而凡是属于阴虚血少体质的人，不能荣养筋脉，以致出现拘挛僵仆的，都是这个证候。比如中风病中有这种情况的，必定是因为年力衰残，阴气败坏；产妇中有这种情况的，必定是因为失血过多，冲任二脉枯竭；疮疡患者中有这种情况的，必定是因为血液随脓液流出，营气枯竭；小儿中有这种情况的，有的因为风热伤阴，遂成为急惊风；有的因为汗泻导致亡阴，遂成为慢惊风。所有这些总属于阴虚的证候。大概精血如果不亏损，即使有邪气干扰，也绝对不会有筋脉拘急的病症，而病情发展到坚强程度，其干枯枯竭的情况就可以知道了。所以治疗此病，应当以补益血气为主。（张景岳）
痉病，以虚为本，风邪为标，不可单纯使用风药。大概血虚则火旺，火旺则风生，风胜则燥作。如果能滋养其阴液，则风邪自然消散而燥邪自然滋润了。（《医学入门》）
阳气，精微部分则养神，柔和部分则养筋。所以治疗气虚引起的筋惕肉瞤（肌肉跳动），应当用人参、黄芪来补益它。手得到血的濡养就能握物，脚得到血的濡养就能行走。所以治疗血虚引起的筋惕肉瞤，应当用当归、地黄来润养它。（《证治汇补》）
湿热证，经过三、四天，出现口噤，四肢牵引拘急，甚至角弓反张，这是湿热侵入经络脉隧中，宜用地龙、秦艽、威灵仙、滑石、丝瓜藤、海风藤、黄连。○湿热证，壮热口渴，舌苔黄或焦红，发生痉病，神志昏迷，胡言乱语或嬉笑，这是邪热灼伤心包，营血已被耗伤。宜用犀角、羚羊角、连翘、生地、元参、钩藤、银花露、鲜菖蒲、至宝丹。○湿热证，发生痉病、神昏、胡言乱笑，脉象洪数有力，用开泄法无效，这是湿热蕴结胸膈，宜用凉膈散。如果大便不通，热邪闭结肠胃，宜仿照承气汤轻微攻下的例子。○有人问：张仲景治疗痉病，原有桂枝汤加栝蒌根，以及葛根汤两个方剂，难道是适宜于古代而不适宜于现代吗？现在的痉病，常与厥证相连，张仲景没有提及厥证，难道是《金匮要略》有遗漏的文字吗？我说：不是这样。药物因病而用，病因既然不同，治法自然不同。《伤寒论》中的痉病来自外感，证候属于太阳经，治疗以疏散外邪为主。湿热之痉来自内生，波及太阳经，治疗以熄灭内风为主。大概三焦与肝、胆共同主管相火，中焦湿热不解，则热势盛于体内。火动则风生，而筋脉挛急；风煽则火势炽盛，而神识混乱昏迷。人体之气，随风火上炎，只有上升没有下降，正常规律完全丧失，由此而形体如同尸厥。正是《内经》所说的血与气，并走于上部，就会发生暴厥的情况。向外窜入经脉则形成痉病，向内并入膻中则为厥证。痉厥同时出现，正气尚存，则气复返而生存；胃津不能支持，则厥逆不回而死。（《湿热条辨》）
脉候
太阳病，发热，脉象沉而细的，名叫痉病，难以治疗。○夫痉病的脉象，按之紧如弦，直上下行。○如果发其汗，寒湿相得，其表更加虚弱，即恶寒严重。发汗之后，其脉象如蛇行般蜿蜒，腹部突然胀大的，为欲解。脉象如故，反而伏弦的是痉病。（《金匮要略》）
按“腹部突然胀大”这五个字，是衍文，应当删除。（《医宗金鉴》）
Thoroughly understanding the interior allows one to avoid the hazard of losing sight of either aspect. (from *Chishui Xuanzhu*)
I believe that Jing disease (Spasm) is a condition characterized by stiffness, rigidity, and opisthotonos (backward arching of the body). Its pathology lies in the sinews and vessels; because the sinews and vessels are contracted and tense, opisthotonos occurs. Its root cause lies in the blood; because the blood is dry and depleted, sinew spasms result.
