（痉当作 ）
疮疡发痉，因气血亏损，外邪所搏，或由虚郁火所致。其形牙关紧急，四肢劲强，或腰
背反张，肢体抽搐。其有汗而不恶寒者，曰柔痉。风能散气，故有汗也。其无汗而恶寒者，曰刚
痉。寒能涩血，故无汗也。皆由亡血过多，筋无所养，故伤寒汗下过多，与溃疡、产后多患
之，乃败症也。若大补气血，多有复生者，若作风治，速其危矣。
治验
秋官张同野，旧有流注，因暴寒睡炕，口目抽搐，手足战掉。余以为气血虚热而然，用
参、 、归、术、川芎、山栀、柴胡、半夏、天麻、炙草，治之而愈。
吴给事赡之，坠马伤首，出血过多，发热烦躁，肉 筋惕。或作破伤风，欲发汗祛风。
余曰∶此亡血火动也，无风可祛，无汗可发，当峻补其血。用圣愈汤，二剂顿愈。又用健脾胃，
养气血而痊愈。
一儒者背疮将愈，发热烦躁，自用降火之剂，项强口噤，自汗恶寒，此汗多内亡津血，
筋无所荣也。用补气血之剂，及地黄丸而愈。
一男子素勤苦早行，遍身发疙瘩，口噤目直，脉弦紧，此劳伤气血，内热外邪所搏也。
用补中益气加山栀、羌活、川芎而瘥。半载后，遍身作痒，搔破成疮，发热作渴，脉洪大而虚。
复以前汤加芍药、麦门、熟地、天麻而愈。
一儒者善怒，患瘰 ，复因大怒跳跃，忽仆地，两臂抽搐，唇口 斜，左目紧小，此肝
火血虚，内热生风。用八珍汤加牡丹皮、钩藤、山栀而愈。次年春，前病复作，兼小便自遗，左
关弦洪而数。余以为肝火血燥，用六味丸加钩藤、五味、麦门、芎、归，治之渐愈；又用补
中益气加山栀、钩藤、牡丹皮而安。
一 妇因怒仆地，疮口出血，语言蹇涩，口眼 斜，四肢拘急，汗出遗尿。或用驱风之
剂，六脉洪大，肝脉尤甚，此肝火炽甚也。用加味逍遥散加钩藤，及六味丸寻愈。
一妇人患内痔，因劳出血甚多，不时发痉，饮食少思，形体倦怠，其面色白，余谓此气
伤而不能统血也。用补中益气汤，反寒热出血，此阳气虚寒也。仍以前汤，加炮姜四剂，寒热渐
止，饮食渐进；又四剂，而血顿止。后因劳役，或怒气即便血，或发痉，投以补中益气汤加
一妇人素性急，患遍身瘙痒，或项间结核，常服搜风顺气之剂，后大怒吐血，唇口牵紧
，小便频数，或时自遗，此怒动肝火而血妄行也。用小柴胡汤加山栀、牡丹皮而愈。
一 妇因劳兼怒，四肢挛屈，烦痛自汗，小便短少，畏见风寒，脉浮弦缓，此气血虚而
风寒湿热相搏也。先用东垣清燥汤渐愈，再用加味逍遥散，及八珍汤加牡丹皮而痊。
一妇人素有肝火，两拗间或肿痛，或寒热，忽然昏愦，螈 抽搐，善伸数欠，四肢筋挛
，痰涎上升，此肺金燥甚而血液衰少也。用清燥丸、六味丸兼服寻愈。
一妇人因大劳患 疮发疙瘩，搔碎成疮，日晡热甚，或口噤发搐，或头目眩晕，此肝脾
气血
脾血热，用加味逍遥散渐愈，又用八珍散加柴胡、山栀而痊。
一妇人发疙瘩，日晡热甚，月经先期，或头目昏眩，或寒热发热，或四肢抽搐，此肝经
风热血燥，用加味逍遥散，治之寻愈。后因怒，前症复作，口噤遗尿，此肝火血燥也，用加味小
柴胡汤治之，渐愈。又夜间发热谵语，此血分有热也，用小柴胡汤加生地而愈。更用加味
逍遥散，调理而安。
一妇人患茧唇，月经先期，余以为肝火血热。不信，乃泛用降火之剂。反致月经过期，
复因劳怒，口噤呻吟，肢体不随，六脉洪大，面目赤色，用八珍、麦门、五味、山栀、丹皮，数
剂渐愈；兼用逍遥散、六味丸料，各三十余剂痊愈。
一妇人经行遇怒，其经即止，甚则口噤筋挛，鼻衄头痛，痰涌搐搦，瞳子上视，此肝火
炽甚。以小柴胡汤加熟地黄、山栀、钩藤钩而愈。
一妇人素阴虚，患遍身瘙痒，误服祛风之药，口噤抽搐，肝脉洪数。余曰∶肝血为阴为
水，肝气为阳为火，此乃肝经血热火盛耳。宜助阴血，抑肝火，遂用四物、麦门、五味、柴胡、
山栀、生草，热搐顿止。又以八珍加黄 、麦门、五味、钩藤钩、炙草调理而愈。
一妇人久患流注，脾胃虚弱，忽痰壅气喘，头摇目札，手扬足掷，难以候脉。视其面，
黄中见青，此肝木乘脾士也。用六君加柴胡、升麻，治之而苏。更以补中益气加半夏、茯苓而安
（“痉”字当作“瘛”，即抽搐之意）
