Second Section on the Treatment of Spasms and Damp Heat Diseases
Section 1
In Taiyang disease, if there is fever without sweating and a feeling of aversion to cold, it is called “Gang Jinjing” (Stiff Spasm).
Introduction: The “Essential Prescriptions from the Golden Cabinet” is edited according to the classification method of Liu Duzhou’s commentary on the text. Annotations are primarily selected from the works of Qing Dynasty and modern medical practitioners. Due to personal understanding limitations, some biases may occur; readers should extract the essence and discard the dross, combining it with clinical practice and focusing on self-understanding. Readers are welcome to leave comments to supplement famous discussions or share their own annotations!
Commentary by Zi Heng
The term “Jing” (痉) is synonymous with “Jin” (痓), meaning spasm. The main manifestations of spasm disease include stiffness in the neck and back, inability to open the mouth, fixed gaze, limb convulsions, and even opisthotonos, caused by deficiency of body fluids and blood, leading to insufficient nourishment of the tendons and meridians. If, at the same time, there is an external cold invasion, resulting in fever and aversion to cold without sweating, it is classified as Taiyang disease. The cold nature causes stagnation and contraction, worsening the symptoms of spasm, and this type of spasm is termed “Gang Jinjing” (Stiff Spasm). The character “Fan” (反) is key to distinguishing between Taiyang cold damage and spasm disease; spasm disease can present with fever without sweating, but without aversion to cold. The aversion to cold indicates Taiyang cold damage, thus it is classified as “Gang Jinjing”.
Qing Dynasty – You Yi’s Commentary on the Essential Prescriptions from the Golden Cabinet
Cheng said: “The ‘Thousand Gold’ states: Taiyang wind, if heavily affected by cold dampness, it transforms into spasm. In Taiyang disease, fever without sweating indicates a solid exterior, thus it should not have aversion to cold. If there is aversion to cold, it indicates Taiyang wind, heavily affected by cold, leading to spasm disease, as the solid exterior is affected by cold, hence it is called ‘Gang Jinjing’; in Taiyang disease, fever with sweating and no aversion to cold indicates a deficiency of the exterior, thus it should have aversion to cold. If there is no aversion to cold, it indicates that the wind pathogen has transformed into heat, externally injuring the tendons and meridians, leading to spasm disease, as the exterior is deficient and not cold, hence it is called ‘Rou Jinjing’ (Soft Spasm). However, spasm indicates strength, and the disease is in the tendons, thus it must also have symptoms of stiffness in the neck and back, heat in the head and cold in the feet, red eyes, head shaking, inability to open the mouth, and opisthotonos. Zhang Zhongjing did not mention this, as the term spasm encompasses it. The ‘Living Person’s Book’ also states: The symptoms of spasm with fever and aversion to cold resemble those of cold damage, but the pulse is deep, slow, and wiry, while the opisthotonos is a distinguishing feature.
Qing Dynasty – Wu Qian’s Medical Canon
[Note]
The character “Fan” (反) in aversion to cold is a derivative. The spasm disease should be known to have aversion to cold.
[Annotation]
Spasm disease belongs to Taiyang, thus it should be based on Taiyang deficiency and solid exterior. Therefore, it is stated: Taiyang disease with fever, no sweating, and aversion to cold indicates solid evil, termed ‘Gang Jinjing’, which is strong and forceful. Fever with sweating and no aversion to cold indicates deficient evil, termed ‘Rou Jinjing’, which is strong but without force.
Qing Dynasty – Gao Xueshan’s Commentary on the Essential Prescriptions from the Golden Cabinet
The term “Jing” (痉) originally was written as “Jin” (痓), and Chen Xiuyuan’s commentary on the Essential Prescriptions from the Golden Cabinet believes it to be a mistake of “Jing”. However, why is there a distinction between “Gang Jinjing” and “Rou Jinjing”? The human body has hot blood and cold water; when there is fever, the hot blood prevails, and when there is no sweating, the water vapor has not been released. In the case of cold damage, those without sweating often have aversion to cold, thus in the absence of sweating, it is inappropriate to say “Fan” (反) aversion to cold. Those without sweating have a solid exterior, and the water vapor is obstructed outside, while the pulse and meridians are tense inside, thus they are termed “Gang Jinjing”. If there is fever with sweating and no aversion to cold, then the exterior qi has been dispersed, and there is no sign of tension in the tendons and meridians, thus it is termed “Rou Jinjing”.
