大意
诸痉强直。皆属于湿。（经文）湿属太阴脾土。土太过反兼风化制之。然兼化者。虚象。而实非风也。大率属气
血虚弱。有火有痰。（丹溪）故身如角弓。四肢强直曰 。
内因
人之筋。各随经络退出于身。血气内虚。筋无所养。故邪得以入之。（三因）然虽外因风寒湿气。内因六欲七
情。皆必挟痰火而后发。（入门）
外候
外症身热足冷。颈项强急。恶寒面赤。手足搐搦。目脉赤。独头摇。卒口噤。背反张者。太阳经 也。若偏在左
眼左手搐搦者。少阳经 也。（伤寒书）
分刚柔
发热恶寒。搐搦无汗者。刚 也。不热恶寒。厥冷汗出者。柔 也。大抵刚 。必先伤寒。而后伤湿。柔 。必先
伤湿。而后伤风也。（汇补）
分阴阳
阳极则为刚。多类风 。宜清热化痰祛风。阴极则为柔。多类厥症。宜温补化痰降火。（汇补）
分风痰痰火
发时昏冒不醒。口眼歪斜。手足搐搦。左右摇动者。风痰也。若发热面赤。喘嗽生痰者。痰火也。大段由淡火
内炽。风热外煽。相搏而成也。（汇补）
诸病变
太阳病。发汗过多则 。风病。下之亦 。复发汗。必拘急。疮家虽身痛。不可汗。汗之则 。产后血虚。腠理不
密。风邪搏之则 。原其所由。皆属气血两亏。不足之症。宜参、术浓煎。佐以竹沥、姜汁。时时啜之。如不应。换
以十全大补汤。（汇补）
虚 非风
有绝无风邪。而筋脉挛急。角弓反张者。此气血虚极。不能养筋也。（正传）凡老年气血衰少。夜着风寒。脚腿筋急
者。亦血虚也。气虚者。补中益气汤。加竹沥。或六君子汤。加黄 、附子。血虚者。四物汤。加羌、防。或大秦艽汤。
痫有别
病发身软。时醒者。为痫。身强直。角弓反张。不醒者。为 。（玉机）
死症
病口张目瞪。昏冒无知者。难治。又戴眼反折。手足螈 。汗出如油。或反张离席一掌者。死。小儿离席一
指者。死。（医统）
脉法
病之脉。上下弦急紧。浮盛为风。洪滑为痰。虚濡为虚。急实者为刚 。沉细者为阴 。伏弦者危。凡 脉
如雨溅出指外者。死。（汇补）
治法
惟宜补血降火。敦土平木。清痰去湿。随症而用。（刘纯）暴起多属痰火。久必是血虚。
风药宜禁
病虚为本。痰为标。切不可纯用风药。故血药在所必加。盖血虚则火旺。火旺则风生。风胜则燥作。能滋
其阴。则风自息。而燥自除。（入门）
补剂当施
阳气者。精则养神。柔则养筋。故气虚筋惕。当用参、 以补之。手得血而能握。足得血而能步。故血虚筋惕。
当用归、地以润之。（汇补）
用药
主以如圣饮。加竹沥、姜汁。有汗。加白术、桂枝。无汗。加苍术、麻黄。或加干葛。痰多。加贝母、栝蒌、枳实、
苏子。火盛。加山栀、门冬、花粉。去羌、防、柴、芍、芷、半、乌药。如口噤切牙。大便实者。加大黄。气虚。加人
参、黄 。血虚。加熟地、黄 。产后去血过多成 者。同治。养筋。加秦艽、钩藤、续断。行血。加牛膝、独活、木
瓜。
病选方
如圣饮 治刚柔二 。螈 同治。
羌活（上） 黄芩（中） 川芎（中） 白芷（中） 柴胡（中） 芍药（中） 人参（中） 当归（中） 甘草
（下） 半夏（下） 乌药（中）
当归补血汤 治去血过多。筋无血养。令人四肢挛急。口噤如 。
黄 （上） 当归（中） 羌活（下） 防风（下） 甘草（下）
水煎。
防风当归饮 治发汗过多。发热头摇。口噤反张。祛风养血。
防风 当归 川芎 生地
等分。水煎。
举卿古拜散 治新产血虚发 。汗后中风。
荆芥穗不拘多少。微炒为末。每服三五钱。以大豆黄卷炒。以热酒汰之。去黄。用汁调下。其效如神。
【大意】
各种痉病（以项背强直、四肢抽搐为主要表现的病证），其病机多归属于湿邪。（出自经文）湿邪属于太阴脾土。当脾土之气过盛时，反而会兼夹风象来制约它。然而这种兼夹的风象，本质上是虚损的表现，实际上并非真正的风邪。大抵上，这属于气血虚弱，并伴有火邪或痰浊。（丹溪观点）所以身体像角弓一样反张，四肢强直，称为“痉”。
【内因】
人体的筋脉，各自随着经络分布于全身。如果体内气血亏虚，筋脉得不到濡养，外邪就容易侵入。（《三因方》观点）虽然外感风寒湿邪，或内伤六欲七情，但都必须夹杂痰火才会发病。（《入门》观点）
【外候】
外在症状表现为：身体发热而足部发冷，颈项强直紧急，怕冷且面部发红，手足抽搐，眼脉络色红，只有头部摇动，突然牙关紧闭，背部向后反折如弓状，这是太阳经的痉病。如果症状偏于左侧，出现左眼和左手抽搐，这是少阳经的痉病。（《伤寒书》观点）
【区分刚柔】
发热、怕冷、抽搐且无汗的，属于刚痉。不发热、怕冷、手脚厥冷且出汗的，属于柔痉。大概来说，刚痉必定先感受寒邪，而后感受湿邪；柔痉必定先感受湿邪，而后感受风邪。（《证治汇补》观点）
【区分阴阳】
阳气亢极则表现为刚痉，多类似风痉，适宜清热、化痰、祛风。阴气亢极则表现为柔痉，多类似厥症，适宜温补、化痰、降火。（《证治汇补》观点）
【区分风痰与痰火】
发病时昏沉冒昧不醒人事，口眼歪斜，手足抽搐，左右摇动的，属于风痰。若伴有发热、面赤、气喘咳嗽且生痰多的，属于痰火。大体上是由相火在内炽盛，风热在外煽动，相互搏结而形成的。（《证治汇补》观点）
【诸病变】
太阳病，如果发汗过多，就会转为痉病。风病，如果误用攻下法，也会转为痉病。再次发汗，必然导致拘急。疮疡患者即使身体疼痛，也不可发汗，若强行发汗，就会转为痉病。产后血虚，腠理不密，风邪侵袭就会转为痉病。推究其根源，都属于气血两亏的不足之症。适宜用人参、白术浓煎，佐以竹沥、姜汁，时时饮用。如果无效，换用十全大补汤。（《证治汇补》观点）
【虚痉非风】
