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Chapter 22 of 29
伤寒杂病论
This chapter discusses three categories of conditions: Convulsive disease (jing bing) , Yin-Yang exchange, and post-major-illness recovery (convalescence) regulation.
Convulsive disease is a condition characterized primarily by stiff neck, lockjaw, opisthotonos (arching of the back), and limb spasm. Ancient physicians believed it was closely related to Taiyang disease (exterior contraction, pathogenic qi residing at the body surface).
Typical manifestations of convulsive disease: The patient has a hot body but cold feet, stiff and tense neck, aversion to cold, sometimes heat in the head, flushed face and red eyes, involuntary head shaking, sudden lockjaw, and arching of the back — this is convulsive disease.
Prognosis after sweating: If erroneous sweating is applied, cold-damp pathogenic factors become entangled, the exterior becomes further vacuous and depleted, and the aversion to cold worsens. After sweating, the pulse moves in a tortuous, snakelike manner. If the pulse suddenly becomes large and forceful, the condition is improving. If the pulse remains as before, or turns deep, hidden, wiry, and tight, the disease is unresolved.
Pulse of convulsive disease: In convulsive disease, the pulse felt with pressure is tight like a drawn bowstring, straight upward and downward, lacking gentle quality — this reflects tension and spasm of the sinews.
Convulsion with moxibustion sores is difficult to treat: If a convulsive disease patient has moxibustion sores, it indicates that fluids and blood are already damaged and treatment is relatively difficult.
Gualou Guizhi Tang (Trichosanthes and Cinnamon Twig Decoction) pattern: All symptoms of Taiyang disease are present, with the body stiff and uncomfortable, and the pulse paradoxically deep and slow — this is convulsive disease. Ancient physicians considered Gualou Guizhi Tang as the main treatment. In this formula, Trichosanthes root (Tian Hua Fen) clears heat, generates fluids, and relaxes the sinews to relieve spasm, combined with Guizhi Tang to harmonize nutritive and defensive qi — suitable for soft convulsion complicated by fluid damage.
Gegen Tang (Kudzu Root Decoction) pattern: Taiyang disease with absence of sweating, scanty urine, qi surging upward into the chest, and lockjaw with inability to speak — this is a manifestation of impending rigid convulsion. Ancient physicians used Gegen Tang as the main treatment. In this formula, kudzu root raises fluids and relaxes the sinews, ephedra opens the interstices and induces sweating, and Guizhi Tang harmonizes nutritive and defensive qi — suitable for rigid convulsion about to develop.
Guizhi Jia Fuzi Danggui Xixin Renshen Ganjiang Tang (Cinnamon Twig plus Aconite, Angelica, Asarum, Ginseng, and Dried Ginger Decoction) pattern: Convulsive disease presenting with cold hands and feet, intermittent fever, cyanotic lips, sunken eye sockets, and deep wiry pulse — ancient physicians considered this wind pathogen penetrating deeply into Jueyin and used this formula to warm the channels, disperse cold, nourish blood, and unblock the vessels, boost qi and restore yang. This falls under severe and deep-seated conditions.
Transition to Yangming with Chengqi-type formulas: Convulsive disease originally pertains to Taiyang. If fever, sweating, and a wiry and forceful pulse appear, this indicates that the pathogenic factor has already shifted into Yangming — Chengqi-type decoctions may be used to purge the replete heat downward.
Da Chengqi Tang (Major Order the Qi Decoction) pattern: Convulsive disease presenting with chest fullness, lockjaw, opisthotonos with inability to lie flat, foot cramping, and teeth grinding — this is Yangming heat exuberance scorching the sinews. Ancient physicians used Da Chengqi Tang to urgently purge the heat pathogen downward to preserve yin fluids.
Yin-Yang exchange is an ancient disease term referring to a condition where, after febrile disease, the proper qi has not yet recovered and the disease qi is transmitted through sexual intercourse. The patient experiences heavy body sensation, shortness of breath, fatigue, lower abdominal tension or cramping with pulling sensation in the genital area, heat rushing upward into the chest, heavy head with reluctance to lift it, blurred vision, and cramping in the knees and shins. Ancient physicians used Shao Kun San (Burned Pants-leg Powder) as the main treatment. This formula involves taking the area of a woman's undergarment near the genitals, burning it to ash, and administering it with water. This practice originates from specific ancient circumstances and is no longer used in modern times. It lacks scientific basis and is referenced only as historical literature for study.
