眭氏 年近六旬，肢麻头晕屡发。今春头右畔麻至舌尖，言蹇目红，龈浮齿痛，厥阳升逆，鼓煽痰火，入
窍入络，轻为麻瞀，甚则口眼 僻，手足不随，偏枯类中，由来者渐矣。用滋阴镇阳以熄风，缓效为宜。熟
地（四钱）、钩藤（三钱）、石斛、杞子、茯神、白芍、牡蛎、磁石（各二钱）、羚羊角（七分）、山栀、
甘菊（俱炒。各一钱）。十数服症减，去磁石，加冬桑叶、黑芝麻，再去钩藤、栀、菊、羚角等，加潞参，
以桑甚熬膏，及阿胶和丸。渐安。
痉症，体劲直而背反张，病在筋也。筋者血之所荣，伤于邪则成痉。经曰∶诸痉项强，皆属于湿。亦有
因寒因风而分刚痉柔痉者，有误汗误下而致痉者，有疮家发汗而痉者，有中风暴仆而痉者，有产后亡血而痉者，
有小儿急慢惊而痉者，有破伤风湿变痉者，有暴病忽见口噤头摇戴眼反折者，皆痉病也。其症身热足寒，项
强齿噤，手足抽掣，角弓反张，脉皆沉伏弦紧。其因多由血液虚燥，筋脉失荣，风寒湿热之邪，得以袭入经络
而为病。此陈无择、薛立斋、张介宾诸贤，所以切指痉为亡血阴虚也。故宜滋营液以治本，疏风湿以治标。症属
表者，如《金匮》云∶太阳病发热无汗，反恶寒，为刚痉，葛根汤主之。太阳病发热汗出，
不恶寒，为柔痉，栝蒌桂枝汤。属里者，痉病胸满口噤，卧不着席，脚挛急，必 齿，属阳明，若便硬，可与
大承气汤。属半表半里者，如《医通》云∶一边牵搐，一眼 斜，属少阳，若往来寒热，小柴胡汤加桂枝、
白芍。此三阳痉也。若三阴痉，俱手足厥冷，筋脉拘急，汗出项强、脉沉，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、生姜。厥阴则头摇口噤， 附汤加当归、肉桂。此三阴痉也。其血
虚发痉，宜大营煎。血虚挟火，必脉洪烦热，一阴煎主之。火盛则阴血燥涸，保阴煎、玉女煎。液虚汗多，宜
三阴煎。汗多兼火，当归六黄汤。痰火发痉，栝蒌枳实汤。风热痰壅发痉，祛风导痰汤。呕泻发痉，胃关煎。
或温胃饮。身冷痉厥，脉沉细，参附汤、十全大补汤。暑风搐搦成痉，三物香薷汤加羌活、防风、黄 、白芍。
温邪劫液成痉，复脉汤，去姜、桂。产后血虚，汗多成痉，十全大补汤，不应，急加附子。三因用小续命汤，
宜去麻黄。
陈无择曰∶寒涩血，故无汗而恶寒，为刚痉。风散气，故有汗而不恶寒，为柔痉。原其所因，多由亡血，
筋失所荣，故邪得袭之。徐忠可曰∶发热恶寒无汗，本伤寒症，若成痉，是太阳寒湿相搏而侵少阴，故恶寒，
寒性劲，故曰刚。发热有汗不恶寒，本伤风而并阳明症，若成痉，是太阳阳明伤湿兼风，风性温，故曰柔。
仲景以葛根汤治刚痉，杜太阳项强，渐成阳明胸满之势也。以栝蒌桂枝汤治柔痉，润太阳既耗之液，使经气通，
散风行湿也。以大承气汤治里症，以热邪入内，故直攻其胃而邪散也。
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，然阳症不厥逆，其
厥逆者，皆阴症也。
张介宾曰∶筋脉拘急，故反张，血液枯燥，故筋挛。观仲景云∶太阳病发汗太多，则致痉。风病下之则成
痉。疮家不可发汗，汗之则痉。可知误汗伤液，误下伤阴，阴液伤而筋失所滋也。如中风之痉，必年力衰残，
阴之败也。产归之痉，必去血过多，冲任竭也。溃疡之痉，必血随脓化，营气涸也。小儿之痉，或风热伤阴，
为急惊，或吐泻亡阴，为慢惊，此虽不因误治，而总属阴虚之症。治此症者先以气血为主，邪甚者或兼治邪，
若邪微则急
培元气，元气复，血脉自行，微邪自去。若从风治，难乎免矣。
丹溪曰∶痉与痫相似而不同，痫病身软，时苏。痉病身强直不时苏，甚有昏冒而遂亡者。
眭氏，年龄接近六十岁，肢体麻木、头晕症状屡次发作。今年春天，头部右侧麻木延伸至舌尖，言语不利，眼睛发红，牙龈浮肿且牙齿疼痛。这是厥阳之气升发逆乱，鼓动煽旺痰火，侵入清窍与经络所致。轻者表现为麻木昏花，重则导致口眼歪斜，手足不能随意运动，偏枯及类中风病症，其形成由来已久，是逐渐积累而成的。治疗宜采用滋阴潜阳以熄风之法，见效缓慢为宜。处方：熟地黄（四钱）、钩藤（三钱）、石斛、枸杞子、茯神、白芍、牡蛎、磁石（各二钱）、羚羊角（七分）、山栀、甘菊（均炒制，各一钱）。服用十余剂后症状减轻，去掉磁石，加入冬桑叶、黑芝麻，随后再去掉钩藤、山栀、甘菊、羚羊角等药，加入党参，用桑葚熬膏，并配合阿胶制成丸药。病情逐渐安稳。
