经云。诸痉项强。皆属于湿。肺移热于肾。传为柔痉。金匮云。太阳之病。发热无汗。反恶
寒者。名曰刚痉。太阳病。发热汗出。而不恶寒者。名曰柔痉。太阳病。发热脉沉而细者。名曰
痉。为难治。太阳病。发汗太多。因致痉。风病下之则痉。复发汗。必拘急。疮家虽身疼痛。不
可发汗。汗出则痉。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。若发其汗者。寒湿相搏。其表益虚。即恶寒甚。发其汗已。其脉如蛇。暴腹
胀大者。为欲解。脉如故。反复弦者痉。夫痉脉按之紧如弦。直上下行。脉经云。痉家脉伏。直
上下行。痉家有灸疮者难治。太阳病。其证备。身体强KT KT （音殊。）然。脉反沉迟。此为
痉。栝蒌桂枝汤主之。太阳病。无汗而小便反少。气上冲胸。口噤不得语。欲作刚痉。葛根汤主
之。痉为病。胸满口噤。卧不着席。脚挛急。必 齿。可与大承气汤。合上十一条推之。则痉病
之属表者。宜用桂枝、葛根。属里者。可用承气。是为邪实者设也。若首二条之葛根、桂枝。所
不待言。第三条无汗。麻黄附子细辛汤。有汗。桂枝附子汤。四条。真武汤。五条。附子汤。六
条。芍药甘。草附子汤。七条。未发汗前。桂枝加附子汤。发其汗已。其脉如蛇。甘草附子汤。
八条。干姜附子汤。九条是统言痉病之脉。无证可验。不得拟方。第十条言痉病之不宜用灸。灸
则艾火助虐。一切辛烈。概不可施。所以难治。惟腹胀便秘者。庶可行下夺一法。虚者可用炙甘
草汤。其脉经云一条与第九条不异。演文无疑。按痉病与金匮开卷第一证治。论证最详。而方治
最略。以其证最危逆。难于造次也。观其论中。惟出太阳阳明邪实三方。不及三阴虚证之治者。
以痉病之脉。皆弦劲伏匿。证多反张
厥逆。是难议攻发。易于温散也。若不通篇体会。乌知先圣立言之旨。
陈无择曰。夫人之筋。各随经络退出于身。血气内虚。外为风寒湿热之所中则痉。盖风散气。
故有汗而不恶寒。曰柔痉。寒泣血。故无汗而恶寒。曰刚痉。原其所因。多由亡血。筋无所营。
故邪得以袭之。所以伤寒汗下过多。与夫病疮人。及产后致斯疾者。概可见矣。诊其脉。皆沉伏
弦紧。但阳缓阴急。则久久拘挛。阴缓阳急。则反张强直。二证各异。不可不别。
张景岳曰。痉之为病。强直反张病也。其病在筋脉。筋脉拘急。所以反张。其病在血液。血
液枯燥。所以筋挛。观仲景曰。太阳病。发汗太多。因致痉。风病下之则成痉。疮家不可发汗。
汗之亦成痉。只此数言。可见病痉者。多由误治之坏证。其虚其实可了然矣。自仲景之后。惟陈
无择能知所因。曰多由亡血。筋无所营。因而成痉。则尽之矣。但惜其言之既善。而复未有善者。
曰。气血内虚。外为风寒湿热所中则痉。斯言不无有误。若其所云。则仍是风湿为邪。而虚反次
之。不知风随汗散。而既汗之后。何复言风。湿随下行。而既下之后。何反致湿。盖误汗者。必
伤血液。误下者。必伤真阴。阴血受伤。则血燥。血燥则筋失所滋。筋失所滋。则为拘为挛。而
反张强直之病。势所必至。又何待风寒湿热之相袭而后为痉耶。且仲景所言。言不当汗而汗也。
不当下而下也。汗下既误。即因误治而成痉矣。岂误治之外。必再受邪而后成痉。无邪则无痉哉。
此陈氏之言。不惟失仲景之意。而反致后人疑惑。用持两端。故凡今人之治此者。未有不以散风
去湿为事。亦焉知血燥阴虚之证。尚能堪此散削否。此千古不明之疑窦。不可不为辨察。故列陈
子之论于前。以资后学之印证。痉证甚多。而人多不识者。在不明其故。而鲜有察之者耳。盖凡
以暴病而见反张戴眼。口噤拘
急之类。皆痉病也。观仲景以汗下为言。谓其误治亡阴。所以然也。予因类推。则常见有不因误治。
而凡属阴虚血少之辈。不能营养筋脉。以致搐挛僵仆者。皆是此证。如中风之有此者。必以年力衰
残。阴之败也。产妇之有此者。必以去血过多。冲任竭也。疮家之有此者。必以血随脓出。营气涸
也。小儿之有此者。或以风热伤阴。遂为急惊。或以汗泻亡阴。遂为慢惊。凡此之类。总属阴虚之
证。盖精血不亏。则虽有邪干。亦断无筋脉拘急之病。而病至坚强。其枯可知。故治此者。必当先
以气血为主。而邪甚者。或兼治邪。若邪微者。通不必治邪。盖此证之所急者在元气。无气复而血
脉行。则微邪自不能留。何足虑哉。奈何今人但见此证。必各分门类。而悉从风治。不知外感之风。
客邪证也。治宜解散。内生之风。血燥证也。止宜滋补。矧此数者。总由内证。本无外邪。既以伤
精败血枯燥而成。而再治风痰。难乎免矣。故予详笔于此。以明痉证之要。仲景云。痉止属太阳。
而不及他经者何也。盖痉必反张。其病在背。背之经络。惟太阳督脉耳。言太阳则督在其中矣。此
其义也。然仲景止言其表。而未详其里。考内经之经脉篇曰。足少阴之脉。贯脊属肾。其直者。从
肾上贯肝膈。经筋篇曰。足少阴之筋。从脊内挟膂上至项。结于枕骨。与足太阳之筋合。又曰。足太
