经云：诸痉项强，皆属于湿。又云：诸暴强直，皆属于风。论曰：太阳病，发汗太多
，因成痉。夫六气皆足以致痉，不专在湿也；六经皆有痉证，亦不专在太阳一经也。
盖身以后，属太阳，凡头项强急，项背几几，脊强反张，腰似折，髀不可以曲，腘如
结，皆太阳痉也。身以前属阳明，头面动摇，口噤齿齘，缺盆纽痛，脚挛急，皆阳明
痉也。身之侧属少阳，口眼喎邪，手足牵引，两□拘急，半身不遂，皆少阳痉也。至
若腹内拘急，因吐利后而四肢挛急者，未尝非太阴痉也。恶寒蜷卧，尻以代踵，脊以
代头，俯而不能仰者，未尝非少阴痉也。睾丸上升，宗筋下注，少腹里急，阴中拘挛
，膝胫拘急者，未尝非厥阴痉也。大抵痉以状名，而痉因筋急，故凡六经筋病，皆得
以痉称之。其因于风寒者，必发热恶寒而无汗，其脉浮紧，其状身强直口噤，即经所
云：诸病强直，皆属于风者也。其势劲急，故名曰刚痉。其因于风湿者，发热汗出，
不恶寒，其脉浮缓，其状项强几几，而身不强直，即经所云：诸痉项强，皆属于湿者
也。其势濡弱，故名曰柔痉。若夫因误汗亡阳，津竭无以养筋而致痉者，即本论所云
：太阳病，发汗太多而成痉，又非因湿因风，而却因燥者也。盖痉之始，本非正病，
多杂于他病之中，如妇人之脱血，跌扑之破伤，俱能致痉。今见患此者，悉指为风，
殊非确论。学者当于证中审察风、寒、湿、燥、内外、虚实之因，分别施治，庶不致
误，慎勿概指为风也。
@@@
伤寒所致太阳病，痉、湿、暍，此三种，宜应别论，以为与伤寒相似，故此见之。
【按】
「伤寒所致」四字，甚无所谓，衍文也。
【注】
伤寒，太阳经中之一病，非谓太阳经惟病伤寒也。盖以六气外感之邪，人中伤之者，
未有不由太阳之表而入者也。痉，风邪也。湿，湿邪也。暍，暑邪也。夫风寒暑湿之
病，固皆统属太阳，然痉、湿、暍三种，虽与伤寒形证相似，但其为病传变不同，故
曰：宜应别论也。
【集注】
方有执曰：痉、湿、暍三者，皆风寒之变证。既成变证，则当别为立论。然自风寒变
来，本属太阳，犹有风寒涉似之疑，须当并为辨论。
@@@
病身热足寒，颈项强急，恶寒，时头热面赤，目脉赤，独头动摇，卒口噤，背反张者
，痉病也。
【注】
病人身热恶寒，太阳证也。颈项强急，面赤目赤，阳明证也。头热阳郁于上也，足寒
阴凝于下也。太阳之脉，循背上头；阳明之筋，上挟于口。风寒客于二经，则有头摇
、口噤、反张、拘强之证，故名痉病也。
【集注】
方有执曰：此以痉之具证。言身热头热，面赤目脉赤，阳邪发于阳也。足寒，阴邪逆
于阴也。独头面摇，风行阳而动于上也。卒，忽然也。噤，寒而口闭也，言忽然唇口
□合，噤急而饮食不通也。背反张者，太阳之脉挟背，寒则筋急而拘挛，热则筋缓而
纵弛也。然刚、柔二痉，则各见证之一偏，惟风寒俱有而致证者，则具见也。
郑重光曰：此总论痉之经俞皆病，气血并伤，而为强急反张之证也。风湿俱有，故为
痉之具证也。
太阳病，发热，脉沉而细者，名曰痉。
【注】
太阳病发热，脉当浮大，脉若沉细，兼少阴也。今发热脉沉细，而名曰痉者，何也？
以其已病痉证，而得沉细脉，不可名太阳、少阴伤寒之脉，当名太阳风湿痉病之脉也
。因风邪郁于阳，故病发热也。湿邪凝于阴，故脉沉细也。此承上条痉病得沉细脉之
义，非谓太阳病发热，脉沉细，即名之曰痉病也。
【集注】
方有执曰：发热、太阳未除也。沉，寒也。细，湿也。
程知曰：脉沉细，法宜救里，而痉又为燥热之病，故『金匮』谓难治。谓未可轻同于
太阳发热脉反沉之例也。
张璐曰：发热脉当浮数，而反沉细，知邪风为湿气所着，所以身虽发热，而脉不能浮
数，是阳证见阴脉，故『金匮』指为难治也。
程应旄曰：痉病有同有独，固以其独者名之矣。然脉在太阳，更有独而无同，以头面
摇，口噤背反张之证，合沉细之脉，虽有太阳发热等证，不致为伤寒所溷，乃可定其
名曰痉也。
@@@
太阳病，发热无汗，反恶寒者，名曰刚痉。太阳病，发热汗出，而不恶寒，名曰柔痉
。
【按】
反恶寒之「反」字，衍文也。刚痉证应恶寒，非反也。
【注】
