1.痉病项强背反张, 有汗为柔无汗刚, 生产血多过汗后, 溃疮犬咬
破风伤.
【注】痉病之证, 详在『伤寒心法』, 有汗为柔痉, 无汗为刚痉. 产
后去血过多, 伤寒发汗过多, 则为内因. 溃疡破伤, 狗咬, 则为外因
.皆风邪乘虚入太阳经而成此病也.
2.痉证脉散多应死, 反张离席一掌亡, 眼小目瞪昏不语, 额汗如珠
命必伤.
【注】反张离席一掌, 调离席四, 五指许也. 眼小, 谓目睫紧小也.
目瞪, 谓眼珠不转也.
葛根汤 桂枝加葛根汤 小续命汤 桂枝加附子汤 当归补血汤 大
承气汤 桃仁承气汤
3.刚痉葛根汤发汗, 柔痉桂枝加葛良, 苦兼杂因小续命, 过汗桂枝
加附汤, 伤血桂枝合补血, 里实瘀血承气方, 溃疡十全加风药, 破伤
狗咬另参详.
【注】刚痉用葛根汤, 即桂枝汤加麻黄葛根. 柔痉用桂枝加葛根汤,
即桂枝汤加葛根汗之. 杂因, 谓风寒湿杂揉为病, 用小续命汤, 随风
寒湿轻重治之. 过汗表虚, 汗出不止, 因而成痉, 用桂枝加附子汤,
即桂枝汤加附子也. 伤血, 谓产后金疮大伤血后, 用桂枝汤合补血汤
,即当归黄耆也. 里实, 谓痉病腹满二便闭, 以大承气汤; 及产后恶
露不尽, 少腹硬急, 以桃仁承气汤下之. 溃疡去脓血过多, 为风所袭
者,用十全大补汤加袪风之药治之.
1. 痉病表现为项部强直、背部向后反折，有汗的称为柔痉，无汗的称为刚痉。产后失血过多或发汗过度，以及溃疡破伤、犬咬伤，均易受风邪侵袭而致病。
【注】痉病的证候，在《伤寒心法》中已有详细记载，有汗的为柔痉，无汗的为刚痉。产后失血过多，或伤寒治疗时发汗过多，属于内因。溃疡破伤、狗咬伤，属于外因。这些都是风邪乘虚侵入太阳经（足太阳膀胱经）而形成的疾病。
2. 痉病患者若脉象散乱，多预示死亡；身体反张至离开床席一掌宽度的，必死无疑；眼睛缩小、眼球固定不动、神志昏迷不能言语的，额头出汗如珠状，也必然危及生命。
【注】“反张离席一掌”，是指身体反张后，背部与床席之间空隙约四指加五指的宽度。“眼小”，是指眼睑紧绷收缩。“目瞪”，是指眼球僵直不转动。
葛根汤 (Ge Gen Tang) 桂枝加葛根汤 (Gui Zhi Jia Ge Gen Tang) 小续命汤 (Xiao Xu Ming Tang) 桂枝加附子汤 (Gui Zhi Jia Fu Zi Tang) 当归补血汤 (Dang Gui Bu Xue Tang) 大承气汤 (Da Cheng Qi Tang) 桃仁承气汤 (Tao Ren Cheng Qi Tang)
3. 刚痉用葛根汤发汗解表，柔痉用桂枝加葛根汤调和营卫兼以解肌，病因复杂夹杂者用小续命汤，发汗过度导致表虚者用桂枝加附子汤，耗伤血液者用桂枝汤合当归补血汤，里有实热瘀血者用承气汤类方剂，溃疡脓血过多者用十全大补汤加祛风药，破伤及犬咬伤者需另行详细辨证论治。
【注】刚痉使用葛根汤，即桂枝汤加入麻黄和葛根。柔痉使用桂枝加葛根汤，即在桂枝汤基础上加入葛根，通过发汗来治疗。杂因，指风寒湿邪混杂致病，使用小续命汤，根据风寒湿邪的轻重分别治疗。发汗过度导致表虚，汗出不止，进而形成痉病，使用桂枝加附子汤，即桂枝汤加入附子。伤血，指产后或金创（金属利器造成的创伤）大量失血后，使用桂枝汤合当归补血汤，即当归和黄耆（黄芪）。里实，指痉病出现腹部胀满、大小便闭塞，使用大承气汤；以及产后恶露不尽，少腹硬痛急迫，使用桃仁承气汤攻下。溃疡排脓血过多，被风邪侵袭者，使用十全大补汤加入祛风药物进行治疗。
1. Spasm disease is characterized by stiffness of the neck and opisthotonos (backward bending of the back). Those with sweating are classified as Soft Spasm (Rou Jing), while those without sweating are classified as Hard Spasm (Gang Jing). Conditions such as excessive blood loss after childbirth, excessive sweating following treatment, ulcerative wounds, or dog bites can all lead to this disease due to wind pathogen invasion.
