陈良甫云∶妇人项筋拘挛强痛，每得此疾，疗之似易而实难。然方册中所载亦少，纵
有言之，议论亦略。以予考之，然既有是疾，
必有是方。何古人言此疾证尚且略，又无的然之论详之，必是挟诸疾而生，所以绝无专
门。予因暇日摭古名方以备检阅。然自明学识浅鄙，未必全备，博学之士，见其遗缺，尚
冀补而完之。
夫颈项之处，乃属足太阳膀胱之经。又许太学云∶是足少阴肾之经，盖肾与膀胱为
表里故也。以感外邪论之，则有太阳经先因感风，又感寒湿，致令外证发热恶寒，与伤
寒相似，颈项强急，腰身反张如中风状，螈 口噤，其身体KT KT ，古人以强直为痉，其
脉沉迟弦细。新产血虚多汗出，喜中风，亦有此证。详见产后中风，兹不赘录。又有挫
枕转项不得者，与三五七散、追风散，仍与急风散搽项上。若因被风吹头目昏眩，太阳
并脑俱痛，项背筋脉拘急，可与蝎附散、都梁丸。许太学治项筋强痛不可转侧，以木瓜
煎。
〔薛〕前证若因肝木自旺，用泻青丸。（头痛。）精血不足，六味丸。（杂病虚劳。）风热淫
肝，加味逍遥散。（调经。）怒动肝火，加味小柴胡汤。（热入血室。）肝经血虚，加味四物汤（即四
物加柴胡、丹皮、山栀。）肾不能生肝，六味丸。膀胱气滞，羌活胜湿汤。（杂病腰痛。）大抵肝火
旺，则肝血虚而筋燥，颈项强急，或腰背反张，或四肢挛拳，或颈项等处结核。一妇
人耳内或耳后项侧作痛，寒热口苦，月经不调，此肝胆经火兼伤脾胃，用四君加柴胡、升
麻、黄 、芍药而愈。后因劳役怒气，呕吐胁胀，用六君子汤加山栀、柴胡而安。一
妇人因怒，寒热作渴，左目紧小，头颈动掉，四肢抽搐，遍身疼痛，此血虚肝热则生风也，
用加味逍遥加钓藤钩数剂，诸证渐愈，又用八珍汤而痊。
追风散 治年深日近，偏正头疼，又治肝脏久虚，血气衰弱，风毒之气上攻，头痛
头眩，目晕心忪，烦热，百节酸疼，脑昏目痛，鼻塞声重，项背拘急，皮肤瘙痒，面上
游风，状若虫行，及一切头风。兼疗妇人血风攻疰，头目昏痛，皆治之。
川乌（炮，去尖皮脐） 防风（去芦） 石膏（ ） 川芎 甘草（炙） 荆芥穗
白僵蚕（炒去丝，各一两） 天南星（炮） 羌活 天麻 地龙 白附子（炮） 全蝎（去尾针）
白芷（各半两） 草乌头（炮，去皮脐尖） 没药（研） 乳香（研） 雄黄（研，各二钱半）
上为细末，每服半钱，入好茶少许同调，食后及临卧服。常服清头目，利咽膈，消风
化痰。
急风散
草乌头（三两，一半烧存性，于酒内蘸令冷，余一半生用） 丹砂（另研，一两，水飞）
黑豆（二钱五分，同草乌一处为末） 麝香（另研，二钱半）
上为细末，入研药匀停，酒调涂痛处。
蝎附散 治一切风邪头痛，夹脑风，痰涎壅盛，呕逆恶心，口吐清水，暗风旋晕，眼
见黑花，牙关紧急，口眼 斜，面目 动，头项拘急，肩背引疼，耳痒目昏，四肢麻木，及
沐浴出暴感风邪，头目昏痛，两太阳疼，远年头风，服诸药无效，并皆治之。
全蝎（炮） 雄黄（水飞） 朱砂（各一钱半，水飞） 附子（炮，去皮脐）
川乌头（炮，去皮脐） 麻黄（去节） 天南星（姜制） 防风（去芦） 白僵蚕（炒，各三
钱） 本（去芦、土） 白芷（各半两）
上为细末，每服半钱，葱茶调下，食后。孕妇不可服。
京城之医，用此药兼嚼如圣饼子，治眼羞明多泪，见物不明，有效。一方，用白附子、蝎梢。
木瓜煎
宣州木瓜（二枚，切顶作盖，刳去瓤） 没药（二两，另研） 乳香（二钱半，另研）
上二味，入木瓜中，用盖子合了，竹签定之，饭上蒸三四次，烂，研成膏子。每服
三匙，生地黄汁半盏，无灰好酒二盏，调和服之。
有人患此病，自午后发，黄昏时定。予曰∶此患必先从足起。经言十二经络各有筋，
