夫发 之候，先伤于风，又感寒湿致之，此虚极生热、热极生风之甚者也。伤风发热，头痛汗出，又自呕逆，汗之
必发 。湿家发汗稍多亦发 。此症项强直，腰身反张，摇头螈 ，口噤不语，发热腹痛不惺惺，其状可畏，病在足太
阳经。刚 无汗，柔 有汗。其面红眼赤，牙紧手张，痰涎壅盛，昏聩烦渴，小便赤涩，先谵语而发者，此刚 也，无
汗当发汗。其大便滑泄，不语不渴，先手足冷而发者，此柔 也，有汗当解肌。并以小续命汤加减，刚 去附子用麻
黄，柔 用附子去麻黄，大便利厥逆者，则以熟附佐之。其间一症，身体壮热，谵语口干，手足反微寒，大便反滑泄，
此为刚柔不分之 ，无汗葛根汤主之，有汗桂枝加葛根汤主之。要知无汗则用麻黄，有汗则谨勿用也，此古方之所禁。
其若痰塞气盛，则南星、半夏、茯苓以消其痰，枳实、陈皮、紫苏以顺其气，痰消则风止，气顺则神清，然后审其热之
轻重而解利之，热轻者败毒散，热盛者小柴胡汤解之。壮热有汗，胸满口噤切牙，而大便秘者，是为内实，大承气汤下
之，后用大柴胡汤解之。 最难痊，十救其一，过三日难治，请早图之。
小续命汤 见第二十七问。
葛根汤 见第十六问。
桂枝加葛根汤 治头疼、项背强KT KT ，汗出恶风者。
桂枝 芍药 甘草（各六钱） 葛根（一两三钱）
上锉散，每服三钱，生姜枣子煎服。
败毒散 见第五十问。
小柴胡汤 治伤寒、温热病，身热恶风，颈项强急，胸胁满痛，呕吐哕逆，烦渴，寒热往来，身面皆黄，小便
不利，大便秘涩，或过经不解，或潮热不除，及瘥后劳复，发热疼痛烦热，经血适来适断，寒热如疟，发作有时。
人参（去芦三钱） 甘草（炙三钱） 黄芩（三钱） 柴胡（去芦、八钱） 半夏（汤泡七次、焙、干二钱半）
上锉散，每服二钱，水一盏，生姜三片，枣一枚，煎去滓，温服不拘时。
大承气汤 治刚 ，胸满内实，口噤切牙，大热发渴，大便秘涩。
大黄 芒硝（各半两） 浓朴（一两） 枳实（二枚）
上锉散，每服三钱，姜三片，水一盏，煎半盏，温服。
大柴胡汤 治伤寒十余日，邪气结在里，往来寒热，大便秘涩，腹满胀痛，谵语，心中痞硬，饮食不下，或不
大便，五六日绕脐刺痛，时发烦躁。及汗后如疟，日晚发热，兼脏腑实，脉有力者可服。
柴胡（去芦、八钱） 黄芩 赤芍药（各三钱） 枳实（去瓤、麸炒、半钱） 半夏（汤泡七次、切片焙干、一钱
半）
上锉散，姜枣煎，加减服之，欲下加川大黄三钱。
所谓发痉的征兆，是先受风邪侵袭，又感受寒湿之气所致，这是极度虚弱产生内热、内热极盛而生风的严重情况。伤风导致发热，头痛出汗，并且伴有呕吐逆气，如果误用发汗法治疗，必然引发痉病。平素多湿之人（湿家），若发汗稍微过多，也会引发痉病。这种病症表现为颈项强直，腰背向后反张，头部摇动且四肢抽搐，牙关紧闭不能言语，发热腹痛且神志不清，其症状令人畏惧，病位在于足太阳经。刚痉表现为无汗，柔痉表现为有汗。如果患者面色红、眼睛赤，牙齿紧咬而手指张开，痰涎壅盛，神志昏聩烦躁口渴，小便短赤涩痛，先出现胡言乱语然后发作的，属于刚痉，无汗应当使用发汗法。如果患者大便滑泄，不语且不渴，先出现手脚冰冷然后发作的，属于柔痉，有汗应当使用解肌法。这两种情况都可以根据小续命汤进行加减：刚痉去掉附子，加入麻黄；柔痉使用附子，去掉麻黄；如果大便通利且出现四肢厥冷，则以熟附子辅助治疗。其中有一种症状，身体高热，胡言乱语口干，手足反而轻微发凉，大便反而滑泄，这是刚痉与柔痉界限不清的痉病，无汗者主用葛根汤，有汗者主用桂枝加葛根汤。必须知道无汗才用麻黄，有汗则千万不要用，这是古方所禁忌的。如果痰浊阻塞、气机旺盛，则用南星、半夏、茯苓来消除痰浊，用枳实、陈皮、紫苏来理顺气机，痰消则风止，气顺则神志清醒，然后再审察热邪的轻重而予以清解。热轻者用败毒散，热盛者用小柴胡汤清解。如果壮热有汗，胸满口噤咬牙，且大便秘结，这属于内实证，用大承气汤攻下，之后再用大柴胡汤清解。痉病最难痊愈，十人中仅能救活一人，超过三天难以治疗，请尽早谋划救治。
小续命汤 见第二十七问。
葛根汤 见第十六问。
桂枝加葛根汤 治疗头疼、项背强直不适，出汗怕风的患者。
桂枝、芍药、甘草（各六钱）、葛根（一两三钱）
以上药物切碎成散剂，每次服用三钱，用生姜、大枣煎服。
败毒散 见第五十问。
小柴胡汤 治疗伤寒、温热病，身体发热怕风，颈项强急，胸胁满痛，呕吐呃逆，烦躁口渴，寒热往来，全身面目发黄，小便不利，大便秘涩，或者经过传变后病邪未解，或者潮热不退，以及病愈后因劳累复发，发热疼痛烦热，月经适来或适断，寒热像疟疾一样，发作有定时。
人参（去芦头三钱）、甘草（炙三钱）、黄芩（三钱）、柴胡（去芦头八钱）、半夏（汤泡七次、焙干二钱半）
以上药物切碎成散剂，每次服用二钱，用水一盏，生姜三片，大枣一枚，煎煮去渣，不拘时候温服。
大承气汤 治疗刚痉，胸满内实，口噤咬牙，大热发渴，大便秘涩。
大黄、芒硝（各半两）、浓朴（一两）、枳实（二枚）
以上药物切碎成散剂，每次服用三钱，姜三片，水一盏，煎至半盏，温服。
大柴胡汤 治疗伤寒十余日，邪气结聚在体内，寒热往来，大便秘涩，腹满胀痛，胡言乱语，心中痞塞硬满，饮食不下，或者不大便，五六天绕脐刺痛，时常发作烦躁。以及发汗后像疟疾一样寒热，傍晚发热，兼有脏腑实证，脉象有力的可以服用。
柴胡（去芦头八钱）、黄芩、赤芍药（各三钱）、枳实（去瓤、麸炒半钱）、半夏（汤泡七次、切片焙干一钱半）
以上药物切碎成散剂，用姜枣煎煮，根据病情加减服用，想要攻下的加川大黄三钱。
