医宗金鉴卷十三

<<Yi Zong Jin Jian>>  Chapter 13

辨痉湿暍 病脉证并治篇

Jing disease, Shi disease, and Ye disease, their pulse, conditions and treatment

经云：诸痉项强，皆属於湿。又云：诸暴强直，皆属於风。论曰：太阳病，发汗太多，因成痉。夫六气皆足以致痉，不专在湿也；六经皆有痉证，亦不专在太阳一经也。

<< Nei Jing >> Said, every Jing syndrome[1] and tight on the neck belongs to the disorder of Shiqi[2]. It also said, every strong spasm syndrome belongs to the Wind. << Shanghan Lun >> said, in the Taiyang stage, over-sweat therapy causes Jing syndrome. However, it should be pointed out that all the six kinds of Xieqi can cause the Jing syndrome, and every six disease stage can have such Jing syndrome.

盖身以後，属太阳，凡头项强急，项背几几，脊强反张，腰似折，髀不可以曲， 如结，皆太阳痉也。身以前属阳明，头面动摇，口噤齿 ，缺盆纽痛，脚挛急，皆阳明痉也。身之侧属少阳，口眼蜗邪，手足牵引，两胁拘急，半身不遂，皆少阳痉也。

This is because the fact that, the back of the body belongs to Taiyang meridian. Every tight and spasm on the head and neck belongs the Jing syndrome in the Taiyang meridian/stage. Front of the body belongs to Yangming, so shaking head, tight jaw, spasm in the upper novel of the chest and groin, and spasm on the feet, all belong to the Yangming meridian/stage. The side of the body belongs to the Jing syndrome in the Shaoyang meridian, so contract and pulling aside of eye and mouth, tight and stiffness in the arm and leg, spasm feeling in the side of upper abdomen and paralysis, all belong to the Jing sundrome in the Shaoyang meridian/stage.

至若腹内拘急，因吐利後而四肢挛急者，未尝非太阴痉也。恶寒倦卧，尻以代踵，脊以代头，俯而不能仰者，未尝非少阴痉也。睾丸上升，宗筋下注，少腹 急，阴中拘挛，膝胫拘急者，未尝非厥阴痉也。大抵痉以状名，而痉因筋急，故凡六经筋病，皆得以痉称之。

Spasm in the abdomen, and arm and leg spasm after vomiting or diarrhea, also can be regarded as Jing syndrome in the Taiyin meridian/stage. Chilly and willing to lie down, bend of the body with head down to the chest and the knee to the abdomen is regarded as Jing syndrome in the Shaoyin meridian/stage. Shrink of the testis into the abdomen, continuous erection of penis, spasm in the lower stomach, vagina spasm, spasm of knee and calf are the Jing syndrome of the Jueyin meridian/stage. Generally, the Jing syndrome is termed for the clinic manifestions and it is due to the spasm of muscle-tendons. Therefore, the disorder of the tendons in any meridian can be called Jing syndrome.

其因於风寒者，必发热恶寒而无汗，其脉浮紧，其状身强直口噤，即经所云：诸病强直，皆属於风者也。其势劲急，故名曰刚痉。其因於风湿者，发热汗出，不恶寒，其脉浮缓，其状项强几几，而身不强直，即经所云：诸痉项强，皆属於湿者也。其势濡弱，故名曰柔痉。

If the Jing syndrome is due to the Wind and Cold, the person will have fever, chilly but no sweat. His pulse is floating and tight, his body is tight, as well as the teeth (jaw). This is what is said in the << Nei Jing >>: every tightness and spasm is due to the Wind. Since it comes urgent and fast, it is called as a Gangjing. [3] If it is due to Fengshi Xieqi, the person has fever, sweat, no chilly. His pulse is floating and slow. He feels the neck and shoulder mild tight, but the body is not tight. This is what means in the << Nei Jing >>: every neck tightness is due to Shi. Since it develops slow, it is called as Roujing. [4]

若夫因误汗亡阳，津竭无以养筋而致痉者，即本论所云：太阳病，发汗太多而成痉，又非因湿因风，而却因燥者也。盖痉之始，本非正病，多杂於他病之中，如妇人之脱血，跌扑之破伤，俱能致痉。今见患此者，悉指为风，殊非确论。学者当於证中审察风、寒、湿、燥、内外、虚实之因，分别施治，庶不致误，慎勿概指为风也。

If the Jing syndrome is due to overwhelming sweat to deplete the Yangqi in the body, the tendons are depleted of wetness to nourish, so to cause a spasm. This is the book here means: in Taiyang stage, too much sweat can cause the Jing syndrome. In this case, it is not due to Wind or Wetness, but to the Dryness. Generally speaking, Jing syndrome is not a single disease. It happens usually during the cause of other clinic conditions. For example it can be seen in women during a heavy bleeding, or in accident due to skin broken (tetanus) and so on. It is therefore not proper to associate all Jing syndromes to Wind invasion. Readers need to verify the reasons to the Jing syndrome in each person, the Wind, the Cold, the Wetness, the Dryness, and the location of the Jing syndrome: inside of the body, or on the surface of the body. Don’t relate all Jing syndrome to the Wind invasion.