疮疡发生抽搐，是因为气血亏损，受到外邪侵袭，或者由虚火郁结所致。其症状表现为牙关紧闭、四肢僵硬强直，或者腰背向后反折、肢体抽搐。其中，有汗出且不恶寒的，称为柔痉。风性疏散气机，所以会有汗出。无汗出且恶寒的，称为刚痉。寒性凝滞血液，所以无汗出。这些情况都是由失血过多，筋脉失去滋养所致，因此伤寒病中发汗或攻下过多，以及溃疡病患者、产后妇女多患此病，这属于危重的败症。如果能大补气血，大多能恢复生机；如果当作风证治疗，会加速其死亡。
治验记录：
秋官张同野，原本患有流注（一种慢性化脓性疾病），因为突然受寒睡在炕上，出现口眼歪斜抽搐、手足颤抖。我认为这是气血虚热导致的，使用人参、[缺失药材]、当归、白术、川芎、山栀、柴胡、半夏、天麻、炙甘草治疗，痊愈了。
吴给事赡之，坠马头部受伤，出血过多，发热烦躁，肌肉跳动、筋脉抽搐。有人认为是破伤风，想要发汗祛风。我说：这是失血导致虚火妄动，没有风可祛，没有汗可发，应当峻补其血。使用圣愈汤，两剂后立刻痊愈。后来又用健脾胃、养气血的方法调理而痊愈。
一位儒生背部疮疡即将愈合时，出现发热烦躁，自行服用降火药物，导致项部僵硬、牙关紧闭、自汗恶寒，这是因为汗出过多导致体内津液和血液亡失，筋脉失去荣养。使用补气血的药物，以及地黄丸治疗而痊愈。
一名男子平时勤劳辛苦且早起赶路，全身发出疙瘩，牙关紧闭、眼睛直视，脉象弦紧，这是劳损伤及气血，内热与外邪相搏所致。使用补中益气汤加入山栀、羌活、川芎而病愈。半年后，全身瘙痒，抓破成疮，发热口渴，脉象洪大而虚。再次用前面的方剂加入芍药、麦门冬、熟地黄、天麻而痊愈。
一位儒生性格易怒，患有瘰疬（颈部淋巴结结核），又因大怒跳跃，突然跌倒在地，双臂抽搐，嘴唇口角歪斜，左眼紧缩变小，这是肝火旺盛兼血虚，内热生风所致。使用八珍汤加入牡丹皮、钩藤、山栀而痊愈。次年春天，前病复发，兼有小便失禁，左关脉弦洪而数。我认为这是肝火旺、血燥，使用六味丸加入钩藤、五味子、麦门冬、川芎、当归，治疗逐渐好转；又用补中益气汤加入山栀、钩藤、牡丹皮而安定。
一位妇人因愤怒跌倒在地，疮口出血，语言蹇涩，口眼歪斜，四肢拘急，出汗遗尿。有人使用驱风药剂，六脉洪大，肝脉尤其明显，这是肝火炽盛。使用加味逍遥散加入钩藤，以及六味丸，不久痊愈。
一名妇人患有内痔，因劳累出血很多，不时发生抽搐，饮食减少思虑，形体倦怠，面色苍白，我认为这是气受损而不能统摄血液。使用补中益气汤，反而出现寒热交替和出血，这是阳气虚寒。仍然用前面的方剂，加入炮姜四剂，寒热逐渐停止，饮食逐渐增加；又服四剂，出血立刻停止。后来因为劳累或怒气，即便血或发生抽搐，投以补中益气汤……（原文此处中断）
一名妇人平素性情急躁，患有全身瘙痒，有时颈部出现结核，常服用搜风顺气的药物，后来大怒吐血，嘴唇口角牵拉紧绷，小便频数，有时自遗，这是愤怒触动肝火导致血液妄行。使用小柴胡汤加入山栀、牡丹皮而痊愈。
一位妇人因劳累兼愤怒，四肢挛缩弯曲，烦痛自汗，小便短少，害怕见到风寒，脉象浮弦缓，这是气血虚弱，风寒湿热相互搏结所致。先用东垣的清燥汤逐渐好转，再用加味逍遥散，以及八珍汤加入牡丹皮而痊愈。
一名妇人素有肝火，两胁间有时肿痛，有时寒热，突然昏愦，身体抽搐，喜欢伸展并频繁打哈欠，四肢筋脉挛急，痰涎上升，这是肺金燥甚而血液衰少所致。使用清燥丸、六味丸同时服用，不久痊愈。
一名妇人因过度劳累患痈疮并发出疙瘩，抓碎成疮，傍晚时分发热严重，有时牙关紧闭发生抽搐，有时头目眩晕，这是肝脾气血不足，脾血热所致，使用加味逍遥散逐渐好转，又用八珍散加入柴胡、山栀而痊愈。
一名妇人发出疙瘩，傍晚时分发热严重，月经提前，有时头目昏眩，有时寒热发热，有时四肢抽搐，这是肝经风热血燥，使用加味逍遥散，治疗不久痊愈。后来因愤怒，前症复发，牙关紧闭遗尿，这是肝火血燥，使用加味小柴胡汤治疗，逐渐好转。又夜间发热说胡话，这是血分有热，用小柴胡汤加入生地黄而痊愈。更用加味逍遥散，调理而安宁。
