（痉症诗曰∶强直反如弓，神昏似中风，痰流唇口动，螈 与痫同。）
许叔微治一人，项强筋急不可转侧，自午后发，黄昏时定，此肝肾二脏受风也。谓此必先从足起，少阴之
筋，自足至项。筋者，肝之合。日中至黄昏，阳中之阴，肺也。自离至兑，阴旺阳弱之时，故《灵宝毕法》云∶
离至干，肾气绝而肝气弱，肝肾二脏受邪，故发于此时。用宣州木瓜二个，取盖去瓤，没药二两，乳香二钱半，
二味入木瓜缚定，饭上蒸三四次，烂研成膏。每用三钱，入生地黄汁半盏，无灰酒二盏，暖化温服，及都梁丸
服之而愈。
易思兰治宗室毅斋，年五十二，素乐酒色，九月初，忽倒地，昏不知人，若中风状，目闭气粗，手足厥冷，
身体强硬，牙关紧闭。有以为中风者，有以为中气中痰者，用乌药顺气散等药俱不效。有作夹阴治者，用附子
理中汤，愈加痰响。五日后召易诊，六脉沉细紧滑，愈按愈有力。曰∶问此何病？曰∶寒湿相搏，痉病也。痉
属膀胱，当用羌活胜湿汤主之。先用稀涎散一匕，吐痰一二碗，昏愦即醒，随进胜湿汤六剂全愈。以八味丸调
理一月，精神复常。其兄宏道问曰∶病无掉眩，知非中风。然与中风、中痰、夹阴，似亦无异，何以独以痉名
之？夫痉缘寒湿而成，吾宗室之家，过于浓暖有之，寒湿何由而得？易曰∶运气所为，体虚者得之。本年癸酉，
戊癸化火，癸乃不及之火也。经曰∶岁火不及，寒水侮之。至季夏土气太旺，土为火子，子为母复仇，土挟制
水。七月八月，主气是湿，客气是水，又从寒水之气，水方得令，不服土制，是以寒湿相搏，太阳气郁而不行，
其症主脊背项强，卒难回顾，腰似折，项似拔，乃膀胱经痉病也。宏道曰∶痉缘湿而成，乌药顺气等药，行气
导痰去湿者也。附子理中，去寒者也，何以不效？用胜湿汤何以速效？易曰∶识病之要，贵在认得脉体形症。
用药之法，全在理会经络运气。脉症相应，药有引经，毋伐天和，必先岁气，何虑不速效耶？夫脉之六部俱沉
细紧滑，沉属里，细为湿，（此句可疑，《脉诀》以濡为湿，并无以细为湿之说。）紧为寒中，又有力而滑，
此寒湿有余而相搏也。若虚脉之症，但紧细而不滑。诸医以为中风，风脉当浮，今不浮而沉，且无眩掉等症，
岂是中风？以为中气中痰，痰气之脉不紧，今脉紧而体强直，亦非中气中痰，故断为痉病。前用乌药、附子
理中汤，去寒不能去湿，去湿不能去寒，又不用引经药，何以取效？胜湿汤， 本、羌活乃太阳之主药，
通利一身百节，防风、蔓荆能胜上下之湿，独活散少阴肾经之寒，寒湿既散，病有不瘳者乎？
张路玉治吴江郭邑侯公子，患柔痉。用桂枝汤及六味地黄汤，咸加蝎尾，服之而愈。
朱丹溪治王秀，湿热大作，脚痛，手筋拘挛，足乏力。生地、当归、川芎、白术各二钱，苍术一钱，甘草
炙三分，木通五分，煎汤下大补丸三十丸。大补丸须炒暖。
张子和治新寨马叟，年五十九，因秋欠税，官杖六十，得惊气，成风搐，已三年矣。病大发则手足颤掉，
不得持物，食则令人代哺，口目张 ，唇舌嚼烂，抖擞之状，如线引傀儡。每发市人皆聚观，夜卧发热，衣被
尽去。倾产求医，致破其家，而病益坚。叟之子，邑中旧小吏也，以讯张。张曰∶此病甚易治。若隆暑时，不
过一涌再涌，夺则愈矣。今以秋寒，可汗之。如未已，更刺俞穴必愈。先以通圣散汗之，继服涌剂，出痰三四
升，如鸡黄成块，状如汤热。叟以手颤不能自探，妻与代探，咽嗌肿伤，昏愦如醉。约一二时许，寻稍省，又
下数行，立觉足轻颤减，热亦不作，足亦能走，手能巾栉，自持匙箸。未至三涌，病去如濯。病后但觉极寒，
张曰∶当以食补之，久则自退。盖大疾之去，卫气未复，故宜以散风导气之药，切不可以热剂温之，恐反成他病也。
按∶是症本因惊而得，尤不能无郁也。盖惊入心，受之则颠痫。今心不受，而反传之肝，而为螈 ，
亦母救其子之义也。肝病则乘其所胜，于是生风生痰，怪症莫测，治以上涌下泄，乃发而兼夺之理，并行
不悖。张案于此症，尤为合法。
黄如一村翁，两手搐搦，喘如曳锯，冬月不能覆被。名医张某之舞阳，道经黄如，不及用药，针其人大指
后中注穴上。曰∶自肘以上皆无病，惟两手搐搦，左氏所谓风淫末疾者此也。或刺后溪，手太阳穴也，屈小指
握纹尽处是穴也。
完颜氏病搐，先右臂并左足，约搐六七十数，两目直视，昏愦不识人，几月余，求治。先逐其寒痰三四升，
