强直反张之病，名痉病。按痉病与伤寒相类，但多项背反张为异。治分表里阴阳、虚实寒
热。《金匮》以太阳发热，无汗恶寒，名刚痉，发热有汗不恶寒，名柔痉。此以有汗无汗，
别寒湿伤营、风湿伤卫而定名者，虽不明言发汗解肌，然细玩首章原文，以有汗无汗立说，
仍暗度金针于太阳伤寒发汗解肌同条处治。但痉病不独在冬月，三时皆有者，故不明示麻桂
辛温，发汗解肌。又因痉劲强直，多有营卫不充，外冒外淫致病，用不得大汗发表。故下章
云∶太阳病，发热脉沉而细者，名曰痉，为难治。盖言太阳发热之痉，惟以散表为正治。今
以脉沉而细，用不得散表，则难治矣。是此可见太阳发热之痉，设脉浮紧而大者，仍可用散
表方法而不曰难治矣。下文又言太阳病发热无汗之病，本宜发汗，若脉沉而细，大发其
汗，因汗太多，亦能致痉。若发热有汗之中风症，脉沉而细者，下之亦能致痉。疮家虽身疼
痛，若脉沉而细者，误发汗亦成痉。即太阳病症备，若脉沉迟，止用栝蒌桂枝汤。再三告戒
脉沉而细者，汗下俱禁者也。然下文云∶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。按此条但言无汗，不言脉沉细，故仍用葛根、麻黄，以发太阳
阳明之表，明示首章发热无汗反恶寒之刚痉，若脉不沉细，仍用发表治法。下文云∶痉为
病，胸满口噤，卧不着席，脚挛急，必介齿，可与大承气汤。按此条不言无汗，不言脉沉
细，明示首章发热有汗之柔痉，若脉不沉细而实大，仍可用大承气汤以下者。首章恐痉病之
脉有沉细者，即无汗表症之刚痉，亦用不得麻黄汤。即有汗发热之柔痉，亦用不得桂枝汤。
此章恐发热无汗，脉大不沉细之刚痉，应汗失汗，故复立葛根麻黄汤。又恐发热有汗，脉数
不沉细之柔痉，应下失下，故复立大承气汤。两面告诫，可见仲景惟以病之无汗有汗，脉之
浮细浮大，沉细沉实，端在表里虚实，详示发表攻里者也。海藏有口噤，背反张，名太阳痉。
低头下视，名阳明痉。一目左右斜视，手足搐搦，名少阳痉。其意欲以背为太阳，胸前为阳
明，目之斜视左右为少阳，以定经络。然项强之症，属阳明者多，而阳明之脉入目，阳明之
脉左右交加。两目亦能斜视，未可以此为定论。丹溪有人参、竹沥主治者，此因内伤痉病，
血液枯燥，经络不润成之故耳。薛新甫有泻青丸、异攻散、六味丸、逍遥散、四物、归脾、
三乙承气，家秘用舒筋汤等，此皆内伤痉病，分别虚实补泻，而非外感六淫致痉之条也。今
余详注仲景之痉病于前，次述三公之论于后，则外感六淫，内伤致痉诸条皆全矣。余读《伤
寒论》，见仲景以冬月伤寒立论，但榜及风湿、风温，而不及三时之寒热等病，读《金匮》痉
病论，见以中湿、湿热、中 等症，次列于后。余今着《伤寒大白》，比例《金匮》痉病论，
先以伤寒、寒热、温热病立论卷首，兼以发 、夹食、痉病。次附于后，则外感致病诸条皆
全矣。
强直、身体向后反折的病症，称为痉病。考察痉病与伤寒相似，但多项以背部向后反张为特征，这是两者的区别。治疗需分表里、阴阳、虚实、寒热。《金匮要略》认为，太阳病发热、无汗、恶寒的，称为刚痉；发热、有汗、不恶寒的，称为柔痉。这是根据有汗和无汗来区分寒湿伤及营分、风湿伤及卫分而命名的。虽然文中没有明确说出发汗解肌的方法，但仔细研读首章原文，以有汗和无汗立论，实际上暗含了将太阳伤寒的发汗法与解肌法合并治疗的深意。但是，痉病不仅仅发生在冬季，春、夏、秋三季也都有发生，所以不明确使用麻黄汤、桂枝汤等辛温药物来发汗解肌。又因为痉病表现为筋脉拘急强直，多因营卫气血不足，外受邪气侵袭致病，因此不能使用大汗法来发表。所以下一章说：太阳病，发热，脉象沉而细的，称为痉病，属于难治之证。这是说太阳发热引起的痉病，只有用疏散表邪才是正治。现在如果脉象沉而细，就不能用疏散表邪的方法，所以说是难治。由此可以看出，如果是太阳发热引起的痉病，假设脉象浮紧而大，仍然可以使用疏散表邪的方法，就不会说难治了。下文又说，太阳病发热无汗的病症，本来应该发汗，但如果脉象沉而细，大发其汗，因为出汗太多，也能导致痉病。如果是发热有汗的中风症，脉象沉而细的，误用攻下法也能导致痉病。患有疮疡的人虽然身体疼痛，但如果脉象沉而细的，误用发汗法也会变成痉病。即使是太阳病的症状具备，但如果脉象沉迟，只需用栝蒌桂枝汤。这里再三告诫脉象沉而细的，是禁止使用发汗和攻下法的。然而下文又说：太阳病无汗，小便反而少，气上冲胸，牙关紧闭不能说话，将要发作刚痉，用葛根汤主治。按此条只说无汗，没说脉象沉细，所以仍然使用葛根、麻黄，来发散太阳、阳明经的表邪，明确显示首章中发热无汗且反恶寒的刚痉，如果脉象不沉细，仍然使用发表的治疗方法。下文又说：痉病，出现胸满、牙关紧闭、睡觉时身体仰卧不能贴席、脚部挛急、必定咬紧牙齿，可以给予大承气汤。按此条没说无汗，也没说脉象沉细，明确显示首章中发热有汗的柔痉，如果脉象不沉细而是实大，仍然可以用大承气汤来攻下。首章恐怕痉病的脉象有沉细者，即即使是有无汗表证的刚痉，也不能使用麻黄汤。即即使是发热有汗的柔痉，也不能使用桂枝汤。本章恐怕发热无汗、脉大不沉细的刚痉，该发汗却失于发汗，所以重新确立葛根汤、麻黄汤（注：此处指葛根汤含麻黄）。又恐怕发热有汗、脉数不沉细的柔痉，该攻下却失于攻下，所以重新确立大承气汤。从这两方面告诫可见，张仲景只是根据病人的无汗或有汗，脉象的浮细或浮大、沉细或沉实，关键在于辨别表里虚实，详细指示了发表和攻里的方法。海藏（张元素）认为口噤、背反张的，称为太阳痉。低头下视的，称为阳明痉。一只眼睛向左右斜视，手足抽搐的，称为少阳痉。他的意图是想以背部为太阳，胸前为阳明，眼睛斜视为少阳，以此来确定经络归属。然而项强的症状，属于阳明的很多，而阳明的经脉进入目内眦，阳明的经脉左右交叉。两只眼睛也能斜视，不可以此为定论。丹溪（朱震亨）有人参、竹沥主治的方法，这是因为内伤导致的痉病，血液枯燥，经络失去滋润的缘故。薛新甫（薛己）有泻青丸、异攻散、六味丸、逍遥散、四物汤、归脾汤、三乙承气汤，家秘用的舒筋汤等，这些都是针对内伤痉病，分别虚实进行补泻治疗，而不是针对外感六淫致痉的情况。现在我详细注释前文仲景关于痉病的论述，其次叙述三位医家的观点在后，那么外感六淫、内伤致痉的各种条文就都齐全了。我读《伤寒论》，见仲景以冬季伤寒立论，但标题涉及风湿、风温，而没有涉及三季的寒热等疾病；读《金匮要略》痉病论，见到其中湿、湿热、中暍等症状列在后面。我现在撰写《伤寒大白》，比照《金匮要略》痉病论，先在卷首以伤寒、寒热、温热病立论，兼以发斑、夹食、痉病附在后面，那么外感致病的所有条文就都齐全了。
The disease characterized by stiffness and opisthotonos (backward arching of the body) is named Jing Disease (Spasm). Upon examination, Jing Disease resembles Shanghan (Cold Damage), but differs in that it predominantly features backward arching of the back. Treatment must differentiate between exterior/interior, yin/yang, deficiency/excess, and cold/heat. The *Jingui Yaolue* states that Taiyang disease presenting with fever, anhidrosis (absence of sweating), and aversion to cold is named Gang Jing (Stiff Spasm); fever with sweating and no aversion to cold