01  伤寒所致太阳病，痉、湿、暍，此三种，宜应别论，以为与伤寒相似，故此见之。

The Cold Xieqi can invade the body to cause Shanghan disease. When it is in the Taiyang stage, it should be distinguished with Jing syndrome, Shi disease[5] and Ye disease,[6] their clinic manifestations are pretty similar.

02   病身热足寒，颈项强急，恶寒，时头热面赤，目脉赤，独头动摇，卒口噤，背反张者，痉病也。

It is called a Jing syndrome, if the person feels hot in the body, but cold in feet, strong tightness on the neck, chilly, and from time to time he feels hot on the head and red in the face, with red blood vesicles in the eyes, shaking on the head (only on the head), sudden tight jaw so that it is hard to open the mouth, the back reverse bend.  

03  太阳病，发热，脉沉而细者，名曰痉。

If a person has above conditions and he feels fever, pulse is deep and thin, it can be diagnosed as Jing syndrome. [7]

04 太阳病，发热无汗，恶寒者，名曰刚痉 (葛根汤主之)。太阳病，发热汗出，而不恶寒，名曰柔痉。(栝蒌桂枝汤主之)

If person has similar condition as Shanghan Taiyang stage, if he has fever, chilly but not sweat, it is Gangjing[8]. If the person has fever and sweat, but no chilly, it is called Roujing[9].

05 太阳病，项背强几几，无汗恶风，葛根汤主之。

If person has similar condition as Shanghan Taiyang stage, if he feels tightness and slight spasm on the neck and back, feels dislike wind and has no sweat, use Gegeng Tang.   

06 太阳病，项背强几几，反汗出恶风者，桂枝加葛根汤主之。

If person has similar condition as Shanghan Taiyang stage, if he feels tightness on the neck and back, dislikes wind but has sweat, use Guizhi jia Gegeng Tang.

桂枝加葛根汤方

Guizhi jia Gegeng Tang

於桂枝汤内，加葛根三两，馀依桂枝汤法。

Add Gegeng 45 gram into standard Guizhi Tang. Cook and drink the tea as for Guizhi Tang.

07 太阳病，发汗太多，因致痉。

During Taiyang stage, if the person has too much sweat with sweat therapy, he will have the Jing syndrome. [10]

08　湿家之为病，一身尽疼，发热，身色如似熏黄。(湿证发黄，须分阴阳表 。阳湿，在里茵陈蒿汤；在表麻黄连轺赤小豆汤。阴湿，在里白术附子汤，在表麻黄白术汤，此阴湿在表而发黄也。)

It is termed Shi syndrome if one feels pain in whole of the body, has fever and dark-yellow color in whole body[11]. (For the jaundice, there are different kinds of jaundice. If the jaundice belongs to Yang condition, [12] and if the Xieqi is in the inside of the body, use Yinchenghao Tang; if the Xieqi is in the surface of the body, use Mahuang Lianqiao Chixiao Dou Tang. If the jaundice belongs to Yin jaundice, and if the Xieqi is in the inside of the body, use Baishu Fuzi Tang; if the Xieqi is in the surface of the body, use Mahuang Baishu Tang. The conditions here indicate the Yin jaundice, body surface condition).

09  湿家病，身上疼痛，发热，面黄而喘，头痛、鼻塞而烦，其脉大，自能饮食，腹中和无病，病在头中寒湿，故鼻塞，内药鼻中则愈。(湿家病，身上疼痛发热，面黄而喘，此内生外受之湿病也，外宜羌活胜湿汤，内宜茵陈五苓散，喘甚大陷胸丸。若更头痛鼻塞而烦，其脉大，证类伤寒，但其人里和能食，知非伤寒，不可发汗，乃湿邪之病在头，故头痛鼻塞，惟宜纳药鼻中，取黄水从涕出，自可愈也。所纳之药，即瓜蒂散类也。)

