一 一人久患肠风，百药不效，用人胞〔一具煮烂。〕侧柏〔向东南者二斤，同胞捣烂，晒干
为末。〕二味蜜丸，空心淡盐汤服〔五钱。〕顿愈。〔治弱症吐血亦效，〕
二 一童子病内伤，大小便俱血。用桃仁、红花，病愈甚。仲淳曰∶血既下行，奈何又重伤之，
伤之则补之而已。以生地、牛膝、杜仲、续断等药饮之，稍平而腹痛不已。因加人参，〔二钱。〕一
剂即止。此经言强者气行则愈之验也。
三 一人大便下血甚多，面色痿黄，发热倦怠，盗汗遗精。士材诊之曰∶脾虚不能统血，肾虚不
能闭藏，法当以补中益气，五帖并一而进之。十日汗止，二十日血止。再以六味地黄丸，间服一月而安。
痉者，筋病强劲不柔和也。甚者，头动摇，背反张，脚挛急，口噤 齿。按经言∶诸暴强直，皆
属于风。又言∶痉筋之病，寒则反折筋急。又言∶诸痉项强，皆属于湿。考《金匮》论痉。亦以风、
寒、湿立言。谓∶太阳病发热无汗为刚痉，太阳病发热汗出为柔痉。又谓∶太阳病发热脉沉而细者，名
为痉，为难治。盖太阴湿邪，淫于太阳，故令背项强直。若寒、湿相合，则成刚痉∶风、湿相合，则
成柔痉∶以太阳为病，而见太阴贼克之脉，故曰难治。徐忠可注云∶痉虽概为风、寒、湿所中，然原其
因，多由亡血，筋无所荣，故邪得以袭之。故仲景撤消痉病之由，而曰∶太阳病发汗太多，因致痉。夫
风病下之则痉，复发汗必拘急，疮家发汗则痉。虽汗下后，或有邪乘，总由阴虚液脱筋燥致痉，则一
也。此丹溪论治痉，所以有不可纯用风药之戒。景岳注《内经》，亦言肝主筋，其化风，故诸暴强直，皆
属于风，非外来之风。内风多燥，若与风剂则益燥，宜补阴以制阳，养荣以润燥。故有治风先治血，血行
风自灭之说也。《千金》谓∶温病热入肾中，亦为痉，小儿痫热盛，亦为痉，俱当养阴清热润燥。盖痉病
皆属阴虚液脱筋燥所致。忠可之说，深得病情，所以产后及金疮折伤，失血过多，痈疽脓溃之后，每有此
症，亦宜养阴清热润燥为主。或金疮所伤，痈疽溃后，冒风致痉者∶即所谓破伤风也。当养血疏风，方为
善治。产后血
舍空虚，外风袭入而成痉者，即《金匮》所言∶新产血虚，多汗出，易中风，故令病痉是也。宜海藏
防风当归为主治之。嘉言谓∶庸愚不知此症，昔贤各从血舍驱风，自有成法可遵。辄称产后惊风，妄用
镇惊之药。千中千死而不悟，深为可慨。又小儿体脆神怯，不耐外感壮热，多如痉病，后世妄以惊风
立名，不治外淫之邪，反投金石脑麝等药，镇坠外邪，深入脏腑，亦千中千死，此通国所当共禁。沈氏
谓∶此乃少阴、少阳客邪所至，为惊为螈，感冒热邪所致，实非惊风，并非痉病，治者审焉。
养阴清热润燥汤〔见燥。〕治汗、下后，产后及金疮折伤，失血过多，痈疽溃后，一切发
痉，可用此方。
宜加牛膝〔入肝养血，拘挛可解。〕木瓜〔入肝养筋，缓急皆宜。〕猪脂〔甘寒润
燥养筋。〕羚羊角〔入血除热舒筋。〕汗多酌加参、 、〔实表敛汗。〕枣、芍。〔收阴敛
汗。〕此养血清热之剂，须对症加减，活泼泼地用之可也。按嘉言云∶痉病之坏，不出亡阴亡阳两途。
亡阴者，精血津液素亏，不能荣养其筋脉，此宜急救其阴。亦间有亡阳者，阳气素虚，不能充养柔和其
筋脉，此宜急救其阳，参、 之品，在所必用。以气主煦之，故益气则津自生也。
海藏防风当归汤 治汗下后及产后，中〔同伤。〕风病痉。并一切破伤风发痉。
防风〔风药之润剂，故用以疏风。〕当归 地黄〔养血。〕川芎〔治一切风，一切
血。〕宜加荆芥〔能入血分而
驱风。〕秦艽 甘菊 胡麻〔养血驱风。〕黑豆〔活血散风。〕竹沥〔逐痰除热，产后及
小儿中风，并破伤风发痉皆用。〕
此养血疏风之剂，果有冒风的症，可用此加减治之。
热而痉者死。〔此系热极生风，大伤阴血而然，既热且痉，乃为死候。〕痉病有灸疮难治。〔火热
内盛，阴血太亏故也。〕
