【歌】 本非风湿上求，有无汗证见刚柔。角弓口噤如风状，燥剂教君勿妄投。
【论】仲景云∶太阳病，发热，脉沉而迟，口痉。伤寒发汗过多，因致痉；大发湿家汗，亦成痉；疮家
发汗亦成痉；产后去血过多，亦成痉。其证身热足寒，颈项强急，恶寒，时头热面赤，目脉赤，独头摇，卒口
噤，背反张者是也。有汗曰柔痉，无汗曰刚痉。刚痉属阳，柔痉属阴。丹溪云∶痉属太阴湿土。故经云∶诸痉
强直，皆属于湿。盖湿土过极，反兼风化制之。然兼化者，虚象，而实非风也，切不可概作风治而用燥药。大
率属气虚，亦有火兼痰者，宜辨之。若身凉，手足冷，脉沉细者，为阴痉。若口眼牵扯，手足战摇伸缩者，为
风痰。若发热喘嗽生痰，为痰火，宜随证治之。若目瞪口开，昏冒不知人者，不治。并用如圣饮加减治之。
如圣饮
治刚、柔二痉，与螈 同治法。
羌活（上） 防风（中） 川芎（中） 白芷（中） 柴胡（中） 芍药（中） 人参（中） 当归（中） 甘
草（中） 半夏（下） 黄芩（中） 乌药（中）
上，用水二盏，姜三片，煎一盏，入姜汁、竹沥温服。
有汗曰柔痉，加白术、桂枝。无汗曰刚痉，加苍术、麻黄，或葛根亦可。痰多加贝母、栝蒌、枳实、紫苏
子。火盛加山栀仁、麦门冬、花粉，去川芎、柴胡、乌药、半夏、羌活、防风、白芷。如口噤切牙，大便实者，
加大黄利之。产后去血过多成痉者，加黄 、熟地黄。
【歌诀】本病并非风湿之邪上犯所致，需根据有无汗出这一证候来辨别刚痉与柔痉。患者出现身体角弓反张、牙关紧闭等类似风病的症状时，切勿妄用燥烈药物。
【论述】张仲景说：太阳病（太阳经受邪所致的病证），表现为发热，脉象沉而迟缓，伴有口部痉挛。伤寒病发汗过多，会导致痉病；素体湿盛之人（湿家）大发其汗，也会形成痉病；患有疮疡的人发汗，同样会形成痉病；产后失血过多，也会形成痉病。这些病症的表现是：身体发热但足部寒冷，颈项僵硬紧急，恶寒，有时头部发热、面色发红，眼络脉赤红，唯独头部摇动，突然牙关紧闭，背部向后反折呈弓形。有汗出的称为柔痉，无汗出的称为刚痉。刚痉属于阳证，柔痉属于阴证。朱丹溪说：痉病归属于太阴湿土经。所以医经中说：各种痉病的强直症状，都归属于湿邪。这是因为湿土之气过极，反而兼夹了风气的制约表现。然而这种兼夹的变化，是虚损的征象，实际上并非真正的风邪，切不可一概当作风病治疗而使用燥性药物。大率来说，痉病多属于气虚，也有火邪兼夹痰浊的情况，应当仔细辨别。如果身体凉爽，手足冰冷，脉象沉细的，属于阴痉。如果口眼牵引歪斜，手足颤抖摇摆、伸缩不定的，属于风痰。如果发热、气喘咳嗽并生痰的，属于痰火，应当随证进行治疗。如果眼睛瞪大、口开不合，昏迷不省人事的，属于不治之症。以上情况均可使用如圣饮进行加减治疗。
如圣饮
治疗刚痉和柔痉，以及抽搐（瘛疭）的治疗方法相同。
药材组成：羌活（上等）、防风（中等）、川芎（中等）、白芷（中等）、柴胡（中等）、芍药（中等）、人参（中等）、当归（中等）、甘草（中等）、半夏（下等）、黄芩（中等）、乌药（中等）。
煎服法：以上药材，用水两盏，生姜三片，煎煮至一盏，加入姜汁、竹沥，温服。
若有汗出属柔痉者，加白术、桂枝。若无汗出属刚痉者，加苍术、麻黄，或者葛根也可以。痰多者加贝母、栝蒌、枳实、紫苏子。火盛者加山栀仁、麦门冬、花粉，去掉川芎、柴胡、乌药、半夏、羌活、防风、白芷。如果牙关紧闭咬切牙齿，大便干结实的，加大黄以通利大便。产后因失血过多导致痉病的，加黄芪、熟地黄。
[Verse] This condition is not caused by wind-dampness attacking from above; one must distinguish between Gang Jing (Stiff Spasm) and Rou Jing (Soft Spasm) based on the presence or absence of sweating. When symptoms such as opisthotonos (body arched backward like a bow) and trismus (lockjaw) resembling wind disease appear, do not recklessly administer drying agents.
