之为病，即《内经》之痉病也。以痉作 ，盖传写之误耳。其证则脊背反张
，头摇口噤，戴眼项强，四肢拘急，或见身热足寒，恶寒面赤之类皆是也。
仲景曰∶太阳之病，发热无汗，反恶寒者，名曰刚 。太阳病，发热汗出而不恶寒
者，名曰柔 。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
。风病，下之则 ，复发汗，必拘急。疮家，虽身疼痛，不可发汗，汗出则
。
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
。盖风散气，故有汗而不恶寒曰柔 。寒泣血，故无汗而恶寒曰刚 。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。
愚谓痉之为病，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 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，
而复有未善者，曰∶血气内虚，外为风寒湿热所中则痉，斯言不无又误。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，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 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
？此不可不为辨察。故余列二子之论于前，以资后学之印证。
一、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。余因类推，则常
见有不因误治，而凡属阴虚血少之辈，不能养营筋脉，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。若微邪者，
通不必治邪。盖此证之所急者在元气，元气复而血脉行，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，寒邪证也，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。故余笔于此，以明 证之要。
一、仲景言痉止属太阳，而不及他经者何也？盖 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，循脊内挟膂，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，膀胱为津液之府，而肾为藏精之
脏，病在二经，水亏可知，故治此者，最当以真阴为主。
所谓痉病，就是《内经》中记载的痉病。将“痉”写作“痓”，大概是传抄过程中的错误罢了。其症状表现为脊背向后反张，头部摇动、牙关紧闭，眼球上视、项部强直，四肢拘挛紧急，或者出现身体发热而足部发冷、恶寒且面色发红等情况，都属于此类。
张仲景说：太阳病，发热无汗，反而恶寒的，称为刚痓（或刚痉）。太阳病，发热有汗且不恶寒的，称为柔痓（或柔痉）。太阳病，发热且脉象沉细的，称为痉病，属于难治之证。太阳病，发汗过多，因而导致痓病。患风病的人，如果误用攻下法，又再次发汗，必然导致肢体拘急。患有疮疡的人，即使身体疼痛，也不可以发汗，如果发汗，也会导致痓病。
陈无择说：人的筋脉，各自随着经络分布显露于体表。如果体内血气虚弱，外部受到风寒湿热的侵袭，就会发生痉挛。因为风性疏散，所以有汗且不恶寒的称为柔痓；寒性凝滞血液，所以无汗且恶寒的称为刚痓。追溯其病因，大多由于失血，导致筋脉得不到濡养，因此邪气得以乘虚而入。所以伤寒病中发汗和攻下过多的，以及患有疮疡的人和产后妇女导致这种疾病的，大概都可以由此理解。诊察这类病人的脉象，多为沉伏弦紧。如果是阳缓阴急，则长期出现拘挛；如果是阴缓阳急，则出现脊背反张和强直。这两种证候各不相同，不可不加以辨别。
我认为，痉病是一种强直反张的疾病，病变部位在筋脉。筋脉拘急，所以导致身体反张。其根本在于血液，血液干枯枯燥，所以导致筋脉挛缩。看张仲景所说：太阳病，发汗太多，因而导致痉病。风病误用攻下法，也会形成痉病。疮疡患者不可发汗，如果发汗，也会形成痉病。仅从这几句话来看，就可以明白患痉病的人大多是由于误治导致的坏证，其本质是虚而非实，这是显而易见的。自张仲景之后，只有陈无择能知晓病因，他说：“大多由于失血，筋脉得不到濡养，因而形成痉病”，这就把道理讲透了。可惜他的言论虽然好，但又有不完善的地方，他说：“血气内虚，外部受到风寒湿热侵袭就会发生痉病”，这话不能说没有错误。按照他的说法，仍然是以风湿为邪气，而将虚损放在次要地位。他不知道风随汗液发散，既然已经发汗了，为何还要提及风邪；湿气随攻下法下行，既然已经攻下了，为何反而会致湿邪。大概误用发汗法，必定损伤血液；误用攻下法，必定损伤真阴。阴血受伤则血液干燥，血液干燥则筋脉失去滋养，筋脉失去滋养就会导致拘挛，这是反张强直病症发展的必然趋势，又何须等待风寒湿热的侵袭才会发生痉病呢？况且张仲景所说的，是指不应当发汗而发了汗，不应当攻下而攻了下。汗法和下法既然误用，就已经因为误治而导致痉病了。难道在误治之外，还必须再感受外邪才会形成痉病吗？如果没有外邪就没有痉病了吗！陈氏的言论，不仅违背了张仲景的本意，反而导致后人产生疑惑，持两种观点而不定。所以现在治疗此病的人，无不以祛风除湿为主要手段，哪里知道对于血燥阴虚的证候，还能承受这种疏散耗损的药物吗？这是不能不为世人辨明考察的。所以我列出这两位医家的论述在前面，以供后学者印证参考。
第一，痉证的种类很多，但人们大多不认识的原因，在于不明白其病因，很少有人仔细考察罢了。大凡突发疾病并出现脊背反张、眼球上视、牙关紧闭、肢体拘急等症状的，都是痉病。看张仲景以发汗和攻下为例，是说误治导致亡阴所以才这样。我因此类推，常见有不因误治，而是凡是属于阴虚血少体质的人，不能濡养筋脉，以致出现抽搐、挛缩、僵倒等症状的，都是这个证候。如中风病中有这种情况的，必定是因为年岁力气衰退，阴气败坏所致。产妇中有这种情况的，必定是因为失血过多，冲任二脉枯竭所致。疮疡患者中有这种情况的，必定是因为血液随脓液流出，营气枯竭所致。小儿中有这种情况的，有的因为风热伤阴，遂成为急惊风；有的因为发汗或泻下导致亡阴，遂成为慢惊风。所有这些情况，总归属于阴虚证候。只要精血不亏损，那么即使有邪气干扰，也绝对不会出现筋脉拘急的疾病，而病情发展到强直僵硬的程度，其干枯状态也就可想而知了。所以治疗此病，必须首先以补益气血为主，如果邪气盛，或许兼治邪气。如果邪气轻微，完全不必治邪。因为这个证候所急需的是元气，元气恢复而血脉通畅，那么微弱的邪气自然无法停留，有什么值得担忧的呢？奈何现在的人只要见到这个证候，必定各自分门别类，全都从治风入手。他们不知道外感的风，属于寒邪证候，治疗宜用解散法；内生的风，属于血燥证候，只宜用滋补法。何况上述几种情况，总由内部病变引起，本来没有外邪，既然已经因为损伤精气、败坏血液导致干枯而成病，如果再按风痰来治疗，恐怕难免出错。所以我在此笔述，以阐明痉证的要旨。
