【因】痉者、强直反张之象。以其筋肉牵引。身体强直也。伤寒有变痉病者。项背强是也。太阳中风。
重感寒湿则变痉。或太阳病发汗太多因致痉。余谓痉即脑筋病也。如《金匮》所谓痉病者。身热足寒。
颈项强急。背反张者。乃脊髓之脑筋病。《内经》骨空论。所谓督脉为病。脊强反折是也。恶寒时头热
面赤。独颈动摇。卒口噤者。乃头巅之脑筋病。《难经》所谓督脉为病。病脊强而厥。《内经》所
谓厥成为癫疾是也。徐灵胎云。诸痉项强。皆属于燥。诸暴强直。皆属于风。燥乃太阴燥金之气。风
乃厥阴风木之气。大抵气血虚弱。有火有痰。陈无择云。人之筋脉。各随经络退出于身。血气内虚。
筋失所养。则风寒湿热之气乘之则痉。或七情六欲内扰。均必挟痰火而后发痉。吴鞠通曰。痉症必兼
风而后成。风为百病之长。六淫之邪。皆因风而入。其强直、背反、螈 之状。皆肝风内动为之也。
吴云峰云。痉症体劲直而背反张。头摇戴眼。筋之病也。原其所因。多由亡血。筋无所荣。故邪得以袭之。
所以伤寒汗下过多。与夫病疮人。乃产后致斯疾者。概可见矣。景岳云。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。仲景以汗下为言。谓其误治亡阴所致。如太阳病发汗太
多因致痉。风家下之则成痉。疮家发汗亦成痉。盖发汗必伤血液。误下必伤真阴。阴血伤则筋失所养。
反张强直之病。势所必至也。无择谓气血内虚。邪客为痉。斯
言不无有误。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。岂误治之外。必再受邪而后成痉。无邪则无痉哉。喻嘉言云。小儿
体脆神怯。外感壮热。多成痉病。后世妄以惊风立名。有四证生八候之说。实则指痉病之头摇手痉者。
为惊风之抽掣。指痉病之口噤脚挛急者。为惊风之搐搦。指痉病之卧不着席者。为惊风之角弓反张。
幼科翕然宗之。病家坦然任之。不治外淫之邪。反投金石冰麝之药。十中九死而不悟也。又如新产
妇人。血室空虚。外感袭入而成痉。仲景之所明言。乃辄称产后惊风。妄投汤药。亦千中千死。俗医
谓产后宜温之说。最足误人。产后外感。生化汤加荆芥穗之方。亦最足误事。余历年临证。窃见产后
病寒者。十中二三。病热者。十中七八。轻年少妇。肝阳盛者。尤易病热。时医罔不误治。轻则烦闷
不宁。重则痉厥殒命者。比比然也。张石顽云。痉病有不因误治者。必阴虚血少之人。不能荣养筋脉。
以致筋挛僵仆。如产后之去血过多。冲任竭也。疮家之血随脓出。营气涸也。小儿之有此者。或以风
热伤阴。或以汗泻亡阴。遂为慢惊。总属阴虚。盖精血不亏。虽有邪干。断无筋脉拘急之病。而病至
坚强。其枯可知。故治此者。必以气血为主。而邪甚者兼治邪。若邪微者。不必治。盖此证所急在元
气。元气复。血脉行。则微邪自不能留。何足虑哉。
【证】发热恶寒。搐搦无汗为刚痉。不发热。但恶寒。厥冷汗出为柔痉。产后血虚。腠理不密。
风邪搏之则成痉。病后身软时醒为痫症。身强直反张不醒为痉证。伤寒有变痉病者。项背强直是也。
《经》曰。病身热足寒。头项强急。恶寒时。头热面赤。目脉赤。独头而摇。卒口噤。背反张者痉病。
夫仲景所谓刚痉柔痉者。并属太阳。以太阳行身之后。故头项强急而反张也。《要略》云。痉之为病。
胸满口噤。卧不着席。脚挛急。必 齿。（筋脉屈伸、齿牙作响、是为
齿。）此属阳明。盖阳明行身之前。不能为反张之证。与太阳痉。自是两般也。《此事难知》云。
头低视下。手足牵引。肘膝相构。阳明痉也。然欲行大承气。必须察其内实。脉沉有力者可下之。
若经来寒热。或左右一目斜牵。或左右一手搐搦。脉弦数者少阳痉也。又有伤寒结胸证。项亦强为柔
痉状。此似痉而非痉也。不可以风药误治之。夫风病下之则痉。复发汗必拘急。太阳病发汗太多者。
因致痉。太阳病发热脉沉细名曰痉。为难治。疮家身虽疼痛。不可发汗。汗出则痉。太阳病。其证状
身体强。KT KT 然。脉反沉迟。此为痉。此张仲景辨痉之证候也。
【脉】痉脉紧急。如经直上下行者。急实为阳痉。沉细为阴痉。浮紧数者属阳。沉细涩者属阴。
浮盛为风热。洪滑为痰火。虚濡为气虚。涩数为阴虚。脉 如蛇者。汗虚致痉也。《活人书》云。
痉病。外证发热恶寒。与伤寒同。但脉沉迟弦细为异耳。若脉沉弦而迟及伏弦。或散于指外者。皆危
候也。
【治】阳痉。宜滋阴养血。阴痉、宜扶脾抑肝。至清痉降火。祛风利湿。各随症治。暴起多属邪盛。
久病必是血虚。痉病虚为本。邪为表。太阳证备。身体强。KT KT 然。脉反沉迟者。主以栝蒌桂枝汤。
（栝蒌根三钱、桂枝八分、白芍钱半、甘草五分、姜二片、枣三枚。）刚痉发热。无汗恶寒。小便反少。
脉浮紧者。属中风。重感于寒。葛根汤。或加独活防风。脉弦细数者。属风热伤筋。血脉失约束之权。
致搐搦反张者。主以如圣饮（羌活、秦艽、川芎、白芍、当归、白芷、黄芩、人参、半夏、甘草。）
风痰多。加竹沥、姜汁。无汗加苍术、麻黄。热痰加贝母、栝蒌。火盛加山栀、花粉。口噤便闭。加
大黄。气虚口闭。加参、 。血虚筋急。加归、地。舒筋、加秦艽、川断、钩藤。活血加丹参、红花、
牛膝。柔痉则汗出不恶寒。脉沉细者属中风。重感于湿。栝蒌桂枝汤。或桂枝加葛根独活防风汤。
（即桂枝汤、加葛根、独活、防风。）表有风邪
未解。为寒所袭者。宜风药解散。风寒为湿所袭者。风药亦能胜湿。阳明痉。胸满口噤。卧不着席。
挛急 齿。宜大承气汤。或防风通圣散。去麻黄下之。必须察脉有力可下。无力切不可不。少阳痉往
来寒热。或一目斜牵。或一手搐搦。小柴胡加防风汤。发热头摇。反张口噤脉弦者。防风当归饮。
（生地、防风、当归、川芎。）主之。若汗下太过。亡失血液。致筋脉失养。不柔和而痉。无外邪可
解者。惟宜补养气血为主。以八珍汤加减。或十全大补汤加竹沥、姜汁。气虚筋纵。加参 以补之。
血虚筋挛。加归地以润之。脉小虚甚者。加熟附子。或大建中汤加羌活、防风。产后去血过多。筋无血养。
挛急发痉。脉浮软者。加味当归补血汤（炙黄 五钱、当归三钱、炙甘草钱半、炒防风、羌活各钱
半、竹沥一杯、姜汁一瓢。）主之。新产亡血。腠理疏豁。风邪乘虚袭伤筋脉。遽尔发痉。脉浮者。
举轻古拜散。（荆芥穗四两、炒黑为末。）每服三钱。酒淋大豆黄卷净汁调下。吴仁斋云。仰面卧。
开目者为阳。合面卧闭目者为阴。口燥渴者为阳。口中和者为阴。属阳易治。属阴难治。口张目瞪。
昏昧无知者治。戴眼反折遗溺者必死。手足螈 。汗出如油如珠者不治。反张离席一掌者死。小儿
离席一指者亦死。
【廉勘】吴鞠通谓痉当分寒，热，虚，实四大纲。小儿痉病螈病。复列九大纲。较方中行痉书。
更精且密。实可补仲景之不足。兹节述于后。如六淫致痉。实证也。产妇亡血。病久致痉。风家误下。
温病误汗。疮家发汗者。虚痉也。风寒湿致痉者。寒证也。风温风热暑燥火致痉者。热证也。俗称慢
脾风者。虚寒痉也。本论后述本脏自病者。虚热痉。此四大纲也。再将小儿痉病螈病之九大纲论。亦
分条列后。以资参考。
（一）寒痉 仲景先师所述方法具在。但须对症细加寻绎。如所云。太阳症项强。KT KT 然。
脉沉迟之类。有汗为柔痉。为风多寒少。而用桂枝汤加法。无汗为刚痉。为寒痉。而用葛根汤。汤内有
麻黄。乃不以桂枝立名。
亦不以麻黄立名者。以其病已至阳明也。诸如此类。须平时熟读其书。临时再加谨慎。手下自有准的矣。风寒
咳嗽致痉者。用杏苏散辛温例。自当附入寒门。
（二）风温痉 此即螈症。少阳之气为之也。乃风之正令。阳气发泄之候。君火主气之时。（廉按其症候。则
头身热。面目赤。猝口噤。背反张。自汗出。足反冷。或恶风。或咳嗽。甚则气逆痰涌。风盛者。颈项强急。
头亦动摇。目眶 动。手足抽掣。热盛者。灼热大汗。神昏谵语。口燥渴饮。HT 唇弄舌。痰盛者。一痉即厥。
喉间痰鸣、语言不出。不省人事。此张仲景所谓风温之为病。剧则状如惊痫。时螈 。而若火薰之候也。亦
即徐嗣伯所谓痰气相触而动风。风火相乱则闷瞀也。）宜用辛凉正法。轻者用辛凉轻剂。重者用辛凉重剂。如
本论（荣斋按∶本论二字，系指《温病条辨》。以下同。）上焦篇银翘散。白虎汤之类。伤津液者加甘凉。如银翘
散加鲜生地、麦冬。玉女煎。以白虎合冬、地之类。神昏谵语。兼用芳香以开膻中。如清宫汤、牛黄丸、紫雪
丹之类。愈后用六味、三才、复脉辈。以复其丧失之津液。风温咳嗽致痉者。用桑菊饮、银翘散辛凉例。与风
寒咳嗽迥别。断不可一概用杏苏辛温也。
（三）温热痉 即六淫之火气。消烁真阴者也。《内经》谓先夏至日为病温者是也。即同上风温论治。但风温之病