惟足下少阴之筋，自足至头。大抵筋者肝之合也，日中至黄昏，天之阳，阳中之阴也，又
曰阳中之阴，肺也。自离至兑，阴旺阳弱之时，故《灵宝秘法》云∶离至干，肾气绝而
肝气弱。肝肾二脏受阴气，故发于是时。予授此方，三服而愈。
余证治论方，俱详杂病本门。
陈良甫说：妇女出现颈项部筋脉拘挛、僵硬疼痛的症状，每次患上这种病，治疗起来看似容易但实际上很难。然而医书典籍中记载的方剂也很少，即使有提及，论述也很简略。根据我的考察，既然存在这种疾病，就一定有对应的方剂。为什么古人对此病证的论述如此简略，又没有确切详尽的理论来阐述它呢？这一定是因为该病症夹杂在其他多种疾病中产生，所以没有专门的治法。我趁着闲暇时间，搜集古代名医的方剂以备查阅。但我自己明察力浅薄，学识鄙陋，未必能完全完备，希望博学的士人看到其中的遗漏缺失，能够加以补充完善。
颈项部位，属于足太阳膀胱经。另外许太学说：这也是足少阴肾经所过之处，大概是因为肾与膀胱互为表里的缘故。从感受外邪的角度来分析，如果是足太阳经先感受风邪，又感受寒湿，导致出现发热、恶寒等外感症状，这与伤寒相似，表现为颈项强直紧急，腰身反张如同中风的样子，抽搐、牙关紧闭，身体僵硬不舒（KT KT 指身体僵硬不适之状），古人将这种强直状态称为“痉”，其脉象沉迟弦细。新产后因血虚多汗，容易感受风邪，也会出现此类证候。详细内容详见“产后中风”篇，此处不再赘述。又有因枕头不合适或转头不当导致颈部活动受限的，可使用三五七散、追风散，并配合急风散涂抹于颈项处。如果是因为被风吹袭导致头目昏眩，太阳经与脑部同时疼痛，颈背部筋脉拘急，可以使用蝎附散、都梁丸。许太学治疗颈项筋脉强痛无法转侧，使用木瓜煎。
〔薛己〕上述证候如果是因为肝木之气自旺所致，使用泻青丸。（伴有头痛。）精血不足，使用六味丸。（杂病中的虚劳。）风热邪气淫溢侵犯肝脏，使用加味逍遥散。（调理月经。）愤怒触动肝火，使用加味小柴胡汤。（热入血室。）肝经血虚，使用加味四物汤（即四物汤加入柴胡、丹皮、山栀。）肾不能滋养肝木，使用六味丸。膀胱气机阻滞，使用羌活胜湿汤。（杂病腰痛。）大抵肝火旺盛，则肝血亏虚而筋脉干燥，导致颈项强直紧急，或者腰背反张，或者四肢蜷缩握拳，或者颈项等处出现结核肿块。有一位妇女耳内或耳后及颈侧疼痛，伴有寒热、口苦、月经不调，这是肝胆经火旺兼损伤脾胃所致，使用四君子汤加入柴胡、升麻、黄芪、芍药而痊愈。后来因劳累和怒气，出现呕吐、胁肋胀满，使用六君子汤加入山栀、柴胡而安定。另一位妇女因愤怒，出现寒热、口渴，左眼紧缩变小，头颈颤动，四肢抽搐，全身疼痛，这是血虚肝热生风所致，使用加味逍遥散加入钩藤数剂，诸症逐渐好转，后又使用八珍汤而痊愈。
追风散 治疗年深日久、时发时止的偏头痛和正头痛，又治疗肝脏长期虚弱，气血衰弱，风毒之气上攻头部，引起头痛、头晕，眼花心慌，烦热，全身关节酸痛，头脑昏沉眼睛疼痛，鼻塞声音重浊，颈背部拘急，皮肤瘙痒，面部游走性风疹，感觉像虫子爬行，以及一切头风病。兼治妇人血风攻注引起的头目昏痛，都能治疗。
川乌（炮制，去掉尖端、皮和脐） 防风（去掉芦头） 石膏（煅） 川芎 甘草（炙） 荆芥穗
白僵蚕（炒去丝，各一两） 天南星（炮制） 羌活 天麻 地龙 白附子（炮制） 全蝎（去掉尾针）
白芷（各半两） 草乌头（炮制，去掉皮、脐和尖） 没药（研碎） 乳香（研碎） 雄黄（研碎，各二钱半）
以上药物研成细末，每次服用半钱，加入少许好茶调匀，饭后及临睡前服用。常服可清利头目，通畅咽喉膈膜，消除风邪化痰。
急风散
草乌头（三两，一半烧至存性，在酒中蘸凉，另一半生用） 丹砂（另研，一两，水飞法处理）