阳之筋病。脊反折。项筋急。足少阴之筋病。主痫螈及痉。阳病者腰反折不能俯。阴病者不能仰。
由此观之。则痉之为病。乃太阳少阴之病也。盖肾与膀胱为表里。膀胱为津液之腑。而肾为藏精之
脏。病在二经。水亏可知。故治此者。最常以真阴为主。
薛立斋曰。痉以有汗无汗辨刚柔。又以厥逆不厥逆辨阴阳。仲景虽曰痉皆身热足寒。然阳证
不厥逆。其厥逆者。皆阴也。刚痉无汗恶寒。项背强。脚挛急。手足搐搦。口噤切牙。仰面开眼。
甚则角弓反张。卧不着席。脉来弦长劲急。葛
根汤。柔痉自汗恶风。四肢不收。闭眼合面。或时搐搦。脉来迟濡弦细。桂枝汤加栝蒌。血虚之
人发痉。或反张。或只手足搐搦。或但左手足动摇。十全大补汤加钩藤、蝎尾。风热痰壅。发痉
不省。或只手足搐搦。或只右手足动摇。宜祛风导痰汤。痉病胸满。口噤切牙。脚挛急。卧不着
席。大便硬者。可与大承气汤。若一边牵搐。一眼 斜者。属少阳。及汗后不解。乍静乍乱。直
视口噤。往来寒热。小柴胡加桂枝、白芍。足三阴痉。俱手足厥冷。筋脉拘急。汗出不止。项强
脉沉。厥阴则头摇口噤。 附汤加当归、肉桂。太阴则四肢不收。术附汤加甘草、生姜。少阴则
闭目合面。参附汤加甘草、干姜。古法。用附子散通治三阴诸痉。多汗。去川芎、独活。加黄 、
当归。贼风口噤。角弓反张成痉。仓公当归汤。产后发痉。详妇人本门。
〔诊〕太阳病发热。脉沉而细者。名曰痉。为难治。痉脉伏。按之紧如弦。直上下行。痉病发
其汗已。其脉如蛇。暴腹胀大者为欲解。脉如故。反伏弦者痉。
《黄帝内经》说：各种痉病出现项部强直，都属于湿邪所致。肺部的热邪转移至肾脏，传变成为柔痉。《金匮要略》说：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，而不恶寒的，称为柔痉。太阳病，发热而脉象沉细的，称为痉病，属于难治之证。太阳病，发汗过多，因而导致痉病。患风病误用攻下法会导致痉病，若再发汗，必然引起肢体拘挛急迫。患有疮疡的人，虽然身体疼痛，不可使用发汗法，若强行发汗导致汗出，就会引发痉病。患者身体发热、足部发凉，颈项强直紧急，恶寒，有时头部发热，面部和眼睛发红，只有头部摇动，突然牙关紧闭，背部反张的，这是痉病。如果对此类病症发汗，寒湿相互搏结，体表更加虚弱，就会严重恶寒。发汗之后，脉象像蛇行一样蜿蜒曲折，突然出现腹部胀大的，是病情将要解除的表现；如果脉象依旧，反复呈现弦脉的，则是痉病。痉病的脉象，重按感觉紧如琴弦，笔直上下运行。《脉经》说：患痉病的人脉象伏匿，笔直上下运行。患痉病又有灸疮的，难以治疗。太阳病，症状具备，身体强直僵硬（音殊），脉象反而沉迟，这是痉病，用栝蒌桂枝汤主治。太阳病，无汗且小便反而量少，气向上冲撞胸部，牙关紧闭不能说话，即将发作刚痉，用葛根汤主治。痉病表现为胸满、牙关紧闭、睡觉时身体不能贴席、脚部拘挛急促，必定咬牙，可以给予大承气汤。综合以上十一条论述来推断，属于表证的痉病，适宜使用桂枝汤、葛根汤；属于里证的痉病，可以使用承气汤，这是为邪气实证设立的治法。至于前两条提到的葛根汤、桂枝汤，是不言自明的。第三条无汗的情况，可用麻黄附子细辛汤；有汗的情况，用桂枝附子汤。第四条，用真武汤。第五条，用附子汤。第六条，用芍药甘草附子汤。第七条，在未发汗之前，用桂枝加附子汤；发汗之后，脉象像蛇行，用甘草附子汤。第八条，用干姜附子汤。第九条是统论痉病的脉象，没有具体症状可验证，无法拟定方剂。第十条说明痉病不宜使用艾灸，因为艾灸的艾火会助长邪气肆虐，一切辛热猛烈之药，一概不可施用，所以难以治疗。只有腹胀便秘的，或许可以采用攻下夺实的方法。虚证者可用炙甘草汤。《脉经》中关于“痉家脉伏”的一条与第九条无异，演绎文字无疑。按：痉病在《金匮要略》开卷第一证治中，论证最为详细，而方治最为简略，因为其证候最为危重逆乱，难以仓促处理。看其论述中，只提出了太阳、阳明邪实的三个方剂，不及三阴虚证的治法，是因为痉病的脉象，都是弦劲伏匿，证候多表现为角弓反张、厥逆，这是难以议用攻发之法，易于采用温散之法。如果不通篇体会，怎么知道先圣立言的宗旨呢？
陈无择说：人的筋脉，各自随着经络显露于身体。血气内部虚弱，外部被风寒湿热所侵袭就会发生痉病。大概风性疏散气机，所以有汗且不恶寒，称为柔痉；寒性凝滞血液，所以无汗且恶寒，称为刚痉。推究其病因，多由亡血导致，筋脉得不到濡养，所以邪气得以侵袭。因此伤寒汗下过多，以及患疮疡的人和产后导致这种疾病的，概可见一斑。诊察其脉象，都是沉伏弦紧。如果是阳缓阴急，则久久拘挛；如果是阴缓阳急，则角弓反张、强直。这两种证候各异，不可不辨别。