痉病既属太阳，当以太阳虚实例之。故曰：太阳病发热无汗，恶寒为实邪，名曰刚痉
；发热汗出，不恶寒，为虚邪，名曰柔痉。此详申上二条痉病虚实，非谓太阳病，发
热无汗，恶寒；汗出不恶寒，即名之曰刚、柔痉病之证也。
【集注】
程知曰：太阳病，发热，无汗，恶寒，为伤寒；发热，汗出，恶风，为伤风；发热，
汗出，不恶寒，为温热。以证有颈项强急，甚则反张，故不谓之风寒、温热病，而谓
之痉也。
张璐曰：『金匮』云：太阳病无汗，而小便反少，气上冲胸，口噤不能言，欲作刚痉
，葛根汤主之，即是申明此条之义，而补其治法也。无汗而小便少者，以太阳、阳明
二经之热，聚于胸中，延伤肺金清肃之气，内外不能宣通故也。又云：太阳病，其证
备，身体强几几，然脉反沉迟，此为痉，栝蒌桂枝汤主之，即是申明此条之义，而补
其治法也。其证备，则发热汗出等证，『金匮』已详，不必赘矣。
@@@
太阳病，项背强几几，无汗恶风，葛根汤主之。
【注】
此略其证脉，单举痉之颈项强急者，以明其治也。太阳脉，下项循肩挟背；阳明脉循
喉咙，入缺盆，贯膈、下乳内廉。太阳主后，前合阳明；阳明主前，后合太阳。今邪
壅于二经之中，故有几几拘强之貌也。太阳之强，不过颈项强；此痉之强，则不能俯
仰，项连胸背而俱强，故曰：项背强几几也。无汗恶风，实邪也，宜葛根汤发之。即
桂枝汤加麻黄葛根，两解太阳、阳明之邪也。
【集注】
方有执曰：几几，鸟之短羽者，动则引颈几几然。形容病人之颈项俱病者，俛仰不能
自如之貌。
@@@
太阳病，项背强几几，反汗出恶风者，桂枝加葛根汤主之。
【注】
太阳病，项背强几几，无汗恶风者，实邪也。今反汗出恶风者，虚邪也，宜桂枝加葛
根汤 ，解太阳之风，发阳明之汗也。
【集注】
江琥曰：太阳病项背强矣，复几几然，颈不得舒，颈之经属阳明，项背与颈几几然，
其状当无汗，今反汗出、恶风，仲景法：太阳病汗出恶风者，桂枝汤主之。今因其几
几然，故加葛根于桂枝汤中，以兼祛阳明经之风也。
【背景信息】
书名：医宗金鉴 作者：吴谦 朝代：清 章节：辨痉湿暍病脉证并治篇 类别：医论
【待处理原文】
经文说：各种痉挛、项背强直，都归属于湿邪。又说：各种突然发生的强直拘急，都归属于风邪。论述说：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、口噤不开甚至角弓反张为主要表现的病证）。六气（风、寒、暑、湿、燥、火）都能导致痉病，并不专指湿邪；六经（太阳、阳明、少阳、太阴、少阴、厥阴）都有痉证，也不仅仅局限于太阳一经。
大概身体后部属于太阳经，凡是头项强急、项背部拘紧不舒、脊柱强直且向后反折、腰部像要折断一样、大腿不能弯曲、膝窝像被捆结住一样，这些都是太阳经的痉病。身体前部属于阳明经，凡是头面部动摇、牙关紧闭、牙齿磨响、锁骨上窝疼痛、脚部挛急，这些都是阳明经的痉病。身体侧面属于少阳经，凡是口眼歪斜、手足牵引抽搐、两胁拘急、半身不遂，这些都是少阳经的痉病。至于腹部拘急，在呕吐腹泻之后出现四肢挛急的，未尝不是太阴经的痉病。怕冷蜷缩而卧，臀部着地代替脚跟站立，脊背弯曲代替头部抬起，只能俯身不能仰头的，未尝不是少阴经的痉病。睾丸上缩，宗筋（汇聚于前阴的筋脉）向下灌注，小腹部里急后重，阴部拘挛，膝盖和小腿拘急的，未尝不是厥阴经的痉病。大抵痉病是以症状命名的，而痉病的成因是筋脉拘急，所以凡是六经的筋脉病变，都可以称为痉病。
那些因风寒引起的，必定发热、怕冷且无汗，脉象浮紧，症状表现为身体强直、牙关紧闭，这就是经文所说的：各种强直病症，都归属于风邪。其势劲急，所以名叫刚痉（伴有恶寒无汗的痉病）。那些因风湿引起的，发热、出汗，不怕冷，脉象浮缓，症状表现为项背强直拘紧但身体不强直，这就是经文所说的：各种痉病项背强直，都归属于湿邪。其势濡弱，所以名叫柔痉（伴有汗出恶风的痉病）。如果是因误用发汗法导致阳气亡失，津液枯竭无法滋养筋脉而导致痉病的，就是本篇所说的：太阳病，发汗太多而成痉，这又不是因湿或因风，而是因燥邪所致。