黑豆（二钱五分，与草乌一起研末） 麝香（另研，二钱半）
以上研成细末，将研好的药混合均匀，用酒调涂于疼痛处。
蝎附散 治疗各种风邪头痛，夹脑风，痰涎壅盛，呕吐恶心，口吐清水，暗风眩晕，眼前见黑花，牙关紧急，口眼歪斜，面目抽动，头项拘急，肩背牵引疼痛，耳痒目昏，四肢麻木，以及沐浴后突然感受风邪，头目昏痛，两侧太阳穴疼痛，多年老年的头风病，服用其他药物无效的，均能治疗。
全蝎（炮制） 雄黄（水飞） 朱砂（各一钱半，水飞） 附子（炮制，去皮脐）
川乌头（炮制，去皮脐） 麻黄（去掉节） 天南星（姜汁制） 防风（去掉芦头） 白僵蚕（炒，各三钱） 藁本（去掉芦头和土） 白芷（各半两）
以上研成细末，每次服用半钱，用葱白和茶调服，饭后服用。孕妇不可服用。
京城的医生，用此药配合咀嚼如圣饼子，治疗眼睛怕光多泪，视物不明，有效。另一配方，使用白附子、蝎梢。
木瓜煎
宣州木瓜（两个，切开顶部作盖，挖去瓤） 没药（二两，另研） 乳香（二钱半，另研）
以上两种药，放入木瓜中，用盖子盖好，用竹签固定，放在饭上蒸三四次，直到烂熟，研成膏状。每次服用三匙，用生地黄汁半盏，无灰好酒二盏，调和后服用。
有人患此病，每天午后发作，黄昏时停止。我说：这个病患一定先从脚部开始。经文说十二经络各有筋，只有足下的少阴之筋，从脚直达头部。大抵筋是肝的外合，中午到黄昏，是天的阳气，阳中之阴，又说阳中之阴对应肺。从午时（离）到酉时（兑），是阴气旺盛阳气微弱的时候，所以《灵宝秘法》说：从离到干（此处原文可能有误，通常指时辰变化），肾气绝而肝气弱。肝肾两脏受到阴气影响，所以在此时发作。我传授此方，服用三次而痊愈。
其余证候的治疗理论和方剂，都详细记载在杂病本门中。
Chen Liangfu stated: Women suffering from stiffness, spasm, and pain in the neck and nape often find that while treatment appears easy, it is actually difficult. However, records in medical texts are scarce; even when mentioned, discussions are brief. Based on my examination, since this disease exists, there must be corresponding prescriptions. Why did ancient authors discuss this condition so briefly without detailed theories? It is likely because this condition arises in conjunction with various other diseases, hence lacking a specialized approach. I have collected famous ancient prescriptions during my leisure time for reference. Given my limited knowledge, this collection may not be exhaustive. I hope learned scholars will identify omissions and help complete it.