张景岳说：痉病，是强直反张的病。病位在筋脉，筋脉拘急，所以反张。病位在血液，血液枯燥，所以筋脉拘挛。看仲景说：太阳病，发汗太多，因而导致痉病；风病误用攻下则成痉；疮家不可发汗，发汗也会成痉。仅这几句话，就可以看出患痉病的人，多由误治导致的坏证，其虚证和实证的道理也就显而易见了。自从仲景之后，只有陈无择能知晓病因，说是多由亡血，筋脉得不到濡养，因而成痉，这就解释得很透彻了。可惜他的言论虽然好，但后来却没有善于补充完善的人。他说：“气血内虚，外部被风寒湿热所侵袭就会发生痉病。”这话不无错误。如果他所说的成立，那仍然是以风湿为邪气，而将虚证放在次要地位。不知道风随汗液发散，既然已经发汗之后，为什么还要再说风？湿随大便下行，既然已经攻下之后，为什么反而导致湿？大概误用汗法，必伤血液；误用下法，必伤真阴。阴血受伤，则血液干燥；血液干燥，则筋脉失去滋养；筋脉失去滋养，就会出现拘挛，那么角弓反张强直的病，就是势所必然的了，又何须等待风寒湿热的侵袭后才发生痉病呢？况且仲景所说的，是说在不应当发汗的时候发了汗，在不应当攻下的时候攻了下。汗下既已误用，就因误治而成痉了。难道在误治之外，必须再受外邪才会成痉吗？如果没有外邪就没有痉病了吗？陈氏的言论，不仅失去了仲景的本意，反而导致后人疑惑，持两端不定。所以现在凡是治疗此病的人，无不把散风去湿作为主要事务，又怎知血燥阴虚的证候，还能承受这种消散克伐的药物呢？这是千古不明的疑窦，不可不为辨析考察。所以我列出陈子的论述在前面，以供后学印证。痉证很多，而人们大多不认识的原因，在于不明白其缘故，很少有仔细考察的人。大概凡是突发疾病而出现反张、戴眼（眼球上翻）、口噤、拘急之类的，都是痉病。看仲景以汗下为言，是说误治亡阴，所以如此。我因此类推，则常见有不因误治，而凡是属于阴虚血少之辈，不能营养筋脉，以致抽搐痉挛、僵仆倒地的，都是这个证候。比如中风有此表现的，必定是因为年力衰残，阴气败坏；产妇有此表现的，必定是因为失血过多，冲任二脉枯竭；患疮疡的人有此表现的，必定是因为血液随脓液流出，营气枯竭；小儿有此表现的，有的因风热伤阴，遂为急惊风；有的因汗泻亡阴，遂为慢惊风。凡此之类，总属阴虚的证候。大概精血不亏损，那么即使有邪气干扰，也绝对不会有筋脉拘急的病。而病发展到坚强程度，其枯槁可知。所以治疗此病，必定应当以补益气血为主，而邪气严重的，或兼治邪气；如果邪气轻微的，完全不必治邪。因为这个证候所急需的是元气，元气恢复而血脉运行，那么微弱的邪气自然不能停留，有什么值得忧虑的呢？奈何现在的人只要见到这个证候，必定各分门类，而全部从风论治。不知道外感的风，是客邪证，治疗宜解散；内生的风，是血燥证，只宜滋补。何况这几种情况，总由内证引起，本无外邪，既然已经因伤精败血、枯燥而成，如果再治风痰，难免有害。所以我详细记录于此，以阐明痉证的要点。仲景说，痉病只属于太阳经，而不涉及其他经脉，为什么呢？大概痉病必见反张，病位在背部，背部的经络，只有太阳经和督脉罢了。说太阳经，督脉就在其中了。这就是其中的义理。然而仲景只说了表证，而未详述里证。考证《内经·经脉篇》说：足少阴肾经的脉，贯穿脊柱，属于肾脏。其直行者，从肾脏上行，贯穿肝脏和膈肌。《经筋篇》说：足少阴肾经的筋，从脊内挟脊骨上行至项部，结于枕骨，与足太阳经的筋相合。又说：足太阳经的筋发病，脊背反折，项部筋脉紧急；足少阴经的筋发病，主痫证抽搐及痉病；阳病者腰背反折不能俯身，阴病者不能仰身。由此看来，痉病，是太阳经和少阴经的病。肾与膀胱互为表里，膀胱是津液之腑，而肾是藏精之脏。病在二经，可知是水液亏虚。所以治疗此病，最常以填补真阴为主。
薛立斋说：痉病通过有汗无汗来辨别刚痉和柔痉，又以是否厥逆来辨别阴阳。仲景虽然说痉病都身热足寒，但是阳证不厥逆，那些厥逆的，都是阴证。刚痉无汗恶寒，项背强直，脚部拘挛急促，手足搐搦，牙关紧闭咬切牙齿，仰面睁眼，甚至角弓反张，睡觉时身体不能贴席，脉象弦长劲急，用葛根汤。柔痉自汗恶风，四肢松弛不收，闭眼合面，有时抽搐，脉象迟濡弦细，用桂枝汤加栝蒌。血虚之人发痉，或者角弓反张，或者只是手足搐搦，或者只是左手足动摇，用十全大补汤加钩藤、蝎尾。风热痰壅，发痉神志不清，或者只是手足搐搦，或者只是右手足动摇，宜用祛风导痰汤。痉病胸满，牙关紧闭咬切牙齿，脚部拘挛急促，睡觉时身体不能贴席，大便硬结的，可以给予大承气汤。如果一边牵拉抽搐，一眼斜视的，属于少阳证，以及发汗后不解，时而安静时而混乱，直视口噤，往来寒热，用小柴胡汤加桂枝、白芍。足三阴经的痉病，都手足厥冷，筋脉拘急，汗出不止，项强脉沉。厥阴经痉病则头摇口噤，用附子汤加当归、肉桂；太阴经痉病则四肢松弛不收，用术附汤加甘草、生姜；少阴经痉病则闭目合面，用参附汤加甘草、干姜。古法，用附子散通治三阴诸痉，多汗者，去掉川芎、独活，加黄芪、当归。贼风引起的口噤，角弓反张成痉，用仓公当归汤。产后发痉，详见妇人本门。