The manifestation of **Jing disease (Spasm)** is caused by initial wind injury followed by cold-dampness invasion. This represents a severe condition where extreme deficiency generates heat, and extreme heat generates wind. Wind injury causing fever, headache, sweating, and spontaneous vomiting; if treated with diaphoresis (sweating method), Jing disease will inevitably occur. Patients with chronic dampness (Shi Jia) who undergo excessive sweating may also develop Jing disease. The symptoms include neck stiffness, opisthotonos (backward arching of the back), head shaking, limb convulsions, trismus (lockjaw) preventing speech, fever, abdominal pain, and clouded consciousness. The presentation is terrifying, and the pathology lies in the Foot-Taiyang Meridian. Gang-Jing (Rigid Spasm) presents without sweat, while Rou-Jing (Soft Spasm) presents with sweat. If the patient has a red face, red eyes, tight teeth with open hands, copious phlegm-saliva, stupor, irritability, thirst, and dark scanty urine, preceded by delirium, this is Gang-Jing; since there is no sweat, diaphoresis should be used. If the patient has loose stools, silence, no thirst, and cold extremities preceding the onset, this is Rou-Jing; since there is sweat, muscle-releasing methods should be used. Both conditions can be treated with modified Xiao Xu Ming Tang (Minor Continuation Life Decoction): for Gang-Jing, remove Fuzi (Prepared Aconite Root) and add Mahuang (Ephedra); for Rou-Jing, use Fuzi and remove Mahuang. If there is free stool accompanied by cold limbs, cooked Fuzi (Prepared Aconite Root) should be added as an assistant. In cases where the distinction between Gang and Rou is unclear—characterized by high fever, delirium, dry mouth, slightly cold extremities, and loose stools—Ge Gen Tang (Kudzu Decoction) is indicated for those without sweat, and Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu) for those with sweat. It must be known that Mahuang is used only when there is no sweat; it is strictly forbidden when sweat is present, according to ancient prescriptions. If phlegm obstructs and qi is abundant, use Nan Xing (Arisaema Cum Bile), Ban Xia (Pinellia Tuber), and Fu Ling (Poria) to resolve phlegm; use Zhi Shi (Immature Bitter Orange), Chen Pi (Tangerine Peel), and Zi Su (Perilla Leaf) to regulate qi. Once phlegm is resolved, wind ceases; once qi is regulated, spirit clears. Then, assess the severity of heat and treat accordingly: for mild heat, use Bai Du San (Detoxification Powder); for severe heat, use Xiao Chai Hu Tang (Minor Bupleurum Decoction). If there is high fever with sweat, chest fullness, trismus, and constipation, this indicates internal excess; Da Cheng Qi Tang (Major Order the Qi Decoction) should be used to purge, followed by Da Chai Hu Tang (Major Bupleurum Decoction). Jing disease is difficult to cure, with only one in ten surviving; after three days, it becomes hard to treat, so early intervention is advised.
