【纲】仲景曰。太阳病。发汗太多。因致痉。脉沉而细。身热足寒。头项强急。恶寒。时头热。
面赤。目脉赤。独头面摇。卒口噤。背反张者。痉病也。
【目】成无己曰。此以风盛于上。风主动摇故也。头者。诸阳之会。诸阳之脉。皆上于头。诸
阴之脉。皆至颈胸中而还。阳脉不治。则头为之摇矣。
柯琴曰。阳气者。精则养神。柔则养筋。汗多则无液养筋。筋伤则挛急而反张矣。太阳主筋
所生病也。要知痉非无因。因伤寒发汗不如法耳。今头痛虽止。而颈项强急恶寒之症未罢。更见面
赤目赤。是将转属阳明。然诸症皆与伤寒
相似而非痉。独头面摇动口噤背反张。与伤寒不相似。故名曰痉。此汗多亡液不转属阳明而成者。
治当滋阴以和其里。用炙甘草汤。金匮用桂枝汤加栝蒌根。恐不胜任。
【纲】仲景曰。摇头言者。里痛也。
【目】成无己曰。里有痛者。言语则剧。欲言则头为之战摇也。里痛。非邪也。痛使之然。痉
病非逆也。风使之然。
【纲】仲景曰。阳反独留。形体如烟熏。直视摇头者。此为心绝也。
【目】许叔微曰。心藏神而为阴之本。阳根于阴。阴根于阳。阴阳相根。则荣卫和。上下相随
矣。绝则神去。而阴竭阳无根者。则不能自主持。故头为摇也。心绝者。真病也。风痉里痛者。邪
气也。观其头摇。又当明其否藏焉。
【纲】仲景曰。衄家不可发汗。汗出必额上陷。脉急紧。目直视。不能 。不得眠。
【目】戴原礼曰。直视者。视物而目睛不转动也。水之精为志。火之精为神。目者。心之使也。
神所寓焉。肝之外候也。精神荣焉。针经云。五脏六腑之气。皆上注于目而为之精。精之窠为眼。
骨之精为瞳子。筋之精为黑睛。血之精为络。气之精为白睛。肌肉之精为约束裹撷。筋骨血气之
精与脉并为系。上属于脑。五脏血气调和。精气充足。则目和而明矣。伤寒目直视者。邪气壅盛。
冒其正气。使神智不慧。藏精之气。不上荣于目。则目为之直视。伤寒至于直视。为邪气已极。症
候已逆。多难治。人以肝受血而能视。今衄家亡血。肝气已虚。目气已弱。又发汗亡阳。阴阳俱虚
所致。虞抟曰。目睛上视。名戴眼。此足太阳经之症。盖太阳目之上纲。而与少阴为表里。少阴之肾
气大亏。则太阳之阴虚血少。故其筋脉燥急。牵引而上。若直视不转者。尤为凶候。速当以培阴养
血为主。今人不知。俱云是风。若用风药。则阴愈虚。血愈燥矣。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），发汗过多，因而导致痉病（以项背强直、角弓反张为主要表现的病证）。脉象沉而细，身体发热但足部寒冷，头项部僵硬拘急，恶寒，有时头部发热，面色发红，眼部血脉充血，唯独头部和面部摇动，突然牙关紧闭，背部向后反折呈弓形者，这是痉病。
【目】成无己说：这是因为风邪盛于上部，风性主动，所以引起摇动。头部是诸阳经汇聚之处，所有阳经的经脉都上行至头部，所有阴经的经脉都只到达颈胸部便返回。如果阳经之气不能正常治理运行，就会导致头部摇动。
柯琴说：阳气，精微时滋养神志，柔和时滋养筋脉。发汗过多则津液亏损，无法滋养筋脉，筋脉受损就会挛急并出现角弓反张。太阳经主管筋脉所发生的疾病。要知道痉病并非没有原因，是因为治疗伤寒时发汗方法不当所致。如今头痛虽然停止，但颈项僵硬拘急、恶寒的症状并未消除，再加上见面色红、眼睛红，这将是转属阳明病（阳明经受邪所致的病证）的征兆。然而这些症状都与伤寒相似而非痉病，唯独头部面部摇动、牙关紧闭、背部反折，与伤寒不相似，所以命名为痉病。这是由于发汗过多导致津液亡失，并未转属阳明病而是形成了痉病。治疗应当滋阴以调和里气，使用炙甘草汤（由炙甘草、生姜、桂枝、麦门冬、阿胶、大枣、麻仁组成的方剂）。《金匮要略》中使用桂枝汤（由桂枝、芍药、生姜、大枣、甘草组成的方剂）加栝蒌根（天花粉），恐怕力量不够胜任。
【目】成无己说：体内有疼痛的人，说话时疼痛加剧，想要说话时头部就会颤抖摇动。体内的疼痛，不是外邪直接造成的，而是疼痛使得身体如此反应。痉病并非逆证，是风邪使得身体如此反应。
【纲】张仲景说：阳气独留于上，形体像被烟熏一样黑晦，两眼直视且摇头的，这是心气绝脱的表现。