【诊法】太阳病发热，脉象沉而细的，称为痉病，为难治。痉病脉象伏匿，重按紧如琴弦，笔直上下运行。痉病发汗之后，脉象像蛇行一样蜿蜒，突然腹部胀大的，是病情将要解除；脉象依旧，反而伏弦的，是痉病。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Various types of Jing disease (spasm syndrome) presenting with neck stiffness and rigidity are all attributed to Dampness. When Heat from the Lung transfers to the Kidney, it transmits into Rou Jing (Soft Spasm). The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: In Taiyang disease, if there is fever without sweating and an aversion to cold, it is named Gang Jing (Hard Spasm). In Taiyang disease, if there is fever with sweating but no aversion to cold, it is named Rou Jing (Soft Spasm). In Taiyang disease, if there is fever with a deep and thin pulse, it is named Jing disease, which is difficult to treat. If Taiyang disease involves excessive sweating, it leads to Jing disease. If Wind disease is treated with purgation, it results in Jing disease; if sweating is induced again, limb cramping and urgency will inevitably occur. Patients with sores/ulcers who experience body pain should not undergo sweating therapy; if sweating occurs, it induces Jing disease. If a patient presents with body heat, cold feet, stiff and urgent neck, aversion to cold, occasional head heat, red face and eyes, only head shaking, sudden lockjaw, and opisthotonos (backward arching of the back), this is Jing disease. If sweating is induced in such cases, Cold and Dampness contend, the exterior becomes more deficient, and severe aversion to cold ensues. After inducing sweating, if the pulse resembles a snake moving, and sudden abdominal distension occurs, it indicates the condition is about to resolve; if the pulse remains unchanged and repeatedly appears wiry, it is Jing disease. The pulse of Jing disease, when pressed firmly, feels tight like a string, running straight up and down. The *Maijing* (Pulse Classic) states: Patients with Jing disease have a hidden pulse, running straight up and down. Patients with Jing disease who also have moxibustion sores