《金匮》云∶病者身热足寒，颈项僵急，恶寒，时头热面赤目赤，独头动摇，卒
口噤，背反张者，痉病也。（《活人书》云∶外证发热恶寒，与伤寒相似，但其脉沉迟弦细，而项背
反张为异耳。）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，名曰柔痉。
太阳病，其证备，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。刚痉为病，胸满口噤，卧不着席，脚挛急，必 齿，
可与大承气汤。（此阳明经药也，阳明总宗筋，以风寒湿热之邪入于胃中，津液不行，宗筋无所养，
故急宜此汤下湿热行津液。故《宣明》云∶痉病目直口噤，背强如弓卧摇动，手足搐搦，宜三一承气
汤下之，亦此意也。然非察证之明，的有实热者，亦不可轻用也。）按∶世知治痉之法创自仲景，而
不知仲景之论伤寒，皆自《内经》中来，其所谓刚痉者，为中风发热重感于寒而得之，与《内经》所
谓赫羲之纪，上羽，其病痉，其义一也。风淫之热与火运之热无少异，其重感于寒亦与上羽之寒同是
外郁者，热因郁则愈甚，甚则热兼燥化而无汗，血气不得宣通，大小筋俱受热害而僵直，故曰刚痉也。
其所谓柔痉者，为太阳发热重感于湿而得之，即《内经》所谓诸痉项僵，皆属于湿。又谓因于湿，首
如裹，湿热不攘，大筋软短，小筋弛长，软短为拘，弛长为痿。肺移热于肾，传为柔痉。注云∶柔谓
筋柔而无力，痉谓骨强而不随。三者之义，比之仲景所言重感于湿为柔
痉者，岂不同是小筋得湿则痿弛而无力者乎。其摇头发热，颈项强急，腰背反张，螈 口噤，与刚痉
形状等者，又岂不同是大筋受热则拘挛强直者乎。后代方论，乃以无汗为表实，有汗为表虚。不思湿
胜者自多汗出，乃以为表虚而用姜附温热等剂，宁不重增大筋之热欤。及守仲景方者，但知刚痉用葛
根汤，柔痉用桂枝加葛根汤。而不解《金匮》于柔痉之脉沉迟者，在桂枝汤不加葛根而加栝蒌根。盖
用葛根，不惟取其解肌之热，而取其体轻、可生在表阳分之津，以润筋之燥急。今因沉迟，沉乃卫气
不足，故用桂枝以和之，迟乃荣血不足，故用栝蒌根，其体重、可生在表阴分之津，此仲景随脉浮沉，
用药浅深之法也。至于太阳传入阳明，胸满口噤，卧不着席，脚挛 齿者，与大承气，亦可见治痉，
与伤寒分六经表里，无纤毫之异矣。至若所谓太阳病，发汗太过，及疮家不可汗而汗之，因致痉者；
太阳病，发热脉沉细而病痉者；病者身热足寒，颈项强急，恶寒，时头热面赤，独头动摇，卒口噤背
反张；若发其汗，寒湿相得，其表益虚，即恶寒甚，发其汗已，其脉如蛇者；暴腹胀大为欲解，脉如
故，反伏弦为痉者，皆不出方言治。虽然，能识疗伤寒随机应变之法，则无患方之不足用也。海藏云∶
发汗太多因致痉，身热足寒，项强恶寒，头
热面肿目赤，头摇口噤，背反张者，太阳痉也。若头低视下，手足牵引，肘膝相构，阳明痉也。若一
目或左右斜视，并一手一足搐搦者，少阳痉也。汗之、止之、和之、下之，各随其经，可使必已。
（太阳痉属表，无汗宜汗之，有汗宜止之。阳明痉属里，宜下之。少阳痉属半表半里，宜和之。所谓
各随其经也。）神术汤加羌活、麻黄，治刚痉解利无汗。白术汤加桂心、黄 ，治柔痉解利有汗。太
阳阳明加川芎、荆芥穗。正阳阳明加羌活、酒大黄。少阳阳明加防风、柴胡根。热而在表者加黄芩。
寒而在表者加桂枝、黄 、附子。热而在里者加大黄。寒而在里者加干姜、良姜、附子。右王氏分经
论痉，固得仲景伤寒之法矣。其间用仲景方，去葛根、栝蒌根，更风药者，殆从风痉筋强而然也。及
《原病式》论筋劲项强而不柔和者，则不然，乃邪在湿淫条下，谓土主安静故耳，亢则害承乃制，故
湿过极，反兼风化制之，然兼化者虚象，而实非风也，岂可尽从风治乎。又海藏分六经不及厥阴，厥
阴固有痉矣。经云∶厥阴在泉，客胜则大关节不利，内为痉强拘急，外为不便者，非乎。《灵枢》又
谓足少阴筋病主痫螈及痉，此非六阴经痉病之例乎。抑海藏所遗，非独此而已。至若《内经》有谓太
阳所至为寝汗痉，手阳明、少阳厥逆，发喉痹、痉者，乃是人之六经所属，风寒湿热燥火之气自相
盛衰，变而为痉者也，亦皆勿论。予尝思，夫外感内伤之邪病痉，治法迥别，不可不辨。天气因八风
之变，鼓舞六淫而入，是为经风外伤腠理，内触五脏，故治邪必兼治风。人气因五性劳役，感动厥阳，
君相二火相扇，六经之淫邪而起，遂有五阳胜负之变，故胜者泻、负者补，必兼治火调胃土，以复火
伤之气，盖不可瘥也。苟于内伤而用外感药以散邪，则原气愈耗，血竭神离，而至于不救矣。丹溪云∶
大率与痫相似，比痫为甚，盖因气血大虚，挟痰挟火而成。药宜人参、竹沥之类，不可用风药。一男
子二十余岁，患痘疮，靥谢后，忽患口噤不开，四肢强直不能屈，时或绕脐腹痛一阵，则冷汗如雨，
痛定则汗止，时作时止，其脉极弦紧而急。此因劳倦伤血，山居多风寒乘虚而感。又因痘疮，其血愈
虚。当用辛温养血，辛凉散风，遂用当归身、芍药为君，川芎、青皮、钩藤为臣，白术、陈皮、甘草
为佐，桂枝、木香、黄连为使，更加红花少许，煎十二帖而安。薛新甫云∶痉病，因伤寒汗下过度，
与产妇、溃疡等病，及因克伐之剂，伤损气血而变。若金衰木旺，先用泻青丸，后用异功散，肾水虚
用六味丸。肝火旺，先用加味小柴胡汤，次用加味四物汤，发热用加味逍遥散。若木侮脾土，用补中
益气加芍药、山栀。脾经郁结，用加味归脾
汤。脾土湿热，用三一承气汤。大凡病后气血虚弱，用参、术浓煎，佐以姜汁、竹沥，时时用之。如
不应，用十全大补汤；更不应，急加附子，或用参附汤，缓则不救。虞搏治一妇人，年三十余，身形
瘦弱，月经后忽发痉，口噤，手足挛缩，角弓反张。此去血过多，风邪乘虚而入。用四物汤加防风、
羌活、荆芥，少加附子行经，二帖病减半，六帖病全安。张子和治吕君玉妻，年三十余，病风搐目眩，
角弓反张，数日不食。诸医皆作风治不效。夫诸风掉眩，皆属肝木。曲直摇动，风之用也。阳主动，
阴主静，由火盛制金，金衰不能平木，肝木茂而自病，因涌风涎二三升，次以寒剂下十余行，又以排
针刺百会穴，出血一杯立愈。（上内伤例）。痉，既以有汗无汗辨刚柔，又以厥逆不厥逆辨阴阳。仲
景虽曰痉皆身热足寒，然阳痉不厥逆，其厥逆者，皆阴也。阳痉已前见。阴痉一二日，面肿，手足厥
冷，筋脉拘急，汗不出，恐阴气内伤，宜八物白术散。若发热脉沉而细者，附太阴也，必腹痛，宜桂
枝加芍药、防风、防己汤，又宜小续命汤。阴痉，手足厥逆，筋脉拘急，汗出不止，颈项僵直，头摇
口噤，宜附子散、桂心白术汤、附子防风散。（上三阴例。）
【诊】太阳病，发热，其脉沉而细者，名曰痉，为难治。痉脉伏，按之紧，如弦坚直，上下行。
（无择云∶凡痉脉皆伏弦沉紧。）痉病，发其汗已，其脉沧沧如蛇，暴腹胀大者，为欲解，脉如故，
反伏弦者痉。（此痉字，恐当作死字。）痉病有灸疮难治。