is named Rou Jing (Soft Spasm). This nomenclature distinguishes between Cold-Dampness injuring the Ying (Nutritive) level and Wind-Dampness injuring the Wei (Defensive) level based on the presence or absence of sweating. Although the text does not explicitly mention diaphoresis (sweating-inducing therapy) or releasing the muscle layer, careful study of the original text of the first chapter reveals that establishing the theory based on sweating versus non-sweating implicitly suggests treating Taiyang Shanghan via both diaphoresis and releasing the muscle layer under the same principles. However, Jing Disease occurs not only in winter but also in spring, summer, and autumn; therefore, acrid-warm herbs like those in Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) for inducing sweat and releasing the muscle layer are not explicitly prescribed. Furthermore, because Jing Disease involves rigid spasms, often due to insufficiency of Ying and Wei levels and invasion by external pathogens, drastic diaphoresis to release the exterior is contraindicated. Hence, the next chapter states: "Taiyang disease, with fever and a deep, thin pulse, is named Jing Disease, and is difficult to treat." This implies that for Jing Disease caused by Taiyang fever, dispersing the exterior is the correct treatment. If the pulse is deep and thin, dispersing the exterior cannot be used, hence it is difficult to treat. From this, we can see that if Taiyang fever-induced Jing Disease presents with a floating, tight, and large pulse, dispersing the exterior method can still be used, and it would not be termed difficult to treat. The following text further states: For Taiyang disease with fever and anhidrosis, sweating should originally be induced; however, if the pulse is deep and thin, inducing heavy sweating may lead to Jing Disease due to excessive fluid loss. For wind-strike syndrome with fever and sweating, if the pulse is deep and thin, purgation may also induce Jing Disease. Patients with sores who experience body pain, if the pulse is deep and thin, mistaken diaphoresis will also result in Jing Disease. Even if all Taiyang disease symptoms are present, if the pulse is deep and slow, only Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) should be used. The repeated warning regarding deep and thin pulses indicates that both diaphoresis and purgation are prohibited. However, the following text states: "Taiyang disease with anhidrosis, accompanied by scanty urination, qi rushing upward to the chest, trismus (lockjaw), and inability to speak, indicating impending Gang Jing, is treated with Gegen Tang (Kudzu Decoction)." This clause mentions only anhidrosis, not a deep/thin pulse; thus, Gegen and Mahuang are still used to release the exterior of the Taiyang and Yangming channels. This clearly indicates that for Gang Jing with fever, anhidrosis, and aversion to cold from the first chapter, if the pulse is not deep and thin, exterior-releasing methods remain applicable. The following text states: "In Jing Disease, if there is chest fullness, trismus, inability to lie flat (body does not touch the bed), calf cramping, and teeth grinding, Da Chengqi Tang (Major Order the Qi Decoction) may be given." This clause mentions neither anhidrosis