第二，张仲景说痉病只属于太阳经，而不提及其他经脉，为什么呢？大概痉病必然出现脊背反张，病变部位在背部，背部的经络只有太阳经和督脉而已，提到太阳经，督脉就在其中了，这就是其中的义理。然而张仲景只讲了表证，而没有详细讲述里证。考证《内经·经脉篇》说：足少阴肾经的脉气，贯穿脊柱，属于肾脏，其直行者从肾脏上行，穿过肝脏和膈肌。《经筋篇》说：足少阴肾经的筋脉，沿着脊柱内侧挟持两旁的肌肉，上行至项部，结聚于枕骨，与足太阳膀胱经的筋脉相合。又说：足太阳膀胱经的筋脉发病，会出现脊背反折，项部筋脉拘急。足少阴肾经的筋脉发病，主要主司癫痫抽搐及痉病。阳经发病者，腰背反折不能前俯；阴经发病者，不能后仰。由此看来，痉病乃是太阳经和少阴经的疾病。因为肾与膀胱互为表里，膀胱是津液汇聚的府库，而肾是藏精的脏器，病变涉及这两条经脉，可知是水液精血亏虚，所以治疗此病，最应当以填补真阴为主。
The so-called Jing disease (Spasm) is precisely the Spasm disease recorded in the *Neijing* (Classic of Internal Medicine). The character "Zhi" (痓) used for "Jing" (痉) is likely a transcription error. Its symptoms include opisthotonos (backward arching of the back), head shaking, trismus (lockjaw), upward staring of the eyes, neck stiffness, and spasticity or contracture of the four limbs. It may also present with fever in the body but coldness in the feet, aversion to cold, and a red face. These are all manifestations of this condition.
Zhang Zhongjing stated: In Taiyang disease (Disease of the Taiyang/Bladder channel), if there is fever, absence of sweating, and aversion to cold, it is named Gang Jing (Yang Spasm/Rigid Spasm). In Taiyang disease, if there is fever, sweating, and no aversion to cold, it is named Rou Jing (Yin Spasm/Soft Spasm). In Taiyang disease, if there is fever with a deep and fine pulse, it is named Jing (Spasm), which is difficult to treat. If Taiyang disease undergoes excessive sweating, it leads to Jing (Spasm). In Wind diseases, if purgation is applied followed by re-sweating, it will inevitably cause contractures. For patients with sores/ulcers, even if they have body pain, sweating therapy should not be used; if sweating is induced, it will lead to Jing (Spasm).
Chen Wuyue stated: The tendons of the human body follow the meridians and emerge throughout the body. When internal Qi and Blood are deficient, external pathogenic factors such as Wind, Cold, Dampness, and Heat can invade, leading to spasms. Because Wind disperses Qi, sweating without aversion to cold is termed Rou Jing (Yin Spasm). Because Cold congeals Blood, absence of sweating with aversion to cold is termed Gang Jing (Yang Spasm). Tracing the etiology, it mostly arises from blood loss, where the tendons lack nourishment, allowing pathogens to attack. Thus, in Shanghan (Cold Damage) cases with excessive sweating or purgation, as well as in patients with sores or postpartum women, the occurrence of this disease can be understood through this principle. Pulse diagnosis reveals deep, hidden, wiry, and tight pulses. If Yang is relaxed and Yin is tense, chronic contractures occur; if Yin is relaxed and Yang is tense, opisthotonos and rigidity occur. These two presentations differ significantly and must be distinguished.