The core of convulsive disease is "fluid damage with sinews losing nourishment"
This chapter repeatedly emphasizes that excessive sweating, erroneous purging, and sweating in patients with sores damage fluids and consume humor, ultimately causing the sinews to lose nourishment and resulting in convulsion. This reflects the consistent scholarly thought in the Treatise on Cold Damage and Miscellaneous Diseases of "protecting stomach qi and preserving fluids". The distinction between rigid and soft convulsion is essentially a differentiation of the degree of exterior pathogen versus fluid damage, and the nature of cold versus heat.
Convulsive disease is not merely an exterior pattern — it can transmit to Yangming and Jueyin
The text mentions both Taiyang convulsive disease and "transition to Yangming" using Chengqi-type formulas, and "wind pathogen entering Jueyin" using warming and channel-dispersing methods. This indicates that although convulsive disease is based in Taiyang, it can progress depending on constitutional factors and depth of pathogen invasion, manifesting in different trajectories such as Yangming heat exuberance or Jueyin deficiency cold.
Post-illness regulation emphasizes "differentiating deficiency and excess, protecting the spleen and stomach"
The patterns of relapse from overexertion, relapse from improper eating, water qi, weakness and emaciation, and frequent salivation all revolve around the core of unrecovered proper qi and weakness of the spleen and stomach after illness. Treatment methods include clearing and dispersing, harmonizing, promoting diuresis, warming the center, and boosting qi with nourishing yin — but the ultimate goal is always restoring spleen and stomach function and preserving fluids.
Yin-yang exchange reflects ancient emphasis on "prohibitions" during recovery
Although the formula "Shao Kun San" itself is not of value, the core thought in the Yin-yang exchange chapter is: immediately after a major illness, when proper qi has not yet recovered, one should avoid sexual indulgence, overexertion, and other behaviors that deplete proper qi. This is consistent with the principle in modern rehabilitation medicine that "adequate rest and avoidance of premature depletion are needed after illness".
Relationship between convulsive disease and neurological or infectious conditions
The manifestations of "stiff neck, opisthotonos, lockjaw, convulsive spasms" in convulsive disease may correspond in modern medicine to meningeal irritation signs, tetanus, febrile seizures, hypocalcemia, and electrolyte imbalances. While the ancients categorized these as "fluid deficiency with sinew malnourishment" or "heat exuberance scorching the sinews", lacking microscopic pathological understanding, their observation that high fever, dehydration, fluid loss from ulcers, and erroneous sweating can induce convulsive spasms shows some correspondence with the modern understanding that high fever, dehydration, and electrolyte derangements can increase neuromuscular excitability.
Value and limitations of Da Chengqi Tang
Da Chengqi Tang is used for convulsive disease with Yangming heat exuberance and repletion accumulation, embodying the thought of "urgent purging to preserve yin". Modern research shows that purgative formulas may have adjunctive roles in certain acute abdominal conditions and severe infections, but they must be used under definite diagnosis and modern medical monitoring — never self-administered according to classical texts.
Limitations of Shao Kun San
Burning undergarments and ingesting the ash does not conform to modern medical and pharmaceutical standards. It represents a historical limitation and should not be used. Its origin relates to the ancient rudimentary understanding of "qi transmission of disease". In modern terms, this should be understood as taking precautions against cross-infection, attending to personal hygiene, and resting after illness — not adopting this formula.
Scientific validity of post-illness care principles
"Reducing food intake leads to recovery" is highly consistent with the modern rehabilitation principle that "after illness, gastrointestinal function is diminished — diet should be light, small in quantity, and easily digestible". The concepts of relapse from overexertion (lao fu) and relapse from overeating (shi fu) also remind people that after illness, one should not engage in premature excessive activity or overeating.
Bu Gua Reminder: This content is based on classic texts of traditional Chinese medicine and is provided solely for cultural and scholarly study. It does not constitute any medical diagnosis, medication guidance, or treatment advice. If you feel unwell, please consult a physician promptly.