大抵痉病起始时，本不是独立的正病，多夹杂在其他疾病之中，如妇女产后脱血，或跌打损伤导致的破伤，都能导致痉病。现在看到患这种病的人，全都指责为风邪，这绝不是确切的结论。学者应当在证候中仔细审察风、寒、湿、燥、内因、外因、虚证、实证的原因，分别施治，才不至于误诊，千万不要一概归结为风邪。
@@@
伤寒所导致的太阳病中的痉病、湿病、暍病（中暑），这三种病，应当单独讨论，因为它们与伤寒相似，所以出现在这里。
【按语】
“伤寒所致”这四个字，没有什么意义，是衍文（多余的文字）。
【注释】
伤寒，是太阳经中的一种病，并不是说太阳经只病伤寒。大概因为六气外感之邪，人受伤害的，没有不从太阳表证而入的。痉，是风邪所致。湿，是湿邪所致。暍，是暑邪所致。风寒暑湿的病，固然都统属于太阳经，然而痉、湿、暍这三种病，虽然与伤寒的形证相似，但其病理传变不同，所以说：应当单独讨论。
【集注】
方有执说：痉、湿、暍三者，都是风寒的变证。既然成为变证，就应当另外立论。然而它们源自风寒，本属太阳经，仍然有风寒疑似的疑惑，应当合并进行辨析。
@@@
病人身体发热、足部寒冷，颈项强直拘急，怕冷，有时头部发热、面色发红、眼目血脉赤红，只有头部动摇，突然牙关紧闭，背部向后反张的，是痉病。
【注释】
病人身体发热、怕冷，这是太阳经证。颈项强直、面赤、目赤，这是阳明经证。头部发热是因为阳气郁结于上部，足部寒冷是因为阴气凝滞于下部。太阳经的经脉，循行背部上行至头；阳明经的筋脉，上行挟持口唇。风寒客居于这两条经脉，就会出现头摇、口噤、反张、拘强的证候，所以名叫痉病。
【集注】
方有执说：这是列举痉病的完整证候。说身体热、头部热，面赤、眼目血脉赤，是阳邪发于阳分。足寒，是阴邪逆于阴分。只有头面部摇动，是风性主动而向上行。卒，是忽然的意思。噤，是因寒而口闭，意思是忽然嘴唇闭合，牙关紧急而不能饮食。背部向后反张，是因为太阳经脉挟持背部，寒则筋脉拘急挛缩，热则筋脉弛缓纵伸。然而刚痉和柔痉，各自只见到证候的一个方面，只有风寒兼具而致病的，才会全部见到这些证候。
郑重光说：这是总论痉病涉及经络腧穴皆病，气血同时受伤，而出现强直反张的证候。风湿兼具，所以是痉病的完整证候。
太阳病，发热，脉象沉而细的，名叫痉病。
【注释】
太阳病发热，脉象应当浮大，如果脉象沉细，兼有少阴经证。现在发热而脉象沉细，却名叫痉病的，为什么呢？是因为已经患有痉病，而得到沉细脉，不能命名为太阳、少阴伤寒的脉象，应当命名为太阳风湿痉病的脉象。因风邪郁结于阳分，所以病见发热。湿邪凝滞于阴分，所以脉象沉细。这是承接上一条痉病得沉细脉的意义，并不是说太阳病发热，脉象沉细，就名叫痉病。
【集注】
方有执说：发热，说明太阳经证未除。沉，代表寒。细，代表湿。
程知说：脉象沉细，依法应当救里，而痉病又是燥热之病，所以《金匮要略》说难治。意思是不可轻易等同于太阳病发热而脉反沉的例子。
张璐说：发热脉象应当浮数，反而沉细，可知邪风被湿气附着，所以身体虽发热，而脉象不能浮数，这是阳证见阴脉，所以《金匮要略》指出为难治。
程应旄说：痉病有共同点也有独特之处，固然是以其独特之处来命名。然而脉象在太阳经，更有独有而无共同之处，以头面摇、口噤、背反张的证候，结合沉细的脉象，虽然有太阳发热等证候，不会混淆为伤寒，才可以确定其名叫痉病。
@@@
太阳病，发热无汗，反而怕冷的，名叫刚痉。太阳病，发热出汗，而不怕冷，名叫柔痉。
【按语】
“反”怕冷的“反”字，是衍文。刚痉证应当怕冷，并非“反”。
【注释】
痉病既属于太阳经，应当用太阳经的虚实来解释。所以说：太阳病发热无汗，怕冷为实邪，名叫刚痉；发热出汗，不怕冷为虚邪，名叫柔痉。这是详细阐述上面两条痉病的虚实，并不是说太阳病，发热无汗、怕冷；出汗、不怕冷，就名叫刚、柔痉病的证候。
【集注】
