论
《内经》曰∶诸痉（滑氏曰痉当作 ）项强，皆属于湿（王注云∶太阳伤湿也）。又曰∶诸暴强直，皆属于风（王注
云∶阳内郁而阴行于外也）。《原病式》曰∶筋劲强直而不柔和也。夫肝木属风而主筋，经曰诸暴强直属风，理宜然也。
其所谓诸 项强而属于湿者何欤？盖太阳经湿甚则兼风化，亢则害承乃制也。是故知 之为病，湿为本，风为标耳。故
仲景有刚柔二 之分，不可不辨，盖刚为阳 而柔为阴 也。若夫太阳发热，无汗恶寒，脉弦长劲急，胸满口噤，手足
挛急，切牙眼开，甚则搐搦，角弓反张，此为刚 。太阳微热，多汗不恶寒，脉迟涩弦细，四体不收，时时搐搦，闭目
合口，此为柔 。大抵因风湿二气，袭于太阳之经，亦有轻重之分。其风气胜者为刚 ，风性刚急故也。湿气胜者为柔
，湿性柔和故也。外有诸虚之候，表虚不任风寒，亦能成 ，是以或产后，或金疮，或跌仆扑伤，痈疽溃脓之后，一
切去血过多之证，皆能成此疾也，是乃虚为本而风为标耳。亦有绝无风邪，而亦能使人筋脉挛急，而为角弓反张之候者，
血脱无以养筋故也。丹溪甚言不可作风治而用风药，恐反燥其阴血而致不救也，可不慎欤！
脉法
《脉经》曰∶太阳病发热，其脉沉而细者，为 。
脉来，按之筑筑然而弦，直上下行。
家，其脉伏坚，直上下。
病，发其汗已，其脉泼泼然如蛇，暴腹胀大，为欲解；脉如故，反伏弦者，必 （此 字恐当作死字）。
太阳病，其证备，身体强KT KT 然，脉沉迟，此为 ，栝蒌桂枝汤主之。
方法
丹溪曰∶大率与痫相似，比痫为虚，切不可作风治而纯用风药。多属气血虚，有火有痰，宜补兼降痰火，参、 、
芎、归、竹沥之类。
一方 治少年痘疮靥后成 ，口噤不开，四肢强直，时或绕脐腹痛一阵，则冷汗如雨，痛定汗止，脉极强紧如
真弦。先因劳倦伤血，疮后血愈虚而又感风寒，当用温药养血，辛凉散风，芍药、当归为君，川芎、青皮、钓钩藤为臣，
白术、甘草为佐，桂枝、木香、黄连为使，更加红花少许，水煎服愈。
（以上丹溪方法凡二条）
栝蒌桂枝汤（活人） 治太阳伤寒成 。
栝蒌根 甘草（炙，各三两） 桂枝 芍药 生姜（各三两） 大枣（十二枚）
上六味细切，作一服，以水九升，煮取三升，作三服连饮取微汗。如汗不出，少顷以热粥发之。
葛根汤（活人） 治太阳病无汗而小便反少，气上冲胸，口噤不得语，欲作刚 。（方见伤寒门。）
麻黄葛根汤（活人） 治刚 ，无汗恶寒。
麻黄 赤芍药（各三钱） 干葛（四钱五分） 豆豉（半合）
上细切，作一服，水二大盏，葱白三茎，煎八分，稍热服。
大承气汤（活人） 治刚 ，大便实热。（方见伤寒门。）
桂枝葛根汤（活人） 治柔 ，有汗不恶寒。（方见伤寒门。）
桂枝栝蒌根汤（活人） 治柔 通用。（方见中风门。）
小续命汤（金匮） 治刚柔二 通用。（方见中风门。）
防风当归汤 治发汗过多，发热头摇，口噤背反张者，宜去风养血。
防风 当归 川芎 生地黄（各二钱五分）
上细切，作一服，水煎服。
当归补血汤（东垣） 治一切去血过多，因无血养筋，令人四肢挛急，口噤如 。
黄 （一两） 当归（五钱，酒浸洗净）
上细切，作一服，水二盏，煎至一盏，温服。如挟风或兼破伤风者，加防风、羌活各一钱，荆芥穗一钱半，甘草五
分，减去黄 一半，煎服。
举卿举败散（活人） 治新产血虚发 者，汗后中风发热亦然。
荆芥穗（不拘多少，微炒）
上为末，每服三、五钱，外以大豆黄卷，以热酒沃之，去黄卷，用汁调下，其效如神。
（丹溪活套）云∶昔之所谓刚柔二 者，当以虚实论之，是也。一属外感，一属内伤。属外感者为刚 ，宜用麻黄
葛根汤、栝蒌桂枝汤、小续命汤；在里者，大承气汤之类。属内伤者为柔 ，宜用补中益气汤、八物汤、四物汤之类。
如以风湿二事分刚柔而治，恐误医者不胜其多；今以虚实分治，其理昭然无疑矣。
（医案）
陶氏妇，年三十余，身材小琐，形瘦弱，月经后，忽一日发 ，口噤，手足挛缩，角弓反张。予知其去血过多，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。
论
《黄帝内经》说：各种痉挛（滑寿注：痉字古作“”，指筋脉拘急），项部强直，都归属于湿邪（王冰注解说：这是太阳经受湿邪侵袭所致）。又说：各种突然发生的肢体强直，都归属于风邪（王冰注解说：这是因为阳气内郁，阴气行于体表所致）。刘完素在《原病式》中说：筋脉劲急强直而不柔和。肝属木，对应风邪而主管筋脉，《内经》说各种突然的强直属于风邪，这在道理上是应当的。那么所谓各种项强而归属于湿邪的情况是怎么回事呢？大概是因为太阳经湿气过重则兼夹风邪化生，这是亢盛则为害，有制约才能平衡的道理。因此知道这种病，湿邪是根本，风邪是标象罢了。所以张仲景将这种病分为刚痉和柔痉两种，不可不加以辨别，因为刚痉属于阳痉，柔痉属于阴痉。如果是太阳经发热，无汗且怕冷，脉象弦长劲急，胸部胀满，牙关紧闭，手足挛急，咬牙睁眼，甚至出现抽搐、角弓反张，这叫做刚痉。如果是太阳经微热，多汗且不恶寒，脉象迟涩弦细，四肢不能收持，时常抽搐，闭目合口，这叫做柔痉。大抵是由于风湿二气，侵袭太阳经脉，也有轻重之分。风气偏胜的称为刚痉，因为风性刚猛急迫的缘故。湿气偏胜的称为柔痉，因为湿性柔和的缘故。此外还有各种虚损的表现，表虚不能耐受风寒，也能导致此病，因此或者是产后，或者是金创（金属利器造成的伤口），或者是跌打扑伤，痈疽溃烂流脓之后，一切失血过多的证候，都能形成这种疾病，这是以虚为本，风邪为标罢了。也有完全没有风邪，却也能使人筋脉挛急，出现角弓反张症状的，这是因为血液脱失无法濡养筋脉的缘故。朱丹溪非常强调不能当作风邪来治疗而使用祛风药，恐怕反而燥伤阴血而导致无法救治，能不谨慎吗！