【妊娠痉】多由风寒湿乘虚而感，皆从太阳经治之。（恐仍当如前例，分六经表里。）薛氏云∶
若心肝风热，用钩藤汤。肝脾血虚，加味逍遥散。肝脾郁怒，加味归脾汤。气逆痰滞，紫苏饮。肝火
风热，钩藤散。脾郁痰滞，二陈、姜汁、竹沥。
【产后痉】《良方》云∶产后汗多变痉，因气血亏损，肉理不密，风邪所乘。其形口噤背强如痫，
或摇头马嘶，不时举发，气息如绝。宜速灌小续命汤。若汗出两手拭不及者，不治。《千金》治产中
风，口噤面青，手足急强，用竹沥一升，分为五服，微温，频服大效。娄全善云∶小续命汤、举卿古
拜散、大豆紫汤，皆治产后痉，太阳、厥阴药也。邪实脉浮弦有力者固宜，但产后血气大虚之人，不
宜轻发其表，第用防风当归散治之为妙。薛氏云∶产后痉，由亡血过多，筋无所养，与
伤寒汗下过多，溃疡脓血大泄，皆败证也。急以十全大补汤，如不应，急加附子。亦有六淫七情所致
者，（治法见上。）
《金匮要略》说：病人身体发热、双脚发凉，颈项僵硬拘急，怕冷，有时头部发热、面色发红、眼睛发红，只有头部摇动，突然牙关紧闭、背部反张（角弓反张）的，这是痉病。（《活人书》说：外证表现为发热恶寒，与伤寒相似，但其脉象沉迟弦细，且出现项背反张，这是不同之处。）太阳病，发热、无汗，反而怕冷的，名叫刚痉。太阳病，发热、有汗，却不恶寒的，名叫柔痉。太阳病的症状具备，身体强直，KT KT 然（形容身体强直不柔和的样子），脉象反而沉迟，这是痉病，用栝蒌桂枝汤主治。太阳病，无汗而小便反而量少，气上冲胸部，牙关紧闭不能说话，将要发作刚痉，用葛根汤主治。刚痉的病证，胸满、牙关紧闭，睡觉时背部不能着席（角弓反张严重），脚部抽筋拘急，必定磨牙，可以给予大承气汤。（这是阳明经的药物，阳明经统摄宗筋，风寒湿热之邪侵入胃中，津液运行不畅，宗筋失去滋养，所以应当紧急使用此汤来通下湿热、通行津液。所以《宣明论》说：痉病目睛直视、牙关紧闭、背部强直如弓、卧不安稳摇动、手足抽搐，宜用三一承气汤攻下，也是这个意思。然而如果不是对证候观察明确、确有实热的情况，也不可轻易使用。）按：世人知道治疗痉病的方法创始于张仲景，却不知道仲景论述伤寒，都源自《黄帝内经》，他所说的刚痉，是中风发热又重感寒邪而得的，与《内经》所说的“赫羲之纪”（指火运太过之年），上羽（水运不及），其病为痉，其义是一样的。风淫产生的热与火运的热没有多少差异，重感寒邪也与上羽之寒相同，都是外邪郁闭，热因郁结而更加严重，严重时热兼燥化而无汗，气血不得宣通，大小筋都受热害而僵直，所以叫刚痉。他所说的柔痉，是太阳发热又重感湿邪而得的，即《内经》所说的各种痉病颈项僵硬，都属于湿。又说因为湿邪，头重如裹，湿热不去，大筋收缩变短，小筋松弛变长，收缩变短导致拘挛，松弛变长导致痿软。肺将热传给肾，传变为柔痉。注解说：柔是指筋柔软而无力，痉是指骨强硬而不随使。这三者的含义，比起仲景所说的重感湿邪为柔痉，难道不是同属于小筋得湿则痿弛无力的情况吗？那些摇头发热、颈项强急、腰背反张、抽搐、牙关紧闭，与刚痉形状相同的，难道不是同属于大筋受热则拘挛强直的情况吗？后代的方论，认为无汗是表实，有汗是表虚。没考虑到湿胜的人自然多汗出，却认为是表虚而使用姜附等温热药剂，难道不会加重筋脉的热邪吗？至于遵守仲景方剂的人，只知道刚痉用葛根汤，柔痉用桂枝加葛根汤。却不理解《金匮》中对于柔痉脉象沉迟的情况，在桂枝汤中不加葛根而加栝蒌根。大概使用葛根，不仅是取其解除肌表之热，而且是取其质地轻清，能生发在表阳分的津液，以滋润筋脉的燥急。现在因为脉沉迟，沉代表卫气不足，所以用桂枝来调和；迟代表营血不足，所以用栝蒌根，它质地沉重，能生发在表阴分的津液，这是仲景根据脉象浮沉来决定用药深浅的方法。至于太阳病传入阳明，出现胸满、牙关紧闭、睡觉背部不着席、脚抽筋、磨牙的，给予大承气汤，也可以看出治疗痉病，与伤寒分六经表里，没有丝毫差异。至于所谓太阳病，发汗太过，以及疮家不可发汗而误汗之，因而导致痉病的；太阳病，发热脉沉细而患痉病的；病人身体发热脚凉，颈项强急，怕冷，有时头热面赤，只有头摇动，突然牙关紧闭背反张；如果发汗，寒湿相合，表更虚，就极度恶寒，发汗后，脉象像蛇一样蜿蜒者；突然腹胀大为欲解，脉象如故，反而伏弦的为痉病，这些都不在方言（此处指前文提到的常规治法或特定语境下的讨论范围，结合上下文可能指未详细展开或需灵活变通的范畴，原文“方言”疑为衍文或特指某类论述，此处依文意译为未在前文详述或需特殊处理的情况）中论述。虽然如此，如果能识别治疗伤寒随机应变的方法，就不担心方剂不够用了。海藏说：发汗太多导致痉病，身体发热脚凉，项强恶寒，头热面肿目赤，头摇口噤，背反张的，是太阳痉。如果头低视下，手足牵引，肘膝相凑，是阳明痉。如果一只眼或左右斜视，并一手一足抽搐的，是少阳痉。发汗、止汗、和解、攻下，各随其所属经络，可以使病必愈。（太阳痉属表，无汗宜发汗，有汗宜止汗。阳明痉属里，宜攻下。少阳痉属半表半里，宜和解。所谓各随其经。）神术汤加羌活、麻黄，治疗刚痉解利无汗。白术汤加桂心、黄芪，治疗柔痉解利有汗。太阳阳明合病加川芎、荆芥穗。正阳阳明加羌活、酒大黄。少阳阳明加防风、柴胡根。热在表者加黄芩。寒在表者加桂枝、黄芪、附子。热在里者加大黄。寒在里者加干姜、良姜、附子。以上王氏分经论述痉病，确实得到了仲景伤寒的方法。其中使用仲景方剂，去掉葛根、栝蒌根，改用风药的，大概是基于风痉筋强的缘故。到了《原病式》论述筋劲项强而不柔和的，却不是这样，而是将其归在湿淫条下，说是土主安静罢了，亢盛则有害，承制才能制约，所以湿过极，反而兼风化来制约它，然而兼化是虚象，其实不是风，怎么能全部从风治疗呢？另外海藏分六经没有包括厥阴，厥阴固有痉病。经文说：厥阴在泉，客胜则大关节不利，内为痉强拘急，外为不便的，不是吗？《灵枢》又说足少阴筋病主痫抽搐及痉，这不是六阴经痉病的例子吗？或许海藏所遗漏的，不仅仅这些。至于《内经》有说太阳所至为寝汗痉，手阳明、少阳厥逆，发喉痹、痉的，乃是人的六经所属，风寒湿热燥火之气自相盛衰，变而为痉的，也都暂且不谈。我曾思考，外感内伤导致的痉病，治法截然不同，不可不辨别。天气因八风变化，鼓舞六淫而入，这是经风外伤腠理，内触五脏，所以治邪必须兼治风。人气因五性劳役，感动厥阳，君相二火相互煽动，六经的淫邪而起，遂有五阳胜负的变化，所以胜者泻、负者补，必须兼治火调胃土，以恢复火伤之气，大概难以痊愈。如果在内伤的情况下使用外感药来散邪，那么元气越耗，血竭神离，以至于无法救治。丹溪说：大体上与痫相似，比痫更严重，大概是因为气血大虚，挟痰挟火而成。药物宜用人参、竹沥之类，不可用风药。一个二十多岁的男子，患痘疮，结痂脱落后，忽然患牙关紧闭不开，四肢强直不能屈，有时绕脐腹痛一阵，则冷汗如雨，痛定则汗止，时作时止，其脉极弦紧而急。