痉者。轻而少。温热之致痉者。多而重也。药之轻重浅深。视病之轻重浅深而已。（廉按吴氏此言未免笼统。夫
吴氏所谓风温者。即叶氏论温二十则。所云温邪上受。首先犯肺。逆传心胞之证。乃新感风热之为病也。若温
热之为病。《素问》所谓冬伤于寒。春必病温。《灵枢》所谓冬伤于寒。春生瘅热是也。病之轻重浅深。一因新感。一
因伏气。原因既异。证治自不得混同。况在温热痉乎。就廉实验所知。凡伏温化火。刺激神经。而发痉者。则
为温痉。伏热化火。冲动神经而发痉者。则为热痉。温痉之中。有因胃肠燥火而发痉者。有因心肝壮火而发痉
者。有因劫烁肾阴而发痉者。有因热伏冲督而发痉者。热痉之中。有因胎热而发痉者。有因痫热而发痉者。有
因丹毒胎毒而发痉者。且温热二痉之中。以夹积食积热为多。若不查明原因。辨明证候。鲜不误殇人命。鞠通
曾谓只治致痉之由。而痉自止。不必沾沾但于痉中求之。若执痉以求痉。吾不知痉为何物。此说诚然。果如其
说。未免前后自相矛盾矣。故余特将温热二痉。分作两节论治。庶几分际清晰。以免笼统之弊。）
（l）温痉 因∶其因有四。一因胃肠积热。二因心肝壮火。三因热烁肾阴。四因热伏冲督。皆足以刺激神经。
而致痉螈之原因。证∶其证灼热自汗。渴不恶寒。面赤唇红。手足螈 。口噤鼻煽。此因于胃肠积热致痉。即
《内经》所谓气上不下。搏阳而为巅疾也。若初起目赤唇红。上视惊啼。角弓反张。手足发搐。嗌干喉塞。甚或头
摇。此因于心肝壮火致痉。即《内经》所谓诸风眩掉。皆属于肝也。若初起暮热朝凉。渴不喜饮。颧红齿槁。脊强
反折。手足厥冷。溺短或闭。此因于热烁肾阴。即《内经》所谓病藏于肾。阴虚阳盛也。若初起脊强头摇。腰背反
张。手足抽搐。昏厥不语。牙关紧急。啼声不出。此因于热伏冲督。即《内经》所谓诸热瞀螈。皆属于火也。脉∶
胃肠积热者。脉必洪数而实。舌必绛红。苔多黄腻。甚或焦黄。心肝壮火者。脉必弦数。舌必紫赤。苔多深
黄。指纹皆青紫浮红。热烁肾阴者。脉多沉数。舌红胖嫩。苔或焦紫。热伏冲任者。脉必弦劲。舌多紫赤。苔
或焦黄。指纹多青紫而黯滞。其症皆因伏温发痉。而其间实热窒塞。阴液耗伤。及有无痰涌。最宜明辨。治∶
胃肠积热症。便闭者。三黄五色丸。（小川连、青子芩、生锦纹各五钱为末、雪水泛丸、如芝麻大、分作五
份、一份辰砂为衣、一份青黛为衣、一份腰黄为衣、一份轻粉为衣、一份芦荟为衣。）乳子服五粒。小儿服十
五粒。余视年龄酌加。通用竹叶灯心汤调下。便通者。羚麻白虎汤。（羚羊角、天麻、生石膏、知母、生甘
草、粳米。）或加减竹叶石膏汤。（鲜竹叶、知母、栝蒌仁、生石膏、天花粉、川连、竹沥半夏、鲜枇杷叶、
淡海蛰、大地栗、二味煎汤代水。）临服药。调下紫雪丹二分。心肝壮火症。便闭热盛者。用当归龙荟丸。挟
痰上涌者。用何氏小红丸。（羚半角屑一钱、飞辰砂五分、真猴枣三分、巴豆霜一分为末、绿豆粉糊为丸、如
黍米大。）乳子服一丸。一岁者二丸。二三岁者三丸。冰糖汤化下。便通溺塞者。用导赤泻心汤。（鲜生地、
黄芩、淡竹叶、小川连、汉木通。）热烁肾阴症。火盛便燥者。青蒿地骨皮汤。（青蒿子、地骨皮、冬桑叶、
知母、丹皮、生川柏、元明粉、白蜜。）阴虚溺塞者。用三汁饮。（鲜生地汁两瓢、鸭梨汁一瓢、解晕草根汁
一瓢、重汤滚数沸。）调下知柏六味丸十粒。热伏冲督症。冲动者。加味青铅镇冲汤（鲜生地四钱、生白芍钱
【病因】痉病，是指身体强直、角弓反张的征象。这是因为筋肉被牵引，导致身体僵硬挺直。伤寒病若发生变证转为痉病，表现为项背部僵硬。太阳中风证，如果再次感受寒湿之邪，就会转变为痉病；或者太阳病发汗过多，因而导致痉病。我认为，痉病就是脑脊髓的疾病。如《金匮要略》中所说的痉病，症状为身热足冷，颈项强急，背部反张，这是脊髓相关的脑病。《黄帝内经·骨空论》中所谓“督脉为病，脊强反折”，指的就是这种情况。如果在恶寒时头部发热、面色发红，唯独颈部动摇，突然牙关紧闭，这是头顶部脑部的疾病。《难经》中所谓“督脉为病，病脊强而厥”，以及《黄帝内经》中所谓“厥逆发展为癫疾”，指的都是这类情况。徐灵胎说：“诸痉项强，皆属于燥；诸暴强直，皆属于风。”燥是太阴燥金之气，风是厥阴风木之气。大抵气血虚弱，兼有火邪和痰浊。陈无择说：人的筋脉，各自随着经络分布于身体各处，如果气血内部空虚，筋脉失去滋养，那么风寒湿热等邪气就会乘虚而入导致痉病。或者是七情六欲在体内扰动，也必然挟带痰火而后引发痉病。吴鞠通说：痉症必须兼夹风邪才能形成，风是百病之长，六淫邪气都因风而侵入人体。其出现的强直、背反张、抽搐等症状，都是肝风内动所致。吴云峰说：痉症身体劲直且背部反张，头部摇动、两目上视，这是筋的病。追溯其原因，多由失血引起，筋脉得不到荣养，所以邪气得以侵袭。因此，伤寒病发汗或攻下过多，以及患疮疡的病人，还有产后妇女患上这种疾病的，大概都可以由此理解。张景岳说：病在筋脉，筋脉拘急，所以出现反张；病在血液，血液干枯，所以筋脉挛缩。张仲景以发汗和攻下为例，说是误治导致亡失阴液。如太阳病发汗太多因而致痉，风家（易感风邪者）误用攻下则成痉，疮家（患疮疡者）发汗也成痉。大概发汗必伤血液，误下必伤真阴。阴血受伤则筋脉失去滋养，出现反张强直的病，是势所必然的。陈无择说气血内部空虚，邪气客居导致痉病，这话不无错误。如果按照他的说法，那仍然是风湿作为邪气，而虚损反而排在次要地位。却不知道风随汗液发散，既然已经发过汗，为何还说风湿？邪气随大便下行，既然已经攻下，为何反而导致湿邪？难道除了误治之外，还必须再受外邪才会形成痉病吗？没有邪气就没有痉病吗？喻嘉言说：小儿体质脆弱、神气怯弱，外感壮热，多会形成痉病。后世医生胡乱设立“惊风”的名称，有“四证生八候”的说法，实际上是将痉病的头摇手抽，说成是惊风的抽掣；将痉病的牙关紧闭、脚挛急，说成是惊风的搐搦；将痉病卧时背部不着席（角弓反张），说成是惊风的角弓反张。儿科医生一致尊崇这种说法，病人家属坦然接受，不治疗外来的淫邪，反而投用金石、冰片、麝香等寒凉药物，十个人中有九个死亡而不醒悟。又如刚生产后的妇人，血室空虚，外邪侵袭而成痉病，这是张仲景明确说明的，却往往被称为产后惊风，胡乱投药，也是千次治疗千次死亡。庸俗的医生认为产后宜用温补的说法，最足以误导人。产后外感，使用生化汤加荆芥穗的方子，也最足以误事。我历年临证观察，私下见到产后患寒证的，十个当中只有二三个；患热证的，十个当中有七八个。年轻少妇，肝阳旺盛的，尤其容易患热证。当时的医生无不误治，轻则烦闷不安，重则发生痉厥丧命，比比皆是。张石顽说：痉病有不因误治而发生的，必定是阴虚血少的人，不能荣养筋脉，以致筋脉挛缩、僵倒。如产后失血过多，冲任二脉枯竭；疮家之血随脓流出，营气枯竭；小儿有此病的，或因风热伤阴，或因发汗泻下亡失阴液，遂成为慢惊风。总属阴虚。只要精血不亏损，虽然有邪气干扰，断不会有筋脉拘急的病。至于病情发展到坚强程度，其枯槁可知。所以治疗此病，必须以补益气血为主，邪气严重的兼治邪气。如果邪气轻微，不必专门治疗。因为这个证候急需的是元气，元气恢复，血脉运行，那么微弱的邪气自然不能停留，有什么可忧虑的呢？
【证候】发热、恶寒、抽搐、无汗，称为刚痉；不发热，只恶寒，四肢厥冷、冷汗出，称为柔痉。产后血虚，腠理不固密，风邪搏结则成痉病。病后身体柔软、时而清醒，是痫症；身体强直、反张且不醒，是痉证。伤寒病若变生痉病，表现为项背强直。《内经》说：病人身热足冷，头项强急，恶寒时头部发热、面色发红，眼脉络赤红，唯独头部摇动，突然牙关紧闭，背部反张，这是痉病。所谓张仲景所说的刚痉、柔痉，都属于太阳经，因为太阳经行于身后，所以出现头项强急而反张。《金匮要略》说：痉病，胸满、牙关紧闭，卧时背部不着席，脚部挛急，必定伴有齘齿（即牙齿咬合作响）。这属于阳明经。因为阳明经行于身前，不能出现反张的证候，与太阳经的痉病，自然是两种不同的情况。《此事难知》说：头低垂、向下看，手足牵引，肘膝相凑，是阳明痉。然而想要使用大承气汤攻下，必须察知内有实邪，脉象沉有力才可以攻下。如果是经期出现寒热往来，或者一只眼睛斜向牵引，或者一只手抽搐，脉象弦数的，是少阳痉。又有伤寒结胸证，项部也强直，呈现柔痉的样子，这是似痉而非痉，不可以用风药误治。风病误用攻下则成痉，再次发汗必致拘急。太阳病发汗太多的，因而导致痉病。太阳病发热，脉象沉细，名叫痉，为难治。患疮疡的人身体虽然疼痛，不可发汗，发汗则致痉。太阳病，其症状身体强直，时时振颤，脉象反而沉迟，这是痉病。这是张仲景辨别痉病的证候。