[Note] The manifestations of spasm disease are detailed in "Shang Han Xin Fa" (Essentials of Cold Damage). Soft Spasm presents with sweating, while Hard Spasm presents without sweating. Excessive blood loss postpartum or excessive diaphoresis during the treatment of cold damage constitute internal causes. Ulcerative wounds and dog bites constitute external causes. In all these cases, wind pathogen invades the Taiyang Meridian (Foot-Taiyang Bladder Meridian) while the body's defensive qi is deficient, resulting in this disease.
2. If a patient with spasm disease has a scattered pulse, death is likely. If the body bends backward so far that it lifts off the bed by the width of a palm, death is inevitable. If the eyes are narrowed, the eyeballs are fixed and immobile, accompanied by coma and inability to speak, or if beads of sweat appear on the forehead, life will be severely endangered.
[Note] "Lifting off the bed by a palm's width" refers to a gap of approximately four fingers plus five fingers between the back and the bed. "Eyes narrowed" refers to tight contraction of the eyelids. "Fixed eyes" refers to immobility of the eyeballs.
Formulas mentioned: Ge Gen Tang (Kudzu Decoction), Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction Plus Kudzu Root), Xiao Xu Ming Tang (Minor Continuation of Life Decoction), Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction Plus Aconite Root), Dang Gui Bu Xue Tang (Angelica Sinensis Blood-Nourishing Decoction), Da Cheng Qi Tang (Major Order the Qi Decoction), Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction).
3. For Hard Spasm, use Ge Gen Tang to induce sweating and release the exterior. For Soft Spasm, use Gui Zhi Jia Ge Gen Tang to harmonize the nutritive and defensive levels and relieve the muscles. For complex mixed etiologies, use Xiao Xu Ming Tang. For excessive sweating leading to exterior deficiency, use Gui Zhi Jia Fu Zi Tang. For blood injury, combine Gui Zhi Tang with Dang Gui Bu Xue Tang. For interior excess with blood stasis, use Cheng Qi Tang formulas. For ulcers with excessive pus and blood loss, use Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) plus wind-dispelling herbs. For traumatic wounds and dog bites, refer to separate detailed discussions.
[Note] Hard Spasm is treated with Ge Gen Tang, which is Gui Zhi Tang added with Ephedrae Herba (Mahuang) and Puerariae Radix (Gegen). Soft Spasm is treated with Gui Zhi Jia Ge Gen Tang, which is Gui Zhi Tang added with Puerariae Radix, treating via sweating. "Mixed etiology" refers to diseases caused by the intermingling of wind, cold, and dampness; Xiao Xu Ming Tang is used, treating according to the severity of wind, cold, and dampness. Excessive sweating leads to exterior deficiency and continuous sweating, subsequently causing spasm; Gui Zhi Jia Fu Zi Tang (Gui Zhi Tang added with Aconiti Lateralis Radix Praeparata, Fuzi) is used. "Blood injury" refers to massive blood loss after childbirth or metal trauma (Jin Chuang); Gui Zhi Tang combined with Dang Gui Bu Xue Tang (consisting of Angelicae Sinensis Radix, Danggui and Astragali Radix, Huangqi) is used. "Interior excess" refers to abdominal fullness and constipation/urinary retention in spasm disease, treated with Da Cheng Qi Tang; and for postpartum lochia remaining in the lower abdomen causing hardness and urgency, Tao Ren Cheng Qi Tang is used to purge. For ulcers with excessive discharge of pus and blood, invaded by wind pathogen, Shi Quan Da Bu Tang plus wind-dispelling herbs is used for treatment.