【目】许叔微说：心藏神志，是阴的根本。阳根源于阴，阴根源于阳，阴阳相互依存，则营卫调和，上下相随。心气绝则神志离去，阴竭而阳无根，就不能自主控制，所以头部摇动。心气绝是真脏病，风邪引起的痉病或体内疼痛属于邪气致病。观察其头部摇动，还应当辨明脏腑的情况。
【纲】张仲景说：经常鼻出血的人不可发汗，如果发汗，必然导致额部动脉凹陷，脉象紧急紧束，两眼直视，不能闭眼，无法入睡。
【目】戴原礼说：直视，是指看东西时眼球不转动。水的精华称为志，火的精华称为神。眼睛是心的使者，神志寄寓其中，也是肝的外在表现。精神气血荣养于此。《灵枢·大惑论》说：五脏六腑的气血，都上行注于眼睛而形成视觉的精光。眼的周围组织为眼窠，骨骼的精华表现为瞳子，筋的精华表现为黑睛，血的精华表现为络脉，气的精华表现为白睛，肌肉的精华为眼睑约束裹挟的结构。筋骨血气的精华与脉络合并成为目系，向上连接于脑。五脏气血调和，精气充足，则眼睛明亮有神。伤寒病出现两眼直视，是邪气壅盛，蒙蔽正气，使神智不清，脏腑精气不能上荣于目，所以眼睛直视。伤寒发展到直视阶段，说明邪气已极，病情已逆，大多难以治疗。人依靠肝脏接受血液才能视物，现在经常鼻出血的人已经亡血，肝气已虚，目气已弱，又因发汗导致亡阳，这是阴阳俱虚所致。虞抟说：眼球向上固定不动，称为戴眼（角弓反张的一种表现，此处指眼珠上翻），这是足太阳膀胱经的症状。因为太阳经主一身之表，与少阴肾经互为表里。如果少阴肾气大亏，则太阳经阴虚血少，导致筋脉干燥急迫，牵引眼球向上。如果是直视不转动，更是凶险的征候。应当迅速以培补阴液、滋养血液为主治原则。现在的人不知道这一点，都说是风邪，如果使用祛风药，则阴液更虚，血液更燥了。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel), excessive sweating may lead to Jing disease (a condition characterized by stiffness of the neck and back, and opisthotonos). The pulse is deep and fine; there is fever in the body but coldness in the feet; stiffness and tension in the head and neck; aversion to cold; occasional heat in the head; redness of the face; congestion of the vessels in the eyes; isolated shaking of the head and face; sudden locking of the jaw; and opisthotonos (backward arching of the back) indicate Jing disease.
[Commentary] Cheng Wuji stated: This occurs because wind pathogen is abundant in the upper part. Since wind is characterized by movement, it causes shaking. The head is the meeting place of all Yang channels; all Yang meridians ascend to the head, while all Yin meridians reach only to the neck and chest before returning. If Yang Qi fails to govern properly, the head will shake.