【脉象】痉病的脉象紧急，如经脉笔直上下行走的，急实属于阳痉，沉细属于阴痉。浮紧数属于阳，沉细涩属于阴。浮盛主风热，洪滑主痰火，虚濡主气虚，涩数主阴虚。脉象像蛇一样蜿蜒曲折的，是汗出过多导致津虚而致痉。《活人书》说：痉病的外证发热恶寒，与伤寒相同，只是脉象沉迟弦细有所不同。如果脉象沉弦而迟及伏弦，或者散乱于手指之外的，都是危重证候。
【治法】阳痉，宜滋阴养血；阴痉，宜扶脾抑肝。至于清痉降火、祛风利湿，各随症状治疗。暴起的多属邪气盛，久病必定是血虚。痉病以虚为本，邪为标。具备太阳证，身体强直，时时振颤，脉象反而沉迟的，主方用栝蒌桂枝汤。（栝蒌根三钱、桂枝八分、白芍一钱半、甘草五分、生姜两片、大枣三枚。）刚痉发热，无汗恶寒，小便反而少，脉浮紧的，属于中风，再次感受寒邪，用葛根汤。或者加独活、防风。脉弦细数的，属于风热伤筋，血脉失去约束之力，导致抽搐反张的，主方用如圣饮（羌活、秦艽、川芎、白芍、当归、白芷、黄芩、人参、半夏、甘草）。风痰多的，加竹沥、姜汁；无汗的，加苍术、麻黄；热痰多的，加贝母、栝蒌；火盛的，加山栀、花粉；牙关紧闭、大便不通的，加大黄；气虚口闭的，加人参、黄芪；血虚筋急的，加当归、地黄；舒筋的，加秦艽、川断、钩藤；活血的，加丹参、红花、牛膝。柔痉则汗出不恶寒，脉沉细的，属于中风，再次感受湿邪，用栝蒌桂枝汤。或者用桂枝加葛根独活防风汤。（即桂枝汤，加葛根、独活、防风。）表有风邪未解，被寒邪侵袭的，宜用风药解散。风寒被湿邪侵袭的，风药也能胜湿。阳明痉，胸满、牙关紧闭、卧时背部不着席、挛急、齘齿的，宜用大承气汤。或者用防风通圣散，去掉麻黄攻下。必须察知脉有力才可攻下，无力切不可攻下。少阳痉，往来寒热，或者一只眼睛斜向牵引，或者一只手抽搐，用小柴胡加防风汤。发热、头摇、反张、牙关紧闭、脉弦的，用防风当归饮。（生地、防风、当归、川芎。）主治。如果发汗攻下太过，亡失血液，导致筋脉失养，不柔和而痉，没有外邪可以解除的，只宜以补养气血为主，用八珍汤加减。或者十全大补汤加竹沥、姜汁。气虚筋软的，加人参、黄芪以补之。血虚筋挛的，加当归、地黄以润之。脉小虚甚的，加熟附子。或者大建中汤加羌活、防风。产后失血过多，筋脉无血滋养，挛急发痉，脉浮软的，用加味当归补血汤（炙黄芪五钱、当归三钱、炙甘草一钱半、炒防风、羌活各一钱半、竹沥一杯、姜汁一瓢。）主治。新产失血，腠理疏松，风邪乘虚侵袭筋脉，突然发痉，脉浮的，用举轻古拜散。（荆芥穗四两，炒黑为末。）每次服用三钱，用酒淋大豆黄卷的净汁调服。吴仁斋说：仰面卧、睁眼的为阳证，俯面卧、闭眼的为阴证。口燥渴的为阳证，口中平和的为阴证。属阳证易治，属阴证难治。口开目瞪、昏昧无知的，可治。戴眼反张、遗尿的必死。手足抽搐、汗出如油如珠的，不治。反张离席一掌宽的，死。小儿离席一指的，也死。
【廉勘按语】吴鞠通认为痉病应当分为寒、热、虚、实四大纲领。小儿痉病、瘛疭病，又列出九大纲领，比方中行关于痉病的论述更精细严密，确实可以补充张仲景的不足。这里节选叙述如下。如六淫导致的痉病，是实证。产妇失血、久病致痉、风家误下、温病误汗、疮家发汗的，是虚痉。风寒湿导致的痉病，是寒证。风温、风热、暑、燥、火导致的痉病，是热证。俗称慢脾风的，是虚寒痉。本论后面叙述的本脏自病的，是虚热痉。这是四大纲领。再将小儿痉病、瘛疭病的九大纲领论述，也分条列在后面，以供参考。
（一）寒痉 张仲景先师所述的方法都在书中，但须对症仔细推求。如所说：太阳证项强，时时振颤，脉沉迟之类。有汗的为柔痉，为风多寒少，而用桂枝汤加减法。无汗的为刚痉，为寒痉，而用葛根汤。汤剂内有麻黄，却不以桂枝立名，也不以麻黄立名的原因，是因为病已传入阳明经。诸如此类，须平时熟读其书，临时再加谨慎，手下自然就有准绳了。风寒咳嗽导致痉病的，用杏苏散辛温例，自然应当附入寒门。
（二）风温痉 这就是瘛疭症，由少阳之气引起，是风的正令，阳气发泄的时候，君火主气之时。（廉按：按其症候，则是头身热，面目赤，突然牙关紧闭，背部反张，自汗出，足反而冷，或者恶风，或者咳嗽，甚则气逆痰涌，风盛的，颈项强急，头也动摇，眼眶跳动，手足抽掣；热盛的，灼热大汗，神昏谵语，口燥渴饮，弄舌舔唇；痰盛的，一痉即厥，喉间痰鸣，语言不出，不省人事。这是张仲景所谓的风温之为病，剧烈时状如惊痫，时时瘛疭，如同火熏一样的证候。也就是徐嗣伯所谓痰气相触而动风，风火相乱则闷瞀的意思。）宜用辛凉正法。轻的用辛凉轻剂，重的用辛凉重剂。如本论（荣斋按：本论二字，系指《温病条辨》，以下同。）上焦篇的银翘散、白虎汤之类。伤津液的加甘凉药，如银翘散加鲜生地、麦冬，玉女煎，以白虎汤合冬地之类。神昏谵语的，兼用芳香药以开膻中，如清宫汤、牛黄丸、紫雪丹之类。痊愈后用六味地黄丸、三才封髓丹、复脉汤等，以恢复其丧失的津液。风温咳嗽导致痉病的，用桑菊饮、银翘散辛凉例，与风寒咳嗽截然不同，断不可一概用杏苏散辛温治疗。
（三）温热痉 即六淫中的火气，消烁真阴的疾病。《内经》说夏至日前得病为温病，就是这个意思。即同上面风温论治，但风温致病致痉的，轻而少；温热致病致痉的，多而重。药物的轻重深浅，视病的轻重深浅而已。（廉按：吴氏此言未免笼统。夫吴氏所谓风温者，即叶氏论温二十则，所云温邪上受，首先犯肺，逆传心胞的证，乃新感风热之为病也。若温热之为病，《素问》所谓冬伤于寒，春必病温，《灵枢》所谓冬伤于寒，春生瘅热是也。病的轻重深浅，一因新感，一因伏气，原因既异，证治自不得混同，况在温热痉乎。就廉实验所知，凡伏温化火，刺激神经而发痉者，则为温痉；伏热化火，冲动神经而发痉者，则为热痉。温痉之中，有因胃肠燥火而发痉者，有因心肝壮火而发痉者，有因劫烁肾阴而发痉者，有因热伏冲督而发痉者。热痉之中，有因胎热而发痉者，有因痫热而发痉者，有因丹毒胎毒而发痉者。且温热二痉之中，以夹积食积热为多。若不查明原因，辨明证候，鲜不误殇人命。鞠通曾谓只治致痉之由，而痉自止，不必沾沾但于痉中求之。若执痉以求痉，吾不知痉为何物。此说诚然，果如其说，未免前后自相矛盾矣。故余特将温热二痉，分作两节论治，庶几分际清晰，以免笼统之弊。）
（1）温痉 因：其因有四。一因胃肠积热，二因心肝壮火，三因热烁肾阴，四因热伏冲督。皆足以刺激神经，而导致痉瘛的原因。证：其证灼热自汗，渴而不恶寒，面赤唇红，手足瘛疭，口噤鼻煽，这是因于胃肠积热致痉，即《内经》所谓气上不下，搏阳而为巅疾也。若初起目赤唇红，上视惊啼，角弓反张，手足发搐，咽干喉塞，甚或头摇，这是因于心肝壮火致痉，即《内经》所谓诸风眩掉，皆属于肝也。若初起暮热朝凉，渴不喜饮，颧红齿槁，脊强反折，手足厥冷，溺短或闭，这是因于热烁肾阴，即《内经》所谓病藏于肾，阴虚阳盛也。若初起脊强头摇，腰背反张，手足抽搐，昏厥不语，牙关紧急，啼声不出，这是因于热伏冲督，即《内经》所谓诸热瞀瘛，皆属于火也。脉：胃肠积热者，脉必洪数而实，舌必绛红，苔多黄腻，甚或焦黄。心肝壮火者，脉必弦数，舌必紫赤，苔多深黄，指纹皆青紫浮红。热烁肾阴者，脉多沉数，舌红胖嫩，苔或焦紫。热伏冲任者，脉必弦劲，舌多紫赤，苔或焦黄，指纹多青紫而黯滞。其症皆因伏温发痉，而其间实热窒塞，阴液耗伤，及有无痰涌，最宜明辨。治：胃肠积热症，便闭者，用三黄五色丸。（小川连、青子芩、生锦纹各五钱为末，雪水泛丸，如芝麻大，分作五份，一份辰砂为衣，一份青黛为衣，一份腰黄为衣，一份轻粉为衣，一份芦荟为衣。）乳儿服五粒，小儿服十五粒，其余视年龄酌加。通用竹叶灯心汤调下。便通者，用羚麻白虎汤。（羚羊角、天麻、生石膏、知母、生甘草、粳米。）或者加减竹叶石膏汤。（鲜竹叶、知母、栝蒌仁、生石膏、天花粉、川连、竹沥半夏、鲜枇杷叶、淡海蛰、大地栗，二味煎汤代水。）临服药时，调下紫雪丹二分。心肝壮火症，便闭热盛者，用当归龙荟丸。挟痰上涌者，用何氏小红丸。（羚半角屑一钱、飞辰砂五分、真猴枣三分、巴豆霜一分为末，绿豆粉糊为丸，如黍米大。）乳儿服一丸，一岁者二丸，二三岁者三丸，冰糖汤化下。便通溺塞者，用导赤泻心汤。（鲜生地、黄芩、淡竹叶、小川连、汉木通。）热烁肾阴症，火盛便燥者，用青蒿地骨皮汤。（青蒿子、地骨皮、冬桑叶、知母、丹皮、生川柏、元明粉、白蜜。）阴虚溺塞者，用三汁饮。（鲜生地汁一瓢、鸭梨汁一瓢、解晕草根汁一瓢，重汤滚数沸。）调下知柏六味丸十粒。热伏冲督症，冲动者，加味青铅镇冲汤（鲜生地四钱、生白芍钱
