涂蔚生曰∶痉之为病，由于发汗太多，以伤卫阳之气，或风病下之，而过伤其阴营之血也。如仲景所云∶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。夫痉而曰刚，曰柔，乃从
太阳之伤寒伤风症夹泻而出。其别于痉之正病，非痉之正证可知。故其下文又曰∶太阳病发汗太多，因致痉。夫
风病下之刚痉，复发汗，必拘急。疮家虽身疼痛，不可发汗，汗出则痉。是痉之由于血枯津少，不能荣养筋脉，已
可概见。然犹恐医者之过于拘泥，不能随症变通，故其后又曰∶太阳病，其症备，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。以见痉之不可汗者，而有时症兼太阳之寒凝筋脉者，亦
可汗之。痉之不可下者，而有时症兼阳明之热灼津液者，亦可下之。其正治之法，虽未揭明，而其曰下之则痉，
汗出则痉，是明教人以治痉之正法，不可汗下，只可生
津液，和筋脉者也。汉后诸医多昧于其借宾定主之文，而不能将此中奥义，详为指出。甚至有除却刚痉、柔痉之
外，尚有阳痉阴痉之说者，殊属可怪。至近代之唐容川出焉，始能将此中精微揭出，诚可谓独具慧眼、启千载之
昏，振万古之迷蒙者矣。余于读客川此节之所得，谨撮其要，以为痉症之谈。
仲景栝蒌桂枝汤（即桂枝加栝蒌一味）
涂蔚生曰∶栝蒌桂枝汤与葛根汤，为仲景治伤风伤寒而兼有痉病者，非治痉之正方也。一则重在栝蒌生津
止渴，大清阳明之热。一则重在葛根疏通经脉，直解太阳之寒。然细揣此中定义，治痉之正病，用药当不外柴胡、
葛根、当归、白芍、生地、川芎、黄芩、党参、石膏、知母、花粉、甘草等味。恍如前之治虚热生风者，既不患
重伤津液之戒，又不患风寒凝于经脉之嫌。若民众既受祸灾以后，图一善后补救之方也。
仲景大承气汤
大黄（一钱） 浓朴（七分） 枳实（七分） 芒硝（一钱）
涂蔚生曰∶此方为仲景治伤寒传于阳明，禀热太甚，全无外症，而有大便不通，发热胸腹胀满等症者。以之
治病在经脉，血虚经燥者，得勿患虚虚之戒乎？然里热过剧，津液实受其伤。火热一时不降，则津液一时不生，
下一分之火热，即所以保一分之津液也。其曰可与二字，盖亦云内热甚于外之症，在经脉，到了危险万分之时，
不得不挺而走险，出于下之一途耳。如吾人以识见未及，不敢作冒昧，可以生地、杭芍、当归、川芎等味加入，
以固津液。迨其内热已清，再为从事养阴血、和筋脉可也。
涂蔚生说：痉病的发生，是因为发汗过多，损伤了卫阳之气；或者是风病误用下法，过度损伤了阴营之血。正如张仲景所说：太阳病（太阳经受邪所致的病证），发热无汗，反而恶寒的，称为刚痉（表现为项背强直、口噤不开、无汗的痉病）。太阳病，发热汗出，而不恶寒的，称为柔痉（表现为项背强直、汗出、不恶寒的痉病）。所谓“刚”和“柔”，是从太阳病的伤寒和伤风症状中夹杂泻利等情况衍生出来的。它们区别于痉病的正病（典型痉病），这就很明显了。所以他在下文又说：太阳病发汗太多，因而导致痉病。患风病误用下法出现刚痉，如果再发汗，必然会导致肢体拘急。患有疮疡的人虽然身体疼痛，不可发汗，如果发汗则会导致痉病。由此可见，痉病是由于血液枯竭、津液稀少，不能濡养筋脉所致。
然而，恐怕医生过于拘泥成法，不能随病症变化而灵活变通，所以在后文中又说：太阳病，症状具备，身体强直，KT KT然（形容身体强直僵硬的样子），脉象反而沉迟，这是痉病，用栝蒌桂枝汤主治。太阳病无汗，而小便反而少，气上冲胸，口噤不能说话，将要发作刚痉，用葛根汤主治。痉病，胸满口噤，睡觉时背部不能着席（角弓反张），脚部挛急，必定咬牙，可以给予大承气汤。以此说明，对于不宜发汗的痉病，有时若兼有太阳经寒凝筋脉的症状，也可以发汗；对于不宜攻下的痉病，有时若兼有阳明经热灼津液的症狀，也可以攻下。其正治之法，虽然没有明确揭示，但他所说的“下之则痉”、“汗出则痉”，是明确教导人们治疗痉病的正确方法，不可轻易发汗或攻下，只应通过生津液、调和筋脉来治疗。汉代以后的许多医生大多不明白这种借宾定主（通过对比衬托主要论点）的写作手法，不能详细指出其中的奥义。甚至有人说除了刚痉、柔痉之外，还有阳痉、阴痉的说法，这确实很奇怪。到了近代唐容川出现，才开始将这里的精微之处揭示出来，真可谓独具慧眼，开启了千年的昏昧，振奋了万古的迷蒙。我阅读唐容川这一节所得到的心得，谨摘录其要点，作为对痉症的论述。