程知说：太阳病，发热，无汗，怕冷，是伤寒；发热，出汗，怕风，是伤风；发热，出汗，不怕冷，是温热病。因为证候有颈项强直，甚至反张，所以不称之为风寒、温热病，而称之为痉病。
张璐说：《金匮要略》说：太阳病无汗，而小便反而少，气上冲胸，牙关紧闭不能说话，将要发作刚痉，用葛根汤主治，就是申明这一条的意义，并补充其治法。无汗而小便少的，是因为太阳、阳明二经的热邪，聚积于胸中，延及损伤肺金清肃之气，内外不能宣通缘故。又说：太阳病，证候具备，身体强直拘紧，然而脉象反而沉迟，这是痉病，用栝蒌桂枝汤主治，就是申明这一条的意义，并补充其治法。其证候具备，则发热出汗等证候，《金匮要略》已详细说明，不必赘述了。
@@@
太阳病，项背强直拘紧，无汗怕风，用葛根汤主治。
【注释】
这里省略了其他证候和脉象，单举痉病的颈项强直者，来说明其治法。太阳经的经脉，下行至项部，循行肩膀挟持背部；阳明经的经脉循行喉咙，进入缺盆，贯穿膈肌，下行至乳房内侧。太阳经主后方，前方合于阳明经；阳明经主前方，后方合于太阳经。现在邪气壅塞在两条经脉之中，所以有拘强不舒的样子。太阳经的强直，不过是颈项强直；这里的痉病的强直，则是不能俯仰，颈部连接胸部和背部都强直，所以叫作项背强直拘紧。无汗怕风，是实邪，适宜用葛根汤发散。即桂枝汤加麻黄、葛根，两解太阳、阳明两经的邪气。
【集注】
方有执说：几几，是羽毛短小的鸟，活动时引颈几几然。形容病人的颈项都患病，俯仰不能自如的样子。
@@@
太阳病，项背强直拘紧，反而出汗怕风的，用桂枝加葛根汤主治。
【注释】
太阳病，项背强直拘紧，无汗怕风的是实邪。现在反而出汗怕风，是虚邪，适宜用桂枝加葛根汤，解除太阳经的风邪，发散阳明经的汗邪。
【集注】
江琥说：太阳病项背强直了，又几几然，颈部不能舒展，颈部的经脉属于阳明经，项背与颈部几几然，其状应当无汗，现在反而出汗、怕风，仲景的法度：太阳病出汗怕风的，用桂枝汤主治。现在因其几几然，所以在桂枝汤中加入葛根，以兼祛阳明经的风邪。
[Background Information]
Book: Yizong Jinjian (Golden Mirror of the Medical Tradition)
Author: Wu Qian
Dynasty: Qing Dynasty
Chapter: Treatise on Pulse, Syndrome, and Treatment of Spasm, Dampness, and Heatstroke
Category: Medical Discourse
[Original Text Translation]
The Classic states: All spasms and neck stiffness belong to dampness. It also states: All sudden rigidity belongs to wind. The commentary says: In Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang meridian), excessive sweating leads to spasm (a disease characterized by neck stiffness, trismus, and opisthotonos). The six qi (wind, cold, summer-heat, dampness, dryness, fire) can all cause spasm, not solely dampness; the six meridians (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) all have spasm syndromes, not limited only to the Taiyang meridian.