次用导水禹功散，泄二十余行，次服通圣散辛凉之剂，不数日而瘥。
薛立斋治一妇人，素有内热，月经不调，经行后四肢不能伸，卧床半载。或用风湿痰火之剂，数日而不见
效。其脉浮缓，按之则滑，名曰痉症，属风寒所乘。用加味逍遥散加肉桂、防风，四剂顿愈。更以八珍汤，调
理两月余而瘥。
一妇人素经行后期，因劳怒，四肢不能屈，名曰 症。此血虚而风热所乘，先用八珍汤加钩藤、柴胡渐愈。
更佐以加味逍遥散，调理而痊。
一妇人素有火，忽然昏愦，螈 抽搐，善伸数欠，四肢筋挛，痰涎上升，此肺金燥甚，血液衰少而然也。
用清燥汤，六味汤丸兼服，寻愈。
薛立斋治一妇人，因怒，经事淋沥，半月方歇。遇怒，其经即至，甚则口噤筋挛，鼻血头痛，痰涎搐搦，
瞳子上视。此肝火炽甚，以小柴胡汤加熟地、山栀、钩藤治之，后不复发。
一妇人素阴虚，患遍身瘙痒，误服祛风之药，口噤抽搐，肝脉洪数。薛曰∶肝血为阴为水，肝气为阳为火，
此乃肝经血虚火盛耳。宜助阴血，抑肝火，用四物、麦冬、五味、钩藤、炙草调理而痊。
一妇人发 遗溺，自汗面赤，或时面青，饮食如故，肝脉弦紧。此肝经血燥风热，痉症也。肝经属木，其
色青，入心则赤。法当滋阴血，清肝火，遂用加味逍遥散，不数剂诸症悉退而安。
许叔微云∶同官歙丞张德操，常言其内子，昔患筋挛，脚不得屈伸逾年，动则令人抱持，求医于泗水杨吉
老。云∶此筋病，宜服下三方，一年而愈。春夏服养血地黄丸∶熟地、蔓荆、山萸、狗脊、地肤子、白术、干
漆、蛴螬、天雄、车前、萆 、山药、泽泻、牛膝。秋服羚羊汤∶羚羊角、附子、独活、白芍、防风、川芎。
冬服乌头汤∶大乌头、细辛、川椒、甘草、秦艽、附子、官桂、白芍、干姜、茯苓、防风、当归、独活。
马元仪治章氏妇，患头身振摇，手足螈 ，诸治不效。诊之，两脉浮虚兼涩。浮为气虚，涩为血伤，得忧
思劳郁，阳明损甚也。盖阳明胃为气血之海，主束筋骨而利机关，若气血不充，则筋脉失养，而动惕不宁。仲
景云∶发汗则动经，身为振振者，茯苓桂枝白术甘草汤主之。凡汗伤津液，犹足扰动经脉，况气血内涸乎。但
彼有外邪搏饮，当涤饮散邪，俾津液四布，以滋养筋经筋脉。此属劳郁所伤，必峻补阳明，使气血内盛，以充
灌周身。令服参、乳，两月而安。
立斋治一人感冒后发痉，不醒人事，磨伤膂肉三寸许一块。此膀胱经必有湿热，诊其脉果数。谓此死肉最
毒，宜速去之，否则延溃良肉，多致不救。遂取之，果不知疼痛。因痉不止，疑为去肉所触。谓此风热未已，
彼不听，另用乳、没之剂，愈甚。复以祛风消毒药敷贴，查春田饮以祛风凉血降火化痰之剂而愈。金工部载阳，
伤寒后亦患此，甚危，亦取去死肉，以神效当归膏敷贴，以内疏黄连汤饮之。狂言愈盛，其脉愈大，更以凉膈
散二剂，又以四物汤加芩、连数剂而愈。凡患疮者，责效太迫，服一二剂未应，辄改服他药，反致有误。不思
病者有轻重，治有缓急，而概欲责效于二三剂之间难矣。况疮疡一症，其所来症深毒久，有形症在肌肉溃损，
较之感冒无形之疾不同，安可旦夕取效？患者审之。
吴桥治程嗣思，体肥白，疡药过当，腠理皆疏，始觉汗多，久而益甚。一发则汗下如雨，厥逆反张，口噤
目瞪，痰喘并作，良久气反，小便不禁，瞑不能言，旬日益深，日十数作。诸医谢去。桥至而按诸方，则曰∶
经云汗多亡阳，此柔痉也，诸君失之矣。乃重用参、 ，次附、桂、芍药，次龙骨、牡蛎，饮之半剂而寝。家人
以为死矣，将升屋而号。桥曰∶药中病而行，得寝乃复，非死也，亟为粥汤待之。顷之，呻吟呼粥，汤少进，
再剂而愈，三月而复初。（《太函集》。）
（关于痉病的诗说道：身体强直反折如弓形，神志昏迷类似中风，痰液流注于唇口并伴有抽动，抽搐发作与癫痫相同。）
许叔微治疗一名患者，颈部僵硬、筋脉拘急，无法转动侧身，症状从午后开始发作，到黄昏时停止。他认为这是肝肾两脏受风邪侵袭所致。他说这病必定先从足部发起，因为少阴经的筋脉，从足部上行至颈部。筋是肝所合的脏腑组织。中午到黄昏，属于阳中之阴，对应肺金。从午时（离）到酉时（兑），是阴气旺盛、阳气衰弱的时刻，所以《灵宝毕法》中说：从离卦到乾卦，肾气竭绝而肝气虚弱，肝肾两脏受到邪气侵袭，因此在这个时间段发病。使用宣州木瓜两个，去掉盖子和瓤，放入没药二两、乳香二钱半，将这两味药装入木瓜中捆扎固定，放在饭上蒸三四次，直到烂熟后研磨成膏。每次服用三钱，加入生地黄汁半盏、无灰酒二盏，加热融化后温服，同时服用都梁丸，最终痊愈。