一名妇人患茧唇（唇部肿瘤样病变），月经提前，我认为这是肝火血热。她不相信，于是泛用降火药物。反而导致月经过期，又因劳累愤怒，牙关紧闭呻吟，肢体不能随意活动，六脉洪大，面目赤色，使用八珍汤、麦门冬、五味子、山栀、丹皮，数剂后逐渐好转；兼用逍遥散、六味丸药料，各三十余剂痊愈。
一名妇人在经期遇到愤怒，经血立即停止，严重时牙关紧闭筋脉挛急，鼻衄头痛，痰涌抽搐，瞳子上视，这是肝火炽盛。用小柴胡汤加入熟地黄、山栀、钩藤而痊愈。
一名妇人平素阴虚，患全身瘙痒，误服祛风药物，牙关紧闭抽搐，肝脉洪数。我说：肝血属阴为水，肝气属阳为火，这是肝经血热火盛。应当助阴血，抑肝火，遂用四物汤、麦门冬、五味子、柴胡、山栀、生甘草，热象抽搐立刻停止。又以八珍汤加入黄芪、麦门冬、五味子、钩藤、炙甘草调理而痊愈。
一名妇人久患流注，脾胃虚弱，忽然痰壅气喘，头摇眨眼，手扬足踢，难以诊脉。看她的面色，黄色中见青色，这是肝木乘克脾土。使用六君子汤加入柴胡、升麻，治疗苏醒。更用补中益气汤加入半夏、茯苓而安定。
("Jing" [Spasm/Convulsion] should be read as "Chi" [Twitching/Convulsion].)
Convulsions occurring in the context of sores and ulcers are caused by deficiency and depletion of Qi and Blood, invasion by external pathogens, or arising from deficiency-fire stagnation. The manifestations include lockjaw, stiffness and rigidity of the four limbs, opisthotonos (backward arching of the back), and limb convulsions. Among these, those with sweating but without aversion to cold are termed *Rou Jing* (Soft Spasm). Wind has the nature of dispersing Qi, hence sweating occurs. Those without sweating and with aversion to cold are termed *Gang Jing* (Hard Spasm). Cold has the nature of coagulating Blood, hence no sweating occurs. All these conditions result from excessive loss of blood, leaving the sinews without nourishment. Therefore, they frequently occur after excessive sweating or purgation in *Shanghan* (Cold Damage diseases), as well as in patients with ulcerative lesions and postpartum women; this is a critical condition indicating failure (*Bai Zheng*). If substantial tonification of Qi and Blood is employed, recovery is often possible; however, if treated as a wind disorder, it will hasten death.
