bubble_chart Concept

Neck rigidity refers to the stiffness of the muscles and tendons in the neck and back, making it difficult to bend forward, backward, or move side to side.

In ancient medical literature, there are numerous descriptions of this condition. Suwen ． Zhizhenyao Da Lun states: "All spasms and neck rigidity are ascribed to dampness." The "Treatise on Cold Damage Diseases" also records "stiffness in the neck and back" and "headache and painful stiff nape."

As for neck rigidity and spasms caused by acute infantile convulsion in children, they are not within the scope of this discussion. Neck rigidity often appears simultaneously with opisthotonos, and one may refer to the entry on opisthotonos for further information.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰Stiff neck, difficulty in turning the head, headache, body pain, aversion to cold with fever, without sweating, thin white tongue coating, floating and tight pulse. Must present with aversion to cold, without sweating, head and body pain, thin white tongue coating, floating and tight pulse, indicating the {|###|}pattern of common cold due to wind-cold{|###|}; treatment should focus on {|###|}dispelling wind and dispersing cold{|###|}, using Pueraria Decoction with modifications.
2. External Contractionwind-dampness︰Stiff neck, difficulty in turning the head, aversion to cold with fever, heaviness of head as if wrapped, soreness and heaviness of limbs, joint pain with a heavy sensation, white tongue coating, floating pulse. The condition must present characteristics of dampness pathogen such as heaviness of head as if wrapped and aching pain with heaviness in the limbs. The treatment should focus on wind-dispelling and dampness-overcoming, and the prescription used is Notopterygium Overcoming Dampness Decoction with modifications.
3. Pathogenic Heatdamage to Fluid︰Stiff neck, or even opisthotonos, spasms of the hands and feet, high fever, dysphoria, or even unconsciousness and delirious speech, lockjaw and grinding of teeth, abdominal distension and fullness, constipation, scanty dark urine, red tongue with yellow and dry coating, wiry and rapid pulse. This syndrome is often caused by exposure to fire-heat pathogens or the transformation of external pathogens into heat that enters the interior, with pathogenic heat scorching the liver meridian and depleting yin fluids, leading to malnourishment of the sinews and vessels. The key points for differentiation are: it commonly occurs in the intermediate stage [second stage] of acute Rebing, and is invariably accompanied by high fever, dysphoria, or even unconsciousness and delirious speech, constipation, and dark urine. Treatment should focus on purging heat accumulation, employing emergent purgation to preserve yin. The recommended formula is Liquid-Increasing Purgative Decoction with modifications.
4. Golden Wound Wind Toxin︰Stiffness and rigidity of the neck, lockjaw, aversion to cold with fever, headache and dysphoria, or even a sardonic smile-like facial expression, convulsions of the limbs, opisthotonos, and a wiry and tight pulse. This syndrome is caused by exposure to wind-toxin pathogens after trauma, with unhealed wounds, leading to obstruction of the meridians and impaired circulation of nutrient-defense qi. The key diagnostic points are: occurrence after trauma, accompanied by aversion to cold with fever, headache, or even a sardonic smile-like facial expression, convulsions of the limbs, and opisthotonos. Treatment should focus on dispelling wind and stopping convulsions, with modifications of Jade-like Vitality Powder as the recommended formula.

The symptom of neck stiffness is a manifestation of malnutrition of the tendons and vessels, often associated with an excess pattern. It may be caused by external pathogens obstructing the collaterals or by pathogenic heat damaging the body fluids. Treatment should prioritize the elimination of pathogenic factors. Once the pathogens are removed, the collaterals will be unblocked, body fluids will regenerate, the tendons and vessels will be nourished, and neck stiffness will naturally cease.

bubble_chart Documentation

1. Yixue Xinwu．Greater Yang Meridian Pattern: "The neck and spine are the areas traversed by the Greater Yang meridian. In Taiyang disease, the neck and spine become stiff. It is also asked: Zhongjing mentions the thoracic accumulation syndrome, with stiffness of the neck and spine, resembling exogenous convulsive disease. What does this mean? The answer is: Originally Taiyang disease, mistakenly treated by the physician, leads to thoracic accumulation, with distending pain in the chest, discomfort in bending and stretching, resembling neck stiffness, but not true neck stiffness. For in Greater Yang, the neck stiffness is at the back of the neck, Jingmai is cramped and painful, but the chest is unaffected. In thoracic accumulation, the neck stiffness is at the front of the neck, with discomfort in bending and stretching in the chest, but the neck is unaffected. Moreover, thoracic accumulation syndrome is formed after mistaken treatment, while Taiyang disease is evident from the onset, hence they are different."
2. Zabing Yuanliu Xizhu．Source and Course of Neck Diseases: "Stiffness and pain in the neck and spine are diseases of the liver, kidney, and bladder. When these three meridians are affected by wind-cold dampness evil, the neck becomes stiff. If wind-heat is predominant, Modified Minor Bupleurum Decoction is suitable; if dampness is predominant, Supplemented Peripatetic Powder is suitable."