易思兰治疗宗室毅斋，五十二岁，平时喜好酒色。九月初，突然倒地，昏迷不省人事，状似中风，眼睛闭合，呼吸粗重，手足冰冷，身体强硬，牙关紧闭。有人认为是中风，有人认为是中气或中痰，使用乌药顺气散等药物均无效。有人按夹阴证治疗，使用附子理中汤，反而使痰声更响。五天后邀请易思兰诊治，六脉沉细紧滑，越按越有力。易思兰问：这是什么病？回答说：寒湿相搏结，是痉病。痉病归属于膀胱经，应当用羌活胜湿汤为主方治疗。先用稀涎散一匕，吐出痰液一二碗，昏愦症状随即清醒，接着服用胜湿汤六剂，完全康复。随后用八味丸调理一个月，精神恢复常态。其兄宏道问道：此病没有眩晕掉摇的症状，知道不是中风。然而它与中风、中痰、夹阴似乎也没有太大区别，为什么唯独命名为痉病？易思兰说：痉病源于寒湿而成。我们宗室之家，过于穿着浓暖衣物是有的，但寒湿是如何得来的呢？《易经》说：这是运气所致，体质虚弱的人容易得此病。本年癸酉年，戊癸化火，癸水是不及之火。医经说：岁火不及，寒水就会侮犯它。到了季夏土气太旺，土为火之子，儿子为母亲复仇，土克制水。七月八月，主气是湿，客气是水，又加上寒水之气，水正当令，不服从土的制约，因此寒湿相搏结，太阳经气郁滞而不运行，其症状主要表现为脊背项部僵硬，突然难以回顾，腰部像折断一样，项部像被拔起一样，这是膀胱经的痉病。宏道说：痉病因湿而成，乌药顺气散等药物，是行气导痰祛湿的；附子理中汤是去寒的，为什么无效？用胜湿汤为什么能迅速见效？易思兰说：认识疾病的关键，贵在认清脉象、形体和症状。用药的方法，全在于理解经络和运气。脉症相应，药物有引经作用，不损伤天和之气，必须首先考虑当年的岁气，何必担心不能迅速见效呢？那脉象六部俱见沉细紧滑，沉属里证，细主湿邪（此句存疑，《脉诀》以濡脉为湿，并无以细脉为湿的说法），紧主寒邪入里，又有力且滑，这是寒湿有余而相互搏结的表现。如果是虚证的脉症，只是紧细而不滑。各位医生认为是中风，风邪的脉象应当浮，现在不浮而沉，且没有眩晕掉摇等症状，难道是中风吗？认为是中气中痰，痰气的脉象不紧，现在脉紧且身体强直，也不是中气中痰，所以断定为痉病。之前使用的乌药顺气散、附子理中汤，去寒不能去湿，去湿不能去寒，又没有使用引经药，怎么能取效呢？胜湿汤中，本（苍术）、羌活是太阳经的主药，通利全身关节，防风、蔓荆子能祛除上下之湿，独活能散少阴肾经之寒，寒湿既已消散，哪有病不愈的道理呢？
张路玉治疗吴江郭邑侯的公子，患柔痉。使用桂枝汤及六味地黄汤，都加入了蝎尾，服用后痊愈。
朱丹溪治疗王秀，湿热大作，脚痛，手筋拘挛，足部乏力。用地黄、当归、川芎、白术各二钱，苍术一钱，甘草炙三分，木通五分，煎汤送服大补丸三十丸。大补丸需要炒热服用。
张子和治疗新寨马叟，五十九岁，因为秋天欠缴税款，被官府杖打六十下，受到惊吓之气，形成风搐，已经三年了。病情大发时手足颤抖掉摇，不能持物，吃饭时需要别人喂食，口眼张开，嘴唇舌头被咬烂，身体抖动，像线牵引傀儡一样。每次发作市人都聚集观看，夜间睡觉发热，把衣被全部脱去。倾尽家产求医，导致破产，而病情更加顽固。马叟的儿子是县里的旧小吏，向张子和咨询。张子和说：这个病很容易治。如果在隆暑时节，不过是用涌吐法两次，夺去痰涎就痊愈了。现在是秋寒季节，可以用发汗法。如果还没好，再针刺俞穴必定痊愈。先用通圣散发汗，继服涌吐剂，吐出痰液三四升，像鸡黄一样成块，温度像热水一样。马叟因为手颤不能自己探取咽喉，妻子代他探取，导致咽嗌肿痛受伤，昏愦如醉酒状态。大约一两个时辰后，稍微清醒，又腹泻数次，立刻觉得脚步轻快颤抖减少，发热也不再出现，脚也能走路，手也能梳洗，自己拿勺子筷子。不到三次涌吐，病去如水洗一般干净。病后只感到极度寒冷，张子和说：应当用食物来补益，久了自然会消退。因为大病去除，卫气尚未恢复，所以适宜用散风导气的药物，切不可用热剂温补，恐怕反而变成其他疾病。