脉法
脉象来势，按之感觉筑筑跳动且弦硬，笔直上下运行。
痉病患者，其脉伏坚，笔直上下运行。
患此病，发汗后，脉象泼泼然如蛇行般滑利，突然腹部胀大，这是将要痊愈；如果脉象依旧，反而变得伏而弦硬的，必定死亡（这个“死”字恐怕原文误作“痉”字）。
太阳病，症状具备，身体强直僵硬，脉象沉迟，这是柔痉，用栝蒌桂枝汤主治。
方法
朱丹溪说：大体上与痫病相似，但比痫病更虚，切不可当作风邪治疗而单纯使用祛风药。多属于气血虚弱，伴有火邪和痰浊，宜用补益兼降化痰火的方法，用人参、白术、川芎、当归、竹沥之类药物。
一方剂治疗少年痘疮结痂后形成痉病，牙关紧闭不开，四肢强直，有时绕脐腹痛一阵，则冷汗如雨下，疼痛停止冷汗也止住，脉象极强紧如真弦脉。先前因为劳倦损伤血液，痘疮后血液更加虚弱又感受风寒，应当用温药养血，辛凉散风，以芍药、当归为君药，川芎、青皮、钓钩藤为臣药，白术、甘草为佐药，桂枝、木香、黄连为使药，再加少许红花，水煎服可愈。
（以上丹溪的治疗法则共两条）
栝蒌根 甘草（炙，各三两） 桂枝 芍药 生姜（各三两） 大枣（十二枚）
以上六味药切碎，作为一服药，用水九升，煮取三升，分三次连续服用以取得微汗。如果不出汗，过一会儿喝点热粥来助发汗。
葛根汤（出自《类证活人书》） 治疗太阳病无汗而小便反而少，气上冲胸，牙关紧闭不能说话，即将发生刚痉。（方剂见伤寒门。）
以上切碎，作为一服药，用水两大盏，葱白三茎，煎至八分满，稍热时服用。
大承气汤（出自《类证活人书》） 治疗刚痉，大便实热。（方剂见伤寒门。）
桂枝葛根汤（出自《类证活人书》） 治疗柔痉，有汗不恶寒。（方剂见伤寒门。）
桂枝栝蒌根汤（出自《类证活人书》） 治疗柔痉通用。（方剂见中风门。）
小续命汤（出自《金匮要略》） 治疗刚痉和柔痉通用。（方剂见中风门。）
防风当归汤 治疗发汗过多，发热头摇，牙关紧闭背反张者，适宜祛风养血。
以上切碎，作为一服药，水煎服。
当归补血汤（李东垣方） 治疗一切失血过多，因无血养筋，令人四肢挛急，牙关紧闭像角弓反张一样。
以上切碎，作为一服药，用水两盏，煎至一盏，温服。如果兼夹风邪或兼有破伤风者，加防风、羌活各一钱，荆芥穗一钱半，甘草五分，减去一半的黄芪，煎服。
举卿举败散（出自《类证活人书》） 治疗新产血虚引发痉病的人，汗后中风发热也是如此。
荆芥穗（不拘多少，微炒）
以上研为末，每次服用三、五钱，外用大豆黄卷，用热酒浇淋，去掉豆卷，用汁液调服，效果神奇。
（丹溪活套）说：以前的所谓刚痉和柔痉，应当以虚实来论述，这是对的。一种属于外感，一种属于内伤。属于外感的称为刚痉，适宜用麻黄葛根汤、栝蒌桂枝汤、小续命汤；在里的，用大承气汤之类。属于内伤的称为柔痉，适宜用补中益气汤、八物汤、四物汤之类。如果用风湿二事来区分刚柔并治疗，恐怕误人的医生数不胜数；现在以虚实来区分治疗，其中的道理明显无疑了。
（医案）
陶氏的妻子，三十多岁，身材矮小瘦弱，月经后，忽然有一天发作痉病，牙关紧闭，手足挛缩，角弓反张。我知道她是失血过多，风邪乘虚而入，用四物汤加防风、羌活、荆芥，少加附子通行经络，两帖病减半，六帖病全愈。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Various spasms (Jing, referring to tendon contraction), with stiffness of the neck and back, all belong to Dampness (Wang Bing's commentary explains: This is due to the Taiyang channel being injured by Dampness). It also states: Various sudden rigidities all belong to Wind (Wang Bing's commentary explains: This is because Yang Qi is constrained internally while Yin Qi circulates externally). Liu Wansu in his *Yuanbing Shi* (Original Treatise on Disease Mechanisms) states: Tendons are tense, rigid, and lack flexibility. The Liver belongs to Wood, corresponds to Wind, and governs the tendons. The Classics state that various sudden rigidities belong to