are difficult to treat. In Taiyang disease, if symptoms are complete, the body is stiff and rigid (sound: shu), and the pulse is unexpectedly deep and slow, this is Jing disease, primarily treated with Gualou Guizhi Tang (Trichosanthes Twig and Cinnamon Twig Decoction). In Taiyang disease, if there is no sweating and urination is unexpectedly scanty, Qi rushes upward to the chest, lockjaw prevents speech, and Gang Jing is impending, Gegen Tang (Kudzu Root Decoction) is primarily used. Jing disease manifesting as chest fullness, lockjaw, inability to lie flat on the bed, leg cramps, and teeth grinding can be treated with Dachengqi Tang (Major Order the Qi Decoction). Synthesizing the above eleven clauses, Jing diseases belonging to the Exterior are suitable for Guizhi Tang (Cinnamon Twig Decoction) or Gegen Tang; those belonging to the Interior can use Chengqi Tang formulas. These are established for excess pathogenic factors. Regarding the first two clauses mentioning Gegen Tang and Guizhi Tang, their application is self-evident. For the third clause involving no sweating, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) may be used; for sweating, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is appropriate. For the fourth clause, Zhenwu Tang (True Warrior Decoction) is used. For the fifth clause, Fuzi Tang (Aconite Decoction) is used. For the sixth clause, Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is used. For the seventh clause, before inducing sweating, Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) is used; after inducing sweating, if the pulse resembles a snake, Gancao Fuzi Tang (Licorice and Aconite Decoction) is used. For the eighth clause, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is used. The ninth clause generally discusses Jing pulses without specific symptoms, making prescription formulation impossible. The tenth clause explains that Jing disease should not undergo moxibustion, as moxa fire aids the