Observing Zhang Zhongjing’s statement: "In Taiyang disease (Disease of the Taiyang channel), excessive sweating leads to Jing disease; applying purgation to Wind disease results in Jing disease; patients with sores/ulcers should not be induced to sweat, and if they are, it also leads to Jing disease." From these few words, it can be seen that those suffering from this disease mostly have complex conditions resulting from mismanagement. Their deficiency or excess nature can be clearly understood. After Zhang Zhongjing, only Chen Wuyue understood the etiology, stating: "It mostly arises from loss of blood, where the sinews lose nourishment, thus forming Jing disease." However, his explanation, while good, had imperfections. He said: "When Qi and Blood are internally deficient, and externally attacked by Wind, Cold, Dampness, or Heat, Jing disease ensues." This statement is not without error. If we follow his logic, it still prioritizes Wind and Dampness as pathogens, relegating deficiency to a secondary position. One does not realize that Wind dissipates with sweat; after sweating, why speak again of Wind? Dampness descends with purgation; after purgation, why mention Dampness? Generally, erroneous sweating inevitably damages Blood, and erroneous purgation inevitably damages True Yin. When Yin is damaged, Blood becomes dry; when Blood is dry, the sinews lose their nourishment, leading to contraction, spasm, and opisthotonos. This progression is inevitable. Why wait for Wind, Cold, Dampness, or Heat to attack sequentially before Jing disease forms? Moreover, what Zhang Zhongjing described refers to inducing sweat or purgation when inappropriate. Since Jing disease has already formed due to mismanagement, must there necessarily be further pathogenic invasion outside of mismanagement for Jing disease to form? Is it true that without external pathogens, there is no Jing disease? This view not only deviates from Zhang Zhongjing’s intent but also holds contradictory positions. Therefore, contemporary physicians treating this disease invariably focus on dispersing Wind and eliminating Dampness. How do they know that patterns of Blood dryness and Yin deficiency can withstand such dispersing and draining treatments? ○ Zhang Zhongjing attributes Jing disease solely to the Taiyang channel, excluding other channels. Why? Jing disease necessarily involves opisthotonos, with pathology located in the back. The meridians of the back belong exclusively to the Taiyang channel and the Du vessel. Mentioning Taiyang implies the inclusion of the Du vessel. However, Zhang Zhongjing only discussed the exterior, neglecting the interior. Examining the *Jingmai* chapter: "The Foot Shaoyin channel penetrates the spine and connects to the Kidney; its straight branch ascends from the Kidney, piercing the Liver and Diaphragm." The *Jingjin* chapter states: "The sinews of the Foot Shaoyin channel run along the inner side of the spine, clamping the paraspinal muscles up to the nape, knotting at the occiput, and merging with the sinews of the Foot Taiyang channel." It further states: "Disease of the sinews of the Foot Taiyang channel causes spinal reversal and neck tendon tension; disease of the sinews of the Foot Shaoyin channel primarily governs epilepsy, convulsions, and Jing disease. Yang channel diseases cause spinal reversal preventing flexion; Yin channel diseases prevent extension." From this, it is evident that Jing disease is a disorder of both the Taiyang and Shaoyin channels. The Kidney and Bladder are interior-exterior pairs; the Bladder is the Fu organ of fluids, while the Kidney is the Zang organ storing Essence. Pathology in these two channels indicates Water (Kidney Yin/Essence) deficiency. Treatment should prioritize replenishing True Yin. ○ There are many types of Jing disease, yet most people do not recognize them. Essentially, any acute illness presenting with opisthotonos, fixed upward gaze (Daiyan), trismus (lockjaw), or contracture constitutes Jing disease. Zhang Zhongjing attributed it to erroneous sweating and purgation causing Yin depletion. I often observe cases not caused by mismanagement, but arising in individuals with Yin deficiency and Blood insufficiency who cannot nourish the sinews, leading to contracture and collapse. For instance, in Stroke patients exhibiting this, it is due to declining vitality and failing Yin; in postpartum women, it is due to excessive blood loss exhausting the Chong and Ren vessels; in patients with sores, it is due to blood loss with pus depleting Ying Qi; in children, it may be due to Wind-Heat injuring Yin, leading to Acute Convulsion, or due to sweating/purgation causing Yin loss, leading to Chronic Convulsion. All these belong to Yin deficiency patterns. If Essence and Blood are not depleted, even with pathogenic interference, sinew contracture would absolutely not occur. When the disease reaches a state of rigidity, its dryness and depletion are evident. Thus, treatment should focus on tonifying Qi and Blood. (Zhang Jingyue)