Wind; this is logically consistent. Then what is the reason for those cases of neck stiffness belonging to Dampness? Generally speaking, when Dampness in the Taiyang channel is excessive, it transforms into Wind due to the principle that excess leads to harm and control brings balance. Therefore, knowing that this disease has Dampness as its root and Wind as its branch is crucial. Thus, Zhang Zhongjing divided this condition into Gang Jing (Rigid Spasm) and Rou Jing (Soft Spasm), which must be distinguished, as Gang Jing belongs to Yang and Rou Jing belongs to Yin. If there is fever in the Taiyang channel, without sweat and aversion to cold, with a string-taut, long, and forceful pulse, chest fullness, trismus (lockjaw), spasm of the hands and feet, teeth grinding, eyes open, and even convulsions or opisthotonos (body arched backward like a bow), this is called Gang Jing. If there is slight fever in the Taiyang channel, with profuse sweating and no aversion to cold, with a slow, choppy, string-taut, and fine pulse, inability to control the four limbs, frequent convulsions, closed eyes and mouth, this is called Rou Jing. Broadly speaking, this is caused by Wind and Dampness invading the Taiyang channel, with variations in severity. Cases where Wind predominance is greater are called Gang Jing, because Wind nature is rigid and urgent. Cases where Dampness predominance is greater are called Rou Jing, because Dampness nature is soft and gentle. Additionally, various deficiency patterns exist; exterior deficiency unable to withstand Wind-Cold can also cause this disease. Therefore, whether postpartum, after metal wounds, falls and bruises, or after abscesses ulcerate and drain pus, any condition involving excessive blood loss can lead to this disease. Here, deficiency is the root and Wind is the branch. There are also cases with absolutely no Wind pathogen that still cause tendon contraction and opisthotonos; this is because blood loss fails to nourish the tendons. Zhu Danxi strongly emphasized not treating this as Wind and using Wind-dispelling herbs, lest one dry up Yin Blood further leading to untreatable conditions. One must be cautious!