Generally, the posterior aspect of the body belongs to the Taiyang meridian. Any case of neck stiffness, tightness in the nape and back, rigid spine with backward arching (opisthotonos), sensation of the waist breaking, inability to flex the thighs, and knotting sensation in the popliteal fossa constitutes a Taiyang spasm. The anterior aspect belongs to the Yangming meridian. Any case of head and face tremors, trismus (lockjaw), teeth grinding, pain in the supraclavicular fossa, and leg cramps constitutes a Yangming spasm. The lateral aspect belongs to the Shaoyang meridian. Any case of facial paralysis (deviation of mouth and eyes), traction of hands and feet, bilateral hypochondriac tension, and hemiplegia constitutes a Shaoyang spasm. As for abdominal tension and limb cramps following vomiting and diarrhea, this may be considered a Taiyin spasm. Aversion to cold, curling up in bed, sitting on the buttocks instead of standing on heels, bending the spine forward instead of lifting the head, and inability to extend the trunk may be considered a Shaoyin spasm. Retraction of the testes, downward flow of the Zongjin (tendons converging at the genitalia), urgency in the lower abdomen, constriction in the yin region, and cramping of the knees and calves may be considered a Jueyin spasm. Generally, spasm is named after its manifestations, and its etiology lies in tendon tension; therefore, any pathology of the tendons of the six meridians can be termed spasm.
Those caused by wind-cold must present with fever, aversion to cold, and anhidrosis, with a floating and tight pulse, and symptoms of body rigidity and trismus. This corresponds to the Classic’s statement: "All rigidity belongs to wind." Due to its forceful and urgent nature, it is called Gangjing (Yang spasm, characterized by aversion to cold and anhidrosis). Those caused by wind-damp present with fever, sweating, no aversion to cold, a floating and moderate pulse, and symptoms of neck stiffness without full-body rigidity. This corresponds to the Classic’s statement: "Spasm with neck stiffness belongs to dampness." Due to its soft and weak nature, it is called Roujing (Yin spasm, characterized by sweating and aversion to wind). If spasm results from erroneous sweating leading to yang exhaustion and fluid depletion failing to nourish the tendons, as stated in this treatise: "Taiyang disease, excessive sweating leads to spasm," this is not due to damp or wind, but rather due to dryness.
In essence, spasm is not originally an independent primary disease but often complicates other diseases, such as postpartum blood loss in women or traumatic injuries, all of which can induce spasm. Currently, those suffering from this are all attributed to wind, which is not an accurate conclusion. Scholars must carefully examine the causes—wind, cold, damp, dry, internal, external, deficiency, and excess—within the syndromes and treat them accordingly to avoid errors. Do not indiscriminately attribute all cases to wind.
@@@
Sunshang (Cold Damage) resulting in Taiyang disease includes Spasm, Dampness, and He (Heatstroke). These three conditions should be discussed separately because they resemble Sunshang, hence their appearance here.
[Note]
The four characters "resulting from Sunshang" are meaningless and are likely interpolations.
