太阳病。发热无汗。反恶寒者。名曰刚痉。太阳病。发热汗出。不恶寒者。名曰柔痉。
此分痉病刚柔之异。以无汗恶寒者。为阴为刚。有汗不恶寒者。为阳为柔。阴性劲切。而阳性
舒散也。然必兼有头动面赤。口噤。背反张。颈项强等证。仲景不言者。以痉字该之也。不然。何异
太阳中风伤寒证。而谓之痉证耶。活人亦云痉证发热恶寒。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。脉沉而细者。名曰痉。为难治。
太阳脉本浮。今反沉者。风得湿而伏也。痉脉本紧弦。今反细者。真气适不足也。攻则正不能
任。补则邪不得去。此痉病之难治者也。
太阳病。发汗太多。因致痉。
痉病有太阳风寒不解。重感寒湿而成者。亦有亡血竭气。损伤阴阳。筋脉不荣而变成痉者。病
在太阳。发汗太多。因致成痉。知其为液脱筋急之痉。而非风淫湿郁之痉矣。经云、气主煦之。
血主濡之。又云、阳
气者。精则养神。柔则养筋。阴阳既衰。筋脉失其濡养。而强直不柔也。此痉病标本虚实之辨也
。
病者。身热足寒。颈项强急。恶寒。时头热。面赤。目赤。独头动摇。卒口噤。背反张者。痉
病也。
痉病不离乎表。故身热恶寒。痉为风强病。而筋脉受之。故口噤。头项强。背反张。脉强直。
经云。诸暴强直。皆属于风也。头热足寒。面目赤。头动摇者。风为阳邪。其气上行而又主动也
。
按以上五条。王叔和本编入痉湿 篇中。在三百九十七法之外。兹特录之。所以广类病之法也
。以下二条。系太阳原文。而实为痉病。故移置此篇。以资辨证。非好为变乱前文也。学人辨诸
。
太阳病。项背强KT KT 。反汗出恶风者。桂枝加葛根汤主之。太阳病。项背强KT KT 。无汗恶风
。葛根汤主之。
二条本是痉证。而有表虚表实之分。表实者无汗。表虚者汗反自出。即所谓刚痉柔痉也。然痉
、筋病也。亦风病也。故虽有刚柔之异。而其项背强KT KT 恶风。则一也。KT KT 项强连背。不能展顾
之貌。桂枝加葛根汤。如太阳桂枝汤例。葛根汤。如太阳麻黄汤例。而并加葛根者。以项背KT KT 。筋
骨肌肉并痹而不用。故加葛根以疏肌肉之邪。且并须桂、芍、姜、枣。以通营卫之气。
桂枝加葛根汤方
葛根（四两） 桂枝（二两去皮） 芍药（二两） 甘草（二两） 生姜（三两切） 大枣（
十二枚）
上六味。以水一斗。先煮葛根。减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。覆取
微似汗。不须啜
粥。余如桂枝汤法。原方有麻黄三两。成氏云、麻黄主表实。后葛根汤证云、太阳病。项背强几几
。无汗恶风。葛根汤主之。药性正与此方同。其无汗者。当用麻黄。今自汗出。恐不加麻黄。但
加葛根也。葛根汤方见正治法下。
太阳病，发热且无汗，反而恶寒的，称为刚痉。太阳病，发热且有汗出，不恶寒的，称为柔痉。
这是区分痉病中刚痉与柔痉的不同。以无汗、恶寒为阴证、刚痉；以有汗、不恶寒为阳证、柔痉。阴性的病势劲急，而阳性的病势舒缓。然而，必须兼见头摇动、面红、口噤（牙关紧闭）、角弓反张（背部反折如弓）、颈项强直等症状。张仲景没有单独列出这些症状，是因为“痉”字已经概括了这些含义。否则，这与太阳中风、伤寒的症状有何区别，又怎能称之为痉病呢？《活人书》也说，痉病的发热恶寒，与伤寒相似，但其脉象沉迟弦细，以及出现项背反张，则是其不同之处。
太阳病的脉象本应浮起，现在反而沉伏，这是因为风邪夹湿而潜伏体内。痉病的脉象本应紧弦，现在反而细弱，这是因为人体真气恰好不足。此时若用攻法，正气无法承受；若用补法，邪气又难以去除。这就是痉病中难治的情况。
痉病有的是因为太阳风寒未解，再次感受寒湿而成；也有的是因为失血耗气，损伤阴阳，导致筋脉失去濡养而变成痉病。病在太阳经，因发汗过多，导致津液枯竭、筋脉拘急而成的痉病，可知这是津液脱失导致的筋急之痉，而非风邪淫溢、湿气郁结所致的痉病。《内经》说：“气主温煦身体，血主濡润身体。”又说：“阳气精微则滋养精神，柔和则滋养筋脉。”既然阴阳都已衰弱，筋脉失去了濡养，就会出现强直而不柔和的症状。这是辨别痉病标本虚实的关键。
患者身体发热，足部发冷，颈项强直紧急，恶寒，有时头部发热，面部发红，眼睛发红，只有头部摇动，突然牙关紧闭，背部反折如弓的，是痉病。
痉病不离表证，所以身体发热、恶寒。痉属于风邪强盛之病，筋脉受邪，所以出现牙关紧闭、头项强直、背部反张、脉象强直。《内经》说：“所有突然发生的强直症状，都归属于风邪。”头部发热、足部发冷，面目发红，头部摇动，是因为风为阳邪，其气向上行且具有主动的特性。
按以上五条，王叔和将其编入《痉湿暍篇》中，位于三百九十七法之外，这里特意收录它们，是为了扩充辨病的方法。以下两条，原本是太阳病的原文，但实际上属于痉病，所以移置到本篇，以供辨证参考，并非故意扰乱前文。请学者们明辨。
太阳病，项背强直不适，反而汗出恶风的，用桂枝加葛根汤主治。太阳病，项背强直不适，无汗恶风的，用葛根汤主治。
这两条原本都是痉证，但有表虚与表实的区别。表实证表现为无汗，表虚证表现为汗自出，即所谓的刚痉和柔痉。然而，痉是筋的病，也是风的病，所以虽然有刚柔的区别，但它们的项背强直不适、恶风症状是一致的。“几几”形容项强连及背部，不能随意回顾转动的样子。桂枝加葛根汤，如同太阳病桂枝汤的例方；葛根汤，如同太阳病麻黄汤的例方，但都加入了葛根，是因为项背强直，筋骨肌肉同时痹阻而功能丧失，所以加入葛根以疏散肌肉层面的邪气，并且仍需桂枝、芍药、生姜、大枣来调和营卫之气。