痉症，表现为身体强直而背部反张，病位在筋脉。筋脉由血液滋养濡润，若受到邪气侵袭则形成痉证。《内经》记载：“各种痉证引起的项部强直，都归属于湿邪。”也有因寒邪或风邪不同而分为刚痉和柔痉的；有因误用发汗或误用攻下法而导致痉证的；有疮疡患者发汗后致痉的；有遭遇中风突然仆倒后致痉的；有产后失血过多致痉的；有小儿急惊风和慢惊风致痉的；有破伤后风湿之邪转化为痉证的；有突发疾病忽然出现牙关紧闭、头部摇动、两目上视、身体反折的，这些都属于痉病范畴。其症状包括身热足冷、项部强直、牙关紧闭、手足抽搐牵引、角弓反张，脉象多呈沉伏、弦紧。其病因多由血液亏虚干燥，筋脉失去濡养，风寒湿热之邪得以侵袭经络而发病。这也是陈无择、薛立斋、张介宾等医家明确指出痉证属于亡血阴虚的原因。因此，治疗应当滋补营阴津液以治本，疏解风湿以治标。
若病症属表证，如《金匮要略》所言：“太阳病发热无汗，反而恶寒，称为刚痉”，主方用葛根汤。“太阳病发热汗出，不恶寒，称为柔痉”，主方用栝蒌桂枝汤。若属里证，痉病患者胸满、牙关紧闭、卧床时背部不能着席、脚部挛急，必定咬齿，属阳明经病，若大便坚硬，可给予大承气汤。若属半表半里证，如《医宗必读》所言：“一侧肢体牵拉抽搐，一眼斜视，属少阳经病”，若伴有往来寒热，用小柴胡汤加桂枝、白芍。这属于三阳经的痉证。
若属三阴经痉证，均表现为手足厥冷、筋脉拘急、出汗、项部强直、脉沉。太阴痉证则四肢松弛无力不收，用术附汤加甘草、生姜。少阴痉证则闭目合面，用人参附子汤加甘草、生姜。厥阴痉证则头部摇动、牙关紧闭，用附子汤加当归、肉桂。这属于三阴经的痉证。
若是血虚引发的痉证，宜用大营煎。血虚兼有火热，必然脉象洪大、心烦发热，主方用一阴煎。火热炽盛导致阴血干枯，用保阴煎、玉女煎。津液亏虚且汗多，宜用三阴煎。汗多兼有火热，用当归六黄汤。痰火引发的痉证，用栝蒌枳实汤。风热痰壅引发的痉证，用祛风导痰汤。呕吐腹泻引发的痉证，用胃关煎，或者温胃饮。身体寒冷、痉厥、脉象沉细，用参附汤、十全大补汤。暑热之风抽搐成痉，用三物香薷汤加羌活、防风、黄芪、白芍。温邪劫夺津液成痉，用复脉汤，去掉干姜、肉桂。产后血虚，汗多成痉，用十全大补汤，若无效，紧急加入附子。三因制宜方面用小续命汤，适宜去掉麻黄。
陈无择说：“寒性凝涩血液，所以无汗且恶寒，称为刚痉。风性疏散气机，所以有汗且不恶寒，称为柔痉。”推究其起因，多由亡血导致筋脉失去濡养，所以邪气得以侵袭。徐忠可说：“发热恶寒无汗，本是伤寒症状，若发展成痉证，是太阳寒湿相搏而侵犯少阴，所以恶寒，寒性劲急，所以叫刚痉。发热有汗不恶寒，本是伤风并见阳明症状，若发展成痉证，是太阳阳明伤湿兼受风邪，风性温和，所以叫柔痉。”张仲景用葛根汤治疗刚痉，是为了杜绝太阳项强渐成阳明胸满的趋势。用栝蒌桂枝汤治疗柔痉，是为了滋润太阳经已耗伤的津液，使经气通畅，散发风邪湿气。用大承气汤治疗里证，是因为热邪入内，所以直接攻伐胃腑而邪气消散。
薛立斋说：“通过有汗无汗来辨别刚痉柔痉，又通过是否厥逆来辨别阴阳。张仲景虽然说过痉证都是身热足寒，然而阳证不出现厥逆，出现厥逆的，都是阴证。”
张介宾说：“筋脉拘急，所以身体反张；血液枯燥，所以筋脉挛缩。看张仲景所说：‘太阳病发汗太多，则导致痉证。’‘风病误用攻下则形成痉证。’‘疮家不可发汗，发汗则致痉。’可知误汗损伤津液，误下损伤阴气，阴液受伤而筋脉失去滋养。如中风的痉证，必然是年力衰残，阴气败坏所致。产后的痉证，必然是失血过多，冲任二脉枯竭所致。溃疡病的痉证，必然是血液随脓液化去，营气枯竭所致。小儿的痉证，或是风热伤阴，为急惊风；或是吐泻亡阴，为慢惊风。这些虽然不是因为误治引起，但总属于阴虚的病症。治疗这类病症，先以气血为主，邪气盛的或许兼治邪气，若邪气微弱则急需培补元气，元气恢复，血脉自然运行，微邪自然去除。如果从风证治疗，恐怕难免失误。”
