活人书云阴阳二痉者阳痉属刚 阴痉属柔 以附子散桂心白术汤附子防风散八物白术汤
可选而用之
按仲景论刚柔二 并属太阳活人论阴阳二 既以阳痉属刚 阴痉属柔 而乃以术附姜桂
诸热药治阴痉则是以阴专为寒治矣恐非至当之论姑
伺明哲其方兹不载详见本论
子和书云吕君玉妻年三十病风搐目眩角弓反张数日不食诸医皆作惊风暗风风痫治之以南
星雄
黄乌附用之不效戴人曰诸风掉眩皆属肝木阳主动阴主静由火盛制金不能平木肝木茂而自病先
涌风痰二三升次以寒剂下之又以 针刺百会穴出血二杯立愈
按风搐本与 证不同而 证属湿土极必兼风木动摇之化风搐属木木极必见金燥紧敛之形
要之亦可同论故取此条以证 病不专于风寒湿之外至亦有风火热之内作者也
三因方云夫人之筋各随经络退出于身血气内虚外为风寒湿热之所中则 以风散气故有汗
而不
恶寒曰柔 寒泣血故无汗而恶寒曰刚 原其所因多由亡血筋无所营故邪得以袭之所以伤寒汗
下过多与夫病疮人及产后致斯疾者概可见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
按伤寒言 专主外邪为病陈无择发明血气内虚一节实与仲景所言汗下过多者相合可谓善
矣惜乎用药未能详明也又言阴缓阳急则太阳 也阳缓阴急则阳明 也
《活人书》说，阴阳两种痉病：阳痉属于刚痉，阴痉属于柔痉。可选用附子散、桂心白术汤、附子防风散、八物白术汤等方剂来治疗。
按：张仲景论述的刚痉和柔痉，都属于太阳病（太阳经受邪所致的病证）。《活人书》论述阴阳二痉，既然将阳痉归为刚、阴痉归为柔，却使用白术、附子、干姜、肉桂等热性药物治疗阴痉，这等于把阴痉专门当作寒证来治了，恐怕不是最恰当的理论。暂且等待明智之士指正，此处不记载具体方药，详见本论。
《儒门事亲》（注：原文“子和”指刘完素弟子张从正，号戴人）书中说：吕君玉的妻子三十岁，患风搐（因风邪引起的抽搐）、目眩、角弓反张（身体向后弯曲如弓状），数日不能进食。众医生都将其作为惊风、暗风、风痫（一种癫痫类疾病）治疗，使用南星、雄黄、乌头、附子等药物，服用后无效。戴人说：“诸风掉眩（眩晕、震颤），皆属于肝木（肝脏功能失调）。阳主动，阴主静。由于火气旺盛制约了肺金（金克木），导致不能平抑肝木，肝木过盛而自病。先用涌吐法吐出风痰二三升，接着用寒凉药剂泻下，又针刺百会穴出血两杯，立刻痊愈。”
按：风搐本来与痓证（筋脉拘急挛缩之证）不同，而痓证属于湿土极盛，必然兼有风木动摇的变化；风搐属于木极，必然出现金燥紧敛的形态。总之也可以一同讨论，所以选取这一条来证明痓病不仅仅由风寒湿外邪引起，也有风火热内生的情况。
《三因极一病证方论》说：人的筋脉各自随着经络显露于身体，若血气内部虚弱，外部被风寒湿热所侵袭，则发生痓病。因为风性发散，所以有汗且不恶寒的称为柔痉；寒气凝涩血液，所以无汗且恶寒的称为刚痉。推究其病因，多由亡血（失血）导致筋脉失去濡养，所以邪气得以侵袭。因此，伤寒病中发汗或攻下过多，以及疮疡病人及产后妇女导致这种疾病的，概可见一斑。诊察其脉象，都是沉伏、弦紧。但如果是阳缓阴急，则久久拘挛；如果是阴缓阳急，则角弓反张、强直。这两种证候各不相同，不可不加以辨别。
按：张仲景在《伤寒论》中论述痓病，主要主张外邪致病。陈无择阐发了血气内部虚弱这一节，实际上与张仲景所说的汗下过多相吻合，可以说是很好的见解。可惜他在用药方面未能详细说明。他又说：阴缓阳急则是太阳经的痓病；阳缓阴急则是阳明经的痓病。
The *Ren Jian Shu* (Book of Vitality) states that there are two types of Jing disease (spasm/stiffness): Yang Jing belongs to Gang Jing (rigid spasm), and Yin Jing belongs to Rou Jing (flexible spasm). Formulas such as Fuzi San (Aconite Powder), Guixin Baizhu Tang (Cinnamon Twig and Atractodes Decoction), Fuzi Fangfeng San (Aconite and Saposhnikovia Powder), and Bawu Baizhu Tang (Eight-Ingredient Atractodes Decoction) can be selected for use.