For person with the Shi syndrome, he feels pain in whole body, fever, yellow color face, headache, nose stiff/plug that makes them annoyed. His pulse is big and stronger. If he has no problem in eating (still has appetite), no any apparent disorder in the abdomen or bowel movement, it will indicate that the illness is Cold and Wetness in the head. In this case, apply herbs within the nose to solve the problems. [13]  (For Shi syndrome, if the person feels fever and body pain, yellow face and asthma, the Shi Xie is in both body surface and inside, use Qianghuo Shenshi Tang for the body surface, and use Yinchen Wuling San for the inside Shixie. For the asthma, use Da Xianxiong Wan. If the person feels more headache, stiff nose and annoyed, has big pulse, similar to a Shanhan disease, but it is not a Shanhan since the person has no problem for appetite. In this case, be careful not use sweat therapy, but use Guidi San to deplete yellow liquid from the nose to solve the Shi syndrome in the head.).  

10 太阳病，关节疼痛而烦，脉沉而细者，此名湿痹。湿痹之候，其人小便不利，大便反快，但当利其小便。

If person has similar condition as Shanghan Taiyang stage, but he feels joint pain[14] and annoyed, and if his pulse is deep and thin, his condition belongs to Shi syndrome. Person with Shi syndrome has difficulty in urine but pretty frequent bowel movement[15]. For the treatment of such Shi syndrome, use urine therapy. [16]  

11湿家，其人但头汗出，背强，欲得被覆、向火，若下之早则哕，胸满，小便不利，舌上如胎者，以丹田有热，胸中有寒，渴欲得水，而不能饮，口燥烦也。

For Shi people[17], if he has sweat on head[18], stiffness in back, likes to be covered and likes to face fire, to early application of bowel-cleansing therapy will cause burping and fullness in chest and difficulty in urine. If his tongue covering is thick and white in color, it furthermore indicates Fire in his lower stomach area but Cold in the chest[19]. This makes him feel very thirsty but cannot actually drink water[20], again this makes him very dry in mouth and annoyed.

12   湿家下之，额上汗出，微喘，小便利者死，若下利不止者，亦死。

If such Shi people has sweat on front head, has slight asthma, and has too frequent urination[21], they tend to die, so as they have too much and heavy diarrhea.

13   病者一身尽疼，发热。日晡所剧者，此名风湿。此病伤於汗出当风，或久伤取冷所致也。

If the person has pain all of the body, has fever that is sever especially on the evening, it indicates Fengshi disease[22]. The reason for this illness is either because he catch wind when he had sweat before[23], or when he touched cold repeatedly before[24].

14  问曰：风湿相搏，一身尽疼痛，法当汗出而解。(桂枝加术汤主之). 值天阴雨不止，医云：此可发汗。汗之病不愈者，何也？答曰：发其汗，汗大出者，但风气去，湿气在，是故不愈也。若治风湿者，发其汗，但微微似欲汗出者，风湿俱去也。

Asked: with the Fengshi in the body, the person should feel pain all of the body. The principle for the treatment of such condition is to use sweat therapy[25] but it does not work in a cloudy and raining weather. From medical book, it is said that indeed sweat therapy should be used, but it doesn’t work. Why? Master: With the Shi body condition (the Fengshi condition), sweat therapy will remove its Wind but left the Shi behind in the body. This counts the failure for the treatment. You should control the extent of the sweat during the sweat therapy, not let the sweat heavily, but keep it mildly[26].

15 伤寒八、九日，风湿相搏，身体疼烦，不能自转侧，不呕不渴，脉浮虚而涩者，桂枝附子汤主之。(若脉浮实者，则又当以麻黄加术汤，大发其风湿也). 若其人大便硬，小便自利者，去桂枝加白术汤主之。

For eight to nine days of a disease similar to Shanghan[27], the person has Fengshi in the body and he feels pain in whole of the body[28] and annoyed, hard to turn the body, no nausea or thirsty. If his pulse is floating, weak and harsh[29], use Guizhi Fuzi Tang. (If the pulse is floating and strong, use Mahuang jia Baishu Tang). If he has hard stool but frequent urine, use Guizhi Fuzi que Guizhi jia Baishu Tang.

桂枝附子去桂枝加白术汤方

Baishu Fuzi Tang

附子（炮，去皮，破）三枚， 白术  四两， 生姜（切）三两， 大枣（擘）十二枚， 甘草（炙）二两

Fuzi (processed) 3 badges, Baishu 60 gram, Fresh ginger 45 gram, Chinese date 12 badges, Gancao (processed) 30 gram.