pathogen's tyranny; all acrid and hot medicines are contraindicated, hence the difficulty in treatment. Only in cases of abdominal distension and constipation might a purgative method be considered. For deficiency patterns, Zhigancao Tang (Roasted Licorice Decoction) may be used. The statement in the *Maijing* regarding "Jing patients have a hidden pulse" is identical to the ninth clause, with no doubt in interpretation. Note: In the opening chapter of the *Jingui Yaolue*, the discussion of Jing disease is most detailed, while prescriptions are sparse, because the syndrome is critical and adverse, making hasty treatment difficult. Observing the discussion, only three formulas for Taiyang and Yangming excess pathogens are presented, omitting treatments for Three Yin deficiency patterns. This is because Jing pulses are wiry, vigorous, and hidden, and syndromes often involve opisthotonos and Jue Ni (reversal cold extremities), making aggressive dispersal difficult and warm dispersal easier. Without comprehending the entire text, how can one understand the intent of the Sages?
Chen Wuyue stated: Human sinews extend along meridians throughout the body. Internal deficiency of Blood and Qi, combined with external invasion by Wind, Cold, Dampness, and Heat, causes Jing. Wind disperses Qi, causing sweating without aversion to cold, termed Rou Jing. Cold congeals Blood, causing no sweating with aversion to cold, termed Gang Jing. Investigating the etiology, it mostly stems from loss of Blood, leaving sinews un-nourished, allowing pathogens to invade. Thus, excessive sweating and purgation in Shanghan (Cold Damage), as well as conditions in sore patients and postpartum women leading to this disease, are evident. Pulse diagnosis reveals deep, hidden, wiry, and tight pulses. If Yang is relaxed and Yin is urgent, chronic cramping occurs; if Yin is relaxed and Yang is urgent, opisthotonos and rigidity occur. These two syndromes differ and must be distinguished.