nor a deep/thin pulse, clearly indicating that for Rou Jing with fever and sweating from the first chapter, if the pulse is not deep and thin but rather solid and large, Da Chengqi Tang can still be used for purgation. The first chapter warns that if Jing Disease presents with a deep/thin pulse, even Gang Jing with exterior signs cannot use Mahuang Tang. Similarly, Rou Jing with fever and sweating cannot use Guizhi Tang. This chapter warns that for Gang Jing with fever, anhidrosis, and a large, non-deep/thin pulse, if sweating was indicated but missed, Gegen Tang and Mahuang-containing formulas are re-established. It also warns that for Rou Jing with fever, sweating, and a rapid, non-deep/thin pulse, if purgation was indicated but missed, Da Chengqi Tang is re-established. These dual warnings show that Zhang Zhongjing relies on the presence or absence of sweating, and whether the pulse is floating/thin, floating/large, deep/thin, or deep/solid, to determine interior/exterior and deficiency/excess, thereby detailing exterior-releasing and interior-purging methods. Haizang (Zhang Yuansu) defines mouth locking and opisthotonos as Taiyang Jing; head drooping and downward gaze as Yangming Jing; unilateral strabismus and limb convulsions as Shaoyang Jing. His intent seems to be assigning the back to Taiyang, the anterior chest to Yangming, and eye deviation to Shaoyang to define meridian involvement. However, neck stiffness frequently belongs to Yangming; the Yangming meridian enters the inner canthus, and its pathways cross bilaterally. Both eyes can deviate, so this cannot be taken as an absolute conclusion. Danxi (Zhu Zhenheng) advocated Ren Shen (Ginseng Radix) and Zhu Li (Bambusa Textilis Sap) for treatment, which applies to internal injury-induced Jing Disease where blood dryness fails to nourish the meridians. Xue Xinpu (Xue Ji) utilized Xie Qing Wan (Drain Green Pill), Yi Gong San (Differentiated Attack Powder), Liuwei Wan (Six-Ingredient Pill), Xiaoyao San (Free and Easy Wanderer Powder), Siwu Tang (Four Substance Decoction), Guipi Tang (Restore the Spleen Decoction), San Yi Chengqi Tang, and his family secret Shujin Tang (Relax Tendons Decoction). These are all for internal injury-induced Jing Disease, differentiating deficiency/excess for tonification/purgation, and do not apply to Jing Disease caused by external Six Evils. Now, I have detailed Zhongjing’s discussion on Jing Disease previously, and subsequently described the theories of these three masters, thereby covering all aspects of external Six Evils and internal injuries causing Jing Disease. Reading the *Shanghan Lun*, I saw Zhongjing established his theory on winter Shanghan, mentioning Wind-Damp and Wind-Warmth, but omitting cold/heat diseases of other seasons. Reading the *Jingui Yaolue* Jing Disease chapter, I saw Zhongshi (Damp Strike), Damp-Heat, and Zhongshu (Heat Stroke) listed later. In my work *Shanghan Dabai*, comparing the *Jingui Yaolue* Jing Disease chapter, I first establish the opening volume with theories on Shanghan, Cold-Heat, and Warm-Thermal diseases, supplementing with Ban (Maculae/Rash), Jia Shi (Food Retention), and Jing Disease appended afterward, thus completing the coverage of all externally contracted pathogenic conditions.