Ke Qin stated: Yang Qi nourishes the Shen (Spirit) when refined and nourishes the sinews when soft. Excessive sweating depletes fluids, failing to nourish the sinews; damaged sinews become spasmodic and result in opisthotonos. The Taiyang channel governs diseases of the sinews. It must be understood that Jing disease has a cause: it results from improper sweating therapy for Shanghan (Cold Damage). Although the headache has ceased, symptoms such as neck stiffness, tension, and aversion to cold persist. Furthermore, facial redness and eye redness suggest a potential transition to Yangming disease (disease of the Yangming channel). However, these symptoms resemble Shanghan rather than Jing disease. Only the shaking of the head and face, locked jaw, and opisthotonos differ from typical Shanghan, hence it is named Jing disease. This condition arises from fluid depletion due to excessive sweating, not from a transition to Yangming. Treatment should focus on nourishing Yin to harmonize the interior, using Zhi Gancao Tang (Honey-fried Licorice Decoction). The *Jin Gui Yao Lue* suggests adding Gualou Gen (Trichosanthes Root) to Guizhi Tang (Cinnamon Twig Decoction), which may be insufficient.
[General Principle] Zhang Zhongjing stated: Shaking the head while speaking indicates internal pain.
[Commentary] Cheng Wuji stated: When there is internal pain, speaking exacerbates it; the desire to speak causes the head to tremble and shake. Internal pain is not caused directly by pathogens but by the pain itself causing this reaction. Jing disease is not a critical reversal syndrome but is caused by wind.
[General Principle] Zhang Zhongjing stated: When Yang Qi remains exclusively in the upper part, the complexion appears dark like smoke, with fixed staring gaze and head shaking, this indicates Heart Qi exhaustion.
[Commentary] Xu Shuwei stated: The Heart stores the Shen and is the root of Yin. Yang roots in Yin, and Yin roots in Yang. When Yin and Yang are mutually rooted, Ying and Wei (Nutritive and Defensive Qi) are harmonious, and the upper and lower parts follow each other. When exhausted, the Shen departs; when Yin is depleted and Yang loses its root, self-control is lost, resulting in head shaking. Heart exhaustion is a true organ failure, whereas shaking due to wind or internal pain is due to pathogenic factors. Observing head shaking requires distinguishing the state of the Zang organs.
[General Principle] Zhang Zhongjing stated: Individuals prone to epistaxis (nosebleeds) should not undergo sweating therapy. If sweating is induced, it will inevitably lead to depression of the arteries in the forehead, a tight and tense pulse, fixed staring gaze, inability to close the eyes, and insomnia.
[Commentary] Dai Yuanli stated: Fixed staring gaze refers to looking at objects without moving the eyeballs. Water's essence is Zhi (Willpower), and Fire's essence is Shen (Spirit). The eyes are the messengers of the Heart, where the Shen resides, and they are the external manifestation of the Liver. Spirit and Qi nourish them. The *Ling Shu* states: The Qi of the five Zang and six Fu organs all ascend to the eyes to form visual clarity. The socket surrounds the eye; the essence of bone manifests as the pupil; the essence of sinew manifests as the black part of the eye; the essence of blood manifests as the collateral vessels; the essence of Qi manifests as the white part of the eye; the essence of muscle manifests as the eyelid constraints. The essences of sinew, bone, blood, and Qi merge with the meridians to form the optic nerve system, connecting upward to the brain. When the Qi and Blood of the five Zang organs are harmonious and Jing Essence is sufficient, the eyes are clear and bright. In Shanghan, fixed staring gaze indicates excess pathogenic Qi obstructing healthy Qi, clouding mental clarity, preventing the essence Qi of the Zang organs from nourishing the eyes. When Shanghan progresses to fixed staring gaze, pathogenic Qi is extreme, and the condition is critical and difficult to treat. Humans rely on the Liver receiving blood to see. In individuals prone to nosebleeds, blood loss has already weakened Liver Qi and Eye Qi. Inducing sweating further depletes Yang, resulting in deficiency of both Yin and Yang. Yu Tun stated: Upward fixation of the eyeballs is called Daiyan (eyes rolling up), a symptom of the Foot-Taiyang Bladder Channel. Since Taiyang governs the exterior and is externally-interiorly related to Shaoyin Kidney, severe depletion of Shaoyin Kidney Qi leads to Yin deficiency and blood scarcity in Taiyang, causing dry and tense sinews that pull the eyes upward. Fixed staring gaze is an especially ominous sign. Treatment should urgently prioritize tonifying Yin and nourishing blood. Modern practitioners often mistake this for wind and use wind-dispelling herbs, which further depletes Yin and dries the blood.