Zhang Jingyue stated: Jing disease is characterized by rigidity and opisthotonos. The pathology lies in the sinews and vessels; sinew cramping causes opisthotonos. The pathology lies in Blood; blood dryness causes sinew cramping. Observing Zhang Zhongjing's words: "Taiyang disease, excessive sweating leads to Jing; Wind disease purged leads to Jing; sore patients should not sweat, and if they do, Jing ensues." These few sentences reveal that Jing disease mostly arises from mismanagement complications, clarifying its deficiency and excess nature. Since Zhang Zhongjing, only Chen Wuyue understood the etiology, stating it mostly stems from blood loss and lack of sinew nourishment, thus forming Jing. This explanation was thorough. However, his statement that "internal deficiency of Qi and Blood, external invasion by Wind, Cold, Dampness, and Heat causes Jing" is erroneous. If true, it prioritizes Wind-Damp as pathogens over deficiency. It ignores that Wind disperses with sweat; why mention Wind after sweating? Dampness descends with purgation; why mention Dampness after purging? Misusing sweating injures Blood; misusing purgation injures True Yin. Injury to Yin and Blood leads to blood dryness; blood dryness deprives sinews of nourishment; deprived sinews cramp, inevitably leading to opisthotonos and rigidity, without waiting for Wind-Cold-Damp-Heat invasion. Moreover, Zhang Zhongjing referred to inappropriate sweating and purgation. Once these errors occur, Jing forms due to mismanagement. Does it require additional pathogen invasion after mismanagement to form Jing? Is there no Jing without pathogens? Chen's words not only miss Zhang Zhongjing's intent but confuse later generations, leading to indecision. Consequently, modern practitioners focus on dispersing Wind and removing Dampness, unaware whether blood-dryness and Yin-deficiency patterns can withstand such draining and reducing methods. This is an ancient ambiguity requiring clarification. I present Chen's argument for student verification. Jing syndromes are numerous but unrecognized due to ignorance of their cause. Generally, acute onset of opisthotonos, staring eyes (Dai Yan), lockjaw, and cramping constitute Jing disease. Zhang Zhongjing attributed them to mismanagement causing Yin loss. By analogy, I observe that many cases not caused by mismanagement, but by Yin deficiency and Blood scarcity failing to nourish sinews, resulting in convulsions, spasms, and collapse, belong to this category. For example, stroke patients with this presentation suffer from declining vitality and Yin failure; postpartum women suffer from excessive blood loss depleting Chong and Ren meridians; sore patients suffer from blood loss with pus depleting Ying Qi; children suffer from Wind-Heat injuring Yin (leading to acute convulsive wind) or sweating/purgation injuring Yin (leading to chronic convulsive wind). All these belong to Yin deficiency. If Essence and Blood are not depleted, even with pathogen interference, sinew cramping will not occur. The severity of rigidity indicates dryness. Therefore, treatment must prioritize replenishing Qi and Blood. For severe pathogens, treat pathogens concurrently; for mild pathogens, do not treat pathogens at all. The urgency lies in Yuan Qi (Original Qi); once Qi recovers and Blood vessels flow, minor pathogens cannot remain. Why worry? Yet modern practitioners categorize every case and treat solely from a Wind perspective. They fail to distinguish that exogenous Wind is an external pathogen requiring dispersal, while endogenous Wind is a blood-dryness pattern requiring tonification. Furthermore, these cases stem from internal disorders without external pathogens. Having formed through injury to Essence and Blood causing dryness, treating Wind-Phlegm again is harmful. I