Pulse Diagnosis
The *Mai Jing* (Pulse Classic) states: In Taiyang disease with fever, if the pulse is deep and thin, it indicates Jing (Spasm).
The pulse comes, feeling pounding and string-taut upon pressure, moving straight up and down.
For patients with Jing, the pulse is deep, firm, and moves straight up and down.
In this disease, after inducing sweating, if the pulse becomes slippery and rapid like a snake, and abdominal distension occurs suddenly, it indicates impending resolution; if the pulse remains unchanged, becoming deep and string-taut, death is certain (the character "Jing" here is likely a typo for "Death").
In Taiyang disease, with complete symptoms, body stiffness, and a deep-slow pulse, this is Rou Jing (Soft Spasm), treated with Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction).
Methods
Zhu Danxi said: Generally similar to Epilepsy (Xian), but more deficient than Epilepsy. It must not be treated as Wind, nor should Wind-dispelling herbs be used exclusively. It mostly belongs to Qi and Blood deficiency, accompanied by Fire and Phlegm. Treatment should involve tonification combined with descending Phlegm and Fire, using herbs such as Renshen (Ginseng), Baizhu (Atractylodes), Chuanxiong (Ligusticum), Danggui (Angelica), and Zhuli (Bamboo Sap).
One formula treats young people who develop Jing (Spasm) after acne/pox scabs fall off, presenting with trismus, rigid limbs, and occasional periumbilical abdominal pain causing cold sweat like rain, stopping when pain subsides. The pulse is extremely tight and string-taut, resembling a true string pulse. Previously, labor and fatigue damaged the Blood; after the pox, Blood was further depleted and Wind-Cold was contracted. Warm herbs to nourish Blood and acrid-cool herbs to disperse Wind should be used. Shaoyao (Peony) and Danggui (Angelica) as Sovereign herbs, Chuanxiong (Ligusticum), Qingpi (Citrus Peel), and Dengouteng (Uncaria) as Minister herbs, Baizhu (Atractylodes) and Gancao (Licorice) as Assistant herbs, Guizhi (Cinnamon Twig), Muxiang (Aucklandia), and Huanglian (Coptis) as Guide herbs, plus a little Honghua (Safflower), decocted in water and taken orally will cure.
(Above are two rules from Danxi)
Gualou Guizhi Tang (from *Lei Zheng Huo Ren Shu*) Treats Taiyang Cold Damage progressing to Rou Jing (Soft Spasm).
Gualou Gen (Trichosanthes Root), Gancao (Licorice, honey-fried, each 3 liang), Guizhi (Cinnamon Twig), Shaoyao (Peony), Shengjiang (Fresh Ginger, each 3 liang), Dazao (Jujube, 12 pieces).
Finely cut the above six ingredients. Take one dose, add 9 sheng of water, boil to obtain 3 sheng. Drink in three doses continuously to induce mild sweating. If sweat does not occur, drink hot porridge shortly after to promote sweating.
Gegen Tang (Pueraria Decoction, from *Lei Zheng Huo Ren Shu*) Treats Taiyang disease with no sweat, reduced urination, Qi rushing to the chest, trismus preventing speech, about to become Gang Jing (Rigid Spasm). (Formula see Shanghan Section.)
Mahuang Gegen Tang (Ephedra and Pueraria Decoction, from *Lei Zheng Huo Ren Shu*) Treats Gang Jing (Rigid Spasm), with no sweat and aversion to cold.