桂枝加葛根汤方
葛根（四两） 桂枝（二两，去皮） 芍药（二两） 甘草（二两） 生姜（三两，切） 大枣（十二枚）
以上六味药，用水一斗，先煮葛根，减少二升水量，去掉上面的泡沫，加入其他药物，煮取三升药液，去渣，温服一升，覆盖衣被使身体微微出汗，不需要喝热粥助汗，其余护理方法同桂枝汤。原方中有麻黄三两，成无己说：麻黄主治表实证。后文葛根汤证说：“太阳病，项背强几几，无汗恶风，葛根汤主之。”药性与此方相同。对于无汗者，应当使用麻黄；此处自汗出，恐怕不加麻黄，只是加了葛根罢了。葛根汤方见正治法下。
Taiyang disease (disease of the Taiyang channel), characterized by fever and absence of sweating, with aversion to cold, is named Gang Jing (Stiff Neck Disease of the Yang type). Taiyang disease, characterized by fever and presence of sweating, without aversion to cold, is named Rou Jing (Stiff Neck Disease of the Yin type).
This distinguishes the differences between Gang Jing and Rou Jing in Stiff Neck Disease. The condition with no sweating and aversion to cold is classified as Yin and Gang; the condition with sweating and no aversion to cold is classified as Yang and Rou. The nature of Yin is tense and rigid, while the nature of Yang is relaxed and dissipating. However, these conditions must be accompanied by symptoms such as head tremor, facial redness, trismus (lockjaw), opisthotonos (arching of the back), and stiffness of the neck and nape. Zhang Zhongjing did not explicitly list these symptoms because the term "Jing" (Stiff Neck) encompasses them all. Otherwise, how would this differ from Taiyang Wind Strike or Cold Damage syndromes, and why would it be called Stiff Neck Disease? *Huoren* also states that the fever and aversion to cold in Stiff Neck Disease are similar to 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 and the pulse is deep and thin, it is named Jing (Stiff Neck Disease) and is considered difficult to treat.
The pulse of Taiyang disease should naturally be floating; now that it is instead deep, it indicates that wind pathogen has sunk due to dampness. The pulse of Jing disease should naturally be tight and wiry; now that it is instead thin, it indicates a temporary insufficiency of true Qi. If one uses attacking methods, the healthy Qi cannot withstand it; if one uses tonifying methods, the pathogenic factor cannot be expelled. This represents the difficult-to-treat category of Jing disease.