Qing Dynasty – Shen Mingzong’s Commentary on Zhang Zhongjing’s Essential Prescriptions from the Golden Cabinet
This distinguishes between the two types of spasm due to wind and cold. Spasm disease occurs when Taiyang is affected by cold, heavily influenced by dampness, or when wind is injured by dampness and transforms into spasm. Therefore, the symptoms of Taiyang fever without sweating and aversion to cold are classified as cold injuring the nutritive qi, termed “Gang Jinjing”, while fever with sweating and no aversion to cold is classified as wind injuring the defensive qi, termed “Rou Jinjing”. However, if the head is lowered and the back is stiff, Zhang Zhongjing classified it as spasm; why? It is to clarify that the absence of sweating and aversion to cold indicates that the nutritive qi is solid, which is the beginning of “Gang Jinjing”, while sweating without aversion to cold indicates that the defensive qi is deficient, which is the precursor to “Rou Jinjing”. Thus, these two sections highlight their key points.
Qing Dynasty – Chen Xiuyuan’s Commentary on the Essential Prescriptions from the Golden Cabinet
The term “Jing” (痉) means strength. Its symptoms include stiffness in the neck and back, heat in the head and cold in the feet, red eyes, head shaking, inability to open the mouth, and opisthotonos, detailed in the following text. Initially, it is not beyond Taiyang. Taiyang disease, when the disease is at the exterior yang, results in fever with the evil at the skin surface, thus the skin surface is solid and without sweating. Since it is at the exterior yang, it should not have aversion to cold; if there is aversion to cold, it is also a disease. Because it is solid at the exterior, it is termed “Gang Jinjing”; Taiyang disease, when the disease is at the exterior yang, results in fever with the evil in the muscles, thus the muscles are solid; while the skin surface is deficient, hence sweating occurs, the exterior is diseased but the root is not, thus it only has fever without aversion to cold, hence it is termed “Rou Jinjing”.
This indicates that Taiyang disease has both “Gang” and “Rou” types of spasm. To trace the origin of spasm, it is a method to distinguish spasm, not the fundamental symptoms of spasm disease. The pulse of “Gang Jinjing” should be tight and wiry, while the pulse of “Rou Jinjing” should be floating and wiry. Zhang Zhongjing did not mention this, but it can be inferred.
The term “Jin” (痉) refers to a blockage, while “Jin” (痓) refers to a spasm. The old texts mistakenly used “Jing” for “Jin”, which is a transcription error. Now it is corrected. Both diseases are caused by a deficiency of blood and fluids, which cannot nourish the tendons, leading to dryness as the disease. However, the “Inner Canon” states: All spasms and stiffness belong to dampness; why is there such a contradiction? It is not known that dampness is one of the six evils; if it invades the Taiyin, it transforms into cold dampness, and the disease flows into the joints causing bi syndrome; if it invades the Yangming, it transforms into damp heat, and when the heat is severe, the Yangming’s drying qi becomes more intense, causing the disease to stiffen the tendons and lead to spasm. This indicates that dampness refers to the condition before it becomes spasm; dryness refers to the moment it is about to become spasm. The text also states: The heat of the sun causes the disease of spasm, indicating that heat suppresses cold, leading to spasm without sweating. It also states: The lung heat moves to the kidney, transforming into soft spasm. This indicates that dampness steams into heat, leading to spasm with sweating. The “Thousand Gold” states: Dampness entering the kidney also causes spasm. In children, high fever also leads to spasm. The teachings of the sages can be referenced, and it is undoubtedly due to the loss of yin and dryness of the tendons.
Liu Duzhou’s Commentary on the Essential Prescriptions from the Golden Cabinet
This section discusses the differentiation of “Gang Jinjing”. “Gang Jinjing” arises from Taiyang wind heavily affected by cold, where the external cold obstructs the nutritive and defensive qi, thus presenting symptoms of aversion to cold, no sweating, headache, fever, and a tight pulse. The wind-cold pathogen stagnates the meridians, causing qi and blood to be obstructed, leading to symptoms of tightness in the tendons and meridians, such as stiffness in the neck and back, and inability to open the mouth. Due to the absence of sweating, it is termed “Gang Jinjing”. According to the “Jia Yi Jing, Volume 7”, the absence of the character “Fan” indicates this.
