太阳病。发热无汗。反恶寒者。名曰刚 。（〔原注〕一作痉余同。○沈柯魏并作痉是。玉函千金翼。反上有而字。）
〔徐〕此条与下条。即伤寒论。辨寒伤荣风伤卫法也。取以为 病刚柔之别。省文也。盖 。即痉。强
直之谓也。 病必有背项强直等的证。故曰 。即省文不言。但治 病。刚柔之辨。最为吃紧。故特首拈无
汗反恶寒为刚。有汗不恶寒为柔。以示辨证之要领耳。
〔程〕 病者。以太阳病发汗太
多。荣血已亡。风寒易中。故筋脉劲急。作刚柔二 也。寒邪内入于营。郁于肌肤。则发热。凝其血脉。则
无汗。无汗为表实。不应恶寒。今反恶寒者。以寒邪严厉。从卫入营。
卫亦因之而不阖。故反恶寒也。其 故名曰刚。
案成无己曰。 当作痉。传写之误也。 。恶也。非强也。今考。 。恶也。见张揖广雅。而说文。痉。
强急也。成说为是。圣济总录云。 又谓之痉者。痉 一类。古人特以强直名之。郭白 云。 是病名。痉
是病证。杨氏直指方。李氏永类钤方。遂立痉 门。皆不考耳。金鉴云。反恶寒之反字。衍文也。玩痉病之
条。自知当恶寒也。今考甲乙经。引本条文。无反字。则知金鉴之说。有所据也。然钱氏溯源
集云。发热无汗。本应恶寒。而曰反恶寒者。不当恶之词也。
然而非也。以时头热面赤。目脉皆赤之见证。似乎热甚。而仍身热足寒。头项强急而恶寒。故曰反也。反者。
甚之之词。根据此解。则反字不必删。而义自通。庞安时。作反不恶寒。亦不可从。
太阳病。发热汗出。而不恶寒。名曰柔 。
〔程〕风伤于卫。则发热。开其腠理则汗出。汗出当恶寒。
今不恶寒者。以风为阳邪。木性曲直和 。虽汗出。亦不恶寒。其 故名曰柔。
案程刚柔之解误。徐则为柔软之义。痉病以强急得名。岂有柔软者乎。其说尤非。金鉴云。太阳病。发
热无汗恶寒。为实邪。名曰刚痉者。强而有力也。发热汗出不恶寒为虚邪。名曰柔痉者。强而无力也。此注
近是。然以有力无力。分刚柔者。未为得矣。盖刚柔。乃阴阳之义。阴阳。乃虚实之谓。表实故称以刚。表
虚故称以柔。神巧万全方云。太阳病。发热不恶寒无汗。为阳痉。发热不恶寒汗出。为阴痉。又活人
书云。刚痉属阳痉。柔痉属阴痉。活人续集解惑论云。合面而卧。为阴痉。仰目者。为阳痉。其义可见耳。
太阳病。发热脉沉而细者。名曰 。为难治。（伤寒论玉函经脉经并无为难治三字。）
〔徐〕古人以强直为 。外证与伤寒相似。但其脉沉细。
而项背反张。强硬如发痫状为异耳。如前二条既以无汗有汗。分刚柔为辨。此复以脉沉细为辨。
溯源集云。邪在太阳。若中风之脉。则当浮缓。伤寒之脉。则当浮紧。此则同是太阳发热之表症。而其
脉与中风伤寒特异。反见沉细者。因邪不独在太阳之表也。则表里皆有风寒邪气。浸淫于皮肤筋骨。脏
腑经络之间。非若中风伤寒之邪。先表后里。以次传变之可比。乃邪之甚。而病之至者。
乃难治危恶之证也。所以金匮此条之下。有为难治三字。
太阳病。发汗太多。因致 。
〔鉴〕太阳病。当发汗。若发汗太过。腠理大开。表气不固。邪气乘虚而入。因成痉者。乃内虚所
召入也。宜以桂枝加附子汤主之。固表温经也。由此推之。凡病出汗过多。新产金疮破伤。出血过多。而
变生此证者。皆其类也。
溯源集云。生气通天论云。阳气者。精则养神。柔则养筋。阳气衰微。不能嘘养其筋骨。故筋脉劲急。
而成 。所以太阳篇云。太阳病。医发汗。遂漏不止。四肢拘急。难以
屈伸者。桂枝加附子汤主之。 之见症。虽又甚焉。亦理之相似者也。
张氏医通云。真武汤。
夫风病下之则 。复发汗必拘急。
〔程〕风伤于卫。若下之虚其阴血。风乘其虚而陷于营血
之中。血不荣筋。因作 。四肢为诸阳之本。复发汗以虚其阳。必令四肢拘急。
张氏医通云。附子汤。
疮家虽身疼痛。不可发汗。汗出则 。
〔鉴〕疮家初起。毒热未成。法当汗散。已经溃后。血气被伤。虽有身痛表证。亦不可发汗。恐汗
出血液愈竭。筋失所养。因而成痉。或邪风乘之。亦令痉也。
〔徐〕产后多致痉。阴虚液脱之故。产后误汗下而致。或亦有之。故仲景不另出方。听人消息。
张氏医通云。芍药甘草附子汤。
巢源。金疮中风痉候云。夫金疮痉者。此由血脉虚竭。饮食未复。未盈月日。营卫伤穿。风气得入五
脏受寒则痉。其状口急背直。摇头马鸣。腰为反折。须臾大发。气息如绝。
汗出如雨。不及时救者。皆死。凡金疮卒无汗者。中风也。边自出黄汁者。中水也。并欲作痉。急治之。又
腕折中风痉候云。夫腕折伤皮肉作疮者。慎不可当风及自扇。若风入疮内。犯诸经络所致痉。痉者。脊背强
直。口噤不能言也。案此后世所谓。破伤风也。其中水者。谓之破伤湿。（见三因方。）巢
源。又有产后中风痉候。（附载于妇人产后病。）
病者。身热足寒。颈项强急。恶寒时头热。面赤目赤。独头动摇。卒口噤背反张者。 病也。若发其
汗者。寒湿相得。其表益虚。即恶寒甚。发其汗已。其脉如蛇。（〔原注〕一云。其脉 。○伤寒论。作目
脉赤。独头面摇。无若发其汗以下二十五字。 病也。作为 也。玉函脉经。无若发其汗以下十七字。脉经
作病发其汗已。其脉 如蛇。相得。程徐作相搏。 。赵本作沧沧。）
〔鉴〕诸家以刚柔二痉。列为首条。今以此为第一条者。
盖刚柔之辨。俱从此条分出。痉病之最备者。宜冠诸首。
〔程〕身热头热。邪在太阳也。面赤目赤。（足阳明之正系目系。）邪在阳明也。颈属阳明。项属太
阳。邪在二经。则颈项强急恶寒也。阳明之脉挟口。故卒口噤。太阳之脉。循背上头。故头独摇。背反张也。
此其人必汗下亡血之后。正气已虚。而邪气但胜于上。其足则寒。此痉病之证具见也。
〔鉴〕李
曰。手三阳之筋。结入于颔颊。足阳明之筋。上挟于口。风寒乘虚。入其筋则挛。故牙关急而口禁。
〔尤〕寒湿相得者。汗液之湿。与外寒之气。相得不解。而表气以汗而益虚。寒气得湿而转增。则恶寒甚也。
〔沈〕其脉坚劲。动犹如蛇。乃譬挣纽奔迫之状。
溯源集云。上文有脉无证。此条有证无脉。合而观之。 病之脉证备矣。身热者。风寒在表也。足寒
者。阴邪在下也。颈项强急。背反张者。太阳之经脉四行。自巅下项。夹
背脊。而行于两旁。寒邪在经。诸寒收引。其性劲急。邪发则筋脉抽掣。故颈项强急。背如角弓之反张。所