这是因为劳倦伤血，居住山多风寒乘虚而感。又因痘疮，其血更虚。应当用辛温养血，辛凉散风，于是用当归身、芍药为君药，川芎、青皮、钩藤为臣药，白术、陈皮、甘草为佐药，桂枝、木香、黄连为使药，再加少许红花，煎服十二帖而安。薛新甫说：痉病，因伤寒汗下过度，以及产妇、溃疡等疾病，和因克伐之剂，损伤气血而变生。若金衰木旺，先用泻青丸，后用异功散，肾水虚用六味丸。肝火旺，先用加味小柴胡汤，次用加味四物汤，发热用加味逍遥散。若木侮脾土，用补中益气加芍药、山栀。脾经郁结，用加味归脾汤。脾土湿热，用三一承气汤。大凡病后气血虚弱，用人参、白术浓煎，佐以姜汁、竹沥，时时服用。如果无效，用十全大补汤；再无效，急加附子，或用参附汤，缓则无法救治。虞搏治疗一个三十多岁的妇人，身形瘦弱，月经后忽然发痉，口噤，手足挛缩，角弓反张。这是去血过多，风邪乘虚而入。用四物汤加防风、羌活、荆芥，少加附子行经，两帖病减半，六帖病全安。张子和治疗吕君玉的妻子，三十多岁，患风搐目眩，角弓反张，数日不食。众医都按风证治疗无效。夫诸风掉眩，皆属肝木。曲直摇动，是风的作用。阳主动，阴主静，由火盛制金，金衰不能平木，肝木茂而自病，因此涌吐风涎二三升，其次用寒剂攻下十余行，又以排针刺百会穴，出血一杯立即痊愈。（以上是内伤的例子）。痉病，既然以有汗无汗辨别刚柔，又以厥逆不厥逆辨别阴阳。仲景虽然说痉都身体发热脚凉，然而阳痉不厥逆，那些厥逆的，都是阴痉。阳痉前面已见。阴痉一二日，面肿，手足厥冷，筋脉拘急，汗不出，恐怕阴气内伤，宜用八物白术散。若发热脉沉而细的，附太阴也，必定腹痛，宜用桂枝加芍药、防风、防己汤，又宜用小续命汤。阴痉，手足厥逆，筋脉拘急，汗出不止，颈项僵直，头摇口噤，宜用附子散、桂心白术汤、附子防风散。（以上是三阴的例子。）
【诊】太阳病，发热，其脉沉而细的，名叫痉，为难治。痉脉伏，按之紧，如弦坚直，上下行。（无择说：凡是痉脉都是伏弦沉紧。）痉病，发汗后，其脉沧沧如蛇，突然腹胀大的，为欲解，脉象如故，反而伏弦的为痉。（这个“痉”字，恐怕当作“死”字。）痉病有灸疮难治。
【妊娠痉】多由风寒湿乘虚而感，都从太阳经治疗。（恐怕仍应当像前面的例子，分六经表里。）薛氏说：若心肝风热，用钩藤汤。肝脾血虚，用加味逍遥散。肝脾郁怒，用加味归脾汤。气逆痰滞，用紫苏饮。肝火风热，用钩藤散。脾郁痰滞，用二陈汤、姜汁、竹沥。
【产后痉】《良方》说：产后汗多变痉，因气血亏损，腠理不密，风邪所乘。其形口噤背强如痫，或摇头马嘶，不时举发，气息如绝。宜速灌小续命汤。若汗出两手拭不及的，不治。《千金方》治产中风，口噤面青，手足急强，用竹沥一升，分为五服，微温，频服大效。娄全善说：小续命汤、举卿古拜散、大豆紫汤，都治产后痉，是太阳、厥阴的药。邪实脉浮弦有力的固然适宜，但产后血气大虚之人，不宜轻发其表，只用防风当归散治疗为妙。薛氏说：产后痉，由亡血过多，筋无所养，与伤寒汗下过多，溃疡脓血大泄，都是败证。急用十全大补汤，如果无效，急加附子。也有六淫七情所致的，（治法见上。）
The *Jingui Yaolue* states: When a patient presents with fever in the body and cold feet, stiffness and tension in the neck and nape, aversion to cold, occasional heat in the head, redness of the face and eyes, isolated shaking of the head, sudden lockjaw (trismus), and opisthotonos (back arching backwards), this is called Jing disease (Spasm). (*Huoren Shu* states: The external manifestations include fever and aversion to cold, resembling Shanghan (Cold Damage), but the pulse is deep, slow, wiry, and thin, and the distinguishing feature is the arching of the neck and back.) In Taiyang disease, if there is fever, anhidrosis (absence of sweating), and aversion to cold, it is named Gangjing (Yang Spasm). In Taiyang disease, if there is fever, diaphoresis (sweating), and no aversion to cold, it is named Roujing (Yin Spasm). When the symptoms of Taiyang disease are complete, the body is stiff, rigid and unyielding, and the pulse is surprisingly deep and slow, this is Jing disease, which should be treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction). In Taiyang disease, if there is anhidrosis and the urine output is surprisingly low, with Qi rushing up to the chest, lockjaw preventing speech, and impending Gangjing, Gegen Tang (Kudzu Root Decoction) should be administered. For Gangjing, characterized by chest fullness, lockjaw, inability to lie flat due to severe opisthotonos, leg cramps, and teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be given. (This