按语：这个病症本来是因为惊吓而得的，尤其不能没有郁结。因为惊入心，受之则成颠痫。现在心不受邪，反而传之于肝，而形成抽搐，这也是母救其子的道理。肝病则乘其所胜，于是生风生痰，怪症莫测，治疗上用涌吐和泻下，是发散兼夺邪的原理，并行不悖。张子和的这个医案，对此症的治疗尤为合法。
黄如一村的老人，两手抽搐，喘息如拉锯声，冬天不能盖被子。名医张某路过舞阳，经过黄如处，来不及用药，针刺其人大指后中注穴上方。说：自肘以上都没有病，只有两手抽搐，这就是左氏所说的“风淫末疾”的情况。或者针刺后溪穴，这是手太阳经的穴位，屈小指握拳纹尽处即是该穴。
完颜氏患病抽搐，先是从右臂和左足开始，大约抽搐六七十次，两眼直视，昏愦不识人，持续一个多月，求治。先驱逐寒痰三四升，其次用导水禹功散，泄下二十多次，其次服用通圣散辛凉之剂，几天后就痊愈了。
薛立斋治疗一名妇人，素有内热，月经不调，月经结束后四肢不能伸展，卧床半年。有人用风湿痰火的药物治疗，几天不见效。她的脉象浮缓，按之则滑，名为痉症，属于风寒乘虚而入。使用加味逍遥散加肉桂、防风，四剂后顿愈。再用八珍汤调理两个多月而痊愈。
另一名妇人素来月经后期，因为劳累愤怒，四肢不能弯曲，名为 症（此处原文可能有误，结合上下文应为痉或类似病症，依原文保留）。这是血虚而风热乘虚而入，先用八珍汤加钩藤、柴胡逐渐好转。再佐以加味逍遥散，调理而痊愈。
另一名妇人素有火邪，忽然昏愦，抽搐，喜欢伸懒腰频繁打哈欠，四肢筋脉拘挛，痰涎上升，这是肺金燥甚，血液衰少所致。使用清燥汤，配合六味地黄丸兼服，不久痊愈。
薛立斋治疗一名妇人，因为发怒，月经淋漓不尽，半个月才停止。遇到发怒，月经就来潮，严重时牙关紧闭筋脉拘挛，鼻出血头痛，痰涎抽搐，瞳子上视。这是肝火炽盛，用小柴胡汤加熟地、山栀、钩藤治疗，后来不再复发。
另一名妇人素来阴虚，患遍身瘙痒，误服祛风药物，导致牙关紧闭抽搐，肝脉洪数。薛立斋说：肝血为阴为水，肝气为阳为火，这是肝经血虚火盛罢了。应该助阴血，抑肝火，使用四物汤、麦冬、五味子、钩藤、炙甘草调理而痊愈。
另一名妇人产后遗尿，自汗面赤，有时面青，饮食正常，肝脉弦紧。这是肝经血燥风热，属于痉症。肝经属木，其色青，入心则赤。治法应当滋阴血，清肝火，于是使用加味逍遥散，几剂后诸症悉退而安。
许叔微说：同官歙丞张德操，常说他内子，从前患筋挛，脚不能屈伸超过一年，一动就让人抱着，在泗水杨吉老处求医。杨吉老说：这是筋病，宜服用以下三个方子，一年而愈。春夏服用养血地黄丸：熟地、蔓荆、山萸、狗脊、地肤子、白术、干漆、蛴螬、天雄、车前、萆薢、山药、泽泻、牛膝。秋季服用羚羊汤：羚羊角、附子、独活、白芍、防风、川芎。冬季服用乌头汤：大乌头、细辛、川椒、甘草、秦艽、附子、官桂、白芍、干姜、茯苓、防风、当归、独活。
马元仪治疗章氏妇，患头身振摇，手足抽搐，各种治疗无效。诊察发现，两脉浮虚兼涩。浮为气虚，涩为血伤，因忧思劳郁，阳明胃受损严重。因为阳明胃是气血之海，主束筋骨而利机关，如果气血不充，则筋脉失养，而动惕不宁。仲景说：发汗则动经，身体振振摇动的，用茯苓桂枝白术甘草汤主治。凡是汗出伤津液，尚且足以扰动经脉，何况气血在内枯竭呢？但是彼时有外邪搏结饮邪，应当涤除饮邪散除外邪，使津液四布，以滋养筋经筋脉。这属于劳郁所伤，必须峻补阳明，使气血内盛，以充灌周身。令其服用人参、乳汁，两个月而安定。
立斋治疗一人感冒后发痉，不醒人事，磨伤膂肉三寸许一块。这是膀胱经必有湿热，诊其脉果然数。说这块死肉最毒，宜速去之，否则延溃良肉，多致不救。于是取去死肉，果然不知疼痛。因为痉不止，怀疑是去肉所触动。说这是风热未已，病人不听，另用乳香、没药之剂，病情加重。复以祛风消毒药敷贴，查春田饮以祛风凉血降火化痰之剂而痊愈。金工部载阳，伤寒后也患此症，非常危险，也是取去死肉，用神效当归膏敷贴，以内疏黄连汤饮用。狂言愈盛，其脉愈大，再用凉膈散二剂，又以四物汤加黄芩、黄连数剂而痊愈。凡是患疮者，责效太迫，服一二剂未应，辄改服他药，反致有误。不思病者有轻重，治有缓急，而概欲责效于二三剂之间难矣。况疮疡一症，其所来症深毒久，有形症在肌肉溃损，较之感冒无形之疾不同，安可旦夕取效？患者审之。