谓筋所生病也。恶寒者。寒邪在表。则当恶寒。在下焦而阳气虚衰。亦所当恶也。时头热面赤目脉赤者。
头为诸阳之会。阳邪独盛于上。所以足寒于下也。时者。时或热炎于上。而作止有时
也。头面为诸阳之所聚。乃元首也。不宜动摇。因风火扇动于上。故独头面动摇。卒然口噤而不言也。
案金鉴云。若发其汗六句。与上文义不属。与后之为欲解脉如故反伏弦者痉句。文义相属。宜分于彼。然
今考此六句。其意不明晰。疑是他篇错简。伤寒论亦无之。宜删。
暴腹胀大者。为欲解。脉如故反伏弦者 。（沈本。脉上有其字。伏。玉函脉经。作复。）
〔程〕暴腹胀大为欲解。于理不顺。脉伏弦。即后条伏坚之意。
〔鉴〕暴腹胀大者句。衍文也。当删之。
夫 脉。按之紧如弦。直上下行。（〔原注〕一作筑筑而弦。脉经云。 家。其脉伏坚。直上下。○案脉
经云。十二字。旧本大书。与原文同。今根据赵本为细注。玉函脉经。作筑筑而弦。）
〔尤〕紧如弦。即坚直之象。李氏曰。上下行者。自寸至尺。皆见紧直之脉也。
〔鉴〕痉之为病。其状
劲急强直。故其脉亦劲急强直。按之紧。劲急之象也。如弦。直行之象也。
案紧。不散也。弦。不缓也。如字。当读为而。玉函脉经可证。
病。有灸疮难治。
〔徐〕治 。终以清表为主。有灸疮者。经穴洞达。火热内盛。阴气素亏。即后栝蒌桂枝汤。葛根汤。嫌
不远热。大承气汤。更虑伤阴。故曰难治。
〔尤〕有灸疮者。脓血久溃。穴俞不闭。娄全善云。即破伤
风之意。盖阴伤而不胜风热。
阳伤而不任攻伐也。故曰难治。
玉函经。栝蒌桂枝汤后。出一条云。脊强者。五痉之总
名。其证卒口噤。背反张而螈 。诸药不已。可灸身柱大椎陶道。案根据此则痉病不必禁灸也。
太阳病。其证备。身体强KT KT 然。脉反沉迟。此为 。
栝蒌桂枝汤主之。（玉函。无反字。）
〔尤〕太阳证备者。赵氏谓太阳之脉。自足上行。循背至头项。此其所过之部。而为之状者。皆是其
证是也。KT KT 背强连颈之貌。沉本 之脉。迟非内寒。乃津液少。而营卫之行不利也。伤寒项背
强KT KT 。汗出恶风者。脉必浮数。为邪风盛于表。此证身体强KT KT 然。脉反沉迟者。为风淫于外。
而津伤于内。故用桂枝则同。而一加葛根。以助其散。一加栝蒌根。兼滋其内。则不同也。
〔沈〕此出柔
痉之方也。虽不言有汗之柔痉。此用桂枝汤和营卫。而解太阳卫分之邪。栝蒌能清胸膈之热。不出有汗
风伤卫之大法。可以意会。
〔程〕KT KT 。俯仰不自如之貌。（按说文。KT 字。无钩挑。有钩挑者。乃
几案之几字也。KT 。乃鸟之短羽。象小鸟毛羽未盛之形。飞KT KT 也。故凫字从KT 。盖形容其颈项强急
之意。○简案明理论。○KT 音殊。KT 。引颈之貌。KT 。短羽鸟也。短羽之鸟。不能飞腾。动
则先伸引其头尔。项背强者。动亦如之。非若几案之几而偃屈也。程注本于此为是。本事
方。为几足之义。三因方。作兀兀。证治准绳。引诗幽风。赤鸟几几为解。并不可从。）
栝蒌桂枝汤方
栝蒌根（二两○程沈作三两） 桂枝（三两） 芍药（三两） 甘草（二两○徐沈有
炙字） 生姜（三两○徐沈有切字） 大枣（十二枚○徐沈有擘字）
上六味。以水九升。煮取三升。分温三服。取微汗。汗不出。食顷啜热粥发。
案神农本经云。栝蒌根。治消渴身热。烦满大热。
三因。栝蒌桂枝汤。治柔 身体强兀兀然。脉反沉迟。
自汗。（即本方。）
又桂枝栝蒌根汤。治伤风汗下不解。郁于经络。随气涌
泄。衄出清血。或清气道闭。流入胃管。吐出清血。遇寒泣之。色必瘀黑者。
于本方。加川芎等分。
太阳病。无汗而小便反少。气上冲胸。口噤不得语。欲作刚 。葛根汤主之。
〔尤〕无汗而小便反少者。风寒湿甚。与气相持。不得外达。亦并不下行也。不外达。不下行。
势必逆而上冲。为胸满。为口噤不得语。驯至面赤头摇。项背强直。所不待言。故曰欲作刚痉。葛根汤。
即桂枝汤。加麻黄葛根。乃刚痉无汗者之正法也。
葛根汤方（三因。名葛根麻黄汤。）
葛根（四两） 麻黄（三两去节） 桂（二两去皮○伤寒论作桂枝当补枝字） 芍药
（二两○赵作三两非） 甘草（二两炙） 生姜（三两○伤寒论有切字） 大枣（十二枚○伤寒论有擘字）
上七味。 咀。以水一斗。先煮麻黄葛根。减二升。去沫。纳诸药。煮取三升。去滓温服
乙升。覆取微似汗。不须啜粥。余如桂枝汤法。将息及禁忌。（一斗。赵作七升非。）
柯氏来苏集云。葛根味甘气凉。能起阴气。而生津液。滋筋脉而舒其牵引。故以为君。麻黄生姜。
能开玄府腠理之闭塞。祛风而去汗。故以为臣。寒热俱轻。故少佐桂芍。同甘枣以和里。此于麻桂二汤
之间。衡其轻重。而为调和表里之剂也。葛根与桂枝。同为解肌和里之药。故有汗无汗。下
利不下利。皆可用。与麻黄专于治表者不同。案神农本经曰。葛根气味甘辛平。治消渴身大热。起阴气。
柯氏以为发表生津之品。全本于本经。而刚痉所主。亦在乎此。实卓见也。
徐沈诸家。皆以为解阳明之邪者。非。
为病。（〔原注〕一本。 字上。有刚字。）胸满口噤。卧不着席。脚挛急。必 齿。可与大
承气汤。（玉函脉经。作刚痉为病。必上有其人二字。徐沈 。作介。）
〔程〕胸满。即气上冲胸之互文。卧不着席。亦反张之互词也。庞安常曰。 病卧不着席者。小儿腰背去
席二指。大人手侧掌。为难治。邪在太阳则挛急。邪在阳明则口噤。灵枢经曰。热而痉者死。腰折螈 噤
齿也。（出热病篇。） 。切齿也。噤之甚者则切。灵枢热病篇。有啮齿。当是 齿之类。
病属表属虚。未可与承气下也。当详之。
〔鉴〕此申痉病入里。以明其治也。痉病而更胸满。里气壅也。卧
不着席。反张甚也。脚挛急。劲急甚也。必 齿。牙紧甚也。此皆阳明热盛灼筋。筋急而甚之象。故以大承气
汤。直攻其热。非攻阳明之实也。
太阳病，发热且无汗，反而恶寒的，称为刚痉。（〔原注〕一作“痉”，其余相同。○沈明宗、魏荔彤均作“痉”是正确的。《玉函经》和《千金翼方》中，“反”字前有“而”字。）