[Pathogenesis] Jing disease (spasm) refers to the manifestation of body stiffness and opisthotonos. This is because the muscles and tendons are pulled, causing the body to become stiff and straight. If a Shanghan (Cold Damage) disease undergoes a transformation into Jing disease, it presents with stiffness in the neck and back. In Taiyang Wind Strike syndrome, if one is additionally affected by Cold and Dampness, it transforms into Jing disease; or if sweating is excessive during Taiyang disease, it may lead to Jing disease. I believe that Jing disease is a disorder of the brain and spinal cord. As described in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), Jing disease is characterized by fever in the upper body and cold feet, stiffness and tension in the neck, and backward arching of the back. This is a disease of the brain related to the spinal cord. The *Nei Jing* (Inner Canon) in the "Gu Kong Lun" chapter states, "Disease of the Du vessel manifests as stiffness of the spine and backward folding," which refers to this condition. If there is fever in the head and redness of the face during chills, but only the neck trembles, and sudden lockjaw occurs, this is a disease of the brain at the vertex of the head. The *Nan Jing* (Classic of Difficult Issues) states, "Disease of the Du vessel manifests as stiffness of the spine and syncope," and the *Nei Jing* states, "Jue (rebellious Qi) developing into Dian Ji (epilepsy)," both referring to such conditions. Xu Lingtai said: "All cases of Jing with neck stiffness belong to Dryness; all sudden severe stiffness belong to Wind." Dryness is the Qi of Taiyin Dry Metal, and Wind is the Qi of Jueyin Wind Wood. Generally, when Qi and Blood are weak, accompanied by Fire and Phlegm, Chen Wuzhe stated: "The tendons and vessels of humans extend along the meridians throughout the body. When internal Qi and Blood are deficient, the tendons lose nourishment, allowing pathogenic factors of Wind, Cold, Dampness, and Heat to invade and cause Jing disease. Alternatively, internal disturbance by the Seven Emotions and Six Desires will inevitably involve Phlegm and Fire before Jing disease develops." Wu Juzhong said: "Jing syndrome must combine with Wind to form; Wind is the leader of a hundred diseases, and all six Exogenous Pathogens enter due to Wind. The manifestations of stiffness, backward arching, and convulsions are all caused by internal stirring of Liver Wind." Wu Yunfeng said: "In Jing syndrome, the body is rigid and the back arches backward, the head shakes, and the eyes stare upward; this is a disease of the tendons. Tracing its cause, it mostly arises from blood loss, where the tendons lack nourishment, so pathogens can invade. Therefore, excessive sweating or purgation in Shanghan, patients with sores/ulcers, and postpartum women suffering from this disease can all be understood through this principle." Zhang Jingyue said: "The disease lies in the tendons and vessels; tendon spasm causes backward arching. The disease lies in the Blood; dry Blood causes tendon contraction." Zhang Zhongjing cited sweating and purgation as examples, stating that mis-treatment leads to the loss of Yin. For instance, excessive sweating in Taiyang disease causes Jing; purgation in wind-prone individuals causes Jing; sweating in patients with sores causes Jing. Sweating damages Blood, and improper purgation damages True Yin. When Yin and Blood