Case Records:
Zhang Tongye, an official of the Ministry of Justice, previously suffered from *Liuzhu* (flowing abscesses). After sudden exposure to cold while sleeping on a heated kang, he developed facial twitching and tremors of the hands and feet. I diagnosed this as deficiency-heat due to Qi and Blood insufficiency and prescribed Ren Shen (Ginseng Root), [missing herb], Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Shan Zhi (Gardeniae Fructus), Chai Hu (Bupleuri Radix), Ban Xia (Pinelliae Rhizoma), Tian Ma (Gastrodiae Rhizoma), and Zhi Gan Cao (Prepared Licorice Root). He recovered.
Wu Shanzhi, a Censor, fell from a horse and injured his head, suffering excessive bleeding. He presented with fever, irritability, muscle twitching, and tremors. Some physicians suspected *Poshang Feng* (tetanus from wound infection) and proposed inducing sweating to dispel wind. I stated: "This is fire agitation due to blood loss. There is no wind to dispel and no sweat to induce; one must vigorously tonify the blood." I prescribed *Shengyu Tang* (Sage Recovery Decoction). After two doses, he recovered instantly. Subsequently, he was treated with formulas to strengthen the Spleen and Stomach and nourish Qi and Blood for full recovery.
A scholar, whose back sore was nearly healed, developed fever and irritability. Having self-administered cooling/fire-draining herbs, he subsequently developed neck stiffness, lockjaw, spontaneous sweating, and aversion to cold. This resulted from excessive sweating leading to the loss of body fluids and blood, causing the sinews to lose nourishment. He was cured using Qi and Blood tonifying formulas combined with *Dihuang Wan* (Rehmannia Pill).
A man who habitually worked hard and rose early developed generalized papules, lockjaw, fixed gaze, and a wiry-tight pulse. This indicated Qi and Blood injury from overwork, with internal heat clashing with external pathogens. He recovered using *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) supplemented with Shan Zhi, Qiang Huo (Notopterygii Rhizoma et Radix), and Chuan Xiong. Half a year later, he experienced generalized pruritus, which, when scratched, became ulcerated, accompanied by fever, thirst, and a surging yet empty pulse. The previous formula was modified with Shao Yao (Paeoniae Radix), Mai Men Dong (Asparagi Radix), Shu Di Huang (Prepared Rehmanniae Radix), and Tian Ma, leading to recovery.
A scholar prone to anger suffered from *Luoli* (scrofula). Following a fit of rage and jumping, he suddenly collapsed, exhibiting arm convulsions, facial deviation, and a constricted left pupil. This was diagnosed as Liver Fire with Blood deficiency, generating internal heat and wind. He recovered using *Bazhen Tang* (Eight Treasure Decoction) supplemented with Mu Dan Pi (Moutan Cortex), Gou Teng (Uncariae Ramulus cum Uncis), and Shan Zhi. In the following spring, the condition recurred with urinary incontinence and a wiry, surging, and rapid pulse at the left Guan position. I attributed this to Liver Fire and Blood dryness, prescribing *Liujun Wan* (Six Ingredient Pill with Rehmannia) supplemented with Gou Teng, Wu Wei Zi (Schisandrae Fructus), Mai Men Dong, Chuan Xiong, and Dang Gui. Gradual improvement followed, stabilized further by *Buzhong Yiqi Tang* supplemented with Shan Zhi, Gou Teng, and Mu Dan Pi.
A woman, angered and falling to the ground, experienced bleeding from a sore, dysarthria, facial deviation, limb contracture, sweating, and urinary incontinence. When administered wind-dispelling agents, her six pulses were surging, particularly the Liver pulse, indicating intense Liver Fire. She recovered using *Jiawei Xiaoyao San* (Modified Free and Easy Wanderer Powder) with Gou Teng, alongside *Liujun Wan*.
A woman with internal hemorrhoids suffered severe bleeding due to exertion, presenting with intermittent spasms, poor appetite, fatigue, and pallor. I diagnosed this as Qi damage failing to control Blood. Prescribing *Buzhong Yiqi Tang*, she paradoxically developed alternating chills and fever with renewed bleeding, indicating Yang deficiency and cold. The same formula was continued with Pao Jiang (Prepared Zingiberis Rhizoma) for four doses, stopping the chills and fever and improving appetite. Four more doses stopped the bleeding completely. Later, due to exertion or anger, she experienced hematochezia or spasms; treatment with *Buzhong Yiqi Tang*... [text cuts off].