Ms. Sui, nearing sixty years of age, has frequently suffered from limb numbness and dizziness. This spring, numbness on the right side of her head extended to the tip of her tongue, accompanied by slurred speech (Yan Jian), red eyes, swollen gums, and toothache. This is due to the rebellious ascent of Jue Yang Qi (Vessel of Shaoyin), which stirs up phlegm-fire, invading the orifices and collaterals. Mild cases manifest as numbness and blurred vision; severe cases lead to deviation of the mouth and eye, inability to move the limbs freely, hemiplegia, and stroke-like syndromes, which develop gradually over time. Treatment should employ nourishing Yin and subduing Yang to extinguish wind; a slow effect is appropriate. Prescription: Shu Di Huang (Prepared Rehmannia Root) 4 qian, Gou Teng (Uncaria Rhynchophylla) 3 qian, Shi Hu (Dendrobium Stem), Qi Zi (Goji Berry), Fu Shen (Poria with Hostwood), Bai Shao (White Peony Root), Mu Li (Oyster Shell), Ci Shi (Magnetite) each 2 qian, Ling Yang Jiao (Antelope Horn) 7 fen, Shan Zhi (Gardenia Fruit), Gan Ju (Chrysanthemum Flower) all stir-fried, each 1 qian. After taking more than ten doses, symptoms subsided. Ci Shi was removed, Dong Sang Ye (Mulberry Leaf) and Hei Zhi Ma (Black Sesame Seed) were added. Subsequently, Gou Teng, Shan Zhi, Gan Ju, and Ling Yang Jiao were removed, and Lu Shen (Codonopsis Root) was added. Mulberry fruit was decocted into an extract and combined with E Jiao (Donkey-hide Gelatin) to make pills. The condition gradually stabilized.