吴桥治疗程嗣思，体肥白，疡药过当，腠理皆疏，始觉汗多，久而益甚。一发则汗下如雨，厥逆反张，口噤目瞪，痰喘并作，良久气反，小便不禁，瞑不能言，旬日益深，日十数作。诸医谢去。吴桥至而按诸方，则曰：经云汗多亡阳，此柔痉也，诸君失之矣。乃重用参、 ，次附、桂、芍药，次龙骨、牡蛎，饮之半剂而寝。家人以为死矣，将升屋而号。吴桥曰：药中病而行，得寝乃复，非死也，亟为粥汤待之。顷之，呻吟呼粥，汤少进，再剂而愈，三月而复初。（《太函集》。）
(The poem on Spasm states: The body is stiff and arched backward like a bow, consciousness is clouded similar to stroke, phlegm flows at the lips and mouth with twitching, spasms are identical to epilepsy.)
Xu Shuwei treated a patient whose neck was stiff and sinews were tight, unable to turn or shift position. Symptoms began in the afternoon and subsided by dusk. He believed this was due to wind pathogenic factors invading the Liver and Kidney organs. He stated that this illness must originate from the feet, as the tendons of the Shaoyin meridian ascend from the foot to the neck. Tendons are the external correspondence of the Liver. From noon to dusk is Yin within Yang, corresponding to the Lung metal. From Li (Wu hour) to Dui (You hour) is the time when Yin is prosperous and Yang is weak. Thus, *Lingbao Bi Fa* states: From Li to Qian, Kidney Qi is exhausted and Liver Qi is weak; the Liver and Kidney organs are invaded by pathogenic factors, hence the onset occurs at this time. Two papayas from Xuanzhou were used; the lid was removed and the pulp scooped out. Myrrh (2 liang) and Frankincense (2.5 qian) were placed inside the papaya, tied securely, and steamed over rice three to four times until soft, then ground into a paste. Each dose consisted of 3 qian, mixed with half a cup of fresh Rehmannia juice and two cups of unadulterated wine, warmed and taken warm. Simultaneously, Duliang Wan was administered, resulting in a cure.