有的完全没有风邪，却出现筋脉挛急、角弓反张的情况，这是因为气血极度虚弱，不能濡养筋脉所致。（《正传》观点）凡是老年人气血衰少，夜间受风寒侵袭，导致腿脚筋脉拘急的，也是血虚。气虚者，用补中益气汤，加竹沥；或者用六君子汤，加黄芪、附子。血虚者，用四物汤，加羌活、防风；或者用大秦艽汤。
【痫病有别】
发病时身体柔软，时而清醒的，是痫病。身体强直，角弓反张，不醒人事的，是痉病。（《玉机》观点）
【死症】
病人张口瞪眼，昏沉无知，难以治疗。又有戴眼（眼球固定向上）、角弓反张、手足抽搐、汗出如油，或者身体反张离床席一掌宽远的，为死症。小儿身体反张离床席一指宽的，也为死症。（《医统》观点）
【脉法】
痉病的脉象，上下弦急紧硬。浮盛有力的属风，洪滑的属痰，虚软的属虚，急实有力的属刚痉，沉细的属阴痉（柔痉）。脉象伏而弦的预后危险。凡是脉象急促，如雨滴溅出指外的，为死症。（《证治汇补》观点）
【治法】
只适宜补血降火，培土抑木（健脾平肝），清化痰浊，去除湿邪，随症状灵活应用。（刘纯观点）突发多属痰火，久病必是血虚。
【禁用风药】
本病以虚为本，痰为标，切不可单纯使用风药。因此必须加入养血药物。因为血虚则火旺，火旺则生风，风胜则燥作。如果能滋养其阴液，则风自息，燥自除。（《入门》观点）
【补剂当施】
阳气，精微部分能养神，柔和部分能养筋。所以气虚导致筋惕肉瞤（肌肉跳动），应当用人参、黄芪来补益。手得到血的濡养才能握持，脚得到血的濡养才能行走。所以血虚导致筋惕肉瞤，应当用当归、地黄来滋润。（《证治汇补》观点）
【用药】
主方用如圣饮，加竹沥、姜汁。有汗的，加白术、桂枝；无汗的，加苍术、麻黄，或者加干葛。痰多的，加贝母、瓜蒌、枳实、苏子。火盛的，加山栀、麦冬、花粉。去掉羌活、防风、柴胡、芍药、白芷、半夏、乌药。如果牙关紧闭、咬齿，大便干实的，加大黄。气虚的，加人参、黄芪。血虚的，加熟地、黄芪。产后失血过多而成痉病的，按此同治。为了养筋，加秦艽、钩藤、续断。为了行血，加牛膝、独活、木瓜。
【痉病选方】
如圣饮：治疗刚痉和柔痉。惊风抽搐也同治。
组成：羌活（上等）、黄芩（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（下等）、半夏（下等）、乌药（中等）。
当归补血汤：治疗失血过多，筋脉无血濡养，导致四肢挛急，口噤不开如角弓反张。
组成：黄芪（上等）、当归（中等）、羌活（下等）、防风（下等）、甘草（下等）。
用法：水煎服。
防风当归饮：治疗发汗过多，发热头摇，口噤反张。功效为祛风养血。
组成：防风、当归、川芎、生地。
用法：等分，水煎服。
举卿古拜散：治疗新产血虚引发的痉病。汗后中风。
组成：荆芥穗不拘多少，微炒研末。每次服用三五钱，用大豆黄卷炒制，用热酒冲洗去豆衣，取汁调服。效果神奇。
[General Principle]
Various Jing diseases (syndromes characterized by stiffness and rigidity of the neck and back, and spasms of the four limbs) are generally attributed to Dampness. (From the Classic text) Dampness belongs to the Taiyin Spleen Earth. When the Qi of Spleen Earth is excessive, it may manifest with Wind-like symptoms to counteract itself. However, this manifested Wind is actually a sign of deficiency, not true Wind. Generally, this belongs to Qi and Blood deficiency, accompanied by Fire or Phlegm. (View of Danxi) Thus, the body arches backward like a bow, and the four limbs become rigid and straight, which is called "Jing" (Spasm).
[Internal Causes]
The tendons of the human body extend throughout the body along the meridians. If internal Qi and Blood are deficient, the tendons lose their nourishment, allowing pathogenic factors to invade. (View from *San Yin Fang*) Although external invasion of Wind-Cold-Dampness or internal injury from the six desires and seven emotions can occur, they must be accompanied by Phlegm and Fire to trigger the disease. (View from *Ru Men*)
[External Manifestations]