involves herbs of the Yangming channel; Yangming governs the Zongjin (major tendons). When pathogenic factors of wind, cold, dampness, or heat enter the Stomach, fluids fail to circulate, and the Zongjin lose nourishment, necessitating urgent use of this decoction to purge damp-heat and promote fluid circulation. Thus, *Xuanming Lun* states: For Jing disease with staring eyes, lockjaw, back stiffness like a bow, restless tossing, and limb convulsions, San Yi Chengqi Tang should be used to purge, following the same principle. However, unless the syndrome is clearly identified as having excess heat, it should not be used lightly.) Note: It is known that the methods for treating Jing disease originated from Zhang Zhongjing, yet few realize that his discussions on Shanghan derive from the *Neijing*. His concept of Gangjing refers to contracting the condition through wind-stroke with fever compounded by cold exposure, which aligns with the *Neijing*'s description of the "He Xi" era (Fire excess year), where Upper Yu (Water deficiency) leads to Jing disease. The heat generated by Wind pathogen and the heat of Fire movement are virtually identical; the compounding cold is also similar to the Upper Yu cold, both being external constraints. Heat intensified by constraint becomes severe, leading to dryness transformation without sweat, blocking Qi and Blood circulation, causing both large and small sinews to suffer heat damage and become stiff, hence termed Gangjing. His concept of Roujing refers to Taiyang fever compounded by dampness, corresponding to the *Neijing*'s statement that all Jing diseases with neck stiffness belong to Dampness. It further states that due to Dampness, the head feels wrapped, and if damp-heat is not cleared, large sinews shorten and become soft, while small sinews elongate and relax; shortening causes spasm, while elongation causes flaccidity. Heat transferring from Lung to Kidney transforms into Roujing. Annotations explain: "Rou" means sinews are soft and weak; "Jing" means bones are stiff and unresponsive. Comparing these three meanings with Zhongjing's view that compounding dampness leads to Roujing, do they not both refer to small sinews becoming flaccid and weak due to dampness? Those presenting with head shaking, fever, neck stiffness, back arching, convulsions, and lockjaw, resembling Gangjing, do they not both refer to large sinews becoming spasmodic and stiff due to heat? Later commentaries consider anhidrosis as Exterior Excess and diaphoresis as Exterior Deficiency. Failing to recognize that excessive dampness naturally causes sweating, they treat it as Exterior Deficiency using warming agents like Ginger and Aconite, would this not exacerbate the heat in the sinews? Those adhering strictly to