record this in detail to clarify the essence of Jing syndrome. Why did Zhang Zhongjing say Jing belongs only to Taiyang and not other meridians? Because Jing involves opisthotonos, located in the back. The back meridians are only Taiyang and Du Mai (Governing Vessel). Mentioning Taiyang includes Du Mai. This is the principle. However, Zhang Zhongjing only discussed the Exterior, not the Interior. Examining the *Neijing Meridian Chapter*: Foot-Shaoyin (Kidney) meridian penetrates the spine and belongs to the Kidney. Its straight branch ascends from the Kidney, passes through Liver and Diaphragm. The *Meridian Sinew Chapter* states: Foot-Shaoyin sinew runs inside the spine, up to the nape, knots at the occiput, combining with Foot-Taiyang sinew. It also states: Foot-Taiyang sinew disease causes spinal reversal and neck stiffness; Foot-Shaoyin sinew disease causes epilepsy, clonic spasms, and Jing; Yang disease causes spinal reversal unable to bend forward; Yin disease causes inability to bend backward. Thus, Jing disease is a disorder of Taiyang and Shaoyin meridians. Kidney and Bladder are interior-exterior pairs; Bladder is the fluid vessel, Kidney stores Essence. Disease in these two meridians indicates Water deficiency. Therefore, treatment most commonly focuses on nourishing True Yin.
Xue Lizhai stated: Jing disease distinguishes Gang and Rou by presence or absence of sweating, and Yin/Yang by presence or absence of Jue Ni. Although Zhang Zhongjing said Jing involves body heat and cold feet, Yang syndromes do not feature Jue Ni; those with Jue Ni are Yin syndromes. Gang Jing features no sweating, aversion to cold, neck/back stiffness, leg cramps, hand/foot tremors, lockjaw, open eyes facing up, severe opisthotonos, inability to lie flat, and wiry-long-vigorous pulse; treat with Gegen Tang. Rou Jing features spontaneous sweating, aversion to wind, flaccid limbs, closed eyes facing down, occasional tremors, and slow-soft-wiry-thin pulse; treat with Guizhi Tang plus Gualou. Blood deficiency causing Jing, with opisthotonos or only hand/foot tremors or left-side movement, treat with Shiquan Dabu Tang plus Gouteng (Uncaria) and Scorpion tail. Wind-Heat and Phlegm obstruction causing Jing with unconsciousness or hand/foot tremors or right-side movement, treat with Qufeng Daotan Tang (Dispel Wind and Guide Out Phlegm Decoction). Jing disease with chest fullness, lockjaw, leg cramps, inability to lie flat, and hard stool, can use Dachengqi Tang. If unilateral pulling/tremors and one eye deviated, it belongs to Shaoyang; after sweating without resolution, alternating calmness and confusion, fixed gaze, lockjaw, alternating chills and fever, treat with Xiaochaihu Tang plus Guizhi and Baishao. Foot Three-Yin Jing diseases all present with cold extremities, sinew cramping, continuous sweating, neck stiffness, and deep pulse. Jueyin Jing involves head shaking and lockjaw; treat with Fuzi Tang plus Danggui and Rougui. Taiyin Jing involves flaccid limbs; treat with Shu Fuzi Tang plus Gancao and Shengjiang. Shaoyin Jing involves closed eyes facing down; treat with Shen Fuzi Tang plus Gancao and Ganjiang. Ancient method uses Fuzi San (Aconite Powder) to treat all Three-Yin Jing. For excessive sweating, remove Chuanxiong and Duhuo, add Huangqi and Danggui. Thief-Wind causing lockjaw and opisthotonos, use Cang Gong Danggui Tang. Postpartum Jing is detailed in the Women's Section.
[Diagnosis] Taiyang disease with fever and deep-thin pulse is named Jing, difficult to treat. Jing pulse is hidden, tight like a string when pressed, running straight up and down. After inducing sweating in Jing disease, if the pulse resembles a snake and sudden abdominal distension occurs, it indicates resolution; if the pulse remains unchanged and becomes hidden-wiry, it is Jing.