are damaged, the tendons lose nourishment, making the disease of backward arching and stiffness inevitable. Chen Wuzhe said that internal deficiency of Qi and Blood allows pathogens to lodge and cause Jing; this statement is not without error. If following his logic, it implies Wind-Dampness is the pathogen, with deficiency being secondary. However, Wind disperses with sweat; after sweating, why speak of Wind-Damp? Pathogens descend with purgation; after purgation, why does Dampness arise? Does one must suffer external pathogens again after mis-treatment to develop Jing? Without pathogens, is there no Jing? Yu Jiayan said: "Children have fragile bodies and timid spirits; exogenous high fever often leads to Jing disease. Later generations wrongly named it 'Jing Feng' (Startled Wind), proposing theories of 'four syndromes generating eight signs.' In reality, they confuse the head shaking and hand spasms of Jing disease with the jerking of Startled Wind; the lockjaw and foot cramps of Jing disease with the twitching of Startled Wind; and the opisthotonos (back not touching the bed) of Jing disease with the opisthotonos of Startled Wind. Pediatricians unanimously follow this, and families accept it passively. Instead of treating the exogenous pathogenic factors, they administer minerals, Borneol, and Musk, resulting in nine deaths out of ten without realizing their mistake. Similarly, for newly delivered women, the blood chamber is empty, and exogenous pathogens invade to cause Jing, as clearly stated by Zhang Zhongjing. Yet, it is often called postpartum Startled Wind, and inappropriate herbs are administered, leading to death every time. Vulgar doctors claim that postpartum conditions require warming, which is most misleading. Using Shenghua Decoction plus Schizonepeta for postpartum exogenous disorders is also most detrimental. In my years of clinical practice, I have privately observed that among postpartum patients, two or three out of ten suffer from Cold patterns, while seven or eight out of ten suffer from Heat patterns. Young women with vigorous Liver Yang are especially prone to Heat patterns. Contemporary physicians invariably misdiagnose and mistreat them. Mild cases result in restlessness and irritability; severe cases result in Jing-Jue (spasm and syncope) and death, which is common. Zhang Shiwan said: "There are Jing cases not caused by mis-treatment, occurring in individuals with Yin deficiency and blood scarcity who cannot nourish the tendons, leading to tendon contraction and collapse. Such as excessive blood loss in postpartum women, exhausting the Chong and Ren vessels; blood loss with pus in patients with sores, depleting Ying Qi; and children with this condition due to Wind-Heat injuring Yin or sweating/purgation losing Yin, becoming Slow Startled Wind. All belong to Yin deficiency. If Essence and Blood are not depleted, even with pathogenic interference, there will certainly be no tendon spasm. When the disease reaches a state of rigidity, the depletion is evident. Therefore, treatment must focus on tonifying Qi and Blood, and if pathogens are severe, treat them concurrently. If pathogens are mild, no specific treatment is needed. Because the urgency in this syndrome lies in Yuan Qi (Original Qi); once Yuan Qi recovers and blood vessels flow, slight pathogens cannot remain. What is there to worry about?"