Zhongjing's formulas know to use Gegen Tang for Gangjing and Guizhi Jia Gegen Tang for Roujing. However, they fail to understand that for Roujing with a deep and slow pulse, *Jingui* prescribes adding Gualou Gen (Trichosanthes Root) instead of Gegen to Guizhi Tang. Using Gegen not only clears muscle-level heat but also, due to its light nature, generates fluids in the Exterior Yang aspect to moisten dry, tense sinews. Given the deep and slow pulse, "deep" indicates insufficient Wei Qi, so Guizhi is used to harmonize; "slow" indicates insufficient Ying Blood, so Gualou Gen is used, whose heavy nature generates fluids in the Exterior Yin aspect. This reflects Zhongjing's method of adjusting medication depth based on pulse floating or sunken. Regarding Taiyang transmitting to Yangming, presenting with chest fullness, lockjaw, inability to lie flat, leg cramps, and teeth grinding, administering Da Chengqi Tang demonstrates that treating Jing disease follows the Six Channels' exterior-interior differentiation of Shanghan without deviation. Cases such as Taiyang disease caused by excessive sweating, or hemorrhoid patients mistakenly induced to sweat leading to Jing; Taiyang disease with fever, deep-thin pulse, and Jing; or patients with fever, cold feet, neck stiffness, aversion to cold, occasional head heat, facial redness, eye redness, isolated head shaking, sudden lockjaw, and opisthotonos—if sweated, cold-damp combine, worsening exterior deficiency and severe aversion to cold; if sweated and the pulse resembles a wriggling snake; or sudden abdominal distension indicating resolution, but pulse remains unchanged or becomes hidden and wiry indicating Jing—these are not detailed in the preceding text. Nevertheless, mastering the flexible application of Shanghan treatments ensures sufficient therapeutic efficacy. Haizang states: Excessive sweating leading to Jing, with fever, cold feet, neck stiffness, aversion to cold, head heat, facial swelling, red eyes, head shaking, lockjaw, and opisthotonos, is Taiyang Jing. If the head is lowered, looking down, limbs pulled, elbows and knees touching, it is Yangming Jing. If one eye deviates sideways or one arm and leg convulse, it is Shaoyang Jing. Sweating, arresting sweating, harmonizing, and purging should each follow their respective channels to ensure cure. (Taiyang Jing is Exterior; anhidrosis requires sweating, diaphoresis requires arresting sweat. Yangming Jing is Interior; purging is indicated. Shaoyang Jing is Half-Exterior Half-Interior; harmonizing is indicated. This is "following each channel.") Shenji Tang added with Qianghuo and Mahuang treats Gangjing with anhidrosis. Baizhu Tang added with Guixin and Huangqi treats Roujing with diaphoresis. Taiyang-Yangming combined adds Chuanxiong and