External symptoms include: fever in the body but cold feet, stiffness and urgency of the neck and nape, aversion to cold with a red face, spasms of the hands and feet, redness of the eye collaterals, isolated head shaking, sudden lockjaw, and opisthotonos (arching of the back). This is Jing disease of the Taiyang Meridian. If symptoms are biased to the left, with spasms of the left eye and left hand, this is Jing disease of the Shaoyang Meridian. (View from *Shanghan Shu*)
[Distinguishing Gang (Rigid) and Rou (Flexible)]
Fever, aversion to cold, spasms, and absence of sweat indicate Gang Jing (Rigid Spasm). Absence of fever, aversion to cold, cold extremities, and sweating indicate Rou Jing (Flexible Spasm). Generally, Gang Jing results from first contracting Cold, then Dampness; Rou Jing results from first contracting Dampness, then Wind. (View from *Zhengzhi Huibu*)
[Distinguishing Yin and Yang]
Extreme Yang manifests as Gang Jing, resembling Wind Jing, and is suitable for clearing Heat, resolving Phlegm, and expelling Wind. Extreme Yin manifests as Rou Jing, resembling Jue syndromes, and is suitable for warming and tonifying, resolving Phlegm, and descending Fire. (View from *Zhengzhi Huibu*)
[Distinguishing Wind-Phlegm and Phlegm-Fire]
During onset, if there is stupor and unconsciousness, deviation of the mouth and eyes, spasms of the hands and feet, and shaking to both sides, it is Wind-Phlegm. If accompanied by fever, red face, asthma, cough, and abundant phlegm, it is Phlegm-Fire. Broadly speaking, this is formed by the internal blazing of Ministerial Fire and external stirring of Wind-Heat, clashing together. (View from *Zhengzhi Huibu*)
[Variations of the Disease]
In Taiyang disease, excessive sweating leads to Jing disease. In Wind disease, improper purgation also leads to Jing disease. Repeated sweating inevitably causes stiffness. For patients with sores/ulcers, even if they have body pain, sweating therapy is contraindicated; inducing sweating will lead to Jing disease. Postpartum blood deficiency makes the pores loose; invasion of Wind pathogen leads to Jing disease. Tracing the origin, all belong to deficiencies of both Qi and Blood. It is appropriate to decoct Ginseng (*Ren Shen*) and Atractylodes Macrocephala Rhizome (*Bai Zhu*) strongly, assisted by Bamboo Sap (*Zhu Li*) and Ginger Juice (*Jiang Zhi*), taken frequently. If ineffective, switch to Shiquan Dabu Decoction (*Shiquan Dabu Tang*). (View from *Zhengzhi Huibu*)