[Syndromes] Fever, aversion to cold, convulsions, and absence of sweat constitute Gang Jing (Rigid Spasm). Absence of fever, only aversion to cold, cold extremities, and cold sweat constitute Rou Jing (Soft Spasm). Postpartum blood deficiency with loose interstices allows Wind Pathogen to bind and cause Jing. After illness, if the body is soft and consciousness returns intermittently, it is Xian Syndrome (Epilepsy); if the body is stiff, arches backward, and consciousness is lost, it is Jing Syndrome. If Shanghan transforms into Jing, it presents with neck and back stiffness. The *Jing* says: "When a patient has fever in the body and cold feet, stiffness in the head and neck, fever in the head and redness of the face during aversion to cold, redness in the eye collaterals, only the head trembles, sudden lockjaw, and backward arching of the back, this is Jing disease." The Gang Jing and Rou Jing mentioned by Zhang Zhongjing both belong to the Taiyang channel, as the Taiyang channel runs along the posterior aspect of the body, hence the stiffness in the head/neck and backward arching. The *Yao Lue* says: "In Jing disease, chest fullness, lockjaw, opisthotonos (back not touching the bed), leg cramps, and necessarily teeth grinding (teeth grinding is the sound of teeth clenching due to tendon flexion/extension) occur. This belongs to the Yangming channel. Since the Yangming channel runs along the anterior aspect, it cannot present with backward arching. It is distinct from Taiyang Jing." *Ci Shi Nan Zhi* says: "Head drooping, looking down, traction of hands and feet, elbows and knees meeting, is Yangming Jing. However, to use Da Cheng Qi Tang, one must examine for interior excess; if the pulse is deep and forceful, purgation is indicated. If there are alternating chills and fever during menstruation, or deviation of one eye, or convulsion of one hand, with a wiry and rapid pulse, it is Shaoyang Jing. There is also the Taiyang Jie Xiong (Chest Binding) syndrome where the neck is stiff, resembling Rou Jing; this is similar to Jing but not Jing, and should not be treated with Wind-dispelling herbs incorrectly. Treating Wind disease with purgation causes Jing; re-sweating causes stiffness. Excessive sweating in Taiyang disease causes Jing. Taiyang disease with fever and a deep, fine pulse is named Jing, and is difficult to treat. Patients with sores having body pain should not be sweated; sweating causes Jing. In Taiyang disease, if the symptom is body stiffness with trembling, and the pulse is surprisingly deep and slow, this is Jing. These are the syndrome manifestations for distinguishing Jing described by Zhang Zhongjing."
[Pulse] The pulse in Jing is urgent and tight, moving straight up and down like a thread; an urgent and forceful pulse indicates Yang Jing, while a deep and fine pulse indicates Yin Jing. Floating, tight, and rapid pulses belong to Yang; deep, fine, and choppy pulses belong to Yin. A floating and abundant pulse indicates Wind-Heat; a surging and slippery pulse indicates Phlegm-Fire; a deficient and soggy pulse indicates Qi Deficiency; a choppy and rapid pulse indicates Yin Deficiency. A pulse winding like a snake indicates Jing caused by fluid deficiency from sweating. The *Huo Ren Shu* says: "The external symptoms of Jing disease, fever and aversion to cold, are the same as Shanghan, differing only in the pulse being deep, slow, wiry, and fine. If the pulse is deep, wiry, and slow, or hidden and wiry, or scattered beyond the fingers, these are critical prognostic signs."