一、有一人长期患有肠风（便血），服用多种药物无效。使用人胞（胎盘，一枚煮熟烂）和侧柏叶（朝向东南方向的二斤，与人胞一起捣烂，晒干后研为粉末）这两味药，炼蜜为丸，空腹时用淡盐汤送服（五钱）。顿时痊愈。（治疗虚损引起的吐血也有效。）
二、有一个童子患内伤，大小便均出血。医生使用桃仁、红花，导致病情加重。张景岳（字仲淳）说：血既然已经下行，为什么还要再次损伤它？损伤了就要进行补益。于是用生地、牛膝、杜仲、续断等药煎服，症状稍平但腹痛不止。因此加入人参（二钱），一剂药后出血即止。这是《内经》所说“正气充足则病愈”的验证。
三、有一人大便下血量多，面色萎黄，发热倦怠，盗汗遗精。李中梓（字士材）诊察后说：脾虚不能统摄血液，肾虚不能固藏精气，治法应当采用补中益气汤，将五帖药合并为一剂服用。十天后汗止，二十天后血止。再服用六味地黄丸，间断服用一个月而安愈。
痉病，是指筋脉病变，表现为强劲僵硬而不柔和。严重的，头部摇动，背部反张（角弓反张），脚部挛急，牙关紧闭咬齿。按《内经》所言：所有突然发生的强直症状，都属于风邪。又说：痉是筋的病，寒邪侵袭则筋脉拘急反折。又说：所有痉病的项背强直，都属于湿邪。考察《金匮要略》论述痉病，也是以风、寒、湿立论。认为：太阳病发热无汗称为刚痉，太阳病发热有汗称为柔痉。又认为：太阳病发热且脉沉细的，名为痉，属于难治。这是因为太阴湿邪，浸淫于太阳经，所以导致背项强直。如果寒、湿相合，则形成刚痉；风、湿相合，则形成柔痉；因为病在太阳，却出现太阴相克制的脉象，所以说难治。徐忠可注释说：痉病虽然概由风、寒、湿所中，但推究其起因，多由亡血导致筋脉失去濡养，所以邪气得以侵袭。所以张仲景分析痉病的成因时说：太阳病发汗过多，因而导致痉病。风病误用下法会导致痉，再次发汗必然导致拘急，疮家（久患疮疡者）发汗也会导致痉。虽然在汗下之后，可能有邪气乘虚而入，但总归是由于阴虚液脱、筋脉干燥导致痉，道理是一样的。这就是朱丹溪论述治疗痉病时，告诫不可单纯使用风药的原因。张景岳注释《内经》，也说肝主筋，其变化化为风，所以诸暴强直都属于风，这不是外来的风邪。内风多燥，如果使用风剂则会更加燥烈，应当补阴以制约阳亢，养血荣润以消除燥热。所以有“治风先治血，血行风自灭”的说法。《千金方》说：温病热入肾中，也会发生痉，小儿痫证热盛，也会发生痉，都应当养阴清热润燥。大概痉病都属于阴虚液脱、筋脉干燥所致。徐忠可的说法，深得病情机理，所以在产后及金创折伤、失血过多、痈疽脓溃之后，常有此症，也应当以养阴清热润燥为主。如果是金创所伤，或痈疽溃后，冒风导致痉的：就是所谓的破伤风。应当养血疏风，才是善治。产后血海空虚，外风袭入而成痉的，就是《金匮要略》所说的：新产血虚，多汗出，易中风，所以令病痉。宜用海藏防风当归汤为主治。汪昂（字嘉言）说：庸医不知此症，从前贤人各从血分驱风，自有成法可遵。却妄称产后惊风，乱用镇惊的药物。千次治疗千次死亡而不醒悟，深为可惜。又小儿体质脆弱神气怯弱，不耐受外感壮热，多表现为类似痉病的症状，后世妄立“惊风”之名，不治疗外淫之邪，反而投用金石、脑麝等药物，镇坠外邪，使其深入脏腑，也是千中千死，这是全国都应当共同禁止的。沈氏说：这是少阴、少阳客邪所致，表现为惊厥抽搐，由感冒热邪引起，实在不是惊风，也并非痉病，医者需审慎辨别。
养阴清热润燥汤（见燥病章节）：治疗汗、下之后，产后及金创折伤，失血过多，痈疽溃后，一切引发痉病的情况，可用此方。
宜加牛膝（入肝养血，拘挛可解）、木瓜（入肝养筋，缓急皆宜）、猪脂（甘寒润燥养筋）、羚羊角（入血除热舒筋）。汗多酌情加人参、黄芪（实表敛汗）、大枣、白芍（收阴敛汗）。这是养血清热的方剂，必须对症加减，灵活应用即可。按汪昂说：痉病的变坏，不出亡阴、亡阳两条途径。亡阴者，精血津液素来亏虚，不能荣养筋脉，这应当急救其阴。也有间有亡阳者，阳气素来虚弱，不能充养柔和筋脉，这应当急救其阳，人参、黄芪之类的药物，在所必用。因为气主温煦，所以益气则津液自然生成。