A woman with an irritable temperament suffered generalized pruritus and occasional cervical lymph node swelling. Habitual use of herbs to search out wind and move Qi led to hematemesis after a fit of rage, along with lip/tightening, polyuria, and occasional incontinence. This was anger-moving Liver Fire causing reckless blood movement. She recovered using *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) supplemented with Shan Zhi and Mu Dan Pi.
A woman, exhausted and angry, presented with limb flexion contractures, painful restlessness, sweating, oliguria, and aversion to wind-cold, with a floating, wiry, and moderate pulse. This indicated Qi and Blood deficiency with clashing of wind-cold-damp-heat. Initial treatment with Dong Yuan's *Qingzao Tang* (Clear Dryness Decoction) brought gradual improvement, followed by *Jiawei Xiaoyao San* and *Bazhen Tang* supplemented with Mu Dan Pi for complete recovery.
A woman with chronic Liver Fire experienced intermittent pain and swelling in the hypochondrium, alternating chills and fever, sudden coma, convulsions, frequent yawning/stretching, limb tendon cramps, and rising phlegm-saliva. This was diagnosed as extreme Lung Metal dryness with depleted Blood. Combined use of *Qingzao Wan* (Clear Dryness Pill) and *Liujun Wan* led to recovery.
A woman, exhausted, developed a carbuncle with papules. Scratching broke the skin into sores, with high fever in the late afternoon, occasional lockjaw and convulsions, and dizziness. This indicated Qi and Blood deficiency of the Liver and Spleen, with Heat in Spleen Blood. *Jiawei Xiaoyao San* brought gradual improvement, followed by *Bazhen San* supplemented with Chai Hu and Shan Zhi for cure.
Another woman presented with papules, high fever in the late afternoon, early menstruation, dizziness, alternating chills/fever, and limb convulsions. This was Wind-Blood Heat and Blood dryness in the Liver Channel. *Jiawei Xiaoyao San* led to quick recovery. Later, anger triggered recurrence with lockjaw and incontinence, indicating Liver Fire and Blood dryness. *Jiawei Xiao Chai Hu Tang* brought gradual improvement. Nighttime fever and delirium indicated Heat in the Blood level, treated with *Xiao Chai Hu Tang* plus Sheng Di Huang (Rehmanniae Radix) for recovery. Finally, *Jiawei Xiaoyao San* was used for regulation and stability.
A woman with *Jian Chun* (callous lip/cancer of the lip) had early menstruation. I diagnosed Liver Fire and Blood Heat. Disbelieving this, she indiscriminately used fire-draining herbs, resulting in delayed menstruation. Subsequent exertion and anger caused lockjaw, groaning, immobility, surging pulses, and red face. Treatment with *Bazhen Tang*, Mai Men Dong, Wu Wei Zi, Shan Zhi, and Dan Pi brought gradual improvement over several doses. Concurrent use of *Xiaoyao San* and *Liujun Wan* ingredients for over thirty doses each resulted in full recovery.
A woman whose menstruation ceased upon anger, progressing to lockjaw, tendon cramps, epistaxis, headache, phlegm surging, convulsions, and upward-gazing pupils, suffered from intense Liver Fire. She recovered using *Xiao Chai Hu Tang* supplemented with Shu Di Huang, Shan Zhi, and Gou Teng.
A woman with inherent Yin deficiency suffered generalized pruritus. Misuse of wind-dispelling herbs led to lockjaw and convulsions, with a surging-rapid Liver pulse. I stated: "Liver Blood is Yin/Water; Liver Qi is Yang/Fire. This is Blood-Heat and Fire-Excess in the Liver Channel." One must assist Yin/Blood and suppress Liver Fire. Prescription: Si Wu Tang (Four Substance Decoction), Mai Men Dong, Wu Wei Zi, Chai Hu, Shan Zhi, and Sheng Gan Cao (Raw Licorice Root). Fever and convulsions stopped immediately. Convalescence was managed with *Bazhen Tang* supplemented with Huang Qi (Astragali Radix), Mai Men Dong, Wu Wei Zi, Gou Teng, and Zhi Gan Cao.
A woman with chronic *Liuzhu* and weak Spleen/Stomach suddenly presented with phlegm obstruction, wheezing, head shaking, blinking, flailing arms and legs, making pulse diagnosis difficult. Her face showed yellow with green undertones, indicating Liver Wood overacting on Spleen Earth. She regained consciousness using *Liujun Zi Tang* (Six Gentlemen Decoction) supplemented with Chai Hu and Sheng Ma (Cimicifugae Rhizoma). Stability was achieved with *Buzhong Yiqi Tang* supplemented with Ban Xia and Fu Ling (Poria).