〔徐忠可〕这一条与下一条，即《伤寒论》中辨别寒邪伤营、风邪伤卫的方法。选取它们作为区分痉病刚柔之别的依据，是省略了文字。大概“痓”就是“痉”，意思是强直。痉病必然有背部和颈部强直的证候，所以说“痓”是省文不言。但在治疗痉病时，刚柔的辨别最为关键，所以特别提出无汗且反恶寒为刚痉，有汗且不恶寒为柔痉，以此显示辨证的要领。
〔程郊倩〕痉病患者，是因为太阳病发汗过多，导致营血已亡，风寒容易侵入，所以筋脉劲急，分为刚、柔两种痉病。寒邪内入于营分，郁结于肌肤，则发热；凝滞血脉，则无汗。无汗属于表实，本不应恶寒，现在反而恶寒，是因为寒邪严厉，从卫分进入营分，卫气也因此不能闭合，所以反而恶寒。其病名叫做刚痉。
按语：成无己说，“痓”当作“痉”，是传写错误。“痓”意为恶，不是强直的意思。现在考证，“痓”意为恶，见于张揖《广雅》，而《说文解字》说：“痉，强急也。”成无己的说法是正确的。《圣济总录》说：“痓又被称为痉，因为痓和痉是一类病，古人特意用强直来命名它。”郭白云说：“痓是病名，痉是病证。”杨氏《直指方》、李氏《永类钤方》于是设立痓、痉门，都是没有考证的缘故。《医宗金鉴》说：“反恶寒”的“反”字是衍文（多余的字）。研读痉病的条文，自然知道应当恶寒。现在考证《甲乙经》引用本条文，没有“反”字，就知道《金鉴》的说法是有根据的。然而钱潢《溯源集》说：“发热无汗，本来应当恶寒，却说‘反恶寒’，是不当恶而恶的词句。”然而这种说法不对。以有时头热、面赤、目脉皆赤的证候来看，似乎热势很盛，但仍然身热足寒，头项强急且恶寒，所以说“反”。“反”是表示程度深的词。根据这种解释，那么“反”字不必删除，义理自然通顺。庞安时将“反不恶寒”连读，也不可从。
〔程郊倩〕风邪伤于卫分，则发热；腠理开泄则汗出。汗出时应当恶寒，现在不恶寒，是因为风为阳邪，木性曲直柔和，虽然汗出，也不恶寒。其病名叫做柔痉。
按语：程郊倩对刚柔的解释是错误的，徐忠可解释为柔软之义，但痉病以强急得名，怎么会有柔软的呢？他的说法尤其不对。《医宗金鉴》说：“太阳病，发热无汗恶寒，为实邪，名叫刚痉，意思是强而有力；发热汗出不恶寒为虚邪，名叫柔痉，意思是强而无力。”这个注解比较接近正确。然而以有力无力来区分刚柔，并没有抓住要点。盖刚柔，是阴阳的含义；阴阳，是虚实的称谓。表实故称刚，表虚故称柔。《神巧万全方》说：“太阳病，发热不恶寒无汗，为阳痉；发热不恶寒汗出，为阴痉。”又《活人书》说：“刚痉属阳痉，柔痉属阴痉。”《活人续集解惑论》说：“合面而卧，为阴痉；仰目者，为阳痉。”其中的义理可见一斑。
太阳病，发热且脉象沉而细的，称为痓，属于难治。（《伤寒论》、《玉函经》、《经脉经》都没有“为难治”这三个字。）
〔徐忠可〕古人以强直为痓。外证与伤寒相似，但其脉象沉细，且项背反张，强硬如同发作痫病的样子，这是不同之处。如前两条既然以无汗、有汗来区分刚柔作为辨别依据，这里又以脉象沉细作为辨别依据。《溯源集》说：“邪在太阳，如果是中风，脉象应当浮缓；如果是伤寒，脉象应当浮紧。这里同样是太阳发热的表症，但其脉象与中风、伤寒特异，反而出现沉细，是因为邪气不仅仅在太阳之表。那么表里都有风寒邪气，浸淫于皮肤筋骨、脏腑经络之间，不像中风伤寒之邪，先表后里，依次传变那样可以相比。这是邪气很盛，病情严重的表现，是难治且危恶的证候。所以《金匮》这一条下面，有‘为难治’三个字。”
〔吴谦〕太阳病，应当发汗，如果发汗太过，腠理大开，表气不固，邪气乘虚而入，因而形成痉病，这是因内虚所招致的。宜用桂枝加附子汤主治，以固表温经。由此推论，凡是疾病出汗过多，新产之后、金疮破伤、出血过多，而变生此证的，都属于此类。
《溯源集》说：《生气通天论》说：“阳气者，精则养神，柔则养筋。”阳气衰微，不能嘘养其筋骨，所以筋脉劲急，而成痉病。所以《太阳篇》说：“太阳病，医生发汗，遂漏汗不止，四肢拘急，难以屈伸的，用桂枝加附子汤主治。”痉病的见症，虽然比这更严重，但道理是相似的。
《张氏医通》说：真武汤。
患风病，误用下法则致痉，再次发汗必定拘急。
〔程郊倩〕风邪伤于卫分，如果误用下法，会使其阴血虚弱，风邪乘虚陷入营血之中，血液不能荣养筋脉，因而作痉。四肢为诸阳之本，再次发汗以损伤其阳气，必定令四肢拘急。
《张氏医通》说：附子汤。
〔吴谦〕疮疡初起，毒热未成，依法应当汗散。已经溃破后，血气被损伤，虽然有身体疼痛的表证，也不可发汗，恐怕汗出使血液更加枯竭，筋脉失去滋养，因而成痉。或者邪风乘虚侵袭，也会令其成痉。
〔徐忠可〕产后多导致痉病，是阴虚液脱的缘故。产后误用汗法、下法而导致痉病的，或许也有这种情况。所以张仲景没有另外开出方剂，听凭医者斟酌处理。
《张氏医通》说：芍药甘草附子汤。
《诸病源候论·金疮中风痉候》说：所谓金疮痉，这是由于血脉虚竭，饮食尚未恢复，未满一个月，营卫受伤穿孔，风气得以进入五脏，受寒则成痉。其症状为口部紧急、背部挺直、摇头、发出马鸣声、腰部反折，片刻后大发，气息微弱如绝，汗出如雨，不及时救治的，都会死亡。凡金疮突然无汗的，是中风。伤口流出黄汁的，是中水。都想要发作成痉，应紧急治疗。又《腕折中风痉候》说：所谓腕折伤皮肉成疮的，千万不要当风及自己扇风，如果风进入疮内，侵犯诸经络所致成痉。痉，是指脊背强直，口噤不能说话。案：这以后世所谓的破伤风。其中水的，称为破伤湿。（见《三因方》。）《诸病源候论》又有《产后中风痉候》。（附载于妇人产后病。）
患痉病的患者，身体发热、足部寒冷、颈项强急、恶寒、有时头部发热、面赤、目赤、只有头部动摇、突然口噤、背部反张的，是痉病。如果发其汗，寒湿相得，其表益虚，即恶寒甚重。发其汗后，其脉如蛇行一般。（〔原注〕一说：其脉“xx”。○《伤寒论》作“目脉赤，独头面摇”，没有“若发其汗以下二十五字”。“痉病也”作“为痉也”。《玉函经》、《脉经》没有“若发其汗以下十七字”。《脉经》作“病发其汗已，其脉xx如蛇”。相得，程、徐作相搏。xx，赵本作“沧沧”。）
〔吴谦〕各家将刚柔二痉列为首条，现在将此条作为第一条，是因为刚柔的辨别，都从此条分出。痉病证候最完备的，适宜冠于篇首。