Jingjie Sui. Zhengyang Yangming adds Qianghuo and Jiuhuangqi. Shaoyang-Yangming adds Fangfeng and Chaihu Gen. Heat in the Exterior adds Huangqin. Cold in the Exterior adds Guizhi, Huangqi, and Fuzi. Heat in the Interior adds Dahuang. Cold in the Interior adds Ganjiang, Liangjiang, and Fuzi. Wang's channel-based discussion of Jing indeed captures Zhongjing's Shanghan methodology. The modification of Zhongjing's formulas by removing Gegen and Gualou Gen in favor of wind-dispelling herbs likely stems from the nature of wind-Jing with stiff sinews. However, *Yuanbing Shi* discusses stiff sinews and neck rigidity under the Dampness category, attributing it to Earth's quiet nature; when extreme, it counteracts via Wind transformation, but this is a false image, not true Wind, so it cannot be treated solely as Wind. Furthermore, Haizang's six-channel classification omits Jueyin, which does have Jing cases. The classics state: When Jueyin is in authority, guest excess causes joint immobility, internal Jing stiffness and cramping, and external inconvenience. *Lingshu* also states that Foot Shaoyin meridian sinew disease governs epilepsy, convulsions, and Jing, serving as an example of Yin meridian Jing. Perhaps Haizang omitted more than just this. *Neijing* mentions Taiyang arriving causes night sweat and Jing; Hand Yangming and Shaoyang reversal causes throat obstruction and Jing; these result from the self-regulating decline and rise of wind, cold, damp, heat, dryness, and fire within the six meridians, transforming into Jing, which we shall not discuss here. I have pondered that exogenous and endogenous causes of Jing require distinct treatments. Heavenly qi, driven by eight winds and six excesses, enters externally affecting the couli and internally contacting the five zang organs; thus, treating pathogens must address Wind. Human qi, damaged by emotional labor, stirs Jueyang, fanning the Ministerial and Imperial fires, triggering six meridian excesses, leading to Five Yang conflicts; therefore, excess is purged, deficiency is tonified, addressing Fire and regulating Spleen-Stomach Earth to restore Qi damaged by Fire, which is difficult to heal. Using exogenous dispersing herbs for endogenous injury depletes Yuan Qi, exhausts Blood, separates Spirit, and leads to untreatable collapse. Danxi states: It resembles epilepsy but is more severe, caused by severe Qi-Blood deficiency with Phlegm and Fire. Medications should include Renshen and Zhuli (Bamboo Sap), avoiding wind-dispersing herbs. A man in his twenties, after chickenpox scabs fell off, suddenly developed lockjaw, rigid limbs unable to flex, intermittent periumbilical pain with profuse cold sweat stopping when pain ceased, and a very wiry, tight, rapid pulse. This was due to fatigue