Yi Silan treated Zongshi Yizhai, aged fifty-two, who had a history of indulgence in alcohol and sexual activity. In early September, he suddenly collapsed, fell into a coma, resembling stroke, with eyes closed, coarse breathing, cold extremities, rigid body, and locked jaw. Some diagnosed it as stroke, others as Qi stagnation or Phlegm obstruction; treatments with Wuyao Shunqi San and other formulas were ineffective. Another practitioner treated it as "Jia Yin" (concealed yin injury) using Fuzi Lizhong Tang, which exacerbated rattling phlegm. Five days later, Yi Silan was summoned. The six pulses were deep, fine, tight, and slippery, becoming more forceful upon pressure. Yi asked: "What disease is this?" The reply was: "Cold and dampness are struggling together; this is Spasm." Spasm belongs to the Bladder meridian; the primary treatment should be Qianghuo Shengshi Tang. First, Xixian San (one bi) was administered to induce vomiting of one to two bowls of phlegm, after which the stupor cleared. Subsequently, Shengshi Tang was given for six doses, leading to complete recovery. Bawei Wan was then used for conditioning for one month, restoring normal spirit. His brother Hongdao asked: "The disease lacks dizziness and tremors, so we know it is not stroke. However, it seems no different from stroke, phlegm obstruction, or Jia Yin. Why name it specifically as Spasm?" Yi answered: "Spasm arises from cold and dampness. Our royal clan tends to wear overly thick and warm clothing, so how could cold and dampness arise?" The *I Ching* states: This is caused by climate luck (Yunqi); those with deficient constitutions contract it. In the year Gui You, Wu and Gui transform into Fire. Gui represents deficient Fire. The classics state: When yearly Fire is deficient, Cold Water usurps its place. In late summer, Earth Qi is excessive. Earth is the child of Fire; the child avenges the mother, controlling Water. In the seventh and eighth months, the dominant Qi is Dampness, and the guest Qi is Water. Combined with Cold Water energy, Water is in command and does not submit to Earth's control. Thus, cold and dampness struggle together, causing Taiyang Qi to stagnate and fail to circulate. The main symptoms are stiffness in the spine, back, and neck, sudden inability to look back, waist feeling like it is broken, and neck feeling like it is pulled out. This is Spasm of the Bladder meridian. Hongdao said: "Spasm is formed by dampness. Wuyao Shunqi San moves Qi, guides out Phlegm, and removes dampness. Fuzi Lizhong removes cold. Why were they ineffective? Why did Shengshi Tang work quickly?" Yi said: "The key to recognizing disease lies in identifying pulse, form, and symptoms. The method of medication relies entirely on understanding meridians and Yunqi. When pulse and symptoms correspond, and medicines have meridian-guiding properties without violating Heavenly Harmony, considering the annual climate first ensures quick efficacy. The six parts of the pulse were all deep, fine, tight, and slippery. Deep indicates interior; Fine indicates dampness (this sentence is questionable; *Mai Jue* associates Ru pulse with dampness, not Xi pulse); Tight indicates Cold entering the interior; Forceful and Slippery indicate excess Cold and Dampness struggling together. If it were a deficiency pattern, the pulse would be tight and fine but not slippery. Physicians thought it was stroke; Wind pulses should be floating. Now it is not floating but deep, and there are no dizziness or tremor symptoms. Could it be stroke? Thought to be Qi/Phlegm obstruction; Phlegm/Qi pulses are not tight. Now the pulse is tight and the body is rigid. It is neither Qi nor Phlegm obstruction. Hence, diagnosed as Spasm. Previous use of Wuyao and Fuzi Lizhong Tang removed cold but not dampness, and dampness but not cold, without meridian-guiding drugs, how could they work? Shengshi Tang contains Cangzhu and Qianghuo, masters of the Taiyang meridian, clearing the whole body's joints; Fangfeng and Manjingzi overcome upper and lower dampness; Duhuo disperses Cold in the Shaoyin Kidney meridian. Once Cold and Dampness dissipate, how can the disease not heal?"
Zhang Luyu treated the young master of Gu Yihou in Wujiang, suffering from Rou Jing (Soft Spasm). He used Guizhi Tang and Liuwei Dihuang Wan, both added with Scorpion tails (Xiewei), resulting in a cure.
Zhu Danxi treated Wang Xiu, who suffered from severe Damp-Heat, foot pain, hand tendon spasm, and leg weakness. He prescribed Shengdi, Danggui, Chuanxiong, Baizhu (each 2 qian), Cangzhu (1 qian), Zhigancao roasted (3 fen), Mutong (5 fen), decocted in water to administer 30 pills of Dabu Wan. Dabu Wan must be fried warm before ingestion.