Hu Xishu’s Lecture on the Essential Prescriptions from the Golden Cabinet
This spasm disease is generally said to not have aversion to cold, but only “Gang Jinjing” does not follow this; the character “Fan” indicates that this is indeed Taiyang cold damage. Cold damage presents with fever, no sweating, and aversion to cold. This section means that spasm, what is spasm? It is a convulsion. It is commonly referred to as “wind”; children have “wind” for five days, seven days, which relates to wind, but in fact, it is not. Modernly, it is referred to as tetanus, which is caused by infection with the tetanus bacillus. When children have their umbilical cords cut, if it is not hygienic, they can get tetanus and convulsions. Nowadays, children have fewer convulsions because hospitals disinfect properly. Therefore, the ancients said that this wind is problematic; the study of TCM is quite broad and requires organization. The term “wind” here, if it is wind, modern mothers do not behave like before; previously, they would keep the room sealed, preventing wind and dampness, and convulsions would still occur. Nowadays, in hospitals, they are not as concerned, so it is not wind for sure, and this has been scientifically proven.
However, from the perspective of TCM, if it is not wind, then what is the treatment? The ancients believed it was to dispel wind; if it is not to dispel wind, then the medicines for dispelling wind become problematic. Therefore, studying TCM requires a practical view; there are too many issues. I originally planned to write about commonly used medicines, but now I fear there is not enough time; there is simply not enough time. If anyone has time, they can write a bit.
This chapter is easy to see; it means that this type of convulsion, if it appears in the form of Taiyang disease with cold damage, is called “Gang Jinjing”. As mentioned earlier, this wind is problematic, but “Gang Jinjing” is indeed a correct representation; the ancients had a good grasp of the symptoms, which is also a rule, and the treatment is indeed correct. Therefore, whether TCM says it is wind or cold, it is about pattern differentiation, not disease differentiation. The treatment is neither to dispel wind nor to treat tetanus, so the brilliance of TCM lies not in how we theorize it, but in the methods and approaches of treatment.
In the “Shang Han Lun”, the methods are explained very clearly; this book is not as clear. You can see this sentence and understand it: “In Taiyang disease, if there is fever without sweating and aversion to cold, it is called ‘Gang Jinjing'”. If there is no spasm issue in it, then this is Taiyang cold damage; how can it be “Gang Jinjing”? It discusses spasm, which is indeed spasm. If spasm occurs, and it appears in the form of Taiyang cold damage, it is called “Gang Jinjing”; that is the meaning. It is not just fever, no sweating, and aversion to cold that is called cold damage in the “Shang Han Lun”; here it is called “Gang Jinjing”; that would be nonsense. Cold damage is simply fever, no sweating, and aversion to cold. But spasm? The symptoms are similar, but there is an additional convulsion; spasm is spasm, which is a clear distinction in the text.
Other Medical Practitioners
Ming Dynasty – Cheng Wujin’s Commentary on the “Shang Han Lun”: “The ‘Thousand Gold’ states: Taiyang wind, heavily affected by cold dampness, transforms into spasm. In Taiyang disease, fever without sweating indicates a solid exterior, thus it should not have aversion to cold. If there is aversion to cold, it indicates Taiyang wind, heavily affected by cold, leading to spasm disease, as the solid exterior is affected by cold, hence it is called ‘Gang Jinjing’.”
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Copyright Notice: Some content of this article is excerpted from “Liu Duzhou’s Commentary on the Essential Prescriptions from the Golden Cabinet”; author/Liu Duzhou; “Hu Xishu’s Lecture on the Essential Prescriptions from the Golden Cabinet”; lecturer/Hu Xishu. The reproduction aims to disseminate knowledge of TCM culture, and the copyright belongs to the relevant rights holders. If there are any improper uses, please feel free to contact us for negotiation. The section titled ‘Zi Heng’s Commentary’ is original content; please indicate the source when reprinting.
Full Chapter Content
Section 1: In Taiyang disease, fever without sweating, aversion to cold, it is called ‘Gang Jinjing’.
Section 2: In Taiyang disease, fever with sweating and no aversion to cold, it is called ‘Rou Jinjing’.
Section 3: In Taiyang disease, fever, with a deep and thin pulse, it is called spasm, which is difficult to treat.
Section 4: If sweating is excessive, it can lead to spasm.
Section 5: If wind disease is purged, it can lead to spasm; if sweating is repeated, it must be tight.
Section 6: Even if there is body pain in ulcer diseases, sweating should not be induced; if sweating occurs, it leads to spasm.