[Annotation]
Sunshang is one type of disease within the Taiyang meridian, implying that the Taiyang meridian does not only suffer from Sunshang. Generally, pathogenic factors from the six qi invading humans do so via the exterior of the Taiyang meridian. Spasm is caused by wind pathogen; Dampness by damp pathogen; He by summer-heat pathogen. Although diseases of wind, cold, summer-heat, and damp are generally categorized under Taiyang, the transmission and progression of Spasm, Dampness, and He differ from Sunshang; thus, it is said they should be discussed separately.
[Collected Notes]
Fang Youzhi stated: Spasm, Dampness, and He are all variations of wind-cold. Once they become variations, separate discussions are warranted. However, since they originate from wind-cold and belong to Taiyang, there remains suspicion of similarity to wind-cold, requiring combined differentiation.
@@@
If a patient presents with fever in the body, cold in the feet, neck stiffness and tension, aversion to cold, occasional fever in the head, red face, red eye vessels, isolated head tremor, sudden trismus, and opisthotonos, it is a spasm disease.
[Annotation]
Body fever and aversion to cold indicate a Taiyang syndrome. Neck stiffness, red face, and red eyes indicate a Yangming syndrome. Head fever indicates yang qi stagnating in the upper part; foot cold indicates yin qi coagulating in the lower part. The Taiyang meridian runs along the back to the head; the Yangming tendon runs up to flank the mouth. When wind-cold lodges in these two meridians, symptoms such as head tremor, trismus, opisthotonos, and tension occur, hence named spasm disease.
[Collected Notes]
Fang Youzhi stated: This lists the complete symptoms of spasm. Body heat, head heat, red face, and red eye vessels indicate yang pathogen manifesting in yang aspects. Foot cold indicates yin pathogen reversing into yin aspects. Isolated head and face tremors indicate wind acting dynamically in the upper part. "Sudden" means abruptly. "Trismus" refers to mouth closure due to cold, meaning lips and mouth suddenly close, jaw becomes tight, and eating/drinking is impossible. Opisthotonos occurs because the Taiyang meridian flanks the back; cold causes tendon tension and contraction, while heat causes tendon relaxation and extension. However, Gangjing and Roujing each show only one side of the syndrome; only when both wind and cold are present are all these symptoms fully manifested.
Zheng Zhongguang stated: This generally discusses how spasm affects meridians and acupoints, injuring both qi and blood, resulting in rigidity and opisthotonos. The presence of both wind and damp makes these the complete symptoms of spasm.
In Taiyang disease, if there is fever and the pulse is deep and fine, it is named spasm disease.
[Annotation]
In Taiyang disease with fever, the pulse should be floating and large. If the pulse is deep and fine, it involves the Shaoyin meridian. Why is fever with a deep and fine pulse named spasm? Because the patient already has a spasm syndrome presenting with a deep and fine pulse, it cannot be named the pulse of Taiyang or Shaoyin Sunshang. It should be named the pulse of Taiyang wind-damp spasm. Wind pathogen stagnating in the yang aspect causes fever. Damp pathogen coagulating in the yin aspect causes a deep and fine pulse. This continues the meaning of the previous clause regarding spasm presenting with a deep and fine pulse; it does not mean that any Taiyang disease with fever and a deep/fine pulse is automatically named spasm.
[Collected Notes]
Fang Youzhi stated: Fever indicates Taiyang syndrome persists. Deep indicates cold. Fine indicates damp.
Cheng Zhi stated: A deep and fine pulse typically warrants treating the interior, but spasm is a disease of dryness and heat, so the *Jinkui Yaolue* states it is difficult to treat. It implies one should not lightly equate this with the example of Taiyang fever with a contrary deep pulse.
Zhang Lu stated: Fever usually presents with a floating and rapid pulse. A contrary deep and fine pulse indicates wind pathogen is adhered to by dampness. Thus, although the body is hot, the pulse cannot be floating and rapid. This is a yang syndrome showing a yin pulse, hence the *Jinkui Yaolue* points to it as difficult to treat.
Cheng Yingmao stated: Spasm has common and unique features. It is named by its unique features. However, if the pulse is in the Taiyang position, showing uniqueness without commonality—combining symptoms like head tremor, trismus, and opisthotonos with a deep and fine pulse—even with Taiyang fever symptoms, it will not be confused with Sunshang, allowing it to be definitively named spasm.