Jing Syndrome (Spasm/Opisthotonos) is characterized by body stiffness and backward arching of the back; the pathology lies in the sinews. Sinews are nourished by blood; when injured by pathogenic factors, Jing syndrome forms. The Classics state: "All spasms with neck stiffness belong to Dampness." There are also Gang Jing (Rigid Spasm) and Rou Jing (Flaccid Spasm) differentiated by Cold or Wind pathogens. Jing syndrome can result from erroneous sweating or purgation, sweating in patients with sores/ulcers, sudden collapse from wind-stroke, excessive blood loss postpartum, acute or chronic convulsions in children, or traumatic wind-dampness transforming into spasm. Sudden onset of trismus, head shaking, upward staring of eyes, and opisthotonos also constitute Jing syndrome. Symptoms include fever in the upper body and cold feet, neck stiffness, trismus, twitching of hands and feet, and opisthotonos. The pulse is typically deep, hidden, wiry, and tight. Etiology often involves deficiency and dryness of blood, causing sinews and vessels to lose nourishment, allowing Wind-Cold-Damp-Heat pathogens to invade the meridians. This is why Chen Wuzhe, Xue Lizhai, and Zhang Jiebin emphasized that Jing syndrome belongs to blood loss and Yin deficiency. Therefore, treatment should nourish Ying fluids to address the root and disperse Wind-Dampness to address the branch.
If the syndrome is exterior, as stated in *Jin Gui Yao Lue*: "Taiyang disease with fever, no sweat, and aversion to cold is Gang Jing," treated with Ge Gen Tang (Kudzu Decoction). "Taiyang disease with fever, sweating, and no aversion to cold is Rou Jing," treated with Gua Lou Gui Zhi Tang (Trichosanthes Root and Cinnamon Twig Decoction). If interior, Jing syndrome with chest fullness, trismus, inability to lie flat (back not touching the bed), leg cramps, and teeth grinding belongs to Yangming. If stool is hard, Da Cheng Qi Tang (Major Order the Qi Decoction) may be given. If half-exterior half-interior, as stated in *Yi Tong*: "Unilateral twitching and one eye deviated belongs to Shaoyang." If accompanied by alternating chills and fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Gui Zhi (Cinnamon Twig) and Bai Shao (White Peony Root) is used. These are the three Yang Jing syndromes.
For the three Yin Jing syndromes, all present with cold extremities, sinew constriction, sweating, neck stiffness, and a deep pulse. Taiyin Jing presents with flaccidity of the four limbs, treated with Zhu Fu Tang (Atractylodes and Aconite Decoction) plus Gan Cao (Licorice Root) and Sheng Jiang (Fresh Ginger). Shaoyin Jing presents with closed eyes and face turned inward, treated with Shen Fu Tang (Ginseng and Aconite Decoction) plus Gan Cao and Sheng Jiang. Jueyin Jing presents with head shaking and trismus, treated with Fu Zi Tang (Aconite Decoction) plus Dang Gui (Angelica Sinensis) and Rou Gui (Cinnamon Bark). These are the three Yin Jing syndromes.