Zihe treated Old Man Ma from Xinzhai, aged fifty-nine. Because he failed to pay autumn taxes, he was beaten sixty strokes by officials, contracting Shock Qi, which developed into Feng Chu (Wind Twitching), lasting three years. During severe attacks, hands and feet trembled, unable to hold objects; eating required others to feed him; mouth and eyes opened wide, lips and tongue bitten raw; body shook like a puppet controlled by strings. Crowds gathered to watch each attack. At night, he felt feverish and removed all bedding. He spent his entire fortune seeking medical help, going bankrupt, yet the disease became more stubborn. Ma's son, an old minor clerk in the county, consulted Zihe. Zihe said: "This disease is very easy to treat. If it were midsummer, two applications of emesis (Yong) would remove the phlegm and cure it. Now, in autumn cold, sweating (Han) is indicated. If not cured, acupuncture at Shu points will surely cure it." First, Tongsheng San was used to induce sweating. Then, emetic agents were given, expelling three to four sheng of phlegm, clotted like chicken yolks, hot as boiling water. Due to hand tremors preventing self-probing, his wife probed his throat, causing swelling and injury to the pharynx, leading to stupor like drunkenness. After about one to two hours, he gradually regained consciousness, followed by several bowel movements. Immediately, his steps became lighter, tremors decreased, fever ceased, legs could walk, and hands could comb and dress himself. Before three emetic treatments, the disease was gone as if washed clean. Post-illness, he felt extreme cold. Zihe said: "Nourish with food; it will recede naturally." Since Wei Qi has not recovered after a major disease, dispersing Wind and guiding Qi is appropriate. Hot tonics must be avoided to prevent other diseases.
Commentary: This disease originated from Shock, involving depression/stagnation. Shock enters the Heart; if received, it causes Dian/Xian (Epilepsy). Here, the Heart did not receive it, but it transmitted to the Liver, causing spasms. This follows the principle of the Mother rescuing the Child. Liver disease conquers what it overcomes, generating Wind and Phlegm, producing unpredictable strange symptoms. Treatment via upper emesis and lower purgation follows the logic of simultaneous release and expulsion, which do not contradict each other. Zihe's case management for this symptom is particularly lawful.
An old man in Huangru village suffered from hand spasms and wheezing like sawing wood, unable to cover himself even in winter. Famous Physician Zhang, passing through Huyang en route to Huangru, had no time to prescribe medicine. He needled the Zhongzhu point above the posterior aspect of the great toe. He said: "There is no disease above the elbow; only hand spasms occur. This is what Zuo Shi called 'Wind Yin Mo Ji' (Wind affecting the extremities)." Alternatively, Houxi point (Hand Taiyang meridian) can be needled; located where the small finger bends and the crease ends.
Wanyan suffered from spasms, starting in the right arm and left foot, occurring about 60-70 times, with fixed gaze, stupor, and loss of recognition, lasting over a month. She sought treatment. First, 3-4 sheng of Cold-Phlegm was expelled. Next, Daoshui Yugong San was used to purge over twenty times. Then, Tongsheng San (acrid-cool formula) was taken, leading to recovery in a few days.
Xue Lizhai treated a woman with chronic internal heat and irregular menstruation. After menstruation, her limbs could not extend, keeping her bedridden for half a year. Treatments for Wind-Damp, Phlegm, and Fire showed no effect. Her pulse was floating and slow, slipping upon pressure. Named Spasm, attributed to Wind-Cold invasion. Jiawei Xiaoyao San plus Rougui and Fangfeng was used; four doses resulted in immediate relief. Bazhen Tang was then used for conditioning for over two months, leading to recovery.
Another woman, previously having delayed menstruation, suffered from inability to flex limbs due to labor and anger, named [Spasm]. This was Blood deficiency with Wind-Heat invasion. Bazhen Tang plus Gouteng and Chaihu was used initially for gradual improvement. Jiawei Xiaoyao San was added for conditioning, leading to full recovery.
Another woman with chronic Fire suddenly fell into stupor, experienced spasms, frequent stretching and yawning, limb tendon cramps, and rising phlegm-saliva. This was due to extreme dryness of Lung Metal and decline of Blood. Qingzao Tang was used, combined with Liuwei Dihuang Wan, leading to recovery soon.
Xue Lizhai treated a woman who, due to anger, had dripping menstruation lasting half a month. Upon anger, menstruation restarted; severely, she had locked jaw, tendon cramps, epistaxis, headache, phlegm-saliva, and twitching, with upward deviation of pupils. This was excessive Liver Fire. Xiao Chaihu Tang plus Shudi, Shanzhi, and Gouteng was used; no recurrence thereafter.
Another woman with chronic Yin deficiency suffered from generalized itching. Mistakenly taking Wind-dispelling drugs, she developed locked jaw and convulsions. Liver pulse was洪数 (Surging-Rapid). Xue said: "Liver Blood is Yin/Water; Liver Qi is Yang/Fire. This is Liver Meridian Blood deficiency with Fire excess." Tonify Yin/Blood, suppress Liver Fire using Siwu Tang, Maidong, Wuweizi, Gouteng, and Zhigancao for conditioning, leading to recovery.