[Treatment] For Yang Jing, nourish Yin and tonify Blood; for Yin Jing, support Spleen and suppress Liver. To clear Jing, reduce Fire, dispel Wind, and promote diuresis to resolve Dampness, treat according to the syndrome. Acute onset usually indicates excess pathogens; chronic illness must be Blood deficiency. Jing disease has deficiency as the root and pathogens as the branch. For Taiyang syndrome with body stiffness, trembling, and a surprisingly deep and slow pulse, the main formula is Gualou Guizhi Tang (Trichosanthes Root 3 qian, Cinnamon Twig 8 fen, White Peony 1.5 qian, Licorice 5 fen, Ginger 2 slices, Jujube 3 pieces). For Gang Jing with fever, no sweat, aversion to cold, reduced urination, and a floating, tight pulse, belonging to Wind Strike compounded by Cold, use Gegen Tang (Kudzu Decoction). Or add Angelica Pubescens and Saposhnikovia. For a wiry, fine, and rapid pulse, belonging to Wind-Heat injuring tendons and losing the restraining power of blood vessels, causing convulsions and arching, the main formula is Rusheng Yin (Notopterygium, Gentian, Ligusticum, White Peony, Angelica Sinensis, Angelica Dahurica, Scutellaria, Ginseng, Pinellia, Licorice). For much Wind-Phlegm, add Bamboo Juice and Ginger Juice; for no sweat, add Atractylodes and Ephedra; for hot Phlegm, add Fritillaria and Trichosanthes; for excess Fire, add Gardenia and Trichosanthes Root; for lockjaw and constipation, add Rhubarb; for Qi deficiency with closed mouth, add Ginseng and Astragalus; for Blood deficiency with tense tendons, add Angelica and Rehmannia; for relaxing tendons, add Gentian, Teasel Root, and Uncaria; for invigorating Blood, add Salvia, Safflower, and Achyranthes. For Rou Jing with sweat, no aversion to cold, and a deep, fine pulse, belonging to Wind Strike compounded by Dampness, use Gualou Guizhi Tang. Or use Guizhi Jia Gegen Duhuo Fangfeng Tang (Guizhi Tang plus Kudzu, Angelica Pubescens, and Saposhnikovia). If exterior Wind Pathogen is unresolved and attacked by Cold, use Wind-dispelling herbs to release the exterior. If Wind-Cold is invaded by Dampness, Wind herbs can also overcome Dampness. For Yangming Jing with chest fullness, lockjaw, opisthotonos, cramps, and teeth grinding, use Dachengqi Tang (Major Order the Yellow Decoction). Or use Fengtong Tongsheng San, removing Ephedra and purging. Must check if the pulse is forceful before purging; never purge if the pulse is weak. For Shaoyang Jing with alternating chills and fever, or deviation of one eye, or convulsion of one hand, use Xiaochaihu Tang plus Saposhnikovia. For fever, head shaking, backward arching, lockjaw, and wiry pulse, use Fengwei Danggui Yin (Rehmannia, Saposhnikovia, Angelica Sinensis, Ligusticum) as the main treatment. If excessive sweating and purgation have led to blood loss, causing tendons to lose nourishment and become non-pliable and spasmodic, with no exterior pathogens to resolve, only tonifying Qi and Blood is suitable, using Bazhen Tang modified. Or Shiquan Dabu Tang plus Bamboo Juice and Ginger Juice. For Qi deficiency with flaccid tendons, add Ginseng and Astragalus to tonify. For Blood deficiency with tendon cramps, add Angelica and Rehmannia to moisten. For very small and deficient pulses, add Prepared Aconite. Or Dajianzhong Tang plus Notopterygium and Saposhnikovia. For postpartum excessive blood loss, where tendons lack Blood nourishment and contract/spasm, with a floating and soft pulse, use Jiawei Danggui Buxue Tang (Roasted Astragalus 5 qian, Angelica Sinensis 3 qian, Roasted Licorice 1.5 qian, Stir-fried Saposhnikovia and Notopterygium each 1.5 qian, Bamboo Juice 1 cup, Ginger Juice 1 ladle) as the main treatment. For new postpartum blood loss with loose interstices, where Wind Pathogen invades tendons due to deficiency causing sudden Jing, with a floating pulse, use Juqing Gubai San (Schizonepeta 4 liang, stir-fried black and powdered). Take 3 qian per dose, mixed with clean juice from Soybean Sprouts soaked in wine. Wu Renzhai said: "Lying on the back with eyes open is Yang; lying on the stomach with eyes closed is Yin. Dry mouth and thirst is Yang; neutral mouth sensation is Yin. Yang is easy to treat; Yin is difficult to treat. Mouth open, eyes staring, unconsciousness/dullness can be treated. Eyes staring upward, backward arching, and urinary incontinence are fatal. Convulsions of hands and feet with sweat like oil or pearls are untreatable. Back arching leaving a palm's width gap from the bed is fatal. For children, leaving a finger's width gap is also fatal."
[Lian's Commentary] Wu Juzhong stated that Jing should be categorized into four major principles: Cold, Heat, Deficiency, and Excess. For pediatric Jing and Chi-Zong (convulsions), he listed nine major principles, which are more refined and detailed than Fang Zhongxing's work on Jing, truly supplementing Zhang Zhongjing's deficiencies. Here is an excerpt. Jing caused by the Six Exogenous Pathogens is Excess. Jing caused by postpartum blood loss, chronic illness, improper purgation in wind-prone individuals, improper sweating in Warm Diseases, and sweating in patients with sores is Deficiency Jing. Jing caused by Wind-Cold-Dampness is Cold Syndrome. Jing caused by Wind-Warmth, Wind-Heat, Summer-Heat, Dryness, and Fire is Heat Syndrome. The commonly known Man Pi Feng (Slow Spleen Wind) is Deficient-Cold Jing. The self-diseases of the viscera described later in this book are Deficient-Heat Jing. These are the four major principles. The nine major principles for pediatric Jing and Chi-Zong are also listed below for reference.
(1) Cold Jing: The methods described by Master Zhang Zhongjing are available, but one must carefully analyze according to the syndrome. For example, Taiyang syndrome with neck stiffness, trembling, and deep/slow pulse. With sweat, it is Rou Jing, indicating more Wind than Cold, treated with Guizhi Tang modified. Without sweat, it is Gang Jing, indicating Cold Jing, treated with Gegen Tang. Although the decoction contains Ephedra, it is not named after Guizhi or Ephedra because the disease has entered the Yangming channel. One must read the classics thoroughly and be cautious clinically to ensure accuracy. For Jing caused by Wind-Cold cough, use Xingsu San (Almond and Perilla Decoction) under the warm-acrid category, naturally attached to the Cold section.
