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，每次遇到这种病证，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，就一定有对应的方药。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分析呢？这一定是因为该症状是伴随其他多种疾病而产生的，所以没有专门的治法。我利用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，希望博学的士人发现其中的遗漏缺失后，能够补充完善它。
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，就会导致外部症状表现为发热恶寒，与伤寒相似，出现颈项强直紧急，腰身向后反张如同中风的样子，肢体抽搐（瘛疭），牙关紧闭（口噤），身体僵硬不柔（KT KT为古籍异体或通假，指强直貌），古人将强直称为“痉”，其脉象沉迟弦细。新产后因血虚多汗出，容易感受风邪，也会出现此证。详见产后中风篇，此处不再赘述。又有因枕头不适导致转头困难的，可用三五七散、追风散，并配合急风散涂抹于颈部。如果是因为被风吹导致头目昏眩，太阳经与脑部俱痛，颈背筋脉拘急，可用蝎附散、都梁丸。许太学治疗颈项筋脉强痛不能转侧，使用木瓜煎。
〔薛己〕上述病症如果是因为肝木自旺引起的，用泻青丸。（伴有头痛。）精血不足，用六味丸。（杂病中的虚劳。）风热之邪淫溢伤肝，用加味逍遥散。（调理月经。）愤怒触动肝火，用加味小柴胡汤。（热入血室。）肝经血虚，用加味四物汤（即四物汤加上柴胡、丹皮、山栀。）肾不能滋养肝，用六味丸。膀胱气机阻滞，用羌活胜湿汤。（杂病腰痛。）大抵肝火旺盛，则肝血虚而筋脉干燥，导致颈项强直紧急，或者腰背向后反张，或者四肢蜷缩握拳，或者颈项等处出现结核肿块。有一位妇人耳内或耳后及颈侧作痛，伴有寒热、口苦、月经不调，这是肝胆经火旺兼损伤脾胃所致，用四君子汤加上柴胡、升麻、黄芩、芍药而痊愈。后来因为劳累和怒气，出现呕吐、胁肋胀满，用六君子汤加上山栀、柴胡而安定。另一位妇人因为发怒，出现寒热、口渴，左眼紧小，头颈颤动，四肢抽搐，遍身疼痛，这是血虚肝热而生风所致，用加味逍遥散加上钩藤数剂，诸症逐渐好转，后又用八珍汤而痊愈。
追风散 治疗年深日久、偏正头痛，又治疗肝脏长期虚弱，气血衰弱，风毒之气上攻，引起头痛头晕，眼睛昏花心慌，烦热，全身关节酸痛，头脑昏沉眼痛，鼻塞声音重浊，颈背拘急，皮肤瘙痒，面部游走性风疹，感觉像虫子爬行，以及一切头风。兼治妇人血风攻注，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（单独研细，一两，水飞法处理）
黑豆（二钱五分，与草乌一起研成末） 麝香（单独研细，二钱半）
以上药物研成细末，混合均匀，用酒调涂于疼痛处。
蝎附散 治疗一切风邪头痛，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，面目跳动，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，多年老久的头风，服用其他药物无效的，都治疗。
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、泥土） 白芷（各半两）
以上药物研成细末，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，用此药同时嚼服如圣饼子，治疗眼睛怕光多泪，视物不明，有效。另一配方，用白附子、蝎梢。
木瓜煎
宣州木瓜（两个，切开顶部做盖子，挖去瓤） 没药（二两，单独研细） 乳香（二钱半，单独研细）
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，从午后发作，黄昏时停止。我说：这个病患一定先从脚开始。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，通常指阴阳转换之时），肾气绝而肝气弱。肝肾两脏受到阴气影响，所以在这个时间发作。我传授了这个方子，服用三次而痊愈。
其余证治论方，都详细记载在杂病本门中。
Chen Liangfu stated: Women suffering from stiffness and pain in the neck tendons often present a condition that appears easy to treat but 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 physicians discuss this syndrome so briefly without detailed theoretical analysis? It is likely because these symptoms arise secondary to various other diseases, hence lacking specialized treatments. I have collected famous ancient prescriptions during my leisure time for reference. My own insight is shallow and learning limited, so completeness may not be achieved; I hope learned scholars will supplement any omissions they find.