Another woman postpartum had urinary incontinence, spontaneous sweating, red face, sometimes blue face, normal diet, and Liver pulse string-tight. This was Liver Meridian Blood dryness with Wind-Heat, classified as Spasm. Liver belongs to Wood, color Green; entering Heart makes it Red. Method: Nourish Yin/Blood, clear Liver Fire. Jiawei Xiaoyao San was used; several doses resolved all symptoms.
Xu Shuwei said: Zhang Decao, Vice Magistrate of Tongguan/Shexian, often spoke of his wife who suffered from tendon cramping, unable to flex/extend legs for over a year, requiring carrying when moving. He sought treatment from Yang Jilao of Sishui. Yang said: "This is a tendon disease. Take these three formulas for one year to cure." Spring/Summer: Yangxue Dihuang Wan (Shudi, Manjing, Shanzhuyu, Gouji, Difuzi, Baizhu, Ganqi, Qicao, Tianxiong, Cheqian, Bibi, Shanyao, Zexie, Niuxi). Autumn: Lingyang Tang (Lingyangjiao, Fuzi, Duhuo, Baishao, Fangfeng, Chuanxiong). Winter: Wutou Tang (Da Wutou, Xixin, Chuanjiao, Gancao, Qinjiao, Fuzi, Guanzi, Baishao, Ganjiang, Fuling, Fangfeng, Danggui, Duhuo).
Ma Yuanyi treated Mrs. Zhang, suffering from head/body trembling and hand/foot spasms, unresponsive to various treatments. Pulse was floating, deficient, and choppy. Floating indicates Qi deficiency; Choppy indicates Blood injury. Caused by worry, thought, labor, and depression, damaging the Yangming significantly. Yangming Stomach is the sea of Qi and Blood, binding sinews/bones and facilitating joints. If Qi/Blood are insufficient, sinews/nerves lose nourishment, causing trembling and restlessness. Zhongjing stated: "Sweating disturbs the channels; body trembling requires Fuling Guizhi Baizhu Gancao Tang." Sweating damages fluids, disturbing channels; how much more so when internal Qi/Blood are depleted? However, here external pathogens struggled with Fluid retention; thus, dispel fluid/pathogens to distribute fluids and nourish sinews/channels. This was damage from labor/depression; must strongly tonify Yangming to fill Qi/Blood throughout the body. Administered Ginseng and Milk; stabilized in two months.
Lizhai treated a man who developed Spasm after a cold, unconscious, with a three-cun patch of necrotic flesh rubbed off. This indicated Damp-Heat in the Bladder meridian; pulse was indeed rapid. He said: "This dead flesh is most toxic; remove it quickly, otherwise it will ulcerate healthy flesh, leading to death." Removal was performed; no pain was felt. Spasm continued, suspected to be triggered by removal. Said: "Wind-Heat persists." Patient refused, used Frankincense/Myrrh instead, worsening condition. Applied Wind-dispelling detoxification paste; used Chuntian Yin (Wind-dispelling, cooling blood, reducing fire, resolving phlegm) for cure. Jin Gongbu Zaiyang also suffered this after Typhoid, critically ill. Necrotic flesh removed, Shenxiao Danggui Gao applied, Neishu Huanglian Tang drunk. Delirium increased, pulse enlarged. Liangge San (two doses) followed by Siwu Tang plus Huangqin/Huanglian (several doses) led to cure. Those with sores often demand quick results; changing medicines after one or two doses without effect leads to error. One must consider disease severity and treatment urgency; expecting results in 2-3 doses is difficult. Sores involve deep, toxic, long-standing pathology with visible muscle damage, unlike invisible colds. How can results be expected overnight? Patients should reflect on this.
Wu Qiao treated Cheng Sisi, fat and white-skinned. Excessive application of sore medicines caused loose pores. Initially felt excessive sweating, worsening over time. Attacks brought sweat pouring like rain, cold reversal, opisthotonos, locked jaw, staring eyes, simultaneous phlegm/wheezing. After a long time, breath returned, urinary incontinence, unconsciousness, inability to speak. Condition deepened over ten days, occurring dozens of times daily. Physicians declined treatment. Wu Qiao examined prescriptions and said: "Classics state: Excessive sweating loses Yang. This is Rou Jing (Soft Spasm). You gentlemen missed it." He heavily used Renshen and [Ginseng root], then Fuzi, Guizhi, Shaoyao, then Longgu, Muli. Half a dose allowed sleep. Family thought he died, preparing to wail on the roof. Wu said: "Medicine acted correctly; sleeping indicates recovery, not death. Prepare porridge immediately." Soon, groaning and calling for porridge occurred. Small amount of soup taken; second dose cured. Recovered fully in three months. (*Taihan Ji*.)