(2) Wind-Warmth Jing: This is Chi-Zong syndrome, caused by Shaoyang Qi, representing the proper season of Wind and the venting of Yang Qi during the time of Ministerial Fire ruling. (Lian notes: According to the syndrome, there is heat in the head and body, redness of face and eyes, sudden lockjaw, backward arching, spontaneous sweating, cold feet, aversion to wind or cough. Severe cases involve rebellious Qi and surging Phlegm; with strong Wind, neck stiffness, head trembling, orbital twitching, and limb convulsions occur. With strong Heat, burning fever, heavy sweating, delirium, dry mouth/thirst, and tongue protrusion/licking occur. With strong Phlegm, syncope occurs immediately upon spasm, phlegm rattle in the throat, inability to speak, and loss of consciousness. This is what Zhang Zhongjing described as Wind-Warmth disease, which becomes severe like Startled Epilepsy with intermittent Chi-Zong, resembling being smoked by fire. It is also what Xu Sibai described as Phlegm-Qi interacting to stir Wind, and Wind-Fire mixing causing mental confusion.) Use acrid-cool standard methods. For mild cases, use light acrid-cool agents; for severe cases, use heavy acrid-cool agents. Such as Yinqiao San (Honeysuckle and Forsythia Powder) and Baihu Tang (White Tiger Decoction) from the Upper Jiao chapter of Ben Lun (*Wen Bing Tiao Bian*). For injured fluids, add sweet-cool herbs like Fresh Rehmannia and Ophiopogon to Yinqiao San, or combine Baihu Tang with Ophiopogon and Rehmannia (Yunü Jian). For delirium, use aromatic herbs to open the Pericardium, such as Qinggong Tang, Niuhuang Wan (Calculus Bovis Pill), or Zixue Dan (Purple Snow Pill). After recovery, use Liuwei Dihuang Wan, Santian Fengsui Dan, or Maigui Decoction to restore lost fluids. For Jing caused by Wind-Warmth cough, use Sangju Yin and Yinqiao San under acrid-cool principles, distinct from Wind-Cold cough; absolutely do not use Xingsu San universally.
(3) Warmth-Heat Jing: This refers to the Fire Qi of the Six Exogenous Pathogens consuming True Yin. The *Nei Jing* states that diseases occurring before the Summer Solstice are Warm diseases. Treat similarly to Wind-Warmth above, but Wind-Warmth causing Jing is mild and rare, whereas Warmth-Heat causing Jing is frequent and severe. The depth and strength of medicine depend on the severity of the disease. (Lian notes: Wu's statement is too general. Wu's "Wind-Warmth" refers to Ye Tianshi's theory of Warm Pathogens entering from above, first attacking the Lung, and reversely transmitting to the Pericardium, which is a new-onset Wind-Heat disease. If "Warmth-Heat" disease, it refers to *Su Wen*'s "Winter injury by Cold, Spring must get Warm disease" and *Ling Shu*'s "Winter injury by Cold, Spring generates Dan-Heat." The severity depends on whether it is new-onset or latent Qi. Since causes differ, treatments cannot be mixed, especially for Warmth-Heat Jing. Based on my experience, Jing caused by latent Warmth transforming into Fire stimulating nerves is Wen Jing (Warm Jing); Jing caused by latent Heat transforming into Fire stimulating nerves is Re Jing (Heat Jing). Among Wen Jing, some are caused by Stomach-Intestine dry Fire, some by Heart-Liver blazing Fire, some by Kidney Yin consumption, and some by Heat lodging in Chong and Du vessels. Among Re Jing, some are caused by fetal heat, epilepsy heat, carbuncle/toxin heat. Both Wen and Re Jing often involve food stagnation heat. Without clarifying causes and differentiating syndromes, lives are frequently lost. Juzhong once said, "Only treat the cause of Jing, and Jing will stop; do not obsessively seek Jing within Jing." If one insists on seeking Jing within Jing, I do not know what Jing is. This saying is true, but if followed strictly, it contradicts itself. Therefore, I specifically divide Warmth and Heat Jing into two sections for treatment to clarify boundaries and avoid generality.)
(1) Wen Jing (Warm Jing): Causes: Four causes. First, Stomach-Intestine accumulated heat; second, Heart-Liver blazing Fire; third, Heat consuming Kidney Yin; fourth, Heat lodging in Chong and Du vessels. All stimulate nerves, causing Jing and Chi-Zong. Syndromes: Burning fever, spontaneous sweating, thirst without aversion to cold, red face and lips, limb convulsions, lockjaw, nasal flaring. This is Jing caused by Stomach-Intestine accumulated heat, i.e., *Nei Jing*'s "Qi rising but not descending, fighting Yang to become head disease." If initially red eyes and lips, upward gaze, startled crying, opisthotonos, limb convulsions, dry throat, or head shaking, this is Jing caused by Heart-Liver blazing Fire, i.e., *Nei Jing*'s "All Wind, dizziness, and tremors belong to Liver." If initially evening fever/morning coolness, thirst without desire to drink, malar flush, dry teeth, spine stiffness/arching, cold extremities, short or absent urine, this is Jing caused by Heat consuming Kidney Yin, i.e., *Nei Jing*'s "Disease stored in Kidney, Yin deficiency with Yang excess." If initially spine stiffness/head shaking, back arching, limb convulsions, syncope/speechlessness, tight jaw, silent crying, this is Jing caused by Heat lodging in Chong/Du, i.e., *Nei Jing*'s "All Heat, mental confusion, and Chi-Zong belong to Fire." Pulses: Stomach-Intestine heat shows surging, rapid, and forceful pulse; crimson-red tongue; yellow greasy coating, possibly scorched yellow. Heart-Liver Fire shows wiry, rapid pulse; purple-red tongue; deep yellow coating; fingerprint blue-purple floating red. Kidney Yin consumption shows deep, rapid pulse; red, fat, tender tongue; possibly scorched purple coating. Chong/Ren heat shows wiry, tough pulse; purple-red tongue; possibly scorched yellow coating; fingerprint blue-purple and dull. These syndromes all arise from latent Warmth triggering Jing; distinguish between interior excess blocking, Yin fluid depletion, and presence of surging Phlegm. Treatment: For Stomach-Intestine heat with constipation, use Sanhuang Wuse Wan (Three Yellows Five-Color Pill: Coptis, Scutellaria, Rhubarb powdered, pill-sized sesame, coated with Cinnabar, Indigo, Realgar, Calomel, Aloe). Infants take 5 pills, children 15, adjust by age. Take with Bamboo Leaf and Centella water. For unblocked bowels, use Lingma Baihu Tang (Antelope Horn, Gastrodia, Gypsum, Anemarrhena, Licorice, Rice). Or Jiajian Zhuye Shigao Tang (Bamboo Leaf, Anemarrhena, Trichosanthes Seed, Gypsum, Trichosanthes Root, Coptis, Pinellia in Bamboo Juice, Loquat Leaf, Jellyfish, Water Chestnut decocted as water). Take Zixue Dan 2 fen with medicine. For Heart-Liver Fire with constipation and excess heat, use Danggui Longhui Wan. With surging Phlegm, use He's Xiaohong Wan (Antelope Horn, Cinnabar, Monkey Date, Croton Frost powdered, pill-sized millet with Mung Bean paste). Infants 1 pill, 1-year-old 2 pills, 2-3 year olds 3 pills, dissolve in Rock Sugar water. For unblocked bowels but blocked urination, use Daochi Xiexin Tang (Fresh Rehmannia, Scutellaria, Bamboo Leaf, Coptis, Akebia). For Heat consuming Kidney Yin with Fire excess and dry stool, use Qinghao Digupi Tang (Artemisia Annua, Groundcherry Root Bark, Mulberry Leaf, Anemarrhena, Moutan Cortex, Phellodendron, Mirabilite, Honey). For Yin deficiency with blocked urination, use Sanzhi Yin (Fresh Rehmannia juice, Pear juice, Jieyun Gen Cao juice, boiled). Take Zhibai Liuwang Wan 10 pills. For Heat lodging in Chong/Du with stirring, use Jiawei Qingqian Zhenchong Tang (Fresh Rehmannia 4 qian, White Peony 1 qian