〔程郊倩〕身热头热，邪在太阳。面赤目赤（足阳明正脉系目系），邪在阳明。颈属阳明，项属太阳。邪在二经，则颈项强急恶寒。阳明之脉挟口，所以突然口噤。太阳之脉，循背上头，所以头部独自摇动，背部反张。此人必定是在汗下亡血之后，正气已虚，而邪气只胜在于上部，其足则寒。这是痉病的证候全部显现。
〔吴谦〕李梴说：手三阳之筋，结入于颔颊；足阳明之筋，上挟于口。风寒乘虚，进入其筋则挛缩，所以牙关紧急而口禁。
〔尤在泾〕寒湿相得，是指汗液之湿与外寒之气，相互结合不解，而表气因汗出而更加虚弱，寒气得到湿气而转增，所以恶寒甚重。
《溯源集》说：上文有脉无证，此条有证无脉，合起来看，痉病的脉证就完备了。身热者，风寒在表。足寒者，阴邪在下。颈项强急、背反张者，太阳经脉四行，自巅顶下行至项，夹背脊，而行于两旁。寒邪在经，诸寒收引，其性劲急，邪气发作则筋脉抽掣，所以颈项强急，背如角弓之反张，这就是所谓“筋所生病”。恶寒者，寒邪在表，则应当恶寒；在下焦而阳气虚衰，也应当恶寒。有时头热、面赤、目脉赤者，头为诸阳之会，阳邪独盛于上，所以足寒于下。“时”字，指有时热炎于上，而有发作停止的时候。头面为诸阳之所聚，乃元首，不宜动摇，因风火扇动于上，所以独头面动摇，突然口噤而不能说话。
按语：《医宗金鉴》说：“若发其汗”六句，与上文义理不相连属，与后文“之为欲解，脉如故，反伏弦者，痉”句，文义相属，适宜分开到后面去。然而现在考证这六句，其意不明晰，怀疑是他篇错简，《伤寒论》也没有，适宜删除。
突然腹部胀大的，为欲解；脉象如故，反而伏弦的，是痉病。（沈本，“脉”上有“其”字。伏，《玉函经》、《脉经》作“复”。）
〔程郊倩〕突然腹部胀大为欲解，于理不顺。脉伏弦，即后条“伏坚”的意思。
患痉病的脉象，按之紧如弦，直上下行。（〔原注〕一作“筑筑而弦”。《脉经》说：“痉家，其脉伏坚，直上下。”○案：《脉经》说十二个字，旧本大字书写，与原文相同，现在根据赵本作为细注。《玉函经》、《脉经》作“筑筑而弦”。）
〔尤在泾〕紧如弦，就是坚直的形象。李梴说：上下行者，是从寸部到尺部，都见到紧直的脉象。
〔吴谦〕痉之为病，其状劲急强直，所以其脉也劲急强直。按之紧，是劲急的形象；如弦，是直行的形象。
按语：紧，不散也；弦，不缓也。“如”字，当读为“而”，《玉函经》、《脉经》可以证明。
〔徐忠可〕治疗痉病，终究以清表为主。有灸疮的人，经穴洞达，火热内盛，阴气素亏，即后面的栝蒌桂枝汤、葛根汤，嫌不远热；大承气汤，更虑伤阴，所以说难治。
〔尤在泾〕有灸疮的人，脓血久溃，穴俞不闭。娄全善说：就是破伤风的意思。盖阴伤而不胜风热，阳伤而不任攻伐，所以说难治。
《玉函经》在栝蒌桂枝汤后，多出一条说：脊强者，是五痉的总名。其证突然口噤，背反张而抽搐。诸药无效，可灸身柱、大椎、陶道穴。案：根据此条，则痉病不必禁灸。
太阳病，其证候具备，身体强直KT KT然，脉象反而沉迟，此为痉病。用栝蒌桂枝汤主治。（《玉函经》没有“反”字。）
〔尤在泾〕太阳证备者，赵氏认为太阳之脉，自足上行，循背至头项，这是其所经过的部位，而出现的状态，都是其证候。KT KT是背强连颈的样子。沉本是涩之脉，迟不是内寒，而是津液少，而营卫之行不利。伤寒项背强KT KT，汗出恶风者，脉必浮数，为邪风盛于表。此证身体强KT KT然，脉反沉迟者，为风淫于外，而津伤于内，所以用桂枝则相同，而一加葛根，以助其发散；一加栝蒌根，兼滋其内，则不同。
〔沈明宗〕此条出自柔痉之方。虽然不说有汗的柔痉，此处用桂枝汤调和营卫，而解太阳卫分之邪。栝蒌能清胸膈之热，不出有汗风伤卫的大法，可以意会。
〔程郊倩〕KT KT，是俯仰不自如的样子。（按《说文解字》，“KT”字，无钩挑，有钩挑者，乃是几案之“几”字。“KT”，乃是鸟之短羽，象小鸟毛羽未盛之形，飞KT KT也。所以“凫”字从“KT”，大概是形容其颈项强急之意。○简案：《明理论》。○KT音殊。KT，引颈之貌。KT，短羽鸟也。短羽之鸟，不能飞腾，动则先伸引其头尔。项背强者，动亦如之，非若几案之几而偃屈也。程注本于此为是。《本事方》作几足之义，《三因方》作兀兀，《证治准绳》引诗《幽风》“赤鸟几几”为解，都不可从。）
栝蒌桂枝汤方
栝蒌根（二两○程、沈作三两） 桂枝（三两） 芍药（三两） 甘草（二两○徐、沈有“炙”字） 生姜（三两○徐、沈有“切”字） 大枣（十二枚○徐、沈有“擘”字）
以上六味，用水九升，煮取三升，分三次温服。取微汗。汗不出，食顷啜热粥以发汗。
按语：《神农本草经》说：栝蒌根，治消渴身热，烦满大热。
《三因方》：栝蒌桂枝汤，治柔痉身体强兀兀然，脉反沉迟，自汗。（即本方。）
又桂枝栝蒌根汤，治伤风汗下不解，郁于经络，随气涌泄，衄出清血。或清气道闭，流入胃管，吐出清血，遇寒泣之，色必瘀黑者。于本方，加川芎等分。
太阳病，无汗而小便反少，气上冲胸，口噤不得语，欲作刚痉。用葛根汤主治。
〔尤在泾〕无汗而小便反少者，风寒湿甚，与气相持，不得外达，亦并不下行也。不外达，不下行，势必逆而上冲，为胸满，为口噤不得语，驯至面赤头摇，项背强直，在所不论。所以说“欲作刚痉”。葛根汤，即桂枝汤，加麻黄、葛根，是刚痉无汗者的正法。
葛根汤方（《三因方》名葛根麻黄汤。）
葛根（四两） 麻黄（三两去节） 桂枝（二两去皮○《伤寒论》作桂枝，当补“枝”字） 芍药（二两○赵本作三两为非） 甘草（二两炙） 生姜（三两○《伤寒论》有“切”字） 大枣（十二枚○《伤寒论》有“擘”字）
以上七味，㕮咀，用水一斗，先煮麻黄、葛根，减二升，去沫，纳诸药，煮取三升，去滓，温服一升。覆取微似汗，不须啜粥。余如桂枝汤法。将息及禁忌。（一斗，赵本作七升为非。）
柯琴《来苏集》说：葛根味甘气凉，能起阴气，而生津液，滋筋脉而舒其牵引，所以作为君药。麻黄、生姜，能开玄府腠理之闭塞，祛风而去汗，所以作为臣药。寒热俱轻，所以少佐桂、芍，同甘、枣以和里。这是在麻、桂二汤之间，衡其轻重，而为调和表里之剂。葛根与桂枝，同为解肌和里之药，所以有汗无汗，下利不下利，皆可用，与麻黄专于治表者不同。案：《神农本草经》曰：葛根气味甘辛平，治消渴身大热，起阴气。柯氏以为发表生津之品，全本于《本经》，而刚痉所主，亦在乎此，确实是卓见。