[Deficiency Jing is not Wind]
Some cases have absolutely no Wind pathogen, yet present with tendon spasms and opisthotonos. This is due to extreme deficiency of Qi and Blood failing to nourish the tendons. (View from *Zhengchuan*) For elderly people with declining Qi and Blood who suffer leg and foot tendon cramps after being exposed to Wind-Cold at night, this is also Blood deficiency. For Qi deficiency, use Buzhong Yiqi Decoction (*Buzhong Yiqi Tang*) with Bamboo Sap (*Zhu Li*); or Liujunzi Decoction (*Liujunzi Tang*) with Astragalus Root (*Huang Qi*) and Prepared Aconite Root (*Fu Zi*). For Blood deficiency, use Siwu Decoction (*Siwu Tang*) with Notopterygium Rhizome (*Qiang Huo*) and Saposhnikovia Root (*Fang Feng*); or Da Qinjiao Decoction (*Da Qinjiao Tang*).
[Differentiation from Epilepsy]
If the body is soft during onset and consciousness returns intermittently, it is Epilepsy (*Xian*). If the body is rigid, with opisthotonos and unconsciousness, it is Jing disease. (View from *Yuji*)
[Fatal Signs]
If the patient has an open mouth, staring eyes, and stupor without awareness, it is difficult to treat. If there is fixed upward gaze (*Daiyan*), opisthotonos, convulsions of hands and feet, sweating like oil, or the body arching away from the bed by a palm's width, it is fatal. For infants, arching away by one finger's width is also fatal. (View from *Yitong*)
[Pulse Diagnosis]
The pulse in Jing disease is wiry, urgent, tight, and hard above and below. Floating and vigorous indicates Wind; surging and slippery indicates Phlegm; deficient and soggy indicates Deficiency; urgent and solid indicates Gang Jing; deep and fine indicates Yin Jing (Rou Jing). Hidden and wiry pulses are critical. Any pulse that is rapid and scattered, like raindrops splashing out from under the fingers, indicates death. (View from *Zhengzhi Huibu*)
[Therapeutic Methods]
It is only appropriate to tonify Blood and descend Fire, strengthen Earth to pacify Wood (Spleen to soothe Liver), clear Phlegm, and remove Dampness, applied according to symptoms. (Liu Chun's view) Sudden onset mostly belongs to Phlegm-Fire; chronic cases must be Blood deficiency.