The neck and nape region belongs to the Foot-Taiyang Bladder Meridian. Additionally, Xu Taixue noted that it is also traversed by the Foot-Shaoyin Kidney Meridian, primarily because the Kidney and Bladder are exterior-interiorly related. From the perspective of external pathogenic factors, if the Foot-Taiyang Meridian is first affected by Wind, followed by Cold-Dampness, it leads to exterior symptoms such as fever and aversion to cold, resembling Shanghan (Cold Damage). Symptoms include stiffness and tension in the neck and nape, opisthotonos (arching of the back) similar to Zhongfeng (Wind Stroke), convulsions, and trismus (lockjaw). The body feels stiff and uncomfortable. Ancient texts refer to this state of rigidity as Jing (Spasm). The pulse is typically deep, slow, wiry, and thin. Postpartum women, due to blood deficiency and excessive sweating, are prone to Wind invasion and may exhibit these symptoms. For details, see "Postpartum Wind Strike"; here we do not repeat. Cases involving restricted neck movement due to pillow issues or awkward turning can be treated with Sanwuqi San (Three-Five Seven Powder) and Zhuifeng San (Wind-Chasing Powder), applied topically to the neck with Jifeng San (Urgent Wind Powder). If wind exposure causes dizziness and headache affecting both the Taiyang meridian and the brain, with stiffness in the neck and back muscles, Xie Fu San (Scorpion and Aconite Powder) or Duliang Wan (Duliang Pill) may be used. Xu Taixue treated severe neck stiffness preventing head rotation using Mugua Jian (Quince Decoction).
[Xue Ji] For the aforementioned conditions: If caused by hyperactive Liver Wood, use Xieqing Wan (Drain Green Pill). [Accompanied by headache.] If due to insufficiency of essence and blood, use Liuwei Wan (Six-Ingredient Pill). [In miscellaneous diseases involving deficiency consumption.] If Wind-Heat invades the Liver excessively, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). [For regulating menstruation.] If anger stirs Liver Fire, use Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction). [For Heat entering the Blood Chamber.] If there is Liver Meridian blood deficiency, use Jiawei Siwu Tang (Modified Four Substances Decoction, i.e., Siwu Tang plus Chai Hu, Mu Dan Pi, Zhi Zi). If the Kidney fails to nourish the Liver, use Liuwei Wan. If there is Qi stagnation in the Bladder, use Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness). [For miscellaneous disease lower back pain.] Generally, when Liver Fire is hyperactive, Liver blood becomes deficient, leading to dry tendons. This results in neck stiffness, opisthotonos, flexion spasms of the four limbs, or nodules in the neck area. One woman experienced pain in or behind the ear and on the side of the neck, accompanied by alternating chills and fever, bitter taste, and irregular menstruation. This was due to Liver-Gallbladder fire combined with Spleen-Stomach injury. She recovered after taking Sijunzi Tang (Four Gentlemen Decoction) added with Chai Hu, Sheng Ma, Huang Qi, and Bai Shao. Later, due to overwork and anger, she suffered vomiting and hypochondriac distension, which stabilized after taking Liujunzi Tang (Six Gentlemen Decoction) added with Zhi Zi and Chai Hu. Another woman, angered, developed chills, fever, thirst, a small left eye, tremors of the head and neck, limb convulsions, and generalized body pain. This was wind generated from blood deficiency and Liver heat. After several doses of Jiawei Xiaoyao San added with Gou Teng (Uncaria Hook), her symptoms gradually improved, and she fully recovered after taking Bazhen Tang (Eight Treasures Decoction).
Zhuifeng San (Wind-Chasing Powder) treats chronic, recurrent lateral and frontal headaches. It also treats long-term Liver deficiency with weakened Qi and blood, where Wind-Toxin attacks upward, causing headache, dizziness, blurred vision, palpitations, irritability, joint soreness, brain fog, eye pain, nasal congestion, heavy voice, neck-back stiffness, skin itching, migratory facial wind-rashes (feeling like insects crawling), and all types of Head Wind disorders. It also treats women's Blood-Wind attacking the chest/head, causing dizziness and pain.
Chuan Wu (Aconiti Lateralis Radix Praeparata, processed, tip/skin/navel removed) Fang Feng (Saposhnikoviae Radix, rhizome removed) Shi Gao (Gypsum Fibrosum, calcined) Chuan Xiong (Ligustici Chuanxiong Rhizoma) Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) Jing Jie Sui (Schizonepetae Spica)
Bai Jiang Can (Bombyx Batryticatus, stir-fried, silk removed, each 1 liang) Tian Nan Xing (Arisaematis Rhizoma, processed) Qiang Huo (Notopterygii Rhizoma et Radix) Tian Ma (Gastrodiae Rhizoma) Di Long (Pheretima) Bai Fu Zi (Typhonii Rhizoma, processed) Quan Xie (Scorpio, tail/stinger removed)
Bai Zhi (Angelicae Dahuricae Radix, each 0.5 liang) Cao Wu Tou (Aconiti Kusnezoffii Radix, processed, skin/navel/tip removed) Mo Yao (Myrrha) Ru Xiang (Olibanum) Xiong Huang (Realgar, each 2.5 qian)
Grind into fine powder. Take 0.5 qian per dose, mixed with a little good tea. Take after meals and before bed. Regular use clears the head and eyes, benefits the throat and diaphragm, dispels wind, and resolves phlegm.