In Taiyang disease, excessive sweating may lead to Jing disease.
Jing disease can arise from unresolved Taiyang wind-cold combined with a secondary contraction of cold-dampness. It can also result from loss of blood and exhaustion of Qi, damaging Yin and Yang, causing the sinews and vessels to lose nourishment and transform into Jing disease. When the disease is in the Taiyang channel, excessive sweating leads to Jing disease. This allows us to know that it is Jing disease caused by fluid depletion and tendon tension, rather than Jing disease caused by wind excess and dampness stagnation. The Classics state: "Qi provides warmth, Blood provides moistening." It also states: "Yang Qi, when refined, nourishes the Shen (Spirit); when soft, it nourishes the sinews." Since both Yin and Yang have declined, the sinews and vessels lose their nourishment, resulting in rigidity and lack of flexibility. This is the distinction between the root and branch, deficiency and excess in Jing disease.
When a patient presents with body heat, cold feet, stiff and urgent neck and nape, aversion to cold, occasional head heat, red face, red eyes, isolated head tremor, sudden trismus, and opisthotonos, it is Jing disease.
Jing disease does not depart from the exterior level, hence the body heat and aversion to cold. Jing is a disease of strong wind affecting the sinews and vessels, hence the trismus, stiff neck and nape, opisthotonos, and rigid pulse. The Classics state: "All sudden cases of rigidity belong to Wind." Head heat and foot cold, red face and eyes, and head tremor occur because wind is a Yang pathogen whose qi ascends and tends to move.
Regarding the above five clauses, Wang Shuhe included them in the *Jing Shi Yue Pian* (Chapter on Stiff Neck, Dampness, and Heat Stroke), outside the scope of the three hundred and ninety-seven methods. Here they are specifically recorded to broaden the classification of diseases. The following two clauses are originally from the Taiyang text but actually pertain to Jing disease, so they are moved to this chapter to aid differentiation. This is not done to arbitrarily disrupt the previous text. Students should distinguish these carefully.
In Taiyang disease, if the neck and back are stiff and uncomfortable, with sweating and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria Root) should be administered. In Taiyang disease, if the neck and back are stiff and uncomfortable, with no sweating and aversion to wind, Gegen Tang (Pueraria Root Decoction) should be administered.
These two clauses originally describe Jing syndromes, but they are divided into Exterior Deficiency and Exterior Excess types. The Exterior Excess type presents with no sweating, while the Exterior Deficiency type presents with spontaneous sweating, which corresponds to Gang Jing and Rou Jing respectively. However, Jing is a disease of the sinews and also a disease of wind; therefore, although there are differences between Gang and Rou, the symptoms of stiff neck and back with aversion to wind are consistent. "Ji Ji" describes the appearance of stiffness extending from the neck to the back, making it impossible to turn the head freely. Guizhi Jia Gegen Tang follows the pattern of the Taiyang Guizhi Tang example; Gegen Tang follows the pattern of the Taiyang Mahuang Tang example, but both add Gegen (Puerariae Radix) because the stiffness of the neck and back involves bi syndrome of the sinews, bones, muscles, and flesh, rendering them dysfunctional. Therefore, Gegen is added to disperse pathogenic factors in the muscle layer, and Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Ziziphi Jujubae Fructus) are required to circulate Ying and Wei Qi.
Formula for Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria Root):
Gegen (Puerariae Radix, 4 liang), Guizhi (Cinnamomi Ramulus, 2 liang, bark removed), Shaoyao (Paeoniae Radix, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 3 liang, sliced), Dazao (Ziziphi Jujubae Fructus, 12 pieces).
Take the above six ingredients, boil in 10 dou of water. First decoct Gegen until the volume reduces by 2 dou, remove the foam on the surface, then add the remaining herbs. Decoct to obtain 3 sheng of liquid, strain, and take 1 sheng warm. Cover the patient to induce a slight sweat. There is no need to drink hot porridge to assist sweating. The remaining care instructions follow those of Guizhi Tang. The original formula contained Mahuang (Ephedrae Herba, 3 liang). Cheng Wuji stated that Mahuang treats Exterior Excess. Later, in the Gegen Tang clause, it says: "Taiyang disease, stiff neck and back Ji Ji, no sweating, aversion to wind, Gegen Tang governs." The medicinal properties are identical to this formula. For cases with no sweating, Mahuang should be used. In this case, since there is spontaneous sweating, Mahuang is likely omitted, and only Gegen is added. See Gegen Tang under the Standard Treatment Methods section.