The neck region belongs to the Foot-Taiyang Bladder Meridian. Additionally, Xu Taixue noted it is also traversed by the Foot-Shaoyin Kidney Meridian, likely due to the exterior-interior relationship between the Kidney and Bladder. From the perspective of external pathogenic factors, if the Foot-Taiyang Meridian first contracts Wind, followed by Cold-Dampness, it leads to external symptoms such as fever and aversion to cold, resembling Shanghan (Cold Damage), with stiff and tight neck, opisthotonos-like back arching, clonic spasms (chì zòng), trismus (mouth locked), and rigid body posture. Ancient texts refer to rigidity as Jing (Spasm). The pulse is deep, slow, wiry, and thin. Postpartum women, due to blood deficiency and excessive sweating, are prone to contracting Wind and may exhibit this syndrome. See the section on Postpartum Wind Strike for details; here we do not repeat. For cases where turning the head is difficult due to pillow discomfort, use Sanwuqi San (Three-Five-Seven Powder) or Zhuifeng San (Wind-Chasing Powder), applied externally with Jifeng San (Urgent-Wind Powder) on the neck. If wind exposure causes dizziness and headache involving both the Taiyang meridian and brain, with stiffness in the neck and back tendons, use Xie Fu San (Scorpion and Aconite Powder) or Duliang Wan (Duliang Pill). Xu Taixue treated severe neck tendon stiffness preventing head rotation using Mugua Jian (Quince Decoction).
[Xue Ji] Regarding the aforementioned syndromes: If caused by hyperactive Liver Wood, use Xie Qing Wan (Drain Green Pill) [accompanied by headache]. If due to insufficiency of essence and blood, use Liuwei Wan (Six-Ingredient Pill) [for deficiency consumptive disorders]. If Wind-Heat invades the Liver, 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, Dan Pi, Shan Zhi). If the Kidney fails to nourish the Liver, use Liuwei Wan. If Bladder Qi stagnates, 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 and tendons dry out, leading to neck stiffness, opisthotonos, limb curling, or nodules in the neck area. One woman experienced pain in the ear, behind the ear, and side of the neck, accompanied by alternating chills and fever, bitter taste, and irregular menstruation; this was Liver-Gallbladder fire combined with Spleen-Stomach injury, cured using Sijunzi Tang (Four Gentlemen Decoction) plus Chai Hu, Sheng Ma, Huang Qin, and Shao Yao. Later, due to overwork and anger, she suffered vomiting and hypochondriac distension, which settled using Liujunzi Tang (Six Gentlemen Decoction) plus Shan Zhi and Chai Hu. Another woman, after anger, presented with chills, fever, thirst, small left eye, trembling head and neck, limb convulsions, and generalized body pain; this was wind generated from blood deficiency and Liver heat, gradually improved with Jiawei Xiaoyao San plus Gou Teng (Uncaria Hook) over several doses, and fully recovered after taking Bazhen Tang (Eight Treasures Decoction).
Zhuifeng San (Wind-Chasing Powder): Treats chronic lateral or frontal headaches; also treats long-standing Liver deficiency with weakened Qi and blood, where Wind-Toxin attacks upward causing headache, dizziness, visual blurring, palpitations, irritability, joint soreness, cerebral dullness, 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. Also treats women’s Blood-Wind attacking fixed points, causing head and eye pain.