In Jing disease, deficiency is the root, and Wind is the branch. One must not use purely Wind-dispersing herbs. Blood deficiency leads to Fire hyperactivity; Fire hyperactivity generates Wind; Wind excess causes Dryness. Nourishing the Yin will naturally disperse the Wind and moisten the Dryness. (from *Yixue Rumen*)
Yang Qi, in its refined aspect, nourishes the Spirit; in its soft aspect, it nourishes the sinews. Therefore, for tremors caused by Qi deficiency, use Ginseng (*Ren Shen*) and Astragalus (*Huang Qi*) to tonify. The hand grasps when it receives Blood; the foot walks when it receives Blood. Therefore, for tremors caused by Blood deficiency, use Angelica (*Dang Gui*) and Rehmannia (*Shu Di Huang*) to moisten. (from *Zhengzhi Huibu*)
In Damp-Heat syndrome, after three or four days, trismus, limb traction and contracture, and even opisthotonos may occur. This indicates Damp-Heat invading the collaterals and sinews. Use Earthworm (*Di Long*), Gentian (*Qin Jiao*), Clematis (*Ling Xiao*), Talc (*Hua Shi), Luffa Vine (*Si Gua Teng*), Flammule Vine (*Hai Feng Teng*), and Coptis (*Chuan Lian*). ○ In Damp-Heat syndrome, with high fever, thirst, yellow or scorched-red tongue coating, Jing disease, coma, delirium, or manic laughter, the pathogenic heat is scorching the Pericardium, and Ying Blood has been consumed. Use Rhinoceros Horn (*Xi Jiao* - note: substitute with Buffalo Horn *Shui Niu Jiao* in modern practice), Antelope Horn (*Ling Yang Jiao*), Forsythia (*Lian Qiao*), Rehmannia (*Sheng Di Huang*), Scrophularia (*Yuan Shen*), Uncaria (*Gou Teng*), Honeysuckle Dew (*Yin Hua Lu*), Fresh Acorus (*Xian Chang Pu*), and Zhibao Pill (*Zhibao Dan*). ○ In Damp-Heat syndrome, with Jing disease, coma, and manic speech, and a surging, rapid, and forceful pulse, if opening and draining methods fail, it indicates Damp-Heat accumulating in the chest and diaphragm. Use Liangge San (*Cool the Chest Powder*). If stool is obstructed and Heat pathogens are closed in the intestines and stomach, imitate the mild purgative method of Chengqi Decoction. ○ Question: Zhang Zhongjing treated Jing disease with Guizhi Tang plus Trichosanthes Root (*Gua Lou Gen*) and Gegen Tang (*Kudzu Decoction*). Are these suitable for ancient times but not for today? Modern Jing disease is often linked to Jue syndrome (Fainting/Collapse), yet Zhang Zhongjing did not mention Jue. Was there omitted text in *Jingui Yaolue*? Answer: No. Medications are used according to the disease; since etiologies differ, treatments differ. Jing disease in *Shanghan Lun* originates from external factors, belongs to the Taiyang pattern, and is treated by dispersing external pathogens. Damp-Heat Jing disease originates internally, affects the Taiyang channel, and is treated by extinguishing internal Wind. The Sanjiao (Triple Burner), Liver, and Gallbladder jointly govern Ministerial Fire. If Damp-Heat in the Middle Jiao is unresolved, Heat intensifies internally. Fire agitation generates Wind, causing sinew contraction and vessel urgency; Wind stirring ignites Fire, causing mental confusion and coma. Body Qi follows the ascending Wind and Fire, rising without descending, losing normal regulation, resulting in a corpse-like fainting state. This corresponds to the *Neijing*: "When Blood and Qi rush together upwards, sudden Jue occurs." Externally invading the meridians forms Jing disease; internally merging into the Danzhong (Chest Center) forms Jue syndrome. When Jing and Jue appear together, if Zheng Qi remains, Qi returns and life is preserved; if Stomach Jin (fluids) cannot sustain, Jue does not reverse and death ensues. (from *Shire Tiaobian*)
Pulse Diagnosis
In Taiyang disease, with fever and a deep, fine pulse, it is named Jing disease, and is difficult to treat. ○ The pulse of Jing disease, when pressed, feels tight like a string, running straight up and down. ○ If sweating is induced, Cold and Dampness combine, the exterior becomes more deficient, and aversion to cold becomes severe. After sweating, if the pulse resembles a slithering snake and the abdomen suddenly distends, it indicates resolution. If the pulse remains unchanged and becomes hidden and wiry, it is Jing disease. (from *Jingui Yaolue*)
Note: The five characters "abdomen suddenly distends" are interpolations (derivative text) and should be deleted. (from *Yizong Jinjian*)