[Contraindication of Wind-Expelling Drugs]
The root of the disease is Deficiency, and Phlegm is the branch. One must absolutely not use purely Wind-expelling drugs. Therefore, Blood-nourishing herbs must be added. Because Blood deficiency leads to Hyperactive Fire, Hyperactive Fire generates Wind, and excess Wind causes Dryness. If Yin fluids are nourished, Wind will subside naturally, and Dryness will be eliminated. (View from *Ru Men*)
[Application of Tonics]
Yang Qi, in its refined form, nourishes the Spirit; in its gentle form, it nourishes the tendons. Thus, Qi deficiency causing muscle twitching should be treated with Ginseng (*Ren Shen*) and Astragalus Root (*Huang Qi*) to tonify. The hands can grasp when nourished by Blood, and the feet can walk when nourished by Blood. Thus, Blood deficiency causing muscle twitching should be treated with Angelica Sinensis Root (*Dang Gui*) and Rehmannia Root (*Di Huang*) to moisten. (View from *Zhengzhi Huibu*)
[Medication]
The main prescription is Rusheng Yin (*Rusheng Yin*), with Bamboo Sap (*Zhu Li*) and Ginger Juice (*Jiang Zhi*). If sweating, add Atractylodes Macrocephala Rhizome (*Bai Zhu*) and Cinnamon Twig (*Gui Zhi*); if no sweating, add Atractylodis Rhizoma (*Cang Zhu*) and Ephedra Herb (*Ma Huang*), or add Kudzu Root (*Gegen*). If abundant phlegm, add Fritillaria Bulb (*Beimu*), Trichosanthes Fruit (*Gualou*), Immature Bitter Orange (*Zhishi*), and Perilla Seed (*Suzi*). If Fire is excessive, add Gardenia Fruit (*Shanzhi*), Ophiopogon Tuber (*Mendong*), and Trichosanthes Root (*Huafen*). Remove Notopterygium Rhizome (*Qiang Huo*), Saposhnikovia Root (*Fang Feng*), Bupleurum Root (*Chaihu*), Peony Root (*Shaoyao*), Angelica Dahurica Root (*Baizhi*), Pinellia Tuber (*Banxia*), and Lindera Root (*Wuyao*). If there is lockjaw and teeth grinding with dry stool, add Rhubarb (*Dahuang*). If Qi deficient, add Ginseng (*Ren Shen*) and Astragalus Root (*Huang Qi*). If Blood deficient, add Prepared Rehmannia Root (*Shudi*) and Astragalus Root (*Huang Qi*). Postpartum Jing caused by excessive blood loss is treated similarly. To nourish tendons, add Gentian Root (*Qinjiao*), Uncaria Ramulus cum Uncis (*Gouteng*), and Dipsacus Root (*Xuduan*). To invigorate Blood, add Achyranthes Root (*Niuxi*), Pubescent Angelica Root (*Duhuo*), and Papaya Fruit (*Mugua*).
[Selected Formulas for Jing Disease]
**Rusheng Yin**: Treats Gang Jing and Rou Jing. Also treats convulsions.
Ingredients: Notopterygium Rhizome (*Qiang Huo*, Superior grade), Scutellaria Root (*Huangqin*, Medium grade), Ligusticum Chuanxiong Rhizome (*Chuanxiong*, Medium grade), Angelica Dahurica Root (*Baizhi*, Medium grade), Bupleurum Root (*Chaihu*, Medium grade), Peony Root (*Shaoyao*, Medium grade), Ginseng (*Renshen*, Medium grade), Angelica Sinensis Root (*Danggui*, Medium grade), Licorice Root (*Gancao*, Inferior grade), Pinellia Tuber (*Banxia*, Inferior grade), Lindera Root (*Wuyao*, Medium grade).
**Danggui Buxue Tang**: Treats excessive blood loss leading to lack of blood nourishing the tendons, causing limb spasms and lockjaw resembling opisthotonos.
Ingredients: Astragalus Root (*Huangqi*, Superior grade), Angelica Sinensis Root (*Danggui*, Medium grade), Notopterygium Rhizome (*Qianghuo*, Inferior grade), Saposhnikovia Root (*Fangfeng*, Inferior grade), Licorice Root (*Gancao*, Inferior grade).
Preparation: Decoct in water.
**Fangfeng Danggui Yin**: Treats excessive sweating leading to fever, head shaking, lockjaw, and opisthotonos. Efficacy: Expels Wind and nourishes Blood.
Ingredients: Saposhnikovia Root (*Fangfeng*), Angelica Sinensis Root (*Danggui*), Ligusticum Chuanxiong Rhizome (*Chuanxiong*), Rehmannia Root (*Shengdi*).
Preparation: Equal parts, decoct in water.
**Juqing Gubai San**: Treats postpartum Jing due to blood deficiency. Wind-stroke after sweating.
Ingredients: Schizonepeta Spike (*Jingjie Sui*), amount unspecified. Lightly stir-fried and powdered. Take 3-5 qian per dose. Stir-fry with Soybean Yellow Sprout (*Dadou Huangjuan*), rinse with hot wine to remove the soybeans, and take the juice mixed with the powder. The effect is miraculous.