Mahuang (Ephedra), Chi Shaoyao (Red Peony, each 3 qian), Gan Ge (Kudzu Root, 4.5 qian), Douchi (Fermented Soybean, half he).
Finely cut, take one dose. Add 2 large zhan of water and 3 stalks of Congbai (Scallion White). Boil to 8/10 volume. Take warm.
Da Chengqi Tang (Major Order the Qi Decoction, from *Lei Zheng Huo Ren Shu*) Treats Gang Jing (Rigid Spasm) with solid heat in the intestines. (Formula see Shanghan Section.)
Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction, from *Lei Zheng Huo Ren Shu*) Treats Rou Jing (Soft Spasm), with sweat and no aversion to cold. (Formula see Shanghan Section.)
Guizhi Gualou Gen Tang (Cinnamon Twig and Trichosanthes Root Decoction, from *Lei Zheng Huo Ren Shu*) Treats Rou Jing (Soft Spasm) generally. (Formula see Zhongfeng Section.)
Xiao Xuming Tang (Minor Continuation Life Decoction, from *Jin Gui Yao Lue*) Treats both Gang Jing (Rigid Spasm) and Rou Jing (Soft Spasm) generally. (Formula see Zhongfeng Section.)
Fangguang Danggui Tang (Saposhnikovia and Angelica Decoction) Treats cases of excessive sweating, fever, head shaking, trismus, and opisthotonos. Suitable for dispelling Wind and nourishing Blood.
Fangfeng (Saposhnikovia), Danggui (Angelica), Chuanxiong (Ligusticum), Shengdihuang (Rehmannia Root, each 2.5 qian).
Finely cut, take one dose, decoct in water and take orally.
Danggui Buxue Tang (Angelica Tonify Blood Decoction, by Li Dongyuan) Treats all conditions of excessive blood loss, where lack of Blood fails to nourish tendons, causing limb spasms and trismus resembling opisthotonos.
Huangqi (Astragalus, 1 liang), Danggui (Angelica, 5 qian, soaked in wine and washed clean).
Finely cut, take one dose. Add 2 zhan of water, boil to 1 zhan. Take warm. If complicated by Wind or Broken Injury Wind, add Fangfeng (Saposhnikovia) and Qianghuo (Notopterygium, each 1 qian), Jingjiesui (Schizonepeta Achenes, 1.5 qian), Gancao (Licorice, 0.5 qian), reduce Huangqi (Astragalus) by half, decoct and take.
Juqing Jubai San (Champion Ascending Defeated Powder, from *Lei Zheng Huo Ren Shu*) Treats new postpartum Blood deficiency causing Jing (Spasm); similarly for Wind-stroke fever after sweating.
Jingjiesui (Schizenepta Achenes, any amount, slightly stir-fried).
Grind into powder. Take 3-5 qian per dose. Externally use Da黄豆 Huangjuan (Yellow Soybean Sprouts), pour hot wine over them, remove sprouts, use the juice to mix with the powder for oral administration. The effect is miraculous.
(Danxi Huotao) states: The so-called Gang Jing (Rigid Spasm) and Rou Jing (Soft Spasm) of old should be discussed in terms of Excess and Deficiency, which is correct. One belongs to External Contraction, the other to Internal Injury. Those belonging to External Contraction are Gang Jing (Rigid Spasm), suitable for Mahuang Gegen Tang, Gualou Guizhi Tang, Xiao Xuming Tang; those interior are treated with Da Chengqi Tang and similar formulas. Those belonging to Internal Injury are Rou Jing (Soft Spasm), suitable for Buzhong Yiqi Tang, Bawu Tang, Siwu Tang and similar formulas. If one divides Gang and Rou based on Wind and Dampness for treatment, many doctors would err; now dividing treatment by Excess and Deficiency makes the principle clear and undeniable.
(Medical Case)
Mrs. Tao, over thirty years old, short and slender, weak constitution. After menstruation, she suddenly developed Jing (Spasm), with trismus, limb contraction, and opisthotonos. I knew she had excessive blood loss, allowing Wind Pathogen to enter via deficiency. I used Siwu Tang (Four Substances Decoction) added with Fangfeng (Saposhnikovia), Qianghuo (Notopterygium), Jingjie (Schizonepeta), and a small amount of Fuzi (Aconite) to unblock meridians. After two doses, the illness halved; after six doses, she was fully recovered.