海藏防风当归汤：治疗汗下之后及产后，中风病痉。以及一切破伤风引发的痉病。
防风（风药中的润剂，故用以疏风）、当归、地黄（养血）、川芎（治一切风，一切血）。宜加荆芥（能入血分而驱风）、秦艽、甘菊、胡麻（养血驱风）、黑豆（活血散风）、竹沥（逐痰除热，产后及小儿中风，并破伤风发痉皆用）。
这是养血疏风的方剂，果真有冒风的症状，可用此方加减治疗。
热极而生痉者死。（这是由于热极生风，大伤阴血所致，既热且痉，乃是死候。）痉病伴有灸疮者难治。（火热内盛，阴血太亏的缘故。）
1. A patient suffered from Changfeng (intestinal wind, characterized by rectal bleeding) for a long time with no effect from various medicines. One placenta (Renbao), boiled until soft, and two jin of Cacumen Platycladi (Cebaiye, specifically from the southeast direction), pounded together with the placenta, dried, and ground into powder, were used to make honey pills. Taken on an empty stomach with light salt water (5 qian), the condition was cured instantly. (This is also effective for hemoptysis due to deficiency syndromes.)
2. A young boy suffered from internal injury with blood in both stool and urine. The physician used Semen Persicae (Taoren) and Flos Carthami (Honghua), which aggravated the condition. Zhang Zhongjing (courtesy name Zhongchun) said: "Since the blood has already flowed downward, why inflict further injury? If injured, it must be tonified." He prescribed decoctions of Radix Rehmanniae Preparata (Shengdi), Radix Achyranthis Bidentatae (Niuxi), Cortex Eucommiae (Duzhong), and Radix Dipsaci (Xuduan). The symptoms subsided slightly, but abdominal pain persisted. Therefore, Radix Ginseng (Renshen, 2 qian) was added, and after one dose, the bleeding stopped. This verifies the statement in the *Neijing*: "When qi is strong, the disease resolves."