徐、沈诸家，都以为是解阳明之邪的，不对。
患痉病，（〔原注〕一本，“痉”字上，有“刚”字。）胸满口噤，卧不着席，脚挛急，必齘齿，可与大承气汤。（《玉函经》、《脉经》作“刚痉为病”，“必”上有“其人”二字。徐、沈“齘”作“介”。）
〔程郊倩〕胸满，即气上冲胸的互文。卧不着席，也是反张的互词。庞安常说：痉病卧不着席者，小儿腰背去席二指，大人手侧掌，为难治。邪在太阳则挛急，邪在阳明则口噤。《灵枢经》说：热而痉者死，腰折螈疭，齘齿也。（出《热病篇》。）齘，切齿也。噤之甚者则切。《灵枢·热病篇》有啮齿，应当是齘齿之类。痉病属表属虚，未可与承气下也。应当详审。
〔吴谦〕此申述痉病入里，以明其治法。痉病而更胸满，是里气壅滞。卧不着席，是反张甚重。脚挛急，是劲急甚重。必齘齿，是牙紧甚重。这都是阳明热盛灼筋，筋急而甚重的象，所以用大承气汤，直攻其热，并非攻阳明之实。
Taiyang disease, characterized by fever and absence of sweating, accompanied by aversion to cold, is termed Gang Jing (Rigid Spasm). ([Original Note] Also written as "Jing" (Spasm), same elsewhere. ○ Shen Mingzong and Wei Liting both write "Jing", which is correct. *Yuhan Jing* and *Qianjin Yifang* have the character "er" (and) before "fan" (instead/reverse).)
[Xu Zhongke] This clause and the next correspond to the method in *Shanghan Lun* for distinguishing between cold injuring the Ying (Nutritive) level and wind injuring the Wei (Defensive) level. They are selected to distinguish the rigid and flexible types of Jing disease, with some text omitted. Essentially, "Zhi" is "Jing", meaning stiffness and rigidity. Jing disease necessarily presents with symptoms such as stiffness and rigidity of the back and neck; thus, saying "Zhi" is an abbreviation. However, in treating Jing disease, the distinction between rigid and flexible is most critical. Therefore, the absence of sweating combined with reverse aversion to cold is specifically highlighted as Gang Jing (Rigid Spasm), while sweating without aversion to cold is Rou Jing (Flexible Spasm), to demonstrate the key points of syndrome differentiation.
[Cheng Jiaoqian] Patients with Jing disease often suffer from excessive sweating during Taiyang disease, leading to the depletion of Ying blood, making them susceptible to wind-cold invasion, resulting in taut sinews and tendons. This divides into two types: Gang and Rou. When pathogenic cold enters the Ying level internally and stagnates in the skin and muscles, fever occurs; when it congeals the blood vessels, there is no sweating. Absence of sweating indicates exterior excess, which should not typically involve aversion to cold. The fact that there is instead aversion to cold suggests that the cold pathogen is severe, moving from the Wei level into the Ying level, causing the Wei Qi to fail to close properly, hence the reverse aversion to cold. This condition is named Gang Jing.