[Discussion] Zhang Zhongjing stated: In Taiyang disease (diseases resulting from pathogenic invasion of the Taiyang meridian), characterized by fever, a deep and slow pulse, and trismus. Excessive sweating in the treatment of Cold Damage (Shanghan) can lead to spasm; excessive sweating in patients with chronic dampness (Shi Jia) also results in spasm; inducing sweating in patients with sores and ulcers similarly causes spasm; and excessive blood loss postpartum can also result in spasm. The manifestations of these conditions include: body heat with cold feet, stiffness and tension in the neck and nape, aversion to cold, occasional heat in the head and redness of the face, redness of the eye collaterals, isolated shaking of the head, sudden trismus, and opisthotonos (backward arching of the back). Those with sweating are termed Rou Jing (Soft Spasm); those without sweating are termed Gang Jing (Stiff Spasm). Gang Jing belongs to Yang patterns, while Rou Jing belongs to Yin patterns. Zhu Danxi stated that spasm is associated with the Taiyin Damp-Earth channel. Thus, the classics state: "All spasms and rigidity belong to dampness." This occurs because extreme damp-earth qi counteracts itself with wind-like characteristics. However, this counteracting transformation is a sign of deficiency, not true wind, and certainly should not be treated generally as wind disease using drying herbs. Generally, it belongs to Qi deficiency, though there are cases where fire combines with phlegm, which requires careful differentiation. If the body is cool, hands and feet are cold, and the pulse is deep and fine, it is Yin Spasm. If there is pulling of the mouth and eyes, and trembling, shaking, and extension-flexion of the limbs, it is Wind-Phlegm. If accompanied by fever, wheezing, coughing, and phlegm production, it is Phlegm-Fire, and treatment should follow the specific syndrome. If the eyes are wide open, the mouth is agape, and the patient is comatose and unconscious, it is incurable. All these conditions can be treated with modifications of Rusheng Yin (Like-Sage Decoction).
Rusheng Yin (Like-Sage Decoction)
Treats both Gang Jing (Stiff Spasm) and Rou Jing (Soft Spasm), and applies to the same treatment method for convulsions (Chi Zong).
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix, superior grade), Fangfeng (Saposhnikoviae Radix, medium grade), Chuanxiong (Ligusticum Chuanxiong Rhizoma, medium grade), Baizhi (Angelicae Dahuricae Radix, medium grade), Chaihu (Bupleuri Radix, medium grade), Shaoyao (Paeoniae Radix Alba, medium grade), Renshen (Ginseng Radix, medium grade), Danggui (Angelicae Sinensis Radix, medium grade), Gancao (Glycyrrhizae Radix et Rhizoma, medium grade), Banxia (Pinelliae Rhizoma, inferior grade), Huangqin (Scutellariae Radix, medium grade), Wuyao (Linderae Radix, medium grade).
Preparation: Take the above ingredients, add two cups of water and three slices of fresh ginger, decoct until one cup remains, then add ginger juice and bamboo sap, and take warm.
For Rou Jing (Soft Spasm) with sweating, add Baizhu (Atractylodis Macrocephalae Rhizoma) and Guizhi (Cinnamomi Ramulus). For Gang Jing (Stiff Spasm) without sweating, add Cangzhu (Atractylodis Rhizoma) and Mahuang (Ephedrae Herba), or Gegen (Puerariae Lobatae Radix) may also be used. For excessive phlegm, add Beimu (Fritillariae Thunbergii Bulbus), Gualou (Trichosanthis Fructus), Zhishi (Aurantii Fructus Immaturus), and Zisuzi (Perillae Fructus). For excess fire, add Shanzhiren (Gardeniae Semen), Maidong (Ophiopogonis Radix), and Huafen (Trichosanthis Radix); remove Chuanxiong, Chaihu, Wuyao, Banxia, Qianghuo, Fangfeng, and Baizhi. If there is severe trismus with teeth grinding and solid stool, add Dahuang (Rhei Radix et Rhizoma) to promote bowel movement. For spasm caused by excessive blood loss postpartum, add Huangqi (Astragali Radix) and Shudihuang (Rehmanniae Radix Preparata).