3. A patient had severe hematochezia, sallow complexion, fever, fatigue, night sweats, and seminal emission. Li Zhongzi (courtesy name Shicai) diagnosed: "Spleen deficiency fails to control blood, and Kidney deficiency fails to secure essence. The method should employ Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), combining five doses into one administration. After ten days, sweating stopped; after twenty days, bleeding stopped. Then, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was taken intermittently for one month, leading to recovery."
Jing disease (spasm) refers to a pathology of the sinews, characterized by stiffness and lack of flexibility. In severe cases, there is head shaking, opisthotonos (back arching), foot cramping, and trismus (locked jaw). According to the classics: "All sudden stiffness and straightness belong to Wind." It also states: "Jing is a disease of the sinews; cold causes them to contract and spasm." And again: "All spasms with neck stiffness belong to Dampness." Examining the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), the discussion on Jing disease is also based on Wind, Cold, and Dampness. It states: "Taiyang disease with fever and no sweat is called Gang Jing (Yang Spasm); Taiyang disease with fever and sweating is called Rou Jing (Yin Spasm)." It further states: "Taiyang disease with fever and a deep, fine pulse is named Jing, and is difficult to treat." This is because Dampness of the Taiyin invades the Taiyang, causing stiffness in the back and neck. If Cold and Damp combine, they form Gang Jing; if Wind and Damp combine, they form Rou Jing. Because the disease is in the Taiyang but presents with a pulse indicative of Taiyin overcoming it, it is termed difficult to treat. Xu Zhongke commented: "Although Jing disease is generally caused by Wind, Cold, and Dampness, its root cause is often blood loss, leaving the sinews without nourishment, allowing pathogens to invade. Thus, Zhang Zhongjing analyzed the etiology of Jing disease, stating: 'Excessive sweating in Taiyang disease leads to Jing.' If Wind disease is treated with purgatives, it leads to Jing; re-sweating causes rigidity; excessive sweating in patients with sores leads to Jing. Although pathogens may exploit the body after sweating or purging, the fundamental cause remains yin deficiency, fluid depletion, and dry sinews. This is why Zhu Danxi warned against using purely Wind-dispelling herbs for treating Jing. Zhang Jingyue, commenting on the *Neijing*, also stated that the Liver governs the sinews and transforms into Wind; thus, sudden stiffness belongs to Wind, but this is not external Wind. Internal Wind is often dry; using Wind-dispelling agents increases dryness. One should tonify Yin to restrain Yang, and nourish Ying to moisten dryness. Hence the saying: 'To treat Wind, first treat the Blood; when Blood moves, Wind extinguishes itself.'" The *Qian Jin Fang* states: "In warm diseases, heat entering the Kidney can cause Jing; in children, severe heat in epilepsy can cause Jing. Both require nourishing Yin, clearing heat, and moistening dryness." Generally, Jing disease results from yin deficiency, fluid depletion, and dry sinews. Xu Zhongke's view deeply grasps the pathology. Therefore, after childbirth, traumatic injuries, excessive blood loss, or ulceration of carbuncles, this syndrome often occurs, and treatment should primarily focus on nourishing Yin, clearing heat, and moistening dryness. If Jing is caused by exposure to Wind after trauma or ulceration, it is referred to as Po Shang Feng (Broken Skin Wind / Tetanus). Treatment should involve nourishing Blood and dispersing Wind. For Jing caused by external Wind invading the emptiness of the Blood Sea after childbirth, this corresponds to the *Jin Gui* statement: "After childbirth, blood deficiency and profuse sweating make one susceptible to Wind, leading to Jing." Haizang Fangfeng Danggui Tang (Haizang's Ephedra and Angelica Decoction) is suitable as the primary treatment. Wang Ang (courtesy name Jiayan) noted: "Ignorant physicians do not understand this syndrome. Ancient sages each drove out Wind from the Blood residence, following established methods. Yet, they wrongly diagnose it as Postpartum Convulsion and recklessly use sedative drugs. Thousands are killed without realizing their error, which is lamentable. Furthermore, children have fragile constitutions and timid spirits, unable to withstand high fever from external contraction. Their symptoms often resemble Jing disease. Later generations wrongly named this 'Convulsion,' failing to treat the external pathogenic factors, and instead administered minerals, borneol, and musk to suppress the pathogen, driving it deep into the zang-fu organs. This also results in death upon every attempt, a practice that should be banned nationwide." Shen stated: "This is caused by guest pathogens in Shaoyin and Shaoyang, manifesting as惊 (startle/convulsion) and 瘛疭 (clonic spasms), resulting from contracted heat pathogens. It is truly not Convulsion, nor is it Jing disease. Physicians must examine carefully."