涂蔚生说：栝蒌桂枝汤与葛根汤，是张仲景治疗伤风、伤寒兼有痉病的方剂，并非治疗痉病的正宗方剂。前者重在栝蒌生津止渴，大清阳明经的热邪；后者重在葛根疏通经脉，直接解除太阳经的寒邪。然而仔细推敲其中的定义，治疗痉病的正病，用药应当不外乎柴胡、葛根、当归、白芍、生地、川芎、黄芩、党参、石膏、知母、花粉、甘草等药物。这就像之前治疗虚热生风的方法一样，既不担心重伤津液的禁忌，也不担心风寒凝结于经脉的嫌疑。这就像是民众遭受祸灾之后，寻求善后补救的方案。
张仲景的大承气汤
大黄（一钱） 浓朴（七分） 枳实（七分） 芒硝（一钱）
涂蔚生说：这个方剂是张仲景治疗伤寒传入阳明经，禀受热邪太盛，完全没有外感症状，而有大便不通、发热、胸腹胀满等症状的情况。用它来治疗经脉中的疾病，如果是血虚经脉干燥的患者，难道不怕犯下“虚虚”（使虚者更虚）的禁忌吗？然而里热过剧，津液确实受到损伤。火热一时不降，津液就一时不生，攻下一分火热，就是保全一分津液。他说“可与”这两个字，大概是指内热重于外热的症状，在经脉方面，到了万分危险的时候，不得不挺而走险，采取攻下的途径罢了。如果我们见识不到这里，不敢冒昧行事，可以在方中加入生地、杭芍、当归、川芎等药物，以固护津液。等到内热已经清除，再从事于滋养阴血、调和筋脉的工作即可。
Tu Weisheng stated: The disease of Jing (spasm) arises from excessive sweating, which injures the Wei-Yang Qi (defensive yang energy), or from the inappropriate use of purgatives in wind diseases, which excessively damages the Yin-Ning Blood (nutritive yin blood). As Zhang Zhongjing said: In Taiyang disease (disease pattern caused by pathogenic invasion of the Taiyang channel), if there is fever, no sweat, and aversion to cold, it is named Gang-Jing (rigid spasm, characterized by neck stiffness, trismus, and anhidrosis). In Taiyang disease, if there is fever, sweating, but no aversion to cold, it is named Rou-Jing (flexible spasm, characterized by neck stiffness, diaphoresis, and absence of aversion to cold). The terms "rigid" and "flexible" are derived from the symptoms of Taiyang cold damage and wind strike complicated with diarrhea. It is evident that these differ from the true form of Jing disease. Therefore, he further states: Excessive sweating in Taiyang disease leads to Jing. If purgatives were used for a wind disease resulting in rigid spasm, and sweating is induced again, limb rigidity will inevitably occur. Patients with chronic sores who experience body pain should not be subjected to sweating; if sweating occurs, Jing will result. This makes it clear that Jing is caused by blood depletion and fluid deficiency, leading to the inability to nourish the sinews and vessels.