@@@
In Taiyang disease, fever with anhidrosis and aversion to cold is named Gangjing (Yang Spasm). In Taiyang disease, fever with sweating and no aversion to cold is named Roujing (Yin Spasm).
[Note]
The character "fan" (contrary/reverse) before "aversion to cold" is an interpolation. Gangjing should naturally present with aversion to cold; it is not "contrary."
[Annotation]
Since spasm belongs to the Taiyang meridian, it should be explained using Taiyang deficiency and excess patterns. Therefore: Taiyang disease with fever, anhidrosis, and aversion to cold represents excess pathogen, named Gangjing; fever with sweating and no aversion to cold represents deficient pathogen, named Roujing. This elaborates on the deficiency and excess of spasm mentioned in the previous two clauses; it does not mean that any Taiyang disease with fever/anhidrosis/cold-aversion or fever/sweating/no-cold-aversion is automatically named Gangjing or Roujing.
[Collected Notes]
Cheng Zhi stated: Taiyang disease with fever, anhidrosis, and aversion to cold is Sunshang (Cold Damage); fever, sweating, and aversion to wind is Shangfeng (Wind Strike); fever, sweating, and no aversion to cold is Warm-Heat disease. Because the syndrome includes neck stiffness and even opisthotonos, it is not called wind-cold or warm-heat disease, but spasm.
Zhang Lu stated: The *Jinkui Yaolue* says: "Taiyang disease with anhidrosis, yet urine output is reduced, qi rushes upward to the chest, trismus prevents speech, indicating impending Gangjing, treated with Gegen Tang." This clarifies the meaning of this clause and supplements its treatment. Anhidrosis with reduced urine occurs because heat from the Taiyang and Yangming meridians accumulates in the chest, damaging the lung metal's clearing and descending qi, preventing internal and external circulation. It also says: "Taiyang disease with complete symptoms, body stiffness and tension, yet the pulse is contrary deep and slow, this is spasm, treated with Gualou Guizhi Tang." This clarifies the meaning of this clause and supplements its treatment. The "complete symptoms" refer to fever and sweating, which are detailed in the *Jinkui Yaolue*, so no need to repeat.
@@@
In Taiyang disease, neck and back stiffness and tension with anhidrosis and aversion to wind, Gegen Tang (Pueraria Decoction) is indicated.
[Annotation]
This omits other symptoms and pulses, highlighting only neck stiffness to illustrate treatment. The Taiyang meridian descends to the neck, runs along the shoulders, and flanks the back; the Yangming meridian runs along the throat, enters the supraclavicular fossa, penetrates the diaphragm, and descends to the inner breast. Taiyang governs the posterior, connecting anteriorly with Yangming; Yangming governs the anterior, connecting posteriorly with Taiyang. Now, pathogen obstructs both meridians, causing a stiff and tense appearance. Taiyang stiffness is limited to the neck; spasm stiffness prevents flexion and extension, involving the neck, chest, and back together, hence "neck and back stiffness and tension." Anhidrosis and aversion to wind indicate excess pathogen, suitable for release with Gegen Tang. This is Guizhi Tang (Cinnamon Twig Decoction) plus Mahuang (Ephedrae Herba) and Gegen (Puerariae Radix), resolving pathogen in both Taiyang and Yangming meridians.
[Collected Notes]
Fang Youzhi stated: "Jijiu" describes a bird with short wings stretching its neck when moving. It describes the patient's neck and back being diseased, unable to flex or extend freely.
@@@
In Taiyang disease, neck and back stiffness and tension with sweating and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction Plus Pueraria) is indicated.
[Annotation]
In Taiyang disease, neck and back stiffness with anhidrosis and aversion to wind is excess pathogen. Now, with sweating and aversion to wind, it is deficient pathogen, suitable for Guizhi Jia Gegen Tang to resolve wind in the Taiyang meridian and induce sweat in the Yangming meridian.
[Collected Notes]
Jiang Hu stated: In Taiyang disease, the neck and back are stiff and tense, unable to relax. The neck meridian belongs to Yangming. With neck and back tension, the condition should present with anhidrosis. Now, with sweating and aversion to wind, according to Zhang Zhongjing's method: Taiyang disease with sweating and aversion to wind is treated with Guizhi Tang. Due to the tension, Gegen (Puerariae Radix) is added to Guizhi Tang to simultaneously dispel wind from the Yangming meridian.