Yangyin Qingre Runzao Tang (Nourish Yin, Clear Heat, and Moisten Dryness Decoction) [See Dryness]: Treats all cases of Jing induced after sweating or purging, postpartum, traumatic injuries, excessive blood loss, or after ulceration of carbuncles.
It is advisable to add Radix Achyranthis Bidentatae (Niuxuan, nourishes Liver Blood, relieves cramping), Fructus Chaenomelis (Mugua, nourishes Liver sinews, suitable for both tension and relaxation), Suet Porci (Zhizhi, sweet and cold, moistens dryness and nourishes sinews), and Cornu Saigae Tataricae (Lingyangjiao, enters Blood to remove heat and relax sinews). For profuse sweating,酌情 add Radix Ginseng (Renshen) and Radix Astragali (Huangqi, solidifies exterior and stops sweating), Fructus Jujubae (Dazao) and Radix Paeoniae Alba (Baishao, gathers Yin and stops sweating). This is a formula for nourishing Blood and clearing heat; it must be modified according to specific symptoms and applied flexibly. According to Wang Ang: "The deterioration of Jing disease falls into two categories: Yin collapse and Yang collapse. In Yin collapse, essence, blood, and fluids are chronically deficient, failing to nourish the sinews and vessels; urgent rescue of Yin is required. In rare cases of Yang collapse, Yang qi is chronically weak, failing to warm and soften the sinews; urgent rescue of Yang is required, making herbs like Renshen and Huangqi essential. Since Qi provides warmth, tonifying Qi generates fluids."
Haizang Fangfeng Danggui Tang: Treats Jing caused by Wind invasion after sweating/purging or postpartum, as well as all cases of tetanus-induced Jing.
Radix Saposhnikoviae (Fangfeng, a moistening Wind-dispelling herb, used here to disperse Wind), Radix Angelicae Sinensis (Danggui), Radix Rehmanniae (Dihuang, nourishes Blood), Radix Chuanxiong (Chuanxiong, treats all Wind and Blood disorders). It is advisable to add Herba Schizonepetae (Jingjie, enters Blood level to drive out Wind), Radix Gentianae Macrophytae (Qinjiao), Flos Chrysanthemi Indici (Ganju), Sesamum indicum (Huma, nourishes Blood and dispels Wind), Glycine max (Heidou, invigorates Blood and scatters Wind), and汁 Bambusae in Taeniam (Zhuli, expels phlegm and clears heat, used for postpartum Wind, pediatric Wind, and tetanus).
This is a formula for nourishing Blood and dispersing Wind. If there are clear signs of Wind exposure, it can be used with modifications.
Death occurs if Jing is accompanied by extreme heat. (This is due to extreme heat generating Wind, severely damaging Yin and Blood; the combination of heat and Jing indicates a fatal prognosis.) Jing disease with moxa scars is difficult to treat. (Due to intense internal fire and severe deficiency of Yin Blood.)