injuring Blood, mountain dwelling exposing him to wind-cold, and chickenpox further depleting Blood. Treatment required acrid-warm blood-nourishing and acrid-cool wind-dispersing herbs: Danggui Shen and Shaoyao as Sovereign, Chuanxiong, Qingpi, and Gouteng as Ministers, Baizhu, Chenpi, and Gancao as Assistants, Guizhi, Muxiang, and Huanglian as Envoys, plus a little Honghua. Twelve doses brought recovery. Xue Xinpu states: Jing disease arises from excessive sweating/purging in Shanghan, postpartum conditions, ulcers, or harsh medications damaging Qi and Blood. If Metal is deficient and Wood hyperactive, use Xieqing Wan followed by Yigong San; if Kidney Water is deficient, use Liuwei Wan. If Liver Fire is hyperactive, use Jiawei Xiaochaihu Tang followed by Jiawei Siwu Tang; if feverish, use Jiawei Xiaoyao San. If Wood insults Spleen Earth, use Buzhong Yiqi Tang added with Shaoyao and Shanzhi. If Spleen Meridian stagnation, use Jiawei Guipi Tang. If Spleen Earth damp-heat, use San Yi Chengqi Tang. Generally, post-illness Qi-Blood weakness is treated with concentrated Renshen and Baizhu decoctions supplemented with Jiangzhi and Zhuli. If ineffective, use Shiquan Dabu Tang; if still ineffective, urgently add Fuzi or use Shenfu Tang, otherwise it is untreatable. Yu Bo treated a woman in her thirties, emaciated, who suddenly developed Jing after menstruation, with lockjaw, limb contraction, and opisthotonos. This was due to excessive blood loss allowing Wind pathogen invasion. Siwu Tang added with Fangfeng, Qianghuo, and Jingjie, with a little Fuzi to move the meridians. Two doses halved the illness; six doses cured it. Zhang Zihe treated Lady Lu, thirty-something, suffering from wind convulsions, vertigo, opisthotonos, and anorexia for days. Physicians failed treating it as Wind. All wind tremors and vertigo belong to Liver Wood. Trembling is the function of Wind. Yang moves, Yin rests. Fire excess controls Metal; Metal deficiency fails to subdue Wood; Wood overgrows and sickens. He induced vomiting of two to three sheng of wind-phlegm, purged ten-plus times with cold herbs, and bled one cup from Baihui point via filiform needles, resulting in immediate cure. (Above are endogenous examples.) Jing disease distinguishes Gang/Rou by sweating/anhidrosis and Yin/Yang by presence/absence of Jue Ni (reversal of Qi). Although Zhongjing states Jing presents with fever and cold feet, Yang Jing does not involve Jue Ni; those with Jue Ni are Yin Jing. Yang Jing was described earlier. Yin Jing appearing in one or two days with facial swelling, cold extremities, tendon-pulse cramping, and anhidrosis suggests internal Yin Qi injury; Baye Baizhu San is indicated. If fever with deep-thin pulse involves Taiyin, abdominal pain is certain; Guizhi Jia Shaoyao, Fangfeng, Fangji Tang or Xiao Xuming Tang is indicated. For Yin Jing with cold extremities, tendon-pulse cramping, continuous sweating, neck stiffness, head shaking, and lockjaw, Fuzi San, Guixin Baizhu Tang, or Fuzi Fangfeng San are indicated. (Above are Three Yin examples.)