For Jing caused by blood deficiency, Da Ying Jian (Great Nourishing Decoction) is suitable. For blood deficiency with fire, manifested by a surging pulse and irritability/fever, Yi Yin Jian (One Yin Decoction) is primary. For excessive fire drying out Yin blood, Bao Yin Jian (Preserve Yin Decoction) and Yu Nu Jian (Jade Woman Decoction) are used. For fluid deficiency with profuse sweating, San Yin Jian (Three Yin Decoction) is indicated. For profuse sweating with fire, Dang Gui Liu Huang Tang (Angelica Sinensis and Six Yellow Decoction) is used. For phlegm-fire induced Jing, Gua Lou Zhi Shi Tang (Trichosanites Root and Immature Bitter Orange Decoction) is used. For Wind-Heat and Phlegm obstruction inducing Jing, Qu Feng Dao Tan Tang (Expel Wind and Guide Out Phlegm Decoction) is used. For vomiting and diarrhea inducing Jing, Wei Guan Jian (Stomach Gate Decoction) or Wen Wei Yin (Warm Stomach Infusion) is used. For cold body, Jing, and syncope with a deep-thin pulse, Shen Fu Tang and Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) are used. For summerheat-wind convulsions leading to Jing, San Wu Xiang Ru Tang (Three Ingredient Elsholtzia Decoction) plus Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root), Huang Qi (Astragalus Root), and Bai Shao is used. For warm pathogens depleting fluids leading to Jing, Mai Mai Fu Mai Tang (Decoction for Restoring the Pulse) is used, removing Jiang (Ginger) and Gui (Cinnamon). For postpartum blood deficiency with profuse sweating leading to Jing, Shi Quan Da Bu Tang is used; if ineffective, Fu Zi (Aconite) should be urgently added. For the Three Causes, Xiao Xu Ming Tang (Minor Extending Life Decoction) is used, preferably without Ma Huang (Ephedra).
Chen Wuzhe said: "Cold congeals blood, hence no sweat and aversion to cold, termed Gang Jing. Wind disperses Qi, hence sweating and no aversion to cold, termed Rou Jing." Investigating the cause, it mostly stems from blood loss, where sinews lose nourishment, allowing pathogens to invade. Xu Zhongke said: "Fever, aversion to cold, and no sweat are originally Shang Han (Cold Damage) symptoms; if they develop into Jing, it is Taiyang Cold-Damp clashing and invading Shaoyin, hence aversion to cold. Cold is rigid, hence 'Gang'. Fever, sweating, and no aversion to cold are originally Shang Feng (Wind Injury) with Yangming symptoms; if they develop into Jing, it is Taiyang-Yangming dampness injury with Wind. Wind is warm, hence 'Rou'." Zhang Zhongjing uses Ge Gen Tang to treat Gang Jing to prevent Taiyang neck stiffness from progressing to Yangming chest fullness. He uses Gua Lou Gui Zhi Tang to treat Rou Jing to moisten depleted fluids in Taiyang, unblocking meridian Qi and dispersing Wind-Damp. He uses Da Cheng Qi Tang for interior syndromes because heat pathogens have entered internally, so he directly attacks the Stomach to dissipate the pathogen.
Xue Lizhai said: "Differentiate Gang and Rou by presence or absence of sweat; differentiate Yin and Yang by presence or absence of Jue Ni (cold extremities/reversal). Although Zhongjing stated Jing involves fever and cold feet, Yang syndromes do not involve Jue Ni; those with Jue Ni are all Yin syndromes."
Zhang Jiebin said: "Sinew constriction causes backward arching; blood dryness causes sinew cramping. Observe Zhongjing's statement: 'Excessive sweating in Taiyang disease leads to Jing.' 'Purgation in Wind diseases leads to Jing.' 'Patients with sores must not sweat; sweating leads to Jing.' Thus, erroneous sweating damages fluids, erroneous purgation damages Yin. When Yin fluids are damaged, sinews lose nourishment. Stroke-related Jing occurs in those with declining vitality due to Yin failure. Postpartum Jing results from excessive blood loss depleting the Chong and Ren vessels. Ulcer-related Jing results from blood loss with pus, depleting Ying Qi. Pediatric Jing is either Ji Jing (Acute Convulsion) from Wind-Heat damaging Yin, or Man Jing (Chronic Convulsion) from vomiting/diarrhea losing Yin. Although not caused by erroneous treatment, these all belong to Yin deficiency syndromes. Treating such syndromes prioritizes Qi and Blood. If pathogens are strong, treat them concurrently; if weak, urgently tonify Yuan Qi. Once Yuan Qi recovers, blood vessels function naturally, and minor pathogens dissipate. Treating this as a Wind syndrome is difficult to avoid error."
Danxi said: "Jing resembles Xian (Epilepsy) but differs. Xian features a soft body with periodic recovery. Jing features a stiff body without periodic recovery; severe cases may lead to coma and death."