Chuan Wu (Prepared Rhizoma Aconiti Lateralis, remove tip, skin, and navel) Fang Feng (Saposhnikoviae Radix, remove radicle) Shi Gao (Calcitum, calcined) Chuan Xiong (Ligustici Chuanxiong Rhizoma) Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) Jingjie Sui (Schizonepetae Spica)
Bai Jiang Can (Cicada Slough, stir-fried to remove silk, each 1 liang) Tian Nan Xing (Arisaematis Rhizoma, prepared) Qiang Huo (Notopterygii Rhizoma et Radix) Tian Ma (Gastrodiae Rhizoma) Di Long (Pheretima) Bai Fu Zi (Typhonii Rhizoma, prepared) Quan Xie (Scorpio, remove tail spine)
Bai Zhi (Angelicae Dahuricae Radix, each half liang) Cao Wu Tou (Radix Aconiti Kusnezoffii, prepared, remove skin, navel, and tip) Mo Yao (Myrrha) Ru Xiang (Olibanum) Xiong Huang (Realgar)
Grind all into fine powder. Take half qian per dose, mix with a little good tea, administer after meals and before bed. Regular use clears the head and eyes, benefits the throat and diaphragm, dispels wind, and transforms phlegm.
Jifeng San (Urgent-Wind Powder):
Cao Wu Tou (Radix Aconiti Kusnezoffii, 3 liang; half burned to retain charred nature, dipped in wine to cool; half used raw) Dan Sha (Cinnabaris, separately ground, 1 liang, water-floating method)
Hei Dou (Sojae Semen Nigrum, 2.5 qian, ground together with Cao Wu Tou) She Xiang (Moschus, separately ground, 2.5 qian)
Grind into fine powder, mix evenly with the ground medicines, apply to painful areas mixed with wine.
Xie Fu San (Scorpion and Aconite Powder): Treats all wind-pathogen headaches, Brain-Clamping Wind, abundant phlegm-saliva, vomiting and nausea, spitting clear water, silent wind vertigo, seeing black spots before eyes, trismus, facial paralysis (deviation of mouth and eye), twitching of face and eyes, neck-head stiffness, shoulder-back radiating pain, itchy ears, dim vision, limb numbness, sudden wind contraction after bathing, head-eye dull pain, bilateral temporal pain, chronic old Head Wind unresponsive to other drugs.
Quan Xie (Scorpio, prepared) Xiong Huang (Realgar, water-floating) Zhu Sha (Cinnabaris, each 1.5 qian, water-floating) Fu Zi (Prepared Radix Aconiti Lateralis, remove skin and navel)
Chuan Wu Tou (Prepared Rhizoma Aconiti Lateralis, remove skin and navel) Ma Huang (Ephedrae Herba, remove joints) Tian Nan Xing (Arisaematis Rhizoma, ginger-processed) Fang Feng (Saposhnikoviae Radix, remove radicle) Bai Jiang Can (Cicada Slough, stir-fried, each 3 qian) Ben Cao (Ligustici Sinensis Rhizoma, remove radicle and soil) Bai Zhi (Angelicae Dahuricae Radix, each half liang)
Grind into fine powder. Take half qian per dose, swallow with green onion and tea decoction, after meals. Pregnant women must not take.
Physicians in the capital use this medicine chewed along with 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, cover with the lid, secure with bamboo pins, steam over rice three to four times until soft, then grind into paste. Take three spoons per dose, mix with half zhan of Sheng Di Huang juice (Rehmanniae Radix) and two zhan of good unadulterated wine, and drink.
Someone suffered from this illness, starting in the afternoon and resolving at dusk. I said: This patient likely started from the feet. The Classics state that each of the twelve meridians has its tendons; only the Shaoyin tendon of the foot extends from the sole to the head. Generally, tendons are the external correspondence of the Liver. From noon to dusk is Heaven's Yang, specifically Yin within Yang, which corresponds to the Lung. From Li (Noon) to Dui (Sunset) is the time when Yin prospers and Yang weakens. Thus, *Lingbao Mifa* states: From Li to Qian, Kidney Qi exhausts and Liver Qi weakens. The Liver and Kidney organs receive Yin Qi, hence the onset at this time. I prescribed this remedy, and he recovered after three doses.
Discussions and formulas for other syndromes are detailed in the Miscellaneous Diseases section.