Commentary: Cheng Wuji stated that "Zhi" should be read as "Jing", a scribal error. He claimed "Zhi" means aversion/dislike, not stiffness. Current research shows "Zhi" means aversion, as seen in Zhang Yi's *Guangya*, whereas *Shuowen Jiezi* states: "Jing means stiffness and urgency." Cheng's view is correct. *Shengji Zonglu* states: "Zhi is also called Jing because they are one category of disease; ancients specifically named them by their stiffness." Guo Baiyun said: "Zhi is the disease name, Jing is the symptom name." Yang Shi's *Zhizhi Fang* and Li Shi's *Yonglei Qianfang* established separate sections for Zhi and Jing, lacking proper textual research. *Yizong Jinjian* claims the character "fan" (reverse) in "fan e han" is a superfluous character. Studying the clauses on Jing disease naturally reveals that aversion to cold should be present. Research on *Jia Yi Jing* citing this clause shows no "fan" character, supporting *Jinjian*'s view. However, Qian Huang's *Suyuan Ji* argues: "Fever and no sweating should naturally involve aversion to cold; saying 'reverse aversion to cold' implies it is inappropriate to have aversion." This interpretation is incorrect. Considering symptoms like occasional head heat, red face, and red eye vessels, which seem to indicate intense heat, yet the body remains hot with cold feet, and the head/neck are stiff with aversion to cold, the term "fan" (reverse) is used. Here, "fan" intensifies the meaning. Based on this, the character "fan" need not be deleted for the logic to hold. Pang Anshi reading it as "fan bu e han" (reverse no aversion to cold) is also unacceptable.
Taiyang disease, characterized by fever and sweating, without aversion to cold, is termed Rou Jing (Flexible Spasm).
[Cheng Jiaoqian] Wind pathogen injuring the Wei level causes fever; opening the cou li (pores) leads to sweating. Sweating should normally bring aversion to cold. The current absence of aversion to cold is because wind is a yang pathogen; its nature is flexible and harmonious. Although sweating occurs, there is no aversion to cold. This condition is named Rou Jing.
Commentary: Cheng Jiaoqian's explanation of rigid/flexible is erroneous. Xu Zhongke interpreted it as "softness," but Jing disease is named for stiffness and urgency; how can it be soft? His view is particularly flawed. *Yizong Jinjian* states: "Taiyang disease with fever, no sweating, and aversion to cold is an excess pathogen, named Gang Jing, meaning strong and forceful. Fever, sweating, and no aversion to cold is a deficient pathogen, named Rou Jing, meaning strong but weak in force." This annotation is closer to correctness. However, distinguishing rigid/flexible merely by force/strength misses the point. Rigid/Flexible refers to Yin/Yang; Yin/Yang refers to Excess/Deficiency. Exterior excess is called Rigid; exterior deficiency is called Flexible. *Shenqiao Wanquan Fang* states: "Taiyang disease, fever, no aversion to cold, no sweating is Yang Jing; fever, no aversion to cold, sweating is Yin Jing." *Huo Ren Shu* states: "Gang Jing belongs to Yang Jing; Rou Jing belongs to Yin Jing." *Huo Ren Xuji Jiehuo Lun* states: "Sleeping face down is Yin Jing; sleeping looking up is Yang Jing." The underlying principle is clear here.
Taiyang disease, characterized by fever and a deep, fine pulse, is termed Zhi, and is difficult to treat. (*Shanghan Lun*, *Yuhan Jing*, and *Maijing* do not contain the three characters "wei nan zhi" / "is difficult to treat".)
[Xu Zhongke] Ancients defined Zhi as stiffness and rigidity. The external symptoms resemble Shanghan, but the pulse is deep and fine, and the neck/back arch backward, with stiffness resembling epilepsy. As the previous two clauses distinguished rigid/flexible based on sweating/no sweating, this clause distinguishes based on the deep/fine pulse. *Suyuan Ji* states: "When pathogen is in Taiyang, if it is Zhongfeng (Wind Strike), the pulse should be floating and slow; if it is Shanghan (Cold Damage), the pulse should be floating and tight. Here, although it is a surface symptom of Taiyang fever, the pulse differs significantly from Zhongfeng and Shanghan, appearing deep and fine. This is because the pathogen is not only on the Taiyang surface. Thus, wind-cold pathogens exist in both interior and exterior, infiltrating skin, bones, tendons, organs, meridians, and collaterals. This cannot be compared to Zhongfeng or Shanghan pathogens, which transmit sequentially from exterior to interior. This represents severe pathogen and critical illness, a difficult and dangerous syndrome. Hence, *Jinkui* adds 'wei nan zhi' (difficult to treat) below this clause."
Taiyang disease, resulting from excessive sweating, leads to Jing disease.
[Wu Qian] Taiyang disease requires sweating. If sweating is excessive, the cou li open widely, exterior Qi fails to consolidate, and pathogens enter due to deficiency, causing Jing disease. This is induced by internal deficiency. One should use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Prepared Aconite Root) to secure the exterior and warm the meridians. By extension, any disease involving excessive sweating, postpartum conditions, traumatic injuries, or excessive bleeding that develops this syndrome belongs to this category.
*Suyuan Ji* cites *Shengqi Tongtian Lun*: "Yang Qi nourishes the spirit when refined and nourishes the sinews when soft." When Yang Qi is weak and unable to nourish bones and sinews, sinews and tendons become taut, leading to Jing disease. Thus, the *Taiyang Pian* states: "In Taiyang disease, if the physician induces sweating, leading to continuous leakage of sweat, spasticity of the four limbs, and difficulty in flexion and extension, Guizhi Jia Fuzi Tang should be used." The manifestations of Jing disease are more severe than this, but the principle is similar.
*Zhangshi Yitong* mentions: Zhenwu Tang.
If a patient suffering from wind disease undergoes purgation, Jing disease ensues; subsequent sweating will cause spasms.
[Cheng Jiaoqian] Wind injuring the Wei level, if treated with purgation, depletes Yin blood. Wind exploits this deficiency, sinking into the Ying and Blood levels. Blood fails to nourish the sinews, causing Jing disease. The four limbs are the root of all Yang Qi. Subsequent sweating further depletes Yang, inevitably causing limb spasms.
*Zhangshi Yitong* mentions: Fuzi Tang.
Patients with sores, even if experiencing body pain, must not undergo sweating therapy; sweating will lead to Jing disease.
[Wu Qian] In early-stage sores where toxic heat has not formed, sweating dispersal is indicated. After ulceration, Qi and Blood are damaged. Even with surface symptoms like body pain, sweating must not be induced. Fear that sweating will further exhaust blood, depriving sinews of nourishment and causing Jing disease. Alternatively, evil wind may invade, also causing Jing.
[Xu Zhongke] Postpartum Jing disease is often due to Yin deficiency and fluid depletion. Mistaken sweating or purgation postpartum can also cause it. Therefore, Zhang Zhongjing did not provide a specific formula, leaving it to the physician's discretion.
*Zhangshi Yitong* mentions: Shaoyao Gancao Fuzi Tang.
*Zhubing Yuanhou Lun · Jin Chuang Zhong Feng Jing Hou* states: "Jin Chuang Jing arises from exhaustion of blood vessels and fluids, incomplete dietary recovery within a month, injury to Ying and Wei, allowing wind qi to enter the five Zang organs. Cold contraction causes Jing. Symptoms include oral tension, straight back, head shaking, horse-like crying, opisthotonos, sudden severe发作, near-apnea, and profuse sweating. Untimely rescue leads to death. Sudden absence of sweating in wounds indicates wind strike. Yellow discharge indicates water strike. Both predispose to Jing; urgent treatment is required."