Section 7: If the patient has body heat and cold feet, stiffness in the neck and back, aversion to cold, occasional head heat, red face and eyes, head shaking, and sudden inability to open the mouth, it is spasm disease. If sweating is induced, the cold dampness will combine, and the exterior will become more deficient, leading to severe aversion to cold. If sweating has already occurred, the pulse will feel like a snake.
Section 8: If there is sudden abdominal distension, the pulse remains the same, and the pulse is tight, it indicates spasm.
Section 9: The pulse of spasm is tight like a string, moving up and down.
Section 10: Spasm disease has moxibustion sores, which are difficult to treat.
Section 11: In Taiyang disease, if all symptoms are present, the body is strong, and the pulse is deep and slow, this is spasm; Guo Lou Gui Zhi Decoction is the main treatment.
Section 12: In Taiyang disease, if there is no sweating and urination is reduced, qi rushes to the chest, and the mouth cannot speak, it is about to become ‘Gang Jinjing’; Ge Gen Decoction is the main treatment.
Section 13: Spasm as a disease, with fullness in the chest and inability to open the mouth, unable to lie down, with tight legs, must grind teeth, can be treated with Da Cheng Qi Decoction.
Section 14: In Taiyang disease, if there is joint pain and restlessness, with a deep and thin pulse, this is called damp bi. In damp bi, urination is not smooth, and bowel movements are frequent; one should only facilitate urination.
Section 15: In damp diseases, the whole body aches, with fever, and the complexion appears yellow.
Section 16: In damp diseases, the person only sweats from the head, with a stiff back, wanting to be covered and facing the fire. If purged too early, it leads to belching, or fullness in the chest, urination is not smooth, the tongue appears like a fetus, indicating heat in the lower abdomen, cold in the chest, thirst wanting to drink but unable to, leading to dryness and restlessness.
Section 17: In damp diseases, if purged, sweating appears on the forehead, slight wheezing, and smooth urination, the patient may die; if diarrhea does not stop, the patient may also die.
Section 18: If wind and dampness combine, the whole body aches, it is appropriate to induce sweating to relieve it. If it is continuously cloudy and rainy, the doctor says this can induce sweating; why does the sweating disease not heal? Because inducing sweating excessively only removes the wind, while the dampness remains, hence it does not heal. If treating wind and dampness, inducing sweating should only be slight, as both wind and dampness will be removed.
Section 19: In damp diseases, if the body is painful and feverish, the face is yellow and wheezing, with headache and nasal congestion, the pulse is large, and the patient can eat and drink, the abdomen is harmonious without disease, the disease is in the cold dampness of the head, thus nasal medication will cure it.
Section 20: In damp diseases, if the body is restless and painful, one can use Ma Huang Jia Shu Decoction, inducing sweating is appropriate, but one must be cautious not to use fire to attack it.
Section 21: If the patient has body pain, fever, and the symptoms are severe in the afternoon, it is called wind dampness. This disease is caused by sweating in the wind or prolonged exposure to cold.
Section 22: In wind dampness, the pulse is floating, the body is heavy, sweating occurs, and there is aversion to wind; Fang Ji Huang Qi Decoction is the main treatment.
Section 23: After eight or nine days of cold damage, if wind and dampness clash, the body aches and is restless, unable to turn or side, without nausea or thirst, the pulse is floating, weak, and rough; Gui Zhi Fu Zi Decoction is the main treatment. If the stool is hard and urination is smooth, remove Gui and add Bai Zhu Decoction as the main treatment.
Section 24: In wind dampness, if there is joint pain and restlessness, with pulling pain that cannot bend or stretch, if close, the pain is severe, sweating occurs with shortness of breath, urination is not smooth, aversion to wind and not wanting to remove clothing, or slight swelling of the body, Gan Cao Fu Zi Decoction is the main treatment.
Section 25: In Taiyang heat, with fever and aversion to cold, the body is heavy and painful, the pulse is wiry, thin, and slow. If urination is smooth, the hair stands, and the hands and feet are cold; if there is slight exertion, the body becomes hot, the mouth opens, and the front teeth are dry. If sweating is induced, the aversion to cold will be severe; if warming needles are applied, the fever will be severe; if purged multiple times, it will lead to dampness.
Section 26: In Taiyang heat, it is heat. If sweating occurs with aversion to cold, the body is hot and thirsty; Bai Hu Jia Ren Shen Decoction is the main treatment.
Section 27: In Taiyang heat, if the body is hot and heavy with a weak pulse, this is caused by cold water in summer, flowing through the skin; Yi Wu Guo Ti Decoction is the main treatment.
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