右五味，以水六升，煮取二升，去滓，分温三服。初一服，其人身如痹，半日许，复服之，三服都尽，其人如冒状，勿怪。此以附子、术，并走皮肉，逐水气未得除，故使之耳，法当加桂四两。此本一方二法，以大便硬、小便自利去桂也。以大便不硬、小便不利，当加桂。附子三枚，恐多也。虚弱家及产妇，宜减服之。

Add the herbs and 1500 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 500 ml. Collect the herbal tea. Drink one third of the tea. The person will feel pain all over the body, seeming that the disease is worse. Drink the second and the last one third tea after four hours each. After finish the dose, if the person feels as cloudy in mind, or little bit dizziness, nothing is wrong. This is because the Fuzi and Baishu works in the skin and muscle, remove Shuiqi but the Shiqi has not been fully removed yet. In this case, can add Guizhi 60 gram to the formula but it is not added since the stool is hard and urine is frequent. If the stool is not hard, and the urine is difficult, the Guizhi should be added. Three badges of Fuzi might be little bit too much for weak person or for pregnancy women, so add less Fuzi in these persons.

16  风湿相抟，骨节疼烦，掣痛不得屈伸，近之则痛剧，汗出短气，小便不利，恶风不欲去衣，或身微肿者，甘草附子汤主之。

Person with Fengshi disease has pain in the small joints and annoyed. The pain is severe so it is hard to bend or stretch. The pain can be worse when touch or press the joints. When the pain is severe, he may feel sweat and short of breath, has hard urine, dislike wind and no willing to take off the clothes. He may also has mild swelling in the fingers or toes. In this case, use Gancao Fuzi Tang.

甘草附子汤方

Gancao Fuzi Tang

甘草（炙）二两, 附子（炮，去皮，破）二枚， 桂枝  四两， 白术  二两

Gancao (processed) 30 gram, Fuzi (processed) 2 badges, Guizhi 60 gram, Baishu 30 gram.

右四味，以水六升，煮取三升，去滓，温服一升，日三服。初服得微汗则解，能食，汗止复烦者，服五合。恐一升多者，宜服六、七合为妙。

Add the herbs and 1500 ml water into a herbal pot. Bring to boil and keep in mild boiling until half of the liquid volume remains. Drink the herbal tea, one third each time, three times a day. After the first drinking with a sweat comes, the symptoms will be improved.[30] For person has good appetite, and feels annoyed after the stop of the sweat, drink about 125 ml each time again. If the one third of the amount is felt too much, give the person about 150 ml to 200 ml each time.  

17  太阳中热者，暍是也。其人汗出恶寒 ，身热而渴也。(宜以人叁白虎汤主治之。)

If the body is invaded by Hot Xieqi in summer, it is called Ye disease. People with the Ye disease has fever, chilly, sweat and thirsty.[31] (the herb Renshen Baihu Tang should be used.).

18 太阳中暍者，发热恶寒，身重而疼痛，其脉弦细芤迟，小便已，洒洒然毛耸，手足逆冷，小有劳，身即热，口开，前板齿燥。若发汗则恶寒甚，加温针则发热甚，数下之则淋甚。(宜以人叁白虎汤主治之。或人叁汤调辰砂六一散亦可．中暍证禁用汗、下、温针)

With the Ye disease, the person feels fever and chilly, feels pain and heavy in the body. Pulse feels string, thin, and slow. After urination, he could feel as the hair on the body straight and has cold feeling in the hands and feet. Little bit labor work could makes him more hot feeling. With mouth open, the front teeth feel very dry. In this condition, sweat therapy could make him more chilly; hot needle acupuncture makes him more hot; and repeated bowel-cleansing therapy makes him feel pain and hot in the urine. [32]

19 太阳中暍者，身热疼重，而脉微弱，此亦夏月伤冷水，水行皮中所致也。(此时即以香薷饮、大顺散汗之，可立愈也。若因循不治，则水气即不得外泄於表而作肿，势必内攻於里而喘胀矣，是又当以葶苈大枣汤或瓜蒂一物散下之也。)

Once the body is affected by the Ye disease, he feels fever and pain and heavy in the body. Pulse feels weak. The reason for the Ye disease is the contact to cold water (when the body is very hot) so that water moves under the skin (that prevent the evaporation of body temperature to cause fever, heavy body and pain). [33]

张璐曰：按论 三条，首言动而得之之病，谓中 ，属外因；次言静而得之之病，虽曰中 ，实暑病也，属内因；末言因热伤冷之病，乃中 之变证，属不内外因，不得以三者混称也。

程应旄曰：可见中 之病，大都阳气在表，而胃中虚冷，所以身热疼重，而脉微弱。夏月饮冷水， 阴郁住表阳，水气不得宣泄，而行於皮中，多有此证。此则开郁宣阳，又为 证中增一义也。