*Wan Zhe Zhong Feng Jing Hou* states: "For wrist fractures damaging skin and flesh into sores, one must avoid wind and self-fanning. If wind enters the sore and invades meridians, Jing results. Jing is characterized by spinal stiffness and locked jaw preventing speech. This corresponds to later generations' concept of Po Shang Feng (Traumatic Tetanus). Water strike is called Po Shang Shi (see *San Yin Fang*). *Zhubing Yuanhou Lun* also includes *Chan Hou Zhong Feng Jing Hou* (attached to Postpartum Women's Diseases)."
A patient with Jing disease presents with body heat, cold feet, neck and nape stiffness, aversion to cold, occasional head heat, red face, red eyes, isolated head tremor, sudden locked jaw, and opisthotonos. This is Jing disease. If sweating is induced, cold and dampness combine, further weakening the exterior, leading to severe aversion to cold. After sweating, the pulse resembles a snake slithering. ([Original Note] One version says: "Its pulse [character].") (*Shanghan Lun* reads "red eye vessels, isolated head and face tremor," omitting the 25 characters starting from "ruo fa qi han" (if sweating is induced)). *Yuhan Jing* and *Maijing* omit 17 characters from "ruo fa qi han." *Maijing* reads: "After inducing sweating in the disease, the pulse [character] resembles a snake." "Xiang de" in Cheng and Xu versions is "Xiang bo." [Character], Zhao Ben reads "Cang Cang."
[Wu Qian] Most families list Gang and Rou Jing as the first clauses. Placing this clause first is because the distinction between Gang and Rou derives from it. This clause contains the most complete symptoms of Jing disease and is appropriately placed at the beginning.
[Cheng Jiaoqian] Body heat and head heat indicate pathogen in Taiyang. Red face and red eyes (Foot-Yangming positive meridian connects to the eye system) indicate pathogen in Yangming. The neck belongs to Yangming, the nape to Taiyang. Pathogen in these two meridians causes neck/nape stiffness and aversion to cold. Yangming meridian flanks the mouth, causing sudden locked jaw. Taiyang meridian runs along the back to the head, causing isolated head tremor and opisthotonos. Such a person likely suffered blood loss via sweating/purgation previously, leaving Zheng Qi (Upright Qi) deficient while pathogen dominates the upper body, causing cold feet. These are full manifestations of Jing disease.
[Wu Qian] Li Chen stated: The sinews of the Three Hand-Yang meridians knot into the jaw and cheeks; the sinews of Foot-Yangming flank the mouth. Wind-cold exploiting deficiency enters the sinews, causing contraction, leading to tight jaw and locked mouth.
[You Zaijing] "Han shi xiang de" means sweat moisture and external cold qi combine unresolved, further weakening exterior Qi via sweating, and cold qi increases with moisture, causing severe aversion to cold.
[Shen Mingzong] The pulse is firm and tense, beating like a snake, metaphorically describing struggling and pressing movements.
*Suyuan Ji* states: The previous clause had pulse but no symptoms; this clause has symptoms but no pulse. Together, Jing disease pulse and symptoms are complete. Body heat indicates wind-cold on the surface. Cold feet indicate yin pathogen below. Neck/nape stiffness and opisthotonos occur because Taiyang meridians run from the vertex down the nape, flanking the spine. Cold pathogen in the meridian causes contraction due to cold nature; pathogen onset draws sinews, causing stiffness and opisthotonos like a drawn bow, known as "diseases of the sinews." Aversion to cold occurs because cold is on the surface; deficiency of Yang Qi in the lower jiao also causes aversion. Occasional head heat, red face, and red eye vessels occur because the head is the meeting of all Yang meridians; yang pathogen dominates above, causing cold feet below. "Shi" (occasionally) means heat flares up intermittently. The head and face gather all Yang Qi and should not move; wind-fire stirring above causes isolated head/face tremor and sudden locked jaw.
Commentary: *Yizong Jinjian* states: The six sentences starting with "ruo fa qi han" do not connect logically with the preceding text but connect with the following clause "wei yu jie, mai ru gu, fan fu xian zhe, jing." It is suspected to be misplaced text from another chapter, absent in *Shanghan Lun*, and should be deleted.
Sudden abdominal distension indicates resolution; if the pulse remains unchanged but becomes hidden and wiry, it is Jing disease. (Shen Ben has "qi" before "mai." Hidden, *Yuhan Maijing* reads "fu" (again).)
[Cheng Jiaoqian] Sudden abdominal distension indicating resolution is illogical. Hidden/wiry pulse corresponds to the "hidden/firm" meaning in the next clause.
[Wu Qian] "Bao fu zhang da zhe" is a superfluous sentence and should be deleted.
The pulse of Jing disease, when pressed, feels tight like a string, running straight from top to bottom. ([Original Note] One version: "Zhu Zhu er xian." *Maijing* says: "Jing jia, qi mai fu jian, zhi shang xia." ○ Case: *Maijing* twelve characters were large print in old editions, same as original text. Now using Zhao Ben for notes. *Yuhan Maijing* reads "Zhu Zhu er xian.")
[You Zaijing] Tight like a string is the image of firmness and straightness. Li Chen said: Running straight from top to bottom means from Cun to Chi, all show tight/straight pulses.
[Wu Qian] Jing disease manifests as taut, stiff, and rigid; thus, its pulse is also taut, stiff, and rigid. Pressed tight is the image of urgency; like a string is the image of straightness.
Commentary: "Jin" means not loose; "Xian" means not slack. "Ru" should be read as "er" (and), proven by *Yuhan Maijing*.
Jing disease with moxibustion sores is difficult to treat.
[Xu Zhongke] Treatment of Jing primarily focuses on clearing the exterior. Patients with moxibustion sores have open acupoints, internal excess fire, and inherent Yin deficiency. Formulas like Gualou Guizhi Tang and Gegen Tang are considered too hot; Dachengqi Tang risks damaging Yin. Hence, it is difficult to treat.
[You Zaijing] Moxibustion sores imply long-standing pus/blood loss and unclosed acupoints. Lou Quanshan stated this is equivalent to Po Shang Feng. Yin deficiency cannot withstand wind-heat; Yang deficiency cannot withstand attack/clearing. Hence, difficult to treat.
*Yuhan Jing* adds after Gualou Guizhi Tang: "Stiff spine is the general name for Five Jing syndromes. Symptoms include sudden locked jaw, opisthotonos, and convulsions. If herbs fail, moxa can be applied to Shenzhu, Dazhui, and Daodao points." According to this, Jing disease does not strictly prohibit moxibustion.
Taiyang disease, with complete symptoms, presents with body stiffness [KT KT], and the pulse is unexpectedly deep and slow. This is Jing disease. Treat with Gualou Guizhi Tang. (*Yuhan Jing* lacks "fan" (unexpectedly).)