Xiao Xu Ming Tang (Minor Continuation Life Decoction) See Question 27.
Ge Gen Tang (Kudzu Decoction) See Question 16.
Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu) Treats headache, neck and back stiffness/discomfort, sweating, and aversion to wind.
Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Gan Cao (Licorice Root) (each 6 qian), Ge Gen (Kudzu Root) (1 liang 3 qian).
Crush into powder, take 3 qian per dose, decoct with fresh ginger and jujube, and take warm.
Bai Du San (Detoxification Powder) See Question 50.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) Treats Shang Han (Cold Damage) and Wen Re Bing (Warm-Heat Disease), presenting with fever, aversion to wind, neck stiffness, chest and hypochondriac fullness/pain, vomiting/hiccuping, irritability/thirst, alternating chills and fever, jaundice of the body and face, dysuria, constipation, or unresolved pathogen after meridian transmission, persistent tidal fever, relapse due to overexertion after recovery, fever/pain/irritability, irregular menstruation, malaria-like chills and fever with regular paroxysms.
Ren Shen (Ginseng Root) (remove rhizome, 3 qian), Gan Cao (Licorice Root) (honey-fried, 3 qian), Huang Qin (Scutellaria Root) (3 qian), Chai Hu (Bupleurum Root) (remove rhizome, 8 qian), Ban Xia (Pinellia Tuber) (soaked in boiling water seven times, dried, 2.5 qian).
Crush into powder, take 2 qian per dose, decoct with one sheng of water, three slices of fresh ginger, and one jujube. Strain and take warm at any time.
Da Cheng Qi Tang (Major Order the Qi Decoction) Treats Gang-Jing (Rigid Spasm), chest fullness with internal excess, trismus, high fever with thirst, and constipation.
Da Huang (Rhubarb Rhizome), Mang Xiao (Mirabilite) (each half liang), Hou Po (Magnolia Bark) (1 liang), Zhi Shi (Immature Bitter Orange) (two pieces).
Crush into powder, take 3 qian per dose, decoct with three slices of ginger and one sheng of water until half a sheng remains. Take warm.
Da Chai Hu Tang (Major Bupleurum Decoction) Treats Shang Han persisting for more than ten days, with pathogen binding internally, alternating chills and fever, constipation, abdominal fullness/pain, delirium, epigastric hardness/fullness, inability to eat, or lack of bowel movement for five to six days with stabbing pain around the navel and occasional irritability. Also treats post-diaphoresis malaria-like symptoms, evening fever, combined with organ excess patterns and strong pulse.
Chai Hu (Bupleurum Root) (remove rhizome, 8 qian), Huang Qin (Scutellaria Root), Chi Shao Yao (Red Peony Root) (each 3 qian), Zhi Shi (Immature Bitter Orange) (remove pulp, bran-fried, 0.5 qian), Ban Xia (Pinellia Tuber) (soaked in boiling water seven times, sliced, dried, 1.5 qian).
Crush into powder, decoct with ginger and jujube, adjust dosage based on symptoms. To induce purgation, add Chuan Da Huang (Sichuan Rhubarb Rhizome) 3 qian.