Commentary: Zhang Zhongjing’s discussion on rigid and flexible Jing both belongs to Taiyang disease (diseases caused by pathogenic factors invading the Taiyang channel). The *Ren Jian Shu*’s discussion on Yin and Yang Jing, having classified Yang Jing as rigid and Yin Jing as flexible, yet uses hot-natured herbs such as Baizhu (Atractodis Rhizoma), Fuzi (Aconiti Lateralis Radix Preparata), Ganjiang (Zingiberis Rhizoma), and Rongui (Cinnamomi Cortex) to treat Yin Jing. This treats Yin Jing exclusively as a cold syndrome, which is likely not the most appropriate theory. I shall await correction from wise scholars; the specific formulas are not recorded here but are detailed in this chapter.
The book by Zihe (Zhang Congzheng, courtesy name Renfu) states: The wife of Mr. Lv Junyu, aged thirty, suffered from Feng Chu (wind-induced convulsions), Xuan Yun (vertigo/dizziness), and Gong Fan (opisthotonos/backward arching of the body), unable to eat for several days. All physicians treated it as Jing Feng (startle wind), An Feng (hidden wind), or Feng Xian (wind epilepsy), using Nanxing (Arisaematis Rhizoma), Xionghuang (Realgar), Wutou (Aconiti Radix), and Fuzi (Aconiti Lateralis Radix Preparata), but with no effect. Dairen (Zhang Congzheng) said: "All wind-induced tremors and vertigo belong to Liver Wood. Yang governs movement, Yin governs stillness. Due to excessive Fire suppressing Metal (Lung), Metal cannot control Wood, causing Liver Wood to become excessive and diseased. First, induce vomiting to expel two to three sheng of wind-phlegm; then purge with cold-natured medicines; finally, puncture the Baihui GV20 acupoint to bleed two cups. The patient was cured immediately."
Commentary: Feng Chu (wind convulsion) is originally different from Ji disease (stiffness/spasm). Ji disease belongs to extreme Damp-Earth, inevitably involving the transformation of Wind-Wood shaking. Feng Chu belongs to extreme Wood, inevitably manifesting the form of Dry-Metal contraction. In essence, they can be discussed together. Therefore, this case is cited to prove that Ji disease is not solely caused by external Wind-Cold-Damp pathogens, but also by internal Wind-Fire-Heat.
The *San Yin Fang* (Formulas of Three Causes) states: The tendons of humans extend along the meridians throughout the body. If Qi and Blood are internally deficient and externally invaded by Wind, Cold, Damp, or Heat, Ji disease occurs. Because Wind disperses Qi, sweating without aversion to cold is called Rou Jing (flexible spasm); because Cold congeals Blood, no sweating with aversion to cold is called Gang Jing (rigid spasm). Tracing the etiology, it mostly arises from blood loss, leaving tendons without nourishment, allowing pathogens to invade. Thus, it is evident that excessive sweating or purging in Shanghan (Cold Damage) diseases, as well as conditions following sores/ulcers or postpartum states, can lead to this disease. Pulse diagnosis reveals sinking, hidden, wiry, and tight pulses. However, if Yang is relaxed and Yin is tense, chronic contracture ensues; if Yin is relaxed and Yang is tense, opisthotonos and stiffness occur. These two syndromes are distinct and must be differentiated.
Commentary: Zhang Zhongjing’s discussion on Ji disease in the *Shanghan Lun* primarily attributes it to external pathogens. Chen Wuyue elucidated the aspect of internal Qi and Blood deficiency, which aligns with Zhang Zhongjing’s statement regarding excessive sweating and purging. This is an excellent insight. Unfortunately, his medication instructions were not detailed enough. He further stated: Yin relaxation and Yang tension constitute Taiyang Ji disease; Yang relaxation and Yin tension constitute Yangming Ji disease.