[Diagnosis] In Taiyang disease, fever with a deep-thin pulse is named Jing, and is difficult to treat. The Jing pulse is hidden, tight upon pressure, wiry, firm, straight, running up and down. (Wuze states: All Jing pulses are hidden, wiry, deep, and tight.) After sweating in Jing disease, if the pulse appears undulating like a snake and sudden abdominal distension occurs, it indicates impending resolution; if the pulse remains unchanged or becomes hidden and wiry, it is Jing. (The character "Jing" here is suspected to be a typo for "Death".) Jing disease with moxa scars is difficult to treat.
[Pregnancy Jing] Mostly caused by wind-cold-damp invading due to deficiency, treated primarily from the Taiyang channel. (It is feared that it should still follow the previous example, differentiating Six Channels' exterior-interior.) Xue states: If Heart-Liver Wind-Heat, use Gouteng Tang. If Liver-Spleen Blood Deficiency, use Jiawei Xiaoyao San. If Liver-Spleen Depression-Anger, use Jiawei Guipi Tang. If Qi Reversal with Phlegm Stagnation, use Zisu Yin. If Liver Fire Wind-Heat, use Gouteng San. If Spleen Depression with Phlegm Stagnation, use Erchen Tang, Jiangzhi, and Zhuli.
[Postpartum Jing] *Liangfang* states: Postpartum sweating transforming into Jing is due to Qi-Blood deficiency, loose couli, and Wind pathogen invasion. Symptoms include lockjaw, back stiffness resembling epilepsy, head shaking, neighing sounds, intermittent attacks, and breathlessness as if dying. Urgently administer Xiao Xuming Tang. If sweating is so profuse hands cannot wipe it, it is untreatable. *Qianjin Fang* treats postpartum wind-stroke with lockjaw, cyanotic face, and limb rigidity using one sheng of Zhuli, divided into five warm doses, frequently administered for great effect. Lou Quanshan states: Xiao Xuming Tang, Juqing Gubai San, and Dadouzi Tang all treat postpartum Jing and are Taiyang-Jueyin herbs. They are suitable for excess pathogens with floating-wiry-strong pulses, but postpartum patients with severe Qi-Blood deficiency should not be lightly treated with exterior-releasing methods; using Fangfeng Danggui San is superior. Xue states: Postpartum Jing results from excessive blood loss leaving sinews without nourishment, similar to excessive sweating/purging in Shanghan or massive discharge in ulcers, constituting a critical condition. Urgently use Shiquan Dabu Tang; if ineffective, urgently add Fuzi. Some cases are caused by six excesses or seven emotions (treatment see above).