Jifeng San (Urgent Wind Powder)
Cao Wu Tou (Aconiti Kusnezoffii Radix, 3 liang; half calcined to retain character, dipped in wine to cool; half raw) Dan Sha (Cinnabaris, separately ground, 1 liang, water-suspended)
Hei Dou (Sojae Semen Nigrum, 2.5 qian, powdered together with Cao Wu Tou) She Xiang (Moschus, separately ground, 2.5 qian)
Grind into fine powder, mix evenly with the separately ground ingredients. Apply to the painful area mixed with wine.
Xie Fu San (Scorpion and Aconite Powder) Treats all wind-pathogen headaches, Brain Wind, copious phlegm-saliva, vomiting/nausea, clear water spitting, silent wind/dizziness, seeing black spots before eyes, trismus, facial paralysis (deviation of mouth and eyes), twitching of face/eyes, neck stiffness, radiating shoulder-back pain, itchy ears, blurry vision, limb numbness. Also treats sudden wind invasion after bathing, causing dizziness/pain, bilateral temporal pain, chronic refractory Head Wind.
Quan Xie (Scorpio, processed) Xiong Huang (Realgar, water-suspended) Zhu Sha (Cinnabaris, each 1.5 qian, water-suspended) Fu Zi (Aconiti Lateralis Radix Praeparata, processed, skin/navel removed)
Chuan Wu Tou (Aconiti Lateralis Radix Praeparata, processed, skin/navel removed) Ma Huang (Ephedrae Herba, joints removed) Tian Nan Xing (Arisaematis Rhizoma, ginger-processed) Fang Feng (Saposhnikoviae Radix, rhizome removed) Bai Jiang Can (Bombyx Batryticatus, stir-fried, each 3 qian) Ben Cao (Ligustici Wallichii Rhizoma et Radix, rhizome/dirt removed) Bai Zhi (Angelicae Dahuricae Radix, each 0.5 liang)
Grind into fine powder. Take 0.5 qian per dose, taken down with green onion and tea, after meals. Pregnant women should not take this.
Doctors in the capital use this medicine chewed alongside Rusheng Bingzi (Like-Sage Cake) to treat photophobia, tearing, and blurred vision, with efficacy. Another formula uses Bai Fu Zi and Xie Shao (Scorpion tail).
Mugua Jian (Quince Decoction)
Xuan Zhou Mugua (Chaenomelis Fructus, 2 pieces, cut top as lid, hollow out pulp) Mo Yao (Myrrha, 2 liang, separately ground) Ru Xiang (Olibanum, 2.5 qian, separately ground)
Place the two medicines inside the quince, replace the lid, secure with bamboo pins, and steam over rice three or four times until soft. Grind into a paste. Take 3 spoons per dose, mixed with half a cup of fresh Sheng Di Huang juice (Rehmanniae Radix) and two cups of good unadulterated wine.
A patient suffered from this condition, starting in the afternoon and resolving at dusk. I said: This illness must originate from the feet. The classics state that the twelve meridians have their associated tendons, but only the Shaoyin tendon of the foot extends from the sole to the head. Generally, tendons are the exterior correspondence of the Liver. From noon to dusk is Yang time, specifically Yin within Yang, which corresponds to the Lung. From Li (Wu hour, noon) to Dui (You hour, dusk), Yin grows strong while Yang weakens. Thus, *Lingbao Mifa* states: From Li to Qian, Kidney Qi exhausts and Liver Qi weakens. The Liver and Kidney organs are affected by Yin Qi, causing onset at this time. I prescribed this decoction; three doses resulted in recovery.
Discussions on other syndromes and formulas are detailed in the main section on Miscellaneous Diseases.