[You Zaijing] "Taiyang zheng bei" means Zhao's view: Taiyang meridian ascends from foot, along back to head/nape. Symptoms in these areas constitute the syndrome. [KT KT] describes back stiffness connecting to the neck. Deep is originally a涩 (rough) pulse; slow is not internal cold, but indicates scarce fluids and poor Ying/Wei circulation. In Shanghan, stiff neck/back with sweating and aversion to wind has a floating/rapid pulse, indicating excess wind on surface. Here, stiff body with unexpected deep/slow pulse indicates wind invading externally and fluids injured internally. Guizhi is used similarly, but adding Gegen aids dispersion, while adding Gualou Gen nourishes internally.
[Shen Mingzong] This provides the formula for Rou Jing. Although it doesn't explicitly mention sweating Rou Jing, using Guizhi Tang harmonizes Ying/Wei and releases Taiyang Wei pathogen. Gualou clears chest/diaphragm heat, adhering to the principle of treating wind injuring Wei with sweating, though implied.
[Cheng Jiaoqian] [KT KT] describes inability to bend/extend freely. (*Shuowen*: "KT" has no hook; with hook is "ji" (table). "KT" is short-winged bird, depicting immature feathers, flying [KT KT]. "Fu" character uses "KT", describing neck stiffness. ○ Commentary: *Ming Lilun*. ○ Pronunciation differs. KT: stretching neck. KT: short-winged bird. Short-winged birds cannot fly high, extending neck before moving. Stiff neck/back moves similarly, unlike table legs. Cheng's note is correct. *Benshi Fang* interprets as table legs; *San Yin Fang* as "Wu Wu"; *Zhengzhi Zhunsheng* cites *Shijing* "Red bird ji ji" – all unacceptable.)
Gualou Guizhi Tang Formula
Gualou Gen (Trichosanthes Root) (2 liang ○ Cheng/Shen 3 liang) Guizhi (Cinnamon Twig) (3 liang) Shaoyao (Peony Root) (3 liang) Gancao (Licorice Root) (2 liang ○ Xu/Shen "Zhi" roasted) Shengjiang (Fresh Ginger) (3 liang ○ Xu/Shen "Qie" sliced) Dazao (Jujube) (12 pieces ○ Xu/Shen "Bo" split)
Six ingredients. Boil in 9 sheng water, reduce to 3 sheng. Divide into three warm doses. Induce slight sweating. If no sweat, drink hot porridge after a meal interval to promote sweating.
Commentary: *Shennong Benjing* states: Gualou Gen treats thirst, body heat, irritability, fullness, and great heat.
*San Yin Fang*: Gualou Guizhi Tang treats Rou Jing, body stiffness [Wu Wu], unexpected deep/slow pulse, spontaneous sweating. (Same formula.)
Also, Guizhi Gualou Gen Tang treats wind-cold where sweating/purgation failed, stagnating in meridians, surging with Qi, causing clear blood epistaxis. Or clear airway blockage, flowing into stomach tube, vomiting clear blood, turning dark/black upon cold contact. Add Chuanxiong equal amount to this formula.
Taiyang disease, with no sweating and unexpectedly reduced urination, Qi rushing upward to the chest, locked jaw preventing speech, impending Gang Jing. Treat with Gegen Tang.
[You Zaijing] No sweating and reduced urination indicate severe wind-cold-dampness holding Qi, preventing outward release or downward flow. Prevented from both, Qi reverses upward, causing chest fullness and locked jaw. Eventually leading to red face, head tremor, and neck/back stiffness is inevitable. Hence "impending Gang Jing." Gegen Tang is Guizhi Tang plus Mahuang and Gegen, the standard method for non-sweating Gang Jing.
Gegen Tang Formula (*San Yin Fang* names it Gegen Mahuang Tang.)
Gegen (Kudzu Root) (4 liang) Mahuang (Ephedra Stem) (3 liang, remove joints) Gui (Cinnamon) (2 liang, remove bark ○ *Shanghan Lun* Gui Zhi, add "Zhi") Shaoyao (Peony Root) (2 liang ○ Zhao 3 liang is incorrect) Gancao (Licorice Root) (2 liang, roasted) Shengjiang (Fresh Ginger) (3 liang ○ *Shanghan Lun* "Qie") Dazao (Jujube) (12 pieces ○ *Shanghan Lun* "Bo")
Seven ingredients. Coarsely crush. Boil in 1 dou water. First boil Mahuang and Gegen, reduce by 2 sheng, skim foam. Add remaining herbs. Boil to 3 sheng. Strain. Warm dose 1 sheng. Cover to induce slight sweat. No need for hot porridge. Rest follows Guizhi Tang instructions. Diet and taboos apply. (1 dou, Zhao 7 sheng is incorrect.)
Ke Qin's *Laisu Ji* states: Gegen is sweet and cool, raises Yin Qi, generates fluids, nourishes sinews, and relieves traction, serving as the Sovereign herb. Mahuang and Shengjiang open Xuan Fu (pores) and cou li, dispel wind, and stop sweating, serving as Ministers. Cold and heat are mild, so minor assistants Guizhi and Shaoyao, together with Gancao and Dazao, harmonize the interior. This balances Ma Huang Tang and Gui Zhi Tang, creating a formula harmonizing exterior and interior. Gegen and Guizhi both relieve muscle layer and harmonize interior; usable with or without sweating, diarrhea or not, differing from Mahuang's exclusive exterior action. Case: *Shennong Benjing* states: Gegen is sweet, pungent, neutral, treats thirst, great heat, raises Yin Qi. Ke Qin considers it releasing exterior and generating fluids, based on *Benjing*, and suitable for Gang Jing. This is indeed a profound insight.
Xu and Shen families mistakenly believe it resolves Yangming pathogen. Incorrect.
Jing disease presenting with chest fullness, locked jaw, inability to lie flat (back off bed), leg cramps, and teeth grinding. Dachengqi Tang may be given. (*Yuhan Maijing* reads "Gang Jing wei bing," adds "qi ren" before "bi." Xu/Shen "Xie" reads "Jie".)
[Cheng Jiaoqian] Chest fullness is synonymous with Qi rushing to chest. Inability to lie flat is synonymous with opisthotonos. Pang Anchang said: For Jing patients unable to lie flat, children's back is 2 fingers off bed, adults' hand width off bed – difficult to treat. Pathogen in Taiyang causes spasms; pathogen in Yangming causes locked jaw. *Lingshu* states: Heat-induced Jing dies, with opisthotonos, convulsions, and teeth grinding (from *Re Bing Pian*). "Xie" means teeth grinding. Severe locking involves grinding. *Lingshu Re Bing Pian* mentions biting teeth, likely similar to "Xie Chi." Jing disease belongs to exterior and deficiency; Dachengqi Tang for purgation is contraindicated. Must examine carefully.
[Wu Qian] This elaborates on Jing disease entering the interior to clarify treatment. Jing disease with chest fullness indicates interior Qi stagnation. Inability to lie flat indicates severe opisthotonos. Leg cramps indicate severe tension. Teeth grinding indicates severe jaw clenching. These are images of Yangming heat flourishing, burning sinews, causing severe tension. Thus, Dachengqi Tang directly attacks the heat, not Yangming excess per se.