I consider that Jing (Spasm) is a disease characterized by rigidity and opisthotonos, located in the sinews and vessels. Sinew contracture causes the backward arching. The root lies in the Blood; when Blood is dry and depleted, sinew cramping occurs. Observing Zhang Zhongjing's statements: excessive sweating in Taiyang disease leads to Spasm; purgation in Wind disease leads to Spasm; inducing sweat in sore-patients leads to Spasm. From these few words, it is evident that most cases of Spasm result from mismanagement and deterioration, revealing that the underlying nature is deficiency rather than excess. After Zhang Zhongjing, only Chen Wuyue identified the cause correctly, stating that it mostly arises from blood loss and lack of sinew nourishment. However, his statement that "internal deficiency of Qi and Blood combined with external invasion of Wind, Cold, Dampness, and Heat causes Spasm" is flawed. This view prioritizes Wind-Damp pathogens over deficiency. He failed to realize that Wind disperses with sweat, so why mention Wind after sweating? Dampness moves downward with purgation, so why mention Dampness after purging? Improper sweating damages Blood; improper purgation damages True Yin. Injury to Yin and Blood leads to Blood dryness; Blood dryness deprives sinews of nourishment, inevitably leading to contracture and opisthotonos, without waiting for external Wind-Cold-Damp-Heat invasion. Furthermore, Zhang Zhongjing referred to inappropriate sweating and purgation. Once these treatments are misapplied, Spasm results from the mismanagement itself. Does one need additional external pathogens to form Spasm after mismanagement? If there are no external pathogens, is there no Spasm? Chen's words not only contradict Zhang Zhongjing's intent but also confuse later practitioners, causing them to hesitate between theories. Consequently, modern practitioners often focus on dispelling Wind and removing Dampness. Who realizes whether patients with Blood dryness and Yin deficiency can tolerate such dispersing and draining methods? This requires clarification. Therefore, I present both scholars' arguments for students to verify.
First, although Spasm has many types, people fail to recognize it because they do not understand its etiology and rarely investigate. Any acute illness presenting with opisthotonos, upward staring, trismus, and contracture is Spasm. Zhang Zhongjing cited sweating and purgation to explain that mismanagement leading to Yin depletion causes this. By analogy, I observe that many cases not caused by mismanagement involve individuals with Yin deficiency and Blood insufficiency who cannot nourish the sinews, resulting in convulsions, cramps, and collapse. For example, in Stroke patients, this results from declining vitality and failing Yin. In postpartum women, it results from excessive blood loss and exhaustion of the Chong and Ren vessels. In sore-patients, it results from blood loss with pus and depletion of Ying Qi. In children, it may result from Wind-Heat injuring Yin (leading to Acute Convulsion) or sweating/purgation depleting Yin (leading to Chronic Convulsion). All these belong to Yin deficiency syndromes. If Essence and Blood are not deficient, even if pathogens interfere, sinew contracture will not occur. The progression to rigidity indicates severe depletion. Therefore, treatment must prioritize replenishing Qi and Blood. If pathogens are strong, address them concurrently; if weak, do not treat pathogens at all. The urgency lies in restoring Yuan Qi (Original Qi); once Yuan Qi recovers and blood vessels flow freely, minor pathogens cannot remain. Why worry? Yet, modern practitioners categorize every case and treat solely for Wind. They fail to distinguish that external Wind is a Cold pathogen requiring dispersion, while internal Wind is a Blood dryness syndrome requiring tonification. Since these cases stem from internal conditions without external pathogens, treating them as Wind-Phlegm is erroneous. I write this to clarify the essentials of Spasm.
Second, why did Zhang Zhongjing state that Spasm belongs only to the Taiyang channel and omit others? Spasm involves opisthotonos, affecting the back. The meridians of the back are primarily the Taiyang and Du Mai (Governing Vessel). Mentioning Taiyang implicitly includes the Du Mai. However, Zhang only discussed exterior aspects without detailing interior aspects. Examining the *Meridian Chapter* of the *Neijing*: The Foot-Shaoyin Kidney meridian passes through the spine and connects to the Kidney; its straight branch ascends from the Kidney through the Liver and Diaphragm. The *Sinew Meridian Chapter* states: The Foot-Shaoyin sinew follows the inside of the spine, ascends to the nape, and knots at the occiput, merging with the Foot-Taiyang sinew. It further states: Pathology of the Foot-Taiyang sinew causes spinal reversal and neck stiffness. Pathology of the Foot-Shaoyin sinew governs epilepsy, clonic seizures, and Spasm. Yang channel pathology causes spinal reversal preventing flexion; Yin channel pathology prevents extension. Thus, Spasm is a disease of both Taiyang and Shaoyin channels. Since the Kidney and Bladder are interior-exterior pairs, and the Bladder stores fluids while the Kidney stores Essence, pathology in these two channels indicates Water/Essence deficiency. Therefore, treatment must primarily focus on nourishing True Yin.