However, fearing that physicians might be too rigid and fail to adapt to changing symptoms, he subsequently states: In Taiyang disease, when all symptoms are present, the body is stiff, KT KTran (describing a state of stiffness and rigidity), and the pulse is unexpectedly deep and slow, this is Jing, treated with Gualou Guizhi Tang (Trichosanthes Twig Decoction). In Taiyang disease, if there is no sweat, yet urination is surprisingly scanty, qi rushes upward to the chest, trismus prevents speech, and Gang-Jing is about to manifest, Gegen Tang (Kudzu Root Decoction) should be administered. For Jing disease, if there is chest fullness, trismus, inability to lie flat with the back touching the bed (opisthotonos), leg cramps, and teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be given. This illustrates that while Jing generally contraindicates sweating, if accompanied by cold stagnation in the Taiyang channels, sweating may be indicated. Similarly, while Jing generally contraindicates purging, if accompanied by heat scorching fluids in the Yangming channels, purging may be indicated. Although the standard treatment method is not explicitly stated, his remarks that "purging causes Jing" and "sweating causes Jing" clearly teach that the correct treatment for Jing should avoid sweating and purging, focusing instead on generating fluids and harmonizing the sinews and vessels. Many physicians after the Han dynasty failed to understand this rhetorical technique of using contrast to highlight the main point and did not elucidate its profound meaning. Some even claimed the existence of Yang-Jing and Yin-Jing beyond Gang-Jing and Rou-Jing, which is quite strange. It was not until the modern era, with the emergence of Tang Rongchuan, that the subtleties here were revealed. He can truly be said to have had unique insight, dispelling millennia of obscurity and awakening ages of confusion. Based on my reading of Tang Rongchuan's section, I have summarized the essentials as a discussion on Jing syndrome.
Zhang Zhongjing's Gualou Guizhi Tang (Guizhi Tang plus Trichosanthes Radix)
Tu Weisheng stated: Gualou Guizhi Tang and Gegen Tang are formulas used by Zhang Zhongjing for wind strike and cold damage complicated by Jing disease; they are not the primary formulas for treating Jing itself. The former focuses on Trichosanthes Radix (Gualou) to generate fluids, relieve thirst, and clear heat in the Yangming channel. The latter focuses on Kudzu Root (Gegen) to unblock the channels and directly resolve cold in the Taiyang channel. However, carefully analyzing the definitions within, the medication for the true form of Jing disease should primarily include Bupleuri Radix (Chaihu), Kudzu Root (Gegen), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Rehmanniae Radix Preparata (Shengdi), Chuanxiong Rhizoma (Chuanxiong), Scutellariae Radix (Huangqin), Codonopsis Radix (Dangshen), Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma (Zhimu), Trichosanthes Radix (Huafen), and Glycyrrhizae Radix et Rhizoma (Gancao). This resembles the previous approach for treating wind generated by deficient heat, avoiding the taboo of severely damaging fluids and the concern of wind-cold stagnating in the channels. It serves as a remedial formula for recovery after disaster.
Zhang Zhongjing's Da Chengqi Tang
Rhei Radix et Rhizoma (Dahuang) (1 qian)
Magnoliae Officinalis Cortex (Nongpu) (0.7 qian)
Immature Citrus Fruit (Zhishi) (0.7 qian)
Mirabilite (Mangxiao) (1 qian)
Tu Weisheng stated: This formula is used by Zhang Zhongjing for cold damage transmitted to the Yangming channel, where heat is extremely intense, external symptoms are absent, and symptoms such as constipation, fever, and abdominal distension and fullness are present. Using it for diseases in the channels involving blood deficiency and dryness of the channels, does one not risk violating the prohibition against "making the deficient more deficient"? However, when internal heat is severe, fluids are indeed damaged. If fire-heat is not reduced promptly, fluids cannot be generated; purging one unit of fire-heat preserves one unit of fluids. The phrase "may be given" implies that in cases where internal heat exceeds external heat, and the condition in the channels reaches a critical danger, one must take a desperate measure and resort to purging. If our understanding is insufficient and we dare not act rashly, we may add Rehmanniae Radix Preparata (Shengdi), Paeoniae Radix Alba (Hangshao), Angelicae Sinensis Radix (Danggui), and Chuanxiong Rhizoma (Chuanxiong) to protect the fluids. Once the internal heat is cleared, we can then proceed to nourish yin-blood and harmonize the sinews and vessels.